Preliminary assessment of patient and physician satisfaction with the use of teleconsultation in urology during the COVID-19 pandemic.

PURPOSE: Lockdown during the COVID-19 pandemic compelled urologists to change access to healthcare, especially for oncology patients. Teleconsultation is a safe way to receive medical advice without a risk of infection, and was implemented urgently in our academic centres. Our purpose was to evaluate patient and physician satisfaction with teleconsultation set up during the COVID-19 pandemic. METHODS: From March 16th 2020, all face-to-face consultations were cancelled in France, except for emergencies. Teleconsultation was started immediately by five senior urologists in two academic hospitals. All patients received an email survey including the validated Teleconsultation Satisfaction Questionnaire (TSQ) and demographic questions. Data were collected prospectively. Physicians also responded to the TSQ. Patient satisfaction was measured objectively with the validated 14-item TSQ. Each item was scored on a 5-point Likert scale. Factors associated with positive satisfaction with teleconsultation were assessed by multivariable logistic regression. RESULTS: Overall, 105 patients replied to the survey (91.3%). Median age was 66 years (IQR: 55‒71) and 95 were men (90.5%). Median overall TSQ score was 67 (IQR: 60‒69); teleconsultation was judged to be a good experience by 88 patients (83.8%) and four physicians (80%). Patients who met their surgeon for the first time were more likely to have a good experience (OR = 1.2 [95% CI 1.1‒1.5], p = 0.03). CONCLUSION: Introduced rapidly during the COVID-19 lockdown, urology teleconsultation attained a high level of satisfaction among both patients and physicians. A major change in telemedicine use is foreseen in the post COVID-19 era.

The Impact of COVID-19 Pandemic on Urological Emergencies: A Multicenter Experience on over 3,000 Patients.

OBJECTIVE: COVID-19 pandemic represents a dramatic challenge for healthcare systems worldwide, and it also affects daily urological practice. After China and Italy, Tessin (Switzerland) has been hit the hardest, due to its close proximity to Lombardy and the high number of frontier workers in the area. Our objective was to share with the scientific community how, during the COVID-19 period, there has been a huge modification in urological emergencies throughout all hospitals included in the Ente Ospedaliero Cantonale (EOC). METHODS: We retrospectively reviewed urgent urological consultations requested by the emergency department (ED) of the 4 public hospitals located in Tessin belonging to EOC in the 3-month period between February 15 and May 15, 2020, and compared them to the 2 previous years cases within the same time frame (February 15 to May 15, 2018 and 2019). The number of daily consultations, urgent invasive procedures performed, and admissions were evaluated. RESULTS: The final sample resulted in 594 consultations performed in 2020, 974 in 2018, and 974 in 2019. A higher number of daily consultations were performed during 2018 and 2019. The number of daily admissions dropped consistently during the COVID-19 pandemic (737 vs. 392). CONCLUSIONS: Our multicenter study aimed to quantify changes in urgent urological care in Tessin in the midst of the COVID-19 pandemic. Urgent urology practice was dramatically affected with a remarkable reduction in urgent urological consultations, whereas a higher risk of admissions was observed in 2020, due to the severity of the patients.

Implantación de un protocolo de actuación en patología prostática en atención primaria e impacto en las derivaciones a urología / Implementing an action protocol on prostatic disease in primary care and impact on referrals to urology

OBJETIVO: Determinar el impacto sobre las derivaciones a Urología desde Atención Primaria, de un protocolo de actuación conjunta en patología prostática en un área sanitaria. MÉTODOS: Se elaboró un protocolo para el manejo del paciente que consulta por clínica relacionada con hiperplasia prostática y para la realización de PSA en varón asintomático. Al mismo tiempo, se abrieron tres direcciones de correo electrónico para consultas generadas desde Atención Primaria y se realizaron sesiones conjuntas en los Centros de Salud. Medimos el impacto del protocolo valorando la adecuación de las derivaciones a Urología por patología prostática, así como determinando la evolución del número total de derivaciones en tres centros de especialidades periféricas. RESULTADOS: Desde enero de 2011, se ha producido una mejor adecuación de las derivaciones a Urología por patología prostática, que han pasado de un 47% de adecuación (valoración previa a la implantación del protocolo) a un 64%. Estos resultados son especialmente buenos cuando consideramos las derivaciones relacionadas con el PSA, que han pasado de un 33% a un 84% de adecuación. En cuanto a la evolución de las derivaciones a Urología, la tasa de derivación (derivaciones por 1000 habitantes) ha descendido en un 15% (de 13,8 a 11,7). CONCLUSIONES: La colaboración entre Urología y Atención Primaria, mediante la implantación de protocolos conjuntos, así como estableciendo nuevos medios de comunicación (correo electrónico, sesiones conjuntas), consigue una mejor adecuación de los pacientes derivados por patología prostática, así como una disminución en el número total de derivaciones (AU)

OBJECTIVES: To determine the impact of implementing a joint action protocol on prostatic disease on the referrals to Urology from Primary Care in a health care area. METHODS: We drafted a protocol for managing patients consulting for clinical signs and symptoms associated to benign prostatic hyperplasia (BPH) and to test PSA in asymptomatic males. At the same time, three e-mail addresses were opened for consultations generated from Primary Care, and joint sessions were carried out in the primary health care centers. We measured the impact of the protocol by assessing the adequacy of prostatic disease referrals to Urology, as well as by determining the course of the total number of referrals in three peripheral specialized health care centers (PSHCC). RESULTS: From January 2011, a better compliance to the referrals to Urology protocol for prostatic disease has been produced, going from 47% (assessment prior to implementing the protocol) to 64%. These results are especially good when we consider referrals associated to PSA, which went from a compliance of 33% to 84%.Regarding the course of the referrals to Urology, the referral rate (referrals per 1000 inhabitants) has decreased by 15% (from 13,8 to 11,7). CONCLUSIONS: The collaboration between Urology and Primary health care, by means of implementing joint protocols, and also by establishing new communication channels (e-mail, joint sessions), achieves a better adequacy of patients referred for prostatic disease, as well as a reduction in the total number of referrals (AU)

[Current state, challenges and prospects for the development of the Russian urological service].

The present study was dedicated to the analysis of the incidence, prevalence and mortality from diseases of the urogenital system. The data on the effectiveness of the hospital bed usage, the patient profile at hospital, the treatment timing and outcomes, surgical activities in urological hospitals, the state of staff assistance in urological service, the efficacy of usage of working time of urologist and human resource of Russian urological service were analyzed. Data analysis revealed a number of issues of administrative and legal nature, which cause modest efficiency of activity of urological service. The ways for solutions of these problems are presented.

El urólogo y las nuevas dianas terapéuticas en el cáncer renal avanzado / Urologist's role in the treatment with new targeted therapies in advanced renal cell carcinoma

No disponible

Cirugía ambulatoria en un Servicio de Urología. Análisis del período 2003-2006 / Ambulatory surgery in a urology department. Analysis of the period 2003-2006

Objetivo: En la cirugía sin ingreso deberemos distinguir entre el concepto de cirugía menor ambulatoria y cirugía mayor ambulatoria. La cirugía ambulatoria, permite que el paciente no esté en el hospital más allá de unas horas, mostrando una seguridad y efectividad similar a la cirugía convencional. Evaluar los resultados de un programa de cirugía ambulatoria. Métodos: Estudio descriptivo retrospectivo de los resultados de funcionamiento de la Cirugía Ambulatoria (C.A) en un Servicio de Urología, incluyendo 4185 pacientes en un periodo de estudio de cuatro años, que comprende desde el 1 de enero del 2003 hasta el 31 de diciembre del 2006. Resultados: En el periodo de estudio el índice de sustitución global fue del 83,6%. El índice de ingresos fue del 2,5%, de los cuales la mayoría fueron ingresos precoces. Las complicaciones mayores se presentaron en 26 pacientes (0,6%), siendo la hemorragia mayor la predominante. La mayoría de las complicaciones son menores o leves, y el dolor en la zona de la herida quirúrgica es el problema encontrado con mayor frecuencia. Conclusiones: El auge y la promoción continua de la cirugía ambulatoria están más que justificadas. La alta satisfacción de los pacientes sometidos a este tipo de cirugía, con el escaso número de complicaciones registradas, nos proporcionan una valiosa herramienta de control del gasto sanitario (AU)

Objectives: When talking about day surgery we have to differentiate between minor and major ambulatory surgery. Ambulatory surgery enables the patient to stay in the hospital not more than a few hours, showing similar safety and efficacy than conventional surgery. The objective of this paper is to evaluate the results of an ambulatory surgery program. Methods: Descriptive retrospective study of the results of the Ambulatory Surgery in a Urology Department, including 4185 patients in a four-year period, from January 1st 2003 to December 31st 2006. Results: In the study period the global substitution rate was 83.6%. The hospital admission rate was 2.5%, most of which were early admissions. Major complications appeared in 26 patients (0.6%), being major bleeding the predominant one. Most complications were minor or mild, and pain at the site of the surgical wound was the most frequent problem found. Conclusions: The increase and continuous promotion of ambulatory surgery are more than justified. The high satisfaction among patients undergoing this type of surgery, with a very low number of complications registered, provides us with a valuable tool for health-care expenditure control (AU)

Evolución cronológica del trasplante renal en España / Chronological evolution of the renal transplant in Spain

Introducción: Pretendemos establecer la evolución cronológica que ha llevado el trasplante renal en España. Apoyados en la heurística recogemos desde las primeras experiencias y trabajos científicos publicados a comienzos de los años sesenta hasta los de finales del siglo XX en el que el procedimiento se encuentra ya consolidado. Material y método: Revisamos la bibliografía urológica española, las publicaciones de trasplante renal, las de diálisis y las nefrológicas y cuantas referencias bibliográficas hemos localizado además de aportar nuestra experiencia personal. Resultados: El afán de ayudar a los pacientes en insuficiencia renal terminal fue el motor que impulsó a los urólogos españoles a comenzar con la práctica de los trasplantes renales. En mayo de 1960 el Dr. Martínez-Piñeiro efectúa el primero, sin resultado satisfactorio y es en julio de 1965 cuando el equipo del Dr. Gil-Vernet realiza un trasplante de cadáver con larga sobrevida del paciente y del órgano. Con los avances en los tratamientos inmunosupresores, el procedimiento se consolida como la mejor opción para el tratamiento de la insuficiencia renal y se suman a los trasplantes los principales hospitales del país. Conclusiones: Los urólogos españoles, con su esfuerzo, dedicación y confianza en los resultados de la técnica, son los iniciadores y principales responsables de la actividad quirúrgica del implante y únicamente cuando el beneficio era evidente se movió la Administración a establecer las normas para su desarrollo; tras la constitución de la ONT, con su despliegue de medios, se logra que España alcance y afiance una primacía mundial tanto en número de donantes como de implantes

Introduction: We try to establish the chronological evolution that has taken the renal transplant in Spain. Supported on the heuristic one we gather from the first experiences and scientific works published at the beginning of the sixties up to those of the finals of the XXth century in which the procedure is already consolidated. Material and method: We check the Spanish bibliography urology, the publications of renal transplant, those of dialysis and the nefrology and all the bibliographical references we have located beside contributing our personal experience. Results: The zeal to help the patients in renal terminal insufficiency was the engine that stimulated the Spanish urologist to begin with the practice of the renal transplants. In May, 1960 the Dr. Martínez-Piñeiro carries out the first one, without satisfactory result and is in july, 1965 when the team of the Dr. Gil-Vernet realizes a transplant of corpse with long billiard cue sobrevida of the patient and of the organ. With the advances in the treatments immunosuppressants, the procedure is consolidated as the best option for the renal insufficiency treatment and the Spain principal hospitals add to the transplants. Conclusions: The Spanish urologist, with their effort, dedication and confidence in the results of the technology, are the beginning and principal persons in charge of the surgical activity of the implant and only when the benefit was evident the Administration moved to establishing the procedure for its development; after the constitution of the ONT, with its unfolding of means, they achieves that Spain reaches and guarantees a world primacy so much in number of donors as of implants

[Further development of urology in the tension field of surgical and molecular medicine]. / Weiterentwicklung der Urologie im Spannungsfeld von operativer und molekularer Medizin.

Methods based on molecular biology and molecular medicine now have important practical applications in many areas of theoretical and clinical medicine, and it is no longer possible to imagine life without them. This means that in a largely surgical discipline, such as urology, completely new challenges are coming to the fore, which urology, as an academic and clinical discipline, now has to face up to, and to a much greater degree than hitherto. However, there is less and less freedom of action in any university department of urology, as a result not only of intensified legal outline conditions in the healthcare sector and tight public budgets, but also of faculty- and hospital-specific blocks to innovation. There is an urgent need for the creation of appropriate outline conditions and innovative structures that will allow efficient surgical care and also an efficient way of working scientifically.

A combined urodynamic and continence unit--a review of the first 19 years.

We have completed a 19-year audit of all patients referred to the urodynamic/continence unit since its inception in 1972 and their subsequent clinical management; a total of 20,437 patients were referred, increasing from 51 in the first year to 1564 in 1990. Although the annual number of referrals has remained constant for the last 8 years, the need for more complex urodynamic assessment such as video-cystourethrography has increased from 5% (56/1164) in 1981 to 25% (385/1564) in 1990. The number of out-patient attendances to medical, physiotherapy and continence clinics has also increased over that period. We conclude that the number of referrals represents increasing recognition of the value of urodynamic assessment. Accurate diagnosis leads to more effective treatment, whether surgical, medical or conservative. Some methods of diagnosis are complex and suitable only for a tertiary referral centre.

Test-request patterns for clinical chemistry in a British and a Canadian renal dialysis unit.

We recorded, during four months, the total number of routine clinical chemistry tests requested for patients with end-stage renal failure who were on regular maintenance hemodialysis during the study: 20 in the Renal Dialysis Unit of a British and 20 in a Canadian teaching hospital. The pattern of tests ordered was substantially the same in each unit, but the frequency of testing was not. The total number of tests (and tests per patient per month) was 1616 (20.2) for the British and 6939 (86.7) for the Canadian unit (significant at p less than 0.001). This study suggests a significant difference between the two countries in the utilization of laboratory services, and supports our earlier findings on total clinical chemical workloads in hospitals.