IF 2 3区医学

Urology Pub Date : 2025-09-09 DOI: 10.1016/j.urology.2025.09.007

Taylor L Lan, Blake R Baer, Jay D Raman

{"title":"Confirmatory Microscopic Urinalysis After Positive Dipstick Microhematuria: Adherence Patterns and Quality Improvement.","authors":"Taylor L Lan, Blake R Baer, Jay D Raman","doi":"10.1016/j.urology.2025.09.007","DOIUrl":"10.1016/j.urology.2025.09.007","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate adherence to the 2025 AUA/SUFU microhematuria (MH) guideline, which requires confirmatory microscopic urinalysis (MUA ≥3 RBC/HPF) after a positive dipstick.</p><p><strong>Materials and methods: </strong>TriNetX Research Network data (109 US health systems) were queried for adults aged 18-90 years with an initial positive dipstick from July 2020 to February 2025. Patients with gross hematuria, urinary tract infections, and kidney and/or ureteral calculi, cystitis, proteinuria, dysuria, and pregnancy diagnoses were excluded. Patients were stratified into three cohorts: no MUA, negative MUA, and positive MUA. We recorded the use of computed tomography (CT) urography, magnetic resonance imaging (MRI) urography, renal ultrasound, or cystoscopy within 6 months of positive dipstick.</p><p><strong>Results: </strong>Among 37,300 eligible patients, 25,904 (69%) received MUA and 11,396 (31%) did not. MUA was positive in 9913 cases (38%) and negative in 15,991 (62%). Downstream testing followed 7.5% of dipstick-only cases, 16.1% of negative-MUA cases, and 16.3% of positive-MUA cases. In total, 855 procedures were performed without any MUA and 2575 after a negative MUA, resulting in potentially avoidable charges. Conversely, 84% of patients with confirmed MH underwent no further evaluation.</p><p><strong>Conclusion: </strong>31% of positive urine dipstick results were not followed by a confirmatory MUA, and 84% of patients with a positive MUA underwent no additional evaluation. These shortfalls point to gaps in the implementation of guideline-based care for MH. Future work should test targeted decision-support tools and simplified referral pathways to improve adherence and patient outcomes.</p>","PeriodicalId":23415,"journal":{"name":"Urology","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145040892","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Claims-based Approach to Defining Renal Colic Episodes: Implications for Researchers, Providers, and Policymakers. 以索赔为基础的方法来定义肾绞痛发作：对研究人员、提供者和决策者的影响。

IF 2 3区医学

Urology Pub Date : 2025-09-09 DOI: 10.1016/j.urology.2025.09.006

Andres Santana, Andrew L Kavee, Lang Li, Kevin Neuzil, Charles D Scales, David F Friedlander

{"title":"Claims-based Approach to Defining Renal Colic Episodes: Implications for Researchers, Providers, and Policymakers.","authors":"Andres Santana, Andrew L Kavee, Lang Li, Kevin Neuzil, Charles D Scales, David F Friedlander","doi":"10.1016/j.urology.2025.09.006","DOIUrl":"10.1016/j.urology.2025.09.006","url":null,"abstract":"<p><strong>Objective: </strong>To define renal colic episodes more accurately using a novel claims-based method and evaluate how clinical and nonclinical factors, including insurance type, affect rates of surgical intervention and Emergency Department (ED) revisits, as well as episode-related expenditures. Traditional fixed-window episode definitions may misclassify care duration and intensity, limiting their utility in assessing real-world utilization.</p><p><strong>Methods: </strong>We analyzed 2016-2019 claims data from North Carolina Medicaid and a large private insurer to identify adults aged 18-64 with an ED visit for renal colic (N = 65,346). Episodes were defined using statistically significant deviations in weekly healthcare charges. Multivariable binary and ordered logistic regression assessed associations between patient characteristics, pharmacotherapy, provider follow-up, and three outcomes: definitive surgery, 30-day ED revisit, and total episode charges.</p><p><strong>Results: </strong>Among patients undergoing surgery, episode duration averaged 10 weeks for privately insured and 6 weeks for Medicaid patients. Among nonsurgical patients, episode duration averaged 4 weeks for both groups. Earlier post-ED ambulatory urology follow-up reduced odds of 30-day revisit (private: OR 0.37, P < .0001; Medicaid: OR 0.29, P < .0001). Alpha blocker prescription at the time of ED discharge was associated with lower 30-day revisit risk (private: OR 0.80, P < .0001; Medicaid: OR 0.83, P < .001). 30-day ED revisit was associated with higher episode-specific expenditures, regardless of surgical/insurance status.</p><p><strong>Conclusion: </strong>We employed a novel claims-based approach to renal colic episode definition, which revealed nuances in care utilization and access driven by potentially modifiable factors like insurance status and timing of post-ED ambulatory follow-up.</p>","PeriodicalId":23415,"journal":{"name":"Urology","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12495504/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145041431","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Improving Clinic Access for Urgent Urology Referrals. 改善泌尿外科急诊转诊的门诊服务。

IF 2 3区医学

Urology Pub Date : 2025-09-08 DOI: 10.1016/j.urology.2025.09.004

Sophia Prendiville, Stephanie Justo, Kathy Luong, Julie Hart, Tara Kelly, Jake Mickelsen, Timothy Chang, Jay Shah, Ryan Sun

{"title":"Improving Clinic Access for Urgent Urology Referrals.","authors":"Sophia Prendiville, Stephanie Justo, Kathy Luong, Julie Hart, Tara Kelly, Jake Mickelsen, Timothy Chang, Jay Shah, Ryan Sun","doi":"10.1016/j.urology.2025.09.004","DOIUrl":"10.1016/j.urology.2025.09.004","url":null,"abstract":"<p><strong>Objective: </strong>To improve access to the general urology clinics for urgent urology referrals. The issue of healthcare accessibility is relevant to urology, since certain urologic conditions require urgent assessment. Despite guidelines for timely assessment, challenges in clinic scheduling frequently cause patient care delays.</p><p><strong>Methods: </strong>The prospective quality improvement study was conducted at outpatient general urology clinics from June 2023 to May 2024. An A3 quality improvement framework was used to develop, implement, and iterate on interventions intended to reduce wait times for urgent urology referrals. These included defining truly urgent diagnoses, streamlining referral template, allocating and protecting urgent clinic slots, and enhancing communication with multidisciplinary stakeholders.</p><p><strong>Results: </strong>A total of 1058 urgent urology patients in the ambulatory setting were seen during the project timeframe. At baseline, mean wait time for urgent referrals was 59.0days, and 3 patients per week were seen within 10days of referral. Following implementation of interventions, the mean wait time decreased to 21.6 days, and 8 patients per week were seen within 10 days (P < .01). These processes were not associated with an adverse effect on wait times for routine referrals during the study.</p><p><strong>Conclusion: </strong>Barriers to timely clinic access for urgent referrals include undefined definitions of urgency, lack of resource allocation dedicated for urgent patients, and lack of communication between referring providers, patient coordinators, and clinic staff. A streamlined referral process that addresses these issues can lead to significant and sustainable reduction in care delay for urgent urology patients.</p>","PeriodicalId":23415,"journal":{"name":"Urology","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145034142","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Does Pediatric Fellowship Training Result in Higher Rates of Salvage in Acute Testicular Torsion? 儿科研究员培训能提高急性睾丸扭转的抢救率吗？

IF 2 3区医学

Urology Pub Date : 2025-09-07 DOI: 10.1016/j.urology.2025.09.005

Helen Zhao, Hoi Doan, Merry Peckham, Lauren Faber, Jessica Ming, Jason Wilson

{"title":"Does Pediatric Fellowship Training Result in Higher Rates of Salvage in Acute Testicular Torsion?","authors":"Helen Zhao, Hoi Doan, Merry Peckham, Lauren Faber, Jessica Ming, Jason Wilson","doi":"10.1016/j.urology.2025.09.005","DOIUrl":"10.1016/j.urology.2025.09.005","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate whether pediatric urology fellowship training affects testicular salvage rates.</p><p><strong>Methods: </strong>A retrospective chart review was conducted for pediatric patients diagnosed with acute testicular torsion between January 2017 and January 2023. Data including age, transfer status, imaging, transportation mode, symptom duration, and surgical outcomes were analyzed. Salvage was defined as orchiopexy at time of intervention without subsequent atrophy on follow-up exam.</p><p><strong>Results: </strong>Of 62 patients, the mean age was 12 years. Pediatric urologists performed 57.1% of the surgeries. Pediatric urologists were significantly more likely to salvage the torsed testis and perform bilateral orchiopexies (P = .003), but there was no significant difference when accounting for atrophy on follow-up exam (P = .27). The majority (71%) of patients were transfers from outside facilities, and 67% were from facilities within 16 miles of the treating facility. No complications were noted at the time of surgery or during the follow-up period.</p><p><strong>Conclusion: </strong>Pediatric urologists more often perform bilateral orchiopexy compared to urologists without pediatric fellowship training, but there was no difference in testicular atrophy rates at 3-month follow up. This study supports the idea that timely intervention remains the most important factor affecting testicular salvage.</p>","PeriodicalId":23415,"journal":{"name":"Urology","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-09-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145030690","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Guidelines for Meta-Analyses and Systematic Reviews in Urology. 泌尿外科荟萃分析和系统评价指南。

IF 2 3区医学

Urology Pub Date : 2025-09-05 DOI: 10.1016/j.urology.2025.08.050

Andrew J Vickers, Melissa Assel, Rodney L Dunn, Graeme MacLennan, Betsy Jane Becker, Richard D Riley

引用次数: 0

Editorial Comment on "Muscle-Invasive Bladder Cancer Treatment Selection in an Emerging Treatment Era: A Patient Preference Study". 编辑评论：新兴治疗时代的肌肉侵袭性膀胱癌治疗选择：一项患者偏好研究。

IF 2 3区医学

Urology Pub Date : 2025-09-04 DOI: 10.1016/j.urology.2025.08.059

Mary E Westerman, Scott E Delacroix

引用次数: 0

Stone Impaction Risk Score: Settling the Debate or Sparking a New One? 结石嵌塞风险评分：解决争论还是引发新的争论？

IF 2 3区医学

Urology Pub Date : 2025-09-02 DOI: 10.1016/j.urology.2025.08.058

Ahmet Burak Yilmaz, Kamal Karimzada, Tanju Keten, Ozer Guzel, Altug Tuncel

{"title":"Stone Impaction Risk Score: Settling the Debate or Sparking a New One?","authors":"Ahmet Burak Yilmaz, Kamal Karimzada, Tanju Keten, Ozer Guzel, Altug Tuncel","doi":"10.1016/j.urology.2025.08.058","DOIUrl":"10.1016/j.urology.2025.08.058","url":null,"abstract":"<p><strong>Objective: </strong>To develop a novel scoring system-the Stone Impaction Risk Score (SIRS)-based on non-contrast computed tomography (NCCT) parameters for preoperative prediction of impacted ureteral stones, and to compare its diagnostic accuracy with three established models: the Impacted Stone Formula (ISF), Wang nomogram, and Qi nomogram.</p><p><strong>Methods: </strong>A total of 466 adult patients who underwent ureteroscopy for solitary ureteral stones measuring 5-10 mm between January 2019 and January 2025 were retrospectively analyzed. A total of 233 patients with impacted stones were matched 1:1 with 233 non-impacted controls. Preoperative NCCT was used to record stone dimensions, ureteral wall thickness (UWT), and Hounsfield unit (HU) measurements. The SIRS formula was defined as: (Stone width × Stone depth/(Stone length)²) × UWT × (HU below/HU above). Receiver operating characteristic (ROC) analysis and DeLong test were used to evaluate and compare model performances.</p><p><strong>Results: </strong>The SIRS demonstrated the highest discriminative ability among all scoring systems, with an area under the curve (AUC) of 0.962 (95% CI: 0.948-0.977, P <.001), sensitivity of 88%, and specificity of 92% at the optimal cutoff value of 3.0. In comparison, the AUCs for ISF, Wang, and Qi nomograms were 0.868, 0.850, and 0.813, respectively. Pairwise DeLong tests revealed that SIRS significantly outperformed all other models, while differences among other scores were not statistically significant.</p><p><strong>Conclusion: </strong>The SIRS outperforms three existing models within the same patient group by integrating both anatomical and local inflammatory findings, resulting in enhanced accuracy and reliability in comparative evaluations.</p>","PeriodicalId":23415,"journal":{"name":"Urology","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145001178","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Editorial Comment on "Antibiotic Prophylaxis Before Urodynamics: A Urine Culture-Based Versus Risk-Factors-Based Protocol to Minimize Usage in the Era of Antibiotic Resistance". 关于“尿动力学之前的抗生素预防：基于尿液培养与基于风险因素的方案以减少抗生素耐药性时代的使用”的社论评论。

IF 2 3区医学

Urology Pub Date : 2025-09-02 DOI: 10.1016/j.urology.2025.08.030

Charles R Powell

引用次数: 0

The Genitourinary Medical Oncology Workforce in the United States 美国泌尿生殖医学肿瘤学工作人员。

IF 2 3区医学

Urology Pub Date : 2025-09-01 DOI: 10.1016/j.urology.2025.02.026

David J. Benjamin , Arash Rezazadeh Kalebasty

{"title":"The Genitourinary Medical Oncology Workforce in the United States","authors":"David J. Benjamin , Arash Rezazadeh Kalebasty","doi":"10.1016/j.urology.2025.02.026","DOIUrl":"10.1016/j.urology.2025.02.026","url":null,"abstract":"<div><h3>Objective</h3><div>To characterize the genitourinary medical oncology workforce in the United States.</div></div><div><h3>Methods</h3><div>Utilizing the top cancer hospitals as ranked by US News & World Reports, genitourinary medical oncologists in each state of the United States were identified. Data including gender, race/ethnicity, site of medical education, and site of clinical practice were collected.</div></div><div><h3>Results</h3><div>A total of 451 genitourinary medical oncologists are involved in clinical care in the United States. Of these medical oncologists, 399 (88.5%) practice in academic settings while 52 (11.5%) practice in community-based settings. 327 (72.5%) of genitourinary medical oncologists are male, while 124 (27.5%) are female. 17 (3.8%) genitourinary medical oncologists are from under-represented minority groups in medicine (Black, Hispanic, or Native American). 321 (71.2%) genitourinary medical oncologists received training at medical schools in the US, while 130 (28.8%) trained at medical schools abroad. The Northeast US has the most genitourinary medical oncologists with 150, followed by the South with 129, the West with 97, and the Midwest with 75. Of note, seven states, including Alaska, Delaware, Idaho, Maine, North Dakota, South Dakota, and Wyoming, have no identified genitourinary medical oncologist.</div></div><div><h3>Conclusion</h3><div>Disparities based off gender, race/ethnicity, and geographic location of practice exist in the genitourinary medical oncology workforce in the United States.</div></div>","PeriodicalId":23415,"journal":{"name":"Urology","volume":"203 ","pages":"Pages 11-14"},"PeriodicalIF":2.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143473106","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Genitourinary Fellowship for Family Medicine Physicians 泌尿生殖系统家庭医学医师奖学金。

IF 2 3区医学

Urology Pub Date : 2025-09-01 DOI: 10.1016/j.urology.2025.02.025

Robert Chang, Jian Yang, Francesco Taormina, Tareq Aro, Lloyd Minsky, Tochi Iroku-Malize, Roger K. Khouri Jr, Louis R. Kavoussi

{"title":"Genitourinary Fellowship for Family Medicine Physicians","authors":"Robert Chang, Jian Yang, Francesco Taormina, Tareq Aro, Lloyd Minsky, Tochi Iroku-Malize, Roger K. Khouri Jr, Louis R. Kavoussi","doi":"10.1016/j.urology.2025.02.025","DOIUrl":"10.1016/j.urology.2025.02.025","url":null,"abstract":"<div><h3>Objective</h3><div><span>To address the significant national shortage of urologists that limits patient access to urological care by creating a novel fellowship program to train </span>family medicine physicians to provide basic urologic counseling and procedures.</div></div><div><h3>Methods</h3><div><span>We created an 18-month fellowship open to applicants who have completed a family medicine residency. The curriculum includes office, hospital, and operating room rotations in andrology, </span>endourology<span><span>, urogynecology, and </span>urologic oncology. We have enrolled a total of seven fellows beginning in 2017.</span></div></div><div><h3>Results</h3><div>The two fellows who did not complete the program were both MDs who worked for several years between residency and fellowship. Four fellows have completed the program, and one is scheduled to graduate in 2025. These five are all DOs who started the fellowship within 4<!--> <span><span>months of completing residency. All four of the graduates are currently practicing genitourinary medicine<span> full-time without the direct supervision of a urologist. All four graduates reported a current annual salary >$250,000. All four were happy with their career choices in genitourinary medicine. Their practice breakdown was approximately 80% outpatient visits, 15% bedside procedures, and 5% operating room procedures. Three of the four graduates routinely take attending urology call where they independently perform bedside procedures and ureteral </span></span>stent placements.</span></div></div><div><h3>Conclusion</h3><div>A urology fellowship for family medicine physicians can help bridge the gap for access to urological care. Graduates can safely provide basic care for patients in office and hospital settings in collaboration with urologists when necessary.</div></div>","PeriodicalId":23415,"journal":{"name":"Urology","volume":"203 ","pages":"Pages 6-8"},"PeriodicalIF":2.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143473130","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

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