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Balasubramanian A, Kohn TP, Santiago JE, Sigalos JT, Kirby EW, Hockenberry MS, Pickett SM, Pastuszak AW, Lipshultz LI. AUTHOR REPLY. Urology 2020; 138:58-59. [PMID: 32252955 DOI: 10.1016/j.urology.2019.10.046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2019] [Accepted: 10/31/2019] [Indexed: 10/24/2022]
Affiliation(s)
| | - Taylor P Kohn
- Department of Surgery, Johns Hopkins School of Medicine, Baltimore, MD
| | | | - John T Sigalos
- Department of Urology, University of California Los Angeles, Los Angeles, CA
| | - E Will Kirby
- Scott Department of Urology, Baylor College of Medicine, Houston, TX; Center for Reproductive Medicine, Baylor College of Medicine, Houston, TX
| | - Mark S Hockenberry
- Scott Department of Urology, Baylor College of Medicine, Houston, TX; Center for Reproductive Medicine, Baylor College of Medicine, Houston, TX
| | | | - Alexander W Pastuszak
- Division of Urology, Department of Surgery, University of Utah School of Medicine, Salt Lake City, UT
| | - Larry I Lipshultz
- Scott Department of Urology, Baylor College of Medicine, Houston, TX; Center for Reproductive Medicine, Baylor College of Medicine, Houston, TX
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Balasubramanian A, Kohn TP, Santiago JE, Sigalos JT, Kirby EW, Hockenberry MS, Pickett SM, Pastuszak AW, Lipshultz LI. Increased Risk of Hypogonadal Symptoms in Shift Workers With Shift Work Sleep Disorder. Urology 2020; 138:52-59. [DOI: 10.1016/j.urology.2019.10.040] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2019] [Revised: 10/27/2019] [Accepted: 10/31/2019] [Indexed: 01/31/2023]
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Butaney M, Thirumavalavan N, Hockenberry MS, Kirby EW, Pastuszak AW, Lipshultz LI. Variability in penile duplex ultrasound international practice patterns, technique, and interpretation: an anonymous survey of ISSM members. Int J Impot Res 2018; 30:237-242. [PMID: 30108336 PMCID: PMC6173975 DOI: 10.1038/s41443-018-0061-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Accepted: 07/23/2018] [Indexed: 01/13/2023]
Abstract
Penile duplex ultrasound (PDU), combined with pharmacologic stimulation of erection, is the gold standard for the evaluation of multiple penile conditions. A 30-question electronic survey was distributed to members of the International Society for Sexual Medicine (ISSM). The survey assessed the variability in current PDU practice patterns, technique, and interpretation. Chi-square test was used to determine the association between categorical variables. Approximately 9.5% of all 1996 current ISSM members completed the survey. Almost 80% of members surveyed reported using PDU, with more North American practitioners utilizing PDU than their European counterparts (94% vs 69%, p < 0.01). Approximately 62% of PDU studies were performed by a urologist and more than 76% were interpreted by a urologist. Although almost 90% of practitioners reported using their own protocol, extreme variation in the technique existed among respondents. Over ten different pharmacologic mixtures were used to generate erections, and 17% of respondents did not repeat dosing for insufficient erection. Urologists personally performing PDU were more likely to assess the cavernosal artery flow using recommended techniques with the probe at the proximal penile shaft (73% vs 40%) and at a 60-degree angle or less (68% vs 36%) compared with non-urologists (p < 0.01). Large differences in PDU diagnostic thresholds were apparent. Only 38% of respondents defined arterial insufficiency with a peak systolic velocity < 25 cm/s, while 53% of respondents defined venous occlusive disease with an end diastolic velocity > 5 cm/s. This is the first study to assess the variability in the PDU protocol and practice patterns, and to pinpoint areas of improvement. As in other surveys, recall bias, generalizability, and response rate (9.5%) are inherent limitations to this study. Although most respondents report utilizing a standardized PDU protocol, widespread variation exists among practitioners in terms of both technique and interpretation, limiting accurate diagnosis and appropriate treatment of penile conditions.
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Affiliation(s)
- Mohit Butaney
- Scott Department of Urology, Baylor College of Medicine, Houston, TX, USA.
| | | | - Mark S Hockenberry
- Scott Department of Urology, Baylor College of Medicine, Houston, TX, USA
| | - E Will Kirby
- Scott Department of Urology, Baylor College of Medicine, Houston, TX, USA
| | | | - Larry I Lipshultz
- Scott Department of Urology, Baylor College of Medicine, Houston, TX, USA
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Rodriguez KM, Kohn TP, Kohn JR, Kirby EW, Pickett SM, Pastuszak AW, Lipshultz LI. PD27-06 SHIFT WORK SLEEP DISORDER AND NIGHT SHIFT WORK SIGNIFICANTLY IMPAIR ERECTILE FUNCTION. J Urol 2018. [DOI: 10.1016/j.juro.2018.02.1357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Sukhu T, Pruthi NR, Deal A, Langston J, Kirby EW, Raynor M, Gonzalez C, McKenna P, Smith AB, Pruthi RS. Workforce Characteristics in Urology. Urology Practice 2018. [DOI: 10.1016/j.urpr.2017.02.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Troy Sukhu
- Department of Urology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Nicholas R. Pruthi
- Department of Urology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Allison Deal
- Department of Urology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Joshua Langston
- Department of Urology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - E. Will Kirby
- Department of Urology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Matthew Raynor
- Department of Urology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | | | - Patrick McKenna
- Department of Urology, University of Wisconsin, Madison, Wisconsin
| | - Angela B. Smith
- Department of Urology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Raj S. Pruthi
- Department of Urology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
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Abstract
Erectile dysfunction (ED) is a common problem in older men and occurs with even greater frequency following the treatment of pelvic malignancies. Inflatable penile prosthesis (IPP) implantation is a safe and effective form of definitive ED treatment for those men who fail more conservative measures, and it can be used with similar outcomes in men following cancer therapy. Although many of these men remain dissatisfied with other therapeutic options for ED, IPPs are underutilized in this population. This review will discuss the current practice patterns, outcomes and nuances to surgical technique regarding the use of IPPs in patients with ED following cancer therapy.
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Affiliation(s)
- Pranav Dadhich
- Department of Urology, Baylor College of Medicine, Houston, Texas, USA
| | - Mark Hockenberry
- Department of Urology, Baylor College of Medicine, Houston, Texas, USA
| | - E Will Kirby
- Department of Urology, Baylor College of Medicine, Houston, Texas, USA
| | - Larry Lipshultz
- Department of Urology, Baylor College of Medicine, Houston, Texas, USA
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Langston JP, Orcutt VL, Smith AB, Schultz H, Hornberger B, Deal AB, Doran TJ, McKibben MJ, Kirby EW, Nielsen ME, Gonzalez CM, Pruthi RS. Advanced Practice Providers in U.S. Urology: A National Survey of Demographics and Clinical Roles. Urol Pract 2017; 4:418-424. [PMID: 37592684 DOI: 10.1016/j.urpr.2016.09.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
INTRODUCTION Projections suggest a significant shortage of urologists coupled with an increasing burden of urological disease due to an aging population. To meet this need, urologists have increasingly partnered with advanced practice providers. However, to this point the advanced practice provider workforce has not been comprehensively evaluated. Understanding the impact of advanced practice providers on the urology workforce is essential to maximize collaborative care as we strive for value and quality in evolving delivery models. METHODS A 29-item, web based survey was administered to advanced practice providers identified by the AUA (American Urological Association), UAPA (Urological Association of Physician Assistants) and SUNA (Society of Urologic Nurses and Associates), querying many aspects of their practice. RESULTS A total of 296 advanced practice providers completed the survey. Advanced practice nurses comprised 62% of respondents while physician assistants comprised the remaining 38%. More than two-thirds of the respondents were female and median age was 46 years. Only 6% reported having participated in formal postgraduate urological training. Advanced practice providers were evenly divided between institutional and private practice settings, and overwhelmingly in urban or suburban environments. The majority of advanced practice providers practice in the ambulatory setting (74%) and characterize their practice as general urology (72%). Overall 81% reported performing procedures independently, with 63% performing some procedures considered to be of moderate or high complexity. CONCLUSIONS Advanced practice providers are active in the provision of urological care in many roles, including complex procedures. Given future workforce needs, advanced practice providers will likely assume additional responsibilities. As roles shift we must ensure we have the necessary educational and training opportunities to equip this vital part of our workforce.
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Affiliation(s)
- Joshua P Langston
- Department of Urology, Eastern Virginia Medical School, and Urology of Virginia PLLC, Norfolk, Virginia
| | - Venetia L Orcutt
- Department of Physician Assistant Studies, School of Health Professions, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Angela B Smith
- Department of Urology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Heather Schultz
- Department of Urology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Brad Hornberger
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Allison B Deal
- Lineberger Comprehensive Cancer Center, Cancer Outcomes Research Group, Biostatistics and Clinical Data Management, Chapel Hill, North Carolina
| | - Todd J Doran
- Department of Family and Preventive Medicine, Physician Associate Program, University of Oklahoma College of Medicine, Oklahoma City, Oklahoma
| | - Maxim J McKibben
- Department of Urology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - E Will Kirby
- Department of Urology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Matthew E Nielsen
- Department of Urology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Chris M Gonzalez
- Department of Urology, Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Raj S Pruthi
- Department of Urology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
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Abstract
Vasectomy is the method of contraception chosen by more than 500,000 American men annually, and by upwards of 8% of married couples worldwide. However, following the procedure, nearly 20% of men express the desire for children in the future, and approximately 2–6% of American men will ultimately undergo vasectomy reversal (VR). VR is a complex microsurgical procedure. Intraoperative decision-making, surgical technique, and postoperative management are each critical step in achieving high success rates. The aim of this article is to provide a detailed description of the operative and perioperative procedures employed by surgeons performing VRs.
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McKibben MJ, Kirby EW, Langston J, Raynor MC, Nielsen ME, Smith AB, Wallen EM, Woods ME, Pruthi RS. Projecting the Urology Workforce Over the Next 20 Years. Urology 2016; 98:21-26. [DOI: 10.1016/j.urology.2016.07.028] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2016] [Revised: 07/12/2016] [Accepted: 07/22/2016] [Indexed: 10/21/2022]
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Kirby EW, Carson CC. Reduced Resident Work Hours in Urology: The History and Impact of Duty Hour Restrictions. Urol Pract 2016; 3:493-498. [PMID: 37592554 DOI: 10.1016/j.urpr.2015.09.005] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
INTRODUCTION The ACGME first mandated duty hour restrictions for resident physicians in 2003, setting a limit of 80 hours per week. While the goals of this and later reforms were to improve patient care and safety, the outcomes have been mixed. In this review we report on the history of duty hour regulations and how these changes have impacted resident and patient outcomes. METHODS A literature search was performed, and articles discussing surgical training, resident duty hours, resident wellness and patient outcomes were reviewed. RESULTS After implementation of duty hour restrictions in 2003, the Harvard Work Hours Health and Safety Group published 3 hallmark studies that suggested duty hour restrictions were associated with improved outcomes. A recently published systematic review reported mixed results from the growing body of research. While 71% of the reviewed studies reported improvement in resident wellness, only 4% illustrated an improvement in resident education, 19% reported improved patient safety outcomes and 13% demonstrated improved patient morbidity. CONCLUSIONS Resident duty hour restrictions were based on a body of evidence illustrating that fatigue and sleeplessness negatively impact decision making, resident wellness and patient care. While initial outcomes suggested that these regulations resulted in better resident and patient outcomes, more recent evidence suggests otherwise. There is very little urology specific evidence addressing these matters.
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Affiliation(s)
- E Will Kirby
- Department of Urology, University of North Carolina School of Medicine, Chapel Hill, North Carolina
| | - Culley C Carson
- Department of Urology, University of North Carolina School of Medicine, Chapel Hill, North Carolina
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Langston JP, Macey M, Sukhu T, Lomboy J, Deal A, Kirby EW, Viprakasit DP, Nielsen M, Pruthi RS, Smith AB. Surgical Equipment Cost Awareness among Urological Surgeons. J Am Coll Surg 2016. [DOI: 10.1016/j.jamcollsurg.2016.08.564] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Abstract
INTRODUCTION There is little information on job satisfaction in the extant literature in urology. The purpose of this study is to examine 1) the current state of job satisfaction among urologists in the United States, and 2) the demographic and work place factors that have the greatest influence on satisfaction. METHODS We collaborated with AUA (American Urological Association) to query its domestic membership of practicing urologists regarding socioeconomic, work force and quality of life issues. A total of 848 responses were collected for a total response rate of 13%. Linear regression models were used to evaluate bivariable and multivariable associations with job satisfaction scores on a 1 to 5 scale. RESULTS Of providers 70% reported being satisfied, 63% reported that they would choose medicine again and 83% would choose urology again. Age and job satisfaction did not demonstrate a linear association on statistical analysis but rather a U-shaped relationship. On bivariate analysis significant factors associated with higher job satisfaction included younger and older age, higher income (p = 0.047), fewer call days (p = 0.006), fellowship training (p = 0.006) and academic practice (overall p = 0.002). On multivariate analysis age (younger and older ages) and academic practice remained significant predictors of job satisfaction (p = 0.01) as did higher income (p = 0.038). CONCLUSIONS The current study helps describe the current state of job satisfaction among American urologists and examined work place factors that influence satisfaction. Income, hours worked, academic practice and age each have a significant impact on job satisfaction for the practicing urologist. Keeping abreast of the drivers of job satisfaction is critical to ensure that urologists continue to care for patients, perform research, educate future physicians and provide service to their communities.
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Affiliation(s)
- Nicholas R Pruthi
- Department of Urology and Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Allison Deal
- Department of Urology and Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Joshua Langston
- Department of Urology and Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - E Will Kirby
- Department of Urology and Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Christopher Gonzalez
- Department of Urology and Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Patrick McKenna
- Department of Urology and Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Matthew E Nielsen
- Department of Urology and Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Angela B Smith
- Department of Urology and Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Raj S Pruthi
- Department of Urology and Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
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McKibben M, Kirby EW, Langston J, Nielsen M, Raynor M, Wallen E, Smith A, Woods M, Pruthi R. PD17-07 PROJECTING THE UROLOGY WORKFORCE OVER THE NEXT 20 YEARS. J Urol 2016. [DOI: 10.1016/j.juro.2016.02.1172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Spencer ES, Deal AM, Pruthi NR, Gonzalez CM, Kirby EW, Langston J, McKenna PH, McKibben MJ, Nielsen ME, Raynor MC, Wallen EM, Woods ME, Pruthi RS, Smith AB. Gender Differences in Compensation, Job Satisfaction and Other Practice Patterns in Urology. J Urol 2016; 195:450-5. [PMID: 26384452 PMCID: PMC5004345 DOI: 10.1016/j.juro.2015.08.100] [Citation(s) in RCA: 79] [Impact Index Per Article: 9.9] [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] [Accepted: 08/11/2015] [Indexed: 10/23/2022]
Abstract
PURPOSE The proportion of women in urology has increased from less than 0.5% in 1981 to 10% today. Furthermore, 33% of students matching in urology are now female. In this analysis we characterize the female workforce in urology compared to that of men with regard to income, workload and job satisfaction. MATERIALS AND METHODS We collaborated with the American Urological Association to survey its domestic membership of practicing urologists regarding socioeconomic, workforce and quality of life issues. A total of 6,511 survey invitations were sent via e-mail. The survey consisted of 26 questions and took approximately 13 minutes to complete. Linear regression models were used to evaluate bivariable and multivariable associations with job satisfaction and compensation. RESULTS A total of 848 responses (660 or 90% male, 73 or 10% female) were collected for a total response rate of 13%. On bivariable analysis female urologists were younger (p <0.0001), more likely to be fellowship trained (p=0.002), worked in academics (p=0.008), were less likely to be self-employed and worked fewer hours (p=0.03) compared to male urologists. On multivariable analysis female gender was a significant predictor of lower compensation (p=0.001) when controlling for work hours, call frequency, age, practice setting and type, fellowship training and advance practice provider employment. Adjusted salaries among female urologists were $76,321 less than those of men. Gender was not a predictor of job satisfaction. CONCLUSIONS Female urologists are significantly less compensated compared to male urologists after adjusting for several factors likely contributing to compensation. There is no difference in job satisfaction between male and female urologists.
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Affiliation(s)
- E Sophie Spencer
- Department of Urology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Allison M Deal
- Cancer Outcomes Research Group, Biostatistics and Clinical Data Management, Lineberger Comprehensive Cancer Center, Chapel Hill, North Carolina
| | - Nicholas R Pruthi
- Department of Urology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Chris M Gonzalez
- Department of Urology, Northwestern University, Chicago, Illinois
| | - E Will Kirby
- Department of Urology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Joshua Langston
- Department of Urology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | | | - Maxim J McKibben
- Department of Urology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Matthew E Nielsen
- Department of Urology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; Cancer Outcomes Research Group, Multidisciplinary Genitourinary Oncology, Lineberger Comprehensive Cancer Center, Chapel Hill, North Carolina
| | - Mathew C Raynor
- Department of Urology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Eric M Wallen
- Department of Urology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; Cancer Outcomes Research Group, Multidisciplinary Genitourinary Oncology, Lineberger Comprehensive Cancer Center, Chapel Hill, North Carolina
| | - Michael E Woods
- Department of Urology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; Cancer Outcomes Research Group, Multidisciplinary Genitourinary Oncology, Lineberger Comprehensive Cancer Center, Chapel Hill, North Carolina
| | - Raj S Pruthi
- Department of Urology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; Cancer Outcomes Research Group, Multidisciplinary Genitourinary Oncology, Lineberger Comprehensive Cancer Center, Chapel Hill, North Carolina
| | - Angela B Smith
- Department of Urology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; Cancer Outcomes Research Group, Multidisciplinary Genitourinary Oncology, Lineberger Comprehensive Cancer Center, Chapel Hill, North Carolina.
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Kirby EW, Verges D, Matthews J, Carson CC, Coward RM. Low testosterone has a similar prevalence among men with sexual dysfunction due to either Peyronie's disease or erectile dysfunction and does not correlate with Peyronie's disease severity. J Sex Med 2015; 12:690-6. [PMID: 25580982 DOI: 10.1111/jsm.12805] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Low testosterone (T) has been suggested as a risk factor for Peyronie's disease (PD) that may correlate with disease severity. Low T is common in men with sexual dysfunction but its role in the pathogenesis of PD remains unclear. AIM The aim of this study was to compare the prevalence of low T (<300 ng/dL) in patients presenting with PD or erectile dysfunction (ED), as well as disease severity between men with PD and either low T or normal T (≥300 ng/dL). METHODS Retrospective review of 300 men with either PD or ED was conducted. Men were excluded for combined PD and ED, psychogenic ED, or prior T use. For men with PD, plaque size, degree of curvature, and surgical correction rate were compared. MAIN OUTCOME MEASURES The main outcome measures were (i) mean T levels in men with PD or ED and (ii) plaque size, degree of curvature, and surgical correction rates among men with PD and either low T or normal T. RESULTS Eighty-seven men with PD and 98 men with ED were identified. Men with PD had mean total T and free T of 328 ng/dL and 11.5 ng/dL, while men with ED had mean levels of 332 ng/dL and 12.1 ng/dL, respectively (P > 0.05). Of PD men, 52.9% had low T, compared with 45.9% of men with ED (P = 0.35). T levels did not correlate with plaque size or degree of curvature in the PD group (P > 0.05). CONCLUSIONS Men with sexual dysfunction characterized by either PD or ED had similarly low T levels, and low T did not correlate with PD severity or surgical correction rate. The comparable prevalence of low T in men with PD or ED suggests the high rate of low T in PD men may be related to a common process among men with abnormal erectile physiology and not specifically causative in plaque formation.
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Affiliation(s)
- E Will Kirby
- Department of Urology, University of North Carolina, Chapel Hill, NC, USA
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Langston JP, Kirby EW, Nielsen ME, Smith AB, Woods ME, Wallen EM, Pruthi RS. Economic Impact of Training and Career Decisions on Urological Surgery. J Urol 2014; 191:755-60. [DOI: 10.1016/j.juro.2013.09.060] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/04/2013] [Indexed: 11/25/2022]
Affiliation(s)
- Joshua P. Langston
- Department of Urology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - E. Will Kirby
- Department of Urology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Matthew E. Nielsen
- Department of Urology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Angela B. Smith
- Department of Urology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Michael E. Woods
- Department of Urology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Eric M. Wallen
- Department of Urology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Raj S. Pruthi
- Department of Urology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
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Johnson D, Kirby EW, Ferguson JE, Smith A, Matthews J, Woods ME, Nielsen ME, Raynor MC, Pruthi RS, Wallen EM. Nutritional predictors for complicatons following radical cystectomy: an analysis of the American College Of Surgeons National Quality Improvement Program (ACS-NSQIP). J Am Coll Surg 2013. [DOI: 10.1016/j.jamcollsurg.2013.07.343] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Kirby EW, Borawski KM, Smith AB. Levels of Evidence and Clinical Guidelines-Considerations for the Practicing Urologist. Sex Med Rev 2013; 1:17-23. [PMID: 27784556 DOI: 10.1002/smrj.1] [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] [Indexed: 11/07/2022]
Abstract
INTRODUCTION It is important for urologists to remain up-to-date regarding research and clinical guidelines within their specialty. This has become increasingly difficult as the volume of research increases while the quality of evidence has not followed suit. It is, therefore, important for urologists to understand the methodology of critical appraisal of evidence, for both the assessment of individual journal articles as well as the construction of organizational clinical guidelines. METHODS The methodology for clinical guideline creation used by the American Urological Association (AUA) is reviewed along with that of the U.S. Preventive Services Task Force (USPSTF). Two popular grading schemas are then reviewed to provide an overview of existing methods for the critical analysis of research. We conclude with a description of the Grading of Recommendations Assessment Development and Evaluation (GRADE)-a classification system that attempts to unify various grading systems and is rapidly gaining popularity among well-reputed national organizations. RESULTS The AUA uses a systematic and evidence-based approach to creating clinical guidelines. The USPSTF is similar to the AUA in its approach to reviewing the literature and creating guidelines. The Centre for Evidence Based Medicine offers a novel approach to evidence-based literature review, providing a metric for the analysis of the literature to answer specific clinical questions. GRADE is working toward the development of a more transparent and standardized approach to the creation and reporting of clinical guidelines. CONCLUSIONS A number of organizations have attempted to standardize and clarify the literature review process to provide physicians with tools to critically evaluate higher quality evidence and apply guidelines to clinical practice. As urologists, we must understand how national organizations review the literature and develop clinical guidelines. Additionally, we must develop our own process for reviewing the literature in order to answer questions that have not yet been addressed by these organizations. Kirby EW, Borawski KM, and Smith AB. Levels of evidence and clinical guidelines-Considerations for the practicing urologist. Sex Med Rev 2013;1:17-23.
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Affiliation(s)
- E Will Kirby
- Department of Surgery, Division of Urology, University of North Carolina, Chapel Hill, NC, USA
| | - Kristy M Borawski
- Department of Surgery, Division of Urology, University of North Carolina, Chapel Hill, NC, USA
| | - Angela B Smith
- Department of Surgery, Division of Urology, University of North Carolina, Chapel Hill, NC, USA.
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Heyer EJ, Gold MI, Kirby EW, Zurica J, Mitchell E, Halazun HJ, Teverbaugh L, Sciacca RR, Solomon RA, Quest DO, Maldonado TS, Riles TS, Connolly ES. A study of cognitive dysfunction in patients having carotid endarterectomy performed with regional anesthesia. Anesth Analg 2008; 107:636-42. [PMID: 18633045 DOI: 10.1213/ane.0b013e3181770d84] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND In previous studies, we found that approximately 25% of patients having carotid endarterectomy with general anesthesia (CEA general) develop cognitive dysfunction compared with a surgical control Group 1 day and 1 mo after surgery. In this study, we tested the hypothesis that patients having CEA with regional anesthesia (CEA regional) will develop significant cognitive dysfunction 1 day after surgery compared with a control group of patients receiving sedation 1 day after surgery. We did not study persistence of dysfunction. METHODS To test this hypothesis, we enrolled 60 patients in a prospective study. CEA regional was performed with superficial and deep cervical plexus blocks in 41 patients. The control group consisted of 19 patients having coronary angiography or coronary artery stenting performed with sedation. A control group is necessary to account for the "practice effect" associated with repeated cognitive testing. The patients from the CEA regional group were enrolled at New York Medical Center and the control group at Columbia-Presbyterian Medical Center. The cognitive performance of all patients was evaluated using a previously validated battery of neuropsychometric tests. Differences in performance, 1 day after compared with before surgery, were evaluated by both event-rate and group-rate analyses. RESULTS On postoperative day 1, 24.4% of patients undergoing CEA regional had significant cognitive dysfunction, where "significant" was defined as a total deficit score > or =2 SD worse than the mean performance in the control group. CONCLUSIONS Patients undergoing CEA regional had an incidence of cognitive dysfunction which was not different than patients having CEA general as previously published and compared with a contemporaneously enrolled group.
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Affiliation(s)
- Eric J Heyer
- Department of Anesthesiology, Columbia University, 620 West 168th Street, New York, NY 10032, USA.
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