Biomedical subjects

Elizabeth Fallon

Publications and source records attributed to Elizabeth Fallon.

4 recordsLinked to original sources

PubMed2005

Minimally invasive therapy for benign prostatic hyperplasia: practice patterns in Minnesota.

BACKGROUND AND PURPOSE: Benign prostatic hyperplasia (BPH) affects more than 50% of men by the age of 60 and 90% by age 85. Many of these men are not candidates for surgical procedures such as transurethral resection of the prostate (TURP), stimulating the development of less-invasive forms of therapy. We studied the utilization of these newer therapies by urologists practicing in Minnesota. MATERIALS AND METHODS: An anonymous questionnaire was sent to 174 members of the Minnesota Urological Society, of which 58 were available for analysis. A case scenario was presented of a patient with BPH refractory to medical therapy. The options were traditional and minimally invasive therapies. The physician was asked to select whether he or she would offer each option and perform the procedure or refer the patient within or outside the practice. Statistical analysis was performed using chi-square and two-sample t-tests on Minitab software. The results were considered significant at P < 0.05. RESULTS: While 59% of the respondents would offer both minimally invasive and traditional alternatives, 10% would offer only minimally invasive therapy, while 29% would offer only traditional therapy (P = 0.01). The most common minimally invasive therapies offered were transurethral microwave thermotherapy and (55%) and transurethral needle ablation (33%). If they offered a form of minimally invasive therapy, the majority of respondents would perform the procedure themselves. Rural urologists were less likely to offer minimally invasive therapy (43%) than metro physicians (81%; P = 0.035). There was no significant difference in the use of minimally invasive therapies by rural and urban urologists (P = 0.409) or urban and metropolitan urologists (P = 0.119). Urologists completing their training between 1960 and 1980 were less likely to offer minimally invasive therapy. There was no significant difference in the likelihood of offering traditional versus minimally invasive alternatives according to the percent of managed care in the practice. CONCLUSIONS: Urologists closer to the completion of their residency training are more likely to include a minimally invasive technique in their treatment plan, while urologists practicing in rural Minnesota are less likely to offer minimally invasive procedures. Further emphasis should be placed on increasing the availability of minimally invasive techniques in rural settings.

Age Factors↗

PubMed2004

Minimally invasive therapy for renal cell carcinoma: is there a new community standard?

OBJECTIVES: To evaluate current practice use of laparoscopic and minimally invasive therapies in the treatment of renal cell cancer. METHODS: A questionnaire was sent to 174 members of the Minnesota Urological Society. The first case scenario described a 6-cm lesion not amenable to nephron-sparing surgery. The second case scenario described a 3-cm lower pole exophytic mass amenable to nephron-sparing surgery. The treatment options included traditional therapy (open partial or radical nephrectomy) and minimally invasive therapy (laparoscopic radical or partial nephrectomy or renal cryoablation). RESULTS: Our survey response rate was 49%. For the first scenario, 86% of respondents would offer open radical nephrectomy; however, 57% would offer laparoscopic surgery. Of those urologists offering laparoscopic surgery, 14% would refer outside their practice and 43% would use a hand-assisted approach. Sixty-four percent of the metropolitan and 56% of the urban respondents would offer a form of minimally invasive therapy; only 29% of rural respondents offered these options. For the second scenario, 90% of respondents would offer open partial nephrectomy and 45% a minimally invasive therapy; however, 24% of these would refer outside their practice. Thirty-eight percent of respondents would offer laparoscopic partial nephrectomy and 22% of respondents would offer renal cryoablation. Urologists completing residency after 1990 were more likely to offer a minimally invasive option (65%) compared with urologists completing residency before 1990 (31%). CONCLUSIONS: Minimally invasive therapy for renal cell cancer is evolving into a community standard of care, with urologists relying heavily on outside referrals to access minimally invasive alternatives. Younger urologists living in metropolitan and urban areas are more likely to offer minimally invasive therapy. Additional emphasis should be placed on increasing the availability of minimally invasive techniques in rural settings.

Adult↗

PubMedDate not supplied

Contemporary management of ureteropelvic junction obstruction: practice patterns in Minnesota.

BACKGROUND AND PURPOSE: Ureteropelvic junction (UPJ) obstruction can be addressed surgically by an open, laparoscopic, endoscopic, or fluoroscopic procedure. Our objective was to establish what surgical alternatives are currently offered by urologists in Minnesota. MATERIALS AND METHODS: A questionnaire was sent to 174 members of the Minnesota Urological Society. Practice settings were characterized as rural, urban, or metropolitan on the basis of the ZIP-code classifications of the Minnesota Ambulance Association and state geographic legislation. Respondents were asked to select initial treatment options for an adult patient with flank pain, decreased renal function, and hydronephrosis secondary to UPJ obstruction. RESULTS: Whereas 60% of the respondents would offer open pyeloplasty, only 12% would offer it as the only treatment option. The two most common minimally invasive therapies offered were the Acucise balloon (48%) and percutaneous antegrade endopyelotomy (48%). Rural urologists were more likely to offer Acucise balloon incision (71%) than were urban (28%; P=0.045) or metropolitan (55%; P=0.412) urologists. CONCLUSIONS: The majority of urologists still offer open pyeloplasty as first-line therapy for UPJ obstruction. Further emphasis should be placed on increasing the availability of endoscopic and laparoscopic procedures.

Adult↗

PubMedDate not supplied

Nephrolithiasis: "scope," shock or scalpel?

PURPOSE: To evaluate treatment preferences for complex urinary calculi. MATERIALS AND METHODS: A questionnaire was sent to 174 members of the Minnesota Urological Society. Three case scenarios were presented: a 1.5-cm lower-pole calculus with unfavorable anatomy, a 1.4-cm proximalureteral calculus, and a staghorn calculus. The treatment options offered were extracorporeal shockwave lithotripsy (SWL), ureteral stenting, ureteroscopy (URS), percutaneous nephrolithotomy (PCNL), and open surgery. RESULTS: Our survey response rate was 49%. A PCNL for staghorn calculi was more likely to be offered by urologists in metropolitan (100%; P<0.001) and urban (100%; P=0.003) settings than rural settings (57%). Whereas only 22% of urban and metropolitan urologists would offer anatrophic nephrolithotomy, 43% of rural urologists would include this among their treatment options. A PCNL was more likely to be offered by urologists trained after 1980 (100%) than by urologists trained before 1980 (81%; P=0.004). For a large lower-pole calculus with unfavorable anatomy, urologists with >50% managed-care practices were more likely (91%) than urologists with <50% managed-care practices (65%) to select PCNL for such stones (P=0.034). Whereas 82% of metropolitan urologists would select PCNL, 43% of rural urologists would consider SWL as initial therapy. A URS was more likely to be offered by urologists trained after 1980 (16%) than by urologists trained before 1980 (0; P=0.044). For a large proximal-ureteral calculus, metropolitan urologists were most likely (64%) to use stents initially (urban 28%; P=0.014; rural 14%; P=0.017). Rural urologists were more likely to offer SWL (100%) than were metro urologists (55%; P=0.024). CONCLUSIONS: Initial therapy for nephrolithiasis differs significantly according to geographic location, year of residency completion, and the percentage of managed-care patients in a urologist's practice. Future emphasis should be placed on increasing the availability of endoscopic techniques in rural settings.

Decision Making↗