Based on a text thread with a few of my Urogynecology colleagues across the country today, we are constantly inheriting poor Urologic management of female issues. Here are a few of them, and I know that modern #urologytwitter won't be doing any of these things! 😉
1) Not listening to the patient/medical gaslighting
I don't know if this is "old school" or ego-based care, or that female Urologic issues do not pay as well as male urology issues do. But please listen and refer them if your training isn't current on female Urology!
I don't know if this is "old school" or ego-based care, or that female Urologic issues do not pay as well as male urology issues do. But please listen and refer them if your training isn't current on female Urology!
2) Not treating the problem they came in for (ie pushing sacroneuromodulation or bulking when the patient is there for prolapse).
3) Doing a bad prolapse repair. Anterior repairs should almost never be done without an apical repair. If you don't know the evidence, refer!
3) Doing a bad prolapse repair. Anterior repairs should almost never be done without an apical repair. If you don't know the evidence, refer!
4) Flomax for really any reason
5) Urethral dilations for anything other than ACTUAL urethral stenosis. Dilations do not treat voiding dysfunction, OAB, painful bladder, or recurrent UTIs. If anything, they cause worsening stress incontinence.
5) Urethral dilations for anything other than ACTUAL urethral stenosis. Dilations do not treat voiding dysfunction, OAB, painful bladder, or recurrent UTIs. If anything, they cause worsening stress incontinence.
6) IC is often endometriosis and pelvic floor spasm. If you don't work in a multidisciplinary team who understands the pathophysiology of this, refer.
7) Treating recurrent UTIs/GSM with abx suppression, repeated cystoscopies, but never putting the patient on vaginal estrogen.
7) Treating recurrent UTIs/GSM with abx suppression, repeated cystoscopies, but never putting the patient on vaginal estrogen.
8) Not prioritizing female sexual function in treatment plans
9) Making comments about the patient's anatomy/sexual preferences/fertility
10) Not referring to pelvic floor PT
9) Making comments about the patient's anatomy/sexual preferences/fertility
10) Not referring to pelvic floor PT
I know there are many amazing Urologists who would never dream of doing any of this. But I see it every day and my colleagues across the country do, too. To be paid less to clean up some real patient suffering is demoralizing. We can do a better job!
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