Urology residency training in Greece. Results from the first national resident survey.

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.

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.

B3 agonists or anticholinergics in the treatment of the lower urinary tract dysfunction in patients with multiple sclerosis?-A randomized study.

INTRODUCTION AND OBJECTIVE: Multiple sclerosis (MS) is the most frequent autoimmune demyelinating disease of the central nervous system. MS patients usually present with lower urinary tract dysfunction (LUTD). Objective of this study is to evaluate and compare the efficacy and safety of treating MS patients with LUTD with either a b3 agonist (mirabegron) or anticholinergics. The study's primary outcome is the LUTD symptom improvement. MATERIAL AND METHODS: This is a multi-center, single-blinded, comparative study including 91 MS patients with LUTD. At baseline, patients underwent thorough clinical examination, urine cultivation and abdominal ultrasound and completed urination diaries and specific, validated questionnaires (NBSS, MusiQoL). At second visit, patients were administered either mirabegron or anticholinergics. Treatment was always carried out alongside with MS treatment. Reevaluation was performed 3 months after first visit. Patients underwent the same clinical and imaging tests that were carried out at first visit. RESULTS: We compared several clinical and imaging parameters between the two groups at first visit and month 3 after treatment. Νo statistical difference was noted between the mirabegron group and the anticholinergic group in terms of LUTD improvement. In both groups, improvement from baseline regarding LUTD was recorded. Statistical analysis was performed using the paired and unpaired t test method. No patient discontinued either medication due to side effects. CONCLUSIONS: MS patients receiving either mirabegron or anticholinergic therapy for LUTD showed improvement. Nevertheless, no statistical difference was noted between the two cohorts at 3 months in terms of drug efficacy in all the statistically significant parameters.

Brachial Artery-Brachial Vein Fistula for Hemodialysis: One- or Two-Stage Procedure-A Review.

Purpose The purpose of the study was to investigate the patency rate of the brachial vein transposition-arteriovenous fistula [BVT-AVF] and to review the available literature regarding the comparison of the one-stage with the two-stage procedure. Methods A multiple electronic health database search was performed, aiming to identify studies on brachial vein superficialization. Case reports and series with five or less patients were excluded from the study. End points of the study were the patency rates at 12, 24, and 36 months of follow-up. The patency of the one- or two-stage BVT-AVF procedure was investigated. Results Overall, 380 BVT-AVFs were analyzed. The primary patency rate at 12 months ranged between 24 and 77%. Rate of early fistula malfunction or failure of maturation of the fistula resulting in loss of functionality ranged from 0 to 53%. Forearm edema, hematomas, wound infection, and early thrombosis were among the most common complications. Limited data were available for the comparison of patency rates between the one- and the two-stage procedure because of the absence of sufficient comparative studies. However, series with one-stage procedure presented a lower patency rate at 12 months compared to series with two stages. Conclusion Patency rates after BVT-AVF, although not excellent, has encouraging results taking into account that patients undergoing these procedures do not have an accessible superficial vein network; failure of maturation and the increased rate of early postoperative complications remain a concern. The BVT-AVF is a valuable option for creating an autologous vascular access in patients lacking adequate superficial veins.

Update on intracorporeal laser lithotripsy.

Nowadays, rigid and flexible ureteroscopy is a precise, minimal invasive surgery that can assess the entire collecting system in order to treat a stone with intracorporeal lithotripsy. The implication of laser technology has revolutionized the intracorporeal lithotripsy. Currently, laser lithotripsy is advancing in two different directions: improvements of the existing Ho:YAG laser platform and the development of novel laser systems. Herein, we review the current literature upon intracorporeal lithotripsy.

The quantum Zeno effect immunizes the avian compass against the deleterious effects of exchange and dipolar interactions.

Magnetic-sensitive radical-ion-pair reactions are understood to underlie the biochemical magnetic compass used by avian species for navigation. Recent experiments have provided growing evidence for the radical-ion-pair magnetoreception mechanism, while recent theoretical advances have unravelled the quantum nature of radical-ion-pair reactions, which were shown to manifest a host of quantum-information-science concepts and effects, like quantum measurement, quantum jumps and the quantum Zeno effect. We here show that the quantum Zeno effect provides for the robustness of the avian compass mechanism, and immunizes its magnetic and angular sensitivity against the deleterious and molecule-specific exchange and dipolar interactions.

Can prostate biopsies affect erectile function?

The impact of transrectal ultrasound (TRUS)-guided prostate biopsies on erectile function was prospectively studied. Forty-six men (median age: 67.51 years) who underwent TRUS-guided prostate biopsies completed the International Index of Erectile Function (IIEF)-5 questionnaire at the day of the biopsy, 1 and 3 months later. Erectile dysfunction (ED) severity was classified into five categories. Concomitant ED-related systemic diseases and/or medications that could affect erectile function were also recorded. The paired t-test was used for statistical analysis. The median IIEF-5 score was 15.91 prior to biopsies, while 1 and 3 months after, the median IIEF-5 score was 14.33 and 14.81 respectively (P > 0.05). Prior to prostate biopsies, ED was reported by 38 patients (82.60%): mild ED in 39.13%, mild to moderate in 19.56%, moderate in 15.21% and severe ED in 8.69%. Concomitant ED-related systemic diseases and/or medications were recorded in 28 patients (60.86%). One month after, ED was revealed in 42 patients (91.30%): mild ED in 26.08%, mild to moderate in 30.43%, moderate in 19.56%, and severe ED in 15.21%. Three months post-biopsy, ED was reported by 41 patients (89.13): mild ED in 21.73%, mild to moderate in 28.26%, moderate in 21.73%, and severe ED in 17.39%. Overall, three and two patients (6.52% and 4.34%) had prostate biopsy attributed ED (i.e. without concomitant ED-related disease or medication) 1 and 3 months after prostate biopsies. TRUS-guided prostate biopsies did not induce ED in a statistically significant manner. Evaluating potency at referral for TRUS-guided prostate biopsies is advisable.

Percutaneous nephrolithotomy to remove a cartridge detonating cap mimicking a renal pelvic stone 12 years after renal trauma.

Complications of gunshot injuries of the kidney usually present in the early postoperative period. We describe a case of a cartridge's plastic detonating cap retained in the renal pelvis of a young male patient for 12 years. Renal colic was the cause of admission. This missile's part was mimicking a renal stone on both an intravenous urogram and a CT scan. The nature of the "stone" was identified during a percutaneous nephrolithotomy procedure during which the foreign body was removed.

Urinary diversion in high-risk elderly patients: modified cutaneous ureterostomy or ileal conduit?

OBJECTIVES: To evaluate the efficacy and safety of the type of urinary diversion during radical cystectomy in high-risk elderly patients by comparing a modified cutaneous ureterostomy with the ileal conduit urinary diversion. METHODS: Of 481 patients who underwent radical cystectomy between 1993 and 2002, 54 individuals older than 75 years with an American Society of Anesthesiologists score of 3e, 4, or 4e were characterized as high risk. These patients were grouped according to those who underwent a modified cutaneous ureterostomy (group 1, 29 patients) and those who underwent ileal conduit urinary diversion (group 2, 25 patients). Student's t and Fisher's exact tests were used for statistical analysis. RESULTS: The patients in group 2 had a longer operative time (P < 0.001), an increased need for blood transfusion (P = 0.025), an increased need for intensive care monitoring (P = 0.032), and a longer mean hospitalization time (P < 0.001) than the patients in group 1. In group 2, we recorded statistically greater rates of intraoperative complications (P = 0.035), early medical and surgical complications (P = 0.031 and P = 0.012, respectively), and late surgical complications (P = 0.004). The intraoperative, early, and late surgical complication rate was 13.7%, 24.1%, and 17.2% in group 1 and 40%, 60%, and 56% in group 2, respectively. One patient in group 2 died in the early postoperative period. CONCLUSIONS: Cutaneous ureterostomy represents a simplified alternative for urinary diversion in high-risk elderly patients. It can be performed quickly, with few early and late postoperative complications compared with the ileal conduit operation.

Colonoscopy effects on serum prostate specific antigen levels.

INTRODUCTION: To evaluate the colonoscopy effects on serum levels of prostate specific antigen (PSA) and PSA ratio. SUBJECTS AND METHODS: Thirty men were studied (median age 68 years, range 32-89). All of them had their serum PSA (total and free) measured 24 hours prior to colonoscopy and also 24 hours, 7 and 30 days after procedure. RESULTS: 14 of 30 (47%) patients, had significantly (p = 0.045) increased Total PSA levels 24 hours after the procedure, 14 (47%) patients had insignificantly (p = 0.139) increased levels 7 days after, while 13 (43%) of them had insignificantly (p = 0.061) increased levels 30 days after colonoscopy. In 7 patients (23%), with total PSA levels in the "gray zone" (4-10 ng/ml) before colonoscopy, a near significant (p = 0.063) raise in PSA ratio was also observed 24 hours after. CONCLUSION: Flexible colonoscopy affect serum PSA (free and total) levels in certain patients. Special attention must be given to those patients with PSA levels in the "gray zone" before colonoscopy.