Professional roles of female urologists: A webinar-based survey of perceptions and obstacles to career development.

BACKGROUND: Urology, traditionally a maledominated specialty, keeping pace with the quickly changing gender landscape, has been characterized by waves of feminization. This study aims to understand the perspectives of women urologists on the obstacles to their career development, and the impact of such hurdles on their professional roles in urological education, practice, and leadership. METHODS: 119 female urology residents/consultants were surveyed via a webinar-based platform, covering relevant questions on domains of Academia, Mentorship, Leadership, Parenting, and Charity. Statistical analysis was done using frequency distribution based on the responses. RESULTS: 46.8% of the respondents felt that there is an under-representation of women in academia. 'Having a good mentor' was the most important factor for a novice to succeed in academia (68%). The most important trait in becoming a good leader was 'good communication skills' (35%), followed by 'visionary' (20%). The greatest challenge faced by leaders in the medical field was considered as 'time management' (31.9%). Only 21.2% of the participants felt difficulty in having a work-personal life balance, whereas 63.8% of them found it difficult only 'sometimes'. As a working parent, 'the guilt that they are not available all the time' was considered the most difficult aspect (59.5%), and 'more flexible schedule' was needed to make their lives as a working parent easier (46.8%). 34% of the respondents were affiliated with some charitable organizations. The biggest drive to do charity was their satisfaction with a noble cause (72.3%). CONCLUSIONS: Need for increased encouragement and recruitment of females into urology, and to support and nurture them in their career aspirations.

Gallic acid reduces the viscosity and water binding capacity of soluble dietary fibers.

Water binding capacity and viscosity of soluble dietary fibers are known to be essential drivers of their nutritional benefits. Phenolic compounds, often found in the presence of dietary fibers, are also known to bind non-covalently with soluble dietary fibers. In this study, we characterized the impact of gallic acid (1-30 mM) on the physical properties of four soluble dietary fibers in solution (0.75% w/w oat ß-glucans with medium and high molecular weights, 0.75% w/w guar galactomannan and 0.5% w/w xanthan mannoglucuronoglucan). Isothermal titration calorimetry and particle size analysis showed that gallic acid and soluble dietary fibers formed poorly dissociable non-covalent complexes, leading to colloidal aggregation of the fibers. Upon complexation, the physical properties of the fibers changed dramatically with up to a 65% increase in water mobility (reflecting a dramatic decrease in water binding capacity), up to a 41% increase in pseudo-plastic behavior leading to near-Newtonian behavior, and up to a 95% decrease in viscosity. This suggests that combinations of free phenolic compounds and soluble dietary fibers may be detrimental to the physical and potentially the nutritional properties of the fibers.

Defining a national reference level for intraoperative radiation exposure in urological procedures: FLASH, a retrospective multicentre UK study.

OBJECTIVES: To define reference levels for intraoperative radiation during stent insertion, ureteroscopy (URS), and percutaneous nephrolithotomy (PCNL); to identify variation in radiation exposure between individual hospitals across the UK, between low- and high-volume PCNL centres, and between grade of lead surgeon. PATIENTS/SUBJECTS AND METHODS: In all, 3651 patients were identified retrospectively across 12 UK hospitals over a 1-year period. Radiation exposure was defined in terms of total fluoroscopy time (FT) and dose area product (DAP). The 75th percentiles of median values for each hospital were used to define reference levels for each procedure. RESULTS: Reference levels: ureteric stent insertion/replacement (DAP, 2.3 Gy/cm2 ; FT, 49 s); URS (DAP, 2.8 Gy/cm2 ; FT, 57 s); PCNL (DAP, 24.1 Gy/cm2 ; FT, 431 s). Significant variations in the median DAP and FT were identified between individual centres for all procedures (P < 0.001). For PCNL, there was a statistically significant difference between DAP for low- (<50 cases/annum) and high-volume centres (>50 cases/annum), at a median DAP of 15.0 Gy/cm2 vs 4.2 Gy/cm2 (P < 0.001). For stent procedures, the median DAP and FT differed significantly between grade of lead surgeon: Consultant (DAP, 2.17 Gy/cm2 ; FT, 41 s) vs Registrar (DAP, 1.38 Gy/cm2 ; FT, 26 s; P < 0.001). CONCLUSION: This multicentre study is the largest of its kind. It provides the first national reference level to guide fluoroscopy use in urological procedures, thereby adding a quantitative and objective value to complement the principles of keeping radiation exposure 'as low as reasonably achievable'. This snapshot of real-time data shows significant variation around the country, as well as significant differences between low- and high-volume centres for PCNL, and grade of lead surgeon for stent procedures.

Malignant transformation of a urachal cyst-a case report and literature review.

Urachal remnant diseases are very uncommon pathologies which are mostly benign. Rarely they can progress to a very aggressive form of Urachal cancer. The rarity of this condition has precluded large studies to help guide the diagnostic and therapeutic management of these potentially malignant lesions. In this case, a urachal cyst was discovered and conservative management was employed after a biopsy proved the lesion was benign. Unfortunately this patient represented several years later with a locally advanced urachal cancer. To date, this is the first clearly documented case of malignant transformation. The available literature surrounding these urachal cysts and cancers will be reviewed to determine if anything could have been done differently in this case and in the future should a similar case present.

The role of the multiparametric MRI in the diagnosis of prostate cancer in biopsy-naïve men.

PURPOSE OF REVIEW: To review the role of prebiopsy multiparametric MRI in biopsy-naïve men for the detection of clinically significant prostate cancer. RECENT FINDINGS: Recent level 1 evidence shows that multiparametric MRI has high sensitivity and negative predictive value for the detection of clinically significant prostate cancer in biopsy-naïve men. Concurrent developments include important work in the standardization of MRI reporting. The low specificity and positive predictive value of MRI means that biopsy is still necessary following MRI. MRI-targeted prostate biopsy has emerged as an alternative diagnostic test to transrectal ultrasound guided prostate biopsy, though its exact role in biopsy-naïve men and the optimal technique remain to be defined. SUMMARY: There is the potential for MRI to be used as a triage test to allow a proportion of men to avoid biopsy and remain on prostate-specific antigen surveillance. MRI-suspicious areas can be sampled more intensively using MRI-targeted biopsy that can be carried out in a variety of ways. Future work should focus on the cost-effectiveness of introducing a prebiopsy MRI pathway in biopsy-naïve men and addressing the training needs for such a change. VIDEO ABSTRACT: http://links.lww.com/COU/A11.

Establishing a community-based lung cancer multidisciplinary clinic as part of a large integrated health care system: aurora health care.

A community cancer clinic, through cooperation with its parent health care system, developed a lung cancer multidisciplinary clinic (MDC) to enhance patient care and prevent out-migration to competing health care systems. The local medical and radiation oncologists collaborated with a thoracic surgeon from the tertiary care hospital in establishing the lung MDC. All the participating physicians are employed by the health care system. A cancer care coordinator assured that all necessary tests were obtained and available to the physicians at least 1 day before the clinic. The multidisciplinary team also included a pulmonologist and met every third week. Other sub-specialists were involved as necessary. Final treatment recommendations using National Comprehensive Cancer Network guidelines were made for each patient at the MDC visit. This clinic, once established, resulted in significant improvements in the quality of care, patient satisfaction and retention of patients. Time from diagnosis to initiation of treatment was reduced to a mean of 18 days from a mean of 24 days. The community cancer clinic had an increase in lung cancer patient care by 28% and a 9.1% increase in gross revenue. The tertiary care hospital benefited by providing all patients with definitive surgery, including minimally invasive surgery. The tertiary hospital thoracic surgeon had a 75% increase in referrals from the lung MDC geographic area over the previous year. This collaboration in the development of MDCs demonstrates how patients, caregivers, and the health care system benefit from MDCs.

A case of traumatic testicular torsion associated with a ruptured epididymis.

To salvage the testis, most urological surgeons advocate early exploration of enlarging scrotal masses or suspected testicular ruptures resulting from trauma. A case of testicular torsion within a hematoma, following blunt testicular trauma is presented, and we suggest that another indication for exploring a scrotal mass following blunt injury is to help establish an early diagnosis of torsion of the testicle.

Advances in the management of erectile dysfunction

The management of erectile dysfunction (ED) is undergoing a metamorphosis. A brief review of the history of ED will be undertaken as a basis for understanding how treatments have evolved. From the 1400s to the Victorian era ED was considered a sign of witchcraft or the result of "evil behaviour". In the 1970s an organic basis for ED was recognised and in the 1980s over 80 percent of cases were identified as having an organic aetiology. The pivotal event for erection is smooth muscle relaxation. For erection to occur the nervous system may be activated centrally by thought, locally by genital stimulation or both. Relaxation of the sinusoidal smooth muscle cells in the aeterioles and trabeculae of the erectile bodies in the penis causes the sinusoids to fill and the suburical vessels to be compressed creating rigidity of the corpora cavernosa. The aetiology of ED is multifunctional and causal factors may be arteriogenic, neurogenic, hormonal, cavernosal and psychogenic or combinations of these. Evaluation includes a medical history, including drug therapy, physical examination, sexual history and diagnostic tests. Current treatment options include counselling, intracavernosal injection therapy, intraurethral medication, vacuum devices, vascular surgery and insertion of prostheses. Finally, as the millenium approaches, research continues to find the "Magic Pill"(AU)

Estimation of a reference range for immunoglobulins by a turbidimetric method

The assay of the major immunoglobulins by a turbidimetric method is described. The reference ranges for the sexes and different age groups have been determined (AU)