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Continuing Innovation Within the Division of Female Pelvic Medicine

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Innovations in Urology | Summer 2023

Recent happenings within University Hospitals Urology Institute’s Division of Female Pelvic Medicine are advancing novel, patient-centered care for women struggling with diminished health and quality of life due to pelvic floor disorders (PFDs).

David Sheyn, MD UrologyDavid Sheyn, MD

“Understanding of female urology has historically lagged within the field, but we are working to change that at UH through innovative treatments and leading-edge research,” says David Sheyn, MD, Division Chief of Female Pelvic Medicine at University Hospitals Cleveland Medical Center.

Plans are under way to expand the division’s clinical and research footprint to increase care access for women experiencing a spectrum of pelvic floor conditions, including weakened pelvic muscles, overactive bladder (OAB), incontinence, organ prolapse, myofascial pelvic pain, oncological sequelae and sexual dysfunction.

According to a 2022 study published in Nature’s Scientific Reports, an analysis of over 25,000 electronic medical records (EMRs) of adult women treated in primary care clinics found that nearly one in three presented with at least one PFD.1 Additionally, Dr. Sheyn explains that patients with pelvic floor challenges — particularly urinary incontinence — tend to spend about two and a half times as much on health care and experience two to three times worse quality of life when compared to individuals without these conditions, even if they share similar comorbidities.

“For us to better serve patients and overcome a deficit in addressing these very common conditions, we need to educate primary care providers, OBGYNs and other specialists to raise awareness about effective treatment modalities,” says Dr. Sheyn. “Although surgical options are available, many individuals see significant symptom improvement through education and physical therapy.”

Renalis: An App for Overactive Bladder Behavioral Therapy

Renalis is an evidence-based software application cleared by the U.S. Food and Drug Administration (FDA) for study as a therapeutic intervention to support patient self-management of symptomatic OAB. University Hospitals recently completed a proof-of-concept trial of the app, enrolling 31 patients.

“We compared individuals before and after treatment, and almost every patient reported substantial improvement, with greater than 50 percent reduction in their OAB symptom score,” says Dr. Sheyn. “These findings are significant because Renalis demonstrated similar outcomes to traditional treatments for OAB — including physical therapy, which may be cost-prohibitive for some patients.”

Once commercially available, the app could potentially be integrated into the EMR, allowing for real-time monitoring of patient progress and referral to escalation of care as needed. “Patients reported feeling highly engaged with the app and comfortable with its usability,” says Dr. Sheyn. “In addition to improvement in bladder symptoms, some users also reported a reduction in anxiety, which was extremely gratifying to see.”

A Study of Urine Choline Levels and OAB

Using data from the Nurses’ Health Study, Dr. Sheyn and colleagues tracked participants from the 1970s through the 2000s, measuring their dietary choline intake. This semi-essential nutrient regulates cell membranes and signaling and is the principal constituent of acetylcholine, a neurotransmitter involved in urination. The research was funded through an R03 grant awarded by the National Institutes of Health’s National Institute on Aging and builds on findings the team published in the journal Female Pelvic Medicine and Reconstructive Surgery that found choline levels were significantly decreased in women complaining of OAB with urgency incontinence.2 In that study, researchers determined that premenopausal women who consumed higher choline levels had a decreased risk of developing urgency incontinence later in life.

During the retrospective study, “we also looked at genomics, metabolomic tissue and blood data for specific compounds that are involved in urination, as well as psychiatric evaluations, medication history, and even whether subjects experienced childhood trauma,” says Dr. Sheyn. “Next, we are going to incorporate all of this data to hopefully get a clearer picture of what risks are significant and how diet impacts the development of OAB.”

In collaboration with Kathryn Penney, ScD, of Harvard Medical School’s Brigham and Women’s Hospital, Dr. Sheyn was awarded the best epidemiology abstract for this research at the 2022 American Urogynecologic Society (AUGS) and International Urogynecological Association (IUGA) Scientific Meeting, held in Austin, Texas.

Eugene Washington PCORI Engagement Award

Given by the Patient-Centered Outcomes Research Institute, the Eugene Washington PCORI Engagement Award supports projects that seek to meaningfully engage patients and other stakeholders in health care research. Along with Sarah Koopman Gonzalez, PhD, a research scientist at Case Western Reserve University, Dr. Sheyn recently received the prestigious award to involve patients, caregivers and community advocates in setting priorities for future urological research initiatives.

“Rather than having someone like me decide what is important to study, this award will allow us to gather broader input about research interests across the entire field of female urology and sexual health,” says Dr. Sheyn. “Physicians obviously help people on an individual level, but we need to include a wide range of people in decision-making to have a massive impact.”

For more information or to refer a patient, contact Dr. Sheyn at David.Sheyn@UHhospitals.org

1https://www.nature.com/articles/s41598-022-13501-w

2https://pubmed.ncbi.nlm.nih.gov/30212388/

Contributing Expert: 
David Sheyn, MD
Division Chief, Female Pelvic Medicine
University Hospitals Urology Institute
University Hospitals Cleveland Medical Center 
Associate Professor of Urology
Case Western Reserve University School of Medicine

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