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Objective In women who undergo provider-guided vaginal biofeedback of pelvic floor muscle strength, we sought to determine whether the level of the provider correlates with the patient’s ability to achieve adequate pelvic floor muscle contractions (PFMCs). Methods From August 2017 to April 2018, patients from 2 urogynecology clinics were recruited to participate in an institutional review board–approved, prospective study examining PFMCs. Pelvic examination and teaching session were done by providers who had specific training on how to assess pelvic floor muscle strength using the validated, modified Oxford scale. Patients were asked to perform a baseline PFMC during a 2-digit pelvic examination. Thereafter, patients were counseled to relax their muscles, identify the levator ani muscles during provider teaching, and perform 3 consecutive provider-guided PFMCs. The strength of each PFMC was measured, and the time-to-teach (TTT) was recorded. The level of provider and TTT were correlated with PFMC1 to PFMC3 using Spearman correlation coefficient. Results One hundred women participated. Obstetrics/gynecology (OB/GYN) residents (post-graduate years 1–4) evaluated 20 patients; female pelvic medicine and reconstructive surgery fellowship trainees (post-graduate years 5–7), 38 patients; OB/GYN nurse practitioners, 18 patients; generalist OB/GYN faculty, 9 patients; and female pelvic medicine and reconstructive surgery faculty, 15 patients. There was no correlation between level of provider and TTT or between level of provider and strength of PFMC1, PFMC2, or PFMC3. Conclusions At the time of pelvic floor muscle assessment, the level of provider does not impact teaching time or PFMC1 to PFMC3. Teaching pelvic floor muscle exercise is a cost-effective, low-resource tool to improve patient care, and providers of any level should be encouraged to teach pelvic floor muscle exercise to patients at the time of office examination.

SREs were reported in 88 (20%) patients with HSPC, 17 (34%) patients with CRPC, 58 (73%) patients with RCC, and 34 (44%) patients with UC. Early treatment with BMAs significantly prolonged the time to the first SREs in CRPC, RCC, and UC (p [ 0.038, 0.004, and 0.014, respectively), but not in HSPC (p [ 0.213) (figure 1). Bone pain, poor performance status, and elevated alkaline phosphatase (ALP) level were independent predictive risk factors of SREs on multivariate analysis. The subgroup analysis revealed that early treatment with BMAs was associated with prolonged time to the first SREs in patients with bone pain or elevated ALP level (figure 2).CONCLUSIONS: Early treatment with BMAs had significantly prolonged time to first SREs in patients with CRPC, RCC, and UC. Early treatment with BMAs should be considered especially for patients with bone pain and elevated ALP level to prevent SREs in patients with GU cancer with BM.