Laena Hines

To evaluate associations between burnout, perfectionism, and grit among urology residents and attendings, hypothesizing that perfectionism would be associated with increased burnout and higher grit would be protective. We conducted a prospective, multi-institutional cross-sectional survey from January-May 2025. Participants completed the Maslach Burnout Inventory, Frost Multidimensional Perfectionism Scale, and Grit Scale. Burnout was defined as Emotional Exhaustion >27 or Depersonalization >10. Perfectionism and grit scores (2-5) were analyzed relative to burnout, including analyses of individuals above the 90th percentile for perfectionism. A total of 108 urologists responded (39% response rate), including 68 attendings (64%) and 39 residents (36%); 70% completed the perfectionism scale. Burnout was identified in 56 respondents (52%; 95% CI, 42%-62%) and was more common among residents than attendings (77% vs 37%; P <.001). Perfectionism showed non-linear association with burnout: moderate levels were associated with lower burnout, while scores above the 90th percentile were associated with higher burnout (77% vs 46%; OR 3.9; 95% CI, 1.3-11.2; P <.01). Grit was inversely associated with burnout; 92% of respondents with low grit were burned out versus 7% with the highest grit (P <.001). Burnout remains prevalent among urologists, particularly trainees. Perfectionism is associated with higher burnout, while grit appears strongly protective, suggesting potential targets for intervention.

Objective: Holmium laser enucleation of the prostate (HoLEP) has emerged as a gold standard for the surgical treatment of benign prostatic hyperplasia (BPH). Modern pulse‐modulated laser systems aim to improve enucleation efficiency and procedural safety, but no head‐to‐head comparison has been reported between MOSES 2.0 and QUANTA 150. This study provides a direct comparative analysis of perioperative efficiency and safety between these two technologies. Methods: We performed a retrospective analysis of HoLEP procedures performed by a single surgeon between July 2023 and June 2024. Patients were grouped by laser platform (MOSES or QUANTA). The primary outcome was total operative time. Secondary outcomes included enucleation and morcellation parameters, perioperative characteristics, and 30‐day outcomes. Multivariable regression models adjusted for age, Charlson comorbidity index, anticoagulant use, and prostate volume were used to control for confounding. Results: A total of 196 patients were included (132 MOSES, 64 QUANTA). The MOSES cohort had higher comorbidity and anticoagulant use ( p < 0.05). After adjustment, QUANTA was associated with significantly shorter total operative, enucleation, laser, and energy times. Morcellation speed was faster with QUANTA ( p = 0.034), while absolute morcellation time was comparable ( p = 0.08). Enucleation speed was also higher ( p = 0.017), and energy efficiency was similar. Site‐related workflow differences may have contributed to nonoperative time variation. Postoperative outcomes—including LOS, catheter duration, hematuria, retention, and 30‐day events—were similar. Conclusion: Both laser systems demonstrated excellent safety. QUANTA 150 was associated with greater procedural efficiency in this single‐surgeon, dual‐site experience, underscoring the need for further prospective evaluation across practice settings.

OBJECTIVE To evaluate associations between burnout, perfectionism, and grit among urology residents and attendings, hypothesizing that perfectionism would be associated with increased burnout and higher grit would be protective. METHODS We conducted a prospective, multi-institutional cross-sectional survey from January–May 2025. Participants completed the Maslach Burnout Inventory, Frost Multidimensional Perfectionism Scale, and Grit Scale. Burnout was defined as Emotional Exhaustion >27 or Depersonalization >10. Perfectionism and grit scores (2–5) were analyzed relative to burnout, including analyses of individuals above the 90th percentile for perfectionism. RESULTS A total of 108 urologists responded (39% response rate), including 68 attendings (64%) and 39 residents (36%); 70% completed the perfectionism scale. Burnout was identified in 56 respondents (52%; 95% CI, 42%–62%) and was more common among residents than attendings (77% vs 37%; P < .001). Perfectionism showed non-linear association with burnout: moderate levels were associated with lower burnout, while scores above the 90th percentile were associated with higher burnout (77% vs 46%; OR 3.9; 95% CI, 1.3–11.2; P < .01). Grit was inversely associated with burnout; 92% of respondents with low grit were burned out versus 7% with the highest grit (P < .001). CONCLUSIONS Burnout remains prevalent among urologists, particularly trainees. Perfectionism is associated with higher burnout, while grit appears strongly protective, suggesting potential targets for intervention.

Introduction: Holmium laser enucleation of the prostate (HoLEP) is an increasingly utilized surgical intervention for benign prostatic hyperplasia (BPH) with lower urinary tract symptoms (LUTS). It is unclear how pre-HoLEP voiding performance (including pre-HoLEP incontinence) affects post-HoLEP urinary symptom performance and recovery which challenges effective patient counseling. Methods: This is a single-institution retrospective analysis of 266 patients who underwent HoLEP. Pre-HoLEP continence status was determined by patient report. Continence (severity and bother, severity broken into urge and stress) and LUTS (total IPSS score and QoL) were assessed preoperatively and 1 week (1wk), 1 month (1m), 3 months (3m), and 1-year (1y) post-HoLEP using the Michigan Incontinence Symptom Index (MISI) and International Prostate Symptom Score (IPSS), respectively. Primary outcome measures were MISI differences between groups at each time point. Results: Of the 376 patients who underwent HoLEP from two surgeons from 11/6/2020 to 12/18/2023, 266 were included in the study. Inclusion criteria were patients undergoing HoLEP during this period. There were no exclusion criteria. A total of 178 participants were continent and 88 were incontinent pre-HoLEP. Average age at time of HoLEP was 70.3 and 70.8 respectively, average preoperative prostate size measured by ultrasound or axial imaging was 109.0 g and 113.7 g, respectively. Based on MISI stress (#1–3) and urge (#4–6) items, pre-HoLEP Stress:Urge ratio in continent pre-HoLEP patients was 1.29:3.02. In the incontinent pre-HoLEP group, Stress:Urge was 2.45:6.18. MISI scores were statistically similar between cohorts at 1wk. Preop incontinent patients had a statistical and clinically significant improvement in MISI severity score at 1y post-HoLEP (5.62 n = 11 vs 10.170 n = 50, p = 0.013). IPSS total scores were statistically similar between cohorts at 1m and IPSS QoL scores were statistically similar at preop. At preop evaluation, urge symptoms were worse than stress symptoms in all cohorts. Conclusions: Preoperative incontinence should not be considered a predictor of poor intermediate or long-term post-HoLEP outcomes. Pre-HoLEP incontinence is likely largely urge-related.

Purpose: There is not yet satisfactory performance data comparing multiparametric MRI (mpMRI) versus biparametric MRI (bpMRI) for detecting prostate cancer (PCa), particularly in high-risk populations. We compared both protocols for detecting overall PCa and clinically significant PCa (CS-PCa; defined as Grade Group ≥ 2) in a multiethnic urban population. Methods: We retrospectively reviewed electronic medical record data from men who underwent image-guided fusion prostate biopsy (FB) between 2016 and 2021 at our institution. Patient characteristics, Prostate Imaging Reporting and Data System (PI-RADS) scores, and FB outcomes were analyzed based on MRI protocol. Multivariate mixed-effects logistic regression models were used to examine associations of bpMRI versus mpMRI for detecting overall PCa and CS-PCa in targeted lesions, among all patients and stratified by race/ethnicity. Results: Overall, 566 men (44.0% Non-Hispanic Black [NHB]; 27.0% Hispanic) with 975 PI-RADS 3–5 lesions on MRI underwent FB. Of these, 312 (55%) men with 497 lesions underwent mpMRI and 254 (45%) men with 478 lesions underwent bpMRI. On multivariate analyses among all men, the odds of detecting overall PCa (OR = 1.18, 95% CI: 1.05–3.11, p = 0.031) and CS-PCa (OR = 2.15, 95% CI: 1.16–4.00, p = 0.014) on FB were higher for lesions identified on bpMRI than mpMRI. When stratified by race/ethnicity, the odds of detecting overall PCa (OR = 1.86; p = 0.15) and CS-PCa (OR = 2.20; p = 0.06) were not statistically different between lesions detected on bpMRI or mpMRI. Conclusion: BpMRI has similar diagnostic performance to mpMRI in detecting overall and CS-PCa within a racially/ethnically diverse population. BpMRI can be utilized for evaluating suspected CS-PCa among NHB and Hispanic men.

Introduction and Objective: Holmium laser enucleation of the prostate (HoLEP) is often offered for symptomatic prostatic enlargement at high risk for bleeding. However, prior studies define clinically significant hematuria (CSH) narrowly as the need for blood transfusion or significant decrease in hemoglobin. We sought to evaluate risk factors contributing to a broader definition of CSH, which may contribute to alteration of clinical course. Methods: We analyzed 164 patients in a prospectively maintained database who underwent HoLEP at a single institution across two surgeons from November 2020 to April 2023. HoLEP was performed using Moses 2.0 (Boston Scientific) laser and the Piranha enucleation system (Richard Wolf). We defined CSH broadly as follows: clot retention, return to operating room, perioperative management variation due to hematuria, or continued gross hematuria past 1 month postoperatively. Univariable and multivariable ANOVAs were used. Multivariable analysis of CSH risk based on the use of antiplatelet (AP) agents or anticoagulants included correction for age, enucleation time (surrogate for case difficulty), and prostate volume. Results: 17.7% (29/164) of our patients developed CSH after HoLEP. Longer enucleation time was a mild risk factor for developing CSH (multivariate odds ratio [OR] 1.01, p = 0.02). The strongest predictor of CSH was the use of anticoagulation or AP agents (OR 2.71 p < 0.02 on univariable analysis, OR 2.34 p < 0.02 on multivariable analysis), even when aspirin 81 mg was excluded. Conclusion: With a broadened definition, 18% of patients developed CSH following HoLEP, which impacted the clinical course. Our data suggest that the current definition of significant hematuria is too narrow and does not capture many patients whose clinical course is affected by hematuria. While safe, anticoagulants and APs significantly predicted an increased CSH risk, and patients should be counseled accordingly.