Development and assessment of an ex-vivo bench model aimed at laparoscopic ureteric reconstructive techniques.

INTRODUCTION/BACKGROUND: Reconstructive and ablative urologic techniques require special technical mastery, especially the intracorporeal suturing. OBJECTIVE: To report the subjective evaluation of a versatile ex-vivo model aimed to practice laparoscopic ureteric reconstructive techniques (LURT) on box-trainer. STUDY DESIGN: The model is a continuous portion of porcine urinary bladder ("dilated pelvis"), the vesico-ureteral joint ("stenosis") and healthy ureter. All 127 participants (n = 119 urologists and n = 8 paediatric surgeons) performed on the model laparoscopic Anderson-Hynes dismembered pyeloplasty, and then, in the animal model, different LURT procedures (ureteroneocystostomy, ureteric reimplantation and/or dismembered pyeloplasty). The model was subjectively evaluated (face and content validity), through a 12 items questionnaire, based on a Likert scale (1-5 points) and a global question (1-10 points). RESULTS: The total mean rating for 11/12 items was very high (>4points). Only one was rated under 3 points. The overall total mean rating from 1 to 10 points was very high (9.19 ± 0.82 points). In 10/12 items, expert's feedback (content validity) prevailed over non-experts (face validity). DISCUSSION/CONCLUSION: The model was highly accepted for the practice of LURT techniques. Additionally, it is cost-effective, easy to assemble, ethically considerate, and realistic.

The assessment of surgical skills as a complement to the training method. Revision.

CONTEXT AND OBJECTIVE: The acquisition and improvement of surgical skills constitute a fundamental element in the training of any practitioner. At present, however, the assessment of these skills is a scarcely developed area of research. The aim of this study was to analyse the peculiarities of the various assessment systems and establish the minimum criteria that a skills and knowledge assessment system should meet as a method for assessing surgical skills in urological surgery. ACQUISITION OF EVIDENCE: Scientific literature review aimed at the various currently available assessment systems for skills and competencies (technical and nontechnical), with a special focus on the systematic reviews and prospective studies. SUMMARY OF THE EVIDENCE: After conducting the review, we found that the various assessment systems for surgical competence have, in our opinion, a number of shortcomings. There is a certain degree of subjectivity in the assessment of surgeons by the evaluators. The assessment of nontechnical competencies is not formally recorded. There is no description of a follow-up assessment or any basic parameters associated with healthcare quality. There is no registration of associated competencies associated with the various surgical techniques. There is also no ranking of these competencies and the specific peculiarities for their application. CONCLUSIONS: We believe that the development of a new assessment system for surgical competencies (technical and nontechnical) aimed at assessing urologists in the various surgical techniques is necessary. To this end, our team has worked on developing the Evaluation System for Surgical Competencies on Laparoscopy, which is based on the definition, ranking and assessment of competencies demonstrated by surgeons.

[Penile fracture: diagnostic assessment and therapeutic approach. Review of the literature]. / Fractura de pene: evaluación diagnóstica y actitudes terapéuticas. Revisión de la literatura.

OBJECTIVE: Rupture of the corpus cavernosum is an uncommon condition that requires immediate treatment in the emergency services. The diagnostic methods and therapeutic approaches are discussed and the literature reviewed. METHODS: Two cases of rupture of the corpus cavernosum diagnosed 8 years and 3 months earlier are presented. One was treated conservatively and the other was submitted to early surgical management. Images showing the technique utilized for cavernosal repair in one of the patients and the satisfactory clinical course of both patients are presented. RESULTS/CONCLUSIONS: Rupture of the corpus cavernosum is an uncommon urological emergency in our setting. Patient history and examination are diagnostic in most of the cases. Early surgical management is advocated.

[Assessment of double-J ureteral catheters at a lithotripsy unit: our experience]. / Evaluación de los catéteres ureterales tipo doble J en una unidad de litotricia: nuestra experiencia.

The present study evaluated a total of 350 patients who underwent placement of double-J catheters as a result of their lithiasic condition. The work includes a review of the patients' urological background, indication for the double-J placement, tolerance to catheter, time of permanence, reason for withdrawal, presence of encrustations in the catheter and relationship between all these parameters. A significant increase of adverse symptoms was observed when permanence of the double-J catheter lasted longer than 6 weeks. Likewise, there was a significant increase in the number of encrustations in catheters retained longer than 6 weeks, as well as when the lithiasic mass was meaningful and urine cultures were positive. The authors consider that double-J catheters effectively prevent the complications of the lithiasic condition but an excessively long permanence, more than 6 weeks, increases occurrence of side-effects significantly.