The prevalence of impostor phenomenon and its association with burnout amongst urologists.

OBJECTIVES: To characterise the prevalence of impostor phenomenon (IP; tendency for high-achieving individuals to perceive themselves as fraudulent in their successes) amongst attending staff in urology, to identify variables that predict more severe impostorism, and to study the association of IP with burnout. SUBJECTS AND METHODS: A survey composed of the Clance Impostor Phenomenon Scale (CIPS), demographic information, practice details, and burnout levels was e-mailed to urologists via urological subspecialty societies. Survey results were analysed to identify associations between IP severity, survey respondent characteristics, and symptoms of professional burnout. This study was conducted in the United States of America. RESULTS: A total of 614 survey responses were received (response rate 11.0%). In all, 40% (n = 213) of responders reported CIPS scores qualifying as either 'frequent' or 'intense' impostorism (i.e., scores of 61-100). On multivariable analysis, female gender, fewer years in practice (i.e., 0-2 years), and lower academic rank were all independently associated with higher CIPS scores (adjusted P < 0.05). Regarding burnout, 46% of responders reported burnout symptoms. On multivariable analysis, increase in CIPS score was independently associated with higher odds of burnout (odds ratio 1.06, 95% confidence interval 1.04-1.07; P < 0.001). CONCLUSION: Impostor phenomenon is prevalent in the urological community and is experienced more severely in younger and female urologists. IP is also independently associated with burnout. Increased female representation may improve IP amongst our female colleagues. More work is needed to determine strategies that are effective in mitigating feelings of IP and professional burnout amongst urologists, particularly those earlier in their careers.

Protocolo de vigilancia activa para el cáncer de próstata en Portugal / Active surveillance protocol in prostate cancer in Portugal

Objetivo: Evaluar los patrones de práctica clínica de urólogos portugueses en el manejo de pacientes incluidos en un protocolo de vigilancia activa.IntroducciónEl cáncer de próstata (CaP) es una enfermedad heterogénea, con un alto porcentaje de adenocarcinomas indolentes y con una probabilidad baja de convertirse en una enfermedad sintomática o potencialmente mortal. La vigilancia activa (VA) es una forma de tratamiento conservador, empleado con el objetivo de limitar el sobretratamiento de los pacientes con CaP de bajo riesgo. A lo largo de los años, la experiencia con VA ha ido aumentado considerablemente, siendo actualmente el manejo estándar en algunos países. Sin embargo, no existe, a día de hoy, un protocolo universal.MétodosEncuesta electrónica anónima de ámbito nacional, sobre los hábitos y prácticas en materia de VA entre urólogos portugueses. La encuesta constaba de 12preguntas y fue enviada por vía electrónica a los 368 miembros actuales de la Asociación Portuguesa de Urología.ResultadosSe encuestó a 56 urólogos (15,21% de respuestas), distribuidos geográficamente de manera uniforme y categorizados según los años de experiencia y el número de pacientes con CaP tratados mensualmente. La gran mayoría de los encuestados recomienda la VA a sus pacientes, en particular en el caso de pacientes de grado 1 de la ISUP, con un nivel sérico de PSA es inferior a 20 ng/ml. No se cuestiona el cumplimiento de los programas de VA por parte de los pacientes, pero la morbilidad psicológica de albergar la enfermedad es un factor preocupante. Según la mayoría de los encuestados, los protocolos de vigilancia propuestos por las guías internacionales son adecuados y suficientes, pero se ponen de manifiesto algunas limitaciones en cuanto a la disponibilidad de la resonancia magnética de forma periódica y al requerimiento de nuevas biopsias (AU)

Objectiv: To examine clinical practice patterns in locally managing patients under an active surveillance protocol among Portuguese urologists.IntroductionProstate cancer (PCa) is a heterogeneous disease with many prostate adenocarcinomas being indolent and a low probability of ever causing symptoms or death. Active surveillance (AS) is a form of conservative management aimed to reduce over-treatment for low-risk PCa patients. Over the years, experience with AS has grown considerably and is now standard in some countries, however a universal protocol still does not exist.MethodsNationwide anonymous e-survey concerning habits and practices on AS among Portuguese urologists, that consisted of 12questions and was sent electronically to all 368 current members of the Portuguese Urological Association.Results56 urologists were surveyed (15.21% answer rate), evenly distributed geographically and allocated according to years of experience as well as number of PCa patients managed monthly. The vast majority of respondents recommends AS to their patients, particularly ISUP grade 1 patients, whose PSA serum level is bellow 20ng/mL. Observance of AS programs by patients was not in question but concerns exist over psychological morbidity while harboring disease. Majority believed that international guidelines surveillance protocols were adequate and sufficient, but there are some constraints concerning availability of periodic MRIs and re-biopsy needs (AU)

Multi-country clinical practice patterns, including use of biomarkers, among physicians' treatment of BCG-unresponsive non-muscle invasive bladder cancer (NMIBC).

BACKGROUND: Intravesical bacillus Calmette-Guérin (BCG) fails in a considerable proportion of non-muscle invasive bladder cancer (NMIBC) patients despite treatment per recommended protocol. This real-world study aimed to understand the current patterns of treatment and disease management for the broad BCG-unresponsive NMIBC patient population, alongside collecting sufficient data on patients who do not undergo cystectomy. METHODS: This was a multicenter, retrospective survey of physicians treating BCG-unresponsive NMIBC patients. Data were collected in eight countries - France, Germany, Spain, Italy, United Kingdom, United States, China, and Japan - between January and May 2019. The study consisted of a short online physician survey and a retrospective chart review of eligible BCG-unresponsive NMIBC patients. Physicians abstracted chart data for the last 10 (five patients in Japan) eligible BCG-unresponsive NMIBC patients meeting the inclusion criteria, and the data were analysed for all countries combined using descriptive statistics. Country-specific analyses were also carried out, as appropriate. RESULTS: Overall, 508 physicians participated in the study. Almost one-quarter (22.9%) of physicians' current NMIBC patient caseload was BCG-unresponsive, whereby BCG therapy was no longer considered an option. Half of physicians (49.4%) did not regularly use biomarker tests in their practice, with particularly few physicians undertaking biomarker testing in Spain and Japan. Biomarker testing varied considerably, with the proportions of physicians selecting 'none' ranging from 11.4% in China to 70.3% in Japan. Physicians reported transurethral resection of the bladder tumor (TURBT) and BCG as the most common current treatments received by their patients. Chemotherapy and anti-PD-L1 treatment options were considered impactful new therapies by 94.7% and 90.0% of physicians surveyed in this study, respectively. CONCLUSIONS: The most common treatments received by patients in this study were TURBT and BCG. Emerging new treatments are driven by exploring biomarkers, but in real-world clinical practice only half of physicians or fewer regularly tested their NMIBC patients for biomarkers; PD-1/PD-L1 was the most common biomarker test used. Most physicians reported that, in addition to chemotherapy, anti-PD-L1 was an impactful new therapy.

Large Variation in International Prescribing Rates of Opioids After Robotic Prostatectomy.

OBJECTIVE: To compare international opioid prescribing patterns for patients undergoing robotic assisted laparoscopic prostatectomy. To our knowledge, this is the first study to assess international opioid prescribing trends among urologists. METHODS: An anonymous Web-based survey assessing the frequency and quantity of opioid prescriptions for robotic assisted laparoscopic prostatectomy was designed using Qualtrics software. The survey was distributed to urologists internationally via Twitter and email in early 2021. Prescribing patterns were analyzed based on country of practice in three groups: United States, Canada, and all other countries. RESULTS: 160 participants from 26 countries completed the survey including the United States (51%), Greece (19%), Canada (9%), Israel (3.1%). The percentage of providers prescribing post-discharge opioids significantly differed between Canada, the United States, and other countries (86%, 63%, and 11%, respectively, P <.0001). There was a significant difference between years of experience in those who provide opioids compared to those who do not (8 years vs 5 years, P = .0004). The average morphine milligram equivalents (MME) provided in those who did prescribe opioids was greatest in the United States but was not significantly different between groups (mean MME: United States 58 mg, Canada 46 mg, all others 54 mg; P = .63). Attending physicians prescribed more MME than trainees (residents, fellows) on average (attending mean MME = 75 mg, trainee mean MME = 40 mg, P = .017). CONCLUSION: Opioid prescriptions after robotic assisted prostatectomy are common in North America and used sparingly in the rest of the world.

Ranking Important Factors for Using Postoperative Chemotherapy in Nonmuscle Invasive Bladder Cancer: Conjoint Analysis Results From the Michigan Urological Surgery Improvement Collaborative (MUSIC).

PURPOSE: National and international guidelines recommend the use of 1 dose of intravesical chemotherapy immediately following surgery for nonmuscle invasive bladder cancer, which is performed infrequently on a population level. We sought to understand the importance of potential environmental and clinical dimensions involved in the decision to offer this therapy. MATERIALS AND METHODS: Urologists from the Michigan Urological Surgery Improvement Collaborative (MUSIC) rated 8 distinct clinical vignettes involving patients with nonmuscle invasive bladder cancer. A ratings-based conjoint analysis method was used to evaluate the clinical vignette responses. Each vignette included 4 clinical dimensions and 2 environmental dimensions, with each dimension consisting of 2 possible attributes. The relative importance of each attribute was derived from the regression model and ranked in order. RESULTS: A total of 58 urologists answered the clinical vignettes which represents >75% of MUSIC sites. The median age of urologists was 53, most were male, and median years in practice was 20 years post residency. An environmental attribute, having a recovery room protocol for instilling and disposing of the chemotherapy, ranked as the most influential attribute for giving postoperative chemotherapy (utility=8.6). The clinical attribute yielding the strongest preference for giving chemotherapy was tumor grade (utility=4.9). These preferences varied by different subgroups of urologists, particularly regarding the type of practice a urologist was in. CONCLUSIONS: This study demonstrates that urologists have clear preferences for when they offer postoperative immediate chemotherapy. Factors beyond just clinical variables play a role in this decision making process such as the structure of the recovery room.

Survey of COVID-19 impact on pediatric urology services.

INTRODUCTION: To better understand how the COVID-19 pandemic has forced rapid operational changes in the global healthcare industry, changes implemented on an individual, institutional basis must be considered. There currently is not adequate literature about the overall impact COVID-19 has had on pediatric urology services worldwide. We believe that they have dramatically decreased during the COVID-19 crisis, but have adapted to accommodate changes. We hypothesize that patient care was widely variant due to inadequate standardized recommendations or crisis planning. MATERIALS AND METHODS: A web-based survey was deployed to 377 pediatric urologists globally via email to analyze COVID-19's impact on various types of pediatric urology practices. Key categories included impacts on elective services, telemedicine use, finances, and recovery operations. A total of 114 responses were collected between April 29th - May 22nd, 2020. RESULTS: The widespread cancellation of elective surgical procedures caused significant disturbances in the field. There was a uniform, significant increase (75%) in telemedicine use across practices. The pandemic has created many changes in care provision for physicians, institutions, and patients themselves. Furthermore, the sudden economic burden on healthcare facilities could lead to cost-cutting measures, creating further strain within institutions. Though telemedicine has its limitations, it is a very viable option when traditional services are unavailable. CONCLUSIONS: Immediate steps should be taken to ensure that the recovery phases of pediatric urology practices are as efficient as possible. Institutions should develop task forces to develop critical workflow processes in the event of health crises, while still maintaining patient-centered care. This will be essential in maximizing appropriate care allocation.

Vasectomy Reversal Online Marketing Practices: What Are We Putting Out There?

OBJECTIVE: To determine characteristics of providers marketing vasectomy reversal (VR) online, degree of information available online, the ease with which patients can compare providers, and the differences in VR practice patterns between academic and private practices. MATERIALS AND METHODS: We identified VR practices operating within the top 50 most populous metropolitan areas in the US. Practice websites were reviewed to obtain information such as provider educational background, level of magnification, ability to perform vasoepididymostomy, surgical volume, and cost. Based on information available, providers were assigned a novel REVERSAL score created by the authors. Descriptive statistics were used to compare results. RESULTS: Of the 107 providers identified (29 academic, 78 private), the majority were male urologists with a Doctor of Medicine degree. Academic providers were more likely to have fellowship training than private practice providers, 96.6 vs 43.6%, respectively (P = 0.00001). Compared to non-urologists, urologists were less likely to purchase online ads or disclose cost. Non-urologists charged significantly less than urologists, $3,584 ± 1,554 and $6,591 ± 1,518, respectively (P = 0.00001). Only one provider provided complete information as defined by REVERSAL score of 12, with the majority (61.7%) of providers achieving score ≤6. CONCLUSION: There is significant lack of transparency in publicly available information from VR practices. Practices should implement measures to improve dissemination of information to the public, so that patients can more easily compare providers and make informed decisions regarding VR.

Factors Influencing the Decision for Fresh vs Cryopreserved Microdissection Testicular Sperm Extraction for Non-Obstructive Azoospermia.

OBJECTIVE: To determine reproductive urologists' (RU) practice patterns for microdissection testicular sperm extraction (microTESE) and factors associated with use of fresh vs frozen microTESE for non-obstructive azoospermia. MATERIALS AND METHODS: We electronically surveyed Society for Study of Male Reproduction members with a 21-item questionnaire. Our primary outcomes were to determine RU preference for fresh or frozen microTESE and to understand barriers to performing microTESE. Pearson's chi-square and Fisher's exact tests were used to analyze categorical outcomes and candidate predictor variables. Firth logistic regression was performed to identify the predictors for preferring and performing fresh vs frozen microTESE. RESULTS: A total of 208 surveys were sent with 76 responses. Most (63.0%) primarily perform frozen microTESE for non-obstructive azoospermia, while 37.0% primarily perform fresh. However, in an ideal practice, 59.3% prefer fresh microTESE, 22.2% prefer frozen microTESE, and 18.5% had no preference. MicroTESE is performed most often (61.1%) at surgical centers not affiliated with a fertility practice. The most commonly reported barriers for both fresh and frozen microTESE are cost (42.6%), scheduling (33.3%), and andrologist unavailability (16.7%). There are no statistically significant differences between these barriers and performing fresh vs frozen microTESE. On multivariable analysis, reproductive endocrinology and infertility-based surgical center (OR 22.9; 95% CI 1.1-467.2; P = 0.04) and professional fee $2,500-$4,999 (OR 20.7; 95% CI 1.27-337.9; P = 0.03) are significant predictors of performing fresh microTESE. CONCLUSION: Frozen microTESE is performed more commonly than fresh, despite most RU preferring fresh microTESE in an ideal setting. Both fresh and frozen microTESE have a role in reproductive care. Barriers to performing fresh microTESE include cost, scheduling and andrologist availability.

Evaluating Quality Improvement and Patient Safety Amongst Practicing Urologists: Analysis of the 2018 American Urological Association Census.

OBJECTIVE: To describe factors associated with Quality improvement and patient safety (QIPS) participation using 2018 American Urological Association Census data. QIPS have become increasingly important in medicine. However, studies about QIPS in urology suggest low levels of participation, with little known about factors predicting non-participation. METHODS: Results from 2339 census respondents were weighted to estimate 12,660 practicing urologists in the United States. Our primary outcome was participation in QIPS. Predictor variables included demographics, practice setting, rurality, fellowship training, QIPS domains in practice, years in practice, and non-clinical/clinical workload. RESULTS: QIPS participants and non-participants significantly differed in distributions of age (P = .0299), gender (P = .0013), practice setting (P <.0001), employment (employee vs partner vs owner vs combination; P <.0001), and fellowship training (P <.0001). QIPS participants reported fewer years in practice (21.3 vs 25.9, P = .018) and higher clinical (45.2 vs 39.2, P = .022) and non-clinical (8.76 vs 5.28, P = .002) work hours per week. Non-participation was associated with male gender (OR = 2.68, 95% CI 1.03-6.95) and Asian race (OR = 2.59, 95% CI 1.27-5.29) for quality programs and private practice settings (ORs = 8.72-27.8) for patient safety initiatives. CONCLUSION: QIPS was associated with academic settings. Interventions to increase rates of quality and safety participation should target individual and system-level factors, respectively. Future work should discern barriers to QIPS engagement and its clinical benefits.

Perceived barriers to the adoption of active surveillance in low-risk prostate cancer: a qualitative analysis of community and academic urologists.

BACKGROUND: Clinical practice guidelines recommend active surveillance as the preferred treatment option for low-risk prostate cancer, but only a minority of eligible men receive active surveillance, and practice variation is substantial. The aim of this study is to describe barriers to urologists' recommendation of active surveillance in low-risk prostate cancer and explore variation of barriers by setting. METHODS: We conducted semi-structured interviews among 22 practicing urologists, evenly distributed between academic and community practice. We coded barriers to active surveillance according to a conceptual model of determinants of treatment quality to identify potential opportunities for intervention. RESULTS: Community and academic urologists were generally in agreement on factors influencing active surveillance. Urologists perceived patient-level factors to have the greatest influence on recommendations, particularly tumor pathology, patient age, and judgements about the patient's ability to adhere to follow-up protocols. They also noted cross-cutting clinical barriers, including concerns about the adequacy of biopsy samples, inconsistent protocols to guide active surveillance, and side effects of biopsy procedures. Urologists had differing opinions on the impact of environmental factors, such as financial disincentives and fear of litigation. CONCLUSIONS: Despite national and international recommendations, both academic and community urologists note a variety of barriers to implementing active surveillance in low risk prostate cancer. These barriers will need to be specifically addressed in efforts to help urologists offer active surveillance more consistently.

Adopting Telehealth During The COVID-19 Era: The Urologist's Perspective.

OBJECTIVE: To evaluate the urology providers' (through a range of training levels) experience utilizing telemedicine given the rapid nationwide implementation of telemedicine in urology practices due to COVID-19. Several studies focusing on the patient's perspective have illustrated that telemedicine is comparable to traditional office visits in terms of cost, communication, and overall satisfaction. However, there is sparse data on the provider's experience. METHODS: With IRB approval, we assessed provider satisfaction with telemedicine at Urology programs in the U.S. through an electronic survey. The 25-question survey was based on the Patient Assessment of Communication of Telehealth which is a validated 33 question instrument that has been utilized to assess the quality of patient-provider communication in telemedicine. Experience with telemedicine was assessed in 2 categories: technical aspects and communication with patients. Variables were rated using a 5-point Likert Scale. RESULTS: There were 144 responses to the survey. 50% of providers reported not receiving any formal training in using telemedicine. This differed significantly by training level with 55% of attendings having had received training vs 20% of residents. Providers felt they would most benefit from training in billing (52%) rather than equipment use (33%) or communication (28%). 87% of providers felt comfortable discussing sensitive topics while only 55% felt comfortable using telehealth to schedule surgery (P < .001). CONCLUSION: Urology providers are generally satisfied with their experience communicating with patients via telemedicine and the majority would opt to continue utilizing telemedicine. Nevertheless, many providers are hesitant to schedule surgery via telemedicine. Providers would benefit from formal training in telemedicine.

SIMPLifying Urology Residency Operative Assessments: A Pilot Study in Urology Training.

PURPOSE: The Society for Improving Medical Professional Learning (SIMPL) app is an innovative, convenient and validated smartphone-based tool to evaluate residents' operative performance. In this study, we describe the initial implementation of SIMPL in our program's pediatric urology rotation-the first among urology residencies-and provide preliminary data on its adoption by residents and faculty. MATERIALS AND METHODS: Residents and faculty in our pediatric urology division submitted SIMPL evaluations following surgical cases from August 2019 to July 2020. Evaluations consisted of ratings in 3 domains: resident autonomy, resident operative performance and patient-related case complexity. An online survey was also used to gauge attitudes towards SIMPL, describe patterns of use and solicit feedback on areas for improvement. RESULTS: Eight residents and 6 faculty submitted 141 evaluations, with 76.6% of evaluated cases having both faculty and resident ratings. Verbal feedback was included in 94.2%. Faculty-resident agreement ranged from 68.6% to 75.2% (kappa=0.47 to 0.61). Faculty rated postgraduate year (PGY)-4 residents as more autonomous (p=0.040) and higher performing (p=0.028) than PGY-3 residents. All participants agreed that SIMPL was easy to use and compared favorably to existing avenues of feedback. Barriers to implementation included lack of reminders for evaluations and evaluation fatigue. CONCLUSIONS: The SIMPL application improved both frequency and quality of resident operative feedback. Among participants, SIMPL was preferred over the existing feedback system at our institution.

Real-World Practice Patterns and Predictors of Continuous versus Intermittent Androgen Deprivation Therapy Use for Prostate Cancer in Older Men.

PURPOSE: Phase-III randomized control trial evidence suggests intermittent androgen deprivation therapy (IADT) is not significantly inferior to continuous androgen deprivation therapy (ADT) for patients with prostate cancer (PC). However, clinical practice and guidelines differ in their recommendations. We evaluate real-world utilization and practice patterns of IADT. MATERIALS AND METHODS: Ontario men ≥65 years of age with PC who initiated ADT for ≥3 months were identified (1997-2017). Lapses in ADT ≥6 months (initial gap) and ≥3 months (subsequent gaps) were used to classify IADT. Neoadjuvant/adjuvant therapy was excluded. Disease stage adjustment was completed for patients with likely metastatic disease based on de novo presentation with ADT. Patient and physician predictors of IADT were analyzed using multivariable logistic regression. RESULTS: We identified 8,544 patients with 1,715 having previously received local therapy. Among all patients, 16.4% received IADT. This ranged from 11.4%-24.8% across health-planning regions and increased to 26.6% in those with previous local therapy. Mean followup was 8.3 years. Patients with prior local therapy (OR 1.85, 95% CI 1.59-2.17, p <0.001) and those in the highest income quintile (OR 1.32, 95% CI 1.08-1.60, p=0.005) had increased odds of receiving IADT. Radiation oncologists were more likely to use IADT than urologists (OR 1.99, 95% CI 1.59-2.50, p <0.001), as were physicians with more experience (≥10 years in practice: OR 1.44, 95% CI 1.11-1.88, p=0.007). In specialty-stratified analyses, case volume was significantly associated with IADT for radiation oncologists (highest quartile: OR 1.73, 95% CI 1.14-2.62, p=0.009). CONCLUSIONS: IADT remains underutilized for patients with PC who ≥65 years of age with only 1 in 4 to 1 in 6 eligible patients receiving this form of care. Clinical, sociodemographic and physician characteristics play an important role in treatment selection.

Characterizing the Epidemiology and Provider Landscape of Male Infertility Care in the United States.

OBJECTIVE: To characterize the epidemiology of male factor infertility and identify which types of providers are treating infertile men in the United States. MATERIALS AND METHODS: The National Ambulatory Medical Care Survey was queried between 2006 and 2016 for all ambulatory care visits. Men with a diagnosis of infertility were identified by international classification of disease coding. Comorbidities, demographic and visit information were abstracted from the patients' medical record by a combination of trained surveyors and physicians. The survey data was weighted to create nationally representative estimates, and a combination of Chi-squared and Student's t-tests were utilized to determine significance. RESULT(S): Among the 8.7 billion patient visits between 2006 and 2016, there were 3,422,000 male encounters with a diagnosis of male factor infertility. The most common provider type for male factor infertility encounters was urology (42.12%) followed by primary care (39.79%), gynecology (7.05%) and all other provider types (11.01%). A significant number of men seen for infertility had comorbidities such as cancer (115,000 men, 3.36%) diabetes (267,000 men, 7.81%), depression (301,000 men, 8.8%), and active tobacco use (857,000 men, 30.3%). CONCLUSION: In a nationally representative sample, more than 50% of ambulatory care visits for male factor infertility were not seen by urologists. These men also had a significant number of comorbidities for a relatively young cohort, emphasizing the importance of multidisciplinary care for men with a diagnosis of infertility.

Cribriform prostate cancer: Morphologic criteria enabling a diagnosis, based on survey of experts.

Among four sub-patterns of Gleason grade 4 prostate cancer, voluminous evidence supports that the cribriform pattern holds an unfavorable prognostic impact, as compared with poorly-formed, fused, or glomeruloid. The International Society of Urological Pathology (ISUP) recommends specifying whether invasive grade 4 cancer is cribriform. Recently, ISUP experts published a consensus definition of cribriform pattern highlighting criteria that distinguish it from mimickers. The current study aimed to analyze morphologic features separately to identify those that define the essence of the cribriform pattern. Thirty-two selected photomicrographs were classified by 12 urologic pathologists as: definitely cribriform cancer, probably cribriform, unsure, probably not cribriform, or definitely not cribriform. Consensus was defined as 9/12 agree or disagree, with ≤1 strongly supporting the opposite choice. Final consensus was achieved in 21 of 32 cases. Generalized estimating equation (GEE) model with logit link was fitted to estimate effect of multiple morphologic predictors. Fisher exact test was used for categorical findings. Presence of intervening stroma precluded calling cribriform cancer (p = 0.006). Mucin presence detracted (p = 0.003) from willingness to call cribriform cancer (only 3 cases had mucin). Lumen number was associated with cribriform consensus (p = 0.0006), and all consensus cases had ≥9 lumens. Predominant papillary pattern or an irregular outer boundary detracted (p = NS). Invasive cribriform carcinoma should have absence of intervening stroma, and usually neither papillary pattern, irregular outer boundary, nor very few lumens. Setting the criteria for cribriform will help prevent over- or undercalling this important finding.

Gender Representation in American Urological Association Guidelines.

OBJECTIVE: To study patterns and factors associated with female representation in the American Urological Association (AUA) guidelines. METHODS: We gathered publicly available information about the panelists, including the AUA section, practice setting, academic rank, fellowship training, years in practice, and H-index. The factors associated with the proportion of female panelists and trends were investigated. We also examined the proportion of female panelists in the European Association of Urology (EAU) and National Comprehensive Cancer Network (NCCN) urology guidelines. RESULTS: There were 483 non-unique panelists in AUA guidelines, and 17% are female. Non-urologist female panelists in AUA guidelines represented a higher proportion than female urologists (30% vs 13%, P<0.0001). Compared with male panelists, females had lower H-indices (median 23 vs 35, P<0.001), and fewer were fellowship-trained (77.2% vs 86.8%; P=0.042). On multivariate analysis, non-urologists and panelists with lower H-indices were more likely to be female but there was no association between guideline specialties, academic ranking, geographic section, years in practice, and fellowship training with increased female authorship. Overtime, the proportion of female participation in guidelines remained stable. In the EAU and NCCN guideline panels, 12.2% and 10.7% were female, respectively. CONCLUSION: Female representation among major urologic guidelines members is low and unchanged overtime. Female urologist participation was proportional to their representation in the urology workforce. Being a non-urologist and lower H-indices were associated with female membership in guideline panels.

Situación actual de la mujer en Urología en Colombia / Current situation of women in Urology in Colombia

INTRODUCCIÓN Y OBJETIVOS: Existe la creencia de que la urología es una especialidad de hombres. Según la American-Urology-Association, en 2013 las mujeres representaban el 7,7% de los urólogos en EE.UU. Actualmente, de 678 urólogos adscritos a la Sociedad Colombiana de Urología, 61 son mujeres (9%), y de 102 residentes, 41 (40%), son mujeres. El objetivo de este estudio es demostrar las tendencias de trabajo de las urólogas, las tendencias a futuro de las residentes, e identificar si los pacientes tienen preferencias en cuanto a la atención según el género de(la) urólogo(a). MATERIAL Y MÉTODOS: Estudio de corte observacional descriptivo con encuestas anónimas realizadas a urólogas, residentes y pacientes. Las preguntas evaluaban las características demográficas de los encuestados; las preguntas a urólogas evaluaban sus tendencias de trabajo, las de las residentes sus planes a futuro como urólogas, y las de los pacientes su deseo de ser valorados en consulta y operados por un urólogo o una uróloga. RESULTADOS: Cincuenta y tres urólogas respondieron la encuesta. El promedio de edad fue 37 años, la mayoría (54%) trabajan en Bogotá. Dieciocho (34%) se han subespecializado, la mayoría en andrología (16%), endourología (16%) y urología pediátrica (16%). La mayoría (73,6%) operan entre 5-20 horas semanales, y las principales cirugías que realizan son colocación de cinta libre de tensión, resección transuretral de próstata, y varicocelectomía. Dieciocho (34%) refieren acoso laboral por el hecho de ser mujer. Treinta y seis de 41 residentes respondieron la encuesta. El promedio de edad era 28 años. El promedio de publicaciones académicas era de 3 (0-12). Ochenta por ciento desean realizar una subespecialización en el futuro, de las cuales 24% lo harían en endourología,17,2% en pediatría o uroginecología, y 10,3% en oncología. Cuarenta y un por ciento refieren acoso laboral por el hecho de ser mujer. Ciento ochenta y ocho pacientes respondieron la encuesta, siendo 96 hombres y 87 mujeres, de los cuales, 44,1% prefieren ser atendidos en consulta por una uróloga, y 49,2% prefieren ser operados por un urólogo. CONCLUSIONES: El número de mujeres urólogas ha aumentado exponcialmente en los últimos años, al igual que el porcentaje de mujeres en la residencia. Las residentes desean subespecializarse en diversos campos de la urología. Los pacientes prefieren ser atendidos en consulta por una uróloga, pero ser operados por un urólogo aunque las mujeres siguen prefiriendo ser operadas por una mujer

INTRODUCTION AND OBJECTIVES: There are 61 (9%) female urologist enrolled at Sociedad Colombiana de Urología. 41 (40%) of urology residentes in Colombia are women. The aim of this study is to demonstrate the work tendencies of female urologist, female residents and patient’s preferences regarding the gender of their urologist. MATERIALS AND METHODS: Descriptive observational sectional study with anonymous surveys carried out to practicing female urologists, female residents, and patients. The questions evaluated the demographic characteristics of the surveyed individuals; the questions for female urologists evaluated their work tendencies; for the residents we evaluated their plans as urologists; and the patients were asked about their preferences to be evaluated in medical consultation and to have a surgery performed by either a male or female urologist. RESULTS: The survey was answered by 53 female urologists. The average age was 37 years, the majority (54%) worked in Bogotá. 34% have subspecialized, the majority in andrology (16%) endourology (16%) and pediatric urology (16%). Most of them (73.6%) perform surgery between 5-20 hours weekly, and the most performed surgery was varicocelectomy. 34% referred to have been harassed in their work environment based on their gender. Thirty-six female residents answered the survey. The average age was 28 years. The average number of academic publications was 3. 80% wish to achieve a sub-specialization, of which 24% would do it in endourology. 41% referred to have been harassed. 188 patients answered the survey, 96 men and 87 women; 44.1% preferred to be attended in medical consultation by a female urologist, and 49.2% preferred to be operated by a male urologist. CONCLUSIONS: The number of female urologists has exponentially increased, just as the percentage of female residents. Female residents wish to subspecialize in diverse areas. Patients prefer to be attended by a female urologist in medical consultation but prefer to have surgery performed by a male urologist