Background:Teaching and learning in the operating room environment are unique and impactful experiences. Little is known about effective and ineffective teaching methods. Our objective was to evaluate urology resident attitudes about aspects of teaching in the operating room that are helpful compared with those that are less effective. Materials and methods:Our mixed-methods analysis included written submitted evaluations of faculty by residents from our institution, as well as semi-structured interviews with trainees from different regions of the United States. We separated evaluations of faculty from 1 May 2013 to 30 April 2023 into highest and lowest quartiles based on numeric scores. We then conducted semi-structured interviews with trainees from institutions in different regions of the United States. Open-ended questions allowed participants to express themselves independently, and follow-up discussions explored their perception of effective methods of teaching in the operating room. All evaluations were printed and interviews transcribed. Three blinded, independent reviewers analyzed feedback to identify common themes associated with effective and ineffective teaching in the operating room. We analyzed transcripts using a multistage, cutting-and-sorting technique in an inductive approach based on grounded theory analysis. This work has been reported in line with the Consolidated criteria for Reporting Qualitative Research (COREQ) criteria. Results:Our analysis included 22 faculty (11 in each quartile) with an average of 16 evaluations each, as well as 20 transcribed interviews. Effective teaching involved clinician decision-making capability, specific communication, and appropriate graduated responsibility with patience. Ineffective teaching was characterized by poor decision making, lack of actionable communication/feedback, and absence of graduated autonomy/patience. Personal likeability was not a feature of effectiveness. Conclusion:Structured analysis of teaching methods in the operating room may allow continuous improvement for all teachers in the academic teaching mission. Further studies may explore consensus panels and potential creation of best practices that can help guide teachers and learners.

You have accessJournal of UrologyCME1 May 2022PD31-12 EVALUATING PREDICTIVE TOOLS FOR ANTERIOR URETHROPLASTY OUTCOMES: A COMPARISON OF THE TURNS LSE SYSTEM AND U-SCORE Jane Kurtzman, Rashed Kosber, Preston Kerr, and Steven Brandes Jane KurtzmanJane Kurtzman More articles by this author , Rashed KosberRashed Kosber More articles by this author , Preston KerrPreston Kerr More articles by this author , and Steven BrandesSteven Brandes More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002582.12AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The choice of surgery for treating anterior urethral strictures depends on disease severity. The TURNS LSE Classification System and the U-Score (US) attempt to classify severity and predict clinical outcomes. We compared each system’s ability to predict surgical complexity (SC), intraoperative outcomes, and stricture recurrence. METHODS: We performed a retrospective chart review of male patients who underwent single-stage anterior urethroplasty from 2016-2020. A US and a TURNS LSE score (TLS) was calculated for each patient. Table 1 displays scoring systems, and point allocation for TLS - which we based on previously published predictive analyses. Pearson’s correlation and linear regression analyses were used to assess for collinearity between US and TLS, and for a relationship between US and TLS with SC, operating room time (ORT) and blood loss (EBL). Kaplan Meier curves and Cox Proportional hazard ratios were used to assess if US and TLS could predict stricture recurrence within 5 years of surgery. RESULTS: A total of 100 patients, mean age of 51 years (SD 17) and mean stricture length of 4.5 cm (SD 3.3), were included. Mean follow-up was 21 months (SD 15). 22% recurred within 5 years. We found a strong positive linear correlation between US and TLS (p<0.001). Both US (r=0.34, p=0.0006) and TLS (r=0.26, p=0.009) positively correlated with SC. Increasing length and location for both US and TLS, linearly correlated with increasing complexity (all p<0.05). TLS was positively correlated with ORT (r=0.20, p=0.048). Increasing TLS was significantly associated with an increased risk of stricture recurrence (HR 1.36, p=0.017), but increasing US was not (p=0.19). Patients with high TLS (7-10) were 3.8 times as likely to recur than patients with a low TLS (3-6), (HR 3.8, p=0.005, Figure 1). CONCLUSIONS: US and TLS can both predict SC, but only TLS can predict OR time and stricture recurrence. Conversion of the TURNS Classification System into a numeric score adds substantial functionality to this novel system. Source of Funding: None © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e546 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Jane Kurtzman More articles by this author Rashed Kosber More articles by this author Preston Kerr More articles by this author Steven Brandes More articles by this author Expand All Advertisement PDF downloadLoading ...

You have accessJournal of UrologyCME1 May 2022MP31-10 SYSTEMATIC REVIEW AND META-ANALYSIS OF FRAILTY INDICES IN UROLOGIC SURGERY: RISK PREDICTION OF POSTOPERATIVE COMPLICATIONS Jane Kurtzman, Preston Kerr, Rashed Kosber, and Steven Brandes Jane KurtzmanJane Kurtzman More articles by this author , Preston KerrPreston Kerr More articles by this author , Rashed KosberRashed Kosber More articles by this author , and Steven BrandesSteven Brandes More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002580.10AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Contemporary surgical planning rarely involves formally assessing patient frailty, especially among urology (GU) patients. Our aim was to systematically review the literature to assess the ability of frailty indices to predict the risk of postoperative complications after GU surgery. METHODS: We systematically reviewed EMBASE, PubMed and SCOPUS according to PRISMA criteria in June 2021. Studies that utilized a validated frailty index (FI) to assess risk of major postoperative complication (Clavien-Dindo ≥3), following GU surgery were eligible for inclusion. Charlson Comorbity Index and Eastern Cooperative Oncology Group were not considered FIs. Administrative studies, those without odds ratios (OR) and/or raw data were excluded. The pooled effect size was calculated as OR and corresponding 95% CI through a random effect model using inverse variance weighing. RESULTS: Of 1,265 unique articles initially identified, 9 studies - from 6 different countries, published from 2019-2021, were eligible for inclusion (4 prospective; 5 retrospective). 8/9 studies assessed only GU oncologic surgery. The Modified Frailty Index (mFI) was the most commonly used index (n=3), followed by the Fried Phenotype Criteria (n=2), the Canadian Study of Health and Aging (CSHA) Index (n=2) and the Rockwood Frailty Index (n=2). Data from a total of 2,153 patients was included. Based on pooled OR from both univariable and multivariable analyses, frailty was associated with a significantly higher odds of postoperative complication at 30 days (OR 2.7, 95% CI: 1.8-4.0, p <0.001 and OR 2.1, 95% CI: 1.5-3.0, p <0.001, Fig 1A-B), but may not be at 90 days (OR 2.0, p=0.11 and OR 1.6, p=0.35, Fig 1C-D). Stratified by FI, higher Rockwood and CSHA scores were associated with an increased odds of 30 d complication (OR 1.8, p <0.001 and OR 2.6, p=0.002), but mFI ≥2 was not (OR 5.0, p=0.11). CONCLUSIONS: Frailty indices are a relatively new addition to the urologist’s toolkit. Preoperative assessment of frailty can help predict risk of early (30 d) major postoperative complications but may be less useful for later complications, though significant additional studies are needed. Further work is also needed to evaluate the impact of frailty on non-oncologic urology patients who undergo major GU surgery. Source of Funding: None © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e525 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Jane Kurtzman More articles by this author Preston Kerr More articles by this author Rashed Kosber More articles by this author Steven Brandes More articles by this author Expand All Advertisement PDF DownloadLoading ...

PURPOSE:We evaluated if scores generated by the LSE classification system and the Urethral Stricture Score system are associated with intraoperative surgical complexity and stricture recurrence risk.MATERIALS AND METHODS:We retrospectively reviewed all consenting patients who underwent single-stage anterior urethroplasty by a single surgeon at 2 institutions. Urethral Stricture Score and a numerical LSE "score" was calculated for each patient. Pearson's correlation and linear regression analyses were used to assess for a relationship between increasing Urethral Stricture Score and LSE score and surgical complexity. Kaplan-Meier curves and Cox proportional hazard regression models were used to assess for an association between Urethral Stricture Score and LSE score and stricture recurrence risk.RESULTS:A total of 187 patients with a mean age of 48 years (SD 16) and mean stricture length of 4.2 cm (SD 3.3) were included. Mean follow-up was 21 months. Forty-six patients recurred over time. We found a strong positive linear correlation between Urethral Stricture Score and LSE score (P < .001). Both increasing Urethral Stricture Score and LSE score independently linearly correlated with increasing surgical complexity (both P < .0001). Univariable analysis demonstrated that increasing LSE score was significantly associated with an increased risk of stricture recurrence (HR 1.2, P = .02) but Urethral Stricture Score was not. Patients with a high LSE score (≥7) were nearly 3 times as likely to recur versus patients with a low LSE score (HR 2.7, P = .001).CONCLUSIONS:Increasing Urethral Stricture Score and LSE score are both associated with increasing surgical complexity, but only LSE score is associated with stricture recurrence risk. Conversion of the LSE classification system into a numeric score adds functionality to this novel system.

You have accessJournal of UrologyCME1 May 2022PD31-07 DOES ORAL HEALTH AND GRAFT HISTOLOGY PREDICT POSTOPERATIVE OUTCOMES FOLLOWING ORAL GRAFT URETHROPLASTY? Jane Kurtzman, Preston Kerr, Rashed Kosber, Carlos Pagan, Mahveesh Chowdhury, and Steven Brandes Jane KurtzmanJane Kurtzman More articles by this author , Preston KerrPreston Kerr More articles by this author , Rashed KosberRashed Kosber More articles by this author , Carlos PaganCarlos Pagan More articles by this author , Mahveesh ChowdhuryMahveesh Chowdhury More articles by this author , and Steven BrandesSteven Brandes More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002582.07AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Preoperative oral health is rarely considered when deciding treatment for urethral stricture disease. However, our previous pilot study of 51 patients and 37 grafts, demonstrated that preoperative oral health impacts oral graft (OG) histology and therefore, may affect urethroplasty success (J Urol., Sept 2021). We aimed to evaluate if oral health and OG histology impacts the risk of stricture recurrence following OG urethroplasty. METHODS: All patients who underwent OG urethroplasty from July 2018-Sept 2021 with completed preoperative oral health surveys: patient-completed Oral Health Impact Profile (OHIP14) and provider-completed Kayser-Jones Brief Oral Health Status Examination (BOHSE), were included. A staff pathologist analyzed OG histology and quantified oral mucositis (OM). Stricture recurrence was defined as a need for a second operative intervention for stenosis. Kaplan Meier (KM) curves and Cox proportional hazard ratios assessed the impact of OG histology and preoperative oral health on recurrence risk within 2 years of surgery. RESULTS: 89 patients (mean age: 47.9 years) and 111 harvested grafts were included. 70 grafts were reviewed in pathology. 51% had non-zero BOHSE (45/89) and 25% had non-zero OHIP14 (21/83) scores. Mean follow-up time was 13.1 months. 13% of patients recurred within 2 years. On age-adjusted analysis, increasing BOHSE and OHIP14 were associated with decreasing epithelial thickness (p=0.01 and p=0.03) and increasing OM score (p=0.01 and p=0.045). Increasing BOHSE also correlated with increased graft stretch (p=0.02). 18% of patients with non-zero BOHSE scores (8/45) recurred within 2 years, compared to 7% with zero BOHSE scores (3/44). Stricture recurrence free survival was not statistically different between these groups (HR 2.8, p=0.13; Figure 1). Cox proportional analysis also did not identify BOHSE (continuous), epithelial thickness, delta stretch or OM score, as risk factors for recurrence (all p>0.05). CONCLUSIONS: We re-demonstrated with a larger cohort, that preoperative oral health is associated with changes in OG histology and graft stretch. There appears to be a trend towards a relationship between worse oral health, measured by BOHSE, and risk of urethroplasty failure, however more patients and longer follow-up are likely needed to reach significance. Source of Funding: NA © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e543 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Jane Kurtzman More articles by this author Preston Kerr More articles by this author Rashed Kosber More articles by this author Carlos Pagan More articles by this author Mahveesh Chowdhury More articles by this author Steven Brandes More articles by this author Expand All Advertisement PDF downloadLoading ...

You have accessJournal of UrologyCME1 May 2022MP10-05 TIME TO OPTIMIZE UROLOGY TRAINEE EDUCATION AND PREPARATION FOR SURGERY: VIDEO-BASED SURGICAL LEARNING Miyad Movassaghi, Rainjade Chung, Zoe Cohen, Rashed Kosber, and Doreen Chung Miyad MovassaghiMiyad Movassaghi More articles by this author , Rainjade ChungRainjade Chung More articles by this author , Zoe CohenZoe Cohen More articles by this author , Rashed KosberRashed Kosber More articles by this author , and Doreen ChungDoreen Chung More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002532.05AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Surgical education has changed over the last several decades. The benefits of surgical video use, for teaching purposes, has been reported across other specialties. However, little data is available in the urology literature regarding usage patterns, preference and overall satisfaction. Our objective was to identify the most utilized video platforms by urology trainees. Secondary outcomes were to evaluate effectiveness, ease of access, and utility of surgical videos. METHODS: Using an anonymous online survey distributed between Sept – Oct 2021 by the Society of Academic Urology (SAU) to urology residents/fellows in the US, data was collected regarding demographics, frequency and source of surgical videos, helpfulness, ease of access, as well as overall effectiveness in case preparation. Study results were analyzed with descriptive statistics. RESULTS: Of current trainees surveyed, 169 completed the survey with demographics outlined in Table 1. All reported using videos (for open, robotic, vaginal and endoscopic mostly) with the majority reporting watching 1 (39%) or 2-3 surgical videos (57%) in preparation for cases. 95.3% of trainees report videos as helpful for case preparation. Similarly, 90% report surgical video use as important in their education/training. The most valued video features include ‘narration’ (58.6%) and ‘presence of tips and tricks’ (22.5%). YouTube (YT) (62.1%) and the AUA University (AUAU) (12.4%) are reportedly the most utilized. When stratified by trainee level, nearly all senior residents (PGY4-6) and fellows report using YT, compared to 38% of junior residents (PGY1-3). Comparing the two, 46% of trainees felt it is easy to navigate AUAU, compared to 77% using YT. Nearly 56% of trainees agreed that videos on AUAU help prepare for cases, compared to 87% using YT. Overall, 57% state they would recommend AUAU as a source for surgical videos, compared to 80% of trainees recommending YT. CONCLUSIONS: Although the AUAU contains a repository of surgical videos, most trainees report utilizing YT as the main source for case preparation. The results from our study support the continued use and optimization of surgical video-based learning for the urology trainee. Increasing access to a peer-reviewed video library will be critical in delivering accurate educational content. Source of Funding: None © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e147 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Miyad Movassaghi More articles by this author Rainjade Chung More articles by this author Zoe Cohen More articles by this author Rashed Kosber More articles by this author Doreen Chung More articles by this author Expand All Advertisement PDF downloadLoading ...