Robot-Assisted Radical Prostatectomy by Lateral Approach: Technique, Reproducibility and Outcomes.

BACKGROUND: Radical prostatectomy by lateral approach allows performing a prostatectomy through a buttonhole, with direct access to the seminal vesicle and fully sparing the anterior pubovesical complex. Our aim is to show the results of reproducing the technique of robotic radical prostatectomy by lateral approach, in terms of intraoperative, postoperative, oncological and functional parameters. METHODS: We analyzed 513 patients submitted to robotic radical prostatectomy by lateral approach from January 2015 to March 2021, operated on by two surgeons in our institution. The oncological and functional results of both surgeons were compared. RESULTS: When comparing both surgeons, the rate of positive surgical margins (PSM) was 32.87% and 37.9% and significant surgical margins (PSM > 2 mm) were 5.88% and 7.58% (p = 0.672) for surgeon 1 and surgeon 2, respectively. Immediate continence was 86% and 85% and sexual potency at one year 73% and 72%, with a similar rate of complications for surgeon 1 and 2. CONCLUSIONS: Radical prostatectomy by the lateral approach technique with preservation of the anterior pubovesical complex is reproducible and offers good oncological and functional results.

Results from a global multicenter registry of 6193 patients to refine endoscopic anatomical enucleation of the prostate (REAP) by evaluating trends and outcomes and nuances of prostate enucleation in a real-world setting.

PURPOSE: To collect a multicentric, global database to assess current preferences and outcomes for endoscopic enucleation of the prostate (EEP). METHODS: Endourologists experienced in EEP from across the globe were invited to participate in the creation of this retrospective registry. Surgical procedures were performed between January 2020 and August 2022. INCLUSION CRITERIA: lower urinary tract symptoms not responding to or worsening despite medical therapy and absolute indication for surgery. EXCLUSION CRITERIA: prostate cancer, concomitant lower urinary tract surgery, previous prostate/urethral surgery, pelvic radiotherapy. RESULTS: Ten centers from 7 countries, involving 13 surgeons enrolled 6193 patients. Median age was 68 [62-74] years. 2326 (37.8%) patients had large prostates (> 80 cc). The most popular energy modality was the Holmium laser. The most common technique used for enucleation was the 2-lobe (48.8%). 86.2% of the procedures were performed under spinal anesthesia. Median operation time was 67 [50-95] minutes. Median postoperative catheter time was 2 [1, 3] days. Urinary tract infections were the most reported complications (4.7%) followed by acute urinary retention (4.1%). Post-operative bleeding needing additional intervention was reported in 0.9% of cases. 3 and 12-month follow-up visits showed improvement in symptoms and micturition parameters. Only 8 patients (1.4%) required redo surgery for residual adenoma. Stress urinary incontinence was reported in 53.9% of patients and after 3 months was found to persist in 16.2% of the cohort. CONCLUSION: Our database contributes real-world data to support EEP as a truly well-established global, safe minimally invasive intervention and provides insights for further research.

Holmium laser with MOSES technology (MoLEP) vs Thulium fiber laser enucleation of the prostate (ThuFLEP) in a real-world setting. Mid-term outcomes from a multicenter propensity score analysis.

PURPOSE: To compare Holmium laser with MOSES technology (MoLEP) and Thulium fiber laser enucleation of the prostate (ThuFLEP) in terms of surgical and functional outcomes. METHODS: We performed a retrospective analysis of all patients who underwent either procedure in five centers (January 2020-January 2022). EXCLUSION CRITERIA: previous urethral/prostatic surgery, radiotherapy, concomitant surgery. Propensity score matching (PSM) analysis was performed to adjust for the bias inherent to the different characteristics at baseline. Differences between procedures were estimated using Firth Penalized Likelihood regression for International prostate symptom score (IPSS), quality of life (QL), maximum flow rate (Qmax). RESULTS: PSM retrieved 118 patients in each group. Baseline characteristics were similar except for PSA and number of men on indwelling catheter (higher in MoLEP group). Median surgical time was significantly longer in the MoLEP group despite the enucleation and morcellation times being similar. Median catheter dwelling time and postoperative length of stay were similar. Most of the early complications were Clavien ≤ 2 grade. There were only two Clavien grade 3 complications (one for each group), one grade 4 in MoLEP group. Rate and type of early and persistent incontinence (> 3 months) were similar. At 12-month, proportion of patients reaching a decrease (Δ) of IPSS ≥ 18 from baseline was significantly larger in MoLEP group, with no significant difference in ΔQmax > 12 ml/sec and ΔQL ≥ -3. CONCLUSION: MoLEP and ThuFLEP were safe and efficacious procedures with similar short-term operative and functional outcomes. At 1-year, MoLEP patients had a sustained reduction of IPPS score.

Evidence-based Medicine: Perceptions, Attitudes, and Skills Among European Urology Residents.

Background: Evidence-based medicine (EBM) was introduced as a concept in the early 1990s as an integration of the best available evidence with clinical expertise and patient values. Objective: To evaluate the current status of EBM training and EBM perception, attitudes, and self-perceived skills among European urology residents. Design setting and participants: Our online open survey comprised 28 multiple-choice items, including ten questions with responses on a five-point Likert scale ranging from 1 = strongly disagree to 5 = strongly agree. The survey was distributed via the mailing lists and social media accounts of the European Society of Residents in Urology, German Society of Residents in Urology, French Society of Urologists in Training, Spanish Urology Residents Working Group, Italian Society of Residents in Urology, and the Urology Social Media Working Group in two rounds (May-July 2019 and July 2020). We excluded responses from non-European countries. Outcome measurements and statistical analysis: The online open survey comprised 28 multiple-choice items. These included ten questions with answers on a five-point Likert scale with response items ranging from strongly disagree (score of 1) to strongly agree (score of 5). Results and limitations: We received 210 responses, of which 181 from 23 European countries were eligible. Approximately three-quarters (73.7%) of the respondents were male, with a mean age of 31 yr. Only 28.2% reported EBM training as part of their urology curriculum and 19.3% felt that the training they received was sufficient to guide their daily practice. An overwhelming majority (91.5%) stated that they would be interested in more formalized EBM training or additional training. There was a strong level of agreement (median score 5, interquartile range 4-5) that EBM is important for daily medical and surgical practice and that it improves patient care. Overall, the mean self-perceived understanding of basic EBM concepts was good. Limitations include concerns about generalizability given its internet-based format, the inability to calculate a response rate, poor representation from some European regions, and limited sample size. Conclusions: Our survey suggests that European urology residents receive a limited amount of EBM training despite considerable appreciation, interest, and self-perceived deficits for more advanced concepts. Formal integration of EBM teaching in all European residency programs should be considered. Patient summary: We performed an online survey of urology residents in Europe. We found that residents have positive perceptions of and attitudes to evidence-based medicine but most programs lack formal training in this area.

Shaping the Undergraduate Curriculum in Europe: Consensus Statement from the European School of Urology.

The European School of Urology has created a taskforce to develop a comprehensive, structured urology curriculum with clinical exposure, practical skills, and hands-on training. The curriculum proposal includes cognitive teaching by symptoms and practical aspects to guarantee uniform access to undergraduate medical education in urology among all European countries, regardless of location, local urology exposure, or bias in national curricula.

Annual educational expenses of European urology residents and the role of sponsorship in urology training: a survey-based analysis.

Introduction: The aim of this article was to evaluate the personal monetary costs associated with the urology residency. Material and methods: The European Society of Residents in Urology (ESRU) designed a 35-item survey and distributed it via email and social media to urology residents in Europe.Monthly net salary and educational expenses (general expenses, literature, congresses and courses) and opinions regarding sponsorship and expenditure were evaluated. Comparisons between different countries and salary cut-offs were made. Results: A total of 211 European urology residents completed the survey from 21 European countries. The median interquartile range (IQR) age was 30 (18-42) years and 83.0% were male. A total of 69.6% receive less than €1500 net per month and 34.6% spent ≥€3000 on education in the previous 12 months. Sponsorships came mainly from the pharmaceutical industry (57.8%), but 56.4% of trainees thought that the ideal sponsor should be the hospital/urology department. Only 14.7% of respondents stated that their salary is sufficient to cover training expenses, and 69.2% agreed that training costs have an influence on family dynamics. Conclusions: Personal expenses during training are high, are not sufficiently covered by the salary and impact family dynamics for a majority of residents in Europe. The majority thought that hospitals/national urology associations should contribute to the educational costs. For homogeneous opportunities across Europe, institutions should strive to increase sponsorship.

Essentials for Standardising the Undergraduate Urology Curriculum in Europe: Outcomes of a Delphi Consensus from the European School of Urology.

BACKGROUND: The burden of urological diseases is rising as the worldwide population ages. Although specialist urological provision is needed, a large proportion of these conditions will be managed in primary care. The importance of including urology in medical education currently remains unclear. OBJECTIVE: To provide recommendations on undergraduate medical education for urology in Europe. DESIGN SETTING AND PARTICIPANTS: A three-round Delphi process to reach consensus on standardising the undergraduate urology curriculum in Europe was endorsed by the European School of Urology. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: The levels of agreement were set using a nine-point scale according to the GRADE grid: 1-3, disagree; 4-6, uncertain; and 7-9, agree. Consensus was defined as at least 70% of the participants scoring within the same 3-point grouping. RESULTS AND LIMITATIONS: Overall, consensus was reached for 20 of 34 statements (70.5%) across the three Delphi rounds, with agreement for 75% (n = 15) and disagreement for 25% (n = 5). The following main points were agreed. Urological teaching should be introduced before year 5 of medical school, with at least 20 h of theoretical activities and at least 30 h of practical activities. Urology should be taught as a stand-alone subject rather than combined with another surgical specialty or a nephrology programme. The participants agreed that urology should be taught according to symptoms. A urology programme should include the anatomy and physiology of the urinary tract, and students should know how to clinically assess a urological patient. CONCLUSIONS: Our recommended urology pathway will allow European medical schools to provide a more comprehensive undergraduate urology curriculum. It will also help to improve and maintain standards of urology undergraduate teaching across Europe. PATIENT SUMMARY: Our survey showed that urology in universities should have, at minimum, time for theoretical and practical activities and should be taught as a stand-alone subject on the basis of symptoms. Students should give feedback to facilitate constant improvement and evolution of the teaching programme.

Robotic Repair of Ureteral Strictures: Techniques and Review.

PURPOSE OF REVIEW: To provide an overview and description of the different surgical techniques for the robotic repair of ureteral strictures. RECENT FINDINGS: The robotic repair of ureteral stenosis has emerged as a useful option for treating strictures unsuitable for endoscopic resolution with good results, lower morbidity, and faster recovery than open techniques. Depending on the stricture's length and location, the reconstructive options are reimplantation, psoas hitch, Boari flap, ureteroureterostomy, appendiceal onlay flap, buccal mucosa graft (BMG) ureteroplasty, ileal replacement, or renal autotransplantation. The robotic approach offers a magnified vision and the possibility of adding near-infrared fluorescence (NIRF) imaging, indocyanine green (ICG), and FireflyTM to facilitate the technique. Multicenter studies with extended follow-up still have to confirm the good results obtained in published case series. Robotic reconstructive techniques are useful for repairing ureteral strictures, obtaining good functional results with less morbidity and faster recovery than open procedures.

The Uro-oncology Patient and Vaccination Against SARS-CoV-2.

As of April 13, 2021, 137 million cases of COVID-19 and 2.95 million deaths have been reported worldwide. On December 21, 2020, the Pfizer-BioNTech vaccine was approved for use in the European Union, with efficacy of 95% protection against COVID-19 infection. Several other vaccines are at different stages of assessment by the European Medicines Agency. In addition to the elderly, oncology patients are a vulnerable population in which COVID-19 infection may be more severe. However, owing to the design of the initial studies, evidence on the safety and efficacy of vaccination against SARS-CoV-2 in these patients is scarce and recommendations are based on the opinion of associations, stakeholders, and experts via extrapolation of information and experience for other vaccines, especially influenza vaccines. Despite the limited evidence, the consensus is that SARS-CoV-2 vaccines are safe and vaccination of oncology patients and their close relatives is recommended, although efficacy may be lower in patients with an impaired immune response and the need for additional booster doses is not yet clear. Recommendations include avoiding the use of vaccines based on viral vectors for patients with an impaired immune response, deferring vaccination for immunosuppressed patients or administering the vaccine before immunosuppression, and avoiding chemotherapy receipt between the two doses of a vaccine or on the same day that the vaccine is administered. These recommendations can be extrapolated to urology patients and although evidence is lacking, there should not be greater interference with SARS-CoV-2 vaccines from androgen deprivation therapy or intravesical bacillus Calmette-Guérin. However, large studies to provide strong evidence for uro-oncology patients are needed. PATIENT SUMMARY: We looked at the effects of COVID-19 vaccination for patients with urological cancers. The consensus is that the vaccines are safe, and vaccination of cancer patients and their close relatives is recommended.

Conservative treatment of upper urinary tract carcinoma in patients with imperative indications.

BACKGROUND: To report our experience for endoscopic treatment of upper urinary tract carcinoma (UTUC) in patients with imperative indications for management. METHODS: Retrospective data were collected for all patients who underwent endoscopic management of UTUC for imperative situations, from September 2013 to January 2019. Comorbidity was determined by using the age-adjusted Charlson Comorbidity Index (CCI). The primary endpoint of the study was overall survival (OS). Secondary outcomes were recurrence-free survival (RFS) rates, complication rates and global renal function. RESULTS: A total of 29 patients were enrolled in the study. The median age was 69.0 (IQR 63.0-79.0) years and the median CCI was 6 (IQR 4-8). Overall, 137 endoscopic procedures were performed; 117 (85.4%) had no complication. Clavien-Dindo grade III and IV complications were 3 (2.2%) and 1 (0.7%) respectively. The median follow-up of 23 months (IQR 14-35). During the follow-up, 2 (6.9%) patients died for cause not related to cancer. Recurrence of UTUC occurred in 18 patients (61.1%). The 24-month OS was 96.4±3.5% and the 24-month RFS was 31.7±9.4%. Lower RFS rates were found in high grade tumor patients (22.2±13.9%) compared to low grade tumor patients (35.6±12.3%) (P=0.237). There was statistical difference in creatinine and eGFR values when comparing baseline to last follow-up (P=0.018 and P=0.005, respectively). CONCLUSIONS: Endoscopic management of UTUC in patients with imperative indications appears to be a reasonable alternative to nephroureterectomy. However, stringent endoscopic follow-up is necessary due to the high risk of disease recurrence.

Knowledge gap across continents: the andrology and male infertility exposure among urology residents in the United States and Europe.

It is well established that resident's exposure and training are of primary importance and positively correlated with patient and health quality outcomes. We aimed to compare and contrast urology residents' self-reported perspectives and attitudes toward exposure and education of andrology and male infertility during residency in both the United States and Europe. We performed a cross-sectional design study using a survey that was distributed to a representative sample of American and European urology residents. The survey included questions regarding demographics, and the residents' perception and description of their training in this specific subspecialty. Response data were analyzed using Chi-square tests. Sixty-five percent of European and thirty-five percent American urology residents reported feeling uncomfortable in a new consultation evaluating an infertile patient and interpreting semen analyses. Surprisingly, more than half of responders replied that they would not go to their own training institutions seeking for male fertility care (78% US and 58% Europeans). In the comparative analysis, although no differences were observed in the very low number (18%) of hospitals that offer formal microsurgical training for urology residents between the US and Europe, more US institutions were reported to have an operating microscope for urology (68% vs. 41%), and more US residents replied reported participating in at least one urologic surgery using the microscope (65% vs. 34%). In conclusion, both American and European residents shared the same frustration regarding their education and exposure to andrology and male infertility during residency training. Collaborative efforts between stakeholders are needed to establish a clear and focused curriculum and training objectives to eliminate this educational gap.

Thulium:YAG Versus Holmium:YAG Laser Effect on Upper Urinary Tract Soft Tissue: Evidence from an Ex Vivo Experimental Study.

Introduction: There are limited data regarding the effect of thulium laser (Tm:YAG) and holmium laser (Ho:YAG) on upper urinary tract. The aim of this study was to compare soft tissue effects of these two lasers at various settings, with a focus on incision depth (ID) and coagulation area (CA). Materials and Methods: An ex vivo experimental study was performed in a porcine model. The kidneys were dissected to expose the upper urinary tract and the block samples containing urothelium and renal parenchyma were prepared. The laser fiber, fixed on a robotic arm, perpendicular to the target tissue was used with a 100 W Ho:YAG and a 200 W Tm:YAG. Incisions were made with the laser tip in contact with the urothelium and in continuous movement at a constant speed of 2 mm/s over a length of 1.5 cm. Total energy varied from 5 to 30 W. Incision shape was classified as follows: saccular, triangular, tubular, and irregular. ID, vaporization area (VA), CA, and total laser area (TLA = VA + CA) were evaluated. Statistical analysis was performed using the SPSS V23 package, p-values <0.05 were considered statistically significant. Results: A total of 216 experiments were performed. Incision shapes were saccular (46%), triangular (38%), and irregular (16%) with the Ho:YAG, while they were tubular (89%) and irregular (11%) with the Tm:YAG. ID was significantly deeper with the Ho:YAG (p = 0.024), while CA and TLA were larger with the Tm:YAG (p < 0.001 and p < 0.005). Conclusion: ID was deeper with Ho:YAG, whereas CA and TLA were larger with the Tm:YAG. Considering surgical principles for endoscopic ablation of upper tract urothelial carcinoma, these results suggest that Tm:YAG may have a lower risk profile (less depth of incision) while also being more efficient at tissue destruction. Future in vivo studies are necessary to corroborate these findings.

En bloc MoLEP (MOSES HoLEP) with early apical dissection and preservation of the sphincter's mucosa. Surgical technique and technology developments that allow a new paradigm of endoscopic prostate enucleation. / MoLEP (MOSES HoLEP) en bloque con liberación apical precoz y preservación de la mucosa esfinteriana. Evolución de la técnica quirúrgica y la tecnológica que permiten un nuevo paradigma de enucleación endoscópica anatómica de próstata.

Endoscopic enucleation of the prostate was first described by Hiraoka in 1986, using a monopolar resectoscope. His contribution was largely ignored until Gilling and Fraundorfer published their three-lobe enucleation technique with the Holmium laser in 1998 ,that ended establishing itself as a reliable option for the treatment of HBP, backed by ample scientific evidence. Later on, enucleation performed with other lasers, as well as bipolar energy, have shown concordance in their clinical results. As a result, the term AEEP (anatomic endoscopic enucleation of the prostate) emerged to encompass all these techniques. During the last few years there have been significant advances in two areas: first, technology, with the development of pulse modulation for Holmium generators (MOSES) as well as high-speed morcellators. Second, the development of new surgical techniques that recognize the importance of the early release of the sphincter from the apex of the adenoma during the operation as well as the careful preservation of the external sphincter's mucosa, to avoid early stress incontinence. In this paper,we review the recent evolution of both technology and surgical technique. AEEP has been risen to a new level, reducing operative time significantly, usually under one hour, and radically reducing the incidence of early temporary stress incontinence, and maybe also facilitating the learning curve of AEEP.

La enucleación endoscópica de próstata fue descrita por primera vez por Hiraoka en 1986, usando un resector monopolar. Su aportación pasó desapercibida hasta que Gilling y Fraundorfer publicaron su técnica de enucleación en tres lóbulos con láser de Holmio en 1998, que se estableció como una opción de tratamiento de la obstrucción prostática benigna ampliamente respaldada por la evidencia científica. Posteriormentes e ha estudiado el uso de otros láseres así como de la energía bipolar para realizar enucleación  endoscópica y se ha observado una concordancia en los resultados de estas técnicas, independientemente de la fuente de energía utilizada, que ha conducido a englobarlas bajo el acrónimo EEAP (enucleación endoscópica anatómica de próstata). En los últimos años se han producido avances muy relevantes en dos ámbitos: Uno, el ámbito tecnológico, con el desarrollo de la tecnología de modulación del pulso del láser de Holmio (MOSES) y de los morceladores de alto rendimiento. Otro, el desarrollo de nuevas técnicas quirúrgicas, que reconocen la importancia de liberar precozmente el esfínter del ápex del adenoma en la intervención y de preservar escrupulosamente la mucosa del esfínter externo, para evitar la incontinencia urinaria precoz postoperatoria. En este artículo se revisa la evolución reciente de la tecnología y de la técnica quirúrgica que han elevado a la enucleación endoscópica de próstata a otro nivel, reduciendo significativamente el tiempo operatorio, normalmente inferior a una hora, disminuyendo radicalmente la incontinencia precoz postoperatoria y probablemente, facilitando el aprendizaje de la técnica.

Simulator Availability Index: a novel easy indicator to track training trends. Is Europe currently at a urological training recession risk?

INTRODUCTION: To evaluate the European trend regarding the availability of surgical simulators and to propose a novel index to easily track this trend. MATERIAL AND METHODS: During European Urology Residents Education Program, from 2014 to 2018, residents were asked through an anonymous survey about the availability of specific simulator training boxes at their department. The Simulator Availability Index (SAI) was made by the ratio between the number of departments with at least one box trainer and the total number of departments evaluated. RESULTS: The SAI decreased in five years from 0.47 to 0.41 for laparoscopic trainers, while the already low initial SAI (0.17) decreased by up to 0.05 in four years for both ureteroscopy (URS) and transurethral resection (TUR) trainers. CONCLUSIONS: A self-analysis may be advisable in order to improve the spread of information and investigate whether any specific reasons may be responsible for this trend. The SAI might be a simple but useful tool to monitor and evaluate this trend in the context of national training plans.

Telemedicine and Smart Working: Recommendations of the European Association of Urology.

CONTEXT: Telemedicine provides remote clinical support using technological tools. It may facilitate health care delivery while reducing unnecessary visits to the clinic. The coronavirus disease 2019 (COVID-19) outbreak has caused an abrupt change in our daily urological practice, converting many of us to be reliant on telehealth. OBJECTIVE: To provide practical recommendations for effective use of technological tools in telemedicine. EVIDENCE ACQUISITION: A Medline-based and gray literature search was conducted through April 2020. We selected the most relevant articles related to "telemedicine" and "smart working" that could provide important information. EVIDENCE SYNTHESIS: Telemedicine refers to the use of electronic information and telecommunications tools to provide remote clinical health care support. Smart working is a model of work that uses new or existing technologies to improve performance. Telemedicine is becoming a useful invaluable tool during and even beyond the COVID-19 pandemic. It is time for us to formalize the place of telemedicine in routine urological practice, and it is our responsibility to adapt and learn about all the tools and possible strategies for their optimal implementation during the pandemic to ensure that the quality of care received by patients and the outcomes of patients and their families are of the highest standard. CONCLUSIONS: Telemedicine facilitates specialized urological clinical support at a distance, solves problems of limitations in mobility, reduces unnecessary visits to clinics, and is useful for reducing the risk of viral transmission in the current COVID-19 outbreak. Furthermore, both personal and societal considerations may favor continued use of telemedicine, even beyond the COVID-19 pandemic. PATIENT SUMMARY: Telemedicine in urology offers specialized remote clinical support to patients, similar to face-to-face visits. It is very useful for reducing unnecessary visits to the clinic, as well as reducing the risk of contagion in the current coronavirus disease 2019 (COVID-19) pandemic.

Undergraduate Education for Urology in Europe. Where Do We Stand?

Regardless of career intentions, junior doctors will meet patients with urological problems. There are no studies on the status of undergraduate education for urology in Europe. We designed an 18-item online survey using the platform www.surveymonkey.com to assess the current status of undergraduate education in urology. A total of 347 medical students, trainees, and urologists responded to the survey. Medical students' exposure to urology during their undergraduate career was heterogeneous. Although the quality of urology education was valued from moderate to high, urology as a speciality did not influence their future training decision making. Decision making in relation to residency training correlated with the number of hours spent on practical training, duration of urology rotation, and year of medical school in which urological exposure was introduced. The current European exposure to urology at undergraduate level is heterogeneous, with various factors influencing future decisions regarding training and specialisation. A uniform undergraduate curriculum would eliminate such heterogeneous exposure and facilitate a workforce fit for the future urological needs. PATIENT SUMMARY: Junior doctors will meet patients with urological problems in the wards, emergency departments, and primary care. Institutions should work together for a urological curriculum that fits the future clinical requirements.

[Implementation of Remote Clinics in urology practice during the COVID-19 era: What have we learned?] / Implementación de la teleconsulta en la práctica urológica durante la era Covid-19: ¿qué hemos aprendido?

The COVID-19 pandemic has requiredd rastic measures for an attempt in controlling its spread. Health resources and facilities are being destined for the treatment of critically ill infected patients. During the past weeks, we, as urologists have faced increasingly difficult changes in practice, as out patient activity and elective surgeries must be postponed in order to save resources and limit the mobilization of patients and faculty. During this conflictive situation, telehealth medicine can provide adequate support using technological tools and trying to simulate face-to-face consults with the use of video or telephone calls. However, many out patient clinics and facilities are not ready yet for telehealth as their experience in this area is low. The benefits for telemedicine in urology are continuing urologic outpatient follow-up, providing recommendations and prescriptions, and the triage of patients who will need urgent procedures. Urology residency training has suffered an abrupt disruption nowadays as outpatient, surgical and academic meetings are cancelled. In this scenario, virtual strategies and "smart learning" activities are being used to continue education. We provide a review of the latest published literature regarding the use of telehealth medicine or telemedicine for the modern urology practice, along side our recommendations and conclusions.

La actual pandemia por COVID-19 ha requeridola implementación de medidas drásticas para frenar su avance. Las instalaciones y recursos sanitarios se están destinando de forma total o parcial para la atención de pacientes críticos. Los urólogos, nos hemos encontrado durante las semanas pasadas con cambios importantes que dificultan nuestra práctica clínica diaria. Las actividades ambulatorias como consultas externas y procedimientos ambulatorios, así como las intervenciones quirúrgicas, han tenido que ser suspendidas o retrasadas. Mientras dure esta situación, la actividad médica telemática puede proveer un soporte adecuado utilizando herramientas tecnológicas y tratando de simular las consultas médicas con vídeo llamadas o llamadas por teléfono. Pero muchos servicios y departamentos médico-quirúrgicos no se encuentran listos para implementar una práctica de consultas telemáticas a gran escala porque su experiencia es escasa. Los beneficios de la telemedicina en urología son permitir el seguimiento de pacientes, dar recomendaciones, prescribir medicamentos, y realizar un triaje de qué pacientes precisan una atención presencial en urgencias. Los programas de formación de residentes de urología también han sufrido una interrupción importante de sus actividades cotidianas, ya que se han suspendido consultas, cirugías y actividad académica. En esta situación, el uso de recursos virtuales y el "aprendizaje inteligente" se están utilizando para mantener la docencia. El objetivo de este artículo es proporcionar una revisión de la más reciente literatura acerca del uso de telemedicina en la práctica urológica moderna, con nuestras recomendaciones y conclusiones.

Semirigid Ureteroscopy: Step by Step.

This article aims to demonstrate a step-by-step technique of semirigid ureteroscopy (URS) for the treatment of ureteral stones, urothelial tumors, and ureteral stenosis. Operating room setup, camera settings, access to the bladder, and negotiation of the ureteral orifice, lasertripsy, basketing of the stone fragments, endoscopic treatment of ureteral tumors and ureteral stenosis, flexible URS at the end of semirigid URS, and Double-J stent placement are described step by step.