BACKGROUND Step 1 has historically been a major criterion to evaluate students for residency match. With Step 1 now being pass/fail (P/F), students are uncertain how to distinguish their applications. We aim to understand student's opinions surrounding the scoring change as this is the first class of students applying to residency in the P/F era. MATERIALS AND METHODS An electronic survey was sent to 3rd and 4th year American medical students. RESULTS Of the 255 students surveyed, 61.6% prefer Step 1 in the P/F format. Students applying for highly competitive specialties (HCS) preferred numerical scoring (55.6%). On a 5-point Likert scale, students entering HCS believed more strongly that they would have a better chance at matching if Step 1 was graded numerically (3.47 vs 2.71) and creates an unfair advantage for those who can afford to pursue a research year (3.46 vs 2.95). Students entering HCS felt finances played a significant role in whether they took a research year and felt added pressure to engage in research. Respondents believe that students from prestigious medical schools, well-connected students, and MD students will benefit most. CONCLUSIONS While students mostly prefer P/F scoring, there were differences of opinion between those going into HCS and LCS. Students indicated that those who have financial means are at a distinct advantage as they can afford to utilize a research year to distinguish their applications. Future efforts should be made to address student concerns and unintended consequences of the scoring change to create an equitable system.

You have accessJournal of UrologyHealth Services Research: Quality Improvement & Patient Safety I (MP02)1 May 2024MP02-11 A SURVEY OF SURGICAL STAFF'S KNOWLEDGE, ATTITUDES, AND BARRIERS TO REDUCING OPERATING ROOM WASTE Jake Drobner, Melinda Fu, Alexis Consalvo, Benjamin Lichtbroun, Kevin Chua, and Danielle Velez Jake DrobnerJake Drobner , Melinda FuMelinda Fu , Alexis ConsalvoAlexis Consalvo , Benjamin LichtbrounBenjamin Lichtbroun , Kevin ChuaKevin Chua , and Danielle VelezDanielle Velez View All Author Informationhttps://doi.org/10.1097/01.JU.0001008600.97797.3b.11AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Up to one-third of total hospital waste is attributable to the operating room (OR). Surgical supplies are often wasted unnecessarily, and waste is often misclassified. Thus, the OR is an area where practical and significant changes can be made to lessen the impact of hospital waste. More sustainable waste management practices will serve to decrease OR expenditure, and the surgery community must integrate waste reduction into its workflow to reduce the environmental consequences of healthcare. METHODS: After IRB approval, a 25-item electronic survey was distributed to surgeons, nurses, anesthesia providers, and technicians who work in the OR at a single academic institution. The survey collected data on respondents' demographic characteristics, attitudes towards OR waste, perceived barriers to waste reduction, and baseline knowledge of proper waste disposal procedures. RESULTS: Out of a total of 51 complete responses, 94% agreed that OR waste is a significant problem (Table 1). 98% of respondents agreed that they were willing to recycle sterile surgical supplies, and 92.2% agreed that they would be willing to adjust their perioperative workflow to reduce waste. The majority of respondents felt that OR waste reduction does NOT occur at the expense of patient safety and will NOT impede OR efficiency. There was 100% agreement that the hospital administration should support solutions for reducing OR waste and 92.2% agreement that reducing OR waste will lead to cost-savings for the hospital. Greater than 90% of respondents felt that they have a personal responsibility— and that the hospital has an ethical responsibility— to reduce the OR waste. However, only 29.4% of respondents correctly answered that blue wrap can be recycled, and only 13.7% knew that intravenous fluid bags could be recycled. Blue towels, sterile gloves, sterile fluid bottles, and unused instruments were subjectively reported as the most wasted items. CONCLUSIONS: Lack of buy-in by key stakeholders is often cited as a reason that OR waste reduction initiatives are unsuccessful. The results of this survey provide evidence that OR personnel are concerned about unnecessary waste and interested in more sustainable waste management practices. Addressing OR waste can be daunting, but even small initiatives are viable and effective. Source of Funding: None © 2024 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 211Issue 5SMay 2024Page: e16 Advertisement Copyright & Permissions© 2024 by American Urological Association Education and Research, Inc.Metrics Author Information Jake Drobner More articles by this author Melinda Fu More articles by this author Alexis Consalvo More articles by this author Benjamin Lichtbroun More articles by this author Kevin Chua More articles by this author Danielle Velez More articles by this author Expand All Advertisement PDF downloadLoading ...

The effect of the Dobbs decision on 2023 Urology match applicants: 88% disapproved, and 1/5 eliminated programs from their rank list.[MeSH = “urology”, “abortion, induced”, “reproductive health”/ “reproductive health services”, “workforce”/ “health workforce”, “internship and residency”/ “medical residency”]ObjectiveTo examine the impact of the 2022 U.S. Supreme Court ruling Dobbs v. Jackson Women’s Health Organization, which declared there is no constitutional right to abortion, on professional decision-making in residency selection and ranking.Materials and MethodsAn IRB-exempt REDCap survey was distributed through the Society of Academic Urologists to all 508 applicants registered for the 2023 Urology Match following the rank list submission deadline on January 10, 2023. The survey closed on February 1, 2023. Responses were anonymized, aggregated, and characterized using descriptive statistics. Thematic mapping of open text comments was performed by two reviewers.ResultsThe response rate was 42% (215/508). 88% of respondents disapproved of the Dobbs ruling. Twenty percent of respondents (15% male/24% female) eliminated programs in states where abortion is illegal. Fifty nine percent (51% male/70% female) would be concerned for their or their partner’s health if they matched in a state where abortion was illegal, and 66% (55% male/82% female) would want their program to assist them or their partner if they required abortion care during residency. Due to the competitive nature of Urology, 68% of applicants reported feeling at least somewhat obligated to apply in states where abortion legislation conflicts with their beliefs. Of the 65 comments provided by respondents, four common themes emerged: 1) Avoidance of states with restrictive abortion laws; 2) Inability to limit applications because of the competitiveness of urology; 3) Impacts on personal healthcare; and 4) Desire for advocacy from professional urology organizations.ConclusionsThe Dobbs ruling will impact the urology workforce by affecting urology applicants’ decision-making regarding residency selection and ranking. Although the competitiveness of the Urology Match pressures applicants to apply broadly, many are taking reproductive healthcare access into consideration.

To investigate if predictors of wound complications differed between patients undergoing excision and primary anastomosis urethroplasty (EPA) and augmented urethroplasty. The National Surgical Quality Improvement Program database from 2006 to 2018 was queried for male patients undergoing urethroplasty. Thirty-day wound complications were identified and categorized (superficial/deep/organ-space surgical site infections and dehiscence). Multivariable logistic regression was performed to determine risk factors associated with wound complications. Smoking history was defined as current smoker within the past year. Urethroplasty was performed in 2251 males, with 25.46

In June 2022, the U.S. Supreme Court ruling Dobbs v. Jackson Women’s Health Organization overturned Roe v. Wade and declared there is no constitutional right to abortion. Twelve states have subsequently passed total abortion bans. We surveyed applicants to the 2023 Urology Residency Match to examine attitudes towards the Dobbs decision and its impact on professional decision-making. An IRB-exempt REDCap survey was distributed by the Society of Academic Urologists (SAU) following the rank list submission deadline on January 10, 2023. The survey closed on February 1, 2023. Participants were applicants to the 2023 Urology Match over age 18. Responses were anonymous, collected in aggregate, and characterized using descriptive statistics. Of 508 applicants, 215 (42%) completed the survey (Table 1). Notably, 88% of participants disapprove of the Dobbs ruling, with 25% of respondents reporting that the Dobbs verdict has factored into their decision to apply or not apply to certain programs. 20% of respondents (15% of male vs. 24% of female) eliminated programs in states where abortion is illegal and 34% (25% of male vs. 44% of female) considered doing so. Overall, 59% (51% of male vs. 70% of female) reported they would be concerned for their or their partner’s health and safety were they to match into a program in a state where abortion was illegal and 66% (55% of male vs. 82% of female) would want their program to assist them or their partner should they require abortion care during their residency. Although applicants’ decisions on residency program selection are multifactorial, 36% reported access to reproductive healthcare as moderately/extremely important. Due to the competitive nature of urology, 68% of applicants reported feeling somewhat obligated to apply to programs in states where abortion legislation conflicts with the applicant’s own beliefs. The Dobbs ruling is showing early impact on the urology workforce distribution by substantially affecting urology applicants’ decision-making regarding residency selection and ranking. Although the competitiveness of Urology pressures applicants to apply broadly, many are still taking reproductive healthcare access into consideration. A majority of respondents want support from their program should they or their partner require abortion care during residency.

You have accessJournal of UrologyCME1 Apr 2023MP75-19 CHARACTERISTICS OF MALE AND FEMALE APPLICANTS WHO SUCCESSFULLY MATCHED INTO UROLOGY RESIDENCY PROGRAMS: ANALYSIS OF THE 2016-2021 UROLOGY RESIDENT COHORT Juliana Kim, Isaac Kim, Labeeqa Khizir, Justin Lee, Rebecca Lee, Ji Hae Park, Saum Ghodoussipour, Danielle Velez, and Thomas Jang Juliana KimJuliana Kim More articles by this author , Isaac KimIsaac Kim More articles by this author , Labeeqa KhizirLabeeqa Khizir More articles by this author , Justin LeeJustin Lee More articles by this author , Rebecca LeeRebecca Lee More articles by this author , Ji Hae ParkJi Hae Park More articles by this author , Saum GhodoussipourSaum Ghodoussipour More articles by this author , Danielle VelezDanielle Velez More articles by this author , and Thomas JangThomas Jang More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003349.19AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Urology has been long recognized as a competitive field, and women have historically remained underrepresented. However, over the last 3 years, the female match rate has exceeded the overall match rate. We undertook this purely descriptive study without causal assumptions to assess differences in the characteristics of male and female urology residents at the time of their match. METHODS: Using publicly available data, demographics and bibliometrics were collected for 1,814 urology residents who attend a US-based ACGME-Accredited program, reflecting matched applicants from 2016-2021. Sex was determined via a combination of resident name, photo, and social media profile, and then compared to the official match statistics compiled by the American Urological Association. Pearson’s chi-squared test and analysis of variance (ANOVA) were used to test for associations. RESULTS: Of 1,814 successfully matched residents, 1,297 (71.5%) were male and 516 (28.5%) were female (Table 1). There were no significant differences between male and female applicants with respect to the most higher educational degrees, except for a higher proportion of females having a Masters of Science compared to males (11.43% vs 8.17%, p=0.029). No significant differences in AOA memberships between males and females were observed (20.66% vs 21.32%, p<0.757). Regarding bibliometrics, male residents had a higher mean number of published papers and abstracts compared to their female counterparts (5.9 vs 4.7, p<0.001) as well as a higher h-index (2.1 vs 1.7, p=0.001). Data on research output was similar post-match as of 2021. CONCLUSIONS: As we seek to close the sex/gender gap in our field, it is critical to understand the characteristics of successful match applicants and to identify and address pre-existing disparities responsible for this gap. Though we found research output and select higher educational degrees varied according to sex of the applicant, these findings are not easily interpretable. Further research is needed to explore other variables not evaluable using publicly available data (i.e. degree and availability of mentorship and resources available to male vs female applicants, etc.). Source of Funding: This work is supported by a grant from the National Cancer Institute (P30CA072720) © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e1088 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Juliana Kim More articles by this author Isaac Kim More articles by this author Labeeqa Khizir More articles by this author Justin Lee More articles by this author Rebecca Lee More articles by this author Ji Hae Park More articles by this author Saum Ghodoussipour More articles by this author Danielle Velez More articles by this author Thomas Jang More articles by this author Expand All Advertisement PDF downloadLoading ...

OBJECTIVE To investigate the prevalence and treatment rates of low testosterone (T) in men with cystic fibrosis (CF). CF is a genetic disease with highly variable presentation that results from a mutation in the cystic fibrosis transmembrane conductance regulator (CFTR) gene. Phenotypic manifestations of CF include alterations in function of the lungs, liver, pancreas, and reproductive system. Despite the well-described association between CF and infertility secondary to congenital bilateral absence of the vas deferens (CBAVD), men with CF report further sexual and reproductive health concerns, many of which are often associated with low testosterone. METHODS We queried the TrinetX database for men over 18 years old with CF or CBAVD to assess what percentage of men had a T level measured, and if hypogonadal (below 300 ng/dL), what percentage received T therapy (TT). We hypothesized that low T would be under-evaluated in the RESULTS Serum T levels were measured in 10.1% of men with CF and 8.9% of men with CBAVD. Within each group, 464 men with CF (32.7%) and 132 with CBAVD (43.0%) demonstrated low T. The majority of men with T < 300 ng/dL went on to appropriately receive TT: 59.3% of men with CF and 78% with CBAVD. CONCLUSION Our data suggests that hypogonadism is highly prevalent in men with CF and CBAVD. Investigation and appropriate treatment of testosterone deficiency may significantly improve quality of life. UROLOGY 182: 143-148, 2023. (c) 2023 Elsevier Inc. All rights reserved.

BACKGROUND:Most males with cystic fibrosis (mwCF) are infertile but with CF transmembrane conductance regulator (CFTR) modulator-conferred benefits, more are utilizing assisted reproductive technologies (ART). Administration of normal human doses of modulators in animal reproductive models caused no genotoxicity; no human data exists. Potential health decline following modulator discontinuation makes the decision to withhold therapy during reproduction challenging. METHODS:From August-October 2021, international CF clinicians completed an anonymous questionnaire regarding mwCF who used modulators during reproduction. RESULTS:We received 42 surveys for mwCF with partner pregnancies. Forty of 42 mwCF utilized ART; 35 continued modulators during sperm retrieval and 40/42 during partner pregnancy. One of four males who discontinued modulators experienced clinical deterioration. First trimester miscarriages occurred in 11.9 % of partner pregnancies. No congenital anomalies were reported. CONCLUSIONS:Use of CFTR modulators during reproduction and partner pregnancy in mwCF did not result in a higher-than-expected miscarriage rate nor congenital anomalies.

Testicular cancer is a common cancer among reproductive age men, with the necessary treatment options having varying impacts on fertility and sexual function. Treatment begins with orchiectomy and is often followed by a combination of chemotherapy, radiation, and/or retroperitoneal lymph node dissection, which have different effects on spermatogenesis, gonadotropin levels, and ejaculation. Alkylating agents such as cisplatin are commonly used for testicular cancer and are amongst the most spermatotoxic chemotherapeutic agents. Radiation poses gonadotoxic effects despite gonadal shielding due to a scatter effect. Suprahilar and bilateral retroperitoneal lymph node dissections can cause ejaculatory dysfunction. Options to preserve fertility vary by pubertal status. While the standard recommendation for post pubertal patients is cryopreservation, prepubertal patients rely on experimental protocols for cryopreservation of germ cells with stem cell capabilities, with the hope that these cells will one day be stimulated to produce sperm. These topics are reviewed to give insight into current literature around fertility in testicular cancer survivorship and determine best possible practices in fertility preservation among patients.

Successful transportation of sperm from their origin within the seminiferous tubules of the testis to their site of emission in the posterior urethra involves a completely patent ductal system. Emerging from the testis into the efferent ducts, sperm enter 6–7 m of the coiled epididymal tubule, which develops into the convoluted vas deferens. The convoluted vas then gradually straightens as it courses up the scrotum, progressing first through the external ring of the inguinal canal, before diving into the retroperitoneum via the internal inguinal ring. Sperm within the vas will ultimately fill the widened ampulla of the vas and join with the seminal vesicle (SV) duct (approximately 2 cm in length) to form the ejaculatory duct (ED) that courses through the prostate. Obstruction can occur anywhere along this ductal system. This chapter will focus on the three most common sites of obstruction: the ED; the vas deferens; and the epididymis. The discussion will begin distally at the ED and progress proximally towards the testis.

To understand the range of male infertility conditions, knowledge of normal male anatomy and its embryology is essential. This chapter will review the major developmental events from fertilization to organization of the germ layers into organ systems. It will review in depth the formation of the male genitourinary system and external genitalia. By laying a strong foundation in embryology and anatomy, providers will have a more thorough understanding of disease states.

OBJECTIVE:To determine the characteristics of US medical schools associated with successful urology match applicants. MATERIALS AND METHODS:Using publicly available data, demographics and bibliometrics were collected for 1814 current urology residents who attend a US-based Accreditation Council for Graduate Medical Education (ACGME) Accredited program, reflecting matched applicants over a 6-year period from 2016-2021. A generated list of US feeder medical schools for urology was analyzed for correlative and predictive factors. Statistical analyses to characterize these factors included Pearson's Correlation Coefficient (PCC) and univariable and multivariable linear regression, respectively, as needed. RESULTS:There were 516 (28.45%) female residents and 58 (3.20%) international medical graduates. The mean number of published papers and abstracts ± SD pre-residency was 5.54 ± 7.20 with a mean h-index of 1.97 ± 2.24. The Cleveland Clinic Lerner College of Medicine had the highest percentage of successful matches into urology (n = 7, 3.65%), while the State University of New York Downstate Medical Center College of Medicine produced the highest absolute number (n = 41, 3.30%). The presence of a home urology program and pre-residency h-index had the strongest correlation with producing urology residents (PCC = 0.5769 and 0.3709, respectively, P<.0001). CONCLUSION:Understanding the characteristics of a successful urology match applicant and the medical schools that produce them will be vital as USMLE Step 1 exam becomes pass/fail. Further research into these schools' curricula is required to better understand the effect of early exposure to urology on matching into urology.

The number of practicing female urologists has increased from < 2% in 1980 to 9.2% in 2018. Despite this increase, urology trails far behind medical fields overall and surgical subspecialties, in achieving gender parity. Barriers, such as pervasive biases and institutional policies, exist at the medical student, resident, and practicing urologist levels. Once recognized as detrimental, action can be taken to combat these forces to allow for advancement of women in the field of urology. This will result in a richer workforce better able to serve its patient population and advance the field.

Primum non nocere. As physicians, our goal is to treat illnesses and alleviate suffering; however, in doing so, we can generate new problems in a game of medical whack-a-mole. For some patients, certain consequences or side effects are tolerable, while others may believe they have no alternative. For a male patient with infertility, a thorough history is imperative to elucidate whether the patient has been or is currently being exposed to medications that will harm libido, spermatogenesis, ejaculation, or the hypothalamic-pituitary-testosterone axis. This article will review the most common medications causing iatrogenic male infertility as well as options to minimize or even reverse their impact. (C) 2021 by American Society for Reproductive Medicine.

Pyospermia (or leukocytospermia) is suspected based on the presence of >1 × 106 round cells/mL of ejaculate and diagnosed using peroxidase stain revealing >1 × 106 white blood cells/mL. The presence of white blood cells is a concern for overt infections or excessive inflammation, both of which have been postulated to negatively impact bulk semen parameters and fertilization capability. The threshold for pyospermia has been debated upon in the literature, as has the optimal treatment method. In the absence of clinical infectious symptoms, it appears that antibiotics, anti-inflammatory agents, and/or frequent ejaculation may improve bulk semen parameters in men with pyospermia. Further research is needed to adequately assess the effect of these methods on pregnancy and live birth outcomes, especially among couples attempting natural conception compared to those attempting intrauterine insemination or in vitro fertilization.

Except for condom use, vasectomy is the only approved form of male contraception. The American Urological Association published guidelines on vasectomy in 2012, which clearly outlined patient counseling, vasectomy techniques to maximize successful occlusion, and postvasectomy care. However, there are certainly areas of further improvement to be addressed. Vasectomy is severely underutilized compared with tubal ligation for sterilization, likely due to lack of patient awareness. Although the majority of vasectomies are performed in the office with local anesthesia, some patients are still routinely prescribed narcotics for postprocedural pain, despite the well-described opioid pandemic. Finally, although patients are counseled on the necessity of a postvasectomy semen analysis to confirm sterility prior to the discontinuation of alternative contraceptives, more than 500/0 of men do not complete this test. Therefore, alternative strategies must be pursued to improve patient compliance. (Fertil Sterile 2021;115:1365-8. (c) 2021 by American Society for Reproductive Medicine.)