PFD Week 2018-Concurrent Session #4: UTI

Video Transcription

Video Summary

In the first video, the speaker discusses the evaluation and management of microscopic hematuria in adults, specifically in women. They explain that guidelines on this topic were published in 2012 by the AUA, but there was some controversy in the urogynecology community because the implications of microscopic hematuria differ between men and women. Urological malignancy is more common in men. However, a recent study identified risk factors for malignancy in women, such as age over 60, smoking history, and gross hematuria. As a result, the ACOG and AUGS published a committee opinion that changed the guidelines on microscopic hematuria in women. They advised that asymptomatic, low-risk women under 50 years old did not need to be screened if they had less than 25 red blood cells per high-power field, as the cancer risk was low. The speaker discusses cost-effectiveness and quality-of-life implications of the different screening strategies for asymptomatic microscopic hematuria in women. They conclude that the ACOG-AUGS gender-specific strategy is more cost-effective and has better quality of life benefits compared to the AUA screening strategy. The video also highlights the limitations of the study, such as the use of retrospective data and simplifying assumptions. In the second video, the speaker discusses the evaluation and management of bladder injuries during hysterectomy. They refer to a previous cost-effectiveness analysis and explain that the study aims to update and expand upon this analysis by including both bladder and ureteral injuries and different modes of hysterectomy. The speaker summarizes the decision analysis model they designed to compare the cost of routine, selective, or no cystoscopy at the time of benign hysterectomy. They highlight the importance of detecting urinary tract injuries and the potential cost savings of selective or routine cystoscopy. They conclude that selective cystoscopy becomes cost-saving at a relatively low threshold, particularly during vaginal hysterectomy. They also highlight the strengths and weaknesses of their study and emphasize the need for guidelines and protocols that consider the cost-effectiveness and outcomes of different screening and management strategies for bladder injuries during hysterectomy.

Asset Subtitle

Caroline Kieserman-Shmokler, MD, Sonia Dutta, MD, Lauren Anne Cadish, MD, Caroline G. Elmer-Lyon, MD, Kimberly L Ferrante, MD, MAS, Elizabeth Southworth, Rachael C Baird, BS, Carrie E Jung, MD, & Christine M Chu, MD

Meta Tag

Category Education

Category Pelvic Pain

Keywords

microscopic hematuria

evaluation

management

women

urological malignancy

risk factors

cost-effectiveness

bladder injuries