Pelvic fracture urethral distraction defects are typically imaged with retrograde urethrogram and voiding cystourethrogram during the work up for delayed posterior urethroplasty following trauma. The imaging results often dictate the decision-making regarding treatment options. Magnetic resonance imaging can offer a more detailed picture of the defect and can aid in preoperative planning. We present the case of an individual who was deemed unrepairable by routine imaging, however, the MRI indicated that surgery was possible.

IntroductionIt is increasingly important to identify and eliminate inefficiencies in resident education. We hypothesize that slower performance of specific operative steps in laparoscopic nephrectomy accounts for much of the slower operative speed observed in junior residents vs. their senior colleagues. Therefore, we sought to evaluate the by-step time-differential between experienced senior residents and their junior colleagues in a live-tissue simulation.Materials and methodsResidents participated in our swine model surgical simulation of laparoscopic radical and partial nephrectomy (LRNx and LPNx). PGY5 and 6 residents were considered senior; junior residents were PGY3 and 4. We defined discrete surgical steps. Residents' post-graduate training levels were tracked and time-to-completion of each operative step was recorded.ResultsSeven live-tissue simulations sessions took place, with 12 residents conducting 22 operations (12 LRNx, 10 LPNx). On average, each resident operated in 2 simulation sessions (range 1–4). The average time required by senior residents for LPNx was 152 min; junior residents required 173 min (p = 0.35). When considering the operative steps, juniors required nearly twice as much time to achieve hilar control (42 min vs. 23 min, p = 0.03). Significant differences in performance time were not seen in the other steps.DiscussionThe performance differential between senior and junior residents conducting nephrectomies was most evident during hilar dissection. Our study suggests that specific efforts should be focused on teaching junior residents the skills required for this step early in their training.

You have accessJournal of UrologyHealth Services Research: Practice Patterns, Quality of Life and Shared Decision Making III (MP23)1 Sep 2021MP23-17 SOCIOECONOMIC FACTORS PREDICT DELAY IN PROSTATE CANCER TREATMENT DECISION AND INITIATION Patrick Probst, Hunter Kraus, Will Fry, Aditya Sathe, Jackson Eber, Jay Fowke, Patricia Goedecke, Maurizio Buscarini, Christopher Ledbetter, Anthony Patterson, and Robert Wake Patrick ProbstPatrick Probst More articles by this author , Hunter KrausHunter Kraus More articles by this author , Will FryWill Fry More articles by this author , Aditya SatheAditya Sathe More articles by this author , Jackson EberJackson Eber More articles by this author , Jay FowkeJay Fowke More articles by this author , Patricia GoedeckePatricia Goedecke More articles by this author , Maurizio BuscariniMaurizio Buscarini More articles by this author , Christopher LedbetterChristopher Ledbetter More articles by this author , Anthony PattersonAnthony Patterson More articles by this author , and Robert WakeRobert Wake More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002014.17AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Although prostate cancer is typically a slow-growing malignancy, pathology and risk stratification can progress in as quick as 3 months. Socioeconomic status (SES) and health disparities have been identified as predictors of worse oncologic and survival outcomes in men with prostate cancer. We sought to identify specific SES characteristics that contribute to delayed treatment decision (TD) and initiation (TI) in a majority black patient population. METHODS: After receiving IRB approval, men with a positive prostate biopsy between Jan. 2013 and Dec. 2019 at the Memphis VA Medical Center were retrospectively reviewed. Those with a known prostate cancer diagnosis or metastatic disease were excluded. Demographic data was compiled using census information corresponding to patient zip codes at time of biopsy. Time from biopsy to TD and time from TD to TI, were recorded (Table 1a.) Univariate chi-square analyses were performed to determine predictors of treatment selection while multivariable logistic regression analysis determined predictors of delayed TD and delayed TI. Delayed TD was defined as >100 days while delayed TI was defined as >150 days. RESULTS: 630 men with mean age of 63.3 years (41-79) and predominantly black (71.9%) met inclusion criteria. Race, age group and cancer risk stratification were strongly associated with type of therapy selected (p <0.0006). When controlling for age and risk, no demographic or socioeconomic factors were significantly associated with delayed TD. However, race and income approached statistical significance. Non-white men were 39% more likely to have a delayed time to decision (p=0.0633). Patients with average income <$40,000 were 78% more likely to have delayed TD (p=0.0769). Men <60 years old were 38% less likely to have delayed TI (p=0.0418). Those with low risk disease and poverty level >30% were 7.4x (p <0.0001) and 2x (p=0.0132) more likely to have delayed TI, respectively. Finally, white men were 67% more likely to have a delay in treatment initiation (p=0.0411). CONCLUSIONS: Individualized patient-specific education and adequate time to consider all therapies should be given to men with newly diagnosed prostate cancer. However, particular attention to those with lower SES is needed to avoid delays in therapy decision and ultimately treatment initiation. Source of Funding: None © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e408-e409 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Patrick Probst More articles by this author Hunter Kraus More articles by this author Will Fry More articles by this author Aditya Sathe More articles by this author Jackson Eber More articles by this author Jay Fowke More articles by this author Patricia Goedecke More articles by this author Maurizio Buscarini More articles by this author Christopher Ledbetter More articles by this author Anthony Patterson More articles by this author Robert Wake More articles by this author Expand All Advertisement Loading ...

You have accessJournal of UrologyStone Disease: Surgical Therapy II (MP18)1 Sep 2021MP18-15 INCREASED STONE BURDEN, ANATOMY COMPLEXITY, CYSTINE STONE COMPOSITION AND IR ACCESS PREDICT LOWER STONE FREE RATES Patrick Probst, Hunter Kraus, Jackson Eber, Maurizio Buscarini, Christopher Ledbetter, Anthony Patterson, and Robert Wake Patrick ProbstPatrick Probst More articles by this author , Hunter KrausHunter Kraus More articles by this author , Jackson EberJackson Eber More articles by this author , Maurizio BuscariniMaurizio Buscarini More articles by this author , Christopher LedbetterChristopher Ledbetter More articles by this author , Anthony PattersonAnthony Patterson More articles by this author , and Robert WakeRobert Wake More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002003.15AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Ureteroscopy (URS) and percutaneous nephrolithotomy (PCNL) are mainstay therapies for nephroureterolithiasis. Our aim was to determine predictors of stone-free rate (SFR) following URS and PCNL in a large series of patients. METHODS: Retrospective review identified 3051 patients undergoing 5586 PCNLs or URSs for nephroureterolithiasis from 2008-2018. Stone size, durility and composition, number and type of operations, SFR, infundibular stenosis, specialty performing access, and complications were noted. Durility was stratified by Hounsfield Units on CT – <60, 60-100 and >100. One endourologist performed all procedures utilizing consistent techniques. All patients underwent CT stone protocol 1 week post-operatively to determine SFR. RESULTS: 3051 patients with a mean stone burden (SB) of 1.18cm underwent 5586 procedures (Table 1a and 1b). The mean number of procedures per patient was 1.8. Patients undergoing >1 procedure were more likely to have larger SB (p <0.001). Patients were 33% more likely to require another procedure with each centimeter increase in SB (p <0.001). Cystine stones were 105x more likely to require more than 1 surgery (p <0.001). Although infundibular stenosis was associated with lower SFR (p=0.021) stone durility was not associated with need for more than one procedure (p=0.791). However increased stone durility was 3.3x as likely to have PCNL (p <0.001). PCNL was 2.4x more likely to require a second procedure than URS (p <0.001). However, stones treated with PCNL were significantly bigger than stones treated with URS (p <0.001). Flexible nephroscopy before concluding PCNL was associated with a higher SFR than just PCNL alone (p <0.001). SFR was significantly better if PCNL access was achieved by urology and not interventional radiology (p=0.001). Complications were more common in those that were not stone free (p=0.003). CONCLUSIONS: Increased SB, complex anatomy and cystine composition predicted lower SFR while stone durility was not associated with SFR. PCNL had lower SFR than URS but was used on larger and harder stones. SFR improved with concurrent flexible nephroscopy during PCNL and if percutaneous access was done by the urologist. This information can be used to guide surgical planning especially since complications appear more common in those with lower SFR. Source of Funding: None © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e324-e324 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Patrick Probst More articles by this author Hunter Kraus More articles by this author Jackson Eber More articles by this author Maurizio Buscarini More articles by this author Christopher Ledbetter More articles by this author Anthony Patterson More articles by this author Robert Wake More articles by this author Expand All Advertisement Loading ...