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Medscape
2 days ago
- Health
- Medscape
How to Make Urology Care More Comfortable for Women
Anne Pelletier Cameron, MD When her patient insisted on receiving Botox bladder injections in the operating room (OR), Anne Pelletier Cameron, MD, asked her why. The patient acknowledged her last time receiving the injections at a different practice had been negative. She explained that six people had been in the room with her. A few were men and one was a representative from the Botox provider. 'No one talked to her,' said Cameron, the James Montie legacy professor of urology at the University of Michigan Medical School, Ann Arbor, Michigan. 'She remembers [the experience] being very painful because she was scared to death. It was almost like a sexual trauma.' Unfortunately, urology care can be inherently uncomfortable for female patients. Pain and fear of pain can hinder women from accessing the care they need for urinary incontinence or other urological problems. But the medical field is starting to notice and address this issue. Recently, the American College of Obstetricians and Gynecologists (ACOG) introduced guidance on pain management for in-office gynecologic procedures. Central to their recommendations is providing comprehensive pain management counseling so patients are aware of their options and can choose for themselves. 'As urologists, we are working in the same vicinity [of the body], and it is really important to acknowledge and help manage patient pain,' said Cameron. Here's how. Reducing Physical Discomfort Felicia Lane, MD 'Doing the minimum number of invasive things to get your diagnosis is key,' said Felicia Lane, MD, a board-certified urogynecologist at UCI Health. In fact, a randomized controlled trial published this year found that urodynamics testing — which is invasive and often uncomfortable — is no more effective than a questionnaire, physical exam, bladder diary, and cough test in assessing female stress urinary incontinence. This was an extension of a trial whose results were published in 2009, said Lane. That trial found 'no value in urodynamics' for patients with stress urinary incontinence, she said. 'We have moved to doing less invasive testing to diagnose our patients with these conditions.' Raveen Syan, MD If possible, avoid routine catheterization, said Raveen Syan, MD, urologist and assistant professor of clinical urology, University of Miami Health System. Women have complained to her about urologists putting in a catheter during their first appointment. 'This is unnecessary and uncomfortable, and patients are bothered. They remember, and don't come back,' she said. Pelvic exams can also be problematic. 'No one likes a pelvic exam,' said Syan, who 'tries to spare patients.' When possible, she conducts them while her patients are under anesthesia for another procedure, like a biopsy or cyst removal. Syan teaches her trainees to use a small speculum and to lock it only when swabbing or conducting a cervical biopsy. 'If it's just an assessment of the pelvic floor, locking [the speculum] is unnecessary.' For pain mitigation during cystoscopies, Syan uses a flexible rather than a rigid camera. When it comes to video urodynamics procedures, she places the catheter into the vagina, not the rectum. 'Some urologists don't realize they can do this, since with men, they need to place it in the rectum,' she said. She starts with a low bladder fill rate of 30 mL/min because 'a patient with an overactive bladder can have spasms and not tolerate the procedure,' she said. With treatments, try to prioritize painless approaches. Lane often recommends vaginal estrogen cream for frequent urinary tract infections and pelvic floor physical therapy for urinary stress or urgency incontinence. For Botox injections in the bladder, 'there is growing evidence five to 10 injection points can be as effective as the traditional template of 12-15 injection points,' said Syan, referencing a recent literature search she co-authored. 'I cut down my injection points to five with 100 units or 10 with 200 units.' Be generous with lubricants and pain relievers, like lidocaine jelly. Allow several minutes for lidocaine to take effect before performing a procedure, like a pessary insertion, catheterization, or Botox injections. What you should not do is minimize pain. 'The least effective instruction you can give someone is to 'just relax,'' said Cameron. 'Don't tell them it won't hurt — and then hurt them. Say 'this will feel like a strong pinch' or 'like a burn and a poke.'' Easing Emotional Discomfort Try to assuage any possible shame or embarrassment about the urologic condition. Syan tells patients that about 16% of all women and 30% of women in their 60s experience urinary continence. 'It is common and not shameful,' she said. 'As the provider, my job is to put someone at ease' Cameron said. 'If they need to hold the nurse's hand, let's make that happen. If they want their partner, let's bring them in. Meet patients where they are. And if you can't help them through a procedure, you can bring them to the OR.' Then walk them through procedures, said Cameron. The procedure will go better if the patient is at ease and knows what to expect, like how long it will last, she said. Distraction in the form of what Cameron calls 'verbal anesthesia' can also help. 'If you are calm enough to have a conversation while doing a procedure, patients will know you have got this,' she said. 'I usually have a conversational talking point while I am doing a procedure, like if someone has beautiful earrings I will ask about them. By the time the patient has answered my questions, they are done.' As the ACOG guidance emphasizes, offering patients agency is critical. For instance, with video urodynamics procedures, Syan informs her patients a third person (the x-ray technician) will be in the room. Since this can cause discomfort, Syan offers them the option of skipping the video component. Above all, treat patients with respect and try to read their cues. Make sure they are draped, maintain eye contact, and tune in to their body language, said Lane. 'When a patient rolls their toes, I can tell they are uncomfortable and I will ask if they need a break.' Apply the Golden Rule When treating female urology patients, 'it's critical to listen to your patients,' said Lane. 'Listening allows you to establish a relationship and really understand what provokes their embarrassment and anxiety.' Then try to put yourself in their shoes, offer them options, and prioritize less invasive, effective approaches. Cameron had no conflicts of interest; Lane is a researcher/consultant for Axonics, Inc; Syan is a board member of the Interstitial Cystitis Association, site primary investigator for Axonics MOAB study, and board member for Sumitomo.
Politico
6 days ago
- Health
- Politico
14 Republican senators urge White House to release delayed NIH funds
It's the latest example of Republican pushback against the Trump administration's pattern of withholding money for any variety of programs that lawmakers have previously approved for a specific purpose. The Republican senators stressed in their letter they shared Vought's 'commitment to ensuring NIH funds are used responsibly and not diverted to ideological or unaccountable programs.' They also expressed their confidence in Health and Human Services Secretary Robert F. Kennedy Jr. and NIH director Jay Bhattacharya, writing, 'Our shared goal is to restore public trust in the NIH precisely because its work is focused on results, accountability, and real-world impact.' But, they added, 'Withholding or suspending these funds would jeopardize that trust and hinder progress on critical health challenges facing our nation. Ultimately, this is about finding cures and seeing them through to fruition.' The NIH is the top funder of biomedical research in the country. The University of Alabama is also major recipient of NIH funding and is the top employer in Britt's home state. Among the signers of the letter is Senate Appropriations Chair Susan Collins of Maine and several other appropriations subcommittee chairs: Sens. Shelley Moore Capito of West Virginia, Lindsey Graham of South Carolina, Mitch McConnell of Kentucky, Jerry Moran of Kansas and Lisa Murkowski of Alaska. Other signatures are Sens. John Boozman or Arkansas, Bill Cassidy of Louisiana, Tim Scott of South Carolina, Dave McCormick of Pennsylvania, Dan Sullivan of Alaska, Thom Tillis of North Carolina and Todd Young of Indiana.
Time of India
19-07-2025
- Politics
- Time of India
'No Secret Police': Blue States Open Fresh Front Against Masked Unmarked ICE Agents I Details
Democratic-led states in the U.S. are proposing bans on ICE agents wearing masks and mandating visible ID cards during operations. California, New York, Massachusetts, and cities like Chicago and Albuquerque are considering such laws, citing public fear of masked agents kidnapping or assaulting immigrants. Supporters argue these measures prevent impersonation crimes, while DHS warns bans will endanger ICE agents and hinder enforcement. The DOJ maintains states cannot regulate federal law enforcement uniforms. Latino communities remain deeply worried about masked raids. Democrats in Congress now push for a national ban on ICE masks, escalating state-federal clashes. Read More
Malaysian Reserve
17-07-2025
- Business
- Malaysian Reserve
Armizan: Comprehensive e-commerce bill expected to be tabled early next year
PUTRAJAYA — A bill to strengthen the legal framework for e-commerce is expected to be tabled in Parliament during its first session next year, said Domestic Trade and Cost of Living Minister Datuk Armizan Mohd Ali. He said the ongoing review of e-commerce legislation commenced in April 2024 and is expected to conclude by August, involving engagement with stakeholders across the industry, among others. 'The review is necessary as the current legal framework lacks clear regulatory powers over electronic transactions, with the existing Electronic Commerce Act serving mainly as an enabling act. 'Enforcement currently depends on the Consumer Protection Act and related regulations, which were meant to be temporary. We need a comprehensive and fair framework accepted by all stakeholders to support e-commerce growth,' he told reporters after an engagement session today. Armizan said Malaysia's e-commerce sector recorded steady growth, with revenue rising from RM1.13 trillion in 2022 to RM1.22 trillion last year. He emphasised that new regulations must not hinder the sector's development, noting that once a mechanism is in place for local platforms, a similar approach will be considered for foreign-based operators. He added that, at present, the ministry has no authority to regulate or monitor foreign platforms without a physical presence in Malaysia, raising concerns over the influx of foreign products and tax inequality. Armizan also said that discussions are underway with countries such as China and Turkiye on a government-to-government (G2G) mechanism, particularly on regulating cross-border e-commerce and direct selling. Meanwhile, Armizan said consumer protection is a key focus in the ongoing review of the e-commerce legal framework, particularly on the use of automated decision-making (ADM) systems or algorithms that may contain manipulative elements. He said the ministry is also looking into growing concerns over recent increases in platform fees imposed by several e-commerce operators, noting that such fee hikes are business decisions made by the platforms themselves. 'In my view, the timing of their fee adjustments is not appropriate, especially since some had already revised their commission fees as recently as August last year,' he said. He added that while blocking such decisions entirely may not be realistic, the ministry is exploring a mechanism requiring platforms to consult with them or relevant agencies before making fee changes that affect users or sellers. To date, the review process has involved 23 engagement sessions, six roundtable discussions, four benchmarking visits abroad and over 300 respondents, with sessions in Sabah and Sarawak to follow. — BERNAMA
Daily Mirror
15-07-2025
- Business
- Daily Mirror
Xander Schauffele sent strong message from dad over £148m LIV Golf offer
Xander Schauffele was offered up to £148m ($200m) to join the LIV Golf breakaway league, but his father Stefan urged him to remain loyal to the PGA Tour Xander Schauffele notably valued silverware over a staggering £148million enticement from LIV Golf, a decision backed by his father. Despite the lure of an enormous payday and new opportunities, his choice to forgo the breakaway tour was steered by sage advice from his father and former coach, Stefan Schauffele. The American golfer is set to tee off at The Open Championship this week, with the aim of retaining the Claret Jug for his trophy cabinet. Schauffele was made an offer that ranged between an approximate £111m and £148m to defect from the PGA Tour to the LIV Golf series, illustrating just how lucrative the Saudi-backed golf circuit has become. But it wasn't purely paternal counsel that influenced the 31-year-old's decision to stay put; concerns over the restriction on world-ranking points available on the rival circuit could hinder participation in major tournaments played a part. The world-ranking tally was crucial for up-and-coming stars like Schauffele, who wanted to etch their names in sporting history rather than the richest athletes list. In an unequivocal stance, Stefan made it clear that even a fortune worth double their original offer would not tempt them away from the integrity of traditional competition. He told The Times: "They could've doubled the money and we still wouldn't do it." That firm stance seemed to pay dividends when Schauffele secured back-to-back majors: the PGA Championship followed by The Open, notching almost £5m in winnings from those high-profile victories alone. His bank balance increased greatly with £2.3m from The Open win and £2.5m from his PGA Championship glory. Schauffele and his father Stefan, who has served as his swing coach and agent, have shared the emotional highs of their incredible journey together, including Xander's gold medal win at the 2021 Tokyo Olympics. Recounting the triumph, Xander said: "That was a seriously emotional moment." The success also deeply touched Stefan, who added: "You're going to make me cry just thinking about it. He understood how huge the Olympics was for me. We got in the car and he gave me the medal and said, 'This is for you.'" With The Open Championship on the horizon, Schauffele is eyeing yet another addition to his already impressive accolades, while aiming to make his dad proud once more. But winning won't be easy, as golf sensations like Rory McIlroy and Scottie Scheffler are also vying for their second major win of the year, promising a riveting challenge for the Claret Jug.
