Urology

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African KhoeSan ancestry linked to high-risk prostate cancer
(BMC (part of Springer Nature), 2019-06-04) Petersen, Desiree C.; Jaratlerdsiri, Weerachai; Van Wyk, Abraham; Chan, Eva K. F.; Fernandez, Pedro; Lyons, Ruth J.; Mutambirw, Shingai B. A.; Van der Merwe, Andre; Venter, Philip A.; Bates, William; Bornman, M. S. R.; Hayes, Vanessa M.
Backgrounds: Genetic diversity is greatest within Africa, in particular the KhoeSan click-speaking peoples of southern Africa. South African populations represent admixture fractions including differing degrees of African, African-KhoeSan and non-African genetic ancestries. Within the United States, African ancestry has been linked to prostate cancer presentation and mortality. Together with environmental contributions, genetics is a significant risk factor for high-risk prostate cancer, defined by a pathological Gleason score ≥ 8. Methods: Using genotype array data merged with ancestry informative reference data, we investigate the contribution of African ancestral fractions to high-risk prostate cancer. Our study includes 152 South African men of African (Black) or African-admixed (Coloured) ancestries, in which 40% showed high-risk prostate cancer. Results: Genetic fractions were determined for averaging an equal African to non-African genetic ancestral contribution in the Coloured; we found African ancestry to be linked to high-risk prostate cancer (P-value = 0.0477). Adjusting for age, the associated African ancestral fraction was driven by a significant KhoeSan over Bantu contribution, defined by Gleason score ≥ 8 (P-value = 0.02329) or prostate specific antigen levels ≥20 ng/ml (Pvalue = 0.03713). Additionally, we observed the mean overall KhoeSan contribution to be increased in Black patients with high-risk (11.8%) over low-risk (10.9%) disease. Linking for the first time KhoeSan ancestry to a common modern disease, namely high-risk prostate cancer, we tested in this small study the validity of using KhoeSan ancestry as a surrogate for identifying potential high-risk prostate cancer risk loci. As such, we identified four loci within chromosomal regions 2p11.2, 3p14, 8q23 and 22q13.2 (P-value = all age-adjusted < 0.01), two of which have previously been associated with high-risk prostate cancer. Conclusions: Our study suggests that ancient KhoeSan ancestry may be linked to common modern diseases, specifically those of late onset and therefore unlikely to have undergone exclusive selective pressure. As such we show within a uniquely admixed South African population a link between KhoeSan ancestry and high-risk prostate cancer, which may explain the 2-fold increase in presentation in Black South Africans compared with African Americans.
Atresia of the colon. A review of the literature with a report of 2 cases
(HMPG, 1973-10) Heydenrych, J. J.; Van der Riet, R. Le S.
Colonic atresia is a rare condition, and only 69 cases have been reported; 2 further cases are described. The first case was diagnosed late and operation was carried out 5.5 days after birth. An ileostomy was performed and a final anastomosis was carried out 9 wk later. The child is now 8 yr old and growing normally.
Bladder cancer histological variants: which parameters could predict the concordance between transurethral resection of bladder tumor and radical cystectomy specimens?
(Urological Association, 2021-09) Mantica, Guglielmo; Tappero, Stefano; Parodi, Stefano; Piol, Nataniele; Spina, Bruno; Malinaric, Rafaela; Balzarini, Federica; Borghesi, Marco; Van der Merwe, André; Suardi, Nazareno; Terrone, Carlo
Introduction The concordance rate of bladder cancer (BCa) histological variants (HV) between transurethral resection of bladder tumor (TURBT) and radical cystectomy (RC) is sub-optimal and is unclear which factors may influence it. The aim of this study was to identify factors that may be correlated to a higher TURBT-RC concordance rate. Material and methods Consecutive patients who had undergone RC between 2000 and 2019 at a single Institution with pathological evidence of HV were included. Patients with diagnosis of HV both at RC and at the previous TURBT were enlisted in the TURBT-RC Concordance Group (CG), whereas patients with only evidence of HV at RC in the TURBT-RC Non-Concordance Group (NCG). Surgical factors evaluated were the source of energy (mono- vs bipolar), surgeon’s experience (10 mm represented an independent predictor of cornd-ance [OR 2.95; CI (1.01–8.61); p = 0.048]. Tumor recurrence, focality and dimension, source of energy, surgeon’s experience, performance of re-TURBT and total number of specimens at TURBT did not significantly predict the concordance. Conclusions Longer specimens at TURBT yield a higher chance to detect HV before RC. In this light, improving the quality of bladder resection means improving the management of BCa.
Correlation between a new visual prostate symptom score (VPSS) and uroflowmetry parameters in men with lower urinary tract symptoms
(Health and Medical Publishing Group (HMPG), 2012-04) Heyns, C. F.; Van der Walt, C. L. E.; Groeneveld, A.
Objective. A visual prostate symptom score (VPSS) compared with the international prostate symptom score (IPSS) for evaluation of lower urinary tract symptoms (LUTS) can be completed without physician assistance by a significantly larger proportion of men with limited education. We aimed to evaluate the correlation of the VPSS and IPSS with uroflowmetry parameters. Methods. Men with LUTS were requested to complete the IPSS and VPSS, consisting of pictograms to evaluate urinary frequency, nocturia, force of the stream and quality of life. The maximum (Qmax) and average urinary flow rate (Qave), voided volume (VV) and post-void residual (PVR) urine volumes were measured. Statistical analysis was performed using the Mann-Whitney and Spearman’s tests. Results. The study included 93 men (mean age 64 years, range 33 - 85), with VV >150 ml in 66 (71%) and <150 ml in 27 (29%) subjects. In the group with VV >150 ml there were significant negative correlations between the IPSS and Qmax (r=-0.30, p=0.016), the IPSS and Qave (r=-0.29, p=0.018), the VPSS and Qmax (r=-0.38, p<0.002) and the VPSS and Qave (r=-0.37, p<0.003). The VPSS question on the subject’s assessment of his urinary stream showed a significant negative correlation with the Qmax (r=-0.37, p=0.002) and Qave (r=-0.31, p=0.011), but the IPSS question on the subject’s urinary stream did not correlate significantly with the Qmax or Qave. Conclusions. The VPSS is equivalent to the IPSS in terms of correlation with Qmax and Qave and can therefore be used instead of the IPSS to evaluate LUTS in men with limited education.
Development of a computer assisted gantry system for gaining rapid and accurate calyceal access during percutaneous nephrolithotomy
(Sociedade Brasileira de Urologia, 2010) Zarrabi, A. D.; Conradie, J. P.; Heyns, C. F.; Scheffer, C.; Schreve, K.
Purpose: To design a simple, cost-effective system for gaining rapid and accurate calyceal access during percutaneous nephrolithotomy (PCNL). Materials and Methods: The design consists of a low-cost, light-weight, portable mechanical gantry with a needle guiding device. Using C-arm fluoroscopy, two images of the contrast-filled renal collecting system are obtained: at 0-degrees (perpendicular to the kidney) and 20-degrees. These images are relayed to a laptop computer containing the software and graphic user interface for selecting the targeted calyx. The software provides numerical settings for the 3 axes of the gantry, which are used to position the needle guiding device. The needle is advanced through the guide to the depth calculated by the software, thus puncturing the targeted calyx. Testing of the system was performed on 2 target types: 1) radiolucent plastic tubes the approximate size of a renal calyx (5 or 10 mm in diameter, 30 mm in length); and 2) foam-occluded, contrast-filled porcine kidneys. Results: Tests using target type 1 with 10 mm diameter (n = 14) and 5 mm diameter (n = 7) tubes resulted in a 100% targeting success rate, with a mean procedure duration of 10 minutes. Tests using target type 2 (n = 2) were both successful, with accurate puncturing of the selected renal calyx, and a mean procedure duration of 15 minutes. Conclusions: The mechanical gantry system described in this paper is low-cost, portable, light-weight, and simple to set up and operate. C-arm fluoroscopy is limited to two images, thus reducing radiation exposure significantly. Testing of the system showed an extremely high degree of accuracy in gaining precise access to a targeted renal calyx.
Early diagnosis of prostate cancer in the Western Cape
(Health & Medical Publishing Group, 2001-08) Heyns, C. F.; Naude, A. M.; Visser, A. J.; Marais, D. C.; Stopforth, H. B.; Nyarko, J. K.; Stellmacher, G. A.
Background. Early stage prostate cancer does not cause symptoms, and even metastatic disease may exist for years without causing symptoms or signs. Whereas early stage prostate cancer can be cured with radical prostatectomy or radiotherapy, the prognosis of patients with locally advanced or metastatic cancer is significantly poorer. Objectives. In view of the high incidence of advanced and therefore incurable prostate cancer seen at the oncology clinic of the Department of Urology, Tygerberg Hospital, we started a prostate clinic with the aim of detecting early stage prostate cancer which is potentially curable. A secondary objective was to investigate the question whether there is a higher incidence of prostate cancer among black African men. Patients and methods. Men aged 50 - 70 years were invited by means of media communications (newspaper and radio) to attend our prostate clinic for a free physical examination, including a digital rectal examination (DRE) and serum prostate specific antigen (PSA) assay. If the DRE was clinically suspicious of malignancy and/or the serum PSA was > 4 ng/ml, the patient was appropriately counselled and referred for transrectal ultrasound (TRUS)-guided sextant prostate biopsy. Results. In the period June 1997 - September 1999 a total of 1 056 men attended the prostate clinic. Biopsies were indicated in 160 cases, and were obtained in 114 (71.3%, i.e. 10.8% of the entire cohort). Prostate cancer was detected on first biopsy in 3.5% of the entire group of men (in 35.9% of those with a clinically abnormal DRE, in 41.3% of those with a serum PSA > 4 ng/ml and in 88.6% of those with an abnormal DRE and serum PSA > 4 ng/ml. In the 37 men with prostate cancer, the clinical tumour stage was T1 - 2 in 83.8% and T3 - 4 in 16.2%. In the group of patients with clinical stage T1 - 2 tumours, the treatment was watchful waiting in 62.5% of cases, radiotherapy in 20.8% and radical prostatectomy in 16.7%. Analysis of the data according to race showed that in the group of 47 black men there was a higher percentage of clinically abnormal DRE, PSA > 4.0 ng/ml and biopsies showing malignancy, and a higher overall prostate cancer detection rate (8.5%). Conclusions. Our prostate cancer detection rate of 3.5% is slightly lower than that reported in larger studies (4.7%), which may be due to the fact that prostate biopsy was performed in only 71% of those who had an indication for biopsy. In the men diagnosed with clinically localised prostate cancer, potentially curative treatment was given in only 37.5% of cases. This compares unfavourably with the historical cohort of men seen at our oncology clinic, where 53% received potentially curative treatment, and a large European study where potentially curative treatment was given in 89% of cases. Our finding that black men had a higher percentage of clinically abnormal DRE, PSA > 4.0 ng/ml and biopsies showing malignancy and a higher overall detection rate of prostate cancer should be interpreted with caution, since black men comprised only 4.5% of our overall study cohort.
Early diagnosis of prostate cancer in the Western Cape
(Health and Medical Publishing Group (HMPG), 2001-08) Heyns, C. F.; Naude, A. M.; Visser, A. J.; Marais, D. C.; Stopforth, H. B.; Nyarko, J. K.; Stellmacher, G. A.
Background. Early stage prostate cancer does not cause symptoms, and even metastatic disease may exist for years without causing symptoms or signs. Whereas early stage prostate cancer can be cured with radical prostatectomy or radiotherapy, the prognosis of patients with locally advanced or metastatic cancer is significantly poorer. Objectives. In view of the high incidence of advanced and therefore incurable prostate cancer seen at the oncology clinic of the Department of Urology, Tygerberg Hospital, we started a prostate clinic with the aim of detecting early stage prostate cancer which is potentially curable. A secondary objective was to investigate the question whether there is a higher incidence of prostate cancer among black African men.
Effective Project Management of a Pan-African Cancer Research Network : Men of African Descent and Carcinoma of the Prostate (MADCaP)
(American Society of Clinical Oncology, 2018) Odiaka, Emeka; Lounsbury, David W.; Adusei, Ben; Diallo, Thierno Amadou; Kane, Papa Moussa Sene; Rockson, Isabella; Okyne, Vicky; Irusen, Hayley; Pentz, Audrey; Makinde, Ifeoluwa; Ajibola, Olalekan Hafees; Petersen, Lindsay; McBride, Jo; Petersen, Desiree C.; Mante, Sunny; Agalliu, Ilir; Adebiyi, Akindele Olupelumi; Popoola, Olufemi; Yeboah, Edward; Mensah, James E.; Hsing, Ann; Fernandez, Pedro; Aisuodionoe- Shadrach, Oseremen; Joffe, Maureen; Singh, Elvira; Gueye, Serigne Magueye; Quintana, Yuri; Fortier, Brian; Rebbeck, Timothy R.; Andrews, Caroline
Purpose Health research in low- and middle-income countries can generate novel scientific knowledge and improve clinical care, fostering population health improvements to prevent premature death. Project management is a critical part of the success of this research, applying knowledge, skills, tools, and techniques to accomplish required goals. Here, we describe the development and implementation of tools to support a multifaceted study of prostate cancer in Africa, focusing on building strategic and operational capacity. Methods Applying a learning organizational framework, we developed and implemented a project management toolkit (PMT) that includes a management process flowchart, a cyclical centerspecific schedule of activities, periodic reporting and communication, and center-specific monitoring and evaluation metrics. Results The PMT was successfully deployed during year one of the project with effective component implementation occurring through periodic cycles of dissemination and feedback to local center project managers. A specific evaluation was conducted 1 year after study initiation to obtain enrollment data, evaluate individual quality control management plans, and undertake risk log assessments and follow-up. Pilot data obtained identified areas in which centers required mentoring, strengthening, and capacity development. Strategies were implemented to improve project goals and operational capacity through local problem solving, conducting quality control checks and following compliancy with study aims. Moving forward, centers will perform quarterly evaluations and initiate strengthening measures as required. Conclusion The PMT has fostered the development of both strategic and operational capacity across project centers. Investment in project management resources is essential to ensuring high-quality, impactful health research in low- and middle-income countries.
Eosinophilic cystitis associated with Glanzmann's thromboasthenia : a case report
(Health & Medical Publishing Group, 1987) Botma, J. P.; Burger, E. G.; De Kock, M. L. S.
Eosinophilic cystitis is a rare condition, only 41 cases having been recorded in the literature. Glanzmann's thrombasthenia has been documented more than 100 times. The presence of these two conditions in one patient has, to our knowledge, not yet been reported in the English-language literature.
Evaluation of the visual prostate symptom score in a male population with great language diversity and limited education : a study from Namibia
(Health & Medical Publication Group, 2014-05) Heyns, C. F.; Steenkamp, B. A.; Chiswo, J.; Stellmacher, G. A.; Fortsch, H.E. A.; Van der Merwe, A.
Background. A visual prostate symptom score (VPSS) using pictograms was developed to assess the force of the urinary stream, urinary frequency, nocturia and quality of life (QoL). Objective. To compare the VPSS with the international prostate symptom score (IPSS) and maximum (Qmax) and average (Qave) urinary flow rates in men from diverse language groups with limited schooling. Methods. Men with lower urinary tract symptoms admitted to the urology ward at Windhoek Central Hospital, Namibia, were evaluated. Patients who were unable to complete the questionnaires alone were assisted by a doctor or nurse. Local ethics committee approval was obtained. Statistical analysis was performed using Student’s t-test and Spearman’s rank correlation test. Results. One hundred men (mean age 56.3 years, range 20.1 - 95.4) were evaluated over a period of one year. All the men understood one or more of 15 languages, and 30 were illiterate; 32 had <5 years of schooling, 34 had 5 - 9 years and 34 had >9 years. The VPSS took significantly less time to complete than the IPSS. There were statistically significant correlations between the total VPSS and IPSS scores, between the four VPSS questions and the corresponding IPSS questions, and between Qmax and Qave and the VPSS total and VPSS questions on the force of the urinary stream and QoL. Conclusion. The VPSS pictograms depicting the force of the urinary stream and QoL correlated significantly with Qmax and Qave, indicating that they can be used as single-item questions to rapidly assess bladder outflow obstruction in men with limited education.
Evaluation of views and perceptions of junior doctors on urology training and exposure during internship in South Africa: are we losing future urologists?
(Medpharm, 2020-12) Silolo, S.; Van Deventer, H.; Van Der Merwe, A.
BACKGROUND: In South Africa, urological and other subspecialty training and exposure vary across each university at undergraduate and internship level. Many students and junior doctors complete their degrees and medical internship with little or no exposure and training to enable them to manage common urological conditions at primary healthcare level with the adequate competency, proficiency and confidence. We aimed to evaluate the exposure and urological training ofjunior doctors during internship and to determine whether it had any impact on their attitudes toward urology as a speciality in which to pursue a career. METHODS: We used a descriptive cross-sectional survey design. We emailed a questionnaire to 200 community service doctors who completed internship during 2016-2018, working across Western Cape hospitals. The questionnaire aimed to assess their clinical exposure to urology, confidence in basic urological knowledge and clinical skills, and their attitudes toward urology as a postgraduate career choice. RESULTS: The response rate was 104/200 (52%), 75% (n = 78) of the respondents had completed their internship without rotating through the urology department, 53.8% (n = 56) felt that their knowledge of essential urology topics was 'average' and still required further teaching and guidance, and 43.3% (n = 45) were not confident of performing a circumcision. 11.5% (n = 12) respondents were interested in pursuing a career in urology. The duration of the rotation through urology during internship and pursuing a career in urology were significantly associated (p = 0.005). CONCLUSION: The study showed that urological exposure and training at internship level is below the standard it needs to be in order to produce proficient and competent doctors able to practise efficiently during community service. The study also highlighted that limited exposure has a negative impact on potential future urologists wanting to pursue a career in the field. Incorporation of necessary urology skills short courses into the internship programme might help mitigate some of
Extra-adrenal phaeochromocytoma. A case report
(Health & Medical Publishing Group, 1986-01) Botma, J. P.; De Kock, M. L. S.
ENGLISH ABSTRACT: A case of hypertension in a young woman caused by an extra-adrenal phaeochromocytoma (EAP) situated in the hilum of the left kidney is reported. Surgical removal of the EAP resulted in control of the patient's hypertension without further drug treatment. The clinical features, diagnostic work-up and management of EAP are briefly discussed.
Falsely elevated plasma creatinine levels as a marker of nitromethane poisoning
(Health and Medical Publishing Group (HMPG), 2008) Boshoff, Pieter Ernst; Gailey, Karen; Moosa, Mohammed Rafique
[No abstract available]
Genetic variations in androgen metabolism genes and associations with prostate cancer in South African men
(Health and Medical Publishing Group (HMPG), 2010) Fernandez, P.; De Beer, P. D.; Van der Merwe, L. D.; Heyns, C. F.
Background. In South Africa white men have the highest incidence of prostate cancer (PCa), coloured (mixed ancestry) men have an intermediate incidence, and low incidences are reported for black and Asian men. It has been suggested that ethnic differences in incidence and mortality of PCa are related to genetic variations in genes that regulate androgen metabolism. We investigated the role of genetic variants in the androgen metabolism genes and the probability of developing PCa in South African coloured and white men. Methods. Genotype and allele counts and frequencies of single nucleotide polymorphisms (SNPs) in CYP3A5, CYP3A4 and CYP3A43 were assessed in coloured men (160 case individuals, 146 control individuals) and white men (121 case individuals, 141 control individuals). Results. A genetic association indicating an increased probability of developing PCa was observed with the G allele of the SNP rs2740574 in CYP3A4 in coloured men, the A allele of rs776746 (CYP3A5) and the G allele of rs2740574 (CYP3A4) in white men, and the G allele of rs2740574 and the C allele of rs501275 (CYP3A43) in the combined ethnic groups analysis. In addition, we identified allele combinations (termed haplotypes) with significantly higher frequencies in the PCa case individuals than in the control individuals. Conclusions. The findings support the role of variants in genes that regulate androgen metabolism and the probability of developing PCa. The study paves the way to identify other genetic associations in South African men, and to establish genetic profiles that could be used to determine disease progression and prognosis.
Genito-urinary tuberculosis : experience with 52 urology inpatients
(Health & Medical Publishing Group, 1993) Allen, F. J.; De Kock, M. L. S.
The current trend in South African health services is toward primary care. Pulmonary tuberculosis is well understood by the majority of primary care doctors and nurses, whereas genito-urinary tuberculosis may not be as easy to diagnose and treat. We reviewed our experience with this condition in 52 patients, who represented 0,74% of urology admissions between 1986 and 1991. There was a 3:2 male/female ratio, the age range was 7-76 years (mean 43 years), and the disease was more common among blacks and coloureds than among whites. Multiple sites of involvement were fairly common. Seventy-five per cent of patients had renal involvement and 17% epididymal involvement. The commonest presenting complaints were urinary frequency and haematuria, although flank and scrotal pain were also reported by a number of patients. Physical examination seldom helped to suggest the diagnosis. On microscopic examination and culture of the urine, sterile pyuria was present in only 50% of our patients and 29% had positive cultures for a 'normal' coliform organism. Fifty patients underwent excretory urography and the findings were very varied. Patients were treated primarily with antituberculosis drugs, but 58% also required some form of surgery; nephrectomy was the commonest operation. Ureteral strictures developed in over 50% of cases with renal involvement. We conclude that the diagnosis of genito-urinary tuberculosis is not simple, and that treatment must include regular follow-up at a specialist institution.
Gunshot wounds to the penis and scrotum : a narrative review of management in civilian and military settings
(Translational Andrology and Urology, 2021-06) Goldman, Charlotte; Shaw, Nathan; Du Plessis, Danelo; Myers, Jeremy B.; Van Der Merwe, Andre; Venkatesan, Krishnan
ENGLISH ABSTRACT: Gunshot wounds (GSW) to the penis and scrotum are present in two thirds of all genitourinary (GU) trauma, with a growing proportion of blast injuries in the military setting. Depending on the energy of the projectile, the injury patterns present differently for military and civilian GSWs. In this review, we sought to provide a detailed overview of GSWs to the external genitalia, from mechanisms to management. We examine how ballistic injury impacts tissues, as well as the types of injuries that occur, and how to assess these injuries to the external genitalia. If there is concern for injury to the deep structures of the penis or scrotum, operative exploration and repair is warranted. Relevant history and physical examination, role of imaging, and choice of conservative or surgical treatment options in the civilian and military setting are discussed, as well as guidelines for management set forth by the American Urological Association (AUA) and European Association of Urology (EAU).
HORTIS-III: Radiation cystitis - a multicenter, prospective, double-blind, randomized, sham-controlled trial to evaluate the effectiveness of hyperbaric oxygen therapy in patients with refractory radiation cystitis
(Stellenbosch : Stellenbosch University, 2010) Smit, S. G.; Heyns, C. F.; Cronje, F. J.; Roberts, C. J.
Objective: Hyperbaric oxygen therapy (HBOT) for refractory late radiation cystitis has been reported with success rates of 60% to 92%. HORTIS (Hyperbaric Oxygen Radiation Tissue Injury Study) is a multicenter study conducted by the Baromedical Research Foundation, South Carolina, USA. Tygerberg Hospital and University of Stellenbosch is one of 6 centers recruiting patients for the radiation cystitis arm (HORTIS-III). Methods: Patients were prospectively randomized: Group A (treatment) received HBOT (100% oxygen at 2.0 atmospheres). Group B (control) received sham treatment (21% oxygen at 1.0 atmosphere). Patients and referring physicians were blinded to the randomization process. Patients received 30-40 sessions of either HBOT or sham treatment. After unblinding, patients in the control group were offered crossover to the treatment group. Primary outcome measures included clinical evaluation, SOMALENT and EPIC scores. Results: In total, 34 patients were screened, 5 met the inclusion and exclusion criteria and agreed to participate. Two patients were randomized to Group A. One patient received 30 sessions of HBOT. One patient absconded after 26 sessions of HBOT. Three patients were randomized to Group B and received 40 sessions of sham treatment. All 3 control patients elected to cross over: two patients completed 40 sessions of HBOT, one stopped at 24 sessions due to an unrelated medical condition (critical limb ischemia). No serious adverse events occurred. At 14 months follow-up after HBOT, 3 patients showed improvement in SOMALENT and EPIC scores. One patient with a vesicovaginal fistula showed complete radiographic resolution at 14 months follow-up. In total, 13 patients have been recruited internationally. Conclusion: HBOT remains a treatment option for refractory late radiation cystitis. The evidence presented is inconclusive due to the low number of patients, but the ongoing multicenter trial is expected to provide conclusive evidence.
Intensive simulation training on urological mini-invasive procedures using Thiel-embalmed cadavers: The IAMSurgery experience
(2020) Mantica, Guglielmo; Pini, Giovannalberto; De Marchi, Davide
Introduction: The objective of the study was to evaluate the benefits perceived by the use of cadaver models by IAMSurgery attendees and to define indications to standardize future similar training camps. Materials and methods: A 25-item survey was distributed via e-mail to all the participants of previous training courses named as "Urological Advanced Course on Laparoscopic Cadaver Lab" held at the anatomy department of the University of Malta, for anonymous reply. Participants were asked to rate the training course, the Thiel's cadaveric model, and make comparison with other previously experienced simulation tools. Results: The survey link was sent to 84 attendees, with a response rate of 47.6% (40 replies). There was improvement in the median self-rating of the laparoscopic skills before and after the training camp with a mean difference of 0.55/5 points in the post-training skills compared to the basal (p < 0.0001). The 72.2% of the urologists interviewed considered Thiel's HCM better than other training methods previously tried, while five urologists (27.8%) considered it equal (p = 0.00077). Globally, 77.5% (31) of attendees found the training course useful, and 82.5% (33) would advise it to colleagues. Conclusions: Thiel's fixed human cadaveric models seem to be ideal for training purposes, and their use within properly structured training camps could significantly improve the surgical skills of the trainees. An important future step could be standardization of the training courses using cadavers, and their introduction into the standardized European curriculum.
Intravesikale BCG as behandeling van herhalende oppervlakkige en in situ oorgangselkarsinoom van die blaas
(Health & Medical Publishing Group, 1990) Schmidt, A. C.; De Kock, M. L. S.; De Klerk, D. P.
Intravesical BCG is already established as effective therapy in the management of superficial bladder cancer. However, varying results have been obtained with different BCG strains; these are ascribed to variations in their immunogenicity. The locally available BCG strain which contains approximately 1.2 x 109colony-forming units per 120 mg was used for intravesical instillation in 27 patients with recurrent superficial transitional cancer of the bladder. Ten of the 13 patients who received BCG prophilactically to reduce or stop recurrencies completed therapy and 7 (70%) were in remission after 1 or 2 courses with a mean follow-up of 2 years. Fourteen patients received BCG therapeutically for in situ carcinoma. Thirteen of these patients completed therapy and 9 (69%) responded favourably after 1 or 2 courses of BCG for a mean follow-up period of 23 months. Adverse effects of the treatment were mild and well tolerated except in a patient who received radiotherapy. Although 21 patients experienced irritable bladder symptoms only 1 discontinued treatment as a direct result. The only other patient in whom treatment had to be stopped, developed severe polyarthritis after 3 instillations. A statistically significant reduction in the number of recurrences (P < 0.001) was experienced by the patients who received BCG prophylactically. Although this is a very limited study, the locally available BCG strain exhibited therapeutic activity. It is cost-effective and warrants further study.
Malignant fibrous histiocytoma of the spermatic cord: A case report
(Health & Medical Publishing Group, 1987-03) Botma, J. P.; De Kock, M. L. S.; Laubscher, W. M. L.
A case of malignant fibrous histiocytoma of the spermatic cord treated by primary local excision, followed 5 days later by radical inguinal orchidectomy and hemi-scrotectomy is reported. At 30 months' follow-up the patient is free from local recurrence.

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