Personalized Pre-clinic Nursing Telemedicine Visit: An Efficient and Efficacious Approach for Bowel and Bladder Dysfunction in Children.

OBJECTIVES: To evaluate the effectiveness and efficacy of a Registered Nurse (RN) led educational pre-clinic telephone call on compliance and outcomes in children with bowel and bladder dysfunction (BBD). METHODS: A retrospective chart review of a prospectively applied protocol in a single academic institution was performed for children aged 4-17 presenting with BBD. All children underwent a pre-clinic RN telemedicine visit where they were educated on pathophysiology of BBD, provided personalized urotherapy and bowel recommendations and instructed to complete pre-clinic questionnaires and voiding diaries. Patients were evaluated by a provider 4weeks following RN call. Data collected included compliance with forms, bowel management and need for imaging/testing, medications, and biofeedback. Patients were considered to improve with urotherapy alone if they were discharged from urology without the need for medications and/or biofeedback. RESULTS: In total, 277 patients completed an RN call and 224 patients attended a provider visit between December 2020 and June 2022. Mean age was 9.4years (3:1 Female to Male ratio). During the RN call, 154 (56%) patients had bowel management initiated. Of the 224 patients seen by a provider, 69% (n = 154) had symptom improvement or resolution with urotherapy alone. Thirty-eight patients (17%) enrolled in biofeedback with 7 (3%) completing all 8 sessions. Thirty-two patients (14%) required medication for daytime bladder symptoms. CONCLUSION: Our novel RN-led pre-clinic telemedicine visit demonstrates excellent compliance and patient outcomes for children with BBD and can reduce the use of unnecessary imaging, medications, and time-consuming treatments such as biofeedback.

Acute Ischemic Priapism Management: An Educational and Simulation Curriculum.

Introduction: Ischemic priapism is a urologic emergency managed by both urologic and nonurologic providers in the community. Given ischemic priapism's rare occurrence and the time-sensitive nature of treatment, effective provider education on management of this entity is imperative. We sought to develop a low-cost effective simulation model and curriculum to enhance trainee education. Methods: A comprehensive didactic curriculum based on national urologic guidelines was developed, along with a low-cost, easily reproducible priapism simulator using hot dogs and Red Vines candy. The simulators cost $1.25 each, and assembly took 10 minutes. All materials were reviewed by three urology faculty members. The curriculum was piloted with two andrology fellowship-trained urology faculty among eight urology residents (PGY2-PGY4/U1-U2) and one medical student. Participants provided feedback regarding the overall course as well as the face and content validity of the simulator. Results: Cognitive test scores significantly improved on average by 15.0% (p = .002), and confidence improved from baseline somewhat or very much among 88.9% of participants after completion of the curriculum. The task trainer was rated easy to use (average score: 4.78 out of 5), and 77.8% of participants though it was somewhat or very useful for training (average score: 4.00 out of 5). Additionally, 77.8% recommended its incorporation into resident training (average score: 4.00 out of 5). Discussion: This simulation curriculum is effective, inexpensive, and easily reproducible, making it ideal for groups with limited resources. Expanding access to simulation-based curricula on priapism management may improve education of both urologic and nonurologic trainees.

Current practices in percutaneous nephrolithotomy among endourologists.

OBJECTIVE: To characterize current practices of percutaneous nephrolithotomy (PCNL) among endourologists in relation to practice setting, experience, and fellowship training. METHODS: An Internet survey was administered to active Endourological Society members. Responses were grouped based on demographic information pertaining to setting of practice, number of years practiced, and fellowship training in endourology. PCNL technique details were evaluated and compared by each group. Statistical analysis was performed using SPSS. RESULTS: Two hundred ninety-three completed responses of 2000 were received. There was a significant difference in the experience level among respondents (p < 0.001), with a relatively greater proportion being 11-20 years in practice. The majority of respondents were academic urologists (74%), with 18% being within a group-based private practice. Seventy-seven percent of respondents obtained their own access while 19% had access by interventional radiologists. Sixty-two percent were endourology fellowship trained, and fellows were significantly more likely to obtain their own access (82% vs 71%, p=0.022). Eighty-six percent used the prone position to obtain access, 10% used supine, and 4% used lateral decubitus. An antegrade approach was preferred by 68%, while 18.5% used a retrograde, and 12% used a combined approach. Overall, 76% placed a nephrostomy tube for postoperative drainage; a ureteral stent or catheter was placed in 28% or 11% of respondents, respectively, and only 6 respondents (2%) performed a "tubeless" procedure without any drainage. CONCLUSIONS: The majority of Endourological Society members performing PCNLs who responded obtain their own access, and there is a higher proportion of self-obtained access in fellowship-trained endourologists. Prone positioning is predominant, and more than 75% of respondents leave a nephrostomy tube postoperatively, underscoring that the tubeless approach is rare.