Urology最新文献

Objective: To assess the extent of racial reporting and enrolment in RCTs of minimally invasive surgical therapies (MIST) for the office-based treatment of benign prostatic hyperplasia (BPH).

Methods: A systematic review was conducted for RCTs assessing six office-based MISTs: transurethral microwave thermotherapy, prostatic artery embolization, prostatic urethral lift, temporary implantable nitinol device, water vapor thermal therapy, and Optilume. MEDLINE, Embase, and the Cochrane CENTRAL databases were searched up to November 3rd, 2023. Publications were excluded if they 1) did not address one of the aforementioned office-based MISTs for the treatment of BPH; 2) were not RCTs; 3) were an abstract or conference proceeding; or 4) were not published in English. In addition to study characteristics, data about racial reporting was collected. Two independent reviewers completed screening at title, abstract, and full-text levels, with conflicts resolved by consensus with a third reviewer.

Results: A total of 61 publications representing 37 unique RCTs (n=4027 unique patients) were reviewed, with publication years spanning from 1993 to 2023. TUMT was the most frequently studied MIST. Most publications (79%) were based solely in Europe or North America. Over 50% of the publications were multicenter trials. None of the included publications reported on race/ethnicity of study participants.

Conclusion: None of the 61 included publications of RCTs of office-based MISTs provided information on racial/ethnic composition of study participants. There is a staggering gap in the standardization of race/ethnicity reporting and enrolment within RCTs of MISTs. More granular data on race/ethnicity allows for better generalizability and equity.

Objective: To assess and contrast attitudes and confidence regarding erectile dysfunction (ED) treatment among urologists (GU) and primary care providers (PCPs), identifying areas for collaboration, practice improvement, and additional training to enhance men's healthcare (MH) quality and access.

Methods: An anonymous survey with 25 questions on ED treatment, rated on a 5-point Likert scale, was conducted among our institution's providers in GU, internal medicine (IM), and family medicine (FM). Data were analyzed using descriptive statistics and Fisher's exact test.

Results: 138 providers responded, including 58 IM, 47 FM, and 33 GU. FM and IM responses generally overlapped with some differences. IM were more positive regarding vacuum erection device (VED) and inflatable penile prosthesis (IPP) satisfaction and risk. Comparing GU to FM + IM, GU displayed greater confidence and knowledge about ED. Notably, 63% of GU used the validated International Index of Erectile Function (IIEF) compared to 3% of FM + IM. Additionally, 100% of GU strongly/agreed that good options remained after pills failed vs 83% of FM + IM. Significant differences in GU vs FM + IM perspectives on IPP included patient willingness to undergo surgery for ED (67% vs. 12%), patient satisfaction (91% vs. 28%), partner satisfaction (79% vs. 26%) and willingness to recommend/repeat surgery (82% vs. 17%). Notably, 82% of GU vs 10% of FM + IM were aware that Medicare covered implants.

Conclusion: This survey reveals significant knowledge gaps in ED treatment between GU and PCPs. Targeted provider education, particularly about penile prostheses, could optimize patient care.