Female Pelvic Floor Immersive Simulation: A Randomized Trial to Test the Effectiveness of a Virtual Reality Anatomic Model on Resident Knowledge of Female Pelvic Anatomy.

STUDY OBJECTIVE: To estimate the effect of a virtual reality (VR) anatomic model (VisCubeSX; VisBox, Inc., Saint Joseph, IL) on obstetrics and gynecology residents' knowledge of female pelvic floor anatomy compared with a traditional curriculum. DESIGN: Randomized controlled trial (Canadian Task Force classification I). SETTING: Academic obstetrics and gynecology resident training program. INTERVENTIONS: Traditional independent study curriculum versus traditional curriculum and VisCubeSX VR curriculum MEASUREMENTS AND MAIN RESULTS: Residents were randomized, stratified by year of training, in a 1:1 fashion to traditional independent study curriculum for pelvic anatomy versus traditional curriculum and the VisCubeSX VR anatomic model. Tests were administered to assess baseline and postintervention knowledge. A postintervention assessment of the VisCubeSX VR anatomic model was performed. Baseline, follow-up, and score improvement were compared between groups using Student t tests and Wilcoxon rank sum tests. Thirty-one residents were randomized. There was a significant improvement in pre- and post-test scores within traditional independent study curriculum participants, 8.1 ± 12.0 points (p = .02), and the VisCubeSX group 8.7 ± 6.4 points (p <.001), but these improvements did not differ between groups (p = .86). This lack of between-group differences was consistent in resident year-stratified analyses. Residents exposed to the VisCubeSX VR anatomic model reported they "somewhat" or "strongly agree" (15/16 [93.8%] and 14/16 [87.5%] of residents, respectively) that the model improved their knowledge of pelvic anatomy and that the model will improve patient care. CONCLUSION: Few studies exist that compare educational outcomes of a traditional independent study of female pelvic anatomy curriculum versus immersive simulation with VR models in female pelvic anatomy. Knowledge scores were not significantly increased with the VR model compared with traditional curriculum, but VR technology was perceived as an enhancement to short-term learning.

Comparison of transvaginal and retropubic bladder neck closure with suprapubic catheter in women.

PURPOSE: Bladder neck closure is an uncommon procedure that is usually reserved for patients with severe urethral incompetence. It may be an acceptable alternative to procedures involving bowel reconstruction. Bladder neck closure can be performed using a transvaginal or a retropubic approach. We compared urethral continence rates, perioperative outcomes, short-term and long-term complications, subsequent procedures and changes in renal function between transvaginal and retropubic bladder neck closure in females at our institution. MATERIALS AND METHODS: We retrospectively reviewed the records of 64 female patients who underwent bladder neck closure with suprapubic catheter placement from May 1990 to February 2013. Baseline variables and the mentioned outcomes were compared between transvaginal and retropubic bladder neck closure. RESULTS: There were 35 women in the transvaginal group and 29 in the retropubic group. Urethral erosion due to a chronic indwelling urethral catheter was the most common indication for bladder neck closure. The urethral continence rate after the first bladder neck closure did not significantly differ between the transvaginal and retropubic groups (85.7% vs 81.5%, p = 0.74). The transvaginal group had significantly shorter mean operative time (78.0 vs 137.5 minutes, p = 0.002) and hospital stay (1.5 vs 4.9 days, p = 0.0003), and fewer short-term complications (5.7% vs 31.0%, p = 0.02) than the retropubic group. The remaining outcomes did not differ between the 2 groups. CONCLUSIONS: There was no difference between transvaginal and retropubic bladder neck closure in achieving urethral continence. Transvaginal bladder neck closure was associated with a shorter operative time and hospital stay as well as fewer short-term complications.

Parameatal urethral cysts in prepubertal males.

PURPOSE: Parameatal urethral cyst in boys is an uncommon and often poorly understood condition. We describe the largest known series of 18 prepubertal boys with parameatal cysts. MATERIALS AND METHODS: We retrospectively reviewed the charts of all pediatric patients at our institution diagnosed with a penile cyst according to our office database between 1992 and 2010. Charts were reviewed to determine patient demographics, symptomatology, pathology, cyst characteristics and treatment. RESULTS: We identified 18 patients during the last 18 years who were diagnosed with a parameatal cyst. Most patients (66%) were asymptomatic. All cysts were less than 1 cm in diameter. Of the patients 50% were circumcised before presentation and 78% underwent surgical excision. There have been no recurrences in patients who underwent excision. One patient had spontaneous resolution of the cyst during the first few weeks of life. Pathology results were available for 6 patients. Three specimens contained a single type of epithelium and 3 contained a combination of transitional, cuboidal and/or columnar epithelia. The transitional and cuboidal epithelia were the most common components. There was no evidence of malignancy in any of the specimens and only 1 specimen contained an inflammatory infiltrate. CONCLUSIONS: Parameatal cysts are a benign, usually asymptomatic condition that may contain a variety of epithelial types. The cysts may resolve spontaneously in neonates but are also easily excised with minimal risk of recurrence.

Co-existing sarcoidosis confounds the staging of bilateral renal cell carcinoma.

We present a case in which the undiagnosed condition of sarcoidosis complicated the staging of bilateral, subtype-discordant renal cell carcinoma. Initially thought to have metastatic renal cell carcinoma based on computed tomography imaging and referred for immunotherapy, a positron emission tomography/computed tomography scan demonstrated different levels of radiotracer activity in the primary site and the presumed pulmonary metastatic sites. The patient underwent bilateral partial nephrectomies and was ultimately diagnosed with stage T1 bilateral renal cell carcinoma and sarcoidosis. This case highlights the need to consider concurrent medical conditions that can lead to false positive results when evaluating for metastatic disease with imaging studies as well as the importance of evaluating the levels of radiotracer activity between different sites.

Women living with disabilities and their experiences and issues related to the context and complexities of leaving abusive situations.

The health of women with disabilities, like other women, is affected by experiences of violence and abuse. However, the experiences of women living with disabilities is less well known and an important issue for rehabilitation professionals. In this paper we focus on presenting women's knowledge and experiences of violence and abuse regarding where abuse takes place, the forms of abuse; and the complexities associated with 'taking action'. Women participants for this study had to be: 18 years of age or older; a Canadian citizen; able to participate in English; self-defined with a disability; and, be living in an urban area of Canada. Data presented is based on an innovative community-academic research study in which focus groups discussions using electronic technology (i.e. blackboard and chat rooms) were conducted with women living with disabilities across the country on important health issues. Participants' recommendations are also presented. Discussion of the findings focus on policy and practice implications related to dedicated resources, access to information and training initiatives for rehabilitation professionals and women themselves.

Parent and teacher report of social skills in children with autism spectrum disorders.

PURPOSE: The purpose of this study was to examine the agreement between parent and teacher perceptions of specific social behaviors in children with autism spectrum disorders (ASD). METHOD: Informant ratings were generated concerning 45 children with ASD between the ages of 5 and 14 years who were enrolled in social skills groups at 2 Midwestern outpatient autism treatment centers. RESULTS: Moderate agreement was observed between parents and teachers for the overall social skills rating scores (r = 0.34; p < 0.05), but there was little agreement on specific social items. Distinct patterns of skill profiles emerged. Parents consistently provided relatively higher ratings on items that pertained to initiating interactions. Teachers, on the other hand, consistently provided higher ratings on items related to responding to and maintaining interactions. Parents and teachers agreed most often on items of affective understanding and perspective taking. CONCLUSION: These findings suggest that specific social behaviors may be context dependent, indicating the need for a multi-informant approach to provide a more complete profile of a child's social abilities, which is necessary for generating a more effective treatment plan.