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BACKGROUND: Prediction of side-specific extraprostatic extension (EPE) is crucial in selecting patients for nerve-sparing radical prostatectomy (RP). Multiple nomograms, which include magnetic resonance imaging (MRI) information, are available predict side-specific EPE. It is crucial that the accuracy of these nomograms is assessed with external validation to ensure they can be used in clinical practice to support medical decision-making. METHODS: Data of prostate cancer (PCa) patients that underwent robot-assisted RP (RARP) from 2017 to 2021 at four European tertiary referral centers were collected retrospectively. Four previously developed nomograms for the prediction of side-specific EPE were identified and externally validated. Discrimination (area under the curve [AUC]), calibration and net benefit of four nomograms were assessed. To assess the strongest predictor among the MRI features included in all nomograms, we evaluated their association with side-specific EPE using multivariate regression analysis and Akaike Information Criterion (AIC). RESULTS: This study involved 773 patients with a total of 1546 prostate lobes. EPE was found in 338 (22%) lobes. The AUCs of the models predicting EPE ranged from 72.2% (95% CI 69.1-72.3%) (Wibmer) to 75.5% (95% CI 72.5-78.5%) (Nyarangi-Dix). The nomogram with the highest AUC varied across the cohorts. The Soeterik, Nyarangi-Dix, and Martini nomograms demonstrated fair to good calibration for clinically most relevant thresholds between 5 and 30%. In contrast, the Wibmer nomogram showed substantial overestimation of EPE risk for thresholds above 25%. The Nyarangi-Dix nomogram demonstrated a higher net benefit for risk thresholds between 20 and 30% when compared to the other three nomograms. Of all MRI features, the European Society of Urogenital Radiology score and tumor capsule contact length showed the highest AUCs and lowest AIC. CONCLUSION: The Nyarangi-Dix, Martini and Soeterik nomograms resulted in accurate EPE prediction and are therefore suitable to support medical decision-making.
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BACKGROUND AND OBJECTIVES: In Germany, approximately 1500 female physicians become pregnant each year. This also applies to urologys. The announcement of a pregnancy is often met with ignorance and unanswered questions by chief physicians and colleagues. The aim of this study is to clarify how urological chief physicians assess the current situation and to present liability risks versus health risks. MATERIALS AND METHODS: From July to October 2019, an anonymous online questionnaire was sent to 340 chief physicians by the Working Group Young Urologists of the German Society of Urology (DGU). The questionnaire asked about the risk assessment of the workplace, the timing of a pregnancy announcement, and the employment possibilities of pregnant employees in urology. In addition, a law firm was commissioned to prepare a brief legal opinion on the topic of medical work and surgery during pregnancy with specific reference to the field of urology, including any liability risks. RESULTS: In all, 62 chief physicians participated in the survey (18.2%): 93.5% of the respondents considered an anticipatory risk assessment of the workplace for pregnant women to be useful; 82.3% would appreciate an overlapping recruitment by the employer. Respondents (62.9%) were skeptical of pregnant employees operating. Taking into account the regulations of the Maternity Protection Act, the liability risk does not exceed that which the employer generally has to bear. CONCLUSION: The amendment of the Maternity Protection Act has not fundamentally changed the reality for female urologists. However, the individual risk assessment provides an opportunity to develop concrete protective measures-also for the operating room-with the employer. The aim must be to provide pregnant women with greater support in asserting their rights in the future.
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Physicians , Urology , Female , Germany , Humans , Pregnancy , Urologists , WorkplaceABSTRACT
INTRODUCTION: The aim of residency is to acquire medical skills and abilities. One didactic model is "Peyton's four-step approach". The aim of the present study was to develop and evaluate a modified Peytonian approach for group interactions. The aim was to develop a course for the acquisition of practical skills and training assistants in suture techniques for urology. METHODS: A prospective study was conducted with a total of 38 participants and 6 tutors. In a modified four-step Peytonian approach, various suturing and knotting techniques were taught in a structured manner. Tutors evaluated the procedural activity using observation sheets. In addition, the learning method was evaluated by the participants and the tutors at the end of the course. In order to check the long-term learning success, a renewed survey of the participants was conducted after 6 months. RESULTS: 80% of the participants rated the modified teaching method as useful and 83% of the tutors rated the procedural implementation as good. Fluid movement sequences were difficult independent of the technique taught. After 6 months, the participants significantly improved their procedural skills in all techniques that were taught. CONCLUSION: This paper defines a four-step Peyton-based approach to teaching practical skills such as suturing and knotting used in urological training. The modified teaching method improved practical skills used in urology. This method should be considered in continuing education to promote self-confidence and increase the competence in surgical skills.
