Simone L. Vernez

C-SATS: Assessing Surgical Skills Among Urology Residency Applicants

Abstract Background: We 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 Methods: Twenty-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 assessmen...Abstract Background: We 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 Methods: Twenty-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 assessmen...BACKGROUND We 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 METHODS Twenty-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. RESULTS Overall, 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. CONCLUSIONS Crowd-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.

Prevalence of Hyperoxaluria in Urinary Stone Formers: Chronological and Geographical Trends and a Literature Review

PURPOSE To report chronological trends and geographical distributions related to the prevalence of hyperoxaluria in stone-forming patients. MATERIALS AND METHODS We systematically reviewed the existing literature between 1982 and 2013 seeking studies that assessed for hyperoxaluria (>45 mg/day [499.5 μmol/24 hour]) in recurrent stone formers. Studies that performed 24-hour urine analysis for urine oxalate in patients with recurrent urinary stones were included. Studies were divided chronologically and by geographical region, and prevalence rates of hyperoxaluria were compared between groups. RESULTS Our literature search provided 22 peer-reviewed articles involving 3636 patients in total. Ten studies were performed between 1982 and 2000, and 12 studies were performed between 2001 and 2013. The prevalence of hyperoxaluria in stone-forming patient cohorts was 24.8% and 45.1% (p = 0.019) in studies performed between 1982 and 2000 and 2001 and 2013, respectively. Hyperoxaluria rates were significantly higher in non-American cohorts compared with American cohorts (40.7% vs 23.0%; p = 0.018). Reported hyperoxaluria rates were higher in Asian countries compared with Western countries (56.8% and 23.8%; p < 0.001). CONCLUSIONS The prevalence of hyperoxaluria in stone-forming patients has increased over the past two decades and may be a contributing factor to the rising global prevalence of urolithiasis. A geographical disparity in hyperoxaluria may exist between Asian and Western countries. Future studies are needed to explain these trends and their consequences.

Effect of tumor location on survival in urinary bladder adenocarcinoma: A population-based analysis.

PURPOSE To investigate the prognostic significance of tumor location on survival outcomes in patients with urinary bladder adenocarcinoma (BAC). METHODS We retrospectively analyzed cases of BAC with known tumor location from the Surveillance, Epidemiology, and End Results database from 1973 to 2012. Data regarding patient demographics, tumor characteristics, and oncological and survival outcomes were collected. Patients were subgrouped according to tumor location into urachal/dome (dome and urachus [UD]), lateral wall (anterior, posterior, and lateral bladder walls [LW]), and base (trigone, ureteral orifices, and bladder neck [BL]). RESULTS A total of 1,361 cases of BAC with known tumor location were identified. More UD tumors were low grade (grade I and II; 51%) than LW (33%) and BL (43%) tumors (P<0.0001). UD lesions were the most likely to have metastatic spread (23% vs. 17% for LW and 15% for BL) (P<0.0001). The 5-year overall survival (OS) and disease-specific survival (DSS) rates were 37.3% and 49.0%, respectively, for all BAC. Furthermore, the 5-year OS rates were 42.3%, 35.9%, and 28.4% for UD, LW, and BL lesions, respectively (P<0.0001), whereas the 5-year DSS rates were 50.2%, 51.7%, and 42.1% for UD, LW, and BL lesions, respectively (P = 0.0097). Multivariate Cox regression analysis controlling for tumor stage and grade demonstrated that both tumors of the LW (hazards ratio [HR] = 1.52 for OS and 1.30 for DSS) and BL (HR = 1.71 for OS and 1.57 for DSS) conferred a worse prognosis relative to those of the UD (P< 0.05). CONCLUSIONS Tumor location of BAC is an independent prognostic factor for disease outcome. Our results suggest that the urachal and dome locations are associated with relatively favorable survival and oncological outcomes, whereas basal location confers poorer outcomes.

Cost Comparisons Between Different Techniques of Percutaneous Renal Biopsy for Small Renal Masses

PURPOSE To compare the costs associated with ultrasound (US)-guided hospital-based (UGHB), CT-guided hospital-based (CTG), and US-guided office-based (UGOB) percutaneous renal biopsy (PRB) for small renal masses (SRMs). METHODS We retrospectively analyzed patient demographics, tumor characteristics, R.E.N.A.L. nephrometry scores, and cost data of patients undergoing PRB for SRM at our institution from May 2012 to September 2015. Cost data, including facility costs, professional fees, and pathology, were obtained from the departments of urology, radiology, and pathology. RESULTS A total of 78 patients were included in our analysis: 19, 31, and 28 UGHB, CTG, and UGOB, respectively. There was no difference in age, gender distribution, or tumor size among the three groups (p-values 0.131, 0.241, and 0.603, respectively). UGOB tumors had lower R.E.N.A.L. nephrometry scores (p=0.008). There were no differences in nondiagnostic rates between the UGHB, CTG, and UGOB groups [4 (21%), 5 (16%), and 6 (21%)] (p=0.852). There were no differences in final tumor treatment strategies utilized among the UGHB, CTG, and UGOB groups (p=0.447). There were 0, 2 (6%), and 0 complications in the UGHB, CTG, and UGOB biopsy groups. Total facility costs were

The challenges in the diagnosis of detrusor underactivity in clinical practice: A mini-review

3449,

Precise Characterization and 3-Dimensional Reconstruction of the Autonomic Nerve Distribution of the Human Ureter

3280, and

Inguinal Hernia Repair

1056 for UGHB, CTG, and UGOB PRB, respectively (p<0.0001). There was no difference between the urologists and radiologists professional fees (p=0.066). Total costs, including facility costs, pathology fees, and professional fees, were

Nerve Sparing Robot-Assisted Radical Prostatectomy: Assessment of Clinical and Technical Factors Impacting Recovery of Sexual Function

4598,

Skin-to-tumor Distance Predicts Treatment Failure of T1A Renal Cell Carcinoma Following Percutaneous Cryoablation

4470, and

MP10-15 PATTERNS OF RECURRENCE IN DIFFERENT HISTOLOGICAL SUBTYPES OF BLADDER CANCER FOLLOWING RADICAL CYSTECTOMY

2129 for UGHB, CTG, and UGOB renal biopsy, respectively (p<0.0001). CONCLUSION For select patients with less anatomically complex, exophytic, and posteriorly located tumors, UGOB PRB provides equivalent diagnostic and complication rates while being significantly more cost-effective than either UGHB or CTG renal biopsy.