Urology Residency Applicant Selection: Program Directors' New Criteria.

OBJECTIVE: To evaluate the impact of the recent changes to the urology residency application process on the criteria utilized by residency program directors (PDs) for interview invitations and their perspectives concerning these changes. METHODS: One hundred thirty-seven urology residency PDs were invited to participate in an anonymous survey to explore interview selection criteria and the impact of the increase in preference signals (PS) per applicant. RESULTS: Fifty-eight PDs (42.8%) completed the survey. The highest-ranked criteria were letters of recommendation (LoR) and successful sub-internship (sub-I) at the PD's institution, without statistically significant differences between these 2. Gender, ethnicity, and medical school prestige were the lowest rated criteria, without significant differences between these 3. Compared to before the increase in the number of PS per applicant, 80.7% of PDs reported that not receiving a PS from an applicant this cycle would more negatively impact the chances of offering an interview to that applicant. Moreover, 12.2% stated they would not interview any applicants who did not send a PS. Finally, 62.1% of PDs believed recent changes worsened the process. CONCLUSION: Recent changes impacted PDs applicant evaluation, with the highest ranked criteria being LoRs and sub-I. Paradoxically, the increase in the number of PS per applicant has increased their importance as applicants are much less likely to receive interview offers from programs they have not signaled. Lastly, most PDs believe changes have worsened the evaluation process.

Long-term Outcomes and Complications of Trans-vaginal Mesh Removal: A 14-year Experience.

OBJECTIVE: To assess the long-term patient outcomes, including the resolution of symptoms and need for subsequent procedures, after vaginal mesh removals (VMR) we evaluate our 14-year experience with VMR from a tertiary center with three FPMRS-trained surgeons. Although the use of transvaginal mesh (TVM) had decreased significantly before its ban in 2019, surgeons are still treating TVM complications and performing vaginal or open/robotic VMR for mesh-related complications. METHODS: A retrospective review of women undergoing VMR with 6 months minimum follow-up was undertaken. The data abstracted included demographics, provider notes, operative reports, pathology findings, outside medical records, peri-operative information, and reoperations. RESULTS: From 2006 to 2020, 133 patients were identified, and 113 patients met study criteria with at least 6 months follow-up. The most common presenting symptoms were dyspareunia (77%) and pain (71%). The majority of VMR were performed vaginally (84.5%). Vaginal mesh was removed from anterior (60%), posterior (11%), and anterior and posterior (10%) compartments. Two ureteral injuries and one rectal injury were repaired intraoperatively. VMR resulted in resolution of pain in 50% of patients. Some patients had persistent pain (21%) and a few developed de novo pain (4%). More than half of the patients had dyspareunia resolution (52%), but 12% had persistent dyspareunia and 2% developed de novo dyspareunia. CONCLUSION: VMR complexity requires advanced surgical expertise. Most patients undergoing VMR had resolution of their presenting symptoms. However, outcomes for pain, sexual function, continence, and/or prolapse can be unpredictable, resulting in multiple surgeries.

Metastasis-directed radiation therapy after radical cystectomy for bladder cancer.

PURPOSE: Metastasis-directed radiation therapy (MDRT) may improve oncologic and quality of life outcomes in patients with metastatic cancer, but data on its use in metastatic bladder cancer is severely limited. We sought to review our institutional experience with MDRT in patients with metastatic bladder cancer following radical cystectomy. MATERIALS AND METHODS: We reviewed records of patients who underwent radical cystectomy and subsequent MDRT at our institution between 2009 and 2020. Baseline demographic and clinical/pathologic factors were collected, as were details of treatment including systemic therapy and MDRT. Cases were categorized by treatment intent as consolidative (intended to prolong survival) and palliative (intended only to relieve symptoms). Response to treatment, survival, and toxicity outcomes were reviewed. RESULTS: A total of 52 patients underwent MDRT following radical cystectomy. MDRT was categorized as consolidative in 40% of cases and palliative in 60%. Toxicity (CTCAE Grade ≥ 2) was reported in 15% of patients, none of which exceeded Grade 3. Most patients undergoing consolidative MDRT were treated with SBRT techniques (76%) and a majority (67%) received concurrent treatment with an immuno-oncology agent. Among patients treated with consolidative intent, 2-year progression-free and overall survival were 19% and 60%, respectively. CONCLUSION: MDRT is safe and well-tolerated by a majority of patients. A majority of patients treated with consolidative intent survived ≥ 2 years from treatment.

A Novel Noninvasive Ultrasound Vibro-elastography Technique for Assessing Patients With Erectile Dysfunction and Peyronie Disease.

OBJECTIVE: To translate a novel ultrasound vibro-elastography (UVE) technique for noninvasively measuring viscoelasticity of the penis. METHODS: A pilot study of UVE was performed in men with erectile dysfunction or Peyronie disease. Assessments were performed in triplicate on the lateral aspect of the penis (bilaterally) at 100, 150, and 200 Hz before and after erectogenic injection administration. Viscoelasticity of the corpora was also calculated and compared before and after injection and against measures of erectile function, including the International Index of Erectile Function-Erectile Function Domain, and the total erectogenic medication volume required for achieving a firm erection. RESULTS: Significant increases in viscoelasticity were found after erectogenic injection, validating the ability of UVE to measure dynamic changes with erections. Baseline measures also significantly correlated with the volume of erectogenic medication required to achieve an erection (100 Hz, parameter estimate [PE] 2.21, P <.001; 150 Hz, PE 0.53, P = .03; 200 Hz, PE 0.34, P = .07) but not with age and International Index of Erectile Function-Erectile Function Domain. As erectogenic medications likely represent the most accurate measure of erectile function, these findings suggest a potential role for UVE as a viable diagnostic modality for erectile dysfunction. CONCLUSION: This first report of the use of elastography with erectile function in humans demonstrates significant associations with responsiveness to erectogenic injection medications. These data have significant potential implications for broader clinical practice and merit further study and validation.