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This article seeks to explore a series of encounters where we engage with research with a view to learning differently. We argue that every encounter is a form of research if we can marshall the connecting threads and consider the individual as both singularity and collective. We use reflexivity to go beyond reflection and strive to construct knowledge as individual and collective purpose. We draw upon striking examples to explore how issues of learning, reflexivity, and pedagogy develop thinking in education, especially in Higher Education (HE). We seek to move beyond accounts of experience that merely describe and report and which borrow from humanistic accounts of a subject (one which both experiences and who thinks) an approach which we dub “De(s)-carting.” We then move toward explorations, which seek more engaged, concrete, ethical approaches that open up possibilities and offer alternative conceptions of working with experience in education, in all its variety.

Objective: The optimal management of bladder stones remains unclear, with a range of approaches described. We aim to describe our results using Holmium:YAG laser lithotripsy for the management of bladder stones. Patients and methods: Data were collected prospectively on 20 (19 male, one female) patients undergoing laser lithotripsy for bladder calculi at a single centre from February 2013 to February 2014. The mean patient age was 69.75 years (range 51–87). Patient demographics, stone size, operative details and post-operative events and hospital stay were recorded. A 365 or 550 micron Holmium:YAG laser fibre, with a power setting of 1.0J and a frequency of 10Hz was used in all cases. Results: The mean stone size was 2.2cm (1–4cm). The mean operative time was 32.85 min (15–70 min). Operative time correlated positively with stone size ( r=0.74). Three patients underwent laser stone fragmentation followed by transurethral resection of the prostate (TURP) during the same anaesthetic. Visibility remained clear in all these patients during lithotripsy, allowing complete fragmentation and stone clearance. Intra-operative bleeding was noted during the TURP procedure as expected. There were two episodes of self-limiting post-operative pyrexia but no reported cases of post-operative sepsis. Apart from the three patients undergoing TURP, there were no cases of post-operative bleeding and no cases required blood transfusion. Stone clearance was complete after a single procedure in 100% of cases. The mean hospital stay was 2.5 days (1–7 days), with a mean post-operative stay of 1.8 days. Conclusion: Laser lithotripsy offers a safe and effective management option for bladder stones, including those which are large and hard. It offers the key benefit of lithotripsy under direct vision, with no recorded mucosal injury in our series and thus no intra-operative or post-operative haematuria (outside of the TURP group).

Percutaneous renal access for percutaneous nephrolithotomy (PCNL) can be performed by either an interventional radiologist or urologist, depending on local expertise. We reviewed the current literature comparing the success and complications in gaining percutaneous access for both groups. An extensive literature search was carried out using Medline which included keywords “PCNL”, “PCNL access”, “percutaneous nephrolithotomy” and “percutaneous nephrostomy”. The search yielded six published articles that compared the success and complication rates between urologist- and radiologist-performed percutaneous access for PCNL. A systematic literature review was performed. Because of the considerable heterogeneity between studies, no pooling of data or statistical analysis was undertaken. In terms of success or complication rates, there was no significant difference between urologist- and radiologist-made percutaneous tracts. We observed, however, that there appears to be an argument that urologists are in a better position to make their own tracts, which requires only a single-stage procedure in theatre. There appears to be low uptake amongst urologists with the common beliefs that it is a radiological procedure, that radiologists have superior equipment, that it increases intraoperative time and that a steep learning curve is required for proficiency, suggesting that competence in percutaneous access would require at least 60 PCNL procedures. It is therefore unsurprising that many trainees may struggle to gain sufficient exposure to this technique, unless they are training in a centre with adequate patient numbers. Nonetheless, the papers reviewed illustrate that the urologists who are practicing this procedure are performing to an acceptably high standard. In conclusion there appears to be no difference in complication rates between the urologist- and the radiologist-made percutaneous tract. The steep learning curve required can be addressed by new teaching methods such as inanimate simulators, virtual-reality (VR) simulators, PCNL workshops and old-fashioned apprenticeships. A prospective study comparing urologist- and radiologist-placed nephrostomies would be beneficial.

INTRODUCTION AND OBJECTIVES: PCNL and FURS for renal stones can be a morbid procedure in view of urosepsis. Endourologists treat all positive pre-operative urine cultures with appropriate antibiotics. However, patients can still develop sepsis in the postoperative period and knowledge of the right microorganisms is not only invaluable but can also be lifesaving. Intraoperative stone cultures described as a tool to cultures the right microorganisms. Aim of this study is to assess if post op urine cultures add any information regarding culturing the right microorganisms in patients undergoing PCNL and FURS for renal stones. METHODS: We prospectively collected data for patient undergoing PCNL and FURS for renal stones in our unit between August 2013 and May 2014. Demographics, details about pre-operative urine, intraoperative stone as well as post-operative urine culture were collected. Data was analysed to assess positive culture rates in each group and specifically assessed if post op urine cultures add anything to our microbiological information. RESULTS: Data was collected for a total of 60 patients over the study period of 10 month period. Subsequently, only patients who had information available regarding pre-operative urine culture, intra-operative stone culture and postoperative urine cultures were included. This criteria led to exclusion of 19 patients and 41 patients were included in the final analysis. Mean age was 57 years with age range of 26 to 86 years. Pre-operative urine culture was positive in 13/41 patients (32). Intraoperative stone culture was positive in 8/41 patients (20%). Postoperative urine culture was positive in 6/41 patients (15%). One patient had exclusively postoperative urine culture and negative pre-operative urine and intraoperative stone culture and this correlated with postoperative sepsis. CONCLUSIONS: Our study indicates that postoperative urine cultures add to our knowledge regarding the right microorganisms in patients undergoing PCNL and FURS for kidney stones and should be carried out routinely to allow appropriate management of postoperative urinary sepsis.

Hydrolysis of pullulan, derived from strain P50 of Aureobasidium pullulans , by amyloglucosidase leaves a major portion of the glucan untouched, suggesting that the polysaccharide does not contain the simple linear sequence of α-(1→6)-linked maltotriosyl residues hitherto ascribed.