Jonathan Makanjuola

Urology apps: a review of all apps available for urologists.

Urology continues to be a technology-driven specialty, and the advent of robotic surgical systems has led urologists to become the world leaders in the use of such technology [ 1 ] . A smartphone is defi ned as a phone enabled for internet or email use. Mobile technology presents an opportunity for urologists to continue to provide the lead in the development of medical technology. Applications (apps) are downloaded items of software onto a smartphone which fulfi l a specifi c function or role. The worldwide market for smartphone apps has grown enormously in recent years. Revenues from applications in the fi rst half of 2010 were estimated at £ 1.4 billion (

Smartphone applications for the urology trainee.

2.2 billion), while in January 2012, Apple announced the twenty-fi fth billionth download from its ‘ App Store ’ [ 2 ] . The ‘ Android Market ’ is the alternative to the Apple App Store developed by Google for Android OS devices ( Fig. 1 ) [ 3 ] . Once downloaded, users can rate the app (out of 5 stars) on the app page so others can assess the usefulness of the app. Raters can also leave comment for prospective users to read.

Evolving Guidance on Ureteric Calculi Management in the Acute Setting.

Sir, We read with interest the recent paper by Abboudi et al . [ 1 ] , on smartphone applications (apps) for the urology trainee. This is a hugely important area with the increasing use of smartphones and availability of apps for them. Whilst the authors discussed the available apps for the Apple platform [ 2 ] , they make little mention of Google ’ s vast app store – Android Market [ 3 ] . This is a fast moving industry and undoubtedly by the time this letter reaches press there will be even more apps. When we reviewed the available urological apps we found 69, 44 on the Apple App store, 16 on the Android Market and nine that were in both stores. The earliest posted urological app was from November 2009 and there was a more than a doubling of the number of urological apps between 2010 and 2011. The mean (range) cost of the urological apps was £ 6.73 (0 – 34.99), with 36 apps available for free. There were 52 apps produced by companies specialising in app development, with 17 produced by Urologists. In all, 35 apps were for reference, 18 for patient information, six for conference use, three for urology news and two for patient records in urological diseases. We found that 65% of the apps were aimed at physicians, 33% aimed at patients and 2% at urology nurses.

Cardiovascular risk with NSAIDs.

Ureteric colic is a common presentation to acute emergency services. The gold standard test for the diagnosis of acute ureteric colic is a non-contrast computer tomography of the kidneys ureters and bladder (CT KUB). Non-steroidal anti-inflammatory drugs (NSAIDs) should be used as first-line analgesia, with studies showing that there is no role for steroid or phosphodiesterase-5 inhibitors. There is emerging evidence that a high body mass index (BMI) is a risk factor. The drugs used to facilitate stone passage are known as medical expulsive therapy (MET). The most evaluated being alpha-blockers. The Spontaneous Urinary Stone Passage Enabled by Drugs (SUSPEND) trial was designed to evaluate the use of MET (tamsulosin and nifedipine). This trial showed that there was no difference with MET and placebo for the spontaneous passage of ureteric stones. There is an emerging role for the use of primary ureteroscopy in the management of non-infective ureteric stones.

Special Conditions: Management of Concomitant Urological Pathology and the Comorbid Patient

Non-steroidal anti-infl ammatory drugs are widely used in medicine. In urology we commonly use them for acute pain relief in renal colic and as postoperative analgesia. They are often prescribed for longer-term use in patients with chronic pain of urological cause, e.g. chronic pelvic pain syndrome. Around 17 million prescriptions for NSAIDs are issued annually in England [ 1 ] with nearly six million for diclofenac alone [ 2 ] . Whilst respiratory and gastrointestinal side effects are well known, there has been increasing concern in the literature regarding their cardiovascular safety, with studies suggesting an increased risk of stroke, myocardial infarction (MI) and death.

“What Goes Up Must Come Down”: Laparoscopic Retrieval of a Migrated Intrathoracic Kidney and Repair of Recurrent Symptomatic Diaphragmatic Hernia

Life expectancy continues to increase and as a result more frail, elderly and co-morbid patents are undergoing surgery (Brodak et al. Clin Interv Aging. 10:379–85, 2015). This is acutely seen in the management of men with prostatic disease. Urologists are increasingly encountering the older man with larger (>100 cc) prostates and concurrent and multiple co-morbidities. Urological diseases such as bladder and renal stones, bladder tumours and benign prostatic enlargement often necessitate concurrent or staged operative management. The grossly enlarged prostate can hinder or obstruct progress in the initial operation due to mass effect and bleeding. Identification and planning is key for successful outcomes in these men. Ensuring that the right equipment is available is a critical step before the cystoscopic inspection of the lower urinary tract has even started.

3D-Holoscopic Imaging: A New Dimension to Enhance Imaging in Minimally Invasive Therapy in Urologic Oncology

Abstract Background: Congenital diaphragmatic hernia is a rare condition describing a developmental defect of the diaphragm. It is managed surgically in the neonatal period by reduction of the herniated viscera followed by repair of the defect. We present a laparoscopic repair of a Bochdalek diaphragmatic hernia recurrence with retrieval and nephropexy of a migrated kidney with reduced function from its ectopic thoracic position. The complexities of managing this rare occurrence and lessons from this surgical challenge are discussed. Case Presentation: A 21-year-old primigravida presented with a 3-day history of right upper quadrant pain and increasing dyspnea. Of note, she had undergone a congenital right-sided diaphragmatic hernia repair as an infant. An MRI revealed a recurrent diaphragmatic defect with ectopic migration of the right kidney and bowel into an intrathoracic position. Due to worsening dyspnea, she underwent prompt laparoscopic repair of her recurrent diaphragmatic hernia. Subsequently, she underwent a planned cesarean section to control her intra-abdominal pressures and reduce the risk of hernia repair failure. Conclusion: Raised intra-abdominal pressures during pregnancy in patients with prior congenital hernia repair can result in recurrence and migration of peritoneal and retroperitoneal contents into the chest. In cases of renal unit migration, the primary concern must be to restore the anatomical position of a functioning kidney. Multidisciplinary specialist involvement in a tertiary referral base is crucial to an effective outcome.

CENTRALISATION OF MAJOR TRAUMA: AN OPPORTUNITY FOR ACUTE UROLOGY SERVICES IN THE UK

BACKGROUND AND PURPOSE Existing imaging modalities of urologic pathology are limited by three-dimensional (3D) representation on a two-dimensional screen. We present 3D-holoscopic imaging as a novel method of representing Digital Imaging and Communications in Medicine data images taken from CT and MRI to produce 3D-holographic representations of anatomy without special eyewear in natural light. 3D-holoscopic technology produces images that are true optical models. This technology is based on physical principles with duplication of light fields. The 3D content is captured in real time with the content viewed by multiple viewers independently of their position, without 3D eyewear. METHODS We display 3D-holoscopic anatomy relevant to minimally invasive urologic surgery without the need for 3D eyewear. RESULTS The results have demonstrated that medical 3D-holoscopic content can be displayed on commercially available multiview auto-stereoscopic display. CONCLUSION The next step is validation studies comparing 3D-Holoscopic imaging with conventional imaging.