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Anderson T, Hopper C, MacCraith E, McCabe A, Shortt CP. Assessment of clinically significant urolithiasis positivity rate using CT KUB for suspected renal colic. Ir J Med Sci 2024; 193:1009-1013. [PMID: 37542633 DOI: 10.1007/s11845-023-03477-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Accepted: 07/24/2023] [Indexed: 08/07/2023]
Abstract
BACKGROUND Unenhanced low-dose computed tomography of the kidneys, ureter and bladder (CT KUB) is the gold standard diagnostic imaging modality in the assessment of suspected renal colic. As the radiation dose is not negligible, it is important to monitor the diagnostic yield of CT KUBs. The aim of this study is to evaluate the diagnostic yield of CT KUB studies performed for suspected renal colic in patients presenting to the emergency department. METHODS A retrospective review was performed of 500 patients who underwent CT KUB for suspected renal colic over a seven month period from June 2019 to January 2020. Clinical information and imaging was reviewed for each patient. Statistical analysis was performed using GraphPad Prism 8 (GraphPad Software, San Diego, CA, USA). RESULTS Forty-nine percent of patients in the series were female (248/500) and the mean age was 45. The positivity rate for obstructing ureteral calculus was 34% (169/500). Concerningly, there was a significantly lower positivity rate in females compared to males (19% versus 48%; p < 0.0001) which raises the issue of unnecessary radiation exposure to this cohort. In the 200 female patients who were negative for obstructing urolithiasis, the mean age was 43. Females also had a significantly higher rate of negative CT KUB (62% versus 37%; p < 0.0001) where no underlying alternative pathology was diagnosed. CONCLUSIONS Women are less likely than men to have obstructing urolithiasis on CT KUB for suspected renal colic. This difference is not accounted for by a higher rate of alternative diagnoses among female patients. The findings of this study should prompt clinicians to exercise caution when considering this imaging modality in this patient cohort.
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Ng A, Asif A, Kasivisvanathan V. Re: Juan Gómez Rivas, Bhaskar Somani, Moises Rodriguez Socarrás, et al. Shaping the Undergraduate Curriculum in Europe: Consensus Statement from the European School of Urology. Eur Urol. 2022;82:581-83. Eur Urol 2023; 83:e58-e59. [PMID: 36446675 DOI: 10.1016/j.eururo.2022.11.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Accepted: 11/10/2022] [Indexed: 11/27/2022]
Affiliation(s)
- Alexander Ng
- Royal Free London NHS Foundation Trust, London, UK; Division of Surgery and Interventional Science, University College London, London, UK; British Urology Researchers in Surgical Training, London, UK.
| | - Aqua Asif
- Division of Surgery and Interventional Science, University College London, London, UK; British Urology Researchers in Surgical Training, London, UK
| | - Veeru Kasivisvanathan
- Division of Surgery and Interventional Science, University College London, London, UK; British Urology Researchers in Surgical Training, London, UK
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Gómez Rivas J, Somani B, Rodriguez Socarrás M, Marra G, Pearce I, Henningsohn L, Zondervan P, Van Poppel H, N'Dow J, Liatsikos E, Palou J. Shaping the Undergraduate Curriculum in Europe: Consensus Statement from the European School of Urology. Eur Urol 2022; 82:581-583. [PMID: 36163308 DOI: 10.1016/j.eururo.2022.09.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Revised: 08/16/2022] [Accepted: 09/02/2022] [Indexed: 11/04/2022]
Abstract
The European School of Urology has created a taskforce to develop a comprehensive, structured urology curriculum with clinical exposure, practical skills, and hands-on training. The curriculum proposal includes cognitive teaching by symptoms and practical aspects to guarantee uniform access to undergraduate medical education in urology among all European countries, regardless of location, local urology exposure, or bias in national curricula.
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Affiliation(s)
- Juan Gómez Rivas
- Department of Urology, Hospital Clínico San Carlos, Madrid, Spain.
| | - Bhaskar Somani
- University Hospital Southampton NHS Trust, Southampton, UK
| | | | - Giancarlo Marra
- Department of Urology, San Giovanni Battista Hospital, Città della Salute e della Scienza, University of Turin, Turin, Italy
| | - Ian Pearce
- Manchester University NHS Foundation Trust, Manchester, UK
| | - Lars Henningsohn
- Department of Urology, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - Patricia Zondervan
- Amsterdam University Medical Centers, Department of Urology, Amsterdam, The Netherlands
| | | | - James N'Dow
- Academic Urology Unit, University of Aberdeen, Aberdeen, UK
| | | | - Joan Palou
- Department of Urology, Fundació Puigvert, Universitat Autònoma de Barcelona, Barcelona, Spain
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Brown G, Johnston M, Struss W, Somani B. Role and effectiveness of an information guide in improving catheter confidence and knowledge in junior clinicians. JOURNAL OF CLINICAL UROLOGY 2022. [DOI: 10.1177/20514158221122534] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective: Referrals to the on-call urology team for catheter-related problems are common. Experience and previous studies highlight that urology exposure and catheter skills are unsatisfactory in undergraduate training as well as in subsequent junior clinical practice. These deficiencies may compromise patient safety and delay appropriate treatment. This study aimed to assess catheter insertion confidence and associated knowledge in junior doctors and advanced nurse practitioners in a single teaching hospital and evaluate whether this could be improved by introducing a freely available catheter information and problem-solving guide. Methods: An online survey assessing confidence inserting two and three-way urethral catheters, changing suprapubic catheters and assessing knowledge related to common catheter problems was delivered to all non-registrar junior clinicians. Based on these results, an information guide was created and made freely available to these clinicians. The survey was then repeated to check for catheter-related knowledge and confidence. Results: A total of 58 junior clinicians responded to the initial survey and 61 to the repeat survey. Catheterisation confidence and knowledge was generally low in the first survey but improved in all areas and across all grades after the introduction of the information guide. Of the respondents, 100% thought the guide was helpful and 93.4% said they would use it in future. Conclusions: A catheter information guide is a simple and effective method of improving junior clinician confidence with catheter insertion and managing catheter-associated problems. Level of Evidence: This study does not directly correlate with a defined level of evidence.
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Affiliation(s)
- George Brown
- Department of Urology, University Hospital Southampton NHS Foundation Trust, UK
| | | | - Werner Struss
- Department of Urology, University Hospital Southampton NHS Foundation Trust, UK
| | - Bhaskar Somani
- Department of Urology, University Hospital Southampton NHS Foundation Trust, UK
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Urology underexposure in medical schools: Are we catching up? Porto Biomed J 2022; 7:e184. [DOI: 10.1097/j.pbj.0000000000000184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Accepted: 04/11/2022] [Indexed: 11/07/2022] Open
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Ng A, V WC, Asif A, Light A, Lam CM, Jayaraajan K, Cambridge WA, Matthews MG, Kulkarni M, S ZYO, Nathan A, Ahmed N, Gadhia S, Morka N, Hinchcliffe Z, Chen W, Yoon WY, Das K, Kufuor RA, Patel K, Ayres B, Dacre J, Harding C, Page T, Pearce I, Bhatt NR, Khadhouri S, Kasivisvanathan V. LEARN: A multi-centre, cross-sectional evaluation of Urology teaching in UK medical schools. BJU Int 2022; 130:676-687. [PMID: 35488402 PMCID: PMC9796355 DOI: 10.1111/bju.15758] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
OBJECTIVE To evaluate the status of UK undergraduate urology teaching against the British Association of Urological Surgeons (BAUS) Undergraduate Syllabus for Urology. Secondary objectives included evaluating the type and quantity of teaching provided, the reported performance rate of General Medical Council (GMC)-mandated urological procedures, and the proportion of undergraduates considering urology as a career. MATERIALS AND METHODS LEARN was a national multicentre cross-sectional study. Year 2 to Year 5 medical students and FY1 doctors were invited to complete a survey between 3rd October and 20th December 2020, retrospectively assessing the urology teaching received to date. Results are reported according to the Checklist for Reporting Results of Internet E-Surveys (CHERRIES). RESULTS 7,063/8,346 (84.6%) responses from all 39 UK medical schools were included; 1,127/7,063 (16.0%) were from Foundation Year (FY) 1 doctors, who reported that the most frequently taught topics in undergraduate training were on urinary tract infection (96.5%), acute kidney injury (95.9%) and haematuria (94.4%). The most infrequently taught topics were male urinary incontinence (59.4%), male infertility (52.4%) and erectile dysfunction (43.8%). Male and female catheterisation on patients as undergraduates was performed by 92.1% and 73.0% of FY1 doctors respectively, and 16.9% had considered a career in urology. Theory based teaching was mainly prevalent in the early years of medical school, with clinical skills teaching, and clinical placements in the later years of medical school. 20.1% of FY1 doctors reported no undergraduate clinical attachment in urology. CONCLUSION LEARN is the largest ever evaluation of undergraduate urology teaching. In the UK, teaching seemed satisfactory as evaluated by the BAUS undergraduate syllabus. However, many students report having no clinical attachments in Urology and some newly qualified doctors report never having inserted a catheter, which is a GMC mandated requirement. We recommend a greater emphasis on undergraduate clinical exposure to urology and stricter adherence to GMC mandated procedures.
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Affiliation(s)
- Alexander Ng
- University College London (UCL) Medical SchoolUCLLondonUK
- British Urology Researchers in Surgical Training (BURST)LondonUK
| | - Wai‐Shun Chan V
- British Urology Researchers in Surgical Training (BURST)LondonUK
- School of Medicine, Faculty of Medicine and HealthUniversity of LeedsLeedsUK
| | - Aqua Asif
- British Urology Researchers in Surgical Training (BURST)LondonUK
- Leicester Medical SchoolUniversity of LeicesterLeicesterUK
| | - Alexander Light
- British Urology Researchers in Surgical Training (BURST)LondonUK
- Department of Surgery and CancerImperial College LondonLondonUK
| | - Chon Meng Lam
- British Urology Researchers in Surgical Training (BURST)LondonUK
- Bronglais General HospitalAberystwythUK
| | - Keerthanaa Jayaraajan
- British Urology Researchers in Surgical Training (BURST)LondonUK
- Faculty of MedicineImperial College LondonLondonUK
| | - William A. Cambridge
- British Urology Researchers in Surgical Training (BURST)LondonUK
- University of EdinburghEdinburghUK
| | | | - Meghana Kulkarni
- British Urology Researchers in Surgical Training (BURST)LondonUK
- Department of UrologyUrology Centre, Guy’s and St Thomas’ NHS Foundation TrustLondonUK
- Cancer Imaging Department, School of Biomedical Engineering and Imaging SciencesKing’s College LondonLondonUK
| | - Zhi Yang Ooi S
- Cardiff University School of MedicineUniversity Hospital WalesCardiffUK
| | - Arjun Nathan
- British Urology Researchers in Surgical Training (BURST)LondonUK
- Division of Surgery and Interventional ScienceUCLLondonUK
| | - Najma Ahmed
- GKT School of Medicine, Faculty of Life Sciences and MedicineKing’s College LondonLondonUK
| | - Shivali Gadhia
- Sheffield Medical SchoolUniversity of SheffieldSheffieldUK
| | - Naomi Morka
- University College London (UCL) Medical SchoolUCLLondonUK
| | | | - Wentin Chen
- Birmingham Medical School, College of Medical and Dental SciencesUniversity of BirminghamBirminghamUK
| | - Won Young Yoon
- School of Medical Sciences, Faculty of Biology, Medicine and HealthUniversity of ManchesterManchesterUK
- Department of BioengineeringImperial College LondonLondonUK
| | - Kieran Das
- School of MedicineUniversity of NottinghamNottinghamUK
| | | | - Kenal Patel
- School of Medicine, Faculty of Medicine and HealthUniversity of LeedsLeedsUK
| | - Ben Ayres
- Department of UrologySt George’s University Hospitals NHS TrustLondonUK
| | | | - Chris Harding
- Department of UrologyFreeman HospitalNewcastle upon TyneUK
- Translational and Clinical Research Institute Newcastle UniversityNewcastle upon TyneUK
| | - Toby Page
- Department of UrologyFreeman Hospital, Newcastle upon Tyne Hospitals TrustNewcastle upon TyneUK
| | - Ian Pearce
- Manchester University NHS Foundation TrustManchesterUK
| | - Nikita R. Bhatt
- British Urology Researchers in Surgical Training (BURST)LondonUK
- Department of UrologyNorfolk and Norwich University HospitalNorwichUK
| | - Sinan Khadhouri
- British Urology Researchers in Surgical Training (BURST)LondonUK
- Health Science Research Unit, The School of Medicine, Medical Sciences and Nutrition, Aberdeen Royal InfirmaryUniversity of AberdeenAberdeenUK
| | - Veeru Kasivisvanathan
- British Urology Researchers in Surgical Training (BURST)LondonUK
- Division of Surgery and Interventional ScienceUCLLondonUK
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Gómez Rivas J, Somani B, Rodriguez Socarrás M, Marra G, Pearce I, Henningsohn L, Zondervan P, van der Poel H, Van Poppel H, N'Dow J, Liatsikos E, Palou J. Essentials for Standardising the Undergraduate Urology Curriculum in Europe: Outcomes of a Delphi Consensus from the European School of Urology. EUR UROL SUPPL 2021; 33:72-80. [PMID: 34738091 PMCID: PMC8551509 DOI: 10.1016/j.euros.2021.09.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/09/2021] [Indexed: 01/15/2023] Open
Abstract
Background The burden of urological diseases is rising as the worldwide population ages. Although specialist urological provision is needed, a large proportion of these conditions will be managed in primary care. The importance of including urology in medical education currently remains unclear. Objective To provide recommendations on undergraduate medical education for urology in Europe. Design, setting, and participants A three-round Delphi process to reach consensus on standardising the undergraduate urology curriculum in Europe was endorsed by the European School of Urology. Outcome measurements and statistical analysis The levels of agreement were set using a nine-point scale according to the GRADE grid: 1–3, disagree; 4–6, uncertain; and 7–9, agree. Consensus was defined as at least 70% of the participants scoring within the same 3-point grouping. Results and limitations Overall, consensus was reached for 20 of 34 statements (70.5%) across the three Delphi rounds, with agreement for 75% (n = 15) and disagreement for 25% (n = 5). The following main points were agreed. Urological teaching should be introduced before year 5 of medical school, with at least 20 h of theoretical activities and at least 30 h of practical activities. Urology should be taught as a stand-alone subject rather than combined with another surgical specialty or a nephrology programme. The participants agreed that urology should be taught according to symptoms. A urology programme should include the anatomy and physiology of the urinary tract, and students should know how to clinically assess a urological patient. Conclusions Our recommended urology pathway will allow European medical schools to provide a more comprehensive undergraduate urology curriculum. It will also help to improve and maintain standards of urology undergraduate teaching across Europe. Patient summary Our survey showed that urology in universities should have, at minimum, time for theoretical and practical activities and should be taught as a stand-alone subject on the basis of symptoms. Students should give feedback to facilitate constant improvement and evolution of the teaching programme.
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Affiliation(s)
- Juan Gómez Rivas
- Department of Urology, Hospital Clínico San Carlos, Madrid, Spain
| | - Bhaskar Somani
- University Hospital Southampton NHS Trust, Southampton, UK
| | | | - Giancarlo Marra
- Department of Urology, San Giovanni Battista Hospital, Città della Salute e della Scienza, University of Turin, Turin, Italy
| | - Ian Pearce
- Manchester University NHS Foundation Trust, Manchester, UK
| | - Lars Henningsohn
- Department of Urology, Karolinska University Hospital, Stockholm, Sweden
| | - Patricia Zondervan
- Department of Urology, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Henk van der Poel
- Department of Urology, The Netherlands Cancer Institute, Netherlands Prostate Cancer Network, Amsterdam, The Netherlands
| | | | - James N'Dow
- Academic Urology Unit, University of Aberdeen, Aberdeen, UK
| | | | - Joan Palou
- Department of Urology, Fundació Puigvert, Universitat Autònoma de Barcelona, Barcelona, Spain
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Re: Roman Sosnowski, Hubert Kamecki, Steven Joniau, Jochen Walz, Zachary Klaassen, Joan Palou. Introduction of Telemedicine During the COVID-19 Pandemic: A Challenge for Now, an Opportunity for the Future. Eur Urol. In press. https://doi.org/10.1016/j.eururo.2020.07.007. Eur Urol 2020; 79:e26-e27. [PMID: 33077304 PMCID: PMC7567662 DOI: 10.1016/j.eururo.2020.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Accepted: 10/02/2020] [Indexed: 11/22/2022]
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Conroy S. Undergraduate Urology Education: A Fundamental Pillar in Building the Next Generation of Urologists. Eur Urol 2020; 78:385-386. [PMID: 32631741 DOI: 10.1016/j.eururo.2020.06.050] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Accepted: 06/22/2020] [Indexed: 11/18/2022]
Affiliation(s)
- Samantha Conroy
- Academic Unit of Urology, University of Sheffield, Sheffield, UK.
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