Role of psa levels and pathological stadiation before radiation therapy in predicting mp-MRI results in patients with prostate cancer recurrence after radical prostatectomy.

OBJECTIVE: To evaluate PSA value in mp-MRI results prediction, analyzing patients with high (GS≥8, pT≥3, pN1) and low grade (GS<8, pT<3, pN0) Prostate Cancer (PCa). MATERIALS AND METHODS: One hundred eighty-eight patients underwent 1.5-Tmp-MRI after Radical Prostatectomy (RP) and before Radiotherapy (RT). They were divided into 2 groups: A and B, for patients with biochemical recurrence (BCR) and without BCR but with high local recurrence risk. Considering Gleason Score (GS), pT and pN as independent grouping variables, ROC analyses of PSA levels at primary PCa diagnosis and PSA before RT were performed in order to identify the optimal cut-off to predict mp-MRI result. RESULTS: Group A and B showed higher AUC for PSA before RT than PSA at PCa diagnosis, in low and high grade tumors. For low grade tumors the best AUC was 0.646 and 0.685 in group A and B; for high grade the best AUC was 0.705 and 1 in group A and B, respectively. For low grade tumors the best PSA cut-off was 0.565-0.58ng/mL in group A (sensitivity, specificity: 70.5%, 66%), and 0.11-0.13ng/mL in B (sensitivity, specificity: 62.5%, 84.6%). For high grade tumors, the best PSA cut-off obtained was 0.265-0.305ng/mL in group A (sensitivity, specificity: 95%, 42.1%), and 0.13-0.15ng/mL in B (sensitivity, specificity: 100%). CONCLUSION: Mp-MRI should be performed as added diagnostic tool always when a BCR is detected, especially in high grade PCa. In patients without BCR, mp-MRI results, although poorly related to pathological stadiation, still have a good diagnostic performance, mostly when PSA>0.1-0.15ng/mL.

Impact of adipose tissue distribution on prostate cancer recurrence after radical prostatectomy.

OBJECTIVE: The aim of our study is to correlate the CT adipose tissue distribution and recurrence risk of Prostatic Cancer (PCa) after Radical Prostatectomy (RP). Furthermore, we evaluated the association of adipose tissue and PCa aggressiveness. MATERIALS AND METHODS: We identified two groups of patients based on presence (group A) and absence (group B or control group) of Bio-chemical Recurrence (BCR) after RP. A semi-automatic function able to recognize the typical attenuation values of adipose tissue was used for sub-cutaneous (SCAT), visceral (VAT), total (TAT) and periprostatic (PPAT) adipose tissues. For both groups of patients, a descriptive analysis of continuous variables and categorical variables was performed. RESULTS: After comparing between groups, a statistically significant difference was found for VAT (p<0.001) and for VAT/TAT ratio (p=0.013). No statistically significant correlation was found for PPAT and SCAT, even if higher values were found in patients with high grade tumors. CONCLUSION: This study confirms visceral adipose tissue as a quantitative imaging parameter related to oncological risk of PCa recurrence development, and the role of abdominal fat distribution measured with CT before RP as an important tool to predict the PCa recurrence risk, particularly in patients with high grade tumors.

Impact of a delayed presentation to the emergency department for acute renal colic on biochemical and clinical outcomes.

INTRODUCTION AND OBJECTIVE: To verify the impact of delay on biochemical and clinical outcomes for patients presenting to the emergency department (ED) with acute renal colic. MATERIALS AND METHODS: Data were retrospectively collected from three institutions of two European countries between 01 January and 30 April 2020. Patients who presented to the ED with unilateral or bilateral renal colic caused by urolithiasis confirmed by imaging tests during the study period were included. A presentation after 24 h since the onset of symptoms was considered a delay. Patients presenting before 24 h from the symptom onset were included in Group A, while the patients presenting after 24 h in Group B. Clinical and biochemical parameters and management were compared. RESULTS: A total of 397 patients who presented to ED with confirmed urolithiasis were analyzed (Group A, n = 199; Group B, n = 198. The median (IQR) delay in presentation was 2 days (1,5-4). At presentation, no statistically significant differences were found amongst the two groups of patients regarding presenting symptoms such as fever and flank pain, and the median serum levels of creatinine, C reactive protein and white blood cells. No differences were found in terms of conservative or operative management. CONCLUSION: Delay in consultation >24 h is not associated with worsening biochemical parameters and clinical outcomes. Most patients with acute loin pain do not necessarily need urgent attendance to the ED and may be managed in the outpatients.

Online surgical education adopted among urology residency programs in response to COVID-19: A pilot study.

OBJECTIVE: To understand the residents' perceptions of the, COVID-19 driven, newly implemented online learning systems adopted among accredited urology residency programs nationwide, and their sustainability following the pandemic era. MATERIALS AND METHODS: A survey was designed and dispersed to urology program coordinators and directors to distribute to their residents. In the survey, Online education models was the all-encompassing term to describe any form of resident education that occurred online. Anonymous surveys were exported from Survey Monkey and data was analyzed for statistical significance. RESULTS: Over 70% of urology residents agreed or were neutral to the statement that Online education models were equivalent to in-person learning. Only 13% of residents stated that online learning should not be continued following the pandemic. Several different parameters were assessed, and only 5 of them showed statistical significance. Stress, personal engagement, interpersonal communication efficiency and non-verbal cues were all lower with online education models. The only attribute that was scored higher by residents was network connectivity issues. CONCLUSIONS: An overwhelming majority of urology residents in the United States believe Online education models should continue to be adopted once the pandemic is over.

[Online surgical education adopted among urology residency programs in response to COVID-19: A pilot study]. / La educación quirúrgica en línea implementada en los programas de residencia urológica como respuesta a la COVID-19: estudio piloto.

Objective: To understand the residents' perceptions of the, COVID-19 driven, newly implemented online learning systems adopted among accredited urology residency programs nationwide, and their sustainability following the pandemic era. Materials and methods: A survey was designed and dispersed to urology program coordinators and directors to distribute to their residents.In the survey, online education models was the all-encompassing term to describe any form of resident education that occurred online. Anonymous surveys were exported from Survey Monkey and data was analyzed for statistical significance. Results: Over 70% of urology residents agreed or were neutral to the statement that online education models were equivalent to in-person learning. Only 13% of residents stated that online learning should not be continued following the pandemic. Several different parameters were assessed, and only 5 of them showed statistical significance. Stress, personal engagement, interpersonal communication efficiency and non-verbal cues were all lower with online education models. The only attribute that was scored higher by residents was network connectivity issues. Conclusions: An overwhelming majority of urology residents in the United States believe online education models should continue to be adopted once the pandemic is over.

The role of multiparametric mri in the diagnosis of local recurrence after radical prostatectomy and before salvage radiotherapy.

PURPOSE: Assess multiparametric-MRI (mp-MRI) diagnostic accuracy in the detection of local recurrence of Prostate Cancer (PCa) after Radical Prostatectomy (PR) and before Radiation Therapy (RT). MATERIALS AND METHODS: A total of 188 patients underwent 1.5-T mp-MRI after RP before RT. Patients were divided into two groups: with biochemical recurrence (group A) and without but with high risk of local recurrence (group B). Continuous variables were compared between two groups using T-Student; categoric variables were analyzed using Pearson chi-square. ROC analysis was performed considering PSA before RT, ISUP, pT and pN as grouping variables. RESULTS: PCa recurrence (reduction of PSA levels after RT) was 89.8% in the group A and 80.3% in the group B. Comparing patients with and without PCa recurrence, there was a significant difference in PSA values before RT for group A and for PSA values before RT and after RT for group B. In group A, there was a significant correlation between PSA before RT and diameter of recurrence and between PSA before RT and time spent before recurrence. The mp-MRI diagnostic accuracy in detecting PCa local recurrence after RP is of 62.2% in group A and 38% in group B. DWI is the most specific MRI-sequence and DCE the most sensitive. For PSA = 0.5 ng/ml, the AUC decreases while sensitivity and accuracy increase for each MRI-sequence. For PSA = 0.9 ng/ml, DCE-AUC increases significantly. CONCLUSION: mp-MRI should always be performed before RT when a recurrence is suspected. New scenarios can be opened considering the role of DWI for PSA ≤ 0.5 ng/ml.

Does minimally invasive surgery for bladder cancer result in unusual sites of metastasis?

BACKGROUND: To compare sites of metastasis for the laparoscopic (LRC) and open (ORC) approaches in a cohort of patients at a district general hospital. Morbidity and mortality for the two approaches are assessed using secondary outcomes of length of stay and complication rate. Metastasis rate and site are compared. METHODS: A retrospective case note review was carried out for all patients who underwent cystectomy for bladder malignancy at Pinderfields General Hospital, Wakefield between 2010 and 2016 (n = 219). There were 150 males and 69 females in 107 minimally invasive cases and 87 open (missing data on 25 cases). Data were analysed using Microsoft Excel XLSTAT. RESULTS: Recurrence rate was 25.1% and did not differ significantly with approach (p = 0.89). Sites of recurrence did not differ with operative approach, the most frequent being pelvis, chest and bone. Unusual sites of recurrence included abdominal wall and sigmoid colon which both occurred in LRC. Length of stay was greater for the open approach (median LRC = 10, ORC = 13, p < 0.01). Five-year survival was 74.9%. Survival distribution did not significantly differ with operative approach (p = 0.43), and there was no significant association between operative approach and patient death within the follow-up period (p = 0.09). Stricture rate was 4.1% and was not significantly different between the 2 groups (p = 0.29). Median time to stricture was 130 days. Clavien-Dindo scores for complications did not differ with approach (p = 0.93), and there was no significant association between operative approach and whether complications developed (p = 0.19). CONCLUSIONS: The adverse oncological outcomes in minimally invasive approaches suggested by some studies are not confirmed here. Those in the LRC group were discharged sooner, though this did not translate into differences in morbidity or survival. Analysis of the association between individual complications and length of stay may clarify this further. Shorter hospital stay is also likely to have significant financial implications. Despite no significant difference in outcomes, the findings demonstrate potential benefits of LRC. Extensions of this study could include: cost-benefit analysis, examination of individual complications' effect on length of stay; and analysis of approach-specific factors contributing to perioperative deaths.

Artificial intelligence and simulation in urology. / Inteligencia artificial y simulación en urología.

INTRODUCTION AND OBJECTIVE: Artificial intelligence (AI) is in full development and its implementation in medicine has led to an improvement in clinical and surgical practice. One of its multiple applications is surgical training, with the creation of programs that allow avoiding complications and risks for the patient. The aim of this article is to analyze the advantages of AI applied to surgical training in urology. MATERIAL AND METHODS: A literary research is carried out to identify articles published in English regarding AI applied to medicine, especially in surgery and the acquisition of surgical skills. RESULTS: Surgical training has evolved over time thanks to AI. A model for surgical learning where skills are acquired in a progressive way while avoiding complications to the patient, has been created. The use of simulators allows a progressive learning, providing trainees with procedures that increase in number and complexity. On the other hand, AI is used in imaging tests for surgical or treatment planning. CONCLUSION: Currently, the use of AI in daily clinical practice has led to progress in medicine, specifically in surgical training.

Artificial intelligence and simulation in urology.

INTRODUCTION AND OBJECTIVE: Artificial intelligence (AI) is in full development and its implementation in medicine has led to an improvement in clinical and surgical practice. One of its multiple applications is surgical training, with the creation of programs that allow avoiding complications and risks for the patient. The aim of this article is to analyze the advantages of AI applied to surgical training in urology. MATERIAL AND METHODS: A literary research is carried out to identify articles published in English regarding AI applied to medicine, especially in surgery and the acquisition of surgical skills. RESULTS: Surgical training has evolved over time thanks to AI. A model for surgical learning where skills are acquired in a progressive way while avoiding complications to the patient, has been created. The use of simulators allows a progressive learning, providing trainees with procedures that increase in number and complexity. On the other hand, AI is used in imaging tests for surgical or treatment planning. CONCLUSION: Currently, the use of AI in daily clinical practice has led to progress in medicine, specifically in surgical training.

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.

Assessment of trends and clinical presentation in the emergency department of patients with renal colic during the COVID-19 pandemic era. / Evaluación de las tendencias y presentación clínica de pacientes con cólico nefrítico que acuden al servicio de urgencias durante la era pandémica del COVID-19.

INTRODUCTION: We hypothesized that the recent COVID-19 pandemic may lead to a delay in renal colic patients presenting to the Emergency Department due to the fear of getting infected. This delay may lead to a more severe clinical condition at presentation with possible complications for the patients. MATERIAL AND METHODS: Retrospective review of data collected from three institutions from Spain and Italy. Patients who presented to Emergency Department with unilateral or bilateral renal colic caused by imaging confirmed urolithiasis during the 45 days before and after each national lockdown were included. Data collected included patients' demographics, biochemical urine and blood tests, radiological tests, signs, symptoms and the therapeutic management. Analysis was performed between two groups, Group A: patients presenting prior to the national lockdown date; and Group B: patients presenting after the national lockdown date. RESULTS: A total of 397 patients presented to Emergency Department with radiology confirmed urolithiasis and were included in the study. The number of patients presenting to Emergency Department with renal/ureteric colic was 285 (71.8%) patients in Group A and 112 (28.2%) patients in Group B (p<0.001). The number of patients reporting a delay in presentation was 135 (47.4%) in Group A and 63 (56.3%) in Group B (p=0.11). At presentation, there were no statistical differences between Group A and Group B regarding the serum creatinine level, C reactive protein, white blood cell count, fever, oliguria, flank pain and hydronephrosis. In addition, no significant differences were observed with the length of stay, Urology department admission requirement and type of therapy. CONCLUSION: Data from our study showed a significant reduction in presentations to Emergency Department for renal colic after the lockdown in Spain and Italy. However, we did not find any significant difference with the length of stay, Urology department admission requirement and type of therapy.

Lifestyle among urology trainees and young urologist in the context of burn-out syndrome. / Estilo de vida y burnout en residentes y urólogos jóvenes.

INTRODUCTION: Burnout syndrome has increased dramatically in urology within recent years. A healthy lifestyle has been described as a protective factor. However, data on lifestyle is lacking among residents and urologists and remains to be elucidated. We aim to assess lifestyle among urology residents and young urologists across Europe. MATERIALS AND METHODS: Members of the European Society of Residents in Urology (ESRU) designed a 34-item online survey via surveymonkey.com. The survey was designed in accordance with Checklist for Reporting Results of Internet E-Surveys (CHERRIES) guidelines and was distributed via e-mail and social media in 23 European countries to urology residents and young urologists. The primary endpoint was reported as self-perceived health status. Secondary endpoints included questions on sleeping disorders, exercise and dietary habits. Data was analyzed SPSS software. RESULTS: A total of 412 residents and young urologists responded to the survey. The mean age of the respondents was 31.4±3.9 yr. The data on dietary intake demonstrate a mean of 2 or more cups/day of coffee and alcohol consumption 2-3 times/week. The intake of fruits and vegetables is very low, almost 60% of responders consume<1 portions of fruit/day and more than half (52%) eat<1 portion of vegetable/day. Overall, the majority of respondents reported to have a moderate to low satisfaction with lifestyle (59.65%) and low to moderate self-perceived health status (45.94%). Moreover, 46% of respondents reported to have some kind of sleep disturbance and 60% only slept 6hours/night or less with 53% reporting a moderate to very low quality of Sleep. Regular exercise of at least 30min twice weekly was only performed by 33% of the respondents. CONCLUSIONS: Residents and young urologists have unbalanced diet, tend to exercise too little and often suffer from sleep disturbances all of which increases the risk of burnout. Physicians, organizations and institutions should strive to promote healthy lifestyle, resiliency and support programs.

Scientific social media, a new way to expand knowledge. What do urologists need to know? / Las redes sociales científicas, una nueva forma de ampliar el conocimiento. ¿Qué necesitan saber los urólogos?

INTRODUCTION AND AIMS: Nowadays, it is almost impossible not to link most of the sources of modern knowledge to information of 2.0 technologies. The aim of this review is to analyse the role of scientific social media (Sc-SoMe) and its potential applications in urology. MATERIAL AND METHODS: A literature search was carried out using the PubMed database until July 2018. The research was performed with the following terms: "Social Media", "urology", "science", "research". RESULTS: Social media (SoMe) offers integrated services and easy tools for communication, collaboration and participation. Popular prototypical platforms of SoMe are Facebook, Twitter or Instagram. SoMe not only influence private life and personal communication, but these also affect business and science sectors. In this sense, the term Sc-SoMe describes the impact and usage of 2.0 technologies platforms on scientific work. There are different models of Sc-SoMe such as author identifiers which are unique identifiers that allow managing the professional identity of each researcher, distinguishing them from other researchers and unequivocally associating their work and author profiles. This helps us manage our own academic profile and control the information available about us and ensure that other researchers are finding correct and complete information about our research and career. Examples of Sc-SoMe are: ResearchGate, ORCID, Mendeley among others. CONCLUSIONS: Sc-SoMe should not only provide important information and services for literature and literature search. These could also be an important catalyst for promoting appropriate and helpful services in the context of a new concept of science, the science 2.0.