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INTRODUCTION: Although there is increased public concern about low testosterone levels in aging men, the diagnosis and treatment of hypogonadism in this growing population is controversial. AIM: To document the current practices of endocrinologists and urologists in the management of older men with low testosterone in Israel. METHODS: A 20-question survey of the management of hypogonadism was sent to members of the Israel Endocrine Society and the Israeli Urology Association MAIN OUTCOME MEASURES: Participants were interviewed about their practice in diagnostic workup, prescription habits and monitoring of testosterone therapy. RESULTS: The response rate was low (range 8-12%). Significant differences were found between members of the 2 professional associations. Overall, endocrinologists take a more conservative approach to the diagnosis and initial workup, modes of treatment, and to concerns about the safety of testosterone therapy. A divergence from the published clinical guidelines was also noted in some aspects of the clinical practices in both groups. CLINICAL IMPLICATIONS: Significant variances in the diagnosis and treatment approach of hypogonadism between endocrinologists and urologists, as well as divergences from clinical guidelines, may lead to misuse of testosterone therapy. STRENGTHS & LIMITATIONS: This is the first study undertaken in Israel among urologists and endocrinologists of this increasingly recognized health issue. In our country, these 2 groups of physicians comprise nearly all of the testosterone treatment providers. The limitation of this study is linked to bias of all surveys based on subjective reporting, the fact that it was performed in only 1 country, and that we did not control for the specific assay used to measure testosterone levels. CONCLUSIONS: These findings highlight the need for the implementation of coordinated guidelines to facilitate the appropriate diagnosis and treatment of men who can benefit from testosterone therapy and to minimize the risks of this therapy. Ishay A, Tzemah S, Nitzan R, et al. Testosterone Management in Aging Males: Surveying Clinical Practices of Urologists and Endocrinologists in Israel. Sex Med 2019;7:409-417.
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OBJECTIVE: Urology practice has undergone several changes in recent years mainly related to novel technologies introduced. We aimed to get the residents' perspective on the current residency program in Israel and propose changes in it. METHODS: A web-based survey was distributed among urology residents. RESULTS: 61 residents completed the survey out of 95 to whom it was sent (64% compliance). A total of 30% replied that the 9 months of mandatory general surgery rotation contributed to their training, 48% replied it should be shortened/canceled, and 43% replied that the Step A exam (a mandatory written certifying exam) in general surgery was relevant to their training. A total of 37% thought that surgical exposure during the residency was adequate, and 28% considered their training "hands-on." Most non-junior residents (post-graduate year 3 and beyond) reported being able to perform simple procedures such as circumcision and transurethral resections but not complex procedures such as radical and laparoscopic procedures. A total of 41% of non-junior residents practice at a urology clinic. A total of 62% of residents from centers with no robotics replied its absence harmed their training, and 85% replied they would benefit from a robotics rotation. A total of 61% of residents from centers with robotics replied its presence harmed their training, and 72% replied they would benefit from an open surgery rotation. A total of 82% of the residents participated in post-graduate courses, and 81% replied they would engage in a clinical fellowship. CONCLUSION: Given the survey results we propose some changes to be considered in the residency program. These include changes in the general surgery rotation and exam, better surgical training, possible exchange rotations to expose residents to robotic and open surgery (depending on the availability of robotics in their center), greater out-patient urology clinic exposure, and possible changes in the basic science period.
ABSTRACT
PURPOSE: Ultrasound is commonly used in urology. Technical advances with reduced size and cost led to diffusion of small ultrasound devices to many clinical settings. Even so, most ultrasound studies are performed by non-urologists. We aimed to evaluate the utility of a pocket-size ultrasound device (Vscan™ GE Healthcare) and the quality of urologist performed study. METHODS: Three consecutive studies were performed: (1) a urologist using the pocket ultrasound, (2) a sonographist using the pocket ultrasound, and (3) a sonographist using a standard ultrasound device. Thirty-six patients were evaluated with a basic urologic ultrasound study. An excepted deviation between studies was preset for numeric parameters and t test performed. Ordinal parameters were analyzed using Cohen's kappa coefficient. RESULTS: Kidney length, renal pelvis length, renal cyst diameter, post-void residual and prostate volume (transabdominal) differences were found to be insignificant when comparing a urologist pocket ultrasound study to a sonographist standard ultrasound study (P = 0.15; P = 0.21; P = 0.81; P = 0.32; P = 0.07, respectively). Hydronpehrosis evaluation (none, mild, moderate and severe) and the presence of ureteral jet signs conferred a high inter-observer agreement when comparing the above studies using the Cohen's kappa coefficient (K = 0.63; K = 0.62, respectively). CONCLUSIONS: Urologist performed pocket ultrasound study is valid in evaluating the upper and lower urinary tract and is practical in many clinical scenarios. The urologic stethoscope is now becoming a reality within reach.
