ABSTRACT
INTRODUCTION AND OBJECTIVE: The COVID-19 pandemic altered many aspects of the urology residency application process, including a shift to virtual interviews and limits on both in-person interactions and away-rotations. We sought to determine how these changes affected match outcomes. METHOD(S): Publicly available match statistics from the American Urological Association (AUA) were analyzed in combination with self-reported applicant data from the Urology Residency Applicant Google Spreadsheet and a list of matched urology residents and their medical schools, verified on social media and residency program websites. Data from pandemic match years of 2021 and 2022 were compared to the four years prior. RESULT(S): Match data from the AUA indicates that the number of applicants per residency spot, number of applications submitted per applicant, and percentage of matched female applicants have been increasing since 2019. The overall match rate during the pandemic was significantly lower than the 4 years prior (70% vs 79%, p<0.0001) and has been decreasing since 2019. According to self-reported match data, during the pandemic applicants received fewer interviews per application submitted (24% vs 31%, p<0.0001) and accepted interview offers at a higher rate (84% vs 68%, p<0.001). The percentage of matched applicants with a residency program at their home institution has been decreasing since 2017. These students were just as likely to match to their home program during the pandemic as in the years prior (p=0.17). CONCLUSION(S): The changes to the match process due to COVID-19 pandemic did not cause fundamental changes in match outcomes but rather accelerated many pre-existing trends, most notably increased competition. (Figure Presented).
ABSTRACT
INTRODUCTION AND OBJECTIVE: Invasion of cells by SARS-CoV-2 is mediated by the ACE2 receptor (ACE2r), which is highly expressed in testicle tissue. It has been proposed that men hospitalized with COVID19 be treated with estrogen (E) or E and Progesterone (P), however results of these trials remain unknown. Transgender women (TW) (male to female) are routinely treated with E or E+P regimens for feminization. We analyzed differences in ACE2r expression in testicles of TW taking E or E+P. METHODS: Orchiectomy specimens were collected from TW undergoing gender-affirming surgery, who were taking E or E+P preoperatively. For controls, we used benign orchiectomy specimens from cis-gender men. All specimens were stained with H&E, Trichrome (fibrosis), insulin-liken3 antibody (INS) (Leydig cell), and ACE2r IHC. Cells per high-powered field (HPF) were counted by cell type (Leydig, Sertoli, Germ). Stain intensity was rated on a 0-2 scale. IHC scoring was performed in a blinded fashion by a senior GU Pathologist. Mean cell type/HPF and stain intensity were compared across cohorts using Student's t-test (p<0.05). Intracohort findings were stratified by age (< or >40). RESULTS: On IHC for Leydig cells and ACE2r staining the EP cohort had fewer Leydig cells compared to controls. The EP cohort also had greater degree of tissue fibrosis compared to controls and the E cohort. On intra-cohort analysis, TW >age 40 had lower Sertoli cell (H&E, ACE2r) and Germ cell (ACE2r) counts, and lower ACE2r stain intensity on Leydig cells. The EP cohort of TW >age 40 also showed increased fibrosis to TW age <age 40. (Table 1) CONCLUSIONS: These findings have implications both for use of feminizing hormones to treat COVID19 in men and for TW seeking to preserve fertility after prolonged hormone therapy. Regarding COVID19: this work supports the hopeful possibility that a short course of P (or E+P) could downregulate ACE2r to protect men from COVID19 infection. Of separate interest to transitioning TW, this work suggests that fertility preservation after E+P may be challenging, given the significant seminiferous tubule fibrosis observed. Furthermore, E+P has the benefit of appearing to decrease endogenous Testosterone production more than E alone.