Urology Practice最新文献

{"title":"Editorial Commentary.","authors":"Michael Ernst","doi":"10.1097/UPJ.0000000000000765","DOIUrl":"10.1097/UPJ.0000000000000765","url":null,"abstract":"","PeriodicalId":45220,"journal":{"name":"Urology Practice","volume":" ","pages":"302"},"PeriodicalIF":0.8,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143190913","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Program Directors' Selection Criteria for Urology Residency Match in a United States Medical Licensing Examination Step 1 Pass/Fail Era.","authors":"Katherine Wu, Emily Huang, Laura Thompson, Kathleen C Kobashi","doi":"10.1097/UPJ.0000000000000761","DOIUrl":"10.1097/UPJ.0000000000000761","url":null,"abstract":"<p><strong>Introduction: </strong>Program directors of urology residencies have historically weighted the United States Medical Licensing Examination Step 1 heavily to select interview candidates. In January 2022, the 3-digit Step 1 score changed to pass/fail, aiming to reduce the burden of examination preparation and promote more holistic review, yet, in doing so, abolished a key objective metric. This study examines the criteria now prioritized in the selection of urology candidates to interview.</p><p><strong>Methods: </strong>A survey was distributed to program directors of 150 nationally accredited urology residency programs, consisting of 26 factors across 4 domains: (1) academics, (2) extracurriculars, (3) virtual etiquette, and (4) applicant diversity. Respondents rated each factor on a 1 to 10 scale (from no importance to most important), with free-text options for additional input.</p><p><strong>Results: </strong>Forty-six program directors completed the survey. The top 5 factors were (1) urology letters of recommendation (mean ± SD, 8.58 ± 1.57), (2) signaling (8.56 ± 1.69), (3) virtual professionalism (7.33 ± 2.71), (4) completion of a subinternship at the director's program (7.22 ± 2.20), and (5) camera on during virtual meetings (7.04 ± 2.75). Notably, a Step 2 score ≥ 250 (5.84 ± 2.45) ranked sixth among 9 academic factors.</p><p><strong>Conclusions: </strong>The shift to a pass/fail Step 1 has reshaped urology applicant selection, where Step 2 scores do not seem to replace Step 1 as a primary metric. The implications of these changes, including their impact on holistic application review and candidate selection, remain to be determined.</p>","PeriodicalId":45220,"journal":{"name":"Urology Practice","volume":" ","pages":"298-302"},"PeriodicalIF":0.8,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143190917","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Editorial Commentary.","authors":"Nityam Rathi","doi":"10.1097/UPJ.0000000000000785","DOIUrl":"10.1097/UPJ.0000000000000785","url":null,"abstract":"","PeriodicalId":45220,"journal":{"name":"Urology Practice","volume":" ","pages":"333-334"},"PeriodicalIF":0.8,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143663976","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evidence-Based Framework for Surgical Irrigation Fluid Stewardship and Endoscopic Case Prioritization During Fluid Shortages.","authors":"Kevin Koo, Meghan A Cooper, Derek J Lomas, Lance A Mynderse, Aaron M Potretzke, Kevin M Wymer","doi":"10.1097/UPJ.0000000000000772","DOIUrl":"10.1097/UPJ.0000000000000772","url":null,"abstract":"<p><strong>Introduction: </strong>The US supply disruption of surgical irrigation fluids in September 2024 prompted the need for fluid conservation and potential deferral of urology procedures. We characterized fluid use in common endoscopic procedures to articulate recommendations for irrigation fluid stewardship and case prioritization during fluid shortages.</p><p><strong>Methods: </strong>We reviewed case volumes and irrigation fluid use for endoscopic urological procedures at our institution during January-September 2024. We convened a panel of high-volume urologists and used a 3-step modified Delphi method to determine consensus recommendations for fluid stewardship and case prioritization.</p><p><strong>Results: </strong>Among 6155 cases, the procedures consuming the highest mean per-case fluid volumes were prostate enucleation (26.6 L), transurethral resection of the prostate (16.7 L), percutaneous nephrolithotomy (12.4 L), and robotic water-jet prostate ablation (10.9 L). These 4 procedures comprised 17% of all cases but consumed 42% of total fluid volume. To prioritize procedures for potential deferral, procedures were stratified into 3 fluid tiers based on fluid consumption and 3 urgency tiers based on clinical indication. Combining both fluid and urgency tiers, we identified 5 procedural priority levels in which lower priority cases that consume more fluid and treat less urgent indications are deferred first. Finally, we defined 4 fluid stewardship principles addressing patient and trainee needs.</p><p><strong>Conclusions: </strong>Among endoscopic urology cases, the 4 most fluid-intensive procedures consume 42% of surgical irrigation fluid. A case prioritization framework that accounts for fluid consumption and clinical urgency can help urology practices navigate potential case deferrals. Fluid stewardship principles may optimize fluid conservation to minimize adverse impact on patients and trainees.</p>","PeriodicalId":45220,"journal":{"name":"Urology Practice","volume":" ","pages":"293-297"},"PeriodicalIF":0.8,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143068586","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Risks and Benefits of Caprini Score Recommended Thromboprophylaxis After Radical Prostatectomy and Nephrectomy.","authors":"Charles Klose, Ingrid L Rodgers, Eric Qualkenbush, Andrew Zganjar, Emily Brennan, Aaron Spaulding, David Thiel, Evan Gibbs, Michael A Edwards","doi":"10.1097/UPJ.0000000000000781","DOIUrl":"10.1097/UPJ.0000000000000781","url":null,"abstract":"<p><strong>Introduction: </strong>Venous thromboembolism (VTE) after urologic surgery occurs in approximately 1% of patients and is associated with perioperative morbidity and mortality. Given variability in thromboprophylaxis practice, we aim to analyze the utilization of Caprini risk-based thromboprophylaxis after prostatectomy and nephrectomy.</p><p><strong>Methods: </strong>Cases were identified using the medical record from large tertiary care centers in the United States. Caprini score was calculated retrospectively. Prophylaxis was classified as either appropriate or inappropriate when comparing Caprini score recommendations with prophylaxis received. Bleeding was determined by International Classification of Diseases-10 diagnostic code, postoperative hemoglobin decrease of > 4 g/dL, or transfusion. Bivariate and multivariate regression analyses compared VTE and bleeding outcomes between prophylaxis cohorts.</p><p><strong>Results: </strong>In the 6241 patients analyzed, inpatient, postoperative VTE rate was 0.72%. Appropriate inpatient prophylaxis was received by 36% of prostatectomy patients and 50% of nephrectomy patients. Less than 5% of patients in both cohorts received recommended appropriate discharge prophylaxis. Appropriate inpatient prophylaxis after prostatectomy resulted in an 8-fold significant reduction in inpatient VTE (0.07% vs 0.61%, <i>P</i> = .009) with an associated increased bleeding incidence (2.3% vs 0.98%, <i>P</i> < .001). The incidence of inpatient VTE after radical nephrectomy was 5.8-fold higher (1.7% vs 0.29%, <i>P</i> = .001) with inappropriate prophylaxis without a significant increased risk of bleeding. There was no significant difference in VTE rates or bleeding at 90 days postoperatively when stratifying by discharge prophylaxis in either cohort.</p><p><strong>Conclusions: </strong>For those identified as high risk by Caprini score, the benefits of inpatient VTE chemoprophylaxis must be balanced with bleeding risk after prostatectomy and nephrectomy.</p>","PeriodicalId":45220,"journal":{"name":"Urology Practice","volume":" ","pages":"343-355"},"PeriodicalIF":0.8,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143190927","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Trends in Outpatient Radical Prostatectomy and Same-Day Discharge for Prostate Cancer: Analysis of the National Inpatient Sample and Nationwide Ambulatory Surgery Sample.","authors":"Grant M Henning, Ekamjit S Deol, Ranveer M Vasdev, Spyridon P Basourakos, David Y Yang, Matthew K Tollefson, Igor Frank, Paras Shah, Abhinav Khanna, R Jeffrey Karnes, Stephen A Boorjian, Vidit Sharma","doi":"10.1097/UPJ.0000000000000778","DOIUrl":"10.1097/UPJ.0000000000000778","url":null,"abstract":"<p><strong>Introduction: </strong>Interest has grown in optimizing radical prostatectomy (RP) pathways for prostate cancer, and RP has been removed from the Centers for Medicare & Medicaid Services inpatient-only list. We aim to determine national trends in outpatient RP.</p><p><strong>Methods: </strong>The National Inpatient Survey and Nationwide Ambulatory Surgery Survey were queried to categorize RPs between 2016 and 2020 as inpatient RP and outpatient RPs, comprising same-day discharge (SDD) and ambulatory encounters. Trends in outpatient RP over time were analyzed. Multivariable logistic regression analysis identified factors associated with SDD. Multivariable generalized linear models were used to compare total hospital charges between SDD and inpatient RPs.</p><p><strong>Results: </strong>In a cohort of 362,123 RPs from 2016 to 2020, outpatient RPs increased from 4.8% to 53.7% (<i>P</i> < .01) and SDD increased from 0.03% to 2.0% (<i>P</i> < .01). Minimally invasive surgery (odds ratio [OR], 1.59, <i>P</i> < .01), highest quartile annual hospital caseload (OR, 1.98, <i>P</i> = .01), and low hospital bed count (OR, 1.96, <i>P</i> = .03) were associated with SDD. Less than 20% of centers used SDD, although a select few hospitals discharged more than 50% of RPs the same day. Ambulatory ($63,060) and SDD ($63,332) RPs had lower total charges compared with inpatient RPs ($69,951). Multivariable analysis demonstrated that SDD was associated with a reduction in total charges (OR, 0.88, <i>P</i> < .01).</p><p><strong>Conclusions: </strong>Over 50% of RPs are now performed as ambulatory or SDD encounters. SDD RP is more common in high-volume facilities with lower bed counts. Although our data suggest lower hospital charges, further study is warranted to evaluate the impact of SDD on readmission rates and direct patient costs.</p>","PeriodicalId":45220,"journal":{"name":"Urology Practice","volume":" ","pages":"305-315"},"PeriodicalIF":0.8,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143190930","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Editorial Commentary.","authors":"Kate Dwyer, Ruchika Talwar","doi":"10.1097/UPJ.0000000000000766","DOIUrl":"10.1097/UPJ.0000000000000766","url":null,"abstract":"","PeriodicalId":45220,"journal":{"name":"Urology Practice","volume":" ","pages":"323-324"},"PeriodicalIF":0.8,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143674721","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Editorial Commentary.","authors":"Evan Kovac, Sandip M Prasad","doi":"10.1097/UPJ.0000000000000784","DOIUrl":"10.1097/UPJ.0000000000000784","url":null,"abstract":"","PeriodicalId":45220,"journal":{"name":"Urology Practice","volume":" ","pages":"315"},"PeriodicalIF":0.8,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143674724","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Editorial Commentary.","authors":"Gabriel Fernandez, Sandip M Prasad","doi":"10.1097/UPJ.0000000000000780","DOIUrl":"10.1097/UPJ.0000000000000780","url":null,"abstract":"","PeriodicalId":45220,"journal":{"name":"Urology Practice","volume":"12 3","pages":"296-297"},"PeriodicalIF":0.8,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144019714","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Editorial Comment.","authors":"Yash B Shah","doi":"10.1097/UPJ.0000000000000762","DOIUrl":"10.1097/UPJ.0000000000000762","url":null,"abstract":"","PeriodicalId":45220,"journal":{"name":"Urology Practice","volume":" ","pages":"301"},"PeriodicalIF":0.8,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143190906","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}