Role of magnetic resonance urography in the diagnosis of noncalcurlar obstruction of the upper urinary tract

785 VIRTUAL RETROPERITONEAL WITH A THREE-DIMENSIONAL

LAPAROSCOPIC MODEL

PROCEDURE

786 URETERORENOSCOPY: CLINICAL SKILLS

IMPACT

OF SIMULATOR-TRAINING

ON

&trade V.‘, Doublet J.D.‘, Traxer 0.‘. Uhl J.F.‘, Gattegno B ‘, Thibault P.‘, Delmas V.?

Knoll T., Trojan L., Hatzinger ‘HBpital Tenon, Department of Urology, Department ofAnatomy, Paris. France

Paris, France, ‘Facult& de Mtdecine

M., Alken P., Kohrmann

K., Michel M.

Paris,

University

Hospital Mannheim,

Department

of Urology, Mannheim,

Germany

INTRODUCTION & OBJECTIVES: To build preoperatively virtual object from CATscan retroperitoneal surgery

films.

for simulation

a three-dimensional (3D) and traming in laparoscopic

MATEfUAL & METHODS: CATscan films were obtained from patients placed in operative position, and computerized in DICOM format. The anatomical structures were drawn manually on every film, using a colour code for every organ, on a laptop computer. A 3D virtual object was built with the 4DXL 6.0 software, representing the abdomen and retroperitoneum of the patient. Virtual instrumenrs, such as a trocar, a needle or a camera were created. RESULTS: The 3D reconstruction the abdomen and of retroperitoneum was completed in 3 patients. The average duration for 3D reconstruction for one patient by a single operator was IO hours. A virtual trocar was inserted through a retroperitoneal approach, mimicking the real procedure for retroperitoneal laparoscopy. A virtual camera gave laparoscopic views of the retroperitoneal area. We could thus confirm, before the effective procedure, that site, angle and depth for the punction were appropriate and safe. Different sites, angles and depths of punction were simulated to demonstrate the risk of wound to adjacent organs.

INTRODUCTION & OBJECTIVES: The recently developed UroMentor provides highly realistic simulation of rigid and flexible ureterorenoscopy (URS). In order to become standard training equipment, the impact on personal clinical improvement and skills must be justified. We therefore evaluated the outcome of training in urological novices and experts. MATERIAL & METHODS: Group 1: 20 experienced urologists (total number of flexible URS 2 1-153) were monitored during flexible URS for treatment of a lower calyx stone and the outcome was correlated to individual experience. A score was compiled based on recorded parameters, e.g. total operation time, stone contact time, complications such as bleeding or perforation, and treatment success. Group 2: 5 urological residents without endourological experience were trained in rigid URS for ureteral stone treatment on the UroMentor. Clinical skills were subsequently compared to those of untrained persons. RESULTS: Group 1: All urologists achieved stone disintegration and removal on the simulator. The reached score was equivalent to their personal experience. Group 2: Simulator training resulted in an inclined learning curve for the residents. Comparison with untrained residents in clinical cases showed distinct advantages in favour of the trainees and confirmed our hypothesis that simulator training is a safe and effective method of URS training.

&NCLUSIONS: 3D anatomical reconstruction of living subjects is useful for preparing actual surgical procedures. Moreover, it offers a very convenient and user-friendly model for teaching and training. The capture of digital information can be used for a more accurate description of existing surgical procedures, for the development of new operations, and in the future, for the feeding of hardware simulators.

CONCLUSIONS: Our data strongly supports the impact of URS simulator training on clinical cases. A high level of personal experience with ureterorenoscopy clearly correlated with skills shown on the simulator. It was further demonstrated that simulator training distinctly improves clinical skills.

787

788

RETRO-PUBIC PROSTATECTOMY: ENOUGH EXPERIENCE?

ARE

TRAINEES

RECEIVING

Donohue J.F., Thomas D., Foster M.C Good Hope Hospital, Department

of Urology, Birmingham,

ROLE OF MAGNETIC RESONANCE UROGRAPHY IN THE DIAGNOSIS OF NONCALCURLAR OBSTRUCTION OF THE UPPER URINARY TRACT Shokeir A., Eassa W., Mosbah A., Mohsen T., Mansour O., El-Kappany

United Klngdom

INTRODUCTION & OBJECTIVES: BPH is one of the commonest conditions seen by urologists. Retro-pubic Prostatectomy (RPP) is considered the treatment of choice for large prostates but the procedure seems to be performed less often. The authors believe that this operation is important, as exposure of the prostate is needed if packing of the prostate is required for excessive bleeding during TURP. A national survey of specialist registrars (SpR) training in urology in the UK was carried out to ascertain what exposure and experience they received and to what extent they thought they had adequate training. MATERIAL & METHODS: A postal survey was sent to all SpR’s on the training database. They were asked how many RPP they assisted and performed. They were also asked how they would treat a 12Occ prostate and whether they would be confident performing a RPP unsupervised. Finally, their opinion on training was sought. RESULTS: 113 (58%) of 205 responded. Overall, trainees on average assisted at 4.8 and performed 4.2 RPP, (Year 1: 1.510.2; Year 3: 2.60.4; Year 5: 8.5/9.5;). 61% would treat a 12Occ prostate with a RPP, (Year 1: 50%; Year 3: 55%; Year 5: 73%). 49% would be comfortable performing a RPP unsupervised, (Year 1: 17%; Year 3: 2 1%; Year 5: 92%;). The proportion that thought they would receive adequate training was 64%, (Year 1: 83%; Year 3: 48%; Year 5: 73%;). There was a great deal of variation between the regions in the UK. CONCLUSIONS: Although a very well known procedure and one that could be required by all urologists, it appears that trainees have little exposure to it and 27% of final year trainees do not expect to receive adequate training in performing it.

Mansoura

Urology & Nephrology

Centre, Urology, Mansoura,

H.

Egypt

INTRODUCTION & OBJECTIVES: To evaluate the role of 2 types of magnetic resonance urography (MRU) [T2 and Tl-weighted images] in the diagnosis of non-calcular ureteric obstruction and to compare their diagnostic accuracy with that of non-contrast computed tomography (NCCT) when excretory urography (IVP) is either contraindicated or inconclusive. MATERIAL & METHODS: A total 108 consecutive patients with noncalcular ureteric obstruction were included in this study. In all patients, IVP was either contraindicated or could not reach the diagnosis. In all patients, calcular obstruction was excluded by NCCT. All patients were subjected to heavily T2weighted and then gadolinium - enhanced Tl weighted MRU. The final definitive diagnosis was considered as a gold standard for diagnosis of obstruction. Normal kidneys in patients with unilateral obstruction were considered as the reference standard for absence of obstruction. Results of both types of MRU were compared with those of NCCT regarding sensitivity, specificity and overall accuracy. RESULTS: The study included 108 patients; 5 had bilateral obstruction and the remaining 103 had unilateral obstruction. Of the latter group, 5 had a solitary kidney, therefore, the total number of renal units was 211; 113 obstructed and 98 normal. The cause of ureteric obstruction was identified in all 113 renal units by T2-MRU (sensitivity of lOO%), in 69 by Tl- MRU (sensitivity of 61%) and in 32 by NCCT (sensitivity of 28%); a difference of significant value in favour of T2-MRU (P
Urology

Supplements

2 (2003) No. 1, pp. 199