Functional Urology: A New Subspecialty or Rebranding

Educational Objectives

The goal of this program is to improve the patient outcomes through optimal development of functional urology. After hearing and assimilating this program, the clinician will be better able to:

1. Compare therapeutic approaches in functional urology with other urologic subspecialties.

Summary

Urology: urology focuses on the urinary and genital tracts; various subspecialties of urology exist; the term genitourinary reconstructive surgeon does not convey the full spectrum of activities; reconstructive urology is a highly specialized field of male urology that restores structure and function to the genitourinary tract (from Wikipedia)

Subspecialties of urology: 2 board-certified subspecialties in urology are female pelvic medicine and reconstructive surgery (FPMRS; now rebranded as urogynecology and reconstructive pelvic surgery) and pediatric urology; the necessity for additional subspecialties and boards within urology is debated, with the history of FPMRS demonstrating challenges in merging different practices and identities within the field; the European Association of Urology (EAU) and the International Continence Society (ICS) are prominent societies defining functional and reconstructive urology (FRU); FRU will advance the care of pelvic floor disorders in men and women; emphasis is placed on rebranding to clarify the field's identity, noting differences in search results and associations with genital reconstruction vs functional medicine

Functional urology: the term functional urology connotes nonoperative urology; however, functional urology encompasses surgical and nonsurgical interventions, and reflects a broader scope beyond traditional surgery; this rebranding mirrors trends seen in functional medicine, expanding beyond surgery to holistic patient care; surgical techniques, including robotic surgery, remain significant in FRU, alongside nonoperative approaches

Definition: functional urology addresses benign conditions of the urinary tract that result in dysfunction and disorders that impact quality of life; management is surgical and nonsurgical

The need for rebranding: arises when the brand lacks awareness, identification, and clear messaging (eg, outdated website, targeting the wrong audience); the transition to FRU addresses the need for clarity in messaging, reaches the target audience, and updates practices to meet evolving patient needs; Welk (2019) opines that urologists should be the experts of the lower urinary tract; urologists are embracing advanced practice providers (APPs), nurse practitioners, and family medicine providers to manage the growing patient load effectively; an integrated model combining long- and short-term care and led by physicians with APPs can improve access to patients

Business of urology: enhance patient experience, improve physician wellness, optimize operational efficiency, increase communication, maximize research, and build a new program for FRU (or other interests); academic departments or institutions can rebrand by improving clinic experiences, improving patient and physician satisfaction, improving access to higher quality of care, involving trainees, and expanding into the community while maintaining core educational missions; resources on FRU are available

Take-home points: functional urology includes management of urinary incontinence in men and women, neurogenic and non-neurogenic disorders, infections, inflammation, and benign prostatic hyperplasia (excludes oncology, stones, and pediatric urology)

Readings

Chapple C. What is new in functional urology?. Eur Urol Focus. 2019;5(3):307-309. doi:10.1016/j.euf.2019.06.010; Mac Bride MB, Rhodes DJ, Shuster LT. Vulvovaginal atrophy. Mayo Clin Proc. 2010;85(1):87-94. doi:10.4065/mcp.2009.0413; Mazeaud C, Salazar BH, Braun M, et al. Functional MRI in neuro-urology: A narrative review. Prog Urol. 2023;33(7):349-356. doi:10.1016/j.purol.2023.03.002; Welk B. A new paradigm for functional urology. Can Urol Assoc J. 2019;13(6):208. doi:10.5489/cuaj.6037.

Disclosures

For this program, the following relevant financial relationships were disclosed and mitigated to ensure that no commercial bias has been inserted into this content: Dr. Flynn is a consultant for Boston Scientific, Cook Myosite, and Uromedica. Members of the planning committee reported nothing relevant to disclose.

Acknowledgements

Dr. Flynn was recorded at the 43rd Annual Ralph E. Hopkins Urology Seminar, held January 31 to February 3, 2024, in Jackson Hole, WY, and presented by Grand Rounds in Urology. For information about upcoming CME activities from this presenter, please visit jacksonholeseminars.com. Audio Digest thanks the speakers and Grand Rounds in Urology for their cooperation in the production of this program.

CME/CE INFO

Accreditation:

The Audio- Digest Foundation is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.

The Audio- Digest Foundation designates this enduring material for a maximum of 0.50 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Audio Digest Foundation is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center's (ANCC's) Commission on Accreditation. Audio Digest Foundation designates this activity for 0.50 CE contact hours.

Lecture ID:

UR471404

Expiration:

This CME course qualifies for AMA PRA Category 1 Credits™ for 3 years from the date of publication.

Instructions:

To earn CME/CE credit for this course, you must complete all the following components in the order recommended: (1) Review introductory course content, including Educational Objectives and Faculty/Planner Disclosures; (2) Listen to the audio program and review accompanying learning materials; (3) Complete posttest (only after completing Step 2) and earn a passing score of at least 80%. Taking the course Pretest and completing the Evaluation Survey are strongly recommended (but not mandatory) components of completing this CME/CE course.

Estimated time to complete this CME/CE course:

Approximately 2x the length of the recorded lecture to account for time spent studying accompanying learning materials and completing tests.