Surgery

The rate at which registrars attain proficiency in laparoscopic surgery is markedly enhanced by training with a virtual reality simulator. Skills equivalent to an experience level of 20–50 laparoscopic salpingectomies were obtained by the 11 predominantly female gynecology/obstetrics trainees randomized to the virtual reality group. In the same period, the 10 trainees in the standard education group attained a proficiency level equivalent to <5 procedures.

Larsen, C. R. et al. Effect of virtual reality training on laparoscopic surgery: randomised controlled trial. BMJ doi:10.1136/bmj.b1802.

Male factor infertility

The outcomes of bilateral varicocelectomy are not superior to those of left-side-only repair in infertile men with left clinical and right subclinical varicoceles. Both procedures, performed using a retroperitoneal approach in 51 and 53 patients in China, improved sperm concentration, motility and morphology markedly and to a similar degree.

Zheng, Y. Q. et al. Efficacy of bilateral and left varicocelectomy in infertile men with left clinical and right subclinical varicoceles: a comparative study. Urology 73, 1236–1240 (2009).

Male factor infertility

The post-orchiopexy fertility index of prepubertal boys with an undescended testis was significantly greater in those randomized to 4 weeks of preoperative treatment with a gonadotropin-releasing hormone (GnRH). Twelve of the 24 boys (mean age 34.5 months) in the study performed in Tunisia received a daily 1.2 mg dose of GnRH via nasal spray. GnRH is thought to promote maturation of germ cells.

Jallouli, M. et al. Neoadjuvant gonadotropin-releasing hormone therapy before surgery and effect on fertility index in unilateral undescended testes: a prospective randomized trial. Urology 73, 1251–1254 (2009).

Pediatrics

Primary vesicoureteral reflux (VUR) is thought to be inherited as an autosomal dominant trait. The observation that some parents of children with the condition are unaffected led Ali Gharavi and colleagues to investigate the possibility of recessive inheritance. Genome-wide linkage analysis of 72 affected individuals from 12 families of diverse ethnicity has confirmed this hypothesis, identifying a major new locus for primary VUR on chromosome 12p11-q13.

Weng, P. L. et al. A recessive gene for primary vesicoureteral reflux maps to chromosome 12p11q13. J. Am. Soc. Nephrol. doi:10.1681/ASN.2008111199.