Repair of lymphoperitoneal fistulae for chylous ascites following robotic-assisted partial nephrectomy: Anatomic foundation for left-sided predominance following renal surgery.

Chylous ascites (CA) is a rare complication following renal surgery. Here we present the case of a 28-year-old female who developed CA after a robotic left partial nephrectomy. After failing conservative management, she underwent successful robotic-assisted diagnostic laparoscopy and ligation of lymphoperitoneal fistulae. The higher incidence of CA after left versus right-sided renal surgery may be explained by the para-aortic drainage of the intestinal lymphatic channels. Surgical intervention should be considered when conservative management fails.

Who Is Shaping the Future of Academic Urology? A Descriptive Analysis of Residency Program Directors.

OBJECTIVE: To characterize the demographics, educational background, and scholarly characteristics of current urology residency program directors (PDs). METHODS: Urology programs were identified by the listing on the "Accredited US Urology Programs" section of American Urological Association website as of October 2021. Demographics and academic data were collected via publicly available department website and Google search engine. Metrics obtained included years of service as PD from time of appointment, sex, medical school/residency/fellowship, all-time H-index, dual degrees obtained, and professorial ranking. RESULTS: One hundred and forty-seven accredited urological residencies were reviewed; every PD was included. The majority were male (78%) and fellowship trained (68%). Women represented only 22% of PDs. The median active time served as PD, as of 11/2021, was 4years (IQR: 2-7). Forty (28%) were faculty at the same program they completed their residency. The median all-time H-index was 12 (IQR: 7-19; range 1-61). Twelve PDs also served as chair of their department. CONCLUSION: The vast majority of PDs are male, fellowship trained, and have served for less than 5years. Future studies are necessary to follow the trends of representation in leaders of urology residency programs.

Twitter Engagement of Medical Students Applying to Urology Residency During COVID-19: A Mixed Methods Study.

OBJECTIVE: To determine how medical students' Twitter engagement impacted the urology residency match and overall student perception of Twitter. METHODS: We utilized a mixed methods approach with (1) Twitter metrics data, (2) online student surveys, and (3) qualitative semi-structured interviews. Interviews were evaluated with iterative thematic content analysis, while quantitative data were analyzed with descriptive statistics, and univariate analyses. RESULTS: We identified 245 Twitter accounts of Urology residency applicants from the 2021 cycle. Matched students were more likely to have a Twitter account (59% matched vs 28% unmatched, P = .002) and account creation increased following the COVID-19 pandemic announcement. Matched students' profiles were associated with more followers, bios mentioning Urology, home Urology residency programs, and no international flags and/or references. The online survey had a 16% response rate. A majority reported utilizing Twitter for residency information (95%), wanting to continue Twitter throughout residency (67%), and feeling uncomfortable tweeting about racial, political, or diversity issues (64%). Nine interviews revealed 4 themes: Twitter's opportunities for networking, Twitter's role in the application process, the burden of social media use, and professionalism. CONCLUSION: Students applying to Urology residency increasingly utilized Twitter during the COVID-19 pandemic and having a Twitter account was associated with matching. While Twitter may not be necessary to succeed in the match and can pose an additional time burden, applicants view it as an opportunity for learning, networking, and personal branding.

A modified Altis® mid-urethral sling that allows immediate post-operative adjustment: experience in 197 patients.

OBJECTIVES: The transobturator mid-urethral Altis® "mini-sling" uses a static and a dynamic anchor on either end of a pulley suture for intraoperative tension adjustment. Given the potential for incorrect tensioning with sling placement, we adopted a modification for post-operative adjustment should stress urinary incontinence (SUI) persist. The objective is to describe technique, rate of postoperative adjustment driven by patient symptoms, and impact of preoperative/intraoperative variables. METHODS: In this single-surgeon experience, retrospective chart review, demographic and clinical data were collected on patients who received the Altis® sling for SUI between 2014 and 2019. We used descriptive statistics and three-group comparison tests to assess difference in variables among tightening, loosening, or no adjustment. RESULTS: Altis® sling placement was performed on 197 female patients with an average age of 58.7 years. Eighty-four percent (165/197) did not receive post-operative adjustment. Of the 32 patients with post-operative adjustment, 8 (4.1%) had loosening and 24 (12.2%) had tightening at an average of 10.5 days post-operatively. All tightening procedures were done in the clinic. Of the 8 patients with post-operative loosening, 6 were performed in clinic and 2 in the operating room. Preoperative and intraoperative variables were not significantly different among tightening, loosening, and no adjustment cohorts. CONCLUSIONS: This modification of the Altis® sling provides surgeons with the ability to tighten and loosen the sling for persistent SUI. All tightening and most loosening procedures were able to be performed in the clinic. The ability to easily tighten a sling in the early post-operative period may be a critical advantage.

Kids, Cops, and Community: A Qualitative Assessment of Police, Youth, and Parent Perceptions of Each Other.

CONTEXT: Police and communities alike have experienced many traumatic incidents over the last 4 years, prompting police departments across the country to rethink their approach to community programs. PROGRAM: Aurora's Gang Reduction Impact Program (A-GRIP) launched "Kids, Cops, and Community" (KC&C) in Aurora, Colorado, as a community-based quality improvement project designed to improve community relations by better understanding Aurora police and community members' perceptions of each other and current A-GRIP and Aurora for Youth programs by assessing police, youth, and parents' perceptions of each other. IMPLEMENTATION: After a review of current scientific literature on police-community relations, a KC&C advisory group oversaw the creation of key informant interview and focus group guides. A-GRIP recruited participants for 37 interviews (20 police, 8 youth, and 9 parents) and 3 youth focus groups. The community advisory group assisted in the development of salient themes and practical recommendations. The final report outlined 5 major themes (pros/cons of types of police interactions, respectful communication, false uniqueness effect, parenting and police as parents, and youth-police programming awareness) and 2 specific recommendations (sustain/increase opportunities for police-youth interactions and increase community awareness of youth programming). EVALUATION: A-GRIP members had a rich discussion of the implications of these findings in which there was broad support for identifying a strategy to use these results to improve police-community relations. The coalition was challenged by identifying clear next steps because of turnover in administration and coalition leadership, but they have made progress in increasing information and resource sharing. DISCUSSION: This project provides the first model we are aware of that incorporates a systematic assessment of police, youth, and parent perspectives from the same community. Other communities may find value in adapting the KC&C process to identify promising approaches and refine programming elements of police-community engagement activities.