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Wang Y, Wilder S, Butaney M, Hijazi M, Gandham D, Van Til M, Goldman B, Qi J, Mirza M, Johnson A, Rudoff M, Wenzler D, Rogers CG, Lane BR. Conversion to Radical Nephrectomy From Robotic Partial Nephrectomy Is Most Commonly Due to Anatomic and Oncologic Complexity. J Urol 2024; 211:669-676. [PMID: 38591701 DOI: 10.1097/ju.0000000000003860] [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: 08/21/2023] [Accepted: 01/22/2024] [Indexed: 04/10/2024]
Abstract
PURPOSE Partial nephrectomy is standard-of-care treatment for small renal masses. As utilization of partial nephrectomy increases and includes larger and complex tumors, the risk of conversion to radical nephrectomy likely increases. We evaluated incidence and reason for conversion to radical nephrectomy in patients scheduled for partial nephrectomy by surgeons participating in MUSIC (the Michigan Urologic Surgery Improvement Collaborative). MATERIALS AND METHODS All patients in whom robotic partial nephrectomy was planned were stratified by completed procedure (robotic partial nephrectomy vs radical nephrectomy). Preoperative and intraoperative records were reviewed for preoperative assessment of difficulty and reason for conversion. Patient, tumor, pathologic, and practice variables were compared between cohorts. RESULTS Of 650 patients scheduled for robotic partial nephrectomy, conversion to radical nephrectomy occurred in 27 (4.2%) patients. No conversions to open were reported. Preoperative documentation indicated a plan for possible conversion in 18 (67%) patients including partial with possible radical (n = 8), partial vs radical (n = 6), or likely radical nephrectomy (n = 4). Intraoperative documentation indicated that only 5 (19%) conversions were secondary to bleeding, with the remaining conversions due to tumor complexity and/or oncologic concerns. Patients undergoing conversion had larger (4.7 vs 2.8 cm, P < .001) and higher-complexity tumors (64% vs 6%, P < .001) with R.E.N.A.L. (for radius, exophytic/endophytic, nearness of tumor to collecting system, anterior/posterior, location relative to polar line) nephrometry score ≥ 10. The converted cases had a higher rate of ≥ pT3 (27% vs 8.4%, P = .008). CONCLUSIONS There was a low rate of conversion from robotic partial to radical nephrectomy in the MUSIC-KIDNEY (Kidney mass: Identifying and Defining Necessary Evaluation and therapY) collaborative, and an even lower risk of conversion due to uncontrolled bleeding. Targeted review of each conversion identified appropriate decision-making based on oncologic risk in most cases.
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Affiliation(s)
- Yuzhi Wang
- Vattikuti Urology Institute, Henry Ford Health, Detroit, Michigan
| | - Samantha Wilder
- Vattikuti Urology Institute, Henry Ford Health, Detroit, Michigan
| | - Mohit Butaney
- Vattikuti Urology Institute, Henry Ford Health, Detroit, Michigan
| | - Mahmoud Hijazi
- Department of Urology, University of Michigan Medical School, Ann Arbor, Michigan
| | - David Gandham
- Department of Urology, University of Michigan Medical School, Ann Arbor, Michigan
| | - Monica Van Til
- Department of Urology, University of Michigan Medical School, Ann Arbor, Michigan
| | | | - Ji Qi
- Department of Urology, University of Michigan Medical School, Ann Arbor, Michigan
| | - Mahin Mirza
- Department of Urology, University of Michigan Medical School, Ann Arbor, Michigan
| | - Anna Johnson
- Department of Urology, University of Michigan Medical School, Ann Arbor, Michigan
| | - Michael Rudoff
- Comprehensive Urology, Beaumont Hospital, Royal Oak, Michigan
| | - David Wenzler
- Comprehensive Urology, Beaumont Hospital, Royal Oak, Michigan
| | - Craig G Rogers
- Vattikuti Urology Institute, Henry Ford Health, Detroit, Michigan
| | - Brian R Lane
- Corewell Health Hospital System, Grand Rapids, Michigan
- Michigan State University College of Human Medicine, Grand Rapids, Michigan
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Nam CS, Tooke BP, Strasser O, Hameed MA, Chinnusamy S, Van Til M, Daignault-Newton S, Dupree JM. Antisperm Antibody Levels After Vasectomy Reversal Are Not Associated With Pregnancy Rates or Method of Conception. Urology 2024; 186:154-161. [PMID: 38417465 DOI: 10.1016/j.urology.2024.02.028] [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: 12/02/2023] [Revised: 02/10/2024] [Accepted: 02/21/2024] [Indexed: 03/01/2024]
Abstract
OBJECTIVE To examine the relationship between antisperm antibody (ASA), pregnancy rates, and method of conception following vasectomy reversal, given that before and after vasectomy reversal, patients wonder if ASAs will prevent them from achieving pregnancy and American Urological Association vasectomy guidelines call for additional research to answer this question. METHODS We performed retrospective chart review and phone interview of patients who underwent vasectomy reversal at our institution from 1/1/2000 to 12/31/2018. We excluded patients who underwent vasectomy reversal for pain, or without postoperative semen analysis with ASA. We categorized patients as having low (<50%) or high (≥50%) ASA levels using the first postoperative semen analysis. Our primary outcome was pregnancy rate, including method of conception. Differences in pregnancy rates were tested using Fisher exact test. RESULTS Two hundred and four patients were chart reviewed. Median age at time of surgery was 40years and median obstruction interval was 7.3years. Median partner age was 32years. One hundred sixty-four (80%) patients underwent bilateral vasovasostomy. Eighty-five patients (42%) had low (<50%) ASA levels and 119 (58%) had high (≥50%) ASA levels. Sixty-seven patients completed phone interviews. Of 27 men with low ASA levels, 19 (70%) achieved a pregnancy with 16 (59%) spontaneous pregnancy. Of 40 men with high ASA levels, 30 (75%) achieved a pregnancy with 16 (40%) spontaneous pregnancy. The Fisher exact test P-value was .2. CONCLUSION ASA levels are not associated with pregnancy rate or method of conception after vasectomy reversal. These findings can improve patient counseling before and after vasectomy reversal.
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Affiliation(s)
- Catherine S Nam
- Department of Urology, Michigan Medicine University of Michigan, Ann Arbor, MI.
| | - Benjamin P Tooke
- Department of Urology, University of California Los Angeles, Los Angeles, CA
| | | | - Mujtaba A Hameed
- Department of Urology, Michigan Medicine University of Michigan, Ann Arbor, MI
| | - Sadhana Chinnusamy
- Department of Urology, Michigan Medicine University of Michigan, Ann Arbor, MI
| | - Monica Van Til
- Department of Urology, Michigan Medicine University of Michigan, Ann Arbor, MI
| | | | - James M Dupree
- Department of Urology, Michigan Medicine University of Michigan, Ann Arbor, MI
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Shapiro K, Anger J, Cameron AP, Chung D, Daignault-Newton S, Ippolito GM, Lee U, Mourtzinos A, Padmanabhan P, Smith AL, Suskind AM, Tenggardjaja C, Van Til M, Brucker BM. Antibiotic use, best practice statement adherence, and UTI rate for intradetrusor onabotulinumtoxin-A injection for overactive bladder: A multi-institutional collaboration from the SUFU Research Network (SURN). Neurourol Urodyn 2024; 43:407-414. [PMID: 38032120 DOI: 10.1002/nau.25334] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Revised: 10/11/2023] [Accepted: 11/03/2023] [Indexed: 12/01/2023]
Abstract
INTRODUCTION Onabotulinumtoxin A (BTX-A) is a well-established treatment for overactive bladder (OAB). The American Urological Association (AUA) 2008 Antibiotic Best Practice Statement (BPS) recommended trimethoprim-sulfamethoxazole or fluoroquinolone for cystoscopy with manipulation. The aim of the study was to evaluate concordance with antibiotic best practices at the time of BTX-A injection and urinary tract infection (UTI) rates based on antibiotic regimen. METHODS Men and women undergoing first-time BTX-A injection for idiopathic OAB with 100 units in 2016, within the SUFU Research Network (SURN) multi-institutional retrospective database were included. Patients on suppressive antibiotics were excluded. The primary outcome was concordance of periprocedural antibiotic use with the AUA 2008 BPS antimicrobials of choice for "cystoscopy with manipulation." As a secondary outcome we compared the incidence of UTI among women within 30 days after BTX-A administration. Each outcome was further stratified by procedure setting (office vs. operating room; OR). RESULTS Of the cohort of 216 subjects (175 women, 41 men) undergoing BTX-A, 24 different periprocedural antibiotic regimens were utilized, and 98 (45%) underwent BTX-A injections in the OR setting while 118 (55%) underwent BTX-A injection in the office. Antibiotics were given to 86% of patients in the OR versus 77% in office, and 8.3% of subjects received BPS concordant antibiotics in the OR versus 82% in office. UTI rates did not vary significantly among the 141 subjects who received antibiotics and had 30-day follow-up (8% BPS-concordant vs. 16% BPS-discordant, CI -2.4% to 19%, p = 0.13). A sensitivity analysis of UTI rates based on procedure setting (office vs. OR) did not demonstrate any difference in UTI rates (p = 0.14). CONCLUSIONS This retrospective multi-institutional study demonstrates that antibiotic regimens and adherence to the 2008 AUA BPS were highly variable among providers with lower rates of BPS concordant antibiotic use in the OR setting. UTI rates at 30 days following BTX-A did not vary significantly based on concordance with the BPS or procedure setting.
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Affiliation(s)
- Katherine Shapiro
- Department of Urology, New York University, New York City, New York, USA
| | - Jennifer Anger
- Department of Urology, University of California San Diego, San Diego, California, USA
| | - Anne P Cameron
- Department of Urology, University of Michigan, Ann Arbor, Michigan, USA
| | - Doreen Chung
- Department of Urology, Columbia University Medical Center, New York City, New York, USA
| | | | - Giulia M Ippolito
- Department of Urology, University of Michigan, Ann Arbor, Michigan, USA
| | - Una Lee
- Virginia Mason Medical Center, Seattle, Washington, District of Columbia, USA
| | - Arthur Mourtzinos
- Department of Urology, Lahey Hospital & Medical Center, Burlington, Massachusetts, USA
| | - Priya Padmanabhan
- Department of Urology, William Beaumont University Hospital, Royal Oak, Michigan, USA
| | - Ariana L Smith
- University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Anne M Suskind
- Department of Urology, University of California San Francisco, San Francisco, California, USA
| | | | - Monica Van Til
- Department of Urology, University of Michigan, Ann Arbor, Michigan, USA
| | - Benjamin M Brucker
- Department of Urology, New York University, New York City, New York, USA
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Wang M, Wittenberg S, Cher ML, Van Til M, Ferrante S, Mirza M, Johnson A, Semerjian A, George A, Rogers C, Wilder S, Sarle R, Ghani KR, Lane B, Ginsburg KB. Does Urologist-level Utilization of Active Surveillance for Low-risk Prostate Cancer Correspond with Utilization of Active Surveillance for Small Renal Masses? Eur Urol 2024; 85:101-104. [PMID: 37507241 DOI: 10.1016/j.eururo.2023.07.005] [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: 04/04/2023] [Revised: 06/27/2023] [Accepted: 07/17/2023] [Indexed: 07/30/2023]
Abstract
Active surveillance (AS) for prostate cancer (CaP) or small renal masses (SRMs) helps in limiting the overtreatment of indolent malignancies. Implementation of AS for these conditions varies substantially across individual urologists. We examined the Michigan Urological Surgery Improvement Collaborative (MUSIC) registry to assess for correlation of AS between patients with low-risk CaP and patients with SRM managed by individual urologists. We identified 27 urologists who treated at least ten patients with National Comprehensive Cancer Network low-risk CaP and ten patients with SRMs between 2017 and 2021. For surgeons in the lowest quartile of AS use for low-risk CaP (<74%), 21% of their patients with SRMs were managed with AS, in comparison to 74% of patients of surgeons in the highest quartile (>90%). There was a modest positive correlation between the surgeon-level risk-adjusted proportions of patients managed with AS for low-risk CaP and for SRMs (Pearson correlation coefficient 0.48). A surgeon's tendency to use AS to manage one low-risk malignancy corresponds to their use of AS for a second low-risk condition. By identifying and correcting structural issues associated with underutilization of AS, interventions aimed at increasing AS use may have effects that influence clinical tendencies across a variety of urologic conditions. PATIENT SUMMARY: The use of active surveillance (AS) for patients with low-risk prostate cancer or small kidney masses varies greatly among individual urologists. Urologists who use AS for low-risk prostate cancer were more likely to use AS for patients with small kidney masses, but there is room to improve the use of AS for both of these conditions.
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Affiliation(s)
- Michael Wang
- Department of Urology, Wayne State University, Detroit, MI, USA.
| | | | - Michael L Cher
- Department of Urology, Wayne State University, Detroit, MI, USA
| | - Monica Van Til
- University of Michigan Medical School, Ann Arbor, MI, USA
| | | | - Mahin Mirza
- University of Michigan Medical School, Ann Arbor, MI, USA
| | - Anna Johnson
- University of Michigan Medical School, Ann Arbor, MI, USA
| | | | - Arvin George
- University of Michigan Medical School, Ann Arbor, MI, USA
| | - Craig Rogers
- Vattikuti Urology Institute, Henry Ford Health Systems, Detroit, MI, USA
| | - Samantha Wilder
- Vattikuti Urology Institute, Henry Ford Health Systems, Detroit, MI, USA
| | - Richard Sarle
- Department of Urology, Sparrow Point Hospitals, Lansing, MI, USA
| | | | - Brian Lane
- Division of Urology, Corewell Health, Grand Rapids, MI, USA
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Steigmann L, Gunaratnam S, Giannobile WV, Van Til M, Daignault-Newton S, Herman WH, Gunaratnam N, Katulanda P, Sarma AV. Poor Glycemic Control Increases Dental Risk in a Sri Lankan Population. Healthcare (Basel) 2024; 12:358. [PMID: 38338243 PMCID: PMC10855197 DOI: 10.3390/healthcare12030358] [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] [Received: 11/27/2023] [Revised: 01/23/2024] [Accepted: 01/29/2024] [Indexed: 02/12/2024] Open
Abstract
Introduction: The aim of our study was to investigate the impact of diabetes-related factors on the dental disease outcomes of diabetes patients in Trincomalee, Sri Lanka. Materials and Methods: Dental data were collected from 80 type-2-diabetic individuals. A dental risk score was calculated based on the frequency of dental outcomes observed and categorized as low risk (≤3 dental outcomes) and high risk (>3 dental outcomes). Results: In this cohort of men and women with type 2 diabetes, there was a high frequency of periodontal related outcomes, including missing teeth (70%), gingival recessions (40%), tooth mobility (41%), and bleeding (20%). Thirty-nine (39%) of participants had high dental risk, while forty-nine (61%) had low risk. Conclusions: After controlling for age, participants with higher capillary blood glucose levels had 3-fold greater odds of a high dental risk score (OR = 2.93, 95%CI = 1.13, 7.61). We found that poor glycemic control indicated by elevated capillary blood glucose was associated with increased dental risk.
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Affiliation(s)
- Larissa Steigmann
- Division of Periodontology, Department of Oral Medicine, Infection, and Immunity, Harvard School of Dental Medicine, Boston, MA 02115, USA
| | - Sejal Gunaratnam
- Department of Internal Medicine, University of Michigan School of Medicine, Ann Arbor, MI 48109, USA
| | - William V. Giannobile
- Division of Periodontology, Department of Oral Medicine, Infection, and Immunity, Harvard School of Dental Medicine, Boston, MA 02115, USA
| | - Monica Van Til
- Department of Urology, University of Michigan School of Medicine, Ann Arbor, MI 48109, USA
| | | | - William H. Herman
- Department of Internal Medicine, University of Michigan School of Medicine, Ann Arbor, MI 48109, USA
| | | | - Prasad Katulanda
- Faculty of Medicine, University of Colombo, Colombo 00300, Sri Lanka
| | - Aruna V. Sarma
- Department of Urology, University of Michigan School of Medicine, Ann Arbor, MI 48109, USA
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Wang Y, Wilder S, Van Til M, Qi J, Mirza M, Gadzinski A, Maatman T, Lane BR, Rogers CG. Reply by Authors. Urol Pract 2024; 11:134. [PMID: 38117966 DOI: 10.1097/upj.0000000000000478.04] [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: 07/07/2023] [Accepted: 10/05/2023] [Indexed: 12/22/2023]
Affiliation(s)
- Yuzhi Wang
- Vattikuti Urology Institute, Henry Ford Health, Detroit, Michigan
| | - Samantha Wilder
- Vattikuti Urology Institute, Henry Ford Health, Detroit, Michigan
| | - Monica Van Til
- Department of Urology, University of Michigan Medical School, Ann Arbor, Michigan
| | - Ji Qi
- Department of Urology, University of Michigan Medical School, Ann Arbor, Michigan
| | - Mahin Mirza
- Department of Urology, University of Michigan Medical School, Ann Arbor, Michigan
| | - Adam Gadzinski
- Comprehensive Urology, Beaumont Hospital, Royal Oak, Michigan
| | | | - Brian R Lane
- Corewell Health Hospital System, Grand Rapids, Michigan
- Michigan State University College of Human Medicine, Grand Rapids, Michigan
| | - Craig G Rogers
- Vattikuti Urology Institute, Henry Ford Health, Detroit, Michigan
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Wang Y, Wilder S, Van Til M, Qi J, Mirza M, Gadzinski A, Maatman T, Lane BR, Rogers CG. Practice-Level Variation in Opioid-Free Discharge Following Surgery for T1 Renal Masses: A MUSIC-KIDNEY Analysis. Urol Pract 2024; 11:126-132. [PMID: 37987620 DOI: 10.1097/upj.0000000000000478] [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: 07/07/2023] [Accepted: 10/05/2023] [Indexed: 11/22/2023]
Abstract
INTRODUCTION Opioid prescription following surgery has played a role in the current opioid epidemic. We evaluated practice-level variation in opioid prescribing following surgery for cT1 renal masses and examined the relationships between opioid-free discharge and postoperative emergency department (ED) visits and readmissions. METHODS We retrospectively examined all T1 renal mass (RM) patients with data regarding postoperative opioid prescriptions within the Michigan Urological Surgery Improvement Collaborative-Kidney Mass: Identifying and Defining Necessary Evaluation and Therapy (MUSIC-KIDNEY) registry from April 2021 to March 2023. Patients were stratified into those who received opioids at discharge and those with opioid-free discharge. Associations with patient, tumor, and surgical factors were evaluated. Rates of postoperative ED visits and readmissions within 30 days were compared between cohorts. Practice-level variation was assessed. RESULTS Of 414 patients who underwent surgery for T1 RM across 15 practices in MUSIC-KIDNEY, 23.7% had opioid-free discharge. Practice-level variation in rates of opioid-free discharge ranged from 6.7% to 55.0%. For patients prescribed opioids, the median number of pills was 10 (IQR 6-12). Patients with cT1b masses were more likely to have opioid-free discharge (44.9% vs 32%, OR 0.44; 95% CI 0.22-0.89). Rates of 30-day ED visits (7.0% vs 3.1%) and readmissions (4.1% vs 2.0%) were lower in the opioid-free discharge group but did not reach statistical significance. CONCLUSIONS MUSIC-KIDNEY data suggest opioid-free discharge is not associated with increased rates of postoperative ED visits or readmissions. There exists wide practice-level variation in opioid prescriptions following surgery for T1 RM in the state of Michigan. Similar variation likely exists throughout the United States, and best surgical practice suggests reduction in opioid prescribing after nephrectomy.
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Affiliation(s)
- Yuzhi Wang
- Vattikuti Urology Institute, Henry Ford Health, Detroit, Michigan
| | - Samantha Wilder
- Vattikuti Urology Institute, Henry Ford Health, Detroit, Michigan
| | - Monica Van Til
- Department of Urology, University of Michigan Medical School, Ann Arbor, Michigan
| | - Ji Qi
- Department of Urology, University of Michigan Medical School, Ann Arbor, Michigan
| | - Mahin Mirza
- Department of Urology, University of Michigan Medical School, Ann Arbor, Michigan
| | - Adam Gadzinski
- Comprehensive Urology, Beaumont Hospital, Royal Oak, Michigan
| | | | - Brian R Lane
- Corewell Health Hospital System, Grand Rapids, Michigan
- Michigan State University College of Human Medicine, Grand Rapids, Michigan
| | - Craig G Rogers
- Vattikuti Urology Institute, Henry Ford Health, Detroit, Michigan
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Glick H, Claflin J, Heximer A, Fiestan GO, Varon D, Daignault-Newton S, Van Til M, Wan J, Kraft KH. Testicular catch-up growth in the non-operative management of the adolescent varicocele. J Pediatr Urol 2023; 19:652.e1-652.e6. [PMID: 37394305 DOI: 10.1016/j.jpurol.2023.06.003] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Revised: 05/05/2023] [Accepted: 06/05/2023] [Indexed: 07/04/2023]
Abstract
INTRODUCTION Adolescent varicocele is a common urologic condition with a spectrum of outcomes, leading to variations in management. Testicular hypotrophy is a common indication for surgery Routine monitoring may be an appropriate form of management for many adolescents with testicular hypotrophy, as studies have shown that a large proportion of these patients may experience catch-up growth of the ipsilateral testis. Furthermore, there are few longitudinal studies which have correlated patient specific factors to catch-up growth. We aimed to determine the frequency of testicular catch up-growth in adolescents with varicocele while also examining if patient specific factors such as BMI, BMI percentile, or height correlated with testicular catch-up growth. METHODS A retrospective chart review found adolescent patients who presented to our institution with varicocele from 1997 to 2019. Patients between the ages of 9 and 20 years with left-sided varicocele, a clinically significant testicular size discrepancy, and at least two scrotal ultrasounds at least one year apart were included in analysis. Testicular size discrepancy of greater than 15% on scrotal ultrasound was considered clinically significant. Testicular size was estimated in volume (mL) via the Lambert formula. Statistical relationships between testicular volume differential and height, body mass index (BMI), and age were described with Spearman correlation coefficients (ρ). RESULTS 40 patients had a testicular volume differential of greater than 15% at some point during their clinical course and were managed non-operatively with observation and serial testicular ultrasounds. On follow-up ultrasound, 32/40 (80%) had a testicular volume differential of less than 15%, with a mean age of catch up growth at 15 years (SD 1.6, range 11-18 years). There were no significant correlations between baseline testicular volume differential and baseline BMI (ρ = 0.00, 95% CI [-0.32, 0.32]), baseline BMI percentile (ρ = 0.03, 95% CI [-0.30, 0.34]), or change in height over time (ρ = 0.05, 95% CI [-0.36, 0.44]). DISCUSSION The majority of adolescents with varicocele and testicular hypotrophy exhibited catch-up growth with observation, suggesting that surveillance is an appropriate form of management in many adolescents. These findings are consistent with previous studies and further indicate the importance of observation for the adolescent varicocele. Further research is warranted to determine patient specific factors that correlate with testicular volume differential and catch up growth in the adolescent varicocele.
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Affiliation(s)
- Hannah Glick
- Department of Urology, University of Michigan, Ann Arbor, MI, USA
| | - Jake Claflin
- Department of Urology, University of Michigan, Ann Arbor, MI, USA
| | - Alisha Heximer
- Department of Urology, University of Michigan, Ann Arbor, MI, USA
| | | | - David Varon
- Department of Urology, University of Michigan, Ann Arbor, MI, USA
| | | | - Monica Van Til
- Department of Urology, University of Michigan, Ann Arbor, MI, USA
| | - Julian Wan
- Department of Urology, University of Michigan, Ann Arbor, MI, USA
| | - Kate H Kraft
- Department of Urology, University of Michigan, Ann Arbor, MI, USA.
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Butaney M, Wilder S, Patel AK, Qi J, Mirza M, Noyes SL, Johnson A, Van Til M, Jafri SM, Ginsburg KB, Rogers CG, Lane BR. Initial Management of Indeterminate Renal Lesions in a Statewide Collaborative: A MUSIC-KIDNEY Analysis. J Urol 2023; 210:79-87. [PMID: 36947795 DOI: 10.1097/ju.0000000000003433] [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: 09/23/2022] [Accepted: 03/14/2023] [Indexed: 03/24/2023]
Abstract
PURPOSE Renal masses can be characterized as "indeterminate" due to lack of differentiating imaging characteristics. Optimal management of indeterminate renal lesions remains nebulous and poorly defined. We assess management of indeterminate renal lesions within the MUSIC-KIDNEY (Michigan Urological Surgery Improvement Collaborative-Kidney mass: Identifying and Defining Necessary Evaluation and therapY) collaborative. MATERIALS AND METHODS Each renal mass is classified as suspicious, benign, or indeterminate based on radiologist and urologist assessment. Objectives were to assess initial management of indeterminate renal lesions and the impact of additional imaging and biopsy on characterization prior to treatment. RESULTS Of 2,109 patients, 444 (21.1%) had indeterminate renal lesions on their initial imaging, which included CT without contrast (36.2%), CT with contrast (54.1%), and MRI (9.7%). Eighty-nine patients (20.0%) underwent additional imaging within 90 days, 8.3% (37/444) underwent renal mass biopsy, and 3.6% (16/444) had reimaging and renal mass biopsy. Additional imaging reclassified 58.1% (61/105) of indeterminate renal lesions as suspicious and 21.0% (22/105) as benign, with only 20.9% (22/105) remaining indeterminate. Renal mass biopsy yielded a definitive diagnosis for 87%. Treatment was performed for 149 indeterminate renal lesions (33.6%), including 117 without reimaging and 123 without renal mass biopsy. At surgery for indeterminate renal lesions, benign pathology was more common in patients who did not have repeat imaging (9.9%) than in those who did (6.7%); for ≤4 cm indeterminate renal lesions, these rates were 11.8% and 4.3%. CONCLUSIONS About 33% of patients diagnosed with an indeterminate renal lesion underwent immediate treatment without subsequent imaging or renal mass biopsy, with a 10% rate of nonmalignant pathology. This highlights a quality improvement opportunity for patients with cT1 renal masses: confirmation that the lesion is suspicious for renal cell carcinoma based on high-quality, multiphase, cross-sectional imaging and/or histopathological features prior to surgery, even if obtaining subsequent follow-up imaging and/or renal mass biopsy is necessary. When performed, these steps lead to reclassification in 79% and 87% of indeterminate renal lesions, respectively.
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Affiliation(s)
| | | | | | - Ji Qi
- Department of Urology, University of Michigan Medical School, Ann Arbor, Michigan
| | - Mahin Mirza
- Department of Urology, University of Michigan Medical School, Ann Arbor, Michigan
| | | | - Anna Johnson
- Department of Urology, University of Michigan Medical School, Ann Arbor, Michigan
| | - Monica Van Til
- Department of Urology, University of Michigan Medical School, Ann Arbor, Michigan
| | | | | | | | - Brian R Lane
- Spectrum Health Hospital System, Grand Rapids, Michigan
- Michigan State University College of Human Medicine, Grand Rapids, Michigan
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Cousins MM, Van Til M, Steppe E, Ng S, Ellimoottil C, Sun Y, Schipper M, Evans JR. Age, race, insurance type, and digital divide index are associated with video visit completion for patients seen for oncologic care in a large hospital system during the COVID-19 pandemic. PLoS One 2022; 17:e0277617. [PMID: 36395112 PMCID: PMC9671352 DOI: 10.1371/journal.pone.0277617] [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] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Accepted: 10/31/2022] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION The COVID-19 pandemic drove rapid adoption of telehealth across oncologic specialties. This revealed barriers to telehealth access and telehealth-related disparities. We explored disparities in telehealth access in patients with cancer accessing oncologic care. MATERIALS/METHODS Data for all unique patient visits at a large academic medical center were acquired pre- and intra-pandemic (7/1/2019-12/31/2020), including visit type (in-person, video, audio only), age, race, ethnicity, rural/urban (per zip code by Federal Office of Rural Health Policy), distance from medical facility, insurance, and Digital Divide Index (DDI; incorporates technology/internet access, age, disability, and educational attainment metrics by geographic area). Pandemic phases were identified based on visit dynamics. Multivariable logistic regression models were used to examine associations of these variables with successful video visit completion. RESULTS Data were available for 2,398,633 visits for 516,428 patients across all specialties. Among these, there were 253,880 visits from 62,172 patients seen in any oncology clinic. Dramatic increases in telehealth usage were seen during the pandemic (after 3/16/2020). In multivariable analyses, patient age [OR: 0.964, (95% CI 0.961, 0.966) P<0.0001], rural zip code [OR: 0.814 (95% CI 0.733, 0.904) P = 0.0001], Medicaid enrollment [OR: 0.464 (95% CI 0.410, 0.525) P<0.0001], Medicare enrollment [OR: 0.822 (95% CI 0.761, 0.888) P = 0.0053], higher DDI [OR: 0.903 (95% CI 0.877, 0.930) P<0.0001], distance from the facility [OR: 1.028 (95% CI 1.021, 1.035) P<0.0001], black race [OR: 0.663 (95% CI 0.584, 0.753) P<0.0001], and Asian race [OR: 1.229 (95% CI 1.022, 1.479) P<0.0001] were associated with video visit completion early in the pandemic. Factors related to video visit completion later in the pandemic and within sub-specialties of oncology were also explored. CONCLUSIONS Patients from older age groups, those with minority backgrounds, and individuals from areas with less access to technology (high DDI) as well as those with Medicare or Medicaid insurance were less likely to use video visits. With greater experience through the pandemic, disparities were not mitigated. Further efforts are required to optimize telehealth to benefit all patients and avoid increasing disparities in care delivery.
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Affiliation(s)
- Matthew M. Cousins
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan, United States of America
- * E-mail: ,
| | - Monica Van Til
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan, United States of America
- Department of Biostatistics, University of Michigan, Ann Arbor, Michigan, United States of America
| | - Emma Steppe
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan, United States of America
| | - Sophia Ng
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan, United States of America
| | - Chandy Ellimoottil
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan, United States of America
- Department of Urology, University of Michigan, Ann Arbor, Michigan, United States of America
| | - Yilun Sun
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan, United States of America
- Department of Biostatistics, University of Michigan, Ann Arbor, Michigan, United States of America
| | - Matthew Schipper
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan, United States of America
- Department of Biostatistics, University of Michigan, Ann Arbor, Michigan, United States of America
| | - Joseph R. Evans
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan, United States of America
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