Surgical mesh information on YouTubeTM: Evaluating the usage and reliability of videos for patient education.

INTRODUCTION: Patients in search of answers to health-related questions often seek out information on the internet. The current study aimed to evaluate the quality of videos on the topic of mesh pertaining to its use in the treatment of stress urinary incontinence or pelvic organ prolapse. METHODS: A total of 100 videos on the topic of mesh on YouTubeTM were screened in this study. From that, a further 30 were selected for review. Five experts in the medical field reviewed each video anonymously, using two video assessment tools. Video characteristics were collected and evaluated. Videos were assessed based on a Global Assessment Score (GAS) and Patient Education Tool for Audiovisual Materials (PEMAT-A/V) scale for ease of patient access and comprehension. The overall correlation between raters and videos was also compared. RESULTS: The GAS and PEMAT-A/V ratings correlation across multiple raters demonstrated excellent inter-rater reliability. We found that the overall GAS score and recommendation was substandard, and the median PEMAT-A/V understandability score was 70% (poorly understandable). Most videos contained some form of marketing, and a scarce number had reliable sources of information. Evidence of neutrality was low. CONCLUSIONS: Through the expert assessment of videos using quality assessment tools, this study demonstrated the overall variable quality of mesh videos on YouTubeTM and the need for further education regarding patient resources.

An update on urethral diverticula: Results from a large case series.

INTRODUCTION: We aimed to describe the presentation, investigations, and management of patients with urethral diverticula and to review the importance of magnetic resonance imaging (MRI) in the diagnosis and surgical management of urethral diverticula. METHODS: This was a retrospective review of female patients who underwent urethral diverticulectomies. This study was approved by the research ethics review board. Data was collected on patient demographics, presenting symptoms, investigations performed, operative technique, and minimum of two-year followup. RESULTS: A total of 17 patients were included in this study, with a median age of 43 years. Most patients (70%) presented with a palpable vaginal lump; 64% presented with either lower urinary tract symptoms (LUTS) or recurrent urinary tract infections (UTIs). Patients underwent a preoperative MRI, which demonstrated that 59% of diverticula were distal and 53% were locally round. These imaging findings were consistent with the operative findings. MRI also demonstrated communication between the urethral diverticulum and the urethral lumen in 80% of cases, compared to only 47% endoscopically. CONCLUSIONS: The most common presentation of a woman with a urethral diverticulum is with either a palpable vaginal lump, LUTS, or recurrent UTIs. A high index of suspicion is required. Pelvic MRI appears to be an ideal imaging modality for the diagnosis of urethral diverticulum. A preoperative MRI is important to exclude alternative pathologies, appropriately counsel the patient, and assist with the surgical planning.

Women doctors in female urology: current status and implications for future workforce.

OBJECTIVE: To objectively determine the percentage of female trainees and consultants who are interested in their career being focussed on female urology (FU) in order to facilitate the improved planning for the future of this sub-specialty. SUBJECTS AND METHODS: This was an international cross-sectional study spanning 1 year, from December 2018 to December 2019. An anonymous, voluntary survey was generated using the online survey generator Survey monkey® . The survey was sent to urology consultants and trainees who were female from Australia, New Zealand, and Canada. RESULTS: The total response rate to the survey was 61%. Up to 50% of female consultants and trainees selected a career in FU due to their gender, but up to 75% of respondents were also interested in FU of their own accord. Common concerns held by a majority of respondents included both the medical community's and the public's lack of awareness of FU as a component of urological expertise. Despite these concerns, most of the trainees were not concerned regarding their future work opportunities in FU, and many had intentions to pursue a fellowship in FU. CONCLUSION: Female urology is an increasingly popular sub-specialisation of urology, given the steady increase in the intake of female trainees. Similar trends were identified internationally. Urology training in this area will need to continue to increase the community's and the primary health care referrer's awareness in order to ensure the continued success and growth of the sub-specialty.

Lower Urinary Tract Functional Assessment of Men Undergoing Radical Prostatectomy: Correlation of Preoperative Clinical and Urodynamic Parameters.

PURPOSE: To assess baseline clinical and urodynamic profiles of a contemporary cohort of men undergoing radical prostatectomy (RP) as part of the ROSE (Robotic and Open Surgery for Prostate Cancer: A Prospective, Multi-centre, Comparative Study of Functional and Oncological Outcomes) study. METHODS: Men with localized prostate cancer undergoing RP were prospectively recruited to undergo clinical assessment and urodynamic testing prior to surgery as part of a clinical trial. The International Prostate Symptoms Score (IPSS) was used to determine participants' degree of lower urinary tract symptoms (LUTS). RESULTS: Eighty-five men with a median age of 64.5 years and a median prostate-specific antigen level of 6.3 ng/mL were prospectively recruited. Of patients with complete baseline data, 36 (50.7%), 28 (39.4%), and 7 (9.9%) had mild (IPSS<8), moderate (IPSS 8-19), and severe (IPSS>20) LUTS, respectively. Obstruction was identified in 18 men (29.5%), and 9 (14.8%) showed detrusor underactivity. Of the 15 patients with detrusor overactivity, 12 (80%) reported overactive bladder (OAB). Of men with urodynamic obstruction, 5 (31.3%), 10 (62.5%), and 1 (6.3%) reported mild, moderate, and severe LUTS, respectively. Of men without OAB, 4 (11.8%, P=0.002) showed filling phase abnormalities, 13 (46.4%, P=0.611) had flow rates of <15 mL/sec, and 7 (30.4%, P=0.767) showed obstruction. Of men with mild or no LUTS, 5 (20%, P=0.072) showed obstruction and 4 (16%, P=0.524) showed poor contractility. CONCLUSION: LUTS and OAB were common in men with localized prostate cancer undergoing RP. Detrusor overactivity and urodynamic filling phase abnormalities were strongly correlated with OAB. IPSS did not show a strong correlation with bladder outflow obstruction or detrusor underactivity. Urodynamic filling abnormalities were found in 11.8% of men without OAB. Symptomatic and functional assessment may therefore have a role in the preoperative counselling of patients and possibly guide postoperative management of LUTS, especially if OAB is present.

Lessons Learned and New Challenges: Re-evaluation of End-User Assessment of a Skills-Based Training Program for Urology Trainees.

OBJECTIVES: To re-assess the perceived benefit and relevance of simulation sessions to Victorian urology trainees and to identify areas for potential improvement. SUBJECTS AND METHODS: All trainees attending skills training sessions between 2011 and 2016 were asked to complete a structured questionnaire at the completion of the session. The questionnaire included 11 topic areas ranging from the year of surgical training to degree of usefulness of the session, including several sections for free-text response to offer more detailed feedback. Sessions were examined both individually and collectively to assess end-user satisfaction with the structure and content of the program. RESULTS: In total, 24 individual skills sessions were held over the 6-year period, with a total of 355 attendees. Of these, 331 attendees completed the majority of the questionnaire, a response rate of over 93%. Overall 88% of the surveyed attendees stated that they had both the support of their supervising consultant and the flexibility of workload to attend the session; 90% of trainees felt that there was adequate reading material provided prior to the skills session, an improvement from 76% in the previous study period; and 97% of those surveyed felt that the existing session structure was appropriate and the same proportion found the sessions both useful and interesting, compared with just 63% in the previous study period. Analysis of individual topics demonstrates some variability in outcome measures, but for nearly every assessed parameter, greater than 90% of participants agreed that the session fulfilled the expected criteria. New topics developed since the 2011 analysis, including renal transplant and vascular repair, also had high levels of satisfaction. The practical models used have been refined and achieved higher scores than those in the previous assessment period. CONCLUSION: The urology skills-based training program has been well received by the surveyed trainees and is now embedded and accepted as part of the Victorian training program. The format of the sessions has matured and the overall rating, both individually and collectively, was high. There has been a clear increase in satisfaction across most areas assessed when compared with previous feedback. Despite this, there remain areas that can be improved, such as the amount and quality of available equipment and the inclusion of video demonstrations of operative techniques.

From humble beginnings the evolution of the FRACS (Urology).

BACKGROUND: Surgery has a rich and colourful history dating as far back as, at least, the Neolithic period. There have been many advances in knowledge and technology, as well as changes to working conditions and public perception and expectations. The urology training programme is jointly managed by the Royal Australasian College of Surgeons and the Urological Society of Australia and New Zealand. Urological training in Australia and New Zealand has undergone a number of changes over the years. METHODS: A PubMed search was performed to find articles related to surgical training and, more specifically, urological training in Australia and New Zealand. The search terms that were used included 'urology training', 'surgical training', 'Australian urology history' and 'New Zealand urology history'. RESULTS: This narrative review outlines the origin and history of this training programme and describes the changes that have led to the current model of urology training. It also relates some of the current and future challenges faced as the training programme continues to evolve in order to improve its ability to train future urologists to meet the needs of the community and to ensure public safety. CONCLUSION: The urological training programme has evolved a number of times in order to tackle the challenges presented by evolving technology, community expectation and the needs of the trainee.

Penile Epithelioid Angiomatoid Nodule.

Cutaneous epithelioid angiomatoid nodule is a rare clinical entity that is common on the trunk and limbs. This is the first report of penile cutaneous epithelioid angiomatoid nodule. Although it is a benign entity, it must be differentiated from vascular neoplasms, as it can bear similar clinical and pathologic features.

Does levator avulsion increase urethral mobility?

OBJECTIVE: It is often assumed that stress urinary incontinence may be due to abnormal pelvic floor muscle function or anatomy. This may be mediated through urethral hypermobility. The aim of the study was to determine the association between major levator ani defects ('avulsion') and urethral mobility. STUDY DESIGN: Three hundred and five women were referred to a tertiary referral service for lower urinary tract and prolapse symptoms between December 2006 and July 2008. All patients had undergone an interview, clinical examination, multichannel urodynamic testing and 4D transperineal ultrasound. Ultrasound volume datasets of 198 women were analysed retrospectively. Tomographic ultrasound imaging was used to diagnose levator avulsion at the time of the original assessment. To determine urethral mobility, data analysis was performed on a desktop PC using proprietary software several months later. The urethra was divided into 5 equal segments with 6 points marked evenly along the urethra from the bladder neck (Point 1) to the external meatus (Point 6) as identified in the mid-sagittal view. Measurements of vertical and horizontal distances from the dorsocaudal margin of the pubic symphysis of these 6 points were taken in the mid-sagittal plane, using volume datatsets obtained at rest and on maximal Valsalva. Mobility vectors of these 6 points were calculated using the formula SQRT ((x(valsalva)-x(rest))(2)+(y(valsalva)-y(rest))(2)) and were correlated with levator status using two sample T tests. RESULTS: Levator avulsion was found in 18% of patients (n=35). Except at the bladder neck which almost reached significance (32.5mm in those with defects vs. 28.9 mm in those without, P=0.07), there was no significant association between urethral mobility and avulsion (all P≥0.17). CONCLUSION: Major levator trauma does not seem to substantially affect urethral mobility, with the possible exception of the bladder neck.