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Background: Ureteroscopy is a common treatment for urolithiasis, but initial ureteral access is not always possible, particularly in pediatrics. Clinical experience suggests that neuromuscular conditions such as cerebral palsy (CP) may facilitate access, thus avoiding the need for pre-stenting and staged procedures., Objective: We sought to determine if probability of successful ureteral access (SUA) during initial attempted ureteroscopy (IAU) is higher in pediatric patients with CP vs. without CP., Study Design: We reviewed IAU cases for urolithiasis (2010-2021) at our center. Patients with pre-stenting, prior ureteroscopy, or urologic surgical history were excluded. CP was defined using ICD-10 codes. SUA was defined as scope access to urinary tract level sufficient to reach stone. Association of CP and other factors with SUA were evaluated., Results: 230 patients (45.7% male, median age: 16 years [IQR: 12-18 y], 8.7% had CP) underwent IAU, with SUA in 183 (79.6%). SUA occurred in 90.0% of patients with CP vs. 78.6% of those without CP (p = 0.38). SUA was 81.7% in patients >12 years (vs. 73.8% in those <12), and the highest SUA was in those >12 years with CP (93.3%), but these differences were not statistically significant. Renal stone location was significantly associated with lower SUA (p = 0.007). Among patients with renal stone only, SUA in those with CP was 85.7% vs. 68.9% in those without CP (p = 0.33). SUA did not differ significantly by gender or BMI., Conclusions: CP may facilitate ureteral access during IAU in pediatric patients, but we were unable to show a statistically significant difference. Further study of larger cohorts may demonstrate whether CP or other patient factors are associated with successful initial access. Improved understanding of such factors would help preoperative counseling and surgical planning for children with urolithiasis., Competing Interests: Conflicts of interest The authors have no conflicts of interest to report., (Copyright © 2023 Journal of Pediatric Urology Company. Published by Elsevier Ltd. All rights reserved.)

Objective: To examine the prenatal diagnosis rates of bladder exstrophy (BE) and Omphalocele-Exstrophy-Imperforate anus-Spinal Defect Syndrome (OEIS) in a large cohort of patients over a 20-year period. We hypothesized that prenatal diagnosis rates improved over time due to evolving techniques in fetal imaging., Methods: A multi-institutional database was queried to identify BE or OEIS patients who underwent primary closure between 2000 and 2020. We retrospectively determined prenatal or postnatal diagnosis. Those with unknown prenatal history were excluded. Multivariable logistic regression was used to investigate temporal pattern in rate of prenatal diagnosis while adjusting for sex and treating institution., Results: Among 197 BE and 52 OEIS patients, 155 BE and 45 OEIS patients had known prenatal history. Overall prenatal diagnosis rates of BE and OEIS were 47.1% (73/155) and 82.2% (37/45), respectively. Prenatal diagnosis rate was significantly lower in BE compared to OEIS (P <.0001). The prenatal diagnosis rate for BE significantly increased over time (OR 1.10; [95%CI: 1.03-1.17]; P = .003). Between 2000 and 2005, the prenatal diagnosis rate of BE was 30.3% (10/33). Between 2015 and 2020, prenatal diagnosis rate of BE was 61.1% (33/54). Prenatal diagnosis rate for OEIS did not change over time. Rates of prenatal diagnosis did not differ by sex or treating institution., Conclusion: Rates of prenatal diagnosis of BE and OEIS are higher than previously reported. Prenatal diagnosis rate of BE doubled in the last 5 years compared to the first 5 years of the study period. Nonetheless, a significant proportion of both BE and OEIS patients remain undiagnosed prior to delivery., (Copyright © 2022 Elsevier Inc. All rights reserved.)

Background and Objectives: As resident physicians specialize, they lose familiarity with knowledge central to other fields. This can yield what we term the dual fallacies: (1) the sense that their own expertise is common knowledge, and (2) unfamiliar clinical situations seem beyond their scope. In graduate medical education, these dual fallacies may engender the perception of inappropriate consults among specialties. This project evaluated biases in residents' perceptions of expected knowledge and inappropriate consults to improve interdisciplinary education among neurology residents (neurologists) and internal medicine residents (internists). Secondarily, we evaluated whether these biases were mitigated after implementing an educational intervention., Methods: Resident neurologists and internists at a large, urban, academic medical center answered board-style questions reflecting neurology and medicine consultation scenarios. They then rated the extent to which each scenario reflected common knowledge to both specialties and whether a consult was warranted. After revising the internal medicine residency curriculum to include a neurology rotation, another cohort of residents was surveyed and participated in semistructured interviews. Paired sample t tests and qualitative data analysis were performed., Results: Neurologists and internists participated in phase 1 (n = 23) and phase 2 (n = 42) of the study. Residents from both fields answered more questions correctly from their own specialty than the other in phase 1 ( p < 0.05) and phase 2 ( p < 0.001). Neurologists and internists in both cohorts thought that each other should know more neurology answers than they actually did ( p < 0.05). Neurologists were less likely to agree than internists that medicine questions deserved a consult ( p = 0.014). Interviews revealed themes regarding perceived consult appropriateness, affected by educational, communication, clinical, and administrative factors. In addition, residents agreed that appropriate consults must pose a specific question and occur only after an initial investigation was performed, but that this rarely happens., Discussion: Our findings support that discordant expectations of expertise contribute to a perception of inappropriate consults among neurologists. Nonclinical factors, from cognitive biases to contextual considerations, inform clinical consultation and interdisciplinary patient care. Implementing rotations on other services alone is insufficient to eradicate discordant expectations; however, we propose additional interventions that may prove valuable in medical education., Competing Interests: S. Krieger reports consulting or advisory work with Biogen, EMD Serono, Genentech, Novartis, Octave, Genzyme/Sanofi, and TG Therapeutics; nonpromotional speaking with Biogen, EMD Serono, and Genentech; and grant and research support from Biogen, BMS, Novartis, and Sanofi. Go to Neurology.org/NE for full disclosures., (© 2023 American Academy of Neurology.)

Objective: To evaluate the feasibility and safety of performing robotic-assisted laparoscopic partial nephrectomy (RAPN) as outpatient surgery in patients with renal masses., Materials and Methods: We analyzed RAPN performed by a single surgeon at an academic medical center from July 2018 to June 2019 and identified those individual patients who were discharged on the same day. These cases were then compared to a concurrent inpatient RAPN group. Relationships with outcome analyzed using Fisher's exact test and Student's t test., Results: Twenty-three of 84 RAPNs (27.4%) were performed as ambulatory. Mean age was 57.4 years. Average tumor size was 2.24 cm. The mean total operative time was 99.4 minutes. Average estimated blood loss was 51.0 mL. When compared to the cohort of patients who stayed overnight, on multivariate analysis, the tumor size (2.24 ± 0.71 vs 3.65 ± 1.55 cm, P <0.001), and operative time (99.5 ± 25.1 vs 131.2 ± 30.8 minutes, P <0.001) were less in ambulatory cases. No differences were seen in regards to Charlson comorbidity index, age, gender, body mass index, estimated blood loss, or surgical approach. Within 90 days of postoperative period, the readmission rate for the entire cohort was 0., Conclusion: RAPN can be performed safely as ambulatory in select patients with comparable outcome without complication or hospital readmission., (Copyright © 2020 Elsevier Inc. All rights reserved.)

Benign prostatic hyperplasia (BPH), with its associated lower urinary tract symptoms (LUTS), can be a debilitating disease in the elderly male. Transurethral resection of the prostate (TURP) remains the gold standard; however, many patients will choose to avoid surgery if possible. Medical therapy is an effective alternative, however, new studies are showing that there may be more side effects than previously realized in the elderly male. Newer, novel minimally invasive techniques, including UroLift® and Rezūm™, are gaining favor as alternative office-based procedural techniques that do not require general anesthesia and may better preserve ejaculatory function. Though promising, at this point, these techniques are not approved for all patients. With a range of medical, procedural, and surgical options for treatment of BPH with LUTS, it is important to have a discussion with your patient regarding the short- and long-term risks and benefits, as well as alternatives, before deciding on a treatment plan for your patient with BPH., Competing Interests: Conflict of interest statement: The authors declare that there is no conflict of interest., (© The Author(s), 2020.)

Objective: To characterize the status of mentorship programs for Urology residencies in the United States, highlight the importance of mentorship in the career of a urology resident, and identify the obstacles of implementing a mentorship program., Methods: With Internal Review Board exemption and approval from the Society of Academic Urologists, a survey was sent to the Program Directors of the Urology Residency programs in the United States containing questions about the presence and structure of a mentorship program in their department., Results: Response rate was 54%. Seventy-five percent of respondents approved of formal mentorship programs. Fifty-eight percent of respondents had 1 established. Five percent of programs had an official training course for faculty mentors. Thirty-eight percent of programs had no requirement on mentor and/or mentee meeting frequency. The most common reason for not having a formal mentorship program was because the program felt that informal mentorship sufficed., Conclusion: While the vast majority of Program Directors for Urology Residency programs in the United States approve of formal mentorship programs, only a little over half have 1 established. Programs should strive to create a formal mentorship program in their residency programs due to their recognized importance., (Copyright © 2019 Elsevier Inc. All rights reserved.)