Training Genitourinary Reconstructive Surgeons: A Survey of Graduated Fellows and Fellowship Directors.

OBJECTIVE: To review the Society of Genitourinary Reconstructive Surgeons fellowship and matching process. There are currently 20 fellowships offered. A centralized match began in 2013-2014. Fellowship directors and graduated fellows were surveyed regarding their experience in their matching process, fellowship, employment opportunities, and their current practice. METHODS: A web-based survey was distributed to fellowship graduates and directors. A total of 20 and 14 open ended and multiple-choice questions were asked, respectively. Multiple choice questions were rated using a Likert scale. RESULTS: A total of 24/41 (59%) graduated fellows and 14/17 (82%) fellowship directors completed the survey. Overall satisfaction for the application and match process was 4/5 for both groups. Fellow respondents reported a 96%, 92%, 92%, and 88% feeling of competency in urethral reconstruction, male incontinence, urinary diversion/ureteral reconstruction, and male sexual health, respectively. A total of 92% of graduates practice in a location that they consider in their top 3 destinations. The majority, 58%, practice in academia. CONCLUSION: The Society of Genitourinary Reconstructive Surgeons has offered a recognized fellowship since 2014. Recent graduates express positive support of their fellowship training with excellent competency and employment opportunities. Fellowship directors continue to discuss broadening training to further advance this dynamic field.

Infection following penile prosthesis placement at an academic training center remains low despite involvement of surgeons-in-training.

Purpose: Primary care providers harbor misconceptions regarding penile prosthetic surgery, largely overestimating the rate of infection. Rates of infection following surgery for primary placement and revision are estimated as 1% to 3% and 10% to 18%, respectively. Our objective was to determine the contemporary incidence of infection following inflatable penile prostheses surgery at an academic training center where surgeons-in-training are routinely involved. Materials and Methods: Review of a prospectively collected single-surgeon database was performed. All cases of inflatable penile prostheses placement from January 2011 through June 2017 were reviewed. Information regarding training level of assistant surgeon(s) was collected, and follow-up data was compiled regarding postoperative infections and need for revision surgery. Results: Three hundred nine cases meeting inclusion criteria were identified. Mean patient age was 64.2 years, and mean follow-up was 28.7 months. Distribution involved 257 (83.2%) for primary placement, 45 (14.6%) for removal/replacement, and 7 (2.3%) in setting of prior device removal. Diabetes was noted in 31.1% of men. Surgeon-in-training involvement was noted in 100% of cases. Infection was confirmed in a patient who had skin breakdown over an area of corporal reconstruction with polytetrafluoroethylene. The overall postoperative infection rate was 0.3%. Conclusions: In this series from an academic training center, infection following penile prosthetic surgery is low, similar to other centers of excellence, even with 100% involvement of surgeons-in-training. This data should be used to better inform primary care providers and members of the general public potentially interested in restoration of sexual function.

Entry into the peritoneal cavity in posthysterectomy prolapse: an educational video.

INTRODUCTION AND HYPOTHESIS: Entry into the peritoneal cavity can be challenging in patients with posthysterectomy prolapse; however, it is important for vaginal surgeons to be able to enter the peritoneal cavity using various techniques to perform an intraperitoneal vaginal vault suspension. METHODS: We present surgical footage of various methods of accessing the peritoneal cavity in posthysterectomy prolapse using posterior, anterior and apical approaches. RESULTS: This video highlights surgical techniques that can be used to enter the peritoneal cavity in posthysterectomy prolapse in a safe and reliable manner. CONCLUSIONS: Vaginal surgeons should be able to safely and confidently identify and enter the peritoneal cavity using various approaches to perform an intraperitoneal vaginal vault suspension.

Identifying Gaps and Inconsistencies in Urogynecologic Surgical Training of Obstetrics and Gynecology Residents.

OBJECTIVE: This study aims to determine the expectations of Obstetrics and Gynecology (ObGyn) residency and Female Pelvic Medicine & Reconstructive Surgery (FPMRS) fellowship program directors (FPDs) for the independent performance of urogynecologic procedures during residency and to compare these expectations with the Council on Resident Education in Obstetrics and Gynecology (CREOG) educational objectives. MATERIALS AND METHODS: Two parallel, anonymous surveys were distributed simultaneously to all directors of accredited ObGyn residency and FPMRS fellowship programs in the United States. Respondents provided their own professional and program demographic information and indicated whether they expected their residents to independently perform 27 selected urogynecologic procedures. RESULTS: Among residency program directors (RPDs) and FPDs, the online survey response rate was 24.8% (n = 59) and 51.9% (n = 27), respectively. More RPDs expected residents to perform prolapse procedures with mesh, including laparoscopic sacrocolpopexy, all apical suspensions, mesh excisions, and cystotomy repairs, than FPDs. In addition, RPDs expected mastery of most urogynecologic procedures by the Post Graduate Year 3 level, whereas most FPDs did not expect independent performance of these procedures during residency at all. There were notable differences between RPDs' expectations and CREOG objectives regarding several surgical procedures. Whereas CREOG recommends independent performance of anterior and posterior repair, vaginal suspension, vaginal hysterectomy, and transobturator slings, a significant number of RPDs did not report expecting mastery of these procedures during residency. Approximately 30% of RPDs expected residents to perform open sacrocolpopexy and vesicovaginal fistula repair, whereas CREOG recommends only the understanding of these, without procedural mastery. CONCLUSIONS: Although community needs vary by region and setting, CREOG objectives serve as the standard for resident surgical education. This study highlights the discordance between these objectives and ObGyn RDPs' reported expectations for resident performance as well as those held by FPMRS FPDs, the outcome of which reflects a misalignment in graduate medical education between RPDs and FPDs, thus hindering a clear standard for resident surgical competencies.

Is there a learning curve for the TVT-O procedure? A prospective single-surgeon study of 372 consecutive cases.

OBJECTIVES: To evaluate for the first time in the literature the learning curve of Inside-out transobturator tape (TVT-O™). STUDY DESIGN: A prospective observational study was conducted in a tertiary reference center. Consecutive women treated by TVT-O™ performed by one surgeon were included. Data regarding subjective, objective cure rates, and adverse events were collected. Trends, over the number of procedures, were estimated using assay analyses. Number of procedures and variables were interpolating in standard curves using linear lines. RESULTS: Three hundred and seventy two procedures were included. Postoperative pain levels decreased with the increase in the level of expertise (pain levels: 1-day: from 6.6 (±3.3) to 4.3 (±3.1); 95%CI: -0.01603 to 0.001235, p=0.04; 2-day: from 5.6 (±4.1) to 3.6 (±3.7); 95%CI: -0.02092 to -0.002497, p=0.01; 12-month: from 0.1 (±0.7) to 0 (±0); 95%CI: -0.001814 to 0.05019, p=0.07). Overall, objective cure rate was achieved in 93.5% of patients. Additionally, 88.2% and 88.7% patients reported "much better" feeling at PGI-I scale and 80% reduction in UDI score, respectively. We observed, that delta ICIQ-sf (from 12 (±8.7) to 14 (±6.0); p=0.04) and delta-UDI (from 91% to 97%; p=0.04) improved over the time. CONCLUSIONS: TVT-O procedure offers excellent outcomes with high objective and subjective cure rates and low complications rate, even at the beginning of the surgeon's learning curve. However, a high experience of the surgeon could significantly improve the subjective cure rate and could reduce postoperative the groin pain.

Laser surgery simulation platform: toward full-procedure training and rehearsal for benign prostatic hyperplasia (BPH) therapy.

Recently, photo-selective vaporization of the prostate (PVP) has been a popular alternative to the standard electrocautery - transurethral resection of prostate (TURP). Here we introduce a new training system for practicing the laser therapy by using a virtual reality (VR) simulator. To interactively and realistically simulate PVP on a virtual organ with an order of a quarter million elements, a few novel and practical solutions have been applied to handle the challenges in modeling tissue ablation, contact/collision and deformation; endoscopic instruments tracking, haptic rendering and a web/database curriculum management module are integrated into the system. Over 40 urologists and surgical experts have been invited nationally and participated in the system verification.

Inicio de la docencia urológica en la universidad española. Dr. Alberto Suárez de Mendoza / The start of urological teaching in the Spanish University. Dr. Alberto Suárez de Mendoza

OBJETIVO: Presentamos la semblanza del Dr. Suárez de Mendoza, uno de los primeros urólogos formado en Urología en el Hospital Necker, de París, junto al Dr. Guyon, que abrió el campo a la creación de la especialidad en España y el primer profesor oficial de la asignatura en la Facultad de Medicina de Madrid. MÉTODO: Hemos revisado su expediente académico en el Archivo Histórico Nacional y buscado datos en la Facultad de Medicina y en el Colegio de Médicos madrileño sobre su presencia en España. Extraído de los Reales Decretos información sobre la escuela libre de Medicina y la creación de las especialidades médicas en los planes de estudios universitarios y, por último, analizamos su obra escrita. RESULTADO/CONCLUSIÓN: Consideramos al Dr. Suárez de Mendoza una de las personalidades que dieron entidad a la Urología en nuestro país, por su formación, por su amplitud de saberes y por su vasta experiencia, como profesor de la asignatura en la Universidad española, como autor de un gran número de trabajos publicados y como inventor por sus aportaciones al desarrollo de la anestesia y de la Urología. Su tratado, el primero en español que recoge con detalle las primeras innovaciones en los medios de exploración urológicos, nos permite conocer y valorar el progresivo avance y evolución del conocimiento que presenta la Urología

OBJECTIVES: We present a biographical sketch of Dr. Suarez de Mendoza, one of the first urologists trained as so in the Necker Hospital in Paris with Dr. Guyon, who opened the field to the creation of this speciality in Spain, and first official professor of the subject of in the Faculty of Medicine of Madrid. METHODS: We reviewed his academic expedient in the National Historical Archive and search for data about his presence in Spain in the Faculty of Medicine and Medical College of Madrid. From the Royal Decrees we obtained information about the Free School of Medicine, and the creation of medical specialities in the University study plans; finally, we analyzed his written works. RESULTS /CONCLUSIONS: We consider Dr. Suarez de Mendoza one of the personalities giving entity to Urology in our country, for his education, for the amplitudeof his knowledge, and for his wide experience, as professor of the subject in the Spanish University, as author of a great number of published works, and as inventor of his contributions to the development of anesthesia and urology. His treaty, the first in Spanish coveringin detail the innovations in urological examination methods, enables us to know and value the progressive advance and evolution of knowledge in urology

El magisterio del profesor D. Francisco Romero Aguirre / The teaching of Dr. Romero Aguirre

Objetivo: Con ocasión del fallecimiento del profesor D. Francisco Romero Aguirre (Zaragoza, 7.IV.1918-28.VI.2006) queremos poner de manifiesto su gran vocación docente, para lo que recorremos su vinculación a la Universidad desde el comienzo de sus estudios hasta su magisterio como primer catedrático de Urología de la Licenciatura en la Universidad española (1961), y su labor al frente de la Escuela Profesional de postgrado en Urología de la Universidad de Zaragoza. Métodos: Revisamos su biografía, su obra editada y las publicaciones de la Cátedra de Urología de la Universidad de Zaragoza y extraemos cuantas referencias encontramos de su actividad docente. Resultado: Desde el inicio de su formación académica mantuvo una constante unión con la Universidad y colaboró en todas las disciplinas con las que tuvo relación hasta lograr ser responsable de la enseñanza de la Urología. Su talante universitario y su gran preparación hicieron ver al catedrático de Patología Quirúrgica la conveniencia de separar la Urología del tronco común de la Cirugía, propuesta que, aceptada por el claustro de la Facultad de Medicina de Zaragoza y elevada al ministerio, dio lugar a la designación de la Urología como asignatura independiente en la Licenciatura de Medicina. Su labor como responsable estuvo marcada por el trabajo y constantes logros en las clases, por numerosas publicaciones, por realización de cursos de doctorado y monográficos de Urología y por la dirección de tesis y memorias, todo lo cual permitieron la creación de la Escuela profesional de especialización urológica con la que culminaron sus más de cuarenta años de dedicación al magisterio universitario. Conclusión: Encontramos en el profesor Romero una vida dedicada íntegramente entregada a la Universidad y a su magisterio. Su gran formación urológica y propedéutica hicieron que fuese la persona que reunía las condiciones y las aptitudes necesarias para hacerse cargo y desempeñar satisfactoriamente el puesto, en la Facultad de Medicina de Zaragoza, de responsable de la enseñanza de la Urología, que, gracias a su virtud y buen hacer, fue elevada por vez primera en la Licenciatura española al rango de asignatura (AU)

Objectives: After the death of Professor Francisco Romero Aguirre (Zaragoza 6/7/1918-6/28/2006) we want to make known his great teaching vocation, so that we covered his link with University from the start of his studies to his professorship as first professor in urology in the Spanish University (1961), and his work at the chairmanship of the Professional Postgraduate School of Urology in the University of Zaragoza. Methods: We reviewed his biography, his edited works and publications of the Urology Chair at the University of Zaragoza, and obtained as many references as we found about his teaching activity. Results: From the start of his academic training he kept a constant union with University and cooperated in all disciplines he had relation with before he got the responsibility of teaching urology. His university spirit and great formation had the chairman of surgical pathology see the convenience of separating urology from the common trunk of surgery, a proposal that, being accepted by the staff meeting of the Faculty of Medicine of Zaragoza and submitted to the Ministry resulted in the designation of urology as an independent subject in the degree of medicine. His labour as responsible was marked by work and continuous achievements in his classes, many publications, doctorate and urological monographic courses carried out, thesis and memories directed, all of which enabled him to create to the Professional Urological Specialization School, the culmination of more than 40 years dedicated to teaching in the university. Conclusions: We find Prof. Romero’s life completely dedicated to University and teaching. His wide urological and propedeutical formation made him a person who joined the necessary conditions and abilities to take the responsibility and carry out a satisfactory performance as responsible of teaching urology in the school of medicine of Zaragoza, a subject which thanks to his virtue and good performance was for the first time elevated to the level of independent subject (AU)

Resident education and training in urogynecology and pelvic reconstructive surgery: a survey.

The aim of the study is to assess satisfaction with urogynecology education among obstetrics and gynecology residents. An Internet-based survey was designed to obtain a cross-sectional sample of third- and fourth-year residents. Didactic and surgical training as well as perceived surgical competency were assessed. Responses were received from 205 residents for this convenience sample. Nearly half (46%) of the respondents were unsatisfied with urogynecology resident education. There was no significant difference between respondents from academic programs and community programs with regard to overall satisfaction, the opportunity to work with the presence of a fellowship-trained urogynecologist or having a dedicated urogynecology rotation. Respondents were more satisfied with their education if they did a urogynecology rotation or worked with a fellowship-trained urogynecologist. Female pelvic medicine and reconstructive surgery fellows were involved in the education of 23.9% of the respondents. Most respondents indicated comfort performing cystoscopy, anterior and posterior repairs, and McCall's culdoplasty following graduation. Overall, respondents indicated that residency training in urogynecology is less and later than desired, although they did feel competent at some urogynecologic surgeries.

[Urological training in the county of Roskilde]. / Den urologiske uddannelse i Roskilde Amt.

INTRODUCTION: Training in surgical skills and the importance of function-bearing units are the subject of much debate at the moment. An exposition is given of the quality of the urological training in the County of Roskilde, which corresponds to a function-bearing unit as to size. MATERIAL AND METHODS: The exposition is based on charts of specific oncological diagnoses during one year and the list of operations performed by phase III interns during a period of six months. RESULTS: The number of operations performed by phase III interns during the two periods in compared with the informal claims of The Danish Urological Society. DISCUSSION: As regards open surgery, the number of operations performed by phase III interns fully lives up to the informal requirements of the Danish Urological Society and the number of operations per intern exceeds what has previously been calculated at branch-specialized departments. The number of endoscopic operations was a little lower than expected and did not quite live up to the requirements. It is concluded that the urological training at a county urological department meets the requirements of the Danish Urological Society.