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.

Urinary Metabolic Disturbances During Topiramate Use and their Reversibility Following Drug Cessation.

Objective: To understand the metabolic disturbances of stone formers currently taking topiramate and to examine the reversibility of these disturbances with cessation of the medication.

Materials And Methods: All progress notes written by 5 endourologists from a single academic center were retrospectively reviewed from January 2010 to July 2020 containing the words "topiramate" or "topamax." Inclusion criteria were age >18 and presence of either a 24-hour urine sample or stone analysis while on topiramate.

Resolution of Hydronephrosis and Pain to Predict Stone Passage for Patients With Acute Renal Colic.

Objective: To study patients who presented to the Emergency Department with acute renal colic to determine if resolution of hydronephrosis and pain accurately predicts stone passage on follow-up CT.

Materials And Methods: This is a secondary analysis of a multicenter prospective randomized clinical trial of patients diagnosed by computed tomography (CT) scan with a symptomatic ureteral stone < 9 mm in diameter. Participants were followed after randomization to evaluate for analgesic use and to assess stone passage and hydronephrosis on a repeat CT scan obtained at 29-36 days.

Resident Duty Hour Compliance and Sleep after Transitioning to a Night Float System: A Prospective Observational Study in an Academic Urology Program.

Introduction: Our urology residency program transitioned to a night float system, where dedicated residents cover nights and are off duty during the day. Junior residents previously covered 5 hospitals every 5 to 7 nights and worked the following day (home call). This prospective observational study compared the 2 systems before and after the transition.

Analgesic and Opioid Use for Patients Discharged from the Emergency Department with Ureteral Stones.

The aim of this study was to describe and characterize the analgesic and opioid use for patients discharged from the emergency department (ED) with renal colic due to ureteral stone. This is a secondary analysis of a multicenter prospective trial of ED patients diagnosed by CT scan as having a symptomatic ureteral stone <9 mm in diameter. Participants were contacted after randomization on days 2, 7, 15, 20, and 29 and reported opioid and nonopioid analgesic use and stone passage.

Accuracy of Patient Reported Stone Passage for Patients With Acute Renal Colic Treated in the Emergency Department.

Objective: To study patients who initially presented to the Emergency Department with acute renal colic to determine if patient-reported stone passage detects stone expulsion as accurately as follow-up computed tomography (CT) scan.

Methods: This is a secondary analysis of a multi-center prospective trial of patients diagnosed by a CT scan with a symptomatic ureteral stone <9 mm in diameter. Patient-reported stone passage, defined as capture or visualization of the stone, was compared to CT scan-confirmed passage performed 29-36 days after initial presentation.

Effect of Tamsulosin on Passage of Symptomatic Ureteral Stones: A Randomized Clinical Trial.

Importance: Urinary stone disease is a common presentation in the emergency department, and α-adrenergic receptor blockers, such as tamsulosin, are commonly used to facilitate stone passage.

Objective: To determine if tamsulosin promotes the passage of urinary stones within 28 days among emergency department patients.

Design, Setting, And Participants: We conducted a double-blind, placebo-controlled clinical trial from 2008 to 2009 (first phase) and then from 2012 to 2016 (second phase).

The Efficacy of Tadalafil Daily vs on Demand in the Treatment of Erectile Dysfunction: A Systematic Review and Meta-analysis.

We present a review comparing the use of tadalafil daily vs on-demand for erectile dysfunction. We examined randomized controlled trials and observational studies that examined the use of tadalafil for at least 8 weeks of follow-up with the primary outcome of International Index for Erectile Dysfunction-Erectile Function domain. Eight studies that examined the desired dosing regimens were identified.

Appearance of Pyelitis Emphysematosa on Computed Tomography.

Pyelitis emphysematosa is a gas-forming infection characterized by gas located within the wall of the collecting system and renal pelvis. There are only 2 reported cases of pyelitis emphysematosa in the literature, neither of which occurred in the era of cross-sectional imaging. Here we present a case of pyelitis emphysematosa occurring in an elderly female with congenital left renal atrophy and chronic right hydronephrosis secondary to ureteropelvic junction obstruction.

Survey of Applicant Experience and Cost in the Urology Match: Opportunities for Reform.

Purpose: The urology match is highly competitive but there is a paucity of published data regarding the costs and barriers that applicants face. We gathered data on contributors to cost in the 2014 urology residency match.

Materials And Methods: A survey was sent to all applicants offered an interview at each of 18 participating institutions.

Segmental testicular infarction due to minocycline-induced antineutrophil cytoplasmic antibody--positive vasculitis.

Segmental testicular infarction is an uncommon clinical entity marked by acute scrotal pain and swelling. Classically, these appear as wedge-shaped, avascular, hypoechoic lesions on a testicular ultrasound. We present a unique case of testicular infarct caused by an antineutrophil cytoplasmic antibody-positive vasculitis secondary to the use of the antibiotic minocycline.

De novo Angiosarcoma of a Renal Allograft.

Prolonged exposure to immunosuppressive medication is a known risk factor for the development of post-transplant malignancies. De novo angiosarcoma in the post-transplant population is extremely rare. We present an 81-year-old female who developed an angiosarcoma at the site of a functioning renal allograft and review contemporary treatment strategies for this devastating disease.

The impact of obesity on urine composition and nephrolithiasis management.

Background And Purpose: Several studies have reported that obese patients have a higher risk of nephrolithiasis. The purpose of this study is to investigate the effect of overweight (OW) and obesity on stone composition, type of treatment, and urine composition.

Methods: With Institutional Review Board approval, charts of adult patients who attended our dedicated stone clinic over a 5-year period starting January 2006 were reviewed.

Comparative hospital cost-analysis of open and robotic-assisted radical prostatectomy.

Objective: To perform a contemporary comparative cost-analysis of robotic-assisted laparoscopic radical prostatectomy (RARP) and open radical retropubic prostatectomy (RRP).

Methods: All patients undergoing RARP (n = 115) or RRP (n = 358) by 1 of 4 surgeons at a single institution during a 15-month period were retrospectively reviewed. The hospital length of stay (LOS), operative time, hospital charges, reimbursement, and direct and indirect hospital costs were analyzed and compared.

Predictors of immediate postoperative outcome of single-tract percutaneous nephrolithotomy.

Objective: To evaluate the efficacy of single tract percutaneous nephrolithotomy (sPCNL) and investigate the preoperative predictive factors associated with stone clearance after sPCNL.

Methods: A retrospective review of 351 cases of sPCNL performed at a single institution by 1 of 2 endourologists between January 2000 and March 2010 was performed. The primary outcome evaluated was stone-free rate (SFR) as assessed immediately after either an initial procedure or a second-look nephroscopy performed on postoperative day 2.

Management of Bladder Cancer following Solid Organ Transplantation.

Objective. Present our experience managing bladder cancer following liver and renal transplantation. Methods.

Real-time tomographic reflection in facilitating percutaneous access to the renal collecting system.

Background And Purpose: Real-time tomographic reflection is a novel technique that uses a geometrically fixed arrangement of a conventional ultrasound transducer, a transducer-incorporated monitor, and a half-silvered mirror. This device, dubbed the Sonic Flashlight, generates a virtual anatomically scaled image, obviating the need for a separate monitor. It may therefore facilitate invasive procedures, such as percutaneous access to the kidney.

Renal access by urologist or radiologist during percutaneous nephrolithotomy.

Purpose: We evaluated percutaneous access for percutaneous nephrolithotomy (PCNL) that was obtained by interventional radiologists or urologists at a single academic institution and compared access outcomes and complications.

Patients And Methods: The records of 233 patients who underwent PCNL at the University of Pittsburgh Medical Center between 2000 and 2008 were retrospectively reviewed. Patients were stratified according to percutaneous access by urologists (group 1) or a group of interventional radiologists (group 2) in 195 and 38 patients, respectively.