C-SATS: Assessing Surgical Skills Among Urology Residency Applicants

BackgroundWe hypothesized that surgical skills assessment could aid in the selection process of medical student applicants to a surgical program. Recently, crowdsourcing has been shown to provide an accurate assessment of surgical skills at all levels of training. We compared expert and crowd assessment of surgical tasks performed by resident applicants during their interview day at the urology program at the University of California, Irvine.Materials and methodsTwenty-five resident interviewees performed four tasks: open square knot tying, laparoscopic peg transfer, robotic suturing, and skill task 8 on the LAP Mentor™ (Simbionix Ltd., Lod, Israel). Faculty experts and crowd workers (Crowd-Sourced Assessment of Technical Skills [C-SATS], Seattle, WA) assessed recorded performances using the Objective Structured Assessment of Technical Skills (OSATS), Global Evaluative Assessment of Robotic Skills (GEARS), and the Global Operative Assessment of Laparoscopic Skills (GOALS) validated assessment tools.ResultsOverall, 3938 crowd assessments were obtained for the four tasks in less than 3.5 hours, whereas the average time to receive 150 expert assessments was 22 days. Inter-rater agreement between expert and crowd assessment scores was 0.62 for open knot tying, 0.92 for laparoscopic peg transfer, and 0.86 for robotic suturing. Agreement between applicant rank on skill task 8 on the LAP Mentor assessment and crowd assessment was 0.32. The crowd match rank based solely on skills performance did not compare well with the final faculty match rank list (0.46); however, none of the bottom five crowd-rated applicants appeared in the top five expert-rated applicants and none of the top five crowd-rated applicants appeared in the bottom five expert-rated applicants.ConclusionsCrowd-source assessment of resident applicant surgical skills has good inter-rater agreement with expert physician raters but not with a computer-based objective motion metrics software assessment. Overall applicant rank was affected to some degree by the crowd performance rating

Clinical, Pathologic, and Functional Outcomes After Nephron-Sparing Surgery in Patients with a Solitary Kidney: A Multicenter Experience

Abstract Background and Purpose: Surgical management of a renal neoplasm in a solitary kidney is a balance between oncologic control and preservation of renal function. We analyzed patients with a renal mass in a solitary kidney undergoing nephron-sparing procedures to determine perioperative, oncologic, and renal functional outcomes. Patients and Methods: A multicenter study was performed from 12 institutions. All patients with a functional or anatomic solitary kidney who underwent nephron-sparing surgery for one or more renal masses were included. Tumor size, complications, and recurrence rates were recorded. Renal function was assessed with serum creatinine level and estimated glomerular filtration rate. Results: Ninety-eight patients underwent 105 ablations, and 100 patients underwent partial nephrectomy (PN). Preoperative estimated glomerular filtration rate (eGFR) was similar between the groups. Tumors managed with PN were significantly larger than those managed with ablation (P<0.001). Ablations were associated with a lower overall complication rate (9.5% vs 24%, P=0.01) and higher local recurrence rate (6.7% vs 3%, P=0.04). Eighty-four patients had a preoperative eGFR ≥60?mL/min/1.73?m2. Among these patients, 19 (23%) fell below this threshold after 3 months and 15 (18%) at 12 months. Postoperatively, there was no significant difference in eGFR between the groups. Conclusions: Extirpation and ablation are both reasonable options for treatment. Ablation is more minimally invasive, albeit with higher recurrence rates compared with PN. Postoperative renal function is similar in both groups and is not affected by surgical approach.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/98449/1/end%2E2012%2E0114.pd

Surgical technique for removal of tined lead for InterStim.

IntroductionWe aimed to introduce our technique describing the removal of a chronic implanted tined-lead in patients with a sacral neuromodulator implant.Materials and methodsWe performed a retrospective review of patients who had chronic sacral neuromodulator (InterStim) implanted by a single surgeon from 2001 through 2015. This simple surgical technique was developed and successfully performed to remove the leads. Primary reasons for removal were elective due to poor symptoms control and failure to maintain response or lead migration. Patient demographics, indication for implantation, as well as installation and removal complications were recorded and analyzed.ResultsTwenty-five patients were included [mean age: 60.4 years (32-86), 17 females]. Primary indications for sacral nerve stimulation were overactive bladder in 16 (64%), mixed incontinence in 6 (24%), urinary retention in 2 (8%), and interstitial cystitis 3 (12%). Mean implant duration was 24.2 (0.5-90) months. The existing tined lead was removed and replaced in 11 (44%) patients while the remaining 14 (56%) underwent complete removal of the unit without subsequent replacement. Successful lead removal without complications was achieved in 24 (96%) patients.ConclusionsThis minimally invasive technique is a simple, safe, and effective method of removing chronic implanted tined leads en bloc

Aftermath of Grade 3 Ureteral Injury from Passage of a Ureteral Access Sheath: Disaster or Deliverance?

Background: The ureteral access sheath (UAS) has revolutionized the management of urinary pathology in the upper tract by providing rapid repeatable access to the upper urinary tract. However, in many practices, it remains a controversial tool in endourology given concerns of possible ureteral injury and presumed long-term sequela from those injuries. This case suggests that these concerns may be more hypothetical than real. Case Presentation: A 32-year-old female with a history of recurrent nephrolithiasis presented with left-sided symptomatic renal colic. She was found to have bilateral nephrolithiasis plus a left 6 × 5 mm proximal ureteral stone with associated moderate hydroureteronephrosis. The patient failed a trial of passage and as such was taken to the operating room for an elective ureteroscopy (URS) during which she sustained a Grade 3 ureteral splitting injury, measuring ∼2-3 cm, to the distal ureter from passage of the 16F UAS. At the end of the procedure a 7/10F endopyelotomy stent was placed. On follow-up URS at 6 weeks, there was no visual evidence of ureteral injury. A Lasix renal scan obtained 8 weeks after stent removal showed no evidence of obstruction. Conclusion: High-grade ureteral injuries sustained from UAS passage are rare. However, when injuries of this nature occur, the concern over long-term damage to the ureter may well be overstated

Surgical technique for removal of tined lead for InterStim.

IntroductionWe aimed to introduce our technique describing the removal of a chronic implanted tined-lead in patients with a sacral neuromodulator implant.Materials and methodsWe performed a retrospective review of patients who had chronic sacral neuromodulator (InterStim) implanted by a single surgeon from 2001 through 2015. This simple surgical technique was developed and successfully performed to remove the leads. Primary reasons for removal were elective due to poor symptoms control and failure to maintain response or lead migration. Patient demographics, indication for implantation, as well as installation and removal complications were recorded and analyzed.ResultsTwenty-five patients were included [mean age: 60.4 years (32-86), 17 females]. Primary indications for sacral nerve stimulation were overactive bladder in 16 (64%), mixed incontinence in 6 (24%), urinary retention in 2 (8%), and interstitial cystitis 3 (12%). Mean implant duration was 24.2 (0.5-90) months. The existing tined lead was removed and replaced in 11 (44%) patients while the remaining 14 (56%) underwent complete removal of the unit without subsequent replacement. Successful lead removal without complications was achieved in 24 (96%) patients.ConclusionsThis minimally invasive technique is a simple, safe, and effective method of removing chronic implanted tined leads en bloc

Three-dimensional evaluation of perirenal fat volume in patients with nephrolithiasis.

The concept of adipose tissue as an organ unto itself represents a new medical construct; already differences in the volume of perirenal fat around a tumor-bearing kidney have been described. We hypothesized that renal calculi may have similar impact on perirenal fat or alternatively abnormalities in urinary metabolites may be the result of perirenal fat affecting renal metabolism and subsequent stone formation. Accordingly, we conducted a study utilizing three-dimensional imaging software to evaluate perirenal fat volume (PFV) in patients with nephrolithiasis. Among 40 patients with a history of unilateral nephrolithiasis who underwent percutaneous nephrolithotomy between 2010 and 2016, the following data were acquired: body mass index, past medical history, stone characteristics and composition (i.e., calcium oxalate, calcium phosphate, uric acid, and struvite calculi). In addition, patients were stratified by dominant stone composition (≥ 50% fraction). Bilateral PFV measurements were obtained using the preoperative computed tomography scan and specialized three-dimensional imaging software. The PFV of stone-bearing kidneys was significantly greater than non-stone-bearing kidneys (397.3 and 323&nbsp;cc, respectively; p = 0.004), with the PFV difference in patients with CO-dominant stone-bearing kidneys reaching statistical significance (p = 0.003). Subgroup analysis showed greater PFV surrounding the stone-bearing kidney irrespective of gender (p = 0.03), with male patients possessing significantly greater stone-bearing (p = 0.01) and bilateral PFV (p = 0.01) compared to females. No significant correlations were found between PFV and stone volume or stone density. The PFV of calcium oxalate stone-bearing kidneys is significantly greater than non-stone-bearing kidneys for both male and female patients with nephrolithiasis