Workplace Bullying of Urology Residents: Implications for the Patient and Provider.

OBJECTIVE: To elucidate whether urology residents in the United States feel bullied by nurses, how respected they feel at work, and whether this impacts personal and patient care. METHODS: We distributed an Institutional Review Board-approved online, validated, revised Negative Acts Questionnaire to US urology residents in their first year or above. We evaluated bullying through scoring work (total range 5-25), person (total range 9-45), and physical intimidation (total range 3-15) related bullying domains. We also solicited how respected residents feel by different staff on a Likert scale and the perceived personal and professional impact of bullying. Bullying domains were assessed with descriptive statistics and mean total bullying scores (MTBS) and demographics compared. RESULTS: We received 102 responses (82% MD, 18% DO). One resident reported never experiencing bullying. Overall average MTBS was 28.9 ± 0.9 (17-68). 98.0%, 82.4%, and 77.5% of residents reported at least 1 incident of work, person, and physical intimidation-related bullying, respectively. DO residents reported higher MTBS than MD residents (33.7 ± 2.2vs 27.8 ± 1.0, P = .015). Higher MTBS scores were seen in residents who feared retaliation and considered transferring programs, while lower scores were seen where the resident-nurse relationship was nurtured. CONCLUSION: Ninety percent of residents perceived some degree of bullying and report a negative impact on personal performance and patient outcomes.

Urethroplasty After Urethral Urolume Stent: An International Multicenter Experience.

OBJECTIVE: To evaluate the outcomes and factors affecting success of urethroplasty in patients with stricture recurrence after Urolume urethral stent. MATERIAL AND METHODS: This is a retrospective international multicenter study on patients treated with urethral reconstruction after Urolume stent. Stricture and stent length, time between urethral stent insertion and urethroplasty, age, mode of stent retrieval, type of urethroplasty, complications and baseline, and posturethroplasty voiding parameters were analyzed. Successful outcome was defined as standard voiding, without need of any postoperative adjunctive procedure. RESULTS: Sixty-three patients were included. Stent was removed at urethroplasty in 61 patients. Reconstruction technique was excision and primary anastomosis in 14 (22.2%), dorsal onlay buccal mucosa graft (BMG) in 9 (14.3%), ventral onlay BMG in 6 (9.5%), dorsolateral onlay BMG in 9 (14.3%), ventral onlay plus dorsal inlay BMG in 3 (4.8%), augmented anastomosis in 5 (7.9%), pedicled flap urethroplasty in 6 (9.5%), 2-stage procedure in 4 (6.4%), and perineal urethrostomy in 7(11.1%). Success rate was 81% at a mean 59.7 ± 63.4 months. Dilatation or internal urethrotomy was performed in 10 (15.9%) and redo-urethroplasty in 5 (7.9%). Total International Prostate Symptom Score, quality of life, urine maximum flow, and postvoid residual significantly improved (P <.0001). Complications occurred in 8 (12.7%), all Clavien-Dindo ≤2. Disease-free survival rate after reconstruction was 88.1%, 79.5%, and 76.7% at 1, 3, and 5 years, respectively. Explant of individual strands followed by onlay BMG is the most common approach and was significantly advantageous over the other techniques (P = .018). CONCLUSION: Urethroplasty in patients with Urolume urethral stents is a viable option of reconstruction with a high success rate and very acceptable complication rate. Numerous techniques are viable; however, urethral preservation, tine-by-tine stent extraction, and use of BMG augmentation produced significantly better outcomes.