Destroyed bladders: Characterization of progressive inflammatory cystitis.

PURPOSE: We identified a subset of patients with noninfectious cystitis who develop refractory symptoms marked by diffuse inflammatory changes, reduced bladder capacity, and vesicoureteral reflux (VUR), termed here as "progressive inflammatory cystitis" (PIC). Our objective was to describe the phenotype, disease outcomes, and pathologic findings of PIC. MATERIAL AND METHODS: A single institution retrospective cohort study of patients with PIC. Patients with a history of pelvic radiation, urologic malignancy, or neurogenic bladder were excluded. We describe cohort characteristics and use bivariate analyses to compare subgroups. Kaplan-Meier methods estimate time to urinary diversion. RESULTS: From 2008 to 2020, 46 patients with PIC were identified. The median age of symptom onset was 63 years old (interquartile range [IQR]: 56, 70) and the most common presenting symptoms were urinary urgency/frequency (54%) and incontinence (48%). Urodynamics showed a median maximum bladder capacity of 80 mL (IQR: 34, 152), commonly with VUR (68%) and hydronephrosis (59%). Ultimately 36 patients (78%) underwent urinary diversion at a median of 4.5 years (IQR: 2, 6.5) after symptom onset. Significant pathologic findings include presence of ulceration (52%), acute and chronic inflammation (68%), including eosinophils (80%), lymphoid follicles (56%), and mast cells in both lamina and muscularis propria (76%). CONCLUSIONS: PIC is a newly defined entity characterized by significantly diminished bladder capacity, upper tract changes, and relatively quick progression to urinary diversion. Larger prospective cohort studies are required to further characterize this severe phenotype of chronic noninfectious cystitis, aid earlier diagnosis, and guide management decisions.

Increasing Diversity, Equity, and Inclusion in Urology Residency Recruitment: Recommendations From the Society of Women in Urology.

OBJECTIVE: To provide a framework for diversifying the urologic workforce through residency recruitment by integrating principles of diversity, equity, and inclusion (DEI) into program mission and values, application review, and interview process. MATERIALS AND METHODS: For this narrative review, the Society of Women in Urology Advancing DEI in Urology Residency Recruitment Task Force identified 4 areas for incorporating DEI into residency recruitment: defining a residency program's mission and values, holistic application review, an objective interview process, and implementing DEI principles into a program. Using PubMed and Google Scholar, we performed a non-systematic literature search of articles from January 2014 to January 2024. Search terms included combinations of "diversity", "equity", "inclusion", "residency", "holistic review", "applications", "interviews", and "initiatives". Additional resources were identified through citations of selected articles. Based on findings from these articles, Task Force members made recommendations for best practices. RESULTS: The diversity of practicing urologists is disproportionate to that of the United States population. Emerging evidence demonstrates that DEI efforts in healthcare are associated with better outcomes and reduction in healthcare inequities. We offer strategies for residency programs to integrate DEI initiatives into their recruitment, application review, and interview process. Furthermore, we address extending DEI principles into a program's mission and culture to create an inclusive environment conducive to training and supporting individuals from unique backgrounds. CONCLUSION: It is critical to recruit and retain diverse talent in urology to improve patient care. We urge residency programs and their supporting institutions to adopt DEI principles into their recruitment efforts.

Self-reported Patient-perpetrated Sexual Harassment and Subsequent Reporting Among Health Care Clinicians in Urology and Obstetrics-Gynecology: A Cohort Survey.

OBJECTIVE: To understand the experiences of urologists and obstetricians-gynecologists (obgyns) with patient-perpetrated sexual harassment (PPSH) since the clinical focus of these specialists may make them particularly vulnerable to PPSH. METHODS: A multiple-choice anonymous online survey was administered in the Departments of Urology and Obgyn at a single institution from 22 September, 2022-18 October, 2022. The survey assessed if clinicians had experienced PPSH, including gender harassment, unwanted sexual attention, and/or sexual coercion from patients, where PPSH was witnessed or experienced, and whether implementation of chaperones impacted their experiences with PPSH. We conducted descriptive analysis by clinician sex, department, and form of PPSH experienced. We also performed logistic regression analysis to identify clinician factors associated with experiencing PPSH. RESULTS: Majority of respondents reported that they experienced or witnessed PPSH (78%, N = 100). Gender harassment was the most common form of PPSH experienced by clinicians (53%, N = 68). PPSH was most often experienced or witnessed in clinic (74%, N = 70) and inpatient wards (66%, N = 62). Of those who utilized chaperones, 80% (N = 57) of clinicians reported they either did not reduce or were unsure if they reduced PPSH. When adjusting for clinician factors, being a female clinician (adjusted odd ratio [aOR] = 5.1, 95% confidence interval (CI) 1.5-17.3), trainee (aOR = 6.9, 95% CI 1.1-44.6), or a urologist (aOR = 18.1, 95% CI 2.0-166.1) were associated with experiencing PPSH. CONCLUSION: Our study highlights the pervasiveness of PPSH among urologists and obgyns. Future studies should elucidate what policy changes can be effective in protecting clinicians from PPSH.

Gender and Racial Diversity among U.S. Urology Residency Programs and Efforts to Improve It: You Can't Be What You Can't See.

INTRODUCTION: The U.S. urology workforce lacks ethnic and gender diversity. Few programs exist to increase diversity, and little is known on their effectiveness. We assessed the landscape of specific programs designed to increase underrepresented in medicine (URiM) and female student participation in the U.S. Urology Match, and understand the concerns and attitudes of those students. METHODS: To better understand urology-specific programs, we sent an 11-item survey to all 143 urology residency programs. To better understand the concerns and attitudes of URiM and female students participating in the U.S. Urology Match, we sent a 12-item survey to the students who participated in the Match from 2017 to 2021. Lastly, we evaluated trends in match rate using Match data from 2019 to 2021. RESULTS: Among programs, 43% responded to our survey. Most residency programs offer a wide array of initiatives to increase their diversity, with unconscious bias training being the most frequent (78.7%). Programs with at least 1 female faculty member were associated with increased recruitment of female residents over time (p=0.047). A similar trend was seen in programs with URiM faculty. Among students, 10.5% responded to our survey, of whom 79.2% were unaware of any programs at their institution geared toward URiM or female students. Match data revealed that women were more likely to match (p=0.002), and URiM students were less likely to match (p <0.001) compared to the overall Match rate. CONCLUSIONS: Urology programs are making substantial efforts to improve diversity, but the message is lacking reach. Having a diverse faculty did make a difference in programs' ability to diversify.

Sacral neuromodulation for nonobstructive urinary retention--is success predictable?

PURPOSE: We investigated whether there are factors which can predict successful stage II (permanent) sacral nerve stimulator (InterStim) implantation for patients with nonobstructive urinary retention. MATERIALS AND METHODS: We retrospectively reviewed our sacral neuromodulation database from January 1, 1999 to January 1, 2006. A total of 29 patients were referred to the William Beaumont Hospital Department of Urology for nonobstructive urinary retention. All patients completed a 3-day voiding log followed by test stimulation. Patients underwent test stimulation for a 2-week trial period. Those who experienced 50% improvement in void volume and/or catheterization frequency subsequently underwent permanent implantation. We reviewed patient charts with respect to age, sex, duration of retention, underlying diagnosis for retention and voiding ability. RESULTS: Of the 29 patients 15 were men and 14 were women. Mean patient age was 58.8+/-16 years (range 18 to 82). The mean age of the men in the study was 55.5+/-18 years while the mean age of the women was 62.3+/-14 years. Although all the patients performed intermittent self-catheterization 18 were able to void (more than 50 cc per void). The remaining 11 patients had minimal (50 cc or less) or no ability to void. Of the 18 patients who were able to void 12 (67%) underwent successful permanent implantation. However, voiding improved after test stimulation in only 2 of the 11 patients (18%) who had been unable to void. This difference was statistically significant (p=0.02) and suggests that pre-implantation ability to void can predict success of test stimulation. CONCLUSIONS: Patient ability to void predicts success of first stage test stimulation. Although we would still offer a trial of sacral neuromodulation to those with nonobstructive urinary retention and the inability to void, this study would allow better counseling regarding the likelihood of successful outcome.

Phenylbutyrate inhibits the invasive properties of prostate and breast cancer cell lines in the sea urchin embryo basement membrane invasion assay.

Histone deacetylase inhibitors, such as phenylbutyrate, are currently undergoing clinical trials as potential anticancer agents. Phenylbutyrate can induce cell differentiation and apoptosis in a number of cancer cell types and can act in synergy with ionizing radiation and chemotherapy to induce apoptosis. We used the sea urchin embryo basement membrane invasion assay to show that phenylbutyrate potently inhibited the invasive properties of both prostate and breast cancer cells at clinically achievable doses. This inhibition was dose-dependent and persisted for at least 24 hr after the drug was removed. These results suggest that in addition to activating apoptosis in cancer cells, phenylbutyrate may be used in prevention of metastatic disease.