3D printed model for flexible ureteroscopy training, a low-cost option for surgical training.

INTRODUCTION: Training in experimental models is a valid option that improves the outcomes and shortens surgical learning curves. Our objective was to develop a 3D printed plastic model for teaching, training and education in flexible ureteroscopy, analyzing costs and suitability for the practice of this surgical technique. METHODS: A 3D printed model was developed based on a CT scan from a real-life patient's upper urinary tract. Horos™ software was used for segmentation and an FDM-Ultimaker for 3D printing. Renal calyces were numbered to be identified, as in the European Association of Urology Endoscopic Stone Treatment training curriculum, Task 4. The following were used: Innovex single-use flexible ureteroscope (Palex) and nitinol baskets (Coloplast). RESULTS: Printing time was 19 h, with a total cost of €8.77. The three-dimensional model allowed the insertion of the flexible ureteroscope and the exploration of the renal calyces by urologists in training as well as in current practice of the specialty without difficulty. The model also allowed the use of baskets and the mobilization and removal of previously placed stones. CONCLUSION: We unveil a valid three-dimensional model for flexible ureteroscopy training exercises with reasonable costs, which will allow acquiring the necessary skills and confidence to initiate the procedure in a real-life scenario.

Incidence of upper tract urothelial carcinoma in Spain. / Incidencia del carcinoma transicional del tracto urinario superior en España.

INTRODUCTION AND OBJECTIVES: The incidence of upper urinary tract tumors is currently unknown. The aim of this study is to determine the real incidence of upper tract urothelial carcinoma (UTUC) in Spain. MATERIAL AND METHODS: A descriptive, prospective and multicenter epidemiological study was conducted in 31 Spanish facilities by means of the Platform for Multicenter Studies of the Spanish Association of Urology. Recruitment was opened from May 1st, 2017 to April 30th, 2018. The original database was exported directly from the electronic Data Collection Logbook on December 15th, 2018, with a total of 404 cases registered (402 valid cases after depuration). Statistical analysis was performed using IBM SPSS software v 23 and EPIDAT v 3.4. RESULTS: The incidence adjusted to Spanish population from raw data was 3.27 cases per 100.000 inhabitants per year (2.93 - 3.61 95% CI) and 3,3 cases per 100.000 inhabitants per year (2.96-3.66 95%CI) when adjusted to European population by age. The mean age at diagnosis was 70 years, and 77% of patients were male. Thirty-four percent of patients had an incidental diagnosis. Tumors were most commonly located in the pyelocalyceal system (54%), followed by the distal ureter (22%). Prior ureteroscopy was performed in 114 patients: this technique modified the subsequent treatment indication in 58% of cases. Radical nephroureterectomy was performed in 311 patients. Kidney-sparing surgery was the elected treatment in 76 patients (20%). Complications were found in 69% of cases, most of them classified as Clavien 1 and 2 (86% of all complications). Postoperative mortality rate was 1.7%. CONCLUSIONS: UTUC adjusted incidence rate in Spain is 3.27 and 3.3 in Europe. Prior URS modified the treatment indication in 18% of patients. We found a 69% complication rate and a 1.7% mortality rate.

[Laparoscopic urinary diversions]. / Derivaciones urinarias laparoscópicas.

INTRODUCTION: The treatment of the invasive bladder cancer and the recurrent T1G3 is clearly established in radical cystectomy and pelvic linphadenectomy. One of the fields where the laparoscopic approach implies more doubts is the treatment of bladder cancer, because it requires experience enough in pelvic laparoscopic surgery and the urinary diversion implies great technical difficulties to the laparoscopic approach. OBJECTIVES: The main goal of this article is to report our results with the urinary diversion after laparoscopic radical cystectomy where the ureteral anastomosis has been performed by a laparoscopic approach. METHODS: From January 2005 to December 2007 we have performed 67 laparoscopic radical cistectomies. We conducted 28 laparoscopic urinary diversions with our technique: 7 neobladder with an average age of 54, 85 years and 21 ileal conduit with an average age of 69, 15 years. RESULTS: The averagesurgical time for enterocistoplasty with laparoscopic urethral and ureteral anastomosis is of 5 hours and 30 minutes. For the cutaneous ureteroileostomy with laparoscopic ureteral anastomosis the average surgical time has been of 4 hours and 30 minutes. We have had 1 case of urinary leakage in the laparoscopic neobladder and 3 cases in the laparoscopic ileal conduit (14%). We have not intestinal dehiscence nor ileal-ureteric stenosis. The average hospital stay for laparoscopic neobladder is for the 85% of cases of 13.6 days, and of 11.8 days for the 77.7% of ileal ureteric laparoscopies. DISCUSSION: The laparoscopic radical cystectomy is still a procedure reserved for groups with great experience in laparoscopic surgery. Nowadays, the most accepted procedure by most groups includes perform the cystectomy by a laparoscopic approach and the urinary diversion by an open approach. There is no evidence of the advantages of laparoscopic urinary diversion. It is necessary to perform comparative studies to clearly define the role of laparoscopic surgery in the urinary diversion.

[Leukemic infiltration of the urinary bladder. A new case and literature review]. / Infiltración vesical por leucemia linfoblástica aguda. A propósito de un caso y revisión de la literatura.

We expose you one case of leukemic infiltration of the urinary bladder. This kind of infiltration is rare so we reviewed the literature finding 14 cases since 1932. Although this hematological infiltration is very unusual, it should be considered in patients with leukemia and hematuria.

[Laparoscopic augmentation enterocystoplasty: initial experience]. / Enterocistoplastia de ampliación laparoscópica: experiencia inicial.

OBJECTIVE: To analyze the initial experience of our group in the realization of the augmentation enterocystoplasty by laparoscopyc approach. METHODS AND PATIENTS: We describe the augmentation enterocystoplasty technique with ileal segment completely achieved by laparoscopyc approach. We present the cases of two patients suffering from hyperreflexic bladder refractory to medical treatment who underwent this surgery. In both cases the technique was realized without intraoperative complications although it was needed a surgical time of 6 and 4.5 hours respectively. The results after 12 and 5 months were satisfactory in both patients, obtaining a low pressure bladder with a good continence. CONCLUSIONS: Laparoscopyc augmentation enterocystoplasty is a complicated technique that requires a great experience, mainly in laparoscopyc suture. It reproduces completely the open surgery and it offers all the advantages inherent to the laparoscopyc surgery.

[Open and laparoscopic adrenalectomy. 10 years review]. / Suprarrenalectomía abierta y laparoscópica. Revisión de 10 años.

We present a 10 years open adrenalectomy review in our Service and the beginning of laparoscopic adrenalectomy in the last year as a part of the retroperitoneal laparoscopic program at the Hospital Universitario La Paz . The first laparoscopic adrenalectomy was done after 21 retroperitoneal laparoscopic surgeries. Our initial experience has been so good that we have reduced the contraindications for this technique and we have increased the number of laparoscopic surgery cases.

[Retroperitoneal laparoscopic surgery; initial experience in the Hospital La Paz]. / Cirugía retroperitoneal laparoscópica; experiencia de los 6 primeros meses del Hospital La Paz.

We present the initial results of retroperitoneal laparoscopic surgery in the Hospital Universitario La Paz from July 2004 to December 2004. The program started after 2 years of pelvic laparoscopy surgery practice. The initial experience has been so good that we have reduced the contraindications for this technique and we have increased the number of laparoscopic surgery cases.