Prostate cancer and podcasts: an analysis and assessment of the quality of information about prostate cancer available on podcasts.

Podcasts represent a new source of information for patients and families dealing with prostate cancer, but no studies have been conducted evaluating the quality of information in them. Evaluating for: (1) quality based on the validated DISCERN criteria, (2) understandability and actionability based on the Patient Education Materials Assessment Tool (PEMAT), (3) misinformation, and (4) commercial bias, we concluded that podcasts are currently not good sources of information for lay health consumers.

The Gender Gap in Promotions: Inhibitors and Catalysts, Strategies to Close the Gap.

The gender gap is an amalgam of gender disparity issues in the workplace ranging from fewer opportunities to network, decreased funding for research, microaggressions, nebulous promotional criteria and difficulty achieving the perception of professionalism because of inherent gender bias. Contributing home factors include more substantial household duties for women typically, spouses who also have a career, and the inherent delay associated with maternity leave for those who choose to have children. This article subdivides gender disparity that impedes promotion into experiences inside and outside the workplace. Disparities within the workplace are divided into directly quantified versus qualitative differences.

Social Media and Apps in Urology.

Purpose of Review: In this study, we aimed to review the common social media (SoMe) apps used and how they have impacted the practice and exchange of information, as well as the challenges of using SoMe in urology. Recent Findings: SoMe has become increasingly popular in the urology community. Lay users often turn to SoMe to learn about urological health and share their own experiences, while medical professionals may use it for career development, networking, education, and research purposes. Summary: It is important to recognize the power of SoMe and to use it responsibly and ethically, particularly given the potential risks of encountering low-quality or misleading information.

Updates to Surgical Treatment of Female Stress Urinary Incontinence (SUI): AUA/SUFU Guideline (2023).

PURPOSE: The purpose of this guideline is to provide a clinical structure with which to approach the diagnosis, counseling, and treatment of female patients with stress urinary incontinence (SUI). MATERIALS/METHODS: The primary source of evidence for the 2017 version of the SUI guideline was the systematic literature review conducted by the ECRI Institute. The initial search spanned literature from January 2005 to December 2015, with an additional updated abstract search through September 2016. The current amendment represents the first update to the 2017 iteration and includes updated literature published through February 2022. RESULTS: This guideline has been amended to reflect changes in and additions to the literature since 2017. The Panel maintained that the differentiation between index and non-index patients remained important. The index patient is a healthy female with minimal or no prolapse who desires surgical therapy for treatment of pure SUI or stress-predominant mixed urinary incontinence. Non-index patients have factors that may affect their treatment options and outcomes, such as high grade prolapse (grade 3 or 4), urgency-predominant mixed incontinence, neurogenic lower urinary tract dysfunction, incomplete bladder emptying, dysfunctional voiding, SUI following anti-incontinence treatment, mesh complications, high body mass index, or advanced age. CONCLUSION: While gains have been made in the field to support new methods for the diagnosis, treatment, and follow-up of patients with SUI, the field continues to expand. As such, future reviews of this guideline will take place to stay in keeping with the highest levels of patient care.

A Contemporary Evaluation of Urological Outcomes After Renal Transplantation.

INTRODUCTION: Urological surgery after renal transplantation leaves patients at risk of infection and further urological complications. Our objective was to discern patient factors associated with adverse outcomes following renal transplantation to identify patients who would benefit from close urological follow-up. METHODS: Retrospective chart review was conducted for patients undergoing renal transplantation between August 1, 2016 and July 30, 2019 at a tertiary care academic center. Data on patient demographics, medical history, and surgical history were collected. Primary outcomes observed were urinary tract infection, urosepsis, urinary retention, unexpected urology visit, and urological procedures within 3 months of transplant. Variables determined significant by hypothesis testing were used in logistic regression modeling for each primary outcome. RESULTS: Of the 789 renal transplant patients, 217 (27.5%) developed postoperative urinary tract infection and 124 (15.7%) developed postoperative urosepsis. Patients with postoperative urinary tract infection were more likely to be female (OR 2.2, P < .01), have pre-existing prostate cancer (OR 3.1, P < .01), and recurrent urinary tract infections (OR 2.1, P < .01). After renal transplant, unexpected urology visits were observed in 191 (24.2%) patients, and urological procedures were performed in 65 (8.2%) patients. Postoperative urinary retention was noted in 47 (6.0%) patients and seen more often in patients with benign prostatic hyperplasia (OR 2.8, P = .033) and prior prostate surgery (OR 3.0, P = .072). CONCLUSIONS: Identifiable risk factors associated with urological complications after renal transplantation include benign prostatic hyperplasia, prostate cancer, urinary retention, and recurrent urinary tract infections. Female renal transplant patients are at increased risk of postoperative urinary tract infection and urosepsis. These patient subsets would benefit from establishing urological care and pre-transplant urological evaluation including urinalysis, urine cultures, urodynamic studies, and close follow-up post-transplant.

Assessment of Stress Urinary Incontinence-Related Podcasts on Stitcher.

OBJECTIVE: To assess the quality, understandability, actionability, accuracy and commercial bias of podcasts regarding stress urinary incontinence (SUI). METHODS: The first 100 Stitcher podcasts from the search, "Stress urinary incontinence" were evaluated using the validated DISCERN criteria, PEMAT tool, and a Misinformation Likert Scale. The accuracy of information was assessed by comparison to the American Urological Association (AUA) SUI Guidelines. RESULTS: Common publisher types included health/wellness channels (66%). Low-moderate quality, poor understandability and misinformation was seen in 67% (DISCERN ≤3), 69% (PEMAT understandability ≤75%) and 17% of podcasts, respectively. Treatments discussed included pelvic floor muscle training (PFMT) (89%) and surgery (47%). Health and wellness channels had the most evidence of commercial bias (44%). Podcasts that discussed surgery more often emphasized shared decision-making (DISCERN15). CONCLUSION: SUI-related podcasts on Stitcher are mostly published by health/wellness channels and skewed toward discussing PFMT. Podcasts are often low-moderate quality, poorly understandable and often have commercial bias.

Vaginal Hormone Therapy for Conditions of the Lower Urinary Tract.

PURPOSE OF REVIEW: Up to half of postmenopausal women experience genitourinary symptoms secondary to hormone deficiency, and there is little consensus on the use of vaginal hormone therapy (VHT) for lower urinary tract symptoms (LUTS) in these patients. This is a review of the scientific literature in the last decade evaluating the use of VHT for disorders of the lower urinary tract including overactive bladder (OAB), stress urinary incontinence (SUI), recurrent urinary tract infections (UTI), and interstitial cystitis/bladder pain syndrome (ICS/BPS). RECENT FINDINGS: Vaginal estrogen therapy improves OAB symptoms in postmenopausal women, but results are mixed when VHT is used in combination with other treatments. There is inconclusive or limited data for the use of VHT to treat SUI and IC/BPS. Vaginal estrogen and prasterone (DHEA) therapies have demonstrated efficacy as treatment modalities for patients who experience recurrent UTIs. VHT preparations show efficacy for the treatment of certain LUTS and can be considered in carefully selected patients when clinically indicated.

Exploring Urological Malignancies on Pinterest: Content Analysis.

BACKGROUND: Pinterest is a visually oriented social media platform with over 250 million monthly users. Previous studies have found misinformative content on genitourinary malignancies to be broadly disseminated on YouTube; however, no study has assessed the quality of this content on Pinterest. OBJECTIVE: Our objective was to evaluate the quality, understandability, and actionability of genitourinary malignancy content on Pinterest. METHODS: We examined 540 Pinterest posts or pins, using the following search terms: "bladder cancer," "kidney cancer," "prostate cancer," and "testicular cancer." The pins were limited to English language and topic-specific content, resulting in the following exclusions: bladder (n=88), kidney (n=4), prostate (n=79), and testicular cancer (n=10), leaving 359 pins as the final analytic sample. Pinterest pins were classified based on publisher and perceived race or ethnicity. Content was assessed using 2 validated grading systems: DISCERN quality criteria and the Patient Education Materials Assessment Tool. The presence of misinformation was evaluated using a published Likert scale ranging from 1=none to 5=high. RESULTS: Overall, 359 pins with a total of 8507 repins were evaluated. The primary publisher of genitourinary malignancy pins were health and wellness groups (n=162, 45%). Across all genitourinary malignancy pins with people, only 3% (n=7) were perceived as Black. Additionally, Asian (n=2, 1%) and Latinx (n=1, 0.5%) individuals were underrepresented in all pins. Nearly 75% (n=298) of the pins had moderate- to poor-quality information. Misinformative content was apparent in 4%-26% of all genitourinary cancer pins. Understandability and actionability were poor in 55% (n=198) and 100% (n=359) of the pins, respectively. CONCLUSIONS: On Pinterest, the majority of the urological oncology patient-centric content is of low quality and lacks diversity. This widely used, yet unregulated platform has the ability to influence consumers' health knowledge and decision-making. Ultimately, this can lead to consumers making suboptimal medical decisions. Moreover, our findings demonstrate underrepresentation across many racial and ethnic groups. Efforts should be made to ensure the dissemination of diverse, high-quality, and accurate health care information to the millions of users on Pinterest and other social media platforms.

Sigmoid conduit-neovaginal fistula: a case report and literature review.

Total pelvic exenterations (TPE) are high morbidity procedures, with up to 38% of patients experiencing a major complication after TPE surgery. We report the case of a 69-year-old woman with a sigmoid conduit-neovaginal fistula who presented with new onset continuous vaginal leakage and decreased urostomy output 3 months post-op from a TPE. We highlight the presentation, diagnosis, conservative management, and surgical management of conduit-vaginal fistulas.

Evaluation of free mobile health applications for pelvic organ prolapse and urinary incontinence.

BACKGROUND: Technology is becoming increasingly integrated into healthcare, including the rapid development of mobile health (mHealth) applications (apps) for various medical conditions such as urinary incontinence and pelvic organ prolapse (POP). As patients turn to these sources more frequently, closer evaluation of the apps becomes more important. OBJECTIVES: To (1) evaluate free applications designed for POP and urinary incontinence using the Xcertia guidelines for medical app quality, (2) analyze user sentiment of the apps, and (3) evaluate app information for quality, understandability, and actionability with the DISCERN and the Patient Education Materials Assessment Tool (PEMAT) tools. METHODS: Mobile medical apps were identified on the Apple App Store or Google Play Store with keywords "pelvic organ prolapse," "incontinence," or "bladder." Exclusion criteria included 1) not free, 2) not updated in past year, 3) required a product for use, 4) not in English. Apps were evaluated using the Xcertia Guidelines. Categories included Operability, Privacy, Security, Content, and Usability. Ratings and sentiment of reviews were assessed, and associations analyzed with one-sided Fisher's exact test. Apps with an informational component were evaluated for quality, usability and actionability using DISCERN and PEMAT criteria. RESULTS: Overall, a total of 73 apps were found and 28 were included. There was an average number of ratings of 2341 and an average score of 3.39 for all the apps included. The average number of reviews was 216.2, with the majority of reviews having positive sentiment. A high number of ratings was associated with a high rating score (p < 0.05) and a high number of reviews was associated with a high percentage of positive reviews (p < 0.05). Based on Xcertia Guidelines, all apps met the guidelines for privacy, security, and usability. Regarding content, 67.9 % of apps incorporated an informational component, but only 17.9 % delineated sources. The average DISCERN score for information quality indicated good quality information (>3). The average PEMAT scores for Understandability and Actionability were 90.6 % and 86.6 %, respectively, which are good scores (≥75 %). CONCLUSIONS: Most free apps were functional and well received by users, however quality of app content varied. Only some apps had an informational component, and even fewer had sources listed. Providers recommending health apps should consider those that meet Xcertia guidelines, have reliable information, and have good understandability and actionability.

Urologic dermatology: a comprehensive foray into the noninfectious etiologies of balanitis.

Balanitis is classically defined as inflammation of the glans penis, often also encompassing the prepuce (balanoposthitis). Several investigations have found that a sizable proportion of urology clinic visits are due to balanitis or related complaints. Balanitis can have numerous complications, including severe pain, urethral stenosis, phimosis, sexual dysfunction, and if untreated, malignancy. Unfortunately, there is no recent or comprehensive review that describes the various etiologies, clinical workup, and treatments for balanitis. Herein this review, we attempt to provide the reader with a complete and updated guide to balanitis in an attempt to improve clinical outcomes.

Characteristics of pelvic organ prolapse content available on social media.

AIMS: To analyze the quality, understandability, and actionability of pelvic organ prolapse (POP) content and to characterize creators of content and treatment options discussed on social media platforms YouTube, Instagram, and Pinterest. METHODS: A cross-sectional, qualitative study was conducted for each platform. A search for "pelvic organ prolapse" was conducted and the first 100 relevant results analyzed. Data collected include source characteristics, treatments discussed, and scores for each criterion of validated Patient Education Materials and Assessment Tool and DISCERN metrics to evaluate quality, actionability, and understandability. The χ 2 analysis, univariate and multivariate logistic regressions were done to assess correlations and the impact of variables on outcomes of interest across platforms. RESULTS: Low to moderate quality was present in 74.1% of posts. Poor understandability was seen in 37.1% of posts, and 56.1% had poor actionability. The most common publisher of content overall was health and wellness or physical therapy groups (44.6%). The most common YouTube publisher was doctors, hospitals, or clinics (49%). Pelvic floor muscle training was the most discussed treatment overall (57.4%). On YouTube surgery was discussed more frequently than Instagram or Pinterest (58% vs. 11% vs. 43%, p < 0.001. Pinterest posts had better understandability ratings than YouTube videos (odds ratio = 0.19; 95% confidence interval: [0.10-0.36]; p < 0.001). CONCLUSION: Information on popular platforms regarding POP demonstrates inconsistent quality and poor understandability and actionability. There is an opportunity for health care providers to direct patients to curated lists of high-quality educational content on these platforms. Awareness of information available on social media is an increasingly important aspect of patient care.

Virtual grand rounds as a novel means for applicants and programs to connect in the era of COVID-19.

BACKGROUND: COVID-19 has disrupted the 2020-2021 residency application cycle with the cancellation of away rotations and in-person interviews. This study seeks to investigate the feasibility and utility of video conferencing technology (VCT) as an opportunity for applicants to interact with faculty from outside programs. METHODS: 18 prospective urology applicants were randomized to 6 urology programs to give a virtual grand rounds (VGR) talk. Presentations were recorded and analyzed to determine audience engagement. Students were surveyed regarding perceived utility of VGR. Faculty were surveyed to determine system usability of VCT and ability to evaluate the applicant. RESULTS: 17 students completed the survey, reporting a 100% satisfaction rate with VGR. A majority felt this was a useful way to learn about outside programs. 85 physicians completed the faculty survey, with nearly half feeling confident in their ability to evaluate the applicant. Video transcription data shows sessions were interactive with minimal distractions. CONCLUSIONS: VGR can be a useful means for medical students to express interest in programs as well as an additional marker for faculty to evaluate applicants.

Analysis of Pelvic Organ Prolapse-related Content on Pinterest.

OBJECTIVES: Our study is a cross-sectional, qualitative study analyzing pelvic organ prolapse-related content on Pinterest, a social media platform that also functions as a visual search engine. Primary outcomes assessed include quality, understandability, and actionability of content. Secondary outcomes include levels of misinformation and commercial bias. Our study further characterizes sources of prolapse content and treatment modalities discussed. METHODS: A Pinterest search was conducted using the term "pelvic organ prolapse," analyzing the first 100 relevant results. We examined the publisher of each pin and the writer of linked content. Using validated tools including the Patient Education Materials Assessment Tool and DISCERN criteria, we assessed understandability and actionability of content. We further compared content to professional guidelines for discussing and treating prolapse, evaluating for misinformation. We also evaluated for commercial bias and subjectively rated pin quality. RESULTS: Of pins evaluated, low understandability was found in 16, low actionability in 30, and low-to-moderate quality in 69. The most common publisher of pins was health and wellness groups, and the most common writer of content was physical therapists. Pelvic floor muscle training (PFMT) is the treatment modality discussed most frequently on Pinterest. CONCLUSIONS: Pinterest content discussing pelvic organ prolapse shows good levels of understandability for patients at all levels of health literacy. However, the number of pins showing poor actionability raises concern that content may not encourage readers to take direct steps toward prolapse assessment and management. In all, a majority of prolapse-related content on Pinterest was of low-to-moderate quality.

A 30-Year Review of Cystectomy Litigation.

INTRODUCTION: Annually the U.S. spends approximately $55.6 billion on malpractice and medical liability, with urology ranked 11th out of 25 specialties for number of malpractice claims. Our objective was to identify common causes for filing claims associated with cystectomy as well as corresponding payout outcomes. METHODS: Using the Westlaw® legal database, a search was conducted using the keywords, "cystectomy," "cystoprostatectomy" and "bladder removal" between January 1, 1990 and January 1, 2020. Each case was evaluated for plaintiff demographics, alleged malpractice claim, defendant specialty, resulting clinical outcome, resulting legal outcome including verdict and monetary award. Alleged malpractice claims were further subdivided based on whether the claimed negligence of duty was preoperative, perioperative or postoperative. Data were analyzed using Microsoft® Office Excel®. RESULTS: After accounting for irrelevant and duplicate cases the Westlaw search returned 42 unique cases. The most common indication for cystectomy was bladder cancer (69%). Preoperative negligence resulted in the highest average payout ($2,062,204.00) and accounted for 76% of filed claims, with delay in diagnosis accounting for the most common complaint (47%). Urologists made up the highest percentage of defendants sued, at 62%. CONCLUSIONS: The bulk of alleged malpractice in cystectomy cases is due to preoperative negligence, most predominantly in the delay of cancer diagnosis. Alleged cases of preoperative negligence also return the highest award for the plaintiff. This study sheds light on areas of concern that urologists should be aware of associated with cystectomy litigation.

Draft Genome Sequence of Pseudomonas aeruginosa Strain PA14-UM.

Pseudomonas aeruginosa is a Gram-negative nosocomial pathogen that is a leading cause of morbidity and mortality in cystic fibrosis patients and immunocompromised individuals worldwide. The isolate examined in this study, PA14-UM, is a well-characterized isolate utilized in studies from the University of Maryland.

Gender differences in urology society award recipients.

BACKGROUND: Approximately 91% of urologists are male and 9% female. We aim to characterize gender differences amongst urology society awardees over the past six decades. METHODS: We queried 16 American urology societies. Inclusion criteria were active membership enrollment, majority urologist members, and awards provided at an annual, biennial or triennial basis. RESULTS: Ten urology societies were included. Between 1963 and 2019, 848 awardees for 34 awards were identified. Men comprised 92.2% and women 7.8% of recipients. The highest percentage of women awardees per year (21.7%) occurred in 2018, increased from 6.5% in 2008 and 0% in 1998. Over the last 11 years, women received 0% of awards offered 61% of the time. CONCLUSIONS: There is an increased trend in the representation of women awardees by urology societies, although the frequency varies widely between societies. This is in keeping with the trend of increasing number of women entering the field of urology.

Trends in female surgeon authorship - The role of the middle author.

BACKGROUND: The objective of this study was to compare middle authorships between male and female general surgeons in the United States. METHODS: A stratified random sample of American College of Surgeons general surgery fellows was identified. Relevant author demographic, affiliation, and publication metrics were collected and compared across cohorts to determine which demographics were prognostic for each outcome variable. The primary endpoint was the number of middle author papers between genders. RESULTS: Males were more likely to enter into practice earlier (p<0.001), be fellowship-trained (p<0.001), obtain higher academic rank (p<0.001), and practice at more highly ranked academic institutions (p=0.019). Females had fewer middle author publications (p=0.044) and higher annual rates of first author publications (p=0.020) despite similar rates of total publications. CONCLUSIONS: Female surgeons hold the middle author position less frequently than males despite similar total publication numbers. Reasons for this finding should be the target of future study.