Perception and satisfaction of patients after telemedicine urology consultations: A matched analysis with physicians' perspective.

INTRODUCTION: During the first regional COVID-19 lockdown in March 2020, we conducted a study aimed at evaluating completeness of telemedicine consultation in urology. Of 1679 consultations, 67% were considered completely managed by phone. The aim of the present study was to assess patients' experience and satisfaction with telemedicine and to compare them with urologists' perceptions about quality and completeness of the telemedicine consultation. METHODS: We contacted a randomly selected sample of patients (n=356) from our previous study to enquire about their experience. We used a home patient experience questionnaire, inspired by the Patient Experiences Questionnaire for Out-of-Hours Care (PEQOHC) and the Consumer Assessment Health Profile Survey (CAHPS). RESULTS: Of 356 patients contacted, 315 agreed to complete the questionnaire. Urological consultations were for non-oncological (104), oncological (121), cancer suspicion (41), and pediatric (49) indications. Mean patient satisfaction score after telemedicine consultation was 8.8/10 (median 9/10) and 86.3% of patients rated the quality of the consultation as either excellent (54.6%) or very good (31.7%). Consultations regarding cancer suspicion had the lowest score (8.3/10). Overall, 46.7% of all patients would have preferred an in-person visit outside of the pandemic situation. Among patients whose consultations were rated suboptimal by urologists, almost a third more (31.2%) would have preferred an in-person visit (p=0.03). CONCLUSIONS: Despite high reported patient satisfaction rates with telemedicine, it is noteworthy that nearly half of the patients would have preferred an in-person visit. Post-pandemic, it will be important to incorporate telemedicine as an alternative, while retaining and offering in-person visits.

A prospective, multisite study analyzing the percentage of urological cases that can be completely managed by telemedicine.

INTRODUCTION: The COVID-19 pandemic has accelerated the development of telemedicine due to confinement measures. However, the percentage of outpatient urological cases that could be managed completely by telemedicine outside of the COVID-19 pandemic remains to be determined. We conducted a prospective, multisite study involving all urologists working in the region of Quebec City. METHODS: During the first four weeks of the regional confinement, 18 pediatric and adult urologists were asked to determine, after each telemedicine appointment, if it translated into a complete (CCM), incomplete (ICM), or suboptimal case management (SCM, adequate only in the context of the pandemic). RESULTS: A total of 1679 appointments representing all urological areas were registered. Overall, 67.6% (95% confidence interval [CI] 65.3; 69.8), 27.1% (25.0; 29.3), and 4.3% (3.5; 5.4) were reported as CCM, SCM, and ICM, respectively. The CCM ratio varied according to the reason for consultation, with cancer suspicion (52.9% [42.9; 62.8]) and pediatric reasons (38.0% [30.0; 46.6]) showing the lowest CCM percentages. CCM percentages also varied significantly based on the setting where it was performed, ranging from 61.1% (private clinic) to 86.8% (endourology and general hospital). CONCLUSIONS: We show that two-thirds of all urological outpatient cases could be completely managed by telemedicine outside of the pandemic. After the pandemic, it will be important to incorporate telemedicine as an alternative for a patient's first or followup visit, especially those with geographical, pathological, and socioeconomic considerations.

Percutaneous nephrolithotomy for staghorn calculi: a single center's experience over 15 years.

BACKGROUND AND PURPOSE: Percutaneous nephrolithotomy (PCNL) for staghorn calculi is one of the more challenging endourologic procedures. Although excellent stone-free rates are universally reported in the literature, complication rates vary widely, especially related to the need for blood transfusion. The purpose of this study was to evaluate the outcomes of PCNL for patients with staghorn calculi in a large series of patients at a single, tertiary referral, endourologic stone center. PATIENTS AND METHODS: Between July 1990 and December 2005, 1338 patients underwent PCNL for renal stone disease at our institution. Among this group, 509 procedures were performed for patients with a partial or complete staghorn calculus. Data analysis included procedure time, length of hospital stay, number of access tracts, transfusion rates, other early and late complications, and stone-free status. RESULTS: Mean patient age was 53.8 years (range 4-84 yrs). The average procedure time was 104 minutes. Sixteen percent of the cases needed multiple access tracts (range 2-5), with the lower calix being the most commonly used in 64.1%, followed by the upper calix in 18.5% and the middle calix in 17.4%. Various intracorporeal lithotriptors were used, including ultrasound, pneumatic, electrohydraulic, and holmium:yttrium-aluminium-garnet laser. The transfusion rate among this group was 0.8%. There was no statistically significant difference in transfusion rates (0.7%-1.2% P = 0.24) or other major complications in patients who were treated with either a single tract or among those needing multiple tracts. Stone-free rates at hospital discharge and at 3 months follow-up were 78% and 91%, respectively. CONCLUSION: PCNL is a safe and effective procedure in the management of staghorn calculi, with outcomes similar to those reported for percutaneous management of smaller volume nonstaghorn stones. Attention to accurate tract selection and placement as well as possession of the full array of endourologic equipment are essential to achieving an excellent outcome.

Occupational noise exposure during endourologic procedures.

INTRODUCTION: Long-term noise exposure in the workplace is a known cause of hearing loss. There has been limited study on the potential harm related to shock wave lithotripsy (SWL) or intracorporeal devices on patients and operating room personnel. PATIENTS AND METHODS: We used a digital sound meter to measure decibel levels in the operating room during several endourologic procedures. The decibel levels were recorded during SWL (Storz SLX-F2), percutaneous nephrolithotomy using single- and dual-probe ultrasonic lithotripters (Olympus LUS-2, CyberWand), and during ureteroscopy using the Versa Pulse Holmium:YAG laser. Findings were compared with the U.S. Department of Labor Occupational Health and Safety Administration and Canadian Centre for Occupational Health recommendations on permissible noise levels in the workplace. RESULTS: The background sound level in the operating room prior to endourologic procedures ranged between 58 and 60 dB. In the SWL control room, 5 m from the source, the mean sound level was 68 dB (range 64-75) during treatment. The mean corresponding decibel level recorded at the patient's head during SWL was 77 dB (range 73-83). Noises produced by intracorporeal lithotripters were recorded at the surgeon's head, 2 m from the source. Measurements of the CyberWand (dual-probe) device revealed a higher mean decibel reading of 93 dB (range 85-102). Noise levels recorded for the Olympus LUS-2 (single-probe) ultrasound and the holmium laser were 65 dB (62 -68) and 60 dB (58-62), respectively. CONCLUSION: Although we noted that patients and urologists maybe exposed to significant noise levels during endourologic procedures, the duration of exposure is short. This risk appears to be minimal, based on current occupational guidelines, for most operating personnel.

Percutaneous nephrolithotomy made easier: a practical guide, tips and tricks.

Percutaneous nephrolithotomy (PCNL) plays an integral role in managing large renal stones. Establishing percutaneous renal access is the most crucial step in the procedure and requires a thorough understanding of renal, retroperitoneal and thoracic anatomy to minimize the risk of complications. Moreover, access to fluoroscopy and the proper equipment are critical to ensuring complete stone removal. In this review we describe the technique of PCNL used in a high-volume endourology centre, where the urologist is involved in all aspects of the procedure.

In vitro reconstruction of a tissue-engineered endothelialized bladder from a single porcine biopsy.

OBJECTIVE: Augmentation of the urinary bladder using a tissue-engineered approach with autologous cells is a very promising technique. To prevent risks of necrosis after transplantation, the graft vascularization process could be markedly enhanced by incorporation of autologous endothelial cells in the tissue-engineered organ. The purpose of this study was to develop a separation technique to extract four bladder cell types from the same biopsy, and to prepare an endothelialized reconstructed bladder. MATERIALS AND METHODS: Fibroblasts, smooth muscle cells (SMC), urothelial cells (UC) and endothelial cells (EC) were extracted from a small porcine bladder biopsy. The SMC, fibroblasts and EC were seeded on the top of the sponge and cultured for 10 days. Then, the UC were seeded on top of these cells for 15 additional days to produce a three-dimensional bladder wall. RESULTS: The UC and EC extracts from a single porcine biopsy were 97.2+/-0.6% keratin 8/18-positive and 97.7+/-0.3% PECAM-1-positive pure cells, respectively, as assessed by flow cytometry. The SMC could not be dissociated from fibroblasts, and were present as 37+/-0.5% desmin-positive cells. UC differentiated into a urothelium characterized by umbrella cells and a laminin-positive basal membrane. The EC reorganized in the matrix to form PECAM-1-positive capillary-like tubes. CONCLUSION: This new model of tissue-engineered bladder has the main advantages of being at least 2mm thick, autologous, and able to promote the formation of capillary-like tubes. It could be a promising alternative to the use of gastrointestinal segments to improve bladder capacity.

Efficacy of prednisone for severe refractory ulcerative interstitial cystitis.

PURPOSE: We know that bladder inflammation has been noted in some patients with interstitial cystitis (IC). Studies with corticotherapy were performed about 50 years ago. Since that time few studies have been done with corticotherapy. We evaluated the efficacy of prednisone in patients with chronic severe IC with Hunner's ulcers unresponsive to first line therapies. MATERIALS AND METHODS: A prospective study was performed on 14 patients with evidence of ulcerative IC between 1998 and 2003. The patients received 25 mg of prednisone daily for 1 to 2 months and the dose was then tapered to the minimum required for relief of symptoms. Efficacy was evaluated with the O'Leary symptom and problem index and a 6-point pain scale. RESULTS: Of the 14 patients 9 (64%) were still using prednisone at the end of the study with an average followup of 16 months. In these 9 patients a 38% reduction (p <0.005) in the total score of the O'Leary index was observed. Pain was decreased by 88% (p = 0.0001). There were 5 patients who dropped out of the study due to lack of improvement or side effects. Overall results for the whole cohort included a reduction of 22% (p <0.02) of the total score of O'Leary index and a 69% improvement in pain control (p <0.001). CONCLUSIONS: These results suggest that a trial of prednisone should be considered in patients with severe ulcerative IC otherwise unresponsive to conventional treatment. Improvement in pain control was particularly impressive in this group of patients.