Frontiers in urology最新文献

Background: Urology is an increasingly competitive specialty that procures a highly selected and clinically excellent cohort of residents. However, other training needs such as leadership and professional development go underrecognized despite an identified need for formal training in these areas. The aim of this study was to implement, evaluate, and pilot a non-clinical skills curriculum, a novel individualized professional development workshop series, at a single institution.

Methods: Eighteen urology residents (15/year, 3 graduates/year) participated in this study over the course of two academic years. A pre-curriculum needs assessment was completed by 15 residents in Year 1 for purposes of curriculum design. The curriculum itself was a series of 1-hour monthly workshops given by an expert speaker on topics relevant to healthcare delivery, leadership and career promotion across various contexts. Survey-based assessments tracked gains in subject knowledge and satisfaction via a pre-post test design.

Results: The pre-curriculum needs assessment indicated that trainees desired additional instruction in non-clinical skills (ps>0.1) and endorsed formal teaching to ensure success in their future careers (p<0.001). Trainees reported pre- to post-curriculum gains across each individual learning topic (Mean=20%, p<0.001) with an aggregate increase in subject knowledge of 17% for senior residents and 21% for junior residents (p<0.001).

Conclusion: A non-clinical skills curriculum implemented as a pilot 'Hidden Curriculum' for urology trainees was feasible and resulted in significant gains in non-clinical subject knowledge. Workshops were highly rated and trainees reported high satisfaction with the curriculum.

Background: There is a lack of understanding of the clinical significance of detrusor contraction duration (DCD) measured on urodynamic studies (UDS). We aimed to identify patient characteristics, presenting symptoms and urodynamic parameters associated with DCD in women.

Methods: Using a single-institution database of UDS (2015-2019), 405 female patients with measurable detrusor contractions were identified. Baseline characteristics, presenting symptoms and UDS parameters were analyzed. Bladder outlet obstruction (BOO) was characterized using the Blaivas-Groutz nomogram. Wilcox Rank Sum Tests were used for descriptive statistics, and a univariable generalized linear model conforming to a gamma distribution was used.

Results: Median age was 65 years (IQR 52-75), BMI was 27.5 kg/m2 (IQR 23.9-31.1) and DCD was 90 seconds (IQR 57-124). On univariable analysis, degenerative disc disease (β = -17.9, p = 0.02), pelvic radiation (β = -31.91, p = 0.04), and stress incontinence (β = -14.11, p = 0.03) were associated with reduced DCD. Black race was associated with longer DCD (β = 22.92, p = 0.01). Analysis of UDS parameters revealed a significant increase in DCD per unit increase of bladder capacity (β = 0.08, p<0.001), detrusor pressure (Pdet) at maximum flow (Qmax) (β = 0.96, p<0.001), and maximum Pdet (β = 1.2, p<0.001). In contrast, a significant decrease in DCD was noted per unit increase in Qmax (β = -1.43, p<0.001). Finally, mild (β = 34.4, p<0.001), moderate (β = 72.52, p<0.001), and severe (β = 64.6, p<0.001) BOO were all associated with increased DCD.

Conclusions: Median DCD in women is 90 seconds. Longer DCD is associated with greater degree of BOO, higher maximum Pdet, Pdet at Qmax, and bladder capacity. Disc disease, irradiation and stress incontinence are associated with reduced DCD. Further studies are needed to evaluate the predictive value of DCD in women.

Introduction: A single-arm pre-post pilot study in an academic setting found that pre-consultation decision support was associated with improved patient knowledge among men with early-stage prostate cancer. We now report on exploratory analyses from a controlled study featuring patients from both academic and community settings.

Methods: We enrolled 58 men to usual care and 61 men to the intervention. We evaluated whether the intervention was associated with patients answering key knowledge items correctly just before their urology visit.

Results: Just prior to the urology visit, 39/56 or 70% in the intervention group replied correctly to key knowledge items, compared to 31/55 or 56% in the usual care group (p=0.15). At baseline, the intervention group started with 42/60 or 70% correct and the usual care group started with 28/56 or 50% (p=0.03). This imbalance at baseline created a ceiling effect: more men in the usual care group had room to improve on their knowledge scores. Indeed, seven men moved from incorrect to correct in the usual care group, versus 5 in the intervention group; and five men in the intervention group moved from correct to incorrect versus 3 in the usual care group (p=0.44).

Discussion: In addition to small sample size, reasons for the null findings may include clustering of highly educated participants at the academic site combined with over-representation of academic site participants in the intervention group. We confirmed, from the pilot study, the feasibility of using pre-health student interns as health coaches. Future research should explore whether increasing adoption of telehealth will improve the feasibility of delivering pre-visit decision support in community settings.

Introduction: Cryptozoospermia is defined by the World Health Organization (WHO) as the presence of isolated sperm cell in the ejaculate only identified after an extended microscopic search or after being pelleted. Although the number of spermatozoa is usually sufficient for intracytoplasmic sperm injection (ICSI), ICSI fails due to poor sperm quality in some cases. Contention remains regarding whether testicular sperm offers any advantage in this unique situation. At our tertiary referral center, we will offer patients a surgical sperm retrieval via conventional or microdissection testicular sperm extraction (microTESE) for men with cryptozoospermia and failed ICSI, or where ejaculated specimens are immotile or insufficient for ICSI. In this study, we sought to describe our experience and evaluate the predictors of success in cryptozoospermic patients who had microTESE at our center.

Methods: We retrospectively reviewed our electronic medical records for all patients with cryptozoospermia who underwent microTESE between 2007- 2021 for failed ICSI with ejaculated sperm or sperm quality deemed to be of insufficient quality for ICSI (e.g., nonmotile sperm). We evaluated demographics, preoperative lab results, pathology results, sperm retrieval rate (SRR) and ICSI outcomes.

Results: 28 cryptozoospermic patients were identified. These patients underwent 37 unique microTESE. 22 of these men had failed previous ICSI treatment with ejaculated sperm, while the other 6 patients had ejaculated sperm with non-suitable quality for ICSI. None had genetic abnormalities. Successful retrieval of motile sperm suitable for ICSI was achieved in in 30 micro TESE procedures (SRR: 81.0%).14 out of 28 patients (50%) who underwent embryo transfer had positive pregnancy result, and 12/28 patients (42.8%) had successful live birth. The most common pathological pattern was hypospermatogenesis found in 65.3% (17/26). Fibrosis pathology was significantly higher in the negative pregnancy group. There were no postoperative complications noted.

Disscussion: The use of testicular sperm in cryptozoospermic men with failed prior ICSI using ejaculated sperm has a high rate of pregnancy and live birth. While still controversial, our results suggest that surgical sperm retrieval is a viable option for these men with minimal risk of complications.

Introduction: Catheter-associated urinary tract infection (CAUTI) is a common complication among patients with urinary catheters and is often treated with antibiotics. With increasing rates of antibiotic resistance, it is necessary to explore alternative treatment options for CAUTIs. The aims of this study were 1) to assess the efficacy and treatment satisfaction of bladder irrigation (BI) with tap water to prevent and treat CAUTIs, 2) and to evaluate the current use of BI for CAUTIs among Dutch clinicians.

Methods: The first part of this study consisted of a cross-sectional study among patients with intermittent or indwelling catheters who performed BI with tap water between March 2020 and May 2021. Efficacy, treatment satisfaction, and Patient Global Impression of Improvement (PGI-I) were assessed using questionnaires. Outcomes were compared between neurogenic lower urinary tract dysfunction (NLUTD) and non-NLUTD patients. Factors associated with overall treatment satisfaction were determined using logistic regression analysis. Second, a nationwide survey of Dutch clinicians was conducted to evaluate the current use of BI for CAUTIs.

Results: A total of 99 patients who were performing BI for at least three months were included. The median age was 61.9 years, 41.4% had NLUTD, and 72.2% performed BI >1 year. The majority of both NLUTD (65.9%) and non-NLUTD patients (68.4%) were (very) satisfied with BI. Women had higher odds of reporting higher satisfaction and each additional CAUTI decreased the odds. Most NLUTD (85.4%) and non-NLUTD (65.5%) patients reported an improvement on the PGI-I with a difference in favour of NLUTD patients (p=0.002). In addition, 40.4% of the patients had no CAUTI, and 59.6% reported 1.39 (SD 2.06) CAUTIs. Only half of these self-reported CAUTIs were treated with antibiotics. In addition, 33 (58.9%) clinicians used BI for CAUTIs, of which ten used tap water as irrigation agent.

Discussion: This study provides first evidence supporting the efficacy of BI with tap water in the treatment of CAUTIs and reducing the use of antibiotics. Patients are overall satisfied and experience improvement in their condition with BI. In addition, the majority of the surveyed Dutch clinicians use BI for CAUTIs. However, irrigation with tap water is still not widely used.

Congenital anomalies of the urinary tract are a major cause of chronic kidney disease in both adults and children. Ureteropelvic junction obstruction, usually detected as urinary tract dilatation in utero, is one of the most common forms of CAKUT. As antenatal ultrasound technology advances and screening becomes more widespread, increasing numbers of infants with this UPJO will be detected. Management of these infants presents a clinical conundrum, as distinguishing mild benign cases from those who may develop severe renal impairment is challenging. Herein we propose that an understanding of normal developmental and pathological mechanisms involved in UPJO is important in the armamentarium for tackling this challenging condition.

With advances in therapeutic interventions, endourology has become standard of care for the treatment of numerous diseases in the field of pediatric urology. However, there remains a lack of agreement and evidence on the optimal approaches and associated complications of endourological treatment of upper urinary tract conditions in children, namely ureteropelvic junction (UPJ) obstruction, primary obstructive megaureter, and nephrolithiasis. While pyeloplasty remains the first-line surgical treatment for pediatric UPJ obstruction, endoscopic retrograde balloon dilatation (ERBD) and endopyelotomy continue to gain traction as less invasive means of treating obstruction, particularly for failed repairs. Studies report success rates ranging from 76-100% although re-stenosis or need for revision surgery is not uncommon. Endourological options for the surgical management of primary obstructive megaureter include ERBD or endoureterotomy, rather than the open option of ureteroneocystotomy with or without tapering. Both have shown long-term success rates ranging from 70-90%, however, there is emerging evidence that these therapies may be associated with a risk of postoperative vesicoureteral reflux. Meanwhile, for stone disease, shock wave lithotripsy (SWL), flexible ureteroscopy (URS), and percutaneous nephrolithotomy (PCNL) are mainstays in the pediatric urologist's armamentarium. Studies have shown that URS and PCNL have comparable stone-free rates, although PCNL can be associated with increased morbidity. Advancements in technology have led to the use of smaller access sheaths without compromising stone-free rates or increasing long-term complications. The use of mini-PCNL in the adult population holds great potential for use in our pediatric patients. The rise of endourology expertise and improved technology makes it an attractive option that could even be considered as a first-line option for the treatment of various urinary tract conditions. Nevertheless, there is a paucity of evidence on outcomes and complications following its use for treatment of upper urinary tract diseases in children. This review aims to summarize and present results of endourological treatments for pediatric UPJ obstruction, primary obstructive megaureter, and nephrolithiasis, as well as highlight advancements in the field of endourology that may increase its utilization in pediatric urology in the future.