General Urology Clinics Research Articles

Pelvic Floor Disorders Among Minority Women: Differences in Prevalence, Severity and Health-Related Social Needs

ObjectiveTo characterize prevalence and severity of pelvic floor disorders (PFDs) in various healthcare settings and to examine unmet Health-related Social Needs (HRSN) among minority women. Materials and MethodsMinority women with PFDs were recruited from our academic urogynecology clinic (UG), a general urology clinic at our institution’s safety net hospital (SNH), and a community outreach mobile clinic (MC). Questions from the Urinary Distress Index-6 (UDI), Pelvic Organ Prolapse Distress Inventory-6 (POPDI), and Female Genitourinary Pain Index (GUPI) were used to identify patients with stress urinary incontinence (SUI), overactive bladder (OAB) and chronic pelvic pain syndrome (CPPS). Results61 (46.6%) women identified as Hispanic, 53 (40.4%) as Black, and 17 (12.9%) as Other. Overall, self-reported PFDs included SUI in 45%, OAB in 74.8%, and CPPS in 24.4% of women. Hispanic women were more likely to report OAB symptoms, compared to Black women (OR 3.4 [1.2-10.2], p = 0.03) or Other women (OR = 5.1 [1.3-20.4], p = 0.02). Participants held a median of five unmet HRSN. Minority women facing issues with family and community support, transportation, and utilities were more likely to report CPPS symptoms, compared to those without psychosocial issues (Support OR: 4.8 [1.7-13.7], p = 0.002; Transportation OR: 2.0 [1.0-8.2], p = 0.05; Utility OR: 7.0 [1.9-28.1], p = 0.005). ConclusionMinority women with PFDs may have several unmet HRSNs which impact their ability to receive appropriate medical care. Our findings may assist in the development of effective strategies to improve healthcare outcomes for women dealing with PFDs.

Comparing Telemedicine and In-Person Clinical Evaluations for Pediatric Urology Concerns

IntroductionTelemedicine may promote equitable health care delivery, particularly in rural and underserved regions. While patient and provider satisfaction with telemedicine appear to be high, it remains unclear if telemedicine accomplishes the same clinical goals as in-person clinic visits. We undertook this study to compare the differences in history-taking, physical examination, and recommended follow-up in new pediatric urology patients seen via telemedicine and in-person. MethodsThis cross-sectional study was performed by retrospectively reviewing the charts of all new patients visiting the general pediatric urology clinic at a single freestanding children's hospital in January and April of three consecutive years (2019, 2020, 2021). Data were abstracted on patient demographics, comprehensiveness of history of present illness, completeness of physical examination, and recommended follow-up. Patients seen by telemedicine and in-person were compared. ResultsOf 1354 patients, 1244 (91.9%) had in-person and 110 (8.1%) telemedicine visits. Telemedicine patients had a median of 4 history of present illness components recorded; in-person patients had 3 (P < 0.0001). Patients seen in-person had a more comprehensive physical examination recorded compared with telemedicine patients (median 12 vs 2 systems, P < 0.0001). Significantly fewer telemedicine patients were discharged from clinic after the initial visit (2.7% vs 16.5%), and significantly more were asked to return for additional evaluation (39.1% vs 23.2, P < 0.0001). ConclusionsInitial pediatric urology telemedicine consultations gathered more historical and fewer physical examination components and were more likely to require an additional clinic visit for evaluation. Goals of care should be considered when selecting a visit modality.

Effect of COVID-19 Pandemic on Urology Clinic Attendance: Which Diseases are Important for Patients?

Introduction: We assessed whether there were changes in the characteristics of the patient population attending our urology clinic during the COVID-19 pandemic. &#x0D; Material and Method: Patients attending the general urology clinic of SB-ODU Education and Research Hospital were assessed. Dates from 3 February 2020-10 March 2020 were accepted as before the pandemic, with 11 March 2020-29 May 2020 accepted as after the pandemic. Complaints of patients on attendance were grouped as follows: benign prostate hyperplasia, ureteral diseases, kidney diseases, testis and scrotum diseases, incontinence, bladder diseases, sexually transmitted diseases, penile diseases, emergency urologic problems, sexual problems, urethral diseases, kidney and ureter stones, pediatric diseases and urologic tumors. &#x0D; Results: While 638 patients attended the urology clinic in the 1.5-month period before the pandemic, 398 patients attended in the 2.5-month period after the pandemic. Additionally, 30.9% of patients attending the clinic before the pandemic were women, while this rate fell to 23.6% after the pandemic. After the pandemic, there were statistically significant reductions identified for attendance due to BPH, ureteral diseases, kidney diseases, incontinence, bladder diseases and urethra diseases. There was no significant difference in attendance due to urinary system tumors, pediatric urologic patient group, attendance due to kidney and ureter stones, sexual problems and emergency urology problems. There were increases identified for attendance for testis and scrotum diseases and sexually-transmitted diseases. &#x0D; Conclusion: During the pandemic, the numbers of patients attending the urology clinic significantly reduced. During the pandemic, there were increases identified for attendance at our clinic for testis and scrotum diseases and sexually-transmitted diseases. While attendance reduced for many disease groups, rates of attendance for urologic emergencies, urinary tumors, pediatric patient group, stone disease and sexual problems continued as usual.

Predictors of pelvic pain in a general urology clinic population.

To assess the prevalence and predictors of chronic pelvic pain in a general urology population presenting for evaluation of unrelated non-painful complaints.Generalized pelvic pain is estimated to afflict between 6% and 26% of women and is often multifactorial in aetiology. A paucity of prospective research exists to characterize chronic pelvic pain patterns and to understand related predictors. This is a prospective, cross-sectional survey-based study of female patients presenting to a general urology clinic over a 10-month period (7/2018-5/2019). Patients completed a 32-item survey with questions pertaining to demographics, comorbidities and chronic pelvic pain characteristics. Comparison tests (chi-squared, Fisher's exact) and stepwise multivariable logistic modelling were performed to assess for predictors of chronic pelvic pain. A total of 181 women completed the survey, with a mean age of 56 years. Overall, 75 (41%) women reported chronic pelvic pain. Those with chronic pelvic pain were younger compared to those without (52 vs 59 years, p= 0.001). Univariable logistic regression analysis identified BMI, depression, fibromyalgia, overactive bladder and any bowel symptoms as possible positive predictors of chronic pelvic pain. Final best-fit multivariable model found overactive bladder, fibromyalgia and presence of bowel symptoms as independent positive predictors of chronic pelvic pain. Our study is one of the few studies that has prospectively analysed chronic pelvic pain and its predictors. The present study identified significant associations with overactive bladder, fibromyalgia and bowel symptoms. Further research is needed to better understand the aetiologies of chronic pelvic pain and the possible relationship with identified clinical predictors.

Do patients with Peyronie's disease perceive penile curvature in adults and children differently than the general population?

As perception of penile curvature varies widely, we sought to understand how adults perceive curvature and how these opinions compare with those of patients with curvature, specifically Peyronie's disease (PD). To investigate the perspectives of curvature correction from adults with and without PD, as well as differences within demographics. A cross-sectional survey was administered to adult patients and nonpatient companions in general urology clinics at 3 institutions across the United States. Men, women, and nonbinary participants were recruited. Patients were grouped as having PD vs andrology conditions without PD vs general urology conditions plus companions. The survey consisted of unlabeled 2-dimensional images of penis models with varying degrees of curvature. Participants selected images that they would want surgically corrected for themselves and their children. Univariable and multivariable analyses were performed to identify demographic variables associated with willingness to correct. Our main outcome was to detect differences in threshold to correct curvature between those with and without PD. Participants were grouped as follows: PD (n = 141), andrology (n = 132), and general (n = 302) . Respectively, 12.8%, 18.9%, and 19.9% chose not to surgically correct any degree of curvature (P = .17). For those who chose surgical correction, the mean threshold for correction was 49.7°, 51.0°, and 51.0° (P = .48); for their children, the decision not to correct any degree of curvature was 21.3%, 25.4%, and 29.3% (P = .34), which was significantly higher than correction for themselves (P < .001). The mean threshold for their children's correction was 47.7°, 53.3°, and 49.4° for the PD, andrology, and general groups (P = .53), with thresholds no different vs themselves (P = .93). On multivariable analysis, no differences were seen in demographics within the PD and andrology groups. In the general group, participants aged 45 to 54 years and those who identified as LGBTQ (lesbian, gay, bisexual, transgender, queer) had a higher threshold for correction as compared with their counterparts when factoring other demographic variables (63.2° vs 48.8°, P = .001; 62.1° vs 50.4°, P = .05). With changing times and viewpoints, this study stresses the importance of shared decision making and balancing risks and benefits to correction of penile curvature. Strengths include the broad population surveyed. Limitations include the use of artificial models. No significant differences were seen in the decision to surgically correct curvature between participants with and without PD, with participants being less likely to choose surgical correction for their children.

(510) Do Patients with Peyronie’s Disease Perceive Penile Curvature Differently than the General Population?

Abstract Introduction Perception of penile curvature (PC) varies widely, and correction of PC is in the eye of the beholder. Objective We sought to investigate if patients with Peyronie’s Disease (PD) had differing opinions on correction of PC compared to general andrology (AD) patients without PD and general urology (URO) patients. Methods A cross-sectional survey was administered to adult patients in andrology and general urology clinics at 3 geographically separate institutions. Patients were grouped with having PD vs AD vs URO conditions. The survey consisted of unlabeled images of penis models with varying degrees of PC (range 10-90°). Respondents were asked to select the images they would want surgically corrected. Univariable and multivariable analyses were performed to identify demographic variables associated with willingness to consider correction. Results Ninety-four PD, 106 AD, and 302 URO patients were recruited. When comparing the 3 groups, besides obvious gender differences with PD patients, PD patients were less in 25-34 age range and more in 55-64 age range (p=0.01 and p=0.007). PD was less represented in Mid-Atlantic (p&amp;lt;0.001). 8% of PD, 12% of AD, and 20% of URO patients chose not to surgically correct any degree of PC (p=0.001). Among those who endorsed willingness to surgically correct PC, the average threshold for correction was 52.5° (SD 13) for PD, 37.2° (SD 29.5) for AD, and 51.0° (SD 19.9) for URO patients. When comparing PD patients with AD patients, no difference in the decision to surgically correct was found (p=0.42). This was also found to be the case when comparing PD with URO (p=0.46) and PD+AD patients vs URO (p=0.67). On univariable analysis, among AD patients, those ages 55-64 were more willing to undergo PC correction at lower degrees of PC (p=0.03) but did not hold up on multivariable analysis (p=0.40). No other demographic factors among PD and AD groups were found to have an impact on willingness to undergo PC correction (Table 1). Conclusions No significant differences were seen in the decision to surgically correct PC when comparing the perspectives of patients with PD, AD, and URO. Roughly 10% of all of these patients would defer on surgical management of any degree of PC. Despite having PC, no demographic differences were seen among PD patients’ willingness to correct PC. Disclosure No

MP54-04 EXAMINING THE INFLUENCE OF RACE AND PELVIC FLOOR DISORDER SEVERITY ON HEALTH-RELATED SOCIAL NEEDS AMONG MINORITY WOMEN

You have accessJournal of UrologyCME1 Apr 2023MP54-04 EXAMINING THE INFLUENCE OF RACE AND PELVIC FLOOR DISORDER SEVERITY ON HEALTH-RELATED SOCIAL NEEDS AMONG MINORITY WOMEN Jasmine Kannikal, Sanjana Satish, Aaron Gurayah, Erin Kobetz, Katherine Amin, Ekene Enemchukwu, and Raveen Syan Jasmine KannikalJasmine Kannikal More articles by this author , Sanjana SatishSanjana Satish More articles by this author , Aaron GurayahAaron Gurayah More articles by this author , Erin KobetzErin Kobetz More articles by this author , Katherine AminKatherine Amin More articles by this author , Ekene EnemchukwuEkene Enemchukwu More articles by this author , and Raveen SyanRaveen Syan More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003307.04AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Pelvic floor disorders (PFD) affect 25% of American women 20 years or older and continues to increase in prevalence. While studies have explored racial disparities in PFD knowledge and treatment, few have analyzed the impact of health-related social needs (HRSN). This study aims to characterize unmet HRSN among minority women, as well as assess the impact of race and PFD severity. METHODS: Our IRB-approved, ongoing prospective study began recruitment in June 2022 from private urogynecology clinics; a general urology clinic at the public safety net hospital (SNH); and a community outreach mobile clinic (MC). The standardized Urinary Distress Index-6 (UDI), Pelvic Organ Prolapse Distress Inventory-6 (POPDI), and Female Genitourinary Pain Index (GUPI) were used to identify PFDs. PFDs exceeding the 33.3 (UDI) or third quartile (POPDI, GUPI) thresholds were characterized as severe. Unmet HRSN were based on the Centers for Medicare & Medicaid Services Accountable Health Communities HRSN Screening Tool: mild and severe represented <8 and >8 unmet HSRN, respectively. Chi-squared tests for PFD presence and severity by race and location were conducted using R. RESULTS: The study cohort (n=107) had a median age of 53 years [IQR 24]. 53 (49.5%) women identified as Hispanic, 38 (35.5%) as Black, and 16 (15%) as Other. Unmet HRSN ranged from 1 to 18. Private clinic participants were 20% less likely to report unmet social needs, compared to MC participants (p=0.020). No statistically significant differences in reported unmet HRSN between SNH and MC, or between racial groups, were observed. Upon chi-squared analysis, no association was found between participants with severe unmet HRSN and those scoring higher on UDI, POPDI, and GUPI (p>0.05). CONCLUSIONS: Community mobile clinic participants were more likely to report severe unmet HRSN, compared to private clinic participants. Black women have a higher prevalence of unmet HRSN, however this did not reach statistical significance with our sample size. This study contributes to an understanding of the role of social determinants of health in disease severity and access to care. This study is ongoing, with a focus on increasing our community-based participant population to better understand health determinants among underserved minorities in non-hospital settings. Source of Funding: Urology Care Foundation Research Scholar Award 2021 © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e754 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Jasmine Kannikal More articles by this author Sanjana Satish More articles by this author Aaron Gurayah More articles by this author Erin Kobetz More articles by this author Katherine Amin More articles by this author Ekene Enemchukwu More articles by this author Raveen Syan More articles by this author Expand All Advertisement PDF downloadLoading ...

Factors that influence preference for male or female urologist among underserved patients in New York City.

To examine the prevalence of patient preference for male or female urologic provider and explore which patient characteristics influence this preference. After obtaining hospital Institutional Review Board approval, a 14-question survey in English and Spanish was administered across four general urology clinic sites in a single hospital system in New York City. The survey asked demographic questions and preference for a male or a female urologist. The survey included questions pertaining to the nature of the clinic visit and subsequent provider preference as well. Statistics were performed using Stata 16 (StataCorp, College Station, TX). A total of 540 patients completed the 14-question survey. The vast majority of survey respondents identified as male (90%). The largest proportion demographic groups were those aged 41-60 (47%), Hispanic or Latino (43%), Catholic (47%), unemployed (40%) and those with a high school level of education (34%). Most patients (60%) did not have a preference for a specific gender provider, whereas 37% preferred a male provider, and 3% preferred a female provider. On univariate analysis, patient age 25-40, less than high school education level and lack of employment were significant predictors of provider gender preference (p < 0.05), with most patients indicating a male provider preference. On multivariate analysis of gender, age, education level and employment status, gender and education level were not significant predictors of preference, whereas age 25-40 and being unemployed were significant predictors (p < 0.05). Patient gender, race and religion do not appear to influence their preference to be seen by a male or a female urologist in the clinic setting. However, patient age, unemployment and potentially educational attainment were significantly associated with a provider gender preference.

Adult Patient's Opinions on Surgical Correction of Congenital Penile Curvature

ABSTRACT Introduction Congenital penile curvature is common and presents with varying levels of severity. The curvature may present during infancy or post-pubertal. Historically, treatment has consisted of surgical correction, typically with penile plication or complex grafting procedures. Most pediatric urologists recommend surgical management for penile curvature (PC) based on curvature severity, with previous work identifying ≥ 30° as a common threshold to recommend correction. Objective To assess adult patients’ opinions on willingness to consider surgical correction for PC in order to determine if this aligns with pediatric urologists’ opinions. Methods In this cross-sectional study, a survey was administered to adult patients and their partners (&amp;gt; 18 years of age) in general adult urology clinics at 3 geographically separate institutions. The survey consisted of unlabeled images of penis models with varying degrees of PC (range 10-90°). Respondents were asked to select the images they would want surgically corrected for themselves or their partners. Univariable and multivariable analyses were performed to identify demographic variables associated with willingness to consider correction (p-values &amp;lt; .05 considered significant). Results Response rate was 77% (300/388). The majority (80%) of participants chose to surgically correct PC, however 20% chose to not surgically correct any degree of PC. Most participants were male (70%), married (62%), heterosexual (92%), and did not work in healthcare (80%) (Table 1). Among those who endorsed willingness to surgically correct PC, the average threshold for correction was 40.5° (SD 25.3). On univariable analysis, there was a significant difference in willingness to undergo PC correction based on gender, age groups, sexual orientation, and region (Table 1). Male patients were more likely to consider surgery at a lower degree of PC compared to females (36.6° vs 50.6°, p&amp;lt;.001). Those who identified as heterosexual also had a lower threshold for correction compared to those identifying as LGBTQ (39.6° vs 56.4°, p=.015). Midwestern residents endorsed an average threshold for correction of 21.5° compared to other regions varying between 40° to 60° (p&amp;lt;.001). Regionality differences remained true on multivariable analysis when accounting for all demographic features (p&amp;lt;.001). Conclusions In surveying adult patients, we identified an average PC threshold of 40° beyond which surgical correction was desired. Females and LGBTQ+ participants had a higher threshold for surgical correction, but when accounting for all demographic factors, only residence in the Midwest US was associated with a lower threshold for correction. Disclosure No

Relationship between Lower Urinary Tract Symptoms and Emotional State among a Sample of Clinic Attendees of a Tertiary Care Center in Central Sri Lanka

Introduction: Lower Urinary Tract Symptoms (LUTS) is a set of symptoms that correlates to the human urinary tract. Among the many reasons associated with LUTS, numerous studies have shown an association between LUTS and the emotional state of patients. Various researches in different geographical locations have been conducted to assess this relationship between LUTS and mental health in different ways. Findings from previous studies were highly dependent on the methodologies and criteria used. The purpose of this study is to evaluate any relationship between LUTS and the emotional state of patients in a sample of clinic attendees of General Urology (GU) clinic in Teaching Hospital, Peradeniya, Sri Lanka where the emotional state is assessed through criteria for depression, anxiety and stress. Here, International Prostate Symptom Score (IPSS) is used as the screening tool to evaluate LUTS and Depression Anxiety Stress Scale-21 (DASS-21) is used to quantify the emotional state.

PD15-04 ADULT OPINIONS ON SURGICAL CORRECTION OF PENILE CURVATURE

You have accessJournal of UrologyPediatric Urology I (PD15)1 Sep 2021PD15-04 ADULT OPINIONS ON SURGICAL CORRECTION OF PENILE CURVATURE Andrew Winkelman, Jordan Holler, Matthew Ziegelmann, Benjamin Breyer, C. D. Anthony Herndon, Tal Cohen, Carlos Villanueva, and Nora Kern Andrew WinkelmanAndrew Winkelman More articles by this author , Jordan HollerJordan Holler More articles by this author , Matthew ZiegelmannMatthew Ziegelmann More articles by this author , Benjamin BreyerBenjamin Breyer More articles by this author , C. D. Anthony HerndonC. D. Anthony Herndon More articles by this author , Tal CohenTal Cohen More articles by this author , Carlos VillanuevaCarlos Villanueva More articles by this author , and Nora KernNora Kern More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000001997.04AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Pediatric urologists recommend surgical management for penile curvature (PC) based on curvature severity, with previous work identifying ≥ 30° as the average threshold. We sought to assess adults’ opinions on willingness to consider surgical correction for PC in order to determine if this aligns with pediatric urologists’ opinions. METHODS: In this cross-sectional study, a survey was administered to adult patients and their partners ( > 18 years of age) in general adult urology clinics at 3 geographically separate institutions. The survey consisted of unlabeled images of penis models with varying degrees of PC (range 10-90°). Respondents were asked to select the images they would want surgically corrected for themselves or their partners. Univariable and multivariable analyses were performed to identify demographic variables associated with willingness to consider correction (p-values < 0.05 considered significant). RESULTS: Response rate was 77% (300/388). The majority (80%) of participants chose to surgically correct PC, however 20% chose to not surgically correct any degree of PC. Most participants were male (70%), married (62%), heterosexual (92%), and did not work in healthcare (80%) (Table 1). Among those who endorsed willingness to surgically correct PC, the average threshold for correction was 40.5° (SD 25.3). On univariable analysis, there was a significant difference in willingness to undergo PC correction based on gender, age groups, sexual orientation, and region (Table 1). Male participants were more likely to consider surgery at a lower degree of PC compared to females (36.6° vs 50.6°, p<0.001). Those who identified as heterosexual also had a lower threshold for correction compared to those identifying as LGBTQ (39.6° vs 56.4°, p=0.015). Midwestern residents endorsed an average threshold for correction of 21.5° compared to other regions varying between 40° to 60° (p<0.001). Regionality differences remained true on multivariable analysis when accounting for all demographic features (p<0.001). CONCLUSIONS: In surveying adults, we identified an average PC threshold of 40° beyond which surgical correction was desired. Females and LGBTQ participants had a higher threshold for surgical correction, but when accounting for all demographic factors, only residence in the Midwest US was associated with a lower threshold for correction. Source of Funding: None © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e273-e273 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Andrew Winkelman More articles by this author Jordan Holler More articles by this author Matthew Ziegelmann More articles by this author Benjamin Breyer More articles by this author C. D. Anthony Herndon More articles by this author Tal Cohen More articles by this author Carlos Villanueva More articles by this author Nora Kern More articles by this author Expand All Advertisement Loading ...

Clinical validation of an audio-based uroflowmetry application in adult males.

Uroflowmetry is a common test to evaluate lower urinary tract symptoms. Audio-based uroflowmetry is a novel, alternative approach that determines urine flow by measuring sound. Available as a smartphone application, it has potential for screening and monitoring common urological pathologies, particularly in out-of-office environments. This study is the first to evaluate audio-based uroflowmetry in a clinical setting against the gold standard. Adult male patients (n=44) attending a general urology clinic were recruited. Audio-based uroflowmetry and conventional uroflowmetry were performed concurrently. Pearson correlation and Bland-Altman analysis were used to compare performance with respect to max flow, time to max flow, and total voiding time. Symmetric mean absolute percentage error (SMAPE) was used to compare curve shapes. Repeatability was evaluated separately in three healthy volunteers using repeat measures correlation. Among urology clinic patients, the correlation for max flow was 0.12. Correlation for time to max flow was 0.46, with limits of agreement of -120-165%. Correlation for total voiding time was 0.91, with limits of agreement of -41-38%. The SMAPE for curve shape was 32.6%, with corresponding accuracy of 67.4%. Among healthy volunteers, the repeat measures correlation for max flow was 0.72. Audio-based uroflowmetry was inconsistent in evaluating flow rate, attributable to high variability and difficult standardization for acoustic signals. Performance improved with respect to temporal variables, as well as flow curve shape. Further work evaluating intra-patient reliability and pathology-specific performance is required to fully evaluate audio-based uroflowmetry as a screening or monitoring tool.

Implementation of a nurse-led lower urinary tract symptoms (LUTS) clinic reduces general urology clinic workload in a Model 4 Hospital: a pilot study in Tallaght University Hospital.

BackgroundWith among the lowest urologist per population ratios in Europe, the demand for urology specialist review in Ireland far exceeds supply. Lower urinary tract symptoms (LUTS) account for a significant number of referrals. The traditional paradigm of every patient being reviewed in a consultant-led clinic is unsustainable. New models of care with nurse-led clinics represent an opportunity to optimise limited resources.MethodsExisting long-waiting male LUTS referrals were triaged to a specialist nurse-led LUTS clinic. After urology CNS assessment, charts were reviewed by a consultant urologist and a plan formulated. Relevant data were prospectively collected and analysed.ResultsFifty-eight new male patients with LUTS were seen over a 6-month period with an average waiting time of 15.8 months. Patients were assessed with uroflowmetry, IPSS and DRE. Mean age was 64, IPSS 14.5, Qmax 18.3 ml/s and PVR 89 ml. Thirty patients (52%) were discharged directly with lifestyle modification and medical therapy.Twenty-eight patients (48%) required one or more further investigations and subsequent review; 11 had flexible cystoscopy, 4 had urodynamics, 5 had prostate MRI, and 2 patients were listed for surgery (TURP and circumcision). The remaining 10 patients were for review post trial of lifestyle modifications and/or medical treatment. After review/investigations, 4 more patients were discharged. A total of 32 patients (55%) were discharged or listed for surgery after initial assessment. This total increased to 62% after a second review/investigations.ConclusionIntroduction of a CNS-led LUTS clinic has significantly reduced the number of patients requiring follow-up in general urology clinics, representing a quality improvement in service provision.Supplementary InformationThe online version contains supplementary material available at 10.1007/s11845-020-02428-8.

Sexual Health Inventory for Men Questionnaire as a Screening Method for Erectile Dysfunction in a General Urology Clinic.

IntroductionSexual Health Inventory for Men (SHIM) is a validated questionnaire that is widely used in urology clinics to evaluate and assess treatment efficacy for erectile dysfunction (ED).AimIn this study, we evaluated the benefit of using the SHIM questionnaire as a screening tool for ED in a general urology clinicMaterial and MethodsWe retrospectively reviewed records of patients presenting to our general urology clinic from October 2018 to June 2019. During this period, all new male urology patients who are 40 years of age or older visiting the general urology clinic for any urologic condition received the SHIM questionnaire. We excluded all patients whose chief complaint was ED, Peyronie's disease, and hypogonadism. Patients were then asked if they want treatment for ED, and those patients who did, received a full ED evaluation and treatment. Factors associated with desire for ED treatment were analyzed using logistic regression.Main Outcome MeasuresSHIM score, desire for ED treatment, and factors influencing desire for treatment.ResultsThree hundred seventy-nine patients received the SHIM questionnaire. Of which, 48 patients (12.7%) declined to fill the questionnaire. We excluded all patients presenting for sexual health issues (67 patients, 17.7%). We included the remaining 264 patients (69.6%). The mean age was 61.7 years (range 40 to 85). Older patients were more likely to want ED treatment and had lower SHIM scores. However, older than the age of 70 years, there was a decline in the number of patients wanting treatment. In a multivariate regression analysis, age between 61 and 70 years and having diabetes mellitus were associated with the desire for ED treatment.ConclusionsThe SHIM questionnaire is a useful tool in the general urology clinic. It can serve as an efficient tool to screen for and quantify ED in patients presenting for other urologic issues. Maximum benefit is seen in patients between the age of 51 and 70 years and in patients with diabetes.Alwaal A, Awad M, Boggs N, et al. Sexual Health Inventory for Men Questionnaire as a Screening Method for Erectile Dysfunction in a General Urology Clinic. Sex Med 2020;8:660–663.

Oral 34 - Introduction of a Nurse Led LUTS clinic leads to a decrease in General Urology clinic workload

Oral 34 - Introduction of a Nurse Led LUTS clinic leads to a decrease in General Urology clinic workload

Characterization and Prevalence of Female Pelvic Pain in a General Outpatient Urology Population

ObjectiveTo assess the character and prevalence of female pelvic pain in a general urology population presenting for evaluation of unrelated non-painful complaints. MethodsThis is an IRB-approved, prospective, cross-sectional survey-based assessment of pelvic pain in a general cohort of female patients presenting to a urology clinic over a 10-month period (7/2018-5/2019). Patients presenting specifically for acute painful complaints (eg, kidney stones) were excluded. Participating patients completed an original 22-item survey with questions pertaining to pelvic pain. Specific focus was placed on pain characteristics, including location, quality, frequency, exacerbating factors, and severity. Descriptive analysis, pain mapping, and plotting analyses were performed to assess pain patterns. ResultsA total of 181 women (mean age 56 years) completed the survey. Overall, 75 (41%) women reported pelvic pain. Two-thirds reported experiencing pain “often” to “always” over the preceding month. Patients described a significant variety of pain locations and qualities. The most common sites of pain were lower back (73%) and bladder (72%), while “dull/aching” was the most common pain quality. A majority (84%) of patients had multiple concurrent pain locations, with 40 unique pain location combinations being reported. Similarly, 13 and 10 unique combinations were seen with pain quality and eliciting activity, respectively. ConclusionA significant percentage of women presenting to a general urology clinic experience pelvic pain. There was wide variety of pain characteristics and unique patterns. Further research is needed to comprehensively assess pain characteristics and develop related diagnostic pathways.

PD36-05 PREVALENCE AND CHARACTERIZATION OF DYSPAREUNIA IN A GENERAL UROLOGY CLINIC POPULATION

You have accessJournal of UrologySexual Function/Dysfunction: Female (PD36)1 Apr 2020PD36-05 PREVALENCE AND CHARACTERIZATION OF DYSPAREUNIA IN A GENERAL UROLOGY CLINIC POPULATION Jacqueline Zillioux, Clinton Yeaman*, Kimberly Boatman, Sarah Krzastek, and David Rapp Jacqueline ZilliouxJacqueline Zillioux More articles by this author , Clinton Yeaman*Clinton Yeaman* More articles by this author , Kimberly BoatmanKimberly Boatman More articles by this author , Sarah KrzastekSarah Krzastek More articles by this author , and David RappDavid Rapp More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000000907.05AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Dyspareunia affects an estimated 8-22% of US women. However, a paucity of investigation exists to better understand the specific location and quality of sexual pain. We aimed to assess the specific character of dyspareunia in a general urology population presenting for evaluation of unrelated non-painful complaints. METHODS: This is an IRB-approved prospective, survey-based study of female patients presenting to a general urology clinic over a 10-month period (7/2018-5/2019). Participants were recruited and screened by a study coordinator in clinic registration, excluding those presenting specifically for a painful complaint or condition (flank pain, interstitial cystitis). Patients were given a 32-item survey with questions pertaining to sexual activity and dyspareunia, with focus on pain location, quality, frequency, and severity. Detailed anatomic figures were included to aid patients with pain localization. Analysis was performed with R programming language (3.6.1). RESULTS: A total of 181 women completed the survey, with a mean age of 56 years. Overall, fifty-three (29%) women reported dyspareunia. However, among currently sexually active women the prevalence of dyspareunia was 46% (38/83). A majority (53%) of patients indicated moderate to severe dissatisfaction with their sexual activity. Despite this finding, a significant proportion (33%) of patients with dyspareunia reported having at least weekly sexual activity. Further, the majority (60%) reported onset of pain prior to age 50. Patients reported a significant variety of pain locations and qualities (Tables 1A and 1B). Whereas women more commonly reported multiple pain locations (median 2 (IQR 1,4)), the majority (70%) endorsed only one pain quality. A significant proportion (34%) reported high or very high pain severity, with 45% having pain most or all times of sexual activity. CONCLUSIONS: A significant percentage of women presenting to a general urology clinic experience dyspareunia. Notably, patient-reported pain characteristics, including location and quality, varied significantly across women assessed. Further study is needed to understand how these characteristics may relate to different and specific etiologies of sexual pain and directed treatment options. Source of Funding: N/A © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 203Issue Supplement 4April 2020Page: e724-e725 Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.MetricsAuthor Information Jacqueline Zillioux More articles by this author Clinton Yeaman* More articles by this author Kimberly Boatman More articles by this author Sarah Krzastek More articles by this author David Rapp More articles by this author Expand All Advertisement PDF downloadLoading ...

Shockwave lithotripsy for urolithiasis: a 12-month analysis of referral data to a metropolitan Australian Hospital

Background: Extracorporeal shockwave lithotripsy (SWL) is still an important option in the treatment of renal tract stones. SWL is not without its limitations and alternatives should be considered. This study investigates the referral data to a new SWL planning meeting to identify reasons why SWL was not offered.Methods: A review of 12 months of data prospectively collected at a weekly stone meeting was supplemented with a retrospective chart analysis to identify the source of all referrals for SWL. The principal reason for diverting a patient to other stone management was noted.Results: 142 patients (median age 52 years) were referred for SWL over the 12-month period. SWL was not recommended in 40 (28.2%) patients. SWL was most commonly contraindicated due to excessive stone size±position (32.5%), anatomical complexity (25.0%) and radiolucency on x-ray (10.0%). The majority of patients who were diverted away from SWL were referred from an emergency department (32.5%) and the general urology clinics (20.0%).Conclusions: A significant portion of patients referred for SWL prove unsuitable for this method of stone clearance. This highlights an educational gap amongst clinicians regarding the indications and more importantly contraindications for SWL. Only 6.3% of total referrals originated from general practice suggesting a lack of awareness of the process of direct referral for SWL. Improving this with guidelines will relieve demand in outpatient clinics and help streamline patient care.

What's in a name? Choosing a title for a female pelvic medicine and reconstructive surgery clinic: A prospective questionnaire.

A new multidisciplinary clinic specializing in female pelvic medicine and reconstructive surgery (FPMRS) opened at our institution. We sought to assess patient preference in naming this new center, and how readability and word choice informs these preferences. We prospectively surveyed patient preference in naming this new center, as well as patient knowledge and societal perception of pelvic floor disorders. This survey was distributed to female patients presenting to general urology and gynecology clinics. There were 300 respondents out of 1000 distributed surveys. Patients preferred titles with accessible readability scores and societally neutral vocabulary. Preferred titles for the clinic were at a 6th-grade readability level. Patients preferred neutral titles that included the word "health" and disliked titles that contained the words "pelvic floor" and "dysfunction." In general, survey participants believed that "incontinence" was associated with negative connotations. Readable and neutral vocabulary in the title of the clinic are key components of patient-preferred titles for an FPMRS clinic and affect patient comfort levels in scheduling an appointment.

Prospective evaluation of a virtual urology outpatient clinic.

Outpatient department (OPD) clinics account for a significant proportion of healthcare expenditure. We report on a pilot study of a virtual outpatient clinic (VC) for urology patients as an alternative to a general urology clinic review. The study aims to assess the safety and cost-effectiveness of a virtual clinic as an alternative to general OPD review. A prospective study performed between March 2015 and December 2015 investigated the effectiveness of a VC in our institution. Eligible patients were recruited from general urology outpatient visits, from medical team members and from general practitioners (GP). Data recorded on each VC review included patient demographics, indication for referral to VC, outcome of VC and method of communication with the patient and their GP after the VC. Three hundred eighty-five patients were registered for the VC. Indications for referral included review of imaging results (n=136), doctor or patient query (n=112) and review of laboratory results (n=67). Outcomes after VC review included general OPD follow-up (n=134), discharge from urology care (n=39), referral for urological intervention (n=29) and referral for radiological investigation (n=23). VC review prevented 217 OPD clinic visits, saved €17,360 and provided a failsafe mechanism for reviewing investigation results. Two patients booked for OPD review following VC review did not receive appointments. Virtual clinic is a safe and cost-effective alternative to general OPD review in appropriately selected patients.