Conservative treatment of upper urinary tract carcinoma in patients with imperative indications.

BACKGROUND: To report our experience for endoscopic treatment of upper urinary tract carcinoma (UTUC) in patients with imperative indications for management. METHODS: Retrospective data were collected for all patients who underwent endoscopic management of UTUC for imperative situations, from September 2013 to January 2019. Comorbidity was determined by using the age-adjusted Charlson Comorbidity Index (CCI). The primary endpoint of the study was overall survival (OS). Secondary outcomes were recurrence-free survival (RFS) rates, complication rates and global renal function. RESULTS: A total of 29 patients were enrolled in the study. The median age was 69.0 (IQR 63.0-79.0) years and the median CCI was 6 (IQR 4-8). Overall, 137 endoscopic procedures were performed; 117 (85.4%) had no complication. Clavien-Dindo grade III and IV complications were 3 (2.2%) and 1 (0.7%) respectively. The median follow-up of 23 months (IQR 14-35). During the follow-up, 2 (6.9%) patients died for cause not related to cancer. Recurrence of UTUC occurred in 18 patients (61.1%). The 24-month OS was 96.4±3.5% and the 24-month RFS was 31.7±9.4%. Lower RFS rates were found in high grade tumor patients (22.2±13.9%) compared to low grade tumor patients (35.6±12.3%) (P=0.237). There was statistical difference in creatinine and eGFR values when comparing baseline to last follow-up (P=0.018 and P=0.005, respectively). CONCLUSIONS: Endoscopic management of UTUC in patients with imperative indications appears to be a reasonable alternative to nephroureterectomy. However, stringent endoscopic follow-up is necessary due to the high risk of disease recurrence.

Knowledge gap across continents: the andrology and male infertility exposure among urology residents in the United States and Europe.

It is well established that resident's exposure and training are of primary importance and positively correlated with patient and health quality outcomes. We aimed to compare and contrast urology residents' self-reported perspectives and attitudes toward exposure and education of andrology and male infertility during residency in both the United States and Europe. We performed a cross-sectional design study using a survey that was distributed to a representative sample of American and European urology residents. The survey included questions regarding demographics, and the residents' perception and description of their training in this specific subspecialty. Response data were analyzed using Chi-square tests. Sixty-five percent of European and thirty-five percent American urology residents reported feeling uncomfortable in a new consultation evaluating an infertile patient and interpreting semen analyses. Surprisingly, more than half of responders replied that they would not go to their own training institutions seeking for male fertility care (78% US and 58% Europeans). In the comparative analysis, although no differences were observed in the very low number (18%) of hospitals that offer formal microsurgical training for urology residents between the US and Europe, more US institutions were reported to have an operating microscope for urology (68% vs. 41%), and more US residents replied reported participating in at least one urologic surgery using the microscope (65% vs. 34%). In conclusion, both American and European residents shared the same frustration regarding their education and exposure to andrology and male infertility during residency training. Collaborative efforts between stakeholders are needed to establish a clear and focused curriculum and training objectives to eliminate this educational gap.

Simulator Availability Index: a novel easy indicator to track training trends. Is Europe currently at a urological training recession risk?

INTRODUCTION: To evaluate the European trend regarding the availability of surgical simulators and to propose a novel index to easily track this trend. MATERIAL AND METHODS: During European Urology Residents Education Program, from 2014 to 2018, residents were asked through an anonymous survey about the availability of specific simulator training boxes at their department. The Simulator Availability Index (SAI) was made by the ratio between the number of departments with at least one box trainer and the total number of departments evaluated. RESULTS: The SAI decreased in five years from 0.47 to 0.41 for laparoscopic trainers, while the already low initial SAI (0.17) decreased by up to 0.05 in four years for both ureteroscopy (URS) and transurethral resection (TUR) trainers. CONCLUSIONS: A self-analysis may be advisable in order to improve the spread of information and investigate whether any specific reasons may be responsible for this trend. The SAI might be a simple but useful tool to monitor and evaluate this trend in the context of national training plans.

[Implementation of Remote Clinics in urology practice during the COVID-19 era: What have we learned?] / Implementación de la teleconsulta en la práctica urológica durante la era Covid-19: ¿qué hemos aprendido?

The COVID-19 pandemic has requiredd rastic measures for an attempt in controlling its spread. Health resources and facilities are being destined for the treatment of critically ill infected patients. During the past weeks, we, as urologists have faced increasingly difficult changes in practice, as out patient activity and elective surgeries must be postponed in order to save resources and limit the mobilization of patients and faculty. During this conflictive situation, telehealth medicine can provide adequate support using technological tools and trying to simulate face-to-face consults with the use of video or telephone calls. However, many out patient clinics and facilities are not ready yet for telehealth as their experience in this area is low. The benefits for telemedicine in urology are continuing urologic outpatient follow-up, providing recommendations and prescriptions, and the triage of patients who will need urgent procedures. Urology residency training has suffered an abrupt disruption nowadays as outpatient, surgical and academic meetings are cancelled. In this scenario, virtual strategies and "smart learning" activities are being used to continue education. We provide a review of the latest published literature regarding the use of telehealth medicine or telemedicine for the modern urology practice, along side our recommendations and conclusions.

La actual pandemia por COVID-19 ha requeridola implementación de medidas drásticas para frenar su avance. Las instalaciones y recursos sanitarios se están destinando de forma total o parcial para la atención de pacientes críticos. Los urólogos, nos hemos encontrado durante las semanas pasadas con cambios importantes que dificultan nuestra práctica clínica diaria. Las actividades ambulatorias como consultas externas y procedimientos ambulatorios, así como las intervenciones quirúrgicas, han tenido que ser suspendidas o retrasadas. Mientras dure esta situación, la actividad médica telemática puede proveer un soporte adecuado utilizando herramientas tecnológicas y tratando de simular las consultas médicas con vídeo llamadas o llamadas por teléfono. Pero muchos servicios y departamentos médico-quirúrgicos no se encuentran listos para implementar una práctica de consultas telemáticas a gran escala porque su experiencia es escasa. Los beneficios de la telemedicina en urología son permitir el seguimiento de pacientes, dar recomendaciones, prescribir medicamentos, y realizar un triaje de qué pacientes precisan una atención presencial en urgencias. Los programas de formación de residentes de urología también han sufrido una interrupción importante de sus actividades cotidianas, ya que se han suspendido consultas, cirugías y actividad académica. En esta situación, el uso de recursos virtuales y el "aprendizaje inteligente" se están utilizando para mantener la docencia. El objetivo de este artículo es proporcionar una revisión de la más reciente literatura acerca del uso de telemedicina en la práctica urológica moderna, con nuestras recomendaciones y conclusiones.

Implementación de la teleconsulta en la práctica urológica durante la era Covid-19: ¿qué hemos aprendido? / Implementation of Remote Clinics in urology practice during the COVID-19 era: What have we learned?

La actual pandemia por COVID-19 ha requeridola implementación de medidas drásticas para frenar su avance. Las instalaciones y recursos sanitarios se están destinando de forma total o parcial para la atención de pacientes críticos. Los urólogos, nos hemos encontrado durante las semanas pasadas con cambios importantes que dificultan nuestra práctica clínica diaria. Las actividades ambulatorias como consultas externas y procedimientos ambulatorios, así como las intervenciones quirúrgicas, han tenido que ser suspendidas o retrasadas. Mientras dure esta situación, la actividad médica telemática puede proveer un soporte adecuado utilizando herramientas tecnológicas y tratando de simular las consultas médicas con vídeo llamadas o llamadas por teléfono. Pero muchos servicios y departamentos médico-quirúrgicos no se encuentran listos para implementar una práctica de consultas telemáticas a gran escala porque su experiencia es escasa. Los beneficios de la telemedicina en urología son permitir el seguimiento de pacientes, dar recomendaciones, prescribir medicamentos, y realizar un triaje de qué pacientes precisan una atención presencial en urgencias. Los programas de formación de residentes de urología también han sufrido una interrupción importante de sus actividades cotidianas, ya que se han suspendido consultas, cirugías y actividad académica. En esta situación, el uso de recursos virtuales y el "aprendizaje inteligente" se están utilizando para mantener la docencia. El objetivo de este artículo es proporcionar una revisión de la más reciente literatura acerca del uso de telemedicina en la práctica urológica moderna, con nuestras recomendaciones y conclusiones

The COVID-19 pandemic has required drastic measures for an attempt in controlling its spread. Health resources and facilities are being destined for the treatment of critically ill infected patients. During the past weeks, we, as urologists have faced increasingly difficult changes in practice, as outpatient activity and elective surgeries must be postponed in order to save resources and limit the mobilization of patients and faculty. During this conflictive situation, telehealth medicine can provide adequate support using technological tools and trying to simulate face-to-face consults with the use of video or telephone calls. However, many outpatient clinics and facilities are not ready yet for telehealth as their experience in this area is low. The benefits for telemedicine in urology are continuing urologic outpatient follow-up, providing recommendations and prescriptions, and the triage of patients who will need urgent procedures. Urology residency training has suffered an abrupt disruption nowadays as outpatient, surgical and academic meetings are cancelled. In this scenario, virtual strategies and "smart learning" activities are being used to continue education. We provide a review of the latest published literature regarding the use of telehealth medicine or telemedicine for the modern urology practice, alongside our recommendations and conclusions

Current status of urology surgical training in Europe: an ESRU-ESU-ESUT collaborative study.

PURPOSE: To determine the current status of surgical training amongst European Urology Residents, including their satisfaction with training and their confidence in performing procedures. METHODS: A 23-item survey was distributed to the 15th European Urology Residents Education Programme (EUREP) 2017 participants. An analysis of demographics, workload, training resources, surgical exposure, surgical caseload, satisfaction and confidence in performing each procedure was performed. RESULTS: A total of 152/350 participants completed the survey (response rate 43%), of which 14% think they perform enough surgeries during their training, and 83% would like to continue training with a fellowship. Confidence in performing procedures without supervision and satisfaction with training was associated with higher surgical caseloads. Confidence in all laparoscopic/robotic procedures (except for laparoscopic/robotic partial nephrectomy) was associated with laparoscopic and robotics training, participation in practical courses and having training resources in hospitals. Satisfaction with surgical training was statistically associated with working ≤  50 h per week, laparoscopic training and having laparoscopic training boxes. CONCLUSIONS: Surgical exposure of European Urology residents for major/minimally invasive procedures, confidence in performing these procedures, and overall satisfaction with training is low. A higher volume of cases, as well as resources for training are associated with higher individual confidence and satisfaction with training.

Simultaneous Bilateral Endoscopic Surgery (SBES) for Patients with Bilateral Upper Tract Urolithiasis: Technique and Outcomes.

BACKGROUND: The incidence of bilateral and multiple renal stones is not negligible. To date, some sparse data on simultaneous bilateral stone surgery are available in literature showing good outcomes in terms of both effectiveness and safety. OBJECTIVE: To describe our series of patients with bilateral renal stones who underwent simultaneous bilateral endoscopic surgery (SBES), reporting its effectiveness and safety. DESIGN, SETTING, AND PARTICIPANTS: A prospective analysis of 27 consecutive patients who underwent simultaneous flexible ureteroscopy (fURS) in one side and percutaneous nephrolithotomy (PCNL) in the other side for bilateral renal stones was performed. SURGICAL PROCEDURE: SBES, performing fURS in one side and PCNL in the other side contemporaneously. MEASUREMENTS: Clinical data were collected in a dedicated database. Intra- and postoperative outcomes were assessed. Comparisons among pre- and postoperative serum creatinine levels and estimated glomerular filtration rate values during the study period were performed using the Kruskal-Wallis test with the Dunn multiple comparison test. RESULTS AND LIMITATIONS: All the procedures were carried out until the end in both sides without encountering any complications intraoperatively. The mean stone size was 27.1±8.1 and 11.1±3.6mm for the PCNL and fURS side respectively. The mean operative time was 79.4±25.2min. There were no differences in patients' creatinine and eGFR when comparing at baseline with 1-mo after SBES. No postoperative major complications were experienced (Clavien-Dindo grade I 3.7%; II 11.1%). Stone-free rate was 74% at 1-mo follow-up. The main limitation of the study is the small size of the group analyzed. CONCLUSIONS: SBES is safe and effective, with minimal morbidity. SBES has the potential advantages of shorter operative time, reduced anesthesia, and reduced hospital time, which can benefit patients, surgeons, and health care systems. PATIENT SUMMARY: Simultaneous bilateral endoscopic surgery is an effective treatment with low complication rates for bilateral urolithiasis. This innovative and complicated procedure should be performed in high-volume centers by experienced surgeons.