Citation indices for social media articles in urology.

PubMed

Calopedos, Ross J S; Garcia, Cindy; Rashid, Prem; Murphy, Declan G; Lawrentschuk, Nathan; Woo, Henry H

2017-05-01

To evaluate the impact of publications on urological participation in social media (SoMe) by virtue of citations in the urological and non-urological literature. On 15 March 2016, a PubMed search was undertaken using the names of the major SoMe platforms in current use and associated with the field of urology. The search term 'urolog*' was used to specifically capture articles that could be associated with 'urology', 'urologist' or 'urological'. Exclusion criteria for analysis included non-English language articles, articles published for the first time online in any form after 1 March 2015, articles irrelevant to the topic of SoMe, and letters of correspondence. Included articles were then searched in Google Scholar and citations analysed to determine if citations were from the urological literature or non-urological literature. Citations from non-urological journals were considered to be as such even if authored by urologists and on the subject of urology and SoMe. Prior to exclusions as defined in the methods, our PubMed search yielded 232 articles of which 17 were non-English language and 66 had been published after 1 March 2015. Allowing for 12 months after the most recent articles were published, we found that the mean number of total citations in any journal was 20.8. There were more citations in journals not specific to urology, with 8.3 citations in urological journals, compared to 12.6 citations in non-urological journals. Urological SoMe journal articles are highly cited, particularly in the non-urological literature. It is likely that the magnitude of citations has positively contributed to the impact factors of the almost all journals publishing these manuscripts. © 2017 The Authors BJU International © 2017 BJU International Published by John Wiley & Sons Ltd.

Career development resource: urology.

PubMed

Gormley, E Ann

2012-07-01

Urology has always been seen as being on the cutting edge of technology and this has been especially prevalent in the past 10 to 15 years with a move to robotic surgery, increased use of laser technology, and stem cell research leading to organ regeneration. Urology has a number of subspecialties including pediatrics, urologic oncology, renal transplantation, male infertility and andrology, calculi, female urology, neurourology, and trauma and reconstruction. Urologists have a wide array of practice options ranging from performing major oncologic procedures with extensive reconstruction to having an office-based practice and performing endoscopic cases with everything else in between. Subspecialization is becoming increasingly more organized and regulated. Copyright © 2012 Elsevier Inc. All rights reserved.

Training, Research, and Working Conditions for Urology Residents in Germany: A Contemporary Survey.

PubMed

Borgmann, Hendrik; Arnold, Hannah K; Meyer, Christian P; Bründl, Johannes; König, Justus; Nestler, Tim; Ruf, Christian; Struck, Julian; Salem, Johannes

2016-12-16

Excellent uniform training of urology residents is crucial to secure both high-quality patient care and the future of our specialty. Residency training has come under scrutiny following the demands of subspecialized care, economical aspects, and working hour regulations. To comprehensively assess the surgical training, research opportunities, and working conditions among urology residents in Germany. We sent a 29-item online survey via email to 721 members of the German Society of Residents in Urology. Descriptive analyses were conducted to describe the surveys' four domains: (1) baseline characteristics, (2) surgical training (cumulative completed case volume for all minor-, medium-, and major-complexity surgeries), (3) research opportunities, and (4) working conditions. Four hundred and seventy-two residents completed the online survey (response rate 65%). Surgical training: the median number of cumulative completed cases for postgraduate yr (PGY)-5 residents was 113 (interquartile range: 76-178). Minor surgeries comprised 57% of all surgeries and were performed by residents in all PGYs. Medium-complexity surgeries comprised 39% of all surgeries and were mostly performed by residents in PGYs 2-5. Major surgeries comprised 4% of all surgeries and were occasionally performed by residents in PGYs 3-5. Research opportunities: some 44% have attained a medical thesis (Dr. med.), and 39% are currently pursuing research. Working conditions: psychosocial work-related stress was high and for 82% of residents their effort exceeded their rewards. Some 44% were satisfied, 32% were undecided, and 24% were dissatisfied with their current working situation. Limitations include self-reported survey answers and a lack of validated assessment tools. Surgical exposure among German urology residents is low and comprises minor and medium-complex surgeries. Psychosocial work-related stress is high for the vast majority of residents indicating the need for structural improvements in German urology residency training. In this study, we evaluated the surgical training, research opportunities, and working conditions among urology residents in Germany. We found low surgical exposure and high rates for psychosocial work-related stress, indicating the need for structural improvements in German urology residency training. Copyright © 2016 European Association of Urology. Published by Elsevier B.V. All rights reserved.

Music and ambient operating room noise in patients undergoing spinal anesthesia.

PubMed

Ayoub, Chakib M; Rizk, Laudi B; Yaacoub, Chadi I; Gaal, Dorothy; Kain, Zeev N

2005-05-01

Previous studies have indicated that music decreases intraoperative sedative requirements in patients undergoing surgical procedures under regional anesthesia. In this study we sought to determine whether this decrease in sedative requirements results from music or from eliminating operating room (OR) noise. A secondary aim of the study was to examine the relationship of response to intraoperative music and participants' culture (i.e., American versus Lebanese). Eighty adults (36 American and 54 Lebanese) undergoing urological procedures with spinal anesthesia and patient-controlled IV propofol sedation were randomly assigned to intraoperative music, white noise, or OR noise. We found that, controlling for ambient OR noise, intraoperative music decreases propofol requirements (0.004 +/- 0.002 mg . kg(-1) . min(-1) versus 0.014 +/- 0.004 mg . kg(-1) . min(-1) versus 0.012 +/- 0.002 mg . kg(-1) . min(-1); P = 0.026). We also found that, regardless of group assignment, Lebanese patients used less propofol as compared with American patients (0.005 +/- 0.001 mg . kg(-1) . min(-1) versus 0.017 +/- 0.003 mg . kg(-1) . min(-1); P = 0.001) and that, in both sites, patients in the music group required less propofol (P < 0.05). We conclude that when controlling for ambient OR noise, intraoperative music decreases propofol requirements of both Lebanese and American patients who undergo urological surgery under spinal anesthesia.

Acupuncture in urological practice--a survey of urologists in England.

PubMed

Tempest, Heidi; Reynard, John; Bryant, Richard J; Hamdy, Freddie C; Larré, Stéphane

2011-02-01

To determine the feasibility of obtaining cooperation from urologists in carrying out large-scale studies on the efficacy of acupuncture for the treatment of urological conditions, based on urologists' general views and knowledge of acupuncture. A questionnaire was distributed to 145 urologists within three training deaneries within England. A response rate of 70% (n=102) was achieved. The majority of urologists rated their knowledge of acupuncture as low (46%, n=46) and their general attitude towards acupuncture was neutral (54%, n=55). The majority of responding urologists (95%) thought that acupuncture may be of value in urological conditions, and acupuncture was suggested to patients by 30 urologists (29%). The urologists most likely to suggest acupuncture to their patients were typically over 40 years of age, more experienced, not in a training post, and since starting their urological career had changed their attitude towards acupuncture. In a multivariate analysis, a change of view regarding the efficacy of acupuncture was found to be the only variable significantly associated with a recommendation of acupuncture to patients. Although overall knowledge about acupuncture was poor, most responding urologists thought acupuncture may be useful for urological conditions. Those who had changed their views were most likely to suggest acupuncture to their patients. Acupuncture for urological conditions warrants further investigation and, as this study has shown high interest within the urological community large clinical trials involving multicentres may be feasible. Copyright © 2010 Elsevier Ltd. All rights reserved.

Commentary on "Robot-assisted laparoscopic vs open radical cystectomy: Comparison of complications and perioperative oncological outcomes in 200 patients." Kader AK, Richards KA, Krane LS, Pettus JA, Smith JJ, Hemal AK, Division of Urology, UC San Diego Health System, San Diego, CA.: BJU Int 2013; 112(4):E290-4. doi:10.1111/bju.12167. [Epub 2013 Jul 1].

PubMed

See, William A

2014-11-01

To compare perioperative morbidity and oncological outcomes of robot-assisted laparoscopic radical cystectomy (RARC) to open RC (ORC) at a single institution. A retrospective analysis was performed on a consecutive series of patients undergoing RC (100 RARC and 100 ORC) at Wake Forest University with curative intent from 2006 until 2010. Complication data using the Clavien system were collected for 90 days postoperatively. Complications and other perioperative outcomes were compared between patient groups. Patients in both groups had comparable preoperative characteristics. The overall and major complication (Clavien ≥ 3) rates were lower for RARC patients at 35 vs 57% (P = 0.001) and 10 vs 22% (P = 0.019), respectively. There were no significant differences between groups for pathological outcomes, including stage, number of nodes harvested or positive margin rates. Our data suggest that patients undergoing RARC have perioperative oncological outcomes comparable with ORC, with fewer overall or major complications. Definitive claims about comparative outcomes with RARC require results from larger, randomised controlled trials. Copyright © 2014 Elsevier Inc. All rights reserved.

The effects of nitrous oxide on vascular endothelial growth factor (VEGF) and its soluble receptor 1 (VEGFR1) in patient undergoing urological surgery

PubMed Central

Hakimoglu, Yasemin; Can, Murat; Hakimoglu, Sedat; Gorkem Mungan, Ayca; Acikgoz, Sereften; Cikcikoglu Yildirim, Nuran; Aydin Mungan, Necmettin; Ozkocak Turan, Isil

2014-01-01

Objective: Anesthesia and surgical intervention, leads to the development of systemic inflammatory response. The severity of the inflammatory response depends on the pharmacological effects of anesthetic agents and duration of anesthesia. Objective of the study was to investigate the effect of nitrous oxide on VEGF and VEGFR1 levels in patients undergoing surgery. Methods: Forty-four patients undergoing elective urological surgery were included in the study. Anesthesia maintenance was provided with 1-2 MAC sevoflurane, O2 50%, N2O 50% in 4L/m transporter gase for group 1 (n=22) and 1-2 MAC sevoflurane, O2 50%, air 50% in 4L/m transporter gase for group 2 (n=22) Venous blood samples for the measurement of VEGF and VEGFR1 were taken before the induction of anaesthesia, 60 minutes of anesthesia induction, at the end of anaesthesia and 24 hours after operation. In statistical analysis Bonferroni test and analysis of variance at the repeated measures were used Results: In the postoperative period serum VEGF levels had decreased significantly in both group whereas VEGFR1 did not show a significant change. Conclusions: Nitrous oxide showed significant effect on angiogenic parameters. Further detailed studies are required to evaluate the effect of nitrous oxide. PMID:24639829

The effects of nitrous oxide on vascular endothelial growth factor (VEGF) and its soluble receptor 1 (VEGFR1) in patient undergoing urological surgery.

PubMed

Hakimoglu, Yasemin; Can, Murat; Hakimoglu, Sedat; Gorkem Mungan, Ayca; Acikgoz, Sereften; Cikcikoglu Yildirim, Nuran; Aydin Mungan, Necmettin; Ozkocak Turan, Isil

2014-01-01

Anesthesia and surgical intervention, leads to the development of systemic inflammatory response. The severity of the inflammatory response depends on the pharmacological effects of anesthetic agents and duration of anesthesia. OBJECTIVE of the study was to investigate the effect of nitrous oxide on VEGF and VEGFR1 levels in patients undergoing surgery. Forty-four patients undergoing elective urological surgery were included in the study. Anesthesia maintenance was provided with 1-2 MAC sevoflurane, O2 50%, N2O 50% in 4L/m transporter gase for group 1 (n=22) and 1-2 MAC sevoflurane, O2 50%, air 50% in 4L/m transporter gase for group 2 (n=22) Venous blood samples for the measurement of VEGF and VEGFR1 were taken before the induction of anaesthesia, 60 minutes of anesthesia induction, at the end of anaesthesia and 24 hours after operation. In statistical analysis Bonferroni test and analysis of variance at the repeated measures were used Results: In the postoperative period serum VEGF levels had decreased significantly in both group whereas VEGFR1 did not show a significant change. Nitrous oxide showed significant effect on angiogenic parameters. Further detailed studies are required to evaluate the effect of nitrous oxide.

Prophylactic antibiotic use in pediatric patients undergoing urinary tract catheterization: a survey of members of the Society for Pediatric Urology.

PubMed

Glaser, Alexander P; Rosoklija, Ilina; Johnson, Emilie K; Yerkes, Elizabeth B

2017-09-06

Current organizational guidelines regarding use of antibiotics during urinary tract catheterization are based on limited evidence and are not directly applicable to the pediatric urology population. We seek to improve understanding of this population by first evaluating current practices. This study aims to investigate practice patterns and attitudes of pediatric urologists regarding the use of antibiotics in the setting of urinary tract catheterization. An online survey was sent to members of the Society for Pediatric Urology. Questionnaire sections included demographics, general questions about antibiotic use with catheterization, and specific clinical scenarios. Descriptive statistics were used, and chi-square analysis was performed to examine associations between demographics and specific responses. Of 448 pediatric urologists surveyed, 154 (34%) responded to the survey. A majority of surveyed urologists (78%) prescribe daily prophylactic antibiotics with a hypospadias stent in place, but extensive variation in use of antibiotics was reported with other catheters and tubes. Extensive variation in practice patterns was also reported for three case scenarios regarding antibiotic prophylaxis with catheterization. Urologists > 50 years of age and fellowship-trained urologists were more likely to prescribe antibiotics for hypospadias stents (p = 0.02, p = 0.03), but no other significant associations between demographic characteristics and antibiotic use were found. There is substantial variation in practice patterns among surveyed pediatric urologists regarding prophylactic antibiotic use with urinary catheterization. This variation, combined with a lack of objective data and increasing pressure to decrease infectious complications and combat antibiotic resistance, highlights the need for development of management guidelines for this unique population.

Life expectancy calculation in urology: Are we equitably treating older patients?

PubMed

Bhatt, Nikita R; Davis, Niall F; Breen, Kieran; Flood, Hugh D; Giri, Subhasis K

2017-01-01

The aim of our study was to determine the contemporary practice in the utilization of life expectancy (LE) calculations among urological clinicians. Members of the Irish Society of Urology (ISU) and the British Association of Urological Surgeons (BAUS) completed a questionnaire on LE utilization in urological practice. The survey was delivered to 1251 clinicians and the response rate was 17% (n = 208/1251). The majority (61%, n = 127) of urologists were aware of methods available for estimated LE calculation.Seventy-one percent (n = 148) had never utilized LE analysis in clinical practice and 81% (n = 170) routinely used 'eyeballing' (empiric prediction) for estimating LE. Life expectancy tables were utilized infrequently (12%, n = 25) in making the decision for treatment in the setting of multi-disciplinary meetings. LE is poorly integrated into treatment decision-making; not only for the management of urological patients but also in the multidisciplinary setting. Further education and awareness regarding the importance of LE is vital.

Evaluation and establishment of a ward-based geriatric liaison service for older urological surgical patients: Proactive care of Older People undergoing Surgery (POPS)-Urology.

PubMed

Braude, Philip; Goodman, Anna; Elias, Tania; Babic-Illman, Gordana; Challacombe, Ben; Harari, Danielle; Dhesi, Jugdeep K

2017-07-01

To assess the impact of introducing and embedding a structured geriatric liaison service, Proactive care of Older People undergoing Surgery (POPS)-Urology, using comprehensive geriatric assessment methodology, on an inpatient urology ward. A phased quality improvement project was undertaken using stepwise interventions. Phase 1 was a before-and-after study with initiation of a daily board round, weekly multidisciplinary meeting, and targeted geriatrician-led ward rounds for elective and emergency urology patients aged ≥65 years admitted over two 1-month periods. Outcomes were recorded from medical records and discharge documentation, including length of inpatient stay, medical and surgical complications, and 30-day readmission and mortality rates. Phase 2 was a quality improvement project involving Plan-Do-Study-Act cycles and qualitative staff surveys in order to create a Geriatric Surgical Checklist (GSCL) to standardize the intervention in Phase 1, improve equity of care by extending it to all ages, improve team-working and streamline handovers for multidisciplinary staff. Phase 1 included 112 patients in the control month and 130 in the intervention month. The length of inpatient stay was reduced by 19% (mean 4.9 vs 4.0 days; P = 0.01), total postoperative complications were lower (risk ratio 0.24 [95% confidence interval 0.10, 0.54]; P = 0.001). A non-significant trend was seen towards fewer cancellations of surgery (10 vs 5%; P = 0.12) and 30-day readmissions (8 vs 3%; P = 0.07). In Phase 2, the GSCL was created and incrementally improved. Questionnaires repeated at intervals showed that the GSCL helped staff to understand their role better in multidisciplinary meetings, improved their confidence to raise issues, reduced duplication of handovers and standardized identification of geriatric issues. Equity of care was improved by providing the intervention to patients of all ages, despite which the time taken for the daily board round did not lengthen. This is the first known paper describing the benefits of daily proactive geriatric intervention in elective and emergency urological surgery. The results suggest that using a multidisciplinary team board round helps to facilitate collaborative working between surgical and geriatric medicine teams. The GSCL enables systematic identification of patients who require a focused comprehensive geriatric assessment. There is potential to transfer the GSCL package to other surgical specialties and hospitals to improve postoperative outcomes. © 2016 The Authors BJU International © 2016 BJU International Published by John Wiley & Sons Ltd.

Gender differences in academic productivity and academic career choice among urology residents.

PubMed

Yang, Glen; Villalta, Jacqueline D; Weiss, Dana A; Carroll, Peter R; Breyer, Benjamin N

2012-10-01

Gender disparities have long existed in medicine but they have not been well examined in urology. We analyzed a large cohort of graduating urology residents to investigate gender disparities in academic productivity, as measured by peer reviewed publications and academic career choice. We assembled a list of urology residents who graduated from 2002 through 2008 who were affiliated with the top 50 urology hospitals, as ranked by 2009 U.S. News & World Report. PubMed® was queried to determine the publication output of each resident during the last 3 years of residency. We used an Internet search to determine the fellowship training, career choice and academic rank of each subject. Gender effects on each factor were evaluated. A total of 459 male (84.5%) and 84 female (15.5%) residents were included in analysis. During residency women produced fewer total publications (average 3.0 vs 4.8, p = 0.01) and fewer as first author (average 1.8 vs 2.5, p = 0.03) than men. A higher proportion of women than men underwent fellowship training (54.8% vs 48.5%, p = 0.29) and ultimately chose an academic career (40.5% vs 33.3%, p = 0.20), although these differences were not statistically significant. Of residents who chose an academic career a higher proportion of men than women (24.7% vs 2.9%, p = 0.01) obtained associate vs assistant professor rank. Women produced fewer peer reviewed publications than men during residency but they were equally likely to undergo fellowship training and choose an academic career. During the study period a higher proportion of men achieved associate professor rank. Copyright © 2012 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.

Exploring for the safer ventilation method in laparoscopic urologic patients? Conventional or low tidal?

PubMed

Ela, Yüksel; Bakı, Elif Doğan; Ateş, Mutlu; Kokulu, Serdar; Keleş, İbrahim; Karalar, Mustafa; Şenay, Hasan; Sıvacı, Remziye Gül

2014-11-01

To study the effects of low tidal volume with positive end-expiratory pressure (PEEP) on arterial blood gases of patients undergoing laparoscopic urologic surgeries. Eighty-six laparoscopic urologic patients were enrolled in this study. Patients were randomized into two groups according to the ventilatory settings. In the conventional group (Group C) (n=43), the tidal volume was 10 mL/kg, and the PEEP was set at 0 cm of H2O. In the low tidal volume with PEEP group (Group LP), the tidal volume was 6 mL/kg, with PEEP of 5 cm of H2O. In both groups total minute volume was 6 L/kg. Peak and plateau airway pressure (PPEAK and PPLAT, respectively) and arterial blood gases were recorded before pneumoperitoneum (PNP) (T1) and the first and third hour (T3) after PNP induction and also after extubation in the intensive care unit. Additionally, heart rate, mean arterial pressure, and peripheral O2 saturation of hemoglobin were recorded. Heart rate, PPEAK, and PPLAT values were similar in both groups. Partial arterial O2 pressure values measured postoperatively were significantly higher in Group LP, whereas those measured before PNP induction were similar (P=.014 and P=.056, respectively). Compared with the baseline, partial arterial CO2 pressure values measured at T1 and at T3 after PNP induction were significantly higher in Group C than in Group LP (P<.001). The pH values of Group C at T1 and at T3 postoperatively were significantly lower than the values of Group LP (P<.001). Extubation times were significantly lower in Group LP. The results of the present study suggest that low tidal volume with PEEP application may be a good alternative for preventing high CO2 levels and yielding better oxygenation and lower extubation times in patients undergoing prolonged laparoscopic urology.

Effect of Music on Outpatient Urological Procedures: A Systematic Review and Meta-Analysis from the European Association of Urology Section of Uro-Technology.

PubMed

Kyriakides, Rena; Jones, Patrick; Geraghty, Robert; Skolarikos, Andreas; Liatsikos, Evangellos; Traxer, Olivier; Pietropaolo, Amelia; Somani, Bhaskar K

2018-05-01

Music is a practical, inexpensive and harmless analgesic and anxiolytic. An increasing number of original studies have been performed to investigate its potential application in urology. Our aim was to identify the effect of music on outpatient based urological procedures. We systematically reviewed the effect of using music during all reported outpatient urology procedures, including transrectal ultrasound guided prostate biopsy, shock wave lithotripsy, urodynamic studies, percutaneous nephrostomy tube placement and cystoscopy. Data were included on all randomized trials from 1980 to 2017 and no language restrictions were applied. Included in analysis were 16 randomized studies in which 972 of 1,950 patients (49.8%) were exposed to music during an outpatient procedure. The procedures included transrectal ultrasound guided prostate biopsy in 4 studies in a total of 286 patients, shock wave lithotripsy in 6 studies in a total of 1,023, cystoscopy in 3 studies in a total of 331, urodynamics in 2 studies in a total of 210 and percutaneous nephrostomy in 1 study in a total of 100. All studies incorporated a visual analog score to measure pain. Anxiety was measured by STAI (State-Trait Anxiety Inventory) in 13 studies and by a visual analog scale in 2. While 14 of the 16 studies showed a reduction in self-reported pain, a reduction in anxiety was seen in 14. When using music, overall procedural satisfaction was better in 9 studies and patient willingness to repeat the procedure was also higher in 7. Our meta-analysis revealed a significant reduction in visual analog scale and STAI findings across all studies (p <0.001). Our systematic review demonstrated a beneficial effect of music on urological outpatient procedures. Music seemed to decrease anxiety and pain. It might serve as a useful adjunct to increase procedural satisfaction and patient willingness to undergo the procedure again. Copyright © 2018 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.

Qualitative Twitter analysis of participants, tweet strategies, and tweet content at a major urologic conference.

PubMed

Borgmann, Hendrik; Woelm, Jan-Henning; Merseburger, Axel; Nestler, Tim; Salem, Johannes; Brandt, Maximilian P; Haferkamp, Axel; Loeb, Stacy

2016-01-01

The microblogging social media platform Twitter is increasingly being adopted in the urologic field. We aimed to analyze participants, tweet strategies, and tweet content of the Twitter discussion at a urologic conference. A comprehensive analysis of the Twitter activity at the European Association of Urology Congress 2013 (#eau2013) was performed, including characteristics of user profiles, engagement and popularity measurements, characteristics and timing of tweets, and content analysis. Of 218 Twitter contributors, doctors (45%) were the most frequent, ahead of associations (15%), companies (10%), and journals (3%). However, journals had the highest tweet/participant rate (22 tweets/participant), profile activity (median: 1177, total tweets, 1805 followers, 979 following), and profile popularity (follower/following ratio: 2.1; retweet rank percentile: 96%). Links in a profile were associated with higher engagement (p<0.0001) and popularity (p<0.0001). Of 1572 tweets, 57% were original tweets, 71% contained mentions, 20% contained links, and 25% included pictures. The majority of tweets (88%) were during conference hours, with an average of 24.7 tweets/hour and a peak activity of 71 tweets/hour. Overall, 59% of tweets were informative, led by the topics uro-oncology (21%), urologic research (21%), and urotechnology (12%). Limitations include the analysis of a single conference analysis, assessment of global profile and not domain-specific activity, and the rapid evolution in Twitter-using habits. Results of this single conference qualitative analysis are promising for an enrichment of the scientific discussions at urologic conferences through the use of Twitter.

Novel biomarkers of acute kidney injury: Evaluation and evidence in urologic surgery

PubMed Central

Schmid, Marianne; Dalela, Deepansh; Tahbaz, Rana; Langetepe, Jessica; Randazzo, Marco; Dahlem, Roland; Fisch, Margit; Trinh, Quoc-Dien; Chun, Felix K-H

2015-01-01

Patients undergoing urologic surgery are at risk of acute kidney injury (AKI) and consequently long-term deterioration in renal function. AKI is further associated with significantly higher odds of perioperative complications, prolonged hospital stay, higher mortality and costs. Therefore, better awareness and detection of AKI, as well as identification of AKI determinants in the urological surgery setting is warranted to pre-empt and mitigate further deterioration of renal function in patients at special risk. New consensus criteria provide precise definitions of diagnosis and description of the severity of AKI. However, they rely on serum creatinine (SCr), which is known to be an inaccurate marker of early changes in renal function. Therefore, several new urinary and serum biomarkers promise to address the gap associated with the use of SCr. Novel biomarkers may complement SCr measurement or most likely improve the diagnostic accuracy of AKI when used in combinations. However, novel biomarkers have to prove their clinical applicability, accuracy, and cost effectiveness prior to implementation into clinical practice. Most preferably, novel biomarkers should help to positively improve a patient’s long-term renal functional outcomes. The purpose of this review is to discuss currently available biomarkers and to review their clinical evidence within urologic surgery settings. PMID:25949930

Pheochromocytoma in Urologic Practice

PubMed Central

Waingankar, Nikhil; Bratslavsky, Gennady; Jimenez, Camilo; Russo, Paul; Kutikov, Alexander

2016-01-01

Context Pheochromocytoma is regularly encountered in urological practice and requires a thoughtful and careful clinical approach. Objective To review clinical aspects of management of pheochromocytoma in urologic practice. Evidence Acquisition A systematic review of English-language literature was performed through year 2015 using the Medline database. Manuscripts were selected with consensus of the coauthors and evaluated using the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) criteria. Evidence Synthesis Findings and recommendations of the evaluated manuscripts are discussed with an emphasis on the description of presentation, diagnosis, evaluation, and perioperative care. Conclusion In addition to surgical expertise, appropriate management of pheochromocytoma in urologic practice requires nuanced understanding of pathophysiology, genetics, and endocrinological principles. When skillfully managed, the vast majority of patients with pheochromocytoma should expect an excellent prognosis. Patient Summary In this article we review the clinical approach to patients with pheochromocytoma, a tumor that stems from the innermost part of the adrenal gland and that often secretes excessive amounts of powerful hormones such as noradrenaline and adrenaline. Significant expertise is required to appropriately manage patients with these tumors. Take Home Message In addition to surgical expertise, appropriate management of pheochromocytoma in urologic practice requires nuanced understanding of pathophysiology, genetics, and endocrinological principles. When skillfully managed, vast majority of patients with pheochromocytoma should expect an excellent prognosis. PMID:28078330

Efficacy of butylscopolamine for the treatment of catheter-related bladder discomfort: a prospective, randomized, placebo-controlled, double-blind study.

PubMed

Ryu, J H; Hwang, J W; Lee, J W; Seo, J H; Park, H P; Oh, A Y; Jeon, Y T; Do, S H

2013-12-01

Catheter-related bladder discomfort (CRBD) secondary to intraoperative catheterization of urinary bladder is one of the most distressing symptoms during recovery from anaesthesia. Butylscopolamine, a peripheral antimuscarinic agent, is effective for relieving the pain, which is because of smooth muscle contraction. The aim of this study was to assess the efficacy and safety profiles of butylscopolamine in treating CRBD after urological surgeries. Adult male patients undergoing urological surgery requiring urinary bladder catheterization intraoperatively were enrolled. Induction and maintenance of anaesthesia were standardized. Patients were randomized into two groups after complaining of CRBD in the post-anaesthesia care unit. The control group (n=29) received normal saline and the butylscopolamine group (n=28) was administered butylscopolamine 20 mg i.v. The severity of CRBD, postoperative pain, and adverse effects were assessed at baseline, 20 min, 1, 2, and 6 h after administration of the study drug. The severity of CRBD observed in the butylscopolamine group was significantly lower than that of the control group at 1, 2, and 6 h after administration of the study drug [59 (12), 50 (16), 40 (21) in the control group vs 41 (22), 32 (25), 23 (18) in the butylscopolamine group, P<0.01]. Rescue analgesics were required less in the butylscopolamine group than in the control group (P=0.001). Adverse events were comparable between the two groups. Butylscopolamine 20 mg administered i.v. after complaining CRBD during recovery reduced both the severity of CRBD and the need for rescue analgesics without adverse effects in patients undergoing urologic surgeries.

Beyond the Lower Urinary Tract: The Association of Urologic and Sexual Symptoms with Common Illnesses

PubMed Central

Fitzgerald, Mary P.; Link, Carol L.; Litman, Heather J.; Travison, Thomas G.; McKinlay, John B.

2008-01-01

Objective In addition to being prevalent and bothersome, urologic and sexual symptoms may be related to chronic medical illnesses. We investigate the relationship between ten urologic and sexual symptoms and four major illnesses (type II diabetes, cardiac disease, hypertension, and depression). Methods We analyze data from the Boston Area Community Health (BACH) Survey, a community-based epidemiologic study of urologic symptoms and risk factors. BACH used a two-stage stratified cluster sampling design to recruit 5,506 adults aged 30–79 (2,301 men, 3,205 women; 1,770 Black, 1,877 Hispanic, and 1,859 White respondents). Results In bivariate analyses, most urologic and sexual symptoms are associated with type II diabetes, cardiac disease, hypertension, and depression. However, in multivariate models adjusting for all four illnesses, gender, race/ethnicity, age, alcohol intake, smoking, physical activity, and body mass index there were fewer significant associations. We found that all urologic symptoms were significantly related to at least one illness, with depression increasing the odds of all urologic and sexual symptoms studied. Conclusions Urinary tract specialists may need to give greater weight to consideration of factors outside the urinary tract that may be contributing to urologic symptoms. It remains unknown whether treatment of medical and psychological illnesses can result in meaningful improvement in urologic symptoms, or conversely, whether urinary tract symptoms can provide valuable insight into an individual’s overall health status. PMID:17382458

Targeting Vasculature in Urologic Tumors: Mechanistic and Therapeutic Significance

PubMed Central

Sakamoto, Shinichi; Ryan, A. Jacqueline; Kyprianou, Natasha

2008-01-01

Recent advances toward understanding the molecular mechanisms regulating cancer initiation and progression provide new insights into the therapeutic value of targeting tumor vascularity by interfering with angiogenic signaling pathways. The functional contribution of key angiogenic factors toward increased vascularity characterizing metastatic tumors and their therapeutic exploitation is considered in three major urologic malignancies, renal, bladder, and prostate cancer. With the realization that the success of the therapeutic efficacy of the various anti-angiogenic approaches for the treatment of urologic tumors has yet to be proven clinically, the challenge remains to select critical angiogenesis pathways that can be targeted for an individual tumor. Here we discuss the major mechanisms that support formation of vasculature in renal, bladder, and prostate tumors and the current results of targeting of specific molecules/regulators for therapeutic intervention against metastastic disease. PMID:17668426

[Urological diseases most frequently involved in medical professional liability claims].

PubMed

Vargas-Blasco, César; Gómez-Durán, Esperanza L; Arimany-Manso, Josep; Pera-Bajo, Francisco

2014-03-01

Clinical safety and medical professional liability are international major concerns, especially in surgical specialties such as urology. This article analyzes the claims filed at the Council of Medical Colleges of Catalonia between 1990 and 2012, exploring urology procedures. The review of the 173 cases identified in the database highlighted the importance of surgical procedures (74%). Higher frequencies related to scrotal-testicular pathology (34%), especially testicular torsion (7.5%) and vasectomy (19.6%), and prostate pathology (26 %), more specifically the surgical treatment of benign prostatic hyperplasia (17.9%). Although urology is not among the specialties with the higher frequency of claims, there are special areas of litigation in which it is advisable to implement improvements in clinical safety. Copyright © 2014 Elsevier España, S.L. All rights reserved.

Anticipating the Impact of the Patient Protection and Affordable Care Act for Patients with Urological Cancer

PubMed Central

Ellimoottil, Chandy; Miller, David C.

2014-01-01

The Affordable Care Act seeks to overhaul the US healthcare system by providing insurance for more Americans, improving the quality of healthcare delivery, and reducing healthcare expenditures. While the law’s intent is clear, its implementation and effect on patient care remains largely undefined. Herein, we discuss major components of the ACA, including the proposed insurance expansion, payment and delivery system reforms (e.g. bundled payments and Accountable Care Organizations) and other reforms relevant to the field of urologic oncology. We also discuss how these proposed reforms may impact patients with urological cancers. PMID:24588021

Surgical simulation: a urological perspective.

PubMed

Wignall, Geoffrey R; Denstedt, John D; Preminger, Glenn M; Cadeddu, Jeffrey A; Pearle, Margaret S; Sweet, Robert M; McDougall, Elspeth M

2008-05-01

Surgical education is changing rapidly as several factors including budget constraints and medicolegal concerns limit opportunities for urological trainees. New methods of skills training such as low fidelity bench trainers and virtual reality simulators offer new avenues for surgical education. In addition, surgical simulation has the potential to allow practicing surgeons to develop new skills and maintain those they already possess. We provide a review of the background, current status and future directions of surgical simulators as they pertain to urology. We performed a literature review and an overview of surgical simulation in urology. Surgical simulators are in various stages of development and validation. Several simulators have undergone extensive validation studies and are in use in surgical curricula. While virtual reality simulators offer the potential to more closely mimic reality and present entire operations, low fidelity simulators remain useful in skills training, particularly for novices and junior trainees. Surgical simulation remains in its infancy. However, the potential to shorten learning curves for difficult techniques and practice surgery without risk to patients continues to drive the development of increasingly more advanced and realistic models. Surgical simulation is an exciting area of surgical education. The future is bright as advancements in computing and graphical capabilities offer new innovations in simulator technology. Simulators must continue to undergo rigorous validation studies to ensure that time spent by trainees on bench trainers and virtual reality simulators will translate into improved surgical skills in the operating room.

30-Day morbidity after augmentation enterocystoplasty and appendicovesicostomy: A NSQIP pediatric analysis.

PubMed

McNamara, Erin R; Kurtz, Michael P; Schaeffer, Anthony J; Logvinenko, Tanya; Nelson, Caleb P

2015-08-01

Augmentation enterocystoplasty and appendicovesicostomy are complex pediatric urologic procedures. Although there is literature identifying long-term outcomes in these patients, the reporting of short-term postoperative outcomes has been limited by small numbers of cases and lack of prospective data collection. Here we report 30-day outcomes from the first nationally based, prospectively assembled cohort of pediatric patients undergoing these procedures. To determine 30-day complication, readmission and reoperation after augmentation enterocystoplasty and appendicovesicostomy in a large national sample of pediatric patients, and to explore the association between preoperative and intraoperative characteristics and occurrence of any 30-day event. We queried the 2012 and 2013 American College of Surgeons National Surgical Quality Improvement Program Pediatric database (ACS-NSQIPP) for all patients undergoing augmentation enterocystoplasty and/or appendicovesicostomy. Surgical risk score was classified on a linear scale using a validated pediatric-specific comorbidity score. Intraoperative characteristics and postoperative 30-day events were reported from prospectively collected data. A composite measure of complication, readmission and/or reoperation was used as primary outcome for the multivariate logistic regression. There were 461 patients included in the analysis: 245 had appendicovesicostomy, 97 had augmentation enterocystoplasty and 119 had both procedures. There were a total of 110 NSQIP complications seen in 87 patients. The most common complication was urinary tract infection (see Table for 30-day outcomes by patient). The composite measure of any 30-day event was seen in 27.8% of the cohort and this was associated with longer operative time, increased number of procedures done at time of primary surgical procedure and higher surgical risk score. The ACS-NSQIPP provides a tool to examine short-term outcomes for these complex urologic procedures that has not been possible before. Although ACS-NSQIP has been used extensively in the adult surgical literature to identify rates of complications, and to determine predictors of readmission and adverse events, its use in pediatric surgery is new. As in the adult literature, the goal is for standardization of practice and transparency in reporting outcomes that may lead to reduction in morbidity and mortality. In this cohort, any 30-day event is seen in almost 30% of the patients undergoing these urologic procedures. Operative time, number of concurrent procedures and higher surgical risk score all are associated with higher odds of the composite 30-day event of complication, readmission and/or reoperation. These data can be useful in counseling patients and families about expectations around surgery and in improving outcomes. Copyright © 2015 Journal of Pediatric Urology Company. Published by Elsevier Ltd. All rights reserved.

Analysis of National Institutes of Health Funding to Departments of Urology.

PubMed

Silvestre, Jason; Agarwal, Divyansh; Lee, David I

2016-05-01

To elucidate the current portfolio of National Institutes of Health (NIH) funding to departments of urology at U.S. medical schools. The NIH Research Portfolio Online Reporting Tools Expenditures and Results was used to generate a comprehensive analysis of NIH research grants awarded to urology departments during 2014. Costs, mechanisms, and institutes were summarized with descriptive statistics. Demographic data were obtained for principal investigators and project abstracts were categorized by research type and area. Fiscal totals were calculated for 2005-2014 and compared with other surgical departments during 2014. One hundred one investigators at 36 urology departments received $55,564,952 in NIH funding during 2014. NIH-funded investigators were predominately male (79%) and PhD scientists (52%). Funding totals did not vary by terminal degree or sex, but increased with higher academic rank (P < .001). The National Cancer Institute (54.7%) and National Institute of Diabetes and Digestive and Kidney Diseases (32.2%) supported the majority of NIH-funded urologic research. The R01 grant accounted for 41.0% of all costs. The top 3 NIH-funded clinical areas were urologic oncology (62.1%), urinary tract infection (8.8%), and neurourology (7.6%). A minority of costs supported clinical research (12.9%). In 2014, urology had the least number of NIH grants relative to general surgery, ophthalmology, obstetrics & gynecology, otolaryngology, and orthopedic surgery. NIH funding to urology departments lags behind awards to departments of other surgical disciplines. Future interventions may be warranted to increase NIH grant procurement in urology. Copyright © 2016 Elsevier Inc. All rights reserved.

The impact of obesity in urology.

PubMed

Mydlo, Jack H

2004-05-01

The incidence and progression of urologic diseases, as well as several urologic cancers.depend on many interrelated factors, such as obesity, diet, genetics, environment, age, and the immune system. Obesity is a risk factor for stress urinary incontinence, ED, infertility, and renal calculi. Numerous publications have demonstrated that a high dietary intake of fat increases prostate cancer risk, although the mechanisms are not clear. Although some reports may demonstrate an association between obesity and prostate cancer, it may be hard to establish because, in general, men with obesity have a high-fat diet. Obesity, recurrent urinary tract infections, increased intake of protein and fried foods, and female sex seem to increase the risk of renal cancer. Environmental toxins seem to be the major factors affecting the incidence of bladder cancers. Thus, dietary modification and other public health measures directed at reducing weight may reduce the incidence of urologic illnesses. More studies are necessary to determine the therapeutic effects of weight loss and dietary modification on the incidence and progression of urologic tumors.

How small is small enough? Role of robotics in paediatric urology

PubMed Central

Ganpule, Arvind P.; Sripathi, Venkat

2015-01-01

The well-known advantages of robotic surgery include improved dexterity, three-dimensional operating view and an improved degree of freedom. Robotic surgery is performed for a wide range of surgeries in urology, which include radical prostatectomy, radical cystectomy, and ureteric reimplantation. Robotic paediatric urology is evolving. The major hindrance in the development of paediatric robotics is, first, the differences in practice patterns in paediatric urology compared with adult urology thereby making development of expertise difficult and secondly it is challenging to conduct proper studies in the paediatric population because of the paucity of cases. The difficulties in conducting these studies include difficulty in designing a proper randomised study, difficulties with blinding, and finally, the ethical issues involved, finally the instruments although in the phase of evolution require a lot of improvement. In this article, we review the relevant articles for paediatric robotic surgery. We emphasise on the technical aspects and results in contemporary paediatric robotic case series. PMID:25598599

How small is small enough? Role of robotics in paediatric urology.

PubMed

Ganpule, Arvind P; Sripathi, Venkat

2015-01-01

The well-known advantages of robotic surgery include improved dexterity, three-dimensional operating view and an improved degree of freedom. Robotic surgery is performed for a wide range of surgeries in urology, which include radical prostatectomy, radical cystectomy, and ureteric reimplantation. Robotic paediatric urology is evolving. The major hindrance in the development of paediatric robotics is, first, the differences in practice patterns in paediatric urology compared with adult urology thereby making development of expertise difficult and secondly it is challenging to conduct proper studies in the paediatric population because of the paucity of cases. The difficulties in conducting these studies include difficulty in designing a proper randomised study, difficulties with blinding, and finally, the ethical issues involved, finally the instruments although in the phase of evolution require a lot of improvement. In this article, we review the relevant articles for paediatric robotic surgery. We emphasise on the technical aspects and results in contemporary paediatric robotic case series.

Leadership in Canadian urology: what is the right stuff?

PubMed

Robinson, Michael; Macneily, Andrew; Afshar, Kourosh; McInnes, Colin; Lennox, Peter; Carr, Nicholas; Skarlicki, Daniel; Masterson, John; Arneja, Jugpal

2013-01-01

There are little data characterizing leadership roles within Canadian Urology. The importance of these positions in urology underscores the need for further investigation to provide insight for recruitment, development, and success. All Canadian Urology Program Directors and Division/Department Heads were invited to complete an online leadership survey as part of a larger national cohort from 11 other surgical specialties. Response rate was 62% (13/21), the majority of whom were Caucasian (77%) and male (92%). Only 8% of respondents in urology hold an advanced degree compared with 45% in other specialties. Additional leadership training was done by 54% of the respondents. Residency was completed in Canada by 92%, but 62% completed fellowships abroad. A majority reported no well-defined job description for their role (54%). The top responsibility reported by leaders was mentoring residents (67%), followed by advising staff (62%). Excellence in patient care and teaching were seen as the most important professional characteristics, whereas integrity was the personal quality felt most important. Leaders reported 17% of their income came from their leadership role, equivalent to the time required for position duties (19%). "Time management" was listed as the greatest challenge faced (54%). Leadership style was reported as "democratic" by 92%. Leaders in urology most often self-rated their leadership skills lower than leaders from other surgical specialties (7 vs 8/10). Positions of leadership in urology are disproportionately represented by Caucasian males and comparatively few hold relevant advanced degrees. Excellence in the areas of teaching and patient care, and high personal integrity are felt to be the most important characteristics for success. Time management issues are viewed as the greatest challenge. These preliminary data may prove useful for the mentoring, recruitment, and success of future leaders in our specialty. Copyright © 2013 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.

EAU standardised medical terminology for urologic imaging: a taxonomic approach.

PubMed

Loch, Tillmann; Carey, Brendan; Walz, Jochen; Fulgham, Pat Fox

2015-05-01

The terminology and abbreviations used in urologic imaging have generally been adopted on an ad hoc basis by different speciality groups; however, there is a need for shared nomenclature to facilitate clinical communication and collaborative research. This work reviews the current nomenclature for urologic imaging used in clinical practice and proposes a taxonomy and terminology for urologic imaging studies. A list of terms used in urologic imaging were compiled from guidelines published by the European Association of Urology and the American Urological Association and from the American College of Radiology Appropriateness Criteria. Terms searched were grouped into broad categories based on technology, and imaging terms were further stratified based on the anatomic extent, contrast or phases, technique or modifiers, and combinations or fusions. Terms that had a high degree of utilisation were classified as accepted. We propose a new taxonomy to define a more useful and acceptable nomenclature model acceptable to all health professionals involved in urology. The major advantage of a taxonomic approach to the classification of urologic imaging studies is that it provides a flexible framework for classifying the modifications of current imaging modalities and allows the incorporation of new imaging modalities. The adoption of this hierarchical classification model ranging from the most general to the most detailed descriptions should facilitate hierarchical searches of the medical literature using both general and specific terms. This work is limited in its scope, as it is not currently all-inclusive. This will hopefully be addressed by future modification as others embrace the concept and work towards uniformity in nomenclature. This paper provides a noncomprehensive list of the most widely used terms across different specialties. This list can be used as the basis for further discussion, development, and enhancement. In this paper we describe a classification system for urologic imaging terms with the aim of aiding health professionals and ensuring that the terms used are more consistent. Copyright © 2014 European Association of Urology. Published by Elsevier B.V. All rights reserved.

Islam and the Urinary Stoma: A Contemporary Theological and Urological Dilemma.

PubMed

Miah, Saiful; Mangera, Altaf; Osman, Nadir I; Venugopal, Suresh; Catto, James; Rosario, Derek

2017-07-13

The prayer ritual is an essential component of Islam that requires entry into a state of physical purity (wudhu) through ablution, which is invalidated by voiding. An important dilemma for patients and surgeons may arise when a Muslim patient is counselled on cystectomy because of the belief by some that an incontinent urinary diversion will automatically invalidate their wudhu. To determine if there are any religious barriers and implications for Muslim patients undergoing an incontinent urinary diversion. A questionnaire was distributed to all UK mosques, addressed to the imam (n=804). A total of 134 imams (response rate 16.7%) responded. There was general agreement among imams, with >90% answering that it is possible for a Muslim to perform ablution, pray, and enter a mosque with a urinary stoma. The majority of imams (86.6%) also stated that refusal of a urinary stoma was not justified by religious teachings. When asked if patients should choose the option of a neobladder despite this surgery having greater risk, 57.5% of respondents stated that they were either unsure or agreed with this alternative. The majority of imams agreed that Muslims with a urinary stoma are able to maintain their ablution, allowing them to conduct their daily prayers, and that this form of surgery should not be refused on religious grounds. Our study suggests that the consensus view is that a urinary stoma is not contraindicated with regard to the practice of Islamic prayer rituals. In this study we investigated if having a urinary stoma would be a religious barrier for Muslim patients in performing their obligatory prayer rituals. The overwhelming majority of imams stated that having a urinary stoma should not stop Muslim patients practising important aspects of their faith. Copyright © 2017 European Association of Urology. Published by Elsevier B.V. All rights reserved.

Association of intraoperative tissue oxygenation with suspected risk factors for tissue hypoxia.

PubMed

Spruit, R J; Schwarte, L A; Hakenberg, O W; Scheeren, T W L

2013-10-01

Tissue hypoxia may cause organ dysfunction, but not much is known about tissue oxygenation in the intraoperative setting. We studied microcirculatory tissue oxygen saturation (StO₂) to determine representative values for anesthetized patients undergoing urological surgery and to test the hypothesis that StO₂ is associated with known perioperative risk factors for morbidity and mortality, conventionally monitored variables, and hypotension requiring norepinephrine. Using near-infrared spectroscopy, we measured StO₂ on the thenar eminence in 160 patients undergoing open urological surgery under general anesthesia (FiO2 0.35-0.4), and calculated its correlations with age, risk level for general perioperative complications and mortality (high if age ≥70 and procedure is radical cystectomy), mean arterial pressure (MAP), hemoglobin concentration (Hb), central venous oxygen saturation (ScvO₂), and norepinephrine use. The time averaged StO₂ was 86 ± 6 % (mean ± SD). In the multivariate analysis, Hb [standardized coefficient (SC) 0.21, p = 0.003], ScvO₂ (SC 0.53, p < 0.001) and high risk level (SC 0.06, p = 0.03) were significant independent variables correlated with StO₂. SStO₂ was partly dependent on MAP only when this was below 65 mmHg (lowest MAP SC 0.20, p = 0.006, MAP area under the curve <65 mmHg SC 0.03, p = 0.02). Finally, StO₂ was slightly lower in patients requiring norepinephrine (85 ± 6 vs. 89 ± 6 %, p = 0.001). Intraoperative StO₂ in urological patients was comparable to that of healthy volunteers breathing room air as reported in the literature and correlated with known perioperative risk factors. Further research should investigate its association with outcome and the effect of interventions aimed at optimizing StO₂.

Renal function and urological complications after radical hysterectomy with postoperative radiotherapy and platinum-based chemotherapy for cervical cancer.

PubMed

Okadome, Masao; Saito, Toshiaki; Kitade, Shoko; Ariyoshi, Kazuya; Shimamoto, Kumi; Kawano, Hiroyuki; Minami, Kazuhito; Nakamura, Motonobu; Shimokawa, Mototsugu; Okushima, Kazuhiro; Kubo, Yuichiro; Kunitake, Naonobu

2018-02-01

We aimed to clarify renal functional changes long term and serious urological complications in women with cervical cancer who undergo radical hysterectomy followed by pelvic radiotherapy and/or platinum-based chemotherapy to treat the initial disease. Data on 380 women who underwent radical hysterectomy at the National Kyushu Cancer Center from January 1997 to December 2013 were reviewed. Main outcome measures were the estimated glomerular filtration rate (eGFR) and monitored abnormal urological findings. Postoperative eGFR was significantly lower than preoperative eGFR in 179 women with surgery alone and in 201 women with additional pelvic radiotherapy and/or chemotherapy (both P < 0.01). Two types of univariate analyses for eGFR reduction in women after treatment showed that older age, advanced stage, pelvic radiotherapy, and platinum-based chemotherapy were significant variables on both analyses. Two types of multivariate analyses showed that platinum-based chemotherapy or pelvic radiotherapy were associated with impaired renal function (odds ratio 1.96, 95% confidence interval 1.08-3.54 and odds ratio 2.85, 95% confidence interval 1.12-7.24, for the respective analyses). There was a higher rate of bladder wall thickening in women with pelvic radiotherapy had than those without it (17.4% vs. 2.7%, P < 0.01). One serious urological complication (intraperitoneal rupture of the bladder) occurred among women who underwent pelvic radiotherapy (0.6% vs. 0%). Surgeons should be aware that eGFR is reduced after platinum-based chemotherapy and/or postoperative pelvic radiotherapy. Serious and life-threatening urological complications are rare, but surgeons should be aware of the possibility during the long follow-up. © The Author 2017. Published by Oxford University Press. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

Gender Differences in Academic Productivity and Academic Career Choice Among Urology Residents

PubMed Central

Yang, Glen; Villalta, Jacqueline D.; Weiss, Dana A.; Carroll, Peter R.; Breyer, Benjamin N.

2012-01-01

Purpose Gender disparities have long existed in medicine but they have not been well examined in urology. We analyzed a large cohort of graduating urology residents to investigate gender disparities in academic productivity, as measured by peer reviewed publications and academic career choice. Materials and Methods We assembled a list of urology residents who graduated from 2002 through 2008 who were affiliated with the top 50 urology hospitals, as ranked by 2009 U.S. News & World Report. PubMed® was queried to determine the publication output of each resident during the last 3 years of residency. We used an Internet search to determine the fellowship training, career choice and academic rank of each subject. Gender effects on each factor were evaluated. Results A total of 459 male (84.5%) and 84 female (15.5%) residents were included in analysis. During residency women produced fewer total publications (average 3.0 vs 4.8, p = 0.01) and fewer as first author (average 1.8 vs 2.5, p = 0.03) than men. A higher proportion of women than men underwent fellowship training (54.8% vs 48.5%, p =0.29) and ultimately chose an academic career (40.5% vs 33.3%, p = 0.20), although these differences were not statistically significant. Of residents who chose an academic career a higher proportion of men than women (24.7% vs 2.9%, p = 0.01) obtained associate vs assistant professor rank. Conclusions Women produced fewer peer reviewed publications than men during residency but they were equally likely to undergo fellowship training and choose an academic career. During the study period a higher proportion of men achieved associate professor rank. PMID:22902027

Use of invisible near infrared light fluorescence with indocyanine green and methylene blue in urology. Part 2.

PubMed

Polom, Wojciech; Markuszewski, Marcin; Rho, Young Soo; Matuszewski, Marcin

2014-01-01

In the second part of this paper, concerning the use of invisible near infrared light (NIR) fluorescence with indocyanine green (ICG) and methylene blue (MB) in urology, other possible uses of this new technique will be presented. In kidney transplantation, this concerns allograft perfusion and real time NIR-guided angiography; moreover, perfusion angiography of tissue flaps, NIRF visualization of ureters, NIR-guided visualization of urinary calcifications, NIRF in male infertility and semen quality assessment. In this part, we have also analysed cancer targeting and imaging fluorophores as well as cost benefits associated with the use of these new techniques. PubMed and Medline databases were searched for ICG and MB use in urological settings, along with data published in abstracts of urological conferences. Although NIR-guided ICG and MB are still in their initial phases, there have been significant developments in a few more major domains of urology, including 1) kidney transplantation: kidney allograft perfusion and vessel reconstruction; 2) angiography perfusion of tissue flaps; 3) visualization of ureters; 4) visualization of urinary calcifications; and 5) NIRF in male infertility and semen quality assessment. Near infrared technology in urology is at its early stages. More studies are needed to assess the true potential and limitations of the technology. Initial studies show that this pioneering tool may influence various aspects of urology.

Epidemiology, natural history, and management of urinary tract infections in pregnancy.

PubMed

Andriole, V T; Patterson, T F

1991-03-01

The urinary tract undergoes profound physiologic and anatomic changes during pregnancy that facilitate the development of symptomatic UTIs in women with bacteriuria. Although the adverse effects of asymptomatic bacteriuria on maternal and fetal health continue to be debated, it is clear that asymptomatic bacteriuria is the major risk factor for developing symptomatic UTI and that symptomatic infections are associated with significant maternal and fetal risks. Because the majority of symptomatic UTIs develop in women with bacteriuria earlier in pregnancy, treatment of bacteriuria is undertaken to prevent symptomatic infections. All women should be screened at the first antenatal visit, which is reliably and inexpensively done with a dipstick culture. Short-course therapy is as effective as prolonged therapy and should be followed with a repeat culture to document clearing of the bacteriuria. Failure to eliminate bacteriuria with repeated therapy or recurrence with the same organism is indicative of renal parenchymal infection or a structural abnormality. All women with persistent bacteriuria or recurrent infection should have follow-up cultures and a complete urologic evaluation after delivery.

Anticipating the effect of the Patient Protection and Affordable Care Act for patients with urologic cancer.

PubMed

Ellimoottil, Chandy; Miller, David C

2014-02-01

The Affordable Care Act seeks to overhaul the US health care system by providing insurance for more Americans, improving the quality of health care delivery, and reducing health care expenditures. Although the law's intent is clear, its implementation and effect on patient care remains largely undefined. Herein, we discuss major components of the Affordable Care Act, including the proposed insurance expansion, payment and delivery system reforms (e.g., bundled payments and Accountable Care Organizations), and other reforms relevant to the field of urologic oncology. We also discuss how these proposed reforms may affect patients with urologic cancers.

[Questions of terminology, systematization and grading of complications of contact ureteral lithotripsy].

PubMed

Dutov, V V; Bazaev, V V; Mamedov, E A; Urenkov, S B; Podoinitsyn, A A

2017-07-01

To investigate the advantages and disadvantages of the current variants of systematization and grading of complications of contact ureteral lithotripsy (CULT) and develop a working classification of CULT complications. The study analyzed results of 545 fluoroscopy-guided endoscopic procedures performed at the MRRCI Clinic of Urology from 2008 to 2015 in 506 patients with ureterolithiasis. The proposed and implemented classification and terminology of CULT complications unifies the diagnostic and management algorithm. This tool is more systematic and structured than the classical classification and universal methods of systematization and grading of CULT complications (classifying CULT complications in "major" and "minor", PULS scale, Satava and Clavien-Dindo grading systems). Given the lack of clear grading of ureteral rupture, it was divided into amputation (two-level rupture) and avulsion (one-level rupture). Using such term as extravasation of the contrast media and/or migration of the stone outside of the ureter is groundless because these complications occur only after the perforation of the ureteral wall. Therefore, these conditions are complications not of CULT, but of the ureteral wall perforation. The ureteral perforation was classified into macro- and micro-perforation. The existing terminology, classification and grading of the CULT complications should undergo a more detailed analysis. None of the existing classifications of CULT complications afford them to be fully staged and systematized. The working classification of complications of CULT developed at the M.F. Vladimirsky MRRCI Clinic of Urology warrants a multi-center prospective study to validate it and investigate its effectiveness.

Quantitative Analysis of Technological Innovation in Urology.

PubMed

Bhatt, Nikita R; Davis, Niall F; Dalton, David M; McDermott, Ted; Flynn, Robert J; Thomas, Arun Z; Manecksha, Rustom P

2018-01-01

To assess major areas of technological innovation in urology in the last 20 years using patent and publication data. Patent and MEDLINE databases were searched between 1980 and 2012 electronically using the terms urology OR urological OR urologist AND "surgeon" OR "surgical" OR "surgery". The patent codes obtained were grouped in technology clusters, further analyzed with individual searches, and growth curves were plotted. Growth rates and patterns were analyzed, and patents were correlated with publications as a measure of scientific support and of clinical adoption. The initial search revealed 417 patents and 20,314 publications. The top 5 technology clusters in descending order were surgical instruments including urinary catheters, minimally invasive surgery (MIS), lasers, robotic surgery, and image guidance. MIS and robotic surgery were the most emergent clusters in the last 5 years. Publication and patent growth rates were closely correlated (Pearson coefficient 0.78, P <.01), but publication growth rate remained constantly higher than patent growth, suggesting validated scientific support for urologic innovation and adoption into clinical practice. Patent metrics identify emergent technological innovations and such trends are valuable to understand progress in the field of urology. New surgical technologies like robotic surgery and MIS showed exponential growth in the last decade with good scientific vigilance. Copyright © 2017 Elsevier Inc. All rights reserved.

The dramatic increase in social media in urology.

PubMed

Matta, Rano; Doiron, Chris; Leveridge, Michael J

2014-08-01

Social media are established tools for rapid information dissemination to a broad audience. A major use has been the compilation of conference specific messaging known as tweets via preselected hashtags on Twitter. We analyzed Twitter use between consecutive years at the AUA (American Urological Association) and CUA (Canadian Urological Association) annual meetings. Publicly available tweets containing the established meeting hashtags were abstracted from an online archive. Tweets were categorized by author type and by content as informative (based on research presented at the conference) or uninformative (unrelated to presented data) according to an established classification scheme. We analyzed 5,402 tweets during the combined 18 meeting days, of which 4,098 were original and 1,304 were rebroadcast prior tweets. There was a large increase in Twitter use at the 2013 annual meetings compared to the 2012 meetings (4,591 tweets from a total of 540 accounts vs 811 from 134). Biotechnology analysts represented the highest volume of tweets (226 or 28%) in 2012 but in 2013 this majority shifted to urologists (2,765 or 60%). Of the tweets 29% were categorized as informative in 2012, which increased to 41% at the 2013 meetings. Twitter has emerged as a significant communication platform at urological meetings. Use increased dramatically between 2012 and 2013. Urologists have increasingly led this discussion with an increased focus on data arising from meeting proceedings. This adjunct to traditional meeting activity merits the attention of urologists and the professional associations that host such meetings. Copyright © 2014 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.

Factors influencing scholarly impact: does urology fellowship training affect research output?

PubMed

Kasabwala, Khushabu; Morton, Christopher M; Svider, Peter F; Nahass, Thomas A; Eloy, Jean Anderson; Jackson-Rosario, Imani

2014-01-01

Residents seek postresidency fellowship training to increase competency with novel surgical techniques and augment their fund of knowledge. Research productivity is a vital component of advancement in academic urology. Our objectives were to use the h-index (an objective and readily available bibliometric that has been repeatedly shown to correlate with scholarly impact, funding procurement, and academic promotion in urology as well as other specialties) to determine whether any relationship exists between fellowship training and scholarly impact among academic urologists. Additional examination was performed to determine whether any differences in scholarly influence are present among practitioners in the major urologic subspecialties. Overall, 851 faculty members from 101 academic urology departments were organized by academic rank and fellowship completed. Research productivity was calculated using the h-index, calculated from the Scopus database. There was no statistical difference in h-index found between fellowship-trained and nonfellowship-trained academic urologists. The highest h-indices were seen among urologic oncologists (18.1 ± 0.95) and nonfellowship-trained urologists (14.62 ± 0.80). Nearly 70% of department chairs included in this analysis were urologic oncologists or general urologists. No difference in h-index existed between fellowship-trained and nonfellowship-trained urologists, although practitioners in the subspecialty cohorts with the highest research productivity (nonfellowship-trained and urologic oncologists) comprised 70% of department chairpersons. This relationship suggests that a strong research profile is highly valued during selection for academic promotion. Differences existed on further comparison by subspecialty. Fellowship training may represent another potential opportunity to introduce structured research experiences for trainees. © 2013 Published by Association of Program Directors in Surgery on behalf of Association of Program Directors in Surgery.

Treatment of urological complications in more than 1,000 kidney transplantations: the role of interventional radiology.

PubMed

Fonio, Paolo; Appendino, Elena; Calandri, Marco; Faletti, Riccardo; Righi, Dorico; Gandini, Giovanni

2015-02-01

The aim of this study is to evaluate the efficacy and safety of interventional radiology procedures in the treatment of major urological complications after kidney transplantation. Between 2000 and 2010, 1,146 kidney transplants were performed at our institution. A total of 146 major complications occurred, including 77 obstructions, 36 leaks and 33 associated perigraft fluid collections. Percutaneous treatment was carried out in 118/146 complications in 91 patients. In the case of stenosis-obstruction and fistulas (104 complications), the first therapeutic step was placement of a nephrostomy catheter, followed by balloon ureteroplasty, placement of external-internal catheters and double-J stents; 14/33 collections were drained under ultrasound guidance. In all 118 percutaneous interventions, we were able to place a nephrostomy or drainage catheter, with a technical success rate of 100 %. The long-term success rate was 49.6 %: in 57/115 (three patients were lost to follow-up) we obtained the complete resolution of the complication. The procedure-related mortality rate was 0 %. There was only one major complication and the rate of minor complications was 14.4 %. Interventional radiology is the first choice option in the treatment of urological complications after kidney transplantation.

Clinical and morphological considerations in one case with cervical cancer and right ureterohydronephrosis.

PubMed

Ghib Para, Cristina Georgiana; Sferdian, Mircea Florin; Daşcău, Voicu; Păiuşan, Lucian; Ioiart, Ioan

2016-01-01

We present the case of a 34-year-old female with cervical cancer and right ureterohydronephrosis. She was admitted to the Urology Clinic of the Emergency County Hospital of Arad, Romania, on November 11, 2015, after previously being diagnosed with stage IIIA cervical cancer in December 2014 and undergoing radio and chemotherapy and laparotomy for staging. At the moment of hospital admission, the patient suffered from fever and right lumbar pain, she was also diagnosed with grade IV right ureterohydronephrosis. The patient was operated at the Urology Clinic of Arad; the intervention involved a total hysterectomy with bilateral adnexectomy and a right obturatory necrectomy of the necrotic lymph nodes. However, the evolution was favorable. The purpose was to increase the patient's survival rate and increase the quality of her life by also applying one palliative method including a urethral stent. As a result, the patient's life was extended.

Visceral and gastrointestinal complications in robotic urologic surgery.

PubMed

Velilla, G; Redondo, C; Sánchez-Salas, R; Rozet, F; Cathelineau, X

2018-03-01

with the widespread use of minimally invasive techniques, robot-assisted urologic surgery has become widely adopted. Despite their infrequency, visceral and gastrointestinal complications could be life-threatening. To identify the main gastrointestinal injuries that occur in a robot-assisted urologic surgery. To know the overall incidence and how is their management. Search in PubMed of articles related to visceral and gastrointestinal complications in robot-assisted urology surgery, written in English or Spanish. Relevant publications as well literature reviews and chapters from books were reviewed. Along with vascular injuries, visceral and gastrointestinal lesions are among most dangerous complications. A complete preoperative study to individualize each patient characteristics and the correct use of imaging could help us to avoid complications in the first place. To know all the risky steps in the different robotic urologic procedures will let us anticipate the damage. Knowledge of main and most dangerous injuries in the different abdominal and pelvic organs is fully recommended. Early diagnosis and evaluation of lesions will let us an acute management during surgery. Recognition delay could change a repairable injury into a life-threatening situation. Despite the undeniable benefits of robotic approach, there are minor and major gastrointestinal injuries that all urologic surgeons must know. Those related with trocar placement are especially important. Immediate diagnosis and management is mandatory. Copyright © 2017 AEU. Publicado por Elsevier España, S.L.U. All rights reserved.

Pelvic fracture and associated urologic injuries.

PubMed

Brandes, S; Borrelli, J

2001-12-01

Successful management of patients with major pelvic injuries requires a team approach including orthopedic, urologic, and trauma surgeons. Each unstable pelvic disruption must be treated aggressively to minimize complications and maximize long-term functional outcome. Commonly associated urologic injuries include injuries of the urethra, corpora cavernosa (penis), bladder, and bladder neck. Bladder injuries are usually extraperitoneal and result from shearing forces or direct laceration by a bone spicule. Posterior urethral injuries occur more commonly with vertically applied forces, which typically create Malgaigne-type fractures. Common complications of urethral disruption are urethral stricture, incontinence, and impotence. Acute urethral injury management is controversial, although it appears that early primary realignment has promise for minimizing the complications. Impotence after pelvic fracture is predominantly vascular in origin, not neurologic as once thought.

Prospective evaluation of unidirectional barbed suture for various indications in surgeon-controlled robotic reconstructive urologic surgery: Wake Forest University experience.

PubMed

Shah, Hemendra N; Nayyar, Rishi; Rajamahanty, Shrinivas; Hemal, Ashok K

2012-06-01

To evaluate the usage of unidirectional barbed suture and its related implications in various surgeon-controlled robotic reconstructive urologic surgeries. From March 2010 to March 2011, all patients undergoing various surgeon-controlled robotic reconstructive urologic surgeries utilizing barbed sutures were prospectively enrolled in this study. Type and number of procedure performed were noted. Intraoperative and peri-operative outcomes potentially related to suture technique and material were recorded. This study reports on 210 patients, in whom barbed suture was used during this period. These included partial nephrectomy (20), pyeloplasty (9), ureteric tailoring and reimplantation (1), closure of bladder after Nephroureterectomy with excision of bladder cuff (8), closure of vaginal cuff in female radical cystectomy (12), partial cystectomy (1), radical prostatectomy (152), simple prostatectomy (2), vesicovaginal fistula repair (3), sacrocolpopexy (1), and hernia repair (1). We encountered 5 instances (2.38%) of tissue cut through possibly attributable to the use of barbed suture and 4 instances of misplacement of suture occurred, of these two required a new suture, whereas retrograde pull back of suture and needle was performed in 2 cases. No instance of slip back/loosening of suture was noted once it was tightened. At mean follow-up of 6.8 (1-14 months) months, we did not encounter any complications of urinary leakage, stone formation or fistula or any clinical evidence of urinary tract obstruction due to the use of barbed suture. Use of unidirectional barbed suture is safe, feasible, and efficient at short-term follow-up for reconstructive part of urological procedures.

Surveillance and management of urologic complications after spinal cord injury.

PubMed

Kreydin, Evgeniy; Welk, Blayne; Chung, Doreen; Clemens, Quentin; Yang, Claire; Danforth, Teresa; Gousse, Angelo; Kielb, Stephanie; Kraus, Stephen; Mangera, Altaf; Reid, Sheilagh; Szell, Nicole; Cruz, Francisco; Chartier-Kastler, Emmanuel; Ginsberg, David A

2018-05-29

Neurogenic bladder due to spinal cord injury has significant consequences for patients' health and quality of life. Regular surveillance is required to assess the status of the upper and lower urinary lower urinary tracts and prevent their deterioration. In this review, we examine surveillance techniques in neurogenic bladder, describe common complications of this disease, and address strategies for their management. This work represents the efforts of SIU-ICUD joint consultation on Urologic Management of the Spinal Cord injury. For this specific topic, a workgroup was formed and comprehensive literature search of English language manuscripts regarding neurogenic bladder management was performed using key words of neurogenic bladder. Articles were compiled, and recommendations in the chapter are based on group discussion and follow the Oxford Centre for Evidence-based Medicine system for Levels of Evidence (LOEs) and Grades of Recommendation (GORs). At a minimum, patients should undergo an annual history and physical examination, renal functional testing (e.g., serum creatinine), and upper tract imaging (e.g., renal ultrasonography). The existing evidence does not support the use of other modalities, such as cystoscopy or urodynamics, for routine surveillance. Urologic complications in neurogenic bladder patients are common and often more complex than in the general population. There is a shortage of high-quality evidence to support any particular neurogenic bladder surveillance protocol. However, there is consensus regarding certain aspects of regular genitourinary system evaluation in these patients. Proper surveillance allows the clinician to avoid or address common urological complications, and to guide, alter, or maintain appropriate therapeutic regimens for individual patients.

A cross-sectional pilot study to investigate patient attitudes and perception regarding the use of real time digital recording of urological procedures for research and teaching purposes

PubMed Central

Sharp, Gary; Mazzon, Giorgio; Thilagarajah, Ranjan

2015-01-01

Little conclusive evidence exists regarding the best way to educate and evaluate skill acquisition of advanced surgical trainees, despite it being recognised as one of the most important aspects of training. Many laparoscopic trainers have been produced with complex engineering at great cost, but, there seems to be a reluctance to use the most precious entity available to us; the patient. We thus propose the use of real time digital recording of urological procedures for research and teaching purposes. This study was prompted by the lack of literature regarding such issues. A 19 question questionnaire was circulated at a single urology out-patient department (Essex, England) over a 6 month period to evaluate attitudes and perceptions of urological patients on potentially having their procedure digitally recorded for educational and research purposes. 11 patients declined, 187 questionnaires were included in the final analysis. Male patients are more willing to consent than female patients. Older patients resulted to have a higher propensity in being recorded for medical teaching. Greater than 50% believe being recorded is intrusive but the majority do not think privacy is an issue. Lastly, the vast majority require a formal debrief post operatively. Our results show that a percentage of the public are potentially willing to be digitally recorded but many financial and social barriers exist. We have also highlighted areas of possible future research, namely the reluctance behind young urology patients to consent and questions regarding how best to educate possible study participants to ensure proper informed consent is gained. PMID:26005568

Asymptomatic Bacteriuria in Clinical Urological Practice: Preoperative Control of Bacteriuria and Management of Recurrent UTI.

PubMed

Cai, Tommaso; Mazzoli, Sandra; Lanzafame, Paolo; Caciagli, Patrizio; Malossini, Gianni; Nesi, Gabriella; Wagenlehner, Florian M E; Köves, Bela; Pickard, Robert; Grabe, Magnus; Bjerklund Johansen, Truls E; Bartoletti, Riccardo

2016-01-05

Asymptomatic bacteriuria (ABU) is a common clinical condition that often leads to unnecessary antimicrobial use. The reduction of antibiotic overuse for ABU is consequently an important issue for antimicrobial stewardship and to reduce the emergence of multidrug resistant strains. There are two issues in everyday urological practice that require special attention: the role of ABU in pre-operative prophylaxis and in women affected by recurrent urinary tract infections (rUTIs). Nowadays, this is the time to think over our practice and change our way of thinking. Here, we aimed to summarize the current literature knowledge in terms of ABU management in patients undergoing urological surgery and in patients with rUTIs. In the last years, the approach to patient with ABU has changed totally. Prior to all surgical procedures that do not enter the urinary tract, ABU is generally not considered as a risk factor, and screening and treatment are not considered necessary. On the other hand, in the case of all procedures entering the urinary tract, ABU should be treated in line with the results of a urine culture obtained before the procedure. In patients affected by rUTIs, ABU can even have a protective role in preventing symptomatic recurrence, particularly when Enterococcus faecalis (E. faecalis) has been isolated.

Urinary tract infection after voiding cystourethrogram.

PubMed

Johnson, E K; Malhotra, N R; Shannon, R; Jacobson, D L; Green, J; Rigsby, C K; Holl, J L; Cheng, E Y

2017-08-01

Reported rates of post-procedural urinary tract infection (ppUTI) after voiding cystourethrogram (VCUG) are highly variable (0-42%). This study aimed to determine the risk of ppUTI after cystogram, and evaluate predictors of ppUTI. A retrospective cohort study of children undergoing VCUG or radionuclide cystogram (henceforth 'cystogram') was conducted. Children with neurogenic bladder who underwent cystogram in the operating room and without follow-up at the study institution were excluded. Incidence of symptomatic ppUTI within 7 days after cystogram was recorded. Predictors of ppUTI were evaluated using univariate statistics. A total of 1108 children (54% female, median age 1.1 years) underwent 1203 cystograms: 51% were on periprocedural antibiotics, 75% had a pre-existing urologic diagnosis (i.e., vesicoureteral reflux (VUR) or hydronephrosis; not UTI alone), and 18% had a clinical UTI within 30 days before cystogram. Of the cystograms, 41% had an abnormal cystogram and findings included VUR (82%), ureterocele (6%), and diverticula (6%). Twelve children had a ppUTI (1.0%; four girls, five uncircumcised boys, three circumcised boys; median age 0.9 years). Factors significantly associated with diagnosis of a ppUTI (Summary fig.) included: pre-existing urologic diagnosis prior to cystogram (12/12, 100% of patients with ppUTI), abnormal cystogram results (11/12, 92%), and use of periprocedural antibiotics (11/12, 92%). All 11 children with an abnormal cystogram had VUR ≥ Grade III. However, among all children with VUR ≥ Grade III, 4% (11/254) had a ppUTI. This is the largest study to date that has examined incidence and risk factors for ppUTI after cystogram. The retrospective nature of the study limited capture of some clinical details. This study demonstrated that the risk of ppUTI after a cystogram is very low (1.0% in this cohort). Having a pre-existing urologic diagnosis such as VUR or hydronephrosis was associated with ppUTI; therefore, children with moderate or high-grade VUR on cystogram may be at highest risk. Development of ppUTI after cystogram also highlighted the potential for a delay in diagnosis or oversight of a healthcare-associated infection due to several factors: 1) cystograms may be ordered, performed/interpreted, and followed up by multiple different providers; and 2) such infections are not captured by traditional healthcare-associated infection surveillance strategies. The risk of ppUTI after a cystogram is very low. Only children with pre-existing urologic diagnoses developed ppUTI in this study. This study's findings suggest that children undergoing a cystogram should not be given peri-procedural antibiotic prophylaxis for the sole purpose of ppUTI prevention. Copyright © 2017 Journal of Pediatric Urology Company. Published by Elsevier Ltd. All rights reserved.

Variation in the Diagnostic Evaluation among Persons with Hematuria: Influence of Gender, Race and Risk Factors for Bladder Cancer.

PubMed

Ark, Jacob T; Alvarez, JoAnn R; Koyama, Tatsuki; Bassett, Jeffrey C; Blot, William J; Mumma, Michael T; Resnick, Matthew J; You, Chaochen; Penson, David F; Barocas, Daniel A

2017-11-01

We sought to determine whether race, gender and number of bladder cancer risk factors are significant predictors of hematuria evaluation. We used self-reported data from SCCS (Southern Community Cohort Study) linked to Medicare claims data. Evaluation of subjects diagnosed with incident hematuria was considered complete if imaging and cystoscopy were performed within 180 days of diagnosis. Exposures of interest were race, gender and risk factors for bladder cancer. Of the 1,412 patients evaluation was complete in 261 (18%). On our adjusted analyses African American patients were less likely than Caucasian patients to undergo any aspect of evaluation, including urology referral (OR 0.72, 95% CI 0.56-0.93), cystoscopy (OR 0.67, 95% CI 0.50-0.89) and imaging (OR 0.75, 95% CI 0.59-0.95). Women were less likely than men to be referred to a urologist (OR 0.59, 95% CI 0.46-0.76). Also, although all patients with 2 or 3 risk factors had 31% higher odds of urology referral (OR 1.31, 95% CI 1.02-1.69), adjusted analyses indicated that this effect was only apparent among men. Only 18% of patients with an incident hematuria diagnosis underwent complete hematuria evaluation. Gender had a substantial effect on referral to urology when controlling for socioeconomic factors but otherwise it had an unclear role on the quality of evaluation. African American patients had markedly lower rates of thorough evaluation than Caucasian patients. Number of risk factors predicted referral to urology among men but it was otherwise a poor predictor of evaluation. There is opportunity for improvement by increasing the completion of hematuria evaluations, particularly in patients at high risk and those who are vulnerable. Copyright © 2017 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.

[Urologists meet in Berlin. Martin Stolze (1900-1989) and the urologist convention in 1959 in East and West Berlin].

PubMed

Moll, F H; Halling, T; Fangerau, H

2013-09-01

Scientific meetings are a major part of policy in science and within the scientific community and furthermore they have a major influence on medical and lay communities. Prominent examples for this are the presidential networks and the opening speeches in which the function of science within the society is presented in a special manner. The last joint meeting of the German Society for Urology (DGU) in East and West Germany was instrumentalized by the rivalry of the two systems during the Cold War but was also a brilliant presentation of the newly established German Urology after World War II and its scientific force.

Asymptomatic bacteriuria.

PubMed

Nicolle, Lindsay E

2014-02-01

Asymptomatic bacteriuria is a common finding. Inappropriate antimicrobial treatment of asymptomatic bacteriuria has been identified as a major issue for antimicrobial stewardship programs. This review summarizes and evaluates recent studies which extend our knowledge of the occurrence, management, and outcomes of bacteriuria. The reported prevalence of bacteriuria is higher in some developing countries than generally reported for developed countries, but reasons for this remain unclear. Clinical studies of young women, renal transplant patients, and patients undergoing minor nontraumatic urologic procedures confirm that treatment of asymptomatic bacteriuria for these populations is not beneficial, and may be harmful. There is also no benefit for treatment of asymptomatic bacteriuria prior to orthopedic surgery to decrease postoperative surgical site infection. Studies continue to report substantial inappropriate antimicrobial use for treatment of asymptomatic bacteriuria. Recent publications confirm that asymptomatic bacteriuria is benign in most patients. Management strategies for pregnant women with recurrent bacteriuria require further clarification. There is a continuing problem with inappropriate treatment of asymptomatic bacteriuria, and sustainable strategies to optimize antimicrobial use for this problem are needed.

Urological injuries following trauma.

PubMed

Bent, C; Iyngkaran, T; Power, N; Matson, M; Hajdinjak, T; Buchholz, N; Fotheringham, T

2008-12-01

Blunt renal trauma is the third most common injury in abdominal trauma following splenic and hepatic injuries, respectively. In the majority, such injuries are associated with other abdominal organ injuries. As urological injuries are not usually life-threatening, and clinical signs and symptoms are non-specific, diagnosis is often delayed. We present a practical approach to the diagnosis and management of these injuries based on our experience in a busy inner city trauma hospital with a review of the current evidence-based practice. Diagnostic imaging signs are illustrated.

Novel survey disseminated through Twitter supports its utility for networking, disseminating research, advocacy, clinical practice and other professional goals.

PubMed

Borgmann, Hendrik; DeWitt, Sasha; Tsaur, Igor; Haferkamp, Axel; Loeb, Stacy

2015-01-01

Twitter use has grown exponentially within the urological community. We aimed to determine the perceptions of the impact of Twitter on users' clinical practice, research, and other professional activities. We performed an 11-item online survey of Twitter contributors during two major urological meetings: the European Association of Urology (EAU) and the American Urological Association (AUA) annual meetings. During the EAU 2014 meeting, we distributed the survey via the meeting official Twitter feed. During the AUA 2014 meeting, we applied a new method by directly sending the survey to Twitter contributors. We performed a subset analysis for assessing the perceived impact of Twitter on the clinical practice of physicians. Among 312 total respondents, the greatest perceived benefits of Twitter among users were for networking (97%) and disseminating information (96%), followed by research (75%), advocacy (74%) and career development (62%). In total, 65% of Twitter users have dealt with guidelines on online medical professionalism and 71% of physician users found that Twitter had an impact on their clinical practice, and 33% had made a clinical decision based on an online case discussion. Our results suggest that Twitter users in the urological community perceive important benefits. These benefits extend to multiple professional domains, particularly networking, disseminating information, remote conference participation, research, and advocacy. This is the first study that has been disseminated to targeted individuals from the urological community directly through tweets, providing a proof of principle for this research method.

Significance of Urinary Tract Involvement in Patients Treated with Cytoreductive Surgery (CRS) and Hyperthermic Intraperitoneal Chemotherapy (HIPEC)

PubMed Central

Randle, Reese W.; Craven, Brandon; Swett, Katrina R.; Levine, Edward A.; Shen, Perry; Stewart, John H.; Mirzazadeh, Majid

2014-01-01

Background Urinary tract involvement in patients with peritoneal surface disease treated with cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) often requires complex urologic resections and reconstruction to achieve optimal cytoreduction. The impact of these combined procedures on surgical outcomes is not well defined. Methods A prospective database of CRS/HIPEC procedures was analyzed retrospectively. Type of malignancy, performance status, resection status, hospital and intensive care unit stay, morbidity, mortality, and overall survival were reviewed. Results A total of 864 patients underwent 933 CRS/HI-PEC procedures, while 64 % (550) had preoperative ureteral stent placement. A total of 7.3 % had an additional urologic procedure without an increase in 30-day (p = 0.4) or 90-day (p = 1.0) mortality. Urologic procedures correlated with increased length of operating time (p < 0.001), blood loss (p < 0.001), and length of hospitalization (p = 0.003), yet were not associated with increased overall 30-day major morbidity (grade III/IV, p = 0.14). In multivariate analysis, independent predictors of additional urologic procedures were prior surgical score (p < 0.001), number of resected organs (p = 0.001), and low anterior resection (p = 0.03). Long-term survival was not statistically different between patients with and without urologic resection for low-grade appendiceal primary lesions (p = 0.23), high-grade appendiceal primary lesions (p = 0.40), or colorectal primary lesions (p = 0.14). Conclusions Urinary tract involvement in patients with peritoneal surface disease does not increase overall surgical morbidity. Patients with urologic procedures demonstrate survival patterns with meaningful prolongation of life. Urologic involvement should not be considered a contraindication for CRS/HIPEC in patients with resectable peritoneal surface disease. PMID:24217789

Significance of urinary tract involvement in patients treated with cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC).

PubMed

Votanopoulos, Konstantinos I; Randle, Reese W; Craven, Brandon; Swett, Katrina R; Levine, Edward A; Shen, Perry; Stewart, John H; Mirzazadeh, Majid

2014-03-01

Urinary tract involvement in patients with peritoneal surface disease treated with cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) often requires complex urologic resections and reconstruction to achieve optimal cytoreduction. The impact of these combined procedures on surgical outcomes is not well defined. A prospective database of CRS/HIPEC procedures was analyzed retrospectively. Type of malignancy, performance status, resection status, hospital and intensive care unit stay, morbidity, mortality, and overall survival were reviewed. A total of 864 patients underwent 933 CRS/HIPEC procedures, while 64 % (550) had preoperative ureteral stent placement. A total of 7.3 % had an additional urologic procedure without an increase in 30-day (p = 0.4) or 90-day (p = 1.0) mortality. Urologic procedures correlated with increased length of operating time (p < 0.001), blood loss (p < 0.001), and length of hospitalization (p = 0.003), yet were not associated with increased overall 30-day major morbidity (grade III/IV, p = 0.14). In multivariate analysis, independent predictors of additional urologic procedures were prior surgical score (p < 0.001), number of resected organs (p = 0.001), and low anterior resection (p = 0.03). Long-term survival was not statistically different between patients with and without urologic resection for low-grade appendiceal primary lesions (p = 0.23), high-grade appendiceal primary lesions (p = 0.40), or colorectal primary lesions (p = 0.14). Urinary tract involvement in patients with peritoneal surface disease does not increase overall surgical morbidity. Patients with urologic procedures demonstrate survival patterns with meaningful prolongation of life. Urologic involvement should not be considered a contraindication for CRS/HIPEC in patients with resectable peritoneal surface disease.

Objective measures of renal mass anatomic complexity predict rates of major complications following partial nephrectomy.

PubMed

Simhan, Jay; Smaldone, Marc C; Tsai, Kevin J; Canter, Daniel J; Li, Tianyu; Kutikov, Alexander; Viterbo, Rosalia; Chen, David Y T; Greenberg, Richard E; Uzzo, Robert G

2011-10-01

The association between tumor complexity and postoperative complications after partial nephrectomy (PN) has not been well characterized. We evaluated whether increasing renal tumor complexity, quantitated by nephrometry score (NS), is associated with increased complication rates following PN using the Clavien-Dindo classification system (CCS). We queried our prospectively maintained kidney cancer database for patients undergoing PN from 2007 to 2010 for whom NS was available. All patients underwent PN. Tumors were categorized into low- (NS: 4-6), moderate- (NS: 7-9), and high-complexity (NS: 10-12) lesions. Complication rates within 30 d were graded (CCS: I-5), stratified as minor (CCS: I or 2) or major (CCS: 3-5), and compared between groups. A total of 390 patients (mean age: 58.0 ± 11.9 yr; 66.9% male) undergoing PN (44.6% open, 55.4% robotic) for low- (28%), moderate- (55.6%), and high-complexity (16.4%) tumors (mean tumor size: 3.74 ± 2.4 cm; median: 3.2 cm) from 2007 to 2010 were identified. Tumor size, estimated blood loss, and ischemia time all significantly differed (p<0.0001) between groups; patient age, body mass index (BMI), and operative time were comparable. When stratified by CCS, minor and major complication rates for all patients were 26.7% and 11.5%, respectively. Minor complication rates were comparable (26.6 vs. 24.9 vs 32.8%; p=0.45), whereas major complication rates differed (6.4 vs. 11.1 vs. 21.9%; p=0.009) among tumor complexity groups. Controlling for age, gender, BMI, type of surgical approach, operative duration, and tumor complexity, prolonged operative time (odds ratio [OR]: 1.01; confidence interval [CI], 1.0-1.02) and high tumor complexity (OR: 5.4; CI, 1.2-24.2) were associated with the postoperative development of a major complication. Lack of external validation is a limitation of this study. Increasing tumor complexity is associated with the development of major complications after PN. This association should be validated externally and integrated into the decision-making process when counseling patients with complex renal tumors. Copyright © 2011 European Association of Urology. Published by Elsevier B.V. All rights reserved.

Benefits and Harms of Treatment of Asymptomatic Bacteriuria: A Systematic Review and Meta-analysis by the European Association of Urology Urological Infection Guidelines Panel.

PubMed

Köves, Bela; Cai, Tommaso; Veeratterapillay, Rajan; Pickard, Robert; Seisen, Thomas; Lam, Thomas B; Yuan, Cathy Yuhong; Bruyere, Franck; Wagenlehner, Florian; Bartoletti, Riccardo; Geerlings, Suzanne E; Pilatz, Adrian; Pradere, Benjamin; Hofmann, Fabian; Bonkat, Gernot; Wullt, Björn

2017-12-01

People with asymptomatic bacteriuria (ABU) are often unnecessarily treated with antibiotics risking adverse effects and antimicrobial resistance. We performed a systematic review to determine any benefits and harms of treating ABU in particular patient groups. Relevant databases were searched and eligible trials were assessed for risk-of-bias and Grading of Recommendations, Assessment, Development and Education quality. Where possible, a meta-analysis of extracted data was performed or a narrative synthesis of the evidence was presented. After screening 3626 articles, 50 studies involving 7088 patients were included. Overall, quality of evidence ranged from very low to low. There was no evidence of benefit for patients with no risk factors, patients with diabetes mellitus, postmenopausal women, elderly institutionalised patients, patients with renal transplants, or patients prior to joint replacement, and treatment was harmful for patients with recurrent urinary tract infection (UTI). Treatment of ABU resulted in a lower risk of postoperative UTI after transurethral resection surgery. In pregnant women, we found evidence that treatment of ABU decreased risk of symptomatic UTI, low birthweight, and preterm delivery. ABU should be treated prior to transurethral resection surgery. In addition, current evidence also suggests that ABU treatment is required in pregnant women, although the results of a recent trial have challenged this view. We reviewed available scientific studies to see if people with bacteria in their urine but without symptoms of urinary tract infection should be treated with antibiotics to eliminate bacteria. For most people, treatment was not beneficial and may be harmful. Antibiotic treatment did appear to benefit women in pregnancy and those about to undergo urological surgery. Copyright © 2017 European Association of Urology. Published by Elsevier B.V. All rights reserved.

Reporting and methodological quality of meta-analyses in urological literature.

PubMed

Xia, Leilei; Xu, Jing; Guzzo, Thomas J

2017-01-01

To assess the overall quality of published urological meta-analyses and identify predictive factors for high quality. We systematically searched PubMed to identify meta-analyses published from January 1st, 2011 to December 31st, 2015 in 10 predetermined major paper-based urology journals. The characteristics of the included meta-analyses were collected, and their reporting and methodological qualities were assessed by the PRISMA checklist (27 items) and AMSTAR tool (11 items), respectively. Descriptive statistics were used for individual items as a measure of overall compliance, and PRISMA and AMSTAR scores were calculated as the sum of adequately reported domains. Logistic regression was used to identify predictive factors for high qualities. A total of 183 meta-analyses were included. The mean PRISMA and AMSTAR scores were 22.74 ± 2.04 and 7.57 ± 1.41, respectively. PRISMA item 5, protocol and registration, items 15 and 22, risk of bias across studies, items 16 and 23, additional analysis had less than 50% adherence. AMSTAR item 1, " a priori " design, item 5, list of studies and item 10, publication bias had less than 50% adherence. Logistic regression analyses showed that funding support and " a priori " design were associated with superior reporting quality, following PRISMA guideline and " a priori " design were associated with superior methodological quality. Reporting and methodological qualities of recently published meta-analyses in major paper-based urology journals are generally good. Further improvement could potentially be achieved by strictly adhering to PRISMA guideline and having " a priori " protocol.

Acute kidney injury in a child: A case of Munchausen syndrome by proxy.

PubMed

Mantan, Mukta; Dhingra, Dhulika; Gupta, Aditi; Sethi, Gulshan Rai

2015-11-01

Renal and urologic problems in pediatric condition falsification (PCF) or Munchausen by proxy (MSP) can result in serious diagnostic dilemma. Symptoms of hematuria, pyuria and recurrent urinary tract infections have occasionally been described. However, MSP presenting as azotemia has not been previously reported. We describe the case of an unfortunate boy who had to undergo unnecessary hemodialysis for persistent hyperkalemia and azotemia before a final diagnosis of the falsification of investigations by the parents was made.

Gender differences in promotions and scholarly productivity in academic urology.

PubMed

Awad, Mohannad A; Gaither, Thomas W; Osterberg, E Charles; Yang, Glen; Greene, Kirsten L; Weiss, Dana A; Anger, Jennifer T; Breyer, Benjamin N

2017-10-01

The gender demographics within urology are changing as more women are entering the workforce. Since research productivity strongly influence career advancement, we aim to characterize gender differences in scholarly productivity and promotions in a cohort of graduated academic urologists. Urologists who graduated between 2002 and 2008 from 34 residency programs affiliated with the top 50 urology hospitals as ranked in 2009 by U.S. News & World Report were followed longitudinally. Only urologists affiliated with an academic teaching hospital were included for analysis. A total of 543 residents graduated, 459 (84.5%) males and 84 (15.5%) females. Of these, 173 entered academia, 137 (79.2%) males and 36 (20.8%) females. Women had fewer publications compared to men (mean 19.3 versus 61.7, p = 0.001). Fewer women compared to men were promoted from assistant professor 11 (30.6%) versus 83 (60.6%), p = 0.005. Fewer women achieved associate professor 10 (27.8%) versus 67 (48.9%), p = 0.005 or professor ranks 1 (2.8%) versus 16 (11.7%), p = 0.005 respectively compared to men. In a multivariate logistic regression analysis, after controlling for the number of total publications and number of years since graduation, gender was not predictive of achieving promotion, OR = 0.81 (95% CI 0.31-2.13), p = 0.673. Women are underrepresented in senior faculty roles in urology. Scholarly productivity seems to play a major role in academic promotion within urology. With increasing women in academic urology, further studies are needed to explore predictors of promotion and how women can achieve higher leadership roles in the field.

A new wave of urologists? Graduating urology residents' practices of and attitudes toward social media.

PubMed

Jain, Kunal; Fervaha, Gagan; Fuoco, Michael B; Leveridge, Michael J

2018-03-19

Social media (SoMe) have revolutionized healthcare, but physicians remain hesitant to adopt SoMe in their practices. We sought to assess graduating urology residents' practices of and attitudes toward SoMe. A close-ended questionnaire, employing five-point Likert scales, was distributed to all final-year residents (n=100) in Canadian urology training programs in 2012, 2014, and 2016 to assess SoMe usage and perceived usefulness. All (100%) questionnaires were completed. Respondents frequently used online services for personal (100%) and professional (96%) purposes. Most (92%) used SoMe. Many (73%) frequently used SoMe for personal purposes, but few (12%) frequently used SoMe for professional purposes. While a majority (59%) opposed direct patient interaction online, most supported using SoMe to provide patients with static information (76%) and collaborate with colleagues (65%). Many (70-73%) were optimistic that novel solutions to privacy issues in online communications will arise, making SoMe and email contact with patients conceivable. Few (2-8%) were aware and had read guidelines and legislations regarding physician online practices; however, awareness of medical associations' and institutional SoMe policies significantly increased over time (p<0.05). Despite their active online use, graduating urology residents rarely used SoMe in professional settings and were wary of using it in patient care. Nevertheless, they were optimistic toward its integration in urology and supported its use in physician-physician communication. Considering SoMe's increased influence on urology and graduating residents' limited awareness of guidelines and legislations, postgraduate medical educators should encourage residents to become more familiar with current online communication recommendations.

Learning curves for urological procedures: a systematic review.

PubMed

Abboudi, Hamid; Khan, Mohammed Shamim; Guru, Khurshid A; Froghi, Saied; de Win, Gunter; Van Poppel, Hendrik; Dasgupta, Prokar; Ahmed, Kamran

2014-10-01

To determine the number of cases a urological surgeon must complete to achieve proficiency for various urological procedures. The MEDLINE, EMBASE and PsycINFO databases were systematically searched for studies published up to December 2011. Studies pertaining to learning curves of urological procedures were included. Two reviewers independently identified potentially relevant articles. Procedure name, statistical analysis, procedure setting, number of participants, outcomes and learning curves were analysed. Forty-four studies described the learning curve for different urological procedures. The learning curve for open radical prostatectomy ranged from 250 to 1000 cases and for laparoscopic radical prostatectomy from 200 to 750 cases. The learning curve for robot-assisted laparoscopic prostatectomy (RALP) has been reported to be 40 procedures as a minimum number. Robot-assisted radical cystectomy has a documented learning curve of 16-30 cases, depending on which outcome variable is measured. Irrespective of previous laparoscopic experience, there is a significant reduction in operating time (P = 0.008), estimated blood loss (P = 0.008) and complication rates (P = 0.042) after 100 RALPs. The available literature can act as a guide to the learning curves of trainee urologists. Although the learning curve may vary among individual surgeons, a consensus should exist for the minimum number of cases to achieve proficiency. The complexities associated with defining procedural competence are vast. The majority of learning curve trials have focused on the latest surgical techniques and there is a paucity of data pertaining to basic urological procedures. © 2013 The Authors. BJU International © 2013 BJU International.

Novel survey disseminated through Twitter supports its utility for networking, disseminating research, advocacy, clinical practice and other professional goals

PubMed Central

Borgmann, Hendrik; DeWitt, Sasha; Tsaur, Igor; Haferkamp, Axel; Loeb, Stacy

2015-01-01

Introduction: Twitter use has grown exponentially within the urological community. We aimed to determine the perceptions of the impact of Twitter on users’ clinical practice, research, and other professional activities. Methods: We performed an 11-item online survey of Twitter contributors during two major urological meetings: the European Association of Urology (EAU) and the American Urological Association (AUA) annual meetings. During the EAU 2014 meeting, we distributed the survey via the meeting official Twitter feed. During the AUA 2014 meeting, we applied a new method by directly sending the survey to Twitter contributors. We performed a subset analysis for assessing the perceived impact of Twitter on the clinical practice of physicians. Results: Among 312 total respondents, the greatest perceived benefits of Twitter among users were for networking (97%) and disseminating information (96%), followed by research (75%), advocacy (74%) and career development (62%). In total, 65% of Twitter users have dealt with guidelines on online medical professionalism and 71% of physician users found that Twitter had an impact on their clinical practice, and 33% had made a clinical decision based on an online case discussion. Conclusions: Our results suggest that Twitter users in the urological community perceive important benefits. These benefits extend to multiple professional domains, particularly networking, disseminating information, remote conference participation, research, and advocacy. This is the first study that has been disseminated to targeted individuals from the urological community directly through tweets, providing a proof of principle for this research method. PMID:26664662

A single-dose regimen for antimicrobial prophylaxis to prevent perioperative infection in urological clean and clean-contaminated surgery.

PubMed

Higuchi, Yoshihide; Takesue, Yoshio; Yamada, Yusuke; Ueda, Yasuo; Suzuki, Toru; Aihara, Kinue; Maruyama, Takuo; Kondoh, Nobuyuki; Nojima, Michio; Yamamoto, Shingo

2011-04-01

A single dose of antimicrobial prophylaxis (AMP) was administered parenterally for the prevention of perioperative infection in a total of 788 patients undergoing urological surgery, including 380 endoscopic-instrumental, 328 clean, and 80 clean-contaminated operations performed at our institute between January 2007 and December 2009. Surgical site infections (SSIs), urinary tract infections (UTIs), and remote infections (RIs) were prospectively surveyed. The definition for a single dose of AMP allowed for the administration of an additional dose of an antimicrobial during surgery if the procedure was longer than 3 h, but not for the parenteral or oral administration at the end of the procedure in the recovery room, or at a later time over a period of more than 24 h. UTI was observed in 12 (3.2%) patients after endoscopic-instrumental operation, 1 (0.3%) after clean operation, and 1 (0.9%) after clean-contaminated operation. SSI was observed in 2 (0.6%) patients after clean operation but in none after clean-contaminated operations. RI was observed in 1 (0.3%) patient after endoscopic-instrumental operation, 3 (0.9%) after clean operation, and none after clean-contaminated operations. A single-dose regimen of AMP was effective and feasible for the prevention of perioperative infections, including SSIs, UTIs, and RIs, in endoscopic-instrumental, clean, and clean-contaminated urological surgical procedures.

Urology training in the developing world: The trainees’ perspective in Kurdistan, Iraq

PubMed Central

Friad, Goran; Sabah, Kawa; Ameen, Ismaeel Hama

2013-01-01

Objective To analyse the advanced systems of urology residency in the developed world, to compare them to a system in the developing world, and thereby identify the shortcomings and make recommendations to improve residency programmes for urology in the Kurdistan Region of Iraq. Methods A survey was conducted amongst the urology Residents (55) in the three governorates of the Kurdistan Region of Iraq, to assess the accessibility of the training programme, the types of the residency programmes, skills acquisition, the use of modern technology for teaching and assessment, the environment of the settings of practice, and the status of research in their training. Results An overwhelming majority (88%) of trainees reported difficulty in securing a training position. A high proportion (43%) felt disappointed at the beginning of their training. There is no unified curriculum of training, and more than two-thirds of the respondents reported a lack of a proper evidence-based medical education. There is no formal subspecialty training programme. Of the respondents, 65% referred to the difficulties in the environment for training, and that there was a low level of research involvement (12%). Conclusions Urology training is not easily accessible, there is no unified programme of residency, there are limited facilities, and a minimal assessment of practical skills. The environment for practice needs enormous improvements and a strong foundation for research should be created. PMID:26019913

Urology training in the developing world: The trainees' perspective in Kurdistan, Iraq.

PubMed

Friad, Goran; Sabah, Kawa; Ameen, Ismaeel Hama

2014-03-01

To analyse the advanced systems of urology residency in the developed world, to compare them to a system in the developing world, and thereby identify the shortcomings and make recommendations to improve residency programmes for urology in the Kurdistan Region of Iraq. A survey was conducted amongst the urology Residents (55) in the three governorates of the Kurdistan Region of Iraq, to assess the accessibility of the training programme, the types of the residency programmes, skills acquisition, the use of modern technology for teaching and assessment, the environment of the settings of practice, and the status of research in their training. An overwhelming majority (88%) of trainees reported difficulty in securing a training position. A high proportion (43%) felt disappointed at the beginning of their training. There is no unified curriculum of training, and more than two-thirds of the respondents reported a lack of a proper evidence-based medical education. There is no formal subspecialty training programme. Of the respondents, 65% referred to the difficulties in the environment for training, and that there was a low level of research involvement (12%). Urology training is not easily accessible, there is no unified programme of residency, there are limited facilities, and a minimal assessment of practical skills. The environment for practice needs enormous improvements and a strong foundation for research should be created.

Reduction of operative mortality after implementation of Surgical Outcomes Monitoring and Improvement Programme by Hong Kong Hospital Authority.

PubMed

Yuen, W C; Wong, K; Cheung, Y S; Lai, P Bs

2018-04-01

Since 2008, the Hong Kong Hospital Authority has implemented a Surgical Outcomes Monitoring and Improvement Programme (SOMIP) at 17 public hospitals with surgical departments. This study aimed to assess the change in operative mortality rate after implementation of SOMIP. The SOMIP included all Hospital Authority patients undergoing major/ultra-major procedures in general surgery, urology, plastic surgery, and paediatric surgery. Patients undergoing liver or renal transplantation or who had multiple trauma or massive bowel ischaemia were excluded. In SOMIP, data retrieval from the Hospital Authority patient database was performed by six full-time nurse reviewers following a set of precise data definitions. A total of 230 variables were collected for each patient, on demographics, preoperative and operative variables, laboratory test results, and postoperative complications up to 30 days after surgery. In this study, we used SOMIP cumulative 5-year data to generate risk-adjusted 30-day mortality models by hierarchical logistic regression for both emergency and elective operations. The models expressed overall performance as an annual observed-to-expected mortality ratio. From 2009/2010 to 2015/2016, the overall crude mortality rate decreased from 10.8% to 5.6% for emergency procedures and from 0.9% to 0.4% for elective procedures. From 2011/2012 to 2015/2016, the risk-adjusted observed-to-expected mortality ratios showed a significant downward trend for both emergency and elective operations: from 1.126 to 0.796 and from 1.150 to 0.859, respectively (Mann- Kendall statistic = -0.8; P<0.05 for both). The Hospital Authority's overall crude mortality rates and risk-adjusted observed-to-expected mortality ratios for emergency and elective operations significantly declined after SOMIP was implemented.

Managed care and its impact on American urology.

PubMed

Holtgrewe, H L

1998-05-01

America's health care is undergoing a revolution. A previous private, fee-for-service, delivery system chiefly centered around hospital specialty care is rapidly being replaced by a commercialized system of managed care, controlled by businessmen whose prime motive is profit. Increasing emphasis of these managed care organizations is upon primary physicians who function as gatekeepers. While this new commercialized method of health care has been attended with reductions in the previous omnipresent health care inflation our country has experienced for the past several decades, its impact on quality of care and patient choice of physician remain a great concern. Especially vulnerable in this new system are our nation's academic centers, which, burdened with responsibility for education and research, are at a disadvantage in the competitive cost-based bidding for managed care contracts. Urology work force issues and the number of urologists in our nation remain another concern for urologists as they compete for access to patients in this new highly competitive environment. In a 1995 survey of a cohort of urologists in seven states, the respondents reported 35.8% of gross income came from managed care contracts, 86% reported the need for preservice approval for many diagnostic and therapeutic undertakings, 87% reported an inability to refer complex cases outside the Managed Care Organization (MCO) network, and 23% reported they were required to retain patients for treatment who they would have otherwise referred to a more qualified urologist. The majority of American urologists are reporting dropping gross revenues and increasing overhead in their dealings with managed care contracts. The advent of managed care is being attended with dropping gross revenues, increasing overhead costs and interference with the practice patterns of American urologists.

Urodynamics findings in transverse myelitis patients with lower urinary tract symptoms: Results from a tertiary referral urodynamic center.

PubMed

Gliga, Louise A; Lavelle, Rebecca S; Christie, Alana L; Coskun, Burhan; Greenberg, Benjamin M; Carmel, Maude E; Lemack, Gary E

2017-02-01

To characterize urodynamic findings in patients referred with transverse myelitis (TM) and lower urinary tract symptoms (LUTS), as well as to identify any characteristics predictive of urodynamics findings. This is a retrospective review of an IRB-approved neurogenic bladder database of patients followed by a single surgeon between 2001 and 2013. Patient characteristics, questionnaire data, radiologic studies, and urodynamic parameters were analyzed. Of the 836 patients in the neurogenic bladder database, 28 patients (17 females, 11 males) were referred with a principle diagnosis of TM (3%). Twenty-one of twenty-eight patients (75%) underwent urodynamics testing. Bladder management at initial urologic evaluation was CIC or urethral catheter for 16/28 patients (57.1%). Median MCC was 303 ml (85-840 ml), detrusor overactivity (DO) was present in 16/21 (76%), detrusor sphincter dyssynergia (DSD) in 10/21 (48%), and decreased compliance in 7/21 (33%). For those voiding, mean Qmax was 12 ± 10 ml/sec and pdet at Qmax was 41 ± 17 cmH 2 O. Longitudinally extensive TM (LETM) was the only patient characteristic associated with DO (P = 0.0276). No other patient characteristics were associated with urodynamics parameters. Significant urodynamic testing abnormalities are noted in the majority of TM patients undergoing urodynamics, with 95% having DO, DSD, altered compliance, or detrusor underactivity. Other than the association between LETM and DO, there were no patient characteristics predictive of urodynamics findings. Based on the severity of urodynamics findings in our series, patients with TM and LUTS should have thorough baseline urological evaluations including urodynamics and be offered ongoing surveillance. Neurourol. Urodynam. 36:360-363, 2017. © 2015 Wiley Periodicals, Inc. © 2015 Wiley Periodicals, Inc.

The use of a gas chromatography-sensor system combined with advanced statistical methods, towards the diagnosis of urological malignancies

PubMed Central

Aggio, Raphael B. M.; de Lacy Costello, Ben; White, Paul; Khalid, Tanzeela; Ratcliffe, Norman M.; Persad, Raj; Probert, Chris S. J.

2016-01-01

Prostate cancer is one of the most common cancers. Serum prostate-specific antigen (PSA) is used to aid the selection of men undergoing biopsies. Its use remains controversial. We propose a GC-sensor algorithm system for classifying urine samples from patients with urological symptoms. This pilot study includes 155 men presenting to urology clinics, 58 were diagnosed with prostate cancer, 24 with bladder cancer and 73 with haematuria and or poor stream, without cancer. Principal component analysis (PCA) was applied to assess the discrimination achieved, while linear discriminant analysis (LDA) and support vector machine (SVM) were used as statistical models for sample classification. Leave-one-out cross-validation (LOOCV), repeated 10-fold cross-validation (10FoldCV), repeated double cross-validation (DoubleCV) and Monte Carlo permutations were applied to assess performance. Significant separation was found between prostate cancer and control samples, bladder cancer and controls and between bladder and prostate cancer samples. For prostate cancer diagnosis, the GC/SVM system classified samples with 95% sensitivity and 96% specificity after LOOCV. For bladder cancer diagnosis, the SVM reported 96% sensitivity and 100% specificity after LOOCV, while the DoubleCV reported 87% sensitivity and 99% specificity, with SVM showing 78% and 98% sensitivity between prostate and bladder cancer samples. Evaluation of the results of the Monte Carlo permutation of class labels obtained chance-like accuracy values around 50% suggesting the observed results for bladder cancer and prostate cancer detection are not due to over fitting. The results of the pilot study presented here indicate that the GC system is able to successfully identify patterns that allow classification of urine samples from patients with urological cancers. An accurate diagnosis based on urine samples would reduce the number of negative prostate biopsies performed, and the frequency of surveillance cystoscopy for bladder cancer patients. Larger cohort studies are planned to investigate the potential of this system. Future work may lead to non-invasive breath analyses for diagnosing urological conditions. PMID:26865331

The landscape of systematic reviews in urology (1998 to 2015): an assessment of methodological quality.

PubMed

Han, Julia L; Gandhi, Shreyas; Bockoven, Crystal G; Narayan, Vikram M; Dahm, Philipp

2017-04-01

To assess the quality of published systematic reviews in the urology literature (an extension of our previously reported work), as high-quality systematic reviews play a paramount role in informing evidence-based clinical practice. Our focus was on systematic reviews in the urology literature that incorporated questions of prevention and therapy. To identify such reviews published during a 36-month period (2013-2015), we systematically searched PubMed and hand-searched the table of contents of four major urology journals. Two reviewers independently assessed the methodological quality of those reviews, using the 11-point 'Assessment of Multiple Systematic Reviews' (AMSTAR) instrument. We performed protocol-driven analyses of the data from our present study's 36-month period alone, as well as in aggregate with the data from our previously reported work's study periods (2009-2012 and 1998-2008). In our literature search of the 36-month period (2013-2015), we initially identified 490 possibly relevant reviews, of which 125 met our inclusion criteria. The most common topic of reviews for the 2013-2015 period was oncology (51.2%; n = 64), followed by voiding dysfunction (21.6%; n = 27). The mean [standard deviation (SD)] AMSTAR score in the 2013-2015 period (n = 125) was 4.8 (2.4); 2009-2012 (n = 113), 5.4 (2.3); and 1998-2008 (n = 57), 4.8 (2.0) (P = 0.127). In the 2013-2015 period, the mean (SD) AMSTAR score for the BJU International (n = 25) was 5.6 (2.9); for The Journal of Urology (n = 20), 5.1 (2.6); for European Urology (n = 60), 4.5 (2.2); and for Urology (n = 20), 4.4 (2.2) (P = 0.106). The number of systematic reviews published in the urology literature has exponentially increased, year by year, but their methodological quality has stagnated. To enhance the validity and impact of systematic reviews, all authors and editors must apply established methodological standards. © 2016 The Authors BJU International © 2016 BJU International Published by John Wiley & Sons Ltd.

Reporting and methodological quality of meta-analyses in urological literature

PubMed Central

Xu, Jing

2017-01-01

Purpose To assess the overall quality of published urological meta-analyses and identify predictive factors for high quality. Materials and Methods We systematically searched PubMed to identify meta-analyses published from January 1st, 2011 to December 31st, 2015 in 10 predetermined major paper-based urology journals. The characteristics of the included meta-analyses were collected, and their reporting and methodological qualities were assessed by the PRISMA checklist (27 items) and AMSTAR tool (11 items), respectively. Descriptive statistics were used for individual items as a measure of overall compliance, and PRISMA and AMSTAR scores were calculated as the sum of adequately reported domains. Logistic regression was used to identify predictive factors for high qualities. Results A total of 183 meta-analyses were included. The mean PRISMA and AMSTAR scores were 22.74 ± 2.04 and 7.57 ± 1.41, respectively. PRISMA item 5, protocol and registration, items 15 and 22, risk of bias across studies, items 16 and 23, additional analysis had less than 50% adherence. AMSTAR item 1, “a priori” design, item 5, list of studies and item 10, publication bias had less than 50% adherence. Logistic regression analyses showed that funding support and “a priori” design were associated with superior reporting quality, following PRISMA guideline and “a priori” design were associated with superior methodological quality. Conclusions Reporting and methodological qualities of recently published meta-analyses in major paper-based urology journals are generally good. Further improvement could potentially be achieved by strictly adhering to PRISMA guideline and having “a priori” protocol. PMID:28439452

Scientific publications in nephrology and urology journals from Chinese authors in East Asia: a 10-year survey of the literature.

PubMed

Xu, Jing; Mao, Zhi-Guo; Kong, Mei; Hu, Liang-Hao; Ye, Chao-Yang; Xu, Cheng-Gang; Rong, Shu; Sun, Li-Jun; Wu, Jun; Dai, Bing; Chen, Dong-Ping; Zhu, Yu-Xian; Zhang, Yi-Xiang; Zhang, Yu-Qiang; Zhao, Xue-Zhi; Mei, Chang-Lin

2011-04-08

Diseases of the kidneys and genitourinary tract are common health problems that affect people of all ages and demographic backgrounds. In this study, we compared the quantity and quality of nephrological and urological articles published in international journals from the three major regions of China: the mainland (ML), Hong Kong (HK), and Taiwan (TW). Nephrological and urological articles originating from ML, TW, and HK that were published in 61 journals from 1999-2008 were retrieved from the PubMed database. We recorded the numbers of total articles, clinical trials, randomized controlled trials, case reports, impact factors (IF), citations, and articles published in the leading general-medicine journals. We used these data to compare the quantity and quality of publication output from the three regions. The total number of articles increased significantly from 1999 to 2008 in the three regions. The number of articles from ML has exceeded that from HK since 2004, and surpassed that from TW in 2008. Publications from TW had the highest accumulated IF, total citations of articles, and the most articles published in leading general-medicine journals. However, HK publications had the highest average IF. Although ML produced the largest quantity of articles, it exhibited the lowest quality among the three regions. The number of nephrological and urological publications originating from the three major regions of China increased significantly from 1999 to 2008. The annual number of publications by ML researchers exceeded those from TW and HK. However, the quality of articles from TW and HK was higher than that from ML.

[The role of social media in academic training in Urology. Adequate use.

PubMed

Gómez Rivas, Juan; Tortolero Blanco, Leonardo; Rodríguez Socarras, Moises; García Sanz, Miguel; Carrión, Diego M; Okhunov, Zhamshid; Veneziano, Domenico

2018-01-01

Social media is characterized because all its services are participative. Users of 2.0 technologies can interact easily and openly with other people, share resources and communicate immediately and simultaneously. Research improves from participatory technologies by allowing groups to share reflections, methodologies, resources and results.The social media platform with greater diffusion and use in urology is possibly Twitter because it allows to realize what is known like "microblogging", the users generate comments and brief messages through the creation of "tweets". It is possible to determine that there are three broad areas from a scientific point of view in which social media are manifested: sharing research, resources and results. The use and applications of social media become a major responsibility in the area of health and urology, obviously for reasons of privacy, scientific rigor, ethics and the nature of the medical - legal content.

Comparative effectiveness in urology: a state of the art review utilizing a systematic approach.

PubMed

Bandari, Jathin; Wessel, Charles B; Jacobs, Bruce L

2017-07-01

Comparative effectiveness research plays a vital role in healthcare delivery by guiding evidence-based practices. We performed a state-of-the-art review of comparative effectiveness research in the urology literature for 2016, utilizing a systematic approach. Seven high-impact papers are reviewed in detail. Across the breadth of urology, there were several important studies in comparative effectiveness research, of which we will highlight two randomized controlled trials and five observational trials: radiotherapy, prostatectomy, and active monitoring have equivalent mortality outcomes in patients with localized prostate cancer; the ideal modality of patient education is yet to be determined, and written education has minimal effect on patient perception of prostate specific antigen screening; robotic prostatectomy is associated with higher perioperative complication rates on a population basis; racial disparities exist in incontinence rates after treatment for localized prostate cancer, but not in irritative, bowel, or sexual function; androgen deprivation therapy is associated with higher fracture, peripheral artery disease, and cardiac-related complications than bilateral orchiectomy; robotic and open cystectomy offer comparable cancer-specific mortality and perioperative outcomes; and bonuses for low-cost hospitals can inadvertently reward low-quality hospitals. There have been major advancements in comparative effectiveness research in urology in 2016.

Patients with urologic cancer and other nonurologic malignancies: analysis of a sample and review of the literature.

PubMed

Mydlo, J H; Gerstein, M

2001-12-01

To describe our experience with patients with urologic cancers who also have malignancies of nonurologic origin, before, after, or simultaneously, to review the literature, and to suggest treatment options. We reviewed our institutions' tumor registry from 1995 to 2000 to discover how many patients had a urologic malignancy and another nonurologic cancer (antecedent, subsequent, or synchronous). We reviewed Medline from 1966 to 2000 and also questioned several urologists at major centers in the United States concerning this clinical dilemma. We encountered 18 patients during a 6-year period with a urologic cancer and another primary malignancy. Thirteen patients had their second cancer detected during the workup of their primary urologic tumor. Two patients developed a second tumor within 1 year of treatment of the primary urologic tumor. Another patient was referred with two primaries already diagnosed, and another had renal carcinoma detected during her colon cancer workup. We found that multiple tumors, although very rare, are usually detected during the preoperative workup of the primary tumor, usually by physical examination and improved radiologic imaging, or during the follow-up examinations. Most reports suggest that treatment should be performed simultaneously, especially if the lesions are relatively small and require a single incision, and the patient's medical condition allows longer anesthesia exposure. If these prerequisites are not met, most investigators agree that treatment should be directed at the more aggressive lesion first, which may improve the condition and/or survival, and thus, if a second operation is warranted, it will be possible. Although patients with multiple malignancies are rare, the urologist and/or other specialist should be alerted to this possibility when evaluating patients for the initially presenting symptoms and/or detected tumor, as well as during the follow-up evaluations.

Young patients with suspected uncomplicated renal colic are unlikely to have dangerous alternative diagnoses or need emergent intervention.

PubMed

Schoenfeld, Elizabeth M; Poronsky, Kye E; Elia, Tala R; Budhram, Gavin R; Garb, Jane L; Mader, Timothy J

2015-03-01

In the United States there is debate regarding the appropriate first test for new-onset renal colic, with non-contrast helical computed tomography (CT) receiving the highest ratings from both Agency for Healthcare Research and Quality and the American Urological Association. This is based not only on its accuracy for the diagnosis of renal colic, but also its ability to diagnose other surgical emergencies, which have been thought to occur in 10-15% of patients with suspected renal colic, based on previous studies. In younger patients, it may be reasonable to attempt to avoid immediate CT if concern for dangerous alternative diagnosis is low, based on the risks of radiation from CTs, and particularly in light of evidence that patients with renal colic have a very high likelihood of having multiple CTs in their lifetimes. The objective is to determine the proportion of patients with a dangerous alternative diagnosis in adult patients age 50 and under presenting with uncomplicated (non-infected) suspected renal colic, and also to determine what proportion of these patients undergo emergent urologic intervention. Retrospective chart review of 12 months of patients age 18-50 presenting with "flank pain," excluding patients with end stage renal disease, urinary tract infection, pregnancy and trauma. Dangerous alternative diagnosis was determined by CT. Two hundred and ninety-one patients met inclusion criteria. One hundred and fifteen patients had renal protocol CTs, and zero alternative emergent or urgent diagnoses were identified (one-sided 95% CI [0-2.7%]). Of the 291 encounters, there were 7 urologic procedures performed upon first admission (2.4%, 95% CI [1.0-4.9%]). The prevalence of kidney stone by final diagnosis was 58.8%. This small sample suggests that in younger patients with uncomplicated renal colic, the benefit of immediate CT for suspected renal colic should be questioned. Further studies are needed to determine which patients benefit from immediate CT for suspected renal colic, and which patients could undergo alternate imaging such as ultrasound.

[Complete necrosis of the penis and testes by strangulation in a psychotic patient].

PubMed

Bart, S; Culty, T; Pizzoferrato, A-C; Thibault, F; Girault, N; Chartier-Kastler, E; Richard, F

2008-07-01

Complete necrosis of the penis and scrotum due to strangulation of the external genitalia is unusually encountered in urologic emergencies. Urological conservative management is recommended. Delayed presentation is a major source of complications. We report the case of a psychotic patient, who was transferred from the emergency department in a context of complete necrosis of the external genitalia. This patient's history included chronic psychotic disorder and positive HIV serology, but he refused to take either neuroleptic or antiretroviral therapy. Complete amputation of the penis and bilateral orchidectomy were performed. We report the first six months of medical management.

Comparison of Perioperative Outcomes Between Holmium Laser Enucleation of the Prostate and Robot-Assisted Simple Prostatectomy.

PubMed

Zhang, Mimi W; El Tayeb, Marawan M; Borofsky, Michael S; Dauw, Casey A; Wagner, Kristofer R; Lowry, Patrick S; Bird, Erin T; Hudson, Tillman C; Lingeman, James E

2017-09-01

To compare perioperative outcomes for patients undergoing holmium laser enucleation of the prostate (HoLEP) and robotic-assisted simple prostatectomy (RSP) for benign prostatic hypertrophy (BPH). Patient demographics and perioperative outcomes were compared between 600 patients undergoing HoLEP and 32 patients undergoing RSP at two separate academic institutions between 2008 and 2015. Patients undergoing HoLEP and RSP had comparable ages (71 vs 71, p = 0.96) and baseline American Urological Association Symptom Scores (20 vs 24, p = 0.21). There was no difference in mean specimen weight (96 g vs 110 g, p = 0.15). Mean operative time was reduced in the HoLEP cohort (103 minutes vs 274 minutes, p < 0.001). Patients undergoing HoLEP had lesser decreases in hemoglobin, decreased transfusions rates, shorter hospital stays, and decreased mean duration of catheterization. There was no difference in the rate of complications Clavien grade 3 or greater (p = 0.33). HoLEP and RSP are both efficacious treatments for large gland BPH. In expert hands, HoLEP appears to have a favorable perioperative profile. Further studies are necessary to compare long-term efficacy, cost, and learning curve influences, especially as minimally invasive approaches become more widespread.

Chlorhexidine allergy in four specialist allergy centres in the United Kingdom, 2009–13: clinical features and diagnostic tests

PubMed Central

Helbert, M.; Sargur, R.; Swallow, K.; Harper, N.; Garcez, T.; Savic, S.; Savic, L.; Eren, E.

2017-01-01

Summary We describe an observational survey of diagnostic pathways in 104 patients attending four specialist allergy clinics in the United Kingdom following perioperative hypersensitivity reactions to chlorhexidine reactions. The majority were life‐threatening. Men undergoing urological or cardiothoracic surgery predominated. Skin prick testing and specific immunoglobulin (sIg)E testing were the most common tests used for diagnosis. Fifty‐three per cent of diagnoses were made on the basis of a single positive test. Where multiple tests were performed the sensitivity of intradermal, basophil activation and skin prick testing was 68% (50–86%), 50% (10–90%) and 35% (17–55%), respectively. Seven per cent were negative on screening tests initially, and 12 cases were only positive for a single test despite multiple testing. Intradermal tests appeared most sensitive in this context. Additional sensitization to other substances used perioperatively, particularly neuromuscular blocking agents (NMBA), was found in 28 patients, emphasizing the need to test for possible allergy to all drugs to which the patient was exposed even where chlorhexidine is positive. PMID:28194756

Factors affecting UK medical students' decision to train in urology: a national survey.

PubMed

Jayakumar, Nithish; Ahmed, Kamran; Challacombe, Ben

2016-10-01

Our aim was to understand the specific factors which influence medical students' choice to train in urology, in order to attract the best and the brightest into the specialty during a challenging time for surgical training in the United Kingdom A cross-sectional web-based survey was generated to evaluate: 1) perceptions of urology; 2) attitudes about urology as a career; 3) exposure to urology at medical school; and 4) proficiency in common urological procedures. The survey was sent to all 33 medical schools in the UK and advertised to all medical students. The survey received 488 responses were received from 14 medical schools; 59.8% of respondents did not consider a career in urology. Factors affecting a career choice in urology included: 1) year of study; 2) male gender; 3) favorable perceptions of urology; 4) favorable attitudes about urology as a career; 5) more hours of urology teaching in preclinical years; 6) attendance at urology theatre sessions; 7) confidence in performing urological procedures; and 8) more attempts at male catheterization. The commonest reason for not considering urology was inadequate exposure to urology. Students in Year 3 were more likely to consider urology than final-year students, due to multifactorial reasons. Year of study is a novel factor affecting students' consideration of urology as a career. This paper clearly shows that early and sustained exposure to urology positively correlated with considering a career in urology. Urologists must be more active in promoting the specialty to medical students.

Personal, professional and financial satisfaction among American women urologists.

PubMed

Marley, Ciara S; Lerner, Lori B; Panagopoulos, Georgia; Kavaler, Elizabeth

2011-01-01

Although nearly half of American medical school classes are comprised of women, less than 5% of female medical students enter the surgical subspecialties compared to nearly 20% of male students. Many women are concerned that a career in a surgical field will limit their personal choices. In an effort to evaluate if urology is conducive to a satisfying lifestyle, we surveyed all 365 board certified women urologists in the United States in 2007 to find out how satisfied they are with their choice of urology. A 114 item anonymous survey was mailed to all 365 American Board Certified female urologists in 2007. Results were analyzed. Of the 244 women (69%) who responded, 86.8% (211) reported being satisfied with their decision to enter urology. Given the choice to repeat the decision, 81% (198) said that they would remain in medicine and 91.4% (222) would choose a surgical subspecialty again. The majority of respondents who stated they would choose a career outside of medicine also stated their family life had been significantly compromised by their career. Those who did not think their family life was compromised reported they would remain in medicine. There was a positive correlation between the level of satisfaction with the work itself and with income level (p = 0.006). Despite the small number of women who choose a career in urology, the number of satisfied women indicates urology is a career conducive to having a balanced and fulfilling life; professionally, personally and financially.

Assessment of Physical Therapy Strategies for Recovery of Urinary Continence after Prostatectomy

PubMed Central

Santos, Nivea Adriano de Santana e; Saintrain, Maria Vieira de Lima; Regadas, Rommel Prata; da Silveira, Romulo Augusto; de Menezes, Francisco Julimar Correia

2017-01-01

Introduction: Urinary incontinence is a complication of radical prostatectomy. Pelvic floor exercises can facilitate recovery of continence after surgery; however, there is not sufficient evidence that physical therapy with biofeedback training is effective, particularly with respect to providing a faster recovery. Objective: To analyze the application of physical therapy techniques in the recovery of urinary incontinence after prostatectomy. Methodology: A randomized clinical trial was conducted from April to October 2015 with patients undergoing radical prostatectomy up to three months after surgery at the Santa Casa de Misericordia in Northeastern Brazil. The physical therapy intervention consisted of up to eight individual sessions. Patients were randomized into the intervention group, which performed exercises and received biofeedback training, and the control group, which performed exercises alone. Participants were assessed before, during and after treatment. The initial assessment included a structured instrument addressing sociodemographic and urological data. Frequencies were calculated for all variables and comparisons were checked by the Mann-Whitney test and for correlation significance. Results: The study included 13 patients aged 54-74 years, the majority undergoing retropubic surgery with mild urinary incontinence [11 (84.6%)]. There was a significant difference in the outcome of the pad test before (p=0.070) and after (p=0.015) treatment between the groups, but the reduction of urinary loss and the time to recovery of continence were equivalent for both groups. Conclusion: Both interventions provided improvement in the degree of incontinence within two months of treatment. PMID:28240013

The Infant and Young Child with Spina Bifida: Major Medical Concerns.

ERIC Educational Resources Information Center

Shaer, Catherine M.

1997-01-01

This review of medical concerns in dealing with spina bifida examines neurologic and neurosurgical issues, learning issues, urological dysfunction, orthopedic issues, bowel control, latex allergy, and prenatal diagnosis and prevention. (JDD)

Complete Expulsion of Testicular Prosthesis via the Scrotum: A Case-Based Review of the Preventive Surgical Strategies

PubMed Central

Deb, A.; Jay Mathias, Suresh; Fraser Saxby, Mark; Fernando, Herman

2015-01-01

Testicular prostheses are regularly used in urological surgery and are important for postoperative psychological well-being in many patients undergoing orchiectomy. One of the recognised complications of this procedure is graft extrusion, which can result in significant morbidity for patients and require operative reintervention. Whilst most cases of extrusion involve upward graft migration to the external inguinal ring or direct displacement through the scrotal skin, we present an unusual case of complete expulsion of testicular implant three weeks postoperatively through a previously healthy scrotum. During surgical insertion of testicular prostheses, the urological surgeon must carefully consider the different surgical strategies at each step of the operation to prevent future extrusion of the graft. A stepwise review of the preventive surgical strategies to reduce the risk of graft extrusion encompasses the choice of optimal surgical incision, the technique of dissection to create the receiving anatomical pouch, the method of fixation of the implant within the receiving hemiscrotum, and the adoption of good postoperative care measures in line with the principles of sound scrotal surgery. PMID:26137344

Complex robotic reconstructive surgical procedures in children with urologic abnormalities.

PubMed

Orvieto, Marcelo A; Gundeti, Mohan S

2011-07-01

Robot-assisted laparoscopic surgery (RALS) is evolving rapidly in the pediatric surgical field. The unique attributes of the robotic interface makes this technology ideal for children with congenital anomalies who often require reconstructive procedures. Furthermore, the system can generate extremely delicate movements in a confined working space such as the one generally found in the pediatric population. Herein, we critically review the current experience with RALS placing a special emphasis in children undergoing complex reconstructive surgical procedures worldwide. A total of 42 original manuscripts on a variety of robot-assisted urologic surgical procedures in children were identified from a MEDLINE database search. Complex reconstructive procedures that are being currently performed include reoperative pyeloplasty, pyeloplasty in infants, pyelolithotomy, ureteropyelostomy/ureterostomy, bladder augmentation with or without appendico-vesicostomy, bladder neck sling procedure, among others. Initial results with robot assistance are encouraging and have demonstrated safety comparable to open procedures and outcomes at least equivalent to standard laparoscopy. Future development of smaller instruments, incorporating tactile feedback, will likely overcome current limitations and spread out the use of this technique in younger children and more advanced procedures.

Anastomic urethroplasty in bulbar urethral stricture. 13 years experience in a department of urology.

PubMed

Sáez-Barranquero, F; Herrera-Imbroda, B; Yáñez-Gálvez, A; Sánchez-Soler, N; Castillo-Gallardo, E; Cantero-Mellado, J A; Julve-Villalta, E; Machuca-Santa Cruz, F J

2016-01-01

Urethral stenosis is a common disease in the clinical practice of urology, with a major impact on the quality of life of patients. The anastomotic urethroplasty is a technique with very precise indications usually membranous or bulbar urethra stenosis with a length of 3 cm or up to 7 cm when it is secondary to urethral disruptions (no stenosis) after pelvic trauma. We review anastomotic urethroplasty performed in our department between 2002 and 2015. A retrospective, descriptive and inferential analysis on 107 patients out of 482 treated with Anastomotic urethroplasty by urethral strictures at the Urology Department of the Hospital "Virgen de la Victoria" (Malaga) from January 2002 to September 2015, establishing effectiveness and safety of the technique, as well as factors that might influence the results. The main diagnostic method was retrograde urethrography and voiding cystourethrography in 100% of patients undergoing surgery, using voiding uroflowmetry for subsequent monitoring. The definition of success was a postoperative flowmetry with Qmax>15 ml/s, and in case of lower flow, we perform a cystoscopy to verify recurrence of stenosis or exclude other pathology. The median age was 42 years, with a mean follow up of 59 months. The length of stenosis valued by retrograde urethrography and voiding cystourethrography was in 91.6% of cases of >1 cm and <2 cm. The most common etiology was idiopathic in 72.9%, followed by iatrogenic with 15.9%. Regarding the location, it was observed that the area most often affected was the bulbar urethra with 82.2%, with the membranous urethra in second place. In 77.6% of patients anastomotic urethroplasty was the initial treatment, followed in frequency by direct vision internal urethrotomy 9.3%. In the case of comorbidities associated with treatment with anastomotic urethroplasty it was observed that only Diabetes Mellitus had a tendency to statistical significance, with p=0.092, not demonstrating such significance in the case of hypertension or when the subject presented Diabetes Mellitus together with hypertension. Finally, the intervention was successful in 102 cases (95.3%), with only 5 cases (4.7%) where it failed, 4 of them treated with a new Anastomotic urethroplasty, with resolution of the stricture. Anastomotic urethroplasty is the treatment of choice for short bulbar urethral stricture, with high success rate and low complication rate, as well as low recurrence of these.

Women Urologists: Changing Trends in the Workforce.

PubMed

Saltzman, Amanda; Hebert, Kristi; Richman, Ashley; Prats, Samantha; Togami, Joanna; Rickey, Leslie; Montgomery, Melissa

2016-05-01

To characterize the current workforce of women urologists in the United States. An anonymous electronic survey was sent to all members of the Society of Women in Urology and all female non-Society of Women in Urology members of the American Urologic Association. The survey was distributed in January of 2015. Demographic, work, and personal life data were collected. Of 1563 e-mails with a link to our survey sent to women urologists in the United States, 365 surveys were completed for a 23% response rate. The average age of all participants was 39 years (range 25-73 years). Practicing women urologists had an average age of 44 years (range 32-65 years) compared to the average age (53 years) of all practicing urologists reported in the 2014 American Urologic Association Census. The majority of practicing female urologists live and work in a population of >1 million whereas a few live and work in rural areas. Practicing women urologists are most likely to work academic or group practice. Twenty percent of practicing women urologists reported working part-time, but almost 70% report working >50 hours/week. Women urologists in the United States are younger than their male counterparts and most work full-time in urban academic centers. Copyright © 2016 Elsevier Inc. All rights reserved.

Deinfibulation for treating urologic complications of type III female genital mutilation: A systematic review.

PubMed

Effa, Emmanuel; Ojo, Olumuyiwa; Ihesie, Austin; Meremikwu, Martin M

2017-02-01

Women and girls who have undergone type III female genital mutilation (FGM) may suffer urologic complications such as recurrent urinary tract infections, obstruction, stones, and incontinence. To assess the effectiveness of deinfibulation for preventing and treating urologic complications in women and girls living with FGM. The following major databases were searched from inception to August 2015: Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, SCOPUS, Web of Science, and ClinicalTrials.gov without language restrictions. Randomized controlled studies (RCTs) or observational studies with controls were considered. We screened the results of the search independently for potentially relevant studies and applied inclusion and exclusion criteria for the full texts of the relevant studies. No RCTs were found. We found three case reports and a retrospective case review, all of which were excluded. There is no evidence on the use of deinfibulation to improve urologic complications among women with type III FGM. Current clinical practice may be informed by anecdotal evidence from case reports. Appropriate RCTs and observational studies with comparison groups in countries where FGM is common are needed. PROSPERO registration: CRD42015024901. © 2017 International Federation of Gynecology and Obstetrics. The World Health Organization retains copyright and all other rights in the manuscript of this article as submitted for publication.

Guideline of guidelines: asymptomatic microscopic haematuria.

PubMed

Linder, Brian J; Bass, Edward J; Mostafid, Hugh; Boorjian, Stephen A

2018-02-01

The aim of the present study was to review major organizational guidelines on the evaluation and management of asymptomatic microscopic haematuria (AMH). We reviewed the haematuria guidelines from: the American Urological Association; the consensus statement by the Canadian Urological Association, Canadian Urologic Oncology Group and Bladder Cancer Canada; the American College of Physicians; the Joint Consensus Statement of the Renal Association and British Association of Urological Surgeons; and the National Institute for Health and Care Excellence. All guidelines reviewed recommend evaluation for AMH in the absence of potential benign aetiologies, with the evaluation including cystoscopy and upper urinary tract imaging. Existing guidelines vary in their definition of AMH (role of urine dipstick vs urine microscopy), the age threshold for recommending evaluation, and the optimal imaging method (computed tomography vs ultrasonography). Of the reviewed guidelines, none recommended the use of urine cytology or urine markers during the initial AMH evaluation. Patients should have ongoing follow-up after a negative initial AMH evaluation. Significant variation exists among current guidelines for AMH with respect to who should be evaluated and in what manner. Given the patient and health system implications of balancing appropriately focused and effective diagnostic evaluation, AMH represents a valuable future research opportunity. © 2017 The Authors BJU International © 2017 BJU International Published by John Wiley & Sons Ltd.

[The William P. Didusch Center for Urologic History of the American Urological Association: new exciting approaches in presenting urologic history, not only in the USA - a personal guided tour].

PubMed

Engel, R M

2011-04-01

The Didusch Center for Urologic History encompasses a rich and varied collection of drawings, photographs, and instruments of historical importance to urology, many displayed in the urological exhibits during the American Urological Association (AUA) conventions. The Center also houses a library devoted to urological and early medical texts and the AUA archives and is the institution of research in all fields of urologic history in the USA. The museum collection features most of Didusch's original drawings, as well as an impressive instrument collection acquired primarily through donations by urologists. The original William P. Didusch Museum (now known as the William P. Didusch Center for Urologic History) was originally housed in the AUA's Baltimore City headquarters building. Upon the association's move to Linthicum, MD in 2003, the museum has evolved into the William P. Didusch Center for Urologic History and taken on new tasks and responsibilities that include the topic of research in urologic history.

Multi-institutional Experience in Laparoendoscopic Single-site Surgery (LESS): For Major Extirpative and Reconstructive Procedures in Pediatric Urology.

PubMed

Gor, Ronak A; Long, Christopher J; Shukla, Aseem R; Kirsch, Andrew J; Perez-Brayfield, Marcos; Srinivasan, Arun K

2016-02-01

To review peri-procedural outcomes from a large, multi-institutional series of pediatric urology patients treated with laparaendoscopic single-site surgery (LESS) for major extirpative and reconstructive procedures. Consecutive LESS cases between January 2011 and May 2014 from three free-standing pediatric referral centers were reviewed. Data include age, sex, operative time, blood loss, length of stay, and complications according to the modified Clavien-Dindo classification. Hasson technique was used for peritoneal entry, GelPOINT advanced access platform was inserted, and standard 5mm laparoscopic instruments were used. Fifty-nine patients (median age 5 years, 4 months-17 years) met inclusion criteria: 29 nephrectomies, 9 nephroureterectomies, 3 bilateral nephrectomies, 5 heminephrectomies, 5 renal cyst decortications, 3 bilateral gonadectomies, 2 Malone antegrade continence enema, 2 calyceal diverticulectomy, and 1 ovarian detorsion with cystectomy. Median operative times for each case type were comparable to published experiences with traditional laparoscopy. Overall mean and median length of stay was 36.2 hours and 1 day, respectively. There were two complications: port site hernia requiring surgical repair (Clavien IIIb) and a superficial port site infection that resolved with antibiotics (Clavien II). Cosmetic outcomes were subjectively well received by patients and their parents. Operative time was significantly shorter between the first half of the experience and the second half (102 vs 70 minutes, P  <  .05). LESS approach can be broadly applied across many major extirpative and reconstructive procedures within pediatric urology. Our series advances our field's utilization of this technique and its safety. Copyright © 2016 Elsevier Inc. All rights reserved.

Acceptance, Prevalence and Indications for Robot-Assisted Laparoscopy - Results of a Survey Among Urologists in Germany, Austria and Switzerland.

PubMed

Imkamp, Florian; Herrmann, Thomas R W; Tolkach, Yuri; Dziuba, Sebastian; Stolzenburg, Jens U; Rassweiler, Jens; Sulser, Tullio; Zimmermann, Uwe; Merseburger, Axel S; Kuczyk, Markus A; Burchardt, Martin

2015-01-01

Robotic-assisted laparoscopy (RAL) is being widely accepted in the field of urology as a replacement for conventional laparoscopy (CL). Nevertheless, the process of its integration in clinical routines has been rather spontaneous. To determine the prevalence of robotic systems (RS) in urological clinics in Germany, Austria and Switzerland, the acceptance of RAL among urologists as a replacement for CL and its current use for 25 different urological indications. To elucidate the practice patterns of RAL, a survey at hospitals in Germany, Austria and Switzerland was conducted. All surgically active urology departments in Germany (303), Austria (37) and Switzerland (84) received a questionnaire with questions related to the one-year period prior to the survey. The response rate was 63%. Among the participants, 43% were universities, 45% were tertiary care centres, and 8% were secondary care hospitals. A total of 60 RS (Germany 35, Austria 8, Switzerland 17) were available, and the majority (68%) were operated under public ownership. The perception of RAL and the anticipated superiority of RAL significantly differed between robotic and non-robotic surgeons. For only two urologic indications were more than 50% of the procedures performed using RAL: pyeloplasty (58%) and transperitoneal radical prostatectomy (75%). On average, 35% of robotic surgeons and only 14% of non-robotic surgeons anticipated RAL superiority in some of the 25 indications. This survey provides a detailed insight into RAL implementation in Germany, Austria and Switzerland. RAL is currently limited to a few urological indications with a small number of high-volume robotic centres. These results might suggest that a saturation of clinics using RS has been achieved but that the existing robotic capacities are being utilized ineffectively. The possible reasons for this finding are discussed, and certain strategies to solve these problems are offered. © 2015 S. Karger AG, Basel.

Ureteroscopic holmium laser cutting for inadvertently sutured drainage tube (report of five cases).

PubMed

Gao, Xu; Lu, Xin; Ren, Shancheng; Xu, Chuanliang; Sun, Yinghao

2008-07-01

The aim of this paper is to report a simple solution for inadvertently sutured drainage tube after urological surgery and discuss the different managements according to different types of this embarrassing complication. From September 2001 to January 2007, five inadvertently sutured drainage tubes were treated with ureteroscopic holmium laser cutting for the suture. All drainage tubes were removed after the operation without other complications. Holmium laser cutting via ureteroscope is a simple solution for the embarrassing problem of inadvertently sutured drainage tube. It can save the patient from undergoing another open surgery.

[Post-operative course in tetraplegics after urological surgers (author's transl)].

PubMed

Vigreux, G; Vacant, J; Lepresle, E; Desalle De Hys, C; Debras, C

1976-06-01

The authors report their experience with 33 tetraplegics undergoing surgery. The operations were varied, endoscopic (resection of the bladder neck, of the prostate or striate sphincter, lithot-itiasis) or surgical (lombotomies, transintentinal cutaneous ureterostomies). The post-operative course may be dramatic or even fatal (acute hypertension with cerebral haemorrhage). Respiratory insufficiency poses no particular problem and can be controlled. Epidural anaesthesia maintained for several days makes it possible to avoid the more serious problems: -- autonomic hyperreflectivity, -- delayed resolution of ileus and digestive complication. The authors hence use epidural anaesthesia routinely and are satisfied with the technique.

Update on Urological Management of Spina Bifida from Prenatal Diagnosis to Adulthood.

PubMed

Snow-Lisy, Devon C; Yerkes, Elizabeth B; Cheng, Earl Y

2015-08-01

We review the current literature regarding urological management of spina bifida from prenatal diagnosis to adulthood. We searched MEDLINE(®), EMBASE(®) and PubMed(®) for English articles published through December 2014 using search terms "spina bifida," "spinal dysraphism" and "bladder." Based on review of titles and abstracts, 437 of 1,869 articles were identified as addressing topics related to open spina bifida in pediatric patients, or long-term or quality of life outcomes in adults with spina bifida. We summarize this literature to inform clinical guidelines and create a framework for disease management. The birth prevalence of spina bifida in the United States has recently plateaued at approximately 30 per 100,000. With improved management more individuals are surviving to adulthood, with an economic impact of $319,000 during the lifetime of an individual with spina bifida. Recent advances in prenatal surgery have demonstrated that prenatal closure of spina bifida is possible. To assess safety and efficacy, the National Institutes of Health sponsored Management of Myelomeningocele Study was undertaken, in which subjects were randomized to prenatal or postnatal closure. Until the urological results of this trial are published, the impact of prenatal intervention on future bladder function remains unclear. Controversy continues regarding the optimal use and timing of urodynamic studies, and the indications for initiation of clean intermittent catheterization and anticholinergics in infants and children. Many favor expectant management, while others argue for a more proactive approach. Based on the current literature, both approaches appear to protect the child from renal injury, although delayed intervention may increase rates of bladder augmentation. The current literature regarding this topic is difficult to interpret and compare due to heterogeneity of patient populations, variable outcome measures and lack of reporting of quality of life outcomes. Surgical intervention is indicated for those at risk for renal deterioration and/or is considered for children who fail to achieve satisfactory continence with medical management. Traditionally surgery concentrates on the bladder and bladder neck, and creation of catheterizable channels. For those with a hostile bladder, enterocystoplasty remains the gold standard for bladder augmentation, although use of bowel for augmentation remains suboptimal due to secondary complications, including increased risk of infections, metabolic abnormalities, neoplastic transformation and risk of life threatening perforation. Recent advances in tissue engineering technology may provide an alternative to traditional augmentation. However, recent results from phase II trials using current techniques to augment the bladder with engineered bladder tissue are disappointing. Catheterizable channels to the bladder and ascending colon further facilitate continence measures and promote independent care. While surgical reconstruction is clearly successful in improving continence, recent outcome studies have questioned the true impact of this type of surgery on quality of life. With improved survival transitional care issues, including health related independence, sexual health needs and development of a support system, are increasingly important. Transitional care remains a significant issue for which few public health measures are being quantitatively evaluated. Despite consensus regarding early urological involvement in the care of patients with spina bifida, controversy remains regarding optimal management. Major reconstructive urological surgeries still have a major role in the management of these cases to protect the upper urinary tract and to achieve continence. However, future studies are needed to better clarify the true impact on quality of life that these interventions have on patients and their families. Transition of urological care to adulthood remains a major avenue for improvement in disease management. Copyright © 2015 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.

Sequential compression devices in postoperative urologic patients: an observational trial and survey study on the influence of patient and hospital factors on compliance.

PubMed

Ritsema, David F; Watson, Jennifer M; Stiteler, Amanda P; Nguyen, Mike M

2013-04-11

Sequential compression devices (SCDs) are commonly used for thromboprophylaxis in postoperative patients but compliance is often poor. We investigated causes for noncompliance, examining both hospital and patient related factors. 100 patients undergoing inpatient urologic surgery were enrolled. All patient had SCD sleeves placed preoperatively. Postoperative observations determined SCD compliance and reasons for non-compliance. Patient demographics, length of stay, inpatient unit type, and surgery type were recorded. At discharge, a patient survey gauged knowledge and attitudes regarding SCDs and bother with SCDs. Statistical analysis was performed to correlate SCD compliance with patient demographics; patient knowledge and attitudes regarding SCDs; and patient self-reported bother with SCDs. Observed overall compliance was 78.6%. The most commonly observed reasons for non-compliance were SCD machines not being initially available on the ward (71% of non-compliant observations on post-operative day 1) and SCD use not being restarted promptly after return to bed (50% of non-compliant observations for entire hospital stay). Mean self-reported bother scores related to SCDs were low, ranging from 1-3 out of 10 for all 12 categories of bother assessed. Patient demographics, knowledge, attitudes and bother with SCD devices were not significantly associated with non-compliance. Patient self-reported bother with SCD devices was low. Hospital factors, including SCD machine availability and timely restarting of devices by nursing staff when a patient returns to bed, played a greater role in SCD non-compliance than patient factors. Identifying and addressing hospital related causes for poor SCD compliance may improve postoperative urologic patient safety.

21 CFR 876.4530 - Gastroenterology-urology fiberoptic retractor.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Gastroenterology-urology fiberoptic retractor. 876... SERVICES (CONTINUED) MEDICAL DEVICES GASTROENTEROLOGY-UROLOGY DEVICES Surgical Devices § 876.4530 Gastroenterology-urology fiberoptic retractor. (a) Identification. A gastroenterology-urology fiberoptic retractor...

21 CFR 876.4370 - Gastroenterology-urology evacuator.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Gastroenterology-urology evacuator. 876.4370... (CONTINUED) MEDICAL DEVICES GASTROENTEROLOGY-UROLOGY DEVICES Surgical Devices § 876.4370 Gastroenterology-urology evacuator. (a) Identification. A gastroenterology-urology evacuator is a device used to remove...

Urologic evaluation of urinary tract infection in pregnancy.

PubMed

Diokno, A C; Compton, A; Seski, J; Vinson, R

1986-01-01

Thirty-three antepartum patients with urinary tract infections underwent urologic evaluation as soon as the infection had been successfully treated. The evaluation included history of voiding habits, cystometry, urethral calibration and cystourethroscopy. A second phase of the urologic evaluation included an excretory urogram and repeat cystometry 10-12 weeks postpartum. Sixty percent had a history of infrequent voiding, and 90% of them had a bladder capacity greater than 450 mL. Forty-one percent of the patients had a normal bladder capacity (less than 450 mL), and 85% of this group did not have any history of infrequent voiding. The radiographic evaluation postpartum in 18 of 33 patients revealed major abnormalities in 50%. These abnormalities were seen as often and were as significant in women with asymptomatic bacteriuria as in those who presented with acute pyelonephritis. The results suggest that the large bladder seen in pregnant women may be secondary to the chronic, unphysiologic habit of infrequent voiding. Furthermore, this study reinforced the fact that most pregnant women with urinary tract infection have preexisting chronic bladder or renal abnormalities that predispose them to infection. Those at risk should be identified early through a careful history and urinalysis to determine which ones need urinary prophylaxis during pregnancy. Postpartum urologic investigation should be carried out to identify any structural or functional problems; understanding them is helpful in present and future management.

A survey of urological manpower, technology, and resources in Canada.

PubMed

Pommerville, Peter; Goldenberg, S Larry; Wilson, James W L; Fradet, Yves; Corcos, Jacques; Morris, Brian A P

2004-06-01

Knowledge of the current status of manpower and resources is important in understanding the state of any medical specialty, and critical in planning for future recruitment, funding and infrastructure development. In 2003, the Canadian Urological Association (CUA) conducted two nationwide surveys examining manpower, resources, and the technology available. One survey went only to academic and hospital leaders across the country (the resources survey), while the other was sent to the entire general membership of the CUA. The response rate for the resources survey was 67%, while that for the membership survey was 50.4%. The respondents' ages were evenly distributed, with the modal 5-year range being 51 to 55 years of age. Eighty-eight percent of respondents were Canadian-trained. Two-thirds of respondents spent over 80% of their practice time in direct patient care, and most practiced general urology. The majority of respondents practiced in smaller hospitals: 57.6% in centres with 300 or fewer inpatient beds, and 47.2% of centres reported < 500 procedures/year. Community hospitals (62% of responses to the resources survey) generally had fewer advanced technologies than academic centres. A quarter of the cystoscopy equipment used by respondents was over 15 years old. The results of these surveys present a snapshot of the current state of urology resources and manpower across Canada, potentially allowing better planning and negotiations with hospitals and governments.

Laparoendoscopic single site surgery in pediatric urology: does it require specialized tools?

PubMed Central

Patel, Nishant; Santomauro, Michael; Marietti, Sarah; Chiang, George

2016-01-01

ABSTRACT Purpose: To describe our experience utilizing Laparoendoscopic single site (LESS) surgery in pediatric urology. Materials and Methods: Retrospective chart review was performed on LESS urologic procedures from November 2009 through March 2013. A total of 44 patients underwent 54 procedures including: nephrectomy (23), orchiopexy (14), varicocelectomy (9), orchiectomy (2), urachal cyst excision (3), and antegrade continence enema (3) (ACE). Results: Median patient age was 6.9 years old. Estimated blood loss (EBL), ranged from less than 5cc to 47cc for a bilateral nephrectomy. Operative time varied from 56 mins for varicocelectomy to a median of 360 minutes for a bilateral nephroureterectomy. Incision length ranged between 2 and 2.5cm. In our initial experience we used a commercial port. However, as we progressed, we were able to perform the majority of our procedures via adjacent fascial punctures for instrumentation at the single incision site. One patient did require conversion to an open procedure as a result of bleeding. Three complications were noted (6.8%), with two Clavien Grade 3b complications. Two patients required additional procedures at 1-year follow-up. Conclusions: The use of LESS applies to many pediatric urologic procedures, ideally for ablative procedures or simple reconstructive efforts. The use of adjacent fascial puncture sites for instrumentation can obviate the need for a commercial port or multiple trocars. PMID:27256182

The importance of Internet usage for urologic patients.

PubMed

Sahin, Cahit; Tuncer, Murat; Yazici, Ozgur; Kafkasli, Alper; Can, Utku; Eryildirim, Bilal; Koca, Orhan; Sarica, Kemal

2014-12-30

To evaluate Internet usage frequency, rate of searched diseases and impact of Internet derived data on future patient physician relationship in patients applying to an Urology Department. A well prepared questionnaire has been given to 1000 referring cases, out of which 589 accepted to participate on a volunteer basis to a face to face interview. Patients were divided into subgroups with respect to age, gender and as well as their educational and economical status. Regarding Internet, questions inquired the use of Internet, the point of view about it, opinions about healthcare system and most commonly urological diseases searched in Internet. Of 589 patients participating, 38.2% reported access to the Internet; in relation to subgroup analysis of data, there was a statistically significant relationship between the use of Internet and age (p < 0.001), gender (p = 0.048), educational status (p < 0.001) and economical status of (p = 0.002) the cases evaluated. Disease specific information was most frequently sought: 18.2% searched for urolithiasis, 14.2% for non-cancer related kidney diseases, and 14.2% for urologic cancers. Younger patients with higher educational status tended to use Internet and the majority of these cases share all these information with their physicians during their visit. These findings indicate that all physicians should consider this fact seriously and make their future plans in the light of internet based activities which provides numerous advantages.

The emerging use of Twitter by urological journals.

PubMed

Nason, Gregory J; O'Kelly, Fardod; Kelly, Michael E; Phelan, Nigel; Manecksha, Rustom P; Lawrentschuk, Nathan; Murphy, Declan G

2015-03-01

To assess the emerging use of Twitter by urological journals. A search of the Journal of Citation Reports 2012 was performed to identify urological journals. These journals were then searched on Twitter.com. Each journal website was accessed for links to social media (SoMe). The number of 'tweets', followers and age of profile was determined. To evaluate the content, over a 6-month period (November 2013 to April 2014), all tweets were scrutinised on the journals Twitter profiles. To assess SoMe influence, the Klout score of each journal was also calculated. In all, 33 urological journals were identified. Eight (24.2%) had Twitter profiles. The mean (range) number of tweets and followers was 557 (19-1809) and 1845 (82-3692), respectively. The mean (range) age of the twitter profiles was 952 (314-1758) days with an average 0.88 tweets/day. A Twitter profile was associated with a higher mean impact factor of the journal (mean [sd] 3.588 [3.05] vs 1.78 [0.99], P = 0.013). Over a 6-month period, November 2013 to April 2014, the median (range) number of tweets per profile was 82 (2-415) and the median (range) number of articles linked to tweets was 73 (0-336). Of these 710 articles, 152 were Level 1 evidence-based articles, 101 Level 2, 278 Level 3 and 179 Level 4. The median (range) Klout score was 47 (19-58). The Klout scores of major journals did not exactly mirror their impact factors. SoMe is increasingly becoming an adjunct to traditional teaching methods, due to its convenient and user-friendly platform. Recently, many of the leading urological journals have used Twitter to highlight significant articles of interest to readers. © 2014 The Authors. BJU International © 2014 BJU International.

[Urology and Psychosomatics. A historical summary].

PubMed

Bernardy, Katrin; Köllner, V

2004-03-01

The investigation and description of psychosomatic interrelationships has a long tradition in the field of urology. At the beginning of last century, psychosomatic theories and therapies involving urologic questions were developed, some of which are still part of current therapeutic strategies. Numerous studies accentuated the need for a psychosomatic diagnostics and therapy of urologic diseases. The appreciation of psychosomatic urology is growing, a fact which is reflected in current urological teaching curricula.

National Utilization of Partial Nephrectomy Pre- and Post- AUA Guidelines: Is This as Good as It Gets?

PubMed

Sorokin, Igor; Feustel, Paul J; O'Malley, Rebecca L

2017-10-01

The purpose of the study was to compare utilization and predictors of partial nephrectomy (PN) in the pre- and post-guideline eras. American Board of Urology certification/recertification operative logs were reviewed from 2003 to 2014. Nephrectomy cases were extracted using Current Procedural Terminology codes. The cases were then stratified according to pre-guidelines (2003-October 2009) and post-guidelines (November 2009-2014). Multivariable logistic regression was used to evaluate patient, surgeon, and practice characteristics as predictors of PN. A general linear model with regression analysis was used to evaluate the change in PN over time relative to the incidence of renal cell carcinoma (RCC). We identified 20,402 and 20,729 nephrectomies in the pre- and post-guidelines eras, respectively. In multivariable analysis, the post-guidelines group was more likely to undergo PN (odds ratio, 1.87; P < .001). The pre- as well as post-guidelines groups had a higher likelihood of undergoing PN with an open approach, higher-volume surgeons, and younger patient age (P < .05). Surgeon subspecialty and US region were no longer significant factors after guidelines publication. Number of PN normalized to the incidence of RCC continued to increase over time (0.14%/y; R 2  = 0.77; P < .001). Partial nephrectomy in the post-guidelines era is no longer confined to urological subspecialists or certain densely populated US regions. Although rates of PN continue to increase relative to the recently decreasing overall incidence of RCC, the slope has leveled off somewhat. This is likely related to clinical intricacies of the best treatment modality and technologic advances rather than changes related to guidelines publication. Published by Elsevier Inc.

Feasibility and safety of augmented reality-assisted urological surgery using smartglass.

PubMed

Borgmann, H; Rodríguez Socarrás, M; Salem, J; Tsaur, I; Gomez Rivas, J; Barret, E; Tortolero, L

2017-06-01

To assess the feasibility, safety and usefulness of augmented reality-assisted urological surgery using smartglass (SG). Seven urological surgeons (3 board urologists and 4 urology residents) performed augmented reality-assisted urological surgery using SG for 10 different types of operations and a total of 31 urological operations. Feasibility was assessed using technical metadata (number of photographs taken/number of videos recorded/video time recorded) and structured interviews with the urologists on their use of SG. Safety was evaluated by recording complications and grading according to the Clavien-Dindo classification. Usefulness of SG for urological surgery was queried in structured interviews and in a survey. The implementation of SG use during urological surgery was feasible with no intrinsic (technical defect) or extrinsic (inability to control the SG function) obstacles being observed. SG use was safe as no grade 3-5 complications occurred for the series of 31 urological surgeries of different complexities. Technical applications of SG included taking photographs/recording videos for teaching and documentation, hands-free teleconsultation, reviewing patients' medical records and images and searching the internet for health information. Overall usefulness of SG for urological surgery was rated as very high by 43 % and high by 29 % of surgeons. Augmented reality-assisted urological surgery using SG is both feasible and safe and also provides several useful functions for urological surgeons. Further developments and investigations are required in the near future to harvest the great potential of this exciting technology for urological surgery.

How much medicine do spine surgeons need to know to better select and care for patients?

PubMed Central

Epstein, Nancy E.

2012-01-01

Background: Although we routinely utilize medical consultants for preoperative clearance and postoperative patient follow-up, we as spine surgeons need to know more medicine to better select and care for our patients. Methods: This study provides additional medical knowledge to facilitate surgeons’ “cross-talk” with medical colleagues who are concerned about how multiple comorbid risk factors affect their preoperative clearance, and impact patients’ postoperative outcomes. Results: Within 6 months of an acute myocardial infarction (MI), patients undergoing urological surgery encountered a 40% mortality rate: similar rates may likely apply to patients undergoing spinal surgery. Within 6 weeks to 2 months of placing uncoated cardiac, carotid, or other stents, endothelialization is typically complete; as anti-platelet therapy may often be discontinued, spinal surgery can then be more safely performed. Coated stents, however, usually require 6 months to 1 year for endothelialization to occur; thus spinal surgery is often delayed as anti-platelet therapy must typically be continued to avoid thrombotic complications (e.g., stroke/MI). Diabetes and morbid obesity both increase the risk of postoperative infection, and poor wound healing, while the latter increases the risk of phlebitis/pulmonary embolism. Both hypercoagluation and hypocoagulation syndromes may require special preoperative testing/medications and/or transfusions of specific hematological factors. Pulmonary disease, neurological disorders, and major psychiatric pathology may also require further evaluations/therapy, and may even preclude successful surgical intervention. Conclusions: Although we as spinal surgeons utilize medical consultants for preoperative clearance and postoperative care, we need to know more medicine to better select and care for our patients. PMID:23248752

Zero ischemia anatomical partial nephrectomy: a novel approach.

PubMed

Gill, Inderbir S; Patil, Mukul B; Abreu, Andre Luis de Castro; Ng, Casey; Cai, Jie; Berger, Andre; Eisenberg, Manuel S; Nakamoto, Masahiko; Ukimura, Osamu; Goh, Alvin C; Thangathurai, Duraiyah; Aron, Monish; Desai, Mihir M

2012-03-01

We present a novel concept of zero ischemia anatomical robotic and laparoscopic partial nephrectomy. Our technique primarily involves anatomical vascular microdissection and preemptive control of tumor specific, tertiary or higher order renal arterial branch(es) using neurosurgical aneurysm micro-bulldog clamps. In 58 consecutive patients the majority (70%) had anatomically complex tumors including central (67%), hilar (26%), completely intrarenal (23%), pT1b (18%) and solitary kidney (7%). Data were prospectively collected and analyzed from an institutional review board approved database. Of 58 cases undergoing zero ischemia robotic (15) or laparoscopic (43) partial nephrectomy, 57 (98%) were completed without hilar clamping. Mean tumor size was 3.2 cm, mean ± SD R.E.N.A.L. score 7.0 ± 1.9, C-index 2.9 ± 2.4, operative time 4.4 hours, blood loss 206 cc and hospital stay 3.9 days. There were no intraoperative complications. Postoperative complications (22.8%) were low grade (Clavien grade 1 to 2) in 19.3% and high grade (Clavien grade 3 to 5) in 3.5%. All patients had negative cancer surgical margins (100%). Mean absolute and percent change in preoperative vs 4-month postoperative serum creatinine (0.2 mg/dl, 18%), estimated glomerular filtration rate (-11.4 ml/minute/1.73 m(2), 13%), and ipsilateral kidney function on radionuclide scanning at 6 months (-10%) correlated with mean percent kidney excised intraoperatively (18%). Although 21% of patients received a perioperative blood transfusion, no patient had acute or delayed renal hemorrhage, or lost a kidney. The concept of zero ischemia robotic and laparoscopic partial nephrectomy is presented. This anatomical vascular microdissection of the artery first and then tumor allows even complex tumors to be excised without hilar clamping. Global surgical renal ischemia is unnecessary for the majority of patients undergoing robotic and laparoscopic partial nephrectomy at our institution. Copyright © 2012 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.

[Non-palpable testicular tumors in adults: A management based on imaging? Issue from the French Urologic Association Genital Cancer committee's edit].

PubMed

Rocher, L; Feretti, L; Camparo, P; Savoie, P H; Morel-Journel, N; Murez, T; Sebe, P; Flechon, A; Méjean, A; Durand, X

2018-04-09

Help in management of non-palpable testicular tumors. French Urologic Association Genital cancer committee's Edit. To review their characterization at imaging findings of non-palpable testicular tumors. Literature review (PubMed, Medline) of urological and radiological studies dealing with testicular tumors using keywords: non-palpable/incidental testicular tumors; color Doppler ultrasound; US elastography; magnetic resonance imaging; contrast enhanced sonography; partial surgery. Color Doppler is the basic exam. The size, the presence of microlithts/microlithiasis/macrocalcifications, the vascular architecture are major semiological findings to suggest the benign or the malignant nature of the lesion. Other techniques like multiparametric MRI, contrast-enhanced sonography, sonographic elastography are still in evaluation. The frequency of benign tumors such as Leydig cell tumors lead to preservation management, through improved characterization, monitoring or tumorectomy. Non-randomized study - a very few prospective studies. The era of total orchiectomy for any uncertain testicular lesion is over. We try the challenge of characterization, and define management's algorithms based on the suspected nature of the tumors. Copyright © 2018 Elsevier Masson SAS. All rights reserved.

Training, Simulation, the Learning Curve, and How to Reduce Complications in Urology.

PubMed

Brunckhorst, Oliver; Volpe, Alessandro; van der Poel, Henk; Mottrie, Alexander; Ahmed, Kamran

2016-04-01

Urology is at the forefront of minimally invasive surgery to a great extent. These procedures produce additional learning challenges and possess a steep initial learning curve. Training and assessment methods in surgical specialties such as urology are known to lack clear structure and often rely on differing operative flow experienced by individuals and institutions. This article aims to assess current urology training modalities, to identify the role of simulation within urology, to define and identify the learning curves for various urologic procedures, and to discuss ways to decrease complications in the context of training. A narrative review of the literature was conducted through December 2015 using the PubMed/Medline, Embase, and Cochrane Library databases. Evidence of the validity of training methods in urology includes observation of a procedure, mentorship and fellowship, e-learning, and simulation-based training. Learning curves for various urologic procedures have been recommended based on the available literature. The importance of structured training pathways is highlighted, with integration of modular training to ensure patient safety. Valid training pathways are available in urology. The aim in urology training should be to combine all of the available evidence to produce procedure-specific curricula that utilise the vast array of training methods available to ensure that we continue to improve patient outcomes and reduce complications. The current evidence for different training methods available in urology, including simulation-based training, was reviewed, and the learning curves for various urologic procedures were critically analysed. Based on the evidence, future pathways for urology curricula have been suggested to ensure that patient safety is improved. Copyright © 2016 European Association of Urology. Published by Elsevier B.V. All rights reserved.

Managing the difficult penile prosthesis patient.

PubMed

Trost, Landon W; Baum, Neil; Hellstrom, Wayne J G

2013-04-01

Inflatable penile prostheses (IPPs) are associated with excellent long-term outcomes and patient/partner satisfaction. A small percentage of patients remain dissatisfied, despite acceptable surgical results. This study aims to evaluate factors associated with patient satisfaction and dissatisfaction, define patient characteristics, which may identify elevated risk of postoperative dissatisfaction, and describe management strategies to optimize functional and psychological patient outcomes. A review of urologic and non-urologic cosmetic surgery literature was performed to identify factors associated with patient satisfaction/dissatisfaction. Emphasis was placed on articles defining "high risk" or psychologically challenging patients. Preoperative factors associated with patient satisfaction/dissatisfaction and character traits, which may identify elevated risk of postoperative dissatisfaction or otherwise indicate a psychologically challenging patient. Contemporary patient and partner satisfaction rates following IPP are 92-100% and 91-95%, respectively. Factors associated with satisfaction include decreased preoperative expectations, favorable female partner sexual function, body mass index ≤30, and absence of Peyronie's disease or prior prostatectomy. Determinants of dissatisfaction include perceived/actual loss of penile length, decreased glanular engorgement, altered erectile/ejaculatory sensation, pain, diminished cosmetic outcome, difficulty with device function, partner dissatisfaction and perception of unnatural sensation, complications, and extent of alternative treatments offered. Personality characteristics which may indicate psychologically challenging IPP patients include obsessive/compulsive tendencies, unrealistic expectations, patients undergoing revision surgery, those seeking multiple surgical opinions, feeling of entitlement, patients in denial of their prior erectile/sexual function and current disease status, or those with other psychiatric disorders. The mnemonic CURSED Patient is presented: "Compulsive/obsessive, Unrealistic, Revision, Surgeon Shopping, Entitled, Denial, and Psychiatric." Although the majority of IPP patients experience excellent, durable satisfaction and outcomes, a challenging subset of patients may be at increased risk of postoperative dissatisfaction. Appropriate recognition/prevention and management of this cohort may help to establish and strengthen relationships, reduce physical, emotional, and legal risk, and ultimately enhance patient satisfaction. © 2013 International Society for Sexual Medicine.

21 CFR 876.5160 - Urological clamp for males.

Code of Federal Regulations, 2011 CFR

2011-04-01

... 21 Food and Drugs 8 2011-04-01 2011-04-01 false Urological clamp for males. 876.5160 Section 876...) MEDICAL DEVICES GASTROENTEROLOGY-UROLOGY DEVICES Therapeutic Devices § 876.5160 Urological clamp for males. (a) Identification. A urological clamp for males is a device used to close the urethra of a male to...

Increased pediatric sub-specialization is associated with decreased surgical complication rates for inpatient pediatric urology procedures.

PubMed

Tejwani, R; Wang, H-H S; Young, B J; Greene, N H; Wolf, S; Wiener, J S; Routh, J C

2016-12-01

Increased case volumes and training are associated with better surgical outcomes. However, the impact of pediatric urology sub-specialization on perioperative complication rates is unknown. To determine the presence and magnitude of difference in rates of common postoperative complications for elective pediatric urology procedures between specialization levels of urologic surgeons. The Nationwide Inpatient Sample (NIS), a nationally representative administrative database, was used. The NIS (1998-2009) was retrospectively reviewed for pediatric (≤18 years) admissions, using ICD-9-CM codes to identify urologic surgeries and National Surgical Quality Improvement Program (NSQIP) inpatient postoperative complications. Degree of pediatric sub-specialization was calculated using a Pediatric Proportion Index (PPI), defined as the ratio of children to total patients operated on by each provider. The providers were grouped into PPI quartiles: Q1, 0-25% specialization; Q2, 25-50%; Q3, 50-75%; Q4, 75-100%. Weighted multivariate analysis was performed to test for associations between PPI and surgical complications. A total of 71,479 weighted inpatient admissions were identified. Patient age decreased with increasing specialization: Q1, 7.9 vs Q2, 4.8 vs Q3, 4.8 vs Q4, 4.6 years, P < 0.01). Specialization was not associated with race (P > 0.20), gender (P > 0.50), or comorbidity scores (P = 0.10). Mortality (1.5% vs 0.2% vs 0.3% vs 0.4%, P < 0.01) and complication rates (15.5% vs 11.7% vs 9.6% vs 10.9%, P < 0.0001) both decreased with increasing specialization. Patients treated by more highly specialized surgeons incurred slightly higher costs (Q2, +4%; Q3, +1%; Q4 + 2%) but experienced shorter length of hospital stay (Q2, -5%; Q3, -10%; Q4, -3%) compared with the least specialized providers. A greater proportion of patients treated by Q1 and Q3 specialized urologists had CCS ≥2 than those seen by Q2 or Q4 urologists (12.5% and 12.2%, respectively vs 8.4% and 10.9%, respectively, P = 0.04). Adjusting for confounding effects, increased pediatric specialization was associated with decreased postoperative complications: Q2 OR 0.78, CI 0.58-1.05; Q3 OR 0.60, CI 0.44-0.84; Q4 OR 0.70, CI 0.58-0.84; P < 0.01. Providers with proportionally higher volumes of pediatric patients achieved better postoperative outcomes than their less sub-specialized counterparts. This may have arisen from increased exposure to pediatric anatomy and physiology, and greater familiarity with pediatric techniques. The NIS admission-based retrospective design did not enable assessment of long-term outcomes, repeated admissions, or to track a particular patient across time. The study was similarly limited in evaluating the effect of pre-surgical referral patterns on patient distributions. Increased pediatric sub-specialization among urologists was associated with a decreased risk of mortality and surgical complications in children undergoing inpatient urologic procedures. Copyright © 2016 Journal of Pediatric Urology Company. Published by Elsevier Ltd. All rights reserved.

Anesthetic and Perioperative Management of Nontransplant Surgery in Patients After Liver Transplant.

PubMed

Ersoy, Zeynep; Ayhan, Asude; Ozdemirkan, Aycan; Polat, Gulsi Gulsah; Zeyneloglu, Pinar; Arslan, Gulnaz; Haberal, Mehmet

2017-02-01

We aimed to document the anesthetic management and metabolic, hemodynamic, and clinical outcomes of liver-graft recipients who subsequently undergo nontransplant surgical procedures. We retrospectively analyzed the data of 96 liver-graft recipients who underwent 144 nontransplant surgeries between October 1998 and April 2016 at Başkent University Hospital. The median patient age at the time of nontransplant surgery was 32 years, and 35% were female (n = 33). The median time between transplant and nontransplant surgery was 1231 days. The most frequent types of nontransplant surgery were abdominal (22%), orthopedic (16%), and urologic (13%). Seventy patients had an American Society of Anesthesiologists status of 2 (49%); the status was 3 in 71 patients (49%) and 4 in 3 patients (2%). Of the 144 procedures, 23 were emergent (16%) and 48% were abdominal. General anesthesia was used in 69%, regional anesthesia in 19%, and sedoanalgesia in 11%. Twenty-five patients required intraoperative blood-product transfusion (17%). Intraoperative hemodynamic instability developed in 17% of patients, and hypoxemia developed in 2%. Eleven patients remained intubated at the end of surgery (8%). Of the 144 procedures, 19 (13%) required transfer to the intensive care unit, 108 (75%) transferred to the ward, and the remaining 17 (12%) were discharged on the same day. Eight patients developed respiratory failure (6%), 7 had renal dysfunction (5%), 4 had coagulation abnormalities (3%), and 10 had infectious complications (7%) in the early postoperative period. The median hospital stay was 4 days, and 5 patients (4%) developed rejection during hospitalization. Five patients died of respiratory or infectious complications (4%). Most liver-graft recipients who undergo nontransplant surgery are given general anesthesia, transferred to the ward after the procedure, and discharged without major complications. We suggest that orthotopic liver transplant recipients may undergo nontransplant surgery without any postoperative graft dysfunction.

Competence in pediatric urology upon graduation from residency: perceptions of residents, program directors and pediatric urologists.

PubMed

Mickelson, Jennifer J; Macneily, Andrew E; Samarasekera, Dinesh; Beiko, Darren; Afshar, Kourosh

2008-06-01

We aimed to clarify the scope of pediatric urological procedures that Canadian urology residents are perceived to be competent to perform upon graduation. We conducted a survey from April 2005 to June 2006 of urology residency program directors (UPDs), senior urology residents (SURs) and Pediatric Urologists of Canada (PUC) members from all 12 Canadian training programs. Questions focused on which of 23 pediatric urological procedures the 3 study groups perceived urology residents would be competent to perform upon completion of residency without further fellowship training. Procedures were based on the "A," "B" and "C" lists of procedures (least complex to most complex) as outlined in the Royal College of Physicians and Surgeons of Canada Objectives of Training in Urology. Response rates were 12/12 (100%), 41/53 (77%) and 17/23 (74%) for UPDs, SURs and PUC members, respectively. Average exposure to pediatric urology during residency was 5.4 (range 3-9) months and considered sufficient by 75% of UPDs and 69% of SURs, but only 41% of PUC members (p = 0.05). Overall, the 3 groups disagreed on the level of competence for performing level "A" and "B" procedures, with significant disagreement between PUC members and UPDs as well as SURs (p < 0.005). PUC members perceive Canadian urology residents' exposure to pediatric urology as insufficient and their competence for procedures of low to moderate complexity as inadequate. Further investigation regarding exposure to and competence in other emerging subspecialty spheres of urology may be warranted. Ongoing assessment of the objectives for training in pediatric urology is required.

The Gatekeeper Disparity: Why Do Some Medical Schools Send More Medical Students into Urology?

PubMed Central

Kutikov, Alexander; Bonslaver, Jason; Casey, Jessica T.; Degrado, Justin; Dusseault, Beau N.; Fox, Janelle A.; Lashley-Rogers, Desri; Richardson, Ingride; Smaldone, Marc C.; Steinberg, Peter L.; Trivedi, Deep B.; Routh, Jonathan C.

2010-01-01

Introduction Urology continues to be a highly desirable specialty, despite decreasing exposure of students to Urology in U.S. medical schools. In this study, we set out to assess how U.S. medical schools compare to one another with regard to the number of students that each sends into Urological training and to evaluate the reasons why some medical schools consistently send more students into urology than others. Materials and Methods The authors obtained AUA Match data for the 5 Match seasons from 2005–2009. A survey of all successful participants was then performed. The survey instrument was designed to determine what aspects of the medical school experience influenced students to choose to specialize in Urology. A bivariate and multivariate analysis was then performed to assess which factors correlated with more students entering Urology from a particular medical school. Results Between 2005 and 2009, 1,149 medical students from 130 medical schools successfully participated in the Urology match. Of the 132 allopathic medical schools, 128 sent at least 1 student into Urology (mean 8.9, median 8, SD 6.5). A handful of medical schools were remarkable outliers, sending significantly more students into Urology than other institutions. Multivariate analysis revealed that a number of medical-school related variables including strong mentorship, medical school ranking, and medical school size correlated with more medical students entering Urology. Conclusion Some medical schools launch more Urologic careers than others. Although reasons for these findings are multifactorial, recruitment of Urologic talent pivots on these realities. PMID:21168862

Repeat Prostate Biopsy Practice Patterns in a Statewide Quality Improvement Collaborative.

PubMed

Burks, Frank N; Hu, Jonathan C; Telang, Dinesh; Liu, Alice; Hawken, Scott; Montgomery, Zack; Linsell, Susan; Montie, James E; Miller, David C; Ghani, Khurshid R

2017-08-01

We examined rebiopsies in MUSIC (Michigan Urological Surgery Improvement Collaborative) to understand adherence to guidelines recommending repeat prostate biopsy in patients with multifocal high grade prostatic intraepithelial neoplasia or atypical small acinar proliferation. We analyzed data on men undergoing repeat biopsy, practice patterns and cancer detection rates. Multivariate regression modeling was used to calculate the proportion of patients undergoing rebiopsy. We used claims data to validate the treatment classification in MUSIC. To understand reasons for not performing rebiopsy we reviewed records of a sample of patients with atypical small acinar proliferation. We identified 5,375 men with a negative biopsy, of whom 411 (7.6%) underwent repeat biopsy. In 718 men with high grade prostatic intraepithelial neoplasia, 350 with atypical small acinar proliferation and 587 with high grade prostatic intraepithelial neoplasia and atypical small acinar proliferation or atypical small acinar proliferation alone at initial biopsy the rebiopsy rate was 20.7%, 42.5% and 55.6%, respectively. The adjusted proportion of patients with rebiopsy in each practice ranged from 0% to 17.2% (p <0.001). The overall cancer detection rate at rebiopsy was 39.3%. It was highest after atypical small acinar proliferation (adjusted probability 0.39, 95% CI 0.30-0.48), and after high grade prostatic intraepithelial neoplasia and atypical small acinar proliferation (adjusted probability 0.50, 95% CI 0.35-0.65). The greatest Gleason 7 or greatest detection rate of 41.1% was found in patients with high grade prostatic intraepithelial neoplasia and atypical small acinar proliferation. Chart review revealed that 45.5% of patients with atypical small acinar proliferation underwent prostate specific antigen testing instead of rebiopsy while 36% failed to undergo rebiopsy despite a recommendation. Rebiopsy rates vary in Michigan practices with relatively low use in men with high grade prostatic intraepithelial neoplasia and atypical small acinar proliferation or atypical small acinar proliferation alone. Quality improvement strategies should target patients with atypical small acinar proliferation and high grade prostatic intraepithelial neoplasia as they have the highest likelihood of cancer detection. Copyright © 2017 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.

Ultrasound guided transversus abdominis plane vs surgeon administered intraoperative regional field infiltration with bupivacaine for early postoperative pain control in children undergoing open pyeloplasty.

PubMed

Lorenzo, Armando J; Lynch, Johanne; Matava, Clyde; El-Beheiry, Hossam; Hayes, Jason

2014-07-01

Regional analgesic techniques are commonly used in pediatric urology. Ultrasound guided transversus abdominis plane block has recently gained popularity. However, there is a paucity of information supporting a benefit over regional field infiltration. We present a parallel group, randomized, controlled trial evaluating ultrasound guided transversus abdominis plane block superiority over surgeon delivered regional field infiltration for children undergoing open pyeloplasty at a tertiary referral center. Following ethics board approval and registration, children 0 to 6 years old were recruited and randomized to undergo perioperative transversus abdominis plane block or regional field infiltration for early post-pyeloplasty pain control. General anesthetic delivery, surgical technique and postoperative analgesics were standardized. A blinded assessor regularly captured pain scores in the recovery room using the FLACC (Face, Legs, Activity, Cry, Consolability) scale. The primary outcome was the need for rescue morphine administration based on a FLACC score of 3 or higher. Two pediatric urologists performed 57 pyeloplasties during a 2.5-year period, enrolling 32 children (16 in each group, balanced for age and weight). There were statistically significant differences in the number of children requiring rescue morphine administration (13 of 16 receiving transversus abdominis plane block and 6 of 16 receiving regional field infiltration, p = 0.011), mean ± SD total morphine consumption (0.066 ± 0.051 vs 0.028 ± 0.040 mg/kg, p = 0.021) and mean ± SD pain scores (5 ± 5 vs 2 ± 3, p = 0.043) in the recovery room, in favor of surgeon administered regional field infiltration. No local anesthetic specific adverse events were noted. Ultrasound guided transversus abdominis plane block is not superior to regional field infiltration with bupivacaine as a strategy to minimize early opioid requirements following open pyeloplasty in children. Instead, our data suggest that surgeon delivered regional field infiltration provides better pain control. Copyright © 2014 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.

Perioperative patient radiation exposure in the endoscopic removal of upper urinary tract calculi.

PubMed

Jamal, Joseph E; Armenakas, Noel A; Sosa, R Ernest; Fracchia, John A

2011-11-01

The efficacy of computed tomography (CT) in detailing upper urinary tract calculi is well established. There is no established acceptable annual recommended limit for medical exposure, yet the global accepted upper limit for occupational radiation exposure is <50 millisieverts (mSv) in any one year. We sought to appreciate the CT and fluoroscopic radiation exposure to our patients undergoing endoscopic removal of upper tract calculi during the periprocedure period. All patients undergoing upper urinary endoscopic stone removal between 2005 and 2009 were identified. To calculate the cumulative radiation exposure, we included all ionizing radiation imaging performed during a periprocedure period, which we defined as ≤90 days pre- and post-therapeutic procedure. A total of 233 upper urinary tract therapeutic patient stone procedures were identified; 127 patients underwent ureteroscopy (URS) and 106 patients underwent percutaneous nephrolithotomy (PCNL). A mean 1.58 CTs were performed per patient. Ninety (38.6%) patients underwent ≥2 CTs in the periprocedure period, with an average number in this group of 2.49 CT/patient, resulting in approximately 49.8 mSv of CT radiation exposure. Patients who were undergoing URS were significantly more likely to have multiple CTs (P=0.003) than those undergoing PCNL. Median fluoroscopic procedure exposures were 43.3 mGy for patients who were undergoing PCNL and 27.6 mGy for those patients undergoing URS. CT radiation exposure in the periprocedure period for patients who were undergoing endoscopic upper tract stone removal is considerable. Added to this is the procedure-related fluoroscopic radiation exposure. Urologic surgeons should be aware of the cumulative amount of ionizing radiation received by their patients from multiple sources.

The potential of 3D printing in urological research and patient care.

PubMed

Colaco, Marc; Igel, Daniel A; Atala, Anthony

2018-04-01

3D printing is an evolving technology that enables the creation of unique organic and inorganic structures with high precision. In urology, the technology has demonstrated potential uses in both patient and clinician education as well as in clinical practice. The four major techniques used for 3D printing are inkjet printing, extrusion printing, laser sintering, and stereolithography. Each of these techniques can be applied to the production of models for education and surgical planning, prosthetic construction, and tissue bioengineering. Bioengineering is potentially the most important application of 3D printing, as the ability to produce functional organic constructs might, in the future, enable urologists to replicate and replace abnormal tissues with neo-organs, improving patient survival and quality of life.

A randomized controlled study comparing intrathecal hyperbaric bupivacaine-fentanyl mixture and isobaric bupivacaine-fentanyl mixture in common urological procedures

PubMed Central

Upadya, Madhusudan; Neeta, S; Manissery, Jesni Joseph; Kuriakose, Nigel; Singh, Rakesh Raushan

2016-01-01

Background and Aims: Bupivacaine is available in isobaric and hyperbaric forms for intrathecal use and opioids are used as additives to modify their effects. The aim of this study was to compare the efficacy and haemodynamic effect of intrathecal isobaric bupivacaine-fentanyl mixture and hyperbaric bupivacaine-fentanyl mixture in common urological procedures. Methods: One hundred American Society of Anesthesiologists physical status 1 and 2 patients undergoing urological procedures were randomized into two groups. Group 1 received 3 ml of 0.5% isobaric bupivacaine with 25 μg fentanyl while Group 2 received 3 ml of 0.5% hyperbaric bupivacaine with 25 μg fentanyl. The parameters measured include heart rate, blood pressure, respiratory rate, onset and duration of motor and sensory blockade. Student's unpaired t-test and the χ2 test were used to analyse the results, using the SPSS version 11.5 software. Results: The haemodynamic stability was better with isobaric bupivacaine fentanyl mixture (Group 1) than with hyperbaric bupivacaine fentanyl mixture (Group 2). The mean onset time in Group 1 for both sensory block (4 min) and motor block (5 min) was longer compared with Group 2. The duration of sensory block (127.8 ± 38.64 min) and motor block (170.4 ± 27.8 min) was less with isobaric bupivacaine group compared with hyperbaric bupivacaine group (sensory blockade 185.4 ± 16.08 min and motor blockade 201.6 ± 14.28 min). Seventy percent of patients in Group 2 had maximum sensory block level of T6 whereas it was 53% in Group 1. More patients in Group 1 required sedation compared to Group 2. Conclusion: Isobaric bupivacaine fentanyl mixture was found to provide adequate anaesthesia with minimal incidence of haemodynamic instability. PMID:26962255

Management of the ventriculo-peritoneal shunt in pediatric patients during robot-assisted laparoscopic urologic procedures.

PubMed

Marchetti, Pablo; Razmaria, Aria; Zagaja, Greg P; Gundeti, Mohan S

2011-02-01

Infection or malfunction of ventriculo-peritoneal (VP) shunts is a severe complication during laparoscopic surgery involving the gastrointestinal or urinary tract. It has been recently suggested to externalize the shunt or convert into a ventriculo-atrial shunt to prevent this complication with laparoscopic approach. Herein, we present a novel technique for management of the VP shunt during robot-assisted laparoscopic (RAL) urologic procedures. After port placement and diagnostic peritoneoscopy, an Endopouch bag (Ethicon Endo-Surgery) was inserted into the peritoneal cavity and the distal end of the shunt was placed into the pouch. The Endopouch suture was synched around the shunt and the pouch was placed in the subhepatic space during the surgery. The intraperitoneal pressure was maintained at 12 mm Hg during the entire procedure. Metronidazole, gentamicin, and vancomycin were administered as prophylaxis. Following the completion of the surgery and profuse irrigation of the peritoneal cavity, the shunt was repositioned within the peritoneum. We evaluated perioperative shunt-related complications. We used this technique in four patients with VP shunt undergoing RAL cystoplasty and appendicovesicostomy and/or colonic enema channel formation. The average age of the patient at surgery was 10.8 (7-14) years. One patient was converted to open because of failure to progress due to multiple adhesions and the shunt was externalized temporarily. At a mean follow-up of 13 (3-20) months, no shunt-related complications were seen. In our preliminary experience, the use of an intracorporeal Endopouch bag with controlled pneumoperitoneal pressure to protect the VP shunt may be an effective alternative to prevent complications related to it during RAL urologic surgery involving the gastrointestinal or urinary tract. Further studies will be needed to confirm our results.

Sequential compression devices in postoperative urologic patients: an observational trial and survey study on the influence of patient and hospital factors on compliance

PubMed Central

2013-01-01

Background Sequential compression devices (SCDs) are commonly used for thromboprophylaxis in postoperative patients but compliance is often poor. We investigated causes for noncompliance, examining both hospital and patient related factors. Methods 100 patients undergoing inpatient urologic surgery were enrolled. All patient had SCD sleeves placed preoperatively. Postoperative observations determined SCD compliance and reasons for non-compliance. Patient demographics, length of stay, inpatient unit type, and surgery type were recorded. At discharge, a patient survey gauged knowledge and attitudes regarding SCDs and bother with SCDs. Statistical analysis was performed to correlate SCD compliance with patient demographics; patient knowledge and attitudes regarding SCDs; and patient self-reported bother with SCDs. Results Observed overall compliance was 78.6%. The most commonly observed reasons for non-compliance were SCD machines not being initially available on the ward (71% of non-compliant observations on post-operative day 1) and SCD use not being restarted promptly after return to bed (50% of non-compliant observations for entire hospital stay). Mean self-reported bother scores related to SCDs were low, ranging from 1–3 out of 10 for all 12 categories of bother assessed. Patient demographics, knowledge, attitudes and bother with SCD devices were not significantly associated with non-compliance. Conclusions Patient self-reported bother with SCD devices was low. Hospital factors, including SCD machine availability and timely restarting of devices by nursing staff when a patient returns to bed, played a greater role in SCD non-compliance than patient factors. Identifying and addressing hospital related causes for poor SCD compliance may improve postoperative urologic patient safety. PMID:23578129

E-cigarettes and Urologic Health: A Collaborative Review of Toxicology, Epidemiology, and Potential Risks.

PubMed

Bourke, Liam; Bauld, Linda; Bullen, Christopher; Cumberbatch, Marcus; Giovannucci, Edward; Islami, Farhad; McRobbie, Hayden; Silverman, Debra T; Catto, James W F

2017-06-01

Use of electronic cigarettes (ECs) is on the rise in most high-income countries. Smoking conventional cigarettes is a known risk factor for urologic malignancy incidence, progression, and mortality, as well as for other urologic health indicators. The potential impact of EC use on urologic health is therefore of clinical interest to the urology community. To review the available data on current EC use, including potential benefits in urologic patients, potential issues linked to toxicology of EC constituents, and how this might translate into urologic health risks. A Medline search was carried out in August 2016 for studies reporting urologic health outcomes and EC use. Snowballing techniques were also used to identify relevant studies from recent systematic reviews. A narrative synthesis of data around EC health outcomes, toxicology, and potential use in smoking cessation and health policy was carried out. We found no studies to date that have been specifically designed to prospectively assess urologic health risks, even in an observational setting. Generating such data would be an important contribution to the debate on the role of ECs in public health and clinical practice. There is evidence from a recent Cochrane review of RCTs that ECs can support smoking cessation. There are emerging data indicating that potentially harmful components of ECs such as tobacco-specific nitrosamines, polyaromatic hydrocarbons, and heavy metals could be linked to possible urologic health risks. ECs might be a useful tool to encourage cessation of conventional cigarette smoking. However, data collection around the specific impact of ECs on urologic health is needed to clarify the possible patient benefits, outcomes, and adverse events. While electronic cigarettes might help some people to stop smoking, their overall impact on urologic health is not clear. Copyright © 2017 European Association of Urology. All rights reserved.

Methodological Quality of Systematic Reviews Published in the Urological Literature from 1998 to 2012.

PubMed

Corbyons, Katherine; Han, Julia; Neuberger, Molly M; Dahm, Philipp

2015-11-01

Systematic reviews synthesize the current best evidence to address a clinical question. Given the growing emphasis on evidence-based clinical practice, systematic reviews are being increasingly sought after and published. We previously reported limitations in the methodological quality of 57 individual systematic reviews published from 1998 to 2008. We provide an update to our previous study, adding systematic reviews published from 2009 to 2012. We systematically searched PubMed® and hand searched the table of contents of 4 major urological journals to identify systematic reviews related to questions of prevention and therapy. Two independent reviewers with prior formal evidence-based medicine training assessed the methodological quality using the validated 11-point AMSTAR (A Measurement Tool to Assess Systematic Reviews) instrument. We performed predefined statistical hypothesis testing for differences by publication period (1998 to 2008 vs 2009 to 2012) and journal of publication. We performed statistical testing using SPSS®, version 23.0 with a 2-sided α of 0.05 using the Student t-test, ANOVA and the chi-square test. A total of 113 systematic reviews published from 2009 to 2012 met study inclusion criteria. The most common topics were oncology (44 reviews or 38.9%), voiding dysfunction (26 or 23.0%) and stones/endourology (13 or 11.5%). The largest contributor was European Urology (46 reviews or 40.7%), followed by BJU International (31 or 27.4%) and The Journal of Urology® (22 or 19.5%). The mean ± SD AMSTAR score for the 2009 to 2012 period was 5.3 ± 2.3 compared to 4.8 ± 2.0 for 1998 to 2008 with a mean difference of 0.5 (95% CI 0.2 to 1.2, p = 0.133). While the number of systematic reviews published in the urological literature has increased substantially, the methodological quality of these studies remains suboptimal. Systematic review authors and editors should make every effort to adhere to well established methodological standards to enhance the impact of their research efforts. Copyright © 2015 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.

National bias in citations in urology journals: parochialism or availability?

PubMed

Grange, R I

1999-10-01

To determine any bias by authors of different nationalities in their citation rate of selected urological journals in papers published in the British Journal of Urology and the Journal of Urology. Using a simple computer program and text files of accepted reports in the BJU, or those available on CD-ROM from J Urol, 212 recent papers in the BJU and 111 from J Urol were analysed to determine the number of citations to four major urological journals (BJU, J Urol, Eur Urol and Urology). The frequencies of citations to these journals were then compared with the national origin of the author(s), grouped as UK, Europe, North America and Other. In both the BJU and J Urol the citation rates of the selected journals differed significantly among authors from different regions. In BJU papers, the citation rate of the BJU was highest by UK authors and their citation rate of J Urol was amongst the lowest of the rates for J Urol. The highest citation rate for J Urol was that by European authors. American authors cited the BJU least, citing the J Urol about five times more often than they cited the BJU. Of the papers in the J Urol sample, over 60% were from American authors, with only four from UK authors; thus the UK group was not analysed separately but included in the European group. The mean citation rate of J Urol was highest in papers by American authors, at about 14 times that for citations to the BJU. The citation rates for the other two journals were not significantly different with nationality or journal, but were generally much lower in J Urol than in the BJU. There are significant differences in citation rates both with authors' nationality and between journals. Citation rates may be influenced by journal accessibility, perceived journal 'prestige' (impact factor) or national bias. Authors, editors and reviewers should be aware of this potential bias in citation habits. Authors should strive to conduct exhaustive searches using electronic methods, so that all relevant papers are assessed, regardless of their origin.

Setting up a pediatric robotic urology program: A USA institution experience.

PubMed

Murthy, Prithvi B; Schadler, Eric D; Orvieto, Marcelo; Zagaja, Gregory; Shalhav, Arieh L; Gundeti, Mohan S

2018-02-01

Implementing a robotic urological surgery program requires institutional support, and necessitates a comprehensive, detail-oriented plan that accounts for training, oversight, cost and case volume. Given the prevalence of robotic surgery in adult urology, in many instances it might be feasible to implement a pediatric robotic urology program within the greater context of adult urology. This involves, from an institutional standpoint, proportional distribution of equipment cost and operating room time. However, the pediatric urology team primarily determines goals for volume expansion, operative case selection, resident training and surgical innovation within the specialty. In addition to the clinical model, a robust economic model that includes marketing must be present. This review specifically highlights these factors in relationship to establishing and maintaining a pediatric robotic urology program. In addition, we share our data involving robot use over the program's first nine years (December 2007-December 2016). © 2017 The Japanese Urological Association.

Urological complications of coitus.

PubMed

Eke, N

2002-02-01

To ascertain the urological complications of coitus, as the proximity of the lower urinary tract to the organs of coitus exposes the tract to coital trauma. Medline was searched from 1966 to 2000 to identify reports on coital injuries. Publications and relevant references were retrieved. Those reporting urological complications were selected for analysis. In all, 1454 cases of reported coital injuries were reviewed; 790 occurred in men while 664 occurred in women, mainly in the genital area. Physical urological complications were more common in men than in women. The injuries were often sustained during voluntary coitus, but one penile fracture was sustained during an attempted rape. The presentations included penile swellings and deviations, haemorrhage, erectile dysfunction and urinary incontinence. Complications included vesicovaginal fistulae, bladder and cavernosal ruptures, and urinary tract infections. Rare complications included isolated rupture of the penile vasculature. Major risk factors included penovaginal disproportion, excessive force at coitus, urethral coitus, fellatio and anal intercourse. Urethral injuries were the commonest complications; in men these were associated with 10-38% of penile fractures. The treatments included cold compress and anti-inflammatory agents in contusions, repairs of lacerations, closure of fistulae and urethral and vaginal reconstruction. The results of treatment were essentially good. Recurrent penile fractures were reported. Coitus, although pleasurable, may be risky. The complications have been termed 'faux pas' implying that they are preventable. While the ultimate prevention is abstinence, this is an unrealistic prescription. Therefore, efforts are necessary to identify risk factors to enable preventive strategies.

The Knowledge of Radiation and the Attitude Towards Radio-Protection among Urology Residents in India.

PubMed

Jindal, Tarun

2015-12-01

Exposure to radiation is a hazard and precautions are necessary to limit it. This study was done to assess the knowledge of radiation and the attitude towards radio-protection among urology residents in India. A questionnaire was administered to assess the knowledge and attitude of urology residents who came from all over the country to attend a clinical meeting at Apollo Gleneagles Hospital, Kolkata, India. All the respondents agreed to being exposed to radiation, with 78.2% using radiation in more than five cases a week. Only 65.2% always took some steps for radio-protection. Lead aprons and thyroid shields were the most common radiation protection devices used. None of the residents ever used lead gloves or protective eye glasses or dosimeters. An 82.6% felt that they did not have adequate knowledge, 85.4% of residents did not receive any formal classes regarding the risk of radiation, 21.7% either rarely or never moved out of the operating room when the radiation was being used, 42.4% did not know that the SI unit of the equivalent absorbed dose of radiation & 52.1% did not know about the amount of radiation delivered to an adult during a contrast enhanced CT scan of the abdomen. Results of the present study reveal that the urology residents of India lack knowledge about the risks of radiation exposure. Majority of them did not take necessary precautions to limit their exposure to radiation.

[Inverse innovation models in the nurse clinic of a Urology Department].

PubMed

Gamarra, Manuela; López, Maria C; Luján, Marcos; Mora, Jose Ramón

2015-01-01

In the urology clinics there is an important volume of limited-complexity pathology that consumes an important part of resources. Delegating some tasks of this type to Nurses may imply a competitive advantage in economic terms without decrease in the quality of the care given to patients and their level of satisfaction. This is an example of the concept of inverse innovation. In this work we try to make public our experience in the management by nursing staff of features of the urology consultation traditionally reserved to physicians, as well as the design of the related processes. We developed the most frequent processes competence of the nursing staff in the unit: 1) Care of ambulatory urological surgery pathology; 2) Urologic ultrasound; 3) Traditional urologic nurse consultation. During 2013 the nursing staff performed 423 ambulatory urologic surgery pathology clinic visits, 931 urologic ultrasounds and 1019 varied actions corresponding to traditional urological nurse work.We developed stabilization formularies and flow diagrams of the aforementioned processes. We performed a quantification of the amount of money saved in comparison with the costs generated if a nurse or a physician was employed. Such saving was 2,78 and 4,00 Euros in the ambulatory urological surgery pathology and urologic ultrasound, respectively. Total savings in both processes was 4900 Euros. Implication of urological nursing staff in certain care tasks traditionally reserved to the physician is possible without increase in quality defects, obtaining an advantage in terms of economic cost and flexibility in staff organization thanks to the expansion of the competence array.

Effect of tension-free vaginal tape and TVT-obturator on lower urinary tract symptoms other than stress urinary incontinence.

PubMed

Ballert, Katie N; Kanofsky, Jamie A; Nitti, Victor W

2008-03-01

Variable effects on lower urinary tract symptoms (LUTS) other than stress urinary incontinence (SUI) have been reported after tension-free vaginal tape (TVT). We measured the effect of TVT on LUTS using the American Urological Association Symptom Index (AUASI). Patients undergoing TVT completed the AUASI pre- and post-operatively. Total scores (TS), storage scores (SS), and voiding scores (VS) were compared overall and among patients with SUI vs mixed urinary incontinence (MUI) and those who underwent TVT vs TVT-obturator (TVT-O). The mean change in TS and SS was -3.6 and -3.0. Mean reductions in TS and SS were significant in all patient subsets with no change in VS. There was no significant difference in the mean changes in TS between patients with SUI vs MUI or those undergoing TVT vs TVT-O. LUTS are improved after TVT in most patients. In general, voiding symptoms were not adversely affected.

From humble beginnings … the evolution of the FRACS (Urology).

PubMed

Pirpiris, Athina; Chung, Amanda S J; Rashid, Prem

2017-07-01

Surgery has a rich and colourful history dating as far back as, at least, the Neolithic period. There have been many advances in knowledge and technology, as well as changes to working conditions and public perception and expectations. The urology training programme is jointly managed by the Royal Australasian College of Surgeons and the Urological Society of Australia and New Zealand. Urological training in Australia and New Zealand has undergone a number of changes over the years. A PubMed search was performed to find articles related to surgical training and, more specifically, urological training in Australia and New Zealand. The search terms that were used included 'urology training', 'surgical training', 'Australian urology history' and 'New Zealand urology history'. This narrative review outlines the origin and history of this training programme and describes the changes that have led to the current model of urology training. It also relates some of the current and future challenges faced as the training programme continues to evolve in order to improve its ability to train future urologists to meet the needs of the community and to ensure public safety. The urological training programme has evolved a number of times in order to tackle the challenges presented by evolving technology, community expectation and the needs of the trainee. © 2017 Royal Australasian College of Surgeons.

21 CFR 876.1075 - Gastroenterology-urology biopsy instrument.

Code of Federal Regulations, 2010 CFR

2010-04-01

... generic type of device includes the biopsy punch, gastrointestinal mechanical biopsy instrument, suction... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Gastroenterology-urology biopsy instrument. 876... Gastroenterology-urology biopsy instrument. (a) Identification. A gastroenterology-urology biopsy instrument is a...

21 CFR 876.1075 - Gastroenterology-urology biopsy instrument.

Code of Federal Regulations, 2011 CFR

2011-04-01

... generic type of device includes the biopsy punch, gastrointestinal mechanical biopsy instrument, suction... 21 Food and Drugs 8 2011-04-01 2011-04-01 false Gastroenterology-urology biopsy instrument. 876... Gastroenterology-urology biopsy instrument. (a) Identification. A gastroenterology-urology biopsy instrument is a...

Health services research in urology.

PubMed

Yu, Hua-Yin; Ulmer, William; Kowalczyk, Keith J; Hu, Jim C

2011-06-01

Health services research (HSR) is increasingly important given the focus on patient-centered, cost-effective, high-quality health care. We examine how HSR affects contemporary evidence-based urologic practice and its role in shaping future urologic research and care. PubMed, urologic texts, and lay literature were reviewed for terms pertaining to HSR/outcomes research and urologic disease processes. HSR is a broad discipline that focuses on access, cost, and outcomes of Health care. Its use has been applied to a myriad of urologic conditions to identify deficiencies in access, to evaluate cost-effectiveness of therapies, and to evaluate structural, process, and outcome quality measures. HSR utilizes an evidence-based approach to identify the most effective ways to organize/manage, finance, and deliver high-quality urologic care and to tailor care optimized to individuals.

mHealth in Urology: A Review of Experts' Involvement in App Development.

PubMed

Pereira-Azevedo, Nuno; Carrasquinho, Eduardo; Cardoso de Oliveira, Eduardo; Cavadas, Vitor; Osório, Luís; Fraga, Avelino; Castelo-Branco, Miguel; Roobol, Monique J

2015-01-01

Smartphones are increasingly playing a role in healthcare and previous studies assessing medical applications (apps) have raised concerns about lack of expert involvement and low content accuracy. However, there are no such studies in Urology. We reviewed Urology apps with the aim of assessing the level of participation of healthcare professionals (HCP) and scientific Urology associations in their development. A systematic search was performed on PubMed, Apple's App Store and Google's Play Store, for Urology apps, available in English. Apps were reviewed by three graders to determine the app's platform, target customer, developer, app type, app category, price and the participation of a HCP or a scientific Urology association in the development. The search yielded 372 apps, of which 150 were specific for Urology. A fifth of all apps had no HCP involvement (20.7%) and only a third had been developed with a scientific Urology association (34.7%). The lowest percentage of HCP (13.4%) and urological association (1.9%) involvement was in apps designed for the general population. Furthermore, there was no contribution from an Urology society in "Electronic Medical Record" nor in "Patient Information" apps. A limitation of the study is that only Android and iOS apps were reviewed. Despite the increasing Mobile Health (mHealth) market, this is the first study that demonstrates the lack of expert participation in the design of Urology apps, particularly in apps designed for the general public. Until clear regulation is enforced, the urological community should help regulate app development. Maintaining a register of certified apps or issuing an official scientific seal of approval could improve overall app quality. We propose that urologists become stakeholders in mHealth, shaping future app design and promoting peer-review app validation.

[Improvement of the recruitment of surgery interns derived from the Epreuves Nationales Classantes (National-Ranking Exam): practical solution applied to urology].

PubMed

Beley, Sébastien; Dubosq, Francis; Simon, Pascal; Larré, Stéphane; Battisti, Simon; Ballereau, Charles; Boublil, Véronique; Richard, François; Rouprêt, Morgan

2005-12-01

To analyse the value of an urology initiation session proposed to young interns to improve recruitment of the discipline since the introduction of the new National-Ranking Exam (NRE). In October 2004, the 77 interns appointed to surgery in Paris on the basis of the ENC participated in a one-day urology initiation session organized by the AFUF, at the AP-HP School of Surgery. All interns were given a questionnaire at the beginning of the session to record the following data: age, gender, teaching hospital, a student attachment in urology and desired specialization as a function of the surgical training programmes proposed by the ENC. Items concerning the desired specialization were resubmitted to the interns at the end of the session. Population. 77 interns, 48 females (62.3%) and 29 males (37.7%) with a mean age of 25.2 +/- 5 years (range: 23-31). 55 interns had trained at a Parisian teaching hospital (67%) and 22 (28.6%) had trained at a provincial teaching hospital. 16 interns (20.8%) had completed at least one urology attachment during their medical training. Desired specialization. Orthopaedics was the discipline most frequently cited (n = 20; 26%). Urology was chosen by 8 interns (10.40%), who had all completed an urology attachment during their medical training. At the end of the urology initiation session, another 8 interns expressed the desire to specialize in urology. Of the 16 potential urology interns, 9 (56.2%) confirmed that their decision was final. Urology occupies a special place and remains a popular surgical speciality among students. Organization of practical sessions constitutes a solution to inform, create an emulation and motivate surgery interns to choose urology.

Mapping the landscape of urology: A new media-based cross-sectional analysis of public versus academic interest.

PubMed

Borgmann, Hendrik; Salem, Johannes; Baunacke, Martin; Boehm, Katharina; Groeben, Christer; Schmid, Marianne; Siegel, Fabian P; Huber, Johannes

2018-05-01

To quantify public and academic interest in the urological field using a novel new media-based methodology. We systematically measured public and academic interest in 56 urological keywords and combined in nine subspecialties. Public interest was quantified as video views on YouTube. Academic interest was quantified as article citations using Microsoft Academic Search. The public-to-academic interest ratio was calculated for a comparison of subspecialties as well as for diseases and treatments. For the selected 56 urological keywords, we found 226 617 591 video views on YouTube and 2 146 287 citations in the academic literature. The public-to-academic interest ratio was highest for the subspecialties robotic urology (ratio 6.3) and andrological urology (ratio 4.6). Prostate cancer was the central urological disease combining both a high public (20% of all video views) and academic interest (26% of all citations, ratio 0.8). Further diseases/treatments of high public interest were premature ejaculation (ratio 54.4), testicular cancer (ratio 11.4), erectile dysfunction (ratio 5.5) and kidney transplant (ratio 3.7). Urological treatments had a higher public-to-academic interest ratio (median ratio 0.25) than diseases (median ratio 0.05; P = 0.029). A quantification of academic and public interest in the urological field is feasible using a novel new media-based methodology. We found several mismatches in public versus academic interest in urological diseases and treatments, which has implications for research strategies, conference planning and patient information projects. Regular re-assessments of the public and academic interest landscape can contribute to detecting and proving trends in the field of urology. © 2018 The Japanese Urological Association.

mHealth in Urology: A Review of Experts’ Involvement in App Development

PubMed Central

Pereira-Azevedo, Nuno; Carrasquinho, Eduardo; Cardoso de Oliveira, Eduardo; Cavadas, Vitor; Osório, Luís; Fraga, Avelino; Castelo-Branco, Miguel; Roobol, Monique J.

2015-01-01

Introduction Smartphones are increasingly playing a role in healthcare and previous studies assessing medical applications (apps) have raised concerns about lack of expert involvement and low content accuracy. However, there are no such studies in Urology. We reviewed Urology apps with the aim of assessing the level of participation of healthcare professionals (HCP) and scientific Urology associations in their development. Material and Methods A systematic search was performed on PubMed, Apple's App Store and Google's Play Store, for Urology apps, available in English. Apps were reviewed by three graders to determine the app’s platform, target customer, developer, app type, app category, price and the participation of a HCP or a scientific Urology association in the development. Results The search yielded 372 apps, of which 150 were specific for Urology. A fifth of all apps had no HCP involvement (20.7%) and only a third had been developed with a scientific Urology association (34.7%). The lowest percentage of HCP (13.4%) and urological association (1.9%) involvement was in apps designed for the general population. Furthermore, there was no contribution from an Urology society in "Electronic Medical Record" nor in "Patient Information" apps. A limitation of the study is that only Android and iOS apps were reviewed. Conclusions Despite the increasing Mobile Health (mHealth) market, this is the first study that demonstrates the lack of expert participation in the design of Urology apps, particularly in apps designed for the general public. Until clear regulation is enforced, the urological community should help regulate app development. Maintaining a register of certified apps or issuing an official scientific seal of approval could improve overall app quality. We propose that urologists become stakeholders in mHealth, shaping future app design and promoting peer-review app validation. PMID:25984916

Outcomes assessment in men undergoing open retropubic radical prostatectomy, laparoscopic radical prostatectomy, and robotic-assisted radical prostatectomy.

PubMed

Kowalczyk, Keith J; Yu, Hua-Yin; Ulmer, William; Williams, Stephen B; Hu, Jim C

2012-02-01

To review the various methods of outcomes assessment used for effectiveness studies comparing retropubic radical prostatectomy (RRP), laparoscopic radical prostatectomy (LRP), and robotic-assisted laparoscopic prostatectomy (RALP). A review of the peer reviewed literature was performed for reported series of RRP, LRP, and RALP using Pubmed and MEDLINE with emphasis on comparing perioperative, functional, and oncologic outcomes. Common methods used for outcomes assessment were categorized and compared, highlighting the pros and cons of each approach. The majority of the literature comparing RRP, LRP, and RALP comes in the form of observational data or administrative data from secondary datasets. While randomized controlled trials are ideal for outcomes assessment, only one such study was identified and was limited. Non-randomized observational studies contribute to the majority of data, however are limited due to retrospective study design, lack of consistent endpoints, and limited application to the general community. Administrative data provide accurate assessment of operative outcomes in both academic and community settings, however has limited ability to convey accurate functional outcomes. Non-randomized observational studies and secondary data are useful resources for assessment of outcomes; however, limitations exist for both. Neither is without flaws, and conclusions drawn from either should be viewed with caution. Until standardized prospective comparative analyses of RRP, LRP, and RALP are established, comparative outcomes data will remain imperfect. Urologic researchers must strive to provide the best available outcomes data through accurate prospective data collection and consistent outcomes reporting.

Emergence of integrated urology-radiation oncology practices in the State of Texas.

PubMed

Jhaveri, Pavan M; Sun, Zhuyi; Ballas, Leslie; Followill, David S; Hoffman, Karen E; Jiang, Jing; Smith, Benjamin D

2012-09-01

Integrated urology-radiation oncology (RO) practices have been advocated as a means to improve community-based prostate cancer care by joining urologic and radiation care in a single-practice environment. However, little is known regarding the scope and actual physical integration of such practices. We sought to characterize the emergence of such practices in Texas, their extent of physical integration, and their potential effect on patient travel times for radiation therapy. A telephone survey identified integrated urology-RO practices, defined as practices owned by urologists that offer RO services. Geographic information software was used to determine the proximity of integrated urology-RO clinic sites with respect to the state's population. We calculated patient travel time and distance from each integrated urology-RO clinic offering urologic services to the RO treatment facility owned by the integrated practice and to the nearest nonintegrated (independent) RO facility. We compared these times and distances using the Wilcoxon-Mann-Whitney test. Of 229 urology practices identified, 12 (5%) offered integrated RO services, and 182 (28%) of 640 Texas urologists worked in such practices. Approximately 53% of the state population resides within 10 miles of an integrated urology-RO clinic site. Patients with a diagnosis of prostate cancer at an integrated urology-RO clinic site travel a mean of 19.7 miles (26.1 min) from the clinic to reach the RO facility owned by the integrated urology-RO practice vs 5.9 miles (9.2 min) to reach the nearest nonintegrated RO facility (P<.001). Integrated urology-RO practices are common in Texas and are generally clustered in urban areas. In most integrated practices, the urology clinics and the integrated RO facilities are not at the same location, and driving times and distances from the clinic to the integrated RO facility exceed those from the clinic to the nearest nonintegrated RO facility. Copyright © 2012 Elsevier Inc. All rights reserved.

Trends in matching to urology residency in Canada: are we becoming noncompetitive?

PubMed

Melnyk, Megan; Nelson, Hilary; Mickelson, Jennifer; Macneily, Andrew E

2013-01-01

Urology is perceived as a competitive specialty choice. Declining undergraduate exposure and the preference for "lifestyle specialties" may jeopardize urology's popularity. Our objective was to assess trends in application and matching rates to urology compared with other surgical specialties. We reviewed data collected by Canadian Residency Matching Service (CaRMS) and the Canadian Post-MD Education Registry since expansion in Canadian medical school enrollment began (2002-2011). The following were examined: applicant preference, number of positions, gender patterns, and match results. "Surgery" included general surgery, orthopedics, plastics, ENT, and urology. From 2002 to 2011 CaRMS applicants increased from 1117 to 2528 (126%). The number of applicants selecting surgery first increased from 178 to 338(90%). The number of surgery positions increased from 138 to 275 (100%). Urology positions increased from 15 to 31 (113%). Applicants to urology increased only 40% (30-42). The proportion of all CARMs applicants selecting urology as their first choice decreased from 2.7% (30) to 1.7% (42). The ratio of first choice urology applicants to positions decreased from 2 to 1.35. The probability of matching urology as first choice increased from 50% to 76%. Female medical graduates increased from 51% to 58%. The female applicants selecting surgery first increased from 21% (49) to 41% (173). In contrast, females selecting urology first rose from 13% (4) to 17% (7). Urology in Canada is becoming less competitive. Residency positions have doubled since 2002 whereas the number of applicants remains static. This trend was not reflected in other surgical specialities. Factors accounting for this may include poor undergraduate exposure, demand for specialties with controllable lifestyles, gender shifts in undergraduate medicine, and lack of role models. The need for undergraduate exposure to urology and vetting numbers of residency positions remains a matter of paramount importance. Copyright © 2013 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.

Emergence of Integrated Urology-Radiation Oncology Practices in the State of Texas

DOE Office of Scientific and Technical Information (OSTI.GOV)

Jhaveri, Pavan M.; Sun Zhuyi; Ballas, Leslie

2012-09-01

Purpose: Integrated urology-radiation oncology (RO) practices have been advocated as a means to improve community-based prostate cancer care by joining urologic and radiation care in a single-practice environment. However, little is known regarding the scope and actual physical integration of such practices. We sought to characterize the emergence of such practices in Texas, their extent of physical integration, and their potential effect on patient travel times for radiation therapy. Methods and Materials: A telephone survey identified integrated urology-RO practices, defined as practices owned by urologists that offer RO services. Geographic information software was used to determine the proximity of integratedmore » urology-RO clinic sites with respect to the state's population. We calculated patient travel time and distance from each integrated urology-RO clinic offering urologic services to the RO treatment facility owned by the integrated practice and to the nearest nonintegrated (independent) RO facility. We compared these times and distances using the Wilcoxon-Mann-Whitney test. Results: Of 229 urology practices identified, 12 (5%) offered integrated RO services, and 182 (28%) of 640 Texas urologists worked in such practices. Approximately 53% of the state population resides within 10 miles of an integrated urology-RO clinic site. Patients with a diagnosis of prostate cancer at an integrated urology-RO clinic site travel a mean of 19.7 miles (26.1 min) from the clinic to reach the RO facility owned by the integrated urology-RO practice vs 5.9 miles (9.2 min) to reach the nearest nonintegrated RO facility (P<.001). Conclusions: Integrated urology-RO practices are common in Texas and are generally clustered in urban areas. In most integrated practices, the urology clinics and the integrated RO facilities are not at the same location, and driving times and distances from the clinic to the integrated RO facility exceed those from the clinic to the nearest nonintegrated RO facility.« less

Perceived Role of Social Media in Urologic Knowledge Acquisition Among Young Urologists: A European Survey.

PubMed

Rivas, Juan Gomez; Socarras, Moises Rodriguez; Patruno, Giulio; Uvin, Pieter; Esperto, Francesco; Dinis, Paulo Jorge; Roupret, Morgan; Borgmann, Hendrik

2017-07-27

Social media (SoMe) are increasingly being integrated into personal and professional life, with urology being a leading medical specialty in SoMe adoption. We aimed to assess the perceived role of SoMe in urologic knowledge acquisition among young urologists across Europe. Members of the European Society of Residents in Urology designed a 20-item online survey via surveymonkey.com. The survey was designed in accordance with Checklist for Reporting Results of Internet E-Surveys (CHERRIES) guidelines and was distributed via e-mail and social media in 23 European countries to urology residents and young urologists. Statistical Package for the Social Sciences (SPSS) software was used for descriptive statistics and statistical analysis. For comparative analysis the Mann-Whitney U test was used. A total of 316 young urologists with a mean age of 31.2±3.9 yr responded to the survey. Of the respondents, 99% use SoMe in a personal and/or professional way. YouTube and LinkedIn are the most frequently used platforms for professional use. SoMe were ranked in third place as an information source for urologic news/updates, lying behind journals and websites but ahead of congresses and books. Video content from YouTube or other sources was ranked as a preferred tool to see/understand surgical techniques ahead of websites and reference books. 61% follow urologic associations, 47% follow urologic events, 44% follow urologic journals, and 39% follow urologic experts on SoMe. The perceived influence of SoMe on urology knowledge was rated as moderate to high by 63% and as low to none by 37% of young urologists. Of the respondents, 44% apply guidelines on the appropriate use of SoMe in urology. SoMe play a significant role in knowledge acquisition by young urologists in Europe. Physicians, organizations, and institutions should strive to spread and provide valuable educational content through SoMe. Social media can be valuable for education in urology because it is useful to keep abreast of new developments in this field of medicine. Copyright © 2016 European Association of Urology. Published by Elsevier B.V. All rights reserved.

Spanish adaptation of the recommendations for the appropriate use of social networks in urology of the European Association of Urology.

PubMed

Rodríguez-Socarrás, M E; Gómez-Rivas, J; Álvarez-Maestro, M; Tortolero, L; Ribal, M J; Garcia Sanz, M; Roupret, M

2016-09-01

To adapt to Spanish the recommendations for the appropriate use of social media (SoMe) in the urological setting prepared by the European Association of Urology (EAU). The use of SoMe has become fairly popular in the international urological community. Due to the nature of the medical content shared among healthcare professionals through SoMe, however, there is the risk of medical and legal problems. For this reason, various international urological associations such as the American Urological Association, the British Association of Urological Surgeons and EAU have published their recommendations for the appropriate use of social media. Efforts have been made to adapt and summarise the recommendations of the EAU in Spanish and to publish them in Actas Urológicas Españolas (@actasurologicas), the official journal of the Spanish Urological Association (@InfoAEU) and the American Confederation of Urology (@CAU_URO). SoMe include well-known platforms such as Twitter, Facebook and YouTube, which have undoubtedly changed the way in which people communicate and interact. SoMe offer clear advantages for communicating between professionals, working in teams, disseminating knowledge and creating professional profiles and are increasingly used by patients and healthcare practitioners. The introduction of SoMe in the urological community has started a revolution in how scientific articles are shared, how people participate in congresses and how international urological associations communicate with their followers. However, SoMe is generally an open public setting, with potential risks for confidentiality and the doctor-patient relationship due to the nature of the shared information. The present recommendations include tools for creating professional profiles, protecting confidentiality and creating honest and responsible content. SoMe represents a fascinating area for the communication and dissemination of knowledge, with considerable applicability in health care and the urological community. New efforts are being directed to extend the use of social media in the urological community, measuring its actual academic impact and standardising the language employed. Copyright © 2015 AEU. Publicado por Elsevier España, S.L.U. All rights reserved.

Outcomes of complex robot-assisted extravesical ureteral reimplantation in the pediatric population.

PubMed

Arlen, Angela M; Broderick, Kristin M; Travers, Curtis; Smith, Edwin A; Elmore, James M; Kirsch, Andrew J

2016-06-01

While open ureteral reimplantation remains the gold standard for surgical treatment of vesicoureteral reflux (VUR), minimally invasive approaches offer potential benefits. This study evaluated the outcomes of children undergoing complex robot-assisted laparoscopic ureteral reimplantation (RALUR) for failed previous anti-reflux surgery, complex anatomy, or ureterovesical junction obstruction (UVJO), and compared them with patients undergoing open extravesical repair. Children undergoing complex RALUR or open extravesical ureteral reimplantation (OUR) were identified. Reimplantation was classified as complex if ureters: 1) had previous anti-reflux surgery, 2) required tapering and/or dismembering, or 3) had associated duplication or diverticulum. Seventeen children underwent complex RALUR during a 24-month period, compared with 41 OUR. The mean follow-up was 16.6 ± 6.5 months. The RALUR children were significantly older (9.3 ± 3.7 years) than the OUR patients (3.1 ± 2.7 years; P < 0.001). All RALUR patients were discharged on postoperative day one, while 24.4% of children in the open group required longer hospitalization (mean 1.3 ± 0.7 days; P = 0.03). Adjusting for age, there was no significant difference in inpatient analgesic usage between the two cohorts. Three OUR patients (7.3%) developed postoperative febrile urinary tract infection compared with a single child (5.9%) undergoing RALUR (P = 1.00). There was no significant difference in complication rate between the two groups (12.2% OUR versus 11.8% RALUR; P = 1.00). A postoperative cystogram was performed in the majority of RALUR patients, with no persistent VUR detected, and one child (6.7%) was diagnosed with contralateral reflux. Reported VUR resolution rates following robot-assisted ureteral reimplantation are varied. In the present series, children undergoing RALUR following failed previous anti-reflux surgery, with complex anatomy, or UVJO experienced a shorter length of stay but had similar analgesic requirements to those undergoing open repair. Radiographic, clinical success rates and complication risk were comparable. This study had several limitations, aside from lack of randomization. Analgesic use was limited to an inpatient setting, and pain scores were not assessed. Not all children underwent a postoperative VCUG, so the true radiographic success rate is unknown. A larger patient cohort with longer follow-up is necessary to determine predictors of radiographic and clinical failure. Older children with a previous history of anti-reflux surgery were more likely to undergo RALUR. These children had success and complication rates comparable to younger patients following complex open extravesical reimplantation, which underscores the expanding role of robot-assisted lower urinary tract reconstructive surgery in the pediatric population. Copyright © 2015 Journal of Pediatric Urology Company. Published by Elsevier Ltd. All rights reserved.

A subtype based analysis of urological chronic pelvic pain syndrome in men.

PubMed

Davis, Seth N P; Binik, Yitzchak M; Amsel, Rhonda; Carrier, Serge

2013-07-01

The current conceptualization of urological chronic pelvic pain syndrome in men recognizes a wide variety of pain, psychosocial, sexual and urological symptoms and markers that may contribute to decreased quality of life. Unfortunately, this syndrome is difficult to clearly define and treat due to heterogeneous symptom profiles. We systematically describe these heterogeneous symptoms and investigated whether they could be subtyped into distinct syndromes. A total of 171 men diagnosed with urological chronic pelvic pain syndrome completed validated questionnaires, a structured genital pain interview, digital pain threshold testing and urological assessment. Pain interview results are systematically presented as descriptive information. We used k-means cluster analysis to define subtypes. Seven homogenous, distinct clusters were defined, each with a remarkably different symptom presentation. These clusters were described and related to previous hypotheses of urological chronic pelvic pain syndrome etiology. These clusters may represent distinct subtypes of urological chronic pelvic pain syndrome that can be used to guide treatment more effectively. Defining subtypes may also improve our understanding of the underlying mechanisms of urological chronic pelvic pain syndrome. Copyright © 2013 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.

Practice variation on use of antibiotics: An international survey among pediatric urologists.

PubMed

Kim, Jin K; Chua, Michael E; Ming, Jessica M; Braga, Luis H; Smith, Grahame H H; Driver, Christopher; Koyle, Martin A

2018-05-19

Although there is abundance in literature focusing on the use of prophylactic antibiotics for adult urological procedures, the evidence for using antibiotics following common pediatric urological procedures is limited with no specific guidelines for use. Consequently, current practices on antibiotic usage for common interventions may be variable among practicing pediatric urologists, lacking evidence-based support. The aim was to evaluate the current practice pattern on antibiotic usage for common interventions amongst pediatric urologists (PU) practicing in four English-speaking sectors of the world. An anonymous survey of five scenarios with multiple choice options was disseminated to all active practicing members of the Pediatric Urologist of Canada (PUC) and Society of Pediatric Urology of Australia and New Zealand (SPUNZA), as well as all those attending the 2016 British Association of Pediatric Urology (BAPU) and 2017 American Association of Pediatric Urology (AAPU) meetings. The response for each scenario was summarized for overall practice pattern variation and the pattern for each sector was compared using the Fisher exact test. A total of 126 respondents completed the survey (68.5% response rate) with at least a 65% response rate for each of the four sectors. The majority of respondents do not use antibiotics for indwelling urethral (46.8%) and suprapubic catheters (53.4%); however, they do give antibiotics for J-J stent placement (65.1%) and hypospadias surgery (84.9%), and use antibiotics after hypospadias surgery where catheters or stents are left indwelling (80.9%, 84.2%, respectively). Among those surveyed, the PUC members and AAPU PU demonstrated similar practice patterns which often significantly differed from that of SPUNZA members and BAPU attendees. Specifically, a significantly larger proportion of the North American pediatric urologists do not use antibiotics for common procedures compared with Australia, New Zealand, and the UK (Table). In the absence of prospective studies in antibiotic use for pediatric patients to guide clinicians, there is a clear variability among sectors in the use of antibiotics for most clinical scenarios investigated. With increasing resistance patterns and possible adverse effects of antibiotics, it is important that the international pediatric urology community engage in discussions and collaborations to address this issue. Practice patterns in antibiotic usage amongst PU varies widely, some of which may be associated with their local "culture." There is a need to understand these differences and begin to standardize treatment in the hopes of increasing appropriate use of antibiotics internationally. Copyright © 2018 Journal of Pediatric Urology Company. Published by Elsevier Ltd. All rights reserved.

Decision making in urological surgery.

PubMed

Abboudi, Hamid; Ahmed, Kamran; Normahani, Pasha; Abboudi, May; Kirby, Roger; Challacombe, Ben; Khan, Mohammed Shamim; Dasgupta, Prokar

2012-06-01

Non-technical skills are important behavioural aspects that a urologist must be fully competent at to minimise harm to patients. The majority of surgical errors are now known to be due to errors in judgment and decision making as opposed to the technical aspects of the craft. The authors reviewed the published literature regarding decision-making theory and in practice related to urology as well as the current tools available to assess decision-making skills. Limitations include limited number of studies, and the available studies are of low quality. Decision making is the psychological process of choosing between alternative courses of action. In the surgical environment, this can often be a complex balance of benefit and risk within a variable time frame and dynamic setting. In recent years, the emphasis of new surgical curriculums has shifted towards non-technical surgical skills; however, the assessment tools in place are far from objective, reliable and valid. Surgical simulators and video-assisted questionnaires are useful methods for appraisal of trainees. Well-designed, robust and validated tools need to be implemented in training and assessment of decision-making skills in urology. Patient safety can only be ensured when safe and effective decisions are made.

The value of a core clinical rotation in urology for medical students.

PubMed

Patel, Premal; Nayak, Jasmir G; McGregor, Thomas B

2015-01-01

In 2013, our institution underwent a change to the undergraduate medical curriculum whereby a clinical urology rotation became mandatory. In this paper, we evaluated the perceived utility and value of this change in the core curriculum. Third year medical students, required to complete a mandatory 1-week clinical urology rotation, were asked to complete a survey before and after their rotation. Fourth year medical students, not required to complete this rotation, were also asked to complete a questionnaire. Chi-squared and Fisher's exact test were used for data analysis. In total, 108 third year students rotated through urology during the study period. Of these, 66 (61%) completed the pre-rotation survey and 54 (50%) completed the post-rotation survey. In total, there were 110 fourth year students. Of these, 44 (40%) completed the questionnaire. After completing their mandatory rotations, students felt more comfortable managing and investigating common urological problems, such as hematuria and renal colic. Students felt they had a better understanding of how to insert a Foley catheter and felt comfortable independently inserting a Foley catheter. Importantly, students felt they knew when to consult urology and were also more likely to consider a career in urology. Compared to fourth year students, third year students felt urology was an important component to a family medicine practice and felt they had a better understanding of when to consult urology. The introduction of a mandatory urology rotation for undergraduate medical students leads to a perceived improvement in fundamental urological knowledge and skill set of rotating students. This mandatory rotation provides a valuable experience that validates its inclusion.

Results of distal hypospadias repair after pediatric urology fellowship training: A comparison of junior surgeons with their mentor.

PubMed

Bush, N C; Barber, T D; Dajusta, D; Prieto, J C; Ziada, A; Snodgrass, W

2016-06-01

Teaching and learning hypospadias repair is a major component of pediatric urology fellowship training. Educators must transfer skills to fellows, without increasing patient complications. Nevertheless, few studies report results of surgeons during their first years of independent practice. To review outcomes of distal hypospadias repairs performed during the same 2-year period by consecutive, recently matriculated, surgeons in independent practice, and to compare them to results by their mentor (with >20 years of experience). Exposure to hypospadias surgery during fellowship was determined from case logs of five consecutive fellows completing training from 2007-2011. TIP was the only technique used to repair distal hypospadias. No fellow operated independently or performed complete repairs under supervision. Instead, the first 3 months were spent assisting their mentor, observing surgical methodology and decision-making. Then, each performed selected portions under direct supervision, including: degloving, penile straightening, developing glans wings, incising and tubularizing the urethral plate, creating a barrier layer, sewing the glansplasty, and skin closure. Overall fellow participation in each case was <50%. In 2011-2012, urethroplasty complications (fistula, glans dehiscence, meatal stenosis, urethral stricture, diverticulum) were recorded for consecutive patients undergoing primary distal repair by these recent graduates in their independent practices. The fellow graduating in 2011 provided 1 year of data. All patients undergoing repair during the study period were included in the analysis, except those lost to follow-up after catheter removal. Composite urethroplasty complications were compared between junior surgeons, and between junior surgeons and their mentor, with Fisher's exact contingency test. Training logs indicated fellow participation ranged from 76-134 hypospadias repairs, including distal, proximal and reoperative surgeries. Post-graduation case volumes ranged from 25-68 by junior surgeons versus 136 by the mentor. With similar mean follow-up, urethroplasty complication rates were statistically the same between the former fellows, and between them versus the mentor, ranging from 5-13%. Nearly all were fistulas or glans dehiscence. Junior surgeons reported they performed TIP as learned during fellowship, with one exception who used 7-0 polydioxanone rather than polyglactin for urethroplasty. This is the first study directly comparing hypospadias surgical outcomes by recently graduated fellows in independent practice with those of their mentor. We found junior surgeons achieved similar results for distal TIP hypospadias repair. Although their participation during training largely comprised observation and surgical assistance, with discrete performance of key steps, skills sufficient to duplicate the mentor's results were transferred. These data suggest there should be no learning curve for distal hypospadias after training. This report raises several considerations for surgical educators. First, mentors should review their own results, to be certain that they are correctly performing and teaching procedures. Second, programs need to determine key steps for procedures they teach, and then emphasize their optimal performance. Finally, mentors should expect former fellows to report back their initial results of hypospadias repair to be certain lessons taught were learned. Otherwise, preventable complications resulting from technical errors will be multiplied in the children operated by their trainees as they enter independent practice. Copyright © 2016 Journal of Pediatric Urology Company. Published by Elsevier Ltd. All rights reserved.

Safeguarding the Future of Urological Research and Delivery of Clinical Excellence by Harnessing the Power of Youth to Spearhead Urological Research.

PubMed

Kasivisvanathan, Veeru; Kutikov, Alexander; Manning, Todd G; McGrath, John; Resnick, Matthew J; Sedelaar, J P Michiel; Silay, Mesrur S

2018-05-01

Trainee-led collaboratives offer exciting new perspectives and approaches to urological research. They provide a central network of expertise in methodology, mentoring, and knowledge of research processes that allows the conduct of large multicentre studies that can recruit quickly. This provides the consultant workforce of tomorrow with the skills required to deliver practice-changing clinical studies in urology. Copyright © 2017 European Association of Urology. Published by Elsevier B.V. All rights reserved.

Nanotechnology applications in urology: a review.

PubMed

Maddox, Michael; Liu, James; Mandava, Sree Harsha; Callaghan, Cameron; John, Vijay; Lee, Benjamin R

2014-11-01

The objectives of this review are to discuss the current literature and summarise some of the promising areas with which nanotechnology may improve urological care. A Medline literature search was performed to elucidate all relevant studies of nanotechnology with specific attention to its application in urology. Urological applications of nanotechnology include its use in medical imaging, gene therapy, drug delivery, and photothermal ablation of tumours. In vitro and animal studies have shown initial encouraging results. Further study of nanotechnology for urological applications is warranted to bridge the gap between preclinical studies and translation into clinical practice, but nanomedicine has shown significant potential to improve urological patient care. © 2014 The Authors. BJU International © 2014 BJU International.

URobotics—Urology Robotics at Johns Hopkins

PubMed Central

Stoianovici, D

2011-01-01

URobotics (Urology Robotics) is a program of the Urology Department at the Johns Hopkins Medical Institutions dedicated to the development of new technology for urologic surgery (http://urology.jhu.edu/urobotics). The program is unique in that it is the only academic engineering program exclusively applied to urology. The program combines efforts and expertise from the medical and engineering fields through a close partnership of clinical and technical personnel. Since its creation in 1996, the URobotics lab has created several devices, instruments, and robotic systems, several of which have been successfully used in the operating room. This article reviews the technology developed in our laboratory and its surgical applications, and highlights our future directions. PMID:11954067

European urology: quality, impact, online.

PubMed

Catto, James W F; Montorsi, Francesco; Schulman, Claude

2013-10-01

European Urology provides contemporary, cutting-edge urologic research, guidance, and discussion. The journal continues to invite collaborative reviews, to invest in rapid but fair peer review, to seek the best research, and to serve the needs of readers and patients. Copyright © 2013 European Association of Urology. Published by Elsevier B.V. All rights reserved.

[The demographic development in Germany : challenge and chances for urology].

PubMed

Schneider, A W; Fichtner, J

2014-08-01

Urology is affected by the demographic development in Germany more than any other medical discipline. Despite a relatively stable total population, by the year 2040 there will be an absolute and relevant increase in urological diseases caused only by the demographic development in the population. This is particularly true for the increase in oncological treatment just in the field of the discipline of urology. Even now the current numbers for tumor development in Germany (RKI 2014) in the urological oncology segment of all tumor diseases show an increasing trend with more than 23 %. This significant increase in performance is in contrast to the age development of the specialists in this discipline. In total but especially due to the significantly over-aged specialist medical profession in urology, this leads to a substantial bottleneck of specialists in the discipline of urology. This deficiency of personnel resources in urology is aggravated by the requirements of Generation Y for a well-adjusted work-life balance and the associated feminization of the medical profession. This requires intelligent strategies for.

Retrospective evaluation of urological admissions to emergency service of a training and research hospital.

PubMed

Topaktaş, Ramazan; Altın, Selçuk; Aydın, Cemil; Akkoç, Ali; Yılmaz, Yakup

2014-12-01

Many patients consult emergency services with urological complaints. The aim of this study was to investigate the epidemiology, clinical presentation and treatments of urological emergency cases in a training and research hospital. We retrospectively evaluated urological emergency patients referred to the emergency unit between July 2012 and July 2013 according to age, gender, affected organ, radiological imaging techniques and treatment. Among 141.844 emergency cases, 3.113 (2.19%) were urological emergencies and 53.2% of the patients were male (mean age: 49.1), and 46.8% of them were female (median age: 42.8). The most frequent illness was genitourinary infection constituting 41.2% of the cases followed by renal colic (36.9%). Among the urological emergencies 483 (15.5%) patients were hospitalized and 152 surgical operations were performed. The mostly performed procedure was the placement of a suprapubic catheter in 34 patients constituting (22.3%) of the cases. Totally eight patients were referred to another experienced health center due to different reasons. Most of the urological emergency patients do not require emergency surgical interventions however, timely identification and management of urological emergencies with in-depth clinical evaluation are important to prevent late complications. Therefore the doctors working in emergency services must be heedful of urological emergencies.

Fast-track surgery concepts for congenital urogenital anomalies.

PubMed

Bizic, Marta R; Majstorovic, Marko J; Vukadinovic, Vojkan; Korac, Gradimir; Krstic, Zoran; Radojicic, Zoran; Ducic, Sinisa; Djordjevic, Miroslav L

2013-01-01

To investigate the possibility of fast-track surgery concepts in pediatric urology department as a single center study model of a developing country. The study included 1620 patients surgically treated at the pediatric urology department, from 2009 to 2011. According to the congenital anomalies, all patients were classified in one of four groups: I - testicular anomalies (197 patients); II - external genital anomalies (453); III - upper urinary tract anomalies (801) and IV - associated anomalies (169). We analyzed the total duration of stay in the hospital of all patients among all treating doctors concerning the anomaly. Statistically significant difference in total length of hospitalization of all patients in Group I was noted in Doctors 1 and 5 (F=10.36** for F0.05;5;12=3.11 and F0.01;5;12=5.06), as well as in the Group II (F=17.01** for F0.05;5;12=3.11 and F0.01;5;12=5.06). Statistical analysis was not possible to be performed in groups III and IV because of lack of the patients. Analyzing the length of hospitalization of the patients treated at the urology department, all doctors showed the tendency to shorten the total length of hospitalization in patients of all groups. Majority of the studies carried out on pediatric urology departments in developed countries, showed that over 50% of children were successfully treated using fast-track surgery concept. Modern methods of surgical management and anesthesia allow decrease of hospitalization length, financial savings to the healthcare system and better comfort for patients.

Unprofessional content on Facebook accounts of US urology residency graduates.

PubMed

Koo, Kevin; Ficko, Zita; Gormley, E Ann

2017-06-01

To characterize unprofessional content on public Facebook accounts of contemporary US urology residency graduates. Facebook was queried with the names of all urologists who graduated from US urology residency programmes in 2015 to identify publicly accessible profiles. Profiles were assessed for unprofessional or potentially objectionable content using a prospectively designed rubric, based on professionalism guidelines by the American Urological Association, the American Medical Association, and the Accreditation Council for Graduate Medical Education. Content authorship (self vs other) was determined, and profiles were reviewed for self-identification as a urologist. Of 281 graduates, 223 (79%) were men and 267 (95%) held MD degrees. A total of 201 graduates (72%) had publicly identifiable Facebook profiles. Of these, 80 profiles (40%) included unprofessional or potentially objectionable content, including 27 profiles (13%) reflecting explicitly unprofessional behaviour, such as depictions of intoxication, uncensored profanity, unlawful behaviour, and confidential patient information. When unprofessional content was found, the content was self-authored in 82% of categories. Among 85 graduates (42%) who self-identified as a urologist on social media, nearly half contained concerning content. No differences in content were found between men and women, MD and DO degree-holders, or those who did or did not identify as a urologist (all P > 0.05). The majority of recent residency graduates had publicly accessible Facebook profiles, and a substantial proportion contained self-authored unprofessional content. Of those identifying as urologists on Facebook, approximately half violated published professionalism guidelines. Greater awareness of trainees' online identities is needed. © 2017 The Authors BJU International © 2017 BJU International Published by John Wiley & Sons Ltd.

Twitter Activity Associated With U.S. News and World Report Reputation Scores for Urology Departments.

PubMed

Ciprut, Shannon; Curnyn, Caitlin; Davuluri, Meena; Sternberg, Kevan; Loeb, Stacy

2017-10-01

To analyze the association between US urology department Twitter presence and U.S. News and World Report (USNWR) reputation scores, to examine the content, informational value, and intended audience of these platforms, and to identify objectives for Twitter use. We identified Twitter accounts for urology departments scored in the 2016-2017 USNWR. Correlation coefficients were calculated between Twitter metrics (number of followers, following, tweets, and Klout influence scores) with USNWR reputation scores. We also performed a detailed content analysis of urology department tweets during a 6-month period to characterize the content. Finally, we distributed a survey to the urology department accounts via Twitter, inquiring who administers the content, and their objectives for Twitter use. Among 42 scored urology departments with Twitter accounts, the median number of followers, following, and tweets were 337, 193, and 115, respectively. All of these Twitter metrics had a statistically significant positive correlation with reputation scores (P <.05). Content analyses revealed that most tweets were about conferences, education, and publications, targeting the general public or urologic community. Survey results revealed that the primary reason for twitter use among urology departments was visibility and reputation, and urologists are considered the most important target audience. There is statistically significant correlation between Twitter activity and USNWR reputation scores for urology departments. Our results suggest that Twitter provides a novel mechanism for urology departments to communicate about academic and educational topics, and social media engagement can enhance reputation. Copyright © 2017 Elsevier Inc. All rights reserved.

The Canadian Urology Fair: a model for minimizing the financial and academic costs of the residency selection process.

PubMed

Grober, Ethan D; Matsumoto, Edward D; Jewett, Michael A S; Chin, Joseph L

2003-12-01

In 1994, the Canadian urology residency training programs designed the "Canadian Urology Fair"--a single-site (Toronto, Ont.), 1-day fair to conduct the personal interview portion of the residency selection process. The objective of the current study was to evaluate the success of the Urology Fair in achieving its original goals of decreasing the financial burden and minimizing time away from medical training for applicants and faculty. Both candidates and Canadian urology training programs were surveyed regarding the financial and academic costs (days absent) of attending the 2001 Urology Fair. Data from the 2001 Canadian Resident Matching Service (CaRMS) was used to compare the financial and academic costs of attending personal interviews incurred by candidates declaring urology as their first-choice discipline to candidates interviewing with other surgical specialties throughout Canada. Financial costs incurred by candidates to attend the Urology Fair (mean Can dollar 367) were significantly lower than candidates' estimated costs of attending on-site interviews at the individual programs (mean Can dollar 2065). The financial costs of attending personal interviews by CaRMS applicants declaring urology as their first-choice discipline (mean Can dollar 2002) were significantly lower than the costs incurred by applicants interviewing with other surgical disciplines (mean Can dollar 2744). Financial costs to urology programs attending the fair (mean Can dollar 1931) were not significantly greater than the programs' estimated costs of conducting on-site interviews at their respective program locations (mean Can dollar 1825). Days absent from medical school to attend interviews were significantly lower among CaRMS applicants declaring urology as their first-choice discipline (3 d) compared with applicants who interviewed with other surgical specialties (9.1 d). The Canadian Urology Fair represents an innovative and efficient method for residency programs to conduct the personal interview portion of the residency selection process and should serve as a model for making the interview process less expensive and time-consuming for both candidates and faculty.

Urological symptoms in a subset of patients with urological chronic pelvic pain syndrome and a polysymptomatic, polysyndromic pattern of presentation.

PubMed

Lai, H Henry; North, Carol S; Andriole, Gerald L; Cupps, Lori; Song, David; Ness, Timothy J; Hong, Barry A

2014-06-01

We characterized urological symptoms in a subset of patients with urological chronic pelvic pain syndrome who have a high somatic symptom burden and a wide symptom distribution fitting a polysymptomatic, polysyndromic presentation pattern. A total of 81 patients with urological chronic pelvic pain syndrome enrolled in the National Institute of Diabetes and Digestive and Kidney Diseases MAPP Research Network Study at Washington University in St. Louis and University of Alabama at Birmingham sites. They completed a symptom questionnaire to assess the somatic symptom burden and its distribution, and GUPI (Genitourinary Pain Index) to assess urological chronic pelvic pain syndrome symptoms, impact on quality of life and self-reported treatment seeking behaviors for urological chronic pelvic pain symptoms. The polysymptomatic, polysyndromic symptom pattern was defined by self-report of numerous painful and nonpainful somatic symptoms across many organ systems and by symptom categories on the polysymptomatic, polysyndromic questionnaire. Patients with urological chronic pelvic pain syndrome and the symptom pattern reported more severe genitourinary pain on a Likert scale, more frequent pain in the last week and more widespread pain distribution in the genital and pelvic areas than patients with urological chronic pelvic pain syndrome without the pattern. Patients with the symptom pattern also had significantly higher scores on the GUPI pain subscale, quality of life subscale (worse) and total questionnaire scores than patients without the pattern. Patients with the pattern reported significantly more treatment seeking behavior than others. The polysymptomatic, polysyndromic pattern might be an important phenotypic factor to assess in the evaluation of urological chronic pelvic pain syndrome with clinical and research implications. This may be a distinct clinical subgroup among patients with urological chronic pelvic pain syndrome. Copyright © 2014 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.

Radical cystectomy in octogenarians--does morbidity outweigh the potential survival benefits?

PubMed

Donat, S Machele; Siegrist, Timothy; Cronin, Angel; Savage, Caroline; Milowsky, Matthew I; Herr, Harry W

2010-06-01

Surveillance, Epidemiology, and End Results data indicate only 19.7% of patients 80 years old or older with muscle invasive bladder cancer undergo radical cystectomy vs 49.4% of those with similar stage disease age 65 to 79 years, reflecting concern for perioperative morbidity. We evaluated the morbidity and survival outcomes of octogenarians treated with radical cystectomy at a tertiary cancer center. We conducted a retrospective review of 1,142 patients entered prospectively into a hospital based complication database between 1995 and 2005 using a modified Clavien system. Complications were classified as minor or major based on the complexity of intervention required. Disease specific and competing risk survival curves for patients younger than 80 years vs 80 years old or older were created. Octogenarians had a nonsignificantly higher rate of minor (55% vs 50%) and major complications (17% vs 13%) than younger patients, respectively (global p = 0.15). After adjusting for baseline characteristics the risk of any complication was roughly flat across all ages (p = 0.9). For major complications risk appeared to increase slightly up to age 65 years and then plateau (p = 0.16). After adjusting for deaths from other causes the cumulative incidence of death from bladder cancer in octogenarians was comparable to that in younger patients (5-year cumulative incidence of death from bladder cancer 26% vs 25%). In our experience radical cystectomy in older patients with bladder cancer provides similar disease control and survival outcomes with risks of high grade perioperative morbidity comparable to those in younger patients, and remains an important treatment option. Copyright 2010 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.

Pain outcomes in children who received intrathecal vs intravenous opioids for pain control following major urologic surgery: a retrospective review.

PubMed

Putnam, Elizabeth M; Koppera, Prabhat; Malviya, Shobha; Voepel-Lewis, Terri

2015-12-01

Intrathecal (IT) opioid administration has been associated with postoperative benefits including reduced pain and opioid use in children. However, the postoperative benefits and risks of IT opioid administration during major urologic surgery in children remain unclear. The aim of this study was to compare postoperative pain and adverse event outcomes among children who received IT vs intravenous (IV) opioids during major urologic surgery. We reviewed the medical records of children 3-17 years of age who underwent ureteroneocystostomy or pyeloplasty between 2006 and 2012. Electronically captured anesthetic and surgical data, postanesthesia care recovery unit (PACU) and nursing flowsheets, and daily progress notes through hospital discharge were reviewed. Analgesic techniques (i.e., IT or IV patient/nurse controlled opioids), all analgesic drugs and doses were recorded. Outcome measures included pain scores, need for rescue analgesics, opioid-related adverse events, and their treatments. Seventy-seven children received IT opioids and 51 received IV opioids. More children in the IV group required rescue analgesics and had higher pain scores at PACU discharge. Children in the IV group required rescue opioids more frequently than the IT group from 0 to 8 h and 8 to 16 h after PACU discharge, but rates were similar by 16-24 h 70% of children in IT group transitioned directly to oral opioids. Seven IT placements were considered as failed due to early need for rescue opioids. Four (8%) of the IV group and seven (9%) of the IT group experienced oxygen desaturation. Two of these, both in IT group required naloxone and one was admitted to ICU for observation. The IT group experienced a higher incidence of pruritus, constipation and hypotension. We observed better postoperative pain control in children who received IT vs IV opioids for the first 16 h with no discernible difference thereafter. The intrathecal group experienced higher incidences of pruritus, constipation, and hypotension. © 2015 John Wiley & Sons Ltd.

Pelviureteric obstruction in children: conventional pyeloplasty is superior to endo-urology.

PubMed

Ahmed, S; Crankson, S; Sripathi, V

1998-09-01

Hydronephrosis secondary to pelviureteric junction (PUJ) obstruction is common in infancy and childhood. Pyeloplasty has until recently been the accepted method of management, but alternative endo-urological techniques have evolved in the last decade. Published results of conventional pyeloplasty for primary PUJ obstruction in children were compared with published results of endo-urological procedures. Sixty-six pyeloplasties were performed in 61 children in a 6-year period. During a similar period, 63 primary endo-urological procedures were reported in the literature. The success rate after pyeloplasty was 95.5% compared with 65% after endo-urology. Conventional pyeloplasty is superior to endo-urology and should remain the gold standard for the treatment of primary PUJ obstruction in children.

Complications Following Common Inpatient Urological Procedures: Temporal Trend Analysis from 2000 to 2010.

PubMed

Meyer, Christian P; Hollis, Michael; Cole, Alexander P; Hanske, Julian; O'Leary, James; Gupta, Soham; Löppenberg, Björn; Zavaski, Mike E; Sun, Maxine; Sammon, Jesse D; Kibel, Adam S; Fisch, Margit; Chun, Felix K H; Trinh, Quoc-Dien

2016-04-01

Measuring procedure-specific complication-rate trends allows for benchmarking and improvement in quality of care but must be done in a standardized fashion. Using the Nationwide Inpatient Sample, we identified all instances of eight common inpatient urologic procedures performed in the United States between 2000 and 2010. This yielded 327218 cases including both oncologic and benign diseases. Complications were identified by International Classification of Diseases, Ninth Revision codes. Each complication was cross-referenced to the procedure code and graded according to the standardized Clavien system. The Mann-Whitney and chi-square were used to assess the statistical significance of medians and proportions, respectively. We assessed temporal variability in the rates of overall complications (Clavien grade 1-4), length of hospital stay, and in-hospital mortality using the estimated annual percent change (EAPC) linear regression methodology. We observed an overall reduction in length of stay (EAPC: -1.59; p<0.001), whereas mortality rates remained negligible and unchanged (EAPC: -0.32; p=0.83). Patient comorbidities increased significantly over the study period (EAPC: 2.09; p<0.001), as did the rates of complications. Procedure-specific trends showed a significant increase in complications for inpatient ureterorenoscopy (EAPC: 5.53; p<0.001), percutaneous nephrolithotomy (EAPC: 3.75; p<0.001), radical cystectomy (EAPC: 1.37; p<0.001), radical nephrectomy (EAPC: 1.35; p<0.001), and partial nephrectomy (EAPC: 1.22; p=0.006). Limitations include lack of postdischarge follow-up data, lack of pathologic characteristics, and inability to adjust for secular changes in administrative coding. In the context of urologic care in the United States, our findings suggest a shift toward more complex oncologic procedures in the inpatient setting, with same-day procedures most likely shifted to the outpatient setting. Consequently, complications have increased for the majority of examined procedures; however, no change in mortality was found. This report evaluated the trends of urologic procedures and their complications. A significant shift toward sicker patients and more complex procedures in the inpatient setting was found, but this did not result in higher mortality. These results are indicators of the high quality of care for urologic procedures in the inpatient setting. Copyright © 2015 European Association of Urology. Published by Elsevier B.V. All rights reserved.

Spanish urological schools (1880-1970).

PubMed

Pérez-Albacete, M

2018-05-11

We researched the start of urological specialisation in Spain, from the end of the 19th century to the institution of the education system (resident medical intern) to learn about the centres and individuals who created the urological teaching units and training schools in which the first Spanish urologists specialised their training. We extracted the references from books on the history of urology, from periodic urological publications and from the posters on history submitted to the congresses of the Spanish Urological Association and filled in the data and dates with the Historical Dictionary of Spanish Urologists. There are 30 urological specialization centres, 8 with official accreditation recognised by the corresponding ministry but whose official status is unknown. These centres are in the urology departments of large Spanish hospitals, university clinic hospitals and in private schools directed by notable urologists. There are 14 main centres, corresponding chronologically to the following cities: Madrid, Barcelona, Santiago de Compostela, Seville, Las Palmas of Gran Canaria, Cadiz, Santander, Valencia, Granada, Bilbao, San Sebastian, Oviedo, Zaragoza and Salamanca. Urological training in Spain from the end of the 19th century to the first half of the 20th century was well-established, both in officially accredited centres and in the urology departments of the main hospitals, in university clinic hospitals and in private schools and clinics. The training was directed by experienced urologists who ensured proper teaching and training, a method that persisted until the institution of the resident medical intern system in 1970. Copyright © 2018 AEU. Publicado por Elsevier España, S.L.U. All rights reserved.

Multiple authorship and article type in journals of urology across the Atlantic: trends over the past six decades.

PubMed

Hammad, Fayez T; Shaban, Sami; Abu-Zidan, Fikri

2012-01-01

The aim of this research was to study the trends in authorship and type of article in European and North American journals of urology over the past 6 decades. Using a self-developed Visual Basic program, the number of authors per article and the type of article in four European journals (BJU International, Current Opinion in Urology, European Urology and Urologia Internationalis) and four North American journals (Journal of Urology, Urologic Clinics of North America, Urology and World Journal of Urology) were extracted from the PubMed website from January 1946 to October 2010, and the number of authors per article in each year was calculated in all the journals. The average number of authors per article has increased and the percentage of single-author articles has decreased in both European and American journals. An increase in the number of authors per article was observed mainly in original articles and case reports. Since the early 1980s, there has also been a decreasing percentage of published case reports and a general increase in the percentage of letters to the editor and editorials. The multiple-authorship trends observed in both European and North American urology journals were similar and appeared to be mainly due to changes in original articles and case reports. Copyright © 2012 S. Karger AG, Basel.

[Urology and Sexology in Berlin 1880-1933: Original citations for the establishment of this frontier of urology - protagonists as reflected in their publications].

PubMed

Moll, Friedrich H; Fangerau, Heiner

2016-02-01

The connections between urology and sexology are often not obvious today. At the end of the 19th century both specialties developed in parallel especially in Berlin and had a fruitful relationship. Urologic journals and books were an ideal forum for publication especially for sexologists.

78 FR 63997 - Kidney, Urologic, and Hematologic Diseases Interagency Coordinating Committee; Urology...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-10-25

... hold a 1-day workshop on November 4, 2013. The workshop will be open to the public, with attendance limited to space available. DATES: The workshop will be held on November 4, 2013, from 8:00 a.m. to 3:30 p... entities. The November 4, 2013, workshop held by the KUHICC Urology Subcommittee, also called the ``Urology...

Basic science research in urology training.

PubMed

Eberli, D; Atala, A

2009-04-01

The role of basic science exposure during urology training is a timely topic that is relevant to urologic health and to the training of new physician scientists. Today, researchers are needed for the advancement of this specialty, and involvement in basic research will foster understanding of basic scientific concepts and the development of critical thinking skills, which will, in turn, improve clinical performance. If research education is not included in urology training, future urologists may not be as likely to contribute to scientific discoveries.Currently, only a minority of urologists in training are currently exposed to significant research experience. In addition, the number of physician-scientists in urology has been decreasing over the last two decades, as fewer physicians are willing to undertake a career in academics and perform basic research. However, to ensure that the field of urology is driving forward and bringing novel techniques to patients, it is clear that more research-trained urologists are needed. In this article we will analyse the current status of basic research in urology training and discuss the importance of and obstacles to successful addition of research into the medical training curricula. Further, we will highlight different opportunities for trainees to obtain significant research exposure in urology.

Robotic surgery in urologic oncology: gathering the evidence.

PubMed

Skolarus, Ted A; Zhang, Yun; Hollenbeck, Brent K

2010-08-01

In less than a decade, the widespread application of robotic technology to the field of urologic oncology has permanently altered the way urologists approach malignancy. The short-term benefits of minimally invasive surgery using robotic assistance (i.e., decreased blood loss, improved convalescence and ergonomic appeal), as well as a broad marketing campaign, have helped the technology gain traction in the field of urology. Although the long-term benefits of its use in urologic surgery are less clear and the costs of robotic surgery are consistently greater than those of other approaches, the numbers of prostate, kidney and bladder cancer cases continue to rise. Identifying transferable surgical processes of care that matter most for each of the robotic cases in urologic oncology (e.g., prostatectomy, cystectomy and partial nephrectomy) is a next step toward broadly improving the quality of urologic cancer care. To this end, urologic professional societies and their surgeons should aim to identify underwriters for and participate in large clinical registries and surgical quality collaboratives.

Pediatric robotic urologic surgery-2014

PubMed Central

Kearns, James T.; Gundeti, Mohan S.

2014-01-01

We seek to provide a background of the current state of pediatric urologic surgery including a brief history, procedural outcomes, cost considerations, future directions, and the state of robotic surgery in India. Pediatric robotic urology has been shown to be safe and effective in cases ranging from pyeloplasty to bladder augmentation with continent urinary diversion. Complication rates are in line with other methods of performing the same procedures. The cost of robotic surgery continues to decrease, but setting up pediatric robotic urology programs can be costly in terms of both monetary investment and the training of robotic surgeons. The future directions of robot surgery include instrument and system refinements, augmented reality and haptics, and telesurgery. Given the large number of children in India, there is huge potential for growth of pediatric robotic urology in India. Pediatric robotic urologic surgery has been established as safe and effective, and it will be an important tool in the future of pediatric urologic surgery worldwide. PMID:25197187

The Impact of Implementation of the European Association of Urology Guidelines Panel Recommendations on Reporting and Grading Complications on Perioperative Outcomes after Robot-assisted Radical Prostatectomy.

PubMed

Gandaglia, Giorgio; Bravi, Carlo Andrea; Dell'Oglio, Paolo; Mazzone, Elio; Fossati, Nicola; Scuderi, Simone; Robesti, Daniele; Barletta, Francesco; Grillo, Luca; Maclennan, Steven; N'Dow, James; Montorsi, Francesco; Briganti, Alberto

2018-03-12

The rate of postoperative complications might vary according to the method used to collect perioperative data. We aimed at assessing the impact of the prospective implementation of the European Association of Urology (EAU) guidelines on reporting and grading of complications in prostate cancer patients undergoing robot-assisted radical prostatectomy (RARP). From September 2016, an integrated method for reporting surgical morbidity based on the EAU guidelines was implemented at a single, tertiary center. Perioperative data were prospectively and systematically collected during a patient interview at 30 d after surgery as recommended by the EAU Guidelines Panel Recommendations on Reporting and Grading Complications. The rate and grading of complications of 167 patients who underwent RARP±pelvic lymph node dissection (PLND) after the implementation of the prospective collection system (Group 1) were compared with 316 patients treated between January 2015 and August 2016 (Group 2) when a system based on patient chart review was used. No differences were observed in disease characteristics and PLND between the two groups (all p≥0.1). Postoperative complications were graded according to the Clavien-Dindo classification system. Overall, the complication rate was higher when the prospective collection system based on the EAU guidelines was used (29%) than when retrospective chart review (10%; p<0.001) was used. In particular, a substantially higher rate of grade 1 (8.4% vs 4.7%) and 2 (14% vs 2.8%) complications was detected in Group 1 versus Group 2 (p<0.001). Although the rate of complications occurred during hospitalization did not differ (13% vs 10%; p=0.3), 31 (19%) complications after discharge were detected in Group 1. This resulted into a readmission rate of 16%. Conversely, no complications after discharge and readmissions were recorded for Group 2. The implementation of the EAU guidelines on reporting perioperative outcomes roughly doubled the complication rate after RARP and allowed for the detection of complications after discharge in more than 15% of patients that would have been otherwise missed, where patients assessed with the EAU implemented protocol had a threefold higher likelihood of reporting complications. The implementation of the European Association of Urology guidelines on reporting and grading of complications after urologic procedures in prostate cancer patients roughly doubled the complication rate after robot-assisted radical prostatectomy compared to retrospective patient chart review. Moreover, it allowed for the detection of complications after discharge in more than 15% of patients that would have been otherwise missed. Copyright © 2018 European Association of Urology. Published by Elsevier B.V. All rights reserved.

Lymph node dissection technique is more important than lymph node count in identifying nodal metastases in radical cystectomy patients: a comparative mapping study.

PubMed

Dorin, Ryan P; Daneshmand, Siamak; Eisenberg, Manuel S; Chandrasoma, Shahin; Cai, Jie; Miranda, Gus; Nichols, Peter W; Skinner, Donald G; Skinner, Eila C

2011-11-01

The value of lymph node dissection (LND) in the treatment of bladder urothelial carcinoma is well established. However, standards for the quality of LND remain controversial. We compared the distribution of lymph node (LN) metastases in a two-institution cohort of patients undergoing radical cystectomy (RC) using a uniformly applied extended LND template. Patients undergoing RC at the University of Southern California (USC) Institute of Urology and at Oregon Health Sciences University (OHSU) were included if they met the following criteria: (1) no prior pelvic radiotherapy or LND; (2) lymphatic tissue submitted from all nine predesignated regions, including the paracaval and para-aortic LNs; (3) bladder primary; and (4) category M0 disease. The number and location of LN metastases were prospectively entered into corresponding databases. LN maps were constructed and correlated with preoperative and pathologic characteristics. Kaplan-Meier curves were constructed to estimate overall survival (OS) and recurrence free survival (RFS) among LN-positive (LN+) patients. Inclusion criteria were met by 646 patients (439 USC, 207 OHSU), and 23% had LN metastases at time of cystectomy. Although there was a difference in the median per-patient LN count between institutions, there were no significant interinstitutional differences in the incidence or distribution of positive LNs, which were found in 11% of patients with ≤pT2b and in 44% of patients with ≥pT3a tumors. Among LN+ patients, 41% had positive LNs above the common iliac bifurcation. Estimated 5-yr RFS and OS rates for LN+ patients were 45% and 33%, respectively, and did not differ significantly between institutions. LN metastases in regions outside the boundaries of standard LND are common. Adherence to meticulous dissection technique within an extended template is likely more important than total LN count for achieving optimal oncologic outcomes. Copyright © 2011 European Association of Urology. Published by Elsevier B.V. All rights reserved.

Ureteral Stones: Implementation of a Reduced-Dose CT Protocol in Patients in the Emergency Department with Moderate to High Likelihood of Calculi on the Basis of STONE Score1

PubMed Central

Moore, Christopher L.; Daniels, Brock; Singh, Dinesh; Luty, Seth; Gunabushanam, Gowthaman; Ghita, Monica; Molinaro, Annette; Gross, Cary P.

2016-01-01

Purpose To determine if a reduced-dose computed tomography (CT) protocol could effectively help to identify patients in the emergency department (ED) with moderate to high likelihood of calculi who would require urologic intervention within 90 days. Materials and Methods The study was approved by the institutional review board and written informed consent with HIPAA authorization was obtained. This was a prospective, single-center study of patients in the ED with moderate to high likelihood of ureteral stone undergoing CT imaging. Objective likelihood of ureteral stone was determined by using the previously derived and validated STONE clinical prediction rule, which includes five elements: sex, timing, origin, nausea, and erythrocytes. All patients with high STONE score (STONE score, 10–13) underwent reduced-dose CT, while those with moderate likelihood of ureteral stone (moderate STONE score, 6–9) underwent reduced-dose CT or standard CT based on clinician discretion. Patients were followed to 90 days after initial imaging for clinical course and for the primary outcome of any intervention. Statistics are primarily descriptive and are reported as percentages, sensitivities, and specificities with 95% confidence intervals. Results There were 264 participants enrolled and 165 reduced-dose CTs performed; of these participants, 108 underwent reduced-dose CT alone with complete follow-up. Overall, 46 of 264 (17.4%) of patients underwent urologic intervention, and 25 of 108 (23.1%) patients who underwent reduced-dose CT underwent a urologic intervention; all were correctly diagnosed on the clinical report of the reduced-dose CT (sensitivity, 100%; 95% confidence interval: 86.7%, 100%). The average dose-length product for all standard-dose CTs was 857 mGy · cm ± 395 compared with 101 mGy · cm ± 39 for all reduced-dose CTs (average dose reduction, 88.2%). There were five interventions for nonurologic causes, three of which were urgent and none of which were missed when reduced-dose CT was performed. Conclusion A CT protocol with over 85% dose reduction can be used in patients with moderate to high likelihood of ureteral stone to safely and effectively identify patients in the ED who will require urologic intervention. PMID:26943230

Robotic technology in urology

PubMed Central

Murphy, D; Challacombe, B; Khan, M S; Dasgupta, P

2006-01-01

Urology has increasingly become a technology‐driven specialty. The advent of robotic surgical systems in the past 10 years has led to urologists becoming the world leaders in the use of such technology. In this paper, we review the history and current status of robotic technology in urology. From the earliest uses of robots for transurethral resection of the prostate, to robotic devices for manipulating laparoscopes and to the current crop of master–slave devices for robotic‐assisted laparoscopic surgery, the evolution of robotics in the urology operating theatre is presented. Future possibilities, including the prospects for nanotechnology in urology, are awaited. PMID:17099094

Regeneration of urologic tissues and organs.

PubMed

Atala, Anthony

2005-01-01

Patients suffering from a variety of urologic diseases may be treated with transplanted tissues and organs. However, there is a shortage of donor tissues and organs, which is worsening yearly owing to the ageing population. Scientists in the field of regenerative medicine and tissue engineering are applying the principles of cell transplantation, material science, and bioengineering to construct biological substitutes that will restore and maintain normal function in diseased and injured urologic tissues. This chapter reviews recent advances that have occurred in the regeneration of urologic organs and describes how these applications may offer novel therapies for patients with urologic disease.

Heart health = urologic health and heart unhealthy = urologic unhealthy: rapid review of lifestyle changes and dietary supplements.

PubMed

Moyad, Mark A

2011-08-01

Almost all aspects of urology are affected positively and negatively by certain lifestyle changes and dietary supplements. Some of these interventions have potential profound impacts independently or in combination with conventional therapy, others have no impact, and some could negatively impact treatment and overall health. The heart-healthiest recommendations have consistently served as the safest and most potentially effective options in urology from benign prostatic hyperplasia, chronic nonbacterial prostatitis, interstitial cystitis, multiple urologic cancers, male infertility, male and female sexual dysfunction, kidney stones, and Peyronie disease. Copyright © 2011 Elsevier Inc. All rights reserved.

Increased pediatric sub-specialization is associated with decreased surgical complication rates for inpatient pediatric urology procedures

PubMed Central

Tejwani, R.; Wang, H-H. S.; Young, B. J.; Greene, N. H.; Wolf, S.; Wiener, J. S.; Routh, J. C.

2016-01-01

Summary Introduction Increased case volumes and training are associated with better surgical outcomes. However, the impact of pediatric urology sub-specialization on perioperative complication rates is unknown. Objectives To determine the presence and magnitude of difference in rates of common postoperative complications for elective pediatric urology procedures between specialization levels of urologic surgeons. The Nationwide Inpatient Sample (NIS), a nationally representative administrative database, was used. Study Design The NIS (1998–2009) was retrospectively reviewed for pediatric (≤18 years) admissions, using ICD-9-CM codes to identify urologic surgeries and National Surgical Quality Improvement Program (NSQIP) inpatient postoperative complications. Degree of pediatric sub-specialization was calculated using a Pediatric Proportion Index (PPI), defined as the ratio of children to total patients operated on by each provider. The providers were grouped into PPI quartiles: Q1, 0–25% specialization; Q2, 25–50%; Q3, 50–75%; Q4, 75–100%. Weighted multivariate analysis was performed to test for associations between PPI and surgical complications. Results A total of 71,479 weighted inpatient admissions were identified. Patient age decreased with increasing specialization: Q1, 7.9 vs Q2, 4.8 vs Q3, 4.8 vs Q4, 4.6 years, P<0.01). Specialization was not associated with race (P>0.20), gender (P>0.50), or comorbidity scores (P=0.10). Mortality (1.5% vs 0.2% vs 0.3% vs 0.4%, P<0.01) and complication rates (15.5% vs 11.7% vs 9.6% vs 10.9%, P<0.0001) both decreased with increasing specialization. Patients treated by more highly specialized surgeons incurred slightly higher costs (Q2, +4%; Q3, +1%; Q4 + 2%) but experienced shorter length of hospital stay (Q2, –5%; Q3, –10%; Q4, –3%) compared with the least specialized providers. A greater proportion of patients treated by Q1 and Q3 specialized urologists had CCS ≥2 than those seen by Q2 or Q4 urologists (12.5% and 12.2%, respectively vs 8.4% and 10.9%, respectively, P=0.04). Adjusting for confounding effects, increased pediatric specialization was associated with decreased postoperative complications: Q2 OR 0.78, CI 0.58–1.05; Q3 OR 0.60, CI 0.44–0.84; Q4 OR 0.70, CI 0.58–0.84; P<0.01. Discussion Providers with proportionally higher volumes of pediatric patients achieved better postoperative outcomes than their less sub-specialized counterparts. This may have arisen from increased exposure to pediatric anatomy and physiology, and greater familiarity with pediatric techniques. Limitation The NIS admission-based retrospective design did not enable assessment of long-term outcomes, repeated admissions, or to track a particular patient across time. The study was similarly limited in evaluating the effect of pre-surgical referral patterns on patient distributions. Conclusions Increased pediatric sub-specialization among urologists was associated with a decreased risk of mortality and surgical complications in children undergoing inpatient urologic procedures. PMID:27363329

[Employees in high-reliability organizations: systematic selection of personnel as a final criterion].

PubMed

Oubaid, V; Anheuser, P

2014-05-01

Employees represent an important safety factor in high-reliability organizations. The combination of clear organizational structures, a nonpunitive safety culture, and psychological personnel selection guarantee a high level of safety. The cockpit personnel selection process of a major German airline is presented in order to demonstrate a possible transferability into medicine and urology.

[Proposals for the introduction of history, art and literature issues on the urology subject].

PubMed

Tundidor Bermúdez, A M

2008-10-01

To contribute to the humanistic education of medical students. A bibliographic review was done on history, art and literature items in relation with Urology. The introduction of cultural items in the Urology subject, as a motivation and complement of the biomedical items, is proposed and illustrated by examples. The Urology subject can contribute to the humanistic education of medical students.

Assessment of the performance of the American Urological Association symptom score in 2 distinct patient populations.

PubMed

Johnson, Timothy V; Schoenberg, Evan D; Abbasi, Ammara; Ehrlich, Samantha S; Kleris, Renee; Owen-Smith, Ashli; Gunderson, Kristin; Master, Viraj A

2009-01-01

Recent research suggests that low education and illiteracy may drive misunderstanding of the American Urological Association Symptom Score, a key tool in the American Urological Association benign prostatic hyperplasia guidelines. It is unclear whether misunderstanding is confined to patients of low socioeconomic status. Therefore, we reevaluated the prevalence and impact of this misunderstanding in a county vs university hospital population. This prospective study involved 407 patients from a county hospital and a university hospital who completed the American Urological Association Symptom Score as self-administered and then as interviewer administered. Responses were compared by calculating correlation coefficients and weighted kappa statistics to assess patient understanding of the American Urological Association Symptom Score. Multivariate logistic regression analyses were used to examine the association between patient characteristics and poor understanding of the American Urological Association Symptom Score. Of the patients 72% understood all 7 American Urological Association Symptom Score questions. Of the measured demographic variables only education level significantly affected this understanding. Compared to patients with more than 12 years of education county hospital patients with less than 9 years of education were 57.06 times more likely to misunderstand the American Urological Association Symptom Score (95% CI 14.32-329.34) while university hospital patients with less than 9 years of education were 38.27 times more likely to misunderstand the American Urological Association Symptom Score (95% CI 1.69-867.83). Of county hospital patients 31% and of university hospital patients 21% significantly misrepresented their symptom severity according to current guidelines. Patients with low education regardless of location are more likely to misunderstand the American Urological Association Symptom Score, misrepresent their symptoms and, therefore, receive inappropriate treatment.

Agreement between electronic medical records and self-reported urologic domains in the National Spina Bifida Patient Registry (NSBPR): Implications for future research.

PubMed

Halline, Christopher G; Meyer, Theresa; Rosoklija, Ilina; Yerkes, Elizabeth B

2017-08-01

Self-report (SR) is an efficient data collection method. However, SR data have been shown to be discrepant with medical record (MR) documentation, which raises questions about using SR to supplement retrospective chart review in research. In this study, pediatric spina bifida (SB) patients who completed SR interviews about continence status and personal bladder/bowel management were identified. We examined agreement between SR data and Urology provider notes in MRs. This study aimed to (1) identify demographic, medical, or methodological factors that might contribute to SR/MR disagreement; (2) postulate how these findings might be significant clinically; and (3) recommend improvements to SR data collection and MR documentation. Our institution participates in the National Spina Bifida Patient Registry (NSBPR). NSBPR-enrolled subjects typically complete annual interviews about their urologic outcomes; we consider this to be a form of SR. After identifying patients who interviewed within 1 month of an encounter with a urology provider, we systematically reviewed and compared their SR responses to the MR. Overall SR/MR agreement (no. of agreeing data pairs/no. of complete data pairs) and strength of agreement (kappa, κ) were assessed. Agreement about daytime continence status was assessed for children ≥5 years or in younger children who were toilet trained. Analyses were also stratified by diagnosis, type of bladder management, and ethnicity. Eleven urologic domains were analyzed for 176 patients. Overall SR/MR agreement was ≥90% for nine out of 11 domains (figure). Daytime urinary and stool incontinence (DUSI) domains demonstrated the lowest overall agreement, at 69% and 74% respectively. Patients with myelomeningocele (MM) and those on clean intermittent catheterization demonstrated twice as much SR/MR disagreement about DUSI than patients without MM and those who void. There was no significant difference in rates of SR/MR agreement about DUSI when analyzed by ethnicity, race, and ambulatory function status. Among cases of SR/MR disagreement about DUSI, the SR and MR had a roughly equal percentage of better outcomes reported for both UI and SI. There was strong SR/MR agreement for the majority of urologic data we analyzed. Medically complex patients faced lower SR/MR agreement, which is consistent with findings in other patient populations. Biased reporting by patients/families or providers was not found. Minimizing SR/MR disagreement through standardized data collection methods and tools, improved definitions of patient outcomes, and documentation of respondent identity will improve large, multisite studies that utilize SR and MR concurrently. Copyright © 2017 Journal of Pediatric Urology Company. Published by Elsevier Ltd. All rights reserved.

BPH and prostate cancer risk.

PubMed

Miah, Saiful; Catto, James

2014-04-01

With the exclusion of non-melanomatous skin malignancy, prostate cancer (PCa) is the second most prevalent cancer in men globally. It has been reported that the majority of men will develop benign prostatic hyperplasia (BPH) by the time they reach their 60s. Together, these prostatic diseases have a significant morbidity and mortality affecting over a billion men throughout the world. The risk of developing prostate cancer of men suffering BPH is one that has resulted in a healthy debate amongst the urological community. Here, we try to address this conundrum with clinical and basic science evidence. Data from an online search and contemporary data presented at international urological congresses was reviewed. BPH and PCa can be linked together at a molecular and cellular level on genetic, hormonal, and inflammatory platforms suggesting that these prostatic diseases have common pathophysiological driving factors. Epidemiological studies are weighted towards the presence of BPH having a greater risk for a man to develop PCa in his lifetime; however, a conclusion of causality cannot be confidently stated. The future workload healthcare practitioners will face regarding BPH, and PCa will substantially increase. Further basic science and large epidemiological studies using a global cohort of men are required prior to the urological community confidently counseling their patients with BPH with regards to their PCa risk.

Current status and future perspectives in laparoendoscopic single-site and natural orifice transluminal endoscopic urological surgery.

PubMed

Autorino, Riccardo; Stein, Robert J; Lima, Estevão; Damiano, Rocco; Khanna, Rakesh; Haber, Georges-Pascal; White, Michael A; Kaouk, Jihad H

2010-05-01

Objective of this study is to provide an evidence-based analysis of the current status and future perspectives of scarless urological surgery. A PubMed search has been performed for all relevant urological literature regarding natural orifice transluminal endoscopic surgery (NOTES) and laparoendoscopic single-site surgery (LESS). In addition, experience with LESS and NOTES at our own institution has been considered. All clinical and investigative reports for LESS and NOTES procedures in the urological literature have been considered. A wide variety of clinical procedures in urology have been successfully completed by using LESS techniques. Thus far, experience with NOTES has largely been investigational, although early clinical reports are emerging. Further development of instrumentation and platforms is necessary for both techniques to become more widely adopted throughout the urological community.

Publication rates of full-text journal articles converted from abstracts presented during the 22nd Turkish National Urology Congress

PubMed Central

Kocaaslan, Ramazan; Kayalı, Yunus; Tok, Adem; Tepeler, Abdulkadir

2016-01-01

Objective To analyze the publication rates of full-text journal articles converted from the abstracts presented in the 22nd Turkish National Urology Congress in 2012. Material and Methods A total of 576 abstracts accepted for presentation at the 22nd Turkish National Urology Association Meeting were identified from the published abstract book. The abstracts were categorized into subsections such as endourology and pediatric urology. The subsequent publication rate for the studies was evaluated by scanning PubMed Medline. Abstracts published before the proceedings were excluded from the study. Results The abstracts were categorized as being presented orally (n=155), by poster (n=421), or by video (n=78). Of the 28 (18.3%) of 155 oral and 34 (8.15%) of 421 poster presentations, were subsequently published in several journals until March 2015. The publication rates of the abstracts based on urology subsections were as follows: neurology (25%), andrology (18.6%), endourology (17.2%), urolithiasis (15.3%), general urology (12.5%), infectious diseases (7.14%), pediatric urology (6.25%), uro-gynecology (6.06%), reconstructive urology (5.8%), and urooncology (3.8%). The average time to publication was 11.77 (0–33) months. Conclusion This is the first study assessing the publication rates of abstracts presented at a Turkish National Urology Congress. It reveals that more qualified randomized studies need to be done to improve the rate of publication. PMID:27011876

"A tree must be bent while it is young": teaching urological surgical techniques to schoolchildren.

PubMed

Buntrock, Stefan

2012-01-01

Playing video games in childhood may help achieve advanced laparoscopic skills later in life. The virtual operating room will soon become a reality, as "doctor games 2.0" will doubtlessly begin to incorporate virtual laparoscopic techniques. To teach surgical skills to schoolchildren in order to attract them to urology as a professional choice later in life. As part of EAU Urology Week 2010, 108 school children aged 15-19 attended a seminar with lectures and simulators (laparoscopy, TUR, cystoscopy, and suture sets) at the 62nd Congress of the German Society of Urology in Düsseldorf. A Pub-Med and Google Scholar search was also performed in order to review the beneficial effects of early virtual surgical training. MeSh terms used were "video games," "children," and "surgical skills." Searches were performed without restriction for a certain period of time. In terms of publicity for urology, EAU Urology Week, and the German Society of Urology, the event was immensely successful. Regarding the literature search, four relevant publications were found involving children. An additional three articles evaluated the usefulness of video gaming in medical students and residents. Making use of virtual reality to attract and educate a new generation of urologists is an important step in designing the future of urology.

Infrequent Reservoir-Related Complications of Urologic Prosthetics: A Case Series and Literature Review.

PubMed

Cui, Tao; Terlecki, Ryan; Mirzazadeh, Majid

2015-12-01

Complications related to inflatable penile prosthesis (IPP) and artificial urinary sphincter (AUS) reservoirs are rare, potentially life threatening, and poorly described in the literature. As more devices are implanted, the incidence of reservoir-related complications may increase, and it will be important to recognize the relevant signs and symptoms. We present a case series of reservoir-related complications presenting to our institution for treatment. We also reviewed all accounts of reservoir-related complications within the urologic literature. Three cases of reservoir-related complications are presented. Case 1 involves erosion of an intact AUS reservoir into the cecum of a patient with a history of myelomeningocele and bladder augmentation. Case 2 involves an IPP reservoir causing vascular compression, resulting in open exploration and repositioning of the reservoir. Case 3 involves intraperitoneal migration of a retained IPP reservoir to a subhepatic area, which was then removed laparoscopically. Literature review yielded descriptions of eight cases of intestinal complications, five cases of vascular complications, but zero reports of migration to a subhepatic area. Other notable complications include 20 reported cases of reservoir erosion into the bladder and inguinal herniation of the reservoir. Complications involving urologic prosthesis reservoirs, although rare, can have serious implications for patients. A high index of suspicion and familiarity with treatment options is required in order to allow timely diagnosis and appropriate treatment. Patients with prior major abdominal surgeries seem to be more prone to intestinal complications of reservoirs and warrant special concern. Cui T, Terlecki R, and Mirzazadeh M. Infrequent reservoir-related complications of urologic prosthetics: A case series and literature review. Sex Med 2015;3:334-338.

Infrequent Reservoir‐Related Complications of Urologic Prosthetics: A Case Series and Literature Review

PubMed Central

Terlecki, Ryan; Mirzazadeh, Majid

2015-01-01

Abstract Introduction and Aim Complications related to inflatable penile prosthesis (IPP) and artificial urinary sphincter (AUS) reservoirs are rare, potentially life threatening, and poorly described in the literature. As more devices are implanted, the incidence of reservoir‐related complications may increase, and it will be important to recognize the relevant signs and symptoms. Methods and Main Outcome Measures We present a case series of reservoir‐related complications presenting to our institution for treatment. We also reviewed all accounts of reservoir‐related complications within the urologic literature Results Three cases of reservoir‐related complications are presented. Case 1 involves erosion of an intact AUS reservoir into the cecum of a patient with a history of myelomeningocele and bladder augmentation. Case 2 involves an IPP reservoir causing vascular compression, resulting in open exploration and repositioning of the reservoir. Case 3 involves intraperitoneal migration of a retained IPP reservoir to a subhepatic area, which was then removed laparoscopically. Literature review yielded descriptions of eight cases of intestinal complications, five cases of vascular complications, but zero reports of migration to a subhepatic area. Other notable complications include 20 reported cases of reservoir erosion into the bladder and inguinal herniation of the reservoir. Conclusion Complications involving urologic prosthesis reservoirs, although rare, can have serious implications for patients. A high index of suspicion and familiarity with treatment options is required in order to allow timely diagnosis and appropriate treatment. Patients with prior major abdominal surgeries seem to be more prone to intestinal complications of reservoirs and warrant special concern. Cui T, Terlecki R, and Mirzazadeh M. Infrequent reservoir‐related complications of urologic prosthetics: A case series and literature review. Sex Med 2015;3:334–338. PMID:26797069

Nocturnal enuresis: A topic review and institution experience

PubMed Central

DiBianco, John Michael; Morley, Chad; Al-Omar, Osama

2014-01-01

The objective is to provide a review of nocturnal enuresis (NE), including its epidemiology, etiology, pathophysiology, evaluation, and current management. We also set to provide further insight on the treatment of this condition from the experience derived from patients cared for at our tertiary-care institution. NE affects approximately 15% of all children at 5-year-old, affecting boys more frequently than girls. At our large university tertiary pediatric urology center, NE and incontinence, in general, is one the most common chief complaints prompting urologic care. In this review, we examine the condition in detail, highlighting specific goals of the initial evaluation and treatment. We contrast the commonly implemented treatment recommendations, available from the literature with strategies we have found valuable from our extensive experience in treating patients with this disorder. Using current urologic reference textbooks, book chapters, Medline, journal articles and reviews describing the many aspects of NE were reviewed in order to describe NE and the current practices at our institution. Although, this is not a systematic literature review, it includes relevant available research, institutional experience and urological expert opinion and current practices at a tertiary state health facility. The treatment of NE remains a challenge for many pediatricians and pediatric urologists. This likely stems from the multiple possible etiologies of the disorder. We have established a treatment algorithm at our institution, which we have found successful in the majority of our patients. This consists of starting patients on urotherapy, then offering both the enuresis alarm device and medication therapy as first line treatments, and finally adding anticholingerics for combination therapy. Our hope is with further research the treatment of NE will continue to improve. PMID:25506580

Urological outcomes following pelvic exenteration for advanced pelvic cancer are not inferior to those following radical cystectomy.

PubMed

Aslim, Edwin J; Chew, Min Hoe; Chew, Ghee Kheng; Lee, Lui Shiong

2018-06-12

Pelvic exenteration (PE) for locally advanced pelvic malignancy requires a multi-disciplinary approach and is associated with significant morbidity. Urinary reconstruction forms a major component of this procedure. The aim of the study is to review the urological outcomes following PE in a newly established pelvic oncology unit, to compare with those following radical cystectomy (RC) for bladder cancer. Patients were identified from prospectively maintained PE and bladder cancer databases, inclusive of all cases performed between January 2012 and December 2016. Those without urinary reconstructions and follow-up durations of less than 3 months were excluded. The outcomes of PE and RC cases were compared, stratifying surgical complications using the Clavien-Dindo classification. Statistical significance was defined as P < 0.05. There were 22 PE cases and 27 RC cases. The median age at surgery was 56 and 65 years, with a median follow-up of 11.7 and 19.8 months, in the PE and RC groups, respectively. Urinary reconstructions comprised n = 20 (91%) conduit diversions and n = 2 (9%) ureteral reimplantations in the PE group, and n = 5 (19%) orthotopic bladder substitutes and n = 22 (81%) ileal conduits in the RC group. The 30-day urological complication rate was 23% in the PE group (n = 4 Clavien-Dindo Grade 1-2, and n = 1 Grade 3) versus 11% in the RC group (n = 1 Grade 1-2, and n = 2 Grade 3), P = 0.801. There were no Grade 4-5 complications in this series. The urological outcomes following PE in complex pelvic oncology are reasonable and not inferior to those after primary RC alone. © 2018 Royal Australasian College of Surgeons.

Coding for urologic office procedures.

PubMed

Dowling, Robert A; Painter, Mark

2013-11-01

This article summarizes current best practices for documenting, coding, and billing common office-based urologic procedures. Topics covered include general principles, basic and advanced urologic coding, creation of medical records that support compliant coding practices, bundled codes and unbundling, global periods, modifiers for procedure codes, when to bill for evaluation and management services during the same visit, coding for supplies, and laboratory and radiology procedures pertinent to urology practice. Detailed information is included for the most common urology office procedures, and suggested resources and references are provided. This information is of value to physicians, office managers, and their coding staff. Copyright © 2013 Elsevier Inc. All rights reserved.

Prenatal diagnosis and telemedicine consultation of fetal urologic disorders.

PubMed

Rabie, Nader Z; Canon, Stephen; Patel, Ashay; Zamilpa, Ismael; Magann, Everett F; Higley, Jared

2016-06-01

In Arkansas, telemedicine is used commonly in obstetrics through Antenatal and Neonatal Guidelines, Education and Learning System (ANGELS), the existing statewide telemedicine network. This network is used primarily for tele-ultrasound and maternal-fetal medicine consultation. This study is a retrospective case series, describing all the patients who had a prenatally diagnosed urologic anomaly that required prenatal urologic consultation. From 2009-2013, approximately 1300 anomalies were recorded in the Arkansas Fetal Diagnosis and Management (AFDM) database, 14% of which were urologic anomalies. Twenty-six cases required prenatal urologic consultation, 25 of which were conducted via telemedicine. Teleconsultation allowed patients to combine maternal-fetal medicine and urologic consultations in one visit, saving time and effort and ultimately, for most patients, providing reassurance that delivery could be accomplished locally with postnatal follow-up already arranged. While there are several studies reporting the use of telemedicine for various subspecialty consultations, to our knowledge, this is the first to describe the use of telemedicine for prenatal urology consultation. Future research could randomize patients prospectively to allow comparison of both the outcomes as well as the patient experience. © The Author(s) 2015.

Parasexuality in genitourinary investigations: a qualitative study

PubMed Central

2014-01-01

Background Genitourinary investigations are performed on a large proportion of middle-aged and older men and the majority undergo investigations for prostate issues. The effects that genitourinary disease can have on men depend on the type of problem, investigations required and treatment including impotence, gynaecomastia and urinary incontinence that have lasting devastating physical, social and psychological effects. The aim was to explore older men’s experience and views of intimate and intrusive genitourinary investigations and specifically to develop hypotheses and theories concerning gender and sexuality issues in intimate genitourinary investigations. Methods Written informed consent was obtained for this qualitative study. Data were collected through one-off, semi-structured interviews involving 15 men in the first year following patient’s last urological procedure. Initially, multiple themes were identified and when analysed further concepts were repeatedly present. As the urological investigations were limited to men, gender and sexuality became prominent issues in the data. Results On analysis, the term parasexuality appeared to explain the dynamic of the situation. Parasexuality is a modified form of sexuality which is channelled and limited to maintain propriety. This was not expressed as sexuality in its overt, explicit sense, but instead a type of covert sexuality where professional boundaries are maintained but nonetheless undercurrents remain. This managed version of sexuality created a common currency by which interactions between staff and patients could take place safely. Feeding into parasexuality were gender role stereotypes and for some of the participants this reflected their own experience, context, historical and cultural norms. Intimate contact in the form of exposure and handling of the participants' genitalia during the investigations particularly challenged the boundaries of parasexuality. In order to remain parasexual, many of the participants suppressed their sexuality. Viewing staff as professional was an additional strategy used by participants to limit any sexuality as parasexuality. Conclusion This study has contributed towards the appeal for more studies to examine privacy perceptions of patients in genitalia-related care, however, it is by no means definitive. Parasexuality goes some way to explain the dynamics of communication between older men and health care professionals during genitourinary investigations. PMID:24606673

Risk factors for urinary tract infection after renal transplantation and its impact on graft function in children and young adults.

PubMed

Silva, Andres; Rodig, Nancy; Passerotti, Carlo P; Recabal, Pedro; Borer, Joseph G; Retik, Alan B; Nguyen, Hiep T

2010-10-01

Urinary tract infection will develop in 40% of children who undergo renal transplantation. Post-transplant urinary tract infection is associated with earlier graft loss in adults. However, the impact on graft function in the pediatric population is less well-known. Additionally the risk factors for post-transplant urinary tract infection in children have not been well elucidated. The purpose of this study was to assess the relationship between pre-transplant and post-transplant urinary tract infections on graft outcome, and the risk factors for post-transplant urinary tract infection. A total of 87 patients underwent renal transplantation between July 2001 and July 2006. Patient demographics, cause of renal failure, graft outcome, and presence of pre-transplant and post-transplant urinary tract infections were recorded. Graft outcome was based on last creatinine and nephrological assessment. Median followup was 3.12 years. Of the patients 15% had pre-transplant and 32% had post-transplant urinary tract infections. Good graft function was seen in 60% of the patients and 21% had failed function. Graft function did not correlate with a history of pre-transplant or post-transplant urinary tract infection (p >0.2). Of transplanted patients with urological causes of renal failure 57% had post-transplant urinary tract infection, compared to only 20% of those with a medical etiology of renal failure (p <0.001). In this study there was no correlation between a history of urinary tract infection (either before or after transplant) and decreased graft function. History of pre-transplant urinary tract infection was suggestive of urinary tract infection after transplant. Patients with urological causes of renal failure may be at increased risk for post-transplant urinary tract infection. Copyright © 2010 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.

Prospective Evaluation of PI-RADS™ Version 2 Using the International Society of Urological Pathology Prostate Cancer Grade Group System.

PubMed

Mehralivand, Sherif; Bednarova, Sandra; Shih, Joanna H; Mertan, Francesca V; Gaur, Sonia; Merino, Maria J; Wood, Bradford J; Pinto, Peter A; Choyke, Peter L; Turkbey, Baris

2017-09-01

The PI-RADS™ (Prostate Imaging Reporting and Data System), version 2 scoring system, introduced in 2015, is based on expert consensus. In the same time frame ISUP (International Society of Urological Pathology) introduced a new pathological scoring system for prostate cancer. Our goal was to prospectively evaluate the cancer detection rates for each PI-RADS, version 2 category and compare them to ISUP group scores in patients undergoing systematic biopsy and magnetic resonance imaging-transrectal ultrasound fusion guided biopsy. A total of 339 treatment naïve patients prospectively underwent multiparametric magnetic resonance imaging evaluated with PI-RADS, version 2 with subsequent systematic and fusion guided biopsy from May 2015 to May 2016. ISUP scores were applied to pathological specimens. An ISUP score of 2 or greater (ie Gleason 3 + 4 or greater) was defined as clinically significant prostate cancer. Cancer detection rates were determined for each PI-RADS, version 2 category as well as for the T2 weighted PI-RADS, version 2 categories in the peripheral zone. The cancer detection rate for PI-RADS, version 2 categories 1, 2, 3, 4 and 5 was 25%, 20.2%, 24.8%, 39.1% and 86.9% for all prostate cancer, and 0%, 9.6%, 12%, 22.1% and 72.4% for clinically significant prostate cancer, respectively. On T2-weighted magnetic resonance imaging the cancer detection rate in the peripheral zone was significantly higher for PI-RADS, version 2 category 4 than for overall PI-RADS, version 2 category 4 in the peripheral zone (all prostate cancer 36.6% vs 48.1%, p = 0.001, and clinically significant prostate cancer 22.9% vs 32.6%, p = 0.002). The cancer detection rate increases with higher PI-RADS, version 2 categories. Copyright © 2017 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.

Tethered cord release: a long-term study in 114 patients.

PubMed

Bowman, Robin M; Mohan, Avinash; Ito, Joy; Seibly, Jason M; McLone, David G

2009-03-01

All children born with a myelomeningocele at the authors' institution undergo aggressive treatment to maintain or improve functional outcome. Consequently, when any neurological, orthopedic, and/or urological changes are noted, a search for the cause is initiated. The most common cause of decline in a child born with a myelomeningocele is shunt malfunction. The second most common cause is tethering of the distal spinal cord at the site of the original back closure. In this report, the authors review the indicators of symptomatic spinal cord tethering and discuss the surgical interventions and outcomes in the children with myelomeningocele who underwent treatment at Children's Memorial Hospital from 1975 to 2008. Among the 502 children who underwent original closure at Children's Memorial Hospital, a symptomatic tethered spinal cord developed in 114 (23%). Eighty-one patients (71%) have undergone 1 untethering procedure, and 33 patients (29%) have undergone multiple untetherings, for a total of 163 total surgeries. The indicators of symptomatic spinal cord tethering include scoliosis, decline in lower-extremity (LE) motor strength, LE contractures, LE spasticity, gait change, urinary changes, and pain. Pain has shown the best response to surgical untethering, with 100% of children experiencing postoperative improvement. The results of long-term follow-up (average 12 years, range 1 month-23.3 years) in this cohort demonstrated scoliosis progression after surgical untethering in 52% of patients, with 28% requiring spinal fusion. On the 3-month postoperative manual muscle test, 70% of patients showed improved LE muscle strength compared to preoperatively. Gait was also similarly improved after untethering as evaluated by an orthopedic surgeon. Spasticity improved in two-thirds of the cohort, and as expected, LE contractures were stable (78%) postoperatively, as assessed by orthopedic and rehabilitation medicine specialists. Urologically, 64% of patients showed improvements on postoperative bladder evaluation. Although this is a clinical outcome study with no control group, the authors' experience has been that tethered cord release is beneficial in maintaining neurological, urological, and orthopedic functioning in children born with a myelomeningocele.

Mamun-TKC parathyroid retractor: Parathyroid glands squashed or scooped!

PubMed

Mahmud, Syed Mamun

2015-03-01

Parathyroid gland by its physiologic and anatomic diversity has interestingly been dealt by multiple specialties, including Urology. Besides primary hyperparathyroidism, urologists in close working relationship with nephrologists, tend to get referrals for tertiary hyperparathyroidism. Data from 1999 to 2012 was retrieved for all parathyroidectomies. Medical record of only cases undergoing parathyroidectomy utilising the instrument Mamun-TKC Parathyroid Retractor were reviewed. It is a metal body surgical instrument resembling Gil Vernet retractor having functional flat metal head attached to solid long handle, designed in two forms; one 'Straight' and other 'Angled' at 30°. During the period, 28 cases of parathyroidectomies were performed. The instrument was used in two cases. It was found to facilitate dissection, retraction and pedicle ligation of parathyroid gland by a-traumatic handling.

Urologic complications of major genitourinary reconstruction in the exstrophy-epispadias complex.

PubMed

Inouye, Brian M; Shah, Bhavik B; Massanyi, Eric Z; Di Carlo, Heather N; Kern, Adam J; Tourchi, Ali; Baradaran, Nima; Stewart, Dylan; Gearhart, John P

2014-08-01

To present the authors' experiences with urologic complications associated with various techniques used to create a continent stoma (CS), augmentation cystoplasty (AC), and neobladder in the exstrophy-epispadias complex (EEC) population. Retrospective review of medical records of patients who underwent CS with or without bladder augmentation were identified from an institutional review board-approved database of 1208 EEC patients. Surgical indications, tissue type, length of hospital stay, age, preoperative bladder capacity, prior genitourinary surgeries, postoperative urological complications, and continence status were reviewed. Among the EEC patients reviewed, 133 underwent CS (80 male, 53 female). Mean follow-up time after initial continent stoma was 5.31 years (range: 6 months to 20 years). Appendix and tapered ileum were the primary bowel segments used for the continent channel and stoma in the EEC population. The most common stomal complications in this population were stenosis, incontinence, and prolapse. Seventy-nine percent of EEC CS patients underwent AC primarily done with sigmoid colon or ileum. Eleven patients (8%) underwent neobladder creation with either colon or a combination of colon and ileum. Bladder calculi, vesicocutaneous fistula, and pyelonephritis were the most common non-stomal complications. Stomal ischemia was significantly increased in Monti ileovesicostomy compared to Mitrofanoff appendicovesicostomy in classic bladder exstrophy patients (p = 0.036). Furthermore, pyelonephritis was more than twice as likely in colonic neobladder than all other reservoir tissue types in the same cohort (OR = 2.53, 95% CI: 1.762-3.301, p < 0.001). To the best of the authors' knowledge, this is the largest study examining catheterizable stomas in the exstrophy population. While Mitrofanoff appendicovesicostomy is preferred to Monti ileovesicostomy because it is technically less challenging, it may also confer a lower rate of stomal ischemia. Furthermore, even though ileum or colon can be used in AC with equally low complication rates, practitioners must be wary of potential urologic complications that should be primarily managed by an experienced reconstructive surgeon. Copyright © 2014 Journal of Pediatric Urology Company. Published by Elsevier Ltd. All rights reserved.

Anticipating the impact of insurance expansion on inpatient urological surgery

PubMed Central

Ellimoottil, Chandy; Miller, Sarah; Wei, John T.; Miller, David C.

2014-01-01

PURPOSE The Affordable Care Act (ACA) is expected to provide coverage for nearly twenty-five million previously uninsured individuals. Because the potential impact of the ACA for urological care remains unknown, we estimated the impact of insurance expansion on the utilization of inpatient urological surgeries using Massachusetts (MA) healthcare reform as a natural experiment. METHODS We identified nonelderly patients who underwent inpatient urological surgery from 2003 through 2010 using inpatient databases from MA and two control states. Using July 2007 as the transition point between pre- and post-reform periods, we performed a difference-indifferences (DID) analysis to estimate the effect of insurance expansion on overall and procedure-specific rates of inpatient urological surgery. We also performed subgroup analyses according to race, income and insurance status. RESULTS We identified 1.4 million surgeries performed during the study interval. We observed no change in the overall rate of inpatient urological surgery for the MA population as a whole, but an increase in the rate of inpatient urological surgery for non-white and low income patients. Our DID analysis confirmed these results (all 1.0%, p=0.668; non-whites 9.9%, p=0.006; low income 6.6%, p=0.041). At a procedure level, insurance expansion caused increased rates of inpatient BPH procedures, but had no effect on rates of prostatectomy, cystectomy, nephrectomy, pyeloplasty or PCNL. CONCLUSIONS Insurance expansion in Massachusetts increased the overall rate of inpatient urological surgery only for non-whites and low income patients. These data inform key stakeholders about the potential impact of national insurance expansion for a large segment of urological care. PMID:25506058

Prostate and Urologic Cancer | Division of Cancer Prevention

Cancer.gov

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The impact of residency match information disseminated by a third-party website.

PubMed

Kutikov, Alexander; Morgan, Todd M; Resnick, Matthew J

2009-01-01

Over the past 10 years, a dramatic shift has occurred toward web-based applications and information dissemination both for medical students applying to residency programs and for current housestaff seeking specialty-specific information. This shift has been witnessed in urology with adoption of the Internet-based Electronic Residency Application Service for residency application submission. Currently, most residency programs devote significant attention to developing and maintaining an attractive web page, as studies have suggested departmental websites may impact applicants' decisions regarding residency preference lists.(1,2) Recently, some third-party websites have been established to provide information to medical students and residents in a variety of specialties. No studies are available that evaluate the impact of these external websites on residency decision making. In 2003, a website under the domain name www.UrologyMatch.com was created by 2 coauthors (A.K. and T.M.M.) with the purpose of assisting medical students through the American Urological Association (AUA) match process. Additionally, by providing a discussion forum for students, residents, and faculty, it sought to aid with the dissemination of information between urology programs and applicants. The website has been gradually expanded to provide educational content for urology trainees at a wide range of levels. Components of the website include an introduction to the field of urology, a detailed description of the match process, an "expert advice" section from urologic leaders, a library of relevant Internet links, a digital surgical atlas, and program-specific questionnaire responses provided by residency directors and department chairs. A discussion board providing an uncensored forum for visitors is integrated into the website to aid with the dissemination of information between and among urology programs, residents, and applicants. The high usage of this site has suggested that external websites may have a marked impact on the residency application process. The purpose of the current study was to evaluate the role of www.UrologyMatch.com in the AUA match process. During the 2007-2008 urology residency match, we evaluated whether information disseminated through the website influenced medical students' decisions to enter the field of urology and whether this information factored into the generation of residency preference lists. We hypothesized that information on this website played a significant role in decision making throughout the urology residency match experience.

Robotic radical prostatectomy: present and future.

PubMed

Bianco, Fernando J

2011-10-01

The last 10 years have witnessed unprecedented evolution regarding de surgical removal of the prostate gland. Laparoscopic radical prostatectomy broke the open paradigm and started to generate great excitement and expectations. Shortly however, robot-assisted, laparoscopic - Robotic Surgery - emerged to address a fundamental pitfall of prostate laparoscopic surgery: execution reproducibility. Today, robotic assisted laparoscopic prostatectomy is the most used surgical approach to remove the prostate gland. Consistent advantages of this technique are: a shorter convalescent state, marked decrease in blood loss and in experienced hands, shorter average surgical times. Importantly it served to highlight the importance of outcomes as ultimate judge of a procedure success. The data suggest equivalency in long-term functional and oncological outcomes, while clear advantages in the short run: perioperative outcomes with patient rapid return to productive state. That said, the major challenge for robotic surgeons still remains: establish a paradigm that breaks with the tradition and prevents biased reporting due to technology and marketing enthusiasm, but rather takes a critical approach based in prospective, controlled, randomize clinical trials. If the latter objective is reached, urologic robotic surgeons will deliver counseling based on clinical evidence delivering major progress for our Urology field.

Consent information leaflets – readable or unreadable?

PubMed Central

Graham, Caroline; Reynard, John M; Turney, Benjamin W

2016-01-01

Objective The objective of this article is to assess the readability of leaflets about urological procedures provided by the British Association of Urological Surgeons (BAUS) to evaluate their suitability for providing information. Methods Information leaflets were assessed using three measures of readability: Flesch Reading Ease, Flesch-Kincaid and Simple Measure of Gobbledygook (SMOG) grade formulae. The scores were compared with national literacy statistics. Results Relatively good readability was demonstrated using the Flesch Reading Ease (53.4–60.1) and Flesch-Kincaid Grade Level (6.5–7.6) methods. However, the average SMOG index (14.0–15.0) for each category suggests that the majority of the leaflets are written above the reading level of an 18-year-old. Using national literacy statistics, at least 43% of the population will have significant difficultly understanding the majority of these leaflets. Conclusions The results suggest that comprehension of the leaflets provided by the BAUS is likely to be poor. These leaflets may be used as an adjunct to discussion but it is essential to ensure that all the information necessary to make an informed decision has been conveyed in a way that can be understood by the patient. PMID:27867520

The prognostic significance of the 2014 International Society of Urological Pathology (ISUP) grading system for prostate cancer.

PubMed

Samaratunga, Hemamali; Delahunt, Brett; Gianduzzo, Troy; Coughlin, Geoff; Duffy, David; LeFevre, Ian; Johannsen, Shulammite; Egevad, Lars; Yaxley, John

2015-10-01

The 2005 International Society of Urological Pathology (ISUP) modified Gleason grading system was further amended in 2014 with the establishment of grade groupings (ISUP grading). This study examined the predictive value of ISUP grading, comparing results with recognised prognostic parameters.Of 3700 men undergoing radical prostatectomy (RP) reported at Aquesta Pathology between 2008 and 2013, 2079 also had a positive needle biopsy available for review. We examined the association between needle biopsy 2014 ISUP grade and 2005 modified Gleason score, tumour volume, pathological stage of the subsequent RP tumour, as well as biochemical recurrence-free survival (BRFS). The median age was 62 (range 32-79 years). Median serum prostate specific antigen was 5.9 (range 0.4-69 ng/mL). For needle biopsies, 280 (13.5%), 1031 (49.6%), 366 (17.6%), 77 (3.7%) and 325 (15.6%) were 2014 ISUP grades 1-5, respectively. Needle biopsy 2014 ISUP grade showed a significant association with RP tumour volume (p < 0.001), TNM pT and N stage (p < 0.001) and BRFS (p < 0.001). Multivariate analysis using Cox proportional hazards regression model showed serum prostate specific antigen (PSA) at the time of diagnosis and ISUP grade >2 to be significantly associated with BRFS.This study provides evidence of the prognostic significance of ISUP grading for thin core needle biopsy of prostate.

“A Tree Must Be Bent While It Is Young”: Teaching Urological Surgical Techniques to Schoolchildren

PubMed Central

Buntrock, Stefan

2012-01-01

Background Playing video games in childhood may help achieve advanced laparoscopic skills later in life. The virtual operating room will soon become a reality, as “doctor games 2.0” will doubtlessly begin to incorporate virtual laparoscopic techniques. Objectives To teach surgical skills to schoolchildren in order to attract them to urology as a professional choice later in life. Materials and Methods As part of EAU Urology Week 2010, 108 school children aged 15–19 attended a seminar with lectures and simulators (laparoscopy, TUR, cystoscopy, and suture sets) at the 62nd Congress of the German Society of Urology in Düsseldorf. A Pub-Med and Google Scholar search was also performed in order to review the beneficial effects of early virtual surgical training. MeSh terms used were “video games,” “children,” and “surgical skills.” Searches were performed without restriction for a certain period of time. Results In terms of publicity for urology, EAU Urology Week, and the German Society of Urology, the event was immensely successful. Regarding the literature search, four relevant publications were found involving children. An additional three articles evaluated the usefulness of video gaming in medical students and residents. Conclusions Making use of virtual reality to attract and educate a new generation of urologists is an important step in designing the future of urology. PMID:23573467

Written information material and availability of sexual health care for men experiencing sexual dysfunction after prostate cancer treatment: An evaluation of Dutch urology and radiotherapy departments.

PubMed

Grondhuis Palacios, L A; Krouwel, E M; Duijn, M; den Oudsten, B L; den Ouden, M E M; Putter, H; Pelger, R C M; Elzevier, H W

2017-03-01

Objective was to investigate content of written information material and availability of sexual health care for men experiencing sexual dysfunction (SD) after prostate cancer treatment. A cross-sectional survey was conducted among Dutch urology and radiotherapy departments to evaluate information materials and availability of sexual health care. Out of 71 eligible departments, 34 urology and 15 radiotherapy departments participated in the survey (response rate 69.0%). Fifty-nine brochures corresponding to 31 urology and 11 radiotherapy departments were analysed. In 88.1% of collected information material, sexual health was mentioned. Regarding extensiveness, 20.4% of the brochures contained extensive information, 50.8% moderate amount of information and 28.8% contained little or no information. Urology departments provided pre-treatment nurse consultations more often than radiotherapy departments. Sexual counselling was more frequently provided by urology departments. Urology departments were more aware of adequate referral possibilities. Information material provided by Dutch urology and radiotherapy departments does not address treatment-related SD routinely. Sexual health care is not available everywhere for men experiencing SD. Applying a standard regarding content of sexual health in information material is recommended as well as improved awareness of referral possibilities and enhanced provision of pre-treatment nurse consultations for men experiencing SD after prostate cancer treatment. © 2016 John Wiley & Sons Ltd.

Procedure competencies and job functions of the urologic advanced practice nurse.

PubMed

Kleier, Jo Ann

2009-01-01

A 2-round modified Delphi study recruited a panel urologic advanced practice nurse experts to identify the procedure competencies and job functions unique to the role of the advanced practice nurse specializing in the care of urology patients.

Influence of social networks on congresses of urological societies and associations: Results of the 81th National Congress of the Spanish Urological Association.

PubMed

Gómez-Rivas, J; Rodríguez-Socarrás, M E; Tortolero-Blanco, L; Garcia-Sanz, M; Alvarez-Maestro, M; Ribal, M J; Cózar-Olmo, M

2017-04-01

To measure social network activity during the 81th National Congress of the Spanish Urological Association (AEU) and to compare it with the activity during other congresses of national and international urological associations. We designed and registered the official hashtag #AEU16 for the 81 th National Congress of the AEU on the Symplur website. The following measurements were recorded: number of participants, number of tweets, tweets by participant, tweets per hour and views. The number of participants in the social network activity during the congress was 207. The measurements of activity in Twitter consisted of a total of 1866 tweets, a mean rate of 16 tweets/h, 9 tweets per participant and 1,511,142 views. The activity during the international congresses is as follows: 2016 American Urological Association annual congress (views: 28,052,558), 2016 European Association of Urology annual congress (views: 13,915,994), 2016 Urological Society of Australia and New Zealand (views: 4,757,453), 2015 Société Internationale d'Urologie annual congress (views: 1,023,038). The activity during the national congresses was recorded as follows: 2016 Annual Conference of The British Association of Urological Surgeons (views: 2,518,880), 81th National Congress of the AEU (views: 1,511,142), 109th Congress of l'Association Française d'Urologie (views: 662,828), 67th German Congress of Urology (views: 167,347). We found 10 posts in Facebook and 2 communications via Periscope TV related to #AEU16. The social network activity during the 81 th National Congress of the AEU was notable given the results of this study. The use of social networks has expanded among urological associations, congresses and meetings, giving them a global character. Copyright © 2016 AEU. Publicado por Elsevier España, S.L.U. All rights reserved.

[Fatigue syndrome: Stress, Burnout and depression in Urology.

PubMed

Rodríguez-Socarrás, Moisés; Vasquez, Juan Luis; Uvin, Pieter; Skjold-Kingo, Pernille; Gómez Rivas, Juan

2018-01-01

To determine the factors related to stress, Burnout and depression in urology, as well as consequences in residents and urologists, in addition to the possible applicable strategies to diminish and treat them. Depression, stress and Burnout syndrome has become a problem in urology specialty. These topics have gained interest in international congresses and urological associations. Efforts are being made to find related factors as well as possible strategies and applicable support programs. Burnout frequency is higher among health professionals than general population, 40-76% in students and residents, its incidence has skyrocketed in recent years, in addition Urology is one of the specialties with highest incidence and severity. Its increase has been related to work overload, documentation, administrative/bureaucratic workload, hostile work environment; its consequences include poor work performance, medical errors, depression, substance abuse, disruption in family and couple relationships and suicidal ideation. Strategies for prevention including resilience training, lifestyle balance, teamwork, and support programs. Stress, burnout and depression are problems in urology, early detection, promoting individual techniques in resilience, lifestyle and teamwork are fundamental now and for the future of the specialty. Developing and implementing support programs should be seriously considered by health systems and urological associations.

Blended E-learning in a Web-based virtual hospital: a useful tool for undergraduate education in urology.

PubMed

Horstmann, M; Renninger, M; Hennenlotter, J; Horstmann, C C; Stenzl, A

2009-08-01

E-learning is a teaching tool used successfully in many medical subspecialties. Experience with its use in urology, however, is scarce. We present our teaching experience with the INMEDEA simulator to teach urological care to medical students. The INMEDEA simulator is an interactive e-learning system built around a virtual hospital which includes a department of urology. It allows students to solve virtual patient cases online. In this study, students were asked to prepare two urological cases prior to discussion of the cases in small groups. This blended teaching approach was evaluated by students through anonymous questionnaires. Of 70 4th year medical students 76% judged this teaching method as good or very good. Eighty-seven percent felt that it offered a good way to understand urological diseases better and 72% felt that learning with this method was fun. Nevertheless, 30 out of 70 free text statements revealed that further improvements of the program, including an easier and more comfortable navigation and a faster supply of information are necessary. Virtual patient cases offer a practicable solution for teaching based on problem solving in urology with a high acceptance rate by students.

A nurse-led ward attender service in urology.

PubMed

Jenner, Cathy

The Department of Urology at East Surrey Hospital, Redhill, serves a catchment population of 400,000 people. It provides acute and elective urological services to both adults and children. Outpatient clinic services are provided at Crawley, Horsham, Dorking, Caterham, Oxted, and East Grindstead.

Overview and fundamentals of urologic robot-integrated systems.

PubMed

Allaf, Mohamad; Patriciu, Alexandru; Mazilu, Dumitru; Kavoussi, Louis; Stoianovici, Dan

2004-11-01

Advances in technology have revolutionized urology. Minimally invasive tools now form the core of the urologist's armamentarium. Laparoscopic surgery has become the favored approach for treating many complicated urologic ailments. Surgical robots represent the next evolutionary step in the fruitful man-machine partnership. The introduction of robotic technology in urology changes how urologists learn, teach, plan, and operate. As technology evolves, robots not only will improve performance in minimally invasive procedures, but also enhance other procedures or enable new kinds of operations.

Globalization in Urology: A Bibliographical Analysis of Cross-Continent Publication between 2002 and 2012.

PubMed

Mani, Jens; Juengel, Eva; Bartsch, Georg; Filmann, Natalie; Ackermann, Hanns; Nelson, Karen; Haferkamp, Axel; Engl, Tobias; Blaheta, Roman A

2015-01-01

Asian scientists have now increasingly begun to contribute to globalization; yet it is not clear whether publishing in the field of urology is paralleled by elevated cross-continental scientific publishing. An exemplary bibliometric analysis of urologic journals from 3 different continents was conducted between 2002 and 2012. Based on the ISI Web of Knowledge Journal Citation Reports, 2 urologic journals with similar impact factors (IFs) in 2013 were selected from Europe ('British Journal of Urology International', 'World Journal of Urology'), Asia ('International Journal of Urology', 'Asian Journal of Andrology') and North America ('Urologic Oncology-Seminars and Original Investigations', 'Urology'). The home continent of the journal, the workplace continental affiliation of the last author, article type (clinical, experimental or review) as well as the IF were documented. Most authors published their manuscripts in journals from the same continent in which they worked. However, a significant increase in cross-continental publishing was apparent from 2002 to 2012. Asians publishing in North America increased from 17% in 2002 to 35% in 2012. Europeans also increased the number of articles they published in North American journals, while publications from North American authors were shifted towards both European and Asian journals. Experimental and clinical articles showed significant increases in cross-continental publishing, while review publishing showed no significant change. The average IF for authors from all 3 continents increased from 2002 to 2012 (p < 0.001). The largest increase in the IF was found for Asian authors (0.11 per year). Cross-continental publication significantly increased during the period from 2002 to 2012. The impact that the Asian authors have experienced was found to be gradually impacting the North American and European colleagues. © 2015 S. Karger AG, Basel.

A review of urologic cancer patients with multiple primary malignancies.

PubMed

Mydlo, J H; Agins, J A; Donohoe, J; Grob, B M

2001-08-01

Much has been written on the treatment of solitary or multiple metastatic nodules that sometimes present in patients with urological malignancies. However, relatively little has been published regarding those patients with urological cancer who have another concomitant primary non-urologic tumor. We describe several cases of patients who presented with a urologic malignancy and a secondary non-urologic tumor. We also reviewed the literature using MEDLINE to gather information concerning this rare occurrence. We found that secondary malignancies, although not very common, are being increasingly reported. They are usually detected during the preoperative work-up of the primary tumor, usually by CT scan, ultrasound, or chest X-ray. Most authors suggest that treatment should be directed at the more aggressive lesion first, which would improve the overall status of the patient, and thus allow a better response from therapy for the secondary lesion. While patients with multiple primary malignancies are rare, the urologist should be alerted to this possibility when evaluating the patient for the initially presenting or detected tumor.

The Urinary Tract Microbiome in Health and Disease.

PubMed

Aragón, Isabel M; Herrera-Imbroda, Bernardo; Queipo-Ortuño, María I; Castillo, Elisabeth; Del Moral, Julia Sequeira-García; Gómez-Millán, Jaime; Yucel, Gozde; Lara, María F

2016-11-14

The urinary tract, previously considered a sterile body niche, has emerged as the host of an array of bacteria in healthy individuals, revolutionizing the urology research field. To review the literature on microbiome implications in the urinary tract and the usefulness of probiotics/prebiotics and diet as treatment for urologic disorders. A systematic review was conducted using PubMed and Medline from inception until July 2016. The initial search identified 1419 studies and 89 were included in this systematic review. Specific bacterial communities have been found in the healthy urinary tract. Changes in this microbiome have been observed in certain urologic disorders such as urinary incontinence, urologic cancers, interstitial cystitis, neurogenic bladder dysfunction, sexually transmitted infections, and chronic prostatitis/chronic pelvic pain syndrome. The role of probiotics, prebiotics, and diet as treatment or preventive agents for urologic disorders requires further investigation. There is a microbiome associated with the healthy urinary tract that can change in urologic disorders. This represents a propitious context to identify new diagnostic, prognostic, and predictive microbiome-based biomarkers that could be used in clinical urology practice. In addition, probiotics, prebiotics, and diet modifications appear to represent an opportunity to regulate the urinary microbiome. We review the urinary microbiome of healthy individuals and its changes in relation to urinary disorders. The question to resolve is how we can modulate the microbiome to improve urinary tract health. Copyright © 2016 European Association of Urology. Published by Elsevier B.V. All rights reserved.

[Changes to diagnosis-related groups in urology in 2007. Urology in the G-DRG-System 2007].

PubMed

Wenke, A; Franz, D; Pühse, G; Hertle, L; Roeder, N

2008-02-01

The German DRG (dose-related groups) system is updated each year by the institution dealing with the remuneration in hospitals (InEK). Once again, the German Spcoety for Urology has supported the adjustment process in a constructive manner. Analysis of the changes and their implications is highly significant for urology. This article describes and discusses the main changes in the system for the specialty of urology insofar as they concern the structure of the DRG system and the catalogues of diagnoses (ICD) and of procedures (OPS). The 2007 edition of the DRG system leads to numerous changes for urology. There are new OPS codes for partial resection of the kidney, treatment of urinary incontinence and radical resection in the pelvis minor. Additional payment for implantation of a prosthetic penis is divided with reference to the type of prosthesis. At DRG level, new DRG splits are found depending on the PCCL and patient age. Combination operations on the bladder and bowel and on the male genitalia are assigned to newly established DRGs. The changes described enhance the professional accuracy of the representations of urological care provision. New strategies designed to solve problems in representation have been established (e.g. multi-step interventions). Various problems persist, e.g. those of operations on the penis (DRG M03Z) and the need for more finely defined representation of laser treatment in urology. In the short term practicable solutions to the problem of improving the quality of representation are needed.

Achievements in postgraduate urologic education in Iran: a quantitative study.

PubMed

Simforoosh, Nasser; Tabatabai, Shima; Ziaee, Seyed Amir Mohsen

2014-01-04

The study focus is on the quantitative achievements in urology education and growth trends in urologic surgical workforce and fellowships by gender since 1979. This comprehensive national quantitative study was performed in Iranian Academy of medical science. The first hand data gathered from The Iran Specialty Training Council of and also from Medical Council of Iran. Over the period 1979 to 2012, the numbers of resident's admission in urology/ fellowships have increased from 5 to 51 and from 0 to 24 respectively, and graduated urologists of national programs has grown from 5 (14%) in 1979 to 47 (100%) in 2012. Iranian urologists workforce haves increased from 315 in 1979 to 1637 in 2012. In 1979, there was 1 urologist for every 117,460 population, while in 2012 there was 1 urologist for every 46120 population. Iran Urologists to population rate is 1:46120. These statistics represents significant improvement from 34 years ago. Number of female urologists has progressively increased from 1 in 1979 (0%) to 110 (7%) in 2012. Urology fellowships are offered in 6 fields since 1994 in Iran. The number of trained fellowships grew sharply and reached to 221 in 2012. The current urology training is successful to improve urology health care. Along with expansion of urology and fellowship training, the number of Iranian female urologists significantly increased. To our knowledge Iran had the greatest growth rate of female urologist training in the Middle East, and is comparable with those in the most progressed countries in the world.

Urodynamics Before Surgery for Stress Urinary Incontinence: The Urodynamic Examination Is Still One of the Best Friends of the Surgeon and of Patients with Stress Urinary Incontinence.

PubMed

Serati, Maurizio; Agrò, Enrico Finazzi

2016-08-01

In the large majority of patients with stress urinary incontinence, urodynamics could provide new information, in comparison to simple clinical examination, and change subsequent management in a relevant percentage of cases. Copyright © 2015 European Association of Urology. Published by Elsevier B.V. All rights reserved.

A manpower calculus: the implications of SUO fellowship expansion on oncologic surgeon case volumes.

PubMed

See, William A

2014-01-01

Society of Urologic Oncology (SUO)-accredited fellowship programs have undergone substantial expansion. This study developed a mathematical model to estimate future changes in urologic oncologic surgeon (UOS) manpower and analyzed the effect of those changes on per-UOS case volumes. SUO fellowship program directors were queried as to the number of positions available on an annual basis. Current US UOS manpower was estimated from the SUO membership list. Future manpower was estimated on an annual basis by linear senescence of existing manpower combined with linear growth of newly trained surgeons. Case-volume estimates for the 4 surgical disease sites (prostate, kidney/renal pelvis, bladder, and testes) were obtained from the literature. The future number of major cases was determined from current volumes based upon the US population growth rates and the historic average annual change in disease incidence. Two models were used to predict future per-UOS major case volumes. Model 1 assumed the current distribution of cases between nononcologic surgeons and UOS would continue. Model 2 assumed a progressive redistribution of cases over time such that in 2043 100% of major urologic cancer cases would be performed by UOSs. Over the 30-year period to "manpower steady-state" SUO-accredited UOSs practicing in the United States have the potential to increase from approximately 600 currently to 1,650 in 2043. During this interval, case volumes are predicted to change 0.97-, 2.4-, 1.1-, and 1.5-fold for prostatectomy, nephrectomy, cystectomy, and retroperitoneal lymph node dissection, respectively. The ratio of future to current total annual case volumes is predicted to be 0.47 and 0.9 for models 1 and 2, respectively. The number of annual US practicing graduates necessary to achieve a future to current case-volume ratio greater than 1 is 25 and 49 in models 1 and 2, respectively. The current number of SUO fellowship trainees has the potential to decrease future per-UOS case volumes relative to current levels. Redistribution of existing case volume or a decrease in the annual number of trainees or both would be required to insure sufficient surgical volumes for skill maintenance and optimal patient outcomes. Published by Elsevier Inc.

Early double J stent removal in renal transplant patients to prevent urinary tract infection - systematic review and meta-analysis of randomized controlled trials.

PubMed

Yahav, Dafna; Green, Hefziba; Eliakim-Raz, Noa; Mor, Eytan; Husain, Shahid

2018-04-01

Ureteral stents are routinely used in renal transplant and are associated with reduced urological complications but increased urinary tract infections (UTIs). There is no agreement on the preferred time to removal of stents after transplantation. We performed a systematic review and meta-analysis of all randomized controlled trials (RCTs) comparing stent duration of <14 days vs > =14 days. Electronic databases were searched to identify RCTs that compared early vs late stent removal. Primary outcome was urinary tract infections. Secondary outcomes included various urological complications. No significant difference in UTI rates was demonstrated between short and long stent duration (relative risk (RR) 0.85, 95% confidence interval (CI) 0.44-1.64), with significant heterogeneity (I 2  = 86%). Sensitivity analysis evaluating studies with low risk of bias for allocation concealment demonstrated statistically significant lower rates of UTI with short stent duration (RR 0.48, 95% CI 0.32-0.71) with no heterogeneity. No significant difference was demonstrated for the outcome of major urological complications (RR 0.72, 95% CI 0.50-1.05), without heterogeneity. Ureteral stenosis rates were significantly lower in the short duration arm (RR 0.42, 95% CI 0.18-0.98). Early removal of ureteral stents after renal transplant may be associated with reduced rates of UTI and ureteral stenosis. Additional RCTs are needed.

[Memory in disciplinary cultures and "sites" of memory in medicine : Maximilian Nitze (1848-1906) and the establishment of urology].

PubMed

Halling, T; Moll, F

2016-09-01

The canon of material and immaterial references of the urological heritage must always be recognized as a part of a continous process of negotiation. Within German Urology the culture of remembrance on Maximilian Nitze reveals one of such processes.

The Current State of Telemedicine in Urology.

PubMed

Miller, Adam; Rhee, Eugene; Gettman, Matthew; Spitz, Aaron

2018-03-01

Telemedicine use in urology is an evolving practice. In this article, the authors review the early experience of telemedicine specifically as it relates to urologic practice and discuss the future implications and the utility of telemedicine as it applies to other fields. Copyright © 2017 Elsevier Inc. All rights reserved.

The history of robotics in urology.

PubMed

Challacombe, Ben J; Khan, Mohammad Shamim; Murphy, Declan; Dasgupta, Prokar

2006-06-01

Despite being an ancient surgical specialty, modern urology is technology driven and has been quick to take up new minimally invasive surgical challenges. It is therefore no surprise that much of the early work in the development of surgical robotics was pioneered by urologists. We look at the relatively short history of robotic urology, from the origins of robotics and robotic surgery itself to the rapidly expanding experience with the master-slave devices. This article credits the vision of John Wickham who sowed the seeds of robotic surgery in urology.

Diagnosis and initial management of urological injuries associated with 200 consecutive pelvic fractures.

PubMed

Palmer, J K; Benson, G S; Corriere, J N

1983-10-01

During 26 months 200 consecutive patients with fracture of the bony pelvis were evaluated and treated for urological injury. There was no correlation between the extent of pelvic injury and degree of hematuria but hematuria was present in all patients with a urological injury. All urological injuries occurred with anterior arch fractures. The over-all incidence of injury was 13.5 per cent (bladder 9 per cent, urethra 3.5 per cent and combined 1 per cent). Limited extraperitoneal bladder ruptures were treated successfully by Foley catheter drainage.

Robotics in urologic oncology.

PubMed

Jain, Saurabh; Gautam, Gagan

2015-01-01

Robotic surgery was initially developed to overcome problems faced during conventional laparoscopic surgeries and to perform telesurgery at distant locations. It has now established itself as the epitome of minimally invasive surgery (MIS). It is one of the most significant advances in MIS in recent years and is considered by many as a revolutionary technology, capable of influencing the future of surgery. After its introduction to urology, robotic surgery has redefined the management of urological malignancies. It promises to make difficult urological surgeries easier, safer and more acceptable to both the surgeon and the patient. Robotic surgery is slowly, but surely establishing itself in India. In this article, we provide an overview of the advantages, disadvantages, current status, and future applications of robotic surgery for urologic cancers in the context of the Indian scenario.

Robotics in urologic surgery: an evolving new technology.

PubMed

Atug, Fatih; Castle, Erik P; Woods, Michael; Davis, Rodney; Thomas, Raju

2006-07-01

Rapid technological developments in the past two decades have produced new inventions such as robots and incorporated them into our daily lives. Today, robots perform vital functions in homes, outer space, hospitals and on military instillations. The development of robotic surgery has given hospitals and health care providers a valuable tool that is making a profound impact on highly technical surgical procedures. The field of urology is one area of medicine that has adopted and incorporated robotic surgery into its armamentarium. Innovative robotic urologic surgical applications and techniques are being developed and reported everyday. Increased utilization and development will ultimately fuel the discovery of newer applications of robotic systems in urologic surgery. Herein we provide an overview of the history, development, and applications of robotics in surgery with a focus on urologic surgery.

Senior medical student opinions regarding the ideal urology interview day.

PubMed

Jacobs, Jesse C; Guralnick, Michael L; Sandlow, Jay I; Langenstroer, Peter; Begun, Frank P; See, William A; O'Connor, Robert Corey

2014-01-01

Applicant interviews for urology residency positions are a stressful and costly process for students, faculty, and staff. We conducted a prospective survey to better determine what urology applicants perceive as an ideal interview process to gain sufficient knowledge about a training program. A questionnaire was anonymously completed by all urology residency applicants interviewing at the Medical College of Wisconsin from 2007 to 2013. Questionnaire subject headings included "ideal interview format," "factors contributing to understanding the residency program," and "factors contributing to final rank list order." Questionnaires were distributed to and completed by 221 senior medical students applying for a urology residency position. Most respondents (>80%) reported they would prefer to partake in 5 to 7 faculty interviews in an office setting with the total interview process spanning half to three-fourths of the workday. Spending time with current residents was considered the most valuable tool to acquire knowledge about a residency program. The most important criteria when ranking a program were resident satisfaction, resident operative experience, and perceived strength of faculty. Academic urology programs may wish to consider applicant ideals when organizing residency interviews. Interaction with current residents appears to be the most valuable resource allowing applicants to garner knowledge about a urology training program. Copyright © 2014 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.

Institutional Review Board approval and innovation in urology: current practice and safety issues.

PubMed

Sundaram, Varun; Vemana, Goutham; Bhayani, Sam B

2014-02-01

To retrospectively review recent publications describing novel procedures/techniques, and describe the Institutional Review Board (IRB)/ethics approval process and potential ethical dilemmas in their reporting. We searched PubMed for papers about innovative or novel procedures/techniques between 2011 and August 2012. A query of titles/abstracts in the Journal of Urology, Journal of Endourology, European Urology, BJU International, and Urology identified relevant papers. These results were reviewed for human studies that described an innovative technique, procedure, approach, initial series, and/or used new technology. In all, 91 papers met criteria for inclusion; 25 from the Journal of Endourology, 14 from the Journal of Urology, nine from European Urology, 15 from the BJU International and 28 from Urology. IRB/ethics approval was given for an experimental procedure or database in 24% and 22%, respectively. IRB/ethics approval was not mentioned in 52.7% of studies. Published IRB/ethics approvals for innovative techniques are heterogeneous including database, retrospective, and prospective approvals. Given the concept that innovations are likely not in the legal or ethical standard of care, strong consideration should be given to obtaining IRB/ethics approval before the actual procedure, instead of approval to merely report database outcomes. © 2013 The Authors. BJU International © 2013 BJU International.

Ramon Guiteras: founder of the American Urological Association, surgeon, sportsman and statesman.

PubMed

Crane, Genevieve M; Bloom, David A

2010-08-01

We conducted an extensive search to learn more about Ramon Guiteras, the founder of the American Urological Association. Scientific publications, newspaper articles, and historical documents and texts were reviewed. Institutions and organizations of which Ramon Guiteras was a member were contacted. Guiteras' career peaked at the turn of the century, just as genitourinary surgery was emerging as an independent field. The American Urological Association began as an organization of the members of Guiteras' clinic with the dream of becoming an inclusive organization for the benefit of all ethical physicians with an interest in the urinary sciences. Guiteras contributed to advances in urological treatments, including improving and helping to bring a method of suprapubic prostatectomy to worldwide attention. He authored numerous scientific articles and a comprehensive, fully illustrated, 2-volume textbook that was widely translated. He pursued adventure through travel and sport, and participated in missions to Cuba and France during President Wilson's term of office. Ramon Guiteras died at age 59 years but his legacy lives on through the American Urological Association, a detailed textbook, contributions to urological instruments and techniques, and a vibrant elementary school in Bristol, Rhode Island that bears his name. Copyright (c) 2010 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.

Search for Microorganisms in Men with Urologic Chronic Pelvic Pain Syndrome: A Culture-Independent Analysis in the MAPP Research Network.

PubMed

Nickel, J Curtis; Stephens, Alisa; Landis, J Richard; Chen, Jun; Mullins, Chris; van Bokhoven, Adrie; Lucia, M Scott; Melton-Kreft, Rachael; Ehrlich, Garth D

2015-07-01

We used next-generation, state-of-the-art, culture independent methodology to survey urine microbiota of males with urologic chronic pelvic pain syndrome and control participants enrolled in the MAPP Network to investigate a possible microbial etiology. Male patients with urologic chronic pelvic pain syndrome and matched controls were asked to provide initial, midstream and post-prostatic massage urine specimens. Specimens were analyzed with Ibis T-5000 Universal Biosensor technology to provide comprehensive identification of bacterial and select fungal species. Differences between urologic chronic pelvic pain syndrome and control study participants for the presence of species or species variation in a higher taxonomic grouping (genus) were evaluated using permutational multivariate analysis of variance and logistic regression. Initial and midstream urine specimens were obtained from 110 (post-prostatic massage urine in 67) participants with urologic chronic pelvic pain syndrome and 115 (post-prostatic massage urine in 62) controls. Overall 78, 73 and 54 species (42, 39 and 27 genera) were detected in initial, midstream and post-prostatic massage urine specimens, respectively. Mean (SD) initial, midstream and post-prostatic massage urine species count per person was 1.62 (1.28), 1.38 (1.36) and 1.33 (1.24) for cases, and 1.75 (1.32), 1.23 (1.15) and 1.56 (0.97) for controls, respectively. Overall species and genus composition differed significantly between participants with urologic chronic pelvic pain syndrome and controls in initial stream urine (p=0.002 species level, p=0.004 genus level), with Burkholderia cenocepacia overrepresented in urologic chronic pelvic pain syndrome. No significant differences were observed at any level in midstream or post-prostatic massage urine samples. Assessment of baseline culture-independent microbiological data from male subjects enrolled in the MAPP Network has identified overrepresentation of B. cenocepacia in urologic chronic pelvic pain syndrome. Future studies are planned to further evaluate microbiota associations with variable and changing urologic chronic pelvic pain syndrome symptom patterns. Copyright © 2015 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.

The unusual history and the urological applications of botulinum neurotoxin.

PubMed

Hanchanale, Vishwanath S; Rao, Amrith Raj; Martin, Francis L; Matanhelia, Shyam S

2010-01-01

Botulinum neurotoxin (BoNT) is probably the most potent biological toxin that can affect humans. Since its discovery by Justinus Kerner, BoNT has seen use in a wide range of cosmetic and non-cosmetic conditions such as cervical dystonia, cerebral palsy, migraines and hyperhidrosis. We tried to trace its history from its inception to its recent urological applications. Historical articles about botulinum toxin were reviewed and a Medline search was performed for its urological utility. We hereby present a brief review of historical aspects of BoNT and its applications in urology. In 1793, the first known outbreak of botulism occurred due to 'spoiled' sausage in Wildebad, Germany. The German physician and poet Justinus Kerner published the first accurate description of the clinical symptoms of botulism (sausage poison). He was also the first to mention its potential therapeutic applications. In urology, BoNT has been used in bladder and urethral lesions with varying degree of success. Recently, BoNT applications were explained for prostatic disorders. BoNT applications in urology are in the treatment of detrusor external sphincter dyssynergia, detrusor overactivity, detrusor underactivity, spastic conditions of the urethral sphincter, chronic prostate pain, interstitial cystitis, non-fibrotic bladder outflow obstruction (including benign prostatic hyperplasia) and acute urinary retention in women. Justinus Kerner is the godfather of botulism research. The role of BoNT in urology has evolved exponentially and it is widely used as an adjuvant in voiding dysfunction. In the future, its utility will broaden and guide the urologist in managing various urological disorders. Copyright © 2010 S. Karger AG, Basel.

78 FR 41937 - Joint Meeting of the Gastroenterology-Urology Panel and the Radiological Devices Panel of the...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-07-12

... DEPARTMENT OF HEALTH AND HUMAN SERVICES Food and Drug Administration [Docket No. FDA-2013-N-0816] Joint Meeting of the Gastroenterology-Urology Panel and the Radiological Devices Panel of the Medical...: Gastroenterology-Urology Panel and Radiological Devices Panel of the Medical Devices Advisory Committee. General...

Urologic Oncology Branch - Training - NCI/AFUD | Center for Cancer Research

Cancer.gov

Postdoctoral Research Training Program This program is designed to train Ph.D. postdoctoral scientists in the growing field of urologic oncology. This program offers fellows the opportunity to participate in a diverse training experience that includes clinical and laboratory research on several urologic malignancies. The program provides an opportunity for selected individuals

77 FR 18829 - Gastroenterology and Urology Devices Panel of the Medical Devices Advisory Committee; Notice of...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-03-28

...] Gastroenterology and Urology Devices Panel of the Medical Devices Advisory Committee; Notice of Meeting AGENCY... public. Name of Committee: Gastroenterology and Urology Devices Panel of the Medical Devices Advisory... and 11, 2012, the committee will discuss general issues related to medical devices intended for obese...

75 FR 57968 - Gastroenterology and Urology Devices Panel of the Medical Devices Advisory Committee; Notice of...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-09-23

...] Gastroenterology and Urology Devices Panel of the Medical Devices Advisory Committee; Notice of Meeting AGENCY... public. Name of Committee: Gastroenterology and Urology Devices Panel of the Medical Devices Advisory... committee will discuss, make recommendations, and vote on information related to the PMA for the LAP-BAND...

[More than just "stones" : On the history of urology in Regensburg].

PubMed

Otto, Wolfgang

2016-07-01

In recent years the regional aspects of medical history in the field of urology have been more intensively studied. There is already an interesting study on the history of urology in Rhineland. This article examines the checkered medical history aspects concerning urology in provincial areas of Germany, exemplified by the Bavarian town of Regensburg. The article combines the history of the over 1800-year-old town of Regensburg, one of the oldest German communities, with selected aspects of medical history and follows the route of "stones" from antiquity to the present day. The article explains what Regensburg, Galen of Pergamon and his professional colleagues from antiquity have in common, why monastery medicine was so successful here, how syphilis patients were treated in imperial cities (Reichsstädte), why one of the greatest "stone cutters" of the era met with an accident in the perpetual Reichstag town of Regensburg and how a main department of urology was finally founded after a delay but ultimately with tempo, which in 2003 led to the establishment of the most recent chair for urology in Germany.

Cost and cost-effectiveness studies in urologic oncology using large administrative databases.

PubMed

Wang, Ye; Mossanen, Matthew; Chang, Steven L

2018-04-01

Urologic cancers are not only among the most common types of cancers, but also among the most expensive cancers to treat in the United States. This study aimed to review the use of CEAs and other cost analyses in urologic oncology using large databases to better understand the value of management strategies of these cancers. A literature review on CEAs and other cost analyses in urologic oncology using large databases. The options for and costs of diagnosing, treating, and following patients with urologic cancers can be expected to rise in the coming years. There are numerous opportunities in each urologic cancer to use CEAs to both lower costs and provide high-quality services. Improved cancer care must balance the integration of novelty with ensuring reasonable costs to patients and the health care system. With the increasing focus cost containment, appreciating the value of competing strategies in caring for our patients is pivotal. Leveraging methods such as CEAs and harnessing large databases may help evaluate the merit of established or emerging strategies. Copyright © 2018 Elsevier Inc. All rights reserved.

Status of women in urology: based on a report to the Society of University Urologists.

PubMed

Lightner, Deborah J; Terris, Martha K; Tsao, Alice K; Naughton, Cathy K; Lohse, Christine M

2005-02-01

Written responses from American trained women in urological surgery were obtained to evaluate practice patterns, career choices and workplace satisfaction. A 3-page unblinded questionnaire was mailed in March 2003 to American trained women in urological surgery available through the databases of the Society of Women in Urology with subsequent statistical analysis. The response rate was 60% but inclusive of all women in current academic practice in the United States. A total of 61% reported working 51 or more hours a week whereas 2% have left practice due to retirement or medical infirmity. There were 41% who had completed fellowships including 87% reporting active practice within their subspecialty, whereas 62% of fellowship trained surgeons remained in an academic practice. Among United States women in academic urological practice, academic progression has occurred in a third of this cohort. Threats to successful practice, consistent with other workplace surveys of physicians and professional women including gender based role limitation and inadequate mentoring, were commonly reported. These correctable workplace deficiencies represent an opportunity for American urology to enhance the professional workplace for all urologists regardless of gender.

Readability assessment of online urology patient education materials.

PubMed

Colaco, Marc; Svider, Peter F; Agarwal, Nitin; Eloy, Jean Anderson; Jackson, Imani M

2013-03-01

The National Institutes of Health, American Medical Association, and United States Department of Health and Human Services recommend that patient education materials be written at a fourth to sixth grade reading level to facilitate comprehension. We examined and compared the readability and difficulty of online patient education materials from the American Urological Association and academic urology departments in the Northeastern United States. We assessed the online patient education materials for difficulty level with 10 commonly used readability assessment tools, including the Flesch Reading Ease Score, Flesch-Kincaid Grade Level, Simple Measure of Gobbledygook, Gunning Frequency of Gobbledygook, New Dale-Chall Test, Coleman-Liau index, New Fog Count, Raygor Readability Estimate, FORCAST test and Fry score. Most patient education materials on the websites of these programs were written at or above the eleventh grade reading level. Urological online patient education materials are written above the recommended reading level. They may need to be simplified to facilitate better patient understanding of urological topics. Copyright © 2013 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.

[Angel Pulido Martín (1878-1970). 4th Chief of the Urology Service of the Provincial Hospital of Madrid].

PubMed

Sáiz Carrero, Ataúlfo

2003-05-01

To review the biography and scientific contributions of Dr. Angel Pulido Martin, fourth chairman of the Department of Urology at the Hospital Provincial of Madrid, and formerly at the Urology Clinic at the San Juan de Dios Hospital of Madrid. In addition, to show a panoramic view on how doctors who obtained scholarships to study outside Spain were trained in a specialty at the beginning of the 20th century. We reviewed memoirs books from Dr. Pulido Martin ("Medical letters", "Dr. Pulido and his time", and "Memoirs of a doctor"), his Ph.D. thesis and other works. We also reviewed biographic data obtained from his contemporaries in different publications. We report his experiences as a student in the specialities of Urology and Gynecology, since he first thought about taking this last one. Main european urologic and gynecologic centers of that time are represented, as well as some of the main characters in these specialties. We appreciate his great working spirit, which was inculcated into him by his father Dr. Pulido Fernandez, his enterprising desire, and the great professional he was, creating departments of urology which were school and model for many urologists of his time. A sincere clinician, Dr. Pulido Martin liked accuracy and daily self-improvement. He also was exceptional for his kindness treating patients and disciples. His publications on urologic topics were numerous; he also was fluent and entertaining as a non medical writer. He was an outstanding urologist in the early 20th century; he was member of the committee which elaborated the statutes of the Spanish Society of Urology, in which he was President for 11 years. He was also one of the founding members of the International Society of Urology and delegate of its Spanish chapter. He was official lecturer in several meetings, and also member of the Spanish Academy of Medicine and Surgery.

High fidelity simulation based team training in urology: a preliminary interdisciplinary study of technical and nontechnical skills in laparoscopic complications management.

PubMed

Lee, Jason Y; Mucksavage, Phillip; Canales, Cecilia; McDougall, Elspeth M; Lin, Sharon

2012-04-01

Simulation based team training provides an opportunity to develop interdisciplinary communication skills and address potential medical errors in a high fidelity, low stakes environment. We evaluated the implementation of a novel simulation based team training scenario and assessed the technical and nontechnical performance of urology and anesthesiology residents. Urology residents were randomly paired with anesthesiology residents to participate in a simulation based team training scenario involving the management of 2 scripted critical events during laparoscopic radical nephrectomy, including the vasovagal response to pneumoperitoneum and renal vein injury during hilar dissection. A novel kidney surgical model and a high fidelity mannequin simulator were used for the simulation. A debriefing session followed each simulation based team training scenario. Assessments of technical and nontechnical performance were made using task specific checklists and global rating scales. A total of 16 residents participated, of whom 94% rated the simulation based team training scenario as useful for communication skill training. Also, 88% of urology residents believed that the kidney surgical model was useful for technical skill training. Urology resident training level correlated with technical performance (p=0.004) and blood loss during renal vein injury management (p=0.022) but not with nontechnical performance. Anesthesia resident training level correlated with nontechnical performance (p=0.036). Urology residents consistently rated themselves higher on nontechnical performance than did faculty (p=0.033). Anesthesia residents did not differ in the self-assessment of nontechnical performance compared to faculty assessments. Residents rated the simulation based team training scenario as useful for interdisciplinary communication skill training. Urology resident training level correlated with technical performance but not with nontechnical performance. Urology residents consistently overestimated their nontechnical performance. Copyright © 2012 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.

Surgical simulators in urological training--views of UK Training Programme Directors.

PubMed

Forster, James A; Browning, Anthony J; Paul, Alan B; Biyani, C Shekhar

2012-09-01

What's known on the subject? and What does the study add? The role of surgical simulators is currently being debated in urological and other surgical specialties. Simulators are not presently implemented in the UK urology training curriculum. The availability of simulators and the opinions of Training Programme Directors' (TPD) on their role have not been described. In the present questionnaire-based survey, the trainees of most, but not all, UK TPDs had access to laparoscopic simulators, and that all responding TPDs thought that simulators improved laparoscopic training. We hope that the present study will be a positive step towards making an agreement to formally introduce simulators into the UK urology training curriculum. To discuss the current situation on the use of simulators in surgical training. To determine the views of UK Urology Training Programme Directors (TPDs) on the availability and use of simulators in Urology at present, and to discuss the role that simulators may have in future training. An online-questionnaire survey was distributed to all UK Urology TPDs. In all, 16 of 21 TPDs responded. All 16 thought that laparoscopic simulators improved the quality of laparoscopic training. The trainees of 13 TPDs had access to a laparoscopic simulator (either in their own hospital or another hospital in the deanery). Most TPDs thought that trainees should use simulators in their free time, in quiet time during work hours, or in teaching sessions (rather than incorporated into the weekly timetable). We feel that the current apprentice-style method of training in urological surgery is out-dated. We think that all TPDs and trainees should have access to a simulator, and that a formal competency based simulation training programme should be incorporated into the urology training curriculum, with trainees reaching a minimum proficiency on a simulator before undertaking surgical procedures. © 2012 THE AUTHORS. BJU INTERNATIONAL © 2012 BJU INTERNATIONAL.

Relationship between chronic nonurological associated somatic syndromes and symptom severity in urological chronic pelvic pain syndromes: baseline evaluation of the MAPP study.

PubMed

Krieger, John N; Stephens, Alisa J; Landis, J Richard; Clemens, J Quentin; Kreder, Karl; Lai, H Henry; Afari, Niloofar; Rodríguez, Larissa; Schaeffer, Anthony; Mackey, Sean; Andriole, Gerald L; Williams, David A

2015-04-01

We used MAPP data to identify participants with urological chronic pelvic pain syndromes only or a chronic functional nonurological associated somatic syndrome in addition to urological chronic pelvic pain syndromes. We characterized these 2 subgroups and explored them using 3 criteria, including 1) MAPP eligibility criteria, 2) self-reported medical history or 3) RICE criteria. Self-reported cross-sectional data were collected on men and women with urological chronic pelvic pain syndromes, including predominant symptoms, symptom duration and severity, nonurological associated somatic syndrome symptoms and psychosocial factors. Of 424 participants with urological chronic pelvic pain syndromes 162 (38%) had a nonurological associated somatic syndrome, including irritable bowel syndrome in 93 (22%), fibromyalgia in 15 (4%), chronic fatigue syndrome in 13 (3%) and multiple syndromes in 41 (10%). Of 233 females 103 (44%) had a nonurological associated somatic syndrome compared to 59 of 191 males (31%) (p = 0.006). Participants with a nonurological associated somatic syndrome had more severe urological symptoms and more frequent depression and anxiety. Of 424 participants 228 (54%) met RICE criteria. Of 228 RICE positive participants 108 (47%) had a nonurological associated somatic syndrome compared to 54 of 203 RICE negative patients (28%) with a nonurological associated somatic syndrome (p < 0.001). Nonurological associated somatic syndromes represent important clinical characteristics of urological chronic pelvic pain syndromes. Participants with a nonurological associated somatic syndrome have more severe symptoms, longer duration and higher rates of depression and anxiety. RICE positive patients are more likely to have a nonurological associated somatic syndrome and more severe symptoms. Because nonurological associated somatic syndromes are more common in women, future studies must account for this potential confounding factor in urological chronic pelvic pain syndromes. Copyright © 2015 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.

[Anti-infective treatments in urology].

PubMed

Bruyère, F; Boiteux, J-P; Sotto, A; Karsenty, G; Bastide, C; Guy, L; Lavigne, J-P

2013-11-01

To define the terms of use of vaccines, probiotics, and cranberry in urology. A literature search was conducted on MEDLINE for all these treatments used in urology. Modes of action, indications in urology and adverse effects have been detailed for each treatment. Vaccines have been published in urinary tract infections. Products for bacterial interference such as probiotics are also used, their properties are described. As for the cranberry widely used in recurrent urinary tract infections, efficacy and mode of action are discussed. The anti-E. coli vaccines, cranberry and probiotics may be useful in urinary tract infection. Copyright © 2013 Elsevier Masson SAS. All rights reserved.

Urology in ancient India

PubMed Central

Das, Sakti

2007-01-01

The practice of medical and surgical measures in the management of urological ailments prevailed in ancient India from the Vedic era around 3000 BC. Subsequently in the Samhita period, the two stalwarts - Charaka in medicine and Susruta in surgery elevated the art of medicine in India to unprecedented heights. Their elaboration of the etiopathological hypothesis and the medical and surgical treatments of various urological disorders of unparalleled ingenuity still remain valid to some extent in our contemporary understanding. The new generation of accomplished Indian urologists should humbly venerate the legacy of the illustrious pioneers in urology of our motherland. PMID:19675749

EAU guidelines for the management of urinary and male genital tract infections. Urinary Tract Infection (UTI) Working Group of the Health Care Office (HCO) of the European Association of Urology (EAU).

PubMed

Naber, K G; Bergman, B; Bishop, M C; Bjerklund-Johansen, T E; Botto, H; Lobel, B; Jinenez Cruz, F; Selvaggi, F P

2001-11-01

A short version of the UTI Guidelines elaborated by the Urinary Tract Infection Working Group of the Health Care Office of the European Association of Urology is presented. The topics include classification, diagnosis, treatment and follow-up of uncomplicated UTI, UTI in children, UTI in diabetes mellitus, renal insufficiency, renal transplant recipients and immunosuppression, complicated UTI due to urological disorders, sepsis syndrome, urosepsis, urethritis, prostatitis, epididymitis, orchitis and principles of perioperative prophylaxis in urology.

Urinary stones in Malaysia--its incidence and management.

PubMed

Sreenevasan, G

1990-06-01

The life of Lord Moynihan is briefly reviewed. Incidence of stones in Peninsular Malaysia appears to show the same trend as in other industrialised countries. Management of urinary calculi both prior to and after the introduction of ESWL in a personal series is discussed. More than 90% of urinary stones are now treated by ESWL threatening the place of surgery in Urology. The pattern of incorporating renal transplantation into the urological training programme as practised in the Institute of Urology and Nephrology in Malaysia is suggested as a way to assure a place for surgery in Urology.

["My first encounter with German urology (1937)". Stefan Wesolowski (1908-2009) - a source in the archives of the German Society for Urology from the oldest corresponding member and promoter of Polish-German relationships].

PubMed

Moll, F H; Krischel, M; Zajaczkowski, T; Rathert, P

2010-10-01

A source in the archives of the German Society of Urology gives us a vivid insight into the situation in Berlin during the 1930s from the perspective of a young Polish doctor, and presents the situation at one of the leading urology institutions of the time in Germany. Furthermore, we learn about the social situation in hospitals as well as the discourse and networking taking place in the scientific community at that time.

Community-based Outcomes of Open versus Robot-assisted Radical Prostatectomy.

PubMed

Herlemann, Annika; Cowan, Janet E; Carroll, Peter R; Cooperberg, Matthew R

2018-02-01

Identifying the optimal surgical approach for patients with localized prostate cancer (PCa) managed in the community setting remains controversial due to the lack of robust, prospective data. To assess surgical outcomes and changes in urinary and sexual quality of life (QOL) over time in patients undergoing radical prostatectomy (RP). Our study included patients enrolled in Cancer of the Prostate Strategic Urologic Research Endeavor (CaPSURE), a large, prospective, mostly community-based, nationwide PCa registry, who underwent RP between 2004 and 2016. Open (ORP) versus robot-assisted radical prostatectomy (RARP) for localized PCa. Demographic and clinicopathologic data and surgical outcomes were compared between ORP and RARP. Self-reported, validated questionnaires (scaled 0-100 with higher numbers indicating better function) were used to evaluate urinary and sexual QOL at different time points. Repeated measures mixed-models assessed changes in function and bother over time in each domain. Among 1892 men (n = 1137 ORP; n = 755 RARP), Cancer of the Prostate Risk Assessment score, Gleason grade at biopsy and RP, and pT-stage were lower in ORP patients (all p < 0.01). Men undergoing RARP had comparable surgical margin rates, lymph node yields, and biochemical recurrence rates. In a subset analysis with 1451 men reporting baseline and follow-up QOL data, ORP patients reported superior scores in urinary incontinence (ORP mean ± standard deviation 69 ± 26 vs RARP 62 ± 27) and bother (ORP 75±29 vs RARP 68±28, both p < 0.01) only in the 1st yr after RP. Differences in sexual outcomes did not differ between groups, nor did any QOL scores beyond 1 yr. Limitations include a decrease in the rate of questionnaire response during follow-up, potential selection biases in terms of patient assignment to ORP versus RARP and survey completion rates, and the fact that RARP cases likely included the initial learning curve for the CaPSURE surgeons. Most patients experienced changes in urinary and sexual QOL in the 1st 3 yr following RP. The pattern of recovery over time was similar between ORP and RARP groups. Patients should not expect different oncologic or QOL outcomes based on surgical approach. Aside from a small, early, and temporary advantage in terms of urinary incontinence and bother favoring open surgery, minimal differences in outcomes are observed when comparing men who undergo open versus robot-assisted prostatectomy in the community setting. Copyright © 2017 European Association of Urology. Published by Elsevier B.V. All rights reserved.

The impact of robotic surgery in urology.

PubMed

Giedelman, C A; Abdul-Muhsin, H; Schatloff, O; Palmer, K; Lee, L; Sanchez-Salas, R; Cathelineau, X; Dávila, H; Cavelier, L; Rueda, M; Patel, V

2013-01-01

More than a decade ago, robotic surgery was introduced into urology. Since then, the urological community started to look at surgery from a different angle. The present, the future hopes, and the way we looked at our past experience have all changed. Between 2000 and 2011, the published literature was reviewed using the National Library of Medicine database and the following key words: robotic surgery, robot-assisted, and radical prostatectomy. Special emphasis was given to the impact of the robotic surgery in urology. We analyzed the most representative series (finished learning curve) in each one of the robotic approaches regarding perioperative morbidity and oncological outcomes. This article looks into the impact of robotics in urology, starting from its background applications before urology, the way it was introduced into urology, its first steps, current status, and future expectations. By narrating this journey, we tried to highlight important modifications that helped robotic surgery make its way to its position today. We looked as well into the dramatic changes that robotic surgery introduced to the field of surgical training and its consequence on its learning curve. Basic surgical principles still apply in Robotics: experience counts, and prolonged practice provides knowledge and skills. In this way, the potential advantages delivered by technology will be better exploited, and this will be reflected in better outcomes for patients. Copyright © 2012 AEU. Published by Elsevier Espana. All rights reserved.

The Publication Ranking Score for pediatric urology: quantifying thought leadership within the subspecialty.

PubMed

Lloyd, Jessica C; Madden-Fuentes, Ramiro J; Nelson, Caleb P; Kokorowski, Paul J; Wiener, John S; Ross, Sherry S; Kutikov, Alexander; Routh, Jonathan C

2013-12-01

Clinical care parameters are frequently assessed by national ranking systems. However, these rankings do little to comment on institutions' academic contributions. The Publication Ranking Score (PRS) was developed to allow for objective comparisons of scientific thought-leadership at various pediatric urology institutions. Faculty lists were compiled for each of the US News & World Report (USNWR) top-50 pediatric urology hospitals. A list of all faculty publications (2006-2011) was then compiled, after adjusting for journal impact factor, and summed to derive a Publication Ranking Score (PRS). PRS rankings were then compared to the USNWR pediatric urology top-50 hospital list. A total of 1811 publications were indexed. PRS rankings resulted in a mean change in rank of 12 positions, compared to USNWR ranks. Of the top-10 USNWR hospitals, only 4 were ranked in the top-10 by the PRS. There was little correlation between the USNWR and PRS ranks for either top-10 (r = 0.42, p = 0.23) or top-50 (r = 0.48, p = 0.0004) hospitals. PRS institutional ranking differs significantly from the USNWR top-50 hospital list in pediatric urology. While not a replacement, we believe the PRS to be a useful adjunct to the USNWR rankings of pediatric urology hospitals. Copyright © 2013 Journal of Pediatric Urology Company. Published by Elsevier Ltd. All rights reserved.

Asymptomatic bacteriuria: when the treatment is worse than the disease.

PubMed

Trautner, Barbara W

2011-12-06

Asymptomatic bacteriuria (ABU) is a condition in which bacteria are present in a noncontaminated urine sample collected from a patient without signs or symptoms related to the urinary tract. ABU must be distinguished from symptomatic UTI by the absence of signs and symptoms compatible with UTI or by clinical determination that a nonurinary etiology accounts for the patient's symptoms. Interactions between the organism, the host, and the bladder environment determine whether bacteriuria leads to ABU or to UTI. ABU is a very common condition that is often treated unnecessarily with antibiotics-it should be detected and treated in pregnant women and patients undergoing urologic surgery, but in most other patient groups, treatment does not confer benefit and can be harmful. A change in prescribing behavior for ABU has been achieved through several fairly high-intensity interventions, such as interactive educational sessions for physicians, but whether these improvements persist beyond the study period is not known. Further research is needed to determine whether screening for and treatment of ABU is beneficial in patients with renal transplants, patients with orthotopic neobladders, patients undergoing prosthetic joint implantation, and patients with neutropenia. © 2012 Macmillan Publishers Limited. All rights reserved

[Novelties in diagnostics and treatment of prostate cancer].

PubMed

Riesz, Péter; Nyírádi, Péter

2016-03-13

Similarly to earlier years, a vast majority of novel findings were published on prostate cancer, which is the most common urological cancer. Clinical trials with long-term follow-up and promising observational studies were published. In this paper the author reviews the relevant novelties including the diagnostic use of magnetic resonance imaging and positron emission tomography/computed tomography as well as active surveillance, cytoreductive prostatectomy and medical treatment.

Palliative management of malignant upper urinary tract obstruction

PubMed Central

Sountoulides, P; Mykoniatis, I; Dimasis, N

2014-01-01

Malignancies of the genitourinary tract are diagnosed with increased frequency compared to the past. Currently prostate and bladder cancer account for the majority of urological malignancies. While for prostate cancer recent developments in the management of local and metastatic disease are likely to lead the majority of patients to either cure from the disease or to longer survival time, for bladder cancer advanced disease will unfortunately lead to death within months. However, the common clinical scenario in both prostate and bladder cancer includes, in high incidence, upper urinary tract obstruction in the advanced stages of these malignancies. This coupled with the fact that average life expectancy in the western world is increasing, will result in a significant patient population with either advanced, non-curable disease or with problems related to the received therapeutic surgical or medical interventions. There is no doubt that in both circumstances the room and role of palliation therapy is increasing. The care of patients with advanced urologic malignancies requires a multi-disciplinary effort from physicians of many specialties under the guiding role of the treating urologist. This review focuses on currently available palliative therapeutic options for upper urinary tract obstruction in the setting of patients with advanced malignancies of the urinary tract, as recently significant advancements have been witnessed in this field. PMID:26052193

Palliative management of malignant upper urinary tract obstruction.

PubMed

Sountoulides, P; Mykoniatis, I; Dimasis, N

2014-01-01

Malignancies of the genitourinary tract are diagnosed with increased frequency compared to the past. Currently prostate and bladder cancer account for the majority of urological malignancies. While for prostate cancer recent developments in the management of local and metastatic disease are likely to lead the majority of patients to either cure from the disease or to longer survival time, for bladder cancer advanced disease will unfortunately lead to death within months. However, the common clinical scenario in both prostate and bladder cancer includes, in high incidence, upper urinary tract obstruction in the advanced stages of these malignancies. This coupled with the fact that average life expectancy in the western world is increasing, will result in a significant patient population with either advanced, non-curable disease or with problems related to the received therapeutic surgical or medical interventions. There is no doubt that in both circumstances the room and role of palliation therapy is increasing. The care of patients with advanced urologic malignancies requires a multi-disciplinary effort from physicians of many specialties under the guiding role of the treating urologist. This review focuses on currently available palliative therapeutic options for upper urinary tract obstruction in the setting of patients with advanced malignancies of the urinary tract, as recently significant advancements have been witnessed in this field.

Active surveillance is suitable for intermediate term follow-up of renal oncocytoma diagnosed by percutaneous core biopsy.

PubMed

Liu, Shuo; Lee, Stephen; Rashid, Prem; Bangash, Haider; Hamid, Akhlil; Lau, Jason; Cohen, Ronald

2016-10-01

To evaluate the intermediate outcome of conservative management in patients with biopsy-proven oncocytoma. Patients with oncocytoma diagnosed on percutaneous core biopsy between January 2000 to December 2014 were identified from the renal biopsy database of a large specialist urologic pathology laboratory. After review of patient clinical records, the study cohort comprised only of patients enrolled in active surveillance. Clinicopathological and follow-up details were reviewed for each case, in particular: type and interval of surveillance imaging, tumour growth, definitive intervention and reason for intervention. Where possible, correlation was made between the final surgical and the initial biopsy specimens. Fifty three patients diagnosed with oncocytoma on core biopsy were initially placed on active surveillance with median follow-up of 34 months (range 6-109). The median age at diagnosis was 65 years (range 20-85) and median tumour size was 30 mm (range 13-87). Mean average tumour growth was 1.4 mm per annum (median 0 mm/year) with the majority (36 of 53, 68%) exhibiting minimal growth (less than 2 mm per annum) or partial regression. Forty seven of the 53 patients remained on active surveillance with no significant progression. Six patients elected to undergo definitive intervention (five surgical excision, one ablation). Renal oncocytoma was confirmed in all five patients who underwent surgical excision of their lesions. The majority of oncocytomas in this study showed minimal growth rate or regression. Patients with biopsy proven oncocytoma can be conservatively managed with active surveillance. © 2016 The Authors BJU International © 2016 BJU International Published by John Wiley & Sons Ltd.

Effective teaching strategies for the older adult with urologic concerns.

PubMed

Zurakowski, Tamara; Taylor, Melissa; Bradway, Christine

2006-10-01

Older adults are able to learn and apply new knowledge, such as management of a urological condition, but their learning style differs from that of younger clients. An understanding of the older adult's learning style, and knowledge of specific teaching strategies will benefit the urologic nurse in the ongoing effort to be a more effective patient educator.

An analysis of leukapheresis and central venous catheter use in the randomized, placebo controlled, phase 3 IMPACT trial of Sipuleucel-T for metastatic castrate resistant prostate cancer.

PubMed

Flanigan, Robert C; Polcari, Anthony J; Shore, Neil D; Price, Thomas H; Sims, Robert B; Maher, Johnathan C; Whitmore, James B; Corman, John M

2013-02-01

Sipuleucel-T is an autologous cellular immunotherapy. We review the safety of the leukapheresis procedure required for sipuleucel-T preparation and complications related to venous catheter use in the randomized, placebo controlled phase 3 IMPACT (IMmunotherapy for ProstAte Cancer Trial) study (NCT 00065442). A total of 512 patients with asymptomatic or minimally symptomatic metastatic castrate resistant prostate cancer were enrolled in the study. All patients were scheduled to undergo 3 standard 1.5 to 2.0 blood volume leukapheresis procedures at 2-week intervals. Leukapheresis related adverse events and those related to venous catheter use were reviewed. Immune cell counts were examined throughout the treatment course. Of 512 enrolled patients 506 underwent 1 or more leukapheresis procedures and were included in this analysis. Adverse events were comparable between the sipuleucel-T and control arms. Leukapheresis related adverse events were primarily associated with transient hypocalcemia (39.3%). Most leukapheresis related adverse events (97%) were of mild/moderate intensity. Median white blood cell count and absolute monocyte and lymphocyte counts were stable and within normal ranges throughout the treatment course. Of all patients 23.3% had a central venous catheter placed primarily for leukapheresis. Patients with vs without a central venous catheter had a higher risk of infection potentially related to catheter use (11.9% vs 1.3%, p <0.0001) and a trend toward a higher incidence of venous vascular events potentially related to catheter use, excluding the central nervous system (5.9% vs 2.1%, p = 0.06). Adverse events related to leukapheresis are manageable and quickly reversible. The majority of patients can undergo leukapheresis without a central venous catheter. Central venous catheters are associated with an increased risk of infections and venous vascular events. Peripheral intravenous access should be used when feasible. Copyright © 2013 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.

Clinical factors associated with shock in bacteremic UTI.

PubMed

Shigemura, Katsumi; Tanaka, Kazushi; Osawa, Kayo; Arakawa, Sochi; Miyake, Hideaki; Fujisawa, Masato

2013-06-01

Urinary tract infection (UTI) often causes bacteremia, resulting in shock. The purpose of this study is to investigate urological bacteremia and bacteremia shock cases and seek for the clinical factors associated with urological bacteremic shock. Seventy consecutive cases with bacteremia caused by UTI from the Department of Urology, Kobe University Hospital were studied. These cases were diagnosed from 2000 to 2010 and had full data available for analysis. We investigated the potential clinical factors associated with bacteremic shock (systolic blood pressure ≤ 90 mmHg with UTI), including: (1) the number of basal general diseases (such as diabetes, malignancy, immune diseases, heart diseases, liver diseases, and kidney diseases), (2) causative bacteria, (3) antibiotics and therapeutic intervention, (4) gram-negative bacteria, (5) resistance to imipenem (which is often used in this infection), and (6) serum white blood cell counts and C-reactive protein (CRP) at the time of diagnosis of bacteremic UTI. A total of 81 causative bacteria were isolated: 42 cases were gram-negative and 39 were gram-positive bacteria. In detail, Escherichia coli was the most common, followed by Methicillin-resistant Staphylococcus aureus. The comparison data revealed that urological bacteremic shock cases had significantly increased CRP (p < 0.001). Our univariate analyses showed indwelling urinary tract catheters (p = 0.02) as a significant clinical factor associated with urological bacteremic shock and multivariate analyses showed that the presence of indwelling urinary tract catheters before UTI was a significant clinical factor associated with urological bacteremic shock (p = 0.04). Indwelling urinary catheters before UTI and high CRP were clinical factors associated with urological bacteremic shock. This result should be considered during decision-making for UTI treatments in high risk cases or urological bacteremia cases.

The role of simulation in urological training - A quantitative study of practice and opinions.

PubMed

Aydin, Abdullatif; Ahmed, Kamran; Shafi, Ahmed M A; Khan, Muhammad Shamim; Dasgupta, Prokar

2016-12-01

Over the past few decades, simulation-based training has rapidly been adopted by many centres for effective technical and non-technical skills training, as a supplementary method to traditional operating room experience. The aim of this study is to assess the current practice in training and seek opinion regarding the future role of simulation in urological training. A cross sectional survey was designed and distributed amongst expert and trainee urological surgeons. The survey consisted of twenty-two questions that were split into three sections; Introduction (6), Technical Skills training in urology (10) and Non-technical skills training in urology (6). A total of 91 residents and 172 specialists completed the survey. In both groups, there was an agreed consensus that laparoscopic training and exposure was insufficient as only 21% of trainees and 23% of specialists believed that they had sufficient training in this area. Furthermore, both groups lacked simulation-based training in common urological procedures including nephrectomy (62%), cystoscopy (69-74%), ureteroscopy (47-59%), transurethral resection of the prostate (56-65%) and percutaneous renal surgery (76-73%). 90% of trainees and 70% of specialists believed (agreed and strongly agreed) that there is a role for non-technical skills simulation in urological training. Simulation training has been under-used thus far and trainees face an uphill challenge to enhance their skills and technical abilities in the operating room. Simulation is recommended by both trainees and specialists and may represent one of the solutions to the challenges of safe and effective urology procedural training. Copyright © 2015 Royal College of Surgeons of Edinburgh (Scottish charity number SC005317) and Royal College of Surgeons in Ireland. Published by Elsevier Ltd. All rights reserved.

Undergraduate exposure to urology: impact of the distributed model of medical education in British Columbia.

PubMed

Hoag, Nathan A; Hamidizadeh, Reza; MacNeily, Andrew E

2013-01-01

With the increased development of distributed sites for medical education across Canada, it is imperative we ensure that the quality of education is comparable between the different campuses. Our objective was to assess medical student experience and comfort with common urologic clinical encounters and to determine whether any differences exist between the distributed education sites at the University of British Columbia (UBC). Questionnaires assessing urologic education were delivered simultaneously to all final-year UBC medical students attending campuses in Vancouver, Victoria and Prince George. Results were analyzed using descriptive statistics. Overall, 55.8% of students felt their exposure to urology was adequate in the medical curriculum; learners in the Northern Program (Prince George) ranked their clinical and didactic experiences significantly higher. Areas requiring improvement include teaching of the male genitourinary exam, digital rectal exam and sexual history, in which learners rated teaching "good/outstanding" in only 18.2%, 47.7% and 43.2% of cases, respectively. Overall, students were most comfortable with the following clinical encounters: urinary tract infection, nephrolithiasis, benign prostatic hyperplasia, hematuria, incontinence and prostate cancer. Few differences in student experience or comfort were noted related to campus site, gender or urology clerkship exposure. A significant minority of learners perceived that they had inadequate exposure to urology in the undergraduate curriculum. Experience in urology was comparable across the distributed sites and was congruent with teaching objectives. Students were comfortable with the clinical scenarios deemed most important in the literature. Learners in the Northern Program were significantly more satisfied with their urologic teaching, which potentially highlights the advantages of learning in a smaller academic setting.

[Urología Clínica, bulletin of the Urology Service of Dr. Sánchez Covisa of the Hospital Provincial of Madrid, edited between 1928 and 1936].

PubMed

Pérez-Albacete, M; Saiz, A

2012-02-01

Make known the important urological work of Sanchez Covisa, third chief of the Urology Service of the Hospital Provincial de Madrid, who beginning in 1928 was able to transform and convert it into possibly the more outstanding one of its time in Spain, comparable to the best hospitals in foreign countries. We have analyzed the contents of the publication Urología Clínica, that collect the changes introduced and the work carried out in said service between 1928 and 1936, reflected in a careful yearly statistics on the care, operations and mortality in addition to the articles published by the members of the Service together with a short bibliographic review of each one. In 1914, he became chief of the Service, and after 14 years, was able to overcome all the obstacles and to extend and modernize the surgery rooms, hospitalization wards and examination resources. In 1931, once the changes were made, he began important clinical and scientific activity, and constituted one of the principal urological schools of the first half of the XXth century in our country. The prestige reached by the Urology Unit of the Hospital Provincial of Madrid attracted patients from all over Spain, many of them treated or operated on in their place of origin. This explains why the condition was complicated with some acceptable results. The quality and honesty of the Urology unit justify its qualification. The works in general are mere reviews and those regarding surgery of the uretero-intestinal shunt stand out. Copyright © 2011 AEU. Published by Elsevier Espana. All rights reserved.

A comparison of radical retropubic with perineal prostatectomy for localized prostate cancer within the Uniformed Services Urology Research Group.

PubMed

Lance, R S; Freidrichs, P A; Kane, C; Powell, C R; Pulos, E; Moul, J W; McLeod, D G; Cornum, R L; Brantley Thrasher J

2001-01-01

To review and compare the outcome of patients undergoing radical retropubic prostatectomy (RRP) or radical perineal prostatectomy (RPP) for clinically localized prostate cancer. From 1988 to 1997, 1382 men who were treated by RRP and 316 by RPP were identified from databases of the Uniformed Services Urology Research Group. The following variables were assessed; age, race, prostate-specific antigen (PSA) level before surgery, clinical stage, biopsy Gleason sum, estimated blood loss (EBL), margin-positive rate, pathological stage, biochemical recurrence rate, short and long-term complication rates, impotence and incontinence rates. To eliminate selection bias, the analysis was concentrated on pairs of patients matched by race, preoperative PSA level, clinical stage and biopsy Gleason sum. In the 190 matched patients there were no significant differences between the RRP and RPP groups in either organ-confined (57% vs 55%), margin-positive (39% vs 43%), or biochemical recurrence rates (12.9% vs 17.6% at a mean follow-up of 47.1 vs 42.9 months), respectively. The mean EBL was 1575 mL in the RRP group and 802 mL in the RPP group (P < 0.001). The only significant difference in complication rates was a higher incidence of rectal injury in the RPP group (4.9%) than in the RRP group (none, P < 0.05). In similar populations of patients, RPP offers equivalent organ-confined, margin-positive and biochemical recurrence rates to RRP, while causing significantly less blood loss.

Robotic technology in surgery: current status in 2008.

PubMed

Murphy, Declan G; Hall, Rohan; Tong, Raymond; Goel, Rajiv; Costello, Anthony J

2008-12-01

There is increasing patient and surgeon interest in robotic-assisted surgery, particularly with the proliferation of da Vinci surgical systems (Intuitive Surgical, Sunnyvale, CA, USA) throughout the world. There is much debate over the usefulness and cost-effectiveness of these systems. The currently available robotic surgical technology is described. Published data relating to the da Vinci system are reviewed and the current status of surgical robotics within Australia and New Zealand is assessed. The first da Vinci system in Australia and New Zealand was installed in 2003. Four systems had been installed by 2006 and seven systems are currently in use. Most of these are based in private hospitals. Technical advantages of this system include 3-D vision, enhanced dexterity and improved ergonomics when compared with standard laparoscopic surgery. Most procedures currently carried out are urological, with cardiac, gynaecological and general surgeons also using this system. The number of patients undergoing robotic-assisted surgery in Australia and New Zealand has increased fivefold in the past 4 years. The most common procedure carried out is robotic-assisted laparoscopic radical prostatectomy. Published data suggest that robotic-assisted surgery is feasible and safe although the installation and recurring costs remain high. There is increasing acceptance of robotic-assisted surgery, especially for urological procedures. The da Vinci surgical system is becoming more widely available in Australia and New Zealand. Other surgical specialties will probably use this technology. Significant costs are associated with robotic technology and it is not yet widely available to public patients.

The change in serum Thiol/Disulphide homeostasis after transrectal ultrasound guided prostate biopsy.

PubMed

Tokgöz, Hüsnü; Taş, Selim; Giray, Özlem; Yalçınkaya, Soner; Tokgöz, Özlem; Koca, Cemile; Savaş, Murat; Erel, Özcan

2017-01-01

The aim of this prospective clinical study was to investigate variations in a novel oxidative stress marker (thiol/disulphide homeostasis) in men who underwent transrectal ultrasound guided prostate biopsy (TRUSB). A total of 22 men undergoing TRUSB of the prostate were enrolled in the study. Patients with abnormal digital rectal examination and/or total prostate specific antigen (PSA) over 4ng/mL underwent TRUSB with 12 cores. Serum samples were obtained before and just after the procedure to evaluate the possible changes in thiol/disulphide homeostasis. Mean age, total PSA and free PSA, prostate volume and histopathological data were also recorded. Mean age of the study population was 65.05±8.89 years. Significant decreases in native and total thiol levels were documented after the biopsy procedure. However, serum disulphide levels and disulphide/native thiol, disulphide/total thiol and native / total thiol ratios did not significantly change after TRUSB. No correlation was observed between oxidative parameters and total PSA and free PSA levels, prostate volume and histopathology of the prostate. However, mean patient age was significantly correlated with mean native and total thiol levels. Significant decreases in serum native and total thiol levels related to the prostate biopsy procedure suggest that TRUSB causes acute oxidative stress in the human body. Since our trial is the first in the current literature to investigate these oxidative stress markers in urology practice, additional studies are warranted. Copyright® by the International Brazilian Journal of Urology.

Applications of three-dimensional printing technology in urological practice.

PubMed

Youssef, Ramy F; Spradling, Kyle; Yoon, Renai; Dolan, Benjamin; Chamberlin, Joshua; Okhunov, Zhamshid; Clayman, Ralph; Landman, Jaime

2015-11-01

A rapid expansion in the medical applications of three-dimensional (3D)-printing technology has been seen in recent years. This technology is capable of manufacturing low-cost and customisable surgical devices, 3D models for use in preoperative planning and surgical education, and fabricated biomaterials. While several studies have suggested 3D printers may be a useful and cost-effective tool in urological practice, few studies are available that clearly demonstrate the clinical benefit of 3D-printed materials. Nevertheless, 3D-printing technology continues to advance rapidly and promises to play an increasingly larger role in the field of urology. Herein, we review the current urological applications of 3D printing and discuss the potential impact of 3D-printing technology on the future of urological practice. © 2015 The Authors BJU International © 2015 BJU International Published by John Wiley & Sons Ltd.

A new era of Asian urology: a SWOT analysis.

PubMed

Kumar, Rajeev

2016-11-01

Economic prosperity and increasing connectivity have made Asia an emerging centre of growth in health care, including in the field of urology. Large and varied patient populations, the availability of a trained workforce, the use of English as a common communication language, and overall low costs have contributed to this change. Rapid growth of regional urological associations and journals has fuelled the aspirations and abilities of Asian urologists to not only keep abreast of but often lead the change in urological disease management. Asian urology has immense potential to expand in areas in which it currently lags behind, the most important being research. The increasing ability to travel aids in developing networks for collaboration. However, Asian urologists will need to look at sustainable models of engagement and temper the need for short-term results if these opportunities are to reach their maximal potential.

[Urology and National Socialism: the fate of Alexander von Lichtenberg 1880-1949].

PubMed

Moll, F H; Krischel, M; Rathert, P; Fangerau, H

2010-09-01

Alexander von Lichtenberg (1880-1949) was one of the famous members of the German Urological Society (DGU) in pre-war Germany. He introduced excretion urography and a special TURP Instrument. In 1928 he was president of the 8th meeting held in the German capital Berlin. His Handbook of Urology, released by Ferdinand Springer publishing house, was a trendsetter in establishing urology as a specialty in Germany and bringing together the whole wisdom of all aspects of urology. He was the founder of the famous Maximilian Nitze Award of the DGU. As a Jew he-like many others-was forced to leave Nazi Germany after 1933. Even in Hungary, his native country, he again had to resist anti-Semitic hostility. Later on he lived in Mexico. Alexander von Lichtenberg has to be remembered with special focus on the exodus of German Jewish scientists during the Nazi time.

Expert Panel Recommendations on Lower Urinary Tract Health of Women Across Their Life Span

PubMed Central

Losada, Liliana; Amundsen, Cindy L.; Ashton-Miller, James; Chai, Toby; Close, Clare; Damaser, Margot; DiSanto, Michael; Dmochowski, Roger; Fraser, Matthew O.; Kielb, Stephanie J.; Kuchel, George; Mueller, Elizabeth R.; Parker-Autry, Candace; Wolfe, Alan J.

2016-01-01

Abstract Urologic and kidney problems are common in women across their life span and affect their daily life, including physical activity, sexual relations, social life, and future health. Urological health in women is still understudied and the underlying mechanisms of female urological dysfunctions are not fully understood. The Society for Women's Health Research (SWHR®) recognized the need to have a roundtable discussion where researchers and clinicians would define the current state of knowledge, gaps, and recommendations for future research directions to transform women's urological health. This report summarizes the discussions, which focused on epidemiology, clinical presentation, basic science, prevention strategies, and efficacy of current therapies. Experts around the table agreed on a set of research, education, and policy recommendations that have the potential to dramatically increase awareness and improve women's urological health at all stages of life. PMID:27285829

Best practices recommendations in the application of immunohistochemistry in urologic pathology: report from the International Society of Urological Pathology consensus conference.

PubMed

Amin, Mahul B; Epstein, Jonathan I; Ulbright, Thomas M; Humphrey, Peter A; Egevad, Lars; Montironi, Rodolfo; Grignon, David; Trpkov, Kiril; Lopez-Beltran, Antonio; Zhou, Ming; Argani, Pedram; Delahunt, Brett; Berney, Daniel M; Srigley, John R; Tickoo, Satish K; Reuter, Victor E

2014-08-01

Members of the International Society of Urological Pathology (ISUP) participated in a half-day consensus conference to discuss guidelines and recommendations regarding best practice approaches to use of immunohistochemistry (IHC) in differential diagnostic situations in urologic pathology, including bladder, prostate, testis and, kidney lesions. Four working groups, selected by the ISUP leadership, identified several high-interest topics based on common or relevant challenging diagnostic situations and proposed best practice recommendations, which were discussed by the membership. The overall summary of the discussions and the consensus opinion forms the basis of a series of articles, one for each organ site. This Special Article summarizes the overall recommendations made by the four working groups. It is anticipated that this ISUP effort will be valuable to the entire practicing community in the appropriate use of IHC in diagnostic urologic pathology.

Caudal bupivacaine supplemented with morphine or clonidine, or supplemented with morphine plus clonidine in children undergoing infra-umbilical urological and genital procedures: a prospective, randomized and double-blind study.

PubMed

Fernandes, Magda L; Pires, Kleber C C; Tibúrcio, Moacir A; Gomez, Renato S

2012-04-01

We aimed to evaluate postoperative analgesia of morphine, or clonidine, or morphine plus clonidine, added to caudal bupivacaine in children undergoing infra-umbilical urological and genital procedures. Eighty patients aged 1-10 years were prospectively enrolled. After the induction of general anesthesia, the patients were randomized to four caudal anesthesia groups: Group B (1.0 mL/kg of bupivacaine 0.166% with epinephrine 1:600,000); Group BM (1.0 mL/kg of bupivacaine 0.166% with epinephrine 1:600,000 plus morphine 20 μg/kg); Group BC (bupivacaine 0.166% with epinephrine 1:600,000 plus clonidine 1.0 μg/kg), and Group BMC (bupivacaine 0.166% with epinephrine 1:600,000 plus morphine 20 μg/kg and clonidine 1.0 μg/kg). Duration of surgery, emergence time, postoperative pain score measured by the face, legs, activity, cry, consolability (FLACC) scale, postoperative analgesia time, and overall use of rescue analgesics were recorded. The FLACC pain score (6, 12, and 24 h after the surgery) and the number of patients requiring analgesics during the first 24 h of the postoperative period were higher in Groups B and BC than in Groups BM and BMC (p < 0.05). The incidence of pruritus and urinary retention was comparable between the groups (p > 0.05). However, the incidence of postoperative nausea and vomiting (PONV) was higher in Groups BM (35%) and BMC (25%) than in Groups B (5%) and BC (5%) (p < 0.05). To conclude, we showed that 20 μg/kg of morphine added to caudal bupivacaine 0.166% plus epinephrine 1:600,000 decreased the use of analgesics in the postoperative period, although it was associated with an increased incidence of PONV. However, the addition of clonidine (1.0 μg/kg) to caudal bupivacaine provided no additional clinical benefit over bupivacaine alone.

[Anti-infectious treatments in urology: general remarks].

PubMed

Bruyère, F; Karsenty, G; Guy, L; Bastide, C; Bernard, L

2013-11-01

To define the general use of anti-infectious treatments in urology. A review of national guidelines and articles published on the subject in the Medline database, selected by keywords, depending on the scientific relevance was performed. While the epidemiology clearly shows the non-reduction of the anti-infectious treatments use in France, the resistance increases to highlight foo-resistant germs. Urology is not an exception to this observation, and different means are set to improve the prescription made by urologists. The epidemiological observation confirms the urgent need to improve the prescription of anti-infectious treatments particularly in urology. Copyright © 2013 Elsevier Masson SAS. All rights reserved.

Amniotic therapeutic biomaterials in urology: current and future applications.

PubMed

Oottamasathien, Siam; Hotaling, James M; Craig, James R; Myers, Jeremy B; Brant, William O

2017-10-01

To examine the rationale and applications of amniotic tissue augmentation in urological surgery. Published literature in English-language was reviewed for basic science and clinical use of amniotic or amnion-chorionic tissue in genitourinary tissues. Basic science and animal studies support the likely benefit of clinical applications of amnion-derived tissues in a variety of urologic interventions. The broad number of properties found in amniotic membrane, coupled with its immunologically privileged status presents a number of future applications in the urological surgical realm. These applications are in their clinical infancy and suggest that further studies are warranted to investigate the use of these products in a systematic fashion.

[Urological emergencies at the Dakar university teaching hospital: epidemiological, clinical and therapeutic features].

PubMed

Fall, B; Diao, B; Fall, P A; Diallo, Y; Sow, Y; Ondongo, A A M; Diagana, M; Ndoye, A K; Ba, M; Diagne, B A

2008-11-01

To present the epidemiological, clinical and therapeutic features of the urological emergencies in Senegal, West Africa. The authors conducted a 20 months retrospective study that analyzed the epidemiological, clinical and therapeutic features of all urological emergencies admitted to the urology department of the university teaching hospital Aristide-Le-Dantec (Dakar). There were 1237 urological emergencies. The mean age of the patients was 58.8 years (range one month-94 years). The sex ratio (M/F) was 20.32. These patients had an age equal to or higher than 60 years in 50.7% of the cases. The most frequent illness was urinary retention (53%) and genitor-urinary system infectious, which represented as a whole 16.4% of the cases. The gangrenes of male external genitalia (Fournier's gangrene) accounted for 4.1% of the cases and the priapism 1.3%. In emergency, 331 surgical operations were performed. The most performed procedures were the installation of a suprapubic catheter (59.8%) and debridement of a gangrene of male external genitalia (15.4%). The most frequent urological emergency in our country was the acute urinary retention. Some serious illness like gangrene of male external genitalia (Fournier's gangrene) and priapism are not rare there.

Urologic Diseases in Korean Military Population: a 6-year Epidemiological Review of Medical Records

PubMed Central

2017-01-01

We sought to describe the incidence rate of the urologic disease in the Korean military by reviewing diagnoses made in active duty soldiers from 2008 to 2013. A total of 72,248 first visits were generated in the Defense Medical Statistics Information System (DMSIS) with its gradually increasing trend over 6 years. A sharp increase of first visit was observed after implementation of the regular health check-up for all conscripted soldiers since 2013. Urolithiasis, prostatitis, epididymoorchitis, urethritis, and varicocele were prevalent. Prostatitis was the highest diagnosis made in the outpatient service, while varicocele was ranked the highest in the inpatient service. The incidence rates of urologic disease varied from 12.3 to 34.2 cases per 1,000 person-years. The urologic disease in conscripted men showed different distribution when we separated the population into conscripted and professional soldiers. Epididymoorchitis was the highest disease followed by urolithiasis, dysuresia, and balanoposthitis in 2013. This study underscores that the urologic disease has spent significant amount of health care resources in the Korean military. This calls for further study to find any significant difference and contributing factors of the urologic disease in the military and the civilian population. PMID:27914143

Prevalence of fluoroquinolone-resistant rectal flora in patients undergoing transrectal ultrasound-guided prostate needle biopsy: A prospective multicenter study.

PubMed

Chung, Ho Seok; Hwang, Eu Chang; Yu, Ho Song; Jung, Seung Il; Lee, Sun Ju; Lim, Dong Hoon; Cho, Won Jin; Choe, Hyun Sop; Lee, Seung-Ju; Park, Sung Woon

2018-03-01

To estimate the prevalence of fluoroquinolone-resistant rectal flora in patients undergoing transrectal ultrasound-guided prostate needle biopsy and to identify the high-risk groups. From January 2015 to March 2016, rectal swabs of 557 men who underwent transrectal ultrasound-guided prostate needle biopsy were obtained from five institutions. Clinical variables, including demographics, rectal swab culture results and infectious complications, were evaluated. Univariable and multivariable analyses were used to identify the risk factors for fluoroquinolone resistance of rectal flora and infectious complications. The incidence of fluoroquinolone-resistant and extended-spectrum beta-lactamase production was 48.1 and 11.8%, respectively. The most common fluoroquinolone-resistant bacteria was Escherichia coli (81% of total fluoroquinolone-resistant bacteria, 39% of total rectal flora), and 16 (2.9%) patients had infectious complications. Univariable and multivariable analysis of clinical parameters affecting fluoroquinolone resistance showed no factor associated with fluoroquinolone resistance of rectal flora. The clinical parameter related to infectious complications after prostate biopsy was a history of operation within 6 months (relative risk 6.60; 95% confidence interval 1.99-21.8, P = 0.002). These findings suggest that a risk-based approach by history taking cannot predict antibiotic resistance of rectal flora, and physicians should consider targeted antibiotic prophylaxis or extended antibiotic prophylaxis for Korean patients undergoing transrectal ultrasound-guided prostate biopsy because of high antibiotic resistance of rectal flora. © 2017 The Japanese Urological Association.

Lack of genitourinary physical examination before urologic consultation--a quality of care issue.

PubMed

Ylitalo, Adam W; Ylitalo, Kelly R; Santucci, Richard A

2012-12-01

To quantify the frequency of genitourinary (GU) physical examinations obtained by the emergency department or primary hospital team before obtaining a urologic consultation and evaluate the role of the different demographic and clinical factors. For 6 weeks, from July to August 2010, 420 consecutive patients evaluated by the urology consultation service had their medical charts reviewed retrospectively, with the frequency of GU physical examination performed by the emergency department or primary hospital team recorded. Of 357 patients requiring a urologic consultation, 88 of 324 (27%) had a GU physical examination performed by the emergency department and 98 of 319 (31%) had a GU physical examination performed by the primary hospital team before the urologic consultation. The emergency department was 6 times more likely to perform a GU physical examination on a male patient than a female patient, and the primary team was twice as likely to perform a GU physical examination on a male patient than a female patient. The likelihood of examination by either team decreased as patients became older. Race was not significantly associated with the likelihood of examination. The results of our study indicate that examinations are performed less than one-third of the time before obtaining a urologic consultation, with the frequency related to age and sex. The low rate of preconsultation examination creates concern for quality of care, the correctness of billing, and unnecessary urologic consultations. Copyright © 2012 Elsevier Inc. All rights reserved.

Gender trends of urology manuscript authors in the United States: a 35-year progression.

PubMed

Weiss, Dana A; Kovshilovskaya, Bogdana; Breyer, Benjamin N

2012-01-01

The presence of women in urology has gradually increased in the last 35 years with an accelerated rate in the last decade. We evaluated manuscript authorship trends by gender. Manuscript authorship is a metric that has been used as a marker of academic productivity. We hypothesized that the number of first and last author publications by women has increased proportionately to the number of women in the field during the last 35 years. We performed a bibliometric study to examine authorship gender in The Journal of Urology® and Urology®. We reviewed all original articles published from American institutions in 1974, 1979, 1984, 1989, 1994, 1999, 2004 and 2009. Of the 8,313 articles reviewed 5,461 were from American institutions, including 97.5% for which we determined author gender. There were 767 articles with female authors, including 440 first and 327 last authors. First and last female authorship increased from 2.7% of all authors in 1979 to 26.5% in 2009 (test for trend p <0.001). This authorship rate surpasses the rate of growth of women in urology, which increased from 0.24% in 1975 to 6.2% in 2008. Based on authorship gender analysis women urologists produce manuscripts at a rate that exceeds their number in the field. Findings show that women in urology are productive, active members of the academic community. Copyright © 2012 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.

A review of routinely collected data studies in urology: Methodological considerations, reporting quality, and future directions.

PubMed

Welk, Blayne; Kwong, Justin

2017-01-01

Studies using routinely collected data (RCD) are common in the urological literature; however, there are important considerations in the creation and review of RCD discoveries. A recent reporting guideline (REporting of studies Conducted using Observational Routinely-collected health Data, RECORD) was developed to improve the reporting of these studies. This narrative review examines important considerations for RCD studies. To assess the current level of reporting in the urological literature, we reviewed all the original research articles published in Journal of Urology and European Urology in 2014, and determined the proportion of the RECORD checklist items that were reported for RCD studies. There were 56 RCD studies identified among the 608 articles. When the RECORD items were considered applicable to the specific study, they were reported in 52.5% of cases. Studies most consistently (>80% of them) reported the names of the data sources, the study time frame, the extent to which the authors could access the database source, the patient selection, and discussed missing data. Few studies (<25%) discussed validation of key coding elements, details on data-linkage, data-cleaning, the impact of changing eligibility over time, or provided the complete list of coding elements used to define key study variables. Reporting factors specifically relevant in RCD studies may serve to increase the quality of these studies in the urological literature. With increased technological integration in healthcare and the proliferation of electronic medical records, RCD will continue to be an important source for urological research.

A novel interactive educational system in the operating room--the IE system.

PubMed

Nakayama, Takayuki; Numao, Noboru; Yoshida, Soichiro; Ishioka, Junichiro; Matsuoka, Yoh; Saito, Kazutaka; Fujii, Yasuhisa; Kihara, Kazunori

2016-02-02

The shortage of surgeon is one of the serious problems in Japan. To solve the problem, various efforts have been undertaken to improve surgical education and training. However, appropriate teaching methods in the operating room have not been well established. The aim of this study is to assess the utility of a novel interactive educational (IE) system for surgical education on urologic surgeries in the operating room. A total of 20 Japanese medical students were educated on urologic surgery using the IE system in the operating room. The IE system consists of two parts. The first is three-dimensional (3D) magnified vision of the operative field using a 3D head-mounted display and a 3D endoscope. The second is interactive educative communication between medical students and surgeons using a small-sized wireless communication device. The satisfaction level with the IE system and the physical burden on medical students was examined via questionnaire. All students utilized the IE system in urologic surgery and responded to the survey. Most students were satisfied with the IE system. They also felt more welcomed by the surgeon when using the IE system than when not using it. No major unpleasant symptoms were observed but five students (25 %) experienced mild eye fatigue as a result of viewing the medical images. The IE system has the potential to motivate students to become interested in surgery and could be an efficient method of surgical education in the operating room.

Management of macroscopic haematuria in the emergency department

PubMed Central

Hicks, Derek; Li, Chi‐Ying

2007-01-01

Macroscopic haematuria is a commonly seen condition in the emergency department (ED), which has a variety of causes. However, most importantly, macroscopic haematuria has a high diagnostic yield for urological malignancy. 30% of patients presenting with painless haematuria are found to have a malignancy. The majority of these patients can be managed in the outpatient setting. This review of current literature suggests a management pathway that can be used in the ED. A literature search was done using Medline, PubMed and Google. In men aged >60 years, the positive predictive value of macroscopic haematuria for urological malignancy is 22.1%, and in women of the same age it is 8.3%. In terms of the need for follow‐up investigation, a single episode of haematuria is equally important as recurrent episodes. Baseline investigation in the ED includes full blood count, urea and electrolyte levels, midstream urine dipstick, β human chorionic gonadotrophin, and formal microscopy, culture and sensitivities. Treatment of macroscopic haematuria aims at RESP—Resuscitation, Ensuring, Safe and Prompt. Indications for admission include clot retention, cardiovascular instability, uncontrolled pain, sepsis, acute renal failure, coagulopathy, severe comorbidity, heavy haematuria or social restrictions. Discharged patients should drink plenty of clear fluids and return for further medical attention if the following occur: clot retention, worsening haematuria despite adequate fluid intake, uncontrolled pain or fever, or inability to cope at home. Follow‐up by a urological team should be promptly arranged, ideally within the 2‐week cancer referral target. PMID:17513531

Characteristics and survival of patients with end stage renal disease and spina bifida in the United States renal data system.

PubMed

Ouyang, Lijing; Bolen, Julie; Valdez, Rodolfo; Joseph, David; Baum, Michelle A; Thibadeau, Judy

2015-02-01

We describe the characteristics, treatments and survival of patients with spina bifida in whom end stage renal disease developed from 2004 through 2008 in the United States Renal Data System. We used ICD-9-CM code 741.* to identify individuals with spina bifida using hospital inpatient data from 1977 to 2010, and physician and facility claims from 2004 to 2008. We constructed a 5:1 comparison group of patients with end stage renal disease without spina bifida matched by age at first end stage renal disease service, gender and race/ethnicity. We assessed the risk of mortality and of renal transplantation while on dialysis using multivariate cause specific proportional hazards survival analysis. We also compared survival after the first renal transplant from the first end stage renal disease service to August 2011. We identified 439 patients with end stage renal disease and spina bifida in whom end stage renal disease developed at an average younger age than in patients without spina bifida (41 vs 62 years, p <0.001) and in whom urological issues were the most common primary cause of end stage renal disease. Compared to patients with end stage renal disease without spina bifida those who had spina bifida showed a similar mortality hazard on dialysis and after transplantation. However, patients with end stage renal disease without spina bifida were more likely to undergo renal transplantation than patients with spina bifida (HR 1.51, 95% CI 1.13-2.03). Hospitalizations related to urinary tract infections were positively associated with the risk of death on dialysis in patients with end stage renal disease and spina bifida (HR 1.42, 95% CI 1.33-1.53). Spina bifida was not associated with increased mortality in patients with end stage renal disease on dialysis or after renal transplantation. Proper urological and bladder management is imperative in patients with spina bifida, particularly in adults. Copyright © 2015 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.

The effect of social media (#SoMe) on journal impact factor and parental awareness in paediatric urology.

PubMed

O'Kelly, F; Nason, G J; Manecksha, R P; Cascio, S; Quinn, F J; Leonard, M; Koyle, M A; Farhat, W; Leveridge, M J

2017-10-01

Social media (SoMe) comprises a number of internet-based applications that have the capability to disseminate multimodal media and allow for unprecedented inter-user connectivity. The role of Twitter has been studied in conferences and education; moreover, there is increasing evidence that patients are more likely to use social media for their own health education. The aim of this study was to assess the impact of social media platforms on the impact factor of both urological and paediatric journals that publish on paediatric urology, and to assess parental awareness of social media in paediatric urology. A filtered Journal of Citation Reports (JCR) search was performed for the period 2012-16 for journals that published articles on paediatric urology. Journals were ranked according to impact factor, and each individual journal website was accessed to assess for the presence of social media. Parents in paediatric urology clinics and non-paediatric urology patients also filled out a questionnaire to assess for awareness and attitudes to social media. All statistical analysis was performed using Prism 6 software (Prism 6, GraphPad Software, California, USA). Overall, there were 50 urological journals and 39 paediatric journals with a mean impact factor of 2.303 and 1.766, respectively. There was an overall average increase in impact factor across all urological journals between 2012 and 16. The presence of a Twitter feed was statistically significant for a rise in impact factor over the 4 years (P = 0.017). The cohort of parents was statistically more likely to have completed post-secondary education, to have and access to a social media profile, use it for health education, and use it to access journal/physician/hospital social media accounts. This study examined, for the first time, the role of social media in paediatric urology, and demonstrated that SoMe use is associated with a positive influence in impact factor, but also a parental appetite for it. Limitations included a non-externally validated questionnaire. There may also have been bias in larger journals that generate and maintain social media platforms such as Twitter, which may then in turn have an influence on impact factor. Social media use within paediatric urology was associated with a higher impact factor, which remained significant after 4 years of analysis. Parents were more likely to use a wide variety of social media to search for conditions and physicians/healthcare providers; therefore, journals and institutions need to embrace and endorse SoMe as a potential source of important clinical information. Copyright © 2017. Published by Elsevier Ltd.

The evolution of robotic urologic surgery.

PubMed

Nguyen, Mike Minh; Das, Sakti

2004-11-01

The incorporation of robotics into surgical technology is a relatively recent development. Robotic surgical systems can be classified as master-slave systems, precise-path systems, or intern-replacement systems. Master-slave systems, the most familiar type, were developed from initial experiments in "telepresence" surgery funded by the US Department of Defense. Urology has embraced the use of commercial robotic surgical systems in a growing number of clinical applications. Although drawbacks and limitations exist for the use of surgical robotics, the systems are developing rapidly and an expanded role for this technology in the future of urology is inevitable. This article reviews the history of the use of robotics in surgery, focusing on its specific application to urology.

The evolution of lasers in urology

PubMed Central

Zarrabi, Amir; Gross, Andreas J.

2011-01-01

The world’s first laser was developed by Theodore Maiman in 1960. Over the course of the past five decades, this technology has evolved into a highly specialized entity, also finding a niche market in the field of urology. Lasers obtained from various lasing mediums producing amplified light of different wavelengths have been tested for urological applications. Today, these lasers are most commonly used in the surgical management of benign prostatic hyperplasia and as intracorporeal lithotripters. Other uses include ablation of various urologic tumors and incising strictures of the upper- and lower urinary tract. A continuous process of evolution of this technology is taking place, resulting in surgical lasers becoming ever safer, more effective, and more affordable. PMID:21869908

[The profile urological emergencies at the Conakry University Teaching Hospital, Guinea].

PubMed

Bobo Diallo, A; Bah, I; Diallo, T M O; Bah, O R; Amougou, B; Bah, M D; Guirassy, S; Bobo Diallo, M

2010-03-01

To stick out the profile urological emergencies at the Conakry University Teaching Hospital, Guinea. This retrospective study, carried out over a period of 3 years (January 2005-December 2007), included 757 urological emergencies admitted to the urology department of the university hospital of Conakry, Guinea. The mean age of patients was 56 years. These patients had an age equal to or higher than 60 years in 58% of the cases. The sex ratio (M/F) was 16.6. According to the social profession, the farmer (40,6%) and workers (21%) were the dominant patients. The most frequent illness was vesical urinary retention (73.9%), hematuria (9.6%) and genito-urinary system trauma (7%). The most performed procedures were the installation of a urethral catheter (55.25%) and the installation of a suprapubic catheter (24.14%). The most frequent urological emergency in our country was vesical urinary retention, the hematuria and genito-urinary system trauma are not rare there. Copyright 2009 Elsevier Masson SAS. All rights reserved.

[Museum, library, and archives of the German Society of Urology as a corporate museum : A neglected, sizeable dimension of scientific collections owened by professional societies].

PubMed

Moll, F H; Rathert, P; Fangerau, H

2016-05-01

Corporate museums make important contributions to science history and daily life. They are an essential part of the historical marketing of organizations, including scientific associations. The museum for the history of urology organized and housed by the German Society of Urology (DGU) can be compared to a corporate museum, because the institution serves two purposes: it represents the society to a wider public and it helps to reconstruct and analyze the history of urology and the history of the society. In a close collaboration with medical historians from all over the world the museum serves as a research institution for the history of urology. The institution is founded at the frontier between a commercial corporate museum similar to that of international companies and a classical scientific museum. The paper describes these aspects of the museum and discusses the inherent value of a museum for a scientific association.

Future robotic platforms in urologic surgery: Recent Developments

PubMed Central

Herrell, S. Duke; Webster, Robert; Simaan, Nabil

2014-01-01

Purpose of review To review recent developments at Vanderbilt University of new robotic technologies and platforms designed for minimally invasive urologic surgery and their design rationale and potential roles in advancing current urologic surgical practice. Recent findings Emerging robotic platforms are being developed to improve performance of a wider variety of urologic interventions beyond the standard minimally invasive robotic urologic surgeries conducted presently with the da Vinci platform. These newer platforms are designed to incorporate significant advantages of robotics to improve the safety and outcomes of transurethral bladder surgery and surveillance, further decrease the invasiveness of interventions by advancing LESS surgery, and allow for previously impossible needle access and ablation delivery. Summary Three new robotic surgical technologies that have been developed at Vanderbilt University are reviewed, including a robotic transurethral system to enhance bladder surveillance and TURBT, a purpose-specific robotic system for LESS, and a needle sized robot that can be used as either a steerable needle or small surgeon-controlled micro-laparoscopic manipulator. PMID:24253803

Integrating Social Media into Urologic Health care: What Can We Learn from Other Disciplines?

PubMed

Salem, Johannes; Borgmann, Hendrik; Murphy, Declan G

2016-02-01

Social media (SoMe) have become an integral part in many aspects of personal and professional life. With current uptake rates of 50-70% among urologists, SoMe platforms merit huge potential for dissemination of information and professional exchange among stakeholders in urology. Application of SoMe includes conference conversations via tweet chats, health education via YouTube videos, and Twitter online journal clubs. In addition, a number of urology journals have embraced SoMe to allow rapid dissemination of their content and engagement with their readers. Guidance for the appropriate use of SoMe is provided to urologists by several organizations. Besides urology, other disciplines have adopted SoMe for a variety of areas: continuing professional development, awareness of rare diseases, recruitment of study participants, patient education and support, and publicizing research. Openness to new approaches is the basic prerequisite for a transfer of successful concepts embraced by other specialties, to the field of urology.

Urological cancer care pathways: development and use in the context of systematic reviews and clinical practice guidelines.

PubMed

Maclennan, Sara Jane; Maclennan, Steven J; Imamura, Mari; Omar, Muhammad Imran; Vale, Luke; Lam, Thomas; Royle, Pamela; Royle, Justine; Swami, Satchi; Pickard, Rob; McClinton, Sam; Griffiths, T R Leyshon; Dahm, Philipp; N'dow, James

2011-06-01

Making healthcare treatment decisions is a complex process involving a broad stakeholder base including patients, their families, health professionals, clinical practice guideline developers and funders of healthcare. This paper presents a review of a methodology for the development of urological cancer care pathways (UCAN care pathways), which reflects an appreciation of this broad stakeholder base. The methods section includes an overview of the steps in the development of the UCAN care pathways and engagement with clinical content experts and patient groups. The development process is outlined, the uses of the urological cancer care pathways discussed and the implications for clinical practice highlighted. The full set of UCAN care pathways is published in this paper. These include care pathways on localised prostate cancer, locally advanced prostate cancer, metastatic prostate cancer, hormone-resistant prostate cancer, localised renal cell cancer, advanced renal cell cancer, testicular cancer, penile cancer, muscle invasive and metastatic bladder cancer and non-muscle invasive bladder cancer. The process provides a useful framework for improving urological cancer care through evidence synthesis, research prioritisation, stakeholder involvement and international collaboration. Although the focus of this work is urological cancers, the methodology can be applied to all aspects of urology and is transferable to other clinical specialties.

Penile prosthesis implantation compares favorably in malpractice outcomes to other common urological procedures: findings from a malpractice insurance database.

PubMed

Chason, Juddson; Sausville, Justin; Kramer, Andrew C

2009-08-01

Some urologists choose not to offer penile prostheses because of concern over malpractice liability. The aim of this study was to assess whether urologists performing penile prosthesis surgery are placed at a greater malpractice risk. Percentage of malpractice suits from prosthesis surgery and other urological procedures that result in payment, average resulting payout from these cases, and category of legal issue that ultimately resulted in payout. A database from the Physician Insurers Association of America, an association of malpractice insurance companies covering physicians in North America, was analyzed to quantitatively compare penile implant surgery to other urological procedures in medicolegal terms. Compared to other common urological procedures, penile implant is comparable and on the lower end of the spectrum in terms of both the percentage of malpractice suits that result in payment and the amount ultimately paid in indemnity from those cases. Additionally, issues of informed consent play the largest role in indemnities for all urological procedures, whereas surgical technique is the most important issue for prosthesis surgery. Urologists who are adequately trained in prosthetic surgery should not avoid penile implant procedures for fear of malpractice suits. A focus on communication and informed consent can greatly reduce malpractice risk for urological procedures.

[Evaluation of the activity of a urological emergency unit in university hospital].

PubMed

Martin, L; Pillot, P; Bardonnaud, N; Lillaz, J; Chabannes, E; Bernardini, S; Guichard, G; Bittard, H; Kleinclauss, F

2014-01-01

To determine the epidemiology of urological emergencies in a university hospital and the interest of a dedicated urological emergency unit. In 2008, a dedicated urological emergency unit was individualized in our department of urology. We conducted a retrospective study including all patients consulting in this unit in 2009 with epidemiological, clinical and therapeutic data. During 2009, 1257 patients consulted in this unit. Main diagnoses were acute urinary retention (303, 24.11%), renal colic (219, 17.42%), urinary infections (278, 22.11%), postoperative complications (141, 11.22%), symptomatic benign prostate hyperplasia (65, 5.17%), genitourinary cancers (61, 4.85%), trauma of urinary apparel (41, 3.26%), and spermatic cords torsion (10, 0.8%). In 99 cases (7.88%) diagnosis did not involved the urinary system. The treatment was surgical in 213 (17.7%) cases, technical procedure under local anesthesia in 368 (29.3%) and a medical treatment in 675 (53.7%) cases. Six hundred and sixty (52.5%) patients were managed ambulatory whereas 596 (47.5%) needed hospitalization. The opening of a dedicated urological emergency unit lead to 1257 emergency consultations. Frequent etiologies were acute urinary retention, renal colic and urinary infection. The creation of this unit allowed to register and to valorize this emergency activity through the ATU emergency amount. Copyright © 2013. Published by Elsevier Masson SAS.

Loss of MeCP2 Causes Urological Dysfunction and Contributes to Death by Kidney Failure in Mouse Models of Rett Syndrome.

PubMed

Ward, Christopher S; Huang, Teng-Wei; Herrera, José A; Samaco, Rodney C; Pitcher, Meagan R; Herron, Alan; Skinner, Steven A; Kaufmann, Walter E; Glaze, Daniel G; Percy, Alan K; Neul, Jeffrey L

2016-01-01

Rett Syndrome (RTT) is a neurodevelopmental disorder characterized by loss of acquired skills during development, autonomic dysfunction, and an increased risk for premature lethality. Clinical experience identified a subset of individuals with RTT that present with urological dysfunction including individuals with frequent urinary tract infections, kidney stones, and urine retention requiring frequent catheterization for bladder voiding. To determine if urologic dysfunction is a feature of RTT, we queried the Rett Syndrome Natural History Study, a repository of clinical data from over 1000 individuals with RTT and found multiple instances of urological dysfunction. We then evaluated urological function in a mouse model of RTT and found an abnormal pattern of micturition. Both male and female mice possessing Mecp2 mutations show a decrease in urine output per micturition event. Furthermore, we identified signs of kidney failure secondary to urethral obstruction. Although genetic strain background significantly affects both survival and penetrance of the urethral obstruction phenotype, survival and penetrance of urethral obstruction do not directly correlate. We have identified an additional phenotype caused by loss of MeCP2, urological dysfunction. Furthermore, we urge caution in the interpretation of survival data as an endpoint in preclinical studies, especially where causes of mortality are poorly characterized.

Loss of MeCP2 Causes Urological Dysfunction and Contributes to Death by Kidney Failure in Mouse Models of Rett Syndrome

PubMed Central

Ward, Christopher S.; Huang, Teng-Wei; Herrera, José A.; Samaco, Rodney C.; Pitcher, Meagan R.; Herron, Alan; Skinner, Steven A.; Kaufmann, Walter E.; Glaze, Daniel G.; Percy, Alan K.; Neul, Jeffrey L.

2016-01-01

Rett Syndrome (RTT) is a neurodevelopmental disorder characterized by loss of acquired skills during development, autonomic dysfunction, and an increased risk for premature lethality. Clinical experience identified a subset of individuals with RTT that present with urological dysfunction including individuals with frequent urinary tract infections, kidney stones, and urine retention requiring frequent catheterization for bladder voiding. To determine if urologic dysfunction is a feature of RTT, we queried the Rett Syndrome Natural History Study, a repository of clinical data from over 1000 individuals with RTT and found multiple instances of urological dysfunction. We then evaluated urological function in a mouse model of RTT and found an abnormal pattern of micturition. Both male and female mice possessing Mecp2 mutations show a decrease in urine output per micturition event. Furthermore, we identified signs of kidney failure secondary to urethral obstruction. Although genetic strain background significantly affects both survival and penetrance of the urethral obstruction phenotype, survival and penetrance of urethral obstruction do not directly correlate. We have identified an additional phenotype caused by loss of MeCP2, urological dysfunction. Furthermore, we urge caution in the interpretation of survival data as an endpoint in preclinical studies, especially where causes of mortality are poorly characterized. PMID:27828991

Can non-urological doctors play a role in early prostate cancer detection?

PubMed

Yazici, Cenk M; Dogan, Cagri

2014-05-06

To evaluate the awareness of non-urological doctors for their role in evaluating prostate cancer (Pca) in scientific manner which may be a possible probability for late diagnosis of Pca. A total of 936 non-urological specialists working in 1 university and 4 education and research hospital who were able to evaluate male patients over 50 years of age were included to the survey. A face to face questionnaire had been administered to all participants. A total of 92 (9.8%) participants were evaluating prostate-specific antigen (PSA) level to all their elderly male patients while 404 (43.2%) participants had never made this evaluation. Among the participants who were evaluating PSA, none was performing an informed decision making consult and even they did not have any idea about the meaning of this strategy. About the criteria for urological consultation, 56 (6%) reported that they consult all their elderly male patients, whereas 880 (94%) answered that they perform consultation if their patients has sought help for any urological symptom. Urologists must remind the non-urological specialists that their approaches to Pca evaluation may change mortality rates of this disease and give them proper information about the scientific evaluation of Pca. This may help us to decrease the mortality rates of Pca.

A review of the available urology skills training curricula and their validation.

PubMed

Shepherd, William; Arora, Karan Singh; Abboudi, Hamid; Shamim Khan, Mohammed; Dasgupta, Prokar; Ahmed, Kamran

2014-01-01

The transforming field of urological surgery continues to demand development of novel training devices and curricula for its trainees. Contemporary trainees have to balance workplace demands while overcoming the cognitive barriers of acquiring skills in rapidly multiplying and advancing surgical techniques. This article provides a brief review of the process involved in developing a surgical curriculum and the current status of real and simulation-based curricula in the 4 subgroups of urological surgical practice: open, laparoscopic, endoscopic, and robotic. An informal literature review was conducted to provide a snapshot into the variety of simulation training tools available for technical and nontechnical urological surgical skills within all subgroups of urological surgery using the following keywords: "urology, surgery, training, curriculum, validation, non-technical skills, technical skills, LESS, robotic, laparoscopy, animal models." Validated training tools explored in research were tabulated and summarized. A total of 20 studies exploring validated training tools were identified. Huge variation was noticed in the types of validity sought by researchers and suboptimal incorporation of these tools into curricula was noted across the subgroups of urological surgery. The following key recommendations emerge from the review: adoption of simulation-based curricula in training; better integration of dedicated training time in simulated environments within a trainee's working hours; better incentivization for educators and assessors to improvise, research, and deliver teaching using the technologies available; and continued emphasis on developing nontechnical skills in tandem with technical operative skills. © 2013 Published by Association of Program Directors in Surgery on behalf of Association of Program Directors in Surgery.

Analysis of Content Legibility for Smartphones of Websites of the Korean Urological Association and Other Urological Societies in Korea

PubMed Central

Lee, Joo Yong; Kang, Dong Hyuk; Moon, Hong Sang; Kim, Yong Tae; Yoo, Tag Keun; Choi, Hong Yong; Lee, Tchun Yong

2011-01-01

Purpose We performed an analysis of the smartphone legibility of the websites of the Korean Urological Association (KUA) and other urological societies. Materials and Methods This study was conducted on the websites of the KUA and nine other urological societies. Each website was accessed via iPhone Safari and Android Chrome, respectively, to evaluate the establishment and readability of the mobile web pages. The provision of Really Simple Syndication (RSS) feeds by the websites and whether the websites had Twitter and Facebook accounts were evaluated. In addition, a validation test on the web standards was performed by using the World Wide Web Consortium (W3C®) Markup Validation Service, and subsequently the numbers of errors and warnings that occurred were analyzed. Results When accessed via Safari, two websites were legible, four were somewhat legible, and four were somewhat illegible. When accessed via Chrome, two websites were legible, six were somewhat legible, and two were somewhat illegible. One website provided an RSS feed and two websites managed members via separate Twitter accounts. No website supported mobile web pages. The result of the W3C® Markup Validation test on 10 websites showed a mean error rate of 221.6 (range, 13-1,477) and a mean warning rate of 127.13 (range, 0-655). Conclusions The smartphone legibility level of the websites of urological societies was relatively low. Improved smartphone legibility and web standard compliance of the websites of urological societies are required to keep up with the popularity of smartphones. PMID:21379433

Financial and educational costs of the residency interview process for urology applicants.

PubMed

Kerfoot, B Price; Asher, Kevin P; McCullough, David L

2008-06-01

To investigate the financial and educational costs of the urology residency interview process, we performed a survey of the applicants to the 2006 urology match. All applicants registered for the 2006 urology match were invited to participate. In January 2006 prior to the match, an anonymous online survey containing 8 questions on the financial and educational costs of the interview process was distributed via email. Survey response rate was 61% (287/468). The median educational debt of the applicants was $125,000 (IQR 65,000 to 160,000). Respondents reported having a median 12 interviews (IQR 8 to 15) with urology residencies and spending a median 20 days (IQR 14 to 30) on the interview trail. The total cost of the interview process was a median $4000 (IQR 2000 to 5200) with a median expense per interview of $330 (IQR 211 to 455). Applicants reported that travel expenses accounted for a median 60% of overall interview expenses, whereas the remainder of the expense was accounted for by lodging (25%), food (10%) and clothing (5%). The money to cover these interview-related expenses was obtained primarily by loans. Forty-six percent of the applicants reported that skipping medical school clerkships and classes for urology interviews was "not at all detrimental" to their medical education, whereas 1% reported that it was "greatly detrimental." The financial cost of the interview process for urology applicants is substantial, although the educational cost appears to be limited. Efforts to reduce the financial impact of the interview process should be initiated at both a regional and national level.

Trends in the Authorship of Peer Reviewed Publications in the Urology Literature.

PubMed

An, Julie Y; Baiocco, Joseph A; Rais-Bahrami, Soroush

2018-05-01

We evaluated the authorship count of all original research and review articles published in prominent Urology journals to trend patterns in authorship over the last decade. Secondarily, we evaluated bibliometric assessments and sought to understand whether authorship count was associated with citation rate and each article's field-normalized measure of impact. Information on authorship count, date of publication, study type, journal of publication, citation rate, and relative citation ratio (RCR) was collected for all original research and review articles published in European Urology, Journal of Urology, Urology , and British Journal of Urology International between 2006 and 2016. We examined trends in authorship count over the past decade, as well as between journals and article types. 21,336 articles were analyzed, of which 19,527 (91.5%) were original research and 1,809 (8.5%) were review articles. Overall, number of authors increased 46.1% from 2006 to 2016. Authorship counts in original research articles increased by an average of 2.45 per manuscript (43.3% increase) over the decade analyzed. More dramatically, authorship counts in review articles increased by an average of 3.14 per manuscript (92.6% increase). Articles with higher authorship counts were associated with more citations and greater RCR (r=0.13, p<0.001). There is a global trend towards more authors per article in urology publications-in both original research publications and review articles, and across each of the individual journals evaluated. An increase in author count has also been associated with increased citations and measures of article impact.

The top 100 cited articles on urological emergencies: A bibliometric analysis.

PubMed

Kazımoğlu, Hatem; Dokur, Mehmet

2018-05-01

In this study, we bibliometrically evaluated the top 100 cited articles on urological emergencies published since 1975 with a multidisciplinary and interdisciplinary perspective. We obtained the data for this study from the Thomson Reuters Web of Science and PubMed. We determined 360 articles which were related directly or indirectly to urological emergencies between 1975 and 2017 and analyzed retrospectively the top 100 cited articles among these. The mean citation impact factor of the top 100 cited articles was 25.8±50.1 (range: 4-467) between 1991 and 2014. We determined that classical articles were cited for 2588 times and the total number of self-citations was 23 (0.8%). Highest publication rate per year was in 2006 (n=9). Among the institutions which published ≥2 articles per year University of Texas led the way with 5 articles. The top 100 articles came from 27 countries and 58% of these are from the USA (n=29), the United Kingdom (n=23) and Germany (n=6). For the top 3 journals of the 33 of top 100 articles most frequently cited were published in journals with an impact factor ≥2 namely, Journal of Urology (n=15), British Journal of Urology International (n=13) and Urology (n=5) respectively. The most frequently cited main topics were penile emergencies with 22 articles and acute scrotal problems with 15 articles. Most of the classical articles on urological emergencies were based on clinical researches (n=95) and also we found that the average level of evidence for the top 100 cited articles was 4.16 (range: 1-5). Mostly preferred publishing language was English among this scientific papers (n=90). Although not considered as a completely unbiased and adequate criterion for scientific evaluations, analysis of the top 100 cited articles provides us with important current data on urological emergencies.

The top 100 cited articles on urological emergencies: A bibliometric analysis

PubMed Central

Dokur, Mehmet

2018-01-01

Objective In this study, we bibliometrically evaluated the top 100 cited articles on urological emergencies published since 1975 with a multidisciplinary and interdisciplinary perspective. Material and methods We obtained the data for this study from the Thomson Reuters Web of Science and PubMed. We determined 360 articles which were related directly or indirectly to urological emergencies between 1975 and 2017 and analyzed retrospectively the top 100 cited articles among these. Results The mean citation impact factor of the top 100 cited articles was 25.8±50.1 (range: 4–467) between 1991 and 2014. We determined that classical articles were cited for 2588 times and the total number of self-citations was 23 (0.8%). Highest publication rate per year was in 2006 (n=9). Among the institutions which published ≥2 articles per year University of Texas led the way with 5 articles. The top 100 articles came from 27 countries and 58% of these are from the USA (n=29), the United Kingdom (n=23) and Germany (n=6). For the top 3 journals of the 33 of top 100 articles most frequently cited were published in journals with an impact factor ≥2 namely, Journal of Urology (n=15), British Journal of Urology International (n=13) and Urology (n=5) respectively. The most frequently cited main topics were penile emergencies with 22 articles and acute scrotal problems with 15 articles. Most of the classical articles on urological emergencies were based on clinical researches (n=95) and also we found that the average level of evidence for the top 100 cited articles was 4.16 (range: 1–5). Mostly preferred publishing language was English among this scientific papers (n=90). Conclusion Although not considered as a completely unbiased and adequate criterion for scientific evaluations, analysis of the top 100 cited articles provides us with important current data on urological emergencies. PMID:29733798

Urology technical and non-technical skills development: the emerging role of simulation.

PubMed

Rashid, Prem; Gianduzzo, Troy R J

2016-04-01

To review the emerging role of technical and non-technical simulation in urological education and training. A review was conducted to examine the current role of simulation in urology training. A PUBMED search of the terms 'urology training', 'urology simulation' and 'urology education' revealed 11,504 titles. Three hundred and fifty-seven abstracts were identified as English language, peer reviewed papers pertaining to the role of simulation in urology and related topics. Key papers were used to explore themes. Some cross-referenced papers were also included. There is an ongoing need to ensure that training time is efficiently utilised while ensuring that optimal technical and non-technical skills are achieved. Changing working conditions and the need to minimise patient harm by inadvertent errors must be taken into account. Simulation models for specific technical aspects have been the mainstay of graduated step-wise low and high fidelity training. Whole scenario environments as well as non-technical aspects can be slowly incorporated into the curriculum. Doing so should also help define what have been challenging competencies to teach and evaluate. Dedicated time, resources and trainer up-skilling are important. Concurrent studies are needed to help evaluate the effectiveness of introducing step-wise simulation for technical and non-technical competencies. Simulation based learning remains the best avenue of progressing surgical education. Technical and non-technical simulation could be used in the selection process. There are good economic, logistic and safety reasons to pursue the process of ongoing development of simulation co-curricula. While the role of simulation is assured, its progress will depend on a structured program that takes advantage of what can be delivered via this medium. Overall, simulation can be developed further for urological training programs to encompass technical and non-technical skill development at all stages, including recertification. © 2015 The Authors BJU International © 2015 BJU International Published by John Wiley & Sons Ltd.

Failure of pre-natal ultrasonography to prevent urinary infection associated with underlying urological abnormalities.

PubMed

Lakhoo, K; Thomas, D F; Fuenfer, M; D'Cruz, A J

1996-06-01

To analyse the reasons underlying the failure of routine pre-natal ultrasonography to prevent the subsequent development of urinary tract infection (UTI) in children with predisposing urological abnormalities. This retrospective study comprised 39 children (22 females and 17 males) who had at least one documented UTI, the presence of an anatomical anomaly of the urinary tract recognized as predisposing to UTI and had undergone ultrasonography of the urinary tract undertaken in fetal life as part of routine maternal ante-natal ultrasonography. Four categories of patients were defined: Group A, those with normal findings on pre-natal ultrasonography and no urological abnormality detected; Group B, those with a urological abnormality detected but where there was a subsequent failure of communication among clinicians; Group C, those with a urological abnormality but who received inappropriate or sub-optimal post-natal management and; Group D, those with a urological abnormality but who had a UTI despite appropriate post-natal management. In each case, the most severe documented episode of UTI was categorized as: Grade I, asymptomatic bacteriuria; Grade II, mild/moderate symptomatic UTI and; Grade III, severe symptomatic UTI necessitating hospital admission. Group A comprised 22 (56%), Group B three (9%), Group C two (5%) and Group D 12 children (31%). Of the 22 children in Group A, nine experienced a UTI of sufficient severity to necessitate hospital admission. Of the 12 children in Group D only one required hospital admission. The failure of pre-natal ultrasonography to identify the underlying predisposing urological abnormality was the most important factor contributing to subsequent UTI in post-natal life. Failure of communication and inappropriate post-natal management were numerically unimportant. In some children, UTI occurred despite pre-natal detection of their underlying anomaly and appropriate post-natal management. However, in this group the UTI was less severe than in those children whose urological anomalies had not been detected by pre-natal ultrasonography.

Implications of Biofilm Formation on Urological Devices

NASA Astrophysics Data System (ADS)

Cadieux, Peter A.; Wignall, Geoffrey R.; Carriveau, Rupp; Denstedt, John D.

2008-09-01

Despite millions of dollars and several decades of research targeted at their prevention and eradication, biofilm-associated infections remain the major cause of urological device failure. Numerous strategies have been aimed at improving device design, biomaterial composition, surface properties and drug delivery, but have been largely circumvented by microbes and their plethora of attachment, host evasion, antimicrobial resistance, and dissemination strategies. This is not entirely surprising since natural biofilm formation has been going on for millions of years and remains a major part of microorganism survival and evolution. Thus, the fact that biofilms develop on and in the biomaterials and tissues of humans is really an extension of this natural tendency and greatly explains why they are so difficult for us to combat. Firstly, biofilm structure and composition inherently provide a protective environment for microorganisms, shielding them from the shear stress of urine flow, immune cell attack and some antimicrobials. Secondly, many biofilm organisms enter a metabolically dormant state that renders them tolerant to those antibiotics and host factors able to penetrate the biofilm matrix. Lastly, the majority of organisms that cause biofilm-associated urinary tract infections originate from our own oral cavity, skin, gastrointestinal and urogenital tracts and therefore have already adapted to many of our host defenses. Ultimately, while biofilms continue to hold an advantage with respect to recurrent infections and biomaterial usage within the urinary tract, significant progress has been made in understanding these dynamic microbial communities and novel approaches offer promise for their prevention and eradication. These include novel device designs, antimicrobials, anti-adhesive coatings, biodegradable polymers and biofilm-disrupting compounds and therapies.

Urologic Oncology Branch - Training - NCI/AFUD | Center for Cancer Research

Cancer.gov

Postdoctoral Research Training Program This program is designed to train Ph.D. postdoctoral scientists in the growing field of urologic oncology. This program offers fellows the opportunity to participate in a diverse training experience that includes clinical and laboratory research on several urologic malignancies. The program provides an opportunity for selected individuals to complete a research project under the direction of a Senior Investigator in the Intramural Program of the National Cancer Institute.

Radiographer-performed abdominal and pelvic ultrasound: its value in a urology out-patient clinic.

PubMed

Nargund, V H; Lomas, K; Sapherson, D A; Flannigan, G M; Stewart, P A

1994-04-01

To assess the efficacy of radiographer-performed ultrasound examination as a routine investigative procedure in a urological out-patient clinic. A total of 151 patients attending a District General Hospital Urological Out-patient Department underwent an ultrasound examination in the clinic. Diagnosis by ultrasound was achieved in 93% of patients. The remaining patients underwent further investigations. Two (1%) patients with normal scans had small bladder tumours. Subsequent intravenous urography in these individuals showed normal upper tracts. Abdominal and pelvic ultrasound examination performed in the urological out-patient clinic on unprepared patients was the only investigation necessary for evaluation of common problems such as non-specific urinary symptoms, recurrent urinary tract infections and bladder outlet obstruction.

Percutaneous endoscopic holmium laser lithotripsy for management of complicated biliary calculi.

PubMed

Healy, Kelly; Chamsuddin, Abbas; Spivey, James; Martin, Louis; Nieh, Peter; Ogan, Kenneth

2009-01-01

Advances in endoscopic techniques have transformed the management of urolithiasis. We sought to evaluate the role of such urological interventions for the treatment of complex biliary calculi. We conducted a retrospective review of all patients (n=9) undergoing percutaneous holmium laser lithotripsy for complicated biliary calculi over a 4-year period (12/2003 to 12/2007). All previously failed standard techniques include ERCP with sphincterotomy (n=6), PTHC (n=7), or both of these. Access to the biliary system was obtained via an existing percutaneous transhepatic catheter or T-tube tracts. Endoscopic holmium laser lithotripsy was performed via a flexible cystoscope or ureteroscope. Stone clearance was confirmed intra- and post-operatively. A percutaneous transhepatic drain was left indwelling for follow-up imaging. Mean patient age was 65.6 years (range, 38 to 92). Total stone burden ranged from 1.7 cm to 5 cm. All 9 patients had stones located in the CBD, with 2 patients also having additional stones within the hepatic ducts. All 9 patients (100%) were visually stone-free after one endoscopic procedure. No major perioperative complications occurred. Mean length of stay was 2.4 days. At a mean radiological follow-up of 5.4 months (range, 0.5 to 21), no stone recurrence was noted. Percutaneous endoscopic holmium laser lithotripsy is a minimally invasive alternative to open salvage surgery for complex biliary calculi refractory to standard approaches. This treatment is both safe and efficacious. Success depends on a multidisciplinary approach.

Percutaneous Endoscopic Holmium Laser Lithotripsy for Management of Complicated Biliary Calculi

PubMed Central

Healy, Kelly; Chamsuddin, Abbas; Spivey, James; Martin, Louis; Nieh, Peter

2009-01-01

Background and Objectives: Advances in endoscopic techniques have transformed the management of urolithiasis. We sought to evaluate the role of such urological interventions for the treatment of complex biliary calculi. Methods: We conducted a retrospective review of all patients (n=9) undergoing percutaneous holmium laser lithotripsy for complicated biliary calculi over a 4-year period (12/2003 to 12/2007). All previously failed standard techniques include ERCP with sphincterotomy (n=6), PTHC (n=7), or both of these. Access to the biliary system was obtained via an existing percutaneous transhepatic catheter or T-tube tracts. Endoscopic holmium laser lithotripsy was performed via a flexible cystoscope or ureteroscope. Stone clearance was confirmed intra- and postoperatively. A percutaneous transhepatic drain was left indwelling for follow-up imaging. Results: Mean patient age was 65.6 years (range, 38 to 92). Total stone burden ranged from 1.7 cm to 5 cm. All 9 patients had stones located in the CBD, with 2 patients also having additional stones within the hepatic ducts. All 9 patients (100%) were visually stone-free after one endoscopic procedure. No major perioperative complications occurred. Mean length of stay was 2.4 days. At a mean radiological follow-up of 5.4 months (range, 0.5 to 21), no stone recurrence was noted. Conclusions: Percutaneous endoscopic holmium laser lithotripsy is a minimally invasive alternative to open salvage surgery for complex biliary calculi refractory to standard approaches. This treatment is both safe and efficacious. Success depends on a multidisciplinary approach. PMID:19660213

Prospective study of robotic partial nephrectomy for renal cancer in Japan: Comparison with a historical control undergoing laparoscopic partial nephrectomy.

PubMed

Tanaka, Kazushi; Teishima, Jun; Takenaka, Atsushi; Shiroki, Ryoichi; Kobayashi, Yasuyuki; Hattori, Kazunori; Kanayama, Hiro-Omi; Horie, Shigeo; Yoshino, Yasushi; Fujisawa, Masato

2018-05-01

To evaluate the outcomes of robotic partial nephrectomy compared with those of laparoscopic partial nephrectomy for T1 renal tumors in Japanese centers. Patients with a T1 renal tumor who underwent robotic partial nephrectomy were eligible for inclusion in the present study. The primary end-point consisted of three components: a negative surgical margin, no conversion to open or laparoscopic surgery and a warm ischemia time ≤25 min. We compared data from these patients with the data from a retrospective study of laparoscopic partial nephrectomy carried out in Japan. A total of 108 patients were registered in the present study; 105 underwent robotic partial nephrectomy. The proportion of patients who met the primary end-point was 91.3% (95% confidence interval 84.1-95.9%), which was significantly higher than 23.3% in the historical data. Major complications were seen in 19 patients (18.1%). The mean change in the estimated glomerular filtration rate in the operated kidney, 180 days postoperatively, was -10.8 mL/min/1.73 m 2 (95% confidence interval -12.3-9.4%). Robotic partial nephrectomy for patients with a T1 renal tumor is a safe, feasible and more effective operative method compared with laparoscopic partial nephrectomy. It can be anticipated that robotic partial nephrectomy will become more widely used in Japan in the future. © 2018 The Japanese Urological Association.

See, Do, Teach? A Review of Contemporary Literature and Call to Action for Communication Skills Teaching in Urology.

PubMed

Kieran, Kathleen; Jensen, Norman M; Rosenbaum, Marcy

2018-04-01

To assess the current state of published literature on communication skills teaching in urology to inform future directions for research and teaching. Excellent patient-physician communication skills increase understanding of medical conditions, facilitate shared decision-making regarding treatment planning, improve clinical outcomes, and decrease lawsuits. Surgical and procedure-based subspecialties, including urology, have generally been slow to incorporate formal communication skills teaching into curricula for postgraduate trainees. We performed a PubMed literature search using multiple keywords, selecting and reviewing articles published in English, and addressing 1 of 3 domains (curriculum development, teaching methods, and assessment methods) of communication skills teaching. The distribution of articles within the urology-specific literature was compared with that of procedure-based specialties as a whole. Eight articles were found in the urology literature, and 24 articles were found in other procedure-based specialties. Within the urology-specific literature, all 8 articles (100%) acknowledged the need for communication curriculum development, 1 article (12.5%) described how communication skills were taught, and 1 article (12.5%) discussed how communication skills were assessed. Fewer articles in other procedure-based specialties acknowledged the need to develop curricula (29.2%, P = .0007) but were equally likely to discuss communication skills teaching (37.5%, P = .63) and assessment (33.3%, P = .73). Orthopedic surgery is the only surgical subspecialty with ongoing, adaptable, formal training for physicians. Most current publications addressing communication skills in procedure-based specialties are specialty specific and focus on only 1 of the 3 communication domains. Opportunities exist to share information and to create more integrated models to teach communication skills in urology. Copyright © 2018 Elsevier Inc. All rights reserved.

Is it necessary to remove the seminal vesicles completely at radical prostatectomy? decision curve analysis of European Society of Urologic Oncology criteria.

PubMed

Secin, Fernando P; Bianco, Fernando J; Cronin, Angel; Eastham, James A; Scardino, Peter T; Guillonneau, Bertrand; Vickers, Andrew J

2009-02-01

A publication on behalf of the European Society of Urological Oncology questioned the need for removing the seminal vesicles during radical prostatectomy in patients with prostate specific antigen less than 10 ng/ml except when biopsy Gleason score is greater than 6 or there are greater than 50% positive biopsy cores. We applied the European Society of Urological Oncology algorithm to an independent data set to determine its predictive value. Data on 1,406 men who underwent radical prostatectomy and seminal vesicle removal between 1998 and 2004 were analyzed. Patients with and without seminal vesicle invasion were classified as positive or negative according to the European Society of Urological Oncology algorithm. Of 90 cases with seminal vesicle invasion 81 (6.4%) were positive for 90% sensitivity, while 656 of 1,316 without seminal vesicle invasion were negative for 50% specificity. The negative predictive value was 98.6%. In decision analytic terms if the loss in health when seminal vesicles are invaded and not completely removed is considered at least 75 times greater than when removing them unnecessarily, the algorithm proposed by the European Society of Urological Oncology should not be used. Whether to use the European Society of Urological Oncology algorithm depends not only on its accuracy, but also on the relative clinical consequences of false-positive and false-negative results. Our threshold of 75 is an intermediate value that is difficult to interpret, given uncertainties about the benefit of seminal vesicle sparing and harm associated with untreated seminal vesicle invasion. We recommend more formal decision analysis to determine the clinical value of the European Society of Urological Oncology algorithm.

Citation Analysis of the Korean Journal of Urology From Web of Science, Scopus, Korean Medical Citation Index, KoreaMed Synapse, and Google Scholar

PubMed Central

2013-01-01

The Korean Journal of Urology began to be published exclusively in English in 2010 and is indexed in PubMed Central/PubMed. This study analyzed a variety of citation indicators of the Korean Journal of Urology before and after 2010 to clarify the present position of the journal among the urology category journals. The impact factor, SCImago Journal Rank (SJR), impact index, Z-impact factor (ZIF, impact factor excluding self-citation), and Hirsch Index (H-index) were referenced or calculated from Web of Science, Scopus, SCImago Journal & Country Ranking, Korean Medical Citation Index (KoMCI), KoreaMed Synapse, and Google Scholar. Both the impact factor and the total citations rose rapidly beginning in 2011. The 2012 impact factor corresponded to the upper 84.9% in the nephrology-urology category, whereas the 2011 SJR was in the upper 58.5%. The ZIF in KoMCI was one fifth of the impact factor because there are only two other urology journals in KoMCI. Up to 2009, more than half of the citations in the Web of Science were from Korean researchers, but from 2010 to 2012, more than 85% of the citations were from international researchers. The H-indexes from Web of Science, Scopus, KoMCI, KoreaMed Synapse, and Google Scholar were 8, 10, 12, 9, and 18, respectively. The strategy of the language change in 2010 was successful from the perspective of citation indicators. The values of the citation indicators will continue to increase rapidly and consistently as the research achievement of authors of the Korean Journal of Urology increases. PMID:23614057

Citation Analysis of the Korean Journal of Urology From Web of Science, Scopus, Korean Medical Citation Index, KoreaMed Synapse, and Google Scholar.

PubMed

Huh, Sun

2013-04-01

The Korean Journal of Urology began to be published exclusively in English in 2010 and is indexed in PubMed Central/PubMed. This study analyzed a variety of citation indicators of the Korean Journal of Urology before and after 2010 to clarify the present position of the journal among the urology category journals. The impact factor, SCImago Journal Rank (SJR), impact index, Z-impact factor (ZIF, impact factor excluding self-citation), and Hirsch Index (H-index) were referenced or calculated from Web of Science, Scopus, SCImago Journal & Country Ranking, Korean Medical Citation Index (KoMCI), KoreaMed Synapse, and Google Scholar. Both the impact factor and the total citations rose rapidly beginning in 2011. The 2012 impact factor corresponded to the upper 84.9% in the nephrology-urology category, whereas the 2011 SJR was in the upper 58.5%. The ZIF in KoMCI was one fifth of the impact factor because there are only two other urology journals in KoMCI. Up to 2009, more than half of the citations in the Web of Science were from Korean researchers, but from 2010 to 2012, more than 85% of the citations were from international researchers. The H-indexes from Web of Science, Scopus, KoMCI, KoreaMed Synapse, and Google Scholar were 8, 10, 12, 9, and 18, respectively. The strategy of the language change in 2010 was successful from the perspective of citation indicators. The values of the citation indicators will continue to increase rapidly and consistently as the research achievement of authors of the Korean Journal of Urology increases.

Sleep-related problems and urologic symptoms: Testing the hypothesis of bi-directionality in a longitudinal, population-based study

PubMed Central

Araujo, Andre B.; Yaggi, H. Klar; Yang, May; McVary, Kevin T.; Fang, Shona C.; Bliwise, Donald L.

2013-01-01

Purpose To evaluate the bi-directional association between urologic symptoms (urinary incontinence (UI), lower urinary tract symptoms (LUTS), and nocturia) and sleep-related variables. Materials and Methods Data were obtained from a prospective cohort study of 1,610 men and 2,535 women who completed baseline (2002–05) and follow-up (2006–10) phases of the Boston Area Community Health (BACH) survey, a population-based random sample survey. Sleep restriction (≤5 hours/night), restless sleep, sleep medication use, and urologic symptoms were assessed by self-report. UI was defined as weekly leakage or moderate/severe leakage, LUTS (overall, obstructive, irritative) was defined by American Urological Association Symptom Index, and nocturia was defined as urinary frequency ≥2 times/night. Results At the 5 year follow-up,10.0%, 8.5% and 16.0% of subjects newly reported LUTS, UI and nocturia, respectively, and 24.2%, 13.3%, 11.6% newly reported poor sleep quality, sleep restriction and use of sleep medication, respectively. Controlling for confounders, the odds of developing urologic symptoms was consistently increased for subjects who reported poor sleep quality and sleep restriction at baseline, but only baseline nocturia was positively associated with incident sleep-related problems at follow-up. Body mass index, a potential mediator, reduced selected associations between sleep and incident UI and irritative symptoms, but C-reactive protein did not. Conclusions These data suggest that self-reported sleep-related problems and urologic symptoms are linked bi-directionally, and BMI may be a factor in the relationship between sleep and development of urologic symptoms. PMID:23867307

Increased risks of upper tract urothelial carcinoma in male and female chinese herbalists.

PubMed

Yang, Hsiao-Yu; Wang, Jung-Der; Lo, Tsai-Chang; Chen, Pau-Chung

2011-03-01

It has been shown that herbs that contain aristolochic acid induce urological cancer. Chinese herbalists have easy access to such herbs. Our previous mortality study has shown a significantly increased risk of urological cancer in female but not male herbalists. To re-examine this risk in male herbalists, the incidence of urological cancer was analyzed. We enrolled all 6550 Chinese herbalists in Taiwan registered during 1985-2000, and we retrospectively followed the development of cancer until 2001 by analysis of data collected from the Taiwan Cancer Registry. Standardized incidence ratios (SIRs) were calculated for urological cancers in herbalists and compared with those for the general population in Taiwan. There were 30 newly diagnosed cases of urological cancer and most of them were transitional cell carcinoma (93.1%). The mean age at diagnosis for urothelial carcinoma was 51.6 years, and 51.9% were in the upper urinary tract. After adjustment for age and sex, the SIR for all urological cancers was 3.51 [(95% confidence interval (CI): 2.37-5.01]. When stratified by location, the SIRs for kidney and upper urinary tract cancers and bladder cancer were 4.24 (95% CI: 2.47-6.80) and 2.86 (95% CI: 1.52-4.89), respectively. When analyzed by sex, the SIRs for all urological cancers, kidney and upper urinary tract cancers, and bladder cancer were also significantly increased in male herbalists. The significant risk of urothelial carcinoma noted in male herbalists increases our suspicion that this is an occupational disease that renders regular health assessment of herbalists an urgent necessity. Copyright © 2011 Formosan Medical Association & Elsevier. Published by Elsevier B.V. All rights reserved.

Longitudinal Gender Disparity in Female Urology Resident Primary Authorship at an American Urological Association Sectional Meeting.

PubMed

Lin, Tony R; Kocher, Neil J; Klausner, Adam P; Raman, Jay D

2017-12-01

To further evaluate the academic representation of female urology residents in the United States, we reviewed abstracts from the Mid-Atlantic American Urological Association (MA-AUA) sectional meetings to determine if the recent increase in the number of female urology residents mirrored an increase in this group's abstract authorship. Full text abstracts from the MA-AUA meetings were analyzed from 2008 to 2014 excluding 1 joint section meeting. First-author gender was determined by querying publicly available institutional websites, social media platforms, and the U.S. News & World Report. First-author gender was indeterminable in 10 abstracts based on search criteria and these were excluded. Individual abstracts were broadly categorized based on keywords into 1 of several topics. Chi-square statistical tests examined the relationship between first-authorship gender, publication year, and abstract category. The number of female urology residents in the MA-AUA increased over the study period. A total of 484 abstracts were analyzed. Three hundred ninety-three abstracts (81%) included a male first-author, whereas 81 abstracts (17%) included a female first-author. Female first-authorship ranged from 13% to 25% annually. Comparison of male-to-female first-authorship was statistically significant in all years evaluated (P <.001). There was a statistically significant difference between male and female first-authorship in all topic categories (P <.01), except Education/Other (P = .56). Despite continued gains and increasing female representation in urology, these data highlight significantly fewer female first-authors at the regional Mid-Atlantic section meetings. Larger studies are necessary to identify contributing factors and further areas for improvement toward decreasing gender imbalances within the academic community. Copyright © 2017 Elsevier Inc. All rights reserved.

From Leonardo to da Vinci: the history of robot-assisted surgery in urology.

PubMed

Yates, David R; Vaessen, Christophe; Roupret, Morgan

2011-12-01

What's known on the subject? and What does the study add? Numerous urological procedures can now be performed with robotic assistance. Though not definitely proven to be superior to conventional laparoscopy or traditional open surgery in the setting of a randomised trial, in experienced centres robot-assisted surgery allows for excellent surgical outcomes and is a valuable tool to augment modern surgical practice. Our review highlights the depth of history that underpins the robotic surgical platform we utilise today, whilst also detailing the current place of robot-assisted surgery in urology in 2011. The evolution of robots in general and as platforms to augment surgical practice is an intriguing story that spans cultures, continents and centuries. A timeline from Yan Shi (1023-957 bc), Archytas of Tarentum (400 bc), Aristotle (322 bc), Heron of Alexandria (10-70 ad), Leonardo da Vinci (1495), the Industrial Revolution (1790), 'telepresence' (1950) and to the da Vinci(®) Surgical System (1999), shows the incredible depth of history and development that underpins the modern surgical robot we use to treat our patients. Robot-assisted surgery is now well-established in Urology and although not currently regarded as a 'gold standard' approach for any urological procedure, it is being increasingly used for index operations of the prostate, kidney and bladder. We perceive that robotic evolution will continue infinitely, securing the place of robots in the history of Urological surgery. Herein, we detail the history of robots in general, in surgery and in Urology, highlighting the current place of robot-assisted surgery in radical prostatectomy, partial nephrectomy, pyeloplasty and radical cystectomy. © 2011 THE AUTHORS. BJU INTERNATIONAL © 2011 BJU INTERNATIONAL.

Exposure to and Attitudes Regarding Transgender Education Among Urology Residents.

PubMed

Dy, Geolani W; Osbun, Nathan C; Morrison, Shane D; Grant, David W; Merguerian, Paul A

2016-10-01

Transgender individuals are underserved within the health care system but might increasingly seek urologic care as insurers expand coverage for medical and surgical gender transition. To evaluate urology residents' exposure to transgender patient care and their perceived importance of transgender surgical education. Urology residents from a representative sample of U.S. training programs were asked to complete a cross-sectional survey from January through March 2016. Respondents were queried regarding demographics, transgender curricular exposure (didactic vs clinical), and perceived importance of training opportunities in transgender patient care. In total, 289 urology residents completed the survey (72% response rate). Fifty-four percent of residents reported exposure to transgender patient care, with more residents from Western (74%) and North Central (72%) sections reporting exposure (P ≤ .01). Exposure occurred more frequently through direct patient interaction rather than through didactic education (psychiatric, 23% vs 7%, P < .001; medical, 17% vs 6%, P < .001; surgical, 33% vs 11%, P < .001). Female residents placed greater importance on gender-confirming surgical training than did their male colleagues (91% vs 70%, P < .001). Compared with Western section residents (88%), those from South Central (60%, P = .002), Southeastern (63%, P = .002), and Mid-Atlantic (63%, P = .003) sections less frequently viewed transgender-related surgical training as important. Most residents (77%) stated transgender-related surgical training should be offered in fellowships. Urology resident exposure to transgender patient care is regionally dependent. Perceived importance of gender-confirming surgical training varies by sex and geography. A gap exists between the direct transgender patient care urology residencies provide and the didactic transgender education they receive. Copyright © 2016 International Society for Sexual Medicine. Published by Elsevier Inc. All rights reserved.

Long-term experience and outcomes of robotic assisted laparoscopic pyeloplasty in children and young adults.

PubMed

Minnillo, Brian J; Cruz, Jose A S; Sayao, Rogerio H; Passerotti, Carlo C; Houck, Constance S; Meier, Petra M; Borer, Joseph G; Diamond, David A; Retik, Alan B; Nguyen, Hiep T

2011-04-01

Laparoscopic pyeloplasty is one of the more common robotic assisted procedures performed in children. However, data regarding long-term experience and clinical outcomes for this procedure are limited. We evaluated the long-term outcomes in a large series of patients undergoing robotic assisted laparoscopic pyeloplasty at a teaching institution, and the effect of a collaborative program between the robotic surgeons, surgical nurses and anesthesiologists on overall operative time. We retrospectively reviewed 155 patients who underwent robotic assisted laparoscopic pyeloplasty between 2002 and 2009. Operative data, including surgical approach, type of procedure, total and specific operative times and placement of ureteral stents, were determined. Postoperative outcome measurements, including duration of hospital stay, duration of Foley catheter drainage, radiological findings and any subsequent complications, were assessed. Mean operative time and length of hospitalization decreased significantly by the end of the study. At a mean followup of 31.7 months the primary success rate was 96% (hydronephrosis was improved in 85% of patients and stable in 11%). The complication rate was 11%, and recurrent obstruction requiring redo robotic assisted laparoscopic pyeloplasty or open pyeloplasty developed in 3% of patients. Success rate and complication rate were unchanged during the study period. This study confirms that even within the confines of a pediatric urology training program successful collaboration between robotic surgeons, surgical nurses and anesthesiologists can lead to shorter operative times and hospital stays. Long-term surgical success and complication rates were comparable to open surgery. Copyright © 2011 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.

Comparison of the epidemiologic features and patterns of initial care for prostate cancer between public and private institutions: a survey by the Brazilian Society of Urology.

PubMed

Nardi, Aguinaldo Cesar; Reis, Rodolfo Borges dos; Zequi, Stenio de Cassio; Nardozza, Archimedes

2012-01-01

To describe the epidemiological features and patterns of initial care for prostate cancer at public and private institutions in the State of Sao Paulo, Brazil. A total of 1,082 physicians affiliated to the Sao Paulo Section of the Brazilian Society of Urology were invited to participate in this cross-sectional, web-based survey. Between September 2004 and September 2005, participating urologists entered data on demographic, clinical and pathological characteristics of patients diagnosed with prostate cancer in their practice. Data on patients attended at public institutions were analyzed and compared with those patients attended at private practice. One hundred and ten society members contributed with data from 1915 patients, 1026 (53.6%) of whom from public institutions. When compared with patients attended at private institutions, those attended at public institutions were older and more likely to be black, had higher serum prostate specific antigen (PSA) levels, had a higher probability of being diagnosed with metastatic disease, but were less likely to undergo prostatectomy (all P < 0.001). In multivariate analysis, age, biopsy Gleason score, and being attended at a public institution were independently associated with metastatic disease upon diagnosis. The significant predictors of nonsurgical treatment were age, black race, and higher serum levels of PSA. A statewide registry provides valuable information regarding patient demographics, clinical features, and patterns of care. The results of this study suggest that significant disparities exist for patients with prostate cancer attended at different health-care systems. The relative contribution of biological versus socioeconomic features remains uncertain.

Comparison of effect of electroacupuncture and nefopam for prevention of postanesthetic shivering in patients undergoing urologic operation under spinal anesthesia

PubMed Central

Hwang, Min-Sub

2016-01-01

Background Shivering during spinal anesthesia is a frequent complication and is induced by the core-to-peripheral redistribution of heat. Nefopam has minimal side effects and prevents shivering by reducing the shivering threshold. Electroacupuncture is known to prevent shivering by preserving the core body temperature. We compared the efficacies of electroacupuncture and nefopam for the prevention of shivering during spinal anesthesia. Methods Ninety patients scheduled for elective urological surgery under spinal anesthesia were enrolled in the study. Patients were randomly divided into the control group (Group C, n = 30), the electroacupuncture group (Group A, n = 30), and the nefopam group (Group N, n = 30). Groups C and A received 100 ml of isotonic saline intravenously for 30 minutes before spinal anesthesia, while Group N received nefopam (0.15 mg/kg) mixed in 100 ml of isotonic saline. Group A received 30 minutes of electroacupuncture before receiving anesthesia. Shivering scores, mean arterial pressure, heart rate, body temperature and side effects were recorded before, and at 5, 15, 30, and 60 minutes after spinal anesthesia. Results The incidence of postanesthetic shivering was significantly lower in Group N (10 of 30) and Group A (4 of 30) compared with that in Group C (18 of 30)(P < 0.017). Body temperature was higher in Group N and Group A than in Group C (P < 0.05). Hemodynamic parameters were not different among the groups. Conclusions By maintaining body temperature during spinal anesthesia, electroacupuncture is as effective as nefopam in preventing postanesthetic shivering. PMID:27924198

Preoperative and intraoperative predictors of cardiac adverse events after general, vascular, and urological surgery.

PubMed

Kheterpal, Sachin; O'Reilly, Michael; Englesbe, Michael J; Rosenberg, Andrew L; Shanks, Amy M; Zhang, Lingling; Rothman, Edward D; Campbell, Darrell A; Tremper, Kevin K

2009-01-01

The authors sought to determine the incidence and risk factors for perioperative cardiac adverse events (CAEs) after noncardiac surgery using detailed preoperative and intraoperative hemodynamic data. The authors conducted a prospective observational study at a single university hospital from 2002 to 2006. All American College of Surgeons-National Surgical Quality Improvement Program patients undergoing general, vascular, and urological surgery were included. The CAE outcome definition included cardiac arrest, non-ST elevation myocardial infarction, Q-wave myocardial infarction, and new clinically significant cardiac dysrhythmia within the first 30 postoperative days. Four years of data demonstrated that of 7,740 noncardiac operations, 83 patients (1.1%) experienced a CAE within 30 days. Nine independent predictors were identified (P < or = 0.05): age > or = 68, body mass index > or = 30, emergent surgery, previous coronary intervention or cardiac surgery, active congestive heart failure, cerebrovascular disease, hypertension, operative duration > or = 3.8 h, and the administration of 1 or more units of packed red blood cells intraoperatively. The c-statistic of this model was 0.81 +/- 0.02. Univariate analysis demonstrated that high-risk patients experiencing a CAE were more likely to experience an episode of mean arterial pressure < 50 mmHg (6% vs. 24%, P = 0.02), experience an episode of 40% decrease in mean arterial pressure (26% vs. 53%, P = 0.01), and an episode of heart rate > 100 (22% vs. 34%, P = 0.05). In comparison with current risk stratification indices, the inclusion of intraoperative elements improves the ability to predict a perioperative CAE after noncardiac surgery.

European Association of Urology - 32nd Annual Congress (March 24-28, 2017 - London, UK).

PubMed

Sharman, R

2017-04-01

The European Association of Urology (EAU) Congress is Europe's biggest urological event and this year's meeting, in London, UK, brought together more than 13,000 participants from over 100 countries to discuss the latest research in this field. With 5 days' worth of lectures, debates, learning courses, presentations and live surgeries the congress provided plenty of opportunity to learn from the 1,400 experts presenting, as well as to network with international peers.

Urological considerations in space medicine.

NASA Technical Reports Server (NTRS)

Cockett, A. T. K.; Adey, W. R.; Roberts, A. P.

1972-01-01

Urological problems encountered during the preparation phases of Biosatellite III, flight of Bonny the Space Monkey, are detailed. The solution to each problem is detailed. The catheter system employed, antibiotic coverage used, and bacteria encountered in the urine of the five animals are detailed. Urinary calcium levels in three ground based animals are illustrated. Testicular alterations encountered in all animals are mentioned. It is concluded that space flights of duration beyond nine days may present serious problems of a urological nature.

Increased Prevalence of Renal and Urinary Tract Anomalies in Children with Congenital Hypothyroidism

PubMed Central

Kumar, Juhi; Gordillo, Roberto; Kaskel, Frederick J.; Druschel, Charlotte M.; Woroniecki, Robert P.

2013-01-01

Objective We investigated the prevalence of congenital renal and urologic anomalies in children with congenital hypothyroidism to determine whether further renal and urologic investigations would be of benefit. Study design Prevalence of congenital hypothyroidism was obtained from the New York State Congenital Malformation Registry. The occurrence of urinary tract anomalies were calculated for children with congenital hypothyroidism and compared to children without congenital hypothyroidism. In addition we obtained congenital hypothyroidism data from New York State newborn screening, and the cases were matched to Congenital Malformation Registry. Results Analysis of Congenital Malformation Registry data showed 980 children with congenital hypothyroidism and 3 661 585 children without congenital hypothyroidism born in New York State (1992-2005). Children with congenital hypothyroidism have a significantly increased risk of congenital renal and urological anomalies with the odds ratio (OR) of 13.2 (10.6-16.5). The other significantly increased defects in congenital hypothyroidism were cardiac, gastrointestinal, and skeletal. Analysis of matched data confirmed an increase of congenital renal and urologic anomalies with OR of 4.8 (3.7-6.3). Conclusions Children with congenital hypothyroidism have an increased prevalence of congenital renal and urologic anomalies. We suggest that these children should be evaluated for the presence of congenital renal and urologic anomalies with renal ultrasonography, and that further studies of common genes involved in thyroid and kidney development are warranted. PMID:18823909

Evaluation and treatment of urinary incontinence in long term care.

PubMed

Pannill, F C; Williams, T F; Davis, R

1988-10-01

All elderly patients with established urinary incontinence residing in an intermediate care facility during one year were evaluated for medical and urological conditions contributing to the incontinence; treatment was initiated for all diagnosed problems if possible. Unstable detrusor function (65%), sphincter weakness (13%), and overflow incontinence (10%) were all frequent urological causes, although several patients required extensive testing in addition to cystometrics to establish a complete diagnosis. Frequent nonurological causes of incontinence included behavioral problems (53%), immobility (45%), medication problems (24%), diabetes (18%), and local pathology (47%). Thirty-seven percent had three or more conditions identified. Treatment aimed at nonurological causes was more successful in ameliorating incontinence than urological medication; side effects were significant limitations to urological treatment success. Of the 22 patients who completed evaluation, treatment, and follow-up, five patients (23%) were cured, three (14%) showed at least a 65% decrease in incontinence, four (18%) showed at least a 30% decrease in incontinence, and 10 (45%) showed no change or worsened. We conclude that nonurological problems frequently contribute to urinary incontinence in long term care facilities; incontinence in some of these patients can be improved without urological therapy. Nonurological problems need careful definition and treatment; patients whose incontinence persists require comprehensive urological evaluation and therapy. A complete solution to incontinence in this setting may require safer drugs and better understanding of urinary pathophysiology.

Readability of American online patient education materials in urologic oncology: a need for simple communication.

PubMed

Pruthi, Amanda; Nielsen, Matthew E; Raynor, Mathew C; Woods, Michael E; Wallen, Eric M; Smith, Angela B

2015-02-01

To determine the readability levels of reputable cancer and urologic Web sites addressing bladder, prostate, kidney, and testicular cancers. Online patient education materials (PEMs) for bladder, prostate, kidney, and testicular malignancies were evaluated from the American Cancer Society, American Society of Clinical Oncology, National Cancer Institute, Urology Care Foundation, Bladder Cancer Advocacy Network, Prostate Cancer Foundation, Kidney Cancer Association, and Testicular Cancer Resource Center. Grade level was determined using several readability indices, and analyses were performed on the basis of cancer type, Web site, and content area (general, causes, risk factors and prevention, diagnosis and staging, treatment, and post-treatment). Estimated grade level of online PEMs ranged from 9.2 to 14.2 with an overall mean of 11.7. Web sites for kidney cancer had the least difficult readability (11.3) and prostate cancer had the most difficult readability (12.1). Among specific Web sites, the most difficult readability levels were noted for the Urology Care Foundation Web site for bladder and prostate cancer and the Kidney Cancer Association and Testicular Cancer Resource Center for kidney and testes cancer. Readability levels within content areas varied on the basis of the disease and Web site. Online PEMs in urologic oncology are written at a level above the average American reader. Simplification of these resources is necessary to improve patient understanding of urologic malignancy. Copyright © 2015 Elsevier Inc. All rights reserved.

Psychological Distress in Twins with Urological Symptoms

PubMed Central

Wright, Lisa Johnson; Noonan, Carolyn; Ahumada, Sandra; Rodríguez, María Ángeles Bullones; Buchwald, Dedra; Afari, Niloofar

2010-01-01

Objective Interstitial cystitis/painful bladder syndrome (IC/PBS) is a chronic pain condition with unclear underlying etiology. Our objectives were to determine if psychological distress was higher in twins with urological symptoms commonly found in IC/PBS than twins without, and if so, did familial influences contribute to this association. Method Data from 1,165 female twins in a community-based sample were used. Urological symptoms, symptoms of posttraumatic stress disorder (PTSD), depression, anxiety, and perceived stress were assessed with standardized questionnaires. Generalized estimating equation regression models were used to examine the relationship between psychological distress and urological symptoms. Results Compared to unaffected twins, twins with urological symptoms were more likely to report PTSD symptoms (OR = 3.9; CI = 2.6-5.8), depression (OR = 3.1; CI = 2.0-5.0), anxiety (OR = 3.4; CI = 2.3-5.2), and perceived stress (OR = 3.2; CI = 2.1-4.9). After adjusting for familial influences, the within-pair effects remained significant for PTSD symptoms (OR = 2.2; CI = 1.2-3.8) and perceived stress (OR = 2.2; CI = 1.2-3.8). Conclusion Familial influences partially explained the relationship between indicators of psychological distress and urological symptoms. Future research should examine shared environmental and genetic mechanisms that may further explain this relationship and improve diagnosis and treatment of this unexplained clinical condition. PMID:20430229

Urologic sequelae of childhood genitourinary trauma and abuse in men: principles of recognition with fifteen case illustrations.

PubMed

McCarty, T; Roberts, L W; Hendrickson, K

1996-05-01

Providing urologic care to men who have been traumatized during childhood may be especially challenging because of the extent, severity, and unusual character of their urogenital problems. Recognition of past trauma entails attentiveness to patients' background and behaviors. As illustrated through these 15 cases, patients who present with too many past surgeries, too many unremitting urologic complaints, too little sexual function and too few genital parts, sexual impulses that are too strong, sexualized conduct in clinical settings, and self-destructive behaviors surrounding sexuality may have experienced trauma in the past. While empirical studies are necessary to demonstrate the ultimate utility of these categories, appreciation of these clinical indications improves the urologic care provided to traumatized men in four ways: by elucidating unusual and unusually recalcitrant urologic complaints, thereby clarifying clinical decisions; by allowing for appropriate use of psychiatric consultation; by promoting a better understanding of the sequelae of trauma in men; and by alleviating the discomfort naturally felt by urologists and their staff when caring for these difficult, multiproblem patients.

[Integrate the surgical hand disinfection as a quality indicator in an operating room of urology].

PubMed

Francois, M; Girard, R; Mauranne, C C; Ruffion, A; Terrier, J E

2017-12-01

The surgical hand disinfection by friction (SDF) helps to reduce the risk of surgical site infections. For this purpose and in order to promote good compliance to quality care, the urology service of Centre Hospitalier Lyon Sud achieved a continuous internal audit to improve the quality of the SDF. An internal audit executed by the medical students of urology was established in 2013. The study population was all operators, instrumentalists and operating aids of urology operating room (OR). Each student realized 5-10 random observations, of all types of professionals. The criteria measured by the audit were criteria for friction. The evolution of indicators was positive. Particularly, the increasing duration of the first and second friction was statistically significant during follow-up (P=0.001). The total duration of friction shows a similar trend for all professionals. The surgical hand disinfection by friction in the urology OR of the Centre Hospitalier Lyon Sud has gradually improved over the iterative audits. Copyright © 2017 Elsevier Masson SAS. All rights reserved.

An improvement project within urological care.

PubMed

Khatami, Annelie; Rosengren, Kristina

2015-01-01

The purpose of this paper is to describe staff experiences in an on-going improvement project regarding patients with ureteral stones. A qualitative descriptive study based on eight group interviews and 48 narratives, was performed. Data were analysed using qualitative content analysis. Trustworthiness was ensured by using a well-documented improvement process method during six months. The results formed three categories: an absent comprehensive view; complexity; and vulnerability within the organisation. A holistic perspective regarding urological care at the micro-, meso- and macro-levels is needed to improve planning and caring processes. This study includes one team (six members, different health professionals) within the same urology department. Results show that staff need information, such as guidelines and support throughout the improvement work to deliver high-quality care. Moreover, there is a need for evidence-based guidelines at national level to support improvement work. Healthcare staff need to pay attention to all team member needs to improve urological care. Organisational and managerial aspect are needed to support clear and common goals regarding healthcare improvement work. Urological improvement projects, generally, are lacking, which is why this study is important to improve nephrolithiasis patient care.

Laser Application in Iran Urology: A Narrative Review

PubMed Central

Razzaghi, Mohammad Reza; Fallah Karkan, Morteza; Ghiasy, Saleh; Javanmard, Babak

2018-01-01

The usage of laser in medicine is not recent, and its history in urology goes back to 40 years ago. For the last 2 decades, common uses of laser have been treatments of subjects with urolithiasis, bladder tumors, benign prostatic enlargement, lesions of the genitalia and urinary tract strictures. To evaluate laser application in urology in Iran, we reviewed all of the Iranian literature on the topic. This study was designed to retrieve all studies on laser application in urology in Iran, regardless of publication status or language, covering years 1990–2017. Twenty-six articles were identified: 12 about urolithiasis, 8 about benign prostatic hyperplasia (BPH), 2 case reports, 1 paper about prostate cancer, 1 on female urethral stricture, 1 review and 1 basic sciences study. We conclude that the use of this technology has not yet found its position in Iran, especially in the field of urology. The main causes for it are the difficult accessibility and disturb of laser devices and its accessories, as well as the lack of adequate knowledge of the medical community about this modality. PMID:29399302

Local epidemiology and resistance profiles in acute uncomplicated cystitis (AUC) in women: a prospective cohort study in an urban urological ambulatory setting.

PubMed

Seitz, Michael; Stief, Christian; Waidelich, Raphaela

2017-10-16

Acute uncomplicated cystitis (AUC) is a common ailment in the urological setting. Guidelines for urinary tract infections are based on large-scale multi-centre, epidemiological and international studies. The objective of this observational study was to establish whether the results of a multi-centre study on the resistance profile of Escherichia coli (E. coli) in patients with AUC could be directly applied to an urological practice in a major European city or whether there are divergences in the resistance profile. An observational study was applied prospectively to 502 patients with AUC between January 2015 and January 2017). Personal data were anonymised. Exclusion criteria were the patient's age (<18) and treatment with an antibiotic in the week preceding examination. The average age was 32 (range 18-56). The most commonly detected bacteria was E. coli with 86%, followed by Enterococcus faecalis with 10% and Klebsiella pneumoniae with 4%. Resistance tests showed E. coli to be highly sensitive to fosfomycin (99.2%), nitrofurantoin (98.1%) and cefpodoxime (92.9%). E. coli exhibited resistance to ciprofloxacin (CIP) in 15.1%, to trimethoprim/sulfamethoxazole (TRS) in 25.2% and to amoxicillin/clavulanic acid (AMC) in 34% of cases. The comparison between data from this study and data from a multi-centre European (ECO-SENSI, ECO-SENSII and the 2014 update) showed relatively good sensitivity rates for fosfomycin and nitrofurantoin but significant differences in respect of resistance levels to TRS, CIP and AMC. AUC should therefore only be treated with TRS, CIP and AMC after a susceptibility test has been carried out.

Acute normovolemic haemodilution for management of blood loss during radical prostatectomy.

PubMed

Gal, R

2008-01-01

The reduction of the risks of anemia and allogeneic transfusion is one the basic parts of the anaesthesia management in large urological procedures. We used acute normovolemic haemodilution (ANH) as a technique of autologous blood procurement in patients scheduled for radical prostatectomy. 15 patients undergoing radical prostatectomy were enrolled in our study. After starting general anaesthesia the left radial artery line was placed for invasive blood pressure monitoring and withdrawing blood for ANH. The restoration of circulated volume was instituted by infusion of crystalloids and colloids. Reinfusion of gained blood was started after transfusion trigger was reached (Hct 0.25). The average total blood loss was in amount of 2393 +/- 238 (ml), autologous blood was infused in amount of 1919 +/- 220 (ml). The preoperative haematocrit was 41 +/- 3, after ANH 29 +/-2 and 31 +/- 3 (%) postoperatively. One unit of allogeneic blood was transfused in 2 patients only. All patients were hemodynamically stable during the entire surgery, with minimal systolic blood pressure of 100 mmHg and were extubated in the operation room with no complications. This study demonstrated the effectiveness and safety of ANH as a method for avoiding the allogeneic blood transfusion in patients undergoing radical prostatectomy (Tab. 1, Ref. 10). Full Text (Free, PDF) www.bmj.sk.

Bladder Morphology Using 2 Different Catheter Designs

ClinicalTrials.gov

2017-04-10

Urologic Injuries; Urologic Diseases; Bladder Infection; Urinary Tract Infections; Mucosal Inflammation; Mucosal Infection; Bladder Injury; Catheter-Related Infections; Catheter Complications; Catheter; Infection (Indwelling Catheter); Pelvic Floor Disorders; Urinary Incontinence

21 CFR 876.4730 - Manual gastroenterology-urology surgical instrument and accessories.

Code of Federal Regulations, 2013 CFR

2013-04-01

... forceps cover, biopsy tray without biopsy instruments, line clamp, nonpowered rectal probe, nonelectrical..., gastro-urology probe and director, nonself-retaining retractor, laparotomy rings, nonelectrical snare...

21 CFR 876.4730 - Manual gastroenterology-urology surgical instrument and accessories.

Code of Federal Regulations, 2012 CFR

2012-04-01

... forceps cover, biopsy tray without biopsy instruments, line clamp, nonpowered rectal probe, nonelectrical..., gastro-urology probe and director, nonself-retaining retractor, laparotomy rings, nonelectrical snare...

21 CFR 876.4730 - Manual gastroenterology-urology surgical instrument and accessories.

Code of Federal Regulations, 2014 CFR

2014-04-01

... forceps cover, biopsy tray without biopsy instruments, line clamp, nonpowered rectal probe, nonelectrical..., gastro-urology probe and director, nonself-retaining retractor, laparotomy rings, nonelectrical snare...

21 CFR 876.4730 - Manual gastroenterology-urology surgical instrument and accessories.

Code of Federal Regulations, 2010 CFR

2010-04-01

... forceps cover, biopsy tray without biopsy instruments, line clamp, nonpowered rectal probe, nonelectrical..., gastro-urology probe and director, nonself-retaining retractor, laparotomy rings, nonelectrical snare...

21 CFR 876.4730 - Manual gastroenterology-urology surgical instrument and accessories.

Code of Federal Regulations, 2011 CFR

2011-04-01

... forceps cover, biopsy tray without biopsy instruments, line clamp, nonpowered rectal probe, nonelectrical..., gastro-urology probe and director, nonself-retaining retractor, laparotomy rings, nonelectrical snare...

Urological disease and tobacco. A review for raising the awareness of urologists.

PubMed

Méndez-Rubio, S; Salinas-Casado, J; Esteban-Fuertes, M; Méndez-Cea, B; Sanz-de-Burgoa, V; Cozar-Olmo, J M

2016-09-01

Smoking is the leading cause of preventable death in our community. Its relationship with urological disease is well documented. To present an updated review on the relationship between urological disease and tobacco consumption and the importance of involving urologists in smoking prevention. We conducted a review of current literature, primarily by searching PubMed and using as the main base the report on the consequences of smoking on health performed by the Surgeon General. Urologists play an essential role in informing patients of the relationship between smoking and urological disease. It is the duty of every urologist to play a more active role in educating patients and promoting smoking cessation. Copyright © 2016 AEU. Publicado por Elsevier España, S.L.U. All rights reserved.

Changes in quality of life after elective surgery: an observational study comparing two measures.

PubMed

Kronzer, Vanessa L; Jerry, Michelle R; Ben Abdallah, Arbi; Wildes, Troy S; McKinnon, Sherry L; Sharma, Anshuman; Avidan, Michael S

2017-08-01

Our main objective was to compare the change in a validated quality of life measure to a global assessment measure. The secondary objectives were to estimate the minimum clinically important difference (MCID) and to describe the change in quality of life by surgical specialty. This prospective cohort study included 7902 adult patients undergoing elective surgery. Changes in the Veterans RAND 12-Item Health Survey (VR-12), composed of a physical component summary (PCS) and a mental component summary (MCS), were calculated using preoperative and postoperative questionnaires. The latter also contained a global assessment question for quality of life. We compared PCS and MCS to the global assessment using descriptive statistics and weighted kappa. MCID was calculated using an anchor-based approach. Analyses were pre-specified and registered (NCT02771964). By the change in VR-12 scores, an equal proportion of patients experienced improvement and deterioration in quality of life (28% for PCS, 25% for MCS). In contrast, by the global assessment measure, 61% reported improvement, while only 10% reported deterioration. Agreement with the global assessment was slight for both PCS (kappa = 0.20, 57% matched) and MCS (kappa = 0.10, 54% matched). The MCID for the overall VR-12 score was approximately 2.5 points. Patients undergoing orthopedic surgery showed the most improvement in quality of life measures, while patients undergoing gastrointestinal/hepatobiliary or urologic surgery showed the most deterioration. Subjective global quality of life report does not agree well with a validated quality of life instrument, perhaps due to patient over-optimism.

Biochemical analysis of tunica vaginalis fluid in patients with or without idiopathic hydroceles.

PubMed

Madlala, T S; Rencken, R K; Bornman, M S; Reif, S; Joubert, H F; Van der Merwe, C A

1994-10-01

To establish the differences, if any, between the biochemical composition of idiopathic hydrocele fluid and the fluid normally present in the tunica vaginalis. Aspiration and sclerotherapy of 37 idiopathic hydroceles from patients who presented to this urology clinic were performed. The biochemical content of the fluid was compared with that of the tunica vaginalis fluid from a small group of controls (n = 8), taken from patients undergoing orchidectomy for carcinoma of the prostate. Differences in several measurements were recorded; in particular, there were significantly higher concentrations of calcium, albumin, total protein and creatine-kinase in the hydrocele group. The levels of potassium, aspartate transaminase, alanine transaminase and alkaline phosphatase were significantly lower in the hydrocele group. Whether these differences have a role in the causation of an idiopathic hydrocele is, at this stage, speculative. A similar study on a larger scale would probably be more conclusive.

[Breast abnormalities: a retrospective study of 208 patients].

PubMed

Famà, Fausto; Gioffrè Florio, Maria Antonietta; Villari, Santa Alessandra; Caruso, Rosario; Barresi, Valeria; Mazzei, Sergio; Pollicino, Andrea; Scarfò, Paola

2007-01-01

Ectopic breast tissue occurs in 0.4-6% of the general population. Usually, these tissues develop along the embryonic milk line but other sites are reported in the literature. Accessory breasts are commonly axillary and may undergo hormonal changes. Some pathologies of normally positioned breasts can occur in ectopic breast tissue, including carcinoma, and therefore require traditional senological flow-charts and imaging strategies. Supernumerary nipples are generally asymptomatic but may sometimes be associated with urological malformations. In our 10-year experience, 208 patients were observed (138 polythelia and 70 polymastia) and 159 surgical procedures were performed, 97 for supernumerary nipple excision and 67 for accessory breast ablation. Five neoplastic lesions and 25 fibrocystic mastopathies were detected in specimens; normal nipple or breast tissue was found in 129. In view of the potentially malignant transformation of accessory breasts, thorough physician evaluation is needed. Surgery is currently suggested in cases of suspected malignancy, in symptomatic cases and for cosmetic problems.

Down syndrome with end-stage renal disease.

PubMed

Kute, Vivek B; Vanikar, Aruna V; Shah, Pankaj R; Gumber, Manoj R; Patel, Himanshu V; Engineer, Divyesh P; Thakkar, Umang G; Trivedi, Hargovind L

2013-10-01

Down syndrome is one of the most common genetic causes of learning disabilities in children. Although the incidence of renal and urological involvement in Down syndrome is not very common, monitoring of patients with Down syndrome for renal diseases should be done regularly as patient's age into the second and third decades. With increased survival, it appears that a growing number of these patients present with chronic renal failure. Down syndrome patients are apparently not suited for peritoneal dialysis because of lacking cooperation. This procedure can be prone to failure, mainly because of an increased risk of peritonitis. Handling such patients especially those on peritoneal dialysis is challenging. Here we report a case of Down syndrome with end-stage renal disease treated with hemodialysis for 6 months. To the best of our knowledge and current literature review this is the first case report of a patient with Down syndrome undergoing hemodialysis.

Cystometric study

MedlinePlus

... dysfunction. In: Wein AJ, Kavoussi LR, Partin AW, Peters CA, eds. Campbell-Walsh Urology. 11th ed. Philadelphia, ... children. In: Wein AJ, Kavoussi LR, Partin AW, Peters CA, eds. Campbell-Walsh Urology. 11th ed. Philadelphia, ...

Uterine prolapse

MedlinePlus

... devices. In: Wein AJ, Kavoussi LR, Partin AW, Peters CA, eds. Campbell-Walsh Urology . 11th ed. Philadelphia, ... prolapse. In: Wein AJ, Kavoussi LR, Partin AW, Peters CA, eds. Campbell-Walsh Urology . 11th ed. Philadelphia, ...

Penis pain

MedlinePlus

... Priapism. In: Wein AJ, Kavoussi LR, Partin AW, Peters CA, eds. Campbell-Walsh Urology . 11th ed. Philadelphia, ... disease. In: Wein AJ, Kavoussi LR, Partin AW, Peters CA, eds. Campbell-Walsh Urology . 11th ed. Philadelphia, ...

Elimination patterns

MedlinePlus

... urethra. In: Wein AJ, Kavoussi LR, Partin AW, Peters CA, eds. Campbell-Walsh Urology . 11th ed. Philadelphia, ... disorders. In: Wein AJ, Kavoussi LR, Partin AW, Peters CA, eds. Campbell-Walsh Urology . 11th ed. Philadelphia, ...

Retrograde ejaculation

MedlinePlus

... ejaculation. In: Wein AJ, Kavoussi LR, Partin AW, Peters CA, eds. Campbell-Walsh Urology . 11th ed. Philadelphia, ... infertility. In: Wein AJ, Kavoussi LR, Partin AW, Peters CA, eds. Campbell-Walsh Urology . 11th ed. Philadelphia, ...

Secondary data analysis of large data sets in urology: successes and errors to avoid.

PubMed

Schlomer, Bruce J; Copp, Hillary L

2014-03-01

Secondary data analysis is the use of data collected for research by someone other than the investigator. In the last several years there has been a dramatic increase in the number of these studies being published in urological journals and presented at urological meetings, especially involving secondary data analysis of large administrative data sets. Along with this expansion, skepticism for secondary data analysis studies has increased for many urologists. In this narrative review we discuss the types of large data sets that are commonly used for secondary data analysis in urology, and discuss the advantages and disadvantages of secondary data analysis. A literature search was performed to identify urological secondary data analysis studies published since 2008 using commonly used large data sets, and examples of high quality studies published in high impact journals are given. We outline an approach for performing a successful hypothesis or goal driven secondary data analysis study and highlight common errors to avoid. More than 350 secondary data analysis studies using large data sets have been published on urological topics since 2008 with likely many more studies presented at meetings but never published. Nonhypothesis or goal driven studies have likely constituted some of these studies and have probably contributed to the increased skepticism of this type of research. However, many high quality, hypothesis driven studies addressing research questions that would have been difficult to conduct with other methods have been performed in the last few years. Secondary data analysis is a powerful tool that can address questions which could not be adequately studied by another method. Knowledge of the limitations of secondary data analysis and of the data sets used is critical for a successful study. There are also important errors to avoid when planning and performing a secondary data analysis study. Investigators and the urological community need to strive to use secondary data analysis of large data sets appropriately to produce high quality studies that hopefully lead to improved patient outcomes. Copyright © 2014 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.

Pediatric urology manpower report 1995. Ellen Shapiro on behalf of the American Association of Pediatric Urologists.

PubMed

Retik, A B; King, L R

1996-08-01

The quality and efficiency of any health care system depend on an appropriate level of manpower. The manpower issues of tomorrow will be influenced by the number of physicians and specialists trained today. The objectives of this manpower survey of pediatric urologists in the United States were to determine anticipated manpower requirements and provide caveats related to the practice of pediatric urology. A manpower questionnaire was distributed to pediatric urologists at the American Urological Association meeting in Las Vegas, Nevada in April 1995. Of the 234 distributed questionnaires 204 (87%) were completed and entered into a computer program. Of responding pediatric urologists 70% were younger than 50 years, 81% practiced full-time pediatric urology and 45% were university based. The rates of respondents indicating that their present workload was too busy, appropriate or not busy enough were 10, 70 and 20%, respectively. A total of 71% of respondents indicated that they would discourage a newly trained individual from setting up a practice in their area. Of practicing pediatric urologists 26% intended to retire within the next 10 years. In April 1995, 80 respondents (39%) representing 67 practices were considering adding an associate within the next 10 years. By the end of 1995 only 56 practices will remain that will add an associate within the next 10 years. A total of 82% of respondents believed that there was an excess number of pediatric urology training programs. The pediatric urology community presently trains 10 to 15 pediatric fellows per year. Based on the 1995 manpower survey, if this trend continues an excess of 40 to 90 pediatric urologists will be trained in the next 10 years. The conclusion that there is an overabundance of pediatric urologists in training is supported by the general consensus of practicing pediatric urologists. Policies related to the training of pediatric urology fellows and urology residents should depend, not on the manpower needs at individual medical centers, but on the collective needs of our specialty and the patients whom we serve.

Prospective evaluation of remote, interactive videoconferencing to enhance urology resident education: the genitourinary teleteaching initiative.

PubMed

Cook, Anthony; Salle, Joao L Pippi; Reid, Joanne; Chow, Karen Fontana; Kuan, James; Razvi, Hassan; Farhat, Walid A; Bagli, Darius J; Khoury, Antoine E

2005-11-01

Changes in referral patterns and resource allocation into Centers of Excellence affect the educational experience of urology trainees by altering resident exposure to patients and clinicians, especially at sites where subspecialty deficiencies exist. Access to educators at Centers of Excellence using interactive videoconferencing technology may facilitate residency training objectives and enhance trainees' overall educational experience. We prospectively evaluated the implementation of this technology at tertiary care teaching centers to enhance urology resident education. Using videoconferencing technology, urology residents at the University of Western Ontario (London, Canada) participated in a series of didactic, interactive pediatric urology teleteaching seminars. These were presented by an expert pediatric urologist from the Hospital for Sick Children, Toronto, Canada. Using a 5-point Likert scale (1-strongly disagree, 5-strongly agree), participants responded to statements pertaining to seminar content, technology and ease of use at the completion of each session. The results were subsequently tabulated and evaluated to determine the effectiveness and accessibility of the program in providing expert pediatric urological education to residents at a remote urology training program. The entire urology resident staff from postgraduate year 1 to 5 participated in the seminar program. The overall acceptance of this medium was high (mean score 4.5). The quality of presentation, as well as picture and sound quality, all received mean scores greater than 4. Participants indicated that their ability to interact with the presenter was not inhibited by using this medium. All participants agreed that they would use this technology in the future (mean score 4.5) and that the presentation would not be improved if the presenter were on-site. Due to preexisting technology at both centers, no direct cost was incurred throughout the study. Our experience suggests that interactive teleteaching using readily available, existing technology, is a cost-effective and accepted method of providing trainees with an appropriate educational experience. In centers where subspecialty deficiencies exist, this medium may provide residents with the necessary education requirements of their respective programs without the need for costly teacher (or student) travel. Continual improvements in technology as well as the addition of multiple sites will increased this medium's impact in the future.

Advanced Prostate Cancer

MedlinePlus

... to learn about these types of treatments. This article is for men with metastatic and castrate-resistant ... Related Resources Urology 101 Fact Sheet UrologyHealth extra® Articles What is Advanced Prostate Cancer? Keeping Your Bones ...

Patent urachus repair

MedlinePlus

... children. In: Wein AJ, Kavoussi LR, Partin AW, Peters CA, eds. Campbell-Walsh Urology . 11th ed. Philadelphia, ... surgery. In: Wein AJ, Kavoussi LR, Partin AW, Peters CA, eds. Campbell-Walsh Urology . 11th ed. Philadelphia, ...

Inflatable artificial sphincter

MedlinePlus

... children. In: Wein AJ, Kavoussi LR, Partin AW, Peters CA, eds. Campbell-Walsh Urology . 11th ed. Philadelphia, ... women. In: Wein AJ, Kavoussi LR, Partin AW, Peters CA, eds. Campbell-Walsh Urology . 11th ed. Philadelphia, ...

Bladder outlet obstruction

MedlinePlus

... failure. In: Wein AJ, Kavoussi LR, Partin AW, Peters CA, eds. Campbell-Walsh Urology . 11th ed. Philadelphia, ... failure. In: Wein AJ, Kavoussi LR, Partin AW, Peters CA, eds. Campbell-Walsh Urology . 11th ed. Philadelphia, ...

Prostate resection - minimally invasive - discharge

MedlinePlus

... approaches. In: Wein AJ, Kavoussi LR, Partin AW, Peters CA, eds. Campbell-Walsh Urology . 11th ed. Philadelphia, ... hyperplasia. In: Wein AJ, Kavoussi LR, Partin AW, Peters CA, eds. Campbell-Walsh Urology . 11th ed. Philadelphia, ...

[The collections of the museum and archives of the German Society of Urology. Reflections on objects in the museum].

PubMed

Moll, F H; Rathert, P; Fangerau, H

2012-09-01

Objects in a museum that were used by urologists are part of the history of urology. If we know how to look at them they can be sources for a better understanding of the history of urology. In a museum visitors are confronted with objects during exhibitions which are the stage on which one possible interpretation of the history of urology is displayed. Objects have become"carriers of symbols" between the past and present (Pomian). Collections from medical societies which are not connected with a university or another public institution cannot be legitimized on the basis of the argument of conserving historical heritage only. The museum itself with its many tasks and as a classical site of scientific communication should be seen as a topic of scientific interest.

Urological diagnosis using clinical PACS

NASA Astrophysics Data System (ADS)

Mills, Stephen F.; Spetz, Kevin S.; Dwyer, Samuel J., III

1995-05-01

Urological diagnosis using fluoroscopy images has traditionally been performed using radiographic films. Images are generally acquired in conjunction with the application of a contrast agent, processed to create analog films, and inspected to ensure satisfactory image quality prior to being provided to a radiologist for reading. In the case of errors the entire process must be repeated. In addition, the radiologist must then often go to a particular reading room, possibly in a remote part of the healthcare facility, to read the images. The integration of digital fluoroscopy modalities with clinical PACS has the potential to significantly improve the urological diagnosis process by providing high-speed access to images at a variety of locations within a healthcare facility without costly film processing. The PACS additionally provides a cost-effective and reliable means of long-term storage and allows several medical users to simultaneously view the same images at different locations. The installation of a digital data interface between the existing clinically operational PACS at the University of Virginia Health Sciences Center and a digital urology fluoroscope is described. Preliminary user interviews that have been conducted to determine the clinical effectiveness of PACS workstations for urological diagnosis are discussed. The specific suitability of the workstation medium is discussed, as are overall advantages and disadvantages of the hardcopy and softcopy media in terms of efficiency, timeliness and cost. Throughput metrics and some specific parameters of gray-scale viewing stations and the expected system impacts resulting from the integration of a urology fluoroscope with PACS are also discussed.

Mimicry of Appendicitis Symptomatology in Congenital Anomalies and Diseases of the Genitourinary System and Pregnancy

PubMed Central

Dalpiaz, Amanda; Gandhi, Jason; Smith, Noel L.; Dagur, Gautam; Schwamb, Richard; Weissbart, Steven J.; Khan, Sardar Ali

2017-01-01

Introduction Appendicitis is a prevailing cause of acute abdomen, but is often difficult to diagnose due to its wide range of symptoms, anatomical variations, and developmental abnormalities. Urological disorders of the genitourinary tract may be closely related to appendicitis due to the close proximity of the appendix to the genitourinary tract. This review provides a summary of the urological complications and simulations of appendicitis. Both typical and urological symptoms of appendicitis are discussed, as well as recommended diagnostic and treatment methods. Methods Medline searches were conducted via PubMed in order to incorporate data from the recent and early literature. Results Urological manifestations of appendicitis affect the adrenal glands, kidney, retroperitoneum, ureter, bladder, prostate, scrotum, and penis. Appendicitis in pregnancy is difficult to diagnose due to variations in appendiceal position and trimester-specific symptoms. Ultrasound, CT, and MRI are used in diagnosis of appendicitis and its complications. Treatment of appendicitis may be done via open appendectomy or laparoscopic appendectomy. In some cases, other surgeries are required to treat urological complications, though surgery may be avoided completely in other cases. Conclusion Clinical presentation and complications of appendicitis vary among patients, especially when the genitourinary tract is involved. Appendicitis may mimic urological disorders and vice versa. Awareness of differential diagnosis and proper diagnostic techniques is important in preventing delayed diagnosis and possible complications. MRI is recommended for diagnosis of pregnant patients. Ultrasound is preferred in patients exhibiting typical symptoms. PMID:28413377

Robotics in urological surgery: evolution, current status and future perspectives.

PubMed

Sivaraman, A; Sanchez-Salas, R; Prapotnich, D; Barret, E; Mombet, A; Cathala, N; Rozet, F; Galiano, M; Cathelineau, X

2015-09-01

Robotic surgery is rapidly evolving and has become an essential part of surgical practice in several parts of the world. Robotic technology will expand globally and most of the surgeons around the world will have access to surgical robots in the future. It is essential that we are updated about the outcomes of robot assisted surgeries which will allow everyone to develop an unbiased opinion on the clinical utility of this innovation. In this review we aim to present the evolution, objective evaluation of clinical outcomes and future perspectives of robot assisted urologic surgeries. A systematic literature review of clinical outcomes of robotic urological surgeries was made in the PUBMED. Randomized control trials, cohort studies and review articles were included. Moreover, a detailed search in the web based search engine was made to acquire information on evolution and evolving technologies in robotics. The present evidence suggests that the clinical outcomes of the robot assisted urologic surgeries are comparable to the conventional open surgical and laparoscopic results and are associated with fewer complications. However, long term results are not available for all the common robotic urologic surgeries. There are plenty of novel developments in robotics to be available for clinical use in the future. Robotic urologic surgery will continue to evolve in the future. We should continue to critically analyze whether the advances in technology and the higher cost eventually translates to improved overall surgical performance and outcomes. Copyright © 2014 AEU. Publicado por Elsevier España, S.L.U. All rights reserved.

German urologists under national socialism.

PubMed

Krischel, Matthis

2014-08-01

The first full-time professorship for urology at a German university was established in 1937 and in 1942, a rare teaching qualification (Habilitation) for urology was granted, both at the prestigious Berlin University. At the same time, nearly a third of all physicians who worked in the field of urology were classified as "non-Aryan" according to Nazi race laws and were forced out of their profession and their homeland. Many of them committed suicide or, if they refused to flee, were murdered in concentration camps. German urologists also contributed to compulsory sterilization of men according to the "law for the prevention of hereditarily diseased offspring" between 1934 and 1945. Historical sources on the history of urology in Nazi Germany were reviewed and analyzed. These include textbooks and medical journals from the 1930s and 1940s, as well as files from different state and university archives. For urologists, the changing political environment in Germany after 1933 offered possibilities to assert their personal and professional interests. Unfortunately, in many cases, moral principles were thrown overboard, and physicians advanced their own careers and the specialty of urology at the expense of their patients and their Jewish colleagues. Under national socialism, German urologists backed Nazi health and race policies and in exchange gained further professionalization for their specialty, including university positions and increased independence from surgery. Only in recent years has this chapter of German urology's past become a topic of debate among members of the professional society.

Application of artificial intelligence to the management of urological cancer.

PubMed

Abbod, Maysam F; Catto, James W F; Linkens, Derek A; Hamdy, Freddie C

2007-10-01

Artificial intelligence techniques, such as artificial neural networks, Bayesian belief networks and neuro-fuzzy modeling systems, are complex mathematical models based on the human neuronal structure and thinking. Such tools are capable of generating data driven models of biological systems without making assumptions based on statistical distributions. A large amount of study has been reported of the use of artificial intelligence in urology. We reviewed the basic concepts behind artificial intelligence techniques and explored the applications of this new dynamic technology in various aspects of urological cancer management. A detailed and systematic review of the literature was performed using the MEDLINE and Inspec databases to discover reports using artificial intelligence in urological cancer. The characteristics of machine learning and their implementation were described and reports of artificial intelligence use in urological cancer were reviewed. While most researchers in this field were found to focus on artificial neural networks to improve the diagnosis, staging and prognostic prediction of urological cancers, some groups are exploring other techniques, such as expert systems and neuro-fuzzy modeling systems. Compared to traditional regression statistics artificial intelligence methods appear to be accurate and more explorative for analyzing large data cohorts. Furthermore, they allow individualized prediction of disease behavior. Each artificial intelligence method has characteristics that make it suitable for different tasks. The lack of transparency of artificial neural networks hinders global scientific community acceptance of this method but this can be overcome by neuro-fuzzy modeling systems.

Adherence to European Association of Urology Guidelines on Prophylactic Antibiotics: An Important Step in Antimicrobial Stewardship.

PubMed

Cai, Tommaso; Verze, Paolo; Brugnolli, Anna; Tiscione, Daniele; Luciani, Lorenzo Giuseppe; Eccher, Cristina; Lanzafame, Paolo; Malossini, Gianni; Wagenlehner, Florian M E; Mirone, Vincenzo; Bjerklund Johansen, Truls E; Pickard, Robert; Bartoletti, Riccardo

2016-02-01

The evolution of resistant pathogens is a worldwide health crisis and adherence to European Association of Urology (EAU) guidelines on antibiotic prophylaxis may be an important way to improve antibiotic stewardship and reduce patient harm and costs. To evaluate the prevalence of antibiotic-resistant bacterial strains and health care costs during a period of adherence to EAU guidelines in a tertiary referral urologic institution. A protocol for adherence to EAU guidelines for antibiotic prophylaxis for all urologic procedures was introduced in January 2011. Data for 3529 urologic procedures performed between January 2011 and December 2013 after protocol introduction were compared with data for 2619 procedures performed between January 2008 and December 2010 before protocol implementation. The prevalence of bacterial resistance and health care costs were compared between the two periods. The outcome measures were the proportion of resistant uropathogens and costs related to antibiotic consumption and symptomatic postoperative infection. We used χ2 and Fisher's exact tests to test the significance of differences. The proportion of patients with symptomatic postoperative infection did not differ (180/3529 [5.1%] vs. 117/2619 [4.5%]; p=0.27). A total of 342 isolates from all patients with symptomatic postoperative infections were analysed. The rate of resistance of Escherichia coli to piperacillin/tazobactam (9.1% vs. 5.4%; p=0.03), gentamicin (18.3% vs. 11.2%; p=0.02), and ciprofloxacin (32.3% vs. 19.1%; p=0.03) decreased significantly after protocol introduction. The defined daily dose (DDD) use of ciprofloxacin fell from 4.2 to 0.2 DDD per 100 patient-days after implementation (p<0.001). Antibiotic drug costs (€76,980 vs. €36,700) and costs related to postoperative infections (€45,870 vs. €29,560) decreased following introduction of the protocol (p<0.001). Adherence to EAU guidelines on antibiotic prophylaxis reduced antibiotic usage without increasing post-operative infection rate and lowered the prevalence of resistant uropathogens. We analysed the impact of adherence to European Association of Urology guidelines on antibiotic prophylaxis for all surgical urologic procedures on the prevalence of infections and resistant bacterial strains and on costs. We found that adherence to the guidelines reduced the rate of bacterial resistance, in particular against piperacillin/tazobactam, gentamicin, and ciprofloxacin, and reduced costs without increasing the risk of postoperative infection after urologic procedures. We recommend adherence to the guidelines as an important part of antibiotic stewardship programmes. Copyright © 2015 European Association of Urology. Published by Elsevier B.V. All rights reserved.

How to decide which infant can have robotic surgery? Just do the math.

PubMed

Finkelstein, J B; Levy, A C; Silva, M V; Murray, L; Delaney, C; Casale, P

2015-08-01

In pediatric urology, robot-assisted surgery has overcome several impediments of conventional laparoscopy. However, workspace has a major impact on surgical performance. The limited space in an infant can significantly impede the mobility of robotic instruments. There is currently no consensus on which infant can undergo robotic intervention and no parameters to help make this decision, especially for those surgeons at the start of their learning curve. We sought to evaluate our experience with infants to create an objective standard to determine which patients may be most suitable for robotic surgery. We prospectively evaluated 45 infants (24 males, 21 females), aged 3-12 months old, who underwent a robotic intervention for either upper or lower urinary tract pathology. At the preoperative office visit the attending surgeon measured the distance between both anterior superior iliac spines (ASIS) as well as the puboxyphoid distance (PXD), regardless of whether the approach was for upper or lower tract disease. Patients' weights were also noted. During surgery, we recorded the number of robotic collisions as well as console time. All surgeries were performed utilizing the da Vinci Si Surgical System by a single surgeon. There were no differences in ASIS, PXD, collisions or console time when stratified by gender, age or weight. When arranging by upper or lower tract approach, there was no difference in the number of collisions. There was a strong inverse relationship between both ASIS distance and PXD and the number of collisions. Additionally, there was a strong correlation between the number of collisions and console time (Fig. 1). Using a cutoff of 13 cm for the ASIS, there were significantly fewer collisions in the >13 cm group as compared to the ≤13 cm group. This was also true for the PXD using a cutoff of 15 cm: there were significantly fewer collisions in the >15 cm group as compared to the ≤15 cm group. Safe proliferation of robotic technology in the infant population is, in part, dependent on careful patient selection. Our data demonstrated a reduction in instrument collisions and console time with increasing anterior superior iliac spine and puboxyphoid distances. Neither age nor weight was correlated with these measurements, the number of instrument collisions or console time. Limitations include that this is a single institution study with all infants being operated on by a single surgeon. Therefore, the findings of this study may not be generalizable to a less experienced surgeon. Yet, we believe that ASIS and PXD measurements can be used as a guide for the novice surgeon who is beginning to perform robotic-assisted surgery in infants. We found that surgeon ability to perform robotic surgery in an infant is restricted by collisions when the infant has an ASIS measurement of 13 cm or less or a PXD of 15 cm or less. Objective assessment of anterior superior iliac spine and puboxyphoid distance can aid in selecting which infants can safely and efficiently undergo robotic intervention with a minimum of instrument collision, thereby minimizing operative time. Copyright © 2015 Journal of Pediatric Urology Company. Published by Elsevier Ltd. All rights reserved.

Laser therapy in the treatment of urological diseases

NASA Astrophysics Data System (ADS)

Nelius, T.; de Riese, W. T.; Reiher, F.; Filleur, S.; Allhoff, E. P.

2006-02-01

Applications of lasers (light amplification by stimulated emission of radiation) in various disciplines of medicine including Urology are well developed. Urology is among the medical specialties that apply many different types of laser systems to treat a broad spectrum of clinical conditions ranging from genital, bladder and urethral tumors to the treatment of benign prostate hyperplasia (BPH), urethral strictures, and stones. The specific application of various laser systems depends on the characteristics of the laser itself, delivery media for the beams, laser-tissue interaction and the desired effect. These complex conditions require an intensive and continuous exchange of information between non-medical researchers and physicians to verify "what is currently technically possible and what is medically needed". Only this exchange can lead to the development of new laser systems. While lasers have become the treatment of choice in some conditions, they could not, despite excellent clinical results, replace conventional therapy options in others. Nonetheless, the use and the introduction of lasers of different wavelengths forces urologists to keep step with the fast developing laser technology. This paper reviews current indications for clinical laser applications relevant to urology and the advantages and disadvantages of using lasers for the management of various urological lesions.

A Study of Varlilumab (Anti-CD27) and Sunitinib in Patients With Metastatic Clear Cell Renal Cell Carcinoma

ClinicalTrials.gov

2017-11-10

Carcinoma, Renal Cell; Kidney Diseases; Kidney Neoplasms; Urogenital Neoplasms; Urologic Diseases; Urologic Neoplasms; Neoplasms; Neoplasms by Histologic Type; Clear-cell Metastatic Renal Cell Carcinoma

Urinary catheters - what to ask your doctor

MedlinePlus

... incontinence. In: Wein AJ, Kavoussi LR, Partin AW, Peters CA, eds. Campbell-Walsh Urology . 11th ed. Philadelphia, ... incontinence. In: Wein AJ, Kavoussi LR, Partin AW, Peters CA, eds. Campbell-Walsh Urology . 11th ed. Philadelphia, ...

Gunshot wounds to the scrotum: a large single-institutional 20-year experience.

PubMed

Simhan, Jay; Rothman, Jason; Canter, Daniel; Reyes, Jose M; Jaffe, William I; Pontari, Michel A; Doumanian, Leo R; Mydlo, Jack H

2012-06-01

Study Type - Therapy (case series) Level of Evidence 4 What's known on the subject? and What does the study add? Penetrating trauma to the scrotum often requires operative intervention, with testicular salvage only possible when enough testicular tissue can be re-approximated in the traumatic setting. The present report represents the largest series of gunshot wound trauma to the scrotum in the literature. Further, it validates recommendations of the European Association of Urology guidelines on urological trauma that advocate operative intervention due to minimal rates of patient morbidity and the inherent limitations of scrotal ultrasonography in discerning testicular compromise. To report our 20-year experience of gunshot wounds (GSWs) to the scrotum and outline the management of this traumatic injury. We queried our institutional database for patients presenting with GSWs to the scrotum between 1985 and 2006. All patients underwent the standard trauma evaluation upon presentation, including physical examination of the external genitalia. Management was dictated by the presence or absence of a penetrating injury to the scrotum and associated traumatic injuries. Nonoperative and operative management of traumatic injury to the scrotum were used. Testicular salvage was performed when anatomically feasible. If testicular salvage was not feasible, an orchiectomy was performed. Scrotal exploration was performed in 91 (94%) patients while six (6%) patients were treated nonoperatively. Testicular injury was found in 44 (48%) patients undergoing exploration, six (7%) of whom had bilateral testicular injuries, which gave a total of 50 injured testicles. Of the injured testicles, 24 (48%) could not be salvaged and required orchiectomy, while 26 (52%) were debrided and repaired. The most common associated genitourinary (GU) injuries were to the corpora cavernosum (n= 20 [21%]) and urethra (n= 10 [10%]). Soft tissue injury of the extremities occurred in 54 patients (56%), representing the most common non-GU-associated injury. Postoperative complications occurred infrequently: one patient (1%) returned for abscess drainage and one (1%) for haematoma evacuation. The present report confirms that any patient with a penetrating injury to the scrotum should undergo immediate scrotal exploration. A low clinical suspicion for performing additional studies to rule out associated urethral and/or penile injury is clinically warranted. Testicular loss occurs in ≈50% of injured testicles. © 2011 THE AUTHORS. BJU INTERNATIONAL © 2011 BJU INTERNATIONAL.

Long-term follow-up and late complications following treatment of pediatric urologic disorders.

PubMed

Akhavan, Ardavan; Stock, Jeffrey A

2011-01-01

Many pediatric urologic disorders have sequelae that may affect patients well into adulthood. Despite adequate treatment, many patients are at risk for progressive urologic deterioration years after surgical reconstruction. While many pediatric urologists follow their patients years after surgery, screening for late complications is a shared responsibility with primary care providers. This article discusses potential late complications and appropriate follow-up for patients who have a history of ureteral reimplantation, pyeloplasty, hypospadias repair, posterior urethral valve ablation, and intestinal interposition. Copyright © 2011 Elsevier Inc. All rights reserved.

Nanotechnology in Urology

PubMed Central

Jayasimha, Sudhindra

2017-01-01

Introduction: Nanotechnology has revolutionized our approach to medical diagnostics as well as therapeutics and has spanned an entirely new branch of research. This review addresses the potential applications of Nanotechnology in Urology. This article is based on the Dr. Sitharaman Best Essay award of the Urological Society of India for 2016. Methods: A PubMed search was performed for all relevant articles using the terms, “nanotechnology, nanoparticles, nanoshells, nanoscaffolds, and nanofibers.” Results: The developments in diagnostics include novel techniques of imaging of genitourinary malignancies, prostate-specific antigen measurement, early detection of mutations that are diagnostic for polycystic kidney disease. The potential applications of nanotechnology are in the targeted therapy of genitourinary malignancies, erectile dysfunction, overactive bladder, bladder reconstruction, construction of artificial kidneys and biodegradable stents as well as in robotic surgery. Conclusions: Nanotechnology is a rapidly emerging branch of research in urology with diverse and clinically significant applications in diagnostics as well as therapeutics. PMID:28197024

The emerging role of social media in urology.

PubMed

Leveridge, Michael J

2014-01-01

Social media have become so integrated into modern communications as to be universal in our personal and, increasingly, professional lives. Recent examples of social media uptake in urology, and the emergence of data to quantify it, reveal the expansion of conventional communication routes beyond the in-person forum. In every domain of urologic practice, from patient interaction through research to continuing professional development, the move online has unlocked another layer of conversation, dissemination, and, indeed, caveats. Social media have a democratizing effect, placing patients, trainees, practitioners, and thought leaders in the same arena and on equal footing. If uptake of social media in medicine even remotely parallels its rise to ubiquity in other areas, it will only expand and evolve in the coming years. For these reasons, this article presents an overview of the most recent data on the impact and potential complications of social media usage in the urologic community.

[The meaning of erection, genitality, and other representations of urologic topics in the paleolithic imaginary].

PubMed

Angulo Cuesta, Javier; García Díez, Marcos

2007-10-01

The history of urology starts with written documents making express reference to procedures, practices and descriptions of morbid processes related with the male genitourinary tract. Oddly, the most recent prehistoric period, the superior Paleolithic (from approximately 40.000 years to 12.000 years ago; the longest period since our species entered the history of humanity) also has graphic documents expressing how the human being understood the physiologic phenomena and how he observed the pathologic processes of this organism. The representations with genitality expressions enable us to understand the meaning of erection from the Paleolithic perspective, and even the possible existence of a culture based on preputial retraction or rituals of circumcision. Several urologic disorders such us phimosis, paraphimosis, discharge, priapism, and even scrotal mass appear represented at that time and constitute the first sign of knowledge of what can be called primitive urologic knowledge.

The Emerging Role of Social Media in Urology

PubMed Central

Leveridge, Michael J

2014-01-01

Social media have become so integrated into modern communications as to be universal in our personal and, increasingly, professional lives. Recent examples of social media uptake in urology, and the emergence of data to quantify it, reveal the expansion of conventional communication routes beyond the in-person forum. In every domain of urologic practice, from patient interaction through research to continuing professional development, the move online has unlocked another layer of conversation, dissemination, and, indeed, caveats. Social media have a democratizing effect, placing patients, trainees, practitioners, and thought leaders in the same arena and on equal footing. If uptake of social media in medicine even remotely parallels its rise to ubiquity in other areas, it will only expand and evolve in the coming years. For these reasons, this article presents an overview of the most recent data on the impact and potential complications of social media usage in the urologic community. PMID:25337040

Prevalence of urinary incontinence and other urological problems during pregnancy: a questionnaire based study.

PubMed

Sharma, J B; Aggarwal, Shena; Singhal, Saurabh; Kumar, S; Roy, K K

2009-06-01

To find out the prevalence of various urological symptoms in pregnant women, the status before pregnancy, and their perceived impact. A questionnaire incorporating various urological problems was prepared and used over 240 pregnant women to know their prevalence in different trimesters of pregnancy and compare them with prevalence before pregnancy. Increased urinary frequency (>10/day) (40.8 vs. 3.8%), nocturia (72.9 vs. 50.6%), burning micturition (21.3 vs. 3.8%), UTI (4.6 vs. 1.6%), urinary hesitancy (14.6 vs. 1.6%), urinary incontinence (25.8 vs. 8.2%) and botheration (22.1 vs. 2.7%) were seen during and before pregnancy, respectively. These also show an increment with advancement of gestation. Urinary incontinence was seen more often with advancing age and parity. There is a very high prevalence of urological symptoms during pregnancy as compared to before pregnancy.

Advanced Practice Nursing in Pediatric Urology: experience report in the Federal District.

PubMed

Souza, Bruna Marcela Lima de; Salviano, Cristiane Feitosa; Martins, Gisele

2018-01-01

To describe the creation and implementation of the extension program Advanced Practice Nursing in Pediatric Urology, developed in the outpatient clinic of a teaching hospital in the Federal District. This is an experience report regarding the implementation of an outpatient service aimed at children and adolescents with symptoms of bladder and bowel dysfunction. Because it is an extension program linked to the university, it follows a different model of care, valuing empowerment, informed and shared decision making, which results in a stronger bond between patients, family and the Pediatric Urology nursing team. It has also become a privileged space for the production and use of scientific knowledge, associated with the principles of evidence-based practice. This project shows a different performance of the nurse-specialist-professor-researcher in Pediatric Urology Nursing, and it has become a reference in the Federal District, mainly for undergraduate and graduate nursing students.

Personal finances of urology residents in Canada.

PubMed

Teichman, J M; Tongco, W; MacNeily, A E; Smart, M

2000-12-01

We examined how Urology residents in Canada manage their personal finances. A survey instrument was designed to elicit information on demographics, expenses, savings and incomes. The questionnaire was completed by 40 Urology residents attending the 2000 Queen's Urology Exam Skills Training (QUEST) program. Twenty-eight residents (70%) had educational debt (median debt $50 000). Seventeen residents (45%) paid credit card interest charges within the last year. Four residents (10%) maintained an unpaid credit card balance > $7500 at 17% annual interest rate. Twenty-six residents (67%) contributed to Registered Retirement Savings Program (RRSP) accounts. Seventeen residents (44%) contributed to non-RRSP retirement accounts. Nineteen residents (50%) budgeted expenses. Median resident income was $45 000. Thirteen residents (34%) had cash reserves < $250. Many residents save little, and incur substantial debt over and above educational loans. Many residents would benefit from instruction concerning prudent financial management. Residents should be informed of the consequences of low saving and high debt.

[Spanish urology in the renaissance].

PubMed

De la Calle Muñoz, I; Martínez Sagarra, J M; Sánchez Santos, J A; De Castro Antolín, M L

1991-01-01

Spanish renaissance urology is a heirloom from both islamic and scholastic medieval trends. Theory and practice of urology generates three types of professionals: doctors, who study at universities and obtain their licence by making a demonstration before the Protomedicato Tribunal; surgeons, who acquire their surgical techniques through a teacher-pupil training relationship outside universities; and empirics, who were in charge of performing surgical operations. Urology literature exhibits greater interest during the second half of the century. Most outstanding are the works of Francisco Díaz. The pathologies arising greater interest are lithiasis and carnosities. Lithiasis is handled by lithotomists through a carving process of which there were two modalities, castilian and italian. Carnosities, which differential diagnosis, as well as that of lithiasis, was outlined by Andrés Laguna, are treated using a dilating bougie or, surgically, with a sharp instrument analogous to the urethrotome devised by Francisco Díaz.

Age-Related Sleep Disruption and Reduction in the Circadian Rhythm of Urine Output: Contribution to Nocturia?

PubMed Central

Duffy, Jeanne F.; Scheuermaier, Karine; Loughlin, Kevin R.

2015-01-01

Aging is associated with a marked increase in sleep complaints, and one factor causing sleep disruption is waking to void (nocturia). Urological surveys have found that few young adults report nocturia symptoms, but about half of those in their 60’s and nearly 80% of older age groups are affected. Sleep surveys have found nocturia is a major cause of sleep disruption, with a majority of older adults with sleep disruption citing the need to void as the cause of their awakening. While much of the urological literature implies that nocturia causes sleep disruption, age-related changes in sleep depth and continuity may make it more likely that an older adult will wake in response to a filling bladder, or that an older adult will wake for another reason and then decide to void. There is also evidence that age-related changes in the amplitude of circadian rhythms contribute to nocturia. There is a well-described circadian rhythm in urine output, and evidence of circadian rhythmicity in some diuretic and anti-diuretic hormones. In this article we describe how age-related changes in sleep depth and continuity and age-related changes in circadian rhythm amplitude may contribute to nocturia, and how nocturia in turn leads to sleep disruption. Better understanding of how changes in sleep and circadian rhythmicity impact nocturia may lead to improved treatments and better quality of life for older adults. PMID:26632430

[Clinical implications of dual-energy computed tomography in the diagnosis and treatment of urolithiasis].

PubMed

Kapanadze, L B; Ternovoy, S K; Rudenko, V I; Serova, N S

2018-03-01

Urolithiasis (urolithiasis) is one of the most common urologic diseases with an estimated prevalence of no less than 3% in the population, usually affecting active working-age patients of 30-50 years. Taking into account major public health and economic significance of this problem, there is the need for the development of effective modern diagnostic techniques. Rapid medical-technological advances of the past two decades have led to the wide spread use of minimally invasive surgery the management of urolithiasis. Nevertheless, surgical intervention only removes the result of a long pathological process and does not change its course. Thus, there is a need for a detailed understanding of the etiology, epidemiology, and pathogenesis of urolithiasis. Diagnostic imaging plays a key role in the diagnosis of urolithiasis. Multislice spiral computed tomography (MSCT) is the gold standard for the diagnosis of urolithiasis. It provides information about the size, location, and density of the calculus. Over the past decade, the use of dual-energy computed tomography (DECT) in urological practice has been widely discussed in the international and domestic literature. One of the main advantages of DECT is the ability to determine the chemical composition of urinary stones. Previous studies have reported a high diagnostic value of the method, including the ability to predict treatment outcomes. However, the shortcomings of the method and the absence of standardized examination protocols leave a wide field for further research. This article reviews major distinctive features of using DECT in the diagnosis of urolithiasis.

Predicted versus observed 30-day perioperative outcomes using the ACS NSQIP surgical risk calculator in patients undergoing partial nephrectomy for renal cell carcinoma.

PubMed

Blair, Brian M; Lehman, Erik B; Jafri, Syed M; Kaag, Matthew G; Raman, Jay D

2018-06-04

The purpose of the study was to evaluate the accuracy of the American College of Surgeons NSQIP Surgical Risk Calculator for predicting risk-adjusted 30-day outcomes for patients undergoing partial nephrectomy (PN) for renal cell carcinoma (RCC). A single institution, multi-surgeon, prospectively maintained database was queried for patients undergoing PN for RCC from 1998 to 2015. 21 preoperative factors were analyzed for each patient with predicted risk for 30-day complications, mortality, and length of stay (LOS) calculated. Differences between the mean predicted risk and observed rate of surgical outcomes were determined using two-sided one-sample t test with significance at p < 0.05. Subgroup analyses of outcomes stratified by surgical approach were also performed. 470 patients undergoing PN for RCC were analyzed. Comparing NSQIP predicted to observed outcomes, clinically significant underestimations occurred with rates of overall complications (9.16 vs. 16.81%, p < 0.001), surgical site infections [SSI] (1.65 vs. 2.77%, p < 0.001), urinary tract infection [UTI] (1.41 vs. 3.40%, p < 0.001), and LOS (3.25 vs. 3.73 days, p < 0.001). On subgroup analysis, 209 open PN and 261 minimally invasive PN (MIPN) were performed. The NSQIP calculator consistently underestimated overall complications, SSI, UTI, and LOS (p < 0.001) among both surgical approaches, while overestimating MIPN severe complications (p < 0.001). Clinically important differences persisted when stratifying the MIPN group by laparoscopic (N = 111) and robotic (N = 150) approaches. The ACS NSQIP Surgical Risk Calculator had significant discrepancies among observed and predicted outcomes. Additional analyses confirmed these differences remained significant irrespective of surgical approach. These findings emphasize the need for urologic oncology-specific calculators to better predict surgical outcomes in this complex patient population.

Role of antibiotic prophylaxis in antenatal hydronephrosis: A systematic review from the European Association of Urology/European Society for Paediatric Urology Guidelines Panel.

PubMed

Silay, Mesrur Selcuk; Undre, Shabnam; Nambiar, Arjun K; Dogan, Hasan Serkan; Kocvara, Radim; Nijman, Rien J M; Stein, Raimund; Tekgul, Serdar; Radmayr, Christian

2017-06-01

The benefits and harms of continuous antibiotic prophylaxis (CAP) versus observation in patients with antenatal hydronephrosis (ANH) are controversial. The aim was to determine the effectiveness of CAP for ANH, and if beneficial to determine the best type and regimen of antibiotic and the most harmful to provide guidance for clinical practice. A systematic literature search was performed in databases including Medline, Embase, and Cochrane in June 2015. The protocol was prospectively registered to PROSPERO (CRD42015024775). The search started from 1980, when maternal ultrasound was first introduced into clinical practice. Eligible studies were critically evaluated for risk of bias using Revman software. The outcomes included reduction in urinary tract infections (UTI), drug-related adverse events and kidney functions. Of 797 articles identified, 57 full text articles and six abstracts were eligible for inclusion (2 randomized controlled trials, 11 non-randomized comparative studies, and 50 case series). It remains unclear whether CAP is superior to observation in decreasing UTIs. No conclusion could be drawn for drug-related adverse events and kidney function because of lack of data. Children who were not circumcised, with ureteral dilatation, and high-grade hydronephrosis may be more likely to develop UTI, and CAP may be warranted for these subgroups of patients. A majority of the studies had low-to-moderate quality of evidence and with high risk of bias. The benefits of CAP in a heterogeneous group of children with ANH involving different etiologies remains unproven. However, the evidence in the form of prospective and retrospective observational studies has shown that it reduces febrile UTI in particular subgroups. Copyright © 2017 Journal of Pediatric Urology Company. Published by Elsevier Ltd. All rights reserved.

Assessing health-related quality of life in urology - a survey of 4500 German urologists.

PubMed

Schmick, A; Juergensen, M; Rohde, V; Katalinic, A; Waldmann, A

2017-06-19

Urological diseases and their treatment may negatively influence continence, potency, and health-related quality of life (HRQOL). Although current guidelines recommend HRQOL assessment in clinical urology, specific guidance on how to assess HRQOL is frequently absent. We evaluated whether and how urologists assess HRQOL and how they determine its practicality. A random sample of 4500 (from 5200 identified German urologists) was drawn and invited to participate in a postal survey (an initial letter followed by one reminder after six weeks). The questionnaire included questions on whether and how HRQOL is assessed, general attitudes towards the concept of HRQOL, and socio-demographics. Due to the exploratory character of the study we produced mainly descriptive statistics. Chi 2 -tests and logistic regression were used for subgroup-analysis. 1557 urologists (85% male, with a mean age of 49 yrs.) participated. Most of them (87%) considered HRQOL assessment as 'important' in daily work, while only 7% reported not assessing HRQOL. Patients with prostate carcinoma, incontinence, pain, and benign prostate hyperplasia were the main target groups for HRQOL assessment. The primary aim of HRQOL assessment was to support treatment decisions, monitor patients, and produce a 'baseline measurement'. Two-thirds of urologists used questionnaires and interviews to evaluate HRQOL and one-quarter assessed HRQOL by asking: 'How are you?'. The main barriers to HRQOL assessment were anticipated questionnaire costs (77%), extensive questionnaire length (52%), and complex analysis (51%). The majority of German urologists assess HRQOL as part of their clinical routine. However, knowledge of HRQOL assessment, analysis, and interpretation seems to be limited in this group. Therefore, urologists may benefit from a targeted education program. The clinical trial was registered with the code VfD_13_003629 at the German Healthcare Research Registry ( www.versorgungsforschung-deutschland.de ).

Survey of Applicant Experience and Cost in the Urology Match: Opportunities for Reform.

PubMed

Nikonow, Tara N; Lyon, Timothy D; Jackman, Stephen V; Averch, Timothy D

2015-10-01

The urology match is highly competitive but there is a paucity of published data regarding the costs and barriers that applicants face. We gathered data on contributors to cost in the 2014 urology residency match. A survey was sent to all applicants offered an interview at each of 18 participating institutions. Information on demographics, interview related costs, access to financial aid, frequency of away rotations and second look invitations was collected. A total of 173 respondents spent a median of $7,000 on the urology match. Applicants attended a mean of 14 interviews with an average per interview cost of $500. Overall 95% of respondents did at least 1 away rotation and 79% reported being asked to return for a second look interview at least once. Of the respondents 66% did not receive any financial aid for interviews and only 28% believed their financial aid departments provided adequate financial planning. Of those surveyed 20% indicated that their financial situation limited the number of interviews they attended. We estimate that $3,122,000 was spent by applicants on the 2014 urology match. One in 5 applicants reported limiting the number of interviews they attended due to financial concerns. Adequate financial planning resources were not widely available. Nearly all applicants went on an away rotation and encouragement to return for second look interviews was common. These factors may contribute to financial and regional bias in the match process, and are potential targets for reform. Copyright © 2015 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.

Diffusion of robotics into clinical practice in the United States: process, patient safety, learning curves, and the public health.

PubMed

Mirheydar, Hossein S; Parsons, J Kellogg

2013-06-01

Robotic technology disseminated into urological practice without robust comparative effectiveness data. To review the diffusion of robotic surgery into urological practice. We performed a comprehensive literature review focusing on diffusion patterns, patient safety, learning curves, and comparative costs for robotic radical prostatectomy, partial nephrectomy, and radical cystectomy. Robotic urologic surgery diffused in patterns typical of novel technology spreading among practicing surgeons. Robust evidence-based data comparing outcomes of robotic to open surgery were sparse. Although initial Level 3 evidence for robotic prostatectomy observed complication outcomes similar to open prostatectomy, subsequent population-based Level 2 evidence noted an increased prevalence of adverse patient safety events and genitourinary complications among robotic patients during the early years of diffusion. Level 2 evidence indicated comparable to improved patient safety outcomes for robotic compared to open partial nephrectomy and cystectomy. Learning curve recommendations for robotic urologic surgery have drawn exclusively on Level 4 evidence and subjective, non-validated metrics. The minimum number of cases required to achieve competency for robotic prostatectomy has increased to unrealistically high levels. Most comparative cost-analyses have demonstrated that robotic surgery is significantly more expensive than open or laparoscopic surgery. Evidence-based data are limited but suggest an increased prevalence of adverse patient safety events for robotic prostatectomy early in the national diffusion period. Learning curves for robotic urologic surgery are subjective and based on non-validated metrics. The urological community should develop rigorous, evidence-based processes by which future technological innovations may diffuse in an organized and safe manner.

Incidence of prostate and urological cancers in England by ethnic group, 2001-2007: a descriptive study.

PubMed

Maruthappu, Mahiben; Barnes, Isobel; Sayeed, Shameq; Ali, Raghib

2015-10-21

The aetiology of urological cancers is poorly understood and variations in incidence by ethnic group may provide insights into the relative importance of genetic and environmental risk factors. Our objective was to compare the incidence of four urological cancers (kidney, bladder, prostate and testicular) among six 'non-White' ethnic groups in England (Indian, Pakistani, Bangladeshi, Black African, Black Caribbean and Chinese) to each other and to Whites. We obtained Information on ethnicity for all urological cancer registrations from 2001 to 2007 (n = 329,524) by linkage to the Hospital Episodes Statistics database. We calculated incidence rate ratios adjusted for age, sex and income, comparing the six ethnic groups (and combined 'South Asian' and 'Black' groups) to Whites and to each other. There were significant differences in the incidence of all four cancers between the ethnic groups (all p < 0.001). In general, 'non-White' groups had a lower incidence of urological cancers compared to Whites, except prostate cancer, which displayed a higher incidence in Blacks. (IRR 2.55) There was strong evidence of differences in risk between Indians, Pakistanis and Bangladeshis for kidney, bladder and prostate cancer (p < 0.001), and between Black Africans and Black Caribbeans for all four cancers (p < 0.001). The risk of urological cancers in England varies greatly by ethnicity, including within groups that have traditionally been analysed together (South Asians and Blacks). In general, these differences are not readily explained by known risk factors, although the very high incidence of prostate cancer in both black Africans and Caribbeans suggests increased genetic susceptibility. g.

Robotic-assisted laparoscopic surgery: recent advances in urology.

PubMed

Autorino, Riccardo; Zargar, Homayoun; Kaouk, Jihad H

2014-10-01

The aim of the present review is to summarize recent developments in the field of urologic robotic surgery. A nonsystematic literature review was performed to retrieve publications related to robotic surgery in urology and evidence-based critical analysis was conducted by focusing on the literature of the past 5 years. The use of the da Vinci Surgical System, a robotic surgical system, has been implemented for the entire spectrum of extirpative and reconstructive laparoscopic kidney procedures. The robotic approach can be applied for a range of adrenal indications as well as for ureteral diseases, including benign and malignant conditions affecting the proximal, mid, and distal ureter. Current evidence suggests that robotic prostatectomy is associated with less blood loss compared with the open surgery. Besides prostate cancer, robotics has been used for simple prostatectomy in patients with symptomatic benign prostatic hyperplasia. Recent studies suggest that minimally invasive radical cystectomy provides encouraging oncologic outcomes mirroring those reported for open surgery. In recent years, the evolution of robotic surgery has enabled urologic surgeons to perform urinary diversions intracorporeally. Robotic vasectomy reversal and several other robotic andrological applications are being explored. In summary, robotic-assisted surgery is an emerging and safe technology for most urologic operations. The acceptance of robotic prostatectomy during the past decade has paved the way for urologists to explore the entire spectrum of extirpative and reconstructive urologic procedures. Cost remains a significant issue that could be solved by wider dissemination of the technology. Copyright © 2014 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.

Iranian Nephrology and Urology Research Output in the Past Two Decades: A Bibliographic Analysis of Medline Database.

PubMed

Einollahi, Behzad; Motalebi, Mohsen; Taghipour, Mehrdad; Ebrahimi, Mehrdad

2015-09-01

We performed a bibliometric search to evaluate the number of papers published in the field of nephrology and urology by Iranian researchers in the past two decades. We did an online search in abstract/title part of articles with 129 keywords such as kidney, renal, hemodialysis, transplant, nephrology, glomerulonephritis, ureteral, nephrolithiasis, and etc. Endnote software version 7 was used to search articles published in PubMed database from November 1993 to November 2013. Those articles in which Iran was the affiliation of at least one of the authors were selected. These articles in the field of nephrology and urology were analyzed regarding the name of originated institution, field of study, total number of publications, type of study, collaboration rate of Iranian nephrologist and urologists for every year, annual sharing of Iranian articles in five journals with highest impact factor (IF) and journal IF. The total number of publications in the field of nephrology and urology was 3,771 (average of 189 papers per year). Most of the Iranian nephrology and urology papers were from the capital city, Tehran (50.03%). There was an increasing trend in the number of publications over the years. Most papers were about transplantation (44.6%), nephrology (20.9%) and hemodialysis (16.4%). Of all, 53.7% were retrospective articles, whereas the proportion of clinical trials was relatively small (10.8%). Although Iranian publications in the field of nephrology and urology have had a considerable and significant increase in the recent years amongst the Middle Eastern countries, there is a wide distance to be a science exporter country.

[Use of social media by French urologists: Results from a study of the National French Urological Association].

PubMed

Misrai, V; Castagnola, C; Descotes, J-L; Rouprêt, M

2015-06-01

Social Media (SoMe) have changed the face of modern medicine. Our purpose was to make an inventory on the use of SoMe within urologists members of the French Urological Association (AFU). A 15 questions-survey was sent by email 2 months to urologists AFU members before the 108th French Congress of Urology (#CFU2014). At the same time, the activity of urologists using Twitter was analyzed over the period of the national conference with the symplur software (www.symplur.com). Overall, 270 (17.3%) surveys were completed. Only 50% of responders had an online SoMe account. The most commonly used social media platforms were: Facebook (36.1%) followed by LinkedIn (28.2%), Google+ (19.6%), YouTube (18.7%) and Twitter (17.4%). The use of SoMe was higher in the age groups 30-40 and 40-50 years than in older age groups (83% versus 36%). Only 38.7% of respondents reported using SoMe in a professional field. At the congress #CFU2014, there were over 1000 tweets generated by 173 different contributors. Only a minority of French urologists have reported to be connected to SoMe and a predominantly personal use. The emergence of Twitter in French urological conferences is very new but seems promising. Further studies are needed, especially within the members of the residents French urological association to better characterize the true impact of SoMe in urology. 4. Copyright © 2015 Elsevier Masson SAS. All rights reserved.

Urologic diseases in America Project: analytical methods and principal findings.

PubMed

Litwin, Mark S; Saigal, Christopher S; Yano, Elizabeth M; Avila, Chantal; Geschwind, Sandy A; Hanley, Jan M; Joyce, Geoffrey F; Madison, Rodger; Pace, Jennifer; Polich, Suzanne M; Wang, Mingming

2005-03-01

The burden of urological diseases on the American public is immense in human and financial terms but it has been under studied. We undertook a project, Urologic Diseases in America, to quantify the burden of urological diseases on the American public. We identified public and private data sources that contain population based data on resource utilization by patients with benign and malignant urological conditions. Sources included the Centers for Medicare and Medicaid Services, National Center for Health Statistics, Medical Expenditure Panel Survey, National Health and Nutrition Examination Survey, Department of Veterans Affairs, National Association of Children's Hospitals and Related Institutions, and private data sets maintained by MarketScan Health and Productivity Management (MarketScan, Chichester, United Kingdom), Ingenix (Ingenix, Salt Lake City, Utah) and Center for Health Care Policy and Evaluation. Using diagnosis and procedure codes we described trends in the utilization of urological services. In 2000 urinary tract infections accounted for more than 6.8 million office visits and 1.3 million emergency room visits, and 245,000 hospitalizations in women with an annual cost of more than 2.4 billion dollars. Urinary tract infections accounted for more than 1.4 million office visits, 424,000 emergency room visits and 121,000 hospitalizations in men with an annual cost of more than 1 billion dollars. Benign prostatic hyperplasia was the primary diagnosis in more than 4.4 million office visits, 117,000 emergency room visits and 105,000 hospitalizations, accounting for 1.1 billion dollars in expenditures that year. Urolithiasis was the primary diagnosis for almost 2 million office visits, more than 600,000 emergency room visits, and more than 177,000 hospitalizations, totaling more than 2 billion dollars in annual expenditures. Urinary incontinence in women was the primary cause for more than 1.1 million office visits in 2000 and 452 million dollars in aggregate primary cause for more than 1.1 million office visits in 2000 and 452 million dollars in aggregate annual expenditures. Other manuscripts in this series present further detail for specific urologic conditions. Recent trends in epidemiology, practice patterns, resource utilization and costs for urological diseases have broad implications for quality of health care, access to care and the equitable allocation of scarce resources for clinical care and research.

Achieving Quality Assurance of Prostate Cancer Surgery During Reorganisation of Cancer Services.

PubMed

Cathcart, Paul; Sridhara, Ashwin; Ramachandran, Navin; Briggs, Timothy; Nathan, Senthil; Kelly, John

2015-07-01

National Health Service England recently oversaw a whole-scale reconfiguration of cancer services in London, UK, for a number of different cancer pathways. Centralisation of cancer surgery has occurred with prostate cancer (PCa) surgery only being commissioned at a single designated pelvic cancer surgical centre. This process has required surgeons to work in teams providing a hub-and-spoke model of care. To report the extent to which the initiation of a quality assurance programme (QAP) can improve the quality of PCa surgical care during reorganisation of cancer services in London. A pre- and postintervention study was initiated with 732 men undergoing robot-assisted radical PCa surgery over a 3-yr period, 396 men before the introduction of the QAP and 336 afterwards. Image-based surgical planning of cancer surgery and monthly peer review of individual surgeon outcomes incorporating rating and assessment of edited surgical video clips. We observed margin status (positive/negative), complication rate of surgery, 3-mo urinary continence, use of nerve-sparing surgery, and potency at 12 mo after surgery. Multivariable logistic regression modelling was used to compare outcomes before and after initiation of the QAP. Cox regression analysis was used to evaluate the return of potency over time. Demographics of patients undergoing surgery did not change following the reorganisation of cancer services. Patient-reported 3-mo urinary continence improved following the initiation of the QAP, both in terms of requirement for incontinence pads (57% continent vs 67% continent; odds ratio [OR]: 2.19; 95% confidence interval [CI], 1.08-4.46; p=0.02) and International Consultation on Incontinence Questionnaire score (5.6 vs 4.2; OR: 0.82; 95% CI, 0.70-0.95; p=0.009). Concurrently, use of nerve-sparing surgery increased significantly (OR: 2.99; 95% CI, 2.14-4.20; p<0.001) while margin status remained static. Potency at 12 mo increased significantly from 21% to 61% in those patients undergoing bilateral nerve-sparing surgery (hazard ratio: 3.58; 95% CI, 1.29-9.87; p=0.04). Interaction was noted between surgeon and 3-mo urinary continence. On regression analysis, incontinence scores improved significantly for all but one surgeon who had low incontinence rates at study initiation. The implementation of a QAP improved quality of care in terms of consistency of patient selection and outcomes of surgery during a period of major reorganisation of cancer services in London. The QAP framework presented could be adopted by other organisations providing complex surgical care across a large network of referring hospitals. The introduction of a quality assurance programme improved the quality of prostate cancer care in terms of consistency of patient selection and outcomes of surgery during a period of major reorganisation of cancer services. Copyright © 2015 European Association of Urology. Published by Elsevier B.V. All rights reserved.

Long term safety of sacral nerve modulation in medicare beneficiaries.

PubMed

Chughtai, Bilal; Sedrakyan, Art; Isaacs, Abby; Lee, Richard; Te, Alexis; Kaplan, Steven

2015-09-01

Sacral nerve stimulation (SNS) is FDA approved as second-line therapy for both urinary and bowel control. However, there is limited evidence regarding long term safety. We determined adverse events associated with SNS among Medicare beneficiaries. We used the 5% national random sample of Medicare claims for 2001-2011 to identify patients. Patients who underwent SNS implantation were identified with Current Procedure Terminology (CPT-4) codes. We determined safety of SNS using analysis of complication occurrences on day of surgery and during 5 years following initial procedure. SAS v9.3 statistical package was used. One thousand four hundred seventy-four patients underwent treatment with SNS in the 5% national sample of Medicare patients within the time period. Representative of real-world patients undergoing SNS surgery, comorbidities included hypertension (69.3%), diabetes (29.4%), chronic pulmonary disease (25.5%), hypothyroidism (25.2%), and depression (22.7%). Few complications occurred on day of surgery. At 90 days, 3.2% of patients had bowel complications, 2.0% urological, 9.4% infectious, and 1.5% stroke. Overall, bowel, neurological health event occurrences were consistent with prior year rates, while infectious events decreased. Of 206 patients who were followed for at least 5 years, 17.3% had devices removed and 11.3% replaced, with 26.1% having at least one of those, leaving 73.9% with original devices. Urological, infectious, and bowel complication occurrences were low after SNS among Medicare beneficiaries with multiple comorbidities. There were infrequent serious complications like hemorrhage and stroke postoperatively. Although SNS appears safe in this high-risk population, a comprehensive registry will ensure continuous safety. © 2014 Wiley Periodicals, Inc.

Variability of inter-observer agreement on feasibility of partial nephrectomy before and after neoadjuvant axitinib for locally advanced renal cell carcinoma (RCC): independent analysis from a phase II trial.

PubMed

Karam, Jose A; Devine, Catherine E; Fellman, Bryan M; Urbauer, Diana L; Abel, E Jason; Allaf, Mohamad E; Bex, Axel; Lane, Brian R; Thompson, R Houston; Wood, Christopher G

2016-04-01

To evaluate how many patients could have undergone partial nephrectomy (PN) rather than radical nephrectomy (RN) before and after neoadjuvant axitinib therapy, as assessed by five independent urological oncologists, and to study the variability of inter-observer agreement. Pre- and post-systemic treatment computed tomography scans from 22 patients with clear cell renal cell carcinoma in a phase II neoadjuvant axitinib trial were reviewed by five independent urological oncologists. R.E.N.A.L. nephrometry score and κ statistics were calculated. The median R.E.N.A.L. nephrometry score changed from 11 before treatment to 10 after treatment (P = 0.002). Five tumours with moderate complexity before axitinib treatment remained moderate complexity after treatment. Of 17 tumours with high complexity before axitinib treatment, three became moderate complexity after treatment. The overall κ statistic was 0.611. Moderate-complexity κ was 0.611 vs a high-complexity κ of 0.428. Before axitinib treatment the κ was 0.550 vs 0.609 after treatment. After treatment with axitinib, all five reviewers agreed that only five patients required RN (instead of eight before treatment) and that 10 patients could now undergo PN (instead of three before treatment). The odds of PN feasibility were 22.8-times higher after treatment with axitinib. There is considerable variability in inter-observer agreement on the feasibility of PN in patients treated with neoadjuvant targeted therapy. Although more patients were candidates for PN after neoadjuvant axitinib therapy, it remains difficult to identify these patients a priori. © 2015 The Authors BJU International © 2015 BJU International Published by John Wiley & Sons Ltd.

National practice patterns and outcomes of pediatric nephrectomy: comparison between urology and general surgery.

PubMed

Suson, Kristina D; Wolfe-Christensen, Cortney; Elder, Jack S; Lakshmanan, Yegappan

2015-05-01

In adults nephrectomy is under the purview of urologists, but pediatric urologists and pediatric general surgeons perform extirpative renal surgery in children. We compared the contemporary performance and outcome of all-cause nephrectomy at pediatric hospitals as performed by pediatric urologists and pediatric general surgeons. We queried the Pediatric Health Information System to identify patients 0 to 18 years old who were treated with nephrectomy between 2004 and 2013 by pediatric urologists and pediatric general surgeons. Data points included age, gender, severity level, mortality risk, complications and length of stay. Patients were compared by APR DRG codes 442 (kidney and urinary tract procedures for malignancy) and 443 (kidney and urinary tract procedures for nonmalignancy). Pediatric urologists performed more all-cause nephrectomies. While pediatric urologists were more likely to operate on patients with benign renal disease, pediatric general surgeons were more likely to operate on children with malignancy. Patients on whom pediatric general surgeons operated had a higher average severity level and were at greater risk for mortality. After controlling for differences patients without malignancy operated on by pediatric urologists had a shorter length of stay, and fewer medical and surgical complications. There was no difference in length of stay, or medical or surgical complications in patients with malignancy. Overall compared to pediatric general surgeons more nephrectomies are performed by pediatric urologists. Short-term outcomes, including length of stay and complication rates, appear better in this data set in patients without malignancy who undergo nephrectomy by pediatric urologists but there is no difference in outcomes when nephrectomy is performed for malignancy. Copyright © 2015 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.

Patient experience and quality of urologic cancer surgery in US hospitals.

PubMed

Shirk, Joseph D; Tan, Hung-Jui; Hu, Jim C; Saigal, Christopher S; Litwin, Mark S

2016-08-15

Care interactions as perceived by patients and families are increasingly viewed as both an indicator and lever for high-value care. To promote patient-centeredness and motivate quality improvement, payers have begun tying reimbursement with related measures of patient experience. Accordingly, the authors sought to determine whether such data correlate with outcomes among patients undergoing surgery for genitourinary cancer. The authors used the Nationwide Inpatient Sample and Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) data from 2009 through 2011. They identified hospital admissions for cancer-directed prostatectomy, nephrectomy, and cystectomy, and measured mortality, hospitalization length, discharge disposition, and complications. Mixed effects models were used to compare the likelihood of selected outcomes between the top and bottom tercile hospitals adjusting for patient and hospital characteristics. Among a sample of 46,988 encounters, the authors found small differences in patient age, race, income, comorbidity, cancer type, receipt of minimally invasive surgery, and procedure acuity according to HCAHPS tercile (P<.001). Hospital characteristics also varied with respect to ownership, teaching status, size, and location (P<.001). Compared with patients treated in low-performing hospitals, patients treated in high-performing hospitals less often faced prolonged hospitalization (odds ratio, 0.77; 95% confidence interval, 0.64-0.92) or nursing-sensitive complications (odds ratio, 0.85; 95% confidence interval, 0.72-0.99). No difference was found with regard to inpatient mortality, other complications, and discharge disposition (P>.05). Using Nationwide Inpatient Sample and HCAHPS data, the authors found a limited association between patient experience and surgical outcomes. For urologic cancer surgery, patient experience may be optimally viewed as an independent quality domain rather than a mechanism with which to improve surgical outcomes. Cancer 2016;122:2571-8. © 2016 American Cancer Society. © 2016 American Cancer Society.

A Prospective Blinded Evaluation of Urine-DNA Testing for Detection of Urothelial Bladder Carcinoma in Patients with Gross Hematuria.

PubMed

Dahmcke, Christina M; Steven, Kenneth E; Larsen, Louise K; Poulsen, Asger L; Abdul-Al, Ahmad; Dahl, Christina; Guldberg, Per

2016-12-01

Retrospective studies have provided proof of principle that bladder cancer can be detected by testing for the presence of tumor DNA in urine. We have conducted a prospective blinded study to determine whether a urine-based DNA test can replace flexible cystoscopy in the initial assessment of gross hematuria. A total of 475 consecutive patients underwent standard urological examination including flexible cystoscopy and computed tomography urography, and provided urine samples immediately before (n=461) and after (n=444) cystoscopy. Urine cells were collected using a filtration device and tested for eight DNA mutation and methylation biomarkers. Clinical evaluation identified 99 (20.8%) patients with urothelial bladder tumors. With this result as a reference and based on the analysis of all urine samples, the DNA test had a sensitivity of 97.0%, a specificity of 76.9%, a positive predictive value of 52.5%, and a negative predictive value of 99.0%. In three patients with a positive urine-DNA test without clinical evidence of cancer, a tumor was detected at repeat cystoscopy within 16 mo. Our results suggest that urine-DNA testing can be used to identify a large subgroup of patients with gross hematuria in whom cystoscopy is not required. We tested the possibility of using a urine-based DNA test to check for bladder cancer in patients with visible blood in the urine. Our results show that the test efficiently detects bladder cancer and therefore may be used to greatly reduce the number of patients who would need to undergo cystoscopy. Copyright © 2016 European Association of Urology. Published by Elsevier B.V. All rights reserved.

Gastroenterology-Urology Devices; Manual Gastroenterology-Urology Surgical Instruments and Accessories. Final rule; technical amendment.

PubMed

2017-03-01

The Food and Drug Administration (FDA) is amending the identification of manual gastroenterology-urology surgical instruments and accessories to reflect that the device does not include specialized surgical instrumentation for use with urogyencologic surgical mesh specifically intended for use as an aid in the insertion, placement, fixation, or anchoring of surgical mesh during urogynecologic procedures ("specialized surgical instrumentation for use with urogynecologic surgical mesh"). These amendments are being made to reflect changes made in the recently issued final reclassification order for specialized surgical instrumentation for use with urogynecologic surgical mesh.

[Objects from scientific collections in demand: the value of the various collections of the Urologic History Center of the German Society of Urology for modern teaching purposes in urology].

PubMed

Moll, F H

2015-02-01

The use of artifacts and objects from scientific medical collections and museums for academic teaching purposes are one of the main qualifying tasks of those institutions. In recent years, this aspect of scientific collections has again become on focus within academics. The collections offer a unique chance for visual and haptic forms of teaching in many fields. Due to the potential of scientific collections, educators in all branches in academic learning should be familiar with handling objects for such purposes.

[Cooperation between professional association and scientific society].

PubMed

Schroeder, A; Hakenberg, O W

2013-08-01

Developments in health economics, urological sciences and social as well as demographic conditions pose numerous problems for the field of urology. In order to solve these problems a close cooperation between the professional association and the scientific society are needed which at first sight seem to have very different interests. The increasing complexity and interdependency in all areas of the healthcare system make a simple separation of interests between the scientific society and the professional association impossible. The Professional Association of German Urologists and the German Society of Urology have acknowledged this situation for many years and have intensified their close collaboration.

Urologic Emergencies.

PubMed

Manjunath, Adarsh S; Hofer, Matthias D

2018-03-01

Urologic emergencies can involve the kidneys, ureters, bladder, urethra, penis, scrotum, or testicles. History and physical examination are essential to diagnosis, whereas imaging is increasingly used to confirm diagnoses. Acute urinary retention should be relieved with Foley placement. Penile emergencies include paraphimosis, which can be treated by foreskin reduction, whereas penile fracture and priapism require urologic intervention. Fournier gangrene and testicular torsion are scrotal emergencies requiring emergent surgery. Nephrolithiasis, although painful, is not an emergency unless there is concern for concomitant urinary tract infection, both ureters are obstructed by stones, or there is an obstructing stone in a solitary kidney. Copyright © 2017 Elsevier Inc. All rights reserved.

Simulators in the urological training armamentarium: A boon or a bane?

PubMed

Aggarwal, Gaurav; Adhikary, Samiran D

2017-06-01

Simulation devices have grasped the attention of almost all industries worldwide and the medical field has not been exempt. With technological advancement, it becomes important to assess whether medical simulators are the way forward as an adjunct or as a replacement to traditional training approaches by assessing their safety, efficacy and cost-effectiveness, and whether they should be made mandatory in the curriculum of urology training. The present review aims to clarify some of these issues, as well as assess their role in urological training and present both the pros and cons of this simulation-based training.

[Education of medical students in urology in Germany: present status].

PubMed

Strunk, T; Mueller, S C

2011-02-01

There is a growing demand for doctors in Germany and diseases of the genitourinary tract have become more prevalent in recent years. Politicians plan to increase the number of students in an already heavily overloaded system but data on quality and structure of medical education in Urology are lacking. The purpose of this study was to investigate the extent and quality of undergraduate medical education in urology. Departments of Urology at German University Hospitals were surveyed using a questionnaire. Questions covered four different fields of medical education and answers were analyzed by descriptive statistics. Of the teachers involved in medical education 97% are physicians and 4% of these have special didactic qualifications. On average 1 teacher is responsible for 13 students and 44% of departments also have to carry out medical duties during teaching lessons. More than half of the departments offer modern learning forms, such as e-learning, problem-oriented learning or skills laboratory training. Urology departments at German University Hospitals spend much time on medical education. Nearly all physicians are involved in medical education, whether they are experienced or not and in many cases teaching is carried out in parallel to patient care. In more than half of the cases modern education tools were employed which implies a good standard of quality but there are no data on outcome.

The holmium laser in urology.

PubMed

Wollin, T A; Denstedt, J D

1998-02-01

To review the physics related to the holmium laser, its laser-tissue interactions, and its application to the treatment of urological diseases. The holmium: YAG laser is a solid-state, pulsed laser that emits light at 2100 nm. It combines the qualities of the carbon dioxide and neodymium:YAG lasers providing both tissue cutting and coagulation in a single device. Since the holmium wavelength can be transmitted down optical fibers, it is especially suited for endoscopic surgery. The authors provide a review of the literature as it relates to the holmium laser and its application to urology. The holmium wavelength is strongly absorbed by water. Tissue ablation occurs superficially, providing for precise incision with a thermal injury zone ranging from 0.5 to 1.0 mm. This level of coagulation is sufficient for adequate hemostasis. The most common urologic applications of the holmium laser that have been reported include incision of urethral and ureteral strictures; ablation of superficial transitional cell carcinoma; bladder neck incision and prostate resection; and lithotripsy of urinary calculi. The holmium: YAG laser is a multi-purpose, multi-specialty surgical laser. It has been shown to be safe and effective for multiple soft tissue applications and stone fragmentation. Its utilization in urology is anticipated to increase with time as a result of these features.

Use of social media in urology: data from the American Urological Association (AUA).

PubMed

Loeb, Stacy; Bayne, Christopher E; Frey, Christine; Davies, Benjamin J; Averch, Timothy D; Woo, Henry H; Stork, Brian; Cooperberg, Matthew R; Eggener, Scott E

2014-06-01

To characterise the use of social media among members of the American Urological Association (AUA), as the use of social media in medicine has greatly expanded in recent years. In December 2012 to January 2013, the AUA e-mailed a survey with 34 questions on social media use to 2000 randomly selected urologists and 2047 resident/fellow members. Additional data was collected from Symplur analytics on social media use surrounding the AUA Annual Meeting in May 2013. In all, 382 (9.4%) surveys were completed, indicating 74% of responders had an online social media account. The most commonly used social media platforms were Facebook (93%), followed in descending order by LinkedIn (46%), Twitter (36%) and Google+ (26%). Being aged <40 years was an important predictor of social media use (83% vs 56%), with greater uptake among residents/fellows compared with attendings (86% vs 66%). Only 28% of respondents used social media partly or entirely for professional purposes. During the 2013 AUA Annual Meeting, there were >5000 tweets from >600 distinct contributors. As of early 2013, among respondents to an e-mail survey, most urologists and urology trainees used some form of social media, and its use in urology conferences has greatly expanded. © 2013 The Authors. BJU International © 2013 BJU International.

The urological complications of renal transplantation: a series of 1535 patients.

PubMed

Streeter, E H; Little, D M; Cranston, D W; Morris, P J

2002-11-01

To determine the incidence of urological complications of renal transplantation at one institution, and relate this to donor and recipient factors. A consecutive series of 1535 renal transplants were audited, and a database of donor and recipient characteristics created for risk-factor analysis. An unstented Leadbetter-Politano anastomosis was the preferred method of ureteric reimplantation. There were 45 urinary leaks, 54 primary ureteric obstructions, nine cases of ureteric calculi, three bladder stones and 19 cases of bladder outlet obstruction at some time after transplantation. The overall incidence of urological complications was 9.2%, with that for urinary leak or primary ureteric obstruction being 6.5%. One graft was lost because of complications, and there were three deaths associated directly or indirectly with urological complications. There was no association with recipient age, cadaveric vs living-donor transplants, or cold ischaemic times before organ reimplantation, although the donor age was slightly higher in cases of urinary leak. There was no association with kidneys imported via the UK national organ-sharing scheme vs the use of local kidneys. The management of these complications is discussed. The incidence of urological complications in this series has remained essentially unchanged for 20 years. The causes of these complications and techniques for their prevention are discussed.

The Contemporary Incidence and Sequelae of Rhabdomyolysis Following Extirpative Renal Surgery: A Population Based Analysis.

PubMed

Gelpi-Hammerschmidt, Francisco; Tinay, Ilker; Allard, Christopher B; Su, Li-Ming; Preston, Mark A; Trinh, Quoc-Dien; Kibel, Adam S; Wang, Ye; Chung, Benjamin I; Chang, Steven L

2016-02-01

We evaluate the contemporary incidence and consequences of postoperative rhabdomyolysis after extirpative renal surgery. We conducted a population based, retrospective cohort study of patients who underwent extirpative renal surgery with a diagnosis of a renal mass or renal cell carcinoma in the United States between 2004 and 2013. Regression analysis was performed to evaluate 90-day mortality (Clavien grade V), nonfatal major complications (Clavien grade III-IV), hospital readmission rates, direct costs and length of stay. The final weighted cohort included 310,880 open, 174,283 laparoscopic and 69,880 robotic extirpative renal surgery cases during the 10-year study period, with 745 (0.001%) experiencing postoperative rhabdomyolysis. The presence of postoperative rhabdomyolysis led to a significantly higher incidence of 90-day nonfatal major complications (34.7% vs 7.3%, p <0.05) and higher 90-day mortality (4.4% vs 1.02%, p <0.05). Length of stay was twice as long for patients with postoperative rhabdomyolysis (incidence risk ratio 1.83, 95% CI 1.56-2.15, p <0.001). The robotic approach was associated with a higher likelihood of postoperative rhabdomyolysis (vs laparoscopic approach, OR 2.43, p <0.05). Adjusted 90-day median direct hospital costs were USD 7,515 higher for patients with postoperative rhabdomyolysis (p <0.001). Our model revealed that the combination of obesity and prolonged surgery (more than 5 hours) was associated with a higher likelihood of postoperative rhabdomyolysis developing. Our study confirms that postoperative rhabdomyolysis is an uncommon complication among patients undergoing extirpative renal surgery, but has a potentially detrimental impact on surgical morbidity, mortality and costs. Male gender, comorbidities, obesity, prolonged surgery (more than 5 hours) and a robotic approach appear to place patients at higher risk for postoperative rhabdomyolysis. Copyright © 2016 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.

Acute inflammatory proteins constitute the organic matrix of prostatic corpora amylacea and calculi in men with prostate cancer

PubMed Central

Sfanos, Karen S.; Wilson, Brice A.; De Marzo, Angelo M.; Isaacs, William B.

2009-01-01

Corpora amylacea (CA) are a frequent microscopic finding in radical prostatectomy specimens from men undergoing treatment for prostate cancer. Although often observed histologically to be associated with inflammation, the contribution of CA to prostatitis-related symptoms of unknown etiology or to prostate carcinogenesis remains unclear. Prostatic calculi (PC), which potentially represent calcified forms of CA, are less common but can cause urological disease including urinary retention and prostatitis. We conducted a comprehensive compositional analysis of CA/PC to gain insight into their biogenesis. Infrared spectroscopy analysis of calculi collected from 23 patients confirmed a prevalence of calcium phosphate in the form of hydroxyapatite. This result sets PC apart from most urinary stones, which largely are composed of calcium oxalate. Tandem mass spectrometry-based proteomic analysis of CA/PC revealed that lactoferrin is the predominant protein component, a result that was confirmed by Western blot analysis. Other proteins identified, including calprotectin, myeloperoxidase, and α-defensins, are proteins contained in neutrophil granules. Immunohistochemistry (IHC) suggested the source of lactoferrin to be prostate-infiltrating neutrophils as well as inflamed prostate epithelium; however, IHC for calprotectin suggested prostate-infiltrating neutrophils as a major source of the protein, because it was absent from other prostate compartments. This study represents a definitive analysis of the protein composition of prostatic CA and calculi and suggests that acute inflammation has a role in their biogenesis—an intriguing finding, given the prevalence of CA in prostatectomy specimens and the hypothesized role for inflammation in prostate carcinogenesis. PMID:19202053

Readmissions, unplanned emergency room visits, and surgical retreatment rates after anti-reflux procedures.

PubMed

Wang, Hsin-Hsiao S; Tejwani, Rohit; Wolf, Steven; Wiener, John S; Routh, Jonathan C

2017-10-01

The choice between endoscopic injection (EI) and ureteroneocystotomy (UNC) for surgical correction of vesicoureteral reflux (VUR) is controversial. To compare postoperative outcomes of EI vs UNC. This study reviewed linked inpatient (SID), ambulatory surgery (SASD), and emergency department (SEDD) data from five states in the United States (2007-10) to identify pediatric patients with primary VUR undergoing EI or UNC as an initial surgical intervention. Unplanned readmissions, additional procedures, and emergency room (ER) visits were extracted. Statistical analysis was performed using multivariate logistic regression using generalized estimating equation (GEE) to adjust for hospital-level clustering. The study identified 2556 UNC and 1997 EI procedures. Compared with patients undergoing EI, those who underwent UNC were more likely to be younger (4.6 vs 6.0 years, P < 0.001), male (30 vs 20%, P < 0.001), and publicly insured (34 vs 29%, P < 0.001). As shown in Summary Figure, compared with EI, UNC patients had lower rates of additional anti-reflux procedures within 12 months (25 (1.0) vs 121 (6.1%), P < 0.001), but a higher rate of 30-day and 90-day readmissions and ER visits. On multivariate analysis, patients treated by UNC remained at higher odds of being readmitted (OR = 4.45; 2.69 in 30 days; 90 days, P < 0.001) and to have postoperative ER visits (OR = 3.33; 2.26 in 30 days; 90 days, P < 0.001); however, EI had significantly higher odds of repeat anti-reflux procedures in the subsequent year (OR = 7.12, P < 0.001). Endoscopic injection constituted nearly half of initial anti-reflux procedures in children. However, patients treated with UNC had significantly lower odds of requiring re-treatment in the first year relative to those treated with EI. By contrast, patients treated with UNC had more than twice the odds of being readmitted or visiting an ER postoperatively. Although the available data were amongst the largest and most well validated, the major limitation was the retrospective nature of the administrative database. The practice setting may not be generalizable to states not included in the analysis. Postoperative readmissions and ER visits were uncommon after any surgical intervention for VUR, but were more common among children undergoing UNC. The EI patients had a more than seven-fold increased risk of surgical re-treatment within 1 year. Copyright © 2017 Journal of Pediatric Urology Company. Published by Elsevier Ltd. All rights reserved.

Effect of Prostate Cancer Severity on Functional Outcomes After Localized Treatment: Comparative Effectiveness Analysis of Surgery and Radiation Study Results.

PubMed

Tyson, Mark Douglas; Koyama, Tatsuki; Lee, Dan; Hoffman, Karen E; Resnick, Matthew J; Wu, Xiao-Cheng; Cooperberg, Matthew R; Goodman, Michael; Greenfield, Sheldon; Hamilton, Ann S; Hashibe, Mia; Paddock, Lisa E; Stroup, Antoinette; Chen, Vivien; Conwill, Ralph; McCollum, Dan; Penson, David F; Barocas, Daniel A

2018-07-01

Whether prostate cancer severity modifies patient-reported functional outcomes after radical prostatectomy (RP) or external beam radiotherapy (EBRT) for localized cancer is unknown. The purpose of this study was to determine whether differences in predicted function over time between RP and EBRT varied by risk group. The Comparative Effectiveness Analysis of Surgery and Radiation (CEASAR) study is a prospective, population-based, observational study that enrolled men with localized prostate cancer in 2011-2012. Among 2117 CEASAR participants who underwent RP or EBRT, 817 had low-risk, 902 intermediate-risk, and 398 high-risk disease. Patient-reported, disease-specific function was measured using the 26-item Expanded Prostate Index Composite (at baseline and 6, 12, and 36 mo). Predicted function was estimated using regression models and compared by disease risk. Low-risk EBRT patients reported 3-yr sexual function scores 12 points higher than those of low-risk RP patients (RP, 39 points [95% confidence interval {CI}, 37-42] vs EBRT, 52 points [95% CI, 47-56]; p<0.001). The difference in 3-yr scores for high-risk patients was not clinically significant (RP, 32 points [95% CI, 28-35] vs EBRT, 38 points [95% CI, 33-42]; p=0.03). However, when using a commonly used binary definition of sexual function (erections firm enough for intercourse), no major differences were noted between RP and EBRT at 3 yr across low-, intermediate-, and high-risk disease strata. No clinically significant interactive effects between treatment and cancer severity were observed for incontinence, bowel, irritative voiding, and hormone domains. The primary limitation is the lack of firmly established thresholds for clinically significant differences in Expanded Prostate Index Composite domain scores. For men with low-risk prostate cancer, EBRT was associated with higher sexual function scores at 3 yr than RP; however, for men with high-risk prostate cancer, no clinically significant difference was noted. Men with high-risk prostate cancer should be counseled that EBRT and RP carry similar sexual function outcomes at 3 yr. In this report, we studied the urinary, sexual, bowel, and hormonal functions of patients 3 yr after undergoing prostate cancer surgery or radiation. We found that for patients with high-risk disease, sexual function was similar between surgery and radiation. We conclude that high-risk patients undergoing radiation therapy should be counseled that sexual function may not be as good as low-risk patients undergoing radiation. Copyright © 2018 European Association of Urology. Published by Elsevier B.V. All rights reserved.

Posterior tibial nerve stimulation vs parasacral transcutaneous neuromodulation for overactive bladder in children.

PubMed

Barroso, Ubirajara; Viterbo, Walter; Bittencourt, Joana; Farias, Tiago; Lordêlo, Patrícia

2013-08-01

Parasacral transcutaneous electrical nerve stimulation and posterior tibial nerve stimulation have emerged as effective methods to treat overactive bladder in children. However, to our knowledge no study has compared the 2 methods. We evaluated the results of parasacral transcutaneous electrical nerve stimulation and posterior tibial nerve stimulation in children with overactive bladder. We prospectively studied children with overactive bladder without dysfunctional voiding. Success of treatment was evaluated by visual analogue scale and dysfunctional voiding symptom score, and by level of improvement of each specific symptom. Parasacral transcutaneous electrical nerve stimulation was performed 3 times weekly and posterior tibial nerve stimulation was performed once weekly. A total of 22 consecutive patients were treated with posterior tibial nerve stimulation and 37 with parasacral transcutaneous electrical nerve stimulation. There was no difference between the 2 groups regarding demographic characteristics or types of symptoms. Concerning the evaluation by visual analogue scale, complete resolution of symptoms was seen in 70% of the group undergoing parasacral transcutaneous electrical nerve stimulation and in 9% of the group undergoing posterior tibial nerve stimulation (p = 0.02). When the groups were compared, there was no statistically significant difference (p = 0.55). The frequency of persistence of urgency and diurnal urinary incontinence was nearly double in the group undergoing posterior tibial nerve stimulation. However, this difference was not statistically significant. We found that parasacral transcutaneous electrical nerve stimulation is more effective in resolving overactive bladder symptoms, which matches parental perception. However, there were no statistically significant differences in the evaluation by dysfunctional voiding symptom score, or in complete resolution of urgency or diurnal incontinence. Copyright © 2013 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.

Racial Variation In Timing Of Pyeloplasty: Prenatal Versus Postnatal Diagnosis

PubMed Central

Routh, Jonathan C.; Pennison, Melanie; Rosoklija, Ilina; Dobbins, Sarah; Kokorowski, Paul J.; Hubert, Katherine C.; Huang, Lin; Nelson, Caleb P.

2013-01-01

Purpose We have previously shown that non-white patients with UPJ obstruction undergo pyeloplasty at a younger age than do whites. The mechanisms behind this are unclear, as there is no known racial variation in the natural history of UPJ obstruction. We sought to use a detailed clinical database to explain this phenomenon. Methods We performed a retrospective review of all patients undergoing primary pyeloplasty at our institution between 1992 and 2008. Over 360 data points were abstracted for each patient, including self-reported patient race, socioeconomic status, symptom duration, and presentation. Results Of 847 patients undergoing pyeloplasty during the study period, 741 met inclusion criteria. Non-white patients underwent surgery younger than did whites (non-white 0.6 v. white 2.6 years, p<0.0001). When stratified by timing of clinical presentation (prenatal versus postnatal), there was no significant difference by race among patients presenting prenatally (0.37 v. 0.36 years, p=0.22). Non-white patients presenting postnatally were significantly younger than white patients (6.3 v. 8.2 years, p=0.03). This appeared to be due to differences in both the age at initial clinical presentation (5.4 v. 7.0 years, p=0.03) and in time from initial clinical presentation to urology evaluation (0.6 v. 3.2 months, p=0.03). These differences persisted after correcting for other factors, including markers of socioeconomic status. Conclusions Consistent with previous studies, we found that non-white patients underwent primary pyeloplasty at a younger age than whites. This difference is limited to patients presenting after birth. Prenatally diagnosed patients underwent surgery at similar ages regardless of race. PMID:22014821

Validation of APACHE II scoring system at 24 hours after admission as a prognostic tool in urosepsis: A prospective observational study.

PubMed

VijayGanapathy, Sundaramoorthy; Karthikeyan, VIlvapathy Senguttuvan; Sreenivas, Jayaram; Mallya, Ashwin; Keshavamurthy, Ramaiah

2017-11-01

Urosepsis implies clinically evident severe infection of urinary tract with features of systemic inflammatory response syndrome (SIRS). We validate the role of a single Acute Physiology and Chronic Health Evaluation II (APACHE II) score at 24 hours after admission in predicting mortality in urosepsis. A prospective observational study was done in 178 patients admitted with urosepsis in the Department of Urology, in a tertiary care institute from January 2015 to August 2016. Patients >18 years diagnosed as urosepsis using SIRS criteria with positive urine or blood culture for bacteria were included. At 24 hours after admission to intensive care unit, APACHE II score was calculated using 12 physiological variables, age and chronic health. Mean±standard deviation (SD) APACHE II score was 26.03±7.03. It was 24.31±6.48 in survivors and 32.39±5.09 in those expired (p<0.001). Among patients undergoing surgery, mean±SD score was higher (30.74±4.85) than among survivors (24.30±6.54) (p<0.001). Receiver operating characteristic (ROC) analysis revealed area under curve (AUC) of 0.825 with cutoff 25.5 being 94.7% sensitive and 56.4% specific to predict mortality. Mean±SD score in those undergoing surgery was 25.22±6.70 and was lesser than those who did not undergo surgery (28.44±7.49) (p=0.007). ROC analysis revealed AUC of 0.760 with cutoff 25.5 being 94.7% sensitive and 45.6% specific to predict mortality even after surgery. A single APACHE II score assessed at 24 hours after admission was able to predict morbidity, mortality, need for surgical intervention, length of hospitalization, treatment success and outcome in urosepsis patients.

The Influence of decision aids on prostate cancer screening preferences: A randomized survey study.

PubMed

Weiner, Adam B; Tsai, Kyle P; Keeter, Mary-Kate; Victorson, David E; Schaeffer, Edward M; Catalona, William J; Kundu, Shilajit D

2018-05-28

Shared decision making is recommended regarding prostate cancer screening. Decision aids may facilitate this process; however, the impact of decision aids on screening preferences is poorly understood. In an online survey, a national sample of adults were randomized to one of six different professional societies' online decision aids. We compared pre- and post-decision aid responses. The primary outcome was change in participant likelihood to undergo or recommend prostate cancer screening on a scale of 1 (unlikely) to 100 (extremely likely). Secondary outcomes included change in participant comfort with prostate cancer screening based on the average of six, five-point Likert-scale questions. Median age was 53 years for the 1,336 participants, and 50% were men. Randomized groups did not differ significantly by race, age, gender, income, marital status, or education level. Likelihood to undergo or recommend prostate cancer screening decreased from 83 to 78 following decision aid exposure (p<0.001; Figure). Reviewing the decision aid from the Centers for Disease Control or American Academy of Family Physicians did not alter likelihood (both p>0.2), while the decision aid from the United States Preventive Services Task Force was associated with the largest decrease in screening preference (-16.0, p<0.001). Participants reported increased comfort with the decision-making process for prostate cancer screening from 3.5 to 4.1 (out of 5, p<0.001) following exposure to a decision aid. Exposure to a decision aid decreased participant likelihood to undergo or recommend prostate cancer screening and increased comfort with the screening process. Copyright © 2018 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.

Does Patient Preference Measurement in Decision Aids Improve Decisional Conflict? A Randomized Trial in Men with Prostate Cancer.

PubMed

Shirk, Joseph D; Crespi, Catherine M; Saucedo, Josemanuel D; Lambrechts, Sylvia; Dahan, Ely; Kaplan, Robert; Saigal, Christopher

2017-12-01

Shared decision making (SDM) has been advocated as an approach to medical decision making that can improve decisional quality. Decision aids are tools that facilitate SDM in the context of limited physician time; however, many decision aids do not incorporate preference measurement. We aim to understand whether adding preference measurement to a standard patient educational intervention improves decisional quality and is feasible in a busy clinical setting. Men with incident localized prostate cancer (n = 122) were recruited from the Greater Los Angeles Veterans Affairs (VA) Medical Center urology clinic, Olive View UCLA Medical Center, and Harbor UCLA Medical Center from January 2011 to May 2015 and randomized to education with a brochure about prostate cancer treatment or software-based preference assessment in addition to the brochure. Men undergoing preference assessment received a report detailing the relative strength of their preferences for treatment outcomes used in review with their doctor. Participants completed instruments measuring decisional conflict, knowledge, SDM, and patient satisfaction with care before and/or after their cancer consultation. Baseline knowledge scores were low (mean 62%). The baseline mean total score on the Decisional Conflict Scale was 2.3 (±0.9), signifying moderate decisional conflict. Men undergoing preference assessment had a significantly larger decrease in decisional conflict total score (p = 0.023) and the Perceived Effective Decision Making subscale (p = 0.003) post consult compared with those receiving education only. Improvements in satisfaction with care, SDM, and knowledge were similar between groups. Individual-level preference assessment is feasible in the clinic setting. Patients with prostate cancer who undergo preference assessment are more certain about their treatment decisions and report decreased levels of decisional conflict when making these decisions.

Novel instrumentation in urologic surgery: Shock wave lithotripsy

PubMed Central

Semins, Michelle J.; Matlaga, Brian R.

2010-01-01

Extracorporeal shock wave lithotripsy (SWL) was first introduced in 1980 and it rapidly revolutionized the treatment of stone disease. SWL is a non-invasive, outpatient procedure that now accounts for the majority of stone removal procedures. Since the introduction of first generation lithotripter, the Dornier HM3 machine, SWL devices have undergone many modifications secondary to limitations, in efforts to create a more effective and efficient way to treat stones and decrease possible morbidities. Herein, we review the evolution of the technology and advances in the instrumentation over the last three decades. PMID:21116366

A Study of Varlilumab and Atezolizumab in Patients With Advanced Cancer

ClinicalTrials.gov

2018-04-26

Carcinoma, Renal Cell; Kidney Diseases; Kidney Neoplasms; Urogenital Neoplasms; Urologic Diseases; Urologic Neoplasms; Neoplasms by Histologic Type; Neoplasms; Clear-cell Metastatic Renal Cell Carcinoma; Melanoma; Triple Negative Breast Cancer; Bladder Cancer; Head and Neck Cancer; Non-small Cell Lung Cancer

[Alfredo Tramoyeres Cases (1910-2002): first chairman of the Department of Urology at the Ciudad Sanitaria La Fe. Documentary-historical analysis of his works].

PubMed

Cánovas Ivorra, José Antonio; Tramoyeres Galvañ, Alfredo; Sánchez Ballester, Francisco; De la Torre Abril, Luis; Ordoño Domínguez, Felipe; Navalón Verdejo, Pedro; Pérez Albacete, Mariano; López Alcina, Emilio; Zaragoza Orts, Julio

2004-12-01

Urology, having been part of general surgery for centuries, was completely consolidated as a medical speciality in the middle of the XX Century as the result of years of evolution and development, and all the studies and works of certain authors that represent today the mainstays of our speciality. Valencia in the middle of the 20th century saw the birth of new hospitals including the "Ciudad Sanitaria La Fe". Alfredo Tramoyeres Cases was the first chairman of the Department of Urology. This article reviews his long and fertile professional life. We have reviewed all his scientific works. The articles have been obtained from Medicina Española, Revista Española de Cirugía Traumatológica y Ortopedia, and Archivos Españoles de Urología. His most important urological work is his doctoral thesis with the title "Sigmoid-procto-ureterostomy: personal modification" published in Valencia in 1976. For his biography we used the" Biographic and bibliographic history of the Spanish Urology over the XX century" and interviews with family members. We emphasize his thorough description of the various types of urinary diversion. He covers the topics of bladder diverticula and bladder neck disorders, in which he supports surgical treatment. Finally, he sets out the rupture of the posterior urethra and various treatments for prostate cancer at that time. Alfredo Tramoyeres Cases contributed to the definitive consolidation of our speciality in the area of Valencia during the second half of the XX century, through his long professional life, with his interesting scientific contributions.

Activity, content, contributors, and influencers of the twitter discussion on urologic oncology.

PubMed

Borgmann, Hendrik; Loeb, Stacy; Salem, Johannes; Thomas, Christian; Haferkamp, Axel; Murphy, Declan G; Tsaur, Igor

2016-09-01

To analyse the activity, content, contributors, and influencers of the Twitter discussion on urologic oncology. We performed a comprehensive quantitative and qualitative Twitter analysis for the hashtags #prostatecancer, #bladdercancer, #kidneycancer, and #testicularcancer. Symplur was used to analyse activity over different time periods and the top influencers of the Twitter discussion. Tweet Archivist and Twitonomy analysis tools were used to assess characteristics of content and contributors. Twitter discussion on urologic oncology in 2014 contained 100,987 tweets created by 39,326 participants. Mean monthly tweet activity was 6,603±2,183 for #prostatecancer, 866±923 for #testicularcancer, 457±477 for #bladdercancer and 401±504 for #kidneycancer. Twitter activity increased by 41% in 2013 and by 122% in 2014. The content analysis detected awareness, cancer, and risk as frequently mentioned words in urologic oncology tweets. Prevalently used related hashtags were the general hashtag #cancer, awareness hashtags, and the respective cancer/urology tag ontology hashtags. Contributors originated from 41 countries on 6 continents and had a mean of 5,864±4,747 followers. They tweeted from platforms on exclusively mobile devices (39%) more frequently than from desktop devices (29%). Health care organizations accounted for 58% of the top influencers in all cancers. The largest proportion of physicians were among the #prostatecancer and #kidneycancer (each 9%) influencers and individual contributors were most frequent in the discussion on #kidneycancer (57%) and #testicularcancer (50%). There is a significant and growing activity in the Twitter discussion on urologic oncology, particularly on #prostatecancer. The Twitter discussion is global, social, and mobile, and merits attention of stakeholders in health care as a promising communication tool. Copyright © 2016 Elsevier Inc. All rights reserved.

Gender Differences in Compensation, Job Satisfaction and Other Practice Patterns in Urology.

PubMed

Spencer, E Sophie; Deal, Allison M; Pruthi, Nicholas R; Gonzalez, Chris M; Kirby, E Will; Langston, Joshua; McKenna, Patrick H; McKibben, Maxim J; Nielsen, Matthew E; Raynor, Mathew C; Wallen, Eric M; Woods, Michael E; Pruthi, Raj S; Smith, Angela B

2016-02-01

The proportion of women in urology has increased from less than 0.5% in 1981 to 10% today. Furthermore, 33% of students matching in urology are now female. In this analysis we characterize the female workforce in urology compared to that of men with regard to income, workload and job satisfaction. We collaborated with the American Urological Association to survey its domestic membership of practicing urologists regarding socioeconomic, workforce and quality of life issues. A total of 6,511 survey invitations were sent via e-mail. The survey consisted of 26 questions and took approximately 13 minutes to complete. Linear regression models were used to evaluate bivariable and multivariable associations with job satisfaction and compensation. A total of 848 responses (660 or 90% male, 73 or 10% female) were collected for a total response rate of 13%. On bivariable analysis female urologists were younger (p <0.0001), more likely to be fellowship trained (p=0.002), worked in academics (p=0.008), were less likely to be self-employed and worked fewer hours (p=0.03) compared to male urologists. On multivariable analysis female gender was a significant predictor of lower compensation (p=0.001) when controlling for work hours, call frequency, age, practice setting and type, fellowship training and advance practice provider employment. Adjusted salaries among female urologists were $76,321 less than those of men. Gender was not a predictor of job satisfaction. Female urologists are significantly less compensated compared to male urologists after adjusting for several factors likely contributing to compensation. There is no difference in job satisfaction between male and female urologists. Copyright © 2016 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.

Painful Bladder Filling and Painful Urgency Are Distinct Characteristics in Men and Women with Urologic Chronic Pelvic Pain Syndromes – A MAPP Research Network Study

PubMed Central

Lai, H. Henry; Krieger, John N.; Pontari, Michel A.; Buchwald, Dedra; Hou, Xiaoling; Landis, J. Richard

2015-01-01

Purpose To describe bladder-associated symptoms in patients with urologic chronic pelvic pain syndromes (UCPPS) and to correlate these symptoms with urologic, non-urologic, psychosocial, and quality of life measures. Methods Participants were 233 women and 191 men with interstitial cystitis/bladder pain syndrome or chronic prostatitis/chronic pelvic pain syndrome in a multi-center study. They completed a battery of measures, including items asking if their pain worsened with bladder filling (“painful filling”) or if their urge to urinate was due to pain, pressure, or discomfort (“painful urgency”). Participants were categorized into 3 groups: 1) “both” painful filling and painful urgency, 2) “either” painful filling or painful urgency, or 3) “neither.” Results Seventy-five percent of men and 88% of women were categorized as “both” or “either.” These bladder characteristics were associated with more severe urologic symptoms (increased pain, frequency, urgency), higher somatic symptom burden, depression, and worse quality of life (all p<0.01, 3-group trend test). A gradient effect was observed across groups (both > either > neither). Compared to those in the “neither” group, men categorized as “both” or “either” reported more frequent UCPPS symptom flares, catastrophizing, and irritable bowel syndrome, and women categorized as “both” or “either” were more likely to have negative affect and chronic fatigue syndrome. Conclusions Men and women with bladder symptoms characterized as painful filling or painful urgency had more severe urologic symptoms, more generalized symptoms, and worse quality of life than participants who reported neither characteristic, suggesting that these symptom characteristics might represent important subsets of UCPPS patients. PMID:26192257

Extended spectrum beta lactamase (ESBL) producing bacteria urinary tract infections and complex pediatric urology.

PubMed

Wragg, Ruth; Harris, Anna; Patel, Mitul; Robb, Andrew; Chandran, Harish; McCarthy, Liam

2017-02-01

Extended spectrum beta lactamase (ESBL) producing bacteria are resistant to most beta-lactam antibiotics including third-generation cephalosporins, quinolones and aminoglycosides. This resistance is plasmid-borne and can spread between species. Management of ESBL is challenging in children with recurrent urinary tract infections (UTIs) and complex urological abnormalities. We aim to quantify the risk in children and specifically in urological patients. Retrospective review of a microbiology database (April 2014 to November 2015). This identified urine isolates, pyuria, ESBL growth and patient demographics. Data analysis was by Chi square, Mann-Whitney U-test and ANOVA. A P value of <0.05 was taken as significant. Analysis of 9418 urine samples showed 2619 with pure isolates, of which 1577 had pyuria (>10×10 6 WC/L). 136 urine cultures (n=79 patients) grew purely ESBL. Overall, 5.2% of urine isolates were ESBL and 9.5% isolates with pyuria (>100×10 6 WC/L) had ESBL, whereas only 22/1032 (2.1%) with no pyuria, (P<0.0001). Urology patients had 86/136 (63%) ESBL positive cultures. These represented 86/315 (27%) of all positive cultures for urology patients vs. 50/2267 (2.2%) for all other specialties (P<0.0001). Potential ESBL transmission between organisms occurred in 3 (all on prophylactic antibiotics). Over the study period, there was no significant rise of the monthly incidence between 2014 and 2015 (ANOVA P=0.1). This study is the first to document the incidence of ESBL in children (5%), and estimate the frequency of possible plasmid transmission between bacterial species in children. This quantifies the risk of ESBL, especially to urology patients, and mandates better antibiotic stewardship. Level IIc. Copyright © 2017. Published by Elsevier Inc.

Is computed tomography-defined obstruction a predictor of urological intervention in emergency department patients presenting with renal colic?

PubMed Central

Massaro, Peter Alexander; Kanji, Avinash; Atkinson, Paul; Pawsey, Ryan; Whelan, Tom

2017-01-01

Introduction Our objective was to determine whether unilateral calculus-induced ureteric obstruction on computed tomography (CT) was independently associated with the need for urological intervention and 30-day return to the emergency department (ED). Methods We performed a retrospective cohort study of patients with symptomatic urinary calculi diagnosed by unenhanced helical CT. Stepwise regression analysis was used to determine the predictors of urological intervention and 30-day return to the ED. Potential predictors assessed included: patient demographics, calculus size, calculus location, degree of obstruction, analgesic doses, signs and symptoms of infection, serum creatinine, cumulative intravenous fluid administered, and the prescription of medical expulsive therapy. Results Of 195 patients, 81 (41.5%) underwent urological intervention. The size of the calculus, its location, and the cumulative opioid dose were all independent predictors for urological intervention. Every 1 mm increase in calculus size increased the likelihood of intervention 2.2 times (odds ratio [OR] 2.17; 95% confidence interval [CI] 1.67–2.85). Proximal stones were 4.7 times more likely to require intervention than distal calculi (OR 0.21; 95% CI 0.09–0.49). Every 10 mg increase in morphine was associated with a 30% increase in the odds of intervention (OR 1.30; 95% CI 1.07–1.58). Degree of obstruction was not associated with the need for urological intervention. Finally, none of the variables were predictors for 30-day return to the ED. Conclusions Although stone size, proximal location, and severe pain, as indicated by higher opioid doses, were associated with the need for intervention, the degree of obstruction did not influence the management of patients with CT-defined urinary calculi. PMID:28515805

The impact of a structured clinical training course on interns' self-reported confidence with core clinical urology skills.

PubMed

Browne, C; Norton, S; Nolan, J M; Whelan, C; Sullivan, J F; Quinlan, M; Sheikh, M; Mc Dermott, T E D; Lynch, T H; Manecksha, R P

2018-02-01

Undergraduate training in core urology skills is lacking in many Irish training programmes. Our aim was to assess newly qualified doctors' experience and confidence with core urological competencies. A questionnaire survey covering exposure to urology and confidence with core clinical skills was circulated to all candidates. The group then attended a skills course covering male/female catheterisation, insertion of three-way catheters, bladder irrigation and management of long-term suprapubic catheters. The groups were re-surveyed following the course. Forty-five interns completed the pre-course questionnaire (group 1) and 27 interns completed the post-course questionnaire (group 2). 24/45 (53%) had no experience of catheter insertion on a patient during their undergraduate training. 26/45 (58%) were unsupervised during their first catheter insertion. 12/45 (27%) had inserted a female catheter. 18/45 (40%) had inserted a three-way catheter. 12/45 (27%) had changed a suprapubic catheter. 40/45 (89%) in group 1 reported 'good' or 'excellent' confidence with male urinary catheterisation, compared to 25/27 (92.5%) in group 2. 18/45 (40%) in group 1 reported 'none' or 'poor' confidence with female catheterisation, compared to 7/27 (26%) in group 2. 22/45 (49%) in group 1 reported 'none' or 'poor' confidence with insertion of three-way catheters, compared to 2/27 (7%) in group 2. 32/45 (71%) in group 1 reported 'none' or 'poor' confidence in changing long-term suprapubic catheters, falling to 3/27 (11%) in group 2. This study raises concerns about newly qualified doctors' practical experience in urology. We suggest that this course improves knowledge and confidence with practical urology skills and should be incorporated into intern induction.

[Current status of urological training in Latin America.

PubMed

Angulo, Javier C; Figueroa, Carlos; Gómez, Reynaldo; Martins, Francisco; Corrales, Juan Guillermo; Secin, Fernando; López-Secchi, Gerardo; León, Antonio; Torrico, Marcelo; Reis, Leonardo O; Plata, Mauricio; Sotomayor, Mariano; Gutiérrez-Aceves, Jorge

2018-01-01

Achieving residents' medical training of quality is a constant concern in the Confederación Americana de Urología (CAU), the third Urological Society worldwide. We aim to analyze the diversity of state training programs, with the intention to identify opportunities for global improvement within them and also to analyse the professional reality in different countries. Data from 2nd and 3rd Foro Educativo CAU regarding postgraduate training and labour implications are reviewed. This information is complemented by the opinion of representatives involved with the academic training in Confederación Americana de Urología, who have analyzed the reality and current status of the urological training through a 10-question survey that describes different aspects of residency program in the countries confederated in CAU. A total of 3,000 graduate doctors train as residents in Urology at the CAU environment. Each year 670 residents begin their training program in Latin America, Spain and Portugal, a territory that serves nearly 650 million people, with an active professional force of around 16.800 professionals. Detailed data on training, employment and supporting reality in the countries that comprise the CAU are presented. We also discuss the proportion of residents who carry out research and doctorate during the residency program. Finally, we examine the proportion of professionals who receive specific training at the end of their residence, the relative importance of this training and what are the most popular environments to carry it out. Current postgraduate training in CAU environment is heterogeneous in their programs, as well as in the modes of accreditation and recertification. Academic activities do not seem to be properly valued. However, specific training offers better expectations of professional development.

Impact of branding on public awareness of healthcare-related governing bodies: a pilot study of the Urological Society of Australia and New Zealand brand.

PubMed

Gianduzzo, Troy R J; Gardiner, Robert A; Rashid, Prem; Young, Rhys; Frydenberg, Mark; Kelly, Sarah

2016-10-01

To assess the general public's understanding of urologists and of the Urological Society of Australian and New Zealand (USANZ) and gauge the effectiveness with which the USANZ disseminates health information about urological conditions to health consumers. Using prostate cancer as an example, a Qualtrics online market survey of Australian healthcare consumers recruited from an online pool was conducted. The number of districts sampled within each state or territory was proportional to the size of the target population within each region and were proportionately distributed across metropolitan and non-metropolitan areas. Demographic characteristics were comparable with the Australian Bureau of Statistics Census figures corresponding to the target age group. The survey assessed knowledge of the roles of medical specialties through open-ended responses to qualitative items, association tasks, and recall/recognition questions. Subjects were asked to rate their familiarity of medical specialists and of six medical specialty logos. There were 302 respondents. Subjects indicated less awareness of urology vs other medical specialties, were relatively unaware that urologists were concerned with the prostate, and the USANZ branding was among the least familiar (P < 0.001, Friedman test). When asked the first medical specialist that came to mind when told of prostate cancer, only 22% wrote urologist. The general public has a limited understanding of urologists and of the USANZ. Sub-brand names that explicitly link urologists to urological conditions, has been suggested as a means to increase the public's understanding of urologists and of the USANZ, and improve the USANZ's ability to promulgate urological health information. © 2016 The Authors BJU International © 2016 BJU International Published by John Wiley & Sons Ltd.

Expert Involvement Predicts mHealth App Downloads: Multivariate Regression Analysis of Urology Apps

PubMed Central

Osório, Luís; Cavadas, Vitor; Fraga, Avelino; Carrasquinho, Eduardo; Cardoso de Oliveira, Eduardo; Castelo-Branco, Miguel; Roobol, Monique J

2016-01-01

Background Urological mobile medical (mHealth) apps are gaining popularity with both clinicians and patients. mHealth is a rapidly evolving and heterogeneous field, with some urology apps being downloaded over 10,000 times and others not at all. The factors that contribute to medical app downloads have yet to be identified, including the hypothetical influence of expert involvement in app development. Objective The objective of our study was to identify predictors of the number of urology app downloads. Methods We reviewed urology apps available in the Google Play Store and collected publicly available data. Multivariate ordinal logistic regression evaluated the effect of publicly available app variables on the number of apps being downloaded. Results Of 129 urology apps eligible for study, only 2 (1.6%) had >10,000 downloads, with half having ≤100 downloads and 4 (3.1%) having none at all. Apps developed with expert urologist involvement (P=.003), optional in-app purchases (P=.01), higher user rating (P<.001), and more user reviews (P<.001) were more likely to be installed. App cost was inversely related to the number of downloads (P<.001). Only data from the Google Play Store and the developers’ websites, but not other platforms, were publicly available for analysis, and the level and nature of expert involvement was not documented. Conclusions The explicit participation of urologists in app development is likely to enhance its chances to have a higher number of downloads. This finding should help in the design of better apps and further promote urologist involvement in mHealth. Official certification processes are required to ensure app quality and user safety. PMID:27421338

Neonatal arterial hypertension in nephro-urological malformations in a tertiary care hospital.

PubMed

Lanzarini, V V; Furusawa, E A; Sadeck, L; Leone, C R; Vaz, F A C; Koch, V H

2006-09-01

An increase in the survival of neonates with antenatal diagnosis of malformations was achieved by the recent technical advances in neonatal intensive care units. The aim of this article is to describe the experience with neonatal arterial hypertension, in newborns with nephro-urological malformations, in a tertiary care referral Nursery, in a period of 4 years. Newborn medical records from the Nursery Annex to the Maternity of Hospital das Clinicas, School of Medicine, University of Sao Paulo, with the diagnosis of nephro-urological malformations and systemic arterial hypertension (SAH) at hospital discharge, in a period from January 1999 to January 2003, were retrospectively analysed. Among 10.278 live newborns in the studied period, 15 (0.15%) newborns were compatible with our inclusion criteria. Of these 15 newborns, 12 (80%) were male and three were premature (20%). In relation to aetiology, 13 (87%) showed urological malformations, 1 (6%) chronic renal insufficiency secondary to kidney dysplasia and one (6%) autosomal recessive polycystic kidney disease. SAH control was achieved with monotherapy in eight patients (53%), five patients (33%) needed an association of two drugs (calcium-channel blocker and angiotensin converting enzyme (ACE) inhibitor), one child used three types of antihypertensive drugs (calcium-channel blocker, ACE inhibitor and hydrochlorothiazide) for pressoric control and one child's blood pressure (BP) was controlled exclusively by peritoneal dialysis. The incidence of nephro-urological malformations in our service during the studied period was 0.89%. SAH incidence among these newborns was 19%. Our data reinforce previous studies pointing to the necessity to consider children with nephro-urological malformations as a risk group for SAH, who should have the BP evaluated since the neonatal period.

Current Trends in the Incidence and Survival Rate of Urological Cancers in Korea.

PubMed

Joung, Jae Young; Lim, Jiwon; Oh, Chang-Mo; Jung, Kyu-Won; Cho, Hyunsoon; Kim, Sung Han; Seo, Ho Kyung; Park, Weon Seo; Chung, Jinsoo; Lee, Kang Hyun; Won, Young-Joo

2017-07-01

This descriptive study assessed the current trends in the incidence of urological cancers and patient survival in Korea. In this nationwide retrospective observational study based on the data from the Korea National Cancer Incidence Database (KNCIDB), this study analyzed the age-standardized incidence rates (ASRs) and annual percentage changes (APCs) of kidney, bladder, prostate, testicular, and penile cancers as well as cancer of the renal pelvis and ureter between 1999 and 2012. The relative survival rates (RSRs) were calculated for urological cancer patients diagnosed between 1993 and 2012 from the KNCIDB data. Prostate cancer was diagnosed in 66,812 individuals followed by bladder (41,549) and kidney (36,836) cancers. The overall ASR (18.26 per 100,000) increased with age because of the higher ASRs of bladder and prostate cancers in the elderly. The ASR for kidney cancer was highest in the 40-59-year-old group, whereas testicular cancer occurred most frequently before the age of 40. The incidence of most urological cancers increased (overall APC, 6.39%; p < 0.001), except for penile (APC, -2.01%; p=0.05) and bladder (APC, -0.40%; p=0.25) cancers. The overall survival increased steadily (5-year RSR, 66.4% in 1993-1995 vs. 84.2% in 2008-2012; p < 0.001), particularly for prostate (by 34.10%) and kidney (by 16.30%) cancers, but not for renal pelvis and ureter cancers (-7.20%). The most common urological cancer in Korea was prostate cancer followed by bladder and kidney cancers. The incidence of most urological cancers, except for penile and bladder cancers, increased. Survival also increased, particularly for prostate and kidney cancers.

An approach to the diagnosis of flat intraepithelial lesions of the urinary bladder using the World Health Organization/ International Society of Urological Pathology consensus classification system.

PubMed

Amin, Mahul B; McKenney, Jesse K

2002-07-01

The classification of flat urothelial (transitional cell) lesions with atypia has historically varied in its application from institution to institution with no fewer than six major nomenclature systems proposed in the past 25 years. In 1998, the World Health Organization/ International Society of Urological Pathology (WHO/ISUP) published a consensus classification that included the following categories for flat urinary bladder lesions: reactive atypia, atypia of unknown significance, dysplasia (low-grade intraepithelial neoplasia), and carcinoma in situ (high-grade intraepithelial neoplasia). This classification expands the definition traditionally used for urothelial carcinoma in situ, basing its diagnosis primarily on the severity of cytologic changes. In proposing the classification system for flat lesions of the bladder with atypia, it was hoped that consistent use of uniform diagnostic terminology would ultimately aid in a better understanding of the biology of these lesions. In this review, the authors discuss the history of the concept of flat urothelial neoplasia, the rationale and histologic criteria for the WHO/ISUP diagnostic categories, an approach to the diagnosis of flat lesions, and problems and pitfalls associated with their recognition in routine surgical pathology specimens.

TRADITIONAL CANISTER-BASED OPEN WASTE MANAGEMENT SYSTEM VERSUS CLOSED SYSTEM: HAZARDOUS EXPOSURE PREVENTION AND OPERATING THEATRE STAFF SATISFACTION.

PubMed

Horn, M; Patel, N; MacLellan, D M; Millard, N

2016-06-01

Exposure to blood and body fluids is a major concern to health care professionals working in operating rooms (ORs). Thus, it is essential that hospitals use fluid waste management systems that minimise risk to staff, while maximising efficiency. The current study compared the utility of a 'closed' system with a traditional canister-based 'open' system in the OR in a private hospital setting. A total of 30 arthroscopy, urology, and orthopaedic cases were observed. The closed system was used in five, four, and six cases, respectively and the open system was used in nine, two, and four cases, respectively. The average number of opportunities for staff to be exposed to hazardous fluids were fewer for the closed system when compared to the open during arthroscopy and urology procedures. The open system required nearly 3.5 times as much staff time for set-up, maintenance during procedures, and post-procedure disposal of waste. Theatre staff expressed greater satisfaction with the closed system than with the open. In conclusion, compared with the open system, the closed system offers a less hazardous and more efficient method of disposing of fluid waste generated in the OR.

77 FR 26021 - Center for Scientific Review; Notice of Closed Meetings

Federal Register 2010, 2011, 2012, 2013, 2014

2012-05-02

... . Name of Committee: Digestive, Kidney and Urological Systems Integrated Review Group; Clinical... 20892, (301) 806-0009, [email protected] . Name of Committee: Digestive, Kidney and Urological Systems Integrated Review Group; Pathobiology of Kidney Disease Study Section. Date: June 4, 2012. Time: 8...

Critical care and the urologic patient.

PubMed

Leung, Anne K H; Tan, Ian K S

2003-01-01

Changing concepts of disease management, expanding indications for invasive therapy to elderly patients, together with technologic advances have changed the management of various urologic diseases. Although minimally invasive surgery may have reduced the need for ICU care, we are faced with new and unique treatment problems.

The microbiome of the urinary tract--a role beyond infection.

PubMed

Whiteside, Samantha A; Razvi, Hassan; Dave, Sumit; Reid, Gregor; Burton, Jeremy P

2015-02-01

Urologists rarely need to consider bacteria beyond their role in infectious disease. However, emerging evidence shows that the microorganisms inhabiting many sites of the body, including the urinary tract--which has long been assumed sterile in healthy individuals--might have a role in maintaining urinary health. Studies of the urinary microbiota have identified remarkable differences between healthy populations and those with urologic diseases. Microorganisms at sites distal to the kidney, bladder and urethra are likely to have a profound effect on urologic health, both positive and negative, owing to their metabolic output and other contributions. Connections between the gut microbiota and renal stone formation have already been discovered. In addition, bacteria are also used in the prevention of bladder cancer recurrence. In the future, urologists will need to consider possible influences of the microbiome in diagnosis and treatment of certain urological conditions. New insights might provide an opportunity to predict the risk of developing certain urological diseases and could enable the development of innovative therapeutic strategies.

Evolving adoptive cellular therapies in urological malignancies.

PubMed

Wong, Yien Ning Sophia; Joshi, Kroopa; Pule, Martin; Peggs, Karl S; Swanton, Charles; Quezada, Sergio A; Linch, Mark

2017-06-01

Immunotherapies have long been used to treat urological cancers but rarely lead to cure. In the past 5 years, success of immune checkpoint inhibition has led to a resurgence of enthusiasm for immunotherapy in the treatment of solid tumours. Increased understanding of tumour immune biology, technological advancements of gene transfer and cell culture, and improved clinical infrastructures for routine delivery of cell products, has made cell-based immunotherapeutics a real prospect for cancer therapy. These scientific and clinical activities, attempting to exploit the innate and adaptive immune systems for therapeutic gain, are well exemplified by the urological malignancies of renal, bladder, prostate, and penile cancer, a group of anatomically localised diseases, each with a distinct biology and different immunotherapeutic challenges. In this Review, we present the results of clinical studies investigating autologous cellular therapies in urological malignancies. Specifically, we discuss the rationale for upcoming studies, and how novel therapies and adoptive cell combinations can be used for personalised cancer therapy. Copyright © 2017 Elsevier Ltd. All rights reserved.

[Malpractice in Urology: lessons of clinical and legal safety.

PubMed

Vargas-Blasco, César; Gómez-Durán, Esperanza L; Martin-Fumadó, Carles; Arimany-Manso, Josep

2018-06-01

Data about urology malpractice claims in our environment are scarce and should be considered a potential opportunity to "learn from errors". We analyzed every claim for alleged malpractice in Urology managed by the Council of Medical Colleges of Catalonia between 1990 and 2012, and specifically evaluated the clinical and medicolegal features of those cases with medical professional responsibility. We identified 182 cases in 22 years, but only the 25,74%showed professional liability. Testicular torsion misdiagnosis, pregnancies after vasectomy and complications of lithiasis should be noted for their frequency of claims and rate of liability. 246 physicians were involved, 89% were males and mean age was 45.6 years. Most cases (n=137, 75.27%) were processed in the courts. Urology has a medium risk of claims, with a moderate rate of medical professional liability and amount of compensation. There are specific actions that would lead to clinical safety improvements, particularly in testicular pathologies, vasectomy and lithiasis. Finally, more attention should be paid to proper patient information.

High-fidelity simulation-based team training in urology: evaluation of technical and nontechnical skills of urology residents during laparoscopic partial nephrectomy.

PubMed

Abdelshehid, Corollos S; Quach, Stephen; Nelson, Corey; Graversen, Joseph; Lusch, Achim; Zarraga, Jerome; Alipanah, Reza; Landman, Jaime; McDougall, Elspeth M

2013-01-01

The use of low-risk simulation training for resident education is rapidly expanding as teaching centers integrate simulation-based team training (SBTT) sessions into their education curriculum. SBTT is a valuable tool in technical and communication skills training and assessment for residents. We created a unique SBTT scenario for urology residents involving a laparoscopic partial nephrectomy procedure. Urology residents were randomly paired with a certified registered nurse anesthetists or an anesthesia resident. The scenario incorporated a laparoscopic right partial nephrectomy utilizing a unique polyvinyl alcohol kidney model with an embedded 3cm lower pole exophytic tumor and the high-fidelity SimMan3G mannequin. The Urology residents were instructed to pay particular attention to the patient's identifying information provided at the beginning of the case. Two scripted events occurred, the patient had an anaphylactic reaction to a drug and, after tumor specimen was sent for a frozen section, the confederate pathologist called into the operating room (OR) twice, first with the wrong patient name and subsequently with the wrong specimen. After the scenario was complete, technical performance and nontechnical performance were evaluated and assessed. A debriefing session followed the scenario to discuss and assess technical performance and interdisciplinary nontechnical communication between the team. All Urology residents (n = 9) rated the SBTT scenario as a useful tool in developing communication skills among the OR team and 88% rated the model as useful for technical skills training. Despite cuing to note patient identification, only 3 of 9 (33%) participants identified that the wrong patient information was presented when the confederate "pathologist" called in to report pathology results. All urology residents rated SBTT sessions as useful for the development of communication skills between different team members and making residents aware of unlikely but potential critical errors in the OR. We will continue to use SBTT as a useful method to develop resident technical and nontechnical skills outside of the high-risk operating environment. Copyright © 2013 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.

Introducing the Twitter Impact Factor: An Objective Measure of Urology's Academic Impact on Twitter.

PubMed

Cardona-Grau, Diana; Sorokin, Igor; Leinwand, Gabriel; Welliver, Charles

2016-10-01

Social media use in academia and urology is rising. Specifically, individual journals now have Twitter accounts (Twitter Inc, San Francisco, CA, USA) and regularly tweet academic content. To present and evaluate the Twitter impact factor (TIF), a novel means of measuring a journal's academic influence in the realm of social media. Journal Citation Reports (JCR; Thomson Reuters, New York, NY, USA) for 2014 was queried for urologic academic journals. English-language journals with active Twitter accounts since 2013 were included. The total number of followers, tweets, and retweets over a 2-yr period were collected. Each journal's TIF was calculated based on the number of retweets per original relevant tweet. Comparisons between the TIF and the journal impact factor (JIF) as well as the Klout score were made using the Pearson correlation. Of 33 journals listed in the JCR for 2014, 7 (21%) had a Twitter presence as of 2013. The number of JCR-listed journals with a Twitter handle increased by 29% in 2014. There was an increase in the mean number of relevant tweets per journal during the study period and a 130% increase in the number of retweets over 1 yr. European Urology (1.80) and BJU International (1.46) had the highest TIFs. The journals with the highest number of Twitter followers were European Urology (5807) and the Journal of Urology (4402). The journals with the highest numbers of relevant tweets were European Urology (1159) and BJU International (1090). There was a positive but statistically insignificant association between the TIF and the JIF (r=0.64, p=0.12). There was a strongly positive linear correlation between the TIF and the Klout score (r=0.84, p=0.0086). With the increasing use of social media by individuals and academic journals, the TIF can be a useful tool to measure the academic reach and impact of a journal on Twitter. Social media is an increasing part of the way in which practitioners and academicians communicate. The TIF can be used to analyze the impact of journal Twitter feeds and their social media content. Published by Elsevier B.V.

Relationships among participant international prostate symptom score, benign prostatic hyperplasia impact index changes and global ratings of change in a trial of phytotherapy in men with lower urinary tract symptoms.

PubMed

Barry, Michael J; Cantor, Alan; Roehrborn, Claus G

2013-03-01

We related changes in American Urological Association symptom index scores with bother measures and global ratings of change in men with lower urinary tract symptoms who were enrolled in a saw palmetto trial. To be eligible for study men were 45 years old or older, and had a peak uroflow of 4 ml per second or greater and an American Urological Association symptom index score of 8 to 24. Participants self-administered the American Urological Association symptom index, International Prostate Symptom Score quality of life item, Benign Prostatic Hyperplasia Impact Index and 2 global change questions at baseline, and at 24, 48 and 72 weeks. In 357 participants global ratings of a little better were associated with a mean decrease in American Urological Association symptom index scores from 2.8 to 4.1 points across 3 time points. The analogous range for mean decreases in Benign Prostatic Hyperplasia Impact Index scores was 1.0 to 1.7 points and for the International Prostate Symptom Score quality of life item it was 0.5 to 0.8 points. At 72 weeks for the first global change question each change measure discriminated between participants who rated themselves at least a little better vs unchanged or worse 70% to 72% of the time. A multivariate model increased discrimination to 77%. For the second global change question each change measure correctly discriminated ratings of at least a little better vs unchanged or worse 69% to 74% of the time and a multivariate model increased discrimination to 79%. Changes in American Urological Association symptom index scores could discriminate between participants rating themselves at least a little better vs unchanged or worse. Our findings support the practice of powering studies to detect group mean differences in American Urological Association symptom index scores of at least 3 points. Copyright © 2013 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.

Royal College surgical objectives of urologic training: A survey of faculty members from Canadian training programs

PubMed Central

Zakaria, Ahmed S.; Haddad, Richard; Dragomir, Alice; Kassouf, Wassim; Andonian, Sero; Aprikian, Armen G.

2014-01-01

Introduction: According to the Royal College objectives of training in urology, urologic surgical procedures are divided as category A, B and C. We wanted to determine the level of proficiency required and achieved by urology training faculty for Royal College accreditation. Methods: We conducted a survey that was sent electronically to all Canadian urology training faculty. Questions focused on demographics (i.e., years of practice, geographic location, subspecialty, access to robotic surgery), operating room contact with residents, opinion on the level of proficiency required from a list of 54 surgical procedures, and whether their most recent graduates attained category A proficiency in these procedures. Results: The response rate was 43.7% (95/217). Among respondents, 92.6% were full timers, 21.1% practiced urology for less than 5 years and 3.2% for more than 30 years. Responses from Quebec and Ontario formed 69.4% (34.7% each). Of the respondents, 37.9% were uro-oncologists and 75.7% reported having access to robotic surgery. Sixty percent of faculty members operate with R5 residents between 2 to 5 days per month. When respondents were asked which categories should be listed as category A, only 8 procedures received 100% agreement. Also, results varied significantly when analyzed by sub-specialty. For example, almost 50% or more of uro-oncologists believed that radical cystectomy, anterior pelvic exenteration and extended pelvic lymphadenectomy should not be category A. The following procedures had significant disagreement suggesting the need for re-classification: glanular hypospadias repair, boari flap, entero-vesical and vesicovaginal fistulae repair. Overall, more than 80% of faculty reported that their recent graduating residents had achieved category A proficiency, in a subset of procedures. However, more than 50% of all faculty either disagreed or were ambivalent that all of their graduating residents were Category A proficient in several procedures. Conclusions: There is sufficient disagreement among Canadian urology faculty to suggest another revision of the current Royal College list of category A procedures. PMID:25024784

New Media for Educating Urology Residents: An Interview Study in Canada and Germany.

PubMed

Salem, Johannes; Borgmann, Hendrik; MacNeily, Andrew; Boehm, Katharina; Schmid, Marianne; Groeben, Christer; Baunacke, Martin; Huber, Johannes

To investigate the usage and perceived usefulness of new media for educating urology residents in Canada and Germany. We designed an 11-item online survey to assess the use and perceived usefulness of new media for education. We performed a comparative analysis. The survey was distributed via e-mail to 143 Canadian and 721 German urology residents. The survey included 58 urology residents from Canada and 170 from Germany. A total of 58 residents from Canada (41% response rate) and 170 from Germany (24% response rate) responded to this survey. Residents spent 45% of their education time on new media. The Internet was used by 91% (n = 208) of the residents for professional education purposes, with a median time of 270 minutes (interquartile range [IQR]: 114-540) per month. Apps were used by 54% (n = 118) of the residents, with a median time of 101 minutes (IQR: 45-293) per month. A total of 23% (n = 47) of the residents used social media (SoMe) for education, with a median time of 90 minutes (IQR: 53-80) per month. In all, 100% (n = 228) rated the Internet, 76% (n = 173) apps, and 43% (n = 97) SoMe as being useful for professional education purposes. A total of 90% (n = 205) watched medical videos for education, and 89% (n = 203) of these videos were on surgical procedures. Canadian urology residents used more new media sources for professional education than did the Germans (58% vs. 41%, p < 0.001). The time spent for education on new media was higher among Canadian residents for the Internet (p < 0.001), apps (p < 0.001), and SoMe (p = 0.033). Canadian residents reported more privacy concerns (p < 0.001). New media play a dominant role in the education of urology residents. The primary source for personal education in urology is the Internet. Future studies and technological developments should investigate and improve new media tools to optimize education during residency. Copyright © 2017 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.

Association between Polymorphisms in MicroRNAs and Risk of Urological Cancer: A Meta-Analysis Based on 17,019 Subjects

PubMed Central

Wang, Yu-Hui; Hu, Han-Ning; Weng, Hong; Chen, Hao; Luo, Chang-Liang; Ji, Jia; Yin, Chang-Qing; Yuan, Chun-Hui; Wang, Fu-Bing

2017-01-01

Accumulating evidence has demonstrated that some single nucleotide polymorphisms (SNPs) existing in miRNAs correlate with the susceptibility to urological cancers. However, a clear consensus still not reached due to the limited statistical power in individual study. Thus, we concluded a meta-analysis to systematically evaluate the association between microRNA SNPs and urological cancer risk. Eligible studies were collected from PubMed, Embase, Web of Science, and CNKI databases. Pooled odds ratio (OR) and corresponding 95% confidence interval (95% CI) were calculated to assess the strength of the relationships between three SNPs (miR-196a2, C>T rs11614913; miR-146a, G>C rs2910164; and miR-499, A>G rs3746444) and the risk of urological cancers. In addition, the stability of our analysis was evaluated by publication bias, sensitivity and heterogeneity analysis. Overall, a total of 17,019 subjects from 14 studies were included in this meta-analysis. We found that CT (miR-196a2, C>T rs11614913) was a risk factor for renal cell carcinoma (CT vs. CC: OR = 1.72, 95%CI = 1.05–2.80, P = 0.03, I2 = 66%), especially in Asian population (CT vs. CC: OR = 1.17, 95%CI = 1.04–1.32, P < 0.01, I2 = 0%). miR-146a G>C rs2910164 was a protective factor of urological cancers (C vs. G: OR = 0.87, 95%CI = 0.81–0.93, P < 0.01, I2 = 0%), especially for bladder cancer. miR-499 A>G rs3746444 was correlated with an increased risk of urological cancers, specifically in Asian population. In conclusion, our meta-analysis suggests that polymorphisms in microRNAs, miR-196a2, C>T rs11614913, miR-146a G>C rs2910164 and miR-499 A>G rs3746444, may be associated with the development of urological cancers and the risks mainly exist in Asian populations. PMID:28579964

[Tyson's glands. On eponymic and discussion in urology and dermatology].

PubMed

Moll, F H; Halling, T; Leissner, J; Fangerau, H

2015-06-01

The use of eponyms in scientific terminology and particularly in medical terminology has a long tradition but discussion often arises especially since the involvement of the protagonists in the National Socialist regime which led to strong controversies (e. g. Clara, Stieve, Reiter, Wegener). They are a component of cultural specialist memories and contribute to the conciseness of the nomenclature. For the specialization of urology a total list of eponyms in general use or an analysis of the use of eponyms does not exist. The eponym Tyson's glands is a good example of the tradition of eponyms in urology and the discussion about the related anatomical facts.

“I will not cut, even for the stone”: origins of urology in the hippocratic collection

PubMed Central

Poulakou-Rebelakou, E.; Rempelakos, A.; Tsiamis, C.; Dimopoulos, C.

2015-01-01

The Hippocratic Collection, including the most of ancient Greek medicine, remains still interesting, despite the recent advances that transformed definitely the urological healing methods. Considering the patient as a unique psycho-somatic entity and avoiding high risk surgical manipulations were the leading principles dictating the everyday practice. Contemporary physicians can still learn from the clinical observations in times of complete absence of laboratory or imaging aid, from the prognostic thoughts, the ethics, and the philosophical concepts, represented by the Hippocratic writings, tracing into them the roots of Rational Medicine in general and Urology in particular. PMID:25928507

Update on advances in molecular PET in urological oncology

PubMed Central

Yamamoto, Shingo; Fukushima, Kazuhito; Minamimoto, Ryogo; Kamai, Takao; Jadvar, Hossein

2017-01-01

Integrated positron emission tomography/computed tomography (PET/CT) with 2-[18F]fluoro-2-deoxy-D-glucose (18F-FDG) has emerged as a powerful tool for the combined metabolic and anatomic evaluation of many cancers. In urological oncology, however, the use of 18F-FDG has been limited by a generally low tumor uptake, and physiological excretion of FDG through the urinary system. 18F-FDG PET/CT is useful when applied to specific indications in selected patients with urological malignancy. New radiotracers and positron emission tomography/magnetic resonance imaging (PET/MRI) are expected to further improve the performance of PET in uro-oncology. PMID:27222021

Concurrent risk-reduction surgery in patients with increased lifetime risk for breast and ovarian cancer: an analysis of the National Surgical Quality Improvement Program (NSQIP) database.

PubMed

Elmi, Maryam; Azin, Arash; Elnahas, Ahmad; McCready, David R; Cil, Tulin D

2018-05-14

Patients with genetic susceptibility to breast and ovarian cancer are eligible for risk-reduction surgery. Surgical morbidity of risk-reduction mastectomy (RRM) with concurrent bilateral salpingo-oophorectomy (BSO) is unknown. Outcomes in these patients were compared to patients undergoing RRM without BSO using a large multi-institutional database. A retrospective cohort analysis was conducted using the American College of Surgeon's National Surgical Quality Improvement Program (NSQIP) 2007-2016 datasets, comparing postoperative morbidity between patients undergoing RRM with patients undergoing RRM with concurrent BSO. Patients with genetic susceptibility to breast/ovarian cancer undergoing risk-reduction surgery were identified. The primary outcome was 30-day postoperative major morbidity. Secondary outcomes included surgical site infections, reoperations, readmissions, length of stay, and venous thromboembolic events. A multivariate analysis was performed to determine predictors of postoperative morbidity and the adjusted effect of concurrent BSO on morbidity. Of the 5470 patients undergoing RRM, 149 (2.7%) underwent concurrent BSO. The overall rate of major morbidity and postoperative infections was 4.5% and 4.6%, respectively. There was no significant difference in the rate of postoperative major morbidity (4.5% vs 4.7%, p = 0.91) or any of the secondary outcomes between patients undergoing RRM without BSO vs. those undergoing RRM with concurrent BSO. Multivariable analysis showed Body Mass Index (OR 1.05; p < 0.001) and smoking (OR 1.78; p = 0.003) to be the only predictors associated with major morbidity. Neither immediate breast reconstruction (OR 1.02; p = 0.93) nor concurrent BSO (OR 0.94; p = 0.89) were associated with increased postoperative major morbidity. This study demonstrated that RRM with concurrent BSO was not associated with significant additional morbidity when compared to RRM without BSO. Therefore, this joint approach may be considered for select patients at risk for both breast and ovarian cancer.

A Surgeon's View of Prostate Cancer | Center for Cancer Research

Cancer.gov

Robert Reiter, M.D., M.B.A., is a Professor of Urology and Molecular Biology, Director of the Prostate Cancer Treatment and Research Program, and Director of Urologic Research at the David Geffen School of Medicine at the University of California, Los Angeles (UCLA).

21 CFR 876.1075 - Gastroenterology-urology biopsy instrument.

Code of Federal Regulations, 2013 CFR

2013-04-01

... biopsy instrument, gastro-urology biopsy needle and needle set, and nonelectric biopsy forceps. This... regulations. (b) Classification. (1) Class II (performance standards). (2) Class I for the biopsy forceps cover and the non-electric biopsy forceps. The devices subject to this paragraph (b)(2) are exempt from...

21 CFR 876.1075 - Gastroenterology-urology biopsy instrument.

Code of Federal Regulations, 2014 CFR

2014-04-01

... biopsy instrument, gastro-urology biopsy needle and needle set, and nonelectric biopsy forceps. This... regulations. (b) Classification. (1) Class II (performance standards). (2) Class I for the biopsy forceps cover and the non-electric biopsy forceps. The devices subject to this paragraph (b)(2) are exempt from...

21 CFR 876.1075 - Gastroenterology-urology biopsy instrument.

Code of Federal Regulations, 2012 CFR

2012-04-01

... biopsy instrument, gastro-urology biopsy needle and needle set, and nonelectric biopsy forceps. This... regulations. (b) Classification. (1) Class II (performance standards). (2) Class I for the biopsy forceps cover and the non-electric biopsy forceps. The devices subject to this paragraph (b)(2) are exempt from...

Transfer of skills on LapSim virtual reality laparoscopic simulator into the operating room in urology.

PubMed

Alwaal, Amjad; Al-Qaoud, Talal M; Haddad, Richard L; Alzahrani, Tarek M; Delisle, Josee; Anidjar, Maurice

2015-01-01

Assessing the predictive validity of the LapSim simulator within a urology residency program. Twelve urology residents at McGill University were enrolled in the study between June 2008 and December 2011. The residents had weekly training on the LapSim that consisted of 3 tasks (cutting, clip-applying, and lifting and grasping). They underwent monthly assessment of their LapSim performance using total time, tissue damage and path length among other parameters as surrogates for their economy of movement and respect for tissue. The last residents' LapSim performance was compared with their first performance of radical nephrectomy on anesthetized porcine models in their 4(th) year of training. Two independent urologic surgeons rated the resident performance on the porcine models, and kappa test with standardized weight function was used to assess for inter-observer bias. Nonparametric spearman correlation test was used to compare each rater's cumulative score with the cumulative score obtained on the porcine models in order to test the predictive validity of the LapSim simulator. The kappa results demonstrated acceptable agreement between the two observers among all domains of the rating scale of performance except for confidence of movement and efficiency. In addition, poor predictive validity of the LapSim simulator was demonstrated. Predictive validity was not demonstrated for the LapSim simulator in the context of a urology residency training program.

[Prospective multi-institutional analysis according to the "Japanese guidelines for prevention of perioperative infections in urological field"].

PubMed

Wada, Koichiro; Uehara, Shinya; Kira, Shinichiro; Matsumoto, Masahiro; Sho, Takehiko; Kurimura, Yuichiro; Hashimoto, Jiro; Uehara, Teruhisa; Yamane, Takashi; Kanamaru, Sojun; Togo, Yoshikazu; Taoka, Rikiya; Takahashi, Akira; Yamada, Yusuke; Yokomizo, Akira; Yasuda, Mitsuru; Tanaka, Kazushi; Hamasuna, Ryoichi; Takahashi, Satoshi; Hayami, Hiroshi; Watanabe, Toyohiko; Monden, Koichi; Kiyota, Hiroshi; Deguchi, Takashi; Naito, Seiji; Tsukamoto, Taiji; Arakawa, Soichi; Fujisawa, Masato; Yamamoto, Shingo; Kumon, Hiromi; Matsumoto, Tetsuro

2013-05-01

The "Japanese guidelines for prevention of perioperative infections in urological field" was edited by the Japanese Urological Association in 2007. They are the first Japanese guidelines for antimicrobial prophylaxis specifically to prevent perioperative infections in the urological field. We report here the results of a multicenter prospective study conducted to examine the validity and usefulness of these guidelines. The subjects were 513 patients who had undergone urological surgeries between July and September 2008 at 10 nationwide university institutions in the Japanese Society of UTI Cooperative Study Group. These surgeries were transurethral resection of bladder (TURBT), transurethral resection of prostate (TURP), adrenalectomy, nephrectomy, nephroureterectomy, radical prostatectomy and total cystectomy. Analysis was performed on patient information, surgical procedures, types and durations of administration of prophylactic antibiotic agents, and the presence of surgical site infections (SSI) and remote infections (RI). Of 513 patients, 387 (75.4%) were administered prophylactic antibiotic agents according to the guidelines. In these patients, the incidences of SSI and RI were 5.9% and 4.1%, respectively. Multivariate analysis showed that significant factors for SSI were the surgical risk (according to the ASA physical status classification system), diabetes, and operation time, and that the only significant factor for RI was the operation time. More large-scale study and evidences are necessary in order to demonstrate the validity and usefulness of these guidelines.

The effects of fatigue on robotic surgical skill training in Urology residents.

PubMed

Mark, James R; Kelly, Douglas C; Trabulsi, Edouard J; Shenot, Patrick J; Lallas, Costas D

2014-09-01

This study reports on the effect of fatigue on Urology residents using the daVinci surgical skills simulator (dVSS). Seven Urology residents performed a series of selected exercises on the dVSS while pre-call and post-call. Prior to dVSS performance a survey of subjective fatigue was taken and residents were tested with the Epworth Sleepiness Scale (ESS). Using the metrics available in the dVSS software, the performance of each resident was evaluated. The Urology residents slept an average of 4.07 h (range 2.5-6 h) while on call compared to an average of 5.43 h while not on call (range 3-7 h, p = 0.08). Post-call residents were significantly more likely to be identified as fatigued by the Epworth Sleepiness Score than pre-call residents (p = 0.01). Significant differences were observed in fatigued residents performing the exercises, Tubes and Match Board 2 (p = 0.05, 0.02). Additionally, there were significant differences in the total number of critical errors during the training session (9.29 vs. 3.14, p = 0.04). Fatigue in post-call Urology residents leads to poorer performance on the dVSS simulator. The dVSS may become a useful instrument in the education of fatigued residents and a tool to identify fatigue in trainees.

Urinary tract infection in children younger than 5 years. Etiology and associated urological anomalies.

PubMed

Garout, Wallaa A; Kurdi, Hassan S; Shilli, Abdulrahman H; Kari, Jameela A

2015-04-01

To investigate the most common underlying organisms, and associated urological anomalies in children presenting with urinary tract infection (UTI). Retrospectively, all children with confirmed UTI between October 2013 and February 2014 were evaluated at King Abdulaziz University Hospital, Riyadh, Kingdom of Saudi Arabia. The electronic files of 279 children presenting with UTI, aged less than 5 years were reviewed. A total of 153 patients (85 males) with a mean (SD) age of 15 (19.86) months were included in the study. Recurrent UTI was present in 45.1%. Urine collection in children less than 2 years of age was through trans-urethral catheterization in 69.4%, while midstream urine was the main method in those above 2 years (78.6%). Escherichia coli (E. coli) was the causative organism in 41.2% of first UTI. The second most common organism was Klebsiella Pneumoniae, seen in 19.6%. Urological anomalies were found in 28.1% of the overall study population. Ninety percent of those with single UTI did not have anomalies. However, urological anomalies were reported in 50.7% of those with recurrent episodes of UTI (p less than 0.005). Non-E. coli cases were associated with a higher percentage of abnormal renal ultrasonography results (p=0.006). Escherichia coli was the most common causative organism for UTI, and a single episode of UTI signified normal urological anatomy.

Urology and the scientific method in ancient Egypt.

PubMed

Gordetsky, Jennifer; O'Brien, Jeanne

2009-03-01

To examine the practice of urology in ancient Egypt using various sources, including the Edwin Smith and Ebers Papyri. The sources of knowledge of ancient Egyptian medicine include medical papyri, paleopathology, art, and hieroglyphic carvings. A brief overview of the medical system in ancient Egypt was completed, in addition to an examination of the training and specialization of the physician in the ancient world. Urologic diseases treated in ancient Egypt and some of the first documented urologic surgeries are presented. Finally, we studied the role of the physician-priest and the intertwined use of religion and magic in ancient Egyptian medicine. The same medical conditions urologists treat in the office today were methodically documented thousands of years ago. Medical papyri show evidence that the ancient Egyptians practiced medicine using a scientific method based on the clinical observation of disease. This has been exemplified by the Edwin Smith Surgical Papyrus, a collection of surgical cases that gives a diagnosis, treatment, and prognosis for each ailment, and the discovery of medical specialization in ancient Egypt, giving us perhaps the world's first urologists. Intertwined with the scientific method was also the rich mysticism and religion of ancient Egypt, which were integral components of the healing process. We present an overview of the practice of urology in ancient Egypt, in terms of both pharmacologic and surgical intervention, as well as with a look into the religion of medicine practiced at that time.

Is there a relationship between National Institutes of Health funding and research impact on academic urology?

PubMed

Colaco, Marc; Svider, Peter F; Mauro, Kevin M; Eloy, Jean Anderson; Jackson-Rosario, Imani

2013-09-01

Scholarly productivity in the form of research contributions is important for appointment and promotion in academic urology. Some believe that this production may require significant funding. We evaluated the relationship between National Institutes of Health (NIH) funding, academic rank and research productivity, as measured by the h-index, an objective indicator of research impact on a field. A total of 361 faculty members from the top 20 NIH funded academic urology departments were examined for research productivity, as measured by the h-index and calculated from the Scopus database (http://www.info.sciverse.com/scopus). Research productivity was compared to individual funding totals, the terminal degree and academic rank. NIH funded faculty members had statistically higher research productivity than nonfunded colleagues. Research productivity increased with increasing NIH funding. Departmental NIH funding correlated poorly with the mean department h-index. Successive academic rank was associated with increasing research productivity. Full professors had higher NIH funding awards than their junior NIH funded colleagues. There is an association among the h-index, NIH funding and academic rank. The h-index is a reliable method of assessing the impact of scholarly contributions toward the discourse in academic urology. It may be used as an adjunct for evaluating the scholarly productivity of academic urologists. Copyright © 2013 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.

Clinical Trials in Benign Prostatic Hyperplasia: A Moving Target of Success.

PubMed

Thomas, Dominique; Chung, Caroline; Zhang, Yiye; Te, Alexis; Gratzke, Christian; Woo, Henry; Chughtai, Bilal

2018-05-24

Benign prostatic hyperplasia (BPH) affects over 50% of men above the age of 50 yr. With half of these men having bothersome lower urinary tract symptoms, this area represents a hot bed of novel treatments. Many BPH therapies have favorable short-term outcomes but lack durability or well-defined adverse events (AEs). Clinical trials are a gold standard for comparing treatments. We characterized all BPH clinical trials registered worldwide from inception to 2017. A total of 251 clinical trials were included. Of the studies, 30.1% used patient-reported outcomes such as the American Urological Association Symptom Score. Approximately 70% of clinical trials studied medical interventions, while the remaining trials investigated surgical approaches. Seventy-nine percent of trials were industry sponsored, while a minority were funded without commercial interest. Only 42% of trials had 12-mo follow-up, with the majority with <3 mo of follow-up. No trials evaluated prevention, diet, behavior, or alternative methods Overall, only 23% of trials reported results. Management options for BPH need unified benchmarks of success, AEs, durability, and standard reporting for all clinical trials, regardless of outcomes. We found that the majority of clinical trials were medical intervention, with very few trials evaluating prevention, diet, behavior, or alternative methods Furthermore, a few trials reported results in peer-reviewed journals. All clinical trials need to report results regardless of outcome, and in conclusion, standardized methods are needed in order to document the successes, adverse events, and durability for all clinical trials. Copyright © 2018 European Association of Urology. Published by Elsevier B.V. All rights reserved.

Upper Tract Urological Laparoendoscopic Single-Site Surgery (LESS)

PubMed Central

Tugcu, Volkan; Sahin, Selcuk; Seker, Gokhan; Kargi, Taner; Tasci, Ali Ihsan

2015-01-01

Background and Objectives: Our objective is to report intermediate-term outcomes for patients who have undergone upper tract urologic laparoendoscopic single-site surgery (LESS) at a single institution. Methods: From January 1, 2008, through November 30, 2012, 107 cases treated with LESS were identified, including pyeloplasty (n = 30), ureterolithotomy (n = 32), nephrectomy (n = 35; simple = 31, partial = 4), and cyst decortication (n = 10). Perioperative data were reviewed, and conversion and complication rates were noted. Results: The median follow-up was 21.5 months for pyeloplasty, 20.5 for ureterolithotomy, 28.0 for simple nephrectomy, 14.0 for partial nephrectomy, and 19.0 for cyst decortication. Major complications were encountered in 8 patients, including 3 intraoperative complications (2 bowel injury with serosal tearing and 1 intraoperative bleeding), which were recognized and repaired with LESS or conversion to conventional laparoscopy (CL). During the intermediate postoperative period (30–90 days) major complications occurred in 5 patients: 4 ureteral strictures (Clavien-Dindo grade [CG] IIIb) and 1 urinoma formation (CG IIIa). During the early postoperative period (<30 days), the most common minor complications were flank pain (CG I) in 16 patients and urinary tract infection (CG II) in 11, followed by urinary leakage (CG I) in 8. Conclusions: Intermediate-term functional outcomes of this single-center study confirm that upper tract LESS is a challenging procedure that can be safe and effective when performed by an experienced team. Prospective studies with longer follow-up periods are needed to investigate the safety of LESS in the treatment of various upper urinary tract conditions. PMID:26648679

75 FR 29766 - Government-Owned Inventions; Availability for Licensing

Federal Register 2010, 2011, 2012, 2013, 2014

2010-05-27

...-member renal cancer cell lines in the Tumor Cell Line Repository of the Urologic Oncology Branch (UOB... genetic features are well characterized: This cell line is part of NCI Urologic Oncology Branch's Tumor... Oncology Branch, is seeking statements of capability or interest from parties interested in collaborative...

About the Prostate and Urologic Cancer Research Group | Division of Cancer Prevention

Cancer.gov

The Prostate and Urologic Cancer Research Group conducts and supports research on prostate and bladder cancers, and new approaches to clinical prevention studies including cancer immunoprevention. The group develops, implements and monitors research efforts in chemoprevention, nutrition, genetic, and immunologic interventions, screening, early detection and other prevention

21 CFR 876.4890 - Urological table and accessories.

Code of Federal Regulations, 2010 CFR

2010-04-01

..., stirrups, and belts used to support a patient in a suitable position for endoscopic procedures of the lower...) Class II (special controls) for the electrically powered urological table and accessories. The device is... § 876.9. (2) Class I for the manually powered table and accessories, and for stirrups for electrically...

How to teach evidence-based medicine to urologists

PubMed Central

Hajebrahimi, Sakineh; Mostafaie, Ali

2011-01-01

The goal of this article is to help develop, disseminate, and evaluate resources that can be used to practice and teach EBM for urology residents and continuing education of urologists to reduce the gap between research and clinical practice. Urology departments should build capacity for residents to shape the future of quality and safety in healthcare through translating evidence into practice. Cutting edge approaches require knowing how to teach Evidence-based urology, to make Bio-statistics easy to understanding and how to lead improvement at every level. The authors shared their experience about ‘what works’ in a surgical department to building an Evidence-based environment and high quality of cares. PMID:22279316

Targeting DNA Methyltranferases in Urological Tumors

PubMed Central

Marques-Magalhães, Ângela; Graça, Inês; Henrique, Rui; Jerónimo, Carmen

2018-01-01

Urological cancers are a heterogeneous group of malignancies accounting for a considerable proportion of cancer-related morbidity and mortality worldwide. Aberrant epigenetic traits, especially altered DNA methylation patterns constitute a hallmark of these tumors. Nonetheless, these alterations are reversible, and several efforts have been carried out to design and test several epigenetic compounds that might reprogram tumor cell phenotype back to a normal state. Indeed, several DNMT inhibitors are currently under evaluation for therapeutic efficacy in clinical trials. This review highlights the critical role of DNA methylation in urological cancers and summarizes the available data on pre-clinical assays and clinical trials with DNMT inhibitors in bladder, kidney, prostate, and testicular germ cell cancers. PMID:29706891

21 CFR 876.1 - Scope.

Code of Federal Regulations, 2010 CFR

2010-04-01

... gastroenterology-urology devices intended for human use that are in commercial distribution. (b) The identification... gastroenterology-urology device that has two or more types of uses (e.g., used both as a diagnostic device and as a... documents referenced in this part are available on the Internet at http://www.fda.gov/cdrh/guidance.html...

[Artificial neural networks for decision making in urologic oncology].

PubMed

Remzi, M; Djavan, B

2007-06-01

This chapter presents a detailed introduction regarding Artificial Neural Networks (ANNs) and their contribution to modern Urologic Oncology. It includes a description of ANNs methodology and points out the differences between Artifical Intelligence and traditional statistic models in terms of usefulness for patients and clinicians, and its advantages over current statistical analysis.

Novel Transparent Urinary Tract Simulator Improves Teaching of Urological Operation Skills at a Single Institution.

PubMed

Zhong, Xiao; Wang, Pingxian; Feng, Jiayu; Hu, Wengang; Huang, Chibing

2015-01-01

This randomized controlled study compared a novel transparent urinary tract simulator with the traditional opaque urinary tract simulator as an aid for efficiently teaching urological surgical procedures. Senior medical students were tested on their understanding of urological theory before and after lectures concerning urinary system disease. The students received operative training using the transparent urinary tract simulator (experimental group, n = 80) or the J3311 opaque plastic urinary tract simulator (control, n = 80), specifically in catheterization and retrograde double-J stent implantation. The operative training was followed by a skills test and student satisfaction survey. The test scores for theory were similar between the two groups, before and after training. Students in the experimental group performed significantly better than those in the control group on the procedural skills test, and also had significantly better self-directed learning skills, analytical skills, and greater motivation to learn. During the initial step of training, the novel transparent urinary tract simulator significantly improved the efficiency of teaching urological procedural skills compared with the traditional opaque device. © 2015 S. Karger AG, Basel.

Robotic-assisted laparoendoscopic single-site surgery (R-LESS) in urology: an evidence-based analysis.

PubMed

Barret, E; Sanchez-Salas, R; Ercolani, M; Forgues, A; Rozet, F; Galiano, M; Cathelineau, X

2011-06-01

The objective of this manuscript is to provide an evidence-based analysis of the current status and future perspectives of robotic laparoendoscopic single-site surgery (R-LESS). A PubMed search has been performed for all relevant urological literature regarding natural orifice transluminal endoscopic surgery (NOTES) and laparoendoscopic single-site surgery (LESS). All clinical and investigative reports for robotic LESS and NOTES procedures in the urological literature have been considered. A significant number of clinical urological procedures have been successfully completed utilizing R-LESS procedures. The available experience is limited to referral centers, where the case volume is sufficient to help overcome the challenges and learning curve of LESS surgery. The robotic interface remains the best fit for LESS procedures but its mode of use continues to evolve in attempts to improve surgical technique. We stand today at the dawn of R-LESS surgery, but this approach may well become the standard of care in the near future. Further technological development is needed to allow widespread adoption of the technique.

Urologic considerations of placenta accreta: a contemporary tertiary care institutional experience.

PubMed

Woldu, Solomon L; Ordonez, Maria A; Devine, Patricia C; Wright, Jason D

2014-01-01

As the incidence of cesarean delivery has increased, we are experiencing a higher incidence of subsequent placenta accreta and the associated complications, including urologic complications. This is a retrospective review of all patients delivered from 2000 to 2011 with a histologically proven diagnosis of placenta accreta. Data were analyzed for baseline maternal characteristics, intraoperative and postoperative outcomes and complications. 83 patients were included in the analysis. The depth of placenta accreta invasion varied in the cohort, with 48, 25 and 27% being classified as placenta accreta, placenta increta and placenta percreta, respectively. 88% of patients had had a previous cesarean delivery, and 58% had more than one prior operative delivery. Cystotomy was encountered in 27% of patients and ureteral injury occurred in 4%. Degree of placenta accreta invasion, number of prior cesarean deliveries and intraoperative blood loss were associated with a higher likelihood of urologic injury. Urologic injuries are among the most frequently encountered intraoperative complications of placenta accreta. Surgeons involved in these cases need to be aware of this risk and maintain a high level of surveillance intraoperatively. © 2014 S. Karger AG, Basel.

Phytotherapy: emerging therapeutic option in urologic disease

PubMed Central

2012-01-01

Phytotherapy belongs to the area of complementary and alternative medicine (CAM) and the definition of phytotherapy is the use of plants or plant extracts for medicinal uses. Interest in phytotherapy is growing in both Asian and western countries for its use in the prevention and management of disease, improvement of general health and anti-aging. And also, there are several studies about the efficacy of phytotherapy in urologic diseases like benign prostatic hyperplasia (BPH), erectile dysfunction (ED), late-onset hypogonadism (LOH) and infertility in males. Phytotherapy for BPH including saw palmetto, pygeum, and nettles, is under vigorous research for the therapeutic effect. No solid evidence showing better effective treatment modality for ED than placebo has been found yet for phytotherapy. Recently, a potent NO donor, L-arginine is under research with promising results. Phytotherapy is used by a number of patients with urological disease, and urologists need to have accurate knowledge about phytotherapy as well as keep a cautious approach. The possible effects and side effects should be defined and related to urologic patients by urologists. PMID:26816707

The impact of the National Treatment Purchase Fund on numbers of core urology training cases at University Hospital Galway.

PubMed

Harney, T J; Dowling, C M; Brady, C M

2011-06-01

Since the National Treatment Purchase Fund (NTPF) scheme was introduced in 2002, public patients waiting longer than three months for investigations and treatment are offered care in the private medical sector. Our aim was to assess the impact of the NTPF scheme on the number of training cases performed at University Hospital Galway (UHG). The number and type of urological procedures performed in the private medical sector under the NTFP scheme in 2008 were obtained from the UHG waiting list office. The number of these procedures performed on public patients by trainees at UHG in 2008 was determined retrospectively by reviewing theatre records. A significant number of core urology procedures were performed in the private sector via the NTPF scheme. Cancer centre designation and implementation of the EWTD will also place further pressures on urological training opportunities in Ireland. Copyright © 2010 Royal College of Surgeons of Edinburgh (Scottish charity number SC005317) and Royal College of Surgeons in Ireland. Published by Elsevier Ltd. All rights reserved.

Natural orifice transluminal endoscopic surgery in urology: Review of the world literature.

PubMed

Bazzi, Wassim M; Raheem, Omer A; Cohen, Seth A; Derweesh, Ithaar H

2012-01-01

Natural orifice transluminal endoscopic surgery (NOTES) has gained momentum in the recent urologic literature as a new surgical approach for intra-abdominal organs with scarless and painless postoperative recoveries. We sought to review the published literature concerning the safety and reproducibility of NOTES in urology. PubMed literature review of articles published in the English language was performed over a 10-year period, i.e., between 2001 and 2011; all articles were critically reviewed and analyzed. Despite its novelty, pure or hybrid surgical approaches have been adapted in performing NOTES. NOTES essentially utilizes transluminal flexible endoscopic instruments along with laparoscopic instruments to gain access to abdominal, pelvic, and/or retroperitoneal cavities. The preliminary results of NOTES in surgery and to a limited extent in urology appear promising, yet further research in animal survival and human cadaveric models is requisite prior to human applications, especially for complex surgeries. Future innovative research, particularly biomedical engineering, should be directed to improving the technicality and mechanistic application of NOTES; hence, better safety and efficacy of NOTES.

Evaluation of a case-based urology learning program.

PubMed

Mishra, Kirtishri; Snow-Lisy, Devon C; Ross, Jonathan; Goldfarb, David A; Goldman, Howard; Campbell, Steven C

2013-12-01

To address the challenges that today's trainees encounter, such as information overload and reduced immersion in the field, and recognizing their preference for novel educational resources, an electronic case-based urology learning program was developed. Each case was designed to illustrate the basic principles of the disease process and the fundamentals of evaluation and management using the Socratic method, recapitulating a prototypical patient encounter. A 21-question survey was developed after review of published reports of classroom and clinical learning environment surveys. The target group was 2 pilot urology training programs (the Cleveland Clinic and University Hospitals-Case Medical Center). The responses were entirely anonymous. A total of 32 trainees participated (8 fellows and 24 residents), representing a 53% response rate. Most trainees (79%) were able to process cases within an average of ≤ 10 minutes. Of the trainees, 91% reported referring back to particular cases for patient care, to review for examinations, or for studying. Most trainees believed a case-based urology learning program would be a potentially important resource for clinical practice (69%) and for preparing for the in-service (63%) or board (69%) examinations. Most trainees believed the program met its goals of illustrating the basics principles of the disease process (88%), outlining the fundamentals of evaluation and management (94%), and improving the trainees' knowledge base (91%). An electronic case-based urology learning program is feasible and useful and stimulates learning at all trainee levels. Copyright © 2013 Elsevier Inc. All rights reserved.

Analysis of closed medical litigation in urology

PubMed Central

Shin, Su Hwan; Kim, So Yoon; Jang, Seung Gyeong

2017-01-01

Purpose The objective of this study was to provide a descriptive understanding of the characteristics of malpractice litigation related to urology by examining court cases. Materials and Methods A total of 6,074 court cases related to medical malpractice litigation filed between 2005 and 2010 were received from the Lower Courts, the Appellate Courts, and the Supreme Court of Korea. Of the received cases, 34 urology-related civil proceedings were analyzed. The following information was compiled and investigated from the cases: background, age and sex of patient, categorization of the defendant, opinion of the court, amount claimed and awarded in damages, type of medical treatment involved, and negative effects resulting from the medical accident. Results The average amount in damages paid out to plaintiffs in this research was 27,186,504±32,371,008 Korean won (KRW) (range, 1,000,000–100,000,000 KRW). A total of 9 of the 34 analyzed cases (26.5%) ruled in favor of the plaintiff, with all 9 cases involving a surgery. An analysis of the surgery sites further revealed that the penis was the most frequently litigated over site of surgery, making up 14 of the 35 sites (40.0%). Conclusions Information regarding urology malpractice lawsuits should be made available to help prevent further disputes and litigation. Continuous efforts must be expended in the prevention of accidents and disputes, alongside research into urology-related cases beyond 2010. Extensive cause analysis and recurrence prevention methods must also be researched to enhance overall patient safety. PMID:28868502

Early laparoscopic management of acute postoperative hemorrhage after initial laparoscopic surgery.

PubMed

Gong, Edward M; Zorn, Kevin C; Gofrit, Ofer N; Lucioni, Alvaro; Orvieto, Marcelo A; Zagaja, Gregory P; Shalhav, Arieh L

2007-08-01

The use of laparoscopic surgery has been well established for the management of abdominal emergencies. However, the value of this technique for postoperative hemorrhage in urology has not been characterized. We present our favorable experience with laparoscopic exploration after urologic surgery and suggest guidelines for laparoscopic management of post-laparoscopy bleeding. Three patients who developed hemorrhage shortly after laparoscopic urologic surgery and were managed by laparoscopic exploration were identified from a series of 910 laparoscopic urologic procedures performed at our institution from October 2002 to June 2006. Three patients, who were hemodynamically stable (two after robot-assisted laparoscopic prostatectomy, one after laparoscopic radical nephrectomy), required prompt surgical exploration for postoperative hemorrhage not stabilized by blood transfusion (mean 2.7 units) at a mean of 19.4 hours after initial surgery. Clots were evacuated with a 10-mm suction-irrigator. Two patients were found to have abdominal-wall arterial bleeding and were managed with suture ligation. The third patient demonstrated diffuse bleeding from the prostatic bed, which was controlled with Surgicel and FloSeal. Bleeding was efficiently controlled in all patients, and none required post-exploration transfusion. The mean post-exploration hospital stay was 2.3 days. Significant hemorrhage after urologic laparoscopy is a rare event. We found laparoscopic exploration to be an excellent way to diagnose and correct such hemorrhage in certain patients. Early diagnosis with clinical and hematologic studies, a lowered threshold for surgical exploration, and specific operative equipment may decrease patient morbidity and the need for open surgical exploration.

Assessment of the core learning objectives curriculum for the urology clerkship.

PubMed

Rapp, David E; Gong, Edward M; Reynolds, W Stuart; Lucioni, Alvaro; Zagaja, Gregory P

2007-11-01

The traditional approach to the surgical clerkship has limitations, including variability of clinical exposure. To optimize student education we developed and introduced the core learning objectives curriculum, which is designed to allow students freedom to direct their learning and focus on core concepts. We performed a prospective, randomized, controlled study to compare the efficacy of core learning objectives vs traditional curricula through objective and subjective measures. Medical students were randomly assigned to the core learning objectives or traditional curricula during the 2-week urology clerkship. Faculty was blinded to student assignment. Upon rotation completion all students were given a 20-question multiple choice examination covering basic urology concepts. In addition, students completed a questionnaire addressing subjective clerkship satisfaction, comprising 15 questions. Between June 2005 and January 2007, 10 core learning objectives students and 10 traditional students completed the urology clerkship. The average +/- SEM multiple choice examination score was 12.1 +/- 0.87 and 9.8 +/- 0.59 for students assigned to the core learning objectives and traditional curricula, respectively (p <0.05). Subjective scores were higher in the core learning objectives cohort, although this result did not attain statistical significance (124.9 +/- 3.72 vs 114.3 +/- 4.96, p = 0.1). Core learning objectives students reported higher satisfaction in all 15 assessed subjective end points. Our experience suggests that the core learning objectives model may be an effective educational tool to help students achieve a broad and directed exposure to the core urological concepts.