To evaluate the status of UK undergraduate urology teaching against the British Association of Urological Surgeons (BAUS) Undergraduate Syllabus for Urology. Secondary objectives included evaluating the type and quantity of teaching provided, the reported performance rate of General Medical Council (GMC)-mandated urological procedures, and the proportion of undergraduates considering urology as a career. Subjects and MethodsThe uroLogical tEAching in bRitish medical schools Nationally (LEARN) study was a national multicentre cross-sectional evaluation. Year 2 to Year 5 medical students and Foundation Year (FY) 1 doctors were invited to complete a survey between 3 October and 20 December 2020, retrospectively assessing the urology teaching received to date. Results are reported according to the Checklist for Reporting Results of Internet E-Surveys (CHERRIES). ResultsIn all, 7063/8346 (84.6%) responses from all 39 UK medical schools were included; 1127/7063 (16.0%) were from FY1 doctors who reported that the most frequently taught topics in undergraduate training were on urinary tract infection (96.5%), acute kidney injury (95.9%) and haematuria (94.4%). The most infrequently taught topics were male urinary incontinence (59.4%), male infertility (52.4%) and erectile dysfunction (43.8%). Male and female catheterisation on patients as undergraduates was performed by 92.1% and 73.0% of FY1 doctors respectively, and 16.9% had considered a career in urology. Theory-based teaching was mainly prevalent in the early years of medical school, with clinical skills teaching, and

Objective: To compare the outcomes of TAP block versus local wound infiltration in reducing postoperative pain in patients undergoing infra-umbilical hernia repair. Study design: Randomized controlled trial Place and Duration of Study: Department of Anaesthesiology, Surgical Intensive Care Unit & Pain Management, Dow Medical College & Civil Hospital Karachi from 1st August 2020 to 31st January 2021. Methodology: One hundred patients with undergoing infra-umbilical hernia mesh repair were randomly allocated into two groups. Fifty patients in group A were treated with transversus abdominis plane block and 50 were in group B for local infiltration. Anaesthetic technique was standardized. The drug was administered according to the weight of the patient. Visual analogue score (VAS), graduated from 0-10 was recorded. Results: The mean age was 41.08±10.36 years. There were 61% males and 39% females. Mean time of analgesia was significantly high in group A than groups B [413.2±63.83 vs 274.16±41.28; p=0.0005]. Mean VAS pain score at rest and movement was also significantly low in group A than group B. Conclusion: Transversus abdominis plane block seemed preferable to local anesthetic wound infiltration in postoperative analgesia. Current evidence is insufficient to suggest that the transversus abdominis plane block will minimize post-operative morphine requirements and associated side effects in comparison with local anesthetic infiltration. Key Words: Hernia repair, Transversus abdominis plane (TAP) block, Local wound infiltration, Postoperative morphine

Background:The positioning of a slit mesh around cord structures during laparoscopic transabdominal preperitoneal (TAPP) hernia repair rests the mesh better without kinks, thereby minimizing recurrences. However, studies also suggest that insufficient closure of the mesh slit may lead to recurrences. Aim: This report describes a novel technique using AbsorbaTacks (Covidien) to close the mesh slit and refashion an artificial 'deep ring' to minimize recurrence. Technique: We report the case of a fit 82-year-old Caucasian male presenting with a recurrent large right indirect inguinoscrotal hernia (8 x 8 × 7 cm with 4 × 4 cm deep inguinal ring). The patient underwent a TAPP repair with a background of unsuccessful open repair by another surgeon previously. Following mesh deployment, the mesh was lifted up by the cord structures, which was under tension due to a large defect. A slit was made in the inferomedial aspect of the mesh. This allowed it to be wrapped around the cord structures. The overlapped trouser flaps were then stapled together encircling the cord, by AbsorbaTacks to create a secure artificial 'deep ring' . Edges of the mesh were also standardly affixed by AbsorbaTacks to the pectineal ligament and posterior abdominal wall. This creates a secure four-point fixation of the mesh scaffold to prevent 'windsock' effect, which happens when the mesh is pushed into the widened deep inguinal ring, leading to early recurrences. The peritoneal incision was also closed with AbsorbaTacks. Conclusion:No complications were registered during the early postoperative period. The patient had an uneventful recovery and was discharged within 20 hours with simple analgesia. No recurrence was reported during the 6 months follow-up period. Clinical significance: The anchoring of a slit mesh with tackers around the cord structures can be used to repair large recurrent inguinal hernias laparoscopically following an open repair. This technique potentially minimizes further recurrences.