Protocol description and initial experience in kidney graft perfusion using infrared thermography.

PURPOSE: Protocol description for renal perfusion study using thermographic technology and description of the thermographic and clinical behavior of the transplanted kidneys before and after unclamping. METHODS: Infrared thermographic images of renal grafts are obtained before kidney reperfusion, 10 min after and just before closing the surgical wound. Thermographic data is evaluated together with the type of graft and donor, cold ischemia time, hypovascularized areas determined by the surgeon during surgical intervention, alterations in vascular flow in postoperative echo-Doppler, time at the beginning of graft function and serum creatinine monitoring during postoperative follow-up. RESULTS: 17 grafts were studied. The mean temperature of the grafts before reperfusion, 10 min after and at the end of the surgery were 18.7 °C (SD 6.27), 32.36 °C (SD1.47) and 32.07 °C (SD1.78) respectively. 4 grafts presented hypoperfused areas after reperfusion. These areas presented a lower temperature compared to the well perfused parenchyma surface using thermographic images. CONCLUSION: The study of the usefulness and applicability of thermography can allow the development of tools that provide additional objective information on organ perfusion in real time and non-invasive manner. Our protocol and initial results can contribute to provide new evidence. Further analyses should be developed to shed light on the role of this technology.

Feasibility and safety of augmented reality-assisted urological surgery using smartglass.

PURPOSE: To assess the feasibility, safety and usefulness of augmented reality-assisted urological surgery using smartglass (SG). METHODS: Seven urological surgeons (3 board urologists and 4 urology residents) performed augmented reality-assisted urological surgery using SG for 10 different types of operations and a total of 31 urological operations. Feasibility was assessed using technical metadata (number of photographs taken/number of videos recorded/video time recorded) and structured interviews with the urologists on their use of SG. Safety was evaluated by recording complications and grading according to the Clavien-Dindo classification. Usefulness of SG for urological surgery was queried in structured interviews and in a survey. RESULTS: The implementation of SG use during urological surgery was feasible with no intrinsic (technical defect) or extrinsic (inability to control the SG function) obstacles being observed. SG use was safe as no grade 3-5 complications occurred for the series of 31 urological surgeries of different complexities. Technical applications of SG included taking photographs/recording videos for teaching and documentation, hands-free teleconsultation, reviewing patients' medical records and images and searching the internet for health information. Overall usefulness of SG for urological surgery was rated as very high by 43 % and high by 29 % of surgeons. CONCLUSIONS: Augmented reality-assisted urological surgery using SG is both feasible and safe and also provides several useful functions for urological surgeons. Further developments and investigations are required in the near future to harvest the great potential of this exciting technology for urological surgery.

Active terahertz beam steering by photo-generated graded index gratings in thin semiconductor films.

We demonstrate active beam steering of terahertz radiation using a photo-excited thin layer of gallium arsenide. A constant gradient of phase discontinuity along the interface is introduced by an spatially inhomogeneous density of free charge carriers that are photo-generated in the GaAs with an optical pump. The optical pump has been spatially modulated to form the shape of a planar blazed grating. The phase gradient leads to an asymmetry between the +1 and -1 transmission diffracted orders of more than a factor two. Optimization of the grating structure can lead to an asymmetry of more than one order of magnitude. Similar to metasurfaces made of plasmonic antennas, the photo-generated grating is a planar structure that can achieve large beam steering efficiency. Moreover, the photo-generation of such structures provides a platform for active THz beam steering.

Breaking the symmetry of forward-backward light emission with localized and collective magnetoelectric resonances in arrays of pyramid-shaped aluminum nanoparticles.

We propose aluminum nanopyramids (ANPs) as magnetoelectric optical antennas to tailor the forward versus backward luminescence spectrum. We present light extinction and emission experiments for an ANP array wherein magnetoelectric localized resonances couple to in-plane diffracted orders. This coupling leads to spectrally sharp collective resonances. Luminescent molecules drive both localized and collective resonances, and we experimentally demonstrate an unconventional forward versus backward luminescence spectrum. Through analytical calculations, we show that the magnetic, magnetoelectric, and quadrupolar moments of ANPs­which lie at the origin of the observed effects­are enhanced by their tapering and height. Full-wave simulations show that localized and delocalized magnetic surface waves, with an excitation strength depending on the plane wave direction, direct the forward versus backward emitted intensity.

Prevalence of urinary tract cancer in the Spanish cohort of the IDENTIFY study.

INTRODUCTION: Malignant tumors of the urinary tract are associated with high morbidity and mortality, and their prevalence can vary worldwide. Recently, the IDENTIFY study has published results on the prevalence of urinary tract cancer at a global level. This study evaluates the prevalence of cancer within the Spanish cohort of the IDENTIFY study to determine whether the published results can be extrapolated to our population. PATIENTS AND METHODS: An analysis of the data from the Spanish cohort of patients in the IDENTIFY study was performed. This is a prospective cohort of patients referred to secondary care with suspected cancer, predominantly due to hematuria. Patients were recruited between December 2017 and December 2018. RESULTS: A total of 706 patients from 9 Spanish centers were analyzed. Of these, 277 (39.2%) were diagnosed with cancer: 259 (36.7%) bladder cancer, 10 (1.4%) upper tract urothelial carcinoma, 9 (1.2%) renal cancer and 5 (0.7%) prostate cancer. Increasing age (OR 1.05 (95% CI 1.03-1.06; P < 0.001)), visible hematuria (VH) OR 2.19 (95% CI 1.13-4.24; P = 0.02)) and smoking (ex-smokers: OR 2.11(95% CI 1.30-3.40; P = 0.002); smokers: OR 2.36 (95% CI 1.40-3.95; P = 0.001)) were associated with higher probability of bladder cancer. CONCLUSION: This study highlights the risk of bladder cancer in patients with VH and smoking habits. Bladder cancer presented the highest prevalence; higher than the prevalence reported in previous series and presented in the IDENTIFY study. Future work should evaluate other associated factors that allow us to create cancer prediction models to improve the detection of cancer in our patients.

Excitation of confined modes on particle arrays.

We describe both theoretically and experimentally the existence and excitation of confined modes in planar arrays of gold nanodisks. Ordered 2D lattices of monodispersive nanoparticles are manufactured, embedded in a silica matrix, and exposed to evanescent prism-coupling illumination, leading to dark features in the reflectivity, which signal the presence of confined modes guided along the arrays. We find remarkable agreement between theory and experiment in the frequency-momentum dispersion of the resonances. Direct excitation of these modes reveals long propagation distances and deep extinction features. This combined experimental and theoretical characterization of guided modes shows a good understanding of the optical response of metallic particles arrays, which can be beneficial in future designs of optical-signal and distant-sensing applications.

Thermalization and cooling of plasmon-exciton polaritons: towards quantum condensation.

We present indications of thermalization and cooling of quasiparticles, a precursor for quantum condensation, in a plasmonic nanoparticle array. We investigate a periodic array of metallic nanorods covered by a polymer layer doped with an organic dye at room temperature. Surface lattice resonances of the array--hybridized plasmonic-photonic modes--couple strongly to excitons in the dye, and bosonic quasiparticles which we call plasmon-exciton polaritons (PEPs) are formed. By increasing the PEP density through optical pumping, we observe thermalization and cooling of the strongly coupled PEP band in the light emission dispersion diagram. For increased pumping, we observe saturation of the strong coupling and emission in a new weakly coupled band, which again shows signatures of thermalization and cooling.

Androgen deprivation therapy in localized prostate cancer. Current status and future trends.

INTRODUCTION: Prostate cancer (PCa) has been recognized as an androgen-sensitive disease since the investigations from Huggins and Hodges in 1941. Thanks to these findings, they received the Nobel Prize in 1966. This was the beginning of the development of androgen deprivation therapy (ADT) as treatment for patients with PCa. OBJECTIVE: To summarize the current indications of ADT in localized PCa. EVIDENCE ACQUISITION: We conducted a comprehensive English and Spanish language literature research, focused on the main indications for ADT in localized PCa. EVIDENCE SYNTHESIS: Nowadays, the indications for ADT as monotherapy in localized PCa have been limited to specific situations, to patients unwilling or unable to receive any form of local treatment if they have a PSA-DT < 12 months, and either a PSA > 50 ng/mL, a poorly differentiated tumor, or troublesome local disease-related symptoms. ADT can be used in combination with local treatment in different scenarios. Although neoadjuvant treatment with ADT prior to surgery with curative intent has no clear oncological impact, as a future sight, PCa is a heterogeneous disease, and there could be a group of patients with high-risk localized disease that could benefit. CONCLUSIONS: We need to optimize the treatment with ADT in localized PCa, selecting the patients accordingly to their disease characteristics. Given that the therapeutic armamentarium evolves day by day, there is a need for the development of new clinical trials, as well as a molecular studies of patients to identify those who might benefit from an early multimodal treatment.

Impact of a delayed presentation to the emergency department for acute renal colic on biochemical and clinical outcomes.

INTRODUCTION AND OBJECTIVE: To verify the impact of delay on biochemical and clinical outcomes for patients presenting to the emergency department (ED) with acute renal colic. MATERIALS AND METHODS: Data were retrospectively collected from three institutions of two European countries between 01 January and 30 April 2020. Patients who presented to the ED with unilateral or bilateral renal colic caused by urolithiasis confirmed by imaging tests during the study period were included. A presentation after 24 h since the onset of symptoms was considered a delay. Patients presenting before 24 h from the symptom onset were included in Group A, while the patients presenting after 24 h in Group B. Clinical and biochemical parameters and management were compared. RESULTS: A total of 397 patients who presented to ED with confirmed urolithiasis were analyzed (Group A, n = 199; Group B, n = 198. The median (IQR) delay in presentation was 2 days (1,5-4). At presentation, no statistically significant differences were found amongst the two groups of patients regarding presenting symptoms such as fever and flank pain, and the median serum levels of creatinine, C reactive protein and white blood cells. No differences were found in terms of conservative or operative management. CONCLUSION: Delay in consultation >24 h is not associated with worsening biochemical parameters and clinical outcomes. Most patients with acute loin pain do not necessarily need urgent attendance to the ED and may be managed in the outpatients.

Online surgical education adopted among urology residency programs in response to COVID-19: A pilot study.

OBJECTIVE: To understand the residents' perceptions of the, COVID-19 driven, newly implemented online learning systems adopted among accredited urology residency programs nationwide, and their sustainability following the pandemic era. MATERIALS AND METHODS: A survey was designed and dispersed to urology program coordinators and directors to distribute to their residents. In the survey, Online education models was the all-encompassing term to describe any form of resident education that occurred online. Anonymous surveys were exported from Survey Monkey and data was analyzed for statistical significance. RESULTS: Over 70% of urology residents agreed or were neutral to the statement that Online education models were equivalent to in-person learning. Only 13% of residents stated that online learning should not be continued following the pandemic. Several different parameters were assessed, and only 5 of them showed statistical significance. Stress, personal engagement, interpersonal communication efficiency and non-verbal cues were all lower with online education models. The only attribute that was scored higher by residents was network connectivity issues. CONCLUSIONS: An overwhelming majority of urology residents in the United States believe Online education models should continue to be adopted once the pandemic is over.

[Online surgical education adopted among urology residency programs in response to COVID-19: A pilot study]. / La educación quirúrgica en línea implementada en los programas de residencia urológica como respuesta a la COVID-19: estudio piloto.

Objective: To understand the residents' perceptions of the, COVID-19 driven, newly implemented online learning systems adopted among accredited urology residency programs nationwide, and their sustainability following the pandemic era. Materials and methods: A survey was designed and dispersed to urology program coordinators and directors to distribute to their residents.In the survey, online education models was the all-encompassing term to describe any form of resident education that occurred online. Anonymous surveys were exported from Survey Monkey and data was analyzed for statistical significance. Results: Over 70% of urology residents agreed or were neutral to the statement that online education models were equivalent to in-person learning. Only 13% of residents stated that online learning should not be continued following the pandemic. Several different parameters were assessed, and only 5 of them showed statistical significance. Stress, personal engagement, interpersonal communication efficiency and non-verbal cues were all lower with online education models. The only attribute that was scored higher by residents was network connectivity issues. Conclusions: An overwhelming majority of urology residents in the United States believe online education models should continue to be adopted once the pandemic is over.

Zinner Syndrome with Ectopic Ureter Emptying into Seminal Vesicle.

A 66-year-old male patient in follow-up in the urology department for a non-muscle-invasive bladder cancer was detected by ultrasound to have absence of the left kidney and a cystic, multilobed image at the location of the seminal vesicle. Magnetic resonance imaging reveals left renal agenesis and the existence of multiple cysts in the ipsilateral seminal vesicle that reaches a size of 6.9 × 3.7 cm, as well as a ureteral remnant that opens into the seminal vesicle. The patient does not present urinary symptoms, neither pain with ejaculation nor hematuria. A triad of seminal vesicle cyst, ipsilateral renal agenesis, and ipsilateral ejaculatory duct obstruction is known as Zinner syndrome. Congenital anomalies of the seminal vesicles are rare; some of them are associated with malformations of the upper urinary system. Seminal vesicle cysts are associated with ipsilateral renal agenesis and ectopic or dysplastic ureter. Patients may remain asymptomatic and be diagnosed incidentally or may present with symptoms such as increased urinary frequency, dysuria, recurrent infections, pain with ejaculation, and perineal discomfort.

The role of multiparametric magnetic resonance imaging in the selection and follow-up of patients undergoing active surveillance for prostate cancer. An European Section of Uro-Technology (ESUT) review. / Papel de la resonancia magnética multiparamétrica en la selección y el seguimiento de pacientes en vigilancia activa por cáncer de próstata. Revisión del grupo de Uro-Tecnología (ESUT) de la EAU.

INTRODUCTION: In recent years, active surveillance (AS) has gained popularity as a safe and reasonable option for patients with low-risk, clinically localized prostate cancer. OBJECTIVE: To summarize the latest information regarding the use of mpMRI in the setting of active surveillance (AS) for the management of prostate cancer (PCa). EVIDENCE ACQUISITION: A PubMed-based, English literature search was conducted through February 2020. We selected the most relevant original articles, meta-analyses and systematic reviews that could provide important information. EVIDENCE SYNTHESIS: The great importance of mpMRI of the prostate in the setting of PCa diagnosis is its ability to visualize primarily high-grade cancerous lesions potentially missed on systematic biopsies. In several studies, mpMRI has shown an improved performance over clinically based models for identifying candidates which will benefit the most from AS. Although data on prostate mpMRI during follow-up of men under AS is sparse, it holds the probability to improve significantly AS programs by a more precise selection of optimal candidates, a more accurate identification of disease progression and a reduction in number of biopsies. The goal of reassessment of patients undergoing AS is to find the most effective moment to change attitude to active treatment. CONCLUSION: The value of mpMRI has been recognized due to its high negative predictive value (NPV) for lesion upgrading in low-risk PCa patients. The improvement in imaging detection, and precise diagnosis with mpMRI could reduce misclassifications at initial diagnosis and during follow-up, reducing the number of biopsies.

Prognostic value of urinary cytology for detecting urothelial carcinoma recurrence after radical cystectomy.

INTRODUCTION: Urethral or upper urinary tract (UUT) recurrence of urothelial carcinoma (UC) after radical cystectomy (RC) are rare (4-6%), and their diagnosis usually occurs within the first two years. Although it is known that its early detection offers benefit in terms of survival, currently there are no clear recommendations for the detection of recurrence in the remnant urothelium (RU). Our aim is to determine the diagnostic value of urinary cytology for the detection of recurrences in the RU and to estimate its impact as an early diagnostic method on survival. MATERIAL AND METHODS: Retrospective review of patients who underwent RC for urothelial carcinoma between 2008-2016, with a follow-up of at least 24 months. RESULTS: The study included 142 patients. In a median follow-up of 68.5 months, nine patients (6.3%) presented recurrences in the RU (urethra: four, UUT: four, synchronous: one). The sensitivity and specificity of urinary cytology for the diagnosis of UUT recurrences were 20% and 96%, respectively. No significant differences were found between overall survival and cancer-specific survival among patients according to the urinary cytology results. CONCLUSION: Recurrences in the RU after RC are infrequent; our study has shown that urinary cytology offers a low sensitivity for their diagnoses. For these reasons, we do not consider that urinary cytology provides useful information for surveillance of these patients.

Artificial intelligence and simulation in urology.

INTRODUCTION AND OBJECTIVE: Artificial intelligence (AI) is in full development and its implementation in medicine has led to an improvement in clinical and surgical practice. One of its multiple applications is surgical training, with the creation of programs that allow avoiding complications and risks for the patient. The aim of this article is to analyze the advantages of AI applied to surgical training in urology. MATERIAL AND METHODS: A literary research is carried out to identify articles published in English regarding AI applied to medicine, especially in surgery and the acquisition of surgical skills. RESULTS: Surgical training has evolved over time thanks to AI. A model for surgical learning where skills are acquired in a progressive way while avoiding complications to the patient, has been created. The use of simulators allows a progressive learning, providing trainees with procedures that increase in number and complexity. On the other hand, AI is used in imaging tests for surgical or treatment planning. CONCLUSION: Currently, the use of AI in daily clinical practice has led to progress in medicine, specifically in surgical training.

Artificial intelligence and simulation in urology. / Inteligencia artificial y simulación en urología.

INTRODUCTION AND OBJECTIVE: Artificial intelligence (AI) is in full development and its implementation in medicine has led to an improvement in clinical and surgical practice. One of its multiple applications is surgical training, with the creation of programs that allow avoiding complications and risks for the patient. The aim of this article is to analyze the advantages of AI applied to surgical training in urology. MATERIAL AND METHODS: A literary research is carried out to identify articles published in English regarding AI applied to medicine, especially in surgery and the acquisition of surgical skills. RESULTS: Surgical training has evolved over time thanks to AI. A model for surgical learning where skills are acquired in a progressive way while avoiding complications to the patient, has been created. The use of simulators allows a progressive learning, providing trainees with procedures that increase in number and complexity. On the other hand, AI is used in imaging tests for surgical or treatment planning. CONCLUSION: Currently, the use of AI in daily clinical practice has led to progress in medicine, specifically in surgical training.

Magnetic resonance as imaging diagnostic tool in prostate cancer: New evidences-The EAU Section of Uro-Technology position. / La resonancia magnética como herramienta para el diagnóstico del cáncer de próstata: nuevas evidencias y posicionamiento de la ESUT (EAU Section of Uro-Technology).

Prostate cancer (PCa) is the second leading cause of cancer-related mortality and the most frequently diagnosed male malignant disease among men. The manifestation of PCa ranges from indolent to highly aggressive disease and due to this high variation in PCa progression, the diagnosis and subsequent treatment planning can be challenging. The current diagnostic approach with PSA testing and digital rectal examination followed by transrectal ultrasound biopsies lack in both sensitivity and specificity in PCa detection and offers limited information about the aggressiveness and stage of the cancer. Scientific work supports the rapidly growing use of multiparametric magnetic resonance imaging as the most sensitive and specific imaging tool for detection, lesion characterization and staging of PCa. Therefore, we carried out an updated review of magnetic resonance imaging in the diagnostic PCa reviewing the latest papers published in PubMed.

Lifestyle among urology trainees and young urologist in the context of burn-out syndrome. / Estilo de vida y burnout en residentes y urólogos jóvenes.

INTRODUCTION: Burnout syndrome has increased dramatically in urology within recent years. A healthy lifestyle has been described as a protective factor. However, data on lifestyle is lacking among residents and urologists and remains to be elucidated. We aim to assess lifestyle among urology residents and young urologists across Europe. MATERIALS AND METHODS: Members of the European Society of Residents in Urology (ESRU) designed a 34-item online survey via surveymonkey.com. The survey was designed in accordance with Checklist for Reporting Results of Internet E-Surveys (CHERRIES) guidelines and was distributed via e-mail and social media in 23 European countries to urology residents and young urologists. The primary endpoint was reported as self-perceived health status. Secondary endpoints included questions on sleeping disorders, exercise and dietary habits. Data was analyzed SPSS software. RESULTS: A total of 412 residents and young urologists responded to the survey. The mean age of the respondents was 31.4±3.9 yr. The data on dietary intake demonstrate a mean of 2 or more cups/day of coffee and alcohol consumption 2-3 times/week. The intake of fruits and vegetables is very low, almost 60% of responders consume<1 portions of fruit/day and more than half (52%) eat<1 portion of vegetable/day. Overall, the majority of respondents reported to have a moderate to low satisfaction with lifestyle (59.65%) and low to moderate self-perceived health status (45.94%). Moreover, 46% of respondents reported to have some kind of sleep disturbance and 60% only slept 6hours/night or less with 53% reporting a moderate to very low quality of Sleep. Regular exercise of at least 30min twice weekly was only performed by 33% of the respondents. CONCLUSIONS: Residents and young urologists have unbalanced diet, tend to exercise too little and often suffer from sleep disturbances all of which increases the risk of burnout. Physicians, organizations and institutions should strive to promote healthy lifestyle, resiliency and support programs.

Assessment of trends and clinical presentation in the emergency department of patients with renal colic during the COVID-19 pandemic era. / Evaluación de las tendencias y presentación clínica de pacientes con cólico nefrítico que acuden al servicio de urgencias durante la era pandémica del COVID-19.

INTRODUCTION: We hypothesized that the recent COVID-19 pandemic may lead to a delay in renal colic patients presenting to the Emergency Department due to the fear of getting infected. This delay may lead to a more severe clinical condition at presentation with possible complications for the patients. MATERIAL AND METHODS: Retrospective review of data collected from three institutions from Spain and Italy. Patients who presented to Emergency Department with unilateral or bilateral renal colic caused by imaging confirmed urolithiasis during the 45 days before and after each national lockdown were included. Data collected included patients' demographics, biochemical urine and blood tests, radiological tests, signs, symptoms and the therapeutic management. Analysis was performed between two groups, Group A: patients presenting prior to the national lockdown date; and Group B: patients presenting after the national lockdown date. RESULTS: A total of 397 patients presented to Emergency Department with radiology confirmed urolithiasis and were included in the study. The number of patients presenting to Emergency Department with renal/ureteric colic was 285 (71.8%) patients in Group A and 112 (28.2%) patients in Group B (p<0.001). The number of patients reporting a delay in presentation was 135 (47.4%) in Group A and 63 (56.3%) in Group B (p=0.11). At presentation, there were no statistical differences between Group A and Group B regarding the serum creatinine level, C reactive protein, white blood cell count, fever, oliguria, flank pain and hydronephrosis. In addition, no significant differences were observed with the length of stay, Urology department admission requirement and type of therapy. CONCLUSION: Data from our study showed a significant reduction in presentations to Emergency Department for renal colic after the lockdown in Spain and Italy. However, we did not find any significant difference with the length of stay, Urology department admission requirement and type of therapy.

Telemedicine and smart working: Spanish adaptation of the European Association of Urology recommendations. / Telemedicina y trabajo inteligente: adaptación al español de las recomendaciones de la Asociación Europea de Urología.

INTRODUCTION: Telemedicine provides remote clinical support through technology tools. It can facilitate medical care delivery while reducing unnecessary office visits. The COVID-19 outbreak has caused an abrupt change in our daily urological practice, where teleconsultations play a crucial role. OBJECTIVE: To provide practical recommendations for the effective use of technological tools in telemedicine. MATERIALS AND METHODS: A literature search was conducted on Medline until April 2020. We selected the most relevant articles related to «telemedicine¼ and «smart working¼ that could provide valuable information. RESULTS: Telemedicine refers to the use of electronic information and telecommunication tools to provide remote clinical health care support. Smart working is a working approach that uses new or existing technologies to improve performance. Telemedicine is becoming a useful and fundamental tool during the COVID-19 pandemic and will be even more in the future. It is time for us to officially give telemedicine the place it deserves in clinical practice, and it is our responsibility to adapt and familiarize with all the tools and possible strategies for its optimal implementation. We must guarantee that the quality of care received by patients and perceived by them and their families is of the highest standard. CONCLUSIONS: Telemedicine facilitates remote specialized urological clinical support and solves problems caused by limited patient mobility or transfer, reduces unnecessary visits to clinics and is useful to reduce the risk of COVID-19 viral transmission.