Urology最新文献

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 to 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 PGY3 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=0.04), 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=0.03). 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.

Conclusions: 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 (one 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.

Conclusions: 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.

Objectives: To compare professional quality of life, sleep-related impairment, sleep disturbance, depression, anxiety, and stress among junior urology residents during a transition from a traditional home call to night float call system within a consistent cohort followed throughout an entire academic year.

Methods: Four validated instruments were administered weekly for 52 weeks to five junior residents undergoing an intra-year transition to the NF model during the 2024-2025 academic year. Instruments measured professional quality of life (ProQOL: compassion, burnout, and secondary traumatic stress); sleep (PROMIS Sleep Disturbance and Sleep-Related Impairment); and mental health (Depression Anxiety Stress Scale-21). Weeks 1-9 corresponded to home call, and weeks 10-52 to NF. Random intercept and intercept-slope models assessed differences with p<0.05 considered significant.

Results: Residents completed 260 surveys (1,040 questionnaires with 100% response rate). Depression, anxiety, and stress scores decreased significantly after NF transition for both NF and non-NF residents (p<0.001). Sleep disturbance was unchanged for NF residents (p=0.946) but decreased for non-NF residents compared with home call (p=0.003). Sleep impairment improved for both NF and non-NF residents (p<0.001). Burnout and secondary traumatic stress increased following NF transition (p<0.001), while compassion scores were unchanged.

Conclusions: Transitioning to NF improved mental health and reduced sleep-related impairment but was associated with higher burnout and secondary traumatic stress. While the NF model may mitigate sleep deprivation, it may introduce new challenges to long-term professional well-being.

Objective: To chronicle the technical evolution of transurethral resection of bladder tumors (TURBT) from early endoscopy to contemporary robotic platforms, analyzing how interdisciplinary innovations addressed persistent challenges in visualization, hemostasis, and resection precision.

Methods: Historical analysis was conducted through examination of primary sources including historical peer-reviewed publications. The technological progression was evaluated across four distinct eras: the development of visualization tools from Bozzini's Lichtleiter to the Nitze-Leiter cystoscope; the integration of electrosurgical techniques beginning with Beer's spark-gap ablation through Bovie-McCarthy resectoscopes; advancements in energy and lasers; and the current digitalization phase featuring robotic platforms and AI detection systems.

Results: The historical review revealed significant milestones. Early cystoscopic techniques reduced reliance on open surgery, though hemostasis remained a challenge until the advent of electrosurgery. The late 20th century saw transformative improvements in safety through continuous irrigation systems and bipolar current, while laser technologies enabled more precise tissue resection. Contemporary robotic systems demonstrate enhanced technical capabilities. Artificial intelligence applications show particular promise in tumor detection. Throughout this evolution, the field has consistently balanced technological innovation with practical clinical implementation challenges.

Conclusion: TURBT's 200-year evolution reflects a paradigm shift from radical excision to precision organ preservation. Modern technologies have addressed historical limitations of visualization and control. The advancement of these technologies has been a multidisciplinary effort, requiring the collaboration of scientists, engineers, and urologists. This team-based approach will be essential to balancing accessibility with precision in future advancements.

Objective: To evaluate residency applicant and program director (PD) perceptions of preference signaling in the 2025 urology match, as well as factors associated with a successful match.

Methods: Two anonymous, web-based surveys were distributed by email to applicants and PDs. Surveys assessed views regarding the signaling process.

Results: 251 applicants and 53 PDs completed the surveys. Applicants applied to a median of 46 (36-63) programs and received 15 (9-19) interview offers, 12 (8-17) of which were from signaled programs. Programs received a median of 115 (70-152) signals and interviewed 40 (35-48) applicants. PDs primarily used signals for initial application screening (81%) and interview offer decisions (62%); only 9% used signals to determine rank list position. Among the 85% of surveyed applicants who matched, 95% did so at a signaled program. Interview yield was the primary distinguishing factor between matched and unmatched applicants (median 14 vs. 4 offers). Overall, 87% of applicants and 68% of PDs were satisfied with the current 30-signal allotment.

Conclusions: Applicants and PDs were satisfied with the current signaling process. Signals played a major role in interview decisions, and most applicants matched at a program they signaled. The expansion from five to 30 preference signals was well-received, associated with fewer applications per applicant, and helped programs identify applicants with genuine interest in their institutions.