Current situation of incision sites in laparoscopic nephrectomy for intact specimens by urologists in China / 现代泌尿外科杂志

【Objective】 To investigate the current status of incision sites to obtain intact specimens in laparoscopic nephrectomy by urologists in China, so as to provide reference for the standardized procedure. 【Methods】 During Jun.20, 2021 and Jul.4, 2021, more than 20 000 urologists in a WeChat group were surveyed with a questionnaire. The general data, incision sites and related complications were statistically analyzed. 【Results】 A total of 601 valid questionnaires were collected, covering urologists from 31 provinces, autonomous regions and municipalities. Surgical approaches: 68 urologists chose trans-abdominal approach, 432 chose posterior abdominal space approach, 101 chose both surgical approaches. Incision sites: 97 urologists chose lumbar transverse incision, 202 chose dorsal oblique incision of the waist, 119 chose ventral oblique incision, 93 chose the paramedian incision, 112 chose the lower abdominal oblique incision (Gibson), 11 chose the transverse lower abdominal incision (Pfannenstiel), 7 chose the median incision of the lower abdomen, 2 chose the median incision in the upper abdomen, 15 chose axillary midline direct incision; 399 chose to cut off the muscles, and 202 chose not to. Complications: 232 urologists reported pain after 2 weeks, 369 reported no pain; 325 reported numbness after 2 weeks, 276 reported no numbness; 66 reported incisional hernia, 535 reported no hernia. 【Conclusions】 Chinese urologists tend to choose retroperitoneoscopic nephrectomy and waist incision to obtain intact specimens. Transperitoneal laparoscopic nephrectomy has a variety of incisions for intact specimens. There is no standardized incision sites to obtain intact specimens.

The Impact of Clostridium Histolyticum Collagenase on the Prevalence and Management of Peyronie's Disease in the United States

PURPOSE: We evaluated the impact of collagenase clostridium histolyticum (CCH) on rates of diagnosis, treatment, and corporal rupture in Peyronie's disease (PD). We examined the impact of CCH on cost of PD treatment. MATERIALS AND METHODS: We extracted data on PD diagnosis (ICD-9 607.95 and ICD-10 N48.6), corporal rupture (ICD-9 959.13 and ICD-10 S39.840A), CCH use (J0775), penile injections (CPT 54200), and corporal rupture repair from 2008 to 2016 in men over 40 years old using the Clinformatics® Data Mart Database (3.7 to 4.9 million males). We analyzed for prevalence of PD, rates of PD treatments, cost associated with treatment, and rates of corporal rupture and repair by year. RESULTS: The prevalence of PD was 0.29% in 2013 and did not increase after CCH entered the market in 2014. An average of 2.52% of men with PD received treatment before CCH, compared with 3.75% after (p<0.0001). Penile injection rates increased (1.34% vs. 2.61%, p<0.0001), while rates of surgical treatments decreased between these periods. There was no change in rate of corporal rupture in men with PD before (0.024%) and after (0.024%) CCH. Overall, only 20.0% of corporal ruptures were repaired. After CCH entered practice, a significant increase in cost occurred (p=0.013). CONCLUSIONS: The prevalence of men with PD did not change after CCH. However, more men with PD received treatment due to an increase in penile injections. The cost of treating PD increased after CCH became available. The overall prevalence of corporal rupture did not change after CCH entered the market.

Clean Intermittent Self-Catheterization as a Treatment Modality for Urinary Retention: Perceptions of Urologists / 대한배뇨장애요실금학회지

PURPOSE: Clean intermittent self-catheterization (CISC) is now considered the gold standard for the management of urinary retention. In the literature, several articles on patients’ perspectives on CISC and adherence to this technique have been published. No studies have yet explored the points of view of professional caregivers, such as nurses and doctors. The aim of this study was to explore the opinions of urologists about CISC and to evaluate the need for dedicated nurses specialized in CISC through a self-administered questionnaire. METHODS: A questionnaire was developed to explore the opinions of professional caregivers about self-catheterization and to evaluate the need to provide nurses with specialized education in CISC. Questionnaires were sent to 244 urologists through email. We received 101 completed questionnaires. The response rate was 41.4%. RESULTS: Hand function, the presence or absence of tremor, and visual acuity were rated as the most important determinants for proposing CISC to a patient. Twenty-five percent of the urologists reported that financial remuneration would give them a greater incentive to propose CISC. The lack of dedicated nurses was reported by half of the urologists as a factor preventing them from proposing CISC. A meaningful number of urologists thought that patients perceive CISC as invasive and unpleasant. Although most urologists would choose CISC as a treatment option for themselves, almost 1 urologist out of 5 would prefer a permanent catheter. CONCLUSIONS: This questionnaire gave valuable insights into urologists’ perceptions of CISC, and could serve as the basis for a subsequent broader international study. Further research should also focus on the opinions of nurses and other caregivers involved in incontinence management. Apart from financial remuneration, it is also clear that ensuring sufficient expertise and time for high-quality CISC care is important. This could be a potential role for dedicated nurses.

Survey of the management of benign prostatic hyperplasia by Chinese urologists / 中华泌尿外科杂志

Objective The aim of this study was to investigate the understanding and application of the Chinese Urological Association (CUA) guidelines of Benign Prostatic Hyperplasia (BPH) (2011 edition) in Chinese urologists.Methods The survey was conducted between September,2012 and November,2012.Questionnaires designed by the CUA were used to investigate the understanding and management of BPH in CUA-registered urologists,who work in clinic for at least 20 hours per week.Data,including general characteristics of the urologists,understanding of BPH,BPH diagnosing in suspected patients,BPH treatment,and follow up,were collected.7500 questionnaires were distributed.A total of 4 897 participants responded (response rate 70.0％).86 questionnaires with incomplete information and 37 duplicate questionnaires were excluded.And 4 774 validate questionnaires were included for the analysis,finally.The mean age of those investigated urologists was (39.9±9.2) years old.Among them,3 802 (81.0％) urologists work in the tertiary hospital,878 (18.7％) urologists work in the secondary hospital and 12 (0.3％) urologists work in the other hospital.The district distribution in those urologists included 455 (9.6％) in northeast china,812 (17.1％) in north china,1 696 (35.6％) in east china,869 (18.2％) in south china,634 (13.3％) in southwest china,295 (6.2％) in northwest china.1 835 (43.8％) urologists have less than ten years working experience.1 505 (35.9％) urologists have 11 to 20 years working experience.The 21 to 20 years working experience was reported in 705 (16.8％) urologist.And the other 149 (3.5％) urologists have working experience more than 31 years.The educational background in this study included doctor degree in 732 (15.8％) urologists,master degree in 1 729 (37.4％) urologists,bachelor degree in 2 067 (44.7％)urologists and college degree in 101 (2.1％) urologists.The position composition included 834 (18.2) directors,1 371 (30.0％) deputy directors,1 605 (35.1％) attendings and 765 (16.7％) residents.The data were analyzed using rank-sum test,2 test,or Fisher's exact test.Results The understanding of BPH clinical progression and progression-associated risk factors in Chinese urologists was poor.Compared to the guidelines,the rate of consistent were only 43.4％ (2 023/4 665) and 10.2％ (477/4 660),respectively.The initial evaluation methods for suspected BPH patients were in low consistency with the guidelines (20.2％,845/4 181) and were inconsistent among different areas [66.5％ (290/436) in northeast china,64.7％ (556/859) in south china,55.6％ (158/284) in northwest china,55.1％ (922/1 672) in east china,54.7％ (435/795) in north china,48.0％ (296/617) in southwest china].The participants showed poor understanding of the primary goal of treatment for BPH (4.9％ consistent,229/4 666) and the criteria about watchful waiting (22.5％ consistent,1 051/4 674).However,the understanding of surgical indications for BPH was good (94.6％ consistent,4 410/4 663).The therapeutic effects of 5α-reductase inhibitor for BPH were acknowledged by 93.4％ (4 388/4 699) participants.The consistent rate with the guidelines of follow-up examinations was low for patients with watchful waiting (7.8％,355/4 531),medication treatment (8.4％,373/4432),and surgery (44.8％,2 105/4 702).Conclusions The understanding of the CUA BPH guidelines is poor in Chinese urologists.Target training in the specific urologists with tailored contents is necessary.

Personal, professional and financial satisfaction among American women urologists

PURPOSE: Although nearly half of American medical school classes are comprised of women, less than 5 percent of female medical students enter the surgical subspecialties compared to nearly 20 percent of male students. Many women are concerned that a career in a surgical field will limit their personal choices. In an effort to evaluate if urology is conducive to a satisfying lifestyle, we surveyed all 365 board certified women urologists in the United States in 2007 to find out how satisfied they are with their choice of urology. MATERIALS AND METHODS: A 114 item anonymous survey was mailed to all 365 American Board Certified female urologists in 2007. Results were analyzed. RESULTS: Of the 244 women (69 percent) who responded, 86.8 percent (211) reported being satisfied with their decision to enter urology. Given the choice to repeat the decision, 81 percent (198) said that they would remain in medicine and 91.4 percent (222) would choose a surgical subspecialty again. The majority of respondents who stated they would choose a career outside of medicine also stated their family life had been significantly compromised by their career. Those who did not think their family life was compromised reported they would remain in medicine. There was a positive correlation between the level of satisfaction with the work itself and with income level (p = 0.006). CONCLUSIONS: Despite the small number of women who choose a career in urology, the number of satisfied women indicates urology is a career conducive to having a balanced and fulfilling life; professionally, personally and financially.

Estudo exploratório da utilização de saw palmetto no tratamento da hiperplasia benigna da próstata por urologistas de Porto Alegre / Investigation study concerning the saw palmetto use for the benign prostatic hyperplasia treatment by urologists in Porto Alegre

O objetivo deste trabalho foi avaliar a utilização de fitoterápicos a base de saw palmetto na terapia sintomática da hiperplasia benigna da próstata (HBP) por médicos urologistas da cidade de Porto Alegre. Consistiu em um estudo transversal, exploratório, por meio de entrevista semi-estruturada aplicada a urologistas de Porto Alegre. A amostra foi obtida utilizando catálogo do plano de saúde UNIMED- Porto Alegre. A randomização foi realizada através de sistemática aleatória, sendo sorteados trinta e cinco médicos, dos quais 21 foram selecionados para realização da pesquisa através de questionário. Todos os urologistas entrevistados avaliam e tratam pacientes com hiperplasia benigna da próstata. O saw palmetto não foi citado como terapia medicamentosa de 1ª ou 2ª escolhas no tratamento da HBP. O grupo farmacológico mais freqüentemente utilizado para o tratamento da HBP foi ∝-bloqueadores. Mais da metade dos médicos entrevistados relata ter conhecimento sobre a utilização do saw palmetto, principalmente através de artigos científicos. Os resultados indicam que o saw palmetto não é prescrito pelos urologistas em Porto Alegre, todavia a maior parte destes profissionais tem conhecimento sobre sua utilização.

The aim of this work was to assess the prescription of saw palmetto phytomedicines for improving symptoms of benign prostatic hyperplasia (BPH) by urologists in Porto Alegre (Brazil). The study was transversal and exploratory consisting of a semi-structured interview with urologists. The sample was obtained from the UNIMED Catalog - Porto Alegre (Brazil). The randomization was made by chance, being selected thirty-five physicians. The first twenty-one who accepted to participate were interviewed. All the interviewed urologists treat patients with benign prostatic hyperplasia. The saw palmetto was not mentioned as the first or second choice for treating BPH. The α-blockers were the most mentioned pharmacological group. However, more than half of urologists have heard about the use of saw palmetto and most of them gathered the information in scientific papers. The results indicate that saw palmetto is not prescribed for urologists in Porto Alegre, although most of them have knowledge about this phytomedicine.

Enhancing Clinical Teaching of Advanced Urologists / 中华医学教育探索杂志

The article summarizes the questions of clinical teaching of advanced urologists,and find out some measures to improve the clinical teaching quality of advanced urologists.