Are urology residents adequately exposed to conservative therapies for managing small renal masses?
OBJECTIVE
Increasing diagnosis of small renal masses (SRMs) necessitates trainees to be familiar with available therapies. We hypothesized that involvement in conservative treatments (ablation and/or active surveillance) occurs infrequently. Therefore, we evaluated resident exposure and participation in treatments as well as proposed management for SRMs.


METHODS
A survey was distributed to residents of the American Urologic Association 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 for management.


RESULTS
Two hundred fifty-seven residents responded to the survey. Two hundred thirty-four (91%) reported ablation was offered at their institution, although only 140 (54%) ever participated in this procedure. Of these, 80 (57%) were involved in fewer than five procedures. Experience with ablation did not increase at higher levels of training (U3-61%, U4-66%, and U5-63%). Two hundred twenty-four (87%) residents noted exposure to surveillance for managing SRMs, increasing from 70% in U1 to 94% in U5. When considering case scenarios, management strategy shifted significantly from extirpation to ablation or surveillance as patient age and comorbidity profile increased. In particular, almost 50% of respondents advocated ablation for SRMs in a comorbid 75-year-old patient.


CONCLUSIONS
Although most residents are adequately exposed to surveillance strategies for SRMs, only 54% participated in an ablative procedure. Nonetheless, almost 50% of residents recommended ablation to manage SRMs in the aging, comorbid patient. This suggests a disconnect between training and future practice pattern.
Division of Urology, Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania 17033, USA.
Vanessa L
VL
Elliott
Paul H
PH
Smith
Jay D
JD
Raman
D055011:Ablation Techniques / Q000193:education; D000368:Aged; D006801:Humans; D007396:Internship and Residency; D007680:Kidney Neoplasms / Q000601:surgery / Q000628:therapy*; D008875:Middle Aged; D011795:Surveys and Questionnaires; D014572:Urology / Q000193:education*