Disposable versus Reusable Cystoscopes: A Micro-Costing Value Analysis in High-Volume and Low-Volume Urology Practices.

INTRODUCTION: Disposable single-use cystoscopes have become increasingly available, demonstrating comparable quality to reusable cystoscopes while eliminating the need for reprocessing and repairs. However, high costs remain a concern. To clarify the role for these scopes, we performed a cost analysis comparison between the single-use Ambu® aScope™ 4 cystoscope and reusable Olympus® CYF-VHR and V2 cystoscopes in 2 clinical settings: a high-volume multi-provider practice and low-volume single-provider practice. METHODS: The number of cystoscopies at each center was recorded between January and December 2019. Elements in the micro-costing analysis included the original purchasing price of the cystoscopes plus accessory equipment, sterilization supplies, repair costs, and personnel. Costs were amortized over 5 or 10 years and calculated on a per-case basis. An annual total cost analysis was performed to evaluate the cost-effectiveness of each device for each facility. RESULTS: In 2019, 1,984 and 245 cystoscopic procedures were performed at the high and low-volume clinics, respectively. At the high-volume multi-provider practice, per-case cost for reusable cystoscopy amounted to $65.98 compared to $227.18 for single-use cystoscopy, with reusable equipment more cost-effective after 294 cystoscopies. At the low-volume single-provider practice, the per-case cost for reusable cystoscopy was $232.62 compared to $461.18 for single-use cystoscopy, with reusable equipment more cost-effective after 19 cases. CONCLUSIONS: Based on this micro-costing analysis, per-case costs favor reusable cystoscopes. While single-use cystoscope pricing may be prohibitive for large and small facilities at this present time, these instruments are powerful adjuncts to urologists' armamentaria when portability and efficiency are prioritized.

Transgender Patient Care in Urology: Evaluation of Attitudes, Knowledge and Practice Patterns among Urologists in the New York Metropolitan Area.

INTRODUCTION: Transgender individuals suffer from significant health disparities, due in part to deficiencies in physician knowledge or comfort with addressing transgender health care needs. In this study we assessed the attitudes and clinical knowledge in caring for transgender patients of a representative sample of urologists in the New York metropolitan area. METHODS: An anonymous, online based questionnaire was sent to members of the New York Section of the American Urological Association. Statements evaluating knowledge and attitudes toward transgender care were scored on a 5-point Likert scale. RESULTS: A total of 92 providers (83.7% male) participated in the study, of whom 78.3% (72) have been in practice for at least 15 years. With respect to physician attitudes, there was a trend toward greater comfort with discussion of gender identity and counseling on gender confirmation surgery based on total number of transgender patients cared for during the course of their career. Regarding knowledge scores there were no significant associations with physician age, gender or years of practice. Despite the relatively weak self-reported fund of knowledge (2.64) and overall clinical competence (2.09), there was no overwhelming support to incorporate transgender care into urology training curricula (3.11). CONCLUSIONS: Despite growing education and awareness of transgender specific medical issues, many urologists self-report deficiencies in requisite knowledge and comfort in providing adequate, culturally competent care for transgender patients. Further work is needed to increase our collective comfort level with this new and evolving aspect of our field.

Effects of Feminizing Hormones on Sperm Production and Malignant Changes: Microscopic Examination of Post Orchiectomy Specimens in Transwomen.

OBJECTIVE: To examine post-orchiectomy specimens of transgender individuals to better understand the reproductive implications of hormonal therapy and to look for potential malignant or premalignant changes. MATERIALS AND METHODS: A retrospective chart review was performed on the orchiectomy specimens from 135 TG individuals who underwent bilateral simple orchiectomy (54) or vaginoplasty with combined orchiectomy (81) at a single institution from 2014-2017. Factors examined included microscopic evidence of spermatogenesis, weight of specimens, evidence of malignant or premalignant changes, and patient demographic information. RESULTS: Four percent (6/135) of all orchiectomy specimens had normal spermatogenesis in both testicles. Twenty-one percent (28/135) demonstrated some stage of spermatogenesis, of which 61% (17/28) were in maturational arrest. The median patient age at surgery was 30 years (range 18-76). Median overall testicle weight was 24 g (range 10.4-71.1), compared with 24 g (range 10-71g) in testicles without evidence of spermatogenesis and 26 g (range 17.9-40.9) in testicles with normal spermatogenesis. None of the specimens demonstrated premalignant or malignant changes. CONCLUSION: Up to 21% of individuals undergoing a gender affirming surgery had microscopic evidence of spermatogenesis in varying stages. Furthermore, 4% of individuals had normal spermatogenesis. None of the specimens had malignant or premalignant changes. These findings may have implications for counseling transgender individuals on sexual and reproductive health and highlight the need for further research in this sector.

Renal mass in solitary, crossed, ectopic pelvic kidney.

A 46-year-old healthy man presented with abdominal pain and a solitary ectopic, crossed pelvic kidney with an enhancing mass, imaged with 3-dimensional computed tomography. He underwent open partial nephrectomy, which revealed Stage T1, grade 2 conventional renal cell carcinoma with negative surgical margins. The incidence of renal cell carcinoma in the computed tomography era in a solitary crossed ectopic kidney is approximately 1 in 22 million.

Outcomes of varicocelectomy treatment: an updated critical analysis.

This article provides an updated analysis of the varicocele literature published since 1994. The present authors have followed the format of the previous review and have included a summary of the results from the 1994 article at the end of each section.

Presentation of a functional pituitary adenoma as a significant decrease in prostate-specific antigen level in a patient followed for prostate cancer.

The stimulatory role of testosterone in the production and release of prostate-specific antigen (PSA) has been well characterized. Testosterone production by the testes is dependent on a functional hypothalamic-pituitary-gonadal axis. High prolactin levels have been shown to disrupt this axis, resulting in decreases in gonadotropins and testosterone levels. We report a patient with prostate cancer and elevated PSA levels followed with "watchful waiting" for several years who experienced a precipitous decrease in PSA level over a 3 month period. The patient was found to have an asymptomatic prolactin-secreting pituitary macroadenoma.

Radionuclide imaging in urology.

Radiopharmaceutic tracers are used commonly to diagnose and monitor benign and malignant conditions of the genitourinary system. Most often, these tracers assess renal function and obstruction in "normal" and transplanted renal units. More recently, especially with the advent of positron emission tomography (PET)/CT, the role of nuclear pharmaceutics in the staging and monitoring of malignancies has expanded.

Recurrent transitional cell carcinoma in a scrotal abscess.

We discuss a case of recurrent transitional cell carcinoma to the scrotum 5 years after cystectomy, along with its postoperative management and implications.