Objectives To design, implement, and evaluate learner attitudes of a virtual urologic surgery clinical rotation for medical students Methods Ten senior medical students at the Perelman School of Medicine at the University of Pennsylvania were enrolled. Students were administered a pre-course test on their perceived confidence of their urologic knowledge, confidence in identifying urologic conditions, comfort with performing urologic evaluations, and confidence placing consults for urologic issues. Students participated in a two-week curriculum that included both asynchronous and synchronous content. Asynchronous content included pre-recorded lectures, self-paced problem-based learning (PBL) modules, directed reading and video content, and an online discussion board. Synchronous content included real-time videoconferences covering case discussions, simulated patient presentations, and critical literature reviews. At the conclusion of the course, students were administered the post-course survey evaluating changes in their ability to identify and understand urologic conditions. Results The post-course survey demonstrated this course significantly increases students’ scores in: self-perceived urologic knowledge, confidence in naming urologic conditions, comfort with performing urologic evaluations, and confidence placing consults for urologic conditions (p<0.05). Conclusions Virtual medical student rotations are scalable and effective at delivering surgical material and can approximate the interpersonal teaching found in clinical learning environments. They may be a useful tool to supplement or augment clinical learning in select situations.

Endoscopic management appears to be an alternative to reimplantation for primary obstructive megaureter with a narrowed segment shorter than 3 cm. Double stenting seems to be effective in maintaining patency of the neo-orifice. Followup into adolescence is needed.

Introduction Use of supplements is common among men seeking urologic evaluation for sexual health matters. With a dizzying array of formulations available and little regulation on the dosage, purity, or ingredients found in these products, the health effects of nutraceuticals are often confusing to patients and medical practitioners alike. Aim In this review, we set out to concisely summarize the data on ingredients found within the top-selling nutraceutical agents marketed for men's sexual health in order to provide a clinical guide for urologists. Methods We used sales data from the most popular retail provider of men's health supplements to identify the top-selling products marketed toward improvement of men's sexual health. We summarized the available information related to the ingredients, dosage, cost, and mechanism of action for these substances and performed an extensive literature search to identify and review the current evidence available for each of the most common ingredients found in these nutraceuticals. Results The top-selling nutraceuticals marked for men's sexual health contain a blend of multiple supplements (up to 33 in one formulation identified), the most common being ginseng, tribulus, zinc, horny goat weed, B complex vitamins/trace minerals, fenugreek, L-arginine, maca, DHEA, ginkgo, and yohimbine. The currently available medical literature evaluating the efficacy of these substances is generally of low quality. Conclusions Despite the dearth of evidence supporting nutraceutical agents in the men's health arena, these substances are still commonly used by patients. As these products can affect the health and well-being of men presenting to a urology clinic, a familiarity with commonly used agents can help the urologist appropriately counsel their patients.

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Our conclusions are based on data derived from the PLCO study which has been criticized on the basis of inconsistent biopsies following positive screening tests, lack of end of study biopsies to determine population disease burden, and low numbers of black men.