How to manage renal masses in kidney transplant recipients? A collaborative review by the EAU-YAU kidney transplantation and renal cancer working groups.

INTRODUCTION: Kidney transplant (KT) recipients have a four-times higher risk of renal malignancies compared to general population. As these patients frequently harbor bilateral or multifocal tumors, the management of renal masses is still under debate. OBJECTIVE: To explore the current management of the native kidney masses in KT patients. ACQUISITION OF EVIDENCE: We performed a literature search on MEDLINE/PubMed database. A number of 34 studies were included in the present review. SYNTHESIS OF EVIDENCE: In frail patients with renal masses below 3 cm, active surveillance is a feasible alternative. Nephron-sparing surgery is not justified for masses in the native kidney. Radical nephrectomy is the standard treatment for post-transplant renal tumors of the native kidneys in KT recipients, with laparoscopic techniques leading to significantly less perioperative complication rates as compared to the open approach. Concurrent bilateral native nephrectomy at the time of transplantation can be considered in patients with renal mass and polycystic kidney disease, especially if no residual urinary output is present. Patients with localized disease and successful radical nephrectomy do not require immunosuppression adjustment. In metastatic cases, mTOR agents can ensure efficient antitumoral response, while maintaining proper immunosuppression in order to protect the graft. CONCLUSIONS: Post-transplant renal cancer of the native kidneys is a frequent occurrence. Radical nephrectomy is most frequently performed for localized renal masses. A standardized and widely-approved screening strategy for malignancies of native renal units is yet to be implemented.

Percutaneous puncture during PCNL: new perspective for the future with virtual imaging guidance.

CONTEXT: Large and complex renal stones are usually treated with percutaneous nephrolithotomy (PCNL). One of the crucial steps in this procedure is the access to the collecting system with the percutaneous puncture and this maneuver leads to a risk of vascular and neighboring organs' injury. In the last years, the application of virtual image-guided surgery has gained wide diffusion even in this specific field. OBJECTIVES: To provide a short overview of the most recent evidence on current applications of virtual imaging guidance for PCNL. EVIDENCE ACQUISITION: A non-systematic review of the literature was performed. Medline, PubMed, the Cochrane Database and Embase were screened for studies regarding the use virtual imaging guidance for PCNL. EVIDENCE SYNTHESIS: 3D virtual navigation technology for PCNL was first used in urology with the purpose of surgical training and surgical planning; subsequently, the field of surgical navigation with different modalities (from cognitive to augmented reality or mixed reality) had been explored. Finally, anecdotal preliminary experiences explored the potential application of artificial intelligence guidance for percutaneous puncture. CONCLUSION: Nowadays, many experiences proved the potential benefit of virtual guidance for surgical simulation and training. Focusing on surgery, this tool revealed to be useful both for surgical planning, allowed to achieve a better surgical performance, and for surgical navigation by using augmented reality and mixed reality systems aimed to assist the surgeon in real time during the intervention.

Exploring the Residents' Perspective on Smart learning Modalities and Contents for Virtual Urology Education: Lesson Learned During the COVID-19 Pandemic. / Explorando la perspectiva de los residentes sobre las modalidades y contenidos de aprendizaje inteligente para la educación virtual de urología: lección aprendida durante la pandemia de la COVID-19.

PURPOSE: The COVID-19 outbreak has substantially altered residents' training activities. While several new virtual learning programs have been recently implemented, the perspective of urology trainees regarding their usefulness still needs to be investigated. METHODS: A cross-sectional, 30-item, web-based Survey was conducted through Twitter from April 4th, 2020 to April 18th, 2020, aiming to evaluate the urology residents' perspective on smart learning (SL) modalities (pre-recorded videos, webinars, podcasts, and social media [SoMe]), and contents (frontal lessons, clinical case discussions, updates on Guidelines and on clinical trials, surgical videos, Journal Clubs, and seminars on leadership and non-technical skills). RESULTS: Overall, 501 urology residents from 58 countries completed the survey. Of these, 78.4, 78.2, 56.9 and 51.9% of them considered pre-recorded videos, interactive webinars, podcasts and SoMe highly useful modalities of smart learning, respectively. The contents considered as highly useful by the greatest proportion of residents were updates on guidelines (84.8%) and surgical videos (81.0%). In addition, 58.9 and 56.5% of responders deemed seminars on leadership and on non-technical skills highly useful smart learning contents. The three preferred combinations of smart learning modality and content were: pre-recorded surgical videos, interactive webinars on clinical cases, and pre-recorded videos on guidelines. CONCLUSION: Our study provides the first global «big picture¼ of the smart learning modalities and contents that should be prioritized to optimize virtual Urology education. While this survey was conducted during the COVID-19 outbreak, our findings might have even more impact in the future.

The impact of T1 renal tumor characteristics on baseline renal function in patients undergoing partial nephrectomy: A renal scan based objective assessment.

INTRODUCTION AND OBJECTIVES: To objectively assess the impact of renal tumors characteristics and other measurable factors on baseline renal function in patient undergoing partial nephrectomy (PN). METHODS: Patients who underwent laparoscopic PN for a T1 renal mass between 2012 and 2016 and who also had a mercapto-acetyltriglycine renal scan prior to surgery were retrieved from a single institution prospectively-collected database. Split renal function (SRF) and Effective Renal Plasma Flow (ERPF) for both the operated kidney and the unaffected contralateral were calculated. Patient demographics and tumor characteristics (e.g. size, location and; nephrometry score) were assessed. Renal function of both the operated and the unaffected; contralateral kidney were compared. Statistical analysis was performed by using Statistica 8.0 (StatSoft). RESULTS: 227 patients were deemed eligible and included in the analysis. Univariable analysis showed a significant impact of age-adjusted CCI (p = 0.027), hypertension (p = 0.031) and age (p < 0.001) on operated kidney ERPF. Gender (p = 0.011), hypertension (p = 0.042), CCI (both standard and age-adjusted, p = 0.021 and = 0.003, respectively) and age (p < 0.001) were significantly; associated with contralateral unaffected kidney ERPF. Multivariable analysis confirmed age (p < 0.001) and hypertension (p < 0.021) as independent factors in both the operated and the unaffected kidney. CONCLUSIONS: Characteristics of the renal mass (including nephrometry score and size) seem to have no clinically relevant impact on baseline renal function in patients undergoing partial nephrectomy for cT1 renal tumors. Age, hypertension and co-morbidities confirm to represent un-modifiable significant factors influencing baseline renal function.