Publications by authors named "Kara Watts"

37 Publications

Gender Bias in YouTube Videos Describing Common Urology Conditions.

Urology 2022 Aug 8. Epub 2022 Aug 8.

Montefiore Medical Center, Bronx, NY, United States; Albert Einstein College of Medicine, Bronx, NY, United States. Electronic address:

Objective: To study implicit and explicit gender biases in YouTube videos describing common urologic conditions based on language patterns, speaker gender, and speaker profession.

Methods: Using a Boolean search, the top 30 videos for benign prostatic hyperplasia (BPH), kidney stones, urinary tract infections (UTIs), overactive bladder (OAB), erectile dysfunction (ED), and pelvic organ prolapse (POP) were retrieved. Using the Linguistic Inquiry and Word Count program (LIWC) software, video transcripts were analyzed for 16 word categories and compared by speaker gender and urology topic to assess for bias.

Results: OAB and POP had the least view counts and subscribers; kidney stone and ED videos had the most. Student education channels were more likely to feature male than female speakers (19 male vs. 6 female, P=0.01). A significant difference was noted between speaker gender in BPH (25 male vs. 4 female, P<0.001), OAB (4 male vs. 22 female, P<0.001), and POP (6 male vs. 23 female, P<0.001) videos. When examining linguistic patterns with the LIWC program, female speakers were more likely to mention personal concerns and use tentative words when speaking alone compared to males.

Conclusions: Gender bias exists in YouTube videos concerning common urologic conditions. We must be mindful of how information is distributed in order to minimize the perpetuation of gender stereotypes that are common in medicine. Awareness of these patterns and biases should encourage Urologists to proactively consider how they present themselves and how they reference the conditions they present in social media outlets.
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http://dx.doi.org/10.1016/j.urology.2022.06.042DOI Listing
August 2022

Evaluating perceptions and usage of natural remedies, herbal medicine, and dietary supplements for kidney stones among a diverse, international, urban patient population.

Urolithiasis 2022 Aug 11;50(4):447-453. Epub 2022 Jun 11.

Department of Urology, Montefiore Medical Center, Albert Einstein College of Medicine, 1250 Waters Pl, Tower 1 Penthouse, Bronx, NY, 10461, USA.

Our goal was to assess the use and perceptions of complementary and alternative medicine (CAM) for kidney stones among a diverse, urban population. This was a cross-sectional study of patients treated for kidney stones in the Bronx, NY. We assessed demographic information, personal history of kidney stones, as well as knowledge and use of CAM for kidney stones. Patient demographics and responses were analyzed using chi-squared, t tests, and binomial logistic regression. 113 patients were surveyed. 90% identified as non-white, of whom 58% indicated Hispanic, 46% Latinx, and 23% Black. 56% of patients were born outside the United States. 56% of patients had heard of CAM for kidney stones and 44% had used CAM for kidney stones. The most common CAM were fruits (N = 42, 84%). Recurrent stone formers were more likely than first-time stone formers to have heard of CAM (68 vs 44% p = 0.013) and to have used CAM (56 vs 30%, p = 0.008). Those identifying as Hispanic were more likely to have both heard of and tried CAM for kidney stones (p = 0.036 and 0.022, respectively) compared to non-Hispanic patients. CAM are commonly used among our diverse, urban patient population. While some remedies are high in citrate and alkali (i.e., lemon, cranberry), others are high in oxalate (i.e., beets) and could potentially contribute to stone formation. These findings underpin the importance that medical providers educate themselves on the CAM used in their specific patient populations and discussing use with patients. Providers should aim to identify and reconcile therapeutics that oppose goals of treatment.
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http://dx.doi.org/10.1007/s00240-022-01340-3DOI Listing
August 2022

Case - Testicular thigh pouches for severe Fournier's gangrene: A how-to guide.

Can Urol Assoc J 2022 May 20. Epub 2022 May 20.

Department of Urology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, United States.

Fournier's gangrene is a surgical emergency that requires prompt debridement of infected tissue. When the majority of scrotum has been resected, placing the testicles into thigh pouches can allow for improved wound granulation/contracture prior to definitive tissue reconstruction. We present a surgical guide on how to create testicular thigh pouches without the use of thigh counter-incisions, and its utility in delayed wound healing for large scrotal wounds. This technique may serve as a valuable adjunct in the urologist's and plastic surgeon's armamentarium to optimize testicular coverage and subsequent genital reconstruction.
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http://dx.doi.org/10.5489/cuaj.7901DOI Listing
May 2022

Analysis of Twitter Engagement in a Progressively More Competitive Urology Match: A Mixed Methods Study.

Urology 2022 May 7. Epub 2022 May 7.

Montefiore Medical Center, Department of Urology, Albert Einstein College of Medicine, 1250 Waters Place, Tower 1, Room PH, Bronx, NY 10461. Electronic address:

Objective: To analyze Twitter engagement in response to the urology match during the COVID-19 pandemic.

Methods: Tweets containing the hashtags "#uromatch" or "#AUAmatch" during the 2021 and 2022 Match Week were reviewed. Date, author type and number of followers, general content, and engagement with each Tweet was collected. Differences in engagement between author type and content were analyzed using the Kruskal-Wallis H test. Tweet characteristics were compared between the 2021 and 2022 Match Cycles using the Chi-Square test.

Results: There were 656 Tweets in total, with 272 (43.5%) from 2021 and 353 (56.5%) from 2022. Medical students' and residency programs' posts received significantly more Tweet engagement than those by residents/fellows, attendings, or the AUA (P <.05). Tweets focusing on announcing a new residency class and personal announcements of match results received significantly more engagements than other content categories (P <.05). In 2022, there was a significantly higher percentage of Tweets about advice for unmatched applicants (2.2 vs 12.5; P <.001), match statistics (0.4 vs 2.9; P = .028) and focus on underrepresented groups in urology (0.7 vs 3.4; P = .029).

Conclusion: The Twitter response to the urology match between 2021 and 2022 mirrored the increase in competitiveness, with greater participation and an increasing focus on the difficulty of matching. During Match Week, Twitter is a readily available source of information for programs, matched students, and unmatched students alike. As we continue to embrace virtual platforms, we believe that Twitter will remain a major source of match-related information and can be an instrumental tool for broader networking in our field.
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http://dx.doi.org/10.1016/j.urology.2022.04.029DOI Listing
May 2022

Diagnosis and Treatment of a Mixed Epithelial Stromal Tumor of the Seminal Vesicle: A Systematic Review.

Urology 2022 Feb 26. Epub 2022 Feb 26.

Albert Einstein College of Medicine, Bronx, NY; Department of Urology, Montefiore Medical Center, Bronx, NY. Electronic address:

Objective: To perform a systematic review of mixed epithelial stromal tumor of the seminal vesicle (SV) to characterize the diagnosis and treatment of this rare condition.

Methods: "Seminal vesicle mixed epithelial stromal tumor" OR "seminal vesicle cystadenoma" were searched on PubMed/MEDLINE for relevant articles through 6 September 2021. Articles were eligible if they were in English, accessible via our university library services, and if the abstract was concordant with the content of the publication. Reference lists of included articles were reviewed to identify additional relevant articles.

Results: In total, 66 articles were identified, of which 34 (N = 36 patients) were included. The most common presenting symptoms were lower urinary tract symptoms (33%, 12/36), dysuria (22%, 8/36), lower abdominal pain (17%, 6/36), and hematuria (17%, 6/36). However, there were eight cases (23%, 8/36) of asymptomatic incidental SV tumors. A biopsy was performed in 47% of cases (17/36), of which 53% (9/17) showed benign findings, 29% (5/17) were inconclusive, and 18% (3/17) SV cystadenoma. Surgical resection was performed using open (57%, 20/35), laparoscopic (26%, 9/35), or robotic (17%, 6/35) techniques. The majority (94%, 34/36) of the SV tumors were low-grade. Long-term follow-up was reported for 15 patients in which two patients (13%, 2/15) had tumor recurrence.

Conclusion: High rate of inconclusive biopsy of SV tumors suggests that routine biopsy is of questionable utility. Surgical excision frequently relieves symptoms and confirms accurate pathologic diagnosis. After tumor removal, patients should be surveilled with cross-sectional imaging of the pelvis given the possibility of tumor recurrence.
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http://dx.doi.org/10.1016/j.urology.2022.02.012DOI Listing
February 2022

Association of Obesity and Diabetes With Prostate Cancer Risk Groups in a Multiethnic Population.

Clin Genitourin Cancer 2022 06 31;20(3):299-299.e10. Epub 2022 Jan 31.

Albert Einstein College of Medicine, Bronx, NY; Department of Urology, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY; Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY. Electronic address:

Introduction: Obesity and diabetes mellitus (DM) have been associated with prostate cancer (PCa) risk, but data examining their combined effects on aggressive PCa are sparse, particularly among non-Hispanic Black and Hispanic men. We investigated the associations of obesity and DM in relation to National Comprehensive Cancer Network (NCCN) PCa risk groups in a racially-diverse patient population.

Patients And Methods: We abstracted demographic and clinical data from men who underwent radical prostatectomy at our institution between 2005 and 2019. Patients were classified into three NCCN PCa risk-groups: low, intermediate and high-risk. Logistic regression models were used to examine the independent and combined associations of body mass index (BMI)/obesity and DM with risks of intermediate and high-risk PCa, adjusting for age and race/ethnicity.

Results: A total of 1303 men with PCa (average age 60 ± 6.9 years) were analyzed. The majority were non-Hispanic Black (N = 493, 38%) or Hispanic (N = 407, 31%). The prevalence of obesity (BMI ≥ 30 kg/m) and DM was 29.3% (N = 382) and 28.3% (N = 369), respectively. In multivariate analyses, obesity was independently associated with an odds ratio (OR) = 2.21 of high-risk PCa (95% CI: 1.28-3.81), while DM was associated with an OR = 1.49 (95% CI: 1.05-2.11) of intermediate-risk PCa. Compared to non-obese men without diabetes, men with BMI ≥ 30 and DM had increased risks of both intermediate (OR = 1.93; 95% CI 1.12-3.43) and high-risk PCa (OR = 2.40; 95% CI 1.22-4.73). Interestingly, most of the association of high-risk PCa was driven by obesity.

Conclusion: In this multiethnic population both obesity and DM were independently associated with intermediate- and high-risk PCa; however, most of the association for high-risk cancer was driven by obesity. Our results corroborate findings that obesity increases the risk of aggressive PCa; however, results regarding DM need to be confirmed in other large multiethnic populations.
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http://dx.doi.org/10.1016/j.clgc.2022.01.016DOI Listing
June 2022

Cross-sectional and comparative analysis of videos on erectile dysfunction treatment on YouTube and TikTok.

Andrologia 2022 Jun 4;54(5):e14392. Epub 2022 Feb 4.

Department of Urology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA.

The aim of this study was to evaluate the quality of information regarding erectile dysfunction (ED) treatment on YouTube and TikTok. The term "erectile dysfunction" was searched on YouTube and TikTok in July 2021. The first 50 videos on each platform that met inclusion were included. Videos were sorted as reliable or unreliable based on accuracy of video content. Quality of information was evaluated using Patient Education Materials Assessment Tool (PEMAT) and 5-point modified DISCERN. TikTok videos were shorter (0.4 minutes vs. 5.2 minutes, p < 0.001) and had more likes (2294 vs. 1000, p = 0.005), views per month (17,281 vs. 3521, p < 0.001) and subscribers/followers (97,500 vs. 23,000, p = 0.016) than YouTube videos. TikTok videos were less reliable than YouTube videos (TikTok 5/50 [10%] vs. YouTube 21/50 [42%], p < 0.001). YouTube mentioned more about phosphodiesterase type 5 inhibitors (32% vs. 10%, p = 0.007), while TikTok mentioned more about alternative supplements (36% vs. 4%, p < 0.001). YouTube had a higher DISCERN (1.99 vs. 0.98, p < 0.001) and PEMAT actionability scores (64.2% vs. 54.0%, p = 0.039) when compared to TikTok. YouTube videos were of higher quality than TikTok videos. Nevertheless, YouTube had a considerable amount of unreliable information. We recommend a collaborative effort from the medical community to improve information regarding ED treatment on YouTube and TikTok.
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http://dx.doi.org/10.1111/and.14392DOI Listing
June 2022

Language Differences in Letters of Recommendation Based On Gender of Letter Writer.

Urology 2022 Jun 19;164:5-10. Epub 2022 Jan 19.

Department of Urology, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY. Electronic address:

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http://dx.doi.org/10.1016/j.urology.2021.11.045DOI Listing
June 2022

National Trends and Prescription Patterns in Opiate Analgesia for Urolithiasis Presenting to Emergency Departments: Analysis of the National Hospital Ambulatory Medical Care Survey, 2006-2018.

Urology 2022 Jun 28;164:80-87. Epub 2021 Dec 28.

Albert Einstein College of Medicine, Bronx, NY; Department of Urology, Montefiore Medical Center, Bronx, NY. Electronic address:

Objective: To analyze the National Hospital Ambulatory Medical Care Survey (NHAMCS) database to determine geographic and temporal trends, as well as variables associated with the likelihood of receiving an opioid prescription for urolithiasis in United States (US) emergency departments (EDs).

Materials And Methods: All ED visits for urolithiasis between 2006 and 2018 in the NHAMCS database were analyzed. Age, race/ethnicity, insurance status, ED provider credentials, geographic region, and urban vs rural hospital status were extracted. Linear regression was used to examine overall/regional trends in opioid prescriptions over time. Logistic regression was used to estimate factors associated with higher odds of receiving opioids.

Results: Fourteen million visits were analyzed, of which, 79.1% (11.0 million) received an opioid prescription. From 2014 to 2018 there was a decline of 3.65%/year of the proportion of visits receiving an opioid prescription (R = 0.86, P = .008). Non-Hispanic Black race was associated with a lower chance of receiving opioid prescription (OR = 0.57, P = .02) compared to Non-Hispanic Whites (NHW). Midwestern hospitals had higher odds of opioid prescription compared to the Northeast (OR = 2.05, P = .006). Rural hospitals had lower odds of opioid prescription compared to urban hospitals (OR = 0.62, P = .02).

Conclusion: Opioid prescriptions for patients presenting with urolithiasis to the ED have steadily declined from 2014 to 2018, except in the Midwest. NHW race, Midwest region, and urban EDs increase the likelihood of receiving opioids. Continued efforts encouraging non-opioid alternatives for urolithiasis are essential, specifically in Midwestern EDs, to mitigate the ongoing opioid epidemic in the US.
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http://dx.doi.org/10.1016/j.urology.2021.09.047DOI Listing
June 2022

The impact of surgical downgrading on prostate cancer recurrence: systematic review and analysis of a multiethnic population.

World J Urol 2022 Mar 30;40(3):709-718. Epub 2021 Nov 30.

Albert Einstein College of Medicine, Bronx, NY, USA.

Objective: To perform a systematic review and a retrospective cohort analysis evaluating the rates of surgical downgrading of prostate cancer (PCa) from biopsy (PBx) to radical prostatectomy (RP), and their association with biochemical recurrence (BCR) in a multiethnic population.

Methods: A systematic review of PubMed and other databases was performed. We included retrospective studies evaluating the relationship between surgical downgrading and BCR-free survival. Data regarding Gleason score (GL) downgrading were abstracted from the articles and categorized as follows: GL8-10 to GL7, GL7 to GL6, and GL 7(4 + 3) to GL7(3 + 4). We also performed a retrospective cohort review of patients who underwent RP at our institution from 2005 through 2020. Kaplan-Meier survival analysis and Cox proportional hazards models were used to compare BCR among downgraded versus non-downgraded men.

Results: Systematic review yielded 137 abstracts; of these, 36 full-texts were reviewed, 8 of which were included in our systematic review. Despite substantial variability, all showed that GL at RP is one of the most important factors of BCR-free survival. A total of 1,484 men with PCa were analyzed from our institution. On multivariate analysis, GL7 to GL6 downgrading (HR = 0.50, p = 0.022) and GL8-10 to GL7 downgrading (HR = 0.42, p = 0.011) were associated with reduced risk of BCR when compared to men with GL7 and GL8-10 concordance, respectively. However, GL7(4 + 3) to GL7(3 + 4) downgrading was not significantly associated with reduced BCR (HR = 0.56, p = 0.12), when compared to GL7(4 + 3) concordance, although HR was similar.

Conclusion: Surgical downgrading at RP was associated with a reduced risk of BCR compared to GL concordant disease, and these findings have been validated within our multiethnic population. Pathologic downgrading at the time of RP may be a more useful predictor of subsequent BCR in comparison to that associated with GL concordant pathology.
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http://dx.doi.org/10.1007/s00345-021-03892-2DOI Listing
March 2022

Patient satisfaction and savings, and clinical outcomes of televisits in female pelvic medicine and reconstructive surgery at an urban academic center.

Neurourol Urodyn 2021 09 3;40(7):1834-1844. Epub 2021 Aug 3.

Albert Einstein College of Medicine, Bronx, New York, USA.

Aim: To evaluate patient satisfaction and savings, and compare visit outcomes based on chief complaint (CC) of women presenting for a televisit to a female pelvic medicine and reconstructive surgery (FPMRS) clinic at an urban academic center.

Methods: A cross-sectional study of women completing a televisit with an FPMRS specialist at our institution from June 19, 2020 to July 17, 2020 was conducted. A telephone questionnaire was administered to patients to assess satisfaction and savings (travel costs/time avoided). Electronic medical records were reviewed to collect patient demographics and comorbidities, CC, and televisit outcomes (e.g., face-to-face (F2F) exam scheduled, orders placed). Logistic regression was used to analyze predictors of satisfaction and need for F2F follow-up.

Results: One hundred eighty-seven of 290 (64.5%) women called completed the survey, of whom 168 (89.8%) were satisfied with their televisit. Eighty-eight (48.1%) saved at least an hour and 54 (28.9%) saved more than $25 on transportation. There were no significant associations between patient characteristics, CC, or televisit outcomes and satisfaction. Ninety-nine (52.9%) televisits resulted in F2F follow-up, with CC of prolapse (odds ratio [OR] = 4.2 (1.7-10.3); p = 0.002), new patient (OR = 2.2 (1.2-4.2); p = 0.01), and Hispanic ethnicity (OR = 3.9 (1.2-13.6); p=.03) as significant predictors.

Conclusion: Most patients were satisfied with FPMRS televisits at our urban academic center. Televisits resulted in patient travel time and cost savings. Women presenting with prolapse and for new patient visits would likely benefit from initial F2F visits instead of televisits. Televisits are an important mode of health care and in some cases can replace F2F visits.
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http://dx.doi.org/10.1002/nau.24759DOI Listing
September 2021

Patient Satisfaction with Telephone Versus Video-Televisits: A Cross-Sectional Survey of an Urban, Multiethnic Population.

Urology 2021 10 29;156:110-116. Epub 2021 Jul 29.

Albert Einstein College of Medicine, Bronx, NY; Department of Urology, Montefiore Medical Center, Bronx, NY. Electronic address:

Objective: To examine differences between telephone and video-televisits and identify whether visit modality is associated with satisfaction in an urban, academic general urology practice.

Methods: A cross sectional analysis of patients who completed a televisit at our urology practice (summer 2020) was performed. A Likert-based satisfaction telephone survey was offered to patients within 7 days of their televisit. Patient demographics, televisit modality (telephone vs video), and outcomes of the visit (eg follow-up visit scheduled, orders placed) were retrospectively abstracted from each chart and compared between the telephone and video cohorts. Multivariate regression analysis was used to evaluate variables associated with satisfaction while controlling for potential confounders.

Results: A total of 269 patients were analyzed. 73% (196/269) completed a telephone televisit. Compared to the video cohort, the telephone cohort was slightly older (mean 58.8 years vs. 54.2 years, P = .03). There were no significant differences in the frequency of orders placed for medication changes, labs, imaging, or for in-person follow-up visits within 30 days between cohorts. Survey results showed overall 84.7% patients were satisfied, and there was no significant difference between the telephone and video cohorts. Visit type was not associated with satisfaction on multivariable analyses, while use of an interpreter [OR:8.13 (1.00-65.94); P = .05], labs ordered [OR:2.74 (1.12-6.70); P = .03] and female patient gender [OR:2.28 (1.03-5.03); P = .04] were significantly associated with satisfaction.

Conclusion: Overall, most patients were satisfied with their televisit. Additionally, telephone- and video-televisits were similar regarding patient opinions, patient characteristics, and visit outcome. Efforts to increase access and coverage of telehealth, particularly telephone-televisits, should continue past the COVID-19 pandemic.
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http://dx.doi.org/10.1016/j.urology.2021.05.096DOI Listing
October 2021

Interprofessional Consultations (eConsults) in Urology.

Urol Pract 2021 May 2;8(3):321-327. Epub 2020 Dec 2.

Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor.

Introduction: An interprofessional consultation (eConsult) is an asynchronous form of telehealth whereby a primary care provider requests electronic consultation with a specialist in place of an in-person consultation. While eConsults have been successfully implemented in many medical specialties, their use in the practice of urology is relatively unknown.

Methods: We included data from four academic institutions: University of Michigan, University of California -San Francisco, University of Washington, and Montefiore Medical Center. We included every urological eConsult performed at each institution from the launch of their respective programs through August 2019. We considered an eConsult "converted" when the participating urologist recommended a full in-person evaluation. We report eConsult conversion rate, response time, completion time, and diagnosis categories.

Results: A total of 462 urological eConsults were requested. Of these, 36% were converted to a traditional in-person visit. Among resolved eConsults, with data on provider response time available (n=119),53.8% of eConsults were addressed in less than 1 day; 28.6% in 1 day; 8.4% in 2 days; 3.4% in 3 days; 3.4% in 4 days; 1.7% in 5 days; and 0.8% in ≥6 days. Among resolved eConsults, with data on provider completion time available (n=283), 50.2% were completed in 1-10 minutes; 46.7% in 11-20 minutes; 2.8% in 21-30 minutes; and less than 1% in ≥31 minutes.

Discussion: Our study suggests that eConsults are an effective avenue for urologists to provide recommendations for many common non-surgical urological conditions and thus avoid a traditional in-person for low-complexity situations. Further investigation into the impact of eConsults on healthcare costs and access to urological care are necessary.
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http://dx.doi.org/10.1097/UPJ.0000000000000209DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8078010PMC
May 2021

A Comparison of Image-Guided Targeted Prostate Biopsy Outcomes by PI-RADS® Score and Ethnicity in a Diverse, Multiethnic Population.

J Urol 2021 09 21;206(3):586-594. Epub 2021 Apr 21.

Albert Einstein College of Medicine, Bronx, New York.

Purpose: NonHispanic Black (NHB) and Hispanic/Afro-Caribbean men have the highest risk of prostate cancer (PCa) compared to nonHispanic White (NHW) men. However, ethnicity-specific outcomes of targeted fusion biopsy (FB) for the detection of PCa are poorly characterized. We compared the outcomes of FB by Prostate Imaging Reporting and Data System (PI-RADS®) score and race/ethnicity among a diverse population.

Materials And Methods: We evaluated all men who underwent image-guided FB for suspicious lesions on prostate magnetic resonance imaging (≥PI-RADS 3) over a 2-year period. We examined associations of race/ethnicity and PI-RADS score with risk of PCa or clinically significant PCa (cs-PCa, Gleason Group ≥2) on FB using mixed-effects logistic regression models.

Results: A total of 410 men with 658 lesions were analyzed, with 201 (49.0%) identified as NHB and 125 (30.5%) identified as Hispanic. NHB men had a twofold increase in the odds of detecting cs-PCa (OR=2.7, p=0.045), while Hispanic men had similar odds of detecting cs-PCa compared to NHW men. With regard to all PCa, NHB men had a similar increase in the odds of detecting all PCa (OR=2.4, p=0.050), which was borderline statistically significant compared to NHW men on FB. When we excluded men on active surveillance, NHB men had even stronger associations with detection of cs-PCa (OR=3.10, p=0.047) or all PCa (OR=2.77, p=0.032) compared to NHW men.

Conclusions: NHB men have higher odds for overall PCa and cs-PCa on FB compared to NHW men. Further work may clarify differences per PI-RADS score. Clinicians should interpret prostate magnetic resonance imaging lesions with more caution in NHB men.
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http://dx.doi.org/10.1097/JU.0000000000001810DOI Listing
September 2021

Using CT-guided stereotactic prostate radiation therapy (CT-SPRT) to assess sustained murine prostate ablation.

Sci Rep 2021 03 22;11(1):6571. Epub 2021 Mar 22.

Department of Cell Biology, Albert Einstein College of Medicine, 1301 Morris Park Ave, Bronx, NY, 10461, USA.

The prostate is a hormone-responsive organ where testicular androgens drive the proliferation and survival of prostatic cells, ensuring the development and functioning of this gland throughout life. Androgen deprivation therapy leads to apoptosis of prostatic cells and organ regression, and is a cornerstone of prostate cancer and benign prostatic hypertrophy treatment. For several decades, androgen deprivation has been used as an adjuvant to external beam radiotherapy, however, emerging data suggests that the low rates of epithelial proliferation in the castrated prostate imparts radio-resistance. As proliferating cells exhibit increased sensitivity to radiation, we hypothesized that short bursts of synchronized epithelial proliferation, which can be achieved by exogeneous testosterone supplementation prior to targeted high-dose radiation, would maximize sustained prostate ablation, while minimizing damage to surrounding tissues. To test this hypothesis, we designed a novel computed-tomography (CT)-guided stereotactic prostate radiation therapy (CT-SPRT) technique to deliver a single high-dose 25 Gy fraction of X-ray radiation. Sustained prostatic cell ablation was assessed post CT-SPRT by measuring prostate weight, epithelial cell number, and relative contributions of luminal and basal epithelial populations in control and testosterone-pretreated glands. CT-SPRT was safely delivered with no observed damage to surrounding rectal and bladder tissues. Importantly, castrated mice that received a pulse of testosterone to induce synchronous cell proliferation prior to CT-SPRT exhibited significant sustained gland ablation compared to control mice. These results provide new insights in stereotactic radiotherapy sensitivity to maximize prostatic cell ablation and improve our understanding of prostate gland regeneration that can potentially lead to improved non-invasive therapies for benign prostatic hypertrophy and prostate cancer.
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http://dx.doi.org/10.1038/s41598-021-86067-8DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7985301PMC
March 2021

Native kidney small renal masses in patients with kidney transplants: Does chronic immunosuppression affect tumor biology?

Can Urol Assoc J 2021 Oct;15(10):339-344

Department of Urology, Montefiore Medical Center, New York, NY, United States.

Introduction: We compared clinicopathological characteristics and outcomes of radical nephrectomy (RN) for small renal masses (SRM) in patients with end-stage renal disease (ESRD) before or after transplant at a high-volume urologic and transplant center.

Methods: We performed a retrospective review of patients with ESRD (glomerular filtration rate [GFR] <15 mL/min) who underwent RN for suspected malignant SRM from 2000-2018. Group 1 consisted of patients who underwent RN after transplant; group 2 underwent RN prior to transplant, and group 3 underwent RN without subsequent transplant. Dominant tumor size and histopathological characteristics, recurrence, and survival outcomes were compared between groups. Chi-squared and Mann-Whitney U tests were used to compare categorical and continuous baseline and histopathologic characteristics, respectively. Univariate analysis and log rank test were used to compare RCC recurrence rates.

Results: We identified 34 nephrectomies in group 1, 27 nephrectomies in group 2, and 70 nephrectomies in group 3. Median time from transplant to SRM radiological diagnosis in group 1 was 87 months, and three months from diagnosis to nephrectomy for all groups. There were no statistically significant differences between pathological dominant mass size, histological subtype breakdown, grade, or stage between the groups. Rates of benign histology were similar between the groups. Univariate analysis did not reveal a statistically significant difference in recurrence-free survival between the groups (p=0.9).

Conclusions: Patients undergoing nephrectomy before or after transplant for SRM have similar indolent clinicopathological characteristics and low recurrence rates. Our results suggest that chronic immunosuppression does not adversely affect SRM biology.
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http://dx.doi.org/10.5489/cuaj.6996DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8525532PMC
October 2021

Methodology for triage of urologic surgical cases in the setting of a pandemic.

BMC Surg 2021 Mar 6;21(1):116. Epub 2021 Mar 6.

Department of Urology, Montefiore Medical Center, Bronx, NY, USA.

Background: The first wave of the COVID-19 pandemic in March 2020 forced our healthcare system in the Bronx, New York to cancel nearly all scheduled surgeries. We developed a framework for prioritizing postponed urologic surgeries that was utilized once cases were permitted to be rescheduled. As many parts of our country experience first and second waves of this pandemic, our framework may serve as a resource for other centers experiencing restrictions on the scheduling of elective urologic surgeries.

Methods: As the COVID-19 pandemic started and peaked in New York, almost all of our scheduled urologic surgeries were cancelled. Each Urologist was asked to rank his/her cancelled surgeries by priority (Level 1-least urgent; Level 2-moderately urgent; Level 3-most urgent). A committee of Urologists assigned a subclass to Level 3 and 2 cases (3a-least urgent; 3b-moderately urgent; 3c-most urgent; 2a-lower priority; 2b-higher priority). The committee then reviewed cases by urgency to derive a final priority ranking.

Results: A total of 478 total urologic surgeries were canceled and categorized: 250 Level 1, 130 Level 2, 98 Level 3 (73 adult, 25 pediatric). Level 3c involved renal cell carcinoma ≥ T2b, high-grade bladder urothelial carcinoma, adrenal mass/cancer > 6 cm, testicular cancer requiring radical orchiectomy, and penile cancer. Level 3b involved T2a renal masses requiring nephrectomy, while high-risk prostate cancer and symptomatic nephrolithiasis were classified as 3a. Level 2 included testicular cancer requiring retroperitoneal lymph node dissection and complicated benign prostatic hyperplasia. Surgeries for urologic reconstruction, non-complicated nephrolithiasis, erectile dysfunction, and urinary incontinence were considered Level 1.

Conclusions: Our disease-specific approach to surgical rescheduling offers appropriate guidance for triaging urologic surgeries. Our system can provide guidance to other institutions as COVID-19 cases surge in different regions and with the growing second wave.
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http://dx.doi.org/10.1186/s12893-021-01067-9DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7936241PMC
March 2021

Variations in Perioperative Antibiotic Prescriptions Among Academic Urologists After Ambulatory Endoscopic Urologic Surgery: Impact on Infection Rates and Validation of 2019 Best Practice Statement.

Urology 2020 12 8;146:101-106. Epub 2020 Aug 8.

Montefiore Medical Center, Department of Urology, Bronx, NY, USA; Albert Einstein College of Medicine, Bronx, NY, USA. Electronic address:

Objective: To evaluate adherence to the American Urologic Association (AUA) best practice statement guidelines regarding antibiotic duration in the perioperative setting for endoscopic urologic surgery. We assessed concordance to these guidelines among adult urologists at a single academic institution and its correlation with postoperative positive urine cultures as it relates to the revised 2019 best practice statement.

Methods: We performed a retrospective review of all adult endoscopic ambulatory urologic surgeries performed over an 18-month period by urologists at our institution. Patient demographics, pre- and postoperative urine cultures, operative details, stent or foley use, and antibiotic prescriptions were reviewed. Chi-squared and linear regression analyses were done.

Results: Three hundred thirty patients were included for analysis. Sixty-two percent of patients were prescribed postoperative antibiotics, for an average of 4 days. Trimethoprim/Sulfamethoxazole and fluroquinolones were most often prescribed (43% and 38%, respectively). Intraoperative stent placement, positive urine culture within 30 days prior to surgery, and a positive urine culture within 1 year prior to surgery predicted antibiotic prescription. No significant differences were seen in rates of positive postoperative urine culture rates between cohorts that received antibiotics postoperatively vs those who did not.

Conclusions: At our academic institution, we observed poor concordance with the AUA best practice statement for perioperative antibiotic prescription after ambulatory endoscopic urologic surgery. Rates of positive postoperative cultures were low and not associated with receipt or duration of antibiotic prescription at the time of surgery, supporting minimal use of antibiotics for most endoscopic cases.
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http://dx.doi.org/10.1016/j.urology.2020.07.049DOI Listing
December 2020

"Virtually Perfect" for Some but Perhaps Not for All: Launching Telemedicine in the Bronx during the COVID-19 Pandemic.

J Urol 2020 11 9;204(5):903-904. Epub 2020 Jun 9.

Department of Urology, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, New York.

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http://dx.doi.org/10.1097/JU.0000000000001185DOI Listing
November 2020

Gender Bias in Medicine: Does It Exist at AUA Plenary Sessions?

Urology 2021 04 18;150:77-80. Epub 2020 May 18.

Montefiore Medical Center, Department of Urology, Bronx, NY; Albert Einstien college of Medicine, Bronx, NY.

Objective: To determine if gender bias exists at the plenary sessions of the American Urological Association (AUA) annual conference by evaluating variations in the use of a professional title (PT) during speaker introductions at these sessions.

Methods: We retrospectively reviewed video archives of all plenary sessions from the AUA annual conferences from 2017 to 2019. Videos that included both plenary introducer and speaker were included for analysis. The following data were collected: conference year, gender, and academic rank of "introducer" and of "speaker," and use of PT (ie, doctor) during speaker introduction. Variations in use of PT for introductions of speakers based on gender of introducer and of speaker were analyzed by chi-square tests.

Results: Four hundred and fourteen videos were reviewed; 195 (47%) with a composite 622 introducer/speaker pairs were reviewed and analyzed. Only 8.7% of introducers and 14.6% of speakers were female (Table 1). Overall, there was no difference in the use of PT for introductions of female vs male speakers (61.5% vs 60.8%, P = 0.90). However, male speakers were more likely to be introduced as doctor when introduced by a female vs a male (75.60% vs 59.60%, P = 0.04). Female speakers were equally likely to be introduced as doctor regardless of introducer gender.

Conclusion: Men represented the majority of presenters and speakers in the plenary session at AUA meetings. However, there is not a significant difference in the use of PT for AUA plenary speaker introductions based on gender.
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http://dx.doi.org/10.1016/j.urology.2020.05.012DOI Listing
April 2021

Telemedicine and eConsults for Hospitalized Patients During COVID-19.

Urology 2020 07 21;141:12-14. Epub 2020 Apr 21.

Department of Urology, University of Michigan, Ann Arbor, MI; Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI.

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http://dx.doi.org/10.1016/j.urology.2020.04.061DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7172813PMC
July 2020

Systematic review and meta-analysis comparing cognitive vs. image-guided fusion prostate biopsy for the detection of prostate cancer.

Urol Oncol 2020 09 19;38(9):734.e19-734.e25. Epub 2020 Apr 19.

Albert Einstein College of Medicine, Bronx, NY; Montefiore Medical Center, Department of Urology, Bronx, NY.

Objective: To perform a systematic review and meta-analysis comparing overall prostate cancer detection rate and clinically-significant prostate cancer detection rate between MRI-ultrasound image guided fusion biopsy (MRI-US FB) and cognitive biopsy (CB).

Methods: A systematic review of Pubmed, EMBASE, MEDLINE, and Cochrane library databases was performed. Identified studies were assessed for clinical relevance and excluded based on a set of predefined criteria. Final articles included in the analysis comprised only prospective trials that compared CB vs. MRI-US FB in men with MRI-identifiable lesions (Prostate Imaging Reporting and Data System score 2+). Articles were reviewed for patient demographics, MRI protocol, and rates of overall and clinically significant prostate cancer detection by both modalities.

Results: Nine studies were analyzed. A composite 1,714 men with mean age 64.6 years and mean PSA 8.2 ng/dL were reviewed. When comparing FB to CB, the odds ratio for overall and for clinically significant prostate cancer detection was 1.11 (95%CI 0.91-1.36, P = 0.30) and 1.13 (95%CI 0.89-1.44, P = 0.32), respectively. Heterogeneity among the studies was moderate but not significant for either overall (X = 14.67; I = 45%; P = 0.07) or clinically significant prostate cancer detection (X = 11.81; I = 49%; P = 0.07).

Conclusion: MRI-US FB demonstrates a trend toward improved rates of prostate cancer detection compared to CB, although this is not statistically significant. Further comparative studies may help to further elucidate whether one of these modalities is superior over the other.
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http://dx.doi.org/10.1016/j.urolonc.2020.03.020DOI Listing
September 2020

Use of beta-blocker types and risk of incident prostate cancer in a multiethnic population.

Urol Oncol 2020 10 17;38(10):794.e11-794.e16. Epub 2020 Apr 17.

Department of Urology, Albert Einstein College of Medicine / Montefiore Medical Center, Bronx, NY.

Purpose: Increased adrenergic innervation is observed in prostate cancer (CaP) and is associated with aggressive disease. Emerging evidence suggests that beta-adrenergic blockade inhibits CaP progression. However, the association between type of beta-blocker use and risk of incident CaP on initial prostate biopsy has not been investigated in multiethnic populations.

Materials And Methods: A retrospective study of racially/ethnically diverse men (64% African-American and Hispanic), who underwent initial prostate biopsy between 2006 and 2016 in a large healthcare system was performed. Oral use of beta-blocker type was assessed by reviewing active prescriptions within the 5-year period preceding initial biopsy. Patient demographics and clinical factors were collected.

Results: Of 4,607 men who underwent initial prostate biopsy, 4,516 met criteria and 2,128 had a biopsy positive for CaP; 20% high-risk, 41% intermediate-risk, and 39% low or very-low risk (National Comprehensive Cancer Network classification). Overall, 15% of patients were taking a beta-blocker prior to initial biopsy, with Metoprolol, Atenolol, and Carvedilol accounting for the majority. Of beta-blocker types, Atenolol alone was associated with a 38% reduction in odds of incident CaP (P= 0.01), with a 40% and 54% reduction in risks of National Comprehensive Cancer Network intermediate and high-risk CaP (P = 0.03 and P = 0.03, respectively) compared to men not taking a beta-blocker. Furthermore, longer duration of Atenolol use (3-5 years) was associated with a 54% and 72% reduction in intermediate and high-risk disease, (P = 0.03 and P = 0.03, respectively).

Conclusions: Among beta blocker types, long-term Atenolol use is associated with a significant reduction in incident CaP risk on initial prostate biopsy for clinically-significant intermediate and high-risk disease compared to men not taking a beta-blocker.
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http://dx.doi.org/10.1016/j.urolonc.2020.03.024DOI Listing
October 2020

Implementing Telemedicine in Response to the COVID-19 Pandemic.

J Urol 2020 07 3;204(1):14-16. Epub 2020 Apr 3.

Department of Urology, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, New York.

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http://dx.doi.org/10.1097/JU.0000000000001033DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7273866PMC
July 2020

Non-Familial Synchronous Bilateral Renal Cell Carcinoma with Bilateral Synchronous Renal Vein Extension and Inferior Vena Cava Thrombus.

Curr Urol 2019 Sep 10;13(1):51-53. Epub 2019 Sep 10.

Albert Einstein College of Medicine.

Bilateral renal cell carcinoma with tumor thrombus extension into the renal vein and/or inferior vena cava - clinical stage T3a+ - is rare. The majority of these cases arise due to a genetic predisposition. We present a case report of a 47-year-old male with bilateral, synchronous renal cell carcinoma with bilateral renal vein and inferior vena cava tumor thrombi with no identifiable familial predisposition.
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http://dx.doi.org/10.1159/000499294DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6771058PMC
September 2019

Baseline chronic kidney disease does not predict long-term renal functional decline after percutaneous nephrolithotomy.

Urolithiasis 2019 Oct 12;47(5):449-453. Epub 2019 Feb 12.

Department of Urology, Montefiore Medical Center, Bronx, USA.

To compare renal functional outcomes in patients with and without chronic kidney disease (CKD) to identify predictors of change in renal function after percutaneous nephrolithotomy (PCNL). We reviewed patients who underwent PCNL by a single surgeon over 3.5 years. Patients' pre- and post-operative Glomerular Filtration Rate (GFR) was calculated. Baseline GFR < 60 ml/min/1.73 m (stage ≥ 3 CKD) defined our CKD cohort. Patients' baseline renal function, comorbidities, stone parameters, and intra-operative variables were analyzed to determine the relationship with post-operative renal function after PCNL by multivariate analysis. 202 patients were analyzed. Mean follow-up time was 16 months. At baseline, 163 (80.7%) patients were free of CKD and 39 (19.3%) had CKD. Patients without CKD had an overall decrease in GFR from 105.6 to 103.3 ml/min/1.73 m (p = 0.494). 14/163 (8.6%) non-CKD patients experienced a significant decline in renal function after PCNL; 7/163 (4.3%) developed de novo CKD and 7 had a ≥ 30% decline in GFR. Patients with CKD had an overall increase in mean GFR post-operatively, from 47.3 to 54.0 ml/min/m (p = 0.067). Two in this cohort (5.1%) experienced a > 30% decline in renal function post-operatively. Age, gender, African American race, presence of comorbidities and pre-operative CKD were not significant predictors of renal function post-operatively on multivariate analysis. PCNL in this cohort appears GFR neutral in the setting of baseline CKD. CKD was not predictive of renal functional decline after PCNL. Given that stone disease carries a high recurrence rate and that CKD is associated with stone formers, further investigation into predictors of renal function change after PCNL is warranted.
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http://dx.doi.org/10.1007/s00240-019-01113-5DOI Listing
October 2019

Abdominal Approach to Vesicovaginal Fistula.

Urol Clin North Am 2019 Feb;46(1):135-146

Department of Urology, Montefiore Medical Center, 1250 Waters Place, Tower 2, Suite 706, Bronx, NY 10461, USA. Electronic address:

Principles of abdominal vesicovaginal fistula (VVF) repair include good exposure of the fistulous tract, double-layer bladder closure, retrograde fill of the bladder to ensure a water-tight seal, tension-free closure and continuous postoperative bladder drainage. Minimally invasive approaches, particularly robot-assisted laparoscopy, have demonstrated shorter operative times, decreased blood loss, improved visibility, and similar cure rates without increased adverse events. These techniques are therefore rising in popularity among surgeons. Ultimately, surgical approach to VVF repair depends upon the individual characteristics of the patient and fistula, as well as the preference and experience of the surgeon.
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http://dx.doi.org/10.1016/j.ucl.2018.08.011DOI Listing
February 2019

Robotic Partial Nephrectomy in Patients with Chronic Kidney Disease: Objective Measurement of Short- and Long-Term Renal Functional Outcomes.

J Endourol 2018 07;32(7):630-634

4 Northwell Health, Smith Institute of Urology , Great Neck, New York.

Background: Minimal literature informs the use of robotic partial nephrectomy (RPN) in patients with chronic kidney disease (CKD). Therefore, we evaluated the renal functional outcomes in CKD patients undergoing RPN.

Methods: We reviewed a prospective database of patients undergoing RPN 2010 to 2015 and identified 182 patients who had preoperative and postoperative nuclear renal scintigraphy (at 2 and 12 months postop). Preoperative and 12-month postoperative eGFR (mL/min/1.73 m, by MDRD) were calculated. CKD was defined as eGFR ≤60 mL/min/1.73 m (CKD stages III and IV). Changes in creatinine, eGFR, and split function on mercaptoacetyltriglycine (MAG)-3 scan were compared by baseline CKD status. Correlations between pre- and postoperative eGFR were calculated.

Results: Of 182 patients, 30 (16.5%) had baseline CKD. Preoperative eGFR was 48.5 and 99.0 in CKD and non-CKD patients, respectively (p < 0.001). From preoperation to 12 months postoperation, eGFR decreased by 2.8 and 1.1 mL/min/1.73 m, respectively (p = 0.6). On MAG-3 scan, the contribution of the surgical kidney to overall renal function decreased by 5.0% and 4.8% (p = 0.9) in the CKD and non-CKD cohorts, respectively. When comparing renal scans at 2 and 12 months postoperation, in both groups the surgical kidney significantly recovered (both p < 0.001) and the patterns of kidney function recovery was similar in both groups (CKD +2.0%, non-CKD +1.4%, p = 0.6). On long-term follow-up (>2 years), eGFR did not change significantly in either the CKD or non-CKD group (-2.8 vs -1.1 mL/min/1.73 m, p = 0.6). On pathology, tumors were more frequently malignant in CKD vs non-CKD patients (93.3% vs 73.2%, p = 0.02) and of higher Fuhrman Grade (grade ≥3: 49.7% vs 28.1%, p < 0.001).

Conclusion: RPN is a reasonable treatment option in patients with CKD, as it did not lead to a greater decline in renal function contributed by the surgical kidney. The patterns of kidney function recovery after surgery are similar between patients with and without CKD.
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http://dx.doi.org/10.1089/end.2018.0151DOI Listing
July 2018

Renoalimentary fistula: Case report of a renoduodenal fistula and systematic literature review.

Urol Case Rep 2018 May 2;18:41-43. Epub 2018 Mar 2.

Albert Einstein College of Medicine, Montefiore Medical Center, Department of Urology, Bronx, NY, 10467, United States.

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http://dx.doi.org/10.1016/j.eucr.2018.02.022DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5854929PMC
May 2018

Designing a theory-based intervention to improve the guideline-concordant use of imaging to stage incident prostate cancer.

Urol Oncol 2018 05 15;36(5):246-251. Epub 2018 Feb 15.

VA New York Harbor Healthcare System, New York University, New York, NY; Department of Urology, New York University, New York, NY; Department of Population Health, New York University, New York, NY; New York University Cancer Institute, New York University, New York, NY; Robert F. Wagner Graduate School of Public Service, New York University, New York, NY. Electronic address:

Among US men, most new prostate cancer cases are clinically localized and do not require imaging as part of staging workup according to guidelines. Two leading specialty societies promote stewardship of health resources by encouraging guideline-concordant care, thereby limiting inappropriate and obsolete imaging. However, imaging to stage low-risk prostate cancer remains high, as almost half of men with localized prostate cancer undergo wasteful imaging following diagnosis. We employed a theory-based approach, based on current evidence and data on existing practice patterns revealing that providers are the drivers to imaging decisions, to design an intervention to improve guideline -concordant prostate cancer staging imaging across populations. We conceptualized preliminary results using the theoretical domains framework and the behavior change wheel, frameworks used concurrently to investigate physicians' behaviors and intervention design in various clinical settings. Through these 2 frameworks, we designed a theory-based, physician-focused intervention to efficiently encourage guideline-concordant prostate cancer imaging, prostate cancer imaging stewardship (PCIS). Prostate cancer imaging stewardship consists of interventions (clinical order check, academic detailing, and audit and feedback) implemented at the individual, facility, and system level to enact provider behavior change by enabling facilitators and appealing to physician motivation.
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http://dx.doi.org/10.1016/j.urolonc.2017.12.019DOI Listing
May 2018
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