Ergonomic Considerations in Urologic Surgery.

PURPOSE OF REVIEW: This paper aims to discuss the various work-related musculoskeletal disorders (WRMDs) among urologists and provide an overview of the latest recommendations to improve awareness of ergonomic principles that can be applied in the operating room, with special consideration of challenges faced during pregnancy. RECENT FINDINGS: Urologists suffer from a large burden of WRMDs. The main drivers of pain associated with the various surgical approaches include repetitive movements, static and awkward body positions, and the use of burdensome equipment. Pregnant surgeons are at an even greater risk of WRMDs and face high rates of pregnancy complications. Laparoscopy, endoscopy, robot-assisted surgeries, and open surgeries present unique ergonomic challenges for the practicing urologist. Proper posture and equipment use, optimal operating room setup, intraoperative stretching breaks, and an emphasis on teaching ergonomic principles can reduce the risk of WRMDs. Surgeons are also at increased risk of WRMDs during pregnancy but may continue to operate while taking measures to limit physical exertion and fatigue. Improving awareness of and incorporating ergonomic principles early in a urologist's career may reduce the risk of injury and improve operative performance and longevity.

The Utility of Renal Mass Biopsy in Shared Decision-Making for Renal Mass Treatment.

OBJECTIVE: To evaluate the utility of renal mass biopsy (RMB) in shared decision-making for renal mass treatment. Underutilization of RMB for patients with renal masses is due in part to physicians believing that results have limited clinical utility. MATERIALS AND METHODS: This was a prospective study of all patients referred for RMB from October 2019 to October 2021. Patients and physicians completed pre- and post-RMB questionnaires. Questionnaires assessed both parties' perceived utility of RMB and the impact of biopsy results on treatment preference using Likert scales. RESULTS: We enrolled 22 patients with a mean age of 66years (SD 14.5) and mean renal tumor size 3.1 cm (SD 1.4). Five were lost to follow-up (three pre-RMB, two post-RMB). Pre-RMB, 100% of patients believed that a biopsy would help them choose a treatment and 45% were unsure of their treatment preferences. After RMB, 92% perceived their biopsy results as useful and only 9% were unsure of treatment preference. Overall, 100% of patients were glad they had a biopsy. Results led patients and physicians to change their treatment preference in 57% and 40% of cases, respectively. Patients and physicians disagreed about treatment in 81% of cases prior to biopsy, but in only 25% of cases after biopsy. CONCLUSION: Discordance between patient and physician treatment preference for renal masses is higher in the absence of RMB data. Select patients are willing to undergo RMB and RMB data can increase patient confidence and comfort in a shared decision-making approach for renal mass treatment.

Heterogeneity in the pharmacological management of radiation-induced hemorrhagic cystitis.

BACKGROUND: Radiation-induced hemorrhagic cystitis is a complication of pelvic radiotherapy, with an incidence of up to 5%. The resultant hematuria may be severe and refractory to conservative measures. Our objective was to describe the pattern of inpatient treatments among a cohort of patients with radiation-induced hemorrhagic cystitis requiring pharmacological management. METHODS: We conducted a retrospective case series to identify all inpatient admissions at a single institution during which patients with radiation cystitis underwent pharmacological intervention for refractory hematuria between 2004 and 2019. Patient demographics, medical history, details of radiation therapy, and relevant admission data were collected. Details of treatment, including the use of pharmacotherapy and surgical treatment, were reviewed and summarized. RESULTS: We identified 21 patients who were treated during 26 admissions. Most were male (91%) with a history of external beam radiation therapy (86%), primarily for prostate cancer (85%), and a median age of 73 (IQR: 67-85). Most patients received continuous bladder irrigation as the first intervention during their admission (65%), for a median duration of 40 hours (IQR: 25-59). Eleven separate pharmacologic agents were used, with variations in initial pharmacotherapy utilization over time. Most patients were treated with a combination of surgical and pharmacological interventions (85%). The median length of stay was 9 days (IQR: 5-17) and the 90-day readmission rate was 35%. CONCLUSIONS: Pharmacologic treatment for refractory radiation-induced hemorrhagic cystitis is inconsistent and lacks evidence to support treatment strategies. Further work is needed to determine the optimal management for this morbid complication.

The Impact of Visiting Rotations on the Urology Residency Match: Insights and Perspectives From the 2021-2022 Applicants.

OBJECTIVE: To survey 2022 Urology Residency Match applicants on their away rotation experiences to better understand the impact of pandemic changes, including the one in-person away rotation limit, on interviews and match outcomes. METHODS: An anonymous post-match online survey was distributed to applicants of study-participating institutions. Data was prospectively collected regarding respondent demographics, away rotation experiences, interviews, utilization of preference signaling, and overall match outcomes. RESULTS: In total, 230 applicants completed the survey. Respondents prioritized geography (28.1%), program reputation (26.1%), and early notification (25.6%) as the top factors in determining whether to accept a rotation offer. The majority (93%) participated in a single away rotation, with nearly all respondents being offered a virtual interview from the program where they completed a visiting clerkship. Of those who declined away rotation offers, 56% were not offered an interview at the program they declined an offer from. The majority matched at either their home institution (20.8%), a program where they submitted a preference signal (22.2%), or a program where they completed an in-person away rotation (13%). Despite 46.3% of respondents reporting that their match outcome was negatively affected by the ability to rotate at only one away rotation, the majority were satisfied (70%) with their rotation selection based on match results. CONCLUSIONS: For applicants, participation in visiting rotations plays a significant role in the match process. Further research regarding mechanisms to optimize the away rotation application process is needed as the capacity to do visiting electives expands in the post-pandemic environment.

Lumbar discectomies in elite rowers: presentation, operative treatment, and return to play.

OBJECTIVE: In a cohort of elite rowers requiring lumbar spine surgery, we report information regarding: (1) presentation, (2) operative treatment, and (3) return to play (RTP). METHODS: All competitive rowers undergoing spine surgery at a single academic institution from 2015 to 2020 were analyzed. Three rowers underwent spine surgery during the allotted time period. Demographic, clinical, operative, and RTP data was recorded. Each athlete's self-reported level of effort/performance was assessed before and after surgery. First RTP was defined as the time of initial return to rowing activities, and full RTP was defined as the time of unrestricted return to rowing activities. Descriptive statistics were performed. RESULTS: The three collegiate rowers ranged from 20- to 21-year-old, each with L5/S1 disc herniations. Preoperative pain levels ranged from 8 to 10, and inciting injury events included back squats, front squats, and rowing during the 'finish' stage. Each athlete underwent a minimally invasive, unilateral L5/S1 decompression, partial medial facetectomy, and partial discectomy with microscopic-assistance. First RTP ranged from 4-6 months, with full RTP at 6-8 months. Pain dissipated to the 0-1 range at full RTP. Final effort/performance improved from 10-60% mid-injury to 90-100% at full RTP. Each athlete's 2000m row time showed a decline mid-injury and an improvement to at or within 10 s of their pre-injury time. CONCLUSIONS: Drawing from three collegiate rowers who underwent lumbar decompression surgery, each athlete successfully returned to rowing, with initial RTP in the 4-6 months range and full RTP in the 6-8 months range. Performance levels rebounded to near or better than pre-injury performance. The results of this small case series warrant replication in larger, multi-institutional samples.

Return to golf after adult degenerative and deformity spine surgery: a preliminary case series of how surgery impacts golf play and performance.

BACKGROUND: Golf is a commonly played sport among older adults, and degenerative and/or deformity spine pathology can severely impact older individuals' ability to play golf. In a cohort of self-identified, avid golfers undergoing degenerative or deformity spine surgery, we report their: (I) presentation, (II) operative treatment, and (III) return-to-play (RTP) process. METHODS: A retrospective case series of self-identified, avid golfers undergoing spine surgery at a single institution from 2015-2019 was undertaken. Demographic, presenting, operative, RTP data, along with numerical rating scale (NRS) pain scores were collected. The first and full RTP time postoperatively, in addition to the following golf metrics: 18-hole rounds per month, handicap, and self-perceived effort/performance were obtained. RESULTS: A total of 6 golfers were included, 3 undergoing each degenerative and deformity operations. Mean age was 60 years, and 5 of 6 (83%) patients were female. All patients were self-identified, avid golfers with a mean experience of 31 years. Mean preoperative NRS back/neck pain was 9.7, which decreased to 0.8 postoperatively (P<0.001). Players undergoing smaller operations (lumbar fusion/cervical laminoplasty) returned to golf sooner than patients undergoing larger deformity corrections, with a mean first RTP of 4.3 months for degenerative patients vs. 9.7 months among deformity patients. All patients played either the same or more rounds of golf after surgery once they reached full RTP. The handicap of all players improved after surgery to better than before surgery, except for one high-level golfer with a handicap of 9 preoperatively that went to 15 postoperatively following an extensive revision deformity reconstruction. CONCLUSIONS: All patients returned to playing golf at or more frequently than their preoperative status. Degenerative patients returned to play sooner than deformity patients. All patients performed at a higher level after surgery, except for one high-level golfer whose handicap worsened slightly. These data provide baseline information for future prospective studies of golfers undergoing spine surgery.