Objectives. To assess the use of new technology by American urologists. Methods. Using the American Urological Association directory, surveys were sent via the U.S. postal service to 1000 randomly selected American ur...
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Objectives. To assess the use of new technology by American urologists. Methods. Using the American Urological Association directory, surveys were sent via the U.S. postal service to 1000 randomly selected American urologists and 3065 urologists who had an Internet address listed in the directory. Results, Responses were received from 601 urologists (415 postal, 186 Internet), Overall, 81% of survey respondents reported performing fewer or the same number of percutaneous procedures as compared with 3 to 4 years ago and 84% reported carrying out more or the same number of ureteroscopic procedures in the treatment of patients with stone disease. Open dismembered pyeloplasty (43%) and Acucise endopyelotomy (42%) were most frequently reported as the preferred treatment for adult patients with symptomatic ureteropelvic junction obstruction. Although 60% of respondents reported that they have taken a laparoscopy course, 67% currently do not perform any laparoscopy in their practice. In addition, only 7% of urologists stated that laparoscopy comprises more than 5% of their practice. When stratified by the number of years in practice, those in practice less than 10 years were more likely than those in practice 10 to 20 years and those in practice longer than 20 years to have performed an endopyelotomy (77%, 60%, and 48%, respectively, P <0.001) and to be currently performing laparoscopy (49%, 36%, and 18%, respectively, P <0.001). Conclusions. Compared with 3 to 4 years ago, American urologists are performing more ureteroscopy and fewer percutaneous stone procedures. Although most urologists have taken laparoscopy courses, this modality has not been widely incorporated into their practices at present. UROLOGY 56: 760-765, 2000. (C) 2000, Elsevier Science Inc.
Objectives. To survey and review the incidence of appendectomy performed during radical cystectomy and urinary diversion. We were interested in the reasons behind the decision and if continent diversions have changed ...
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Objectives. To survey and review the incidence of appendectomy performed during radical cystectomy and urinary diversion. We were interested in the reasons behind the decision and if continent diversions have changed the policy. Methods. We performed a selective survey among urologists in academic centers throughout the United States regarding their practice of incidental appendectomy during radical cystectomy. We also reviewed the literature regarding the rationale for incidental appendectomy in general and during radical cystectomy in particular. Results. Among the 13 departments and 26 urologists replying to the survey, 9 (69%) departments and 20 (77%) individual clinicians are not performing routine incidental appendectomy. In 2 departments, it is considered a matter of choice, and, in 4 (31%) departments, appendectomy is performed routinely. Many believe that the low risk of subsequent appendicitis does not justify the procedure and that the appendix may be useful for future reconstruction. A review of the literature suggests that incidental appendectomy during radical cystectomy is not necessary. Conclusions. Incidental appendectomy during radical cystectomy is not necessary and is no longer being performed in many academic centers. The risk of subsequent appendicitis is extremely low. The decision may depend on the form of urinary diversion planned. UROLOGY 56: 241-244, 2000. (C) 2000, Elsevier Science Inc.
Surgical services are an important part of modern health care, but providing them to isolated rural citizens is especially difficult. Public policy initiatives could influence the supply, training, and distribution of...
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Surgical services are an important part of modern health care, but providing them to isolated rural citizens is especially difficult. Public policy initiatives could influence the supply, training, and distribution of surgeons, much as they have for rural primary care providers. However, so little is known about the proper distribution of surgeons, their contribution to rural health care, and the safety of rural surgery that policy cannot be shaped with confidence. This study examined the volume and complexity of inpatient surgery in rural Washington state as a first step toward a better understanding of the current status of rural surgical services. Information about rural surgical providers was obtained through telephone interviews with administrators at Washington's 42 rural hospitals. The Washington State Department of Health's Commission Hospital Abstract Recording System (CHARS) data provided a count of the annual surgical admissions at rural hospitals. Diagnosis‐related group (DRG) weights were used to measure complexity of rural surgical cases. Surgical volume varied greatly among hospitals, even among those with a similar mix of surgical providers. Many hospitals provided a limited set of basic surgical services, while some performed more complex procedures. None of these rural hospitals could be considered high volume when compared to volumes at Seattle hospitals or to research reference criteria that have assessed volume‐outcome relationships for surgical procedures. Several hospitals had very low volumes for some complex procedures, raising a question about the safety of performing them. The leaders of small rural hospitals must recognize not only the fiscal and service benefits of surgical services–and these are considerable–but also the potentially adverse effect of low surgical volume on patient outcomes. Policies that encourage the proper training and distribution of surgeons, the retention of basic rural surgical services, and the rational regionali
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