Renal Cell Carcinoma with Venous Extension: Safety of Laparoscopic Surgery for Thrombus Levels I-IIIa.

Background: Novel studies are helping to consider minimally invasive surgery for treating patients with renal cell carcinoma and venous tumor thrombus. Evidence regarding its feasibility and safety is still sparse and does not include a subclassification for level III thrombi. We aim to compare the safety of laparoscopic vs open surgery in patients with levels I-IIIa thrombus. Materials and Methods: This is a cross-sectional comparative study using single-institutional data on adult patients treated surgically between June 2008 and June 2022. Participants were categorized into open and laparoscopic surgery groups. Primary outcome was difference in the incidence of 30-day major postoperative complications (Clavien-Dindo III-V) between groups. Secondary outcomes were differences in operative time, length of hospital stay, intraoperative blood transfusions, delta hemoglobin level, 30-day minor complications (Clavien-Dindo I-II), estimated overall survival, and progression-free survival between groups. A logistic regression model was performed including adjustment for confounding variables. Results: Overall, 15 patients in the laparoscopic group and 25 patients in the open group were included. Major complications occurred in 24.0% of patients within the open group and 6.7% of patients were treated laparoscopically (p = 0.120). Minor complications arose in 32.0% of patients treated with open surgery and in 13.3% of patients treated in the laparoscopic group (p = 0.162). Although not significant, there was a higher perioperative death rate within open surgery cases. The laparoscopic approach presented a crude odds ratio for major complications of 0.22 (95% confidence interval 0.02-2.1, p = 0.191) compared with open surgery. No differences were found between groups regarding oncologic outcomes. Conclusion: Laparoscopic approach for patients with venous thrombus levels I-IIIa seems to be as safe as open surgery.

Clinical and histopathological features of bladder cancer following radiotherapy for prostate cancer: A comparative study.

INTRODUCTION: Low certainty exists on how bladder cancer (BCa) after pelvic radiotherapy (RT) differs from BCa in radiation-naive patients from a histopathological and clinical perspective. This study aims to compare histopathological features of bladder tumors between patients with previous RT for prostate cancer (PCa) and radiation-naive patients using single-institutional data and to estimate relapse-free survival (eRFS) and cystectomy-free survival (eCFS) in both groups. MATERIALS AND METHODS: Comparative study in adult men diagnosed with BCa in Hospital Italiano de Buenos Aires, Argentina, between January 2015 and December 2020. Included patients were categorized as previously irradiated for PCa or radiation-naive. PRIMARY OUTCOME: differences in prevalence of aggressiveness features of bladder tumors (variant histology; high-grade tumors; muscle-invasive disease; criteria compliance for high or very-high risk of progression) between irradiated and radiation-naive patients at diagnosis of BCa. SECONDARY OUTCOMES: differences in eRFS and eCFS between groups. RESULTS: In total, 34 and 291 patients were included in the Irradiated and Radiation-naive groups, respectively. Mean age at the time of diagnosis of BCa was 72.7 years (CI 95% 71.6-73.8). Median follow-up of the overall cohort was 25 months (IQR 11-45.5). Concerning primary outcomes, no statistical differences were found except for a higher prevalence of low-grade tumors between irradiated patients and high-grade tumors between radiation-naive patients (P 0.018). Regarding secondary outcomes, prior RT did not increase neither eRFS nor eCFS in both univariate and multivariate analysis. CONCLUSIONS: BCa after RT for PCa has similar histological features and cystectomy free-survival compared to BCa in a radiation-naive population. For patients with non-muscle invasive BCa arising after prostate RT, the risk of recurrences appears to be similar to non-irradiated patients.

[Study on most common overnight urological service consultations.] / Principales consultas urológicas a la guardia de un hospital de alta complejidad.

INTRODUCTION: In Argentina, our institutionhas a urology resident on call who handles requests to the single radio during nighttime. Few studies address this important issue that provides useful information to promote education and optimize hospital dynamics. OBJECTIVE: To describe the characteristics of the calls received in the urology radio during night shifts. MATERIALS AND METHODS: During the night shifts, all calls to the radio were recorded during the period between June and July 2019. We determined: time, source, sex, and age of the patient, reason for the call and classified the calls according to: calls for immediate resolution (which required urological instrumental intervention, bladder catheterization or lavage, etc.), unnecessary calls (wrong number), and the number of emergencies that require calling a superior for immediate surgical resolution. RESULTS: We registered a total of 325 calls, most of them male patients. The main reason for calling was for placement, replacement, or washing of the urinary catheter or suprapubic catheter. We obtained 139 calls that required urological intervention. The highest number of calls was from the emergency department (119), followed by the Internal Medicine staff (47). Most of them (242) did not require patient admission. The total of unnecessary calls was three, corresponding to wrong number. CONCLUSION: This study helped us to characterize the calls to the Urology radio from other services and emergency department, allowing us to identify the most common problems and educate based on this.

INTRODUCCIÓN: En Argentina nuestra institución cuenta con un residente de guardia activa de urología que se ocupa de las llamadas al radio único durante la noche. Existen pocos trabajos que tratan este tema que resulta importante, ya que brinda información útil para promover educación y optimizar la dinámica hospitalaria.OBJETIVO: Describir las características de las llamadas al radio de urología durante la guardia.MATERIALES Y MÉTODOS: Durante la guardia activa, se registraron llamadas al radio durante el período comprendido en junio y julio de 2019. Determinamos:  hora, fuente, sexo y edad del paciente, motivo de la llamada y los clasificamos según: llamadas para guardia inmediata (que necesitó intervención instrumental urológica como sonda, talla o lavado vesical, etc.), llamadas innecesarias (número equivocado) y número de urgencias que requieren llamar a médico urólogo de pasiva para guardia quirúrgica inmediata.RESULTADOS: Se recopilaron un total de 325 llamadas, la mayoría de pacientes de sexo masculino. El principal motivo de la llamada fue para colocación, recambio o lavado de sonda vesical y/o talla vesical. Obtuvimos 139 llamadas que requirieron intervención urológica. El mayor número de llamadas fue de la Guardia externa (119), seguidos de Clínica Médica (47). La mayoría de las llamadas (242) no fueron ingresos. El total de llamadas innecesarias fueron 3 que corresponden al número equivocado.CONCLUSIÓN: Este trabajo permitió detallar las llamadas al radio de Urología provenientes de otros servicios y guardia externa, pudiendo identificar las problemáticas más comunes y educar en base a esto.

Principales consultas urológicas a la guardia de un hospital de alta complejidad / Main urological consultations on duty at a highly complex hospital

Introducción: En Argentina nuestrainstitución cuenta con un residente de guardia activa deurología que se ocupa de las llamadas al radio únicodurante la noche. Existen pocos trabajos que tratan estetema que resulta importante, ya que brinda informaciónútil para promover educación y optimizar la dinámicahospitalaria.Onjetivo: Describir las características de las llamadasal radio de urología durante la guardia.Materiales y métodos: Durante la guardia activa,se registraron llamadas al radio durante el período comprendido en junio y julio de 2019. Determinamos: hora,fuente, sexo y edad del paciente, motivo de la llamaday los clasificamos según: llamadas para guardia inmediata (que necesitó intervención instrumental urológicacomo sonda, talla o lavado vesical, etc.), llamadas innecesarias (número equivocado) y número de urgenciasque requieren llamar a médico urólogo de pasiva paraguardia quirúrgica inmediata.Resultados: Se recopilaron un total de 325 llamadas,la mayoría de pacientes de sexo masculino. El principalmotivo de la llamada fue para colocación, recambio olavado de sonda vesical y/o talla vesical. Obtuvimos139 llamadas que requirieron intervención urológica. Elmayor número de llamadas fue de la Guardia externa(119), seguidos de Clínica Médica (47). La mayoría delas llamadas (242) no fueron ingresos. El total de llamadas innecesarias fueron 3 que corresponden al númeroequivocado.Conclusión: Este trabajo permitió detallar las llamadas al radio de Urología provenientes de otros serviciosy guardia externa, pudiendo identificar las problemáticas más comunes y educar en base a esto.(AU)

Introduction: In Argentina, our institution has a urology resident on call who handles requests to the single radio during nighttime. Few studiesaddress this important issue that provides useful information to promote education and optimize hospital dynamics.Objetive: To describe the characteristics of the callsreceived in the urology radio during night shifts. Materials ans methdos: During the night shifts,all calls to the radio were recorded during the periodbetween June and July 2019. We determined: time,source, sex, and age of the patient, reason for the calland classified the calls according to: calls for immediate resolution (which required urological instrumentalintervention, bladder catheterization or lavage, etc.),unnecessary calls (wrong number), and the number ofemergencies that require calling a superior for immediate surgical resolution.Results: We registered a total of 325 calls, most ofthem male patients. The main reason for calling wasfor placement, replacement, or washing of the urinarycatheter or suprapubic catheter. We obtained 139 callsthat required urological intervention. The highest number of calls was from the emergency department (119),followed by the Internal Medicine staff (47). Most ofthem (242) did not require patient admission. The totalof unnecessary calls was three, corresponding to wrongnumber.Conclusion: This study helped us to characterizethe calls to the Urology radio from other services andemergency department, allowing us to identify the mostcommon problems and educate based on this.(AU)

Glans Preservation in Surgical Treatment of Distal Urethral Strictures With Dorsal Buccal Mucosa Graft Onlay by Subcoronal Approach.

OBJECTIVE: To describe dorsal onlay buccal mucosa graft urethroplasty technique by subcoronal approach and glans preservation in distal penile urethral strictures with fossa navicularis involvement and to report safety, effectiveness, and cosmetic outcomes. METHODS: Retrospective review of a prospective database of patients treated at Hospital Italiano de Buenos Aires between January 2011 and December 2019. Main surgical steps: ventral subcoronal incision, dorsal dissection of glandelar urethra until piercing the tip of the glans, dorsal urethrotomy, and graft transposition. Low urinary tract symptoms, uroflowmetry, and urinalysis were assessed at follow-up. Simplified International Index Erectile Function and Hypospadias Objective Scoring Evaluation were applied 1 year after surgery. RESULTS: Sixteen patients with a median age of 56.5 years (IQR 35.7-66.7) were included. Median stricture length was 5.5 cm (IQR 4-8.7). In 3 patients, Clavien-Dindo grade I-II complications were reported. At 1 year, median peak flow was 18 mL/seg (IQR 12.7-27.4) and median mean flow 7.8 mL/seg (IQR 6.1-9.9). At 41.5 months follow-up (IQR 13.2-74), all patients were stricture free and had no changes in erectile function. Hypospadias Objective Scoring Evaluation score ≥14 points was achieved by 14 patients (87.5%). CONCLUSION: For treatment of distal penile urethral strictures with fossa navicularis involvement, dorsal onlay buccal mucosa graft by subcoronal approach and glans preservation is a feasible technique with excellent functional outcomes, minimal complications, and substantial cosmetic results.