Standardized Reporting of Machine Learning Applications in Urology: The STREAM-URO Framework.

The Standardized Reporting of Machine Learning Applications in Urology (STREAM-URO) framework was developed to provide a set of recommendations to help standardize how machine learning studies in urology are reported. This framework serves three purposes: (1) to promote high-quality studies and streamline the peer review process; (2) to enhance reproducibility, comparability, and interpretability of results; and (3) to improve engagement and literacy of machine learning within the urological community.

Impact of Perioperative Complications on Living Kidney Donor Health-Related Quality of Life and Mental Health: Results From a Prospective Cohort Study.

BACKGROUND: Although living kidney donation is safe, some donors experience perioperative complications. OBJECTIVE: This study explored how perioperative complications affected donor-reported health-related quality of life, depression, and anxiety. DESIGN: This research was a conducted as a prospective cohort study. SETTING: Twelve transplant centers across Canada. PATIENTS: A total of 912 living kidney donors were included in this study. MEASUREMENTS: Short Form 36 health survey, Beck Depression Inventory and Beck Anxiety Inventory. METHODS: Living kidney donors were prospectively enrolled predonation between 2009 to 2014. Donor perioperative complications were graded using the Clavien-Dindo classification system. Mental and physical health-related quality of life was assessed with the 3 measurements; measurements were taken predonation and at 3- and 12-months postdonation. RESULTS: Seventy-four donors (8%) experienced a perioperative complication; most were minor (n = 67 [91%]), and all minor complications resolved before hospital discharge. The presence (versus absence) of a perioperative complication was associated with lower mental health-related quality of life and higher depression symptoms 3-month postdonation; neither of these differences persisted at 12-month. Perioperative complications were not associated with any changes in physical health-related quality of life or anxiety 3-month postdonation. LIMITATIONS: Minor complications may have been missed and information on complications postdischarge were not collected. No minimal clinically significant change has been defined for kidney donors across the 3 measurements. CONCLUSIONS: These findings highlight a potential opportunity to better support the psychosocial needs of donors who experience perioperative complications in the months following donation. TRIAL REGISTRATION: NCT00319579 and NCT00936078.

CONTEXTE: Bien que le don vivant d'un rein soit une procédure sécuritaire, certains donneurs souffrent tout de même de complications périopératoires. OBJECTIFS: Cette étude a examiné l'incidence des complications périopératoires sur la qualité de vie liée à la santé et les symptômes de dépression et d'anxiété rapportés par les donneurs. TYPE D'ÉTUDE: Étude de cohorte prospective. CADRE: Douze centers de transplantation à travers le Canada. SUJETS: 912 donneurs vivants d'un rein. MESURES: Un questionnaire abrégé de 36 questions sur l'état de santé, l'inventaire de dépression Beck et l'inventaire d'anxiété Beck. MÉTHODOLOGIE: Les donneurs ont été inscrits avant le don de façon prospective entre 2009 et 2014. Les complications périopératoires des donneurs ont été classées à l'aide du système de classification Clavien-Dindo. La qualité de vie liée à la santé physique et mentale a été évaluée à l'aide des trois outils de mesure; ces mesures ont été faites avant le don, puis 3 et 12 mois après le don. RÉSULTATS: Au total, 74 donneurs (8 %) ont souffert d'une complication périopératoire; la plupart étaient mineures (n = 67 [91 %]) et ont été résolues avant le congé de l'hôpital. La présence (par rapport à l'absence) d'une complication périopératoire a été associée à une plus faible qualité de vie liée à la santé mentale et à des symptômes de dépression plus graves 3 mois après le don; aucune de ces différences n'a persisté après 12 mois. Les complications périopératoires n'ont pas été associées à des changements dans la qualité de vie liée à la santé physique ou à l'anxiété 3 mois après le don. LIMITES: Certaines complications mineures ont pu être manquées. L'information sur les complications survenues après le congé n'a pas été recueillie. Dans les trois outils de mesure, aucune variation minimale cliniquement significative n'a été définie pour les donneurs d'un rein. CONCLUSION: Ces résultats soulignent une occasion de mieux répondre aux besoins psychosociaux des donneurs d'un rein qui présentent des complications périopératoires dans les mois suivant le don.

Living Kidney Donors' Financial Expenses and Mental Health.

BACKGROUND: Living kidney donors incur donation-related expenses, but how these expenses impact postdonation mental health is unknown. METHODS: In this prospective cohort study, the association between mental health and donor-incurred expenses (both out-of-pocket costs and lost wages) was examined in 821 people who donated a kidney at one of the 12 transplant centers in Canada between 2009 and 2014. Mental health was measured by the RAND Short Form-36 Health Survey along with Beck Anxiety Inventory and Beck Depression Inventory. RESULTS: A total of 209 donors (25%) reported expenses of >5500 Canadian dollars. Compared with donors who incurred lower expenses, those who incurred higher expenses demonstrated significantly worse mental health-related quality of life 3 months after donation, with a trend towards worse anxiety and depression, after controlling for predonation mental health-related quality of life and other risk factors for psychological distress. Between-group differences for donors with lower and higher expenses on these measures were no longer significant 12 months after donation. CONCLUSIONS: Living kidney donor transplant programs should ensure that adequate psychosocial support is available to all donors who need it, based on known and unknown risk factors. Efforts to minimize donor-incurred expenses and to better support the mental well-being of donors need to continue. Further research is needed to investigate the effect of donor reimbursement programs, which mitigate donor expenses, on postdonation mental health.

Can Split Renal Volume Assessment by Computed Tomography Replace Nuclear Split Renal Function in Living Kidney Donor Evaluations? A Systematic Review and Meta-Analysis.

BACKGROUND: As part of their living kidney donor assessment, all living donor candidates complete a computed tomography (CT) angiogram, but some also receive a nuclear renogram for split renal function (SRF%). OBJECTIVE: We considered whether split renal volume (SRV%) assessed by CT can predict SRF%. DESIGN: Systematic review and meta-analysis. SETTING: Living donor candidates undergoing evaluation as potential living kidney donors. PATIENTS: Living donor candidates who received both a nuclear renogram for split function and CT for SRV as part of their living donor work-up. MEASUREMENTS: Split renal volume from CT scans and SRF from nuclear renography. METHODS: We performed a systematic review and meta-analysis of the literature, abstracting data and digitizing plots where possible. We searched Medline, EMBASE, and the Cochrane Library. We added data from donor candidates assessed in London, Ontario from 2013 to 2016. We used fixed and random-effects models to pool Fisher's z-transformed Pearson's correlation coefficient (r). We conducted random-effects meta-regression on digitized and aggregate data. Studies were restricted to living kidney donors or living donor candidates. RESULTS: After pooling 19 studies (n = 1479), we obtained a pooled correlation of r = 0.74 (95% confidence interval [CI] = 0.61-0.82). By linear regression using individual-level data, we observed a 0.76% (95% CI = 0.71-0.81) increase in SRF% for every 1% increase in SRV%. Split renal volume had a specificity of 88% for discriminating SRF at a threshold that could influence the decision of which kidney is to be removed (between-kidney difference ≥10%). Predonation SRV and SRF both moderately predicted kidney function 6 to 12 months after donation: r = 0.75 for SRV and r = 0.73 for SRF; Δr = 0.05 (-0.02, 0.13). LIMITATIONS: Most studies were retrospective and measured SRV and SRF only on selected living donor candidates. Efficiency gains in removing the SRF from the evaluation will depend on the transplant program. CONCLUSION: Split renal volume has the potential to replace SRF for some candidates. However, it is uncertain whether it can do so reliably and routinely across different transplant centers. The impact on clinical decision-making needs to be assessed in well-designed prospective studies. TRIAL REGISTRATION: The digitized data are registered with Mendeley Data (doi10.17632/dyn2bfgxxj.2).

CONTEXTE: Dans le cadre de leur évaluation comme donneur, tous les candidats au don de rein vivant passent une angiographie par tomodensitométrie (CT), mais certains sont également soumis à un rénogramme nucléaire qui mesure la fonction rénale séparée (% de la FRS). OBJECTIF: Nous souhaitions vérifier si le volume rénal séparé (% du VRS) évalué par tomodensitométrie pouvait prédire le pourcentage de la FRS. TYPE D'ÉTUDE: Une revue systématique et une méta-analyse. CADRE: Évaluation des candidats au don d'un rein de leur vivant. SUJETS: Les candidats au don d'organes vivants qui, dans le cadre de leur évaluation, ont été soumis à un rénogramme nucléaire (mesure de la FRS) et à une tomodensitométrie (mesure du VRS). MESURES: Le volume rénal séparé mesuré par tomodensitométrie et la fonction rénale séparée mesurée par rénogramme nucléaire. MÉTHODOLOGIE: Nous avons effectué une revue systématique et une méta-analyse de la littérature sur Medline, EMBASE et Cochrane Library dont nous avons extrait les données et, dans la mesure du possible, numérisé les schémas. Les données des candidats donateurs évalués à London, en Ontario, entre 2013 et 2016 ont été ajoutées. Nous avons utilisé des modèles à effets fixes et aléatoires pour regrouper la transformation de Fisher du coefficient de corrélation de Pearson (r). Nous avons procédé à une méta-régression des données numérisées et agrégées. Les études ont été limitées aux donneurs vivants d'un rein ou aux candidats au don d'organes vivants. RÉSULTATS: Après la mise en commun de 19 études (n = 1 479 sujets), nous avons obtenu une corrélation combinée (r) de 0,74 (IC à 95 %: 0,61-0,82). Par régression linéaire, en utilisant les données individuelles, nous avons observé une augmentation de 0,76 % (IC à 95 %, 0,71-0,81) du pourcentage de la FRS pour chaque augmentation de 1 % du VRS. Ce dernier présentait une spécificité de 88 % pour la discrimination de la FRS à un seuil qui pourrait influencer la décision dans le choix du rein à retirer (différence entre les reins ≥ 10 %). Le VRS et la FRS pré-don se sont tous deux avérés modérément sensibles pour prédire la fonction rénale six à douze mois après le don: r = 0,75 pour le VRS et r = 0,73 pour la FRS; Δr = 0,05 [-0,02 à 0,13]. LIMITES: La plupart des études retenues étaient rétrospectives et ne mesuraient le VRS et la FRS que pour certains candidats. Les gains d'efficacité obtenus en supprimant la mesure de la FRS de l'évaluation dépendront du programme de transplantation. CONCLUSION: La mesure du VRS pourrait remplacer la mesure de la FRS chez certains candidats. On ignore toutefois s'il est possible de le faire de manière fiable et systématique dans différents centres de transplantation. L'impact de ce remplacement sur la prise de décision clinique doit être évalué dans le cadre d'études prospectives bien conçues.

Financial Costs Incurred by Living Kidney Donors: A Prospective Cohort Study.

BACKGROUND: Approximately 40% of the kidneys for transplant worldwide come from living donors. Despite advantages of living donor transplants, rates have stagnated in recent years. One possible barrier may be costs related to the transplant process that potential willing donors may incur for travel, parking, accommodation, and lost productivity. METHODS: To better understand and quantify the financial costs incurred by living kidney donors, we conducted a prospective cohort study, recruiting 912 living kidney donors from 12 transplant centers across Canada between 2009 and 2014; 821 of them completed all or a portion of the costing survey. We report microcosted total, out-of-pocket, and lost productivity costs (in 2016 Canadian dollars) for living kidney donors from donor evaluation start to 3 months after donation. We examined costs according to (1) the donor's relationship with their recipient, including spousal (donation to a partner), emotionally related nonspousal (friend, step-parent, in law), or genetically related; and (2) donation type (directed, paired kidney, or nondirected). RESULTS: Living kidney donors incurred a median (75th percentile) of $1254 ($2589) in out-of-pocket costs and $0 ($1908) in lost productivity costs. On average, total costs were $2226 higher in spousal compared with emotionally related nonspousal donors (P=0.02) and $1664 higher in directed donors compared with nondirected donors (P<0.001). Total costs (out-of-pocket and lost productivity) exceeded $5500 for 205 (25%) donors. CONCLUSIONS: Our results can be used to inform strategies to minimize the financial burden of living donation, which may help improve the donation experience and increase the number of living donor kidney transplants.

Duration of Living Kidney Transplant Donor Evaluations: Findings From 2 Multicenter Cohort Studies.

BACKGROUND: A prolonged living kidney donor evaluation may result in worse outcomes for transplant recipients. Better knowledge of the duration of this process may help inform future donors and identify opportunities for improvement. STUDY DESIGN: 1 prospective and 1 retrospective cohort study. SETTING & PARTICIPANTS: At 16 Canadian and Australian transplantation centers (prospective cohort) and 5 Ontario transplantation centers (retrospective cohort), we assessed the duration of living kidney donor evaluation and explored donor, recipient, and transplantation factors associated with longer evaluation times. Data were obtained from 2 sources: donor medical records using chart abstraction and health care administrative databases. PREDICTORS: Donor and recipient demographics, direct versus paired donation, center-level variables. OUTCOMES: Duration of living donor evaluation. RESULTS: The median total duration of transplantation evaluation (time from when the candidate started the evaluation until donation) was 10.3 (IQR, 6.5-16.7) months. The median duration from evaluation start until approval to donate was 7.9 (IQR, 4.6-14.1) months, and from approval until donation was 0.7 (IQR, 0.3-2.4) months, respectively. The median time between the first and last consultation among donors who completed a nephrology, surgery, and psychosocial assessment in the prospective cohort was 3.0 (IQR, 1.0-6.3) months, and between computed tomography angiography and donation was 4.8 (IQR, 2.6-9.2) months. After adjustment, the total duration of transplantation evaluation was longer if the donor participated in paired donation (6.6 [95% CI, 1.6-9.7] months) and if the recipient was referred later relative to the donor's evaluation start date (0.9 [95% CI, 0.8-1.0] months [per month of delayed referral]). Results depended on whether the recipient was receiving dialysis. LIMITATIONS: Living donor candidates who did not donate were not included and proxy measures were used for some dates in the donor evaluation process. CONCLUSIONS: The duration of kidney transplant donor evaluation is variable and can be lengthy. Better understanding of the reasons for a prolonged evaluation may inform quality improvement initiatives to reduce unnecessary delays.

Risk of Nephrectomy in Previous Living Kidney Donors.

BACKGROUND: For patients with a solitary kidney, such as living kidney donors, the surgical treatment of renal tumors may result in loss of function of the remaining kidney. METHODS: We conducted a retrospective, matched cohort study to determine the long-term risk of partial or total nephrectomy in previous living kidney donors compared to healthy nondonors. We reviewed the predonation charts for all living kidney donors in Ontario, Canada between 1992 and 2010 and linked this information to provincial healthcare databases. RESULTS: We matched 2119 donors to 21190 nondonors from the general population with similar baseline health. The median length of follow-up was 9.5 years (maximum 21.7 years). The rate of nephrectomy in follow-up was lower in donors versus nondonors (0 vs. 1.78 per 10000 person years; P = 0.037). In a subset of 1773 donors matched to 1773 healthy nondonors with renal imaging (median follow-up 7.6 years, maximum 21.0 years), the rate of nephrectomy was not statistically different in donors versus nondonors (0 vs. ≤5 per 10000 person years; P > 0.08). CONCLUSION: No living kidney donor in our cohort received a partial or total nephrectomy of their remaining kidney during our follow-up period. Although we will continue to follow people in this study, these interim results are reassuring for the safety of kidney donation.

Pico Lantern: a pick-up projector for augmented reality in laparoscopic surgery.

The Pico Lantern is proposed as a new tool for guidance in laparoscopic surgery. Its miniaturized design allows it to be picked up by a laparoscopic tool during surgery and tracked directly by the endoscope. By using laser projection, different patterns and annotations can be projected onto the tissue surface. The first explored application is surface reconstruction. The absolute error for surface reconstruction using stereo endoscopy and untracked Pico Lantern for a plane, cylinder and ex vivo kidney is 2.0 mm, 3.0 mm and 5.6 mm respectively. The absolute error using a mono endoscope and a tracked Pico Lantern for the same plane, cylinder and kidney is 0.8mm, 0.3mm and 1.5mm respectively. The results show the benefit of the wider baseline produced by tracking the Pico Lantern. Pulsatile motion of a human carotid artery is also detected in vivo. Future work will be done on the integration into standard and robot-assisted laparoscopic surgery.

Experimental validation of an intrasubject elastic registration algorithm for dynamic-3D ultrasound images.

PURPOSE: In image-guided therapy, real-time visualization of the anatomy and adjustments in the therapy plan due to anatomical motions during the procedure is of outmost importance. 3D ultrasound has the potential to enable this real-time monitoring; however, nonrigid registration of a sequence of 3D ultrasound volumes remains to be a challenging problem. The authors present our recent results on the development of a computationally inexpensive feature-based registration algorithm for elastic alignment of dynamic-3D ultrasound images. METHODS: Our algorithm uses attribute vectors, based on the image intensity and gradient information, to perform feature-based matching in a sequence of 3D ultrasound images. Prior information from both the fixed and previous moving images is utilized to track features throughout the 3D image series. The algorithm has been compared to various publicly available registration techniques, i.e., the B-splines deformable registration, the symmetric forces Demons, and the fast free-form deformable registration method. RESULTS: Using a series of validation experiments on datasets collected from carotid artery, liver, and kidney of 20 subjects, the authors demonstrate that the feature-based, B-splines, Demons, and fast free-form deformable registration techniques can all recover volume deformations in a 3D ultrasound image series with reasonable accuracy; however, the proposed feature-based registration technique has substantial computational advantage over the other approaches. CONCLUSIONS: The proposed feature-based registration technique has the potential for real-time implementation on a computationally inexpensive platform and has the capability of recovering nonrigid deformations in tissue with reasonable accuracy.

Scrotal lymphangiomatosis: a case report.

Lymphangiomas are benign tumours of the lymphatic system, and there are several reported cases of scrotal lymphangioma in the literature to date. We report a rare case of multilocular cutaneous lymphangiomatosis treated with surgical excision (total scrotectomy and reconstruction using split-thickness skin grafts with vacuum-assisted closure dressing).

Acute dialysis risk in living kidney donors.

BACKGROUND: Reduced kidney function confers a higher risk of acute kidney injury at the time of an inciting event, such as sepsis. Whether the same is true in those with reduced renal mass from living kidney donation is unknown. METHODS: We conducted a population-based matched cohort study of all living kidney donors in the province of Ontario, Canada who underwent donor nephrectomy from 1992 to 2009. We manually reviewed the medical records of these living kidney donors and linked this information to provincial health care databases. Non-donors were selected from the healthiest segment of the general population. RESULTS: There were 2027 donors and 20 270 matched non-donors. The median age was 43 years (interquartile range 34-50) and individuals were followed for a median of 6.6 years (maximum 17.7 years). The primary outcome was acute dialysis during any hospital stay. Reasons for hospitalization included infectious diseases, cardiovascular diseases and hematological malignancies. Only one donor received acute dialysis in follow-up (6.5 events per 100 000 person-years), a rate which was statistically no different than 14 non-donors (9.4 events per 100 000 person-years). CONCLUSIONS: These results are reassuring for the practice of living kidney donation. Longer follow-up of this and other donor cohorts will provide more precise estimates about this risk.

Registration of CT to 3D ultrasound using near-field fiducial localization: A feasibility study.

OBJECTIVE: Registration of ultrasound to computed tomography (CT) images is used in several image-guided procedures, including laparoscopic surgery and radiation therapy. Conventional approaches use an external tracker calibrated to the ultrasound transducer and CT system, but several calibration steps are required. Registration can also be performed by aligning image features between modalities, but differences in feature depiction make matching difficult and initial approximate alignment is often needed. Registration using fiducials is a simpler approach but is limited by the need to implant fiducials in the anatomical region of interest so they are visible to both ultrasound and CT. This paper investigates the feasibility of using fiducials near the skin surface, and whether such fiducials can be sufficiently localized in the very near field of a 3D ultrasound transducer without significantly degrading image quality. This approach can also be used as an initialization step for feature-based registration techniques. MATERIALS AND METHODS: A stand-off pad containing fiducials (n > 3) was constructed using polyvinyl chloride and steel ball fiducials that are visible in both 3D ultrasound and CT images. Experiments on phantoms were performed to assess image quality and registration errors. Controlled variables included pad thickness and ultrasound imaging parameters. Initial tests were also conducted of a potential application in partial nephrectomy surgery. RESULTS: Image quality was degraded by an average of 6-11-13% (elevational-axial-lateral) in resolution of point targets and 5% in lesion contrast. Average fiducial localization error was 1.34 mm (axial) to 2.38 mm (lateral and elevational); average fiducial registration error (FRE) was 0.46 mm (axial), 1.08 mm (lateral) and 0.90 mm (elevational); and average total registration error (TRE) was 1.84 mm (axial), 0.89 mm (lateral) and 3.31 mm (elevational). Clinical results showed a similar FRE to that in the phantom study, but with an average TRE of 14.04 mm (over three patients). Ultimate alignment of the organ boundaries was affected mainly by motion from respiration. CONCLUSIONS: The small loss of image quality from the fiducial stand-off pad and the minimal inconvenience of using the pad at the time of the CT scan may be a worthwhile trade-off for purposes of registration since the pad provides a registration accuracy of several millimeters while still allowing subsequent feature-based registration. Future research will focus on using the registration from the fiducial stand-off pad for deformable feature-based registration of 3D ultrasound to CT for tumor localization in renal surgery.

Focal segmental glomerular sclerosis in renal transplant recipients: predicting early disease recurrence may prolong allograft function.

Recurrence of focal segmental glomerular sclerosis (FSGS) in the allograft following renal transplantation can be graft threatening. To assess risk factors associated with FSGS recurrence, we analyzed 22 patients with FSGS who underwent transplantation between 1996 and 2004. Five patients (Group I, 23%) developed FSGS post-transplantation. Of these patients, 60% had undergone bilateral nephrectomy (BN) for progressive disease compared with none of the patients that were free of recurrence (Group II) (p = 0.0006). Other factors linked with recurrent FSGS were time to first dialysis (Group I: 3.1 +/- 1.1 yr vs. Group II: 11.9 +/- 1.9 yr; p = 0.03), pre-transplant proteinuria (Group I: 7.0 +/- 1.8 g/d vs. Group II: 2.5 +/- 0.7 g/d; p = 0.02), young age at transplantation (p = 0.09) and female sex (Group I: 80% vs. Group II: 24%; p = 0.021). Eighty percent of Group I patients received a living related transplant vs. 24% in Group II (p = 0.021). All grafts continue to function at last follow-up with comparable serum creatinines. Overall, post-transplant FSGS recurrence may be associated with BN, severity of pre-transplant FSGS, female gender, and living donation. These patients should be monitored closely for early recurrence and may benefit from early plasmapheresis to restore and facilitate long-term graft function.

Perfusion of renal allografts with verapamil improves graft function.

The effect of adding a calcium channel antagonist to kidney allograft perfusate solution was assessed. All renal transplants in which both kidneys from the same donor used for transplantation were studied between November, 2003 and August, 2005 (n=46). The first renal allograft was perfused on the backtable with 1 L of histidine-tryptophan-ketoglurate solution and the second with 1 L of histidine-tryptophan-ketoglurate with 5 mg/L of verapamil. Both organs were transplanted in the usual manner. Baseline demographic parameters were similar between first and second kidney recipients other than BMI and cold ischemic time. At 6 and 12 months, renal function was significantly improved in the verapamil versus control cohort (creatinine clearance 73.8+/-23.5 mL/min vs. 55.8+/-17.0 mL/min, P<0.05 and 87.5+/-28.4 mL/min vs. 59.7+/-21.3 mL/min, P<0.05 respectively). Additionally, rates of hypotension during graft reperfusion and other adverse reactions were similar in both groups. In conclusion, verapamil supplemented perfusate significantly improved renal function posttransplantation.

Implementation of a PDA based program to quantify urology resident in-training experience.

INTRODUCTION: There currently is no simple and reliable mechanism for Residency program directors to assess how well their trainees are being exposed to all spheres of their specialty. We report on the use of hand-held personal digital assistants (PDA's) to document all clinical and academic activities of urology residents at one academic institution. MATERIALS AND METHODS: Software was developed to create customized pick lists allowing residents to record all activities on their individual PDA's. Categories included Adult Ambulatory, Pediatric Ambulatory, Adult operative, Pediatric operative, and Academic. Activities were subcategorized into detailed pick lists and time-tracking fields. Residents synchronized with a central database on a standalone hotsync server. RESULTS: In the first 8 months, 21 178 resident-hours and 5333 activities were recorded. Preliminary observations can be made regarding how residents spend the majority of their time: 28% operative, 20% self-study, 19% ward work, 10% Academics, 6% ER consultations, 5% clinic, and 4% inpatient consultations. The most common adult diagnoses encountered while attending to clinic, ward, or ER consultations were lower urinary tract symptoms, urolithiasis and hematuria. Similarly for Pediatrics: neurogenic bladder, antenatal hydronephrosis, infection, and hypospadias were most often reported. Residents reported 5,333 activities, relating to the following spheres of Urology: academics (23%), endourology (18%), oncology (15%), lower urinary tract symptoms (10%), congenital anomalies (5%), urolithiasis (5%), reconstruction (5%), and infection (3%). CONCLUSIONS: This tool provides an objective assessment of resident experience as it relates to selection of rotations, and for addressing curriculum weaknesses. It is applicable at a national level for the study of regional differences in training experience, and trends in graduate Urological education. With minimal effort it could be modified for application to other specialty training programs.