Urology最新文献

Objective: To compare general anxiety and prostate cancer (PCa)-specific anxiety and PCa-specific functioning reported at 24-months after diagnosis between men who initially chose and remained on active surveillance (AS), those who initially chose active treatment (AT), and those who initially chose AS but later switched to AT (Delayed AT).

Methods: We conducted telephone interviews (N=1139) after initial diagnosis (but before treatment) and follow-up interviews 2 years thereafter (N=950; 87.1%). We assessed anxiety (general and PCa-specific) and PCa-specific function, comparing AS (N=442), AT (N=420), and Delayed AT (N=88) at 24-months using multivariable linear regression.

Results: Adjusting for pre-treatment anxiety, clinical, and sociodemographic factors, the AS group reported higher general anxiety (mean=48.4) than the AT group (mean=46.5, p=0.01) but did not differ from the Delayed AT group (mean=48.7, p=.76). The AS group also reported higher PCa-specific anxiety (mean=10.9) compared to both treatment groups (9.2, p<.0001). However, the AS group reported significantly better PCa-related outcomes than either treatment group for urinary incontinence, sexual function, and bowel function (all p-values <.01).

Conclusions: At 2 years after diagnosis, men who remained on AS reported significantly higher general anxiety than the AT group, and significantly higher PCa-specific anxiety compared to the AT or Delayed AT groups. Our findings highlight the importance of assessing general and prostate-specific anxiety alongside physical functioning to help tailor disease management for men with low-risk PCa.

Objective: Our objective was to characterize PubMed-indexed research productivity among all matched applicants in the 2024-2025 Urology Residency Match and evaluate its association with residency program tier in the post-USMLE Step 1 pass/fail era.

Methods: PGY1 urology residents were identified through independent verification of publicly available residency program rosters. PubMed-indexed publications completed prior to application submission were identified and verified using a standardized attribution framework. Programs were stratified into five tiers based on Doximity 2025-2026 reputation rankings. Publication counts were compared across tiers using nonparametric testing. Receiver operating characteristic (ROC) analysis assessed publication thresholds associated with matching into higher-tier programs.

Results: Among 418 matched residents, 1,313 PubMed-indexed publications were identified. The median publication count was 1 (interquartile range 0-3), and 28.0% of matched applicants had no publications at the time of application. Research productivity differed significantly across program tiers (p < 0.0001), with higher-tier programs demonstrating greater publication volume and a higher concentration of high-output outliers. ROC analysis demonstrated moderate discrimination for top-tier program matching (area under the curve 0.64). A threshold of approximately two publications optimized discrimination, with diminishing returns observed at higher publication counts.

Conclusions: Research productivity among matched urology applicants is highly heterogeneous but demonstrates a graded association with residency program tier. Approximately two PubMed-indexed publications maximize probabilistic discrimination for higher-tier matching, supporting focused scholarly engagement rather than high-volume output. These findings provide contemporary benchmarks for applicants and program directors.

Objectives: To evaluate whether exposure to different metronome rhythms is associated with variations in patient-reported pain intensity and anxiety levels during transperineal prostate biopsy performed under local anesthesia.

Methods: This single-center, prospective, non-randomized study included 200 patients undergoing TPBx. Patients were assigned according to routine clinical workflow to a control group or metronome rhythm groups at 60, 80, 100, or 120 bpm. Pain was assessed using the Visual Analog Scale, and anxiety was evaluated using the State-Trait Anxiety Inventory. The primary outcome was overall procedural pain.

Results: Final analysis included 196 patients. Overall pain scores and pain during local anesthetic administration differed significantly among groups (p < 0.001). The lowest pain scores were observed in the 100 bpm group. Post-procedural anxiety scores were significantly lower in the 60-100 bpm groups compared with the control and 120 bpm groups. Baseline characteristics were comparable.

Conclusions: Metronome rhythm-based auditory stimulation was associated with differences in pain and anxiety during TPBx and may represent a simple adjunct to improve patient experience.

Objective: To investigate institutional support, resources, and lactation policies for female urologists and to compare male and female urologist perspectives on lactation.

Methods: An anonymous survey was distributed to 11,115 American Urologic Association members, assessing demographics, lactation support, awareness of laws, and personal views on lactation. Descriptive statistics summarized responses, and Fisher's exact tests compared male and female perspectives.

Results: 682 completed the survey. Of those who took leave, 73% reported no work adjustments upon returning from leave. Only 35% had protected pumping time, 17% had reduced clinic time, and fewer had reduced operative time (5%), call volume (2%), or call responsibility (2%). Just 21% of birthing parents reported call adjustments during pregnancy, and only 54% felt their lactation goals were supported at work. Among respondents who breastfed (37%), 75% had a private place to pump, but only 45% had adequate time. Few (9%) believed a colleague's lactation impacted their workload, and males were more likely to report an impact (18% vs. 7%, p=0.0002). Males were also less likely to value protecting lactation rights (91% vs. 96%, p=0.0036) and less aware of policies on breastfeeding (38% vs. 62%, p<0.0001).

Conclusions: Barriers to adequate lactation support persist for urologists, with significant gender differences in perspectives and awareness. Improved institutional support and education are needed to address these longstanding challenges.