Current status of robotic training during the urology residency: results from a national survey in Spain.

INTRODUCTION AND OBJECTIVES: The increasing number of robotic urological procedures observed in recent years highlights the need to expand training opportunities in robotic surgery. Our objective is to investigate the state of robotic training during urology residency in Spain in order to identify significant deficiencies. MATERIALS AND METHODS: A 20-item online survey was conducted among urology residents in Spain who were registered in the database of the Residents and Young Urologists Group of the Spanish Association of Urology. The survey assessed subjective opinions, institutional aspects, training resources, and experience regarding robotic surgery. A total of 455 email invitations were sent throughout the year 2021. Descriptive analysis of the responses was performed. RESULTS: The participation rate reached 30%, with a total of 135 residents. 52% of respondents lacked access to a robotic system in their institution, of which only 48% could compensate for this deficiency through external rotations. Among those with access to a robotic system, 25% and 23% reported having access to theoretical and practical training, respectively. The existence of a formal training program was low (13%). 85% of the respondents considered robotic surgery training in Spain to be deficient. CONCLUSIONS: Training for Spanish residents in robotic urological surgery is perceived as inadequate, emphasizing the crucial need for improvement in training programs in this field.

[Complex renal cyst. Laparoscopic treatment]. / Quiste renal complejo. Tratamiento laparoscópico.

The difference between the simple renal cysts, that doesn't require surgical treatment, and those that need it, sometimes is difficult. The laparoscopic surgical treatment (laparoscopic cyst decortication -laparoscopic partial nefrectomy or radical laparoscopic nefrectomy) its becoming the gold standard technique, recommending this procedure in Bosniak cyst type III or IV, and in the symptomatic renal cyst type I/II and in any patients with Bosniak cyst renal II. We present a case report in which a renal cell carcinoma was found after laparoscopic cyst decortication of Bosniak cyst type II with laparoscopic radical nefrectomy posteriorly.

[Unilateral agenesis of structures dependent on the mesonephric duct. Presentation of a case]. / Agenesia unilateral de las estructuras dependientes del conducto mesonéfrico. Presentación de un caso.

The mesonefric duct plays an essential role in the development of the genitourinary tract. From that duct derive structures as the ureter, the vas deferens and the seminal vesicles. Also, the ureteral bud interact with the mesonefric blastema and induce its conversion to renal tissue. The origin of these anomalies of the embrionary development is unknown. In some cases, mutations on the gene of the cystic fibrosis (CFRT) could play a role, assuming that there is a relationship between the congenital absence of the vas deferens and the cystic fibrosis. Usually, the absence of these structures has a silent course. Thus, the most important diagnostic factor is the clinical suspicion. The knowledge of this association can lead to the diagnosis of other congenital abnormalities. In addition, it is important to know that these anomalies could be present isolated as expression of other non-urological diseases, specially the cystic fibrosis, the most common hereditary disease between the Caucasian race.

[Localized sarcomatoid renal carcinoma. Which factors may predict its course?]. / Carcinoma renal sarcomatoide localizado. Qué factores pueden prever su evolución?

Sarcomatoid renal carcinoma constitutes an uncommon variant of renal carcinoma. Typically its behaviour is more aggressive than other forms of renal carcinoma and usually it is diagnosed at advanced stages. The main prognostic factor is the clinical stage at the time of the diagnosis. However, some cases initially are diagnosed at low stages having a poor prognosis, probably because there are other factors than the clinical stage which determinate its outcome. We report a case of sarcomatoid renal carcinoma confined inside the kidney capsule at the time of the diagnosis which had a rapidly bad progression. We review the characteristics of this tumour variant and analyse what factors, basically histological, could be helpful to predict its evolution.

[Small cell carcinoma of the bladder. Report of a new case and review of the literature]. / Carcinoma vesical de células pequeñas. Aportación de un nuevo caso y revisión de la literatura.

Small cell carcinoma of the bladder is a rare entity occurring in fewer than 1% of all the primary bladder tumors. Its clinic and epidemiologyc characteristics are similar to the transitional cell carcinoma. But, its more aggressive with a high tendency to infiltrate the muscular layer and to metastasize. Thus, therapeutic approach used by the pulmonary form has been applied to the bladder carcinoma. The best results has been achieved using systemic chemotherapy, not only in survival rates but in preserving the bladder integrity, playing the radical cystectomy a rescue role in cases of recurrence or persistence of the tumor. We report a new case of small cell carcinoma of the bladder and review the literature with special attention to the different therapeutic approaches.

[Primary retroperitoneal hydatidosis]. / Hidatidosis retroperitoneal primaria.

Genitourinary involvement by the Echinococcus granulosus larvae (urinary hydatidosis) ranks third in order of frequency after liver and lung involvement. The finding of a primary hydatidic cyst with retroperitoneal location is an uncommon fact. This paper presents once case of this infrequent disease. A revision of the different etiopathogenic mechanisms, as well as diagnostic and therapeutic approaches is made.

[Usefulness of the dynamic sentinel node technique in patients with penile carcinoma]. / Utilidad de la técnica del ganglio centinela dinámico en pacientes con carcinoma de pene.

OBJECTIVE: To explain and analyse when and how to use the new staging technique used in patients with squamous carcinoma of the penis, through the procedure of dynamic biopsy of the sentinel lymph node. PATIENTS AND METHODS: We demonstrate the technical application of the dynamic biopsy of the sentinel lymph node, in a 40-year-old patient, diagnosed as suffering from squamous carcinoma of the penis. We use preoperative lymphatic visualization through lymphogammagraphy, together with intraoperative detection through gamma scanning, in order to detect and identify the sentinel lymph node. CONCLUSIONS: We consider the dynamic biopsy of the sentinel node by the individual pattern of the lymphatic drainage as a new applicable Nuclear Medicina technique. It is an extremely useful technique in order to achieve early dissemination, by allowing us to identify patients with sub-clinic lymphatic spread, who will be candidates to regional lymphatic dissection.

Multicenter study on costs associated with two surgical procedures: GreenLight XPS 180 W versus the gold standard transurethral resection of the prostate.

OBJECTIVE: To analyze the costs associated with two surgical procedures for lower urinary tract symptoms secondary to benign prostatic hyperplasia: GreenLight XPS 180¦W versus the gold standard transurethral resection of the prostate. METHODS: A multicenter, retrospective cost study was carried out from the National Health Service perspective, over a 3-month time period. Costs were broken down into pre-surgical, surgical and post-surgical phases. Data were extracted from records of patients operated sequentially, with IPSS=15, Qmax=15 mL/seg and a prostate volume of 40-80mL, adding only direct healthcare costs (€, 2013) associated with the procedure and management of complications. RESULTS: A total of 79 patients sequentially underwent GL XPS (n: 39) or TURP (n: 40) between July and October, 2013. Clinical outcomes were similar (94.9% and 92.5%, GL XPS and TURP, respectively) without significant differences (P=.67). The average direct cost per patient was reduced by €114 in GL XPS versus TURP patients; the cost was higher in the surgical phase with GL XPS (difference: €1,209; P<.001) but was lower in the post-surgical phase (difference: €-1,351; P<.001). CONCLUSIONS: The GreenLight XPS 180-W laser system is associated with a reduction in costs with respect to transurethral resection of prostate in the surgical treatment of LUTS secondary to PBH. This reduction is due to a shorter inpatient length of stay that offsets the cost of the new technology.

Cost-effectiveness analysis at 2 years of surgical treatment of benign prostatic hyperplasia by photoselective vaporization of the prostate with GreenLight-Photo vaporization 120 W versus transurethral resection of the prostate.

INTRODUCTION: Transurethral resection of the prostate is the gold standard of surgical treatment of lower urinary tract symptoms associated to benign prostate hyperplasia. The new Green Light Photovaporization has been shown to be an alternative that is as effective for this condition as the transurethral resection of the prostate. OBJECTIVES: To compare the efficiency of Green Light Photovaporization 120 W versus transurethral resection of the prostate in the treatment of benign prostate hyperplasia (BPH) in a 2-year time horizon from the perspective of the Spanish health service perspective. METHODS: A cost utility analysis was performed retrospectively with the data from 98 patients treated sequentially with transurethral resection of the prostate (n: 50) and Green Light Photovaporization 120 W (n: 48). A Markov model was designed to estimate the cost (2012€) and results (quality adjusted life years) in a 2-year time horizon. RESULTS: The total cost associated to Green Light Photovaporization 120 W treatment was less (3,377€; 95% CI: 3,228; 3,537) than that of the transurethral resection of the prostate (3,770€; 95% CI: 3,579; 3,945). The determining factor of the cost was the surgical phase (difference: -450€; 95% CI: -625; -158) because admission to hospital after surgery was not necessary with the GreenLight-PhotoVaporization. CONCLUSIONS: Surgical treatment of BPH patients with GreenLight-PhotoVaporization 120 W is more efficient than transurethral resection of the prostate in the surgical treatment of benign prostate hyperplasia as it has similar effectiveness and lower cost (-393€; 95% CI: -625; -158).

Quiste renal complejo. Tratamiento laparoscópico / Complex renal cyst. Laparoscopic treatment

La diferenciación entre los quistes renales benignos, que no requieren tratamiento quirúrgico, y aquellos que requieren exploración quirúrgica en ocasiones es difícil. El tratamiento mediante cirugía laparoscópica (Decorticación quística - Nefrectomía laparoscópica parcial o radical según los hallazgos) se establece día a día como el tratamiento de elección en los pacientes con quiste Renal atípico o complejo Grado III y IV de Bosniak, así como en los quistes renales tipo I/II sintomáticos y en determinados pacientes con quiste renal etiquetado como IIF de Bosniak. Presentamos un caso clínico en el que se halla carcinoma renal de células claras tras decorticación laparoscópica de un quiste Grado II de Bosniak, con realización posterior de nefrectomía radical laparoscópica

The difference between the simple renal cysts, that doesn’t require surgical treatment, and those that need it, sometimes is difficult. The laparoscopic surgical treatment (laparoscopic cyst decortication –laparoscopic partial nefrectomy or radical laparoscopic nefrectomy) its becoming the gold standard technique, recommending this procedure in Bosniak cyst type III or IV, and in the symptomatic renal cyst type I/II and in any patients with Bosniak cyst renal II . We present a case report in which a renal cell carcinoma was found after laparoscopic cyst decortication of Bosniak cyst type II with laparoscopic radical nefrectomy posteriorly

Agenesia unilateral de las estructuras dependientes del conducto mesonéfrico. Presentación de un caso / Unilateral agenesis of the structures dependent on development of mesonefric duct. A case report

El conducto mesonéfrico juega un papel fundamental en el desarrollo del sistema genitourinario. De él, derivarán directamente el uréter, el conducto deferente y las vesículas seminales. A su vez, el brote ureteral interaccionando con el blastema mesonéfrico inducirá su conversión hacia tejido renal. Se desconoce el origen de estas anomalías del desarrollo embrionario. En algunos casos, se atribuye cierto papel al gen responsable de la fibrosis quística (CFRT) por la estrecha relación entre la agenesia deferencial y la fibrosis quística. La ausencia de estas estructuras suele tener un curso silente. Con frecuencia, su hallazgo es casual al explorar los deferentes o tras una prueba radiológica. La principal herramienta diagnóstica es la sospecha clínica. El conocimiento de estas asociaciones es lo que conducirá al diagnostico del resto de estructuras ausentes. Por otra parte, es necesario tener presente que también se pueden dar de forma aislada y su posible asociación con otras anomalías o enfermedades no urológicas, en especial con la fibrosis quística, la enfermedad hereditaria más frecuente en la raza caucásica (AU)

The mesonefric duct plays an essential role in the development of the genitourinary tract. From that duct derive structures as the ureter, the vas deferens and the seminal vesicles. Also, the ureteral bud interact with the mesonefric blastema and induce its conversion to renal tissue. The origin of these anomalies of the embrionary development is unknown. In some cases, mutations on the gene of the cystic fibrosis (CFRT) could play a role, assuming that there is a relationship between the congenital absence of the vas deferens and the cystic fibrosis. Usually, the absence of these structures has a silent course. Thus, the most important diagnostic factor is the clinical suspicion. The knowledge of this association can lead to the diagnosis of other congenital abnormalities. In addition, it is important to know that these anomalies could be present isolated as expression of other non-urological diseases, specially the cystic fibrosis, the most common hereditary disease between the Caucasian race (AU)

Carcinoma renal sarcomatoide localizado. ¿Qué factores pueden prever su evolución? / Localized sarcomatoid renal carcinoma. what factors could foresse its evolution?

El carcinoma renal sarcomatoide constituye una variante poco frecuente del carcinoma renal. Típicamente su comportamiento es más agresivo que el de otras formas de carcinoma de células renales, siendo habitualmente diagnosticado en estadios avanzados. El principal factor pronóstico es el estadio en el momento del diagnóstico. Sin embargo, algunos casos inicialmente se presentan aparentemente en estadios bajos mostrando igualmente un mal pronóstico probablemente porque existan otros factores, además del estadio, que determinen su evolución. Presentamos un caso de carcinoma renal sarcomatoide órgano-confinado en el momento del diagnóstico que presentó una evolución fulminante. Revisamos las características de estos tumores y analizamos que otros factores, fundamentalmente histológicos, que además del estadio clínico pueden ayudar a predecir la evolución del tumor (AU)

Carcinoma vesical de células pequeñas. Aportación de un nuevo caso y revisión de la literatura / Small cell carcinoma of the bladder. Report of a new case and review of the literature

El carcinoma vesical de células pequeñas representa menos del 1 per cent de los tumores vesicales. Sus características clínicas y epidemiológicas son similares a las del carcinoma transicional. Sin embargo, presenta una mayor agresividad con una elevada tendencia a la infiltración muscular y a la diseminación a distancia. Estos factores y la baja supervivencia observada en estos tumores han motivado la aplicación de esquemas terapéuticos similares a los empleados en el carcinoma pulmonar de células pequeñas. Con la quimioterapia sistémica como eje del tratamiento se han conseguido los mejores resultados no sólo en cuanto a supervivencia sino también en cuanto a preservación vesical, jugando la cistectomía radical un papel de rescate en caso de persistencia local de la enfermedad. Presentamos un nuevo caso de carcinoma vesical de células pequeñas y revisamos la literatura con especial énfasis en las mejores opciones terapéuticas de estos tumores (AU)

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Utilidad de la técnica del ganglio centinela dinámico en pacientes con carcinoma de pene / Utility of dynamic sentinel lymph node procedure in patients with carcinoma of the penis

OBJETIVO: Explicar y analizar, cuándo y cómo realizar la nueva técnica de estadiaje utilizada en los pacientes con carcinoma escamoso de pene, mediante el procedimiento de biopsia dinámica del ganglio centinela. MATERIAL Y MÉTODOS: Exponemos la aplicación de la técnica de biopsia dinámica de ganglio centinela en un paciente de 40 años, diagnosticado de carcinoma escamoso de pene. Mediante combinación de la visualización linfática preoperatoria mediante linfogammagrafía, con la detección intraoperatoria con sonda gamma, se logra detectar e identificar el ganglio centinela. CONCLUSIONES: Consideramos la biopsia dinámica del ganglio centinela, por el patrón individual de drenaje linfático, como una nueva exploración aplicable de Medicina Nuclear. Se trata de una técnica de gran utilidad en la detención precoz de diseminación, permitiendo la identificación de pacientes con afectación linfática, clínicamente inadvertida, que puedan y deban ser subsidiarios de disección regional linfática (AU)