Consultant Urologists Research Articles

Trends in disagreement with outside genitourinary pathology diagnoses at an academic center

AimsTo evaluate the frequencies and types of disagreements in a contemporary urological second-opinion consult service in order to improve pathologist awareness. MethodsFor 7 years ending 30 October 2021, records were kept of our department’s total urologic outside consultation and disagreed-upon cases. Disagreements were categorized according to specimen type and nature of conflict. All grading and staging assignments used International Society of Urological Pathology (ISUP) criteria.Statistical analyses for each specimen type included the percent disagreement. Cohen’s kappa analysis was done to measure interrater reliability on the prostate biopsies, prostatectomies, and the bladder biopsies/resections. In addition, for the prostate biopsies, the potential for change in treatment candidacy calculation (CTC), was assessed as sum of changes from cancer to non-malignant tissue or the reverse, plus changes from Gleason Grade group (GG)1 to GG ≥ 2 (3 +4 =7) or the reverse. ResultsOverall mean disagreement rate for all specimens was 15.2%. The highest rate was among 1545 prostate biopsy cases, where 410 contained disagreements (26.5%). 118 (7.6%) met criteria for CTC: 10 cases were altered from cancer to non-cancer, 38 cases downgraded from GG≥ 2 to GG1, and 70 upgraded from GG1 to GG≥ 2. Second opinion downgraded the overall highest GG more often than it upgraded it, with downgrade:upgrade ratios of 64:37 for the GG1/GG2 threshold, 79:67 for the GG2/GG3, and 14:0 for the GG3/GG4. 146 specimen parts had disagreements as to cancer vs. suspicious vs. benign, with 85 undercalled and 61 overcalled. Other rates of disagreement included: prostatectomy 34/198 (17.2%); bladder resection or biopsy 68/591 (11.5%); kidney 27/175 (15.4%); and orchiectomy 9/82 (11.0%). In bladder specimens, overgrading was 6X more frequent than undergrading; and overstaging muscularis propria invasion was 6X more frequent than understaging. ConclusionsThe review of uropathologic materials before definitive therapy can lead to changes that impact clinical decisions significantly. As an example, for prostate biopsies, candidacy for active surveillance versus definitive treatment hinges on GG1 versus 2 and this distinction constituted most CTC cases. The above findings highlight aspects of urological pathology to be emphasized to residents in training, and pathologists in practice.

Venous thromboembolism (VTE) prophylaxis following transurethral resection of the prostate (TURP): An audit of practice in Scotland

Objectives: To establish the current practice of urologists in Scotland with regard to venous thromboembolism (VTE) prophylaxis following transurethral resection of the prostate (TURP). Methods: An electronic survey was distributed to all practicing urology consultants and trainees in Scotland. Participants were asked questions regarding their current practice with regard to peri-operative VTE prophylaxis and were offered free-text responses. Findings were compared with a previous UK-wide study from 2002, and with current European Association of Urology (EAU) guidelines. Results: 56/113 (49.6%) of urologists responded to the survey. Overall, 71.4% of responding urologists prescribed pharmacological VTE prophylaxis following TURP. No urologists routinely prescribe VTE prophylaxis on discharge. 94.6% of responding urologists utilise mechanical prophylaxis in the form of thromboembolic deterrent (TED) stockings, with 35.7% of urologists discharging patients with TED stockings. No urologists reported a death from uncontrollable bleeding after TURP in the previous 10 years, whereas 10% of respondents had a patient whom had suffered a death or serious complication from a thromboembolic event following TURP in the past 10 years. A range of free-text responses were given. Conclusion: Our national audit has identified a wide variation between practice and current published guidance. These results contrast dramatically with a previous UK wide audit from 2002, which found 14% of urologists utilised pharmacological prophylaxis, 50% utilised mechanical prophylaxis only and 23% used no thromboprophylaxis at all. Recent guidance from the EAU recommends against using pharmacological prophylaxis due to the increased bleeding risk. Given that current practice does not marry with published recommendations; we believe that further research is required in this area for stronger evidence-based guidelines to be developed. Level of evidence: 4

Case - The folly of a misplaced Foley.

Traumatic Foley catheterization and malplacement is a common urological consultation. Although most urethral injuries are self-resolving, there are reports of long-standing complications, including urethral strictures, false passage formation, fistulization, and penile necrosis.1 We present a case of a malpositioned Foley catheter leading to the formation of a dorsal penile artery pseudoaneurysm resulting in transfusion-dependent anemia and severe urethrorrhagia.

Perception and satisfaction of patients after telemedicine urology consultations: A matched analysis with physicians' perspective.

During the first regional COVID-19 lockdown in March 2020, we conducted a study aimed at evaluating completeness of telemedicine consultation in urology. Of 1679 consultations, 67% were considered completely managed by phone. The aim of the present study was to assess patients' experience and satisfaction with telemedicine and to compare them with urologists' perceptions about quality and completeness of the telemedicine consultation. We contacted a randomly selected sample of patients (n=356) from our previous study to enquire about their experience. We used a home patient experience questionnaire, inspired by the Patient Experiences Questionnaire for Out-of-Hours Care (PEQOHC) and the Consumer Assessment Health Profile Survey (CAHPS). Of 356 patients contacted, 315 agreed to complete the questionnaire. Urological consultations were for non-oncological (104), oncological (121), cancer suspicion (41), and pediatric (49) indications. Mean patient satisfaction score after telemedicine consultation was 8.8/10 (median 9/10) and 86.3% of patients rated the quality of the consultation as either excellent (54.6%) or very good (31.7%). Consultations regarding cancer suspicion had the lowest score (8.3/10). Overall, 46.7% of all patients would have preferred an in-person visit outside of the pandemic situation. Among patients whose consultations were rated suboptimal by urologists, almost a third more (31.2%) would have preferred an in-person visit (p=0.03). Despite high reported patient satisfaction rates with telemedicine, it is noteworthy that nearly half of the patients would have preferred an in-person visit. Post-pandemic, it will be important to incorporate telemedicine as an alternative, while retaining and offering in-person visits.

Neurogenic lower urinary tract dysfunction in association with severity of degenerative spinal diseases: Short-term outcomes of decompression surgery.

Cervical myelopathy (CM) and lumbar canal stenosis (LCS) are common degenerative spinal diseases among the elderly, and the major associated complaints include lower urinary tract symptoms (LUTS). The aim of this study was to investigate subjective and objective urological parameters of patients undergoing decompression surgery for CM and LCS. We retrospectively reviewed patients who underwent evaluation by the International Prostate Symptom Score (IPSS) and uroflowmetry before decompression surgery for CM and LCS. Patients with comorbidities that can affect LUTS were excluded. Postoperative changes were evaluated in patients followed up within 1 month. Among referrals to urological consultations for LUTS, 231 patients were evaluated preoperatively. Moderate-severe urinary symptoms (IPSS ≥ 8) were present in 59.8% of 92 CM patients and 64.0% of 139 LCS patients. Poor voiding patterns defined as maximum urinary flow rate <12 mL/s or postvoid residual volume >100 mL were identified in 26.1% of CM and 25.2% of LCS. While IPSS did not associate with disease severity, poor voiders presented with worse Japanese Orthopedic Association scores. Moreover, poor voiders suffered for a longer period of time from orthopedic symptoms due to LCS. In followed-up patients (CM, n=32; LCS, n=47), total IPSS, storage subscores, and voiding subscores were significantly improved after surgery, as was voiding time from uroflowmetry. This study demonstrated high prevalence of lower urinary tract dysfunction of CM and LCS as well as short-term effectiveness of decompression surgery. These results would encourage urologists to consider an orthopedic consultation when lower urinary tract dysfunction is identified in patients with degenerative spinal diseases.

MP20-07 UROLOGY CONSULTATION IS ASSOCIATED WITH ADHERENCE TO IMAGING GUIDELINES AND DECREASED NEPHRECTOMY IN HIGH GRADE RENAL TRAUMA

You have accessJournal of UrologyCME1 May 2022MP20-07 UROLOGY CONSULTATION IS ASSOCIATED WITH ADHERENCE TO IMAGING GUIDELINES AND DECREASED NEPHRECTOMY IN HIGH GRADE RENAL TRAUMA Shirley Wang, Pranjal Agrawal, Mary Rostom, Nikita Gupta, Albert Holler, Isabelle Pan, Kent Stevens, Raymond Fang, Elliott Haut, Ryan Fransman, Renu Berry, and Andrew Cohen Shirley WangShirley Wang More articles by this author , Pranjal AgrawalPranjal Agrawal More articles by this author , Mary RostomMary Rostom More articles by this author , Nikita GuptaNikita Gupta More articles by this author , Albert HollerAlbert Holler More articles by this author , Isabelle PanIsabelle Pan More articles by this author , Kent StevensKent Stevens More articles by this author , Raymond FangRaymond Fang More articles by this author , Elliott HautElliott Haut More articles by this author , Ryan FransmanRyan Fransman More articles by this author , Renu BerryRenu Berry More articles by this author , and Andrew CohenAndrew Cohen More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002553.07AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Renal trauma is unique in that acute management involves the trauma team, primarily urology, or joint management. The ideal management pathway has yet to be established. We aim to describe rates of urology consultation following renal trauma and assess subsequent impact on imaging and intervention. METHODS: We conducted an IRB-approved retrospective review of patients at a Level I trauma center sustaining renal trauma between 2014 and 2021. Demographic, injury, radiologic, and intervention variables were extracted and compared by urology and trauma surgery management using chi-squared, Fischer’s exact tests, and Mann-Whitney U tests. All available images were ultimately graded using American Association for the Surgery of Trauma (AAST) scoring. Analyses were performed using STATA with p <0.05 considered significant. RESULTS: From 2014-2021, 118 patients with median age 29 (IQR 22-41) incurred renal trauma. Urology was consulted in 18 (15.3%) cases. Demographic and injury characteristics were similar between the two groups. AAST renal injury grade was transcribed in the initial radiologic reports for 49 (41.5%) of patients. Among the full cohort including AAST grade I through V injuries, urology consult was associated with greater likelihood of receiving delayed contrast imaging (50.0% vs. 17.0%, p=0.002); however, there was no significant difference in rate of follow-up imaging within 48 hours among patients with grade IV and V injuries (Table 1). In this sub-group, there was no significant difference in rates of penetrating injury or whether an initial exploratory laparotomy was conducted. Of patients with high-grade injuries, those with urology consult were less likely to undergo nephrectomy (36% vs. 79%, p=0.018). CONCLUSIONS: We observed differences in imaging patterns between renal trauma patients who are managed primarily by trauma surgery versus urology. However, the further downstream impact of these differences in imaging remains to be elucidated. Among patients with high-grade renal trauma, urology consult was associated with decreased rate of nephrectomy, highlighting the feasibility of renal salvage in a multidisciplinary trauma setting. In our center, future quality improvement may involve improved compliance with AAST Renal Trauma Grading. Source of Funding: N/A © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e319 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Shirley Wang More articles by this author Pranjal Agrawal More articles by this author Mary Rostom More articles by this author Nikita Gupta More articles by this author Albert Holler More articles by this author Isabelle Pan More articles by this author Kent Stevens More articles by this author Raymond Fang More articles by this author Elliott Haut More articles by this author Ryan Fransman More articles by this author Renu Berry More articles by this author Andrew Cohen More articles by this author Expand All Advertisement PDF DownloadLoading ...

The first year of a national-access adult Klinefelter's Syndrome multi-disciplinary team (KSMDT) clinic: patient and clinician reported outcomes

ABSTRACT Introduction Klinefelter's syndrome is the most common chromosomal abnormality seen in men, affecting 1 in 650 men. It is a group of chromosomal disorders with at least one extra X chromosome (47, XXY) occurring due to non-disjunction at the time of gametogenesis. Most adult men are diagnosed at the time of fertility investigations. However, the syndrome has an array of clinical presentations which patients require input from numerous medical specialities during their lifetime. The setting up of a national-access Klinefelter Syndrome multidisciplinary clinic (KSMDT) approach comprising Urology, Endocrinology, Genetics, Reproductive medicine, Radiology, Psychosexual medicine, a specialist pharmacist as well as a patient representative has led to improvements in fertility and long- term management and waiting times. Here we describe the patient-reported outcomes and clinician perspectives of the clinic as it approached its 1st year. Method Between 2019 and 2020, 72 patients were seen in the adult KS MDT clinic. To assess the quality of care received in the clinic, an 8 -point feedback questionnaire was given to each patient attending the clinic to fill out at the end of the clinic. The form included a space for feedback for each speciality involved. The feedback forms were reviewed by 2 individual researchers and entries were assessed using an adapted Likert scale (0 – 5). Clinicians involved in the clinic were also encouraged to attend and rate the other specialties, the effectiveness of the pre and post clinic MDTs and to describe achievements derived from KSMDT clinic team-working. Results All the patients (n = 72) took the questionnaire reported that the clinic was beneficial to their understanding of KS &amp; its management and had enough time during consultations. In terms of scoring 86% were very satisfied (score = 5) about genetic consultation compared to 92%, 82%, 82% and 88% in endocrine, fertility, psychosexual and urology consultation, respectively. Key factors influencing these positive results included the presence of an MDT, the access to a patient liaison and knowledge of support groups during the consult, digitized patient information sheets and a cohesive approach between endocrine and fertility teams. Clinician feedback was positive with all members agreeing that the pre and post clinic MDTs allowed effective pinpointing of often missed issues (e.g. hormone induction, social issues). Key milestones for the clinic included the reduction in waiting times by almost 80%, securing funding for costly hormone medication and assisted reproduction, improving sperm retrieval rates (from 11 – 29%) and a thrombo-embolism awareness programme. Conclusion The overall patient and clinician feedback for the adult KSMDT clinic was uniformly positive, with the multispecialty approach allowing communication with and between all relevant specialities on the same day, avoiding the need to come for multiple separate appointments across different sites (especially relevant during the COVID-19 era). The feedback has also been useful in developing patient information tools such as digital resources and has led to the development of a supportive community group for newly diagnosed KS men. More research is underway to investigate the complex issues affecting KS men long term, after fertility management. Disclosure Work supported by industry: no.

MP31-15 TELEUROLOGY: EXPANDING HORIZONS TO INPATIENT ECONSULTS

You have accessJournal of UrologyCME1 May 2022MP31-15 TELEUROLOGY: EXPANDING HORIZONS TO INPATIENT ECONSULTS Nathan Feiertag, Benjamin Green, Justin Loloi, Brendon Hopgood, Farzaan Kassam, Olsjon Shperdheja, Priya Dave, Jubin Matloubieh, Jennifer Nauheim, Mustufa Babar, Max Abramson, Alex Sankin, Nitya Abraham, Ahmed Aboumohamed, Alexander Small, Jillian Donnelly, Frank Lowe, Melissa Laudano, and Kara Watts Nathan FeiertagNathan Feiertag More articles by this author , Benjamin GreenBenjamin Green More articles by this author , Justin LoloiJustin Loloi More articles by this author , Brendon HopgoodBrendon Hopgood More articles by this author , Farzaan KassamFarzaan Kassam More articles by this author , Olsjon ShperdhejaOlsjon Shperdheja More articles by this author , Priya DavePriya Dave More articles by this author , Jubin MatloubiehJubin Matloubieh More articles by this author , Jennifer NauheimJennifer Nauheim More articles by this author , Mustufa BabarMustufa Babar More articles by this author , Max AbramsonMax Abramson More articles by this author , Alex SankinAlex Sankin More articles by this author , Nitya AbrahamNitya Abraham More articles by this author , Ahmed AboumohamedAhmed Aboumohamed More articles by this author , Alexander SmallAlexander Small More articles by this author , Jillian DonnellyJillian Donnelly More articles by this author , Frank LoweFrank Lowe More articles by this author , Melissa LaudanoMelissa Laudano More articles by this author , and Kara WattsKara Watts More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002580.15AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Telemedicine use rapidly increased during the COVID-19 pandemic. However, the efficacy of telemedicine in the inpatient setting has yet to be addressed. To this end, we measured patient and provider satisfaction with video and face-to-face (FTF) consults for inpatient urology consultations and sought to identify the urologic conditions most suitable for video consults. METHODS: New inpatient urology consults between August 2021-October 2021 were randomized to either video or FTF consult. Patient surveys were administered within 24 hours to assess satisfaction and perceived quality of care during the consult (3-point ordinal Likert scale). Survey results were analyzed using Mann-Whitney U tests. Participating urology attendings completed a survey assessing satisfaction and utility of both consultation mediums (3-point ordinal Likert scale), and suitability of video consults for common urologic consultation conditions (5-point ordinal Likert scale). RESULTS: A total of 48 patients were included; 23 (48%) received video consult and 25 (52%) FTF consults. There were no significant differences in age or race between the cohorts. The most common reasons for consultation were acute urinary retention (Video: 5 [22%], FTF: 5 [20%]) and urolithiasis (Video: 5 [25%], FTF: 3 [12%]). Both cohorts agreed that they were overall satisfied with their visit (Video: 22 [95.7%], FTF: 25 [100%]; p=0.297), received high-quality care (Video: 22 [95.7%], FTF: 23 [92.0%]; p=0.61), and would accept the visit modality again in the future (Video: 21 [91.3%], FTF: 25 [100%]; p=0.14). Urologists agreed on the utility of both consultation mediums, including ability to gather complete information (Video: 7 [100%], FTF: 7 [100%]) and manage the patient (Video: 6 [85.7%], FTF: 7 [100%]; p=0.71). Physician satisfaction was lower for video consult than FTF (Video: 5 [71.4%], FTF: 7 [100%]; p=0.38), and physicians were less likely to agree that video consults were satisfactory compared to FTF visits (4 [57.1%]). The most suitable urologic conditions for video consultation were elevated PSA and urinary retention (4.85±0.38), followed by urinary incontinence and nephrolithiasis (4.71±0.49). The least suitable was scrotal wall swelling (2.71±0.76). CONCLUSIONS: With increasing telemedicine utilization, video consults offer an alternative to FTF rounding that may combat difficulties of urologist shortages. Video consults enable urologists to see a wide variety of inpatient consults without hindering patient satisfaction. However, adoption of this tool will rely on physician preference and competence with video technology. Source of Funding: None © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e527 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Nathan Feiertag More articles by this author Benjamin Green More articles by this author Justin Loloi More articles by this author Brendon Hopgood More articles by this author Farzaan Kassam More articles by this author Olsjon Shperdheja More articles by this author Priya Dave More articles by this author Jubin Matloubieh More articles by this author Jennifer Nauheim More articles by this author Mustufa Babar More articles by this author Max Abramson More articles by this author Alex Sankin More articles by this author Nitya Abraham More articles by this author Ahmed Aboumohamed More articles by this author Alexander Small More articles by this author Jillian Donnelly More articles by this author Frank Lowe More articles by this author Melissa Laudano More articles by this author Kara Watts More articles by this author Expand All Advertisement PDF DownloadLoading ...

MP41-18 DIFFICULT FOLEY? A LOOK INTO DIFFICULT FOLEY CONSULTS

You have accessJournal of UrologyCME1 May 2022MP41-18 DIFFICULT FOLEY? A LOOK INTO DIFFICULT FOLEY CONSULTS Katharina Mitchell, Amr Elbakry, Caitlyn Patton, John Barnard, and Chad Morley Katharina MitchellKatharina Mitchell More articles by this author , Amr ElbakryAmr Elbakry More articles by this author , Caitlyn PattonCaitlyn Patton More articles by this author , John BarnardJohn Barnard More articles by this author , and Chad MorleyChad Morley More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002607.18AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: While urethral catheters are usually placed without issue, many factors can make placement challenging. Here we aim to further understand reasons for difficulty and the role of urology consultation. METHODS: This is a prospective study that was conducted at a tertiary care hospital from April 2018 through March 2020. We prospectively collected data on multiple parameters including patient demographics, reason for consultation determined by consulting service, consulting service, whether the patient was ICU status, and the level of, and reason for difficulty determined by the urology team. Patients were divided into two groups according to level of difficulty. RESULTS: Most consultations were male patients (88.1%). The most common reason for consultation per consulting team was inability to advance at a level of the prostate (49.5%). Advanced interventions for foley placement which were investigated included guidewire, dilation, and cystoscopy-of these the most commonly utilized was guidewire (36.6% of cases). The most common reason for difficult placement, as determined by the urologist, was inadequate technique (26.7%). The level of difficulty was determined by set criteria of interventions employed by the urologist- the most commonly ascribed was level 3 (23.8%). Most common reason for consultation in the non-difficult group was resistance at the prostate, while the most common reason for difficulty was inadequate technique. When comparing foleys placed in the difficult and non-difficult classifications- it was seen using Chi-Squared statistical analysis that there was not a statistically significant difference among the groups when comparing variables such as age, gender, weight, BMI. However, there was a statistically significant difference between the groups when examining the reason for consults and reason for difficulty determined by urologist, 0.001 and 0.000 respectively. CONCLUSIONS: Our study provides an understanding of reasons for consultations regarding foley placement and different levels and reasons for difficulty, which can help optimize and improve the process of foley placement in the hospital setting. Source of Funding: None © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e727 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Katharina Mitchell More articles by this author Amr Elbakry More articles by this author Caitlyn Patton More articles by this author John Barnard More articles by this author Chad Morley More articles by this author Expand All Advertisement PDF DownloadLoading ...

Implementation of a Standardized Renal Trauma Protocol at a Level 1 Trauma Center: 7-Year Protocol and 10-Year Institutional Review.

ObjectiveCurrent urologic renal trauma guidelines favor conservative management. In 2012, we implemented an institution-wide renal trauma protocol to standardize management. This protocol details initiation of DVT (deep vein thrombosis) prophylaxis, cessation of bed rest, and frequency of laboratory studies. We hypothesized that low-grade injuries (grade I–III) could be managed without urologic consultation and that our chemical DVT prophylaxis regimen would not pose an increased risk of hemorrhage requiring transfusion.MethodsWe performed a cross-sectional analysis of a prospectively maintained database containing all renal trauma at our institution from 2009 to 2019. We segregated injuries based on grade, presence of multi-organ trauma, and evaluated the presence and types of intervention, initiation of chemical DVT prophylaxis, and post-DVT prophylaxis hemorrhage requiring transfusion.ResultsWe identified 295 cases of renal trauma, of which 62 were isolated injuries. Forty-three of the isolated renal injuries were transferred from outside facilities, 70% of which were classified as low-grade injuries. There were 220 low-grade lacerations and 75 high-grade lacerations. No grade I or II lacerations required any interventions. Two (2.5%) grade III lacerations required IR embolization. Twenty-five (41%) grade IV lacerations required intervention, of which five were nephrectomy. Seven (54%) grade V lacerations required intervention, of which 5 were nephrectomies. Upon review of our protocol with early ambulation and DVT prophylaxis, there were no cases of isolated renal injury where initiation of either treatment resulted in delayed hemorrhage requiring transfusion or surgical intervention.ConclusionOnly 2/220 low-grade renal lacerations required intervention. Our data suggest that grade I and II renal lacerations can be managed safely without urologic consultation. Consultation is warranted for grade III injuries given the possibility of initial understaging. Furthermore, we believe our renal laceration protocol in our admittedly small, isolated sample has shown our DVT prophylaxis initiation to not pose increased risk.

Evaluation of YouTube Videos as a Source of Patient Information for Ureteric Stent Placement: A Quality Assessment Study.

ObjectiveTo assess the quality of YouTube videos on ureteric stent placement (USP) as a source of patient available.MethodsYouTube was searched using search terms “DJ stenting,” “Double J stenting,” and “ureteric stenting.” The initial 100 videos displayed with each of the above mentioned search terms were scrutinized. The selected videos reviewed by 3 independent consultant urologists against a pre-agreed scoring system based upon European Association of Urology (EAU) patient information sheet on ureteric stent placement. The videos were scored qualitatively and quantitatively based on the scores achieved in various domains of the scoring Performa. Data was also collected for the number of views, likes, dislikes, and time duration of each video.ResultsA total of 22 videos which fulfilled the inclusion criteria were reviewed. All the videos were uploaded by healthcare organizations or healthcare websites. None of the videos were classified as “Good” based on reviewer scores and only one video was classified as “acceptable.” Fourteen videos were classified as “very poor” with a score of <5/20. General information about stents was described by majority of the studies whilst preoperative information, procedure description, danger signs, and follow up were scarcely described by most videos.ConclusionMajority of YouTube videos on USP are of poor overall quality and lack pertinent information. This calls for creation of comprehensive and unbiased videos for patient information on USP.

Reproductive urologic consultation in subfertile men: predictors of establishing care and patient perceptions after abnormal semen testing

To evaluate the predictors of establishing care with a reproductive urologist (RU) among men with abnormal semen analyses (SAs) ordered by nonurologists and examine patient perceptions of abnormal SAs in the absence of RU consultation. Retrospective cohort study with cross-sectional survey. Large, integrated academic healthcare system during 2002-2019. We identified adult men undergoing initial SAs with nonurologists who had abnormalities. Patients with index SAs during 2002-2018 were included for the analysis of RU consultation. Men tested in 2019 were recruited for cross-sectional survey. Cross-sectional survey. RU consultation and accurate perception of abnormal SAs. A total of 2,283 men had abnormal SAs ordered by nonurologists, among whom 20.5% underwent RU consultation. Mixed-effect logistic regression modeling identified oligospermia as the strongest predictor of RU care (odds ratio, 3.08; 95% confidence interval, 2.43-3.90) with a significant provider-level random intercept. We observed substantial provider-level heterogeneity among nonurologists with provider-specific rates of RU evaluation ranging from 3.7% to 35.8%. We contacted 310 men who did not undergo RU consultation with a 27.2% survey response rate. Of respondents, 6.7% reported receiving an RU referral. Among men with abnormal SAs not evaluated by RU, 22.7% appropriately perceived an abnormal SA. In men with abnormal SAs diagnosed by nonurologists, the rate of RU consultation was low and associated with substantial provider-level variation among ordering providers. Patients without RU consultation reported inaccurate perceptions of their SA. Multidisciplinary efforts are needed to ensure that subfertile men receive appropriate RU evaluation.

Voiding Function and Dysfunction, Bladder Physiology and Pharmacology, and Female Urology.

Voiding Function and Dysfunction, Bladder Physiology and Pharmacology, and Female Urology.

Two methodologies of the rendezvous procedure to establish ureteral continuity from a delayed ureteral leak following pelvic surgery

BackgroundUreteral trauma recognized in the operating theater is managed, for the most part, at the same surgical procedure oftentimes with urologic consultation. A delayed urine leak presents unique problems in that direct access to the site of the leak is not possible except by a reoperative procedure. MethodsIn patients who develop delayed urine leakage following cancer surgery, the leakage may be controlled by the collaborative efforts of a urologist and interventional radiologist. Success depends on placement of a nephroureteral stent by the rendezvous procedure. ResultsThe sequence of procedures to reestablish ureteral continuity following a delayed leak are important in the successful placement of a nephroureteral stent. In the first methodology, through a percutaneous nephrostomy, a guidewire is placed in the ureter and down to the ureteral defect. The guidewire is then recovered and advanced into the bladder using a ureteroscope and grasping forceps. A nephroureteral stent is placed over the guidewire to bridge the gap and stent the ureteral defect. In the second methodology, the urologist passed a guidewire into the distal ureter, out of the ureteral defect, and into the free peritoneal space. Under fluoroscopic control, the wire loop must snare the ureteral guidewire and pull it out at the percutaneous nephrostomy. The nephroureteral stent is passed over the ureteral wire into the bladder. ConclusionsTwo different methodologies were described to complete the rendezvous procedure. It can be successful a large percentage of the time with a delayed ureteral leakage. Success requires a combined interventional radiology and urologic procedure.

A Complication Arising as a Result of a Severe COVID-19 Infection: Prostatic Infarction

A 57-year-old male patient diagnosed with coronavirus disease nearly 2 months ago and started to be treated was admitted to intensive care after 2 weeks due to the deterioration of his general condition. The patient’s general condition improved during 3 weeks of intensive care, and he was moved to the regular unit, and his catheter was removed. Three days after being discharged from the hospital, the patient went to the emergency department due to urethral bleeding and inability to urinate. The patient had urethrorrhagia and globe vesical. A cystofix was inserted as a catheter could not be inserted. Following the urology consultation, it was decided to perform a transurethral resection of the prostate surgery. The prostate was found to be fully infarcted during the operation. Three days after the surgery, his catheter was removed, and the patient urinated spontaneously. He was then discharged. It was understood that prostatic infarctions may arise as a result of COVID-19 infection.

Prostate Cancer Screening by General Practitioners in Lom&amp;#233;, Togo

Background: Prostate cancer is a common disease in men over 50 years. Only early detection by screening can guarantee a favourable outcome. Objective: The objective of the study is to report on the practice of prostate cancer screening by general practitioners in Lomé. Material and Method: This was a practice survey. A questionnaire administered to general practitioners allowed to examine the following parameters: the practitioner’s years of practice, the screening criteria, the screening tools and the factors motivating the request for urological advice. The data were analysed using the software Epi info 7.1.5. The P value was considered significant below 0.05. Results: One hundred and eighty (180) physicians average-aged 29 were administered among whom one hundred and fifty-seven (157) males and twenty-three (23) females. The average duration of the medical practice was 35.2 months (6 months - 204 months). The screening criteria were age (47.2%), family history of cancer (17.8%), and age over 50 years associated with symptoms of the low urinary tract (35%). The practitioner’s experience did not affect these criteria (p = 0.12). The screening tools were the digital rectal examination (DRE) associated with prostate specific antigen (PSA) assay (20.5%), PSA alone (29.5%), DRE alone (6.6%), suprapubic ultrasound (32.3%) and endorectal ultrasound (11.1%). The choice of the screening tool was related to the practitioner’s experience (p = 0.03). The determining factor for a urological consultation was a high PSA (>4 ng/ml) independent of the DRE. Conclusion: Prostate cancer screening is largely done by general practitioners in Lomé. However, the use of some criteria and tools for the screening is not optimal.

Impact of COVID on management of urological cases in a tertiary care non-COVID institute: A patient-centered study

Background: Health-care systems across the globe have been overwhelmed by coronavirus disease-19 (COVID 19). It has affected non-COVID patient management as well. While service, hospital-oriented data on effect of the pandemic on urological diseases have been published, there is scarce data on patient-centered issues in urology, particularly from India. Hence, we planned this study to determine the impact of COVID on management of urological cases.Materials and Methods: This is a prospective observational single-center study conducted at Indira Gandhi Institute of Medical Sciences, Patna, from April 2020 to November 2020. Consecutive non-COVID adult patients presenting to the indoor, outdoor, and telemedicine services of the urology department of our institute were included. Patients who were moribund, having altered sensorium, severe cardiorespiratory illness, unable to understand and respond, and those unwilling to participate were excluded from the study. A questionnaire-based data were collected. The same interviewer explained the questionnaire to patients in their own language (English/Hindi/Bhojpuri) either in person or telephonically and recorded the findings.Results: Two hundred consecutive patients were screened. One hundred and fifty were included in the study. Mean age of patients was 50 ± 3.2 years. One hundred and five patients were male. Thirty-eight patients had comorbid conditions. One hundred and thirty-seven patients reported delay to consult an urologist since development of the first urological symptom. The average delay was 68 ± 20 days. Thirty-two patients suffered COVID-19 disease during the urological illness. One hundred and twelve were advised for urology consultation after the first evaluation at a local health-care center. The reasons cited for delay by these patients (n = 112) were lock-down and reduced/unavailable public transport (n = 20) and fear of contacting corona infection (n = 10), both (n = 56), suffered COVID-19 (n = 18), and others (n = 8). The distance of patients' residence from the hospital was median 50 km, with interquartile range of 5–254 km. One hundred and three patients received definitive treatment and 47 were still undergoing delays due to various reasons. Sixty-two patients were advised surgery. 25 of these 62 were found to have complications due to delay.Conclusion: Delay in all aspects of management of urological illness, including consultation, work up, and definitive treatment was observed. Of all who were advised surgery, about 40% were found to have complications due to delay in surgery.

Management of Chronic Prostatitis/Chronic Pelvic Pain Syndrome

<i>Context</i>: First cause of seeking for urologic consultation in the world, chronic prostatitis is a real public health care problem. <i>Objective</i>: Analyze epidemioclinical aspect of chronic prostatitis/chronic pelvic pain syndrome (CP∕CPPS) and proceed in management assessment. <i>Patients and methods</i>: Descriptive Prospective and analytique study about all CP/CPPS admitted in our service from 1^st January 2016 to 30 October 2016. <i>Results</i>: Fifty fours (54) patients have been enrolled, accounting for 9.85% of our activities. Mean age: 36.24±13.44. The majorities (87, 50%) of our patients were celibataire or married, but living separated to their wife. They were doing anxiogenic and prolonged sitting activities (Car driver, Seller, Tailor). The most frequent (60%) clinical manifestation was Pelviperineal and/or testicular pain. Complaints were often associated to uretrovesical obstruction and irritation Signs, sexual dysfunction. Digital rectal examination tenderness was the only physical examination founding. We found solely 4 cases of PCB type II with E Coli as germ responsible. PCNB type IIIA was the most prevalent (48%). Systematical antibiotherapy based on quinolone using alone or in combination with azithromycin has been adopted. It’s associated to AINS, alpha blockers and anxiolytis. Therapeutic result has been evaluated during 4-6 months after treatment and was judged satisfactory (NIH-CPSI decrease of 6 points) for 72.50% patients. <i>Conclusion</i>: Multimodal treatment taking account to the main symptom and socioprofessional habits is the only way for good result. It necessary to found new bio markers in the aim to help for diagnostic and treatment result assessment.

Urological emergencies in a regional hospital in Senegal: a 20-month retrospective study

urological emergencies are diverse and varied, and are frequently encountered in urological practices. The purpose of this work was to study the epidemiological features and management of urological emergencies at the regional hospital of Kolda, Senegal. we conducted a retrospective and descriptive study collecting data from the medical records of all patients admitted as a urological emergency for 20 months (January 2020 and August 31, 2021). urological emergencies accounted for 3.6% of admissions to the Emergency Department and for 20.4% of urological consultations. The average age of patients was 51.9 ± 21.5 years, ranging from 1 to 98 years. Urinary retention was the most common urological emergency, observed in 249 cases (57.3%), followed by urogenital infections 89 (20.5%). Renal colic affected 48 (11%) of patients. Emergency management was based on urinary catheterization, which was performed in 193 patients (44.3%). The most common surgical procedures were suprapubic catheterization (42 patients; 51.9%) and emergency scrotal exploration (15 patients; 18.6%). in our context, urological emergencies are dominated by urinary retention due to prostatic disorders and urethral stenosis. Traumatic emergencies are uncommon.

Effectiviness, Safety and Satisfaction in Teleurology

Introduction: Telemedicine has been used as a tool for improving access to health services worldwide. The aim of the present study is thus to evaluate the effectiveness of urological consultation by videoconference, perceptions regarding safety on the part of medical teams providing video consultation services and patient satisfaction after a urological appointment. Materials and Methods: A cross-sectional, observational, and analytical study was carried out with 50 volunteers referred from the basic health unit for a urology appointment. All patients were evaluated remotely by videoconference and in person by different urology teams. Results: The study revealed that effectiveness in terms of the degree of match between diagnoses performed by video consultation and those performed in person was 92%. The urology team’s perception regarding safety, measured using an in-house safety questionnaire, was high for both videoconferencing and in-person consultations and there was no statistical difference between the two (overall safety score for video consultation compared to in-person consultation was 9.7 ± 0.8 compared to 9.6 ± 0.8 and the p-value was 0.3 for Student’s t-test). Patient satisfaction with the appointment was similarly high for both groups, averaging 9.72 ± 0.4 among patients who attended a video consultation and 9.82 ± 0.4 among those whose consultation was conducted in person, with a p-value of 0.10478 for Student’s t-test. Conclusion: Video consultation in urology is an effective way to perform diagnoses, with high levels of perceived safety among urologists and high satisfaction rates among patients.