Preference and perception of treatment choices between radiologists and urologists for treatment for urgent urinary obstruction – nephrostomy versus retrograde ureteric stent: European survey from YAU and ESUT Endourology groups

Introduction & Objectives: Urological emergencies related to urinary obstruction need Percutaneous Nephrostomy (PCN) or Retrograde Ureteric Stent (RUS). The choice of treatment is often debated between radiologists and urologists due to differences in perception for given scenarios and the skill set needed for these. We wanted to conduct a European survey to determine the preference of treatment in different clinical situations. Materials & Methods: A European survey was conducted via the EAU sections (YAU and ESUT) for preference and treatment choices between radiologists and urologists for using PCN or RUS or primary ureteroscopy (URS) in various clinical scenarios. Responders were asked to select urinary drainage for 3 clinical scenarios before and after reading evidence from literature on use of PCN or RUS. The scenarios were ureteric stone related – infected obstructed kidney (scenario 1), obese patient with pain and hydronephrosis (scenario 2) and solitary kidney with deranged renal function (scenario 3). Results: Of the responses (n=367), there were 15.4% (n=57) radiologists and 310 (84.5%) urologists. The choice of drainage for scenario 1,2 and 3 between urologists and radiologists pre- and post-evidence perusal are shown in Table 1. Regarding QoL, cost and radiation dose (Table 2), the perception was that Radiologists appear to consider JJ stents to provide a better QoL (p=0.0004) and more radiation exposure (p<0.0001) than Urologists. The perception in both groups was that stent was more expensive (p=0.652507). With COVID-19 pandemic, there was also a rise in the usage of local anaesthetic stent and URS procedures. (Table Presented) Conclusions: Choice of urinary drainage for urological emergencies is dependent on multiple factors, but prompt management is paramount. This survey has shown how urologists and radiologists both put patient safety at the forefront and their choice of treatment reflects their expertise in the given technique.

Efficacy and safety of the EMS Swiss LithoClast® Trilogy for PCNL: results of the European multicentre prospective study on behalf of European Section of UroTechnology.

PURPOSE: PCNL requires a lithotrite to efficiently break stones, and some devices include active suction to remove the fragments. We set out to determine the efficacy and safety of the Swiss LithoClast® Trilogy, in a prospective European multicentre evaluation and compared it to published stone clearance rates for Trilogy based on surface area (68.9 mm2/min) and using the 3D calculated stone volume (526.7 mm3/min). METHODS: Ten European centres participated in this prospective non-randomized study of Trilogy for PCNL. Objective measures of stone clearance rate, device malfunction, complications and stone-free rates were assessed. Each surgeon subjectively evaluated ergonomic and device effectiveness, on a 1-10 scale (10 = extremely ergonomic/effective) and compared to their usual lithotrite on a 1-10 scale (10 = extremely effective). RESULTS: One hundred and fifty seven PCNLs using Trilogy were included (53% male, 47% female; mean age 55 years, range 13-84 years). Mean stone clearance rate was 65.55 mm2/min or 945 mm3/min based on calculated 3D volume. Stone-free rate on fluoroscopy screening at the end of the procedure was 83%. Feedback for suction effectiveness was 9.0 with 9.1 for combination and 9.0 for overall effectiveness compared to lithotrite used previously. Ergonomic score was 8.1, the least satisfactory element. Complications included 13 (8.2%) Clavien-Dindo Grade II and 2 (1.3%) Grade III. Probe breakage was seen in 9 (5.7%), none required using a different lithotrite. CONCLUSIONS: We have demonstrated that Trilogy is highly effective at stone removal. From a user perspective, the device was perceived by surgeons to be highly effective overall and compared to the most commonly used previous lithotrite, with an excellent safety profile.

Urology residency training in Greece. Results from the first national resident survey. / Formación de la residencia de Urología en Grecia. Resultados de la primera encuesta nacional.

BACKGROUND AND OBJECTIVES: This is the first national survey assessing Greek Urology residency programs. The main objective of this study is to assess the level of confidence and perception of Greek Urology residents regarding their educational program and detect areas of improvement. MATERIAL AND METHODS: A 51-question survey was developed via an electronic platform and answered by 91 out of 104 Greek residents from March 2019 until May 2019. Fisher's exact test, chi-squared test and Kruskal-Wallis test were used with statistical significance set at p=.05. RESULTS: The median overall satisfaction regarding surgical training was 6/10 regardless of working schedule, working in a University Department, PGY or number of residents in clinic. Most residents have not performed any scrotal ultrasound or pressure-flow-studies; however, they are more familiar with KUB ultrasound. Double-J stent insertion and cystoscopy were common procedures for residents. Bureaucracy was reported as a major issue by 70.4% of residents. ESWL has not been performed by 80.2% of residents, 58.2% residents performed less than 10 ureteroscopies, and only the last year trainees performed more than 10 TURBT and TURP. Most residents mentioned to rarely perform basic steps in many open or laparoscopic urological procedures. Surprisingly, 59.3% of residents have not published any study in peer-reviewed journals. Regarding satisfaction, 44% rarely feel satisfied at work and 59.3% sometimes suffer from burnout. Response rate reached 87.5%. CONCLUSIONS: Considering the results from this survey, regulatory authorities should join forces to establish a structured curriculum of clinical, surgical and research training in Urology across Europe.