Age-related prevalence of diabetes mellitus, cardiovascular disease and anticoagulation therapy use in a urolithiasis population and their effect on outcomes: the Clinical Research Office of the Endourological Society Ureteroscopy Global Study.

PURPOSE: This study examined the prevalence of risk factors for urological stone surgery and their possible influence on outcome and complications following ureteroscopy (URS). METHODS: The Clinical Research Office of the Endourological Society Ureteroscopy Global Study collected prospective data on consecutive patients with urinary stones treated with URS at centers around the world for 1 year. The prevalence of common comorbidities and anticoagulation therapy and their relationship with complications and age were examined. RESULTS: Of 11,719 patients, 2,989 patients (25.8%) had cardiovascular disease, including 22.6% with hypertension, and 1,266 patients (10.9%) had diabetes mellitus. Approximately six percent of patients were receiving oral anticoagulation therapy, including aspirin (3.7%) and clopidogrel (0.8%). The prevalence of hypertension and diabetes mellitus and the proportion of patients receiving anticoagulant medication and/or antidiabetes treatment increased with age. Elderly were more likely to develop a postoperative complication when they had diabetes, a cardiovascular disease or received anticoagulation therapy. Post-operative bleeding was higher in patients receiving anticoagulants than those not receiving them (1.1 vs. 0.4%; p < 0.01). Patients with risk factors for stone formation had more complications than those without (4.9 vs. 3.0%, p < 0.001). CONCLUSIONS: This is the first study confirming in a global population that URS can effectively and safely be performed in a population with high comorbidity. The risk of a complication was highest among elderly patients presenting with comorbidities.

[Prostate adenocarcinoma. Predictive clinical model of seminal vesicle involvement]. / Adenocarcinoma de próstata. Modelo clínico predictivo de afectación de vesícula seminal.

OBJECTIVES: Our aim is to design a predictive model of seminal vesicle involvement. using clinical data. METHODS: We studied 1128 patients with clinically localized adenocarcinoma treated by radical prostatectomy (127 were pT3b). We identified (logistic regression) clinical variables related with pT3b. With the multivariate study influential variables a seminal vesicle involvement risk model is designed. RESULTS: Seminal vesicle involvement related factors: In univariate study: the influential variables are: Gleason 7 (OR:2);Gleason 8-10 (OR:4.5) T2 (OR:2.6); bilateral involvement in biopsy (OR:3.1); PSA 10-20 ng/ml ( OR:3.3); PSA >20 ng/ ml (OR:9.5). In the multivariate study are influential: Gleason 7 (OR:1.56) Gleason 8-10 ( OR: 3.4); T2 (OR:1.9); PSA 10-20 ng/ml (OR:3.1) and PSA >20 ng/,ml (OR:8.8). Predictive model: using multivariate logistic regression the weight of each variable is valued and a value between 1 and 4 is given. Gleason 2-6, T1; PSA<10 ng/ml value 1; Gleason 7; T2 y PSA 10-20 ng/ml value 2; Gleason 8-10 and PSA >20 ng/ml value 4. Each patient has a marker that fluctuates between 3 and 10. 5 Groups are designed with significantly different risks (p<0.05 in all cases ): Group 1 (3 points) (OR:1) (risk: 2.4% 95%IC 0.7%-4.3%) Group 2 (4 points) (OR:2.7) (risk: 6.5% 95%IC 5%-7.9%); Group 3(5-6 points) (OR:7.1)( risk:15% 95%IC 11%-19%) Group 4 ( 7--8 points) (OR:33.4) (risk: 45.5%; 95%IC 30%-59%) Group 5 (9-10 points) (OR:57.3) (risk: 58.8% 95%IC 35%- 82%). CONCLUSION: The clinical model allows an accurate approximation to the seminal vesicles involvement risk.

Percutaneous nephrolithotomy and chronic kidney disease: results from the CROES PCNL Global Study.

PURPOSE: We compared the characteristics and outcomes of patients treated with percutaneous nephrolithotomy in the CROES (Clinical Research Office of the Endourological Society) Global Study according to preoperative renal function. MATERIALS AND METHODS: Prospective data on consecutive patients treated with percutaneous nephrolithotomy in a 1-year period were collected from 96 participating centers. The glomerular filtration rate was estimated using the Modification of Diet in Renal Disease formula based on preoperative serum creatinine measurement. Patients were divided into 3 groups by glomerular filtration rate, including chronic kidney disease stages 0/I/II-greater than 60, stage III-30 to 59 and stages IV/V-less than 30 ml/minute/1.73 m(2). Patient characteristics, operative characteristics, outcomes and morbidity were assessed. RESULTS: Estimated glomerular filtration rate data were available on 5,644 patients, including 4,436 with chronic kidney disease stages 0/I/II, 994 with stage III and 214 with stages IV/V. A clinically significant minority of patients with nephrolithiasis presented with severe chronic kidney disease. A greater number of patients with stages IV/V previously underwent percutaneous nephrolithotomy, ureteroscopy or nephrostomy and had positive urine cultures than less severely affected patients, consistent with the higher incidence of staghorn stones in these patients. Patients with chronic kidney disease stages IV/V had statistically significantly worse postoperative outcomes than those in the other chronic kidney disease groups. CONCLUSIONS: Poor renal function negatively impacts the post-percutaneous nephrolithotomy outcome. By more aggressive removal of kidney stones, particularly staghorn stones, at first presentation and more vigilantly attempting to prevent recurrence through infection control, pharmacological or other interventions, the progression of chronic kidney disease due to nephrolithiasis may be mitigated.

Comparative outcomes of pure squamous cell carcinoma and urothelial carcinoma with squamous differentiation in patients treated with radical cystectomy.

PURPOSE: We compared clinical outcomes, and identified predictors of cancer specific and overall survival after radical cystectomy in patients with urothelial carcinoma with squamous differentiation and those with pure squamous cell carcinoma. MATERIALS AND METHODS: We reviewed data on 2,031 patients treated with radical cystectomy and pelvic lymph node dissection at a single high volume referral center. Of these patients 78 had squamous cell carcinoma and 67 had squamous differentiation. Survival estimates by histological subtype were described using Kaplan-Meier methods. Within histological subtypes pathological stage, nodal invasion, soft tissue margins, age and gender were evaluated as predictors of cancer specific survival and overall survival using univariate Cox regression. RESULTS: Median followup was 44 months. Of 104 patient deaths 60 died of their disease. We did not find a statistically significant difference between survival curves of patients with squamous cell carcinoma and squamous differentiation (log rank overall survival p = 0.6, cancer specific survival p = 0.17). Positive soft tissue margins were associated with worse cancer specific survival (HR 6.92, 95% CI 2.98-16.10, p ≤0.0005) and overall survival (HR 3.68, 95% CI 1.84-7.35, p ≤0.0005) in patients with pure squamous cell carcinoma. Among patients with squamous differentiation, pelvic lymphadenopathy was associated with decreased overall survival (HR 2.52, 95% CI 1.33-4.77, p = 0.004) and cancer specific survival (HR 3.23, 95% CI 1.57-6.67, p = 0.002). CONCLUSIONS: There appears to be no evidence of a difference in cancer specific survival or overall survival between patients with squamous cell carcinoma and those with squamous differentiation treated with radical cystectomy and pelvic lymph node dissection. Patients with squamous differentiation and tumor metastases to pelvic lymph nodes should be followed more closely, and adjuvant treatment should be considered to improve survival. Wide surgical resection is critical to achieve local tumor control and improve survival in patients with squamous cell carcinoma.

Perineal radical prostatectomy in the minimally invasive era.

Radical prostatectomy is currently the standard of care for localized prostate cancer. In the last decade, the minimally invasive surgery, especially the robotic surgery has been growing and open techniques are less frequent performed. A non-systematic review of the literature is performed, highlighting the current situation of the perineal radical prostatectomy in the minimally invasive era, its indications, and functional and oncological outcomes. Radical perineal prostatectomy, when compared with other surgical approaches, still experience favorable outcomes. Urologist might be abandoning an underused surgical approach.

Sentinel Lymph Node Biopsy in Endometrial Cancer: Dual Injection, Dual Tracer-A Multidisciplinary Exhaustive Approach to Nodal Staging.

INTRODUCTION: Sentinel lymph node (SLN) has recently been introduced as a standard staging technique in endometrial cancer (EC). There are some issues regarding team experience and para-aortic detection. OBJECTIVE: to report the accuracy of SLN detection in EC with a dual tracer (ICG and Tc99) and dual injection site (cervix and fundus) during the learning curve. METHODS: A prospective, observational single-center trial including 48 patients diagnosed with early-stage EC. Dual intracervical tracer (Tc99 and ICG) was injected at different times. High-risk patients had a second fundus injection with both tracers. RESULTS: the detection rates were as follows: 100% (48/48) overall for SLNs; 98% (47/48) overall for pelvic SLNs; 89.5% (43/48) for bilateral SLNs; and 2% (1/48) for isolated para-aortic SLNs. In high-risk patients, the para-aortic overall DR was 66.7% (22/33); 60.7% (17/28) with ICG and 51.5% (17/33) with Tc99 (p = 0.048)). Overall rate of lymph node involvement was 14.6% (7/48). Macroscopic pelvic metastasis was found in four patients (8.3%) and microscopic in one case (2%). No metastasis was found in any para-aortic SLNs. Half of the patients with positive pelvic SLNs had positive para-aortic nodes. In high-risk patients, when para-aortic SLNs mapped failed, 36.4% (4/11) had positive nodes in para-aortic lymphadenectomy. The sensitivity and negative predictive value (NPV) of SLN pelvic detection was 100%. CONCLUSIONS: Multidisciplinary exhaustive approach gives a suitable accuracy of SLN during learning curve. Dual injection (cervical and fundal) with dual tracer (ICG and Tc99) offers good overall detection rates and increases para-aortic SLN detection.

Impact of smoking on outcomes after intravesical bacillus Calmette-Guérin therapy for urothelial carcinoma not invading muscle of the bladder.

UNLABELLED: Study Type - Prognosis (case series). LEVEL OF EVIDENCE: 4. What's known on the subject? and What does the study add? The main goal of a prostate biopsy is to identify clinically relevant prostate cancer with the lowest possible morbidity from the procedure. Through time many have tried different variations in the procedure in an attempt to find the optimal methodology for performing prostate biopsies. These changes include better equipment in helping optimize cancer localizing, varying the number of cores in efforts to improve cancer detection and sampling various areas of the prostate to find cancer that may be hiding. To our knowledge we are the first to describe performing prostate biopsies with keeping the sampling size constant and varying the number of cores based on the size of the prostate. The study adds a variation in the current techniques used for prostate biopsies. In certain situations using a standard number of cores makes obtaining proper sampling of a prostate difficult. We propose a methodology in performing prostate biopsies that will allow for standardization of the tissue per core analyzed thus allowing for an improved sampling of the prostate. OBJECTIVE: To determine the influence of smoking on the outcomes of patient with urothelial carcinoma of the bladder (UCB) not invading muscle treated with BCG therapy. MATERIALS AND METHODS: A retrospective chart review was conducted on 623 consecutive patients treated with BCG therapy for high-grade Ta (n= 219; 35.2%), T1 (n= 215; 34.5%) and/or carcinoma in situ (n= 189; 30.3%). Cigarette smoking status was categorized as (smokers vs non-smokers) and as (current smokers vs past smokers vs never smokers). In addition, we analyzed the time since smoking cessation as a continuous and categorical variable (smoking cessation after diagnosis vs 0.1-10 years before diagnosis vs more than 10 years before diagnosis). Association with outcomes was examined by univariate and multivariable analyses, adjusting for the effects of age, gender, stage and grade. RESULTS: The study cohort consisted of 423 males (67.9%) and 200 females (32.1%). Overall, 386 patients (62.0%) were past smokers, 97 (15.6%) were current smokers and 140 (22.5%) had never smoked. In both univariate and multivariable analyses, smoking status by any definition was not associated with the response to BCG therapy, disease recurrence, progression, all-cause mortality or UCB-specific mortality. TUR grade was significantly associated with disease progression. TUR stage and BCG response at 6 months were significantly associated with disease recurrence, progression, all-cause mortality and UCB-specific mortality. CONCLUSIONS: Smoking does not appear to affect the response to BCG therapy or long-term oncological outcomes.

Association of steroid and xenobiotic receptor (SXR) and multidrug resistance 1 (MDR1) gene expression with survival among patients with invasive bladder carcinoma.

UNLABELLED: What's known on the subject? and What does the study add? SXR and MDR1 are known as responsible for chemo and radiotherapy resistance in some cancers, like kidney cancer (MDR1). Invasive bladder cancer is an aggressive disease, with different behaviour upon its tumoral stage, and also within the same tumoral stage, therefore molecular markers are sought. This study shows a new molecular marker, which has shown as a predictor for bad prognosis cancers, therefore, allowing us for a better patient selection for aggressive therapies. OBJECTIVE: To investigate the prognostic value of steroid and xenobiotic receptor (SXR) and multidrug resistance 1 (MDR1) gene expression in relation to survival among patients with invasive bladder cancer. PATIENTS AND METHODS: The prospective study included 67 patients diagnosed with invasive bladder cancer and treated with radical cystectomy at one of two institutions. SXR and MDR1 gene expression was assessed by real-time quantitative polymerase chain reaction (RT-PCR) in tumoral and normal tissue from frozen surgical specimens. RESULTS: Patients were followed for a mean of 29 months; 31 patients (46%) had progression. In univariate analysis, significant predictors of overall survival (OS) were pathological stage, lymph node (LN) status, histological grade, vascular-lymphatic invasion, and SXR expression. In multivariate analysis, independent predictors of OS were LN status (odds ratio [OR], 2.96; P=0.034), vascular-lymphatic invasion (OR, 2.50; P=0.029), and SXR expression (OR, 1.05, P=0.03). Among the 51 patients with negative LNs (pN0), univariate predictors of OS were SXR expression, MDR1 expression, and pathological stage. In multivariate analysis, SXR expression (OR, 1.06; P=0.01) and MDR1 expression (OR, 3.27; P=0.03) were independently associated with survival. Within the pN0 group, patients with SXR expression had shorter progression-free survival than did those without expression (P=0.004). This association persisted in the N0 subgroup with stage pT3-pT4 disease (P=0.028). However, in the pN1 group SXR expression did not have any influence. CONCLUSIONS: For patients with invasive bladder cancer, SXR expression has value as a predictor of survival independent of the standard pathological predictors. Its maximum importance appears to be in patients with stage pT3-pT4 pN0 disease.

Immediate renal Doppler ultrasonography findings (<24 h) and its association with graft survival.

PURPOSE: Renal Doppler ultrasonography (DUS) is the gold-standard image test for follow-up after renal transplantation, it is potentially useful to detect renal disease and it could be related with long-term survival. We evaluate whether renal graft survival can be predicted by immediate renal Doppler ultrasonography (IRDUS), defined as ultrasonography carried out in the first 24 h post-surgery. MATERIALS AND METHODS: Immediate renal DUS findings (resistance index, hydronephrosis, fluid collection, bruises, and vascularization abnormalities) and their association with graft survival were analyzed in a retrospective observational study of 343 renal allografts. Renal transplantation was done using a standard technique, and DUS was performed 24 h post-transplantation. The association of variables with graft survival was evaluated by Cox univariate and multivariate proportional hazards analysis. Kaplan-Meier survival analysis and the log-rank test were used to examine graft survival. RESULTS: The follow-up median was 85 months. On IRDUS, 137 patients (39.9%) had abnormal findings. The best RI cutpoint for the prediction of graft survival was 0.7; therefore, we defined two different groups: RI ≤ 0.7 (n = 247) versus RI > 0.7 (n = 96). Univariate analysis revealed that graft survival was significantly lower in patients with RI > 0.7 (P ≤ 0.001), vascularization abnormalities (P ≤ 0.001) or bruises (P = 0.026). In multivariate analysis, the only factors independently associated with graft survival were RI (odds ratio 2.4; 95% CI 1.4-4.1) and vascularization abnormalities (odds ratio 2.7; 95% CI 1.1-6.5). CONCLUSIONS: IRDUS can be useful, besides being highly useful in the diagnosis of graft primary dysfunction in the transplanted patient also yields information that can help to predict long-term graft survival.

Role of positron emission tomography in urological oncology.

• Positron emission tomography (PET) is a diagnostic tool using radiotracers to show changes in metabolic activities in tissues. We analysed the role of PET and PET/computed tomography (CT) in the diagnosis, staging, and follow-up of urological tumours. • A critical, non-structured review of the literature of the role of PET and PET/CT in urological oncology was conducted. • PET and PET/CT can play a role in the management of urological malignancies. For prostate cancer, the advances in radiotracers seems promising, with novel radiotracers yielding better diagnostic and staging results than 18F-fluorodeoxyglucose (18F-FDG). In kidney cancer, PET and PET/CT allow a proper diagnosis before the pathological examination of the surgical specimen. For testis cancer, PET and PET/CT have been shown to be useful in the management of seminoma tumours. In bladder cancer, these scans allow a better initial diagnosis for invasive cancer, while detecting occult metastases. • PET and its combined modality PET/CT have shown their potential in the diagnosis of urological malignancies. However, further studies are needed to establish the role of PET in the management of these diseases. Future applications of PET may involve fusion techniques such as magnetic resonance imaging with PET.

Medical expulsive therapy for distal ureteral stones.

Although minimally invasive treatments for ureteral stones are efficacious, they are not free of complications and are associated with high cost. Medical expulsive therapy (MET) has recently emerged as an alternative strategy for the initial management of small distal ureteral stones. A MEDLINE search was undertaken to evaluate all currently available data on efficacy and safety of MET therapy in such patients. The specific mechanism of action on the ureteral smooth muscle and the emerging evidence of the efficacy (defined as either an increase in expulsion rate or a decrease in time to expulsion) and low-risk profile suggest that alpha-adrenergic receptor antagonists (alpha-blockers) and calcium channel antagonists should be the initial medical treatment in patients amenable to conservative therapy. NSAIDs and anticholinergics have not shown efficacy as single agents or in combination with alpha-blockers or nifedipine. Corticosteroids may provide a small additive effect when combined with either alpha-blockers or nifedipine.

Biopsy of a renal mass: where are we now?

PURPOSE OF REVIEW: To review the most recent literature concerning renal mass biopsy with special consideration to three points: variation in results related to the standard used as comparison, biopsy in small renal masses (up to 4 cm in diameter) and the case for nondiagnostic biopsy. RECENT FINDINGS: The overall rate of failed and indeterminate biopsies shows a trend for improvement. However, selection bias and the lack of a uniform index test for comparison preclude a definitive statement. Fine-needle aspiration may equal results of core biopsy, but its role in the diagnostic algorithm is not yet defined. In-vivo accuracy decreases in small renal masses with the same limitations exposed for the overall literature on renal mass biopsy. When nondiagnostic biopsies are considered, there is a need for standardization of the nomenclature in order to compare results. Re-biopsies or surgery after a nondiagnostic biopsy shows malignancy in up to 75% of the cases of renal cell carcinoma. SUMMARY: There is a trend in increasing interest and accuracy on the subject of percutaneous biopsy of renal masses as well as a decreasing trend in the rate of nondiagnostic biopsies. In the small renal masses, most likely to be benign, a diagnostic percutaneous biopsy may have a definitive role. However, the higher rate of nondiagnostic results in this population calls for prospective studies with standard definitions and when possible homogenous index test to properly assess the diagnostic performance of the biopsy.

Advances in ultrasound technology in oncologic urology.

Continuous innovations and clinical research in ultrasound (US) technology have upgraded the position of US in the imaging armamentarium of urologists. In particular, contrast-enhanced US and sonoelastography seem to be promising in the diagnosis of urologic cancers, implementation of ablative treatments, and monitoring of treatment response. This article focuses on the potential clinical applications of recent advances in US technology in oncologic urology.

Advances in diagnosis and follow-up in kidney cancer.

PURPOSE OF REVIEW: To review the most recent data on preoperative diagnostic methods in kidney cancer and in follow-up and monitoring after ablation therapy. RECENT FINDINGS: Although the role of the percutaneous biopsy in the diagnostics of renal masses has been limited, new data suggest a high accuracy of the percutaneous core biopsy in the diagnostics of malignancy and a fair to perfect interobserver and intraobserver variability. Accuracy in determining the subtype is also high but lower for Fuhrman grade determination. Data on fine needle aspiration remain controversial. Refinements in cross-sectional imaging might have a value in differentiation of low-fat content angiomyolipoma from renal cell carcinoma. Contrast cross-sectional imaging remains the reference standard in the assessment of ablation results. Contrast-enhanced ultrasound shows promising results in this field but further confirmation is needed. SUMMARY: Although few changes are evident in the diagnostic imaging of kidney tumors, percutaneous core biopsy has gained attention and in the light of the current results might play an extended role in the preoperative workup of renal masses. New techniques should be investigated for monitoring after ablation therapies in order to reduce toxicity and costs.

[Training program in endourological surgery. Future perspectives.] / Programa formativo en cirugía endoscópica. Perspectivas de futuro.

Current training in urological endoscopy lacks a specific training program. However, there is a clear need for a specific and uniform program, which will ensure the training, regardless of the unit where it is carried out. So, the goal is to first evaluate the current model and then bring improvements for update. The hospital training accreditation programme are only the adjustment of the official program of the urology specialty to the specific circumstances of each center, which causes variability in training of residents. After reviewing 19 training programs belonging to 12 Spanish regions. The current outlook shows that scarcely 10% of hospitals quantify the number of procedures/ year, although the Spanish program emphasizes that the achievement of the residents should be quantified. Urology residents, sense their training as inadequate and therefore their level of satisfaction is moderate. The three main problems detected by residents as an obstacle on their training are: the lack of supervision, tutors completing their own learning. Finally, the lack of quantification in surgical activities is described as a threat. This has no easy solution, since the learning curve of the most common techniques in endourology is not correctly established. Regarding aspects that can improve the current model, they highlight the need to design a specific program. The need to customize the training, the ineludible accreditation of tutors and obviously dignify the tutor's teaching activity. Another basic aspect is the inclusion of new technologies as training tools, e-learning. As well as the implementation of an adequate competency assessment plan and the possibility of relying on simulation systems. Finally, they highlight the need to attend monographic meetings and external clinic rotations to promote critical training.

Laparoscopic Partial Nephrectomy With Potassium-titanyl-phosphate Laser Versus Conventional Laparoscopic Partial Nephrectomy: An Animal Randomized Controlled Trial.

OBJECTIVE: To explore the feasibility, safety, and short-term results of potassium-titanyl-phosphate (KTP) laser laparoscopic partial nephrectomy (KTP-LPN) vs conventional laparoscopic partial nephrectomy (C-LPN). MATERIALS AND METHODS: Thirty large white female pigs were randomized to KTP-LPN or C-LPN. Laparoscopic radical right nephrectomy was performed, and an artificial renal tumor was placed in the left kidney in 3 locations. A week later, 15 pigs underwent C-LPN and 15 underwent KTP-LPN. All C-LPNs were performed with renal ischemia. A 120-W setting was used, without arterial clamping in the KTP-LPN group. Follow-up was done at day 1, week 3, and week 6. Retrograde pyelography was performed at 6 weeks, followed by animal sacrifice and necropsy. RESULTS: All KTP-LPNs were performed without hilar clamping. C-LPNs were performed with hilar clamping, closing of the collecting system, and renorraphy. In the KTP laser group, 2 pigs died due to urinary fistula in the first week after surgery. In the C-LPN group, 1 pig died due to myocardial infarction and another due to malignant hyperthermia. Hemoglobin and hematocrit recovery were lower at 6 weeks in the KTP-LPN group. Renal function 24 hours after surgery was worse in the KTP-LPN group but recovered at 3 weeks and 6 weeks. No differences were observed in surgical margins. The necropsy showed no differences. Limitations of the study are the impossibility to analyze the collecting tissue sealing by the KTP, and the potential renal toxicity of the KTP laser. CONCLUSION: Although KTP-LPN is feasible and safe in the animal model, further studies are needed.

Preliminary Assessment of a New Antireflux Ureteral Stent Design in Swine Model.

OBJECTIVE: To assess a new antireflux ureteral stent in animal model. The design expects to reduce morbidity associated with JJ ureteral stents. MATERIALS AND METHODS: Twelve pigs were used in this study. The study began with a nephrosonographic assessment and excretory urography. Afterward, measurement of the internal diameter of both ureteropelvic junctions (UPJ) by retrograde ureteropyelography was performed. A 3 Fr (ARS group) antireflux ureteral stent was placed in the right kidney and a JJ 4 Fr (JJ group) stent was placed in the left. Follow-ups were performed at 3-6 weeks; both stents were removed at 6 weeks. The final follow-up was completed at 5 months. This includes the above-mentioned diagnostic methods and an anatomopathological study. RESULTS: There were no significant differences in UPJ diameter evolution between groups. During renal damage assessment, significant differences at 3 and 6 weeks were found, renal dilation being larger in JJ group. The JJ group shows a higher degree of vesicoureteral reflux at 3 and 6 weeks. After assessment of ureteral orifice, significant differences between groups were found at 3 weeks, 6 weeks, and 5 months, damage being more severe in the JJ group. After anatomopathological assessment, no statistical significance at UPJ was observed. However, statistical significance was found at ureterovesical junction, damage being more severe in the JJ group. CONCLUSION: The antireflux ureteral stent design dilates the upper urinary tract without affecting ureterovesical junction, and consequently reduces morbidity associated with JJ ureteral stents. Therefore, its patient tolerance will possibly be better than that to existent designs.

Development and Validation of a Novel Skills Training Model for Retrograde Intrarenal Surgery.

PURPOSE: The aim of this study is to validate a training model that combines the use of nonbiologic and biologic simulators as well as live porcine animal model in endoscopic retrograde intrarenal surgery (RIRS). MATERIALS AND METHODS: A total of 60 urologists took part in this study, and the activity lasted for 2 days. The training model was divided into three modules: Module-I, related to the acquisition of basic theoretical knowledge; Module-II, consisting of an internship with bench models; and Module III, in which animal models were used. First, trainees practiced with animals without using a lesion model (placement of an ureteral access sheath under fluoroscopic guidance and flexible ureterorenoscopy). Afterward, they practiced on a porcine animal model of bilateral renal lithiasis. Performance was measured using a validated global rating score and RIRS checklist score. Face and content validation as well as constructive validation provided by trainees in front of 15 experts were performed during the practice. RESULTS: Face and content validations were satisfactory. "Individual" constructive validity showed statistical significance between the first and the last time that trainees practiced on an animal model. Statistical significance was also found between trainees and expert scores. There were 73.4% of trainees who increased their skills by more than 40%. CONCLUSION: This RIRS training model allows for the acquisition of technical knowledge and skills as face, content, and constructive validation show. A structured use of nonbiologic, biologic, and animal model simulators allows the increase of RIRS skills.