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. Information on demographics, interview related costs, access to financial aid, frequency of away rotations and second look invitations was collected. Results A total of 173 respondents spent a median of $7,000 on the urology match. Applicants attended a mean of 14 interviews with an average per interview cost of $500. Overall 95% of respondents did at least 1 away rotation and 79% reported being asked to return for a second look interview at least once. Of the respondents 66% did not receive any financial aid for interviews and only 28% believed their financial aid departments provided adequate financial planning. Of those surveyed 20% indicated that their financial situation limited the number of interviews they attended. Conclusions We estimate that $3,122,000 was spent by applicants on the 2014 urology match. One in 5 applicants reported limiting the number of interviews they attended due to financial concerns. Adequate financial planning resources were not widely available. Nearly all applicants went on an away rotation and encouragement to return for second look interviews was common. These factors may contribute to financial and regional bias in the match process, and are potential targets for reform.
Purpose Imaging is routinely done preoperatively and postoperatively to assess patients treated with percutaneous nephrolithotomy. We developed a nomogram for percutaneous nephrolithotomy success. ...Materials and Methods From November 2007 to December 2009 the CROES (Clinical Research Office of the Endourological Society) collected data on consecutive patients at 96 centers globally. Patients were evaluated for stone-free status using plain x-ray of the kidneys, ureters and bladder. Treatment success was defined as no visible stones or residual fragments less than 4 mm. Multivariate regression was used to model the relationship between preoperative descriptors and the stone-free rate. Variables included case load, prior treatment, body mass index, staghorn stones, renal anomalies, and stone burden, location and count. Bootstrapping techniques were used to validate the model. Adjusted chi-square statistic values were used to rank the prognostic value of variables. A nomogram was developed using significant predictors from the model. We assessed the predictive accuracy of the nomogram using the ROC curve AUC. The nomogram was calibrated. Results Stone burden was the best predictor of the stone-free rate (chi-square = 30.27, p <0.001). Other factors associated with the stone-free rate were case volume (chi-square = 35.75, p <0.001), prior stone treatment (chi-square = 14.55, p <0.012), staghorn stone (adjusted chi-square = 4.73, p <0.029), stone location (chi-square = 14.74, p <0.001) and stone count (chi-square = 4.78, p <0.004). A nephrolithometric nomogram was developed with predictive accuracy (AUC 0.76). Conclusions The percutaneous nephrolithotomy stone-free rate can be predicted using preclinical data and radiological information. We present a nephrolithometric nomogram for percutaneous nephrolithotomy.
Purpose WISQOL (Wisconsin Stone Quality of Life questionnaire) is a disease specific, health related quality of life measure designed for patients who form kidney stones. The purpose of this study ...was to demonstrate the external and convergent validity of WISQOL and assess its psychometric properties. Materials and Methods At the WISQOL creation site (development sample) and at 8 geographically diverse centers in the United States and Canada (consortium sample) patients with a history of kidney stones were recruited. Item response option variability, correlation patterns and internal consistency were compared between samples. Convergent validity was assessed by patients who completed both WISQOL and SF-36v2® (36-Item Short Form Health Survey, version 2). Results Results were analyzed in 1,609 patients, including 275 in the development sample and 1,334 in the consortium sample. Response option variability patterns of all items were acceptable. Internal WISQOL consistency was acceptable. Intersample score comparisons revealed few differences. For both samples the domain-total WISQOL score correlations exceeded 0.86. Item level analyses demonstrated suitable variation, allowing for discriminatory scoring. At the time that they completed WISQOL, patients with stones and stone related symptoms scored lowest for health related quality of life. Patients with stones but no symptoms and those with no stones scored higher. The convergent validity substudy confirmed the ability of WISQOL to identify stone specific decrements in health related quality of life that were not identified on SF-36v2. Conclusions WISQOL is internally consistent and discriminates among patients with different stone statuses and symptoms. WISQOL is externally valid across the North American population. It may be used for multicenter health related quality of life studies in kidney stone disease.
The journey of minimally invasive (MI) urology is one of quality improvement (QI) and patient safety. New techniques have been progressively studied for adoption and growth. As more advanced methods ...of data collection and analysis are developed, a review of the patterns and history of these principles in the development of MI urology can inform future urologic QI and patient safety initiatives.
To perform a scoping review identifying patterns of QI and patient safety in MI urology.
PubMed and the American Urological Association (AUA) journal search page were screened on December 2022 for publications using the search parameters "quality improvement" and "minimally invasive." Articles were screened according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis extension for scoping reviews (PRISMA-ScR).
The initial literature search identified 471 articles from PubMed and 57 from the AUA journal search page. After screening, 528 articles were relevant to the topic and reviewed. Four hundred eighty-two articles were duplicates or did not meet inclusion criteria. Forty-six are included in this review.
Urology has developed a pattern of assessing MI surgery
the open counterpart. This includes analyzing the newest approach to understand complications, examining the factors contributing to complications, and lastly designing projects to mitigate future risk. This information, as well as advanced methods of data collection, has identified areas of improvement for new QI projects. The stage is set for a promising future with the adoption of advanced QI in daily urologic practice to improve patient safety and minimize errors.
Objective
To characterise the use of social media among members of the American Urological Association (AUA), as the use of social media in medicine has greatly expanded in recent years.
Subjects and ...Methods
In December 2012 to January 2013, the AUA e‐mailed a survey with 34 questions on social media use to 2000 randomly selected urologists and 2047 resident/fellow members. Additional data was collected from Symplur analytics on social media use surrounding the AUA Annual Meeting in May 2013.
Results
In all, 382 (9.4%) surveys were completed, indicating 74% of responders had an online social media account. The most commonly used social media platforms were Facebook (93%), followed in descending order by LinkedIn (46%), Twitter (36%) and Google+ (26%). Being aged <40 years was an important predictor of social media use (83% vs 56%), with greater uptake among residents/fellows compared with attendings (86% vs 66%). Only 28% of respondents used social media partly or entirely for professional purposes. During the 2013 AUA Annual Meeting, there were >5000 tweets from >600 distinct contributors.
Conclusion
As of early 2013, among respondents to an e‐mail survey, most urologists and urology trainees used some form of social media, and its use in urology conferences has greatly expanded.
Surgical training programs are pivotal in shaping skilled and compassionate surgeons, with mentors playing a crucial role in instilling clinical competence and essential attributes. This study aims ...to describe the characteristics of the program directors of Endourological Society-accredited fellowship programs.
The Endourological Society's website was used to identify program directors. The following data points were extracted: year of graduation from medical school, year of completing residency, if they had attended fellowship training or held additional degrees such as (PhD, MS, MBA, MSc, etc.), and number of publications on Scopus. Descriptive statistics were used to analyze the data.
A total of 84 fellowship programs and 115 program directors were identified. Geographically, 77.4% (
= 65) were in North America, 8.3% (
= 7) in Asia, 8.3% (
= 7) in the Middle East, 3.6% (
= 3) in Europe, and 2.4% (
= 2) in South America. Of the 115 program directors, 94.8% were male, and only 5.2% were female. Program directors graduated medical school with a median year of 1998 (1966-2015). Eighty percent attended fellowship programs, and 19.1% held additional degrees (PhD, MS, MBA, MSc, etc.). The median number of publications was 79 (4-1963), with a median citation of 1607 (1-43,565). The median H-index was 23 (range: 1-110).
Most program directors of Endourological Society-accredited fellowship programs are fellowship-trained and a notable number held a second degree. However, a pronounced gender disparity is observed, with limited female representation among program directors. This assessment contributes valuable insights into the urology and endourology mentorship, emphasizing the need for broader diversity and inclusivity in leadership roles.
Large stone burden can be treated ureteroscopically, but the treatment often requires more than one procedure. Placement of a preoperative stent may theoretically enhance stone clearance by dilating ...the ureter to facilitate both access and stone removal. This study determines the impact of stent placement before ureteroscopy on operative time, radiologic stone clearance, and reoperative rates.
We retrospectively reviewed the records of patients who underwent ureteroscopic stone intervention at our institution from 2002 to 2008 by a single surgeon. Nonstented matched controls were used for comparison. Demographics, stone characteristics (size, number, density, and location), presence of preprocedural ureteral stent, operative time, and results of postoperative imaging were compared between the two cohorts. Statistical analysis was performed.
There were 104 patients included in the study (45 prestented and 59 nonstented). Median stone size was 1 cm (range 0.3-4 cm). Overall stone clearance was 95.8%. The median number of procedures was one. Prestenting significantly reduced operative time during first ureteroscopy in patients with large stone requiring multiple ureteroscopies (p = 0.008) and total operative time to stone clearance in patients with stone >1 cm (p = 0.01), but not in patients with stone burdens <1 cm (p = 0.48). Prestenting also significantly reduced reoperative rates in patients with stone burden >1 cm (p = 0.001), especially for stones located in proximal ureter and kidney. Prestenting improves postoperative radiologic clearance, but this was not statistically significant (p = 0.56).
Results show that ureteroscopic lithotripsy of large stone burden can be performed with a high success rate. Preureteroscopic stent placement was associated with a decreased operative time and reoperative rates in patients with larger stone burdens of >1 cm.
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