Improving Gender Diversity in Urologic Residency Training.

PURPOSE OF REVIEW: Women remain underrepresented in urology despite being well-represented in medicine overall. A more diverse urological workforce has the potential to lead to better health outcomes for patients. This paper presents an overview of barriers faced by women in urology at the student, resident, and attending level and potential solutions to mitigate these issues. RECENT FINDINGS: Although the number of women entering urology has increased since the first woman became a board-certified urologist in 1962, women still are underrepresented, advance more slowly, and hold only a small percentage of leadership positions. Women in urology and surgical fields in general face numerous challenges and obstacles which can be improved to bring and keep more women in the field of urology. Recent efforts by both academic urologists and trainees themselves offer hope for change. Women in urology face challenges in the field which include more limited mentorship opportunities, harassment and bias, and 'pigeonholing'. Recent efforts by both academic urologists and trainees themselves offer hope for change to attract and keep more women in the field. These efforts include the American Urological Association's public commitment to advocating for and fostering a diverse and inclusive environment within urology. A more diverse urological workforce has the potential to lead to better health outcomes for patients, particularly in those populations where access to urological care may be limited.

Revisiting One-Stage Urethroplasties for Distal Urethral Strictures.

BACKGROUND: Reconstructive approaches for distal urethral strictures range from simple meatotomy to utilizing grafts or flaps depending on the etiology, length and location. We describe a contemporary cohort of distal urethral strictures and report a surgical technique termed distal one-stage urethroplasty developed to address the majority of distal urethral strictures encountered. METHODS: Thirty-four patients were included. The mean age was 56.7 years (range 15.7-84.9 years), the mean stricture length was 1.1 cm (0.5-1.5) and the mean follow-up was 42.5 months (28-61.3). RESULTS: The vast majority of distal strictures (27/34 (79.4%)) were treated with our hybrid one-stage approach combining a distal urethral reconstruction with excision of the scar tissue without the need to use grafts or flaps. The average stricture length was 0.68 cm and average operative time was 24.43 min. Post-operative spraying was reported in a minority of patients (4/27 (14.8%)). The length of stricture and surgery were significantly longer in those 7/34 (20.6%) patients in whom grafts or flaps were used (2.88 cm and 154.8 min, respectively, p < 0.001 for both when compared to the hybrid one-stage approach). We noted 6/34 (17.6%) recurrences of distal urethral strictures, all of which were treated successfully with graft and flap repairs. CONCLUSIONS: The vast majority of distal urethral strictures are amenable to a distal one-stage urethroplasty, avoiding the use of grafts and/or flaps while achieving reasonable outcomes. This limited approach, at least initially, is associated with shorter operative time and time of catheter placement and avoids morbidity associated with graft or flap harvesting. Spraying of urine is seldomly encountered and comparable to other approaches addressing distal urethral strictures.

Altered ocular parameters from circadian clock gene disruptions.

The pathophysiology of refractive errors is poorly understood. Myopia (nearsightedness) in particular both blurs vision and predisposes the eye to many blinding diseases during adulthood. Based on past findings of diurnal variations in the dimensions of the eyes of humans and other vertebrates, altered diurnal rhythms of these ocular dimensions with experimentally induced myopia, and evolving evidence that ambient light exposures influence refractive development, we assessed whether disturbances in circadian signals might alter the refractive development of the eye. In mice, retinal-specific knockout of the clock gene Bmal1 induces myopia and elongates the vitreous chamber, the optical compartment separating the lens and the retina. These alterations simulate common ocular findings in clinical myopia. In Drosophila melanogaster, knockouts of the clock genes cycle or period lengthen the pseudocone, the optical component of the ommatidium that separates the facet lens from the photoreceptors. Disrupting circadian signaling thus alters optical development of the eye in widely separated species. We propose that mechanisms of myopia include circadian dysregulation, a frequent occurrence in modern societies where myopia also is both highly prevalent and increasing at alarming rates. Addressing circadian dysregulation may improve understanding of the pathogenesis of refractive errors and introduce novel therapeutic approaches to ameliorate myopia development in children.