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Background: Implantation of the double J stent is a common procedure in urology. The function of this device is to maintain the flow of urine from the ureteropelvic junction to the urinary bladder when the ureter is blocked or partially blocked for some reason. Once in place, the stent may cause low back pain, hematuria, symptoms of urinary irritation, a reduction in labor capacity, infection and calcification which are side effects that are easy to manage. However, severe complications can occur, such as the insertion of the stent into the circulatory system, such as the vena cava, which, although uncommon, is one of the most severe and difficult to manage. This work reports the case of a patient with the accidental insertion of a double J stent into the inferior vena cava.Case Description: An 80-year-old female patient with repeated urinary tract infections using a double J stent due to stenosis of the right distal ureter distal presenting retroperitoneal fibrosis secondary to previous radiotherapy. The patient had Lynch syndrome, ovarian and uterine cancer, colorectal cancer, and nephrolithiasis. She had been submitted to multiple previous surgeries. Due to the possibility of viral infection by COVID 19, chest computed tomography was performed, which suggested the insertion of the double J stent in the inferior vena cava, confirmed by abdominal computed tomography. As the distal end of the stent was within the bladder, the decision was made to remove the stent by cystoscopy, with the implantation of a new stent using fluoroscopic control for the confirmation of its trajectory. No intraoperative or postoperative complications occurred and the patient is currently in outpatient follow-up.Conclusions: Situations such as this require caution during the implantation of the drainage device, with the occurrence of resistance indicating the need to discontinue the procedure and perform a new assessment with imaging exams. No intraoperative or postoperative complications occurred and the patient is currently in outpatient follow-up.
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The current COVID-19 climate has caused an unforeseen supply shortage of iodinated contrast media (ICM) worldwide, disrupting global distribution.1 In addition, the scarcity has resulted in a ripple effect in healthcare facilities such as radiology departments where ICM is required to perform contrast-enhanced examinations. ICM plays a significant part in contrast-enhanced CT, angiography and fluoroscopic procedures within the radiology department, holding a primary role in the differentiation and diagnosis of pathologies which range from pulmonary emboli to tumours.1 Its use extends beyond radiology, where ICM is heavily relied on in cardiology, urology and gastrointestinal studies, further highlighting the heavy dependence on the critical agent.2 With the global increase in the number of CT examinations requested, where approximately 60% of studies require ICM, optimal usage of ICM must be considered to meet heightened demand.3 The shortage has represented an opportunity for imaging providers to re-examine current imaging protocols and identify whether non-contrast imaging, alternative contrast agents and other imaging modalities could be viable options moving forward.1,2 Additionally, current literature has discussed volume-reduction strategies and dual-energy use in newer-generation CT scanners to conserve ICM.1,4 This review will explore currently proposed solutions that can be implemented in the radiology department to maximise ICM supply with minimal impact on patient care.
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Introduction: The COVID-19 pandemic has disrupted health care systems worldwide, but the specific impact on pediatric surgery in low-and-middle-income countries has received little attention. This study evaluated the changes in pediatric surgical case volume at a central referral hospital in Malawi from 2019 through 2021 to quantify the impact of COVID-19. Method(s): We retrospectively reviewed all pediatric surgical cases performed at our institution from May-August 2019, 2020, and 2021. These months were chosen because they coincided with the first major wave of COVID cases in Malawi in 2020. We compared the number of cases performed per week between years and analyzed case numbers by specialty (general, orthopedic, plastic, neurosurgery, ENT, and urology). Result(s): A total of 1032 procedures were performed. There was a 32% reduction in case volume between 2019 to 2020 (344 to 235 cases, 19.5 vs 13.8 per week, p=0.04), with a subsequent 93% increase from 2020 to 2021 (235 to 435 cases, 13.8 vs 26.4 per week, p<0.001). The most significantly impacted specialties were ENT and plastics, both with 78% fewer procedures in 2020 compared with 2019, and a subsequent 4-fold and 22-fold increase in cases from 2020 to 2021, respectively (Chi-Square;p=0.007 and p<0.001). Orthopedic and Neurosurgical case numbers were impacted the least, with reductions ranging from 22% to 35%. Conclusion(s): The COVID-19 pandemic significantly reduced the number of pediatric surgical cases performed at the central referral hospital in Malawi across all specialties, thereby further limiting essential surgical services to an already marginalized patient population.
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Background: COVID-19 has brought unprecedented changes in every aspect of life throughout the world including the healthcare delivery system. After a grinding halt in surgical practice due to this pandemic, the conventional protocols needed a thorough overhaul before kick-starting formal services. This study discusses ways and procedure changes adopted at the Urology department to navigate this crisis and extend adequate urological care to patients at the same time. Aim(s): To share our experience of patient management in the era of the COVID-19 pandemic. Method(s): It's a descriptive review article based on patient management protocols and clinical audit in the era of COVID-19 pandemic at the Departmentof Urology, MTI, Lady Reading Hospital from 20th Marchto 20th June 2020. Clinical implication the benefit of this study is how to organize things and continue health care provision in a deadly pandemic. Furthermore, it will set a precedence that how to cope with such a pandemic in the future. Conclusion(s): All surgical patients should be screened for COVID-19, with preference given to PCR tests. All elective surgeries should be put on hold as a result of the limited availability of ventilators, manpower, and hospital beds. Only semi-elective, lifesaving and oncologic surgeries that cannot be delayed should be done with full PPEs provided to every personnel frequenting operating theaters during the procedure. Furthermore, more efforts are needed to lift the infrastructure of hospitals and make them capable to face problems of such proportions in the future.Copyright © 2023 Lahore Medical And Dental College. All rights reserved.
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OBJECTIVE: COVID-19 resulted in Regional tiered restrictions being introduced across the UK with subsequent implications for planned and emergency surgical care. Specific to Merseyside, Tier 4, Tier 2 and Tier 5 restrictions were introduced in late 2020 and early 2021. The purpose of this study was to examine the nature and workload of emergency urological procedures during three different national lockdown Tiers in the North West of England. METHOD: A 3-month prospective study examining all emergency urological activity was conducted from November 2020 when Tier 4 restrictions were introduced and included Tier 2 restrictions in December and then concluded at the end of January 2021 when Tier 5 restrictions were in place. Data was obtained by identifying patients using the electronic theatre listing system. RESULTS: A total of 71 emergency cases were performed (24 in November (Tier 4), 28 in December (Tier 2), 19 in January 2021 (Tier 5)) with 15 different types of procedures performed. The most frequently performed procedure was stent insertion (36), followed by scrotal exploration (10). The least commonly performed procedure was suprapubic catheter insertion under general anaesthesia (1). One patient required transfer to a different hospital. In total 6 calls were made by general surgery and 3 by gynaecology for urgent urological assistance in theatre. Three urology patients returned to the theatre as emergencies following elective procedures. CONCLUSION: Unlike the Spring lockdown, acute urological presentations requiring operative intervention still presented daily. Of the 71 cases performed, most occurred in Tier 2. Stent insertion was the most commonly performed procedure, with the majority of the cases performed by registrars.
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Background and objective Urology residency match occurs through the American Urological Association (AUA), and hence information about the success of applicants in finding a match is not readily available. The average number of publications a successful urology applicant has when applying for residency is unknown. In light of this, we conducted this study to examine the number of PubMed-indexed research projects involving US senior medical students who successfully matched into the top 50 urology residency programs in the 2021, 2022, and 2023 match cycles. We also assessed these applicants based on their medical schools and gender. Methods Doximity Residency Navigator was used to generate the top 50 residency programs as sorted by reputation. Newly matched residents were found using program Twitter accounts and residency program websites. PubMed was queried for peer-reviewed publications of incoming interns. Results The average number of publications across all incoming interns in the three years was 3.65. The average number of urology-specific publications was 1.86 and that of first-author urology publications was 1.11. The median number of total publications for matched applicants was 2, and applicants with a total of five publications were in the 75th percentile for research productivity. Conclusion A successful applicant had two PubMed-indexed urology papers on average and also had a urology-specific first-author paper in the cycles we surveyed. There has been an increase in publications per applicant when comparing the results to previous application cycles, which can be attributed to post-pandemic changes.
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INTRODUCTION: The COVID-19 pandemic disrupted all routine health care services in 2020. To date, data regarding adjustment and coverage of surgical backlog in the post-COVID era actually remains scarce. The aim of this study was to compare the number of urological procedures coded between 2019 and 2021 in public and private institutions to (i) quantify the variation in surgical activity linked to the shutdown in 2020 and (ii) study the adjustment of procedures over the year 2021. MATERIALS AND METHODS: This is a comprehensive retrospective analysis of all urological surgeries coded between January 1, 2019 and December 31, 2021 in France. Data were extracted from the open access dataset of the national Technical Agency for Information on Hospital Care (ATIH) website. In total, 453 urological procedures were retained and allocated in 8 categories. Primary outcome was the impact of COVID-19 analyzed by the 2020/2019 variation. The secondary outcome was the post-COVID catch-up analyzed by the 2021/2019 variation. RESULTS: Surgical activity in public hospitals dropped by 13.2% in 2020 compared to 7.6% in the private sector. The most impacted areas were functional urology, stones and BPH. Incontinence surgery did not recover at all in 2021. BPH and stone surgeries were far less impacted in the private sector, with even explosive activity in 2021, post-COVID period. Onco-urology procedures were roughly maintained with a compensation in 2021 in both sectors. CONCLUSION: The recovery of surgical backlog was much more efficient in the private sector in 2021. The pressure on the health system associated to the multiple COVID-19 waves may generate a gap between public and private surgical activity in the future.
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Communication trends between patients and healthcare professionals have evolved over the last decade and most notably during the 2020 COVID-19 pandemic. Digital technology such as email, smartphones, text messaging, and social media have transformed communication in the healthcare setting. This chapter will highlight how digital technology is changing the way urologists communicate with patients and colleagues as well as provide guidance on how to avoid some of the pitfalls associated with this form of communication. © Springer Nature Switzerland AG 2022.
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The purpose of simulation is to refine the process of surgical training through valid, reliable, and feasible platforms. Immersive technology describes a spectrum of simulation platforms which balance the physical world on one end and the virtual world on the other. The value of immersive technology in urological simulation has been evidenced by a prolific literature base. This has demonstrated its pedagogic value and cost-efficiency with increasing investments in science and technology in order to advance the models and modalities available to deliver simulation. Urology is a unique specialty, at the forefront of innovative surgical techniques, with a trend towards progressively minimally invasive surgery, featuring a range of laparoscopic, robotic and endoscopic procedures, each associated with a unique learning curve. As a result, it is important to cater the simulation model to the type of urological procedure practiced and the needs of the learner. This chapter also discusses how the implementation of these technologies both in surgical training and in the operating theatre has been accelerated by several historic pressures on surgical training, such as the introduction of the European Working Time Directive and more recently, the COVID-19 pandemic, which exposed deficiencies in existing systems and reiterated the value of virtual platforms. These technologies are beneficial in the formative years of surgical training, aiding the development of technical and non-technical skills as well as in the real-life operative setting, clinical application, enhancing patient treatment and aiding doctor-patient collaboration. Finally, research and innovation consider the potential of immersive technologies to advance surgical practice and techniques by providing an intermediary between laboratory based research and the real world, bypassing some of the ethical concerns associated with conducting research in the context of surgery. © The Author(s), under exclusive license to Springer Nature Switzerland AG 2022.
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INTRODUCTION AND OBJECTIVE: Telemedicine has gained wide acceptance during the COVID-19 pandemic. Worldwide lockdowns made this interface an indispensable one for patient care. Recent evidence suggests that urology patients were receptive to telemedicine;however, no systematic review has been done to date on andrology patients in particular and their perception of telemedicine. METHOD(S): Three electronic databases: PubMed, Scopus, and Web of Science, were searched from their inception until June 2022 for relevant articles. Two independent teams reviewed s and extracted data from the selected manuscripts. A meta-analysis was completed in line with PRISMA 2020 and AMSTAR Guidelines. For our study, we limited telemedicine to communication through videoconferencing or telephone encounters between patients and medical professionals. Positive response to telemedicine was defined as patients "wishing for telemedicine consultation", "preferring telemedicine over in person", "accepting the current telemedicine arrangement", "having needs addressed with teleconsultation", or "willingness to do a teleconsultation". RESULT(S): Of the 1128 retrieved s, 56 underwent fulltext review and 12 were included in the final analysis, comprising a total cohort of >4021 cases. All 8 studies that assessed perception of andrology patients to telemedicine showed that most patients had "positive perception". Telemedicine was shown to save an average cost of $149-252/patient. Pooled analyses of positive response to telemedicine were 68.7% (95% CI = 49.4-83.1%, p=0.057) and of patients who recommended telemedicine were 65.1% (95% CI = 18.4-93.9%, p=0.577). 84.6% pooled proportion for recommending video compared to 38.9 % pooled proportion for recommending telephone practice, p=0.035. In the telephone-only encounters, 27.1% of patients preferred in-person visits as security and privacy of any mode of telecommunication were of concern. CONCLUSION(S): Most patients have a positive perception of telemedicine, particularly with videoconferencing and less so with telephone visits. Telemedicine will plausibly continue to be integral in andrology practice.
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Objective: In this paper, we wanted to review the annual British Association of Urological Surgeons (BAUS) programme to analyse the female and ethnic minority (EM) representation and find out whether there is ethnic and gender disparity, and if it does reflect the reality of the workforce. Method(s): To investigate gender and EM representation, we requested data for BAUS annual meetings over a 13-year period (2009-2021). All speakers and chairpersons for all four sub-sections including Endourology, Oncology, Andrology and Female, Neurological and Urodynamic urology (FNUU) were collated. We also looked at the geographic distribution of the speakers (London area, rest of England, Scotland, Northern Ireland and Wales). Data were analysed separately before and after the COVID-19 pandemic (cut-off March 2020), as in the latter 2 years, the meeting was held virtually. Result(s): A total of 2569 speakers (range: 135-323 speakers/year) were included in our analysis and 2187 (85%) speakers were from the United Kingdom. Of the UK speakers, more than three-quarters (76.6%, n = 1676) were males and females of White ethnicity and (23.4%, n = 511) were EM. The vast majority of speakers throughout the years were males (86%, n = 1891) with only 14% (n = 296) females regardless of their origin and ethnicity. The presence of EM females was only 1.9% (n = 43). The percentage of female representation rose consistently over time from 6.7% (n = 8) in 2009 to 21.1% (n = 44) in 2020, suggesting an upward trend. Regional distribution showed 31%, 63%, 3.6%, 1.6% and 0.2% from London, Rest of England, Scotland, Wales and Northern Ireland, respectively. Both gender and EM representation doubled in the last 2 years during the pandemic (p < 0.001). Conclusion(s): Annual BAUS meetings have seen a higher proportion of ethnic and gender representation in recent years. However, considering the workforce within urology, more needs to be done to address this historical disparity. Hopefully, the BAUS 10-point programme will provide a framework for addressing Equality, Diversity and Inclusion issues related to this bias. Level of Evidence: Not applicable.Copyright © British Association of Urological Surgeons 2022.
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INTRODUCTION AND OBJECTIVE: Patients with acute renal colic due to stones frequently visit the ED. With limited ED resources due to the COVID-19 pandemic, we developed a best practice management pathway within our electronic medical records (EMR) to provide consistent, expeditious and appropriate care for patients with nephrolithiasis. The objective of this study is to describe the development and 1 year outcomes of our EMR Care Pathway for nephrolithiasis. METHOD(S): Our hospital system is composed of many centers. To standardize best practice care, we convened a clinical consensus group, with key stakeholders in emergency medicine, urology, interventional and diagnostic radiology to develop a pathway for the initial work up and management of acute renal colic. AUA guidelines, current literature, and expert consensus across specialties were used to develop the pathway to guide work up and management. Risk assessment tools, and criteria for specific imaging modalities, lab work, and pain protocols were outlined. Criteria for routine discharge with follow-up, including pre-populated links for referrals, indications for urology consult, hospital admission and urgent decompression (stent versus nephrostomy tube) were provided. Data was gathered through the EMR analytics team and descriptive statistics were performed. RESULT(S): The Care Pathway was utilized 944 times from August 3, 2021-September 17, 2022 at 11 different hospitals or care centers (Table 1). Usage increased overtime (r2=0.77). The majority of usage was in the ED (892, 94.4%). A total of 194 providers utilized the Pathway with the majority being residents (64, 33.0%). The pathway included care of 505 unique patients, with 106 primary diagnosis key words triggering pathway use. 139 Urology referrals were placed through the pathway with 124 new 28 day prescriptions of tamsulosin. CONCLUSION(S): An EMR-integrated care pathway has been readily utilized in our system and may augment triage and best practice management of patients presenting with stone disease. Further studies are needed to understand the full impact on outcomes.
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INTRODUCTION AND OBJECTIVE: Burnout is one of the many challenges physicians may face in their careers. While there are studies focusing on burnout among surgical specialties, there are limited studies focusing on burn out at different levels of training. The aim of this study is to measure and compare rates of burnout between junior and senior trainees in urological surgery as well as to identify changes in training that could be made to improve work-life balance. METHOD(S): To assess professional burnout, respondents completed the 22-item Maslach Burnout Inventory Human Services Survey as part of the 2019 AUA census. Respondents were categorized into junior trainees (PGY1, PGY2, PGY3) and senior trainees (PGY4, PGY5, and fellow). RESULT(S): A total of 512 respondents were included. Senior trainees represented 57% while junior trainees represented 43% of the total cohort. The prevalence of burnout (p=0.005) and high levels of depersonalization (p=0.018) were 50% in junior trainees and 38% in senior trainees. High levels of emotional exhaustion were 9% for junior and 5% for senior trainees (p=0.053) (Table 1). The top changes to improve work life balance for urology trainees were access to meal plans, on-call rooms, and time to attend health appointments (Figure 1). CONCLUSION(S): Juniors experience higher levels of burnout, depersonalization, and emotional exhaustion when compared to seniors. Providing meal plans, on-call quarters, and time to attend health appointments are the top changes to improve work-life balance among urology trainees. These changes may have a dramatic impact on the well-being of our trainees, especially in this post-COVID era. (Figure Presented).
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INTRODUCTION AND OBJECTIVE: Due to the COVID-19 pandemic, urology residency programs have had to adjust their typical practices, including the adoption of virtual recruiting and interviewing. Such efforts have included utilizing social media and improving program websites, which are often the starting point for potential applicants to obtain information about a program. We sought to evaluate the transparency and quality of information dissemination among urology residency program websites. METHOD(S): The websites of all 143 non-military, accredited United States urology residency programs were evaluated for various measures grouped into distinct categories including program priorities, program curriculum, program profiles, program quality of life, medical student opportunities, interview process, selection/exclusion criteria, and social media. Programs that have yet to graduate residents were excluded. Programs were separated based on American Urological Association (AUA) section. Percentage values were determined by the number of programs reporting information on a particular measure. RESULT(S): The most reported category was program profiles (84%), with many programs providing details such as resident hometowns, faculty research interests, and alumni fellowship matches. The least reported category was selection/exclusion criteria (32%), with 8% of programs discussing a minimum/preferred Step 1 score and 23% discussing osteopathic applicants. Program mission/objective statements, training site locations, and current resident and faculty profiles were subcategories reported by greater than 90% of programs. DEI and wellness initiatives/statements were discussed by 45% and 36% of programs, respectively. For virtual opportunities, 21% of programs provided online open house information, and 85% had an active Twitter account with 34% providing direct links. Average AUA overall transparency was 53.7%, with the Northeastern Section highest at 62.4%. CONCLUSION(S): The importance of transparency and quality of information dissemination is greater than ever with the increasing utilization of virtual formats in the residency application process. Our results indicate several areas of improvement that urology residency programs can amend to provide improved transparency for applicants during the application process. (Figure Presented).
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INTRODUCTION AND OBJECTIVE: The COVID-19 pandemic altered many aspects of the urology residency application process, including a shift to virtual interviews and limits on both in-person interactions and away-rotations. We sought to determine how these changes affected match outcomes. METHOD(S): Publicly available match statistics from the American Urological Association (AUA) were analyzed in combination with self-reported applicant data from the Urology Residency Applicant Google Spreadsheet and a list of matched urology residents and their medical schools, verified on social media and residency program websites. Data from pandemic match years of 2021 and 2022 were compared to the four years prior. RESULT(S): Match data from the AUA indicates that the number of applicants per residency spot, number of applications submitted per applicant, and percentage of matched female applicants have been increasing since 2019. The overall match rate during the pandemic was significantly lower than the 4 years prior (70% vs 79%, p<0.0001) and has been decreasing since 2019. According to self-reported match data, during the pandemic applicants received fewer interviews per application submitted (24% vs 31%, p<0.0001) and accepted interview offers at a higher rate (84% vs 68%, p<0.001). The percentage of matched applicants with a residency program at their home institution has been decreasing since 2017. These students were just as likely to match to their home program during the pandemic as in the years prior (p=0.17). CONCLUSION(S): The changes to the match process due to COVID-19 pandemic did not cause fundamental changes in match outcomes but rather accelerated many pre-existing trends, most notably increased competition. (Figure Presented).
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INTRODUCTION AND OBJECTIVE: The COVID-19 pandemic initiated rapid widespread utilization of telemedicine affecting all health care providers, including those in pediatric urology. Understanding the factors of patient and parent satisfaction can aid in health care delivery. The aim of this study was to identify key indicators of patient and parent satisfaction with pediatric urology telemedicine visits. METHOD(S): We conducted a prospective cross-sectional survey of all patients evaluated with a telehealth visit from October 2021 - April 2022. We included all consecutive patients aged 0-18 years who received an outpatient pediatric urology telehealth visit. All patients received an 8-question patient/parent reported outcome (PRO) survey via email within 30 days of the visit, including 5 satisfaction questions regarding various aspects of telemedicine rated on a scale of 1-5. Statistical analysis was performed using Pearson correlation, Mann- Whitney U, and Chi Squared tests, with p<0.05 considered significant. RESULT(S): A total of 1213 patients completed a telehealth visit, of which 83 (7%) completed the PRO survey. Visit type included 40 (48%) post-operative, 29 (35%) follow-up, and 14 (17%) new consults. From the survey responses, 84% reported time savings, 31% reported money savings, 30% avoided time away from work, and 27% of children avoided missing school. No technical issues were experienced in 86% of the visits. Satisfaction with telehealth was highest for the post-operative patient, 4.8/5 after orchiopexy and 4.4/5 after circumcision. Patients saved a median travel distance of 22 miles [IQR: 15-41]. Patients living farther than 22 miles had higher satisfaction scores in terms of simplicity and preference to in-person visits compared to those who lived closer (p=0.019). Patients living in zip codes below the median household income had significantly higher satisfaction scores (p =0.032). Patients with public health insurance had significantly higher overall satisfaction scores compared to those with private health insurance (p=0.022). There was no difference in satisfaction based on parent age or whether the patient was evaluated for a new, follow-up, or post-operative video visit. CONCLUSION(S): Children and their caregivers were satisfied with pediatric urology telehealth visits when seen as a new, follow-up, or post-operative patient. Indicators for satisfaction may include long travel distance to the clinic, lower than median household income zip codes, and public health insurance. Appropriate use of telehealth may provide better access to care and optimize healthcare delivery.
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Purpose of Study: We hypothesize that patient and parent satisfaction of telemedicine is influenced by patient key indicators. By delineating these key indicators, we can strategically utilize video visits in a way that maximizes patient satisfaction, while maintaining high quality care. The aim of this study is to reveal which key indicators are predictive of patient and parent satisfaction with video visits. Methods Used: We performed a retrospective review of all patients and parents who were evaluated via video visit for Loma Linda University Pediatric Urology from October 2021 - April 2022. All patients received an 8-question validated satisfaction survey via email within 30 days of the visit. Patient demographics, clinical data, and survey responses were collected. We analyzed all patients who completed a telemedicine visit and the post-visit survey. Exclusion criteria included incomplete survey responses. Primary outcomes include high satisfaction scores on survey questions. Univariate analysis was conducted for indicators of patient and parent satisfaction using Pearson correlation, Mann-Whitney U, and Chi Squared, with clinical significance defined as p value < 0.05 using SPSS. Summary of Results: A total of 1213 patients had video visits from October 2021 - April 2022. Of those who completed a video visit, 83 patients (7%) completed the satisfaction survey. Of those who completed the survey, 40 (48%) were post-operative visits, 29 (35%) were follow-up visits, and 14 (17%) were new visits. Families said telemedicine saved them time (84%), saved them money (31%), allowed them to avoid time away from work (30%), allowed their child to avoid missing school (27%), and that they did not experience any technical issues (86%). Mean overall satisfaction score (1-5) was 4.36 for post-op circumcision patients and 4.80 for post-op orchiopexy patients. Median travel distance saved by performing a video visit was 22 miles (IQR 15 - 41 miles). Compared to those who lived closer, patients who lived farther than 22 miles from the clinic had significantly higher satisfaction scores for Q3 (p < 0.019) and Q4 (p < 0.049) [reference Table]. Compared to higher household incomes based on zip code, patients with lower than median household income of $64,384 had significantly higher satisfaction scores for Q1 (p < 0.032), Q3 (p < 0.039), and Q4 (p < 0.040). Patients with public insurance had significantly higher satisfaction scores compared to those with private insurance for Q1 (4.68 vs 4.15, p < 0.022), Q2 (4.90 vs 4.64, p < 0.018), and Q3 (4.82 vs 4.58, p < 0.050). Median parent age was 40 (IQR 32.4 - 42.2 years). There was no difference in satisfaction based on visit type or parent age. Conclusion(s): Overall, patients and parents in pediatric urology are satisfied with video visits across visit type and diagnosis. Patients who live farther away from the office, live in zip codes with lower median household incomes, or have public insurance seem to be more satisfied with video visits. (Table Presented).
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INTRODUCTION AND OBJECTIVE: Given widespread disruptions to healthcare during the COVID-19 pandemic, the objective was to assess the national case logs of graduating Female Pelvic Medicine and Reconstructive Surgery (FPMRS) fellows for effects on surgical volume. METHOD(S): The nationally aggregated Accreditation Council for Graduate Medical Education case logs were obtained for graduating FPMRS fellows, both urology and obstetrics and gynecology (OBGYN), for available academic years (AYs) 2018-2019, 2019-2020, and 2020- 2021. Standard deviation was derived from percentile data. Case volume differences for tracked index category averages were compared between AYs with one-way analysis of variance. RESULT(S): Graduating fellows logged an average of 517.4 (SD 28.6) and 818.0 (SD 37.9) cases, for urology and OBGYN respectively, over their fellowship training during the examined period. Total surgical procedures were not statistically different between pre-COVID AY 2018- 2019 and COVID-affected AYs 2019-2020 and 2020-2021 for either specialty. For urology fellows, the only index case category with a statistically significant difference was a decrease in AY 2020-2021 compared to 2019-2020 in GI procedures (8.9 vs 4.2, p=0.04). Reclassification of mesh removal cases to genital procedures in 2020- 2021 resulted in a statistical decrease for both specialties of graft/mesh augmentation prolapse cases for that same AY. There were no other statistically significant differences between AYs for OBGYN fellows. CONCLUSION(S): Compared to pre-pandemic case volumes, FPMRS urology and FPMRS OBGYN graduating fellow surgical volume remained stable. Both total surgical procedures and index case categories showed no statistically significant difference between pre-COVID and COVID-affected years. Despite nationwide disruptions in health care, FPMRS trainee case volumes remained consistent.
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INTRODUCTION AND OBJECTIVE: Contemporary rates of burnout amongst urologists are reported to be 60-80%. These rates have significant implications on physician well-being and retention. We investigated predictors of burnout in female surgeons. METHOD(S): An electronic census survey was distributed to residents, fellows and practicing urologists by the Society of Women in Urology in the United States and territories via email and social media between February and May 2022. We assessed participant demographics, personal and professional characteristics, practice environment, compensation, and burnout with chi-square and t-test analyses. RESULT(S): There were 379 survey participants with an average age of 42 years (SD 10). A majority identified as cis-gendered heterosexual females (96%) and were practicing urologists (74%), while 10% were fellows and 15% residents/interns. Average reported time in practice was 9 years (SD 9 years). Most respondents reported burnout (273, 72%), with 87% agreeing COVID worsened burnout in the community. Those reporting burnout worked an average of 58 (SD 15) hours per week versus 49 (SD 18) hours (p<0.00001). Table 1 demonstrates significant personal and professional characteristics for participants who reported burnout. On multivariable logistic regression analysis, increased hours worked per week (OR 1.03, p=0.002), Relative Value Unit based pay versus salary (OR 4.4, p=0.007), correlated to burnout and feeling income is comparable to peers (OR 0.4, p=0.03) was inversely related. Common shared experiences included lack of staffing, reduced operating room time, lack of administrative support, predominance of non-operative referrals, gender and racial inequity or microaggressions, electronic health records with increased documentation demands, increased non-clinical administrative duties, and insufficient compensation or lack of financial advancement. CONCLUSION(S): A majority of women in urology report burnout with work-hours and compensation inequity as leading contributing factors. Concerns raised in this study such as lack of support staff, racial and gender inequity, and poor referral patterns should be further evaluated to determine a comprehensive plan to reduce burnout. (Figure Presented).
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INTRODUCTION AND OBJECTIVE: In 2016 we began offering optional same-day discharge (SDD) to all robotic prostatectomy (RP) patients with increasing acceptance that accelerated during the COVID pandemic. Our resulting 98% SDD rate for RP after COVID facilitated initiation of an ambulatory surgery center (ASC) robotic urology program without overnight capability and planned SDD in all patients. We assessed our outcomes with planned outpatient RP in all patients in both the hospital and ASC settings. METHOD(S): We reviewed one year of consecutive RPs performed by a single surgeon at either a free-standing ASC or one of three hospitals between October 2021-October 2022. Pelvic lymphadenectomy was performed in all patients. Assignment to ASC versus hospital RP was based primarily on insurance eligibility. ASC policy for robotic or non-robotic procedures alike excluded history of severe cardiac disease, difficult airway, malignant hyperthermia, or BMI >45kg/m2 with no additional limitations applied to robotic surgery. All patients were instructed to expect same-day discharge (SDD) directly from the recovery room regardless of ASC or hospital location with overnight stay only for unexpected complications or side effects of anesthesia. RESULT(S): Among 359 RP cases (162 ASC and 197 hospital), 356 (99%) were successfully discharged the same day as surgery with 3 overnight stays in the hospital group and none in the ASC group. Patients in the ASC group were younger (61.4yrs vs 67.1yrs, p<001) with no statistically-significant difference in BMI (29.2 kg/m2 vs 29.3 kg/ m2, p=0.3), preoperative Gleason Score (p=0.1), operative time (131min vs 134min, p=0.2) or blood loss (87.5cc vs 84.8cc, p=0.71). Excluding the three overnight patients in the hospital group, the mean postoperative recovery room stay among SDD patients was shorter in the ASC group (1.7hrs vs 2.3hrs, p<0.0001). The 90-day readmission rate was 2.5% in both groups (4/162 and 5/197, p=0.93). No readmissions occurred within 24 hours of surgery and only one within the first week. CONCLUSION(S): Same day discharge as a routine following robotic prostatectomy is feasible and safe with readmission rates no higher than series with overnight stays. SDD may enable ASC RP when overnight stay capabilities are not available at an ASC with minimal risk of need for hospital transfer.