Harris AM, Teplitsky S, Kraft KH, Fang R, Meeks W, North A. Burnout: a call to action from the AUA Workforce Workgroup. J Urol. 2023;209(3):573-579.

Special thanks to Drs Ashraf Selim and Mahmoud Mima at the University of Illinois at Chicago.

Burnout is an enormous problem among physicians, and urologists are no exception with increasing rates over time despite increased discussion and awareness. A Mayo Clinic study in 2016 found it to be as high as 64%, and an AUA survey that year identified a 40% rate. Rates were nearly the same overall in an AUA Census in 2021, but when analyzed, burnout among female urologists increased by 14%.

The younger age group seemed to suffer more, and this was attributed to financial factors as well as longer hours of work. Interestingly, COVID-19 did not seem to have increased the rate of burnout. Spending time replying to patients via the electronic health record as well as lack of autonomy, increased regulation, increased bureaucracy, isolation, increased administrative burden, and decreased reimbursement were among the major factors cited. High rates of depression and suicide have been reported among trainees, constituting a major cause of death in this demographic.

For the good of our field, burnout must be addressed in depth. In addition to the financial burden on the health system, burnout can lead to physician depression and deterioration in the quality of patient care and patient satisfaction. Although there are no silver bullets, there are opportunities for leaders to drive material change. Institutions can take a systemic approach to improve employee mental health and well-being, as well as practical interventions such as scribes. Burnout is real, and it is imperative that we give it the thoughtful care that it is due.

Wu J, Ho W, Klotz L, Yuan M, Lee JY, Krakowsky Y. Assessing “spin” in urology randomized controlled trials with statistically nonsignificant primary outcomes. J Urol. 2023;209(3):494-503.

Special thanks to Drs Graham Hale and Samuel Ohlander at the University of Illinois at Chicago.

Medical research scandals have lately captured news headlines, particularly within Alzheimer’s research. These authors embarked on a timely and critical appraisal of a small sliver of our own field’s literature, assessing spin and its severity in randomized controlled trials (RCTs) with statistically nonsignificant primary outcomes. They found the use of spin, defined as an emphasis or language manipulation in reporting that may influence the interpretation of results, was pervasive in this setting and reported it present in 76% of studies. They categorized the degree as moderate or severe in nearly half (46%).

In this study, 2 independent reviewers analyzed a sample of 46 urology-related negative RCTs across a range of journals between 2019 and 2021. Using Boutron’s criteria to classify the strategies and severity of spin, they report the most prevalent spin strategy in abstracts was “obscuring the statistical nonsignificance of the primary outcome and focusing on statistically significant secondary results” and “emphasis of trend despite nonsignificant results” within the main text.

Although taken from a modest sample size and with only negative RCTs, this study highlights an important issue permeating our literature and suggests that we may benefit from a more comprehensive review. The publication bias against negative results is well known and may be pressuring authors to contort their findings. Perhaps journals can try to lessen this bias while simultaneously enforcing clearer and more rigorous research methodologies. While the ultimate burden of incorporating research findings into clinical practice lies with the reader, patients, clinicians, and researchers all lose while this affliction lingers.

Hakam N, Shaw NM, Lui J, Abbasi B, Myers JB, Breyer BN. Role for conservative management in grade V renal trauma. J Urol. 2023;209(3):565-572.

Special thanks to Drs Grace Chen and Simone Crivellaro at the University of Illinois at Chicago.

How can we confidently determine which patients to select for nonsurgical management of grade V renal trauma? By studying the outcomes of currently utilized management strategies, the authors of this paper sought to identify the patient characteristics associated with a successful course of conservative management.

Nearly 2,000 patients with grade V renal trauma were identified and stratified first by survival, then by whether a conservative or operative management strategy was employed. Conservative management included any intervention other than renorrhaphy, nephrectomy, or angioembolization, with the most common being the placement of a percutaneous drain or ureteral stent. Over one-third of surviving patients were successfully managed with conservative treatments. Factors associated with the decision to pursue conservative management included favorable hemodynamic factors such as a lower mean pulse rate and fewer blood transfusions, nonpenetrating mechanisms of injury, and lack of other abdominal injuries.

Of note, the mortality rate for patients managed conservatively was about 11%, which was less than half of the mortality rate for those who underwent surgery. While the authors understandably attributed this finding to selection bias, it provides evidence that hemodynamic stability and blunt mechanism of injury are important prognostic factors in successful nonoperative management. Another important question the authors posed was whether specific injury characteristics were important for delineating which patients would be amenable to conservative treatment. Unfortunately, the radiological data in this study were too limited to differentiate these diagnoses. For now, hemodynamic stability seems to be the most important factor in safely proceeding with conservative management.