Oluwarotimi Nettey

Disparities in female urologic case distribution with new subspecialty certification and surgeon gender

To examine surgical case volume characteristics in certifying urologists associated with common female urologic procedures to evaluate the practice patterns, given the recent establishment of subspecialty certification in Female Pelvic Medicine and Reconstructive Surgery (FPMRS) and changes in urologist gender composition.

Prolapse repair with and without apical resuspension—Practice patterns among certifying American urologists

To examine surgeon characteristics in certifying urologists performing prolapse surgeries. Anterior compartment prolapse is often associated with apical prolapse, with high rates of recurrence when anterior repair is performed without apical resuspension.

Gender Representation in Urologic Subspecialties

OBJECTIVE To examine associations between urologic subspecialization, surgeon gender and practice patterns among certifying urologists over the last 13 years. MATERIALS AND METHODS Demographic data of certifying and recertifying urologists (2004 to 2015) were obtained from the American Board of Urology. We investigated gender-specific trends in self-reported practice type (academic practice, private practice), subspecialization, and employment as a full-time vs part-time physician, relative to certification year and cycle. RESULTS Of 9140 urologists applying for certification or recertification over the study period, 815 (8.9%) were women. The largest proportion of female surgeon candidates (65.0%) was first-time certifiers. Women represented 16.7% of first-time certifying urologists (P < .001) and reported practicing in academia more frequently (23.6%) compared with 13.7% of men (P < .001). Female surgeons identified as subspecialists in greater numbers (46.4%) than their male counterparts (23.4%) across all certification years and cycle cohorts (P < .001). Women reported subspecializing in female urology (24.2%) and pediatrics (10.2%) at higher frequencies than their male colleagues (4.6% and 3.1% respectively, both P < .001). Female and male surgeon candidates requested certification in equal proportion in andrology and infertility (P = .83) and endourology (3.6% female vs 5.8% male, P = .13), however differed in oncology (4.2% female vs 7.2% male, P = .001). CONCLUSION A growing proportion of certifying urologists are women, with the greatest enrichment among those seeking first-time certification. Since 2004, female surgeons account for a disproportionate volume of urologists who practice in the academic setting and identify as subspecialists.

Self-reported Black race predicts significant prostate cancer independent of clinical setting and clinical and socioeconomic risk factors

INTRODUCTION AND OBJECTIVE Studies have linked Black race to prostate cancer (CaP) risk but most fail to account for established risk factors such as 5-ARI use, prostate volume, socioeconomic status, and hospital setting. We assess whether Black race remains associated with CaP and Gleason ≥3 + 4 CaP, after adjusting for clinical setting and socioeconomic and clinical factors at prostate biopsy, with a focus on men aged 40-54 years, who may be excluded from current screening guidelines. METHODS We recruited 564 men age 40-79 undergoing initial prostate biopsy for abnormal PSA or digital rectal examination (DRE) from three publicly funded and two private hospitals from 2009-2014. Univariate and multivariate analyses examined the associations between hospital type, race, West African Ancestry (WAA), clinical, and sociodemographic risk factors with CaP diagnosis and Gleason ≥3 + 4 CaP. Given changes in CaP screening recommendations, we also assess the multivariate analyses for men aged 40-54. RESULTS Black and White men had similar age, BMI, and prostate volume. Black men had higher PSA (8.10 ng/mL vs. 5.63 ng/mL) and PSA density (0.22 ng/mL/cm3 vs. 0.15 ng/mL/cm3, all p < 0.001). Blacks had higher frequency of CaP (63.1% vs. 41.5%, p<0.001) and Gleason ≥3+4 CaP relative to Whites in both public (27.7% vs 11.6%, p<0.001) and private (48.4% vs 21.6%, p = 0.002) settings. In models adjusted for age, first degree family history, prostate volume, 5-ARI use, hospital type, income, marital and educational status, Black race was independently associated with overall CaP diagnosis (OR = 2.13, p = 0.002). There was a significant multiplicative interaction with Black race and abnormal DRE for Gleason ≥3 + 4 CaP (OR = 2.93, p = 0.01). WAA was not predictive of overall or significant CaP among Black men. Black race (OR = 5.66, p = 0.02) and family history (OR = 4.98, p = 0.01) were independently positively associated with overall CaP diagnosis for men aged 40 to 54. CONCLUSIONS Black race is independently associated with CaP and Gleason ≥3+4 CaP after accounting for clinical and socioeconomic risk factors including clinical setting and WAA, and has a higher odds ratio of CaP diagnosis in younger men. Further investigation into optimizing screening in Black men aged 40 to 54 is warranted.

Ureteral Complications of Pediatric Renal Transplantation

Purpose: Ureteral complications following renal transplantation are more common in children than in adults. We identify potential risk factors for ureteral complications in pediatric patients. Materials and Methods: We retrospectively studied a cohort of patients who underwent renal transplantation at Lurie Childrens Hospital between 2004 and 2016. We analyzed the associations between patient characteristics, operative factors, graft characteristics and postoperative complications. Results: A total of 224 renal transplantations in 219 patients were identified. Preexisting bladder pathology was present in 25% of cases. Overall rate of ureteral complications was 16%, with symptomatic vesicoureteral reflux being the most common. Ureteral complications were seen significantly more frequently in patients with underlying bladder pathology (26% vs 12%, p = 0.01). Rate of postoperative vesicoureteral reflux in patients with bladder pathology was lower when a urologist performed the reimplantation but the difference was not statistically significant (15% vs 27%, p = 0.35). Urologists were significantly more likely to perform the ureteral anastomosis in patients on clean intermittent catheterization (85% vs 43%, p = 0.004) and in patients with a history of complex bladder reconstruction (75% vs 28%, p <0.001). Conclusions: Patients with existing bladder pathology are at increased risk for ureteral complications, particularly vesicoureteral reflux. Since pediatric urologists routinely perform ureteral reimplantation in patients with existing bladder pathology, these patients may benefit from a multidisciplinary approach between urology and transplant surgery at renal transplantation.

MP86-18 GENDER DIFFERENCES IN UROLOGICAL SUBSPECIALTIES

INTRODUCTION AND OBJECTIVES: To examine representation in urological subspecialties in relation to surgeon gender and characterize practice patterns among certifying urologists over the last 13 years. METHODS: Demographic and case log data of certifying and recertifying urologists (2004 to 2015) was obtained from the American Board of Urology (ABU). We investigated gender-specific trends in selfreported practice type (academic or private practice), sub-specialization, and employment as a full-time versus part-time physician, relative to certification year and cycle. RESULTS: Of a total of 9,140 urologists applying for certification or recertification over the study period, 815 (8.9%) were women, with first time certifiers representing the largest proportion of women surgeon candidates at 65.0% of all women certifying and 16.7% of total first time certifying urologists (p<0.001). 23.6% of women surgeons identified their practice as being academic compared to 13.7% of their male colleagues(p<0.001). Women surgeons identify as sub-specialists in greater numbers (46.4%) than their male counterparts (23.4%) across all certification cycle cohorts and certification years (p<0.001). 25.4% of all women urologists requesting certification identify as subspecialists in female urology and 10.4% in pediatrics compared to 4.8% and 3.1% of their male colleagues respectively (both p<0.001). Female and male surgeons request certification in equal proportion in infertility (1.9% women compared to 1.8% men). Female surgeons however lag behind their male colleagues in oncology (4.5% compared to 7.6%) as well as endourology and stone disease (4.0% women compared to 6.1% men) across all certification years. CONCLUSIONS: A growing proportion of certifying urologists are women surgeons, who are disproportionately first time certifiers. Women surgeons account for a disproportionate volume of urologists who practice in the academic setting and identify as sub-specialists. Source of Funding: None

MP85-10 HIGH RATES OF ADMISSION SEEN WITH ADULT SPINA BIFIDA PATIENTS PRESENTING TO THE EMERGENCY ROOM

35). 21 (78%) had NGB due to spina bifida. Median dLPP on index UDS was 47 cm H2O (IQR 42, 60). The most common interventions for dLPP>40 were adjustment to anticholinergics (n1⁄417, 63%), modification of CIC schedule (n1⁄414, 52%), and BTX (n1⁄44, 15%). Last median follow-up was 1.2 years for repeat UDS, 2.5 years for glomerular filtration rate (GFR), and 2.4 years for RUS. There was a median 2.3 mL/min/1.73 m decrease in GFR (IQR -17, 7.5). No patients advanced their CKD stage. Repeat UDS demonstrated dLPP>40 resolved in 16/ 27 (59%) patients. New, mild hydronephrosis was seen in 1 patient. CONCLUSIONS: At interim follow up of 2.4 years, a carefully tailored non-surgical treatment protocol for patients with NGB and dLPP>40 is safe and effective in patients with rigorous follow-up. Selecting patients for augmentation cystoplasty requires a balanced assessment of a multitude of patient-specific factors.