Introduction of 1.9 mm Trilogy lithotripter in miniature percutaneous nephrolithotomy: Description of technique and case outcomes.

INTRODUCTION: We aimed to evaluate the novel use of a 1.9 mm Trilogy lithotripter probe with varying locations and composition of renal stones. METHODS: We prospectively enrolled patients to undergo mini percutaneous nephrolithotomy (mPCNL) procedures using the 1.9 mm (instead of the standard 1.5 mm) Trilogy probe from August 2021 to April 2022. Several adjunctive irrigation measures compensated for reduced flow with the larger probe. Primary outcome was treatment efficiency. Patient demographics, preoperative demographics, and comorbidities, as well as real-time surgical data were extracted. Statistical analysis was performed using Kruskal-Wallis tests to compare stone type and location. RESULTS: A total of 110 patients were included in this study. The median total treatment time was 6.8 minutes, median lithotripsy time was 3.3 minutes, median stone treatment efficiency was 0.34 mm/min, and treatment efficacy was 50.4 (lithotripter time/treatment time). Overall median lithotripter efficiency was 104.6 mm3/min. Treatment efficiency was similar among stone composition (p=0.245) and location (p=0.263). Lithotripter 3D and 1D efficiency was also similar among stone composition (p=0.637 and p=0.766, respectively). Lithotripter 1D efficiency was nearly twice as fast in the lower pole compared to other stone locations (p=0.010). Overall broken probe rate for this procedure was 12%, mostly at the beginning, suggesting a learning curve. Five patients had minor complications, including one patient that required admission to the hospital for postoperative pain management. CONCLUSIONS: The 1.9 mm Trilogy lithotripter can be effective in mPCNL procedures with the use of easily implementable adjunctive irrigation techniques, decreasing the gap between lithotripsy time and total treatment time.

Burnout in Urological Education: An In-Depth Study of Residents and Fellows in the 2021 AUA Census.

PURPOSE: Our goal was to explore the current trends in burnout, career choice regret, and well-being needs among urology residents and fellows, with specific emphasis on identifying key factors associated with burnout. MATERIALS AND METHODS: The AUA Workforce Workgroup collaborated with the AUA Data Team to analyze data from the 2021 AUA Census, comprising a total of 243 residents and fellows. Key demographics, benefits and resources, career choice and debt, and burnout levels were analyzed, focusing on variables like gender, PGY (postgraduate year) level, debt burden, and personal health appointments. RESULTS: Overall, 48% of residents and 33% of fellows met criteria for professional burnout, with a higher incidence among PGY-2 residents (70%). Depersonalization was particularly notable, with 74% of residents reporting medium to high levels. Burnout was significantly associated with difficulty attending personal health appointments (52% vs 34%) and lack of access to on-call rooms (54% vs 36%). In contrast, having children during residency was associated with lower burnout levels (30.8% vs 49.1%). Meal plans were ranked as the most desired benefit (32%), followed by ability to attend health appointments during work hours (17%) and paid family leave (16%). Educational debt over $150,000 was carried by 53% of residents and 48% of fellows. Interestingly, burnout rates showed no statistically significant difference in response rates across genders, relationship status, amount of educational debt, presence of paid maternity or paternity leave, and type of childcare arrangements. CONCLUSIONS: Burnout remains a significant issue among urology trainees, with a complex interplay of factors like lack of personal time and provision of call rooms. The alarming rates of depersonalization and exhaustion highlight the urgency of implementing targeted interventions. Enhanced support systems, improved access to health care appointments, provision of call rooms, and debt management programs are recommended to alleviate the growing problem of professional burnout in the field of urology.

Exploring the Demands of Urology: On-Call Compensation, Frequency, and Variability.

INTRODUCTION: We investigate and analyze the available information regarding on-call patterns among urologists in the US. METHODS: The AUA Workforce Workgroup collaborated with the AUA Data Team to analyze information from the 2022 AUA Census. Extracted data were analyzed to identify variability across gender, subspecialty, hours worked per week, AUA section, salary, and practice setting. We used χ2 tests to compare the groups with respect to each factor and defined statistical significance as a P value less than .05. RESULTS: There were significant differences by gender and several other on-call factors including being required to take call to maintain hospital privileges (reported by 76% of female urologists vs 67% of male urologists; P = .026), getting paid for weekend call (28% of females vs 38% of males; P = .030), and making over $500 per day when taking weekend call (18% of females vs 32% of males; P < .001). Other differences existed between AUA sections in percentage of physicians receiving over $500 for weekday or weekend calls (P < .001). Lastly, practice setting differed in likelihood of being paid over $500 for weekday call (44% reported by private practice urologists, 7% reported by academic urologists, 14% reported by institutional urologists; P < .001). CONCLUSIONS: These results underscore the substantial variability in on-call responsibilities and structure within the AUA workforce. Further research and regular participation in future censuses are recommended to continue to characterize these trends.