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Introduction: Percutaneous nephrolithotomy (PCNL) is a challenging procedure that urology trainees should be familiar with during residency. Simulators, such as the PERC Mentor, allows the development of this competency in a safer, stress-free environment. There are two primary fluoroscopic methods of gaining percutaneous renal access: the triangulation method and the bull’s eye method. Our goal was to assess which method is easier to teach novices by using the PERC Mentor simulator. A secondary goal is to assess differences in subjective and objective outcomes. Methods: Fifteen simulator and procedure-naive medical trainees were randomized into two groups using a crossover, randomized study design. Participants were provided with written, video, in-person demonstrations and hands-on practice for each technique. They then performed each method and were assessed objectively using the PERC Mentor performance data report and subjectively using the PCNL global rating scale (GRS) scoring system. Statistical analysis was performed using Student’s T-test and non-parametric Wilcoxon signed rank test. Results: There was no statistical difference in the outcomes and complication rates between the two methods. The bull’s eye method of obtaining percutaneous access was associated with a significant decrease in operative time (91 seconds vs. 128 seconds, p=0.03) and fluoroscopy time (87 seconds vs, 123 seconds, p=0.03) compared to the triangulation method. Conclusions: Teaching of both techniques was equally well-acquired by students. Both techniques had similar outcomes; however, the bull’s eye method was associated with less operative and fluoroscopy time when compared to the triangulation method among novices.

Introduction: There are no clinical guidelines for the manipulation of chronic indwelling ureteral stents. The goal of this study was to survey, through a simulated case, how urologists initially manage a patient with a chronic ureteral stent presenting with urosepsis. Methods: An online questionnaire was shared from July 1 to August 31, 2021, through social media (Twitter) and email lists. The scenario described a 50-year-old female, known for a chronic indwelling ureteral stent, presenting to the emergency department with fever, tachycardia, and flank pain. In the scenario, the stent was in adequate position and the last exchange had been performed one month prior. Respondents could choose between treating with antibiotics and keeping the same exchange schedule, urgent stent exchange, or an alternative management that they defined. P

Background Learning curve of laparoscopic nephrectomy (LN) is mainly affected by two main factors: plotting performance and experience. However, there is paucity in the literature addressing the number of cases required to adopt LN. Herein, we aimed to assess the learning curve of LN for various renal disorders and number of cases required to adopt the technique. Between September 2015 and December 2017, consecutive patients undergoing LN for various renal diseases were enrolled in this study. Patients were divided into two groups, the first 20 cases (group A) and subsequent 20 cases (group B). All procedures were performed by a single trainee urologist under supervision of an expert endourologist. Learning curve was assessed using operative time and incidence of complications. Results A total of 40 patients were included in this pilot clinical study. Mean age was 38.2 ± 16.3 years. The mean operative time for patients in group B was significantly lower than the mean operative time for patients in group A (108.5 vs. 139.3 min, p p = 0.081), conversion to open surgery (5% vs. 10%; p = 0.256) and postoperative complications (5% vs. 15%; p = 0.09) for group B and group A, respectively. Similarly, there was no significant difference between both groups in terms of hospital stay (42 ± 8 vs. 46 ± 11 h p = 0.01). The trainee surgeon reached a plateau after 22 cases. Conclusions Our study suggests that a minimum of 22 LN procedures are needed in order to adopt the technique of laparoscopic nephrectomy. Learning curve of LN is mainly affected by number of performed procedures within a short period of time.

This study was conducted to detect the effect of some essential oil (EOs) extracts (Thyme, Oregano, and Menthol) as natural food preservatives against some food-borne pathogens (salmonella Typhimurium and E. coli, Staphylococcus aureus, Bacillus cereus and listeria monocytogens). The selected extracts were in concentrations ranging from 0.01% to 0.8% v/v using broth dilution technique. The Obtained results revealed that the minimum inhibitory concentrations (MICs) of the used extracts 0.3%, 0.1% and 0.8% for Thyme, Oregano, and Menthol, respectively, depended on the concentrations which inhibited Bacillus cereus as it is considered the most resistant Gram-positive spore-forming strain. Studying the mode of action of the used EOs against Salmonella sp. were performed using Transmission Electron Microscope (TEM) which indicated cell wall and plasma membrane damage. Also, the obtained MICs of EOs were used in preparation of luncheon to study the possibility of its usage instead of or together with the chemicals used for preservation during luncheon processing. The obtained results showed that, in luncheon processing, thyme extract has the same preservative effect as sodium nitrite (125 ppm) when it is used as the lonely preservative substance while using the obtained MICs of the used EO with 50 ppm of sodium nitrite had a reliable preserving effect in luncheon process.

Objective: To compare regular and Moses modes of holmium laser lithotripsy during ureteroscopy in terms of fragmentation/pulverization and procedural times in addition to perioperative complications. Patients and Methods: After obtaining ethics approval, a prospective double-blinded randomized trial was conducted for patients undergoing holmium laser lithotripsy during retrograde ureteroscopy. Patients were randomly assigned to either regular or Moses modes. Patients and surgeons were blinded to the laser mode. Lumenis 120W generator with 200 Moses D/F/L fibers were used. Demographic data, stone parameters, perioperative complications, and success rates were compared. The degree of stone retropulsion was graded on a Likert scale from 0—no retropulsion to 3—maximum retropulsion. Results: A total of 72 patients were included in the study (36 per arm). Both groups were comparable in terms of age and preoperative stone size (1.4 cm vs 1.7 cm, p > 0.05). When compared with the regular mode, Moses mode was associated with significantly lower fragmentation/pulverization time (21.1 minutes vs 14.2 minutes; p = 0.03) and procedural time (50.9 minutes vs 41.1 minutes, p = 0.03). However, there were no significant differences in terms of lasing time (7.4 minutes vs 6.1 minutes, p > 0.05) and total energy applied to the stones (11.1 kJ vs 10.8 kJ, p > 0.05). Moses mode was associated with significantly less retropulsion (mean grade was 1.0 vs 0.5, p = 0.01). There were no significant differences between both modes in terms of intraoperative complications (11.1% vs 8.3%, p > 0.05), with one patient requiring endoureterotomy for stricture in the Moses group. Success rate at the end of 3 months was comparable between both groups (83.3% vs 88.4%, p > 0.05). Conclusion: Moses technology was associated with significantly lower fragmentation/pulverization and procedural times. The reduced fragmentation/pulverization time seen using Moses technology could be explained by the significantly lower retropulsion of stones during laser lithotripsy.

Introduction: We aimed to compare objective structured clinical examinations (OSCE) performance of residents from four Canadian urology programs, based on resident and station characteristics. We also aimed to evaluate OSCE contents by station type and subspecialty. Methods: Scores of 109 post-graduate year (PGY)-3 to PGY-5 residents were retrospectively reviewed from 19 OSCEs from May 2008 to February 2019. Scores were grouped by station type/subspecialty, PGY level, medical graduate type (Canadian medical graduate [CMG], international medical graduate [IMG]), sex, and choice of fellowship/practice. Linear mixed modelling was performed to obtain least square means to account for repeated measures. Results: Score increases from PGY-3 to PGY-5 were significant for all station types and subspecialties (p≤0.001). Scores were similar between male and female residents, and between CMGs and IMGs, except in visual recognition examinations (VREs) (males: 44.3±1.0, females: 39.0±1.6, p=0.005; IMG: 47.3±1.7, CMG: 41.6±0.9, p=0.004). Relative to uro-oncology stations, scores were lower in andrology (p=0.010) and functional urology (p

Introduction: We aimed to assess flexible ureteroscopic stone extraction skill of urology postgraduate trainees (PGTs) at an Objective Structured Clinical Examination (OSCE) and to determine whether previous experience in the operating theatre or practice on the simulator correlated with performance.Methods: After obtaining ethics approval, PGTs from postgraduate years (PGYs) 3‒5 were recruited from all four Quebec urology training programs during an OSCE. After a short orientation to the UroMentorTM simulator, PGTs were asked to perform Task 10 for 15 minutes, where two small stones from the left proximal ureter and renal pelvis were extracted using a basket. Competency of PGTs in performing the task was assessed using objective assessment from the simulator and subjective evaluations using Ureteroscopy- Global Rating Scale (URS-GRS). Simulator performance reports and URS-GRS scores were analyzed.Results: Thirty PGTs (9 PGY-3, 11 PGY-4, 10 PGY-5) participated in this study. PGTs had performed a mean of 55.9 semi-rigid and 45.7 flexible ureteroscopies prior to the study. Mean URS-GRS score of the participants was 20.0±4.4. Using norm-referenced method with three experts, cutoff score of 19 on the URS-GRS was determined to indicate competency. Sixty percent (18/30) of PGTs were competent. All eight PGTs who had practiced on the simulator were competent. Previous experience in the operating theatre and PGY level did not correlate with performance. Conclusions: This study confirmed the feasibility of incorporating the UroMentor at OSCEs to assess competency of urology PGTs in ureteroscopic stone extraction skill. PGTs who practiced on the simulator scored significantly higher than those who did not practice; however, the software needs to be updated to improve its face validity and to include more complex tasks, such as holmium laser lithotripsy. Future studies with larger sample sizes and more complex cases are needed to confirm these results.

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To assess competency of urology post-graduate trainees (PGTs) in percutaneous renal access (PCA). Upon obtaining ethics approval and informed consents, PGTs between post-graduate years (PGY-3 to PGY-5) from all four urology programs in Quebec were recruited. PCA competency of each participant was assessed objectively by performing task 4 on the PERC Mentor™ simulator, where they had to correctly access and pop 7 balloons in 7 different renal calyces and subjectively by the validated Percutaneous Nephrolithotomy—Global Rating Scale (PCNL-GRS). A total of 26 PGTs with a mean age of 29.2 ± 0.7 years participated in this study. When compared with the 21 PGTs without practice, all 5 PGTs who had practiced on the simulator were competent (p = 0.03), performed the task with significantly shorter operative time (13.9 ± 0.7 vs. 4.4 ± 0.4 min; p

Objectives To provide a contemporary review of the epidemiology, diagnosis and treatment of premature ejaculation (PE) and erectile dysfunction (ED). Methods We searched for English-language articles published in the past 12 months using the PubMed database. Relevant articles on the subjects of sexual dysfunction, ED and PE were selected for review. Conclusions Recent studies on male sexual dysfunction have provided new therapeutic possibilities. Tramadol, a well-used analgesic, has a new role in the treatment of PE. Super-selective targeting of dorsal penile nerves by surgery or cryoablative technologies might become a viable treatment option for refractory PE in the future. The role of ED as a harbinger of important comorbidities allows for the early detection and intervention of these conditions, which can optimise therapeutic outcomes. The long-term effect of chronic phosphodiesterase-5 inhibitors on endothelial dysfunction, the angiogenic potential of low-intensity extracorporeal shock wave therapy, and further advances in drug-eluting endovascular stents might in future allow clinicians to treat ED more definitively.

Objective To study the effect of ascorbic acid (AA) supplementation on urinary pH, metabolic stone workup parameters, and development of de novo urolithiasis in stone-forming patients. Material and methods A retrospective review of the patients followed-up at a tertiary stone centre between September 2009 and October 2015 was performed. Patients with recurrent urolithiasis who received AA supplementation as a urinary acidifying agent were included in the study. Detailed metabolic stone work-up, including two 24-hour urine collections obtained pre- and post-AA supplementation were compared. In addition, imaging studies were reviewed to assess the development of de novo urolithiasis. Results Twenty-four patients were included in the study with a mean age of 60.6 years and a median daily AA dose of 1000 mg (range: 500-2000 mg). Median follow-up period was 22.6 months (range: 19.7-32.1). After AA supplementation, there was a significant decrease in urinary pH (7.6 vs. 6.9, p=0.02). Although there was no significant increase in the daily oxalate excretion, two patients (8.3%) had their AA dose reduced or discontinued due to de novo hyperoxaluria (342.9 vs 510.2 umol/day; p=0.75). Other serum and urinary parameters did not show any significant changes. Eight (33.3%) patients developed de novo urolithiasis with struvite and carbonate apatite being the major components. Conclusion AA supplementation resulted in significantly lower urinary pH in patients with recurrent urolithiasis and alkaline urine pH. Prospective studies are needed to assess whether this reduction in urinary pH is associated with lower stone recurrence rates.

Several studies have examined the relationship between direct antisperm antibody (ASA) levels in semen and pregnancy rate after advanced assisted reproductive technologies (ARTs) but the results have been inconsistent. The aim of our study was to further evaluate the relationship between ASA and pregnancy after IVF or ICSI by systematic review and meta-analysis.We conducted a systematic Medline search of all relevant full papers on direct semen ASA and pregnancy after IVF or ICSI. Three investigators independently reviewed the papers, followed by group discussion to choose the included papers. Meta-analysis was performed to get an odds ratio (OR) for the effect of ASA on pregnancy using IVF or ICSI.The study identified and analyzed 16 valid studies (10 IVF and 6 ICSI). The study characteristics (including the ASA cutoff values) were heterogeneous. Our meta-analysis revealed that the combined OR for failure to achieve a pregnancy using IVF or ICSI in the presence of positive semen ASA was 1.22 (95% CI: 0.84, 1.77) and 1.00 (95% CI: 0.72, 1.38), respectively. The overall (IVF + ICSI) combined OR was 1.08 (95% CI: 0.85, 1.38).This systematic review and meta-analysis indicate that semen antisperm antibodies are not related to pregnancy rates after IVF or ICSI, suggesting that both forms of ART remain viable options for infertile couples with semen ASA. However, additional, well-designed prospective studies using appropriate ASA cutoff levels are needed to further address this issue.

Partial cystectomy (PC) remains a viable alternative to radical cystectomy (RC) for management of invasive bladder cancer in approximately 5% of patients. We used a population-based database to examine practice patterns and recurrence after partial cystectomy. We obtained billing records of all partial and radical cystectomies performed for bladder cancer in Quebec from 1983 until 2005. Analysis included age, gender, year of surgery, surgeon’s age, hospital type, preoperative and postoperative visits with accompanying diagnoses and dates of recurrences salvage RC, and death. A total of 714 (30.4%) patients with invasive bladder cancer underwent PC. Majority of PC (65%) were performed in non-academic institutions. Pelvic lymphadenectomy was performed in only 163 patients (23%) and concomitant ureteral reimplantation was performed in 89 patients (13%). Of 714 patients, 52 (23.7%) required a salvage RC. Median time from PC to salvage RC was 17.6 months (range 1–240 months), respectively. Patients who underwent PC had similar 5-year overall survival compared with patients who underwent upfront RC (49.8% vs. 51%, p = 0.21). Rate of PC for invasive bladder cancer is significantly higher than expected. Pelvic lymphadenectomy is underutilized in bladder cancer patients treated with PC. Whether prevalent use of PC is due to less stringent selection criteria remains unknown. Since late recurrence is not uncommon, lifelong follow-up is recommended.

BACKGROUND. Active surveillance (AS) with deferred treatment is an established management option for patients with prostate cancer and favorable clinical parameters. The impact of repeat biopsy after diagnosis was examined in a cohort of men with prostate cancer on AS. METHODS. In all, 186 men with prostate cancer with favorable parameters or who refused treatment were conservatively managed by AS. Of these, 92 patients had at least 1 biopsy after diagnosis. Patients were followed every 3 to 6 months with prostate-specific antigen (PSA) and physical examination and were offered rebiopsy annually or if there were any changes on physical examination or in the PSA value. Disease progression while on AS was defined as having ≥1 of the following: ≥cT2b disease, ≥3 positive cores, >50% of cancer in at least 1 core, or a predominant Gleason pattern of 4 in rebiopsies. RESULTS. The median age of the patients at the time of diagnosis was 67 years (range, 49–78 years). The median follow-up was 76 months (range, 20–169 months). Of the 92 patients who underwent repeat biopsies, 42 patients, 25 patients, 13 patients, 10 patients, and 2 patients had 1, 2, 3, 4, and 5 rebiopsies, respectively. A total of 34 patients (36%) demonstrated disease progression on rebiopsy. The first rebiopsy was positive for cancer in 48 patients (52.2%) and negative in 44 patients (47.8%). The 5-year actuarial progression-free probability was 82% for patients with a negative first repeat biopsy compared with 50% for patients with a positive first rebiopsy (P = .02). A PSA doubling time

In Canada there is growing concern that waiting time for cancer surgery has been increasing. We used population based data to estimate the average PD for RC in Quebec and assess whether delayed surgery has a negative impact on long-term survival.We used the provincial billing database of the maladie du Quebec to identify all patients with bladder cancer 18 years or older who underwent RAMQ from 1990 to 2002. PD was calculated as the time elapsed between the most recent transurethral resection and the date of RC. Patients were categorized according to PD tertiles into 3 groups, namely 1) 20 or less, 2) 21 to 47 and (C) 48 days or greater. Cox proportional hazards models were used to assess the effect of PD on overall survival, while adjusting for patient and provider factors.During the study period 1,592 radical cystectomies were performed. Overall median PD was 33 days (95% CI 30 to 35). Median PD increased from 23 days in 1990 to 50 in 2002. After adjusting for calendar year, and patient and provider variables there were no significant differences in survival among the 3 delay categories. However, patients subject to greater than 12 weeks of delay were at 20% greater risk for dying (95% CI 1.0 to 1.5, p = 0.051).In line with previous reports PD greater than 12 weeks seems to be associated with a worse long-term prognosis.

Shockwave lithotripsy (SWL) and ureteroscopy (URS) are minimally invasive treatment alternatives for kidney stones. Although less invasive, SWL subjects the renal parenchyma to a high level of energy and the potential to cause renal injury. The ability to detect renal injury post-SWL in a reliable and noninvasive way would be clinically beneficial. Kidney injury molecule 1 (KIM-1) and N-acetyl-β-D-glucosaminidase (NAG) are two proteins secreted by the kidney into the urine and have been found to be sensitive markers of acute kidney injury in transplant patients. The aim of this work was to measure urinary levels of KIM-1 and NAG in patients with kidney stone who were treated by SWL or URS and in nonstone volunteers.Patients with kidney stones who were treated by SWL (n = 50) or URS (n = 10) were recruited. Voided urine samples were collected before and 2 to 3 hours after URS and SWL. In addition, further urinary specimens were collected 2 days and 2 weeks post-SWL treatment. Voided urine samples from healthy volunteers were also collected.Mean KIM-1 values were increased in patients with kidney stones when compared with volunteers. KIM-1 and NAG levels significantly increased post-SWL and returned to baseline within 2 weeks post-SWL. Poor kidney function was significantly associated with increased biomarker activity both in baseline and post-SWL measurements. There was no significant change in urinary KIM-1 and NAG concentrations before and after URS.Kim-1 and NAG levels significantly increased post-SWL treatment suggesting a potential role for these urinary markers in identifying patients at higher risk of tissue injury.

To quantify the effective radiation dose associated with the evaluation and follow-up of patients with urolithiasis.Retrospective review was performed for consecutive patients presenting to a tertiary stone clinic with acute stone episodes between November 2007 and December 2008, and had at least 2 years of follow-up. Number and modality of imaging studies were collected. Effective radiation exposure (ERE) doses were calculated from the dose length product values reported with each computed tomography (CT) scan.There were 72 males and 32 females with a mean age of 49 years (range 21-78). Patients underwent an average 1.8 (range 0-5) and 0.7 (range 0-2) plain radiographs, 0.82 (range 0-4) and 0.15 (range 0-2) CTs, 0.09 (range 0-1) and 0.03 (range 0-1) intravenous urograms, and 0.3 (range 0-1) and 0.6 (range 0-2) ultrasounds (US) during the first and second years, respectively (all P.05). The average calculated ERE dose per CT scan was 23.16 mSv (range 4.94-72.77). The calculated mean ERE dose per patient significantly decreased from 29.29 mSv (range 1.7-77.27) in the first year to 8.04 mSv (range 1.4-24.72) in the second year (P.01). This was because of significantly fewer CT scans and significantly more US imaging during the second year (P.05). Although 18 (17.3%) patients exceeded 50 mSv during the first year, none exceeded this threshold during the second year. The mean ERE dose did not correlate with stone location, patient age, and sex.The calculated mean ERE dose significantly decreased during the second year of follow-up in patients with urolithiasis because of significantly higher use of US.

Objectives: It remains controversial whether we can apply similar principles in the management of upper urinary tract urothelial carcinoma (UUT-UC) based on the behavior of bladder urothelial carcinoma (B-UC). We sought to assess whether UUT-UC and B-UC have similar biology and performed a stage-by-stage comparative analysis of outcome between the 2 groups. Methods: A retrospective review was performed on patients who underwent nephroureterectomy for UUT-UC and radical cystectomy for B-UC from 1991 to 2006. Standard variables were collected and recurrence-free and overall survival (OS) rates were calculated. Results: 280 patients with a median age of 69 years were included (99 UUT-UC treated via nephroureterectomy and 181 B-UC treated via radical cystectomy). Median follow-up was 29 months. None received neoadjuvant chemotherapy. Patients with UUT-UC presented less commonly with invasive disease compared to those with B-UC (44 vs. 77% were >pT2). Overall, 5-year OS for the B-UC group was significantly lower than for the UUT-UC group (60.8 vs. 74.5%, p = 0.02). However, when patients were stratified by stage (>pT2), patients with B-UC had similar OS compared to those with UUT-UC (54.6 vs. 60.8%, p = 0.74). Conclusion: Invasive UUT-UC appears to have similar tumor biology compared to B-UC. Whether we can safely extrapolate on the benefit of neoadjuvant and adjuvant strategies to patients with UUT-UC requires further investigation.

Many studies have suggested that nutritional factors may affect prostate cancer development. The aim of our study was to evaluate the relationship between dietary habits and prostate cancer detection.We studied 917 patients who planned to have transrectal ultrasonography-guided prostatic biopsy based on an elevated serum prostate-specific antigen (PSA) level, a rising serum PSA level or an abnormal digital rectal examination. Before receiving the results of their biopsy, all patients answered a self-administered food frequency questionnaire. In combination with pathology data we performed univariable and multivariable logistic regression analyses for the predictors of cancer and its aggressiveness.Prostate cancer was found in 42% (386/917) of patients. The mean patient age was 64.5 (standard deviation [SD] 8.3) years and the mean serum PSA level for prostate cancer and benign cases, respectively, was 13.4 (SD 28.2) mug/L and 7.3 (SD 4.9) mug/L. Multivariable analysis revealed that a meat diet (e.g., red meat, ham, sausages) was associated with an increased risk of prostate cancer (odds ratio [OR] 2.91, 95% confidence interval [CI] 1.55-4.87, p = 0.027) and a fish diet was associated with less prostate cancer (OR 0.54, 95% CI 0.32-0.89, p = 0.017). Aggressive tumours were defined by Gleason score (/= 7), serum PSA level (/= 10 mug/L) and the number of positive cancer cores (/= 3). None of the tested dietary components were found to be associated with prostate cancer aggressivity.Fish diets appear to be associated with less risk of prostate cancer detection, and meat diets appear to be associated with a 3-fold increased risk of prostate cancer. These observations add to the growing body of evidence suggesting a relationship between diet and prostate cancer risk.

Introduction: To evaluate the predictors of prostate cancer in follow-up of patientsdiagnosed on initial biopsy with high-grade prostatic intraepithelial neoplasia(HGPIN) or atypical small acinar proliferation (ASAP).Methods: We studied 201 patients with HGPIN and 22 patients with ASAPon initial prostatic biopsy who had subsequent prostatic biopsies. The meantime of follow-up was 17.3 months (range 1–62). The mean number of biopsy sessions was 2.5 (range 2–6), and the median number of biopsy cores was10 (range 6–14).Results: On subsequent biopsies, the rate of prostate cancer was 21.9% (44/201)in HGPIN patients. Of these, 32/201 patients (15.9%), 9/66 patients (13.6%)and 3/18 patients (16.6%) were found to have cancer on the first, second and third follow-up biopsy sessions, respectively. In ASAP patients, the cancer detectionrate was 13/22 (59.1%), all of whom were found on the first follow-upbiopsy. There was a statistically significant difference between the cancer detectionrate in ASAP and HGPIN patients (p < 0.001). Multivariate analysis showedthat the independent predictors of cancer were the number of cores in theinitial biopsy, the number of cores (> 10) in the follow-up biopsy and a prostate specific antigen (PSA) density of ≥ 0.15 (odds ratio 0.77, 3.46 and 2.7,8 respectively;p < 0.04). Conversely, in ASAP patients none of these variables werefound to be associated with cancer diagnosis.Conclusion: ASAP is a strong predictive factor associated with cancer when comparedwith HGPIN. The factors predictive of cancer on follow-up biopsy ofHGPIN are number of cores on initial biopsy, more than 10 cores in rebiopsyand elevated PSA density. As the cancer detection rate on repeated biopsy of HGPIN patients is the same as that of patients without HGPIN, perhaps the standard of repeat biopsy in all patients with HGPIN should be revisited.

Introduction: We evaluated the use of the GreenLight Simulator (GL-SIM) (American Medical Systems, Guelph, ON) in the skill assessment of postgraduate trainees (PGTs) in photoselective vaporization of the prostate (PVP). We also sought to determine whether previous PVP experience or GL-SIM practice improved performance.Methods: PGTs in postgraduate years (PGY-3 to PGY-5) from all 4 Quebec urology training programs were recruited during 2 annual Objective Structured Clinical Examinations (OSCEs). During a 20-minute OSCE station, PGTs were asked to perform 2 exercises: (1) identification of endoscopic landmarks and (2) a PVP of a 30-g normal prostate. Grams vaporized, global scores, and number of correct anatomical landmarks were recorded and correlated with PGY level, practice on the GL-SIM, and previous PVP experience.Results: In total, 25 PGTs were recruited at each OSCE, with 13 PGTs participating in both OSCEs. When comparing scores from the first and second OSCEs, there was a significant improvement in the number of grams vaporized (2.9 vs. 4.3 g; p = 0.003) and global score (100 vs. 165; p = 0.03). There was good correlation between the number of previously performed PVPs and the global score (r = 0.4, p = 0.04). Similarly, PGTs with previous practice on the GL-SIM had significantly higher global score (100.6 vs. 162.6; p = 0.04) and grams vaporized (3.1 vs. 4.1 g; p = 0.04) when compared with those who did not practice on GL-SIM. Furthermore, there were significantly more competent PGTs among those who had previously practiced on the GL-SIM (32.7% vs. 10.2%; p = 0.009). PGY level did not significantly affect grams vaporized or global score (p > 0.05).Conclusion: Performance on the GL-SIM at OSCEs significantly correlated with previous practice on the GL-SIM and previous PVP experience rather than PGY level. Furthermore, there were significantly more competent PGTs among those who had previously practiced on the GL-SIM.

We report our experience using buccal mucosa in the multistage repair of complex hypospadias, and the observed histological changes.We evaluated 31 patients (14 adults and 17 children). A total of 19 patients presented after failed hypospadias repair with deficient ventral skin, 5 presented with scrotal hypospadias and 7 presented with perineal hypospadias. Patients who had previously undergone hypospadias repair had 3 to 7 failed trials. Two stage buccal mucosa graft was performed using the Bracka technique. In the first stage residual fibrosis was released, the glans was split and the buccal mucosa graft was sutured to the ventral surface of the penis to form a future urethral plate. Second stage reconstruction was performed after 6 months with interposed scrotal dartos tissue. Buccal mucosa was histologically studied before grafting, and at 6 months after graft uptake and exposure to the air.Buccal mucosa free graft showed excellent uptake within 5 days in all cases. At 6 months the buccal mucosa was well vascularized and pliable. Minute fistulas occurred in 3 cases (9.7%), which were closed at a later stage. Histological analysis of buccal mucosa tissues before and after graft and prolonged exposure to the air (more than 6 months) was conducted. The buccal mucosa displayed epithelial hyperplasia with mild and focal keratinization. The lamina propria was slightly edematous and minimally infiltrated by mononuclear inflammatory cells. The lamina propria papillae were elongated, extending to 75% of the mucosal thickness compared to the normal buccal mucosa. The buccal mucosal graft displayed good vascularization, similar to that of the normal mucosa.Multistage repair using buccal mucosa is an excellent option for urethral reconstruction. It guarantees excellent graft uptake and good vasculature, which improves success. It also provides supple tissue for glanular and urethral reconstruction in cases of severe complex hypospadias.

We performed a systematic review of publications describing a correlation between oral anticoagulant medications and intravesical BCG outcome. We collected information on the impact of such medications on tumour recurrence and progression and we excluded papers not reporting outcome correlations. Patients were divided into group 1 and 2 based on whether they were taking or not taking any anticoagulant medications. A total of 7 manuscripts published between 1990 and 2009 were included in this study. Data heterogeneity precluded meta-analysis. In studies combining all anticoagulant medications, 3 out of 5 (60%) publications did not identify any difference in outcome, while 2 (40%) documented significantly more recurrences in group 1 patients. In studies performing multivariate analysis and only examining the intake of 1 medication, warfarin alone seemed to be associated with increased risk of bladder tumour recurrences and progression following intravesical BCG treatment, while ASA alone seemed to be associated with more protective effects. There is no strong evidence to support the allegations of a protective role of ASA and a deleterious role for warfarin. Further, well-designed experimental and clinical studies are needed to clarify the mechanism of action of intravesical BCG along with possible drug interactions.

Objective: Treatment delays have been associated with adverse outcomes in patients with bladder cancer treated with radical cystectomy (RC). We sought to evaluate the impact of treatment delay on disease recurrence and survival in patients with bladder cancer treated with partial cystectomy (PC) in Quebec. Methods: We reviewed and obtained billing records for all patients who underwent PC and/or RC for bladder cancer in Quebec between 1983 and 2005. Analysis included age, sex, year of surgery, surgeon’s age, hospital type, preoperative and postoperative visits with accompanying diagnoses and dates of death. Results: A total of 714 patients underwent PC. The median patient age was 70 years. Two-hundred nineteen (30.7%) patients experienced recurrence; of these, 52 (23.7%) required salvage RC. Five-year overall and recurrence-free survival for patients who underwent PC were 49.8% and 40.3%, respectively. Patients delayed more than 12 weeks from transurethral resection of bladder tumours (TURBT) to PC were at significantly increased risk of requiring salvage RC compared with those delayed 12 weeks or less (hazard ratio [HR] 3.0, p < 0.001). Patients who underwent salvage RC had worse survival than patients who had upfront RC (HR 1.5, p = 0.006). Variables including age, sex, presence of hematuria, intravesical therapy, surgeon age, hospital PC volume, surgeon PC volume, type of hospital (academic v. nonacademic) or year of surgery were not significantly associated with PC treatment delay. Conclusion: Treatment delay in patients with bladder cancer managed with PC was associated with increased risk of salvage RC. Patients with bladder cancer who underwent salvage RC had worse outcomes than those who had upfront cystectomy. Objectif : Chez les patients atteints de cancer de la vessie traites par cystectomie radicale (CR), un delai avant l’instauration du traitement est associe a des resultats defavorables. Nous avons tente d’evaluer l’impact d’un tel delai sur la recidive de la maladie et le taux de survie des patients atteints de cancer de la vessie traites par cystectomie partielle (CP) au Quebec. Methodologie : Les dossiers de facturation ont ete obtenus pour les patients ayant subi une CP et/ou une CR pour le traitement d’un cancer de la vessie au Quebec de 1983 a 2005. L’analyse tenait compte de l’âge, du sexe, de l’annee de l’intervention chirurgicale, de l’âge du chirurgien, du type d’hopital, des visites preoperatoires et postoperatoires, des comorbidites et des dates de deces. Resultats : En tout, 714 patients dont l’âge moyen etait de 70 ans ont subi une CP. De ce nombre, 219 patients (30,7 %) ont presente une recidive, dont 52 (23,7 %) necessitant une CR de sauvetage. La survie globale apres 5 ans et la survie sans recidive chez les patients ayant subi une CP etaient respectivement de 49,8 % et de 40,3 %. Un intervalle superieur a 12 semaines entre la resection transuretrale de la tumeur et la CP a ete associe a un taux accru de CR de sauvetage en comparaison avec un intervalle de 12 semaines ou moins (risque relatif [RR] 3,0, p < 0,001]. La CR de sauvetage etait associee a un taux inferieur de survie en comparaison avec les patients traites par CR des le depart (RR 1,5, p = 0,006). Les autres variables, soit l’âge, le sexe, la presence d’une hematurie, le recours a une therapie intravesicale, l’âge du chirurgien, le nombre de CP effectuees a l’hopital, le nombre de CP effectuees par le chirurgien, le type d’hopital (universitaire ou non universitaire), et l’annee de l’intervention chirurgicale n’ont pas ete associees de facon significative au delai avant la CP. Conclusion : Le delai avant l’instauration du traitement chez les patients atteints de cancer de la vessie traites par CP a ete associe a un taux accru de CR de sauvetage. Les patients atteints de cancer de la vessie qui ont subi une CR de sauvetage presentaient une issue de la maladie moins favorable que les patients traites par cystectomie des le depart.

Background: Many studies have suggested that nutritional factors may affect prostate cancer development. The aim of our study was to evaluate the relationship between dietary habits and prostate cancer detection.Methods: We studied 917 patients who planned to have transrectal ultrasonography–guided prostatic biopsy based on an elevated serum prostate specific antigen (PSA) level, a rising serum PSA level or an abnormal digital rectal examination. Before receiving the results of their biopsy, all patients answered a self-administered food frequency questionnaire. In combination with pathology data we performed univariable and multivariable logistic regression analyses for the predictors of cancer and its aggressiveness.Results: Prostate cancer was found in 42% (386/917) of patients. The mean patient age was 64.5 (standard deviation [SD] 8.3) years and the mean serum PSA level for prostate cancer and benign cases, respectively, was 13.4 (SD 28.2) μg/L and 7.3 (SD 4.9) μg/L. Multivariable analysis revealed that a meat diet (e.g., red meat, ham, sausages) was associated with an increased risk of prostate cancer (odds ratio [OR] 2.91, 95% confidence interval [CI] 1.55–4.87, p = 0.027) and a fish diet was associated with less prostate cancer (OR 0.54, 95% CI 0.32–0.89, p = 0.017). Aggressive tumours were defined by Gleason score (≥ 7), serum PSA level (≥ 10 μg/L) and the number of positive cancer cores (≥ 3). None of the tested dietary components were found to be associated with prostate cancer aggressivity.Conclusion: Fish diets appear to be associated with less risk of prostate cancer detection, and meat diets appear to be associated with a 3-fold increased risk of prostate cancer. These observations add to the growing body of evidence suggesting a relationship between diet and prostate cancer risk.

Background: The province of Quebec has the highest incidence of urothelialtumours in Canada. Radical cystectomy remains the standard treatment for invasivebladder cancer. We have previously observed that prolonged delays betweentransurethral resection of bladder tumour (TURBT) and radical cystectomy leadto worse survival in Quebec.Objective: The aim of our study was to characterize the various periods of delaysustained by bladder cancer patients before radical cystectomy across Quebecand to determine their relation to survival.Methods: We obtained the billing records for all patients treated with radicalcystectomies for bladder cancer across Quebec from 1990 to 2002. Collectedinformation included patient age and sex; dates of family physician (FP) andspecialist visits with accompanying diagnoses; dates of cystoscopy, TURBT andCT scanning; surgeon age; surgical volume and dates of death.Results: We analyzed a total of 25 862 visits for 1633 patients. Median diagnosticdelays from FP to specialist, then to cystoscopy, then to TURBT and finallyfrom TURBT to CT were 20, 11, 4 and 14 days, respectively, over the entirestudy period. Median overall delay from FP visit to radical cystectomy was93 days. In addition, median FP to radical cystectomy delay progressivelyincreased from 1990 to 2000 from 58 to 120 days (p < 0.01). Multivariate analysesshowed that patients with an overall delay of either < 25 or > 84 dayshad a 2.1 and 1.4 times increased risk of dying, respectively (p ≤ 0.01).Conclusion: Preoperative delays have been progressively increasing over time.Overall, delays from FP to radical cystectomy of < 25 and > 84 days may translateinto worse outcomes. Poor survival in cases with < 25 days delay maybe attributed to case selection, with more advanced cases being managed muchquicker. Poor survival in cases with delays of > 84 days may be attributed todisease progression while awaiting completion of management.