"Síndrome de agotamiento": Estrés, Burnout y depresión en Urología / Fatigue syndrome: Stress, Burnout and depression in Urology

Objetivo: Determinar los factores relacionados con estrés, "Burnout" y depresión en urología, así como las consecuencias en residentes y urólogos, además de las posibles estrategias aplicables para disminuir y tratar los mismos. Adquisición de la Evidecia: Depresión, estrés y síndrome de "Burnout" se han convertido en un problema en la especialidad de urología. Estos tópicos han ganado interés en congresos internacionales y asociaciones urológicas. Se están realizando esfuerzos para investigar los factores relacionados, así como posibles estrategias y programas aplicables. Síntesis de la Evidencia: La frecuencia de "Burnout" es más elevada entre profesionales de la salud que la población general, 40-76% en estudiantes y residentes, su incidencia se ha aumentado recientemente, además la urología es una de las especialidades con mayor incidencia y severidad. Se ha relacionado su incremento con la sobrecarga de trabajo, documentación, informatización, burocracia, ambiente laboral hostil. Sus consecuencias incluyen menor rendimiento laboral, errores médicos, depresión, abuso de sustancias, disrupción en relaciones familiares y de pareja, así como ideación suicida. Las estrategias para su prevención incluyen resiliencia, estilo de vida saludable, balance personal, trabajo en equipo y programas de soporte. Conclusion: Estrés, Burnout y depresión son problemas en urología, la detección temprana, promocionar técnicas individuales en resiliencia, estilo de vida y trabajo en equipo son fundamentales. Desarrollar y aplicar programas de soporte debería considerase seriamente por parte de los sistemas de salud y las asociaciones urológicas (AU)

Objective: To determine the factors related to stress, Burnout and depression in urology, as well as consequences in residents and urologists, in addition to the possible applicable strategies to diminish and treat them Acquisition of the evidence: Depression, stress and Burnout syndrome has become a problem in urology specialty. These topics have gained interest in international congresses and urological associations. Efforts are being made to find related factors as well as possible strategies and applicable support programs. Synthesis of evidence: Burnout frequency is higher among health professionals than general population, 40-76% in students and residents, its incidence has skyrocketed in recent years, in addition Urology is one of the specialties with highest incidence and severity. Its increase has been related to work overload, documentation, administrative/bureaucratic workload, hostile work environment; its consequences include poor work performance, medical errors, depression, substance abuse, disruption in family and couple relationships and suicidal ideation. Strategies for prevention including resilience training, lifestyle balance, teamwork, and support programs. Conclusions: Stress, burnout and depression are problems in urology, early detection, promoting individual techniques in resilience, lifestyle and teamwork are fundamental now and for the future of the specialty. Developing and implementing support programs should be seriously considered by health systems and urological associations (AU)

[Fatigue syndrome: Stress, Burnout and depression in Urology.] / "Síndrome de agotamiento": Estrés, Burnout y depresión en Urología.

OBJECTIVE: To determine the factors related to stress, Burnout and depression in urology, as well as consequences in residents and urologists, in addition to the possible applicable strategies to diminish and treat them. ACQUISITION OF THE EVIDENCE: Depression, stress and Burnout syndrome has become a problem in urology specialty. These topics have gained interest in international congresses and urological associations. Efforts are being made to find related factors as well as possible strategies and applicable support programs. SYNTHESIS OF EVIDENCE: Burnout frequency is higher among health professionals than general population, 40-76% in students and residents, its incidence has skyrocketed in recent years, in addition Urology is one of the specialties with highest incidence and severity. Its increase has been related to work overload, documentation, administrative/bureaucratic workload, hostile work environment; its consequences include poor work performance, medical errors, depression, substance abuse, disruption in family and couple relationships and suicidal ideation. Strategies for prevention including resilience training, lifestyle balance, teamwork, and support programs. CONCLUSION: Stress, burnout and depression are problems in urology, early detection, promoting individual techniques in resilience, lifestyle and teamwork are fundamental now and for the future of the specialty. Developing and implementing support programs should be seriously considered by health systems and urological associations.

Perioperative Systemic Inflammatory Response following Robot-Assisted Laparoscopic Cystectomy vs. Open Mini-Laparotomy Cystectomy: A Prospective Study.

INTRODUCTION: Surgeries, such as radical cystectomy (RC), induce a systemic inflammatory response (SIR). SIR plays an important role in controlling the human immune system. This study aims at comparing the SIR in robot-assisted laparoscopic cystectomy (RALC) to open mini-laparotomy cystectomy (OMC) with a urinary diversion (UD). Comparison was based on immunologic markers of SIR, thus quantifying the degree of tissue trauma. MATERIALS AND METHODS: Forty-two male patients underwent RC with an ileal conduit. Either OMC RC (OMC; n = 20), RALC with extracorporeal UD (RALC-EUD; n = 13), or RALC with intracorporeal UD (RALC-IUD; n = 9) was performed. Blood samples were obtained preoperatively (PREOP), immediately after surgery (POD0), 24 (POD1) and 48 h (POD2) postoperatively. Clinical parameters were collected from medical records. RESULTS: Estimated blood loss and blood transfusion volume was higher in OMC (p's < 0.001). The operative time was longer in RALC groups (p < 0.001). On POD0, interleukin (IL)-6 showed significant lower level in RALC-IUD compared to OMC (p = 0.016). IL-10 level was higher at POD0 (p = 0.029) and POD1 (p = 0.038) in OMC vs. RALC-EUD. MCP-1 levels for RALC-IUD were significantly lower compared to RALC-EUD (p = 0.027). CONCLUSIONS: This study found that postoperative SIR was overall less pronounced in RALC, thus depicting reduced tissue trauma. No major clinical differences between RALC-IUD and -EUD were found.