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INTRODUCTION: Previous studies have demonstrated the feasibility of bedside placement of ureteric stents; however, they have traditionally required two skilled operators and were associated with some stent malposition especially for proximal ureteric obstruction. We sought to investigate the efficacy and safety of a modified technique for ultrasound-assisted bedside ureteric stent insertion without the presence of a skilled assist. METHODS: A single institution prospective study was performed from April-August 2023. Indications for stenting included infection, renal insufficiency, or intractable colic. Exclusion criteria included age <18 years, hemodynamic instability, and patients with history of chronic pain. Point-of-care ultrasound (POCUS) was used to confirm wire placement in the kidney and presence of a hydronephrotic drip from a 5 French ureteric catheter was used to confirm placement beyond the level of obstruction. RESULTS: Of 28 patients, all patients underwent successful bedside ureteric stent placement. Mean age was 64.9 years and mean body mass index (BMI) was 33.2. Proximal ureter obstruction was present in 52% of patients and mid/distal obstruction in 48%. In cases with obstructing stones, the mean stone size was 8.1 mm with a range of 4-15 mm. Infection was the indication for stent placement in most patients (71%), followed by pain (4%) and acute kidney injury (AKI) (4%). All patients who underwent successful stent placement had presence of hydronephrotic drip from the ureteric catheter. CONCLUSIONS: Ultrasound-assisted bedside ureteric stent insertion without a skilled assist is a safe and feasible option for management of acute ureteral obstruction. Presence of hydronephrotic drip can indicate successful access beyond the level of obstruction as an alternative to POCUS.
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INTRODUCTION: Accurate diagnostic staging of upper tract urothelial cancer (UTUC) is challenging. Endoscopic staging is limited by its ability to provide adequate sampling of deeper layers of the ureter and renal pelvis. Further ability to accurately predict invasive disease would aid in better selecting the appropriate treatment for patients. We aimed to analyze the ability of preoperative cross-sectional radiologic findings to predict pathologic outcomes, including tumor grade, muscle-invasive disease, and presence of lymphovascular invasion (LVI). METHODS: All patients diagnosed with localized UTUC (cN0M0) who underwent nephroureterectomy between February 2012 and December 2018 in Manitoba, Canada, were identified. Preoperative radiologic characteristics, including the presence and severity of hydronephrosis, as well as tumor location were recorded. Patients' and pathologic characteristics were also recorded. Logistic regression analysis was used to assess the association between radiologic variables and pathologic outcomes at radical surgery. RESULTS: A total of 112 pathology reports of patients with UTUC were obtained. The median age was 70 years (range 50-87), and 58.8% of patients were men. On univariate analysis, ureteric location on computed tomography (odds ratio [OR] 2.240, 95% confidence interval [CU] 1.049- 4.783, p=0.037) and presence of hydronephrosis (OR 2.455, 95% CI 1.094-5.506, p=0.0029) were each independently associated with locally invasive disease (>pT2). No radiologic variables were found to be a predictor of adverse pathology on multivariable analysis. Only the presence of hydronephrosis was associated with high-grade disease on univariate analysis (OR 2.533, 95% CI 1.083-5.931, p=0.032). CONCLUSIONS: Our findings suggest a limited role for cross-sectional imaging in predicting the presence of high-grade disease, LVI, or locally advanced disease in UTUC.
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Reproductive medicine has made significant advancements over the last 70 years, much of it in the way of female contraception. Reliable male contraception continues to be restricted to condoms and vasectomy. The purpose of this narrative review is to provide an overview of the contemporary usage of male contraceptive methods, including ethical and political standpoints, as well as, to summarize the current and future studies being done on male hormonal and non-hormonal contraceptive options.
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INTRODUCTION: There has been a rapid expansion of the armamentarium for managing benign prostatic hyperplasia (BPH). Due to the invasiveness and complication risks of traditional surgical management, minimally invasive procedures have emerged. Rezum water vapor therapy is a safe, effective alternative. Given the minimally invasive nature, there is interest in administering conscious sedation over general anesthesia to decrease procedural times and costs and increase accessibility by completing procedures in an office-based setting. We sought to assess and describe patient-reported tolerability for Rezum completed under oral and deep intravenous sedation. METHODS: Patients who underwent Rezum between April and November of 2022 under conscious sedation with oral sedation and local anesthesia (OSLA) or deep intravenous sedation (DIS) were enrolled. Baseline information was collected, and followup interviews were conducted where patient tolerability scores, future anesthetic preferences, and complication data was prospectively obtained. RESULTS: Fourteen patients were enrolled in each group. The OSLA and DIS cohorts had a median tolerability score of 8 (interquartile range [IQR] 3.5) and 9 (IQR 1.75), respectively, indicating highly tolerable experiences. There was no significant difference between groups (p=0.13). On followup, 85.7% of patients in the OSLA and 100% in DIS groups expressed their future preference for conscious sedation over general anesthetic, with no significant difference between the two groups (p=0.46). CONCLUSIONS: Our study demonstrates OSLA and DIS are both viable conscious sedation methods for Rezum, with patients reporting high tolerability to the procedure regardless of sedation choice. Almost all patients receiving conscious sedation would choose to undergo Rezum using conscious sedation again and had minimal complications.
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INTRODUCTION: Postgraduate education is transitioning to a competency-based curriculum in an effort to standardize the quality of graduating trainees. The learning experiences and opportunities in each institution are likely variable, as no standard exists regarding the teaching curriculum offered through residency. The objective of this study is to examine the various teaching curricula among different Canadian urology residency programs and to identify which teaching modalities are prioritized by program directors. METHODS: A 10-question anonymous survey was sent electronically to program directors at all 12 urology residency programs across Canada. Questions were designed to quantify the time allotted for teaching and to assess the various teaching session types prioritized by programs to ensure the successful training of their graduates. We assessed each program's perceived value of written exams, oral exams, didactic teaching session, and simulation sessions. Responses were assessed using a Likert-scale and a ranking format. Descriptive statistics were performed. RESULTS: Overall survey response rate from residency program directors was 75% (9/12). Sixty-seven percent of programs designated one day of teaching per week, whereas 33% split resident teaching over two days. Review of chapters directly from Campbell-Walsh Urology textbook were deemed the most valuable teaching session. Practice oral exams were also prioritized, whereas most programs felt that simulation labs contributed the least to residency education. All programs included review of the core urology textbook in their weekly teaching, while only 67% of programs included faculty-led didactic sessions and case presentations. Forty-four percent of programs included resident-led didactic sessions. Practice oral exams and simulation labs were the least commonly included teaching modalities. CONCLUSIONS: Although most program directors prioritize the review of chapters in the core urology textbook, we found significant heterogeneity in the teaching sessions prioritized and offered in current urology residency curricula. As we move to standardize the quality of graduating trainees, understanding the impact of variable educational opportunities on residency training may become increasingly important.