Durant AM, Reeson EA, Grimsby GM. Greater obstetric barriers for female urologists compared to peer-physicians. Urology. 2024;183:274-280. doi:10.1016/j.urology.2023.08.048

Special thanks to Drs Rachel Passarelli, Sahithi Reddi, and Danielle Velez Leitner at Rutgers Robert Wood Johnson Medical School.

It is no secret that female physicians experience family planning barriers. These investigators surveyed female physician social media groups from June to August 2021 to compare pregnancy demographics and complication rates in urologists to those of the general population and physician peers.

Compared to the general population, female urologists were 2 to 3 times more likely to undergo an infertility evaluation, fertility treatment, miscarry, or experience preterm labor. Compared to other physicians, female urologists had fewer children, were less likely to have children or receive workplace support such as lactation accommodations, and were more likely to be discouraged from starting a family. Some of these issues may be due to an unpredictable work schedule, long hours, and feelings of intimidation. Also concerning was that only 9% of surveyed female urologists received education on the risks of delaying pregnancy compared to 16% of other female surgeons, a glaring deficiency given that male infertility, a closely related subject, is a core competency of urological training. With women comprising 45% of the 2024 urology match and training and early practice occurring during peak reproductive years, this is a vulnerable and growing population.

Hospital administration, program directors, and urology department superiors should be cognizant of providing appropriate education for trainees, maternity support to minimize poor outcomes and complications, time for postpartum recovery, and accommodations for lactation and future childcare needs. Some of these discrepancies are intrinsic to the nature of urology given the increasing demands of an aging population. Identifying the problem and calling attention to it is the first step to providing a solution.

Lackner JM, Clemens JQ, Radziwon C, et al. Cognitive behavioral therapy for chronic pelvic pain: what is it and does it work?. J Urol. 2024;211(4): 539-550. doi:10.1097/JU.0000000000003847

Special thanks to Dr Rabun Jones at the University of Illinois at Chicago.

What exactly is cognitive behavioral therapy for chronic pelvic pain, and does it work? These authors answer that question in this review article. The prevalence, morbidity, and difficulty in managing urologic chronic pelvic pain syndrome is well known to all urologists. The authors emphasize the very real central nervous system pathology known as nociplastic pain involved in this disease process. They explain that the chronicity, constellation, and severity of symptoms are linked to the cognitive patterns these patients develop, and changing those cognitive patterns can be therapeutic. The 3 phases of cognitive behavioral therapy including education, cognitive strategies, and relapse prevention empower the patient to rewire the cognitive patterns contributing to their symptoms.

The authors recognize the nuanced challenges of incorporating psychotherapy into the multimodal treatment of this pelvic pain syndrome. It would be very easy for a patient to feel as if their legitimate physical symptoms are not being addressed, or to be told that “it’s all in your head” when presented with the recommendation to pursue cognitive behavioral therapy. In order to help combat those concerns, the authors offer a script for practitioners to use during counseling, as well as detailed patient selection criteria.

The authors ultimately introduce the Easing Pelvic Pain Interventions Clinical Research program, a multicenter NIH trial comparing cognitive behavioral therapy for this pelvic pain syndrome to a control regimen based on AUA guidelines. The program will provide critical insight into the durability and efficacy of cognitive behavioral therapy for the syndrome, help determine which domains of the syndrome are best addressed by cognitive behavioral therapy, and further refine patient selection criteria. We and our patients alike eagerly await the trial’s findings!

Mian A, Huang E, Starke NR, Trost L, Helo S. The utilization of fine-needle vasography to localize obstruction of the male reproductive tract. Urology. Published online March 12, 2024. doi:10.1016/j.urology.2024.03.015

Special thanks to Dr Andrew Lai at the University of Illinois at Chicago.

I am a trainee at an institution known for subspecialty male infertility care. Typically when we want to identify the location of a vasal obstruction, we pass a 3-0 or 4-0 nylon suture in the abdominal direction as far as it goes, withdraw it, and measure the length. But it doesn’t give the satisfaction of seeing the obstructive anatomy. What a rare scenario for vasography for obstructive azoospermia to be the correct answer in clinical practice. Yet, it remains a precise tool in the urologist’s armamentarium, particularly when transrectal ultrasound results are nondiagnostic. The authors of this study highlight their fine-needle vasography technique in a multi-institutional case series over 8 years. Targeted treatments were then offered to each of the 16 patients described, reminding us of the heterogenous presentation of the condition. This article is worth reading just to appreciate the x-ray images.