An Assessment of an Outpatient Urology Clinic's Compassion, Comfort and Knowledge of Transgender Care.

INTRODUCTION: Transgender patients face significant barriers to care, including providers who lack compassion, comfort and knowledge. We assessed the preparedness of an outpatient urology clinic in caring for transgender patients by administering a questionnaire to all staff. METHODS: Institutional review board approval was obtained to administer a questionnaire to assess transgender education, baseline compassion, comfort and knowledge of members of an outpatient urology clinic. Each section included 4 questions based on a 1 to 5 Likert scale. Responses to all questions in each section were summed for a section score of 4 to 20. RESULTS: The questionnaire was completed by 67 members (14 administrative staff, 14 medical assistants or nurses, 20 practicing providers and 19 trainees). Mean (±SD) participant age was 38.0 years (±12.7, range 23 to 74). Overall 26 (38.8%) participants had received some prior transgender education while only 3 (11.5%) said they believed their training was satisfactory. Mean response to the comfort section was 13.4 (±4.4), mean response to the compassion section was 15.9 (±3.5) and mean response to the knowledge section was 11.8 (±4.2). No statistical differences were seen among member responses for each section score. CONCLUSIONS: Clinic staff showed a high level of compassion toward the transgender community. However, knowledge of how to properly care for and help these individuals lagged behind. We aim to narrow this gap at our institution by developing educational seminars. Since the patient experience encompasses all parts of the clinic from check-in to check-out, education will be directed at all staff.

Orbital Compartment Syndrome as the Presenting Sign of Disseminated Intravascular Coagulation From Metastatic Prostatic Cancer to the Orbit.

A 70-year-old man with castrate-resistant metastatic prostate cancer to the lumbar spine presented with sudden onset of left orbital compartment syndrome. Hematologic workup revealed disseminated intravascular coagulation with isolated left orbital hemorrhage. A canthotomy and blood product transfusions failed to control the bleeding and restore vision. Operative intervention found a new left orbital roof metastasis from primary prostatic carcinoma. Acute onset of headache or ocular pain in patients with metastatic prostate cancer warrants further workup to rule out orbital and intracranial metastases, rare but significant clinical entities that can lead to severe complications.