Research Articles (Urology)

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    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.
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    Urology apps: overview of current types and use
    (2020) Mantica, Guglielmo; Malinaric, Rafaela; Dotta, Federico; Paraboschi, Irene
    Introduction In recent years numerous applications have been developed with different purposes, aimed both at simplifying the lives of doctors and patients also within the urological field. Material and methods In January 2020 we conducted a search in the Apple App Store and Google Play Store. Results A total of 521 apps were reviewed, an increase of 8 times as compared to the last complete available review of eight years ago. Most of the urological apps are geared towards the patient and provide information and services to improve the understanding and treatment of different diseases. Some of these apps also get the patient directly in touch with healthcare staff allowing for an improvement in doctor-patient communication. Conclusions Although the usefulness of many of these tools is undoubted, the problem of scientific validation, content control and privacy are not yet solved.
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    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.
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    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).
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    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