Urology Practice最新文献

{"title":"Editorial Commentary.","authors":"Ahmed Abdelhalim, Osama Al-Omar","doi":"10.1097/UPJ.0000000000000822","DOIUrl":"https://doi.org/10.1097/UPJ.0000000000000822","url":null,"abstract":"","PeriodicalId":45220,"journal":{"name":"Urology Practice","volume":"12 5","pages":"515-516"},"PeriodicalIF":1.7,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144973370","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}

{"title":"Editorial Comment.","authors":"Alexander Battin, Matthew A Meissner","doi":"10.1097/UPJ.0000000000000844","DOIUrl":"https://doi.org/10.1097/UPJ.0000000000000844","url":null,"abstract":"","PeriodicalId":45220,"journal":{"name":"Urology Practice","volume":"12 5","pages":"556"},"PeriodicalIF":1.7,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144973407","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}

{"title":"A Novel Electronic Health Record-Integrated Clinical Pathway for Nephrolithiasis: Development and Management Outcomes.","authors":"Soum D Lokeshwar, Ankur U Choksi, Shayan Smani, Daniel Heacock, Naga S Kanaparthy, Devin M Shaheen, Meir Dashevsky, Thomas Martin, Dinesh Singh, Piruz Motamedinia, Rohit B Sangal","doi":"10.1097/UPJ.0000000000000847","DOIUrl":"10.1097/UPJ.0000000000000847","url":null,"abstract":"<p><strong>Introduction: </strong>Acute renal colic from nephrolithiasis is a common condition in emergency departments (EDs). Variation in clinical management contributes to unnecessary opioid use, inadequate discharge planning, and repeat visits. To address these challenges, we implemented an electronic health record-integrated clinical pathway to standardize management. We aimed to enhance pain control, streamline discharge practices, and optimize overall ED patient care. This study evaluates the impact of this pathway on important nephrolithiasis management process measures.</p><p><strong>Methods: </strong>This retrospective cohort study examined patients presenting with renal colic or ureteral stones at 9 EDs in a northeast health system between January 1 and December 31, 2023. Outcomes analyzed included utilization of opioid alternatives (eg, lower-dose ketorolac and IV lidocaine), 28-day tamsulosin prescription at discharge, and time to urology follow-up. Statistical methods included Mann-Whitney <i>U</i> tests, Pearson χ² tests, and logistic regression.</p><p><strong>Results: </strong>Of 5733 patients, 585 (10.2%) were managed through the nephrolithiasis pathway, while 5148 received standard care. Pathway use increased administration of the recommended ketorolac dose (33.2% vs 26.8%, <i>P</i> = .006), intravenous lidocaine use (5.6% vs 0.8%, <i>P</i> < .001), and 28-day tamsulosin prescriptions (22.7% vs 6.8%, <i>P</i> < .001). Multivariate analysis identified pathway utilization as a significant predictor for each intervention (ketorolac 15 mg dose: OR: 1.37, 95% CI: 1.10-1.71, <i>P</i> = .004; IV lidocaine: OR: 6.54, 95% CI: 4.09-10.46, <i>P</i> < .001; tamsulosin: OR: 3.78, 95% CI: 2.97-4.79, <i>P</i> < .001).</p><p><strong>Conclusions: </strong>The electronic health record-integrated nephrolithiasis pathway effectively promoted evidence-based pain management promoting nonopioid pain control and appropriate medical expulsive therapy.</p>","PeriodicalId":45220,"journal":{"name":"Urology Practice","volume":" ","pages":"603-612"},"PeriodicalIF":1.7,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144209845","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}

{"title":"Editorial Commentary.","authors":"Salvador Jaime-Casas, Wesley Yip","doi":"10.1097/UPJ.0000000000000828","DOIUrl":"https://doi.org/10.1097/UPJ.0000000000000828","url":null,"abstract":"","PeriodicalId":45220,"journal":{"name":"Urology Practice","volume":"12 5","pages":"566-567"},"PeriodicalIF":1.7,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144973377","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}

{"title":"Editorial Commentary.","authors":"Pablo J Santamaria, Martha K Terris","doi":"10.1097/UPJ.0000000000000848","DOIUrl":"https://doi.org/10.1097/UPJ.0000000000000848","url":null,"abstract":"","PeriodicalId":45220,"journal":{"name":"Urology Practice","volume":"12 5","pages":"488"},"PeriodicalIF":1.7,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144973382","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}

{"title":"Editorial Comment.","authors":"Martin A Koyle","doi":"10.1097/UPJ.0000000000000820","DOIUrl":"https://doi.org/10.1097/UPJ.0000000000000820","url":null,"abstract":"","PeriodicalId":45220,"journal":{"name":"Urology Practice","volume":"12 5","pages":"507-516"},"PeriodicalIF":1.7,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144973389","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}

{"title":"The Impact of Do-Not-Resuscitate Orders on Outcomes of Urological Surgeries.","authors":"Behzad Abbasi, Mikołaj Frankiewicz, Nizar Hakam, Anna Faris, Benjamin M MacCurtain, Kristine E W Breyer, Benjamin N Breyer","doi":"10.1097/UPJ.0000000000000827","DOIUrl":"10.1097/UPJ.0000000000000827","url":null,"abstract":"<p><strong>Introduction: </strong>This study aims to investigate intraoperative and 30-day postoperative outcomes in patients with do-not-resuscitate orders (DNR) undergoing urological surgery.</p><p><strong>Methods: </strong>Data from the American College of Surgeons National Surgical Quality Improvement Program (2005-2012) were used to identify urology patients with documented DNR orders. Controls were propensity score-matched based on sex, age, BMI, smoking status, functional status, American Society of Anesthesiologists classification, surgery type, wound class, and comorbidities.</p><p><strong>Results: </strong>We identified 245 DNR patients and 234 matched controls. Most DNR patients were male (75%), White (69%), hypertensive (75%), and underwent minor surgeries (57%). Baseline characteristics showed no significant differences between DNR and non-DNR cohorts. Compared with non-DNR, DNR patients had higher mortality rates (14% vs 6%, <i>P</i> = .003), especially in minor surgeries (6.9% vs 2.6%, <i>P</i> = .016), shorter time from operation to death (14 days, IQR 4-22 vs 18 days, IQR 11-21, <i>P</i> = .4), longer median hospital stay (6 days, IQR 1-14 vs 1 day, IQR 0-6, <i>P</i> < .001), and extended time to discharge (3 days, IQR 1-7 vs 1 day, IQR 0-4; <i>P</i> < .001). DNR patients also had more minor postoperative complications (12% vs 6%, <i>P</i> = .025), most notably UTIs (10% vs 4.3%, <i>P</i> = .013).</p><p><strong>Conclusions: </strong>DNR patients undergoing urological surgery face higher mortality, longer hospital stays, and more minor complications. Clinicians should weigh surgical benefits against increased mortality risk, considering the lower threshold for withdrawing life support and potential failure or delays in complication management.</p>","PeriodicalId":45220,"journal":{"name":"Urology Practice","volume":" ","pages":"613-621"},"PeriodicalIF":1.7,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144037814","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}

{"title":"Variability in Health Care Utilization and Perioperative Outcomes Among Urinary Diversion Patients: Analysis of the National Surgical Quality Improvement Program Database.","authors":"Anthony Fadel, Bridget L Findlay, Alexander M Pinkhasov, Vidit Sharma, Katherine T Anderson, Boyd R Viers","doi":"10.1097/UPJ.0000000000000839","DOIUrl":"10.1097/UPJ.0000000000000839","url":null,"abstract":"<p><strong>Introduction: </strong>Bladder cancer (BC) urinary diversion (UD) outcomes remain the benchmark to which all other UDs are compared. However, a sizable proportion are performed for other invasive cancers or benign etiologies of the bladder. We aim to compare health care utilization (HU) and 30-day morbidity among benign and malignant UD etiologies.</p><p><strong>Methods: </strong>The American College of Surgeons National Surgical Quality Improvement Program was used to collect data on 20,885 patients who underwent UD for various indications: BC, gastrointestinal/gynecologic cancer (GC), radiation (R), interstitial cystitis/benign bladder, and neurogenic bladder/bowel (NGB; assigned using International Classification of Diseases codes). Risk-adjusted regression models were developed to identify predictors of HU, prolonged length of stay (PLOS), 30-day readmissions, discharge to continued care (DCC), and morbidity (30-day complications and mortality). Frailty was also compared among different etiologies using the 5-Item Frailty Index.</p><p><strong>Results: </strong>Most patients had primary BC (91%, N = 19,060). GC had the highest complication rate (71%) and PLOS (50%), R had the highest readmission rate (23%), while NGB had the highest DCC (30%). GC was the least frail (≈14% with 5-Item Frailty Index ≥2) while NGB and R were the frailest (28% and 27%, respectively, <i>P</i> < .05). Moreover, frail radiated patients had the highest HU rate (81%, <i>P</i> < .001) while frail patients with GC had the highest complication rate (77%, <i>P</i> < .001). Compared with patients with BC, adjusted odds of PLOS, DCC, and 30-day complication rates significantly differed among UD etiologies (<i>P</i> < .05), except for interstitial cystitis/benign bladder.</p><p><strong>Conclusions: </strong>Postoperative HU and morbidity are greatly influenced by UD etiology. Care management in these vulnerable patient populations requires an individualized etiology-centered approach and cannot be benchmarked against those undergoing BC UD.</p>","PeriodicalId":45220,"journal":{"name":"Urology Practice","volume":" ","pages":"548-556"},"PeriodicalIF":1.7,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144152375","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}

{"title":"Penile Prosthesis Implantation After Radical Prostatectomy in the United States.","authors":"Jacob McCann, Camilo Arenas-Gallo, Adithya Balasubramanian, Jack Millot, Leo D Dreyfuss, Manish Kuchakulla, Anyull D Bohorquez-Caballero, Edward Zhang, Stephen Rhodes, Nannan Thirumavalavan, Jonathan E Shoag","doi":"10.1097/UPJ.0000000000000831","DOIUrl":"10.1097/UPJ.0000000000000831","url":null,"abstract":"<p><strong>Introduction: </strong>The aim of this study was to describe national trends in the use of penile prosthesis implantation (PPI) after radical prostatectomy, median time to implantation postoperatively, and the predictors of implantation in the United States.</p><p><strong>Methods: </strong>The MarketScan Commercial and Medicare Claims Database was used to identify men who underwent radical prostatectomy between January 2012 and December 2021. Included participants were analyzed for postoperative PPI. Kaplan-Meier and Cox proportional hazards models were used to assess the likelihood and factors associated with undergoing PPI.</p><p><strong>Results: </strong>A total of 55,572 participants who had undergone radical prostatectomy were included (median age 60.0 years), 81% of whom had commercial insurance and 19% Medicare. The probability of undergoing PPI was 4.1% at 5 years. Overall, 1100 PPIs were observed with a median duration from radical prostatectomy to PPI of 22.9 months (IQR: 13.6-34.8). The strongest predictor of PPI was an erectile dysfunction diagnosis before radical prostatectomy (HR: 1.98; 95% CI: 1.74-2.25), followed by diabetes (HR: 1.36; 95% CI: 1.18-1.57) and Charlson Comorbidity Index ≥ 4 (HR: 1.35; 95% CI: 1.17-1.56). For those with erectile dysfunction preoperatively, the probability of undergoing PPI was 4.4% and 6.9% at 3 and 5 years, respectively.</p><p><strong>Conclusions: </strong>We found only 1 in 25 men undergoing radical prostatectomy undergo PPI with a median time to implantation of almost 2 years after radical prostatectomy. Improving awareness about PPI may improve overall utilization and quality of life in prostate cancer survivors.</p>","PeriodicalId":45220,"journal":{"name":"Urology Practice","volume":" ","pages":"541-547"},"PeriodicalIF":1.7,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144200381","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}

{"title":"Editorial Commentary.","authors":"James M Cummings","doi":"10.1097/UPJ.0000000000000835","DOIUrl":"https://doi.org/10.1097/UPJ.0000000000000835","url":null,"abstract":"","PeriodicalId":45220,"journal":{"name":"Urology Practice","volume":"12 5","pages":"602"},"PeriodicalIF":1.7,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144973395","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}