Faculty Bibliography

IMPORTANCE/OBJECTIVE:Despite its frequent use for visualization of ureteral efflux during pelvic/abdominal surgery, there are limited data on indigo carmine pharmacokinetics and duration of blue color in postdose urine. Understanding how long the blue color persists allows the clinician to make accurate assessments of the urinary system during complex surgical procedures. OBJECTIVES/OBJECTIVE:This study observed the plasma and urinary pharmacokinetics of indigo carmine in healthy volunteers and the voided urine color. STUDY DESIGN/METHODS:This study was an open-label, randomized clinical trial in 16 healthy participants who received either a 2.5-mL or a 5.0-mL intravenous injection of indigo carmine. Blood (pre, 2, 5, 7, 10, 15, 20, 30, 40 minutes and 1, 2, 3, 4, 6, 12 hours post) and urine (predose, 0-2, 2-6, 6-12 hours post) were collected. The first postdose stool was collected. RESULTS:Plasma concentration peaked within 5 minutes, and all plasma concentrations were below the limit of quantification by 2 hours postdose. The estimated plasma half-life of indigo carmine was 12 minutes. Voided urine through 2 hours postdose was visibly discolored compared with the matched predose urine. In some cases, urine discoloration persisted through 6 hours (10/16) and 12 hours (1/16). Unchanged indigo carmine eliminated in stool was observed in 4 of 16 participants (25%). CONCLUSIONS:The short half-life and rapid urinary excretion of indigo carmine favor its clinical use for intraoperative cystoscopy and are consistent with the reported median time of 6 minutes postinjection to ureteral efflux in patients undergoing surgical procedures.

INTRODUCTION AND HYPOTHESIS:The purpose of our study was to identify the most common reasons why postoperative urogynecology patients called their surgeon within the first 6 weeks of surgery. We hypothesize that implementing a follow-up postoperative call (FPC) policy would decrease the number of patient-initiated calls within this postoperative period. METHODS:This is a prospective before-and-after cohort study that was conducted in two phases. The initial phase identified the most common reasons why patients call within 6 weeks of their inpatient or outpatient urogynecological surgery. In the second phase, an intervention was implemented where each postoperative patient was called within 48 to 72 h of discharge: the intervention group. The primary outcome was the number of phone calls initiated by patients during the 6-week postoperative period. RESULTS:There were 226 patients in the control group and 233 patients in the intervention group. Significantly fewer calls were initiated by patients in the intervention group, both groups having a median of 1 call per person, range 0-8 in the control group and 0-10 in the intervention group (p = 0.04). The five most common complaints were as follows: pain (20.4%), medication management (17.4%), disability paperwork (15.5%), and laboratory results (11.5%). There was a significant reduction in calls concerning constipation, laboratory/pathology results, and disability insurance claims after implementing the FPC policy. CONCLUSIONS:The implementation of the FPC policy resulted in fewer patient-initiated calls. As such, there were significant reductions in postoperative complaints of constipation, vaginal bleeding, incomplete bladder emptying, and inquiries into laboratory results and disability paperwork.

OBJECTIVE:To provide an updated report on the status of urology education in the United States. METHODS:Forty-one randomly selected accredited medical schools in the United States were surveyed concerning their urology curriculum. All schools were included in the randomization, even those that had not produced any successful urology applicants during the past 5 years. RESULTS:In 48% of the schools, there were no urology lectures or coursework required before third-year clinical rotations. Two schools (5%) had a mandatory urology clinical clerkship. All schools offered an elective urology clerkship during either the third or fourth year of medical school. Fifty-five percent of medical schools used a core curriculum, and 31% based their curriculum on the American Urological Association's medical student core curriculum. Twenty-nine percent used Web-based resources during their clerkship, and 21% had a urology interest group. CONCLUSION/CONCLUSIONS:This survey further reveals that there is a decline in exposure of medical students in the United States to formal urology teaching. In an attempt to minimize any possible adverse impact and to ensure that students are being exposed to the most important urologic topics and skills needed, some medical schools have instituted the use of a core curriculum in their clerkships. Despite the persistent decline in required medical student exposure to urology, urology residency programs remain extremely competitive.