First Canadian experience with robotic laparoendoscopic single-site vs. standard laparoscopic living-donor nephrectomy: A prospective comparative study

INTRODUCTION: We aimed to compare the outcomes of robotic laparoendoscopic single-site living donor nephrectomy (R-LESS LDN) vs. standard laparoscopic living donor nephrectomy (LLDN). METHODS: Between October 2013 and November 2015, 39 patients were allocated to either standard LLDN (n=25) or R-LESS LDN (n=14). Patient demographics, perioperative outcomes, analgesic requirement, visual analogue scale of pain at postoperative days 1, 3, 7, and 30, and a health-related quality of life and body image questionnaire were prospectively collected. RESULTS: There were no significant differences in demographics and intraoperative outcomes between the two cohorts. The R-LESS LDN cohort had lower analgesic requirement (p=0.002) and lower visual pain scores on days 1 and 3 (p=0.001). Additionally, body image and satisfaction scores in the R-LESS group were also superior compared to the LLDN cohort (p=0.008). There was no significant difference in the postoperative complications according to the Clavien-Dindo system. Recipient graft functional outcomes were equivalent. CONCLUSIONS: This is the first evidence that R-LESS LDN is safe and associated with comparable surgical and early functional outcomes compared to LLDN, while pain, donor body image, and satisfaction scores were improved compared to LLDN

Histone deacetylase 8 protects human proximal tubular epithelial cells from hypoxia-mimetic cobalt- and hypoxia/reoxygenation-induced mitochondrial fission and cytotoxicity

Cell death by hypoxia followed by reoxygenation (H/R) is responsible for tissue injury in multiple pathological conditions. Recent studies found that epigenetic reprogramming mediated by histone deacetylases (HDACs) is implicated in H/R-induced cell death. However, among 18 different isoforms comprising 4 classes (I-IV), the role of each HDAC in cell death is largely unknown. This study examined the role of HDAC8, which is the most distinct isoform of class I, in the hypoxia mimetic cobalt- and H/R-induced cytotoxicity of human proximal tubular HK-2 cells. Using the HDAC8-specific activator TM-2-51 (TM) and inhibitor PCI34051, we found that HDAC8 played a protective role in cytotoxicity. TM or overexpression of wild-type HDAC8, but not a deacetylase-defective HDAC8 mutant, prevented mitochondrial fission, loss of mitochondrial transmembrane potential and release of cytochrome C into the cytoplasm. TM suppressed expression of dynamin-related protein 1 (DRP1) which is a key factor required for mitochondrial fission. Suppression of DRP1 by HDAC8 was likely mediated by decreasing the level of acetylated histone H3 lysine 27 (a hallmark of active promoters) at the DRP1 promoter. Collectively, this study shows that HDAC8 inhibits cytotoxicity induced by cobalt and H/R, in part, through suppressing DRP1 expression and mitochondrial fission

Urologist burnout: Frequency, causes, and potential solutions to an unspoken entity

Physician burnout has been linked to decreased job performance, increased medical errors, interpersonal conflicts, and depression. Recent multispecialty studies suggest that urologists have higher rates (up to 63.6%) of burnout compared to physicians in other specialties; however, these reports were limited by low sample sizes.1 We aimed to evaluate the prevalence of urologist burnout, verify risk factors, and recommend preventative measures and solutions for colleagues at risk or suffering from burnout. Urologist burnout is a true entity that transcends level of training and nationality. Its roots appear to be deep-seated in our tireless efforts to strive for excellence in care for our patients, our growing academic and research pursuits, and surmounting administrative responsibilities; these virtues, which are regarded as the foundations of our career successes, are often obtained at the expense of personal health and wellbeing, as well as family sacrifice. Various other medical societies have become increasingly vocal about the issue of physician burnout and have actively initiated successful strategies to minimize its impact on their members. As an organization with a strong national presence, the Canadian Urological Association (CUA) should promote tools to prevent and interventions to assist those at risk for and suffering from burnout. Increased awareness in the general medical community has led to strategies and tools that can help prevent, identify, or assist physicians in their recovery from burnout. The CUA should develop and facilitate access to information and offer comprehensive support for urologists struggling with burnout

Perceptions on competence by design in urology

Introduction: The Royal College of Physicians and Surgeons of Canada has begun implementing Competence by Design (CBD). However, it is unclear how much urology trainees and faculty know about CBD, their attitudes towards this change, and their willingness to embrace and participate in this new model of training. Methods: This cross-sectional study was conducted through an online survey, which was administered to all trainees and faculty at Canadian urology programs prior to the implementation of CBD. The final survey consisted of eight demographic questions, 17 five-point Likert items, one visual analog scale question, 11 multiple-choice questions, and two open-ended questions. Results: A total of 74 participants (38 faculty and 36 trainees) across 12 universities responded, with a completion rate of 82.4%. This corresponded to an overall response rate of 20.5%. Overall, there was a lack of resounding enthusiasm towards this shift to CBD in urology. Although both trainees and faculty had overall positive perceptions of CBD on assessment, teaching, and readiness, most agreed that this transition will be costly and associated with increased requirements for time, funding, and administrative support. Furthermore, there were significant concerns regarding the lack of valid assessment tools and evidence for the validity of entrustable professional activities. Conclusions: While this survey has demonstrated an appreciation for the benefits of CBD, challenges are equally anticipated. CBD in urology will be a fertile research area; this study has identified several important educational questions regarding the model\u27s effectiveness and consequences, thus, providing collaborative opportunities among all Canadian programs

Development, implementation, and evaluation of a competency-based didactic and simulation-focused boot camp for incoming urology residents: Report of the first three years

Introduction: The Royal College of Physicians and Surgeons of Canada’s Competence by Design (CBD) initiative presents curricula challenges to ensure residents gain proficiency while progressing through training. To prepare first-year urology residents (R1s), we developed, implemented, and evaluated a didactic and simulation-focused boot camp to implement the CBD curriculum. We report our experiences and findings of the first three years. Methods: Urology residents from two Canadian universities participated in the two-day boot camp at the beginning of residency. Eleven didactic and six simulation sessions allowed for instruction and deliberate practice with feedback. Pre-and post-course multiple-choice questionnaires (MCQs) and an objective structured clinical exam (OSCE) evaluated knowledge and skills uptake. For initial program evaluation, three R2s served as historical controls in year 1. Results: Nineteen residents completed boot camp. The mean age was 26.4 (±2.8) and 13 were male. Participants markedly improved on the pre- and post-MCQs (year 1: 62% and 91%; year 2: 55% and 89%; year 3: 58% and 86%, respectively). Participants scored marginally higher than the controls on four of the six OSCE stations. OSCE scores remained \u3e88% over the three cohorts. All participants reported higher confidence levels post-boot camp and felt it was excellent preparation for residency. Conclusions: During its first three years, our urology boot camp has demonstrated high feasibility and utility. Knowledge and technical skills uptake were established via MCQ and OSCE results, with participants’ scores near or above those of R2 controls. This boot camp will remain in our CBD curriculum and can provide a framework for other urology residency programs

Physiological roles of nitric oxide during maturation in conscious lambs

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Demarcated Truncal Jaundice: A Sign of Retroperitoneal Bile Leakage

The characteristic feature of the clinical sign described here is the demarcation between jaundiced and unaffected areas of the body. The flanks and the genitalia are stained more than would be expected by examination of the sclera or estimation of bilirubin level. Superiorly, a horizontal line about 3 cm below the clavicles, corresponding to the insertion of the fascia of Scarpa into the clavipectoral fascia, allows an easy comparison between the jaundiced trunk and unaffected adjacent areas, such as the neck, shoulder, and arm. Similarly, a line 3 cm below the groin skin crease corresponds to the insertion of the fascia of Scarpa into the fascia lata of the thigh. In former times, such a sign might have been called icterus marginatus