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Introduction: Social determinants of health (SDH) are nonbiologic influencers of disease and health care disparities. This study focused on understanding the association between SDH and urology clinic "no-show" visits within a diverse urban population., Methods: We retrospectively identified patients scheduled for urology clinic visits from October 2015 to June 2022 who completed a 10-question social needs screener. For each patient, demographic variables, and number of missed clinic appointments were abstracted. Multivariable logistic regression was performed to determine the association of unmet social needs and no-shows., Results: Of 5761 unique patients seen in clinic, 5293 completed a social needs screener. Respondents were most commonly male (62.8%), Hispanic (50.3%), English-speaking (75.5%), and insured by Medicare (46.0%). Overall, 8.2%, 4.6%, and 6.1% reported 1, 2, and 3+ unmet social needs, respectively. Most patients (61.7%) had 0 no-shows; 38.3% had 1+ no-shows. Between the 0 and 1+ no-show groups, we found significant differences with respect to gender ( P =.05), race/ethnicity ( P = .002), preferred language ( P = .006), insurance payer ( P < .001), SDH status ( P = .003), and total number of unmet social needs ( P = .006). On multivariable analysis, patients concerned about housing quality (odds ratio [OR] = 1.50, P = .002), legal help (OR = 1.53, P = .009), and with 3+ unmet social needs (OR = 1.39, P = .006) were more likely to have 1+ no-shows., Conclusions: Unmet social needs were associated with increased no-show urology clinic visits. Routine social needs screening could identify at-risk patients who would benefit from services. This may be particularly pertinent for patients with urgent diagnoses or those requiring frequent office visits where missing appointments could impact morbidity and mortality.

Introduction: This study aimed to evaluate predictors of timely urological evaluation among men referred for initial elevated PSA in a diverse, high-risk, urban community., Methods: We conducted a retrospective cohort study of all men aged 50+ referred to urology within our healthcare network between January 2018 and December 2021 for initial elevated PSA. Time to initial urological evaluation was categorized as timely (within 4 months of referral), late (after 4 months), or absent (no urology evaluation). Demographic and clinical variables were abstracted. A multivariable multinomial logistic regression model was conducted to identify predictors of timely vs late vs absent urological evaluation controlling for age, referral year, household income, distance to care, and PSA at referral., Results: A total of 1,335 men met inclusion criteria; 589 (44.1%), 210 (15.7%), and 536 (40.1%) had timely, late, and absent urological evaluation, respectively. The majority were non-Hispanic Black (46.7%), English-speaking (84.0%), and married (54.6%). Median time to initial urological evaluation differed significantly between timely and late groups (16 vs 210 days, P < .001). Multivariable logistic regression revealed the following to be significant predictors of timely urological evaluation: non-Hispanic Black (OR=1.59, P = .03), Hispanic (OR=2.07, P = .001), Spanish-speaking (OR=1.44, P = .03), or former-smokers (OR=1.31, P = .04)., Conclusions: In our diverse community, men who are non-Hispanic White or English-speaking have a decreased odds of timely urological evaluation after a referral for elevated PSA in our diverse patient population. Our study underscores cohorts that may benefit from implementation of institutional safeguards such as patient navigation systems to facilitate and ensure appropriate follow-up upon referral for elevated PSA.

Introduction: There is a need to better understand the role of postoperative care via telemedicine (TM). We evaluated patient satisfaction and outcomes of postoperative face-to-face (F2F) versus TM visits for adult ambulatory urological surgeries in an urban academic center. Methods:This was a prospective, randomized controlled trial. At surgery, patients undergoing ambulatory endoscopic procedures or open surgery were randomized 1:1 to a postoperative F2F or TM visit. After the visit, a telephone survey assessing satisfaction was administered. Primary outcome was patient satisfaction; secondary outcomes were time and cost savings, and 30-day safety outcomes. Results:A total of 197 patients were approached; 165 (83%) consented and were randomized-76 (45%) to F2F and 89 (54%) to TM cohorts. There were no significant differences in baseline demographics between the cohorts. Both cohorts were equally satisfied with their postoperative visit (F2F 98.6% vs TM 94.1%, p=0.28) and found their visit to be an acceptable form of health care (F2F 100% vs TM 92.7%, p=0.06). The TM cohort saved a significant amount of time (TM 66.2% spent <15 minutes vs F2F 43.1% spent 1-2 hours, p <0.0001) and money (44.1% TM saved $5-$25 vs 43.1% F2F spent $5-$25, p=0.041) associated with travel. There were no significant differences in 30-day safety outcomes between the cohorts. Conclusions:TM for postoperative visits after ambulatory adult urological surgery saves patients time and money without compromising satisfaction or safety. TM should be offered as an alternative to F2F for routine postoperative care for certain ambulatory urological surgeries.

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.

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., Competing Interests: DECLARATION OF CONFLICTING INTERESTS: The Authors declare that there is no conflict of interest.

Introduction: Opioid addiction is a rising public health crisis. We evaluated if a New York State-mandated online opioid awareness course impacted our urology opioid prescription practices for outpatient endoscopic surgeries., Methods: We completed a retrospective review of all ambulatory endoscopic cases identified by CPT codes for all adult urology faculty between February 2016 and January 2018. Patients were divided into 2 cohorts, ie pre-mandated and post-mandated training. Patient demographics, procedure details, psychiatric history and postoperative pain prescriptions were collected. Changes in opioid prescription practices prior to and after the mandated online course were reviewed. Chi-square and linear regression analyses were performed., Results: A total of 356 cases were analyzed. After the training course, overall frequency of department opioid prescriptions did not change significantly (47.9% vs 47.5%, p=0.95). However, the percentage of patients receiving an oxycodone/acetaminophen prescription decreased from 90.2% to 63.0% (p <0.001) and the average number of tablets prescribed decreased (8.6 vs 16.9, p <0.001). On multivariate analysis, placement of a ureteral stent, older patient age and higher body mass index were predictors of an opioid prescription. In those patients who had a stent placed, nonopioid prescriptions increased from 42% to 88% (p <0.001)., Conclusions: Overall, the New York State-mandated education session did impact opioid prescription practices for outpatient urological endoscopic surgery at our institution. The largest impact was seen within patients undergoing procedures requiring stent placement, with a decrease in total number of oxycodone/acetaminophen prescriptions and number of tablets prescribed per prescription. These data begin to demonstrate effective interventions that may impact physician practice patterns within opioid research.

Purpose: Obesity is a risk factor for metabolic syndrome and urolithiasis, particularly uric acid stones. As estimated by visceral fat area, visceral obesity is a more specific measure of the risk of metabolic syndrome than body mass index. We investigated the effects of visceral fat area and other metabolic factors on uric acid stone formation in patients treated with percutaneous nephrolithotomy., Materials and Methods: We retrospectively reviewed the records of 269 patients who underwent percutaneous nephrolithotomy. Visceral fat area was measured in each patient on a CT axial slice at the umbilical level using the Aquarius iNtuition fat analysis tool. Analysis was performed to determine the effect of visceral fat area and other comorbidities on uric acid stone formation., Results: Of the 269 patients analyzed there was no difference in baseline comorbidities between uric acid and nonuric acid stone formers. Patients with uric acid stones had a significantly higher mean visceral fat area (209.3 vs 161.9 cm², p = 0.001), and rates of hypertension (67.4% vs 47.3%) and coronary artery disease (14.3% vs 4.6%, each p = 0.011). On logistic regression analysis hypertension (OR 2.16, 95% CI 1.05-4.45, p = 0.04) and a high visceral fat area (OR 3.64, 95% CI 1.22-10.85, p = 0.02) were independent risk factors for uric acid stones., Conclusions: As a marker of visceral obesity, visceral fat area contributes to the risk of metabolic syndrome and urolithiasis. Uric acid stone formers showed a significantly higher hypertension rate and mean visceral fat area, which were independent risk factors for uric acid urolithiasis. Evaluating these characteristics in stone formers may facilitate a tailored metabolic assessment and treatment plan., (Copyright © 2013 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.)