Publications (2)4.19 Total impact
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Article: Expert training with standardized operative technique helps establish a successful penile prosthetics program for urologic resident education.
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ABSTRACT: The challenge of resident education in urologic surgery programs is to overcome disparity imparted by diverse patient populations, limited training times, and inequalities in the availability of expert surgical educators. Specifically, in the area of prosthetic urology, only a small proportion of programs have full-time faculty available to train residents in this discipline. To examine whether a new model using yearly training sessions from a recognized expert can establish a successful penile prosthetics program and result in better outcomes, higher case volumes, and willingness to perform more complex surgeries. A recognized expert conducted one to two operative training sessions yearly to teach standardized technique for penile prosthetics to residents. Each session consisted of three to four operative cases performed under the direct supervision of the expert. Retrospective data were collected from all penile prosthetic operations before (February, 2000 to June, 2004: N = 44) and after (July, 2004 to October, 2007: N = 79) implementation of these sessions. Outcomes reviewed included patient age, race, medical comorbidities, operative time, estimated blood loss, type of prosthesis, operative approach, drain usage, length of stay, and complications including revision/explantation rates. Statistical analysis was performed using Student's t-tests, Fisher's tests, and survival curves using the Kaplan-Meier technique (P value ≤ 0.05 to define statistical significance). Patient characteristics were not significantly different pre- vs. post-training. Operative time and estimated blood loss significantly decreased. Inflatable implants increased from 19/44 (43.2%, pre-training) to 69/79 (87.3%, post-training) (P < 0.01). Operations per year increased from 9.96 (pre-training) to 24 (post-training) (P < 0.01). Revision/explantation occurred in 11/44 patients (25%, pre-training) vs. 7/79 (8.9%, post-training) (P < 0.05). These data demonstrate that yearly sessions with a recognized expert can improve surgical outcomes, type, and volume of implants and can reduce explantation/revision rates. This represents an excellent model for improved training of urologic residents in penile prosthetics surgery.Journal of Sexual Medicine 08/2011; 8(10):2726-32. · 3.55 Impact Factor -
Article: Prostaglandin E₂mediates spontaneous rhythmic contraction in rabbit detrusor muscle.
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ABSTRACT: The purpose of this investigation was to determine if prostaglandin E₂(PGE₂) is produced by rabbit detrusor free of urothelium and demonstrate that PGE₂ is responsible for the generation of spontaneous rhythmic contraction (SRC). A bioassay was performed in which contraction frequency in strips of rabbit detrusor was compared before and after addition of superfusate from incubating sections of rabbit detrusor. Specificity was determined by testing the effects of SC-51089, a PGE₂(EP1) antagonist. Effects on development of tension were determined in artery segments after treatment with increasing doses of PGE₂, PGF₂α, and TXA₂, and a section of femoral artery was used as a negative control. Confirmation of PGE2 production was then determined using EIA kits. Increased rhythmic frequency was identified after superfusate from a section of rabbit detrusor free of urothelium was added to strips of detrusor from the same animal. Additional experiments demonstrated that rhythmic frequency generated after treatment with PGE₂ was significantly reduced after treatment with SC-51089. In artery smooth muscle, prostaglandin dose response experiments demonstrated that only TXA₂ induced contraction at physiologic doses (<10⁻⁷M). As a negative control, subsequent treatment of a section of femoral artery with detrusor superfusate failed to increase tension, confirming a lack of TXA₂ production. EIA confirmed that PGE₂ production increased by 4.8-fold in strips of detrusor free of urothelium after 15 minutes of incubation and that this production was blocked by ibuprofen and a COX-1 inhibitor. Rabbit detrusor produces PGE₂ which is the most likely mediator of SRC.The Canadian Journal of Urology 04/2011; 18(2):5608-14. · 0.64 Impact Factor
