Interest In Urology Research Articles

Attitudes and knowledge of urethral catheters: a targeted educational intervention.

To assess the training of medical students and their confidence in urethral catheter placement, given growing evidence of unnecessary urology consults and iatrogenic injury. A third-year medical school class was queried about their attitudes and knowledge of catheter placement before and after the Clinical Biennium. The Clinical Biennium introduces hands-on skills prior to clinical clerkships. Urethral catheterisation is one of the skill stations that students rotate through, and urology residents provide a didactic session and supervised simulation. Confidence was self-rated regarding catheter technique, knowledge, troubleshooting, and comfort with placement in the same and opposite gender. Factual questions were posed about proper insertion and malfunctioning catheters. In all, 92 students participated in the initial survey, 41% female and 59% male, and 87% of the students had never placed a catheter. Students desired high confidence in catheter skills (4.4/5). There were no significant differences in responses for those with a desire to pursue urology vs other specialties, or procedural fields compared with non-procedural fields. Prior independent learning was reported by 38% of students and was a predictor for increased confidence across all domains (P < 0.05). In all, 16.7% of students initially identified proper male urethral insertion distance, which improved to 95.6% after the session. Student interest in urology modestly increased after the educational session (P = 0.028). At 3-6 months follow-up, students had performed a median (interquartile range) of 4 (2-7) urethral catheter placements, and 74.2% of students rated training useful or extremely useful. Indeed, 54.8% desired more instruction. Knowledge assessment indicated that 93% of students retained comprehension of proper male urethral insertion distance. Clinical Foley training rarely contradicted instruction from the Clinical Biennium (6.5%). At all time-points, medical student knowledge for troubleshooting catheters was low. Medical students strive for high confidence in urethral catheter placement. Prior targeted education improves confidence and knowledge. Together with clinical experience, these effects are durable up to 6 months.

Surgical management of renal tract problems

Abstract The majority of renal tract problems in childhood are congenital in origin with an overall incidence of 2–4 per 1000 live births. Some anomalies may occur in isolation e.g. posterior urethral valves; whilst others may be part of a more complex spectrum of anomalies. Prenatal screening has highlighted an increasing number of children with renal tract anomalies which may require paediatric specialist involvement in the immediate postnatal period. Most congenital renal tract problems are managed by paediatric urologists and paediatric surgeons with a special interest in urology. However, it is important that paediatricians have an understanding of optimal management. The aim of this review is to highlight the most common renal tract disorders of childhood and to discuss their aetiology, clinical presentation, investigation and surgical management.

Treatment expectations and health-related quality of life in stone formers.

The objective of this article is to address patients' expectations of stone treatment - both surgical and medical - and their health-related quality of life (HRQOL). We present a rationale for greater inclusion of measures to assess patient expectations, satisfaction, and HRQOL into surgical and medical management for patients with recurrent urolithiasis. Patients' treatment expectations and HRQOL are fundamental and progressive new areas of interest in urolithiasis. Patients whose treatment regimens result in outcomes that match their expectations are likely to be more satisfied, which may influence their HRQOL, a valid and valuable outcome of any medical treatment or procedure. Patient perceptions of treatment effects for stones, whether surgical or medical, are complex and may not reflect only stone-free rates, surgical complication rates, and side-effects, the outcomes of traditional interest in urology. If we understand the issues of most importance to our patients, we can provide appropriate information and education that ensures the most realistic expectations, minimizes disappointment and risk, and contributes most to the patients' HRQOL.

Medical students and foundation doctors need more exposure to basic urology

With few foundation doctors (FDs) expressing any interest in urology and the lack of a formal undergraduate curriculum in urology, 1 it has been documented that undergraduate exposure to urology is inadequate 2 and that FDs are unable to perform basic urological procedures, 3 in which they should be competent as specified in the General Medical Council (GMC) publication Tomorrow’s Doctors. 4

Ronald Ogier Ward, urologist, hero &amp; first president of BAUS

Ronald Ogier Ward, urologist, hero &amp; first president of <scp>BAUS</scp>

Book Reviews

Lower urinary tract symptoms (LUTs) are common and, owing to the ageing population, likely to be a huge economic burden. They significantly reduce a man’s quality of life and, with many new developments in this field, this book is a timely overview of a common urological problem. This is a small handbook that aims to provide a comprehensive summary of LUTs for general practitioners, students, urologists and physicians with an interest in urology. The text is structured into 24 short and concise chapters. Each chapter starts with a box of key points and there are good take-home messages interspersed throughout them. The book is reader friendly and an easy ‘walk through’ of LUTs and benign prostatic hyperplasia. The tables are well done and supplement the text appropriately. Landmark papers are cited at the end of each chapter while other up-to-date references are also listed, should the reader wish to investigate the subject further. There is an excellent index. I liked the style and much of the content of this book but found many of the chapters repetitive. There are some very useful algorithms, flowcharts and tables but the text size in these is prohibitively small to read comfortably. A section of the book dedicated to when to refer a patient to secondary care may be useful for our primary care colleagues. Overall, I felt this book was an easy read but perhaps too specific for many of its target audience.

Benign prostatic hyperplasia and lower urinary uract symptoms in men

Lower urinary tract symptoms (LUTs) are common and, owing to the ageing population, likely to be a huge economic burden. They significantly reduce a man’s quality of life and, with many new developments in this field, this book is a timely overview of a common urological problem. This is a small handbook that aims to provide a comprehensive summary of LUTs for general practitioners, students, urologists and physicians with an interest in urology. The text is structured into 24 short and concise chapters. Each chapter starts with a box of key points and there are good take-home messages interspersed throughout them. The book is reader friendly and an easy ‘walk through’ of LUTs and benign prostatic hyperplasia. The tables are well done and supplement the text appropriately. Landmark papers are cited at the end of each chapter while other up-to-date references are also listed, should the reader wish to investigate the subject further. There is an excellent index. I liked the style and much of the content of this book but found many of the chapters repetitive. There are some very useful algorithms, flowcharts and tables but the text size in these is prohibitively small to read comfortably. A section of the book dedicated to when to refer a patient to secondary care may be useful for our primary care colleagues. Overall, I felt this book was an easy read but perhaps too specific for many of its target audience.

Uro-Oncology: An Evolution of Past Four Decades in India

During the last 40 years, Uro-oncology as a subspecialty has slowly and steadily evolved and a lot of urologists are getting interested in this superspecialty. At the same time, uro-oncology remains affiliated to Urology – the parent specialty. In the early 1970s, Urology was a part of General Surgery and many general surgeons tackled urological and uro-oncological patients as per concepts of treatment that prevailed then. Urology as a separate specialty also evolved slowly and initially it started as a subsection of ASI around 1960. When Urological Society of India was initiated from the year 1991, there were less than 200 members but with increasing interest in Urology over the years, the number of members practicing solely Urology has increased approximately to 2000 in the year 2010. Today, there is a wider scope for Uro-oncology provided there are adequate numbers of centres to train urologists in this subspecialty, with sufficient number of patients with urological cancers to impart the desired expertise.

Medical Students' Exposure to Urology in the Undergraduate Curriculum, a Web Based Survey

Objective: Urological knowledge and skills are lacking in junior doctors and Urology is undersubscribed for specialist training. Lack of exposure as undergraduates may be responsible. We aimed to assess Urology exposure, confidence about managing common conditions and career prospects, in current UK medical students. Methods: All UK medical schools were contacted. Final year students were asked to complete an online survey about Urology. Results: 610 responses were received. Only 42% of respondents had a compulsory clinical attachment in Urology, lasting on average 1 week. 46% had compulsory attachments partially based in Urology, mainly with other surgical specialities. Common urological activities had been attended by &gt;50% of respondents, however 6% had not attended any. Over 80% of respondents received teaching on common Urology topics except for urological emergencies (62%). Lectures and anatomy sessions were the main teaching methods. 87% of teaching was from Urologists. Most respondents felt ‘confident’ managing common urological problems, but 32% felt ‘not very confident' with urological emergencies. Only 14% of respondents would consider a career in Urology. Conclusion: Urology experience is not compulsory in UK medical schools and is variable. Final year students lack confidence managing urological emergencies and have limited interest in Urology as a career. Development of a Urology undergraduate curriculum should help address these issues.

Dora Teleky – Ein frühes Mitglied der Deutschen Gesellschaft für Urologie

Dora Teleky (1879/81-1963) was one of the first female Physicians in Austria and the first woman, who was member of the old Deutsche Gesellschaft für Urologie (German Society of Urology). She was a specialist for gynaecology with great interest in urology, what was reflected in her scientific publications. Furthermore she tried to strengthen the women's position in the male-dominated medicine. In 1939 she emigrated to the USA, because as a Jewish descendant she was pursued after the Austrian "Anschluss" to Germany (Austria's annexation to the German "Third Reich"). There she continued working as specialist for gynaecology. After she had retired, she came back to Europe and died 1963 in Switzerland.

The urologist: the life of the party

This article made me reflect upon what piqued my interest in urology when I began researching medical career options. What was it that initially attracted me to urology? Was it the fact I was able to “combine surgery and medicine in a single specialty” or was it “the variety of surgeries one could do in urology from endourology to the big open cases”? These were definite factors that swayed my decision to enter urology, but I still recall the impact of the urologists I met during my pre-clerkship rotation. Until this point, I was not even aware what urology was or what a urologist did. Early in medical school, our pre-clerkship group was having a session on digital rectal examination and prostate disease. I encountered a very spirited, gregarious and enthusiastic urologist. I could not get over his excitement over teaching a group of medical student how to perform a digital rectal examination. I knew after this experience, this specialty warranted further exploring. In this issue of the CUAJ, Dr. MacNeily and colleagues compared differences in personality traits between urologists and non-urologist surgeons, as well as between surgeons and non-surgeons.1 Overall, the study found urologists to be more extroverted compared to non-urological surgeons and non-surgeons. This study appears to validate my own personal thoughts of the typical urologist’s personality. Dealing with “unmentionables” day in and day out does require a certain personality to thrive. But does it really matter what kind of personality you have? Must you have an “extroverted personality” with tendencies for “excitement seeking, gregariousness and positive emotions” to become a successful urologist? Of course not, but it can certainly influence the persona and the dynamics of a residency program. Anecdotally, I have seen how personalities influence resident selection. The candidate’s personality is at the forefront of many committee group discussions at the annual Urology Fair. In addition to technical skills and intelligence, how well the candidate worked with the residents, nurses and other staff during an elective rotation is a critical aspect of selection. During the resident selection process, we frequently hear of a candidate’s “positive attitude,” “upbeat personality” and “outgoing nature.” For residents and staff on a residency selection committee, the candidate’s personality is an important factor and helps determine the group dynamics of a urology residency program. Obviously, not all urologists have “extroverted” personality types; there are many “introverted” urologists who are successful and admired by learners, coworkers and patients. A recent study by a group from the University of Minnesota found that the new cohort of residents, the “Generation X,” has personality attributes that differ considerably from previous group of surgical residents.2 The new generation of surgical residents had more “introverted” personalities, influenced by a more individualistic upbringing partially explained by the loss of traditional family dynamics. Whether the influences of the “Generation X” have an impact on the fabric of urology persona will be an interesting study in the future. There is something to be said about the personalities of urologists and some truth to the saying “birds of a feather, flock together.” And if this is true, it bodes well for our specialty in the future because who wouldn’t want to go into a specialty associated with a bunch of outgoing, excitement-seeking, gregarious and positive individuals. I’m sure glad I did!

Technique du ganglion sentinelle dans le cancer de la prostate

Urological interest of sentinel lymph node procedure in prostate cancer, and methods, both are presented in conformity with the presentation of action concertée en medecine nucléaire (ACOMEN).

Effectiveness of Acupuncture in Patients with Category IIIB Chronic Pelvic Pain Syndrome: A Report of 97 Patients

Chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) is of significant interest in urology and unfortunately, the therapy modalities recommended are not fully effective. Therefore, we undertook a pilot study to determine whether acupuncture improves the pain, voiding symptoms, and quality of life in men with category IIIB CP/CPPS. Prospective, one-group trial, cohort study. Outpatient urology clinic. Ninety-seven CP/CPPS patients received six sessions of acupuncture to the BL-33 acupoints once a week. The National Institute of Health Chronic Prostatitis Symptom Index (NIH-CPSI) was completed by each patient before and after the treatment and on 12th and 24th weeks following the treatment. Mean values of total CPSI score, pain subscore, urinary subscore, and quality of life subscore after the treatment and on follow-up after the treatment were compared with the baseline values. There was a statistically significant decrease in all of the subscores evaluated at all periods compared with the baseline. Eighty-six patients out of 93 (92.47%) were NIH-CPSI responders (more than 50% decrease in total NIH-CPSI score from baseline) at the end of the treatment. The results of this study suggest that acupuncture appears to be a safe and potentially effective treatment in improving the symptoms and quality of life of men clinically diagnosed with CP/CPPS.

28. Lithotomy through the ages: Big stones, small stones and all the ways to cut them out

The first known specimen of urological interest was a vesicle calculi dated to 5000 BC, found by Elliot Smith in 1901, in an ancient tomb in Egypt. Since these ancient times, urolithiasis has been a condition which fascinated and frustrated the medical world, both in understanding of its etiology and in how to treat patients afflicted with such stones. &#x0D; Medical management of urinary calculi has a complex and suspect past; when such therapies failed, as their mystical and unscientific approaches often did, patients sometimes resorted to more drastic and dramatic means such as lithotomy.&#x0D; Lithotomy was known since early times in India and Persia; when it was introduced to Europe is unclear. Writings by Susruta in India describe early forms of the procedure, and techniques were improved by Celsus of Rome (1st Century AD), remaining in use, largely unchanged until the eighteenth Century.&#x0D; Marianus Sanctus (1490-1550) described a technique, the “grand appareil” which superseded the Celsus method, and other approaches by Franco (1500-1570), Jacques de Beaulieu (1651-1714), Johann Rau (1658-1709) and William Cheselden (1688-1752) gained and lost dominance over the centuries.&#x0D; Perhaps most interesting about lithotomy was the development of the tools used in its practice. From the beginning, the various knives, forceps, dilators and sounds became ever more complicated, intricate and gruesome looking, resembling more the armamentarium of a torture master than the curative tools of a physician. &#x0D; As endoscopic techniques began and evolved, the necessity to make large incisions for stone removal decreased. Nonetheless, the approaches and instrumentation used to treat bladder stones helped shape the practice of urology and contributed to the continuing goal of minimizing invasion of the patient while still providing effective treatment of stone disease and other genitourinary problems. &#x0D; Murphy LJT. The History of Urology. Springfield, Ill.: Charles C. Thomas, 1972.&#x0D; Chevalier RL. Kidney and urologic disorders in the age of enlightenment. Am J Nephrol 1994; 14(4-6):461-6.&#x0D; Herman, JR. Urology; a view through the retrospectroscope. Hagerstown, Md.: Harper &amp; Row, 1973.

La biografía de Maximilian Nitze (1848-1906) y su contribución a la Urología

Maximilian Carl Friedrich Nitze was born on the 18 of September of 1848 in Berlin the capital of Prussia. 1869 while still being a Student of the Heidelberg University the first nephrectomy of the world performed by Gustav Simon (1824-1876) woke his interest in urology. 1874 by the age of 26 he passed his state examination and obtained a doctor degree in medicine. On the 2 October of 1877 he presented the first cystoscope to the members of the Real Medical School in Dresden. Nitzes doubtless valuable contribution to urology was making real the endoscopical exploration of the genitourinary system and initializiring the era of surgical treatments under direct vision. By the beginning of the XX century urology reached the status of an independent specialty by separating from surgery, dermatology/venerology, internal medicine and pathology.

Pharmacologic penile rehabilitation

Penile rehabilitation therapy following radical prostatectomy is a new area of interest in urology. Preliminary clinical evidence supports the use of early pharmacologic penile rehabilitative therapies; however, large prospective multicenter placebo-controlled trials are needed to determine the benefits and costeffectiveness of particular pharmacologic penile rehabilitative therapies and of therapies in both nervesparing and non-nerve-sparing radical prostatectomy patients. This paper presents and analyzes recent medical literature pertaining to pharmacologic penile rehabilitation therapy after radical prostatectomy.

Specialty Spotlight: Urology

Life experience, whether it is a former life as a technician or a family member's illness, generally influences the specialty area future physicians choose when it comes time for a residency. My exposure and interest in urology came by way of my previous career as a medical journalist working for the Journal of Andrology. The 2 years that I spent working in urology and andrology piqued my interest in a possible career choice as I now enter my second year of medical school. Urology, also known as genitourinary surgery, is a surgical subspecialty that tackles a wide spectrum of disease involving the male and female urinary tracts and the male reproductive system. The field of urology has long been a desirable specialty, attracting some of the most competitive medical students, according to the Society of Women in Urology. For Dr Cathy K. Naughton, assistant professor of Urology at the Washington University School of Medicine, she credits her interest in urology to three factors: exposure to the field, process of elimination, and role models. “It takes one person to spark your interest in something,” Naughton said. “Mentorship is key.” Relating to the people in the field is just one of the many reasons to pursue a career in urology. The broad range of surgeries performed, the lifestyle, research and technology, specialization, and flexibility within urology are some other factors that make the field attractive. People going into surgical fields generally mention qualities like enjoying working with their hands and valuing team-work. Having a strong interest in surgery is one of the most important reasons to enter into urology. For medical students interested in urology, Dr Peter Schlegel, chairman of the Department of Urology at the Weill Medical College of Cornell University offers this piece of advice: “Learn as much about the field from residents, other students who have applied for residency positions, and local faculty members.” Participation in a urology rotation is also important to gain exposure to the field. According to Schlegel, many students take more than 1 month of urology subinternship, but he also notes that it is not necessary for interview or residency preparation. If all this exposure to the field has confirmed the decision to pursue urology, some other areas of the potential application should be considered. According to both Naughton and Schlegel, a well-rounded applicant who expresses interest in urology through clinical, research, or apprentice-based experience is critical. The importance of research is dependent on the program. The more academic programs will be interested in research but do not necessarily require that the research be in the field of urology. For Osteopathic medical students interested in urology, the American College of Osteopathic Surgeons requires that a resident with a surgical specialty develop a research project and follow through with it, ending with a paper suitable for publication, according to Dr Al DePolo, Jr, program director for the Department of Urology at the Michigan State University College of Osteopathic Medicine. Although many factors are taken into consideration when deciding between applicants for a coveted residency spot, DePolo cites some qualities that go beyond class-room performance, rotations, and research. “I think the best things a prospective candidate can bring to any residency are: a strong desire to learn, a good work ethic, honesty, a sense of fair play, and the willingness to be part of a team,” Depolo said. According to statistics released by the National Residency Match Program for 2005, 108 nonmilitary accredited urology residency programs in the United States listed 232 positions, with all vacancies being matched. Medical student applicants, totaling 347, submitted preference lists netting 115 unmatched applicants, giving a 78% match rate. Although there are many reasons to choose urology and many people who have decided on urology as their career of choice, not everyone follows this path. Trainees might not select this specialty because surgery is not for everyone and because surgical training can oftentimes be brutal. In addition, future Urologists need to be comfortable with the topic material and with the reality that urology is a male-dominated field. Despite this, it is important to remember, as Dr Schlegel points out, that women with an interest in urology are often viewed favorably because they have been “underrepresented in the field in the past.” With all this information to digest, I know I will follow a wise piece of advice cited by DePolo: “Do not become set in your choice too early. Take the time and the effort to experience other areas of medicine and surgical sub-specialties. A decision about a career area can wait until the third year.” And you never know, after all is said and done and I have followed the advice of all, urology might just be in my future.

Diet and prostate cancer.

There are four mini-reviews in this section, all on different areas of urological interest. Diet and prostate cancer continues to offer areas of clinical and laboratory research for investigation. Not every urologist looks after patients with spinal cord injury, but neuropathic bladder problems caused by other conditions are common. One of the acute conditions in these patients is autonomic dysreflexia, and this is covered here. I am about to introduce a series of papers which will form a consensus on the management of genitourinary trauma, which appears elsewhere in the journal. In this section this month, authors from Germany describe the diagnosis and treatment of male genital injuries. Finally, the concept that the urologists who operate on the largest volume of cases have the best outcomes from a particular operation is examined.

Julian Smith: scientific surgeon, photographer, inventor.

Julian Augustus Romaine Smith was one of the surgeons who, in the company of Thomas Dunhill, Hugh Devine, Douglas Shields and David Murray Morton, established Saint Vincent's Hospital, Melbourne, as arguably the premier surgical hospital in Victoria, if not Australia. Smith abandoned a most promising scientific career to study medicine, completing his medical course in Melbourne where he graduated top of his year in 1898/1899. He gained his MD in 1901 and set up practice in Morwell, a Victorian country town, where he initiated his surgical career. In 1905 Smith returned to Melbourne and worked as assistant to Mr F. D. Bird, a prominent surgeon. He travelled overseas in 1906, visiting leading medical centres in England where Almroth Wright's work on vaccination made a deep impression on him. On his return to Australia in 1908 he joined the surgical staff at Saint Vincent's Hospital as surgeon to outpatients, finally retiring as surgeon to inpatients in 1928. Smith was made a Foundation Fellow of the Australasian College of Surgeons in 1927. Smith was regarded by his peers as a brilliant innovative surgeon with a special interest in urology. He became an expert cystoscopist. After he retired, he continued his long-standing interest in portrait photography for which he was considered a master. During World War II he designed and built an elegant roller pump for use in direct blood transfusion. He died in 1947, survived by his wife, a daughter and three sons, one of whom became President of the Royal Australasian College of Surgeons.

Preoperative radiologic evaluation of tumors of the renal parenchyma

Renal cell carcinoma is frequently a matter of urological interest. In recent years there were significant improvements regarding the earlier diagnosis, more precise preoperative staging and appropriate therapy. One hundred patients (42-78 years old) with the preoperative diagnosis of renal cell carcinoma were analyzed. Preoperative radiological evaluation included: transabdominal ultrasound, intravenous urography, computer-assisted tomography, and angiography. In all patients after radical nephrectomy pathohistological diagnosis was established and patients with the confirmed renal cell carcinoma tumour staging was performed. All histological findings were compared with the preoperative results of radiological examinations. Reliability of all of them is separately determined. Our results confirmed that the most efficient method of preoperative staging was computer-assisted tomography (accuracy 93%). Diagnostic methods that were previously used like intravenous urography and angiography, were not useful for routine diagnostic purposes. Ultrasound is a precise but not an enough informative diagnostic tool (accuracy 87%). Combine used of both ultrasound and contrast computer-assisted tomography is cost-effective, and an enough precise combination for everyday use.