5 research outputs found
Isolated tuberculous epididymitis: a review of forty cases
Background: Tuberculous epididymitis is one of the causes of chronic
epididymal lesions. It is difficult to diagnose in the absence of renal
involvement. Aim : To profile isolated tuberculous epididymitis and to
assess our approach in the evaluation of this group of patients.
Setting and Design : Retrospective study done at Christian Medical
College, Vellore, South India. Methods and Materials : Between 1992
and 2002, 156 fine needle aspiration cytology specimens and 108
epididymal biopsies were carried out in 187 men for evaluation of
chronic epididymal nodules. Isolated epididymal tuberculosis was
defined as "tuberculous infection affecting the epididymis without
evidence of renal involvement as documented by the absence of acid fast
bacilli in the urine sample and on imaging". The age, laterality, mode
of presentation and method of histological diagnosis were studied with
the objective of profiling isolated tuberculous epididymitis. Results
: Fifty-four of the 187 men (median age 32 years; interquartile range:
21-37 years) had tuberculous epididymitis. Fourteen were excluded from
the analysis (10 had associated urinary tract tuberculosis and 4 were
lost to follow-up). None of the 40 men with isolated tuberculous
epididymitis had urinary symptoms. Bilateral involvement was seen in
five (12.5%) cases. The salient presenting features included painful
swelling (16 subjects, 40%), scrotal sinus (4, 20%) and acute
epididymitis (2, 10%). Past history or concomitant presence of
tuberculosis was noted in three subjects each. Anti TB treatment
resulted in a complete response in 10 and partial response in 18. Five
subjects underwent epididymectomy. Tuberculous epididymitis was found
incidentally in 5 (10%) cases on high orchiectomy specimen done for
suspected testicular tumour. Conclusions : Tuberculous epididymitis
can be the sole presentation of genitourinary tuberculosis
The Success and Evolution of a Urological "Boot Camp" for Newly Appointed UK Urology Registrars:Incorporating Simulation, Nontechnical Skills and Assessment
BACKGROUND: Urological training has dramatically changed in recent years. Training durations are shorter and a drive toward consultant led care has reduced trainees experience. Within the UK, approximately 50 registrars annually embark on a 5-year Urology training programme, with variable levels of basic urological experience. OBJECTIVE: To describe a simulation programme aimed at delivering the knowledge and skills necessary to safely and effectively start working as a registrar in Urology by intensive training with a 1:1 faculty to delegate ratio. DESIGN, SETTING, AND PARTICIPANTS: Our course content mirrors the UK training syllabus for junior Urology registrars. We delivered 8 modules over a 4-day programme with a fifth day of assessments. Delegates level of urological knowledge, operative competency and confidence pre-, immediately post-training and at 3-months postcourse were assessed. Objective delegate and faculty feedback was also collected. Technical skills modules include; inguinoscrotal surgery, ureteroscopy, transurethral resection, urodynamics, and Botox administration as well as basic reconstructive and laparoscopic operative skills. "Nontechnical" skills included simulated ward round, out-patient, and emergency scenarios. RESULTS: Feedback from delegates and faculty members has been overwhelmingly positive. We have used this feedback to tailor the content of the course for following years. An increased knowledge level (based on mean examination scores [precourse 55.5%, postcourse 70.1%]) and operative competency was observed in all skills assessed (transurethral resection of the prostate, transurethral resection of bladder tumor, Ureteroscopy, laparoscopic skills, and instrument assembly). Operative confidence was increased immediately and at 3-months postcourse. CONCLUSIONS: Our "boot camp" course provides a realistic introduction and foundation to begin Urological practice. Being delivered at the beginning of the training scheme, prior to intensive patient exposure, registrars are in an optimum position to develop their newly acquired knowledge and skills to enhance training and intends to improve patient safety and satisfaction