Impact of Urology Trainee Debt Levels on Future Practice Choices and Expectations.

Introduction: Excessive trainee debt continues to be a problem. Little is known about how debt influences future practice decisions. We sought to examine the correlation between educational debt and anticipated practice choices and career expectations to better understand the impact of debt on urology trainees to inform urology workforce policy.

Squamous Cell Carcinoma in a Transgender Man's Neo-Urethra after Metoidioplasty.

Metoidioplasty is a gender-affirming surgery for transgender men, which creates a neophallus using vaginal mucosa and labia majora. One known complication of this procedure is urethral stricture. We report the novel case of a patient with urethral stricture 4 years after metoidioplasty found to have squamous cell carcinoma in situ likely originating from the vaginal mucosa grafted to the neourethra, and highlight the importance of sending such strictures for pathologic evaluation.

Preoperative Testing for Urethroplasty is Not Associated With Outcomes-A NSQIP Study.

Objective: To assess the current practice of routine preoperative testing before urethroplasty and to determine if the results are clinically significant.

Methods: Data was obtained from the National Surgical Quality Improvement Program (NSQIP) database. We identified 1527 patients who underwent urethroplasty from 2010 to 2017.

Use of Surgery for Post-Prostatectomy Incontinence.

Purpose: Stress urinary incontinence following radical prostatectomy is common and potentially debilitating. Surgical therapy with a urethral sling or an artificial urinary sphincter is an effective option with high patient satisfaction in men in whom conservative measures fail to treat post-prostatectomy incontinence. We sought to characterize the contemporary utilization of surgical therapy of post-prostatectomy incontinence using an all payer database.

Antibiotic prophylaxis after urethroplasty may offer no benefit.

Purpose: Patients often receive antibiotic prophylaxis after urethroplasty to minimize the risk of urinary tract infection (UTI). The aim of this study was to determine the frequency of UTIs after urethroplasty and its impact on urethral and incisional healing.

Methods: Patients undergoing urethroplasty by a single surgeon from 2000 to 2012 were retrospectively reviewed.

Advanced Practice Providers in U.S. Urology: A National Survey of Demographics and Clinical Roles.

Introduction: Projections suggest a significant shortage of urologists coupled with an increasing burden of urological disease due to an aging population. To meet this need, urologists have increasingly partnered with advanced practice providers. However, to this point the advanced practice provider workforce has not been comprehensively evaluated.

Coordination of cortical and thalamic activity during non-REM sleep in humans.

Every night, the human brain produces thousands of downstates and spindles during non-REM sleep. Previous studies indicate that spindles originate thalamically and downstates cortically, loosely grouping spindle occurrence. However, the mechanisms whereby the thalamus and cortex interact in generating these sleep phenomena remain poorly understood.

Low Serum Testosterone Level Predisposes to Artificial Urinary Sphincter Cuff Erosion.

Objective: To examine the association between decreased serum testosterone levels and artificial urinary sphincter (AUS) cuff erosion.

Materials And Methods: We evaluated serum testosterone levels in 53 consecutive patients. Low testosterone was defined as <280 ng/dL and found in 30/53 patients (56.

Risk Factors and Timing of Early Stricture Recurrence After Urethroplasty.

Objective: To compare recurrence after urethroplasty, identifying associated risk factors for early recurrence.

Materials And Methods: Among 262 urethroplasties (2001-2010) with ≥6 months of follow-up, we identified 65 patients (24.8%) with recurrence (defined by obstruction in the area of repair on cystoscopy).

Management of radiation-induced urethral strictures.

Radiation as a treatment option for prostate cancer has been chosen by many patients. One of the side effects encountered are radiation-induced urethral strictures which occur in up to 11% of patients. Radiation damage has often left the irradiated field fibrotic and with poor vascularization which make these strictures a challenging entity to treat.

An Analysis of Case Logs From American Urologists in the Treatment of Peyronie's Disease.

Objective: To review recent trends in the treatment of Peyronie's disease (PD), we assess surgical practice patterns of urologists in the United States with emphasis on specialty training, demographics, and temporal changes.

Methods: Six-month case log data of American urologists between 2004 and 2013 were obtained from the American Board of Urology. Current Procedural Terminology (CPT) codes were used to identify surgical procedures, including plaque injection.

Current Concepts in Infections Associated with Penile Prostheses and Artificial Sphincters.

Implantation of penile prostheses and artificial urinary sphincters have gained widespread acceptance for the treatment of refractory erectile dysfunction and incontinence, respectively. In the past 3 decades, improved device design and an increased understanding of the pathophysiology of device infections have contributed to a decrease in infection rates. However, understanding the concepts related to infection prevention and management remains critical.

Gender Differences in Compensation, Job Satisfaction and Other Practice Patterns in Urology.

Purpose: The proportion of women in urology has increased from less than 0.5% in 1981 to 10% today. Furthermore, 33% of students matching in urology are now female.

Radical Cystectomy Perioperative Care Redesign.

Objective: To present an evidence-based review of the perioperative management of the radical cystectomy (RC) patient in the context of a care redesign initiative.

Methods: A comprehensive review of the key factors associated with perioperative management of the RC patient was completed. PubMed, Medline, and the Cochrane databases were queried via a computerized search.

Male Sling and Artificial Urethral Sphincter for Male Stress Urinary Incontinence Among Certifying American Urologists.

Objective: To examine case volume characteristics among certifying urologists performing male sling and artificial urinary sphincter (AUS) procedures to evaluate practice patterns in male stress urinary incontinence (SUI).

Materials And Methods: Six-month case log data of certifying urologists (2003-2013) were obtained from the American Board of Urology. Cases specifying Current Procedural Terminology code for male sling, AUS, and removal or revision of either procedure in males ≥18 years were analyzed.

Practice Patterns in the Treatment of Urethral Stricture Among American Urologists: A Paradigm Change?

Objective: To examine surgical case volume characteristics among certifying urologists associated with treatment of urethral stricture to compare practice patterns of recent graduates to recertifying attending urologists and trends over time.

Materials And Methods: Six-month case log data of certifying and recertifying urologists (2003-2013) were obtained from the American Board of Urology. Cases specifying a CPT code for urethral dilation, direct vision internal urethrotomy (DVIU), urethroplasty, and graft harvest in males ≥18 years were analyzed for surgeon-specific variables.

Risk of urethral stricture recurrence increases over time after urethroplasty.

Objective: To report a single institutional experience with urethroplasty outcomes and success rates at long-term follow up.

Methods: A retrospective review was carried out of all urethroplasties performed by a single surgeon from 2000 to 2010. A total of 347 patients underwent urethroplasty during this time period, of which 227 had minimum 1-year follow-up data available.

Long-term outcomes of urethroplasty with abdominal wall skin grafts.

Objective: To report the long-term outcomes of urethroplasty using abdominal wall skin (AWS) grafts. Men with long-segment strictures, prior urethroplasty, and lichen sclerosus (LS) pose challenges in surgical management, including the choice of graft tissue for urethral reconstruction. AWS grafts are an alternative when buccal mucosa or penile grafts are not feasible or chosen by the patient.