Current urology reports
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Current urology reports · May 2018
ReviewSurgical Education, Simulation, and Simulators-Updating the Concept of Validity.
Competency-based medical education (CBME) is rooted in the use of iterative assessments. We must ensure that the assessments used in CBME are valid, to make acceptable and accurate decisions regarding the competency of a trainee. Until recently, much of the educational and assessment literature in urology have used a now-outdated method of determining validity, based on theory and recommendations from over 50 years ago. We describe a contemporary approach to gathering construct validity evidence for the assessment of urologic trainees, for use in both clinical and simulation environments. ⋯ Five sources of evidence make up Messick's contemporary framework of validity: test content, response process, internal structure, relationship to other variables, and consequences. These are all components of construct validation and concern the accuracy, quality, reproducibility, generalizability, and wider impact of the scores generated by an assessment, respectively. When deciding the competency of a trainee, program directors and educators must have a clear understanding of how the validity is established and is determined in each assessment context. The contextual specificity of validity means that stakeholders must be prepared to defend the outcome of an assessment, particularly when making high-stake or summative decisions.
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Chronic pelvic pain is a heterogeneous condition that often requires multiple physician visits and various treatments prior to achieving an acceptable management strategy. Neuromodulation has been used to treat chronic pelvic pain that has failed other therapies. ⋯ Numerous modalities of neuromodulation have been used to alleviate chronic pelvic pain with promising results. Numerous modalities of neuromodulation have demonstrated efficacy in the management of pelvic pain. Further investigation is needed to elucidate the most effective treatment modality and to identify the patients who would benefit most from this therapy.
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Current urology reports · Mar 2018
Review Historical ArticleFemale Pelvic Medicine and Reconstructive Surgery-What Does Certification Mean?
There are advantages and disadvantages of subspecialty certification for physicians, trainees, patients, and society at large. As female pelvic medicine and reconstructive surgery (FPMRS) became the second subspecialty of urology to offer subspecialty certification, understanding the effects of FPMRS subspecialty certification on the healthcare system is important. ⋯ While subspecialty certification may improve training, identify experts, and ultimately lead to improved patient outcomes, certification might also be unnecessary for some physicians, weaken residency training, and limit the number of physicians who are deemed qualified to offer certain treatments. As pelvic floor disorders can considerably affect quality of life, and their prevalence is expected to increase with the aging population, high-quality FPMRS care is needed. In this article, we describe the history of FPMRS subspecialty certification as well as its potential advantages and disadvantages as suggested by literature. There are advantages and disadvantages of FPMRS subspecialty certification. Further research is needed to assess the effect of FPMRS subspecialty certification on patient outcomes.
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Varicocele may play a significant role in a subset of patients presenting with male factor infertility. Despite its relatively high prevalence amongst subfertile men, there has been controversy over the effectiveness of surgical treatments, patient selection, and when to administer treatment, particularly in the era of assisted reproductive technology. ⋯ In line with earlier finding, recent evidence strongly suggests that varicocelectomy improves pregnancy rates and semen parameters. The currently available literature still does not clearly elucidate the answer to this question, due to flaws in retrospective study design. Patients undergoing subinguinal microsurgical varicocelectomy appear to have the highest pregnancy rates, and lowest complication rates, compared to other surgical approaches. Current research has given us a better understanding of the relationship between varicocele and infertility. Amongst men presenting with semen analysis abnormalities and varicoceles, including those patients presenting with non-obstructive azoospermia or couples with a significant male factor component failing previous attempts at in vitro fertilization, varicocelectomy may improve take home baby rates. More robust, prospective, controlled studies are needed to further clarify the population of subfertile men with varicocele most likely to benefit from varicocelectomy.
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Vesico-vaginal fistulae (VVF) remain the most prevalent genitourinary fistula detrimentally impacting quality of life. ⋯ Obstructed labor is the leading cause of VVF in the developing world with most repairs performed via the transvaginal approach. Conversely, the predominate etiology in industrialized nations is iatrogenic injury with an increasing trend towards abdominal repair via a minimally invasive (laparoscopic and robotic) approach. No studies have compared transvaginal repair to minimally invasive transabdominal approaches. Further, an increasing number of authors have developed algorithms to determine optimum surgical approaches and risk factors for persistent incontinence. As surgeons become more facile with laparoscopic and robotic skills, there is a growing trend for minimally invasive surgical management of VVF in developed countries, perhaps widening the disparity gap between developing nations where transvaginal approaches predominate with good success. Further studies are needed to compare transvaginal to minimally invasive transabdominal approaches.