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Increasing Diversity, Equity, and Inclusion in Urology Residency Recruitment: Recommendations From the Society of Women in Urology 提高泌尿外科住院医师招聘的多样性、公平性和包容性：泌尿外科妇女协会的建议。

IF 2.1 3区医学 Q2 UROLOGY & NEPHROLOGY

Urology

Pub Date : 2024-09-01 DOI: 10.1016/j.urology.2024.04.053

Objective

To provide a framework for diversifying the urologic workforce through residency recruitment by integrating principles of diversity, equity, and inclusion (DEI) into program mission and values, application review, and interview process.

Materials and Methods

For this narrative review, the Society of Women in Urology Advancing DEI in Urology Residency Recruitment Task Force identified 4 areas for incorporating DEI into residency recruitment: defining a residency program’s mission and values, holistic application review, an objective interview process, and implementing DEI principles into a program. Using PubMed and Google Scholar, we performed a non-systematic literature search of articles from January 2014 to January 2024. Search terms included combinations of “diversity”, “equity”, “inclusion”, “residency”, “holistic review”, “applications”, “interviews”, and “initiatives”. Additional resources were identified through citations of selected articles. Based on findings from these articles, Task Force members made recommendations for best practices.

Results

The diversity of practicing urologists is disproportionate to that of the United States population. Emerging evidence demonstrates that DEI efforts in healthcare are associated with better outcomes and reduction in healthcare inequities. We offer strategies for residency programs to integrate DEI initiatives into their recruitment, application review, and interview process. Furthermore, we address extending DEI principles into a program’s mission and culture to create an inclusive environment conducive to training and supporting individuals from unique backgrounds.

Conclusion

It is critical to recruit and retain diverse talent in urology to improve patient care. We urge residency programs and their supporting institutions to adopt DEI principles into their recruitment efforts.

目的通过将多样性、公平性和包容性（DEI）原则纳入项目使命和价值观、申请审核和面试过程，提供一个通过住院医师招聘实现泌尿外科劳动力多样化的框架：泌尿外科妇女协会推进泌尿外科住院医师招聘中的多元化、公平与包容（DEI）原则特别工作组确定了将多元化、公平与包容（DEI）原则纳入住院医师招聘的四个方面：确定住院医师项目的使命与价值观、全面的申请审核、客观的面试流程以及在项目中实施多元化、公平与包容（DEI）原则。我们使用 PubMed 和 Google Scholar 对 2014 年 1 月至 2024 年 1 月期间的文章进行了非系统性文献检索。搜索关键词包括 "多样性"、"公平"、"包容性"、"住院实习"、"整体审查"、"申请"、"面试 "和 "倡议 "的组合。通过引用所选文章还发现了其他资源。根据这些文章的研究结果，工作组成员提出了最佳实践建议：执业泌尿科医生的多样性与美国人口的多样性不成比例。新的证据表明，医疗保健领域的多元化发展与更好的治疗效果和减少医疗保健中的不公平现象息息相关。我们为住院医师培训项目提供了将 "全员参与 "计划纳入其招聘、申请审核和面试流程的策略。此外，我们还探讨了如何将 "全员参与 "原则延伸到项目的使命和文化中，以创造一个有利于培训和支持来自独特背景的个人的包容性环境：招聘和留住泌尿外科的多元化人才对于改善患者护理至关重要。我们敦促住院医师培训项目及其支持机构在招聘工作中采用 DEI 原则。

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引用次数: 0

Editorial Comment on “Teaching Hospitals and Textbook Outcomes After Major Urologic Cancer Surgery” 关于 "教学医院与泌尿系统癌症大手术后的教科书成果 "的编辑评论。

IF 2.1 3区医学 Q2 UROLOGY & NEPHROLOGY

Urology

Pub Date : 2024-09-01 DOI: 10.1016/j.urology.2024.06.066

引用次数: 0

Intraprostatic Injection of Tranexamic Acid Decrease Blood Loss During Monopolar Transurethral Resection of the Prostate: A Randomized Controlled Clinical Trial 前列腺内注射氨甲环酸可减少单极前列腺切除术中的失血量：一项随机对照临床试验。

IF 2.1 3区医学 Q2 UROLOGY & NEPHROLOGY

Urology

Pub Date : 2024-09-01 DOI: 10.1016/j.urology.2024.05.015

Objective

To assess the role of intraprostatic injection of tranexamic acid (TXA) in reducing blood loss during transurethral resection of the prostate (TURP).

Methods

We conducted a randomized, controlled, double-blind trial involving 60 patients with benign prostatic hyperplasia aged 50-85 years, undergoing monopolar TURP. Patients' prostatic weights ranged from 50 to 80 g. They were divided equally into two groups: group I received an intraprostatic injection of 1 g of TXA (Cyklokapron) dissolved in 50 mL of 0.9 % saline at multiple sites, while group II (control) received a 60 mL saline injection. Comprehensive clinical assessments and standard laboratory tests, including screenings for TXA hypersensitivity, were performed for all patients.

Results

Group I exhibited significantly lower intraoperative blood loss and hemoglobin concentration in irrigation fluid immediately postsurgery and at the 6-hour postoperative mark compared to group II (P < .05). Coagulation parameters—activated partial thromboplastin time, prothrombin time, fibrinogen level, and thrombin clotting time—showed no significant differences between the groups preoperatively or at 6 and 24 hours postoperatively. No thromboembolic events or other complications were reported in either group.

Conclusion

The intraprostatic injection of TXA during monopolar TURP is safe, with minimal adverse effects, and effectively reduces blood loss.

Registration

The study was registered on ClinicalTrials.gov No (ID: NCT05913466).

目的评估经尿道前列腺切除术（TURP）中前列腺内注射氨甲环酸（TXA）对减少失血量的作用：我们进行了一项随机对照双盲试验，60 名年龄在 50-85 岁之间的良性前列腺增生症（BPH）患者接受了单极 TURP 手术。患者的前列腺重量从 50 克到 80 克不等。他们被平均分为两组：I 组在多个部位接受前列腺内注射 1 克溶于 50 毫升 0.9% 生理盐水的 TXA（Cyklokapron），II 组（对照组）接受 60 毫升生理盐水注射。对所有患者进行了全面的临床评估和标准实验室检测，包括 TXA 过敏筛查：结果：与 II 组相比，I 组的术中失血量和术后即刻灌洗液中的血红蛋白浓度以及术后 6 小时的血红蛋白浓度均明显降低（P < 0.05）。凝血参数--活化部分凝血活酶时间（APTT）、凝血酶原时间（PT）、纤维蛋白原水平（FB）和凝血酶凝固时间（TT）--在术前、术后 6 小时和 24 小时时各组间无明显差异。两组患者均未发生血栓栓塞事件或其他并发症：结论：在单极 TURP 术中睾丸内注射 TXA 是安全的，不良反应极小，并能有效减少失血。

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引用次数: 0

Predicting Peak Productivity in Urologic Medicare Practice via Work-Relative Value Units 通过工作相对价值单位预测泌尿科医疗保险实践中的峰值生产率。

IF 2.1 3区医学 Q2 UROLOGY & NEPHROLOGY

Urology

Pub Date : 2024-09-01 DOI: 10.1016/j.urology.2024.03.037

Objective

To explore factors associated with productivity in urologic practice. Work-relative value units (wRVUs), the basis for Center for Medicare & Medicaid Services (CMS) and private payer reimbursements, commonly serve to estimate physician productivity. Limited data describes which practice factors predict increased wRVU productivity.

Methods

The 2017 and 2018 CMS databases were retrospectively queried for urologic Medicare provider demographics and procedural/service details. Medical school graduation year was used to estimate years in practice and generation (Millennial, Gen X, Baby Boomer, or Post-War). Treated patients’ demographics were obtained. Adjusted and unadjusted linear mixed models were performed to predict wRVU production.

Results

Included were 6773 Medicare-participating urologists across the United States. Millennials produced 1115 wRVUs per year, while Gen X and Baby Boomers produced significantly more (1997 and 2104, respectively, P <.01). Post-War urologists produced numerically more (1287, P = .88). In adjusted analyses, predictors of Medicare wRVU productivity included female and pelvic medicine and reconstructive surgery (exponentiated beta estimate (β) 1.46, 95% CI 1.32-1.60), men’s health (β 1.22, 95% CI 1.13-1.32), and oncologic subspecialization (β 1.08, 95% CI 1.02-1.14), female gender (β 0.87, 95% CI 0.82-0.92), wRVUs generated from inpatient procedures (β 1.08, 95% CI 1.06-1.09) and office visits (β 0.88, 95% CI 0.87-0.89), and the level of education (β 1.10, 95% CI 1.07-1.14) and percent impoverished patients (β 0.85, 95% CI 0.83-0.88) in provider’s practice zip code.

Conclusion

Urologic experience, specialization, demographics, practice patterns, and patient demographics are significantly associated with wRVU productivity in Medicare settings. Further work should incorporate quality metrics into wRVUs and ensure patient demographics do not affect reimbursement.

目的探讨与泌尿科工作效率相关的因素。工作相对价值单位（wRVUs）是医疗保险和医疗补助服务中心（CMS）以及私人支付方报销的基础，通常用于估算医生的生产率。有限的数据说明了哪些实践因素可预测wRVU生产率的提高。方法回顾性查询了2017年和2018年CMS数据库中泌尿科医疗保险提供者的人口统计数据和程序/服务细节。医学院毕业年份用于估算从业年限和世代（千禧一代、X一代、婴儿潮一代或战后一代）。获得了接受治疗的患者的人口统计数据。结果包括全美 6773 名参加医疗保险的泌尿科医生。千禧一代每年产生 1115 个 wRVU，而 X 代和婴儿潮一代则明显更高（分别为 1997 年和 2104 年，P <.01）。战后泌尿科医生的产量更高（1287，P = .88）。在调整分析中，医疗保险 wRVU 生产率的预测因素包括女性和盆腔内科及整形外科（指数化贝塔估计值 (β) 1.46，95% CI 1.32-1.60）、男性健康（β 1.22，95% CI 1.13-1.32）、肿瘤亚专科（β 1.08，95% CI 1.02-1.14）、女性性别（β 0.87，95% CI 0.82-0.92）、住院手术产生的 wRVUs（β 1.08，95% CI 1.结论在医疗保险机构中，临床经验、专业、人口统计学、实践模式和患者人口统计学与 wRVU 生产率显著相关。进一步的工作应将质量指标纳入 wRVU，并确保患者人口统计学特征不会影响报销。

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引用次数: 0

Design and Validation of a Novel 3D-Printed Retrograde Intrarenal Surgery Trainer 设计和验证新型 3d 打印逆行肾内手术训练器。

IF 2.1 3区医学 Q2 UROLOGY & NEPHROLOGY

Urology

Pub Date : 2024-09-01 DOI: 10.1016/j.urology.2024.06.061

OBJECTIVE

To report on the design of a novel 3D-printed retrograde intrarenal surgery (RIRS) benchtop trainer and detail its validation against real-life experiences.

METHODS

Digital Imaging and Communications in Medicine (DICOM) files of 2 patients with normal computed tomography of the kidney and bladder were converted into stereolithography files to create 3D triangular mesh models. These images were further refined using Autodesk Meshmixer. These 3D models were fabricated through additive manufacturing, a process commonly known as 3D printing, and assembled in a polypropylene case. After development, the model was validated by 40 experienced urologists and urology residents in their final year of training. They were asked to rate the components of the simulation using a 9-point questionnaire.

RESULTS

The model’s value in understanding the principles of RIRS and simulating contextual anatomy had mean scores of 9.43 (standard deviation [SD] = 0.74) and 9.21 (SD = 1.03), respectively. Mean scores for specific steps in RIRS were 8.07 (SD 1.47) for cannulating the ureteric orifice, 8.61 (SD 1.24) for inserting the ureteric access sheath, 9.29 (SD 0.97) for performing a renoscopy and evaluating all the calyces, 9.46 (SD 0.87) for laser lithotripsy, and 9.17 (SD 0.94) for manual stone retrieval. Participants scored the model with a mean score of 9.04 (SD 0.87) regarding realism and a mean score of 9.18 (SD 0.89) when evaluating its ability to enhance a trainee’s confidence in RIRS.

CONCLUSION

The model performed well for all components of RIRS. This model allows high fidelity of the simulation and is cost-effective, portable, durable, reusable, and compatible with standard ureteroscopes.

目的报告新型三维打印逆行肾内手术（RIRS）台式训练器的设计情况，并详细介绍其与实际经验的验证情况：方法：将两名肾脏和膀胱正常计算机断层扫描患者的数字成像和医学通信（DICOM）文件转换为立体光刻文件，以创建三维三角形网格模型。使用 Autodesk Meshmixer 进一步完善了这些图像。这些三维模型是通过增材制造（即通常所说的三维打印工艺）制作的，并组装在一个聚丙烯外壳中。模型开发完成后，40 位经验丰富的专家对模型进行了验证，并要求他们使用九分问卷对模拟的各个组成部分进行评分：结果：该模型在理解 RIRS 原理和模拟背景解剖学方面的价值平均值分别为 9.43（标准差 [SD] = 0.74）和 9.21（标准差 = 1.03）。RIRS 具体步骤的平均得分分别为：输尿管口插管 8.07 分（标准差 1.47）、插入输尿管通道鞘 8.61 分（标准差 1.24）、进行肾镜检查和评估所有肾盏 9.29 分（标准差 0.97）、激光碎石 9.46 分（标准差 0.87）和人工取石 9.17 分（标准差 0.94）。学员们对模型真实性的平均评分为 9.04 分（标准差为 0.87 分），对模型增强学员 RIRS 信心的能力的平均评分为 9.18 分（标准差为 0.89 分）：该模型在 RIRS 的所有组成部分方面都表现良好。结论：该模型在 RIRS 的所有组成部分上都表现良好。该模型可实现高保真模拟，而且经济实惠、便于携带、经久耐用、可重复使用，并与标准输尿管镜兼容。

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引用次数: 0

Editorial Comment on “Eulogy for B&O Suppositories: A Resident’s Remembrance of Rectal Relief” 为 B&O 栓剂讴歌》的社论评论：一位居民对直肠舒缓的回忆"。

IF 2.1 3区医学 Q2 UROLOGY & NEPHROLOGY

Urology

Pub Date : 2024-09-01 DOI: 10.1016/j.urology.2024.06.057

引用次数: 0

Systematic Review of the Global Literature on Uncomplicated Recurrent Urinary Tract Infections in Women: Underscoring Major Heterogeneity 关于女性非复杂性复发性尿路感染的全球文献系统性综述：强调主要异质性。

IF 2.1 3区医学 Q2 UROLOGY & NEPHROLOGY

Urology

Pub Date : 2024-09-01 DOI: 10.1016/j.urology.2024.06.015

Objective

To examine the global literature database on uncomplicated recurrent urinary tract infections (rUTI), this systematic review assesses the availability of rUTI data based on geographic region and elucidates the current state of research and gaps in knowledge.

Methods

The databases PubMed, Embase, WHO Global Index Medicus, and SciELO were searched for keywords related to rUTI between 2000 and 2023. Three independent reviewers screened studies restricted to female participants age ≥18 years with uncomplicated rUTIs. Studies were excluded if they did not provide a definition for rUTI or did not cite or report an estimate for rUTI prevalence. The review was registered in PROSPERO and conformed to PRISMA guidelines.

Results

The search yielded 2947 studies of which 124 were ultimately included. Convenience samples were used for 91% of studies and sample sizes were 30% n <50, 29% n = 50-99, 22% n = 100-199, 36% n ≥200. Most studies were conducted in Europe (41%) or North America (39%), were prospective (52%), at tertiary centers (49%) and included all ages ≥18 (60%). The most common definition for rUTI was 2 UTI/6 m or 3 UTI/1 y (62%). Regardless of study location, most studies cited prevalence estimates for rUTI derived from U.S.-based populations.

Conclusion

This study represents the first formal investigation of the global literature base on uncomplicated rUTI. Studies on rUTIs are globally of small scale and definitions used for rUTI are heterogeneous. More studies are needed to ascertain the true prevalence of rUTI outside of North America and Europe.

目的：为了研究全球有关无并发症复发性尿路感染（rUTI）的文献数据库，本系统性综述根据地理区域评估了rUTI数据的可用性，并阐明了研究现状和知识差距：方法：在PubMed、Embase、WHO Global Index Medicus和SciELO等数据库中搜索2000年至2023年间与rUTI相关的关键词。三位独立审稿人筛选了仅限于年龄≥18 岁、患有无并发症 rUTI 的女性参与者的研究。如果研究未提供 rUTI 的定义或未引用或报告 rUTI 流行率的估计值，则将其排除在外。该综述已在 PROSPERO 中注册，并符合 PRISMA 指南：结果：检索结果显示有 2,947 项研究，其中 124 项最终被纳入。91%的研究使用了方便样本，样本量为 30%：本研究是对全球无并发症 rUTI 文献基础的首次正式调查。有关急性尿路感染的研究在全球范围内规模较小，对急性尿路感染的定义也不尽相同。需要进行更多的研究，以确定 rUTI 在北美和欧洲以外地区的真实发病率。

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引用次数: 0

Editorial Comment on “Increasing Diversity, Equity, and Inclusion in Urology Residency Recruitment: Recommendations From the Society of Women in Urology” 关于 "提高泌尿外科住院医师招聘的多样性、公平性和包容性：泌尿外科妇女协会的建议 "的编辑评论。

IF 2.1 3区医学 Q2 UROLOGY & NEPHROLOGY

Urology

Pub Date : 2024-09-01 DOI: 10.1016/j.urology.2024.06.008

引用次数: 0

Editorial Comment on “Incidence and Management of Radiation Cystitis After Pelvic Radiotherapy for Prostate Cancer: Analysis from a National Database” 关于 "前列腺癌盆腔放疗后放射性膀胱炎的发病率和处理方法：来自全国数据库的分析"。

IF 2.1 3区医学 Q2 UROLOGY & NEPHROLOGY

Urology

Pub Date : 2024-09-01 DOI: 10.1016/j.urology.2024.05.035

引用次数: 0

Social Vulnerability and Receipt of Neoadjuvant Chemotherapy in Patients Undergoing Radical Cystectomy for Bladder Cancer 膀胱癌根治性切除术患者的社会脆弱性与接受新辅助化疗的情况。

IF 2.1 3区医学 Q2 UROLOGY & NEPHROLOGY

Urology

Pub Date : 2024-09-01 DOI: 10.1016/j.urology.2024.05.006

Objective

To evaluate the association between a population-level measure of social determinants of health, the Centers for Disease Control and Prevention Social Vulnerability Index (SVI), and receipt of neoadjuvant chemotherapy in patients with muscle-invasive bladder cancer (MIBC) undergoing radical cystectomy.

Methods

We queried our institutional database for patients with nonmetastatic MIBC treated with radical cystectomy between 2000 and 2022. Patients were assigned an SVI via ZIP code of residence and grouped into quintiles of SVI (ie, least vulnerable to most vulnerable). Multivariable logistic regression was performed to evaluate the association between SVI and receipt of neoadjuvant chemotherapy, adjusting for age, race, gender, and cancer stage. A sub-analysis was performed to evaluate the association between subthemes of SVI (socioeconomic status, household composition/disability, race/ethnicity/language, and housing/transportation) and receipt of neoadjuvant chemotherapy.

Results

Of the 978 patients identified, 490 (50.1%) received neoadjuvant chemotherapy. Patients that received neoadjuvant chemotherapy had a lower SVI, were younger, and had >cT2 stage (all, P <.05). The most vulnerable patients had lower odds of receiving neoadjuvant chemotherapy (OR 0.61, 0.39-0.95) compared to the least vulnerable patients. Analysis of subthemes of SVI demonstrated similar associations by socioeconomic status (OR 0.56, 0.36-0.86) and household composition/disability (OR 0.57, 0.33-0.99).

Conclusion

Adverse social determinants of health, or social vulnerability, are associated with suboptimal and disparate utilization of neoadjuvant chemotherapy in patients with MIBC undergoing radical cystectomy. Strategies for identifying vulnerable populations may allow for more targeted interventions that would improve equity in bladder cancer care.

目的目的：评估健康的社会决定因素（美国疾病控制和预防中心社会弱势指数（SVI））与接受根治性膀胱切除术的肌浸润性膀胱癌（MIBC）患者接受新辅助化疗之间的关系：我们在机构数据库中查询了 2000 年至 2022 年间接受根治性膀胱切除术的非转移性 MIBC 患者。通过居住地的邮政编码为患者分配一个 SVI 值，并将患者分成 SVI 值的五分位数（即从最脆弱到最脆弱）。在对年龄、种族、性别和癌症分期进行调整后，进行了多变量逻辑回归，以评估 SVI 与接受新辅助化疗之间的关系。还进行了一项子分析，以评估 SVI 的子主题（社会经济地位、家庭组成/残疾、种族/民族/语言和住房/交通）与接受新辅助化疗之间的关系：在已确认的 978 名患者中，490 人（50.1%）接受了新辅助化疗。接受新辅助化疗的患者的 SVI 值较低，年龄较轻，分期>cT2（均为 pDiscussion）：健康的不利社会决定因素或社会脆弱性与接受根治性膀胱切除术的MIBC患者对新辅助化疗的次优和差异化利用有关。识别弱势人群的策略可以采取更有针对性的干预措施，从而提高膀胱癌治疗的公平性。

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