Isolated epididymal injury after blunt scrotal trauma from high velocity paintball round.

Isolated epididymal injury without associated underlying scrotal or testicular injury in the setting of blunt trauma is exceedingly rare. We present a case of an isolated epididymal injury incurred after scrotal trauma from a high velocity paintball round. Ultrasound demonstrated an enlarged, hypoechoic left epididymis with no evidence of underlying testicular injury. This case highlights the importance of obtaining imaging to evaluate for signs of testicular rupture, potentially obviating the need for surgery. It also reinforces the need for appropriate protective gear when participating in activities with potential for high velocity scrotal trauma.

VURD syndrome--does it really preserve long-term renal function?

PURPOSE: VURD (posterior urethral valves, unilateral vesicoureteral reflux and renal dysplasia) syndrome is the combination of persistent unilateral vesicoureteral reflux associated with an ipsilateral dysplastic, poorly functioning kidney in patients with posterior urethral valves. It was postulated that this syndrome may result in preservation of long-term renal function due to a pressure release pop-off mechanism. We determined the effects of VURD long-term renal outcomes. MATERIALS AND METHODS: We retrospectively reviewed the records of boys diagnosed with posterior urethral valves between 1983 and 2009 at a single pediatric tertiary hospital. Patients were divided into those with and those without VURD syndrome. The outcome of interest was renal impairment, defined as stage 3 or greater chronic kidney disease (glomerular filtration rate less than 60 ml/min/1.73 m(2)). RESULTS: We identified 89 patients, of whom 23 (26%) had VURD. Median followup was 77 and 57 months in the VURD and nonVURD groups, respectively. Seven patients (30%) with and 26 (39%) without VURD had significant renal impairment. Survival analysis using a Cox proportional hazard model showed no association between VURD and renal impairment (HR 1.05, 95% CI 0.65-1.70). The main predictors of renal function were the creatinine nadir and patient age at diagnosis. CONCLUSIONS: VURD syndrome does not seem to have a long-term protective effect on renal function.

Organ procurement surgery as a means of increasing open surgical experience during urology residency training.

INTRODUCTION: The introduction and advancement of minimally invasive surgery (MIS) has resulted in a reciprocal decline in exposure to open surgery during urology residency training. We propose organ procurement surgery as a potential vehicle to facilitate an increase in open surgical experience among trainees. We define the surgical case volume for organ procurement surgeries currently performed by urology residents in Canada, and determine what capacity exists for expansion. METHODS: Data on organ procurement surgeries were extracted for Canadian urology residents case-logs between 2005 and 2009. Case-logs were anonymously analyzed through the voluntary self-reporting program T-Res (Resilience Software Inc.). National deceased organ donor data were obtained from the Canadian Institute for Health Information. RESULTS: The graduating Canadian urology resident has performed an average of 0.95 organ procurement surgeries during 5 years of training. An average of 469.6 procurement surgeries were performed yearly in Canada between 2005 and 2009. The theoretical capacity exists for each graduating resident to perform an additional 16.3 organ procurements during residency. CONCLUSIONS: With the establishment of MIS as standard of care for many urologic surgeries, the decrease in open operative experience is concerning. Innovative ways to enrich open surgical experience may be required, and increased formal incorporation of organ procurements into urology residency training curriculum may help fill the void.

Pediatric bladder neuroblastoma: Case report and literature review.

Neuroblastoma (NBL) of the urinary bladder is an extremely rare diagnosis, with only 6 cases reported in the literature to date. We report the case of a 3-year-old boy who presented with gross hematuria, and was diagnosed with bladder NBL after partial cystectomy. Two-year follow-up has been unremarkable. This case highlights a rare neoplasm of the urinary bladder in a pediatric patient.

Cystic intratesticular lesions in pediatric patients.

BACKGROUND/PURPOSE: Intratesticular cysts are a rare clinical entity in the pediatric population. Recently, testes sparing surgery has been recommended. We share our experience with the management of pediatric testicular cysts. METHODS: A retrospective review of all pediatric patients referred for intratesticular cysts was conducted at a single pediatric institution from 2002 to 2010. Charts were evaluated for patient demographics, diagnosis, and management. RESULTS: Seven patients were identified and included in this series. After partial orchiectomy, the final diagnosis in three patients was epidermoid cyst. Three further patients were diagnosed as mature cystic teratoma, with two of these demonstrating adjacent intra-tubular germ cell neoplasia (ITGCN). One cyst in the series underwent spontaneous resolution after eight months. CONCLUSION: All of the cystic lesions in our case series were benign with one undergoing complete resolution. The remainder became smaller and developed a solid component prompting surgery. The pre-pubertal findings of ITGCN in two patients raise a dilemma regarding the optimal long-term management for these patients. Initial conservative observation is an option for the majority of pre-pubertal cystic testicular lesions until such time that testis sparing surgery is deemed technically feasible. Testes sparing surgery should be advocated in those patients undergoing surgical management.

Genitourinary tuberculosis masquerading as a ureteral calculus.

The genitourinary tract is a common extrapulmonary site of tuberculosis infection, yet remains a rare clinical entity in North America. We report the case of a 37-year-old man who presented for extracorporeal shock wave lithotripsy for a suspected ureteral stone on imaging. Further workup confirmed a diagnosis of genitourinary tuberculosis. Medical management was undertaken and, ultimately, nephrectomy performed. This case highlights the importance of maintaining a high index of clinical suspicion for genitourinary tuberculosis.

Undergraduate exposure to urology: impact of the distributed model of medical education in British Columbia.

BACKGROUND: With the increased development of distributed sites for medical education across Canada, it is imperative we ensure that the quality of education is comparable between the different campuses. Our objective was to assess medical student experience and comfort with common urologic clinical encounters and to determine whether any differences exist between the distributed education sites at the University of British Columbia (UBC). METHODS: Questionnaires assessing urologic education were delivered simultaneously to all final-year UBC medical students attending campuses in Vancouver, Victoria and Prince George. Results were analyzed using descriptive statistics. RESULTS: Overall, 55.8% of students felt their exposure to urology was adequate in the medical curriculum; learners in the Northern Program (Prince George) ranked their clinical and didactic experiences significantly higher. Areas requiring improvement include teaching of the male genitourinary exam, digital rectal exam and sexual history, in which learners rated teaching "good/outstanding" in only 18.2%, 47.7% and 43.2% of cases, respectively. Overall, students were most comfortable with the following clinical encounters: urinary tract infection, nephrolithiasis, benign prostatic hyperplasia, hematuria, incontinence and prostate cancer. Few differences in student experience or comfort were noted related to campus site, gender or urology clerkship exposure. CONCLUSION: A significant minority of learners perceived that they had inadequate exposure to urology in the undergraduate curriculum. Experience in urology was comparable across the distributed sites and was congruent with teaching objectives. Students were comfortable with the clinical scenarios deemed most important in the literature. Learners in the Northern Program were significantly more satisfied with their urologic teaching, which potentially highlights the advantages of learning in a smaller academic setting.

CONTEXTE: En raison de l'augmentation du nombre de sites « satellites ¼ de formation médicale au Canada, il est impératif de s'assurer que la qualité de l'éducation est comparable d'un campus à l'autre. Notre objectif était d'évaluer l'expérience des étudiants en médecine et leur niveau d'aise avec les cas courants rencontrés en urologie et de déterminer s'il existe des différences entre les différents sites de formation de l'Université de la Colombie-Britannique (UCB). MÉTHODOLOGIE: Des questionnaires évaluant la formation en urologie ont été livrés simultanément à tous les étudiants de l'UCB en dernière année de médecine des campus de Vancouver, Victoria et Prince George. Les résultats ont été analysés à l'aide de statistiques descriptives. RÉSULTATS: Dans l'ensemble, 55,8 % des étudiants croyaient que leur expérience en urologie était adéquate dans le cadre du cursus médical. Les étudiants du programme du nord (Prince George) ont accordé des cotes significativement plus élevées à leur expérience clinique et didactique. Les domaines où une amélioration était sou-haitée incluaient l'enseignement de l'examen génito-urinaire chez l'homme, du toucher rectal et de la vérification des antécédents sexuels, où les répondants ont évalué l'enseignement comme étant « bon/excellent ¼ dans seulement 18,2 %, 47,7 % et 43,2 % des cas, respectivement. Règle générale, les étudiants étaient le plus à l'aise avec les cas cliniques suivants : infection des voies urinaires, néphrolithiase, hyperplasie bénigne de la prostate, hématurie, incontinence et cancer de la prostate. Peu de différences ont été notées dans l'expérience ou le niveau d'aise des étudiants selon le campus, le sexe ou le fait d'avoir fait un stage clinique en urologie. CONCLUSION: Une minorité significative d'étudiants percevaient que leur expérience en urologie dans le cadre du curriculum de premier cycle était insuffisante. L'expérience en urologie était comparable dans les sites « satellites ¼ et cohérente avec les objectifs d'apprentissage. Les étudiants étaient à l'aise avec les scénarios cliniques jugés les plus importants selon la littérature. Les étudiants du programme du nord étaient significativement plus satisfaits de l'enseignement urologique reçu, ce qui fait peut-être ressortir l'avantage d'étudier sur un plus petit campus.

Trends in urology resident exposure to minimally invasive surgery for index procedures: a tale of two countries.

OBJECTIVE: To interrogate case-log data for American and Canadian urology residents to define trends in minimally invasive surgery (MIS) and open surgery and compare operative experiences between these 2 groups. METHODS: Case-log data from 2004 to 2009 for American urology residents was compared with Canadian residents for 8 index cases, which are routinely performed in both an MIS and open approach. These included nephrectomy (donor, radical, simple, partial), prostatectomy (radical), adrenalectomy, pyeloplasty, and nephroureterectomy. RESULTS: Linear regression analysis demonstrated a significant increase in the percentage of MIS radical prostatectomies performed by American residents (11.2%-52%), compared with Canadian residents (0.74%-11.2%). There was also a significant increase in the percentage of MIS donor nephrectomies by Canadian residents (5.6%-68.7%), compared with American residents (70.1%-89.1%). For Canadian residents, exposure to the following 3 MIS procedures increased significantly over open approaches: adrenalectomy, radical prostatectomy, and donor nephrectomy. For American residents, all index procedures with the exception of adrenalectomy underwent a significant increasing trend (all p < 0.05). CONCLUSIONS: Trends for 8 index procedures confirm a continuing shift towards MIS for the majority of procedures in both countries. Differences may be only temporal and relate to dissimilar health care delivery models with a resultant lag in the adoption of laparoscopy and robotics in Canada. The impact of these trends upon ultimate surgical competence of graduates remains to be seen.

Drainage characteristics of the 3F MicroStent using a novel film occlusion anchoring mechanism.

PURPOSE: To determine whether the overall ureteral flow through an obstructed ureter using the 3F MicroStent™ that uses a novel film occlusion anchoring mechanism is comparable to the flow using a conventional 3F and 4.7F Double-J stent. MATERIALS AND METHODS: An in vitro silicone ureter model and an ex vivo porcine urinary model (kidney and ureter) were used to measure the overall flow through obstructed and unobstructed ureters with either a 3F Double-J stent (Cook), 3F MicroStent (PercSys), or 4.7F Double-J stent (Cook). Mean flow rates were compared with descriptive statistics. RESULTS: Mean flow rates through the obstructed silicone ureter (12-mm stone) for the 3F MicroStent, 3F Double-J stent, and 4.7F Double-J stent were 326.7±13.3 mL/min, 283.3±19.2 mL/min, and 356.7±14.1 mL/min, respectively. In the obstructed ex vivo porcine ureter model, the flow as a percentage of free flow was 60%, 53%, and 50 %, respectively. In both ureteral models, flow rates of the 3F MicroStent and 4.7F Double-J stents were not statistically different. CONCLUSIONS: The 3F MicroStent demonstrated drainage equivalent to a 4.7F Double-J stent, in both in vitro silicone and ex vivo porcine obstructed urinary models. We have demonstrated the crucial first step that this 3F stent, using a novel film occlusion anchoring mechanism, has equivalent, if not slightly improved, drainage rates when compared with its larger counterpart.

Penile fracture with bilateral corporeal rupture and complete urethral disruption: case report and literature review.

Penile fracture is a rare injury most commonly sustained during sexual intercourse. We report the case of a 35-year-old man who presented with bilateral rupture of the corpora cavernosa and complete disruption of the urethra. A review of the literature on penile fracture is also presented. Urgent surgical exploration was performed and the injuries repaired primarily. In follow-up, the patient reported satisfactory erectile function. This case highlights the importance of early surgical repair and evaluation for concomitant urethral injuries in cases of penile fracture.