External validation of a prostate biopsy simulator.

INTRODUCTION: Simulation-based training has proven to be a promising option allowing for initial and continuous training while limiting the impact of the learning curve on the patient. The Biopsym simulator was developed as a complete teaching environment for the prostate biopsy procedure. This paper presents the results of an external validation of this simulator, involving urology residents recruited during a regional teaching seminar. METHODS: Residents from 4 academic urology departments of the French Auvergne Rhône-Alpes region, who did not take part in the previous simulator validation studies, were enrolled. After a short presentation and standardized initiation session, residents carried out a simulated systematic 12-core biopsy procedure and were asked to fill in a questionnaire collecting their expectations and evaluation of the Biopsym simulator. The number of biopsies reaching each targeted sector, the total score provided by the simulator and the duration of the procedure were recorded. RESULTS: Twenty-three residents were recruited. The overall added value (/100) for learning was rated at a median of 100 (interquartile range 83-100), overall realism of the biopsy procedure at 80 (65-89). The median percentage of biopsies reaching the targeted sector was 66.7% (62-75). The median score provided by the simulator was 50% (37-60). For both, the difference between residents with or without prior biopsy experience was not statistically significant. The median duration of the simulated biopsy procedure was 4:58 (minutes: seconds) (3:49-6:00). Resident with prior experience required less time to complete the biopsy procedure 3:53 (3:39-4:56) vs. 5:10 (4:59-7:10), P=0.01. CONCLUSION: This external validation study confirms a high acceptance of the simulator by the target audience. To our knowledge, the Biopsym simulator is the only prostate biopsy simulator that demonstrated such validity as evaluated by clinicians, outside the center involved in its early development. LEVEL OF EVIDENCE: 3.

Torsion of the spermatic cord in adults: a multicenter experience in adults with surgical exploration for acute scrotal pain with suspected testicular torsion.

Acute scrotal pain (ASP) requiring surgical exploration is common in the pediatric population, but little has been reported on this subject with regard to the adult population. The aim of this study was to investigate the demographic and clinical characteristics and outcomes of scrotal explorations performed on adult patients. Patients over 21 years of age who underwent surgical exploration for ASP with suspected testicular torsion (TT) at 14 French hospitals between January 2005 and December 2019 were included in this study. The main outcome measures were demographic characteristics, pathology found during scrotal exploration, and perioperative outcomes. Logistic regression was used to perform univariate and multivariate analyses to identify predictors of TT. Data for 1329 men were analyzed. The median age was 30 (interquartile range [IQR]: 25-35; range: 21-89) years. Regarding the clinical examination, 867 (65.2%) patients presented with an elevation of the testicle, 613 (46.1%) patients with scrotal edema or erythema, and 211 (15.9%) patients with nausea or vomiting. Operative findings identified TT in only 684 (51.5%) patients, epididymo-orchitis in 112 (8.4%) patients, a tumor in 16 (1.2%) patients, and no causes in 475 (35.7%) patients. Orchiectomy for nonviable testes was required in 101 (7.6%) patients. In multivariate analysis, an elevation of the testicle, erythema/swelling, and the presence of nausea/vomiting were found to be associated with the occurrence of TT. Testicular torsion is not exclusive to children and adolescents, so must be considered in males of any age with acute scrotal findings. However, one-third of scrotal explorations in adults did not lead to a diagnosis.