Investigative Urology

Self-reported Patient-Perpetrated Sexual Harassment and Subsequent Reporting Among Health Care Clinicians in Urology and Obstetrics-Gynecology: A Cohort Survey

To understand the experiences of urologists and obstetricians-gynecologists (obgyns) with patient-perpetrated sexual harassment (PPSH) since the clinical focus of these specialists may make them particularly vulnerable to PPSH.

A multiple-choice anonymous online survey was administered in the Departments of Urology and Obgyn at a single institution from 22 September, 2022-18 October, 2022. The survey assessed if clinicians had experienced PPSH, including gender harassment, unwanted sexual attention, and/or sexual coercion from patients, where PPSH was witnessed or experienced, and whether implementation of chaperones impacted their experiences with PPSH. We conducted descriptive analysis by clinician sex, department, and form of PPSH experienced. We also performed logistic regression analysis to identify clinician factors associated with experiencing PPSH.

Majority of respondents reported that they experienced or witnessed PPSH (78%, N = 100). Gender harassment was the most common form of PPSH experienced by clinicians (53%, N = 68). PPSH was most often experienced or witnessed in clinic (74%, N = 70) and inpatient wards (66%, N = 62). Of those who utilized chaperones, 80% (N = 57) of clinicians reported they either did not reduce or were unsure if they reduced PPSH. When adjusting for clinician factors, being a female clinician (adjusted odd ratio [aOR] = 5.1, 95% confidence interval (CI) 1.5-17.3), trainee (aOR = 6.9, 95% CI 1.1-44.6), or a urologist (aOR = 18.1, 95% CI 2.0-166.1) were associated with experiencing PPSH.

Our study highlights the pervasiveness of PPSH among urologists and obgyns. Future studies should elucidate what policy changes can be effective in protecting clinicians from PPSH.

Source: Catherine S. Nam, Priyanka Gupta, Daphna Stroumsa, Kaitland M. Byrd, Kathleen T. Lee, Meidee Goh, Anne P. Cameron, Elizabeth M. Viglianti. October 05, 2023. Self-reported Patient-perpetrated Sexual Harassment and Subsequent Reporting Among Health Care Clinicians in Urology and Obstetrics-Gynecology: A Cohort Survey. WOMEN IN UROLOGY| VOLUME 182, P239-243, DECEMBER 2023

Effect of 3-Dimensional Virtual Reality Models for Surgical Planning of Robotic-Assisted Partial Nephrectomy on Surgical Outcomes: A Randomized Clinical Trial

Importance: Planning complex operations such as robotic-assisted partial nephrectomy requires surgeons to review 2-dimensional computed tomography or magnetic resonance images to understand 3-dimensional (3-D), patient-specific anatomy.

Objective: To determine surgical outcomes for robotic-assisted partial nephrectomy when surgeons reviewed 3-D virtual reality (VR) models during operative planning.

Design, Setting, and Participants: A single-blind randomized clinical trial was performed. Ninety-two patients undergoing robotic-assisted partial nephrectomy performed by 1 of 11 surgeons at 6 large teaching hospitals were prospectively enrolled and randomized. Enrollment and data collection occurred from October 2017 through December 2018, and data analysis was performed from December 2018 through March 2019.

Interventions: Patients were assigned to either a control group undergoing usual preoperative planning with computed tomography and/or magnetic resonance imaging only or an intervention group where imaging was supplemented with a 3-D VR model. This model was viewed on the surgeon’s smartphone in regular 3-D format and in VR using a VR headset.

Main Outcomes and Measures: The primary outcome measure was operative time. It was hypothesized that the operations performed using the 3-D VR models would have shorter operative time than those performed without the models. Secondary outcomes included clamp time, estimated blood loss, and length of hospital stay.

Results: Ninety-two patients (58 men [63%]) with a mean (SD) age of 60.9 (11.6) years were analyzed. The analysis included 48 patients randomized to the control group and 44 randomized to the intervention group. When controlling for case complexity and other covariates, patients whose surgical planning involved 3-D VR models showed differences in operative time (odds ratio [OR], 1.00; 95% CI, 0.37-2.70; estimated OR, 2.47), estimated blood loss (OR, 1.98; 95% CI, 1.04-3.78; estimated OR, 4.56), clamp time (OR, 1.60; 95% CI, 0.79-3.23; estimated OR, 11.22), and length of hospital stay (OR, 2.86; 95% CI, 1.59-5.14; estimated OR, 5.43). Estimated ORs were calculated using the parameter estimates from the generalized estimating equation model. Referent group values for each covariate and the corresponding nephrometry score were summed across the covariates and nephrometry score, and the sum was exponentiated to obtain the OR. A mean of the estimated OR weighted by sample size for each nephrometry score strata was then calculated.

Conclusions and Relevance: This large, randomized clinical trial demonstrated that patients whose surgical planning involved 3-D VR models had reduced operative time, estimated blood loss, clamp time, and length of hospital stay.

Authors: Joseph D. Shirk, MD1; David D. Thiel, MD2; Eric M. Wallen, MD3; Jennifer M. Linehan, MD4; Wesley M. White, MD5; Ketan K. Badani, MD6; James R. Porter, MD7

Author Affiliations: 

1. David Geffen School of Medicine, Department of Urology, University of California, Los Angeles
2. Department of Urology, Mayo Clinic Florida, Jacksonville
3. Chapel Hill School of Medicine, Department of Urology, University of North Carolina, Chapel Hill
4. John Wayne Cancer Institute, Providence St John’s Health Center, Santa Monica, California
5. Department of Urology, The University of Tennessee Medical Center, Knoxville
6. Department of Urology, Icahn School of Medicine at Mount Sinai, New York, New York
7. Swedish Urology Group, Seattle, Washington

Source: Shirk JD, Thiel DD, Wallen EM, et al. Effect of 3-Dimensional Virtual Reality Models for Surgical Planning of Robotic-Assisted Partial Nephrectomy on Surgical Outcomes: A Randomized Clinical Trial. JAMA Netw Open. 2019;2(9):e1911598.

Vitamin A Rich Diet Diminishes Early Urothelial Carcinogenesis by Altering Retinoic Acid Signaling.

Urinary bladder cancer is one of the leading malignancies worldwide, with the highest recurrence rates. A diet rich in vitamin A has proven to lower the risk of cancer, yet the molecular mechanisms underlying this effect are unknown.

The capability of coenzyme Q10 to enhance heat tolerance in male rabbits: evidence from improved semen quality factor (SQF), testicular oxidative defense, and expression of testicular melatonin receptor MT1.

Heat stress (HS) has a great influence on the etiology of male infertility. Coenzyme Q10 (CoQ10), known to have powerful antioxidant effects, has been reported to have such actions that are effective to treat infertility caused by HS.

Direct in vivo comparison of [18F]PSMA-1007 with [68Ga]Ga-PSMA-11 and [18F]AlF-PSMA-11 in mice bearing PSMA-expressing xenografts.

The aim of this preclinical study was to directly compare [18F]PSMA-1007 with both [68Ga]Ga-PSMA-11 and [18F]AlF-PSMA-11 in mice bearing PSMA-positive tumor xenografts. Uptake was assessed by PET/CT at 1, 2 and 4 h post-injection, and by ex vivo measurement after 4 h.

The effects of oral administration of the novel muscarinic receptor antagonist DA-8010 on overactive bladder in rat with bladder outlet obstruction.

DA-8010 is a novel compound developed for the treatment of overactive bladder (OAB) and urinary incontinence. The aims of this study were to investigate the effects of DA-8010 on OAB in a rat model.

MicroRNA-381 facilitates autophagy and apoptosis in prostate cancer cells via inhibiting the RELN-mediated PI3K/AKT/mTOR signaling pathway.

MicroRNAs (miRNAs) function as oncogenes or tumor suppressors in an extensive variety of human cancers, including prostate cancer (PCa). Herein, the aim of this study is to investigate the effect of miR-381 on autophagy and apoptosis of PCa cells through the reelin (RELN)-mediated the PI3K/AKT/mTOR signaling pathway.

Effects of vibegron, a novel β3-adrenoceptor agonist, and its combination with imidafenacin or silodosin in a rat with partial bladder outlet obstruction.

Urgency is regarded as a core symptom of overactive bladder (OAB) and may correspond to detrusor overactivity (DO). One of the causes of OAB in men is bladder outlet obstruction (BOO) associated with benign prostatic hyperplasia (BPH).

Cytotoxic T Lymphocytes Regenerated from iPS Cells Have Therapeutic Efficacy in a Patient-Derived Xenograft Solid Tumor Model.

Current adoptive T cell therapies conducted in an autologous setting are costly, time consuming, and depend on the quality of the patient's T cells. To address these issues, we developed a strategy in which cytotoxic T lymphocytes (CTLs) are regenerated from iPSCs that were originally derived from T cells and succeeded in regenerating CTLs specific for the WT1 antigen, which exhibited therapeutic efficacy in a xenograft model of leukemia.

Benign prostatic hyperplasia treatment using plasmonic nanoparticles irradiated by laser in a rat model.

In the current study we have stimulated the efficacy of plasmonic nanoparticles (NPs) by laser hyperthermia to achieve a less invasive method for tumor photothermal therapy of benign prostatic hyperplasia (BPH).