Purpose:Renal masses can be characterized as “indeterminate” due to lack of differentiating imaging characteristics. Optimal management of indeterminate renal lesions remains nebulous and poorly defined. We assess management of indeterminate renal lesions within the MUSIC-KIDNEY (Michigan Urological Surgery Improvement Collaborative–Kidney mass: Identifying and Defining Necessary Evaluation and therapY) collaborative.Materials and Methods:Each renal mass is classified as suspicious, benign, or indeterminate based on radiologist and urologist assessment. Objectives were to assess initial management of indeterminate renal lesions and the impact of additional imaging and biopsy on characterization prior to treatment.Results:Of 2,109 patients, 444 (21.1%) had indeterminate renal lesions on their initial imaging, which included CT without contrast (36.2%), CT with contrast (54.1%), and MRI (9.7%). Eighty-nine patients (20.0%) underwent additional imaging within 90 days, 8.3% (37/444) underwent renal mass biopsy, and 3.6% (16/444) had reimaging and renal mass biopsy. Additional imaging reclassified 58.1% (61/105) of indeterminate renal lesions as suspicious and 21.0% (22/105) as benign, with only 20.9% (22/105) remaining indeterminate. Renal mass biopsy yielded a definitive diagnosis for 87%. Treatment was performed for 149 indeterminate renal lesions (33.6%), including 117 without reimaging and 123 without renal mass biopsy. At surgery for indeterminate renal lesions, benign pathology was more common in patients who did not have repeat imaging (9.9%) than in those who did (6.7%); for ≤4 cm indeterminate renal lesions, these rates were 11.8% and 4.3%.Conclusions:About 33% of patients diagnosed with an indeterminate renal lesion underwent immediate treatment without subsequent imaging or renal mass biopsy, with a 10% rate of nonmalignant pathology. This highlights a quality improvement opportunity for patients with cT1 renal masses: confirmation that the lesion is suspicious for renal cell carcinoma based on high-quality, multiphase, cross-sectional imaging and/or histopathological features prior to surgery, even if obtaining subsequent follow-up imaging and/or renal mass biopsy is necessary. When performed, these steps lead to reclassification in 79% and 87% of indeterminate renal lesions, respectively.

Introduction The COVID-19 pandemic drove rapid adoption of telehealth across oncologic specialties. This revealed barriers to telehealth access and telehealth-related disparities. We explored disparities in telehealth access in patients with cancer accessing oncologic care. Materials/Methods Data for all unique patient visits at a large academic medical center were acquired pre- and intra-pandemic (7/1/2019-12/31/2020), including visit type (in-person, video, audio only), age, race, ethnicity, rural/urban (per zip code by Federal Office of Rural Health Policy), distance from medical facility, insurance, and Digital Divide Index (DDI; incorporates technology/internet access, age, disability, and educational attainment metrics by geographic area). Pandemic phases were identified based on visit dynamics. Multivariable logistic regression models were used to examine associations of these variables with successful video visit completion. Results Data were available for 2,398,633 visits for 516,428 patients across all specialties. Among these, there were 253,880 visits from 62,172 patients seen in any oncology clinic. Dramatic increases in telehealth usage were seen during the pandemic (after 3/16/2020). In multivariable analyses, patient age [OR: 0.964, (95% CI 0.961, 0.966) P<0.0001], rural zip code [OR: 0.814 (95% CI 0.733, 0.904) P = 0.0001], Medicaid enrollment [OR: 0.464 (95% CI 0.410, 0.525) P<0.0001], Medicare enrollment [OR: 0.822 (95% CI 0.761, 0.888) P = 0.0053], higher DDI [OR: 0.903 (95% CI 0.877, 0.930) P<0.0001], distance from the facility [OR: 1.028 (95% CI 1.021, 1.035) P<0.0001], black race [OR: 0.663 (95% CI 0.584, 0.753) P<0.0001], and Asian race [OR: 1.229 (95% CI 1.022, 1.479) P<0.0001] were associated with video visit completion early in the pandemic. Factors related to video visit completion later in the pandemic and within sub-specialties of oncology were also explored. Conclusions Patients from older age groups, those with minority backgrounds, and individuals from areas with less access to technology (high DDI) as well as those with Medicare or Medicaid insurance were less likely to use video visits. With greater experience through the pandemic, disparities were not mitigated. Further efforts are required to optimize telehealth to benefit all patients and avoid increasing disparities in care delivery.

The COVID-19 pandemic drove rapid adoption of telehealth across medicine, including radiation oncology, to minimize inperson contact. This exposed patient barriers to telehealth access and created care disparities in the absence of specific access assistance which have been little studied. A better understanding of these telehealth access barriers will help direct assistance resources to improve access in radiation oncology patients in the future. Materials/Methods: Data for all unique patient visits at a large academic medical center between 4/1/2020 and 6/30/2020 were generated, including visit type (in person, video, audio only), age, race, ethnicity, rural/urban home address (zip code assessment by Federal Office of Rural Health Policy), and Digital Divide Index (DDI; incorporates metrics of technology and internet access, age, disability, and educational attainment in a geographic area). A multivariable logistic regression model evaluated the association of these variables with successful video visit completion. Results: A total of 1990 visits by patients seen in radiation oncology for 1698 unique individuals were assessed. The median age was 66 (IQR: 14); patients were 38.1% female and 89.4% Caucasian. The median age of those completing at least one video visit was 64 (IQR: 15) vs. 68 (IQR: 14) for those who completed audio visits only (P < 0.001). Among African American patients, 22.7% completed at least one video visit, while 36.7% of Caucasian patients completed at least one video visit (P = 0.003). In multivariable analyses, patient age (OR: 0.965; 95% CI 0.956-0.973; P < 0.001), DDI (OR: 0.986; 95% CI 0.976-0.996; P = 0.006), and race (OR: 0.472; 0.294-0.756; P = 0.039) predicted completion of at least one video visit. Those who were older, had higher DDI (greater digital divide), or African American race were less likely to complete a video visit. Gender, ethnicity, and rural/urban home address were not significantly associated with video visit completion. Conclusion: This work is to our knowledge the first characterization of telehealth usage in radiation oncology patients and demonstrates associations between patient characteristics and video visit completion that have implications for clinical practice and future research. First, older patients, those with minority backgrounds, and those from areas with less access to technology (high digital divide) are less likely to be able to access care through video visits. Second, audio visits were a significant proportion of visits early in the pandemic, and subsequent data should be analyzed to determine their importance as a means to continue providing virtual care to prevent further care disparities. Third, future research is needed to address barriers to care experienced by elderly and minority patients as well as those from communities with high DDI. Fourth, researchers should explore markers of access barriers such as DDI and other potential pre-visit screening metrics for use in directing resources to those in need.

INTRODUCTION AND OBJECTIVE:The Census Taskforce of the Society for Women in Urology (SWIU) created and distributed a census survey to women urologists, throughout the United States, in order to identify the demographics of females practicing Urology and to investigate specific needs and challenges pertaining to women in the urologic workforce.METHODS: An electronic survey was sent via email and social media sites to all SWIU members including residents, fellows, and women urologists practicing in the US and its territories, between February-May 2022. Data on demographics, practice type, workplace, personal, family issues, barriers, and career plans were collected. Descriptive statistical analysis was performed. Continuous variables were described with measures of central tendency (mean, median) and dispersion (range, standard deviation). Categorical variables were summarized as frequencies and percentages. Between groups, comparisons such as age or type of practice were analyzed using a chi-square test of independence or Fisher's exact test for categorical variables.RESULTS: Of the estimated 1,509 female urologists, we received 379 survey responses corresponding to an estimated response rate of 25.1 % response rate. Almost all respondents (98%) are members of the AUA. The average age was 42.9 years (SD 18.6). In terms of ethnicity, most self-reported as White 71.0%, followed by 16.4% Asian or Asian American, and 6.3 % African American. The majority reported practicing in urban locations (63.5%) at an academic setting (55.7%), followed by similar distribution between private practice and hospital-employed settings (17.0%, 16.7%, respectively). The vast majority, 89.6%, reported working full-time, while only 10.4 % worked part-time. The average hours of work per week were 56.7 (SD 14.5). In terms of personal demographics, 81.9 % were married, 17.3% were single and 1% did not answer. 68.8% of responders had children, with the majority of these children being born during or after training.CONCLUSIONS: The number of women urologists continues to increase, and although still there are racial disparities, these are less stark among women compared to the existing in the overall AUA Census. Our findings related to practice patterns and caregivers' responsibilities must be considered to develop future interventions directed to the specific needs of female urologists.