Urology最新文献

Objective: To examine the relationship between market dynamics, in the form of commercial prices paid to urologists, and utilization of services, as measured by Medicare spending, in men with newly diagnosed prostate cancer.

Methods: We performed a retrospective national cohort study of Medicare beneficiaries with newly diagnosed prostate cancer between 2014 and 2019, with follow-up through 2020.The primary exposure was the commercial price index (i.e., the ratio of commercial prices to Medicare prices for a common set of services performed by urologists). The primary outcome was Medicare spending for prostate cancer, in the 12-month period after diagnosis.

Results: Across zip codes, commercial prices were, on average, 190% of Medicare prices (range 102-421%), with mean spending per beneficiary of $16,704. There was an inverse relationship between the price index and Medicare spending for men for prostate cancer. Specifically, standardized Medicare spending was $1,485 (95%CI $939 to $2,030) higher per beneficiary among those managed in zip codes at the bottom decile for commercial prices compared to the top decile. This effect was similar in the subgroup of men who underwent treatment, where standardized Medicare spending was $1,461 (95%CI $848 to $2,073) higher per beneficiary among those managed in zip codes in the bottom decile for commercial prices compared to the top decile.

Conclusions and relevance: Commercial prices for a set of frequently performed services are substantial higher than those paid by Medicare and vary widely across zip codes. Higher commercial prices were associated with significantly lower utilization, as measured by standardized Medicare spending, in men with newly diagnosed prostate cancer.

Penile augmentation strategies provide fascinating examples of humanity's creativity and ingenuity in medical science. This essay summarizes the lengthy history of penile enhancement. Snake bites, herbal remedies, and traction therapy are examples of ancient penile enlargement strategies. Currently, injectable fillers and grafting represent modern techniques for girth enhancement. Meanwhile, V-Y advancement and suspensory ligamentolysis are foundational techniques for penile lengthening, along with penile disassembly, circumcision ligamentolysis, and sliding elongation. While these strategies can significantly increase penile length or girth, complications remain a concern, as do inconsistent psychological outcomes and patient satisfaction, even after measurable gains in penis size.

Objectives: To investigate whether social vulnerability is associated with the direct and indirect burdens of urinary incontinence. Urinary incontinence affects over half of all adult women living in the United States and can affect quality of life. While individual-level social determinants of health have been associated with urologic disease, the effect of community-level factors is poorly characterized. Community-level social vulnerability as measured using the social vulnerability index from census-level data has been associated with worse health outcomes.

Methods: Women with urinary incontinence were recruited from our urology outpatient clinic and via ResearchMatch to complete questionnaires on urinary incontinence symptoms and incontinence-specific quality of life. Home zip code was merged with census data to determine SVI. Urinary symptom severity and quality of life were compared between those living in low versus high social vulnerability areas, and multivariable logistic regression was performed.

Results: This sample included 1,004 women. Women with urinary incontinence living areas with the highest social vulnerability had significantly worse urinary incontinence severity and incontinence-specific quality of life, even after adjusting for covariates.

Conclusions: In this cohort, community-level social vulnerability is associated with worse urinary incontinence and worse incontinence-specific quality of life in women, even when controlling for multiple covariates. This suggests that community-level drivers of health play a significant role in urologic outcomes and urinary conditions, and that the social vulnerability index measure may be a useful tool to identify communities who may benefit most from targeted policy intervention efforts.

Objectives: To examine the frequency and rate at which transfeminine patients receive prostate specific antigen testing compared to a matched cisgender cohort.

Methods: Patients with prostates who had encounters in our health system, are currently age 46 or older, and who are alive were included in our study. Transfeminine patients were identified through diagnosis codes and chart review. A 1:5 matched cohort was created based on patient age, race, and area deprivation index. Conditional logistic regression was done to compare odds of receiving any testing and Poisson regression was done to compare the total tests.

Results: A total of 275,112 patients were included in the study, of which 315 were confirmed to be transfeminine. A well matched 1:5 propensity matched cohort was created. Our results suggest that transfeminine patients were 0.28 (95% CI 0.20 - 0.38, p<0.001) times as likely as cisgender patients to receive at least one PSA test at our institution and received only 32% (95% CI 27%-37%, p <0.001) as many total PSA tests.

Conclusion: Until more is known about the best practices for PSA testing in the transfeminine population, these patients should receive PSA testing. However, our results suggest that transfeminine patients are significantly less likely to receive any testing and significantly fewer tests in their lifetimes, which may represent a significant healthcare disparity.

Objective: To report our experience of outpatient peri-urethral injections of Bulkamid® under local anesthesia in the office in female patients for stress urinary incontinence (SUI). Polyacrylamide hydrogel (Bulkamid®) is a relatively recent bulking agent which may have a better safety profile than previous generations.

Methods: The data of all women who underwent outpatient peri-urethral Bulkamid® injections under local anesthesia in the office at a single academic center were collected prospectively between November 2019 and August 2023. This therapeutic option was offered to patients who had SUI if > 80-year-old and/or had multiple comorbidities or if they declined all other therapeutic options.

Results: Ninety-two patients were included. The mean age was 78 years (30-97). Twenty-two patients experienced postoperative complications (21%), seventeen were Clavien 1 complication, only one complication was Clavien =4. The USP SUI and OAB subscores and the ICIQ-SF were all significantly improved at 3 months (p<0.001). The VAS for urethral coaptation self-assessed by the surgeon at the end of the procedure was the strongest predictor of postoperative outcomes. Peri-urethral Bulkamid® injections are feasible in an outpatient setting in the office using a simplified local anesthesia protocol with a great tolerance and with similar functional outcomes than previously reported. The injections have a low rate of complications and every complication has been well tolerated.

Conclusion: These options may be of great value in frail patients and those looking for a minimally invasive treatment. The local anesthesia protocol with the office setting may be of particular interest.

Objectives: To prospectively investigate the predictive value of radiological stone heterogenicity for the success of SWL in patients with high-density upper urinary tract stones.

Methods: This multi-center prospective study was conducted from June 2020 to December 2023. The radiological stone density index measured by CT included mean, standard deviation (SD) and coefficient variation (CV) of HU value of stones. The success was defined as no evidence of clinically significant stone fragments (≥ 4 mm) on a plain X-ray and ultrasound of the upper urinary tract one month after SWL. Binary logistic regression models were used to assess the odds ratios(ORs) and 95% confidence intervals(CIs).

Results: Finally, 533 patients with high-density upper urinary tract stones were enrolled in this study. There were 68.5% (379/533) patients experienced success after SWL treatment. After adjusted confounding variables, compared with the patients in the lowest quartile of stone density index, the OR (95% CI) for the extreme quartile was 1.42 (0.71, 2.81, P for trend = 0.443), 0.03 (0.01, 0.09, P for trend < 0.001), and 0.02 (0.01, 0.07, P for trend < 0.001) for MSD, SD, and CV, respectively. Furthermore, this linear association was confirmed only for SD and CV regardless of gender, body mass index, stone size, and stone location.

Conclusions: This multi-center prospective study demonstrated a positive association between the stone heterogenicity and the success of SWL in patients with high-density upper urinary tract stones regardless of gender, body mass index, stone size, and stone location. However, this association was not observed in MSD.