Assessment of clinically significant urolithiasis positivity rate using CT KUB for suspected renal colic.

BACKGROUND: Unenhanced low-dose computed tomography of the kidneys, ureter and bladder (CT KUB) is the gold standard diagnostic imaging modality in the assessment of suspected renal colic. As the radiation dose is not negligible, it is important to monitor the diagnostic yield of CT KUBs. The aim of this study is to evaluate the diagnostic yield of CT KUB studies performed for suspected renal colic in patients presenting to the emergency department. METHODS: A retrospective review was performed of 500 patients who underwent CT KUB for suspected renal colic over a seven month period from June 2019 to January 2020. Clinical information and imaging was reviewed for each patient. Statistical analysis was performed using GraphPad Prism 8 (GraphPad Software, San Diego, CA, USA). RESULTS: Forty-nine percent of patients in the series were female (248/500) and the mean age was 45. The positivity rate for obstructing ureteral calculus was 34% (169/500). Concerningly, there was a significantly lower positivity rate in females compared to males (19% versus 48%; p < 0.0001) which raises the issue of unnecessary radiation exposure to this cohort. In the 200 female patients who were negative for obstructing urolithiasis, the mean age was 43. Females also had a significantly higher rate of negative CT KUB (62% versus 37%; p < 0.0001) where no underlying alternative pathology was diagnosed. CONCLUSIONS: Women are less likely than men to have obstructing urolithiasis on CT KUB for suspected renal colic. This difference is not accounted for by a higher rate of alternative diagnoses among female patients. The findings of this study should prompt clinicians to exercise caution when considering this imaging modality in this patient cohort.

Robotic simulation training for urological trainees: a comprehensive review on cost, merits and challenges.

Simulation in surgery is a safe and cost-effective way of training. Operating room performance is improved after simulation training. The necessary attributes of surgical simulators are acceptability and cost-effectiveness. It is also necessary for a simulator to demonstrate face, content, predictive, construct and concurrent validity. Urologists have embraced robot-assisted surgery. These procedures require steep learning curves. There are 6 VR simulators available for robot-assisted surgery; the daVinci Skills Simulator (dVSS), the Mimic dV Trainer (MdVT), the ProMIS simulator, the Simsurgery Educational Platform (SEP) simulator, the Robotic Surgical Simulator (RoSS) and the RobotiX Mentor (RM). Their efficacy is limited by the lack of comparative studies, standardisation of validation and high cost. There are a number of robotic surgery training curricula developed in recent years which successfully include simulation training. There are growing calls for these simulators to be incorporated into the urology training curriculum globally to shorten the learning curve without compromising patient safety. Surgical educators in urology should aim to develop a cost-effective, acceptable, validated simulator that can be incorporated into a standardised, validated robot-assisted surgery training curriculum for the next generation of robotic surgeons.

Efficacy of urodynamic studies in predicting long-term outcomes of the transobturator tape: do they augment clinical assessment?

INTRODUCTION: Some controversy exists regarding necessity for urodynamic evaluation prior to surgical management of stress urinary incontinence (SUI). We aimed to interrogate the role of pre and post-operative urodynamic studies versus clinical assessment in predicting long-term patient reported outcomes of transobturator tape (TOT) placement. MATERIAL AND METHODS: A 100 patient cohort of women post TOT insertion for stress/mixed urinary incontinence 2005-2010, under a single surgeon, was identified. Results of pre and post-operative clinical assessment and urodynamic studies were retrospectively evaluated. Long-term patient reported outcome measures (PROMs) were assessed using the International Consultation on Incontinence Questionnaire (ICIQ) Short Form, Patient Global Impression of Severity (PGI-S) and Patient Global Impression of Improvement (PGI-I) questionnaires. The role of urodynamic studies in predicting postoperative voiding dysfunction, and long-term procedure outcomes was analysed. Statistical correlations were performed using SPSS. RESULTS: Questionnaire response rate was 76/100 (76%) at mean follow-up 9.4 years (7.25-12.75). Mean ICIQ score was 6.32 (1-20). No significant correlations between preoperative pDet QMax and postoperative uroflow/duration of intermittent self catheterisation (ISC), or between preoperative leak-point pressures and outcome were observed. Postoperative urodynamic tests did not reliably predict long-term success in SUI cure. Preoperative clinical urgency was a more reliable predictor of long-term clinical urgency than urodynamic detrusor overactivity. Whilst patients with mixed urinary incontinence at long-term follow-up tended to have the highest (worst) overall ICIQ-SF and ICIQ quality of life score, no studied variables on preoperative CMG were significantly correlated with long-term PROMs. CONCLUSIONS: Whilst urodynamic studies provide important baseline bladder function data, prior to mid-urethral sling placement, this study finds no specific value of either pre or postoperative urodynamics in predicting long-term patient reported outcomes of transobturator tape placement.

Identification and Cost of Disposable Endourological Devices for Nephrolithiasis: A Cross-Sectional Study Among Urological Trainees.

INTRODUCTION: Knowledge on health economics among urology trainees is not formally assessed. The cost of commonly utilised endourological devices may not be considered by trainees. AIM: The present study was conducted with the aim to assess whether urology trainees were knowledgeable on identification and cost of commonly used disposable devices in the management of nephrolithiasis. MATERIALS AND METHODS: Forty urology trainees in Ireland were invited to complete a visual online questionnaire on the identification of 10 frequently utilised disposable endourological devices. In addition, trainees were requested to estimate the cost of 12 disposable endourological devices. Responses were stratified according to trainee grade and urological subspecialty of interest. Data are presented as a mean ± standard deviation. RESULTS: The response rate was 70% (28/40). Endourology was the subspecialty of interest in 21% (n= 6). No trainee correctly identified all 10 endourological devices and the mean test score was 5.32 ± 2.28. No trainee accurately estimated the cost for all 12 devices assessed. The cost of endourological devices was underestimated by €67.13 ± €60.76 per device. A total of 54% (n=15) of trainees underestimated the total cost of disposable devices used during standard flexible ureterorenoscopy, laser lithotripsy and JJ stent insertion by €303.66 ± €113.83. CONCLUSION: Our findings indicate deficiencies in trainee knowledge on endourological devices and their associated costs. Incorporating a health economics module into postgraduate urology training may familiarise trainees with healthcare expenditure within their departments.