Urology Training Research Articles

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The potential solutions and policy changes aimed at reducing professional burnout and career regret among urology trainees are numerous, complex, and interrelated. The present study highlights responses that contemporary trainees prioritize, several of which not only address universal needs, but are also consistent with Accreditation Council for Graduate Medical Education Program Requirements. But we would caution against interpreting the results as a prescriptive guide for programs and institutions to select from a menu of “concessions.” Doing so risks framing solutions to professional burnout as a series of performative checkboxes—a free lunch here, a group retreat there.

Application of Mixed Reality in Medical Training and Surgical Planning Focused on Minimally Invasive Surgery

Introduction:Medical training is a long and demanding process, in which the first stages are usually based on two-dimensional, static, and unrealistic content. Conversely, advances in preoperative imaging have made it an essential part of any successful surgical procedure. However, access to this information often requires the support of an assistant and may compromise sterility in the surgical process. Herein, we present two solutions based on mixed reality that aim to improve both training and planning in minimally invasive surgery.Materials and Methods:Applications were developed for the use of the Microsoft HoloLens device. The urology training application provided access to a variety of anatomical and surgical training contents. Expert urological surgeons completed a questionnaire to evaluate its use. The surgical planning solution was used during laparoscopic renal tumorectomy in an experimental model and video-assisted right upper lobectomy in an adult patient. Surgeons reported their experience using this preoperative planning tool for surgery.Results:The solution developed for medical training was considered a useful tool for training in urological anatomy, facilitating the translation of this knowledge to clinical practice. Regarding the solution developed for surgical planning, it allowed surgeons to access the patient’s clinical information in real-time, such as preoperative imaging studies, three-dimensional surgical planning models, or medical history, facilitating the surgical approach. The surgeon’s view through the mixed reality device was shared with the rest of the surgical team.Conclusions:The mixed reality-based solution for medical training facilitates the transfer of knowledge into clinical practice. The preoperative planning tool for surgery provides real-time access to essential patient information without losing the sterility of the surgical field. However, further studies are needed to comprehensively validate its clinical application.

Design and assessment of a penile fracture simulation model

ObjectiveTo design and assess a novel penile fracture simulation model for teaching penile fracture repair. MethodsWe used a validated circumcision simulator to create a model. Foreskin for a circumcision was divided into two halves. A transverse slit (“simulated fracture”) was created on one part of the first half of the foreskin (mimicking “tunica”) and was applied over the penile model. A red jelly tablet (“clot”) was placed underneath the cut. A second full-length of foreskin was applied over it to cover the defect. The model was assessed by participants and expert faculty at the Urology Simulation Boot Camp. Evaluation was performed using a 5-point Likert Scale questionnaire. Data was analysed using Microsoft Excel and IBM SPSS Statistics V25. The intra-class correlation was calculated using a “One-way random model”. ResultsTwenty-two urology trainees and four experts participated in the evaluation. The majority of trainees strongly agreed (59%, n = 13) the model is useful for training with experts similarly agreeing in 75% of cases. The appearance of penile fracture was considered good by both trainees (68%, n = 14) and faculty (75%). Overall, the ability of the model to represent a realistic simulation of the task was considered excellent by 23% of participants and good by 64%. Personal confidence after simulation in managing a similar situation was considered high among trainees. The main difficulties reported were related to fascial planes and urethra. ConclusionThis is the first simulation model for penile fracture repair and has demonstrated face validity at a national urology bootcamp.

The utilization of perfused cadaver simulation in urologic training: a pilot study

BackgroundWe sought to determine if participating in a surgical training session using perfused fresh human cadavers (PFHC) had a positive effect on urology residents’ confidence in performing open and endoscopic procedures.MethodsUrology residents at our institution participated in a surgical training session in the West Virginia University Fresh Tissue Training Program, which utilized fresh cadavers with vascular perfusion. The session consisted of performing different urologic procedures (open and endoscopic) on the perfused fresh human cadavers (PFHC). Residents were given a survey to rate their confidence in different urologic procedures before, after, and 6 months after the session. Each procedure on the survey had 3–6 questions associated with it, with scores ranging from 0 (no confidence) to 4 (great confidence). Scores for each procedure before and after the session were compared.ResultsSix residents participated in the session. There was an increase in the score for every procedure performed after the session. Scores at 6 month follow up remained higher than the pre-session scores.ConclusionPFHCs offer an excellent opportunity to teach a wide variety of urologic procedures to residents. Incorporation of PFHCs may be very useful in urologic training, and further studies on its use are warranted.

Prevalence of Sexually Transmitted Diseases in Men of 25 - 60 Years in Iran

Background: Sexually transmitted diseases (STDs), especially in men, can lead to multiple morbidities and facilitate the transmission of serious pathogens, such as the human immunodeficiency virus. The present study used the data from a nationwide survey on male morbidities to estimate the prevalence of STDs among men in Iran. Methods: This cross-sectional study used the data from a nationwide project on male reproductive morbidities in 2007. A total of 2296 men within the age range of 25 - 60 years were recruited by systematic cluster sampling from four provinces (i.e., Golestan, Hormozgan, Kermanshah, and Isfahan, Iran). The data on the symptoms of STDs, including genital secretion, pushing out, itching or genital ulcers, and lymphadenopathy of the inguinal area after sexual contact, were collected by trained urologists. Data analysis was carried out using SPSS software (version18.0, Chicago, IL, USA). The independent samples t-test and chi-square test were used for data analysis. Results: A total of 2296 men with a mean age value of 39.95 ± 10.3 years were interviewed in this study. Two-thirds of all the subjects (75%) were aware of using condoms in suspected sexual relationships; however, only 69% of the aforementioned subjects used condoms in those circumstances. Overall, 14 subjects (0.6%) had one type of STDs at the study time. Moreover, 110 subjects (4.7%) answered “yes” to the question of whether they were referred to a physician for sexual problems. Conclusions: The prevalence of STDs is still low among the male population in Iran. Careful and well-designed surveillance systems to monitor the incidence of STDs and proper preventive measures to restrict the spread of sexually transmitted pathogens are among the proposed recommendations.

Urology residency training in Greece. Results from the first national resident survey

Background and objectivesThis is the first national survey assessing Greek Urology residency programs. The main objective of this study is to assess the level of confidence and perception of Greek Urology residents regarding their educational program and detect areas of improvement. Material and methodsA 51-question survey was developed via an electronic platform and answered by 91 out of 104 Greek residents from March 2019 until May 2019. Fisher's exact test, chi-squared test and Kruskal–Wallis test were used with statistical significance set at p = .05. ResultsThe median overall satisfaction regarding surgical training was 6/10 regardless of working schedule, working in a University Department, PGY or number of residents in clinic. Most residents have not performed any scrotal ultrasound or pressure-flow-studies; however, they are more familiar with KUB ultrasound. Double-J stent insertion and cystoscopy were common procedures for residents. Bureaucracy was reported as a major issue by 70.4% of residents. ESWL has not been performed by 80.2% of residents, 58.2% residents performed less than 10 ureteroscopies, and only the last year trainees performed more than 10 TURBT and TURP. Most residents mentioned to rarely perform basic steps in many open or laparoscopic urological procedures. Surprisingly, 59.3% of residents have not published any study in peer-reviewed journals. Regarding satisfaction, 44% rarely feel satisfied at work and 59.3% sometimes suffer from burnout. Response rate reached 87.5%. ConclusionsConsidering the results from this survey, regulatory authorities should join forces to establish a structured curriculum of clinical, surgical and research training in Urology across Europe.

Knowledge is Key: Viewpoints of New Recurrent Urinary Tract Infections Guidelines

To evaluate management patterns, measure familiarity with the new guidelines, and gauge the level of education and confidence in treating rUTIs according to recent guidelines, specifically in the context of trainee education. Recurrent urinary tract infections (rUTI) are a common urologic complaint and a heavy burden on the healthcare system. Until recently, the AUA did not have a guideline on the management of rUTIs. Participants were medical students (PGY3-4, n=41), residents (n=48), and fellows (n=11) from a single institution (N=100) from both urology and non-urology backgrounds. This prospective survey study measured demographic information, personal history of rUTI management, knowledge of the new guideline, personal practice patterns, and guideline education. Trainees reported that they felt "slightly unknowledgeable" (M=2.6/4, P < .001) about rUTI treatment, although level of knowledge increased with increased training level. Participants were asked about the new rUTI guidelines that were published in 2019, with urology trainees (M=83.3%) more aware (P < .001) of their recent release compared to non-urology residents and fellows (M=12.2%) and medical students (M=7.5%). When looking specifically at peri- and postmenopausal women, antibiotic treatment was the highest recommendation for rUTI in both peri- (70.6%), and post-menopausal women (68.2%), followed by cranberry juice/extract (43.5% vs 42.4%). Providers were more likely to recommend vaginal estrogens for post-menopausal (45.9%) compared to perimenopausal (28.2%, P < .05) women. Better trainee education about the current rUTI guidelines is warranted, including management of peri- and postmenopausal women which have specific guideline recommendations.

A review of simulation training and new 3D computer-generated synthetic organs for robotic surgery education

We conducted a comprehensive review of surgical simulation models used in robotic surgery education. We present an assessment of the validity and cost-effectiveness of virtual and augmented reality simulation, animal, cadaver and synthetic organ models. Face, content, construct, concurrent and predictive validity criteria were applied to each simulation model. There are six major commercial simulation machines available for robot-assisted surgery. The validity of virtual reality (VR) simulation curricula for psychomotor assessment and skill acquisition for the early phase of robotic surgery training has been demonstrated. The widespread adoption of VR simulation has been limited by the high cost of these machines. Live animal and cadavers have been the accepted standard for robotic surgical simulation since it began in the early 2000s. Our review found that there is a lack of evidence in the literature to support the use of animal and cadaver for robotic surgery training. The effectiveness of these models as a training tool is limited by logistical, ethical, financial and infection control issues. The latest evolution in synthetic organ model training for robotic surgery has been driven by new 3D-printing technology. Validated and cost-effective high-fidelity procedural models exist for robotic surgery training in urology. The development of synthetic models for the other specialties is not as mature. Expansion into multiple surgical disciplines and the widespread adoption of synthetic organ models for robotic simulation training will require the ability to engineer scalability for mass production. This would enable a transition in robotic surgical education where digital and synthetic organ models could be used in place of live animals and cadaver training to achieve robotic surgery competency.

MP20-20 EVALUATION OF UROLOGY TRAINEE PREFERENCES IN DIDACTIC EDUCATION: AN INTERNATIONAL CHOICE-BASED CONJOINT ANALYSIS

You have accessJournal of UrologyEducation Research III (MP20)1 Sep 2021MP20-20 EVALUATION OF UROLOGY TRAINEE PREFERENCES IN DIDACTIC EDUCATION: AN INTERNATIONAL CHOICE-BASED CONJOINT ANALYSIS Kyle Spradling, Caleb Seufert, Nora Kern, Michael Borofsky, Mathew Sorensen, Lindsay Hampson, and Simon Conti Kyle SpradlingKyle Spradling More articles by this author , Caleb SeufertCaleb Seufert More articles by this author , Nora KernNora Kern More articles by this author , Michael BorofskyMichael Borofsky More articles by this author , Mathew SorensenMathew Sorensen More articles by this author , Lindsay HampsonLindsay Hampson More articles by this author , and Simon ContiSimon Conti More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002005.20AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Didactic lectures are a commonly used educational tool during urology residency training. Although all residency programs are expected to provide didactic content for their residents, the format of these sessions vary by presenter and institution. Currently, it is not clear which didactic format provides the most educational benefit. Herein, we aimed to evaluate which attributes of didactic education are most preferred by contemporary urology trainees. METHODS: Urology trainees during the 2020-21 academic year were invited to complete an online choice-based conjoint analysis exercise assessing four attributes associated with didactic education: method of delivery, presentation style, presenter credentials, and curriculum design. The survey was distributed via social media platforms and the Urology Collaborative Online Video Didactics (COViD) website. A sensitivity analysis (Sawtooth Software, Inc. Utah, USA) was used to determine relative importance of each attribute and predict trainee preferences in didactic format (online/virtual vs. in-person). RESULTS: Of the 431 trainees who received the survey, 73 (17%) completed the conjoint analysis exercise, including 60 participants from the United States and 11 from international training programs. Nearly all trainees (72/73) preferred at least 1 hour of dedicated didactic education per week, with 67% responding that 2-3 hours of didactic time per week is ideal. Overall, the majority of respondents preferred online/virtual presentations (77%, 95% CI 70-84%) compared to in-person presentations. Respondents placed the most importance on presenter credentials, preferring national experts from visiting institutions to faculty members from their local institutions. Conjoint analysis revealed a preference trend toward an online didactic curriculum by increasing PGY year, with senior residents and fellows showing stronger preferences for online didactics compared to more junior trainees (Figure 1). CONCLUSIONS: Contemporary urology trainees prefer didactic education that is available in an online/virtual format, standardized across training institutions, and organized and presented by national experts in the field. This data should inform national educational efforts to standardize didactic learning for urology trainees. Source of Funding: No funding source to declare © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e345-e345 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Kyle Spradling More articles by this author Caleb Seufert More articles by this author Nora Kern More articles by this author Michael Borofsky More articles by this author Mathew Sorensen More articles by this author Lindsay Hampson More articles by this author Simon Conti More articles by this author Expand All Advertisement Loading ...

PD24-11 THE IMPACT OF RESIDENT TRAINING ON ROBOTIC OPERATIVE TIMES: IS THERE A JULY EFFECT?

INTRODUCTION AND OBJECTIVE:Incoming surgical trainees in urology begin their residency programs in July. This incoming flux of interns is often associated with increased medical errors, surgical co...

MP20-17 INFLUENCE OF THE COVID-19 PANDEMIC ON THE BURNOUT RATES OF GRADUATING CANADIAN UROLOGY RESIDENTS

You have accessJournal of UrologyEducation Research III (MP20)1 Sep 2021MP20-17 INFLUENCE OF THE COVID-19 PANDEMIC ON THE BURNOUT RATES OF GRADUATING CANADIAN UROLOGY RESIDENTS Jeannette Johnstone, Adam Gabara, and Naji Touma Jeannette JohnstoneJeannette Johnstone More articles by this author , Adam GabaraAdam Gabara More articles by this author , and Naji ToumaNaji Touma More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002005.17AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Burnout is a work-related psychologic syndrome characterized by emotional exhaustion, decreased sense of personal accomplishment, and depersonalization.1 Burnout among surgeons is increasing with prevalence rates exceeding 50%.2COVID-19 has affected the medical system with evidence of increased stress and levels of depression in our medical trainees. This study aims to assess the influence COVID-19 is having on burnout rates in Canadian Urology trainees. METHODS: Thirty-seven chief residents among the Canadian Urology residency programs attended the Queen’s Urology Exam Skills Test (QUEST) on December, 2019 pre-pandemic and thirty-nine chief residents attended virtually on November, 2020 during the pandemic. The Maslach Burnout Inventory (MBI) questionnaire was administered anonymously. The MBI covers emotional exhaustion, depersonalization, and personal accomplishment.4 Descriptive statistics were used to analyze the data. RESULTS: There was 100% response rate in the convenience sample (n=37) in 2019 and 64.1% response rate (n=25) in 2020. 70% of chief residents in Canadian Urology programs showed evidence of burnout in 2019 compared to 88% in 2020. There was a statistically significant difference between the two cohorts in emotional exhaustion (45.9% in 2019 and 68% in 2020, p=0.005) and depersonalization scores (62.2% in 2019 and 80% in 2020, p=0.02). CONCLUSIONS: This study is the first to examine the impact of the pandemic on burnout rates in urology trainees. Burnout rates are high in trainees at baseline, and the pandemic appears to have exacerbated this problem. Vigilance and proactive steps need to be implemented to alleviate this crisis. Source of Funding: I have nothing to disclose © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e343-e344 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Jeannette Johnstone More articles by this author Adam Gabara More articles by this author Naji Touma More articles by this author Expand All Advertisement PDF downloadLoading ...

Perception of Harrasment or Discrimination during Urology Residency in Colombia

Abstract Purpose Workplace bullying (harassment, abuse, or discrimination), practiced persistently against an individual, can generate a hostile workplace environment, consequently leading to exhaustion, with poor psychological outcomes, and the onset of symptoms such as loss of confidence, fatigue, depressive thoughts, desertion, and suicidal thoughts. There are no publications regarding this issue in Colombia.Our objective is to describe the residents' perception of gender and workplace discrimination and verbal/sexual harassment during their urological training. Methods Observational, descriptive, cross-sectional study with anonymous surveys. We evaluated the demographic characteristics and the residents' perception of harassment, the type of harassment, how it affected their performance during residency, and from whom it was perceived. Results We were able to obtain answers from 82/115 residents (71.3%), most of them men (45 [56%]). In total, 66% (54) reported workplace harassment; and 35.4% (29) felt gender discrimination, most of them women (17; 58.6%). Verbal abuse was reported by 64.6% (53), and it affected the work of 92.5%. The parception of workplace harassment was similar among both men and women (32 [69.5%] men and 21 [61.1%] women). A total of 7(19%) women reported sexual abuse. Regarding the source of the abuse, 39 (65.8%) was by professors, 26 (45%), by other residents, and 17 (35.4%), by patients. Conclusion The perception of harassment during urology residency in Colombia is real, and it affects the work of residents. This abuse is greater on the part of men, and is mainly perpetrated by professors. We consider our work the starting point to continue researching a topic of national and international importance.

Abstract 64 - Contemporary trends for urological training and management of stress urinary incontinence in Ireland

The aim of this study is to evaluate the trends in stress urinary incontinence (SUI) surgery since the 2018 pause on use of the polypropylene (PP) mid-urethral sling (MUS) and to quantify the effect this has had on surgical training. Two anonymous surveys were sent to all current urology trainees and to all consultant surgeons who specialise in stress urinary incontinence surgery. Prior to the pause, 86% (6 out of 7) of consultant urologists and 73% (11 out of 15) of consultant gynaecologists would “always”/“often” perform MUS for SUI. After that, 100% (22 out of 22) of consultants reported that they “never” perform MUS. There has been a modest increase in the use of urethral bulking agent (UBA) procedures among urologists, with 43% (3 out of 7) now “often” performing this, compared with 71% (5 out of 7) “never” performing it pre-2018. Trainee exposure to SUI surgery reduced by 75% between 2016 and 2020. Despite a ten-fold increase in UBA procedures logged by trainees, the decline in MUS has resulted in a major reduction in total SUI surgeries. Coinciding with this decrease in surgeries, there was a 56% reduction in trainees’ self-assessed competence at SUI surgery. Thirteen percent of trainees are interested in specialising in Female Urology and those trainees had significantly greater exposure to SUI procedures during their training than those who did not (p = 0.0072). This study has identified a downward trend in SUI surgery, which is concerning for the undertreatment of females with SUI. A decline in SUI surgery training has resulted in reduced trainee confidence and interest in this subspecialty.

MP12-19 TRENDS IN GENDER DISPARITY OF AUTHORSHIP IN UROLOGY PUBLICATIONS

INTRODUCTION AND OBJECTIVE:A global surge in females enrolling into urology training programmes has driven initiatives for improving retention and progression of female urological trainees. Contrib...

Abstract 74 - Left behind? Handedness and operative habits of Irish Urology trainees

Abstract 74 - Left behind? Handedness and operative habits of Irish Urology trainees

MP12-15 THE ACADEMIC FRONT LINE: EVALUATING THE IMPACT OF ANTI-RACISM SERVICE ON BLACK MEDICAL STUDENTS PURSING UROLOGY AND SURGICAL SPECIALTIES

You have accessJournal of UrologyEducation Research II (MP12)1 Sep 2021MP12-15 THE ACADEMIC FRONT LINE: EVALUATING THE IMPACT OF ANTI-RACISM SERVICE ON BLACK MEDICAL STUDENTS PURSING UROLOGY AND SURGICAL SPECIALTIES Cheyenne Williams, Tasha Posid, Alicia Scimeca, Dinah Diab, and Cheryl Lee Cheyenne WilliamsCheyenne Williams More articles by this author , Tasha PosidTasha Posid More articles by this author , Alicia ScimecaAlicia Scimeca More articles by this author , Dinah DiabDinah Diab More articles by this author , and Cheryl LeeCheryl Lee More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000001985.15AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Historically, underrepresented physicians shoulder disproportionate academic service related to diversity and inclusion (DI) initiatives, but this is not well-reported among students. As racial representation among urology trainees continues to lag behind other specialties, it is critical to understand competing interests experienced by underrepresented minority medical students and how this may impact their academic trajectories. We analyzed the perceived impact of DI service following the summer 2020 movements for racial justice on Black medical students interested in urology and surgical specialties. METHODS: A 39-item survey was distributed between August 2020-November 2020 to Student National Medical Association, a Black medical student organization. Survey items measured specialty interest, a validated racial discrimination score, time commitments to academic and DI efforts before vs after June 2020, and perceived impact of DI service on student wellness and academic performance. Survey responses were compared between students interested in urology vs. other surgical fields and all surgical fields vs. non-surgical fields. RESULTS: We evaluated surveys of 400 students from 105 medical schools. Participants were 53% female, 97.2% Black, and had a mean age of 24.6 years. 29.6% (118/400) of students indicated interested in surgical specialties, with 14.7% (17/118) of students reporting interest in urology. Responses from students pursuing urology were comparable to those of students pursuing other surgical fields. Students interested in surgical specialties more frequently reported that participation in DI activities had a negative impact on their academic performance and said that it prevented them from pursuing other, non-DI involvement (p=0.003) (Table 1). CONCLUSIONS: Black medical students are heavily engaged in institutional service for racial justice. This service has a more negative perceived impact on the academic performance of Black students pursuing urology and surgical specialties. As we seek to recruit a diverse urology workforce, these results warrant exploration of interventions to acknowledge and reward DI service and ultimately ameliorate the “minority tax” on Black trainees. Source of Funding: N/A © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e194-e194 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Cheyenne Williams More articles by this author Tasha Posid More articles by this author Alicia Scimeca More articles by this author Dinah Diab More articles by this author Cheryl Lee More articles by this author Expand All Advertisement Loading ...

Abstract 39 - Competitiveness for urology training and gender diversity in higher surgical training in Ireland

Abstract 39 - Competitiveness for urology training and gender diversity in higher surgical training in Ireland

PD02-04 TOP-HEAVY TRAINING: TRENDS IN UROLOGY RESIDENT EXPOSURE TO MAJOR SURGERY

You have accessJournal of UrologyEducation Research I (PD02)1 Sep 2021PD02-04 TOP-HEAVY TRAINING: TRENDS IN UROLOGY RESIDENT EXPOSURE TO MAJOR SURGERY Ezra Margolin, Daniel Schoenfeld, Suzanne Merrill, Jay Raman, R. Houston Thompson, Adam Reese, Dipen Parekh, John Lynch, Baruch Grob, Daniel Williams, Richard Lee, Stanley Zaslau, Thomas Guzzo, Patrick Shenot, and Gina Badalato Ezra MargolinEzra Margolin More articles by this author , Daniel SchoenfeldDaniel Schoenfeld More articles by this author , Suzanne MerrillSuzanne Merrill More articles by this author , Jay RamanJay Raman More articles by this author , R. Houston ThompsonR. Houston Thompson More articles by this author , Adam ReeseAdam Reese More articles by this author , Dipen ParekhDipen Parekh More articles by this author , John LynchJohn Lynch More articles by this author , Baruch GrobBaruch Grob More articles by this author , Daniel WilliamsDaniel Williams More articles by this author , Richard LeeRichard Lee More articles by this author , Stanley ZaslauStanley Zaslau More articles by this author , Thomas GuzzoThomas Guzzo More articles by this author , Patrick ShenotPatrick Shenot More articles by this author , and Gina BadalatoGina Badalato More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000001966.04AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The landscape of urologic training has shifted dramatically with the emergence of robotic surgery. Increased utilization of robotic surgery may alter the level of training at which residents are exposed to major urologic cases. We queried this through evaluation of volume trends in major cases among urology residents at different stages of training at a multi-institutional level. METHODS: Urology resident ACGME case logs from 12 institutions from 2011-2017 were obtained and de-identified. Trends in surgical case distribution were measured using linear regression for residents at each level of urologic training (URO1, URO2, URO3, and URO4). RESULTS: From a sample of 221 resident graduates, a total of 348,656 total cases were logged, of which 116,363 (33%) were major (robotic and open). Major case distribution included 60% oncology, 27% reconstructive and 13% pediatric. Robotic surgeries constituted 34% of all major cases, and the proportion of robotic cases increased by 1.4% per year (p<0.001 for slope). Major cases accounted for 17% of all cases done by URO1 residents, 21% for URO2, 39% for URO3, and 55% for URO4. From 2011 to 2017, the percentage of major cases among URO1 residents decreased from 26% to 13% (-1.8% per year, p<0.001 for slope). This trend primarily reflected a decrease in exposure to oncology cases (-1.8% per year, p<0.001). Among URO4 residents, the proportion of major cases increased from 52% to 60% (+0.9% per year, p=0.045). The proportions of major cases among URO2 and URO3 residents were not significantly changed. Although there was considerable inter-institutional variability in the percentage of major cases done by URO1 residents (ranging from 5% to 35%), the percentage decreased over time in 11 of the 12 institutions. CONCLUSIONS: Increased utilization of robotic surgery has coincided with a shift in exposure to major cases among urology residents at different stages of training, with less exposure to major cases among URO1 residents and more exposure among URO4 residents. This trend calls into question the preparedness of junior residents for senior-level training and the surgical proficiency of resident graduates. Source of Funding: None © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e38-e38 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Ezra Margolin More articles by this author Daniel Schoenfeld More articles by this author Suzanne Merrill More articles by this author Jay Raman More articles by this author R. Houston Thompson More articles by this author Adam Reese More articles by this author Dipen Parekh More articles by this author John Lynch More articles by this author Baruch Grob More articles by this author Daniel Williams More articles by this author Richard Lee More articles by this author Stanley Zaslau More articles by this author Thomas Guzzo More articles by this author Patrick Shenot More articles by this author Gina Badalato More articles by this author Expand All Advertisement Loading ...

MP36-19 PLATELET-RICH PLASMA AND STEM CELL THERAPY FOR ERECTILE DYSFUNCTION: CHARACTERIZATION OF MARKET FORCES IN MAJOR METROPOLITAN AREAS

You have accessJournal of UrologySexual Function/Dysfunction: Medical, Hormonal & Non-surgical Therapy II (MP36)1 Sep 2021MP36-19 PLATELET-RICH PLASMA AND STEM CELL THERAPY FOR ERECTILE DYSFUNCTION: CHARACTERIZATION OF MARKET FORCES IN MAJOR METROPOLITAN AREAS Gary Shahinyan, Robert Shahinyan, Shangyang Christopher Yang, James Weinberger, Jesse Mills, and Sriram Eleswarapu Gary ShahinyanGary Shahinyan More articles by this author , Robert ShahinyanRobert Shahinyan More articles by this author , Shangyang Christopher YangShangyang Christopher Yang More articles by this author , James WeinbergerJames Weinberger More articles by this author , Jesse MillsJesse Mills More articles by this author , and Sriram EleswarapuSriram Eleswarapu More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002045.19AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: A robust industry focusing on “regenerative” therapies has emerged to cater to men experiencing erectile dysfunction (ED). Independent providers have begun to market platelet-rich plasma (PRP) or stem cells directly to consumers, despite lack of scientific evidence. These treatments are not recommended beyond an investigational role by the AUA. We sought to characterize the landscape of PRP and stem cell treatments for ED by evaluating trends in marketing and deployment of these therapies in large metropolitan areas. We aim to describe costs of treatment, training and qualifications of providers, and level of standardization across treatment plans. METHODS: Using Google Search, we identified regenerative medicine treatment providers in seven large U.S. metropolitan areas. Search terms included: “PRP for ED in [city]”; “P shot in [city]”; “PRP for erectile dysfunction in [city]”; “Priapus shot in [city]”. Clinics were contacted by telephone; data regarding providers, prices, and durations of treatment were collected. RESULTS: A summary of results is shown in Table 1. Eighty-seven clinics provide PRP or stem cell treatments for ED in the metropolitan areas sampled. Comprehensive information was available for 68% of the clinics identified. 8% of providers had formal urology training. The average price of PRP injections was $1519 per injection (range $500-$2500). Stem cell therapy was offered by 10 providers, averaging $3620 per treatment (range $1000-$7000). Treatment courses ranged from one injection to indefinite injections based on patient circumstance. CONCLUSIONS: PRP and stem cell treatments suffer from substantial inconsistency and lack of standardization. Non-urologists predominate, and costs and frequency of therapy appear to be market-driven without evidence base. Advertised outcomes vary: some clinics suggest a single injection will be sufficient for cure, while others recommend repeat injections for indefinite time periods. The AUA and SMSNA classify these treatments as experimental and state explicitly that providers should not charge patients for these treatments. There is a critical need for urologists to take an active role in patient education and clinical research for these novel methodologies. Source of Funding: None © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e643-e643 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Gary Shahinyan More articles by this author Robert Shahinyan More articles by this author Shangyang Christopher Yang More articles by this author James Weinberger More articles by this author Jesse Mills More articles by this author Sriram Eleswarapu More articles by this author Expand All Advertisement Loading ...

MP67-12 UROLOGY-DIRECTED INTERNATIONAL COLLABORATIONS THROUGH US-BASED ACADEMIC RESEARCH CENTERS

You have accessJournal of UrologyGlobal Health/Humanitarian (MP67)1 Sep 2021MP67-12 UROLOGY-DIRECTED INTERNATIONAL COLLABORATIONS THROUGH US-BASED ACADEMIC RESEARCH CENTERS Adrian Fernandez, Michelle Bui, Ian Metzler, and David Bayne Adrian FernandezAdrian Fernandez More articles by this author , Michelle BuiMichelle Bui More articles by this author , Ian MetzlerIan Metzler More articles by this author , and David BayneDavid Bayne More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002028.12AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: International surgical collaboration presents an opportunity to address the need for specialized urologic care and teaching in low-middle income countries (LMICs) and provides invaluable opportunities for education. Longitudinal relationships between academic research centers (ARCs) and hospitals in LMICs provide an opportunity for sustainable and bilateral collaboration and education, but are often the exception. The current project seeks to identify urology-directed collaborations, organized through academic research centers (ARCs) between the United States (US) and LMICs. METHODS: The webpages of each ACGME-accredited Urology residency training program were reviewed for information regarding international outreach programs. Pubmed, Google, and Google Scholar were also searched using combinations of the terms, “global”, “international”, “partnership”, “volunteer”, and “Urology” to identify international service and education work through Urologic ARCs. We specifically sought to include programs that demonstrated active collaborations between urology training programs in the US and training urology programs or specific hospitals in LMICs for more than two consecutive years. RESULTS: One hundred and forty ACGME-accredited Urology residency training programs were included and 14/140 (10%) programs listed opportunities for international work. A total of 8/140 (6%) programs listed independent, longitudinal relationships with specific hospitals in LMICs. India and Kenya were the countries with the most affiliations with US ARCs in Urology. CONCLUSIONS: Collaborations between US ARCs in Urology and hospitals in LMICs allow for institutionally sustainable educational, clinical, and research work. At the moment, approximately 6% of ACGME accredited Urology residency programs demonstrate formal collaborations with training institutions/hospitals in LMICs as part of their online presence, suggesting an opportunity for greater global impact from formalized Urology ARCs. Source of Funding: UCSF Center for Health Equity in Surgery and Anesthesia © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e514-e514 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Adrian Fernandez More articles by this author Michelle Bui More articles by this author Ian Metzler More articles by this author David Bayne More articles by this author Expand All Advertisement Loading ...