Structured learning can be implemented in an academic robotic program with high levels of trainee and evaluator participation, encouraging both quantitative and verbal feedback. A proficiency assessment tool developed for step-specific proficiency has construct and concurrent validity.
Background Pelvic radiation is a known risk factor for the development and progression of erectile dysfunction. When medical therapy fails, the 3-piece inflatable penile prosthesis (IPP) can offer patients a definitive treatment option. Because of radiation-induced vascular changes and tissue fibrosis, a careful surgical approach is necessary to avoid intraoperative complications and attain successful outcomes. Despite its widespread use in prostate cancer treatment, there are no contemporary studies examining the effects that pelvic radiation can have on 3-piece IPP placement and device survival. Aim To present technical considerations and contemporary outcomes of placing a 3-piece IPP for refractory erectile dysfunction in patients with a history of pelvic radiation. Methods We retrospectively reviewed 78 patients who underwent placement of a 3-piece IPP (AMS 700; Boston Scientific, Marlborough, MA, USA) after being treated with pelvic radiotherapy from 2003 through 2016. All patients had been treated with external beam and/or brachytherapy for treatment of prostate malignancy. An infrapubic approach was used in all patients, with reservoir placement in the space of Retzius or in the lateral retroperitoneal space. Patient demographics, perioperative data, and postoperative outcomes including prosthetic infection and mechanical failure were examined and statistical analysis was performed. Outcomes Rates of device infection, revision surgery, and reservoir complications. Results No intraoperative complications were observed. After a mean follow-up of 49.0 months (6.6–116.8), 2 patients developed an infection of their prosthesis that required explantation. These patients underwent successful IPP removal and immediate reimplantation. 11 patients (14.1%) required revision surgery (pump replacement, n = 4; pump relocation, n = 2; cylinder replacement, n = 4; reservoir replacement owing to leak, n = 1). No reservoir-related complications such as herniation or erosion into adjacent structures were observed. Clinical Implications The 3-piece IPP can be placed safely in a broad range of patients treated with pelvic radiotherapy. Strengths and Limitations This study describes contemporary long-term outcomes of the IPP in patients treated with pelvic radiation and includes patients with prior pelvic surgery and artificial urinary sphincter, which are commonly encountered in practice. It is limited by its single-center experience and lacks a comparison group of patients. Objective patient satisfaction data were not available for inclusion. Conclusions The 3-piece IPP can be placed successfully in patients with a history of pelvic radiation without a significant increase in infectious complications, reservoir erosion, or mechanical failure compared with the global literature.
A torsion oscillator is a vibrating system that experiences a restoring torque given by τ = −κθ when it experiences a rotational displacement θ from its equilibrium position. The torsion constant κ (kappa) is analogous to the spring constant k for the traditional translational oscillator (for which the restoring force F is proportional to the linear displacement x of the mass). An effective torsion oscillator can be constructed by integrating a spring's translational harmonic properties into an Atwood2 arrangement where a disk serves as the pulley for the system and the spring(s) exert restoring torques on the oscillating disk. Both effective torsion constants and effective spring constants can be expressed in terms of adjustable parameters of the system. These expressions enable one to theoretically describe the motion of the hybrid oscillator and to calculate its period. A comparison of the translational and rotational interpretations teaches of their analogous mathematical properties and challenges the intuitive skills of those considering such systems.
age was 25.5 and 53.8% were females. The average "Tubes" score for the dV-Trainer and dVSSS were 10/100 and 48.5/100 respectively. Scores of MS and JR were similar (p¼0.36). GEARS scores of participants who initially used the dVSSS compared to the dV-Trainer were significantly higher (21/25 vs. 17.2/25, p¼0.04). Similarly, RACE scores of participants who used the dVSSS were also significantly higher compared to the dV-Trainer (23.2/25 vs. 17.8/25, p¼0.02). Scores of MS and JR were similar for GEARS (p¼0.50) and RACE score (p¼0.57). Intraclass correlation coefficient for the GEARS and RACE scoring were 72.6 and 89.3 respectively.CONCLUSIONS: The dVSSS trainer lead to superior scores in performing UVA in the OR for both MS and JR compared to the dV-Trainer. The dVSSS can be used to improve teaching in surgical trainees in a safe and effective manner.
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