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Khera M, Bernie HL, Broderick G, Carrier S, Faraday M, Kohler T, Jenkins L, Watter D, Mulhall J, Raheem O, Ramasamy R, Rubin R, Spitz A, Yafi F, Sadeghi-Nejad H. Sexual Medicine Society of North America (SMSNA)/American Urological Association (AUA) telemedicine and men's health white paper. J Sex Med 2024; 21:318-332. [PMID: 38430132 DOI: 10.1093/jsxmed/qdad151] [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: 07/28/2023] [Revised: 10/16/2023] [Accepted: 10/20/2023] [Indexed: 03/03/2024]
Abstract
PURPOSE The purpose of this white paper is to educate health care professionals about the evolution of telemedicine (TM) and to propose a hybrid model that leverages the strengths of traditional in-person medicine as well as virtual medicine while maximizing the safety and quality of men's sexual health care. LITERATURE SEARCH STRATEGY A literature search focused on the use of TM in urology and men's health was performed through PubMed/MEDLINE, Embase, and Web of Science (January 1, 2012-April 26, 2022). Keywords included all known permutations of the terminology used to refer to virtual health, care as well as the terminology used to refer to urologic diseases, issues specific to men's health, and men's sexual health concerns. Publications that emerged after the literature search that met this criterion also were incorporated. Opinion pieces, letters to the editor, meeting abstracts, and conference proceedings were excluded. Additional resources were retrieved, such as governmental technical reports, legislative updates and reviews, and blogs. This search strategy yielded 1684 records across databases after removal of duplicates. Abstracts from the retrieved records were reviewed for relevance. Relevant publications were defined as those that reported data on any aspect of TM use specific to urology, men's health, and/or men's sexual health. If relevance was unclear from the abstract, then the full text of the article was retrieved for a more detailed review. In addition, the published evidence-based practice guidelines relevant to care for erectile dysfunction, Peyronie's disease, ejaculatory dysfunction, and hypogonadism were retrieved. The most common reasons for article exclusions were a focus on TM use in disciplines other than urology and the absence of data (ie, opinion pieces). After exclusions, a total of 91 publications remained and constituted the evidence base for this paper.
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Affiliation(s)
- Mohit Khera
- Scott Department of Urology, Baylor College of Medicine, Houston, TX 77030, United States
| | - Helen L Bernie
- Department of Urology, Indiana University, Indianapolis, IN 46202, United States
| | - Gregory Broderick
- Department of Urology, Mayo Clinic Alix School of Medicine, Jacksonville, Florida 32224, United States
| | - Serge Carrier
- Surgical Department /Urology Division, McGill University, Montreal, Quebec, H4A 3J1, Canada
| | - Martha Faraday
- Four Oaks Consulting, Berryville, VA 22611, United States
| | - Tobias Kohler
- Department of Urology, Mayo Clinic, Rochester, MN 55905, United States
| | - Lawrence Jenkins
- Department of Urology, Tulane University School of Medicine, New Orleans, LA 70112, United States
| | - Daniel Watter
- Morris Psychological Group, P.A., Parsippany, NJ 07054, United States
| | - John Mulhall
- Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY 10022, United States
| | - Omer Raheem
- Section of Urology, Department of Surgery, University of Chicago, Chicago, IL 60637, United States
| | - Ranjith Ramasamy
- Desai Sethi Urology Institute, University of Miami Miller School of Medicine, Miami, FL 33136, United States
| | - Rachel Rubin
- Department of Urology, Georgetown University, Washington, DC 20007, United States
| | - Aaron Spitz
- Orange County Urology Associates, Laguna Hills, California, CA 92653, United States
| | - Faysal Yafi
- Department of Urology, University of California Irvine, CA 92660, United States
| | - Hossein Sadeghi-Nejad
- Department of Urology, NYU Langone Grossman School of Medicine, New York, NY 10017, United States
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Ungerer GN, Winoker JS, Healy KA, Shah O, Koo K. Mobile and eHealth technologies in the management and prevention of nephrolithiasis: A systematic review. Actas Urol Esp 2024; 48:25-41. [PMID: 37364768 DOI: 10.1016/j.acuroe.2023.06.010] [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] [Received: 04/17/2023] [Accepted: 04/19/2023] [Indexed: 06/28/2023]
Abstract
INTRODUCTION Kidney stone disease (KSD) is a common urological condition that often requires long-term care. Mobile health (mHealth) and eHealth technologies have the potential to enhance chronic disease management and behavioral change. To assess opportunities to apply these tools to improve KSD treatment and prevention, we aimed to assess current evidence on the use, benefits, and limitations of mHealth and eHealth in KSD. METHODS We performed a systematic review of primary research studies of mHealth and eHealth in the evaluation and management of KSD. Two independent researchers screened citations by title and abstract for relevance, then full-text review was performed for descriptive summary of the studies. RESULTS A total of 37 articles were included for analysis. Primary domains of evidence included: 1) "smart" water bottles and mobile-device apps for tracking fluid consumption, which showed increased intake in most studies; 2) ureteral stent tracking platforms, which improved the rate of long-term retained stents; 3) virtual stone clinics, which have been suggested to increase access, lower costs, and have satisfactory outcomes; 4) smartphone-based endoscopy platforms, which offered cost-effective image quality in resource-limited settings; 5) patient information about KSD online, which was typically characterized as poor quality and/or accuracy, particularly on YouTube. Most studies were proof-of-concept or single-arm intervention designs, with limited assessment of effectiveness or long-term clinical outcomes. CONCLUSIONS Mobile and eHealth technologies have significant real-world applications to KSD prevention, intervention, and patient education. A lack of rigorous effectiveness studies currently limits evidence-based conclusions and incorporation in clinical guidelines.
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Affiliation(s)
- G N Ungerer
- Department of Urology, Mayo Clinic, Rochester, MN, USA
| | - J S Winoker
- Smith Institute for Urology at Lenox Hill, Northwell Health, New York, NY, USA
| | - K A Healy
- Department of Urology, Columbia University Irving Medical Center, New York, NY, USA
| | - O Shah
- Department of Urology, Columbia University Irving Medical Center, New York, NY, USA
| | - K Koo
- Department of Urology, Mayo Clinic, Rochester, MN, USA.
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Nam CS, Daignault-Newton S, Kraft KH, Herrel LA. The Future is Female: Urology Workforce Projection from 2020 to 2057. Urol Clin North Am 2023; 50:501-513. [PMID: 37775209 DOI: 10.1016/j.ucl.2023.06.011] [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: 10/01/2023]
Abstract
Multiple estimates have approximated a urologist shortage per capita of around 30% by 2030. In the context of the impending urologic workforce shortage, it is critical to have a nuanced understanding of the degree of workforce shortage in comparison with the US population to mitigate the negative downstream effects in the future. In continued growth and stagnant growth projection models, we found that female urologists make up a significant proportion of the workforce growth over the next four decades. This projection highlights the need for purposeful recruitment, structural changes, and advocacy among urology leadership to support and retain female urologists.
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Affiliation(s)
- Catherine S Nam
- Department of Urology, Michigan Medicine University of Michigan, Ann Arbor, MI, USA.
| | | | - Kate H Kraft
- Department of Urology, Michigan Medicine University of Michigan, Ann Arbor, MI, USA
| | - Lindsey A Herrel
- Department of Urology, Michigan Medicine University of Michigan, Ann Arbor, MI, USA
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Li KD, Chu CE, Patel M, Meng MV, Morgan TM, Porten SP. Cxbladder Monitor testing to reduce cystoscopy frequency in patients with bladder cancer. Urol Oncol 2023; 41:326.e1-326.e8. [PMID: 36868882 DOI: 10.1016/j.urolonc.2023.01.009] [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] [Received: 11/22/2022] [Revised: 01/04/2023] [Accepted: 01/12/2023] [Indexed: 03/05/2023]
Abstract
PURPOSE Bladder cancer surveillance is associated with high costs and patient burden. CxMonitor (CxM), a home urine test, allows patients to skip their scheduled surveillance cystoscopy if CxM-negative indicating a low probability of cancer presence. We present outcomes from a prospective multi-institutional study of CxM to reduce surveillance frequency during the coronavirus pandemic. MATERIALS AND METHODS Eligible patients due for cystoscopy from March-June 2020 were offered CxM and skipped their scheduled cystoscopy if CxM-negative. CxM-positive patients came for immediate cystoscopy. The primary outcome was safety of CxM-based management, assessed by frequency of skipped cystoscopies and detection of cancer at immediate or next cystoscopy. Patients were surveyed on satisfaction and costs. RESULTS During the study period, 92 patients received CxM and did not differ in demographics nor history of smoking/radiation between sites. 9 of 24 (37.5%) CxM-positive patients had 1 T0, 2 Ta, 2 Tis, 2 T2, and 1 Upper tract urothelial carcinoma (UTUC) on immediate cystoscopy and subsequent evaluation. 66 CxM-negative patients skipped cystoscopy, and none had findings on follow-up cystoscopy requiring biopsy. Six of these patients did not attend follow-up, 4 elected to undergo additional CxM instead of cystoscopy, 2 stopped surveillance, and 2 died of unrelated causes. CxM-negative and positive patients did not differ in demographics, cancer history, initial tumor grade/stage, AUA risk group, or number of prior recurrences. Median satisfaction (5/5, IQR 4-5) and costs (26/33, 78.8% no out-of-pocket costs) were favorable. CONCLUSIONS CxM safely reduces frequency of surveillance cystoscopy in real-world settings and appears acceptable to patients as an at-home test.
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Affiliation(s)
- Kevin D Li
- Department of Urology, University of California San Francisco, San Francisco, CA
| | - Carissa E Chu
- Urology Service, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Milan Patel
- Department of Urology, University of Michigan, Ann Arbor, MI
| | - Maxwell V Meng
- Department of Urology, University of California San Francisco, San Francisco, CA
| | - Todd M Morgan
- Department of Urology, University of Michigan, Ann Arbor, MI
| | - Sima P Porten
- Department of Urology, University of California San Francisco, San Francisco, CA.
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Matulewicz RS, Fankhauser CD, Sheinfeld J, Bagrodia A. Novel approaches to redesign surveillance strategies following orchiectomy for localized testicular cancer: a narrative review. Transl Androl Urol 2023; 12:1016-1022. [PMID: 37426604 PMCID: PMC10323446 DOI: 10.21037/tau-22-855] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Accepted: 05/09/2023] [Indexed: 07/11/2023] Open
Abstract
Background and Objective Surveillance is the preferred management strategy for most men with clinical stage I testicular cancer after orchiectomy. However, frequent office visits, imaging tests, and laboratory studies place a significant burden on patients, which may contribute to poor compliance with guideline-recommended surveillance regimens. Identifying strategies to overcome these barriers may help improve quality of life, reduce costs, and improve adherence for patients. We reviewed evidence for three strategies that may help with surveillance redesign: telemedicine, implementing microRNA (miRNA) as a biomarker, and novel imaging protocols. Methods A web-based literature search for novel imaging strategies, diagnostic utility of miRNA, and telehealth as they relate to early-stage testicular germ cell cancer was completed during the month of August 2022. We focused our search on contemporary PubMed-indexed and Google Scholar-registered manuscripts written in English. Supportive data sourced from current guideline statements were also included. Evidence was compiled for narrative review. Key Content and Findings Telemedicine is a safe and acceptable platform for urologic cancer follow-up care, but it requires further study specifically among men with testicular cancer. Access to care may either be improved or reduced depending on system- and patient-level characteristics and should be implemented with this in mind. miRNA may potentially be a helpful biomarker for men with localized disease, but further research on diagnostic accuracy and marker kinetics are needed before implementing it into routine surveillance strategies or using it to deviate from long-standing surveillance regiments. Novel imaging strategies with less frequent imaging and the use of magnetic resonance imaging (MRI) instead of computed tomography (CT) appear to be non-inferior in clinical trials. However, use of MRI requires expert radiologist availability and may be more costly with a lower ability to detect small, early recurrences when used in routine practice. Conclusions Using telemedicine, integrating miRNA as a tumor marker, and adopting less intensive imaging strategies may improve guideline-concordant surveillance for men with localized testicular cancer. Future studies are needed to assess the risks and benefits of using these novel approaches separately or together.
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Affiliation(s)
- Richard S. Matulewicz
- Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Christian D. Fankhauser
- University of Zurich, Zurich, Switzerland
- Department of Urology, Luzerner Kantonsspital, Lucerne, Switzerland
| | - Joel Sheinfeld
- Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Aditya Bagrodia
- Department of Urology, University of California at San Diego, San Diego, CA, USA
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Gander JC, Goodrich G, McDonald B, McCracken CE, Tavel HM, Davis TL, Weinfield NS, Ritzwoller DP, Roblin DW. Virtual Care and Urinary Tract Infection Management: Comparing Ancillary Service Orders and Patient Order Fulfillments Between Virtual and In-person Encounters During the COVID-19 Pandemic in the United States. Med Care 2023; 61:S21-S29. [PMID: 36893415 PMCID: PMC9994568 DOI: 10.1097/mlr.0000000000001805] [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: 03/11/2023]
Abstract
BACKGROUND During the COVID-19 pandemic, more health care issues were being managed remotely. Urinary tract infections (UTIs) are being managed more often using telehealth although few reports compare the rate of UTI ancillary service orders placed and fulfilled during these visits. OBJECTIVES We aimed to evaluate and compare the rate of ancillary service orders and order fulfillments in incident UTI diagnoses between virtual and in-person encounters. RESEARCH DESIGN The retrospective cohort study involved 3 integrated health care systems: Kaiser Permanente (KP) Colorado, KP Georgia, and KP Mid-Atlantic States. SUBJECTS We included incident UTI encounters from adult primary care data from January 2019 to June 2021. MEASURES Data were categorized as: prepandemic (January 2019-March 2020), COVID-19 Era 1 (April 2020-June 2020), and COVID-19 Era 2 (July 2020-June 2021). UTI-specific ancillary services included medication, laboratory, and imaging. Orders and order fulfillments were dichotomized for analyses. Weighted percentages for orders and fulfillments were calculated using inverse probability treatment weighting from logistic regression and compared between virtual and in-person encounters using χ2 tests. RESULTS We identified 123,907 incident encounters. Virtual encounters increased from 13.4% prepandemic to 39.1% in COVID-19 Era 2. Ancillary service orders from virtual encounters were not placed as often as in-person encounters. However, the weighted percentage for ancillary service order fulfillment across all services remained above 65.3% across sites and eras, with many fulfillment percentages above 90%. CONCLUSIONS Our study reported a high rate of order fulfillment for both virtual and in-person encounters. Health care systems should encourage providers to place ancillary service orders for uncomplicated diagnoses, such as UTI, to provide enhanced access to patient-centered care.
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Affiliation(s)
- Jennifer C. Gander
- Center for Research and Evaluation, Kaiser Permanente Georgia, Atlanta, GA
| | - Glenn Goodrich
- Institute for Health Research, Kaiser Permanente Colorado, Aurora, CO
| | - Bennet McDonald
- Center for Research and Evaluation, Kaiser Permanente Georgia, Atlanta, GA
| | | | - Heather M. Tavel
- Institute for Health Research, Kaiser Permanente Colorado, Aurora, CO
| | - Teaniese L. Davis
- Center for Research and Evaluation, Kaiser Permanente Georgia, Atlanta, GA
| | - Nancy S. Weinfield
- Kaiser Permanente Mid-Atlantic Research Institute, Kaiser Permanente Mid-Atlantic States, Rockville, MD
| | | | - Douglas W. Roblin
- Kaiser Permanente Mid-Atlantic Research Institute, Kaiser Permanente Mid-Atlantic States, Rockville, MD
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Creating an Inclusive Urology Practice. CURRENT BLADDER DYSFUNCTION REPORTS 2023; 18:131-138. [PMID: 36817083 PMCID: PMC9925931 DOI: 10.1007/s11884-023-00694-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/30/2022] [Indexed: 02/16/2023]
Abstract
Purpose of Review Patients seeking urologic care come from diverse backgrounds. Therefore, clinics should strive for inclusivity to make all patients feel comfortable seeing a urologist. This review aims to outline and analyze literature relevant to the care of LGTBQIA+ (lesbian, gay, transgender/transexual, queer/questioning, intersex, asexual/allies, nonbinary/genderqueer +), racial and ethnic minorities, those who have disabilities, and those with a high body mass index (BMI). Although this review article presents the care of diverse communities separately, there is an overlap of the various social axes influencing healthcare outcomes. Healthcare workers should be open-minded to learning about evolving community needs. Recent Findings Creating a safe space for LGTBQIA+ requires understanding terminology, awareness of community-specific challenges and health risks, and changing heteronormative behaviors built into medicine. Specific clinical care delivery structural processes and patient-physician-centered practices can make a clinic welcoming for patients from underrepresented backgrounds and with disabilities. BMI surgical requirements may pose barriers to care, and if implemented, there should be assistance to reach specified weight goals. Summary Creating an inclusive urology clinical practice takes time, but it can be achieved by building a collaborative team. Treating patients with consideration of their personal identities and social determinants of health will lead to better patient-center care and health outcomes.
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Chen J, Jarvi K, Lajkosz K, Smith J, Lau S, Lo K, Grober E, Samplaski MK. How far will they go? Distance and driving times that north American men travel to see a reproductive urologist. Andrologia 2022; 54:e14551. [PMID: 36054603 PMCID: PMC9787797 DOI: 10.1111/and.14551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Revised: 06/19/2022] [Accepted: 07/24/2022] [Indexed: 12/30/2022] Open
Abstract
Male factor infertility affects about 50% of infertile couples. However, male factor infertility is largely under-evaluated due to multiple reasons. This study is to determine the time men travel for fertility evaluation, and factors associated with driving longer. Data from the Andrology Research Consortium were analysed. Driving distance and time were calculated by comparing "patient postal code" with "clinic postal code", then stratified into quartiles. Patients with the longest driving times (> 75th percentile [Q4]) were compared with those having shorter driving times. Logistic regression analysis was used to identify factors associated with longer driving times. Sixteen clinics and 3029 men were included. The median driving distance was 18.1 miles, median driving time was 32 min, and Q4 driving time was 49 min. Factors correlated with having Q4 driving time were age > 30 years, native Indian and Caucasian race, body mass index (BMI) > 30 kg/m2 , history of miscarriage, children with previous partner, self-referral, prior vasectomy, and prior marijuana use. On logistic regression, males aged < 30 years were more likely to be in Q4 for driving time versus older males. Blacks and Asians were less likely to travel further than Caucasians. Overweight/obese men, those having children with previous partner, and with prior vasectomy were more likely to be in Q4 travelling time. Factors correlated with longer driving times include younger age, native Indian and Caucasian race, higher BMI, children with prior partner, and prior vasectomy. These may reflect groups that drive long distances for reproductive care. The study provides an opportunity to better access these groups and minimise their barriers to fertility care.
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Affiliation(s)
- Jian Chen
- Institute of Urology, University of Southern CaliforniaLos AngelesCaliforniaUSA
| | - Keith Jarvi
- Division of Urology, Mount Sinai HospitalUniversity of TorontoTorontoOntarioCanada
| | - Katherine Lajkosz
- Division of Urology, Mount Sinai HospitalUniversity of TorontoTorontoOntarioCanada
| | - James Smith
- Department of UrologyUniversity of CaliforniaSan FranciscoCaliforniaUSA
| | - Susan Lau
- Division of Urology, Mount Sinai HospitalUniversity of TorontoTorontoOntarioCanada
| | - Kirk Lo
- Division of Urology, Mount Sinai HospitalUniversity of TorontoTorontoOntarioCanada
| | - Ethan Grober
- Division of Urology, Mount Sinai HospitalUniversity of TorontoTorontoOntarioCanada
| | - Mary K. Samplaski
- Institute of Urology, University of Southern CaliforniaLos AngelesCaliforniaUSA
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Eyrich NW, Andino JJ, Ukavwe RE, Farha MW, Patel AK, Triner D, Ellimoottil C. The Lack of a Physical Exam During New Patient Telehealth Visits Does Not Impact Plans for Office and Operating Room Procedures. Urology 2022; 167:109-114. [PMID: 35772487 PMCID: PMC9313530 DOI: 10.1016/j.urology.2022.06.017] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Revised: 06/09/2022] [Accepted: 06/15/2022] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To understand how the lack of a physical examination during new patient video visits can impact urological surgery planning during the COVID-19 pandemic. METHODS We retrospectively reviewed 590 consecutive urology patients who underwent new patient video visits from March through May 2020 at a single academic center. Our primary outcome was procedural plan concordance, the proportion of video visit surgical plans that remained the same after the patient was seen in-person, either in clinic or on day of surgery. Median days between video and in-person visits were compared between concordant and discordant cases using the Mann-Whitney U test; P < .05 was significant. RESULTS Overall, 195 (33%) were evaluated by new patient video visits and had a procedure scheduled, of which, 186 (95%) had concordant plans after in-person evaluation. Further, 99% of plans for in-office procedures and 91% for operating room procedures were unchanged. Four patients (2.1%) had surgical plans altered after changes in clinical course, two (1%) due to additional imaging, and three (1.5%) based on genitourinary examination findings. Days between video visit and in-person evaluation did not differ significantly in concordant cases (median 37.5 [IQR, 16 - 80.5]) as compared to discordant cases (median 58.0 [IQR, 20 - 224]; P = .12). CONCLUSIONS Most surgical plans developed during new patient video visits remain unchanged after in-person examination. However, changes in clinical course or updated imaging can alter operative plans. Likewise, certain urologic conditions (eg, penile cancer) rely on the genitourinary examination to dictate surgical approach.
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Affiliation(s)
- Nicholas W Eyrich
- Department of Urology, Emory University School of Medicine, Atlanta, GA; Department of Urology, Michigan Medicine, Ann Arbor, MI.
| | - Juan J Andino
- Department of Urology, Michigan Medicine, Ann Arbor, MI
| | | | - Mark W Farha
- Department of Urology, Michigan Medicine, Ann Arbor, MI
| | - Akshar K Patel
- Department of Anesthesiology, Michigan Medicine, Ann Arbor, MI
| | - Daniel Triner
- Department of Urology, Michigan Medicine, Ann Arbor, MI
| | - Chad Ellimoottil
- Department of Urology, Michigan Medicine, Ann Arbor, MI; Institute for Healthcare Policy and Innovation, Ann Arbor, MI
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Naik N, Nandyal SR, Nayak SG, Shah M, Ibrahim S, Hameed BMZ, Patil A, Suresh G, Shetty PA, Rai BP, TP R, Rice P, Reddy SJ, Bhat N, Garg D, Chlosta P, Somani BK. Telemedicine and Telehealth in Urology: Uptake, Impact and Barriers to Clinical Adoption. Front Surg 2022; 9:911206. [PMID: 35846972 PMCID: PMC9280027 DOI: 10.3389/fsurg.2022.911206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2022] [Accepted: 06/13/2022] [Indexed: 11/13/2022] Open
Abstract
Telemedicine has great potential in urology as a strong medium for providing patients with continuous high-quality urological care despite the hurdles involved in its implementation. Both clinicians and patients are crucial factors in determining the success of tele-consults in terms of simplicity of use and overall satisfaction. For it to be successfully incorporated into routine urological practice, rigorous training and evidence-based recommendations are lacking. If these issues are addressed, they can provide a significant impetus for future tele-consults in urology and their successful deployment, even beyond the pandemic, to assure safer and more environment-friendly patient management.
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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
- iTRUE (International Training and Research in Uro-oncology and Endourology) Group, Manipal, Karnataka, India
| | - Shreyas Raghavan Nandyal
- Gandhi Medical College, Kaloji Narayana Rao University of Health Sciences, Secunderabad, Telangana, India
| | - Sanjana Ganesh Nayak
- Department of Computer Science and Engineering, Manipal Institute of Technology, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Milap Shah
- iTRUE (International Training and Research in Uro-oncology and Endourology) Group, Manipal, Karnataka, India
- Robotics and Urooncology, Max Hospital and Max Institute of Cancer Care, New Delhi, India
| | - Sufyan Ibrahim
- iTRUE (International Training and Research in Uro-oncology and Endourology) Group, Manipal, Karnataka, India
- Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - B. M. Zeeshan Hameed
- iTRUE (International Training and Research in Uro-oncology and Endourology) Group, Manipal, Karnataka, India
- Department of Urology, Father Muller Medical College, Mangalore, Karnataka, India
- Correspondence: B. M. Zeeshan Hameed
| | - Ananth Patil
- A.J. Institute of Medical Sciences and Research Centre, Mangalore, Karnataka, India
| | - Gopika Suresh
- Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Pritam A. Shetty
- Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Bhavan Prasad Rai
- iTRUE (International Training and Research in Uro-oncology and Endourology) Group, Manipal, Karnataka, India
- Department of Urology, Freeman Hospital, Newcastle upon Tyne, United Kingdom
| | - Rajeev TP
- Department of Urology, Government Medical College Hospital, Guwahati, India
| | - Patrick Rice
- Department of Urology, University Hospital Southampton NHS Trust, Southampton, United Kingdom
| | - Suraj Jayadeva Reddy
- Department of Urology, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Nandakishore Bhat
- Department of Urology, Father Muller Medical College, Mangalore, Karnataka, India
| | - Deepesh Garg
- Department of Information and Communication Technology, Manipal Institute of Technology, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Piotr Chlosta
- Department of Urology, Jagiellonian University in Krakow, Kraków, Poland
| | - Bhaskar K. Somani
- iTRUE (International Training and Research in Uro-oncology and Endourology) Group, Manipal, Karnataka, India
- Department of Urology, University Hospital Southampton NHS Trust, Southampton, United Kingdom
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Jones JE, Damery SL, Phillips K, Retzer A, Nayyar P, Jolly K. Real-time remote outpatient consultations in secondary and tertiary care: A systematic review of inequalities in invitation and uptake. PLoS One 2022; 17:e0269435. [PMID: 35657995 PMCID: PMC9165897 DOI: 10.1371/journal.pone.0269435] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Accepted: 05/23/2022] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Health policies in most high income countries increasingly recommend provision of routine outpatient care via remote (video and/or telephone) appointments, especially due to the pandemic. This is thought to improve access to care and promote efficiency within resource-constrained health services. There is limited evidence about the impact on existing inequalities in the invitation and uptake of health services when remote outpatient care is offered. AIM To systematically review the evidence on the offer and/or uptake of real-time remote outpatient consultations in secondary and tertiary care, assessed according to key sociodemographic characteristics. METHODS Seven electronic bibliographic databases were searched for studies reporting the proportion of patients with key characteristics (following PROGRESS Plus criteria) who were offered and/or accepted real-time remote outpatient consultation for any chronic condition. Comparison groups included usual care (face-to-face), another intervention, or offer/uptake within a comparable time period. Study processes were undertaken in duplicate. Data are reported narratively. RESULTS Twenty-nine studies were included. Uptake of video consultations ranged from 5% to 78% and telephone consultations from 12% to 78%. Patients aged over 65, with lower educational attainment, on lower household incomes and without English as a first language were least likely to have a remote consultation. Females were generally more likely to have remote consultations than males. Non-white ethnicities were less likely to use remote consultations but where they did, were significantly more likely to choose telephone over video appointments (p<0.001). CONCLUSIONS Offering remote consultations may perpetuate or exacerbate existing health inequalities in access to healthcare. More research is needed on current health disparities by sociodemographic characteristics and to explore what works well for different patient groups and why so that processes can be designed to ameliorate these health disparities. TRIAL REGISTRATION PROSPERO registration no: CRD42021241791.
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Affiliation(s)
- Janet E. Jones
- Institute of Applied Health Research, University of Birmingham, Birmingham, United Kingdom
| | - Sarah L. Damery
- Institute of Applied Health Research, University of Birmingham, Birmingham, United Kingdom
| | - Katherine Phillips
- Institute of Applied Health Research, University of Birmingham, Birmingham, United Kingdom
| | - Ameeta Retzer
- Institute of Applied Health Research, University of Birmingham, Birmingham, United Kingdom
- Centre for Patient Reported Outcomes Research, Institute of Applied Health Research, University of Birmingham, Birmingham, United Kingdom
| | - Pamela Nayyar
- Institute of Applied Health Research, University of Birmingham, Birmingham, United Kingdom
| | - Kate Jolly
- Institute of Applied Health Research, University of Birmingham, Birmingham, United Kingdom
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12
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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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13
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Telepresence Robots at the Urology and Emergency Department: A Pilot Study Assessing Patients’ and Healthcare Workers’ Satisfaction. Int J Telemed Appl 2022; 2022:8787882. [PMID: 35341067 PMCID: PMC8941569 DOI: 10.1155/2022/8787882] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Revised: 02/18/2022] [Accepted: 03/07/2022] [Indexed: 01/04/2023] Open
Abstract
COVID-19 intensified interest in telemedicine, yet no study has evaluated the use of a telepresence robot on unselected urological patients. Therefore, we performed a survey study of patients, bedside caregivers and urologists, investigating the satisfaction and applicability of a telepresence robot (Beam Pro, Suitable Technologies, USA) at the urology ward and emergency department. The primary outcome was the number of patient encounters solved without the urologist's physical presence. Between March 2021 and May 2021, patients, caregivers, and urologists filled in 42, 35, and 54 questionnaires, respectively. Most patients were male (79%), with a mean age of 64 (SD ± 17). Two of the department's ten urologists participated. The urologists responded that physical examination was required in 7 (13%) encounters. The caregivers would have preferred the urologist physically present in 11 (31%) cases. Most patients (71%) “agreed” or “strongly agreed” that they were willing to be attended by a telepresence robot at future evaluations and generally, patients gave high satisfaction scores. Though implementation among the department's urologists was a major challenge, participating urologists reported that physical presence could be avoided in 87% of the patient encounters. Studies of patient-reported outcome measures comparing telemedical and physical patient encounters are needed.
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14
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Abstract
PURPOSE OF REVIEW The purpose of this review article is to discuss the impact of Coronavirus Disease 2019 (COVID-19) on the evolution of telemedicine use for urology office visits. RECENT FINDINGS The COVID-19 pandemic has caused a dramatic change in the delivery of healthcare. Fraught with numerous barriers previously, the need for healthcare delivery during a time of social distancing and increased healthcare requirements drove the adoption of telemedicine forward. This 'trial period' over the last year has allowed us to appreciate the potential utility of telehealth-associated services in practice and consider its role even after the pandemic. Multiple studies equating its utility to in-person visits whereas simultaneously providing added convenience and cost-related savings have been published in the urologic literature. Permanent regulatory changes will need to be implemented to allow us the flexibility to use telehealth in the future. SUMMARY It is clear that telemedicine is an effective strategy for delivery of healthcare under the right circumstances. Although it initially started to fill a need out of necessity, it can help us effectively deliver healthcare as long as the regulations surrounding telemedicine allow us to continue to use it. This period has been challenging for healthcare delivery and led to policy changes that served as a catalyst to help us better understand this previously underutilized resource.
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Affiliation(s)
- Mohit Butaney
- Vattikuti Urology Institute, Henry Ford Health System, Detroit, Michigan, USA
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15
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Nam CS, Daignault-Newton S, Kraft KH, Herrel LA. Projected US Urology Workforce per Capita, 2020-2060. JAMA Netw Open 2021; 4:e2133864. [PMID: 34783827 PMCID: PMC8596195 DOI: 10.1001/jamanetworkopen.2021.33864] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Accepted: 09/12/2021] [Indexed: 12/21/2022] Open
Abstract
Importance Projections to 2035 have demonstrated concern regarding a worsening urology workforce shortage. Objective To project the size and demographic characteristics of the urology workforce per capita into 2060 and to anticipate the timing and degree of the impending urology workforce shortage. Design, Setting, and Participants This population-based cross-sectional study used the 2019 American Urological Association Annual Census data and the Accreditation Council for Graduate Medical Education's Data Resource Book from 2007 to 2018. The cohort included practicing urologists in 2019. US Census data were used to approximate the projected US population. Data analysis was performed from June 2020 to March 2021. Exposures Continued growth stock and flow model of 13.8% and stagnant growth model of 0% increase of the incoming urology workforce with cohort projection per projected US population. Main Outcomes and Measures The primary outcome was urology workforce projection per the population aged 65 years and older. Urology workforce projections per capita and demographic characteristics of the urology workforce up to 2060 were calculated under guided assumptions with 2 stock and flow models. Results In 2019, there were 13 044 urologists (11 758 men [90.1.%]; 1286 women [9.9%]; median age range, 55-59 years), with 3.99 urologists per 100 000 persons and 311 new urologists entering the workforce. In a continued growth model, 2030 will have the lowest number of urologists per capita of 3.3 urologists per 100 000 persons, and recovery to baseline will occur by 2050. There are 23.8 urologists per 100 000 persons aged 65 years and older in 2020, which decreases to 15.8 urologists per 100 000 persons aged 65 years and older in 2035 and never recovers to its baseline level by 2060. In a stagnant growth model, there will be a continued decrease of urologists per capita to 3.1 urologists per 100 000 persons by 2060. There is a continued decrease in per capita urologists at each time point, with 13.1 urologists per 100 000 persons aged 65 years and older by 2060. Conclusions and Relevance With the impending urology workforce shortage, there will be an exaggerated shortage of total urologists per persons aged 65 years and older in both models. This projection highlights the need for structural changes and advocacy to maximize the available urology workforce.
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Affiliation(s)
- Catherine S. Nam
- Department of Urology, Michigan Medicine, University of Michigan, Ann Arbor
| | | | - Kate H. Kraft
- Department of Urology, Michigan Medicine, University of Michigan, Ann Arbor
| | - Lindsey A. Herrel
- Department of Urology, Michigan Medicine, University of Michigan, Ann Arbor
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16
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Video Visits are Practical for the Follow-up and Management of Established Male Infertility Patients. Urology 2021; 154:158-163. [PMID: 34022261 DOI: 10.1016/j.urology.2021.03.050] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Revised: 03/15/2021] [Accepted: 03/31/2021] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To study the use of video visits for male infertility care prior to the COVID-19 pandemic METHODS: We reviewed video visits for male infertility patients completed at a tertiary academic center in southeast Michigan. These patients had follow-up after an initial in-person evaluation. We designed this retrospective case series to describe the diagnostic categories seen through telehealth, management steps completed during video visits, and to understand whether additional in-person care was required within 90 days of video visits. In addition, we estimated time and cost savings for patients attributed to video visits. RESULTS Most men seen during video visits had an endocrinologic (29%) or anatomic (21%) cause for their infertility. 73% of video visits involved reviewing results; 30% included counseling regarding assistive reproductive technologies; and 25% of video visits resulted in prescribing hormonally active medications. The two patients (3%) who were seen in clinic after their video visit underwent a varicocelectomy in the interim. No patients required an unplanned in-person visit. From a patient perspective, video visits were estimated to save a median of 97 minutes (IQR 64-250) of travel per visit. Median cost savings per patient- by avoiding travel and taking time off work for a clinic visit-were estimated to range from $149 (half day off) to $252 (full day off). CONCLUSION Video visits for established male infertility patients were used to manage different causes of infertility while saving patients time and money. Telehealth for established patients did not trigger additional in-person evaluations.
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17
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Shiff B, Frankel J, Oake J, Blachman-Braun R, Patel P. Patient Satisfaction With Telemedicine Appointments in an Academic Andrology-focused Urology Practice During the COVID-19 Pandemic. Urology 2021; 153:35-41. [PMID: 33450281 DOI: 10.1016/j.urology.2020.11.065] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Revised: 11/10/2020] [Accepted: 11/29/2020] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To evaluate patient satisfaction with telemedicine appointments as an alternative to in-person appointments at an Andrology-focused academic urology practice during the coronavirus disease 2019 pandemic. METHODS Between March and June 2020, all appointments at the practice of a single Andrology-focused academic urologist were conducted by telephone. Consecutive patients were contacted by telephone following their appointment to complete a telephone questionnaire. Baseline demographic information was obtained, and perceptions regarding telephone appointments were assessed using a Likert scale. RESULTS Ninety-six patients completed the telephone questionnaire. Median age was 48.5 years (interquartile range 37.3-62.8 years) with 55 of 96 (57.3%) of the appointments Andrology-focused. Mean distance of residence from the hospital was 8.4 km (interquartile range 4.7-25.2 km). Only 9 of 96 (9.3%) of the patients felt that the telephone format did not adequately address their needs. However, 26 of 96 (27.1%) of patients said they would prefer an in-person appointment. On multivariable analysis adjusting for age, gender, presenting complaint, type of appointment, education level, and employment status, no factors were associated with feeling that the telephone appointment adequately addressed needs or preference for an in-person appointment in the future. CONCLUSION Patients were generally satisfied with telephone appointments as an alternative to in-person appointments during the coronavirus disease 2019 pandemic. Nonetheless, a substantial portion of patients said they would prefer in-person appointments in the future.
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Affiliation(s)
- Benjamin Shiff
- Section of Urology, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Jed Frankel
- Faculty of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Justin Oake
- Section of Urology, University of Manitoba, Winnipeg, Manitoba, Canada
| | | | - Premal Patel
- Section of Urology, University of Manitoba, Winnipeg, Manitoba, Canada.
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18
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Das A, Darves-Bornoz A, Joshi T, Keeter MK, Wren JM, Bennett NE, Brannigan RE, Halpern JA. Online access to male factor infertility care: the challenge of finding a specialist. F S Rep 2020; 1:227-232. [PMID: 34223249 PMCID: PMC8244381 DOI: 10.1016/j.xfre.2020.09.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 09/12/2020] [Accepted: 09/21/2020] [Indexed: 02/04/2023] Open
Abstract
OBJECTIVE To investigate internet search results available to couples searching for a male factor infertility specialist. DESIGN Cross-sectional. SETTING Online search engine. PATIENTS The phrase "male infertility specialist " was searched in Google for 50 states and Washington D.C. The top 10 results (i.e., first page) of each search were evaluated for website content. INTERVENTIONS None. MAIN OUTCOME MEASURES The first page of each search was evaluated for provider type (urology vs. obstetrics and gynecology), level of training (fellowship vs. none), male factor fertility information provided, and procedures offered. We compared search position rank (1-10) to determine the likelihood of finding an urologist versus a practitioner in obstetrics and gynecology. RESULTS A total of 419 results were identified; the majority were obstetrics and gynecology-related (N = 229, 54.7%). Urology-related results appeared higher than obstetrics and gynecology-related results (median, 4 vs. 5). Andrology fellowship-trained urologists were identified in 153 (36.5%) results. Among 229 obstetrics and gynecology results, 152 unique practices were identified. A small portion (N = 38, 16.6%) of these practices had a fellowship-trained urologist identified on the website. Most obstetrics and gynecology websites did not mention vasectomy reversal (N = 116, 76.3%) or varicocele repair (N = 93, 61.2%). A minority of practices offered referral to urologists for sperm extraction (N = 23, 15.1%) or offered sperm retrieval themselves (N = 23, 15.1%). CONCLUSIONS When searching online for a male factor infertility specialist, most results identified obstetrics and gynecology physicians. A large proportion of obstetrics and gynecology websites lacked information on male factor fertility treatments and did not offer these treatments. These data indicate the need for a more robust online presence of male reproductive urologists to optimize online access.
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Affiliation(s)
- Arighno Das
- Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Anne Darves-Bornoz
- Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Tejas Joshi
- Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Mary Kate Keeter
- Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - James M. Wren
- Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Nelson E. Bennett
- Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Robert E. Brannigan
- Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Joshua A. Halpern
- Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
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