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Previously, we identified 8 objective suturing performance metrics highly predictive of urinary continence recovery after robotic-assisted radical prostatectomy. Here, we aimed to test the feasibility of providing tailored feedback based upon these clinically relevant metrics and explore the impact on the acquisition of robotic suturing skills.Training surgeons were recruited and randomized to a feedback group or a control group. Both groups completed a baseline, midterm and final dry laboratory vesicourethral anastomosis (VUA) and underwent 4 intervening training sessions each, consisting of 3 suturing exercises. Eight performance metrics were recorded during each exercise: 4 automated performance metrics (derived from kinematic and system events data of the da Vinci® Robotic System) representing efficiency and console manipulation competency, and 4 suturing technical skill scores. The feedback group received tailored feedback (a visual diagram+verbal instructions+video examples) based on these metrics after each session. Generalized linear mixed model was used to compare metric improvement (Δ) from baseline to the midterm and final VUA.Twenty-three participants were randomized to the feedback group (11) or the control group (12). Demographic data and baseline VUA metrics were comparable between groups. The feedback group showed greater improvement than the control group in aggregate suturing scores at midterm (mean Δ feedback group 4.5 vs Δ control group 1.1) and final VUA (Δ feedback group 5.3 vs Δ control group 4.9). The feedback group also showed greater improvement in the majority of the included metrics at midterm and final VUA.Tailored feedback based on specific, clinically relevant performance metrics is feasible and may expedite the acquisition of robotic suturing skills.

In-flight medical events are rare but may cause significant distress as access to care is limited. There is a paucity of data on in-flight urological medical events. We describe urological in-flight medical emergencies and report clinical and flight outcomes.We reviewed all in-flight urological medical emergencies between 2015 and 2017 from MedAire®, a ground based medical support center that provides remote medical advisory services to approximately 35% of commercial airline passenger traffic worldwide. Our primary end point was the incidence rates of in-flight urological medical events. We also characterized the types of in-flight medical emergencies, in-flight management and their impact on flight status. Statistical analyses included Student's t-tests, chi-square analysis and analysis of variance.We identified 1,368 (1%) urological in-flight medical emergencies from a total of 138,612 in-flight medical emergencies, with an incidence of 0.5 per million passengers. The most common in-flight medical emergencies were lower urinary tract symptoms (35%), urinary retention (30%) and flank pain (21%). Among in-flight medical emergencies 883 (60%) resolved in flight, 273 (28%) required on-arrival medical evaluation and 21 (1.5%) resulted in flight diversions. Of the flight diversions the majority were due to urinary retention (12, 57%) and less commonly flank pain (6, 28%) and testicular/abdominal pain (3, 15%).The most common causes of urological in-flight medical emergencies are lower urinary tract symptoms, urinary retention and renal colic, the majority of which resolved in flight. These data are useful for informing flight personnel and emergency kit equipment needs to minimize the impact of these events when they occur.

High animal protein intake is a risk factor for nephrolithiasis. Whether plant based sources of protein are associated with kidney stone risk is not well studied. We examined the association of animal and plant protein intake with the risk of incident kidney stones in Shanghai, China.Dietary intakes were obtained from a validated food frequency questionnaire at baseline. Self-reported stone events were ascertained at baseline and at followup visits. Multivariable Cox regression models were used to evaluate the associations of protein intake with the incident stone risk.During 319,211 and 696,950 person-years of followup 1,451 men and 1,202 women, respectively, reported incident stones. The average ± SD intake of animal and plant protein standardized to 2,000 kcal was 31.3 ± 13.7 and 48.4 ± 7.2 gm per day in women, and 30.8 ± 13.3 and 51.3 ± 7.6 gm per day, respectively, in men. On multivariable analysis participants in the highest quintiles of animal and nondairy animal protein intake showed an increased risk of incident stones compared to those in the lowest quintiles (HR 1.16, 95% CI 1.01-1.32, p=0.03 vs HR 1.14, 95% CI 1.01-1.30, p=0.04). Compared to the lowest quintile the highest intake quintiles of the animal-to-plant protein ratios and the nondairy animal-to-plant protein ratios were positively associated with stone risk (HR 1.17, 95% CI 1.03-1.33, p=0.02 and HR 1.20, 95% CI 1.06-1.36, p=0.005, respectively). No association was observed with plant protein intake (pIn this population with a relatively low animal protein intake and a high plant protein intake, a greater animal protein intake was associated with a kidney stone risk. Increasing the proportion of plant protein relative to animal protein appeared protective against the risk.

INTRODUCTION AND OBJECTIVE:Kidney stone disease is a condition characterized by recurring stone events over time. Given the chronic nature of the condition and varying individual risk for recurrenc...

INTRODUCTION AND OBJECTIVE:The experience for patients who make a selection between observation or surgery for renal calculi has not been well established. We compared the experiences of patients w...

INTRODUCTION AND OBJECTIVE:To enable earlier preventative interventions or guide empiric therapy for kidney stone disease, our objective was to demonstrate feasibility of predicting 24-hour urine a...

INTRODUCTION AND OBJECTIVE:Recent studies show no benefit to a selective approach to preventive pharmacological therapy (PPT) for patients with urinary stone disease (i.e., obtaining 24-hour urine ...

INTRODUCTION AND OBJECTIVE:While surgical stone treatment falls under the domain of Urology, stone prevention is often the responsibility of nephrologists, endocrinologists, and primary care physic...

INTRODUCTION AND OBJECTIVE:Significant increases in kidney stone prevalence have been reported for Black and Hispanic individuals in the US, but the gender-specific contribution to this trend is un...

INTRODUCTION AND OBJECTIVE:Proton pump inhibitors (PPIs) are widely prescribed medications that have effects on both gastrointestinal and renal function with an unknown effect on risk of nephrolith...

INTRODUCTION AND OBJECTIVE:Urinary citrate is a potent inhibitor of kidney stones; hypocitraturia is a common abnormality in the recurrent stone former. The American Urological Association guidelin...

INTRODUCTION AND OBJECTIVE:Given recent studies that show similar recurrence outcomes among patients with urinary stone disease regardless of whether 24-hour urine testing is evaluated prior to ini...

INTRODUCTION AND OBJECTIVE:The Recurrence of Kidney Stones (ROKS) nomogram predicts subsequent symptomatic kidney stone recurrence. However, while external validation studies have shown fair predic...

INTRODUCTION AND OBJECTIVE:The definitive management of urothelial carcinoma of the ureter is challenging due to difficulty in preoperative diagnostic staging. Some studies have identified preopera...

INTRODUCTION AND OBJECTIVE:Nephrolithiasis is a disease dependent on patients’ self-management; however, little is known on the effect of health literacy on treatment outcomes. We sought to underst...