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A letter to the editor in response to the article "Treatment of localised prostate cancer using high-intensity focused ultrasound," by T. Uchida, H. Ohkusa, Y. Nagata, T. Hyodo, T. Satoh and A. Irie is presented.

Objective: To assess the general public's understanding of urologists and of the Urological Society of Australian and New Zealand (USANZ) and gauge the effectiveness with which the USANZ disseminates health information about urological conditions to health consumers., Subjects and Methods: Using prostate cancer as an example, a Qualtrics online market survey of Australian healthcare consumers recruited from an online pool was conducted. The number of districts sampled within each state or territory was proportional to the size of the target population within each region and were proportionately distributed across metropolitan and non-metropolitan areas. Demographic characteristics were comparable with the Australian Bureau of Statistics Census figures corresponding to the target age group. The survey assessed knowledge of the roles of medical specialties through open-ended responses to qualitative items, association tasks, and recall/recognition questions. Subjects were asked to rate their familiarity of medical specialists and of six medical specialty logos., Results: There were 302 respondents. Subjects indicated less awareness of urology vs other medical specialties, were relatively unaware that urologists were concerned with the prostate, and the USANZ branding was among the least familiar (P < 0.001, Friedman test). When asked the first medical specialist that came to mind when told of prostate cancer, only 22% wrote urologist., Conclusion: The general public has a limited understanding of urologists and of the USANZ. Sub-brand names that explicitly link urologists to urological conditions, has been suggested as a means to increase the public's understanding of urologists and of the USANZ, and improve the USANZ's ability to promulgate urological health information., (© 2016 The Authors BJU International © 2016 BJU International Published by John Wiley & Sons Ltd.)

Background: Atorvastatin and metformin are known energy restricting mimetic agents that act synergistically to produce molecular and metabolic changes in advanced prostate cancer (PCa). This trial seeks to determine whether these drugs favourably alter selected parameters in men with clinically-localized, aggressive PCa., Methods/design: This prospective phase II randomized, controlled window trial is recruiting men with clinically significant PCa, confirmed by biopsy following multiparametric MRI and intending to undergo radical prostatectomy. Ethical approval was granted by the Royal Brisbane and Women's Hospital Human and The University of Queensland Medical Research Ethics Committees. Participants are being randomized into four groups: metformin with placebo; atorvastatin with placebo; metformin with atorvastatin; or placebo alone. Capsules are consumed for 8weeks, a duration selected as the most appropriate period in which histological and biochemical changes may be observed while allowing prompt treatment with curative intent of clinically significant PCa. At recruitment and prior to RP, participants provide blood, urine and seminal fluid. A subset of participants will undergo 7Tesla magnetic resonance spectroscopy to compare metabolites in-vivo with those in seminal fluid and biopsied tissue. The primary end point is biochemical evolution, defined using biomarkers (serum prostate specific antigen; PCA3 and citrate in seminal fluid and prostatic tissue). Standard pathological assessment will be undertaken., Discussion: This study is designed to assess the potential synergistic action of metformin and atorvastatin on PCa tumour biology. The results may determine simple methods of tumour modulation to reduce disease progression., (Copyright © 2016 Elsevier Inc. All rights reserved.)

Objective: To review the emerging role of technical and non-technical simulation in urological education and training., Method: A review was conducted to examine the current role of simulation in urology training. A PUBMED search of the terms 'urology training', 'urology simulation' and 'urology education' revealed 11,504 titles. Three hundred and fifty-seven abstracts were identified as English language, peer reviewed papers pertaining to the role of simulation in urology and related topics. Key papers were used to explore themes. Some cross-referenced papers were also included., Results: There is an ongoing need to ensure that training time is efficiently utilised while ensuring that optimal technical and non-technical skills are achieved. Changing working conditions and the need to minimise patient harm by inadvertent errors must be taken into account. Simulation models for specific technical aspects have been the mainstay of graduated step-wise low and high fidelity training. Whole scenario environments as well as non-technical aspects can be slowly incorporated into the curriculum. Doing so should also help define what have been challenging competencies to teach and evaluate. Dedicated time, resources and trainer up-skilling are important. Concurrent studies are needed to help evaluate the effectiveness of introducing step-wise simulation for technical and non-technical competencies., Conclusion: Simulation based learning remains the best avenue of progressing surgical education. Technical and non-technical simulation could be used in the selection process. There are good economic, logistic and safety reasons to pursue the process of ongoing development of simulation co-curricula. While the role of simulation is assured, its progress will depend on a structured program that takes advantage of what can be delivered via this medium. Overall, simulation can be developed further for urological training programs to encompass technical and non-technical skill development at all stages, including recertification., (© 2015 The Authors BJU International © 2015 BJU International Published by John Wiley & Sons Ltd.)

Purpose: Energy sources used during nerve sparing radical prostatectomy are known to compromise cavernous nerve function. Lasers offer the potential for accurate dissection while minimizing collateral injury to delicate neural structures. We evaluated cavernous nerve function following KTP laser dissection and compared outcomes to those of ultrasonic shears and cold scissor dissection., Materials and Methods: Laparoscopic unilateral neurovascular bundle mobilization was performed in 36 survival dogs using a KTP laser, ultrasonic shears and an athermal technique with cold scissors and clips in 12 each. Peak intracavernous pressure upon cavernous nerve stimulation, expressed as a percent of mean arterial pressure, was measured acutely and at 1 month. Thermal spread from the KTP laser and ultrasonic shears was assessed histologically ex vivo in harvested peritoneum., Results: Median peak intracavernous pressure as a percent of mean arterial pressure was similar immediately and 1 month after laser and athermal dissection, and significantly decreased after dissection with ultrasonic shears. Acute peak intracavernous pressure as a percent of mean arterial pressure was 53%, 96% and 98% for ultrasonic shears, laser and the athermal technique, respectively (laser vs athermal p = 0.51, ultrasonic shears vs laser p <0.001 and ultrasonic shears vs athermal p <0.001). Chronic peak intracavernous pressure as a percent of mean arterial pressure was 56%, 98% and 100% for ultrasonic shears, laser and the athermal technique, respectively (laser vs athermal p = 0.38, ultrasonic shears vs laser p = 0.016 and ultrasonic shears vs athermal p = 0.013). The median depth of acute laser injury was 600 microm compared to 1.2 mm for ultrasonic shear dissection and 450 microm crush injury due to the athermal technique. Thermography revealed less collateral thermal spread from the laser than from the ultrasonic shears (median greater than 60C thermal spread 1.07 vs 6.42 mm, p <0.01)., Conclusions: The KTP laser was comparable to the athermal technique and superior to the ultrasonic shears for preserving cavernous nerve function.

Since the Ruby laser was first developed in 1960 as the first successful optical laser, laser energy has continued to be developed and used in industry and medicine alike. Laser use in urology has been limited, however, largely until the last decade. The unique properties of laser energy have now led to its widespread use within urology, particularly in the treatment of benign prostatic hyperplasia, urolithiasis, stricture disease, and novel laparoscopic applications. This article details laser developments in each of these areas.

Objective: To examine, in a pilot study, the feasibility of laser dissection of the neurovascular bundle (NVB) during nerve-sparing laparoscopic radical prostatectomy (NSLRP). NSLRP demands precise NVB mobilization with minimal collateral tissue trauma and optimal haemostasis. Unlike other methods of delivering energy, lasers have the potential to provide rapid, precise dissection with good haemostasis and minimal adjacent tissue injury., Patients and Methods: Five patients were treated with NSLRP; in patient 1 the right NVB was dissected using clips and scissors and the left NVB using the 1064 nm Nd:YAG laser (8 W, continuous-wave mode). In the subsequent four patients, the NVB was dissected bilaterally using the laser. The NVBs were excised for histological analysis., Results: In patient 1, the estimated blood loss for the left (laser) NVB dissection was 20 mL, while the estimated blood loss for the right NVB was 100 mL. The maximum depth of laser necrosis was 327 microm. For the next four patients the mean (range) total operative duration was 214 (166-245) min, the mean NVB dissection time 22 (8-33) min, the mean total blood loss 213 (100-300) mL, the mean estimated NVB blood loss 28 (10-45) mL and the mean depth of tissue injury was 687 microm. There were no complications. There was no recurrence, as assessed by prostate-specific antigen levels, at a mean follow-up of 12 months and all patients were continent., Conclusion: Laser NSLRP was relatively straightforward and caused minimal blood loss, allowed a rapid dissection and minimal adjacent tissue injury. It is a promising technique that warrants further evaluation.