Urology Practice最新文献

{"title":"Editorial Commentary.","authors":"Brigitte K Smith, S Elizabeth Ames","doi":"10.1097/UPJ.0000000000000803","DOIUrl":"10.1097/UPJ.0000000000000803","url":null,"abstract":"","PeriodicalId":45220,"journal":{"name":"Urology Practice","volume":"12 4","pages":"476-477"},"PeriodicalIF":1.7,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144477223","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":"Michael Ernst","doi":"10.1097/UPJ.0000000000000800","DOIUrl":"10.1097/UPJ.0000000000000800","url":null,"abstract":"","PeriodicalId":45220,"journal":{"name":"Urology Practice","volume":"12 4","pages":"476"},"PeriodicalIF":1.7,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144477222","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":"The Use of an Objective Structured Clinical Examination With a Standardized Patient Actor to Assess Professionalism and Communication for the Oral Certifying Examination: The Initial Experience of the American Board of Urology.","authors":"Nicholas J Lanzotti, Gary E Lemack, Andrew Jones, J Brantley Thrasher, Christopher M Gonzalez","doi":"10.1097/UPJ.0000000000000798","DOIUrl":"10.1097/UPJ.0000000000000798","url":null,"abstract":"<p><strong>Introduction: </strong>Promotion of professionalism/communication (P/C) is a strategic initiative within the American Board of Medical Specialties; however, reliable assessment of this competency in the certification process is lacking. In this article, we present the findings of the American Board of Urology's P/C objective structured clinical examination (OSCE), which was implemented on the 2023 and 2024 certifying examinations.</p><p><strong>Methods: </strong>The certifying examination was administered to 694 candidates (335 in 2023 and 359 in 2024). Each candidate was administered two 5-item OSCEs and four 10-item standard oral examinations (SOEs). One OSCE focused on P/C with simulated patient (SP) actors and one on diagnosis/imaging. SP actors interacted with examinees on the 10-minute P/C OSCE. A criterion-referenced standard was used for pass/fail decisions, and the Rasch model was used for scoring.</p><p><strong>Results: </strong>The candidate's mean score and protocol difficulty did not differ significantly from 2023 to 2024. Reliability with the P/C and diagnostic OSCEs was similar both years. In 2023, the diagnostic OSCE had a higher average score than the P/C OSCE, with both OSCEs scoring higher than the SOEs. In 2024, the average diagnostic OSCE score was higher than that of the P/C OSCE and SOEs, which had similar scores. There was low correlation between the OSCEs and SOEs both years.</p><p><strong>Conclusions: </strong>The initial experience of P/C OSCEs on the American Board of Urology certification examination showed acceptable scoring, reliability, and low correlation with standard protocols. Initial data suggest that the P/C OSCE is a distinct construct from SOEs that specifically assesses P/C skills in the oral certification process.</p>","PeriodicalId":45220,"journal":{"name":"Urology Practice","volume":" ","pages":"469-477"},"PeriodicalIF":1.7,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143558296","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":"Disproportionality Analysis of Hypotension-Related Adverse Drug Reactions Associated With Type 1a Selective Alpha-Blockers in VigiBase.","authors":"Jonathan J Song, Zhiyu Jason Qian, Mansoo Cho, David-Dan Nguyen, Quoc-Dien Trinh, Daniel A Wollin","doi":"10.1097/UPJ.0000000000000790","DOIUrl":"10.1097/UPJ.0000000000000790","url":null,"abstract":"<p><strong>Introduction: </strong>Some evidence suggests no association between type 1a (T1a) selective alpha-blockers and hypotension-related adverse drug reactions (HR-ADRs), although safety concerns still exist. We sought to investigate the association of HR-ADRs with selective T1a blockers and identify at-risk groups.</p><p><strong>Methods: </strong>We used disproportionality analysis to detect signals of HR-ADRs (dizziness, fainting, falls, and fractures) reported with selective T1a blocker use (tamsulosin and silodosin) in VigiBase, a global database of individual case safety reports. Excluding duplicates, all reports were included (1967-2022). Significance was determined using lower bound 95% empiric Bayes estimator > 1; only then were reporting odds ratios (RORs) and 95% CIs reported. Subgroup analyses were stratified by sex, age (<65 and ≥65 years), and indication for men only (urinary stone disease [USD] and benign prostatic hyperplasia [BPH]).</p><p><strong>Results: </strong>We identified 5963 reports of HR-ADRs with selective T1a blockers. Selective T1a blockers were significantly associated with HR-ADRs (ROR 1.46; 95% CI 1.42-1.49). In men, selective T1a blockers for USD were associated with increased risk of HR-ADRs (ROR 1.60; 95% CI 1.56-1.65), which only remained significant in the older subgroup (ROR 6.70; 95% CI 3.20-14.01). No association was found for BPH. In women, selective T1a blockers were associated with an increased risk of HR-ADRs (ROR 1.09; 95% CI 0.99-1.09). This was only significant in the younger subgroup (ROR 1.17; 95% CI 1.03-1.32).</p><p><strong>Conclusions: </strong>In older men with USD and younger women, selective T1a blockers were associated with higher risk of HR-ADRs, suggesting the need for continued monitoring in these populations. No signal was observed for men with BPH.</p>","PeriodicalId":45220,"journal":{"name":"Urology Practice","volume":" ","pages":"433-440"},"PeriodicalIF":1.7,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143366198","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":"A Rescoping Investigation of Burnout vs Moral Injury in Urology and the Broader Health Care Field.","authors":"Michael Wang, Emma Ross, Aron Liaw","doi":"10.1097/UPJ.0000000000000811","DOIUrl":"10.1097/UPJ.0000000000000811","url":null,"abstract":"<p><strong>Introduction: </strong>Urology burnout has been extensively studied, but despite numerous interventions its prevalence remains high. Recent insights suggest that what is often labeled as burnout may actually be moral injury, the challenge of knowing the care patients need but being unable to provide it due to factors beyond the health care provider's control. This study seeks to reclassify factors traditionally linked to burnout in urology as manifestations of moral injury and proposes holistic strategies to address these systemic issues.</p><p><strong>Methods: </strong>A literature review was performed to identify the most significant contributors to urology burnout. These factors were then analyzed through the lens of moral injury. This study focused on systemic issues such as increased patient volume, declining reimbursements, loss of physician autonomy, and the burden of electronic medical records. This analysis also reviewed the effectiveness of current interventions and their success in addressing these challenges.</p><p><strong>Results: </strong>The study found that many of the factors that are traditionally associated with urology burnout are more accurately aligned with moral injury. Interventions aimed at individual physicians, such as mentorship programs and personalized electronic medical record training, fall short of addressing the root causes of these issues. The evidence shows that mitigating moral injury requires a more integrated systemic approach.</p><p><strong>Conclusion: </strong>This study highlights the importance of distinguishing between burnout and moral injury. Addressing moral injury requires a shift in focus from individual-level treatments to systemic interventions that enhance physician autonomy, reduce administrative burdens, and ensure adequate resources for patient care. It also requires physicians to understand the business behind medicine to participate in workplace decision-making. By accurately identifying moral injury and implementing comprehensive, system-wide strategies, the health care field can better support providers, improve patient outcomes, and mitigate long-term psychological harm among health care professionals.</p>","PeriodicalId":45220,"journal":{"name":"Urology Practice","volume":" ","pages":"357-363"},"PeriodicalIF":1.7,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143639732","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":"Vannita Simma-Chiang","doi":"10.1097/UPJ.0000000000000815","DOIUrl":"10.1097/UPJ.0000000000000815","url":null,"abstract":"","PeriodicalId":45220,"journal":{"name":"Urology Practice","volume":"12 4","pages":"362-363"},"PeriodicalIF":1.7,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144477230","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":"Letter: Difficulty With Board Certification in Urology Is Associated With Adverse Medical License Actions.","authors":"Brigitte Smith, Brenessa Lindeman","doi":"10.1097/UPJ.0000000000000797","DOIUrl":"10.1097/UPJ.0000000000000797","url":null,"abstract":"","PeriodicalId":45220,"journal":{"name":"Urology Practice","volume":" ","pages":"366-367"},"PeriodicalIF":0.8,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143606644","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":"Changes in Vasectomy Practice Patterns After Dobbs: A Multi-Institutional Study.","authors":"Rutul D Patel, Justin Loloi, Reza Kianian, Juan J Andino, Dattatraya Patil, Akanksha Mehta, Tenny R Zhang, Jonathan Gal, Robert Fisch, Susan M MacDonald, Crystal L Valadon, Ajay K Nangia, Avi Sura, Robert C Welliver, Kara Watts","doi":"10.1097/UPJ.0000000000000810","DOIUrl":"10.1097/UPJ.0000000000000810","url":null,"abstract":"<p><strong>Introduction: </strong>Following the Dobbs decision overruling <i>Roe v Wade</i>, public interest in vasectomies increased. This ruling directly affected urologic practice patterns and warrants further investigation. We aimed to conduct a multi-institutional study quantifying the change in vasectomy practice volume between the pre-Dobbs (PD) and after-Dobbs (AD) eras.</p><p><strong>Methods: </strong>Multiple geographically distinct US academic medical centers participated in the study. Patients with an initial vasectomy consult between January 1, 2021, and December 31, 2022, were included and categorized as pre-Dobbs (January 1, 2021-June 24, 2022) and after-Dobbs (June 25, 2022-December 31, 2022). Dates of subsequent vasectomy procedures and patient demographic information were compared between the 2 groups.</p><p><strong>Results: </strong>A total of 4326 initial vasectomy consults were analyzed. Among these, 3691 had subsequent vasectomies (2742 pre-Dobbs [152 cases/mo] vs 949 AD [158 cases/mo]). Men in the AD group were more likely to be younger (median age 38 years vs 39 years, <i>P</i> < .001), non-Hispanic White (68% vs 64%, <i>P</i> = .009), English speaking (94% vs 91%, <i>P</i> = .005), and privately insured (92% vs 89%, <i>P</i> = .008). The AD group also had fewer children (median number 2 [1-2] vs 2 [2-3], <i>P</i> < .001) and longer median wait time between the vasectomy consult and procedure (56 days vs 52, <i>P</i> < .001). Married men in the AD group were more likely to be childless (11% vs 5%, <i>P</i> < .001), as were single men (40% vs 23%, <i>P</i> < .001).</p><p><strong>Conclusions: </strong>The Dobbs decision not only affected vasectomy volume nationwide but also the typical patient seeking a vasectomy. Urologists may need to adjust practice patterns to accommodate and educate the evolving vasectomy demographic.</p>","PeriodicalId":45220,"journal":{"name":"Urology Practice","volume":" ","pages":"426-432"},"PeriodicalIF":1.7,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143606643","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":"Use and Usefulness of Risk Prediction Tools in Urologic Surgery: Current State and Path Forward.","authors":"Elizabeth M Nazzal, Allison M Deal, Benjamin Borgert, Hillary Heiling, Antonia V Bennett, Susan Blalock, William Meeks, Raymond Fang, Randall Teal, Maihan B Vu, David Gotz, Matthew E Nielsen, Alex H S Harris, Ethan Basch, Hung-Jui Tan","doi":"10.1097/UPJ.0000000000000808","DOIUrl":"10.1097/UPJ.0000000000000808","url":null,"abstract":"<p><strong>Introduction: </strong>Although the enthusiasm for artificial intelligence (AI) to enhance surgical decision-making continues to grow, the preceding advance of risk prediction tools (RPTs) has had limited impact to date. To help inform the development of AI-powered tools, we evaluated the role of RPTs and prevailing attitudes among urologists.</p><p><strong>Methods: </strong>We conducted a national mixed methods study using a sequential explanatory design. Through the 2019 AUA Census, we surveyed urologists on RPT use, helpfulness, and trust. Based on responses, we interviewed 25 participants on RPTs, risk evaluation, and surgical decision-making. Coding-based thematic analysis was applied and integrated with survey findings.</p><p><strong>Results: </strong>Among 2081 urologic surgeons (weighted sample 12,366), 30.4% (95% CI, 28.2%-32.6%) routinely used RPTs and 34.3% (95% CI, 31.9%-36.6%) found them helpful while 47.0% (95% CI, 44.6%-49.5%) generally trusted their own assessment over RPT-generated estimates. More years in practice was negatively associated with RPT use, helpfulness, and trust (<i>P</i> < .001). Qualitatively, participants described relying on their intuition for surgical risks and benefits and using gist-based approximations rather than numerical information, which RPTs provide. RPT helpfulness centered on risk/benefit confirmation, calibration, and communication, but methodological (eg, individual vs group estimates and missing variables) and operational (eg, ease of use and clinical workflow) challenges limit greater RPT use.</p><p><strong>Conclusions: </strong>Despite their wide availability, RPTs remain limited in their use and helpfulness. This reflects both the intuitive nature of surgical decision-making and implementation challenges. For AI to reach its promise and improve surgical care and outcomes, both types of barriers will need to be addressed.</p>","PeriodicalId":45220,"journal":{"name":"Urology Practice","volume":" ","pages":"459-468"},"PeriodicalIF":1.7,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12187546/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143606646","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Editorial Commentary.","authors":"Othmane Zekraoui, Naeem Bhojani","doi":"10.1097/UPJ.0000000000000796","DOIUrl":"10.1097/UPJ.0000000000000796","url":null,"abstract":"","PeriodicalId":45220,"journal":{"name":"Urology Practice","volume":"12 4","pages":"424-425"},"PeriodicalIF":1.7,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144477220","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}