The Journal of urology
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The Journal of urology · Aug 2004
The orthotopic T pouch ileal neobladder: experience with 209 patients.
A serous lined extramural ileal flap valve technique called the T limb was developed to prevent reflux of urine in an orthotopic bladder substitute called the T pouch. We evaluate our intermediate clinical and functional experience with the orthotopic T pouch ileal neobladder. ⋯ With intermediate followup the functional results of the T pouch ileal neobladder are acceptable. The antirefluxing T limb provides unobstructed urinary flow in 95% and reflux prevention in 90% of patients. Although these results are encouraging, further followup is required to assess the long-term results of the T pouch ileal neobladder.
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The Journal of urology · Jul 2004
Randomized Controlled Trial Clinical TrialLaboratory based training in urological microsurgery with bench model simulators: a randomized controlled trial evaluating the durability of technical skill.
We evaluated the durability of laboratory based technical skills training in urological microsurgery using bench model simulators. ⋯ Laboratory based technical skills training with bench models can lead to a significant retention of technical skill by novice surgeons. Measured performance improvements appear to be durable with time. However, the opportunity for repeat hands-on practice appears to maximize the retention of technical skill.
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The Journal of urology · Jul 2004
An historical review of graduate medical education and a protocol of Accreditation Council for Graduate Medical Education compliance.
A brief history of American graduate medical education is discussed to provide a context for understanding the new standards set forth by the Accreditation Council on Graduate Medical Education (ACGME). The evaluation protocol of the University of Washington, which is structured around the 6 core competencies, is described. ⋯ A key factor to the success of residency training and ACGME accreditation will be the education of residents and faculty about the new ACGME regulations. The University of Washington Department of Urology is poised to engage the new model by creating new call coverage strategies, applying new metrics to old teaching models and using electronic database systems.
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The Journal of urology · Jul 2004
Hand assisted laparoscopic training for postgraduate urologists: the role of mentoring.
Hand assisted laparoscopy (HAL) has recently been accepted as a safe alternative for nephrectomy. HAL courses have been offered at several institutions to train novice laparoscopic surgeons in this minimally invasive surgical procedure. Mentoring by a course instructor or an experienced laparoscopist provides assistance to surgeons with their initial operation. However, to our knowledge the impact of mentoring on the clinical practice of HAL is not known. Therefore, we evaluated the clinical practice patterns of urologists following a postgraduate HAL course, comparing course graduates who underwent subsequent mentoring with those who were not mentored. ⋯ Mentoring provides a useful adjunct to postgraduate urological training and the integration of laparoscopic techniques into the community based practice of urology.
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The Journal of urology · Jun 2004
High expression of chemokine gene as a favorable prognostic factor in renal cell carcinoma.
The presence and potential role of chemokines in clinical tumors remain poorly understood. Chemokines are a large family of chemoattractant cytokines with several members that are also able to regulate angiogenesis. We hypothesized that chemokines may have an important role in regulating tumor growth in renal cell carcinoma (RCC). To begin to test this hypothesis chemokine gene expression and its influence on prognosis, cellular infiltration and angiogenesis in RCC were examined. ⋯ These results suggest that IP-10, MIG and MIP-1beta are expressed at high levels in tumors that rarely recur after surgery. The antitumorigenic effect of IP-10, MIG and MIP-1beta may result from the recruitment of lymphocyte infiltration and/or inhibition of angiogenesis in RCC. The amplification of chemokine expression by immunotherapy or gene therapy may be a practical and effective strategy to promote tumor regression.