Who Is The Best Urologist In Birmingham Alabama?

• JB. Dr. James E. Bryant. Urology. Urology.
• VB. Dr. Vincent M. Bivins. Urology. Urology.
• PK. Dr. Peter N. Kolettis. Urology. Urology.
• JB. Dr. Jason K. Burrus. Urology. Urology.
• JN. Dr. Jeffrey W. Nix. Urology. Urology.
• MD. Dr. Mell L. Duggan. Urology. Urology.
• DA. Dr. Dean G. Assimos. Urology. Urology.
• LH. Dr. Lee N. Hammontree. Urology. Urology.

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Who is the best doctor for urinary problems?

What is a urologist? – A urologist is a doctor who specializes in diagnosing and treating diseases of the urinary system, This system keeps the body clean by filtering out wastes and toxins and taking them out of the body. The urinary tract includes:

Bladder. Kidneys. Ureters. Urethra.

A urologist also treats conditions involving the reproductive organs and the adrenal glands. The adrenal glands are located on top of the kidneys. The reproductive systems of males and females are linked closely to their urinary systems. You might hear someone use the word “genitourinary.” This refers to symptoms, conditions or treatments that affect both systems.

Who is the world’s best urologist?

Dr. Jerry Blaivas is the World Leading Expert on Complicated Urological Problems.

Do urologists treat Bladder?

What is a urologist? – A urologist is a specialist who provides medical treatment to both men and women experiencing problems of the:

Bladder Kidneys Urinary system Reproductive systems

A urologist will review your symptoms, ask about your health history and perform a complete physical exam. “Depending on your symptoms, we may order blood or urine labs, imaging studies, such as computed tomography ( CT) scans, or perform diagnostic procedures,” says Dr. Michael Brooks, a urologist at Houston Methodist.

What is the number one urology hospital in the US?

Expertise Mayo Clinic has one of the largest and most experienced practices in the United States, with campuses in Arizona, Florida and Minnesota. Staff members skilled in dozens of specialties work together to ensure quality care and successful recovery.

Comprehensive cancer center. Mayo Clinic Comprehensive Cancer Center meets strict standards for a National Cancer Institute comprehensive cancer center, recognizing scientific excellence and a multispecialty approach focused on cancer prevention, diagnosis and treatment. Top-ranked education program. The Urology Residency program at Mayo Clinic College of Medicine and Science campuses in Arizona, Florida and Minnesota ranks among the top-performing programs by Doximity.

Mayo Clinic in Rochester, Minnesota, is ranked No.1 for urology in the U.S. News & World Report Best Hospitals rankings. Mayo Clinic in Phoenix/Scottsdale, Arizona, is ranked among the Best Hospitals in the nation and Mayo Clinic in Jacksonville, Florida, is ranked highly performing for urology by U.S.

Which country has best urologist?

India is at the forefront of modern urological treatments. The latest advancements include minimally invasive surgeries such as laparoscopic and robotic urological procedures. For example, robotic-assisted laparoscopic prostatectomy is the latest technique used in the treatment of prostate cancer.

Why does a urologist deal with both urinary tract problems?

Types of Urinary System Specialists – There are a few types of specialties in the field of urology, including urologic oncology, kidney transplantation, sexual medicine, and male infertility. Urinary specialists work with other medical specialists (such as endocrinologists or oncologists) to treat conditions related to but not exclusive to the urogenital tract.

Urologists specialize in the structures and anatomy of the urinary tract, which includes the kidneys, ureters, urethra, and bladder. they also look at issues with the kidney that arise from structural problems such as cancer, kidney stones, infertility, or kidney damage. Often urologists will work with both the urinary system and the genital system because the two systems are closely related. Together these systems are referred to as the urogenital system, Nephrologists examine the functions (physiology) of just the kidney more exclusively, often starting a simple blood panel that reveals an issue such as high blood sugar.

What does a urologist do for frequent urination?

2. You’re urinating a lot or leaking urine. – Urologists work with both men and women to manage the symptoms of overactive bladder (OAB) and urinary incontinence, If it is OAB, lifestyle modifications, medications and surgical treatments can help get the symptoms under control.

What is the highest degree in urology?

What is Urology – Urology is the study of the urinary system of the human body and its functioning. A person that completes the study of urology is expected to deal with problems and diseases related to the urinary tract and the organs linked to it. The organs that these specialists mostly operate are urethra, kidneys and bladder.

Is urology the same as urologist?

What are Urology and Nephrology? – Urology According to the American Urological Association ‘s definition, urology is the field of medicine that specializes in diagnosing, treating, and managing diseases of the male and female urinary tract. The urinary tract includes the following parts:

Kidneys UretersBladderUrethra

Urologists, the doctors that practice urology, have received extensive education and training in the urinary system. Urology is considered a surgical specialty, but urologists do much more than perform surgical procedures. Many urologists are in general practice and can treat a variety of urologic conditions.

1. Other urologists have a specialty in a certain area, like urologic cancer, male infertility, or pediatric urology.
2. Nephrology Nephrology is the field of medicine that focuses on diagnosing and treating diseases that affect the kidneys.
3. Like urologists, nephrologists receive extensive education and training in their field.

Unlike urology, the scope of nephrology does not include other parts of the urologic system. Nephrologists don’t deal with disorders of the male reproductive system either. The focus of nephrology is on the kidneys. A nephrologist may also deal with factors linked to kidney disorders, such as high blood pressure or heart disease.

But they would not treat these problems outside of their relationship to the kidneys. Similarities As you can tell, urology and nephrology do share certain characteristics. Sometimes both urologists and nephrologists will share a medical practice because they may need to work together. However, even with overlapping factors, the two fields are distinct.

The most common point of overlap is the fact that both nephrologists and urologists will treat kidney issues. But, there are differences in what aspects of kidney health are covered under each specialty.

Who is the father of urology?

Hugh Hampton Young : father of American urology.

How does a urologist test your bladder?

Video urodynamic tests – Video urodynamic tests use x-rays or ultrasound to take pictures and videos of your bladder while it fills and empties. A trained technician may use a catheter to fill your bladder with contrast or dye for a better picture.

What is the most prestigious US hospital?

World’s Best Hospitals 2023

Rank	Publication Name	Score
1	Mayo Clinic – Rochester	97.50%
2	Cleveland Clinic	92.59%
3	Massachusetts General Hospital	92.27%
4	The Johns Hopkins Hospital	89.95%

What is the most beautiful hospital in us?

20 most beautiful hospitals in the US Pipestone (Minn.) County Medical Center and Family Clinic Avera is the most beautiful hospital in the U.S. in 2019, according to Soliant Health’s annual list of the 20 Most Beautiful Hospitals in America. Soliant Health, a healthcare staffing company in Atlanta, July 18.

1. Hospitals featured on the list earned the highest number of votes on Soliant’s website during a month-long voting period.
2. Altogether, there were more than 8.5 million votes cast.
3. The 20 most beautiful hospitals in the country, according to Soliant: 1.
4. Pipestone County Medical Center and Family Clinic Avera 2.

Golisano Children’s Hospital of Southwest Florida (Fort Myers, Fla.) 3. Hackensack Meridian Health Riverview Medical Center (Red Bank, N.J.) 4. Hills & Dales General Hospital (Cass City, Mich.) 5. UT Health Quitman (Texas) 6. San Juan Regional Medical Center (Farmington, N.M.)

7. UPMC Children’s Hospital of Pittsburgh 8. HealthPark Medical Center (Fort Myers) 9. Huntsman Cancer Institute (Salt Lake City)

10. Northwestern Medicine Lake Forest (Ill.) 11. Baptist Medical Center Beaches (Jacksonville, Fla.) 12. Norton Sound Regional Hospital (Nome, Alaska) 13. Broughton Hospital (Morganton, N.C.) 14. Community Hospital of the Monterey Peninsula (Monterey, Calif.) 15.

Which country respect doctors the most?

According to a survey conducted in 28 countries, doctors are the world’s most trusted profession. As of 2022, Spain, Mexico and the Netherlands recorded the highest percentages of respondents who indicated doctors as trustworthy, with about 70 percent of the interviewees, respectively.

What is the average age of a urologist in the US?

Key Points Question What are the projected size and demographic characteristics of the urology workforce per capita in the US through 2060? Findings In this cross-sectional study, 2 stock and flow models of continued (13.8%) and stagnant (0%) growth of the urology workforce based on the American Urological Association Annual Census data in 2019 and the US Census Bureau’s projections showed that within the context of the impending urology workforce shortage, there will be an exaggerated shortage of total urologists per capita for populations aged 65 years and older.

• Meaning These findings highlight the need for structural changes and advocacy to increase the available urology workforce.
• Importance Projections to 2035 have demonstrated concern regarding a worsening urology workforce shortage.
• Objective To project the size and demographic characteristics of the urology workforce per capita into 2060 and to anticipate the timing and degree of the impending urology workforce shortage.

Design, Setting, and Participants This population-based cross-sectional study used the 2019 American Urological Association Annual Census data and the Accreditation Council for Graduate Medical Education’s Data Resource Book from 2007 to 2018. The cohort included practicing urologists in 2019.

• US Census data were used to approximate the projected US population.
• Data analysis was performed from June 2020 to March 2021.
• Exposures Continued growth stock and flow model of 13.8% and stagnant growth model of 0% increase of the incoming urology workforce with cohort projection per projected US population.

Main Outcomes and Measures The primary outcome was urology workforce projection per the population aged 65 years and older. Urology workforce projections per capita and demographic characteristics of the urology workforce up to 2060 were calculated under guided assumptions with 2 stock and flow models.

Results In 2019, there were 13 044 urologists (11 758 men ; 1286 women ; median age range, 55-59 years), with 3.99 urologists per 100 000 persons and 311 new urologists entering the workforce. In a continued growth model, 2030 will have the lowest number of urologists per capita of 3.3 urologists per 100 000 persons, and recovery to baseline will occur by 2050.

There are 23.8 urologists per 100 000 persons aged 65 years and older in 2020, which decreases to 15.8 urologists per 100 000 persons aged 65 years and older in 2035 and never recovers to its baseline level by 2060. In a stagnant growth model, there will be a continued decrease of urologists per capita to 3.1 urologists per 100 000 persons by 2060.

There is a continued decrease in per capita urologists at each time point, with 13.1 urologists per 100 000 persons aged 65 years and older by 2060. Conclusions and Relevance With the impending urology workforce shortage, there will be an exaggerated shortage of total urologists per persons aged 65 years and older in both models.

This projection highlights the need for structural changes and advocacy to maximize the available urology workforce. Multiple estimates have found impending workforce shortages across surgical fields due to the Balanced Budget Act of 1997, which limits the funding necessary to train residents and caps the number of government-subsidized residency positions.

This workforce shortage will be exacerbated by the silver tsunami, where by 2030, the youngest members of the Baby Boomer generation will be in the Medicare age group that heavily uses health care services.1 – 3 Urology is no exception, and our current supply of practicing urologists of 13 044 is still far short of the 14 400 urologists that the US Department of Health projected to be necessary to meet the demand for urological services.1 The American Urological Association (AUA) has recognized the workforce shortage as a federal advocacy priority, with only 38% of all US counties having practicing urologists, recent declines in the number of urologists per capita, and older median age of urologists.4 In addition, because the Medicare population uses urological services 3 times more often than the general population, there have been projections that even if we maintain the current number of urologists per capita, there will be a shortage of urologists by 46% in 2035.5 This has substantial downstream consequences on access to care, delays for surgical evaluation, longer travel time for rural patients, and heightened pressure on practicing urologists to meet the increased demands, placing them at risk for burnout.6 In addition to concerns of the workforce shortage, there have been concerns about how the future urology workforce can better reflect our patient population, particularly with regard to race and gender.7 Despite growth of female representation in urology compared with other specialties, it continues to be a heavily male-dominated field with only 9.9% of practicing urologists being female.8, 9 Female urologists continue to be underrepresented relative to the 30% of urological patient population being female.7 There has not been an updated projection of the urology workforce per capita beyond 2035 with an understanding of the present-day urology workforce.

The US Department of Health and Human Services recognizes that at least a decade is required to enact policies and programs to increase the physician workforce, given the length of training and time required to change physician training infrastructure.1 Therefore, it is time critical to have a nuanced understanding of the impending workforce shortage in urology.

1. Our study projects the urology workforce per capita and demographic representation over the next 40 years under guided assumptions with 2 stock and flow models.
2. We hypothesize that in our continued growth model, there will be a recovery beyond the current 2020 urology workforce per capita, whereas in our growth stagnant model, we will see a continued decline in the urology workforce per capita.

We also hypothesize that the urology workforce shortage per capita will be more severe for the population aged 65 years and older. Finally, we hypothesize that in the context of a decreasing number of urologists per capita in the next 4 decades, there will be an overall growth per capita of female urologists.

1. Because we used publicly available data, our institution deemed this analysis exempt from institutional review board oversight.
2. Informed consent was waived by our institution for this reason.
3. This study followed the Strengthening the Reporting of Observational Studies in Epidemiology ( STROBE ) reporting guidelines.

Current Practicing Urologists and US Population Data According to the 2019 AUA Census, which defines the urologist population by National Provider Identifier, valid medical licenses of both urologists and pediatric urologists, and American Board of Urology certification records, there are currently 13 044 practicing urologists, including 11 758 men (90.1%) and 1286 women (9.9%).10 The AUA Census provides the age distribution for all practicing urologists.

These were used to estimate the number of practicing urologists by age and gender in 2020. Each gender and age are divided proportionally into 5-year age categories and used as the estimate of practicing urologists by gender and age group in 2020. For US population data, we used the US Census Bureau 2017 national population projections based on the US Census data from 2010 using a cohort-component method and assumptions about demographic components of change, such as future trends in births, deaths, and net international migration from 2017 to 2060.11 The stock and flow model estimates the number of practicing urologists in a year with the addition of urology residents entering the current practicing urologist population and subtraction of the retiring urologists, as follows: urologists i  + 1  = urologists i  + residents i  − retirees i, where i  = half-decade increment in time.

Given that 311 urologists entered the workforce in 2018 according to the Accreditation Council for Graduate Medical Education Data Resource Book, we assume that 320 urologists would enter the workforce annually.8, 10, 12 Among those entering workforce in 2018, 24.4% were female.12 The median age of those entering the workforce is 32 years.8 We assume the future proportion will continue to be 25% female and 75% male and that they enter at 32 years of age.8 For the growth model, we assume continued growth of urologists entering the workforce by 13.8% every 5 years using the Accreditation Council for Graduate Medical Education growth rate from 2013 to 2018.12 For the stagnant model, the number of incoming urologists is constant at 320.

The flow portion of the model subtracts the retiring urologists from the population using the 2019 AUA Census. The 2019 AUA Census provided the proportion of urologists in 5-year increments of planned age at full retirement separately by gender. On the basis of the stable planned retirement age in AUA census from 2016 to 2020, we assume that these retirement proportions would remain constant throughout the time projected.10, 13, 14 We performed a sensitivity analysis to see how this projection would change with the planned retirement age of 70 years.

The per capita estimates are calculated using the estimated urologist population and dividing by the US population. We calculated total urologists, male urologists, and female urologists per total capita. We also calculated the number of urologists per the population aged 65 years and older and urologists per matching gender per capita.

We then calculated the number of urologists needed to maintain the current urologists per capita and how many additional urology residency slots would need to be added annually to maintain the current level of 4 urologists per 100 000. Stock and flow models were generated in Excel software version 2016 (Microsoft).

Data analysis was performed from June 2020 to March 2021. In 2019, according to the AUA census, there were 3.99 urologists per 100 000 in the US (total, 13 044 urologists; 11 758 male and 1286 female ).8 The median age range of urologists was 55 to 59 years.

1. In 2020, using our assumptions listed in the Table, we project that there were 13 365 total practicing urologists, with 11 999 (89.8%) being men and 1366 (10.2%) being women.
2. In our continued growth model of 13.8% more urologists joining practice every 5 years, 2030 will have the lowest urologists per capita of 3.3 urologists per 100 000 persons ( Figure 1 A).

By 2060, there will be 5.2 urologists per 100 000 persons. For the Medicare population, there are currently 23.8 urologists per 100 000 persons aged 65 years and older in 2020 ( Figure 2 A). This ratio will be the lowest in 2035, with 15.8 urologists per 100 000 persons aged 65 years and older, and increases to 22.3 by 2060 and never recovers to its 2020 baseline level.

When matching female urologists to the female population, there are 0.8 female urologists for 100 000 female persons in 2020, which increases at each time interval to 2.5 female urologists to 100 000 female persons by 2060 ( Figure 3 A). In our stagnant growth model of 0%, there will be a continued decrease of urologists per capita to 3.1 urologists per 100 000 persons in 2035 and beyond ( Figure 1 B).

For the Medicare population, there is a continued decrease at each time point with 13.1 urologists per 100 000 persons aged 65 years and older by 2060 ( Figure 2 B). When matching female urologists to the female population, there is continued growth that plateaus at 1.5 female urologists to 100 000 female persons in 2050 and beyond ( Figure 3 B).

1. Our sensitivity analysis examining retirement age of 70 years showed no significant changes from our primary analyses and conclusions.
2. Finally, we found that to maintain the current urologists per capita to 2060, an additional 3851 urologists are required.
3. This translates to an increase of at least 96 urology residency slots annually until 2060.

To our knowledge, this cross-sectional study is the first to project the urology workforce per capita and demographic characteristics of urologists over the next 40 years and has 3 key findings. First, the total number of practicing urologists per capita will decrease in the coming decades, even with sustained growth of the resident complement across urology training programs, and will not recover to baseline until 2060.

• Second, there will be an exaggerated shortage of total urologists per population aged 65 years and older in both models of our projections.
• Finally, female urologists per capita will continue to increase in the context of decreasing urologists per capita in both continued growth and growth stagnant models.

Collectively, these projections highlight the severity of the impending shortage of urologists and importance of structural change and advocacy to maximize our available urology workforce. On the basis of our model, we found that to maintain the current urologists per capita to 2060, an additional 3851 urologists are required.

1. To meet the demands of more urologists, we would need to increase at least 96 urology residency slots annually.
2. Our analysis demonstrates that prior efforts to increase the urology workforce have been insufficient, with problems escalating in the decades to come.
3. Specifically, despite an additional 14 accredited urology residency programs between 2013 and 2018, our current supply of practicing urologists of 13 044 is still far short of the 14 400 urologists projected necessary to meet the demand for urological services.1, 12 Our projections demonstrate that the disparity will worsen in the coming decades even with continued growth of 13.8% graduating urologists every 5 years.1 Because of the number of retiring urologists, the number of urologists per capita will not reach baseline 2020 levels until 2050.

Without additional growth of training positions, the workforce shortage will become even more severe, with a continued decline in urologists per capita through 2060. We provided these 2 alternate models for workforce projections, understanding that the actual urology workforce will most likely fall between these 2 projections.

Regardless, our field must be prepared to face a growing shortage of physicians for the next 40 years, and possibly beyond. The impending shortage will be felt most keenly by the elderly and most medically vulnerable patients. Given the increased prevalence of urological conditions in an aging population, the Medicare population heavily uses urology services.15 Etzioni et al 16 found that the group of patients aged 65 years and older used 64.8% of all urological services.

McKibben et al 5 reaffirmed that adults aged 65 years and older use urological services at a rate 3 times higher than the general population. This is consistent with findings of Urologic Diseases in America project, 5 which documented substantial and growing incidence and prevalence of a number of urological conditions, such as benign prostatic hyperplasia, incontinence, and urological cancers, that affect the older population.

Although it is possible that some Medicare physicians overuse urological services, this finding has been confirmed by multiple authors and is consistent with how commonly urological conditions affect elderly patients more than the rest of the population. Both of our models show a decline in urologists per 100 000 persons aged 65 years and older in the coming years, which is particularly concerning given that this population heavily uses urology services, thereby exacerbating the existing shortage of urologist supply relative to the demand.5 This has major downstream consequences on access to care, delays for surgical evaluation, and potential for worse patient outcomes.6 It is worthwhile to consider the impact of telemedicine in this context.

Although urology has pioneered the integration of telemedicine to provide care for our patients, it is still largely unknown whether video visits in urology can serve as a substitute for clinic evaluations and how it affects clinical efficiency.17, 18 In addition, the patients who use telemedicine to access care tend to be younger and female, which may still preclude providing care for the elderly patient population.17 However, we anticipate that telemedicine will continue to be an integral part of providing care for our patients and will be further used by the Medicare population as this population becomes more accustomed to technological advances required for telemedicine.

1. One positive aspect of the projections in this study is that the number of female urologists consistently increases in both projection models.
2. Although both male and female urologists provide urological care for diverse patient populations, there are substantial differences in practice patterns by gender.

Almost one-half of female urologists see a majority of female patients as part of their practice, whereas only 3.5% of male urologists see a majority of female patients as part of their practice.10 Although this is partially owing to more female urologists subspecializing in female pelvic medicine and reconstructive surgery, when comparing general urologists of each gender, female general urologists logged 2.2 times the number of urogynecological cases compared with their male counterparts.19, 20 Currently, with 0.8 female urologists per 100 000 female population, there is substantial underrepresentation of female urologists for a gender-concordant population in the US.7 This is particularly noteworthy given that 30% of urology patients are female, and patient surveys have highlighted patient preference for gender-concordant urologists for urinary incontinence.21 With an increasing number of female urologists in our projection, they have not only increased availability to provide care for female patients but also increase the likelihood of mutually respective care for diverse patient populations by contributing to the diversity of the urology workforce.9 Limitations and Strengths Our study has several limitations.

The projections of the workforce model are dependent on assumptions listed in the Table, Although 24.4% of the current urology resident workforce is female, which is much higher than previously, we did not think that this growth in representation would be linear. Therefore, we assumed that approximately 25% of the resident workforce will be female, understanding that this could be an underestimate.

We also used planned retirement age as a surrogate for actual retirement age because that was the closest data we had available. We assumed that because the planned retirement age was stable from 2016 to 2020, it would remain constant throughout the projection.13, 14 If all urologists delay retiring until age 70 years, the greatest increase made would be, at most, 2% more urologists in 2060 compared with our original models.

Thus, the results and conclusions do not change overall. There are limited longitudinal data for some of our assumptions, but the 2 scenarios of continued and stagnant growth were modeled to account for possible variability, understanding that the actual urology workforce will most likely fall between these 2 models.

Next, we cannot account for the changes in urologist practice variation with the increasing number of practicing urologists. For example, approximately 10% of the urologists who currently plan to retire at age 70 or beyond listed that their reasoning for continuing to practice is their inability to recruit a replacement.10 If there are more urologists available, the decision-making process regarding retirement or total work hours could be affected, which is not accounted for in our modeling.

1. Finally, our US population projection is based on the US Census Bureau projections from 2017, which could deviate from the actual population in the future but is the best estimate and projection of each time point available.
2. These limitations notwithstanding, our findings highlight the time sensitivity and importance of continued advocacy for increased graduate medical education funding and other policies to ensure that we effectively mitigate the impending urology workforce shortage by funding additional urology residency positions.

Without such interventions, there will be negative downstream consequences for patient care and outcomes.6 One clinical example is evaluation of hematuria, a common diagnosis that leads to referral from primary care or the emergency department and requires further urological workup to identify 1 in 10 patients who may have a life-threatening malignancy or other treatable condition.22 Many studies looking at diagnostic evaluation, such as cystoscopy, of patients with hematuria, have already identified multifactorial reasons for delay in full evaluation that have led to later stage of diagnosis, higher disease burden, and less favorable cancer outcomes.22 – 25 Given the impending urology workforce shortage, we can project that the further delay in patient care would lead to worse patient outcomes.

Continued utilization of advanced practice practitioners may bridge the gap between patient’s access to care by serving as vital partners in providing quality care to patients.5 However, it is crucial to sustain growth in the number of urologists alongside that of advanced practice practitioners given that urologists are key practitioners of surgical services and the extent of advanced practice practitioners’ practice within urology is understudied at this time.26 Physician burnout remains a constant threat to a stable urology workforce.14 Creating organizational cultures where urologists are supported through greater autonomy and flexibility, improvements in work-life balance, more diverse and inclusive work communities, and greater efficiency will help buffer against burnout and lead to a more robust, stable, and productive workforce.

In our projection of the urology workforce to 2060, we found that the total number of practicing urologists per capita will decrease in the coming decades, with a nadir in the year 2030, even with sustained growth of the resident complement across urology training programs.

• Second, there will be an exaggerated shortage of total urologists for the population aged 65 years and older in both models of our projections.
• Finally, the number of female urologists per female capita will continue to increase in the context of decreasing urologists per capita in both continued growth and stagnant growth models.

Given the length of training and time required to change physician training and practice infrastructure, there is an urgent need for advocacy for increasing the graduate medical education budget to train more urologists and mitigate other factors, such as burnout, that contribute to the urology workforce shortage.

Accepted for Publication: September 12, 2021. Published: November 16, 2021. doi: 10.1001/jamanetworkopen.2021.33864 Open Access: This is an open access article distributed under the terms of the CC-BY License, © 2021 Nam CS et al. JAMA Network Open, Corresponding Author: Lindsey A. Herrel, MD, MS, Department of Urology, Michigan Medicine, University of Michigan, 1500 E Medical Center Dr, Ann Arbor, MI 48109 ( [email protected] ).

Author Contributions: Drs Nam and Herrel had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis. Concept and design: Nam, Kraft, Herrel. Acquisition, analysis, or interpretation of data: All authors.

• Drafting of the manuscript: Nam, Daignault-Newton, Herrel.
• Critical revision of the manuscript for important intellectual content: All authors.
• Statistical analysis: Daignault-Newton, Herrel.
• Administrative, technical, or material support: Herrel.
• Supervision: Kraft, Herrel.
• Conflict of Interest Disclosures: Dr Herrel reported receiving grants from National Cancer Institute outside the submitted work.

No other disclosures were reported.19. Liu JS, Dickmeyer LJ, Nettey O, Hofer MD, Flury SC, Kielb SJ. Disparities in female urologic case distribution with new subspecialty certification and surgeon gender.  Neurourol Urodyn,2017;36(2):399-403. doi: 10.1002/nau.22942 PubMed Google Scholar Crossref

Which is the best hospital for prostate?

Expertise and rankings – Mayo physicians bring nationally ranked urologic and surgical expertise to prostate cancer care Mayo Clinic doctors are widely respected for the experience and expertise in caring for people with prostate cancer. When you seek care at Mayo Clinic, you can expect:

• Personalized care. Mayo Clinic urologists, oncologists, radiation oncologists, pathologists and radiologists work together to ensure all of your needs are addressed when creating your customized treatment plan. At Mayo Clinic you have access to a full range of treatment options. Your care team determines which treatments are most effective in your specific situation and works closely with you to choose the treatments that meet your needs and preferences.
• Experience you can trust. Each year, more than 17,000 people with prostate cancer receive care at Mayo Clinic. This experience means your care team is prepared with knowledge and resources to provide you with exactly the care you need. Research shows that doctors who perform many prostate surgeries and work in medical centers that care for many men undergoing prostate surgery generally provide superior outcomes.
• Nationally recognized expertise. Mayo Clinic Comprehensive Cancer Center meets the strict standards for a National Cancer Institute comprehensive cancer center, which recognize scientific excellence and a multispecialty approach focused on cancer prevention, diagnosis and treatment.

Mayo Clinic in Rochester, Minnesota, and Mayo Clinic in Phoenix/Scottsdale, Arizona, have been ranked among the Best Hospitals for urology and cancer in the nation by U.S. News & World Report. Mayo Clinic in Jacksonville, Florida, is ranked high-performing for urology and cancer by U.S. News & World Report.

Who is the best doctor for prostate problems?

Prostate cancer can spread to the pubic lymph nodes or other regions of the body. The most common symptoms are swelling and discomfort in the area where cancer has spread. The fundamental cause of prostate cancer is most likely hormonal. Fats increase the production of testosterone and other hormones, and testosterone has been shown to speed the growth of prostate cancer.

What is the commonest urology emergency?

Obstructive Uropathy: – Lower Urinary Tract Obstruction: Acute urinary retention (AUR), or the involuntary inability to pass urine from the bladder, is the most common reason for emergent urologic care, 1 with 10% of men aged 70-79 and 30% of men aged 80-89 having at least one episode.2 AUR (the passage of no or only extremely small amounts of urine) may result from an acute obstruction to urine outflow or from abnormalities in bladder contractility.

• Obstructed urine flow may result from any blockage of the bladder neck, urethra, or meatus, including stones, tumors, blood clots, prostate enlargement, local edema, or phimosis.
• Women may have pelvic organ prolapse or urethral diverticula.2, 3 Abnormalities in bladder contractility can arise from neurologic conditions or medications.

Trauma, drugs, and neurologic conditions may cause either problems with contractility or difficulties with outflow. For example, anticholinergic drugs may decrease bladder contractility, while sympathomimetic drugs may prevent sufficient relaxation of the bladder neck.

After surgery, acute urinary retention may occur in up to 70% of patients and is often due at least in part to anesthesia (general or regional, including epidural), drugs (including narcotic pain medications), constipation, and decreased mobility.4 Patients with significant urinary retention often have significant discomfort and a palpable bladder (Figure 1).

Imaging, including bedside ultrasound, can also confirm the presence of a large volume of urine in the bladder. Initial treatment consists of decompression of the bladder; typically placement of a urethral (or catheterizable channel) catheter is sufficient although suprapubic catheter placement may be necessary in cases where a urethral catheter is unsuccessful.

If a catheter cannot be placed to decompress the bladder, a short term intervention includes needle decompression of the bladder to empty some of the retained urine. This allows additional time to prepare for interventions (example: procedures in the operating room) without imminent threat of bladder rupture.

Any patient in whom urinary outflow is completely obstructed should be monitored postoperatively for the development of postobstructive diuresis. Postobstructive diuresis is diagnosed when the urine output exceeds 200 cc/hour for two consecutive hours, or more than three liters in 24 hours.5 While the incidence of postobstructive diuresis is widely variable, 6 a high index of suspicion for its development must be maintained in the first 24 hours after decompression, as solute loss accompanying the diuresis may be associated with severe electrolyte derangements as well as hypovolemia. Figure 1: Acute urinary retention, with a distended bladder and enlarged prostate. Gross Hematuria with Clot Retention: Gross hematuria is the presence of visible blood in the urine and may develop from renal or urologic pathology. True hematuria (the presence of red blood cells in the urine) should be distinguished from other causes of reddish urine, including myoglobinuria, hemoglobinuria, and drugs (e.g.

rifampin) or dietary causes (e.g. beets). In children, renal causes of hematuria predominate.7 While true gross hematuria necessitates a prompt evaluation, clot retention, or the inability to urinate owing to the volume of blood clot in the bladder, is a true emergency. Urinary clots develop when the amount of blood in the bladder exceeds the ability of the urinary urokinase to prevent clot formation; retention of urine associated with blood clots in the urine can occur when the clots physically block the urethra or bladder neck (see Figure 2).

Thus, treatment of clot retention has two goals: to relieve the outflow blockage and to prevent new clot formation.8, 9 In patients who are unable to void because of clots, placement of a large urethral catheter (usually at least 22 Fr, and often larger), and irrigation with 0.9% normal saline and a catheter-tipped syringe is often sufficient to remove the intravesical clots and re-establish spontaneous bladder drainage.

1. Hematuria catheters, which have large drainage holes at the tip and which are often reinforced so as not to collapse with withdrawal of fluid, are helpful when irrigating.
2. If a three-way catheter is used, it is important to remember that the lumen of the drainage port is smaller than in a two-way catheter of similar external (French) size.

Patients in whom the urine cannot be cleared using hand irrigation require cystoscopy and clot evacuation in the operative setting, in which intravesical clots can be removed and any specific actively bleeding sites can be treated. Once the urine has been successfully cleared of clots, continuous bladder irrigation (CBI) with 0.9% normal saline through a three-way catheter is typically used to prevent further clotting in the immediate postoperative period, with the irrigation rate titrated to the minimal amount needed to achieve clear or very light pink urine. Figure 2: Bladder distension due to clot retention; the heterogeneous nature of the intravesical fluid reflects mixing of clot and urine. Ureteral Obstruction: Ureteral obstruction, in which the antegrade flow of urine from the kidney to the bladder is blocked, can occur in either or both renal units.

• Urgent or emergent intervention is needed when obstruction affects all renal units, infection or immunosuppression are present, or in the presence of acute worsening of renal function.
• Causes of ureteral obstruction may be intrinsic (including stones, ureteropelvic junction obstruction, ureteral polyps or tumors, blood clots, or ureteroceles), or extrinsic (including blood vessels or external masses such as tumors, retroperitoneal fibrosis).

Stones (Figure 3) are the most common cause of ureteral obstruction, with an 11% lifetime risk of nephrolithiasis, and can be diagnosed using ultrasound or CT scans.10 Figure 4 shows an obstructing ureterocele with infected urine. Figure 3: Left ureteral stone with associated collecting system dilatation. Figure 4: An obstructing ureterocele containing purulent urine. In patients in whom adequate pain control can be achieved, in whom there is no evidence of immunosuppression (e.g. diabetes, pregnancy, immunosuppressive medications such as chemotherapy or antirejection medications) or infection (e.g.

fever, urinalysis suggestive of infection), and in whom serum creatinine is not elevated from baseline, non-urgent management based on the underlying etiology of the obstruction may be considered.11,12 In patients with obstruction of both kidneys or of a solitary functioning kidney, or in whom there is worsening of renal function from baseline, urgent endoscopic drainage with a ureteral stent or percutaneous drainage with a nephrostomy tube should be considered.

Patients with fevers or significant pain that cannot be controlled with oral medications should undergo drainage as well; while both endoscopic (stent) and percutaneous (nephrostomy tube usually placed by Interventional Radiology) approaches may be considered in these cases, patients with sepsis associated with ureteral obstruction should be managed with percutaneous rather than endoscopic drainage.