Faculty Bibliography

The use of social media is growing rapidly in health care. The purpose of this study was to provide updated data on utilization of social media in urology. A survey was emailed to 19 840 American Urological Association (AUA) members in September 2017, and responses were compared to our previous survey in 2013. Overall, 74% of 1731 respondents have a social media account. Facebook and YouTube were the platforms most commonly used. However, use of Instagram, LinkedIn, Twitter, and Pinterest significantly increased. Among social media users, 33% agreed that it has impacted their practice, and one-third have followed a medical conference remotely. At the 2018 AUA meeting (#AUA18), there were 18,863 tweets from 3887 contributors, which achieved 73,878 million impressions, a significant increase since 2013. More than half of users were not familiar with professional guidelines on social media. The most common reasons for non-use were not seeing any value and not wanting invasion of privacy. In conclusion, social media use has increased substantially in urology, providing opportunities for global conference participation and influencing clinical practice for a substantial proportion of users. Professional standards for online conduct should be integrated into medical education as use of social media continues to increase. PATIENT SUMMARY: The use of social media in urology has increased over time. Although Facebook and YouTube are the platforms most commonly used, use of Instagram, LinkedIn, Twitter, and Pinterest has significantly increased over time. Use of social media at medical conferences has increased over time, and a substantial proportion of urologists reported that social media influenced their clinical practice.

BACKGROUND:Little is known about the key composition of a successful tweet in urology. OBJECTIVE:To investigate for predictors of engagement with urology content on Twitter. DESIGN, SETTING, AND PARTICIPANTS/METHODS:This was a cross-sectional study based on 2-wk Twitter data surrounding a major international urology conference. INTERVENTION/METHODS:We examined the engagement for all original tweets containing the hashtags for the European Association of Urology conference ("#EAU19" and/or "#EAU2019"). OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS/UNASSIGNED:Study outcomes included engagement with tweets, as measured by the number of "likes" and "retweets." Tweet- and Twitter user-related parameters of each individual tweet were recorded. Multiple linear regression analyses were performed to investigate for predictors of likes and retweets. RESULTS AND LIMITATIONS/CONCLUSIONS:From March 9 to 22, 2019, there were a total of 37 222 tweets. Among them, 3534 were "original tweets" that had 31 889 likes and 10 031 retweets. On multivariable analysis, the word count, number of mentions, and presence of a photo were predictors of likes and retweets. An increasing number of hashtags were associated with fewer likes. The number of "followings" and "followers" of the contributor, and their time since joining Twitter did not have any associations with the number of likes or retweets. The major limitation of the study is the lack of assessment about the quality of the tweet content. CONCLUSIONS:Based on the Twitter data from a urology conference, we concluded that the word count, number of mentions, and presence of a photo within the tweet were associated with audience engagement. PATIENT SUMMARY/UNASSIGNED:We could engage the audience more successfully by increasing the number of words and mentions, and including a photo within a tweet. The results formulated the basic principles in creating successful tweets for sharing urological knowledge.

Data from the Health Information National Trends Survey (HINTS) show that the Internet is the first place people go to when they need information about health or medical topics. Searches for online health information have both benefits and challenges for patient-physician communication. To fully appreciate these issues, it is important to understand the following: (1) who is going online; (2) why are they going; (3) where are they going; (4) what needs are being met; and (5) how, if at all, do they discuss health information found online with their doctors. The objective of this mini-review is to highlight contemporary issues regarding the impact of the internet on patient-physician communication and to present directions for future research. PATIENT SUMMARY: The growing use of the Internet has implications for people seeking information on health matters. Our review shows that the Internet can be helpful for patient-physician communication, but this depends on the quality of health information found and whether the information is discussed during medical visits.

Active surveillance is now the recommended management option for low-risk prostate cancer. In this lecture we will discuss trends in use of active surveillance worldwide, optimal patient selection and monitoring. For men with intermediate- to high-risk localized prostate cancer, radical prostatectomy remains a gold standard treatment option. We will discuss recent trends in the surgical management of localized prostate cancer

The use of social media in medicine has rapidly increased. Social networks are used by clinicians for many purposes, including clinical case discussions, professional networking, advertising their practice, and patient education. Researchers are using social media for recruitment and dissemination of research, and as a source of data. Patients are also using social media as a source of information on health conditions, although there is a significant amount of misinformation. In this lecture, wewill discuss the pros and cons of social media use by clinicians, researchers and patients

Introduction: Current guidelines recommend active surveillance (AS) as the preferred strategy for men with low-risk prostate cancer (PCa). AS involves serial testing to monitor the disease, and curative intervention is offered if the disease progresses. Studies show significant heterogeneity regarding testing frequency and when AS is discontinued.
Objective(s): To identify factors clinicians consider when decreasing/stopping AS for PCa.
Method(s): This qualitative study used data from semi-structured interviews with clinicians who monitor men on AS. Purposive sampling was used to ensure geographic variation in the U.S. Data collection continued until thematic saturation was achieved. Audio-recorded interviews with clinicians were transcribed verbatim and imported into Atlas.ti for data management and analysis. Framework analysis guided coding and identification of themes. Two researchers coded all transcripts independently, met to discuss, and reached consensus. Results and
Conclusion(s): Of the 24 clinicians, 83% were urologists representing 11 states, 92% were male, and 62% were white. Clinicians reported their experiences with either decreasing/stopping AS (Fig. 1, overleaf). Life expectancy, considering age and comorbidities, was the dominant theme influencing the decision to decrease/stop AS. Generally, clinicians did not have a specific age for when they would consider decreasing/stopping AS, but one clinician felt that 75 years should be the cut-off. The fear of missing the window of curability or being sued could limit clinicians' willingness to decrease/stop AS. One clinician's patient reported him to the medical board when he refused to do a rectal exam that was not clinically needed. Clinicians also mentioned situations where men stop showing up, due to work or transportation issues, or say they want to stop because of biopsy fatigue. These findings suggest that clinicians make decisions about changing AS in response to both clinical and pragmatic concerns. As AS use increases, additional recommendations are needed to guide decisions about decreasing/stopping AS. Disclosure of interest: None declared
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PURPOSE/OBJECTIVE:To define the role of focal laser ablation (FLA) as clinical treatment of prostate cancer (PCa) using the Delphi consensus method. METHODS:A panel of international experts in the field of focal therapy (FT) in PCa conducted a collaborative consensus project using the Delphi method. Experts were invited to online questionnaires focusing on patient selection and treatment of PCa with FLA during four subsequent rounds. After each round, outcomes were displayed, and questionnaires were modified based on the comments provided by panelists. Results were finalized and discussed during face-to-face meetings. RESULTS:Thirty-seven experts agreed to participate, and consensus was achieved on 39/43 topics. Clinically significant PCa (csPCa) was defined as any volume Grade Group 2 [Gleason score (GS) 3+4]. Focal therapy was specified as treatment of all csPCa and can be considered primary treatment as an alternative to radical treatment in carefully selected patients. In patients with intermediate-risk PCa (GS 3+4) as well as patients with MRI-visible and biopsy-confirmed local recurrence, FLA is optimal for targeted ablation of a specific magnetic resonance imaging (MRI)-visible focus. However, FLA should not be applied to candidates for active surveillance and close follow-up is required. Suitability for FLA is based on tumor volume, location to vital structures, GS, MRI-visibility, and biopsy confirmation. CONCLUSION/CONCLUSIONS:Focal laser ablation is a promising technique for treatment of clinically localized PCa and should ideally be performed within approved clinical trials. So far, only few studies have reported on FLA and further validation with longer follow-up is mandatory before widespread clinical implementation is justified.

PURPOSE/OBJECTIVE:North American studies have reported that ∼3-7% of opioid-naïve surgical patients transition to chronic opioid use after a single prescription. We examined the risk of chronic opioid use following radical prostatectomy (RP) using nationwide Swedish data. MATERIALS AND METHODS/METHODS:For 25,703 men in National Prostate Cancer Register of Sweden who underwent RP, linkage was performed to the Prescribed Drug Register. Opioid use was assessed in three time periods: baseline (13-1 month preoperatively), perioperative (1 month before and after), and postoperative (1-12 months). Multivariable logistic regression was used to identify predictors of new late use (≥1 opioid prescription in three consecutive months >2 months after surgery). RESULTS:Overall, 16,368 (64%) men filled an opioid prescription during the 13 months before or after surgery. Use of strong opioids increased over time and use of weak opioids decreased. 1.9% of men had opioid prescriptions during the baseline period, followed by a spike around surgery (59%), which sharply decreased in the second postoperative month. However, thereafter the proportion of men with opioid prescriptions remained slightly higher (2.2%) compared to the pre-RP baseline. Among chronic late users, 57% were previous users and 43% were new chronic users. Higher cancer risk category, greater comorbidity, unmarried status, and low educational level were associated with risk of new chronic opioid use. CONCLUSIONS:Slightly more than half of Swedish filled an opioid prescription after RP, and <1% became chronic opioid users. These rates are lower than previous studies of postoperative opioid use from North America.