Greetings from the 2011 American College of Obstetrics and Gynecology (ACOG) annual meeting here in our own backyard in Washington, DC! I am very excited to be keeping you up to date this week as we discuss the latest technological and clinical trends in women's health. As hospitals look for new ways to reach their patients and better serve populations with unique health care needs, women's health programs have garnered a lot of attention recently as a potential market differentiator.
One area within women's health becoming a larger focus of many practices is urogynecology. Across the next 30 years, demand for urogynecology services will increase substantially as the number of women between ages 60 and 65 increases by approximately 85%. This substantial group of women will likely need some form of incontinence services in the years ahead. While many of these procedures are moving to physician offices, owing to favorable reimbursement and their non-invasive nature, hospital providers can still play a large role in this market through partnering with physician offices or opening pelvic floor centers. Partnering with physician offices or outpatient centers will also help to ensure that downstream surgical referrals are realized.
First, detecting and diagnosing urinary incontinence (stress or urge) requires novel technologies beyond basic ultrasound. Urodynamics equipment is a must-have technology for any urogynecology program. Used to determine the type of incontinence present, a catheter is placed in the patient and the bladder filled to assess problems with voiding or sudden urges. Newer technologies on display this year are now wireless allowing patients to remain in more natural positions such as sitting or standing rather than laying down. Information is transmitted wirelessly to a laptop creating a much smaller footprint, of particular importance in office and outpatient use.
Moving forward to treating women with pelvic organ prolapsed (POP), there are a multitude of surgical and non-surgical options available. Often, the most important determining factor in selecting a treatment option is the desire of the patient to maintain sexual function. Prior to any surgery, clinicians recommend having open and honest discussions with patients on their sexual preferences. Satisfaction and happiness with the procedure often depend on the discussions had prior to treatment. Patients, not wishing to regret anything or fault physicians for not being upfront in describing potential risks, should be sure to have this active discussion prior to receiving pelvic reconstruction.
For non-surgical management of stress incontinence, vaginal mesh presents one option for treating patients unwilling or unable to undergo surgery. TVT slings are no longer considered innovative or research-focused as these have now become mainstays in many urogynecology offices due to widespread use. This increased use led to many vendors releasing kits containing pre-cut mesh and accessories to help physicians increase the reproducibility of their POP repair. With widespread use and a higher than desired complication rate, the FDA in 2008 released a public health notice regarding the safety and efficacy of these devices. This caused many physicians to take a second-look at these devices as there is a paucity of clinical data detailing their effectiveness. Without randomized studies to rely upon, physicians will continue to present anecdotal evidence and are encouraged to develop literature to help better educate patients and maintain FDA compliance.
One of the resounding themes throughout urogynecology discussions has been the movement of many procedures to the physician office setting and away from the hospital. Gynecologists prefer to not perform many procedures in the hospital as it interrupts their daily workflow in seeing patients in the office. As many technologies no longer require anesthesia and have decreasing recovery times, hospitals will need to find creative strategies to stay in this market, such as the creation of dedicated women's health centers, of which we continue to see great interest.
Stay tuned to The Pipeline for more updates from ACOG tomorrow and Wednesday as we continue to cover this ever-changing terrain!