Browsing by Author "Rourke, Keith F."

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    Experiences and Outcomes of the Society of Genitourinary Reconstructive Surgeons Fellowship Training: Growth in Fellowships Mirrors the Evolution of the Discipline
    (Elsevier Inc., 2024) Calvo, Carlos I.; Buckley, Jill C.; Joshi, Pankaj; Peterson, Andrew; Wood, Hadley; Simhan, Jay; Rourke, Keith F.
    © 2024 The AuthorsObjective: To describe experiences and outcomes of the Society of Genitourinary Reconstructive Surgeons (GURS) fellowship match. In 2012, GURS developed a centralized fellowship match which has grown from 13 to 30 programs. Methods: GURS match statistics and case logs were reviewed from 2013-2024. Additionally, a 37-question survey evaluating satisfaction, procedural competency, fellowship experience, and employment opportunities were sent to graduates. Linear regression was performed to examine trends over time. Results: Over the study period, program match success remained stable (94.7%; P =.50) while applicant success (63.3%) increased over time (P =.04). North American and female applicants experienced higher match success (72.8% and 73.6%) compared to their international (35.5%; P <.0001) and male counterparts (60.0%; P =.02). On case log analysis, mean surgical volumes per year increased in urethral reconstruction (mean=88.1; P =.02), male sexual health (n = 32.7; P =.03), genital reconstruction (mean = 16.4; P <.01) and abdominal reconstruction (mean = 24.5; P =.03). Male incontinence surgeries remained stable (mean = 30.5; P =.21) while female reconstruction declined (mean = 23.2; P =.01). With a survey response rate of 54.5% (97/178), training satisfaction was 95.9% which did not differ by gender (P =.54) or year of training (P =.22). Around 97.9% felt competent to enter unsupervised reconstructive practice, 94.8% reported an understanding of the relevant literature and 96.9% were satisfied with their job as a reconstructive urologist. Around 49.5% identified a different case mix in practice compared to fellowship, most commonly related to abdominal (44.9%) or genital reconstruction (16.3%). Conclusion: GURS fellowships have grown organically over the last decade and mirror the growth and evolution of the discipline with sustained high levels of graduate satisfaction, surgical experience, competence, scholarly inquiry and employment.
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    Refining Bacteriuria as a Risk Factor for Complications After Urethroplasty: Identifying the Culprit
    (2024) Calvo, Carlos I.; Hoy, Nathan; Rourke, Keith F.
    OBJECTIVE To determine which bacteria are associated with an increased risk of 90-day complications after urethroplasty. Preoperative bacteriuria is associated with an increased risk of complications after urethroplasty. However, it remains unclear which specific micro-organisms are the primary drivers of this morbidity. METHODS A single-institution, 2-surgeon retrospective review was performed on patients undergoing urethroplasty from 08/2003 to 06/2021. Preoperative bacteriuria was considered significant when the patient had a mixed culture with >= 108 CFU/L or an identifiable micro-organism with >= 106 CFU/L. Descriptive statistics were used to summarize the results and chi-square was used to determine the association between 90-day complications (Clavien >= 2) and clinical characteristics/bacteria. RESULTS Out of 1611 patients, 23.2% (373) had significant preoperative bacteriuria. The most common pathogens included coagulase-negative staphylococcus 18.5% (69), mixed growth 15.8% (59), Escherichia coli 10.7% (40), and Enterococcus 14.2% (53). 7.9% (128/1611) experienced a significant 90-day complication (Clavien-Dindo >= 2). Gram-negative bacilli including E coli, and Morganella sp were associated with higher rates of postoperative complications (14.2%; P = .01) as well as Enterococcus sp (15.1%; P = .03). However, gram-positive cocci (7.9%; P = .97), gram-positive bacilli (11.8%; P = .47), mixed growth (5.1%; P = .54) and Candida (16.7%; P = .27) were not. Neither escalating concentrations of bacteria (P = .44) or number of strains (P = .08) were associated with increased risk of complications. CONCLUSION The main driver of bacteriuria-related complications after urethroplasty are gram-negative bacilli and Enterococcus sp. Patients with bacteriuria related to other micro-organisms can likely proceed with urethroplasty without increased risk of postoperative complications. UROLOGY 186: 1-6, 2024. (c) 2024 Elsevier Inc. All rights reserved.
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    Routine Imaging After Bulbar Urethral Reconstruction Does Not Impact Surgical Outcomes and May Not Be Necessary
    (2024) Calvo, Carlos I.; Rourke, Keith F.
    OBJECTIVE To assess whether omitting routine post-operative imaging adversely impacts clinical outcomes after bulbar urethroplasty. Contrast imaging is commonly performed prior to catheter removal after urethroplasty but the clinical need for this is unclear.
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    Routine Imaging After Bulbar Urethral Reconstruction Does Not Impact Surgical Outcomes and May Not Be Necessary
    (2024) Calvo, Carlos I.; Rourke, Keith F.
    OBJECTIVE To assess whether omitting routine post-operative imaging adversely impacts clinical outcomes after bulbar urethroplasty. Contrast imaging is commonly performed prior to catheter removal after urethroplasty but the clinical need for this is unclear.