Urology Practice最新文献

Introduction: Clinic no-shows result in misallocation of health care resources and decreased access to care. There is minimal published data examining factors associated with no-shows for ambulatory urology visits. We analyzed data from a large cohort of outpatient encounters at a tertiary health system to identify factors that increase the likelihood of ambulatory urology no-show.

Methods: Data were available from scheduled ambulatory urology appointments at 18 clinics in an academic, tertiary health system between January 1, 2018, and June 30, 2023. A control group of completed appointments and a study group of no-show appointments were used for comparative statistics. χ² and t tests were used to make comparisons. The false discovery rate-adjusted P value was calculated using Bonferroni method.

Results: Data were available from a total of 990,749 appointments. A total of 187,036 appointments from 10 clinics met inclusion and exclusion criteria, among which 177,718 (95%) were completed appointments and 9318 (5%) were patient no-shows. Patients who no-showed were younger (58 years vs 62 years; P < .01) and Black (odds ratio [OR] 3.74). No-shows were more common if the visit was virtual (OR 1.50) or follow-up (OR 1.50). Patients referred from the emergency department were more likely to no-show (OR 1.50). Of the 26 urologic diagnoses examined, testis cancer (OR 2.58) and orchitis (OR 2.49) appointments were more likely to no-show.

Conclusions: We analyzed ambulatory urology appointments within our hospital enterprise and found factors associated with a higher rate of no-show. These data may be helpful to identify patients at risk of no-show and to implement tailored strategies to enhance clinic attendance.

Introduction: Our goal was to understand health care utilization by comparing hospital encounters among individuals with spina bifida and the general population and to identify the factors associated with utilization.

Methods: Using the Department of Health Care Access and Information database (1995-2017), individuals with spina bifida were identified and matched to controls by birth year. The primary outcome measures were the number of hospital encounters (stratified as ≤2 vs ≥3 encounters) and the time between the first and second encounters. Univariate, multivariate, and subgroup analyses were performed to identify factors associated with ≥ 3 encounters.

Results: When compared to controls, individuals with spina bifida had more ≥ 3 hospital encounters (69% vs 29%), spent more days in the hospital (58 days vs 13 days), and had a higher average charge per hospital stay ($433,537 vs $99,975, P < .001 for all). After adjusting for covariates, we found that having spina bifida was associated with increased hospital encounters compared to controls (odds ratio 3.95, 95% CI 3.77-4.14, P < .001). Individuals with spina bifida were found to have less time between their first and second encounters (2.5 vs 3.3 years, P < .001). Within the spina bifida population, sex, race, ethnicity, comorbidities, and nonprivate insurance were associated with ≥ 3 encounters.

Conclusions: Spina bifida is associated with more hospital encounters and fewer days between first and second encounters compared to the general population. These findings highlight factors driving increased utilization of resources, thereby empowering providers to better support this vulnerable population.

Introduction: We sought to determine the utilization of various benign prostatic hyperplasia (BPH) procedures among patients diagnosed with BPH in the US to better understand the dispersion of the various BPH technologies.

Methods: The AUA Quality (AQUA) registry was used to identify patients with a diagnosis of BPH from January 2014 to December 2021. Patient characteristics and procedure characteristics were abstracted. Trends were analyzed using Mann-Kendall tests, and a 2-way analysis of variance test was used to compare treatment utilization.

Results: Of 2,202,107 men diagnosed with BPH in our cohort, 53% (1,173,366) were managed with at least 1 BPH medication, and 7.8% (172,681) received a BPH treatment. Compared to 2014, prostatic urethral lift (n = 178), water vapor thermal therapy (n = 1116), and other genitourinary procedures (n = 254) increased by 3730%, 123%, and 853%, respectively. Regional and racial variations existed based on treatment type. There was significant regional variation in time to intervention based on the state and age of the patient.

Conclusions: The management of BPH has undergone temporal changes throughout the study period. The treatment modalities for BPH vary by region and race in a real-world context.

Introduction: Placing ureteral stents at the ureteroileal anastomosis for radical cystectomy with ileal conduit (RCIC) has long been common practice. Recently, some providers have begun omitting stents. We sought to investigate differences in perioperative and 30-day outcomes between patients who underwent RCIC with and without stents placed at the ureteroileal anastomosis.

Methods: We identified RCICs performed between 2019 and 2021 in the National Surgical Quality Improvement Program database and corresponding Cystectomy-Targeted Participant Use File. Baseline demographics, comorbidities, and operative parameters were compared via Pearson's χ² and t tests between stented and stentless RCICs. Outcomes of interest, including rates of UTIs, acute kidney injury, renal failure requiring dialysis, ileoileal anastomotic leaks, ureteral obstruction, urinary leak or fistula formation, reoperations, and 30-day hospital readmissions, were compared using Pearson's χ². All statistical tests were 2-tailed with P < .05 considered significant.

Results: A total of 5418 RCICs were identified. Four hundred ninety-eight (9.2%) were stentless. There were no differences in baseline demographics or comorbidities. Significantly fewer stented patients had robotic-assisted operations (23% vs 29%, P < .01). Stented patients had lower rates of urinary leak or fistula formation (3.1% vs 4.8%, P = .04). There was no significant difference in 30-day rates of UTIs, acute kidney injuries, renal failure, ileoileal anastomotic leaks, ureteral obstruction, reoperations, and readmissions. Limitations include retrospective design and lack of longitudinal tracking past 30 days.

Conclusions: Stentless patients had noninferior outcomes compared to stented patients in most important 30-day outcomes. Our analysis suggests that stents may not be necessary in ileal conduit urinary diversion procedures.

Introduction: Prior work notes the AUA In-Service Exam (ISE) percentile ranking of chief residents correlates with the American Board of Urology Qualifying Exam (QE) performance. We present a 5-year analysis of resident performance on the ISE and subsequent QE to determine if earlier time points in training may identify those needing additional educational support.

Methods: Participant ISE scores over a 5-year period from 2014 to 2018 and subsequent QE scores in 2019 were recorded. Pearson's correlation coefficient measured the association between percentage questions correct for each ISE year and QE. Youden Index calculated the optimal cut point for yearly ISE percentage correct that would predict scoring greater than the lowest quartile and decile on the QE.

Results: Median percent questions correct on ISE increased over postgraduate year (PGY) 1 (47%), PGY2 (56.5%), and PGY3 (70%) but remained stable thereafter (PGY4-PGY5) at approximately 70%. Median QE percent correct in 2019 was 66% (SD 7.6%). Correlation of percent questions correct between ISE and QE improved from 0.31 to 0.53 over training duration. The lowest decile and quartile percent correct scores on the QE were 56% and 60%, respectively. Percent correct ISE score predicting performance above the lowest decile 2019 QE score increased from 38% in PGY1 to 57% in PGY2 and leveled off after PGY3 (∼70%). Similar observations were noted with lowest quartile QE score.

Conclusions: Scoring approximately 70% of questions correct on the ISE during PGY3 and later years was associated with a low risk of failing the QE. Such information provides benchmarks for residency programs to offer targeted educational content for at-risk candidates.