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1.
Urology ; 147: 14-20, 2021 01.
Artigo em Inglês | MEDLINE | ID: mdl-33091386

RESUMO

OBJECTIVE: To assess the effectiveness of a telemedicine service for ureteric colic patients in reducing the number of unnecessary face-to-face consultations and shortening waiting time for appointments. METHODS: A telemedicine workflow was implemented as a quality improvement study using the Plan-Do-Study-Act method. All patients presenting with ureteric colic without high-risk features of fever, severe pain, and hydronephrosis, were recruited, and face-to-face appointments to review scan results were replaced with phone consultations. Data were prospectively collected over 3 years (January 2017 to December 2019). Patient outcomes including the reduction in face-to-face review visits, time to review, reattendance and intervention rates, were tracked in an interrupted time-series analysis, and qualitative feedback was obtained from patients and clinicians. RESULTS: Around 53.2% of patients presenting with ureteric colic were recruited into the telemedicine workflow. A total of 465 patients (46.2%) had normal scan results and 250 patients (24.9%) did not attend their scan appointments, hence reducing the number of face-to-face consultations by 71.1%. A total of 230 patients (22.9%) required subsequent follow-up with urology, while 61 patients (6.1%) were referred to other specialties. Mean (SD) time to review was 30.0 (6.2) days, 6-month intervention rate was 3.4% (n = 34) and unplanned reattendance rate was 3.2% (n = 32). Around 93.1% of patients reported satisfaction with the service. CONCLUSION: The ureteric colic telemedicine service successfully and sustainably reduced the number of face-to-face consultations and time to review without compromising on patient safety. The availability of this telemedicine service has become even more important in helping us provide care to patients with ureteric colic in the current COVID-19 pandemic.


Assuntos
Melhoria de Qualidade , Consulta Remota/organização & administração , Cólica Renal/diagnóstico , Cálculos Ureterais/diagnóstico , Urologia/organização & administração , Adulto , /prevenção & controle , Feminino , Implementação de Plano de Saúde/organização & administração , Humanos , Controle de Infecções/organização & administração , Controle de Infecções/normas , Masculino , Pessoa de Meia-Idade , Pandemias/prevenção & controle , Segurança do Paciente/normas , Satisfação do Paciente , Projetos Piloto , Estudos Prospectivos , Pesquisa Qualitativa , Consulta Remota/normas , Cólica Renal/etiologia , Cólica Renal/terapia , Singapura/epidemiologia , Telefone , Centros de Atenção Terciária/organização & administração , Centros de Atenção Terciária/normas , Tomografia Computadorizada por Raios X , Ureter/diagnóstico por imagem , Cálculos Ureterais/complicações , Cálculos Ureterais/terapia , Urologia/métodos , Urologia/normas
2.
Urology ; 147: 21-26, 2021 01.
Artigo em Inglês | MEDLINE | ID: mdl-32979378

RESUMO

OBJECTIVES: To explore the perspective of urological patients on the possibility to defer elective surgery due to the fear of contracting COVID-19. METHODS: All patients scheduled for elective urological procedures for malignant or benign diseases at 2 high-volume centers were administered a questionnaire, through structured telephone interviews, between April 24 and 27, 2020. The questionnaire included 3 questions: (1) In light of the COVID-19 pandemic, would you defer the planned surgical intervention? (2) If yes, when would you be willing to undergo surgery? (3) What do you consider potentially more harmful for your health: the risk of contracting COVID-19 during hospitalization or the potential consequences of delaying surgical treatment? RESULTS: Overall, 332 patients were included (51.5% and 48.5% in the oncology and benign groups, respectively). Of these, 47.9% patients would have deferred the planned intervention (33.3% vs 63.4%; P < .001), while the proportion of patients who would have preferred to delay surgery for more than 6 months was comparable between the groups (87% vs 80%). These answers were influenced by patient age and American Society of Anesthesiologists score (in the Oncology group) and by the underlying urological condition (in the benign group). Finally, 182 (54.8%) patients considered the risk of COVID-19 potentially more harmful than the risk of delaying surgery (37% vs 73%; P < .001). This answer was driven by patient age and the underlying disease in both groups. CONCLUSIONS: Our findings reinforce the importance of shared decision-making before urological surgery, leveraging patients' values and expectations to refine the paradigm of evidence-based medicine during the COVID-19 pandemic and beyond.


Assuntos
/prevenção & controle , Procedimentos Cirúrgicos Eletivos/normas , Pandemias/prevenção & controle , Doenças Urológicas/cirurgia , Procedimentos Cirúrgicos Urológicos/normas , Idoso , Idoso de 80 Anos ou mais , /transmissão , Tomada de Decisão Compartilhada , Medicina Baseada em Evidências/normas , Feminino , Hospitais com Alto Volume de Atendimentos/normas , Humanos , Controle de Infecções/normas , Transmissão de Doença Infecciosa do Profissional para o Paciente/prevenção & controle , Masculino , Pessoa de Meia-Idade , Preferência do Paciente/estatística & dados numéricos , Estudos Prospectivos , Inquéritos e Questionários/estatística & dados numéricos , Tempo para o Tratamento/normas , Urologia/normas
3.
Urol Clin North Am ; 48(1): 137-146, 2021 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-33218588

RESUMO

The use of robotic surgery in urology has grown exponentially in the past 2 decades, but robotic surgery training has lagged behind. Most graduating residents report a lack of comfort independently performing common robotic urologic surgeries, despite an abundance of available resources. There is a general consensus on the key components of a comprehensive robotics curriculum, and well-validated tools have been developed to assess trainee competency. However, no single curriculum has emerged as the gold standard on which individual programs can build their own robotics curricula.


Assuntos
Educação de Pós-Graduação em Medicina/tendências , Procedimentos Cirúrgicos Robóticos/educação , Procedimentos Cirúrgicos Urológicos/educação , Urologia/educação , Competência Clínica , Currículo/normas , Currículo/tendências , Previsões , Humanos , Sistemas Automatizados de Assistência Junto ao Leito , Procedimentos Cirúrgicos Robóticos/normas , Procedimentos Cirúrgicos Robóticos/tendências , Procedimentos Cirúrgicos Urológicos/normas , Procedimentos Cirúrgicos Urológicos/tendências , Urologia/normas , Urologia/tendências
4.
J Urol ; 205(1): 241-247, 2021 01.
Artigo em Inglês | MEDLINE | ID: mdl-32716742

RESUMO

PURPOSE: Resumption of elective urology cases postponed due to the COVID-19 pandemic requires a systematic approach to case prioritization, which may be based on detailed cross-specialty questionnaires, specialty specific published expert opinion or by individual (operating) surgeon review. We evaluated whether each of these systems effectively stratifies cases and for agreement between approaches in order to inform departmental policy. MATERIALS AND METHODS: We evaluated triage of elective cases postponed within our department due to the COVID-19 pandemic (March 9, 2020 to May 22, 2020) using questionnaire based surgical prioritization (American College of Surgeons Medically Necessary, Time Sensitive Procedures [MeNTS] instrument), consensus/expert opinion based surgical prioritization (based on published urological recommendations) and individual surgeon based surgical prioritization scoring (developed and managed within our department). Lower scores represented greater urgency. MeNTS scores were compared across consensus/expert opinion based surgical prioritization and individual surgeon based surgical prioritization scores. RESULTS: A total of 204 cases were evaluated. Median MeNTS score was 50 (IQR 44, 55), and mean consensus/expert opinion based surgical prioritization and individual surgeon based surgical prioritization scores were 2.6±0.6 and 2.2±0.8, respectively. Median MeNTS scores were 52 (46.5, 57.5), 50 (44.5, 54.5) and 48 (43.5, 54) for individual surgeon based surgical prioritization priority 1, 2 and 3 cases (p=0.129), and 55 (51.5, 57), 47.5 (42, 56) and 49 (44, 54) for consensus/expert opinion based surgical prioritization priority scores 1, 2, and 3 (p=0.002). There was none to slight agreement between consensus/expert opinion based surgical prioritization and individual surgeon based surgical prioritization scores (Kappa 0.131, p=0.002). CONCLUSIONS: Questionnaire based, expert opinion based and individual surgeon based approaches to case prioritization result in significantly different case prioritization. Questionnaire based surgical prioritization did not meaningfully stratify urological cases, and consensus/expert opinion based surgical prioritization and individual surgeon based surgical prioritization frequently disagreed. The strengths and weaknesses of each of these systems should be considered in future disaster planning scenarios.


Assuntos
/prevenção & controle , Procedimentos Cirúrgicos Eletivos/normas , Doenças Urológicas/cirurgia , Procedimentos Cirúrgicos Urológicos/normas , Urologia/normas , Adulto , Idoso , /transmissão , Tomada de Decisão Clínica , Controle de Doenças Transmissíveis/normas , Consenso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pandemias/prevenção & controle , Seleção de Pacientes , Medição de Risco/métodos , Medição de Risco/normas , Fatores de Tempo , Triagem/normas , Estados Unidos/epidemiologia , Adulto Jovem
5.
Actas urol. esp ; 44(10): 644-652, dic. 2020. ilus, tab
Artigo em Espanhol | IBECS | ID: ibc-195507

RESUMO

INTRODUCCIÓN: La telemedicina ofrece un soporte clínico remoto utilizando herramientas tecnológicas. Puede facilitar la atención médica al tiempo que reduce las visitas innecesarias a la consulta. La pandemia COVID-19 ha provocado un cambio brusco en nuestra práctica urológica diaria convirtiéndose en algo muy necesario el acto de la teleconsulta. OBJETIVO: Proporcionar recomendaciones prácticas para el uso efectivo de herramientas tecnológicas en telemedicina. MATERIALES Y MÉTODOS: Se realizó una búsqueda en la literatura en la plataforma Medline hasta abril de 2020; seleccionamos los artículos más relevantes relacionados con «telemedicina» y «trabajo inteligente» que podrían proporcionar información útil. RESULTADOS: La telemedicina se refiere al uso de la información electrónica y a las herramientas de telecomunicaciones para proporcionar apoyo clínico remoto a la atención médica. El trabajo inteligente es un modelo de trabajo que utiliza tecnologías nuevas o existentes para mejorar el rendimiento. La telemedicina se está convirtiendo en una herramienta útil y necesaria durante la pandemia COVID-19 e incluso más allá de la misma. Es hora de que formalicemos y demos el lugar que se merece a la telemedicina en nuestra práctica clínica y es nuestra responsabilidad adaptar y conocer todas las herramientas y posibles estrategias para su implementación de una manera óptima, garantizar una atención de calidad a los pacientes y que dicha atención sea percibida por pacientes y familiares como de alto nivel. CONCLUSIONES: La telemedicina facilita la atención clínica urológica especializada a distancia y resuelve problemas como las limitaciones en la movilidad o el traslado de los pacientes, reduce las visitas innecesarias a las clínicas y es útil para reducir el riesgo de transmisión viral de la COVID-19


INTRODUCTION: Telemedicine provides remote clinical support through technology tools. It can facilitate medical care delivery while reducing unnecessary office visits. The COVID-19 outbreak has caused an abrupt change in our daily urological practice, where teleconsultations play a crucial role. OBJECTIVE: To provide practical recommendations for the effective use of technological tools in telemedicine. MATERIALS AND METHODS: A literature search was conducted on Medline until April 2020. We selected the most relevant articles related to «telemedicine» and «smart working» that could provide valuable information. RESULTS: Telemedicine refers to the use of electronic information and telecommunication tools to provide remote clinical health care support. Smart working is a working approach that uses new or existing technologies to improve performance. Telemedicine is becoming a useful and fundamental tool during the COVID-19 pandemic and will be even more in the future. It is time for us to officially give telemedicine the place it deserves in clinical practice, and it is our responsibility to adapt and familiarize with all the tools and possible strategies for its optimal implementation. We must guarantee that the quality of care received by patients and perceived by them and their families is of the highest standard. CONCLUSIONS: Telemedicine facilitates remote specialized urological clinical support and solves problems caused by limited patient mobility or transfer, reduces unnecessary visits to clinics and is useful to reduce the risk of COVID-19 viral transmission


Assuntos
Humanos , Infecções por Coronavirus/epidemiologia , Pandemias , Betacoronavirus , Telemedicina/organização & administração , Telemedicina/normas , Urologia/métodos , Poluição do Ar/prevenção & controle , Agendamento de Consultas , Confidencialidade , Técnicas de Diagnóstico Urológico , Registros Eletrônicos de Saúde , Urologia/organização & administração , Urologia/normas , Consentimento Livre e Esclarecido , Guias de Prática Clínica como Assunto , Qualidade da Assistência à Saúde , Sociedades Médicas , Triagem/métodos , Europa (Continente)/epidemiologia
6.
Urol Oncol ; 38(12): 929.e1-929.e10, 2020 12.
Artigo em Inglês | MEDLINE | ID: mdl-33036903

RESUMO

OBJECTIVE: Ad-hoc guidelines for managing the COVID-19 pandemic are published worldwide. We investigated international applications of such policies in the urologic-oncology community. METHODS: A 20-item survey was e-mailed via SurveyMonkey to 100 international senior urologic-oncology surgeons. Leaders' policies regarding clinical/surgical management and medical education were surveyed probing demographics, affiliations, urologic-oncologic areas of interest, and current transportation restrictions. Data on COVID-19 burden were retrieved from the ECDC. Statistical analyses employed non-parametric tests (SPSS v.25.0, IBM). RESULTS: Of 100 leaders from 17 countries, 63 responded to our survey, with 58 (92%) reporting university and/or cancer-center affiliations. Policies on new-patient visits remained mostly unchanged, while follow-up visits for low-risk diseases were mostly postponed, for example, 83.3% for small renal mass (SRM). Radical prostatectomy was delayed in 76.2% of cases, while maintaining scheduled timing for radical cystectomy (71.7%). Delays were longer in Europe than in the Americas for kidney cancer (SRM follow-up, P = 0.014), prostate cancer (new visits, P = 0.003), and intravesical therapy for intermediate-risk bladder cancer (P = 0.043). In Europe, COVID-19 burden correlated with policy adaptation, for example, nephrectomy delays for T2 disease (r = 0.5, P =0.005). Regarding education policies, trainees' medical education was mainly unchanged, whereas senior urologists' planned attendance at professional meetings dropped from 6 (IQR 1-11) to 2 (IQR 0-5) (P < 0.0001). CONCLUSION: Under COVID-19, senior urologic-oncology surgeons worldwide apply risk-stratified approaches to timing of clinical and surgical schedules. Policies regarding trainee education were not significantly affected. We suggest establishment of an international consortium to create a directive for coping with such future challenges to global healthcare.


Assuntos
/epidemiologia , Oncologia/tendências , Urologistas/estatística & dados numéricos , Urologia/tendências , /prevenção & controle , Previsões , Humanos , Oncologia/educação , Oncologia/normas , Guias de Prática Clínica como Assunto , Inquéritos e Questionários , Neoplasias Urológicas/diagnóstico , Neoplasias Urológicas/terapia , Urologistas/tendências , Urologia/educação , Urologia/normas
7.
Urology ; 146: 1-3, 2020 12.
Artigo em Inglês | MEDLINE | ID: mdl-33049230

RESUMO

OBJECTIVE: To investigate the perception and value of virtual open houses for urology applicants in the COVID-19 era, since students can no longer attend subinternships and all interviews will be conducted virtually. METHODS: A Twitter survey was sent to 230 likely urology applicants connected through the UroResidency platform. It asked about the relative value of components of the virtual open house and areas for suggested improvement. RESULTS: Seventy responded. Most potential applicants valued virtual open houses that discussed strengths and weaknesses of the program, had time to interact directly with the faculty, and included resident led presentations or discussions. Most agreed programs needed to have more direct time with residents to better understand the culture of the program. CONCLUSION: In this first virtual interview season for urology, likely applicants generally engage in virtual open houses and strongly prefer time to interact directly with residents to assess the program culture.


Assuntos
Internato e Residência/normas , Urologia/educação , Escolha da Profissão , Educação a Distância , Humanos , Candidatura a Emprego , Administração de Recursos Humanos/métodos , Avaliação de Programas e Projetos de Saúde , Inquéritos e Questionários , Estados Unidos , Urologia/normas , Realidade Virtual
8.
Urology ; 146: 36-42, 2020 12.
Artigo em Inglês | MEDLINE | ID: mdl-33007312

RESUMO

OBJECTIVE: To capture the perspective of prospective urology applicants experiencing unique challenges in the context of COVID-19. METHODS: A voluntary, anonymous survey was distributed online, assessing the impact of COVID-19 on a large sample of US medical students planning to apply to urology residencies. Themes of (1) specialty discernment, (2) alterations to medical education, and (3) the residency application process were explored. RESULTS: A total of 238 medical students, 87% third and fourth years, responded to the survey. While 85% indicated that the pandemic had not deterred their specialty choice, they noted substantial impacts on education, including 82% reporting decreased exposure to urology. Nearly half of students reported changes to required rotations and 35% reported changes to urology-specific rotations at their home institutions. Students shared concerns about suspending in-person experiences, including the impact on letters of recommendation (68% "very concerned) and program choice (73% "very concerned"). Looking to the possibility of virtual interactions, students identified the importance of small group and one-on-one communication with residents (83% "very important") and opportunities to learn about hospital facilities (72% "very important"). CONCLUSION: Despite the impacts of COVID-19 on medical education, prospective urology applicants appear to remain confident in their specialty choice. Students' biggest concerns involve disruption of away rotations, including impacts on obtaining letters of recommendation and choosing a residency program.


Assuntos
Internato e Residência/estatística & dados numéricos , Pandemias , Estudantes de Medicina/estatística & dados numéricos , Urologia/educação , Escolha da Profissão , Humanos , Internet , Internato e Residência/organização & administração , Candidatura a Emprego , Estudantes de Medicina/psicologia , Inquéritos e Questionários , Estados Unidos , Urologia/normas , Urologia/estatística & dados numéricos
9.
Actas Urol Esp ; 44(10): 644-652, 2020 12.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-33012592

RESUMO

INTRODUCTION: Telemedicine provides remote clinical support through technology tools. It can facilitate medical care delivery while reducing unnecessary office visits. The COVID-19 outbreak has caused an abrupt change in our daily urological practice, where teleconsultations play a crucial role. OBJECTIVE: To provide practical recommendations for the effective use of technological tools in telemedicine. MATERIALS AND METHODS: A literature search was conducted on Medline until April 2020. We selected the most relevant articles related to «telemedicine¼ and «smart working¼ that could provide valuable information. RESULTS: Telemedicine refers to the use of electronic information and telecommunication tools to provide remote clinical health care support. Smart working is a working approach that uses new or existing technologies to improve performance. Telemedicine is becoming a useful and fundamental tool during the COVID-19 pandemic and will be even more in the future. It is time for us to officially give telemedicine the place it deserves in clinical practice, and it is our responsibility to adapt and familiarize with all the tools and possible strategies for its optimal implementation. We must guarantee that the quality of care received by patients and perceived by them and their families is of the highest standard. CONCLUSIONS: Telemedicine facilitates remote specialized urological clinical support and solves problems caused by limited patient mobility or transfer, reduces unnecessary visits to clinics and is useful to reduce the risk of COVID-19 viral transmission.


Assuntos
/epidemiologia , Pandemias , Telemedicina , Urologia/métodos , Poluição do Ar/prevenção & controle , Agendamento de Consultas , Confidencialidade , Técnicas de Diagnóstico Urológico , Registros Eletrônicos de Saúde , Europa (Continente)/epidemiologia , Humanos , Consentimento Livre e Esclarecido , Guias de Prática Clínica como Assunto , Qualidade da Assistência à Saúde , Sociedades Médicas , Telemedicina/organização & administração , Telemedicina/normas , Triagem/métodos , Urologia/organização & administração , Urologia/normas
11.
Curr Opin Obstet Gynecol ; 32(6): 456-460, 2020 12.
Artigo em Inglês | MEDLINE | ID: mdl-32889970

RESUMO

PURPOSE OF REVIEW: Amidst the worldwide coronavirus disease 2019 pandemic, a new medical landscape revolving around telemedicine has arisen. The purpose of this review is to describe and analyze current urogynecologic guidelines for optimizing usage of telemedicine when treating women with pelvic floor disorders. RECENT FINDINGS: Women managed by urogynecologists are on average older, and hence more likely to have comorbidities that make them susceptible to developing coronavirus disease 2019 with severe symptoms. Telemedicine is key in minimizing exposure without sacrificing treatments and quality of life. Recent studies published prior to the pandemic helped set the stage for successful components of virtual care. Nonsurgical options are crucial to beginning a treatment plan while elective surgeries are still restricted in many hospitals. Medication management and innovative technology, such as smart telephone applications, play a prominent role. The comprehensive literature review discussed here describes the degree of evidence supporting each management option, while also noting the limitations of telemedicine. SUMMARY: Telemedicine has opened a new door for the field of urogynecology allowing for continued safe, evidence-based care. The pandemic culture has tipped the balance away from surgery and toward nonsurgical treatments while attempting not to sacrifice outcomes or quality of care.


Assuntos
Infecções por Coronavirus , Ginecologia/métodos , Pandemias , Distúrbios do Assoalho Pélvico/terapia , Pneumonia Viral , Telemedicina/métodos , Urologia/métodos , Infecções por Coronavirus/prevenção & controle , Feminino , Ginecologia/normas , Humanos , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Guias de Prática Clínica como Assunto , Telemedicina/normas , Urologia/normas
12.
Curr Urol Rep ; 21(10): 37, 2020 Aug 17.
Artigo em Inglês | MEDLINE | ID: mdl-32803400

RESUMO

PURPOSE OF REVIEW: In light of the announcement that the United States Medical Licensing Examination Step 1 exam will transition to pass/fail reporting, we reviewed recent literature on evaluating residency applicants with a focus on identifying objective measurements of applicant potential. RECENT FINDINGS: References from attending urologists, Step 1 scores, overall academic performance, and research publications are among the most important criteria used to assess applicants. There has been a substantial increase in the average number of applications submitted per applicant, with both applicants and residency directors indicating support for a cap on the number of applications that may be submitted. Additionally, there are increasing efforts to promote diversity with the goal of improving care and representation in urology. Despite progress in standardizing interview protocols, inappropriate questioning remains an issue. Opportunities to improve residency application include promoting diversity, enforcing prohibitions of illegal practices, limiting application numbers, and finding more transparent and equitable screening measures to replace Step 1.


Assuntos
Internato e Residência , Candidatura a Emprego , Urologia/educação , Humanos , Internato e Residência/normas , Seleção de Pessoal/normas , Estados Unidos , Urologia/normas
13.
Wilderness Environ Med ; 31(3): 358-366, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32773355

RESUMO

The objective of this review is to provide recommendations on the evaluation and management of urologic conditions in a resource-poor or austere setting from the perspective of the urological literature. The material was synthesized predominantly from urologic society guidelines and journals to bring additional urology-focused insight to the topic to complement the currently available literature, which is largely based on recommendations from nonurologic specialties. We sought to provide a reference guide from a urology-based framework that encourages a collaborative multidisciplinary approach to the development of a resource that serves those in a wilderness, austere, or resource-poor setting.


Assuntos
Guias como Assunto , Doenças Urológicas , Medicina Selvagem/normas , Humanos , Sociedades Médicas , Doenças Urológicas/diagnóstico , Doenças Urológicas/patologia , Doenças Urológicas/fisiopatologia , Doenças Urológicas/terapia , Urologia/normas
14.
J Urol ; 204(6): 1312-1317, 2020 12.
Artigo em Inglês | MEDLINE | ID: mdl-32799727

RESUMO

PURPOSE: In 2012 the American Urological Association published vasectomy guidelines to promote best practices, including when to obtain post-vasectomy semen analyses. In this study we assessed practice patterns of post-vasectomy semen analysis since this guideline publication. MATERIALS AND METHODS: We retrospectively analyzed a database of men who underwent post-vasectomy semen analysis between 2013 and 2017. Vasectomies were performed by urologist and nonurologist providers in academic and community settings. RESULTS: A total of 4,827 men underwent post-vasectomy semen analysis with 22.3% undergoing 1 or more repeat analyses. On initial analysis 58.2% were azoospermic, 28.3% had less than 100,000/ml rare nonmotile sperm, 8.7% had greater than 100,000/ml nonmotile sperm and 4.8% had motile sperm. The rate of repeat post-vasectomy semen analysis decreased from 30.7% in 2013 to 18.6% in 2016. Overall 72% of repeat post-vasectomy semen analyses were performed for patients with azoospermia or rare nonmotile sperm on initial post-vasectomy semen analysis. Of the 421 men with greater than 100,000/ml nonmotile sperm, 61.3% did not obtain a repeat analysis. Among cases of repeat analysis after initially having greater than 100,000/ml nonmotile sperm, 67.5% were downgraded to rare nonmotile sperm or azoospermia, 32.5% had a persistent count greater than 100,000/ml nonmotile sperm and none developed motile sperm. CONCLUSIONS: The rate of repeat post-vasectomy semen analysis is decreasing, likely highlighting a decrease in unnecessary testing. However, there is ongoing discordance between vasectomy guidelines and practice patterns, with 72% of repeat post-vasectomy semen analyses obtained unnecessarily based on guideline recommendations. Interestingly, no men with greater than 100,000/ml nonmotile sperm went on to have motile sperm on repeat post-vasectomy semen analysis. Further provider education is warranted and subsequent studies may allow for guideline modification wherein all nonmotile sperm are characterized similarly.


Assuntos
Azoospermia/diagnóstico , Fidelidade a Diretrizes/estatística & dados numéricos , Padrões de Prática Médica/estatística & dados numéricos , Análise do Sêmen/estatística & dados numéricos , Vasectomia , Adulto , Azoospermia/etiologia , Humanos , Masculino , Período Pós-Operatório , Guias de Prática Clínica como Assunto , Padrões de Prática Médica/normas , Estudos Retrospectivos , Análise do Sêmen/normas , Sociedades Médicas/normas , Fatores de Tempo , Estados Unidos , Urologia/normas
15.
Curr Urol Rep ; 21(10): 36, 2020 Aug 13.
Artigo em Inglês | MEDLINE | ID: mdl-32789759

RESUMO

PURPOSE OF REVIEW: The objectives of this literature review are to appraise current approaches and assess new technologies that have been utilized for evaluation and feedback of residents, with focus on surgical trainees. RECENT FINDINGS: In 1999, the Accreditation Council for Graduate Medical Education introduced the Milestone system as a tool for summative evaluation. The organization allows individual program autonomy on how evaluation and feedback are performed. In the past, questionnaire evaluations and informal verbal feedback were employed. However, with the advent of technology, they have taken a different shape in the form of crowdsourcing, mobile platforms, and simulation. Limited data is available on new methods but studies show promise citing low cost and positive impact on resident education. No one "best approach" exists for evaluation and feedback. However, it is apparent that a multimodal approach that is based on the ACGME Milestones can be effective and aid in guiding programs.


Assuntos
Competência Clínica/normas , Avaliação Educacional , Internato e Residência , Urologia , Benchmarking , Comunicação , Crowdsourcing , Avaliação Educacional/métodos , Avaliação Educacional/normas , Feedback Formativo , Humanos , Internato e Residência/métodos , Internato e Residência/normas , Relações Interpessoais , Tutoria , Aplicativos Móveis , Simulação de Paciente , Smartphone , Especialidades Cirúrgicas/educação , Especialidades Cirúrgicas/métodos , Especialidades Cirúrgicas/normas , Inquéritos e Questionários , Urologia/educação , Urologia/normas
16.
Curr Urol Rep ; 21(10): 39, 2020 Aug 17.
Artigo em Inglês | MEDLINE | ID: mdl-32803426

RESUMO

PURPOSE OF REVIEW: The goal of this paper was to identify areas of importance in modern urology education that are not currently emphasized in current urological curricula. RECENT FINDINGS: We identified curricular deficits in robotic surgical simulation, transgender health, leadership, business management, and social media training. Few practicing urologists feel comfortable managing transgender-specific needs, and most training programs do not adequately address transgender health. Urology programs also do not sufficiently emphasize topics in leadership, business management, or appropriate social media usage. With respect to simulation, while it is currently included in the Accreditation Council for Graduate Medical Education (ACGME) program requirements, it is currently under-utilized for training in robotic surgery. It is important for urologists to receive adequate training for the modern practice landscape. Where knowledge gaps among early practicing urologists arise, programs should adapt their curricula to address them.


Assuntos
Currículo/normas , Internato e Residência/normas , Prática Profissional , Urologia , Competência Clínica/normas , Educação de Pós-Graduação em Medicina/normas , Serviços de Saúde para Pessoas Transgênero/normas , Humanos , Liderança , Gerenciamento da Prática Profissional , Prática Profissional/normas , Procedimentos Cirúrgicos Robóticos/educação , Mídias Sociais , Urologia/educação , Urologia/normas
18.
Int Braz J Urol ; 46(suppl.1): 201-206, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32618465

RESUMO

Proposal: To highlight the indications for emergency surgery during the 2019 Coronavirus pandemic (COVID-19) that support recommendations published in mid-March 2020 by the American Confederation of Urology on its website. MATERIALS AND METHODS: A bibliographic search was conducted in PubMed and Cochrane Library to perform a non-systematic review, using key words: Urology, Emergency and COVID-19, to determine recommendations for patients that should receive emergency care due to urological pathology. RESULTS: The main recommendations and protocols in the management of different urological emergencies during the COVID-19 pandemic are reviewed and discussed. CONCLUSIONS: We are living a new condition with the COVID-19 pandemic, which obliges urologists to conform to the guidelines that appear on a daily basis formulated by multidisciplinary surgical groups to manage urological emergencies. Consequently, in this time of health crisis, we must adapt to the resources available, implementing all biosecurity measures to protect patients and all health personnel who are in charge of patient management.


Assuntos
Pandemias , Guias de Prática Clínica como Assunto , Procedimentos Cirúrgicos Urológicos/estatística & dados numéricos , Urologistas/psicologia , Urologia/normas , Betacoronavirus , Infecções por Coronavirus/epidemiologia , Humanos , Transmissão de Doença Infecciosa do Paciente para o Profissional/prevenção & controle , Pneumonia Viral/epidemiologia , Procedimentos Cirúrgicos Urológicos/efeitos adversos , Urologia/tendências
19.
Eur Urol Focus ; 6(5): 1070-1085, 2020 Sep 15.
Artigo em Inglês | MEDLINE | ID: mdl-32532703

RESUMO

CONTEXT: The first case of the new coronavirus, severe acute respiratory syndrome coronavirus 2 (SARS-CoV2), was identified in Wuhan, China, in late 2019. Since then, the coronavirus disease 2019 (COVID-19) outbreak was reclassified as a pandemic, and health systems around the world have faced an unprecedented challenge. OBJECTIVE: To summarize guidelines and recommendations on the urology standard of care during the COVID-19 pandemic. EVIDENCE ACQUISITION: Guidelines and recommendations published between November 2019 and April 17, 2020 were retrieved using MEDLINE, EMBASE, and CINAHL. This was supplemented by searching the web pages of international urology societies. Our inclusion criteria were guidelines, recommendations, or best practice statements by international urology organizations and reference centers about urological care in different phases of the COVID-19 pandemic. Our systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) statement. Of 366 titles identified, 15 guidelines met our criteria. EVIDENCE SYNTHESIS: Of the 15 guidelines, 14 addressed emergency situations and 12 reported on assessment of elective uro-oncology procedures. There was consensus on postponing radical prostatectomy except for high-risk prostate cancer, and delaying treatment for low-grade bladder cancer, small renal masses up to T2, and stage I seminoma. According to nine guidelines that addressed endourology, obstructed or infected kidneys should be decompressed, whereas nonobstructing stones and stent removal should be rescheduled. Five guidelines/recommendations discussed laparoscopic and robotic surgery, while the remaining recommendations focused on outpatient procedures and consultations. All recommendations represented expert opinions, with three specifically endorsed by professional societies. Only the European Association of Urology guidelines provided evidence-based levels of evidence (mostly level 3 evidence). CONCLUSIONS: To make informed decisions during the COVID-19 pandemic, there are multiple national and international guidelines and recommendations for urologists to prioritize the provision of care. Differences among the guidelines were minimal. PATIENT SUMMARY: We performed a systematic review of published recommendations on urological practice during the coronavirus disease 2019 (COVID-19) pandemic, which provide guidance on prioritizing the timing for different types of urological care.


Assuntos
Infecções por Coronavirus/epidemiologia , Pneumonia Viral/epidemiologia , Guias de Prática Clínica como Assunto , Padrão de Cuidado , Neoplasias Urológicas/cirurgia , Urologia/normas , Betacoronavirus , Tomada de Decisão Clínica , Endoscopia/métodos , Humanos , Laparoscopia/métodos , Gradação de Tumores , Estadiamento de Neoplasias , Pandemias , Procedimentos Cirúrgicos Robóticos/métodos , Doenças Urológicas/cirurgia , Neoplasias Urológicas/patologia , Procedimentos Cirúrgicos Urológicos/métodos
20.
Eur Urol Focus ; 6(5): 1032-1048, 2020 Sep 15.
Artigo em Inglês | MEDLINE | ID: mdl-32553544

RESUMO

CONTEXT: The unprecedented health care scenario caused by the coronavirus disease 2019 (COVID-19) pandemic has revolutionized urology practice worldwide. OBJECTIVE: To review the recommendations by the international and European national urological associations/societies (UASs) on prioritization strategies for both oncological and nononcological procedures released during the current emergency scenario. EVIDENCE ACQUISITION: Each UAS official website was searched between April 8 and 18, 2020, to retrieve any document, publication, or position paper on prioritization strategies regarding both diagnostic and therapeutic urological procedures, and any recommendations on the use of telemedicine and minimally invasive surgery. We collected detailed information on all urological procedures, stratified by disease, priority (higher vs lower), and patient setting (outpatient vs inpatient). Then, we critically discussed the implications of such recommendations for urology practice in both the forthcoming "adaptive" and the future "chronic" phase of the COVID-19 pandemic. EVIDENCE SYNTHESIS: Overall, we analyzed the recommendations from 13 UASs, of which four were international (American Urological Association, Confederation Americana de Urologia, European Association of Urology, and Urological Society of Australia and New Zealand) and nine national (from Belgium, France, Germany, Italy, Poland, Portugal, The Netherlands, and the UK). In the outpatient setting, the procedures that are likely to impact the future burden of urologists' workload most are prostate biopsies and elective procedures for benign conditions. In the inpatient setting, the most relevant contributors to this burden are represented by elective surgeries for lower-risk prostate and renal cancers, nonobstructing stone disease, and benign prostatic hyperplasia. Finally, some UASs recommended special precautions to perform minimally invasive surgery, while others outlined the potential role of telemedicine to optimize resources in the current and future scenarios. CONCLUSIONS: The expected changes will put significant strain on urological units worldwide regarding the overall workload of urologists, internal logistics, inflow of surgical patients, and waiting lists. In light of these predictions, urologists should strive to leverage this emergency period to reshape their role in the future. PATIENT SUMMARY: Overall, there was a large consensus among different urological associations/societies regarding the prioritization of most urological procedures, including those in the outpatient setting, urological emergencies, and many inpatient surgeries for both oncological and nononcological conditions. On the contrary, some differences were found regarding specific cancer surgeries (ie, radical cystectomy for higher-risk bladder cancer and nephrectomy for larger organ-confined renal masses), potentially due to different prioritization criteria and/or health care contexts. In the future, the outpatient procedures that are likely to impact the burden of urologists' workload most are prostate biopsies and elective procedures for benign conditions. In the inpatient setting, the most relevant contributors to this burden are represented by elective surgeries for lower-risk prostate and renal cancers, nonobstructing stone disease, and benign prostatic hyperplasia.


Assuntos
Infecções por Coronavirus/epidemiologia , Pneumonia Viral/epidemiologia , Guias de Prática Clínica como Assunto , Neoplasias Urológicas/diagnóstico , Neoplasias Urológicas/terapia , Urologia/tendências , Assistência Ambulatorial/tendências , Betacoronavirus , Europa (Continente)/epidemiologia , Previsões , Hospitalização/tendências , Humanos , Procedimentos Cirúrgicos Minimamente Invasivos/tendências , Pandemias , Sociedades Médicas , Telemedicina/tendências , Doenças Urológicas/diagnóstico , Doenças Urológicas/terapia , Procedimentos Cirúrgicos Urológicos/tendências , Urologia/organização & administração , Urologia/normas
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