430 Background: Malignant melanoma of the female urethra accounts for less than 1% of all melanoma and less than 4% of urethral cancer. Due to limited data regarding management and outcomes of this condition, we evaluated the management and outcomes of urethral melanoma in females over the last 20 years at our institution. Methods: Patients were identified via retrospective review of the medical record. Those with metastatic disease at initial diagnosis were excluded. We evaluated primary and adjuvant treatments, disease recurrence and overall survival. Results: Fifteen women (median age 71, range 55, 82) were identified. Majority of masses involved the distal urethra (86.6%). All patients underwent primary surgical resection (60.0% partial urethrectomy, 40.0% radical urethrectomy). Disease recurrence and metastatic spread occurred in 73.3% (median 7 months, IQR 4, 12) and 60% (median 6 months, IQR 3, 9) of patients, respectively. 90.9% of patients with recurrence received adjuvant therapy: 5 chemotherapy and radiation, 4 chemotherapy only, 1 anterior exenteration. Of the 9 patients undergoing chemotherapy, treatment regimens were varied and included checkpoint inhibitors (2/9), platinum-based chemotherapy (3/9), tyrosine kinase inhibitors (2/9), taxels (2/9), and alkylating agents (1/9). Median overall survival was 27 months (IQR 7.5, 57.5). Conclusions: Malignant melanoma of the urethra is locally aggressive with a high likelihood of recurrence and metastases resulting in poor long-term survival. Despite high recurrence rates, our data highlight the lack of consensus adjuvant treatment regimens. Future research is required to identify neoadjuvant, combination, and adjuvant treatment approaches to improve disease outcomes.

Purpose: The purpose of this guideline is to provide a clinical framework for the diagnosis and treatment of non-neurogenic overactive bladder (OAB). Materials & Methods: The primary source of evidence for the original version of this guideline was the systematic review and data extraction conducted as part of the Agency for Healthcare Research and Quality (AHRQ) Evidence Report/Technology Assessment Number 187 titled Treatment of Overactive Bladder in Women (2009). That report was supplemented with additional searches capturing literature published through December 2011. Following initial publication, this guideline underwent amendment in 2014 and 2018. The current document reflects relevant literature published through October 2018. Results: When sufficient evidence existed, the body of evidence for a particular treatment was assigned a strength rating of A (high), B (moderate), or C (low). Such statements are provided as Standards, Recommendations, or Options. In instances of insufficient evidence, additional guidance information is provided as Clinical Principles and Expert Opinions. Conclusions: The evidence-based statements are provided for diagnosis and overall management of OAB, as well as for the various treatments. Diagnosis and treatment methodologies can be expected to change as the evidence base grows and as new treatment strategies become obtainable.

Objective The objective of the study was to evaluate the utility of urodynamic studies performed before primary midurethral sling placement for stress urinary incontinence in predicting the need for subsequent sling release for voiding dysfunction. Methods The health records of women managed with primary synthetic midurethral sling placement at Mayo Clinic (Rochester, MN) from January 1, 2002, to December 31, 2012, were reviewed. The primary outcome was surgical sling release for postoperative voiding dysfunction (ie, prolonged retention, elevated postvoid residual volumes with new voiding symptoms, or de novo onset or worsening of overactive bladder symptoms). Logistic regression models were used to evaluate associations between potential clinical risk factors and the primary outcome. Results Overall, 1629 women underwent primary synthetic midurethral sling placement during the study time frame, including 1081 patients (66%) who underwent a preoperative multichannel urodynamic evaluation. A sling release for voiding dysfunction was performed for 51 patients (3.1%) at a median of 1.9 months postoperatively (interquartile range, 1.3–9.3 months). Patients undergoing sling release were significantly more likely to have had retropubic sling placement ( P = 0.003) and concomitant prolapse surgery ( P = 0.005). On univariate analysis, no urodynamic parameters were associated with the risk of sling release; evaluated parameters included peak flow rate ( P = 0.20), postvoid residual volume ( P = 0.37), voiding without detrusor contraction ( P = 0.96), and detrusor pressure at maximal flow ( P = 0.23). Conclusions Sling release for voiding dysfunction was rare in our cohort. No urodynamic parameters were associated with the risk of sling release.

PURPOSE:There has been a marked increase in testosterone prescriptions in the past decade resulting in a growing need to give practicing clinicians proper guidance on the evaluation and management of the testosterone deficient patient.MATERIALS AND METHODS:A systematic review utilized research from the Mayo Clinic Evidence Based Practice Center and additional supplementation by the authors. Evidence-based statements were based on body of evidence strength Grade A, B, or C and were designated as Strong, Moderate, and Conditional Recommendations with additional statements presented in the form of Clinical Principles or Expert Opinions (table 1 in supplementary unabridged guideline, http://jurology.com/).RESULTS:This guideline was developed by a multi-disciplinary panel to inform clinicians on the proper assessment of patients with testosterone deficiency and the safe and effective management of men on testosterone therapy. Additional statements were developed to guide the clinician on the appropriate care of patients who are at risk for or have cardiovascular disease or prostate cancer as well as patients who are interested in preserving fertility.CONCLUSIONS:The care of testosterone deficient patients should focus on accurate assessment of total testosterone levels, symptoms, and signs as well as proper on-treatment monitoring to ensure therapeutic testosterone levels are reached and symptoms are ameliorated. Future longitudinal observational studies and clinical trials of significant duration in this space will improve diagnostic techniques and treatment of men with testosterone deficiency as well as provide more data on the adverse events that may be associated with testosterone therapy.

Autologous pubovaginal sling placement remains a treatment option in index patients, given high, long-term success rates. This video reviews the technical considerations for performing an autologous rectus fascia sling.

A variety of treatment options exist for patients suffering from stress urinary incontinence (SUI), ranging from conservative to surgical therapy. Urethral injection of bulking agents remains an attractive option that offers less morbidity to patients as compared to surgical treatments. Many different bulking agents have been studied over the years, with various risks and benefits. Herein, we review the mechanisms, technique, efficacy, complications, and future directions of injectable bulking agents for the treatment of SUI.

PURPOSE:The AUA (American Urological Association) QIPS (Quality Improvement and Patient Safety) committee created a white paper on the diagnosis and management of nonneurogenic chronic urinary retention. MATERIALS AND METHODS:Recommendations for the white paper were based on a review of the literature and consensus expert opinion from the workgroup. RESULTS:The workgroup defined nonneurogenic chronic urinary retention as an elevated post-void residual of greater than 300 mL that persisted for at least 6 months and documented on 2 or more separate occasions. It is proposed that chronic urinary retention should be categorized by risk (high vs low) and symptomatology (symptomatic versus asymptomatic). High risk chronic urinary retention was defined as hydronephrosis on imaging, stage 3 chronic kidney disease or recurrent culture proven urinary tract infection or urosepsis. Symptomatic chronic urinary retention was defined as subjectively moderate to severe urinary symptoms impacting quality of life and/or a recent history of catheterization. A treatment algorithm was developed predicated on stratifying patients with chronic urinary retention first by risk and then by symptoms. The proposed 4 primary outcomes that should be assessed to determine effectiveness of retention treatment are 1) symptom improvement, 2) risk reduction, 3) successful trial of voiding without catheterization, and 4) stability of symptoms and risk over time. CONCLUSIONS:Defining and categorizing nonneurogenic chronic urinary retention, creating a treatment algorithm and proposing treatment end points will hopefully spur comparative research that will ultimately lead to a better understanding of this challenging condition.

Working as a physician, scientist, or senior health care administrator is a demanding career. Studies have demonstrated that burnout and other forms of distress are common among individuals in these professions, with potentially substantive personal and professional consequences. In addition to system-level interventions to promote well-being globally, health care organizations must provide robust support systems to assist individuals in distress. Here, we describe the 15-year experience of the Mayo Clinic Office of Staff Services (OSS) providing peer support to physicians, scientists, and senior administrators at one center. Resources for financial planning (retirement, tax services, college savings for children) and peer support to assist those experiencing distress are intentionally combined in the OSS to normalize the use of the Office and reduce the stigma associated with accessing peer support. The Office is heavily used, with approximately 75% of physicians, scientists, and senior administrators accessing the financial counseling and 5% to 7% accessing the peer support resources annually. Several critical structural characteristics of the OSS are specifically designed to minimize potential stigma and reduce barriers to seeking help. These aspects are described here with the hope that they may be informative to other medical practices considering how to create low-barrier access to help individuals deal with personal and professional challenges. We also detail the results of a recent pilot study designed to extend the activity of the OSS beyond the reactive provision of peer support to those seeking help by including regular, proactive check-ups for staff covering a range of topics intended to promote personal and professional well-being.

You have accessJournal of UrologySexual Function/Dysfunction: Penis/Testis/Urethra: Benign Disease & Malignant Disease I1 Apr 2017PD49-11 SURVIVAL AMONG FEMALE URETHRAL CANCER PATIENTS 2004-2013, A NATIONAL CANCER DATABASE ANALYSIS Mary E. Westerman, Vidit Sharma, Derek J. Gearman, Matthew K. Tollefson, Stephen A. Boorjian, Deborah J. Lightner, and R. Jeffrey Karnes Mary E. WestermanMary E. Westerman More articles by this author , Vidit SharmaVidit Sharma More articles by this author , Derek J. GearmanDerek J. Gearman More articles by this author , Matthew K. TollefsonMatthew K. Tollefson More articles by this author , Stephen A. BoorjianStephen A. Boorjian More articles by this author , Deborah J. LightnerDeborah J. Lightner More articles by this author , and R. Jeffrey KarnesR. Jeffrey Karnes More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2017.02.2235AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Primary urethral cancers account for less than 1% of all GU cancers. Due to the rarity of this condition, the literature is limited to retrospective case series and case reports. Therefore we sought to characterize female urethral cancer in a contemporary cohort. METHODS Years 2004-2013 of the National Cancer Database (NCDB) were used to identify primary urethral neoplasms among women. Clinicopathologic variables including age, race, tumor histology, grade, and treatment modality were analyzed. Overall survival (OS) was estimated using the Kaplan-Meier method. Associations with survival were evaluated using Cox regression models. RESULTS Between 2004 and 2013 there were 1,088 cases of primary female urethral cancer in NCDB. The median age at diagnosis was 66 years (IQR 56, 77) and the majority of women were Caucasian (66%) or African-American (30%). Adenocarcinoma (AC) was the most common histologic subtype (34%), followed by squamous (SCC) (26%) and urothelial cell carcinoma (UC) (25%). Women with AC were younger (63 years vs 69 for UC and 67 for SCC, p<0.001) and more likely to be African American (56.0 % vs 24.2%, p<0.001). At diagnosis 45% of all patients were ≥cT3 and 38% were clinical stage III or higher. 16.6% had clinical node positive disease while 8.8% had distant metastatic disease. Among those with AC 56.8% were ≥cT3 compared to 48.2% of SCC and 35% with UC (p<0.001). Patients with AC were most likely to undergo definitive surgery (72% vs 68% for UC and 59% for SCC, p=0.0067). Conversely, those with SCC were more likely to be treated with primary chemo-radiation (16% vs 7% of AC and 5% of UC, p<0.0001). Nearly 44% of patients with SCC received radiation therapy during treatment compared to 37% and 21% of AC and UC patients respectively (p<0.0001). Median survival for those living was 47 months while 5 year OS was 41%. By subtype, 5 year OS for AC was worse than SCC or UC (Figure 1) (Log-Rank 0.013). On multivariate analysis, after adjusting for clinical TNM stage, race, age, and treatment modality, histology was no longer significantly associated with overall survival (p=0.57). CONCLUSIONS Patients with AC are younger, more likely to be African American, and present at a later stage than those with SCC or UC. Five year overall survival is poor regardless of histology, but worse among those with AC. © 2017FiguresReferencesRelatedDetails Volume 197Issue 4SApril 2017Page: e978 Advertisement Copyright & Permissions© 2017MetricsAuthor Information Mary E. Westerman More articles by this author Vidit Sharma More articles by this author Derek J. Gearman More articles by this author Matthew K. Tollefson More articles by this author Stephen A. Boorjian More articles by this author Deborah J. Lightner More articles by this author R. Jeffrey Karnes More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

You have accessJournal of UrologySexual Function/Dysfunction: Penis/Testis/Urethra: Benign Disease & Malignant Disease I1 Apr 2017PD49-12 PRIMARY MALIGNANT MELANOMA OF THE FEMALE URETHRA: MANAGEMENT AND LONG-TERM OUTCOMES AT A TERTIARY REFERRAL CENTER Brian Montgomery, Derek Lomas, Vidit Sharma, and Deborah Lightner Brian MontgomeryBrian Montgomery More articles by this author , Derek LomasDerek Lomas More articles by this author , Vidit SharmaVidit Sharma More articles by this author , and Deborah LightnerDeborah Lightner More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2017.02.2236AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Malignant melanoma of the female urethra is a rare tumor. There is limited data regarding management and outcomes of this condition. We therefore sought to evaluate the management and outcomes of urethral melanoma in females at our institution. METHODS A retrospective analysis was performed of all women presenting to a tertiary referral center with primary malignant melanoma of the urethra from 1950 to 2016. All patients with identifiable metastatic disease at time of diagnosis were excluded. We evaluated pathology, tumor characteristics, presenting symptoms, initial and subsequent treatments, tumor recurrences, and survival. RESULTS A total of 23 women (median age 71; range 51, 86) were identified with a pathologic diagnosis of malignant melanoma of the urethra. Median width of the urethral mass was 2.2 cm (IQR 1.4, 3.0) with a median depth of invasion of 7 mm (IQR 3, 12). The majority of masses involved the distal urethra (83%, 19/23), while four involved the entire urethra (17%). Concurrent vaginal involvement (pathologic T3) was present in 65% of patients (15/23). Reason for presentation to clinic include bleeding (74%, 17/23), mass (17% 4/23), pain (13%, 3/23), and voiding difficulty (4%, 1/23). All patients underwent surgical resection as first line therapy (65% partial urethrectomy, 26% radical urethrectomy, 9% anterior exenteration). Fifteen (65%) patients had recurrence of disease at a median of 7 months (IQR 4, 13). Local recurrence occurred in 80% of patients (12/15). Metastatic disease was identified in 60% of patients (9/15) with lungs being the most common site (78%, 7/9), followed by inguinal lymph nodes (44%, 4/9) and brain (33%, 3/9). Metastatic disease occurred at a median of 5 months (IQR 3, 25). A total of thirteen patients died secondary to melanoma (65%, 13/20). Median overall survival is 25 months (IQR 9, 53) and cancer specific survival is 53 months (IQR 12, 72). CONCLUSIONS Malignant melanoma of the urethra in females commonly recurs (65%) with a large proportion of those patients progressing to metastatic disease (80%) at a median of 5 months after initial surgical resection. These patients should be closely monitored for development of systemic disease with timely initiation of adjuvant therapies. © 2017FiguresReferencesRelatedDetails Volume 197Issue 4SApril 2017Page: e978-e979 Advertisement Copyright & Permissions© 2017MetricsAuthor Information Brian Montgomery More articles by this author Derek Lomas More articles by this author Vidit Sharma More articles by this author Deborah Lightner More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

OBJECTIVE:To evaluate changes over time in female representation among urology residents compared to those within other specialties. MATERIALS AND METHODS:Urology match data were obtained from the American Urological Association from 1996 to 2015. Trends in match rates of male and female urology applicants were assessed. Data for gender representation among residencies were extracted from reports in the Journal of the American Medical Association from 1978 to 2013. We compared the annual percentage of women among urology residents vs residents of other specialties over time. RESULTS:Mean number of male vs female urology applicants per year was 285.0 ± 27.1 vs 76.5 ± 21.8 (P < .001). There was no statistically significant difference in the mean successful match rate of male vs female applicants (68.2% vs 66.6%, P = .36). From 1978 to 2013, the proportion of female residents across all specialties rose from 15.4% to 46.1%, whereas female residents in urology rose from 0.9% to 23.8%. Between 2009 and 2013, obstetrics and gynecology and orthopedics had the highest and lowest average proportion of women, respectively (80.7% and 13.5%). The largest growth occurred in urology among all other specialties (P < .001), with an 11-fold increase seen during the study period. CONCLUSION:Male and female applicants to urology residency have similar match rates. Although urology demonstrated the greatest fold-increase in proportion of women among all specialties during the study period, women have remained a minority among urology residents. Gender representation within urology is a reflection of many factors and demonstrates a need for further improvement.

INTRODUCTION:Medication related problems are common but may be preventable outcomes of prescribing choices. Risks associated with medications in the older adult population are greater due to changes in physiological function with age or disease. Older adults and those with significant comorbidities are often excluded from the clinical trials used to develop medications. In 2012 the American Geriatrics Society published the most recent update of the Beers Criteria for Potentially Inappropriate Medication Use in Older Adults. Several medications included in sections of the Beers Criteria are frequently used in clinical urology, including nitrofurantoin, alpha-1 blocker medications, and antimuscarinic anticholinergic medications for the treatment of urge incontinence and overactive bladder. We describe the challenges and considerations that are useful in prescribing medications for geriatric patients.METHODS:A literature review was performed targeting publications from 2003 to 2013 on the topics of the Beers Criteria, potentially inappropriate medications and specific urological medications included in the current version of the Beers Criteria. An expert panel was convened to evaluate this information and create this white paper with the purpose of educating the urological community on these issues.RESULTS:The rationale for the creation and implementation of the Beers Criteria and its implications for urological practice are reviewed. Careful examination of the Beers Criteria can help clinicians avoid potentially inappropriate prescribing choices for their geriatric patients. We also identified that the HEDIS® high risk medications list of potentially inappropriate medications has been implemented as a negative quality indicator, even though this was not an original purpose of the Beers Criteria. In other words, decisions of denial of coverage and/or requirements for preauthorization are being made using the Beers Criteria as justification by third party payers and other entities.CONCLUSIONS:The Beers Criteria were developed to improve prescribing practices for older adult patients to reduce or avoid potential risks and complications. We encourage clinicians to educate themselves about the Beers Criteria recommendations and associated initiatives that are aimed at improving the care of older adult patients. Urologists should have a key role in the development, evaluation, implementation and analysis of practice measures and the resulting policies.

INTRODUCTION:Through systematic data review and expert consensus, the AUA (American Urological Association) produces clinical practice guidelines that serve to provide evidence-based guidance with an explicit clinical scope and purpose. In this study we determined whether urologists use clinical practice guidelines when making clinical decisions, and whether demographic factors are associated with not using the guidelines or with a lack of guideline awareness.METHODS:We examined the 2014 AUA Census. Our outcome was a question regarding whether the participant used AUA clinical practice guidelines in clinical decision making. We performed comparative statistical analyses, stratifying our outcome by demographic and practice specific variables.RESULTS:A total of 2,204 urologists completed the census, representing 18.9% of practicing urologists in the United States. Median age was 53 years and 91.1% were male. The majority of urologists used clinical practice guidelines (94.8%) in clinical decision making. Clinical practice guidelines had the lowest use among urologists 65 years old or older (89.2%), those in solo practice (88.3%) and pediatric specialists (87.9%). Based on a multivariable logistic regression analysis, factors associated with not using clinical practice guidelines included increasing age, metropolitan practice setting and solo practice. Gender, AUA section, level of rurality and fellowship training were not statistically associated with clinical practice guideline use.CONCLUSIONS:The majority of urologists (approximately 95%) use AUA clinical practice guidelines to inform clinical decisions. Our findings support the importance of clinical practice guidelines and highlight potential opportunities for better targeted outreach to improve clinical practice guideline use among practicing urologists.

INTRODUCTION:The 2014 American Urological Association Overactive Bladder Guidelines provide for the evaluation and effective treatment of patients with overactive bladder by all providers. Once the evaluation rules out other causes of these symptoms, the primary treatment of overactive bladder is behavioral. Changing bladder behavior is associated with a high degree of symptom improvement and is successful in most whereas cure remains elusive. Patient treatment outcomes will likely be inadequate if the patient remains uninformed about achievable bladder behavior, if shared and realistic goals of treatment are not established, and if the patient does not actively participate in modifying his/her bladder behavior.METHODS:The senior authors of the AUA Overactive Bladder Guidelines from 2 major medical centers, specializing in lower urinary tract symptoms, present a unified clinical strategy for the busy outpatient clinic. A single visit rapidly evaluates and stratifies the management options for those with overactive bladder, establishing realistic treatment goals.RESULTS:Patient evaluation, management and outcomes are remarkably similar between 2 independently developed practices, both centered on achieving patient education and clinical efficiency.CONCLUSIONS:An algorithmic approach to the evaluation and management of overactive bladder based on the AUA guidelines emphasizes education, the setting of realistic and shared goals for management, and enhancing self-care. Evaluation and behavioral management can be efficiently started within a single visit, reducing pressure on the urologist to provide ultimately unhelpful or even harmful therapies.

Purpose: To our knowledge there are no guidelines for the evaluation and management of incontinence in women with an orthotopic neobladder. We propose a treatment algorithm based on our experience with treating this patient population.Materials and Methods: We identified women in whom orthotopic neobladder diversion and surgery for incontinence were performed from January 1, 1995 to January 1, 2014. Charts were reviewed for management, outcomes and complications within 30 days of surgery.Results: At this institution 12 women with orthotopic neobladder diversion were treated with surgery for incontinence between 1995 and 2014. Six women (50%) had an undiagnosed neovesicovaginal fistula, of whom 3 (50%) underwent successful fistula repair. A total of 12 bulking agent injections were performed in 6 women (50%). The outcomes were continued dryness after 1 injection (8%), transient improvement after 9 (75%), immediate failure after 1 (8%) and secondary fistula development after 1 (8%). Four transobturator slings and 4 pubovaginal slings were placed in a total of 6 patients (50%), of whom 1 (17%) was dry and 1 (17%) was improved. At a median followup of 22.9 months (IQR 11.1-46.4) 6 women (50%) were dry or improved and 6 (50%) had no improvement in leakage. Of the 6 (50%) women who were dry or improved 2 (17%) achieved planned intermittent catheterization after surgery and 2 (17%) underwent ileal conduit conversion.Conclusions: Bulking agents have low long-term efficacy and carry the risk of fistula formation. The efficacy of tension-free sling placement is low and continence requires an obstructing sling. Counseling should include acceptance of multiple procedures, which may be necessary to achieve continence, and consideration of conduit diversion.

You have accessJournal of UrologyGeneral & Epidemiological Trends & Socioeconomics: Practice Patterns, Cost Effectiveness II1 Apr 2015PD12-09 EFFICIENCY AND SATISFACTION OF VIDEO-VISITS IS EQUIVALENT TO AN OFFICE VISIT: A PROSPECTIVE RANDOMIZED CONTROLLED STUDY IN UROLOGY Boyd Viers, Marcelino Rivera, Igor Frank, Matthew Tollefson, R. Houston Thompson, R. Jeffrey Karnes, Stephen Boorjian, Daniel O'Neil, Matthew Gardner, Sarah Jenkins, Deborah Lightner, and Matthew Gettman Boyd ViersBoyd Viers More articles by this author , Marcelino RiveraMarcelino Rivera More articles by this author , Igor FrankIgor Frank More articles by this author , Matthew TollefsonMatthew Tollefson More articles by this author , R. Houston ThompsonR. Houston Thompson More articles by this author , R. Jeffrey KarnesR. Jeffrey Karnes More articles by this author , Stephen BoorjianStephen Boorjian More articles by this author , Daniel O'NeilDaniel O'Neil More articles by this author , Matthew GardnerMatthew Gardner More articles by this author , Sarah JenkinsSarah Jenkins More articles by this author , Deborah LightnerDeborah Lightner More articles by this author , and Matthew GettmanMatthew Gettman More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2015.02.1061AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES The escalating costs of medical care have required providers to develop efficient, readily available and cost-effective healthcare delivery models. As such, we performed a prospective randomized trial to investigate the efficiency, acceptability and costs associated with a patient-physician encounter, in the ambulatory urological setting, using remote video-visit technology (VV) compared to a traditional office-visit (OV). METHODS From June 2013 to March 2014, 55 men with a history of prostatectomy for localized prostate cancer were randomized to an OV or VV. Patients performed VV from home, or work, with the urologist during a standard outpatient clinic. Clinical timing parameters for both study arms were assessed. Following each visit, patients and physicians were surveyed with a standard questionnaire (Likert scale 1 = strongly agree to 7 = strongly disagree). The primary outcome was visit timing efficiency. Secondary outcomes included patient/provider satisfaction and costs incurred. RESULTS Of the 55 patients enrolled, 28 underwent a VV and 27 an OV. Among men randomized to a VV, relative to an OV, there was equivalence in efficiency including patient-provider face time (mean 14.5 vs 14.3 minutes; p = 0.96), patient wait time (18.4 vs 13.0 minutes; p = 0.2) and total time devoted to the patient's care (17.9 vs 17.8 minutes; p = 0.97). The mean age of men studied was 62 years (range 44–79); of whom 96% of VV and 100% of OV responded that they would meet with their provider in the same setting again. There was no significant difference in the patient's perception of visit confidentiality (mean Likert response; 1.1 vs 1.0), efficiency (2.1 vs 1.4), education quality (1.3 vs 1.4) or overall satisfaction (1.2 vs 1.1) between cohorts. Likewise, there was a high level of urologist satisfaction among both VV (88%) and OV (90%). Specifically, 88% of providers rated VV communication quality as very good/excellent. Finally, VV participants incurred significantly less costs, including distance traveled (median 0 vs 95 miles), travel time (0 vs 95 minutes), missed work (0 vs 1 days) and money spent on travel ($0 vs $48) (all p < 0.0001). CONCLUSIONS Our results suggest equivalent efficiency, similar satisfaction and significantly reduced costs to patients participating in VV. As such, VV in the ambulatory urological setting may have a future role in healthcare delivery by reducing costs, increasing access and enhancing productivity; thus, benefiting the patient, provider, and healthcare system. © 2015 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 193Issue 4SApril 2015Page: e259 Advertisement Copyright & Permissions© 2015 by American Urological Association Education and Research, Inc.MetricsAuthor Information Boyd Viers More articles by this author Marcelino Rivera More articles by this author Igor Frank More articles by this author Matthew Tollefson More articles by this author R. Houston Thompson More articles by this author R. Jeffrey Karnes More articles by this author Stephen Boorjian More articles by this author Daniel O'Neil More articles by this author Matthew Gardner More articles by this author Sarah Jenkins More articles by this author Deborah Lightner More articles by this author Matthew Gettman More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...