1
|
Hebert KJ, Bearrick E, Anderson KT, Viers BR. High Rates of Discordant Ureteral Perfusion During Open Ureteral Reconstruction with Indocyanine Green: Does Near-Infrared Fluorescence Imaging Change Management or Stricture Outcomes? Urology 2024:S0090-4295(24)00305-4. [PMID: 38754791 DOI: 10.1016/j.urology.2024.04.055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Revised: 04/10/2024] [Accepted: 04/16/2024] [Indexed: 05/18/2024]
Abstract
OBJECTIVE To determine the role of near-infrared fluorescence imaging (NIFI) combined with indocyanine green (ICG) to assess ureteral tissue perfusion in a benign genitourinary reconstruction cohort with a high prevalence of prior abdominopelvic radiation and surgery. MATERIALS AND METHODS A prospective, single-surgeon series, between June 2018 and April 2022, of patients who underwent open genitourinary reconstructive surgeries in which NIFI/ICG was utilized to intraoperatively assess ureteral tissue perfusion prior to ureteral anastomosis. Primary outcome was ureteroanastomotic stricture (UAS). Secondary outcomes included impact of NIFI/ICG on surgical decision-making and ureter resection length. RESULTS 39 patients, median age 66, underwent 40 multimodality reconstructive surgeries during which NIFI/ICG was utilized in the open setting. Radiation-induced etiology was present in 32 of 40 (80%) patients. UAS occurred in 1 of 57 (1.8%) anastomoses with median follow-up 23.4 months. Use of NIFI/ICG changed intraoperative decision-making in 63% of cases. Change in intraoperative decision-making was more common in patients with prior abdominopelvic radiation (66%) compared to non-radiated patients (13%), p=0.007. Discordance between subjective (white-light) and objective (NIFI/ICG) ureteral perfusion (white-light) occurred in 61% of ureters. Mean length of resected ureter was higher following objective assessment with NIFI/ICG (3.6 cm) versus subjective assessment (white light) conditions (1.8 cm), p=0.001. CONCLUSIONS Use of NIFI/ICG was associated with low rates of UAS at 2 years follow-up in a cohort with high prevalence of prior radiation. NIFI/ICG was associated with longer lengths of ureter resection and ureteral perfusion assessment discordance compared to subjective surgeon assessment under white-light conditions.
Collapse
Affiliation(s)
- Kevin J Hebert
- Department of Urology, Louisiana State University Health, Shreveport, LA USA.
| | | | | | - Boyd R Viers
- Department of Urology, Mayo Clinic, Rochester, MN USA.
| |
Collapse
|
2
|
Jefferson FA, Fadel A, Findlay BL, Robinson MO, Seyer AK, Koo K, Granberg CF, Boorjian SA, Anderson KT. The prevalence of impostor phenomenon and its association with burnout amongst urologists. BJU Int 2024; 133:579-586. [PMID: 38378021 DOI: 10.1111/bju.16301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/22/2024]
Abstract
OBJECTIVES To characterise the prevalence of impostor phenomenon (IP; tendency for high-achieving individuals to perceive themselves as fraudulent in their successes) amongst attending staff in urology, to identify variables that predict more severe impostorism, and to study the association of IP with burnout. SUBJECTS AND METHODS A survey composed of the Clance Impostor Phenomenon Scale (CIPS), demographic information, practice details, and burnout levels was e-mailed to urologists via urological subspecialty societies. Survey results were analysed to identify associations between IP severity, survey respondent characteristics, and symptoms of professional burnout. This study was conducted in the United States of America. RESULTS A total of 614 survey responses were received (response rate 11.0%). In all, 40% (n = 213) of responders reported CIPS scores qualifying as either 'frequent' or 'intense' impostorism (i.e., scores of 61-100). On multivariable analysis, female gender, fewer years in practice (i.e., 0-2 years), and lower academic rank were all independently associated with higher CIPS scores (adjusted P < 0.05). Regarding burnout, 46% of responders reported burnout symptoms. On multivariable analysis, increase in CIPS score was independently associated with higher odds of burnout (odds ratio 1.06, 95% confidence interval 1.04-1.07; P < 0.001). CONCLUSION Impostor phenomenon is prevalent in the urological community and is experienced more severely in younger and female urologists. IP is also independently associated with burnout. Increased female representation may improve IP amongst our female colleagues. More work is needed to determine strategies that are effective in mitigating feelings of IP and professional burnout amongst urologists, particularly those earlier in their careers.
Collapse
Affiliation(s)
| | - Anthony Fadel
- Department of Urology, Mayo Clinic, Rochester, Minnesota, USA
| | | | | | - Amanda K Seyer
- Department of Urology, Mayo Clinic, Rochester, Minnesota, USA
| | - Kevin Koo
- Department of Urology, Mayo Clinic, Rochester, Minnesota, USA
| | | | | | | |
Collapse
|
3
|
Pence ST, Findlay BL, Bearrick EN, Pinkhasov AM, Fadel A, Anderson KT, Viers BR. Evaluation of an opioid-free pathway for perineal reconstructive surgery: A 1-year pilot study. Urology 2024:S0090-4295(24)00304-2. [PMID: 38677369 DOI: 10.1016/j.urology.2024.04.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Revised: 04/08/2024] [Accepted: 04/18/2024] [Indexed: 04/29/2024]
Abstract
OBJECTIVE To evaluate the impact of a standardized perioperative pain management pathway on postoperative opioid prescribing practices following male perineal reconstructive surgery at our institution. METHODS Patients undergoing perineal reconstructive surgery (urethroplasty, artificial urinary sphincter, urethral sling) by a single surgeon from July 2022 to June 2023 were prospectively followed. A standardized nonopioid pathway was implemented in the perioperative period. Intraoperative local anesthetic included liposomal bupivacaine mixed with 0.25% bupivacaine. Opioids are administered in the recovery room at the discretion of anesthesiology providers. As of July 2022, our standard practice does not include a postoperative opioid prescription unless pain is poorly controlled in the recovery area. Postoperative communication encounters and opioid prescriptions were tracked through the electronic health record in order to assess the efficacy of an opioid-free pathway. RESULTS 67 patients met criteria during the study period, 64/67 performed in an outpatient setting. 6/67 (9%) patients were prescribed an opioid postoperatively; 4 related to post-surgical pain, and 2 related to chronic pain. No refills were prescribed. Of the 26 patients who received an opioid in the recovery area, 2 (7.6%) were prescribed an opioid at discharge. 15/67 (22%) patients had a communication encounter related to pain within 30 days, most commonly related to bladder spasm management. Only 2 of these encounters resulted in an electronic opioid prescription. CONCLUSION An opioid-free pathway is appropriate for opioid naïve men undergoing perineal reconstructive surgery. When necessary, electronic opioid prescribing should be employed following discharge for breakthrough pain.
Collapse
Affiliation(s)
| | | | | | | | | | | | - Boyd R Viers
- Department of Urology, Mayo Clinic, Rochester, MN.
| |
Collapse
|
4
|
Pinkhasov AM, Anderson KT. EDITORIAL COMMENT. Urology 2024; 185:e150-e151. [PMID: 38307730 DOI: 10.1016/j.urology.2023.11.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2024]
|
5
|
Youssef Y, Neblett MF, Cope AG, Burnett TL, VanBuren WM, Anderson KT, Khan Z. Surgical Management of Endometriosis Involving the Bladder and Ureter. Urology 2024; 184:e258-e259. [PMID: 38072247 DOI: 10.1016/j.urology.2023.11.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Revised: 11/08/2023] [Accepted: 11/22/2023] [Indexed: 01/01/2024]
Abstract
BACKGROUND Endometriosis is a chronic, debilitating condition affecting up to 10% of reproductive-age women. Urinary tract endometriosis is found in 1%-6% of women diagnosed with pelvic endometriosis, with the most common sites being the bladder (70%-85%), ureter (9%-23%), and kidney (4%). Patients typically present with symptoms such as lower abdominal pain, dysuria, and urgency. Unfortunately, urinary tract endometriosis is often asymptomatic, potentially leading to silent obstructive uropathy and kidney failure. OBJECTIVE To demonstrate a step-by-step approach for the surgical management of urinary tract endometriosis using conventional laparoscopy for partial cystectomy and robotic-assisted laparoscopy for ureteroneocystostomy. MATERIAL AND METHOD Surgical video of 2 cases managed in an academic tertiary referral center for endometriosis. The first case was a 38-year-old Gravida 3, Para 3 with a history of hysterectomy who had an MRI which revealed a T2 hypointense bladder nodule consistent with endometriosis. Patient had significant urinary urgency, dysuria, and suprapubpic pain that improved but did not disappear after starting oral progestin therapy (5 mg of norethindrone). A cystoscopy was first performed to confirm MRI findings of bladder lesion and to delineate borders and depth of invasion. The second case was a 35-year-old nulliparous woman with chronic pelvic pain and primary infertility. The patient had a history of stage IV endometriosis with deep endometriosis into the bowel and extrinsic encasement of the ureters causing subsequent hydronephrosis requiring bilateral ureteral stents. She had continued daily pelvic pain despite of being on oral contraceptives for medical management of endometriosis. She subsequently underwent bilateral percutaneous nephrostomy tube placement to allow for ureteral rest prior to surgery. RESULTS In the first case, conventional laparoscopy was utilized to perform bilateral ureterolysis, bladder mobilization, partial cystectomy for complete excision of the lesion, and 2-layered bladder closure. Use of indigo carmine assisted with ureteral orifice identification. In the second case, a cystoscopy was performed with injection of Indocyanine green to assist with ureteral identification. After ureterolysis, distal ureteric obstruction due to extensive disease was confirmed on laparoscopy and ureteroscopy. Bilateral ureteroneocystostomy with placement of Double-J ureteral stents was performed using a robotic-assisted approach. Each patient had an indwelling Foley catheter for bladder decompression during recovery. Pathology in both cases revealed endometriosis. Both patients had an uneventful postoperative course. A postoperative retrograde cystogram confirmed adequate repair prior to removal of each Foley catheter. Patient 2 had uncomplicated office stent removal 6 weeks postoperatively and had a normal renal ultrasound with no hydronephrosis 6 months postoperatively. CONCLUSION Endometriosis is an increasingly common condition. It is important for gynecological surgeons to have the proper understanding of anatomy, surgical technique, and multidisciplinary care needed with urology for safe and complete excision of bladder and ureter endometriosis.
Collapse
Affiliation(s)
- Youssef Youssef
- Department of Obstetrics and Gynecology, Division of Minimally Invasive Gynecologic Surgery, Maimonides Medical Center, Brooklyn, NY
| | - Michael F Neblett
- Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility, Mayo Clinic, Rochester, MN
| | - Adela G Cope
- Department of Obstetrics and Gynecology, Division of Minimally Invasive Gynecologic Surgery, Mayo Clinic, Rochester, MN
| | - Tatnai L Burnett
- Department of Obstetrics and Gynecology, Division of Minimally Invasive Gynecologic Surgery, Mayo Clinic, Rochester, MN
| | | | | | - Zaraq Khan
- Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility, Mayo Clinic, Rochester, MN; Department of Obstetrics and Gynecology, Division of Minimally Invasive Gynecologic Surgery, Mayo Clinic, Rochester, MN.
| |
Collapse
|
6
|
Findlay BL, Lyon TD, Bearrick EN, Robinson M, Viers BR, Ball CT, Anderson KT. Characterization of Gender Differences in H-index Within Urological Subspecialties. Reply. J Urol 2023; 210:585-586. [PMID: 37584319 DOI: 10.1097/ju.0000000000003648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Accepted: 08/02/2023] [Indexed: 08/17/2023]
Affiliation(s)
| | - Timothy D Lyon
- Department of Urology, Mayo Clinic, Jacksonville, Florida
| | | | | | - Boyd R Viers
- Department of Urology, Mayo Clinic, Rochester, Minnesota
| | - Colleen T Ball
- Department of Quantitative Health Sciences, Division of Clinical Trials and Biostatistics, Mayo Clinic, Jacksonville, Florida
| | | |
Collapse
|
7
|
Findlay BL, Lyon TD, Bearrick EN, Robinson M, Viers BR, Ball CT, Anderson KT. Characterization of Gender Differences in H-index Within Urological Subspecialties. J Urol 2023; 210:341-349. [PMID: 37154679 DOI: 10.1097/ju.0000000000003537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Accepted: 05/01/2023] [Indexed: 05/10/2023]
Abstract
PURPOSE Previous work in urology has shown that men have higher h-indices than women. However, the degree to which h-indices vary by gender within urological subspecialties has not been well defined. Herein, we assess gender differences in h-index among different subspecialties. MATERIALS AND METHODS Demographics were recorded for academic urologists using residency program websites as of July 2021. Scopus was queried to identify h-indices. Gender differences in h-index were estimated from a linear mixed-effects regression model with fixed effects for gender, urological subspecialty, MD/PhD status, years since first publication, interactions of subspecialty with years since first publication, and interactions of subspecialty with gender and random effects for AUA section and institution nested within AUA section. The Holm method was used to adjust for multiplicity (7 hypothesis tests). RESULTS Of 1,694 academic urologists from 137 institutions, 308 were women (18%). Median years since first publication was 20 for men (IQR 13, 29) and 13 for women (IQR 8, 17). Among all academic urologists, the median h-index was 8 points higher for men (15 [IQR 7, 27]) vs women (7 [IQR 5, 12]). There was no significant gender difference in h-index for any of the subspecialties after adjusting for urologist experience and after applying the Holm method for multiplicity correction. CONCLUSIONS We were unable to demonstrate a gender difference in h-index after adjusting for urologist experience for any urological subspecialties. Future study is warranted as women become more senior members of the urological workforce.
Collapse
Affiliation(s)
| | - Timothy D Lyon
- Department of Urology, Mayo Clinic, Jacksonville, Florida
| | | | | | - Boyd R Viers
- Department of Urology, Mayo Clinic, Rochester, Minnesota
| | - Colleen T Ball
- Department of Quantitative Health Sciences, Division of Clinical Trials and Biostatistics, Mayo Clinic, Jacksonville, Florida
| | | |
Collapse
|
8
|
Findlay BL, Lyon TD, Bearrick EN, Robinson M, Viers BR, Ball CT, Anderson KT. Reply by Authors. J Urol 2023; 210:349. [PMID: 37416956 DOI: 10.1097/ju.0000000000003537.03] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/08/2023]
Affiliation(s)
| | - Timothy D Lyon
- Department of Urology, Mayo Clinic, Jacksonville, Florida
| | | | | | - Boyd R Viers
- Department of Urology, Mayo Clinic, Rochester, Minnesota
| | - Colleen T Ball
- Department of Quantitative Health Sciences, Division of Clinical Trials and Biostatistics, Mayo Clinic, Jacksonville, Florida
| | | |
Collapse
|
9
|
Findlay BL, Bearrick EN, Hebert KJ, Britton CJ, Ziegelmann MJ, Anderson KT, Viers BR. Reply by Authors. Urol Pract 2023; 10:145. [PMID: 37103427 DOI: 10.1097/upj.0000000000000369.02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2022] [Accepted: 11/03/2022] [Indexed: 02/22/2023]
Affiliation(s)
| | | | - Kevin J Hebert
- Division of Urology, University of Utah, Salt Lake City, Utah
| | | | | | | | - Boyd R Viers
- Department of Urology, Mayo Clinic, Rochester, Minnesota
| |
Collapse
|
10
|
Fendereski K, McCormick BJ, Keihani S, Hagedorn JC, Voelzke B, Selph JP, Figler BD, Johnsen NV, da Silva RD, Broghammer JA, Gupta S, Miller B, Burks FN, Eswara JR, Osterberg EC, Carney KJ, Erickson BA, Gretzer MB, Chung PH, Harris CR, Murphy GP, Rusilko P, Anderson KT, Shridharani A, Benson CR, Alwaal A, Blaschko SD, Breyer BN, McKibben M, IanSchwartz, Simhan J, Vanni AJ, Moses RA, Myers JB. The Outcomes of Pelvic Fracture Urethral Injuries Stratified by Urethral Injury Severity: A Prospective Multi-institutional Genitourinary Trauma Study (MiGUTS). Urology 2022; 170:197-202. [PMID: 36152870 DOI: 10.1016/j.urology.2022.09.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Revised: 09/05/2022] [Accepted: 09/08/2022] [Indexed: 10/14/2022]
Abstract
OBJECTIVES To determine patient outcomes across a range of pelvic fracture urethral injury (PFUI) severity. PFUI is a devastating consequence of a pelvic fracture. No study has stratified PFUI outcomes based on severity of the urethral distraction injury. METHODS Adult male patients with blunt-trauma-related PFUI were followed prospectively for a minimum of six months at 27 US medical centers from 2015-2020. Patients underwent retrograde cystourethroscopy and retrograde urethrography to determine injury severity and were categorized into three groups: (1) major urethral distraction, (2) minor urethral distraction, and (3) partial urethral injury. Major distraction vs. minor distraction was determined by the ability to pass a cystoscope retrograde into the bladder. Simple statistics summarized differences between groups. Multi-variable analyses determined odds ratios for obstruction and urethroplasty controlling for urethral injury type, age, and Injury Severity Score. RESULTS There were 99 patients included, 72(72%) patients had major, 13(13%) had minor, and 14(14%) had partial urethral injuries. The rate of urethral obstruction differed in patients with major (95.8%), minor (84.6%), and partial injuries (50%) (p< 0.001). Urethroplasty was performed in 90% of major, 66.7% of minor, and 35.7% of partial injuries (p<0.001). CONCLUSIONS In PFUI, a spectrum of severity exists that influences outcomes. While major and minor distraction injuries are associated with a higher risk of developing urethral obstruction and need for urethroplasty, up to 50% of partial PFUI will result in obstruction, and as such need to be closely followed.
Collapse
Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | - Jairam R Eswara
- St. Elizabeth's Medical Center, Boston University School of Medicine.
| | | | | | | | | | - Paul H Chung
- Sidney Kimmel Medical College of Thomas Jefferson University.
| | | | | | | | | | | | | | | | | | | | | | - IanSchwartz
- Division of Urology Hennepin County Medical Center, University of Minnesota.
| | | | | | | | - Jeremy B Myers
- University of Utah, Department of Surgery (Primary Investigator).
| |
Collapse
|
11
|
Clatts MC, Heimer R, Abdala N, Goldsamt LA, Sotheran JL, Anderson KT, Gallo TM, Hoffer LD, Luciano PA, Kyriakides T. HIV-1 transmission in injection paraphernalia: heating drug solutions may inactivate HIV-1. J Acquir Immune Defic Syndr 1999; 22:194-9. [PMID: 10843535 DOI: 10.1097/00126334-199910010-00013] [Citation(s) in RCA: 46] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
In response to recent concerns about risk of HIV-1 transmission from drug injection paraphernalia such as cookers, ethnographic methods were used to develop a descriptive typology of the paraphernalia and practices used to prepare and inject illegal drugs. Observational data were then applied in laboratory studies in which a quantitative HIV-1 microculture assay was used to measure the recovery of infectious HIV-1 in cookers. HIV-1 survival inside cookers was a function of the temperature achieved during preparation of drug solutions; HIV-1 was inactivated once temperature exceeded, on average, 65 degrees C. Although different types of cookers, volumes, and heat sources affected survival times, heating cookers 15 seconds or longer reduced viable HIV-1 below detectable levels.
Collapse
Affiliation(s)
- M C Clatts
- National Development and Research Institutes, Inc., New York, New York 10048, USA.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
12
|
Payne NR, Steinberg SS, Ackerman P, Chrenka BA, Sane SM, Anderson KT, Fangman JJ. New prospective studies of the association of Ureaplasma urealyticum colonization and chronic lung disease. Clin Infect Dis 1993; 17 Suppl 1:S117-21. [PMID: 8399901 DOI: 10.1093/clinids/17.supplement_1.s117] [Citation(s) in RCA: 44] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
This study examined the association between Ureaplasma urealyticum colonization and the development of chronic lung disease (CLD) in 93 premature infants who were treated with surfactant and who had birth weights < 1251 g. Nasopharyngeal and tracheal cultures for U. urealyticum were obtained at 2 +/- 1 and at 14 +/- 1 days after birth and were positive in 17 (18%) of 93 patients. Infants born vaginally were 4.5 times more likely to be colonized than were those born by cesarean section. Colonization with U. urealyticum was associated with 1.66 (95% confidence interval, 1.24-2.20, P = .024) times the risk of developing CLD and with a greater incidence of > or = 2+ polymorphonuclear leukocytes in the tracheal aspirate at 2 +/- 1 days of age compared with uncolonized infants (P = .025). We conclude that U. urealyticum colonization is associated with CLD even after surfactant treatment. The presence of U. urealyticum is also associated with inflammatory cells in the tracheal aspirate.
Collapse
Affiliation(s)
- N R Payne
- Department of Neonatology, Minneapolis Children's Medical Center, Minnesota
| | | | | | | | | | | | | |
Collapse
|