Pinto Vicktor Bruno Pereira, de Bessa Jose, Prezotti José Antonio Penedo, Anzolch Karin Marise Jaeger, Fernandes Jose Ailton, Gomes Cristiano Mendes
Division of Urology, Divisao de Clinica Urologica, School of Medicine, Hospital das Clinicas da Universidade de Sao Paulo, Avenida Dr. Eneas de Carvalho Aguiar, 255-Room 710F. 7th Floor, Sao Paulo, SP, CEP 05403-000, Brazil.
Department of Surgery, State University of Feira de Santana, Bahia, Brazil.
World J Urol. 2024 Dec 18;43(1):36. doi: 10.1007/s00345-024-05407-1.
Urethral instrumentation (UI) in patients with an artificial urinary sphincter (AUS) demands technical considerations and poses a risk of urethral erosion, leading to serious clinical and legal consequences. We conducted a national survey to evaluate the knowledge and experience of Brazilian urologists with UI in these patients.
This study used an electronic survey distributed to members of the Brazilian Society of Urology. The survey included 19 multiple-choice questions assessing sociodemographic characteristics, practice patterns, AUS training, knowledge of AUS components and functionality, experience with UI in AUS patients, and interest in further training. Urologists were classified as 'competent' in AUS manipulation if they had prior experience and confidence in performing UI.
Among 536 participants (median age 47 years [39-55]), 72.8% reported involvement in urological emergencies, with 89.9% indicating inadequate AUS training during residency. Only 29.7% had occasional or regular involvement with AUS surgeries. Of the participants, 53.4% had performed UI in men with an AUS. Prior UI had been attempted by healthcare staff in 36.2% of cases. Only 46.8% reported knowledge of AUS components and 45.1% felt competent in deactivating it. Regarding urethral catheterization, 47.2% knew the safe catheter diameter, and 20.9% identified safe catheterization duration. Overall, 45.1% self-declared competence in UI, yet many gave incorrect answers on catheter size and duration. Competence strongly correlated with knowledge of AUS components, regular implant involvement, and prior experience. Most (89.3%) expressed interest in additional training for UI.
This study highlights significant gaps in training and knowledge among Brazilian urologists regarding UI in AUS patients. These deficiencies underscore the potential for enhanced education to improve patient outcomes and reduce AUS-associated complications in Brazil and possibly broader international contexts.
对植入人工尿道括约肌（AUS）的患者进行尿道器械操作（UI）需要技术考量，且存在尿道侵蚀风险，会导致严重的临床和法律后果。我们开展了一项全国性调查，以评估巴西泌尿外科医生对这些患者进行UI的知识和经验。
本研究采用电子调查问卷，分发给巴西泌尿外科学会的成员。该调查问卷包含19道多项选择题，评估社会人口统计学特征、执业模式、AUS培训情况、对AUS组件及功能的了解、对AUS患者进行UI的经验，以及对进一步培训的兴趣。如果泌尿外科医生有进行UI的既往经验且有信心，则被归类为AUS操作“胜任”。
在536名参与者（中位年龄47岁[39 - 55岁]）中，72.8%报告参与过泌尿外科急诊，89.9%表示住院医师培训期间AUS培训不足。只有29.7%偶尔或经常参与AUS手术。在参与者中，53.4%曾对植入AUS的男性进行过UI操作。36.2%的病例中，医护人员曾尝试过既往UI操作。只有46.8%报告了解AUS组件，45.1%觉得自己能熟练停用AUS。关于尿道插管，47.2%知道安全的导管直径，20.9%能确定安全的插管持续时间。总体而言，45.1%自称在UI方面有能力，但许多人在导管尺寸和持续时间方面给出了错误答案。能力与对AUS组件的了解、经常参与植入手术以及既往经验密切相关。大多数人（89.3%）表示有兴趣接受UI方面的额外培训。
本研究凸显了巴西泌尿外科医生在AUS患者UI培训和知识方面存在的重大差距。这些不足强调了加强教育对于改善巴西乃至更广泛国际背景下患者预后及减少AUS相关并发症的潜力。
