Current perceptions and working time models of female urologists in Germany: results of a large-scale survey.

PURPOSE: Female urologists are distinctly underrepresented in leading positions. The reasons behind this inequity remain unclear, with some suggesting factors such as family responsibilities, part-time work and insufficient mentorship. This study aimed to explore and characterize the working conditions of female urologists in Germany, with a focus on factors influencing the working time model. METHODS: A questionnaire was developed and distributed to 1343 female members of the German Society of Urology between February and March 2022. The survey consisted of 43 questions covering the categories demographics, occupation situation, satisfaction at work, family situation, career aspects and research activity. RESULTS: Of the 487 female German urologists who participated in the survey, 167 (34.3%) worked part-time. Doctors in training were significantly less likely to work part-time than colleagues who had completed their specialist training (p < 0.001). Only 10% of female doctors in training reported working part-time. Similarly, having children (p < 0.001) and engaging in scientific activities (p = 0.03) were independent factors influencing part-time work, with children increasing the likelihood of working part-time as expected, while scientifically active female urologists were more likely to work full-time. CONCLUSION: This study provides the largest survey on the situation of female urologists in German-speaking countries to date. Part-time work during specialist training is rare, while more than 50% of female urologists with children work part-time. With the projected decline in the number of practicing physicians and the increasing demand for medical attention, it is crucial to find ways to retain and support healthcare professionals, particularly female urologists.

[The urologist's role in assisted reproductive technology (ART)]. / Place de l'urologue dans le parcours d'aide médicale à la procréation (AMP).

BACKGROUND: Following on from the Rapport vers une stratégie nationale de lutte contre l'infertilité (Report on a national strategy to combat infertility) submitted to the French Minister of Health in 2022, whose objective 13 is: to better identify and diagnose male infertility, we wanted to clarify with reproductive specialists what role the urologist should play in the management of the infertile couple. METHODS: An expert consensus was reached with the Pedagogical Committee and pilots of the Transversal Specialized Training in Reproductive Medicine and Biology - Andrology, and with the presidents, board and scientific council of the French Federation for Reproductive Study (FFER). RESULTS: In the case of infertility in a couple, the fertility of both partners should be assessed from the outset, and in the event of abnormality or failure of ART, the patient should be referred to a uro-andrologist for expert management. The uro-andrologist will set up medical or surgical treatments to improve the prognosis of the man's fertility, in conjunction with the entire ART team. It is also important for the urologist/andrologist to take charge of the man's health before conception, because of the benefits for the patient himself and for his offspring. CONCLUSION: This expert consensus has shed light on the role of the uro-andrologist in the ART pathway, on the need for training in Andrology and on the medical demography required.

Emergency upper urinary tract decompression: double-J stent or nephrostomy? A European YAU/ESUT/EULIS/BSIR survey among urologists and radiologists.

PURPOSE: To evaluate the decompression of the pelvicalyceal system between urologists and radiologists. METHODS: A survey was distributed to urologists and to radiologists comparing double-J stent (DJS), percutaneous nephrostomy (PN) and primary ureteroscopy (URS) for three clinical scenarios (1-febrile hydronephrosis; 2-obstruction and persistent pain; 3-obstruction and anuria) before and after reading literature The survey included perception on radiation dose, cost and quality of life (QoL). RESULTS: Response rate was 40% (366/915). 93% of radiologists believe that DJS offers a better QOL compared to 70.6% of urologists (p = 0.006). 28.4% of urologists consider PN to be more expensive compared to 8.9% of radiologists (p = 0.006). 75% of radiologists believe that radiation exposure is higher with DJS as opposed to 33.9% of urologists. There was not a difference in the decompression preference in the first scenario. After reading the literature, 28.6% of radiologists changed their opinion compared to 5.2% of urologists (p < 0.001). The change favored DJS. In the second scenario, responders preferred equally DJS and they did not change their opinion. In the third scenario, 41% of radiologists chose PN as opposed to 12.6% of urologists (p < 0.001). After reading the literature, 17.9% of radiologists changed their opinion compared to 17.9% of urologists (p < 0.001), in favor of DJS. Although the majority of urologists (63.4%) consistently perform primary URS, only 3, 37 and 21% preferred it for the first, second and third scenarios, respectively. CONCLUSION: The decision on the type of drainage of a stone-obstructing hydronephrosis should be individualized.

Appropriate management reduces radiation exposure in daily urological practice.

OBJECTIVES: To identify and raise awareness of the radiation exposure of urologists due to X-ray fluoroscopic procedures in daily practice. METHODS: This was a single-center, cohort study of 30 consecutive patients who underwent periodic percutaneous or transurethral replacements of urinary tract catheters. A total of 55 replacements every 3 months with cases aligned were performed by a single urologist. The urologist's radiation exposure and the incident dose to patients per case were measured with thermoluminescent dosimeters. In the latter 3-month period, the pulse fluoroscopy condition was changed from 15 to 7.5 pulses per second, and collimation was added to the field of view. RESULTS: In the analysis of all patients, the use of a modified pulse rate and collimation did not affect the fluoroscopy time, but it did significantly reduce the air kerma and dose area product; in addition, with respect to the medical exposure dose during percutaneous catheter replacement, fluoroscopy time was longer, but air kerma and dose area product showed significant decreases. As with decreases in medical exposure of patients, the equivalent dose for eye lenses of the urologist decreased from 1.2 mSv in the first 3-month period to 0.2 mSv in the second 3-month period. Similarly, the exposure dose for the extremities also decreased significantly, from 33.9 mSv to 8.1 mSv. CONCLUSIONS: Urologists are exposed to non-negligible amounts of radiation due to fluoroscopy. Appropriate management such as modified pulse fluoroscopy condition and precautions are required.

[STATUS FOR A FEMALE DOCTOR IN MODERN UROLOGY. THE RESULTS OF A WOMEN UROLOGISTS SURVEY IN RUSSIA].

INTRODUCTION: In recent years, the role of women in medicine, particularly in surgical practice, has increasingly become a subject for discussion. Traditionally, male doctors have dominated in surgical specialties, especially in urology. Slow rhythm of changes in the structure of the specialty remains the problem relevant, despite the optimistic perspectives of the world urological community gender heterogeneity. MATERIALS AND METHODS: We have conducted an anonymous survey. Respondents were asked to complete a survey, which included questions from the survey of the European Association of Urology. The sample included 63 women, who were divided into two groups. RESULTS: Despite the opinion of both groups about the lack of a separation into «female¼ and «male¼ specialties, there are concerns about a conflict with stereotypes and ideas about the impossibility of women working in a surgical specialty. Respondents of both groups had more than 70% assurance that in order to achieve professional success, a female surgeon needs more efforts than a male surgeon. In the question of the future status after 10 years, the student population in more than 60% noted the option «operating urologist¼ and less than 10% of respondents chose the «researcher¼. At the same time, the ratio among female-doctors has 41 and 33%, respectively. Among female students, in most cases, indicated the lack of such a dilemma (family/career). Female doctors have a ratio of 50:50, respectively. In the question about pay, more than 75% of respondents were confident about receiving equal pay, similar to male doctors. CONCLUSION: The increasing number of female urologists across the world is a nowadays reality. Rejection of existing stereotypes, elements of gender discrimination from colleagues and patients, mentoring, awareness-building - will help attract young female doctors to the urological specialty. These aspects will be the first step in changing of the current urology.

The usefulness of uroflowmetry and ultrasound bladder scanning as diagnostic tools in primary care for new male patients with lower urinary tract symptoms; a cluster randomized controlled trial.

BACKGROUND: Uroflowmetry and ultrasound scanning of the post-void residual volume are diagnostic instruments in specialist urological care of men referred with lower urinary tract symptoms (LUTS). We hypothesized that implementing uroflowmetry and post-void ultrasound bladder scanning in primary care for men with LUTS will reduce the number of referrals to urologists. OBJECTIVE: To assess the effect on referrals to urologists for new male patients over 50 years of age with LUTS when performing uroflowmetry and post-void ultrasound bladder scanning in primary care. METHODS: A cluster randomized controlled trial was conducted among Dutch general practitioners (GPs). The GPs enrolled male patients with the first-time presentation of LUTS, these were randomized to primary-care treatment with or without uroflowmetry and post-void bladder scanning. Primary outcome: percentage of patients referred to urologists within 3 and 12 months. Secondary outcomes: changes in the International Prostate Symptom Score (IPSS) and the IPSS-Quality of Life, patient satisfaction and urologic medication usage after 12 months. RESULTS: Four GPs were randomly assigned to the intervention group (132 patients) and seven to the control group (212 patients). The percentage of patients referred to urologists did not differ significantly between the intervention group vs the control group: within 3 months 19.7% versus 10.4% (OR 1.9, 95% CI 0.8 to 5.0), and within 12 months 28.8% versus 21.2% (OR 1.5, 95% CI 0.9 to 2.5). CONCLUSIONS: Performing uroflowmetry and ultrasound bladder scanning in primary care as additional diagnostic tools do not reduce the number of referrals to urologists. We do not recommend using these diagnostic tools in general practice in the diagnostic work-up of these patients.

Choosing a Specialist: An Explanatory Study of Factors Influencing Patients in Choosing a Urologist.

OBJECTIVES: While research on doctor-patient interaction has often focused on the decision-making abilities of physicians, it rarely centers around the question of how patients choose their respective practitioners. Research on fundamental decision processes is of high importance and understanding the factors that influence people's choices in real-life decision-making would potentially provide patients, and physicians alike, with the means to provide better resources to achieve greater satisfaction from visits to a medical practitioner. METHODS: At our tertiary referral center, patients were given the opportunity to voluntarily participate in our survey. We collected questionnaires from 1,002 patients during their visit from November 2018 to February 2020. Statistical analysis was performed using SPSS V26.0 software (SPSS Statistics, Version 26.0.; IBM, Armonk, NY, USA). Results are reported as percentages for categorial variables. RESULTS: Our patient cohort consisted of a higher percentage of men than of women (82 vs. 18%) with significantly more men having a university-based education (44 vs. 31%; p = 0.001). Women were more likely to have statutory health insurance than men (85 vs. 74%; p = 0.013). Men significantly preferred to be treated by a doctor of the same sex (24 vs. 8%; p < 0.001), which significantly increased with age. Overall, more women than men trusted a referral by their primary care physician (75 vs. 66%, p = 0.017), while preference of a higher academic degree in the attending urologist was significantly correlated with the patients' education. CONCLUSIONS: Information on a specialist, such as professional qualifications and academic accomplishments, is easily accessible to patients with or without access to the Internet. However, recommendations and referrals, in addition to consistent care by the same treating physician, seem to be of high importance to all patients, regardless of gender or age.

Re-evaluation of birth trends and pregnancy complications among female urologists: Have we made any progress?

AIMS: Females are becoming surgeons at ever-increasing rates and doing so while many have or wish to have children. This study follows up on a 2007 effort to study the problems and conditions such women faced. We ask here if these challenges are different after a decade that included changes in working rules. METHODS: A survey was sent to all female American Board of Urology diplomates. Birth trends, pregnancy complications, infertility service requirements, and satisfaction were evaluated in respondents (n = 183) and compared to the previous survey of female urologists who completed residency before August 2007 as well as Center for Disease Control data. RESULTS: Seventy-six physicians completed the survey who were residents before 2007, while 107 replied who experienced residency after. The first group's average age was 50.2 and the second's 38.3. Overall, these women gave birth 6 to 7 years later than the US mean. Complications did not decrease, infertility occurred at similar levels, and both were higher than US norms. Length of maternity leave correlated with respondents' level of overall satisfaction. The most positive responses came from those with more than 8 weeks off (P = .002). CONCLUSIONS: Women practicing in urology gave birth later, had greater fertility issues, used assisted reproductive technology (ART) more and reported a higher level of at least one complication during pregnancy than American women overall. Changes in hours and awareness of this issue have not made giving birth a healthier event for these physicians. Further investigation into factors other than work hours is needed.

What Should Be Known by a Urologist About the Medical Management of COVID-19's Patients?

PURPOSE OF REVIEW: The alarming number of confirmed COVID-19 cases put a strain on the healthcare systems, which had to reallocate human and technical resources to respond to the emergency. Many urologists became integrated into multidisciplinary teams, dealing with this respiratory illness and its unknown management. It aims to summarize the epidemiological, clinical, diagnostical, and therapeutical characteristics of COVID-19, from a practical perspective, to ease COVID-19 management to non-physician staff. RECENT FINDINGS: We performed a narrative review of the literature regarding COVID-19, updated to May 8th, 2020, at PubMed and COVID resource platforms of the main scientific editorials. COVID-19, characterized by fever, myalgias, dyspnea, and dry cough, varies widely from asymptomatic infection to death. Arrhythmias and thrombotic events are prevalent. Lymphopenia and inflammatory reactant elevation on laboratory, as well as bilateral and peripheral ground-glass opacities or consolidations on X-Ray, are usually found in its assessment. Little is known about SARS-CoV-2 immunology. To date, no therapy has demonstrated efficacy in COVID-19. Of-level or compassionate-use therapies are prescribed in the context of clinical trials. We should become familiar with specific adverse events and pharmacological interactions. The COVID-19 pandemic has paralyzed the urological activity, and its long-term consequences are unpredictable. Despite not being used to deal with respiratory diseases, the urologists become easily qualified to manage COVID-19 by following protocols and being integrated into multidisciplinary teams, helping to overcome the pandemic.

"I Don't Know What I'm Doing I Hope I'm Not Just an Idiot": The Need to Train Pediatric Urologists to Discuss Sexual and Reproductive Health Care With Young Women With Spina Bifida.

INTRODUCTION: Although pediatric urologists have taken responsibility for initiating discussions on sexual and reproductive health with spina bifida patients, research shows that very few girls and women with spina bifida have ever discussed this topic with any physician. AIM: We sought to better understand pediatric urologists' gaps in knowledge and training needs in the sexual and reproductive health education of women with spina bifida with the goal of creating a tool kit to equip providers to have these discussions. METHODS: In this qualitative study, pediatric urologists were interviewed separately about their current practices, perceived barriers, knowledge gaps, and recommendations for the tool kit until thematic saturation was reached. The interviews were recorded and transcribed verbatim, then analyzed using grounded theory by 3 independent reviewers. MAIN OUTCOME MEASURES: To evaluate the perspectives and practices of pediatric urologists, we identified the overlapping themes of the interviews. Consensus on themes was reached. RESULTS: 10 Pediatric urologists participated in the study, including 5 men and 5 women, of whom 4 were fellows and 6 were attending physicians (mean years of practice 18, range 6-31 years). The mean number of patients followed up in the respective spina bifida clinics or by the provider was 434 (range 24-1,500). The following themes regarding pediatric urologists' experience providing sexual and reproductive health education to women with spina bifida emerged. Pediatric urologists': (i) lack of formal training; (ii) knowledge gaps such as spina bifida sexuality, fertility, and pregnancy experience; (iii) barriers to having sexual and reproductive health conversations such as lack of comfort and lack of time; (iv) facilitators of these conversations such as a long-term relationship with the patient and the patient's own initiative; (v) desire to learn and provide competent care; and (vi) recommendations for a web-based tool kit that would include content to address the knowledge gaps and training about how to start sexual and reproductive health conversations. CLINICAL IMPLICATIONS: These findings can provide the beginning concepts for the development of training on providing sexual and reproductive health education for pediatric urologists' care for women with spina bifida. STRENGTHS & LIMITATIONS: This study gives the perspectives of 10 pediatric urologists with a diversity of backgrounds, but all of whom care for a large number of spina bifida patients. This does not give the perspectives of the spina bifida women themselves, which will be evaluated in the next phase of the study. CONCLUSION: Pediatric urologists are not trained and do not feel prepared to provide sexual and reproductive health education for girls and women with spina bifida. However, they do see it as their scope of practice and wish to acquire competence in this area. Streur CS, Schafer CL, Garcia VP, et al. "I Don't Know What I'm Doing… I Hope I'm Not Just an Idiot": The Need to Train Pediatric Urologists to Discuss Sexual and Reproductive Health Care With Young Women With Spina Bifida. J Sex Med 2018;15:1403-1413.

Urologists' attitudes to sexual complications of LUTS/BPH treatments.

INTRODUCTION: Many LUTS/BPH treatments currently available may affect sexual function (SD). We wished to assess urologists' attitude and practice in this area. METHODS: Attendees of an international meeting were randomly selected, interviewed and stratified by professional status and LUTS/BPH cases seen per month. There were four questions: treatment options offered, frequency of discussing erectile dysfunction (ED) with each treatment, frequency of discussing ejaculatory dysfunction (EjD) with each treatment, and offering alternative treatment based on the risks of sexual dysfunction. RESULTS: 199 of the 245 interviewed (81%) were urologists. The most common treatments offered were α-blockers (99.5%), 5-ARI (95.0%) and TURP (92.5%). About 70% of the specialists discuss ED before α-blockers (not known to cause ED). Regarding EjD, 70% discuss this prior to prescribing α-blockers, 60% before 5-ARI therapy, while 80% before TURP. A significant minority fails to discuss this complication in all areas. Many respondents do not routinely discuss alternative therapies on the risk of SD. The higher the caseload, the less likely was a urologist to offer alternative therapies, with 37% of urologists seeing over 30 LUTS/BPH patients per month stating they would "Not at all often" offer alternative therapies for this reason. CONCLUSIONS: There is a significant discrepancy in attitudes to counselling patients on SD related to LUTS/BPH treatments. This may, in some cases, affect the validity of consent to the treatment. Most urologists do not discuss alternative treatments with patients based on the risks of different outcomes and complications, and this seems more marked in those with the busier practices. This may sit ill with the concept of personalised healthcare.

Current work environments: What problems are being faced by Japanese urologists?

Computer technology has contributed to innovative progress in industrial infrastructures and has had a major influence on various work environments. Evaluations of work environments are routinely carried out in Western countries, but historically there has been resistance to such evaluations in Japan. In this mini-review, we discuss the current work environments of urologists in Japan. The number of urologists has increased each year, and the population density of urologists was 5.4 (per 100 000 people) in 2014. The average age of urologists in Japan was 48.9 years, and the percentage of female urologists was just 5.3%. Additionally, the geographic distribution of urologists was uneven in Japan. From projections based on population dynamics, the need for more urologists in the near future will probably increase. Because medical environments vary depending on the country, it is necessary to understand current work environments in greater detail initially. Furthermore, we should determine original measures for the establishment of satisfactory urological work environments in Japan.

Percutaneous nephrolithotomy access by urologist or interventional radiologist: practice and outcomes in the UK.

OBJECTIVE: To compare outcomes of urologist vs interventional radiologist (IR) access during percutaneous nephrolithotomy (PCNL) in the contemporary UK setting. PATIENTS AND METHODS: Data submitted to the British Association of Urological Surgeons PCNL data registry between 2009 and 2015 were analysed according to whether access was obtained by a urologist or an IR. We compared access success, number and type of tracts, and perceived and actual difficulty of access. Postoperative outcomes, including stone-free rates, lengths of hospital stay and complications, including transfusion rates, were also compared. RESULTS: Overall, percutaneous renal access was undertaken by an IR in 3453 of 5211 procedures (66.3%); this rate appeared stable over the entire study period for all categories of stone complexity and in cases where there was predicted or actual difficulty with access. Only 1% of procedures were abandoned because of failed access and this rate was identical in each group. IRs performed more multiple tract access procedures than urologists (6.8 vs 5.1%; P = 0.02), but had similar rates of supracostal punctures (8.2 vs 9.2%; P = 0.23). IRs used ultrasonograhpy more commonly than urologists to guide access (56.6% vs 21.7%, P < 0.001). There were no significant differences in complication rates, lengths of hospital stay or stone-free rates. CONCLUSIONS: Our findings suggest that favourable PCNL outcomes may be expected where access is obtained by either a urologist or an IR, assuming that they have received the appropriate training and that they are skilled and proficient in the procedure.

The pregnant urologist.

Female urologists represent an ever-increasing percentage of the work force; more and more of our colleagues will be working through pregnancy. There is a lack of clear and concise advice for pregnant urologists about occupational risks during pregnancy. Urology exposes expectant mothers to potential risks from radiation, teratogenic and cytotoxic drugs, iodine hand scrub, infections, and long working hours. We aim to provide a review of the current evidence and guidance to aid expectant mothers in their decision making. Relevant research articles and up-to-date guidance were reviewed. The millisevert (the average accumulated background radiation dose to an individual for 1 year, exclusive of radon) was used as the main unit of radiation dose. There is no published evidence to date in pregnant clinicians that shows a received radiation dose of more than the recommended dose for a pregnant lady, and no data showing an increased risk of foetal abnormalities in clinicians who continue to screen during pregnancy; however, the data are from small studies. There is strong advice suggesting avoidance of contact with crushed or broken 5α-reductase inhibitor tablets (finasteride and dutasteride), mitomycin and other cytotoxic drugs during pregnancy. Pregnant surgeons should avoid frequent use of iodine hand wash. Good hygiene precautions will protect from many infections along with up-to-date immunisations and use of personal protective equipment for certain cases.

Knowledge, attitudes and beliefs towards management of men with locally advanced prostate cancer following radical prostatectomy: an Australian survey of urologists.

OBJECTIVE: To investigate Australian urologists' knowledge, attitudes and beliefs, and the association of these with treatment preferences relating to guideline-recommended adjuvant radiotherapy for men with adverse pathologic features following radical prostatectomy. SUBJECTS AND METHODS: A nationwide mailed and web-based survey of Australian urologist members of the Urological Society of Australia and New Zealand (USANZ). RESULTS: 157 surveys were included in the analysis (45% response rate). Just over half of respondents (54%) were aware of national clinical practice guidelines for the management of prostate cancer. Urologists' attitudes and beliefs towards the specific recommendation for post-operative adjuvant radiotherapy for men with locally advanced prostate cancer were mixed. Just over half agreed the recommendation is based on a valid interpretation of the underpinning evidence (54.1%, 95% CI [46%, 62.2%]) but less than one third agreed adjuvant radiotherapy will lead to improved patient outcomes (30.2%, 95% CI [22.8%, 37.6%]). Treatment preferences were varied, demonstrating clinical equipoise. A positive attitude towards the clinical practice recommendation was significantly associated with treatment preference for adjuvant radiotherapy (rho = 0.520, P < 0.0001). There was stronger preference for adjuvant radiotherapy in more recently trained urologists (registrars) while preference for watchful waiting was greater in more experienced urologists (consultants) (b = 0.156, P = 0.034; 95% CI [0.048, 1.24]). Urologists' attitudes towards clinical practice guidelines in general were positive. CONCLUSION: There remains clinical equipoise among Australian urologists in relation to adjuvant radiotherapy for men with adverse pathologic features following radical prostatectomy.

Urologist referral delay and its impact on survival after radical cystectomy for bladder cancer.

BACKGROUND: Evidence shows that wait times before bladder cancer surgery have been increasing, and wait time can negatively affect survival. We aimed to determine if a long delay caused by an indirect referral before a first urologist visit affects the survival of patients undergoing radical cystectomy for bladder cancer. METHODS: We analyzed data from 1271 patients who underwent surgery for bladder cancer during the decade 2000-2009. The cohort was obtained by linking two administrative databases in the province of Quebec. Patients were considered to have been directly referred to a urologist if they had 5 or fewer visits with a general practitioner before their first urologist visit; otherwise, they were considered to have been indirectly referred. The effect on survival after surgery of a longer delay before a first urologist visit was assessed using Cox regression models. RESULTS: Median referral delay for the study population was 30 days (56 days for women, 23 days for men; p < 0.0001). Indirect referral was observed for 49% of women and 33% of men. Compared with patients who were directly referred, those who were indirectly referred after first symptoms of bladder cancer experienced poorer survival (hazard ratio: 1.29; 95% confidence interval: 1.10 to 1.52). Women who were indirectly referred had a significant 47% greater risk of death after radical cystectomy. Men who were indirectly referred also experienced decreased survival (adjusted hazard ratio: 1.25; 95% confidence interval: 1.03 to 1.51). CONCLUSIONS: Patients indirectly referred to a urologist had an increased risk of mortality after surgery. Compared with men, women had longer wait times and poorer survival.

Racial disparities in urologist visits among elderly men with prostate cancer: a cohort analysis of patient-related and county of residence-related factors.

BACKGROUND: Factors contributing to the lower likelihood of urologist follow-up among African American (AA) men diagnosed with prostate cancer may not be strictly related to patient factors. The authors investigated the relationship between crime, poverty, and poor housing, among others, and postdiagnosis urologist visits among AA and white men. METHODS: The authors used linked cancer registry and Medicare claims data from 1999 through 2007 for men diagnosed with American Joint Committee on Cancer stage I to III prostate cancer. The USA Counties and County Business Patterns data sets provided county-level data. Variance components models reported the percentage of variation attributed to county of residence. Postdiagnosis urologist visits for AA and white men were investigated using logistic and modified Poisson regression models. RESULTS: A total of 65,635 patients were identified; 87% of whom were non-Hispanic white and 9.3% of whom were non-Hispanic AA. Approximately 16% of men diagnosed with stage I to III prostate cancer did not visit a urologist within 1 year after diagnosis (22% of AA men and 15% of white men). County of residence accounted for 10% of the variation in the visit outcome (13% for AA men and 10% for white men). AA men were more likely to live in counties ranked highest in terms of poverty, occupied housing units with no telephone, and crime. AA men were less likely to see a urologist (odds ratio, 0.65 [95% confidence interval, 0.6-0.71]; rate ratio, 0.94 [95% confidence interval, 0.92-0.95]). The sign and magnitude of the coefficients for the county-level measures differed across race-specific regression models of urologist visits. CONCLUSIONS: Among older men diagnosed with stage I to III prostate cancer, the social environment appears to contribute to some of the disparities in postdiagnosis urologist visits between AA and white men.

[Current state of compensation of on-duty and on-call urologists in France: a study from AFUF]. / État des lieux des rémunérations des gardes et astreintes d'urologie en France: une étude de l'AFUF.

INTRODUCTION: The French Association of Urologists-in-training (AFUF) aimed to assess the current state of remunerations of on-call and on-duty residents, assistants and lecturers in urology in France. MATERIAL AND METHODS: Data were collected from February to May 2013 through a questionnaire sent to all members of the AFUF (327 members). Remunerations were given in gross values. RESULTS: Forty-three residents took part in the study, 16 assistants and 16 lecturers, representing 62 % of the whole centers (54 hospitals out of the 92 centers practicing urology in France). Most of responders were on security or operational on-call. Twenty hospitals were practicing multi-organ removal. Median remunerations of residents were about 59.51€ per on-call when moving at hospital for work and about 119.02€ per onsite duty. Assistants and lecturers were paid a flat fee rate for 37.5 % of them (140€ for assistants [with variability from 40 to 195€] and 130€ for lecturers [42.5-180]) or an hourly rate depending on the hours spent at hospital for the others (62.5 %): first, second move or move<3h were paid 100€ for assistants and 65€ for lecturers, 233.5€ and 236€ respectively for the third one or above 3h, 365€ and 473€ respectively above 8h. Multi-organ removals were paid a flat fee rate (60 %) or an hourly rate (40 %) as well. Beyond a threshold of 2-3hours, the hourly rate was more interesting than the flat fee rate. CONCLUSION: There were disparities in remuneration of on-call and on-duty urologists. Greater variability affected on-call flat fee rate remuneration beyond a certain threshold of hours and remuneration of multi-organ removal. These disparities should be considered in order to get a national harmonization.

Estimated prospects of demand and supply of urologists in Korea over the next 10 years.

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.

Understanding current ergonomics setup for urologists conducting anatomical endoscopic enucleation of the prostate surgeries: Survey analysis from the endourological society.

BACKGROUND: Ensuring ergonomic posture and safety for surgeons is key to preventing work-related injuries and promoting sustained practice. We evaluated ergonomic aspects of Anatomic Endoscopic Enucleation of the Prostate (AEEP) and its relation to musculoskeletal injuries. METHOD: A two-month online survey involving 119 Endourological Society members provided an in-depth analysis of AEEP practices and their musculoskeletal impacts. RESULTS: The sample experienced general (65.5%), back (32.8%), neck (35.3%) and shoulder (37%) pain. Female AEEP surgeons reported greater back pain. Experience and age were inversely related to MSK injuries, and operative times over 2 â€‹h increased back pain. AEEP procedures predominantly involved sitting (86%) on backless stools (58%), with most surgeons wearing protective eyewear (75.6%) and using large resectoscopes (76.5%). Monitors were usually above eye-level (57%) and beyond 1 â€‹m (68.9%). CONCLUSION: Musculoskeletal complaints are prevalent among AEEP endourologists. More awareness and further studies on risk factors are necessary to limit work-related injuries in urology.