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  • Canadian Urological Association Journal  (34)
  • 1
    Online Resource
    Online Resource
    Canadian Urological Association Journal ; 2019
    In:  Canadian Urological Association Journal Vol. 13, No. 12 ( 2019-02-22)
    In: Canadian Urological Association Journal, Canadian Urological Association Journal, Vol. 13, No. 12 ( 2019-02-22)
    Abstract: Introduction: The number of female medical students and physicians entering the workforce is increasing. Despite this trend, some surgical specialties are still considered male-dominant. Urology has a significant male predominance in both residency and independent practice. This male predominance could have an impact on the physician work force, mentorship opportunities for females pursuing surgery, and on medical student attraction to urology as a specialty. Research conducted in the U.S. has shown that although fewer females enter the field of urology, acceptance rates between the two genders are similar. This study aims to identify if a trend towards gender-specific acceptance into urology residency exists within Canada. We also seek to identify if gender trends in acceptance to urology differ from other surgical specialties in Canada and assess the current workforce trends in Canadian urological practice. Methods: Canadian Residency Matching Services (CARMS) data from the previous 10 years was analyzed. This data was accessed from the CARMS website.1 Logistic regression analyses were used to assess if any significant difference exists between the rates of female and male applicant acceptance into urology. These rates were then compared to the rates of female and male acceptance into surgical residency as a whole and to specific surgical specialties, such as general surgery, orthopedics, and otolaryngology. Results: Within urology applicants, there is no evidence that the success rate over time between males and females differs (p=0.47). Within surgical residency applicants, there is no evidence that the success rate over time differs between male and female applicants (p=0.84). In comparing these two rates, there is also no significant difference between rates of acceptance to urology vs. surgery in general for female applicants (p=0.45). General surgery has a higher growth of females entering into the specialty compared to urology (p=0.026). Conversely, otolaryngology (p=0.123) and orthopedics (p=0.163) did not show a significant difference in the rates of female acceptance as compared to males over time. Our small sample size of 451 applicants over the 10-year time span (122 female, 329 male) could represent a limitation, however, we did ensure to analyze a 10-year sample to attempt to get an accurate representation of any trends. Conclusions: Our data identifies that there is no significant trend toward male acceptance into urology over female applicants. There is no significant difference related to female acceptance specifically into urology or any difference between rates of females accepted into urology as compared to all other surgical subspecialties combined.
    Type of Medium: Online Resource
    ISSN: 1920-1214 , 1911-6470
    Language: Unknown
    Publisher: Canadian Urological Association Journal
    Publication Date: 2019
    detail.hit.zdb_id: 2431403-1
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  • 2
    In: Canadian Urological Association Journal, Canadian Urological Association Journal, Vol. 15, No. 4 ( 2020-09-28)
    Abstract: Introduction: The Royal College of Physicians and Surgeons of Canada’s Competence by Design (CBD) initiative presents curricula challenges to ensure residents gain proficiency while progressing through training. To prepare first-year urology residents (R1s), we developed, implemented, and evaluated a didactic and simulation-focused boot camp to implement the CBD curriculum. We report our experiences and findings of the first three years. Methods: Urology residents from two Canadian universities participated in the two-day boot camp at the beginning of residency. Eleven didactic and six simulation sessions allowed for instruction and deliberate practice with feedback. Pre-and post-course multiple-choice questionnaires (MCQs) and an objective structured clinical exam (OSCE) evaluated knowledge and skills uptake. For initial program evaluation, three R2s served as historical controls in year 1. Results: Nineteen residents completed boot camp. The mean age was 26.4 (±2.8) and 13 were male. Participants markedly improved on the pre- and post-MCQs (year 1: 62% and 91%; year 2: 55% and 89%; year 3: 58% and 86%, respectively). Participants scored marginally higher than the controls on four of the six OSCE stations. OSCE scores remained 〉 88% over the three cohorts. All participants reported higher confidence levels post-boot camp and felt it was excellent preparation for residency. Conclusions: During its first three years, our urology boot camp has demonstrated high feasibility and utility. Knowledge and technical skills uptake were established via MCQ and OSCE results, with participants’ scores near or above those of R2 controls. This boot camp will remain in our CBD curriculum and can provide a framework for other urology residency programs.
    Type of Medium: Online Resource
    ISSN: 1920-1214 , 1911-6470
    Language: Unknown
    Publisher: Canadian Urological Association Journal
    Publication Date: 2020
    detail.hit.zdb_id: 2431403-1
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  • 3
    Online Resource
    Online Resource
    Canadian Urological Association Journal ; 2013
    In:  Canadian Urological Association Journal Vol. 7, No. 3-4 ( 2013-04-16), p. e251-3
    In: Canadian Urological Association Journal, Canadian Urological Association Journal, Vol. 7, No. 3-4 ( 2013-04-16), p. e251-3
    Abstract: Transplant renal artery stenosis (TRAS) is a potentially treatable cause of allograft dysfunction, hypertension and graft loss. The mainstay of treatment includes angioplasty and endovascular stenting, although observation and surgery are at times indicated. We present an unusual case of TRAS secondary to mechanical compression from a patient’s enlarged native polycystic kidneys. This was treated with bilateral native nephrectomy and evidence of TRAS improved both clinically and radiographically. Recognition and treatment is important in preventing irreversible complications of TRAS.
    Type of Medium: Online Resource
    ISSN: 1920-1214 , 1911-6470
    Language: Unknown
    Publisher: Canadian Urological Association Journal
    Publication Date: 2013
    detail.hit.zdb_id: 2431403-1
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  • 4
    Online Resource
    Online Resource
    Canadian Urological Association Journal ; 2014
    In:  Canadian Urological Association Journal Vol. 8, No. 5-6 ( 2014-06-19), p. 413-
    In: Canadian Urological Association Journal, Canadian Urological Association Journal, Vol. 8, No. 5-6 ( 2014-06-19), p. 413-
    Abstract: Introduction: The incidence of renal cell carcinoma (RCC) continues to rise concurrently with the increased prevalence of end-stage renal disease worldwide. Treatment for small renal masses continues to be partial nephrectomy mostly involving the clamping of renal blood vessels. Although necessary, this technique results in warm renal ischemia and reperfusion injury (IRI) to the afflicted kidney. We have recently demonstrated that hydrogen sulfide (H2S), a novel endogenous gaseous molecule, protects against prolonged cold and short-term warm renal IRI. In the current study, we examined whether exogenous H2S has long-term protective effects against warm renal IRI associated with renal surgical procedures.Methods: Uni-nephrectomized Lewis rats underwent 1 hour of warm ischemia induced by clamping of the renal pelvis. Animals underwent either intraperitoneal treatment with phosphate buffered saline (PBS; IRI group) or PBS supplemented with 150 μM NaHS (H2S group), and were compared against Sham-operated rats.Results: H2S treatment improved long-term renal function as serum creatinine at day 7 was significantly decreased in the H2S group compared to IRI animals (p 〈 0.05). H2S treatment decreased the expression of pro-inflammatory markers TLR-4, TNF-α, IFNγ, IL-2and ICAM-1, increased the expression of pro-survival molecule Bcl-2 and decreased the expression of pro-apoptotic marker BID at postoperative day 1. H2S-treated kidneys also showed a significant decrease (p 〈 0.05) in infiltration of macrophages at day 7 post-IRI compared to no treatment.Conclusion: H2S treatment improved long-term renal function and decreased long-term inflammation associated with warm IRI, and may offer a novel therapeutic approach to preventing warm IRI-induced renal injury associated with renal surgical procedures.
    Type of Medium: Online Resource
    ISSN: 1920-1214 , 1911-6470
    Language: Unknown
    Publisher: Canadian Urological Association Journal
    Publication Date: 2014
    detail.hit.zdb_id: 2431403-1
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  • 5
    Online Resource
    Online Resource
    Canadian Urological Association Journal ; 2016
    In:  Canadian Urological Association Journal Vol. 10, No. 3-4 ( 2016-04-18), p. 83-
    In: Canadian Urological Association Journal, Canadian Urological Association Journal, Vol. 10, No. 3-4 ( 2016-04-18), p. 83-
    Abstract: 〈 p 〉 〈 strong 〉 Introduction: 〈 /strong 〉 We compared the outcomes of single-incision, robotassisted laparoscopic pyeloplasty vs. multiple-incision pyeloplasty using the da Vinci robotic system. 〈 /p 〉 〈 p 〉 〈 strong 〉 Methods: 〈 /strong 〉 We reviewed all consecutive robotic pyeloplasties by a single surgeon from January 2011 to August 2015. A total of 30 procedures were performed (16 single:14 multi-port). Two different single-port devices were compared: the GelPort (Applied Medical, Rancho Santa Margarita, CA) and the Intuitive single-site access port (Intuitive Surgical, Sunnyvale, CA). 〈 /p 〉 〈 p 〉 〈 strong 〉 Results: 〈 /strong 〉 Patient demographics were similar between the two groups. Mean operating time was similar among the single and multi-port groups (225.2 min vs. 198.9 minutes [p=0.33]). There was no significant difference in length of hospital stay in either group (86.2 hr vs. 93.2 hr [p=0.76] ). There was no difference in success rates or postoperative complications among groups. 〈 /p 〉 〈 p 〉 〈 strong 〉 Conclusions: 〈 /strong 〉 Single-port robotic pyeloplasty is non-inferior to multiple-incision robotic surgery in terms of operative times, hospitalization time, success rates, and complications. Verifying these results with larger cohorts is required prior to the wide adoption of this technique. Ongoing objective measurements of cosmesis and patient satisfaction are being evaluated. 〈 /p 〉 〈 p 〉   〈 /p 〉
    Type of Medium: Online Resource
    ISSN: 1920-1214
    Language: Unknown
    Publisher: Canadian Urological Association Journal
    Publication Date: 2016
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  • 6
    Online Resource
    Online Resource
    Canadian Urological Association Journal ; 2014
    In:  Canadian Urological Association Journal Vol. 8, No. 7-8 ( 2014-08-11), p. 278-
    In: Canadian Urological Association Journal, Canadian Urological Association Journal, Vol. 8, No. 7-8 ( 2014-08-11), p. 278-
    Abstract: Introduction: Native nephrectomy in patients with autosomal dominant polycystic kidney disease (ADPKD) is performed on a case-by-case basis. We determine if pre-transplant maximal kidney length (MKL) can be used to predict ultimate nephrectomy status.Methods: We performed a retrospective review of ADPKD patients who underwent renal transplantation at our centre between January2000 and December 2012. Pre-transplant measurements of MKL alone, MKL adjusted for height (HtMKL), weight (WtMKL) and body mass index (BMI-MKL) were each assessed for their predictive ability via a receiver operating characteristic (ROC) curve analysis.Results: In total, 84 patients met our inclusion criteria, of which17 (20.2%) underwent native nephrectomy. An MKL ROC curve analysis revealed an area under the curve (AUC) of 0.867 (95% confidence interval [CI] 0.775–0.931; p 〈 0.001). An optimal cut-off criterion of 〉 21.5 cm revealed a sensitivity of 94.1% (95% CI 71.3–99.9) and specificity of 70.1% (95% CI 57.7–80.7) for eventual nephrectomy. The AUC of HtMKL, WtMKL and BMI-MKL ROC curves did not differ significantly from MKL alone. HtMKL improved specificity, but not overall test performance. The determination of the cut-off MKL may be influenced by the single-centre retrospective nature of this analysis, as well as the fact that renal size was determined by ultrasound and not computerized tomography or magnetic resonance imaging.Conclusion: MKL in patients with ADPKD is associated with the eventual need for nephrectomy and may be a useful clinical tool to risk stratify these patients and therefore guide patient conversations to a decision to leave the native kidneys in situ.
    Type of Medium: Online Resource
    ISSN: 1920-1214 , 1911-6470
    Language: Unknown
    Publisher: Canadian Urological Association Journal
    Publication Date: 2014
    detail.hit.zdb_id: 2431403-1
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  • 7
    In: Canadian Urological Association Journal, Canadian Urological Association Journal, Vol. 13, No. 11 ( 2019-01-24)
    Abstract: Introduction: We aimed to evaluate the impact of thrombo-embolic-deterrent + intermittent pneumatic compression (TED + IPC) vs. muscle pump activator (MPA) on incisional wound healing in kidney and simultaneous pancreas- kidney (SPK) transplant recipients. Methods: We conducted a single-centre, randomized controlled trial in which 104 patients (kidney n=94; SPK n=10) were randomly assigned to wear TED + IPC (n= 52) or MPA (n=52) for the first six days following surgery. Patient demographics, postoperative outcomes, and incisional wound images were taken using a HIPAA-compliant application on postoperative days (POD) 3, 5, and 30, and assessed using the validated Southampton Wound Care Score. Results: There were no demographic differences between the groups. The MPA group had a significant improvement in wound healing on POD 3 (p=0.04) that persisted until POD 5 (p=0.0003). At POD 30, both groups were similar in wound healing outcomes (p=0.51). Bayesian inferential analysis revealed that the use of TED + IPC following transplantation had inferior outcomes compared to the use of MPA with sequential moderate evidence. The rate of complex wound infections was significantly greater in the TED + IPC group compared to the MPA group (29% vs. 12%, respectively; p=0.03). Patients were more satisfied with the use of a MPA device than TED + IPC. No major complications were encountered in either group. Conclusions: The use of a MPA device in the immediate postoperative period leads to a significant improvement in immediate and early wound healing, and decreased number of complex wound infections following kidney and SPK transplantation compared to standard TED + IPC therapy. Patients were more satisfied with the use of a MPA device than TED + IPC.
    Type of Medium: Online Resource
    ISSN: 1920-1214 , 1911-6470
    Language: Unknown
    Publisher: Canadian Urological Association Journal
    Publication Date: 2019
    detail.hit.zdb_id: 2431403-1
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  • 8
    Online Resource
    Online Resource
    Canadian Urological Association Journal ; 2020
    In:  Canadian Urological Association Journal Vol. 14, No. 5 ( 2020-03-30)
    In: Canadian Urological Association Journal, Canadian Urological Association Journal, Vol. 14, No. 5 ( 2020-03-30)
    Type of Medium: Online Resource
    ISSN: 1920-1214 , 1911-6470
    Language: Unknown
    Publisher: Canadian Urological Association Journal
    Publication Date: 2020
    detail.hit.zdb_id: 2431403-1
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  • 9
    Online Resource
    Online Resource
    Canadian Urological Association Journal ; 2020
    In:  Canadian Urological Association Journal Vol. 15, No. 4 ( 2020-09-28)
    In: Canadian Urological Association Journal, Canadian Urological Association Journal, Vol. 15, No. 4 ( 2020-09-28)
    Abstract: Introduction: The purpose of this study was to document the variability of faculty surgeon electrodermal activity (EDA) peaks during laparoscopic donor nephrectomy (LDN) to determine the effect of case difficulty and learner expertise on the stress response. Methods: EDA for a single faculty surgeon was captured over 15 LDN cases using an Empatica E4 wristband. During each case, one of three transplant fellows (novice, intermediate, or expert level LDN expertise) participated. Difficulty was rated preoperatively as “low/moderate/high” by the faculty. EDA peaks were collected and analyzed; the frequency and magnitude of EDA peaks, case difficulty, and fellow expertise were compared using a two-way factorial ANOVA. Results: The main effects of learner expertise (F[2, 308]=11.27, p 〈 0.001) and difficulty rating (F[2, 414]=15.13, p 〈 0.001) were significant. The interaction between difficulty and expertise on faculty EDA peaks was also significant (F[3, 391]=14.29, p 〈 0.001). The novice fellow resulted in higher faculty EDA levels compared to intermediate and expert fellows on low-difficulty cases, but not moderate- or high-difficulty cases. Conclusions: This is the first report examining faculty surgeon EDA across cases of varying difficulty and varying learner expertise during a high-stakes operation. EDA levels were inversely proportional to the expertise of the learner and case difficulty, suggestive of a significant impact of learner autonomy on faculty stress response.
    Type of Medium: Online Resource
    ISSN: 1920-1214 , 1911-6470
    Language: Unknown
    Publisher: Canadian Urological Association Journal
    Publication Date: 2020
    detail.hit.zdb_id: 2431403-1
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  • 10
    Online Resource
    Online Resource
    Canadian Urological Association Journal ; 2021
    In:  Canadian Urological Association Journal Vol. 15, No. 6S1 ( 2021-06-01), p. S2-4
    In: Canadian Urological Association Journal, Canadian Urological Association Journal, Vol. 15, No. 6S1 ( 2021-06-01), p. S2-4
    Type of Medium: Online Resource
    ISSN: 1920-1214 , 1911-6470
    Language: Unknown
    Publisher: Canadian Urological Association Journal
    Publication Date: 2021
    detail.hit.zdb_id: 2431403-1
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