Case Report: Mini-endoscopic combined intrarenal surgery in an en-bloc kidney transplant.

BACKGROUND: Overall incidence of stones in kidney transplant recipients is 1%. En-bloc kidney transplant is a rare anatomical condition in which kidney stones treatment can be extremely difficult to treat. As far as we know, no cases of staghorn calculi in en-bloc kidney transplant have been published so far. CASE PRESENTATION: A 27-year-old woman presented to the Emergency Department because of asthenia, adynamia and weight loss associated with lower urinary tract symptoms and subfebrile temperature. Ten years before, she had undergone an en-bloc kidney transplant because of end-stage renal disease secondary to perinatal asphyxia syndrome. One kidney was implanted capo-volta in the right iliac fossa and the other one in the right flank. NCCT scan showed incomplete staghorn calculi in the iliac fossa transplanted kidney. Besides, severe dilation of the native and the right flank transplanted kidney, due to two ureteral stones of 6 and 7 mm impacted in the uretero-ureteral anastomosis, was found. After hospital admission and under ceftriaxone prophylaxis, an attempt to perform primary RIRS following our COVID protocol was carried out. Nevertheless, we ended up placing a JJ stent because once the guidewire passed through the ureteral stones, purulent material came out from the ureteral orifice. She stayed 9 days in-hospital for management of postobstructive polyuria and was discharged with oral antibiotics. Three weeks afterward, we removed the stent and performed flexible ureteroscopy and holmium laser lithotripsy of the ureteral stones. In the same procedure, we performed Mini-ECIRS (21 French) previous ultrasound-guided upper pole puncture. Postoperative NCCT scan showed neither residual fragments nor operative complications. CONCLUSION: This is the first clinical case reporting Mini-ECIRS in a patient with an en-bloc kidney transplant. This endourological approach seems to be a feasible, safe and effective approach to treat stones in this anatomically challenging condition.

Global Survey of the Roles and Attitudes Toward Social Media Platforms Amongst Urology Trainees.

OBJECTIVES: To perform a global survey assessing the role of and the attitudes toward media platforms amongst training Urologists METHODS: We distributed a 21-item online survey on social medial (SoMe) and other media platforms to current Urology trainees by email via individual institutions and multiple Urological associations. The survey acquired data including baseline characteristics, the role of and attitudes toward SoMe and other media platforms in training and assessed the prevalence of Social Media Disorder (SMD) based on the validated 9-item SMD Scale. Stata IC was used for statistical analysis. RESULTS: Three hundred and seventy-two urology trainees in 6 continents participated in the survey. Overall, 99.4% used SoMe and 27.3% listened to healthcare-focused podcasts. Most trainees (85.5%) are using guideline apps for education purposes, with the top 3 most utilized apps being the EAU, AUA, and UpToDate applications. There was mixed sentiment regarding the impact of SoMe on the patient-physician relationship, wherein most felt it challenges the doctor's authority (56.7%) but also empowers the patient (62.7%) and encourages shared-care (57.3%). Unfortunately, 11.3% of urology trainees met criteria for SMD while 65.4% had not reviewed professional guidelines on appropriate SoMe use. CONCLUSION: Despite practically all urology trainees using SoMe and guideline applications, the majority of trainees have not reviewed or have been educated on professional guidelines for SoMe usage. There is a small but significant number of trainees who are at risk for SMD which may be contributing to higher rates of physician burnout amongst urologists.

Telemedicine Usage Among Urologists During the COVID-19 Pandemic: Cross-Sectional Study.

BACKGROUND: Prior to the COVID-19 pandemic, urology was one of the specialties with the lowest rates of telemedicine and videoconferencing use. Common barriers to the implementation of telemedicine included a lack of technological literacy, concerns with reimbursement, and resistance to changes in the workplace. In response to the COVID-19 pandemic declared in March 2020, the delivery of urological services globally has quickly shifted to telemedicine to account for the mass clinical, procedural, and operative cancellations, inadequate personal protective equipment, and shortage of personnel. OBJECTIVE: The aim of this study was to investigate current telemedicine usage by urologists, urologists' perceptions on the necessity of in-person clinic appointments, the usability of telemedicine, and the current barriers to its implementation. METHODS: We conducted a global, cross-sectional, web-based survey to investigate the use of telemedicine before and after the COVID-19 pandemic. Urologists' perceived usability of telemedicine was assessed using a modified Delphi approach to create questions based on a modified version of the validated Telehealth Usability Questionnaire (TUQ). For the purposes of this study, telemedicine was defined as video calls only. RESULTS: A total of 620 urologists from 58 different countries and 6 continents participated in the survey. Prior to COVID-19, 15.8% (n=98) of urologists surveyed were using telemedicine in their clinical practices; during the pandemic, that proportion increased to 46.1% (n=283). Of the urologists without telemedicine experience, interest in telemedicine usage increased from 43.7% (n=139) to 80.8% (n=257) during the COVID-19 pandemic. Among urologists that used telemedicine during the pandemic, 80.9% (n=244) were interested in continuing to use it in their practice. The three most commonly used platforms were Zoom, Doxy.me, and Epic, and the top three barriers to implementing telemedicine were patients' lack of technological comprehension, patients' lack of access to the required technology, and reimbursement concerns. CONCLUSIONS: This is the first study to quantify the use, usability, and pervading interest in telemedicine among urologists during the COVID-19 pandemic. In the face of this pandemic, urologists' usage of telemedicine nearly tripled, demonstrating their ability to adopt and adapt telemedicine into their practices, but barriers involving the technology itself are still preventing many from utilizing it despite increasing interest.

Oncocitomas: hallazgos tomográficos y correlación anatomopatológica / Oncocytomas: Imaging Findings and Anatomopathology Correlation

Introducción: En imágenes, los hallazgos del oncocitoma generalmente coinciden con el carcinoma de células renales (CCR) por lo que resulta muy poco segura su discriminación mediante imágenes. Objetivos: Evaluar el comportamiento de una muestra de oncocitoma en tomografía (TC). Métodos: Se seleccionaron retrospectivamente los pacientes con cirugía de tumor renal y diagnóstico anatomopatológico de oncocitoma, que fueron tratados entre enero de 2015 y diciembre de 2017. Se incluyeron los pacientes a quienes se les realizó TC con medio de contraste endovenoso en nuestra institución. Resultados: Del total de pacientes (n = 44), 43 tenían una lesión única renal, mientras que uno tenía tres lesiones. Del total de las lesiones (n = 47), 20 (42,55 %) fueron diagnosticadas tras una nefrectomía radical y 24 (51,10 %) fueron diagnosticadas por una nefrectomía parcial. La media de diámetro máximo fue de 36,5 mm (RIQ 22-44,25), de los cuales se agruparon en menores y mayores a 4 cm; se encontraron 22 tumores en este último grupo (47 %). De estos, en 15 tumores (31,91 %) que tenían más de 4 cm se encontró la cicatriz central. Se evidenciaron calcificaciones en 3 pacientes (6,8 %). Se encontró 1 tumor (2,1 %) con inversión de realce segmentario luego de la administración medio de contraste endovenoso. En este caso, el oncocitoma era menor a 4 cm. Conclusión: El hallazgo de una masa sólida con realce más intenso que el parénquima circundante durante la fase nefrográfica obliga a considerar al oncocitoma entre los diagnósticos diferenciales

Introduction: The imaging findings of oncocytomas usually coincide with renal cell carcinoma (RCC), which makes it difficult to discriminate them in imaging. Objective: To evaluate the imaging findings of a sample of oncocytomas in tomography (CT). Methods: We retrospectively selected patients with renal tumor surgery and oncocytoma anatomopathological diagnosis, who were treated between January 2015 and December 2017. Patients who underwent CT with intravenous contrast at our institution were included. Results: Of the total number of patients (n = 44), 43 had a single renal lesion while one patient presented 3 lesions. Of the total lesions (n = 47), 20 (42.55%) were diagnosed after a radical nephrectomy and 24 (51.10%) were diagnosed by a partial nephrectomy. The mean maximum diameter was 36.5 mm (RIQ 22-44, 25), of which they were grouped by tumor length into smaller or larger than 4 cm, with 22 tumors in this last group (47%). Of these, 15 tumors (31.91 %) that were larger than 4 cm had a central scar. Calcifications were evident in 3 patients (6.8 %). One tumor (2.1%) was found with the presence of inversion of segmental enhancement after administration of intravenous contrast. In this case, the oncocytoma was less than 4 cm. Conclusion: The finding of a solid mass with more enhancement than the surrounding parenchyma during the nephrographic phase makes it necessary to consider oncocytoma among the differential diagnoses

Resultados del trasplante renal con donante vivo: análisis comparativo entre arteria renal única y múltiple / Outcome in Living Donor Kidney Transplant: Comparative Análisis of Single and Multiple Renal Arteries

Objetivos: Realizar un análisis comparativo de los resultados funcionales y complicaciones en trasplantados renales y sus respectivos donantes vivos con arteria renal única versus múltiple. Materiales y métodos: Trabajo retrospectivo analítico de una base de datos confeccionada prospectivamente de pacientes sometidos a trasplantes renales con donante vivo en nuestra institución entre mayo de 2010 y julio de 2014. Según el número de arterias presentes en la angiotomografía preoperatoria se confeccionaron dos grupos: grupo 1 (arteria renal única) y grupo 2 (arteria renal múltiple). Resultados: De los 91 pacientes incluidos, el 37% (n=34) presentaba arterias renales múltiples. Se realizó una nefrectomía laparoscópica al 63% (n=36) y el 41% (n=14) de los donantes del grupo 1 y el grupo 2, respectivamente (p=0,05). Tiempos promedio de isquemia total (grupo 1: 55,6 min; grupo 2: 56 min; p=0,931), de anastomosis (grupo 1: 29,6 min; grupo 2: 29,7 min; p=0,982) y de "cirugía de banco" (grupo 1: 23,5 min; grupo 2: 23,8 min; p=0,948). Transfusión de glóbulos rojos en los receptores (grupo 1: 7%; grupo 2: 14%; p=0,23). Porcentaje de hemodiálisis en la primera semana (grupo 1: 5,2%; grupo 2: 5,8%; p=1). No se hallaron diferencias significativas entre grupos a nivel de tasa de complicaciones y días de internación. Ambos grupos presentaron una sobrevida del injerto del 100% a los 35,6 meses de seguimiento promedio. Conclusiones: La presencia de multiplicidad arterial no debe ser considerada una contraindicación para el donante vivo, ya que el implante de estos injertos logra resultados funcionales similares a los injertos renales con arteria única, sin aumentar la morbilidad del procedimiento. (AU)

Objectives: TTo compare functional outcomes and complications in patients with a single artery versus multiple arteries undergoing living donor nephrectomy. Materials and methods: Retrospective analysis of a prospective collected database of living donor kidney transplantations performed at our institution between May 2010 and July 2014. According to the number of arteries present in preoperative angiotomography, two groups of patients were organized: group 1 (single artery) and group 2 (multiple arteries). Results: TNinety-one living donor kidney transplantations were performed during this period. A total of 34 patients (37%) had multiple renal arteries. Mean total ischemia time (single: 55.6 min; multiple: 56 min; p=0.931), anastomosis time (single: 29.6 min; multiple: 29.7 min; p=0.982), bench surgery time (single: 23.5 min; multiple: 23.8 min; p=0.948). Blood transfusion rate was 7% and 14% for group 1 and group 2, respectively (p=0.23). Three patients in group 1 (5.2%) and two patients in group 2 (5.8%) needed dialysis during the first postoperative week (p=1). Overall, recipient complication rate and hospital stay were similar between group 1 and 2. Both groups had a 100% graft survival with a mean follow-up of 35.6 months. Conclusions: The presence of multiple renal arteries should not be considered a contraindication for the living donor nephrectomy, since these grafts achieve similar functional results to single artery renal grafts, without increasing the morbidity of the procedure. (AU)

Técnica de ablación rápida en el transplante ortotópico del higado en el cerdo / Techinic of rapid ablation in the orthopic liver transplentation in pig

Se describen detalladamente la técnica de ablación rápida del hígado en el cerdo, llevada a cabo en 14 de 30 trasplante ortotópicos del hígado; se lograron implantar 13 hígados con resultados similares a los observados cuando se utilizó la técnica clásica. A pesar d elos incovenientes del método (mayor requerimento de líquidos, menor volumen de sangre recuperado y mayor tiempo de isquemia hepática), se consiguen 2 ventajas significativas: lograr la ablación independientemente del estado hemodinámico del donante, y en menor tiempo

Técnica de ablación rápida en el transplante ortotópico del higado en el cerdo / Techinic of rapid ablation in the orthopic liver transplentation in pig

Se describen detalladamente la técnica de ablación rápida del hígado en el cerdo, llevada a cabo en 14 de 30 trasplante ortotópicos del hígado; se lograron implantar 13 hígados con resultados similares a los observados cuando se utilizó la técnica clásica. A pesar d elos incovenientes del método (mayor requerimento de líquidos, menor volumen de sangre recuperado y mayor tiempo de isquemia hepática), se consiguen 2 ventajas significativas: lograr la ablación independientemente del estado hemodinámico del donante, y en menor tiempo (AU)

Cirugía paliativa en el cáncer gástrico / Palliative surgery in gastric cancer

Sonbre un total de 329 tumores diagnosticados se comentan 98 casos (29,7%) de cáncer gástrico en los que no se pudo realizar cirugía radical. Aproximadamente a la mitad (51 pacientes, 15,5%) se les realizó cirugía paliativa y a los 47 restantes (14,2%) sólo laparotomías exploradoras. Se discuten las ventajas y los incovenientes observados en ambos grupos, recomendando un manejo quirúrgico prudente de estos pacientes en razón de las cifras de morbimortalidad observadas

Cirugía paliativa en el cáncer gástrico / Palliative surgery in gastric cancer

Sonbre un total de 329 tumores diagnosticados se comentan 98 casos (29,7%) de cáncer gástrico en los que no se pudo realizar cirugía radical. Aproximadamente a la mitad (51 pacientes, 15,5%) se les realizó cirugía paliativa y a los 47 restantes (14,2%) sólo laparotomías exploradoras. Se discuten las ventajas y los incovenientes observados en ambos grupos, recomendando un manejo quirúrgico prudente de estos pacientes en razón de las cifras de morbimortalidad observadas (AU)