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Urology Practice
Journal Prestige (SJR): 0.398

Number of Followers: 2

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ISSN (Print) 2352-0779
Published by Elsevier

[3201 journals]

Editorial Commentary
- Abstract: Publication date: Available online 2 July 2018Source: Urology PracticeAuthor(s): Sarah Krzastek, Randy Vince, Riccardo Autorino
Charge-to-Cost Ratio Varies among Common Urological Surgery Procedures
- Abstract: Publication date: Available online 2 July 2018Source: Urology PracticeAuthor(s): Tyler R. McClintock, Matthew Mossanen, Mahek A. Shah, Ye Wang, Benjamin I. Chung, Steven L. Chang
Editorial Commentary
- Abstract: Publication date: Available online 2 July 2018Source: Urology PracticeAuthor(s): James M. Cummings
Editorial Commentary
- Abstract: Publication date: July 2018Source: Urology Practice, Volume 5, Issue 4Author(s): Kirsten L. Greene
Editorial Commentary
- Abstract: Publication date: July 2018Source: Urology Practice, Volume 5, Issue 4Author(s): Jeffrey M. Holzbeierlein
The Promise and Disappointment of Neoadjuvant Chemotherapy and
Transurethral Resection for Muscle Invasive Bladder Cancer: Updated
Results and Long-Term Followup
- Abstract: Publication date: July 2018Source: Urology Practice, Volume 5, Issue 4Author(s): Stanley A. Yap, Neil Pugashetti, Thenappan Chandrasekar, Marc A. Dall’Era, Christopher P. Evans, Primo N. Lara, Ralph W. deVere White IntroductionRadical cystectomy with neoadjuvant chemotherapy is the standard of care for patients with localized muscle invasive urothelial carcinoma of the bladder. One of the strongest predictors of survival in these patients is pathological response to initial treatment. Our objective was to determine whether we could stratify the need for radical cystectomy based on pathological response to neoadjuvant chemotherapy.MethodsWe present a cohort of patients with muscle invasive urothelial carcinoma of the bladder to whom surveillance and bladder preservation were offered if complete response was achieved following neoadjuvant chemotherapy. Descriptive statistics and survival analysis were performed to assess overall, cancer specific and metastasis-free survival. Patients were stratified based on pathological response to neoadjuvant chemotherapy.ResultsA total of 60 patients were included in the cohort, of whom 32 (55%) had absence of residual disease on post-neoadjuvant chemotherapy transurethral resection and 27 (45%) had persistent disease. Of patients undergoing surveillance 52% maintained the bladder without evidence of recurrence. By comparison, of those with recurrence only 20% preserved the bladder and were without evidence of disease.ConclusionsLong-term followup shows a subset of patients achieving good outcomes while preserving the bladder. However, we also observed an inability to reliably identify this subset of patients given current clinical and pathological markers. Until we are able to achieve that goal, the safest oncologic approach remains neoadjuvant chemotherapy followed by radical cystectomy.
Editorial Commentary
- Abstract: Publication date: July 2018Source: Urology Practice, Volume 5, Issue 4Author(s): Elizabeth C. Wendel, K. Jeff Carney, Muta M. Issa
Editorial Commentary
- Abstract: Publication date: July 2018Source: Urology Practice, Volume 5, Issue 4Author(s): Steven K. Wilson
Editorial Commentary
- Abstract: Publication date: July 2018Source: Urology Practice, Volume 5, Issue 4Author(s): Robert Moldwin
The Interstitial Cystitis/Bladder Pain Syndrome Clinical Picture: A
Perspective from Patient Life Experience
- Abstract: Publication date: July 2018Source: Urology Practice, Volume 5, Issue 4Author(s): J. Curtis Nickel, Dean A. Tripp, Darren Beiko, Victoria Tolls, Sender Herschorn, Lesley K. Carr, Kerri-Lynn Kelly, Nicole Golda IntroductionWe hypothesize that optimal management of interstitial cystitis/bladder pain syndrome requires more personalized data than obtained with symptom questionnaires and standard urological assessment. We used a qualitative approach to develop a best evidence series of questions to explore the total clinical picture in the patient with interstitial cystitis/bladder pain syndrome.MethodsThe methodology of this project included preliminary focus groups, individual patient interviews, content development and validity analyses to develop a series of questions of value to patients with interstitial cystitis/bladder pain syndrome. A new convenience sample of patients with this syndrome completed the series of questions exploring not only pain and urination symptoms, but also other biopsychosocial parameters noted to be of relevance to these patients.ResultsContent of final series of questions addressed pain, urination symptoms, flares and the 10 most important domains impacted by interstitial cystitis/bladder pain syndrome. Further questions addressed thoughts or feelings, attitudes and suicidal ideation. A series of questions addressed how patients cope with and manage their condition. A total of 32 patients with interstitial cystitis/bladder pain syndrome completed the finalized series of questions. Bladder pain and urination symptoms were primary concerns of patients but other domains related to associated nonurological conditions (poor sleep/persistent fatigue, irritable bowel syndrome-like symptoms, low back and general muscle pain, interference/impact [eg sleep, diet, travel, activities, sexual functioning], positive and negative beliefs/attitudes, and coping mechanisms) make up the total clinical picture for each patient.ConclusionsThe biopsychosocial information provided by our patients will better inform the health care professional on how to develop personalized treatment strategies and also individualized patient directed outcomes independent of bladder pain and urination symptoms.
Reply by Authors
- Abstract: Publication date: July 2018Source: Urology Practice, Volume 5, Issue 4Author(s):
Editorial Commentary
- Abstract: Publication date: July 2018Source: Urology Practice, Volume 5, Issue 4Author(s): Lane S. Palmer
Editorial Commentary
- Abstract: Publication date: July 2018Source: Urology Practice, Volume 5, Issue 4Author(s): Daniel Liberman, Luc Valiquette
Editorial Commentary
- Abstract: Publication date: July 2018Source: Urology Practice, Volume 5, Issue 4Author(s): James Furr, Ash Bowen
Costs and Sustainability of a Behavioral Intervention for Urinary
Incontinence Prevention
- Abstract: Publication date: July 2018Source: Urology Practice, Volume 5, Issue 4Author(s): Todd H. Wagner, Jennifer Yang Scott, Diane K. Newman, Janis M. Miller, Keri Kirk, Mary Ann DiCamillo, Trivellor E. Raghunathan, Ananias C. Diokno, Carolyn M. Sampselle IntroductionMany women choose behavioral interventions as first line treatment for urinary incontinence. We developed a 20-minute abbreviated video, which proved to be similar to a 2-hour in-person class in a randomized trial. This study examines economic end points for the 20-minute video relative to the 2-hour class.MethodsWe randomized 332 participants to the 2-hour class and 315 to the 20-minute video. We estimated the cost for the 2-hour class, the 20-minute video and followup health care utilization. Participants were followed for 3, 12 and 24 months, and asked about health care utilization, quality of life and lost productivity. To measure perceived value, we queried each participant regarding willingness to pay. Regression analysis was used for statistical comparisons.ResultsThe estimated per participant cost for a 2-hour class was $38, which was more than the marginal cost of the video ($0). We found no significant differences between the treatment groups at each followup for quality of life, lost productivity or health care utilization. Women were willing to pay $26, $21 and $30 for a copy of the DVD, video on the Web and in-person class, respectively, all of which were less than the average cost of the in-person class ($38).ConclusionsPoor adherence remains a challenge for many behavioral interventions designed to prevent urinary incontinence. The 20-minute video is less expensive than the 2-hour class and is equally effective. Distributing the video on the Internet will improve access and will be easier to sustain than in-person classes.
Reply by Authors
- Abstract: Publication date: July 2018Source: Urology Practice, Volume 5, Issue 4Author(s):
Editorial Commentary
- Abstract: Publication date: July 2018Source: Urology Practice, Volume 5, Issue 4Author(s): Bob Dowling
Patient Acceptance of Teleurology via Telephone vs Face-to-Face Clinic
Visits for Hematuria Consultation at a Veterans Affairs Medical Center
- Abstract: Publication date: July 2018Source: Urology Practice, Volume 5, Issue 4Author(s): Ilan J. Safir, Vitaly Zholudev, Dean Laganosky, Louis Aliperti, Usama Al-Qassab, Jennifer Lindelow, Christopher P. Filson, Muta M. Issa IntroductionWe evaluated the experience and preferences of patients undergoing hematuria consultation via teleurology compared to a conventional face-to-face clinic visit.MethodsPatients evaluated for hematuria with teleurology or face-to-face clinic visit were surveyed regarding their experience and preferences. The survey consisted of 27 questions evaluating overall acceptance and satisfaction (8 questions), impact factors (17) and preference (2).ResultsA total of 450 patients participated in the survey at a 2-to-1 ratio (300 via teleurology, 150 via face-to-face visits). Overall, patient satisfaction level was higher with teleurology compared to face-to-face clinic visits (mean score 9.2 vs 8.4, p
Information for Contributors
- Abstract: Publication date: July 2018Source: Urology Practice, Volume 5, Issue 4Author(s):
Instructions for Authors
- Abstract: Publication date: July 2018Source: Urology Practice, Volume 5, Issue 4Author(s):
Editorial Commentary
- Abstract: Publication date: July 2018Source: Urology Practice, Volume 5, Issue 4Author(s): Roger Dmochowski
Editorial Commentary
- Abstract: Publication date: July 2018Source: Urology Practice, Volume 5, Issue 4Author(s): Gary E. Lemack
Editorial Commentary
- Abstract: Publication date: July 2018Source: Urology Practice, Volume 5, Issue 4Author(s): Richard A. Watson
Editorial Commentary
- Abstract: Publication date: Available online 28 June 2018Source: Urology PracticeAuthor(s): Alice Semerjian, Trinity J. Bivalacqua
Reply by Authors
- Abstract: Publication date: Available online 27 June 2018Source: Urology PracticeAuthor(s):
Editorial Commentary
- Abstract: Publication date: Available online 27 June 2018Source: Urology PracticeAuthor(s): Louis R. Kavoussi
Editorial Commentary
- Abstract: Publication date: Available online 27 June 2018Source: Urology PracticeAuthor(s): Richard Boxer
Editorial Commentary
- Abstract: Publication date: Available online 20 June 2018Source: Urology PracticeAuthor(s): Saad Juma
Reply by Authors
- Abstract: Publication date: Available online 20 June 2018Source: Urology PracticeAuthor(s):
Editorial Commentary
- Abstract: Publication date: Available online 20 June 2018Source: Urology PracticeAuthor(s): Howard B. Goldman
Editorial Commentary
- Abstract: Publication date: Available online 18 June 2018Source: Urology PracticeAuthor(s): Amihay Nevo, Timothy D. Averch
Editorial Commentary
- Abstract: Publication date: Available online 18 June 2018Source: Urology PracticeAuthor(s): Jennifer Robles, Ryan S. Hsi
Editorial Commentary
- Abstract: Publication date: Available online 18 June 2018Source: Urology PracticeAuthor(s): Aaron Potretzke, Ilya Sobol
Editorial Commentary
- Abstract: Publication date: Available online 18 June 2018Source: Urology PracticeAuthor(s): David C. Johnson
Editorial Commentary
- Abstract: Publication date: Available online 13 June 2018Source: Urology PracticeAuthor(s): Martin A. Koyle
Editorial Commentary
- Abstract: Publication date: Available online 26 May 2018Source: Urology PracticeAuthor(s): Daniel C. Parker, Michael S. Cookson
Reply by Authors
- Abstract: Publication date: Available online 26 May 2018Source: Urology PracticeAuthor(s):
Editorial Commentary
- Abstract: Publication date: Available online 26 May 2018Source: Urology PracticeAuthor(s): Ahmad Shabsigh, Cheryl Taylore Lee
Editorial Commentary
- Abstract: Publication date: Available online 26 May 2018Source: Urology PracticeAuthor(s): Andrew G. Winer, Richard J. Macchia
Evaluating clinical implementation approaches for prostate cancer decision
support
- Abstract: Publication date: Available online 22 May 2018Source: Urology PracticeAuthor(s): Donna L. Berry, Fangxin Hong, Barbara Halpenny, Martin G. Sanda, Viraj A. Master, Christopher P. Filson, Peter Chang, Gary W. Chien, Meghan Underhill, Erica Fox, Justin McReynolds, Seth Wolpin PurposeShared decision making is widely promoted for counseling men with localized prostate cancer. Results of randomized trials suggest decision aid efficacy. However, few practices or institutions have implemented decision support as standard practice. The purpose of this study was to evaluate various implementation strategies for the decision aid, Personal Patient Profile-Prostate, and analyze feedback from clinical site staff and providers.Materials and MethodsA hybrid type-1 effectiveness-implementation trial was conducted. Primary data were collected in six urology clinics of three geographically-distinct health networks. During the implementation phase, site-specific strategies were co-designed with site leaders. Referral and access metrics for men with localized prostate cancer were monitored for up to 7 months. Clinical staff reports of barriers and facilitators of implementation were evaluated in professionally-facilitated focus groups.ResultsOf 495 men with localized prostate cancer seen in the clinics, 252 (51%; 95% CI 46-55%) were informed of the program, and 107 of those (43%; 95% CI 36-49%) accessed it. The highest access rates were observed with patient care coordinator email and telephone contact (82%) or verbal physician instruction followed by email and phone invitations (87%). During focus groups, physicians appraised the summaries as useful. Staff-identified barriers included creating new workflows within heavy workloads, and staff misunderstanding of context and resources. Promoters to successful implementation included an identified clinical lead and physician engagement.ConclusionsImplementation success was realized when physicians engaged and staff provided follow-up contacts. New practice changes to implement interventions require multi-modal strategies for early success.
Role of mpMRI PSA Density and PI-RADS Score in Predicting Upstaging in Men
on Active Surveillance
- Abstract: Publication date: Available online 21 May 2018Source: Urology PracticeAuthor(s): Michelle Van Kuiken, Robert H. Blackwell, Bryan Bisanz, Cara Joyce, Joseph Yacoub, Steven Shea, Ari Goldberg, Marcus L. Quek, Robert C. Flanigan, Gopal N. Gupta PurposeUsing a combination of magnetic resonance imaging of the prostate and prostate specific antigen density, we aim to determine which men on active surveillance are at risk of being upstaged, and which men could avoid repeat biopsy while remaining on surveillance.MethodsWe reviewed 110 men on active surveillance with Gleason 6 disease who underwent magnetic resonance imaging followed by Uronav-fusion biopsy. Using univariable and multivariable logistic regression analyses, we examined the effect of age, race, prostate specific antigen, prostate specific antigen density, prostate volume, Prostate Imaging - Reporting and Data System (PI-RADS) score, number and size of target lesions, and time on surveillance to determine the likelihood of upstaging to Gleason ≥7 disease.ResultsA total of 33 men, or 30%, were upstaged. On multivariable analysis, prostate specific antigen density and PI-RADS score were significant predictors of upstaging with adjusted odds ratios of 3.97 for prostate specific antigen density of ≥0.16 (CI 1.31-12.00, p
Minimizing the Cost of Treating Asymptomatic Ureterolithiasis
- Abstract: Publication date: May 2018Source: Urology Practice, Volume 5, Issue 3Author(s): Remy W. Lamberts, Emily Lines, Simon L. Conti, John T. Leppert, Christopher S. Elliott IntroductionTreatment of patients with ureterolithiasis who report resolution of their symptoms but do not recall passing the stone presents a clinical challenge. We analyzed the cost of different therapeutic strategies for these patients.MethodsWe performed a cost minimization analysis using published efficacy data and Medicare reimbursement costs. We compared 1) up-front ureteroscopy with planned lithotripsy, 2) followup imaging to determine presence or absence of stone using computerized tomography, abdominal plain film or ultrasound and 3) observation. We performed sensitivity analyses on the factors driving cost, including the probability of stone passage and ultrasound sensitivity.ResultsObservation was associated with the lowest costs for patients likely to spontaneously pass the ureteral stone (greater than 62%). Initial imaging with computerized tomography was the least costly approach for patients with an intermediate probability of stone passage (21% to 62%). When the sensitivity of ultrasound was modeled to be high (greater than 79%), it surpassed computerized tomography as the least costly approach across a wide range of spontaneous passage rates. Ureteroscopy was associated with the lowest costs when the probability of spontaneous stone passage was low (less than 21%).ConclusionsThe probability of spontaneous passage of a ureteral stone can be used to optimize treatment strategies for patients. Observation minimizes costs for patients with stones likely to pass spontaneously, whereas ureteroscopy minimizes costs for stones unlikely to pass. For ureteral stones with an intermediate probability of spontaneous passage computerized tomography to guide treatment is associated with the lowest estimated costs.
Information for Contributors
- Abstract: Publication date: May 2018Source: Urology Practice, Volume 5, Issue 3Author(s):
Editorial Commentary
- Abstract: Publication date: May 2018Source: Urology Practice, Volume 5, Issue 3Author(s): Deborah Lightner
Editorial Commentary
- Abstract: Publication date: May 2018Source: Urology Practice, Volume 5, Issue 3Author(s): Martha K. Terris
Editorial Commentary
- Abstract: Publication date: May 2018Source: Urology Practice, Volume 5, Issue 3Author(s): Mark Schoenberg
Instructions for Authors
- Abstract: Publication date: May 2018Source: Urology Practice, Volume 5, Issue 3Author(s):
Editorial Commentary
- Abstract: Publication date: May 2018Source: Urology Practice, Volume 5, Issue 3Author(s): Jack W. McAninch
Urethroplasty Practice Patterns of Genitourinary Reconstructive Surgeons
- Abstract: Publication date: May 2018Source: Urology Practice, Volume 5, Issue 3Author(s): John M. Lacy, Sara Johnson, Adam Dugan, Shubham Gupta IntroductionTo our knowledge there are no studies evaluating urethroplasty practice patterns among genitourinary reconstructive surgeons.MethodsAn electronic survey was sent to members of the Society of Genitourinary Reconstructive Surgeons. Respondents were queried regarding approach to bulbar urethral reconstruction in 6 index cases.ResultsA total of 91 society members who regularly treated men with urethral strictures responded to the survey. For a 1.5 cm stricture excision and primary anastomosis was the preferred treatment, although less unanimously than expected (only 83% in older men and 67% in younger men). For 2.5 cm strictures urethroplasty with buccal mucosal graft was the preferred treatment for a 35-year-old man, and excision and primary anastomosis for a 65-year-old man. Excision and primary anastomosis was preferred less frequently in younger patients and in patients with longer strictures (Cochran Q test, p
Reply by Authors
- Abstract: Publication date: May 2018Source: Urology Practice, Volume 5, Issue 3Author(s):
Editorial Commentary
- Abstract: Publication date: May 2018Source: Urology Practice, Volume 5, Issue 3Author(s): Faysal A. Yafi
Reduction in Opioid Prescribing Using a Postoperative Pain Management
Protocol following Scrotal and Subinguinal Surgery
- Abstract: Publication date: May 2018Source: Urology Practice, Volume 5, Issue 3Author(s): Christopher Starks, Anna M. Zampini, Nicholas N. Tadros, John McGill, Karen Baker, Edmund S. Sabanegh IntroductionExcess prescribing of opioid pain medication increases medical costs and the potential for abuse by patients and others. We sought to improve our understanding of postoperative pain and opioid use after scrotal and subinguinal urological surgery to develop a protocol for pain management.MethodsWe retrospectively analyzed opioid prescribing and usage in 20 patients undergoing scrotal or subinguinal surgery. Collected data were used to develop a standardized postoperative protocol. This protocol included enhanced pain management education and limiting outpatient opioid prescriptions. Outcomes analysis was then performed for 60 consecutive patients via questionnaire. Statistical analysis was performed using the Wilcoxon rank sum test and ANOVA. Linear regression was performed comparing age and narcotic use.ResultsComparison of preprotocol and postprotocol implementation opioid prescriptions and consumption showed a statistically significant decrease in the number of tablets prescribed but no difference in opioid usage. Preprotocol and postprotocol opioid prescription usage was 20 and 10 tablets, respectively, while median usage was 3.5 and 3 tablets, respectively.ConclusionsEvaluation of postoperative pain management revealed excessive prescribing of opioid medications compared to actual usage. Our protocol resulted in a significant decrease in opioid prescribing without compromising management of postoperative pain. Adjunct treatments for pain, including scrotal support, ice packs, elevation and nonsteroidal anti-inflammatory drugs, may improve postoperative pain control without increasing opioid usage. The combination of enhanced patient education and reduced opioid prescribing may result in decreased opioid use, opioid abuse and medication costs.
Editorial Commentary
- Abstract: Publication date: May 2018Source: Urology Practice, Volume 5, Issue 3Author(s): Alice Semerjian, Phillip Pierorazio
Editorial Commentary
- Abstract: Publication date: May 2018Source: Urology Practice, Volume 5, Issue 3Author(s): Justin T. Matulay, Mitchell C. Benson
Evaluation of the Use of Remodelable Pericardial Bolsters during
Cystectomy and Diversion to Prevent Enterocutaneous Fistulas
- Abstract: Publication date: May 2018Source: Urology Practice, Volume 5, Issue 3Author(s): Kevin Krughoff, Sarah Ha, David Crawford, Shandra Wilson IntroductionEnterocutaneous fistula is one of the most serious and potentially devastating complications after radical cystectomy, a complex operation with a significant morbidity rate. In this analysis we examined the potential benefit of biomaterial buttressing of staple lines in reducing the incidence of enterocutaneous fistula in patients undergoing cystectomy.MethodsWe retrospectively reviewed 398 patients undergoing cystectomy for bladder cancer during an approximately 11-year period at the University of Colorado Hospital, and compared the frequency of enterocutaneous fistula before and after the implementation of biomaterial buttressing for bowel anastomosis.ResultsIn total, 301 surgical cases preceded biomaterial buttressing and 97 received buttressing with bovine pericardial strips. Seven cases (2.3%) of enterocutaneous fistula occurred without adjunctive reinforcement whereas zero cases were identified in the period using buttressing with bovine pericardial strips. Thus buttressing was associated with a nonsignificant reduction in the odds of enterocutaneous fistula (OR 0.20; 95% CI 0.01, 3.56; p=0.20). Although risk factor adjustment was prohibited by the low frequency of events, none of the cases of enterocutaneous fistula had received prior radiation therapy. Incidentally, the odds of postoperative functional bowel obstruction were significantly decreased after the implementation of buttressing (OR 0.28; 95% CI 0.08, 0.93; p=0.03).ConclusionsThe absolute reduction in the incidence of enterocutaneous fistula and significantly decreased odds of functional bowel obstruction in this cohort warrant future investigation to confirm the benefit of bovine pericardial strip buttresses for bowel anastomoses in cystectomy.
Comparative Outcomes of Conventional and Miniaturized Percutaneous
Nephrostolithotomy for the Treatment of Kidney Stones—Does a
Miniaturized Tract Improve Quality of Care'
- Abstract: Publication date: May 2018Source: Urology Practice, Volume 5, Issue 3Author(s): Jessica Noelle Lange, Jorge Gutierrez-Aceves IntroductionPercutaneous nephrostolithotomy is the method of choice to treat renal stones larger than 2 cm due to its high stone-free rates but it has potentially increased blood loss, postoperative pain and hospital stay compared to other treatments. Miniaturizing the percutaneous tract has recently gained interest. We performed a quality improvement study to investigate whether mini percutaneous nephrostolithotomy would reduce postoperative analgesic use, blood loss, operative time and/or hospital stay relative to the conventional approach while maintaining stone-free rates in our patient population.MethodsThe outcomes of 29 consecutive mini percutaneous nephrostolithotomies were compared to 27 conventional procedures performed by a single surgeon at our institution. Inclusion criteria were age 18 years or older, body mass index 18 to 40 kg/m2 and first look percutaneous nephrostolithotomy for stones 1 to 3.5 cm. Conventional percutaneous nephrostolithotomy was performed through a 30Fr tract, whereas the mini approach was done through a 16.5Fr tract. All percutaneous access was performed by the surgeon.ResultsA total of 17 patients in the conventional percutaneous nephrostolithotomy group and 19 in the mini approach group were stone-free after 1 procedure. There was no significant difference in residual stone burden, operative time or postoperative analgesic use between groups. There was significantly less blood loss (p = 0.02) in the mini percutaneous nephrostolithotomy group.ConclusionsConventional and mini percutaneous nephrostolithotomies are effective methods of removing renal stones 1 to 3.5 cm in greatest dimension. There is no difference in residual stone volume, postoperative analgesic use or operative time between the 2 modalities, but blood loss is less in the mini percutaneous nephrostolithotomy group.
Reply by Authors
- Abstract: Publication date: May 2018Source: Urology Practice, Volume 5, Issue 3Author(s):
Editorial Commentary
- Abstract: Publication date: May 2018Source: Urology Practice, Volume 5, Issue 3Author(s): Charles Welliver
Editorial Commentary
- Abstract: Publication date: May 2018Source: Urology Practice, Volume 5, Issue 3Author(s): Peter N. Schlegel
The Landscape of Coverage for Fertility Preservation in
Male Pediatric Patients
- Abstract: Publication date: May 2018Source: Urology Practice, Volume 5, Issue 3Author(s): Molly Benoit, Kelly Chiles, Michael Hsieh IntroductionThe Patient Protection and Affordable Care Act significantly increased the number of Americans with health insurance and has greatly improved access to health care services. However, states retain considerable jurisdiction over what benefits must be offered. The lack of a federal mandate for fertility preservation coverage results in a patchwork of benefits dependent on state statutes and regulation. Pediatric, adolescent and unmarried patients diagnosed with cancer or autoimmune diseases that impact fertility are often excluded from such coverage.MethodsWe analyzed legislative and regulatory efforts in 10 states to determine the breadth of fertility preservation coverage in private, employer based insurance plans and Medicaid, with particular interest in coverage for pediatric and adolescent patients.ResultsA total of 15 states require coverage of fertility preservation in private insurance plans, with 5 states extending this benefit only to females. The statutes differ in terms of whom the coverage extends to based on marital status, diagnosis, length of fertility problems and monetary limit of the benefit. Fertility preservation is not a mandatory benefit under federal Medicaid regulation. However, states can opt to include it in their state Medicaid plan. No state currently covers fertility preservation as an optional benefit.ConclusionsCoverage of fertility preservation is extremely limited in scope of benefits and the number of states that require such benefits. State governments can increase access to a fertility preservation benefit by removing spousal criteria and expanding diagnostic criteria, and by including the benefit in Medicaid plans.
Editorial Commentary
- Abstract: Publication date: May 2018Source: Urology Practice, Volume 5, Issue 3Author(s): Richard A. Santucci
Editorial Commentary
- Abstract: Publication date: May 2018Source: Urology Practice, Volume 5, Issue 3Author(s): Ron Golan, James Kashanian
Editorial Commentary
- Abstract: Publication date: May 2018Source: Urology Practice, Volume 5, Issue 3Author(s): W. Bedford Waters
What Gay and Bisexual Men Treated for Prostate Cancer Want in a Sexual
Rehabilitation Program: Results of the Restore Needs Assessment
- Abstract: Publication date: May 2018Source: Urology Practice, Volume 5, Issue 3Author(s): B. R. Simon Rosser, Nidhi Kohli, Lindsey Lesher, Benjamin D. Capistrant, James DeWitt, Gunna Kilian, Badrinath R. Konety, Enyinnaya Merengwa, Darryl Mitteldorf, William West IntroductionWhile erectile dysfunction and urinary incontinence are well-documented effects of prostate cancer treatment, the impact of sexual concerns on the lives of gay and bisexual men treated for prostate cancer has not been well researched. Specifically there are no known studies investigating what gay and bisexual men want in sexual recovery treatment.MethodsTo conduct this needs assessment, we recruited 193 gay and bisexual men with prostate cancer from the largest online cancer support group in North America. As part of a wider study of sexual functioning, participants completed a 32-item needs assessment and a qualitative question assessing their needs.ResultsThere was high interest in a sexual recovery program across race/ethnicity and by treatment type. The most preferred formats were a self-directed online curriculum and participation in a support group specific to gay and bisexual men with prostate cancer. A variety of formats, language and contents were deemed appropriate and important by most participants. Frank explicit language and content were preferred. Three themes emerged in the qualitative analysis.ConclusionsGay and bisexual men treated for prostate cancer want a recovery curriculum that explicitly addresses the sexual challenges they face before, during and after treatment. While differences were identified across race and treatment type, they were relatively few and minor in magnitude, suggesting that a single online curriculum could advance rehabilitation for this population.
What Gay and Bisexual Men Treated for Prostate Cancer are Offered and
Attempt as Sexual Rehabilitation for Prostate Cancer: Results from the
Restore Study
- Abstract: Publication date: May 2018Source: Urology Practice, Volume 5, Issue 3Author(s): B. R. Simon Rosser, Badrinath R. Konety, Darryl Mitteldorf, Nidhi Kohli, Lindsey Lesher, William West, Benjamin D. Capistrant, James DeWitt, Enyinnaya Merengwa, Gunna Kilian IntroductionThis is the first known study to investigate what gay and bisexual men are offered and what they try as rehabilitation to address the sexual and urinary effects of prostate cancer treatment.MethodsA total of 193 gay and bisexual men with prostate cancer were recruited from a large male cancer survivor support and advocacy website. Online participants completed survey questions asking what rehabilitation treatments were offered, what they tried and what their satisfaction was with outcomes.ResultsMost participants (68.4%) reported being out as gay/bisexual to at least 1 cancer specialist. Only 8.8% reported that a sexual history was taken. The most common problems reported were loss of ejaculate (93.8%), erectile difficulties (89.6%), change in sense of orgasm (87.0%), loss of sexual confidence (76.7%), changes to the penis (65.8%), increased pain in receptive anal sex (64.8%), urinary incontinence not related to sex (64.2%) and urinary incontinence during sex (49.2%). Of these factors only loss of ejaculate, erectile difficulties and nonsexual urinary problems were commonly discussed by clinicians during prostate cancer treatment. Satisfaction with specific rehabilitation options varied widely.ConclusionsTreatment for prostate cancer lacks adequate history taking and consensus around rehabilitation practices, resulting in idiosyncratic approaches to rehabilitation. Four clinical questions may improve outcomes. Prostate cancer specialists need education to become culturally competent in addressing the unique needs of gay and bisexual patients.
Editorial Commentary
- Abstract: Publication date: May 2018Source: Urology Practice, Volume 5, Issue 3Author(s): Brad Schwartz
Operating Room Supply Cost Awareness: A cross-sectional analysis
- Abstract: Publication date: Available online 27 April 2018Source: Urology PracticeAuthor(s): Bogdana Schmidt, Maxwell V. Meng, Lindsay A. Hampson ObjectiveTo assess surgeon knowledge of commonly used instruments and disposable items and to describe attitudes toward incorporating cost data into daily practice.MethodsAn electronic, e-mail based survey was distributed to faculty and trainees within the UCSF Department of Urology. The 26 question survey assessed opinions regarding general operating room supply cost information and specific costs of 10 supplies used for laparoscopic nephrectomy. A response was considered accurate when it fell within 50% of the actual cost.ResultsResponse rate was 71% among faculty (n=13) and 90% among trainees (n=17). Fifty-five percent of faculty and 82% of trainees considered their knowledge of costs “fair” or “poor”. The overall accuracy of cost estimation for ten commonly-used supply items was 27% (SD ±45%), with no significant difference between trainees and faculty (p=0.70). Accuracy was not associated with self-reported cost knowledge (p=0.25) or number of laparoscopic nephrectomies performed (p=0.47). Thirty-three percent of faculty and 41% of trainees reported that having more knowledge of costs would motivate them to decrease their operating room supply costs, and 42% of faculty raised the idea of an incentive program. 75% of study participants believe that there is “too little” or “not enough” emphasis placed on cost awareness.ConclusionsTrainees and faculty generally have poor knowledge of operating room supply costs. In our academic setting, we noted an interest among both faculty and residents to make cost data more accessible. These data would provide an opportunity for surgeons to act as cost arbiters in the operating room.
Patient Perceptions of Chaperones During Intimate Exams and Procedures in
Urology Clinic
- Abstract: Publication date: Available online 12 April 2018Source: Urology PracticeAuthor(s): Julia Han, Blake Noennig, Jonathan Pavlinec, Liana Damiano, Sharon Lo, Shahab Bozorgmehri, Louis Moy Introductionand Objectives: The objective was to survey patients regarding their expectations and preferences regarding chaperones during intimate exams and procedures in urology clinic.MethodsPatients identified in the outpatient urology clinic were queried for demographics, expectations, and preferences regarding chaperones through a 16-item survey.ResultsWe collected data from 200 patients (52.5% male; 47.5% female), average age 60.5 years (SD ± 15.5). Most patients were Caucasian (84.5%), completed some college (65.5%), and were married (52.0%). Most had a prior genitourinary procedure (74.7% males; 62.4% females) of which 21.5% of men compared to 60.7% of women had chaperones present. Most patients did not care if they had a chaperone (53.3% males; 54.7% females). Only 11.5% of patients preferred a chaperone. Of that minority there was a higher percentage of women who preferred a chaperone over men (3.8% males; 20% females). The majority of patients did not care about the gender of the chaperone but cited comfort level with the provider (50.0% males; 54.9% females) and invasiveness of procedure or exam (36.4% males; 35.4% females) as most important. The majority of patients (84.8% males; 88.4% females) felt that they should have the right to refuse a chaperone.ConclusionsA minority of patients preferred a chaperone during an intimate exam or procedure in urology clinic. Patients prioritized comfort level with the provider which trumped gender of provider, invasiveness of exam, and who the chaperone was. The use of chaperones during intimate exams and procedures is routine in many institutions. In an era of patient centered care, it is crucial to understand patient preferences and expectations.
Gender-based differences in discriminatory questions asked of urology
applicants during residency interviews
- Abstract: Publication date: Available online 1 March 2018Source: Urology PracticeAuthor(s): Mary Kate Keeter, Ashima Singal, Alysen Demzik, Alicia Roston, Nirali Shah, Stephanie J. Kielb IntroductionInterviews are essential to the residency application process. Questions regarding marital status, child bearing, ethnicity, and religion violate employment law if asked by the interviewer. The purpose of this study was to determine rates of discriminatory questions asked during urology residency interviews and to assess for differences by applicant gender.MethodsA 22-question anonymous survey was distributed to 340 urology residency applicants. Questions were asked in a two-part, stepwise fashion. If a candidate replied “no” to whether they introduced a restricted topic, they were subsequently asked how often interviewers introduced the topic.ResultsOverall, 35% of respondents believed they were asked an inappropriate question. However, of the seven restricted topics assessed by this survey, 54.5% of respondents reported being asked at least one unprompted illegal question. Of note, 85%, of females compared to 44.9% of males reported being asked about one of the restricted topics from the survey (p
The timing and frequency of infectious complications after radical
cystectomy: an opportunity for rescue antibiotic treatment
- Abstract: Publication date: Available online 15 February 2018Source: Urology PracticeAuthor(s): Brian J. Jordan, Kevin C. Lewis, Richard S. Matulewicz, Shilajit Kundu ObjectivesTo evaluate the timing, frequency, and antibiotic sensitivity of post-radical cystectomy (RC) urinary tract infections (UTI) in order to guide an infection reduction initiative.MethodsA combined review of all patients undergoing RC in the 2011-2013 ACS-NSQIP database and 100 consecutive patients from our institution was performed. The rates and timing of postoperative UTI and sepsis in addition to associations with readmissions were evaluated. Specific culture data and treatment interventions were assessed and an institution-specific UTI antibiogram was created.ResultsOf the 3,495 patients identified in NSQIP, the 30-day rates of UTI and sepsis were 9.5% and 9.4%, respectively. Median days to UTI and sepsis were 15 and 13, respectively. Median post-RC length of stay was 10.4 days. A total of 61.5% of UTIs and 52.1% sepsis episodes occurred after discharge. At our institution, the rates of UTI and sepsis were 15% and 9%, and occurred at median of 14 and 18 days, respectively. The 30-day readmission rate was 21%, with 10 readmissions for infections, including 7 for UTI and 5 for bacteremia. We identified 9 patients with positive urine or blood cultures for yeast requiring antifungal therapy. Of the UTIs, 88% were sensitive to oral agents and 79% were sensitive to either nitrofurantoin or ciprofloxacin.
The July Effect in Urologic Surgery: Myth or Reality'
- Abstract: Publication date: Available online 13 February 2018Source: Urology PracticeAuthor(s): Eric J. Kirshenbaum, Robert H. Blackwell, Belinda Li, Emanuel Eguia, Haroon M. Janjua, Adrienne N. Cobb, Kristin Baldea, Paul C. Kuo, Alex Gorbonos PurposeThe July Effect is the widely held belief that medical care is compromised at the beginning of the academic year due to transitioning medical trainees. We sought to determine its impact on surgical outcomes in urologic surgery.Materials and MethodsThe Healthcare Cost and Utilization Project State Inpatient Database, Ambulatory Surgery and Services Database and Emergency Department Database for California were utilized for years 2007-2011. Patients were identified who underwent surgery in July, August, April and May and separated into early (July and August) and late (April and May) cohorts. Surgical outcomes for early vs. late surgery were compared for academic centers. Adjusted multivariate models were fit to determine the effect of early surgery as a predictor of adverse outcomes.ResultsFor major urologic surgery July/August surgery had no impact on length of stay, 30 day readmission, 30 day emergency room visits, never events, perioperative complications or mortality (all p-values>0.05). Similarly, for stone, groin, bladder outlet and cystoscopic bladder procedures, July/August surgery had no impact on rates of urinary retention, ER visits within 30 days, clot evacuations within 30 days, perioperative complications or 30 day readmissions (all p-values>0.05). At the end of the year, cystectomies had increased odds of intraoperative complications (OR 0.63(CI 0.4-0.97) while nephrectomies had higher odds of major complications (OR 0.69(CI 0.53-0.89).ConclusionsOur study demonstrated that surgical outcomes are not compromised by having surgery at the beginning of the academic year despite resident turnover representing appropriate oversight during this potentially vulnerable time.
Follow-Up Care after ED Visits for Kidney Stones—A Missed
Opportunity
- Abstract: Publication date: Available online 31 January 2018Source: Urology PracticeAuthor(s): Amy N. Luckenbaugh, Phyllis L. Yan, Casey A. Dauw, Khurshid R. Ghani, Brent K. Hollenbeck, John M. Hollingsworth Introductionand Objective: Follow-up care after an ED visit for kidney stones may help reduce ED revisits and increase use of stone prevention strategies. To test these hypotheses, we analyzed medical claims from working-age adults with kidney stones.MethodsUsing data from MarketScan (2003 to 2006), we first identified patients with an ED visit for kidney stones. We then determined which patients had an outpatient visit within 90 days of ED discharge. Finally, we used multivariable logistic regression to evaluate the association between receipt of follow-up care and ED revisit, as well as use of stone prevention strategies (24-hour urine testing and PPT prescription).ResultsOnly 48.0% (n=33,741) of patients seen in the ED for kidney stones received follow-up care, 68.3% of which was with a urologist. While follow-up care was not associated with fewer ED revisits, patients who received it were more likely to undergo 24-hour urine testing (predicted probability, 2.2% vs. 0.9%; P