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    - UROLOGY, NEPHROLOGY AND ANDROLOGY (159 journals)

UROLOGY, NEPHROLOGY AND ANDROLOGY (159 journals)                     

Showing 1 - 159 of 159 Journals sorted alphabetically
Acta Urológica Portuguesa     Open Access   (Followers: 1)
Actas Urológicas Españolas     Full-text available via subscription   (Followers: 3)
Actas Urológicas Españolas (English Edition)     Full-text available via subscription   (Followers: 1)
Advances in Chronic Kidney Disease     Full-text available via subscription   (Followers: 11)
Advances in Urology     Open Access   (Followers: 13)
African Journal of Nephrology     Open Access  
African Journal of Urology     Open Access   (Followers: 7)
AJP Renal Physiology     Hybrid Journal   (Followers: 8)
Aktuelle Urologie     Hybrid Journal   (Followers: 4)
American Journal of Kidney Diseases     Hybrid Journal   (Followers: 42)
American Journal of Men's Health     Open Access   (Followers: 9)
American Journal of Nephrology     Full-text available via subscription   (Followers: 38)
Andrologia     Hybrid Journal   (Followers: 2)
Andrology     Hybrid Journal   (Followers: 4)
Andrology & Gynecology : Current Research     Hybrid Journal   (Followers: 4)
Andrology and Genital Surgery     Open Access   (Followers: 7)
Andrology-Open Access     Open Access  
Annales d'Urologie     Full-text available via subscription  
Arab Journal of Nephrology and Transplantation     Open Access   (Followers: 1)
Arab Journal of Urology     Open Access   (Followers: 7)
Archives of Clinical Nephrology     Open Access   (Followers: 2)
Archivio Italiano di Urologia e Andrologia     Open Access   (Followers: 1)
Archivos Españoles de Urología     Open Access  
Asian Journal of Andrology     Open Access   (Followers: 1)
Asian Journal of Urology     Open Access   (Followers: 3)
Bangladesh Journal of Urology     Open Access   (Followers: 5)
BANTAO Journal     Open Access  
Basic and Clinical Andrology     Open Access  
BJU International     Hybrid Journal   (Followers: 34)
BJUI Compass     Open Access   (Followers: 2)
BMC Nephrology     Open Access   (Followers: 11)
BMC Urology     Open Access   (Followers: 14)
Canadian Journal of Kidney Health and Disease     Open Access   (Followers: 8)
Canadian Urological Association Journal     Open Access   (Followers: 2)
Cancer Urology     Open Access   (Followers: 2)
Cardiorenal Medicine     Full-text available via subscription   (Followers: 1)
Case Reports in Nephrology     Open Access   (Followers: 5)
Case Reports in Nephrology and Dialysis     Open Access   (Followers: 9)
Case Reports in Urology     Open Access   (Followers: 12)
Clinical and Experimental Nephrology     Hybrid Journal   (Followers: 4)
Clinical Journal of the American Society of Nephrology     Full-text available via subscription   (Followers: 22)
Clinical Kidney Journal     Open Access   (Followers: 4)
Clinical Medicine Insights : Urology     Open Access   (Followers: 3)
Clinical Nephrology     Full-text available via subscription   (Followers: 8)
Clinical Nephrology and Urology Science     Open Access   (Followers: 6)
Clinical Queries: Nephrology     Hybrid Journal   (Followers: 1)
Cuadernos de Cirugía     Open Access   (Followers: 3)
Current Opinion in Nephrology & Hypertension     Hybrid Journal   (Followers: 10)
Current Opinion in Urology     Hybrid Journal   (Followers: 12)
Current Urology     Open Access   (Followers: 10)
Current Urology Reports     Hybrid Journal   (Followers: 5)
Der Nephrologe     Hybrid Journal  
Der Urologe     Hybrid Journal   (Followers: 1)
Diabetic Nephropathy     Open Access   (Followers: 1)
EMC - Urología     Full-text available via subscription  
Enfermería Nefrológica     Open Access   (Followers: 1)
European Urology     Full-text available via subscription   (Followers: 33)
European Urology Focus     Hybrid Journal   (Followers: 5)
European Urology Oncology     Hybrid Journal   (Followers: 1)
European Urology Open Science     Open Access   (Followers: 10)
Forum Nefrologiczne     Full-text available via subscription  
Geriatric Nephrology and Urology     Hybrid Journal   (Followers: 7)
Giornale di Clinica Nefrologica e Dialisi     Open Access  
Herald Urology     Open Access   (Followers: 2)
Hong Kong Journal of Nephrology     Open Access   (Followers: 3)
Human Andrology     Partially Free   (Followers: 2)
IJU Case Reports     Open Access  
Indian Journal of Nephrology     Open Access   (Followers: 2)
Indian Journal of Urology     Open Access   (Followers: 5)
International Brazilian Journal of Urology     Open Access   (Followers: 5)
International Journal of Nephrology     Open Access   (Followers: 2)
International Journal of Nephrology and Renovascular Disease     Open Access   (Followers: 2)
International Journal of Urology     Hybrid Journal   (Followers: 12)
International Urology and Nephrology     Hybrid Journal   (Followers: 7)
Jornal Brasileiro de Nefrologia     Open Access  
Journal für Urologie und Urogynäkologie/Österreich     Hybrid Journal  
Journal of Clinical Nephrology     Open Access   (Followers: 2)
Journal of Clinical Urology     Hybrid Journal   (Followers: 14)
Journal of Endoluminal Endourology     Open Access  
Journal of Endourology     Hybrid Journal   (Followers: 2)
Journal of Endourology Case Reports     Hybrid Journal  
Journal of Genital System & Disorders     Hybrid Journal   (Followers: 3)
Journal of Integrative Nephrology and Andrology     Open Access   (Followers: 2)
Journal of Kidney Cancer and VHL     Open Access  
Journal of Lower Genital Tract Disease     Hybrid Journal  
Journal of Nephrology     Hybrid Journal   (Followers: 4)
Journal of Nephrology Research     Open Access   (Followers: 3)
Journal of Pediatric Nephrology     Open Access   (Followers: 5)
Journal of Renal Care     Hybrid Journal   (Followers: 8)
Journal of Renal Nursing     Full-text available via subscription   (Followers: 12)
Journal of Renal Nutrition     Hybrid Journal   (Followers: 28)
Journal of Renal Nutrition and Metabolism     Open Access   (Followers: 1)
Journal of the American Society of Nephrology     Full-text available via subscription   (Followers: 31)
Journal of The Egyptian Society of Nephrology and Transplantation     Open Access  
Journal of Translational Neurosciences     Open Access  
Journal of Urology     Full-text available via subscription   (Followers: 46)
Journal of Urology & Nephrology     Open Access   (Followers: 2)
Kidney Disease and Transplantation     Open Access   (Followers: 4)
Kidney Diseases     Open Access   (Followers: 3)
Kidney International     Hybrid Journal   (Followers: 46)
Kidney International Reports     Open Access   (Followers: 3)
Kidney Medicine     Open Access  
Kidney Research Journal     Open Access   (Followers: 6)
Kidneys (Počki)     Open Access   (Followers: 1)
Nature Reviews Nephrology     Full-text available via subscription   (Followers: 22)
Nature Reviews Urology     Full-text available via subscription   (Followers: 13)
Nefrología (English Edition)     Open Access  
Nefrología (Madrid)     Open Access  
Nephro-Urology Monthly     Open Access   (Followers: 1)
Nephrology     Hybrid Journal   (Followers: 13)
Nephrology Dialysis Transplantation     Hybrid Journal   (Followers: 27)
Nephron     Hybrid Journal   (Followers: 4)
Nephron Clinical Practice     Full-text available via subscription   (Followers: 4)
Nephron Experimental Nephrology     Full-text available via subscription   (Followers: 4)
Nephron Extra     Open Access   (Followers: 1)
Nephron Physiology     Full-text available via subscription   (Followers: 4)
Neurourology and Urodynamics     Hybrid Journal   (Followers: 1)
OA Nephrology     Open Access   (Followers: 2)
Open Access Journal of Urology     Open Access   (Followers: 6)
Open Journal of Nephrology     Open Access   (Followers: 5)
Open Journal of Urology     Open Access   (Followers: 6)
Open Urology & Nephrology Journal     Open Access  
Pediatric Urology Case Reports     Open Access   (Followers: 7)
Portuguese Journal of Nephrology & Hypertension     Open Access   (Followers: 1)
Progrès en Urologie     Full-text available via subscription  
Progrès en Urologie - FMC     Full-text available via subscription  
Prostate Cancer and Prostatic Diseases     Hybrid Journal   (Followers: 6)
Renal Failure     Open Access   (Followers: 12)
Renal Replacement Therapy     Open Access   (Followers: 4)
Research and Reports in Urology     Open Access   (Followers: 4)
Revista de Nefrología, Diálisis y Trasplante     Open Access   (Followers: 1)
Revista Mexicana de Urología     Open Access   (Followers: 1)
Revista Urologia Colombiana     Open Access  
Saudi Journal of Kidney Diseases and Transplantation     Open Access   (Followers: 2)
Scandinavian Journal of Urology     Hybrid Journal   (Followers: 7)
Seminars in Nephrology     Hybrid Journal   (Followers: 11)
The Prostate     Hybrid Journal   (Followers: 8)
Therapeutic Advances in Urology     Open Access   (Followers: 4)
Trends in Urology & Men's Health     Partially Free   (Followers: 1)
Ukrainian Journal of Nephrology and Dialysis     Open Access   (Followers: 1)
Uro-News     Hybrid Journal   (Followers: 1)
Urolithiasis     Hybrid Journal   (Followers: 2)
Urologia Internationalis     Full-text available via subscription   (Followers: 2)
Urologia Journal     Hybrid Journal  
Urologic Clinics of North America     Full-text available via subscription   (Followers: 4)
Urologic Nursing     Full-text available via subscription   (Followers: 4)
Urologic Radiology     Hybrid Journal  
Urological Science     Open Access  
Urologicheskie Vedomosti     Open Access  
Urologie in der Praxis     Hybrid Journal  
Urologie Scan     Hybrid Journal  
Urology     Hybrid Journal   (Followers: 33)
Urology Annals     Open Access   (Followers: 4)
Urology Case Reports     Open Access   (Followers: 3)
Urology Practice     Full-text available via subscription   (Followers: 2)
Urology Times     Free   (Followers: 3)
Urology Video Journal     Open Access   (Followers: 1)
World Journal of Nephrology and Urology     Open Access   (Followers: 15)
World Journal of Urology     Hybrid Journal   (Followers: 11)

           

Similar Journals
Journal Cover
Urology Practice
Journal Prestige (SJR): 0.398
Number of Followers: 2  
 
  Full-text available via subscription Subscription journal
ISSN (Print) 2352-0779
Published by Elsevier Homepage  [3305 journals]
  • Urinary Molecular Biomarker Test Impacts Prostate Biopsy Decision-making
           in Clinical Practice
    • Abstract: Publication date: Available online 5 November 2018Source: Urology PracticeAuthor(s): Neal Shore, Jason Hafron, Timothy Langford, Marshall Stein, Jessica DeHart, Michael Brawer, Daphne Hessels, Jack Schalken, Wim Van Criekinge, Jack Groskopf, Kirk Wojno IntroductionThere is an unmet need for non-invasive methods to better identify patients at increased risk for clinically significant prostate cancer. SelectMDx is a molecular urine test validated for detection of Gleason score 7 and higher cancers (ISUP Grade group 2-5). In this multicenter trial, we evaluated the test’s impact on prostate biopsy decision making in clinical practice.Materials and MethodsThe study involved 5 U.S. community urology practices which sequentially enrolled 418 patients who received a SelectMDx test between May 2016 and April 2017, while undergoing evaluation for initial prostate biopsy. All tests were ordered by the urologist for patient management. We determined biopsy and prostate cancer detection rates in SelectMDx positive versus SelectMDx negative patients.ResultsOf the 418 subjects evaluated with SelectMDx, 253 (61%) were negative and 165 (39%) were positive. Subsequent biopsy rates for SelectMDx positive and negative men were 60% (99/165) and 12% (32/253), respectively (P
       
  • Advance Care Planning and Patient Preferences in a Feasibility Pilot Study
           to Improve End-of-Life Communication among Men with Metastatic Urological
           Malignancies
    • Abstract: Publication date: November 2018Source: Urology Practice, Volume 5, Issue 6Author(s): Stephanie C. Pannell, Aaron A. Laviana, Kathy H.Y. Huen, Jeremy B. Shelton, Lorna Kwan, Carol J. Bennett, Karl A. Lorenz, Jonathan Bergman IntroductionRates of advance care planning for patients with cancer are poor despite efforts to enhance discussions regarding goals of care. Good patient-physician communication is critical to providing quality end-of-life care and, thus, it is important to identify effective interventions to improve systems through which patient preferences are addressed.MethodsTo improve rates of advance care planning as well as examine patient preferences regarding end-of-life care, we developed an integrated urology-palliative care clinic. All patients with a new diagnosis of a metastatic urological malignancy or castration resistant prostate cancer seen in a urology clinic within the Veterans Affairs Greater Los Angeles Healthcare System were offered a palliative care referral to be performed immediately after their urology appointment. The primary outcome was completion of an advance directive or POLST (Physician Orders for Life-Sustaining Treatment) form and the secondary outcome was patient preference regarding end-of-life care.ResultsA total of 59 patients were enrolled in the study between February 2012 and October 2016, and no patients were lost or excluded. There were 25 eligible patients who declined enrollment. Overall 85% of patients completed an advance directive or POLST form, and 98% chose to withhold cardiopulmonary resuscitation, advanced cardiac life support and artificially administered nutrition.ConclusionsHigh levels of advance care planning are achievable in an integrated urology-palliative care clinic and the majority of patients with a terminal illness are averse to aggressive end-of-life care.
       
  • Trends in Urological Referral Patterns: A Study of Community and
           University Urologists in the United States
    • Abstract: Publication date: November 2018Source: Urology Practice, Volume 5, Issue 6Author(s): Ryan P. Terlecki, Nicole L. Miller, Brant A. Inman IntroductionNumerous factors are associated with changes in practice patterns, some provider specific (eg age, gender, training, practice type, sense of well-being) and others extrinsic (eg changes in reimbursement, medicolegal environment, government involvement). Through the American Urological Association Leadership Program we evaluated trends in same specialty referral patterns among U.S. urologists.MethodsWe queried case logs from the American Board of Urology and analyzed case trends from 2005 to 2015. Additionally, we surveyed practicing urologists regarding perceived trends in referral patterns during the last 5 years and their opinion regarding principal drivers of change.ResultsThe number of female urologists is increasing, as is subspecialization. Open surgical cases are decreasing in number as laparoscopic, robotic and percutaneous procedures are increasing. Female urology procedures have decreased dramatically. Survey results suggest that compared to 5 years ago, urologists are increasingly likely to refer cases to another provider for all queried operations other than transurethral benign prostatic hyperplasia procedures. Cases within oncology and reconstruction/prosthetics were associated with the highest reported avoidance. The most common factors influencing the decision to refer were surgical training (48.1%), change in practice type (36.7%), complications (25.5%), medicolegal concerns (22.2%) and reimbursement (21%).ConclusionsTrends in urological referral patterns show an increased likelihood of referral for common urological surgical procedures, regardless of subspecialty or disease. While most referrals are reportedly directed to academic medical centers, there appears to be an increasing trend toward internal referral among practices. The most commonly cited factor for referral was surgical training, which has implications for physician education.
       
  • Editorial Commentary
    • Abstract: Publication date: November 2018Source: Urology Practice, Volume 5, Issue 6Author(s): Louis Potters
       
  • Patient Reported Comparative Effectiveness of Contemporary Intensity
           Modulated Radiation Therapy Versus External Beam Radiation Therapy of the
           Mid 1990s for Localized Prostate Cancer
    • Abstract: Publication date: November 2018Source: Urology Practice, Volume 5, Issue 6Author(s): Brock O’Neil, Karen E. Hoffman, Tatsuki Koyama, JoAnn Rudd Alvarez, Ralph M. Conwill, Peter C. Albertsen, Matthew R. Cooperberg, Michael Goodman, Sheldon Greenfield, Ann S. Hamilton, Sherrie H. Kaplan, Mia Hashibe, Janet L. Stanford, Antoinette M. Stroup, Lisa E. Paddock, Viven Chen, Xiao-Cheng Wu, Matthew J. Resnick, David F. Penson, Daniel A. Barocas IntroductionLittle is known about differences in patient reported outcomes between contemporary external beam radiation therapy for localized prostate cancer that delivers higher doses of conformal radiation and older techniques. We examined sexual, urinary and bowel function between men undergoing contemporary intensity modulated radiation therapy vs those undergoing external beam radiation therapy in the mid 1990s.MethodsSubjects were selected from 2 large population based prospective cohort studies. Main outcomes were between-group differences in adjusted mean scores at 6 and 12 months. Secondary analyses examined odds ratios comparing groups reporting a clinically significant decline in function.ResultsThe cohort consisted of 943 men, 467 diagnosed in 2011 to 2012 and 476 diagnosed in 1994 to 1995. Men undergoing contemporary intensity modulated radiation therapy reported better bowel function at 6 months (mean difference 4.3 points, 95% CI 1.6–7.0) but not at 12 months. Patients receiving contemporary intensity modulated radiation therapy reported statistically worse but probably not clinically meaningful different urinary function at 12 months (2.7, 0.5 to 4.8 points), and no difference at 6 months. No differences in sexual function at 6 or 12 months were found. Secondary analyses demonstrated lower odds of reporting clinically meaningful declines in bowel function at 6 and 12 months and sexual function at 12 months for contemporary intensity modulated radiation therapy. However, patients receiving intensity modulated radiation therapy had higher odds of reporting clinically meaningful declines in urinary continence at 12 months.ConclusionsDespite the delivery of higher doses of radiation, men treated with contemporary intensity modulated radiation therapy reported fewer gastrointestinal and possibly fewer sexual side effects than those treated with external beam radiation therapy in the mid 1990s. However, delivery of dose escalated intensity modulated radiation therapy may cause more urinary side effects.
       
  • Editorial Commentary
    • Abstract: Publication date: November 2018Source: Urology Practice, Volume 5, Issue 6Author(s): Angela B. Smith
       
  • Morbidity Associated with Urinary Diversion in the United States: A
           Contemporary Evaluation Using the NSQIP Database
    • Abstract: Publication date: November 2018Source: Urology Practice, Volume 5, Issue 6Author(s): Robert C. Kovell, David C. Brooks, Devin Haddad, Ryan Terlecki IntroductionWe identified preoperative differences between patients undergoing incontinent vs continent diversion, and compared 30-day complication outcomes between the 2 procedures.MethodsUsing the NSQIP® (National Surgical Quality Improvement Program) database we identified patients undergoing urinary diversion incorporating bowel, with or without cystectomy, between 2010 and 2012. We compared preoperative characteristics, surgical parameters and 30-day postoperative outcomes. We stratified patients based on the continence status of the diversion as incontinent vs continent.ResultsWe identified 1,959 urinary diversions in the NSQIP database, including 1,568 incontinent diversions (80.0%) and 391 continent diversions (20.0%). Significantly higher rates of chronic obstructive pulmonary disease (9.1% vs 4.3%), previous cardiac surgery (4.3% vs 1.8%), hypertension (63.3% vs 47.1%) and disseminated disease (4.7% vs 2.1%) were noted in patients undergoing incontinent diversion. Patients undergoing continent diversion were significantly more likely to have received preoperative chemotherapy (10.5% vs 5.2%). Operative time was longer for continent diversion (388 vs 336 minutes). Postoperative urinary tract infection (13.8% vs 7.9%) and sepsis rates (11.5% vs 7.9%) were significantly higher with continent diversion, whereas transfusion rates were higher with incontinent diversion (45.2% vs 37.1%). Thirty-day readmission rates (18.2% vs 15.6%), length of stay (10.2 vs 10.7 days), presence of at least 1 NSQIP captured complication (61.4% vs 64.0%) and mortality (1.5% vs 2.1%) were not statistically different between continent diversion and incontinent diversion.ConclusionsUrinary diversion incorporating bowel continues to carry a significant risk of postoperative morbidity. While continent diversion offers potential long-term advantages, these must be balanced against longer operative times and higher rates of postoperative infectious complications.
       
  • Reply by Authors
    • Abstract: Publication date: November 2018Source: Urology Practice, Volume 5, Issue 6Author(s):
       
  • Editorial Commentary
    • Abstract: Publication date: November 2018Source: Urology Practice, Volume 5, Issue 6Author(s): Eugene Y. Rhee
       
  • Improving Male Sling Selectivity and Outcomes—A Potential Role for
           Physical Demonstration of Stress Urinary Incontinence Severity'
    • Abstract: Publication date: November 2018Source: Urology Practice, Volume 5, Issue 6Author(s): Boyd R. Viers, Maia E. VanDyke, Travis J. Pagliara, Nabeel A. Shakir, Jeremy M. Scott, Allen F. Morey IntroductionWe reviewed our 9-year experience with AdVance™ Male Sling System cases to determine clinical features associated with treatment success and to refine procedure selectivity. We hypothesized that preoperative physical demonstration of stress urinary incontinence by the standing cough test improves patient selection for male sling surgery.MethodsRetrospective review of primary AdVance sling surgeries between 2008 and 2016 was performed. Patients without standing cough test results were excluded from study. Success was defined as 1 pad per day or less postoperatively and no further intervention. Standing cough test was performed during preoperative consultation and objectively graded using the MSIGS (Male Stress Incontinence Grading Scale).ResultsOf the 203 male patients who underwent sling placement 80 (39%) experienced treatment failure during a median followup of 63.5 months. From 2008 to 2016 the proportion of AdVance slings performed as a surgical treatment modality for stress urinary incontinence decreased from 66% to 13%. Increasing selectivity correlated with greater treatment success. Success was greater among men using 2 pads per day or less preoperatively (77% vs 36%, p
       
  • Editorial Commentary
    • Abstract: Publication date: November 2018Source: Urology Practice, Volume 5, Issue 6Author(s): Kymora B. Scotland, Ben H. Chew
       
  • Retained Ureteral Stents at a Tertiary Referral Stone Center—Who is
           at Risk'
    • Abstract: Publication date: November 2018Source: Urology Practice, Volume 5, Issue 6Author(s): Rajat Jain, Hemant Chaparala, Mohamed Omar, Vishnu Ganesan, Sri Sivalingam, Mark Noble, Manoj Monga IntroductionEncrustation of retained ureteral stents can lead to significant morbidity. We examined the treatment of patients with retained stents.MethodsPatients with retained stents were identified from a prospectively collected stone registry at a high volume center. The electronic medical record was queried using a relational database management program to parse operative notes for the terms “retained” and “encrusted.” The generated list was manually validated, and data were collected and analyzed retrospectively. We collected demographics, medical history, insurance type, and surgical and postoperative data. Preoperative degree of encrustation was graded using the forgotten, encrusted, calcified system. A cohort of patients undergoing ureteroscopy for urolithiasis was identified as a control group.ResultsOverall 66 patients with retained, encrusted stents and 4,962 controls were identified. The indication for stent insertion was most commonly obstructing stone (53%), after ureteroscopy (15%) and after extracorporeal shock wave lithotripsy (11%). There were no differences in age, body mass index or gender distribution. Patients in the encrusted stent group were more likely to have Medicaid or no insurance (p
       
  • Quality Improvement Summit 2016: Shared Decision Making and Prostate
           Cancer Screening
    • Abstract: Publication date: November 2018Source: Urology Practice, Volume 5, Issue 6Author(s): Danil V. Makarov, Margaret Holmes-Rovner, David R. Rovner, Timothy Averch, Michael J. Barry, Kristin Chrouser, William F. Gee, Kate Goodrich, Mike Haynes, Murray Krahn, Christopher Saigal, Harold C. Sox, Dawn Stacey, Christopher Tessier, Robert L. Waterhouse, Angela Fagerlin IntroductionThe American Urological Association Quality Improvement Summit occurs regularly to provide education and promote dialogue around the issues of quality improvement and patient safety. Nearly all prostate cancer screening guidelines recommend shared decision making strategies when determining whether prostate specific antigen testing is right for a specific patient. This summit, held in partnership with the Society for Medical Decision Making, focused on techniques to identify and understand patient values in relation to prostate cancer screening and treatment, and to promote incorporation of shared decision making into prostate cancer screening discussions.MethodsInformation presented at the Quality Improvement Summit was provided by physicians and leading experts in the field of shared decision making. The open forum of this summit encouraged contributions from participants about their personal experiences with shared decision making and their thoughts on the tools presented during the day.ResultsShared decision making supports collaboration between physician and patient in situations where there are multiple preference sensitive options.ConclusionsPractitioners should include formal shared decision making procedures surrounding prostate specific antigen testing in their practices to ensure that testing is in accordance with patient values and desired outcomes. Tools and strategies like those reviewed in this Quality Improvement Summit are invaluable for alleviating potential burden on providers, ensuring communication and improving quality of care.
       
  • Factors Influencing Prostate Specific Antigen Testing in the United States
    • Abstract: Publication date: November 2018Source: Urology Practice, Volume 5, Issue 6Author(s): Nicolas von Landenberg, Matthew Mossanen, Ye Wang, Jesse D. Sammon, Nawar Hanna, Philipp Gild, Joachim Noldus, Florian Roghmann, Mani Menon, Adam S. Kibel, Maxine Sun, Steven L. Chang, Quoc-Dien Trinh IntroductionGiven the ongoing controversies regarding its benefit, prostate specific antigen based prostate cancer screening should be offered with patient preferences in mind. Understanding subsets of men who may or may not choose prostate specific antigen screening and their associated characteristics may allow more efficient care and may identify subsets of patients for whom additional counseling is warranted.MethodsWe analyzed male participants from the 2001 to 2010 cycles of the NHANES (National Health and Nutrition Examination Survey) who were 40 years old or older, and without a history of prostate cancer, recent prostate manipulation or hormone therapy use (8,133). All men were given an opportunity to undergo or refuse prostate specific antigen testing after a standardized explanation about prostate cancer screening from a physician. Univariable and multivariable logistic regressions were conducted after adjusting for survey weights to identify independent sociodemographic and clinical predictors for opting out of prostate specific antigen testing.ResultsA total of 7,732 men met the inclusion criteria. Overall 95.64% of the study cohort elected to undergo prostate specific antigen testing. The odds of declining prostate specific antigen testing were significantly higher in men 80 years old or older (OR 1.78, p=0.008), black men (OR 3.23, p 
       
  • Increasing Adherence to an AUA Guideline: A Durable Impact on Immediate
           Postoperative Mitomycin C Use
    • Abstract: Publication date: November 2018Source: Urology Practice, Volume 5, Issue 6Author(s): Andrew Stamm, Ryan Donahue, Kathryn Dahl, Rochelle Gaudet, Sydney Akapame, John M. Corman IntroductionIn this quality initiative we assessed whether providing surgeons with the American Urological Association guideline regarding intravesical mitomycin C at the time of surgery scheduling impacts compliance. Furthermore, we examined the durability of the intervention and the influence of surgeon volume on guideline adherence.MethodsAll patients (105) undergoing transurethral bladder tumor resection from July 2015 to February 2016 at Virginia Mason Medical Center were included prospectively. At the scheduling of surgery urologists were provided with a preoperative tool that included the relevant guideline. Mitomycin C use during the study period was compared to historical and subsequent year’s use. Additionally, we stratified results by high and low volume resectionists.ResultsBefore this study mitomycin C was used in 17.1% (25 of 146) of all resections. During the intervention period its use nearly tripled to 43% (28 of 65), an increase of 25.9%. The year after the intervention its use decreased to 32.7% (36 of 110). Durability was strongest for high volume surgeons and trended toward significance for low volume surgeons.ConclusionsProviding surgeons with a copy of the guideline at the time of surgery scheduling resulted in a threefold increase in guideline compliance. This change is durable and most impactful for higher volume surgeons. We believe this model can be used to ensure adherence and consideration for many guidelines.
       
  • Editorial Commentary
    • Abstract: Publication date: November 2018Source: Urology Practice, Volume 5, Issue 6Author(s): Andrew M. Harris
       
  • Cost-Effectiveness of Single Versus Confirmatory Urinalysis in the
           Evaluation of Asymptomatic Microhematuria
    • Abstract: Publication date: November 2018Source: Urology Practice, Volume 5, Issue 6Author(s): Jathin Bandari, Matthew E. Nielsen, Bruce L. Jacobs, Kenneth J. Smith IntroductionIn 2012 the American Urological Association released asymptomatic microhematuria guidelines that resulted in criticisms of overtreatment and improper risk stratification, particularly in women. Specifically, concerns have been raised regarding overtreatment in low risk female patients. Evaluating trade-offs between cost and effectiveness can provide valuable insight into the applicability of these guidelines in different patient populations.MethodsWe used a decision analysis model to estimate the cost-effectiveness of a microhematuria evaluation according to the 2012 guidelines, using varying strategies according to whether confirmatory urinalysis was obtained and stratifying by sex. Where applicable, model parameter values were from prospective observational trials. Costs were estimated based on U.S. databases.ResultsUp-front evaluation costs 20% more than confirmatory evaluation ($792.76 vs $662.65). When considering costs per quality adjusted life-year, up-front evaluation costs $125,105 per quality adjusted life-year gained in the overall population. When stratified by sex, up-front evaluation costs $94,777 per quality adjusted life-year gained in male patients and $390,954 per quality adjusted life-year gained in female patients. At a cost-effectiveness threshold of $100,000 per quality adjusted life-year, up-front evaluation is cost-effective in male but not in female patients or the overall population compared to a delayed evaluation.ConclusionsUp-front microhematuria evaluation may be economically justifiable in men but not in women or in the overall population. Sex specific risk stratification and confirmatory urinalyses may have a role in populations with a lower risk of urinary tract malignancy.
       
  • Editorial Commentary
    • Abstract: Publication date: November 2018Source: Urology Practice, Volume 5, Issue 6Author(s): Matthew Mossanen, Justin C. Brown
       
  • Burnout in Urology: Findings from the 2016 AUA Annual Census
    • Abstract: Publication date: November 2018Source: Urology Practice, Volume 5, Issue 6Author(s): Amanda C. North, Patrick H. McKenna, Raymond Fang, Alp Sener, Brian Keith McNeil, Julie Franc-Guimond, William D. Meeks, Steven M. Schlossberg, Christopher Gonzalez, J. Quentin Clemens IntroductionPhysician burnout is linked to decreased job performance, increased medical errors, interpersonal conflicts and depression. Two recent multispecialty studies showed that urologists had the highest rate of burnout. However, these reports were limited by a low sample size of urologists (119). We aimed to establish the prevalence of urologist burnout and associated factors.MethodsIn the 2016 American Urological Association Census, Maslach Burnout Inventory questions were randomly assigned to half of the respondents. Using matrix sampling, the 1,126 practicing urologists who received and answered the Maslach Burnout Inventory questions represented the entire 2,301 who completed the census. Burnout was defined as scoring high on the scales of emotional exhaustion or depersonalization. Demographic and practice variables were assessed to establish factors correlating to burnout.ResultsOverall 38.8% of urologists met the criteria for burnout, with 17.2% scoring high for emotional exhaustion and 37.1% scoring high for depersonalization. Multivariate analysis revealed that urologist burnout is associated with more patient visits per week, younger age, being in a subspecialty area other than pediatric or oncology, in solo or multispecialty practice, practice size greater than 2 and greater number of work hours per week.ConclusionsThese results suggest that the burnout rate for urologists is lower than previously reported, and are consistent with rates reported in other medical and surgical specialties. However, burnout continues to be an important issue. Greater workload correlated with increased burnout while other practice patterns appeared to be protective. It is critical to keep urologists in the workforce to help lessen projected shortages.
       
  • Evaluation of Missed Clinic Visits at an Academic Multi-Provider Urology
           Clinic
    • Abstract: Publication date: November 2018Source: Urology Practice, Volume 5, Issue 6Author(s): Bryan J. Wilson, Jordan Foreman, Julie M. Riley IntroductionIn this study we elucidated patient characteristics and reasons for visit associated with missed appointments for patients in a multi-provider urology clinic.MethodsWe retrospectively reviewed characteristics of clinic patient data for 4 urologists at 0.5 FTE (full-time equivalent) at a single location between March 18, 2014 and March 18, 2015. Data were collected on new and established patients, including age, health insurance status, time of appointment, reason for clinic visit and gender. The reasons for clinic visit were divided into 27 groups. We used chi-square analysis to evaluate statistical significance (p
       
  • Information for Contributors
    • Abstract: Publication date: November 2018Source: Urology Practice, Volume 5, Issue 6Author(s):
       
  • Editorial Commentary
    • Abstract: Publication date: November 2018Source: Urology Practice, Volume 5, Issue 6Author(s): E. Ann Gormley
       
  • Instructions for Authors
    • Abstract: Publication date: November 2018Source: Urology Practice, Volume 5, Issue 6Author(s):
       
  • The Confluence Of The Aging Of The American Population And The Aging Of
           The Urologic Workforce: The Parmenides Fallacy
    • Abstract: Publication date: Available online 21 September 2018Source: Urology PracticeAuthor(s): Kevin R. LoughlinPurposeTo analyze the interaction of the aging of the American population and the urologic workforce and its impact on the future delivery of urologic care.Materials and MethodsAn analysis of workforce data published by the American Urological Association and the American Association of Medical Colleges was performed. The United States Census Bureau demographic projections were reviewed. A Medline Paperchase Search was performed using mesh terms; aging, urologic and workforce.ResultsThe U.S. population will grow by 11% by the year 2030. However, the increase in the population over 65yo will increase by 50% and the population over 75yo will grow by 69%. Concurrent with this will be an aging of the urologic workforce which will ultimately result in a decrease in the number of practicing urologists. This physician shortage will cause an increased reliance on advanced practice providers (APPs) to deliver urologic care.ConclusionsThe confluence of the significant aging of the American population with the aging and subsequent shortage of urologic physicians will have a major impact on the character of urologic practice in the United States as early as 2030.
       
  • Ambulatory bladder cancer care in the United States
    • Abstract: Publication date: Available online 20 September 2018Source: Urology PracticeAuthor(s): Talia Stark, Jonathan Shoag, Joseph Nicolas, Neal Patel, Benjamin Taylor, Douglas S. Scherr PurposeContemporary data on bladder cancer care in the United States (US) is lacking. Here, we use nationally representative data to characterize outpatient bladder cancer care in the US and identify potential areas for quality improvement.Materials and MethodsThe National Ambulatory Medical Care Survey (NAMCS), conducted annually by the Centers for Disease Control and Prevention, is designed to generate weighted estimates of national ambulatory care practice patterns. We evaluated NAMCS data from 2001 to 2014 to characterize patient, physician, and visit characteristics associated with a diagnosis of bladder cancer.ResultsOver the 14-year study period there were 7,410,240 weighted visits to a urologist for a diagnosis of bladder cancer. The total number of urology visits for bladder cancer significantly increased over the study period (p=0.03). Thirty-five percent of bladder cancer patients saw their urologist 6 or more times annually. The mean visit duration was 21.8 minutes. The mean age of patients with a bladder cancer diagnosis was 71.3. Men and women accounted for 8,106,756 and 3,052,690 visits, respectively (p< 0.01). Medicare coverage represented the largest payer system (60.7%). Urologists provided smoking cessation counseling to only 21.2% of current smokers, and nutrition counseling was provided for just 14.7% of all obese patients with bladder cancer.ConclusionsBladder cancer visits account for over half a million ambulatory urology visits annually. Routine lifestyle interventions, such as smoking cessation and nutrition counseling, should be implemented during urology visits to further improve the care of bladder cancer patients.
       
  • The Applicants’ Perspective of the Urology Residency Match Process
    • Abstract: Publication date: Available online 20 September 2018Source: Urology PracticeAuthor(s): Roger K. Khouri, Byron D. Joyner, Gary E. Lemack BackgroundDespite the competitiveness and high stakes of the Urology Residency Match, little research has focused on the application process from the applicants’ perspective.MethodsIn April 2018, we emailed a 23-question multiple-choice survey to all applicants to the 2018 Urology Residency Match.ResultsOf the 436 applicants, 186 (42.7%) completed our survey. Among the most interesting of the responses was the finding that most applicants (65.1%) would prefer limiting the number of applications per applicant to 60 or fewer, and the vast majority of applicants (89.8%) would prefer a system where interviews are organized by geographic region to reduce cross-country travel. Most applicants (86.6%) also prefer the January match over the NRMP Match in March.ConclusionsThis study provides the applicants’ perspective of the Urology Residency Match process as well as a working framework for improving the application process at both the national and individual program levels. Combining these findings with the perspective of the residency program directors should provide the optimal guidance for the structure of the match process going forward.
       
  • Comparison of Inter-hospital Urological Transfers Between a Metropolitan
           and Rural Tertiary Care Institution
    • Abstract: Publication date: Available online 20 September 2018Source: Urology PracticeAuthor(s): Ian Berger, Marilyn Hopkins, Justin Ziemba, Alexander Skokan, Andrew James, Patrick Michael, Andrew Harris IntroductionUrological services are not available at all hospitals, and the transfer of patients between medical centers provides an avenue to meet medical need. In rural areas, patients often visit community medical centers with limited services and require transfer. We aimed to compare the transfer process between two tertiary care institutions, one serving a metropolitan and the other a rural population.MethodsTwo academic medical centers were selected, one which primarily services a large metropolitan city center, while the second primarily services a large rural population. Transfer logs for the urological services from September 2015 to September 2017 were compared. Records were examined for an affiliated urologist at the originating hospital, distance traveled, reason for transfer, and the need for surgical management. Variables were analyzed using descriptive statistics.ResultsOverall, 606 transfers were included, with 16% (97/606) transferred to the metropolitan center and 84% (509/606) to the rural center. Patients transferred to the rural center were younger (53.3 versus 61.9; p
       
  • Examining and Understanding Value: The Cost of Preoperative
           Characteristics, Intraoperative variables, and Postoperative Complications
           of Minimally-Invasive Partial Nephrectomy
    • Abstract: Publication date: Available online 20 September 2018Source: Urology PracticeAuthor(s): Andrew M. Harris, Patrick Hensley, Jeff Goodwin, Adam Dugan, John Roger Bell, Amul Bhalodi, Jason Bylund IntroductionAs value-based health care gains favor and reimbursement models move toward quality rather than quantity of care, a better understanding of cost and its predictors becomes increasingly important. We aim to identify how preoperative characteristics, intraoperative variables, and postoperative complications impact cost of partial nephrectomy.MethodsOur institution’s NSQIP database was accessed for MIPN performed from January 2012 to March 2017. Perioperative and financial data were collected through retrospective chart review. Total cost (TC) and direct cost (DC) were analyzed relative to clinical variables.Results215 MIPN were included. Median TC was $17,000 and median DC was $11,500. Among preoperative characteristics, age 56-65 and diabetes were associated with an increased median DC of $2,000 and $800. ASA class III was associated with increased DC of $1,400 compared to ASA class I-II. Among intraoperative variables, increasing operative duration was associated with increasing DC. Robot-assisted cases increased DC by $3,000. Estimated blood loss (EBL) over 250cc was associated with an increased DC of $800. R.E.N.A.L. score did not affect cost parameters. Patients experiencing any postoperative complications were found to have increased direct cost compared to those who did not. Blood transfusions were associated with increased DC of $3,700 and unplanned reintubation of $14,500. On multivariable analysis, age, operative duration, robot use, and complications retained significance.ConclusionAge, diabetes, ASA class, operative duration, EBL, robot use, and post-operative complications are associated with increased cost. Increased understanding of cost predictors can be used to optimize perioperative care, value, and contribute to improved alternative reimbursement models.
       
  • Identifying Current Trends in the Urologic Oncology Workforce: Does
           Completion of Fellowship Significantly Change Future Practice'
    • Abstract: Publication date: Available online 20 September 2018Source: Urology PracticeAuthor(s): Alice Semerjian, Antonio R.H. Gorgen, C.J. Stimson, Stephen A. Boorjian, Christian P. Pavlovich PurposeTo assess fellowship impact on subsequent practice type and case-mix, we compared urologists who completed a urologic oncology fellowship (OF) to urologists who did not complete a fellowship (NF).Materials and MethodsAnnualized case log data were obtained from the American Board of Urology from 2004 to 2016, including initial certification (C1) and re-certifications 1 (R1) and 2 (R2). We evaluated trends in major urologic oncology case volume using relevant Current Procedural Terminology codes. Surgeon-specific data, including fellowship training, practice type, and practice area population, were analyzed using chi-squared and 2-sample t-tests.ResultsOF (N=338) were more likely than NF (N=7,785) to practice in larger population areas (p
       
  • Retroperitoneal Lymph Node Dissection (RPLND) as an alternative treatment
           strategy for low-volume, clinical stage II testicular seminoma: a survey
           of patients and providers
    • Abstract: Publication date: Available online 20 September 2018Source: Urology PracticeAuthor(s): Jason C. Warncke, Amanda F. Saltzman, Paul D. Maroni, Siamak Daneshmand, Nicholas G. Cost IntroductionRPLND for low-volume, clinical stage II (CSII) testicular seminoma may provide an alternative to radiation therapy or chemotherapy for local control, preserving the high rate of cure while reducing exposure to long-term side effects. The objective of this study was to determine the willingness of patients and providers to participate in a clinical trial with this approach.MethodsTwo surveys were distributed, one to testicular seminoma patients, and one to providers who treat testicular cancer. This study included patients with pure seminoma and providers currently in clinical practice. Logistic regression analysis was performed to identify factors associated with willingness to participate in the proposed trial.Results193 patients with testicular seminoma and 178 actively practicing providers responded to the surveys. 148 patients (76.7%) and 167 providers (81.9%) reported they would be willing to participate in the proposed clinical trial. For patients, on univariate analysis, age, stage, management after orchiectomy, and relapse status did not impact willingness to enroll. For providers, on univariate analysis, years in practice, number of testicular cancer patients evaluated annually, practice setting, and association with a CCC did not impact willingness to offer enrollment.ConclusionsOur surveys found that the majority of patients and providers would be willing to participate in a trial of RPLND as an alternative treatment strategy for low-volume, CSII testicular seminoma.
       
  • Transgender patient care in urology: an evaluation of attitudes,
           knowledge, and practice patterns among urologists in the New York
           metropolitan area
    • Abstract: Publication date: Available online 19 September 2018Source: Urology PracticeAuthor(s): Jared S. Winoker, Marissa A. Kent, Olamide O. Omidele, Aaron B. Grotas IntroductionTransgender (TG) individuals suffer from significant health disparities, due in part to deficiencies in physician knowledge or comfort with addressing TG health care needs. This study aims to assess the attitudes and clinical knowledge in caring for TG patients of a representative sample of urologists in the New York metropolitan area.MethodsAn anonymous, online-based questionnaire was sent to members of the New York Section of the American Urological Association. Statements evaluating knowledge and attitudes toward TG care were scored on a 5-point Likert scale.Results92 providers (83.7% male) participated in the study, of whom 78.3% (72/92) have been in practice for at least 15 years. With respect to physician attitudes, there was a trend toward greater comfort with discussion of gender identity and counseling on GCS based on total number of TG patients cared for over the course of their career. Regarding knowledge scores, there were no significant associations with physician age, gender, or years of practice. Despite the relatively weak self-reported fund of knowledge (2.64) and overall clinical competence (2.09), there was no overwhelming support to incorporate TG care into urology training curricula (3.11).ConclusionsDespite growing education and awareness of transgender-specific medical issues, many urologists self-report deficiencies in requisite knowledge and comfort in providing adequate, culturally competent care for TG patients. Further work is needed to increase our collective comfort level with this new and evolving aspect of our field.
       
  • Use of Advanced Practice Providers to Improve Patient Access in Urology
    • Abstract: Publication date: Available online 19 September 2018Source: Urology PracticeAuthor(s): Melody Chen, Jonathan Kiechle, Zachary Maher, Christopher Gonzalez
       
  • Vasectomy Simulation Curriculum and Trainer with Enhanced Face, Content,
           and Construct Validity
    • Abstract: Publication date: Available online 19 September 2018Source: Urology PracticeAuthor(s): Ram A. Pathak, Carl C. Edge, Garrett M. Thomas, David D. Thiel, Gregory A. Broderick, Delaney La Rosa, Amy Lannen, Monica C. Moore, Ryan D. Frank, Todd C. Igel IntroductionThe primary objective is to assess the face, content, and construct validity of a newly created vasectomy simulation module.MethodsPre- and post-simulation surveys quantifying simulation effectiveness, impact on confidence level, and critiques of the overall design were obtained in July 2015 to assess face and content validity. Residents were subdivided based on year of residency and construct validity was ascertained via a 20-objective checklist and individual Likert score as graded by a single attending physician in a blinded fashion.ResultsA total of 2 medical students and 8 residents (2 Pre-urology, 2 Uro-1, 2 Uro-2, and 2 Uro-3) were included in the analysis. The response rate was 100% (10/10) for the simulation exercise, and all residents (100%, 8/8) were used in the metric data analysis. Simulation increased the confidence to perform a vasectomy independently on average of 1.58 points based on pre- and post-questionnaire analysis (95% CI 1.09—2.89, P=.02). Training year had a significantly positive association (overall P
       
  • Commercial insurance coverage for inflatable penile prosthesis at a
           tertiary care center
    • Abstract: Publication date: Available online 19 September 2018Source: Urology PracticeAuthor(s): John M. Masterson, Bruce Kava, Ranjith Ramasamy IntroductionInflatable penile prosthesis (IPP) has become an important treatment modality for men with erectile dysfunction (ED) that is refractory to medication. Despite high levels of patient satisfaction following IPP placement and IPP coverage by Medicare, coverage by commercial insurance providers is unknown. The purpose of this study was to determine the coverage of IPP by commercial insurance providers.MethodsFollowing IRB approval, all men with ED interested in obtaining IPP at our tertiary care center between January 2016 and December 2017 were evaluated. We reviewed billing records for CPT code 54405 during the study period to evaluate the insurance provider for all men who received IPP. We also reviewed a manually maintained record of excluded or denied IPP claims for men who desired IPP but could not obtain IPP. Through medical record review we recorded the etiology of ED and the specific type of insurance policy for each man.ResultsMedicare is the most common insurer of IPP, insuring 87 of 220 (39.5%) men seeking IPP between 2016 and 2017. Among the remaining 127 men seeking IPP with commercial insurance coverage, 61 (48.0%) were unable to obtain IPP due to exclusions in their coverage or denials. Among commercially insured men seeking IPP, 77 (62.6%) and 37 (30.0%) had Health Maintenance Organization (HMO) and Preferred Provider Organization (PPO) plans respectively. The most prevalent indications for IPP among the entire study population were status-post radical prostatectomy (30.9%), organic ED (30.5%), and diabetes mellitus (20.9%).ConclusionsThe largest insurer of IPP in the Miami region is Medicare. While patients seeking IPPs can receive insurance coverage, a large percentage (48.0%) of patients are not able to receive coverage despite having a medical necessity for treatment of ED.
       
  • Impact of Accountable Care Organizations on Prostate Cancer Screening &
           Biopsies in the United States
    • Abstract: Publication date: Available online 19 September 2018Source: Urology PracticeAuthor(s): Quoc-Dien Trinh, Maxine Sun, Anna Krasnova, Ashwin Ramaswamy, Alexander P. Cole, Sean A. Fletcher, David F. Friedlander, Jesse D. Sammon, Stuart R. Lipsitz, Adam S. Kibel, Joel S. Weissman PurposeAccountable care organizations (ACOs) are designed to financially incentivize efficiency and reduce low-value care. To determine if ACOs impacted prostate cancer screening patterns, we analyzed trends in prostate-specific antigen (PSA) screening and prostate biopsies by ACO and non-ACO providers.Materials & MethodsUsing a random 20% sample of Medicare claims, we selected men aged 66 years and older. In 2014, beneficiaries were attributed to ACO and non-ACO providers using a modified MSSP algorithm. Beneficiaries treated by these same providers in 2010 served as the control population. Inverse-probability weighting and difference-in-differences analyses were utilized to compare trends in PSA screening and prostate biopsies in 2010 and 2014. Analyses were stratified by age groups: 1) 66-69 years and 2) ≥70 years.ResultsOf beneficiaries treated by ACO and non-ACO providers, PSA screening rates were 62.4% and 60.5% in 2010 vs. 55.9% and 54.4% in 2014 in men aged 66-69, respectively (p=0.3). Prostate biopsy rates were 2.5% and 2.3% in 2010 vs. 1.7% and 1.6% in 2014, respectively (p=0.6). In men aged ≥70, PSA screening rates were 54.3% and 54.2% in 2010 vs. 46.0% and 46.4% in 2014, respectively (p=0.2). Similarly, prostate biopsy rates were 1.8% and 1.7% in 2010 vs. 1.1% and 1.1% in 2014, respectively (p=0.7).ConclusionsThough decreasing utilization of low-value services is a fundamental goal of ACOs, PSA screening and prostate biopsy trends were similar for ACO and non-ACO providers across all age groups in the study years. This suggests that ACO implementation did not have an impact on PSA screening or prostate biopsies usage.
       
  • Managing the High Incidence of Testicular Pain and Pathology in
           Prisoners with Telemedicine
    • Abstract: Publication date: September 2018Source: Urology Practice, Volume 5, Issue 5Author(s): Brenton G. Sherwood, Kenneth G. Nepple, Bradley A. Erickson IntroductionMedical transportation of prisoners involves inherent risks. Telemedicine may allow prisoners to receive appropriate evaluation, testing and treatment with minimal need for transportation. Our medical center manages the urological complaints of all prisoners in our state and uses telemedicine to evaluate patients before transportation. In this study we determined the clinical course of prisoners with testicular pain and pathology, and assessed the safety and potential effectiveness of telemedicine for the evaluation and treatment of these patients.MethodsWe retrospectively reviewed the medical records of all prisoners evaluated by telemedicine from January 2007 to July 2014. Records were examined for urological complaints, diagnoses, initial tests and treatments, outcomes and eventual surgery. The effectiveness of telemedicine was determined by comparing the telemedicine and in-person visit diagnosis.ResultsThere were 376 prisoners with urological complaints, of which 29% were for testicular pain and pathology. Tests were ordered in 78% at the telemedicine encounter (73% ultrasound). Clinic visit followed telemedicine in 49% of cases, of which the telemedicine diagnosis was confirmed in 98%. Elective surgery was performed in 8% and no patients had malignancy.ConclusionsTesticular pain and pathology represented nearly a third of the urological complaints in this population, all of which were benign with few requiring surgery. It appears that testicular pain and pathology could be mostly managed with telemedicine and testing at local facilities without compromising quality of care, potentially reducing health care expenditure by the prison and health care systems.
       
  • Editorial Commentary
    • Abstract: Publication date: September 2018Source: Urology Practice, Volume 5, Issue 5Author(s): Richard Boxer
       
  • Initial Experience with Telemedicine at a Single Institution
    • Abstract: Publication date: September 2018Source: Urology Practice, Volume 5, Issue 5Author(s): Deborah T. Glassman, Ajay K. Puri, Sarah Weingarten, Judd E. Hollander, Anna Stepchin, Edouard Trabulsi, Leonard G. Gomella IntroductionSeveral studies have documented the efficacy of and patient satisfaction with video visits in place of face-to-face encounters. We evaluated patient satisfaction by diagnosis and determined whether specific urological diagnoses are more amenable to being managed via remote encounters. A secondary objective was to evaluate patient satisfaction according to patient age and distance from the clinic.MethodsWe conducted a retrospective review of 611 consecutive telemedicine encounters at an urban academic urology practice between October 2015 and December 2016. Patients rated their provider and the videoconference platform on a Likert scale of 1 to 5. Spearman’s correlation coefficient was used to correlate age and distance with satisfaction. ANOVA testing was used to determine significant difference in patient satisfaction based on diagnosis.ResultsA total of 289 patients (47.2%) completed the survey. Mean patient age was 54.4 years (range 18 to 89) and mean patient distance to the practice was 44.6 miles (range 0.4 to 327.0). Mean patient-provider satisfaction rating was 4.94 (SD 0.32) and mean system satisfaction was 4.63 (SD 0.97). Significant negative correlation was found between age and patient-system satisfaction (CC -0.15, p=0.025) with no significant correlation between satisfaction and distance. ANOVA testing revealed no significant difference in system satisfaction or provider satisfaction across primary diagnoses.ConclusionsVideo visits can be used across a wide variety of diagnoses with high patient satisfaction regardless of distance from a facility. Patient satisfaction with their provider is high regardless of diagnosis but satisfaction with system use may be more variable.
       
  • Editorial Commentary
    • Abstract: Publication date: September 2018Source: Urology Practice, Volume 5, Issue 5Author(s): James M. Cummings
       
  • Editorial Commentary
    • Abstract: Publication date: September 2018Source: Urology Practice, Volume 5, Issue 5Author(s): Sarah Krzastek, Randy Vince, Riccardo Autorino
       
  • Medicaid Patients Experience Longer Wait Times at Academic Urology Clinics
           Compared to Patients with Medicare
    • Abstract: Publication date: September 2018Source: Urology Practice, Volume 5, Issue 5Author(s): Wai Lee, Andrew Chen, Ramsey Kalil, Tal Cohen, William T. Berg, Wayne C. Waltzer, Jason Kim, Howard L. Adler IntroductionIt has been established that Medicaid patients face unequal access to health care. There is a paucity of literature comparing wait times for Medicaid patients to those of patients with other types of insurance. We determined whether Medicaid patients experience longer wait times at academic urology clinics compared to patients with Medicare.MethodsA prospective cross-sectional telephone survey was conducted in October 2016. The study involved collection of data from multiple academic centers with telephone interviews conducted from a single institution. Calls were made to all accredited urology residency programs (131). Earliest appointment times were established for fictional patients with Medicaid and then Medicare. The main outcome was the difference in wait times for a new patient appointment in a urology clinic for Medicaid vs Medicare patients. The wait time in days was the difference between the date of the appointment and the date of the telephone call.ResultsThere were 108 academic urology clinics that accepted Medicaid and Medicare patients in our final analysis (82.4% participation rate). A 2-tailed t-test was performed with unequal variances for the wait times between Medicaid and Medicare groups. There was a significant difference (p 
       
  • Editorial Commentary
    • Abstract: Publication date: September 2018Source: Urology Practice, Volume 5, Issue 5Author(s): Martin A. Koyle
       
  • Potential Savings in Medicare Part D for Common Urological Conditions
    • Abstract: Publication date: September 2018Source: Urology Practice, Volume 5, Issue 5Author(s): Peter S. Kirk, Tudor Borza, James M. Dupree, John T. Wei, Chad Ellimoottil, Megan E.V. Caram, Mary Burkhardt, Joel J. Heidelbaugh, Brent K. Hollenbeck, Ted A. Skolarus IntroductionMillions of patients take prescription medications each year for common urological conditions. Generic and brand-name drugs have widely divergent pricing despite similar therapeutic benefit and side effect profiles. We examined prescribing patterns across provider types for generic and brand-name drugs used to treat 3 common urological conditions, and estimated economic implications for Medicare Part D spending.MethodsWe extracted 2014 prescription claims and payments from Medicare Part D and categorized oral medications used to treat 3 urological conditions, namely benign prostatic hyperplasia, erectile dysfunction and overactive bladder. We examined claims and payments for each medication among urologists and nonurologists. Lastly, we estimated potential savings by selecting a low cost or generic drug as a cost comparator for each class.ResultsThere were significant differences in prescribing patterns across these conditions, with urologists prescribing more brand-name and expensive medications (p
       
  • Charge-to-Cost Ratio Varies among Common Urological Surgery Procedures
    • Abstract: Publication date: September 2018Source: Urology Practice, Volume 5, Issue 5Author(s): Tyler R. McClintock, Matthew Mossanen, Mahek A. Shah, Ye Wang, Benjamin I. Chung, Steven L. Chang
       
  • Reply by Authors
    • Abstract: Publication date: September 2018Source: Urology Practice, Volume 5, Issue 5Author(s):
       
  • Editorial Commentary
    • Abstract: Publication date: September 2018Source: Urology Practice, Volume 5, Issue 5Author(s): Saad Juma
       
  • Editorial Commentary
    • Abstract: Publication date: September 2018Source: Urology Practice, Volume 5, Issue 5Author(s): Howard B. Goldman
       
  • Cost Analysis of Vaginal Mid Urethral Sling Suburethral Removal
    • Abstract: Publication date: September 2018Source: Urology Practice, Volume 5, Issue 5Author(s): Connie Wang, Jeannine Foster, Alana Christie, Philippe Zimmern IntroductionFor cost analysis of mid urethral sling surgery there is a lack of data on costs associated with long-term complications. Therefore, we studied the costs related to a vaginal suburethral synthetic sling removal procedure over 2 consecutive years.MethodsFrom a prospectively maintained database of consecutive women who underwent 1 vaginal suburethral synthetic sling removal only, we analyzed the cost of suburethral synthetic sling removal for 2013 and 2014. Costing data were obtained for operating room expenses, medical and surgical supplies, pharmacy, anesthesia supplies, and room and bed. Professional fees for the suburethral synthetic sling removal procedure were obtained from the Medicare fee-for-service schedule. Costs for 2013 were adjusted by 3% to match 2014 costs.ResultsFrom 2013 to 2014 a total of 46 women underwent suburethral synthetic sling removal. Mean ± SD length of surgery was 62 ± 22 minutes and median length of stay was 1 day (range 0 to 2). Costs for medical and surgical supplies decreased significantly from 2013 to 2014 while operating room and total cost increased during that time. No significant differences were found among payer types. With the 3% inflation adjustment for 2013 the mean total cost based on these factors was $3,714 ± $941, with a median cost of $3,556. Of the 46 women 13 were treated on an outpatient basis and the median cost was reduced at $3,030.ConclusionsAt our tertiary care center the mean total cost of suburethral synthetic sling removal was $3,714, with a slight total cost increase from 2013 to 2014 but a cost saving for those treated as outpatients. This information will be useful for inclusion in the overall cost of mid urethral sling procedures.
       
  • Reply by Authors
    • Abstract: Publication date: September 2018Source: Urology Practice, Volume 5, Issue 5Author(s):
       
  • Editorial Commentary
    • Abstract: Publication date: September 2018Source: Urology Practice, Volume 5, Issue 5Author(s): Louis R. Kavoussi
       
  • Variation in Laparoscopic Nephrectomy Surgical Costs: Opportunities for
           High Value Care Delivery
    • Abstract: Publication date: September 2018Source: Urology Practice, Volume 5, Issue 5Author(s): Lindsay A. Hampson, Anobel Y. Odisho, Maxwell V. Meng IntroductionRising health care costs are leading to efforts to minimize costs while maintaining high quality care. Practice variation in the operating room that is not dictated by patient necessity or clinical guidelines presents an opportunity for cost containment. We identified variation in surgical supply costs among urological surgeons performing laparoscopic nephrectomy and evaluated whether this variation was associated with patient outcomes.MethodsA total of 211 consecutive laparoscopic nephrectomies performed at an academic center between September 1, 2012 and December 31, 2015 were identified and surgical supply costs for each case were determined from the institutional negotiated rate. Patient and surgical factors relevant to case complexity, comorbidity and perioperative outcomes were obtained. Univariate and multivariable analysis of predictors of surgical supply costs and patient outcome as determined by length of stay was conducted.ResultsMedian supply cost was $2,537, with individual medians ranging from $1,642 to $4,524, representing a significant variation among surgeons (p
       
  • Editorial Commentary
    • Abstract: Publication date: September 2018Source: Urology Practice, Volume 5, Issue 5Author(s): Aaron Potretzke, Ilya Sobol
       
  • Editorial Commentary
    • Abstract: Publication date: September 2018Source: Urology Practice, Volume 5, Issue 5Author(s): Jennifer Robles, Ryan S. Hsi
       
  • Time-Driven Activity-Based Costing Analysis of Urological Stone Disease
    • Abstract: Publication date: September 2018Source: Urology Practice, Volume 5, Issue 5Author(s): Matthew E. Pollard, Aaron A. Laviana, Alan L. Kaplan, Casey Pagan, Christopher S. Saigal IntroductionThe documented increasing incidence of nephrolithiasis in the United States will likely be associated with significant economic impact. Time-driven activity-based costing is an analytical method that has been successfully adapted from industrial analysis for use in health care. Using this costing approach we characterized the cost of 4 stone treatment modalities at our academic medical center, including trial of passage, semirigid ureteroscopy, flexible ureteroscopy and extracorporeal shock wave lithotripsy.MethodsWe developed process mapping for urological evaluation, treatment and followup of renal or ureteral stones less than 10 mm in size for each treatment method. We calculated cost of resources, equipment, disposables, personnel and space used for each step in the process. Cost was based on the capacity of each resource and the amount of time required for the treatment process.ResultsThe cost for trial of stone passage, $389, was expectedly lower than for surgical interventions and was mainly driven by clinic visit costs. Extracorporeal shock wave lithotripsy and semirigid and flexible ureteroscopy costs were $4,367, $4,830 and $5,356, respectively. Intraoperative disposables and personnel were the top contributors to overall treatment costs.ConclusionsConservative management is less costly than surgical interventions. Flexible ureteroscopy is the most expensive of surgical interventions. We describe the first time-driven activity-based cost analysis of stone management to our knowledge. Identifying the main drivers of cost can help to improve the value of urological care and improve future cost-effectiveness analyses.
       
  • Information for Contributors
    • Abstract: Publication date: September 2018Source: Urology Practice, Volume 5, Issue 5Author(s):
       
  • Instructions for Authors
    • Abstract: Publication date: September 2018Source: Urology Practice, Volume 5, Issue 5Author(s):
       
  • Reply by Authors
    • Abstract: Publication date: September 2018Source: Urology Practice, Volume 5, Issue 5Author(s):
       
  • Editorial Commentary
    • Abstract: Publication date: September 2018Source: Urology Practice, Volume 5, Issue 5Author(s): Andrew G. Winer, Richard J. Macchia
       
  • Improving Resident and Nurse Communication Practices: Results of a
           Collaborative Culture Initiative
    • Abstract: Publication date: September 2018Source: Urology Practice, Volume 5, Issue 5Author(s): Duncan R. Morhardt, Amy N. Luckenbaugh, Tiffany Hecklinski, John Killian L. Rodgers, Adam Mellem, Christina Reames, Abbas Alhassan, Gary J. Faerber IntroductionPaging is a critical modality for urgent hospital communication. We sought to improve overnight nurse paging practices to reduce noncritical pages, improve resident sleep practices and create a team approach to patient care between residents and overnight nursing staff.MethodsResidents, overnight urology nurses and a communications liaison met during 2 overnight sessions in October 2014 to develop a training curriculum for overnight paging, which consisted of a paging protocol based on page urgency, and batching nonurgent communication into a cluster page. Overnight (11 p.m. to 7 a.m.) pages per night were assessed from March 2014 to March 2015. Nurses and residents categorized page messages for perceived urgency. Pre-training and post-training surveys examined physician-nurse opinion after collaboration.ResultsBefore training the nurses and residents had variable agreement across all urgency categories (Cohen’s kappa=0.25 indicating poor agreement, sample size 132 pages). On trained floors average nightly pages decreased from 2.6 during training to 1.6 after training (November to January, Mann-Whitney p=0.007). This reduction was stable 5 months after training (1.8 pages per night, p=0.994 compared to after training). There was also a paging decrease on untrained floors (7.9 from 9.8 pages per night, p=0.005) but the decrease was lost at 5 months (6.29 pages per night, p=0.0493). Paging frequency from trained floors was proportionally lower (50% reduction) than from untrained floors (29% reduction). The post-training survey demonstrated that new paging practices improved overnight communication, physician response and mutual respect.ConclusionsThis nurse-physician training collaborative produced a lasting reduction in overnight pages, an improved resident response to urgent pages and an enhanced culture of mutual respect.
       
  • Editorial Commentary
    • Abstract: Publication date: September 2018Source: Urology Practice, Volume 5, Issue 5Author(s): Amihay Nevo, Timothy D. Averch
       
  • Editorial Commentary
    • Abstract: Publication date: September 2018Source: Urology Practice, Volume 5, Issue 5Author(s): David C. Johnson
       
  • Educational Resources for Resident Training in Quality Improvement:
           A National Survey of Urology Residency Program Directors
    • Abstract: Publication date: September 2018Source: Urology Practice, Volume 5, Issue 5Author(s): Justin B. Ziemba, Brian R. Matlaga, Christopher D. Tessier IntroductionA key physician competency outlined in the Urology Milestone Project is engagement in quality improvement. Despite this mandate little is known about the attitudes of urology residency program directors regarding the relative importance of quality improvement education. Therefore, we performed a national survey of program directors.MethodsA 25-item survey was developed to investigate program director knowledge and training in quality improvement methodology, participation in quality improvement related activities, curriculum support for resident quality improvement educational activities, and attitudes regarding the relative importance of quality improvement education. The survey was sent via e-mail (November 1, 2016) to all program directors affiliated with the Society of Academic Urologists (sample size 116 of 134, 87% of Accreditation Council for Graduate Medical Education programs).ResultsA total of 36 program directors returned a completed survey for a response rate of 31%. Only 22% (8) of program directors reported receiving formal education or training in quality improvement methodology. Overall 44% (16) of program directors reported that their program offers formal education or a curriculum in quality improvement methodology for their trainees. Program directors expressed a strong desire for residents to learn quality improvement methodology (positive response 32 of 36, 89%) and understand how to apply it to conduct a quality improvement project (positive response 30 of 35, 86%). Program directors strongly believe that a urology oriented quality improvement curriculum would be a valuable resource (positive response 31 of 36, 86%) with a need for support from our professional society (positive response 29 of 36, 81%).ConclusionsA minority of programs have quality improvement education available for residents. However, program directors agree that quality improvement is an integral part of residency training that should be promoted by our profession.
       
  • Editorial Commentary
    • Abstract: Publication date: September 2018Source: Urology Practice, Volume 5, Issue 5Author(s): Alice Semerjian, Trinity J. Bivalacqua
       
  • NSQIP® Indexed Complications Following Transurethral Bladder Tumor
           Resection and Contemporary Financial Implications
    • Abstract: Publication date: September 2018Source: Urology Practice, Volume 5, Issue 5Author(s): Maxx K. Caveney, David C. Brooks, Devin A. Haddad, Robert C. Kovell, Ryan P. Terlecki IntroductionWe determined the incidence of NSQIP (National Surgical Quality Improvement Project) indexed complications by tumor size and investigated the related financial implications based on contemporary reimbursement schedules.MethodsTransurethral bladder tumor resection procedures performed from 2010 to 2012 were identified and stratified by size specific CPT coding. Preoperative characteristics, surgical parameters and 30-day perioperative outcomes were compared using chi-square analysis and Student’s t-test. Financial data for all inpatient transurethral bladder tumor resections performed during the most recent fiscal year at our institution were collected and analyzed, and a comparison was made using up-to-date Medicare reimbursement schedules.ResultsWe identified 8,116 cases, including 3,533 coded as small (43.3%), 2,734 medium (33.5%) and 1,849 large (22.6%). Large resections required longer operative time (small—25.8 minutes, medium—33.0 minutes, large—49.0 minutes, p
       
  • Editorial Commentary
    • Abstract: Publication date: September 2018Source: Urology Practice, Volume 5, Issue 5Author(s): Ahmad Shabsigh, Cheryl Taylore Lee
       
  • Editorial Commentary
    • Abstract: Publication date: September 2018Source: Urology Practice, Volume 5, Issue 5Author(s): Daniel C. Parker, Michael S. Cookson
       
  • Identifying Institutional Causes of Delay to Radical Cystectomy among
           Patients with High Risk Bladder Cancer Treated at a Tertiary Referral
           Center Using Process Map Analysis
    • Abstract: Publication date: September 2018Source: Urology Practice, Volume 5, Issue 5Author(s): Nima Almassi, Katherine E. Glass, Jennifer L. Lonzer, Dennis S. Urbanek, Petros Grivas, Brian Rini, Jorge Garcia, Andrew J. Stephenson, Eric A. Klein, Venkatesh Krishnamurthi IntroductionTreatment delay among patients with muscle invasive bladder cancer is associated with reduced survival. With limited existing literature examining institutional causes of treatment delay, we identified such causes of delay to radical cystectomy among patients with high risk bladder cancer.MethodsWe conducted a retrospective review of 176 patients with bladder cancer who underwent radical cystectomy at our tertiary referral center in 2013 to 2014. Process mapping was used to define each step in the path to cystectomy and the time interval between each step was quantified. Patients experiencing treatment delay (more than 90 days to cystectomy or chemotherapy initiation) were identified and the causes of delay examined.ResultsMedian time from diagnosis to referral was 17 days (IQR 9–36). Following referral the urology and medical oncology evaluations occurred at a median of 5 (IQR 2–9) and 6 days (IQR 1–9), respectively. Median time from urological evaluation to transurethral resection was 14 days (IQR 8–20) and from oncology evaluation to chemotherapy initiation was 9 days (IQR 7–14). Median time to cystectomy for patients proceeding directly from urological evaluation was 28 days (IQR 20–46). Longer intervals were noted from transurethral bladder tumor resection or chemotherapy completion to cystectomy (41 and 44 days, respectively). Overall 24 patients (13.6%) experienced treatment delay. Delays in referral, awaiting preoperative medical clearance, staging studies and surgical scheduling prolonged the time to treatment.ConclusionsSeveral institutional factors contribute to treatment delays among patients with bladder cancer. Process mapping allowed characterization of complex paths to cystectomy and identification of causes of treatment delay.
       
  • Comparative Effectiveness of Transurethral Resection Techniques in the
           Inpatient Setting for Benign Prostatic Hyperplasia
    • Abstract: Publication date: September 2018Source: Urology Practice, Volume 5, Issue 5Author(s): Christian P. Meyer, David F. Friedlander, Ye Wang, Michael Hollis, Stuart R. Lipsitz, Jairam Eswara, Martin Kathrins, Naeem Bhojani, Bilal Chughtai, Maxine Sun, Benjamin I. Chung, Steven L. Chang, Quoc-Dien Trinh IntroductionMonopolar transurethral resection is the conventional surgical standard of care for bladder outlet obstruction due to benign prostatic enlargement. Bipolar resection and GreenLight™ photovaporization have emerged as options with favorable safety profiles. The literature comparing these modalities is limited by sample size and absence of cost data. We compared costs and short-term safety of monopolar, bipolar and laser vaporization techniques in an all-payer inpatient discharge database.MethodsA total of 20,323 men 40 to 80 years old with a diagnosis of benign prostatic hyperplasia who underwent an outlet procedure between 2003 and 2013 were identified in the Premier Research Database. Using propensity weighted logistic regression we assessed treatment trends and perioperative safety outcomes.ResultsMonopolar resection remained the most commonly performed procedure between 2003 and 2013. However, its use decreased by 20% (p 0.99), length of stay (p=0.82) and 90-day complication rates (p=0.34), GreenLight photovaporization was associated with prolonged operative time (+12 minutes, 95% CI 10.25 to 13.75, p
       
  • Local Antibiogram Predicts Appropriate Antibiotic Selection for Prostate
           Biopsy Prophylaxis
    • Abstract: Publication date: Available online 6 July 2018Source: Urology PracticeAuthor(s): Elizabeth Rourke, Steven Madsen, Andrea Yunes, Joseph Basler, Michael A. Liss PurposeWe evaluate our local antibiogram to determine the accuracy of its use in antibiotic augmentation prior to transrectal prostate biopsy (TRPB).Materials and MethodsWe analyzed pre-TRPB rectal swabs from January 2016 to September 2017 at the South Texas Veterans Health Care System (STVHCS). A query was run on pre-procedure rectal swabs positive for fluoroquinolone resistance in men undergoing TRPB during this time. Culture results and antibiotic resistance profiles were recorded and compared to the proportion of antibiotic resistance in the STVHCS 2016 antibiogram.ResultsWe identified 611 patients who underwent pre-TRPB rectal culture, of which 98 were ciprofloxacin resistant E.coli (CRE) isolates. Our cohort demonstrated 80% sensitivity to ciprofloxacin as compared to the STVHCS antibiogram sensitivity of 65% (p
       
  • Outcomes of Intradetrusor OnabotulinumtoxinA Injection in Adults with
           Congenital Spinal Dysraphism in Tertiary Transitional Urology Clinic
    • Abstract: Publication date: Available online 5 July 2018Source: Urology PracticeAuthor(s): Aaron Kaviani, Rashmi Pande, Timothy B. Boone, Rose Khavari PurposePublished data regarding intradetrusor injection of onabotulinumtoxinA in adults with congenital spinal dysraphism are scarce. In this study, we retrospectively investigated the outcomes of intradetrusor injection of onabotulinumtoxinA in this setting.Materials and MethodsBilling codes were used to identify 149 patients who underwent onabotulinumtoxinA injection between 2012−2016 at our tertiary transitional urology clinic. Charts were then reviewed to identify patients with congenital spinal dysraphism.ResultsA total of 18 patients with the mean age of 20.76 (±3.03) years at the time of 1st onabotulinumtoxinA injection were identified. All patients had urinary incontinence. Urinary incontinence improved by injection of 200 or 300 U of onabotulinumtoxinA in 81.2% of patients and 63.6% of them became dry (p= 0.023). Mean glomerular filtration rate before and 13.3 (±9) months after treatment was 100.2 (±17.2) and 120.1 (±16.6) mL/min/1.73 m2 respectively (p= 0.41). Baseline hydronephrosis improved in 3 of 4 patients. Repeat urodynamic study after injection was done in 11 patients who did not clinically improve or who had loss of bladder compliance at baseline (29.3 Vs. 67.2 ml/cmH2O). Mean maximum cystometric capacity before and after injection was 310.1 and 380.2 mL (p= 0.045). Mean bladder compliance before and after treatment was 29.2 and 28.7 ml/cmH2O respectively (p= 0.48) in this high risk group.ConclusionsIntradetrusor onabotulinumtoxinA injection may improve refractory urinary incontinence in selected adults with spinal dysraphism. However, despite improvement in maximum cystometric capacity, bladder compliance does not improve following therapy in patients who had loss of compliance at baseline.
       
  • Gender and racial disparities in early urology exposures during medical
           school
    • Abstract: Publication date: Available online 11 June 2018Source: Urology PracticeAuthor(s): Thomas W. Gaither, Mohannad A. Awad, Benjamin N. Breyer, Kirsten L. Greene PurposeWorkforce disparities in medicine have been well documented. Early medical school exposures have been shown to highly influence career choice. We hypothesize that gender and racial disparities exist in early medical school exposures to urology.MethodsWe surveyed urology residency applicants who interviewed at our institution from 2016-2017. Student demographics were collected in addition to forms of urology exposures (both clinical and research). Early urology exposure was defined as occurring before the 3rd year of medical school. Early exposures were compared by gender and underrepresented in medicine (UIM) racial/ethnic groups.ResultsDuring the study period, 72 interviewees were invited to participate, and 71 interviewees completed the survey (response rate=98.6%). The majority of participants were male (54, 76%). Thirteen participants (18%) met UIM criteria. Fewer female applicants discovered urology (41% v. 75%, p=0.01), first shadowed a urologist (35% v. 68%, p=0.02), first operated with a urologist (29% v. 60%, p=0.03), and began research (0% v. 49%, p
       
  • Genitourinary Prosthetic Use Among Prostate Cancer Survivors Treated with
           Radical Prostatectomy
    • Abstract: Publication date: Available online 23 May 2018Source: Urology PracticeAuthor(s): Louis A. Aliperti, Dattatraya Patil, Christopher P. Filson, Lindsey M. Hartsell, Kenneth J. Carney, Martin G. Sanda, Akanksha Mehta ObjectiveErectile dysfunction and urinary incontinence are well-known side effects of radical prostatectomy that, when refractory to medical therapy, can be addressed by major genitourinary prosthetic surgery (urethral slings, artificial urinary sphincters (AUS), penile prostheses (PP)). Though these procedures have been evaluated in single institution studies, population-based analyses regarding their utilization have been sporadic. Thus, we sought to characterize post-prostatectomy genitourinary prosthetic surgery in a contemporary, population-based cohort of men with private insurance.Material and MethodsUsing MarketScan Commercial Claims data, we identified men undergoing RP between 2009-2010 based on coding. Our primary outcome was receipt of genitourinary prosthetic device based on codes documented in claims from 2009 through 2015. Other factors of interest included patient age, comorbidity, and geographic region.ResultsWe identified 23,813 men who underwent radical prostatectomy in 2009 and 2010 (mean age (SD) = 55.5 years (9.1)). Overall, 731 men (3.07%) underwent genitourinary prosthetic surgery, including 243 (1.0%) male slings, 111 (0.5%) AUS, and 377 (1.6%) PP. Median time to the first prosthetic surgery was 21.7 months (SD 12.9; range = 1.2-54.5). Men undergoing prosthetic surgery for post-prostatectomy complications were older (57.1 vs. 55.5y, p=0.001), and more likely to be diabetic (31.9 vs. 22.6%, p0.05).ConclusionsOverall, receipt of genitourinary prosthetic surgery for incontinence (1.5%) or erectile dysfunction (1.6%) was rare following radical prostatectomy. However, diabetic and older men demonstrated a greater likelihood of device placement.

       
  • 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
       
  • Trends in the Setting and Cost of Ambulatory Urological Surgery: An
           Analysis of Five States in the Healthcare Cost and Utilization Project
    • Abstract: Publication date: Available online 7 May 2018Source: Urology PracticeAuthor(s): Hiten D. Patel, Brian R. Matlaga, Justin B. Ziemba IntroductionWith the rising costs of healthcare, surgical procedures have migrated from the inpatient to outpatient setting with>60% of urological procedures performed in the ambulatory setting. Ambulatory surgical centers (ASCs) can potentially reduce costs but may also lead to overutilization. We assessed utilization of ASCs for urological procedures, case-mix distribution compared to hospital-based outpatient surgery departments (HOPD), and cost implications.MethodsAll outpatient urological procedures were identified from 5 states in the United States (2010-2014) using all-payer data. Patient demographics, regional data, facility type (ASC vs. HOPD), and total charges (converted to costs and inflation adjusted to 2014 USD) were determined. Analyses of overall number of procedures, population-adjusted rates, annual percent change (APC), and adjusted linear regression models were performed.ResultsOf>37 million surgical procedures, 1,842,630 (4.9%) were urological with overall APC +0.97% (+1.09% HOPD vs. +0.41% ASCs) and 20.0% performed in ASCs. The proportion performed in ASCs slightly decreased over time (-0.48%/year, p
       
  • 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.
       
  • Influential Factors in Pursuit of Pediatric Urology Fellowship Training
    • Abstract: Publication date: Available online 12 April 2018Source: Urology PracticeAuthor(s): Bradley Morganstern, Vinaya Vasudevan, Preeya K. Mistry, Adam Howe, Wayland Wu, Lane S. Palmer ObjectiveTo investigate factors that helped recent fellows achieve a successful match and to further understand the influences for pursuing a career in pediatric urology.Selecting to continue training after urology residency entails much consideration; however, there is a paucity of tangible resources available to help residents understand the process.MethodsA 20-item web based survey was emailed to second year fellows and recent graduates of pediatric urology fellowships from graduating classes of 2013-2015 (n=103). The survey explored factors that affected the decision to pursue this field along with the influence of mentors, fellows, and other residents that applied to pediatric urology. We assessed the key factors that helped applicants achieve a successful match. Descriptive statistics and univariate logistic regression analysis was used to determine relationships between program characteristics and respondents’ decisions to apply and interview at different programs.ResultsIn total, 59 out of 103 surveyed (57.3%) responded to the survey. Faculty, program reputation and clinical volume play key roles in ranking programs while satisfaction with the match result is contingent upon accurately assessing programs based on key factors such as family considerations, location, program reputation, faculty, clinical year volume and “gut feeling.” In addition, our survey demonstrated that having a pediatric urology fellow at one’s institution had very little impact on a resident’s decision to pursue pediatric urology.ConclusionAs the subspecialty of pediatric urology continues to grow, we identified key elements that help shape and influence choices to participate in the future of this ever-evolving field.
       
  • 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.
       
  • Laser Papillotomy for Chronic Flank Pain – A Reassessment of Efficacy in
           the Era of Automated Opioid Prescription Monitoring
    • Abstract: Publication date: Available online 21 March 2018Source: Urology PracticeAuthor(s): Karen L. Stern, Manoj Monga ObjectiveTo determine if laser papillotomy for patients with chronic flank pain decreased narcotic pain medication usage post-surgery. Specifically the introduction of state-specific automated prescription reporting systems offers the opportunity for a more objective longitudinal assessment of outcomes in patients who often utilize multiple providers for pain management.Materials and MethodsPatients who underwent laser papillotomy for chronic flank pain at a single institution between January 2013 and January 2017 were identified. Narcotic prescription refill information for the 12 months prior to the surgery and the 12 months after was obtained through the Ohio Automated Rx Reporting System (OARRS) and the Pennsylvania Prescription Drug Monitoring Program (PA PDMP).Results10 patients underwent laser papillotomy for chronic flank pain. Preoperative outpatient narcotic prescriptions filled ranged from 0 to 23 prescriptions, with a mean of 10.5 separate prescriptions per patient. Postoperatively, 8/10 (80%) of patients were considered failures. Six patients had multiple narcotic pain medication refills, with the mean number of pills filled recorded as 993.3 in the 12 months post-surgery. One patient became a heroin addict postoperatively and another required ongoing care in the chronic pain clinic.ConclusionsLaser papillotomy for chronic flank pain has a high failure rate, especially in patients who are on narcotic pain medication preoperatively. In the era of automated opioid prescription monitoring, urologists should use such information to make surgical decisions and properly counsel patients.
       
  • Trends in insurance status during initial presentation of testicular
           carcinoma: Examining health outcomes and implications of health reform for
           young adults in the United States.
    • Abstract: Publication date: Available online 1 March 2018Source: Urology PracticeAuthor(s): Juan Chipollini, Dominic H. Tang, Junmin Zhou, Richard R. Reich, Andrew R. Leone, Scott M. Gilbert, Wade J. Sexton IntroductionTo evaluate trends in insurance status and assess socioeconomic factors associated with clinically metastatic (cM) testicular cancer presentation and potential barriers to treatment in the United States.MethodsThe National Cancer Database was queried for patients with germ cell tumors of the testicle diagnosed from 2004 to 2014. Temporal trends and forecast of insurance status were examined in the years before and after the Affordable Care Act (ACA). Multivariable logistic regression was used to assess predictors of cM presentation.ResultsA total of 58,348 patients were identified with 37.95% presenting with cM disease. The uninsured rate remained relatively unchanged during the years before and after the ACA (11.7% vs. 11.9%, respectively). Predictors for cM presentation were Medicaid (OR= 2.12, 1.80-2.50), Medicare (OR= 1.35, 1.13-1.60), and uninsured status (OR=1.41, 1.22-1.64) when compared to privately insured patients. A forecast model revealed no significant changes in the uninsured rate (11.58 to 11.60%) for the years 2015 through 2017.ConclusionsSocioeconomic disparities continue to be barriers for young adults presenting with testicular cancer in the United States. Longer prospective follow-up will be required to assess the impact of payer status with the reportedly increased health coverage fostered by the ACA.
       
  • Patient Factors Influencing Decision to Undergo Vasectomy Reversal
    • Abstract: Publication date: Available online 1 March 2018Source: Urology PracticeAuthor(s): Michael A. Moriarty, Jessica Auld, Jay I. Sandlow IntroductionVasectomy reversal is one of the options for children following a vasectomy. While previous reports have demonstrated this as a cost-effective procedure, barriers continue to exist preventing some couples from utilizing this method. This study’s goal was to determine factors that influence patients’ decision to undergo vasectomy reversal (VR) as well as identify possible barriers.MethodsA review was conducted of 398 patients who were seen for consultation regarding vasectomy reversal between January 2006 and January 2016. Patients were contacted via mail and asked to fill out an anonymous survey. Medical records of patients who returned surveys were reviewed and de-identified data accrued in our data set. Patient demographics, socioeconomic data, family composition, and patient-identified barriers to VR were characterized. Data was analyzed with standard comparative and descriptive statistical analysis.ResultsOverall, 30.9% of patients responded to the survey and subsequently underwent chart review. Patient demographics were similar for individuals who did and did not undergo VR. The most common reason for initial consultation was both patient and partner’s desire for children (74.0%). The most commonly identified barrier to VR was cost (53.7%) followed by concern about success rate (31.7%). Patients who underwent VR more often had an income greater than $100,000 per year as compared to those who did not undergo VR (50.5% v. 21.9%, p=0.004). Individuals who did not undergo VR more often had a new partner since vasectomy (87.5% v. 70.3%, p=0.05) and were unmarried (28.1% v. 8.8%, p=0.02).ConclusionsThe most common reason for presentation for VR is a joint desire for children. The largest barrier to VR was cost. Individuals with lower incomes, a new partner, and unmarried status were less likely to undergo VR.
       
  • The Role of Patient- and Procedure-Specific Factors on Urology Operating
           Room Peri-Operative Times
    • Abstract: Publication date: Available online 1 March 2018Source: Urology PracticeAuthor(s): David J. Kozminski, Matthieu J. Cerf, Daniel Loman, Paul J. Feustel, Barry A. Kogan IntroductionThough not traditionally examined, the non-operative time a patient spends in the OR is potentially significant. Our objective was to determine the role of patient- and procedure-specific characteristics on non-operative times in urology cases.MethodsAll patients at our tertiary institution had routine pre-operative collection of patient and procedure-specific data. Following IRB approval, we retrospectively reviewed the following time landmarks: the pre-operative OR time (the time from when the patient enters the room until the procedure starts) and the post-operative OR time (the time from the procedure end until the patient exits the room). Study inclusion criteria consisted of ASA I-IV and those cases with complete available data. Emergency cases (ASA score>4) were excluded. Multivariable regression was used to assess influence of patient and procedure variables on pre-operative and post-operative OR time.ResultsA total of 1488 patients undergoing 1786 urology procedures over a 9 month period (January-September 2016) met inclusion criteria. Following multivariable analysis, ASA class and CCI were significantly associated with an increase in pre-operative time. The only variable that had a significant association with both pre-operative and post-operative times was location (hospital vs. ambulatory). Procedure type also had significant effect on peri-operative OR times.ConclusionsOur analysis is a novel approach to assessing OR efficiency by characterizing the non-operative time a patient spends in the OR. Robotic cases have longer non-operative times and increasing patient complexity prolongs pre-operative time in the OR. Better preparation of complex patients pre-operatively will allow better use of constrained OR resources.
       
  • 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.
       
  • An Intervention to Increase 24-Hour Urine Collection Compliance
    • Abstract: Publication date: Available online 6 February 2018Source: Urology PracticeAuthor(s): Carter Boyd, Kyle Wood, Omotola Ashorobi, Lisa Harvey, Robert Oster, Ross P. Holmes, Dean G. Assimos PurposeCompliance with 24-hour urine collections for assessing kidney stone risk is important for assigning preventive therapy. The objectives were to determine factors associated with compliance and the impact of an intervention.Materials and MethodsIn 2015, patients needing 24 hour urine testing were instructed to contact the vendor (Litholink®) and given instructions by the same nurse to arrange for collections. In 2016, a practice change was implemented and all requests were sent directly to the vendor by FAX. In 2015/2016, 24-hour urine studies were ordered in 368 adult stoneformers (SF). Demographic data included age, gender, race, insurance status, partner status, income, and education. Statistical methods included ANOVA, Fisher’s exact test, Chi-squared, and t-test. Compliance was based on completion of 24-hour urine collections. Data were analyzed for 2015, 2016, and both years combined (2015/2016).ResultsAverage age of SF was 49.6 years at time of collection; 47.5% were female; 84.2% were Caucasians;15.8% were African Americans. Most patients were adequately insured (90.5%) and had domestic partners (61.4%). Compliance increased after the intervention from 46.9% to 65.1% (p
       
  • 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
       
  • Predictors of Urology Resident Surgical Skills, Clinical-Communication
           Skills, Common Sense, and In-Service Scores
    • Abstract: Publication date: Available online 29 December 2017Source: Urology PracticeAuthor(s): R. Houston Thompson, Christine M. Lohse, Douglas A. Husmann, Bradley C. Leibovich, Matthew T. Gettman ObjectiveTo evaluate predictors of urology resident surgical skills, clinical-communication skills, common sense, and in-service scores.MethodsWe reviewed the Mayo Clinic experience with 49 urology residents who graduated between 2006 and 2016. Residents were independently scored 1-10 based on surgical skills, clinical-communication skills, and common sense by the Program Director and Associate Program Director. Discrepant scoring by>2 was resolved by the former Program Director. Associations of features from the medical student application with an excellent score (defined as 8-10) and in-service scores were evaluated with logistic and linear regression.ResultsDiscrepant scoring>2 was noted in only 1, 0, and 1 resident for surgical skills, clinical-communication skills, and common sense, respectively. The mean scores for surgical skills, clinical-communication skills, and common sense were 6.4, 7.1, and 7.0, respectively, and an excellent score was noted in 16 (33%), 19 (39%), and 24 (49%) residents, respectively. The strongest feature associated with an excellent score in each category was honors in all core clinical clerkships (p
       
 
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