Annual educational expenses of European urology residents and the role of sponsorship in urology training: a survey-based analysis.

Introduction: The aim of this article was to evaluate the personal monetary costs associated with the urology residency. Material and methods: The European Society of Residents in Urology (ESRU) designed a 35-item survey and distributed it via email and social media to urology residents in Europe.Monthly net salary and educational expenses (general expenses, literature, congresses and courses) and opinions regarding sponsorship and expenditure were evaluated. Comparisons between different countries and salary cut-offs were made. Results: A total of 211 European urology residents completed the survey from 21 European countries. The median interquartile range (IQR) age was 30 (18-42) years and 83.0% were male. A total of 69.6% receive less than €1500 net per month and 34.6% spent ≥€3000 on education in the previous 12 months. Sponsorships came mainly from the pharmaceutical industry (57.8%), but 56.4% of trainees thought that the ideal sponsor should be the hospital/urology department. Only 14.7% of respondents stated that their salary is sufficient to cover training expenses, and 69.2% agreed that training costs have an influence on family dynamics. Conclusions: Personal expenses during training are high, are not sufficiently covered by the salary and impact family dynamics for a majority of residents in Europe. The majority thought that hospitals/national urology associations should contribute to the educational costs. For homogeneous opportunities across Europe, institutions should strive to increase sponsorship.

Using Data Mining to Assist in Predicting Reproductive Outcomes Following Varicocele Embolization.

We carried out a retrospective analysis of infertile couple data using several methodologies and data analysis techniques, including the application of a novel data mining approach for analyzing varicocele treatment outcomes. The aim of this work was to characterize embolized varicocele patients by ascertaining the improvement of some of their clinical features, predicting the success of treatment via pregnancy outcomes, and identifying data patterns that can contribute to both ongoing varicocele research and the more effective management of patients treated for varicocele. We retrospectively surveyed the data of 293 consenting couples undergoing infertility treatment with male varicocele embolization over a 10-year period, and sperm samples were collected before and at 3, 6, and 12 months after varicocele embolization treatment and analyzed with World Health Organization parameters-varicocele severity grades were assessed with medical assessment and scrotal ultrasound, patient personal information (e.g., age, lifestyle, and embolization complications) was collected with clinical inquiries, and varicocele embolization success was measured through pregnancy outcomes. Varicocele embolization significantly improved sperm concentration, motility, and morphology mean values, as well as sperm chromatin integrity. Following this study, we can predict that a male patient without a high varicocele severity grade (with grade I or II) has a 70.83% chance of conceiving after embolization treatment if his partners' age is between 24 and 33 with an accuracy of 70.59%. Furthermore, male patients successful in achieving pregnancy following embolization are mostly characterized by having a normal sperm progressive motility before treatment, a normal sperm concentration after treatment, a moderate to low varicocele severity grade, and not working in a putatively hazardous environment.

Prostate Indeterminate Lesions on Magnetic Resonance Imaging-Biopsy Versus Surveillance: A Literature Review.

CONTEXT: The indeterminate multiparametric prostate magnetic resonance image (mpMRI) lesion is one which cannot be classified as "positive" or "negative" for suspected cancer. Currently, there is no consensus on how to manage patients with indeterminate mpMRIs where areas cannot be classified as positives or negatives (Prostate Imaging Reporting and Data System [PI-RADS] 3 or Likert 3). OBJECTIVE: To define the concept of indeterminate lesion and describe the management strategies that may be adopted for these patients. EVIDENCE ACQUISITION: A literature search of the PubMed database was performed including the search terms "prostate indeterminate lesions", "PI-RADS 3", "Likert 3", "magnetic resonance imaging", and "prostate cancer". EVIDENCE SYNTHESIS: There is no universally accepted definition of what constitutes an indeterminate lesion on mpMRI. This is partly due to the experience of the reporting radiologist and their willingness to call a lesion indeterminate, knowing that this may have consequences for biopsy decisions. This is also partly due to the significant variation in mpMRI acquisition parameters used between different sites. Strategies for managing the indeterminate lesion include: (1) biopsy, where there is a highly variable prevalence of prostate cancer (PCa), reflecting the differences in clinically significant PCa definitions, mpMRI protocols and interobserver variability in characterization of indeterminate lesions and (2) surveillance, where early results suggest that this strategy may be of value for some selected patients with prostate-specific antigen (PSA) monitoring and/or interval mpMRI. The use of prebiopsy MRI, in conjunction with traditional clinical parameters and secondary biomarkers-nomograms, may allow a more accurate selection of patients who can avoid biopsy. CONCLUSIONS: A strategy of close surveillance based on PSA monitoring and interval mpMRI is a feasible management option for motivated patients with indeterminate mpMRI. This surveillance strategy could result in fewer men needing to undergo biopsy, and although early results are promising, long-term results for such a strategy are awaited. PATIENT SUMMARY: In some patients who have an MRI scan of their prostate, the scan may identify an area which may or may not contain cancer. This area is typically called the "indeterminate" lesion. In this report, we attempted to define the concept of indeterminate lesion on multiparametric magnetic resonance (mpMRI) and described the strategies that may be performed for these patients. The use of mpMRI in conjunction with traditional clinical parameters may allow more accurate risk stratification and assessment of the need for prostate biopsy.

Validez del cuestionario de Edimburgo para el diagnóstico de arteriopatía periférica en pacientes con diabetes mellitus tipo 2 / Validity of the Edinburgh claudication questionnaire for diagnosis of peripheral artery disease in patients with type 2 diabetes

Objetivo: Determinar en pacientes diabéticos tipo 2 la prevalencia de arteriopatía periférica y la validez de las manifestaciones clínicas para su diagnóstico. Métodos: Ámbito: Centro de Salud (Mariñamansa, Orense). Periodo: Enero de 2011 - enero de 2013. Criterios inclusión: Pacientes diabéticos tipo 2, con consentimiento informado. Mediciones: Edad, sexo, tiempo de evolución de diabetes, índice de masa corporal, índice de Charlson, presión arterial, índice tobillo-brazo, niveles de colesterol, hábito tabáquico. Riesgo cardiovascular (UKPDS). Cuestionario de Edimburgo. Tamaño muestral: n=323(±5,5% precisión; 95% seguridad). Análisis estadístico: Análisis multivariado de regresión logística. Estudio de sensibilidad, especificidad valores predictivos y concordancia. Aprobado por el Comité Ético de Investigación (2010/278). Resultados: La edad media fue de 71,56±12,73 años, la media de evolución de la diabetes tipo 2 fue de 12,38±9,96 años. El 26,4% referían síntomas de claudicación intermitente. El 37,2% presentaban un índice tobillo-brazo normal (ITB 0,9- 1,1), un 26,5%<0,9 y un 36,2%>1,10. La concordancia de la arteriopatía periférica según el cuestionario de Edimburgo y el ITB fue reducida (índice Kappa=0,33). El cuestionario de Edimburgo mostró una sensibilidad del 50,7% para predecir el diagnóstico de arteriopatía periférica (ITB< 0,9) una especificidad del 82,6%, un valor predictivo positivo y negativo de 48,6 y 83,8% respectivamente. Conclusiones: Una cuarta parte de los pacientes diabéticos tipo 2 presenta arteriopatía periférica. Existe una baja concordancia entre la evaluación de síntomas de claudicación intermitente y los resultados del ITB. La presencia de los síntomas de claudicación o su ausencia no permiten descartar ni confirmar la enfermedad arterial periférica (AU)

Objective: To assess the prevalence of peripheral artery disease and the validity of clinical signs for its diagnosis in patients with type 2 diabetes. Methods: Setting: Health center (Mariñamansa, Orense).Period: January 2011-January 2013. Inclusion criteria Patients with type 2 diabetes, informed consent. Measurements: Age, sex, diabetes duration, body mass index, Charlson index, blood pressure, ankle-brachial index (ABI), cholesterol levels, smoking. Cardiovascular risk (UKPDS). Edinburgh Claudication Questionnaire. Sample size: n=323 (± 5.5% accuracy, 95% confidence). Statistical analysis: multivariate logistic regression analysis. Sensitivity, specificity, predictive values, and agreement were estimated. Informed consent and ethics committee approval were obtained (2010/278). Results: Mean patient age was 71.56±12.73 years, and mean diabetes duration 12.38±9.96 years. Symptoms of intermittent claudication were reported by 26,4% of patients, ABI was normal (0.9-1.1) in 37.2% of patients, less than 0.9 in 26,5%, and higher than 1.10 in 36.2% of patients. The kappa index of agreement of peripheral artery disease according to the Edinburgh Claudication Questionnaire and the ankle-brachial index was 0.33). The questionnaire showed a sensitivity of 50.7% for predicting the diagnosis of peripheral artery disease (ABI <0.9) with a specificity of 82.6%, with positive and negative predictive values of 48.6% and 83.8% respectively. Conclusions: One-fourth of patients with type 2 diabetes had peripheral artery disease. There was a low level of agreement between the evaluation of symptoms of intermittent claudication and the results of the ankle-brachial index. Presence or absence of symptoms of claudication did not allow for confirming or ruling out peripheral artery disease (AU)

Validity of the Edinburgh claudication questionnaire for diagnosis of peripheral artery disease in patients with type 2 diabetes. / Validez del cuestionario de Edimburgo para el diagnóstico de arteriopatía periférica en pacientes con diabetes mellitus tipo 2.

OBJECTIVE: To assess the prevalence of peripheral artery disease and the validity of clinical signs for its diagnosis in patients with type 2 diabetes. METHODS: Setting: Health center (Mariñamansa,Orense). PERIOD: January 2011-January 2013. INCLUSION CRITERIA: Patients with type 2 diabetes, informed consent. MEASUREMENTS: Age, sex, diabetes duration, body mass index, Charlson index, blood pressure, ankle-brachial index (ABI), cholesterol levels, smoking. Cardiovascular risk (UKPDS). Edinburgh Claudication Questionnaire. SAMPLE SIZE: n=323 (± 5.5% accuracy, 95% confidence). STATISTICAL ANALYSIS: multivariate logistic regression analysis. Sensitivity, specificity, predictive values, and agreement were estimated. Informed consent and ethics committee approval were obtained (2010/278). RESULTS: Mean patient age was 71.56±12.73 years, and mean diabetes duration 12.38±9.96 years. Symptoms of intermittent claudication were reported by 26,4% of patients, ABI was normal (0.9-1.1) in 37.2% of patients, less than 0.9 in 26,5%, and higher than 1.10 in 36.2% of patients. The kappa index of agreement of peripheral artery disease according to the Edinburgh Claudication Questionnaire and the ankle-brachial index was 0.33). The questionnaire showed a sensitivity of 50.7% for predicting the diagnosis of peripheral artery disease (ABI <0.9) with a specificity of 82.6%, with positive and negative predictive values of 48.6% and 83.8% respectively. CONCLUSIONS: One-fourth of patients with type 2 diabetes had peripheral artery disease. There was a low level of agreement between the evaluation of symptoms of intermittent claudication and the results of the ankle-brachial index. Presence or absence of symptoms of claudication did not allow for confirming or ruling out peripheral artery disease.

Deep Infiltrating Endometriosis-Urinary Tract Involvement and Predictive Factors for Major Surgery.

OBJECTIVE: To evaluate urinary tract involvement by deep infiltrating endometriosis as well as the surgical treatment and existence of predictive factors for major urologic surgery. METHODS: We conducted a retrospective analysis of 656 women submitted to surgery for endometriosis, of which 28 patients underwent minor or major surgery for deep infiltrating endometriosis involving the urinary tract, with a mean age of 38 ± 6.9 years (27-50) at diagnosis. Clinical data, surgeries performed, and complications were analyzed. Minor surgery was defined by endoscopic surgery or insertion of a percutaneous nephrostomy catheter, and major surgery included open or laparoscopic procedures. RESULTS: Endometriomas affected the ureter in 13 (46.4%), the bladder in 11 (39.3%), and both structures in 4 (14.3%) patients. Twelve (42.9%) patients had decreased renal function, and ureteral involvement was predictive of renal function loss (P = .034). Minor surgeries were performed in most women with isolated bladder involvement and in 12 (42.9%) patients with ureteral infiltration. Patients with ureteric involvement underwent major surgeries more often (n = 12 vs n = 3; P = .025) and had longer hospitalization (8.2 vs 3.1 days, P = .05). After a mean follow-up of 36.3 (1-102) months, there was no bladder involvement recurrence. The most common complication was ureteral stenosis (Clavien-Dindo grade IIIb) in 3 (10.7%) patients. CONCLUSION: Surgery is highly successful in most cases. Patients with ureteric involvement are more likely to lose kidney function, undergo major surgery, and have longer hospitalization.

Organ-sparing surgery for large cell calcifying Sertoli cell tumour in a patient with Carney complex.

Carney complex is a rare genetic disease characterised by a complex of myxomas, spotty pigmentation and endocrine overactivity. At diagnosis, about one-third of male patients presents with testicular tumours, namely large cell calcifying Sertoli cell tumours, which are often multicentric and/or bilateral and have a low malignant potential. Although radical orchiectomy is the gold standard for the treatment of testicular neoplasms, a conservative approach with partial orchiectomy or tumourectomy may be the best treatment option for these patients, allowing the preservation of endocrine function, fertility and body image. We present a case of a 19-year-old man with a known history of Carney complex with early identification of a small testicular tumour treated with organ-sparing surgery.

Arterioureteral fistula: an unusual clinical case.

Arterioureteral fistulas (AUFs) are abnormal communications between a major artery and the mid to distal ureter. It is a rare but potentially life-threatening condition that is seldom recognised. We present a case of a 66-year-old man who was admitted to the surgical ward owing to infection of an aortic bifemoral bypass graft. During admission, the patient developed persistent haematuria with considerable loss of haemoglobin. He was submitted to urgent surgical exploration of the graft. An ascending pyelography performed at the beginning of the surgery clearly shows a communication between the left ureter and the vascular graft. Open surgical exploration was undertaken, the fistulised section of the ureter resected and an end-to-end ureteroplasty was performed. The vascular graft was removed and the patient later submitted to left supracondylar amputation. Urinary drainage remained intact.

Metabolic laparoscopic gastric bypass for obese patients with type 2 diabetes.

BACKGROUND: Bariatric surgery has been proposed as the most effective treatment for patients with type 2 diabetes mellitus (T2DM) and body mass index (BMI) above 35 kg/m(2). The purpose of our study was to access remission rate and improvement of metabolic control of T2DM after gastric bypass. METHODS: A prospective study was carried out on 94 diabetic patients, who underwent gastric bypass with a 200-cm biliopancreatic limb. Characteristics evaluated included weight, BMI, percentage of excess BMI lost (% EBMIL), fasting glucose, HbA1c, and lipid profile up to 36 months after surgery, as well as anti-diabetic treatment before and after surgery. RESULTS: At the time of surgery, patients had a mean BMI of 44.3 ± 0.65 kg/m(2) and length of T2DM diagnosis of 6.2 ± 0.98 years and HbA1c of 6.6 ± 0.21%. After a mean time of follow-up of 2.6 ± 0.13 years, the weight loss was significant from 3 months onwards after surgery, reaching its peak at 24 months with a BMI of 32.1 ± 0.9 kg/m(2) and corresponding % EBMIL of 69.0 ± 2.84%. Remission rates of diabetes were 87.91% at 6 months, 92.68% at 12 months, 92.85% at 24 months, and 100% at 36 months of follow-up. CONCLUSIONS: Gastric bypass in obese patients is associated with a high remission rate of diabetes and improvement of the metabolic control. Although confirmation with randomized controlled studies is needed, these results suggest that this type of surgery might be particularly indicated for obese diabetic patients with good pancreatic reserve.