How well do urology residency program webpages recruit underrepresented minorities?

INTRODUCTION: Historically, the field of medicine has suffered from a lack of diversity. This project examines if urology residency program websites were actively attempting to recruit underrepresented minority applicants with the hypothesis that while some programs would attempt to attract such applicants on their website, the majority would not. MATERIALS AND METHODS: A cross-sectional analysis of program webpages for information regarding underrepresented minorities was performed. Electronic Residency Application Service residency database was used to identify 130 urology residency programs. Three were no longer accepting residents and were not included. The publicly available webpages of 137 urology residency training programs identified were reviewed. RESULTS: Only 26.3% (36) of programs included any information regarding diversity or inclusion on their webpage. The most common references to diversity were a link to a Department of Diversity and Inclusion (28, 20.4%) and information regarding a "commitment to diversity" (28, 20.4%). Only two programs included all seven categories searched for. CONCLUSIONS: Residency program websites may be an important tool to recruit underrepresented minorities and currently there is significant room for improvement. Given that urology is already behind other fields in terms of representation, it is especially important to make an active, visible attempt to recruit underrepresented minorities.

Contract Costs Associated with Maintaining Flexible Ureteroscopes: A Single Center Experience.

INTRODUCTION: We compared the cost of flexible ureteroscope processing and maintenance contracts offered by a scope manufacturer and a third-party company. METHODS: Use and repairs of the Storz 11278AU1 Flex X2 Flexible Ureteroscope are prospectively recorded at our large, 371-bed, acute care hospital. A retrospective analysis of the processing of ureteroscopic instruments during a 3-year period (2011 to 2013) was completed. We compared the handling of ureteroscopes between 1 year under a third-party contractor (Integrated Medical Systems International, Inc. [IMS]) and 2 prior years under the manufacturer (KARL STORZ) contract. RESULTS: From January 1, 2011 through October 1, 2012 our institution used the manufacturer for the processing of ureteroscopic instruments. From January 1, 2013 through December 9, 2013 our institution used the third-party contractor IMS for repairs. The number of procedures performed per repair/exchange during the manufacturer contract was 19.9 and the number of procedures performed per repair/exchange during the third-party contract was 11. The third-party contract resulted in a reduction of procedures performed per repair/exchange by 52%. Adjusted for inflation, the yearly cost of ureteroscope repairs was $125,715 during the manufacturer contract and $158,040 during the third-party contract. By analyzing the costs incurred in 2013, if our institution had maintained the manufacturer contract for all 3 years, the estimated repair cost would have resulted in a savings of $32,325. CONCLUSIONS: Using the manufacturer repair contract is more cost-effective than using that of third-party companies.

30-Day Morbidity and Mortality Outcomes of Prolonged Minimally Invasive Kidney Procedures Compared with Shorter Open Procedures: National Surgical Quality Improvement Program Analysis.

BACKGROUND AND PURPOSE: Prolonged operative time (ORT) is often considered a drawback to minimally invasive surgery (MIS) because of increased morbidity. Limited data exist comparing long laparoscopic ORT with similar or shorter open ORT. This study aims to identify ORT when a minimally invasive procedure becomes inferior to its open counterpart. METHODS: Minimally invasive and open total and partial nephrectomies and nephroureterectomies were identified in the National Surgical Quality Improvement Program (NSQIP) from 2005 to 2012. Procedures were split into open and minimally invasive nephrectomy and then stratified into four ORT groups: 0 to 90 minutes, 91 minutes to 3 hours, 3 to 6 hours, and ≥ 6 hours. Thirty-day mortality and morbidity were analyzed. Univariate analysis was performed using chi-square and Fisher exact tests. Significant univariate results were then tested using stepwise logistic regression, controlling for demographics, comorbidities, and preoperative treatments. RESULTS: There were 14,813 patients identified. Both partial and total minimally invasive kidney procedures had significantly improved outcomes compared with open counterparts of similar ORT. In the total nephrectomy group, a minimally invasive approach had a lower rate of surgical site infections, sepsis, pneumonia, return to operating room, and overall length of stay when compared with open procedures of the same duration. Length of hospital stay decreased in MIS regardless of operative time, except when comparing minimally invasive cases longer than 6 hours with open cases less than 90 minutes. Transfusion rates also significantly decreased in minimally invasive total nephrectomy cases. In the partial nephrectomy group, similar outcomes were seen in terms of length of stay and infectious outcomes. Interestingly, transfusion risk was decreased in the open partial nephrectomy group when comparing cases less than 90 minutes with minimally invasive partial nephrectomies lasting 3 to 6 hours; otherwise there was no significant correlation with transfusion risk. CONCLUSIONS: Minimally invasive operations are less morbid than open operations of similar ORT. Longer and likely more complex laparoscopic procedures continue to provide a benefit to patients when compared with shorter and possibly less complex open procedures. These data should be considered during a surgeon's preoperative and operative decision-making.

Ureteral stents placed at the time of urinary diversion decreases postoperative morbidity.

OBJECTIVE: To determine the impact of stenting ureteroenteric anastomoses on postoperative stricture rate and gastrointestinal recovery in continent and noncontinent urinary diversions (UDs). PATIENTS AND METHODS: We retrospectively reviewed the clinical and pathologic data on 192 consecutive patients who underwent a radical cystectomy and UD. Patients received either a continent or noncontinent UD with or without stent placement through the ureteroenteric anastomoses. Stricture rate, gastrointestinal recovery, length of hospital stay, and stricture characteristics were analyzed. Study endpoints were compared between four groups--stented and nonstented continent and stented and nonstented noncontinent UDs. RESULTS: 36% of patients were stented and 64% were nonstented at the time of UD. Total ureteral stricture rate was 9.9%. There was no statistically significant difference in stricture rate (p = 0.11) or length of hospital stay (p = 0.081) in stented compared to nonstented patients. There was a significantly (p = 0.014) greater rate of ileus in patients who were nonstented in both continent and noncontinent UDs. CONCLUSION: Stenting of ureteroenteric anastomoses in both continent and noncontinent UD has no effect on postoperative stricture rate, but is associated with lower rates of postoperative ileus.

Endoscopic treatment of urothelial tumours of the renal pelvis and ureter.

Endoscopic treatment of urothelial tumors of renal pelvis and ureter is gaining acceptance as a conservative treatment modality. Technological advances have increased its applicability. Ureteroscopic and percutaneous tumor ablation have become reasonable treatment options for patients with imperative indications, such as bilateral disease, renal insufficiency or solitary kidney. However, endoscopic tumor ablation is being utilized more frequently for patients with UTTCC even in the setting low grade disease and a normal contralateral kidney, provided long-term close surveillance to detect and treat recurrences is ensured. This paper reviews the current role of endoscopic management of UTTCC.

Tratamiento endoscopicode los tumors uroteliales en pelvis renal y ureter / Endoscopic treatment of urothelial tumours of the renal pelvis and ureter

OBJETIVO: El tratamiento endoscópico de los tumores uroteliales de la pelvis renal y el uréter está ganando aceptación como modalidad de tratamiento conservador. Los avances tecnológicos han aumentado su aplicabilidad. La ablación ureteroscópica y percutánea de los tumores se ha convertido en una opción de tratamiento razonable para pacientes con indicaciones imperativas, tales como enfermedad bilateral, insuficiencia renal o riñón único. Sin embargo, la ablación endoscópica de tumores se está utilizando con mayor frecuencia en pacientes con carcinoma de células uroteliales del tracto urinario incluso en el escenario de enfermedad de bajo grado y riñón contralateral normal, con la condición de que se asegure un estrecho seguimiento a largo plazo para detectar y tratar las recurrencias. Este artículo revisa el papel actual del manejo endoscópico del tumor urotelial del tracto urinario superior(AU)

Endoscopic treatment of urothelial tumors of renal pelvis and ureter is gaining acceptance as a conservative treatment modality. Technological advances have increased its applicability. Ureteroscopic and percutaneous tumor ablation have become reasonable treatment options for patients with imperative indications, such as bilateral disease, renal insufficiency or solitary kidney. However, endoscopic tumor ablation is being utilized more frequently for patients with UTTCC even in the setting low grade disease and a normal contralateral kidney, provided long-term close surveillance to detect and treat recurrences is ensured. This paper reviews the current role of endoscopic management of UTTCC(AU)

Laparoscopic renal descensus for upper tract reconstruction.

We describe a modern use of laparoscopic renal descensus during the reconstruction of the upper urinary tract. The patient is a 76-year-old mononephric man with recurrent carcinoma in situ in the distal ureter. Using the described technique, we produced an additional 8 to 10 cm of ureteral length and performed a simple ureteroneocystotomy instead of using a traditional psoas hitch and Boari flap creation, bowel interposition, or autotransplantation. Laparoscopic renal descensus is an uncommonly used but simple procedure that may prevent the need for bladder mobilization or Boari flap creation, particularly in the setting of a hostile pelvis.

Vascular pseudoaneurysms in urology: clinical characteristics and management.

BACKGROUND AND PURPOSE: Vascular pseudoaneurysm is a well-documented complication that results after injury to an arterial wall. We review the urologic literature for all reported postprocedural and post-traumatic cases of pseudoaneurysm. METHODS: A comprehensive review of the peer-reviewed literature was performed for reported cases of vascular pseudoaneurysm, with emphasis on clinical presentation and treatment options. RESULTS: Vascular pseudoaneurysm is a high-pressure collection of blood that communicates directly with an arterial vessel. The clinical presentation varies, depending on the location and size of the lesion, and can be quite dramatic and potentially life threatening. There may be an increasing incidence of pseudoaneurysms after minimally invasive and laparoscopic techniques. Selective and superselective embolization is the preferred treatment for patients with vascular pseudoaneurysms. CONCLUSIONS: Vascular pseudoaneurysm is an important but rare complication that is increasingly reported after minimally invasive urologic surgery. This diagnosis necessitates a high index of suspicion and radiologic acumen. Treatment is individually tailored to each patient, but selective embolization appears to be the standard of care.

Current status of nephron-sparing robotic partial nephrectomy.

PURPOSE OF REVIEW: Partial nephrectomy has become the standard of treatment for renal tumors less than 4 cm in size. Recent reports have even applied this technique for T1b lesions as well. With advancement in minimally invasive techniques, laparoscopic and robotic surgeries are performed with the advantage of decreased morbidity while maintaining the same oncologic principles as those of open surgery. RECENT FINDINGS: Feasibility studies confirmed that robot-assisted partial nephrectomy can be performed safely. Short-term outcomes are similar to those of laparoscopic and open partial nephrectomy. Complex renal tumors, such as hilar and endophytic lesions, have also been performed robotically. SUMMARY: Robot-assisted partial nephrectomy is feasible with short-term results comparable to those of open and laparoscopic surgery. With challenges of pure laparoscopic surgery, robotic assistance may provide more opportunities for minimally invasive nephron-sparing surgery.

Prevalence of erectile dysfunction in men screened for prostate cancer.

OBJECTIVES: The Sexual Health Inventory for Men (SHIM) is a widely used scale for the screening and diagnosis of erectile dysfunction (ED). Our objective was to incorporate the SHIM into our prostate cancer screening program to estimate the prevalence of ED among men screened for prostate cancer. METHODS: During September 2006, men younger than 75 years of age living in the Washington, DC area were invited to participate in the George Washington University Prostate Cancer Screening Program. The SHIM questionnaire was administered to all participants. Information regarding primary care physician use, phosphodiesterase-5 inhibitor use, serum prostate-specific antigen levels, and digital rectal examination findings was also obtained. Those who registered SHIM scores of 17 or less or who were taking a phosphodiesterase-5 inhibitor were considered to have ED. RESULTS: Overall, 333 men attended the program. Of the 328 men, 123 (37.5%) met our definition of ED; 30 (9%) were using a phosphodiesterase-5 inhibitor and 93 (28%) had an SHIM score of 17 or less. Univariate analysis suggested a significant difference in the prevalence of ED between African-American men and non-African-American men, with 25% and 41%, respectively, found to have a SHIM score of 17 or less (P < .01); however, this difference was not significant once we controlled for age (P > .05). Among our participants, 33% lacked a primary care physician. Of these, 22% had a SHIM score of 17 or less. CONCLUSIONS: The results of our study have shown that ED increases in a nonlinear fashion with age, consistent with the findings of previous reports. Of greater concern, however, given the strong association between ED and cardiovascular disease, was the number of those with ED who lacked a primary care physician.

Bladder cryoablation in a porcine model: evaluation of three surgical approaches and cryolesion predictability.

PURPOSE: To determine the feasibility of bladder cryoablation (BC) applied laparoscopically, percutaneously, and transurethrally in a porcine survival study. The expected and observed area of cell death after BC was also examined. MATERIALS AND METHODS: Nine pigs were divided equally into the three treatment groups. Cryoablation was performed with two freeze-thaw cycles after the bladder had been insufflated with CO2. Each animal was observed for 7 days after the procedure for treatment-related complications. After cystectomy, each specimen was examined pathologically to determine the degree and dimension of cell death achieved. RESULTS: BC applied via the laparoscopic and percutaneous approach is feasible and safe. No BC-related complications occurred in these two groups. A complication resulting from BC developed in all three animals that were treated cystoscopically, including two intraperitoneal bladder perforations at the time of BC necessitating immediate sacrifice, and one enterovesical fistula discovered at cystectomy. Transmural necrosis was demonstrated in seven of seven animal specimens that survived to the end of the protocol. The observed diameter of tissue necrosis was highly predictable based on the reported cryoprobe isotherms given by the manufacturer. CONCLUSION: All locations within the bladder can be successfully and predictably treated with cryoablation. Of the three approaches, laparoscopically administered BC appears to be the most safe and consistent method. Transurethral BC was not safe with the equipment available without laparoscopic assistance to prevent bowel complications.

Incidentally discovered renal masses: oncological and perioperative outcomes in patients with delayed surgical intervention.

OBJECTIVE: To evaluate whether a period of surveillance before laparoscopic partial nephrectomy (LPN) affects the pathological and clinical outcomes of patients with a small renal mass, as although the standard treatment for an enhancing renal mass remains surgical extirpation, surveillance of small renal masses has become a potential option in appropriately selected patients. PATIENTS AND METHODS: The clinical and pathological data of 32 patients who had LPN for a small clinical stage T1a renal mass after a surveillance period of >or=3 months was analysed and compared with those from a matched group of patients who had immediate LPN. RESULTS: The mean interval between diagnosis and LPN in the surveillance group was 15.8 months. The mean tumour size at presentation was 1.97 cm in the surveillance group with a growth rate of 0.56 cm/year. The proportion of patients upstaged from cT1 to pT3a was no different between the groups. There was no difference between the groups in warm ischaemia time, blood loss, operating room time, complications and length of stay after LPN. At the last follow-up (mean 60 months) there were no local recurrences or distant metastases. CONCLUSION: Baseline size does not appear to predict tumour malignant potential, and growth rates of malignant and benign tumours were similar in the two groups. A delay in surgery of >1 year was not associated with added surgical morbidity, nor did it preclude patients from undergoing definitive surgery via a minimally invasive approach with an equally effective early oncological outcome.

Surgical options in the management of ureteropelvic junction obstruction.

Ureteropelvic junction obstruction (UPJO) is a common cause of upper urinary tract obstruction that can be clinically silent or lead to symptoms such as pain, chronic urinary tract infections, and urinary stone disease. UPJO does not always mandate treatment, but when an indication for correction is present, there are several minimally invasive surgical options available. Surgical reconstruction represents the gold-standard treatment for UPJO, although endoscopic pyelotomy is a well established and efficacious alternative.

Glassy cell carcinoma of the urethra.

Glassy cell carcinoma is a poorly differentiated form of adenosquamous carcinoma that has never been reported in the urinary tract. We present the first case of primary glassy cell carcinoma of the urethra in a 48-year-old woman. She presented with a newly developed bulky mass protruding from her urethra. A biopsy of this mass revealed sheets of large polygonal cells with a "ground-glass" cytoplasm among a heavy inflammatory infiltrate, establishing the diagnosis of glassy cell carcinoma of the urethra. Treatment of her tumor included a combined surgical and chemotherapeutic approach.