BackTable / Urology / Podcast / Episode #12

Management of Cystitis & Pelvic Pain Syndrome

with Dr. Yahir Santiago-Lastra and Dr. Jose Silva

We talk with Dr. Yahir Santiago-Lastra, director of the Women's Pelvic Medicine Center at UC San Diego Health about the management of cystitis and pelvic pain syndromes. She shares her insights on genitourinary syndrome of menopause, pain evaulation and treatment, and procedural options including botox and sacral neuromodulation.

Management of Cystitis & Pelvic Pain Syndrome with Dr. Yahir Santiago-Lastra and Dr. Jose Silva on the BackTable Urology Podcast)
Ep 12 Management of Cystitis & Pelvic Pain Syndrome with Dr. Yahir Santiago-Lastra and Dr. Jose Silva
00:00 / 01:04

BackTable, LLC (Producer). (2021, July 28). Ep. 12 – Management of Cystitis & Pelvic Pain Syndrome [Audio podcast]. Retrieved from https://www.backtable.com

Earn CME

Reflect on how this Podcast applies to your day-to-day and earn AMA PRA Category 1 CMEs.
Follow the button below to get started with CMEfy.

BackTable CMEfy button

Stay Up To Date

Follow:

Subscribe:

Sign Up:

Podcast Contributors

Dr. Yahir Santiago-Lastra discusses Management of Cystitis & Pelvic Pain Syndrome on the BackTable 12 Podcast

Dr. Yahir Santiago-Lastra

Dr. Yahir Santiago-Lastra is an associate professor of urology and the director of the Women's Pelvic Medicine Center at UC San Diego in California.

Dr. Jose Silva discusses Management of Cystitis & Pelvic Pain Syndrome on the BackTable 12 Podcast

Dr. Jose Silva

Dr. Jose Silva is a board certified urologist practicing in Central Florida.

Show Notes

In this episode of BackTable Urology, Dr. Jose Silva discusses cystitis and pelvic pain syndrome with Dr. Yahir Santiago-Lastra, a urogynecologist and director of the Women’s Pelvic Medicine Center at UC San Diego Health.

The initial evaluation of a pelvic pain or cystitis patient must address the patient’s detailed symptoms and pain. On the first visit, Dr. Santiago-Lastra emphasizes the importance of discussing the frequency of symptoms, past treatments sought by the patient, and qualitative descriptions of the pain. She notes that some urologists will forget to consider genitourinary syndrome of menopause (GSM) as a cause for recurrent UTIs. Then, she outlines her 5-step pelvic examination procedure: vulvovaginal examination, urethral examination, classic pelvic examination, vaginal/cervix examination, and anal examination. If she finds something abnormal during the pelvic exam, she will use a hand mirror to show patients the anatomical location of their pain.

Next, Dr. Santiago-Lastra discusses the kinds of medical treatment for patients presenting with recurrent UTIs and consistently positive urine cultures. She prefers to prescribe vaginal estrogen over long-term antibiotics, but acknowledges that some patients, such as premenopausal breast cancer patients, may refuse vaginal estrogen. In these cases, she recommends Refresh cream, methenamine, prophylactic post-coital/nightly antibiotics, and sometimes intravesical gentamicin instillation. Aside from medical treatments, Dr. Santiago-Lastra also recommends pelvic floor therapy and sometimes additional holistic treatment, as pelvic pain may originate from sexual trauma.

Dr. Santiago-Lastra then discusses different options for treating pelvic pain and cystitis. For her, opioids play an extremely limited role for pelvic and bladder pain. She typically uses injections (nerve blocks), neuromodulation, pyridium, vaginal diazepam, vaginal lidocaine, gabapentin, and vaginal/systemic cannabis to treat pelvic and bladder pain. She does not usually prescribe NSAIDS because of their adverse effects from long-term use. For patients with confirmed localized bladder pain, she notes that IC cocktail (instillations) can provide some pain relief. In the rare case that all medical options have been exhausted, urinary diversion, an open surgery that removes the bladder completely, is a possible option.

Finally, Dr. Santiago-Lastra and Dr. Silva discuss Botox and InterStim (sacral neuromodulation), two new treatments for patients who have both pelvic pain and incontinence/urgency symptoms. Although Botox and InterStim are equivalent treatments, there are certain indications for each treatment. For instance, InterStim is recommended for patients with voiding dysfunction and severe bowel symptoms because Botox only directs its efficacy to the bladder.

To conclude, Dr. Santiago-Lastra emphasizes the importance of taking time to listen to pelvic pain and cystitis patients’ concerns and desires, as they commonly become long-term patients.

Transcript Preview

[Dr. Yahir Santiago-Lastra]
So a lot of women who are referred to the office with recurrent UTIs will actually have this genitourinary syndrome of menopause or GSM. Typically when we see patients with GSM in the office or a patient comes in with those complaints, the first thing that we do is get an inventory of their symptoms and talk about what is actually bothering them. It could be that they have a lot of urinary frequency, urgency, and dysuria only when they have UTI.

Disclaimer: The Materials available on BackTable.com are for informational and educational purposes only and are not a substitute for the professional judgment of a healthcare professional in diagnosing and treating patients. The opinions expressed by participants of the BackTable Podcast belong solely to the participants, and do not necessarily reflect the views of BackTable.

Earn CME When You Listen to BackTable CMEfy

Up Next

Management of Female Stress Incontinence and Pelvic Organ Prolapse with Dr. Amy Park on the BackTable Urology Podcast)
Women's Sexual Health with Dr. Ashley Winter on the BackTable Urology Podcast)
Evaluation & Management of Post-Prostatectomy Incontinence with Dr. Steve Hudak and Dr. Aditya Bagrodia on the BackTable Urology Podcast)
Management of Pelvic Floor Dysfunction with Dr. Yahir Santiago-Lastra and Dr. Jose Silva on the BackTable Urology Podcast)
Hitting Reset with Dr. Jose Silva and Anish Parikh on the BackTable Urology Podcast)
Breaking Down Upper Tract Malignancy with Dr. Katie Murray on the BackTable Urology Podcast)

Articles

A surgeon performing a urinary diversion with cystectomy to treat complications of genitourinary syndrome of menopause

Genitourinary Syndrome of Menopause: Procedural & Surgical Management

Female physician talking to a patient about genitourinary syndrome of menopause

Genitourinary Syndrome of Menopause: Medical & Holistic Treatment Approaches

Topics

Botox for Pelvic Pain Procedure Prep
Cystitis Condition Overview
Cystoscopy Procedure Prep
Genitourinary Syndrome of Menopause Condition Overview
Pelvic Pain Syndrome Condition Overview
Recurrent Urinary Tract Infection Condition Overview

Get in touch!

We want to hear from you. Let us know if you’re interested in partnering with BackTable as a Podcast guest, a sponsor, or as a member of the BackTable Team.

Select which show(s) you would like to subscribe to:

Thanks! Message sent.