ABSTRACT
Introduction: Throughout the COVID-19 pandemic, medical office culture has changed to incorporate telemedicine. Now that regular office visits are occurring once again, many health care settings are left with a hybrid model. Throughout the pandemic, patients with incontinence were treated with telemedicine through many successful avenues. Behavioral, medical, and conservative management are valuable first-line interventions for overactive bladder and are possible in the telemedicine setting. It is important to examine the usefulness of telemedicine to discern if this is an appropriate alternative throughout the future of medicine. Objective: To assess the utility of telemedicine for patients undergoing management of overactive bladder. Methods: This is a retrospective chart review spanning March of 2019 through November 2021 at a urogynecologic practice. Patients were included based on CPT codes (N39.41, N32.81, N39.46). These codes are specifically for overactive bladder, urge, or mixed incontinence, respectively. Telemedicine visits started after April of 2020. Visit types including cancellations, re-scheduled visits, and no shows were compiled to look at compliance of in-person versus telemedicine visits. Analytical methods were performed using Python software. Descriptive analysis for all primary and secondary objective variables are reported independently and presented as percent and count within category. Results: There were 2176 patients who met inclusion criteria during the 32 month time frame. Patient compliance was the measure used to determine the utility of telemedicine visits. It was measured by collecting patient cancellations and rescheduled visits. In the time before April 2020 16.1% of visits resulted in patients not attending their originally scheduled appointment in comparison to 17.8% after. When broken down into the type of visit, 10% of telemedicine visits were not attended versus 18.2% of in-person visits. Of the visits that were not attended, if a visit was originally for in-person it was rare (4%) that they would switch their next visit to be telemedicine. And the same was true for telemedicine visits. However, when compiling no-show visits, 2.5% of in-person visits resulted in no-show in comparison to 4.4% of telemedicine visits. Conclusions: There were fewer canceled or rescheduled telemedicine visits overall in our sample of visits for urge incontinence. This could be due to greater flexibility of appointment type and decreased barriers such as transportation or timing of the appointment. Increased compliance with the originally scheduled appointment time strengthens the argument that telemedicine is a useful alternative to in-person appointments. This seems especially useful in the management of chronic medical conditions, such as urge incontinence, which do not require an in-person exam. Interestingly, the no-show rate was greater among telemedicine visits. Patients who do not show up for their appointment without notifying the office prior seem to be a different group from those who cancel. This could highlight a difference in the way patients view this type of medical care. Further research is needed to determine behavioral aspects of telemedicine care.
ABSTRACT
Introduction: Postmenopausal women with recurrent urinary tract infections (RUTI) are repeatedly exposed to antibiotics and therefore at risk for colonization by multi-drug resistant organisms. Methenamine hippurate (MH) is FDAapproved for the prevention of RUTI;however, the mechanism of action of MH or, more specifically, the role of MH in the alteration of the urobiome is not known. Since preliminary data has shown that MH may be effective against some bacteria (e.g., Escherichia coli), but not others (e.g., Enterococcus faecalis), we hypothesize that resident bladder microbiota will be altered by administration of MH. Objective: Our objective is to determine the longitudinal effect of MH on the urobiome of postmenopausal women with RUTI. Methods: A longitudinal study with a convenient sample of 10 postmenopausal women with a clinical history of RUTI was conducted (Figure 1). UDI6 questionnaires, voided urine, catheterized urine, and peri-urethral swabs were obtained at baseline and three months after daily MH use. Expanded quantitative urine culture (EQUC) was performed on these specimens. In addition, during the 3-month timeframe, four self-collection windows were completed (windows A-D): (A) prior to initiating MH (baseline urobiome), (B) one week after starting MH, (C) two weeks before the 3-month follow-up, and (D) one week before the 3-month follow-up. Voided urine and peri-urethral swabs were collected daily for one week during windows A-D to determine how the urobiome changed. Sequencing of samples from these collection windows is pending. Results: Ten participants enrolled;however, three participants were not able to complete the study due to allergic reaction, improper handling of samples, and COVID infection. Six participants have completed the study;microbiological studies for one participant are still in process. There were no episodes of acute cystitis for any participant during the length of the study. UDI6 results suggested a trend towards a decrease in frequency, leakage with urgency, and abdominal pain;however, none of these were statistically significant (Table 1). Of the six remaining participants, the average baseline urine pH was 5.8 ± 0.8. For the completed participants, an initial microbiological comparison of EQUC results at baseline and 3-month visits show differences in sample diversity. Specifically, the number of species detected (richness) in catheterized urine increased for all but one participant (Figures 2A and 2B) though there was little or no changes in overall diversity (Shannon Index, Figure 2B) or evenness (Pielou's Index, Figure 2C) for any sample type. Exposure to MH did not result in the loss of uropathogenic species present in catheterized urine at baseline;instead, additional uropathogenic and commensal microbiota were detected at the 3-month visit. Conclusions: UDI6 trended towards symptom improvement in frequency, urge incontinence, and pain, consistent with RUTI prevention and symptoms control. Microbiological results suggest that MH increases the richness of the bladder urobiome. This consistent trend suggests MH may reduce RUTI events by altering the urobiome community richness instead of eliminating uropathogenic microbiota from the bladder. Further studies are needed to understand the interaction between MH and a host that is susceptible to uropathogen overgrowth (Table Presented).