Program Directors' Perspectives on Residency Applications in the Post‒United States Medical Licensing Examination Step 1 Era: A Case for Standardized Letters of Recommendation?

Introduction: The United States Medical Licensing Examination (USMLE) Step 1 test evolved into a key metric utilized by program directors (PDs) in assessing candidates for residency. The transition to a USMLE Step 1 binary pass/fail scoring system has resulted in a loss of an important objective assessment. With national movements toward pass/fail systems for clerkship grading and trends toward abandonment of class ranking, assessing residency applications has become increasingly challenging.

Gender-based Disparity Exists in the Surgical Experience of Female and Male Urology Residents.

Objective: To determine if a discrepancy exists in the number and type of cases logged between female and male urology residents.

Materials And Methods: ACGME case log data from 13 urology residency programs was collected from 2007 to 2020. The number and type of cases for each resident were recorded and correlated with resident gender and year of graduation.

Longitudinal Changes in the Operative Experience for Junior Urology Residents.

Objective: To evaluate longitudinal trends in surgical case volume among junior urology residents. There is growing perception that urology residents are not prepared for independent practice, which may be linked to decreased exposure to major cases early in residency.

Methods: Retrospective review of deidentified case logs from urology residency graduates from 12 academic medical centers in the United States from 2010 to 2017.

Characterizing the biofilm of artificial urinary sphincters (AUS).

Background: There is a paucity of data regarding the bacterial colonization on artificial urinary sphincter (AUS) devices following revision surgery. We aim to evaluate the microbial compositions of explanted AUS devices identified on standard culture at our institution.

Methods: Twenty-three AUS devices explanted were included in this study.

Conversion of Holmium Laser Enucleation of Prostate to Open Prostatectomy.

Objective: To determine the incidence and predictive factors for conversion to an open procedure during Holmium Laser Enucleation of Prostate (HoLEP).

Methods: A retrospective review was performed on files of all patients that underwent HoLEP at our institution between 2013 and 2020. Data collected included demographics, pre-operative estimated prostate size, intraoperative data, pathologic data, and functional baseline.

Management of urinary incontinence following treatment of prostate disease.

Unlabelled: INTRODUCTION Men who undergo treatment for prostate disease are at increased risk of urinary incontinence (UI). UI has a known negative impact on patient quality of life. Once a thorough evaluation has been performed, there are effective modalities for treatment that can be tailored to the patient.

Management of neurogenic detrusor overactivity.

Unlabelled: INTRODUCTION Neurogenic lower urinary tract dysfunction (NLUTD) refers to altered function of the urinary bladder, bladder outlet, and external urinary sphincter related to a confirmed neurologic disorder. Neurogenic detrusor overactivity (NDO) is a subset of NLUTD that frequently results in incontinence and may be associated with elevated bladder storage and voiding pressures resulting in upper urinary tract damage.

Materials And Methods: This article provides an update on the evaluation and management of patients with NDO.

Holmium Laser Enucleation of the Prostate Following Previous Prostatic Urethral Lift.

To determine the feasibility and operative challenges of holmium laser enucleation of the prostate (HoLEP) in patients with previous prostatic urethral lift (PUL) procedure. A retrospective review was performed on files of all patients that underwent HoLEP at our institution between 2013 and 2021. Seven hundred ninety-three consecutive HoLEP cases were identified.

How I Do It: PureWick female external catheter: a non-invasive urine management system for incontinent women.

Catheter associated urinary tract infections (CAUTIs) are common hospital-acquired infections and remain a significant medical and financial challenge to the healthcare system. Despite this risk, incontinent women may require prolonged catheterization to accurately monitor urine output and prevent skin breakdown. The PureWick Female External Urinary Catheter is a promising non-invasive urine collection system for use in incontinent women that may help reduce CAUTI rates, maintain skin integrity, accurately quantify urine output, and avoid extra healthcare costs.

Attitude is everything: keep probe pitch neutral during side-fire prostate biopsy. A simulator study.

Objectives: To develop and validate on a simulator a learnable technique to decrease deviation of biopsied cores from the template schema during freehand, side-fire systematic prostate biopsy (sPBx) with the goal of reducing prostate biopsy (PBx) false-negatives, thereby facilitating earlier sampling, diagnosis and treatment of clinically significant prostate cancer.

Participants And Methods: Using a PBx simulator with real-time three-dimensional visualization, we devised a freehand, pitch-neutral (0°, horizontal plane), side-fire, transrectal ultrasonography (TRUS)-guided sPBx technique in the left lateral decubitus position. Thirty-four trainees on four Canadian and US urology programmes learned the technique on the same simulator, which recorded deviation from the intended template location in a double-sextant template as well as the TRUS probe pitch at the time of sampling.

Urinary undiversion by conversion of the incontinent ileovesicostomy to augmentation ileocystoplasty in spinal cord injured patients.

Spinal cord injury (SCI) patients with neurogenic bladder and the inability to self-catheterize may require incontinent diversion to provide low-pressure drainage while avoiding the use of indwelling catheters. We demonstrate that in patients with significant functional improvement, the ileovesicostomy can be a reversible form of diversion, with simultaneous bladder augmentation using the same segment of ileum utilized for the ileovesicostomy. Multidisciplinary management should be utilized to assure mastery of intermittent catheterization before urinary undiversion.

Next-generation DNA sequencing for infected genitourinary implants: How I do it.

Infection of artificial urinary sphincters or inflatable penile prostheses is one of the most devastating complications after prosthetic surgery and can have a significant impact on a quality of life. Patients undergoing revision surgery with or without device replacement may have increased risk for infection when compared to initial primary surgery. As such, surgeons may utilize traditional culture results to direct antimicrobial therapy for these patients.

Faculty Development: How Do We Encourage Faculty to Become Better Teachers and Mentors?

Purpose Of Review: A healthy mentor relationship is a mutually beneficial experience and a necessary part of the natural progression of a career in academic medicine. We sought to explore the advantages of and challenges to becoming a mentor in current academic urology.

Recent Findings: Mentorship can promote self-confidence in the ability to choose a career, drive academic productivity, and even inspire a career in academic medicine.

Iatrogenic bladder rupture in individuals with disability related to spinal cord injury and chronic indwelling urethral catheters.

Introduction: Bladder rupture in patients with indwelling urethral catheters is rare. Herein, we describe two spinal cord injured (SCI) patients with neurogenic bladder dysfunction managed with chronic indwelling catheters who presented with extraperitoneal bladder rupture related to bladder instillation. One case was during continuous bladder irrigation for hematuria, the other during routine cystography.

Female Representation at High-profile Urology Conferences, 2014-2019: A Leadership Metric.

Objective: To measure female leadership through speakership at urology conferences and compare involvement to the overall representation of women in the urologic workforce.

Methods: A cross-sectional analysis was conducted to identify the gender of conference speakers from 2014 to 2019. Six high-profile urology conferences were selected: AUA; SUFU; SPU; SUO; GURS; WCE.

Stress Urinary Incontinence post-Holmium Laser Enucleation of the Prostate: a Single-Surgeon Experience.

Purpose: To identify incidence and predictors of stress urinary incontinence (SUI) following Holmium laser enucleation of the prostate (HoLEP).

Materials And Methods: We performed a retrospective review of 589 HoLEP patients from 2012-2018. Patients were assessed at pre-operative and post-operative visits.

The Balance between Open and Robotic Training among Graduating Urology Residents-Does Surgical Technique Need Monitoring?

Purpose: A minimum number of index procedures is required for graduation. Without thresholds for surgical technique, it is unclear if robotic and open learning is balanced. We assessed the distribution of robotic and open surgeries performed by residents upon graduation.

Industry payments to female pelvic medicine and reconstructive surgeons: an analysis of Sunshine Act open payments from 2014-2017.

Introduction And Hypothesis: We aim to examine the financial relationship between industry and female pelvic medicine and reconstructive surgeons (FPMRS) during the first four full calendar years since the implementation of the Sunshine Act.

Methods: All board-certified FPMRS specialists were identified using the American Board of Medical Specialties directory. Program directors (PDs) were identified using an Accreditation Council for Graduate Medical Education (ACGME) database.

A retrospective comparison of diode to holmium for laser enucleation of the prostate.

Introduction: Holmium endoscopic laser enucleation of the prostate (HoLEP) is a well-established alternative to traditional transurethral resection and open prostatectomy for the treatment of benign prostatic hyperplasia (BPH). We investigate the 1470 nm diode laser for enucleation as an alternative to HoLEP. The safety, efficacy, and initial outcomes of diode enucleation of the prostate (DiLEP), when compared to HoLEP, were examined.