Mini Endoscopic Combined Intra-Renal Surgery (MiniECIRS) with endoview puncture in A 12 month boy. A safe but challenging procedure.

INTRODUCTION: Associating minipercutaneous nephrolithotomy and retrograde flexible ureteroscopy (fURS) is called Mini Endoscopic Combined Intra-Renal Surgery (miniECIRS). It's a safe and efficient technique, also in children. MATERIAL AND METHODS: The video describes miniECIRS in a 12 month-old boy with an infectious pelvic left stone (16 mm) and multiple caliceal stones. The UAS used was a 10FR and the percutaneous access was a 14Fr with Clear-Petra® sheath. RESULTS: The operative time was 180 min and blood losses were virtually absent. There were no intra- or post-operative complications and the patient was discharged at the 5th day. After 1 month, double J was removed having a stone free status. CONCLUSIONS: MiniECIRS with endoview puncture is a safe and efficient technique when performed by experienced hands. Therefore, it is an alternative to consider for the treatment of complex lithiasis in the pediatric population.

If you can make it, you can share it - Perspectives on the first DIY-fair at the European congress of medical physics (ECMP, DUBLIN 2022).

The medical physics and engineering community is known for being active in conjuring do-it-yourself (DIY) -solutions to support their clinical and research work. To facilitate the exchange of solutions and ideas, a DIY-fair was held for the first time at the European Congress of Medical Physics (ECMP) in August 2022 in Dublin, Ireland. Altogether 32 contributions were presented, consisting of software, scripts, 3D-printed customized solutions, devices, gadgets and phantoms. All contributions were published in video format on a dedicated YouTube channel, and most were also presented in person at the conference. The fair demonstrated that there is an unmet need for sharing and distributing information on self-created solutions in the medical physics community. The authors propose the creation of a dedicated platform for sharing such content within our community, as well as a continuity of DIY-fairs at future ECMP meetings.

Endomicroscopía láser confocal en el tratamiento del tumor urotelial del tracto urinario superior / Confocal laser endomicroscopy for the treatment of upper urinary tract transitional cellcarcinoma

Objetivos: La endomicroscopía láser confocal (CLE) es una técnica óptica que permite la caracterización citológica en vivo de un tejido. Estudios previos en lesiones del tracto digestivo y respiratorio han mostrado una alta concordancia entre el resultado en vivo y el resultado histopatológico. Recientemente, se ha propuesto el uso de la CLE en el estudio del tracto urinario superior (TUS) durante la ureteroscopia, ya que permite obtener información a tiempo real del grado tumoral y complementa la información de las biopsias ureteroscópicas, que dadas sus limitaciones, pueden infraestimar el grado y el estadío de la lesión hasta en un 43% de los casos. Métodos: Se llevó a cabo una revisión de la literatura en la base de datos Pubmed/Medline siguiendo las normas Prisma. Se utilizaron 21 artículos que cumplieron los criterios de inclusión para la síntesis de la evidencia. Resultados: La sensibilidad y especificidad descrita, alcanza el 79%/78% y 67%/79% para tumores de bajo y alto grado respectivamente, con una concordancia sustancial entre observadores cirujano/anatomopatólogo; K=0,64). No se han reportado complicaciones asociadas a la utilización de la fluoresceína ni sondas de CLE. Conclusiones: La CLE representa una herramienta útil y segura, capaz de proporcionar información citológica de tumores del TUS en tiempo real que permitela identificación del grado tumoral con sustancial grado de acuerdo entre la tipificación en vivo y su análisis histopatológico final. Por este motivo, actualmente, la CLE es considerada como una herramienta en el manejo conservador del carcinoma del TUS en las guidelines de la European Association of Urology (EAU)

Objectives: Confocal lasser endomicroscopy (CLE) is an optical technique that enables in vivo cytological characterization of a tissue. Previous studies have shown it useful in the evaluation of urinary and respiratory tracts for a better characterization of mucosal lesions, showing a high concordance between in vivo and final histopathological results. Recently, the use of CLE has been proposed for the study of transitional cell carcinoma of the upper urinary tract (UUT) during ureteroscopy, because it enables real time information about tumor grade and supplements the information of ureteroscopic biopsies, which may understimate the grade and stage of the lesion up to 43% of the cases due to its limitiations. Methods: We performed a systematic review of the literature in the Pubmed/Medline database following the PRISMA standard. We selected 20 articles that complied with the inclusion criteria for evidence synthesis. Results: Equipment miniaturization has enabled CLE as part of the diagnostic options in upper urinary tract tumors. This technique performs in vivo cytological characterization of the evaluated tissue, accomplishing differentiation between tumor and normal tissue, as well as tumor grade identification. Its communicated sensitivity and specificity reach 79%/78% respectively for low grade tumors and 67%/79% for high grade, with a substantial inter observer concordance (surgeon/pathologist;k=0.64). No complications have been communicated in the literature with the use of fluorescein or confocal laser microscopy probes in patients undergoing this technique. CONCLUSIONS: CLE represents a useful and safe tool, capable of providing cytological real time information of UUT tumors that enables tumor grade identification with substantial concordance between in vivo tumor typifying and the final histopathological analysis. For this, CLE is currently considered a tool for conservative management of UUT transitional cell carcinoma in the European Association of Urology (EAU) guidelines