Urology最新文献

Objectives: To characterize the genitourinary medical oncology workforce in the United States.

Methods: Utilizing the top fifty hospitals as ranked by US News & World Reports, genitourinary medical oncologists in each state of the United States (US) were identified. Data including gender, race/ethnicity, site of medical education, and site of clinical practice were collected.

Results: A total of 451 genitourinary medical oncologists are involved in clinical care in the United States. Of these medical oncologists, 399 (88.5%) practice in academic settings while 52 (11.5%) practice in community-based settings. 327 (72.5%) of genitourinary medical oncologists are male, while 124 (27.5%) are female. 17 (3.8%) genitourinary medical oncologists are from under-represented minority groups in medicine (Black, Hispanic, or Native American). 321 (71.2%) genitourinary medical oncologists received training at medical schools in the US, while 130 (28.8%) trained at medical schools abroad. The Northeast US has the most genitourinary medical oncologists with 150, followed by the South with 129, the West with 97, and the Midwest with 75. Of note, seven states, including Alaska, Delaware, Idaho, Maine, North Dakota, South Dakota, and Wyoming, have no identified genitourinary medical oncologist.

Conclusions: Disparities based off gender, race/ethnicity, and geographic location of practice exist in the genitourinary medical oncology workforce in the United States.

Objective: To address the significant national shortage of urologists that limits patient access to urological care by creating a novel fellowship program to train family medicine physicians to provide basic urologic counseling and procedures.

Methods: We created an 18-month fellowship open to applicants who have completed a family medicine residency. The curriculum includes office, hospital, and operating room rotations in andrology, endourology, urogynecology, and urologic oncology. We have enrolled a total of seven fellows beginning in 2017.

Results: The two fellows who did not complete the program were both MDs who worked for several years between residency and fellowship. Four fellows have completed the program, and one is scheduled to graduate in 2025. These five are all DOs who started the fellowship within four months of completing residency. All four of the graduates are currently practicing genitourinary medicine full-time without the direct supervision of a urologist. All four graduates reported a current annual salary >$250,000. All four were happy with their career choices in genitourinary medicine. Their practice breakdown was approximately 80% outpatient visits, 15% bedside procedures, and 5% operating room procedures. Three of the four graduates routinely take attending urology call where they independently perform bedside procedures and ureteral stent placements.

Conclusions: A urology fellowship for family medicine physicians can help bridge the gap for access to urological care. Graduates can safely provide basic care for patients in office and hospital settings in collaboration with urologists when necessary.

Objective: To evaluate the proportion of US Medicare patients undergoing ureteroscopy (URS) for kidney stone management at risk for adverse outcomes and analyze the association between risk factors and adverse events.

Methods: Data from Medicare patients aged ≥65 who underwent URS between 2019-2023 were analyzed. Nine risk factors were examined for their prevalence, and association with sepsis and intensive care unit (ICU) admission within 30 days, extended length of stay (LOS) during the index procedure, and death within 90 days.

Results: Among 290,610 Medicare patients who underwent URS, 94.4% had ≥1 (n=274,396) and 76.3% had ≥2 risk factors. The proportion of patients with each risk factor was: age over 70 (64.6%), preoperative stent (59.4%), female (46.4%), urinary tract infection (UTI) within 3 months (39.1%), diabetes (33.0%), history of sepsis (17.3%), multiple UTIs within 6 months (13.1%), Charlson Comorbidity Index score of ≥7 (10.2%), and ischemic heart disease (2.9%). Patients with risk factors experienced a higher incidence of adverse outcomes. Notably, among patients with sepsis history, the incidence of sepsis, ICU admission within 30 days, and death within 90 days were 30.3%, 2.5%, and 0.86%, respectively, vs. 2.2%, 0.80%, and 0.18% without sepsis history (all p<0.001). Median LOS was 5 days among patients with sepsis history versus 3 days without (p<0.001).

Conclusions: Most URS Medicare patients had risk factors. Those with risk factors were more likely to experience sepsis, ICU admission, prolonged hospital LOS, and death. These findings underscore the need for targeted prevention and careful management for high-risk URS patients.

Objectives: To clarify what urinary condition causes post micturition dribble (PMD) in non-elderly healthy men. We focused on men with PMD who do not have PMD every time they void. We clarified what urinary condition associated with PMD in individuals to prevent PMD.

Materials and methods: Twenty healthy volunteer men who had experienced PMD were included in the study between 2018 and 2021 using a portable uroflowmeter for 48 hours. They recorded symptoms of PMD and strength of desire to void (none, weak, normal or strong) for each void. We investigated the risk factors of PMD and the correlation between strength of desire to void and PMD or parameters measured by uroflowmeter.

Results: The mean age of the volunteer men was 35.9±6.9 years. During the study, 20 volunteers experienced a total of 208 episodes of voiding. Of them, 57 (27%) were associated with PMD. Lower voided volume than usual was a significant risk factor for PMD in univariate analysis (p<0.01). There was a statistically significant correlation between the strength of the desire to void and the voided volume (p<0.01). The voiding with none or weak desire to void significantly caused PMD compared to voiding with normal or strong desire to void (36% vs. 21%, p=0.03).

Conclusions: Lower voided volume than usual and voiding with less strength of desire to void are risk factors for PMD. Instructing male patients with PMD to refrain from voiding when the desire to do so is ambiguous can contribute to preventing PMD.

Objective: To investigate national trends in newborn circumcision complication and secondary procedure rates and whether clinician specialty affects these rates.

Methods: The Merative^TM MarketScan® Database was queried for claims from 2010 to 2022. CPT® 54150 identified newborn circumcisions; CPT 54162, 54163, 54164, 54300, and 54450 identified secondary procedures; ICD-9 and ICD-10 codes identified complications. Multivariable logistic regression was performed to analyze the association between clinician specialty and circumcision revision or secondary procedure.

Results: A thirty-day complication was coded for 0.96% of newborns. Two- and five-year secondary procedure rates decreased from 2.90% and 3.62% in 2010 to 2.45% in 2020 and 2.89% in 2017, respectively. Compared to newborn circumcisions performed by obstetrician/gynecologists, the odds of secondary procedure within two years were lower for those performed by pediatricians (OR 0.73, 95% CI 0.68-0.78, p<0.001), pediatric surgeons (0.57 [0.42-0.76], p<0.001), advanced practice clinicians (APC) (0.80 [0.65-0.98], p=0.03), and other clinicians (0.67 [0.63-0.71], p<0.001). Compared to newborn circumcisions performed by obstetricians/gynecologists, the odds of revision within two years were lower for those performed by pediatricians (0.46 [0.42-0.51], p<0.001), urologists (0.29 [0.19-0.44], p<0.001), pediatric urologists (0.38 [0.22-0.66], p=0.001), pediatric surgeons (0.60 [0.36-0.98], p=0.04), and other clinicians (0.59 [0.52-0.66], p<0.001).

Conclusion: Revision rates did not increase over time, and secondary procedure rates slowly declined. Compared to newborn circumcisions performed by obstetrician/gynecologists, the odds of a secondary procedure were either not different or lower for those performed by all other specialties, including APCs, suggesting that newborn circumcision workforce planning should involve training of and collaboration with APCs.