Newswise — Investigators in Female Pelvic Medicine at Hackensack Meridian Hackensack University Medical Center Department of Urology have completed two studies and are conducting a third aimed at improving the standard of care for common urologic disorders in women. The studies address voiding dysfunction (problems with urination) and the management of urinary tract infections (UTIs) and have yielded compelling data that will be presented at professional conferences and published in academic medical journals.
"Problems with urination and UTIs impact the health and quality of life of many women. My colleagues and I are leading innovative clinical trials aimed at improving the care of these women and optimizing their outcomes," explained Debra Fromer, MD, chief of Female Pelvic Medicine and Reconstructive Surgery at Hackensack University Medical Center and associate professor of Urology at Hackensack School of Medicine. She led studies to answer the following questions:
Can women with voiding dysfunction predict their voided volumes and post-void residual void volumes? "Women who have voiding dysfunction often tell us they have to go to the bathroom very frequently and every time they go, there's a large amount of urine OR there isn't a large amount and they feel like their bladder is still full," Dr. Fromer explained. They are often asked to complete "voiding diaries," where they measure how much urine they have voided and log it into a diary, which can be a very cumbersome process. Alternatively, they may be asked to undergo invasive urodynamic testing to assess their voiding dysfunction. The researchers wondered if the women could accurately predict how much they voided and how much they believed remained in their bladder afterward, to see if it could spare them from completing the diaries and/or invasive urologic testing. Their findings showed that the vast majority of women could not accurately predict how much they had urinated or how much was left behind. These results reinforce the importance of voiding diaries and testing in the management of women with urination problems. "Accurate assessment of urinary volume is important for determining how we treat each patient," Dr. Fromer noted.
What is the role of cystoscopy in the management of women with recurrent UTIs? Cystoscopy is the examination of the inside of the bladder, in a doctor's office, using a slender scope inserted into the urethra with a camera at its tip. It is typically used when a woman has UTIs that persist or continue to come back, to see if there is some other problem inside the bladder or ureters that is causing the UTIs. Dr. Fromer and her team retrospectively analyzed the medical records of several hundred women (the largest study population to date to explore this issue) who had cystoscopy for recurrent UTIs. They found that very few women had anything identifiable on cystoscopy of any significance that was related to their bladder infections, particularly among women with uncomplicated UTIs. The researchers concluded that cystoscopy should only be considered for select women with complicated recurrent UTIs. It is currently overused and should not routinely be used for all women with recurrent infections.
Are there any trends in microbial resistance among women with recurrent UTI seeking urologic care in the New York-New Jersey metropolitan area? The Hackensack Meridian Health Center for Discovery & Innovation is conducting this study by exploring the medical records of thousands of women treated for recurrent UTIs to see if there are patterns of resistance in the bacteria causing these infections. The study is ongoing, but preliminary data are showing that the rate of resistance to antibiotics among these bacteria is very high and increasing with time. "This is most likely due to the overuse of antibiotics," said Dr. Fromer.
Experts in the Female Pelvic Medicine and Reconstructive Surgery division at Hackensack University Medical Center are leaders in the management of urogynecologic issues and offer the latest treatments and technologies. One example is Bulkamid®, a "bulking agent" that is injected into the urethra under a local anesthetic in a doctor's office that has been shown to help women with stress incontinence ("leaky bladder"). It has been used in Europe for several years and recently became available for use in the United States.
Dr. Fromer and her colleagues have also adopted new techniques for sacral neuromodulation for the treatment of overactive bladder, urinary retention, and fecal incontinence. The neurostimulator device is implanted in the upper buttocks and is thought to normalize nerve communication between the bladder and brain and the bowel and brain. Newer technologies employ batteries in the device that are rechargeable.
"Our specialists in the field of female urology are dedicated to improving the care and the lives of the patients we serve," concluded Michael Stifelman, MD, chair of the Department of Urology at Hackensack University Medical Center and professor and chair of Urology at the Hackensack School of Medicine. "The clinical trials we are conducting and the novel technologies we offer demonstrate our leadership in this field."
Additionally, the Female Pelvic Medicine and Reconstructive Surgery division, Department of Obstetrics and Gynecology at Hackensack Meridian Jersey Shore University Medical Center also continues to add to existing medical knowledge via publication of its clinical research. Under the direction of Department Chair Scott W. Smilen, M.D., FACOG, Professor, Vice Chair,
Department of Obstetrics and Gynecology at Hackensack Meridian School of Medicine, an acknowledged leader in the field of Female Pelvic Medicine and Reconstructive Surgery, and his board-certified colleagues from the OB GYN and Urology specialties, research has been completed on various topics over the past few years. They include treatment of Interstitial Cystitis, Percutaneous Tibial Nerve Stimulation (PTNS) to treat Overactive Bladder, evaluation of urinary symptomatology in women, prediction of the occurrence of venous thromboembolism in women undergoing vaginal surgery for pelvic organ prolapse and Coronavirus complicating pelvic surgery.1
Dr. Smilen, an acknowledged leader in the field of Female Pelvic Medicine and Reconstructive Surgery, is also the current Chair of the Publications Committee for the American Urogynecologic Society, which publishes documents on key topics within the field to guide practitioners in their care of patients. He is the co-author of the American College of Obstetricians and Gynecologists (ACOG) Practice Bulletin on Urinary Incontinence, which describes the current understanding of the causes of urinary incontinence in women as well as the most up-to-date treatment options.
To make an appointment with a doctor in Female Pelvic Medicine and Reconstructive Surgery, call 551-996-8090. To make an appointment with a doctor in Female Pelvic Medicine and Reconstructive Surgery physician at Jersey Shore University Medical Center, call 732-776-3797.
ABOUT HACKENSACK UNIVERSITY MEDICAL CENTER
Hackensack University Medical Center, a 771-bed nonprofit teaching and research hospital, is the largest provider of inpatient and outpatient services in New Jersey. Founded in 1888 as Bergen County's first hospital, it was the first hospital in New Jersey and second in the nation to become a Magnet®-recognized hospital for nursing excellence. The academic flagship of Hackensack Meridian Health, Hackensack University Medical Center's campus is home to facilities such as John Theurer Cancer Center, the Heart & Vascular Hospital, and the Sarkis and Siran Gabrellian Women’s and Children’s Pavilion. Recognized as being in the top 1% of hospitals in the nation and #2 in New Jersey by U.S. News & World Report’s 2020-21 "Best Hospitals" Honor Roll, Hackensack University Medical Center also ranked as high-performing in cancer care, cardiology and heart surgery, gastroenterology and GI surgery, geriatrics, nephrology, neurology and neurosurgery, orthopedics, pulmonology, and urology. Hackensack University Medical Center’s comprehensive clinical research portfolio includes studies focused on precision medicine, translational medicine, immunotherapy, cell therapy, and vaccine development.
ABOUT JERSEY SHORE UNIVERSITY MEDICAL CENTER
Located in Neptune, N.J., Hackensack Meridian Jersey Shore University Medical Center is a not-for-profit teaching hospital and the only Level II Adult and Pediatric Trauma Center in Monmouth and Ocean counties. It is home to K. Hovnanian Children’s Hospital – the first children’s hospital in Monmouth and Ocean counties. With more than 1,200 physicians and dental staff in 60 specialty areas, Jersey Shore University Medical Center’s (JSUMC) team provides high-quality care in a patient-centered, environmentally-friendly setting.
The team’s commitment to excellence has earned JSUMC numerous accolades, including being named the #7 best hospital in New Jersey, #23 in the NY metro area and high performing in nine specialties, procedures and conditions by U.S. News & World Report for 2021-2022. JSUMC has also received numerous national recognitions demonstrating clinical quality from Healthgrades including America’s 250 Best Hospitals, 100 Best Hospitals for Stroke Care and Patient Safety Excellence Awards as well as Excellence Awards in Neurosciences and Bariatric Surgery in 2021. Jersey Shore’s programs and services continue to receive numerous national recognitions, including designation as high-performing in cardiac, stroke, surgical and oncology services.
The medical center’s clinical research program and longstanding commitment to medical education is evident through an affiliation with Hackensack Meridian School of Medicine and an affiliation with St. George’s University School of Medicine. JSUMC serves as an academic center dedicated to advancing medical knowledge, training future physicians and providing the community with access to promising medical breakthroughs.
JSUMC’s HOPE Tower – a $265 million, 10-story medical office building provides a healing outpatient experience. Guided by a patient-centered approach towards care, and informed by the latest medical breakthroughs, HOPE Tower includes advanced imaging services, a clinical academic center, innovative simulation laboratory, state-of-the-art amphitheater, specialty physician offices, a nine-level parking garage, and a 58,000 square foot cancer facility. The cancer facility features a range of comprehensive treatment options, including surgical specialties, medical oncology, and the most advanced radiation therapy and minimally invasive interventional therapies. Nurse navigators guide patients through every step and provide an extra layer of support and coordination. For information, visit https://www.jerseyshoreuniversitymedicalcenter.com/.
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