Narrative Comments about Urologists on Physician Rating Websites Provide Insight into What Drives Patient Satisfaction Surveys.

INTRODUCTION: We examined publicly available narrative comments on physician rating websites and how they may provide valuable insight on what motivates patients to provide positive or negative feedback. METHODS: Searches of all American urologists who are members of the Northeastern Section of the American Urological Association were performed across 5 major physician rating websites. Narrative comments were classified by reviewers as positive or negative, and assessed for mention of 7 factors including punctuality/ease of appointment, bedside manner, time spent with the patient, communication/education skills, quality of staff, technical aspects of care and followup care. Providers without narrative comments were excluded from analysis, as were neutral comments. RESULTS: Bedside manner, technical aspects of care and communication/education skills were the more frequently citied aspects of care throughout all narrative comments. However, negative comments were more likely to mention staff quality than communication/education skills. In addition, female urologists received more comments and higher ratings than male urologists, and urban urologists received more comments and higher ratings than rural urologists. CONCLUSIONS: Bedside manner, technical aspects of care and communication/education skills are key elements that influence the satisfaction of urological patients. Furthermore, staff quality and punctuality are patient care areas in which urologists may benefit from improving. Further research is warranted to better understand the effects of practitioner gender and geography on patient reported satisfaction with care.

Comparative Genomic Profiling of Refractory and Metastatic Penile and Nonpenile Cutaneous Squamous Cell Carcinoma: Implications for Selection of Systemic Therapy.

PURPOSE: Metastatic penile squamous cell carcinoma is an aggressive malignancy with limited treatment options. We compared the potential therapy impacting genomic alterations between metastatic penile squamous cell carcinoma and nonpenile metastatic cutaneous squamous cell carcinoma. MATERIALS AND METHODS: DNA was extracted from 40 µ of formalin fixed, paraffin embedded samples from 78 cases of metastatic penile squamous cell carcinoma and 338 of metastatic cutaneous squamous cell carcinoma. Comprehensive genomic profiling was performed using a hybrid capture, adaptor ligation based, next generation sequencing assay to a mean coverage depth of greater than 500×. The tumor mutational burden was determined on 1.1 Mbp of sequenced DNA and microsatellite instability was determined on 114 loci. RESULTS: Potential targeted therapy opportunities in metastatic penile squamous cell carcinoma cases included alterations in the MTOR pathway ( NF1 genomic alterations in 7% and PTEN genomic alterations in 4%) and in the DNA repair pathway ( BRCA2 and ATM genomic alterations in 7% each) and tyrosine kinase ( EGFR genomic alterations in 6%, and FGFR3 and ERBB2 genomic alterations in 4% each). The tumor mutational burden was significantly higher in predominantly ultraviolet light exposed metastatic squamous cell carcinoma than in metastatic penile squamous cell carcinoma, making metastatic squamous cell carcinoma potentially more responsive to immunotherapies than metastatic penile squamous cell carcinoma. Microsatellite high status was extremely rare for metastatic penile and metastatic cutaneous squamous cell carcinoma. CD274 ( PD-L1) amplification was also rare in both tumor types. CONCLUSIONS: Metastatic penile squamous cell carcinoma is a unique subtype of squamous cell carcinoma with distinctive genomic features which contrast with those identified in metastatic cutaneous squamous cell carcinoma of nonpenile ultraviolet light exposed skin. Although not rich in predictors of the response to immunotherapy (the tumor mutational burden and microsatellite instability are low), more than a quarter of metastatic penile squamous cell carcinoma cases may potentially benefit from existing and available therapies targeting MTOR, DNA repair and tyrosine kinase pathways.

Disparity between pre-existing management of penile cancer and NCCN guidelines.

OBJECTIVE: To determine the locoregional management of penile cancer before the introduction of NCCN guidelines and how much shift in practice patterns is required to meet the guidelines. METHODS: The National Cancer Data Base was queried to identify 6,396 patients with squamous cell carcinoma of the penis diagnosed between 2004 and 2013. The cohort was divided into management groups based on the NCCN guidelines: cTa and cTis (cTa/is), pT1 low grade (T1LG), pT1 high grade (T1HG), and pT2 or greater (T234). These groups were analyzed to determine if management of locoregional disease complies with the 2016 NCCN guidelines and logistic regression analyses were performed to determine factors associated with adherence. RESULTS: Nationwide management of the primary tumor closely follows the NCCN guidelines, with 96.9% adherence for cTa/is, 91.4% for T1LG, and 94.2% for T234. Management of regional lymph nodes (LNs) was inadequate with only 62.9% of patients with clinical N1 or N2 disease undergoing regional LN dissection (LND). The percentage of patients with known LN metastases who received regional LND increased over time (46.2% in 2004 to 69.4% in 2013, P = 0.034). Patients treated at community cancer programs (odds ratio [OR] = 0.26, 95% CI: 0.19-0.35), comprehensive community cancer programs (OR = 0.34, 95% CI: 0.29-0.41), and integrated network cancer programs (OR = 0.36, 95% CI: 0.25-0.52) were significantly less likely to receive LND compared with patients treated at academic comprehensive cancer programs. CONCLUSIONS: Before the introduction of NCCN guidelines, national practice patterns for the management of the primary tumor were consistent with the recommendations. However, the management of regional LNs deviated from the guidelines, reflecting an area for improvement.

Suburothelial Bladder Contraction Detection with Implanted Pressure Sensor.

AIMS: Managing bladder pressure in patients with neurogenic bladders is needed to improve rehabilitation options, avoid upper tract damage, incontinence, and their associated co-morbidities and mortality. Current methods of determining bladder contractions are not amenable to chronic or ambulatory settings. In this study we evaluated detection of bladder contractions using a novel piezoelectric catheter-free pressure sensor placed in a suburothelial bladder location in animals. METHODS: Wired prototypes of the pressure monitor were implanted into 2 nonsurvival (feline and canine) and one 13-day survival (canine) animal. Vesical pressures were obtained from the device in both suburothelial and intraluminal locations and simultaneously from a pressure sensing catheter in the bladder. Intravesical pressure was monitored in the survival animal over 10 days from the suburothelial location and necropsy was performed to assess migration and erosion. RESULTS: In the nonsurvival animals, the average correlation between device and reference catheter data was high during both electrically stimulated bladder contractions and manual compressions (r = 0.93±0.03, r = 0.89±0.03). Measured pressures correlated strongly (r = 0.98±0.02) when the device was placed in the bladder lumen. The survival animal initially recorded physiologic data, but later this deteriorated. However, endstage intraluminal device recordings correlated (r = 0.85±0.13) with the pressure catheter. Significant erosion of the implant through the detrusor was found. CONCLUSIONS: This study confirms correlation between suburothelial pressure readings and intravesical bladder pressures. Due to device erosion during ambulatory studies, a wireless implant is recommended for clinical rehabilitation applications.

Trends of Systemic Therapy Use for Renal Cell Carcinoma in the United States.

OBJECTIVE: To assess the utilization of immunotherapy after the advent of tyrosine-kinase inhibitors and mammalian target of rapamycin inhibitors for metastatic renal cell carcinoma (RCC) in the United States, as well as to better understand the variables associated with the implementation of these systemic therapies. METHODS: The National Cancer Data Base Participant User File for Renal Cancer was queried. Patients diagnosed with metastatic RCC were identified. From that group, patients who received either immunotherapy or chemotherapy (single or multiagent), given as a first-course therapy from 1998 to 2011 were selected. Multivariate analysis was used to assess patient, disease, and provider factors associated with immunotherapy or chemotherapy overall usage between 2003 and 2011. RESULTS: A total of 25,186 patients diagnosed with metastatic RCC were identified; 3107 received immunotherapy and 8640 received chemotherapy. The use of immunotherapy decreased from 30.3% in 1998 to 3.8% in 2011. The use of chemotherapy increased from 16.2% in 1998 to 54.0% in 2011. The most dramatic period of change was from 2004 to 2006. Independent negative predictors of receiving immunotherapy included progressive years of diagnosis (P <.0001), increasing age (P <.0001), female gender (P = .001), and African American race (P = .04). CONCLUSION: There has been a significant decrease in the use of immunotherapy for metastatic RCC in the United States since the introduction of targeted chemotherapeutic agents in the past decade.