title: Urinary diversions: A time to enrich surgical training?
abstract: OBJECTIVE
  To assess the potential exposure to complex urologic procedures, specifically urinary diversion, during a gynecologic oncology fellowship.
  
  
  METHODS
  We queried the University HealthSystem Consortium (UHC) database to determine the total number of urinary diversions performed from October 2008 to August 2012. This data was used to estimate the mean number of urinary diversions performed each year. Gender, primary diagnosis, type of diversion, gynecologic oncologist involvement, and medical center were explored.
  
  
  RESULTS
  Of the nearly 21,000 urinary diversions performed in UHC participating hospitals during the study period, 6180 (29.5%) were performed in women. On average, 1648 urinary diversions are performed in women each year, with gynecologic malignancies accounting for 6.8% of cases. We estimate that a gynecologic oncologist was involved with 87 cases per year at nonprofit academic medical centers in the US. With approximately 112 clinically active fellows per year during the study period, this equates to less than one diversion per clinical fellow per year if cases are equally distributed among centers. However, the majority of urinary diversions with gynecologic oncologist involvement were performed at just a fraction of centers. Thus, only a small contingent of fellows may be getting the greatest exposure to urinary diversions.
  
  
  CONCLUSIONS
  The majority of urinary diversions in women in the US are performed for bladder carcinoma by urologists. The estimated number of cases per clinical gynecologic oncology fellow per year is less than one. Strategies to improve fellow exposure to urinary diversion and consideration of alternative surgical training modalities should be explored.
authors.affiliation: Rebecca and John Moores UCSD Cancer Center, Department of Reproductive Medicine, Division of Gynecologic Oncology, La Jolla, CA, United States. Electronic address: ninashahmd@gmail.com.
authors.forename: Nina R
authors.initials: NR
authors.lastname: Shah
authors.affiliation: University of Florida College of Medicine, Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Jacksonville, FL, United States.
authors.forename: Kristy K
authors.initials: KK
authors.lastname: Ward
authors.affiliation: Rebecca and John Moores UCSD Cancer Center, Department of Reproductive Medicine, Division of Gynecologic Oncology, La Jolla, CA, United States.
authors.forename: Steven C
authors.initials: SC
authors.lastname: Plaxe
authors.affiliation: Rebecca and John Moores UCSD Cancer Center, Department of Reproductive Medicine, Division of Gynecologic Oncology, La Jolla, CA, United States.
authors.forename: Cheryl C
authors.initials: CC
authors.lastname: Saenz
authors.affiliation: Rebecca and John Moores UCSD Cancer Center, Department of Reproductive Medicine, Division of Gynecologic Oncology, La Jolla, CA, United States.
authors.forename: Michael T
authors.initials: MT
authors.lastname: McHale
mesh_terms: D000046:Academic Medical Centers / Q000706:statistics & numerical data; D005260:Female; D006176:Gynecology / Q000193:education* / Q000379:methods / Q000706:statistics & numerical data*; D006801:Humans; D007396:Internship and Residency / Q000706:statistics & numerical data; D008297:Male; D008495:Medical Oncology / Q000193:education / Q000379:methods / Q000706:statistics & numerical data; D014547:Urinary Diversion / Q000193:education* / Q000379:methods* / Q000706:statistics & numerical data*