La interdisciplinariedad en la cirugía urológica mínimamente invasiva / Interdisciplinarity in Minimally Invasive Urologic Surgery

Introducción: La interdisciplinariedad es el resultado de la puesta en práctica de varias disciplinas, que permite afrontar el objeto de estudio de modo integral y promover el desarrollo de nuevas intervenciones para la solución de problemas. En el campo de la medicina involucra la contribución de diversas disciplinas y la participación de especialistas de diversas áreas que integra el pensamiento de diferentes profesiones o tecnologías para lograr un resultado común. Objetivos: Exponer una visión integral acerca de cómo la interdisciplinariedad ha permitido el desarrollado de la cirugía mínimamente invasiva en la especialidad de urología. Métodos: Se realizó una revisión sistemática y crítica de artículos reportados sobre la interdisciplinariedad en el campo de la cirugía mínimo invasiva, en idioma español e inglés, desde 2005 hasta 2022, en sitios Web (PubMed, SciELO, MedLine, Lilacs y Science Direct. Se referenciaron 22 artículos de los consultados. Conclusiones: Las evidencias reportadas y consultadas ofrecen una visión integral de las diversas intervenciones que certifican la interdisciplinariedad en el campo de la cirugía urológica mínimamente invasiva, que fortalece el marco curricular de la especialidad y permite alcanzar un nivel de profesionalidad significativo, evidenciado en un excelente desempeño profesional(AU)

Introduction: Interdisciplinarity results from implementing several disciplines, allowing to address the object of study comprehensively, as well as promote the development of new interventions to solve problems. In the field of medicine, it involves the contribution of various disciplines and the participation of specialists from different areas, integrating the thinking from different professions or technologies to achieve a common result. Objectives: To present a comprehensive perspective of how interdisciplinarity has allowed the development of minimally invasive surgery in the specialty of urology. Methods: A systematic and critical review was carried out with reported articles on interdisciplinarity in the field of minimally invasive surgery, in Spanish and English, from 2005 to 2022, in Web sites (PubMed, SciELO, MedLine, Lilacs and Science Direct). Twenty-two of the consulted articles were referenced. Conclusions: The reported and consulted evidence offers a comprehensive perspective of the various interventions certifying interdisciplinarity in the field of minimally invasive urologic surgery, which strengthens the curricular framework of the specialty and allows to achieve a significant level of professionalism, evidenced through excellent professional performance(AU)

Abordaje quirúrgico primario en un paciente con eritroplasia de Queyrat / Primary surgical approach to a patient with erythroplasia of Queyrat

Presentación del caso. Paciente masculino de 52 años que se presentó a la consulta de urología con historia de dos años de notar una lesión en el glande y el prepucio, de color rojo brillante, pruriginosa y dolorosa con aumento progresivo del tamaño que no mejoró con tratamientos antibióticos y anti fúngicos. Intervención terapéutica. Se realizó una glandectomía parcial con injerto de piel de muslo. Evolución clínica. Luego de un mes, el injerto presentó un 95 % de acoplamiento. No se observó recurrencia local de cáncer. El estudio histopatológico reportó un carcinoma escamoso invasor en la lesión del prepucio y en la piel del glande, con todos los márgenes quirúrgicos, limites laterales y profundos, negativos a malignidad. Luego de ocho meses posquirúrgicos, se observó el recubrimiento del glande con un adecuado resultado estético, con apariencia similar a la cubierta natural

Case presentation. A A 52-year-old male patient presented to the urology office with a two-year history of noticing a bright red, pruritic, and painful lesion on the glans and foreskin with a progressive increase in size that did not improve with antibiotic and antifungal treatments. Treatment. Partial glandectomy with thigh skin graft was performed. Outcome. After After one month, the graft presented a 95 % of coupling. No local recurrence of cancer was observed. The histopathological study reported invasive squamous cell carcinoma in the lesion of the foreskin and glans skin, with all surgical margins, lateral and deep limits, negative for malignancy. After eight months post-surgery, the covering of the glans was observed with an appropriate esthetic result, with a similar appearance to the natural covering

Low-fidelity simulation models in urology resident's microsurgery training

Purpose: To evaluate the gain of microsurgical skills and competencies by urology residents, using low-fidelity experimental models. Methods: The study involved the use of training boards, together with a low-fidelity microsurgery simulator, developed using a 3D printer. The model consists in two silicone tubes, coated with a resin, measuring 10 cm in length and with internal and external diameters of 0.5 and 1.5 mm. The support for the ducts is composed by a small box, developed with polylactic acid. The evaluation of the gain of skills and competencies in microsurgery occurred throughout a training course consisting of five training sessions. The first sessions (S1-S4) took place at weekly intervals and the last session (S5) was performed three months after S4. During sessions, were analyzed: the speed of performing microsurgical sutures in the pre and post-training and the performance of each resident through the Objective Structure Assessment of Technical Skill (OSATS) and Student Satisfaction Self-Confidence tools in Learning (SSSCL). Results: There was a decrease in the time needed to perform the anastomosis (p=0.0019), as well as a progressive increase in the score in the OSATS over during sessions S1 to S4. At S5, there was a slightly decrease in performance (p<0.0001), however, remaining within the expected plateau for the gain of skills and competences. The SSSCL satisfaction scale showed an overall approval rating of 96.9%, with a Cronback alpha coefficient of 83%. Conclusions: The low-fidelity simulation was able to guarantee urology residents a solid gain in skills and competencies in microsurgery.

Evidências tecnológicas para assistência ambulatorial e domiciliar em urologia pediátrica: revisão de escopo / Technological evidence for outpatient and home care in pediatric urology: a scoping review

RESUMO Objetivo mapear as evidências sobre as tecnologias baseadas na internet e sua aplicabilidade no cuidado ambulatorial e domiciliar em urologia pediátrica. Métodos trata-se de revisão de escopo, com buscas conduzidas em seis bases de dados, sem limite de tempo, nos idiomas português, inglês e espanhol. Resultados 2.200 artigos foram obtidos, sendo 19 publicações elegíveis para a amostra final. As tecnologias baseadas na internet mais utilizadas foram telessaúde e telemedicina (47,3%), programas de intervenção online (21,0%) e aplicativos móveis (15,8%), com uma taxa menor de uso de serious game s, mídias sociais e vídeos de micção (5,3%), majoritariamente no contexto domiciliar. Conclusão o mapeamento das evidências tecnológicas na assistência ambulatorial e domiciliar em urologia pediátrica permitiu identificar os tipos de tecnologia e suas aplicações voltadas para o autogerenciamento dos sintomas e autoeficácia, para o monitoramento e acompanhamento do cuidado urológico. Contribuições para a prática: as evidências sintetizadas contribuem para uma prática profissional expandida, qualificada e inovadora junto à população pediátrica com sintomas urinários e intestinais, características relacionadas a uma prática avançada de enfermagem, além de favorecer diagnóstico precoce e maior adesão terapêutica, particularmente por apoiar intervenções personalizadas às necessidades do paciente pediátrico e sua família.

ABSTRACT Objective to map the evidence on web-based technologies and their applicability in outpatient and home care in pediatric urology. Methods this is a scoping review, with searches conducted in six databases, with no time limit, in Portuguese, English, and Spanish. Results 2,200 articles were obtained, with 19 publications eligible for the final sample. The most used web-based technologies were telehealth and telemedicine (47.3%), online intervention programs (21.0%), and mobile apps (15.8%), with a lower rate of use of serious games, social media, and urination videos (5.3%), mostly in the home setting. Conclusion the mapping of technological evidence in outpatient and home care in pediatric urology allowed us to identify the types of technology and their applications focused on self-management of symptoms and self-efficacy, for monitoring and follow-up of urologic care. Contributions to practice: the synthesized evidence contributes to an expanded, qualified, and innovative professional practice with the pediatric population with urinary and bowel symptoms, characteristics related to advanced nursing practice, in addition to favoring early diagnosis and greater therapeutic adherence, particularly by supporting interventions tailored to the needs of the pediatric patient and his family.

Vigilância ativa do câncer de próstata - um conceito em evolução / Active surveillance of prostate cancer - an ongoing concept

A vigilância ativa é a solução encontrada pela urologia para a condução de tumores prostáticos com características de pouca agressividade. Desenvolvida especialmente após as polêmicas que envolveram a validade do rastreamento, essa abordagem vem sendo consolidada como a melhor maneira de se evitar o tratamento desnecessário do câncer de próstata e precisa ser compreendida por todos os médicos que lidam com a saúde do homem.

Active surveillance is the solution found by urology to deal with low-aggressivity prostate tumours. Having been developed following controversies over screening strategies, this has been considered the best approach to avoid unnecessary treatment of prostate cancer and such a concept needs to be well understood by every medical doctor who deals with men's health.

Moviéndonos hacia la Urología Híbrida / Moving Towards Hybrid Urology

"Cogito ergo sum" la famosa frase de René Descartes tendría que replantearse hoy como "decido, luego existo". La inteligencia natural es esencialmente una batalla de la racionalidad contra el sesgo y el ruido, la vida finalmente se trata de una suma de decisiones. La medicina no es ajena a este conflicto; es una ciencia humana que gravita sobre la incertidumbre y por ello quienes la ejercemos debemos considerar el fallo como un potencial desenlace, pero el fenómeno de la ilusión terapéutica algunas veces produce un efecto cegador que perpetúa nuestro sesgo. La promesa de disminuir este potencial riesgo en las decisiones y la optimización consecuente en los procesos humanos es lo que dio origen al desarrollo al que llamamos "inteligencia artificial".

"Cogito ergo sum" the famous phrase of René Descartes would have to be rephrased today as "I decide, therefore I am". Natural intelligence is essentially a battle of rationality against bias and noise; life is ultimately a sum of decisions. Medicine is no stranger to this conflict; it is a human science that gravitates on uncertainty and therefore those of us who practice it must consider failure as a potential outcome, but the phenomenon of therapeutic illusion sometimes produces a blinding effect that perpetuates our bias. The promise of reducing this potential risk in decisions and the consequent optimization of human processes is what gave rise to the development we call "artificial intelligence".

La urología colombiana en el contexto latinoamericano / Colombian Urology in the Context of Latin America

Según el portal de Scimago Journal & Country Rank, que desde 1996 mide la producción científica a nivel global,[1] la urología colombiana, con 117 publicaciones en 2021, ocupa el tercer lugar de la región, detrás de Brasil (con 412 publicaciones) y de México (con 230). Esa tercera posición la mantiene Colombia desde 2014, cuando, por primera vez, superó tanto a Chile como a Argentina. Las 117 publicaciones en urología con algún autor basado en Colombia (que es lo que mide el portal a partir de las revistas indexadas en la base de datos de Scopus) ubican al país en la posición 32 a nivel global, con Brasil en el puesto 14 y México en el 22. Estos tres países han ido ganando posiciones de manera progresiva en este cuarto de siglo, ya que en 1996 Brasil y México se ubicaban en los puestos 27 y 32, respectivamente. No han tenido la misma suerte Argentina, que entre 2000 y 2021 ha perdido 5 posiciones, al pasar de la 32 a la 37, Venezuela, que en el mismo lapso ha pasado del puesto 50 al 99, o Cuba, que ha descendido del 45 al 86. Aunque el puesto 32 a nivel global es todo un logro, hay todavía espacio para mejorar. Vale decir que esa posición es superior a la que tiene el país en todas las disciplinas de la ciencia, con la posición 47, o en todas las especialidades de la Medicina, con el puesto 43. El ingreso de Urología Colombiana a la base de datos de Scopus a partir de 2014 sin duda ha jugado un papel importante en la divulgación de la producción científica nacional,[2] y es deber tanto de la Revista como de la Sociedad Colombiana de Urología propender por ratificar a Colombia como uno de los tres países que lideran la disciplina en América Latina.

According to the Scimago Journal & Country Rank portal, which has been measuring scientific production globally since 1996,[1] Colombian urology, with 117 publications in 2021, ranks third in the region, behind Brazil (with 412 publications) and Mexico (with 230). This third position has been held by Colombia since 2014, when, for the first time, it surpassed both Chile and Argentina. The 117 publications in urology with some author based in Colombia (which is what the portal measures based on the journals indexed in the Scopus database) place the country in 32nd position globally, with Brazil in 14th place and Mexico in 22nd. These three countries have been progressively gaining positions during this quarter of a century, since in 1996 Brazil and Mexico were ranked 27th and 32nd, respectively. Argentina, which lost 5 positions between 2000 and 2021, from 32nd to 37th, Venezuela, from 50th to 99th place, and Cuba, from 45th to 86th place, have not been as fortunate. The entry of Colombian Urology to the Scopus database in 2014 has undoubtedly played an important role in the dissemination of national scientific production,[2] and it is the duty of both the Journal and the Colombian Society of Urology to strive to ratify Colombia as one of the three leading countries in the discipline in Latin America.

Melanoma metastásico a vejiga / Metastatic melanoma to the bladder / Melanoma metastático na bexiga

Introducción. El compromiso tumoral metastásico del melanoma al tracto genitourinario es frecuente, pero, la metástasis a vejiga es rara, constituye menos del 2% de los casos. Sin embargo, en autopsias realizadas a pacientes con melanoma se ha encontrado metástasis en la vejiga en entre un 18% y un 37% de los casos, lo que la convierte en la segunda en incidencia posterior al adenocarcinoma gástrico. La media de supervivencia suele ser entre 6 - 7.5 meses. El objetivo de este trabajo es presentar el caso de un melanoma metastásico a vejiga, entidad poco frecuente y poco diagnosticada por ser la mayoría de las veces asintomática. Presentación del caso. Paciente femenina de 62 años, con antecedente de melanoma al nivel del primer artejo del pie, con manejo quirúrgico y farmacológico. Consultó por hematuria. La cistoscopia evidenció una lesión única sólida, eritematosa, con necrosis y fácil sangrado y se indicó realizar resección transuretral (RTU). La patología demostró compromiso por melanoma ulcerado metastásico. Se inició manejo de segunda línea (Pembrolizumab) y presentó progresión a miembros superiores y recaída a nivel vesical. La paciente falleció un año después. Discusión. Las metástasis de melanoma al tracto genitourinario son frecuentes, pero las metástasis vesicales aisladas son raras. El tratamiento suele ser RTU de la lesión, cistectomía, quimioterapia y radioterapia. La RTU es curativa para las lesiones restringidas al epitelio, aunque la cistectomía radical suele ser la terapia de elección ante un paciente con un tumor localizado. El Pembrolizumab ha demostrado aumentar la supervivencia. El pronóstico depende del tamaño y profundidad de la invasión. Conclusiones. El compromiso vesical metastásico es poco frecuente y diagnosticado, puede estar presente en pacientes con melanoma, síntomas irritativos urinarios no específicos y hematuria. Suele ser de mal pronóstico, y requiere de manejo quirúrgico asociado a manejo sistémico.

Introduction. Metastatic tumor compromise of melanoma to the genitourinary tract is frequent, but metastasis to the bladder is rare, representing less than 2% of cases. However, autopsies performed on patients with melanoma have found metastases in the bladder in 18-37% of cases, making it the second incidence after gastric adenocarcinoma. The median survival is usually 6 to 7.5 months. The objective of this work is to present the case of a metastatic melanoma to the bladder, a rare and underdiagnosed condition because most of the time it is asymptomatic. Case Presentation. 62-year-old female patient, with a history of melanoma at the level of the first toe, with surgical and pharmacological management. The reason for consultation was hematuria. Cystoscopy revealed a single solid, erythematous lesion with necrosis and easy bleeding, and a transurethral resection (TUR) was indicated. The pathology found compromise for metastatic ulcerated melanoma. Second-line treatment (Pembrolizumab) was started and presented progression to the upper limbs and relapse at the bladder level. The patient died a year later. Discussion. Melanoma metastases to the genitourinary tract are common, but isolated bladder metastases are rare. Treatment is usually TUR of the lesion, cystectomy, chemotherapy, and radiation therapy. TUR is curative for lesions restricted to the epithelium, although radical cystectomy is usually the therapy of choice in patients with a localized tumor. Pembrolizumab has been shown to increase survival. The prognosis depends on the size and depth of the invasion. Conclusions. Metastatic bladder compromise is rare and underdiagnosed, it may be present in patients with melanoma, non-specific urinary irritative symptoms, and hematuria. It tends to have a poor prognosis, and requires surgical management associated with systemic management.

Introdução. O comprometimento do tumor metastático do melanoma no trato geniturinário é comum, mas a metástase na bexiga é rara, constituindo menos de 2% dos casos. Entretanto, em autópsias realizadas em pacientes com melanoma, foi encontrada metástase na bexiga entre 18% e 37% dos casos, o que a torna a segunda em incidência após o adenocarcinoma gástrico. A média de sobrevivência é geralmente entre 6 - 7,5 meses. O objetivo deste trabalho é apresentar o caso de um melanoma metastático na bexiga, uma entidade pouco frequente e subdiagnosticada, pois na maioria das vezes é assintomática. Apresentação do caso. Paciente do sexo feminino, 62 anos, com antecedentes de melanoma no nível do hálux, com manejo cirúrgico e farmacológico. Ela consultou por hematúria. A cistoscopia revelou uma única lesão sólida, eritematosa com necrose e sangramento fácil, e foi indicada uma ressecção transuretral (RTU). A patologia mostrou comprometimento de melanoma ulceroso metastático. O tratamento de segunda linha (Pembrolizumab) foi iniciado e a patologia avançou para os membros superiores e uma recaída no nível da bexiga. A paciente morreu um ano depois. Discussão. As metástases de melanoma para o trato geniturinário são frequentes, mas as metástases vesicais isoladas são raras. O tratamento é geralmente RTU da lesão, cistectomia, quimioterapia e radioterapia. A RTU é curativa para lesões restritas ao epitélio, embora a cistectomia radical seja geralmente a terapia de escolha para um paciente com um tumor localizado. O Pembrolizumab demonstrou aumentar a sobrevivência. O prognóstico depende do tamanho e da profundidade da invasão. Conclusões. O comprometimento vesical metastático é raro e subdiagnosticado, pode estar presente em pacientes com melanoma, sintomas irritantes urinários não específicos e hematúria. Geralmente tem um prognóstico negativo e requer manejo cirúrgico em associação com manejo sistêmico.

Revista Urología Colombiana RUC: 35 de años evolución, cambio e impacto / Revista Urología Colombiana RUC: 35 years of evolution, change and impact

La Revista Urología Colombiana materializa un objetivo de la Sociedad Colombiana de Urología (SCU) como medio de difusión científico oficial de los resultados de investigación original, y de otro tipo trabajos de diferente diseño metodológico, con el único propósito de contribuir al incremento del conocimiento médico en el campo de nuestra especialidad. Tardaría casi 30 años desde la fundación de la SCU para lograr la aparición de RUC, que precedida por publicaciones efímeras como el "Boletín de Actividades" o el resumen del congreso.

The Revista Urología Colombiana materializes an objective of the Colombian Society of Urology (SCU) as a means of official scientific dissemination of the results of original research, and other work of different methodological design, with the sole purpose of contributing to the increase of medical knowledge in the field of our specialty. It would take almost 30 years since the foundation of the SCU to achieve the appearance of RUC, which was preceded by ephemeral publications such as the "Bulletin of Activities" or the summary of the congress.