ABSTRACT
The Coronavirus (COVID-19) pandemic, typified as such in March 2020 by the World Health Organization (WHO), has exceeded the capacity of health systems to aid victims, and triggered a radical change in medical research, and in the monitoring of the enrollment for clinical trials in urologic fields around the world. Last year, almost 90% of clinical sites closed patient enrollment, while at the same time, researchers around the world initiated almost 1000 COVID-19 clinical trials. This catastrophic pandemic has allowed us to expand our medical knowledge exponentially. The global urological community has created and published an infinity of scientific articles: establishing guideline reactions for diagnosis, treatment, and follow-up of the different urologic conditions across all areas of the field, reporting the experiences at urology services, and putting forward new strategies. The Confederacion Americana de Urologia (CAU) has promoted international collaborative projects that have led to gaining insight into how the Latin American Urology Services faced the pandemic, including the challenges, strengths, and the areas of opportunity for urologic care. It also allowed us to increase the number and quality of publications. Also, we have created new virtual platforms and international networks to exchange our knowledge. We have as well transformed this social, economic and health crisis brought upon us by COVID-19, into a source of opportunities for the growth and promotion of research in Latin America. Urologic patients, require researchers to work on favoring their goals. A collaborative network, the established and coordinated protocols, the safety of patients and researchers, assertive and constant communication, and effective technology use, are the essential tools to resume institutional investigation under these critical conditions. Copyright © 2022 Sociedad Mexicana de Urologia. Colegio de Profesionistas A.C.. All rights reserved.
ABSTRACT
Introduction: Metastatic kidney cancer continues to be a therapeutic challenge for urologies and oncologies. With the new systemic therapies, the indication for initial cytoreductive nephrectomy is becoming increasingly controversial. The treatment of the primary tumor at a stage with systemic involvement continues to be a controversial issue. Material(s) and Method(s): By conducting a survey of Latin American hospitals, this publication aims to evaluate the indication for cytoreductive nephrectomy, the preferred surgical technique and the results obtained, estimating regional therapeutic lines. Online survey was made, based on the most important topics of discussion on cytoreductive nephrectomy and metastatic kidney cancer. Result(s): A total of 20 centers participated on the survey, al of them affirmatively about the realization of cytoreductive nephrectomy. Most of them also offer systemic treatment. Regarding the surgical technique used, most used minimally invasive techniques. Discussion(s): The international evidence about the role of cytoreductive nephrectomy in this context is varied and subject to permanent change. Individualized treatment, multidisciplinary team are fundamental for the approach of these patients. Conclusion(s): The subgroup of patients with metastatic kidney cancer is conceptually heterogeneous. Cytoreductive nephrectomy continues to play an important role, sometimes leading role, in the management of selected patients. Copyright © 2022 Sociedad Mexicana de Urologia. Colegio de Profesionistas A.C.. All rights reserved.
ABSTRACT
Introduction & Objectives: In the last two decades, several therapeutic schemes have been proposed for erectile rehabilitation (ER) after radical prostatectomy (RP), but none has been standardized or validated due to the lack of high-level evidence in the Literature. We performed an international Survey focused on the current worldwide approach to ER, highlighting the contact and divergent aspects. Materials & Methods: We purposed an online Survey between July and December 2020 using email lists and Twitter, aiming to evaluate the ER protocols after RP performed by urologists and andrologists in daily practice. The following sections were investigated: 1) Demographics;2) Number and type of RP performed;3) Type and schedule, timing and duration of ER erectile programs;4) Standard treatment protocol. The specialists were contacted with the support of Confederación Americana de Urología (CAU), Urological SOcial MEdia (UroSoMe) Working Group, Functional Urology- Techno Urology- Research (FUTURe) Group and by a dedicated uro-andrologists spaces on Twitter platform of iTRUE Group. Results: The Survey was completed by 518 responders from 52 worldwide countries. The main criteria to candidate patients for ER were nerve sparing surgery (72.8%), lack of significant comorbidities (66.4%), patient’s request (55.4%), valid pre-operative EF (55%), age (48.1%), and partner’s willing (19.1%). Surgical techniques reported were: 38.9% open RP, 22.9% video laparoscopic RP, 38.2% robot- assisted RP. There were no significant differences (p>0.05) among the main surgical techniques and the time of EF recovery beginning, protocol and duration. The use of specific ER protocols was reported by 61.4%. The beginning of ER was reported by 33% of responders at catheter removal, after one month from surgery by 22%, and before RP by 15%. PDE5i were more frequently used as first line treatment (99.4%). Tadalafil 20 mg was the most prescribed in monotherapy, prescribed daily (48.2%) or 2-3 times/week (46%). PGE1 intra-cavernosal injection (67.9%) was the second more common prescription in monotherapy, followed by the association of PDE5i and vacuum device (29.6%). A minority of specialists 44/518 (8.5%) recommended low intensity shock wave therapy, while 63/518 (12.2%) proposed this in association to other therapies. The duration of ER was: in 16.2% <6 months, in 39% between 6 and 11 months;in 31.9% between 12 and 18 months;in 9.2% between 19-24 months, and in 3.7% >24 months. In case of first-line failure, the majority of the responders shifted to another treatment after at least 3 months (71%). During COVID-19 outbreak, the 37.4% of responders did not perform EF recovery consultations, while 26.8% had normal consultations, and 35.7% used telemedicine. Conclusions: This Survey showed an inhomogeneous approach to ER, reflecting the lack of high-level evidence on this topic. A worldwide accepted guideline on ER is therefore needed.
ABSTRACT
The SARS-CoV 2 outbreak is one of the most important events of public health around the world;this disease has affected millions of people, has killed over 430.000 people and has increased the needed of intensive care unit beds around the world. During the pandemic the world has seen a decline in the organ donation and transplantation activities, Colombian transplant model has been affected too. This paper wants to show the current situation of organ donation and transplantation during SARS-CoV 2 pandemic and explore some dilemmas around organ donation and transplantation for emerging countries.