S. K. Giri

The Long-Term Results of Pubovaginal Sling Surgery Using Acellular Cross-Linked Porcine Dermis in the Treatment of Urodynamic Stress Incontinence

PURPOSE Acellular cross-linked porcine dermis is a potential substitute for rectus fascia as a sling material with the advantage of decreased morbidity. However, the long-term efficacy is unknown. We compared the 3-year efficacy of PD vs autologous rectus fascia as a sling material for pubovaginal sling surgery in the treatment of urodynamic stress incontinence. MATERIALS AND METHODS Between July 2000 and December 2001 a total of 101 consecutive, nonrandomized patients with USI underwent a PD (51) or RF (50) sling procedure. Patients were assessed at 6 weeks, and at 3, 6 and 12 months postoperatively. Urodynamic study was repeated in cases of treatment failure. A detailed survey questionnaire was mailed to all patients at least 36 months after surgery and all responders were then retested by telephone interview by a blinded assessor. The primary outcome measure was patient perceived success rate (cured or improved) at least 36 months after PVS. Secondary outcome measures were patient satisfaction 36 months after surgery, durability of success with time and reoperation rate. RESULTS Complete data were available on 94 patients (48 treated with PD and 46 treated with RF sling). The groups were well matched for age, leak point pressure, prior incontinence surgery and urge symptoms. Pubovaginal sling was successful (cured or improved) in 37 (80.4%) patients treated with RF but in only 26 (54%) patients treated with PD 36 months after surgery (Fishers exact test p = 0.009; 95% CI 8.03, 44.4). Treatment failure occurred by 9 months after RF and by 24 months after PD sling procedure. Repeat urodynamic study showed USI to be the cause of treatment failure in 18 (37.5%) of 20 patients treated with PD but in only 3 (6.5%) of 8 patients treated with RF. CONCLUSIONS We have shown that use of the PD sling, although reducing early morbidity, results in a significantly inferior long-term cure rate in comparison to the RF sling. Therefore, acellular cross-linked porcine dermis should not be used as a substitute for rectus fascia.

The use of smartphone applications by urology trainees.

OBJECTIVE Mobile phone technology is continuously advancing- the smartphone allows users instant access to information via the internet. Downloadable applications (apps) are becoming widespread across medical specialities. The aim of this study was to assess the use of smartphone apps among urology trainees in Ireland. METHODS An anonymous electronic survey was distributed via Survey Monkey(®) to all urology trainees in Ireland assessing their ownership and use of smartphones and downloadable apps. A search of urology apps was performed using the Apple App Store and the Android Market. RESULTS 36 (81.8%) of trainees responded with 100% ownership of smartphones. 28 (77%) report downloading apps with 11 (30.6%) reporting paying for them. The mean number of apps downloaded was 4 (Range 1-12). 16 (44.4%) trainees think apps for smartphones are very useful in clinical practice, 14 (42.4%) think they are useful. A total of 126 urology apps were available. 76 (60.3%) were designed for physicians, 46 (36.5%) for patients, 2 (1.6%) for students and 2 (1.6%) for urological nurses. CONCLUSION There are an ever increasing number of urology apps available. Urology trainees are using smartphones as an educational and reference tool and find them a useful aide in clinical practice.

YouTube as an educational tool regarding male urethral catheterization

Abstract Objective. Urethral catheterization (UC) is a common procedure carried out on a daily basis. The aims of this study were to assess the quality of YouTube as an educational tool regarding male UC and to assess the experience of newly qualified doctors regarding UC. Materials and methods. YouTube was searched for videos containing relevant information about male UC. A checklist for evaluating content for male UC was devised. The top-ranked video was shown to interns and they were questioned regarding their experience of UC and the usefulness of the video. Results. A total of 100 videos was screened and 49 unique videos were identified. The median length of video was 7 min 15 s (range 1 min 44 s to 26 min 44 s). Regarding the Safe Catheter Insertion Score, the mean score was 5.18 ± 1.64. 9 (18.4%) deemed useful, 24 (49%) somewhat useful and 16 (32.7%) not useful. There was no difference in the number of views (p = 0.487), duration of video (p = 0.364) or number of days online (p = 0.123) between those categorized as useful, somewhat useful and not useful. Twenty-six interns (89.7%) attended the UC teaching session. All reported the video to be a useful educational adjunct. Nine of the respondents (42.9%) had independently inserted a urinary catheter before the educational session. Conclusions. The quality of videos on YouTube regarding male UC is widely variable. Preselected videos are deemed useful by junior doctors regarding male UC and can be used as an educational adjunct before performing hands-on tasks.

Direct mechanical characterization of prostate tissue-a systematic review

Direct mechanical characterization of tissue is the application of engineering techniques to biological tissue to ascertain stiffness or elasticity, which can change in response to disease states. A number of papers have been published on the application of these techniques to prostate tissue with a range of results reported. There is a marked variability in the results depending on testing techniques and disease state of the prostate tissue. We aimed to clarify the utility of direct mechanical characterization of prostate tissue in identifying disease states.

On-table urethral catheterisation during laparoscopic appendicectomy: Is it necessary?

INTRODUCTION Laparoscopic appendicectomy (LA) is the most commonly performed surgical emergency procedure. The aim of this study was to highlight a series of iatrogenic bladder injuries during LA and suggest a simple method of prevention. METHODS A retrospective review was carried out of all LA performed in a university teaching hospital over a two year period 2012-2013. Iatrogenic visceral injuries were identified and operative notes examined. RESULTS During the study period 1124 appendicectomies were performed. Four iatrogenic bladder injuries occurred related to secondary trocar insertion. No patient was catheterised preoperatively. One of the injuries was identified intra-operatively, another in the early postoperative period where as two re-presented acutely unwell post-discharge from hospital. Three were repaired by laparotomy and one laparoscopically. CONCLUSION Iatrogenic secondary trocar induced bladder injuries are a rare but preventable and potentially serious complication of LA. Urethral catheterisation during LA is a safe and simple method which can prevent this complication.

Patient satisfaction, safety and morbidity of transrectal ultrasound-guided prostate needle biopsy: results of a retrospective review in an Irish regional hospital

ConclusionsTransrectal prostate biopsy is safe with few major but frequent minor complications. Sedation can significantly reduce patient discomfort and make the procedure more acceptable to the patient.