LOGBOOK EBU ORAL EXAM 2015 Surname First Name Date of Birth (daymonthyear) MEDICAL DEGREE (MD) UROLOGIST TRAINING: - Training in urology - Training in surgery (as part of the urology training) - Other obligatory parts of the urologist training (e.g. fellowship service) Start date urologist training End date urologist training CERTIFICATION AS UROLOGIST (expected) date Date obtained (monthyear) Country Total number of months years Total number of months years Total number of months years Total number of months years Monthyear start training Country: Monthyear end training Country: Month year Country: Name Training Centre Address Zip Code City Country (or stamp of hospital with abovementioned details) Signature certifying data: of Programme Director or Hospital Administrator (please also sign page 9 Totals) Name: Position: Signature: (page 1 and 9) Date (daymonthyear) All candidates (residents and certified urologists) are required to submit the original logbook by post and must keep a copy of this logbook to present at the EBU Oral Examination on 6-6-2015. This logbook should cover the period January 2013 December 2014 From January 2013 Until (month year) Signature: (applicant must sign page 1 and 9) 1 UNION EUROPÉENNE DES MÉDECINS SPÉCIALISTES (U.E.M.S.)
INTRODUCTION This logbook is a record of your urological experience. For each item, please give number (#) of operations performed as: S = as Surgeon A = as Assistant to Senior Surgeon Calculate total for each category, and grand total in the consolidated report sheet (page 9). Please use the following classification; when selecting "other", please specify. Most procedures can be grouped under one heading. If your practice is different, please clarify this at the end of page 9. I. OPEN SURGERY 1. kidney 2 2. ureter 2 3. bladder 2 4. prostate 2 5. urethra 6. external genitalia 7. retroperitoneum nodes 2 vascular procedures 8. other II. RENAL TRANSPLANTATION 1 1. transplantation 2. donor nephrectomy 3. transplantectomy 4. revision 5. vascular access 6. other III. ENDOSCOPIC SURGERY 1. percutaneous upper tract (kidneyureter) 2. retrograde upper tract (kidneyureter) 3. bladder 4. prostate 5. urethra 6. laparoscopic 7. other IV. ESWL 1. kidney 2. ureter 3. bladder 4. other V. DIAGNOSTIC & MINOR PROCEDURES 1. endoscopy 2. ultrasound 3. ultrasound transrectal 4. prostate biopsy 5. interventional uro radiol. procedures 6. urodynamics 7. other 1 2 Renal transplantation and related procedures are under separate heading; do not include in renal or vascular surgery counts Several combined procedures count for two points: ie. node dissections in radical surgery, urinary diversion in total cystectomy. 2 UNION EUROPÉENNE DES MÉDECINS SPÉCIALISTES (U.E.M.S.)
I. OPEN SURGERY 1. KIDNEY S A 1. Nephrectomy: - non-tumour - radical, for tumour Nephroureterectomy: - non-tumour - for tumour 2. Partial nephrectomy 3. Pyelolithotomy Nephrolithotomy 4. Open nephrostomy Open biopsy Nephropexy 5. Pyeloplasty 6. Other : TOTAL OPEN KIDNEY 2. URETER S A 1. Ureterotomy Ureterolysis Ureterectomy 2. Uretero-neocystostomy (# ureters) Transuretero-ureterostomy Megaureter (# ureters) 3. External urinary diversion (all) idem, continent Internal urinary diversion (all) Revision urinary diversion 4. Other: TOTAL URETER 3 UNION EUROPÉENNE DES MÉDECINS SPÉCIALISTES (U.E.M.S.)
3. BLADDER S A 1. Partial cystectomy Radical cystectomy Bladder substitution (replacement) Augmentation cystoplasty 2. Diverticulectomy Excision urachal cysttumour CystotomyCystostomy 3. Fistula (all types) Repair of trauma Exstrophy 4. Incontinence surgery Bladder neck plasty Artificial urinary sphincter 5. Other: TOTAL OPEN BLADDER 4. PROSTATE S A 1. Open "prostatectomy" (ie. adenomectomy) - retropubic - perineal - suprapubic 2. Radical prostatectomy 3. Other: TOTAL OPEN PROSTATE 5. URETHRA S A 1. Urethroplasty (all, except hypospadias) 2. Hypospadias (all types) Epispadias 3. Urethrectomy Diverticulectomy Repair fistula Repair urethral rupture 4. Other : TOTAL OPEN URETHRA 4 UNION EUROPÉENNE DES MÉDECINS SPÉCIALISTES (U.E.M.S.)
6. EXTERNAL GENITALIA S A 1. PENIS circumcision penectomy (all) prosthesis priapism 2. TESTIS radical orchidectomy (cancer) inguinal hernia orchidopexy biopsy prosthesis 3. EPIDIDYMIS SPERMATIC CORD SCROTUM vasectomy vaso-vasostomy epididymectomy, cysts, biopsy spermatocele hydrocele varicocele scrotum excision (totalpartial) 4. Other: TOTAL EXTERNAL GENITALIA 7. RETROPERITONEUM NODES VASCULAR PROCEDURES S A 1. RETROPERITONEUM adrenal surgery retroperitoneal tumour 2. NODES periaortic retroperitoneal node dissection pelvic node dissection inguinal node dissection 3. VASCULAR PROCEDURES cavotomy for tumour thrombus for impotence TOTAL RP NODES VASCULAR 5 UNION EUROPÉENNE DES MÉDECINS SPÉCIALISTES (U.E.M.S.)
8. OTHER S A 1. Laparotomy (exploratory) Appendectomy Herniorrhaphy 2. Colporrhaphy 3. Other: TOTAL OTHER OPEN PROCEDURES II. TRANSPLANTATION Renal transplantation S A 1. Transplantation 2. Donor nephrectomy 3. Transplant nephrectomy 4. Revision 5. Vascular access for dialysis 6. Other: TOTAL TRANSPLANT III. ENDOSCOPIC SURGERY 1. PERCUTANEOUS UPPER TRACT : KIDNEYURETER S A Stone Tumour stricture UPJ obstruction Other : 2. RETROGRADE UPPER TRACT : KIDNEYURETER S A Stone Tumourstricture (dilation, incision) Internal stents Other: 3. BLADDER S A TUR bladder tumour Stone foreign body Other: 6 UNION EUROPÉENNE DES MÉDECINS SPÉCIALISTES (U.E.M.S.)
4. PROSTATE BLADDER NECK S A TUR ProstateBladder neck TU Incision prostatebladder neck Other: 5. URETHRA S A Internal urethrotomy TUR posterior urethral valves Other: 6. LAPAROSCOPY node dissection S A Testis varicocele Kidney Bladder other 7. OTHER : TOTAL ENDOSCOPIC PROCEDURES IV. ESWL Extracorporeal shock wave lithotripsy S A 1. Kidney 2. Ureter 3. Bladder 4. Other: TOTAL ESWL SESSIONS 7 UNION EUROPÉENNE DES MÉDECINS SPÉCIALISTES (U.E.M.S.)
V. DIAGNOSTIC & MINOR PROCEDURES S A 1. ENDOSCOPY urethrocystoscopy id + biopsy, coagulationfulguration id + ureteral catheterisation urethral dilation 2. ULTRASOUND STUDIES all sites, except TRUS-prostate 3. TRANSRECTAL ULTRASOUNDS (TRUS) 4. PROSTATE BIOPSY all techniques 5. INTERVENTIONAL URO-RADIOL. PROCEDURES percutaneous nephrostomy, drainage 6. URODYNAMICS urodynamic studies (except flow) radio-urodynamic studies 7. OTHER : TOTAL DIAGNOSTIC & MINOR PROCEDURES 8 UNION EUROPÉENNE DES MÉDECINS SPÉCIALISTES (U.E.M.S.)
TOTALS TYPE EXPERIENCE ORGAN TOTAL S TOTAL A I. OPEN SURGERY 1. Kidney 2. Ureter 3. Bladder 4. Prostate 5. Urethra 6. External genitalia 7. R-p, nodes, vascular 8. Other: TOTAL OPEN II. TRANSPLANTATION 1. Transplantation 2. Donor nephrectomy 3. Transplantectomy 4. Revision 5. Vascular access 6. Other: TOTAL TRANSPLANTATION III. ENDOSCOPIC SURGERY 1. Percutaneous upper tract 2. Retrograde upper tract 3. Bladder 4. Prostate 5. Urethra 6. Laparoscopic 7. Other: TOTAL ENDOSCOPIC IV. ESWL TOTAL ESWL SESSIONS V. DIAGNOSTIC & MINOR PROCEDURES 1. Endoscopy 2. Ultrasounds 3. TR-us prostate 4. Prostate biopsy 5. Interventional uro-radiologic procedures 6. Urodynamic studies 7. Other: TOTAL DIAGNOSTIC Comments: Signature applicant: Signature PD or Hospital Administrator --------------------------------- ------------------------------------------------------ 9 UNION EUROPÉENNE DES MÉDECINS SPÉCIALISTES (U.E.M.S.)