Urogynecology Research Articles

Trends Among Female Pelvic Medicine and Reconstructive Surgery Fellowships and Graduates.

Understanding differences in female pelvic medicine and reconstructive surgery (FPMRS) urology and gynecology-based fellowships is important because both are accredited by the American Board of Medical Subspecialties. The aim of the study was to characterize urology-based and gynecology-based FPMRS fellowships. An institutional review board-approved 21-item survey was emailed to Accreditation Council for Graduate Medical Education-accredited FPMRS fellowship program directors from January 8 through March 9, 2021. The survey aimed to characterize fellowships through a series of common and specialty-specific questions. Responses were collected with Qualtrics and analyzed using STATA/MP Version 16.1. The response rate was 75% (52/69). Many programs accept both gynecology- and urology-trained applicants (urology-based fellowships, 45.4%; gynecology-based fellowships, 68.3%) since the Accreditation Council for Graduate Medical Education accreditation in 2012. Within the gynecology-based cohort, there have been 10 urology-trained graduates among 7 programs (n = 1-2). Barriers to accepting urology applicants were limited gynecologic knowledge/experience (n = 14) and length of training (n = 11). Thirty-seven (94.8%) reported their graduates log more than 30 hysterectomies and 8.3% (n = 3) log 3 or more urinary diversions.Within the urology-based cohort, there have been 16 gynecology-trained graduates among 4 programs (n = 2-7). Lack of urologic clinical knowledge (n = 4) and training length (n = 2) were cited as barriers to accepting gynecology-trained applicants. Three (27%) reported that their graduates log more than 30 hysterectomies, while 8 (72.7%) reported that graduates log 3 or more urinary diversions. Despite many FPMRS programs stating that they accept gynecology or urology-trained applicants, few fellows graduate from outside specialty FPMRS training programs. Several barriers were identified that may prevent trainees acceptance outside of their residency specialty. Procedural training experience differs between urology- and gynecology-based fellowships.

Long-term complications of bulking agents in the treatment of stress urinary incontinence: Results of a national survey

Introduction and Objectives: Bulking agents have been used for decades as an alternative treatment for patients with stress urinary incontinence who are not appropriate for surgery. Despite this their long-term complications are poorly documented and can be misdiagnosed. This paper presents a literature review and the results of a national survey of members of the Section of Female, Neurological and Urodynamic Urology (FNUU) of the British Association of Urological Surgeons (BAUS) identifying the common long-term complications of widely used bulking agents in clinical practice. Methods: Following a comprehensive literature review an electronic survey was sent to members of the BAUS Section of FNUU. Data included hospital trust, use of urethral bulking agents (including type), the approximate number of procedures performed and whether any long-term complications had been observed and managed in their practice. Long-term complications were defined as those arising more than 12 months after treatment. Results: The literature review revealed multiple case reports of complications secondary to bulking agent injection but no high-level evidence regarding frequency or severity. The survey revealed complications including granulomas, erosions, abscesses and misdiagnoses of urethral diverticula and calculi formation. 88% of urologists who responded to the survey had performed a urethral bulking agent injection and 51% of urologists had observed or treated a long-term complication, some many decades after injection. Conclusion: Patients should be made aware of possible long-term complications of what appears to be a minimally invasive procedure in order for them to make an informed choice about treatment options. Level of evidence: Not applicable

Effect of COVID-19 on Female Pelvic Medicine and Reconstructive Surgery Fellowship Education and Training.

ImportanceThe COVID-19 pandemic has caused a noticeable disruption in national medical and surgical care, including medical training.ObjectivesWe designed a survey to examine the educational effect of the pandemic on female pelvic medicine and reconstructive surgery (FPMRS) training and secondarily to identify areas for innovation and opportunity in FPMRS fellowship training.Study DesignWe used an online survey, approved by the American Urogynecologic Society Scientific Committee and distributed it to FPMRS fellows with responses obtained and stored in REDCap. Demographic data, educational and surgical experiences, the implications of the changes, and data regarding working from home were collected.ResultsThe survey was completed by 88 fellows, with 92% of respondents being obstetrics and gynecology- based. All 10 geographic regions had at least one response. Six regions had a 50% or greater redeployment rate. Only 16% of respondents were not redeployed or on-call to be redeployed. Eighty-five percent of the ob/gyn fellow redeployments were within their home department. There was no relationship between training region and redeployment. Only 31.7% of the respondents continued to perform any FPMRS surgery. Approximately 35% of the fellows desired the opportunity for surgical simulation training because surgical cases were reduced.No relationship was seen between either redeployment status and needs (P = 0.087–0.893) or difficulties (P = 0.092–0.864) nor training location and needs (P = 0.376–0.935) or difficulties (P = 0.110–0.921).ConclusionsThere was a high rate of redeployment among fellows; however, this was not associated with their reported needs and difficulties. The FPMRS-related surgical experience was affected during this time, and the fellows desired increased surgical simulation training.

The Impact of Social Determinants of Health on Female Sexual Function

ABSTRACT Introduction Social Determinants of Health (SDOH) like economic stability, education, neighborhood & environment, and social and community context, may significantly impact overall health and drive health disparities. Objective Our aim was to evaluate the association between female sexual function and SDOH. Methods We conducted a cross-sectional study of women 18 and older presenting to outpatient female pelvic medicine and reconstructive surgery (FPMRS) clinics at Montefiore Medical Center (Bronx, NY) from November 2018 to November 2019. The Female Sexual Function Index (FSFI-6) was administered to screen for female sexual dysfunction (FSD) and The Accountable Health Communities Health-Related Social Needs Screening Tool to evaluate unmet social needs. Ordinal logistic regression models were used to examine the association between FSD (defined as FSFI-6 score 19 or less for FSD and FSFI-6 >20 as no FSD) and each social need item, while adjusting for potential confounders. Results 89 women were included in the analysis, with mean age 55.7 years (SD=13.5) and mean BMI 32 (SD=8.4). 4.5% were White, 38.2% Black, 48.3% Hispanic, and 9% did not identify a race or ethnicity. FSD was associated with women who spoke a language other than English or wanted more schooling/training, whereas women who were searching for employment were less likely to have FSD. However, needing family or community support for completion of their activities of daily living (AOR=4.27, 95% CI:(1.05, 17.38), p = .04) was the only social need statistically significantly associated with FSD after adjusting for age, race, BMI, parity and previous pelvic surgery in ordinal logistic regression analysis. Conclusions Family or community support is a social need that was associated with FSD in our diverse, urban cohort. Further exploration with patient interviews may reveal social and cultural beliefs that explain this association. Urologists should consider screening for SDOH to better serve patients with FSD. Disclosure No

Effect of Gender on Practice Patterns of Andrology Fellowship Graduates

ABSTRACT Introduction Women in urology are more likely than their male counterparts to treat a majority female patient population, despite training in non-urogynecologic fellowships. Female urology is accordingly one of the most popular fellowship training choices for female urology residents, while less is known about the traditionally male-dominated subspecialties. Objective We sought to evaluate the current landscape of male reproductive and sexual medicine fellowships as well as characteristics of past andrology fellows and post-fellowship career paths. Methods The websites of the American Urological Association (AUA), Society for the Study of Male Reproduction (SSMR), and Sexual Medicine Society of North America (SMSNA) were reviewed for sponsored fellowships. Program coordinators and institutional websites were queried for information including length of training, curriculum, faculty, current and past fellows. A Google search was performed for each institution in combination with the keywords “male reproduction”, “sexual medicine”, “male infertility”, “prosthetics” and “fellowship” to identify former fellows not listed on institutional websites. Medical school, residency program, current employment, and conditions treated as advertised online were noted. Descriptive statistics and t-tests were used to compare outcomes by gender. P values <0.05 were considered statistically significant. Results The SMSNA endorsed 73% of programs (29/40), and SSMR 48% (19/40) while only 45% of all programs (18/40) participated in the 2021 AUA match. Median length of training was 1 year. Median number of fellowship faculty was 2. Only 20% (8/40) programs had any female andrology faculty. The earliest reported fellows dated back to 1982. From 1982-2021, 324 andrology fellows were identified, 53 of whom were female (16.4%). Of the fellows identified, 43.2% (140/324) were currently working in in an academic position, with 54.5% of women pursuing academia versus 45.5% of men (p=0.39). Men and women were equally likely to advertise an exclusive andrology practice, 65.4 and 61.4%, respectively (p=0.78) versus also seeing general urology indications. We assessed for a change in the proportion of female versus male fellows over time by comparing fellows who began training prior to 2010, and those who began training in 2010 or later. The number of andrology fellows increased from 111 to 213 (91.9%), with an increase in the proportion of female fellows from 8.1% to 20.7%, p=0.0038. Conclusions Less than half of andrology fellowships participate in the AUA match and over a quarter are not endorsed by the SMSNA. Only 1 in 5 fellowship programs had a female faculty member. Male andrology fellows were and remained in the majority over time. Despite this, female andrologists were equally likely to pursue academic careers. National urology and andrology societies have taken steps towards standardizing andrology fellowship training however much of the information is not easily available for residents to view. The limited information on fellowship graduates somewhat restricts interpretation of gender-based differences in practice environment. However, we found there was no negative impact in female andrologists’ ability to practice andrology or enter academic careers despite being in a male-dominated subspecialty. While encouraging, further work is needed by andrology societies to make program information accessible to all trainees and standardize the application process. Disclosure No

Voiding Function and Dysfunction, Bladder Physiology and Pharmacology, and Female Urology.

Voiding Function and Dysfunction, Bladder Physiology and Pharmacology, and Female Urology.

Voiding Function, Bladder Physiology and Pharmacology, and Female Urology.

Voiding Function, Bladder Physiology and Pharmacology, and Female Urology.

Do Women Have a Seat at the Table: Trends in Female Representation Among the Board of Directors in American Urological Association Subspecialty Societies.

IntroductionAlthough women remain vastly underrepresented in urology, the proportion of female urology residents and practicing urologists has steadily increased over the last four decades. However, it remains critical to evaluate the representation of females in the pipeline when examining trainees and practicing urologists. As it pertains to leadership positions, the gender distribution among the board of directors (BOD) and committee chairs in the American Urological Association (AUA) subspecialties has not been studied to date. Therefore, we plan to analyze the proportion of females among the BOD and committee chairs in different subspecialty societies recognized by the AUA over time.MethodsWe conducted a cross-sectional observational study, quantitatively comparing the composition of gender in BOD and Committee Chair members belonging to different AUA-recognized subspecialty societies from 2014 to 2020. The websites for each subspecialty society were searched and contacted.ResultsWe evaluated BODs from 10 AUA subspecialty societies and committee chair members from 6 AUA subspecialty societies. From 2014 to 2020, the total proportion of female BOD amongst all AUA sub-specialty societies did not change significantly, with a small increase from 10.6% (n = 29) to 13.5% (n = 36). However, female representation among committee chair members significantly increased from 9.8% (n = 20) to 19.2% (n = 44; p = 0.006), along with the total number of women in urology, from 897 (8.9%) to 1,375 (10.3%). Increases in female representation were seen in the Society for the Study of Male Reproduction (SSMR) from 0% to 9% and in the Indian American Urological Association (IAUA) from 4% to 13%. Of note, there were no elected female board members in the Society of Urologic Oncology (SUO) or the Urologic Society for Transplantation and Renal Surgery (USTRS) from 2014 to 2020.ConclusionFemales remain a minority in leadership positions at AUA sub-specialty societies despite increased female representation in recent years. Future efforts should promote the advancement of women to positions of leadership to reflect the changing landscape of the urology workforce and surgical specialties.

Has the quality of sgs research improved over the years?

The Society of Gynecologic Surgeons’ (SGS) mission is to disseminate knowledge and promote excellence in gynecologic surgery through advancements in research and education. Members are various specialists from both private and academic practice. We aim to determine if the society’s mission has been achieved by examining the increase in research quality measured by the distribution of types of study presented at the SGS Annual meeting. Further, we aim to compare differences in research quality before and after the American Board of Medical Specialties (ABMS) designated Female Pelvic Medicine and Reconstructive Surgery (FPMRS) an accredited subspecialty in 2011. All oral and oral poster presentation abstracts from SGS annual meetings between 2007 to 2021 were reviewed by two investigators, and discrepancies adjudicated by a third investigator. Data extraction included year of abstract, presentation type (oral vs oral poster), study type, and subspecialty topic [FPMRS, Reproductive Endocrinology (REI), Gynecologic Oncology (ONC), Minimally Invasive Gynecologic Surgery (MIGS), General Gynecology (GYN), or other]. Study type was classified from highest quality to lowest quality and included systematic review/ meta-analysis, randomized control trial (RCT), cohort (retrospective or prospective), case-control, cross-sectional, case series/case report, expert opinion, and “other.” The number and categories of presentations was tallied by year and compared. FPMRS studies were further tallied in two groups: before 2011 (accreditation) and after 2011, and groups compared. Data were described as counts/percentages and compared with chi-square. A total of 623 abstracts were reviewed, 305 oral and 318 oral poster presentations. The most common study was a cohort (36.1%), followed by case series or case report (27.7%), and RCT (14.4%). Over the last 15 years, subspecialty representation included 423 (68%) FPMRS, 40 (9.6%) MIGS, 114 (18%) GYN, 20 (3.2%) ONC, 1 (0.1%) REI, and 5 (0.8%) Other. Over time the distribution of type of study changed, p=0.03 and RCT studies increased (Figure 1). The number of high-level studies (RCTs and cohorts) among FPMRS studies has improved after ABMS accreditation in 2011 (p = 0.003, Figure 2). The quality of research presented at SGS annual meetings has increased since 2007 (more RCTs). FPMRS is the most represented subspecialty at SGS annual scientific meetings in the past decade and these studies have most notably demonstrated an increase in quality coinciding with formal ABMS accreditation in 2011.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

Evaluation of linguistic differences by race in letters of recommendation for female pelvic medicine and reconstructive surgery fellowship applicants

Prior studies have reported linguistic differences based on race within letters of recommendation written for residency and fellowship candidates in multiple medical specialties. We sought to determine if linguistic differences based on race exist in letters of recommendation (LORs) for applicants to Female Pelvic Medicine and Reconstructive Surgery (FPMRS) fellowship.

Evaluation of telehealth services in a pelvic floor physical therapy clinic

The Coronavirus pandemic of 2019 (COVID-19) significantly increased telehealth utilization. This study focuses on the use of telehealth in Female Pelvic Medicine and Reconstructive Surgery (FPMRS) patients receiving pelvic floor physical therapy (PFPT). FPMRS patients may face several barriers to care including limited mobility due to incontinence, as well as geographic, social, and transportation barriers. We compared adherence to scheduled in-person visits for PFPT prior to and during COVID-19 with adherence to scheduled telehealth visits during the pandemic.

Pattern of suture use for pelvic organ prolapse surgery

Permanent and delayed suture types may be similar in anatomic outcomes after surgical correction of pelvic organ prolapse; however, surgeon preference could vary. A survey investigating the practice patterns of suture use in female pelvic reconstructive surgery was conducted. An IRB-approved survey was distributed through the Society of Gynecologic Surgeons by a link via email to 278 members and shared on Twitter using #gynecologic surgery, @FPMRS, @Gyn Surgery, and @iugaoffice. Surgeon demographics and suture preference for various pelvic organ prolapse surgeries was queried with 36 questions. Responses were analyzed with descriptive statistics. We received 110/278 (40%) responses from surgeons including 86% urogynecologists, 6% Ob/Gyn, and 8% other. 47% were male, and 52% female. 20% of respondents were 0-4 years in practice, 21% were 5-9 years, 15% 10-15, years 12% 16-20 years, and 33% were >20 years in practice. Most respondents were academically affiliated (73%), whereas 10% were in hospital practice and 15% were in private practice. Most respondents perform >50 prolapse surgeries per year (76%) and 6% perform <20. The majority (99%) were Ob Gyn trained vs Urology trained (1%) and 80% are board certified in Female Pelvic Medicine and Reconstructive Surgery (FPMRS). The types of sutures used varied between the different surgeries (Table 1). Some surgeries had a strong suture preference among surgeons, with 88% of surgeons preferring to use permanent sutures for sacral attachment during sacrocolpopexy, and 56% using delayed absorbable for the vaginal attachment. Delayed absorbable suture was the most common preference for uterosacral ligament suspension (USLS) 54%, and sacrospinous ligament fixation (SSLF) 54%. There was greater disparity in responses regarding suture preference for anterior colporrhaphy, posterior colporrhaphy, and colpocleisis; however, most surgeons reported a preference for absorbable (38-46%) or delayed absorbable suture (32-49%). In this group of predominantly gynecology trained FPMRS surgeons in SGS, there was a strong preference for permanent suture for the sacral attachment for sacrocolpopexy and delayed absorbable for the vaginal attachment. Delayed absorbable suture was also the preference for apical sutures for USLS and SSLF. We acknowledge limitations of small sample size; however, we did query highly trained, high volume surgeons. Our next step is to expand this survey to capture more respondents.

Intravaginal cleansing practices among women attending a female pelvic medicine and reconstructive surgery clinic

To determine the prevalence of intravaginal cleansing practices, the associated factors, and the relationship with vulvovaginal and urinary symptoms amongst women attending a Female Pelvic Medicine and Reconstructive Surgery (FPMRS) clinic. This cross-sectional study was conducted between October 20, 2019 and February 20, 2020. We included women aged eighteen and above who presented for a new patient visit to our FPMRS clinic. We excluded women who were unable to speak and read either English or Spanish and women with a history of dementia. The primary outcome was the overall prevalence of intravaginal cleansing practices among women who practice at least monthly intravaginal cleansing. We obtained baseline demographic and clinical characteristics, information regarding intravaginal/vulvar cleansing practices, vulvovaginal/urinary symptoms, as well as the history of treatment for urinary/vaginal infections during the preceding 12 months. Validated questionnaires including the Vulvovaginal Symptom Questionnaire (VSQ) and the Urinary Distress Inventory Short Form (UDI-6) were collected. Data was analyzed utilizing Student’s t-test and chi-squared test or Fisher’s exact test, as appropriate. Seventy-nine women were recruited in this study. The mean age was 61.1±14.5 years. Most women were white (75%), married (62%), born in the United States (81%), with a bachelor’s degree or higher (49%), with incomes above $100,000 (45%), non-smokers (93%), currently sexually active (53%) and not currently using vaginal estrogen (85%). Fifteen women (19%) reported current intravaginal cleansing practice. The most common reasons for intravaginal cleansing were cleanliness (100%), reducing unpleasant odors (58%), protection against infections (33%), and cleaning after and before sexual intercourse (42% and 25%, respectively). Vulvovaginal symptoms were significantly higher in women who currently perform intravaginal cleansing (19%) compared to those who do not (81%) (p=0.02). However, there were no significant correlations between intravaginal cleansing and sensation of vaginal bulge or UDI-6 score (p=0.78 and p=0.07, respectively). Moreover, urinary tract and vaginal infections treatment over the prior twelve months were not associated with current intravaginal cleansing (p=0.3 and p=0.98, respectively). Despite its potential adverse effects, intravaginal cleansing is still a common practice among women across various age groups. Vulvovaginal symptoms were higher in women who cleansed intravaginally, whereas urinary tract and vaginal infections were not associated. Larger and more diverse populations are necessary to more accurately determine possible associations with intravaginal cleansing.

Comparing Laparoscopic Sacrocolpopexy with Vaginal Sacrospinous Ligament Fixation in the Treatment of Vaginal Apical Prolapse; the First Randomized Clinical Trial: A pilot study.

To compare two methods of laparoscopic sacrocolpopexy (LSCP) and sacrospinous ligament fixation (SSLF) in terms of efficacy and safety in the treatment of vaginal apical prolapse. This prospective, randomized controlled clinical trial was conducted on 32 patients with symptomatic vaginal apical prolapse, referred to the female urology clinic of Kerman University, Iran, during 2018-2019. The patients were re-examined at 12 months after surgery. Objective success was recorded using Pelvic Organ Prolapse Quantification (POP-Q) classification as primary outcome. The subjective success of the methods was determined by the quality-of-life parameters, based on Pelvic Floor Impact Questionnaire (PFIQ-7), Pelvic Floor Distress Inventory (PFDI-20), and Organ Prolapse/Urinary Incontinence Sexual Questionnaire (PISQ-12) scores as secondary outcomes. Moreover, complications were recorded in both groups. The amount of intraoperative bleeding was significantly higher in the SSLF group, compared to the LSCP group (P = 0.01). Persistent pain was observed in two (12%) patients in the LSCP group and five (31%) patients in the SSLF group (P = 0.2). The decrease in the total PFIQ-7 score was in favor of the LSCP group but not statistically significant (p = 0.06). The LSCP group showed bigger improvement in vaginal (p = 0.04) and bowel (p = 0.03) scores. The results of the PISQ-12 and PFDI-20 questionnaires as well as POP-Q examination were not different in two groups. Although the surgical methods of LSCP and SSLF can be equally effective in the treatment of apical prolapse, LSCP appears to be superior to SSLF regarding less bleeding.

Sex and Racial/Ethnic Diversity in Accredited Obstetrics and Gynecology Specialty and Subspecialty Training in the United States

To compare trends in racial and gender diversity in Obstetrics and Gynecology (OBGYN) residency and fellowship programs from beginning of program accreditation in 2012 to the most recently published report for 2018. Data was abstracted in August 2020 from publicly available reports on the Accreditation Council for Graduate Medical Education (ACGME) website. Reports from 2012 to 2018 were compared with Chi-square tests and the Cochran-Armitage trend test assessed trends over time. U.S. medical residents and fellows, with a focus on those in accredited OBGYN fellowship programs (Female Pelvic Medicine and Reconstructive Surgery (FPMRS), Gynecologic Oncology (GYNONC), Maternal Fetal Medicine (MFM), and Reproductive Endocrinology and Infertility (REI)). From 2012 to 2018 men in all residency programs increased 0.88% (from 53.92% male to 54.80%, p < 0.0001). Across all years there were less men in OBGYN (16.89%) compared to all residency programs (54.39%, p < 0.0001). All OBGYN fellowships combined had more men proportionately than OBGYN residencies (24.14% vs. 16.89%, p < 0.0001). MFM had the most men (26.7%) then GYNONC (25.18%), FPMRS (21.36%), and REI (20.09%) (p = 0.024). There were no statistically significant trends in sex or race over time. From 2012 to 2018 residents overall were 42.96% white. OBGYN residents overall were 54.20% white. GYNONC had the highest percentage of white trainees (73.45%), followed by MFM (67.8%), REI (65.62%), then FPMRS (60%) (p = 0.0003). According to ACGME core competencies, residents are expected to demonstrate sensitivity and responsiveness to diverse patient populations (professionalism) and advocate for improvements to systems-based practice. These results may suggest systemic issues in the recruitment of women and people of color into competitive sub-specialty programs. Such deficiencies in representation can impact patient care. Future research is needed to assess trends over time as data become available and to evaluate specific barriers to applications and selection of minority applicants.

Voiding Function and Dysfunction, Bladder Physiology and Pharmacology, and Female Urology.

Voiding Function and Dysfunction, Bladder Physiology and Pharmacology, and Female Urology.

Development of a questionnaire set to evaluate adaptations to COVID era: The ICS TURNOVER project (Transition of fUnctional uRology to New COVID ERa).

Coronavirus disease 2019 (COVID-19) pandemic has caused a massive cutdown in outpatient urological investigations, procedures, and interventions. Female and functional urology (FFU) has been probably the most affected subspecialty in urology. Several scientific societies have published guidelines to manage this new situation, providing general recommendations. The aim of this study was to devise a robust questionnaire covering every different aspect of FFU to obtain recommendations on COVID-19 adaptations. Delphi methodology was adapted to devise the survey questionnaires for male/female lower urinary tract symptoms (LUTS), pelvic organ prolapse (POP), chronic pelvic pain (CPP), and neuro-urological disease. Content validity, face validity, and internal consistence were assessed to establish the final questionnaire. This study was ethically approved by the Local Research Ethics Committee. A total 97, 59, 79, 85, and 84 items for female and male LUTS, POPs, CPP, and neuro-urology respectively were approved by the participants. Content validity over 0.70 was obtained which seemed reasonable content validity scores. Internal consistency obtains values of Cronbach's alpha was between 0.70 and 0.90 which was acceptable. The collective wisdom obtained through a global survey using validated questionnaires covering every different aspect of FFU patient management is necessary. We have developed a robust and validated tool consisting of five questionnaires covering the most prevalent pathologies in FFU.

How did the first year of the COVID-19 pandemic affect urology practice in Arab countries? A cross-sectional study by the Arab Association of Urology research group.

Objective:The aim of this study was to assess of the effect of coronavirus disease 2019 (COVID-19) pandemic on urology practice in the Arab world during the first year of the crisis.Methods:An Internet-based questionnaire was created and sent out via email to members of the Arab Association of Urology (AAU) using ‘Google Forms’. The survey assessed participants’ demographics in terms of age, gender, country of origin, type of practice and position. Impacts of COVID-19 on urological practice were assessed in terms of the changes in hospital policies regarding consultations, and elective and emergency surgical cases. Moreover, impacts of COVID-19 on urologists were assessed.Results:A total of 255 AAU members across 14 Arab countries (Emirates, Egypt, Saudi Arabia, Iraq, Jordan, Algeria, Kuwait, Yemen, Qatar, Lebanon, Libya, Oman, Sudan and Syria) completed the survey; 4% were female urologists. Consultations at outpatient clinics were closed or restricted to emergency cases or replaced by telemedicine in almost 15%, 40% and 25% of hospitals, respectively. Elective surgeries were stopped or reduced to under 25% of surgical capacity in >10% and about 25% of hospitals, respectively. Almost 90% (228) reported changes in the policy for emergency theatres. Nearly 65% of hospitals offered preoperative COVID-19 testing to patients and 50% of hospitals provided personal protective equipment (PPE) to their urologists. Of 99% (253) who reported a change in urological education, 95% relied on online webinars. About 56% of respondents had their own private practice, of whom 91% continued private practice during the crisis. About 38% of participants reported exposure to intimidation (75% emotional, 20% verbal and 5% physical).Conclusion:The COVID-19 pandemic resulted in major changes in hospitals’ policies regarding outpatient consultations, elective and emergency operative cases, and the shift to telemedicine. Arab urologists have been facing major challenges either in both the governmental or the private sectors, and some of them were exposed to emotional, verbal and even physical intimidation.

Redefining the Gender Gap in Urology Authorship: An 18-Year Publication Analysis

BackgroundAcademic authorship is a critical productivity metric used for academic promotion. ObjectiveTo characterize temporal changes in female representation in academic authorship in ten primary urology journals as the complement of female urologists is increasing. Design, setting, and participants:Publication records were retrieved from 2002 to 2020 for the ten urology journals with the highest impact factor. The names of all authors were gathered and gender was inferred using first names. Outcome measurements and statistical analysisTrends in first and last/senior authorship by gender were evaluated overall, within journals, and by geographic region. ResultsA total of 59,375 articles were analyzed, of which 94.1% had gender information for the first author and 94.2% had gender information for the last author. The percentage of overall female authors increased positively from 17.2% (95% highest density interval [HDI] 12.9–21.4%) in 2002 to 27.2% (HDI 21.7–33.6%; p < 0.01) in 2020. Overall female first authorship increased from 15.2% (95% HDI 11.0–19.5%) to 28.5% (95% HDI 21.8–35.6%; p < 0.01). There was also significant growth for female senior authors from 10.4% (95% HDI 7.6–13.5%) to 18.6% (95% HDI 13.6–23.8%; p < 0.01). Assessment of journal-specific changes revealed that Neurourology and Urodynamics (12.6%, 95% HDI 9.9–15.1%) and The Journal of Sexual Medicine (16.2%, 95% HDI 13.6–19.0%) had significantly higher growth in female authorship when compared to Journal of Endourology (7.2%, 95% HDI 5.5–8.7%) and Urologic Oncology (4.5%, 95% HDI 2.0–6.8%; p < 0.05). ConclusionsAlthough overall female authorship increased between 2002 and 2020, women remain underrepresented in urology authorship. The percentage of females in senior (last) author positions is less than the percentage of females in first author positions. Journal-specific differences can probably be attributed to gender-based differences in subspecialized fields. Patient summaryIn this study, we characterized the underrepresentation of women as authors in urology journals and analyzed the change in female authorship for ten academic urology journals over the course of 18 years. Although the proportion of female authors has increased over that time, the percentage of females in senior authorship roles is less than the percentage of females in first author positions.

Professional roles of female urologists: A webinar-based survey of perceptions and obstacles to career development.

Urology, traditionally a maledominated specialty, keeping pace with the quickly changing gender landscape, has been characterized by waves of feminization. This study aims to understand the perspectives of women urologists on the obstacles to their career development, and the impact of such hurdles on their professional roles in urological education, practice, and leadership. 119 female urology residents/consultants were surveyed via a webinar-based platform, covering relevant questions on domains of Academia, Mentorship, Leadership, Parenting, and Charity. Statistical analysis was done using frequency distribution based on the responses. 46.8% of the respondents felt that there is an under-representation of women in academia. 'Having a good mentor' was the most important factor for a novice to succeed in academia (68%). The most important trait in becoming a good leader was 'good communication skills' (35%), followed by 'visionary' (20%). The greatest challenge faced by leaders in the medical field was considered as 'time management' (31.9%). Only 21.2% of the participants felt difficulty in having a work-personal life balance, whereas 63.8% of them found it difficult only 'sometimes'. As a working parent, 'the guilt that they are not available all the time' was considered the most difficult aspect (59.5%), and 'more flexible schedule' was needed to make their lives as a working parent easier (46.8%). 34% of the respondents were affiliated with some charitable organizations. The biggest drive to do charity was their satisfaction with a noble cause (72.3%). Need for increased encouragement and recruitment of females into urology, and to support and nurture them in their career aspirations.