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Editorial: Specimen fascia width reflects nerve-sparing technique

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The authors have reported a pathological analysis showing that various levels of nerve-sparing technique were reflected in the radical prostatectomy (RP) specimen. Intriguingly, the authors found that the fascia width on the left side was much wider than the right side in the RP specimen with the interfascial nerve-sparing technique. This is important information for robotic surgeons. Looking at the literature, almost twice as many positive surgical margins have been reported on the left side in patients treated with laparoscopic RP and robot-assisted RP (RARP). Secin et al. also reported similar results, which revealed the tendency for left-side dominance of positive surgical margins. These results seem to be in large part due to the left side being more technically challenging, resulting in less precise dissection.

For lymph node dissection, our own unpublished data of 1005 patients who underwent RARP indicates that the mean lymph node yield is higher on the left side (7.5 vs 7.1, P = 0.004), while the author’s previous study found a higher lymph node yield on the right side. Although, we could not establish which factors contributed to the contrary results, it seems that side preference also exists when performing robotic lymph node dissection.

While the da Vinci Surgical System® has been shown to eliminate innate hand dominance, the observed findings were of novice robotic surgeons and meticulous dissection of the neurovascular bundle is usually performed using a dominant hand even in experienced robotic surgeons. Moreover, differences in robot instruments of both arms and assistant positioning may also play a role in different outcomes by laterality. Nevertheless, the da Vinci Surgical System provides surgeons with magnified three-dimensional vision equally on both sides and promotes meticulous lateral dissection. We think that the imprecision of surgery on the left side could be overcome if surgeons are aware of the potential difference in laterality. Finally, we congratulate Ko et al. for their novel work. A follow-up study with multiple surgeons and analysis that reflects the effect of the surgeon’s learning curve on the outcomes would also be informative.

Kwang Hyun Kim and Koon Ho Rha
Department of Urology, Yonsei University College of Medicine, Seoul, Korea

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Social media @BJUIjournal: what a start!

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When Prokar Dasgupta assumed the role of new Editor-in-Chief of the BJUI in January 2013, he outlined his vision and some of the major changes that the Journal would make as it transitioned to a new editorial team. After ten years of progress under Professor John Fitzpatrick, it was clear that we are now working in a much-changed publishing landscape, one that will change even more in the next few years. In particular, the way in which medical professionals receive information and interact with colleagues, patients, journals and other professional groups is unrecognizable from what it was just two or three years ago.

Social media is the driver of much of this change. It has transformed the way in which the current generation of trainees interact – Facebook, Twitter, YouTube, LinkedIn, Urban Spoon, Expedia, Trip Advisor, Instagram – all of these platforms are key conduits for how Generation Z experiences life. This generation will find the idea of a printed journal arriving in the post every month to be anathema. In a world with an ever-increasing amount of content being produced, and much competition for our limited attention span, Gen Z live their lives through mobile platforms capable of delivering the precise content they want, immediately to their devices. Not just that, this content, whether that be breaking news via Twitter, friend status updates on Facebook, job opportunities via LinkedIn, is delivered through vibrant media that allows them to engage and respond by liking, sharing, favourite-ing, re-tweeting and commenting even as the content reaches them. All of this activity is done through convenient and increasingly pervasive mobile platforms while on the train to work, while queuing for a coffee, between cases in theatre, during a lecture, first thing in the morning, last thing at night. Gen Z will not seek out this type of content – it will seek them out and be delivered straight to their timeline/twitter-feed.

My role as Associate Editor (Social Media) at BJUI, has been to devise and implement a strategy to ensure that the BJUI evolves in this new world – to ensure that the next generation of trainees find us a meaningful organization to engage with and be informed, educated and entertained by. My fellow Associate Editors, Dr Matt Bultitude (Website), Dr Ben Challacombe (Innovation) and Dr Quoc-Dien Trinh (Health Services Research), play important roles here as do our publishers, our Executive team and Editor-in-Chief at BJUI.

So what have we done? If you are on Twitter or Facebook you will have noticed that BJUI has come to life on these key social media platforms.

 

Since 1st January, our followers on Twitter have grown by over 20% to 1151 and we have generated huge traffic back to our website with over 2000 link clicks from the 500 interactions we have had during this period.

 

Advanced metrics allow us to measure all of this activity against other organisations active in urology. For example our Klout score has increased from 46 to 53 with a corresponding increase in our Peerindex rating. We are leading the field across all of the key domains we have targeted to date and continue to make progress as we introduce further changes at bjui.org in 2013.

Our Facebook site is now highly engaging and is constantly updated with news and content from our website.

 

We have recorded over 73,000 page impressions by 11,000 Facebook visitors in the first two months of 2013, a huge rise from previously, and all of this traffic gets directed back to content at bjui.org, whether that be a Journal article, blog, picture quiz or our new “poll of the week”.

 

Our YouTube site is updated with videos from authors and other multimedia content to complement citable articles published in the Journal. You will see a lot more content added here in coming months.

But perhaps the most talked-about area we have introduced is Blogs@BJUI. And although we are the first mainstream urology journal to introduce a blog site, other journals have done so with great success. In September, Matt Bultitude and I visited the social media team at the BMJ to get some tips on how they had developed their social media strategy into the very successful multi-platform spectacular that they now oversee. Juliet Dobson, Blogs Editor and Assistant Web Editor at the BMJ offered some excellent advice to help us get up and running and their former Editor, Richard Smith, remains one of the bloggers I most admire. BMJ Blogs is well worth a visit for aspiring bloggers to read some of the best.

We launched our new website on the 2nd January 2013 to coincide with the new Editor taking the helm, and also published our first blog that day. From then until the 28th February 2013, Blogs@BJUI has featured the following:

  • 35 blogs contributed by 25 authors on three continents
  • 133 comments from all over the world
  • 8 editorial blogs from our specialty Associate Editors
  • Multidisciplinary contributions from both authors and comment-leavers

The topics have included everything from urology humour, through the European Working Time Directive, reality TV and an eminent urologist describing his recent personal experience of robotic radical prostatectomy. Our contributors have included many of the key opinion leaders in social media in urology, many of whom are rising stars or already established in academic urology. Also established urology opinion-leaders who are rather new to social media but enjoying the challenge! Other contributors are young trainees who have proved themselves to be talented bloggers already. I am quite pleased that the most-read blogs in January and February were written by two young trainees of mine in Melbourne. But I am sure the self-appointed King of Twitter, Ben Davies, and other established stars of urology social media will be vying for such coveted titles as the months go by.

I had set a target that by the end of the first quarter we would have 1000 readers per month visiting Blogs@BJUI. By the end of the February, we had already had over 9000 visits to our blog site! Each reader spent over 3.5 minutes per blog and many of them left comments or pushed out links to our blogs using Twitter or Facebook. We have had many comments posted by readers from every corner of the world and have enjoyed some very humorous posts. For us, social media is all about engagement. We want to use these platforms to allow readers to passively engage with us by liking, sharing, tweeting content that they enjoy whether that is a full paper in the BJUI, a blog post, YouTube video, weekly poll or Picture Quiz of the Week. And for those who want to engage more actively, we strongly encourage you to join the conversation and add a comment to any of our blogs.

So we have had a great start to our social media push at the BJUI. And there will be a lot more to come in the coming months – watch for our activity during the upcoming conference season and look forward to the results of the inaugural BJUI Social Media Awards to be announced at the American Urological Association Annual Meeting. For those of you who are new to social media, I encourage you to dip your toes in by reading a blog or two and adding a comment. Before you know it you will have downloaded the Twitter app to your smartphone and you’ll be off and running! For the Twitterati, I thank you for all your enthusiasm in helping us get social media up and running at the BJUI and I look forward to your blogs, mentions, re-tweets and podcasts over the coming months. Social media is all about engagement – join the conversation @BJUIjournal.

 

Declan Murphy is a uro-oncologist in Melbourne and is Associate Editor of Social Media at the BJUI. Follow him on Twitter @declangmurphy

Does Michelangelo’s David have an increased risk of prostate cancer?

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Recently when researching on the Italian Renaissance master Michelangelo and his suffering with kidney stones, I stumbled upon a project on his famous masterpiece David. At the precise time, I was browsing BJUI and came across the article by Motofei et al, on the sexual side effects of finasteride as related to hand preference (right-handed or left-handed) for men undergoing treatment of male pattern baldness. This manuscript reminded me of several articles that measured different parts of the male body and correlated with the risk of prostate cancer. With this paper on my mind and at the same time looking at David, it just occurred to me whether I could predict the possibility him getting prostate cancer!

Let’s start from the beginning. Being born as a male, he had acquired a 1 in 6 chance of being diagnosed with prostate cancer and 1 in 36 chance that he would have died from it. The moment David stood erect as a toddler; the risk of getting prostate cancer became a reality. Indeed, the authors of the study go on to claim the link of erect posture of humans with BPH and infertility. For those interested, the theoretical aspects of erect posture and its effects on the male reproductive tract can be found in this review.

It is worth analyzing the David’s anthropometric measurements and bodily features from head to toe and correlate them to the current available evidence. David’s height has been calculated at being 497 cm. This, in real life would probably make him around 5’ 8” to 6’. According to the findings of the PLCO trial, being tall increased his risk of developing more aggressive prostate cancer and at a younger age. This is supported also by the findings of the ProtecT trial, which demonstrated that for high-grade tumours, there was a 23% increase in risk per 10 cm increase in height. The study group’s meta-analysis of published literature also support the increased risk of prostate cancer with increasing height.

Let us start from his head. Fortunately, David is not bald. Recent evidence suggests a strong correlation between vertex pattern androgenic alopecia and significant risk of prostate cancer. Looking at the elegance of the face, it is quite obvious that he is a clean-shaven man. Fortunately, being white, the age at which he started shaving indicating early or delayed adolescence, does not seem make his chances of getting prostate cancer worse.

Going on to his chest, it is apparent that David did not suffer from Gynaecomastia. There is considerable controversy in the literature regarding the association of gynaecomastia and future risk of prostate cancer. A cohort study following men with histologically proven gynaecomastia did not find any increased risk of prostate cancer but surprisingly showed an increased risk of testicular cancer. David’s chest, abdomen and back lack excess dense body hair. A Japanese study has shown that dense body hair raises the risk of prostate cancer!

A lot of research has gone into determining whether David is a right-handed or a left-handed man. If you take a closer look at the statue, the sling is held by the left hand and a rock on the right, suggesting that he could indeed be left handed, like his creator Michelangelo! Although no specific research has been carried out in prostate cancer, it has been shown in a few studies that women who are left handed are more prone to get breast cancer as compared to those who are right handed. The authors claim the effect of prenatal hormones on the foetus that determines the dominance of the side can also have effects on the breast tissue. A study found that men who were exposed to DES in utero were more likely to be left-handed. Similarly mouse experiments have shown an increased risk of prostate cancer in those exposed to DES. So, there may be a connection between left-handedness and risk of prostate cancer!

Coming to his fingers: The ratio of second to fourth digit length (2D:4D) would allow us to further assess the risk. It is now understood that the 2D:4D ratio is determined by Homeobox (Hox) a and d genes that also regulate urogenital system. What is even more interesting is the study that showed the patients with a lower 2D:4D ratio have higher risks of undergoing prostate biopsy and prostate cancer. The same group indeed went on to prove that a lower digit ratio was related to high percentage core cancer volume and higher Gleason score!

Fortunately, David’s waist circumference (WC) is within reasonable limits, thereby reducing his risk of prostate cancer. A recent study has shown that increased WC seems to be associated with high-grade disease at the time of biopsy.

It is obvious looking at David that he was not circumcised. Although aesthetically pleasing for many, there is considerable debate in the medical as well as philosophical literature whether David was circumcised or not?! Not being circumcised unfortunately increases his risk for prostate cancer.

There is a huge controversy about the size of David’s flaccid penis. Penis size has not (yet) been shown to correlate with risk of prostate cancer. Although, indirectly you conclude that because the 2D:4D digit ratio has been correlated with penis size and as shown above 2D:4D ratio has been correlated with prostate cancer. Therefore, the smaller the penis, greater the risk of prostate cancer! With so many manuscripts being published on 2D:4D ratio, I decided to research more on it and landed up on the Wikipedia page. I was astonished to find the various conclusions that have been reached with the curious case of 2D:4D ratio, including a recent study in Germany that found its correlation with male to female transsexuals!

Although not possible, but of interest would have been to measure David’s anogenital distances from anus to upper penis and from anus to scrotum. A study published in BJUI showed that a higher measurement between the anus and the penis was associated with lower risk of prostate cancer. As you may have guessed, yes there is research going on finding a relationship between anogenital distance and the 2D:4D ratio!

My interest then turned to David’s feet. Looking at it, it does seem that he would have been wearing a shoe size of 10 or 11 at least. Does it matter? Comparing his shoe size and the length of his flaccid penis, I was just reminded of the seminal paper by Jyoti Shah et al, which disproved that shoe size has got to do anything with the size of the penis. However, contrary to this paper, a study confirmed significant evidence of older age at the maximal shoe size (20.1 versus 17.6 years, P <0.05) was associated with increased risk of prostate cancer. Yes, as you may have guessed by now, there is a relationship between the 2D:4D to your penis size!

To conclude on the observations, there are several factors that increased David’s risk and several others that are protective, as shown in Table 1. I would leave it to the reader’s judgment, whether you would recommend a PSA test for David or indeed climb on to him and measure the most important parameter, the 2D:4D ratio!

Amrith Rao is a Consultant Urological Surgeon at Wexham Park Hospital, Wexham, UK. His views are his own. @urorao

 

Comments on this blog are now closed.

 

Get Angry People

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Hello colleagues. You look stressed. Your blood shot eyes have little golden crusty particles stuck in them. Oy. And your face has taken on a sickly grey hue. Have you missed me my pasty, swollen friend? Of course not. You are too busy with EHR, surgery, robots, family, research, horse meat chatter, papal scandals, Twitter, Facebook  and emails. Relax my people! Have you not read any of the latest research on productivity?

It is clear – my hard working friend – that you are not resting enough. A multitude of bio-shrinko-sociologic studies have proven as much. Did you read Tony Schwartz’s New York Times essay entitled: “Relax, You will be more Productive”. In it we learn that you can only work effectively for 90 minute intervals. In fact there is a biologic basis for this assertion.  Borrowing from sleep cycle experts and psychologists who have studied successful athletes, musicians, and artists it is a biologic factoid that we can only concentrate in 90 minute packages. That is all you need to know. Start compressing your operative cases to 90 minutes! Never mind that 90 minutes would only incorporate the bladder removal portion of your operation. We can do the nodes and reconstruction after my jog and light lunch of spinach tofu salad.

Want some more advice from the productivity experts? Of course you do. I am here to solve your problems today. Perhaps you have missed the latest and greatest TED talks on “The Art of Stress-Free Productivity”. Spend some time listening to this profound man – a Mr. Ted Allen. Find him here on YouTube. Let me paraphrase his advice: create a project list of everything that has a defined beginning and end in your life. Everything. Go ahead start writing it all down people. You need to look and update your lists every week. You need to sort, prioritize, collate, and make a master list that is all encompassing. You can not? Why? Because you are a surgeon and lead a life of uncertainty. Weak brother. Weak.

Fine. Let me suggest another tact: Get your pens out please. Read this essay by a famous oncologist Dr. Stephanie J. Lee entitled “Tips for Success As an Academic Clinical Investigator” published in the Journal of Clinical Oncology this past month. Ooh how the urotwitterati loved this essay. For days the reviews were glowing. And she does have some great words in this essay (chronophage is the best). To be clear there are 43 tips! Thankfully the last one is “Have fun!”. The others have a more pedantic and ridiculous tone – like “surround yourself with people of high standards, skills, work habits, and compatibility”. This amounts to making sure you work with eHarmony.com compatible co-workers – it’s a must for academic success but sadly impossible to implement. Other gems: “work many hours” (check!), “work efficiently” (uhhh I have residents), “think deeply and clearly”, “make a to-do list”, and “study others you admire”. The productivity list reads like a moral sermon from a high school teacher only less helpful.

Have I depressed you enough? I hope not. I want you angry. Very angy. Why? You must not have read the article by Nakamura et al “Prognostic Value of Depression, Anxiety, and Anger in Hospitalized CAD Patients for Predicting Adverse Cardiac Outcomes” in this week’s American Journal of Cardiology. You see anger my obese, stressed-out urology friend PREVENTS adverse cardiovascular outcomes (hazard ratio 0.34, p <0.01). So perk up my friends! Get angry – it’s good for you.

Benjamin Davies is Assistant Professor of Urology at the University of Pittsburgh; Program Director, Urologic Oncology Fellowship and Chief, Division of Urology Shadyside Hospital. His views are his own. @daviesbj

 

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What’s the diagnosis?

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Test yourself against our experts with our weekly quiz.

You can type your answers here if you want to compare with our answers, or just click the ‘submit’ button below.

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Individualised reporting of surgical outcomes in the UK

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Its happening and its happening fast. What the cardiothoracic surgeons in the UK have lived with for 8 years is coming to a specialty near you very soon. Individual urological surgeons results to be published openly, in the press in the UK from summer 2013.

It’s a massive change to the way we work and to the way surgical data is presented. No longer will the interesting elements of the urological literature be studies of the results of a few surgeons in a few centres of world renown but rather the performance of outliers. Reports will start to reflect what is achieved throughout the nation not in one or two centres in that nation. Warts and all if you like.

There are risks. Big risks. For surgeons and for patients.

Will surgeons who operate on high risk cases be smeared because they appear to be underperforming?

Will patients who are high risk be denied operations because surgeons subliminally start to make recommendations that are good for the surgeon but not for the patient?

Will surgeons continue to train junior surgeons or will juniors simply cut the stitches?

Why should surgeons carry the can for the performance of the whole team?

Will sample sizes be big enough to ensure that results could not be due to chance?

What outcomes should we be measuring in order to judge the quality of many operations?

Who should collect the data – the surgeons or independent reviewers?

Are surgeons going to be tabloid fodder?

Is it simply time to head for the hills with a cigar and a bottle of red…..

In cardiac surgery all these were live questions and they have worked it out. Standards have been shown to be astonishingly high. Will urology be the same? The specialities have been challenged to come up with a plan. Why not contribute to that process and add to the blog….

Tim O’Brien is a Consultant Urological Surgeon at Guy’s and St Thomas’s NHS Hospital, London. His views are his own.

 

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Editorial: The need to devise a better means of training

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There is increasing concern that current UK trainees at the end of their training are less experienced than their previous counterparts and continue to require more education, skills and support when they assume their consultant posts in the form of mentoring.

It is generally accepted that the numbers of hours required to become an ‘expert’ is 10 000–30 000 and currently in the UK our trainees experience =6000 h of training. Much of this is due to the impact of the European Working Time Directive (EWTD) and the government ‘New Deal’ initiative on junior doctors contracts introduced in 2003. The UK conundrum shared with many other healthcare systems is how to provide effective training within the demands of service commitment and the EWTD. Skills training has therefore been seen as the mechanism to resolve the situation, encompassing the acquisition of both technical and non-technical skills. The challenge therefore is to devise innovative ways of training within the limit of fewer hours and training, not service, must become the priority for trainees and for those surgeons, departments and hospitals that train them.

Contemporary urology training is moving out of clinical practice and simulation is increasingly used to provide a safe and supportive learning environment for learning and maintaining skills. However, this needs the following criteria:

• An agreed curriculum

• Agreed set of standards

• A validated form of assessment

• The availability of local and national skills centres

• Educators and trainers

The problem is that traditionally the UK has few training centres, together with a lack of trained manpower and funding. However, controversy still remains over the efficacy of simulation for training and those who are able to fund such projects comment on the paucity of available data in relation to the predictability of future outcomes and patient safety.

Projects such as the Simulation and Technology enhanced Learning Initiative (STeLI) initiative documented in this paper are important contributors to the evidence base. The programme aims to establish the feasibility and acceptability of a centralised, simulation-based system incorporating both skills and non-technical skills aspects of training. The latter involving crisis resource management using the SimMan model to teach team-working, decision-making, and communication skills in various settings between senior and junior trainees. Not surprisingly senior trainees scored significantly better on virtual reality simulators, bench-top box trainers and the European wet-lab training facility, as well as in human patient simulation training in crisis resource management (CRM) using SimMan, than junior trainees. The interesting point raised in this paper is that the trainees’ behaviour shows the value of inclusion of the CRM training and the interplay between technical and non-technical skills. Non-technical skills have often been sidelined in courses focusing on technical skills acquisition and this paper highlights the importance and added-value of incorporating such a skill set into future course content and curricula.

Thus, there is no doubt that some surgical skills can be learned in the laboratory and although this will never be a substitute for operative experience, the first steps of training can be accelerated with potential reduction of risk to patients. Increasingly data from sources such as the STeLI project underline a better appreciation of the importance of the training in non-technical skills, which equip surgeons in working under stress and more importantly working as a team player. However, the ultimate test for simulation is whether the model and content is able to reduce surgical errors, improve patient safety and reduce operative time and costs. To try and answer these questions BAUS in conjunction with the Specialist Advisory Committee (SAC) in Urology have recognised that the technology is there but there is a need to identify trainers keen to train, with the nomination of a national lead for simulation to develop a national strategy to deliver a viable programme aligned to the curriculum to try and answer the important question: ‘Does simulation enhance real-life performance of a surgical technique?’.

Adrian D. Joyce
St James’ University Hospital, Leeds LS9 7TF, UK

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On the Receiving End!

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It was weird, having spent a career looking after men with prostate problems, to discover that my own PSA was raised to 4.3ng/mL. A 3 Tesla MRI with gadolinium enhancement revealed a lesion in the right peripheral zone, which a biopsy confirmed as a Gleason 3+4=7 adenocarcinoma. The decision wasn’t difficult for me: I opted for a robot-assisted radical prostatectomy (RARP), to be performed by the Editor-in-Chief of this journal, Professor Prokar Dasgupta, ably assisted by Ben Challacombe and Krishna Patil. Details of my whole journey are available here for those who are interested.

The key point for discussion in this blog is the availability of the latest technology for the care of patients with prostate cancer who are less in the know than me. Shouldn’t we be lobbying for greater access for all to the latest pieces of high tech gear?

3 Tesla MRI imaging, together with the expertise to interpret the findings of diffusion-weighted images, for example, offers the possibility of a “prostate mammogram” which facilitates the targeting of the biopsy and holds the promise of avoiding biopsies in those in whom the MRI images appear blameless.

Da Vinci robotic technology undoubtedly facilitates the surgical procedure, especially the preservation of the neurovascular bundles and the very precise vesico-urethral anastomosis. It certainly was an interesting experience to sit and watch the DVD of my own operation at home, with a catheter still draining my bladder, wondering about my future continence and sexual function, as well as the histopathology report! After an operation like this anybody is going to need assistance to move around the house just to do basic activities like go to the bathroom or even change clothes. That’s why it is very important to check into a nursing home where they offer their professional service. In some cases these nurses don’t work professionally and often neglect their patients needs, so that is why it’s recommended to contact a nursing home neglect attorney for situations like this for legal help.

Am I discombobulated by this experience? Not especially, I genuinely found being on the receiving end of prostate surgery a truly educational experience and I now feel energised to help others get through their journey. In the upcoming issue of Trends in Urology three other of our urological colleagues share their own experiences of prostate cancer, as well as the lessons that can be learned from them. Check out the Trends in Urology website from mid-March onwards.

In the meantime we would be interested in your own thoughts on these issues. Do add a comment or question to this blog.

Roger Kirby
The Prostate Centre, London W1G 8GT

 

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Learning curve vs discovery curve: Training urological surgeons, what can we learn from sport?

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Improving training in the United Kingdom may benefit from a more analytical assessment of natural abilities, individual learning curves and understanding and providing the necessary training methods to let trainees reach their potential. It used to be said that surgeons learnt from their mistakes, but surely this philosophy and approach is unacceptable in the 21st Century. To learn from a mistake when it could have been avoided in the first place, with the correct guidance, could be considered negligence. Of course to err is human and none of us are superhuman. However, what we must try to avoid is the “self-discovery” curve in surgery.

Vickers paper assessing fellowships to learn radical prostatectomy showed that a fellowship could shorten your learning curve. I have been on several fellowships abroad and what they had in common was of course numbers. Centres do not get a reputation or expertise by doing one case a year. However they also had in common a structured approach to training fellows that started with observation in theatre, then bedside assisting and finally doing defined steps of the procedure.

The combination of structured training and suitable experience is key to good surgical development. The individual who takes up golf and teaches himself or herself is unlikely to become a scratch golfer and may develop ugly habits that hold them back from reaching their potential. This can be seen in surgery. To complete the golfing analogy (and apologies to non-golfers): once a golfer has a reasonable swing and knows what he/she is doing, the single thing that will define how good he/she gets is how often they play.

Modern professional sportsmen are assessed for their technique using technology and we are starting to see this level of scrutiny in robotic training. Anyone who has used the Mimic technology in the Da Vinci robotic training, will recognise that it looks at several aspects of surgical technique, including economies of movement. In my own experience as an early trainee in open or endoscopic surgery I was rarely told how to hold an instrument properly or indeed about ergonomics and economies of movement. The focus was usually on the operative field, where to cut etc.

In professional sports much thought and investment has gone into creating the optimum environment to initially assess individuals for natural ability, then supporting and nurturing their talent, strengthening them both mentally and physically so that their “investment” is enabled to perform in the toughest situations as well as having longevity. Should we not aspire to do the same for our surgical trainees?

Justin Collins is a Consultant Urologist at Ashford and St Peters NHS Foundation Trust, UK and is a regular trainer on the faculty at IRCAD, Strasbourg, France. @4urology

 

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Podcasts Made Simple

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The other day we were listening to a podcast of a surgical technique; sadly, it sounded like a report from the BBC’s war correspondent in Afghanistan. The static was considerable and the recording of poor quality, as if transmitted by radiophone from a remote part of the world.

In keeping with our pledge to improve the quality of the BJUI, we present here a simple method of recording and submitting podcasts of the highest quality from your home or office. The results are obvious on bjui.org, where you can listen to a 60-second podcast on successful podcasting, in the BJUI Tube section. We encourage authors who have had their papers accepted to try this simple trick. We look forward to receiving your podcasts, which may enhance your articles in the right circumstances.

If you use an iPhone you should select the preinstalled ‘Voice Memo’ app. Similar apps are available for Android and other systems.

Simply tap ‘record’ when you are ready and start talking. Remember to breathe normally and speak in an even tone.

Once you are happy with your recording, simply use the share button to submit the file to us using our editorial office email address: [email protected]

 

 

In this issue, the Article of the Month is by Cooperberg et al. who present an analysis of the lifetime cost-utility of treatments for localised prostate cancer. This is a timely and controversial paper with an accompanying editorial from Pickard and Vale, who have been involved in a number of Health Technology Assessment. Cost-effectiveness ratios are now as important as clinical effectiveness although it does not necessarily mean that cheaper is always better. You can also enjoy a YouTube video provided by the authors to accompany their article in the BJUI Tube section of our website. To promote immediacy, we request you to add your comments to Blogs@BJUI. These will eventually replace the current section entitled Letter to the Editor. The debate needs to be topical and timely and not a year on when hardly anyone can remember what the original fuss was all about.

Prokar Dasgupta
Editor-in-Chief

Matthew Bultitude
Associate Editor, Web

 

Disclaimer: The BJUI does not support any particular smart phone. That choice is entirely up to our readers. Who knows, you may even decide not to have one, hence here is the paper version of our simple trick.

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