Urology Practice最新文献

{"title":"Impact of FDA Position Statements on Complication Rates Within 30 Days After Stress Urinary Incontinence Sling Surgery.","authors":"Arshia Aalami Harandi, Natalie Braun, Jason Kim","doi":"10.1097/UPJ.0000000000000867","DOIUrl":"10.1097/UPJ.0000000000000867","url":null,"abstract":"<p><strong>Introduction: </strong>The US Food and Drug Administration (FDA) has issued 3 notices regarding the use of synthetic material in stress urinary incontinence (SUI) sling surgeries. In 2011, the FDA published a 15-page report on the use of mesh in SUI procedures, reviewing nearly 4000 cases of adverse events including erosion, infection, pain, and difficulty urinating. This study investigated the impact of these notices on sling placement patterns and their complication rates.</p><p><strong>Methods: </strong>This was a retrospective analysis of the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database from 2008 to 2020 with current procedural terminology code 57288. Exclusion criteria included male sex, ASA class IV-V, primary surgical specialty other than urology or gynecology, or concurrent major operations (hysterectomy, colpocleisis, rectocele repair, etc).</p><p><strong>Results: </strong>Of the 79,536 surgical cases of SUI slings, 41,856 met the study criteria and were included in analysis. In the examine timeframe (2012-2014) following the 2011 FDA statement, there was a significant decline in complications after SUI sling placement and a significant increase in the number of fascial slings. Cases performed after the statement had 18% decreased odds of any complications. Cases performed by urologists had 41% reduced odds of complications compared with those performed by gynecologists. Fascial slings had 4-fold increased odds of complications.</p><p><strong>Conclusions: </strong>FDA monitoring and communication regarding implantable synthetics may influence surgical practice and outcomes. Additional study is needed to investigate whether the FDA should have more frequent communication regarding procedures with synthetic implantation.</p>","PeriodicalId":45220,"journal":{"name":"Urology Practice","volume":" ","pages":"101097UPJ0000000000000867"},"PeriodicalIF":0.8,"publicationDate":"2025-06-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144508800","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":"Advancing the Future of Urology: Initial Experience and Program Design of an Innovative Incubation and Mentorship Program.","authors":"Justin S Han, Gwen M Grimsby, Nathan Grunewald, Larissa Bresler","doi":"10.1097/UPJ.0000000000000864","DOIUrl":"10.1097/UPJ.0000000000000864","url":null,"abstract":"<p><strong>Introduction: </strong>Urology faces a growing workforce shortage, with significant implications for patient care and access particularly in rural and underserved areas. There is a critical need to attract a large and multidimensional pool of trainees to address this shortage and meet the needs represented by this patient cohort.</p><p><strong>Methods: </strong>A national, multifaceted mentorship program was developed by the AUA to attract a wide-ranging group of medical students to urology. The program includes both virtual and in-person elements, as well as the creation of a resource library and funding/incubator efforts for grassroots organizations.</p><p><strong>Results: </strong>Within 1 year, the AUA student mentorship program has grown rapidly to include 822 active users representing 610 mentees and 212 mentors in the virtual platform. Several in-person events have been held, with 70 mentees and 50 mentors participating in the most recent in-person program at the 2024 AUA Annual Meeting. Feedback from both mentees and mentors has been overwhelmingly positive (93% of mentees and 88% of mentors would recommend to others), fostering a strong sense of community and engagement.</p><p><strong>Conclusions: </strong>The creation of the AUA student mentorship program-an innovative, comprehensive, and international mentoring program-has demonstrated that a specialty society driven pipeline program can engage meaningfully with medical students and potentially help address future workforce issues.</p>","PeriodicalId":45220,"journal":{"name":"Urology Practice","volume":" ","pages":"101097UPJ0000000000000864"},"PeriodicalIF":0.8,"publicationDate":"2025-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144498340","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":"Letter: National and Location-Specific Medicare Physician Fee Reimbursement Trends in Urologic Oncology from 2002 to 2024.","authors":"Sierra N Tolbert, Kevin Koo","doi":"10.1097/UPJ.0000000000000850","DOIUrl":"10.1097/UPJ.0000000000000850","url":null,"abstract":"","PeriodicalId":45220,"journal":{"name":"Urology Practice","volume":" ","pages":"101097UPJ0000000000000850"},"PeriodicalIF":0.8,"publicationDate":"2025-06-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144334097","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":"Racial Differences in Benign Prostatic Hyperplasia Diagnosis and Management in the United States Veteran Population.","authors":"Michael K Tram, Nikolas Moring, Darren E Gemoets, Lori Lerner, Brian M Inouye, Charles Welliver","doi":"10.1097/UPJ.0000000000000859","DOIUrl":"10.1097/UPJ.0000000000000859","url":null,"abstract":"<p><strong>Introduction: </strong>Benign prostatic hyperplasia (BPH) epidemiology has been broadly investigated. However, less is known about how race affects BPH diagnosis and management. This study analyzed racial trends in the diagnosis and surgical management of BPH among US Veterans.</p><p><strong>Methods: </strong>Veterans Affairs (VA) Corporate Data Warehouse database was queried from January 1, 2000, to October 20, 2024, to identify Veterans with a diagnosis of BPH. We assessed the rates of BPH procedures and compared trends in diagnosis and surgical management across different demographics including race.</p><p><strong>Results: </strong>We identified 532,886 Veterans with BPH. Black men were diagnosed at a younger age (63.1 years) compared with White men (66.7 years, <i>P</i> < .01). Black men had a lower rate of surgical management (12.2%) compared with White men (14.6%, <i>P</i> < .01). On Cox regression, Black men had a lower likelihood of surgery when controlling for age and comorbidity status (HR 0.87, 95% CI [0.85-0.89], <i>P</i> < .01). Black men experienced a longer interval between diagnosis and surgery compared with White men (5.2 vs 4.7 years, <i>P</i> < .01). Black men had the lowest rate of transurethral resection of the prostate (65.8%) but had the highest rate of simple prostatectomy (6.7%).</p><p><strong>Conclusions: </strong>As Veterans have equal health care access through the VA system, our study provides an analysis of BPH management that is unaffected by insurance coverage disparities. Black men were diagnosed with BPH at a younger age, underwent fewer surgical procedures, and had a longer interval between diagnosis and surgery compared with White men. These findings demonstrate significant racial variations, which may contribute to existing racial disparities in healthcare.</p>","PeriodicalId":45220,"journal":{"name":"Urology Practice","volume":" ","pages":"101097UPJ0000000000000859"},"PeriodicalIF":0.8,"publicationDate":"2025-06-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144334098","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":"Does Routine Urine Culture Testing Before Endoscopic Prostate Surgery Decrease Postoperative Urinary Tract Infection? An Analysis of the Veteran Affairs Surgical Quality Improvement Program.","authors":"Muhieddine Labban, William J O'Brien, Kalpana Gupta, Lori B Lerner","doi":"10.1097/UPJ.0000000000000858","DOIUrl":"10.1097/UPJ.0000000000000858","url":null,"abstract":"<p><strong>Introduction: </strong>Endoscopic prostate surgery increases septic morbidity and mortality. While urology guidelines recommend preoperative urine testing, surgeons determine what test to obtain. It remains unknown whether preoperative urine culture (UCX) decreases postoperative UTIs in these patients.</p><p><strong>Methods: </strong>A retrospective analysis of a prospectively collected cohort of men who underwent benign prostate endoscopic surgery including transurethral resection of the prostate (TURP), laser enucleation (LEP), laser vaporization, and redo-TURP was collected through the Veteran Affairs Surgical Quality Improvement Program between 2015 and 2022. We evaluated patients with postoperative UTI within 30 days of surgery and identified factors associated with preoperative UCX testing.</p><p><strong>Results: </strong>The cohort included 22,825 veterans, with 83.5% undergoing preoperative UCX. Adjusted analysis showed no association between preoperative UCX and postoperative UTI (aOR = 0.89; 95% CI [0.72-1.10]; <i>P</i> = .29). A historically positive UCX within a year before surgery was the strongest factor associated with postoperative UTI (aOR = 1.33; 95% CI [1.13-1.57]; <i>P</i> = .001). Men who had LEP (vs TURP) were less likely to have postoperative UTI (aOR = 0.56; 95% CI [0.31-0.92]; <i>P</i> = .031). Factors associated with preoperative UCX testing included men with a historically positive UCX (aOR = 1.62; 95% CI [1.51-1.73]; <i>P</i> < .001) and undergoing LEP (vs laser vaporization; aOR = 1.83; 95% CI [1.49-2.27]; <i>P</i> < .001).</p><p><strong>Conclusions: </strong>Routine preoperative UCX testing was not associated with postoperative UTI risk in endoscopic prostate surgery. Veterans with a historically positive UCX were more likely to receive a preoperative UCX but still had higher postoperative UTI risk. It remains unclear if these patients may be better served by broader spectrum periprocedural antibiotics as opposed to culture-directed antibiotics.</p>","PeriodicalId":45220,"journal":{"name":"Urology Practice","volume":" ","pages":"101097UPJ0000000000000858"},"PeriodicalIF":0.8,"publicationDate":"2025-06-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144327185","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":"Cryotherapy and High-Intensity Focused Ultrasound: National Utilization Trends (2016-2022).","authors":"Elie Kaplan-Marans, Christopher Edwards, Michael West, Yitzchak E Katlowitz, Katiana Vazquez-Rivera, Ariel Schulman, David Silver","doi":"10.1097/UPJ.0000000000000856","DOIUrl":"10.1097/UPJ.0000000000000856","url":null,"abstract":"","PeriodicalId":45220,"journal":{"name":"Urology Practice","volume":" ","pages":"101097UPJ0000000000000856"},"PeriodicalIF":0.8,"publicationDate":"2025-06-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144327184","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":"Readability of Public-Facing Urologic Oncology Trial Summaries on ClinicalTrials.gov.","authors":"Avi S Baskin, Cameron J Britton, Lan Ahn Galloway, Daniel D Joyce","doi":"10.1097/UPJ.0000000000000855","DOIUrl":"10.1097/UPJ.0000000000000855","url":null,"abstract":"<p><strong>Purpose: </strong>To assess the readability of clinical trial brief summaries for urologic oncology studies listed on ClinicalTrials.gov and evaluate readability variation by cancer type, time, or study sponsor.</p><p><strong>Materials and methods: </strong>We analyzed all clinical trials related to 6 urologic cancers registered on ClinicalTrials.gov. We extracted the brief summary and calculated surface metrics (word count, sentence length, vocabulary size, and abbreviation count) and 5 standard readability scores including the Flesch-Kincaid Grade Level (FKGL) and Flesch Reading Ease (FRE). We used interrupted time series analysis to assess readability trends, with 2017 as the intervention point following the NIH's clear language guidance release. We categorized sponsor types (government, academic, and industry) to compare readability across sponsor groups.</p><p><strong>Results: </strong>We identified 17,175 trials across 6 cancer types. The average FKGL was 18.7 and FRE was 7.4. The median length was 24 (IQR 20-30) words. Interrupted time series analysis showed that from 2000 to 2016, brief summaries became increasingly more complex with FKGL rising and FRE decreasing (both <i>P</i> < .01). After the plain language guidance from the NIH, readability improved with FKGL decreasing and FRE increasing (both <i>P</i> < .01). Government-sponsored trials were most readable (FKGL = 16.0, FRE = 27.3), followed by academic (FKGL 18.1, FRE 8.7) and industry (FKGL 19.1, FRE 7.3); all differences were significant (<i>P</i> < .01).</p><p><strong>Conclusions: </strong>Brief summaries of urologic oncology trials on ClinicalTrials.gov remain highly complex requiring a graduate level reading ability. There is improvement since NIH's plain language directive. Efforts to enhance the clarity of clinical trial descriptions are needed to support informed patient participation.</p>","PeriodicalId":45220,"journal":{"name":"Urology Practice","volume":" ","pages":"101097UPJ0000000000000855"},"PeriodicalIF":1.7,"publicationDate":"2025-06-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144310565","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 Urology Care Hotel: Implementation of a New Model of Care for Postoperative Patients With Determination of Safety, Satisfaction, and Costs.","authors":"Jackson J S Cabo, Mahnoor Ashraf, Lisa Giocondi, Mitchell R Humphreys","doi":"10.1097/UPJ.0000000000000851","DOIUrl":"10.1097/UPJ.0000000000000851","url":null,"abstract":"<p><strong>Introduction: </strong>Urologic patients, especially comorbid patients and those traveling a significant distance from home, are often observed overnight in a hospital bed after minimally invasive procedures, resulting in additional expense. The Urology Care Hotel is a 6-bedroom stand-alone facility, established to decrease outpatient in bed occupancy. We endeavored to determine the safety, financial implications, and patient experience of this new model of care.</p><p><strong>Methods: </strong>Demographic, surgical, satisfaction, and comorbidity data were gathered for patients who stayed at least 1 night at the Care Hotel from February 1, 2022, to October 22, 2024. The primary end point was emergency room (ER) encounters and readmissions within 72 hours, whereas secondary end points were cost implications and patient satisfaction. Multivariable logistic regression was used to assess predictors of ER presentation.</p><p><strong>Results: </strong>A total of 756 postoperative urology patients stayed at the Care Hotel, with a median age of 69 years and 235 having an American Society of Anesthesiology score of ≥ 3 (32%). Forty-six (6.1%) patients presented to the ER within 72 hours of Care Hotel check-in with 10 (1.32%) requiring readmission. Logistic regression indicated that patients with American Society of Anesthesiology scores ≥ 3 were not at an increased risk of ER presentation (OR: 1.29, 95% CI: 0.68-2.36; <i>P</i> = .42). The estimated cost of a Care Hotel admission was 52.4% of estimated outpatient in a bed costs in 2024. Ninety-seven percent of Care Hotel users reported that they would recommend the service.</p><p><strong>Conclusions: </strong>Introduction of the Urology Care Hotel provided a safe option for postoperative care after minimally invasive urologic procedures with high patient satisfaction. This model of care offers increased hospital capacity while delivering significant cost savings to the institution and patient.</p>","PeriodicalId":45220,"journal":{"name":"Urology Practice","volume":" ","pages":"101097UPJ0000000000000851"},"PeriodicalIF":0.8,"publicationDate":"2025-06-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144286785","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":"Under Pressure: A Quality Improvement Initiative to Reduce Rhabdomyolysis and Hospital-Acquired Pressure Injuries Following Retroperitoneal Surgery.","authors":"Matthew Miller, Lauren Loebach, Ruben Blachman-Braun, Daniel Nethala, Braden Millan, Milan Patel, Jaskirat Saini, Karen Chandler Axelrod, Ning Miao, Xiaowei Lu, Andrew Mannes, Sandeep Gurram, W Marston Linehan, Mark W Ball","doi":"10.1097/UPJ.0000000000000852","DOIUrl":"10.1097/UPJ.0000000000000852","url":null,"abstract":"<p><strong>Introduction: </strong>Present a retrospective quality improvement analysis assessing the incidence and factors associated with elevated creatine kinase (CK) levels, clinical rhabdomyolysis, and hospital-acquired pressure injuries (HAPIs) following complex retroperitoneal surgeries before and after the implementation of The Pink Pad for intraoperative positioning.</p><p><strong>Methods: </strong>We performed a retrospective analysis of 364 patients who underwent renal or retroperitoneal surgery in the lateral decubitus position between July 2018 through July 2023. The 2 cohorts-pre-and post-Pink Pad utilization-were analyzed, each with 2.5 years of prospectively-maintained data available for analysis.</p><p><strong>Results: </strong>Three hundred forty-five patients were analyzed and of those, 153 (44.3%) had flank surgery without and 192 (55.7%) with The Pink Pad. In the whole cohort, patients who developed elevated CK values were younger, had a higher BMI, higher preoperative Cr, and longer operative time (<i>P</i> < .05). HAPIs were more frequent in younger patients, those having right-sided surgery, those with hypertension, and in patients with longer surgeries (<i>P</i> < .05). The frequency of HAPIs (without Pink Pad = 7 [4.6%] vs with Pink Pad = 2 [1%], <i>P</i> = .041), elevated CK values (without Pink Pad = 18 [11.8%] vs with Pink Pad = 0, <i>P</i> < .001), and clinical rhabdomyolysis (without Pink Pad = 9 [2.6%] vs with Pink Pad = 0, <i>P</i> < .001) was significantly lower in The Pink Pad group.</p><p><strong>Conclusions: </strong>Implementation of The Pink Pad significantly reduced rates of postoperative CK value elevation and HAPIs caused by lateral decubitus positioning. Further studies should be performed to confirm these findings.</p>","PeriodicalId":45220,"journal":{"name":"Urology Practice","volume":" ","pages":"101097UPJ0000000000000852"},"PeriodicalIF":1.7,"publicationDate":"2025-06-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12375947/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144286786","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}

{"title":"Editorial Commentary.","authors":"Richard J Boxer","doi":"10.1097/UPJ.0000000000000764","DOIUrl":"10.1097/UPJ.0000000000000764","url":null,"abstract":"","PeriodicalId":45220,"journal":{"name":"Urology Practice","volume":" ","pages":"323"},"PeriodicalIF":0.8,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143190909","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}