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Diane Newman: Welcome. I'm Diane Newman. I'm a nurse practitioner and I'm the medical director of UroToday. I'm here today with a really interesting concept regarding a patient-centered pelvic floor prolapse device. And I have a guest here with me today, Dr. Bilal Chughtai, who is here at the American Urologic Association, and I'm going to talk with him about this new technology. Welcome.

Bilal Chughtai: Well, thank you for having me. So I'm a urologist. I've been in practice for about 12 years. I was in academic practice for about 10 years, and now I've transitioned over to the community where we're growing out our center that's focused on benign urology, so in men, mainly BPH, in females, prolapse, and incontinence. And I'm delighted to talk to you about the product with Cosm, where Cosm has really brought innovation to prolapse in an area of pessaries where we haven't seen innovation in a very long time.

Diane Newman: So these are specifically for women who have a prolapsed uterus or bladder and really struggle with some type of support device, right?

Bilal Chughtai: True. So basically what ends up happening is that when it comes to pessary fittings, pessary fittings have been sort of done in a very similar fashion, which is a patient comes in, we're going to try a pessary. "Oh, it's too tight." "Okay, we'll take that one out." "Oh, that one fell out." And when you're trying to use the bathroom, it flushes down the toilet, "Okay, well, let's try a different one." "Oh, these ring pessaries aren't working for you. We're going to move you to a Gellhorn pessary. You want to self-manage a pessary? Well, this is what we have."

So in a lot of ways, we're taking this process that's very trial-and-error based, and sometimes it can be very frustrating for a patient. And with Cosm's product, they're changing the model into something where they're bringing science to this area where they're looking at how to take the pessary and really custom mold it to areas of strength and weaknesses of the tissue and bring prolapse support for these patients.

Diane Newman: So Cosm, it's really like they're printing the pessary, right? You assess the woman, specifically the measurement of the prolapse, the degree of prolapse, and then you basically make them their own device to use.

Bilal Chughtai: Yes. So they're essentially 3D printing a pessary based on the measurements that you make in the office.

Diane Newman: And they've coined a new term, Gynethotics. It's like a comparison to orthopedics-like support devices. Correct?

Bilal Chughtai: I think it's a very similar model, and I think when we think about it, if you have some type of orthotic, let's say it's an insert for a shoe, could you imagine where someone said to you, "Hey, try this insert and if it hurts after a mile of walking, why don't you come back and we'll get you a new insert?" No, it's sort of like you measure, you come up with the right fit and most of the time it works for that patient. And I think with this model, measuring first and understanding where the prolapse is, the degree of prolapse, areas of weaknesses and strength of the tissue, I think it's moving the field forward.

Diane Newman: Well, tell me, I'm really surprised because urologists tend not to deal with prolapse damage and you do surgery, correct? You have a practice where you do fit pessaries?

Bilal Chughtai: I do. So I would say that there's a lot of women that come in. I mean, when you present different options, I think a lot of us in general gravitate towards options that have the ability to be reversed. And I think some women come in while they're still of childbearing age. There's some women who are kind of like when you present the idea of a hysterectomy, they're sort of like, "This is not for me," or, "I'm not sure if I want this," but how do you have this patient walk out and go, "Well, there's nothing I can offer you." I mean, if there's a way to offer them saying, "Hey, look, we've got this potential device, a pessary fitting," that's a step for them where they can start to feel better.

Diane Newman: What do you think as far as when this will be available to women though? I mean, this is kind of a process. It's still in development, right?

Bilal Chughtai: It's still in development. I do believe they've done a study on eight women so far where they've actually custom-fitted the pessary and they've had better outcomes than standard-fit pessaries. So I think it's an ongoing process. I think it should be available sometime in the near future though.

Diane Newman: But isn't usually your policy with the algorithm that you follow in your practice that you'll try the pessary one with prolapse prior to taking them for surgery?

Bilal Chughtai: I'll always offer pessaries, then I'll always show a pessary to women saying that, "Hey, look, this is what a pessary looks like. We can always give this a try." Some women will look at it and go, "This is absolutely not for me." And there's some women who will go, "Well, I want to try to get it fit." And then we get into, "All right, well, I'd like you to come into the office." It's going to be typically the first or last visit of the day. When it comes to the pessary itself, it's sort of like we're going to try a few of them. And sometimes it's hard to even schedule that visit because it takes a while for them to get in. It takes a while for them to stay in the office as well.

Diane Newman: Well, I think this is exciting though, right? I mean it's really new technology. Pessaries have been around forever, but the thing is we've not had any really change in how you fit them, how you design them, or really what's available. So I think this is really moving this whole field forward.

Bilal Chughtai: Yeah, I think what Cosm is doing is taking a field of trial and error, and I think with a combination of their digital platform, the way that you follow patients with it, you actually have patient-reported outcomes that are captured on their dashboard. I think you're bringing science to an area where it's been purely trial and error.

Diane Newman: And really you'll be able to put the measurements of the prolapse into the computer and be able to determine exactly what the shape and the size of this pessary will be, right? I mean, that's what I think is so exciting about, so individualized to that individual woman, as opposed to just picking up a ring with support or a Gellhorn and saying, "Oh, I think you're a size X." We'll really be able to measure exactly what that woman needs.

Bilal Chughtai: Absolutely. So I think that's the evolution. I think the company is innovative enough and I think they're also dynamic enough where, as time goes on, I think there'll be some predictability as well. So in other words, you put in just measurements and it tells you, look, I think this person will do well with a cube. This person will do well with a Gellhorn shape or some variety of shapes that we probably haven't really thought of because we're limited by what we have.

Diane Newman: Right. Well, thank you very much. I really appreciate it, and it's really nice talking with a urologist who's working with this type of device. So thanks.

Bilal Chughtai: Thank you.