Barriers for pregnancy and perceptions of gender discrimination of urologists in training in France: Results of a national survey.

INTRODUCTION: Gender discrimination seems more prevalent in surgery than other medical specialties. In addition, female urologists are more likely to have obstetric complications and to be discouraged from starting a family during training. The objective of this study was to determine the prevalence of perceived gender discrimination and barriers for pregnancy during fellowship, among French urology residents and fellows. MATERIAL AND METHODS: The French Association of Urologists in Training performed a national online survey between August and September 2022. Participants were assured that their participation was anonymous. Respondents were questioned on demographics, gender discrimination and on pregnancy barriers during fellowship. RESULTS: In total, 153 members answered the questionnaire out of the 427 members of the association (36%), among which 75 women (49%). Thirty nine percent of the female respondents found that their gender was a barrier in their career advancement, versus 1% of the male (P<0.0001). Forty female respondents (53%) perceived that female urologists earned less respect than their male counterparts versus 22% of the male (P<0.0001). Among the female respondents, 19 (25%) have felt that it would not be possible to become pregnant at the time they would have wanted it and 7 (9%) reported having already been threatened to lose a fellowship position in case of a pregnancy. CONCLUSION: This survey found a high prevalence of gender discrimination among French urologists in training, perceived in majority by women. Female urologists perceived obstacles and received threats when wanting to become pregnant during their training.

Should You Fix Testicular Prosthesis? A Satisfaction Survey From a Monocentric Cohort.

OBJECTIVE: To evaluate whether testicular prosthesis should be fixed. METHODS: Retrospective monocentric study including 169 patients who had implantation of testicular prosthesis between January 2013 and December 2022. Patients answered a telephone questionnaire regarding prosthesis characteristics and satisfaction. RESULTS: Prosthesis was sutured for 59 patients (34.9%) out of 169. 146 patients answered the questionnaire. Satisfaction was excellent regarding size, weight, consistency, and shape. A position too high was a major complain in both groups. Pain and discomfort were significantly higher in the fixed group (30.8% vs 9.78%, P < .001). Few patients reported discomfort with the anchor prosthesis (22.9%). CONCLUSION: Overall satisfaction of the prosthesis is high but discomfort and high positioning are the two items remaining to improve. Our study suggests that fixing prosthesis is a cause of discomfort and won't allow a better positioning.

Cut-off time for surgery and prediction of orchiectomy in spermatic cord torsion: a retrospective multicentric study over 15 years.

PURPOSE: Cut-off time to avoid orchiectomy relies on small series of patients. The objective was to determine the cut-off time to avoid orchiectomy in torsion of the spermatic cord in a large cohort. METHODS: We performed a retrospective multicenter study (TORSAFUF cohort) of patients with suspected spermatic cord torsion between 2005 and 2019. All patients aged > 12 years who were suspected of having a torsion of the spermatic cord in 14 University Hospitals in France were included (n = 2986). Patients for whom data on pain duration were not available (n = 923) or for whom the final diagnosis was not torsion of the spermatic cord (n = 807) were excluded. The primary outcome was orchiectomy. The secondary outcomes were testicular survival time and the prediction of orchiectomy with the duration of pain. RESULTS: 1266 patients were included with an orchiectomy rate of 12% (150 patients). The mean age was 21.5 years old in the salvage group and 23.7 years old in the orchiectomy group (p = 0.01), respectively. The median time from the onset of pain to surgery was 5.5 (IQR = 5) hours in the salvage group and 51.1 (IQR = 70) hours in the orchiectomy group (p < 0.0001). The risk of orchiectomy increased after a time cut-off of 6 h 30. A delay of 15 h 30 in pain duration was found to predict orchiectomy (sensitivity: 0.81; specificity: 0.87). CONCLUSIONS: Pain duration can predict the probability of salvaging the testicles and performing orchiectomy. Rapid intervention should be recommended, regardless of the time elapsed from the onset of pain.

Torsion of the spermatic cord in adults: a multicenter experience in adults with surgical exploration for acute scrotal pain with suspected testicular torsion.

Acute scrotal pain (ASP) requiring surgical exploration is common in the pediatric population, but little has been reported on this subject with regard to the adult population. The aim of this study was to investigate the demographic and clinical characteristics and outcomes of scrotal explorations performed on adult patients. Patients over 21 years of age who underwent surgical exploration for ASP with suspected testicular torsion (TT) at 14 French hospitals between January 2005 and December 2019 were included in this study. The main outcome measures were demographic characteristics, pathology found during scrotal exploration, and perioperative outcomes. Logistic regression was used to perform univariate and multivariate analyses to identify predictors of TT. Data for 1329 men were analyzed. The median age was 30 (interquartile range [IQR]: 25-35; range: 21-89) years. Regarding the clinical examination, 867 (65.2%) patients presented with an elevation of the testicle, 613 (46.1%) patients with scrotal edema or erythema, and 211 (15.9%) patients with nausea or vomiting. Operative findings identified TT in only 684 (51.5%) patients, epididymo-orchitis in 112 (8.4%) patients, a tumor in 16 (1.2%) patients, and no causes in 475 (35.7%) patients. Orchiectomy for nonviable testes was required in 101 (7.6%) patients. In multivariate analysis, an elevation of the testicle, erythema/swelling, and the presence of nausea/vomiting were found to be associated with the occurrence of TT. Testicular torsion is not exclusive to children and adolescents, so must be considered in males of any age with acute scrotal findings. However, one-third of scrotal explorations in adults did not lead to a diagnosis.

Contralateral Orchiopexy at the Time of Urgent Scrotal Exploration-Is It Safe? A Propensity Score Matched Analysis from the TORSAFUF Cohort.

PURPOSE: We evaluate the safety of immediate contralateral orchiopexy (ICLO) at the time of scrotal exploration for testicular torsion suspicion. MATERIALS AND METHODS: Patient data were retrieved from the TORSAFUF cohort project, which is a multicenter national study conducted at 14 academic French hospitals between 2005 and 2019. Each patient who underwent surgical exploration for testicular torsion suspicion was included. The primary study outcome was the safety of ICLO compared to ipsilateral scrotal exploration alone. The primary outcome of interest was the complication rate within 90 days of surgery. The end point was planned before data collection. RESULTS: Overall, 2,775 patients were included, of whom 1,554 (56%) underwent ICLO. After propensity score matching and multivariable analysis, ICLO was associated with a higher complication rate (OR 1.51, 95% CI 1.1-2.1, p=0.01), especially a higher rate of hematoma (OR 2.9, 95% CI 1.3-6.6, p=0.01), and delayed wound healing (OR 3.0, 95% CI 1.8-5.2, p <0.001). CONCLUSIONS: At the time of scrotal exploration for acute scrotum, ICLO was associated with an increased postoperative complication rate, with a particular increase in hematoma, and delayed wound healing. ICLO should not be performed systematically.