Urethral pyogenic granuloma in a pediatric patient.

Pyogenic granuloma, also known as lobular capillary hemangioma, is a benign vascular tumor rarely found in the genitourinary tract. Here, we present a case of a 6-year-old boy presenting with gross hematuria who was found to have a mass at the bladder base on ultrasound. Endoscopic resection was performed, revealing the base of the mass originating from the prostatic urethra. Pathology found pyogenic granuloma. This entity has not previously been reported to arise from the pediatric urethra and should be considered on the differential for children presenting with gross hematuria and those found to have bladder or urethral masses.

Twitter and Instagram Use in the Urology Residency Application Process.

OBJECTIVE: To define urology applicant attitudes and usage trends of social media (SM) during the 2021 urology match cycle. METHODS: We emailed an anonymous, de-identified 22-question, multiple choice survey to all applicants to our institution for the 2021 Urology Residency Match. We asked participants about use of SM and which aspects they found useful in the application process. Univariate descriptive analyses were conducted based on survey responses. Chi-square analyses were performed to define significant differences in use of social media and resultant match outcomes. RESULTS: Of the 528 students who registered for the 2021 AUA Match, 398 received our survey (75%), and 144 responded (27% of applicants nationwide). Of survey participants, 49% made a new account on Twitter while 30% had a preexisting account. Most participants (71%) had a preexisting Instagram account, while only 3% made a new account. Most participants agreed Twitter was used as a source to gather information about programs (84%) and learn about events (89%). Participants found SM most helpful for announcing event dates (71%) and highlighting resident social life (59%). Applicants did not match more highly on their rank lists if they used Twitter (P = .427) or Instagram (P = .166) and were not more likely to get more interviews if they used Twitter (P = .246) or Instagram (P = .114) CONCLUSION: Applicants found Twitter to be an important source of information through the virtual interview process. Despite the use of SM by most applicants, published content did not impact rank list decisions nor did SM engagement predict match outcomes.

Long-term lower urinary tract sequelae following AUS cuff erosion.

AIMS: To examine the rate of lower urinary tract complications (LUTC) and urinary diversion (UD) after artificial urinary sphincter (AUS) explantation with the acute reconstruction of AUS cuff erosion defects. METHODS: We performed a retrospective study of patients who underwent in-situ urethroplasty (ISU) for AUS cuff erosion from June 2007 to December 2020. Outcomes included LUTC (urethral stricture, diverticulum, fistula), AUS reimplantation, and UD. Defect size was prospectively estimated acutely and a subanalysis was performed to determine the impact of erosion severity (small erosions [<33% circumferential defect] and large erosions [≥33%]) on these outcomes. Kaplan-Meier curves were created to compare survival between the two groups. RESULTS: A total of 40 patients underwent ISU for urethral cuff erosion. The median patient age was 76 years old with a median erosion circumference of 46%. The overall LUTC rate was 30% (12/40) with 35% (14/40) of patients requiring permanent UD. Secondary AUS placement occurred in 24/40 (60%) patients with 11/24 (46%) leading to repeat erosion. On subanalysis, small erosion was associated with improved LUTC-free and UD-free survival but not associated with AUS reimplantation. CONCLUSIONS: Lower urinary tract complications are common after AUS cuff erosion and can lead to the need for permanent UD. Patients with larger erosions are more likely to undergo UD and reach this end-stage condition earlier compared to patients with small erosions.

The Virtual Urology Residency Match Process: Moving Beyond the Pandemic.

OBJECTIVES: To define applicant response to the 2021 Urology Residency Match Process in the COVID-19 Pandemic and to extrapolate lessons to optimize the urology resident selection process after the pandemic. METHODS: We emailed an anonymous, de-identified 22-question, multiple choice survey to all applicants to our institution for the 2021 Urology Residency Match, including a summary of the study with a survey link (RedCap). RESULTS: Of the 398 survey recipients, 144 responded (36%). Even if the match process were not limited by COVID-19, 39% of applicants thought interviews should remain in virtual format, 23% said "no," and 30% said "not sure." Nearly all applicants (97%) thought all interview offers should be released on the same day. Regarding the early match, 84% thought this should remain. When asked what factors had the most impact on rank lists, faculty and resident interviews were overwhelmingly favored. Open houses and resident "happy hours" were less important. Most applicants agreed that the faculty and resident interviews and informational talks were adequately replicated on the virtual platform. A majority of applicants (65%) spent under $2000 for the application cycle. CONCLUSION: The COVID-19 pandemic dramatically changed the urology match process. The faculty and resident interviews remained the most important factors in program ranking, and most applicants agreed those were adequately replicated in the virtual format. A plurality of applicants felt that the interview process should remain virtual in a post-COVID-19 environment. The virtual application cycle reduced the cost of applying to residency.

Bouveret syndrome: current management strategies.

Bouveret syndrome is a rare complication of cholelithiasis that usually presents with signs and symptoms of gastric outlet obstruction. Given the relative rarity of this condition, there are no standardized guidelines for the management of this condition. In this paper, we review the diagnosis and management options (endoscopic, laparoscopic, and open approaches) of patients with Bouveret syndrome, including a report of one case to illustrate some of the endoscopic and surgical principles of management.

Imaging gently? Higher rates of computed tomography imaging for pediatric appendicitis in non-children's hospitals.

BACKGROUND: Growing concerns regarding radiation exposure in children have led to recommendations to minimize computed tomography imaging for appendicitis. We hypothesized that within a metropolitan hospital system (1 children's hospital and 8 non-children's hospitals), use of preoperative computed tomography is much greater in non-children's hospitals. METHODS: We conducted a retrospective study of patients <18 years of age undergoing appendectomy for acute appendicitis from April 2012 to April 2015. Patient demographics, location, and imaging modality (computed tomography and ultrasonography) were evaluated. RESULTS: A total of 1,448 pediatric patients were identified (children's hospital = 215, 15%; non-children's hospitals = 1,233, 85%). Children's hospital patients had fewer computed tomography scans (23% vs 70%, P < .01) and more ultrasonography (75% vs 20%, P < .01). On multivariate regression, increased preoperative computed tomography use was significantly associated with non-children's hospitals (odds ratio 7.6, 95% confidence interval 5.4-10.8). At non-children's hospitals, older age (age >10: odds ratio 2.4, 95% confidence interval 1.8-3.1) and higher patient weight (>45 kg odds ratio 2.0, 95% confidence interval 1.4-2.8) predicted computed tomography use. Children presenting at a children's hospital were much more likely to undergo ultrasonography (odds ratio 11.7, 95% confidence interval 8.3-16.6). CONCLUSION: There are significant differences in imaging modalities for pediatric appendicitis between a children's hospital and non-children's hospitals. Further investigation is needed to identify other factors contributing to imaging preference in the pediatric population in order to establish clinical practice guidelines to decrease or prevent unnecessary radiation exposure in children.

Meaningful use and good catches: More appropriate metrics for checklist effectiveness.

BACKGROUND: The benefit of utilizing surgical safety checklists has been recently questioned. We evaluated our checklist performance after implementing a program that includes checklist-related good catches. METHODS: Multifaceted interventions aimed at the preincision checklist and 5 prospective audits were conducted from 2011-2015. We documented adherence to the checklist (verbalization of each checkpoint), fidelity (meaningful performance of each checkpoint), and good catches (events with the potential to cause the patient harm but that were prevented from occurring). Good catches were divided into quality improvement-based categories (processes, medication, safety, communication, and equipment). RESULTS: A total of 1,346 checklist performances were observed (range, 144-373/yr). Adherence to the preincision checklist improved from 30% to 95% (P < .001), while adherence to the preinduction and debriefing checklists decreased (71% to 56%, P = .002) and remained unchanged (76%), respectively. Preincision fidelity decreased from 86% to 76% (P = .012). Good catches were identified during 16% of preincision checklist performances; process issues were most common (32%) followed by issues of medication administration (30%) and safety (22%). CONCLUSION: Implementation of a systematic checklist program resulted in significant and sustainable improvement in performance. Meaningful use and associated good catches may be more appropriate metric than actual patient harm for measuring checklist effectiveness. Although not previously described, checklist-related good catches represent an unknown benefit of checklists.