Urological Practice Research Articles

Reply by Authors.

No AccessUrology PracticeOriginal Clinical Practice4 May 2023Reply by Authors Mahmoud A. Hijazi, Zachary J. Prebay, Anna Johnson, Samantha Wilder, Amit Patel, Rohit Mehra, James E. Montie, Sabrina L. Noyes, Mahin Mirza, Mohammad Jafri, Alon Weizer, Richard Sarle, Khurshid R. Ghani, Craig Rogers, and Brian R. Lane Mahmoud A. HijaziMahmoud A. Hijazi Oakland University William Beaumont School of Medicine, Rochester Hills, Michigan More articles by this author , Zachary J. PrebayZachary J. Prebay Department of Urology, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania More articles by this author , Anna JohnsonAnna Johnson Department of Urology, University of Michigan, Ann Arbor, Michigan More articles by this author , Samantha WilderSamantha Wilder Vattikuti Urology Institute, Henry Ford Health System, Detroit, Michigan More articles by this author , Amit PatelAmit Patel Vattikuti Urology Institute, Henry Ford Health System, Detroit, Michigan More articles by this author , Rohit MehraRohit Mehra Department of Pathology and Michigan Center for Translational Pathology, University of Michigan, Ann Arbor, Michigan More articles by this author , James E. MontieJames E. Montie Department of Urology, University of Michigan, Ann Arbor, Michigan More articles by this author , Sabrina L. NoyesSabrina L. Noyes Division of Urology, Spectrum Health, Grand Rapids, Michigan More articles by this author , Mahin MirzaMahin Mirza Department of Urology, University of Michigan, Ann Arbor, Michigan More articles by this author , Mohammad JafriMohammad Jafri Comprehensive Urology, Royal Oak, Michigan More articles by this author , Alon WeizerAlon Weizer Department of Urology, University of Michigan, Ann Arbor, Michigan More articles by this author , Richard SarleRichard Sarle Sparrow Medical Group Urologist, Lansing, Michigan More articles by this author , Khurshid R. GhaniKhurshid R. Ghani Department of Urology, University of Michigan, Ann Arbor, Michigan More articles by this author , Craig RogersCraig Rogers Vattikuti Urology Institute, Henry Ford Health System, Detroit, Michigan More articles by this author , and Brian R. LaneBrian R. Lane *Correspondence: Urologic Oncology, Michigan State University College of Human Medicine Division of Urology, Spectrum Health Hospital System, 145 MichiganSt NE, MC120, Grand Rapids, MI 49503 E-mail Address: [email protected] Division of Urology, Spectrum Health, Grand Rapids, Michigan Michigan State University College of Human Medicine, Grand Rapids, Michigan More articles by this author for the Michigan Urologic Surgery Improvement Collaborative View All Author Informationhttps://doi.org/10.1097/UPJ.0000000000000399.03AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack Citations ShareFacebookLinked InTwitterEmail "Reply by Authors." Urology Practice, Publish Ahead of Print, pp. REFERENCE 1. . Utilization of a virtual tumor board for the care of patients with renal masses: experience from a quality improvement collaborative. Urol Pract. 2023; 10(4):000-000. Google Scholar Submitted December 2, 2022; accepted March 3, 2023; published 000. © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Mahmoud A. Hijazi Oakland University William Beaumont School of Medicine, Rochester Hills, Michigan More articles by this author Zachary J. Prebay Department of Urology, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania More articles by this author Anna Johnson Department of Urology, University of Michigan, Ann Arbor, Michigan More articles by this author Samantha Wilder Vattikuti Urology Institute, Henry Ford Health System, Detroit, Michigan More articles by this author Amit Patel Vattikuti Urology Institute, Henry Ford Health System, Detroit, Michigan More articles by this author Rohit Mehra Department of Pathology and Michigan Center for Translational Pathology, University of Michigan, Ann Arbor, Michigan More articles by this author James E. Montie Department of Urology, University of Michigan, Ann Arbor, Michigan More articles by this author Sabrina L. Noyes Division of Urology, Spectrum Health, Grand Rapids, Michigan More articles by this author Mahin Mirza Department of Urology, University of Michigan, Ann Arbor, Michigan More articles by this author Mohammad Jafri Comprehensive Urology, Royal Oak, Michigan More articles by this author Alon Weizer Department of Urology, University of Michigan, Ann Arbor, Michigan More articles by this author Richard Sarle Sparrow Medical Group Urologist, Lansing, Michigan More articles by this author Khurshid R. Ghani Department of Urology, University of Michigan, Ann Arbor, Michigan More articles by this author Craig Rogers Vattikuti Urology Institute, Henry Ford Health System, Detroit, Michigan More articles by this author Brian R. Lane Division of Urology, Spectrum Health, Grand Rapids, Michigan Michigan State University College of Human Medicine, Grand Rapids, Michigan *Correspondence: Urologic Oncology, Michigan State University College of Human Medicine Division of Urology, Spectrum Health Hospital System, 145 MichiganSt NE, MC120, Grand Rapids, MI 49503 E-mail Address: [email protected] More articles by this author Expand All Submitted December 2, 2022; accepted March 3, 2023; published 000. Advertisement PDF downloadLoading ...

Editorial Commentary.

No AccessUrology PracticeOriginal Clinical Practice4 May 2023Editorial CommentaryThis article comments on the following:Utilization of a Virtual Tumor Board for the Care of Patients With Renal Masses: Experience From a Quality Improvement Collaborative Jesse B. Persily and William C. Huang Jesse B. PersilyJesse B. Persily Department of Urology, NYU Langone Health, New York, New York More articles by this author and William C. HuangWilliam C. Huang Department of Urology, NYU Langone Health, New York, New York More articles by this author View All Author Informationhttps://doi.org/10.1097/UPJ.0000000000000399.02AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack Citations ShareFacebookLinked InTwitterEmail "Editorial Commentary." Urology Practice, Publish Ahead of Print, pp. REFERENCES 1. . Utilization of a virtual tumor board for the care of patients with renal masses: experience from a quality improvement collaborative. Urol Pract. 2023; 10(4):000-000. Google Scholar 2. . Virtual tumor board increases provider attendance and case presentations. JCO Oncol Pract. 2022; 18(10):e1603-e1610 Crossref, Medline, Google Scholar 3. . A prospective observational study on the structuring process and implementation of a large regional, inter-hospital, virtual multidisciplinary tumor board on prostate cancer. Anticancer Res.2023; 43(1):501-508 Crossref, Medline, Google Scholar 4. . The impact of tumor board on cancer care: evidence from an umbrella review. BMC Health Serv Res.2020; 20(1):73. Crossref, Medline, Google Scholar Submitted December 2, 2022; accepted March 3, 2023; published 000. © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetailsRelated articlesUrology Practice4 Apr 2023Utilization of a Virtual Tumor Board for the Care of Patients With Renal Masses: Experience From a Quality Improvement Collaborative Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Jesse B. Persily Department of Urology, NYU Langone Health, New York, New York More articles by this author William C. Huang Department of Urology, NYU Langone Health, New York, New York More articles by this author Expand All Submitted December 2, 2022; accepted March 3, 2023; published 000. Advertisement PDF downloadLoading ...

Practice Competition and Treatment of Newly Diagnosed Prostate Cancer

To examine the effect of urology practice market competition on use of treatment in men with newly diagnosed prostate cancer. We performed a retrospective national cohort study of 48,067 Medicare beneficiaries with newly diagnosed prostate cancer between 2014 and 2018. The primary exposure was urology practice-level market competition. Markets were established by the flow of patients to a practice using a variable radius approach. Practice level competition was measured annually using the Herfindahl-Hirschman Index. The primary outcome was use of treatment for prostate cancer (ie, surgery, radiation, or cryotherapy) stratified by 10-year risk of noncancer mortality. Between 2014 and 2018, there was a decrease in the total percent of urologists practicing in small single-specialty groups (49%-41%) with an increase in multispecialty practices (38%-47%). After adjusting for demographic and clinical characteristics, a lower percentage of men underwent treatment in practices with low competition relative to those managed in practices with high competition (70% vs 67.0%, P <.001). Among men with the highest risk of noncancer mortality, those managed in practices in the least competitive markets were less likely to receive treatment relative to men managed by practices in the most competitive markets (48% vs 60%, P-value<.001). Reduction in competition between urology practices is not associated with greater use of treatment in men with newly diagnosed prostate cancer, particularly in those with a high risk of noncancer mortality.

Editorial Commentary.

No AccessUrology PracticeClinical Research3 May 2023Editorial CommentaryThis article comments on the following:The Feasibility and Value of a Focal Therapy Multidisciplinary Tumor Board, Including Radiographic and Pathological Overreads in Refining the Selection for High Intensity Focused Ultrasound in Prostate Cancer Patients Mitchell Sokoloff Mitchell SokoloffMitchell Sokoloff Department of Urology, University of Massachusetts Medical School, UMass Memorial Health Care, Worcester, Massachusetts More articles by this author View All Author Informationhttps://doi.org/10.1097/UPJ.0000000000000400.01AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack Citations ShareFacebookLinked InTwitterEmail "Editorial Commentary." Urology Practice, Publish Ahead of Print, pp. Reference 1. The feasibility and value of a focal therapy multidisciplinary tumor board, including radiographic and pathological overreads in refining the selection for high intensity focused ultrasound in prostate cancer patients. Urol Pract. 2023; 10(4):000. Google Scholar © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetailsRelated articlesUrology Practice16 Mar 2023The Feasibility and Value of a Focal Therapy Multidisciplinary Tumor Board, Including Radiographic and Pathological Overreads in Refining the Selection for High Intensity Focused Ultrasound in Prostate Cancer Patients Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Mitchell Sokoloff Department of Urology, University of Massachusetts Medical School, UMass Memorial Health Care, Worcester, Massachusetts More articles by this author Expand All Advertisement PDF downloadLoading ...

Radiation-induced cataract-an occult risk for urologists

Radiation-induced cataracts represent arelevant risk to people occupationally exposed to radiation. The annual limit dose for the eye lens was reduced to 20 mSv per year by German legislation (radiation protect law StrlSchG 2017; 2013/59/Euratom) based on recommendation of International Commission on Radiation Protection (2011 ICRP) to avoid radiation-induced cataracts. Is there arisk of exceeding the annual limit dose for the eye lens in routine urological practice without special radiation protection for the head? As part of aprospective, monocentric dosimetry study, of 542 different urological, fluoroscopically guided interventions, the eye lens dose was determined using aforehead dosimeter (thermo-luminescence dosemeter TLD, Chipstrate) over aperiod of 5months. An average head dose of 0.05 mSv per intervention (max. 0.29 mSv) was found with an average dose area product of 485.33 Gy/cm2. Significant influencing factors for ahigher dose were ahigher patient body mass index (BMI), alonger operation time, and ahigher dose area product. The level of experience of the surgeon showed no significant influence. With 400 procedures per year or an average of 2procedures per working day, the critical annual limit value for the eye lenses or for the risk of radiation-induced cataract would be exceeded without special protective measures. Consistently effective radiation protection of the eye lens is essential for daily work in uroradiological interventions. This may require further technical developments.

Discriminative capacity of guideline recommendations in the assessment of patients with asymptomatic microhematuria.

Asymptomatic microhematuria (aMh) remains a diagnostic challenge in urological practice: while aMh is a risk factor of urothelial carcinoma (UC), prevalence of aMh is high. Guidelines were developed to permit risk stratification and reduce diagnostic workload. This study investigates the efficacy of several recommendations. Sixty hundred eight patients with newly diagnosed aMh without previous UC from an academic referral center (A; n = 320) and a private outpatient clinic (B; n = 288) were included. All patients underwent clinical workup including medical history, urine cytology, upper tract imaging and cystoscopy. Eleven former and current guidelines were applied to each patient individually; every patient was classified as either low risk (no further workup recommended) or high risk. Furthermore, a recently developed nomogram for hematuria assessment was included. The cohort comprised 142 females and 466 males (mean age 62 [range 18-92] years). Sixty-one patients (10.0%) were diagnosed with UC. Excluding the Swedish and recent NICE guideline generally advising against urologic workup, application of 9 other recommendations would have diagnosed all UCs and saved 1.6% to 16.1% of patients from workup. For the 2020 US guideline, solely applied to cohort B, 10.6% of patients were classified as low risk. The use of the nomogram would have saved 17.1% to 25% of patients from workup. Practical relevance of current guidelines is limited as they do not sufficiently identify patients not requiring clinical work up. Thus, guideline adherence may trigger overdiagnosis and even overtreatment. New ways of risk stratification are needed to improve aMh assessment.

Sarah Faris, MD

Sarah Faris, MD

Editorial Commentary.

No AccessUrology PracticeHealth Policy1 May 2023Editorial CommentaryThis article comments on the following:eConsult Provides a Novel Opportunity to Evaluate Hematuria Referrals for Medicaid Patients in the “Real-World” Community Nicholas Lanzotti and Kristin G. Baldea Nicholas LanzottiNicholas Lanzotti Department of Urology, Loyola University Medical Center, Maywood, Illinois More articles by this author and Kristin G. BaldeaKristin G. Baldea Department of Urology, Loyola University Medical Center, Maywood, Illinois More articles by this author View All Author Informationhttps://doi.org/10.1097/UPJ.0000000000000391.01AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail "Editorial Commentary." Urology Practice, 10(3), p. 243

Attainment of early, deep prostate-specific antigen response in metastatic castration-sensitive prostate cancer: A comparison of patients initiated on apalutamide or enzalutamide.

Deep prostate-specific antigen (PSA) response, defined as a ≥90% decline in PSA (PSA90), is an important early response indicator for achieving radiographic progression-free and overall survival in patients with metastatic castration-sensitive prostate cancer (mCSPC) treated with a next-generation androgen signaling inhibitor (ASI), such as apalutamide or enzalutamide. The objective of this study was to compare deep PSA response among patients with mCSPC newly initiated on apalutamide or enzalutamide. Clinical data from 69 community urology practices in the United States were evaluated. Patients with mCSPC were classified into cohorts based on their first dispensation (index date) for apalutamide or enzalutamide and were followed until the earliest of treatment discontinuation, initiation of a new next-generation androgen receptor signaling inhibitor, end of clinical activity (including death), or end of data availability (03/05/2021). Inverse probability of treatment weights (IPTW) were used to reduce baseline confounding. PSA90 was defined as the earliest ≥90% PSA decline relative to baseline PSA. The proportion of patients achieving PSA90 and time to PSA90 were reported using weighted Kaplan-Meier analysis and weighted Cox proportional hazards models, respectively. The apalutamide and enzalutamide cohorts comprised 186 and 165 patients, respectively. Patient characteristics were generally well balanced after IPTW. By 6 months, patients initiated on apalutamide had a 56% greater likelihood of attaining PSA90 than those initiated on enzalutamide (P = 0.014). This result remained significant through the end of the observation period. The median time to achieving PSA90 was 3.1 months with apalutamide and 5.2 months with enzalutamide. This real-world study demonstrated that apalutamide initiation is associated with a significantly higher likelihood of achieving ≥90% reduction in PSA as compared to initiation of enzalutamide. Moreover, this deep PSA response was observed to occur earlier with apalutamide treatment than with enzalutamide.

Comparison of prostate-specific antigen response in patients with metastatic castration-sensitive prostate cancer initiated on apalutamide or abiraterone acetate: A retrospective cohort study.

Deep prostate-specific antigen (PSA) response (≥90% reduction in PSA [PSA90]) is an important early response indicator of radiographic progression-free survival and overall survival in patients with metastatic castration-sensitive prostate cancer (mCSPC). This study compared PSA90 responses by 6 months between patients with mCSPC at first use of apalutamide or abiraterone acetate, both androgen receptor signaling inhibitors. Clinical data from 77 community urology practices in the United States were analyzed. Patients with mCSPC were classified into treatment cohorts based on their first filled prescription (index date) for apalutamide or abiraterone acetate on or after September 17, 2019 (approval date of apalutamide for mCSPC). Patients were followed from the index date until the earliest of index treatment discontinuation, treatment switch, end of clinical activity, or end of data availability (September 17, 2021). Inverse probability of treatment weighting (IPTW) was used to ensure similarity in distribution of baseline characteristics between cohorts. PSA90 was defined as the earliest attainment of ≥90% reduction in PSA relative to baseline (most recent value within 13 weeks pre-index). Time to PSA90 between cohorts was compared by weighted Kaplan-Meier analysis and with Cox proportional hazards models. A total of 364 patients treated with apalutamide and 147 treated with abiraterone acetate met the study criteria. Patient characteristics were well balanced after IPTW. By 6 months post-index, patients initiated on apalutamide were 53% more likely to achieve PSA90 than those initiated on abiraterone acetate (P = 0.016). Similar results were observed by 9 and 12 months post-index (both P ≤ 0.019). The median time to PSA90 was 3.5 months for the apalutamide cohort and not reached for the abiraterone acetate cohort. In real-world patients with mCSPC, significantly more patients achieved PSA90 with apalutamide than with abiraterone acetate, and this response was achieved earlier with apalutamide.

Factors affecting the postoperative quality of life and psychological well-being in pediatric urology patients

While most studies in pediatric urology investigate the clinical results, very few explore the relationship between surgery and quality of life and psychosocial well-being in pediatric urology practice. The determination of the effects of the surgical method on the quality of life (QoL) is of increasing importance. This study investigated the effect of surgery type on the postoperative QoL and psychological well-being of pediatric urological surgery patients. A total of 151 children and adolescents (4-18 years old) undergoing elective urological surgery between September 2020 and July 2021 were evaluated preoperatively; those who currently had psychiatric disorders were excluded. Of the 98 patients undergoing subsequent detailed preoperative assessment using standardized instruments to evaluate QoL and depression and anxiety symptom levels, only 63 could be re-evaluated postoperatively at a 6-month follow-up. Additionally, preoperative parental psychiatric symptom load was assessed using standardized self-report forms. The patients were classified into two categories for analysis-open versus endourological surgery and major versus minor surgery. In the latter category, there was a significant increase in the postoperative QoL in children undergoing minor urological surgery (p=0.037). Furthermore, the table depicted the regression analysis indicating the predictors for lower postoperative QoL. Those predictors were higher parental preoperative psychiatric symptom load, a greater number of previous surgeries, and female gender (p<0.001, adjusted R2=0.304). Postoperative QoL of children/adolescents undergoing pediatric urology surgery is affected more by the patient's preoperative medical condition and the psychological status of the patient's parents, rather than the surgical method opted for.

Urethral Stricture and Methods for its Correction

A stricture is a type of narrowing of the urethra, which can be caused by a variety of reasons. In addition, urethral strictures are associated with a wide range of symptoms and require special diagnostic examination before proceeding with any treatment. The treatment of urethral strictures has remained a challenge for many years. Stricture recurrence is still a serious problem in reconstructive urology. During the second half of the 20th century, urologists tried to find solutions for treating both simple and complex urethral strictures. Within the last few decades research has mainly focused on improving existing procedures to mitigate the negative postoperative effects. Despite considerable scientific achievements in this area, numerous studies have revealed a lack of knowledge about urethral stricture surgery among urologists and have shown that patients with urethral strictures are generally offered inadequate treatment options. Currently, many surgical interventions are available to treat this condition. However, the variety of treatment methods reflects a lack of optimal technique. This bibliographical review presents data on the effectiveness of minimally invasive (endoscopic) and various urethroplasty options in urological practice.

Editorial Commentary.

No AccessUrology PracticePatient Care1 May 2023Editorial CommentaryThis article comments on the following:International Iohexol Shortage: Alternative Contrast Agents and Imaging Procedures for the Urologist Kevin F. Hanna and Kevin Koo Kevin F. HannaKevin F. Hanna Department of Urology, Mayo Clinic, Rochester, Minnesota More articles by this author and Kevin KooKevin Koo Department of Urology, Mayo Clinic, Rochester, Minnesota More articles by this author View All Author Informationhttps://doi.org/10.1097/UPJ.0000000000000396.01AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail "Editorial Commentary." Urology Practice, 10(3), p. 277

Artificial Intelligence and the Changing Landscape of Urological Practice

Artificial Intelligence and the Changing Landscape of Urological Practice

Editorial Commentary.

No AccessUrology PracticeHealth Policy1 May 2023Editorial CommentaryThis article comments on the following:Outcome Measures and Inclusion/Exclusion Criteria in Benign Prostatic Hyperplasia Trials on ClinicalTrials.govis a letter which has replyReply by Authors Kevin T. McVary Kevin T. McVaryKevin T. McVary Center for Male Health, Department of Urology, Stritch School of Medicine, Loyola University Medical Center, Maywood, Illinois More articles by this author View All Author Informationhttps://doi.org/10.1097/UPJ.0000000000000397.01AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail "Editorial Commentary." Urology Practice, 10(3), p. 259

Knotted Stent—Emphasizing the Need of Radiology Assistance in Urology

Ureteral double-J stents have become a part and parcel in contemporary urologic practice. As the use of stents is increasing, the complications are also increasing. Knot formation in the double-J stent is rare phenomenon. Twenty-seven cases have been reported till now. This case would be the 28th case to be reported, in a young male with solitary left kidney and who was on regular periodic stent substitution.

Treatment of cryptorchidism in pediatric surgical practice: a multicenter study

Introduction. Cryptorchidism is a common disease in pediatric urological and andrological practice since the issues of tactical approaches and its optimal treatment remain extremely relevant. Cryptorchidism makes a significant contribution to the structure of male infertility.Objective. To conduct a retrospective analysis of treatment results in children and adolescents with cryptorchidism.Materials &amp; methods. This study summarises the treatment results of 8308 patients with cryptorchidism aged from 6 months to 17 years who underwent inpatient treatment in the Russian Federation and the Republic of Uzbekistan.Results. It was revealed that from 2015 to 2019, patients were admitted for surgical treatment evenly over the years. The ratio of right-sided / left-sided / bilateral cryptorchidism was 4.6 : 4.4 : 1 The inguinal form prevailed more than 6 times over the abdominal location. At the same time, 26.1% of the patients underwent surgery at the optimal time, and 9.8% were older than 10 years. More often, children are operated from an open inguinal access (95.0%), much less often — laparoscopically and percutaneously. Stage-by-stage treatment was carried out in 6.0% of patients.Conclusion. Thus, the approach presented in the study in the surgical treatment of cryptorchidism provided good treatment results. The number of disease relapses was 1.9% (mainly among children over 7 years old). Most surgeons are very reserved about primary orchidectomies (only 3.8% were performed).

MP21-15 PRIVATE EQUITY FAVORS UROLOGY PRACTICES IN AFFLUENT AND LESS DIVERSE NEIGHBORHOODS

You have accessJournal of UrologyCME1 Apr 2023MP21-15 PRIVATE EQUITY FAVORS UROLOGY PRACTICES IN AFFLUENT AND LESS DIVERSE NEIGHBORHOODS Stephen Kisty, Michael Stencel, Alex Watts, Bruce Jacobs, and Benjamin Davies Stephen KistyStephen Kisty More articles by this author , Michael StencelMichael Stencel More articles by this author , Alex WattsAlex Watts More articles by this author , Bruce JacobsBruce Jacobs More articles by this author , and Benjamin DaviesBenjamin Davies More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003246.15AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Private equity involvement in healthcare has increased rapidly over the past 20 years, but the first urology practice was not acquired until 2016. After acquisition of a medical practice, private equity firms commonly deploy a “buy and build” model where they increase revenue and decrease costs to grow practice valuation before selling the practice within 5-7 years to a larger private equity firm. This study aimed to describe the private equity-ownership in urology practices and identify key characteristics of the populations these clinics serve. METHODS: We identified private equity-owned urology practices from February 25, 2022 through May 31, 2022. Practice acquisition was confirmed by cross referencing news releases, platform websites, and Pitchbook (a comprehensive market data warehouse). Population-level data was obtained from the U.S. Census website for each zip code tabulation area (ZCTA) within each county that had at least 1 private equity-owned urology clinic. Zip codes were converted to ZCTAs for analysis using a crosswalk. Zip codes containing private equity-backed urology clinics were compared to zip codes that did not contain a private equity-backed urology clinic but were in the same county. Data was analyzed using one-way ANOVA, and Chi-squared tests of significance. RESULTS: As of June 2022, 7 private equity platforms operate 387 urology clinics in 18 states, across 100 unique counties and employ 731 urologists. Zip codes that contained private equity-backed urology clinics (n=316) had higher rates of residents with a bachelor’s degree or higher, higher median family incomes, more white and less African American and Hispanic residents, and a greater proportion of privately insured residents than zip codes that did not contain a private equity-owned urology clinic (n=3,145, Table 1). These differences were universally amplified in zip codes that had higher concentration of PE-owned clinics (2 ≤ private equity-owned urology clinics). CONCLUSIONS: Private equity ownership in urology has grown significantly since the first acquisition and is concentrated in areas of higher socio-economic status and less racial diversity. If there are quality benchmarks that are improved by private equity acquisition, those benefits are being disproportionally directed at wealthy and largely white communities thus far. Source of Funding: NIH/NIDDK University of Pittsburgh O'Brien Cooperative Research Center Program (U54 DK112079) © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e291 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Stephen Kisty More articles by this author Michael Stencel More articles by this author Alex Watts More articles by this author Bruce Jacobs More articles by this author Benjamin Davies More articles by this author Expand All Advertisement PDF downloadLoading ...

MP06-08 ASSESSING BASELINE KNOWLEDGE AND USAGE PATTERNS OF GENDER-AFFIRMING ELECTRONIC HEALTH RECORD MODULES WITHIN A UROLOGY DIVISION AT A SINGLE TERTIARY CARE INSTITUTION

You have accessJournal of UrologyCME1 Apr 2023MP06-08 ASSESSING BASELINE KNOWLEDGE AND USAGE PATTERNS OF GENDER-AFFIRMING ELECTRONIC HEALTH RECORD MODULES WITHIN A UROLOGY DIVISION AT A SINGLE TERTIARY CARE INSTITUTION James Ding, Rosemary Thomas, Thomas Guzzo, and Daniel Lee James DingJames Ding More articles by this author , Rosemary ThomasRosemary Thomas More articles by this author , Thomas GuzzoThomas Guzzo More articles by this author , and Daniel LeeDaniel Lee More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003217.08AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: No studies evaluate how gender-affirming electronic health record (EHR) modules (which enable seamless integration of patient sexual orientation and gender identity [SOGI] data) are being used by providers/staff within a urology practice. METHODS: All 120 patient-facing providers/staff with EHR access within a urology division at a tertiary care center were offered a 39-question Qualtrics-based survey, which assessed respondents’ cultural competency, baseline knowledge of SOGI EHR modules, and SOGI module usage patterns. Cultural competency was assessed using the LGBT-Development of Clinical Skills Scale instrument. Chi-squared tests and linear regression models were used to determine differences in SOGI module use between roles and drivers of cultural competency. RESULTS: 96 providers completed the survey (response rate, 89%). Only 25% of respondents received training on using SOGI data in the EHR. Respondents possessed high levels of LGBTQ attitudinal awareness (M=6.38/7) but low clinical preparedness (M=4.32/7), largely due to perceived inadequate training to work with LGBT patients. Major drivers of clinical preparedness were respondent role and number of LGBT patients seen in the past year (R2:30.8%, p=0.02). While respondents uniformly report ease finding SOGI data, all providers/staff (particularly physicians) rarely use formal SOGI documentation tools. Few respondents partook in SOGI EHR training; those that did were significantly more likely to use formal SOGI documentation tools. CONCLUSIONS: This study revealed that providers/staff possess high general LGBTQ cultural competency and ability to find relevant SOGI data in the EHR, while also highlighting limited training in gender-affirming EHR tools and low usage of formal documentation tools. This framework could be a roadmap for evaluating gender-affirming EHR use by urology practices as such features increase in popularity. Source of Funding: This research was funded through a FOCUS Student Fellowship in Women’s Health supported by the Bertha Dagan Berman Award © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e56 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information James Ding More articles by this author Rosemary Thomas More articles by this author Thomas Guzzo More articles by this author Daniel Lee More articles by this author Expand All Advertisement PDF downloadLoading ...

MP19-02 IMPACT OF PRIVATE EQUITY ACQUISITION ON UROLOGIC PROCEDURAL VOLUME

You have accessJournal of UrologyCME1 Apr 2023MP19-02 IMPACT OF PRIVATE EQUITY ACQUISITION ON UROLOGIC PROCEDURAL VOLUME Shyam Patnaik, Danielle Sharbaugh, Michael Stencel, Cameron Jones, Stephen Kisty, Divya Nateson, Charlotte Stahlfeld, Sarah Erpenbeck, Cailey Guercio, Mia Alcorn, Jonathan Yabes, Bruce Jacobs, and Benjamin Davies Shyam PatnaikShyam Patnaik More articles by this author , Danielle SharbaughDanielle Sharbaugh More articles by this author , Michael StencelMichael Stencel More articles by this author , Cameron JonesCameron Jones More articles by this author , Stephen KistyStephen Kisty More articles by this author , Divya NatesonDivya Nateson More articles by this author , Charlotte StahlfeldCharlotte Stahlfeld More articles by this author , Sarah ErpenbeckSarah Erpenbeck More articles by this author , Cailey GuercioCailey Guercio More articles by this author , Mia AlcornMia Alcorn More articles by this author , Jonathan YabesJonathan Yabes More articles by this author , Bruce JacobsBruce Jacobs More articles by this author , and Benjamin DaviesBenjamin Davies More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003244.02AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Private equity firms have been increasing investment in urology in recent years. Despite the changing ownership model in urology private practice, the effect of these acquisitions on urologic practice and procedural volume has yet to be determined. We sought to investigate the impact on procedural volume in a variety of urologic procedures before and after private equity acquisition. METHODS: Private equity acquisitions of urology practices were identified via the existing literature, which utilized a compilation of financial databases cataloguing both public and private transactions. Yearly office visit and procedure volume by provider was extracted from the publicly available “Medicare Physician & Other Practitioners by Provider and Service” dataset from 2013-2019. The most commonly billed procedures were chosen for analysis: post-void residual (PVR), cystometrogram (CMG), uroflow, cystoscopy, prostate biopsy, extracorporeal shock-wave lithotripsy (ESWL), and ureteroscopy. Mixed regression model and sensitivity analyses were conducted. RESULTS: 1,564,853 office visits and 867,216 procedures were analyzed over a 5-year period. Using mixed model analysis, the number of cystoscopies, PVRs, ESWL, and ureteroscopies per physician-year showed no statistically significant change after private equity acquisition (Table 1). Prostate biopsy and complex CMG showed statistically significant increases by an average of 2.06 and 6.88 procedures per physician-year respectively after private equity. Complex uroflow had a significant decrease by an average of 13.5 procedures per physician-year after acquisition. The average number of each urologic procedure per 100 visits remained stable from before private equity acquisition to after acquisition. In terms of the average number of new patient visits, the observed trends for 30-, 45-, and 60- minute visits per 100 visits remained stable from before to after private equity acquisition. CONCLUSIONS: In this study we demonstrate the impact of private equity ownership on urologic practices before and after acquisition. We found that both prostate biopsy and complex CMG procedures rates increased significantly since private equity acquisition. The fiscal impact of these changes has yet to be determined. Source of Funding: N/A © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e264 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Shyam Patnaik More articles by this author Danielle Sharbaugh More articles by this author Michael Stencel More articles by this author Cameron Jones More articles by this author Stephen Kisty More articles by this author Divya Nateson More articles by this author Charlotte Stahlfeld More articles by this author Sarah Erpenbeck More articles by this author Cailey Guercio More articles by this author Mia Alcorn More articles by this author Jonathan Yabes More articles by this author Bruce Jacobs More articles by this author Benjamin Davies More articles by this author Expand All Advertisement PDF downloadLoading ...