Urology Practice最新文献

Introduction: The presence of an artificial urinary sphincter can be overlooked resulting in inadvertent urethral catheterization and cuff erosion. A hard-stop best practice advisory was created in the electronic medical record to alert for the presence of an artificial urinary sphincter. We evaluated its utilization and impact on patient outcomes.

Methods: Our advisory fired for men with an artificial urinary sphincter implanted or in place between August 1, 2016, and September 30, 2023. We calculated exposure years (total time in years of implant duration during each time period), which were used to determine incidence rates of explants, erosions, and erosions preceded by catheterization before and after advisory implementation. Rate ratios (adverse event rate/exposure years) were compared before and after advisory using a test of 2 rates based on Poisson distribution. P values < .05 were considered statistically significant.

Results: Two hundred thirteen unique implants were identified in 194 patients. The advisory fired 2425 times for a median of 36 unique patients per month. Twenty-five explants occurred, with 22 (0.6/exposure years) before advisory and 3 (0.1/exposure years) after advisory (P = .01). Nineteen (0.03/exposure years) of the 25 explants were due to cuff erosion, with 17 of 19 (0.04/exposure years) occurring before advisory and 2 of 19 (0.01/exposure years) occurring after advisory (P = .02). Ten (0.03/exposure years) of the 19 erosions were preceded by inadvertent catheterization without implant deactivation, all of which occurred before advisory. No erosions preceded by inadvertent catheterization occurred after advisory.

Conclusions: Our novel advisory has strong implications for patient safety in men with artificial urinary sphincters.

Introduction: No consensus exists on performance standards for evaluation of generative artificial intelligence (AI) to generate medical responses. The purpose of this study was the assessment of Chat Generative Pre-trained Transformer (ChatGPT) to address medical questions in prostate cancer.

Methods: A global online survey was conducted from April to June 2023 among > 700 medical oncologists or urologists who treat patients with prostate cancer. Participants were unaware this was a survey evaluating AI. In component 1, responses to 9 questions were written independently by medical writers (MWs; from medical websites) and ChatGPT-4.0 (AI generated from publicly available information). Respondents were randomly exposed and blinded to both AI-generated and MW-curated responses; evaluation criteria and overall preference were recorded. Exploratory component 2 evaluated AI-generated responses to 5 complex questions with nuanced answers in the medical literature. Responses were evaluated on a 5-point Likert scale. Statistical significance was denoted by P < .05.

Results: In component 1, respondents (N = 602) consistently preferred the clarity of AI-generated responses over MW-curated responses in 7 of 9 questions (P < .05). Despite favoring AI-generated responses when blinded to questions/answers, respondents considered medical websites a more credible source (52%-67%) than ChatGPT (14%). Respondents in component 2 (N = 98) also considered medical websites more credible than ChatGPT, but rated AI-generated responses highly for all evaluation criteria, despite nuanced answers in the medical literature.

Conclusions: These findings provide insight into how clinicians rate AI-generated and MW-curated responses with evaluation criteria that can be used in future AI validation studies.

Introduction: Twenty percent of Americans live in non-urban areas, and the challenges in providing high-quality health care in rural areas are well described. These challenges are further exacerbated by the fact that rural citizens are often older and sicker than their urban colleagues, as well as by the ongoing workforce shortage in urology. This study aims to describe the current practice experiences of non-metropolitan urologists (NMUs) in the United States.

Methods: Based on the results of the 2022 American Urological Association Census, a secondary questionnaire was developed and distributed electronically to urologists who self-identified in the Census as practicing in non-metropolitan areas. Multiple choice answers were summarized as proportions and free-text answers were collected and grouped by theme.

Results: One hundred and thirteen of 552 (20.5%) urologists responded. Most respondents were male (92.9%), aged >55 years (76.1%), in practice >25 years, and in solo practice (25.5%) or a subspecialty group (20.8%). Stressors for NMUs included recruitment (61.3%), call concerns (59.3%), workforce issues (59.3%), difficulty interacting with tertiary medical centers (45.1%), and lack of resources (40.7%). Nearly half of respondents (48.5%) experience burnout more than once monthly, and 31.9% anticipate continuing their current practice and pace for the next five years. Call burden is the most likely reason to leave practice (40%).

Conclusions: Most urologists practicing in non-metropolitan areas are older, endorse high rates of burnout, and have active plans to leave or decrease practice within five years. Understanding contemporary stressors can inform policies to support current and future NMUs.

Introduction: This study assesses the effects of the recent changes to the urology residency match process.

Methods: We emailed an anonymous, multiple-choice survey to each candidate who applied to any of our 3 urology programs for the 2024 Urology Residency Match.

Results: Of the 433 candidates invited, 146 (33.7%) completed the survey. Of the 133 respondents who matched, 38.3% matched where they did an away subinternship (sub-I), 20.3% matched with their home program, and 91.0% matched with a program where they sent a preference signal (PS); only 8 respondents (6.0%) matched with a program where they did not complete a sub-I or send a PS. Of the 4 candidates who did not take Step 2 before submitting their application, only 1 matched. The 126 applicants who completed 3 or more sub-Is, including the home sub-I, had a higher match rate (95.2%) than the 20 applicants who completed 1 or 2 (65.0%, P < .0005). Disclosing any geographic preferences was associated with a decreased probability of matching (relative risk = 0.89, P < .05).

Conclusions: Taking Step 2 before submitting applications and completing 3 or more sub-Is were both correlated with a higher match rate. Geographic signaling was correlated with a lower match rate. There was little benefit to applying to programs outside of those where the applicant had completed a sub-I or sent a PS. Future candidates should consider these findings early in the application process. These findings should be taken into consideration when making future changes to the application process.

Introduction: The AUA recommends delayed-phase imaging (DPI) in renal injuries to evaluate the collecting system. A renal trauma imaging protocol for early conservative management of urinary extravasation (UE) was implemented to improve guideline adherence. We aimed to determine if increased adherence led to changes in outcomes.

Methods: Patients with American Association for the Surgery of Trauma III to V renal injury presenting from January 2018 to September 2022 were identified from an institutional trauma registry. Patients were included if a contrasted CT scan of the abdomen was obtained on admission. Frequency of DPI and patient outcomes were compared before and after protocol implementation.

Results: Of 223 included patients, 131 (58.7%) were pre protocol and 92 (41.3%) were post protocol. Following protocol implementation, the rate of DPI on admission nearly doubled from 32.8% to 58.7% (P < .001). The rate of follow-up cross-sectional imaging increased from 18.3% to 58.7% (P < .001). Although there were no significant differences in rates of immediate or delayed interventions following protocol implementation, the postprotocol immediate intervention rate did decrease to 0%. Readmissions due to symptomatic UE were unchanged after protocol implementation (0.0% vs 0.0%).

Conclusions: Implementation of a multidisciplinary renal trauma early imaging and management protocol improved AUA guideline adherence. With protocol adherence, there was also an elimination of immediate interventions for UE. Despite decreases in early intervention, there was no significant increase in interval interventions or UE-related readmissions. More research is needed to determine the role for routine follow-up imaging in conservative management of high-grade renal trauma.