LOGBOOK -JCPU Joint Committee on Paediatric Urology

 

Date (day/month/year) .. / .. / ….
NAME, first name
Birth date (day/month/year) .. / .. / ….
Country of Residence
MEDICAL DEGREE (MD)

 

 

POST-GRADUATE (PG) TRAINING (urology, surgery or paediatric surgery not including paediatric urology)

 

 

 

 

 

 

 

CERTIFICATION

(Paed. surgery / Urology/other)

 

 

PAEDIATRIC UROLOGY

TRAINING

Institution / Country

Date obtained (mo/year)

For each PG training field[1]

Field

Institution / Country

Date started – ended (mo/year)

Number of years

Field

Institution / Country

Date started – ended (mo/year)

Number of years

Total PG training years

Type of certification

Institution / country

Date obtained  (mo/year)

Date started (mo/year)

Present year

Date (to be) completed

Total P.Urology training years

…………… /…………… ….

.. / ….

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.. / ….        –       .. / ….

….

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………….…. /………………

.. / ….        –       .. / ….

….

…..

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Name of Paediatric Urology Training Centre Address  
Programme Director

Address – contact info

Signatures certifying data Paediatric urology Trainee Programme Director
This Logbook covers

the period [2]

From (month/year)

To (month/year)

… / ….

.. / …. [3]

INTRODUCTION

This logbook is a record of your paediatric urological experience; do not include postgraduate (PG) training in paediatric surgery or urology.

For each item, please give number (N°) performed as surgeon under supervision (SS), as surgeon unsupervised (S: surgeon), acting as assisting surgeon (AS), only observation (OO)

Calculate total for each category, and grand total in the consolidated report sheet (p9).

N° Operations

ORGAN

PROCEDURE

All paediatric urology cases  in

children < 18 years

SS

Supervised

Surgery

S

Surgeon

AS

Assisting

Surgery

OO

Observation

Only

 

Please use the following classification; when selecting “other”, please specify. Most procedures can be grouped under one heading; if your practice is different, please use page n°10.

A. OPEN SURGERY 1. kidney ²

2. ureter²

3. bladder²

4. urethra

5. external genitalia

6. retroperitoneal surgery

7  other

B. RENAL

TRANSPLANTATION1

1. transplantation

2. donor nephrectomy

3  dialysis surgery

4. other

C. ENDOSCOPIC

SURGERY

1. percutaneous upper tract (kidney/ureter)

2. retrograde upper tract (kidney/ureter)

3. bladder

4. urethra

5. laparoscopic

6. other

D.  DIAGNOSTIC &

MINOR PROCEDURES

1. endoscopy

2. ultrasound

3. interventional uroradiol. procedures

4. ESWL

5. urodynamics

6. other

1 Renal transplantation and related procedures are under separate heading; do not include in renal or vascular surgery counts
2 Several combined procedures count for two surgeries: ie. Creation of continent stomain augmentation

 

 

 

 

 

 

  1. OPEN SURGERY
1. KIDNEY and upper urinary tract 00 AS SS

S

1. Nephrectomy:

  • non-tumour

·         tumour

o    Wilms

o    Neuroblastoma

  • Other

Nephroureterectomy

 

2. Partial nephrectomy

Heminephrectomy

3. Pyelolithotomy

Nephrolithotomy

4. Open nephrostomy

Open biopsy

Nephropexy

5. Pyeloplasty

–          Neonatal

–          Other ages

Ureterocalycostomy

 

6. Other reconstructive surgery in a congenitally     anomalous kidney or injured kidney
7.  Other
TOTAL OPEN KIDNEY
2. URETER OO AS SS

S

1. Ureterotomy-ureterolithotomy

Uretero-ureterostomy

Transuretero-ureterostomy

Ureterectomy

2. Uretero-neocystostomy (N° ureters)

–       Extravesical

–       Intravesical

–       Psoas Hitch

Remodelling of megaureter (N° ureters)

 

3. Surgery for ureteral duplication
Excision of a ureterocoele
4. External urinary diversion (all)

Internal urinary diversion (all)

Revision urinary diversion

5. Other

TOTAL OPEN URETER

3. BLADDER OO AS SS

S

1. Augmentation cystoplasty

·         Intestinal

·         Gastric

·         Ureteral

·         Autoaugmentation

·         Others

Mitrofanoff Procedure

Radical cystectomy

Bladder substitution (replacement)

Urinary undiversion

2.  Diverticulectomy

Excision urachal cyst/tumour

Cystotomy/Cystostomy

3.   Exstrophy repair

Cloacal malformation

Fistula (all types)

Traumatic lesions

 

4. Incontinence surgery

·         Bladder neck plasty

·         Sling

·         Artificial urinary sphincter

·         Closure of bladder neck

·         Urethral lengthening techniques

5. Other

TOTAL OPEN BLADDER

4 . URETHRA OO AS SS

S

1. Urethroplasty (all, except hypospadias)
2. Hypospadias

·         Distal

·         Penile

·         Penoscrotal

·         –

·         Chordee repair alone

·         Fistula repair

 

3.     Epispadias

·         Glandular

·         Penile

·         Penopubic

4. Other

TOTAL OPEN URETHRA

5. MALE EXTERNAL GENITALIA OO AS SS

S

1. Penis

  • circumcision
  • preputial plasty
  • buried penis
  • penoscrotal web
  • penoscrotal transposition
  • priapism
  • congenital penile curvature
  • other
2. Testis

  • radical orchiectomy (cancer)
  • inguinal orchiopexy
  • two stage orchiopexy
  • Reduction of torsion
  • other
3. Epididymis, spermatic cord, scrotum

varicocele

·         varicocelectomy

·         microsurgery

·         sclerotherapy

scrotum excision (total/partial)

other

4. OTHER
TOTAL MALE EXTERNAL GENITALIA
6. RETROPERITONEUM / NODES / VASCULAR PROC. OO AS SS

S

1. Retroperitoneum

  • adrenal surgery
  • retroperitoneal tumour
2. Nodes

  • paraaortic
  • retroperitoneal node dissection
  • pelvic node dissection
  • inguinal node dissection
  • other
3. Vascular procedures

  • cavotomy for tumour thrombus
  • microvascular orchidopexy
  • other
TOTAL RP / NODES / VASCULAR
7. OTHER OO AS SS

S

1. Laparotomy (exploratory)

Herniorrhaphy

2. Vaginoplasty

Clitoroplasty

3. Other
TOTAL OTHER OPEN PROCEDURES

 

 

B. RENAL INSUFFICIENCY

1. Renal transplantation OO AS SS

S

1. transplantation
2. donor nephrectomy

transplant nephrectomy

revision

3. dialysis surgery

CAPD

  • catheter placement
  • revision

vascular access for dialysis

4. other
TOTAL TRANSPLANT

 

  1. ENDOSCOPIC SURGERY
1. PERCUTANEOUS UPPER TRACT :
KIDNEY/URETER
OO AS SS

S

stone
stricture / UPJ obstruction
other
2. RETROGRADE UPPER TRACT :
KIDNEY/URETER
stone
stricture (dilation, incision)
internal stents
other
3. BLADDER
TUR tumour/ biopsy
Stone / foreign body
Injection therapy for reflux
Bladder neck injection
other
4. URETHRA
internal urethrotomy
TUR posterior urethral valves
other
5. LAPAROSCOPY AND RETROPERITONEOSCOPY
Testis
varicocele
Kidney and upper urinary tract
bladder / other
6. OTHER
TOTAL ENDOSCOPIC PROCEDURES

 

 

  1. DIAGNOSTIC and MINOR PROCEDURES
OO AS SS

S

1. DIAGNOSTIC ENDOSCOPY

urethro/cystoscopy

ureteral catheterization

urethral dilation

other

2. ULTRASOUND STUDIES

all sites,

3. INTERVENTIONAL URO-RADIOL. PROCEDURES

percutaneous nephrostomy

percutanous renal biopsy

percutanous cystostomy

4. Extracorporeal shock wave lithotripsy     ESWL

kidney

ureter

bladder

5. URODYNAMICS

urodynamic studies (except flow)

radio-urodynamic studies

biofeedback therapy

6. OTHER

peritoneal catheter placement

central line placement

  

TOTAL DIAGNOSTIC & MINOR PROCEDURES

 

 

 

CONSOLIDATED EXPERIENCE : TOTALS

TYPE EXPERIENCE ORGAN Total N° of operations
OO AS SS

S

A. OPEN SURGERY 1. kidney
2. ureter
3. bladder
4. urethra
5. external genitalia
6. r-p, nodes, vascular
7. other
TOTAL OPEN
B. TRANSPLANTATION 1. transplantation
2. donor nephrectomy
3. dialysis surgery
4. other
  TOTAL TRANSPLANTATION
C.ENDOSCOPIC

SURGERY

1. percutaneous upper tract
2. retrograde upper tract
3. bladder
4. urethra
5. laparoscopic
6. other
TOTAL ENDOSCOPIC
D. DIAGNOSTIC &  MINOR

PROCEDURES

1. endoscopy
2. ultrasounds
3. interventional uro-radiol. procedures
4. ESWL
5. urodynamic studies
6. other
TOTAL DIAGNOSTIC

Operative Log

Date Hosp # Diagnosis Operation Code  Status Comments
 

Record of educational scientific meetings attended.

DATES

 

NAME OF MEETING PARTICIPATION ORGANIZATION CERTIFICATE
 

List of scientific presentations, publications, projects

Presentations:

Title ,  authors , scientific meeting presented.

 
Publications

Title ,  authors ,  source

 
Unpublished Work

Title ,  authors

 
Projects and thesis

Title , abstract,  date of completion

 
Please write comments and suggestions:

 

concerns

page n°

[1] please specify if the trainee has done PG training in more than one field and give information for each.

[2] this is a period during training/after accreditation

[3] a minimum period of 2 years preceding the application is required