Current status of robotic training during the urology residency: results from a national survey in Spain.

INTRODUCTION AND OBJECTIVES: The increasing number of robotic urological procedures observed in recent years highlights the need to expand training opportunities in robotic surgery. Our objective is to investigate the state of robotic training during urology residency in Spain in order to identify significant deficiencies. MATERIALS AND METHODS: A 20-item online survey was conducted among urology residents in Spain who were registered in the database of the Residents and Young Urologists Group of the Spanish Association of Urology. The survey assessed subjective opinions, institutional aspects, training resources, and experience regarding robotic surgery. A total of 455 email invitations were sent throughout the year 2021. Descriptive analysis of the responses was performed. RESULTS: The participation rate reached 30%, with a total of 135 residents. 52% of respondents lacked access to a robotic system in their institution, of which only 48% could compensate for this deficiency through external rotations. Among those with access to a robotic system, 25% and 23% reported having access to theoretical and practical training, respectively. The existence of a formal training program was low (13%). 85% of the respondents considered robotic surgery training in Spain to be deficient. CONCLUSIONS: Training for Spanish residents in robotic urological surgery is perceived as inadequate, emphasizing the crucial need for improvement in training programs in this field.

Estenosis de la anastomosis ureteroileal en derivaciones urinarias realizadas mediante abordaje abierto, laparoscópico y robótico. Incidencia y manejo en un centro de tercer nivel / Ureteroileal anastomosis stricture after urinary diversions performed by open, laparoscopic and robotic approaches. Incidence and management in a tertiary care center

Introducción Las estenosis de anastomosis ureteroileal son complicaciones frecuentes en conductos ileales y neovejigas ortotópicas. Analizamos su incidencia en función del tipo de derivación urinaria y del abordaje quirúrgico (abierto, laparoscópico o robótico). Describimos su manejo y los resultados obtenidos.Material y métodos Estudio retrospectivo descriptivo durante 6 años en pacientes con derivación urinaria empleando íleon (conducto ileal o neovejiga ileal). Se recogen datos demográficos, comorbilidades, datos quirúrgicos (abordaje, complicaciones) y resultados. Seguimiento mínimo de un año. Comparación entre grupos, mediante test de la chi al cuadrado en variables dicotómicas. Variables cuantitativas comparadas empleando la prueba de la t Student para grupos independientes o la prueba de Mann-Whitney. Consideramos significación estadística p<0,05.Resultados Incluimos a 182 pacientes (84% varones y 16% mujeres). Edad media 68 años. Abordaje de cistectomía: laparoscópica (67/37%), robótica (63/35%), abierta (43/24%). Tipo de derivación: conducto ileal (138/76%) y neovejiga ileal ortotópica (44/24%). Tipo de reimplante: Bricker (108/59%) y Wallace (47/26%). Estenosis de anastomosis ureteroileal (50/27%): bilateral (26), izquierda (16) y derecha (8). Estenosis según abordaje de cistectomía: laparoscópica (23/46%), robótica (16/32%), abierta (9/18%). Tratamiento de estenosis (33/18%): reimplante ureteroileal (13), nefrostomía permanente (13), dilatación endoscópica (4), nefroureterectomía (2), endoureterotomía (1). Abordaje del reimplante: laparoscópico (5/38%), robótico (6/46%) y abierto (2/15%). Resultados tras reimplantes: reestenosis (0/0%), reintervención (3/23%), estenosis ureteroileal contralateral posterior (1/8%).ConclusiónEl tipo de abordaje empleado en la cistectomía no parece influir en la aparición de estenosis ureteroileales. Abordajes laparoscópicos y robóticos permiten su reparación con resultados

Introduction Ureteroileal anastomosis stricture is a frequent complication after radical cystectomy and ileal conduit or orthotopic neobladder formation. We analyze their incidence based on the technique for urinary diversion and on the surgical approach (open, laparoscopic or robot-assisted). Stricture management is described, along with surgical outcomes.Material and methodsDescriptive retrospective study over 6 years in patients who underwent urinary diversion using ileum (ileal conduit or orthotopic neobladder). Demographic data, comorbidities, surgical approach, complications, and outcomes were collected. Minimum follow-up of 1 year. Comparison between groups using Chi-square test for dichotomous variables. Quantitative variables were compared using the Student's t test for independent groups or Mann-Whitney test. Statistical significance if P<.05.Results The study included 182 patients (84% males and 16% females). Mean age 68 years. Cystectomy approach: laparoscopic (67/37%), robot-assisted (63/35%), open (43/24%). Urinary diversion: ileal conduit (138/76%) and orthotopic ileal neobladder (44/24%). Ureteric reimplantation technique: Bricker (108/59%) and Wallace (47/26%). Ureteroileal anastomosis strictures (50/27%): bilateral (26), left (16) and right (8). Strictures according to cystectomy approach: laparoscopic (23/46%), robot-assisted (16/32%), open (9/18%). Treatment of strictures (33/18%): ureteric reimplantation (13), indwelling nephrostomy (13), endoscopic dilatation (4), nephroureterectomy (2), endoureterotomy (1). Ureteroileal reimplantation approach: laparoscopic (5/38%), robot-assisted (6/46%), open (2/15%). Outcomes after reimplantation: restenosis (0/0%), reintervention (3/23%), contralateral ureteroileal stricture (1/8%).Conclusion Surgical approach in cystectomy does not influence future development of ureteroileal strictures. Laparoscopic and robot-assisted ureteroileal reimplantation achieves high success rates (AU)

Ureteroileal anastomosis stricture after urinary diversions performed by open, laparoscopic and robotic approaches. Incidence and management in a tertiary care center.

INTRODUCTION: Ureteroileal anastomosis stricture is a frequent complication after radical cystectomy and ileal conduit or orthotopic neobladder formation. We analyze their incidence based on the technique for urinary diversion and on the surgical approach (open, laparoscopic or robot-assisted). Stricture management is described, along with surgical outcomes. MATERIAL AND METHODS: Descriptive retrospective study over 6 years in patients who underwent urinary diversion using ileum (ileal conduit or orthotopic neobladder). Demographic data, comorbidities, surgical approach, complications, and outcomes were collected. Minimum follow-up of 1 year. Comparison between groups using Chi-square test for dichotomous variables. Quantitative variables were compared using the Student's t-test for independent groups or Mann-Whitney test. Statistical significance if P < .05. RESULTS: The study included 182 patients (84% males and 16% females). Mean age 68 years. Cystectomy approach: laparoscopic (67/37%), robot-assisted (63/35%), open (43/24%). Urinary diversion: ileal conduit (138/76%) and orthotopic ileal neobladder (44/24%). Uretericre implantation technique: Bricker (108/59%) and Wallace (47/26%). Ureteroileal anastomosis strictures (50/27%): bilateral (26), left (16) and right (8). Strictures according to cystectomy approach: laparoscopic (23/46%), robot-assisted (16/32%), open (9/18%). Treatment of strictures (33/18%): ureteric reimplantation (13), indwelling nephrostomy (13), endoscopic dilatation (4), nephroureterectomy (2), endoureterotomy (1). Ureteroileal reimplantation approach: laparoscopic (5/38%), robot-assisted (6/46%), open (2/15%). Outcomes after reimplantation: restenosis (0/0%), reintervention (3/23%), contralateral ureteroileal stricture (1/8%). CONCLUSION: Surgical approach in cystectomy does not influence future development of ureteroileal strictures. Laparoscopic and robot-assisted ureteroileal reimplantation achieves high success rates.

Ureteroileal anastomosis stricture after urinary diversions performed by open, laparoscopic and robotic approaches. Incidence and management in a tertiary care center. / Estenosis de la anastomosis ureteroileal en derivaciones urinarias realizadas mediante abordaje abierto, laparoscópico y robótico. Incidencia y manejo en un centro de tercer nivel.

INTRODUCTION: Ureteroileal anastomosis stricture is a frequent complication after radical cystectomy and ileal conduit or orthotopic neobladder formation. We analyze their incidence based on the technique for urinary diversion and on the surgical approach (open, laparoscopic or robot-assisted). Stricture management is described, along with surgical outcomes. MATERIAL AND METHODS: Descriptive retrospective study over 6 years in patients who underwent urinary diversion using ileum (ileal conduit or orthotopic neobladder). Demographic data, comorbidities, surgical approach, complications, and outcomes were collected. Minimum follow-up of 1 year. Comparison between groups using Chi-square test for dichotomous variables. Quantitative variables were compared using the Student's t test for independent groups or Mann-Whitney test. Statistical significance if P<.05. RESULTS: The study included 182 patients (84% males and 16% females). Mean age 68 years. Cystectomy approach: laparoscopic (67/37%), robot-assisted (63/35%), open (43/24%). Urinary diversion: ileal conduit (138/76%) and orthotopic ileal neobladder (44/24%). Ureteric reimplantation technique: Bricker (108/59%) and Wallace (47/26%). Ureteroileal anastomosis strictures (50/27%): bilateral (26), left (16) and right (8). Strictures according to cystectomy approach: laparoscopic (23/46%), robot-assisted (16/32%), open (9/18%). Treatment of strictures (33/18%): ureteric reimplantation (13), indwelling nephrostomy (13), endoscopic dilatation (4), nephroureterectomy (2), endoureterotomy (1). Ureteroileal reimplantation approach: laparoscopic (5/38%), robot-assisted (6/46%), open (2/15%). Outcomes after reimplantation: restenosis (0/0%), reintervention (3/23%), contralateral ureteroileal stricture (1/8%). CONCLUSION: Surgical approach in cystectomy does not influence future development of ureteroileal strictures. Laparoscopic and robot-assisted ureteroileal reimplantation achieves high success rates.

Radiofrecuencia percutánea en el tratamiento de masas renales pequeñas: análisis de resultados y complicaciones tras diez años de experiencia / Percutaneous radiofrequency for the treatment of small renal masses: Analysis of outcomes and complications after 10 years of experience

Introducción y objetivo: El manejo de tumoraciones renales ≤ 4 cm en población anciana o con comorbilidades supone un reto, constituyendo las terapias ablativas una alternativa interesante. El objetivo es evaluar la radiofrecuencia percutánea en el tratamiento de masas renales pequeñas en nuestro centro, las complicaciones asociadas y los resultados obtenidos.Material y métodosEvaluación retrospectiva de las radiofrecuencias realizadas entre abril de 2010 y abril de 2020 en nuestro centro. Se revisaron datos demográficos, comorbilidades asociadas, características tumorales, complicaciones y resultados oncológicos y funcionales.ResultadosSe trataron 57 tumores en 53 pacientes. Seguimiento medio de 48,2 meses. Se obtuvo un 89,5% de ablaciones completas. Hubo un 19,3% de complicaciones. Fueron catalogadas como mayores un 3,5% y un 5,3% según Clavien-Dindo y SIR. Se encontró asociación estadísticamente significativa entre el resultado inicial de la ablación y la edad (p = 0,047), el score RENAL modificado (RENAL-m) (p = 0,044), la presencia de componente quístico (p = 0,049) y el tamaño tumoral (p = 0,01). El punto de corte de tamaño quedó establecido en 25 mm (p = 0,012). En el análisis multivariante, únicamente el tamaño permaneció como predictor de resultado inicial de ablación (p = 0,01; OR 1,183; IC 95% 1,041-1,345). La supervivencia cáncer específica y supervivencia libre de recurrencia a cinco años fueron del 98,1% y del 89,5% respectivamente.Se observó una disminución media del MDRD-4 de 6,59 mL/min (p = 0,005) en los seis primeros meses tras radiofrecuencia (RFA).ConclusionesDados los excelentes resultados oncológicos y funcionales demostrados, la radiofrecuencia percutánea guiada por ecografía es una terapia eficaz y segura en el tratamiento de masas renales pequeñas en pacientes seleccionados. (AU)

Introduction and objective: The management of renal tumors ≤ 4 cm in elderly population or patients with comorbidities is a challenge, for which ablative therapies are an interesting alternative. The objective is to evaluate in our center the role of percutaneous radiofrequency in the treatment of small renal masses, the associated complications and the results obtained.Material and methodsRetrospective evaluation of the radiofrequency treatments carried out between April 2010 and April 2020 in our center. Demographic data, associated comorbidities, tumor characteristics, complications and oncological and functional outcomes were reviewed.ResultsFifty-seven tumors were treated in 53 patients. Mean follow-up of 48.2 months. The percentage of complete ablations obtained was of 89.5%. There were 19.3% of complications. According to Clavien-Dindo and SIR classification systems, 3.5% and 5.3% were major complications. A statistically significant association was found between the initial result of ablation and age (p = 0.047), RENAL-m (p = 0.044), the presence of cystic component (p = 0.049) and tumor size (p = 0.01). The cut-off point for size was established at 25 mm (p = 0.012). In multivariate analysis, only size remained as a predictor of initial ablation result (p = 0.01; OR 1.183; CI 95% 1.041-1.345). Cancer-specific survival and 5-year recurrence-free survival were 98.1% and 89.5%, respectively.A mean decrease of MDRD-4 of 6.59 mL/min (p = 0.005) was observed in the first six months after RFA.ConclusionsGiven the excellent oncological and functional results demonstrated, ultrasound-guided percutaneous radiofrequency ablation is an effective and safe treatment for small renal masses in selected patients. (AU)

Actividad y resultados a corto plazo del trasplante renal durante la pandemia COVID-19 / Activity and short-term outcomes of kidney transplantation during the COVID-19 pandemic

INTRODUCCIÓN: Durante la pandemia COVID-19, la actividad nacional de trasplante se ha visto reducida por la sobrecarga del sistema sanitario y la preocupación por la seguridad de los pacientes en esta situación. El objetivo de nuestro trabajo es exponer la actividad de trasplante renal en Cantabria durante el estado de alarma, así como valorar la seguridad del programa de trasplante. MATERIAL Y MÉTODOS: Estudio retrospectivo de los trasplantes renales realizados en nuestro Centro desde el inicio del estado de alarma hasta el inicio del desconfinamiento en Cantabria. Análisis descriptivo de los datos demográficos de receptores y sus donantes, datos intraoperatorios y resultados postoperatorios. Análisis comparativo con los datos del mismo periodo de 2017-2019, mediante los estadísticos χ2 para variables categóricas, T-Student y U de Mann-Whitney en caso de variables cuantitativas de distribución normal y no normal, respectivamente. RESULTADOS: Se realizaron 15 trasplantes renales en el periodo descrito. El 7,5% de pacientes presentaron función renal retrasada (FRR); el 26,6% mostró datos de rechazo agudo; ningún paciente presentó enfermedad por COVID-19. En el análisis comparativo, es llamativo el aumento del número de trasplantes frente a periodos anteriores (15 vs. 5,6), a expensas de donantes de fuera de Cantabria (93,3%). No encontramos diferencias estadísticamente significativas en cuanto a tiempo de isquemia fría (p = 0,77), FRR (p = 0,73), necesidad de diálisis (p = 0,54), o aparición de complicaciones posquirúrgicas (p = 0,61). CONCLUSIONES: La evolución de la pandemia en nuestra región y la adopción de medidas de protección rigurosas han permitido reiniciar el programa de trasplante renal de una forma temprana y segura, aumentando el número de trasplantes realizados frente a años anteriores y manteniendo unos resultados postoperatorios tempranos comparables

INTRODUCTION: During the COVID-19 pandemic, the national transplant activity has been reduced due to the overload of the health system and concern for patient safety in this situation. The aim of our work is to expose the activity of kidney transplantation in Cantabria during the state of alarm, as well as to assess the safety of the transplantation program. MATERIAL AND METHODS: Retrospective study of kidney transplants performed in our Center from the beginning of the state of alarm until the beginning of the lockdown easing in Cantabria. Descriptive analysis of the demographic data of recipients and their donors, intraoperative data and postoperative outcomes. Comparative analysis with the data of the same period in 2017-2019, by means of the χ2 for categorical variables, Student's T and Mann-Whitney U tests in case of quantitative variables of normal and non-normal distribution, respectively. RESULTS: Fifteen kidney transplants were performed in the period described. Delayed renal function (DRF) was seen in 7.5% of patients, and 26.6% showed data of acute rejection; no patient presented COVID-19 disease. Comparative analysis showed a remarkable increase in the number of transplants in comparison with previous periods (15 vs 5.6), at the expense of donors from outside Cantabria (93.3%). We found no statistically significant differences in terms of cold ischemia time (p = 0.77), DRF (p = 0.73), need for dialysis (p = 0.54), or appearance of post-surgical complications (p = 0.61). CONCLUSIONS: The evolution of the pandemic in our region, and the adoption of strict protective measures has allowed the early and safe resumption of the renal transplantation program, increasing the number of transplants performed compared to previous years and maintaining comparable early post-operative results

Percutaneous radiofrequency for the treatment of small renal masses: Analysis of outcomes and complications after 10 years of experience. / Radiofrecuencia percutánea en el tratamiento de masas renales pequeñas: análisis de resultados y complicaciones tras diez años de experiencia.

INTRODUCTION AND OBJECTIVE: The management of renal tumors ≤ 4 cm in elderly population or patients with comorbidities is a challenge, for which ablative therapies are an interesting alternative. The objective is to evaluate in our center the role of percutaneous radiofrequency in the treatment of small renal masses, the associated complications and the results obtained. MATERIAL AND METHODS: Retrospective evaluation of the radiofrequency treatments carried out between April 2010 and April 2020 in our center. Demographic data, associated comorbidities, tumor characteristics, complications and oncological and functional outcomes were reviewed. RESULTS: Fifty-seven tumors were treated in 53 patients. Mean follow-up of 48.2 months. The percentage of complete ablations obtained was of 89.5%. There were 19.3% of complications. According to Clavien-Dindo and SIR classification systems, 3.5% and 5.3% were major complications. A statistically significant association was found between the initial result of ablation and age (p = 0.047), RENAL-m (p = 0.044), the presence of cystic component (p = 0.049) and tumor size (p = 0.01). The cut-off point for size was established at 25 mm (p = 0.012). In multivariate analysis, only size remained as a predictor of initial ablation result (p = 0.01; OR 1.183; CI 95% 1.041-1.345). Cancer-specific survival and 5-year recurrence-free survival were 98.1% and 89.5%, respectively. A mean decrease of MDRD-4 of 6.59 mL/min (p = 0.005) was observed in the first six months after RFA. CONCLUSIONS: Given the excellent oncological and functional results demonstrated, ultrasound-guided percutaneous radiofrequency ablation is an effective and safe treatment for small renal masses in selected patients.

Activity and short-term outcomes of kidney transplantation during the COVID-19 pandemic. / Actividad y resultados a corto plazo del trasplante renal durante la pandemia COVID-19.

INTRODUCTION: During the COVID-19 pandemic, the national transplant activity has been reduced due to the overload of the health system and concern for patient safety in this situation. The aim of our work is to expose the activity of kidney transplantation in Cantabria during the state of alarm, as well as to assess the safety of the transplantation program. MATERIAL AND METHODS: Retrospective study of kidney transplants performed in our Center from the beginning of the state of alarm until the beginning of the lockdown easing in Cantabria. Descriptive analysis of the demographic data of recipients and their donors, intraoperative data and postoperative outcomes. Comparative analysis with the data of the same period in 2017-2019, by means of the χ2 for categorical variables, Student's T and Mann-Whitney U tests in case of quantitative variables of normal and non-normal distribution, respectively. RESULTS: Fifteen kidney transplants were performed in the period described. Delayed renal function (DRF) was seen in 7.5% of patients, and 26.6% showed data of acute rejection; no patient presented COVID-19 disease. Comparative analysis showed a remarkable increase in the number of transplants in comparison with previous periods (15 vs 5.6), at the expense of donors from outside Cantabria (93.3%). We found no statistically significant differences in terms of cold ischemia time (p=0.77), DRF (p=0.73), need for dialysis (p=0.54), or appearance of post-surgical complications (p=0.61). CONCLUSIONS: The evolution of the pandemic in our region, and the adoption of strict protective measures has allowed the early and safe resumption of the renal transplantation program, increasing the number of transplants performed compared to previous years and maintaining comparable early post-operative results.

Impacto de la nefrectomía radical en la función renal y factores pronósticos de eventos cardiovasculares adversos / Impact of radical nephrectomy on kidney function and prognostic factors for adverse cardiovascular events

INTRODUCCIÓN Y OBJETIVOS: Analizar la evolución de la función renal tras nefrectomía e investigar la existencia de factores de riesgo de aparición de eventos cardiovasculares adversos (ECVA) durante el seguimiento a largo plazo. MATERIAL Y MÉTODOS: Estudio retrospectivo de los pacientes a los que se realizó una nefrectomía radical por neoplasia renal en nuestro hospital en el periodo comprendido entre enero del 1996 y enero del 2016. Analizamos la función renal posnefrectomía y durante seguimiento a largo plazo. Estudiamos los predictores de ECVA mediante análisis multivariante. RESULTADOS: Se produjo un descenso marcado de la filtración glomerular tras nefrectomía (-21,2ml/min), que posteriormente durante el seguimiento se mantuvo estable en la mayoría de casos. En el análisis de regresión logística, donde valoramos en nuestro grupo de pacientes qué factores se muestran como predictores de la aparición de un evento cardiovascular, la presencia de enfermedad cardiovascular previa (0,270, IC del 95%, 0,123-0,594, p > 0,001), diabetes (0,364, IC del 95%, 0,162-0,818, p = 0,015) e hipertensión arterial de novo (0,239, IC del 95%, 0,098-0,581, p = 0,002) se asociaron de manera independiente con la aparición de ECVA. CONCLUSIÓN: Tras nefrectomía se produce un deterioro de la función renal marcado que se mantiene estable durante los años sucesivos en la mayoría de pacientes. Aproximadamente la mitad de los pacientes presentan una tasa estimada de filtración glomerular menor de 60 ml/min tras la nefrectomía. La presencia de enfermedad cardiovascular previa, diabetes e hipertensión arterial denovo tras nefrectomía fueron factores predictores para la aparición de ECVA tras la cirugía

INTRODUCTION AND OBJECTIVES: To analyze the evolution of kidney function after radical nephrectomy and to evaluate risk factors for adverse cardiovascular events during a long follow-up. MATERIAL AND METHODS: Retrospective study of patients submitted to radical nephrectomy due to renal cancer from January of 1996 to January of 2016. We evaluated their renal function after nephrectomy and during follow-up. We analyzed the possible predictive factors for adverse cardiovascular events with univariate and multivariate logistic regression analyses. RESULTS: There was an acute drop in glomerular filtration rate (GFR) after nephrectomy (21.2 ml/min), which stabilized during follow-up in most cases. We evaluated the possible predictive factors for adverse cardiovascular events with logistic regression analyses, which presented previous cardiovascular disease (0,270, 95% CI 0,123-0,594, P<.001), diabetes (0,364, 95% CI 0,162-0,818 P=.015) and de novo hypertension (0,239, 95% CI 0,098-0,581, P=.002) as independently associated with the occurrence of adverse cardiovascular events. CONCLUSIÓN: There was a deleterious effect in renal function after nephrectomy which remained stable during subsequent years in most patients. Approximately half of our patients had a GFR lower than 60 mL/min after nephrectomy. Previous cardiovascular disease, diabetes and de novo hypertension were shown as risk factors for adverse cardiovascular events

Impact of radical nephrectomy on kidney function and prognostic factors for adverse cardiovascular events. / Impacto de la nefrectomía radical en la función renal y factores pronósticos de eventos cardiovasculares adversos.

INTRODUCTION AND OBJECTIVES: To analyze the evolution of kidney function after radical nephrectomy and to evaluate risk factors for adverse cardiovascular events during a long follow-up. MATERIAL AND METHODS: Retrospective study of patients submitted to radical nephrectomy due to renal cancer from January of 1996 to January of 2016. We evaluated their renal function after nephrectomy and during follow-up. We analyzed the possible predictive factors for adverse cardiovascular events with univariate and multivariate logistic regression analyses. RESULTS: There was an acute drop in glomerular filtration rate (GFR) after nephrectomy (21.2ml/min), which stabilized during follow-up in most cases. We evaluated the possible predictive factors for adverse cardiovascular events with logistic regression analyses, which presented previous cardiovascular disease (0,270, 95% CI 0,123-0,594, P<.001), diabetes (0,364, 95% CI 0,162-0,818 P=.015) and de novo hypertension (0,239, 95% CI 0,098-0,581, P=.002) as independently associated with the occurrence of adverse cardiovascular events. CONCLUSION: There was a deleterious effect in renal function after nephrectomy which remained stable during subsequent years in most patients. Approximately half of our patients had a GFR lower than 60mL/min after nephrectomy. Previous cardiovascular disease, diabetes and de novo hypertension were shown as risk factors for adverse cardiovascular events.

Actividad y resultados a corto plazo del trasplante renal durante la pandemia COVID-19 / Activity and short-term outcomes of kidney transplantation during the COVID-19 pandemic

INTRODUCCIÓN: Durante la pandemia COVID-19, la actividad nacional de trasplante se ha visto reducida por la sobrecarga del sistema sanitario y la preocupación por la seguridad de los pacientes en esta situación. El objetivo de nuestro trabajo es exponer la actividad de trasplante renal en Cantabria durante el estado de alarma, así como valorar la seguridad del programa de trasplante. MATERIAL Y MÉTODOS: Estudio retrospectivo de los trasplantes renales realizados en nuestro Centro desde el inicio del estado de alarma hasta el inicio del desconfinamiento en Cantabria. Análisis descriptivo de los datos demográficos de receptores y sus donantes, datos intraoperatorios y resultados postoperatorios. Análisis comparativo con los datos del mismo periodo de 2017-2019, mediante los estadísticos χ2 para variables categóricas, T-Student y U de Mann-Whitney en caso de variables cuantitativas de distribución normal y no normal, respectivamente. RESULTADOS: Se realizaron 15 trasplantes renales en el periodo descrito. El 7,5% de pacientes presentaron función renal retrasada (FRR); el 26,6% mostró datos de rechazo agudo; ningún paciente presentó enfermedad por COVID-19. En el análisis comparativo, es llamativo el aumento del número de trasplantes frente a periodos anteriores (15 vs. 5,6), a expensas de donantes de fuera de Cantabria (93,3%). No encontramos diferencias estadísticamente significativas en cuanto a tiempo de isquemia fría (p = 0,77), FRR (p = 0,73), necesidad de diálisis (p = 0,54), o aparición de complicaciones posquirúrgicas (p = 0,61). CONCLUSIONES: La evolución de la pandemia en nuestra región y la adopción de medidas de protección rigurosas han permitido reiniciar el programa de trasplante renal de una forma temprana y segura, aumentando el número de trasplantes realizados frente a años anteriores y manteniendo unos resultados postoperatorios tempranos comparables

INTRODUCTION: During the COVID-19 pandemic, the national transplant activity has been reduced due to the overload of the health system and concern for patient safety in this situation. The aim of our work is to expose the activity of kidney transplantation in Cantabria during the state of alarm, as well as to assess the safety of the transplantation program. MATERIAL AND METHODS: Retrospective study of kidney transplants performed in our Center from the beginning of the state of alarm until the beginning of the lockdown easing in Cantabria. Descriptive analysis of the demographic data of recipients and their donors, intraoperative data and postoperative outcomes. Comparative analysis with the data of the same period in 2017-2019, by means of the χ2 for categorical variables, Student's T and Mann-Whitney U tests in case of quantitative variables of normal and non-normal distribution, respectively. RESULTS: Fifteen kidney transplants were performed in the period described. Delayed renal function (DRF) was seen in 7.5% of patients, and 26.6% showed data of acute rejection; no patient presented COVID-19 disease. Comparative analysis showed a remarkable increase in the number of transplants in comparison with previous periods (15 vs 5.6), at the expense of donors from outside Cantabria (93.3%). We found no statistically significant differences in terms of cold ischemia time (p = 0.77), DRF (p = 0.73), need for dialysis (p = 0.54), or appearance of post-surgical complications (p = 0.61). CONCLUSIONS: The evolution of the pandemic in our region, and the adoption of strict protective measures has allowed the early and safe resumption of the renal transplantation program, increasing the number of transplants performed compared to previous years and maintaining comparable early post-operative results

Effect of Cold Ischemia Time on Kidney Graft Function and Survival: Differences Between Paired Kidney Transplants From the Same Donor.

INTRODUCTION: Kidney transplantation procedures commonly result in a cold ischemia time (CIT) gap when both kidney grafts are implanted in the same center. Owing to logistics, the procedure is usually consecutive, first accomplishing one surgery and then the other. CIT constitutes an independent risk factor for the development of delayed graft function (DGF) in kidney transplants. The effect that CIT exerts on graft and patient survival is still unclear. This study evaluates the relation of CIT and transplant outcomes by comparing paired kidney transplants in terms of survival and graft function. METHODS: We accomplished a retrospective analysis of 402 kidney transplants performed in our center between 2000 and 2017. We selected all transplants where both organs from the same donor were implanted at our hospital, establishing 2 study groups (group 1: first graft implanted and group 2: second graft implanted) to compare by paired data statistical methods. RESULTS: We found an increase in the incidence of DGF in group 2 (42% vs 28.8%; P < .05). Group 2 had significantly worse graft function on day 5 posttransplant (4.7 ± 2.88 vs 3.86 ± 2.8 mg/dL of serum creatinine; P < .05). No significant differences in graft function were found on days 30 and 90 posttransplant. We didn't find any difference in graft survival between both groups. Length of hospitalization stay (17.6 days [± 13] vs 21.6 days [± 17]) and hemodialysis sessions (mean of 2.8 [± 2] vs 3.6 [± 2.2]) were higher in group 2. CONCLUSION: CIT acts as an independent risk factor for the development of DGF in kidney transplantation. CIT had no isolated effect on graft survival.

Experiencia inicial con la nueva plataforma de puerto único da Vinci robótico / Initial experience with the new da Vinci single-port robot-assisted platform

Objetivo: Describir nuestra experiencia en los primeros casos de cirugías urológicas realizadas mediante el puerto único robótico da Vinci. Material y métodos: Se realizaron 5 cirugías robóticas por puerto único (R-LESS) entre mayo y octubre de 2014. Se realizaron 3 reimplantes ureterales, una ureteropieloplastia en un riñón invertido y una nefrectomía parcial. Se recogieron los resultados peri- y postoperatorios así como un informe de las complicaciones según la clasificación de Clavien. Resultados: De los 5 procedimientos, 4 se realizaron completamente por LESS, mientras que uno se reconvirtió a cirugía robótica multipuerto. No hubo complicaciones intraoperatorias. Se observaron complicaciones perioperatorias en 4 pacientes, siendo todas de grado 1 o 2. El tiempo operatorio medio fue de 262 min (rango 230-300). Discusión: En nuestra experiencia inicial con el dispositivo da Vinci, la cirugía R-LESS es factible y segura. Persisten algunas limitaciones en su uso, que requieren de nuevas plataformas R-LESS mejoradas

Objective: To describe our experience in the first cases of urological surgeries performed with the da Vinci single-port robot-assisted platform. Material and methods: We performed 5 single-port robot-assisted surgeries (R-LESS) between May and October 2014. We performed 3 ureteral reimplant surgeries, one ureteropyeloplasty in an inverted kidney and 1 partial nephrectomy. The perioperative and postoperative results were collected, as well as a report of the complications according to the Clavien classification system. Results: Of the 5 procedures, 4 were performed completely by LESS, while 1 procedure was reconverted to multiport robot-assisted surgery. There were no intraoperative complications. We observed perioperative complications in 4 patients, all of which were grade 1 or 2. The mean surgical time was 262 minutes (range, 230-300). Discussion: In our initial experience with the da Vinci device, R-LESS surgery was feasible and safe. There are still a number of limitations in its use, which require new and improved R-LESS platforms

Initial experience with the new da Vinci single-port robot-assisted platform. / Experiencia inicial con la nueva plataforma de puerto único da Vinci robótico.

OBJECTIVE: To describe our experience in the first cases of urological surgeries performed with the da Vinci single-port robot-assisted platform. MATERIAL AND METHODS: We performed 5 single-port robot-assisted surgeries (R-LESS) between May and October 2014. We performed 3 ureteral reimplant surgeries, one ureteropyeloplasty in an inverted kidney and 1 partial nephrectomy. The perioperative and postoperative results were collected, as well as a report of the complications according to the Clavien classification system. RESULTS: Of the 5 procedures, 4 were performed completely by LESS, while 1 procedure was reconverted to multiport robot-assisted surgery. There were no intraoperative complications. We observed perioperative complications in 4 patients, all of which were grade 1 or 2. The mean surgical time was 262minutes (range, 230-300). DISCUSSION: In our initial experience with the da Vinci device, R-LESS surgery was feasible and safe. There are still a number of limitations in its use, which require new and improved R-LESS platforms.

La formación del residente de urología en cirugía laparoscópica. Elaboración de un modelo de realidad virtual / Urology residents training in laparoscopic surgery. Develoment of a virtual reality model

Introducción: El entrenamiento y aprendizaje de los residentes en la cirugía laparoscópica tiene limitaciones legales, económicas y tecnológicas. La simulación es una herramienta imprescindible en la formación de los mismos como complemento a su formación en la cirugía laparoscópica. Dicha formación debe estar estructurada en un ambiente adecuado, con objetivos claros determinados previamente, tutelada por profesionales con experiencia en clínica y docencia en simulación y con modelos realísticos, usando tanto animales como tejidos ex-vivo de los mismos. Es imprescindible incorporar mecanismos de evaluación objetivos en el progreso formativo del residente. Objetivo: Presentamos el modelo de entrenamiento en cirugía laparoscópica para los resientes de urología en el Hospital Universitario Valdecilla, que se realiza en el Hospital Virtual Valdecilla, centro asociado al Center for Medical Simulation de Boston y acreditado por el Colegio Americano de Cirujanos. Material y método: El modelo está diseñado en 3 bloques, básico para R1, intermedio para R2-3 y avanzado para R4-5, con 9 módulos a entrenar. El entrenamiento se realiza en programas de 4 h en 4 tardes, a razón de 3 semanas por año de residencia, lo que conlleva que al final de la misma hayan realizado 240 h de formación laparoscópica en simulación. Para cada módulo utilizamos como medida de progresión formativa del residente evaluaciones objetivas estructuradas. Resultados: Desde 2003 se han formado 9 residentes de urología más los 5 que están actualmente en formación. El modelo se ha ido modificando y adecuando según las necesidades que el feedback con los alumnos nos trasmitía. La adquisición de las habilidades en un modelo de realidad virtual ha permitido la transferencia a la práctica real con seguridad. Conclusiones: El diseño de un programa formativo en cirugía laparoscópica, en bloques estructurados y de progresiva complejidad, permite alcanzar una formación adecuada para transferir las habilidades adquiridas mediante este modelo a un escenario real con seguridad para el paciente

Introduction: The training and learning of residents in laparoscopic surgery has legal, financial and technological limitations. Simulation is an essential tool in the training of residents as a supplement to their training in laparoscopic surgery. The training should be structured in an appropriate environment, with previously established and clear objectives, taught by professionals with clinical and teaching experience in simulation. The training should be conducted with realistic models using animals and ex-vivo tissue from animals. It is essential to incorporate mechanisms to assess the objectives during the residents’ training progress. Objective: We present the training model for laparoscopic surgery for urology residents at the University Hospital Valdecilla. The training is conducted at the Virtual Hospital Valdecilla, which is associated with the Center for Medical Simulation in Boston and is accredited by the American College of Surgeons. Material and method: The model is designed in 3 blocks, basic for R1, intermediate for R2-3 and advanced for R4-5, with 9 training modules. The training is conducted in 4-hour sessions for 4 afternoons, for 3 weeks per year of residence. Residents therefore perform 240 hours of simulated laparoscopic training by the end of the course. For each module, we use structured objective assessments to measure each resident's training progress. Results: Since 2003, 9 urology residents have been trained, in addition to the 5 who are currently in training. The model has undergone changes according to the needs expressed in the student feedback. The acquisition of skills in a virtual reality model has enabled the safe transfer of those skills to actual practice. Conclusions: A laparoscopic surgery training program designed in structured blocks and with progressive complexity provides appropriate training for transferring the skills acquired using this model to an actual scenario while maintaining patient safety

Urology residents training in laparoscopic surgery. Development of a virtual reality model.

INTRODUCTION: The training and learning of residents in laparoscopic surgery has legal, financial and technological limitations. Simulation is an essential tool in the training of residents as a supplement to their training in laparoscopic surgery. The training should be structured in an appropriate environment, with previously established and clear objectives, taught by professionals with clinical and teaching experience in simulation. The training should be conducted with realistic models using animals and ex-vivo tissue from animals. It is essential to incorporate mechanisms to assess the objectives during the residents' training progress. OBJECTIVE: We present the training model for laparoscopic surgery for urology residents at the University Hospital Valdecilla. The training is conducted at the Virtual Hospital Valdecilla, which is associated with the Center for Medical Simulation in Boston and is accredited by the American College of Surgeons. MATERIAL AND METHOD: The model is designed in 3 blocks, basic for R1, intermediate for R2-3 and advanced for R4-5, with 9 training modules. The training is conducted in 4-hour sessions for 4 afternoons, for 3 weeks per year of residence. Residents therefore perform 240 hours of simulated laparoscopic training by the end of the course. For each module, we use structured objective assessments to measure each resident's training progress. RESULTS: Since 2003, 9 urology residents have been trained, in addition to the 5 who are currently in training. The model has undergone changes according to the needs expressed in the student feedback. The acquisition of skills in a virtual reality model has enabled the safe transfer of those skills to actual practice. CONCLUSIONS: A laparoscopic surgery training program designed in structured blocks and with progressive complexity provides appropriate training for transferring the skills acquired using this model to an actual scenario while maintaining patient safety.

Reparación de fístula urinaria en injerto renal mediante nefrectomía parcial y omentoplastia / Urinary Fistula Repair in a Renal Graft Throught a Partial Nephrectomy and Omentoplasty

Objetivos: Presentar el manejo mediante nefrectomía parcial e interposición del epiplón en casos de fístula urinaria en pacientes receptores de trasplante renal. Material y método: Presentamos un paciente con necrosis del polo inferior del injerto renal que afecta al sistema calicial, pero con la vascularización pieloureteral conservada, manejado de manera satisfactoria mediante nefrectomía parcial del segmento renal necrótico y sutura primaria del sistema colector con interposición del epiplón mayor. Realizamos una revisión de los casos de nefrectomía parcial en injerto renal descritos, analizando sus características y destacando la forma de presentación, los métodos diagnósticos, así como las técnicas quirúrgicas empleadas y sus resultados posteriores. Resultados: Existen pocos casos en la literatura contemporánea que describan un manejo quirúrgico conservador de las fístulas urinarias por necrosis segmentaria tras un injerto renal. El abordaje mediante nefrectomía parcial en estos casos presenta buen resultado en nuestra experiencia y en los casos descritos. Conclusiones: El manejo conservador de nefronas es factible y debería aplicarse en casos en los que la función renal previa y la cantidad de parénquima sano indiquen una correcta evolución posterior del injerto renal, a pesar de la evidente complejidad quirúrgica (AU)

Objectives: We present the management with partial nephrectomy and interposition of the greater omentum in case of urinary fistulas in renal allograft. Material and method: We present a patient with necrosis at the inferior pole of the renal graft that affected calyceal system but with pyeloureteral vascularization preserved. The patient’s condition was satisfactorily managed with a partial nephrectomy of the necrotic renal segment and primary suturing of the collecting system with interposition of the greater omentum. Were viewed the cases published to date of partial nephrectomy in renal allograft, and examined their outcomes by analyzing the patient presentation, diagnostic tools, and surgical techniques used. Results: There are few cases in the current literature that describe conservative surgical management of urinary fistulas caused by segmental necrosis after renal transplantation. Surgical approach using partial nephrectomy in these cases produces favorable outcomes in our experience and reported cases. Conclusions: Despite its obvious surgical complexity, this nephron-sparing management is feasible and should be implemented in cases where the prior renal function and the quantity of healthy parenchyma indicate a favorable subsequent evolution for the renal graft (AU)

Urinary fistula repair in a renal graft through a partial nephrectomy and omentoplasty.

OBJECTIVES: We present the management with partial nephrectomy and interposition of the greater omentum in case of urinary fistulas in renal allograft. MATERIAL AND METHOD: We present a patient with necrosis at the inferior pole of the renal graft that affected calyceal system but with pyeloureteral vascularization preserved. The patient's condition was satisfactorily managed with a partial nephrectomy of the necrotic renal segment and primary suturing of the collecting system with interposition of the greater omentum. We reviewed the cases published to date of partial nephrectomy in renal allograft, and examined their outcomes by analyzing the patient presentation, diagnostic tools, and surgical techniques used. RESULTS: There are few cases in the current literature that describe conservative surgical management of urinary fistulas caused by segmental necrosis after renal transplantation. Surgical approach using partial nephrectomy in these cases produces favorable outcomes in our experience and reported cases. CONCLUSIONS: Despite its obvious surgical complexity, this nephron-sparing management is feasible and should be implemented in cases where the prior renal function and the quantity of healthy parenchyma indicate a favorable subsequent evolution for the renal graft.

Hemangioma del labio superior tratado con éxito con propranolol / Hemangioma of the upper lip treated successfully with propranolol

Los hemangiomas son los tumores benignos más frecuentes de la infancia, suelen localizarse en cabeza y tronco, y en la mayoría de los casos tienden a involucionar espontáneamente. Los hemangiomas labiales tienen mayor riesgo de producir deformidades, cicatrices residuales o ulceraciones. Una minoría de casos, bien por su tamaño, su ubicación o su evolución complicada, requieren tratamiento, empleándose tradicionalmente corticoides orales. En los últimos años han aparecido casos tratados con propranolol oral con excelentes resultados. Presentamos un lactante varón de tres meses, sin antecedentes de interés, que presentaba un hemangioma en el labio superior que le dificultaba la succión y le provocaba una deformidad estética. Tras descartar patología asociada, a los cuatro meses comenzó tratamiento ambulatorio con propranolol oral en dosis inicial de 1,5 mg/kg/día, con buenos resultados y sin complicaciones. La evolución fue satisfactoria, disminuyendo el tamaño y el color de la lesión. Consideramos que el propranolol es una opción terapéutica eficaz y segura, y aunque son necesarios estudios clínicos amplios en los que el mecanismo de acción, la dosis y la duración del tratamiento queden aclarados, queremos destacar la figura del pediatra de Atención Primaria en la detección de posibles efectos adversos, en el seguimiento del paciente y en el apoyo a la familia (AU)

Hemangiomas are the most common benign tumours in childhood, usually located in the head and neck, and most of them suffer a spontaneous regression. Lip hemangiomas have a higher risk of causing deformities, residual scarring or ulceration. A minority of cases, either because of size, location or their complicated evolution, require therapy, traditionally using oral corticosteroids. In recent years, excellent results have been obtained in cases treated with oral propranolol. We present the case of a 3-month-old male infant, with no history of interest, who had a hemangioma in his upper lip that made suction difficult and produced an aesthetic deformity. After ruling out associated pathology, at the age of 4 months our patient began outpatient treatment with oral propranolol with an initial dose of 1.5 mg/kg/day, with good results and without complications. The evolution was satisfactory, and the size and colour of the injury were reduced. We believe that propranolol is an effective and safe therapeutic option, and although comprehensive clinical studies are needed in which the mechanism of action, dosage and duration of treatment are clarified, we would like to highlight the important role of the primary care pediatrician in the detection of possible adverse effects, in patient monitoring, and in family support (AU)