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Naik N, Talyshinskii A, Rassweiler J, Hameed BMZ, Somani BK. Digital health innovations in urology: telemedicine, wearables, and mobile applications - a systematic review of literature. Curr Opin Urol 2024; 34:116-127. [PMID: 38038411 DOI: 10.1097/mou.0000000000001153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2023]
Abstract
PURPOSE OF REVIEW There are enough publications on the use of telemedicine, wearable devices, and mobile applications in urology; however, their collective impact on urological care has not been adequately studied. This review seeks to address this deficiency by providing a descriptive analysis of the recent use of telemedicine, wearable technology, and mobile applications in urology as well as elucidating their associated challenges. RECENT FINDINGS There are studies that were dedicated to the use of telemedicine, wearables, and mobile apps in urology according to inclusion criteria, respectively. They were successfully implemented in different urological subfields, such as urogynecology, endourology, pediatric urology, and uro-oncology, and led to time safety, remote monitoring, and better patient awareness. However, several concerns also exist, such as issues with data safety, measurement deviations, technical limitations, and lack ofquality. SUMMARY Telemedicine, wearables, and mobile apps have already shown their potential in urological practice. However, further studies are needed to expand both our understanding of their current state and their potential for further development and clinical use.
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Affiliation(s)
- Nithesh Naik
- Department of Mechanical and Industrial Engineering, Manipal Institute of Technology, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Ali Talyshinskii
- Department of Urology, Astana Medical University, Astana, Kazakhstan
| | - Jens Rassweiler
- Department of Urology and Pediatric Urology, SLK Kliniken Heilbronn, University of Heidelberg, Heidelberg, Germany
| | - B M Zeeshan Hameed
- Department of Urology, Father Muller Medical College, Mangalore, Karnataka, India
| | - Bhaskar K Somani
- Department of Urology, University Hospital Southampton NHS Trust, Southampton, UK
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Hamouche F, Hakam N, Unno R, Ahn J, Yang H, Bayne D, Stoller ML, Smith S, Finlayson E, Smith J, Chi T. Reimagining Ambulatory Care in Urology: Conversion of the Urology Clinic into a Procedure Center Improves Patient's Experience. Telemed J E Health 2024; 30:748-753. [PMID: 37862049 PMCID: PMC11265608 DOI: 10.1089/tmj.2023.0272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Accepted: 05/25/2023] [Indexed: 10/21/2023] Open
Abstract
Introduction: The coronavirus disease 2019 (COVID-19) pandemic made it necessary to practice social distancing and limited in-person encounters in health care. These restrictions created alternative opportunities to enhance patient access to care in the ambulatory setting. We hypothesized that by transforming clinics into centers that prioritize procedures and transitioning ambulatory appointments to telehealth, we could establish a secure, streamlined, and productive method for providing patient care. Methods: Clinic templates were restructured to allow the use of the physical space to perform procedure-based clinics exclusively, while switching to virtual telemedicine for all nonprocedural encounters. Staff members were given specific roles to support one of the patient care modalities for a given day (Procedures vs. Telehealth). Performance and patient satisfaction metrics were collected between two periods of time defined as P1 (February-June 2019) and P2 Post-COVID (February-June 2020) and compared. These served as proxies of periods when the clinic workflow and templates were structured in the traditional versus the emerging way. Statistical analysis was performed using bivariate analyses. Results: The percentage of procedures performed among all in-person visits were higher in P2 compared to P1 (45% vs. 29%, p < 0.001). Although total charges and relative value units were lower in P2, the overall revenue generated was higher compared to P1 ($4,597,846 vs. $4,517,427$, respectively). This increase in revenue was mainly driven by the higher relative income generated by procedures. Patient experience, reflected through patient-reported outcomes, was more favorable in P2 where patients seemed more likely to "Recommend this provider office" (90% vs. 85.7%, p = 0.01), report improved "Access overall" (56% vs. 49%, p = 0.02), and felt they were "Moving through your visit overall" (59% vs. 51%, p = 0.007). Conclusions: Our data suggest that reorganizing urology clinics into a space that is centered around outpatient procedures can represent a model that improves the patient's access to care and clinical experience, while simultaneously improving operational financial strength. This efficient care model could be considered for many practice settings and drive high-value outpatient care.
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Affiliation(s)
- Fadl Hamouche
- Department of Urology, University of California, San Francisco, San Francisco, California, USA
| | - Nizar Hakam
- Department of Urology, University of California, San Francisco, San Francisco, California, USA
| | - Rei Unno
- Department of Urology, University of California, San Francisco, San Francisco, California, USA
| | - Justin Ahn
- Department of Urology, University of California, San Francisco, San Francisco, California, USA
| | - Heiko Yang
- Department of Urology, University of California, San Francisco, San Francisco, California, USA
| | - David Bayne
- Department of Urology, University of California, San Francisco, San Francisco, California, USA
| | - Marshall L. Stoller
- Department of Urology, University of California, San Francisco, San Francisco, California, USA
| | - Susan Smith
- Department of Urology, University of California, San Francisco, San Francisco, California, USA
| | - Emily Finlayson
- Department of Urology, University of California, San Francisco, San Francisco, California, USA
| | - James Smith
- Department of Urology, University of California, San Francisco, San Francisco, California, USA
| | - Thomas Chi
- Department of Urology, University of California, San Francisco, San Francisco, California, USA
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Dufour S, Clancy A, Wu M. Technical Update No. 433: eHealth Solutions for Urinary Incontinence Among Women. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2023; 45:150-159.e1. [PMID: 36273716 DOI: 10.1016/j.jogc.2022.10.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The purpose of this technical update is to establish the state of the science regarding emerging and novel electronic health (eHealth) and mobile health (mHealth) solutions for urinary incontinence among women. TARGET POPULATION Women over 18 years with urinary incontinence. OPTIONS Websites and mobile health applications are useful in the conservative care of urinary incontinence. Relevant care providers should be familiar with such tools, particularly those that use motivational principles for behaviour change, which can be used as adjunct tools for urinary incontinence care. Telemedicine is an effect mode to provide services for the conservative care of urinary incontinence. OUTCOMES Use of eHealth and mHealth solutions has potentially significant health outcomes for patients, providers, and global health systems. Broader use of telemedicine, in and of itself, could improve care access and reduce costs incurred by patients and the health care system. BENEFITS, HARMS, AND COSTS Evidence for the efficacy of eHealth and mHealth technologies and applications for urinary incontinence ranges from weak to strong. However, the research landscape for many of these novel solutions is developing rapidly. Furthermore, these options have minimal or no harm and confer an established cost benefit and care access benefit. EVIDENCE The Cochrane Library, Medline, EMBASE, CENTRAL databases (from January 2014 to April 2019) were searched to find articles related to conservative care of urinary incontinence in women (over 18 years) and studies on eHealth and mHealth interventions for urinary incontinence. Articles were appraised, and the collective evidence was graded. VALIDATION METHODS The authors rated the quality of evidence and strength of recommendations using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. See online Appendix A (Tables A1 for definitions and A2 for interpretations of strong and conditional [weak] recommendations). INTENDED AUDIENCE Relevant primary care providers and medical specialists, including physicians, nurses, midwives, and pelvic health physiotherapists. SUMMARY STATEMENTS RECOMMENDATIONS.
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Dufour S, Clancy A, Wu M. Mise à jour technique N o433 : Cybersanté et incontinence urinaire chez la femme. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2023; 45:160-171.e1. [PMID: 36925223 DOI: 10.1016/j.jogc.2022.10.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/16/2023]
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D’Almeida Lucas Macharet DV, Mendes LN, Pereira GMV, de Castro Monteiro MV. Implementing telemedicine in urogynecology: A feasibility study. Int Urogynecol J 2022:10.1007/s00192-022-05392-2. [PMID: 36331581 PMCID: PMC9638453 DOI: 10.1007/s00192-022-05392-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Accepted: 09/29/2022] [Indexed: 11/06/2022]
Abstract
INTRODUCTION AND HYPOTHESIS Telemedicine has been recommended for the management of urogynecological conditions during the coronavirus (COVID 19) pandemic. This study aimed to evaluate the feasibility of telemedicine for urogynecology at a Brazilian public hospital. METHODS A descriptive observational study was performed at a urogynecology outpatient clinic. The primary outcome was the desire to continue with telemedicine. Secondary outcomes were appointment resolvability, technical aspects of the appointment, and patient satisfaction. The participants had in-person appointments that were canceled because of the COVID-19 pandemic. We collected data on sociodemographic characteristics and clinical and technical aspects of the appointments. The participants responded to satisfaction questionnaires 7-15 days post-procedure. The categorical variables were evaluated based on absolute and relative frequency. The continuous variables were described as the mean and standard deviation. A chi-square test was performed to determine the association between variables. RESULTS In total, 225 patients had appointments canceled due to the COVID-19 pandemic, of which 171 were eligible for the study. Telemedicine appointments were agreed upon by 48% of the participants and 85.5% responded to the satisfaction survey. We found that 57.7% of the participants desired to continue with telemedicine. The appointment resolvability rate was 76.1%, 63.4% of the appointments met the technical criteria, and the satisfaction rate was 93%. The only variable associated with the desire to continue telemedicine was overall patient satisfaction (p=0.02). CONCLUSIONS Telemedicine in urogynecology is feasible and can be implemented in the studied population. However, actions are essential to adequately support patient preference and improve the acceptance of telemedicine.
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Terziotti F, Gregório EP, Averbeck MA, Almeida SHM. Incontinence outcomes in women undergoing retropubic mid-urethral sling: a retrospective cohort study comparing Safyre™ and handmade sling. Int Braz J Urol 2022; 48:649-659. [PMID: 35503703 PMCID: PMC9306358 DOI: 10.1590/s1677-5538.ibju.2021.0646] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Accepted: 02/26/2022] [Indexed: 11/22/2022] Open
Abstract
Purpose This study examined and compared efficacy, safety, satisfaction, and complications of the retropubic Safyre™ sling and a retropubic hand-made synthetic sling (HMS) in a short-, mid- and long-term follow-up. Methods We retrospectively reviewed a prospectively maintained database of women who underwent Safyre™ or HMS between March 7ths 2005 and December 27ths, 2017. Patients had first assessment (7-10 days), second (40-45 days), and third (sixth month) postoperatively. Between September and December 2018, patients who completed at least one year of surgery, received a telephone call. Follow-up compared quartiles of follow-up time to determine complications (Clavien-Dindo), success rates (International Consultation on Incontinence Modular Questionnaire for Urinary Incontinence Short Form – ICIQ-UI SF), and patient satisfaction. Results Three hundred fifty-one patients underwent surgery and 221 (63%) were evaluated after a median of 78.47 (± 38.69) months, 125 (55%) in the HMS, and 96 (45%) in the Safyre™ group. Higher intraoperative bladder injury was observed with Safyre™ (0% vs. 4.2%, p=0.034), and a tendency for urinary retention, requiring indwelling urinary catheter over 24 hours (2.4% vs. 8.3%, p=0.061). Both HMS (p<0.001) and Safyre™ (p<0.001) presented improvements on ICIQ-UI SF. There were no differences in satisfaction, subjective cure rates, ICIQ-UI SF, or complications between groups. Conclusions Both HMS and Safyre™ have similar satisfaction and subjective cure rates, with marked ICIQ-UI SF score improvement. Higher rates of intraoperative bladder injury were seen in patients who received Safyre™ retropubic sling.
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Affiliation(s)
- Fernando Terziotti
- Programa de Pós-Graduação em ciências da saúde da Universidade Estadual de Londrina - UEL, Londrina, PR, Brasil
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Uppal A, Kothari AN, Scally CP, Roland CL, Bednarski BK, Katz MHG, Vauthey JN, Chang GJ. Adoption of Telemedicine for Postoperative Follow-Up After Inpatient Cancer-Related Surgery. JCO Oncol Pract 2022; 18:e1091-e1099. [PMID: 35263166 DOI: 10.1200/op.21.00819] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
PURPOSE The COVID-19 pandemic has resulted in significant changes in health care delivery, including the rapid adoption of telemedicine across multiple specialties and practice environments. This includes postoperative visits (POV), despite limited data on outcomes following these telemedicine POV. We sought to determine whether these types of visits successfully identify and address postoperative complications when compared with in-person POV. METHODS This was a retrospective cohort study of patients undergoing elective inpatient cancer-related surgery from March 2020 through December 2020. The exposure variable was type of POV (telemedicine v in-person). The primary outcome was unplanned hospital readmission within 90 days, and secondary outcomes included 30-day readmission, length of stay of first readmission, and mortality. RESULTS Five-hundred thirty-five patients underwent elective inpatient operations and met our inclusion criteria. Of these, 98 (18.5%) had an initial telemedicine POV. There was no difference in 90-day readmission on the basis of POV type (16.3% telemedicine v 16.5% in-person, P = .99). Reasons for readmission did not differ between patients who underwent a telemedicine POV compared with in-person POV (all P > .05). After adjustment for patients' demographic and clinical factors, telemedicine POV was not associated with 90-day readmission (odds ratio, 0.89; 95% CI, 0.43 to 1.70; P = .77). CONCLUSION Telemedicine POV use adopted during the COVID-19 pandemic did not increase risk of readmission when compared with in-person visits following inpatient oncologic surgery. These data can help inform policy on the continued use and application of telemedicine after the pandemic.
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Affiliation(s)
- Abhineet Uppal
- University of Texas MD Anderson Cancer Center, Department of Colon and Rectal Surgery, Division of Surgery, Houston, TX
| | - Anai N Kothari
- University of Texas MD Anderson Cancer Center, Department of Surgical Oncology, Division of Surgery, Houston, TX.,Medical College of Wisconsin, Department of Surgery, Division of Surgical Oncology, Madison, WI
| | - Christopher P Scally
- University of Texas MD Anderson Cancer Center, Department of Surgical Oncology, Division of Surgery, Houston, TX
| | - Christina L Roland
- University of Texas MD Anderson Cancer Center, Department of Surgical Oncology, Division of Surgery, Houston, TX
| | - Brian K Bednarski
- University of Texas MD Anderson Cancer Center, Department of Colon and Rectal Surgery, Division of Surgery, Houston, TX
| | - Matthew H G Katz
- University of Texas MD Anderson Cancer Center, Department of Surgical Oncology, Division of Surgery, Houston, TX
| | - Jean-Nicholas Vauthey
- University of Texas MD Anderson Cancer Center, Department of Surgical Oncology, Division of Surgery, Houston, TX
| | - George J Chang
- University of Texas MD Anderson Cancer Center, Department of Colon and Rectal Surgery, Division of Surgery, Houston, TX
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- Data-Driven Determinants for COVID-19 Oncology Discovery Effort (D3CODE) Team, University of Texas, MD Anderson Cancer Center, Houston, TX
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Bhanvadia RR, Carpinito G, Kavoussi M, Lotan Y, Margulis V, Bagrodia A, Roehrborn C, Gahan JC, Cadeddu JA, Woldu S. Safety and Feasibility of Telehealth Only Preoperative Evaluation Prior to Minimally Invasive Robotic Urologic Surgery. J Endourol 2022; 36:1070-1076. [PMID: 35596562 DOI: 10.1089/end.2021.0819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
PURPOSE Telehealth utilization has increased dramatically over the past few years due to improvement in technology and the COVID-19 pandemic. To date, no study has examined whether a telehealth visit alone for preoperative evaluation is safe and sufficient prior to surgery. We examined the safety and feasibility of preoperative telehealth visits alone prior to minimally invasive urologic surgery Materials & Methods Single institution retrospective review of robotic prostate, kidney, and cystectomy procedures between April - Dec 2020. Cases were dichotomized into those who underwent preoperative evaluation by telehealth-only versus traditional in-person visits. Outcomes included complications, blood loss, conversion to open surgery rates, and operative times. We assessed efficiency of care by measuring time from preoperative visit to surgery. Results 314 patients were included in the study, with 14% of cases (n = 45) being performed after a preoperative telehealth visit. The majority of cases included in analysis were robotic surgeries of the prostate (56.1% of all cases, n = 176) and the kidney (35.0% of all cases, n = 110). Patients seen via telehealth alone preoperatively had no significant differences in any grade of complications, perioperative outcomes, blood loss, operative time, and length of stay. There was no difference in change in anticipated procedure between groups, and there was no cases of conversion to open surgery in the telehealth only group. Time from preoperative visit to surgery was significantly shorter for the telehealth group by 13 days. Conclusion Our study is the first to analyze the safety of telehealth-only preoperative visits prior to minimally invasive urologic surgery. We found no difference in perioperative outcomes including conversion to open surgery or change in planned procedure. Further, telehealth preoperative visits appeared to facilitate shorter time to surgery. This study has important implications for expediting patient care and medico-legal considerations.
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Affiliation(s)
- Raj Ramnik Bhanvadia
- University of Texas Southwestern Medical Center at Dallas, 12334, 2001 Inwood Road, 4th Floor, WBCE3, Dallas, Texas, United States, 75390;
| | | | | | - Yair Lotan
- University of Texas Southwestern Medical Center, Department of Urology, 5323 Harry Hines Blvd. J8.112, Dallas, Texas, United States, 75390;
| | - Vitaly Margulis
- UT Southwestern Medical, Urology, 5339 harry hines blvd, Dallas, Texas, United States, 75390;
| | - Aditya Bagrodia
- UT Southwestern, 12334, Urology, Dallas, Texas, United States;
| | - Claus Roehrborn
- UT Southwestern Medical Center, Urology, 5323 Harry Hines Blvd, J8 142, Dallas, Texas, United States, 75390-9110;
| | - Jeffrey C Gahan
- UT Southwestern medical center, Urology, 5323 Harry Hines Blvd., J8.106, Dallas, Texas, United States, 75390;
| | - Jeffrey A Cadeddu
- UT Southwestern Medical Center, Urology, 5323 Harry Hines Blvd, Dallas, Texas, United States, 75390-9110;
| | - Solomon Woldu
- University of Texas Southwestern Medical Center at Dallas, 12334, Urology, Dallas, Texas, United States, 75390;
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Testosterone replacement therapy in the era of telemedicine. Int J Impot Res 2022; 34:663-668. [PMID: 34799712 PMCID: PMC8604198 DOI: 10.1038/s41443-021-00498-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Revised: 10/26/2021] [Accepted: 11/05/2021] [Indexed: 11/18/2022]
Abstract
The events of the 2019 SARS-CoV2 virus pandemic have all but ensured that telemedicine will remain an important aspect of patient care delivery. As health technologies evolve, so must physician practices. Currently, there is limited data on the management of testosterone replacement therapy (TRT) in the era of telemedicine. This review aims to explore the potential benefits and pitfalls of TRT management via telemedicine. We also propose a theoretical framework for TRT management via telemedicine. Telemedicine provides patients and physicians with a new mechanism for American Urological Association guideline-concordant TRT management that can increase patient access to care and provide a safe space for men who may otherwise not have been comfortable with in-person evaluation. However, there are significant limitations to the use of telemedicine for the management of TRT, including the inability to perform a physical exam, inability to administer specific medications, technological barriers, data security, and medical-legal considerations, and both patients and providers should engage in shared decision making before pursuing this approach. Understanding and acknowledging the potential pitfalls of telemedicine for TRT management will enable both patients and providers to achieve optimal outcomes and satisfaction.
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