Evaluating the perceptions of Canadian urology residents and program directors regarding the current training in genitourinary imaging.

INTRODUCTION: Competency in interpreting genitourinary (GU) imaging is an important skill for urologists; however, no nationally accredited GU imaging curriculum exists for Canadian urology residency training programs. The main objectives of our study were to 1) characterize GU imaging training in Canada; (2) evaluate residents' self-perceived competencies in interpreting GU imaging; (3) explore program directors' (PD) and residents' perceptions regarding the current imaging curriculum and suggestions for future directions. METHODS: From November to December 2022, a survey examining current imaging education in residency, perceived resident imaging knowledge, avenues for improvement in imaging education, and the role of point-of-care ultrasound within urology was distributed to all Canadian urology PDs and residents. RESULTS: All PDs (13/13) and 40% (72/178) of residents completed the survey. Only two programs had a formal GU imaging curriculum. PDs and residents reported trainees were least comfortable interpreting Doppler ultrasound of renal, gonadal, and penile vessels. PDs reported that residents were most comfortable with non-contrast computed tomography (CT) scans (9.5/10), CT urogram (9.3/10), and retrograde pyelography (9.3/10). All but one PD favored increasing imaging training in their program. PDs highlighted the lack of time in the curriculum (n=3) and lack of educators (n=3) as the primary barriers to increasing imaging training in their program. CONCLUSIONS: Most PDs and residents believe there needs to be more imaging training offered at their institution; however, addressing this is challenging due to the limited time in the curriculum and the need for available educators.

Ambulatory surgery for Moses™ holmium laser enucleation of the prostate A prospective, real-practice study from a single center.

INTRODUCTION: Use of ambulatory holmium laser enucleation of the prostate (HoLEP) is uncommon among Canadian urologists. Our objectives were to determine the feasibility (ambulatory success rate) and safety (early complication rate) of ambulatory HoLEP in a Canadian population. METHODS: We prospectively evaluated consecutive patients from June 2020 to May 2022 presenting for ambulatory HoLEP using Moses™ technology at our institution (MoLEP). Ambulatory success was defined as no hospital admission within 48 hours following the procedure. Thirty-day adverse events were also identified and graded according to the Clavien-Dindo (CD) classification. All procedures were planned to be ambulatory regardless of prostate size or anticoagulant treatment. We generated a logistic regression model to identify factors associated with ambulatory failure. RESULTS: A total of 61 patients underwent MoLEP, 52 of whom met the eligibility criteria. The mean age was 71.0 years (standard deviation 6.2). Most patients (67%, 35/52) were catheter or self-catheterization-dependent. The ambulatory success rate was 87% (45/52); 6/52 (11.5%) required hospitalization following MoLEP and one patient (2%) was re-admitted within 48 hours of the procedure. Hematuria was the sole cause of ambulatory failure. Thirty-day major complication rate (CD ≥3) was 6% (3/52) and the minor complication rate (CD <3) was 37% (19/52). The identified adverse events included hematuria (10/52), urinary retention (6/52), and cystitis (4/52). Based on univariate analysis, we did not identify factors significantly associated with ambulatory failure. CONCLUSIONS: The MoLEP ambulatory success rate is high, and the 30-day major adverse event rate is low. In this small, Canadian cohort, ambulatory MoLEP seems feasible and safe.

Testicular tumours discovered during infertility workup are predominantly benign and could initially be managed by sparing surgery.

BACKGROUND AND OBJECTIVES: To evaluate the pathological features and recurrence of incidental testis tumours treated by partial orchiectomy in a population of infertile men. METHODS: We retrospectively pooled, from four andrology referral centres, 32 patients diagnosed with testis mass during regular infertility workup. Patients included had an impaired sperm analysis and testis sparing surgery was performed to prevent secondary azoospermia or androgen therapy. RESULTS: Mean age was 36 (IQR, 32 to 37). The mean largest tumoral diameter was 8.5 mm (IQR, 5 to 10). A total of 25% (8 of 32) of patients had a malignant tumour (seminoma, 7 of 32, 22%; teratoma, 1 of 32, 3%) and 75% (24 of 32) had a benign lesion (Leydig cell tumour, 23 of 32, 72%; scar tissue, 1 of 32, 3%). Malignant tumours were then managed by total orchiectomy (six of eight) or by radiotherapy (two of eight). With a mean follow up of 26 months (IQR, 8 to 32), one patient (3%) had an homolateral recurrence, which was a Leydig cell tumour. Not a single patient developed metastasis. CONCLUSION: Seventy-five per cent of the tumours discovered during infertility management were of a benign pathology. A conservative approach could be proposed initially to avoid unnecessary orchiectomies. Orchiectomy and radiotherapy could be discussed as salvage therapies for malignant lesions.

Total Preperitoneal Robot-Assisted Kidney Transplantation.

To date, kidney transplant recipients have always undergone open surgery. The type and length of the wound vary, but most commonly, a modified Gibson's incision is made in the lower abdomen for the transplantation. Risk factors for wound complications are well defined in general surgery literature. The laparoscopic kidney transplantation (LKT) technique has been developed recently, and several teams have published studies on the intraperitoneal technique. In this case report, we present our technique of total preperitoneal LKT using the Da Vinci robotic surgical system.

Safety and Feasibility of Laparoscopic Nephrectomy for Big Tumors (≥ 10 cm): A Retrospective Multicentric Study.

OBJECTIVE: Evaluate the feasibility of laparoscopic nephrectomy for big tumors. MATERIAL AND METHODS: Data from 116 patients were retrospectively collected from 16 tertiary centres. Clinical and operative parameters, tumor characteristics, pre- and postoperative parameters, and renal function before and after surgery were analyzed. RESULTS: Mean age and body mass index were 61 years and 27.8 kg/m(2), respectively. Males represented 63.8% of patients, and 54.4% presented symptoms at diagnosis. Median tumor size was 11 cm, and 75% of the cases were performed by expert surgeons. Median operative time and blood loss were 180 minutes and 200 mL respectively. Conversion to open surgery was necessary in 20.7% of cases. Intraoperative complications related to massive hemorrhage occurred in 16.4% of patients, resulting in open conversion in 62.5%. Major postoperative complications occurred in only 10 patients (8.6%). In univariate analysis, intraoperative complications, age, and blood loss were predictive factors of conversion to open surgery. Positive surgical margins occurred in 6 patients (5.2%). None of them presented a local recurrence. Predictive factors of recurrence or progression were lymph node invasion, metastases, and Furhman grade. CONCLUSION: Laparoscopic nephrectomy for tumors > 10 cm can be performed safely. Complication rate and positive surgical margins are similar to open surgery. In experienced hands, the benefit of a mini invasive surgery remains evident.

Neoadjuvant targeted molecular therapies in patients undergoing nephrectomy and inferior vena cava thrombectomy: is it useful?

OBJECTIVE: To assess the effect of neoadjuvant targeted molecular therapies (TMTs) on size and level of inferior vena cava tumor thrombi and to evaluate their impact on surgical management. METHODS: We retrospectively analyzed the data of 14 patients treated for a clear cell renal cell carcinoma with inferior vena cava thrombi by neoadjuvant TMT before nephrectomy. Clinical, pathological and perioperative data were gathered retrospectively at each institution. The primitive tumor size and the thrombus size were defined by computed tomography before TMT. The tumor thrombus level was defined according to the Novick's classification. RESULTS: Before TMT, thrombus level was staged I for 1 (7%), II for 10 (72%) and III (21%) for 3 patients. First-line therapy was sunitinib in 11 cases and sorafenib in 3 cases. Median therapy duration was two cycles (1-5). Three patients experienced major adverse effects (grade III) during TMT. Following TMT, 6 (43%) patients had a measurable decrease, 6 (43%) had no change, and 2 (14%) had an increase in the thrombus. One patient (7%) had a downstage of thrombus level, 12 (85%) had stable thrombi, and 1 (7%) had an upstage. Regarding primary tumor, 7 (50%), 5 (36%) and 2 (14%) patients had a decrease, stabilization and an increase in tumor size, respectively. CONCLUSION: Neoadjuvant TMT appears to have limited effects on renal tumor thrombi. This retrospective study failed to demonstrate a significant impact of neoadjuvant TMT on surgical management of clear cell renal cell carcinoma with inferior vena cava tumor thrombi.