Urology Practice最新文献

The Effect of Preoperative Tamsulosin on Pediatric Ureteroscopic Access: A Multi-Institutional Experience.

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Urology Practice Pub Date : 2025-03-05 DOI: 10.1097/UPJ.0000000000000793

Kayla M Meyer, Kwesi Asantey, Jonathan S Ellison, Aditya Jadcherla, Tori Kostman, Adam Ostergar, Erica J Traxel, Alethea Paradis, Joel Vetter, Douglas W Storm, Linder Wendt, Patrick Ten Eyck, Erik S Davis, Lauren McGee, Kate H Kraft

{"title":"The Effect of Preoperative Tamsulosin on Pediatric Ureteroscopic Access: A Multi-Institutional Experience.","authors":"Kayla M Meyer, Kwesi Asantey, Jonathan S Ellison, Aditya Jadcherla, Tori Kostman, Adam Ostergar, Erica J Traxel, Alethea Paradis, Joel Vetter, Douglas W Storm, Linder Wendt, Patrick Ten Eyck, Erik S Davis, Lauren McGee, Kate H Kraft","doi":"10.1097/UPJ.0000000000000793","DOIUrl":"https://doi.org/10.1097/UPJ.0000000000000793","url":null,"abstract":"Introduction: The ability to perform flexible ureteroscopy in children may be limited due to a smaller pediatric ureterovesical junction and ureteral diameter. Tamsulosin has been shown to improve success rates of ureteral instrumentation in adults. To date, the efficacy of this medication to facilitate pediatric ureteral access remains unclear.Methods: We conducted a multi-institutional retrospective review of patients aged 0-17 years who underwent ureteroscopy for the treatment of nephrolithiasis from 2013 to 2022. Patients were excluded if they had undergone ureteroscopy or ureteral stent placement within the prior year, underwent semi-rigid ureteroscopy, or had a known genitourinary abnormality. Study groups included patients prescribed 0.4 mg tamsulosin daily for at least one week preoperatively and patients who did not receive tamsulosin.Results: There were 382 patients included, with 126 in the tamsulosin group and 256 in the no tamsulosin group. Although there were no differences in gender, race, and stone characteristics between the two groups, the tamsulosin group was significantly older and had a larger BMI. One week of preoperative tamsulosin was associated with a significantly increased success of flexible ureteroscopic access on first attempt ureteroscopy, with a 24% failure in the no tamsulosin group versus a 13% failure in the tamsulosin group (p=0.010).Conclusions: Our results expand on prior research and suggest that at least one week of preoperative tamsulosin facilitates flexible ureteroscopic access in the pediatric population. These results have significant clinical implications, with the potential to reduce multiple procedures and spare children from repeat anesthetic exposures.","PeriodicalId":45220,"journal":{"name":"Urology Practice","volume":" ","pages":"101097UPJ0000000000000793"},"PeriodicalIF":0.8,"publicationDate":"2025-03-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143558294","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

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The use of an OSCE with a standardized patient actor to assess professionalism and communication for the oral certifying exam: the initial experience of the American Board of Urology.

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Urology Practice Pub Date : 2025-03-05 DOI: 10.1097/UPJ.0000000000000798

Nicholas J Lanzotti, Gary E Lemack, Andrew Jones, J Brantley Thrasher, Christopher M Gonzalez

{"title":"The use of an OSCE with a standardized patient actor to assess professionalism and communication for the oral certifying exam: the initial experience of the American Board of Urology.","authors":"Nicholas J Lanzotti, Gary E Lemack, Andrew Jones, J Brantley Thrasher, Christopher M Gonzalez","doi":"10.1097/UPJ.0000000000000798","DOIUrl":"https://doi.org/10.1097/UPJ.0000000000000798","url":null,"abstract":"Purpose: Promotion of professionalism/communication (P/C) is a strategic initiative within the American Board of Medical Specialties; however, reliable assessment of this competency in the certification process is lacking. Herein we present the findings of the American Board of Urology's (ABU) P/C Objective Structured Clinical Exam (OSCE) which was implemented on the 2023 and 2024 certifying exams.Methods: The certifying exam was administered to 694 candidates (335 in 2023 and 359 in 2024). Each candidate was administered two 5-item OSCEs and four 10-item Standard Oral Examinations (SOEs). One OSCE focused on P/C with simulated patient (SP) actors and one on diagnosis/imaging. SP actors interacted with examinees on the 10-minute P/C OSCE. A criterion-referenced standard was used for pass/fail decisions and the Rasch model was used for scoring.Results: The candidate's mean score and protocol difficulty did not differ significantly from 2023 to 2024. Reliability with the P/C and diagnostic OSCEs was similar both years. In 2023, the diagnostic OSCE had a higher average score than the P/C OSCE with both OSCEs scoring higher than the SOEs. In 2024, the average diagnostic OSCE score was higher than the P/C OSCE and SOEs which had similar scores. There was low correlation between the OSCEs and SOEs both years.Conclusion: The initial experience of P/C OSCEs on the ABU certification examination showed acceptable scoring, reliability, and low correlation with standard protocols. Initial data suggests that the P/C OSCE is a distinct construct from SOEs which specifically assesses P/C skills in the oral certification process.","PeriodicalId":45220,"journal":{"name":"Urology Practice","volume":" ","pages":"101097UPJ0000000000000798"},"PeriodicalIF":0.8,"publicationDate":"2025-03-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143558296","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

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National and Location-Specific Medicare Physician Fee Reimbursement Trends in Urologic Oncology from 2002-2024.

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Urology Practice Pub Date : 2025-03-05 DOI: 10.1097/UPJ.0000000000000795

Kyle Kopechek, Matthew Satariano, Tasha Posid, Shawn Dason

{"title":"National and Location-Specific Medicare Physician Fee Reimbursement Trends in Urologic Oncology from 2002-2024.","authors":"Kyle Kopechek, Matthew Satariano, Tasha Posid, Shawn Dason","doi":"10.1097/UPJ.0000000000000795","DOIUrl":"https://doi.org/10.1097/UPJ.0000000000000795","url":null,"abstract":"Introduction: In recent years, Medicare physician reimbursement has been a target for national healthcare spending adjustments, but detailed national and location-specific trends in urologic oncology are lacking. This study investigated reimbursement trends over the past two decades.Methods: The Centers for Medicare & Medicaid Services Physician Fee Schedule Look-Up Tool was used to extract physician reimbursement data for urologic oncology procedures from 2002 to 2024. We analyzed 20 common or relevant urologic oncology CPT codes. Reimbursement data were recorded biennially and inflation-adjusted to 2024 United States Dollars. The compound annual growth rate (CAGR) over the study period was calculated for each procedure. Location-specific reimbursement trends were analyzed for robot-assisted radical prostatectomy (RARP, CPT 55866) in all available Medicare localities (n=89).Results: Reimbursement data for the 20 procedures were retrieved with an average inflation-adjusted percent change of -41.08% from 2002-2024. For all procedures, the 2014-2024 CAGR indicated a faster rate of decline compared to the 2002-2014 CAGR. RARP showed the most significant inflation-adjusted decline. Kidney procedures experienced an average inflation-adjusted CAGR of -2.15%, bladder -2.49%, prostate -2.53%, and testicular -2.34%. Open surgeries averaged a CAGR of -2.32%, endoscopic -2.60% and laparoscopic/robotic -2.73%. Reimbursement for RARP declined across all 89 Medicare localities from 2014-2024, with slight variability in magnitude.Conclusion: Inflation-adjusted Medicare physician reimbursement has been declining for all urologic oncology procedures over the past two decades, with more substantial declines noted in recent years. As key stakeholders, urologists must remain active in policy decisions pertaining to physician reimbursement.","PeriodicalId":45220,"journal":{"name":"Urology Practice","volume":" ","pages":"101097UPJ0000000000000795"},"PeriodicalIF":0.8,"publicationDate":"2025-03-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143558061","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Higher Risk Renal Angiomyolipomas: Surveillance Remains a Safe Management Option.

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Urology Practice Pub Date : 2025-03-01 Epub Date: 2025-02-21 DOI: 10.1097/UPJ.0000000000000756

Mark T Dawidek, Juan Sebastian Arroyave Villada, Katiana Vazquez-Rivera, Hannah Fuchs, Lina Posada Calderon, Lennert Eismann, Stephen W Reese, Marc Ganz, Fourat Ridouani, Irina Ostrovnaya, Karim A Touijer, Jonathan A Coleman, Paul Russo, A Ari Hakimi

{"title":"Higher Risk Renal Angiomyolipomas: Surveillance Remains a Safe Management Option.","authors":"Mark T Dawidek, Juan Sebastian Arroyave Villada, Katiana Vazquez-Rivera, Hannah Fuchs, Lina Posada Calderon, Lennert Eismann, Stephen W Reese, Marc Ganz, Fourat Ridouani, Irina Ostrovnaya, Karim A Touijer, Jonathan A Coleman, Paul Russo, A Ari Hakimi","doi":"10.1097/UPJ.0000000000000756","DOIUrl":"10.1097/UPJ.0000000000000756","url":null,"abstract":"Introduction: This retrospective study furthers our understanding of risk factors associated with hemorrhage and intervention in renal angiomyolipomas (R-AMLs), particularly in larger tumors (≥4 cm) and in childbearing-age (CBA; younger than 50 years) women. The objective was to refine risk stratification and optimize patient management.Methods: Review of our institutional database identified patients with radiographic R-AML from 1997 to 2023. Patient characteristics, R-AML characteristics, and clinical course were collected. Patients were grouped by management trajectories and analyzed across R-AML size, sex, and CBA woman status. Growth rates were modeled using linear mixed-effects regression.Results: Of the 162 patients in this cohort, 22% had large R-AMLs (≥4 cm), of which the majority (66%) were managed with surveillance and a substantial portion (43%) never underwent intervention. The 23% of the cohort who were CBA women were similarly primarily managed with surveillance (74%), and more than half never underwent intervention (53%). The median follow-up on surveillance was 5.4 years. There was a significantly higher modeled growth rate with larger baseline tumor size, but growth rate was not affected by CBA woman status. Most cases of bleeding were in patients with markedly enlarged R-AMLs with multiple risk factors, but there were no serious adverse events.Conclusions: This study is enriched for large R-AMLs and uniquely focuses on CBA women. It reinforces the notion that most large R-AMLs are treated asymptomatically and do not necessarily represent the bleeding risk historically ascribed to them. It suggests that CBA woman status alone should not motivate R-AML treatment.","PeriodicalId":45220,"journal":{"name":"Urology Practice","volume":" ","pages":"274-280"},"PeriodicalIF":0.8,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11845299/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143059990","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Increased Tobacco Taxation Associated With Decreased Consumption and Bladder Cancer Incidence. 提高烟草税与减少烟草消费和膀胱癌发病率有关。

IF 0.8

Urology Practice Pub Date : 2025-03-01 Epub Date: 2024-10-25 DOI: 10.1097/UPJ.0000000000000743

Ryan Wong, Richard S Matulewicz, Ruchika Talwar, Kimberly A Shoenbill, Adam O Goldstein, Marc A Bjurlin

{"title":"Increased Tobacco Taxation Associated With Decreased Consumption and Bladder Cancer Incidence.","authors":"Ryan Wong, Richard S Matulewicz, Ruchika Talwar, Kimberly A Shoenbill, Adam O Goldstein, Marc A Bjurlin","doi":"10.1097/UPJ.0000000000000743","DOIUrl":"10.1097/UPJ.0000000000000743","url":null,"abstract":"Introduction: The temporal relationship between smoking exposure and bladder cancer (BC) diagnosis remains ill defined. This study aims to cross-correlate and temporally associate changes in US tobacco tax and consumption with BC incidence.Methods: US tobacco consumption, tobacco tax data, and BC incidence rates from 1975 to 2019 were retrieved. A cross-correlation lag time for tobacco tax and consumption on BC incidence was calculated while controlling for national health expenditure. Proxied lag weighted semi-log linear models were used to determine the rate of change in BC incidence rates associated with a 1% change in tobacco tax percentages on a national and state level.Results: A 1% increase in tobacco tax was associated with a 1.77% decrease in BC incidence over a 6-year period (R2 = 0.9687, P = .00044). Twenty-two states had a statistically significant decline in BC incidences correlated with increasing tobacco taxation. Reduction in BC incidence > 0.5% was observed in states along the western and eastern US borders. Montana, Utah, Nebraska, Arkansas, and Tennessee did not have decreasing BC incidences from tobacco tax increases. California had the most drastic decline in BC incidence (1.98%). Nationally, tobacco consumption decrease in 1 pack per capita was associated with a 0.47% decrease in BC incidence over a 28-year period (R2 = 0.984, P = .00011).Conclusions: Declining US tobacco consumption may indicate significant reduction in BC incidence through 2047. Primary prevention through adaptation of state-legislated tax changes may contribute to a reduction in BC incidence in states lying within the Central United States. A national tobacco tax initiative can be considered given the improvement in population health.","PeriodicalId":45220,"journal":{"name":"Urology Practice","volume":" ","pages":"250-256"},"PeriodicalIF":0.8,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142510079","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

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Reply by Authors.

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Urology Practice Pub Date : 2025-03-01 Epub Date: 2024-11-20 DOI: 10.1097/UPJ.0000000000000754

Edward K Kim, Lily A Brown, Denise Hartzell-Leggin, Uduak U Andy, Camryn E Harvie, Kristene E Whitmore, Diane K Newman, Rebecca F Hamm, Lily A Arya

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Reply: Development, Implementation, and Impact of an Electronic Medical Record Alert System for Implanted Artificial Urinary Sphincters.

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Urology Practice Pub Date : 2025-03-01 Epub Date: 2025-02-21 DOI: 10.1097/UPJ.0000000000000758

Philip Olson, Richard Kershen

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Industry-Sponsored Research Funding to Urologists in the United States Between 2014 and 2022. 2014 年至 2022 年美国泌尿科医生获得的行业赞助研究经费。

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Urology Practice Pub Date : 2025-03-01 Epub Date: 2024-10-25 DOI: 10.1097/UPJ.0000000000000742

Anju Murayama, David-Dan Nguyen, Anna-Lisa V Nguyen, Liam Murad, Alan Cheng, Dean S Elterman, Girish S Kulkarni, Naeem Bhojani, Raj Satkunasivam, Quoc-Dien Trinh, Deborah C Marshall, Christopher J D Wallis

{"title":"Industry-Sponsored Research Funding to Urologists in the United States Between 2014 and 2022.","authors":"Anju Murayama, David-Dan Nguyen, Anna-Lisa V Nguyen, Liam Murad, Alan Cheng, Dean S Elterman, Girish S Kulkarni, Naeem Bhojani, Raj Satkunasivam, Quoc-Dien Trinh, Deborah C Marshall, Christopher J D Wallis","doi":"10.1097/UPJ.0000000000000742","DOIUrl":"10.1097/UPJ.0000000000000742","url":null,"abstract":"Introduction: Urologists face challenges in obtaining public research funding, leading to increasing reliance on the industry for research support. This study aimed to examine the extent and trends in industry-sponsored research payments to urologists from 2014 to 2022 in the United States.Methods: We identified all US urologists using the Centers for Medicare and Medicaid Services National Plan and Provider Enumeration System database and extracted their industry-sponsored research payments data from the Centers for Medicare and Medicaid Services Open Payments Database. We performed descriptive analyses of the payments data.Results: Among 13,902 US urologists, 1330 (9.6%) received at least 1 industry-sponsored research payment. Urologists received $605.1 million between 2014 and 2022. Of all research payments, 98.7% ($597.4 million) were associated research payments for research where urologists served as principal investigators. The top 10% of urologists in research payments received 79.3% ($480.0 million) of total research payments. Only 0.4% ($2.3 million) of research payments were for preclinical research, whereas registered clinical trials totaled $159.0 million (26.3% of all research payments). The annual value of research payments increased from $35.2 million in 2014 to $101.7 million in 2022. The average percentage change in total payments showed a significant annual increase of 13.9% (95% CI, 11.6%-16.3%; P < .001) in value. There was no significant trend in the number of urologists receiving research payments.Conclusions: Industry-sponsored research payments to urologists are substantial and have increased in both payment amount and number over time.","PeriodicalId":45220,"journal":{"name":"Urology Practice","volume":" ","pages":"282-290"},"PeriodicalIF":0.8,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142510080","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

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A Flipped Classroom Model to Enhance Simulation Education for Percutaneous Renal Surgery.

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Urology Practice Pub Date : 2025-03-01 Epub Date: 2025-02-21 DOI: 10.1097/UPJ.0000000000000752

Robert Qi, Aaron M Potretzke, Christine W Liaw, Elizabeth N Bearrick, Bridget L Findlay, Garrett N Ungerer, Candace F Granberg, Boyd R Viers, Kevin Koo

{"title":"A Flipped Classroom Model to Enhance Simulation Education for Percutaneous Renal Surgery.","authors":"Robert Qi, Aaron M Potretzke, Christine W Liaw, Elizabeth N Bearrick, Bridget L Findlay, Garrett N Ungerer, Candace F Granberg, Boyd R Viers, Kevin Koo","doi":"10.1097/UPJ.0000000000000752","DOIUrl":"10.1097/UPJ.0000000000000752","url":null,"abstract":"Introduction: The limitations of lectures are magnified when teaching technical skills. A \"flipped classroom\" (FC) model allows learners to first review material and replaces lectures with active teacher-learner engagement. FC has been shown to improve knowledge retention, but its impact on skill acquisition is unknown. This exploratory study assesses the feasibility and learner perception of an FC model for percutaneous nephrolithotomy (PCNL) simulation.Methods: Urology residents participated in a PCNL simulation curriculum. Residents first reviewed materials on obtaining percutaneous access, followed by an in-person discussion and 4 simulation activities. Pre-/post-simulation surveys were collected regarding prior experience, confidence in skills (rating scale from 1-5, unable to perform to can perform independently), and scores on a validated Flipped Classroom Perception Instrument (agreement scale 1-5).Results: Thirteen residents with varying PCNL experience reported significantly increased confidence in obtaining access across all measures (P < .01): performing new access overall, new fluoroscopic access with bull's-eye and triangulation techniques, and using existing access. There was no difference in the increase in confidence ratings based on prior PCNL experience. FC was highly rated, with mean scores on the perception instrument 4.0 to 4.5 before and 4.2 to 4.7 after the activity. Each simulation component was perceived as highly effective (overall mean, 4.7; pre-simulation materials, 4.3; in-person discussion, 4.4; simulation, 4.8). There was no difference based on prior PCNL experience.Conclusions: An FC model was feasible and rated by learners as highly effective for teaching percutaneous renal access and significantly improved residents' skill confidence regardless of prior PCNL experience.","PeriodicalId":45220,"journal":{"name":"Urology Practice","volume":" ","pages":"187-190"},"PeriodicalIF":0.8,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143059185","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

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Reply: Fertility Preservation for Iatrogenic Infertility: Patient Barriers and Opportunities for the Reproductive Medicine Workforce.

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Urology Practice Pub Date : 2025-03-01 Epub Date: 2025-02-21 DOI: 10.1097/UPJ.0000000000000759

Emily Huang, Akhil Muthigi

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