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Williams C, Familusi O, Kovell RC, Wein AJ, Butler PD, Lloyd-Harris JE. AUTHOR REPLY. Urology 2023; 174:34. [PMID: 37030914 DOI: 10.1016/j.urology.2022.09.047] [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: 03/16/2022] [Accepted: 09/26/2022] [Indexed: 04/10/2023]
Affiliation(s)
- Cheyenne Williams
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Olivia Familusi
- Divison of Plastic Surgery, Department of Surgery, University of Pennsylvania, Philadelphia, PA
| | - Robert C Kovell
- Divison of Urology, Department of Surgery, University of Pennsylvania, Philadelphia, PA
| | - Alan J Wein
- Divison of Urology, Department of Surgery, University of Pennsylvania, Philadelphia, PA
| | - Paris D Butler
- Divison of Plastic Surgery, Department of Surgery, University of Pennsylvania, Philadelphia, PA
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Williams C, Familusi O, Kovell RC, Wein AJ, Butler PD, Lloyd-Harris JE. Representation Matters: One Urology Residency Program's Approach to Increasing Workforce Diversity. Urology 2022; 174:28-34. [PMID: 36586426 DOI: 10.1016/j.urology.2022.09.045] [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: 03/16/2022] [Revised: 09/02/2022] [Accepted: 09/26/2022] [Indexed: 12/29/2022]
Abstract
OBJECTIVE To address the challenge in urology in recruiting physicians from backgrounds racially and ethnically underrepresented in medicine (URiM), we sought to design, implement, and evaluate methods for recruiting URiM candidates to our urology residency program. METHODS We developed a 3-pronged approach aimed at increasing the number of interviewed applicants, and subsequently number of URiM residents recruited to our program. The 3 facets included: (1) funded visiting student rotation, (2) holistic evaluation of applications, (3) implemented targeted outreach. Statistical analysis of the applicants interviewed and matched into our residency program, as well as traditional metrics used for residency recruitment, were performed from 2015 to 2022. RESULTS The number of URiM interviewees significantly increased from 6.1% in 2015 to its peak, 40%, in 2020. In 2015, there were no URiM residents in our urology residency program. By 2022, the total URiM complement increased to 35%. In evaluating traditional metrics of residency recruitment, there was no significant difference in mean USMLE Step 1 score before compared with after the implementation of our recruitment approach. The maximum rank number reached to fill the urology residency positions also remained relatively stable throughout the study period, with a range from 5 to 38. CONCLUSION We demonstrate that the implementation of our innovative and intentional 3-pronged recruitment approach effectively increased the number of URiM interviewees and residents in our residency program. The diversification of our urology workforce depends on the implementation of such efforts, and we encourage urologists to lead the way on such initiatives.
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Affiliation(s)
- Cheyenne Williams
- Divison of Urology, Department of Surgery, University of Pennsylvania, Philadelphia, PA; Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Olivia Familusi
- Divison of Urology, Department of Surgery, University of Pennsylvania, Philadelphia, PA; Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Robert C Kovell
- Divison of Urology, Department of Surgery, University of Pennsylvania, Philadelphia, PA
| | - Alan J Wein
- Divison of Urology, Department of Surgery, University of Pennsylvania, Philadelphia, PA
| | - Paris D Butler
- Divison of Plastic Surgery, Department of Surgery, University of Pennsylvania, Philadelphia, PA
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Bittar JM, Bittar PG, Nugent ST, Raj LK, Neal DE, Dany M, Wan MT, Sharkey J, Etzkorn JR, Sobanko JF, Shin TM, Kovach S, Kovell RC, Latif N, Miller CJ. Interdisciplinary Management of Extramammary Paget's Disease using Mohs Micrographic Surgery with Frozen Section Cytokeratin-7 Immunostains. Urology 2022; 166:164-169. [PMID: 35561850 DOI: 10.1016/j.urology.2022.04.036] [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: 03/11/2022] [Revised: 04/24/2022] [Accepted: 04/27/2022] [Indexed: 10/18/2022]
Abstract
OBJECTIVES To describe local recurrence rates and patient reported outcomes when Mohs micrographic surgery with cytokeratin-7 immunostains (MMS-CK7) is included in the interdisciplinary management of extramammary Paget's Disease (EMPD). METHODS A retrospective study was conducted of EMPD treated with MMS-CK7 as part of an interdisciplinary team at an academic medical center between 2009 and 2016. Local recurrence rates and patient-reported outcomes were determined by record review and patient surveys. RESULTS Twenty tumors in 19 patients were treated using MMS-CK7. After MMS-CK7 defined clear microscopic margins, seventy-five percent (15/20) of tumors underwent excision or reconstruction by a surgical colleague. Internal malignancy screening was performed by multiple specialties in 17 patients, with one associated malignancy of prostate cancer detected. No local recurrence was detected with a mean follow-up of 75.2 months. Most patients were satisfied with appearance (18/19, 95%) and function (16/19, 84%) after surgery. CONCLUSIONS Interdisciplinary teams that include MMS-CK7 can treat EMPD with low local recurrence rates, high patient satisfaction, and thorough internal malignancy screening.
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Affiliation(s)
- Julie M Bittar
- Section of Dermatology, Rush University Medical Center; Chicago, IL
| | - Peter G Bittar
- Department of Dermatology, Indiana University School of Medicine; Indianapolis, IN
| | - Shannon T Nugent
- Sidney Kimmel Medical College, Thomas Jefferson University; Philadelphia, PA
| | - Leela K Raj
- Department of Dermatology, Hospital of the University of Pennsylvania; Philadelphia, PA
| | - Donald E Neal
- Department of Dermatology, Mayo Clinic; Rochester, MN
| | - Mohammed Dany
- Department of Dermatology, Hospital of the University of Pennsylvania; Philadelphia, PA
| | - Marilyn T Wan
- Department of Dermatology, Hospital of the University of Pennsylvania; Philadelphia, PA
| | - John Sharkey
- St. George's University School of Medicine, True Blue, Grenada
| | - Jeremy R Etzkorn
- Department of Dermatology, Hospital of the University of Pennsylvania; Philadelphia, PA
| | - Joseph F Sobanko
- Department of Dermatology, Hospital of the University of Pennsylvania; Philadelphia, PA
| | - Thuzar M Shin
- Department of Dermatology, Hospital of the University of Pennsylvania; Philadelphia, PA
| | - Stephen Kovach
- Department of Plastic Surgery, Hospital of the University of Pennsylvania; Philadelphia, PA
| | - Robert C Kovell
- Department of Urology, Hospital of the University of Pennsylvania; Philadelphia, PA
| | - Nawar Latif
- Department of Obstetrics and Gynecology, Hospital of the University of Pennsylvania; Philadelphia, PA
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Chen B, Talwar R, Schwartz LE, Terlecki RP, Guzzo TJ, Kovell RC. Second opinion pathologic review in the management of prostate cancer. Can J Urol 2021; 28:10530-10535. [PMID: 33625343] [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] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
UNLABELLED INTRODUCTION Inter-institutional re-review of prostate needle biopsy (PNBx) material is required at many institutions before definitive treatment, but adds time and cost and may not significantly alter urologic management. We aim to determine the utility of universal PNBx re-review on influencing the decision to recommend definitive local therapy for patients with prostate cancer. MATERIALS AND METHODS From 2017-2020, 590 prostate biopsy specimens from outside institutions were re-reviewed at our center for patients considering prostatectomy. Clinical and pathologic characteristics from initial and secondary review were analyzed. Potential for change in treatment candidacy (CTC) was determined by re-diagnosis to non-malignant tissue or change in candidacy for active surveillance (AS) versus definitive treatment (i.e. prostatectomy or radiation therapy). Thus, the following scenarios were considered CTC: downgrading to non-malignant tissue, downgrading ISUP Grade Group (GG) ≥ 2 to GG1, and upgrading GG1 to GG ≥ 2. Any changes between GG2 to GG5 were not considered CTC, as definitive treatment would be offered to all groups. RESULTS Overall, 55 patients (9.3%) had potential for CTC based on secondary review, all of whom had initial pathologic GG (iGG) ≤ 2. Of the 152 patients with iGG1, 8 were downgraded to no malignancy and 41 were upgraded to GG2 or GG3. Of the 185 patients with iGG2, 6 were downgraded to GG1. No patients with iGG ≥ 3 qualified for a CTC. Features associated with CTC included iGG, number of positive cores, and highest core percentage. Upon multivariable analysis, only iGG1 diagnosis was predictive of CTC (OR 23.66, p < 0.001). CONCLUSION Second review may be helpful in determining need for definitive treatment in patients with GG1 and GG2 prostate cancer, i.e. those considering AS. This process appears unnecessary in GG3+ patients, as management for patients considering surgery would not change. This may allow for judicious redirection of hospital resources.
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Affiliation(s)
- Bofeng Chen
- Division of Urology, Department of Surgery, University of Pennsylvania Health System, Philadelphia, Pennsylvania, USA
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Chouhan JD, Pearlman AM, Kovell RC, Terlecki RP. A Quality Analysis of the Last Decade's Most Heavily Cited Data Relative to Outcomes After Penile Prosthesis Placement. J Sex Med 2020; 17:861-869. [DOI: 10.1016/j.jsxm.2020.02.025] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2019] [Revised: 02/20/2020] [Accepted: 02/26/2020] [Indexed: 10/24/2022]
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Kovell RC, Brooks DC, Haddad D, Terlecki R. Morbidity Associated with Urinary Diversion in the United States: A Contemporary Evaluation Using the NSQIP Database. Urology Practice 2018. [DOI: 10.1016/j.urpr.2017.09.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Robert C. Kovell
- Division of Urology, Department of Surgery, University of Pennsylvania Health System, Philadelphia, Pennsylvania
| | - David C. Brooks
- Department of Urology, Wake Forest University School of Medicine, Winston-Salem, North Carolina
| | - Devin Haddad
- Division of Urology, Department of Surgery, University of Pennsylvania Health System, Philadelphia, Pennsylvania
- Department of Internal Medicine, Ohio State University College of Medicine, Columbus, Ohio
| | - Ryan Terlecki
- Department of Urology, Wake Forest University School of Medicine, Winston-Salem, North Carolina
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Abstract
The field of transitional urology has taken on an increasing importance in recent years as more individuals with congenital urologic issues are living and thriving into adulthood. This article reviews the transitional process itself including barriers to successful transition and the consequences of failing to properly transition. Also provided is a broad overview of the urologic issues faced by patients who may benefit from lifelong care and the providers who will be helping them with transition and assuming their care.
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Affiliation(s)
- Robert C Kovell
- Division of Urology, Department of Surgery, University of Pennsylvania Health System, Children's Hospital of Philadelphia, Perelman Center for Advanced Medicine, 3400 Civic Center Boulevard, 3 West, Philadelphia, PA 19104, USA.
| | - Alexander J Skokan
- Division of Urology, Department of Surgery, University of Pennsylvania Health System, Perelman Center for Advanced Medicine, 3400 Civic Center Boulevard, 3 West, Philadelphia, PA 19104, USA
| | - Dan N Wood
- Department of Urology, University College London Hospitals, 16-18 Westmoreland Street, London W1H 6PL, UK
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Bittar JM, Bittar PG, Wan MT, Kovell RC, Guzzo TJ, Shin TM, Etzkorn JR, Sobanko JF, Miller CJ. Systematic Review of Surgical Treatment and Outcomes After Local Surgery of Primary Cutaneous Melanomas of the Penis and Scrotum. Dermatol Surg 2018; 44:1159-1169. [PMID: 29985865 DOI: 10.1097/dss.0000000000001579] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
BACKGROUND Few data exist to guide surgical management and counseling about local recurrence after surgery of primary male genital melanoma. OBJECTIVE To compile all available data on local recurrence rates after surgery of primary cutaneous melanoma of the penis and scrotum. MATERIALS AND METHODS A systematic review of PubMed, Literatura Latino-Americana e do Caribe em Ciências da Saúde (LILACS), Excerpta Medica database (EMBASE), and Web of Science identified all surgically treated penile and scrotal melanomas that reported local recurrence status and follow-up time. RESULTS One hundred twenty-seven melanomas from 74 manuscripts were included. Eighty-six percent of melanomas were located on the penis, and 14% were located on the scrotum. Average follow-up time was 35.7 months. Scrotal melanomas were predominantly treated with organ-sparing surgeries (16/18, 88.9%), whereas penile melanomas were treated more often with amputation (61/109, 56.0%). Overall, local recurrence rate was 15.7% (20/127). Local recurrence rates for penile cases were 18.8% (9/48) after organ-sparing surgery versus 13.1% (8/61) for amputative surgery. Local recurrence rates were 66.7% (4/6) after positive surgical margins versus 10.2% (5/49) after negative surgical margins. CONCLUSION Local recurrence rates are high after both organ-sparing and amputative surgery of primary cutaneous melanoma of the penis and scrotum. There is a need to standardize reporting for this rare tumor, as more complete data are necessary to develop consensus guidelines for surgical management of male genital melanoma.
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Affiliation(s)
- Julie M Bittar
- Indiana University School of Medicine, Indianapolis, Indiana
| | - Peter G Bittar
- Duke University School of Medicine, Durham, North Carolina
| | - Marilyn T Wan
- Department of Dermatology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Robert C Kovell
- Department of Surgery, Division of Urology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Thomas J Guzzo
- Department of Surgery, Division of Urology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Thuzar M Shin
- Department of Dermatology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Jeremy R Etzkorn
- Department of Dermatology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Joseph F Sobanko
- Department of Dermatology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Christopher J Miller
- Department of Dermatology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
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Sterling ME, Kovell RC, Jaffe WI. Primary Seminal Vesicle Adenocarcinoma Presenting With Bilateral Orbital Metastasis: A Case Report. Urol Case Rep 2016; 6:33-5. [PMID: 27175340 PMCID: PMC4856340 DOI: 10.1016/j.eucr.2016.02.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2016] [Revised: 02/15/2016] [Accepted: 02/17/2016] [Indexed: 11/25/2022] Open
Abstract
Seminal vesicle (SV) adenocarcinoma is a rare and poorly understood malignancy. Symptoms are non-specific and prognosis is extremely poor. Herein we present a case report of a primary SV clear cell adenocarcinoma with bilateral orbital metastases at the time of initial presentation treated with multimodal therapy including radiotherapy and multi-drug chemotherapy.
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Affiliation(s)
- Matthew E Sterling
- Division of Urology, Department of Surgery, University of Pennsylvania Health System, Philadelphia, PA 19104, USA
| | - Robert C Kovell
- Division of Urology, Department of Surgery, University of Pennsylvania Health System, Philadelphia, PA 19104, USA
| | - William I Jaffe
- Division of Urology, Department of Surgery, University of Pennsylvania Health System, Philadelphia, PA 19104, USA
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Kovell RC, Brooks DC, Haddad DA, Aboumohamed AA, Terlecki RP. PD9-09 ANALYSIS OF PERIOPERATIVE OUTCOMES FOR PROCEDURES INVOLVING URINARY DIVERSION USING THE NATIONAL SURGICAL QUALITY IMPROVEMENT PROGRAM (NSQIP) DATABASE. J Urol 2015. [DOI: 10.1016/j.juro.2015.02.936] [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: 10/23/2022]
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Cui T, Kovell RC, Brooks DC, Terlecki RP. MP5-13 DOES DIGITAL RECTAL EXAMINATION PROVIDE ADDITIONAL VALUE IN THE ERA OF PSA SCREENING?: LESSONS FROM THE PLCO STUDY. J Urol 2015. [DOI: 10.1016/j.juro.2015.02.240] [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: 10/23/2022]
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Cui T, Kovell RC, Brooks DC, Terlecki RP. A Urologist's Guide to Ingredients Found in Top-Selling Nutraceuticals for Men's Sexual Health. J Sex Med 2015; 12:2105-17. [DOI: 10.1111/jsm.13013] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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