Urology最新文献

{"title":"Comprehensive Analysis of Mail-In Andrology Kits Compared to Traditional Clinic Collection","authors":"Jordan Kassab ,&nbsp;Phillip Westbrook ,&nbsp;Parth Joshi ,&nbsp;Richard Schoor","doi":"10.1016/j.urology.2025.04.023","DOIUrl":"10.1016/j.urology.2025.04.023","url":null,"abstract":"<div><h3>Objective</h3><div><span>To evaluate mail-in semen collection services for </span>cryopreservation, focusing on costs, transparency, and efficacy due to the advancements of direct access to fertility testing and treatment.</div></div><div><h3>Methods</h3><div>Using Google, we identified eight prominent companies offering mail-in sperm cryopreservation services. We analyzed their costs, storage practices, marketing strategies, and prescription requirements. For comparison, we examined academic institutions offering similar services, exploring differences in pricing, processes, and accessibility.</div></div><div><h3>Results</h3><div>The average upfront cost to process and freeze sperm was $730 (range $329 to $1575) with 10-year storage costs of $3117, on average (range $1450 to $5500), which may or may not be guaranteed to remain level. Not all services disclosed future costs such as transport, thawing, and disposal fees, with some firms being less transparent. Two firms offered client depositor storage on-site and the remainder outsourced to partner labs scattered around the country. One facility offered storage of tissue samples for men with azoospermia; none of the companies required men to have an order from their doctor to use the service.</div></div><div><h3>Conclusion</h3><div>Mail-in cryopreservation services provide convenience but present challenges, including varying costs, transparency issues, and potential limitations in medical oversight. Integrating these services into traditional healthcare settings could optimize patient outcomes and satisfaction.</div></div>","PeriodicalId":23415,"journal":{"name":"Urology","volume":"203 ","pages":"Pages 70-75"},"PeriodicalIF":2.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144062190","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}

{"title":"The Peritoneal Neovagina After Robotic-Assisted Peritoneal Flap Gender-Affirming Vaginoplasty: A Morphologic and Histologic Investigation of the Neovaginal Lining.","authors":"Jaya K Dhami, Michelle Bonapace-Potvin, Peter C Ferrin, Travis L Rice-Stitt, Daniel D Dugi, Terry K Morgan, Geolani W Dy, Blair R Peters","doi":"10.1016/j.urology.2025.08.056","DOIUrl":"10.1016/j.urology.2025.08.056","url":null,"abstract":"<p><strong>Objective: </strong>To assess histologic changes in the peritoneal neovagina following robotic-assisted peritoneal flap gender-affirming vaginoplasty (RPGAV) to better guide shared decision-making regarding vaginoplasty techniques. RPGAV uses pedicled flaps of pelvic peritoneum to form the proximal neovagina. Early reports of peritoneal vaginoplasty suggested potential for \"self-lubrication\"; however, long-term maintenance of fluid production remains uncertain.</p><p><strong>Methods: </strong>Five patients were recruited between August 2024 and March 2025. Patients included were at least 12 months post-RPGAV and had elected for vulvar revision surgery. Patients with a diagnosis of neovaginal stenosis or extensive granulation tissue were excluded. Biopsies were obtained from the peritoneal portion of the neovagina during revision surgery. Primary pathology review was blinded other than biopsy location: \"vagina\". Unblinded secondary pathology review was performed to identify diagnostic pitfalls.</p><p><strong>Results: </strong>All 5 biopsies showed stratified squamous epithelium and no residual mesothelial cells. This demonstrated metaplasia from peritoneal mesothelium to stratified squamous epithelium. Sixty percent of the biopsies showed histologic features mimicking low-grade condylomatous dysplasia. One case required p16 immunostaining to exclude moderate to high-grade dysplasia. Diffuse strong superficial hypergranulosis was a key element to exclude condyloma.</p><p><strong>Conclusion: </strong>We observed a process of metaplasia: a transition from peritoneal mesothelium to stratified squamous epithelium. While the peritoneal neovagina may produce fluid initially, it is unlikely to be maintained. There was also evidence of atypia, with histologic features mimicking low-grade condylomatous dysplasia; in the context of vaginoplasty, these findings likely represent chronic reactive changes. These histologic changes may have implications for cancer screening and tailored surveillance strategies.</p>","PeriodicalId":23415,"journal":{"name":"Urology","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144993179","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}

{"title":"Clinically Meaningful Improvements With Vibegron in Men With Overactive Bladder and Benign Prostatic Hyperplasia: A Responder Analysis of the Phase 3 COURAGE Trial.","authors":"Kenneth M Peters, Janet Owens-Grillo, Elizabeth Thomas, David Staskin, Eric S Rovner, Salim Mujais","doi":"10.1016/j.urology.2025.08.051","DOIUrl":"10.1016/j.urology.2025.08.051","url":null,"abstract":"<p><strong>Objective: </strong>To demonstrate the impact of vibegron treatment in the phase 3 COURAGE trial (NCT03902080) on clinically meaningful response parameters in men with overactive bladder (OAB) receiving pharmacological therapy for benign prostatic hyperplasia (BPH) as measured by standard, validated patient-reported outcomes.</p><p><strong>Methods: </strong>Men age ≥45 years with OAB receiving pharmacotherapy for BPH were randomly assigned 1:1 to vibegron 75 mg or placebo for 24 weeks. Participants completed bladder diaries assessing changes in micturition frequency, nocturia, and urge urinary incontinence (UUI); International Prostate Symptom Score (IPSS); and OAB questionnaire (OAB-q). Post hoc analyses assessed the percentage of responders (ie, ≤8 daily micturitions, ≤1 nightly nocturia episodes, ≤1 daily UUI episodes, ≥3-point decrease in IPSS scores, ≥10-point improvement in OAB-q subscale scores). Responder endpoints were analyzed using a Cochran-Mantel-Haenszel common risk difference estimation.</p><p><strong>Results: </strong>Of 1105 participants, 1080 were included in the analysis (vibegron, n=538; placebo, n=542). At week 12, greater percentages of participants receiving vibegron vs placebo achieved responder endpoints for micturitions (33.3% vs 20.5%, respectively; P<.0001), nocturia episodes (34.6% vs 26.8%; P=.0036), and UUI episodes (65.8% vs 53.0%; P=.0267). At week 12, greater percentages of participants receiving vibegron versus placebo achieved a ≥3-point decrease in IPSS storage, voiding, and total scores and 10-point increase in OAB-q subscale scores. Results were generally sustained through week 24.</p><p><strong>Conclusion: </strong>In this post hoc responder analysis from the phase 3 COURAGE trial, participants receiving vibegron vs placebo achieved clinically relevant reductions in bothersome OAB symptoms, as well as improvements in IPSS and OAB-q scores.</p>","PeriodicalId":23415,"journal":{"name":"Urology","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144993736","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}

{"title":"Turnover Among Early Career Advanced Practice Providers in Urology","authors":"Max J. Hyman ,&nbsp;Armaan Singh ,&nbsp;Susanne A. Quallich ,&nbsp;Ted A. Skolarus ,&nbsp;Parth K. Modi","doi":"10.1016/j.urology.2025.02.036","DOIUrl":"10.1016/j.urology.2025.02.036","url":null,"abstract":"<div><h3>Objective</h3><div>To understand the patterns and predictors of practice movement among advanced practice providers (APPs). The role of APPs in urology has grown significantly, yet early career turnover is common and remains poorly understood.</div></div><div><h3>Materials and Methods</h3><div><span>We conducted a retrospective cohort study using Medicare Data on Provider Practice and Specialty files between 2010 and 2021. We identified nurse practitioners and physician assistants who first billed Medicare Part B in urology practices. Time-to-event analysis was performed to examine the risk of practice movement, and Cox </span>proportional hazards regression models identified factors associated with movement.</div></div><div><h3>Results</h3><div>Of the 1003 APPs identified, 307 (30.6%) moved to a different practice, with a median time to movement of 14 months. Physician assistants were more likely to move compared to nurse practitioners, and APPs who moved were more often female and in practices with fewer physicians and other APPs. Most APPs who left urology transitioned to non-surgical specialties, with only 8.8% joining another urology practice.</div></div><div><h3>Conclusion</h3><div>Practice movement among APPs in urology is common in the early career and most APPs who leave urology practices go on to work in other specialties. Factors such as clinician type, gender, and practice size may influence practice movement. Our findings suggest that smaller practices may require improved strategies to retain APPs. Further work is needed to better understand reasons for this turnover and identify strategies for retention.</div></div>","PeriodicalId":23415,"journal":{"name":"Urology","volume":"203 ","pages":"Pages 16-22"},"PeriodicalIF":2.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143537766","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}

{"title":"Editorial Comment on “The Workforce: Keeping Urology Available and Accessible”","authors":"Amanda North","doi":"10.1016/j.urology.2025.02.052","DOIUrl":"10.1016/j.urology.2025.02.052","url":null,"abstract":"","PeriodicalId":23415,"journal":{"name":"Urology","volume":"203 ","pages":"Page 5"},"PeriodicalIF":2.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143586841","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}

{"title":"Paratesticular Tumors: A Systematic Review and Proposed Risk-Based Management Algorithm.","authors":"Daniel Jhang, Kirulus Amin, Ala'a Farkouh, Eli Eshaghian, Muhannad Alsyouf, Brian Hu","doi":"10.1016/j.urology.2025.08.055","DOIUrl":"10.1016/j.urology.2025.08.055","url":null,"abstract":"<p><strong>Objective: </strong>To comprehensively review the literature on paratesticular tumors and to develop a new management algorithm.</p><p><strong>Methods: </strong>A systematic review was conducted from 1980 to 2024 in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A search was performed on PUBMED to identify studies investigating paratesticular tumors, limited to cases >16 years of age. Data on histologic type, laterality, age, treatment, stage at presentation, imaging findings, follow-up, and outcomes were extracted.</p><p><strong>Results: </strong>Of 1073 articles reviewed, 85 met criteria for analysis. A total of 479 cases were reviewed: 397 malignant and 82 benign. For malignant cases, the most common presentation was painless scrotal mass, while benign cases presented with a painless scrotal mass or were identified incidentally. Radiographic characteristics were compared between malignancy and benign histology. The most common malignant and benign diagnosis was liposarcoma (40%) and adenomatoid (34%), respectively. Radical orchiectomy for malignant tumors and local excision for benign tumors were the most described treatments. Important variables identified in literature were used to develop a risk-based management algorithm.</p><p><strong>Conclusion: </strong>This first systematic review of paratesticular tumors describes clinical and radiographic characteristics stratified by malignant or benign histology. The analysis of the literature was leveraged to develop a novel management algorithm to help with clinical decision-making. OSF REGISTRY: https://doi.org/10.17605/OSF.IO/4BDUY. After extensive searching, this registry was deemed the most appropriate given that all the articles included in the analysis were non-interventional retrospective studies or case series.</p>","PeriodicalId":23415,"journal":{"name":"Urology","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144992980","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}

{"title":"Applying a Process Improvement Approach to Optimize Operating Room Turnover in Urology","authors":"Emily Huang ,&nbsp;Suyog Iswalkar ,&nbsp;Sharlyn Leh ,&nbsp;Rohit Nayak ,&nbsp;Kathleen Kobashi","doi":"10.1016/j.urology.2025.03.058","DOIUrl":"10.1016/j.urology.2025.03.058","url":null,"abstract":"<div><h3>Objective</h3><div>To apply a process improvement approach to optimizing operating room (OR) turnover time at an ambulatory surgery center.</div></div><div><h3>Methods</h3><div>Turnover was defined as the time a patient leaves the OR to the time the room is ready to receive the next patient. This process was observed multiple times to define the steps and operators involved. Each step was timed and meticulously studied to identify opportunities for improvement. New times for each step were obtained. The projected impact on the system capacity and potential financial implications were calculated using $1 per second as the “rent” of an OR.</div></div><div><h3>Results</h3><div>The OR turnover baseline time ranged from 31:45 to 42:49 minutes:seconds. Four opportunities for improvement were identified and proposed: 1) calling housekeeping earlier so they can be ready to enter the OR as the patient is being rolled out, 2) mopping the floor starting from the side of the OR where the back table is located to allow back table preparation to proceed without delay, 3) performing as much set up in the attached annex room as possible, and 4) rolling the next patient in as the scrub technician is scrubbing in and completing last minute organization. The theoretical financial benefits resulting from the implementation of these process improvements were calculated to be $1559 per turnover, with an annual saving of $2,025,000 per individual OR.</div></div><div><h3>Conclusion</h3><div>By applying process improvement techniques, the authors uncovered a multitude of opportunities to improve the OR turnover process, which, if optimized, could generate significant financial benefit.</div></div>","PeriodicalId":23415,"journal":{"name":"Urology","volume":"203 ","pages":"Pages 60-64"},"PeriodicalIF":2.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143796169","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}

{"title":"Payment Bundles for Prostatectomy: A New Way to Improve Value for Prostate Cancer Care","authors":"Yash B. Shah ,&nbsp;Vishnukamal Golla ,&nbsp;Matthew E. Nielsen ,&nbsp;Ruchika Talwar","doi":"10.1016/j.urology.2025.03.033","DOIUrl":"10.1016/j.urology.2025.03.033","url":null,"abstract":"<div><div>American healthcare expenditures exceed $4 trillion annually, with prostate cancer (PCa) accounting for $22 billion. Prostatectomy, a common treatment for PCa, incurs significant cost variability. Value-based care (VBC), emphasizing outcomes and efficiency over volume, has emerged as a potential solution. Bundled payment models, such as Medicare’s Comprehensive Care for Joint Replacement (CJR), attempt to align financial incentives with quality but face challenges, including patient variability and misaligned incentives. Building on this, the Transforming Episode Accountability Model (TEAM) introduces longitudinal, episode-based bundles for five predefined surgeries. While urologic surgeries are currently excluded, the evolving landscape presents an opportunity to implement prostatectomy-specific bundles. Urology has piloted condition-specific bundles, such as Vanderbilt University’s kidney stone bundle and the Large Urology Group Practice Association's (LUGPA) active surveillance bundle for PCa. These initiatives align incentives for comprehensive, guideline-based care but have yet to achieve widespread adoption. We propose a novel prostatectomy bundle that incentivizes urologists to optimize surgical outcomes, reduce complications, and enhance postoperative care. By incorporating disease-specific quality metrics and graded payments based on cancer severity, this model addresses critical barriers, including fair physician compensation and equity in access. Urology, uniquely positioned at the intersection of surgery and office-based care, can lead VBC innovation. TEAM’s emphasis on care coordination, equity, and quality offers a promising foundation for refining bundles. With active physician involvement in VBC design, prostatectomy-specific bundles could advance cost, efficiency, and outcomes in PCa care.</div></div>","PeriodicalId":23415,"journal":{"name":"Urology","volume":"203 ","pages":"Pages 38-41"},"PeriodicalIF":2.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143693470","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}

{"title":"Reply to Editorial Comment on “Genitourinary Fellowship for Family Medicine Physicians”","authors":"Roger K. Khouri Jr,&nbsp;Robert Chang,&nbsp;Jian Yang,&nbsp;Francesco Taormina,&nbsp;Tareq Aro,&nbsp;Lloyd Minsky,&nbsp;Tochi Iroku-Malize,&nbsp;Louis R. Kavoussi","doi":"10.1016/j.urology.2025.03.019","DOIUrl":"10.1016/j.urology.2025.03.019","url":null,"abstract":"","PeriodicalId":23415,"journal":{"name":"Urology","volume":"203 ","pages":"Page 10"},"PeriodicalIF":2.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143674561","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}

{"title":"Analyzing the Patterns of Industry Payments in Urology: A Benchmark Comparison With Other Surgical Specialties","authors":"Daniel Salevitz ,&nbsp;Madison Ransdell ,&nbsp;Chung-Yon Lin ,&nbsp;Gwen Grimsby","doi":"10.1016/j.urology.2025.05.043","DOIUrl":"10.1016/j.urology.2025.05.043","url":null,"abstract":"<div><h3>Objective</h3><div>To examine differences in industry payments across multiple surgical specialties and to examine differences in payments to pediatric urologists (PU) with other urologic subspecialists (UO).</div></div><div><h3>Methods</h3><div>The 2022 Open Payments dataset was downloaded from the Center for Medicare and Medicaid website. Industry payments were collected for urologists, otolaryngologists (ENT), orthopedic<span> (Ortho), and plastic (Plastics) surgeons for comparison. Descriptive statistics with Kruskal-Wallis and chi-square tests were performed to evaluate payment distributions across these specialties and between PU and OU.</span></div></div><div><h3>Results</h3><div>In 2022, industry payments were reported to 9686 urologists. Ortho received the highest number and dollar amount of payments, with 315,664 payments valuing nearly $600 million. Urologists received 207,961 payments at $33.5 million, Plastics with 58,446 at $93 million, and ENT with 70,006 payments and $13.7 million. The specialties had statistically significantly different distribution of payments in total number and amount of money paid (<em>P</em> &lt;.0001). PU received 906 payments and $162,826, versus OU with 207,055 payments valuing $33.4 million, and the distribution of these payments was also significantly different (<em>P</em> &lt;.0001).</div></div><div><h3>Conclusion</h3><div>The distribution of payments differed significantly across the surgical sub-specialties examined. There was also a staggering difference in industry payments between PU and other urologists, which highlights a disparity in interactions between medical device and pharmaceutical companies even within the specialty of urology.</div></div>","PeriodicalId":23415,"journal":{"name":"Urology","volume":"203 ","pages":"Pages 101-107"},"PeriodicalIF":2.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144182892","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}