Development and assessment of an ex-vivo bench model aimed at laparoscopic ureteric reconstructive techniques.

INTRODUCTION/BACKGROUND: Reconstructive and ablative urologic techniques require special technical mastery, especially the intracorporeal suturing. OBJECTIVE: To report the subjective evaluation of a versatile ex-vivo model aimed to practice laparoscopic ureteric reconstructive techniques (LURT) on box-trainer. STUDY DESIGN: The model is a continuous portion of porcine urinary bladder ("dilated pelvis"), the vesico-ureteral joint ("stenosis") and healthy ureter. All 127 participants (n = 119 urologists and n = 8 paediatric surgeons) performed on the model laparoscopic Anderson-Hynes dismembered pyeloplasty, and then, in the animal model, different LURT procedures (ureteroneocystostomy, ureteric reimplantation and/or dismembered pyeloplasty). The model was subjectively evaluated (face and content validity), through a 12 items questionnaire, based on a Likert scale (1-5 points) and a global question (1-10 points). RESULTS: The total mean rating for 11/12 items was very high (>4points). Only one was rated under 3 points. The overall total mean rating from 1 to 10 points was very high (9.19 ± 0.82 points). In 10/12 items, expert's feedback (content validity) prevailed over non-experts (face validity). DISCUSSION/CONCLUSION: The model was highly accepted for the practice of LURT techniques. Additionally, it is cost-effective, easy to assemble, ethically considerate, and realistic.

Actividad médico-quirúrgica y estado actual de la formación de los residentes de urología en España: Resultados de una encuesta nacional / Medical-surgical activity and the current state of training of urology residents in Spain: Results of a national survey

Objetivos: Conocer el estado actual de la actividad médico-quirúrgica y de la formación de los residentes de urología en España. Material y método: Se diseñaron 2 encuestas anónimas y fueron cargadas en la herramienta Google Docs© para ser contestadas vía online. El periodo de recolección online fue de septiembre de 2015-enero de 2016. Los datos recolectados fueron procesados utilizando el programa estadístico IBM SPSS para Windows, Versión 21.0 y el programa R versión 3.2.3. Resultados: El número de total de respondedores fue de 163. En referencia al número de guardias de presencia física la mayoría de los residentes realizan entre 4 y 6 guardias al mes. Ochenta y cuatro de los encuestados refieren estar menos de 20 horas semanales en quirófano y 43 de estos incluso menos de 10 horas. El 30% de los encuestados no ha realizado ninguna resección transuretral, la mayoría ha realizado al menos una adenomectomía prostática, pero a su vez no ha realizado ningún procedimiento oncológico mayor, ya sea por vía laparoscópica o abierta. En las preguntas destinadas a entrenamiento y cursos de formación encontramos que la mayoría de los residentes entrena laparoscopia en el hospital o en casa. La satisfacción global de la residencia fue valorada en 2,6. En este sentido podría considerarse la satisfacción global como moderada. Conclusiones: Se deberían orientar esfuerzos para estandarizar la adquisición de habilidades quirúrgicas y no quirúrgicas, garantizar el acceso a cursos de formación, establecer un mínimo de intervenciones requeridas por año y lograr una evaluación objetiva de la especialidad

Objectives: To determine the actual state of medical-surgical activity and training for urology residents in Spain. Material and method: We designed 2 anonymous surveys, which were uploaded with the Google Docs© tool so that the respondents could answer the surveys online. The online collection period was September 2015 to January 2016. The collected data were processing using the statistical programme IBM SPSS for Windows, Version 21.0 and the programme R version 3.2.3. Results: The total number of responders was 163. In reference to the number of physically present on-call residents, the majority conducted between 4 and 6 shifts a month. Eighty-four of those surveyed indicated that they were in the operating room less than 20hours a week, and 43 of these even less than 10hours. Thirty percent of those surveyed had not performed any transurethral resection. The majority had performed at least one prostatic adenomectomy, but had not performed any major oncologic procedure, either laparoscopically or openly. In the questions concerning training and training courses, we found that most of the residents trained in laparoscopy at the hospital or at home. The overall satisfaction for the residence was assessed at 2.6. Based on this score, the overall satisfaction could be considered moderate. Conclusions: Efforts should be directed towards standardising the acquisition of surgical and nonsurgical skills, ensuring access to training courses, establishing a minimum of required operations per year and achieving an objective assessment of the specialty

Medical-surgical activity and the current state of training of urology residents in Spain: Results of a national survey. / Actividad médico-quirúrgica y estado actual de la formación de los residentes de urología en España: Resultados de una encuesta nacional.

OBJECTIVES: To determine the actual state of medical-surgical activity and training for urology residents in Spain. MATERIAL AND METHOD: We designed 2 anonymous surveys, which were uploaded with the Google Docs© tool so that the respondents could answer the surveys online. The online collection period was September 2015 to January 2016. The collected data were processing using the statistical programme IBM SPSS for Windows, Version 21.0 and the programme R version 3.2.3. RESULTS: The total number of responders was 163. In reference to the number of physically present on-call residents, the majority conducted between 4 and 6 shifts a month. Eighty-four of those surveyed indicated that they were in the operating room less than 20hours a week, and 43 of these even less than 10hours. Thirty percent of those surveyed had not performed any transurethral resection. The majority had performed at least one prostatic adenomectomy, but had not performed any major oncologic procedure, either laparoscopically or openly. In the questions concerning training and training courses, we found that most of the residents trained in laparoscopy at the hospital or at home. The overall satisfaction for the residence was assessed at 2.6. Based on this score, the overall satisfaction could be considered moderate. CONCLUSIONS: Efforts should be directed towards standardising the acquisition of surgical and nonsurgical skills, ensuring access to training courses, establishing a minimum of required operations per year and achieving an objective assessment of the specialty.

La evaluación de competencias quirúrgicas como complemento al método formativo. Revisión / The assessment of surgical skills as a complement to the training method. Revision

Contexto y objetivo: La adquisición y mejora de las habilidades quirúrgicas son un elemento fundamental en la formación de cualquier profesional. Si bien, la propia evaluación de estas constituye, por ahora, un campo con escaso desarrollado. El objetivo de este trabajo es analizar las particularidades de los diferentes sistemas de evaluación y establecer los criterios mínimos que debe reunir un sistema de evaluación de habilidades y conocimientos, como método de evaluación de competencias quirúrgicas en cirugía urológica. Adquisición de evidencias: Revisión de la literatura científica orientada a los diferentes sistemas de evaluación de habilidades y competencias, técnicas y no técnicas, disponibles en la actualidad, con especial atención a las revisiones sistemáticas realizadas y a los estudios prospectivos. Síntesis de evidencias: Tras la revisión efectuada, encontramos que los diferentes sistemas de evaluación de competencias quirúrgicas presentan, a nuestro juicio, una serie de carencias: existe cierto grado de subjetividad en la evaluación de un cirujano por parte del evaluador; no se recoge formalmente la evaluación de competencias no técnicas.; no se describe un seguimiento de la evaluación ni unos parámetros básicos asociados a calidad sanitaria y no existe un registro de competencias asociadas a las diferentes técnicas quirúrgicas, como tampoco se describe la graduación de las mismas y las particularidades específicas para su aplicación. Conclusiones: Entendemos necesario el desarrollo de un nuevo sistema de evaluación de competencias quirúrgicas, técnicas y no técnicas, orientado a la evaluación de urólogos en diferentes técnicas quirúrgicas. Para ello, nuestro equipo ha trabajado en el desarrollo del sistema Evaluation System for Surgical Competencies on Laparoscopy, fundamentado en la definición, graduación y evaluación de aquellas competencias que demuestra un cirujano

Context and objective: The acquisition and improvement of surgical skills constitute a fundamental element in the training of any practitioner. At present, however, the assessment of these skills is a scarcely developed area of research. The aim of this study was to analyse the peculiarities of the various assessment systems and establish the minimum criteria that a skills and knowledge assessment system should meet as a method for assessing surgical skills in urological surgery. Acquisition of evidence: Scientific literature review aimed at the various currently available assessment systems for skills and competencies (technical and nontechnical), with a special focus on the systematic reviews and prospective studies. Summary of the evidence: After conducting the review, we found that the various assessment systems for surgical competence have, in our opinion, a number of shortcomings. There is a certain degree of subjectivity in the assessment of surgeons by the evaluators. The assessment of nontechnical competencies is not formally recorded. There is no description of a follow-up assessment or any basic parameters associated with healthcare quality. There is no registration of associated competencies associated with the various surgical techniques. There is also no ranking of these competencies and the specific peculiarities for their application. Conclusions: We believe that the development of a new assessment system for surgical competencies (technical and nontechnical) aimed at assessing urologists in the various surgical techniques is necessary. To this end, our team has worked on developing the Evaluation System for Surgical Competencies on Laparoscopy, which is based on the definition, ranking and assessment of competencies demonstrated by surgeons

The assessment of surgical skills as a complement to the training method. Revision.

CONTEXT AND OBJECTIVE: The acquisition and improvement of surgical skills constitute a fundamental element in the training of any practitioner. At present, however, the assessment of these skills is a scarcely developed area of research. The aim of this study was to analyse the peculiarities of the various assessment systems and establish the minimum criteria that a skills and knowledge assessment system should meet as a method for assessing surgical skills in urological surgery. ACQUISITION OF EVIDENCE: Scientific literature review aimed at the various currently available assessment systems for skills and competencies (technical and nontechnical), with a special focus on the systematic reviews and prospective studies. SUMMARY OF THE EVIDENCE: After conducting the review, we found that the various assessment systems for surgical competence have, in our opinion, a number of shortcomings. There is a certain degree of subjectivity in the assessment of surgeons by the evaluators. The assessment of nontechnical competencies is not formally recorded. There is no description of a follow-up assessment or any basic parameters associated with healthcare quality. There is no registration of associated competencies associated with the various surgical techniques. There is also no ranking of these competencies and the specific peculiarities for their application. CONCLUSIONS: We believe that the development of a new assessment system for surgical competencies (technical and nontechnical) aimed at assessing urologists in the various surgical techniques is necessary. To this end, our team has worked on developing the Evaluation System for Surgical Competencies on Laparoscopy, which is based on the definition, ranking and assessment of competencies demonstrated by surgeons.

[Bone lithiasis in the period of the Enlightenment: D.F.J.B. Trehet]. / La litiasis ósea en el periodo de la ilustración: D.F.J.B. Trehet.

OBJECTIVE: To briefly describe the life and works of D.F.J.B. Trehet, a physician of the city of Rouen (France), who was the first to describe the "osseous points" in a renal calculus. Trèhet has not been recognized or referenced for this original observation in the urological publications. METHODS: Trehet lived in the period of the Enlightenment and endured the upheavals of the French Revolution. Data gleaned from several sources have permitted and elaborate description of this French physician from both the social and professional perspectives. RESULTS: After completing his studies at the Hôtel Dieu in Rouen, D.F.J.B. Trehet pursued his education at the School of Health in Paris. He read his doctorate's thesis at the Paris School of Medicine in 1803 and published his observation of a renal calculus "with osseous points" in 1812. Other studies by D.F.J.B. Trehet were also published in Le Journal de Médecine, Chirurgie et Pharmacie. CONCLUSIONS: D.F.J.B. Trehet should be recognized as the first to describe an osseous renal calculus.

[Detubularized ureterosigmoidostomy Mainz II: a diversion with a future?]. / Ureterosigmoidostomía destubulizada Mainz II: una derivación con futuro?

OBJECTIVE: To review the results achieved with the Mainz II detubularized ureterosigmoidostomy for urinary diversion in patients undergoing bladder resection. METHODS: This study was conducted on 12 prospective patients undergoing radical cystectomy for urothelial carcinoma after 1996. All patients met the following selection criteria: no changes in upper urinary tract functions, normal rectosigmoid, no previous radiation to the area and good anal continence. RESULTS: All patients had a diagnosis of infiltrating urothelial carcinoma of the bladder. Four of these patients died from tumor progression. Renal function is preserved at 31.7 months' mean follow-up, although 3 patients developed moderate metabolic acidosis despite the prophylactic alkalization therapy instituted after surgery. One patient presented recurrent pyelonephritis and stricture of the ureterointestinal anastomosis that required surgical correction. Colonoscopy was unremarkable in all but one patient who showed adenomatous polyp of the colon, which was removed endoscopically, and no other local changes. Continence was complete from the time the urinary catheters were removed. Voiding occurred every 2.9 hours during the day and 2.2 times during the night. CONCLUSIONS: The Mainz II modified ureterosigmoidostomy clearly reduces the upper urinary tract complications because accommodation of the reservoir is better and the pressure inside the pouch is reduced. This technique of urinary diversion is well-accepted by the patients because voiding can be achieved comfortably, a stoma is not required and body image is preserved. The degree of patient satisfaction was high in all cases.

[Penile fracture: diagnostic assessment and therapeutic approach. Review of the literature]. / Fractura de pene: evaluación diagnóstica y actitudes terapéuticas. Revisión de la literatura.

OBJECTIVE: Rupture of the corpus cavernosum is an uncommon condition that requires immediate treatment in the emergency services. The diagnostic methods and therapeutic approaches are discussed and the literature reviewed. METHODS: Two cases of rupture of the corpus cavernosum diagnosed 8 years and 3 months earlier are presented. One was treated conservatively and the other was submitted to early surgical management. Images showing the technique utilized for cavernosal repair in one of the patients and the satisfactory clinical course of both patients are presented. RESULTS/CONCLUSIONS: Rupture of the corpus cavernosum is an uncommon urological emergency in our setting. Patient history and examination are diagnostic in most of the cases. Early surgical management is advocated.

[Adult renal polycystosis as the causal entity of an intercostal hernia containing an intestinal loop: an unusual clinical case]. / Poliquistosis renal del adulto como entidad causante de hernia intercostal que contiene asa intestinal: caso clínico excepcional.

OBJECTIVE: To describe a case of adult renal polycystosis causing intercostal hernia with intestinal segment. To our knowledge, no such case has been previously reported in the literature. METHODS/RESULTS: Diagnosis was by abdominal CT. Treatment was by bilateral nephrectomy and surgical repair of the diaphragmatic and intercostal hernia. CONCLUSIONS: Surgery is indicated in adult renal polycystosis if kidney size causes gastrointestinal involvement and above all, if the lungs are compromised by the intercostal diaphragmatic hernia.

[Adenomatoid tumor of testicular tunica albuginea: a case report. Histogenetic and therapeutic considerations]. / Tumor adenomatoide de la albuginea testicular: aportación de un nuevo caso. Consideraciones histogenéticas y terapéuticas.

OBJECTIVE: To describe a rare case of adenomatoid tumor of the testicular tunica albuginea and to discuss the clinical, histogenetic and therapeutic aspects. METHODS/RESULTS: A rare case of adenomatoid tumor of the testicular tunica albuginea is presented. The clinical, histogenetic and therapeutic aspects are discussed. CONCLUSIONS: Adenomatoid tumors of the testicular tunica albuginea are rare and are therefore rarely considered. Although 99% of testicular tumors are malignant, it must be emphasized that there are benign testicular tumors, such as adenomatoid tumor, that initially do not require aggressive surgical treatment but intraoperative biopsy and tumor resection.

[Infrequent association: massive inguinoscrotal bladder hernia, multiple scrotal lithiasis, and bilateral obstructive uropathy]. / Una asociación poco frecuente: hernia vesical inguinoescrotal masiva, litiasis escrotal múltiple y uropatía obstructiva bilateral.

Vesical hernias occur in a significant number of patients with inguinal hernia, though massive inguinoscrotal vesical hernias are uncommon. This paper presents a case report of a male patient where massive inguinoscrotal vesical hernia, and scrotum-located multiple vesical lithiasis was associated to a large amount of lithiasic mass and bilateral ureterohydronephrosis. We consider this association of urinary conditions extremely rare, since to our knowledge bilateral ureterohydronephrosis has only been formerly documented in one case.

[Endometriosis: the cause of hematuria in the dysfunctional ureter]. / Endometriosis: causa de hematuria en uréter desfuncionalizado.

OBJECTIVES: To review the diagnosis and treatment of ureteral stenosis arising from endometriosis and describe a case of mixed (intrinsic and extrinsic) ureteral endometriosis. METHODS: The diagnostic and therapeutic aspects of ureteral stenosis due to endometriosis are reviewed. The case of a patient with a nonfunctioning right kidney and hematuria is described. The patient had previously undergone hysterectomy and double adnexectomy for uterine leiomyofibromas and a right ureteral lesion that warranted cuff ureterocystoneostomy leaving the extreme distal third of the pelvic ureter. CT evaluation disclosed a right retrovesical mass. The therapeutic strategy consisted in performing percutaneous nephrostomy, ureteroscopy of nonfunctioning ureter and determining the nature of the retrovesical mass by fine needle punction aspiration biopsy. RESULTS: Percutaneous nephrostomy achieved functional recovery of the renal unit. Endoscopic incision of the stricture with intravesical invagination of the compromised segment was performed with the combined antegrade and retrograde approach. The anatomopathological findings of ureteroscopic biopsy of an intraureteral lesion in the nonfunctioning ureter disclosed ureteral endometriosis. This finding obviated fine needle punction aspiration biopsy and the patient was treated with danazol for 6 months. CONCLUSIONS: Diagnosis by ureteroscopy should be considered in intrinsic and mixed forms of ureteral endometriosis. Endoscopic incision of the ureteral stricture combined with hormone therapy is a valid therapeutic option.

[Treatment of ureteral stenoses with the Acucise catheter]. / Tratamiento de las estenosis ureterales con el catéter Acucise.

OBJECTIVES: A new form of minimally invasive treatment of ureteral stricture with the Acucise catheter is described herein. METHODS: The method for catheter use for the ureteral incision using radiological control alone is described. RESULTS: The technique is easy to perform. There were no early postoperative complications in strictures at the juxtavesical or upper lumbar ureter. CONCLUSIONS: The availability of balloon dilatation catheters equipped with an electrocautery device permits incision of the ureteral stricture using radiological control alone, preferably those in the juxtavesical or upper lumbar ureter. Those localized to other levels of the ureter are not free from vascular or visceral lesions.

[Assessment of double-J ureteral catheters at a lithotripsy unit: our experience]. / Evaluación de los catéteres ureterales tipo doble J en una unidad de litotricia: nuestra experiencia.

The present study evaluated a total of 350 patients who underwent placement of double-J catheters as a result of their lithiasic condition. The work includes a review of the patients' urological background, indication for the double-J placement, tolerance to catheter, time of permanence, reason for withdrawal, presence of encrustations in the catheter and relationship between all these parameters. A significant increase of adverse symptoms was observed when permanence of the double-J catheter lasted longer than 6 weeks. Likewise, there was a significant increase in the number of encrustations in catheters retained longer than 6 weeks, as well as when the lithiasic mass was meaningful and urine cultures were positive. The authors consider that double-J catheters effectively prevent the complications of the lithiasic condition but an excessively long permanence, more than 6 weeks, increases occurrence of side-effects significantly.

[Endoscopic treatment of congenital paraureteral diverticuli and cavities]. / Tratamiento endoscópico de los divertículos y cavidades paraureterales congénitos.

We report 4 cases of primary congenital paraurethral diverticula or cavities (3 diverticula and 1 cyst of Cowper's glands) that were treated by endoscopic surgery. All the foregoing cases were diagnosed as primary in the absence of coexisting pathologies or associated disorders. The wall between the diverticulum and the urethral lumen was sectioned endoscopically. All patients recovered normal clinical and morphological status.

[Abnormalities of the inferior vena cava: the retrocaval ureter]. / Malformaciones de la vena cava inferior: el uréter retrocavo.

We report three cases of retrocaval ureter with a clear indication for surgery: one patient with severe hydronephrosis and two cases with mild dilatation of the renal pelvis, calyces and upper ureter, both complicated by renal stones. The initial diagnosis was based on the ultrasound and the intravenous urogram findings, and was confirmed by a retrograde pyelogram in combination with cavography and CT. All patients were submitted to surgery (1 nephrectomy and 2 uretero-ureteric anastomosis). Renal stone was resolved at the same time in one case, and by ESWL after surgery in the other.

[Bone lithiasis: experimental and clinical histopathology]. / Litiasis ósea: histopatología experimental y clínica.

There is scant literature on bone lithiasis, a disease entity whose diagnosis depends fundamentally upon the anatomopathological findings. The data gleaned from animal experiments have been shown to overlap with those observed in the clinical setting. Conservative treatment should include resection of the urothelial bony metaplasia to avoid recurrence. The importance of making a correct diagnosis cannot be overemphasized since this condition may be associated with a tumoral lesion and a close follow-up is therefore warranted.

[The therapeutic approach in vascular damage from pyelocaliceal endoscopic urology]. / Actitud terapéutica en el daño vascular de la endourología pielocalicial.

Six cases of vascular lesion associated with percutaneous removal of renal calculi are described. The lesions had been caused during percutaneous access or ultrasound fragmentation of the stone. Those that had resolved spontaneously have not been included. When vascular injury is suspected during the procedure, the appropriate measures must be taken to resolve the different complications, such as arteriovenous, arteriocaliceal or venocaliceal fistula. Since there is little reference to this subject in the Spanish literature, the experience described herein may be of interest to the urologist who has only recently begun to perform this technique.

[Endourologic treatment of tumors of the superior urothelium: results and clinical course]. / Tratamiento endourológico del tumor de urotelio superior: resultados y evolución.

Presentation of 31 patients with suspected diagnosis of upper urothelium tumour seen between 1986 and 1991. In agreement with our study protocol and the endourological treatment followed in this type of tumours, there were eight false positive, which were excluded. Five cases were treated by retrograde ureterorenoscopy while in the remaining 18 cases the anterograde percutaneous approach was used. A review of both the aspects of endoeurological treatment and the evolution of these patients during that period is included.

[Endourologic treatment of tumor of the upper urothelium: results and clinical course]. / Tratamiento endourológico del tumor de urotelio superior: resultados y evolución.

Presentation of 31 patients with suspected diagnosis of upper urothelium tumour seen between 1986 and 1991. In agreement with our study protocol and the endourological treatment followed in this type of tumours, there were eight false positive, which were excluded. Five cases were treated by retrograde ureterorenoscopy while in the remaining 18 cases the anterograde percutaneous approach was used. A review of both the aspects of endourological treatment and the evolution of these patients during that period is included.