Richard Grills

Percutaneous peritoneal drainage for intraperitoneal bladder perforations during transurethral resection of bladder tumors.

PURPOSE To demonstrate the safety and efficacy of percutaneous drainage of the peritoneal cavity using an 8F pigtail catheter placed under ultrasound guidance in cases of intraperitoneal perforation of the bladder as a result of transurethral resection of a bladder tumor (TURBT). PATIENTS AND METHODS Three patients undergoing TURBT had inadvertent but significant intraperitoneal perforations of the bladder. All patients developed signs and symptoms of peritonism despite large catheters draining the bladder. An 8F pigtail catheter (Boston Scientific, Watertown, MD, USA) was inserted percutaneously under ultrasound guidance with local anesthetic infiltration. RESULTS All three patients made a good recovery without needing a laparotomy. Cystograms a week later confirmed an intact bladder. Clinical review revealed no sequelae as a result of the perforation or its treatment. CONCLUSION Percutaneous drainage of the abdomen in patients with intraperitoneal perforation of the bladder during TURBT is a safe alternative to laparotomy.

Outcome from percutaneous nephrolithotomy in patients with spinal cord injury, using a single-stage dilator for access.

The use of percutaneous nephrolithotomy to treat renal calculi in patients with spinal cord injury is described by authors from Melbourne. This is the first contemporary series reported for over 13 years, and the authors describe various unique features about their series and compare their results to previously reported studies.

Lessons learned: end-user assessment of a skills laboratory based training programme for urology trainees

• To evaluate the benefit of a skills laboratory based training programme to urology resident training by end‐user assessment.

Clinical fellows: valuable or not? Opinions of Australian and New Zealand urology trainees and consultants.

As subspecialized urology fellowship training becomes more commonplace in Australia and New Zealand (ANZ), there exists an imperative to study the impact of fellows in greater depth. Little is known about the beliefs and opinions of local trainees surrounding the integration of clinical fellows into urology departments, and how it relates to their own education. Previously stated benefits of fellows to their respective departments include academic productivity, clinical service, teaching of more junior trainees and increasing their reputation and expertise on a national and international scale. A literature review by Plerhoples et al. attempted to assess the impact of fellowships on surgical residents in several subspecialties. Of the 23 articles reviewed, one was found to have positive impact on resident education, while nine had negative impact. Of the other 13 studies, mixed results were noted in six, with minimal to no impact in seven. It was noted by the authors that any conclusions were limited by the quality of the data in their analysis. A survey exploring the opinions of the American orthopaedic surgery faculty and trainees noted that a majority of trainees expressed the role of the fellow in the operating theatre as a major source of conflict, while 86% agreed that fellowship training is an important educational issue for residency programmes. A minority of these residents (29%) believed that their educational experience had been compromised. Our aim is to survey ANZ urology trainees and consultants in order to gauge their beliefs on the issue of clinical urology fellows. We also aim to compare these opinions with previously published opinions of urology trainees in Canada. With permission from the Urological Society of Australia and New Zealand (USANZ), hard-copy questionnaires were given to ANZ urology trainees in attendance at a mandatory meeting for those in training years 3–5. Questionnaires were modified based upon a previously published survey, with permission (Appendix S1). Electronic surveys were emailed inviting consultant members of USANZ to participate, with a reminder sent 2 months after the first email. Responses were recorded using the 5-point Likert scale (1, strongly disagree; 2, disagree; 3, neutral; 4, agree; 5, strongly agree). A two-group unpaired t-test with equal variances was performed to evaluate the differences between ANZ trainees and consultants. The one-sample mean comparison t-test was used to compare ANZ trainees to Canadian urology trainees from a single institution (University of Toronto). The previously published mean values were used as the comparator figure. All tests were two sided with significance set at 0.05. Analysis was performed using Stata v. 12.0 SE (Statacorp LP, College Station, TX, USA). Overall response rate from registrars and consultants was 47% (52/111) and 11% (48/420), respectively. Responses to survey questions posed to ANZ urology trainees and consultants are summarized in Table 1 and the associated P-values comparing responses between ANZ trainees/consultants and ANZ trainees/ Canadian trainees for each question are also shown. The most commonly mentioned ‘characteristics of a good clinical fellow’ were being a ‘team player’ (58.6%), ‘teaching’ (43.7%) and being ‘collegial/supportive’ (34.4%). As the specialty of urology trends towards an increasing emphasis on subspecialization, the presence of clinical fellows will likely continue to increase. Department heads, urology educational programme directors, fellows and trainees will need to work in concert to strike an appropriate balance sharing learning opportunities to maximize educational value for all parties. As was seen in our survey, ANZ trainees felt less strongly than their previously questioned Canadian counterparts that fellows ‘steal’ operative cases, although there was agreement that fellows add to the overall education of urology trainees in both countries. It does highlight the potential challenges in striking a balance in providing optimal educational opportunities for both trainees and fellows. Open communication, setting of roles/objectives for trainees and fellows and good working relationships would likely be of great benefit in fostering an agreeable working environment and ensuring fair distribution of learning opportunities. The top two most frequently cited desirable characteristics of a good clinical fellow were being a team player and teaching. It underscores the importance of selecting for these attributes when advertising and interviewing for potential fellows. The introduction of additional fellows should be carried out cautiously, so as to maintain the balance of educating local trainees while raising the profile of individual departments on the worldwide stage and attracting the best possible international fellows. It may also be of benefit for local urology units to clearly define the roles of trainees and fellows to promote a more harmonious relationship between the two entities. Several limitations exist for this study. The study was administered only to those in attendance at trainee session where the survey was conducted. The relatively low response rate by consultants represents another important limitation. As urology fellowship opportunities continue to proliferate in ANZ, it remains of upmost importance to strive to maintain an optimal balance respecting the training needs of all parties. Maintaining communication between local urology departments and training coordinators is essential to ensure that the personnel are optimally assigned. When appropriate integration of trainees and fellows is achieved, the educational benefits towards enhancing trainee learning may be significant.

Response to Re: Interns’ perceptions of exposure to urology during medical school education in Victoria, Australia

1. Azer S, Khan M, Hoag N et al. Interns’ perceptions of exposure to urology during medical school education in Victoria, Australia. ANZ J. Surg. 2017; 87: 10–1. 2. Hill DA. Integration of the surgical specialties into an innovative undergraduate curriculum. Med. Educ. 1993; 27: 489–94. 3. Louie-Johnsun MW, Munzel B, Murphy DL. Hospital medical officers and basic urology: are they up to scratch? BJU Int. 2006; 98: 491–2. 4. Patel M, Pleass H. Teaching urology to medical students: “is this as good as it gets”? ANZ J. Surg. 2017; 87: 7–8.