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Introduction: The field of urology is predominantly male; however, there has been an increasing number of women in the workforce. Peak reproductive years frequently overlap with residency training and early attending career timelines. Exposure to ionizing radiation is a common occupational hazard in many procedural specialties. The use of radiation, for example, in interventional cardiology and interventional radiology, has shown little adjustments in practice patterns, with no adverse outcomes reported among pregnant physicians in their fields in the setting of appropriate radiation safety measures. The impact of radiation exposure during pregnancy for urologists is largely unknown. Our objective was to determine attitudes and practices of urologists related to radiation exposure and to characterize the experience of urologists who have previously been pregnant. Methods: An anonymous online survey was distributed through relevant society membership bases, which included the Endourological Society and the Society for Women in Urology, and social media. Demographics, practice patterns, and changes to practice patterns were recorded for respondents. Statistical analysis was performed in R studio. Results: There were 384 respondents, 255 of whom identified as women. Of these, 164 had been previously pregnant. Female respondents were younger, completed training more recently, and were more likely to have adjusted their caseload due to radiation concerns compared with their male counterparts. Of women who had been pregnant, few had access to policies for who to notify (19%), policies for safety precautions (22%), custom-fitted lead (35%), and maternity lead (20%). Most women (66%) relied on their own research for guidance on radiation safety during pregnancy, while some (41%) also used information from colleagues or mentors. Forty-six percent of women would have taken greater precautions during pregnancy than they did. Conclusions: Access to the appropriate tools to safely navigate pregnancy is inconsistent among practicing urologists. Evidence-based guidelines are needed to better empower pregnant urologists. [ABSTRACT FROM AUTHOR]

Introduction: Only 9.9% of practicing urologists in the United States are women. This percentage is even smaller in leadership positions and high-ranking appointments. Endourology is one of the least reported fellowships completed by women urologists. We sought to evaluate how endourologists perceived the climate for women physicians and compare perceptions and experiences of gender equity. Materials and Methods: An IRB approved and validated survey, Culture Conducive to Women's Academic Success (CCWAS) questionnaire was sent out to the Endourological Society listserve. Subcategories of equal access, work-life balance, freedom of gender bias, and leadership support were analyzed. An open comment section was provided for respondents to include their own experiences. Wilcoxon rank-sum and Kruskal–Wallis tests were used to compare CCWAS scores between groups. Results: A total of 104 completed surveys were received. Response rate was 7% (104/1492), 26.9% of which were female. There was a statistically significant difference between male and female respondent CCWAS scores; p < 0.05. The male CCWAS score median was 196.0 (interquartile range [IQR] 176.75–214.0) vs female CCWAS score median of 166.5 (IQR 127.5–210.0). There was no significant difference in CCWAS scores based on years in practice, parental status, or academic vs private practice. Discussion: In this study, male endourologists' perceptions of gender equity were incongruent with the reported experiences of their female colleagues. This indicates that male respondents perceive the culture in their department toward women more positively than their female colleagues. This is suggestive that there are gender-based differences in how gender inequities are perceived and potentially experienced. [ABSTRACT FROM AUTHOR]

Introduction: Surgeons and residents report using videos to prepare for procedures, with a preference for open access resources, specifically YouTube. The educational quality of online videos is uncertain. Videos are uploaded without quality assessment, and ranked by popularity. This study aims to better characterize the available pediatric robotic pyeloplasty videos on YouTube, and assess for conformity to LAParoscopic surgery Video Educational GuidelineS (LAP-VEGaS). Methods: The most viewed videos of "pediatric robotic pyeloplasty" on YouTube were reviewed for baseline characteristics, educational content, inclusion of critical domains of the procedure (positioning, ports, exposure, ureteral mobilization, renal pelvis dissection, hitch stitch, spatulation, and anastomosis), and conformity to LAP-VEGaS. Results: Once ranked by views, 23 videos met inclusion criteria. Views per video ranged from 40 to 15,664 (mean of 1912). The two oldest videos were uploaded in 2009, and had the highest number of views. Audio and written educational content accompanied videos, 22% and 48% of the time, respectively. United States and India were the most common countries of origin. Only six videos contained all critical steps of the procedure. No videos contained all 16 points of the LAP-VEGaS essential checklist (mean 7.6), and most videos neglected preoperative information and outcomes. Percentage conformity was 48% overall (range for each video was 25%–81%). The most viewed videos were not associated with higher conformity to LAP-VEGaS. Conclusions: Despite studies demonstrating preferences for YouTube videos as an educational tool, and pyeloplasty being the most commonly performed pediatric robotic procedure, there are currently few high value educational videos available on YouTube. Videos often lack important procedure domains, and demonstrate low conformity to LAP-VEGaS guidelines. This demonstrates an opportunity to improve the educational quality and value of open access videos, starting by adopting established video reporting guidelines. [ABSTRACT FROM AUTHOR]

Conventional laparoscopic dismembered pyeloplasty (LP) is an established alternative to open pyeloplasty given equivalent intermediate-term outcomes and decreased morbidity. Laparoendoscopic single-site (LESS) pyeloplasty has the potential to further decrease the morbidity of LP, while yielding superior cosmesis. It is, however, technically very challenging even with the use of an accessory port, largely because of the difficulty of intracorporeal suturing through a single umbilical incision. Application of the da Vinci robotic surgical platform to LESS pyeloplasty (R-LESS) has the potential to overcome these limitations. We describe our technique for R-LESS pyeloplasty using the da Vinci Si robot. We have found that use of the robotic system in conjunction with certain technique modifications helps to reduce the technical difficulty of LESS pyeloplasty and to shorten the physical learning curve associated with the procedure. [ABSTRACT FROM AUTHOR]

Background and Purpose: Laparoscopic repair of ureteropelvic junction obstruction is now the standard of care at many institutions. The objective of this study is to compare costs associated with robot-assisted pyeloplasty (RP) vs laparoscopic pyeloplasty (LP). Materials and Methods: A decision analysis model was developed to compare costs of each procedure based on hospital-related cost centers. A literature search was performed to identify nonoverlapping studies with outcomes for RP and LP. Weighted means were calculated for operative time and length of stay. Cost data were obtained from our institution. One- and two-way sensitivity analyses were performed to evaluate the effect of changing variables on the cost-effectiveness of RP. Results: Eight studies were identified with 181 and 145 patients undergoing RP or LP, respectively. Operative times were 211 minutes for RP and 224 minutes for LP. Hospital stays were shorter for RP at 1.54 days compared with 1.98 days for LP. Mean direct costs were higher for RP at $10,635 vs $9,065 for LP. The largest difference was in fixed surgical supply costs per case at $1357 for RP and $406 for LP. One-way sensitivity analysis showed that RP would be cost effective if performed in less than 96 minutes. Even if RP was performed on an outpatient basis or more than 1000 cases/year, however, LP would still be cost superior. Two-way analyses showed areas where RP could be more cost-effective than LP. Conclusions: RP is associated with higher cost compared with LP, predominately because of the cost of the robot and surgical supply costs. Decreasing operative time and equipment costs may result in RP being more cost-effective than LP. Shorter hospital stay alone, however, is insufficient to allow RP to be cost-effective. One would need to demonstrate tangible advantages to the robot to justify the added costs. [ABSTRACT FROM AUTHOR]

AbstractA secure and hemostatic renorrhaphy is the primary challenge of minimally invasive nephron-sparing surgery (MINSS). The laparoscopic surgeon's ability to maintain constant tension on the suture while oversewing the transected parenchyma and collecting system is difficult, even when using robotic technology. A self-retaining barbed suture (SRBS) is a recent innovation that maintains tissue apposition and tension using a novel “self-cinching” mechanism. We describe our technique for SRBS use during MINSS. In our experience, the use of SRBS in this setting is safe and improves suturing efficiency during the time constraint of warm ischemia. We believe that intracorporeal suturing with SRBS during MINSS may help shorten the learning curve associated with this technically challenging step and have adopted it in our standard practice. [ABSTRACT FROM AUTHOR]