Meeting the Demand for Pelvic Wellness

Identification: P01_Research_CE

The Center for Pelvic Wellness (CPW) provides highly specialized and progressive treatments for various pelvic floor disorders. Patient care is delivered by a collaborative multidisciplinary team of healthcare professionals, including physicians and nurse navigators, with pelvic floor physical therapists as the primary clinicians. As more treatment options and techniques become available through new evidence-based research and the incidence of pelvic health conditions continues to rise, the demand for pelvic health services will also continue to increase. There is a need for innovative methods to engage and treat the increasing pelvic health needs. Our center provides highly individualized patient care to meet the pelvic health needs of our community while delivering an exceptional patient experience. We are in the process of testing, implementing, and validating questionnaires that would measure the patient’s perception of their outcomes with pelvic floor physical therapy.
Learning Objective:
  • After completing this learning activity, the participant will be able to assess innovations being used by other professionals in the specialty and evaluate the potential of implementing the improvements into practice

Understanding Post Prostatectomy Non-Compliance with Kegel Exercise to Improve Urinary Continence

Identification: P02_Research_CE

Introduction: Urinary incontinence is common after radical prostatectomy (RP). Kegel exercises can improve continence rates, but patient compliance is poor.

Purpose: This project identified patient barriers to Kegel exercises. Findings provide important factors of non-compliance that should be included in patient education.

Methods: 28 men diagnosed with localized prostate cancer and elected to undergo RP. At the one-week visit following RP, after Foley catheter removal, the nurse practitioner instructed patients in performing three Kegel exercises with 10 repetitions of each exercise done three times daily at home. At the one-month visit, patients completed the Kegel Exercise Barrier Questionnaire with the question of “How many times a day do you do the exercise?” and 10 statements regarding possible barriers to Kegel exercises in which the patients responded “yes” or “no/not applicable.” Content validity of the questionnaire was obtained by review of experts in the field of voiding dysfunction including urologists, physical therapists, and urology nurses in addition to pilot interviews with patients who had previously done the Kegel exercises after having undergone RP.

Results: The barrier indicated by the most number of patients was “body soreness,” which was selected by 10 (35.7%) patients performing the exercise an average of 2.5 exercises per day. The second most-frequently indicated barrier was “damage the area of surgery”; which was selected by 7 (25%) patients, performing the exercises an average of 2.4 times per day.

Conclusions: Pain and perceived possible damage to the surgical site are reported to be the main reasons underlying Kegel exercise noncompliance in patients with urinary incontinence following RP in this QI project. These findings may provide opportunity for nurses and other health professionals to educate patients on pain management strategies and general anatomy of the pelvic floor and site of surgery, especially within the first four weeks following RP.
Learning Objective:
  • After completing this learning activity, the participant will be able to assess innovations being used by other professionals in the specialty and evaluate the potential of implementing the improvements into practice

An Interdisciplinary Approach to Optimize Urologic Nursing Care Through Education

Identification: P03_NonResearch_CE

A recent systematic review showed that better patient outcomes may occur when hospital staff nurses are specially trained to care for specific patient populations (Butler et al, 2019). A recent study showed that when urology nurses are prepared for practice and providing nurses with the required training ensures consistency and excellence in patient care provided (Albaugh, 2012). Inadequate urologic nursing education can lead to an increase in long-term urinary catheter placements and high incidence of urinary retention in post-operative urology patients. The annual cost/patient for urinary catheter related infections as approximately $790-$1200 and estimated annual overall cost as $115 million - $1.82 billion (Sutherland et al, 2015).

The purpose of this project was to improve urology patient outcomes using an education intervention designed to increase nursing staff knowledge of fundamentals of urologic nursing care through a collaborative, interdisciplinary approach. The gaps in nursing care knowledge for urologic patients were identified across the hospital by urologists and nursing leaders. Nursing care processes were inconsistent among staff caring for urology patients, leading to poor patient outcomes and increased length of hospital stay for both medically and surgically managed urologic patients.

An interdisciplinary team of nursing leaders and clinicians, led by the medical clinical nurse specialist, was formed, and one unit was selected as designated urology unit. Education was provided to the nursing staff on that unit. A urology nursing education curriculum using evidence-based practice guidelines as the framework was developed. 50 registered nurses attended the course and based on their feedback, 40% appreciated learning about suprapubic catheters, 20% found post-operative care and continuous bladder irrigation very useful and 10% wanted more hands-on time during class and continuous staff training and updates for future classes. A workgroup was also created to update the current urology clinical practice guidelines used across the hospital.
Learning Objective:
  • After completing this learning activity, the participant will be able to assess innovations being used by other professionals in the specialty and evaluate the potential of implementing the improvements into practice

Implementation of a Clinical Practice Guideline to Improve Knowledge Retention and Decrease Anxiety in Patients Undergoing a Partial or Radical Nephrectomy

Identification: P04_NonResearch_CE

Introduction: The purpose of this project was to determine if the implementation of a clinical practice guideline would improve knowledge retention and decrease anxiety in patients undergoing a partial or radical nephrectomy.

Patients and Methods: A clinical practice guideline was created to assist providers in the delivery of pre-operative education. Data was collected using a pre/post-operative survey modified from the State Trait Inventory for Adults. Patients were asked to rank their anxiety levels and knowledge regarding their upcoming procedure and disease process using a Likert scale. Providers were also asked to evaluate the clinical practice guideline regarding the effectiveness of educating the patient and the sustainability for use with future patients. To evaluate the project data a statistical analysis was completed using a Wilcoxon Signed Rank Test.

Results: A Wilcoxon Signed Rank Test was used to compare the pre-/post-survey results following the implementation of a clinical practice guideline. Analysis indicated that all ten survey questions were noted to be statistically significant (at the 5% level), showing a difference in responses from pre- to post-survey based on the null hypothesis. The null hypothesis for the data collected represents the median of the differences between pre-survey and post-survey 1 and equals 0. The significance of this test was noted to be .000. Since the asymptomatic sing (2-tailed) is 0.000 or
Learning Objective:
  • After completing this learning activity, the participant will be able to assess innovations being used by other professionals in the specialty and evaluate the potential of implementing the improvements into practice

Nursing Considerations and Patient Safety of Transperineal Prostate Biopsy in a Urology Clinic

Identification: P05_Nonresearch_CE

Significance and background: Prostate biopsy is the gold standard to diagnose prostate cancer and is typically performed in the outpatient setting. Nurses heavily support this procedure by managing procedure set-up, assisting during the procedure, and providing emotional support and education to the patient. Due to the nature of the transrectal approach, sepsis is a common complication, with a reported rate of 1-17.5%. Transperineal prostate biopsy (TPPB) has been successfully transitioned to the outpatient setting, more commonly performed in Europe. In the United States, this approach is usually performed in the OR.

Purpose: This procedure was recently implemented in a high-volume outpatient urology clinic, which performs approximately 50 prostate biopsies a month. This abstract will share the logistics and nursing implications on transitioning this procedure into an outpatient setting.

Interventions: An interdisciplinary team explored the safety and feasibility of implementing the TPPB procedure to high risk patients. Literature was reviewed to understand the safety, procedural steps, and clinical considerations of converting this procedure from the operating room to the outpatient setting. In-services were developed to help educate nursing staff.

Evaluation: A high-risk immunocompromised patient was selected to pilot this procedure in the urology clinic. The patient underwent the biopsy without difficulty and showed no signs of sepsis post procedure. The patient’s experience was comparable to the typical transrectal approach, although pain management was noted to be an opportunity for improvement. Several more patients have been scheduled and outcomes will be reported at a later date.

Discussion: The implications for urology nurses include need for education related to equipment, procedure set-up, and support for physician and patient. Nurses are pivotal in supporting patients through this procedure due to its significance in accurately diagnosing cancer. The experience from this clinic can be shared with other urology clinics considering adopting this procedure.
Learning Objective:
  • After completing this learning activity, the participant will be able to assess innovations being used by other professionals in the specialty and evaluate the potential of implementing the improvements into practice

Once-Daily Vibegron 75 mg for Overactive Bladder (OAB): Double-Blind 52-Week Results From an Extension Study of the International Phase 3 Trial (EMPOWUR)

Identification: P06_NonCE

Purpose: Results are reported for the 40-week extension to the phase 3 randomized, double-blind, 12-week EMPOWUR trial of OAB patients.

Background/significance: Vibegron is a novel, oral, once-daily β3 agonist being investigated for OAB treatment. In EMPOWUR (N=1518), vibegron 75 mg statistically significantly improved co-primary OAB endpoints of daily micturitions and urged urinary incontinence (UUI) (p5% for vibegron; vibegron/tolterodine) were hypertension (8.8%/8.6%), urinary tract infection (6.6%/7.3%), and headache (5.5%/3.9%). One death (due to arteriosclerotic disease, judged not related to study drug by investigators or sponsor) occurred in the vibegron group. EMPOWUR vibegron and tolterodine patients showed improvement in adjusted mean change from baseline at week 52 in micturitions (-2.4, vibegron/-2.0, tolterodine), UUI (-2.2/-1.7), urgency (-3.4/3.2), and total incontinence (-2.5/-1.9); 61.0% of 143 vibegron patients had ≥75% UUI reduction, and 40.8% became dry (100% reduction) at week 52.

Conclusions/implications: Vibegron demonstrated favorable long-term safety in extension patients and showed durable improvements in micturitions, and UUI, urgency, and total incontinence episodes; 40.8% of OAB-wet patients became dry at week 52.

Funding: Urovant Sciences

Once-Daily Vibegron 75 mg for Overactive Bladder (OAB) Is Generally Safe and Well Tolerated, and Is Efficacious in Patients Aged ≥65 or ≥75 Years: EMPOWUR Randomized, International, Phase 3 Study

Identification: P07_NonCE

Purpose: For EMPOWUR, key efficacy endpoints are reported for patients with OAB aged ≥65 and ≥75 years, and overall.

Background/significance: Vibegron is a novel, once-daily, oral β3 agonist for OAB. In EMPOWUR, vibegron 75 mg showed statistically significant improvement in daily micturitions and urged urinary incontinence (UUI) episodes (p4% vibegron and >placebo) was headache (placebo, 2.2%; vibegron, 4.5%; tolterodine 2.3%).

Conclusions/implications: Treatment with vibegron for 12 weeks was generally safe and well tolerated, and was efficacious in all OAB patients, including those aged ≥65 and ≥75 years.

Funding: Urovant Sciences

Female Urethral Catheterization: The Practicing Nurses’ Perception

Identification: P08_NonCE

Catheter-associated urinary tract infections (CAUTI) are mostly caused by instrumentation of the urinary tract and catheter contamination. While both male and female patients can suffer the consequences of inappropriate catheterization, the intricate anatomy of the female pelvic region makes them particularly susceptible to CAUTI. Specifically, the opening of the female urethra is located within the vulvar vestibule, making insertion of urinary catheters a greater technical challenge than in males. Consequently, most microorganisms causing CAUTI in females derive from the patient's own colonic and perineal flora. Previous studies have correlated the incidence of infections with the level of training of the nurses. This study has been designed to assess the perception of graduated practicing nurses regarding female urethral catheterization and the potential need for improvement of the catheterization technique. Nurses with different levels of professional experience were invited to answer a 14-question survey on their daily experience of female catheterization. One hundred seven participants working in hospitals and clinics in the urban and rural areas of Nebraska completed the survey. The resultant data was organized into categories (e.g., gender, age, number of years since graduation, type of nursing degree, type of nursing practice, etc.) and analyzed through a combination of descriptive statistics and nonparametric inferential statistics (chi-square and cross tabulation). Cross-tabulation was used to evaluate the relationship between categories. Chi-square test was used to identify potential associations between variables. Some results were also represented by frequencies and percentage. Among those that responded, 90% of nurses across all experience levels admitted using more than one catheter during the catheterization of females, at least once in a while. Similarly, 91% admitted that at least once in a while they needed the help of a second nurse during the catheterization of a woman. Significantly, over 90% of nurses across different levels of experience recognized the need for a device to help with female catheterization and to teach female catheterization to nursing students. Overall, our findings suggest that regardless of experience, nurses overwhelmingly recognized the troubles associated with catheterizing females and highlighted their willingness to try alternatives to aid in safer and efficient female urethral catheterization.