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Velez D, Seideman CA. Author Response on: Impact of Dobbs v. Jackson Women's Health Organization on Professional Decision Making Among Urology Applicants. Urology 2024:S0090-4295(24)00172-9. [PMID: 38521209 DOI: 10.1016/j.urology.2024.03.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2024] [Accepted: 03/12/2024] [Indexed: 03/25/2024]
Affiliation(s)
- Danielle Velez
- Rutgers University, Robert Wood Johnson Medical School, New Brunswick, NJ.
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Peters CE, Seideman CA, Kauderer S, Gore JL, Holt SK, Mehta A, Singer EA, Tabakin AL, Thavaseelan S, Vemulakonda V, Posid T, Velez D. Impact of Dobbs v. Jackson Women's Health Organization on Professional Decision-Making Among Urology Applicants. Urology 2024:S0090-4295(24)00130-4. [PMID: 38431159 DOI: 10.1016/j.urology.2023.12.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2023] [Accepted: 12/12/2023] [Indexed: 03/05/2024]
Abstract
MATERIALS AND METHODS An Institutional Review Board-exempt REDCap survey was distributed through the Society of Academic Urologists to all 508 applicants registered for the 2023 Urology Match following the rank list submission deadline on January 10, 2023. The survey closed on February 1, 2023. Responses were anonymized, aggregated, and characterized using descriptive statistics. Thematic mapping of open text comments was performed by 2 reviewers. RESULTS The response rate was 42% (215/508). Eighty-eight percent of respondents disapproved of the Dobbs ruling. Twenty percent of respondents (15% male/24% female) eliminated programs in states where abortion is illegal. Fifty-nine percent (51% male/70% female) would be concerned for their or their partner's health if they matched in a state where abortion was illegal, and 66% (55% male/82% female) would want their program to assist them or their partner if they required abortion care during residency. Due to the competitive nature of Urology, 68% of applicants reported feeling at least somewhat obligated to apply in states where abortion legislation conflicts with their beliefs. Of the 65 comments provided by respondents, 4 common themes emerged: (1) avoidance of states with restrictive abortion laws; (2) inability to limit applications because of the competitiveness of urology; (3) impacts on personal health care; and (4) desire for advocacy from professional urology organizations. CONCLUSION The Dobbs ruling will impact the urology workforce by affecting urology applicants' decision-making regarding residency selection and ranking. Although the competitiveness of the Urology Match pressures applicants to apply broadly, many are taking reproductive health care access into consideration.
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Affiliation(s)
| | | | | | | | | | | | - Eric A Singer
- The Ohio State University Wexner Medical Center, Columbus, OH.
| | - Alexandra L Tabakin
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Uniondale, NY.
| | | | | | - Tasha Posid
- The Ohio State University Wexner Medical Center, Columbus, OH.
| | - Danielle Velez
- Robert Wood Johnson University Hospital, New Brunswick, NJ.
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Seideman CA. Casey A. Seideman, MD. Urol Pract 2024; 11:51-52. [PMID: 37916948 DOI: 10.1097/upj.0000000000000485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Accepted: 10/18/2023] [Indexed: 11/03/2023]
Affiliation(s)
- Casey A Seideman
- Pediatric Urology, Oregon Health & Science University Hospital, Portland, Oregon
- Online Content Assistant Editor
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Osunsanya O, Cooley K, Seideman CA. Assessment of the Presence of Diversity, Equity, and Inclusion Content on Urology Residency Programs Websites. Urol Pract 2023; 10:528-530. [PMID: 37551940 DOI: 10.1097/upj.0000000000000442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Accepted: 07/20/2023] [Indexed: 08/09/2023]
Affiliation(s)
| | - Keiko Cooley
- Department of Urology, Oregon Health and Science University, Portland, Oregon
| | - Casey A Seideman
- Department of Urology, Oregon Health and Science University, Portland, Oregon
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Peters CE, Lee J, Holt SK, Wolff E, Gore JL, Seideman CA. Attitudes Among Society of Women in Urology Members Toward Dobbs v. Jackson Women's Health Organization. Urology 2023; 180:295-302. [PMID: 37390972 DOI: 10.1016/j.urology.2023.04.044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Revised: 04/25/2023] [Accepted: 04/27/2023] [Indexed: 07/02/2023]
Abstract
OBJECTIVE To evaluate attitudes of women in urology regarding the Supreme Court ruling Dobbs v. Jackson Women's Health Organization, including impacts on personal/professional decision-making and the urology workforce. METHODS An IRB-exempt survey including Likert questions on participant views and free text questions was distributed to 1200 members of the Society of Women in Urology on 9/2/2022. Participants were medical students, urology residents, fellows, and practicing/retired urologists over 18. Responses were anonymous and aggregated. Quantitative responses were characterized with descriptive statistics and free-text responses were analyzed using thematic mapping. To complement this analysis, urologist density was mapped by county using 2021 National Provider Identifier data. State abortion laws were categorized based on Guttmacher Institute data on 10/20/2022. Data were analyzed using logistic regression, Poisson regression, and multiple linear regression. RESULTS 329 respondents completed the survey. 88% disagree/strongly disagree with the Dobbs ruling. 42% of trainees may have changed their rank list if current abortion laws existed during their match. 60% of respondents said Dobbs will impact where they choose their next job. 61.5% of counties had zero urologists in 2021, 76% of which were in states with restrictive abortion laws. Urologist density was inversely associated with abortion law restrictiveness compared with the most protective counties. CONCLUSION The Dobbs ruling will significantly impact the urology workforce. Trainees may change how they rank programs in states with restrictive abortion laws, and urologists may consider abortion laws when choosing jobs. Restrictive states are at higher risk for worsening access to urologic care.
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Affiliation(s)
- Chloe E Peters
- University of Washington, Department of Urology, Seattle, WA.
| | - Jenney Lee
- University of Washington, Department of Urology, Seattle, WA
| | - Sarah K Holt
- University of Washington, Department of Urology, Seattle, WA
| | - Erika Wolff
- University of Washington, Department of Urology, Seattle, WA
| | - John L Gore
- University of Washington, Department of Urology, Seattle, WA
| | - Casey A Seideman
- Oregon Health and Science University, Department of Urology, Portland, OR
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Peters CE, Lee J, Holt SK, Wolff E, Gore JL, Seideman CA. AUTHOR REPLY. Urology 2023; 180:301-302. [PMID: 37558582 DOI: 10.1016/j.urology.2023.04.046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/11/2023]
Affiliation(s)
- Chloe E Peters
- University of Washington, Department of Urology, Seattle, WA.
| | - Jenney Lee
- University of Washington, Department of Urology, Seattle, WA
| | - Sarah K Holt
- University of Washington, Department of Urology, Seattle, WA
| | - Erika Wolff
- University of Washington, Department of Urology, Seattle, WA
| | - John L Gore
- University of Washington, Department of Urology, Seattle, WA
| | - Casey A Seideman
- Oregon Health and Science University, Department of Urology, Portland, OR
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Affiliation(s)
| | - Casey A Seideman
- Department of Urology, Oregon Health and Science University, Portland, OR.
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Cameron AP, Seideman CA. Abortion is a urology workforce issue. Nat Rev Urol 2023:10.1038/s41585-023-00763-w. [PMID: 36964407 DOI: 10.1038/s41585-023-00763-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/26/2023]
Affiliation(s)
- Anne P Cameron
- Department of Urology, University of Michigan, Ann Arbor, MI, USA.
| | - Casey A Seideman
- Department of Urology, Oregon Health & Science University, Portland, OR, USA
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Martin LH, Haslam RE, Agnor R, Collins A, Bassale S, Seideman CA. Perceptions of Gender Equity by Urologic Subspecialty. Urology 2023; 174:35-41. [PMID: 36702444 DOI: 10.1016/j.urology.2022.12.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Revised: 12/08/2022] [Accepted: 12/18/2022] [Indexed: 01/24/2023]
Abstract
OBJECTIVES To evaluate how urologists in various subspecialties view the climate for female urologists, comparing perceptions of gender inequity based on characteristics including gender, subspecialty training, faculty status, parental status, and years in practice. Despite growth in female representation in urology, gender inequalities in career opportunities and compensation continue to exist. METHODS An IRB approved survey was sent out to the following list-serves: Society of Urological Oncology (SUO), Society of Endourology (ENDO), Genitourinary Reconstructive Surgeons (GURS), Society of Pediatric Urology (SPU), Society of Urodynamics, Female Pelvic Medicine and Urogenital Reconstruction (SUFU), and American Urogynecologic Society (AUGS). A validated study, the Culture Conducive to Women's Academic Success (CCWAS) was used, and scores analyzed using Wilcoxon Rank-Sum and Kruskal-Wallace tests. RESULTS There were 430 survey responses (35.3% female, 64.7% male). There was a statistically significant difference in CCWAS score for gender, parental status, and society. On multiple regression analysis controlling for gender, parental status and society were not statistically significant. Years in practice and practice type were not significant. Male urologists perceived practice culture toward women as more equitable than their female colleagues, (median [interquartile range] CCWAS score, 203.5 [184.25, 225.0] vs 162.5 [130.75, 188.0]; P < .0001). This discrepancy in perception between genders was consistent across all subcategories; equal access, work-life balance, freedom of gender bias, and leadership support. CONCLUSIONS This study suggests that there are gender-based differences in how gender inequities are perceived and experienced in urology. Acknowledgment of these differences is the first step in identifying opportunities for improvement.
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Affiliation(s)
| | | | - Rebecca Agnor
- Biostatistics Shared Resources, Knight Cancer Institute, Portland, OR
| | - Austin Collins
- Biostatistics Shared Resources, Knight Cancer Institute, Portland, OR
| | - Solange Bassale
- Biostatistics Shared Resources, Knight Cancer Institute, Portland, OR
| | - Casey A Seideman
- Doernbecher Children's Hospital, Oregon Health and Science University, Portland, OR.
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Malik RD, Rubin RS, Winter AG, Seideman CA. Uncovering the Impact and Influence of Urologists on Social Media. Eur Urol Focus 2023:S2405-4569(23)00002-0. [PMID: 36682963 DOI: 10.1016/j.euf.2023.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Accepted: 01/04/2023] [Indexed: 01/22/2023]
Affiliation(s)
- Rena D Malik
- Division of Urology, Department of Surgery, University of Maryland School of Medicine, Baltimore, MD, USA.
| | - Rachel S Rubin
- Department of Urology, Medstar Georgetown Urology, Washington, DC, USA; Department of Urology, George Washington Urology, Washington, DC, USA
| | | | - Casey A Seideman
- Department of Urology, Oregon Health & Science University School of Medicine, Portland, OR, USA
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Abstract
Introduction: Only 9.9% of practicing urologists in the United States are women. This percentage is even smaller in leadership positions and high-ranking appointments. Endourology is one of the least reported fellowships completed by women urologists. We sought to evaluate how endourologists perceived the climate for women physicians and compare perceptions and experiences of gender equity. Materials and Methods: An IRB approved and validated survey, Culture Conducive to Women's Academic Success (CCWAS) questionnaire was sent out to the Endourological Society listserve. Subcategories of equal access, work-life balance, freedom of gender bias, and leadership support were analyzed. An open comment section was provided for respondents to include their own experiences. Wilcoxon rank-sum and Kruskal-Wallis tests were used to compare CCWAS scores between groups. Results: A total of 104 completed surveys were received. Response rate was 7% (104/1492), 26.9% of which were female. There was a statistically significant difference between male and female respondent CCWAS scores; p < 0.05. The male CCWAS score median was 196.0 (interquartile range [IQR] 176.75-214.0) vs female CCWAS score median of 166.5 (IQR 127.5-210.0). There was no significant difference in CCWAS scores based on years in practice, parental status, or academic vs private practice. Discussion: In this study, male endourologists' perceptions of gender equity were incongruent with the reported experiences of their female colleagues. This indicates that male respondents perceive the culture in their department toward women more positively than their female colleagues. This is suggestive that there are gender-based differences in how gender inequities are perceived and potentially experienced.
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Affiliation(s)
- Leigh H Martin
- School of Medicine, Oregon Health and Science University, Portland, Oregon, USA
| | - Sara L Best
- Department of Urology, University of Wisconsin, Wisconsin, USA
| | - Michelle Jo Semins
- Department of Urology, West Virginia University, Wheeling, West Virginia, USA
| | - Roxanne E Haslam
- Department of Urology, Oregon Health and Science University, Portland, Oregon, USA
| | - Rebecca Agnor
- Biostatistics Shared Resources, Knight Cancer Institute, Portland, Oregon, USA
| | - Casey A Seideman
- Department of Pediatric Urology, Doernbecher Children's Hospital, Oregon Health and Science University, Portland, Oregon, USA
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Affiliation(s)
- Leigh H Martin
- Cleveland Clinic, Glickman Urological Institute, Cleveland, OH
| | - Keiko Cooley
- Cleveland Clinic, Glickman Urological Institute, Cleveland, OH
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Affiliation(s)
| | - Casey A Seideman
- Department of Urology, Oregon Health and Science University, Portland, Oregon
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Seideman CA. Society of Women in Urology (SWIU) Statement on Dobbs vs. Jackson Women's Health Organization. Urology 2022; 168:12. [PMID: 35901999 DOI: 10.1016/j.urology.2022.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Accepted: 07/05/2022] [Indexed: 10/16/2022]
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Pavuluri H, Malik R, Seideman CA. AUTHOR REPLY. Urology 2022; 165:119. [PMID: 35843691 DOI: 10.1016/j.urology.2022.01.058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Affiliation(s)
- Haritha Pavuluri
- University of South Carolina School of Medicine Greenville, Greenville, SC
| | - Rena Malik
- Division of Urology, University of Maryland School of Medicine, Baltimore, MD
| | - Casey A Seideman
- Department of Urology, Oregon Health and Science University, Portland, OR
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McGee LM, Lin-Brande M, Woods K, Seideman CA. Pubertal Suppression and Surgical Management of a Patient with 5-alpha Reductase Deficiency. Urology 2022; 165:e29-e31. [DOI: 10.1016/j.urology.2022.03.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Revised: 03/14/2022] [Accepted: 03/20/2022] [Indexed: 10/18/2022]
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Pavuluri H, Malik R, Seideman CA. An Assessment of Residency Wellness Programming in Urology Training Programs. Urology 2022; 165:113-119. [PMID: 35276201 DOI: 10.1016/j.urology.2022.01.051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Revised: 12/05/2021] [Accepted: 01/02/2022] [Indexed: 11/19/2022]
Abstract
OBJECTIVES To assess the prevalence and characteristics of wellness programming provided in urology residency programs (URPs). METHODS Websites for all 145 ACGME-accredited URPs in the United States were assessed for mention of "wellness" or "well-being." Program directors and/or coordinators for each URP were e-mailed asking about the presence of formal wellness programming, informal wellness activities, and wellness programming offered by the institution or graduate medical education (GME). A description of what wellness programming was offered was also requested. RESULTS Assessment of program websites found that 29 programs (20%) mentioned "wellness" or "well-being." Representatives from 58 URPs (40%) responded to the survey, with 38 programs (65.5%) indicating formal wellness programming and 54 programs (93.1%) indicating informal wellness programming. Compilation of data from e-mail responses and information from program websites revealed that 112 URPs (77.2%) offer residents wellness resources from the institution or GME, 58 (40%) provide wellness events for residents, and 29 (20%) provide wellness lectures to residents. Other metrics noted included presence of wellness committees, scheduled check-ins from program directors/faculty, and conferences for open resident discussion of issues. CONCLUSIONS Given that wellness programming is a requirement for ACGME, it is unsurprising that most programs have institutional wellness programming available. Wellness programing from individual URPs appears limited, showing that there is significant room for improvement.
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Affiliation(s)
- Haritha Pavuluri
- University of South Carolina School of Medicine Greenville, Greenville, SC.
| | - Rena Malik
- Department of Surgery, Division of Urology, University of Maryland School of Medicine, Baltimore, MD
| | - Casey A Seideman
- Department of Urology, Oregon Health and Science University, Portland, OR
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Wenzel J, Dudley A, Rowe C, Seideman CA. AUTHOR REPLY. Urology 2022; 160:108. [PMID: 35216687 DOI: 10.1016/j.urology.2021.03.062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
- Jessica Wenzel
- Department of Urology, Oregon Health and Sciences University, Portland, OR
| | - Anne Dudley
- Division of Urology, Connecticut Children's Hospital University of Connecticut Medical School, Hartford, CT
| | - Courtney Rowe
- Division of Urology, Connecticut Children's Hospital University of Connecticut Medical School, Hartford, CT
| | - Casey A Seideman
- Department of Urology, Oregon Health and Sciences University, Portland, OR
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Shoureshi P, Guerre M, Seideman CA, Callejas DG, Amling CL, Bassale S, Chouhan JD. Addressing Burnout in Urology: A Qualitative Assessment of Interventions. Urol Pract 2022; 9:101-107. [PMID: 37145567 DOI: 10.1097/upj.0000000000000282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/03/2021] [Indexed: 11/26/2022]
Abstract
INTRODUCTION We characterized physician burnout among urologists to determine the prevalence and efficacy of specific burnout interventions utilized and to determine involvement of workplaces in effective burnout interventions. METHODS The Western Section of the American Urological Association created an electronic, 29 question workforce survey. Several questions focused on assessing the level of urologist burnout, prevalence of work sponsored burnout interventions and efficacy of specific interventions. RESULTS A total of 440 responses were received (25.9% response rate); 82.2% of responders were male. The majority of urologists noted some level of burnout (79.5%) with no significant difference between those who reported no burnout vs some level of burnout (p=0.30). The most commonly tried interventions to reduce burnout were participating in regular physical exercise (76.6%), reading nonmedical literature (67.1%) and decreasing or modifying work hours (52.3%). The interventions most frequently cited as "very effective" were hiring a scribe (62.5%), regular exercise (56.1%) and participating in 1-on-1 gatherings with colleagues outside of work (44.6%). There were no significant differences noted when comparing "very effective" interventions by gender. The interventions most frequently cited as not effective were stress or burnout seminars (26.9%) and meditation/mindfulness training (11.5%); 42.5% reported workplace interventions to help prevent or reduce burnout. CONCLUSIONS Certain practice-changing and personal burnout interventions were noted to be "very effective" in decreasing burnout. Fewer than half of responders noted workplace sponsorship of interventions. Organizational support may lead to increased participation and effectiveness of burnout interventions.
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Affiliation(s)
- Poone Shoureshi
- Oregon Health & Science University, Department of Urology, Portland, Oregon
| | - Megan Guerre
- Oregon Health & Science University, School of Medicine, Portland, Oregon
| | - Casey A Seideman
- Oregon Health & Science University, Department of Urology, Portland, Oregon
| | | | | | - Solange Bassale
- Oregon Health & Science University, Knight Cancer Institute Biostatistics, Portland, Oregon
| | - Jyoti D Chouhan
- Oregon Health & Science University, Department of Urology, Portland, Oregon
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Bayne AP, Austin JC, Seideman CA. Robotic assisted retrovesical approach to prostatic utricle excision and other complex pelvic pathology in children is safe and feasible. J Pediatr Urol 2021; 17:710-715. [PMID: 34511376 DOI: 10.1016/j.jpurol.2021.08.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Revised: 07/29/2021] [Accepted: 08/06/2021] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Excision of the prostatic utricle has been a challenging surgical problem due to the location deep in the pelvis between the rectum and bladder. Robotic-assisted laparoscopic surgery allows minimally invasive access to this location. OBJECTIVE To describe the robotic surgical outcomes and important techniques associated with robotic excision of the prostatic utricle and explain how these techniques apply to similar pediatric pelvic pathology. STUDY DESIGN Retrospective chart evaluation of patients treated at a single institution with robotic excision of a prostatic utricle as well as two other patients in which the similar approach was employed. RESULTS 4 patients underwent robotic excision of a prostatic utricle. A fifth patient underwent excision of urethral diverticulum that was the remnant of an ectopic ureter. The sixth patient had a high urogenital sinus that required laparoscopic assisted vaginoplasty approached in a similar manner to the above listed cases. Mean age at surgery was 35.5 months for the utricle patients. Mean follow-up duration for the utricle patients was 30.75 months. Average hospital stay for the utricle patients was one day. In the utricle patients one patient developed transient urinary retention and one had a postoperative urinary tract infection. Concomitant cystoscopy used in the two non-utricle patients was a key step in defining the proper location of dissection. DISCUSSION Robotic-assisted laparoscopic retrovesical excision of the prostatic utricle is a safe operation that requires a skill set that can be readily applied to other complex pelvic pathology such as the ectopic ureter, urethral diverticulum, and urogenital sinus. Concomitant cystoscopy can aid significantly in defining the location and limits of dissection.
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Affiliation(s)
- Aaron P Bayne
- Oregon Health and Science University, Portland, OR, USA.
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Jones P, Rajasegaran A, Brassale S, Chen Y, Haslam R, Austin C, Seideman CA. Assessment of the Educational Value of Distal Hypospadias Repair Videos on YouTube. Urology 2021; 159:28-32. [PMID: 34461144 DOI: 10.1016/j.urology.2021.08.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Revised: 08/04/2021] [Accepted: 08/15/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVE To evaluate the quality of YouTube videos depicting distal hypospadias repair. METHODS The search terms "distal hypospadias repair" were used to identify surgical videos on YouTube. Videos were sorted by view count and the top 34 videos were reviewed for baseline video characteristics, key surgical steps covered, and conformity to a modified LAParoscopic surgery Video Educational GuidelineS (LAP-VEGaS) checklist. All videos were reviewed and discussed for conformity by 2 attending pediatric urologists and a urology resident. RESULTS Of the 34 videos reviewed, 16 videos were excluded due to content. The median length of videos was 9.94 minutes (range, 2.57-99.12 minutes). Video quality was deemed of high quality in only 39% of videos. The most common type of hypospadias procedures described were tubularized incised plate urethroplasty (n = 13) and meatal advancement and glanuloplasty incorporated (n = 2). The median view count was 7828.5 (range, 1,133-58,619 views). Only 1 video met all modified LAP-VEGaS criteria (range of 33%-100%), and only 2 videos showed every surgical step of distal hypospadias repair (range 33%-100%). Modified LAP-VEGaS score, surgical step score, or quality of the video was not associated with a higher view count. CONCLUSION Despite being a common procedure, there is a paucity of high-quality videos on YouTube describing distal hypospadias repair techniques. It is unclear how learners select videos for study purposes and the most utilized videos on YouTube are not the most educational videos.
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Affiliation(s)
- Paul Jones
- Oregon Health & Science University, Portland, OR.
| | - Abirami Rajasegaran
- Texas Tech University Health Sciences Center, School of Medicine, Lubbock, TX
| | | | - Yiyi Chen
- Oregon Health & Science University, Portland, OR
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22
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Cannon S, Seideman CA, Thavaseelan S, Wilson S, Zaila KE, Delgado J, Simons ECG, Dy GW. Urologists for Equity: A Collective Approach Toward Diversity, Equity, and Inclusion in Urology. Urology 2021; 162:33-37. [PMID: 34333037 DOI: 10.1016/j.urology.2021.07.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 06/10/2021] [Accepted: 07/18/2021] [Indexed: 11/16/2022]
Affiliation(s)
- Shannon Cannon
- Department of Urology, University of Washington; Division of Pediatric Urology, Seattle Children's Hospital, Seattle, WA.
| | - Casey A Seideman
- Department of Urology, Oregon Health & Science University, Portland, OR
| | | | | | - Kassandra E Zaila
- David Geffen School of Medicine, University of California, Los Angeles, CA
| | | | | | - Geolani W Dy
- Department of Urology & Transgender Health Program, Oregon Health & Science University, Portland, OR
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Wenzel J, Dudley A, Agnor R, Bassale S, Chen Y, Rowe C, Seideman CA. Women are underrepresented in prestigious recognition awards in the American Urological Association. Urology 2021; 160:102-108. [PMID: 34153364 DOI: 10.1016/j.urology.2021.03.058] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Revised: 03/07/2021] [Accepted: 03/14/2021] [Indexed: 11/25/2022]
Abstract
OBJECTIVES To determine the proportion of women who received awards from the American Urological Association (AUA) and evaluate whether this has changed over time as the proportion of practicing female urologists has increased. METHODS A retrospective review of award recipients from the AUA website was performed. Gender of award recipient, type of award and year received were collected and the trend over time was compared with the AUA census. RESULTS Of the 622 award recipients, 43 (6.9%) were women. There was a larger proportion of women who received early career awards (15/65; 23.1%) compared to women who received more prestigious mid (1/44; 2.3%) or senior (27/513; 5.3%) career awards. Additionally, 17/43 (39.5%) of female award recipients were not clinical urologists, compared to only 33/579 (5.7%) of male award recipients. CONCLUSIONS Despite increased representation by women in the field of urology, women remain underrepresented in awards given by the AUA. Although the proportion of women receiving awards over time has increased, it remains less than expected given the increased proportion of practicing female urologists. Strategic initiatives should be employed to help advance women in academic urology.
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Affiliation(s)
- Jessica Wenzel
- Oregon Health and Sciences University, Department of Urology, Portland, Oregon 97239
| | - Anne Dudley
- Connecticut Children's Hospital, University of Connecticut Medical School, Division of Urology, Hartford, Connecticut 06106
| | - Rebecca Agnor
- Oregon Health and Sciences University, Department of Urology, Portland, Oregon 97239
| | - Solange Bassale
- Oregon Health and Sciences University, Department of Urology, Portland, Oregon 97239
| | - Yiyi Chen
- Oregon Health and Sciences University, Department of Urology, Portland, Oregon 97239
| | - Courtney Rowe
- Connecticut Children's Hospital, University of Connecticut Medical School, Division of Urology, Hartford, Connecticut 06106
| | - Casey A Seideman
- Oregon Health and Sciences University, Department of Urology, Portland, Oregon 97239.
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Haslam RE, Collins A, Martin LH, Bassale S, Chen Y, Seideman CA. Perceptions of gender equity in pediatric urology. J Pediatr Urol 2021; 17:406.e1-406.e7. [PMID: 33558178 DOI: 10.1016/j.jpurol.2021.01.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Revised: 01/08/2021] [Accepted: 01/14/2021] [Indexed: 11/18/2022]
Abstract
INTRODUCTION/OBJECTIVE Women constitute more than 50% of medical students in the United States. However, only 9.9% of practicing urologists are women, with much fewer numbers in high ranking appointments and positions of leadership. With a growing number of women in pediatric urology, we sought to evaluate how pediatric urologists perceive the climate for women physicians and compare perceptions and experiences of gender equity based on characteristics including gender, practice type, parental status, and years in practice. STUDY DESIGN An IRB approved survey was sent out to the Society of Pediatric Urology (SPU) listserve of active members. We utilized a validated study, the Culture Conducive to Women's Academic Success questionnaire (CCWAS, higher scores indicating better perceived culture toward women). Subcategories (equal access, work-life balance, freedom of gender bias, and leadership support) were also analyzed. A comment section was provided for respondents to include their own experiences. Descriptive statistics were used for demographics and clinical characteristics. Wilcoxon Rank-Sum and Kruskal-Wallace tests were used to compare CCWAS scores between groups. RESULTS A total of 116 practicing physicians returned completed surveys for analysis (response rate, 116/355 (33%) [ n = 41,35.3%] female [n = 75,64.7%] male). There was a statistically significant difference in total CCWAS score between male and female genders, indicating male physicians perceived the culture of their department toward women more positively than their female counterparts (median [ interquartile range] CCWAS score, 208.0 [189.0-228.0] vs 164.0 [136.0-190.3]; P < 0.0001). There was no significant difference in CCWAS scores based on years in practice, parental status, or academic versus private practice. DISCUSSION Limitations of our survey include both participation and non-response bias. Those with strong opinions may have been more likely to respond to the survey. Male respondents comprised 64.7% (n = 75) of overall respondents, representing 25% active male SPU members. Whereas the response rate of active female members of the SPU was 70%. The survey was designed to assess gender equity in academia, and may not be as generalizable to the private practice community. Yet, the differences in perceptions and experiences of gender equity of this study have been noted by studies in other specialties, as well as the 2018 AUA Census report, and may provide insight into the presence and perpetuation of unconscious or systemic biases within medicine. CONCLUSION In this study, male physician perceptions of gender equity were different from those reported by female physicians, suggesting there are gender-based differences in how gender inequities are perceived and experienced.
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Affiliation(s)
- Roxanne E Haslam
- Oregon Health and Science University 3303 SW Bond Avenue, CH10U, Portland, OR, 97239, USA.
| | - Austin Collins
- Biostatistics Shared Resources, Knight Cancer Institute, 2720 SW Moody Avenue, KCRB 4133 Portland, OR, 97201, USA
| | - Leigh H Martin
- Oregon Health and Science University 3303 SW Bond Avenue, CH10U, Portland, OR, 97239, USA
| | - Solange Bassale
- Biostatistics Shared Resources, Knight Cancer Institute, 2720 SW Moody Avenue, KCRB 4133 Portland, OR, 97201, USA
| | - Yiyi Chen
- Biostatistics Shared Resources, Knight Cancer Institute, 2720 SW Moody Avenue, KCRB 4133 Portland, OR, 97201, USA
| | - Casey A Seideman
- Doernbecher Children's Hospital, Oregon Health and Science University, 700 SW Campus Drive, Portland, OR, 97239 USA
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Shoureshi PS, Rajasegaran A, Kokorowski P, Sparks SS, Seideman CA. Social media engagement, perpetuating selected information, and accuracy regarding CA SB-201: Treatment or intervention on the sex characteristics of a minor. J Pediatr Urol 2021; 17:372-377. [PMID: 33663998 DOI: 10.1016/j.jpurol.2021.01.047] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Revised: 01/28/2021] [Accepted: 01/29/2021] [Indexed: 12/15/2022]
Abstract
INTRODUCTION Disorders/differences of sex development (DSD) is a medical term used to encompass patients born with congenital conditions that lead to atypical development of the genitalia and reproductive structures. OBJECTIVE To evaluate the factual accuracy of shared articles from popular social media platforms regarding the California State Bill, SB-201, Treatment or Intervention: Sex Characteristics of a Minor. DESIGN We used the BuzzSumo© search engine to analyze the terms "SB 201", "intersex," "DSD," and "surgery ban" for worldwide social media engagement (Facebook, Twitter, Pinterest, and Reedit) one month before and after bill introduction on January 31, 2019, and final hearing on January 13, 2020. Articles were categorized based on source, opinion of the author, accuracy of scientific information, use of term intersex versus disorder/difference of sex development (DSD), definition of intersex, advocacy group quoted, reference to surgical "gender assignment," mention of negative consequences of the bill/other banned surgeries, the definition of medical necessity, parental rights, psychosocial concerns, and photographic content. RESULTS Twenty unique articles with peak activity were analyzed. Eighteen were from news and two from editorial web sources. All mentioned SB-201.50% were classified as one-sided, meaning both arguments for and against were not presented. 60% of articles were perpetuating selected information correlating with the author's opinion. 65% of articles were misleading in terms of factual accuracy. All articles used the term intersex. 20% of articles used scientific terms such as atypical genitalia (2), DSD (2), and born with variations of sex characteristics (1). A urologist was quoted in 45% of articles, while 75% quoted intersex advocacy groups. 55% of articles referred to the surgeries as "gender normalizing," and 75% referred to "assigning gender". Three articles mentioned other non-DSD surgeries that SB-201 would ban in addition to any that "normalize appearance." 45% (9) included any definition of medical necessity, the most common being inability to urinate (7), which is incompatible with post-natal viability. DISCUSSION Our study demonstrates that some of the most disseminated information on social media surrounding the introduction and hearing of SB-201 that did not include input from the medical community, perpetuated selected information, and lacked appropriate factual content. CONCLUSION Misinformation in the media can be harmful to patients and the general public. This study highlights the need for balanced and accurate reporting on medical topics that can have emotional and political consequences when speaking to broader audiences.
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Affiliation(s)
| | - Abirami Rajasegaran
- Texas Tech University Health Sciences Center, School of Medicine, Lubbock, TX, USA
| | - Paul Kokorowski
- Division of Pediatric Urology Children's Hospital Los Angeles, Keck School of Medicine, University of Southern California, USA
| | - Stephen S Sparks
- Division of Pediatric Urology Children's Hospital Los Angeles, Keck School of Medicine, University of Southern California, USA
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Jiang DD, Chakiryan NH, Gillis KA, Acevedo AM, Chen Y, Austin JC, Seideman CA. Relative value units do not adequately account for operative time in pediatric urology. J Pediatr Surg 2021; 56:883-887. [PMID: 32732162 DOI: 10.1016/j.jpedsurg.2020.06.043] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 06/12/2020] [Accepted: 06/26/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Relative value units (RVUs) are the measure of value used in United States Medicare and Medicaid reimbursement. The Relative Update Committee (RUC) determines physician work RVU (wRVUs) based on operative time, technical skill and effort, mental effort and judgment, and stress. The primary aim of this study was to assess whether operative time is adequately accounted for in the wRVU system in pediatric urology. METHODS The American College of Surgeons National Surgical Quality Improvement Program Pediatric Participant User File (ACS-NSQIPP-PUF) was reviewed from 2012 to 2017. Most common single pediatric urology current procedural terminology (CPT) codes were included. The primary variable was wRVU per hour of operative time (wRVU/h). Linear regression analysis was used to assess the relative influence that operative time had on wRVU/h. RESULTS 25,432 cases were included in the final study population from 45 unique CPT codes. The median operative time was 79 min, and the median RVU/h was 12.2. Procedures with operative time less than 79 min had higher wRVU/h compared with procedures longer than 79 min (14.5 vs 10.5, p < 0.001). Procedures with higher than average incidence of any complications had a lower wRVU/h (9.0 vs. 14.6 p < 0.001). Linear regression analysis revealed that each additional hour of operative time was expected to decrease wRVU/h by 4.2 (-0.70 per 10 min, 95% CI: -0.71 to -0.69, p < 0.001; R2 = 0.39). CONCLUSION This analysis of contemporary large pediatric population national-level data suggests that the wRVU system significantly favors shorter and less complex procedures in Pediatric Urology. Pediatric urologists performing longer and more complex procedures are not adequately compensated for the increase in complexity. EVIDENCE LEVEL III Retrospective comparative study.
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Affiliation(s)
- Da David Jiang
- Oregon Health & Science University, Department of Urology, Portland, Oregon; O'Brien Research Group, Portland, Oregon.
| | - Nicholas H Chakiryan
- Oregon Health & Science University, Department of Urology, Portland, Oregon; O'Brien Research Group, Portland, Oregon
| | - Kyle A Gillis
- Oregon Health & Science University, Department of Urology, Portland, Oregon; O'Brien Research Group, Portland, Oregon
| | | | - Yiyi Chen
- Oregon Health & Science University, Department of Urology, Portland, Oregon
| | - J Christopher Austin
- Oregon Health & Science University, Department of Urology, Portland, Oregon; Doernbecher Children's Hospital, Department of Pediatric Urology, Portland, Oregon
| | - Casey A Seideman
- Oregon Health & Science University, Department of Urology, Portland, Oregon; Doernbecher Children's Hospital, Department of Pediatric Urology, Portland, Oregon
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Hougen HY, Goodstein FR, Bassale S, Chen Y, Seideman CA, Isharwal S. Gender Representation in American Urological Association Guidelines. Urology 2021; 156:47-51. [PMID: 33676953 DOI: 10.1016/j.urology.2021.02.027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2020] [Revised: 02/16/2021] [Accepted: 02/23/2021] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To study patterns and factors associated with female representation in the American Urological Association (AUA) guidelines. METHODS We gathered publicly available information about the panelists, including the AUA section, practice setting, academic rank, fellowship training, years in practice, and H-index. The factors associated with the proportion of female panelists and trends were investigated. We also examined the proportion of female panelists in the European Association of Urology (EAU) and National Comprehensive Cancer Network (NCCN) urology guidelines. RESULTS There were 483 non-unique panelists in AUA guidelines, and 17% are female. Non-urologist female panelists in AUA guidelines represented a higher proportion than female urologists (30% vs 13%, P<0.0001). Compared with male panelists, females had lower H-indices (median 23 vs 35, P<0.001), and fewer were fellowship-trained (77.2% vs 86.8%; P=0.042). On multivariate analysis, non-urologists and panelists with lower H-indices were more likely to be female but there was no association between guideline specialties, academic ranking, geographic section, years in practice, and fellowship training with increased female authorship. Overtime, the proportion of female participation in guidelines remained stable. In the EAU and NCCN guideline panels, 12.2% and 10.7% were female, respectively. CONCLUSION Female representation among major urologic guidelines members is low and unchanged overtime. Female urologist participation was proportional to their representation in the urology workforce. Being a non-urologist and lower H-indices were associated with female membership in guideline panels.
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Affiliation(s)
- Helen Y Hougen
- Department of Urology, Oregon Health and Science University, Portland, OR.
| | | | - Solange Bassale
- Biostatistics Shared Resources, Knight Cancer Institute, Oregon Health and Science University, Portland, OR
| | - Yiyi Chen
- Biostatistics Shared Resources, Knight Cancer Institute, Oregon Health and Science University, Portland, OR
| | - Casey A Seideman
- Division of Pediatric Urology, Department of Urology, Oregon Health and Science University, Portland, OR
| | - Sudhir Isharwal
- Department of Urology, Oregon Health and Science University, Portland, OR
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Haslam RE, Seideman CA. Educational Value of YouTube Surgical Videos of Pediatric Robot-Assisted Laparoscopic Pyeloplasty: A Qualitative Assessment. J Endourol 2020; 34:1129-1133. [DOI: 10.1089/end.2020.0102] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Affiliation(s)
- Roxanne E. Haslam
- Department of Urology, Oregon Health and Science University, Portland, Oregon, USA
| | - Casey A. Seideman
- Department of Urology, Doernbecher Children's Hospital, Oregon Health and Science University, Portland, Oregon, USA
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Jiang DD, Gillis KA, Chakiryan NH, Acevedo AM, Austin JC, Seideman CA. Work relative value units do not account for complexity and operative time in hypospadias surgery. J Pediatr Urol 2020; 16:459.e1-459.e5. [PMID: 32451244 DOI: 10.1016/j.jpurol.2020.04.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Revised: 04/22/2020] [Accepted: 04/29/2020] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Relative value units (RVU) are the measure of value used in United States Medicare and Medicaid reimbursement. The Relative Update Committee (RUC) determine physician work RVU (wRVU) based on operative time, technical skill and effort, mental effort and judgement, and stress. In theory, wRVU should account for the complexity and operative time involved in a procedure. OBJECTIVE The primary aim of this study is to assess if operative time and complexity of hypospadias surgery is adequately accounted for by the current wRVU assignments. STUDY DESIGN The American College of Surgeons National Surgical Quality Improvement Program Participant User File (ACS-NSQIP PUF) database was utilized from 2012 to 2017. Single stage hypospadias current procedural terminology (CPT) codes (including acceptable secondary CPT codes) were extracted. Using total wRVU and total operative time, the primary variable of wRVU per hour was calculated (wRVU/hr). Multivariable linear regression analysis was used to assess the relative influence that wRVU and operative time had on the wRVU/hr variable. RESULTS 9810 cases were included in the final study population divided into four categories: simple distal (eg. MAGPI, V-Flap), single stage distal, single stage mid, single stage proximal. On analysis of variance, there was statistically significant different wRVU/hr for the four different types of hypospadias repairs with simple distal having the highest mean wRVU/hr of 19.5 and the lowest being proximal hypospadias repairs at 13.2. Simple distal, distal and midshaft hypospadias had statistically significantly higher wRVU/hr compared to proximal hypospadias (16.2, 95% CI: 15.8-16.5 vs. 13.2, 95% CI 10.9-15.5; p<0.001). Multivariable linear regression revealed that each additional hour of operative time was expected to decrease wRVU/hr by 10.5 (-10.5, 95% CI: -11.0 to -10.1, p < 0.001); total work wRVU had a statistically significant independent association with wRVU/hr (0.6, 95%CI: 0.5-0.7, p <0.001). DISCUSSION This the first objective assessment of the current wRVU assignments with regards to one stage hypospadias repairs. More complex and longer hypospadias procedures are not adequately compensated by wRVU. Most notably, simple distal procedures are reimbursed at a mean of 19.5 wRVU/hr compared to 13.2 wRVU/hr for one stage proximal repairs. CONCLUSION This analysis of national-level data suggests that the current wRVU assignments significantly favor shorter and simpler procedures in hypospadias surgery.
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Affiliation(s)
- Da David Jiang
- Department of Urology, Oregon Health & Sciences University, Portland, OR, USA; O'Brien Research Group, Portland, OR, USA.
| | - Kyle A Gillis
- Department of Urology, Oregon Health & Sciences University, Portland, OR, USA; O'Brien Research Group, Portland, OR, USA
| | - Nicholas H Chakiryan
- Department of Urology, Oregon Health & Sciences University, Portland, OR, USA; O'Brien Research Group, Portland, OR, USA
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Jiang DD, Chakiryan NH, Gillis KA, Acevedo AM, Austin JC, Seideman CA. Perioperative complications within 30 days of hypospadias surgery: Results from NSQIP-Pediatrics. J Pediatr Urol 2020; 16:316.e1-316.e7. [PMID: 32317234 DOI: 10.1016/j.jpurol.2020.03.026] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Accepted: 03/29/2020] [Indexed: 11/26/2022]
Abstract
INTRODUCTION There are no large multi-institutional studies reporting on perioperative complications of hypospadias repairs. We sought to determine perioperative complications of hypospadias repairs from the National Surgical Quality Improvement Program Pediatrics (NSQIP-P) to aid in patient counseling. STUDY DESIGN This cohort study from 2012 to 2017 was conducted using NSQIP-P database. Pediatric patients undergoing hypospadias surgery were identified and compared based on 4 major categories: distal/midshaft repair, one-stage repair proximal, stage one repair, and stage two repair. Baseline demographics between the four groups and perioperative parameters were compared. Multivariable logistic regression analysis models including type of repair was used to determine associations with overall complications, infectious complications, and dehiscence. DISCUSSION There were 11,292 patients identified in the study population. Overall, 78% underwent distal/midshaft hypospadias repair, 12% underwent one-stage proximal repair, 1.4% underwent proximal first stage repair and 9% underwent proximal second stage repair. Multivariable logistic regression analysis revealed that proximal first stage procedures had similar overall complications to distal/mid repairs but proximal one-stage and proximal second stage procedures were associated with significantly more overall complications, local infectious complications, and dehiscence. Age, race, operative time, prematurity were also independently associated with increased overall complications. As expected, complication rates are higher in those with proximal hypospadias. In staged hypospadias, first stage has a lower complication rate compared to second stage. All complications, especially of infectious and dehiscence are the highest in the one-stage proximal and proximal second stage repairs. CONCLUSION We report large multi-institutional analysis of 30-day peri-operative hypospadias repair complications; this information is useful for patient counseling and education.
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Affiliation(s)
- Da David Jiang
- Department of Urology, Oregon Health & Sciences University, Portland, OR, USA; O'Brien Research Group, Portland, OR, USA.
| | - Nicholas H Chakiryan
- Department of Urology, Oregon Health & Sciences University, Portland, OR, USA; O'Brien Research Group, Portland, OR, USA
| | - Kyle A Gillis
- Department of Urology, Oregon Health & Sciences University, Portland, OR, USA; O'Brien Research Group, Portland, OR, USA
| | | | | | - Casey A Seideman
- Department of Urology, Oregon Health & Sciences University, Portland, OR, USA
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Hougen HY, Seideman CA, Adam MP, Amies Oelschlager AM, Fechner PY, Ramsell L, Shnorhavorian M, Squire A, Austin JC. Congenital virilization of female infants recognized after pregnancies with retained levonorgestrel intrauterine devices. J Pediatr Urol 2020; 16:241-243. [PMID: 32265103 DOI: 10.1016/j.jpurol.2020.03.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Accepted: 03/12/2020] [Indexed: 11/25/2022]
Abstract
The Mirena intrauterine device (IUD) is a hormone-secreting contraceptive device. Pregnancy with the Mirena is rare and effects to the fetus are unknown. Here we present four females with genital virilization after pregnancy with persistent Mirena IUD. All patients had a 46, XX karyotype and normal hormone evaluation. All underwent exam under anesthesia, demonstrating posterior labial fusion and short urogenital sinus with normal bladder, urethra, vagina, and cervix. Three of four patients underwent flap vaginoplasty without complications and good cosmetic outcomes. This series suggests that persistent levonorgestrel-secreting IUD during pregnancy is associated with genital virilization in female fetuses.
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Affiliation(s)
- Helen Y Hougen
- Department of Urology, Oregon Health and Sciences University, 3303 SW Bond Ave. CH10U. Portland, OR, 97239, USA.
| | - Casey A Seideman
- Division of Pediatric Urology, Department of Urology, Oregon Health and Sciences University, 3181 SW Sam Jackson Park Rd. Portland, OR, 97239, USA.
| | - Margaret P Adam
- Division of Genetic Medicine, Department of Pediatrics, University of Washington School of Medicine, 4800 Sand Point Way NE, Seattle, WA, 98105, USA; Seattle Children's Hospital, 4800 Sand Point Way NE, Seattle, WA, 98105, USA.
| | - Anne-Marie Amies Oelschlager
- Department of Obstetrics and Gynecology, University of Washington School of Medicine, 1959 NE Pacific Street, Seattle, WA, 98195, USA.
| | - Patricia Y Fechner
- Seattle Children's Hospital, 4800 Sand Point Way NE, Seattle, WA, 98105, USA; Division of Endocrinology, Department of Pediatrics, University of Washington School of Medicine, 4800 Sand Point Way NE, Seattle, WA, 98105, USA
| | - Linda Ramsell
- Seattle Children's Hospital, 4800 Sand Point Way NE, Seattle, WA, 98105, USA
| | - Margarett Shnorhavorian
- Seattle Children's Hospital, 4800 Sand Point Way NE, Seattle, WA, 98105, USA; Division of Pediatric Urology, Department of Urology, University of Washington School of Medicine, 4800 Sandpoint Way NE, Seattle, WA, 98105, USA.
| | - Audrey Squire
- Seattle Children's Hospital, 4800 Sand Point Way NE, Seattle, WA, 98105, USA
| | - J Christopher Austin
- Division of Pediatric Urology, Department of Urology, Oregon Health and Sciences University, 3181 SW Sam Jackson Park Rd. Portland, OR, 97239, USA.
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Jiang DD, Acevedo AM, Bayne A, Austin JC, Seideman CA. Factors associated with delay in undescended testis referral. J Pediatr Urol 2019; 15:380.e1-380.e6. [PMID: 31072764 DOI: 10.1016/j.jpurol.2019.03.029] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Accepted: 03/29/2019] [Indexed: 10/27/2022]
Abstract
INTRODUCTION Undescended testis (UDT) is one of the most common congenital disorders and is associated with infertility and testicular cancer. Multiple guidelines internationally have recommended orchiopexy by 18 months. Multiple large retrospective studies published in the last decade have found persistent delay in timing of orchiopexy. OBJECTIVE The aim of the study was to determine timing at which UDTs are referred at the tertiary pediatric hospital and assess factors that are associated with delay in UDT referral. STUDY DESIGN Based on clinical observations and previous data, a series of clinical and socio-economic variables were constructed to design a prospective database. All patients who underwent orchiopexy for UDT from March 1, 2017, to August 31, 2018, were reviewed for demographic and clinical data. Referral appointments after 18 months were considered delayed. Factors associated with delay in UDT referral were analyzed using univariate and multivariate analysis with logistic regression. RESULTS One hundred seventy-eight patients underwent orchiopexy for UDT. The median age was 44 months, and 64% of them had delay in referral. On univariate analysis, normal birth testicular examination, diagnosis of 'retractile testicle,' long gap without seeing pediatrician, diagnosis by a new physician, and primary language non-English were associated with delayed UDT referral. On multivariate analysis, delayed referral was associated with normal testicular examination at birth, history of 'retractile testis,' diagnosis not by the regular primary care provider, and other health or social issues that may have led to delay. DISCUSSION This is the first prospective study analyzing timing of referral for boys with cryptorchidism. It was found that timing of treatment of UDT with orchiopexy has not improved over the last decade. Major causes in delay in referral may be due to poor of education of families and lack of routine testicular examinations by referring providers. Secondary ascent may account a significant number of delayed orchiopexy cases. CONCLUSION Most patients at Doernbecher had delayed referral of cryptorchidism. Factors associated with delay were determined. To improve treatment of cryptorchidism, quality-based interventions and the importance of education and routine testicular examinations need to be focused on.
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Affiliation(s)
- D D Jiang
- Department of Urology, Oregon Health & Sciences University, Portland, OR, USA
| | - A M Acevedo
- Department of Urology, Oregon Health & Sciences University, Portland, OR, USA
| | - A Bayne
- Department of Pediatric Urology, Doernbecher, Portland, OR, USA
| | - J C Austin
- Department of Pediatric Urology, Doernbecher, Portland, OR, USA
| | - C A Seideman
- Department of Pediatric Urology, Doernbecher, Portland, OR, USA.
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Palmer LS, Seideman CA, Lotan Y. Cost-effectiveness of antimicrobial prophylaxis for children in the RIVUR trial. World J Urol 2018; 36:1441-1447. [PMID: 29707736 DOI: 10.1007/s00345-018-2302-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Accepted: 04/19/2018] [Indexed: 11/25/2022] Open
Abstract
PURPOSE We evaluated the cost-effectiveness of antimicrobial prophylaxis to prevent recurrent UTIs in children with vesicoureteral reflux based on the RIVUR trial. MATERIALS AND METHODS A decision tree model compared strategies of antimicrobial prophylaxis vs. placebo in children with reflux using results from the RIVUR trial. Risk reduction was 50% based on intention to treat analysis. Costs were based on Medicare reimbursement and data in literature. The model incorporated costs of medications, imaging and complications such as pyelonephritis, likelihood of surgery and loss of work. One- and two-way sensitivity analyses were performed evaluating the effect of changing variables on the cost-effectiveness of antibiotic prophylaxis in preventing recurrent UTIs. RESULTS Mean costs were higher for treatment vs. placebo at $3092 and $2932, respectively, with 12.7 fewer infections per 100 children. One-way sensitivity analyses showed that antibiotics would be cost equivalent if the yearly medical cost was $386, rate of recurrent UTI increased to 32%, antibiotic risk reduction was 63%, or rate of pyelonephritis in the placebo group was 48%. Two-way analyses modifying antibiotic cost, risk reduction of antibiotics and probability of infection showed areas where antibiotics could be more cost-effective than placebo. CONCLUSIONS Antibiotic prophylaxis is associated with marginally higher costs compared with placebo, but significantly fewer infections. A slight decrease in antibiotic cost or increase in recurrent UTIs on placebo may result in prophylaxis being more cost-effective. We recognize that the marginal overall cost in antibiotics may have a substantial impact on the quality of life for the individual patient and family.
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Affiliation(s)
- Lane S Palmer
- Division of Pediatric Urology, Cohen Children's Medical Center of NY, Hofstra Northwell School of Medicine, Long Island, NY, USA
| | - Casey A Seideman
- Division of Pediatric Urology, Cohen Children's Medical Center of NY, Hofstra Northwell School of Medicine, Long Island, NY, USA
| | - Yair Lotan
- Department of Urology, UT Southwestern Medical Center, 5323 Harry Hines Blvd. J8.122, Dallas, TX, 75390-9110, USA.
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Seideman CA, Gitlin JS. T-shaped Shunt With Intracavernosal Tunneling for a Pediatric Case of Refractory Ischemic Priapism. Urology 2016; 110:220-222. [PMID: 27693479 DOI: 10.1016/j.urology.2016.08.047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2016] [Revised: 08/04/2016] [Accepted: 08/08/2016] [Indexed: 11/16/2022]
Abstract
We present the first reported case of refractory pediatric priapism treated by intracavernosal tunneling T shunt. A 12-year-old male, with sickle cell disease, presented with 72 hours of painful erection. The patient failed conservative measures including aspiration, injection of phenylephrine, as well as distal shunt procedure. A T-T shunt was performed, as previously described in the adult literature. There was immediate resolution of the erection with no complications. At 1-year follow-up, he reports no subsequent episodes of priapism and normal erections. T shunt with tunneling can be performed in select cases of severe pediatric refractory ischemic priapism.
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Gahan JC, Richter MD, Seideman CA, Trimmer C, Chan D, Weaver M, Olweny EO, Cadeddu JA. The Performance of a Modified RENAL Nephrometry Score in Predicting Renal Mass Radiofrequency Ablation Success. Urology 2015; 85:125-9. [DOI: 10.1016/j.urology.2014.08.026] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2014] [Revised: 08/03/2014] [Accepted: 08/24/2014] [Indexed: 11/25/2022]
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Tausch TJ, Zhao LC, Morey AF, Siegel JA, Belsante MJ, Seideman CA, Flemons JR. Malleable penile prosthesis is a cost-effective treatment for refractory ischemic priapism. J Sex Med 2014; 12:824-6. [PMID: 25536880 DOI: 10.1111/jsm.12803] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Refractory ischemic priapism (RIP) can be difficult to treat, consuming significant healthcare-related resources. Acute insertion of a malleable penile prosthesis (MPP) has been reported as an effective therapy that treats the priapism and restores sexual function. AIM We report our 6-year, urban public hospital experience with acute insertion of MPP in patients with RIP. METHODS We retrospectively reviewed the records of patients receiving MPPs for RIP from 2007 to 2013. Data analyzed included duration of erection, number of emergency room (ER) visits, hospital admissions, days of hospitalization, and postoperative course. Costs were estimated using standard Medicare reimbursement rates. MAIN OUTCOME MEASURE Healthcare-related costs of treatment of RIP episodes in men presenting to our institution. RESULTS During the study period, 14 men underwent MPP placement acutely for refractory priapism. Thirteen presented with RIP, and one had stuttering priapism over a 14-day hospitalization. Etiologies included sickle cell anemia (4/13, 29%), medication-induced (3/14, 21%), and idiopathic (7/14, 50%). Average preoperative duration of RIP was 82 hours with considerable consumption of health-care resources (average US $83,818 estimated cost, 4 ER visits [range 1-27], 2 hospital admissions [range 1-5], 1.5 shunt procedures [range 1-3], 5 irrigation and drainage procedures using phenylephrine injection [range 2-20], and 5 hospital admission days [range 2-14]). All patients were discharged within 24 hours of MPP surgery. CONCLUSIONS The management of RIP is associated with multiple ER visits, prolonged hospital admissions, and significant resource utilization. MPP insertion is efficacious for the immediate resolution of refractory priapism, with potential cost and resource benefits.
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Affiliation(s)
- Timothy J Tausch
- Department of Urology, UT Southwestern Medical Center, Dallas, TX, USA
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Belsante MJ, Tausch TJ, Seideman CA, Scott JF, Zhao LC, Morey AF. PD20-05 COST EFFECTIVENESS OF ACUTE INSERTION OF MALLEABLE PENILE PROSTHESIS FOR REFRACTORY ISCHEMIC PRIAPISM IN PUBLIC HOSPITAL SETTING. J Urol 2014. [DOI: 10.1016/j.juro.2014.02.1695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Seideman CA, Zhao LC, Hudak SJ, Mierzwiak J, Adibi M, Morey AF. Is prolonged catheterization a risk factor for artificial urinary sphincter cuff erosion? Urology 2013; 82:943-6. [PMID: 24074987 DOI: 10.1016/j.urology.2013.06.044] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2013] [Revised: 06/17/2013] [Accepted: 06/19/2013] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To evaluate the relative risk of prolonged urethral catheterization (PC), >48 hours, on artificial urinary sphincter (AUS) cuff erosion in a tertiary referral population. METHODS All men who had undergone AUS implantation or revision by multiple surgeons at our institution from 2000 to 2010 with ≥6 months of follow-up were reviewed for urethral erosion, catheterization after AUS placement, and comorbid conditions. RESULTS Of the 258 AUS patients reviewed, 200 met the inclusion criteria, with an average follow-up of 24 months. AUS cuff erosions were noted in 24 men (12%) and were diagnosed at a mean of 16.9 months (range 0.8-87.1). PC was identified in 44 of the 200 men (22%)-of these men, erosions occurred in 17 (39%, P <.001). The indication for PC was most often major nongenitourinary surgery (36%) or urinary retention (32%). Univariate analysis identified an increased risk of erosion associated with hypertension, diabetes, coronary artery disease, PC, previous radiotherapy, and secondary AUS placement (P <.05). On multivariate analysis, only PC, radiotherapy, and revision surgery were significant (P <.05), but cuff size and concomitant inflatable penile prosthesis were not associated with AUS cuff erosion. CONCLUSION PC is an independent risk factor for AUS cuff erosion.
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Affiliation(s)
- Casey A Seideman
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX
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Seideman CA, Gahan J, Weaver M, Olweny EO, Richter M, Chan D, Cadeddu JA. Renal tumour nephrometry score does not correlate with the risk of radiofrequency ablation complications. BJU Int 2013; 112:1121-4. [DOI: 10.1111/bju.12276] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Affiliation(s)
- Casey A. Seideman
- Department of Urology; University of Texas Southwestern Medical Center; Dallas TX USA
| | - Jeffrey Gahan
- Department of Urology; University of Texas Southwestern Medical Center; Dallas TX USA
| | - Matthew Weaver
- Department of Urology; University of Texas Southwestern Medical Center; Dallas TX USA
| | - Ephrem O. Olweny
- Department of Urology; University of Texas Southwestern Medical Center; Dallas TX USA
| | - Michael Richter
- Department of Interventional Radiology; University of Texas Southwestern Medical Center; Dallas TX USA
| | - Danny Chan
- Department of Interventional Radiology; University of Texas Southwestern Medical Center; Dallas TX USA
| | - Jeffrey A. Cadeddu
- Department of Urology; University of Texas Southwestern Medical Center; Dallas TX USA
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Seideman CA, Bagrodia A, Gahan J, Cadeddu JA. Robotic-Assisted Pyeloplasty:Recent Developments in Efficacy, Outcomes, and New Techniques. Curr Urol Rep 2012. [DOI: 10.1007/s11934-012-0291-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Dillon BE, Seideman CA, Lee D, Greenberg B, Frohman EM, Lemack GE. A surprisingly low prevalence of demonstrable stress urinary incontinence and pelvic organ prolapse in women with multiple sclerosis followed at a tertiary neurogenic bladder clinic. J Urol 2012; 189:976-9. [PMID: 23022010 DOI: 10.1016/j.juro.2012.09.101] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2012] [Accepted: 09/10/2012] [Indexed: 10/27/2022]
Abstract
PURPOSE We report the prevalence of stress urinary incontinence and pelvic organ prolapse in patients with multiple sclerosis referred to a tertiary care neurogenic bladder clinic. MATERIALS AND METHODS We queried an institutional review board approved neurogenic bladder database for urodynamic and demographic data on patients with multiple sclerosis followed for lower urinary tract symptoms in a 12-year period. Demographic information included multiple sclerosis classification, age at initial visit, body mass index, parity and pelvic examination findings. Prolapse was defined as stage 2 prolapse or greater. Stress urinary incontinence was defined as urodynamic stress incontinence and/or incontinence on a supine stress test. RESULTS Included in analysis were 280 women with a mean age of 50 years and a mean 13-year history of multiple sclerosis. Relapse remitting multiple sclerosis was noted in 40% of patients, while 45 (16%) had stress urinary incontinence. Women with stress urinary incontinence had a higher average maximum urine flow (14 vs 9 ml per second, p <0.003), higher voided volume (272 vs 194 cc, p = 0.018) and higher body mass index (30 vs 25 kg/m(2), p <0.005). Overall, 23 women (9%) had pelvic organ prolapse, including 2 (9%) with posterior prolapse only, 8 (35%) with anterior prolapse only and 13 (56%) with posterior and anterior prolapse. There was no difference in age, body mass index or multiple sclerosis subtype between women with vs without pelvic organ prolapse. CONCLUSIONS The 14% prevalence of demonstrable stress urinary incontinence and 9% rate of pelvic organ prolapse are markedly lower than published historical data on an age matched cohort without multiple sclerosis. The surprisingly low prevalence of stress urinary incontinence and pelvic organ prolapse in women with multiple sclerosis may be attributable to decreased activity, a neurogenically enhanced vesicourethral unit or other functional or anatomical etiologies.
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Affiliation(s)
- Benjamin E Dillon
- Department of Urology, University of Texas Southwestern, Dallas, Texas 75390-9110, USA.
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Affiliation(s)
- Casey A. Seideman
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Joshua P. Sleeper
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Yair Lotan
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, Texas
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Seideman CA, Tan YK, Faddegon S, Park SK, Best SL, Cadeddu JA, Olweny EO. Robot-assisted laparoendoscopic single-site pyeloplasty: technique using the da Vinci Si robotic platform. J Endourol 2012; 26:971-4. [PMID: 22260717 DOI: 10.1089/end.2011.0573] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Conventional laparoscopic dismembered pyeloplasty (LP) is an established alternative to open pyeloplasty given equivalent intermediate-term outcomes and decreased morbidity. Laparoendoscopic single-site (LESS) pyeloplasty has the potential to further decrease the morbidity of LP, while yielding superior cosmesis. It is, however, technically very challenging even with the use of an accessory port, largely because of the difficulty of intracorporeal suturing through a single umbilical incision. Application of the da Vinci robotic surgical platform to LESS pyeloplasty (R-LESS) has the potential to overcome these limitations. We describe our technique for R-LESS pyeloplasty using the da Vinci Si robot. We have found that use of the robotic system in conjunction with certain technique modifications helps to reduce the technical difficulty of LESS pyeloplasty and to shorten the physical learning curve associated with the procedure.
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Affiliation(s)
- Casey A Seideman
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, Texas 75390-9110, USA
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Olweny EO, Park SK, Seideman CA, Best SL, Cadeddu JA. Self-retaining barbed suture for parenchymal repair during laparoscopic partial nephrectomy; initial clinical experience. BJU Int 2011; 109:906-9. [DOI: 10.1111/j.1464-410x.2011.10547.x] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Montag S, Rais-Bahrami S, Seideman CA, Rastinehad AR, Vira MA, Kavoussi LR, Richstone L. Delayed haemorrhage after laparoscopic partial nephrectomy: frequency and angiographic findings. BJU Int 2010; 107:1460-6. [DOI: 10.1111/j.1464-410x.2010.09645.x] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Seideman CA, Richstone L, Reggio E, Bluebond-Langner R, Pinto PA, Trock BJ, Kavoussi LR. PATHOLOGIC FINDINGS IN PATIENTS WITH URETEROPELVIC JUNCTION OBSTRUCTION AND CROSSING VESSELS. J Urol 2009. [DOI: 10.1016/s0022-5347(09)60631-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Seideman CA, Herati AS, Pan S, Cho JS, Cinman N, Tai J, Liu E, Shi E, Vira M. PROGNOSTIC CORRELATION OF CIRCULATING TUMOR CELLS IN THE SETTING OF UROTHELIAL AND RENAL CELL CARCINOMA. J Urol 2009. [DOI: 10.1016/s0022-5347(09)60310-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Richstone L, Seideman CA, Reggio E, Bluebond-Langner R, Pinto PA, Trock B, Kavoussi LR. Reply. Urology 2009. [DOI: 10.1016/j.urology.2008.12.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Seideman CA, Huckabay C, Smith KD, Permpongkosol S, Nadjafi-Semnani M, Lee BR, Richstone L, Kavoussi LR. Laparoscopic ureteral reimplantation: technique and outcomes. J Urol 2009; 181:1742-6. [PMID: 19233424 DOI: 10.1016/j.juro.2008.11.102] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2008] [Indexed: 10/21/2022]
Abstract
PURPOSE We describe our experience with laparoscopic ureteral reimplantation in 45 adults, and report success rates and complications at intermediate term followup. MATERIALS AND METHODS We performed a retrospective chart review of 45 patients who underwent laparoscopic ureteral reimplantation between 1997 and 2007. Demographics, clinicopathological parameters, perioperative course, complications and followup studies were analyzed. RESULTS Elective laparoscopic ureteral reimplantation was performed in 35 female and 10 male patients with a mean followup of 24.1 months (range 1 to 76). All patients presented with distal ureteral stricture with a mean stricture length of 3 cm and a mean +/- SD preoperative serum creatinine of 0.91 +/- 0.04 mg/dl. Mean patient age was 47.8 +/- 2.2 years (range 17 to 87). Mean American Society of Anesthesiologists score was 2 (range 1 to 3). Median estimated blood loss was 150 ml. The overall success rate, defined as radiographic evidence of no residual obstruction, symptoms, renal deterioration or need for subsequent procedures, was 96%. Two patients had recurrent strictures and 1 underwent nephrectomy for flank pain and preexisting chronic pyelonephritis. CONCLUSIONS According to intermediate followup data laparoscopic ureteral reimplantation can be performed with an excellent success rate and low morbidity. Our data substantiate this technique as an effective method for managing distal ureteral stricture.
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Affiliation(s)
- Casey A Seideman
- North Shore-Long Island Jewish Health System, New Hyde Park, New York, USA
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Richstone L, Seideman CA, Reggio E, Bluebond-Langner R, Pinto PA, Trock B, Kavoussi LR. Pathologic findings in patients with ureteropelvic junction obstruction and crossing vessels. Urology 2009; 73:716-9; discussion 719. [PMID: 19193425 DOI: 10.1016/j.urology.2008.10.069] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2008] [Revised: 09/07/2008] [Accepted: 10/09/2008] [Indexed: 12/01/2022]
Abstract
OBJECTIVES To define the role of crossing vessels in the pathophysiology of ureteropelvic junction (UPJ) obstruction, we analyzed the relationship between the presence of crossing vessels and UPJ pathologic findings in patients undergoing laparoscopic pyeloplasty. The significance of crossing renal vessels in patients with UPJ obstruction is unclear. METHODS We performed a retrospective analysis of 155 consecutive patients undergoing laparoscopic pyeloplasty. Pathologic specimens from the UPJ were evaluated in 95 patients. The presence or absence of crossing vessels was documented intraoperatively. The histopathologic findings allowed for categorization into 5 groups: group 1, normal ureteral tissue; group 2, chronic inflammation; group 3, smooth muscle hypertrophy, group 4, fibrosis; and group 5, smooth muscle atrophy. The pathologic findings between patients with and without crossing vessels were compared. RESULTS Overall, crossing vessels were identified in 98 patients (63.2%). Of the 95 cases with specimens retrieved for histologic analysis, 65 had crossing vessels and 30 did not. The most common UPJ histologic finding in patients with crossing vessels was no intrinsic abnormality (43%). In contrast, this was seen in only 10% of patients without a crossing vessel. In the group without crossing vessels, chronic inflammation (40%) was the predominant histologic findings. Patients with a crossing vessel were less likely to have intrinsic histologic pathologic findings (P < .0003). CONCLUSIONS Patients with crossing vessels and UPJ obstruction had no histologic abnormalities identified in 43% of cases. This finding implicates crossing vessels in the pathogenesis of select cases of UPJ obstruction and direct mechanical compression as the etiology of obstruction in these individuals.
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Affiliation(s)
- Lee Richstone
- Smith Institute for Urology, North Shore-Long Island Jewish Health System, New Hyde Park, New York 11040, USA.
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