Endourology Fellowship: More Than a Stone's Throw Away for Women.

Objective: To characterize the trends in female representation in the endourology fellowship match compared with the urology residency match. Materials and Methods: Available deidentified match data from 2017 to 2022 was obtained from the American Urological Association and Endourology Society annual census data. We evaluated gender-specific participation in the urology residency and endourology fellowship match and compared differences in the trends over the last 6 years. Results: Between the years 2017 and 2021, there were a total of 313 applicants for a fellowship in endourology, and of those, only 8.6% were women. In that same time period, a significantly larger number of women (27.1%) participated in the urology residency match (p = 0.0002). When specifically examining the endourology applicant trend, there is no significant increase in participation (R = 0.7, p = 0.35) between 2017 and 2021, as compared with the significant increase in total number of applicants (R = 7.1, p = 0.04). However, in the urology match, there has been a constant and significant increase in both female (R = 13.7, p = 0.03) and total applicants (R = 27, p = 0.04) between 2017 and 2022. Conclusions: Although there has been an overall increase in the number of applicants to urology, the number of women in endourology fellowship has not increased at a commensurate rate. In light of these findings, it is the responsibility of the endourology community to identify social and systemic barriers for women in this field and advocate for change.

The diversity of hypospadias management in North America: a survey of pediatric urologists.

PURPOSE: To determine trends in hypospadias management, including surgical techniques and perioperative care, by pediatric urologists in North America. METHODS: An anonymous online survey was devised to assess approaches to hypospadias repair and management, including anesthetic considerations, catheter placement, choice of dressing, and postoperative antibiotic treatment. The survey was sent to all practicing members of the Societies for Pediatric Urology. RESULTS: The survey was completed by 133 (34.5%) respondents. Hypospadias repair was overwhelmingly recommended between ages 6-12 months (89.5%). A local or regional anesthetic block (caudal, penile, pudendal, spinal) is performed nearly universally (96.2%). The majority of surgeons perform distal repairs outpatient (70.7%), while fewer perform outpatient staged repairs (47.4%) or redo surgery (33.8%). Nearly all respondents preferred either VicrylTM/DexonTM (50.4%) or MaxonTM/PDSTM (48.1%) for urethroplasty. All but one respondent leaves a stent for midshaft to proximal repairs whereas stenting for glanular repairs was split with 53.4% leaving a stent. Most surgeons (60.9-70.9%) prescribe postoperative antibiotics regardless of severity and the majority (72.9%) prescribe narcotics for analgesia. CONCLUSIONS: Approaches to hypospadias repair are extremely varied such that there is a lack of consensus among pediatric urologists regarding most aspects of hypospadias management. Investigations comparing hypospadias practice patterns are necessary to develop a standard of care for this complex pediatric urologic entity.

Authorship in Urology: A Gender Reveal.

OBJECTIVE: To evaluate female author representation in urologic literature as compared to the proportion of female practicing urologists. METHODS: A cross-sectional study was designed to analyze trends in women authorship of urology publications in 2019 as compared to AUA 2019 census data. The 5 highest impact urologic journals in 2019 were identified using the publicly available SCImago Journal Rank (SJR) indices. Author genders and study categorization were independently determined by 2 authors. Chi-squared test was used for statistical analyses. RESULTS: The 5 highest impact urologic journals in 2019 as per SJR were European Urology, Journal of Urology, British Journal of Urology International, Prostate Cancer and Prostatic Diseases, and Nature Reviews Urology. A total of 501 publications were included for analysis. Women comprised 22.1% of first authors and 14.6% of senior authors. The proportion of publications authored by women was significantly higher than would be expected based on population proportions from the AUA 2019 census data for women as both first (P < .0001) and senior author (P =.0005). Similarly, women authorship was significantly higher than expected for basic science (P < .0001), clinical medicine (P <.0001), economics/practice management (P =.0002), editorial (P =.0027), and review/meta-analysis (P <.0001) publications. CONCLUSION: The present study demonstrates that women contribute to the urologic literature significantly more than would be expected based on the proportion of practicing female urologists. However, with the persistence of gender gap in academic medicine promotions, further research into contributing factors and strategies for improvement are needed to promote greater women representation in academia.

Lower Urinary Tract Symptoms in Young Men-Causes and Management.

PURPOSE OF REVIEW: This review explores the subject of lower urinary tract symptoms (LUTS) in young men. RECENT FINDINGS: Young men (aged 39 or younger) can be affected by a variety of conditions that can cause LUTS. Approximately half of young men report LUTS. Storage or "irritative" voiding symptoms are nearly twice as common as "obstructive" symptoms in young men. Infectious or inflammatory causes such as prostatitis are the most common cause of LUTS in this age group, while other etiologies include urethral strictures, primary bladder neck obstruction, as well as neurogenic and non-neurogenic bladder dysfunction. A thorough clinical evaluation is critical for determining the correct diagnosis and directing the appropriate treatment plan. Young men experience lower urinary tract symptoms at relatively high rates. Clinical treatments range from behavioral therapy to medications and/or surgical interventions. Ambulatory urodynamics and wearable sensors may provide more accurate and real-world diagnostic assessment of bladder dysfunction in this relatively under-studied group. More study is needed to characterize the disease burden and impact in this specific group of patients.

Obstructing Nephrolithiasis in an 84-year-old Patient With a Diaphragmatic Herniated Ureter.

Diaphragmatic herniations of the ureter are a rare occurrence overall, with fewer than 10 cases reported. Obstructing nephrolithiasis in the setting of diaphragmatic ureteral herniation has sparsely been documented. Management options to consider include ureteroscopy and laser lithotripsy to alleviate obstruction in herniated ureters. The abnormal path of the ureter and surrounding structures pose unique risks that require careful attention and a high level of operator skill. We present imaging of an 84-year-old woman incidentally found to have right ureteral herniation through the diaphragm with an obstructing 8 mm stone in the right proximal ureter with moderate hydronephrosis.

Diffuse Large B-cell Lymphoma Occurring with Rhinophyma: A Case Report.

Rhinophyma is the final stage in the evolution of acne rosacea, a common vasoactive dermatosis. Individuals with rhinophyma present with a typical, disfiguring nasal appearance consisting of bulbous enlargement, erythema, and telangiectasia with a sebaceous, oily skin surface. This classic appearance permits a facile diagnosis but may also lead the physician to overlook a coexistent malignancy. We report the occurrence of a diffuse large B-cell lymphoma (DLBCL) arising synchronously with a marked rhinophyma. A wide local excision of the malignancy was performed, and the defect was reconstructed with forehead flaps. The rhinophyma was treated with a skin graft and cheek flaps. Following surgery, chemotherapy was used to manage the systemic disease. This case demonstrates the necessity for clinical scrutiny in the diagnosis and treatment of rhinophyma. It is imperative to entertain a high degree of suspicion when non-typical changes are observed within a rhinophymatous lesion or in adjacent areas of the nose.