Training the Next Generation of Urogynecologists
The Center for Women’s Pelvic Health is a multispecialty center with urologists and gynecologists dedicated to providing comprehensive and personalized care for pelvic floor disorders. Our urogynecologists are double certified in their specialty, as well as in female pelvic medicine and reconstructive surgery (FPMRS).
The Center also integrates training for future urogynecologists through the UCLA Female Pelvic Medicine and Reconstructive Surgery (FPMRS) Fellowship led by Dr. Victor Nitti, Program Director and Chief of Female Pelvic Medicine and Reconstructive Surgery in Urology, and Dr. Christopher Tarnay, Associate Program Director and Chief of Female Pelvic Medicine and Reconstructive Surgery in Obstetrics and Gynecology. The Center trains 5-6 fellows each year.
“During my own training, what got me into caring for people with pelvic floor disorders was the lack of attention to these conditions despite them being quite common,” says Christopher Tarnay, MD, Health Science Professor of Obstetrics and Gynecology and Urology. “With more awareness, education and access to care, along with research and clinical studies to improve treatment options, more women can find the care they need to improve their quality of life.”
With an integrative and cooperative approach, trainees get a broad exposure to clinical situations, from more routine surgical cases to complex reconstruction, as well as the opportunity for individual and collaborative research. Dr. Tarnay said, “We are excited about the excellent research work that, under the direction and mentoring of Dr. A. Lenore (Lenny) Ackerman, Research Director for FPMRS, our current fellows are doing to advance the field of care for women with pelvic floor disorders.”
Dr. Michelle Torosis, third year FPMRS fellow, is researching the potential benefits of transvaginal electrical stimulation for overactive bladder (OAB) without incontinence (OAB-dry).
OAB is a chronic disorder with an overall prevalence in the adult population of over 10%, but that may exceed 40% in elderly groups. Treatment of OAB is aimed at relieving symptoms and not necessarily at reversing pathophysiologic abnormalities. Though treatments currently are at best 80% efficacious there are some options such as pelvic floor physical therapy that have significant barriers to care.
To help reduce health inequities, Dr. Torosis is investigating a simple home transvaginal therapy for the treatment of OAB-dry. This therapy, involving a TENS unit and transvaginal probe, is relatively inexpensive and easy to use. The hope is this study will demonstrate high efficacy of this treatment modality, increasing the treatment options for patients while decreasing barriers to care in this patient population.
The article “Overactive Bladder Patients With and Without Urgency Incontinence: A Spectrum of One Condition or Different Phenotypes?” was recently published in Urogynecology, 2023 Jan 1; 29(1):33-40. Dr. Torosis is the first author.
Dr. Alec Szlachta-McGinn, second year FPMRS fellow, is characterizing urinary candida strain virulence and the host inflammatory response in women with the vexing condition of bladder pain syndrome (BPS). The significance of this research is to investigate the impact of differences in strain virulence of individual patient-derived urinary Candida isolates on host inflammation and bladder dysfunction. As BPS remains a poorly understood disease, efforts are needed to better understand the underlying pathophysiologic molecular mechanisms in order to direct future novel diagnostic and therapeutic strategies for this common and debilitating condition in women.
Other FPMRS ongoing research projects include:
- Assessment of the diagnostic utility of quantitative polymerase chain reaction and next generation sequencing in women with recurrent urinary tract infection and chronic lower urinary tract symptoms
- Pudendal block at the time of transvaginal prolapse repair does not improve postop pain: A randomized controlled trial
- Evaluation of if PNB at the time of transvaginal prolapse repair improves postop pain
- A clinical consensus treatment algorithm for patients with high-tone pelvic floor dysfunction: A Delphi study of national experts
- Novel treatment algorithm for the treatment of HTPFD (manuscript submitted for publication)
- Primary care perceptions on the barriers to providing guideline-driven care for recurrent UTI
- Understanding barriers to care for patients with rUTI and referral patterns from PCPs to subspecialist care
Research in the FPMRS division is focused on both clinical and translational research projects to better understand the pathophysiology of lower urinary tract disorders with the goal of devising better ways to treat them for the optimization of women’s health.