Urology Practice最新文献

Purpose: This retrospective study furthers our understanding of risk factors associated with hemorrhage and intervention in renal angiomyolipomas (R-AMLs), particularly in larger tumors (≥ 4 cm) and in childbearing-age (CBA; younger than 50 years) women. The objective was to refine risk stratification and optimize patient management.

Methods: Review of our institutional database identified patients with radiographic R-AML from 1997 to 2023. Patient characteristics, R-AML characteristics, and clinical course were collected. Patients were grouped by management trajectories and analyzed across R-AML size, sex, and CBA woman status. Growth rates were modeled using linear mixed-effects regression.

Results: Of the 162 patients in this cohort, 22% had large R-AML (≥ 4 cm), of which the majority (66%) were managed with surveillance and a substantial portion (43%) never underwent intervention. The 23% of the cohort who were CBA women were similarly primarily managed with surveillance (74%), and more than half never underwent intervention (53%). The median follow-up on surveillance was 5.4 years. There was a significantly higher modeled growth rate with larger baseline tumor size, but growth rate was not affected by CBA woman status. Most cases of bleeding were in patients with markedly enlarged R-AML with multiple risk factors, but there were no serious adverse events.

Conclusions: This study is enriched for large R-AML and uniquely focuses on CBA women. It reinforces the notion that most large R-AMLs are treated asymptomatically and do not necessarily represent the bleeding risk historically ascribed to them. It suggests that CBA woman status alone should not motivate R-AML treatment.

Introduction: Board certification in urology is a multistep process including a written qualifying examination (QE), followed by an oral certifying examination (CE) approximately 2 years after residency or fellowship completion. The goal of this process is to ensure that urologists are well trained, have an extensive fund of knowledge, demonstrate professionalism and competence in practice, and are safe to practice urology. Board certification in urology serves to both establish and confirm physician competence and ultimately protect the public. We sought to examine the relationship between board certification in urology and adverse medical license actions.

Methods: We retrospectively studied deidentified physicians who attempted initial ABU certification between 1980 and 2022. The primary outcome was adverse state medical license action, defined as severe (surrendered, suspended, or denied licenses) or moderate (required CME, imposed conditions, fines, reprimands, and probations). Statistical analyses were conducted using χ² and Fisher exact tests.

Results: Five thousand five physicians were included in analyses. One hundred nineteen physicians did not obtain board certification. Only 1.4% of physicians who certified on initial attempt received disciplinary action compared with 3.0% who obtained certification on repeated attempts (Fisher exact test 0.013, P < .05) and 5.9% who never obtained certification (Fisher exact test 0.0018, P < .05).

Conclusions: Failure to complete or repeated attempts at board certification was associated with increased rates of disciplinary actions. This association highlights the continued relevance of ABU certification in protecting the public.

Introduction: The limitations of lectures are magnified when teaching technical skills. A "flipped classroom" (FC) model allows learners to first review material and replaces lectures with active teacher-learner engagement. FC has been shown to improve knowledge retention, but its impact on skill acquisition is unknown. This exploratory study assesses the feasibility and learner perception of a FC model for percutaneous nephrolithotomy (PCNL) simulation.

Methods: Urology residents participated in a PCNL simulation curriculum. Residents first reviewed materials on obtaining percutaneous access, followed by an in-person discussion and 4 simulation activities. Pre/post-lab surveys were collected regarding prior experience, confidence in skills (rating scale from 1-5, unable to perform to can perform independently), and scores on a validated Flipped Classroom Perception Instrument (agreement scale 1-5).

Results: Thirteen residents with varying PCNL experience reported significantly increased confidence in obtaining access across all measures (P < .01): performing new access overall, new fluoroscopic access with bull's-eye and triangulation techniques, and using existing access. There was no difference in the increase in confidence ratings based on prior PCNL experience. FC was highly rated, with mean scores on the perception instrument 4.0 to 4.5 before and 4.2 to 4.7 after the activity. Each lab component was perceived as highly effective (overall mean, 4.7; pre-lab materials, 4.3; in-person discussion, 4.4; simulation, 4.8). There was no difference based on prior PCNL experience.

Conclusions: A FC model was feasible and rated by learners as highly effective for teaching percutaneous renal access and significantly improved residents' skill confidence regardless of prior PCNL experience.