67th Annual Meeting Abstracts
Are Urology Residents Adequately Exposed to Treatment Modalities for Small Renal Masses?
Vanessa L Elliott, *Paul H Smith, Jay D Raman
Penn State Milton S. Hershey Medical Center, Hershey, PA
Introduction: The increasing diagnosis of small renal masses (SRMs) necessitates urology trainees to be familiar with available therapies. We evaluated resident exposure to treatments and management patterns for SRMs.
Materials & Methods: The survey was distributed electronically to resident members of the American Urological Association (AUA) and queried exposure to ablation and surveillance for SRMs. Three case scenarios (SRM in a healthy 55 year old, healthy 75 year old, and comorbid 75 year old patient) were presented.
Results: 257 residents responded with equal distribution across AUA sections and levels of training. 234 (91%) reported ablation was offered at their institution; only 140 (54%) participated in this procedure. Of these, 80 (57%) were involved in fewer than 5 procedures. Experience with ablation did not increase with level of training (U3 - 61%, U4 - 66%, U5 - 63%). 224 (87%) residents noted exposure to surveillance for managing SRMs, increasing from 70% in U1 to 94% in U5. When considering case scenarios, management shifted significantly from extirpation to ablation or surveillance as the comorbidity profile increased. (Table 1).
Conclusions: While most residents have exposure to surveillance for SRMs, only 54% participated in ablation. Despite this lack of exposure, a significant percentage recommended ablation to manage SRMs in comorbid patients suggesting that training should be adapted such that urologists completing residency are better exposed to therapies they recommend.
Table 1: Resident responses to case scenarios of patients with SRMs (n=257 total)| Treatment | 55 year old Healthy
No. (%) | 75 year old Healthy
No. (%) | 75 year old comorbidities
No. (%) |
| Radical nephrectomy (open or lap) | 0 (0) | 2 (0.8) | 0 (0) |
| Partial nephrectomy (open or lap) | 251 (97.7) | 159 (61.9) | 40 (15.6) |
| Thermal ablation (RFA or Cryo; perc or lap) | 5 (1.9) | 69 (26.8) | 123 (47.9) |
| Active surveillance | 2 (0.8) | 21 (8.2) | 94 (36.6) |
