Urology最新文献

Objective: To assess self -reported surgeon fatigue and discomfort in different body regions after performing flexible ureteroscopy.

Methods: An anonymous survey was designed and distributed among urologists and trainees in four hospitals. Participants rated their discomfort in different body and hand regions as well as overall fatigue before and immediately after each flexible ureteroscopy procedure they performed.

Results: The final working sample size was 45 unique surgeons (26 female and 19 male) completing 58 procedures. Respondents were 38.2 ±14.7 years of age. Forty-two percent of respondents were male, 75% were right-hand dominant and 25% reported existing musculoskeletal disorder. Urologists' overall fatigue score significantly increased after ureteroscopy, but females had a significantly larger increase (female β: 1.74, p<0.001; male β: 0.78, p=0.017). Women experienced higher discomfort in neck, upper back, right shoulder and right elbow than men. Across different hand regions, increased post-procedural discomfort was reported mostly in the thenar area (41.8 %) followed by hypothenar area (28.5%) and thumb area (27.9%).

Discussion: Urologists experience significant increase in overall fatigue and discomfort across most body and hand regions. Women seem to be disproportionally affected. Additional studies are needed to determine the causality of these findings and explore potential interventions aimed at reducing procedure-related discomfort among all urologists, especially women.

Healthcare in the United States is in a time of great transition. Consolidation and corporatization are increasingly normalized. Physician autonomy and self-determination has been deprioritized, contributing to burnout and workforce shortages. One of the most striking and controversial evolutions has been the entry of Private Equity investment into medicine. In this review article, we will explain the construct of Private Equity, its rationale for investing in medical practices including urology, and the potential benefits and risks of physician partnership.

Objective: To evaluate public interest in "Hims," a men's health platform, to assess its impact on healthcare access, and identify geographic trends reflecting gaps in traditional healthcare availability.

Methods: Relative search volume data for erectile dysfunction and early climax terms in "Hims" were collected via Google Trends from November 2017 to December 2023 across the United States. Data were analyzed in two intervals (2017-2020 and 2020-2023) using paired t-tests to compare relative search volume and Kruskal-Wallis tests to assess differences among terms. Geographic regions were examined to identify underserved regions.

Results: Public interest in "Hims" increased significantly, with median relative search volume rising from 0 (interquartile range: 0-33) in 2017-2020 to 62 (interquartile range: 30-95) in 2020-2023 (p < 0.05). Searches related to erectile dysfunction rose from a median relative search volume of 18 (interquartile range: 0-100) to 46 (interquartile range: 0-100) (p < 0.001), with similar growth observed in searches related to early climax. High relative search volume was noted in states like Colorado, Wyoming, and Maine, highlighting increased interest in regions with limited healthcare resources. A marked rise in telehealth engagement during the COVID-19 pandemic further emphasized the role of digital platforms in healthcare delivery during periods of restricted access.

Conclusions: The rise in search interest for "Hims" underscores the increasing demand for telehealth services to for men's health, particularly in underserved regions. These findings highlight the potential of digital platforms to bridge gaps in healthcare access.

Objectives: To confirm the clinical performance and safety of the rechargeable InterStim^TM Micro sacral neuromodulation system, we report the first results from the global ELITE study for the non-obstructive urinary retention (NOUR) cohort through 6 months of follow-up.

Methods: Subjects were enrolled following successful therapy evaluation and neurostimulator implant. The primary objective was improvement in the number of clean intermittent self-catheterizations (CISC) per day at 3-months post-implant compared to baseline.

Results: The change in number of CISC per day from baseline was -3.5 (95% CI: -4.77, -2.26; n=23) at 3-month follow-up, which was statistically significant (p<0.001) and signifies that the primary objective was met. This change was sustained at 6-month follow-up, with a change of -3.5 (95% CI: -4.73, -2.29; n=24). There was a reduction in post-void residual of 244 mL (95% CI: -334.6, -154; n=22) at 3 months and 264 mL (95% CI: -366.43, -161.56; n=21) at 6 months vs baseline. On the Patient Global Impression of Improvement, 88% and 79% of subjects reported that their bladder condition was better at 3 and 6 months, respectively, compared to before they were treated with InterStim Micro. Device-, procedure-, or therapy-related AEs included implant site pain (11.1%; 3/27), medical device site discomfort (7.4%; 2/27) and pain in extremity (7.4%; 2/27).

Conclusions: This study reports on the NOUR population of the global ELITE study, demonstrating efficacy and safety of the InterStim Micro system through 6 months of follow-up.

Objective: To apply a process improvement approach to optimizing operating room (OR) turnover time at an ambulatory surgery center.

Methods: Turnover was defined as the time a patient leaves the OR to the time the room is ready to receive the next patient. This process was observed multiple times to define the steps and operators involved. Each step was timed and meticulously studied to identify opportunities for improvement. New times for each step were obtained. The projected impact on the system capacity and potential financial implications were calculated using $1 per second as the "rent" of an OR.

Results: The OR turnover baseline time ranged from 31:45 to 42:49 minutes:seconds. Four opportunities for improvement were identified and proposed: 1) calling housekeeping earlier so they can be ready to enter the OR as the patient is being rolled out 2) mopping the floor starting from the side of the OR where the back table is located to allow back table preparation to proceed without delay 3) performing as much set up in the attached annex room as possible 4) rolling the next patient in as the scrub technician is scrubbing in and completing last minute organization. The theoretical financial benefits resulting from the implementation of these process improvements were calculated to be $1,559 per turnover, with an annual saving of $2,025,000 per individual OR.

Conclusion: By applying process improvement techniques, the authors uncovered a multitude of opportunities to improve the OR turnover process which, if optimized, could generate significant financial benefit.

Objective: To synthesize current knowledge on urobiome alterations, innovative diagnostic advancements, and emerging therapeutic strategies targeting urobiome dysbiosis in inflammatory urinary tract disorders, including urinary tract infections (UTIs), non-gonococcal urethritis (NGU), and interstitial cystitis.

Methods: A systematic review was conducted by screening the most important scientific databases. The search included the keywords: (microbiome) OR (microbial) OR (bacteria) OR (bacterial profile) AND (urine) OR (urinary) AND (first-morning sample) OR (first void). Only original studies in English involving human specimens were considered.

Results: Of the 760 articles initially identified, a final sample of 20 original studies met the inclusion criteria. Disruptions in the urobiome composition were associated with increased colonization by pathogens such as Escherichia coli and Mycoplasma genitalium, resulting in inflammation and recurrent urinary conditions. Advanced diagnostic techniques, including metaproteomics, metagenomics, and point-of-care assays like NG-LFA, demonstrated enhanced capabilities for rapid pathogen detection and differentiation of inflammatory conditions. Therapeutic interventions targeting urobiome dysbiosis, particularly probiotics (Lactobacillus rhamnosus, L. reuteri, L. crispatus), showed promising efficacy in reducing recurrence and inflammation in clinical trials.

Conclusions: Urobiome dysbiosis plays a critical role in inflammatory urinary tract disorders. Innovative diagnostic methods and targeted therapeutic approaches, especially probiotics, offer substantial potential to improve patient outcomes. Further research is warranted to refine these strategies and validate their clinical applicability.

Objective: To evaluate postoperative outcomes after a minimal approach of water vapor thermal therapy (WVTT; Rezum, Boston Scientific, Marlborough, MA, USA), defined as 1 treatment per prostate lobe, among men with benign prostatic hyperplasia (BPH).

Methods: We performed a multi-institutional retrospective review of patients who underwent WVTT from 2018 to 2022. Propensity score matching (PSM) was utilized to generate patient cohorts based on number of treatments per lobe (1 per lobe, including median lobe if present [minimal group], vs ≥2 per lobe [non-minimal group]) matched for age, body mass index, and preoperative prostate volume. Primary outcome was postoperative complications and storage phase symptoms beyond 30 days. We then conducted a non-PSM independent T-test to analyze differences in International Prostate Symptom Score (IPSS), uroflowmetry, and surgical retreatment rate postoperatively.

Results: 146 patients were included, with 73 in each arm. The non-minimal group had their median lobe treated more frequently (p=0.021) and experienced higher postoperative de-novo retention (p=0.009) and urinary tract infection (p=0.003) rates. On multivariate analysis, increasing number of treatments (hazard ration [HR] 1.3, p= 0.039) and median lobe treatment (HR 4.7, p=0.008) were significant risk factors for postoperative storage phase symptoms. Mean IPSS and uroflowmetry parameters were similar at 1, 3, 6 and 12 months postoperatively. Surgical retreatment rates were comparable at 2 years (3% vs 1%; p=0.444).

Conclusion: Minimal approach to WVTT is associated with decreased postoperative complications with comparable IPSS, maximum flow rate, and surgical retreatment rate. Further studies are needed to investigate longer term outcomes.

Ewing sarcoma (ES) is a common malignant bone tumor in children, but primary extraosseous Ewing sarcoma (EES) in the pelvic region is particularly rare. We report a 21-month-old male with a 10-cm complex cystic mass adherent to the bladder. Core biopsy demonstrated a small round cell neoplasm positive for CD99, NKX2-2, and EWSR1:ERG fusion. The patient had a residual mass following induction chemotherapy, and underwent surgical resection with anterior detrusorrhaphy with no other pelvic organ involvement. Pathology showed <10% residual tumor with negative margins. Following completion of consolidation chemotherapy, imaging has shown no evidence of recurrent disease 13 months post-surgery.