At-home semen analyses, telecystoscopy among telemedicine’s applications in urology


"There's...this concept of the virtualist; truly, the virtual urologist who has a potentially full-time telehealth practice but geared toward really delivering care, and these positions exist," says Kara L. Watts, MD.

In this video, Jennifer Robles, MD, MPH, and Kara L. Watts, MD, share examples of novel telehealth usage in urology. Robles is an assistant professor of urology at Vanderbilt University Medical Center in Nashville, Tennessee, and Surgical Quality Officer and Chief of Urology at the Tennessee Valley (VA) Healthcare System, and Watts is an associate professor of urology at Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, New York.


Robles: In my practice, there are 2 things that we're doing that are really interesting. The first is we've started using at-home semen analysis for post-vasectomy patients, and then we're going to be starting it for fertility analysis. That really addresses a problem for many urology clinics, which is that many men have issues giving samples for this and then have to potentially come into clinic in person and give a sample in person, which is very awkward for everyone involved. Being able to do at-home analyses not only really helps patient comfort, patient anxiety, and stress, but also reduces resources for the clinician, and makes it easier for us. The second is I also work in the VA system, and the VA system has a really innovative teleurologist program. There are about 8 or so full-time teleurologists around the country, including in my region, that are 100% remote care, seeing patients through mostly video visits, some phone, new consults, and follow- up patients and so on. I think that that is another example of how we can better harness telehealth for outreach and access for patients even in urology, a surgical specialty.

Watts: Absolute props to the VA system for showing us a bigger vision for what telehealth can be on a national level. I will add to this not so much within our own practice, but what some of our speakers talked about in terms of novel uses. Dr. Lisa Finkelstein from Jackson Hole, Wyoming gave a really wonderful talk on the technological revolution and this concept of basically "innovate or die." She brought up a number of really interesting topics. One of them is the use of a butterfly ultrasound, which is a technology that's available to any urologist, if we want. It's a remote way of using ultrasound to monitor the bladder for bladder scans or even remote bladder monitoring for uroflows. There's also this concept of the virtualist; truly, the virtual urologist who has a potentially full-time telehealth practice but geared toward really delivering care, and these positions exist. Dr. Robles' group in the VA has been actually hiring one to really increase delivery to patients in rural areas. There's also a huge group in Virginia that's using telecystoscopy. Having a physician extender on the ground who is performing cystoscopy that is remotely monitored by a urologist, so not physically there, but still reviewing the images, providing the feedback, but delivering that procedure for diagnostic purposes to patients who otherwise would have a hard time coming in to get that procedure done. The last part that I'll mention is this idea of telementoring or teleproctoring. We traditionally think of telehealth as a patient in one location and the provider in another location, one-on-one interaction, but you can take this to another level of having a resident or a mid-level or even an ER provider, examining a patient in the emergency room or urgent care for example, and then having a live telehealth encounter with a urologist for an evaluation that was not necessarily on a scheduled panel, but bridging that gap between the lack of urologists on the ground there and delivering real-time evaluation and feedback from the urologist's perspective, so really a lot of innovative and great work being done in a lot of different settings.

This transcription was edited for clarity.

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