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To examine stakeholder perspectives regarding the lack of in-person externships and transition to a virtual urology residency interview format. The unprecedented disruption from the COVID-19 pandemic forced an abrupt pivot to a "virtual" Urology Match for the 2021 cycle. We aim for our study to inform ongoing deliberations on the future of the Urology Match.Following Urology Match day in February 2021, two surveys were distributed by the Society of Academic Urologists to all applicants and program directors (PDs) who participated in the 2021 Urology Match.Overall, 192 of 481 applicants (40%) and 63 of 160 PDs (39%) responded. Most applicants (67%) were satisfied with their match outcomes, although unmatched applicants were significantly more likely to be unsatisfied than matched applicants (98% vs 9%, P.0001). Most PDs were equally (79%) or more satisfied (13%) with their match outcomes compared with prior years. Nearly all applicants (93%) and PDs (94%) recommended retaining an in-person externship option. Most applicants (61%) and PDs (71%) felt their outcomes would not have changed with in-person interviews. Applicants and PDs were evenly split as to whether interviews should be conducted in-person or virtually in the future.The vast majority of applicants and PDs recommended retaining in-person externships for future match cycles despite high costs. In contrast, there was ambivalence amongst both groups of stakeholders regarding the format of interviews for future match cycles. We recommend virtual interviews moving forward to help alleviate the financial burden placed on applicants and increase equity.

Objective To study the use of video visits for male infertility care prior to the COVID-19 pandemic Methods We reviewed video visits for male infertility patients completed at a tertiary academic center in southeast Michigan. These patients had follow-up after an initial in-person evaluation. We designed this retrospective case series to describe the diagnostic categories seen through telehealth, management steps completed during video visits, and to understand whether additional in-person care was required within 90 days of video visits. In addition, we estimated time and cost savings for patients attributed to video visits. Results Most men seen during video visits had an endocrinologic (29%) or anatomic (21%) cause for their infertility. 73% of video visits involved reviewing results; 30% included counseling regarding assistive reproductive technologies; and 25% of video visits resulted in prescribing hormonally active medications. The two patients (3%) who were seen in clinic after their video visit underwent a varicocelectomy in the interim. No patients required an unplanned in-person visit. From a patient perspective, video visits were estimated to save a median of 97 minutes (IQR 64-250) of travel per visit. Median cost savings per patient— by avoiding travel and taking time off work for a clinic visit—were estimated to range from $149 (half day off) to $252 (full day off). Conclusion Video visits for established male infertility patients were used to manage different causes of infertility while saving patients time and money. Telehealth for established patients did not trigger additional in-person evaluations.

Introduction:Consultations represent a significant workload for inpatient urology providers, yet consult patterns are poorly described. We report trends in billable urology consult activity...

On 11 March 2020, the World Health Organization declared SARS-CoV-2 and its associated disease, COVID-19, a global pandemic. Across the world, governments took action to slow the spread and hospitals rushed to accommodate an influx of patients with this highly infectious and lethal disease. The urology departments in Ann Arbor, Michigan, USA, and Herlev and Gentofte, Copenhagen, Denmark — which are linked by the pre-existing CopMich Collaborative — had to respond with massive changes to the organization, staffing and workload of their teams. In this Viewpoint, authors from different urological subspecialties and at different career stages reflect on their experiences during the pandemic. Although their countries’ responses to the COVID-19 pandemic differed radically, the similarities between the responses in Copenhagen and Michigan demonstrate the universal characteristics of medicine and the value of teamwork, flexibility and collaboration., The contributors Juan J. Andino is a third-year urology resident at the University of Michigan. He completed his undergraduate and medical degrees, and an MBA at the University of Michigan. Dr Andino is interested in telehealth and health policy and hopes to work at the intersection of these fields to optimize the delivery of urological care. James M. Dupree is an Associate Professor of Urology at the University of Michigan. He completed his residency at Northwestern University and his fellowship in Male Reproductive Medicine and Surgery at Baylor College of Medicine. He also completed a Health Policy Fellowship with the American College of Surgeons. Dr Dupree specializes in the advanced treatment of male infertility, and his research focuses on male infertility and reproductive health policy. Dr Dupree is also the Ambulatory Care Clinical Chief for Urology at the University of Michigan. Christian Fuglesang S. Jensen received his medical degree from the University of Copenhagen in 2015 and is currently enrolled as a PhD trainee working with male infertility at the Department of Urology, Herlev and Gentofte Hospital. Dr Jensen has previously worked at the Department of Urology, University of Michigan, performing research into andrology and male infertility. Dr Jensen serves as chair on the ESSM Scientific Sub-Committee for new technologies and sexual function and is a co-founder and member of the Core Unit of the CopMich Collaborative. Ganesh S. Palapattu is the George F. and Sandy G. Valassis Professor and Chair of the Department of Urology at the University of Michigan. He attended the University of Texas at Austin where he earned a Bachelor of Arts degree in Humanities and then Baylor College of Medicine in Houston, Texas, where he earned his medical degree. Subsequently, Dr Palapattu completed his surgical internship, urology training and chief residency in urology at the David Geffen School of Medicine at UCLA followed by a laboratory research fellowship in Urologic Oncology at the Johns Hopkins Hospital Brady Urological Institute. His clinical interest is in the evaluation and management of men with prostate and kidney cancer. Jens Sønksen received his medical degree from the University of Copenhagen in 1988 and earned his PhD and Doctor of Medical Science in 1995 and 2003, respectively. He is currently Professor of Urology at the University of Copenhagen and Head of the Urological Research Center and Section of Andrology, Herlev and Gentofte Hospital, Denmark. Dr Sønksen is currently serving as Adjunct Secretary General of the European Association of Urology and is a co-founder and member of the Core Unit of the CopMich Collaborative. Daniela Wittmann received her BA Hons at Keele University, Keele, UK, her Master’s in Social Work at Simmons College School of Social Work, Boston, MA and her PhD at Michigan State University. She is an Associate Professor in the Department of Urology and Adjunct Associate Professor at the School of Social Work at the University of Michigan. Dr Wittmann is a leading member of the Brandon Prostate Cancer Survivorship Program at the University of Michigan and serves as the Chair of the Mental Health Committee of the Sexual Medicine Society of North America. She is also a member of the Prostate Health Committee of the Urology Care Foundation.

PURPOSE: To characterize patient preferences regarding gender-affirming hormone therapy (HT) providers and telemedicine use. METHODS: Between May and October 2019, a survey was administered to adult patients attending a tertiary medical center's HT clinic. The survey included questions on demographics, barriers to care, and preferences for HT follow-up care. Interest in telemedicine was measured using a Likert scale. Multivariable logistic regression was used to identify patient factors associated with interest in telemedicine. RESULTS: Among 111 patients, 63.1% (n=70) preferred an in-person visit with a specialist and 21.6% (n=24) preferred a video visit with their specialist. While only 15.3% (n=17) preferred follow-up with a primary care provider (PCP), 71.0% (n=80) felt comfortable transitioning future care to a PCP. Notably, 52.3% (n=58) of patients were interested in a telemedicine visit. Factors associated with interest in telemedicine included identifying as a transgender man (aOR 3.94, 95% CI [1.24–12.53], p=0.02), minority race/ethnicity (aOR 6.71, 95% CI [1.79–25.17], p=0.005), no need to travel (aOR 3.34, 95% CI [1.14–9.85], p=0.03), no concerns about video visits (aOR 14.66, 95% CI [4.34–49.56], p

To understand how the lack of a physical examination during new patient video visits can impact urological surgery planning during the COVID-19 pandemic.We retrospectively reviewed 590 consecutive urology patients who underwent new patient video visits from March through May 2020 at a single academic center. Our primary outcome was procedural plan concordance, the proportion of video visit surgical plans that remained the same after the patient was seen in-person, either in clinic or on day of surgery. Median days between video and in-person visits were compared between concordant and discordant cases using the Mann-Whitney U test; P.05 was significant.Overall, 195 (33%) were evaluated by new patient video visits and had a procedure scheduled, of which, 186 (95%) had concordant plans after in-person evaluation. Further, 99% of plans for in-office procedures and 91% for operating room procedures were unchanged. Four patients (2.1%) had surgical plans altered after changes in clinical course, two (1%) due to additional imaging, and three (1.5%) based on genitourinary examination findings. Days between video visit and in-person evaluation did not differ significantly in concordant cases (median 37.5 [IQR, 16 - 80.5]) as compared to discordant cases (median 58.0 [IQR, 20 - 224]; P = .12).Most surgical plans developed during new patient video visits remain unchanged after in-person examination. However, changes in clinical course or updated imaging can alter operative plans. Likewise, certain urologic conditions (eg, penile cancer) rely on the genitourinary examination to dictate surgical approach.

INTRODUCTION AND OBJECTIVE: Most health insurance organizations have reimbursed both video and audio-only (i.e., phone) visits during the COVID-19 pandemic, but may discontinue phone visit coverage after the public health emergency. We sought to understand predictors of video versus audio-only (phone) visits for urologic patients during the COVID-19 pandemic. METHODS: We performed a retrospective review of outpatient urologic encounters at Michigan Medicine from April 1-June 30, 2020. Patients who used telehealth were divided into those with any video visits and those with only phone visits. We obtained demographic information including age, gender, race, ethnicity, need for an interpreter, primary insurance status, and home zip code. We compared use of video versus phone visit across the patient demographic, socioeconomic and geographic characteristics using multivariable analysis. RESULTS: There were 4,744 telehealth users and 2,068 patients (43.6%) received care through phone visits. Patient characteristics associated with lower probability of using video visits included age (average marginal effect [AME] -11.7% for patients between 19-64 years old and -38.3% for patients older than 65), Black/African- American (AME -10.2%) or American Indian/Alaska Native (AME -10.2%), need an interpreter (AME -4.5%), Medicaid as primary insurance (AME -13.3%), live in a rural zip code (AME -7.2%), and live in a zip code with low broadband access (AME -3.7 to -12.8% by quartile;Table). Most patients had more than one factor which further reduced their probability of using video visits. CONCLUSIONS: Age and other social determinants of health including race, geography, insurance status, and access to broadband internet were associated with decreased probability of using video to receive urologic care. This data suggests that without coverage and reimbursement of phone visits, video-only telehealth could exacerbate health disparities in access to urologic care. (Table Presented).

INTRODUCTION AND OBJECTIVE:There is an age-related decline in male testosterone production. It is therefore surprising that younger men are evaluated for hypogonadism with the same cutoff of 300ng/...

INTRODUCTION AND OBJECTIVE: During the COVID-19 pandemic, there was a surge in the use of video visits for both established and new patients. As policymakers and clinicians think about the permanent role of video visits after the pandemic, there is a critical need to understand how the lack of a physical exam during video visits can impact surgical management of urologic conditions. METHODS: We reviewed medical records for 350 consecutive urology patients who underwent new patient video visits from March through May 2020. We identified all patients who had a procedure (or surgery) recommended during, and scheduled after, their video visit. Our primary outcome was procedural plan concordance, the proportion of video visit plans that remained the same after the patient was seen in-person, either in clinic or on day of surgery. The median days between video and in-person visits was compared between concordant and discordant cases using the Mann-Whitney U test;p

INTRODUCTION AND OBJECTIVE:Chronic scrotal pain is common, and has traditionally been difficult to manage. Epididymectomy is a treatment option for a subset of these men who have pain localized to ...

Although a wide array of interventions exist for men seeking fertility after vasectomy, up to 6% of them will elect for a vasectomy reversal. While the widespread adoption of telemedicine promises convenience and improved access, lack of ability to do a physical examination may hinder appropriate counselling. Although vasectomy reversal is successfully completed in most of the men either with a vasovasostomy or a vasoepididymostomy, there could be various reasons for the inability to successfully complete the operation. Our commentary outlines the reasons why a vasectomy reversal is not possible or successful. We also discuss a pre-operative management algorithm in men seeking vasectomy reversal to ensure appropriate counselling with a thorough pre-operative history, physical examination and on occasion, hormonal evaluation.

Background Most health insurance organizations reimbursed both video and audio-only (i.e., phone) visits during the COVID-19 pandemic, but may discontinue phone visit coverage after the pandemic. The impact of discontinuing phone visit coverage on various patient subgroups is uncertain. Objective Identify patient subgroups that are more probable to access telehealth through phone versus video. Design Retrospective cohort. Patients All patients at a U.S. academic medical center who had an outpatient visit that was eligible for telehealth from April through June 2020. Main Measures The marginal and cumulative effect of patient demographic, socioeconomic, and geographic characteristics on the probability of using video versus phone visits. Key Results A total of 104,204 patients had at least one telehealth visit and 45.4% received care through phone visits only. Patient characteristics associated with lower probability of using video visits included age (average marginal effect [AME] −6.9% for every 10 years of age increase, 95%CI −7.8, −4.5), African-American (AME −10.2%, 95%CI −11.4, −7.6), need an interpreter (AME −19.3%, 95%CI −21.8, −14.4), Medicaid as primary insurance (AME −12.1%, 95%CI −13.7, −9.0), and live in a zip code with low broadband access (AME −7.2%, 95%CI −8.1, −4.8). Most patients had more than one factor which further reduced their probability of using video visits. Conclusions Patients who are older, are African-American, require an interpreter, use Medicaid, and live in areas with low broadband access are less likely to use video visits as compared to phone. Post-pandemic policies that eliminate insurance coverage for phone visits may decrease telehealth access for patients who have one or more of these characteristics. Supplementary Information The online version contains supplementary material available at 10.1007/s11606-021-07172-y.

INTRODUCTION: Telehealth is gaining more attention in multiple specialties, including urology. Video visits in particular have shown high satisfaction and cost-saving for patients. However, there has been little investigation into how video visits compare to traditional clinic visits on measures of clinical efficiency and reimbursement. METHODS: Our dataset included 250 video visits of established patients at Michigan Medicine Department of Urology and 250 in-person clinic visits with the same providers completed between July 2016 and July 2017. Information on visit completion and cancellation rates; cycle time (time from check in to check out); reimbursement; and patient out-of-pocket expenses was collected using the electronic medical record and billing data. RESULTS: Completion rates were similar between video and clinic visits (58% versus 61%, respectively; p=0.24). Average cycle time for video visits was significantly shorter compared to clinic visits (24 min vs 80 min, respectively; p

The use of telemedicine in clinical care has grown significantly in the last few years and has only increased during the COVID-19 pandemic. Given that many physicians will be expected to deliver virtual care moving forward, it is important for medical students to gain exposure via this modality during their clinical training. Many medical schools are actively working to integrate students into telemedicine. This article aims to provide guidance for readers incorporating medical students in telemedicine visits at an institutional or departmental level. This article covers essential topics such as coordinating key stakeholders, conducting needs assessments, addressing technological or software considerations, and creating appropriate workflows for students and physicians.

PURPOSE: Utilization of neoadjuvant chemotherapy (NAC) for the management of muscle-invasive bladder cancer remains low. We sought to understand our practice of NAC use in order to design a quality improvement initiative geared towards optimizing medical oncology referral. MATERIALS AND METHODS: We identified 339 patients with ≥cT2 bladder cancer treated with radical cystectomy between 2012-2017 at our institution. We assessed the rate of referral to medical oncology, rate of NAC administration, as well as medical, patient and provider variables associated with NAC use. Bayesian logistic regression modeling identified variables associated with NAC use and chart review provided granular patient-level data. RESULTS: 85% (n=289) of patients were referred to medical oncology and 62.5% (n=212) received NAC. Renal insufficiency, hearing loss, and treating urologist were conclusively associated with lower odds of NAC use. 46 patients were not referred to medical oncology and 50% of these had medical contraindications to cisplatin cited as the reason for no referral. 38 patients met with medical oncology but did not receive NAC. 30 (79%) had comorbidities that impacted this decision with 15 (39%) ineligible based on impaired renal function. CONCLUSIONS: Despite the relatively high rates of medical oncology referral and NAC use in this cohort, there are still opportunities to improve the efficiency of this practice. Quality improvement initiatives could optimize the referral of patients with ≥T2 bladder cancer for consideration of cisplatin-based NAC and establish an important quality metric in the management of these patients.

Objective To evaluate whether video visits were being used as substitutes to clinic visits prior to COVID-19 at our institution's outpatient urology centers. Methods We reviewed 600 established patient video visits completed by 13 urology providers at a tertiary academic center in southeast Michigan. We compared these visits to a random, stratified sample of established patient clinic visits. We assessed baseline demographics and visit characteristics for both groups. We defined our primary outcome (“revisit rate”) as the proportion of additional healthcare evaluation (ie, office, emergency room, hospitalization) by a urology provider within 30 days of the initial encounter. Results Patients seen by video visit tended to be younger (51 vs 61 years, P

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Objective: There has been a rapid expansion of video visits, a form of telehealth, with the COVID-19 pandemic;however, little is known about the feasibility or benefits of video visits for patients seeking male infertility care Herein we summarize a single institution’s experience using video visits to manage infertility prior to the COVID-19 pandemic Specifically, we evaluate the number of patients engaging in video visits for the first time, and the patient resources saved by forgoing in-person appointments Design: Retrospective case series of patients undergoing video visits for follow-up of male-infertility care Materials and Methods: We identified all video visits performed at our institution between August 21, 2017 and March 17, 2020 We included men seen for male infertility by a single urologist We used chart review to collect patient demographic information including age, primary language, race, and occupation Patients were identified as blue collar versus white collar workers with respect to their engagement in manual labor We determined whether patients had a prior video visit completed at our institution We used Google MapsTM to calculate round-trip driving distance and time saved based on patients’ city of residence Driving costs saved were calculated by using American Automobile Association’s cost estimate of >source 59/mile Finally, salaries were used to estimate wages lost if taking a half or full day off to attend an in-person clinic visit Results: 70 male infertility video visits were completed by 56 patients Median age of patients was 36 years old (range 20-56), 96% identified preferred language as English, and 78% self-identified as white There were a total of 49 unique occupations among the 56 men 32% were blue collar workers and 68% were white collar workers For 55 of 56 patients, this study period represented their first use of video visits in our health system Video visits allowed patients to save a median of 80 miles (interquartile range 46-244) and 97 minutes (IQR 64-250) of travel per visit This resulted in a median of $47 (IQR 27–144) of driving costs saved per visit By not having to miss a half or full day of work, patients potentially avoided a median of $102 (IQR $69 – 133) to $205 (IQR $137 – 266) in lost wages, respectively Total median savings per patient ranged from $149 (half day off) to $252 (full day off) Median salary of our cohort was $51,331 In total, 70 video visits saved 56 patients 11,646 miles and 12,070 minutes in travel Total estimated savings to patients was $14,539 (half day off) to $22,206 (full day off) Conclusions: Video visits are a feasible option for follow-up infertility care and are a patient-centric modality that reduces travel and financial burdens 98% of patients were first-time video visit users suggesting that men are amenable to using video visits for male infertility care Calculated cost savings may have underestimated total expenses as we did not account for meals, parking fees and other expenses incurred by traveling for an in-person appointment

INTRODUCTION AND OBJECTIVE:The 2018 American Urological Association Census reported that 60% of counties in the United States do not have a practicing urologist. We evaluated the impact of this dis...

INTRODUCTION AND OBJECTIVE:While insurance companies are increasingly providing coverage for telehealth services, such as video visits, and healthcare providers are increasingly utilizing these mod...

Objective: With the rapid expansion of telehealth use during COVID-19, it remains unknown how video visits are being used to evaluate male infertility particularly when patients are not able to undergo a physical exam We sought to assess what diagnoses were seen and which tests were pursued as part of the new patient evaluation Herein we summarize a single institution’s experience with video visits for male infertility during COVID-19 Design: Retrospective case series of patients with male infertility managed via video visits Materials and Methods: We identified video visits completed at our institution between March 23, 2020 and April 29, 2020 for male infertility We included new patients visits and return visits for men 18 years of age or older completed by two andrology-trained urologists We collected and categorized scheduled visit type;visit completion rate;patient demographic and referral information;primary diagnoses;and laboratory and imaging tests ordered for new patient evaluations Results: There were 51 scheduled video visits with 21 (41 2%) new patient and 30 (58 8%) established patient encounters Eight (15 7%) video visits were cancelled—7 re-scheduled and 1 converted to a telephone encounter due to technical issues—and 6 (11 8%) were no-shows The median age was 32 years (range 22 – 48) and most patients were referred by their primary care provider or their partner’s reproductive endocrinologist (53% and 18%, respectively) For the 38 completed video visits, primary diagnoses included 11 (29%) idiopathic cases, 11 (29%) endocrinologic derangements, and 9 (24%) cases had anatomic contributors to infertility such as varicocele, previous vasectomy or ejaculatory duct obstruction Additional diagnoses included genetic abnormalities (5%), concurrent partner evaluation (3%), sperm DNA integrity concerns (3%), active infection with pyospermia (3%), and post-operative hematoma (3%) Of the 17 completed new patient visits, most were diagnosed with idiopathic 6 (35%) or anatomic (24%) conditions Only 4 new patients (24%) had previously undergone an examination by a urologist Eleven new patients (65%) required additional hormonal testing, 5 (29%) required another semen analysis, and 5 (29%) had scrotal ultrasound ordered due to inability to perform a physical exam due to limited use of outpatient clinics during COVID-19 Three (18%) required genetic testing, 2 (12%) a pituitary MRI, and 1 (6%) required DNA fragmentation testing Conclusions: Due to COVID-19, use of video visit has expanded to include new patient, male infertility evaluations The most commonly ordered tests for these men included additional hormonal testing, additional semen analyses, and scrotal ultrasounds While the physical exam is a crucial aspect of the infertility work-up, this series suggests that video visits could help ensure that a complete evaluation takes place even before a man undergoes a physical exam in clinic

Objective: While the COVID-19 pandemic has resulted in a rapid expansion of telehealth services, it remains unknown how video visits, a form of telehealth, can be used to treat male infertility We sought to evaluate what infertility diagnoses were see and how they were managed through telehealth Herein we summarize a single institution’s experience with video visits for male infertility prior to COVID-19 Design: Retrospective case series of patients with male infertility managed via video visits Materials and Methods: We identified video visits completed at our institution between August 21, 2017 and March 17, 2020 for male infertility All men had a previous in-person examination We collected patient demographic and referral information, grouped primary diagnoses, categorize what management steps were taken, and determined whether in-person examinations were needed within 90 days Results: 70 video visits were completed by 56 men The median age was 36 years (interquartile range 32 - 40), 78 5% were white, and most patients were referred by their primary care provider or their partner’s reproductive endocrinologist (47% and 33%, respectively) Most men were diagnosed with endocrinologic (29%) or anatomic (21%) contributors to infertility See Table1A for full diagnostic categories 73% of video visits involved reviewing results such as semen analysis and hormonal testing 30% of visits involved counseling for assistive reproductive technologies (ART) and, in 25% of visits, hormonally active medications were prescribed See Table1B for all management categories There were only two in-person visits within 90 days after a video visit, both of which were planned post-operative visits [Formula presented] Conclusions: Video visits can be used with established patients to manage a broad spectrum of diagnoses that contribute to male infertility In the short-term, these visits are serve as substitutes for clinic visits without resulting in additional in-person encounters

Objective To examine the value that urologic patients place on video visits before the implementation of a telemedicine program at our institution's outpatient urology clinic. Methods We conducted an on-site survey at a tertiary medical center's outpatient urology clinic over a 3-month period. Our survey questions assessed patient access to technology needed for video visits, patients' perceptions about video visits, the amount patients would be willing to pay out-of-pocket for video visits, and total time patients expect to spend during a standard clinic visit. Results We completed 108 surveys of adult patients. Of the patients, 94% owned a device that could be used for a video visit. The median level of patient interest in video visits was reported as 72 out of 100 (interquartile range: 51.25; scale: 0-100,) with a statistically significant difference in interest level across different age groups ( P = .022). The median amount patients reported they were willing to pay out-of-pocket for video visits was $20 (interquartile range: $39.25, max: $174). Conclusion The vast majority of patients in our outpatient urology clinic possess the technology necessary to engage in video visits. Patients are highly interested in video visits and report a willingness to share in the costs of these visits. Given that a portion of patients travel long distances for specialty clinic visits, video visits have the potential to substantially improve the patient experience.