And many times we just go ahead and treat patients, in no way are we evaluating, assessing their situation and their needs. Tell us what I'm missing, tell us what urologic surgeons many times are not focusing on.
Raveen Syan: Sure. Well, so when it comes to pelvic floor disorders, we tend to talk about four areas of focus. So, one would be sexual function, which is probably the most impacted by bladder cancer treatment, then there's overactive bladder, so irritable bladder symptoms, there's pelvic pain, and then there's defecatory disorders, constipation or incontinence. It's very common in women to experience these disorders. In women over age 50, about 30 to 40% of women will have at least one of these symptoms.
Now, what's challenging about bladder cancer treatment is, naturally the oncologist and the patient is focused on cancer care, cancer treatment, and control. But these treatments can really dramatically impact existing pelvic floor disorders, it can exacerbate them, worsen them, and it can even precipitate new onset of these symptoms. So, understandably, the oncologist who has a large volume of things to discuss and consider has been missing, and has acknowledged themselves. The SUO, they did a survey of urologic oncologists who self-admitted that they don't ask about sexual function, any sort of pelvic disorders, and they acknowledge they should.
So, in the frame of knowing that there's a limited amount of time of counseling and discussing and intervening on pelvic floor disorders, which oncologists may be less familiar with, we really have introduced the idea of you don't have to worry about it. If you simply screen, ask questions about pain, are you sexually active, and overactive bladder issues, then just send them to us, send them to your gynecologists and we can really take care. We can support patients throughout their treatment process, and during and after their care. And we've shown with this implementation, we really improve patient's outcomes.
Sam Chang: So, for those of us that are focusing on the oncologic aspect, it's clearly high on the list of priorities, but understanding the impact of the therapies that we place on these patients, I think is really important. How should we be screening? Are there certain questionnaires? Are there certain just baseline questions that we should be considering prior to our interventions?
Raveen Syan: So, I think handouts are your best friends, you can leave them in the office rooms, in the waiting area, and you can simply ask women, "Hey, are you having any issues with urination, any sexual problems, or pain?" Keep it that vague. And if they say yes, then you say, "Would you like to speak with a urogynecologist who can maybe just help you while you're getting these treatments?" And then we'll take care of everything else, you don't have to get in the deep in the weeds with OAB questionnaires or anything crazy like that. This is where we are experts and this is what we love to do.
Sam Chang: So, do you think that with this... I think we should probably be considering this with our male and female patients prior to interventions, clearly the different types of intravesical therapies, just the resections, the biopsies themselves really have an impact. As you start seeing these patients, you named the four main areas of concerns, almost all of our patients are going to have some. For you, as you consider what we do in terms of treatments, are there certain treatments that seem to be more problematic or more concerning? Where do you really get an area of like, oh, we're really going to probably need to intervene because they're going to get so-and-so, or they're thinking about doing this? Tell me the areas that are buzzwords for you as you consider steps into intervention.
Raveen Syan: Sure. So, when it comes to intravesical therapies, these are the ones we really worry about in patients with underlying irritative bladder symptoms, so overactive bladder or pain or discomfort, these things get really markedly worse. And the oncologist, I'm sure you are aware, you experience patients say, "I have a UTI, I have a UTI..." And it's just like, "No, no, it'll get better, it'll pass." Which is true, it's all true, it's just there are ways that we can support patients with simple medications, pelvic floor physical therapy, just to help them through the process and after the process. So, when it comes to intravesical therapies, I do think it's valuable to ask and screen for what we call irritative symptoms of the bladder.
Now, pelvic pain can exacerbate in women with any of these conditions, we tend to carry our stress in our pelvis, and we have a very poor awareness and conscious control over those muscles. And in settings of stress and procedures, those muscles can go into spasm and then people have pretty significant either daily pain or certainly worsening pain with intercourse. And again, the solution's very easy, it's working with a pelvic floor physical therapist, but it's knowing for the patient that that exists, and where to find the care that is the missing link. For men as well, the irritated symptoms can worsen with intravesical therapy. So it's absolutely true that this can be a valuable resource for both men and women.
Women just tend to be a little bit more specifically impacted because they're just more likely to have those underlying disorders. Now, when it comes to surgeries, talking about radical cystectomy or partial cystectomies, if that's the new vogue fashion, really the question is coming down to are we doing vaginal preserving or not? That's a gap where oncologists themselves acknowledge they often don't have that discussion about those options, and if they do, the vagina is very different than what it was. So, those women actually really would benefit from early connection with urogynecology so we can help work through these major changes and navigate afterwards how to actually still preserve sexual function.
And a study was done of people over age 65, and 50% of men and women are still sexually active and consider sexual activity a very important part of their lives, at least the study showed at least two times a month, which is meaningful. It impacts relationships and how one views oneself, and sense of self and self-image. So, both these fields really could benefit from addressing these issues.
Sam Chang: Recognizing the issue is the first part, and I think that we as a treating group have really underestimated, under-acknowledged, and clearly underappreciated the significance of the impacts of our therapy, of the diagnosis, et cetera, and really appreciate you highlighting the next steps in terms of, okay, we have recognition and then the next steps in terms of making improvements. So, Dr. Syan, thank you so much for spending some time with us, and look forward to getting together soon.
Raveen Syan: Thank you. Thank you so much.