Chondroblastoma of the vertebra is a very rare condition. To our knowledge fewer than 20 cases have been reported in the world literature. We report a 54-year-old man with chondroblastoma of the fifth lumbar vertebra. The clinical and radiological aspects of the tumor are discussed, emphasizing the presence of an extraosseous mass suggestive of locally aggressive behavior.

Purpose To investigate pre-operative urodynamic parameters in male sling patients to ascertain whether this might better predict surgical outcomes and facilitate patient selection. Methods We performed a retrospective, case notes and video-urodynamics, review of men who underwent AdVanceXP male sling in three London hospitals between 2012 and 2019. Urodynamics were performed in all centres, while retrograde leak point pressure (RLPP) was performed in one centre. Results Successful outcome was seen in 99/130 (76%) of men who required one pad or less per day. The dry rate was 51%. Pad usage was linked to worse surgical outcomes, mean 2.6 (range 1-6.5) for success vs 3.6 (range 1-10) although the ranges were wide (p = 0.002). 24 h pad weight also reached statistical significance (p = 0.05), with a mean of 181 g for success group versus 475 g for the non-successful group. The incidence of DO in the non-successful group was significantly higher than in successful group (55% versus 29%, p = 0.0009). Bladder capacity less than 250 ml was also associated with worse outcomes (p = 0.003). Reduced compliance was not correlated with outcomes (31% for success groups vs 45% for non-successful group, p = 0.15). Preoperative RLPP was performed in 60/130 patients but did not independently reach statistical significance (p = 0.25). Conclusion Urodynamic parameters related to bladder function-detrusor overactivity and reduced maximum cystometric capacity predict male sling outcomes and may help in patient selection for male sling (or sphincter) surgery; whereas urodynamic parameters of sphincter incompetency (RLPP) were not predictive. Further larger scale studies are required to confirm these findings.

the development of a virtual urology sub-internship rotation our institution for visiting fourth year medical students. The purpose of this study was to implement a virtual urologic surgery sub-internship program and evaluate medical student impressions of the experience.METHODS: A two-week urology curriculum was created with content delivered by two-way, interactive videoconferencing. The curriculum included synchronous and individual learning with live patient clinical experiences in the outpatient clinic and operating room, faculty lectures, and departmental conferences. The students also completed self-reflective writing exercises and a grand rounds presentation. Student impressions of the rotation were assessed with an anonymous exit survey. Descriptive statistics were utilized to evaluate the 5-point Likert Scale responses, with 5 being "strongly positive" and 1 "strongly negative".RESULTS: A total of 40 students applied for the rotation and 18 were selected for 1 of 5 two-week rotation blocks. All students successfully completed the rotation and received a Pass. Of the 18 students who participated in the virtual rotation, 16 (88.9%) completed the exit survey. The overall experience was rated as "strongly positive" by 14 of 16 (87.5%) students. The learning experience was rated as 4.75AE0.45 (averageAESD). The rotation positively impacted our virtual students' plan to apply to this residency program (4.81AE0.54). All students reported they would recommend this rotation to a fellow student. All feedback regarding the self-reflection activities was positive.CONCLUSIONS: We successfully implemented a two-week virtual urologic sub-internship rotation with a wide variety of clinical and educational experiences. This is a unique experience in surgery that can easily be implemented by other urology or surgical subspeciality programs in the future.

Aims Post‐prostatectomy stress urinary incontinence (PPI) is a common condition with significant impact on patient quality of life. With rising numbers of prostatectomies performed, recognition of incontinence during survivorship care is growing. With increasing hesitance of the use of suburethral mesh in females, urethral bulking injections in this patient population as a minimally invasive alternative to surgery are evaluated. This review aims to evaluate the existing evidence base for urethral bulking therapy in PPI and provide a summary of its efficacy, durability, and side‐effect profile. Methods A literature search of Medline/Pubmed and Cochrane databases was conducted to identify publications reporting the clinical outcomes of urethral bulking injections in patients with PPI, up to and including October 1st, 2018. Case reports, letters and reviews were excluded. Results We identified 25 studies that fit our inclusion criteria, comprised of one RCT, two large retrospective cohort studies, and 22 case series. The success rates reported varying widely from 13%‐100% with reports of symptomatic control deterioration. Complication rates remain low. This review highlighted a poor performance using the more historic bulking agents (BA), and the lack of strong evidence with the more novel BA in PPI and discussed challenges regarding optimal patient selection and techniques. Conclusions There exists poor clinical evidence base concerning the use of urethral bulking in PPI with few high‐level studies and a significant lack of consistency between studies. Further study in this area is required to evaluate the role of BA in this patient population.

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It comes as no surprise that to tackle gender inequality in the future of the medical profession, the experiences of those who will become it must first be reviewed. Gender inequality is rife throughout all aspects of medical student life; from the classroom to clinical placements, from other healthcare professionals and public alike, for both male and female students. This chapter will discuss these, review literature, and share experiences. Consequently, this has an impact on their career choices, attrition, and mental health. By improving experiences and encouraging diversity, the hope is to reduce the negative effects discussed within the chapter, and break the cycle of inequality.

Objective: To review the use of ultrasound imaging in the diagnosis of testicular rupture and in relation to current guidelines. Methods: Data was retrospectively collected for all patients diagnosed with testicular rupture at a major trauma centre between 2011 and 2018. Data included patient demographics, mechanism of trauma, specific findings on ultrasound and outcomes. On review of ultrasound imaging, specific findings identified include a breach in the tunica albuginea (currently advised in guidelines), heterogenicity and contour loss. Results: Eight patients were identified with average age 37 years old, mechanism of trauma was 50%, 37.5% and 12.5% for motorcycle road traffic collision, sporting injury and workplace injury respectively. A breach of tunica albuginea was identified on ultrasound in 65% of cases, compared with 100% of cases showing contour loss and heterogenicity. Of the 87.5% patients who were managed surgically one needed orchidectomy (and later testosterone replacement). Conclusion: Guidelines have varied on how to use ultrasound imaging in diagnosing a clinically difficult condition. Our case series demonstrates that diagnosing testicular rupture by looking for more easily identifiable characteristics (heterogenicity and contour loss) than currently recommended in the guidelines (breech in the tunica albuginea) will aid diagnosis and patient pathway and improve outcomes. Level of evidence: 5

METHODS: AUS and male sling procedures performed between 2003 and 2015 in both inpatient and outpatient ambulatory setting in New York State were extracted from the Statewide Planning and Research Cooperative System (SPARCS) database utilizing CPT and ICD-9/10 procedure codes. Spearman correlation analysis was performed to assess trends.RESULTS: A total of 1830 male sling placements and 1481 AUS insertions were identified. AUS placement increased steadily from 45 cases in 2003 to 221 cases in 2015 (P <0.001) (figure 1A). Male sling placement trended upwards from 51 cases in 2003 to 134 in 2015 (p[0.049). It surpassed AUS placement from 2008-2013 but slowly decreased by 40% from 228 cases in 2009 to 134 cases in 2015. AUS removal/revision trended upwards during the study period (p<0.001) (figure 1B). Interestingly, despite an overall increase in sling placement, sling revision/removal remained relatively stable.CONCLUSIONS: In New York State, the utilization of both AUS and male urethral sling has increased over the past decade. AUS removal/revision trended upwards during this time period, whereas incidence of male sling revision/removal remained relatively low and stable. Future studies are warranted to investigate physician and patient factors influencing the trends of surgical management of male SUI.