Victor Palit - Academia.edu (original) (raw)

Papers by Victor Palit

Research paper thumbnail of Erectile dysfunction and faecal incontinence after pelvic rectal cancer surgery

International Journal of Surgery, Nov 1, 2014

We compared all colonoscopy procedures performed by joint advisory group (JAG) on GI endoscopy ap... more We compared all colonoscopy procedures performed by joint advisory group (JAG) on GI endoscopy approved surgical and gastroenterology endoscopists during the period January 2008 till June 2013. Results: A total of 6718 colonoscopies were performed by 6 gastroenterology and 8 surgeon endoscopists with comparable completion rates. The surgeons performed twice more colonoscopies (n¼4611) with statistically significant difference in patient's age (62.3 years vs. 57.6 years, p <0.001). The surgeons also performed more therapeutic procedures (1529 vs. 442, p <0.001) with higher polyp excision rates (p 0.001). During the procedures, surgeons used less sedation (mean dose: Fentanyl dose 55.31 mcg vs. 61.53 mcs, p <0.001; Midazolam 2.6mg vs. 2.7mg, p <0.001) but high dose of Buscopan (9mg vs. 1.5 mg, p <0.001) resulting in overall less patient discomfort levels (p 0.001). Conclusions: The study demonstrates a high volume of diagnostic and therapeutic colonoscopy service provided by surgeons. This study highlights the need for incorporation of endoscopy training into surgical curriculum.

Research paper thumbnail of 368 Expression of hypoxia inducible proteins in prostate cancer

European Urology Supplements, Feb 1, 2004

Research paper thumbnail of 398: Clinical Significance of HIF-1α and GLUT-I in Prostate Cancer

The Journal of Urology, Apr 1, 2005

Radiation resistance assays were performed using y-radiation (5Gy) in the presence or absence of ... more Radiation resistance assays were performed using y-radiation (5Gy) in the presence or absence of i50JLM ZnS04 • For both assays, cell viability was measured after 72 hours by MTS assay. Experiments were repeated 3 times and the data analyzed using a mixed effects ANOV A model to compare cisplatin or radiation doses in the presence or absence of 150JLM ZnS04 • P-values of < 0.05 were considered significant. RESULTS: The addition of increasing concentrations of ZnS04 up regulated MT expression in a dose dependent manner, compared to untreated LNCaP or C4-2 cells. Cells treated with cisplatin in the presence of zinc showed a significantly decreased sensitivity to cisplatin (p<0.005 at all study concentrations below 50JLM) compared to no zinc controls. Cells irradiated in the presence of zinc showed a significantly decreased sensitivity to radiation (p<0.005) compared to no zinc controls. CONCLUSIONS: Our data confirms that treatment of prostate cancer cells with Zn causes a several fold-increase in MT expression, which is strongly associated with resistance to both cisplatin chemotherapy and radiation in prostate cancer cells. Therapeutic targeting of MT may therefore provide a means to simultaneously overcome both chemoresistance and radiation resistance in prostate cancer.

Research paper thumbnail of Five-Year results of a multi-specialty induction course for surgical training

Frontiers in Surgery

BackgroundThe Essential Surgical Skills Course (ESSC) is a multi-specialty induction “boot camp” ... more BackgroundThe Essential Surgical Skills Course (ESSC) is a multi-specialty induction “boot camp” style course that has been run successfully for five years. The aim of the current paper is to create an accurate guide for the replication of the course by other teams and assess the course's fitness for purpose, through the survey feedback provided by trainees.MethodsThe course's fitness for purpose was assessed through cumulative five-year survey feedback from trainees. This observational study describes the design and process of content adjustment according to feedback.ResultsThe course its five-year span offered twelve different procedural skills in four different specialties. Feedback for each session was persistently >8/10. Key themes identified as beneficial include teacher-to-trainee ratio (often 1:1), teaching style, course structure and responsiveness.ConclusionsThe ESSC was found to be fit for purpose for the induction of trainees into surgical training. The key fa...

Research paper thumbnail of Endoscopic surgical simulation using low-fidelity and virtual reality transurethral resection simulators in urology simulation boot camp course: trainees feedback assessment study

World Journal of Urology, 2021

Objectives The objective of our study was to study trainees' feedback and rating of models for tr... more Objectives The objective of our study was to study trainees' feedback and rating of models for training transurethral resection of bladder lesions (TURBT) and prostate (TURP) during simulation. Methods The study was performed during the ''Transurethral resection (TUR) module" at the boot camp held in 2019. Prior to the course, all trainees were required to evaluate their experience in performing TURBT and TURP procedures. Trainees simulated resection on two different models; low-fidelity tissue model (Samed, GmBH, Dresden, Germany) and virtual reality simulator (TURPMentor, 3D Systems, Littleton, US). Following the completion of the module, trainees completed a questionnaire using a 5-point Likert scale to evaluate their assessment of the models for surgical training. Results In total, 174 simulation assessments were performed by 56 trainees(Samed Bladder-40, Prostate-45, TURPMentor Bladder-51, Prostate-37). All trainees reported that they had performed < 50 TUR procedures. The Samed model median scores were for appearance (4/5), texture (5/5), feel (5/5) and conductibility (5/5). The TURPMentor median score was for appearance (4/5), texture and feel (4/5) and conductibility (4/5). The most common criticism of the Samed model was that it failed to mimic bleeding. In contrast, trainees felt that the TURPMentor haptic feedback was inadequate to allow for close resection and did not calibrate movements accurately. Conclusions Our results demonstrate that both forms of simulators (low-fidelity and virtual reality) were rated highly by urology trainees and improve their confidence in performing transurethral resection and in fact complement each other in providing lower tract endoscopic resection simulation.

Research paper thumbnail of Is Using Lignocaine Gel prior to Flexible Cystoscopy Justified?

Urologia Internationalis, 2003

Objective: We evaluate the discomfort and efficacy of instilling 2% lignocaine gel (Instillagel) ... more Objective: We evaluate the discomfort and efficacy of instilling 2% lignocaine gel (Instillagel) versus smearing water-soluble gel (Aquagel) around the flexible cystoscope and external urethral meatus in men undergoing flexible cystoscopy for the first time and the overall efficacy of lignocaine gel in completion of the procedure. Materials and Methods: A total of 140 patients divided into two groups, were randomized for this study: group A (n = 70) received approximately 11 ml of 2% lignocaine gel (Instillagel) intraurethrally for approximately 15 min, while in group B (n = 70) approximately 10–15 ml of water-soluble gel (Aquagel) was smeared around the scope and external urethral meatus. Total completion time for each procedure was recorded. Primary outcomes were pain during instillation of lignocaine, during insertion of scope and cystoscopy. Pain was recorded by the patient using a 100-mm nongraphic rating visual analogue scale. Secondary outcome included procedure time and cost...

Research paper thumbnail of Endoscopic management of upper tract transitional cell carcinoma

Indian Journal of Urology, 2010

Upper urinary tract transitional cell carcinoma (TCC) accounts for up to 10% of cases of neoplasm... more Upper urinary tract transitional cell carcinoma (TCC) accounts for up to 10% of cases of neoplasm of the upper urinary tract. The &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot;gold standard&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot; management of upper tract TCC is nephroureterectomy. Technological innovations, miniaturisations and increased availability of energy sources such as Holmium laser fibers have improved the armamentarium of endoscopic management of upper tract TCC. Endoscopic management of upper tract TCC includes the percutaneous (antegrade) and retrograde approaches. Modern flexible ureterorenoscopy allows retrograde approach to small (&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;1.5cm), low grade and noninvasive tumors, which is inaccessible to standard rigid ureteroscopes without breaching the urothelial barrier. In patients with large tumors or in whom retrograde access is difficult, the percutaneous approach to the renal pelvis, although more invasive, provides an alternative access and control. Both retrograde and percutaneous approaches allow instillation of various chemotherapeutic agents. Careful selection of patients is the key point in the successful endoscopic management of upper tract TCC. Patient selection is based on tumor size, grade and multifocality and other patient factors such as comorbidities, single kidney, post kidney transplant and patient choice. Both motivation and compliance of patients are needed for long-term successes. However, until large randomized trials with long term follow-up are available, endoscopic management of upper tract TCC should be reserved for only selected group of patients. This review summarizes the current techniques, indications, contraindications and outcomes of endoscopic management of UTTCC and the key published data.

Research paper thumbnail of Updates in endourology

Current Urology Reports, Mar 1, 2008

Rapid urologic innovations in minimally invasive treatment are creating exciting new horizons in ... more Rapid urologic innovations in minimally invasive treatment are creating exciting new horizons in endourology. However, these new concepts are blurring the traditional boundary between endourology and oncology. Organ-sparing surgery, laparoscopy, robotics systems, and image-guided ablation techniques enable surgeons to develop specifically tailored treatments for patients. We examine recent developments and future prospects for how new technology will continue to advance the field of endourology.

Research paper thumbnail of Living with Penile Cancer: Effects on Psychology and Quality of Life

Research paper thumbnail of The Validation of the Clinical Male Pelvic Trainer Mk 2—Advanced Models for Scrotal Examination Simulation

Journal of Surgical Education, May 1, 2017

OBJECTIVES: To validate the use of a novel physical model, the "Clinical Male Pelvic Trainer (CMP... more OBJECTIVES: To validate the use of a novel physical model, the "Clinical Male Pelvic Trainer (CMPT) Mk 2-Advanced," for scrotal examination simulation and evaluate its use for surgical education. MATERIALS AND METHODS: A total of 7 CMPT Mk 2-Advanced scrotal models were used for teaching: normal, varicocele, testicular tumor, epididymal cyst, hydrocele, epididymo-orchitis, and indirect inguinoscrotal hernia. At 4 surgical courses in the West Yorkshire Foundation Deanery, UK, between 2015 and 2016, trainees were asked to assess their clinical experience, confidence levels in diagnosing scrotal pathology and simulation properties of the scrotal models on a 5-point Likert Scale. Expert responses were used to validate these findings. RESULTS: In total, 65 trainees and 12 experts (including 3 senior residents) participated in the study (n ¼ 77). There was a positive-tailed distribution in responses from experts for realistic simulation of scrotal contents and pathology; only 1.5% and 14.4% of all responses by experts were scored as a "1" (strongly disagree) or "2" (disagree). The intraclass coefficient (k) was 0.86 among experts. No significant differences between experts and trainees in assessment of simulation were observed. Following use of the models, there was a significant increase in confidence scores matched by trainee (p o 0.001). Approximately 92.9% and 100% of trainees and experts were in favor of using the models for assessment and future training respectively. CONCLUSIONS: Our study demonstrates that the CMPT MK 2-Advanced models have high "face validity" and may be a valuable tool for surgical education. The use of these models should be explored for use in the curriculum at medical school.

Research paper thumbnail of Expression of HIF-1α and Glut-1 in human bladder cancer

Oncology Reports, Oct 1, 2005

Research paper thumbnail of 174Single centre experience with the new Storz Modulith SLK lithotriptor using lithotrack targeting system for stone localisation

European Urology Supplements, Mar 1, 2005

Research paper thumbnail of An Update on Evaluation and Management in Cystinuria

Research paper thumbnail of Laparoscopic Heminephrectomy of a Horseshoe Kidney

JSLS, 2011

Minimally invasive surgery has revolutionized surgery for urologic disorders, and laparoscopic pr... more Minimally invasive surgery has revolutionized surgery for urologic disorders, and laparoscopic procedures have become widely available for several different ablative and reconstructive operations. Laparoscopic heminephrectomy in patients with horseshoe kidney can be a technically challenging procedure due to aberrant vessels, functional parenchyma in the isthmus, and abnormal location. We report the management of a case of symptomatic nonfunctioning left moiety of a horseshoe kidney with emphasis on its surgical technique combined with a review of the literature. Laparoscopic heminephrectomy is a feasible option in the surgical management of benign and malignant conditions of the horseshoe kidney and can be performed safely using a transperitoneal or a retroperitoneal approach.

Research paper thumbnail of An update on new oral PDE5 inhibitors for the treatment of erectile dysfunction

Nature Reviews Urology, Nov 1, 2010

The management of erectile dysfunction (ED) has been revolutionized by the discovery of phosphodi... more The management of erectile dysfunction (ED) has been revolutionized by the discovery of phosphodiesterase 5 (PDE5) inhibitors, which have been commercially available for more than a decade and are the first-line therapeutic option for men with ED. Sildenafil, vardenafil and tadalafil were approved by the European Medicine Agency and the US FDA for the treatment of ED on the back of their high efficacy rates and favorable safety profiles. However, despite the fact that more than 50 million patients with ED worldwide have been successfully treated with one of these PDE5 inhibitors, some men-most notably those with severe neurologic damage, diabetes mellitus or severe vascular disease-are resistant to the currently available drugs and require more-invasive treatments, such as intracavernosal injection therapy. Partly as a consequence of this, research into alternative therapeutic approaches continues, including the development of new PDE5 inhibitors, centrally acting pharmaceutical agents, and application of molecular technologies such as gene therapy and stem cell therapy.

Research paper thumbnail of A continuous bladder neck-urethral anastomosis after open radical retropubic prostatectomy

Research paper thumbnail of The Use of Captopril—Angiotensin Converting Enzyme (ACE) Inhibitor for Cystinuria During COVID-19 Pandemic

Research paper thumbnail of Impact of urology simulation boot camp in improving endoscopic instrument knowledge

BMJ Simulation and Technology Enhanced Learning, Jul 11, 2018

ObjectiveEducation and training of surgeons has traditionally focused on the development of indiv... more ObjectiveEducation and training of surgeons has traditionally focused on the development of individual knowledge, technical skills and decision making. Knowledge about endoscopic instruments is one of the core elements of urological training. We assessed the precourse knowledge of newly appointed urology trainees and the impact of boot camp in improving their knowledge.MethodsNewly appointed specialty trainees in urology took part in a pilot 5-day urology simulation boot camp (USBC). The aim of the USBC was to improve their confidence, procedural performance and non-technical skills, with one of the modules looking at the trainees’ knowledge about common endoscopic instruments in urology. Delegates were first asked to identify and assemble the instruments, followed by one-to-one teaching about the instruments. An Objective Structured Assessment Tool was used to assess their knowledge in the identification and assembly of the cystoscope, resectoscope and optical urethrotome, before and at the end of the course.ResultsData of two successive boot camps were collected to assess knowledge of instruments of newly appointed urology trainees. Majority of the trainees had good precourse knowledge of the cystoscopy kit, with 84% able to correctly identify the parts. Seventy-six per cent of candidates were able to identify the resectoscope equipment, but only approximately a third of trainees were able to correctly identify the urethrotome kit. The assembly of cystoscope, resectoscope and urethrotome was performed correctly in 74%, 42% and 32% at baseline and 94%, 90% and 77% postcourse, respectively. Overall performance improved significantly in the postcourse assessment (<0.001).ConclusionThis urology boot camp has addressed gaps in trainees’ core equipment knowledge and guided them to improve their knowledge with respect to identification and assembly of cystoscope, resectoscope and urethrotome.

Research paper thumbnail of 174Single centre experience with the new Storz Modulith SLK lithotriptor using lithotrack targeting system for stone localisation

European Urology Supplements, 2005

Research paper thumbnail of Noninfective Cutaneous Granuloma with Leuprorelin Acetate—Reality or Myth

Urology, Apr 1, 2007

We present our experience with 7 patients who developed injection site granuloma with leuprorelin... more We present our experience with 7 patients who developed injection site granuloma with leuprorelin acetate injection. Although isolated case reports exist, this is the largest collection of cases from a single center. The exact mechanism of the granuloma formation is not well understood, although theories are associated with the vehicle used for injection. Our discussion focuses on the nature of the granuloma formation and its etiology. The reaction appears to be more common with leuprorelin acetate than with other forms of luteinizing hormone-releasing hormone analogues.

Research paper thumbnail of Erectile dysfunction and faecal incontinence after pelvic rectal cancer surgery

International Journal of Surgery, Nov 1, 2014

We compared all colonoscopy procedures performed by joint advisory group (JAG) on GI endoscopy ap... more We compared all colonoscopy procedures performed by joint advisory group (JAG) on GI endoscopy approved surgical and gastroenterology endoscopists during the period January 2008 till June 2013. Results: A total of 6718 colonoscopies were performed by 6 gastroenterology and 8 surgeon endoscopists with comparable completion rates. The surgeons performed twice more colonoscopies (n¼4611) with statistically significant difference in patient's age (62.3 years vs. 57.6 years, p <0.001). The surgeons also performed more therapeutic procedures (1529 vs. 442, p <0.001) with higher polyp excision rates (p 0.001). During the procedures, surgeons used less sedation (mean dose: Fentanyl dose 55.31 mcg vs. 61.53 mcs, p <0.001; Midazolam 2.6mg vs. 2.7mg, p <0.001) but high dose of Buscopan (9mg vs. 1.5 mg, p <0.001) resulting in overall less patient discomfort levels (p 0.001). Conclusions: The study demonstrates a high volume of diagnostic and therapeutic colonoscopy service provided by surgeons. This study highlights the need for incorporation of endoscopy training into surgical curriculum.

Research paper thumbnail of 368 Expression of hypoxia inducible proteins in prostate cancer

European Urology Supplements, Feb 1, 2004

Research paper thumbnail of 398: Clinical Significance of HIF-1α and GLUT-I in Prostate Cancer

The Journal of Urology, Apr 1, 2005

Radiation resistance assays were performed using y-radiation (5Gy) in the presence or absence of ... more Radiation resistance assays were performed using y-radiation (5Gy) in the presence or absence of i50JLM ZnS04 • For both assays, cell viability was measured after 72 hours by MTS assay. Experiments were repeated 3 times and the data analyzed using a mixed effects ANOV A model to compare cisplatin or radiation doses in the presence or absence of 150JLM ZnS04 • P-values of < 0.05 were considered significant. RESULTS: The addition of increasing concentrations of ZnS04 up regulated MT expression in a dose dependent manner, compared to untreated LNCaP or C4-2 cells. Cells treated with cisplatin in the presence of zinc showed a significantly decreased sensitivity to cisplatin (p<0.005 at all study concentrations below 50JLM) compared to no zinc controls. Cells irradiated in the presence of zinc showed a significantly decreased sensitivity to radiation (p<0.005) compared to no zinc controls. CONCLUSIONS: Our data confirms that treatment of prostate cancer cells with Zn causes a several fold-increase in MT expression, which is strongly associated with resistance to both cisplatin chemotherapy and radiation in prostate cancer cells. Therapeutic targeting of MT may therefore provide a means to simultaneously overcome both chemoresistance and radiation resistance in prostate cancer.

Research paper thumbnail of Five-Year results of a multi-specialty induction course for surgical training

Frontiers in Surgery

BackgroundThe Essential Surgical Skills Course (ESSC) is a multi-specialty induction “boot camp” ... more BackgroundThe Essential Surgical Skills Course (ESSC) is a multi-specialty induction “boot camp” style course that has been run successfully for five years. The aim of the current paper is to create an accurate guide for the replication of the course by other teams and assess the course's fitness for purpose, through the survey feedback provided by trainees.MethodsThe course's fitness for purpose was assessed through cumulative five-year survey feedback from trainees. This observational study describes the design and process of content adjustment according to feedback.ResultsThe course its five-year span offered twelve different procedural skills in four different specialties. Feedback for each session was persistently >8/10. Key themes identified as beneficial include teacher-to-trainee ratio (often 1:1), teaching style, course structure and responsiveness.ConclusionsThe ESSC was found to be fit for purpose for the induction of trainees into surgical training. The key fa...

Research paper thumbnail of Endoscopic surgical simulation using low-fidelity and virtual reality transurethral resection simulators in urology simulation boot camp course: trainees feedback assessment study

World Journal of Urology, 2021

Objectives The objective of our study was to study trainees' feedback and rating of models for tr... more Objectives The objective of our study was to study trainees' feedback and rating of models for training transurethral resection of bladder lesions (TURBT) and prostate (TURP) during simulation. Methods The study was performed during the ''Transurethral resection (TUR) module" at the boot camp held in 2019. Prior to the course, all trainees were required to evaluate their experience in performing TURBT and TURP procedures. Trainees simulated resection on two different models; low-fidelity tissue model (Samed, GmBH, Dresden, Germany) and virtual reality simulator (TURPMentor, 3D Systems, Littleton, US). Following the completion of the module, trainees completed a questionnaire using a 5-point Likert scale to evaluate their assessment of the models for surgical training. Results In total, 174 simulation assessments were performed by 56 trainees(Samed Bladder-40, Prostate-45, TURPMentor Bladder-51, Prostate-37). All trainees reported that they had performed < 50 TUR procedures. The Samed model median scores were for appearance (4/5), texture (5/5), feel (5/5) and conductibility (5/5). The TURPMentor median score was for appearance (4/5), texture and feel (4/5) and conductibility (4/5). The most common criticism of the Samed model was that it failed to mimic bleeding. In contrast, trainees felt that the TURPMentor haptic feedback was inadequate to allow for close resection and did not calibrate movements accurately. Conclusions Our results demonstrate that both forms of simulators (low-fidelity and virtual reality) were rated highly by urology trainees and improve their confidence in performing transurethral resection and in fact complement each other in providing lower tract endoscopic resection simulation.

Research paper thumbnail of Is Using Lignocaine Gel prior to Flexible Cystoscopy Justified?

Urologia Internationalis, 2003

Objective: We evaluate the discomfort and efficacy of instilling 2% lignocaine gel (Instillagel) ... more Objective: We evaluate the discomfort and efficacy of instilling 2% lignocaine gel (Instillagel) versus smearing water-soluble gel (Aquagel) around the flexible cystoscope and external urethral meatus in men undergoing flexible cystoscopy for the first time and the overall efficacy of lignocaine gel in completion of the procedure. Materials and Methods: A total of 140 patients divided into two groups, were randomized for this study: group A (n = 70) received approximately 11 ml of 2% lignocaine gel (Instillagel) intraurethrally for approximately 15 min, while in group B (n = 70) approximately 10–15 ml of water-soluble gel (Aquagel) was smeared around the scope and external urethral meatus. Total completion time for each procedure was recorded. Primary outcomes were pain during instillation of lignocaine, during insertion of scope and cystoscopy. Pain was recorded by the patient using a 100-mm nongraphic rating visual analogue scale. Secondary outcome included procedure time and cost...

Research paper thumbnail of Endoscopic management of upper tract transitional cell carcinoma

Indian Journal of Urology, 2010

Upper urinary tract transitional cell carcinoma (TCC) accounts for up to 10% of cases of neoplasm... more Upper urinary tract transitional cell carcinoma (TCC) accounts for up to 10% of cases of neoplasm of the upper urinary tract. The &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot;gold standard&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot; management of upper tract TCC is nephroureterectomy. Technological innovations, miniaturisations and increased availability of energy sources such as Holmium laser fibers have improved the armamentarium of endoscopic management of upper tract TCC. Endoscopic management of upper tract TCC includes the percutaneous (antegrade) and retrograde approaches. Modern flexible ureterorenoscopy allows retrograde approach to small (&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;1.5cm), low grade and noninvasive tumors, which is inaccessible to standard rigid ureteroscopes without breaching the urothelial barrier. In patients with large tumors or in whom retrograde access is difficult, the percutaneous approach to the renal pelvis, although more invasive, provides an alternative access and control. Both retrograde and percutaneous approaches allow instillation of various chemotherapeutic agents. Careful selection of patients is the key point in the successful endoscopic management of upper tract TCC. Patient selection is based on tumor size, grade and multifocality and other patient factors such as comorbidities, single kidney, post kidney transplant and patient choice. Both motivation and compliance of patients are needed for long-term successes. However, until large randomized trials with long term follow-up are available, endoscopic management of upper tract TCC should be reserved for only selected group of patients. This review summarizes the current techniques, indications, contraindications and outcomes of endoscopic management of UTTCC and the key published data.

Research paper thumbnail of Updates in endourology

Current Urology Reports, Mar 1, 2008

Rapid urologic innovations in minimally invasive treatment are creating exciting new horizons in ... more Rapid urologic innovations in minimally invasive treatment are creating exciting new horizons in endourology. However, these new concepts are blurring the traditional boundary between endourology and oncology. Organ-sparing surgery, laparoscopy, robotics systems, and image-guided ablation techniques enable surgeons to develop specifically tailored treatments for patients. We examine recent developments and future prospects for how new technology will continue to advance the field of endourology.

Research paper thumbnail of Living with Penile Cancer: Effects on Psychology and Quality of Life

Research paper thumbnail of The Validation of the Clinical Male Pelvic Trainer Mk 2—Advanced Models for Scrotal Examination Simulation

Journal of Surgical Education, May 1, 2017

OBJECTIVES: To validate the use of a novel physical model, the "Clinical Male Pelvic Trainer (CMP... more OBJECTIVES: To validate the use of a novel physical model, the "Clinical Male Pelvic Trainer (CMPT) Mk 2-Advanced," for scrotal examination simulation and evaluate its use for surgical education. MATERIALS AND METHODS: A total of 7 CMPT Mk 2-Advanced scrotal models were used for teaching: normal, varicocele, testicular tumor, epididymal cyst, hydrocele, epididymo-orchitis, and indirect inguinoscrotal hernia. At 4 surgical courses in the West Yorkshire Foundation Deanery, UK, between 2015 and 2016, trainees were asked to assess their clinical experience, confidence levels in diagnosing scrotal pathology and simulation properties of the scrotal models on a 5-point Likert Scale. Expert responses were used to validate these findings. RESULTS: In total, 65 trainees and 12 experts (including 3 senior residents) participated in the study (n ¼ 77). There was a positive-tailed distribution in responses from experts for realistic simulation of scrotal contents and pathology; only 1.5% and 14.4% of all responses by experts were scored as a "1" (strongly disagree) or "2" (disagree). The intraclass coefficient (k) was 0.86 among experts. No significant differences between experts and trainees in assessment of simulation were observed. Following use of the models, there was a significant increase in confidence scores matched by trainee (p o 0.001). Approximately 92.9% and 100% of trainees and experts were in favor of using the models for assessment and future training respectively. CONCLUSIONS: Our study demonstrates that the CMPT MK 2-Advanced models have high "face validity" and may be a valuable tool for surgical education. The use of these models should be explored for use in the curriculum at medical school.

Research paper thumbnail of Expression of HIF-1α and Glut-1 in human bladder cancer

Oncology Reports, Oct 1, 2005

Research paper thumbnail of 174Single centre experience with the new Storz Modulith SLK lithotriptor using lithotrack targeting system for stone localisation

European Urology Supplements, Mar 1, 2005

Research paper thumbnail of An Update on Evaluation and Management in Cystinuria

Research paper thumbnail of Laparoscopic Heminephrectomy of a Horseshoe Kidney

JSLS, 2011

Minimally invasive surgery has revolutionized surgery for urologic disorders, and laparoscopic pr... more Minimally invasive surgery has revolutionized surgery for urologic disorders, and laparoscopic procedures have become widely available for several different ablative and reconstructive operations. Laparoscopic heminephrectomy in patients with horseshoe kidney can be a technically challenging procedure due to aberrant vessels, functional parenchyma in the isthmus, and abnormal location. We report the management of a case of symptomatic nonfunctioning left moiety of a horseshoe kidney with emphasis on its surgical technique combined with a review of the literature. Laparoscopic heminephrectomy is a feasible option in the surgical management of benign and malignant conditions of the horseshoe kidney and can be performed safely using a transperitoneal or a retroperitoneal approach.

Research paper thumbnail of An update on new oral PDE5 inhibitors for the treatment of erectile dysfunction

Nature Reviews Urology, Nov 1, 2010

The management of erectile dysfunction (ED) has been revolutionized by the discovery of phosphodi... more The management of erectile dysfunction (ED) has been revolutionized by the discovery of phosphodiesterase 5 (PDE5) inhibitors, which have been commercially available for more than a decade and are the first-line therapeutic option for men with ED. Sildenafil, vardenafil and tadalafil were approved by the European Medicine Agency and the US FDA for the treatment of ED on the back of their high efficacy rates and favorable safety profiles. However, despite the fact that more than 50 million patients with ED worldwide have been successfully treated with one of these PDE5 inhibitors, some men-most notably those with severe neurologic damage, diabetes mellitus or severe vascular disease-are resistant to the currently available drugs and require more-invasive treatments, such as intracavernosal injection therapy. Partly as a consequence of this, research into alternative therapeutic approaches continues, including the development of new PDE5 inhibitors, centrally acting pharmaceutical agents, and application of molecular technologies such as gene therapy and stem cell therapy.

Research paper thumbnail of A continuous bladder neck-urethral anastomosis after open radical retropubic prostatectomy

Research paper thumbnail of The Use of Captopril—Angiotensin Converting Enzyme (ACE) Inhibitor for Cystinuria During COVID-19 Pandemic

Research paper thumbnail of Impact of urology simulation boot camp in improving endoscopic instrument knowledge

BMJ Simulation and Technology Enhanced Learning, Jul 11, 2018

ObjectiveEducation and training of surgeons has traditionally focused on the development of indiv... more ObjectiveEducation and training of surgeons has traditionally focused on the development of individual knowledge, technical skills and decision making. Knowledge about endoscopic instruments is one of the core elements of urological training. We assessed the precourse knowledge of newly appointed urology trainees and the impact of boot camp in improving their knowledge.MethodsNewly appointed specialty trainees in urology took part in a pilot 5-day urology simulation boot camp (USBC). The aim of the USBC was to improve their confidence, procedural performance and non-technical skills, with one of the modules looking at the trainees’ knowledge about common endoscopic instruments in urology. Delegates were first asked to identify and assemble the instruments, followed by one-to-one teaching about the instruments. An Objective Structured Assessment Tool was used to assess their knowledge in the identification and assembly of the cystoscope, resectoscope and optical urethrotome, before and at the end of the course.ResultsData of two successive boot camps were collected to assess knowledge of instruments of newly appointed urology trainees. Majority of the trainees had good precourse knowledge of the cystoscopy kit, with 84% able to correctly identify the parts. Seventy-six per cent of candidates were able to identify the resectoscope equipment, but only approximately a third of trainees were able to correctly identify the urethrotome kit. The assembly of cystoscope, resectoscope and urethrotome was performed correctly in 74%, 42% and 32% at baseline and 94%, 90% and 77% postcourse, respectively. Overall performance improved significantly in the postcourse assessment (<0.001).ConclusionThis urology boot camp has addressed gaps in trainees’ core equipment knowledge and guided them to improve their knowledge with respect to identification and assembly of cystoscope, resectoscope and urethrotome.

Research paper thumbnail of 174Single centre experience with the new Storz Modulith SLK lithotriptor using lithotrack targeting system for stone localisation

European Urology Supplements, 2005

Research paper thumbnail of Noninfective Cutaneous Granuloma with Leuprorelin Acetate—Reality or Myth

Urology, Apr 1, 2007

We present our experience with 7 patients who developed injection site granuloma with leuprorelin... more We present our experience with 7 patients who developed injection site granuloma with leuprorelin acetate injection. Although isolated case reports exist, this is the largest collection of cases from a single center. The exact mechanism of the granuloma formation is not well understood, although theories are associated with the vehicle used for injection. Our discussion focuses on the nature of the granuloma formation and its etiology. The reaction appears to be more common with leuprorelin acetate than with other forms of luteinizing hormone-releasing hormone analogues.