Editorial comment
Letters of recommendation have been a mainstay of applications for training since the inception of modern training programs in the late 19th century. Aside from the applicant's personal statement, they represent the only truly subjective portion of the application. Herein lies the great conundrum of letters of recommendation (LORs): They are a potent window into the applicants ’ humanity, work ethic, and curiosity—all values we seek in training applicants—and yet they also present the greatest opportunity for bias in selection decisions in that they cannot truly be “blinded.” (Source: Urology)
Source: Urology - June 1, 2022 Category: Urology & Nephrology Authors: Hadley M. Wood Source Type: research

Editorial comment
Despite the implementation of the Universal Protocol in 2004 for hospitals accredited by the Joint Commission, wrong-site surgeries continue to occur with an estimate of about one event per 100,000 surgical procedures.1 The protocol involves preoperative verification of the patient, marking the surgery site, and having a time out amongst the operating room personnel to verify the patient and the operation to be performed. In this case, the scrotal ultrasound should have been available and intraoperative verification could have been done since the right testicular mass was palpable. (Source: Urology)
Source: Urology - June 1, 2022 Category: Urology & Nephrology Authors: Joseph Y. Clark Source Type: research

Author reply
We thank Dr. Clark for his interest and insightful points regarding our case of wrong-side orchiectomy and testicular replantation.1 Herein, we aim to address the queries raised by the author and to provide further understanding of the implications of our report. (Source: Urology)
Source: Urology - June 1, 2022 Category: Urology & Nephrology Authors: Fatma Betul Tuncer, Russell S. Frautschi, Scott D. Lundy, Georges- Pascal Haber, Brian Gastman Source Type: research

Editorial comment
Health literacy has been increasingly identified as a significant contributor to health-related outcomes. Increasing attention has been drawn to its impact on healthcare utilization, complication rates, all-cause mortality, and patient satisfaction.1 Despite the profound impact on health outcomes, the effects of health literacy on the surgical population remains an understudied topic, with only a few urologic studies published to date.2,3 Elucidating the impact of health literacy among surgical patients is paramount as patients navigate complex decision-making, including understanding the risks and benefits of surgical int...
Source: Urology - June 1, 2022 Category: Urology & Nephrology Authors: Kassandra E. Zaila Ardines, Petar Bajic Source Type: research

Author reply
We thank the editorial staff for their insightful comments and agree with their assessment. Our study aimed to raise awareness about health literacy disparities that exist amongst urology patients – as increasing awareness is the first step toward implementing change. Providers often underestimate a patient's health literacy which can greatly impact preoperative counseling, education, and surgical outcomes.1 While health literacy has been studied amongst urologic oncology patients, there ar e limited to no data available regarding the effects of health literacy on surgical outcomes following reconstructive and prosthetic...
Source: Urology - June 1, 2022 Category: Urology & Nephrology Authors: Rohan G. Bhalla, Niels V. Johnsen Source Type: research

Editorial comment
The transgender population is increasing, with an estimated 25 million people worldwide1 and over 1 million the United States.2 I think we are all aware of the recent interest in creating programs to serve this population with the creation of specialized centers. This very well done video is a testament to the need for specialized providers with expert skills in order to perform these complex surgeries. The female to male gender affirming surgical techniques are rapidly evolving but still incredibly complex, technically challenging, and present a high chance for short and long-term complications. (Source: Urology)
Source: Urology - June 1, 2022 Category: Urology & Nephrology Authors: Andrew C. Peterson Source Type: research

Author reply
We appreciate thoughtful and encouraging editorial comments. We feel fortunate to have been able to accumulate and now share our early experience in management of these complex problems in patients with complications of neophallic urethra. We know how confusing, disorienting and frustrating these simultaneous fistulas, long strictures and recurrent cavities could be. The goal of this 7-min video was to summarize the 7 years of our center's early experience and share it with the other learners in this new field. (Source: Urology)
Source: Urology - June 1, 2022 Category: Urology & Nephrology Authors: Dmitriy Nikolavsky Source Type: research

Editorial comment
Inthis 2022 edition of Urology, Tay et al performed a retrospective analysis with 7.5 months of follow up to compare perioperative outcomes of 283 patients undergoing holmium laser enucleation of the prostate (HoLEP) by two experienced surgeons based on gland size ( (Source: Urology)
Source: Urology - June 1, 2022 Category: Urology & Nephrology Authors: Mark A. Assmus, Matthew S. Lee, Amy E. Krambeck Source Type: research

Author reply
We like to thank Assmus and colleagues for the insightful editorial comment of the article titled ‘HoLEP: A comparative study of men with massive prostate volumes ≥150 mL and (Source: Urology)
Source: Urology - June 1, 2022 Category: Urology & Nephrology Authors: Li June Tay, Meghana Kulkarni, Akinlolu Oluwole-Ojo, Leigh James Spurling, Oussama El-hage, Ella DiBenedetto, Marios Hadjipavlou, Rick Popert, Ben Challacombe Source Type: research

Editorial comment
This survey study provides informative perspectives about the January 2021 Urology match, which was conducted in the heart of the COVID-19 pandemic with restricted access to externships and via virtual interviews. The authors report that most responders, both candidates and program directors (PDs), were satisfied with their match outcomes. Nearly all candidates and PDs were strongly in favor of expanding future opportunities for in-person externships. These externships allow candidates to visit another program, build relationships and assess potential fit, and obtain reference letters, and they are particularly important f...
Source: Urology - June 1, 2022 Category: Urology & Nephrology Authors: Steven C. Campbell, Jack A. Campbell, Jacob M. Knorr, Bryan Naelitz Source Type: research

Editorial comment
The landscape of urologic employment has changed dramatically over the past 10 years. Older models of employment, such as independent practice and academic practice have given way to new models of employment, such as hospital-based employment, multispecialty group practice, and private equity (PE) acquired practices. Nie et al demonstrated that private equity acquisitions have become a dominant form of urology practice consolidation.1 They estimate that 7.2% of private practice urologists were employed by private equity backed firms and 25% of urologists in New Jersy and Maryland are employed by private equity firms. (Source: Urology)
Source: Urology - June 1, 2022 Category: Urology & Nephrology Authors: Damara Kaplan Source Type: research

Author reply
We thank the author for highlighting the significance of access for early detection and prompt treatment of urologic disease. Healthcare access for Medicaid-insured patients will be important to monitor as private equity acquisitions continue to reshape the urology landscape. In the year since our initial study, at least 1 additional private equity backed platform company has formed and numerous practices have been acquired in roll-up acquisitions.1,2 In addition, the first known “exit” by a private equity firm has occurred with the sale of northeast urology platform to a for-profit, multispecialty physician group. (Source: Urology)
Source: Urology - June 1, 2022 Category: Urology & Nephrology Authors: James Nie, Benjamin N. Breyer, Michael S. Leapman Source Type: research

Cover 1
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Source: Urology - June 1, 2022 Category: Urology & Nephrology Source Type: research

Aims and Scope
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Source: Urology - June 1, 2022 Category: Urology & Nephrology Source Type: research

Editorial Board
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Source: Urology - June 1, 2022 Category: Urology & Nephrology Source Type: research