Discomfort and relieving factors among patients with bladder cancer undergoing office-based cystoscopy.

OBJECTIVE: To evaluate the degree of discomfort among patients with bladder cancer undergoing office-based cystoscopy and identify factors and interventions that influence discomfort and anxiety. METHODS: We conducted a survey of the Bladder Cancer Advocacy Network Patient Survey Network (BCAN PSN) to investigate the degree of discomfort associated with office-based cystoscopy and prevalence of interventions used to reduce discomfort. All patients had undergone at least one previous cystoscopy. Bivariable and multivariable logistic regression were used to identify factors associated with moderate-to-severe cystoscopy discomfort. RESULTS: Among 488 BCAN PSN respondents (50% response rate), 392 responded with demographic data and discomfort score. Cystoscopy was associated with moderate-to-severe discomfort in 52% of patients. Respondents who reported moderate-to-severe discomfort were more likely to describe their most recent cystoscopy discomfort as worse than prior (P<0.001) and to be interested in planning discomfort mitigation for cystoscopy (P<0.001). On multivariable analysis, gender was the only factor independently associated with discomfort, with women reporting less discomfort than men (OR 0.59, 95%CI 0.37-0.95,P=0.03). Patients reported a wide variety of cystoscopy-specific interventions with differing perceived effectiveness, the most common being intraurethral lidocaine. CONCLUSIONS: Over half of patients undergoing office-based cystoscopy for bladder cancer report moderate-to-severe discomfort, constituting a substantial problem among patients undergoing the procedure. Future large pragmatic comparative effectiveness trials are needed to better understand which interventions work most effectively to reduce discomfort associated with cystoscopy.

Correlation of Relative Value Units With Surgical Complexity and Physician Workload in Urology.

OBJECTIVE: To define the relationship between urology relative value units (RVUs) and measures of surgical complexity and physician workload. Secondary objectives include: (1) identifying procedures with outlying RVU values for their measures of surgical complexity and workload; and (2) calculating projected RVU values for these procedures. METHODS: We obtained surgical case data for 71 urology current procedural terminology (CPT) codes from the 2017 American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database. Pearson correlation coefficients were calculated to measure the association between mean total work RVU and operative time, length of hospital stay, serious adverse events, readmissions, and mortality. We developed a multivariable regression model to predict mean total work RVU from these measures. Studentized residuals were used to identify outlying CPT codes for both bivariable and multivariable regression models, and empirically derived RVU values from complexity and work effort metrics were estimated. RESULTS: We analyzed 71 urology CPT codes encompassing 55,068 cases. RVUs correlated well with median length of hospital stay (R = 0.81), median operative time (R = 0.92), serious adverse events (R = 0.83), and readmissions (R = 0.74). RVUs were poorly correlated with mortality (R = 0.34). Outlying procedures identified using the multivariable model were retroperitoneal lymph node dissection (projected +21.09 RVUs), laparoscopic ureteroneocystotomy (projected -12.34 RVUs), and cystectomy with bilateral pelvic lymphadenectomy (projected +9.37 RVUs). CONCLUSION: Urology work RVUs correlate more with operative time than other measures of surgical complexity and physician workload. There exist several significant outlying procedures for various work measures. Incorporating objective work data may improve RVU assignments in the future.

Why Work for Women in Urology? / ¿Por qué trabajar para mujeres en urología?

"Destiny guides our fortunes more favorably than we could have expected" wrote Miguel de Cervantes Saavedra, author of the legendary novel Don Quixote of La Mancha. These words describe exactly what has happened to us over the past year. We met by chance at a urology congress last August in the City of Barranquilla. We took the opportunity to sit down unsuspectingly with coffee in hand and started talking about the big picture of urology in the world and especially in Latin America. We soon realized that despite being born in two countries as different as the United States and Colombia, we both shared similar barriers as women urologists. The truth is that despite the increase in the number of women in careers such as medicine, the growth in terms of medical and surgical specialties is still very low. According to the latest census of the American Urological Association (AUA), female urologists currently make up only 9.9% of the total membership in the US academy.[1] What is contradictory is that many studies have evaluated the change in the workforce that has been occurring in this branch of medicine for a few years, since it is assumed that by 2060 there will be a growth in the number of women of 3.7% versus 1.3% compared to men.[2] These two surprising facts forced us to think about the need to find solutions.

"El destino guía nuestra suerte más favorablemente de lo que podíamos esperar", escribió Miguel de Cervantes Saavedra, autor de la legendaria novela Don Quijote de la Mancha. Estas palabras describen exactamente lo que nos ha ocurrido en el último año. Nos conocimos por casualidad en un congreso de urología el pasado mes de agosto en la ciudad de Barranquilla. Aprovechamos la oportunidad para sentarnos desprevenidamente con un café en la mano y empezamos a hablar sobre el gran panorama de la urología en el mundo y especialmente en Latinoamérica. Pronto nos dimos cuenta que a pesar de haber nacido en dos países tan diferentes como Estados Unidos y Colombia, ambas compartíamos barreras similares como mujeres urólogas. Lo cierto es que a pesar del aumento del número de mujeres en carreras como medicina, el crecimiento en cuanto a especialidades médicas y quirúrgicas es aún muy bajo. Según el último censo de la Asociación Americana de Urología (AUA), en la actualidad las mujeres urólogas representan sólo el 9,9% del total de miembros de la academia estadounidense[1] Lo contradictorio es que muchos estudios han evaluado el cambio en la fuerza laboral que se viene dando en esta rama de la medicina desde hace algunos años, pues se presume que para el año 2060 habrá un crecimiento en el número de mujeres del 3,7% frente al 1,3% de los hombres[2] Estos dos sorprendentes datos nos obligaron a pensar en la necesidad de encontrar soluciones.