Trends in outpatient versus inpatient urologic surgery at a university academic medical center.

PURPOSE OF REVIEW: To analyze trends in outpatient and inpatient urologic surgeries at a large university academic medical center and test the hypothesis that the proportion of outpatient surgeries has been increasing as compared to inpatient surgeries in urology. RECENT FINDINGS: We analyzed a total of 33,054 claims for urologic surgeries at a large university academic medical center from 2010 to 2020, of which 23.2% met inpatient criteria (n = 7695), whereas 76.7% were outpatient (n = 25,359). Although outpatient claims increased yearly by an average of 24%, inpatient claims increased yearly by an average of only 1%. Over the same period, Medicare-specific outpatient claims mirrored these trends, and Medicare-specific inpatient claims decreased. SUMMARY: Outcomes of inpatient surgeries are used as a metric for quality by the Centers for Medicare and Medicaid Services (CMS) as well as US News and World Report (USNWR) rankings. However, with increasing numbers of minimally invasive operations, a large proportion of urologic surgeries are performed on an outpatient basis. As this trend continues, it will be important for organizations like CMS and USNWR to incorporate methods of measuring quality that better reflect outpatient surgical outcomes for the urologic subspecialty.

Comparative assessment of outcomes and adverse effects using two different intramuscular testosterone therapy regimens: 100 mg IM weekly or 200 mg IM biweekly.

This study aimed to compare the change in levels of several laboratory values and the development of adverse events using two commonly used intramuscular testosterone therapy regimens. Men were included if they were 18 years or older and received one of the following testosterone therapy regimens: 100 mg intramuscular once weekly or 200 mg intramuscular once every other week. Primary outcomes were relative changes in total testosterone, free testosterone, estradiol, prostate-specific antigen, and hematocrit at 6 months after initiation of testosterone therapy. Secondary outcomes were any significant rises in estradiol, hematocrit, prostate-specific antigen, and any other treatment-related adverse events requiring cessation of testosterone therapy. A total of 263 men were enrolled. In a subanalysis of men who had a baseline hematocrit below 54% before intramuscular testosterone therapy initiation, we found the following: men who received 100 mg weekly injections were significantly less likely to have hematocrit levels rising above 54% (1/102 (1%) vs. 4/51 (8%); p = 0.023). No significant differences were recorded in the increase in total testosterone, free testosterone, prostate-specific antigen, and estradiol levels between both groups. A higher average serum testosterone over the dosing interval seen with the 200 mg regimen appears to be associated with a higher risk of erythrocytosis.

Discordant erectile function assessment between validated questionnaire scores and penile Doppler ultrasound in Peyronie's disease.

Peyronie's disease results in curvature of the penis which may cause difficulty with penetrative intercourse. The diagnosis of Peyronie's disease is easily obtained through history and physical examination alone, but the severity of erectile dysfunction relies on patient history and use of validated questionnaires. However, erectile dysfunction questionnaires were not validated in the Peyronie's disease population and may not be a reliable assessment. Penile Doppler ultrasound is a noninvasive tool that assesses vascular function. We hypothesized that penile Doppler ultrasound will be discordant with International Index of Erectile Function (IIEF) results in men with Peyronie's disease and erectile dysfunction. In this cross-sectional study, we reviewed a prospectively collected database of men with Peyronie's disease. In total, 108 men had questionnaire and ultrasound data. Of them, 87 had erectile dysfunction based on IIEF-EF or IIEF-5 (SHIM). However, 48 (55%) of those men had normal vascular parameters. Interestingly, among a subgroup of 33 men with severe erectile dysfunction on IIEF-EF or IIEF-5, 20 (61%) had normal vascular parameters. Our study demonstrates significant discordance between questionnaires and penile Doppler ultrasound. Therefore, ultrasound may be a useful tool in the workup of men with Peyronie's disease and erectile dysfunction.

SARS-CoV-2 pandemic and repercussions for male infertility patients: A proposal for the individualized provision of andrological services.

The prolonged lockdown of health facilities providing non-urgent gamete cryopreservation-as currently recommended by many reproductive medicine entities and regulatory authorities due to the SARS-CoV-2 pandemic will be detrimental for subgroups of male infertility patients. We believe the existing recommendations should be promptly modified and propose that the same permissive approach for sperm banking granted for men with cancer is expanded to other groups of vulnerable patients. These groups include infertility patients (eg, azoospermic and cryptozoospermic) undergoing medical or surgical treatment to improve sperm quantity and quality, as well as males of reproductive age affected by inflammatory and systemic auto-immune diseases who are about to start treatment with gonadotoxic drugs or who are under remission. In both scenarios, the "fertility window" may be transitory; postponing diagnostic semen analysis and sperm banking in these men could compromise the prospects of biological parenthood. Moreover, we provide recommendations on how to continue the provision of andrological services in a considered manner and a safe environment. Our opinion is timely and relevant given the fact that fertility services are currently rated as of low priority in most countries.

Hospitalization Rates and Direct Medical Costs for Fever in a Pediatric Cohort in South India.

BACKGROUND: Primary data on causes and costs of hospitalization are necessary for costing and cost-effectiveness analysis. Data on incidence and causes of hospitalization and consequent expenses among Indian children are limited. METHODS: A cohort of 6000 children aged 0.5-15 years residing in urban Vellore was followed for 3 years, under the Vellore Typhoid Study, 2016-2017, and later under the Surveillance for Enteric Fever project, 2017-2019. Data on hospitalization events and associated antibiotic use, and direct medical costs for fever-related hospitalization of study children were obtained from caregivers through weekly follow-up by study field workers. RESULTS: The incidence of hospitalization was 33 per 1000 child-years of observation. Children aged 0.5-5 years had the highest incidence of hospitalization. The top 5 infectious causes for hospitalization were acute undifferentiated fevers, respiratory tract infections, acute gastroenteritis, enteric fever, and dengue. The overall median cost of hospitalization for fever was 4243 (interquartile range, 2502-7215) Indian rupees (INR). An episode of dengue had a median cost of 5627 INR, followed by acute undifferentiated fevers and enteric fever with median costs of 3860 and 3507 INR, respectively. CONCLUSIONS: Hospitalization for fever is common in young children and impacts household finances in low-income Indian households.

Prediction of male infertility by the World Health Organization laboratory manual for assessment of semen analysis: A systematic review.

OBJECTIVE: To discuss the role, reliability and limitations of the semen analysis in the evaluation of fertility with reference to the World Health Organization (WHO) fifth edition guidelines, with semen analysis reference values published in 2010. We also discuss the limitations of using a single threshold value to distinguish 'abnormal' and 'normal' parameters. METHODS: The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were used to search the MEDLINE, EMBASE, and the Cochrane electronic database for articles discussing the effectiveness of semen analysis. RESULTS: Limitations affecting the reliability of semen analysis as a predictor of fertility were found. These include: the lack of consideration of the female factor, the vaguely defined threshold values, and the intra-individual variation in semen parameters. CONCLUSIONS: Impaired semen parameters alone cannot be used to predict fertility as these men still have a chance of being fertile, except when a man has azoospermia, necrospermia or globozoospermia.

Men With Severe Oligospermia Appear to Benefit From Varicocele Repair: A Cost-effectiveness Analysis of Assisted Reproductive Technology.

OBJECTIVE: To evaluate the outcomes of men who underwent varicocelectomy for total motile sperm count (TMSC) <2 million and to perform a cost-effectiveness analysis of intrauterine insemination (IUI) and in vitro fertilization with intracyctoplasmic sperm injection after varicocelectomy. METHODS: We prospectively collected data of men with TMSC <2 million who underwent microsurgical subinguinal varicocelectomy. Men with azoospermia were excluded. Serum testosterone, luteinizing hormone, and follicle-stimulating hormone were measured preoperatively. Postoperative semen analysis was collected first at 3 months and then every 3 months thereafter. Cost-effectiveness for assisted reproductive technologies was calculated using reported costs. RESULTS: A total of 17 men underwent varicocele repair for TMSC <2 million. The mean sperm concentration, motility, and TMSC was 1.1 ± 1.4 million/mL, 15.5% ± 12.8%, and 0.44 ± 0.54 million prior to varicocelectomy, respectively. After varicocelectomy, 14 of 17 men had improvements in TMSC. The mean change in sperm concentration, motility, and TMSC was 4.3 ± 4.7 million/mL, 12% ± 17.2%, and 6.0 ± 8.5 million, respectively. The mean postoperative sperm concentration, motility, and TMSC was 5.4 ± 5.4 million/mL, 27.5% ± 25.1%, and 6.5 ± 8.5 million, respectively. A total of 10 of 17 men had TMSC greater than 2 million. Of the 10 men, 1 man achieved spontaneous pregnancy and 7 men underwent a cycle of IUI; 2 of the 7 (28.6%) men achieved successful pregnancy with IUI (cost per pregnancy: $35,924). CONCLUSION: Varicocelectomy increases TMSC in severely oligospermic patients, thus providing previously ineligible couples an opportunity to elect for IUI, a less invasive and less expensive alternative to in vitro fertilization with intracyctoplasmic sperm injection.

Policy on Posthumous Sperm Retrieval: Survey of 75 Major Academic Medical Centers.

OBJECTIVE: To evaluate the presence and content of policies on posthumous sperm retrieval at 75 major academic medical centers in the U.S. MATERIALS AND METHODS: We surveyed the top 75 major academic medical centers ranked for research in 2016 by U.S. News & World Report using a questionnaire-based telephone/web survey. We gathered data on the presence and content of posthumous sperm retrieval policies on the Internet. If not published, we contacted the legal counsel, the ethics and compliance offices, the urology department, as well as the infertility treatment center associated with each institution. In addition, we also surveyed members of the Society for Male Reproduction and Urology. RESULTS: We gathered data regarding posthumous sperm retrieval from 41 out of the 75 major academic medical centers. Of the 41 institutions, only 11 (26.8%) had policies regarding posthumous sperm retrieval. Out of those 11 centers, 4 required prior written consent, whereas the remaining 6 allowed for verbal or inferred consent from the surviving life partner. One policy prohibited the procedure. Five of the policies in this survey included a bereavement period. Of the 30 (73.2%) centers without policies, lack of legal guidance was cited as the most common barrier to policy adoption. CONCLUSION: Only a small proportion of major academic medical centers have policies on posthumous sperm retrieval. Medical centers can adopt individualized policies based on guidelines published by professional societies.