Divya Ajay, MD, MPH

Project Title: Vaginal Estrogen in Women Cancer Survivors with Recurrent UTIs and Overactive Bladder: Trends, Determinants, and Outcomes in Urology

Project Summary: Many women who survive cancer develop frequent urinary tract infections and bothersome bladder symptoms that affect their daily lives. A low-dose vaginal estrogen treatment can safely help prevent infections and improve bladder symptoms, but it is often avoided because of fears about hormone exposure. These concerns are especially strong among cancer survivors, even though guidelines and research show this treatment is safe for many cancer survivors. This study will examine national urology data to understand how often vaginal estrogen is used in cancer survivors and what factors influence its use. The results will help doctors better follow evidence-based guidelines, reduce unnecessary antibiotic use, and support informed, shared decision-making for women after cancer treatment.

Connor J. O’Leary, BA

Co-Investigators: Saum Ghodoussipour, MD; Vignesh Packiam, MD; Thomas Jang, MD, MPH, FACS; Hari Iyer, ScD.

Research Project Title: Evaluating and Enhancing Risk Stratification Models and Intravesical Therapies for Non-Muscle-Invasive Bladder Cancer (NMIBC) Using U.S. Real-World Data

Project Summary:  Non–muscle-invasive bladder cancer (NMIBC) accounts for approximately 75% of bladder cancer diagnoses and is marked by high recurrence rates and heterogeneous risk of progression, making accurate risk stratification essential to individualized management. Multiple NMIBC risk prediction models are incorporated into contemporary guidelines; however, these tools were largely developed in international or clinical trial cohorts and their performance in large, real-world U.S. populations remains uncertain. Using the Qdata NMIBC dataset from the AUA Quality (AQUA) Registry, which includes EHR-linked data on more than 84,000 NMIBC patients nationwide, this project aims to evaluate the real-world performance of established NMIBC risk stratification models in U.S. practice. This data will be used to develop a simplified, EHR-friendly risk tool using routinely documented clinical variables to improve clinical applicability and decision support. Secondary analyses will characterize contemporary intravesical therapy patterns and compare oncologic outcomes across treatment strategies, including gemcitabine/docetaxel and cystectomy in BCG-unresponsive disease. Overall, this project seeks to improve risk stratification and support evidence-based, patient-centered management of NMIBC in routine U.S. urologic practice.

Kenneth Aaron Softness, MD

Co-Investigators: Caleb Nelson, MD, MPH; Rena Xu, MD, MB

Research Project Title: Access Gaps in Beta-3 Agonist Therapy in Neurogenic Bladder Using the AQUA Registry

Project Summary: Our project examines disparities in access to beta-3 adrenergic agonist therapy for non-elderly patients with neurogenic lower urinary tract dysfunction (NLUTD), a medically complex population at high risk for incontinence, renal damage, and reduced quality of life. Although beta-3 agonists are safe, effective, and better tolerated than anticholinergics, their high cost and restrictive payer policies may exacerbate existing health equity gaps in this vulnerable population. Using the AQUA Registry, we will assess whether state Medicaid policies such as step therapy and prior authorization requirements, and social determinants of health are associated with the likelihood of receiving beta-3 agonist therapy compared with anticholinergics. Multivariable logistic regression models will evaluate state-level policy effects among Medicaid beneficiaries and SDOH effects across all insurance types, while controlling for provider and practice characteristics. By quantifying how benefit design and social factors influence access to this important therapeutic class, this study addresses a critical gap in the NLUTD literature and will provide actionable evidence for clinicians and policymakers seeking to reduce inequities, improve access, and inform future drug pricing and coverage decisions for vulnerable populations.