Urology Residents Research Articles

The Financial Relationship Between the Medical Industry and Residency Leadership in OB/GYN and Urology.

Background Industry payments to physicians exceed millions of dollars. Payments can influence physicians' practices and potentially impact trainees. Objective To examine the magnitude of industry payments to obstetrics and gynecology (OB/GYN) and urology residency directors and department chairs in the United States. Methods For this retrospective cross-sectional study, program directors and department chairs of OB/GYN and urology residency programs were identified in December 2021. Nonresearch payments between August 1, 2013, and December 31, 2020, from drug or device manufacturers to program directors and department chairs of OB/GYN and urology residency programs were compiled from the Centers for Medicare & Medicaid Services Open Payments Database. Statistical analysis was conducted using the Kruskal-Wallis test and a linear mixed-effects model. Results A total of 19 903 payments, totaling $6,041,585, were provided to 396 physicians, with a median of $232.62 per physician over the 6 years analyzed. Urologists received more payments and higher amounts per payment than OB/GYNs (7820 vs 12 083, P<.01; $1,689,519.48 vs $4,352,066.40, P<.01). Department chairs received more payments per year than program directors (8 vs 4, P<.01). There were also geographic differences, with higher payments in the Northeast US region ($131.10 more, P<.01). Based on the linear mixed-effects model, 3 variables predicted the magnitude of industry payments received: physician age, number of years in leadership position, and geographic location. Conclusions Urologists and OB/GYN US residency program directors and department chairs received considerable nonresearch industry payments from 2013 to 2020.

Editorial Comment: Utilization of Instagram by Urology Residency Programs for Applicant Recruitment

Editorial Comment: Utilization of Instagram by Urology Residency Programs for Applicant Recruitment

Utilization of Instagram by Urology Residency Programs for Applicant Recruitment

Purpose: To assess Instagram content and trends by urology residency programs. Materials and Methods: A cross-sectional analysis of urology residency program Instagram accounts was completed after data collection between October 1 and 20, 2022. Included accounts were reviewed and descriptive details were recorded, such as number of followers, those followed, and post content. All posts were then coded on a predetermined list of 7 categories: (1) resident promotion; (2) faculty/departmental promotion; (3) activities outside medicine; (4) research, presentation, or awards; (5) urology match/application-related promotion; (6) “urology in general”; and (7) other. Results: Overall, 66 of 147 (44.9%) programs had an account at the time of analysis. About half (31 of 66, 47%) of accounts were created between June and December 2020. Accounts had a median of 633 followers (IQR: 254,844) and 39 posts (IQR: 18,64). Of the 3236 posts analyzed, the majority featured residents or activities outside medicine; video posts were least used. Posts promoting residents had significantly higher average likes per post compared with all other categories except posts about “urology in general.” Conclusions: To our knowledge, this is the first study analyzing the use of Instagram by urology residency programs for recruitment. Our study describes an increasing number of urology residency program Instagram accounts for showcasing residents and life outside of medicine to engage with followers.

Gender Bias in Letters of Recommendation: Relevance to Urology Match Outcomes and Pursuit of Fellowship Training/Academic Career

To review applications to a single urology residency program to determine application characteristics predictive of (1) successful match into urology residency and (2) pursuit of fellowship training and/or academic practice after completion of residency. Our principal variables of interest were gender bias as assessed in letters of recommendation (LOR), personal statements, Medical Student Performance Evaluation (MSPE), race, and gender. Applications submitted to our urology residency program in the 2014 cycle were reviewed. Twenty-three variables were analyzed, including applicant demographics, application materials, and gender bias. Deidentified text from LOR, personal statements, and MSPE was evaluated for gender bias using an open-source gender bias calculator. A subanalysis of applicants who matched at a top 25 urology program was performed. Logistic regression analysis was performed to identify applicant variables associated with (1) match success and (2) fellowship training or academic employment as of September 2021. Two hundred and twenty-two completed applications were analyzed. First authorship of a published manuscript was significantly associated with greater odds of matching. Female gender and top 25 medical school attendance were both significant predictors of matching at a top 25 urology program. The number of first-author publications was associated with completion of fellowship training or current employment in an academic position. First-author publications are the most important preinterview determinant of match success and subsequent pursuit of academic practice/fellowship training. Certain applicant characteristics are associated with matching at highly ranked programs. Gender bias in application materials (including LOR) does not appear to exert a significant influence on match and early career outcomes.

Urology Match: Important Factors Women Consider When Choosing a Residency Training Program

ObjectiveTo determine factors that women urology resident physicians rate as most influential when selecting residency programs. MethodsSurveys were emailed to female urology residents during the 2021-2022 academic year. Residents scored 19 factors influencing residency program choice from 1 “least” to 5 “most” important and ranked their top five most influential factors. Data was analyzed via descriptive statistics and quantile regression. ResultsOne hundred thirty-six (37%) of 367 female urology residents who received the survey participated. 82% percent had no children and 57% did not plan to have children during residency.The three highest scoring factors derived from Likert scale ratings were: resident camaraderie (4.6 ± 0.5 [mean ± SD]), resident happiness (4.6 ± 0.6), and case variety/number (4.4 ± 0.8). As a whole, the lowest scoring characteristics were attitudes toward maternity leave (2.6 ± 1.2) and maternity leave policies (2.5 ± 1.2).Married residents were more likely than those who were single and engaged/in a committed relationship to rank attitudes and policies towards maternity leave as more important (3 vs. 2 vs. 2, p < 0.0001). Residents with children were more likely than those without children to rank maternity leave policies as more important (3 vs. 2, p < 0.0001). ConclusionsAs a whole, women urology residents prioritized non-gender-related factors. However, gender-specific factors were rated highly by married residents and those with children or planning to have children. Urology training programs may use these results to highlight desirable characteristics to aid recruitment of female residents.

Selecting an Endourology Society Fellowship Program: The Candidates' Perspectives.

Introduction: Understanding the factors that influence the decision of urology residents to pursue an Endourology Society (ES) fellowship and the criteria used by applicants to rank programs may help residents and program directors (PDs) optimize the match process. In the present study, we surveyed current ES fellows to gain better insight surrounding their decision-making process. Materials and Methods: A survey was emailed to all ES fellows, comprising Endourology and Stone Disease (ESD), Laparoscopic and Robotic Surgery (MIS), and combination of ESD/MIS (COM) programs. A Likert scale ranging from 1 to 5 was used. The survey captured demographics such as geographic region, program type, duration, applicants' reasons for pursuing fellowship, criteria for ranking programs, and perceived improvements in surgical comfort levels at the end of their training. Results: Out of the 60 fellows who were surveyed, 40 (66.7%) responded. Among the respondents, 9 (22.5%) pursued ESD, 10 (25%) pursued MIS, and 21 (52.5%) pursued COM programs. The primary reason for seeking a fellowship was to improve surgical skills while increasing earning potential and enhancing research opportunities were deemed the least important. Fellows enrolled in 1-year programs were less likely to pursue fellowships for academic reasons. The two most significant factors in selecting a program were both related to gaining operative experience. Lastly, there was an increase in the level of comfort performing all endourological surgeries independently after fellowship. Conclusions: ES fellowship is seen as an opportunity to hone surgical skills and increase job competitiveness. When selecting a program, operative experience is the most important factor, and fellowship improves operative confidence. The information obtained from this study may mutually help guide future applicants and PDs in the decision process of the Endourology Match.

Predictors of Excellent Urology Residents at the Time of the Urology Match

ObjectiveTo update our experience and report on features predictive of high quality urology residents at the time of the urology match, because data predicting which medical students will mature into excellent urology residents are sparse. MethodsWe reviewed our experience with 84 urology residents who graduated from 2006 to 2023. Residents were independently scored 1-10 based on overall quality by the current and former Program Director. Discrepant scoring by >2 was resolved by an independent review. Associations of features from the medical student application with an excellent score (defined as 8-10) were evaluated with logistic regression. ResultsDiscrepant scoring >2 was noted in only 5 (6%) residents. Among the 84 residents, the median overall score was 7 (range 1-10) and 36 (43%) residents had an excellent score of 8-10. Univariably, higher USMLE step II score (p=0.03), election to AOA (p=0.004), no negative interview comments (p=0.002), honors in OB/Gyn (p=0.048) and psychiatry clerkships (p=0.04), and honors in all core clinical clerkships (p<0.001) were significantly associated with an excellent score. In a multivariable model, no negative interview comments (p=0.003) and honors in all core clinical clerkships (p=0.001) were independently associated with an excellent score (c-index 0.76). There were several notable features (sex, letters of recommendation, USMLE step I, externship at our institution, surgery clerkship grade, and rank list) that were not significantly associated with excellent residents. ConclusionsWe demonstrate features associated with excellent urology residents, most notably no negative interview comments and an honors grade in all core clinical clerkships.

A survey of exposure to the use of Xiaflex for the treatment of Peyronie's disease among United States urology residency programs.

Xiaflex® (collagenase clostridium histolyticum) is a Food and Drug Administration-approved treatment for patients with Peyronie's disease. Despite its approval and implementation, there is concern that urologists in training are offered minimal exposure to its use. Thus, the purpose of this study was to evaluate the exposure of urology residents to Peyronie's disease and its management, particularly Xiaflex®. A Google Forms survey regarding the exposure of residents to Peyronie's disease and use of Xiaflex® was created and disseminated through email to urology programs. Overall, 47 institutional responses were received. At 45 institutions (95.7%), residents receive training in directly evaluating and caring for patients with Peyronie's disease. At 46 institutions (97.9%), residents receive training in observing and/or performing surgical procedures for Peyronie's disease. Residents at 31 institutions (66.0%) receive observational or procedural training for non-surgical management of Peyronie's disease, specifically Xiaflex®. Residents receive non-surgical training from an academic faculty who is fellowship trained in sexual medicine at 25 institutions and an academic faculty not trained in sexual medicine at six institutions. There exists a glaring disparity in residency exposure to Xiaflex®. Further research is warranted to elucidate how programs can provide residents with further exposure to the use of Xiaflex® in patients with Peyronie's disease.

Improving the Educational Gap with Implementing of Teaching Scholarship in Virtual Multidisciplinary Tumor Boards

Background: Cancer management has become increasingly challenging due to the emergence of a personalized approach that requires careful assessment, multidisciplinary efforts, and experienced physicians. Objectives: Because of the COVID-19 pandemic’s effect on executing all medical meetings as well as multidisciplinary tumor boards (MTB), we decided to design, perform, and evaluate a teaching scholarship in virtual MTB for urologic cancer patients. Methods: In this prospective study from December 2020 to July 2022, the authors evaluated the designing, implementation, and learning efficacy of a virtual tumor board in the Urology Department of Shahid Beheshti University of Medical Sciences (SBMU). All the faculty members (N = 25) and urology residents (N = 35) were included in this investigation. To make the sessions multidisciplinary, other related departments including pathology, radio-oncology, medical oncology, radiology, and nuclear medicine were also included. Virtual tumor boards were implanted monthly in 20 sessions. Results: A short interview was conducted for the needs assessment. The faculty members' and residents’ statements were divided into high, intermediate, and low importance. After implementation, a satisfaction questionnaire based on the first level of the Kirkpatrick model was recorded and the means were 76% and 71% in faculty members and residents respectively for virtual execution. The results of evaluating the intervention according to the second level of the Kirkpatrick model and through the tests before and after tumor boards were recorded and the mean differences evaluated by paired t test were statistically significant. In the last step for external evaluation, the satisfaction rate of 5 arbitrators was 75% for executing a proper virtual MTB. Conclusions: A virtual board is an effective learning method for the medical education of urology residents. It could help the practitioner to coordinate and discuss with different specialties and lead to the best decision for urologic cancer patients.

Recent Advances in Surgical Simulation For Resident Education.

Surgical simulation has become a cornerstone for the training of surgical residents, especially for urology residents. Urology as a specialty bolsters a diverse range of procedures requiring a variety of technical skills ranging from open and robotic surgery to endoscopic procedures. While hands-on supervised training on patients still remains the foundation of residency training and education, it may not be sufficient to achieve proficiency for graduation even if case minimums are achieved. It has been well-established that simulation-based education (SBE) can supplement residency training and achieve the required proficiency benchmarks. Low-fidelity modules, such as benchtop suture kits or laparoscopic boxes, can establish a strong basic skills foundation. Eventually, residents progress to high-fidelity models to refine application of technical skills and improve operative performance. Human cadavers and animal models remain the gold standard for procedural SBE. Recently, given the well-recognized financial and ethical costs associated with cadaveric and animal models, residency programs have shifted their investments toward virtual and more immersive simulations. Urology as a field has pushed the boundaries of SBE and has reached a level where unexplored modalities, e.g., 3D printing, augmented reality, and polymer casting, are widely utilized for surgical training as well as preparation for challenging cases at both the residents, attending and team training level.

The Role of Alumni Networks and Career Advising in Early Career Stability of Urologists: Results of a Multi-institutional Study

To characterize training program and early career factors that impact decision-making and job retention following graduation in a diverse population of urologists. We performed a computer-based survey distributed to residency graduates from 25 urology training programs. Five focus institutions were identified with a goal >30% response rate. The survey included questions about training program specifics and post-training employment characteristics. We obtained 180 responses from urology residency graduates of 25 programs. Overall, 72% (N = 129) remain in their initial post-training position at a median of 6years postgraduation (Interquartile Range (IQR) 3-10). On Cox-regression analysis stronger trainee-rated formal career advising was associated with lower risk of changing jobs (HR 0.77, 0.60-0.99, P = .048). Location/proximity to family was the most consistently cited as the top reason for selecting a job (41%). Sixty-three respondents (35%) joined practices employing graduates of the same residency program. Cox regression analysis showed that joining a practice with alumni of the same program was associated with lower risk of changing jobs from one's initial post-training position (HR 0.39, 95% CI 0.17-0.91, P = .03). In this multi-institutional study of urologists, we observed a high rate of job retention out to a median of 6years following completion of training, with formal career advising and joining alumni in practice being associated with job retention. Collectively, our data highlights that training programs should emphasize advising programs and alumni networking in guiding their graduates in the job search process.

Confronting new challenges: Faculty perceptions of gaps in current laparoscopic curricula in a changing training landscape

BackgroundOpportunities for residents to develop laparoscopic skills have decreased with the rise in robotic operations and the development of complex, subspecialized laparoscopic operations. Given the changing training landscape, this study aimed to identify laparoscopic surgeons' perceptions of gaps in current laparoscopic skills in general surgery, obstetrics-gynecology, and urology residency programs. MethodsLaparoscopic surgeons who operate with residents participated in semi-structured interviews. Questions addressed expectations for resident proficiency, deficits in laparoscopic surgical skills, and barriers to learning and teaching. Two authors independently coded de-identified transcripts followed by a conventional content analysis. ResultsFourteen faculty members from thirteen subspecialties participated. Faculty identified three main areas to improve laparoscopic training across specialties: foundational knowledge, technical skills, and cognitive skills. They also recognized an overarching opportunity to address faculty development. ConclusionsThis qualitative study highlighted key deficiencies in laparoscopic training that have emerged in the current, changing era of minimally invasive surgery. Key messageThis qualitative study identified laparoscopic educators' perceptions of deficiencies in laparoscopic training. Findings emphasized the importance of incorporating high quality educational practices to optimize training in the current changing landscape of laparoscopic surgery.

Urologist Workforce and Services in Ethiopia.

Urological conditions are a cause of diminishing quality of life, hence affecting productivity. Despite the need for urological treatment, it was excluded from receiving priority in both United Nation and Lancet commission. Most of the surgeries in sub-Saharan Africa are open surgeries. The lack of basic endourology equipment and a shortage of experts have limited Africans from receiving the privileges of minimally invasive surgeries, especially in urology. This study describes the socio demographics of the urologists in Ethiopia, the field of services they provide and their access to endourology equipment. This study presents data from a survey of urologists in Ethiopia who are members of Urology Society of Ethiopia (USE). Thirty-three urologists of the 43 responded, making the response rate 76.5%. Qualification by urology residency in Ethiopia accounted for 66.7% of participants, followed by 21.2% by fellowship training abroad after general surgery training. All respondents practice open surgeries and 75.8% perform endourology. Video endoscope and cystoscopy sets were available to all those practicing endourology, with Direct Visual Internal Urethrotomy (DVIU) sets having the next highest availability and Flexible UreteroRenoScope(URS) and laser lithotripters the least accessible. Urology in Ethiopia is in its infancy, where the lack of advanced medical equipment combined with a paucity of qualified urologists have created a huge challenge for the provision of these services.

Expanding horizons and navigating challenges for enhanced clinical workflows: ChatGPT in urology.

ChatGPT has emerged as a potential tool for facilitating doctors' workflows. However, when it comes to applying these findings within a urological context, there have not been many studies. Thus, our objective was rooted in analyzing the pros and cons of ChatGPT use and how it can be exploited and used by urologists. ChatGPT can facilitate clinical documentation and note-taking, patient communication and support, medical education, and research. In urology, it was proven that ChatGPT has the potential as a virtual healthcare aide for benign prostatic hyperplasia, an educational and prevention tool on prostate cancer, educational support for urological residents, and as an assistant in writing urological papers and academic work. However, several concerns about its exploitation are presented, such as lack of web crawling, risk of accidental plagiarism, and concerns about patients-data privacy. The existing limitations mediate the need for further improvement of ChatGPT, such as ensuring the privacy of patient data and expanding the learning dataset to include medical databases, and developing guidance on its appropriate use. Urologists can also help by conducting studies to determine the effectiveness of ChatGPT in urology in clinical scenarios and nosologies other than those previously listed.

Understanding the prevalence and distribution of fellowship trained female and male genitourinary reconstruction and men's health/andrology academic faculty in the United States.

We evaluated the prevalence, distribution, and specialist to population ratio of male and female reconstruction and andrology/prosthetics faculty within United States urologic training programs. Our objective was to help determine the current need/demand for reconstructive fellowship trained faculty for necessary clinical exposure during residency in the midst of a nationwide residency expansion. All non-military urology residency programs were evaluated. Programs were sorted into their American Urologic Association Sections and websites were analyzed for evidence of fellowship training and/or clinical expertise/interest: (I) male genitourinary reconstruction (MGR); (II) female genitourinary reconstruction (FGR) and (III) infertility/andrology/men's health (AMH). The 2020 US Census data was used to determine specialist to population ratios by sections. Of 137 evaluated programs, FGR had the highest percentage of fellowship-trained faculty (76%) followed by AMH (66%) and MGR (61%). Clinical/surgical interest was noted in pelvic organ prolapse (88%), inflatable penile prosthesis (79%) and urethral stricture disease (75%). Over 10% of training programs had two or more faculty with MGR, FGR and AMH fellowship training. Significant geographic variation amongst academic programs exists with the South and Southeastern parts of the US being relatively underserved, both in percentage of programs with fellowship-trained faculty, and by faculty per 1,000,000 inhabitants. The majority of US urology residencies have faculty with fellowship training and/or stated clinical interest in MGR, FGR and AMH. Still, many programs remain without these faculty while others have two or more in their respective fields. The geographic trends noted here have both educational and recruitment significance.

Effects of standardized language on remote ultrasound-guided percutaneous nephrolithotomy training: A mixed-methods explorative pilot study

BackgroundRemote teaching of procedural skills has demonstrated equivalence in knowledge acquisition compared to in-person teaching. Variations in terminology for probe and needle movements may serve as a barrier in remote training of ultrasound (US)-guided renal access for percutaneous nephrolithotomy (PCNL). This pilot study investigated the utility of standardized terminology in remote training of US-guided renal access for PCNL. HypothesisStandardization of verbal terminology to describe US probe and needle movement instruction improves remote teaching of US-guided renal access. MethodsFifteen urology residents (PGY1-6) were stratified by year and randomized into two groups. We provided participants with images illustrating US probe and needle movements labeled with predetermined standardized terminology for the intervention group and images without labels for the control group. Both groups were asked to perform US-guided renal access on a training mannequin with a remote faculty educator with (intervention) or without (control) use of standardized movement instructions. Quantitative outcomes included number of attempts and time to achieve access. All trainees completed pre- and post-session surveys and participated in focus groups; authors conducted thematic analysis of focus group transcripts. ResultsDifferences in primary outcomes between groups, including number of attempts and time to achieve access of the renal pole, were not statistically significant. Analysis of focus group interviews revealed that the use of standardized terminology in the setting of remote training can reduce trainee confusion by clarifying ambiguity in educator feedback. DiscussionUse of standardized terminology during remote surgical skills training allows for more effective feedback to trainees.

Evaluating the perceptions of Canadian urology residents and program directors regarding the current training in genitourinary imaging.

Competency in interpreting genitourinary (GU) imaging is an important skill for urologists; however, no nationally accredited GU imaging curriculum exists for Canadian urology residency training programs. The main objectives of our study were to 1) characterize GU imaging training in Canada; (2) evaluate residents' self-perceived competencies in interpreting GU imaging; (3) explore program directors' (PD) and residents' perceptions regarding the current imaging curriculum and suggestions for future directions. From November to December 2022, a survey examining current imaging education in residency, perceived resident imaging knowledge, avenues for improvement in imaging education, and the role of point-of-care ultrasound within urology was distributed to all Canadian urology PDs and residents. All PDs (13/13) and 40% (72/178) of residents completed the survey. Only two programs had a formal GU imaging curriculum. PDs and residents reported trainees were least comfortable interpreting Doppler ultrasound of renal, gonadal, and penile vessels. PDs reported that residents were most comfortable with non-contrast computed tomography (CT) scans (9.5/10), CT urogram (9.3/10), and retrograde pyelography (9.3/10). All but one PD favored increasing imaging training in their program. PDs highlighted the lack of time in the curriculum (n=3) and lack of educators (n=3) as the primary barriers to increasing imaging training in their program. Most PDs and residents believe there needs to be more imaging training offered at their institution; however, addressing this is challenging due to the limited time in the curriculum and the need for available educators.

Does experience change the role of systematic biopsy during MRI-fusion biopsy of the prostate?

PurposeTo determine the role of biopsy experience regarding a potential benefit of additional systematic biopsies and fusion failures during MRI-targeted biopsy of the prostate.Subjects/patients and methodsWe retrospectively evaluated 576 men undergoing transrectal (MRI)-targeted biopsy of the prostate by seven residents in urology between November 2019 and March 2022. Benefit of systematic biopsies (detection of ISUP ≥ 2 PCa (clinically significant PCa (csPCa)) solely in systematic biopsies) and fusion failure (detection of csPCa during systematic biopsies in the area of a reported MRI-lesion and no detection of csPCa in targeted biopsy) were compared by growing biopsy experience levels. Multivariable regression analyses were calculated to investigate the association with benefit of systematic biopsies and fusion failure.ResultsThe overall PCa detection rate was 72% (413/576). A benefit of systematic biopsies was observed in 11% (63/576); of those, fusion failure was seen in 76% (48/63). Benefit of systematic biopsies and fusion failure were more common among residents with very low experience compared to highly experienced residents (18% versus 4%, p = 0.026; 13% versus 3%, p = 0.015, respectively). Increasing biopsy experience was associated with less benefit from systematic biopsies (OR: 0.98, 95% CI 0.97–0.99) and less fusion failure (OR: 0.98, 95% CI 0.97–0.99).ConclusionsThe benefit of systematic biopsies following targeted biopsy decreases with growing biopsy experience. The higher risk of fusion failure among inexperienced residents necessitates systematic biopsies to ensure the detection of csPCa. Further prospective trials are warranted before a targeted only approach can be recommended in routine clinical practice.

Retrograde Intrarenal Surgery Learning Curves of Urology Residents Supervised by an Experienced Endourologist: An RIRSearch Study

Introduction: Although retrograde intrarenal surgery (RIRS) is being performed with increasing frequency, there are only a limited number of studies about the learning curve (LC). This study aimed to analyze the LC of RIRS for five surgeons who underwent the same training. Materials and Methods: The data of the 410 patients who underwent RIRS between April 2017 and 2022 in a single institution, which were performed consecutively by five surgeons, were analyzed. All 50 cases performed by each surgeon were included and numbered consecutively and separately, according to the date of the operation. The combined stone-free rate (SFR) was calculated for each surgeon’s cases in the same row, and the LCs were created using moving average and cumulative sum (CUSUM) analyses. Separate multivariable analyses identified each period’s (LC vs. beyond) characteristics. Results: The LCs from the combined SFRs reached a plateau after approximately 50 cases for both the CUSUM and the moving average. The effect of stone burden on SFR was more evident in the first 50 cases compared to subsequent cases in the multivariable analyses (p = 0.001 and p = 0.047, respectively). Case order and stone density were independent factors in the first 50 cases (OR: 1.02 [95% CI 1.00–1.04], p = 0.04 and OR: 0.99 [95% CI 0.99–1.00], p = 0.04) but not significant in subsequent cases (OR: 0.97 [95% CI 0.94–1.00], p = 0.1 and OR: 1.00 [95% CI 0.99–1.00], p = 0.7, respectively). Compared to single locations except the lower calyx, the unfavorable effect of the multiple-stone localization on SFR grew in strength after the 50th case (OR: 0.42 [95% CI 0.23–0.78], p = 0.01 and OR: 0.20 [95% CI 0.09–0.46], p < 0.001, respectively). Conclusions: This is the first study reporting on the RIRS LCs of urology residents. While stone burden, density, and multiple-stone localization were the factors determining SFR in the learning period, after completing the LC, the effect of stone burden weakened and multiple-stone localization became stronger.

Assessment of the Presence of Diversity, Equity, and Inclusion Content on Urology Residency Programs Websites.

Assessment of the Presence of Diversity, Equity, and Inclusion Content on Urology Residency Programs Websites.