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Objetivo: Diseñar y evaluar un nuevo modelo de simulación de fractura de pene para la enseñanza de su reparación.MétodosHemos utilizado un simulador de circuncisión validado para crear un nuevo modelo. El prepucio para circuncisión se dividió en 2 mitades. Se creó un corte transversal («simulación de fractura») en una parte de la primera mitad del prepucio (imitando la «túnica») y se colocó sobre el modelo de pene. Se colocó una pastilla de gelatina roja («coágulo») debajo del corte. Se aplicó un segundo trozo para completar el prepucio por encima y cubrir el defecto. El modelo fue evaluado por los participantes y docentes expertos del boot camp de simulación de urología. La evaluación se realizó mediante un cuestionario con escala de Likert de 5 puntos. Los datos se analizaron mediante Microsoft Excel e IBM SPSS Statistics V25. La correlación intraclase se calculó mediante «un modelo aleatorio unidireccional».ResultadosVeintidós estudiantes de urología y 4 expertos participaron en la evaluación. La mayoría de los aprendices estuvieron muy de acuerdo (59%, n=13) en la utilidad del modelo para la formación, y los expertos también estuvieron de acuerdo en el 75% de los casos. Tanto alumnos (68%, n=14) como docentes (75%) consideraron correcta la apariencia de la fractura del pene. En general, la capacidad del modelo para representar una simulación realista de la tarea fue considerada excelente por el 23% de los participantes y buena por el 64%. Tras la simulación los alumnos afirmaron tener una mayor confianza en el manejo de este tipo de casos. Las principales dificultades señaladas estaban relacionadas con los planos fasciales y la uretra.ConclusiónEste es el primer modelo de simulación para la reparación de fracturas de pene y ha demostrado su validez en un boot camp de urología nacional. (AU)

Objective: To design and assess a novel penile fracture simulation model for teaching penile fracture repair.MethodsWe used a validated circumcision simulator to create a model. Foreskin for a circumcision was divided into two halves. A transverse slit (“simulated fracture”) was created on one part of the first half of the foreskin (mimicking “tunica”) and was applied over the penile model. A red jelly tablet (“clot”) was placed underneath the cut. A second full-length of foreskin was applied over it to cover the defect. The model was assessed by participants and expert faculty at the Urology Simulation Boot Camp. Evaluation was performed using a 5-point Likert Scale questionnaire. Data was analysed using Microsoft Excel and IBM SPSS Statistics V25. The intra-class correlation was calculated using a “One-way random model”.ResultsTwenty-two urology trainees and four experts participated in the evaluation. The majority of trainees strongly agreed (59%, n=13) the model is useful for training with experts similarly agreeing in 75% of cases. The appearance of penile fracture was considered good by both trainees (68%, n=14) and faculty (75%). Overall, the ability of the model to represent a realistic simulation of the task was considered excellent by 23% of participants and good by 64%. Personal confidence after simulation in managing a similar situation was considered high among trainees. The main difficulties reported were related to fascial planes and urethra.ConclusionThis is the first simulation model for penile fracture repair and has demonstrated face validity at a national urology bootcamp. (AU)

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OBJECTIVE: To design and assess a novel penile fracture simulation model for teaching penile fracture repair. METHODS: We used a validated circumcision simulator to create a model. Foreskin for a circumcision was divided into two halves. A transverse slit ("simulated fracture") was created on one part of the first half of the foreskin (mimicking "tunica") and was applied over the penile model. A red jelly tablet ("clot") was placed underneath the cut. A second full-length of foreskin was applied over it to cover the defect. The model was assessed by participants and expert faculty at the Urology Simulation Boot Camp. Evaluation was performed using a 5-point Likert Scale questionnaire. Data was analysed using Microsoft Excel and IBM SPSS Statistics V25. The intra-class correlation was calculated using a "One-way random model". RESULTS: Twenty-two urology trainees and four experts participated in the evaluation. The majority of trainees strongly agreed (59%, n = 13) the model is useful for training with experts similarly agreeing in 75% of cases. The appearance of penile fracture was considered good by both trainees (68%, n = 14) and faculty (75%). Overall, the ability of the model to represent a realistic simulation of the task was considered excellent by 23% of participants and good by 64%. Personal confidence after simulation in managing a similar situation was considered high among trainees. The main difficulties reported were related to fascial planes and urethra. CONCLUSION: This is the first simulation model for penile fracture repair and has demonstrated face validity at a national urology bootcamp.

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OBJECTIVE: To design and assess a novel penile fracture simulation model for teaching penile fracture repair. METHODS: We used a validated circumcision simulator to create a model. Foreskin for a circumcision was divided into two halves. A transverse slit ("simulated fracture") was created on one part of the first half of the foreskin (mimicking "tunica") and was applied over the penile model. A red jelly tablet ("clot") was placed underneath the cut. A second full-length of foreskin was applied over it to cover the defect. The model was assessed by participants and expert faculty at the Urology Simulation Boot Camp. Evaluation was performed using a 5-point Likert Scale questionnaire. Data was analysed using Microsoft Excel and IBM SPSS Statistics V25. The intra-class correlation was calculated using a "One-way random model". RESULTS: Twenty-two urology trainees and four experts participated in the evaluation. The majority of trainees strongly agreed (59%, n=13) the model is useful for training with experts similarly agreeing in 75% of cases. The appearance of penile fracture was considered good by both trainees (68%, n=14) and faculty (75%). Overall, the ability of the model to represent a realistic simulation of the task was considered excellent by 23% of participants and good by 64%. Personal confidence after simulation in managing a similar situation was considered high among trainees. The main difficulties reported were related to fascial planes and urethra. CONCLUSION: This is the first simulation model for penile fracture repair and has demonstrated face validity at a national urology bootcamp.

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INTRODUCTION: Nutritional support has been demonstrated to improve recovery from radical cystectomy, but is expensive and when used inappropriately may actually increase the costs and morbidity of surgery. We sought to establish national patterns of practice with regard to feeding following cystectomy in the UK. AIMS AND METHODS: Following consultation with the specialist nutrition team, a questionnaire was designed to investigate the feeding strategy after cystectomy and dispatched by post to all UK urologists. RESULTS: The majority (60%) of respondents employed a traditional strategy of resting the bowel and feeding orally after bowel recovery. A minority used either early total parenteral nutrition (TPN; 18.5%) or enteral nutrition (6.5%), but a larger proportion (29%) felt enteral nutrition was the 'optimal' feeding regime. Only 30% used guidelines and 52% felt trials would help to establish a nutrition strategy following cystectomy. CONCLUSION: There is little evidence that TPN improves the outcome of cystectomy and it may actually increase morbidity and costs, whereas enteral nutrition may improve recovery. Despite this evidence TPN is widely used by urologists whereas enteral nutrition is used infrequently. Implementation of an evidence-based feeding regime after cystectomy is likely to reduce the morbidity and financial costs of cystectomy.

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Raman spectroscopy (RS) is an optical technique that provides an objective method of pathological diagnosis based on the molecular composition of tissue. Studies have shown that the technique can accurately identify and grade prostatic adenocarcinoma (CaP) in vitro. This study aimed to determine whether RS was able to differentiate between CaP cell lines of varying degrees of biological aggressiveness. Raman spectra were measured from two well-differentiated, androgen-sensitive cell lines (LNCaP and PCa 2b) and two poorly differentiated, androgen-insensitive cell lines (DU145 and PC 3). Principal component analysis was used to study the molecular differences that exist between cell lines and, in conjunction with linear discriminant analysis, was applied to 200 spectra to construct a diagnostic algorithm capable of differentiating between the different cell lines. The algorithm was able to identify the cell line of each individual cell with an overall sensitivity of 98% and a specificity of 99%. The results further demonstrate the ability of RS to differentiate between CaP samples of varying biological aggressiveness. RS shows promise for application in the diagnosis and grading of CaP in clinical practise as well as providing molecular information on CaP samples in a research setting.

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The objective of the study was to investigate the safety and reliability of internet websites selling and providing medical information regarding herbal substitutes for Viagra. Using keywords 'Herbal' and 'Viagra', websites selling and providing medical information regarding herbal substitutes were identified. The top 50 sequential sites were assessed for safety and reliability against the Health on the Net (HON) criteria. Medically trained staff provided information in only 21% of the sites yet just 24% stated that the information was not a replacement for medical advice. No sites warned patients about erectile dysfunction (ED)-associated cardiovascular disease. In all, 88 and 70% of sites indicated drug efficacy and ingredients but only 36 and 21% provided contraindications and side effects, respectively. All sites fell short of the HON requirements. In conclusion, acquiring medical information and herbal substitutes for ED from the internet is convenient and easy. However, patients should be cautious as safety and reliability of this approach is poor.

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1. The acetates of several long chain (3 to 12 methylene groups) analogues of choline have been prepared and their pharmacological properties studied.2. None of the compounds had a high level of activity at the post-ganglionic parasympathetic acetylcholine receptors. The lower members of the series showed weak agonist activity and the homologues with 8 to 10 methylene groups had very weak anticholinergic activity.3. All the compounds had a depolarizing action at the acetylcholine receptors of the neuromuscular junction and of sympathetic ganglia. At the neuromuscular junction there were two peaks of stimulant activity, one with the hexamethylene and one with the dodecamethylene homologue, whereas at the ganglion there was only one peak, with the hexamethylene homologue.4. The ganglion-stimulant activity of the higher members of the series was blocked by pretreatment with the anticholinesterase drug dyflos, whereas the activity of lower members was either unaffected by such treatment or slightly potentiated.5. The results are discussed in terms of possible spatial arrangements of acetylcholine receptor units in the neuromuscular junction and the ganglion.

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