Long surgical waiting list times are associated with an increased rate of negative ureteroscopies.

INTRODUCTION: Negative ureteroscopy (NURS) is "a ureteroscopy in which no stone is found during the procedure." We aimed to determine the association between the surgical waiting list time (WLT) and the NURS rate. METHODS: We retrospectively analyzed all patients scheduled for ureteroscopy in our center between January 2017 and July 2019. The inclusion criterion was unilateral, semirigid ureteroscopy for a single ureteral stone; exclusion criteria were renal-only stones, incomplete ureteroscopy, and stones >10 mm. We analyzed age; gender; body mass index; stone size, density, and location; presence of a temporary double-J (DJ) stent; use of medical expulsive therapy; and WLT. Complications while waiting for surgery were also collected and analyzed. RESULTS: We included 219 patients, 41 (18.7%) of whom had NURS. The median WLT was 74 days (interquartile range [IQR] 45-127). Variables protective against NURS were large stone size (odds ratio [OR] 0.78, 95% confidence interval [CI] 0.66-0.93), presence of a temporary DJ stent (OR 0.43, 95% CI 0.2-0.8), and radiopaque stones (OR 0.44, 95% CI 0.21-0.88). A long WLT ((≥60 days) increased the risk of NURS (OR 2.18, 95% CI 1.02-4.61). Complications requiring emergency department visits while waiting for surgery were documented in 58/137 (42.3%) patients with indwelling DJ stents; nonetheless, a WLT greater than the median was not associated with an increased risk of complications (p=0.38). CONCLUSIONS: Long WLT has an independent, direct, and linear correlation with NURS rates. Patients at higher risk of NURS, may be offered preoperative re-evaluation with a computed tomography scan in a resource-limited setting.

Iterative renal transplantation: our experience on third transplants.

PURPOSE: To report our experience on third kidney transplantation, analyzing the complications and graft survival rates as compared to previous transplants. METHODS: Retrospective study of third renal transplants performed at our center. Outcomes were compared with a cohort of first and second transplants. RESULTS: Of a total of 4143, we performed 72 third transplants in 46 men and 26 women with an average age of 46 years and mean time on dialysis of 70 months. Thirty-seven patients were hypersensitized [panel-reactive antibody (PRA) > 50%]. They were all from deceased donors, with a mean cold ischemia time of 19.2 h. The extraperitoneal heterotopic approach was used in 88.8%, transplantectomy was performed in 80.6% and vascular anastomoses were realized mostly to external iliac vessels, using the common iliac artery in 15 cases, and the inferior vena cava in 16. The main ureteral reimplantation technique was the Politano-Leadbetter (76.4%). Third transplantation reported a significantly higher incidence of lymphocele (13.9% vs. 3.2% in first and 4.5% in second transplants; p < 0.001), rejection (34.7% vs. 14.9% and 20.5%, p < 0.001) and urinary obstruction (11.1% vs. 3.6% and 6.3%, p 0.002). Graft survival rates for first, second and third transplants were 87%, 86% and 78% at 1 year, 83%, 82% and 74% at 3 years and 80%, 79% and 65% at 5 years, respectively. CONCLUSION: Iterative transplantation constitutes a valid therapeutic option with adequate surgical and survival results compared to previous transplants. It is a challenging procedure which must be performed by experienced surgeons.

Analgesic refractory colic pain: Is prolonged conservative management appropriate?

OBJECTIVES: To propose a clear definition and management pathway of patients with analgesic refractory colic pain (ARCP). PATIENTS AND METHODS: Prospective cohort study from February 2018 to February 2019 including patients with ARCP defined as ongoing renal colic pain after one dose of IV NSAID, IV paracetamol, and a parenteral opioid, given sequentially in that order. Patients were observed in-hospital under full parenteral analgesic management for 8-12 h, whenever patients had minimal or absent pain after conservative management (CM) they were discharged, and followed-up with new imaging within four weeks. If the pain was not controlled after CM, surgical management (double-J stent or ureteroscopy) was performed. We excluded patients with any other indication for urgent intervention or in cases where CM was deemed inappropriate (sepsis, acute renal failure, stones >10 mm in size, suspected concomitant urinary tract infection, bilateral ureteral stones, pregnancy, patients with a single kidney, kidney transplant recipients, difficult access to medical care or refusal to undergo CM). RESULTS: Data from 60 patients was collected. The only variable associated with an increased risk of failed CM was a history of previous renal colic (OR 3.98 [95% CI 1.14-13.84], p = 0.02). Neither gender, age, stone size, location, or hydronephrosis grade were able to predict CM failure. 41.6% of patients were successfully managed conservatively and only 8% of them required scheduled surgical management at follow-up. CONCLUSION: Our results show that a high proportion of patients with ARCP may be successfully managed conservatively with an extended observation period without complications at follow-up. These results should be replicated in a randomized controlled trial to confirm them.

Programa formativo en urología médica: perspectivas para el futuro / Training program on medical urology: Future perspectives

La Urología está definida como la especialidad médico-quirúrgica que engloba el estudio, diagnóstico y tratamiento de las afecciones médicas del aparato urinario. Queda bien especificado por la Comisión Nacional de Especialidades que debemos conocer la patología médica que nos compete. Sin embargo, en ocasiones, la formación de los residentes se centra en el ámbito quirúrgico y la patología oncológica, que, si bien es uno de los grandes pilares de la especialidad, suele ser en detrimento de la formación en patología médica y funcional. Hemos realizado una encuesta a residentes de cuarto año de Urología de España, en la que preguntamos sobre la calidad de la formación en Andrología y Urología Funcional. La media de tiempo de rotación es de 3,5 meses en cada unidad. Solo un 20% considera que su formación es satisfactoria y suficiente en Andrología. El 75% de los residentes encuestados considera que su formación en Urología Funcional es aceptable o suficiente, tanto a nivel médico como quirúrgico. Existen numerosos campos de actuación para la mejora de la formación de los residentes y jóvenes urólogos de este país en el manejo de la patología médica urológica. El futuro está abierto, y está en nuestra mano configurar una formación para los residentes de urología dentro de la excelencia y que sea reconocida tanto a nivel nacional como internacional como uno de los grandes pilares de la Urología española. En este capítulo analizaremos la situación actual en la formación de los Residentes de Urología españoles en la patología médica urológica, y nos vamos a centrar en la formación en urología funcional y andrología (AU)

Urology is defined as the medical-surgical specialty that includes the study, diagnosis and treatment of medical conditions of the urinary system. It is well specified by the National Commission of Specialties that we must know the medical pathology that concerns us. However, on occasions, resident training focuses on the surgical field and oncological pathology, which, although one of the main pillars of the specialty, is usually to the detriment of training in medical and functional pathology. We conducted a survey of residents in the fourth year of Urology in Spain, where we asked about the quality of training in Andrology and Functional Urology. The average rotation time is 3.5 months in each unit. Only 20% consider that their training is satisfactory and sufficient in Andrology. Seventy-five percent of residents surveyed believe that their training in Functional Urology is acceptable or sufficient, both medical and surgical. There are numerous fields of action to improve the training of residents and young urologists in this country in the management of urological medical pathology. The future is open, and it is in our hand to set up a training for urology residents within excellence and to be recognized both nationally and internationally as one of the great pillars of Spanish Urology. In this chapter we will analyze the current situation in the training of Spanish Urology Residents in urological medical pathology, and we will focus on training in functional urology and andrology (AU)

[Training program on medical urology: Future perspectives.] / Programa formativo en urología médica: perspectivas para el futuro.

Urology is defined as the medical-surgical specialty that includes the study, diagnosis and treatment of medical conditions of the urinary system. It is well specified by the National Commission of Specialties that we must know the medical pathology that concerns us. However, on occasions, resident training focuses on the surgical field and oncological pathology, which, although one of the main pillars of the specialty, is usually to the detriment of training in medical and functional pathology. We conducted a survey of residents in the fourth year of Urology in Spain, where we asked about the quality of training in Andrology and Functional Urology. The average rotation time is 3.5 months in each unit. Only 20% consider that their training is satisfactory and sufficient in Andrology. Seventy-five percent of residents surveyed believe that their training in Functional Urology is acceptable or sufficient, both medical and surgical. There are numerous fields of action to improve the training of residents and young urologists in this country in the management of urological medical pathology. The future is open, and it is in our hand to set up a training for urology residents within excellence and to be recognized both nationally and internationally as one of the great pillars of Spanish Urology. In this chapter we will analyze the current situation in the training of Spanish Urology Residents in urological medical pathology, and we will focus on training in functional urology and andrology.