Rural-Urban Disparities in Patient Care Experiences among Prostate Cancer Survivors: A SEER-CAHPS Study.

BACKGROUND: We sought to evaluate rural-urban disparities in patient care experiences (PCEs) among localized prostate cancer (PCa) survivors at intermediate-to-high risk of disease progression. METHODS: Using 2007-2015 Surveillance Epidemiology and End Results (SEER) data linked to Medicare Consumer Assessment of Healthcare Providers and Systems (CAHPS) surveys, we analyzed survivors' first survey ≥6 months post-diagnosis. Covariate adjusted linear regressions were used to estimate associations of treatment status (definitive treatment vs. none) and residence (large metro vs. metro vs. rural) with PCE composite and rating measures. RESULTS: Among 3779 PCa survivors, 1798 (53.2%) and 370 (10.9%) resided in large metro and rural areas, respectively; more rural (vs. large metro) residents were untreated (21.9% vs. 16.7%; p = 0.017). Untreated (vs. treated) PCa survivors reported lower scores for doctor communication (ß = -2.0; p = 0.022), specialist rating (ß = -2.5; p = 0.008), and overall care rating (ß = -2.4; p = 0.006). While treated rural survivors gave higher (ß = 3.6; p = 0.022) scores for obtaining needed care, untreated rural survivors gave lower scores for obtaining needed care (ß = -7.0; p = 0.017) and a lower health plan rating (ß = -7.9; p = 0.003) compared to their respective counterparts in large metro areas. CONCLUSIONS: Rural PCa survivors are less likely to receive treatment. Rural-urban differences in PCEs varied by treatment status.

Robotic-assisted laparoscopic ureteral reimplantation with psoas hitch: a multi-institutional, multinational evaluation.

OBJECTIVES: To report the collective experience of three multinational institutions with the use of robotics to evaluate and treat complex distal ureteral obstruction. METHODS: A total of 12 patients from The Ohio State University, Columbus, Ohio; Onze-Lieve-Vrouw Ziekenhuis, Aalst, Belgium; and Hospital Sultanah Aminah, Kuala Lumpur, Malaysia underwent robotic-assisted laparoscopic ureteral reimplantation between August 2004 and July 2006. The indications for ureteral reimplantation included ureteral stricture (n = 10) and ureterovaginal fistula (n = 2). Nine patients had pathology on the left side and 4 patients had right-sided disease. Surgery was performed by three experienced laparoscopic robotic surgeons with the daVinci Surgical System. RESULTS: The mean patient age (range) was 41.3 years (19 to 67 years). The mean operative time was 208 minutes (80 to 360 minutes). The mean robot time was 173 minutes (75 to 300 minutes). The mean estimated blood loss was 48 mL (45 to 100 minutes). The mean length of hospitalization was 4.3 days (2 to 8 days). All the procedures were completed successfully robotically without open conversion. There were no intraoperative or postoperative complications. Postoperative intravenous urography and Mercapto Acetyl TriGlycine 3 showed normal findings in 10 patients and a mild residual hydronephrosis in 2 patients. After a mean follow-up of 15.5 months, all patients were asymptomatic of their initial disease state. CONCLUSIONS: This multi-institutional, multinational experience illustrates that ureteral reimplantation with psoas hitch can be performed safely and effectively to treat lower tract ureteral obstruction.

Robot-assisted laparoscopic pyeloplasty: a review of minimally invasive treatment options for ureteropelvic junction obstruction.

Our aim was to examine the current status of minimally invasive approaches to ureteropelvic junction (UPJ) obstruction and compare it to the gold standard of open pyeloplasty. A review of the literature was conducted using PubMed and Medline databases for UPJ obstruction. Open pyeloplasty achieves good results, in the range of 90-100%. Laparoscopic pyeloplasty results are as good as those of open surgery. However, the goal of laparoscopic pyeloplasty as a means of providing minimally invasive surgery to a larger number of patients has not been achieved. The reason for this is the difficulty faced by most urologists in acquiring the technical skills to perform a laparoscopic pyeloplasty. In reports of robot-assisted pyeloplasty, results in the range of 88-97% appear to be achieved. Robotic technology has the potential to make minimally invasive pyeloplasty an easier skill to acquire for a larger number of urologists. Long-term data are still required to determine its efficacy.