Modelo impreso en 3D para entrenamiento en ureteroscopia flexible, una opción de bajo coste para el entrenamiento quirúrgico / 3D printed model for flexible ureteroscopy training, a low-cost option for surgical training

Introducción La práctica en modelos experimentales es una opción válida que mejora los resultados y acorta las curvas de aprendizaje de las técnicas quirúrgicas.Nuestro objetivo fue desarrollar un modelo en plástico, impreso en 3D para la docencia, el entrenamiento y la formación en ureteroscopia flexible, analizando costes e idoneidad para la práctica de esta técnica quirúrgica.Métodos Se elaboró un modelo impreso en 3D a partir de una tomografía axial computarizada de una vía urinaria superior de un paciente real. La segmentación se llevó a cabo mediante el software HorosTM y la impresión mediante una impresora FDM-Ultimaker.Se numeró los cálices renales para ser identificados, como en el plan de formación de tratamiento endoscópico de litiasis, ejercicio 4, de la Asociación Europea de Urología.Se utilizaron: un ureteroscopio flexible desechable Innovex (Palex) y cestillas de nitinol (Coloplast).Resultados El tiempo de impresión fue de 19h, con un coste total de 8,77€.El modelo tridimensional permitió la introducción del ureteroscopio flexible y la exploración de los cálices renales por parte de urólogos tanto en formación como en ejercicio actual de la especialidad sin dificultad.El modelo también permitió la utilización de cestillas y la movilización y extracción de litiasis previamente colocadas.Conclusión Damos a conocer un modelo tridimensional válido para ejercicios de formación en ureteroscopia flexible con unos costes razonables, que permitirá adquirir la destreza y la confianza necesaria para iniciar el procedimiento en un escenario real (AU)

Introduction Training in experimental models is a valid option that improves the outcomes and shortens surgical learning curves.Our objective was to develop a 3D printed plastic model for teaching, training and education in flexible ureteroscopy, analyzing costs and suitability for the practice of this surgical technique.Methods A 3D printed model was developed based on a CT scan from a real-life patient's upper urinary tract. HorosTM software was used for segmentation and an FDM-Ultimaker for 3D printing.Renal calyces were numbered to be identified, as in the European Association of Urology Endoscopic Stone Treatment training curriculum, Task 4.The following were used: Innovex single-use flexible ureteroscope (Palex) and nitinol baskets (Coloplast).Results Printing time was 19hours, with a total cost of €8.77.The three-dimensional model allowed the insertion of the flexible ureteroscope and the exploration of the renal calyces by urologists in training as well as in current practice of the specialty without difficulty.The model also allowed the use of baskets and the mobilization and removal of previously placed stones.Conclusion We unveil a valid three-dimensional model for flexible ureteroscopy training exercises with reasonable costs, which will allow acquiring the necessary skills and confidence to initiate the procedure in a real-life scenario (AU)

3D printed model for flexible ureteroscopy training, a low-cost option for surgical training.

INTRODUCTION: Training in experimental models is a valid option that improves the outcomes and shortens surgical learning curves. Our objective was to develop a 3D printed plastic model for teaching, training and education in flexible ureteroscopy, analyzing costs and suitability for the practice of this surgical technique. METHODS: A 3D printed model was developed based on a CT scan from a real-life patient's upper urinary tract. Horos™ software was used for segmentation and an FDM-Ultimaker for 3D printing. Renal calyces were numbered to be identified, as in the European Association of Urology Endoscopic Stone Treatment training curriculum, Task 4. The following were used: Innovex single-use flexible ureteroscope (Palex) and nitinol baskets (Coloplast). RESULTS: Printing time was 19 h, with a total cost of €8.77. The three-dimensional model allowed the insertion of the flexible ureteroscope and the exploration of the renal calyces by urologists in training as well as in current practice of the specialty without difficulty. The model also allowed the use of baskets and the mobilization and removal of previously placed stones. CONCLUSION: We unveil a valid three-dimensional model for flexible ureteroscopy training exercises with reasonable costs, which will allow acquiring the necessary skills and confidence to initiate the procedure in a real-life scenario.

Evaluation of teleconsultation system in the urological patient during the COVID-19 pandemic. / Evaluación de la teleconsulta en el paciente urológico durante la pandemia COVID-19.

INTRODUCTION: The global pandemic of COVID-19 has led to rapid implementation of telemedicine, but there is little information on patient satisfaction of this system as an alternative to face-to-face care. OBJECTIVE: To evaluate urological patient satisfaction with teleconsultation during the COVID-19 pandemic. MATERIAL AND METHODS: Observational, prospective, cross-sectional, non-interventional study carried out by telephone survey during the period considered as the peak of the pandemic (March-April 2020). A quality survey composed of 11 questions on urological care provided by physicians during the COVID-19 pandemic was conducted, selecting a representative sample of patients attended by teleconsultation. RESULTS: Two hundred patients were contacted by telephone to answer a survey on the quality of teleconsultation. The distribution of patients surveyed among the specialized consultations was homogeneous with the number of consultations cited in the period; 18% of them required assistance from family members. Sixty percent of patients avoided going to a medical center during the pandemic. Of the surveyed patients, 42% had cancelled diagnostic tests, 59% had cancelled medical consultations, 3.5% had cancelled treatments and 1% had cancelled interventions. Ten percent reported a worsening of urological symptoms during confinement. According to physicians, consultations were effectively delivered in 72% of cases, with teleconsultation being carried out by their usual urologist in 81%. Teleconsultation overall satisfaction level was 9 (IQI8-10), and 61.5% of respondents consider teleconsultation as a «health care option¼ after the healthcare crisis. CONCLUSION: Teleconsultation has been evaluated with a high level of satisfaction during the COVID-19 pandemic, offering continuous care to urological patients during the healthcare crisis. The perceived quality offers a field of optional telematic assistance in selected patients, which should be re-evaluated in a period without confinement measures.

[RIGHT VARICOCELE AS FINDING OF RIGHT RENAL MASS]. / VARICOCELE DERECHO COMO PRESENTACIÓN DE MASA RENAL DERECHA.

Abdominal and scrotal ultrasounds were requested and, in order of the findings watched they were complemented with an abdominal contrast enhanced CT scan (CECT). The CETC demonstrated a large right renal tumor sized 12 cm located in the upper pole of the right kidney, in contact with hepatic parenchyma (Figure 1). Renal vein and artery were not affected. Important peritumoral collateral circulation was noticed. Consequently to the large tumor size and extrinsic compression, there was dilatation of right spermatic vein. Both Collateral circulation and right spermatic dilated vein converged in the inguinal duct explaining the presence of right varicocele. The image was 3D reconstructed.

Giant retroperitoneal sarcoma: case report.

OBJECTIVE: To report a new case of giant retroperitoneal mass with silent beginning. METHODS: We present the case of a 36 year old man with a giant retroperitoneal liposarcoma 35 × 15 cm in size. The only symptom was a one month history of minimal abdominal pain. CONCLUSION: Liposarcoma is the most frequent retroperitoneal mass. In most of the cases clinical symptoms are silent, being this the reason why diagnosis is late and the size is large. The best image options are CT scan or MRI but final diagnosis is based on pathology results. Its treatment is surgery and relapse is very usual.