Quality of care in urology

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/75376/1/j.1464-410X.2004.05064.x.pd

OUTCOMES FOR RADIATION THERAPY AFTER RADICAL PROSTATECTOMY FOR PROSTATE CANCER: WHAT REALLY MATTERS?

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/75426/1/j.1464-410X.2007.07057.x.pd

Understanding the Use of Prostate Biopsy Among Men with Limited Life Expectancy in a Statewide Quality Improvement Collaborative

BACKGROUND: The potential harms of a prostate cancer (PCa) diagnosis may outweigh its benefits in elderly men. OBJECTIVE: To assess the use of prostate biopsy in men with limited life expectancy (LE) within the practices comprising the Michigan Urological Surgery Improvement Collaborative (MUSIC). DESIGN, SETTING, AND PARTICIPANTS: MUSIC is a consortium of 42 practices and nearly 85% of the urologists in Michigan. From July 2013 to October 2014, clinical data were collected prospectively for all men undergoing prostate biopsy. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: We calculated comorbidity-adjusted LE in men aged ≥66 yr and identified men with(limited LE) undergoing a first biopsy. Our LE calculator was not designed for men agedyr; thus these men were excluded. Multivariable models estimated the proportion of all biopsies performed for men with limited LE in each MUSIC practice, adjusting for differences in patient characteristics. We also evaluated what treatments, if any, these patients received. RESULTS AND LIMITATIONS: Among 3035 men aged ≥66 yr undergoing initial prostate biopsy, 60% had none of the measured comorbidities. Overall, 547 men (18%) had limited LE. Compared with men with a longer LE, these men had significantly higher prostate-specific antigen levels and abnormal digital rectal examination findings. The adjusted proportion of biopsies performed for men with limited LE ranged from 3.8% to 39% across MUSIC practices (p \u3c 0.001). PCa was diagnosed in 69% of men with limited LE; among this group, 74% received any active treatment. Of these men, 46% had high-grade cancer (Gleason score 8-10). CONCLUSIONS: Among a large and diverse group of urology practices, nearly 20% of prostate biopsies are performed in men with limited LE. These data provide useful context for quality improvement efforts aimed at optimizing patient selection for prostate biopsy. PATIENT SUMMARY: In this report, nearly 2 of every 10 men undergoing prostate biopsy had a life expectancy (LE)biopsy

‘Should I get a PSA test?’ – the question is not that simple

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/113754/1/tre484.pd

Cost‐effectiveness of magnetic resonance imaging and targeted fusion biopsy for early detection of prostate cancer

Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/144625/1/bju14151_am.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/144625/2/bju14151.pd

What Couples Say about Their Recovery of Sexual Intimacy after Prostatectomy: Toward the Development of a Conceptual Model of Couples' Sexual Recovery after Surgery for Prostate Cancer

IntroductionInterventions designed to help couples recover sexual intimacy after prostatectomy have not been guided by a comprehensive conceptual model.AimWe examined a proposed biopsychosocial conceptual model of couples' sexual recovery that included functional, psychological, and relational aspects of sexuality, surgery‐related sexual losses, and grief and mourning as recovery process.MethodsWe interviewed 20 couples preoperatively and 3 months postoperatively. between 2010 and 2012. Interviews were analyzed with Analytic Induction qualitative methodology, using NVivo software. Paired t‐tests described functional assessment data. Study findings led to a revised conceptual model.Main Outcome MeasuresCouples' experiences were assessed through semi‐structured interviews; male participants' sexual function was assessed with the Expanded Prostate Cancer Index Composite and female participants' sexual function with the Female Sexual Function Index.ResultsPreoperatively, 30% of men had erectile dysfunction (ED) and 84% of partners were postmenopausal. All valued sexual recovery, but worried about cancer spread and surgery side effects. Faith in themselves and their surgeons led 90% of couples to overestimate erectile recovery. Postoperatively, most men had ED and lost confidence. Couples' sexual activity decreased. Couples reported feeling loss and grief: cancer diagnosis was the first loss, followed by surgery‐related sexual losses. Couples' engagement in intentional sex, patients' acceptance of erectile aids, and partners' interest in sex aided the recovery of couples' sexual intimacy recovery. Unselfconscious sex, not returning to erectile function baseline, was seen as the end point. Survey findings documented participants' sexual function losses, confirming qualitative findings.ConclusionsCouples' sexual recovery requires addressing sexual function, feelings about losses, and relationship simultaneously. Perioperative education should emphasize the roles of nerve damage in ED and grief and mourning in sexual recovery. Wittmann D, Carolan M, Given B, Skolarus TA, Crossley H, An L, Palapattu G, Clark P, and Montie JE. What couples say about their recovery of sexual intimacy after prostatectomy: Toward the development of a conceptual model of couples' sexual recovery after surgery for prostate cancer. J Sex Med 2015;12:494–504.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/110610/1/jsm12732.pd

Open surgical partial nephrectomy for upper tract urothelial carcinoma

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/106973/1/iju12301.pd

Measuring health-related quality of life outcomes in bladder cancer patients using the Bladder Cancer Index (BCI)

BACKGROUND. Health-related quality of life (HRQOL) has not been adequately measured in bladder cancer. A recently developed reliable and disease-specific quality of life instrument (Bladder Cancer Index, BCI) was used to measure urinary, sexual, and bowel function and bother domains in patients with bladder cancer managed with several different interventions, including cystectomy and endoscopic-based procedures. METHODS. Patients with bladder cancer were identified from a prospective bladder cancer outcomes database and contacted as part of an Institutional Review Board-approved study to assess treatment impact on HRQOL. HRQOL was measured using the BCI across stratified treatment groups. Bivariate and multivariable analyses adjusted for age, gender, income, education, relationship status, and follow-up time were performed to compare urinary, bowel, and sexual domains between treatment groups. RESULTS. In all, 315 bladder cancer patients treated at the University of Michigan completed the BCI in 2004. Significant differences were seen in mean BCI function and bother scores between cystectomy and native bladder treatment groups. In addition, urinary function scores were significantly lower among cystectomy patients treated with continent neobladder compared with those treated with ileal conduit (all pairwise P < .05). CONCLUSIONS. The BCI is responsive to functional and bother differences in patients with bladder cancer treated with different surgical approaches. Significant differences between therapy groups in each of the urinary, bowel, and sexual domains exist. Among patients treated with orthotopic continent urinary diversion, functional impairments related to urinary incontinence and lack of urinary control account for the low observed urinary function scores. Cancer 2007. © 2007 American Cancer Society.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/55989/1/22556_ftp.pd

Optimizing active surveillance strategies to balance the competing goals of early detection of grade progression and minimizing harm from biopsies

Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/142555/1/cncr31101.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/142555/2/cncr31101_am.pd

Evaluation of a needle disinfectant technique to reduce infection‐related hospitalisation after transrectal prostate biopsy

Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/142074/1/bju13982_am.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/142074/2/bju13982.pd