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De Win G. Response to the letter to the Editor re "Long term risks of childhood surgery". J Pediatr Urol 2024; 20:175. [PMID: 37778917 DOI: 10.1016/j.jpurol.2023.08.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Accepted: 08/31/2023] [Indexed: 10/03/2023]
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Dzhuma K, De Win G, Mishra P, Biassoni L, Cherian A. Laparoscopic strategies in complex upper urinary tract obstruction. J Pediatr Urol 2024; 20:305-311. [PMID: 38000949 DOI: 10.1016/j.jpurol.2023.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2023] [Revised: 10/22/2023] [Accepted: 11/05/2023] [Indexed: 11/26/2023]
Abstract
OBJECTIVES We enumerate the various laparoscopic strategies to resolve upper urinary tract (UUT) obstruction in the context of variations in anatomy and report their outcomes. PATIENTS AND METHODS Retrospective review of primary laparoscopic UUT reconstructions performed between May 2012 and May 2021. Anomalies included: malrotated kidney (MRK), horseshoe kidney (HSK), duplex kidney (DK), pure intrarenal pelvis (IRP) and mid-ureteric stenosis (MUS). Success was defined by postoperative resolution of symptoms, improvement of anterior-posterior renal pelvic diameter (APD) on US and drainage on Mag3. Complications were categorised by Clavien-Dindo grading. Outcomes compared using the student's t-test with P < 0.05 considered statistically significant. RESULTS Of the 214 laparoscopic primary UUT reconstructions, 37 (17.2 %) were: 13-MRK, 12-HSK, 4-DK, 4-IRP and 4-MUS. Median age at surgery was 5-years (range 0.3-15). Dismembered pyeloplasty: 8; pyeloplasty with renal sinus dissection: 8; neo-PUJ anastomosis: 8; primary ureterocalycostomy: 7; pyeloureterostomy: 2; and uretero-ureterostomy: 4. Median follow-up was 43-months (range 8-108) with a success rate of 94.5 % (35/37). Complete resolution of symptoms in 20/21 patients; improvement of hydronephrosis on US in 35/37 patients (median pre-operative APD 27 mm vs. median postoperative APD 8 mm) [P < 0.001]; improvement of drainage on diuretic renogram in 32/34 kidneys and stable/improved DRF in 34/35 kidneys (median preoperative DRF - 45 % vs. median postoperative DRF - 47 %) [P > 0.05]. Postoperative complications managed medically (II Clavien) included urinary tract infections - 2 patients (5 %), stent-related symptoms in 2 (5 %) and umbilical port site collection in 1 patient (3 %). Recurrent pelvi-ureteric junction obstruction PUJO occurred in one patient (3 %) requiring redo surgery (IIIb Clavien), renal stones in 1 (3 %) which resolved with ESWL (IIIb Clavien); in 1 (3 %) patient with a HSK there was complete loss of ipsilateral kidney function but this was managed conservatively up to date (I Clavien). CONCLUSION Laparoscopic transperitoneal approach allows the prompt recognition of in-situ anatomical variants. UUT obstruction in such settings calls for a variety of strategies with excellent outcomes.
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Affiliation(s)
- Kristina Dzhuma
- Department of Urology, Great Ormond Street Hospital NHS Foundation Trust, London, United Kingdom
| | - Gunter De Win
- Department of Urology, University Hospital Antwerp, Edegem, Belgium
| | - Pankaj Mishra
- Department of Paediatric Urology, Evelina London Children's Hospital, London, United Kingdom
| | - Lorenzo Biassoni
- Department of Radiology, Great Ormond Street Hospital NHS Foundation Trust, London, United Kingdom
| | - Abraham Cherian
- Department of Urology, Great Ormond Street Hospital NHS Foundation Trust, London, United Kingdom.
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De Win G, De Kort L, Learner H, Noah A, Dautricourt S, Nijman R, Stein R. Long-term risks of childhood surgery. J Pediatr Urol 2024; 20:165-172. [PMID: 37487882 DOI: 10.1016/j.jpurol.2023.07.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Accepted: 07/10/2023] [Indexed: 07/26/2023]
Abstract
INTRODUCTION Several patients, who underwent major reconstruction under the care of an experienced pediatric urologist are now, as adults, several years later, appearing with long term problems and complications. This consensus process was undertaken to give an overview of long term consequences (and their management) of urological childhood surgery. MATERIAL AND METHODS Several known urologists with experience in life-long follow up and revisional surgery of patients with congenital conditions were asked to review literature and comment based on their experience about several complications of childhood surgery. RESULTS Renal impairment, metabolic consequences, bladder stones, Vit B 12 deficiency and recurrent infections are often encountered. Also recurrent ureteric strictures and difficulties with catheterizable channel (both obstruction and incontinence) can be challenging to manage. Specific attention is needed regarding female sexuality and pregnancy. Both the development of malignancies in reconstructed bladders as secondary malignancies need to be taken into account during follow up. CONCLUSION Follow up of patients with rare congenital conditions is highly specialized and revisional surgery can be challenging. Therefore, follow up needs to be organized in specialized centers.
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Affiliation(s)
- Gunter De Win
- University Hospital Antwerp, Department of Urology, Edegem, Belgium; ASTARC, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium; Adolescent & Congenital Lifelong Urology, University College London Hospitals, London, UK.
| | | | - Hazel Learner
- Adolescent Gynaecology, University College London Hospitals, London, UK
| | - Anthony Noah
- Adolescent & Congenital Lifelong Urology, University College London Hospitals, London, UK
| | | | - Rien Nijman
- Department of Pediatric Urology, University Medical Center Groningen, the Netherlands
| | - Raimund Stein
- Paediatric and Reconstructive Urology, University Hospital Mannheim, Germany
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Desai D, Harrison W, Raveenthiran S, Samaratunga H, De Win G. UrethroNAV: the aetiology and extent of idiopathic urethral stricture in an Australian population. Transl Androl Urol 2024; 13:423-432. [PMID: 38590965 PMCID: PMC10999018 DOI: 10.21037/tau-23-549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Accepted: 01/18/2024] [Indexed: 04/10/2024] Open
Abstract
Background Lichen sclerosus (LS) is considered a causative factor in 10% of cases of idiopathic urethral stricture disease (IUSD), which is important for determining management strategies due to the underlying pathophysiology. Traditional excision urethroplasty may not be effective as inflammation often extends beyond the macroscopic stricture. This pilot study aims to answer two research questions: is LS an underlying cause of some idiopathic cause of strictures, and, if there is histological evidence suggesting predisposition of the surrounding tissue to strictures. Methods Biopsies were taken from the stricture site as well as 1 and 2 cm proximal and distal in patients with IUSD. Histological features, including macroscopic and microscopic findings, were reported, including the presence of LS, hyperkeratosis, epidermal changes, lichenoid infiltrates, ulceration, scarring, and inflammation. Methylene blue was used to aid in locating damaged urothelium. Patients were prospectively followed up after urethroplasty. Results From 109 urethroplasties performed between 2019 to 2022, 15 male patients were enrolled after meeting specific inclusion criteria. These criteria included a diagnosis of IUSD and the absence of any evidence of trauma, macroscopic inflammatory disease, or previous endoscopic instrumentation of the urethra. Patients had to be at least 16 years old and medically suitable for undergoing urethroplasty. The study was approved by the hospitals ethics committees. None had macroscopic evidence of LS. One patient had microscopic evidence of LS at the 2 cm proximal biopsy only. A total of 93% of patients had scarring proximal and distal to the stricture, while 20-40% had inflammatory change. The patient with microscopic LS and two inflammatory change patients had stricture recurrence after urethroplasty. Additionally, one patient with inflammatory changes was diagnosed with penile intraepithelial neoplasia (PeIN) and underwent partial penectomy. Conclusions Findings suggest that an underlying cause of IUSD could be LS. Additionally, the pathophysiology may involve scarring and inflammation beyond the limits of the stricture with extension distal from the stricture site. Careful evaluation for concomitant urethral pathology should be considered in cases of inflammatory changes. These findings should be considered in the surgical management of IUSD and warrant further research into the role of routine biopsy and drug targets in USD.
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Affiliation(s)
- Devang Desai
- Department of Urology, Toowoomba Hospital, Toowoomba, QLD, Australia
- Faculty of Medicine, University of Queensland, Brisbane, QLD, Australia
- Faculty of Medicine, Griffith University, Mount Gravatt, QLD, Australia
- Faculty of Medicine, University of Southern Queensland, Darling Heights, QLD, Australia
- Department of Urology, St Andrew’s Toowoomba Hospital, Rockville, QLD, Australia
- Department of Urology, St Vincent’s Private Hospital Toowoomba, East Toowoomba, QLD, Australia
- Department of Urology, Toowoomba Specialists, East Toowoomba, QLD, Australia
| | - William Harrison
- Department of Urology, Toowoomba Hospital, Toowoomba, QLD, Australia
- Department of Urology, Toowoomba Specialists, East Toowoomba, QLD, Australia
| | - Sheliyan Raveenthiran
- Department of Urology, Toowoomba Hospital, Toowoomba, QLD, Australia
- Faculty of Medicine, University of Queensland, Brisbane, QLD, Australia
- Department of Urology, Toowoomba Specialists, East Toowoomba, QLD, Australia
| | - Hemamali Samaratunga
- Faculty of Medicine, University of Queensland, Brisbane, QLD, Australia
- Department of Pathology, Aquesta Specialised Uropathology, Toowong, QLD, Australia
- Department of Pathology, Greenslopes Private Hospital, Greenslopes, QLD, Australia
| | - Gunter De Win
- Department of Urology, Antwerp University Hospital, Edegem, Antwerp, Belgium
- Faculty of Medicine and Health Sciences, Antwerp University, Wilrijk, Antwerp, Belgium
- Department of Adolescent Urology, University College London Hospital, London, UK
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Kalfa N, Nordenström J, De Win G, Hoebeke P. Adult outcomes of urinary, sexual functions and fertility after pediatric management of differences in sex development: Who should be followed and how? J Pediatr Urol 2024:S1477-5131(24)00052-4. [PMID: 38423920 DOI: 10.1016/j.jpurol.2024.01.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Revised: 12/19/2023] [Accepted: 01/21/2024] [Indexed: 03/02/2024]
Abstract
The management of Differences of Sex Development (DSD) has evolved considerably in recent years. The questioning of systematic early childhood treatment of DSD requires a better understanding of the outcomes of such treatments and long-term studies are therefore essential to better evaluate the prognosis of DSD. Unfortunately, limitations are numerous including the limited size of the series, the absence of standardized methodology, the evaluation of managements that no longer take place today and the absence of prospective and comparative studies. Despite these difficulties, the purpose of this paper is to present the current data on the long-term follow-up of patients with DSD from the urological, sexual and fertility points of view. Even if it remains difficult at present to establish precise recommendations, we recapitulate the most important points that should drive follow-up of these patients especially the constitution of a multidisciplinary team with a holistic approach, the organization of the transition between adolescence and adulthood, a particular attention to psychological care, a careful communication with the patients and his/her family and the use of standardized data collection systems.
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Affiliation(s)
- Nicolas Kalfa
- Département de Chirurgie Infantile, Service de Chirurgie Viscérale et Urologie Pédiatrique, CHU de Montpellier, Montpellier, France; Centre de Référence Maladies Rares DEVGEN Constitutif Sud, CHU de Montpellier, Montpellier, France; UMR 1302 Institute Desbrest of Epidemiology and Public Health, INSERM, Univ Montpellier, Montpellier, France.
| | - Josefin Nordenström
- Department of Pediatric Surgery/Urology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Gunter De Win
- Department of Urology, University Hospital Antwerp, Edegem, Belgium; Astarc, Faculty of Medicine and Health Science, University of Antwerp, Belgium; Adolescenty Urology, University College London Hospitals, London, UK
| | - Piet Hoebeke
- Department of Urology, Ghent University Hospital, Gent, Belgium
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Abdelmaksoud S, Lobo S, Cho A, Upasani A, Blackburn S, Curry J, Davies B, Martin R, De Win G, Cherian A. Fetal ascites in cloacal malformations-a red flag. Pediatr Surg Int 2023; 39:293. [PMID: 37971531 DOI: 10.1007/s00383-023-05564-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/01/2023] [Indexed: 11/19/2023]
Abstract
INTRODUCTION Cloacal malformation is a rare anomaly that remains a diagnostic challenge prenatally, despite the current advances in ultrasonography and MRI. This condition can in some, present with isolated ascites or with other findings, such as a pelvic cyst or upper urinary tract dilatation. In a minority, the ascites may be progressive, questioning the role of antenatal intervention. METHODS We report on ten patients that have been identified from our Cloaca database between 2010 and 2022. RESULTS The presence of ascites was associated with extensive bowel adhesions and matting, leading to a challenging initial laparotomy and peri-operative course. CONCLUSIONS Antenatal finding of ascites in newborns with cloacal malformations should raise a red flag. The surgeon and anaesthetist should be prepared for the operative difficulties secondary to bowel adhesions and the higher risk of haemodynamic instability at the initial surgery. An experienced team at initial laparotomy in such patients is vital. LEVEL OF EVIDENCE II.
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Affiliation(s)
- Sherif Abdelmaksoud
- Department of Urology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Sara Lobo
- Department of Urology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Alexander Cho
- Department of Urology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Anand Upasani
- Department of Urology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Simon Blackburn
- Department of Paediatric Surgery, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Joe Curry
- Department of Paediatric Surgery, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Brian Davies
- Department of Paediatric Surgery, Nottingham Childrens Hospital, Nottingham, UK
| | - Ruppert Martin
- Department of Urology & Paediatric Surgery, University Hospital, Antwerp, Belgium
| | - Gunter De Win
- Department of Urology & Paediatric Surgery, University Hospital, Antwerp, Belgium
| | - Abraham Cherian
- Department of Urology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK.
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Bladt L, Kashtiara A, Platteau W, De Wachter S, De Win G. First-Year Experience of Managing Urology Patients With Home Uroflowmetry: Descriptive Retrospective Analysis. JMIR Form Res 2023; 7:e51019. [PMID: 37847531 PMCID: PMC10618888 DOI: 10.2196/51019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Revised: 08/31/2023] [Accepted: 09/04/2023] [Indexed: 10/18/2023] Open
Abstract
BACKGROUND Lower urinary tract symptoms affect a large number of people of all ages and sexes. The clinical assessment typically involves a bladder diary and uroflowmetry test. Conventional paper-based diaries are affected by low patient compliance, whereas in-clinic uroflowmetry measurement face challenges such as patient stress and inconvenience factors. Home uroflowmetry and automated bladder diaries are believed to overcome these limitations. OBJECTIVE In this study, we present our first-year experience of managing urological patients using Minze homeflow, which combines home uroflowmetry and automated bladder diaries. Our objective was 2-fold: first, to provide a description of the reasons for using homeflow and second, to compare the data obtained from homeflow with the data obtained from in-clinic uroflowmetry (hospiflow). METHODS A descriptive retrospective analysis was conducted using Minze homeflow between July 2019 and July 2020 at a tertiary university hospital. The device comprises a Bluetooth-connected gravimetric uroflowmeter, a patient smartphone app, and a cloud-based clinician portal. Descriptive statistics, Bland-Altman plots, the McNemar test, and the Wilcoxon signed rank test were used for data analysis. RESULTS The device was offered to 166 patients, including 91 pediatric and 75 adult patients. In total, 3214 homeflows and 129 hospiflows were recorded. Homeflow proved valuable for diagnosis, particularly in cases where hospiflow was unreliable or unsuccessful, especially in young children. It confirmed or excluded abnormal hospiflow results and provided comprehensive data with multiple measurements taken at various bladder volumes, urge levels, and times of the day. As a result, we found that approximately one-fourth of the patients with abnormal flow curves in the clinic had normal bell-shaped flow curves at home. Furthermore, homeflow offers the advantage of providing an individual's plot of maximum flow rate (Q-max) versus voided volume as well as an average or median result. Our findings revealed that a considerable percentage of patients (22/76, 29% for pediatric patients and 24/50, 48% for adult patients) had a Q-max measurement from hospiflow falling outside the range of homeflow measurements. This discrepancy may be attributed to the unnatural nature of the hospiflow test, resulting in nonrepresentative uroflow curves and an underestimation of Q-max, as confirmed by the Bland-Altman plot analysis. The mean difference for Q-max was -3.1 mL/s (with an upper limit of agreement of 13 mL/s and a lower limit of agreement of -19.2 mL/s), which was statistically significant (Wilcoxon signed rank test: V=2019.5; P<.001). Given its enhanced reliability, homeflow serves as a valuable tool not only for diagnosis but also for follow-up, allowing for the evaluation of treatment effectiveness and home monitoring of postoperative and recurrent interventions. CONCLUSIONS Our first-year experience with Minze homeflow demonstrated its feasibility and usefulness in the diagnosis and follow-up of various patient categories. Homeflow provided more reliable and comprehensive voiding data compared with hospiflow.
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Affiliation(s)
- Lola Bladt
- Product Development, Faculty of Design Sciences, University of Antwerp, Antwerp, Belgium
| | - Ardavan Kashtiara
- Antwerp Surgical Training, Anatomy and Research Centre, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Wouter Platteau
- Antwerp Surgical Training, Anatomy and Research Centre, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Stefan De Wachter
- Antwerp Surgical Training, Anatomy and Research Centre, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
- Department of Urology, University Hospital Antwerp, Antwerp, Belgium
| | - Gunter De Win
- Antwerp Surgical Training, Anatomy and Research Centre, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
- Department of Urology, University Hospital Antwerp, Antwerp, Belgium
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De Win G, Jacobs T, Geuens S. Do pornography use and masturbation play a role in erectile dysfunction and relationship satisfaction in men? Int J Impot Res 2023; 35:581-584. [PMID: 36450920 DOI: 10.1038/s41443-022-00644-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Revised: 11/06/2022] [Accepted: 11/08/2022] [Indexed: 12/03/2022]
Affiliation(s)
- Gunter De Win
- Department of Urology, Adolescent Urology, University Hospital Antwerp, Edegem, Belgium.
- Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium.
- Adolescent Urology, University College London Hospitals, London, UK.
| | - Tim Jacobs
- Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Sam Geuens
- PXL University College of Applied Arts & Sciences, Department of Healthcare - Midwifery and Nursing Science, Hasselt, Belgium
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Lourdaux PJ, Vaganée D, Leysen C, De Wachter S, De Win G. Evolution of testicular asymmetry during puberty in adolescents without and with a left varicocele. BJU Int 2023; 131:348-356. [PMID: 36196674 DOI: 10.1111/bju.15914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To assess the evolution of the Testicular Atrophy Index (TAI) in adolescent boys with and without a left varicocele with special attention for the currently postulated cut-off value of 20%. SUBJECTS AND METHODS During 2015-2019, 364 adolescent boys aged 11-16 years were recruited. Genital examination and scrotal ultrasonography were repeatedly performed (≥4 month intervals). Testicular volume (TV) was calculated using the Lambert formula (length × width × height × 0.71). TAI was calculated using the formula: [(TVright - TVleft)/TVlargest (right, left)] × 100. RESULTS The final study population comprised 239 participants, 161 (67.36%) controls and 78 (32.64%) adolescent boys with left varicocele. The mean (sd) number of measurements per participant was 3.82 (1.08). A TAI of ≥20% at first measurement occurred in 9.94% and 35.90%, respectively. Of these, only 31.25% and 46.43% had a TAI of ≥20% at the last measurement, respectively. Nevertheless, the risk of ending up with a TAI of ≥20% was significantly higher if a TAI of ≥20% was recorded at first measurement (P = 0.041 and P = 0.002, respectively). The normalisation rate did not differ significantly between the groups (P = 0.182). Normalisation occurred most frequently in Tanner Stages III and IV. Normalisation was mostly (≥74%) due to catch-up growth of the left testis, in contrast to growth retardation of the right testis, in both groups. The TAI seems to be a fluctuating parameter. CONCLUSION A TAI of ≥20% is a phenomenon seen in boys with and without varicocele but is more common in boys with varicocele. Although normalisation of a high TAI is frequently seen, both adolescent boys with and without a left varicocele who have an initial TAI of ≥20% have a higher risk of a TAI of ≥20% in the future. As the TAI is a fluctuating parameter during pubertal development, it's use as indicator for varicocelectomy based on a single measurement during pubertal development is questioned.
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Affiliation(s)
- Pieter-Jan Lourdaux
- Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Donald Vaganée
- Department of Urology, Antwerp University Hospital, Edegem, Belgium.,Department of Urology, Faculty of Medicine and Health Sciences, Antwerp Surgical Training, Anatomy and Research Centre (ASTARC), Wilrijk, Belgium
| | - Cynthia Leysen
- Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Stefan De Wachter
- Department of Urology, Antwerp University Hospital, Edegem, Belgium.,Department of Urology, Faculty of Medicine and Health Sciences, Antwerp Surgical Training, Anatomy and Research Centre (ASTARC), Wilrijk, Belgium
| | - Gunter De Win
- Department of Urology, Antwerp University Hospital, Edegem, Belgium.,Department of Urology, Faculty of Medicine and Health Sciences, Antwerp Surgical Training, Anatomy and Research Centre (ASTARC), Wilrijk, Belgium
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Van den Eede E, Sterckx M, Vangelabbeek K, Dunford C, Noah A, Wood D, De Win G. An observational study on the sexual, genital and fertility outcomes in bladder exstrophy and epispadias patients. J Pediatr Urol 2023; 19:36.e1-36.e7. [PMID: 37856541 DOI: 10.1016/j.jpurol.2022.10.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Revised: 10/06/2022] [Accepted: 10/08/2022] [Indexed: 11/11/2022]
Abstract
INTRODUCTION Bladder exstrophy and epispadias complex (BEEC) is a spectrum of congenital malformations ranging from an isolated epispadias to a full exstrophy. It is an uncommon disease and little is known on how patients cope with its implications later in life. OBJECTIVE The goal of this study is to assess the sexual, continence and fertility outcomes of BEEC patients, who had reconstructive bladder surgery during childhood. Considering the sensitive nature of these topics, they are not easily spoken about in the doctor's office. Our aim is to shed some light on possible points of improvement in follow-up. STUDY DESIGN 63 patients between 18 and 45 years old were sent an electronic questionnaire based on previous existing standardized questionnaires. They were asked about sexual and psychosexual wellbeing, urinary incontinence and fertility. Data from their medical files (medical history on previous surgeries). and questionnaire answers are linked through an anonymous subject number and put into an Excel file for descriptive representation. RESULTS 22 men and 8 women filled in the questionnaire. All but 2 are sexually active. Reasons to avoid sexual activity are equally divided as BEEC-related and non-BEEC-related. Sexual satisfaction is lower in the male group due to problems with erection, ejaculation, condom usage and embarrassment about physical appearance. In females problems concerning pain and reaching orgasm are mentioned. 30% report depressive feelings. There is a clear correlation between number of reconstructive surgeries and sexual satisfaction. 90% of patients urinate via catheterization, mostly through a Mitrofanoff connection. This leads to complications such as foul odors, infection, embarrassment and sexual dysfunction. 8 out of 13 men conceived a child (with the use of their own sperm), 2 out of 4 women did. DISCUSSION A strength of this study is the use of standardized questionnaires which allow comparison to a control patient group. Our study is one of the first to show how patients cope with the challenges of BEEC by the use of open questions. We see an overall high quality of life yet an important impact on mental health. CONCLUSION BEEC is associated with many challenges in the adult life of patients. A more holistic and interdisciplinary approach is needed to include sensitive topics in long term follow-up.
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Affiliation(s)
- Emma Van den Eede
- Faculty of Medicine and Health Sciences, University of Antwerp, Universiteitsplein 1 Wilrijk, Antwerp, 2610, Belgium
| | - Mira Sterckx
- Faculty of Medicine and Health Sciences, University of Antwerp, Universiteitsplein 1 Wilrijk, Antwerp, 2610, Belgium
| | - Kato Vangelabbeek
- Faculty of Medicine and Health Sciences, University of Antwerp, Universiteitsplein 1 Wilrijk, Antwerp, 2610, Belgium
| | - Charlotte Dunford
- Department of Urology, University College London Hospitals, 16-18 Westmoreland Street, London, United Kingdom
| | - Anthony Noah
- Department of Urology, University College London Hospitals, 16-18 Westmoreland Street, London, United Kingdom
| | - Dan Wood
- Department of Urology, University College London Hospitals, 16-18 Westmoreland Street, London, United Kingdom; Department of Urology at Children's Hospital Colorado - University of Colorado 13123 E 16th Ave, Aurora, CO 80045, USA
| | - Gunter De Win
- Faculty of Medicine and Health Sciences, University of Antwerp, Universiteitsplein 1 Wilrijk, Antwerp, 2610, Belgium; Department of Urology, University College London Hospitals, 16-18 Westmoreland Street, London, United Kingdom; Department of Urology, Antwerp University Hospital, Drie Eikenstraat 655, 2650 Edegem, Belgium.
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Sloth SB, Jensen RD, Seyer-Hansen M, De Win G, Christensen MK. Ticket to perform: an explorative study of trainees' engagement in and transfer of surgical training. BMC Med Educ 2023; 23:64. [PMID: 36698177 PMCID: PMC9878748 DOI: 10.1186/s12909-023-04048-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/24/2022] [Accepted: 01/20/2023] [Indexed: 06/17/2023]
Abstract
BACKGROUND Research suggests that simulation-based surgical skills training translates into improved operating room performance. Previous studies have predominantly focused on training methods and design and subsequent assessable performances and outcomes in the operating room, which only covers some aspects of training engagement and transfer of training. The purpose of this qualitative study was to contribute to the existing body of literature by exploring characteristics of first-year trainees' engagement in and perceptions of transfer of surgical skills training. METHODS We conducted an explorative study based on individual interviews with first-year trainees in General Surgery, Urology, and Gynaecology and Obstetrics who participated in a laparoscopic skills training program. Informants were interviewed during and two months after the training program. A thematic cross-case analysis was conducted using systematic text condensation. RESULTS We interviewed 12 informants, which produced 24 transcripts for analysis. We identified four main themes: (1) sportification of training, (2) modes of orientation, (3) transferrable skills, and (4) transfer opportunities. Informants described their surgical training using sports analogies of competition, timing, and step-by-step approaches. Visual orientations, kinaesthetic experiences, and elicited dialogues characterised training processes and engagement. These characteristics were identified in both the simulated and the clinical environment. Experiences of specific skills transfer included ambidexterity, coordination, instrument handling, and visuospatial ability. General transfer experiences were salient in informants' altered training approaches. Informants considered the simulation-based training an entry ticket to perform in the operating room and mentioned supervisor-trainee relationships and opportunities in the workplace as critical conditions of transfer. CONCLUSIONS Our findings elucidate characteristics of surgical training engagement that can be interpreted as self-regulated learning processes that transcend surgical training environments. Despite appreciating the immediate skills improvements resulting from training, trainees' narratives reflected a struggle to transfer their training to the clinical setting. Tensions existed between perceptions of transferable skills and experiences of transfer within the clinical work environments. These results resonate with research emphasising the importance of the work environment in the transfer process. Our findings provide insights that may inform the development of training programs that support self-regulated learning and transfer of training from the simulated to the clinical environment.
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Affiliation(s)
- Sigurd Beier Sloth
- Centre for Educational Development, Aarhus University, Trøjborgvej 82-84, 8200, Aarhus, Denmark.
- Department of Clinical Medicine, Aarhus University, Palle Juul-Jensens Boulevard 11, 8200, Aarhus, Denmark.
| | - Rune Dall Jensen
- Department of Clinical Medicine, Aarhus University, Palle Juul-Jensens Boulevard 11, 8200, Aarhus, Denmark
- Corporate HR, MidtSim, Central Denmark Region, Palle Juul-Jensens Boulevard 82, 8200, Aarhus, Denmark
| | - Mikkel Seyer-Hansen
- Department of Clinical Medicine, Aarhus University, Palle Juul-Jensens Boulevard 11, 8200, Aarhus, Denmark
- Department of Gynaecology and Obstetrics, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200, Aarhus, Denmark
| | - Gunter De Win
- Antwerp Surgical Training, Anatomy and Research Center (ASTARC), Faculty of Medicine and Health Sciences, University of Antwerp, Universiteitsplein 1, 2610, Wilrijk, Belgium
- Department of Urology, University Hospital Antwerp, Drie Eikenstraat 655, 2650, Edegem, Belgium
| | - Mette Krogh Christensen
- Centre for Educational Development, Aarhus University, Trøjborgvej 82-84, 8200, Aarhus, Denmark
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De Laet C, De Win G. Glans Preserving Buccal Mucosa Urethroplasty for Glandular and Distal Urethral Strictures. Turkish Journal of Urology 2022; 48:309-314. [PMID: 35913448 PMCID: PMC9612693 DOI: 10.5152/tud.2022.22024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Background: To describe a step-by-step approach for glans preserving urethroplasty with a dorsal inlay graft used for distal urethral strictures. Description of the Technique: The reconstruction was performed through a keyhole incision in the urethra. In this way, we achieve maximal exposure by a minimal incision and saving of the glans. After incision of the diseased dorsal urethral mucosa through the keyhole and the meatus, a buccal mucosa graft pull-through resulting in a dorsal inlay is done. Patient(s) and Methods: We treated 10 patients in different clinical settings with success by using the newly described technique below. We highlight and illustrate 1 case of a 34-year-circumcised male. Antegrade urethrogram showed a distal penile and fossa navicularis stricture with a total estimated length of 3.5 cm. Results: In this specific case the glans sparing approach had a surgical duration of 115 minutes. After 3 weeks the urinary catheter was removed. At 12 months, the patient reported no remaining urinary tract symptoms. Examination showed a fully healed lesion and an adequate uroflowmetry with a Qmax of 24 mL/s coming from 4 mL/s pre-operatively. In our 10-patient case series, all treated patients had complete resolution of their complaints, significant improvement in flow rates and excellent cosmetic results without complications. Conclusion: In selected cases, the described technique is feasible, safe, and effective with excellent functional outcomes and better cosmetic results especially due to the glans preservation.
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Affiliation(s)
| | - Gunter De Win
- Department of Urology, Antwerp University Hospital, Antwerp, Belgium
- University of Antwerp Faculty of Medicine and Health Sciences/ASTARC, Antwerp, Belgium
- Adolescent and Reconstructive Urology, University College London Hospitals, London, UK
- Corresponding author:Gunter De Win E-mail:
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13
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Tilborghs S, Van de Borne S, Vaganée D, De Win G, De Wachter S. The Influence of Electrode Configuration Changes on the Sensory and Motor Response During (Re)Programming in Sacral Neuromodulation. Neuromodulation 2021; 25:1173-1179. [PMID: 35088741 DOI: 10.1016/j.neurom.2021.09.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2021] [Revised: 06/11/2021] [Accepted: 07/13/2021] [Indexed: 11/15/2022]
Abstract
OBJECTIVES This study aimed to assess the neurophysiological basis behind troubleshooting in sacral neuromodulation (SNM). Close follow-up of SNM patients with program parameter optimization has proven to be paramount by restoring clinical efficacy and avoiding surgical revision. MATERIALS AND METHODS A total of 34 successful SNM patients (28 overactive bladder wet, six nonobstructive urinary retention) with an implantable pulse generator were included. All possible bipolar and monopolar electrode settings were tested at sensory threshold (ST) to evaluate sensory (mapped on a perineal grid with 1 cm2 coordinates) and motor (peak-to-peak amplitude and latency of muscle action potential) responses of the pelvic floor. Pelvic floor muscle electromyography was recorded using a multiple array probe, placed intravaginally. Parametric tests were used for paired data: repeated-measures ANOVA or t-test. A nonparametric test was used for paired data: Friedman ANOVA or Wilcoxon signed rank (WSR) test; p < 0.05 was considered statistically significant. If significant, ANOVA was followed by Dunn-Bonferroni post hoc analysis. RESULTS Monopolar configurations showed significantly lower STs-1.38 ± 0.73 V vs 1.76 ± 0.89 V (paired t-test: p < 0.0001)-and presented with significantly higher peak-to-peak amplitudes-115.67 ± 79.03 μV vs 90.77 ± 80.55 μV (WSR: p = 0.005)-than bipolar configurations. When polarity was swapped, configurations with the cathode distal to the anode showed significantly lower STs, 1.73 ± 0.91 V vs 1.85 ± 0.87 V (paired t-test: p = 0.003), and mean peak-to-peak amplitudes, 81.32 ± 72.82 μV vs 100.21 ± 90.22 μV (WSR: p = 0.0001). Cathodal changes resulted in more changes in sensory responses than anodal changes (χ2 test: p = 0.044). In cathodal changes only, peak-to-peak amplitudes were significantly higher when the distance between electrodes was maximally spread (WSR: p = 0.046). CONCLUSIONS From a neurophysiological point of view, monopolar configurations stimulated more motor nerve fibers at lower STs, therefore providing more therapeutic efficiency. Swapping polarity or changing the position of the cathode led to different sensory and motor responses, serving as potential reprogramming options.
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Affiliation(s)
- Sam Tilborghs
- Department of Urology, Antwerp University Hospital, Edegem, Belgium; Department of Urology, Antwerp Surgical Training, Anatomy and Research Centre (ASTARC), Faculty of Medicine and Health Sciences, Anatomy, University of Antwerp, Antwerp, Belgium
| | - Sigrid Van de Borne
- Department of Urology, Antwerp University Hospital, Edegem, Belgium; Department of Urology, Antwerp Surgical Training, Anatomy and Research Centre (ASTARC), Faculty of Medicine and Health Sciences, Anatomy, University of Antwerp, Antwerp, Belgium
| | - Donald Vaganée
- Department of Urology, Antwerp University Hospital, Edegem, Belgium; Department of Urology, Antwerp Surgical Training, Anatomy and Research Centre (ASTARC), Faculty of Medicine and Health Sciences, Anatomy, University of Antwerp, Antwerp, Belgium
| | - Gunter De Win
- Department of Urology, Antwerp University Hospital, Edegem, Belgium; Department of Urology, Antwerp Surgical Training, Anatomy and Research Centre (ASTARC), Faculty of Medicine and Health Sciences, Anatomy, University of Antwerp, Antwerp, Belgium
| | - Stefan De Wachter
- Department of Urology, Antwerp University Hospital, Edegem, Belgium; Department of Urology, Antwerp Surgical Training, Anatomy and Research Centre (ASTARC), Faculty of Medicine and Health Sciences, Anatomy, University of Antwerp, Antwerp, Belgium.
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14
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Jacobs T, Geysemans B, Van Hal G, Glazemakers I, Fog-Poulsen K, Vermandel A, De Wachter S, De Win G. Associations Between Online Pornography Consumption and Sexual Dysfunction in Young Men: Multivariate Analysis Based on an International Web-Based Survey. JMIR Public Health Surveill 2021; 7:e32542. [PMID: 34534092 PMCID: PMC8569536 DOI: 10.2196/32542] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2021] [Revised: 08/24/2021] [Accepted: 09/17/2021] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND Expanding access to the internet has resulted in more and earlier consumption of online pornography. At the same time, a higher prevalence of erectile dysfunction (ED) among young men is seen. Increased pornography consumption has been suggested as a possible explanation for this rise. OBJECTIVE The aim of this study was to better understand associations between problematic pornography consumption (PPC) and ED. METHODS A 118-item survey was published online, and data collection took place between April 2019 and May 2020. Of the 5770 men who responded, the responses from 3419 men between 18 years old and 35 years old were analyzed. The survey used validated questionnaires such as the Cyber Pornography Addiction Test (CYPAT), International Index of Erectile Function (IIEF-5), and Alcohol Use Disorders Identification Test-Concise (AUDIT-C). The estimated amount of porn watching was calculated. Univariable and multivariable analyses were performed. For the multivariable analysis, a logistic regression model using a directed acyclic graph was used. RESULTS According to their IIEF-5 scores, 21.48% (444/2067) of our sexually active participants (ie, those who attempted penetrative sex in the previous 4 weeks) had some degree of ED. Higher CYPAT scores indicating problematic online pornography consumption resulted in a higher probability of ED, while controlling for covariates. Masturbation frequency seemed not to be a significant factor when assessing ED. CONCLUSIONS This prevalence of ED in young men is alarmingly high, and the results of this study suggest a significant association with PPC. TRIAL REGISTRATION Research Registry researchregistry5111; https://tinyurl.com/m45mcaa2.
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Affiliation(s)
- Tim Jacobs
- Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Björn Geysemans
- Department of Social Epidemiology and Health Policy, University of Antwerp, Antwerp, Belgium
| | - Guido Van Hal
- Department of Social Epidemiology and Health Policy, University of Antwerp, Antwerp, Belgium
| | - Inge Glazemakers
- Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | | | - Alexandra Vermandel
- Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium.,Department of Urology, University Hospital Antwerp, Edegem, Belgium
| | - Stefan De Wachter
- Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium.,Department of Urology, University Hospital Antwerp, Edegem, Belgium
| | - Gunter De Win
- Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium.,Department of Urology, University Hospital Antwerp, Edegem, Belgium
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15
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Flynn H, Ong M, De Win G, Desai D. Narrowing in on urethral strictures. Aust J Gen Pract 2021; 50:214-218. [PMID: 33786543 DOI: 10.31128/ajgp-03-20-5280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND Urethral strictures have affected men for millennia, and they are commonly iatrogenic, idiopathic or traumatic in nature. When left untreated, urethral strictures can devastate the health and function of the urinary tract. For centuries, simple urethral dilation and endoscopic urethrotomy have provided temporary relief. However, in only the past 20 years, urethroplasty has emerged as a curative treatment. OBJECTIVE The aims of this article are to review the aetiology and clinical manifestations of urethral strictures, evaluate the traditional but temporising treatments for urethral strictures, highlight the relatively recent evolution of urethroplasty and promote awareness of the success of urethroplasty in curing urethral strictures. DISCUSSION Urethral strictures are an important, but often overlooked, cause of bothersome urinary symptoms in men. In this article, the authors provide a summary of the aetiology, clinical manifestations and recent trends in the management of urethral strictures.
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Affiliation(s)
- Hannah Flynn
- MBBS, MS, MASc (Chemistry), BASc, Principal House Officer, Toowoomba Hospital, Qld
| | - Michelle Ong
- MBBS, Principal House Officer, Toowoomba Hospital, Qld
| | - Gunter De Win
- MD, PhD, Consultant Urologist, Department of Urology, Antwerp University Hospital, BE; Professor, Antwerp Surgical Training, Anatomy and Research Centre (ASTARC), Faculty of Medicine and Health Sciences, Wilrijk, BE; Honorary Consultant in Adolescent @ Reconstructive Urology, University College London Hospital, London, UK
| | - Devang Desai
- MBBS, FRACS (Urology), MS (Urology), Consultant Urologist, Toowoomba Hospital, Qld; Associate Professor, The University of Queensland, Qld
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16
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Sloth SB, Jensen RD, Seyer-Hansen M, Christensen MK, De Win G. Remote training in laparoscopy: a randomized trial comparing home-based self-regulated training to centralized instructor-regulated training. Surg Endosc 2021; 36:1444-1455. [PMID: 33742271 PMCID: PMC7978167 DOI: 10.1007/s00464-021-08429-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Accepted: 03/03/2021] [Indexed: 01/16/2023]
Abstract
Background Simulation-based surgical training (SBST) is key to securing future surgical expertise. Proficiency-based training (PBT) in laparoscopy has shown promising results on skills transfer. However, time constraints and limited possibilities for distributed training constitute barriers to effective PBT. Home-based training may provide a solution to these barriers and may be a feasible alternative to centralized training in times of assembly constraints. Methods We randomly assigned first-year trainees in abdominal surgery, gynecology, and urology to either centralized instructor-regulated training (CIRT) or home-based self-regulated training (HSRT) in laparoscopy. All participants trained on portable box trainers providing feedback on metrics and possibility for video reviewing. Training in both groups was structured as PBT with graded proficiency exercises adopted from the Fundamentals of Laparoscopic Surgery (FLS). The HSRT group trained at home guided by online learning materials, while the CIRT group attended two training sessions in the simulation center with feedback from experienced instructors. Performance tests consisted of hand–eye and bimanual coordination, suture and knot-tying, and FLS exercises. We analyzed passing rates, training time and distribution, and test performances. Results Passing rates were 87% and 96% in the CIRT and HSRT group, respectively. HSRT facilitated distributed training and resulted in greater variation in training times. Task times for hand–eye and bimanual coordination were significantly reduced between pretest and posttest in both groups. Trainees maintained their posttest performances at the 6-month retention test. Our analyses revealed no significant inter-group differences in performances at pretest, posttest, or retention test. Performance improvements in the two groups followed similar patterns. Conclusion CIRT and HSRT in laparoscopy result in comparable performance improvements. HSRT in laparoscopy is a feasible and effective alternative to CIRT when offered inside a supportive instructional design. Further research is needed to clarify trainees’ preferences and explore facilitators and barriers to HSRT.
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Affiliation(s)
| | - Rune Dall Jensen
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.,Corporate HR MidtSim, Central Denmark Region, Aarhus, Denmark
| | - Mikkel Seyer-Hansen
- Department of Obstetrics & Gynecology, Aarhus University Hospital, Aarhus, Denmark
| | | | - Gunter De Win
- Antwerp Surgical Training, Anatomy and Research Center (ASTARC), Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium.,Department of Urology, University Hospital Antwerp, Edegem, Belgium
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17
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Sloth SB, Christensen P, Dall R, De Win G, Seyer-Hansen M, Christensen MK. Trainees' surgical activity and opportunity to transfer after simulation-based training. Dan Med J 2020; 67:A05200306. [PMID: 33215601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
INTRODUCTION Simulation-based surgical training (SBST) is predicated on the assumption that trainees transfer their acquired skills and competencies into the operating room. Research on transfer of surgical training has focused on trainees' performance improvements and not on their actual opportunity to transfer their trained skills. METHODS This was a retrospective study conducted using data on surgical procedures performed by first-year trainees in abdominal surgery, gynaecology and urology in the Central Denmark Region. We included data on trainees who participated in two different SBST courses; open surgery and laparoscopic surgery from 2014 to 2018. RESULTS Data on a total of 127 first-year trainees were included. Our results revealed considerable variation in the number of procedures performed by first-year trainees in the three specialities. Comparing surgical activity after and before the SBST courses, we found median differences between 0 and 3, indicating no consistent increases in trainees' surgical activity in the post-course periods (five out of six comparisons were insignificant (p > 0.05)). CONCLUSIONS Trainees' surgical exposure varies within specialities and this may have consequences for achieving uniform levels of competence among trained specialists. Our results suggest that trainees do not have timely opportunities to intensify their clinical surgical activities after participating in SBST courses. A delay in opportunities to perform may inhibit the trainee's use of acquired skills and competencies and hamper transfer of training. FUNDING none. TRIAL REGISTRATION not relevant.
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18
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Vermandel A, Van Hall G, Van der Cruyssen K, Van Aggelpoel T, Neels H, De Win G, De Wachter S. 'Elimination signals' in healthy, NON toilet trained children aged 0-4 years: A systematic review. J Pediatr Urol 2020; 16:342-349. [PMID: 32253149 DOI: 10.1016/j.jpurol.2020.03.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2019] [Accepted: 03/05/2020] [Indexed: 11/30/2022]
Abstract
OBJECTIVE An early start of toilet training, which is related to a younger age of acquiring full bladder control, can generate important health advantages. Children display different 'elimination signals' related to voiding or defaecation. The aim of this systematic review is to map these 'elimination signals' in young, healthy children aged 0-4 years. METHOD The systematic literature search was performed in two databases and was conducted using the preferred reporting items for systematic reviews and meta-analyses (PRISMA statement). RESULTS Two main distinctions in elimination signals were made. The first could be classified as visual, auditory and tactile, most frequently involving a change in facial expression, often combined with body movements and verbal expressions such as a short cry or grunting. Secondly significant changes in heart rate, respiratory frequency or EEG frequency could be defined as 'clinically assessed elimination signals'. CONCLUSION Different 'elimination signals' could be detected in healthy children while voiding or defaecating and should be observed when initiating toilet training. Detection of noticeable visual, auditory and tactile signals will facilitate and shorten this process.
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Affiliation(s)
- Alexandra Vermandel
- Antwerp University, Faculty of Medicine and Health Sciences, Belgium; University Hospital Antwerp, Department of Urology, Belgium.
| | - Guido Van Hall
- Antwerp University, Faculty of Medicine and Health Sciences, Belgium.
| | | | - Tinne Van Aggelpoel
- Antwerp University, Faculty of Medicine and Health Sciences, Belgium; University Hospital Antwerp, Department of Urology, Belgium.
| | - Hedwig Neels
- Antwerp University, Faculty of Medicine and Health Sciences, Belgium; University Hospital Antwerp, Department of Urology, Belgium.
| | - Gunter De Win
- Antwerp University, Faculty of Medicine and Health Sciences, Belgium; University Hospital Antwerp, Department of Urology, Belgium.
| | - Stefan De Wachter
- Antwerp University, Faculty of Medicine and Health Sciences, Belgium; University Hospital Antwerp, Department of Urology, Belgium.
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Spinoit AF, Waterschoot M, Sinatti C, Abbas T, Callens N, Cools M, Hamid R, Hanna MK, Joshi P, Misseri R, Salle JLP, Roth J, Tack LJW, De Win G. Fertility and sexuality issues in congenital lifelong urology patients: male aspects. World J Urol 2020; 39:1013-1019. [PMID: 32067073 DOI: 10.1007/s00345-020-03121-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2019] [Accepted: 02/03/2020] [Indexed: 01/25/2023] Open
Abstract
PURPOSE To review existing literature about fertility and sexuality of boys born with complex congenital genitourinary anomalies. METHODS A Pubmed review was performed in December 2018 to identify the most relevant original manuscripts regarding male complex congenital conditions affecting the urogenital system in male patients including spina bifida (SB), bladder exstrophy-epispadias complex (BEEC) and hypospadias. A comprehensive review was drafted exploring sexual dysfunction from a medical, psychosexual, surgical and reproductive point of view during transition from childhood (or adolescence) to adulthood. RESULTS About 75% of men with SB have erectile dysfunction (ED) (Gamé et al. in Urology 67(3):566-570, 2006; Diamond et al. in 58(4):434-435, 1986). Most SB patients have impaired sexual development mainly due to diminished self-esteem, dependence on caregivers and lack of privacy (Blum et al. in Pediatrics 88(2):280-285, 1991). Men with BEEC have fewer intimate relationships than women because of the greater difficulties with issues regarding their genitalia and sexual activities (Deans et al. in Am J Obstet Gynecol 206(6):496.e1-496.e6, 2012). However, a good quality of life is achievable with the effective use of coping strategies (Deng et al. in Transl Androl Urol 7:941, 2018; Rikken et al. in BMC Womens Health 18(1):163, 2018; Friedler et al. in Reprod Biomed Online 32(1):54-61, 2016). Chordee occurs in 25% of all hypospadias patients. More severe hypospadias is related to a greater risk for complications. The long-term sexual quality of life (QoL) in men who underwent hypospadias surgery is influenced by a lot of factors. Therefore, an interactive and dynamic biopsychosocial model of sexual QoL was proposed. CONCLUSIONS The care of patients with congenital urologic conditions becomes a challenge especially in the period of 'transition'. The goal of follow-up is a holistic management viewed from a medical, psychosexual, surgical end reproductive point. All patients should be asked for specific urinary, fecal or sexual concerns.
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Affiliation(s)
| | | | - Céline Sinatti
- Department of Urology, Ghent University Hospital, Ghent, Belgium
| | - Tariq Abbas
- Pediatric Urology, Sidra Hospital, Doha, Qatar
| | - Nina Callens
- Centre for Research on Culture and Gender, Department of Languages and Cultures, Ghent University, Ghent, Belgium
| | - Martine Cools
- Department of Paediatric and Adolescent Endocrinology and Diabetology, Ghent University Hospital, Ghent, Belgium
| | - Rizwan Hamid
- Department of Neuro-Urology, Royal National Orthopaedic Hospital, Stanmore, Middlesex, UK.,University College London Hospitals, London, UK
| | - Moneer K Hanna
- New York Presbyterian/Weill Cornell Medical Center, New York, USA
| | - Pankaj Joshi
- Kulkarni Reconstructive Urology Centre, Pune, India
| | - Rosalia Misseri
- Pediatric Urology, Riley Hospital for Children at Indiana University Health, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Joao Luiz Pippi Salle
- Division of Urology, Department of Surgery, Sidra Medical and Research Center, Doha, Qatar
| | - Joshua Roth
- Paediatric Urology, Riley Hospital for Children, Indiana University Health, Indianapolis, IN, USA
| | - Lloyd J W Tack
- Division of Paediatric Endocrinology, Department of Internal Medicine and Paediatrics, Ghent University Hospital, Ghent, Belgium
| | - Gunter De Win
- Faculty of Medicine and Health Science, University of Antwerp, University Hospital Antwerp, Antwerp, Belgium.,Department of Urology, University of College London Hospitals, London, UK
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Cherian A, Paul A, De Win G, Kumar Mishra P. Prone posterior retroperitoneoscopic access to the kidney in children: the controlled optical trocar approach. J Pediatr Urol 2019; 15:580-581. [PMID: 31495778 DOI: 10.1016/j.jpurol.2019.08.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2019] [Accepted: 08/04/2019] [Indexed: 10/26/2022]
Abstract
INTRODUCTION Conventional access for renal surgery through the retro-peritoneum includes the blind percutaneous approach using a haemostatic clip and the Gaur balloon dissection technique or alternatively the open cut-down approach. The authors present a video detailing the technique of optical access into the retro-peritoneum. OBJECTIVE Demonstration of the optical access technique into the retroperitoneal space using the optical trocar. METHOD Video describing the technique is carried out. With the patient in the prone position the optical trocar is introduced posteriorly traversing the different layers under vision to safely enter the space just outside gerota's fascia. Blunt dissection with the telescope tip and positive pressure aids creation of the working space. RESULTS A total of 35 renal surgeries including nephrectomy and nephro-ureterectomy were performed via optical access to the retro-peritoneum. Ages ranged from 6 months to 14 years, and kidney sizes ranged from 1.6 cm to 15 cm, with operating times being 66-137 min. No complications or conversions were encountered. DISCUSSION Optical access as described previously is achieved with a small incision, with complete control at every stage of the access with no room for error or subjective feeling. At all points, the operator recognises the different layers and is able to predictably reach the right space very quickly and safely. In contrast, the percutaneous technique was blind and the open cut-down required a bigger incision and was practically quite challenging in obese patients with leakage around the port and surgical emphysema. Optical access overcame all these drawbacks and made it reliable, predictable and reproducible. CONCLUSION Access to the retroperitoneum in the prone posterior approach is achieved safely under vision and is reproducible. Every step in this access is performed in a controlled way and is therefore more predictable as compared to conventional techniques.
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Affiliation(s)
- Abraham Cherian
- Dept of Paediatric Urology, Great Ormond Street Hospital for Children, UK.
| | - Anu Paul
- Dept of Paediatric Urology, Evelina London Children's Hospital, London, UK
| | - Gunter De Win
- Dept of Urology, Antwerp University Hospital, Antwerp, Belgium
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Vaganée D, Kessler TM, Van de Borne S, De Win G, De Wachter S. Sacral neuromodulation using the standardized tined lead implantation technique with a curved vs a straight stylet: 2-year clinical outcomes and sensory responses to lead stimulation. BJU Int 2019; 123:E7-E13. [DOI: 10.1111/bju.14650] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Affiliation(s)
- Donald Vaganée
- Department of Urology; Antwerp University Hospital, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp; Edegem Belgium
| | - Thomas M. Kessler
- Neuro-Urology, Spinal Cord Injury and 6 Research; University of Zürich; Balgrist University Hospital; Zürich Switzerland
| | - Sigrid Van de Borne
- Department of Urology; Antwerp University Hospital, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp; Edegem Belgium
| | - Gunter De Win
- Department of Urology; Antwerp University Hospital, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp; Edegem Belgium
| | - Stefan De Wachter
- Department of Urology; Antwerp University Hospital, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp; Edegem Belgium
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22
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Abstract
BACKGROUND Fistula formation in hidradenitis suppurativa follows an uncontrolled infection with subcutaneous tracts leading to 'watering-can' or 'pus-pot' perineum. Closure of this type of fistula implies major surgery and is bound to fail in refractory inflammatory environment. Minimally invasive techniques have become the first line of choice in every type of surgery. METHODS Fistula-tract Laser Closure (FiLaC™, Biolitec, Germany) is a novel technique already reported to have been used in the treatment of fistula-in-ano and pilonidal sinus. It consists of blind cauterization and obliteration of the fistula tract from the inside by means of a radial-emitting laser probe. We present two patients who underwent surgery for urethroperineal fistula using this technique. RESULTS In both cases, the fistula tracts were completely closed after 3 months of follow-up. The wounds had healed smoothly and complete resolution of symptoms was noted. CONCLUSIONS The use of FiLaC™ for the treatment of urethroperineal fistula is feasible and safe. The minimally invasive nature of the technique and limited postoperative pain permit daycare surgery.
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Affiliation(s)
- Ben Gys
- Department of Abdominal Surgery, AZ Sint-Dimpna, Geel, Belgium
| | - Nicolas De Hous
- Department of Abdominal Surgery, University Hospital of Antwerp, Edegem, Belgium
| | - Guy Hubens
- Department of Abdominal Surgery, University Hospital of Antwerp, Edegem, Belgium
| | - Gunter De Win
- Department of Urology, University Hospital of Antwerp, Edegem, Belgium
| | - Niels Komen
- Department of Abdominal Surgery, University Hospital of Antwerp, Edegem, Belgium
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Vanderbruggen W, Cherian A, De Baets K, De Wachter S, De Win G. Laparoscopy-Assisted Cutaneous Ureterostomy in Children: Early Experience. J Laparoendosc Adv Surg Tech A 2018; 29:286-291. [PMID: 30358477 DOI: 10.1089/lap.2017.0261] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE Laparoscopy-assisted cutaneous ureterostomy (LA-CU) is a minimally invasive approach for temporary urinary diversion in children. We describe the technique, its feasibility, potential advantages, and outcomes in 12 children treated for a variety of conditions. METHODS Three trocars were used transperitoneally, one transumbilical, and another placed at the later stoma site. In the semilateral position, with a panoramic view, the ureter of interest is easily identified, mobilized, and exteriorized for stoma creation. We retrospectively reviewed our experience at two tertiary-care centers and included both refluxing and end ureterostomies. The study period was between October 2014 and February 2017. Renal function and growth curves were noted at follow-up. RESULTS Twelve children underwent LA-CU: 3 end and 9 refluxing ureterostomy. Mean age was 18.75 ± 17.60 months. Mean operating time was 94.44 ± 34.86 minutes. Follow-up ranged from 10 to 38 months. No major postoperative complications occurred. Renal function and growth curves improved in the majority of children. CONCLUSIONS Primary surgical correction of obstructive or refluxing uropathy is the gold standard; however, temporary urinary diversion is useful in specific scenarios. In these patients, laparoscopic assistance may offer better and direct visualization, achieves accurate and rapid identification of ureter, and provides adequate mobilization, tension-free exteriorization, and excision of redundant ureter in some to optimize drainage. One trocar at the eventual stoma site minimizes scarring.
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Affiliation(s)
- Wies Vanderbruggen
- 1 Faculty of Medicine and Health Sciences, University of Antwerp , Antwerp, Belgium .,2 Urology Department, Antwerp University Hospital , Antwerp, Belgium
| | - Abraham Cherian
- 1 Faculty of Medicine and Health Sciences, University of Antwerp , Antwerp, Belgium .,3 Department of Paediatric Urology, Great Ormond Street Hospital for Children NHS Foundation Trust , London, United Kingdom
| | - Karen De Baets
- 2 Urology Department, Antwerp University Hospital , Antwerp, Belgium
| | - Stefan De Wachter
- 1 Faculty of Medicine and Health Sciences, University of Antwerp , Antwerp, Belgium .,2 Urology Department, Antwerp University Hospital , Antwerp, Belgium
| | - Gunter De Win
- 1 Faculty of Medicine and Health Sciences, University of Antwerp , Antwerp, Belgium .,2 Urology Department, Antwerp University Hospital , Antwerp, Belgium
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24
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Vaganée D, Daems F, Aerts W, Dewaide R, van den Keybus T, De Baets K, De Wachter S, De Win G. Testicular asymmetry in healthy adolescent boys. BJU Int 2018; 122:654-666. [DOI: 10.1111/bju.14174] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Donald Vaganée
- Faculty of Medicine and Health Sciences; University of Antwerp; Antwerp Belgium
- Department of Urology; Antwerp University Hospital; Edegem Belgium
| | - Frederik Daems
- Faculty of Medicine and Health Sciences; University of Antwerp; Antwerp Belgium
| | - William Aerts
- Faculty of Medicine and Health Sciences; University of Antwerp; Antwerp Belgium
| | - Rosina Dewaide
- Faculty of Medicine and Health Sciences; University of Antwerp; Antwerp Belgium
| | | | - Karen De Baets
- Department of Urology; Antwerp University Hospital; Edegem Belgium
| | - Stefan De Wachter
- Faculty of Medicine and Health Sciences; University of Antwerp; Antwerp Belgium
- Department of Urology; Antwerp University Hospital; Edegem Belgium
| | - Gunter De Win
- Faculty of Medicine and Health Sciences; University of Antwerp; Antwerp Belgium
- Department of Urology; Antwerp University Hospital; Edegem Belgium
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25
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De Wachter S, Vaganée D, De Win G. Fowler’s-like syndrome in a 20-year-old man with non-specific pelvic pain and dysfunctional voiding: A case report. Journal of Clinical Urology 2017. [DOI: 10.1177/2051415817715853] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Stefan De Wachter
- University of Antwerp, Belgium
- Department of Urology, Antwerp University Hospital, Belgium
| | | | - Gunter De Win
- University of Antwerp, Belgium
- Department of Urology, Antwerp University Hospital, Belgium
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26
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Henderickx MMEL, Brits T, De Baets K, Seghers M, Maes P, Trouet D, De Wachter S, De Win G. Renal papillary necrosis in patients with sickle cell disease: How to recognize this 'forgotten' diagnosis. J Pediatr Urol 2017; 13:250-256. [PMID: 28341428 DOI: 10.1016/j.jpurol.2017.01.020] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2016] [Accepted: 01/31/2017] [Indexed: 12/17/2022]
Abstract
INTRODUCTION Renal papillary necrosis is not commonly seen in daily practice, but can have severe consequences when it is not diagnosed in time. It is known to be associated with sickle cell hemoglobinopathies; however a wide range of etiologies are possible, and it is therefore not the first diagnosis clinicians consider in patients with sickle cell disease who present with hematuria. METHODS A literature search was performed to summarize the current knowledge about renal papillary necrosis associated with sickle cell disease. These findings are illustrated with a case of a 9-year old girl with sickle cell disease who was referred with painless gross hematuria. RESULTS Typical radiologic signs for renal papillary necrosis are necrotic cavities that fill with contrast, small collections of contrast peripheral to the calyces in the papillary region (ball-on-tee sign), calcification of the papillary defect, filling defects, hydronephrosis, blunted papillary tip, clefts in the renal medulla filled with contrast, hyperattenuated medullary calcifications, non-enhanced lesions surrounded by rings of excreted contrast, and clubbed calyces. DISCUSSION This study focuses on the pathophysiology of renal papillary necrosis associated with sickle cell disease, the possible symptoms, as well as the diagnostic steps, with a special interest in particular presentation on old (retrograde pyelography) and new (computed tomography) gold standard in radiologic imaging, and the management for this pathology. CONCLUSION This study aims to remind clinicians of this "forgotten" diagnosis and what signs to look for in pediatric patients with sickle cell disease who present with hematuria. In pediatric cases radiation protection is important, therefore knowing what radiologic signs can be found on retrograde pyelography can lead to early identification of this pathology without having to proceed to computed tomography.
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Affiliation(s)
| | - Tim Brits
- Department of Urology, University Hospital Antwerp, Edegem, Belgium
| | - Karen De Baets
- Department of Urology, University Hospital Antwerp, Edegem, Belgium
| | - Mattias Seghers
- Department of Radiology, University Hospital Antwerp, Edegem, Belgium
| | - Philip Maes
- Department of Pediatrics, University Hospital Antwerp, Edegem, Belgium
| | - Dominique Trouet
- Department of Pediatrics, University Hospital Antwerp, Edegem, Belgium
| | | | - Gunter De Win
- Department of Urology, University Hospital Antwerp, Edegem, Belgium
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Van Putte L, De Win G. Modified one-stage dorsal-inlay buccal mucosa graft technique for ventral penile urethral and penile skin erosion: A step-by-step guide. Arab J Urol 2016; 14:312-316. [PMID: 27900223 PMCID: PMC5122800 DOI: 10.1016/j.aju.2016.08.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2016] [Revised: 07/23/2016] [Accepted: 08/21/2016] [Indexed: 11/19/2022] Open
Abstract
Objective To demonstrate the use of a modified single-stage technique for the repair of a ventral penile urethral erosion with involvement of the penile skin, as penile urethral erosion is a rare but potential complication of chronic indwelling catheterisation with a lack of available recommendations for reconstructive options. Patient and methods A 44-year-old male with paraplegia, neurogenic bladder dysfunction and chronic sacral decubitus, presented with a large mid-penile erosion of the ventral penile shaft and urethra, which was caused by chronic transurethral indwelling catheterisation while being hospitalised in an intensive care unit. The reconstruction involved a single-stage dorsal-inlay buccal mucosa graft urethroplasty (Asopa) in addition to the second stage of a two-stage urethroplasty. The urethroplasty as well as the buccal mucosa graft harvest were performed by a single team. Results The modified single-stage urethroplasty procedure had a duration of 158 min with a postoperative hospitalisation of 3 days. At 8-months follow-up, the lesion had fully healed and the patient was back on clean intermittent self-catheterisation with solifenacin 10 mg daily. No complications occurred postoperatively. Conclusion The modified single-stage dorsal-inlay technique is a viable method for repairing ventral penile urethral erosion with involvement of penile skin.
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Affiliation(s)
- Lennert Van Putte
- Faculty of Medicine and Health science, University of Antwerp, Antwerp, Belgium
- Corresponding author at: Faculty of Medicine and Health Science, University of Antwerp, Berkenlaan 36, 2610 Wilrijk, Antwerp, Belgium. Fax: +32 3 821 44 79.Faculty of Medicine and Health ScienceUniversity of AntwerpBerkenlaan 362610 WilrijkAntwerpBelgium
| | - Gunter De Win
- Faculty of Medicine and Health science, University of Antwerp, Antwerp, Belgium
- Department of Urology, Antwerp University Hospital, Antwerp, Belgium
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28
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Horebeek IV, Wyndaele M, Verlinde P, Ost D, Cherian A, De Win G, Trouet D. Fibroepithelial ureteral polyps as a cause of ureteropelvic junction obstruction in children: A case report. PUCR 2016. [DOI: 10.14534/pucr.2016520778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
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De Win G, Van Bruwaene S, Kulkarni J, Van Calster B, Aggarwal R, Allen C, Lissens A, De Ridder D, Miserez M. An evidence-based laparoscopic simulation curriculum shortens the clinical learning curve and reduces surgical adverse events. Adv Med Educ Pract 2016; 7:357-70. [PMID: 27512343 PMCID: PMC4962760 DOI: 10.2147/amep.s102000] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
BACKGROUND Surgical simulation is becoming increasingly important in surgical education. However, the method of simulation to be incorporated into a surgical curriculum is unclear. We compared the effectiveness of a proficiency-based preclinical simulation training in laparoscopy with conventional surgical training and conventional surgical training interspersed with standard simulation sessions. MATERIALS AND METHODS In this prospective single-blinded trial, 30 final-year medical students were randomized into three groups, which differed in the way they were exposed to laparoscopic simulation training. The control group received only clinical training during residency, whereas the interval group received clinical training in combination with simulation training. The Center for Surgical Technologies Preclinical Training Program (CST PTP) group received a proficiency-based preclinical simulation course during the final year of medical school but was not exposed to any extra simulation training during surgical residency. After 6 months of surgical residency, the influence on the learning curve while performing five consecutive human laparoscopic cholecystectomies was evaluated with motion tracking, time, Global Operative Assessment of Laparoscopic Skills, and number of adverse events (perforation of gall bladder, bleeding, and damage to liver tissue). RESULTS The odds of adverse events were 4.5 (95% confidence interval 1.3-15.3) and 3.9 (95% confidence interval 1.5-9.7) times lower for the CST PTP group compared with the control and interval groups. For raw time, corrected time, movements, path length, and Global Operative Assessment of Laparoscopic Skills, the CST PTP trainees nearly always started at a better level and were never outperformed by the other trainees. CONCLUSION Proficiency-based preclinical training has a positive impact on the learning curve of a laparoscopic cholecystectomy and diminishes adverse events.
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Affiliation(s)
- Gunter De Win
- Department of Urology, Antwerp University Hospital
- Faculty of Health Sciences, University of Antwerp, Antwerp
- Correspondence: Gunter De Win, Department of Urology, Antwerp University Hospital, Wilrijkstraat 10, 2650 Edegem, Belgium, Tel +32 3 821 5586, Fax +32 3 821 4479, Email
| | - Siska Van Bruwaene
- Department of Urology, University Hospitals of KU Leuven
- Centre for Surgical Technologies, KU Leuven, Leuven, Belgium
| | | | - Ben Van Calster
- Department of Development and Regeneration, KU Leuven, Leuven, Belgium
| | - Rajesh Aggarwal
- Department of Surgery, Faculty of Medicine
- Steinberg Centre for Simulation and Interactive Learning, Faculty of Medicine, McGill University, Montreal, QC, Canada
| | - Christopher Allen
- School of Arts and Sciences, University of Pennsylvania, Philadelphia, PA, USA
| | - Ann Lissens
- Centre for Surgical Technologies, KU Leuven, Leuven, Belgium
| | - Dirk De Ridder
- Department of Urology, University Hospitals of KU Leuven
| | - Marc Miserez
- Centre for Surgical Technologies, KU Leuven, Leuven, Belgium
- Department of Abdominal Surgery, University Hospitals Leuven, Leuven, Belgium
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Abstract
OBJECTIVE We have previously reported our early experience (2 patients) of single-incision nephrectomy via the retroperitoneal prone route using an advanced access platform (GelPOINT Mini). Here, we review our series to date and also present a detailed video demonstrating the technique. METHOD In the prone position, a single transverse incision was made at the midpoint on a line along the lateral border of erector spinae bounded by the lower border of the 12th rib and iliac crest. Posterior abdominal muscles were split and the deep lumbodorsal fascia incised. The Alexis retractor was positioned and the Gel-Seal cap with low-profile sleeves locked in place. Hilar vessels were divided by endoclip application or harmonic scalpel. The kidney was retrieved directly or via an endobag. The Alexis retractor was removed and wound closed with absorbable sutures. RESULTS Between July 2013 and March 2015, we have used this approach to perform 10 nephrectomies in nine patients (4 male and 5 female). The median age at nephrectomy was 10.9 years (range 2.7-15.9 years). The median kidney length was 7.5 cm (range 3.7-11.5 cm). No complications occurred and none converted to open procedure. CONCLUSION Single incision retroperitoneal nephrectomy is feasible, safe, and provides excellent cosmesis.
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Affiliation(s)
- Neil C Featherstone
- Department of Paediatric Urology, Great Ormond Street Hospital for Sick Children, London, WC1N 3JH, UK.
| | - Gunter De Win
- Urology Department, Antwerp University Hospital, Antwerp, Belgium
| | - Shabnam Undre
- Department of Paediatric Urology, Great Ormond Street Hospital for Sick Children, London, WC1N 3JH, UK
| | - Abraham Cherian
- Department of Paediatric Urology, Great Ormond Street Hospital for Sick Children, London, WC1N 3JH, UK
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31
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Van der Cruyssen K, De Wachter S, Van Hal G, De Win G, Van Aggelpoel T, Vermandel A. The voiding pattern in healthy pre- and term infants and toddlers: a literature review. Eur J Pediatr 2015; 174:1129-42. [PMID: 26074371 DOI: 10.1007/s00431-015-2578-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2015] [Revised: 04/29/2015] [Accepted: 06/03/2015] [Indexed: 11/26/2022]
Abstract
UNLABELLED Toilet training in Western culture starts between 18 and 24 months. At this age, a child is assumed to have procured the competences needed for bladder control. Since the knowledge of reference values of a normal micturition serves as a guide to diagnose urologic pathology, the aim of this systematic review is to obtain a more comprehensive picture of normal voiding pattern in healthy infants, who have not yet reached bladder control. The systematic literature search was performed in two databases. This systematic review was conducted by the preferred reporting items for systematic reviews and meta-analyses (PRISMA statement). Twenty-one studies were selected that demonstrate factors associated with voiding pattern. Diuresis, interrupted voiding, post-void residual urine and voiding frequency are parameters decreasing with age. Bladder capacity, the lowest volume triggering micturition, flow rate, voiding volume and the level of awake voiding expand with age. CONCLUSION When evaluating the voiding pattern in infants, the normal evaluation of micturition parameters in healthy normal developing infants must be taken into consideration. WHAT IS KNOWN • Different voiding parameters in healthy infants who are not yet toilet trained are reported. • Voiding was believed to be induced by a constant bladder volume, while nowadays, it is detected that infants possess a functional spino-pontospinal voiding pathway. WHAT IS NEW • Arousal was detected in less than 60 % of all preterm micturitions, while it was present in more than 90 % of the micturitions of healthy "term" infants. • Voided volume, bladder capacity, and flow rate tend to increase with age. In contrast, voiding frequency, post-void residual urine, and interrupted voiding diminishes with an increasing age.
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Affiliation(s)
- Kelly Van der Cruyssen
- Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, University of Antwerp, Universiteitsplein 1, 2610, Antwerp, Belgium,
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Van Bruwaene S, Schijven MP, Napolitano D, De Win G, Miserez M. Porcine cadaver organ or virtual-reality simulation training for laparoscopic cholecystectomy: a randomized, controlled trial. J Surg Educ 2015; 72:483-90. [PMID: 25555673 DOI: 10.1016/j.jsurg.2014.11.015] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/06/2014] [Revised: 10/30/2014] [Accepted: 11/30/2014] [Indexed: 05/26/2023]
Abstract
OBJECTIVES As conventional laparoscopic procedural training requires live animals or cadaver organs, virtual simulation seems an attractive alternative. Therefore, we compared the transfer of training for the laparoscopic cholecystectomy from porcine cadaver organs vs virtual simulation to surgery in a live animal model in a prospective randomized trial. DESIGN After completing an intensive training in basic laparoscopic skills, 3 groups of 10 participants proceeded with no additional training (control group), 5 hours of cholecystectomy training on cadaver organs (= organ training) or proficiency-based cholecystectomy training on the LapMentor (= virtual-reality training). Participants were evaluated on time and quality during a laparoscopic cholecystectomy on a live anaesthetized pig at baseline, 1 week (= post) and 4 months (= retention) after training. SETTING All research was performed in the Center for Surgical Technologies, Leuven, Belgium. PARTICIPANTS In total, 30 volunteering medical students without prior experience in laparoscopy or minimally invasive surgery from the University of Leuven (Belgium). RESULTS The organ training group performed the procedure significantly faster than the virtual trainer and borderline significantly faster than control group at posttesting. Only 1 of 3 expert raters suggested significantly better quality of performance of the organ training group compared with both the other groups at posttesting (p < 0.01). There were no significant differences between groups at retention testing. The virtual trainer group did not outperform the control group at any time. CONCLUSIONS For trainees who are proficient in basic laparoscopic skills, the long-term advantage of additional procedural training, especially on a virtual but also on the conventional organ training model, remains to be proven.
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Affiliation(s)
- Siska Van Bruwaene
- Center for Surgical Technologies, Leuven, Belgium; Department of Urology, University Hospitals Leuven, Leuven, Belgium.
| | - Marlies P Schijven
- Department of Surgery, Academic Medical Center Amsterdam, Amsterdam, The Netherlands
| | | | - Gunter De Win
- Center for Surgical Technologies, Leuven, Belgium; Department of Urology, University Hospitals Leuven, Leuven, Belgium; Department of Urology, University Hospitals Antwerp, Edegem, Belgium
| | - Marc Miserez
- Center for Surgical Technologies, Leuven, Belgium; Department of Abdominal Surgery, University Hospitals Leuven, Leuven, Belgium
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Declercq P, De Win G, Van der Aa F, Beels E, Elodie B, Van der Linden L, Van Poppel H, Willems L, Ludo W, Spriet I, Isabel S. Reduced length of stay in radical cystectomy patients with oral versus parenteral post-operative nutrition protocol. Int J Clin Pharm 2015; 37:379-86. [PMID: 25666940 DOI: 10.1007/s11096-015-0072-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2014] [Accepted: 01/27/2015] [Indexed: 11/30/2022]
Abstract
BACKGROUND In Europe, parenteral nutrition is often used after radical cystectomy to avoid postoperative malnourishment. To the best of our knowledge, however, there is a paucity of data to conclude on the best modality for delivering nutritional support to this patient group. OBJECTIVE The parenteral nutrition policy was reconsidered and an oral nutrition protocol was implemented by the clinical pharmacist and evaluated in terms of length of stay, number and type of postoperative complications and parenteral nutrition avoided costs. SETTING A prospective interventional non-randomized before-after study was conducted. Regular radical cystectomy patients presenting without preoperative contra-indications for enteral nutrition were eligible. METHODS Postoperatively, in the control group, the parenteral nutrition policy from the ward was applied. Parenteral nutrition was initiated systematically and continued until the patient was able to tolerate solid food. In the interventional group, an oral nutrition protocol was implemented. Parenteral nutrition could be initiated if oral intake remained insufficient after 5 days. Main outcome measure The primary end point was postoperative length of stay. Secondary endpoints included the number of patients in whom the oral nutrition protocol was implemented successfully, as well as the number and type of postoperative complications. RESULTS A total of 94 eligible patients was assigned consecutively to the control (n = 48) and to the interventional group (n = 46). Baseline demographics were comparable. A significant reduction in median length of stay was associated with the oral nutrition protocol [18 days (IQR 15-22) in the control group vs. 14 days (IQR 13-18) in the interventional group (p < 0.001)]. In 40 out of 46 patients from the interventional group, the oral nutrition protocol was implemented successfully. The number and type of postoperative complications did not differ significantly. Implementing the oral nutrition protocol resulted in a direct parenteral nutrition infusion bag cost saving of approximately €512 and a reduction in hospitalization cost of €2,608 per patient. CONCLUSION The findings of our study showed that an oral nutrition protocol, when compared to the systematic postoperative use of parenteral nutrition, was associated with a decreased length of stay and costs in a regular radical cystectomy patient population.
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Affiliation(s)
- Peter Declercq
- Pharmacy Department, University Hospitals Leuven, Herestraat 49, 3000, Leuven, Belgium,
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De Win G, Everaerts W, De Ridder D, Peeraer G. Laparoscopy training in Belgium: results from a nationwide survey, in urology, gynecology, and general surgery residents. Adv Med Educ Pract 2015; 6:55-63. [PMID: 25674032 PMCID: PMC4321567 DOI: 10.2147/amep.s75747] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
BACKGROUND The purpose of this study was to investigate the exposure of Belgian residents in urology, general surgery, and gynecology to laparoscopic surgery and to training of laparoscopic skills in dedicated training facilities. METHODS Three similar specialty-specific questionnaires were used to interrogate trainees in urology, general surgery, and gynecology about their exposure to laparoscopic procedures, their acquired laparoscopic experience, training patterns, training facilities, and motivation. Residents were contacted via their Belgian specialist training organization, using Survey Monkey as an online survey tool. Data were analyzed with descriptive statistics. RESULTS The global response rate was 58%. Only 28.8% of gynecology respondents, 26.9% of urology respondents, and 52.2% of general surgery respondents felt they would be able to perform laparoscopy once they had finished their training. A total 47% of urology respondents, 66.7% of general surgery respondents, and 69.2% of gynecology respondents had a surgical skills lab that included laparoscopy within their training hospital or university. Most training programs did not follow the current evidence about proficiency-based structured simulation training with deliberate practice. CONCLUSION Belgian resident training facilities for laparoscopic surgery should be optimized.
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Affiliation(s)
- Gunter De Win
- Department of Urology, University Hospital Antwerp, Belgium
- Faculty of Medicine, University of Antwerp, Antwerp, Belgium
| | - Wouter Everaerts
- Department of Development and Regeneration, KU Leuven, Leuven, Belgium
- Department of Urology, Royal Melbourne Hospital, Melbourne, VIC, Australia
| | - Dirk De Ridder
- Department of Development and Regeneration, KU Leuven, Leuven, Belgium
| | - Griet Peeraer
- Faculty of Medicine, University of Antwerp, Antwerp, Belgium
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Loposso MN, Ndundu J, De Win G, Ost D, Punga AM, De Ridder D. Obstetric fistula in a district hospital in DR Congo: Fistula still occur despite access to caesarean section. Neurourol Urodyn 2014; 34:434-7. [PMID: 24706479 DOI: 10.1002/nau.22601] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2013] [Accepted: 03/03/2014] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To study the profile of classification, etiology, and the relation between initial classification, and the results of vesicovaginal fistula surgery in a district hospital in DR Congo. METHODS This study was based on the analysis of all consecutive patients being treated for VVF in Kisantu between November 2006 and November 2012. The fistula was classified according to the classification of Waaldijk. The location of VVF and degree of fibrosis were noted. Post-operatively, the first examination of patients took place a few days after catheter removal and subsequent review 2-3 months later. Statistical analysis was done in Graphpad Prism 6. RESULTS Among 146 patients with VVF, 117 had a primary fistula. The majority of fistula was type I (56%) followed by type III (21%). The majority underwent a caesarean section (63.4%). The mean duration of labor was 30.7 hr. Delay in getting a caesarean in time was due to difficulties in reaching the hospital in 55%. Overall, the closure rate after the first surgical treatment was 65%. The continence rate of the patients with a successful closure was 63%. CONCLUSION VVF can occur after caesarean section because of the prolonged labor that already causes ischemia and necrosis of the bladder wall and vesicovaginal septum before or while the caesarean section is being performed. Access to general hospitals and the management of the pregnant women needs to be improved. Despite a reasonable closure rate of 65%, post-fistula incontinence remains an important clinical problem.
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Affiliation(s)
- Matthieu Nkumu Loposso
- Department of Surgery, Urology Division, Kinshasa University Hospital, Kinshasa, Democratic Republic of Congo
| | - Jean Ndundu
- Department of Obstetrics & Gynaecology, Saint Luc Hospital, Kisantu, Democratic Republic of Congo
| | - Gunter De Win
- Department of Urology, University Hospital Antwerp, Antwerp, Belgium
| | - Dieter Ost
- Department of Urology, St. Blasius Hospital, Dendermonde, Belgium
| | - Augustin Maole Punga
- Department of Surgery, Urology Division, Kinshasa University Hospital, Kinshasa, Democratic Republic of Congo
| | - Dirk De Ridder
- Department of Urology, University Hospitals KU Leuven, Leuven, Belgium
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Van Bruwaene S, De Win G, Schijven M, De Leyn P, Miserez M. Effect of a short preclinical laparoscopy course for interns in surgery: a randomized controlled trial. J Surg Educ 2014; 71:187-192. [PMID: 24602708 DOI: 10.1016/j.jsurg.2013.07.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/11/2013] [Revised: 06/23/2013] [Accepted: 07/08/2013] [Indexed: 06/03/2023]
Abstract
OBJECTIVES Surgical interns are often not well prepared and have high anxiety about the execution of basic technical skills. This study investigates whether a short preclinical course focusing on laparoscopic camera-navigating skills is useful in the preparation for internship. DESIGN Through randomization, an experimental group who attended a short laparoscopic training session and a control group were created. Students' interest for this training and their confidence for laparoscopic exposure during surgical internship were inquired. During internship, camera-navigating skills were assessed by the operating surgeons (using a validated global rating scale) as well as by the students themselves (using a 10-points Likert scale). SETTING All research was performed in the Center for Surgical Technologies, Leuven, Belgium. PARTICIPANTS A total of 205 fifth-year medical students at the University of Leuven, Belgium. RESULTS Of the control group students, 80% were interested in attending the training session. There was no difference in confidence between experimental and control group. According to the surgeons and students, there was a significant improvement in clinical performance from the first (scores on global rating and Likert scales ±50%) to the last procedure (scores ±70%) for both groups. However, there was no difference in performance between groups. CONCLUSIONS Students are very interested in attending a preclinical laparoscopic training session. However, trained students did not display higher confidence or better clinical performance during internship. Even without previous training, students are fast to acquire the necessary skills during surgical internship.
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Affiliation(s)
- Siska Van Bruwaene
- Center for Surgical Technologies, Leuven, Belgium; Department of Urology, University Hospitals Leuven, Leuven, Belgium.
| | - Gunter De Win
- Center for Surgical Technologies, Leuven, Belgium; Department of Urology, University Hospitals Leuven, Leuven, Belgium; Department of Urology, Antwerp University Hospital, Antwerp, Belgium
| | - Marlies Schijven
- Department of Surgery, Academic Medical Center, Amsterdam, The Netherlands
| | - Paul De Leyn
- Department of Thoracic Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Marc Miserez
- Center for Surgical Technologies, Leuven, Belgium; Department of Abdominal Surgery, University Hospitals Leuven, Leuven, Belgium
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De Win G, Van Bruwaene S, Aggarwal R, Crea N, Zhang Z, De Ridder D, Miserez M. Laparoscopy training in surgical education: the utility of incorporating a structured preclinical laparoscopy course into the traditional apprenticeship method. J Surg Educ 2013; 70:596-605. [PMID: 24016370 DOI: 10.1016/j.jsurg.2013.04.001] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/16/2013] [Accepted: 04/01/2013] [Indexed: 06/02/2023]
Abstract
OBJECTIVE To investigate whether preclinical laparoscopy training offers a benefit over standard apprenticeship training and apprenticeship training in combination with simulation training. DESIGN This randomized controlled trial consisted of 3 groups of first-year surgical registrars receiving a different teaching method in laparoscopic surgery. SETTING The KU LEUVEN Faculty of Medicine is the largest medical faculty in Belgium. PARTICIPANTS Thirty final-year medical students starting a general surgical career in the next academic year. METHODS Thirty final-year medical students were randomized into 3 groups, which differed in the way they were exposed to laparoscopic simulation training but were comparable in regard to ambidexterity, sex, age, and laparoscopic psychomotoric skills. The control group received only clinical training during surgical residentship, whereas the interval group received clinical training in combination with simulation training. The registrars were allowed to do deliberate practice. The Centre for Surgical Technologies Preclinical Training Programme (CST PTP) group received a preclinical simulation course during the final year as medical students, but was not exposed to any extra simulation training during surgical residentship. At the beginning of surgical residentship and 6 months later, all subjects performed a standardized suturing task and a laparoscopic cholecystectomy in a POP Trainer. All procedures were recorded together with time and motion tracking parameters. All videos were scored by a blinded observer using global rating scales. RESULTS At baseline the 3 groups were comparable. At 6 months, for suturing, the CST PTP group was better than both the other groups with respect to time, checklist, and amount of movements. The interval group was better than the control group on only the time and checklist score. For the cholecystectomy evaluation, there was a statistical difference between the CST PTP study group and both other groups on all evaluation scales in favor of the CST PTP group. CONCLUSIONS Structured, preclinical proficiency-based training is better than clinical training combined with laboratory training or clinical training alone.
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Affiliation(s)
- Gunter De Win
- Centre for Surgical Technologies, K.U.LEUVEN, Leuven, Belgium; Department of Urology, University Hospitals K.U.LEUVEN, Leuven, Belgium; Department of Urology, University Hospital Antwerp, Antwerp, Belgium.
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Bogaert G, Orye C, De Win G. Pubertal Screening and Treatment for Varicocele do not Improve Chance of Paternity as Adult. J Urol 2013; 189:2298-303. [DOI: 10.1016/j.juro.2012.12.030] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2012] [Accepted: 12/12/2012] [Indexed: 10/27/2022]
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De Win G, Van Bruwaene S, Allen C, De Ridder D. Design and implementation of a proficiency-based, structured endoscopy course for medical students applying for a surgical specialty. Adv Med Educ Pract 2013; 4:103-15. [PMID: 23901308 PMCID: PMC3726649 DOI: 10.2147/amep.s41681] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
BACKGROUND Surgical simulation is becoming increasingly important in surgical education. Despite the important work done on simulators, simulator model development, and simulator assessment methodologies, there is a need for development of integrated simulators in the curriculum. In this paper, we describe the design of our evidence-based preclinical training program for medical students applying for a surgical career at the Centre for Surgical Technologies. METHODS Twenty-two students participated in this training program. During their final months as medical students, they received structured, proficiency-based endoscopy training. The total amount of mentored training was 18 hours and the training was organized into three training blocks. The first block focused on psychomotor training, the second block focused on laparoscopic stitching and suturing, and the third block on laparoscopic dissection techniques and hemostasis. Deliberate practice was allowed and students had to show proficiency before proceeding to the next training block. Students' psychomotor abilities were tested before the course and after each training block. At the beginning of their careers as surgical registrars, their performance on a laparoscopic suturing task was compared with that of registrars from the previous year who did not have this training course. Student opinions about this course were evaluated using a visual analog scale. RESULTS All students rated the training course as useful and their psychomotor abilities improved markedly. All students performed deliberate practice, and those who participated in this course scored significantly (P < 0.0001) better on the laparoscopic suturing task than first year registrars who did not participate in this course. CONCLUSION Organization of a structured preclinical training program in laparoscopy for final year medical students is feasible, attractive, and successful.
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Affiliation(s)
- Gunter De Win
- Centre for Surgical Technologies, University Hospitals, KU Leuven, Leuven, Belgium
- Department of Urology, University Hospitals, KU Leuven, Leuven, Belgium
| | - Siska Van Bruwaene
- Centre for Surgical Technologies, University Hospitals, KU Leuven, Leuven, Belgium
| | | | - Dirk De Ridder
- Department of Urology, University Hospitals, KU Leuven, Leuven, Belgium
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De Win G, Van Bruwaene S, De Ridder D, Miserez M. The optimal frequency of endoscopic skill labs for training and skill retention on suturing: a randomized controlled trial. J Surg Educ 2013; 70:384-93. [PMID: 23618450 DOI: 10.1016/j.jsurg.2013.01.005] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/14/2012] [Revised: 01/13/2013] [Accepted: 01/23/2013] [Indexed: 05/11/2023]
Abstract
OBJECTIVE To determine, given a fixed amount of training, the optimal distribution of sessions needed to acquire intracorporeal endoscopic suturing skills and to retain said skills for 1 to 6 months. DESIGN A randomized controlled trial consisted of 6 study groups who received identical laparoscopic suturing training but at differing frequencies of sessions. SETTING The faculty of medicine of the KULEUVEN is the largest medical faculty in Belgium. PARTICIPANTS Medical students without experience in laparoscopy (n = 145). METHODS After baseline assessments, the students were randomized into 6 groups to receive 6 training sessions of 1.5 hours each. Training Groups were as follows: 3 sessions daily (TD), bidaily sessions, 1 session daily (OD), 1 session on alternative days, 1 session weekly, and 1 session weekly with an optional "deliberate practice" in between sessions (WD). All exercises and feedback given were identical. One and 6 months after the final session, an evaluation was performed where a 5-cm chicken-skin incision had to be closed with 3 laparoscopic knots. The cumulative time to approximate the skin edges adequately was used for qualitative and quantitative analysis. RESULTS There were no significant differences amongst the groups at baseline concerning ambidexterity, motivation, or spatial abilities. The group OD outperformed the massed groups (TD and bidaily sessions) and the weekly groups (1 session weekly and WD) significantly (p = 0.003). After 1 month there was still a significant advantage for regular training groups (OD, 1 session on alternative days, and WD) over massed training groups (TD) (p = 0.004). After 6 months only a statistical difference (p = 0.04) between group OD and group TD was observed. Group WD's score remained stable after 6 months. CONCLUSIONS Short-term, once daily 1.5-hours session seems most beneficial for learning intracorporeal endoscopic suturing. After 6 months, distributed shorter training still remains better than massed practice but weekly training and daily training are comparable. "Optional Deliberate Practice" between the official training sessions reduces skill decay.
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Affiliation(s)
- Gunter De Win
- Centre for Surgical Technologies, K.U. Leuven, Leuven, Belgium.
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Tang HW, Van Brussel H, Vander Sloten J, Reynaerts D, De Win G, Van Cleynenbreugel B, Koninckx PR. Evaluation of an intuitive writing interface in robot-aided laser laparoscopic surgery. ACTA ACUST UNITED AC 2010; 11:21-30. [PMID: 16531339 DOI: 10.3109/10929080500450886] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE The feasibility of the conceptual Intuitive Writing Interface (IWI) in robot-aided laser laparoscopic surgery has been demonstrated previously. This paper investigates the potential improvement of IWI by comparing conventional manipulation (CM) and IWI manipulation (IM) and conducting an animal experiment. MATERIALS AND METHODS Three tasks were designed that were considered to be representative of laser laparoscopic surgical procedures. All test participants used both CM and IM in all tasks. Completion time and error level of each task were taken as comparative indices and were integrated into a self-defined Index of Time and Error (ITE). Six sequential in vitro trials were carried out to investigate learning curves. In addition, nephrectomy was performed on a rabbit by employing IWI in robot-aided laser laparoscopic surgery. RESULTS The results showed significant advantages for IM, with shorter completion time, more successful shots, and smaller error length in the three tasks, as compared to CM. The learning curve showed a promising trend for IM. More than half of the participants performed better with IM. The animal model experiment demonstrated the clinical feasibility of IM, but at the same time revealed some limitations. CONCLUSIONS The new IWI interface definitely improved laser laparoscopic procedures by taking advantage of familiar writing skills. With its flexibility of implementation and ease of use, IWI has clear potential for use in laser laparoscopic procedures.
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Affiliation(s)
- Hsiao-Wei Tang
- Division of Production Engineering, Machine Design and Automation, Katholieke Universiteit Leuven, Leuven, Belgium.
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Walraevens J, Willaert B, De Win G, Ranftl A, De Schutter J, Sloten JV. Correlation between compression, tensile and tearing tests on healthy and calcified aortic tissues. Med Eng Phys 2008; 30:1098-104. [DOI: 10.1016/j.medengphy.2008.01.006] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2006] [Revised: 09/12/2007] [Accepted: 01/30/2008] [Indexed: 11/27/2022]
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Molinas CR, De Win G, Ritter O, Keckstein J, Miserez M, Campo R. Feasibility and construct validity of a novel laparoscopic skills testing and training model. ACTA ACUST UNITED AC 2008. [DOI: 10.1007/s10397-008-0391-0] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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