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Objectives: This study aims to assess the impact of a virtual reality trainer in improving percutaneous renal access skills of urological trainees. Methods: A total of 36 urology trainees participated in this prospective study. Initially, they were taken through the exercise of gaining access to the lower pole calyceal system and introducing a guidewire down the ureter. Trainees’ performance was then assessed by virtual reality-derived parameters of the simulator at baseline and after 2 h of training. Results: Participants who underwent training with the simulator demonstrated significant improvement in several parameters compared to their baseline performance. There was a statistically significant correlation between total time to perform the procedure and time of radiation exposure, radiation dose and correct calyx puncture (p < 0.01). Trainees needed a mean of 15.8 min from skin puncture to correct guidewire placement into the pelvicalyceal system before and 6.49 min following training. Conclusions: We found percutaneous renal access skills of trainees improve significantly on a number of parameters as a result of training on the PERC Mentor TM VR simulator. Such simulated training has the potential to decrease the risks and complications associated with the early stages of the learning curve when training for percutaneous renal access in patients.

Summary Aims We investigated the role of human papillomavirus (HPV) in the development of transitional cell carcinoma (TCC) arising in renal transplant recipients. Methods Genomic DNA was extracted from 10 µm paraffin embedded sections of five TCCs arising in five renal transplant recipients using the QIAamp DNA mini kit according to the manufacturer's instructions. β-globin PCR was performed to test DNA adequacy. Samples were tested for the presence of HPV DNA by broad spectrum HPV PCR method using non-biotinylated SPF10 primers (SPF1A, SPF1B, SPF1C, SPF1D, SPF2B, SPF2D) which amplify a short 65 bp fragment. Positive bands were identified on a 3% gel. Positive samples underwent a second HPV PCR and were amplified using biotinylated SPF10 primer set, which amplifies the same 65 bp region of the L1 open reading frame. INNO-LiPA line probe assay was then performed to genotype the samples which uses a reverse hybridisation principle. Results Four of five TCCs examined were positive for HPV. The high risk HPV16 was detected in three cases whereas in the fourth case an unclassifiable HPV genotype was present. In all DNA samples, β-globin amplification was successful. Conclusions Our results indicate that HPV and in particular HPV16 may play an aetiological role in the development of TCC in renal transplant patients.

Certain groups of patient are at higher risk of UTI, for example, diabetics. We discuss the reasons why they are more prone in this chapter. We also touch upon the more severe complications, which the reader should be aware of, such as emphysematous pyelonephritis. Some of these cases require urgent surgery, and therefore it is essential that the clinician has a low threshold of suspicion in cases of urosepsis in diabetics, and therefore early involvement of urological input is justified.

Urinary incontinence (UI) is regarded as a major health issue affecting a large sector of the population. The International Continence Society defines UI as the complaint of involuntary leakage of urine that is objectively demonstrated and is a social and hygienic problem. It is caused by a wide range of factors and it has a great negative impact on the lifestyle of patients, as well as a burden on the healthcare system, since it affects an estimated 10 million patients in the USA. Approximately 50% of all nursing home residents and between 15 and 30% of women over the age of 65 years have UI. The treatment modalities vary according to the underlying causes and the results are often unsatisfactory. With the introduction of the artificial urinary sphincter there has been a dramatic change in the management of refractory cases of UI. The artificial urinary sphincter is a device, usually in the form of an inflatable silicone cuff, inserted around the bladder neck or around the bulbous urethra in adult males. It mimics the biological urinary sphincter by providing a competent bladder outlet during urinary storage and an open outlet to permit voluntary voiding. In this review we give an overview of UI and the artificial urinary sphincter as a method of treatment.

Suprapubic catheter insertion is a fundamental practical skill that all clinicians should be familiar with, yet there are great practical difficulties in training in this area. A training model was designed to facilitate teaching, and then this model was subsequently tested in an emergency urology practical skills course.