Assessing the Impact of Urology Resident Involvement on Overall Patient Satisfaction.

INTRODUCTION: To assess the impact of resident participation on patient satisfaction by comparing post-discharge satisfaction scores between academic faculty, private urologists who work with residents, and private urologists with no involvement in resident education. METHODS: Post-discharge Hospital Consumer Assessment of Healthcare Providers and Systems surveys from academic and private urologists at a single institution with an accredited Urology residency program from January 1, 2014 to December 31, 2016 (n = 530) were reviewed. The surveys were de-identified and categorized based on 3 subgroups of providers: academic faculty, private with residents, and private without residents. Overall rating, physician (MD) communication, nursing (RN) communication, discharge information, and overall management during their hospitalization were assessed. RESULTS: The faculty group received an overall patient satisfaction score of 88.3% (percentage of 9 or 10). The private with resident group had an overall satisfaction score of 92.0% and the private without resident group had an overall satisfaction score of 96.7%. There was no statistical difference in patient satisfaction scores between groups across all categories with the exception of MD and RN communication. Private urologists with residents had better MD and RN communication scores than the 2 other groups (p < 0.001, p = 0.013, respectively). CONCLUSIONS: Resident involvement in patient care with faculty or private attendings did not have a negative effect on patient satisfaction scores of any factor measured. Patients were more satisfied with MD and RN communication when residents worked with private attendings.

The Impact of Comorbidity and Age on Timing of Androgen Deprivation Therapy in Men with Biochemical Recurrence after Radical Prostatectomy.

INTRODUCTION: Older men with major comorbidities have higher risks of morbidity and mortality from androgen deprivation therapy, and the benefits of immediate androgen deprivation therapy after biochemical recurrence in these men are unclear. We assessed variation in timing of androgen deprivation therapy by age and comorbidity in a cohort of men with biochemical recurrence after radical prostatectomy. METHODS: We analyzed 2,097 men with biochemical recurrence after radical prostatectomy from 2000 to 2017 in the VA SEARCH database. We ascertained age and Deyo-Charlson comorbidity index scores at biochemical recurrence. Kaplan-Meier analysis and multivariable logistic regression were used to determine association of age and Deyo-Charlson comorbidity index with prostate specific antigen at the initiation of androgen deprivation therapy. RESULTS: In Kaplan-Meier analysis with prostate specific antigen at androgen deprivation therapy as the outcome, median prostate specific antigen at androgen deprivation therapy initiation was 6.2 ng/ml (95% CI 5.1-7.1) across all patients but differed among those who received adjuvant/salvage radiation (3.6 ng/ml, 95% CI 2.8-4.3) and those who did not (12.1 ng/ml, 95% CI 9.6-15.2, p <0.001). In multivariable Cox regression, advanced age (p=0.03) but not worse comorbidity (p=0.25) was associated higher prostate specific antigen at initiation of androgen deprivation therapy. Across all patients, prostate specific antigen at androgen deprivation therapy was lower among those <60 years old (3.7 ng/ml, 95% CI 2.6-5.8) compared to those 60-64 (5.0 ng/ml, 95% CI 3.9-6.6), 65-69 (6.6 ng/ml, 95% CI 4.9-8.8), 70-74 (8.8 ng/ml, 95% CI 6.1-12.3) and ≥75 years old (14.1 ng/ml, 95% CI 5.5-37.8). In contrast, prostate specific antigen at androgen deprivation therapy was similar among comorbidity subgroups (Deyo-Charlson comorbidity index 0: 6.3 ng/ml, 95% CI 5.0-7.9 vs Deyo-Charlson comorbidity index 3 or higher: 5.6 ng/ml, 95% CI 4.1-7.4). In general, these relationships were consistent among subgroups receiving adjuvant/salvage radiation. CONCLUSIONS: Men with comorbid disease at increased risk of morbidity and mortality with androgen deprivation therapy often receive androgen deprivation therapy at low prostate specific antigen values.

Priapism from Recreational Intracavernosal Injections in a High-Risk Metropolitan Community.

INTRODUCTION: Recreational use of intracavernosal injections (ICIs) is a high-risk behavior that involves sharing of these agents by men without physician regulation. AIM: To characterize the etiologies and outcomes of priapism at a Los Angeles metropolitan medical center to better understand patterns of usage of recreational ICIs and the public health implications of such practices. METHODS: With institutional review board approval, we retrospectively reviewed all cases of priapism presenting to the emergency room of a Los Angeles tertiary medical center from 2010 to 2018. We compared outcomes between patients who presented with priapism after recreational ICI and patients who presented with other etiologies. MAIN OUTCOME MEASURE: We describe patient characteristics, etiologies, and treatments of priapism at our institution. RESULTS: We identified 169 priapism encounters by 143 unique patients. Recreational ICIs accounted for 82 of the 169 priapism encounters (49%). Patients who used recreational injections were younger than those who presented with other etiologies (43.5 years vs 47.5 years; P = .048) and had delayed presentations (median, 12 hours vs 8 hours; P < .0001). There was no statistical difference across groups in the proportion of patients requiring operative intervention (14.6% of recreational ICI users vs 16.1% of all other patients; P = .23). A total of 36 out of 72 patients who used recreational ICIs (50%) were HIV+. CLINICAL IMPLICATIONS: Our study adds to the relatively sparse literature on priapism outcomes. We identify and describe a high-risk population that uses recreational intracavernosal injections. STRENGTHS & LIMITATIONS: To our knowledge, this is the largest series of priapism encounters. However, the data are retrospective from a single institution, and there is a lack of long-term follow up. CONCLUSION: A large proportion of priapism visits at our institution were attributed to recreational use of ICIs. This is a high-risk patient population that may not be aware of the risks of recreational ICIs and the consequences of priapism. Further effort should be made to increase public and physician awareness of this harmful practice. Zhao H, Berdahl C, Bresee C, et al. Priapism from Recreational Intracavernosal Injections in a High-Risk Metropolitan Community. J Sex Med 2019;16:1650-1654.

Association of Social Media Presence with Online Physician Ratings and Surgical Volume Among California Urologists: Observational Study.

BACKGROUND: Urologists are increasingly using various forms of social media to promote their professional practice and attract patients. Currently, the association of social media on a urologists' practice is unknown. OBJECTIVES: We aimed to determine whether social media presence is associated with higher online physician ratings and surgical volume among California urologists. METHODS: We sampled 195 California urologists who were rated on the ProPublica Surgeon Scorecard website. We obtained information on professional use of online social media (Facebook, Instagram, Twitter, blog, and YouTube) in 2014 and defined social media presence as a binary variable (yes/no) for use of an individual platform or any platform. We collected data on online physician ratings across websites (Yelp, Healthgrades, Vitals, RateMD, and UCompareHealthcare) and calculated the mean physician ratings across all websites as an average weighted by the number of reviews. We then collected data on surgical volume for radical prostatectomy from the ProPublica Surgeon Scorecard website. We used multivariable linear regression to determine the association of social media presence with physician ratings and surgical volume. RESULTS: Among our sample of 195 urologists, 62 (32%) were active on some form of social media. Social media presence on any platform was associated with a slightly higher mean physician rating (ß coefficient: .3; 95% CI 0.03-0.5; P=.05). However, only YouTube was associated with higher physician ratings (ß coefficient: .3; 95% CI 0.2-0.5; P=.04). Social media presence on YouTube was strongly associated with increased radical prostatectomy volume (ß coefficient: 7.4; 95% CI 0.3-14.5; P=.04). Social media presence on any platform was associated with increased radical prostatectomy volume (ß coefficient: 7.1; 95% CI -0.7 to 14.2; P=.05). CONCLUSIONS: Urologists' use of social media, especially YouTube, is associated with a modest increase in physician ratings and prostatectomy volume. Although a majority of urologists are not currently active on social media, patients may be more inclined to endorse and choose subspecialist urologists who post videos of their surgical technique.

High Catastrophizing in Subjects With Painful Mesh Complications Leads to Worse Outcomes.

OBJECTIVE: To identify the rate of catastrophizing in a cohort of subjects with chronic pain after self-reported mesh complications and identify interactions of catastrophization with other patient factors, such as age, number of pelvic surgeries, and intent to sue. Catastrophizing has been shown to be a risk factor for chronicity of pain, disability, and depression. METHODS: The pain catastrophization scale (PCS) identifies patients likely to have an exaggerated, negative thought process in response to pain. Subjects throughout the United States with self-described complications of vaginal mesh completed an internet-based, anonymous survey, featuring multiple standardized questionnaires including the PCS and female Genitourinary Pain Index (GUPI). A previously defined threshold score of >30 on the PCS defined high-pain catastrophizing. Statistical analysis was performed using χ² test and t test for categorical and continuous variables, respectively. RESULTS: Ninety of 167 participants (54%) were found to have high-pain catastrophizing. Age, intent to sue, or number of previous pelvic surgeries did not correlate with high catastrophization. Subjects who catastrophized were significantly more likely to have a higher overall GUPI score (35.0 vs 30.5, P < .001), which came from increases in the pain (18.0 vs 14.2, P < .001) and quality of life (11.0 vs 9.5, P < .001) GUPI subdomains. CONCLUSION: Subjects with self-described mesh complications have a high rate of pain catastrophizing associated with significantly worse quality of life and higher pain. Identifying high catastrophizing patients in the setting of chronic pelvic pain from mesh complications may help guide treatment and be an indicator for early or adjunctive psychosocial intervention.

What is the ideal antibiotic prophylaxis for intravesically administered Botox injection? A comparison of two different regimens.

INTRODUCTION: Onabotulinum toxin A (Botox®) administered intravescially is an effective treatment for idiopathic detrusor overactivity, of which urinary tract infections (UTIs) are a common complication. The purpose of this study was to compare two prophylactic antibiotic regimens with the goal of decreasing UTI rates following intravesically administered Botox® injection. MATERIALS AND METHODS: A retrospective review of two groups of patients undergoing intravesically administered Botox® injections was performed-one with idiopathic and one with neurogenic detrusor overactivity. One group received a dose of ceftriaxone intramuscularly (IM) at the time of Botox® injection, and a second group received a 3-day course of a fluoroquinolone orally starting the day before the procedure. The rate of postprocedure UTI was examined using a χ2 test. A secondary analysis was performed using logistic regression modeling to test the association between clinical characteristics and antibiotic regimen and risk of postprocedure UTIs. RESULTS: Botox® injections were performed on 284 patients: 236 received a single dose of ceftriaxone IM and 48 received 3 days of a fluoroquinolone orally. The UTI rate was significantly lower in the fluoroquinolone group (20.8%) vs. the cephalosporin group (36%), p = 0.04. Predictors of postprocedure UTIs included single dose of antibiotics IM [odds ratio (OR 2.80, p = 0.02] and a positive preprocedure urine culture (OR 1.31, p = 0.03). CONCLUSIONS: We found a significantly lower rate of UTIs when patients received a 3-day course of a fluoroquinolone orally as opposed to a single dose of a third-generation cephalosporin IM. Patients with a positive preprocedure culture might benefit from an even longer duration of antibiotics at the time of Botox® injection.