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Purpose: Treatment delays in muscle invasive bladder cancer (MIBC) have been shown to be associated with worse outcomes. While every attempt is made to provide adequate treatment expeditiously, Black and Hispanic patients often experience delays at a higher rate than their White counterparts. This study aims to quantify the mechanisms that contribute to this disparity in treatment delay., Methods: Retrospective analysis of clinical T-stages II-IVa MIBC patients who underwent surgical resection from 2004 to 2017 in the National Cancer Database. A causal inference mediation analysis using the counterfactual framework was implemented to estimate the extent to which racial/ethnic disparities in patient and system factors explain the racial/ethnic disparities in time to treatment. Mediators included income, education, comorbidities, insurance, and hospital type., Results: Among 22,864 patients who met inclusion criteria, 7%, 3%, 2% were of Black, Hispanic, and Other race/ethnicity, respectively. In multivariable models, compared to White patients, Black, and Hispanic patients were associated with 26% (odds ratio = 1.26, 95% confidence interval = 1.12-1.42) and 29% (odds ratio = 1.29, 95% confidence interval = 1.07-1.55) increased odds of having a treatment delay relative to White patients. Mediation analyses suggested that 49% and 26% the treatment delay among Black and Hispanic patients, respectively, could be removed if an intervention equalized the distribution of academic treatment, education, and insurance status to that of White patients. Treatment at an academic hospital and education were the mediators that explained the largest portion of the racial/ethnic disparity in treatment delay., Conclusion: Black and Hispanic MIBC patients experience treatment delays when compared to White patients. Intervening upon patient and system factors could reduce substantial treatment delays. Future research is needed to identify other causes of disparities in treatment delays and may help population health initiatives to address racial/ethnic disparities in clinical settings., (Copyright © 2022 Elsevier Inc. All rights reserved.)

Introduction: The proportion of robotic procedures continues to rise. The literature reinforces that robotic procedures take longer and are often more costly. We compared cost and perioperative outcomes of laparoscopic radical nephrectomy (LRN) and robot-assisted radical nephrectomy (RARN) at our high-volume center. Materials and Methods: We retrospectively reviewed our 2012-2015 data repository for patients undergoing RARN and LRN for a renal mass. Perioperative and oncologic outcomes were compared. We performed a multivariate analysis of operative time, estimated blood loss, length of stay (LOS), and overall and major 90-day complication rates while controlling for demographic data, Charlson comorbidity index (CCI), tumor size, and surgeon factors. We compared fixed, variable, and distinct procedural costs. Results: We identified 99 LRN and 95 RARN cases. There was no difference in demographic data, tumor size, preoperative renal function, and malignant histology. LRN patients had more comorbidities (49.5% vs 27.3% CCI 2+, p  = 0.018). The mean preoperative glomerular filtration rate was higher in the robotic cohort (84.8 vs 75.1, p  = 0.48). Mean operative time was 32.7 minutes longer ( p  = 0.002) and estimated blood loss 145 mL higher ( p  = 0.007) for the RARN cohort. There was no difference in mean LOS. Major and all 90-day complication rates were no different. The mean procedural cost for RARN was higher by $464 when controlling for operative time ( p  < 0.001). Fixed costs were not statistically different. Variable costs for RARN were estimated to be $2,310 higher ( p  = 0.045). Conclusions: Even with cost-conscious, experienced renal surgeons, RARN is associated with a longer procedure, higher supply costs, and higher hospitalization costs. There was no difference in positive surgical margin and complications. There were fewer 30-day readmissions for the RARN cohort, which may represent under-recognized cost savings. With fewer LRN cases in the United States each year, discussion to address cost is warranted. Without better outcomes for robotic surgery, a change in reimbursement to cover costs is unlikely to happen.

Objective: To provide an update on the web pages of academic Urology departments in the United States and to evaluate for consistency of information available to applicants., Materials and Methods: The American Urologic Association accredited listing of US urology residency programs was accessed in January 2018. One hundred and thirty-five urology residency program websites were then accessed and searched for the presence or absence of 44 criteria. Criteria were grouped into 7 categories: program overview and contact information, application information, program curriculum, current residents, alumni, faculty, and resident benefits. Programs were categorized based on US census bureau designated regions, program size, and by program ranking by the Doximity Urology Residency Program Navigator., Results: Out of 135, 134 (99%) of the AUA accredited listing of US urology residency programs had functional websites. The most commonly available information included clinical rotation sites (84%), resident curriculum (78%), number and names of current residents (76% and 77%, respectively), and faculty names and corresponding subspecialties (74% and 72%, respectively). These trends were similar across geographic regions. The top 20 residency programs on Doximity were more likely to list alumni names (70% vs 35%, P = .005), alumni fellowships (75% vs 30% P = .0003) and alumni jobs (75% vs 29%, P = .001) compared to all other residency programs., Conclusion: There is high variability regarding comprehensiveness of urology residency websites. An informative and well-constructed website has the potential to improve optics and marketability of a residency program. Top notch residency programs are more likely to display fellowship and faculty information, both desirable prospects after residency., (Copyright © 2020 Elsevier Inc. All rights reserved.)