A new wave of urologists? Graduating urology residents' practices of and attitudes toward social media.

INTRODUCTION: Social media (SoMe) have revolutionized healthcare, but physicians remain hesitant to adopt SoMe in their practices. We sought to assess graduating urology residents' practices of and attitudes toward SoMe. METHODS: A close-ended questionnaire, employing five-point Likert scales, was distributed to all final-year residents (n=100) in Canadian urology training programs in 2012, 2014, and 2016 to assess SoMe usage and perceived usefulness. RESULTS: All (100%) questionnaires were completed. Respondents frequently used online services for personal (100%) and professional (96%) purposes. Most (92%) used SoMe. Many (73%) frequently used SoMe for personal purposes, but few (12%) frequently used SoMe for professional purposes. While a majority (59%) opposed direct patient interaction online, most supported using SoMe to provide patients with static information (76%) and collaborate with colleagues (65%). Many (70-73%) were optimistic that novel solutions to privacy issues in online communications will arise, making SoMe and email contact with patients conceivable. Few (2-8%) were aware and had read guidelines and legislations regarding physician online practices; however, awareness of medical associations' and institutional SoMe policies significantly increased over time (p<0.05). CONCLUSIONS: Despite their active online use, graduating urology residents rarely used SoMe in professional settings and were wary of using it in patient care. Nevertheless, they were optimistic toward its integration in urology and supported its use in physician-physician communication. Considering SoMe's increased influence on urology and graduating residents' limited awareness of guidelines and legislations, postgraduate medical educators should encourage residents to become more familiar with current online communication recommendations.

Penile amputation and successful reattachment and the role of winter shunt in postoperative viability: A case report and literature review.

Traumatic self-amputation of the penis by a psychotic patient is rare. Microvascular replantation is the favored management approach. There are no known cases of self-amputation followed by ingestion of the stump and subsequent replantation. A 51-year-old patient with paranoid schizophrenia presented 2 hours following penile amputation. He had swallowed the excised portion, which was endoscopically retrieved from the stomach in the emergency department. Successful reattachment was achieved including microvascular repair of the dorsal penile arteries without cavernosal arterial anastamoses. A Winter's shunt was performed to improve venous circulation. The patient has been followed for 3 years from the date of repair. He has adequate erection for intercourse and good urinary function, but has experienced sensory loss over the dorsal aspect and glans and urethral stricture dilation. This is the first report of replantation following ingestion of an amputated penis.

Early adopters or laggards? Attitudes toward and use of social media among urologists.

OBJECTIVE: To understand the attitudes and practices of urologists regarding social media use. Social media services have become ubiquitous, but their role in the context of medical practice is underappreciated. SUBJECTS AND METHODS: A survey was sent to all active members of the Canadian Urological Association by e-mail and surface mail. Likert scales were used to assess engagement in social media, as well as attitudes toward physician responsibilities, privacy concerns and patient interaction online. RESULTS: Of 504 surveys delivered, 229 were completed (45.4%). Urologists reported frequent or daily personal and professional social media use in 26% and 8% of cases, respectively. There were no differences between paper (n = 103) or online (n = 126; P > 0.05) submissions. Among frequent social media users, YouTube (86%), Facebook (76%), and Twitter (41%) were most commonly used; 12% post content or links frequently to these sites. The most common perceived roles of social media in health care were for inter-professional communication (67%) or as a simple information repository (59%); online patient interaction was endorsed by 14% of urologists. Fewer than 19% had read published guidelines for online patient interaction, and ≤64% were unaware of their existence. In all, 94.6% agreed that physicians need to exercise caution personal social media posting, although 57% felt that medical regulatory bodies should 'stay out of [their] personal social media activities', especially those in practice <10 years (P = 0.001). In all, 56% agreed that social media integration in medical practice will be 'impossible' due to privacy and boundary issues; 73% felt that online interaction with patients would become unavoidable in the future, especially those in practice >20 years (P = 0.02). CONCLUSION: Practicing urologists engage infrequently in social media activities, and are almost universal in avoiding social media for professional use. Most feel that social media is best kept to exchanges between colleagues. Emerging data suggest an increasing involvement is likely in the continuing professional development space.

Multiple sensitivity phenotype in interstitial cystitis/bladder pain syndrome.

INTRODUCTION: Phenotypic differentiation of patients with interstitial cystitis/bladder pain syndrome (IC/BPS) may improve our understanding of the condition, as well as the development of patient-specific treatment strategies. We identified a distinct subgroup of IC/BPS patients with a multiple sensitivity phenotype. METHODS: We defined patients with this IC/BPS associated multiple sensitivity syndrome as having at least 3 confirmed allergies/sensitivities to medications and/or environmental factors and a diagnosis of IC/BPS. These IC/BPS patients identified with a multiple sensitivity phenotype (cases) were compared to age-matched IC/BPS patients with few or no allergies (controls) at a 1:2 ratio. Comparisons were undertaken using standardized case assessment parameters (age, duration of symptoms, medical history, Interstitial Cystitis Symptoms Index [ICSI] and pelvic pain and urinary urgency/frequency [PUF] symptom scores, and urinary, psychosocial, organ specific, infection, neurologic/systemic, tenderness [UPOINT] categorization). RESULTS: The study consisted of 17 cases and 34 age-matched controls; the mean age was 55 and 56 years, respectively. There was statistically more medication and environmental allergies in the cases versus controls. Cases reported more concomitant illnesses (9.6 vs. 6.2, p < 0.001) and number of bodily systems affected (6.0 vs. 3.8, p ≤ 0.001). The prevalence of irritable bowel syndrome and fibromyalgia was higher in the case group (p = 0.028, p ≤ 0.001, respectively). Additionally, there were more reported psychiatric diseases (p = 0.019), allergic/immune diseases (p = 0.003), and pulmonary diseases (p < 0.001) in the case group. UPOINT classification differed with more patients in the case group being categorized in the psychosocial and neuropathic/systemic domains (p = 0.045, p = 0.007, respectively). Total UPOINT classification (out of 6) was also higher in cases than controls (4.6 vs. 3.2, p = 0.001, respectively). CONCLUSIONS: We have characterized a distinct phenotypic group of patients with IC/BPS and multiple sensitivities. The limitations of our study include the retrospective case-control matching design, biases in phenotype definition, single centre patient recruitment, and the lack of follow-up. Nonetheless, the observation of this specific phenotype suggests that further research in this group may help develop targeted therapeutic strategies for patients with a concomitant multiple sensitivity syndrome and IC/BPS.

Tracked ultrasonography snapshots enhance needle guidance for percutaneous renal access: a pilot study.

BACKGROUND AND PURPOSE: Although ultrasonography-guided percutaneous nephrostomy is relatively safe, a number of factors make it challenging for inexperienced operators. A computerized needle navigation technique using tracked ultrasonography snapshots was investigated to determine whether performance of percutaneous nephrostomy by inexperienced users could be improved. METHODS: Ten operators performed the procedure on a phantom model with alternating needle guidance between conventional ultrasonography and tracked ultrasonography snapshots. The needle was reinserted until fluid backflow confirmed calyceal access. Needle trajectories were recorded using the real time needle navigation system for offline evaluation of operator performance. Recorded needle trajectories were used to measure needle motion path length inside the phantom tissue, number of reinsertions, total procedure time, and needle insertion time as end points of this study. RESULTS: Needle path length measured inside the phantom tissue was significantly lower with ultrasonography snapshots guidance (295.0±23.1 mm, average±standard error of the mean) compared with control procedures (977.9±144.4 mm, P<0.01). This was associated with a significantly lower number of needle insertion attempts with ultrasonography snapshots (average 1.27±0.10 vs 2.83±0.31, P<0.01). The total procedure time and the needle insertion time were also significantly lower with ultrasonography snapshots guidance. CONCLUSION: Tracked ultrasonography snapshots appear to improve the performance of percutaneous nephrostomy in these preliminary investigations, justifying further validation studies. The presented navigation system is reproducible because of commercially available hardware and open-source software components, facilitating its potential role in clinical practice.