Candida Bezoars in Adults: Determining Optimal Management.

Fungal bezoars, or fungal balls, are rare pathologic consequences of funguria in immunocompromised patients. Current treatment recommendations are based on expert opinion and low level evidence. We present a case of a Candida glabrata bezoar that was effectively treated with percutaneous amphotericin B instillations. A subsequent literature review is presented to assess the available case reports and treatment outcomes of Candida spp. bezoars in adults.

Validation of a high fidelity adult ureteroscopy and renoscopy simulator.

PURPOSE: Surgical simulation technology may efficiently train and accurately assess the acquisition of many skills. Surgical simulators often lack realism and can be expensive at $3,000 to more than $60,000. We assessed the face, content and construct validity of a newly developed, anatomically accurate, reasonably priced high fidelity ureteroscopy and renoscopy trainer. MATERIALS AND METHODS: A total of 46 participants, including attending urologists, urology residents, medical students and industry representatives, assessed the face and content validity of the simulator using a standard questionnaire. Ten experienced ureteroscopists with greater than 30 procedures per year and 10 novice ureteroscopists with 0 were assessed on the ability to perform flexible ureteroscopy, renoscopy and intrarenal basket extraction of a lower pole calculus using the adult ureteroscopy trainer (Ideal Anatomic Modeling, Holt, Michigan). Subject performance was assessed by an experienced ureteroscopist using a checklist, global rating scale and time to task completion. RESULTS: Of participants 100% rated the trainer as realistic and easy to use, and thought it was a good training tool, 98% thought that it would serve as a good training format and 96% would recommend it to urology trainees. All participants recommended it for use in residency programs and 96% would or would have used it during residency. Only 37.5% vs 100% of experienced vs novice ureteroscopists would use it to practice. Of participants 9% foresaw a problem with the trainer. On the trainer experienced ureteroscopists scored significantly higher on the global rating scale (mean +/- SD 33.1 +/- 1.3 vs 15.0 +/- 2.7, p <0.0001) and checklist (4.1 +/- 1.0 vs 2.4 +/- 1.1, p = 0.004), and required less time to complete the task (141.2 +/- 40.1 vs 447.2 +/- 301.7 seconds, p = 0.01). CONCLUSIONS: Our preliminary study suggests the face, content and construct validity of the adult ureteroscopy trainer as a high fidelity ureteroscopy and renoscopy trainer.

Postoperative hemorrhage following robotic-assisted laparoscopic prostatectomy controlled with external penile compression.

We report a postoperative hemorrhage of the dorsal vein complex after transperitoneal robotic-assisted laparoscopic prostatectomy managed with external penile compression. Control of the dorsal vein required two sutures, and the estimated blood loss due to the procedure was 400 ml. Severe gross hematuria developed on postoperative day 2, but this quickly subsided with external compression at the base of the penis. Transfusions were required, but the patient refused re-exploration. A self-adherent bandage was applied circumferentially to the entire penis for 48 h. During this time there was no further hematuria, and the patient recovered uneventfully.