Alek Mishail

Deficits in urological knowledge among medical students and primary care providers: potential for impact on urological care.

PURPOSE Recent data indicate a decline in the urological education of third and fourth year medical students. To determine if this decline has an impact on the treatment of patients we performed a survey to evaluate the general level of knowledge, attitudes and practices with regard to common urological issues seen in a general medical practice among medical students and faculty involved in primary care at an academic institution. MATERIALS AND METHODS A confidential questionnaire was distributed to attendings, residents and fellows, and the clinical medical students at our academic institution to ascertain how they evaluate and treat patients with common urological complaints. All responses were entered into SPSS statistical software. RESULTS A total of 300 surveys were distributed, 150 of which were returned with complete information for data analysis. Knowledge with regard to various conditions including hematuria, recognition of an age specific abnormality in serum prostate specific antigen and overactive bladder was low for all groups. Furthermore, respondents demonstrated a low likelihood of requesting formal urological evaluation for these conditions. Exposure to a urology elective in medical school had a positive impact on some areas of urological evaluation. CONCLUSIONS General urological knowledge with regard to the primary care setting is insufficient. The potential for impact on patient care is enormous. These data highlight the need for a definitive urological curriculum in medical school as well as continued education at the resident and faculty level with regard to evaluation, management and recognition of when to request formal urological evaluation in the primary care setting.

Sociodemographic predictors of postvasectomy noncompliance.

Background: Postvasectomy semen analysis (PVSA) is critical to establish the success of the vasectomy but the rate of compliance with PVSA is notoriously low. We determined various sociodemographic predictors of high noncompliance rate. Study design: Retrospective chart review of 214 patients who have undergone vasectomy by one surgeon was performed. All men had similar preoperative consultation with written instruction to provide two PVSA 2 and 4 months after vasectomy. Noncompliance was defined as a failure to provide PVSA. Sociodemographic data including age, marital status, number of children, level of education and smoking history were analyzed. Results: Of 214 patients, 99 (46.2%) provided no PVSA. Rate of noncompliance was independently higher in men with four or more children, smokers and those with lower educational level. Marital status and age had no impact on postoperative compliance Conclusion: Objective sociodemographic variables were associated with a higher risk of PVSA noncompliance. A more thorough approach to vasectomy counseling and timely reminder of upcoming PVSA in a preoperatively defined group of patients will help to improve compliance and prevent possible medical and legal repercussions.

Impact of a second semen analysis on a treatment decision making in the infertile man with varicocele

OBJECTIVE To evaluate the impact of second semen analysis (SA) on a treatment decision in infertile men with varicocele and abnormal first SA. DESIGN Retrospective chart review. SETTING University hospital. INTERVENTION None. MAIN OUTCOME MEASURE(S) Standard clinical semen analysis. PATIENT(S) A total of 160 infertile men with varicocele and abnormal first SA were evaluated. Two SA were performed in the same andrology lab 3 to 8 weeks apart. Exclusion criteria were azoospermia, low semen volume, leukocytospermia, febrile illness within 3 months, and habitual heat exposure. RESULT(S) Despite fluctuation in absolute values of sperm concentration, motility, and morphology, the second SA remained abnormal in 111 out of 112 men (99.1%) with abnormal first SA. CONCLUSION(S) Initial abnormal SA is a sufficient indication for varicocele treatment because in most patients the second SA remains abnormal and does not change treatment decision. This approach will expedite treatment of infertile men with varicocele and increase its cost effectiveness.