Multicenter comparative study of open, laparoscopic, and robotic pyeloplasty in the pediatric population for the treatment of ureteropelvic junction obstruction (UPJO)

ABSTRACT Introduction: Dismembered open pyeloplasty described by Anderson and Hynes is the "gold standard" for the treatment of ureteropelvic junction obstruction. The aim of our study was to compare the results of open (OP) vs laparoscopic (LP) vs robotic (RALP) pyeloplasty. Material and Methods: A multicenter prospective review was conducted of pyeloplasty surgeries performed at five high-volume centers between 2014 and 2018. Demographic data, history of prenatal hydronephrosis, access type, MAG3 renogram and differential renal function, surgery time, length of hospital stay, and complication rate (Clavien-Dindo) were recorded. Access type was compared using the Kruskal-Wallis, Chi-square, or Fisher's exact tests. Results: A total of 322 patients were included: 62 OP, 86 LP, and 174 RALP. The mean age was 8.13 (r: 1-16) years, with a statistically significant lower age (mean 5 years) in OP (p < 0.001). There were no significant differences in the distribution of the side affected. Operative time was 110.5 min for OP, 140 min for LP, and 179 min for RALP (p < 0.0001). Hospital stay was significantly shorter in the RALP group than in the other groups (p < 0.0001). There were no differences in postoperative complications and reoperations between the three groups. Conclusions: Minimally invasive surgery for the management of UPJO in children is gaining more acceptance, even in patients younger than 1-year-old. Operative time continues to be significantly shorter in OP than in LP and RALP. Hospital stay was shorter in RALP compared to the other techniques. No differences were found in complication rates, type of complications, and reoperation rate.

Multicenter comparative study of open, laparoscopic, and robotic pyeloplasty in the pediatric population for the treatment of ureteropelvic junction obstruction (UPJO).

INTRODUCTION: Dismembered open pyeloplasty described by Anderson and Hynes is the "gold standard" for the treatment of ureteropelvic junction obstruction. The aim of our study was to compare the results of open (OP) vs laparoscopic (LP) vs robotic (RALP) pyeloplasty. MATERIAL AND METHODS: A multicenter prospective review was conducted of pyeloplasty surgeries performed at five high-volume centers between 2014 and 2018. Demographic data, history of prenatal hydronephrosis, access type, MAG3 renogram and differential renal function, surgery time, length of hospital stay, and complication rate (Clavien-Dindo) were recorded. Access type was compared using the Kruskal-Wallis, Chi-square, or Fisher's exact tests. RESULTS: A total of 322 patients were included: 62 OP, 86 LP, and 174 RALP. The mean age was 8.13 (r: 1-16) years, with a statistically significant lower age (mean 5 years) in OP (p < 0.001). There were no significant differences in the distribution of the side affected. Operative time was 110.5 min for OP, 140 min for LP, and 179 min for RALP (p < 0.0001). Hospital stay was significantly shorter in the RALP group than in the other groups (p < 0.0001). There were no differences in postoperative complications and reoperations between the three groups. CONCLUSIONS: Minimally invasive surgery for the management of UPJO in children is gaining more acceptance, even in patients younger than 1-year-old. Operative time continues to be significantly shorter in OP than in LP and RALP. Hospital stay was shorter in RALP compared to the other techniques. No differences were found in complication rates, type of complications, and reoperation rate.

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.

Precisión y utilidad de la resonancia magnética para el diagnóstico de cáncer de testículo / Magnetic resonance imaging accuracy and utility for testicular cancer diagnosis

Objetivo: El objetivo de este trabajo es analizar los hallazgos en resonancia magnética testicular (RMt) y el tipo histopatológico de las lesiones para determinar qué características relacionadas con las imágenes pueden constituir predictores de malignidad.Materiales y métodos: Se analizaron de manera retrospectiva 46 pacientes con lesiones testiculares, a quienes se evaluó inicialmente con ultrasonido (US) y luego con RMt empleando un equipo de 1,5 teslas. Los estudios de resonancia magnética (RM) fueron analizados por un radiólogo con 8 años de experiencia en RMt. Los hallazgos en las imágenes como el tamaño de la lesión, la intensidad de señal en secuencias T1, T2, y el realce tras la administración de contraste se correlacionaron con el diagnóstico de anatomía patológica (AP). Se estudió la sensibilidad, la especificidad, el valor predictivo positivo (VPP) y el valor predictivo negativo (VPN).Resultados: El realce tras administración de contraste fue el hallazgo de mejor performance con una sensibilidad, especificidad, VPP y VPN de 90 (71-97), 47 (24-71), 74 (56-87) y 73 (40-92), respectivamente. Los resultados para las lesiones hiperintensas, hipointensas o heterogéneas en secuencias ponderadas en T2 y con realce con el contraste endovenoso fueron de 87 (49-84), 47 (44-89), 74 (55-86) y 67 (35-89), respectivamente (sensibilidad, especificidad, VPP y VPN).Conclusión: El hallazgo de una lesión testicular de baja intensidad de señal y/o heterogénea en secuencias T2, con realce con contraste EV representa un valioso predictor de malignidad. Siendo esta última característica la más sensible como predictor de malignidad en las imágenes. (AU)

Purpose: The purpose of our study is to analyze the imaging findings described in MRI and the histopathologic type of testicular lesions to determine which findings are the best predictors of malignancy.Materials and methods: Forty six (46) patients with testicular lesions were initially studied with ultrasound (US) and with testicular MRI (tMRI) on a 1.5-T magnet. MRIs were reviewed by a radiologist with 8 years of experience and imaging findings such as the size of the lesion, the signal intensity in T1, T2 weighted sequences, and the enhancement after endovenous contrast administration, were correlated with the histopathologic diagnosis. Sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) were analyzed.Results: The enhancement after administration of contrast was the finding of better performance with a sensitivity, specificity, PPV and NPV of 90 (71-97), 47 (24-71), 74 (56-87) and 73 (40-92), respectively. Meanwhile, the results for hypointense/heterogeneous lesions in T2 weighted sequences and with enhancement with intravenous contrast were 87 (49-84), 47 (44-89), 74 (55-86) y 67 (35-89), respectively.Conclusion: The finding of a testicular lesion of low signal intensity and heterogeneous in T2 weighted sequences, with IV contrast enhancement represents a valuable predictor of malignancy. The latter being the most sensitive as a predictor of malignancy. (AU)

[Magnetic resonance imaging accuracy and utility for testicular cancer diagnosis]. / Precisión y utilidad de la resonancia magnética para el diagnóstico de cáncer de testículo.

PURPOSE: The purpose of our study is to analyze the imaging findings described in MRI and the histopathologic type of testicular lesions to determine which findings are the best predictors of malignancy. MATERIALS AND METHODS: Forty six (46) patients with testicular lesions were initially studied with ultrasound (US) and with testicular MRI (tMRI) on a 1.5-T magnet. MRIs were reviewed by a radiologist with 8 years of experience and imaging findings such as the size of the lesion, the signal intensity in T1, T2 weighted sequences, and the enhancement after endovenous contrast administration, were correlated with the histopathologic diagnosis. Sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) were analyzed. RESULTS: The enhancement after administration of contrast was the finding of better performance with a sensitivity, specificity, PPV and NPV of 90 (71-97), 47 (24-71), 74 (56-87) and 73 (40-92), respectively. Meanwhile, the results for hypointense/heterogeneous lesions in T2 weighted sequences and with enhancement with intravenous contrast were 87 (49-84), 47 (44-89), 74 (55-86) y 67 (35-89), respectively. CONCLUSION: The finding of a testicular lesion of low signal intensity and heterogeneous in T2 weighted sequences, with IV contrast enhancement represents a valuable predictor of malignancy. The latter being the most sensitive as a predictor of malignancy.

Urological Cancers and Kidney Transplantation: a Literature Review.

PURPOSE OF REVIEW: The aim of this review is to provide an overview of epidemiology, risk factors, and treatment of urological malignancies in renal transplant recipients (RTR). RECENT FINDINGS: Although optimal immunosuppressive therapy and cancer management in these patients remain controversial, adherence to general guidelines is recommended. Kidney transplantation is recognized as the standard of care for the treatment of end-stage renal disease (ESRD) as it offers prolonged survival and better quality of life. In the last decades, survival of RTRs has increased as a result of improved immunosuppressive therapy; nonetheless, the risk of developing cancer is higher among RTRs compared to the general population. Urological malignancies are the second most common after hematological cancer and often have more aggressive behavior and poor prognosis.

Predictores de cirugía uretral compleja en estenosis de la uretra anterior / Predictors of complex urethral surgery in urethral stricture former

Objetivo: Determinar los factores predic-tores asociados a Cirugía Uretral Compleja (CUC) enlos casos de estenosis de la uretra anterior.Material y método: Estudio transversal con registro de datos retrospectivo, incluye a todos los pacientes masculinos a quienes se les practicó una plastía dela uretra anterior entre 2011 y 2018. Como CUC seconsideró a la Uretroplastia con dos o más injertos, laanastomosis término terminal ampliada, la uretroplastíacombinada y la cirugía por estadíos. Los datos se recabaron de la historia clínica electrónica consignándoseaquellos demográficos, antecedente de tratamientosprevios, así como las características de la estenosis(etiología, ubicación anatómica, longitud, número deestenosis entre otras). Se realizó un análisis univariadoy multivariado para identificar variables predictoras deCUC. Resultados: Se analizaron los datos de 665 pacientes con criterios de inclusión válidos. La media de edadfue de 56,1 años, 27,5% eran fumadores crónicos,32,5% habían recibido algún tratamiento previo, siendolas dilataciones el procedimiento más común (17,6%),la etiología más prevalente fue la iatrógena seguida porla idiopática en un 61,1 y un 20,3% respectivamente,la ubicación más común fue la uretra bulbar en 56,2%mientras que la media de longitud de la estenosis fuede 4,8 cm. En el análisis univariado y multivariable elantecedente de dilataciones (HR 2,6), la multifocalidad(HR 2,51), la longitud de la estenosis (>4 cm) (HR 1,49)y la etiología hipospadias (HR 11,9) resultaron ser factores predictores independientes para CUC (p<0,05).Conclusiones: La hipospadia fue dentro de lasetiologías analizadas la única que predice la necesidad de CUC. En lo que respecta a antecedentes yhallazgos radiológicos, las dilataciones y las estenosisextensas y multifocales respectivamente fueron predictores de CUC.(AU)

Objective: To determine the clinical-sur-gical factors associated with Complex Urethral Surgery(CUC) in anterior urethral stenosis.Material and method: This is a cross-sectionalstudy with retrospective data recording, including allmale patients who underwent anterior urethroplasty between 2011 and 2018. CUC included two or moregrafts urethroplasty, excisional augmented anastomoticurethroplasty, combined flaps and grafts urethroplastyand stages surgery. The data were collected electronic medical record, recording the demographicdata, background of previous treatments as well as thecharacteristics of the stenosis (etiology, anatomical location, length, number of strictures, among others). A univariate and multivariate analysis were conducted usingthe chi-squared test and logistic regression to identify thevariables related to CUC.Results: The data of 665 patients met the inclusioncriteria were analyzed. The mean age was 56.1 years,27.5% were smokers, 32.5% had received some previous treatment, and dilatations were the most commonprocedure. The most prevalent etiology was iatrogenic,followed by idiopathic in a 61.1 and 20.3% respectively. Bulbar urethral stricture were the most commonlocation (56.2%) while the mean length of the stenosiswas 4.8 cm. After univariate and multivariate analysis,previous dilations (HR 2.6), multifocality (2.51), lengthof stenosis (>4 cm) (HR 1.49) and the hypospadias etiology (HR 11.9) were independent predictors for CUC(p<0.05).Conclusions: Hypospadias was the only etiologyfactor that predicts the need for CUC. Regarding radiological findings, extensive and multifocal stenosis, werepredictors of complex surgery. History of previous dilations were also predictors of CUC.from the

[Predictors of complex urethral surgery in anterior urethral stricture disease.] / Predictores de cirugía uretral compleja en estenosis de la uretra anterior.

OBJECTIVE: To determine the clinical-surgical factors associated with Complex Urethral Surgery (CUC) in anterior urethral stenosis. MATERIAL AND METHOD: This is a cross-sectional study with retrospective data recording, including all male patients who under went anterior urethroplasty between 2011 and 2018. CUC included two or more grafts urethroplasty, excisional augmented anastomotic urethroplasty, combined flaps and grafts urethroplasty and stages surgery. The data were collected from the electronic medical record, recording the demographic data, background of previous treatments as well as the characteristics of the stenosis (etiology, anatomical location, length, number of strictures, among others). A univariate and multivariate analysis were conducted using the chi-squared test and logistic regression to identify the variables related to CUC. RESULTS: The data of 665 patients met the inclusion criteria were analyzed. The mean age was 56.1 years, 27.5% were smokers, 32.5% had received some previous treatment, and dilatations were the most common procedure. The most prevalent etiology was iatrogenic, followed by idiopathic in a 61.1 and 20.3% respectively. Bulbar urethral stricture were the most common location (56.2%) while the mean length of the stenosis was 4.8 cm. After univariate and multivariate analysis, previous dilations (HR 2.6), multifocality (2.51), lengthof stenosis (>4 cm) (HR 1.49) and the hypospadias etiology (HR 11.9) were independent predictors for CUC (p<0.05)CONCLUSIONS: Hypospadias was the only etiology factor that predicts the need for CUC. Regarding radiological findings, extensive and multifocal stenosis, were predictors of complex surgery. History of previous dilations were also predictors of CUC.

OBJETIVO: Determinar los factores predictores asociados a Cirugía Uretral Compleja (CUC) en los casos de estenosis de la uretra anterior.MATERIAL Y MÉTODO: Estudio transversal con registro de datos retrospectivo, incluye a todos los pacientes masculinos a quienes se les practicó una plastía de la uretra anterior entre 2011 y 2018. Como CUC se consideró a la Uretroplastia con dos o más injertos, la anastomosis término terminal ampliada, la uretroplastia combinada y la cirugía por estadíos. Los datos se recabaron de la historia clínica electrónica consignándose aquellos demográficos, antecedente de tratamientos previos, así como las características de la estenosis (etiología, ubicación anatómica, longitud, número de estenosis entre otras). Se realizó un análisis univariado y multivariado para identificar variables predictoras de CUC. RESULTADOS: Se analizaron los datos de 665 pacientes con criterios de inclusión válidos. La media de edad fue de 56,1 años, 27,5% eran fumadores crónicos, 32,5% habían recibido algún tratamiento previo, siendo las dilataciones el procedimiento más común (17,6%), la etiología más prevalente fue la iatrógena seguida por la idiopática en un 61,1 y un 20,3% respectivamente, la ubicación más común fue la uretra bulbar en 56,2% mientras que la media de longitud de la estenosis fue de 4,8 cm. En el análisis univariado y multivariable el antecedente de dilataciones (HR 2,6), la multifocalidad (HR 2,51), la longitud de la estenosis (>4 cm) (HR 1,49) y la etiología hipospadias (HR 11,9) resultaron ser factores predictores independientes para CUC (p<0,05). CONCLUSIONES: La hipospadia fue dentro de las etiologías analizadas la única que predice la necesidad de CUC. En lo que respecta a antecedentes y hallazgos radiológicos, las dilataciones y las estenosis extensas y multifocales respectivamente fueron predictores de CUC.

Prognostic Factors in De Novo Metastatic Renal Cell Carcinoma: A Report From the Latin American Renal Cancer Group.

PURPOSE: To assess the effect of clinical and pathological variables on cancer-specific and overall survival (OS) in de novo metastatic patients from a collaborative of primarily Latin American countries. PATIENTS AND METHODS: Of 4,060 patients with renal cell carcinoma diagnosed between 1990 and 2015, a total of 530 (14.5%) had metastasis at clinical presentation. Relationships between clinical and pathological parameters and treatment-related outcomes were analyzed by Cox regression and the log-rank method. RESULTS: Of 530 patients, 184 (90.6%) had died of renal cell carcinoma. The median OS of the entire cohort was 24 months. American Society of Anesthesiology classification 3-4 (hazard ratio [HR]: 1.64), perirenal fat invasion (HR: 2.02), and ≥ 2 metastatic organ sites (HR: 2.19) were independent prognostic factors for 5-year OS in multivariable analyses. We created a risk group stratification with these variables: no adverse risk factors (favorable group), median OS not reached; one adverse factor (intermediate group), median OS 33 months (HR: 2.04); and two or three adverse factors (poor risk group), median OS 14 months (HR: 3.58). CONCLUSION: Our study defines novel prognostic factors that are relevant to a Latin American cohort. With external validation, these easily discerned clinical variables can be used to offer prognostic information across low- and middle-income countries.

Comparing open and robotic salvage radical prostatectomy after radiotherapy: predictors and outcomes.

INTRODUCTION: In the present study, we aim to provide more evidence about benefits of salvage radical prostatectomy (SRP). Our main objective is to assess prostatic-specific antigen control and postoperative urinary incontinence in open and robotic approaches as primary outcomes. MATERIALS AND METHODS: After the Institutional Review Board approval (IRB00010193), we retrospectively analyzed 76 consecutive patients who underwent open or robot-assisted SRP for locally relapsed prostate cancer between 2004 and 2019 at the Urology Department of Hospital Italiano de Buenos Aires, Argentina. Data were collected from our electronic medical record and prospective database.Postoperative variables, such as urinary incontinence, erectile function preservation, and vesicourethral anastomosis stricture development, were analyzed. RESULTS: Before SRP, 59 patients (76.6%) were treated with 3D external beam radiotherapy, 11 (14.3%) with brachytherapy, and 6 (7.8%) with intensity-modulated radiotherapy. Fifty patients underwent open SRP, and 26, robot-assisted SRP. Comparing surgical approaches, the global incontinence rate was 34.2% versus 9.1% in open versus robot-assisted approach, respectively (p: 0.01).Vesicourethral anastomosis stricture occurred in six patients (8.7%), all in the open approach group (p: 0.07). Five patients of 69 (7.2%) preserved erectile function with/without use of phosphodiesterase 5 inhibitors. Two patients in the open approach group needed blood transfusion. Estimated 2-year biochemical recurrence-free survival rate in the open approach group and robot-assisted group was 67% (95% confidence interval: 53.7-80.3) and 60.9% (95% confidence interval: 40.5-81.3), respectively, with no statistical difference (log-rank test p: 0.873). CONCLUSIONS: Robot-assisted SRP is a reliable procedure to treat local recurrences after external beam radiotherapy or brachytherapy, reducing the risk of anastomotic strictures and blood loss and improving continence outcomes.

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.

Bulbomembranous Urethral Strictures Repair After Surgical Treatment of Benign Prostatic Hyperplasia. Experience From a Latin American Referral Centre.

OBJECTIVE: To evaluate stricture recurrence and urinary incontinence (UI) rates in patients who underwent bulbomembranous anastomosis for management of short (≤ 2cm) bulbomembranous urethral stricture (BMS) after benign prostatic hyperplasia (BPH) surgical treatment. In addition, we studied if there was any relation between post urethroplasty UI and the method employed for BPH surgical treatment. MATERIALS AND METHODS: A retrospective study was conducted between January 2011 and October 2019. We included all patients who developed BMS after undergoing Transurethral Resection of the Prostate, Holmium Laser Enucleation of the Prostate or Open Simple Prostatectomy (OSP). We excluded patients with UI after BPH surgical treatment as well as patients who underwent a dorsal or ventral onlay oral graft urethroplasty for longer proximal bulbar strictures, and also patients with associated bladder neck contracture or other strictures locations. We defined failure as the need for any intervention to restore the urethral caliber. RESULTS: Overall, 77 patients were included in the study with mean age 70 years (sd 8). Median BMS length was 1.5 cm (IQR 1-2). Median follow-up was 53 months (IQR 24 to 82). Of the patients, 74/77 (96.1%) were classified as success and 3/77 (3.9%), as failure. Out of the 6/77 (7.8%) patients who had postoperative UI, 5 of them had been treated for their BPH with OSP (p 0.001). CONCLUSIONS: Bulbomembranous anastomosis is a suitable reconstructive option for short proximal bulbar urethral strictures after BPH surgical treatment. OSP was associated with postoperative UI more frequently than endoscopic treatments modalities.

Exploring Urological Experience in the COVID-19 Outbreak: American Confederation of Urology (CAU) Survey.

PURPOSE: To explore the current situation faced by Latin American urology departments during the COVID-19 Outbreak in terms of knowledge, actions, prioritization of urology practices, and implementation of internal clinical management protocols for inpatients and outpatients. MATERIAL AND METHODS: A non-validated, structured, self-administered, electronic survey with 35 closed multiple choice questions was conducted in Spanish, Portuguese, Italian, and English and Deutsch versions from April 1st to April 30th, 2020. The survey was distributed through social networks and the official American Confederation of Urology (CAU) website. It was anonymous, mainly addressed to Latin American urologists and urology residents. It included 35 questions exploring different aspects: 1) Personal Protective Equipment (PPE) and internal management protocols for healthcare providers; 2) Priority surgeries and urological urgencies and 3) Inpatient and outpatient care. RESULTS: Of 864 surveys received, 846 had at least 70% valid responses and were included in the statistical analyses. Surveys corresponded to South America in 62% of the cases, Central America and North America in 29.7%. 12.7% were residents. Regarding to PPE and internal management protocols, 88% confirmed the implementation of specific protocols and 45.4% have not received training to perform a safe clinical practice; only 2.3% reported being infected with COVID-19. 60.9% attended urgent surgeries. The following major uro-oncologic surgeries were reported as high priority: Radical Nephrectomy (RN) 58.4%, and Radical Cystectomy (RC) 57.3%. When we associate the capacity of hospitalization (urologic beds available) and percentage of high-priority surgery performed, we observed that centers with fewer urological beds (10-20) compared to centers with more urological beds (31-40) performed more frequently major urologic cancer surgeries: RN 54.5% vs 60.8% (p=0.0003), RC 53.1% vs 64.9% (p=0.005) respectively. CONCLUSIONS: At the time of writing (May 13th 2020) our data represents a snapshot of COVID-19 outbreak in Latin American urological practices. Our findings have practical implications and should be contextualized considering many factors related to patients and urological care: The variability of health care scenarios, institutional capacity, heterogeneity and burden of urologic disease, impact of surgical indications and decision making when prioritizing and scheduling surgeries in times of COVID-19 pandemic.

Impact of COVID-19 Pandemic on Ibero-American Urology Residents: Perspective of American Confederation of Urology (CAU)

ABSTRACT Introduction: Since World Health Organization (WHO) declared COVID-19 as a global pandemic, urology services have developed strategies to prioritize and not to differ urgent and oncological patient's medical attention, in order to optimize resources and decrease infection probability among staff and patients. This unprecedented situation has generated a decrease in assistance and academic activities in most medical residences. The aim of this manuscript is to evaluate the impact of this health crisis on training programs through a survey addressed to urology medical residents. Materials and Methods: Cross sectional designed study, with multiple-choice non validated survey answered online by residents. Questionnaire was developed through the CAU EDUCACION platform. Results: A total of 148 responses from 18 countries coming from Latin America and Spain answering the survey. Of total, 82% answered that the activity of their urology department was significantly reduced, attending only urgent surgical pathologies, 15 % that, the urology activity has been closed completely and the staff was assigned to COVID-19 patients care, 3% continue with the regular clinic activity. Likewise, 75% stated that their surgical training has been completely affected, 93% receive urological information through tools such as Skype, ZOOM meeting, Cisco Webex, being Webinar modality the most used. Despite technological boom, 65% answered their academic training has been partially or completely affected. Most of the surveyed residents consider that period of residence should be extended to retrieve the educational targets. Conclusion: This unprecedented reality is negatively impacting the heterogeneous residency programs that American Confederation of Urology (CAU) nucleates. It is necessary to continue with technological innovation and allocate time and resources to easily generate accessible tools to favor the training of future urologists.

Exploring Urological Experience in the COVID-19 Outbreak: American Confederation of Urology (CAU) Survey

ABSTRACT Purpose: To explore the current situation faced by Latin American urology departments during the COVID-19 Outbreak in terms of knowledge, actions, prioritization of urology practices, and implementation of internal clinical management protocols for inpatients and outpatients. Material and Methods: A non-validated, structured, self-administered, electronic survey with 35 closed multiple choice questions was conducted in Spanish, Portuguese, Italian, and English and Deutsch versions from April 1st to April 30th, 2020. The survey was distributed through social networks and the official American Confederation of Urology (CAU) website. It was anonymous, mainly addressed to Latin American urologists and urology residents. It included 35 questions exploring different aspects: 1) Personal Protective Equipment (PPE) and internal management protocols for healthcare providers; 2) Priority surgeries and urological urgencies and 3) Inpatient and outpatient care. Results: Of 864 surveys received, 846 had at least 70% valid responses and were included in the statistical analyses. Surveys corresponded to South America in 62% of the cases, Central America and North America in 29.7%. 12.7% were residents. Regarding to PPE and internal management protocols, 88% confirmed the implementation of specific protocols and 45.4% have not received training to perform a safe clinical practice; only 2.3% reported being infected with COVID-19. 60.9% attended urgent surgeries. The following major uro-oncologic surgeries were reported as high priority: Radical Nephrectomy (RN) 58.4%, and Radical Cystectomy (RC) 57.3%. When we associate the capacity of hospitalization (urologic beds available) and percentage of high-priority surgery performed, we observed that centers with fewer urological beds (10-20) compared to centers with more urological beds (31-40) performed more frequently major urologic cancer surgeries: RN 54.5% vs 60.8% (p=0.0003), RC 53.1% vs 64.9% (p=0.005) respectively. Conclusions: At the time of writing (May 13th 2020) our data represents a snapshot of COVID-19 outbreak in Latin American urological practices. Our findings have practical implications and should be contextualized considering many factors related to patients and urological care: The variability of health care scenarios, institutional capacity, heterogeneity and burden of urologic disease, impact of surgical indications and decision making when prioritizing and scheduling surgeries in times of COVID-19 pandemic.

Impact of COVID-19 Pandemic on Ibero-American Urology Residents: Perspective of American Confederation of Urology (CAU).

INTRODUCTION: Since World Health Organization (WHO) declared COVID-19 as a global pandemic, urology services have developed strategies to prioritize and not to differ urgent and oncological patient's medical attention, in order to optimize resources and decrease infection probability among staff and patients. This unprecedented situation has generated a decrease in assistance and academic activities in most medical residences. The aim of this manuscript is to evaluate the impact of this health crisis on training programs through a survey addressed to urology medical residents. MATERIALS AND METHODS: Cross sectional designed study, with multiple-choice non validated survey answered online by residents. Questionnaire was developed through the CAU EDUCACION platform. RESULTS: A total of 148 responses from 18 countries coming from Latin America and Spain answering the survey. Of total, 82% answered that the activity of their urology department was significantly reduced, attending only urgent surgical pathologies, 15 % that, the urology activity has been closed completely and the staff was assigned to COVID-19 patients care, 3% continue with the regular clinic activity. Likewise, 75% stated that their surgical training has been completely affected, 93% receive urological information through tools such as Skype, ZOOM meeting, Cisco Webex, being Webinar modality the most used. Despite technological boom, 65% answered their academic training has been partially or completely affected. Most of the surveyed residents consider that period of residence should be extended to retrieve the educational targets. CONCLUSION: This unprecedented reality is negatively impacting the heterogeneous residency programs that American Confederation of Urology (CAU) nucleates. It is necessary to continue with technological innovation and allocate time and resources to easily generate accessible tools to favor the training of future urologists.

Dorsal oral mucosa graft in combination with ventral penile flap as an alternative to repair obliterative stenosis of the anterior urethra in a single surgical time

ABSTRACT Purpose: Obliterative urethral stenosis is a type of urethral lesion that compromises the whole corpus spongiosum's circumference. We present our experience in resolving complex long segment urethral obliteration in a single procedure using a combination of dorsal onlay oral mucosa graft (OMG) and ventral fasciocutaneous penile skin flap. Materials and methods: A prospectively maintained database was reviewed, which included data of men presenting long, obliterative strictures. Patients were excluded if they were lost to follow-up before one year. Failure was defined as need for further urethral instrumentation. The surgical technique used consisted on the fixation of OMG to the tunica albuginea of the corpus cavernosum, thus creating a new urethral plate. Penile or foreskin flaps were employed to complete the ventral aspect. Postoperative follow-up was done with a voiding cystourethrography at week 3. Results: A total of 21 patients were included with a median age of 49 years. Mean follow-up was 25 months. Failure was found for 3 patients (2 of them needing dilations and only one required a new urethral reconstruction). Conclusion: Single stage combination of dorsal OMG with ventral fasciocutaneous penile flap showed good results for selected patients affected with obliterative urethral stenosis.

Dorsal oral mucosa graft in combination with ventral penile flap as an alternative to repair obliterative stenosis of the anterior urethra in a single surgical time.

PURPOSE: Obliterative urethral stenosis is a type of urethral lesion that compromises the whole corpus spongiosum's circumference. We present our experience in resolving complex long segment urethral obliteration in a single procedure using a combination of dorsal onlay oral mucosa graft (OMG) and ventral fasciocutaneous penile skin flap. MATERIALS AND METHODS: A prospectively maintained database was reviewed, which included data of men presenting long, obliterative strictures. Patients were excluded if they were lost to follow-up before one year. Failure was defined as need for further urethral instrumentation. The surgical technique used consisted on the fixation of OMG to the tunica albuginea of the corpus cavernosum, thus creating a new urethral plate. Penile or foreskin flaps were employed to complete the ventral aspect. Postoperative follow-up was done with a voiding cystourethrography at week 3. RESULTS: A total of 21 patients were included with a median age of 49 years. Mean follow-up was 25 months. Failure was found for 3 patients (2 of them needing dilations and only one required a new urethral reconstruction). CONCLUSION: Single stage combination of dorsal OMG with ventral fasciocutaneous penile flap showed good results for selected patients affected with obliterative urethral stenosis.

Safety and effectiveness evaluation of open reanastomosis for obliterative or recalcitrant anastomotic stricture after radical retropubic prostatectomy

ABSTRACT Purpose: To evaluate safety, efficacy and functional outcomes after open vesicourethral re - anastomosis using different approaches based on previous urinary continence. Materials and Methods: Retrospective study of patients treated from 2002 to 2017 due to vesicourethral anastomosis stricture (VUAS) post radical prostatectomy (RP) who failed endoscopic treatment with at least 3 months of follow-up. Continent and incontinent patients post RP were assigned to abdominal (AA) or perineal approach (PA), respectively. Demographic and perioperative variables were registered. Follow-up was completed with clinical interview, uroflowmetry and cystoscopy every 4 months. Success was defined as asymptomatic patients with urethral lumen that allows a 14 French flexible cystoscope. Results: Twenty patients underwent open re-anastomosis for VUAS after RP between 2002 and 2017. Mean age was 63.7 years (standard deviation 1.4) and median follow-up was 10 months (range 3 - 112). The approach distribution was PA 10 patients (50%) and AA 10 patients (50%). The mean surgery time and median hospital time were 246.2 ± 35.8 minutes and 4 days (range 2 - 10), respectively with no differences between approaches. No significant complication rate was found. Three patients in the AA group had gait disorder with favorable evolution and no sequels. Estimated 2 years primary success rate was 80%. After primary procedures 89.9% remained stenosis - free. All PA patients remained incontinent, and 90% AA remained continent during follow-up. Conclusion: Open vesicourethral re - anastomosis treatment is a reasonable treatment option for recurrent VUAS after RP. All patients with perineal approach remained incontinent while incontinence rate in abdominal approach was rather low.

Safety and effectiveness evaluation of open reanastomosis for obliterative or recalcitrant anastomotic stricture after radical retropubic prostatectomy.

PURPOSE: To evaluate safety, efficacy and functional outcomes after open vesicourethral re - anastomosis using different approaches based on previous urinary continence. MATERIALS AND METHODS: Retrospective study of patients treated from 2002 to 2017 due to vesicourethral anastomosis stricture (VUAS) post radical prostatectomy (RP) who failed endoscopic treatment with at least 3 months of follow-up. Continent and incontinent patients post RP were assigned to abdominal (AA) or perineal approach (PA), respectively. Demographic and perioperative variables were registered. Follow-up was completed with clinical interview, uroflowmetry and cystoscopy every 4 months. Success was defined as asymptomatic patients with urethral lumen that allows a 14 French flexible cystoscope. RESULTS: Twenty patients underwent open re-anastomosis for VUAS after RP between 2002 and 2017. Mean age was 63.7 years (standard deviation 1.4) and median follow-up was 10 months (range 3 - 112). The approach distribution was PA 10 patients (50%) and AA 10 patients (50%). The mean surgery time and median hospital time were 246.2 ± 35.8 minutes and 4 days (range 2 - 10), respectively with no differences between approaches. No significant complication rate was found. Three patients in the AA group had gait disorder with favorable evolution and no sequels. Estimated 2 years primary success rate was 80%. After primary procedures 89.9% remained stenosis - free. All PA patients remained incontinent, and 90% AA remained continent during follow-up. CONCLUSION: Open vesicourethral re - anastomosis treatment is a reasonable treatment option for recurrent VUAS after RP. All patients with perineal approach remained incontinent while incontinence rate in abdominal approach was rather low.