Patient Perceptions of Chaperones during Intimate Examinations and Procedures in Urology Clinic.

INTRODUCTION: We surveyed patients on their expectations and preferences regarding chaperones during intimate examinations and procedures in urology clinic. METHODS: Patients identified in the outpatient urology clinic were queried for demographics, expectations and preferences regarding chaperones through a 16-item survey. RESULTS: We collected data from 200 patients (52.5% male, 47.5% female), average age 60.5 years (SD ± 15.5). Most patients were Caucasian (84.5%), completed some college (65.5%) and were married (52.0%). Most had a prior genitourinary procedure (men 74.7%, women 62.4%), during which 21.5% of men vs 60.7% of women had chaperones present. Most patients did not care if they had a chaperone (men 53.3%, women 54.7%). Only 11.5% of patients preferred a chaperone. Of that minority there was a higher percentage of women who preferred a chaperone compared to men (men 3.8%, women 20%). The majority of patients did not care about the gender of the chaperone but cited comfort level with the provider (men 50.0%, women 54.9%) and invasiveness of procedure or examination (men 36.4%, women 35.4%) as most important. The majority of patients (men 84.8%, women 88.4%) felt that they should have the right to refuse a chaperone. CONCLUSIONS: A minority of patients preferred to have a chaperone during an intimate examination or procedure in urology clinic. Patients prioritized comfort level with the provider, which trumped gender of provider, invasiveness of examination and identity of the chaperone. The use of chaperones during intimate examinations and procedures is routine at many institutions. In an era of patient centered care it is crucial to understand patient preferences and expectations.

Using Aorta-Lesion-Attenuation Difference on Preoperative Contrast-enhanced Computed Tomography Scan to Differentiate Between Malignant and Benign Renal Tumors.

OBJECTIVE: To evaluate the ability of Aorta-Lesion-Attenuation Difference (ALAD) to differentiate malignant renal tumors from renal oncocytomas. METHODS: A retrospective review of preoperative computed tomography (CT) scans and surgical pathology was performed on patients undergoing partial nephrectomy for small, solid renal masses. ALAD was calculated by measuring the difference in Hounsfield units (HU) between the aorta and the lesion of interest on the same image slice on preoperative CT scan. The discriminative ability of ALAD to differentiate malignant pathology from oncocytoma was evaluated by sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and area under curve (AUC) using receiver operating characteristic analysis. RESULTS: A total of 227 preoperative CT scans and corresponding pathology reports were reviewed. ALAD values were calculated during the excretory and nephrographic phases. Nephrographic ALAD was able to differentiate malignant pathology from oncocytoma using a HU threshold of 24 with a sensitivity of 84%, specificity of 86%, PPV of 98%, and NPV of 33%. The AUC for malignant pathology vs oncocytoma was 0.86 (95% confidence intervals 0.77-0.96). Nephrographic ALAD was able to differentiate chromophobe renal cell carcinoma (RCC) from oncocytoma using a HU threshold of 24 with a sensitivity of 100%, specificity of 86%, PPV of 75%, and NPV of 100%. The AUC for chromophobe RCC vs oncocytoma was 0.98 (95% confidence intervals 0.91-1.00). CONCLUSION: ALAD discriminates well between chromophobe RCC and oncocytoma, which may aid in the management of patients with indeterminate diagnoses of oncocytic neoplasm on diagnostic needle biopsy. Further validation of ALAD will be necessary prior to routine use in clinical practice.

Evaluation of Intraoperative Versus Postoperative Adjuvant Mitomycin C with Nephroureterectomy for Urothelial Carcinoma of the Upper Urinary Tract.

BACKGROUND: Results of randomized trials support a single dose of intravesical chemotherapy following radical nephroureterectomy (RNU) for urothelial carcinoma. OBJECTIVE: To evaluate the impact of the timing of intravesical mitomycin C (MMC) administration on the rate of bladder tumor recurrence (BTR) following RNU. METHODS: We performed a retrospective review of patients who underwent RNU for upper tract urothelial carcinoma (UTUC) and received intravesical MMC between 2008 and 2016. Patients were categorized into two separate groups based on the timing of MMC administration: patients who received MMC intraoperatively (IO) and patients who received MMC on post-operative day 1 or later (PO). Our primary endpoint was BTR rate within the first year after surgery. RESULTS: Fifty-one patients met our inclusion criteria: (IO: n = 30; PO: n = 21). There were no statistically significant differences in baseline characteristics of age, gender, race, surgical approach, tumor grade, tumor stage, surgical margins, nodal status, concomitant CIS, or history of bladder cancer. The median length of follow-up for each group was 22 months for IO and 12 months for PO (P = 0.10). The estimated probability of 1-year BTR rates for the IO and PO groups were 16% and 33%, respectively (p = 0.09). Cox analysis noted that the IO patients had a significantly lower rate of BTR in the first year postoperatively (HR = 0.113, 95% CI = 0.28-0.63, p = 0.01). CONCLUSIONS: The use of intraoperative MMC at the time of RNU was associated with a decrease in the risk of 1-year recurrence within the bladder.