American Urological Association Research Articles

Analysis of evidence on nutraceutical interventions for Peyronie's disease: a guideline-based critical review.

The management of Peyronie's disease (PD) is a challenge for the clinician. Despite the lack of etiologic therapy, different nonsurgical approaches have often been empirically proposed. The most used treatment is based on nutraceutical drugs with antioxidant activity, although such an intervention remains controversial. We reviewed the evidence from the randomized controlled trials included in the recommendations of the American Urological Association (AUA), Canadian Urological Association (CUA), European Association of Urology, and International Society for Sexual Medicine. We searched PubMed, Scopus, Web of Science, and Cochrane Library for randomized controlled trials, reviews, and guidelines on nutraceutical interventions for PD. Our analysis provides detailed information on potential interventions, underlying the inconsistent evidence. Acetyl esters of carnitine, although not recommended by any of the available guidelines, showed potential benefit in some selected studies. Omega-3 fatty acids are not recommended due to withdrawn study evidence. The CUA and AUA were the only societies to consider the use of coenzyme Q10. While the CUA suggested that it might be offered as a treatment option, the AUA refrained from taking a definitive stance due to insufficient evidence. Similarly, conflicting recommendations have been produced on potassium para-aminobenzoate. While the CUA considers potassium para-aminobenzoate potentially useful in slowing PD progression, the AUA deems the evidence insufficient. Conversely, both the International Society for Sexual Medicine and European Association of Urology do not recommend its use. This critical comparative analysis of the most recent guidelines produced by the leading scientific societies highlights some inconsistencies in the recommendations on nutraceutical intervention for PD, even within a background of overall ineffectiveness of this treatment approach.

Online Interest in Urology Residency: A Comprehensive Analysis of Current Internet Temporal and Geographic Patterns

Urology is one of the most competitive specialties in medicine, creating a challenge for prospective students looking to secure a residency position. Our study aims to assess online interest in urology residency by querying online interaction with search terms and criteria for urology residency programs. Utilizing Google Trends analysis from 2011 to 2024, this study examined urology-related search volume indexes, as well as temporal and geographical patterns. Furthermore, the number of residency positions from the American Urological Association database for the 2022 match process was evaluated. Our analysis of temporal trends revealed increased interest in urologist salaries from 2011 to 2019, followed by a decline from 2019 to 2023. Interest in urology-related interviews, applications, research, and letters increased in 2019, marked by the start of the COVID-19 pandemic. California, New York, and Texas had the lowest interest-to-position (IP) ratio, while Maryland, New Jersey, and Virginia had the highest IP ratio. Our analysis reveals an evolving interest in salaries, residency programs, and USMLE Step 1 changes in areas connected with urology. We report key geographical areas with high urology residency interest and low numbers of programs, implying a need for expanded residencies in underserved yet high-interest areas. Awareness and continued interest monitoring after the COVID-19 pandemic is critical for understanding interest in urology applicants.

Effects of antisperm antibodies post vasectomy reversal on pregnancy rates.

To investigate the correlation between antisperm antibodies (ASAs), pregnancy rates, and the method of conception following vasectomy reversal. This is particularly relevant as patients undergoing vasectomy reversal often express concerns about the potential inhibitory effects of ASAs on achieving pregnancy. Additionally, the American Urological Association guidelines for vasectomy emphasize the need for further research to address this question. We conducted a retrospective analysis involving chart reviews and phone interviews with individuals who underwent vasectomy reversal at our institution between May 2015 and April 2023. Patients who underwent vasectomy reversal for reasons other than fertility, as well as those lacking postoperative semen analysis with ASA data, were excluded. We classified patients based on low (below 50%) or high (50% or above) ASA levels determined by their initial postoperative semen analysis. The primary outcome measured was the pregnancy rate, including details on the method of conception. A total of 145 patients were subjected to chart review. The median age at the time of surgery was 43 years, with a median obstruction interval of 7.7 years. The median age of their partners was 29 years. The majority (80%) of patients underwent bilateral vasovasostomy. Among them, 60 patients (41.4%) exhibited low (< 50%) ASA levels, while 85 (58.6%) had high (≥ 50%) ASA levels. Follow-up phone interviews were completed by 48 patients. Among them, the 19 men with low ASA levels, 13 (68.4%) achieved pregnancy, with 6 (31.6%) experiencing spontaneous conception. For the 29 men with high ASA levels, 21 (72.4%) achieved pregnancy, including 11 (38%) through spontaneous conception. The p-value from Fisher's exact test was 0.2. Our findings suggest that ASA levels do not show a significant association with either the pregnancy rate or the method of conception following vasectomy reversal.

Defining the "Cutoff" on the Urethral Caliber in Diagnosing a Female Urethral Stricture.

Introduction The rarity in detecting female urethral stricture (FUS) backed by the inconsistency regarding the cutoff on the caliber to direct any treatment for its increase poses a challenge to its existence. Therefore, the present study was conducted to determine the caliber of the urethra that clearly identifies aFUS. Materials and method In this prospective observational study conducted between November 2015 and July 2017, women with obstructive lower urinary tract symptoms (LUTS) and a history of relief on at least a single urethral dilatation were included if the American Urological Association (AUA) score was more than seven and the maximum flow rate (Qmax) was less than 20 mL/sec. Of the 71 women recruited, 10 women had recognizable external causes: caruncle (five), mucosal prolapse (three), and meatal stenosis (two). The remaining 61 underwent voiding cystourethrogram (VCUG) and urodynamics followed by urethrocystoscopy, if the findings suggested a stricture. A definitive diagnosis was sought in those without stricture disease. We categorized all patients as either having a "true" stricture or an alternate etiology. Categorical variables were presented in number and percentage (%) and continuous variables as mean ± standard deviation (SD). Results The mean dilatationranged between one and six; the mean AUA score, ~17.82 ± 3.59; mean Qmax, ~10.21 ± 3.39 mL/sec; and the mean post-void residue (PVR), 106.65 ± 51 mL. A total of 29 patients were diagnosed to have stricture (dense = 17; flimsy = 12). None of the patients in this group had a urethral caliber of more than 14 French (Fr). Other etiologies were dysfunctional voiding (17), underactive bladder (seven), cystocele (four), and primary bladder neck obstruction (PBNO) (four). Conclusion Women with voiding LUTS should be screened for FUS only if the urethral caliber is ≤14 Fr.

Plasma-Derived Cell-Free DNA as a Biomarker for Early Detection, Prognostication, and Personalized Treatment of Urothelial Carcinoma.

Bladder cancer (BC) is one of the most common malignancies in the United States, with over 80,000 new cases and 16,000 deaths each year. Urothelial carcinoma (UC) is the most common histology and accounts for 90% of cases. BC management is complicated by recurrence rates of over 50% in both muscle-invasive and non-muscle-invasive bladder cancer. As such, the American Urological Association (AUA) recommends that patients undergo close surveillance during and after treatment. This surveillance is in the form of cystoscopy or imaging tests, which can be invasive and costly tests. Considering this, there have been recent pushes to find complements to bladder cancer surveillance. Cell-free DNA (CfDNA), or DNA released from dying cells, and circulating tumor DNA (ctDNA), or mutated DNA released from tumor cells, can be analyzed to detect and characterize the molecular characteristics of tumors. Research has shown promising results for ctDNA use in the BC care realm. A PubMed literature review was performed finding studies discussing cfDNA and ctDNA in BC detection, prognostication, and monitoring for recurrence. Keywords used included bladder cancer, cell-free DNA, circulating tumor DNA, urothelial carcinoma, and liquid biopsy. Studies show that ctDNA can serve as prognostic indicators of both early- and late-stage BC, aid in risk stratification prior to major surgery, assist in detection of disease progression and metastatic relapse, and can assess patients who may respond to immunotherapy. The benefit of ctDNA is not confined to BC, as studies have also suggested its promise as a biomarker for neoadjuvant chemotherapy in upper-tract UC. However, there are some limitations to ctDNA that require improvements in ctDNA-specific detection methods and BC-specific mutations before widespread utilization can be achieved. Further prospective, randomized trials are needed to elucidate the true potential ctDNA has in advancements in BC care.

Clinical Decision Support for Surgery: A Mixed Methods Study on Design and Implementation Perspectives From Urologists

ObjectivesTo assess urologist attitudes toward clinical decision support embedded into the electronic health record and define design needs to facilitate implementation and impact. With recent advances in big data and artificial intelligence, enthusiasm for personalized, data-driven tools to improve surgical decision-making has grown, but the impact of current tools remains limited. MethodsA sequential explanatory mixed methods study from 2019-2020 was performed. First, survey responses from the 2019 American Urological Association annual census evaluated attitudes toward an automatic clinical decision support tool that would display risk/benefit data. This was followed by the purposeful sampling of 25 urologists and qualitative interviews assessing perspectives on clinical decision support impact and design needs. Bivariable, multivariable, and coding-based thematic analysis were applied and integrated. ResultsAmong a weighted sample of 12,366 practicing urologists, the majority agreed clinical decision support would help decision-making (70.9%, 95% CI 68.7–73.2%), aid patient counseling (78.5%, 95% CI 76.5–80.5%), save time (58.1%, 95% CI 55.7–60.5%), and improve patient outcomes (42.9%, 95% CI 40.5–45.4%). More years in practice was negatively associated with agreement (p<0.001). Urologists described how clinical decision support could bolster evidence-based care, personalized medicine, resource utilization, and patient experience. They also identified multiple implementation barriers and provided suggestions on form, functionality, and visual design to improve usefulness and ease of use. ConclusionsUrologists have favorable attitudes toward the potential for clinical decision support in the electronic health record. Smart design will be critical to ensure effective implementation and impact.

An Analysis of American Urological Association Census Trends: Earlier Planned Retirement and Practice Pattern Changes May Exacerbate the Urology Workforce Shortage

ObjectiveTo explore how changes in planned retirement age, practice setting, and physician productivity may impact the workforce shortage in urology. MethodsWe compared data between the 2015 and 2022 American Urological Association census, a specialty-wide annual survey which collects data on demographics, practice patterns and procedures from a representative sample of US urologists. Workforce productivity was measured by the self-reported number of hours worked per week and patients seen per week. A novel formula was developed to demonstrate how planned retirement age and productivity impact the workforce’s production capacity. ResultsThe total number of practicing urologists increased during the period from 2015 to 2022 (11,990 to 13,976), while the mean age of practicing urologists decreased slightly (55.0 to 54.5 years; p <0.002). During this period, the mean planned age of retirement for all urologists decreased from 68.9 years to 67.7 (p <0.001). Urologists in solo practice had a significantly higher planned age of retirement at 71.9 years (p <0.001) as compared to all other practice models. The number of patients seen per week for all urologists decreased from 78.7 to 72.9 (p <0.001). The amount of hours worked per week remained relatively constant between the study periods. The maximum possible number of patients seen by the workforce prior to retirement increased by only 2.4% during the study interval. ConclusionThough the US urology workforce is growing and the mean age is decreasing, decreases in planned retirement age and productivity may offset these gains and intensify the physician shortage for US urologists.

The impact of american urological association antibiotic prophylaxis guidelines at the time of sacral neuromodulation implantation on rates of infection

The impact of american urological association antibiotic prophylaxis guidelines at the time of sacral neuromodulation implantation on rates of infection

Guidelines of Guidelines: Conservative, Pharmacological, and Surgical Management for Neurogenic Lower Urinary Tract Dysfunction.

Neurogenic lower urinary tract dysfunction (NLUTD) encompasses a broad spectrum of neurological conditions affecting the lower urinary tract. Managing NLUTD requires a tailored approach focused on preserving kidney function and enhancing patients' quality of life. Clinical guidelines provide valuable guidance for healthcare professionals, but discrepancies in recommendations arise among other factors due to limited high-quality clinical evidence. Prominent guidelines from organisations like the International Consultation of Incontinence, the European Association of Urology, the American Urological Association, and the National Institute for Health and Care Excellence offer varying recommendations for NLUTD management. This study reviews and summarizes the recommendations for conservative, pharmacological, and surgical management options across these guidelines. Cite this article as: Ochoa DC, Mahoney AC. Fontaine C, Hashim H. Guidelines of guidelines: conservative, pharmacological, and surgical management for neurogenic lower urinary tract dysfunction (NLUTD). Urol Res Pract. Published online March 31, 2024. doi: 10.5152/tud.2024.23232.

Association between dietary fatty acids and urinary incontinence

BackgroundDietary nutrient intake contributes to urination; however, the association between dietary nutrient intake, especially that of fat, and urinary incontinence (UI) is not well understood. The most common types of UI include stress UI (SUI) and urgency UI (UUI). ObjectiveTo investigate the potential effect(s) of dietary fat intake on UI and explore its mechanism of action in relation to body mass index (BMI). MethodsA cross-sectional survey of data from 15,121 individuals (20–85 years of age) from the National Health and Nutrition Examination Survey (2001–2008), a random population-based sample, was performed. Data regarding dietary nutrient intake were collected through 24 h dietary recall interviews. UI and covariate data were collected through in-person interviews. UI was assessed according to the American Urological Association Symptom Index. The odds ratio (OR) for SUI and UUI were calculated using multivariate logistic regression analysis. The mediation effect was estimated using observational mediation analysis. ResultsHigher total fat intake was positively associated with increased odds for developing UI (OR 1.44 [95% confidence interval (CI) 1.08–1.93]). Females who consumed more saturated fatty acids (SFA), monounsaturated fatty acids (MUFA), and polyunsaturated fatty acids (PUFA) were more likely to develop SUI. BMI partially explained the association between total fat, SFA, MUFA, and PUFA and SUI; the proportions of the mediation effect of BMI were 14.7%, 13.0%, 18.7%, and 16.3%, respectively. ConclusionsResults of this study emphasize the key role of dietary fat intake in the prevalence of UI. Higher fat intake was positively associated with UI and BMI partially mediated the effect of fat intake on SUI.

The SUB-urothelial DUrvalumab InjEction-1 (SUBDUE-1) trial: first-in-human trial in patients with bladder cancer.

To assess the safety of sub-urothelial injection of durvalumab and examine the impact on tissue and circulating immune cell populations. The patients were chemotherapy and immunotherapy naïve (bacille Calmette-Guérin allowed) with non-metastatic muscle-invasive bladder cancer or non-muscle-invasive bladder cancer planned for radical cystectomy (RC). The study was a Phase Ib 3 + 3 dose-escalation design with sub-urothelial injection of durvalumab at three pre-determined doses (25, 75, 150 mg) diluted in 25 mL normal saline, injected at 25 locations (25 × 1 mL injections), at least 2 weeks before RC. A total of 11 patients were recruited (10 male, one female). No significant changes were reported on American Urological Association Symptom Score or O'Leary Interstitial Cystitis Scale. In all, 14 adverse events (AEs) were reported (10 Grade 1, three Grade 2, one Grade 3), none considered immune-related. No Grade 4 or 5 AEs were recorded. All the patients underwent RC. Tissue immune populations changed following durvalumab injection (P = 0.012), with a statistically significant increase in M2-macrophage (CD163) when comparing the 25-150 mg dose (P = 0.021). Basal/mixed cancers showed a larger CD163 increase than luminal cancers (P = 0.033). Sub-urothelial injection of durvalumab is feasible and safe without immune-related AEs and shows local immunological effects.

Efficacy and safety of tibial nerve stimulation using a wearable device for overactive bladder.

To evaluate the efficacy and safety of a wearable, smartphone-controlled, rechargeable transcutaneous tibial nerve stimulation (TTNS) device in patients with overactive bladder (OAB). This multicentre, prospective, single-blind, randomised clinical trial included eligible patients with OAB symptoms who were randomly assigned to the stimulation group or sham group. The primary efficacy outcome was change from baseline in voiding frequency/24 h after 4 weeks of treatment. The secondary efficacy outcomes included changes in bladder diary outcomes (urgency score/void, nocturia episodes/day, micturition volume/void, and incontinence episodes/day), questionnaires on Overactive Bladder Symptom Score (OABSS), Patient Perception of Bladder Condition (PPBC), and American Urological Association Symptom Index Quality of Life Score (AUA-SI-QoL) at baseline and after 4 weeks of treatment. Device-related adverse events (AEs) were also evaluated. In the full analysis set (FAS), the mean (sd) change of voiding frequency/24 h in the stimulation group and sham group at 4 weeks were -3.5 (2.9) and -0.6 (2.4), respectively (P < 0.01). Similar results were obtained in the per-protocol set (PPS): -3.5 (2.9) vs -0.4 (2.3) (P < 0.01). In the FAS and PPS, micturition volume/void significantly improved at 4 weeks (P = 0.01 and P = 0.02). PPBC improvement almost reached significance in the FAS (P = 0.05), while it was significant in the PPS (P = 0.02). In the FAS and PPS, AUA-SI-QoL significantly improved at 4 weeks in the two groups (P < 0.01 and P < 0.01), whereas there were no significant differences in urgency score/void, nocturia episodes/day or OABSS between the groups. Also, no device-related serious AEs were reported. The non-invasive neuromodulation technique using the novel ambulatory TTNS device is effective and safe for treating OAB. Its convenience and easy maintenance make it a new potential home-based treatment modality. Future studies are warranted to confirm its longer-term efficacy.

A 27-Year Experience With Day Surgery Transurethral Resection of the Prostate.

Introduction Transurethral resection of the prostate (TURP) is the standard surgical procedure forobstructive symptoms of the lower urinary tract when medical management fails. Progression in TURP procedures has led to reduced catheterization time following transurethral prostatic resection. This study describes the methods and results of TURP performed in the day surgery setting. Materials and methods This retrospective study was performed at a day surgical hospital serving a patient population of more than 200,000 people. Over a 27-year period, a total of 1,123 patients with a mean age of 73.6 years (range: 49 to 91 years) underwent same-day conventional (electrosurgical monopolar) transurethral prostatic resection. Of the procedure, 43 patients (11%) received spinal anaesthesia, and the remainder received general anaesthesia. Results Over the years, there has been an increase in the use of medication to manage bladder outflow obstructive symptoms, which has led to the preoperative post-micturition volumes of urine being increased (>200 ml) at the time of surgical intervention. The mean American Urological Association (AUA) score was 22 (range: 10-35). Due to the reduced bladder tone preoperatively and the noted intraoperative distension of the bladder, early catheter removal is contraindicated in these patients. The mean duration of catheterization was 6.4 days (range: two to 28 days). No patient was readmitted to the hospital for retention of urine. However, 11 patients in the series had re-catheterization due to failure of micturition after the removal of the catheter. No patients were admitted to the hospital for clot retention or sepsis postoperatively. This resulted in the patients being discharged home with a catheter in place, which became our standard practice. Conclusion Conventional transurethral resection of the prostate can be effectively managed in the day surgery setting with minimal morbidity. This improves the patient's quality of life as well as the burden on hospital costs. Additionally, the outpatient nature of day surgery may lead to decreased overall healthcare expenses for both the patient and the healthcare system. As healthcare systems continue to prioritize streamlined and patient-centred approaches, day surgery for TURP emerges as a viable and advantageous option.

Current global status of male reproductive health.

Current global status of male reproductive health.

(033) Artificial Intelligence ChatGPT and GPT4 Performance on Male and Female Sexual Dysfunction, Sexually Transmitted Infection, and Male Factor Infertility in the 2019 to 2023 American Urological Association Self-Assessment Study Programs

Abstract Introduction Large Language Model (LLM) applications in Medicine are increasing. Chatbots ChatGPT and GPT4 were tested against medical exams. The vetting of these tests as a source of information for both the patient and physician is needed. A credible source of medical information may be used as the gold standard against which the LLM can be tested. Objective We assess the performance of ChatGPT and GPT4 to answer the American Urological Association (AUA) Self-Assessment Study Program (SASP) questions on male sexual dysfunction (MSD), female sexual dysfunction (FSD), sexually transmitted infection (STI), and male factor infertility (MFI). We aim to find out how credible this LLM is as a source of medical advice. Methods Four registered users of the SASP identified the questions using open book mode in tests from 2019 to 2023, spanning their subscriptions. The questions were ranked for difficulty on a five-point Likert scale. OpenAI ChatGPT 3.5 and GPT4 were used to answer the questions. The GPT program was set to turn off chat history. No plug-ins or feedback were permitted. Prompts were generated from question stems masking question ID and adding the phrase "I am a urologist preparing for my board exam. Please answer the following question:" Images were deleted from questions and substituted with a brief description. All questions were answered separately, first using GPT-4 and then ChatGPT. Three consecutive responses were generated for each prompt, and the consensus answer was tallied. Answers were compared between GPT and provided answer key of SASP. Descriptive statistics, chi-Pearson Chi-square, and Fisher's exact tests were applied. Results We identified 115 questions in the domains of sexual dysfunction, STI, and MFI. Only one question had an associated image. GPT4 performed better than ChatGPT in all domains, providing correct answers of 60% versus 40% (p=0.000). A total of 89.9% of correct answers were three times unanimously regenerated by GPT4 (p=0.007) and 67.4% by ChatGPT (p=0.244). Within each domain, there was no significant difference in the correct answers for each chatbot (Table-1) or test year (p=0.682). The SASP source reference answers were Campbell's Urology only in 38.3 %, AUA guidelines only in 17.4%, AUA core curriculum only in 10.4%, and combinations with other sources in 33.9%. There was no significant association of source reference with the correct answers of GPT4 (p=0.058) or ChatGPT (p=0.451). Only 19.1% were open-access sources, 20% were partially open-access, and 60.9% were restricted to subscribers. The availability of the source did not significantly affect the correct answers of GPT4 (p=0.272) or ChatGPT (p=0.231). Both chatbots' correct answers were associated significantly with easier questions (Table-2). Conclusions The LLM tested has an average accuracy as a source of credible medical information on Sexual dysfunction, STI, and MFI. GPT4 performs better than ChatGPT, especially when there is a unanimous regenerated response. The development of a better model to serve a broader group of physicians and patients will require training of the chatbot on credible urology literature that includes the currently 81% restricted sources. Disclosure No.

Surgical treatment of cryptorchidism: current insights and future directions.

Cryptorchidism presents with an incidence of 1-5% with potential long-term implications on future fertility and overall health. This review focuses on surgical treatment modalities, their impact on testicular development, and function while addressing the Nordic consensus statement as well as current European Association of Urology (EAU) and American Urological Association (AUA) guidelines. Congenital and acquired cryptorchidism present distinctive challenges in surgical management, with different implications for fertility. While congenital cryptorchidism entails a risk to fertility and warrants early intervention, both retractile testes and acquired cryptorchidism also pose risks to fertility potential, underscoring the importance of evaluating treatment options. Testicular location and the child's age form the basis of a practical classification system for undescended testicles. Early diagnosis by clinical examination enables timely treatment. Imaging is reserved for selected cases only. Following guidelines, orchidopexy is recommended between 6-12 months of age for congenital cryptorchidism. Evidence increasingly suggests the benefits of early surgery for promoting testicular health and fertility potential. Current surgical options range from open to laparoscopic techniques, with the choice largely determined by the location and accessibility of the undescended testicle. The advancement in laparoscopic approaches for non-palpable testes underscores the evolving landscape of surgical treatment. Sequential surgeries may be required depending on the mobility of the undescended testes. More research is needed to explore both the potential and limitations of hormonal therapy, which is secondary to surgical treatment and can selectively have a role as adjunct to surgery. Long-term follow-up is imperative to evaluate fertility outcomes, risk of testicular malignancy, and psychological impact. By integrating current guidelines with the latest evidence, this review intends to facilitate a comprehensive understanding of cryptorchidism, thereby optimizing patient management and outcomes.

Sexual Medicine Society of North America (SMSNA)/American Urological Association (AUA) telemedicine and men's health white paper.

The purpose of this white paper is to educate health care professionals about the evolution of telemedicine (TM) and to propose a hybrid model that leverages the strengths of traditional in-person medicine as well as virtual medicine while maximizing the safety and quality of men's sexual health care. A literature search focused on the use of TM in urology and men's health was performed through PubMed/MEDLINE, Embase, and Web of Science (January 1, 2012-April 26, 2022). Keywords included all known permutations of the terminology used to refer to virtual health, care as well as the terminology used to refer to urologic diseases, issues specific to men's health, and men's sexual health concerns. Publications that emerged after the literature search that met this criterion also were incorporated. Opinion pieces, letters to the editor, meeting abstracts, and conference proceedings were excluded. Additional resources were retrieved, such as governmental technical reports, legislative updates and reviews, and blogs. This search strategy yielded 1684 records across databases after removal of duplicates. Abstracts from the retrieved records were reviewed for relevance. Relevant publications were defined as those that reported data on any aspect of TM use specific to urology, men's health, and/or men's sexual health. If relevance was unclear from the abstract, then the full text of the article was retrieved for a more detailed review. In addition, the published evidence-based practice guidelines relevant to care for erectile dysfunction, Peyronie's disease, ejaculatory dysfunction, and hypogonadism were retrieved. The most common reasons for article exclusions were a focus on TM use in disciplines other than urology and the absence of data (ie, opinion pieces). After exclusions, a total of 91 publications remained and constituted the evidence base for this paper.

G.G. Smith: A Urologist on the Western Front

Objectives World War I (WWI) left a devastating impact on Europe. Urologist George Gilbert (GG) Smith served with a Harvard-associated group of surgeons and nurses stationed at the western front from 1915-1916. First-hand accounts and medical observations from the front are rare, so Smith’s wartime diary is a valuable source to gain further insight into what was once termed the ‘War to End All Wars’. Our objective was to study Smith’s diaries from WWI to better understand the personal and professional experiences and sacrifices of those who fought and served Methods The GG Smith diaries were obtained courtesy of the Smith family. Archives were consulted from the American Urological Association (AUA) William P. Didusch library (Linthicum, MD), Center for the History of Medicine at Countway Library (Cambridge, MA), the British Red Cross, the American Hospital of Paris, and cited secondary sources. Results Smith graduated from Harvard medical school in 1908 after training at Massachusetts General Hospital (MGH). He joined the growing urology faculty at Harvard under the leadership of Hugh Cabot. Following the start of WWI and before the United States’ formal involvement in the war, the Harvard Surgical Unit (HSU) was one of a number of ‘neutral’ medical corps from America’s elite hospitals, composed of individual doctors and nurses who were deployed wherever they were needed for a 3-month tour of duty. As a member of the HSU, Smith was stationed by the warfront, braving air attacks and bombs to care for hundreds of wounded, combatting infections, trauma, and fractious personalities.. The skill in leadership he developed served him well as President of the AUA from 1935-1936, Chair of Urology at MGH from 1938-1945, and President of the Massachusetts Society of Social Hygiene from 1937-1945 Conclusions Smith’s war time diary is testimony to the great philanthropic efforts of America’s institutions during WWI, to the remarkable progress in medical and surgical care that was motivated by the devastation of that war, and to the diversity of people whose pragmatic heroism contributed to the Allied victory.

Refurbishing a Rusty Cystoscope into the Retrospectroscope Award

Objectives The AUA Earl Nation Retrospectroscope Award is presented annually for the best presentation and paper at the annual History Forum. The award, bestowed by voting members of the AUA History Committee, includes a personalized and refurbished Brown-Buerger cystoscope and an AUA honorarium. The history of this prestigious award itself, however, is not widely known. Our objective was to identify the persons, vision, and processes required to establish the award and continue its tradition as a highlight of the annual meeting of the AUA. Methods We reviewed contemporaneous documents including AUA Board of Directors’ Meeting items, AUA archives, History Committee minutes, and notes by the AUA museum curators. Original newspaper archives were obtained as cited from digital resources. Secondary publications regarding the founding of the AUA History Club, the History of Urology Forum, its creators, and the award itself were obtained from the AUA Archives or from on-line resources as indicated. Results The annual History Forum at the American Urologic Association national meeting has been held annually since 1975, modelled after the smaller history meetings moderated by Earl Nation and Frank Bicknell since 1965. The development of an award for the top history paper was proposed at the 2005 meeting and formally approved by the AUA Board of Directors in 2006. During this time the AUA Museum had collected numerous ACMI Brown-Buerger cystoscopes from urologists who were switching to fiberoptic instruments. The Retrospectroscope Award, later named after 1977 AUA President Earl Nation, thus came into existence whereby the winning History Forum presenter would be given one of the donated cystoscopes and a small honorarium. The first Retrospectoscope winner was Shamim Baker for her 2005 paper on the Tuskegee experiment. The prize has been awarded annually for the past 19 years, eventually coming under AUA sponsorship in 2014. Conclusions The History of Urology Club at the AUA began in 1965 but an award for the best presentation has only been awarded since 2006. The AUA website lists prior award winners. The History of Urology Forum has significantly increased in popularity from the original 5 presentations in 1965 to 21 podium presentations in 2022 with 14 posters, a keynote “Bicknell Oration”, and a Medical Ethics Debate. As competition for the AUA Earl Nation Retrospectroscope Award has increased, contenders must submit a completed manuscript in addition to their presentation.

Characterizing the spectrum of bladder health and lower urinary tract symptoms among men: Results from the CARDIA study.

To operationalize a new definition for bladder health, we examined the distribution and impact of lower urinary tract symptoms (LUTS), along with risk factors, among men in the Coronary Artery Risk Development in Young Adults (CARDIA) study. LUTS were defined by American Urologic Association Symptom Index (AUASI) scores and impact on quality of life (QoL). Separate questions assessed urinary incontinence (UI) and postvoid dribbling. We performed cluster analyses using AUASI scores, with and without urine incontinence and postvoid dribbling, and impact collected in 2010-11. We performed analyses to evaluate sociodemographic and cardiovascular risk factors between clusters. Among CARDIA men (mean age: 50.0, SD = 3.6; range: 42-56 years) with complete LUTS data (n = 929), we identified and compared four clusters: men who reported no or very mild symptoms and no impact on well-being (bladder health, n = 696, 75%), men with moderate symptoms and moderate impact on well-being (moderate symptoms/impact, n = 84, 9%), men with high symptoms and high impact on well-being (severe symptoms/impact, n = 117, 13%), and a separate group that reported moderate symptoms and UI with a high impact on well-being (UI + moderate symptoms/severe impact, n = 32, 3%). Exploration of the groupings showed a large percentage of postvoid dribbling across groups (overall 69%). Sociodemographic and cardiovascular risk factors were not associated with symptom/impact groups. Bladder health clustered into four categories. A majority of middle-aged men in the community showed no or mild bladder symptoms without impact on QoL. Postvoid dribbling is pervasive but did not cluster with a specific LUTS or impact category.