Virtual reality simulator metrics cannot be used to assess competence in ureteronephroscopy and stone removal - a validation study.

OBJECTIVE: The growing use of simulation-based training makes it necessary to develop efficient training programs in order to ensure optimal use of time and resources. Our aim was to develop and gather validity evidence for a simulation-based test in ureteronephroscopy and set a pass/fail standard for the test that will allow future mastery learning. DESIGN: This study is a validation study. A test in ureteronephroscopy and stone removal on the URO Mentor™ virtual reality simulator (3D Systems, USA) was developed by two experienced urologists in order to ensure content. Participants with different experience completed three standardized tasks on the simulator and simulator-generated metrics were used as outcome parameters to minimize bias and ensure a fair response process. RESULTS: Twenty novices, 15 intermediates, and 8 experienced urologists were included in the study. Validity evidence for internal structure and relationship to other variables was questionable with weak and mostly insignificant correlations across all four metrics (Cronbach's alpha = 0.14, p = 0.15) and across the three modules (Cronbach's alpha = 0.41 (p = 0.02), 0.35 (p = 0.06), 0.10 (p = 0.35), and 0.30 (p = 0.09) for each metric, respectively). It was not possible to establish a pass/fail score for the simulation test with meaningful consequences. CONCLUSION: Our study showed that automatically generated simulator metrics cannot be used as a valid way of assessing competence in ureteronephroscopy. Virtual-reality simulator training could still be a valuable and patient-safe way to practice these skills, but an experienced supervisor is needed to determine when the trainee is ready to continue to supervised practice on patients.

Associations between statin use and progression in men with prostate cancer treated with primary androgen deprivation therapy.

INTRODUCTION: In several observational studies, statin use has been associated with reduced risk of progression and mortality in men with prostate cancer (PCa). The study aim was to investigate the association between statin use at time of PCa diagnosis and time to PCa progression in men with advanced or metastatic PCa receiving androgen deprivation therapy (ADT) as primary treatment. PATIENTS AND METHODS: The study population consisted of all men receiving ADT as primary therapy at two Danish Urological Departments in 2007-2013. The primary outcome was time to progression defined as castration-resistant PCa (CRPC) or PCa death. Survival analyses were conducted with Kaplan-Meier analyses, cause specific Cox proportional hazards models, and competing risk analyses. RESULTS: A total of 537 men were included, of whom 141 were statin users at time of diagnosis. The median follow-up time was 5.7 years (95% CI: 5.1-6.2). No significant difference in progression-free survival between statin users and non-statin users was observed at 5 years; 29% for statin users (95% CI: 19-40%) and 28% (95% CI: 23-34%) for non-statin users, p = 0.31. In multivariable Cox analyses, there was no significant association between statin use and risk of progression, HR 0.98 (95% CI: 0.72-1.32). In competing risk analyses the 5-year cumulative incidence of progression was 55% (95% CI: 46-64%) for statin users and 62% (95% CI: 57-67%) for non-statin users, p = 0.11. CONCLUSION: In the current study, statin use at time of PCa diagnosis was unrelated to time to progression in men primarily treated with ADT.

[Treatment of erectile dysfunction after radical prostatectomy should be in accordance with standard regimens]. / Mænd med rejsningsbesvær efter radikal prostatektomi bør behandles efter sædvanlige retningslinjer.

Penile rehabilitation programmes aim to improve long-term sexual function after nerve-sparing radical prostatectomy. Programmes aim to improve cavernous oxygenation to avoid structural damage in penile tissue. Especially, daily use of phosphodiesterase type 5 (PDE5) inhibitors has been studied. The method is effective in animal models, but the results cannot be confirmed in humans. At this time, treatment regimens which actually create erections and allow for sexual intercourse following surgery should be prescribed. These include PDE5 inhibitors, vacuum erection devices, injection therapy, urethral suppositories and penile implants.

Spina bifida and sexuality.

OBJECTIVE: To evaluate sexual function amongst adult individuals with spina bifida and to register their subjective satisfaction with their sexual life and relationships. SETTING: Department for Spinal Cord Injuries, East Denmark. STUDY DESIGN AND METHODS: Cohort study. Medical record information, neurological examination, personal interview, Functional Independence Measure (FIMTM), Medical Outcome Study Short Form 36 (SF-36) on quality of life, and questions on sexual function and related topics. Study cohort: Fifty-three participants (27 women, 26 men) with spina bifida (mean age 27.1, range 18-35) years. Response rate 74%. RESULTS: Fifty-one percent of subjects regarded their sexual life as a failure or dysfunctional. However, 45% reported being satisfied with their sexual life. Participants with partners were more satisfied with their sexual life than those without partners. Faecal, but not urinary, incontinence was associated with poorer sexual function and less satisfaction. Forty-nine percent of subjects indicated that the sexual education they received at puberty was useful; however, 32% lacked knowledge about their sexual functioning with regard to their disability. CONCLUSION: There is a need for further sexual education and counselling for adults with spina bifida in order to improve their sexuality and quality of life.

Sexual function in a traumatic spinal cord injured population 10-45 years after injury.

OBJECTIVE: To examine sexual function at least 10 years after traumatic spinal cord injury. STUDY DESIGN: Cross-sectional questionnaire plus retrospective and prospective data from medical files. SUBJECTS: A total of 279 individuals with traumatic spinal cord injury. RESULTS: For spinal cord injured women: 94% had no problems with impaired vaginal lubrication; 22% had given birth after the injury; and 69% reported being satisfied with their sexual life. The women who were satisfied with their sexual life were younger than those who were not, and were younger at the time of injury. For spinal cord injured men: 75% could achieve erection, and they were younger than those who could not achieve erection; 35% used aid(s) for erection; 78-94% had positive reported effect of penile vibration, drugs and intracavernous injection for erection; 44% could achieve ejaculation, and they were younger than those who could not; 56% used aid(s) for ejaculation; 19% had made a woman pregnant, and a higher frequency of these men could achieve erection and ejaculation; 54% reported being satisfied with their sexual life; and significantly more men who had made a woman pregnant were satisfied with their sexual life. For both genders problems regarding bladder and bowel management, pressure ulcers, spasticity or pain correlated with lower satisfaction with sexual life.

Urinary calculi following traumatic spinal cord injury.

OBJECTIVE: To investigate the time aspect of the development of renal and bladder calculi in individuals with traumatic spinal cord injury (SCI) and a possible relation between the development of calculi and the bladder-emptying method. MATERIAL AND METHODS: The study comprised a retrospective data collection from medical records and a questionnaire follow-up at least 10 years after the SCI. RESULTS: A total of 236 individuals with SCI (82% male, 18% female; 47% tetraplegic, 53% paraplegic) who were injured between 1956 and 1990 participated in the study and the response rate was 84.6%. The mean age at the time of follow-up was 50.5 years (range 28-84 years). The mean duration from the time of SCI was 24.1 years (range 10-45 years). During follow-up 47 participants (20%) had at least one episode of renal calculi and 32 (14%) had at least one episode of bladder calculi. The risk of first renal and bladder calculus was highest within the first 6 months post-injury. The cumulative proportion of calculi-free participants 45 years post-injury was 62% for renal calculi and 85% for bladder calculi. For participants who did not develop renal calculi within the first 2 years post-injury, the risk of having a renal calculus within the next 43 years was 34%. For bladder calculi the corresponding risk of having a bladder calculus within the next 43 years was 5%. No significant differences were found regarding the bladder-emptying method and either renal or bladder calculi, only a non-significant trend that more participants with bladder calculi used indwelling catheters. Participants with renal or bladder calculi were not statistically significantly different from the remainder of the study group regarding gender, para- or tetraplegia or Frankel classification. CONCLUSIONS: The risk of developing renal and bladder calculi was higher in the SCI population compared to the normal population. Bladder calculi primarily occur early post-injury and renal calculi appear both early post-injury and years later. Therefore, it is important to follow individuals with SCI regularly by means of urological investigations from the time of the injury until death.