Genitourinary Radiation Injury Following Prostate Cancer Treatment: Assessment of Cost and Health Care System Burden.

OBJECTIVE: To evaluate the healthcare resource impact of radiation injury following prostate cancer treatment. METHODS: Using IBM MarketScan, we performed a retrospective study of men with prostate cancer who were treated with radiotherapy and subsequently developed low-grade (LGRI) and high-grade radiation injury (HGRI). Radiation injury diagnoses included bladder neck stenosis, hematuria/cystitis, fistula, ureteral stricture, and incontinence. LGRI and HGRI included injury diagnosis without intervention and with intervention, respectively. Health care visits and costs were measured over 5 time periods including 2 years before radiation, 1 year before radiation, radiation to injury diagnosis, injury diagnosis to first intervention (LGRI), and following first intervention (HGRI). Negative binomial regression modeling was used to assess the effect of radiation injury on average cost adjusting for demographics and comorbidities. RESULTS: Between 2008 and 2017, we identified 121,027 men who received radiotherapy following prostate cancer diagnosis of which 10,057 (8.3%) experienced a HGRI. The frequency of urologic visits and average costs were similar in those without injury and LGRI. However, men with HGRI experienced higher visit frequency and monthly costs. Amongst high-grade injuries, urinary fistula had the highest frequency of visit utilization at 378 visits before first intervention and 245 visits after first intervention. Following radiation injury diagnosis, the average monthly cost was twice as high in those with HGRI ($85.78) compared to LGRI ($38.66). CONCLUSIONS: HGRI was associated with increased urologic health care use and average monthly cost when compared to those who experienced LGRI or no injury. Urinary fistula was associated with the largest resource burden.

A Survey of Perceptions and Acceptance of Wearable Technology for Health Monitoring in a Urological Patient Population.

INTRODUCTION: Through real-time monitoring of biophysical parameters, physical activity monitors may represent a medium by which urologists can actively engage patients and improve treatment outcomes. We examined patient reported acceptance of physical activity monitor technology in an ambulatory urology setting. METHODS: Patients treated at a single urology department during a 6-month period were identified. A web based survey was conducted evaluating patient characteristics and acceptance of physical activity monitors. RESULTS: A total of 1,043 (19%) patients completed the survey, of whom 210 (20%) reported using physical activity monitors for health and wellness. Overall 854 (82%) respondents were willing to use these devices for urological care. Compared to patients who disagreed, those willing to use physical activity monitors for medical care reported greater perceived medical benefit (86% vs 14%), improved communication (85% vs 26%), confidentiality (89% vs 45%), less interference with daily activity (4% vs 55%) and improved health (81% vs 13%, all p <0.0001). Benefits and usefulness among accepting patients included health monitoring convenience (82%), goal related feedback (82%), ease of communication (57%) and monitoring of post-procedure recovery (56%). After controlling for associated patient characteristics, the degree of perceived burden, medical benefit, health improvement and enhancement in communication were modifiable, and independently associated with physical activity monitor acceptance. CONCLUSIONS: There is a high level of acceptance for wearable technology among urology patients. This may have significant implications for improving patient engagement, perioperative care pathways and surgical outcomes. Finally, these findings may assist urologists in directing future efforts to clinically integrate physical activity monitors to enhance patient acceptance and potential outcomes.

Efficiency, satisfaction, and costs for remote video visits following radical prostatectomy: a randomized controlled trial.

BACKGROUND: Telemedicine in an ambulatory surgical population remains incompletely evaluated. OBJECTIVE: To investigate patient encounters in the outpatient setting using video visit (VV) technology compared to traditional office visits (OVs). DESIGN, SETTING, AND PARTICIPANTS: From June 2013 to March 2014, 55 prescreened men with a history of prostate cancer were prospectively randomized. VVs, with the patient at home or at work, were included in the outpatient clinic calendar of urologists. INTERVENTION: Remote VV versus traditional OV. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: An equivalence analysis was used to assess the primary outcome, visit efficiency as measured by time studies. Secondary outcomes were patient/provider satisfaction and costs. RESULTS AND LIMITATIONS: There were 28 VVs and 27 OVs. VVs were equivalent in efficiency to relative to OVs, as measured by patient-provider face time (mean 14.5 vs 14.3min; p=0.96), patient wait time (18.4 vs 13.0min; p=0.20), and total time devoted to care (17.9 vs 17.8min; p=0.97). There were no significant differences in patient perception of visit confidentiality, efficiency, education quality, or overall satisfaction. VVs incurred lower costs, including distance traveled (median 0 vs 95 miles), travel time (0 vs 95min), missed work (0 vs 1 d), and money spent on travel ($0 vs $48; all p<0.0001). There was a high level of urologist satisfaction for both VVs (88%) and OVs (90%). The major limitation was sample size. CONCLUSIONS: VV in the ambulatory postprostatectomy setting may have a future role in health care delivery models. We found equivalent efficiency, similar satisfaction, but significantly reduced patient costs for VV compared to OV. Further prospective analyses are warranted. PATIENT SUMMARY: Among men with surgically treated prostate cancer, we evaluated the utility of remote video visits compared to office visits for outpatient consultation with a urologist. Video visits were associated with equivalent efficiency, similar satisfaction, and significantly lower patient costs when compared to office visits. We conclude that video visits may have a future role in health care delivery models.

Assessment of sexual dysfunction and sexually related personal distress in patients who have undergone orthotopic liver transplantation for end-stage liver disease.

INTRODUCTION: Sexual dysfunction (SD) status post-orthotopic liver transplant (OLT) for end-stage liver disease (ESLD) has long been recognized. To date, there are no studies examining how sexually related personal distress (SRPD) impacts sexual function in this population. AIMS: To assess SD and SRPD in men and women who have undergone OLT for ESLD and to compare them with previously published reports on subjects without SD. METHODS: 283 subjects (182 men and 101 women) who underwent OLT since 2005 were mailed a survey. Men received the International Index of Erectile Function (IIEF) and Female Sexual Distress Scale-Revised (FSDS-R). Women received the Female Sexual Function Index (FSFI) and the FSDS-R. All surveys asked about the presence of a current sexual partner. MAIN OUTCOME MEASURES: Total and subscale scores on the IIEF, the FSFI, and the FSDS-R. RESULTS: Ninety-six patients (33.9%) completed and returned the surveys consisting of 34 women (33.7%) and 62 men (34.0%). Also, 83.9% of men and 88.2% of women reported having an available sexual partner. Two-thirds of men and three-quarters of women were sexually active. In all domains, IIEF demonstrates that men have mild to moderate SD. FSFI demonstrates that women also have SD. Both genders reported relatively mild SRPD based on FSDS-R. Compared to previously published controls, all domain values were lower in both genders. CONCLUSION: The IIEF, FSFI, and SDS-R results demonstrate that men and women who undergo OLT do exhibit mild to moderate SD. Their distress, though, is also mild to moderate, as evidenced by a high rate of continued sexual activity after OLT. Therefore, although SD may be widely prevalent in people who undergo OLT, aggressive intervention may not be warranted so long as the level of sexual distress remains low.