Specialty Of Urology Research Articles

Laparoscopic Urologic Surgery: The Financial Realities

Since 1990, laparoscopic surgery has gained an important role in the specialty of urology. This article provides a financial analysis of the three most common urolaparoscopic procedures compared with their open surgical counterpart. The intraoperative costs of laparoscopic surgery are more expensive, but the postoperative expenses are less compared with open surgery. The financial ramifications of a shorter period of convalescence following laparoscopic surgery must be considered.

Medical problems of adults who were sexually abused in childhood.

The aim of the study was to see whether adults who had been sexually abused in childhood were vulnerable to physical symptoms and therefore investigation and intervention. The case histories of seven patients who were aged 22-39, were under the care of three consultant psychiatrists, had experienced childhood sexual abuse, and had a history of medical or surgical intervention were surveyed. The patients had had a mean of 18 contacts with non-psychiatric consultant teams and a mean of eight operations, with a high rate (66-70%) of normal findings. They had experienced many somatic symptoms, which led to investigations and interventions in the specialties of gynaecology, obstetrics, gastroenterology, urology, rheumatology, haematology, orthopaedics, neurology, and neuropsychiatry. The history of childhood sexual abuse was recognised only in the later stages of this medical and surgical intervention. The possibility of childhood sexual abuse should be considered earlier in such cases to prevent further unnecessary intervention.

The application of a surgical bed simulation model

This paper describes a computer simulation model of inpatient care for the General Surgery and Urology specialties in an English health district. The model can be used to answer a variety of questions concerning the operation of the specialties. Some initial results obtained by the author are given. The model will be used in more detail by administrators and doctors within the district.

Percutaneous ultrasonic lithotripsy. A simplified treatment for renal stones.

Advances in techniques and skills within the specialties of urology and invasive radiology have dramatically changed the treatment of renal calculus disease. One recently developed treatment is per...

Kidney Stone Removal: Percutaneous Versus Surgical Lithotomy

Percutaneous removal of most urinary tract calculi may be performed as a 1-stage effort with techniques and skills developed recently in the specialties of urology and radiology. Ultrasonic fragmentation of most calculi was done to permit their extraction. Percutaneous ultrasonic lithotripsy was performed on 250 consecutive (a single exception) patients bearing stones that required removal. Targeted calculi were removed successfully from 97 per cent of these patients. One patient required surgical lithotomy. The previous 100 patients with stones underwent surgical lithotomy with 96 per cent success.Complications of percutaneous ultrasonic lithotripsy appeared equitable with those of surgical lithotomy. Of the patients who underwent percutaneous ultrasonic lithotripsy 6 (6 per cent) required extended hospital days or additional procedures for management of complications. None of these patients required a surgical incision.Anesthesia times were similar for both groups—average 159 plus or minus 4 (standard error) minutes for percutaneous ultrasonic lithotripsy and 193 plus or minus 8 minutes for surgical lithotomy. Hospital recovery days averaged 5.5 plus or minus 0.3 for percutaneous ultrasonic lithotripsy and 8.4 plus or minus 0.5 for surgical lithotomy (p less than 0.01). Associated costs averaged $7,203 plus or minus 55 for lithotripsy and $8,849 plus or minus 660 for lithotomy (p less than 0.01). The number of narcotic administrations per patient (days 1 to 5 postoperatively) averaged 9.88 plus or minus 0.70 for lithotripsy and 16.82 plus or minus 0.78 for lithotomy (p less than 0.01). The average patient who underwent percutaneous ultrasonic lithotripsy felt capable of full activity 2.0 plus or minus 0.2 weeks following stone removal, whereas no patient who underwent previous surgical lithotomy recalls a recovery period of less than 3 weeks (p less than 0.01).We believe that most upper urinary tract calculi may be removed cost-effectively with a percutaneous approach. Compared to surgical lithotomy, percutaneous ultrasonic lithotripsy may result in rapid convalescence with diminished pain.

Ureteroscopy and ureteropyeloscopy

Transurethral endoscopic access to the upper urinary tract using rigid optics is evolving into a significant addition to the specialty of urology. The basic endoscopic expertise urologists have perfected for use in the urethra, prostate, and bladder is readily transposed to the ureter and renal pelvis. Indications, precautions, instrumentation, and procedural techniques are detailed.

Formal training in pediatric emergency medicine: The surgeon's contribution

The emergency department offers an unparalleled arena in which to teach, to carry out clinical research, and to influence the quality of patient care. In the United States, 31 formal programs have been established to prepare physicians for careers in adult emergency medicine. Until recently, no university medical center provided a formal training program in the emergency medicine of childhood. The first such program was launched in July 1977 in a large children's hospital with 57,000 emergency department visits per year. The objective is to prepare Board-eligible pediatricians to assume full-time supervisory positions in emergency departments in children's hosptials or large teaching general hospitals. The trainees enter the program with less experience in dealing with surgical emergencies than with pediatric medical emergencies. For this reason the teaching contributions of general pediatric surgery and the pediatric surgical specialties of orthopedics, neurosurgery, anesthesia, thoracic surgery, urology, plastic surgery, and otolaryngology are especially important. These are coordinated by the author. A review of the first 9 mo suggests that the conflicting needs of the emergency medicine fellows and those of other trainees in pediatric medicine and the pediatric surgical specialties are easily resolved. Improvement in patient care and teaching in the emergency department has been documented, and a start has been made toward developing a research program in the emergency problems of children. The emergency department offers an unparalleled arena in which to teach, to carry out clinical research, and to influence the quality of patient care. In the United States, 31 formal programs have been established to prepare physicians for careers in adult emergency medicine. Until recently, no university medical center provided a formal training program in the emergency medicine of childhood. The first such program was launched in July 1977 in a large children's hospital with 57,000 emergency department visits per year. The objective is to prepare Board-eligible pediatricians to assume full-time supervisory positions in emergency departments in children's hosptials or large teaching general hospitals. The trainees enter the program with less experience in dealing with surgical emergencies than with pediatric medical emergencies. For this reason the teaching contributions of general pediatric surgery and the pediatric surgical specialties of orthopedics, neurosurgery, anesthesia, thoracic surgery, urology, plastic surgery, and otolaryngology are especially important. These are coordinated by the author. A review of the first 9 mo suggests that the conflicting needs of the emergency medicine fellows and those of other trainees in pediatric medicine and the pediatric surgical specialties are easily resolved. Improvement in patient care and teaching in the emergency department has been documented, and a start has been made toward developing a research program in the emergency problems of children.

The Search for an Integrated Options Strategy

<h3>Objectives</h3> The Versius surgical system has been developed for use in robot-assisted minimal access surgery (MAS). This study aimed to evaluate the effectiveness of the Versius training program. <h3>Design</h3> A 3.5-day program following 10 hours of online didactic training. Participants were assessed during the technical training using the Global Evaluative Assessment of Robotic Skills (GEARS). <h3>Setting</h3> Dry box exercises were conducted in classrooms, and wet lab sessions simulated an operating room environment using cadaveric specimens. <h3>Participants</h3> Seventeen surgical teams participated; surgeons represented general, colorectal, obstetrics/gynecology, and urology specialties. All surgeons had previous laparoscopic MAS experience, while experience with robotics varied. <h3>Main outcomes measures</h3> Participants were scored on a five-point Likert Scale for each of six validated GEARS domains (depth perception, bimanual dexterity, efficiency, force sensitivity, autonomy, and robotic control). Additional metrics used to chart surgeon performance included: combined instrument path length; combined instrument angular path; and time taken to complete each task. <h3>Results</h3> Participants demonstrated an overall improvement in performance during the study, with a mean GEARS Score of 21.0 (SD: 1.9) in Assessment 1 increasing to 23.4 (SD: 2.9) in Validation. Greatest improvements were observed in the depth perception and robotic control domains. Greatest differences were observed when stratifying by robotic experience; those with extensive experience consistently scored higher than those with some or no experience. <h3>Conclusions</h3> The Versius training program is effective; participants were able to successfully operate the system by program completion, and more surgeons achieved intermediate-level and expert-level GEARS scores in Validation compared with Assessment 1.

The Objective Assessment of Urology Specialty Candidates—test Construction and Analysis—the Problems and Potentialities

The Objective Assessment of Urology Specialty Candidates—test Construction and Analysis—the Problems and Potentialities

Educational problems in the urological specialty.

Educational problems in the urological specialty.

EFFECTS OF ENVIRONMENT ON GENITOURINARY TRACT.

has given him an increasingly active role in the treatment of pediatric urological patients. His influence is gradually being felt throughout the hospitals of New York because of his exemplary training program in urology. More recently, Dr. Lattimer has been elected Chairman of the American College of Surgeons Advisory Council on Urology and Chairman of the Committee on Pediatric Urology of the American Academy of Pediatrics. He has pioneered in the use of motion pictures in urological undergraduate teaching and has worked vigorously to point out the advantages of the urological specialty to the more able medical students coming under his influence. During his tour of duty in the army in Europe during World War II, where he achieved the rank of major, and in subsequent tours in South America, Dr. Lattimer has had ample opportunity to examine environmental factors in the world at large as they affect the genitourinary tract. From his department have come papers ranging from the effect of tropical parasites to those of ultrasound as they affect the living organism and man in particular. Among his hobbies are driving a tractor during weekends on his country estate within ten minutes of uptown N ew York and collecting early Americana for loan to children's schools and libraries. Characteristic of him are his insatiable capacity for work, an unfailing good humor, and perhaps most typically of all, the fact that although his middle name is Kingsley, he dropped the nickname of King at the time he actually became one. HANS H. ZINSSER, MD

THE TREATMENT OF URETHRAL STRICTURE BY EXCISION

The important subject of the treatment of urethral stricture by excision is given very scant attention in the textbooks of general surgery, and not much more by the authors writing on the specialty of urology. Resection of strictures as a surgical procedure for effecting a relative cure of permanent duration has never gained great popularity with the surgical world, chiefly because of lack of accurate knowledge of the anatomy of the urethra and the perineum, and of the ever present fear that the removal of any portion of the corpus spongiosum will result in lasting multilation, with prevention of erection, and impotence. There has also been a natural apprehension that after the removal of sections of the canal of considerable extent, there might result a necrosis of the approximated cut ends. For these reasons, reports of resections have usually been confined to the results obtained from the removal of the