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1.
Ulus Travma Acil Cerrahi Derg ; 30(9): 685-693, 2024 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-39222498

RESUMO

BACKGROUND: This study aimed to evaluate the approaches of pediatric surgeons and pediatric urologists in Türkiye regarding the diagnosis and treatment of testicular torsion (TT) and their adherence to the European Association of Urology (EAU) pediatric urology guideline. METHODS: A survey consisting of 19 questions, accompanied by an annotation describing the objective of the study, was emailed to pediatric surgeons and pediatric urologists in June and July 2023. RESULTS: Of the 95 respondents, 62.1% had over 10 years of experience, and 48.4% treated more than five cases of TT annually. Of the participants, 87.4% stated that scrotal Doppler ultrasonography (US) was always used, and 12.6% stated that US was used in cases of doubtful diagnosis. Concerning treatment, 14.7% reported performing manual detorsion, 70.5% never did, and 14.7% did so only if the operating room was unavailable soon. A total of 92.6% of participants opted for emergency surgery. Among participants who perform manual detorsion, 71.4% perform surgery within 24 hours after successful manual detorsion. Regarding fixation of the contralateral testicle, 14.7% never performed it, and 27.4% did so only when they performed an orchiectomy on the torsion testicle. CONCLUSION: While most participants follow EAU pediatric urology guidelines by performing emergency surgery, the rate of manual detorsion is low. Few participants stated that emergency surgery may not be performed after manual detorsion. While all of the participants performed fixation of the torsion testicle in accordance with the guidelines, the same adherence was not observed in the contralateral testicle.


Assuntos
Torção do Cordão Espermático , Torção do Cordão Espermático/cirurgia , Torção do Cordão Espermático/diagnóstico , Torção do Cordão Espermático/terapia , Torção do Cordão Espermático/diagnóstico por imagem , Humanos , Masculino , Turquia , Inquéritos e Questionários , Padrões de Prática Médica/estatística & dados numéricos , Criança , Urologistas/estatística & dados numéricos , Cirurgiões , Pediatria , Fidelidade a Diretrizes/estatística & dados numéricos
2.
J Sex Med ; 21(10): 904-911, 2024 Sep 28.
Artigo em Inglês | MEDLINE | ID: mdl-39214554

RESUMO

BACKGROUND: Studies have shown insufficient utilization of care for patients with erectile dysfunction (ED) after radical prostatectomy (RP). AIM: The aim of this study was to evaluate variables associated with barriers to seeking and receiving ED treatment. METHODS: In this multicenter prospective cross-sectional study, the functional outcomes of 936 patients were assessed 10 to 15 years after RP. A total of 525 patients with ED or incontinence were asked about their treatment experiences or lack thereof. The data were analyzed using the chi-square test, t test, and multivariate logistic analyses. OUTCOMES: Patients answered validated questionnaires regarding information sources, communication with their partner and urologist, and barriers to ED treatment. RESULTS: Of the 525 patients, 80 were not available to survey. A total of 304 patients answered the survey (response: 68.0%). A total of 246 patients had ED and were included in this study. The mean age at surgery was 64.4 ± 6.1 years, and the mean age at the time of this survey was 77.1 ± 6.2 years. The mean follow-up duration was 12.7 ± 1.5 years. Forty-six percent (n = 114 of 246) of the patients had never received ED treatment. The most important conversation partners regarding the ED were the partner (69% [n = 169 of 246]) and the urologist (48% [n = 118 of 246]). Patients who never received ED treatment were less likely to have conversations with their urologist (34% vs 60%; P < .001), had less support (51% vs 68%; P = .01), and had less interest in sex from their partner (20% vs 40%; P = .001). Communication with other groups (general practitioners, other physicians, family, friends, and the Internet) had no influence on ED treatment utilization. The most relevant barrier to receiving ED treatment was the belief that treatment would not help (65%). No interest in sex from their partner (odds ratio, 3.9) and no conversation with their urologist about ED (odds ratio, 2.9) were found to be independent predictors of not receiving ED treatment. CLINICAL IMPLICATIONS: Urologists should have enhanced awareness of how to approach patients directly about their ED and actively offer them treatment options. STRENGTHS AND LIMITATIONS: These results should be further validated in a multicenter, prospective study. Response bias may have affected the results. Furthermore, the current cohort was relatively old. CONCLUSION: This study revealed that no interest in sex from one's partner and insufficient communication with a urologist were relevant barriers to insufficient utilization of ED treatment after RP.


Assuntos
Disfunção Erétil , Prostatectomia , Humanos , Masculino , Disfunção Erétil/etiologia , Prostatectomia/efeitos adversos , Estudos Transversais , Pessoa de Meia-Idade , Idoso , Estudos Prospectivos , Inquéritos e Questionários , Urologistas/estatística & dados numéricos , Comunicação , Relações Médico-Paciente , Parceiros Sexuais/psicologia , Incontinência Urinária/etiologia , Complicações Pós-Operatórias/terapia , Complicações Pós-Operatórias/etiologia , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Neoplasias da Próstata/cirurgia
3.
Urology ; 192: 30-35, 2024 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-39032796

RESUMO

OBJECTIVE: To evaluate the relationship between patient complexity, practice setting, and surgeon reimbursement for ureteroscopy and percutaneous nephrolithotomy (PCNL). METHODS: The "2021 Medicare Physician and Other Provider" file was used to collect Rural-Urban Commuting Area (RUCA) codes and hierarchical condition category (HCC) scores of urologists. Higher HCC score corresponds to higher medical complexity and higher RUCA code corresponds to a more rural area. Medicare reimbursement for ureteroscopy and PCNL were collected. Linear regressions were performed to predict change in reimbursement based on RUCA and HCC scores. RESULTS: In 2021, 52,816 procedures under Current Procedural Terminology (CPT) code 52356 (ureteroscopy) and 1649 procedures under 50080 or 50081 (PCNL) were billed to Medicare. Mean reimbursement was $338.24 for ureteroscopy and $957.89 for PCNL. For ureteroscopy, higher HCC score predicted lower reimbursement (P <.001). Higher HCC score predicted higher reimbursement for PCNL (P <.01). Average RUCA for ureteroscopy was higher than for PCNL (P = .02). Rural location predicted lower reimbursement for ureteroscopy (P <.001), however, there was no association for PCNL. CONCLUSION: For ureteroscopy, higher-risk patients are associated with lower reimbursement while the opposite holds true for PCNL. Rural practices were associated with lower reimbursement for ureteroscopy, but there was no association between location and PCNL reimbursement. Together, these findings suggest practice pattern variation between ureteroscopy and PCNL and highlight gaps in reimbursement policy. Risk-adjusted reimbursement should be considered to incentivize urologists to treat complex patients within their practice scope.


Assuntos
Medicare , Ureteroscopia , Urolitíase , Urologia , Humanos , Urolitíase/economia , Urolitíase/cirurgia , Estados Unidos , Ureteroscopia/economia , Ureteroscopia/estatística & dados numéricos , Medicare/economia , Urologia/economia , Nefrolitotomia Percutânea/economia , Reembolso de Seguro de Saúde/economia , Reembolso de Seguro de Saúde/tendências , Serviços de Saúde Rural/economia , Serviços de Saúde Rural/estatística & dados numéricos , Serviços de Saúde Rural/tendências , Urologistas/estatística & dados numéricos , Urologistas/economia , Padrões de Prática Médica/economia , Padrões de Prática Médica/estatística & dados numéricos , Padrões de Prática Médica/tendências , Mecanismo de Reembolso
4.
Investig Clin Urol ; 65(4): 326-333, 2024 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-38978212

RESUMO

PURPOSE: This study aimed to provide the basic data needed to estimate future urologist supply and demand by applying various statistical models related to healthcare utilization. MATERIALS AND METHODS: Data from multiple sources, including the Yearbook of Health and Welfare Statistics, Korean Hospital Association, Korean Medical Association, and the Korean Urological Association, were used for supply estimation. Demand estimation incorporated data on both clinical and non-clinical urologists, along with future population estimates. In-and-out moves and demographic methods were employed for supply estimation, while the Bureau of Health Professions model was utilized for demand estimation. Supply estimation assumptions included fixed resident quotas, age-specific death rates, migration rates, and retirement age considerations. Demand estimation assumptions included combining clinical and nonclinical urologist demands, adjusting population size for age-related healthcare usage variations. Urologist productivity was determined by adjusting productivity levels to 100%, 90%, and 80% of the base year based on actual clinical practice volumes. RESULTS: Estimations of both demand and supply consistently indicate an oversupply of urologists until 2025, followed by an expected shortage by 2035 owing to increased deaths and retirements attributed to the aging urologist population. This shortage becomes more pronounced when employing more reliable models, such as logit or ARIMA (autoregressive integrated moving average), underscoring the growing need for urologists in the future. CONCLUSIONS: All estimation models estimated an oversupply of urologists until 2025, transitioning to a deficit due to reduced supply thereafter. However, considering potential unaccounted factors, greater effort is needed for accurate predictions and corresponding measures.


Assuntos
Necessidades e Demandas de Serviços de Saúde , Urologistas , Urologia , República da Coreia , Humanos , Urologistas/provisão & distribuição , Urologistas/estatística & dados numéricos , Necessidades e Demandas de Serviços de Saúde/tendências , Necessidades e Demandas de Serviços de Saúde/estatística & dados numéricos , Urologia/tendências , Urologia/estatística & dados numéricos , Previsões , Pessoa de Meia-Idade , Masculino , Recursos Humanos/estatística & dados numéricos , Recursos Humanos/tendências , Feminino
5.
Investig Clin Urol ; 65(4): 411-419, 2024 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-38978221

RESUMO

PURPOSE: The Open Payments Program (OPP), established in 2013 under the Sunshine Act, mandated medical device and pharmaceutical manufacturers to submit records of financial incentives given to physicians for public availability. The study aims to characterize the gap in real general and real research payments between man and woman urologists. MATERIALS AND METHODS: The study sample included all urologists in the United States who received at least one general or research payment in the OPP database from 2015 to 2021. Recipients were identified using the National Provider Identifier and National Downloadable File datasets. Payments were analyzed by geography, year, payment type, and years since graduation. Multivariable analysis on odds of being in above the median in terms of money received was done with gender as a covariate. This analysis was also completed for all academic urologists. RESULTS: There was a total of 15,980 urologists; 13.6% were woman, and 86.4% were man. Compared to man urologists, woman urologists were less likely to be in the top half of total payments received (odds ratio [OR] 0.62) when adjusted for other variables. When looking at academic urologists, 18.1% were woman and 81.9% were man. However, woman academic urologists were even less likely to be in the top 50% of payments received (OR 0.55). CONCLUSIONS: This study is the first to characterize the difference in industry payments between man and woman urologists. The results should be utilized to educate physicians and industry, in order to achieve equitable engagement and funding for woman urologists.


Assuntos
Urologia , Humanos , Feminino , Masculino , Urologia/economia , Estados Unidos , Indústria Farmacêutica/economia , Médicas/economia , Médicas/estatística & dados numéricos , Urologistas/estatística & dados numéricos , Urologistas/economia
6.
J Urol ; 212(4): 610-617, 2024 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-38885535

RESUMO

PURPOSE: Our goal was to understand the general attitudes of pediatric urologists regarding the U.S. News & World Report rankings for Best Children's Hospitals in Urology. MATERIALS AND METHODS: We performed a cross-sectional survey study distributed via email to active and candidate members of the Societies for Pediatric Urology from October 2022 to December 2022. This anonymous survey was iteratively developed to contain multiple choice questions gathering information on demographics, personal interaction with the rankings system, and about attitudes toward the rankings across various domains. RESULTS: Of the 515 members surveyed, 264 pediatric urologists responded to the survey for a response rate of 51%. There was representation from all sections of the AUA and across all age categories and practice models. Overall, of the respondents, 71% disagreed that the rankings had led to improvements in care and 75% disagreed that programs were reporting their data honestly. Additionally, 71% believed the rankings are inaccurate in reflecting patient outcomes. The majority (86%) of respondents stated they would support organized efforts to withdraw from the rankings. This was significantly different by ranking cohort, with 78% from top 10 programs endorsing withdrawal vs 89% from those programs not in the top 10. CONCLUSIONS: Our survey found that most pediatric urologists would support efforts to withdraw from participating in the rankings and believe that programs are dishonest in reporting their data. The majority also do not believe a survey can adequately distinguish between programs. This highlights a clear need for a critical reevaluation of the rankings.


Assuntos
Atitude do Pessoal de Saúde , Urologistas , Urologia , Humanos , Estudos Transversais , Estados Unidos , Masculino , Feminino , Urologistas/estatística & dados numéricos , Criança , Hospitais Pediátricos/normas , Hospitais Pediátricos/estatística & dados numéricos , Inquéritos e Questionários , Adulto , Pediatria/normas , Pessoa de Meia-Idade
8.
Urol Oncol ; 42(9): 288.e7-288.e15, 2024 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-38762384

RESUMO

INTRODUCTION: Multidisciplinary consultations improve decisional conflict and guideline-concordant treatment for men with prostate cancer (PC), but differences in the content discussed by specialty during consultations are unknown. METHODS: We audiorecorded and transcribed 50 treatment consultations for localized PC across a multidisciplinary sample of urologists, radiation oncologists, and medical oncologists. Conversation was coded for narrative content using an open coding approach, grouping similar topics into major content areas. The number of words devoted to each content area per consult was used as a proxy for time spent. Multivariable Poisson regression calculated incidence rate ratios (IRR) for content-specific word count across specialties after adjustment for tumor risk and patient demographics. RESULTS: Coders identified 8 narrative content areas: overview of PC; medical history; baseline risk; cancer prognosis; competing risks; treatment options; physician recommendations; and shared decision making (SDM). In multivariable models, specialties significantly differed in proportion of time spent on treatment options, SDM, competing risks, and cancer prognosis. Urologists spent 1.8-fold more time discussing cancer prognosis than medical oncologists (IRR1.80, 95%CI:1.14-2.83) and radiation oncologists (IRR1.84, 95%CI:1.10-3.07). Urologists (IRR11.38, 95%CI:6.62-19.56) and medical oncologists (IRR10.60, 95%CI:6.01-18.72) spent over 10-fold more time discussing competing risks than radiation oncologists. Medical oncologists (IRR2.60, 95%CI:1.65-4.10) and radiation oncologists (IRR1.77, 95%CI:1.06-2.95) spent 2.6- and 1.8-fold more time on SDM than urologists, respectively. CONCLUSIONS: Specialists focus on different content in PC consultations. Our results suggest that urologists should spend more time on SDM and radiation oncologists on competing risks. Our results also highlight the importance of medical oncologists in facilitating SDM.


Assuntos
Neoplasias da Próstata , Encaminhamento e Consulta , Humanos , Masculino , Neoplasias da Próstata/terapia , Encaminhamento e Consulta/estatística & dados numéricos , Pessoa de Meia-Idade , Idoso , Oncologistas/estatística & dados numéricos , Urologistas/estatística & dados numéricos , Urologia/estatística & dados numéricos , Relações Médico-Paciente
9.
Urology ; 190: 15-23, 2024 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-38697362

RESUMO

OBJECTIVE: To assess urologist attitudes toward clinical decision support (CDS) embedded into the electronic health record (EHR) and define design needs to facilitate implementation and impact. With recent advances in big data and artificial intelligence (AI), enthusiasm for personalized, data-driven tools to improve surgical decision-making has grown, but the impact of current tools remains limited. METHODS: A sequential explanatory mixed methods study from 2019 to 2020 was performed. First, survey responses from the 2019 American Urological Association Annual Census evaluated attitudes toward an automatic CDS tool that would display risk/benefit data. This was followed by the purposeful sampling of 25 urologists and qualitative interviews assessing perspectives on CDS impact and design needs. Bivariable, multivariable, and coding-based thematic analysis were applied and integrated. RESULTS: Among a weighted sample of 12,366 practicing urologists, the majority agreed CDS would help decision-making (70.9%, 95% CI 68.7%-73.2%), aid patient counseling (78.5%, 95% CI 76.5%-80.5%), save time (58.1%, 95% CI 55.7%-60.5%), and improve patient outcomes (42.9%, 95% CI 40.5%-45.4%). More years in practice was negatively associated with agreement (P <.001). Urologists described how CDS could bolster evidence-based care, personalized medicine, resource utilization, and patient experience. They also identified multiple implementation barriers and provided suggestions on form, functionality, and visual design to improve usefulness and ease of use. CONCLUSION: Urologists have favorable attitudes toward the potential for clinical decision support in the EHR. Smart design will be critical to ensure effective implementation and impact.


Assuntos
Atitude do Pessoal de Saúde , Sistemas de Apoio a Decisões Clínicas , Urologistas , Humanos , Urologistas/estatística & dados numéricos , Procedimentos Cirúrgicos Urológicos/métodos , Masculino , Registros Eletrônicos de Saúde , Feminino , Pessoa de Meia-Idade , Urologia , Inquéritos e Questionários , Adulto
10.
Urology ; 188: 80-86, 2024 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-38663584

RESUMO

OBJECTIVE: To characterize differences between urologists and advanced practice providers (APPs) in the utilization of cystoscopy for hematuria. METHODS: We identified patients initially evaluated for hematuria by a urologist or urology APP between 2015 and 2020 in the MarketScan Research Databases. We determined whether they received a cystoscopy within 6 months of their urology visit and the number of days until cystoscopy. We used multivariable regression to analyze the association between these outcomes and whether the urology clinician was an advanced practice registered nurse (APRN), physician assistant (PA), or urologist. RESULTS: We identified 34,470 patients with microscopic hematuria and 17,328 patients with gross hematuria. Patients evaluated by urologists more often received a same-day cystoscopy than those evaluated by APPs (13% vs 5.8%). The odds that patients evaluated for microscopic and gross hematuria received a cystoscopy were 46.2% and 26.2% lower, respectively, if they were evaluated by an APRN vs a urologist. Patients seeing an APRN for microscopic and gross hematuria also waited approximately 7 and 14 days longer for their cystoscopy, respectively. No differences were observed for patients evaluated by PAs vs urologists. CONCLUSION: Patients evaluated for hematuria by an APRN were less likely to receive a cystoscopy and had a longer wait until the procedure compared to those evaluated by a urologist; however, no differences were observed between PAs and urologists. Better understanding APP integration into urology clinics is warranted.


Assuntos
Cistoscopia , Hematúria , Urologistas , Humanos , Hematúria/diagnóstico , Hematúria/etiologia , Masculino , Feminino , Pessoa de Meia-Idade , Urologistas/estatística & dados numéricos , Fatores de Tempo , Idoso , Adulto , Urologia , Padrões de Prática Médica/estatística & dados numéricos , Assistentes Médicos/estatística & dados numéricos , Utilização de Procedimentos e Técnicas/estatística & dados numéricos
11.
Int J Urol ; 31(8): 899-905, 2024 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-38686938

RESUMO

OBJECTIVES: To assess whether the coronavirus disease (COVID-19) pandemic affected the outcomes of robot-assisted radical prostatectomy (RARP) and urologists' treatment behaviors. METHODS: We retrospectively examined the medical records of 208 patients who had undergone RARP between August 2017 and December 2022. We compared the rate of preoperative androgen deprivation therapy (ADT), waiting period for RARP, patients' baseline characteristics and quality of life (QOL), proportion of adverse pathology on the RARP specimen, rate of Gleason grade group upgrading from biopsy to the RARP specimen, and prostate-specific antigen (PSA) recurrence-free survival between the pre-pandemic and pandemic groups. RESULTS: The rate of preoperative ADT was significantly higher during than before the COVID-19 pandemic (13.7% vs. 1.9%; p = 0.002). The baseline physical and mental QOL scores did not differ significantly between the groups. The proportion of D'Amico low-risk patients was significantly lower (13.6% vs. 1.2%, p = 0.005) and waiting period for RARP was significantly shorter (median 3.5 months vs. 4.0 months, p = 0.016) in the pandemic group than in the pre-pandemic group. There was no significant difference in the proportion of adverse pathology between the groups (p = 0.104); however, the upgrading rate was significantly higher in the pre-pandemic group (p = 0.002). There was no significant difference in PSA recurrence-free survival between the groups (log-rank, p = 0.752). CONCLUSIONS: The COVID-19 pandemic did not adversely affect the oncologic outcomes of RARP and QOL before RARP. However, it caused urologists to increase the use of preoperative ADT and to reserve RARP for higher-risk cases.


Assuntos
COVID-19 , Prostatectomia , Neoplasias da Próstata , Procedimentos Cirúrgicos Robóticos , Humanos , Masculino , Prostatectomia/métodos , Estudos Retrospectivos , COVID-19/epidemiologia , Neoplasias da Próstata/cirurgia , Neoplasias da Próstata/patologia , Idoso , Pessoa de Meia-Idade , Qualidade de Vida , Centros de Atenção Terciária/estatística & dados numéricos , Urologistas/estatística & dados numéricos , Padrões de Prática Médica/estatística & dados numéricos , Antagonistas de Androgênios/uso terapêutico , SARS-CoV-2 , Gradação de Tumores , Japão/epidemiologia
12.
Urology ; 188: 1-6, 2024 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-38677377

RESUMO

OBJECTIVE: To explore how changes in planned retirement age, practice setting, and physician productivity may impact the workforce shortage in urology. METHODS: We compared data between the 2015 and 2022 American Urological Association census, a specialty-wide annual survey which collects data on demographics, practice patterns, and procedures from a representative sample of U.S. urologists. Workforce productivity was measured by the self-reported number of hours worked per week and patients seen per week. A novel formula was developed to demonstrate how planned retirement age and productivity impact the workforce's production capacity. RESULTS: The total number of practicing urologists increased during the period from 2015 to 2022 (11,990 to 13,976), while the mean age of practicing urologists decreased slightly (55.0 to 54.5years; P < .002). During this period, the mean planned age of retirement for all urologists decreased from 68.9years to 67.7 (P < .001). Urologists in solo practice had a significantly higher planned age of retirement at 71.9years (P < .001) as compared to all other practice models. The number of patients seen per week for all urologists decreased from 78.7 to 72.9 (P < .001). The amount of hours worked per week remained relatively constant between the study periods. The maximum possible number of patients seen by the workforce prior to retirement increased by only 2.4% during the study interval. CONCLUSION: Though the U.S. urology workforce is growing and the mean age is decreasing, decreases in planned retirement age and productivity may offset these gains and intensify the physician shortage for U.S. urologists.


Assuntos
Censos , Padrões de Prática Médica , Aposentadoria , Urologia , Estados Unidos , Aposentadoria/estatística & dados numéricos , Urologia/estatística & dados numéricos , Humanos , Pessoa de Meia-Idade , Padrões de Prática Médica/tendências , Padrões de Prática Médica/estatística & dados numéricos , Masculino , Idoso , Sociedades Médicas/estatística & dados numéricos , Feminino , Urologistas/estatística & dados numéricos , Urologistas/provisão & distribuição , Mão de Obra em Saúde/estatística & dados numéricos , Mão de Obra em Saúde/tendências , Recursos Humanos/estatística & dados numéricos , Fatores Etários
13.
Ir J Med Sci ; 193(4): 2071-2075, 2024 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-38430412

RESUMO

INTRODUCTION: Clinicians frequently rely on patients to accurately tell them what prescription medications and doses they are taking in outpatient visits. This information is essential to monitor the efficacy of a medication and to determine any adverse interactions. This study aimed to assess urologist and urology trainee's visual recognition of common urology medications. METHODS: An online survey was distributed to urologists and urology trainees in Ireland. Images of 11 commonly prescribed urological medications were presented with free text options for answering. Information was gathered on respondent's role and experience. Data was analysed using STATA version 17. RESULTS: The survey had a 90% response rate from 50 distributions. Respondents' roles were consultant (31.1%), specialist registrar (33.3%), registrar (22.2%), senior house officer (11.1%) and intern (2.2%). Forty six percent had more than six years urology experience. Average rate of correct responses was 39.4% ± 23.9. The most accurate group were consultants (46.1% ± 22.1), followed by specialist registrars (41.2% ± 24.9), registrars (39.1% ± 26.8), senior house officers (21.8% ± 10.4) and interns (9.1% ± 0). The most and least recognised medications were sildenafil (Viagra©) (84.4%) and fesoterodine (Toviaz©) (11.1%), respectively. Just 28.9% of respondents had previously handled any of the medications listed. CONCLUSION: Patients often do not reliably know their own medications other than to describe them or show an unpackaged tablet. Prescribing safety is paramount to ensuring patient safety and reducing the risk of adverse drug reactions. This study shows that even experienced clinicians do not recognise the medications they regularly prescribe, and decisions should not be made without accurate medication reconciliation.


Assuntos
Agentes Urológicos , Humanos , Estudos Transversais , Inquéritos e Questionários , Irlanda , Agentes Urológicos/uso terapêutico , Urologistas/estatística & dados numéricos , Urologia , Feminino , Masculino , Comprimidos
14.
BJU Int ; 134(2): 239-248, 2024 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-38506410

RESUMO

OBJECTIVE: To evaluate the nationwide online decision aid 'Entscheidungshilfe Prostatakrebs' (established in 2016, >11.000 users and 60 new users/week) for patients with non-metastatic prostate cancer (PCa), from the perspective of patients and urologists. PATIENTS AND METHODS: To provide personalised information, the tool collects most of the International Consortium for Health Outcomes Measurement standard set, personal preferences, psychological features, and a validated rating of the tool. To evaluate urologists' opinions, we developed a structured two-page questionnaire. All data were collected anonymously. RESULTS: From June 2016 to December 2020, 11 290 patients used the PCa decision aid. Their median (interquartile range [IQR]) age was 67 (61-72) years. The median (IQR) time from initial diagnosis to using the tool was 4 (3-7) weeks. In all, 87.7% of users reported high satisfaction. In a multivariable model, predictors for considering observation were higher knowledge, using the decision aid alone, lower oncological risk, normal erectile function, and respective personal preferences. Of 194 urologists, 91 (47%) had implemented the decision aid in their clinical practice. The urologists' mean (SD) satisfaction score (1 'very good'; 6 'unsatisfactory') with it was 1.45 (0.55), and 92% recommended it. Half of the urologists reported time savings. CONCLUSION: Patients and urologists report a very high level of acceptance and satisfaction with this online tool. It offers advantages in shared decision-making and time efficiency. The usage of the decision aid might improve the adoption of active surveillance and watchful waiting when indicated.


Assuntos
Técnicas de Apoio para a Decisão , Neoplasias da Próstata , Urologistas , Humanos , Masculino , Neoplasias da Próstata/terapia , Neoplasias da Próstata/psicologia , Idoso , Pessoa de Meia-Idade , Alemanha , Urologistas/estatística & dados numéricos , Inquéritos e Questionários , Satisfação do Paciente , Internet
15.
Urol J ; 21(4): 269-270, 2024 Jun 09.
Artigo em Inglês | MEDLINE | ID: mdl-38493316

RESUMO

PURPOSE: To evaluate Iranian urologists' approach to urethral stricture and assess how often they select open urethroplasty over minimally invasive procedures. MATERIAL AND METHODS: This cross-sectional observational study was conducted via www. SURVEY: porsline.ir among members of the Iranian urologists' community. The urologists were contacted via email and social media applications (e.g., WhatsApp, Telegram), and data, including their demographic information and years of practice, as well as questions related to their attitude towards the management of urethral stricture, were collected. RESULTS: A total number of 376 patients were included in the current survey. The specialty of reconstructive urology was selected by less than 2% (n=5) as their field of interest. Only 6.64% (n=25) of the urologists stated that they received adequate training for management of urethral stricture. Only about 5% (n=19), believed that according to scientific resources, chose open urethroplasty as the initial management. Almost 94% (n=353) did not perform any urethroplasties during the past year and about 0.2% (n=2) performed more than 20 open urethroplasties. For diagnosing urethral stricture, almost 99% of them chose RUG+VCUG, 72% chose urethrocystoscopy, and 69% chose uroflowmetry in the third place. For evaluation of urethroplasty postoperative outcomes, 76% (n=269) used RUG+VCUG, 15% (n=56) used Rigid Cystoscopy, and 8% (n=29) used Flexible Cystoscopy, Conclusion: Iranian urologists prefer minimally invasive procedures for treating urethral stricture, similar to other countries. This lack of urologists' interest in open urethroplasty is greatly due to poor training during the residency years and little experience with urethral strictures. Therefore, further considerations in order to improve urologists' knowledge and expertise for management of urethral stricture is recommended.


Assuntos
Padrões de Prática Médica , Estreitamento Uretral , Estreitamento Uretral/cirurgia , Humanos , Estudos Transversais , Irã (Geográfico) , Padrões de Prática Médica/estatística & dados numéricos , Masculino , Urologia , Adulto , Procedimentos Cirúrgicos Urológicos Masculinos/métodos , Pessoa de Meia-Idade , Inquéritos e Questionários , Urologistas/estatística & dados numéricos
16.
Int J Urol ; 31(6): 653-661, 2024 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-38366737

RESUMO

OBJECTIVE: According to the rapid progress in surgical techniques, a growing number of procedures should be learned during postgraduate training periods. This study aimed to clarify the current situation regarding urological surgical training and identify the perception gap between trainees' competency and the competency expected by instructors in Japan. METHODS: Regarding the 40 urological surgical procedures selected via the Delphi method, we collected data on previous caseloads, current subjective autonomy, and confidence for future skill acquisition from trainees (<15 post-graduate years [PGY]), and the competencies when trainees became attending doctors expected by instructors (>15 PGY), according to a 5-point Likert scale. In total, 174 urologists in Hokkaido Prefecture, Japan were enrolled in this study. RESULTS: The response rate was 96% (165/174). In a large proportion of the procedures, caseloads grew with accumulation of years of clinical practice. However, trainees had limited caseloads of robotic and reconstructive surgeries even after 15 PGY. Trainees showed low subjective competencies at present and low confidence for future skill acquisition in several procedures, such as open cystectomy, ureteroureterostomy, and ureterocystostomy, while instructors expected trainees to be able to perform these procedures independently when they became attending doctors. CONCLUSION: Trainees showed low subjective competencies and low confidence for future skill acquisition in several open and reconstructive procedures, while instructors considered that these procedures should be independently performable by attending doctors. We believe that knowledge of these perception gaps is helpful to develop a practical training program.


Assuntos
Competência Clínica , Procedimentos Cirúrgicos Urológicos , Urologia , Humanos , Japão , Urologia/educação , Procedimentos Cirúrgicos Urológicos/educação , Procedimentos Cirúrgicos Urológicos/normas , Masculino , Feminino , Inquéritos e Questionários/estatística & dados numéricos , Avaliação das Necessidades , Educação de Pós-Graduação em Medicina , Adulto , Urologistas/educação , Urologistas/estatística & dados numéricos , Urologistas/normas , Técnica Delphi , Pessoa de Meia-Idade
17.
Urology ; 187: 39-45, 2024 May.
Artigo em Inglês | MEDLINE | ID: mdl-38354914

RESUMO

OBJECTIVE: To project the proportion of the urology workforce that is from under-represented in medicine (URiM) groups between 2021-2061. METHODS: Demographic data were obtained from AUA Census and ACGME Data Resource Books. The number of graduating urology residents and proportion of URiM graduating residents were characterized with linear models. Stock and Flow models were used to project future population numbers and proportions of URiM practicing urologists, contingent on assumptions regarding trainee demographics, retirement trends, and growth in the field. RESULTS: Currently, there is an increase in the percentage of URiM graduates by 0.145% per year. If historical trends continue, URiM urologists will likely comprise 16.2% of urology residency graduates and 13.3% of the practicing urological workforce in 2061. These percentages would constitute an underrepresentation of URiM urologists relative to the projected 44.2% of the U.S. population who would identify as American Indian/Alaskan Native, Black/African American, Latinx/Hispanic and Native Hawaiian/Pacific Islander by 2060.1 An increase in the percentage of URiM graduates by 0.845% per year would result in 44.2% URiM urology residency graduates and 26.1% URiM practicing urologists by 2061. An interactive app was designed to allow for a range of assumptions to be explored and for future data to be incorporated. CONCLUSION: URiM physician representation within urology over the next 40years will remain disproportionately low compared to that of the projected share of people of color in the general U.S. POPULATION: In order to achieve the AUA's Diversity, Equity and Inclusion goals, a concerted effort to implement interventions to recruit, train, and retain a generation of racially diverse urologists appears necessary.


Assuntos
Previsões , Urologia , Humanos , Masculino , Etnicidade/estatística & dados numéricos , Mão de Obra em Saúde/estatística & dados numéricos , Mão de Obra em Saúde/tendências , Internato e Residência/estatística & dados numéricos , Internato e Residência/tendências , Grupos Raciais/estatística & dados numéricos , Estados Unidos , Urologistas/estatística & dados numéricos , Urologistas/provisão & distribuição , Urologistas/tendências , Urologia/estatística & dados numéricos , Urologia/educação , Urologia/tendências , Recursos Humanos/estatística & dados numéricos , Recursos Humanos/tendências , Indígena Americano ou Nativo do Alasca , Negro ou Afro-Americano , Hispânico ou Latino , Havaiano Nativo ou Outro Ilhéu do Pacífico
18.
BJU Int ; 133(5): 579-586, 2024 May.
Artigo em Inglês | MEDLINE | ID: mdl-38378021

RESUMO

OBJECTIVES: To characterise the prevalence of impostor phenomenon (IP; tendency for high-achieving individuals to perceive themselves as fraudulent in their successes) amongst attending staff in urology, to identify variables that predict more severe impostorism, and to study the association of IP with burnout. SUBJECTS AND METHODS: A survey composed of the Clance Impostor Phenomenon Scale (CIPS), demographic information, practice details, and burnout levels was e-mailed to urologists via urological subspecialty societies. Survey results were analysed to identify associations between IP severity, survey respondent characteristics, and symptoms of professional burnout. This study was conducted in the United States of America. RESULTS: A total of 614 survey responses were received (response rate 11.0%). In all, 40% (n = 213) of responders reported CIPS scores qualifying as either 'frequent' or 'intense' impostorism (i.e., scores of 61-100). On multivariable analysis, female gender, fewer years in practice (i.e., 0-2 years), and lower academic rank were all independently associated with higher CIPS scores (adjusted P < 0.05). Regarding burnout, 46% of responders reported burnout symptoms. On multivariable analysis, increase in CIPS score was independently associated with higher odds of burnout (odds ratio 1.06, 95% confidence interval 1.04-1.07; P < 0.001). CONCLUSION: Impostor phenomenon is prevalent in the urological community and is experienced more severely in younger and female urologists. IP is also independently associated with burnout. Increased female representation may improve IP amongst our female colleagues. More work is needed to determine strategies that are effective in mitigating feelings of IP and professional burnout amongst urologists, particularly those earlier in their careers.


Assuntos
Transtornos de Ansiedade , Esgotamento Profissional , Urologistas , Humanos , Esgotamento Profissional/epidemiologia , Esgotamento Profissional/psicologia , Feminino , Masculino , Urologistas/psicologia , Urologistas/estatística & dados numéricos , Prevalência , Adulto , Pessoa de Meia-Idade , Estados Unidos/epidemiologia , Urologia , Inquéritos e Questionários , Autoimagem
19.
BMC Urol ; 22(1): 27, 2022 Feb 26.
Artigo em Inglês | MEDLINE | ID: mdl-35219307

RESUMO

BACKGROUND: Intravesical bacillus Calmette-Guérin (BCG) fails in a considerable proportion of non-muscle invasive bladder cancer (NMIBC) patients despite treatment per recommended protocol. This real-world study aimed to understand the current patterns of treatment and disease management for the broad BCG-unresponsive NMIBC patient population, alongside collecting sufficient data on patients who do not undergo cystectomy. METHODS: This was a multicenter, retrospective survey of physicians treating BCG-unresponsive NMIBC patients. Data were collected in eight countries - France, Germany, Spain, Italy, United Kingdom, United States, China, and Japan - between January and May 2019. The study consisted of a short online physician survey and a retrospective chart review of eligible BCG-unresponsive NMIBC patients. Physicians abstracted chart data for the last 10 (five patients in Japan) eligible BCG-unresponsive NMIBC patients meeting the inclusion criteria, and the data were analysed for all countries combined using descriptive statistics. Country-specific analyses were also carried out, as appropriate. RESULTS: Overall, 508 physicians participated in the study. Almost one-quarter (22.9%) of physicians' current NMIBC patient caseload was BCG-unresponsive, whereby BCG therapy was no longer considered an option. Half of physicians (49.4%) did not regularly use biomarker tests in their practice, with particularly few physicians undertaking biomarker testing in Spain and Japan. Biomarker testing varied considerably, with the proportions of physicians selecting 'none' ranging from 11.4% in China to 70.3% in Japan. Physicians reported transurethral resection of the bladder tumor (TURBT) and BCG as the most common current treatments received by their patients. Chemotherapy and anti-PD-L1 treatment options were considered impactful new therapies by 94.7% and 90.0% of physicians surveyed in this study, respectively. CONCLUSIONS: The most common treatments received by patients in this study were TURBT and BCG. Emerging new treatments are driven by exploring biomarkers, but in real-world clinical practice only half of physicians or fewer regularly tested their NMIBC patients for biomarkers; PD-1/PD-L1 was the most common biomarker test used. Most physicians reported that, in addition to chemotherapy, anti-PD-L1 was an impactful new therapy.


Assuntos
Biomarcadores Tumorais/análise , Padrões de Prática Médica/estatística & dados numéricos , Neoplasias da Bexiga Urinária/terapia , Adjuvantes Imunológicos/uso terapêutico , Idoso , Antineoplásicos/uso terapêutico , Atitude do Pessoal de Saúde , Vacina BCG/uso terapêutico , China , Europa (Continente) , Feminino , Pesquisas sobre Atenção à Saúde , Humanos , Inibidores de Checkpoint Imunológico/uso terapêutico , Japão , Masculino , Oncologistas/estatística & dados numéricos , Estudos Retrospectivos , Estados Unidos , Neoplasias da Bexiga Urinária/patologia , Urologistas/estatística & dados numéricos
20.
J Urol ; 207(2): 293-301, 2022 02.
Artigo em Inglês | MEDLINE | ID: mdl-34551594

RESUMO

PURPOSE: National and international guidelines recommend the use of 1 dose of intravesical chemotherapy immediately following surgery for nonmuscle invasive bladder cancer, which is performed infrequently on a population level. We sought to understand the importance of potential environmental and clinical dimensions involved in the decision to offer this therapy. MATERIALS AND METHODS: Urologists from the Michigan Urological Surgery Improvement Collaborative (MUSIC) rated 8 distinct clinical vignettes involving patients with nonmuscle invasive bladder cancer. A ratings-based conjoint analysis method was used to evaluate the clinical vignette responses. Each vignette included 4 clinical dimensions and 2 environmental dimensions, with each dimension consisting of 2 possible attributes. The relative importance of each attribute was derived from the regression model and ranked in order. RESULTS: A total of 58 urologists answered the clinical vignettes which represents >75% of MUSIC sites. The median age of urologists was 53, most were male, and median years in practice was 20 years post residency. An environmental attribute, having a recovery room protocol for instilling and disposing of the chemotherapy, ranked as the most influential attribute for giving postoperative chemotherapy (utility=8.6). The clinical attribute yielding the strongest preference for giving chemotherapy was tumor grade (utility=4.9). These preferences varied by different subgroups of urologists, particularly regarding the type of practice a urologist was in. CONCLUSIONS: This study demonstrates that urologists have clear preferences for when they offer postoperative immediate chemotherapy. Factors beyond just clinical variables play a role in this decision making process such as the structure of the recovery room.


Assuntos
Quimioterapia Adjuvante/normas , Cistectomia , Padrões de Prática Médica/normas , Neoplasias da Bexiga Urinária/terapia , Urologia/normas , Administração Intravesical , Adulto , Quimioterapia Adjuvante/estatística & dados numéricos , Feminino , Humanos , Masculino , Michigan , Pessoa de Meia-Idade , Invasividade Neoplásica , Guias de Prática Clínica como Assunto , Padrões de Prática Médica/estatística & dados numéricos , Inquéritos e Questionários/estatística & dados numéricos , Bexiga Urinária/patologia , Bexiga Urinária/cirurgia , Neoplasias da Bexiga Urinária/patologia , Urologistas/normas , Urologistas/estatística & dados numéricos , Urologia/estatística & dados numéricos
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