Are urology residents ready to treat premature ejaculation after their training?

INTRODUCTION: The management of premature ejaculation (PE) among urology residents (URs) in the era of standard definition and new treatments is unknown. AIM: To determine how future urologists currently address PE and to review their adherence to guidelines. METHODS: A specifically designed survey on the preferred approaches to the treatment of PE was given to residents during the Eighth European Urology Education Programme. The results were tabled, and descriptive statistics were used to analyze differences in practice patterns. MAIN OUTCOMES MEASURES: The responses are compared with clinical guidelines and recommendations. RESULTS: A total of 360 URs attended the recommendation course, and 140 answered the survey (response rate: 38.8%). Seventeen (12.1%) of the respondents considered PE to be a very common sexual dysfunction, 62 (44.3%) considered PE to be frequent, 33 (23.6%) considered this condition uncommon, and 28 (20%) did not consider PE to be a dysfunction. Regarding incidents, 67 residents (47.9%) treated one patient per week. To assess PE, 132 (94.3%) used sexual history, 37 (26.4%) used physical examination, 38 (27.1%) used questionnaires, and 4 (2.9%) used laboratory testing. The preferred initial management strategy for PE was psychological/behavioral therapy for 65 (46.4%) residents. Topical anesthetic, andrological referral, and prescription of selective serotonin reuptake inhibitors (SSRIs) on demand were favored by 34 (24.3%), 19 (13.6%), and 8 (12.9%) of the respondents, respectively. Other options were psychiatric referral, which was preferred by two (1.4%) respondents, and prescription of daily SSRIs, which was preferred by two (1.4%) respondents. The preferred secondary treatment for patients who did not improve initially was prescription of SSRIs for on demand, which was 46 (32.9%) respondents. In cases where patients had concomitant erectile dysfunction (ED), 16 (11.4%) URs treated only the ED and 60 (42.9%) treated both conditions. CONCLUSIONS: The majority of URs follow the established guidelines for diagnosis of PE, but not for treatment. The URs have an insufficient medical education in sexual medicine.

Effectiveness of three-dimensional fluoroscopy in percutaneous nephrostomy: an animal model study.

OBJECTIVES: To present, in an experimental study, an assessment of innovative digital fluoroscopy systems with three-dimensional (3D) reconstruction for use in endourologic applications. METHODS: The experiment was performed in a pig model. We used 5 pigs. An obstructive uropathy model was created in the right kidney to dilate the urinary tract for group 1. Group 2 consisted of the nondilated left kidney. After selecting the tract on the 3D image, the lower caliceal group was punctured in the 2 kidneys under fluoroscopic control, to assess the efficiency of the 3D reconstruction when selecting the renal calix to be punctured. RESULTS: The 3D reconstruction system allowed us to obtain reconstruct the pelvis in three dimensions, isolated as the pelvis and renal parenchyma, as well as the adjacent bony relationships. In this study, the success rate was 100% for locating the selected renal calix. CONCLUSIONS: With this 3D reconstruction system, we were able to obtain a series of images that allowed for the study of the volume of the kidney, perfectly determining its renal calix distribution in the operating room. This enabled us to determine the precise delineation of the target calix. We, therefore, consider this new urologic application of fluoroscopy very useful in surgical planning for antegrade access of the upper urinary tract.

The role of the complexed-to-total prostate-specific antigen ratio in predicting the final pathological stage of clinically localized prostate cancer.

OBJECTIVES: To examine the association between the complexed-to-total (C:T) prostate-specific antigen (PSA) ratio and prostate cancer pathological stage to assess whether the C:T PSA ratio may predict the final pathological stage in patients with clinically localized prostate cancer. PATIENTS AND METHODS: In a prospective study, 101 men with clinically localized prostate cancer underwent a staging pelvic lymphadenectomy and radical prostatectomy. Total PSA (tPSA) and PSA complexed to alpha(1)-antichymotrypsin (cPSA) were measured from preoperative plasma and were correlated with the clinical and pathological stage, and with surgical margin status. The pathological stage was determined as organ-confined (n=59) and extracapsular extension (n=42). RESULTS: The distributions of tPSA and cPSA were significantly different in men with locally confined and those with locally extended disease. This finding was not observed for the C:T PSA ratio. The area under the receiver operating characteristic (ROC) curve to predict the final pathological stage was significantly greater for tPSA (0.684) and cPSA (0.677) than for the C:T PSA ratio (p<0.032). TPSA (0.685) and cPSA (0.670) also showed areas under the ROC curve greater than that of the C:T PSA ratio (0.542) (p<0.05) for prediction of positive surgical margins. CONCLUSIONS: Our results show that the C:T PSA ratio does not improve the performance of total PSA for predicting the final pathological stage in patients with clinically localized prostate cancer.