Urology Practice最新文献

{"title":"The Growing Urology Workforce Crisis: Lessons from Rising Transfer Burden in Central Massachusetts.","authors":"Orly Guerra, Xiao J Tong, Elisa Rocha, Jeffrey Merida, Jennifer E Fantasia, Jennifer K Yates, Mitchell H Sokoloff","doi":"10.1097/UPJ.0000000000001078","DOIUrl":"10.1097/UPJ.0000000000001078","url":null,"abstract":"","PeriodicalId":45220,"journal":{"name":"Urology Practice","volume":" ","pages":"101097UPJ0000000000001078"},"PeriodicalIF":1.6,"publicationDate":"2026-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148881605","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":"Postoperative Upper Tract Reconstruction Renal Ultrasound Protocol: Safe and Effective Ureteral Stricture Surveillance and Outcomes.","authors":"Benjamin E Cedars, Anh T Nguyen, Michael W Witthaus, Eric Y Cho, Sunchin Kim, Thomas W Fuller, Jill C Buckley","doi":"10.1097/UPJ.0000000000001083","DOIUrl":"10.1097/UPJ.0000000000001083","url":null,"abstract":"<p><strong>Introduction: </strong>There is no standardized postoperative surveillance for upper tract reconstruction, with frequent use of nuclear medicine renal scans (NMRSs). We propose a protocol using renal ultrasonography (RUS) as the initial assessment tool, reserving secondary studies to evaluate patients with worse hydronephrosis or persistent symptoms.</p><p><strong>Methods: </strong>This was a retrospective analysis of a prospectively designed imaging protocol at a single institution, 2016 to 2022. The protocol uses screening RUS at 3 and 12 months, with NMRS or ureteroscopy as clinically indicated. Diagnostic accuracy of 3-month RUS was assessed with 95% CIs.</p><p><strong>Results: </strong>One hundred thirty-six patients underwent ureteral reconstruction, accounting for 144 reconstructive procedures. The primary success rate was 91.9%, increasing to 94.1% after revision surgery. Among 110 renal units with paired baseline and 3-month RUS, hydronephrosis was improved in 65.5%, stable in 31.8%, and worse in 2.7%. Eleven patients required reintervention. Based on clinical suspicion and/or worsening imaging, 27 patients (19.9%) underwent NMRS and 18 underwent ureteroscopy. Three-month RUS was highly specific (98.1%) for subsequent reintervention, and 102 of 107 renal units (95.3%) with stable/improved hydronephrosis required no intervention. Five of the 6 reinterventions among imaged units followed reassuring ultrasound and were identified by symptom-directed evaluation.</p><p><strong>Conclusions: </strong>RUS with clinical monitoring is an effective modality for postoperative surveillance after ureteral reconstruction, allowing more than 80% of patients to avoid NMRS. Stable or improved hydronephrosis reliably identified patients requiring no further intervention, while most failures were detected through symptoms rather than imaging alone. Nuclear scans and ureteroscopy should be reserved for patients with symptoms or imaging suggestive of obstruction.</p>","PeriodicalId":45220,"journal":{"name":"Urology Practice","volume":" ","pages":"101097UPJ0000000000001083"},"PeriodicalIF":1.6,"publicationDate":"2026-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148881577","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":"Burnout in Urology is a Quality of Care Problem, and Joy in Work is the Solution.","authors":"Max Bowman, John S Lam, Kevin Koo, Kate H Kraft, Andrew Harris, Amanda North","doi":"10.1097/UPJ.0000000000001027","DOIUrl":"10.1097/UPJ.0000000000001027","url":null,"abstract":"","PeriodicalId":45220,"journal":{"name":"Urology Practice","volume":" ","pages":"464-467"},"PeriodicalIF":1.6,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148043214","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":"Reply by Authors.","authors":"Aidan Weitzner, Soum Lokeshwar, Nirmish Singla","doi":"10.1097/UPJ.0000000000001016","DOIUrl":"10.1097/UPJ.0000000000001016","url":null,"abstract":"","PeriodicalId":45220,"journal":{"name":"Urology Practice","volume":" ","pages":"559-560"},"PeriodicalIF":1.6,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147784917","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":"Survivorship Outcomes and Patient Perceptions of Care in the Evolved Landscape of Stage I Testis Cancer Management.","authors":"Adri Durant, Mimi Nguyen, Cullen Hudson, Hanna Schaeffeler, David Helfinstine, Holly Van Houten, Nahid Punjani, Clint Cary, Timothy Masterson, Mark Tyson","doi":"10.1097/UPJ.0000000000001022","DOIUrl":"10.1097/UPJ.0000000000001022","url":null,"abstract":"<p><strong>Introduction: </strong>Our purpose was to compare survivorship outcomes between patients with stage I testicular cancer (TCa) undergoing surveillance or adjuvant therapy and examine patient perceptions on counselling and management.</p><p><strong>Methods: </strong>Administrative claims data from the Optum Labs Data Warehouse (2007-2022) were reviewed to identify patients with stage I TCa managed with either surveillance or adjuvant therapy. Trends in TCa management were evaluated, and survivorship outcomes were assessed using propensity score-matched survival analyses. Qualitative surveys and interviews explored patient perspectives on decision-making and identified themes in patient experiences with counseling.</p><p><strong>Results: </strong>Of 3613 patients with stage I TCa, the mean age at diagnosis was 38.6 years (SD 13.6) with surveillance rates increasing up to 78.7% by 2022. When comparing the matched surveillance to chemotherapy groups, there were higher rates of men's health diagnoses in the chemotherapy group (35.2% vs 23.9%, <i>P</i> = .027). However, time-to-event analysis showed no difference in survivorship outcomes between surveillance or adjuvant therapy. Twenty surveyed patients with stage I TCa revealed satisfaction and understanding of their care but endorsed concerns regarding survivorship outcomes. Five interviewed patients communicated 4 key themes: (1) trust in physician recommendations, (2) proactive personal and family research, (3) gaps in communication of care, and (4) coping.</p><p><strong>Conclusions: </strong>This study suggests that adjuvant chemotherapy may be linked to higher rates of men's health diagnoses, but over time, these risks do not differ significantly from surveillance. Patient perspectives underscore the importance of communication, shared decision-making, and addressing survivorship concerns as part of comprehensive care. Further research into survivorship outcomes is needed.</p>","PeriodicalId":45220,"journal":{"name":"Urology Practice","volume":" ","pages":"533-543"},"PeriodicalIF":1.6,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147844323","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":"Early Subspecialization Alignment: How Residents Tailor Experiences Before Fellowship.","authors":"Sri Saran Manivasagam, Raidizon Mercedes, Gary E Lemack, Marisa M Clifton, Adam P Klausner, Akanksha Mehta, Humphrey Atiemo, Richard Lee, Mathew D Sorensen, Ryan Smith, Jill Buckley, R Houston Thompson, Benjamin N Breyer, Gina M Badalato, Eric M Wallen, Jay D Raman","doi":"10.1097/UPJ.0000000000001009","DOIUrl":"10.1097/UPJ.0000000000001009","url":null,"abstract":"<p><strong>Introduction: </strong>Urology residency is designed to equip trainees with the skills necessary for independent practice. Over recent decades, however, the educational landscape has evolved, with fellowship-trained urologists constituting > 45% of the workforce. We examine whether residents perform a greater number of cases aligned with their intended fellowship and whether, after matching, they tailor their chief resident year to reinforce their chosen subspecialty.</p><p><strong>Methods: </strong>We conducted a multi-institutional, retrospective analysis of Accreditation Council of Graduate Medical Education case logs from residents of 14 programs from 2010 to 2022. Cases were categorized into 5 domains: Endourology, Reconstruction, Oncology, Pediatrics, and General. Residents who pursued fellowship training were identified, and case volumes were compared between those who matched into a given subspecialty and those who entered directly into practice/other fellowships.</p><p><strong>Results: </strong>Of 340 residents, 199 (58.5%) pursued fellowship. Residents entering fellowship logged significantly more cases in their aligned domains: Oncology (median 274 vs 259, <i>P</i> = .034), Pediatrics (259 vs 186, <i>P</i> < .001), and Endourology (260 vs 229, <i>P</i> = .027). No significant difference was observed in Reconstructive Surgery (160.5 vs 154.5, <i>P</i> = .489). During the chief year, residents continued to align case selection with fellowship: Oncology (173 vs 136.5, <i>P</i> < .001), Pediatrics (13 vs 4, <i>P</i> = .025), and Endourology (48 vs 32, <i>P</i> = .003). Reconstructive case volume did not follow this trend (47.5 vs 43, <i>P</i> = .383).</p><p><strong>Conclusions: </strong>These findings suggest that for most specialties, subspecialization seems to begin during residency, with residents aligning their operative experience with future fellowship plans. Chief year case selection seems to reflect strategic preparation for fellowship.</p>","PeriodicalId":45220,"journal":{"name":"Urology Practice","volume":" ","pages":"514-521"},"PeriodicalIF":1.6,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147595442","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":"Advocacy Convergence in Medicine: Analyzing Legislative Priorities and Political Action Committee Overlap Among Major Medical Societies.","authors":"Dhruv Puri, Kaitlyn P Lew, Isaac E Kim, Michelle Li, Jessica Y Hsueh, Anthony Galvez, Kshitij Pandit, Sirpi Nackeeran, Aditya Bagrodia, Hans C Arora, Yahir Santiago Lastra","doi":"10.1097/UPJ.0000000000001021","DOIUrl":"10.1097/UPJ.0000000000001021","url":null,"abstract":"<p><strong>Introduction: </strong>Advocacy in health policy involves a broad coalition of medical professionals, including physicians, advanced practice providers, and patient advocacy stakeholders. These advocacy efforts shape federal policies that directly influence urology practice, including procedural reimbursement, prior authorization, telehealth access, and surgical liability. Medical societies are key intermediaries between physicians and policymakers, yet the extent of alignment in advocacy priorities across organizations remains unclear. We evaluated convergence in legislative priorities, lobbying activities, and political engagement among major medical societies to contextualize urology advocacy within the broader health policy landscape.</p><p><strong>Methods: </strong>This cross-sectional study analyzed advocacy efforts, legislative priorities, and political action committee (PAC) contributions of 10 US medical and specialty societies from 2020 to 2024 using publicly available data from OpenSecrets, the Federal Election Commission, and organizational websites. Societies included the American Urological Association and 9 other national medical societies selected based on national presence, advocacy activity, and clinical scope. Legislative priorities of each society were grouped into 13 policy categories. Lobbying and PAC data were analyzed by agency targets, legislation, expenditures, and campaign recipients.</p><p><strong>Results: </strong>All 10 societies prioritized reducing administrative burdens, expanding telemedicine, supporting physician well-being, and advancing health equity. Most lobbied the Centers for Medicare & Medicaid Services and the Department of Health and Human Services in 2024. The American Medical Association reported the highest lobbying expenditures. PAC contributions across societies targeted legislators on the House Energy and Commerce, Appropriations, and Ways and Means committees.</p><p><strong>Conclusions: </strong>Medical society advocacy agendas have substantial overlap, suggesting opportunities for coordinated efforts to shape health policies affecting payment structures, coverage decisions, and workforce sustainability in urology.</p>","PeriodicalId":45220,"journal":{"name":"Urology Practice","volume":" ","pages":"473-482"},"PeriodicalIF":1.6,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147821228","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":"Mitchell H Sokoloff","doi":"10.1097/UPJ.0000000000001030","DOIUrl":"10.1097/UPJ.0000000000001030","url":null,"abstract":"","PeriodicalId":45220,"journal":{"name":"Urology Practice","volume":" ","pages":"467"},"PeriodicalIF":1.6,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148296721","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":"Kaitlyn E Schultis, Kevin Koo","doi":"10.1097/UPJ.0000000000001028","DOIUrl":"10.1097/UPJ.0000000000001028","url":null,"abstract":"","PeriodicalId":45220,"journal":{"name":"Urology Practice","volume":"13 5","pages":"471-472"},"PeriodicalIF":1.6,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148799253","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":"Contemporary Microbial Profile of Artificial Urinary Sphincter Erosions.","authors":"Ming-Yeah Y Hu, Thomas Schroeder, Brent Nosé, Mariela Martinez, Kiran Sury, Aaron C Lentz, Andrew C Peterson, Jordan R Foreman","doi":"10.1097/UPJ.0000000000001035","DOIUrl":"10.1097/UPJ.0000000000001035","url":null,"abstract":"<p><strong>Introduction: </strong>There is a dearth of data for artificial urinary sphincter (AUS) erosions after the introduction of InhibiZone-coated devices in 2008. We aim to identify common organisms associated with noninfected and infected AUS device erosions.</p><p><strong>Methods: </strong>We reviewed our prospectively collected, institutionally approved quality improvement database of AUS implantations, removals, or revisions performed at our facility. Devices implanted after 2008 that subsequently eroded were included for review. Erosion was confirmed cystoscopically in all cases. Urine cultures and intraoperative cultures (tissue, aspirate, or swab) were reviewed. Descriptive analyses of clinical and culture data were performed.</p><p><strong>Results: </strong>We performed 1104 AUS cases between 2008 and 2022 and identified 80 (7.2%) erosions of InhibiZone-coated AUS devices in 67 patients. Median time to erosion was 10.5 months (IQR 3-29). Forty-nine patients (73%) received prior pelvic radiation. Sixty-seven (84%) erosion cases had urine cultures, and 36 (45%) had intraoperative cultures available for review. Of the 47 (70%) positive urine cultures, the most common results were mixed flora (36%), <i>Escherichia c</i><i>oli (7%)</i>, and <i>Klebsiella (7%)</i>. Top isolates from the 26 (72%) positive intraoperative cultures were <i>Staphylococcus</i> species (14%) and <i>Pseudomonas (14%)</i>, <i>followed by E</i> <i>c</i><i>oli</i> (11%), <i>Candida</i> (11%), and <i>Klebsiella</i> (11%). Positive intraoperative cultures isolated more gram-negative organisms (47%) than gram-positive organisms (38%).</p><p><strong>Conclusions: </strong>InhibiZone-coated AUS device erosions were associated with a wide variety of organisms, including gram-positive, gram-negative, and fungal species. This can help guide modern antimicrobial prophylaxis practices and empiric treatment pathways in the eroded patient.</p>","PeriodicalId":45220,"journal":{"name":"Urology Practice","volume":" ","pages":"544-550"},"PeriodicalIF":1.6,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148206262","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}