Current Urology Reports最新文献

Purpose of review: Supporting struggling urology residents is an important yet challenging task. We describe strategies to assess resident performance, challenges in the clinical learning environment that contribute to resident remediation, and support mechanisms. This review highlights existing resources for positive outcomes in remediation and promotes exploration of innovative strategies to support future urology residents.

Recent findings: Burnout is associated with poor resident performance. Factors that promote burnout include unsatisfactory work-life balance, education or financial debt, access to mental health care, and identifying as a member of an underrepresented group. Competency-based assessment and tailored educational interventions can effectively address the needs of a struggling learner. Efforts to create standardized language, specialty-specific remediation programs, and robust mentorship infrastructure have been successful in other specialties. Study of interventions and outcomes for struggling urology residents is somewhat limited; deeper understanding of prevailing remediations practices and individual needs of struggling residents will be critical to develop more robust support for trainees.

Purpose of review: Tranexamic acid (TXA) is an anti-fibrinolytic agent that prevents degradation of fibrin by blocking the ability of plasminogen to bind to fibrin and the proteolytic activity of plasmin. TXA has been proven to be useful in reducing bleeding complications in multiple types of surgery. In this article, we will review the current usage of TXA in endoscopic surgeries for benign prostatic hyperplasia (BPH).

Recent findings: The use of TXA for endoscopic BPH surgeries has mainly been studied for transurethral resection of the prostate (TURP). In the clinical trials assessing the use of TXA and TURP, TXA demonstrated reduced intraoperative bleeding independent of administration route. However, this did not consistently translate to reduced hospitalization or catheterization times. Evidence for the use of TXA and holmium laser enucleation of the prostate (HoLEP) has begun to emerge, and to date limited benefit has been demonstrated. This result is likely due to the excellent innate hemostatic control associated with the procedure. However, further studies are required to validate these findings. With recent innovation in new types of endoscopic BPH surgeries, the benefit of TXA during other types of BPH procedures also require more study. Within the context of endoscopic surgeries for BPH, TXA appears to have the most benefit when performing TURP. More evidence is required to conclude on the benefit in other types of BPH surgery including HoLEP.

Purpose of review: There is a high number of acute renal colic cases that present to the emergency department, and it is crucial to have reliable parameters that can accurately predict the likelihood of spontaneous stone passage. In this narrative review, we examined the latest data from the literature regarding the relationship between ureteral wall thickness and the probability of spontaneous stone passage.

Recent findings: The thickness of a normal ureteral wall ranges between 0.95 and 2 mm, with an increase in thickness observed with advancing age. Current data suggests that thinner ureteral wall thickness may favor the spontaneous stone passage. However, the discrepancy between data from the literature is mainly caused by the small study cohorts, heterogeneous protocols, and the intra- and interobserver variability in evaluating non-contrast computed tomography results. There remains a need to better understand the mechanisms behind stone expulsion, as current models rely on oversimplified assumptions about the ureter's biomechanical properties.

Purpose of review: Conflict is inevitable in any setting where individuals must work towards a common goal. In the context of a surgical residency, there exists several etiologies through which conflict can emerge and be exacerbated. It is important to understand how best to resolve these issues as collaboration is essential among residents, faculty, and hospital staff to achieve the best patient outcomes and resident training.

Recent findings: There exists many strategies for conflict resolution such as the Thomas Kilmann Conflict Model, Levine 7-Step Model, or AIDET communication framework. Many of these emphasize the importance of understanding the role of perspective for those involved in conflict. Our review provides background to these tools and their applications in resolving conflicts. In this review, we highlight sources of resident conflict, and models of resolution that can be employed. Furthermore, we provide applications of how conflict resolution strategies can directly address common problems encountered within surgical residencies.

Purpose of review: A urology curriculum is not often a standard component of undergraduate medical education in the United States. As a means to build interest among students, Urology Interest Groups and surgical skills sessions are specific resources available that can connect students with mentors and offer an introduction to the field.

Recent findings: Mandatory preclinical and clinical exposure to Urology in medical school is associated with higher numbers of students entering the field. Student-led efforts such as interest groups and surgical skills sessions can have the same effect, while also creating opportunities for finding mentorship, professional development, and clinical exposure. Medical student access to urology interest groups and surgical skills sessions are important for building specialty interest, especially during a time that a future workforce shortage may be growing.

Purpose of review: Renal transplantation has become the standard of care for patients with end-stage renal disease (ESRD) due to significant advancements across various medical and surgical fields. This review highlights the evolution of renal transplantation techniques, while also exploring the latest tools and practices that promise to further improve their outcomes.

Recent findings: Since the first successful renal transplant, numerous innovations have been implemented in the various stages of renal graft implantation. These include improved techniques in vascular and urinary anastomoses, graft positioning, and the recent emergence of modern technologies such as robotics and artificial intelligence (AI) which have shown promise in enhancing surgical performance. The field of renal transplantation is continuously evolving. As new and more efficient technologies continue to emerge, these too will become the standard of care and training. It is essential for transplant surgeons to understand the key historical developments that have led to our current level of expertise, so we can make effective use of these tools in further advancing the field.

Purpose of review: The present review explores the prevalence of musculoskeletal work-related injuries associated with endoscopic treatment of benign prostatic hyperplasia, ergonomic factors and potential current and future solutions.

Recent findings: Work-related musculoskeletal pain and injuries are prevalent in urology, with modifiable risk factors identified in the endoscopic treatment of benign prostatic hyperplasia. Future endeavors should focus on instrument design, formalized ergonomic training curricula and cultural shifts among the surgeon community. The combination of advancements in urology and a growing aging population has led to a rising volume of endoscopic treatments for benign prostatic hyperplasia. Ergonomic considerations are especially critical in endourology, where surgeons perform prolonged procedures requiring repetitive, precise movements. Optimizing ergonomics through surgeon education, training, improved operating room and instrument design, and ongoing research is essential to mitigating work-related musculoskeletal strain and enhancing surgical performance.

Purpose of review: To review the landscape of bladder preservation management and active surveillance for those who achieve clinical complete response to neoadjuvant chemotherapy.

Recent findings: Multiple cohorts of patients with clinical complete response report overall survival rates over 80% multiple years after treatment without cystectomy. Most recently, prospective clinical trials have been pursuing clinical complete response as a valid primary endpoint. Recent advances in immunotherapy and molecular biomarkers present new horizons in expanding the potential patient population as well as accuracy in prediction of pathologic complete response. While neoadjuvant chemotherapy followed by radical cystectomy is the standard of care for muscle-invasive bladder cancer, interest in active surveillance is growing as evidenced by the increasing number of studies. Accumulating evidence and new prospective data suggest this could be a plausible option in the future. These cohorts remain highly selected, thus generalizability is still under investigation.

Purpose of the review: To review the outcomes of robotic-assisted laparoscopic donor nephrectomy in the published literature.

Recent findings: Robotic-assisted laparoscopic donor nephrectomy has demonstrated to be a safe, efficient and effective technique of minimally invasive surgery, that offers multiple advantages to the surgeon, and good outcomes for the kidney donor and recipient. Although still a recent technique, it has been adopted by multiple centers worldwide. Robotic donor nephrectomy studies demonstrated consistent perioperative outcomes with low complication rates. Mean operative time was approximately 208 min, which is within acceptable limits. Mean warm ischemia time of 3.84 min remains well below the threshold for graft function preservation. Blood loss during is consistently low, below 150 mL, and conversion to open surgery remains rare, with a rate of 1.08%. These findings suggest that robotic-assisted procedures are feasible and safe for donor nephrectomy.

Purpose: This review offers an evaluation of the limited literature detailing the outcomes of incontinent urinary diversion in the pediatric neurogenic bladder patient. We will discuss the indications for incontinent urinary diversion, procedural options, surgical techniques, postoperative complications, and overall patient impact.

Recent findings: Incontinent urinary diversions remain a valuable treatment option for patients with neurogenic bladder especially the highly selected patient with few other options. Irrespective of the diversion chosen, postoperative complications do arise, and long-term follow-up is imperative. Ensuring the longevity and effectiveness of the diversion is critical, especially in a pediatric patient cohort with multiple long term risks including obesity- a factor that can directly impact reconstructive function. The dearth of available data highlights the need for more longitudinal studies of pediatric patient cohorts to determine true impact and risk related to incontinent urinary diversion.