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Objectives To conduct a nationwide evaluation of student and program director (PD) perspectives of virtual subinternships that took place during the COVID-19 pandemic. Methods In December 2020, we distributed anonymous surveys to all 534 urology residency applicants and 161 urology PDs at academic medical centers across the United States to evaluate virtual subinternships. Surveys assessed curriculum composition, goals, satisfaction, barriers, and future reusability. The primary outcome was overall satisfaction with the subinternship, evaluated on a 5-point Likert scale. Results The survey was completed by 174 students (33%) and 82 PDs (51%), including 81 students (47%) and 32 PDs (41%) who participated in virtual subinternships at 29 institutions. Overall, 77% of students and 78% of PDs rated the electives "excellent" or "very good." On ordinal logistic regression, higher student ratings were associated with duration ≥3 weeks (OR 4.64, p=0.003) and class size ≤4 students (OR 3.33, p=0.015). Higher PD ratings were associated with full-time electives (OR 11.18, p=0.019), class size ≤4 students (OR 13.99, p=0.042), and utilization of the standardized Guidebook from the Society of Academic Urologists (OR 11.89, p=0.038). The most commonly reported challenge to the subinternship's efficacy was lack of hands-on learning (87% of students and 81% of PDs). Looking forward, 45% of students and 66% of PDs recommended incorporating virtual components into future electives. Conclusions The virtual subinternship was a coordinated nationwide initiative to provide urologic education to medical students during a pandemic. The most successful courses were structured with longer duration, full-time commitment, and small class size.

Objective During the COVID-19 pandemic, limitations on in-person medical school clerkships created a deficit in urologic learning opportunities. We sought to develop and evaluate a blended curriculum of interactive online modules with small-group discussion to enhance the educational experience for medical students in urology. Materials and Methods We created a curriculum of four online case-based urology modules. Between July and October 2020, 14 fourth-year medical students completed the modules. Students answered questions on a discussion board and engaged in asynchronous dialogue with 16 physicians, in addition to a weekly live review session. Students and physicians completed anonymous surveys to assess satisfaction and perceived learning outcomes, with questions scored on a 5-point Likert scale. Results Thirteen students (93% response rate) and 12 physicians (75% response rate) completed the survey. Overall, 12/13 students and 11/12 physicians “strongly agree” or “somewhat agree” that the modules improved the rotation. Students and physicians perceived that the modules were effective for learning/teaching foundational knowledge (average ratings 4.8 and 4.5, respectively) and facilitating performance assessment (4.4 and 4.0). Students reported high learning scores across multiple Accreditation Council for Graduate Medical Education core competencies, and 12/13 students found the modules fun/engaging. The majority of students (12/13) and physicians (10/12) felt that the online modules should be incorporated into future urology electives. Conclusions A blended learning curriculum utilizing online modules is an effective tool for enhancing urologic education, improving perceived learning outcomes and facilitating performance assessment. Supplementary Information The online version contains supplementary material available at 10.1007/s40670-021-01427-3.

Objective To develop and evaluate the first 4-week virtual subinternship in urology. Design Following a needs assessment, we established four course objectives: to teach foundational knowledge, assess students' abilities, highlight our program culture, and evaluate students' compatibility with our program. To meet these objectives, we developed a virtual curriculum that consisted of department conferences, small group didactic sessions, clinical/surgical encounters, interactive online modules, and informal sessions. At the conclusion of the subinternship, we sent anonymous surveys to students and physicians to measure success in meeting the course objectives. Student learning was measured using the framework of the Accreditation Council for Graduate Medical Education (ACGME) core competencies. Setting The study was conducted at Columbia University Irving Medical Center, a tertiary care academic institution. Participants Over a 2-month span, the virtual subinternship enrolled a total of 8 fourth-year medical students from 7 different medical schools in 5 different states. All residents and attending urologists in the Columbia University Department of Urology were involved in teaching. Results Overall, 100% of students and 63% of physicians rated the elective as “very good” or “excellent.” The highest-rated components of the elective were the didactic curriculum and online modules. All course objectives were met, especially teaching foundational knowledge and highlighting program culture. Students reported high learning scores in all ACGME core competencies and urologic subspecialties, as well as increased confidence in managing a range of urologic conditions. The majority of students and physicians recommended incorporating virtual educational tools into future urology electives, particularly didactic sessions, online modules, and conferences/Grand Rounds presentations. Conclusions A virtual subinternship in urology is a novel and successful model to enable student education, assessment, demonstration of program culture, and evaluation of student-program fit. This curriculum can serve as a template and springboard for the effective integration of virtual learning into surgical education.

To examine changes in Social Media (SoMe) use among urology residency applicants before and after the COVID-19 pandemic.We distributed surveys to individuals who applied to our residency program for application cycles ending in 2018, 2019, and 2021. The surveys included questions about applicants' SoMe use and perceptions of programs' SoMe use during the application process, both before (2018/2019) and after (2021) the COVID-19 pandemic. The primary outcome was SoMe use for professional purposes.We received survey responses from 33% (162 of 496) and 29% (84 of 294) of applicants from the 2018/2019 and 2021 cohorts, respectively. There was a significant increase in professional SoMe use in the 2021 cohort (80%) compared with the 2018/2019 cohort (44%) (P.001). In 2021 compared to 2018/2019, more applicants used SoMe to connect directly with residents (69% vs 34%, P.001) and with faculty members (65% vs 15%, P.001). Applicants in 2021 compared to 2018/2019 more often found SoMe to be useful for making decisions about applying to (33% vs 10%), interviewing at (26% vs 7%), and ranking programs (20% vs 9%) (all P.05). Twitter was the most common platform for applicants to access program information, increasing from 38% to 71%.The COVID-19 pandemic ushered in a period of unprecedented SoMe usage among urology applicants, who used it to learn about and connect with residency programs in new ways. The use of SoMe by residency programs has become an important component of trainee recruitment and is likely to continue in the future.

Purpose The rapid expansion of telemedicine has presented a challenge for the care of patients with genitourinary malignancies. We sought to assess patient and physician perspectives on the use of telemedicine for genitourinary cancer care. Methods We conducted a prospective cross-sectional study of patients who had telemedicine visits with urology, medical oncology, or radiation oncology for management of genitourinary malignancies from July-August 2020. Patients and physicians each received a questionnaire regarding the telemedicine experience. Responses were scored on a 5-point Likert scale. The primary outcomes of the study were patient and physician satisfaction. Results Of the 115 patients who enrolled, we received 96 patient responses and 46 physician responses. Overall, 77% of patients and 70% of physicians reported being “extremely satisfied” with the telemedicine encounter. Satisfaction was high among all components of the encounter including patient-physician communication, counseling, shared decision making, time spent, timeliness and efficiency, and convenience. Additionally, 78% of patients and 85% of physicians “strongly agreed” that they were able to discuss sensitive topics about cancer care as well as they could at an in-person visit. Nine telemedicine visits (9%) encountered technological barriers. Technological barriers were associated with lower overall satisfaction scores among both patients and physicians (p ≤ 0.01). Conclusion We observed high levels of patient and physician satisfaction for telemedicine visits for management of genitourinary malignancies. Technological barriers were encountered by 9% of patients and were associated with decreased satisfaction.

To determine the rate of and predictors for guideline-discordant preoperative gentamicin dosing in urologic surgery and to assess the risk of nephrotoxicity in patients who receive the recommended high-dose prophylaxis.We retrospectively reviewed all adult patients who received preoperative gentamicin for urologic surgery from January 1, 2017 - October 3, 2019. Doses were categorized as guideline-concordant or -discordant using a cutoff of 4.5 mg/kg dosing weight. We used multivariable logistic regression to identify predictors for guideline-discordant dosing. Postoperative kidney injury was assessed using RIFLE criteria.Among 2134 patients, 89% received a preoperative dose ≤ 4.5 mg/kg. Older age (70+ years) and endoscopic surgery were significant risk factors for guideline-discordant dosing (OR 2.54, P0.001; OR 6.21, P0.001). Among 735 patients with complete data, there was no significant difference in the risk of kidney injury between those who received a dose less than 4.5 mg/kg and those who received a higher dose (OR 0.89, 95% CI: 0.26 - 2.99, P = 0.75).Preoperative gentamicin is commonly administered at lower than recommended doses for urologic surgery. Older age and endoscopic surgery are significant predictors of guideline-discordant dosing. The risk of kidney injury following high-dose preoperative gentamicin for urologic procedures is likely comparable to the risk at lower doses.

Background: The acute care surgery model has led to improved outcomes for emergent surgical conditions, but similar models of care have not been implemented in urology. Our department implemented an acute care urology (ACU) service in 2015, and the service evolved in 2018. We aimed to evaluate the impact of the ACU model on the management of nephrolithiasis. Materials and Methods: We conducted a retrospective review of all patients with urology consults in the emergency department for nephrolithiasis, who required surgical intervention from 2013 to 2019. Patients were divided into three cohorts based on date of consultation: Pre-ACU (2013-2014), Phase 1 (2015-2017), and Phase 2 (2018-2019). Results: We identified 733 patients with nephrolithiasis requiring intervention (162 pre-ACU, 334 Phase 1, and 237 Phase 2). Before ACU implementation, median time from consult to definitive intervention was 36 days. After ACU implementation, median time to intervention decreased to 22 days in Phase 1 (p

INTRODUCTION AND OBJECTIVE:Though radical nephroureterectomy (RNU) is the standard of care for upper tract urothelial carcinoma (UTUC), many patients desire kidney-sparing treatments, including end...

INTRODUCTION AND OBJECTIVE:The landscape of urologic training has shifted dramatically with the emergence of robotic surgery. Increased utilization of robotic surgery may alter the level of trainin...

INTRODUCTION AND OBJECTIVE:In 2015, our institution’s Department of Urology implemented an Acute Care Urology (ACU) model, with the goal of improving the delivery of timely and high-quality care fo...

INTRODUCTION AND OBJECTIVE: In-person subinternships for visiting medical students were discouraged during the COVID-19 pandemic. The Society of Academic Urologists (SAU) endorsed virtual subinternships in urology (vSIU) and provided all institutions with a standardized vSIU Guidebook containing a structured curriculum and curated resources. We sought to evaluate the successes and limitations of the vSIU at a national level. METHODS: In December 2020, we sent anonymous surveys via email to all medical students who submitted applications to the urology residency match and to all urology residency program directors (PDs) and associate PDs on the SAU email list. Surveys evaluated goals, curriculum composition, satisfaction, and future reusability. Outcomes were evaluated on a 5-point Likert scale. RESULTS: A total of 162 students (30%) and 78 PDs (48%) completed the survey, including 76 students (47%) and 32 PDs (41%) who participated in vSIU at 29 institutions. Of these electives, 66% were 1-2 weeks in duration, 48% were full-time, and 76% utilized the SAU guidebook. Electives consisted of a wide range of curricular elements (Figure). The most important goals for both students and PDs were experiencing/demonstrating program culture and evaluating whether the program/student are a good fit (≥ 50% rated “extremely important”). These goals were achieved by > 80% of students and PDs. Overall, 79% of students and 78% of PDs rated the vSIU “excellent” or “very good.” On multivariable ordinal logistic regression, duration ≥ 3 weeks and class size ≤ 4 students were associated with higher student ratings (p

INTRODUCTION AND OBJECTIVE:Renal colic due to obstructing ureteral stones is a common cause of emergency department (ED) visits. In the absence of sepsis or overt infectious symptoms, it is often c...

Problem Subinternships are integral to medical education as tools for teaching and assessing fourth-year medical students. Social distancing due to COVID-19 has precluded the ability to offer in-person subinternships – negatively impacting medical education and creating uncertainty surrounding the residency match. With no precedent for the development and implementation of virtual subinternships, the Society of Academic Urologists (SAU) developed an innovative and standardized curriculum for the Virtual Subinternship in Urology (vSIU). Methods The vSIU committee's mandate was to create a standardized curriculum for teaching foundational urology and assessing student performance. Thirty-three members from 23 institutions were divided into working groups and given 3 weeks to develop 10 modules based on urologic subspecialties, Accreditation Council for Graduate Medical Education core competencies, technical skills training and student assessment. Working groups were encouraged to develop innovative learning approaches. The final curriculum was assembled into the “vSIU Guidebook.” Results The vSIU Guidebook contains 212 pages – 64 pages core content and 2 appendices (patient cases and evaluations). It outlines a detailed 4-week curriculum with a sufficient volume of resources to offer a completely adaptable virtual course with the same rigor as a traditional subinternship. Modules contain curated teaching resources including journal articles, lectures, surgical videos and simulated clinical scenarios. Innovative learning tools include reflective writing, mentorship guidelines, videoconference-based didactics, surgical simulcasting and virtual technical skills training. The guidebook was disseminated to program directors nationally. Next Steps The vSIU is the first virtual subinternship in any specialty to be standardized and offered nationally, and it was implemented by at least 19 urology programs. This curriculum serves as a template for other specialties looking to develop virtual programs and feedback from educators and students will allow the curriculum to evolve. As the pandemic continues to challenge our paradigm, this rapid and innovative response exemplifies that the medical community will continue to meet the needs of an ever-changing educational landscape.

INTRODUCTION AND OBJECTIVE:Gentamicin is an aminoglycoside antibiotic commonly used for antimicrobial prophylaxis in urologic procedures. As of 2013, both the American Society of Health-Systems Pha...

We evaluated the discordance between ureteroscopic biopsy and surgical pathology findings for grading and staging upper tract urothelial carcinoma. We also sought to establish preoperative predictors of aggressive tumors.We retrospectively reviewed the records of 314 patients who underwent ureteroscopic biopsy followed by surgical management of upper tract urothelial carcinoma from 2000 to 2016 at a total of 3 institutions. Our primary outcomes were muscle invasive (pT2 or greater) disease at surgical pathology and upgrading of clinical low grade tumors to pathological high grade.At biopsy 61% of the patients had clinical high grade tumors and 21% had subepithelial connective tissue invasion (cT1+). On final pathology 79% of the patients had pathological high grade tumors and 45% had stage pT2 or greater. On multivariate analysis advanced patient age, clinical high grade and cT1+ were independently associated with pT2 or greater. The combined presence of clinical high grade and cT1+ had 86% positive predictive value for muscle invasion while the combined absence of clinical high grade and cT1+ had 80% negative predictive value. The likelihood of missing invasion on biopsy in patients with muscle invasive disease was increased when biopsy fragments were limited to 1 mm or less. Of clinical low grade cases on biopsy 51% were upgraded at surgery. The presence of positive urine cytology was associated with an increased risk of upgrading but this was not statistically significant.Clinical high grade, cT1+ on biopsy and advanced patient age are independent risk factors for muscle invasive upper tract urothelial carcinoma. There is a significant risk of upgrading in patients with clinical low grade tumors on biopsy, especially when urine cytology is positive. The predictive value of biopsy can likely be improved by more extensive ureteroscopic sampling.

Introduction Penile size has long been an important fixation in men’s lives. On the one hand, a smaller penis has been associated with anxiety and apprehension; on the other hand, a larger penis has generally been related to virility and strength. These perceptions predominate during an erection, when penile size is representative of a man’s masculinity. Aim To assess adult penile length and summarize average penile length assessments from the literature; analyze how various urologic diseases and therapies affect penile length and volume; and review how surgical treatments for Peyronie’s disease, penile prosthesis implantation, and radical prostatectomy can affect penile size to appropriately counsel patients seeking such therapies and set realistic goals for patients. Methods To achieve the aim of this review, we analyzed the literature on penile size and volume and how these can be affected by various urologic diagnoses and therapies. We summarize common diagnoses and therapies that can affect penile size. Main Outcome Measure We thoroughly discuss how the aforementioned diagnoses and therapies can negatively affect penile size. In doing so, we allow readers to understand the intricacies of penile size when faced with such diagnoses and therapies in their patients. Results Surgical treatments for Peyronie’s disease, penile prosthesis implantation for refractory erectile dysfunction, and radical prostatectomy for prostate cancer can lead to a decrease in penile size. Conclusion Urologists must recognize that the different therapies they offer can affect a man’s penile size, often negatively. This in turn can lead to poorer satisfaction outcomes in patients. Davoudzadeh EP, Davoudzadeh NP, Margolin E, et al. Penile Length: Measurement Technique and Applications. Sex Med Rev 2018;6:261–271.

The goal of this study was to investigate the association between serum oestradiol levels and clinically significant erectile dysfunction in a cohort of men presenting for andrological evaluation. Retrospective review was conducted of patients that presented to a urologist with practice in andrology over an 18-month period. Patients completed the Male Sexual Health Questionnaire and had serum total testosterone and oestradiol measurements prior to 10:30 a.m. via immunoassay. t Tests, chi-square tests and multivariate logistic regression were used to compare clinical characteristics between those with adequate erectile function (erection scale score > 2) vs. clinically significant erectile dysfunction (erection scale score ≤ 2). Among 256 patients, average age was 49 years (SD 15), average serum oestradiol was 22.3 pg/ml (SD 10.6), and average serum total testosterone was 465.9 pg/ml (SD 206.3). On multivariate logistic regression, serum oestradiol was associated with clinically significant erectile dysfunction (OR 1.52 per SD increase, 95% CI 1.11-2.09, p = 0.009) when controlling for serum total testosterone, age, body mass index and smoking status. These results warrant future studies on the utility of measuring serum oestradiol in patients with erectile dysfunction and the use of aromatase inhibitors in patients with erectile dysfunction and elevated serum oestradiol.

Background Non-curvature penile deformities are prevalent and bothersome manifestations of Peyronie's disease (PD), but the quantitative metrics that are currently used to describe these deformities are inadequate and non-standardized, presenting a barrier to clinical research and patient care. Aim To introduce erect penile volume (EPV) and percentage of erect penile volume loss (percent EPVL) as novel metrics that provide detailed quantitative information about non-curvature penile deformities and to study the feasibility and reliability of three-dimensional (3D) photography for measurement of quantitative penile parameters. Methods We constructed seven penis models simulating deformities found in PD. The 3D photographs of each model were captured in triplicate by four observers using a 3D camera. Computer software was used to generate automated measurements of EPV, percent EPVL, penile length, minimum circumference, maximum circumference, and angle of curvature. The automated measurements were statistically compared with measurements obtained using water-displacement experiments, a tape measure, and a goniometer. Outcomes Accuracy of 3D photography for average measurements of all parameters compared with manual measurements; inter-test, intra-observer, and inter-observer reliabilities of EPV and percent EPVL measurements as assessed by the intraclass correlation coefficient. Results The 3D images were captured in a median of 52 seconds (interquartile range = 45–61). On average, 3D photography was accurate to within 0.3% for measurement of penile length. It overestimated maximum and minimum circumferences by averages of 4.2% and 1.6%, respectively; overestimated EPV by an average of 7.1%; and underestimated percent EPVL by an average of 1.9%. All inter-test, inter-observer, and intra-observer intraclass correlation coefficients for EPV and percent EPVL measurements were greater than 0.75, reflective of excellent methodologic reliability. Clinical Translation By providing highly descriptive and reliable measurements of penile parameters, 3D photography can empower researchers to better study volume-loss deformities in PD and enable clinicians to offer improved clinical assessment, communication, and documentation. Strengths and Limitations This is the first study to apply 3D photography to the assessment of PD and to accurately measure the novel parameters of EPV and percent EPVL. This proof-of-concept study is limited by the lack of data in human subjects, which could present additional challenges in obtaining reliable measurements. Conclusion EPV and percent EPVL are novel metrics that can be quickly, accurately, and reliably measured using computational analysis of 3D photographs and can be useful in describing non-curvature volume-loss deformities resulting from PD.