Urology Registrar Research Articles

Preconceived Impressions Regarding Holmium:YAG Laser Safety in the Urology Operating Theatre.

Since its introduction over two decades ago, the surgical laser has served in the lithotripsy of urinary calculi, resection of bladder tumours, bladder neck incisions, and prostate enucleation. Concerns regarding the safe use of holmium lasers have resulted in potentially excessive and overly precautious theatre regulations. We aimed to evaluate the preconceived impressions and practice patterns at a single site surrounding laser use in endourology. We designed a three-part online questionnaire that could be accessed using a smart device or computer. This survey was distributed to all theatre staff involved in laser surgery at our single site, including surgical, nursing, and anaesthetic staff of varying seniority. It asked questions regarding holmium laser safety, provided an up-to-date summary of published literature surrounding the safe use of lasers, and finally gave participants further option to alter the answers to several previously encountered questions. A total of 54 theatre staff completed the survey, including 17 theatre nurses (31.5%), 10 urology consultants (18.5%), 8 urology registrars (14.8%), 7 anaesthetic registrars (13%), 4 anaesthetic consultants (7.4%). About 51.9% of participants believed that current laser safety protocols were adequate, with 38.9% finding them excessive. After reading recently published information on laser safety, 22.2% thought current laser safety measures were adequate (57% decrease) and 77.8% found them to be excessive (100% increase). About 74.1% of participants found that laser safety goggles impair their vision and that 79.6% would choose not to wear them if they were optional. Strict laser safety guidelines reflect an overestimated risk associated with using holmium laser in operating theatres. Laser safety regulations should be re-evaluated to align with current research and potential hazards inherent to the device. In doing so, a more effective distribution of staff could enable greater access to laser surgery, thereby reducing patient morbidity and hospital wait times.

A pilot study of performance enhancement coaching for newly appointed urology registrars.

To assess the feasibility of performance enhancement coaching (PEC) for newly appointed Urology registrars (ST3s), specifically: whether the concept appealed, and which areas beyond technical skills acquisition were felt to be most relevant or useful. All delegates on the Urology Bootcamp 2023 were invited to take part in an online survey before and after a 2-hour PEC workshop, collecting: basic demographic data, performance challenges, and the important aspects to include in, and consider with, a coaching programme. The workshop was delivered by a surgeon with a professional coaching qualification, to groups of four delegates at a time over 4 days. Ten pre-defined areas were offered during the session. On a scale of 1 (poor) to 10 (excellent), the 62 participants' overall health was reported as a median of 8/10 (physical) and 7/10 (mental). Anxiety during performance was the most common concern (63%) and was accompanied by a tremor in 55%. The next most popular concerns, with 19% of responses each, were: sleep, insufficient operative skill or expertise, and worry about relationships with trainers. The commonest topics discussed were 'the inner critic' (100%), 'autonomic modulation' (69%), 'not working, well' (13%) and 'optimising study' (6%). Seventy-seven per cent were unaware of PEC for practising surgeons. All respondents felt that they would benefit from PEC to some extent (80% ≥8/10 where 10/10 was 'very useful'), ideally at the ST3 level. Sixty-two percent of respondents said there should be a fee for trainees, whereas 38% thought it should be free and paid for by their training authorities. The concept of PEC is acceptable to ST3 Urology trainees, with particular interest in techniques to mitigate negative self-talk and autonomic modulation techniques. Existing barriers to coaching for the surgical community would need to be addressed in designing an acceptable coaching programme.

Exposure of plastic surgery and urology registrars in the United Kingdom to gender affirming care of transgender patients: A cross-sectional survey of training programme directors

To assess the expected duration of exposure of United Kingdom urology and plastic surgery trainees to the provision of gender affirming healthcare to transgender patients. This observational, cross-sectional survey asked UK training programme directors (TPDs) to report the volume of training in gender affirming care of transgender patients that urology and plastic surgery trainees are expected to receive. A Google Form online questionnaire was distributed to each regional TPD in the UK both for plastic surgery and urology. Eleven of 14 TPDs in plastic surgery and 13 of 19 urology TPDs completed the survey with responses representing 487 trainees. The total estimated exposure of UK trainees to any aspect of gender affirming healthcare was a median of one hour of training per trainee per year (clinical or didactic). Thirteen deaneries reported that trainees received some (didactic or clinical) training in transgender care each year. Only eight of these deaneries reported provision of direct clinical training. The remaining eleven deaneries reported that trainees received no training in gender affirming care. No training was expected to take place for any trainee of either speciality within multi-disciplinary team meetings or in masculinising genital surgery. The above evidence demonstrates the low exposure of plastic surgery and urology registrar trainees to gender affirming care during their training years in the UK.

Oral 1 - Is it good to talk? The on call telephone workload of Urology Registrars in a UK University Teaching Hospital – a 4 month prospective study

Oral 1 - Is it good to talk? The on call telephone workload of Urology Registrars in a UK University Teaching Hospital – a 4 month prospective study

Factors influencing urology physicians in Saudi Arabia for choosing their subspecialty program.

Aim:The aim of the study was to identify factors that influence urology physicians for choosing subspecialty and to know the most competitive urology subspecialty among residents.Methodology:An online questionnaire was sent to all Saudi Urology residents, registrars, and fellows all over Saudi Arabia, during February 2019–June 2019. The survey included demographic data, level and location of training, a subspecialty of interest, as well as 15 influencing factors that could affect physicians' choice in the form of Likert scale, ranging from strongly disagree = 0 to strongly agree = 4.Results:Of the 193 urology Saudi physicians, 85 replied (44.1%). Their mean age was 29 + 3.2 years. The majority of them were male (98.8%). There were 66 (77.6%) residents, 12 (14.1%) were fellows, and 7 (8.2%) were registrars. Four factors were found to be significantly different across positions, i.e., personal interest in the subspecialty, patient's prognosis, potential to join a private hospital, and family/friend advice. Among residents, the highest score means of the impact factors were the patient's prognosis, potential to join a private hospital and family/friend advice. The most prominent factors that influence urology physicians to select their subspecialty were personal interest in the specialty (88.2%), followed by the patient prognosis and lifestyle (84.7%, 78.8%). About 28.2% of the participants have a desire of endourology, followed by infertility and pediatric urology (23.5% and 20%, respectively).Conclusion:The most influencing factors among urology physicians for choosing their subspecialty are the patient's prognosis and personal interest. Female medical graduates should be encouraged to join a urology residency.

The Success and Evolution of a Urological “Boot Camp” for Newly Appointed UK Urology Registrars: Incorporating Simulation, Nontechnical Skills and Assessment

Urological training has dramatically changed in recent years. Training durations are shorter and a drive toward consultant led care has reduced trainees experience. Within the UK, approximately 50 registrars annually embark on a 5-year Urology training programme, with variable levels of basic urological experience. To describe a simulation programme aimed at delivering the knowledge and skills necessary to safely and effectively start working as a registrar in Urology by intensive training with a 1:1 faculty to delegate ratio. Our course content mirrors the UK training syllabus for junior Urology registrars. We delivered 8 modules over a 4-day programme with a fifth day of assessments. Delegates level of urological knowledge, operative competency and confidence pre-, immediately post-training and at 3-months postcourse were assessed. Objective delegate and faculty feedback was also collected. Technical skills modules include; inguinoscrotal surgery, ureteroscopy, transurethral resection, urodynamics, and Botox administration as well as basic reconstructive and laparoscopic operative skills. "Nontechnical" skills included simulated ward round, out-patient, and emergency scenarios. Feedback from delegates and faculty members has been overwhelmingly positive. We have used this feedback to tailor the content of the course for following years. An increased knowledge level (based on mean examination scores [precourse 55.5%, postcourse 70.1%]) and operative competency was observed in all skills assessed (transurethral resection of the prostate, transurethral resection of bladder tumor, Ureteroscopy, laparoscopic skills, and instrument assembly). Operative confidence was increased immediately and at 3-months postcourse. Our "boot camp" course provides a realistic introduction and foundation to begin Urological practice. Being delivered at the beginning of the training scheme, prior to intensive patient exposure, registrars are in an optimum position to develop their newly acquired knowledge and skills to enhance training and intends to improve patient safety and satisfaction.

An academic year in Sub-Saharan Africa: The clinical experience of a British Urology Registrar

Introduction‘Out-of-programme year for clinical experience’ (OOP-E) is an option available to all the urology registrars in the United Kingdom (UK) as part of the specialty’s training curriculum, in recognition of the holistic benefit of such a year to a surgeon’s in-training professional life. ObjectivesBeing interested in reconstructive urology, I organised an academic year as a registered volunteer resident in two of Sub-Saharan Africa’s (SSA) main academic hospitals, known for their heavy workload in the particular field. Subjects and methodsThe personal logbook and diary of operations and clinical activities kept over this period of twelve calendar months was retrospectively studied in order to assess the overall benefit of this exercise. ResultsApart from highlighting the significant breadth and operative load of surgical exposure offered in SSA training schemes, this summarised report also gives a comprehensive account of all aspects of a surgeon's working life, during this overseas clinical attachment. ConclusionsWorking in different countries as a surgeon improves one’s perception of the diseases’ spectra of manifestation and management, while enabling participation to surgical activities nowadays seldom in the West. The holistic benefit of such a year, to a surgeon’s in-training professional life cannot be over-emphasised; both on the grounds of experiencing different surgical realities and building upon professional skills, but also in cultivating an international network.

Multi-centre, prospective evaluation of the Seldinger technique for difficult male urethral catheter insertions by non-urology trained doctors.

To evaluate the safety and effectiveness of the Seldinger technique by non-urology trained (NUT) doctors for difficult male indwelling urinary catheter (IDC) insertions. In all, 115 patients and 57 participating NUT doctors were recruited by the urologist or urology registrar, when contacted in regards to failed IDC insertion. The successful passage of an IDC by the NUT doctors using the Seldinger technique with a straight, hydrophilic guidewire was assessed in our prospective, multicentre evaluation. Instruction of this technique was via bedside teaching by the urology registrar or via video media. The 115 patients, involving 57 NUT doctors, were prospectively evaluated across four sites; 93% (107/115) of cases had successful placement of an IDC with the Seldinger technique by a NUT doctor. No complications with the Seldinger technique were recorded. In 80 patients (69.6%), the technique was successfully performed by a NUT doctor without attendance by a urologist or urology registrar, with instruction provided from video media or prior bedside teaching by the urology registrar. Our study is the first to validate the safety and effectiveness of the Seldinger technique for difficult male IDC insertion performed by NUT doctors. This technique can be taught via video education and thus has important implications for health services where urological support is not readily available.

Urology registrar of the week: how does it improve patient care?

Urology registrar of the week: how does it improve patient care?

Mobile phone applications in management of enuresis: The good, the bad, and the unreliable!

The proliferation of medical-type applications or 'apps' on smartphones is a typical example of the impact technology has had on medical practice. Maintaining a bladder diary is a recommended part of evaluating the effect of interventions for patients suffering from enuresis. Traditional pen-and-paper bladder diaries have poor completion rates, inconsistent patterns in data entry, and are deficient in validation. Electronic bladder diaries have been proposed to overcome these obstacles. With increasing numbers of smartphone apps available to the general public, it is important to distinguish well-designed apps for childhood enuresis. To identify, evaluate, and rank all available mobile-phone apps for the management of childhood enuresis. On August 21, 2014, a search was conducted on iTunes, Android Play Store, and BlackBerry World for smartphone apps using the following search terms: bladder, bedwetting, bladder diary, enuresis, incontinence, and wetting. Apps that did not have a bladder diary function and that were unrelated to the investigation, follow-up, and treatment of childhood enuresis were excluded. Apps were rated by a paediatric urology consultant, fellow, registrar, and resident medical officer using standardised criteria including: design; ease of use; languages; quality of instructions; security; accordance with ICCS definition of enuresis; and ability to store histories; record bowel habits; transfer data to other devices; and print data. Across all three search platforms, a total of 1041 apps were identified. Only 24 were included and reviewed based on exclusion criteria. Average ratings for apps ranged from 10 to 30.75 out of 50 based on standardised criteria. Smartphone apps are playing an increasingly significant role in the management of enuresis in place of pen-and-paper bladder diaries. Apps available to the general public vary in quality and it can be difficult for patients to identify one appropriate for use. We found apps with higher ratings consistently had engaging interfaces, were easy to use, and defined the primary purpose clearly. Lower ratings and performance often was caused by poor quality of experience through "freezing"/"crashing." Bladder diary apps can eliminate disadvantages of pen-and-paper diaries in the management of enuresis. Currently, apps available vary in quality. The three best-rated apps currently available are My Dryness Tracker, Bedwetting Tracker, and HapPee Time. There is room for medical associations to collaborate with developers for further app development.

Is it good to talk? Analysing the out-of-hours telephone workload of urology registrars in a university teaching hospital

The European WorkingTime Regulations have curtailed the hours that non-consultant hospital doctors work. Specialties with significant emergency operative workloads such as general surgery mandate senior non-consultant cover in hospital on a shift basis to satisfy service provision. As a surgical specialty, urology enjoys a lower emergency operative rate and hence service demands are dealt with via the traditional non-resident system. However, emergency admissions remain frequent and advice is often sought by telephone from junior colleagues on acute clinical presentations. Additionally, professions allied to medicine working in the hospital environment such as laboratory personnel may require advice from registrars to aid in result interpretation.

Ranking of Urology Registrar Placements within a Region. An SAC Pilot

Background: There is a continual desire to improve educational standards, demonstrate quality assurance of training and to respond to the growing pressure to reduce SpR numbers. Any reduction would need to be based on an assessment which looks at educational value and trainee experience. We describe our experience using a tool to rank urology registrar posts in a single region. Methods and materials: An assessment scoring tool was created with equal trainee and trainer components. The trainee and trainer elements were developed from the proposed JCST trainee assessment and the GMC standards for trainers, with a maximum score of 200 achievable. Higher scores could be obtained by the unit being pro-active with educational activities. This tool was completed by all the training units and trainees within a single region. Results: Results were obtained from all units within the region, with scores ranging from 130 to 168 (mean 149). Units scoring highly in trainee components also scored highly in the trainer component. Conclusion: This tool allows objective assessment of training posts using evidence from the training unit, trainee and TPD. Incorporating this data into the annual ARCP would potentially improve the process. There was widespread support for repeating the exercise and the tool provided a powerful means of engagement in improving training.

Patients' perceptions of surgical registrars' training in the private hospital setting

What's known on the subject? and What does the study add? The Australian private health sector is increasingly being recognised as an opportunity for advanced surgical training. Little is known about what the patients think of urology training in the private sector. Patients perceptions on the place of urology registrars in the Australian private sector are assessed for the first time. We can confirm that there appears to be acceptance of urology training in the private sector. • To determine the acceptance of surgical trainees in a private hospital setting. • This was an ethics approved prospective study using a written survey. • A total of 177 consecutive patients presenting for private consultation were recruited. A self-administered written survey was completed by each patient in the waiting room prior to consultation. • Only 36.8% of subjects (confidence interval 29.6-44.1) initially understood the term registrar which significantly increased to 75% (confidence interval 68.4-81.6, P < 0.05) after reading explanatory notes. • Perceived differences between private and public hospitals were choice of surgeon (28%), waiting times for an operation (28%), standard of care (17%), cost (16%) and waiting times for an appointment (11%). • Patients' acceptance of registrar involvement with either a small part of an operation, a large part of an operation, the whole operation and assistance only were 34%, 16%, 13% and 37%. • Patients have a poor understanding of the term registrar. • Acceptance of registrars in private hospitals is increased if consultant involvement is emphasized. • Surgical assistance and performance of minor parts of surgery by trainees is well accepted.

A Gender Transformation in Urology

A Gender Transformation in Urology

Comparison of kidney‐ureter‐bladder abdominal radiography and computed tomography scout films for identifying renal calculi

To assess the sensitivity of computed tomography (CT) scout topograms and kidney-ureter-bladder abdominal radiography (KUB) in detecting urinary tract stones. We assessed films taken on presentation for 163 consecutive patients referred to our service for stone follow-up. Only those with both CT and KUB imaging on the same day were studied further. Two urology registrars examined the films independently. Location, size and length of stone were recorded. Where there was discordance, the films were examined by an independent radiologist. In all, 108 of 163 patients had both CT and KUB imaging on the same day. Stones were identified in 63% (68/108) of patients with KUB, with a mean length of 4.93 mm. There were 40/108 radiolucent stones subsequently measured on CT, with a mean length of 4.90 mm. Stones were seen on 47% (51/108) of the CT scouts, with a mean length of 5.22 mm. Importantly, all stones visible on CT scout were also visible on KUB. There was no correlation between stone location and visibility on KUB or CT scout films. KUB could be used for follow-up in 63% of cases. All stones seen on CT scout were also visible on KUB. Scout detected 75% of stones visible on KUB. We suggest CT scout film should be reported before proceeding to KUB. If the stone is visible on CT scout film, then the decision to use KUB for follow-up can be made. This minimizes radiation exposure and other costs.

Vasectomy under local anaesthesia performed free of charge as a family planning service: complications and results.

To evaluate the safety and efficacy of vasectomy performed under local anaesthesia by junior doctors at a secondary level hospital as part of a free family planning service. Men requesting vasectomy were counselled and given written instructions to use alternative contraception until two semen analyses 3 and 4 months after vasectomy had confirmed azoospermia. Bilateral vasectomy was performed as an outpatient procedure under local anaesthesia by junior urology registrars. Statistical analysis was performed using the Mann-Whitney, Kruskal-Wallis, Fisher's exact or Spearman's rank correlation tests as appropriate. Between January 2004 and December 2005, 479 men underwent vasectomy at Karl Bremer Hospital, Western Cape, South Africa; their average age was 36.1 (range 21 - 66) years, they had a median of 2 (range 0 - 10) children, and only 19% had 4 or more children. The average operation time was 15.5 (range 5 - 53) minutes. Complications occurred in 12.9%; these were pain (7.3%), swelling (5.4%), haematoma (1.3%), sepsis (1%), difficulty locating the vas (1%), vasovagal episode (0.6%), bleeding (0.6%), wound rupture (0.4%) and dysuria (0.2%) (some men had more than one complication). Of the men 63.3% returned for one semen analysis and 17.5% for a second. The vasectomy failure rate ranged from 0.4% (sperm persisting > 365 days after vasectomy) to 2.3% (sperm seen > 180 days after vasectomy and/or in the second semen specimen). No pregnancies were reported. The complication (5.6%) and failure rates (0%) were lowest for the registrar who had performed the smallest number of vasectomies and whose average operation time was longest. Comparing the first one-third of procedures performed by each of the doctors with the last one-third, there was a significant decrease in average operating times but not in complication rates. Vasectomy can be performed safely and effectively by junior doctors as an outpatient procedure under local anaesthesia, and should be actively promoted in South Africa as a safe and effective form of male contraception.

PD-10.10: Results and complications of bilateral vasectomy performed under local anaesthesia by urology registrars at a secondary level hospital

PD-10.10: Results and complications of bilateral vasectomy performed under local anaesthesia by urology registrars at a secondary level hospital

56 Prostate glands larger than 75 cc result in worse outcomes following radical prostatectomy: implications for registrar training

Introduction and Objective: Open radical prostatectomy is a difficult and complex operation to teach residents. Many patient factors can increase the complexity of the operation, with the majority not being predictable prior to the operation. We hypothesised that large prostate glands (&gt;75 cc) would result in increased difficulty, higher intraoperative complications, and subsequently poorer cancer and functional outcomes.Methods: A retrospective analysis of the records of patients in our database of radical prostatectomies performed at Westmead Hospital. Patients operated on by the training urology registrar were identified and further analysed. Intraoperative as well as postoperative complications, pathology results and postoperative gain of potency and continence were evaluated.Results: Between 2/6/1998 to 14/8/04, 181 open radical prostatectomies were performed at Westmead Public Hospital by the training registrar. Preoperative variables revealed that the majority of these patients had large volume cancer (171 pts with cT2 cancer, 70 pts with Gleason Score ≥7). PSA ranged from 1.2–27 ng/ml (median 6.9 ng/ml). Prostate size ranged from 11–112 cc (median 31 cc) measured by TRUS ultrasound. Correlation between calculated TRUS volume and prostate weight at surgery was high (r = 0.93). Prostate glands greater than 75 cc were associated with older age (P = 0.001), longer operation time (P &lt; 0.001)and higher estimated blood loss (P &lt; 0.001). Postoperatively, prostate glands &gt;75 cc required median of 7 vs 3 months to achieve continence (P &lt; 0.001). At a median follow time of 45 months, men with prostates &lt;75 cc had a 62% chance of achieving potency compared to 10% of men who has glands &gt;75cc (P &lt; 0.001). Oncologically, larger prostates had less positive surgical margins (P = 0.006) and less PSA recurrence (P = 0.024).Conclusions: Prostates larger than 75 cc result in longer operative times, higher blood loss as well as poorer continence and potency. Patients should be counselled accordingly and trainers should be prepared to supervise more carefully when teaching inexperienced trainees.

Surgical experience obtained by urology registrars: changes in the volume and spectrum of operative procedures: 1975-2002

Objective: To analyze changes in the operative experience of Urology registrars at Tygerberg Hospital, an academic training hospital attached to the University of Stellenbosch, South Africa. Materials and Methods: Computerized analysis of 32,703 operating room cases (60,096 procedures) performed or assisted by 30 registrars in the period January 1975 to December 2002. Results: The average total number of procedures/registrar decreased by 32% (from 1752 to 1163) for those who started training in the period 1990-99 compared with 1975-90 (p=0.0005), largely due to a 35% reduction in bed numbers and theatre time resulting from budgetary restrictions. Comparison of the period 1994-2002 with 1976-84 showed a >4-fold increase in percutaneous nephrolithotomy, radical prostatectomy and inguinal herniotomy, with a moderate (≥50%) increase in bladder rupture repair (54%), circumcision (89%), orchidopexy (105%), insertion of peritoneal dialysis catheter (274%), laparotomy (54%) and surgical debridement (215%). There was a ≥50% decrease in nephrectomy (57%), renal exploration for trauma (75%), open kidney stone surgery (87%), pyeloplasty (44%), reimplantation of the ureter (60%), ureterolithotomy (66%), suprapubic cysto-tomy (71%), transurethral resection of the prostate (54%), open prostatectomy (90%), urethral dilatation (78%), internal urethrotomy (54%), urethroplasty (72%), varicocelectomy (62%), and creation of arteriovenous fistula for dialysis (58%). Conclusions: There have been substantial changes in the spectrum of surgical procedures performed or assisted by Urology registrars in the period 1975 to 2002. The significant decrease in the total number of procedures per registrar in the past decade is a reason for concern, although it remains unknown what the minimum number of any given urological procedure should be in order to ensure adequate operative training. Key words: surgical training, urology, registrars, residents, operative procedures Experience chirurgicale obtenue par les residents d\'urologie – Changements dans le volume et le spectre des procedures en vigueur: 1975 – 2002 Objectif: Analyser les changements dans l\'experience en vigueur des residents d\'Urologie a l\'Hopital Tygerberg, un hopital de formation universitaire attache a l\'Universite de Stellenbosch, Afrique du Sud. Materiels et Methodes: On a informatise l\'analyse de 32.703 cas en salle d\'operation (60.096 procedures) realises ou assistees par 30 residents dans la periode : janvier 1975 a decembre 2002. Resultats: Le nombre total moyen de procedures/ residents a diminue par 32% (de 1752 a 1163) pour ceux qui ont commence a etre formes dans la periode 1990-99 compares a ceux de 1975-90 (p=0.0005), en grande partie du a une reduction de 35% dans le nombre des lits et la duree d\'hospitalisation qui resultent des restrictions budgetaires. La comparaison de la periode 1994-2002 avec 1976-84 a montre une augmentation >4-fois des nephrolithotomies percutanees, prostatectomies radicales et herniotomie inguinale, avec une augmentation modere (≥50%) des reparations de la rupture de la vessie (54%), circoncision (89%), orchidopexie (105%), insertion de sonde de dialyse peritoneale (274%), laparotomie (54%) et debridement chirurgical (215%). Il y avait une baisse de ≥50% des nephrectomies (57%), exploration renale pour trauma (75%), rein ouvert chirurgie lithiasique (87%), pyeloplastie (44%), reimplantation de l\'uretere (60%), ureterolithotomie (66%), cystostomie sus-pubienne (71%), resection transurethrale de la prostate (54%), prostatectomie a ciel ouvert (90%), dilatation de l\'urethre (78%), uretrotomie interne (54%), uretroplastie (72%), varicocelectomie (62%), et creation de fistule arterio-veineuse pour dialyse (58%). Conclusions: Il y a eu des changements substantiels dans le spectre des procedures chirurgicales executees ou aidees par les residents d\'Urologie dans la periode 1975 a 2002. La baisse considerable dans le nombre total de procedures par residents dans la decennie passee est une raison d\'inquietude, bien qu\'il reste inconnu ce que le nombre minimum de toute procedure urologique donnee devrait etre pour assurer la formation adequate en vigueur. African Journal of Urology Vol.11(2) 2005: 82-88

Can computed tomography in the protocol for renal colic be interpreted by urologists?

To examine the ability of urologists to independently (with no radiology consultation) interpret non-contrast-enhanced spiral computed tomography (CT) in patients with acute renal colic. One hundred consecutive patients presenting to the emergency department with suspected renal colic and evaluated with non-contrast spiral CT were retrospectively reviewed. The CT films of each patient were assessed separately by a first-year urology registrar and by a consultant urologist (neither of whom were subspecialized in uroradiology or endourology). The acute presentation details were provided to mimic the emergency situation. Ureteric calculi causing acute renal colic were evident in 54 patients. The consultant radiologist reported 51 ureteric calculi, and had a sensitivity, specificity and positive predictive value of 94.5%, 100% and 100%, respectively. The consultant urologist correctly identified 52 calculi, with sensitivity, specificity and positive predictive values of 96.3%, 82.7% and 86.7%. The urology registrar detected 51 stones with sensitivity, specificity and positive predictive values of 94.5%, 93.5% and 94.5%, respectively. Non-contrast spiral CT in patients with acute renal colic is an effective diagnostic tool which allows rapid and accurate evaluation of the urinary tract, thereby facilitating the acute management of patients with renal colic.