ABSTRACT
PURPOSE: Percutaneous renal puncture (PRP) is one of the most important and critical step of urology, especially while performing percutaneous nephrostomy and percutaneous nephrolithotomy (PCNL). In the learning period of this procedures, there is a need for validated, effective, economical models for such training. This study describes a simple non - biological model for learning PRP. The aim was to determine the effectivity of this model as a training and assessment tool, and to assess its cost relative to other models. MATERIALS AND METHODS: We designed a training box, made of foam and rubber with two open sides and performed radiopaque pelvicalyceal system maquettes to insert inside it. Experts in PCNL (i.e., > 100 cases) andnovices (i.e., pediatric surgeons and urologists without PCNL experience) performed percutaneous renal puncture. Novices performed a pre -test and a post - test (i.e., after 2 hour training). Data recorded were total procedure time, X - ray exposure time, and number of puncture attempts. Experts who performed PRP successfully were asked torate the model using a questionnaire. RESULTS: Five experts and 21 novices completed the study. Four experts rated the model as an "excellent" (score 5) training and assessment tool; one expert rated these as "very good" (score 4). Comparisons of novices' pre - and post - test median results revealed significant skill acquisition with shorter procedure time, less X - ray exposure, and fewer attempts for successful puncture (all P < .001). CONCLUSION: This new non - biological training model is an effective training tool that helps learners improve skills in PRP. The model is simple to construct, economical, and highly re-useable compared to others. It provides good visibility and imaging, is portable, and could be used widely in training centres.
Subject(s)
Punctures , Simulation Training , Urology/education , Attitude of Health Personnel , Clinical Competence , Fluoroscopy , Humans , Nephrostomy, Percutaneous/education , Operative Time , Radiation ExposureABSTRACT
A 38-year-old man was admitted to our clinic with an enlarging right scrotal mass that had been present for 7 years. Right radical inguinal orchiectomy was performed and a histopathological diagnosis confirmed a very rare case of cholesterol granuloma of the paratesticular tissue. It can be very difficult to preoperatively distinguish testicular tumours from cholesterol granulomas of the testis or epididymis. Cholesterol granuloma should be kept in mind in patients with large and non-tender scrotal masses.
ABSTRACT
The repair of hypospadias is among the most difficult problems in urology, as it demands the construction of a well-functioning urethra and a good cosmetic appearance. We performed a retrospective analysis of 422 cases subjected to one-stage anterior hypospadias repair between 1982 and 1999 in our clinic and investigated the effects of factors like degree of hypospadias, surgical technique, and the surgeon's experience on outcome. The operations used were MAGPI (91), urethral advancement (10), Mathieu (260), modified Allen-Spence (50), onlay island flap (5), and double-faced island flap (6) procedures. The early complication rate was 18%, while the final success rate following secondary interventions was 95%. The complications included fistula formation in 49 cases (12%), flap necrosis in 12 (3%), meatal problems in 12 (3%), residual chordee in 4 (1%), and urethral stricture in 1 (<1%). Complication rates were significantly higher if the meatus was proximal or there was severe chordee and in the first 6 years of the study. The flap procedures were associated with a higher complication rate. It is concluded that one-stage procedures are successful in the repair of anterior hypospadias in experienced hands with proper patient selection.
