Money Talks: The Shifting Effect of Limiting Monetary Incentives for Urology Resident Research.

OBJECTIVE: To assess incentive changes on resident publication behavior. In 2020, we demonstrated the positive effect of an unlimited $1000 publishing incentive for Urology residents. Following this publication, institutional changes led to a limit of a single $1000 publishing incentive per resident per year. METHODS: The PubMed database was assessed to quantify average resident primary authorship and average overall publications. Average primary authorships and total PubMed listings were then compared by year before any incentive (June 2008-June 2016), during unlimited incentive (July 2016-October 2020), and after the limited financial incentive (November 2020-June 2023). RESULTS: Scholarly activity from 30 out of 30 possible residents was evaluated. The average PubMed research participation for the program per year increased significantly from 2.44 preincentive to 8.0 when the incentive was unlimited but decreased to 4.0 when the incentive was limited (P = .026). Similarly, the average PubMed primary resident authorships per year increased from 1.0 preincentive to 6.25 during the unlimited incentive period but decreased to 2.0 when the incentive was limited (P < .001). CONCLUSION: Our data showed an unlimited monetary incentive resulted in a significant increase in average primary resident authorship and average resident participation for publications to PubMed. The limited monetary incentive model resulted in a significant decrease on resident publication and participation in research compared to unlimited incentives. However, limited monetary incentives have a positive, though restricted, effect on Urology resident publication and participation in research compared to no incentive.

Effects of the 2012 and 2018 US preventive services task force prostate cancer screening guidelines on pathologic outcomes after prostatectomy.

BACKGROUND: In May 2018, the US Preventive Services Task Force (USPSTF) recommended prostate cancer (PCa) screening for ages 55-69 be an individual decision. This changed from the USPSTF's May 2012 recommendation against screening for all ages. The effects of the 2012 and 2018 updates on pathologic outcomes after prostatectomy are unclear. METHODS: This study included 647 patients with PCa who underwent prostatectomy at our institution from 2005 to 2018. Patient groups were those diagnosed before the 2012 update (n = 179), between 2012 and 2018 updates (n = 417), and after the 2018 update (n = 51). We analyzed changes in the age of diagnosis, pathologic Gleason grade group (pGS), pathologic stage, lymphovascular invasion (LVI), and favorable/unfavorable pathology. Multivariable logistic regression adjusting for pre-biopsy covariables (age, prostate-specific antigen [PSA], African American race, family history) assessed impacts of 2012 and 2018 updates on pGS and pathologic stage. A p  < 0.05 was statistically significant. RESULTS: Median age increased from 60 to 63 (p = 0.001) between 2012 and 2018 updates and to 64 after the 2018 update. A significant decrease in pGS1, pGS2, pT2, and favorable pathology (p < 0.001), and a significant increase in pGS3, pGS4, pGS5, pT3a, and unfavorable pathology (p < 0.001) was detected between 2012 and 2018 updates. There was no significant change in pT3b or LVI between 2012 and 2018 updates. On multivariable regression, diagnosis between 2012 and 2018 updates was significantly associated with pGS4 or pGS5 and pT3a (p < 0.001). Diagnosis after the 2018 update was significantly associated with pT3a (p = 0.005). Odds of pGS4 or pGS5 were 3.2× higher (p < 0.001) if diagnosed between 2012 and 2018 updates, and 2.3× higher (p = 0.051) if after the 2018 update. Odds of pT3a were 2.4× higher (p < 0.001) if diagnosed between 2012 and 2018 updates and 2.9× higher (p = 0.005) if after the 2018 update. CONCLUSIONS: The 2012 USPSTF guidelines negatively impacted pathologic outcomes after prostatectomy. Patients diagnosed between 2012 and 2018 updates had increased frequency of higher-risk PCa and lower frequency of favorable disease. In addition, data after the 2018 update demonstrate a continued negative impact on postprostatectomy pathology. Thus, further investigation of the long-term effects of the 2018 USPSTF update is warranted.

Urology Resident Involvement in Patient Safety and Quality Improvement Activities.

PURPOSE OF REVIEW: To assess current urology resident engagement in patient safety and quality improvement (PSQI) and how to improve resident involvement in PSQI. RECENT FINDINGS: Overall urology resident participation in PSQI is low, especially when compared to other non-surgical residency programs. Multiple methods have been successfully implemented to increase resident participation in PSQI. Patient safety and quality improvement are extremely important to the progression of both urology and the healthcare community. True and meaningful participation in PSQI is lacking for many urology residents. However, there are easily adopted methods to improve resident involvement in this area of healthcare. These methods include direct communication and access between residents and hospital PSQI boards, resident-led safety councils, monetary incentives, formal training, and PSQI resident support teams.

The Positive Effect of Monetary Incentive on Urology Resident Research.

OBJECTIVE: To evaluate whether a financial incentive changed research patterns among residents over a 12-year period. METHODS: At our institution, beginning July 2016, any resident work that led to a PubMed citation was awarded $1,000. A review of the PubMed database and the regional meeting of the South Central Section of AUA (SCS/AUA) presentation itineraries were used to quantify and qualify the participation in research by these residents before and after introduction of the financial incentive. RESULTS: Scholarly activity from thirty out of thirty possible residents was evaluated. The monetary incentive resulted in increased production post-incentive (6.33) vs pre-incentive (2.44) in average total authorship participation published to PubMed per year (P = .0125). The average number of PubMed primary authorships per resident per year increased from 0 in July 2007-June 2008 to 0.7 in July 2018-June 2019, displaying upward trajectory. Average primary authorship of research produced per year presented at SCS/AUA and published to PubMed increased postincentive (9.00) vs pre-incentive (4.89) (P = .0479). More review articles and less basic science research were published after the incentive. CONCLUSION: Offering financial incentives to urology residents increased publications and meaningful participation in research.

Primary extragonadal yolk sac tumor originating from adrenal gland.

Extragonadal germ cell tumors are germ cell tumors with no evidence of a primary tumor within the gonads, most often located in the mediastinum or retroperitoneum. We present an extragonadal yolk sac tumor that presented as an adrenal carcinoma and required left adrenalectomy, nephrectomy, and significant IVC thrombectomy. This case, to our knowledge, is the first documented case of extragonadal yolk sac tumor originating from the adrenal gland.

Symptomatic Rosai-Dorfman Disease Presenting as Isolated Bilateral Perinephric Infiltration.

This case explores a rare initial presentation of Rosai-Dorfman disease isolated to the peri-renal space. Also described as sinus histiocytosis with massive lymphadenopathy, Rosai-Dorfman disease is non-neoplastic and most often presents with massive cervical lymphadenopathy, but the disease can affect any organ system. Not often considered by those in the urology community or found in urology journals, this report reviews a clinical presentation of Rosai-Dorfman disease affecting bilateral kidneys and the fundamental histopathology needed for its diagnosis.

A Potential Link: Cross-fused Renal Ectopia With Concomitant Absent Left Testicle.

Cross-fused renal ectopia (CFRE) is a rare congenital anomaly in which both kidneys are located on a unilateral side of the retroperitoneal space. The ureter of the ectopic kidney is seen to pass over the midline to insert in its normal anatomic position. Frequently this anomaly goes undetected until there is radiologic screening for other purposes or when other genitourinary issues are investigated. Although frequently isolated, this condition has been reported to be associated with other congenital anomalies, genetic disorders, and various urogenital anomalies more than 50% of the time. However, we found no cases linking CFRE with a solitary testicle. This is a case of a 30-year-old man with left-to-right CFRE with concomitant absent left testicle and obstructing distal calculus.