Evidence-based Medicine: Perceptions, Attitudes, and Skills Among European Urology Residents.

Background: Evidence-based medicine (EBM) was introduced as a concept in the early 1990s as an integration of the best available evidence with clinical expertise and patient values. Objective: To evaluate the current status of EBM training and EBM perception, attitudes, and self-perceived skills among European urology residents. Design setting and participants: Our online open survey comprised 28 multiple-choice items, including ten questions with responses on a five-point Likert scale ranging from 1 = strongly disagree to 5 = strongly agree. The survey was distributed via the mailing lists and social media accounts of the European Society of Residents in Urology, German Society of Residents in Urology, French Society of Urologists in Training, Spanish Urology Residents Working Group, Italian Society of Residents in Urology, and the Urology Social Media Working Group in two rounds (May-July 2019 and July 2020). We excluded responses from non-European countries. Outcome measurements and statistical analysis: The online open survey comprised 28 multiple-choice items. These included ten questions with answers on a five-point Likert scale with response items ranging from strongly disagree (score of 1) to strongly agree (score of 5). Results and limitations: We received 210 responses, of which 181 from 23 European countries were eligible. Approximately three-quarters (73.7%) of the respondents were male, with a mean age of 31 yr. Only 28.2% reported EBM training as part of their urology curriculum and 19.3% felt that the training they received was sufficient to guide their daily practice. An overwhelming majority (91.5%) stated that they would be interested in more formalized EBM training or additional training. There was a strong level of agreement (median score 5, interquartile range 4-5) that EBM is important for daily medical and surgical practice and that it improves patient care. Overall, the mean self-perceived understanding of basic EBM concepts was good. Limitations include concerns about generalizability given its internet-based format, the inability to calculate a response rate, poor representation from some European regions, and limited sample size. Conclusions: Our survey suggests that European urology residents receive a limited amount of EBM training despite considerable appreciation, interest, and self-perceived deficits for more advanced concepts. Formal integration of EBM teaching in all European residency programs should be considered. Patient summary: We performed an online survey of urology residents in Europe. We found that residents have positive perceptions of and attitudes to evidence-based medicine but most programs lack formal training in this area.

Current trends in erectile rehabilitation after radical prostatectomy: Results from a worldwide survey.

We aimed to analyse the current trend of erectile rehabilitation (ER) following radical prostatectomy (RP) using a dedicated survey. An online survey was developed between July and September 2020, aiming to evaluate the ER protocols after RP in daily practice among urologists, andrologists, sexual medicine specialists and residents. We investigated demographics data, type of RP performed, and type, schedule, timing and duration of ER protocols. In total, 518 responders from 52 countries completed the survey. Surgical techniques reported were: 38.9% open, 22.9% laparoscopic and 38.2% robot-assisted RP. 33% of the responders begin ER at the catheter removal, 22% 1 month after surgery and 15% before surgery. Phosphodiesterase inhibitors were the most used medication as first-line treatment (99.4%). Tadalafil 20 mg was the most prescribed, and used daily in 48.2% of the cases, and 2-3 times/week in 46%. Intra-cavernosal injection of prostaglandin E1 was the second most common prescribed monotherapy (67.9%) followed by the association of phosphodiesterase inhibitors and vacuum-erection device (29.6%). The duration of ER was <6 months in 16.2%, between 6 and 11 months in 39%, between 12 and 18 months in 31.9%, between 19-24 months in 9.2% and >24 months in 3.7%. This study showed that the approach to ER after RP was inhomogeneous. International guidelines are urgently needed to standardise ER protocols.

Social media influence in the COVID-19 Pandemic

ABSTRACT Never before in human history has it been possible to communicate so quickly during a pandemic, social media platforms have been a key piece for the dissemination of information; however, there are multiple advantages and disadvantages that must be considered. Responsible use of these tools can help quickly disseminate important new information, relevant new scientific findings, share diagnostic, treatment, and followup protocols, as well as compare different approaches globally, removing geographic boundaries for the first time in history. In order to use these tools in a responsible and useful way, it is recommended to follow some basic guidelines when sharing information on social networks in the COVID-19 era. In this paper, we summarize the most relevant information on the influence, and advantages, and disadvantages of the use of social networks during the COVID-19 pandemic.

Social media influence in the COVID-19 Pandemic.

Never before in human history has it been possible to communicate so quickly during a pandemic, social media platforms have been a key piece for the dissemination of information; however, there are multiple advantages and disadvantages that must be considered. Responsible use of these tools can help quickly disseminate important new information, relevant new scientific findings, share diagnostic, treatment, and follow-up protocols, as well as compare different approaches globally, removing geographic boundaries for the first time in history. In order to use these tools in a responsible and useful way, it is recommended to follow some basic guidelines when sharing information on social networks in the COVID-19 era. In this paper, we summarize the most relevant information on the influence, and advantages, and disadvantages of the use of social networks during the COVID-19 pandemic.

A global knowledge, attitudes and practices survey on anatomical endoscopic enucleation of prostate for benign prostatic hyperplasia among urologists.

There is an increasing use of the procedure, anatomical endoscopic enucleation of the prostate, as an alternative to conventional transurethral resection of prostate for surgical treatment of benign prostatic hyperplasia. However, barriers to adoption of this procedure remain and no prior studies explored this important aspect till date. The aim of this study is to identify the predictors and barriers of surgeon-related practices in this area. The study findings may also provide valuable insight into current practice trends worldwide. To achieve the objectives, we conducted an online, cross-sectional, questionnaire-based study between 1st September 2019 and 5th October 2019 to investigate the knowledge, attitudes and practices among urologists worldwide. Our findings showed that the main barriers for adoption of the procedure were lack of mentorship, a steep learning curve, and unavailability of morcellator, bipolar or laser energy sources. Fear of urinary incontinence, bleeding and bladder injury were not major hindrance to adoption of this technique. The results also demonstrated that there will be continued increase in utility of the procedure in the future.

[Usefulness of photodynamic diagnosis in high-grade Bladder Cancer and subsequent BCG failure. Bibliographic review.] / Utilidad del diagnóstico fotodinámico en el carcinoma vesical de alto grado y posterior al fracaso de BCG. Revisión de la literatura.

OBJECTIVES: Bladder tumors are thesecond highest incidence urological tumor in the adultpopulation. In recent years, new techniques such as photodynamicdiagnosis have arisen in order to improvethe sensitivity for the detection of non muscle invasivebladder cancer (NMIBC). We intend to update the roleof photodynamic diagnosis in the diagnosis of NMIBC,in cases refractory to BCG and as a treatment in therecurrent bladder cancer. MATERIAL AND METHOD: We performed a descriptivestudy and bibliographic review on the usefulness of photratatodynamicdiagnosis in NMIBC, early recurrence andrefractoriness to BCG published in the universal medicalliterature. RESULTS: Photodynamic cystoscopy increases the detectionsensitivity for NMIBC, especially carcinoma in situ(CIS) from 15% to 30% according to the different seriespublished. Regarding high-grade bladder cancer recurrence,photodynamic therapy increases disease-freetime in 20% of patients. In the use of photodynamictechniques for the detection of CIS after BCG, studiesindicate an increase in sensitivity with an increase in therate of false positives. CONCLUSION: Photodynamic diagnosis could improvesensitivity for the early detection of patients withCIS and/or T1G3. May be, at the same time, an alternativein the recurrence of bladder cancer, especiallyCIS.

OBJETIVO: Los tumores vesicales son el segundo tumor urológico con mayor incidencia en la población adulta. En los últimos años han surgido nuevas técnicas como el diagnóstico fotodinámico, con el fin de mejorar la sensibilidad para la detección del tumor vesical no musculo invasivo (TVNMI). Pretendemos actualizar el papel del diagnóstico fotodinámico en el diagnóstico del TVNMI, en los casos refractarios a BCG y como tratamiento en el tumor vesical  recidivante.MATERIAL Y MÉTODO: Revisión bibliográfica y estudio descriptivo sobre la utilidad del diagnóstico fotodinámico en el TVNMI, en la recurrencia precoz y en la refractariedad a BCG publicados en la literatura médica universal. RESULTADOS: La cistoscopia fotodinámica aumenta la sensibilidad de detección del TVNMI, sobre todo del carcinoma in situ (CIS) desde un 15% hasta un 30% según las distintas series publicadas. En cuanto a la recidiva del tumor vesical de alto grado, la terapia fotodinámica aumenta el tiempo libre de enfermedad en un 20% de los pacientes. En el uso de técnicas fotodinámicas para la detección del CIS tras el uso de BCG, los estudios indican un aumento de sensibilidad con un incremento de la tasa de falsos positivos.CONCLUSIÓN: El diagnóstico fotodinámico podría mejorar la sensibilidad para la detección precoz de pacientes con CIS y/o T1G3. Puede ser, a su vez, una alternativa en la recurrencia del cáncer vesical, sobre todo del CIS.

Utilidad del diagnóstico fotodinámico en el carcinoma vesical de alto grado y posterior al fracaso de BCG. Revisión de la literatura / No disponible

Objetivo: Los tumores vesicales son el segundo tumor urológico con mayor incidencia en la población adulta. En los últimos años han surgido nuevas técnicas como el diagnóstico fotodinámico, con el fin de mejorar la sensibilidad para la detección del tumor vesical no musculo invasivo (TVNMI). Pretendemos actualizar el papel del diagnóstico fotodinámico en el diagnóstico del TVNMI, en los casos refractarios a BCG y como tratamiento en el tumor vesical recidivante. Material y método: Revisión bibliográfica y estudio descriptivo sobre la utilidad del diagnóstico fotodinámico en el TVNMI, en la recurrencia precoz y en la refractariedad a BCG publicados en la literatura médica universal. Resultados: La cistoscopia fotodinámica aumenta la sensibilidad de detección del TVNMI, sobre todo del carcinoma in situ (CIS) desde un 15% hasta un 30% según las distintas series publicadas. En cuanto a la recidiva del tumor vesical de alto grado, la terapia fotodinámica aumenta el tiempo libre de enfermedad en un 20% de los pacientes. En el uso de técnicas fotodinámicas para la detección del CIS tras el uso de BCG, los estudios indican un aumento de sensibilidad con un incremento de la tasa de falsos positivos. Conclusión: El diagnóstico fotodinámico podría mejorar la sensibilidad para la detección precoz de pacientes con CIS y/o T1G3. Puede ser, a su vez, una alternativa en la recurrencia del cáncer vesical, sobre todo del CIS

Objectives: Bladder tumors are the second highest incidence urological tumor in the adult population. In recent years, new techniques such as photodynamic diagnosis have arisen in order to improve the sensitivity for the detection of non muscle invasive bladder cancer (NMIBC). We intend to update the role of photodynamic diagnosis in the diagnosis of NMIBC, in cases refractory to BCG and as a treatment in the recurrent bladder cancer. Material and method: We performed a descriptive study and bibliographic review on the usefulness of pho tratatodynamic diagnosis in NMIBC, early recurrence and refractoriness to BCG published in the universal medical literature. Results: Photodynamic cystoscopy increases the detection sensitivity for NMIBC, especially carcinoma in situ (CIS) from 15% to 30% according to the different series published. Regarding high-grade bladder cancer recurrence, photodynamic therapy increases disease-free time in 20% of patients. In the use of photodynamic techniques for the detection of CIS after BCG, studies indicate an increase in sensitivity with an increase in the rate of false positives. Conclusion: Photodynamic diagnosis could improve sensitivity for the early detection of patients with CIS and/or T1G3. May be, at the same time, an alternative in the recurrence of bladder cancer, especially CIS

Situación laboral en España tras finalizar la residencia en Urología. Análisis de una encuesta a nivel nacional / Job status after the resident training period in Spain. Analysis of a national survey

Objetivos: Desde la instauración de las enseñanzas de especialización a través del sistema de residencia, la sanidad española ha pretendido mantener un equilibrio entre las necesidades establecidas y los profesionales formados, con el objetivo de evitar el déficit o exceso de especialistas sanitarios con las consecuencias que de ello pudieran derivar. El objetivo de la presente revisión es conocer la situación laboral de los médicos especialistas en urología al finalizar el periodo formativo MIR. Métodos: Se presentan los resultados de una encuesta destinada a médicos especialistas en urología que finalizaron su contrato de residencia desde el 2012 hasta 2016, valorando situación laboral, datos académicos y laborales durante los primeros meses tras la finalización de la formación especializada. Resultados: Se recogieron un total de 42 respuestas. La totalidad de los encuestados tuvo contrato laboral a los 6 meses tras finalizar el MIR. El 71% contaba con un contrato temporal, la mayoría con una duración menor de un año. Hay más números de contratos en la empresa pública, aunque aumentan progresivamente en la privada. Más de la mitad de los encuestados se encontraban satisfechos con su situación laboral. Conclusiones: La inserción laboral de los urólogos recientemente especializados es alta, llegando al 100% a los 6 meses de finalizar su especialización. No son tan positivas cuestiones relacionadas con la calidad laboral, observando una gran inestabilidad laboral asociada a una alta proporción de contratos temporales menores de 6 meses (AU)

Objectives: Since the establishment of specialization of medicine through the residency system, Spanish health care has sought to maintain a balance between established needs and trained professionals, with the aim of avoiding the deficit or excess of health specialists with its consequences. The objective of the present review is to know the working conditions of urologist specialists at the end of the residency training period. Méthods: The results of a survey for urologist who completed their residency contract from 2012 to 2016 are presented, assessing working status, academic and working data during the first months after the completion of specialized training. Results: A total of 42 surveys were collected. All respondents had a working contract within 6 months of completing their training. 71% had a temporary contract, most with duration of less than one year. There are more contract numbers in the public health system, although they increase progressively in the private sector. More than half of the respondents were satisfied with their work situation. Conclusiones: The work insertion of the recently specialized urologists is high, reaching 100% within 6 months of finishing their specialization. Labor quality issues are not so positive, observing great working instability associated to a high proportion of temporary contracts lower than 6 months (AU)

El papel de las redes sociales en la formación académica urológica. Uso adecuado / The role of social media in academic training in Urology. Adequate use

Las redes sociales se caracterizan porque todos sus servicios son participativos. Los usuarios de las tecnologías 2.0 pueden relacionarse de forma sencilla y abierta con otras personas, compartir recursos y comunicarse de forma inmediata y simultánea. La investigación se favorece de las tecnologías participativas, al permitir que los grupos compartan reflexiones, metodologías, recursos y resultados. La red social con mayor difusión y uso en la urología posiblemente sea Twitter ya que permite realizar lo que se conoce como "microblogging", los usuarios generan comentarios y mensajes breves a través de la creación de "tweets". Es posible determinar que existen tres grandes ámbitos en los que las redes sociales desde un punto de vista científico se manifiestan: compartir investigación, recursos y resultados. El uso y las aplicaciones de las redes sociales se convierten en una gran responsabilidad en el área de la salud y la urología, obviamente por razones de privacidad, rigor científico, ética y la naturaleza del contenido médico - legal (AU)

Social media is characterized because all its services are participative. Users of 2.0 technologies can interact easily and openly with other people, share resources and communicate immediately and simultaneously. Research improves from participatory technologies by allowing groups to share reflections, methodologies, resources and results. The social media platform with greater diffusion and use in urology is possibly Twitter because it allows to realize what is known like "microblogging", the users generate comments and brief messages through the creation of "tweets". It is possible to determine that there are three broad areas from a scientific point of view in which social media are manifested: sharing research, resources and results. The use and applications of social media become a major responsibility in the area of health and urology, obviously for reasons of privacy, scientific rigor, ethics and the nature of the medical - legal content (AU)

[Job status after the resident training period in Spain. Analysis of a national survey.] / Situación laboral en España tras finalizar la residencia en Urología. Análisis de una encuesta a nivel nacional.

OBJECTIVES: Since the establishment of specialization of medicine through the residency system, Spanish health care has sought to maintain a balance between established needs and trained professionals, with the aim of avoiding the deficit or excess of health specialists with its consequences. The objective of the present review is to know the working conditions of urologist specialists at the end of the residency training period. METHODS: The results of a survey for urologist who completed their residency contract from 2012 to 2016 are presented, assessing working status, academic and working data during the first months after the completion of specialized training. RESULTS: A total of 42 surveys were collected. All respondents had a working contract within 6 months of completing their training. 71% had a temporary contract, most with duration of less than one year. There are more contract numbers in the public health system, although they increase progressively in the private sector. More than half of the respondents were satisfied with their work situation. CONCLUSIONS: The work insertion of the recently specialized urologists is high, reaching 100% within 6 months of finishing their specialization. Labor quality issues are not so positive, observing great working instability associated to a high proportion of temporary contracts lower than 6 months.

[The role of social media in academic training in Urology. Adequate use.] / El papel de las redes sociales en la formación académica urológica. Uso adecuado.

Social media is characterized because all its services are participative. Users of 2.0 technologies can interact easily and openly with other people, share resources and communicate immediately and simultaneously. Research improves from participatory technologies by allowing groups to share reflections, methodologies, resources and results.The social media platform with greater diffusion and use in urology is possibly Twitter because it allows to realize what is known like "microblogging", the users generate comments and brief messages through the creation of "tweets". It is possible to determine that there are three broad areas from a scientific point of view in which social media are manifested: sharing research, resources and results. The use and applications of social media become a major responsibility in the area of health and urology, obviously for reasons of privacy, scientific rigor, ethics and the nature of the medical - legal content.

[Urinary lithiasis. The patient also plays.] / Urolitiasis: el paciente también juega.

Renal lithiasis is known for its high incidence and prevalence, but mainly for its morbidity and recurrence. Despite a good indication and appropriate surgical treatment, the essential problem, the origin of the formation of the stones, generally persists and it is not uncommon that patients suffer multiple treatments and discomfort secondary to ancillary measures normally used to prevent complications. It is widely known, for consistency, that a prophylactic treatment with general or, in a smaller group of patients, specific measures are appropriate to diminish recurrences. Nevertheless, prophylaxis is not usually used by many urologists and, on top of that, in the majority of those cases when it is taken into consideration, it is the patient who fails for inadequate treatment compliance. It is very important, in any of our conversations with the urinary lithiasis' patient in relation with the disease, that the urologist provides a proper and detailed information about all its features, from diagnosis to active treatment and possible complications and, of course in those cases where prophylaxis is going to be essential to avoid new unpleasant episodes of pain and associated surgical interventions, emphasizing that improving his/her quality of life depends, to a great extent, on the patient himself. In this article, considering the existing evidence and personal experience, we intend to detail those behaviors we should take into consideration to facilitate the patient both therapeutic decisions and a positive attitude towards his/her disease, with the aim to control it in the best possible way.

Urolitiasis: el paciente también juega / Urinary lithiasis. The patient also plays

La litiasis renal es conocida por su alta incidencia y prevalencia, pero sobre todo por su morbilidad y recurrencia. A pesar de una buena indicación y un tratamiento quirúrgico apropiado, el problema de fondo, es decir el origen la formación de los cálculos, normalmente sigue existiendo y no es raro que los pacientes sufran múltiples tratamientos y molestias secundarias a las maniobras auxiliares que normalmente empleamos para prevenir complicaciones. Es de sobra sabido, por coherente, que un tratamiento profiláctico con medidas generales o, en un menor grupo de pacientes, específicas son convenientes para disminuir las recidivas. Sin embargo, la profilaxis no suele ser empleada por una buena parte de los urólogos y, por si fuera poco, en una buena parte de aquellos casos en los que sí se tiene en cuenta, es el paciente el que falla por inadecuada adherencia al tratamiento. Es de gran importancia, en cualquiera de las conversaciones con el paciente litiásico relacionadas con su enfermedad, que el urólogo le proporcione una correcta y detallada información sobre todos los aspectos de la misma, desde el diagnóstico al tratamiento activo y posibles complicaciones y, desde luego en aquellos casos en los que la profilaxis vaya a ser fundamental para evitar nuevos episodios desagradables de dolor e intervenciones quirúrgicas asociadas, haciendo hincapié en que del propio paciente depende, en buena medida, que mejore su calidad de vida. En este artículo se pretende enumerar aquellas actitudes que debemos tener en cuenta, contando con la evidencia existente y la experiencia personal, para facilitar al paciente tanto las decisiones terapéuticas como una actitud positiva del mismo hacia su propia enfermedad, con el propósito de controlarla de la mejor manera posible

Renal lithiasis is known for its high incidence and prevalence, but mainly for its morbidity and recurrence. Despite a good indication and appropriate surgical treatment, the essential problem, the origin of the formation of the stones, generally persists and it is not uncommon that patients suffer multiple treatments and discomfort secondary to ancillary measures normally used to prevent complications. It is widely known, for consistency, that a prophylactic treatment with general or, in a smaller group of patients, specific measures are appropriate to diminish recurrences. Nevertheless, prophylaxis is not usually used by many urologists and, on top of that, in the majority of those cases when it is taken into consideration, it is the patient who fails for inadequate treatment compliance. It is very important, in any of our conversations with the urinary lithiasis´ patient in relation with the disease, that the urologist provides a proper and detailed information about all its features, from diagnosis to active treatment and possible complications and, of course in those cases where prophylaxis is going to be essential to avoid new unpleasant episodes of pain and associated surgical interventions, emphasizing that improving his/her quality of life depends, to a great extent, on the patient himself. In this article, considering the existing evidence and personal experience, we intend to detail those behaviors we should take into consideration to facilitate the patient both therapeutic decisions and a positive attitude towards his/her disease, with the aim to control it in the best possible way