Urology最新文献

Objective: To assess the current medical school curricula for the presence or lack of physician fertility education, and secondarily, perspectives on who should be responsible for informing students about potential future infertility.

Materials and methods: Two different surveys were sent to medical students and curriculum leaders via REDCap. Student surveys were distributed by the snowball method as well as with the help of offices of Student Affairs. Contacts for curriculum leaders were identified on official school websites.

Results: There were a total of 279 medical student respondents and 12 curriculum leader respondents. Most students were not aware of the term "physician infertility" (57.4%). Students reported that physician infertility (87%) and/or their own fertility were not discussed in school (86.6%). While 82% of students believe it is their own responsibility to be informed, 92.8% think it would be helpful if there were formal discussions regarding family planning. This echoes the results from curriculum leaders who reported that current curricula do not include physician fertility discussion (75%) and that students should be responsible for being informed of the consequences of delaying childbearing (75%). When comparing between the responses by male and female students, results were similar except for male students being less familiar of the term "physician infertility" (P <.02).

Conclusion: Despite widespread delay in childbearing due to the pursuit of a medical career, our study found that most institutions do not address family planning or potential physician infertility. The vast majority of students expressed an interest in education regarding their future fertility.

Male infertility affects one in 10 men, yet we have seen few changes in the diagnostic tests recommended in the guidelines in the recent decade. Here we review the literature to identify newly available or emerging diagnostic tools in male infertility. From "-omics" (such as genomic, transcriptomics, or proteomics), tests of sperm function, advanced and innovated imaging technology, and integrating artificial intelligence, there are many potential areas where these diagnostic tests can improve patient care. These tools will hopefully allow to continue to unlock the underlying pathophysiology and understand the heterogeneous nature of male infertility.

Objective: To determine how many urology residency training programs offer rural rotations. Given that 60% of US counties do not have a urologist and medium-range projected urology workforce shortages, we endeavored to understand this and the barriers and interest in developing such rotations.

Methods: A collaboration with the American Urological Association Leadership program and the Society of Academic Urology, produced a survey of urology residency program directors to assess current rural training opportunities, barriers, impact on residents, and desire for alternative training tracks.

Results: Of the 151 training programs that received the survey, 64 responded (42.3%). Currently, 18.75% have a non-metropolitan resident experience, while 75% occur in the PGY-3 or 4 training year and range from 2-12 weeks. Case mix is broad encompassing nearly all aspects of urology. The most common barrier was managing call schedules (25%) and resident salary support (21%) during these rotations.

Conclusion: Nearly 1 in 6 responding programs have a non-metropolitan urology resident training rotation. Program directors perceive these to offer high value to trainees, though barriers to greater implementation exist. Such a rotation may help improve urology workforce distribution.

Objective: To evaluate the impact of radiation and sex differences on urinary quality of life outcomes following ureteral reimplant with bladder flap, including lower urinary tract symptoms requiring medications and postoperative flank pain from reflux.

Methods: Of the 95 patients who underwent bladder flap reconstruction at our institution (2018-2024), 81 were included for analysis. Patients were surveyed postoperatively to assess urinary outcomes (Urinary Distress Inventory Short Form, UDI-6), development of symptomatic reflux, and need for persistent use of medications to manage bladder symptoms. Survey response rate was 69% (56/81).

Results: Of the 81 patients, 62% (n = 50) were female and 38% (n = 31) had prior radiation. Overall reconstructive success was 97% at a median follow-up of 2.3 years. Median flap length was 5 cm (IQR 4-8). Median UDI-6 score was 42 (IQR 33-58). Females had higher scores compared to males (42 vs 33; P = .04), and both females and radiated patients reported more urinary incontinence postoperatively. New persistent medication use was identified in 12 (15%) patients, with higher proportions in females compared to males (22% vs 1%; P = .03). Of the 9/81 (11%) patients with flank pain related to reflux, only 1 radiated patient with a solitary kidney required intervention with a nephrostomy tube due to development of poor bladder compliance.

Conclusion: Bladder flap ureteral reconstruction is well tolerated with mildly bothersome urinary symptoms postoperatively, even in select patients with history of radiation. Female patients should be counseled on the potential for new persistent use of medications to manage irritative voiding symptoms postoperatively.

Objective: To assess sexual function, quality of life, and urinary continence in young adult men with bladder exstrophy and evaluate their interrelationships.

Methods: From our IRB-approved database, the Erection Hardness Score (EHS), International Index of Erectile Function (IIEF)-15, and Short Form Health Survey were sent to adult males with bladder exstrophy. Medical and surgical histories were reviewed. Continence was assessed by catheterization, leakage, pad usage, and satisfaction.

Results: Of 23 eligible men, 22 responded (mean age 27.6 years). Twelve patients had continent urinary diversion with Mitrofanoff appendicovesicostomy (1 closed stoma), and 10 did not have continent urinary diversion. The mean IIEF-15 score was 28.4 ± 15.6, indicating moderate sexual dysfunction. Intercourse satisfaction showed severe dysfunction, while sexual desire showed mild dysfunction. The mean EHS was 3.2 ± 1.1, indicating fairly good rigidity. The mean physical (PCS-12) and mental (MCS-12) health scores were 48.9 ± 9.4 and 38.5 ± 13.4, respectively, highlighting mental health concerns. Patients reporting recent intercourse were significantly older than those without. Older patients reported better erectile function but poorer mental well-being. Continence status and satisfaction were not associated with sexual function or quality of life, whereas redo epispadias repair was associated with better physical health.

Conclusion: Sexual dysfunction was present despite acceptable rigidity. Age was associated with intercourse, better erectile function, but poorer mental well-being, while redo epispadias repair was associated with better physical health. Continence did not correlate with sexual function or quality of life. Recognizing these relationships may guide treatment planning.