Urology Service Research Articles

How will hybrid-DRGs (diagnosis related groups) change German urology? : A survey and potential analysis

The introduction of hybrid DRGs on 1January 2024 is intended to create incentives to perform inpatient urology services, e.g., ureterorenoscopy (URS), on an outpatient basis. The effects on the reality of care are currently unclear. The aim of the survey was to gather an opinion on the introduction of hybrid DRGs in urology and to analyze initial practical experiences and future prospects. In aGermany-wide online survey conducted between May and July 2024, 32questions were asked about patient care, further training and other indications, among other things. In addition, an assessment of the outpatient potential for URS for ureteral and kidney stones and hydrocele resections was requested. Atotal of 364 urologists responded to the survey: 54.5% were in private practice and 45.5% worked in hospitals. 91.1% were active surgeons. The concept of hybrid DRGs was rated positively by 34% of those working in surgery, but 68% saw no relief in their everyday work. 51% expressed concerns about the negative impact on further training. The proportion of URS performed on an outpatient basis in 2023 was 21% (ureteral stones) and 11% (kidney stones), with along-term potential increase of up to 33%. Two thirds of hydrocele resections were already performed on an outpatient basis, and 74% of respondents considered these to be billable in ahybrid DRG. The survey shows adifferentiated opinion on hybrid DRGs in urology, but the sample only comprises around 6% of urologists in Germany. It would make sense to repeat the survey at alater date in order to evaluate developments in practical use.

The COVID-19 pandemic and Urology - reflecting on successful initiatives and lessons in Australia.

To summarise the impact of the coronavirus disease 2019 (COVID-19) pandemic on urological practice globally with a focus on Australian initiatives, as the pandemic resulted in radical changes in healthcare infrastructure and policies. We conducted a literature review of the Medical Literature Analysis and Retrieval System Online (MEDLINE), Excerpta Medica dataBASE (EMBASE) and Web of Science medical databases. The key terms used to conduct our search algorithm comprised of 'COVID', 'wait list or wait time or delay', 'urology', 'surgery' and 'outcomes', and generated 231 articles. Abstracts were reviewed for relevance and 40 studies selected for full-text review. Society position statements and government level press release statements were identified through citation tracking and additionally included. The halt on elective surgical services during the pandemic was deemed necessary to curb infection rates and conserve healthcare resources. However, it resulted in extended wait times and large surgical backlogs with major downstream effects. Australia fared favourably with regards to infection rates compared to international populations consequent upon strict border control, vaccine mandates, and stringent lockdowns. However, similar trends were noted in both oncological and non-oncological urology service reduction, resulting in significant concerns regarding the long-term sequelae of delayed surgery and missed appointments upon patient clinical outcome. Initiatives including collaborative partnerships between public and private hospital sectors, government-funded programmes and adoption of telehealth were successfully established as part of Australia's efforts to stabilise our healthcare system in response to the pandemic. Australia's pandemic efforts have highlighted the escalating imbalance between increasing demand from a growing and ageing population on an already over-burdened system with finite resources. The additional strain of managing post-COVID-19 pandemic fallout in this context provides further challenges for clinicians and healthcare administrators alike. Collaboration by all stakeholders must continue in order to seek innovative solutions to maximise efficiency of healthcare service utilisation, so that quality universal healthcare provision may continue in the future.

THE RATIO OF UROLOGISTS FOR EACH REGENCY AND CITY IN EAST JAVA INDONESIA AND THE INDICATORS AFFECTING THEIR DISTRIBUTION

Objective: Research on the distribution of urology in Indonesia, especially in East Java, has not been widely discussed. There are still several areas in East Java that do not have a urologist at all. We try to find out the factors underlying this distribution through several indicators. Material & Methods: Data from all hospitals in East Java were compiled with data of urologists in East Java obtained from the Indonesian Urological Association, supplemented by information from social media and the telephone of the hospital operator. The number of urologists and hospitals with urology services is then correlated with the human development index, the education index, purchasing power index, health index, and regional minimum wage. Results: The ratio of urologists in each district and city in East Java is not evenly distributed, and likewise with the hospitals that provide urology services in each district and city in East Java. The ratio of urologists and the number of hospitals providing urology services are significantly related to the human development index, the education index, the purchasing power index, the health index, and the regional minimum wage. Conclusion: The location of a urologist's practice is related to the development of an area, which in this study is assessed through indicators of human development, education, health, and economy. Keywords: Urologist Ratio, East Java, Urology.

Rise of long-distance urology transfer during the COVID-19 pandemic: Identifying factors to enhance transfers of care efficiency and clinical outcomes.

The objective of this study is to identify variables associated with clinical outcomes after urologic transfers before and during the COVID pandemic. After IRB approval, a retrospective chart review was performed on adult patients transferred to our institution from 01/01/2018 to 12/31/2019 ("pre-COVID") and from 01/02/2020 to 12/31/2022 ("COVID"). We identified demographics, origin hospitals, ICD-10 pre- and post-transfer diagnoses, distance of transfer, and post-transfer CPT codes. During the study period, our adult urology service accepted 160 transfers with a mean patient age of 71 years. A total of 49/160 (30%) of subjects made up the "pre-COVID" cohort and 111/160 (70%) made up the "COVID" cohort. There were 11/111 (10%) transfers of >100 miles in the COVID period but 0/49 in the pre-COVID period (p = 0.02). Patients from the COVID period waited on average 1.2 days longer for a procedure after transfer compared to pre-COVID period (p = 0.03). The time until a patient's surgical procedure after transfer was a significant predictor of length of stay > 5 days (OR 1.91, CI 1.43 - 2.58, p < 0.01). Different diagnosis upon re-evaluation after transfer was associated with a decreased rate of subsequent readmission (OR 0.30, CI 0.09-0.97, p = 0.05). Long-distance transfer, even >100 miles (which we termed "mega-transfers"), was a new pandemic-related phenomenon at our institution. Delays in definitive care and changes in diagnoses after transfer were associated with readmission and length of stay. Our findings illustrate the importance of inter-institutional communication, diagnostic accuracy, and post discharge planning when managing transfer patients.

Impact of Covid 19 pandemic on tertiary care urological services - Sri Lankan experience

Impact of Covid 19 pandemic on tertiary care urological services - Sri Lankan experience

Perioperative management of patients with glioblastoma copresenting with pheochromocytoma: illustrative case.

Undiagnosed pheochromocytoma can present with hemodynamic instability during surgical procedures. Here, the authors discuss a 69-year-old male with isocitrate dehydrogenase (IDH)-wildtype glioblastoma copresenting with undiagnosed pheochromocytoma, which, to the authors' knowledge, is the second reported case in the literature. The patient presented to the emergency department with a 1-month history of coordination difficulties, progressive morning headache, and mild left-side weakness. Imaging showed a 5-cm peripherally enhancing intra-axial right parietal mass with surrounding vasogenic edema. Intraoperatively, the patient had significant uncontrollable hypertension up to 240/120 mm Hg, and the operation was promptly aborted. Contrast-enhanced computed tomography imaging of the chest, abdomen, and pelvis identified a 4.9-cm left adrenal mass of indeterminant etiology. Endocrinology diagnosed the incidentaloma as a pheochromocytoma, initiating alpha blockade followed by beta blockade, and the urology service performed a laparoscopic adrenalectomy after patient stabilization. The neurosurgery service removed the intra-axial brain lesion 2 days after adrenalectomy, which was diagnosed as IDH-wildtype glioblastoma. The patient was discharged home after 6 days in stable condition. This case highlights the importance of preoperative screening for pheochromocytoma in neurosurgical patients with adrenal incidentalomas, especially in incidentalomas > 4 cm, even without high clinical suspicion. https://thejns.org/doi/10.3171/CASE24374.

Modulating the organization of medical care and early diagnosis of prostate cancer

Aim. To analyze the existing system of medical care organization and timely diagnostics for prostate cancer (PC).Materials and Methods. The study utilized data from official statistics to analyze the system of medical care organization and the diagnostic methods applied for prostate cancer at different stages.Results. In the country, medical care for patients with prostate cancer is organized into three levels. The first level involves family physicians, urologists, and oncologists in oncology clinics, where access to modern diagnostic facilities is limited. The second level provides advanced diagnostic services through regional oncology centers and major urology departments. The third level offers specialized care at the National Cancer Research Center (NCRC) and select urology clinics. Based on the experience of other countries, it is recommended to improve the system of medical care for prostate cancer by establishing four stages of care. The proposed model takes into account the real situation, emphasizing the need for prevention, timely diagnosis, and effective treatment in accordance with clinical protocols, as well as the coordinated use of human and technological resources from oncology, urology, and morphological services at all stages.Conclusions. The proposed model for organizing medical care, based on evidence-based practices, aims to improve early detection of prostate cancer, enhance the clinical effectiveness of treatment, and optimize the use of resources.

Uncovering the Evidence for Sustainability in Urology: A Scoping Review.

This article focuses on the environmental impact of urology devices and procedures in hospitals and identifies practices that can reduce greenhouse gas emissions associated with urology services. A scoping review following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines was conducted using MEDLINE, EMBASE, and Google Scholar to find studies on the carbon footprint of urologic procedures and sustainable practices. We identified 14 studies, 6 of which used life cycle assessments to compare the environmental impact of single-use and reusable urology devices. Three studies favored single-use devices, 2 favored reusable ones, and 1 found no significant difference, with the sterilization of reusable devices being a major carbon contributor. To enhance sustainability in urology, 8 articles suggested measures including day-case procedures, minimizing low-value care, drapeless cystoscopy, fluid management systems, using quick response (QR) codes in documentation, telehealth initiatives, and low-emission anesthetics. Promoting sustainability in healthcare requires more than just using reusable equipment; it necessitates a comprehensive approach from manufacturing to disposal, including the carbon footprint of sterilization. Encouraging low-emission anesthetics, QR codes, and telemedicine can significantly reduce emissions in urology.

Nurse-patient ratio according to the delta test in the Urology Service at the Hospital de Clínicas, Paraguay, 2023

El ratio enfermera-paciente es el número mínimo de enfermeras a cargo de una determinada cantidad de pacientes. El estudio se realizó en el servicio de Urología del Hospital de Clínicas, con el objetivo de determinar la relación enfermera-paciente según el grado de dependencia según el Test de Delta. Se empleó un enfoque cuantitativo y un diseño observacional descriptivo. La población incluyó 57 pacientes hospitalizados en septiembre-noviembre de 2023, seleccionados mediante muestreo no probabilístico por conveniencia. El 57% de los pacientes eran hombres, con edades predominantemente entre 60-69 años con 30%. Se identificó que el 46% estaban en el posoperatorio inmediato. En cuanto a la dependencia, el 32% eran válidos, el 28% asistidos leves, el 35% asistidos moderados y el 5% asistidos severos. El 67% requería 1,8-2,2 horas de atención directa, mientras que solo el 5% necesitaba 5,4 horas. Se observó una relación directa entre el grado de dependencia y el personal de enfermería necesario, siendo mayor para los pacientes asistidos moderados. En términos de dependencia física, la mayoría mantenía buena movilidad. En cuanto a la dependencia Física y Psíquica el 70%, seguido por el 23% déficit leve. En cuanto a las consideraciones éticas se tuvo como referencia el informe de Belmont. Y el Comité de Ética de la FCM-UNA aprobó el trabajo investigado. El estudio proporciona información valiosa para mejorar la gestión de recursos humanos y la calidad de la atención en el servicio de Urología, destacando la importancia de adaptar la atención a las necesidades específicas de cada paciente.

MO45-4 New initiatives for urological cancer genome outpatient services at our hospital

MO45-4 New initiatives for urological cancer genome outpatient services at our hospital

Point-of-Care Ultrasound Diagnosis of Pyocele: A Rare Complication of Testicular Infection

BackgroundEpididymo-orchitis is one of the common causes of acute scrotal pain that requires an accurate diagnosis as delayed management can result in complications such as pyocele, abscess, or testicular infarction. Point-of-care ultrasound (PoCUS) has emerged as a valuable diagnostic tool in the management of testicular emergencies in the emergency department (ED) including testicular infections Case ReportHere we report a case of an elderly man who presented to the ED with a complaint of right-sided testicular pain and swelling. The diagnosis of pyocele was made using a PoCUS, facilitating an early referral to urology services.Why should an emergency physician be aware of this case?In conclusion, this case underscores the important role of PoCUS in the timely and accurate diagnosis of pyocele. The prompt identification of pyocele enabled early referral to urology services, highlighting the significance of integrating PoCUS into the management of testicular emergencies in the ED.

Prevalence and management of castration-resistant prostate cancer of unknown metastatic status in the real-world setting: The AfroDiTA study

BackgroundEarly identification and management of metastases in prostate cancer (PC) patients is crucial. This study aimed to describe the nonpharmacological management and characteristics of patients with castration-resistant PC with unknown metastatic status (CRPC-MX) and estimate their prevalence in Spain. MethodsCross-sectional, multicenter, real-world study including adult (≥18 years) CRPC-MX patients from 46 Urology services. In a first phase, patients on continuous ADT for ≥6 months were screened and classified as hormone-sensitive PC (HSPC), castration-resistant PC (CRPC), and unknown hormonal status, with metastases (M1), without (M0) and unknown metastatic status (MX) using an ad hoc designed algorithm. In Phase 2, 15 months (m) after Phase 1, all patients on ADT were reviewed and reclassified again using the algorithm. ResultsAmong 6169 eligible PC patients, 294 (4.8%) were classified as CRPC-MX, which decreased to 179 of 4050 (4.4%) 15 m after study initiation. We included 103 CRPC-MX patients with a median age at diagnosis of 75.4 years (IQR: 67.8, 80.4); 26 (25.2%) lacked a histological diagnosis, and only 25 (24.5%) received treatment with curative intent, despite ECOG being ≤1 at inclusion in 83.5%. In the 15 m before inclusion, most CRPC-MX patients had <5 prostate-specific antigen (PSA) determinations (80.6%) and no imaging (63.1%). After CRPC-MX identification (15 m after inclusion), metastatic status was assessed in 55.4%, with an increased number of patients with ≥5 PSA determinations (P = 0.0357), visits per patient (P < 0.0001), patients with some imaging test (P < 0.0001), imaging tests/patient (P < 0.0001), and visits to onco-urology specialized consultation units (52.0% before and 79.2% after). ConclusionA substantial proportion of PC patients on ADT in the real-world setting are not appropriately followed up. Identification of CRPC-MX patients raised awareness among physicians and improved their adherence to guidelines, resulting in improved care for these patients.

Investigation of Non-visible Haematuria in a Tertiary Urology Service: Can We See the Reward?

Investigation of Non-visible Haematuria in a Tertiary Urology Service: Can We See the Reward?

(243) DELAY OF CARE NEGATIVELY IMPACTS FEMALE PARTNERS OF PATIENTS WITH MALE FACTOR INFERTILITY

Abstract Introduction Approximately half of couples with infertility will be found to have a male factor. However, historical data has revealed that infertility is preferentially attributed to the female partner. This often-wrong assumption may cause female partners to undergo invasive and expensive procedures and treatments when the couple’s lack of fertility is ultimately due to male-related factors. Objective We aimed to quantify the impact of delayed urologic care for male-factor infertility. Methods An electronic survey was delivered through REDCap to patients who were evaluated in our clinic for male-factor infertility from January 2023 to June 2024. The survey assessed each couple’s reproductive care quantitatively and qualitatively prior to seeking urologic services at our institution. Descriptive statistics were employed to analyze the data. Results A total of 121 couples completed the anonymous survey. 35.5% of the couples reported experiencing early focused female gynecologic care and 13.3% sought out reproductive endocrinology and female fertility counseling prior to seeing a urologist for male infertility evaluation. Of those who first sought other specialties before investigating the possibility of male-related infertility, respondents stated that they spent a range of 2 months to 6 years on solely female reproductive care. Additionally, 51.5% considered their treatments invasive and costly. Almost half (48.7%) of all respondents wish they sought out urologic care sooner. Conclusions Delayed urologic care for male-related factors can result in significant premature costs, both financially and in time invested, and in invasive treatments for female partners, who are often presumed to be the primary cause of infertility. These findings highlight the need for early and equitable evaluation of both partners in infertility cases to optimize patient care and minimize unnecessary procedures. Further, the results indicate patients who did not seek urologic care earlier regretted not doing so. This delay underscores the significance of better patient education and awareness regarding male-factor infertility. Disclosure No.

Bladder Lymphoma. Presentation of clinical case

Introduction: lymphomas develop in lymphoid tissue located in lymph nodes and in dissimilar organs of the human body. They are malignant tumors located in the lymphoid tissue with a low incidence in the genitourinary tract as the primary site; among them, those of the bladder are uncommon. Primary bladder lymphomas present an indistinguishable clinical-radiological pattern, of solid growth and with characteristics similar to urothelial carcinoma. Objective: to present a clinical case, with a diagnosis of primary bladder lymphoma treated in the Oncology service of the “Abel Santamaría Cuadrado” General Teaching Hospital in Pinar del Río. Case presentation: patient, 58 years old, male, white, relative health history; In February 2020, he went to the clinic due to bleeding in his urine, urinary urgency, droplet urination, as well as weight loss of more than 15 lbs. and evening fever. He was evaluated by the urology service, which suspected urothelial carcinoma of the bladder, which led to a systematic diagnosis that determined infiltration of the bladder wall by intermediate B cell non-Hodgkin lymphoma. Conclusions: the diagnosis in these cases is determined by immunohistochemistry studies and tumor monoclonality demonstrated by molecular biology techniques. Primary bladder lymphomas have a solid growth pattern similar to that of urothelial carcinoma. The choice for treatment consists of a regimen consisting of CHOP chemotherapy (cyclophosphamide, vincristine, prednisone, doxorubicin) combined with the anti-CD20 monoclonal antibody rituximab. We present a case of infradiaphragmatic intermediate B cell non-Hodgkin lymphoma with extralymphatic involvement of the bladder

Clinical characteristics and factors associated with survival rate of patients with non-muscle invasive bladder cancer attending at a Tertiary Hospital in Somalia

BackgroundA few studies regarding the epidemiology and risk factors of Non-muscle Invasive Bladder Cancer (NMIBC) are reported from Sub-Saharan African countries (SSA), including Somalia, and the African literature is scant on the management of NMIBC. The present study aims to evaluate the clinical-histopathological characteristics and factors associated with the survival rate of patients with NMIBC.MethodThis six-year cohort study included 196 patients with NMIBC. It reviewed the clinical and histopathological characteristics and factors predicting cancer-specific survival for these patients.ResultsThe mean patient age was 59.01 ± 11.50 years, with a male-to-female ratio of 2.8:1. Urothelial carcinoma (UC) constituted the most common pathological type, accounting for 90.8%; Ta LG and T1HG were the most common histopathological tumour stage and grade (n = 90, 45.9%, vs. n = 56, 28.6%), respectively. The mean tumour size was 4.72 ± 2.81 cm. The cancer-specific mortality(CSM) was 13.3%. Age [2.252(2.310–2.943], p < 0.001], Gender [1.031(0.981-1.1.242),p < 0.001], tumour stage and grade [4.902(3.607–5.614),p < 0.001], tumour location [1.135(0.806–1.172),p < 0.001], number [0.510(0.410–0.920),p = 0.03], tumour size [1.523(0.936–1.541),p < 0.001], use of intravesical chemotherapy or BCG [2.810(1.972–4.381),p < 0.001], preoperative hydronephrosis grade [1.517(1.172–2.154),p < 0.001], and follow-up compliance [3.376(2.633–5.018),p < 0.001] were all associated with CSM. The 5-year overall survival was 57.1%, and cardiovascular diseases were the leading cause of mortality (n = 34), followed by diabetes (n = 28).ConclusionOur study findings revealed that UC constituted the most common pathological subtype, though less than forty per cent of our patients receive intravesical adjuvant therapies, which are crucial to minimizing disease morbidity and mortality. Initiatives improving uro-oncological care, including subspecialty training in oncology and essential cancer therapies, better access to urology services, and cancer screening programs, are much needed for optimal management plans and care in the country.

Retrospective Cross-Sectional Epidemiological Study of Human Papillomavirus-Associated Precancers and Anogenital Warts in Patients Attending Specialized Clinics in Russian Federation

Background. In Russia, there are no country level registries on HPV-associated pre-cancers (cervical intraepithelial neoplasia, CIN; vulvar intraepithelial neoplasia, VIN; vaginal intraepithelial neoplasia, VaIN; anal intraepithelial neoplasia, AIN; penile intraepithelial neoplasia PIN) and anogenital warts (AWs) and no national-level cervical cancer screening program. Aims — the aim of this study was to assess the proportion of patients with CIN, VIN, VaIN, AIN, PIN and AWs diagnosis in the clinical settings in Russia. Methods. This study was a non-interventional retrospective multi-center chart-review study in 28 investigational sites representing 21 Federal subjects of 6 Federal Districts of Russia. Medical charts of adult men and women visited gynecology, sexual health, dermatovenerology or urology services between 1 Jan 2000 — 31 Dec 2019 were reviewed. Data were abstracted, using a standardized approach, on patient demographic characteristics, presence or absence of pre-cancers and AWs diagnoses, method of diagnosing pre-cancer and HPV infection, and grade of neoplasia. Results. A total of 11 520 patients (1732 male and 9788 female) were included in the analysis. The overall proportion of patients with HPV-associated precancers and AWs was 10.8%. By service type, cases of HPV-associated conditions were revealed most often in dermatological departments (14.5%) and gynecological hospitals (13.8%). CIN detection rate in Russian clinical settings increased over the 20-years from 3.2 to 11.1% and was higher in gynecological in-patient departments compared to out-patient departments (12.5 and 5.2% respectively). The number of non-cervical precancers (VIN, VaIN, AIN, PIN) cases were very low (the detection rate was less than 1%). The frequency of HPV type 16 and 18 detection increased from 0.6 to 4.8%, and from 0.2 to 1.9%, respectively, for the 20-years period. Conclusions. Our study suggested high level of HPV-related pre-cancer and AW disease burden as well as presence of high-risk HPV types. Preventive strategy through effective national HPV immunization program would be beneficial to reduce HPV-related disease burden in Russia.

Resistencia bacteriana en urocultivos durante una década

Introduction: Bacterial resistance to antibiotics is a global problem; Due to its great variability, each hospital should carry out its own microbiological surveillance. Objective: To identify changes in bacterial resistance in urine cultures with Gram-negative isolation from the urology department over a decade. Material and methods: Analytical, retrospective cross-sectional study, 1072 urine cultures requested by the urology department of Hospital Juárez de México were collected between 6/01/2012 and 5/31/2022. The percentage of resistance by germ and antibiotic was divided into three periods: initial, intermediate and final to compare with X2 trends. According to the sensitivity report, high resistance &gt;16 and high sensitivity ≤2 were defined. Statistical analysis was performed using IBM SPSS V.25 software and Epi Info Companion V.5.5.10 software. Results: For a decade, the urology service of Hospital Juárez de México has a total of 1072 records in the database, initial date 6/01/2012 and end date 06/01/2022. The most frequent germs were Escherichia coli 709 (66 %), Klebsiella pneumoniae 61 (6 %) and Pseudomonas aeruginosa 56 (5 %). The majority of antibiotics showed persistence in the percentage of resistance. Amoxicillin with clavulanate had a significant decrease (X2 Tend=13.17, p=0.0003). Cefepime (X2 Tend=4.84, p=0.027) and amikacin (X2 Tend=5.76, p=0.016) had a slight significant increase. Cefazolin (X2 Tend=5.00, p=0.025), Levofloxacin (X2 Tend=7.81, p=0.005), Ceftazidime (X2 Tend=3.74, p=0.05) significantly increased the percentage of resistance. Conclusion: Dividing the patterns of bacterial resistance by uropathogens, family of antibiotics, levels of resistance and sensitivity, improves knowledge and favors a better selection of treatments in the population attended by the urology service of the Hospital Juárez de México.

Impact of multidisciplinary tumor boards on clinical decision making in a genitourinary oncology clinic in Mexico city.

e23217 Background: Effective management of genitourinary neoplasms demands a comprehensive approach due to the diverse treatment options and the need for multiple specialists. Multidisciplinary tumor board (MDTB) meetings are a platform for experts to collectively assess and discuss the latest evidence and provide their expertise to tailor treatment plans for patients. Methods: Cases discussed during uro-oncology MDTB meetings at the Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán in Mexico City over a five-year period (01/2018 to 12/2022) were included. We analyzed the type of neoplasm, reason for case discussion, specialties involved and whether the final decision led to a modification of the original plan. Descriptive statistics were used for analysis. Chi-squared test was used to determinate differences and p value &lt; 0.05 was considered statistically significant. A logistic regression analysis was performed for multivariate analysis. Results: Over the study period, 500 discussions involving 399 patients were included. 87% were men. Prostate, kidney, testicular, upper tract urothelial and bladder carcinoma, represented: 223 (44.6%), 117 (23.4%), 84 (16.8%), 37 (7.4%), 32 (6.4%) of cases, respectively. The majority were presented by urology (319 cases; 63.6%). The primary reason for presentation was surgical decisions in 54.6%. Regarding final conclusions, 55.8% underwent modifications in the treatment plan, 33.2% had no changes and 11% remained inconclusive, requiring further assessment. Individuals with metastatic disease had a higher likelihood of treatment plan changes in 61.6% vs 52.3% (OR 1.46 95%CI 1.01-2.12; p = 0.042). The 163 cases (32.6%) presented during the COVID-19 pandemic were more prone to have treatment modifications 62.6% vs 52.5% (OR 1.51 95%CI 1.03-2.22; p = 0.034); cases presented for surgical reasons during this period were more likely to have a change in treatment modality 74% vs 52.3% (OR 2.6 95%CI 1.34-5.04; p = 0.004). Implementation of results was successful in most cases (72%), with a median time of 3.6 weeks. Reasons for not implementing the plan included: patient decision, treating physician decision, comorbidities, death, and lack of resources. Factors associated with implementation in the multivariate analysis included: male gender (OR 2.81), cases presented during pandemic (OR 2.0), and by urology service (OR 1.92). Conclusions: Among patients presented in our uro-oncology MDTB meetings, more than half will have a change in the original treatment plan, and this agreed strategy is successfully implemented in most individuals. These sessions remained key for patient management during the COVID-19 pandemic.

Testicular Traction Technique with Intact Cremasteric Reflex, a Novel Approach for Manual Detorsion: Case Report.

Recognizing testicular torsion is extremely important in patients presenting to the emergency department (ED) with acute scrotal pain. Traditional manual detorsion techniques are frequently employed by emergency physicians but are not always successful. Delays in detorsion increase the risk of testicular infarction and infertility, and the need for orchiectomy. Novel techniques such as the testicular traction technique have been described as a potential solution for difficult-to-detorse testicles. Our case report describes a 20-year-old male with no significant past medical history who presented to a rural ED with acute, atraumatic testicular pain secondary to testicular torsion with an intact cremasteric reflex. After confirming the diagnosis using Doppler ultrasound, manual detorsion using the traditional "open book" technique was attempted and unsuccessful. The patient was subsequently successfully detorsed using the novel testicular traction technique. The testicular traction technique is a safe, rapid, and effective primary or adjunctive technique in manual testicular detorsion. Given the time-sensitive nature of testicular torsions, adjunctive techniques play a crucial role in managing challenging detorsions, particularly in resource-limited rural settings with limited access to urologic services. Although it is commonly thought that the cremasteric reflex is absent in testicular torsions, it may be present in rare circumstances, and its presence should not be an absolute in ruling out torsion.