Objective
To discuss the impact of COVID‐19 on global health, particularly on urological practice and to review some of the available recommendations reported in the literature.
Material and Methods
...In the current narrative review the PubMed database was searched to identify all the related reports discussing the impact of COVID‐19 on the urological field.
Results
The COVID‐19 pandemic is the latest and biggest global health threat. Medical and surgical priorities have changed dramatically to cope with the current challenge. These changes include postponements of all elective outpatient visits and surgical procedures to save facilities and resources for urgent cases and patients with COVID‐19 patients. This review discuss some of the related changes in urology.
Conclusions
Over the coming weeks, healthcare workers including urologists will be facing increasingly difficult challenges, and consequently, they should adopt triage strategy to avoid wasting of medical resources and they should endorse sufficient protection policies to guard against infection when dealing with COVID‐19 patients.
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BFBNIB, FZAB, GIS, IJS, KILJ, NLZOH, NUK, OILJ, SBCE, SBMB, UL, UM, UPUK
Objective
To improve endoscopic recognition of the most frequently encountered urinary stone morphologies for a better aetiological approach in lithiasis by urologists.
Materials and Methods
An ...expert urologist intraoperatively and prospectively (between June 2015 and June 2018) examined the surface, the section, and the nucleus of all encountered kidney stones. Fragmented stones were subsequently analysed by a biologist based on both microscopic morphological (i.e. binocular magnifying glass) and infrared (i.e. Fourier transform‐infrared spectroscopy) examinations (microscopists were blinded to the endoscopic data). Morphological criteria were collected and classified for the endoscopic and microscopic studies. The Wilcoxon–Mann–Whitney test was used to detect differences between the endoscopic and microscopic diagnoses. A diagnosis for a given urinary stone was considered ‘confirmed’ for a non‐statistically significant difference.
Results
A total of 399 urinary stones were included in this study: 51.4% of the stones had only one morphological type, while 48.6% were mixed stones (41% had at least two morphologies and 7.6% had three morphologies). The overall matching rate was 81.6%. Diagnostics were confirmed for the following morphologies: whewellite (Ia or Ib), weddellite (IIa or IIb), uric acid (IIIa or IIIb), carbapatite‐struvite association (IVb), and brushite (IVd).
Conclusions
Our preliminary study demonstrates the feasibility of using endoscopic morphology for the most frequently encountered urinary stones and didactic boards of confirmed endoscopic images are provided. The present study constitutes the first step toward endoscopic stone recognition, which is essential in lithiasis. We provide didactic boards of confirmed endoscopic images that pave the way for automatic computer‐aided in situ recognition.
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BFBNIB, DOBA, FZAB, GIS, IJS, IZUM, KILJ, NLZOH, NUK, OILJ, PILJ, PNG, SAZU, SBCE, SBMB, UILJ, UKNU, UL, UM, UPUK
Objective
To assess automatic computer‐aided in situ recognition of the morphological features of pure and mixed urinary stones using intra‐operative digital endoscopic images acquired in a clinical ...setting.
Materials and Methods
In this single‐centre study, a urologist with 20 years' experience intra‐operatively and prospectively examined the surface and section of all kidney stones encountered. Calcium oxalate monohydrate (COM) or Ia, calcium oxalate dihydrate (COD) or IIb, and uric acid (UA) or IIIb morphological criteria were collected and classified to generate annotated datasets. A deep convolutional neural network (CNN) was trained to predict the composition of both pure and mixed stones. To explain the predictions of the deep neural network model, coarse localization heat‐maps were plotted to pinpoint key areas identified by the network.
Results
This study included 347 and 236 observations of stone surface and stone section, respectively; approximately 80% of all stones exhibited only one morphological type and approximately 20% displayed two. A highest sensitivity of 98% was obtained for the type ‘pure IIIb/UA’ using surface images. The most frequently encountered morphology was that of the type ‘pure Ia/COM’; it was correctly predicted in 91% and 94% of cases using surface and section images, respectively. Of the mixed type ‘Ia/COM + IIb/COD’, Ia/COM was predicted in 84% of cases using surface images, IIb/COD in 70% of cases, and both in 65% of cases. With regard to mixed Ia/COM + IIIb/UA stones, Ia/COM was predicted in 91% of cases using section images, IIIb/UA in 69% of cases, and both in 74% of cases.
Conclusions
This preliminary study demonstrates that deep CNNs are a promising method by which to identify kidney stone composition from endoscopic images acquired intra‐operatively. Both pure and mixed stone composition could be discriminated. Collected in a clinical setting, surface and section images analysed by a deep CNN provide valuable information about stone morphology for computer‐aided diagnosis.
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BFBNIB, DOBA, FZAB, GIS, IJS, IZUM, KILJ, NLZOH, NUK, OILJ, PILJ, PNG, SAZU, SBCE, SBMB, UILJ, UKNU, UL, UM, UPUK
Objectives
To investigate the role of cancer‐associated fibroblasts (CAFs) in clear cell renal cell carcinoma (ccRCC) with respect to tumour aggressiveness, metastasis development, and resistance to ...anti‐angiogenic therapy (vascular endothelial growth factor receptor‐tyrosine kinase inhibitors VEGFR‐TKI).
Patients and Methods
Our study involved tissue samples from three distinct and independent cohorts of patients with ccRCC. The presence of CAFs and tumour lymphangiogenesis was investigated, respectively, by transcriptional signatures and then correlated with tumour development and prognosis. The effect of these CAFs on tumour cell migration and VEGFR‐TKI resistance was analysed on co‐cultures of ccRCC cells with CAFs.
Results
Results from our cohorts and from in silico investigations showed that VEGFR‐TKI significantly increase the number of CAFs in tumours. In the same populations of patients with ccRCC, the proportion of intra‐tumoral CAFs correlated to shorter disease‐free and overall survival. The presence of CAFs was also correlated with lymphangiogenesis and lymph node metastasis. CAFs increased the migration and decreased the VEGFR‐TKI‐dependent cytotoxic effect of tumour cells.
Conclusions
Our results show that VEGFR‐TKI promote the development of CAFs, and CAFs favour tumour aggressiveness, metastatic dissemination, and resistance to treatment in ccRCC. CAFs could represent a new therapeutic target to fight resistance to treatment of ccRCC. Targeting CAF and immunotherapies combination are emerging as efficient treatments in many types of solid tumours. Our results highlight their relevance in ccRCC.
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BFBNIB, DOBA, FZAB, GIS, IJS, IZUM, KILJ, NLZOH, NUK, OILJ, PILJ, PNG, SAZU, SBCE, SBMB, UILJ, UKNU, UL, UM, UPUK
The drought of summer 2018, which affected much of Northern Europe, resulted in low river flows, biodiversity loss and threats to water supplies. In some regions, like the Scottish Highlands, the ...summer drought followed two consecutive, anomalously dry, winter periods. Here, we examine how the drought, and its antecedent conditions, affected soil moisture, groundwater storage, and low flows in the Bruntland Burn; a sub‐catchment of the Girnock Burn long‐term observatory in the Scottish Cairngorm Mountains. Fifty years of rainfall‐runoff observations and long‐term modelling studies in the Girnock provided unique contextualisation of this extreme event in relation to more usual summer storage dynamics. Whilst summer precipitation in 2018 was only 63% of the long‐term mean, soil moisture storage across much of the catchment were less than half of their summer average and seasonal groundwater levels were 0.5 m lower than normal. Hydrometric and isotopic observations showed that ~100 mm of river flows during the summer (May‐Sept) were sustained almost entirely by groundwater drainage, representing ~30% of evapotranspiration that occurred over the same period. A key reason that the summer drought was so severe was because the preceding two winters were also dry and failed to adequately replenish catchment soil moisture and groundwater stores. As a result, the drought had the biggest catchment storage deficits for over a decade, and likely since 1975–1976. Despite this, recovery was rapid in autumn/winter 2018, with soil and groundwater stores returning to normal winter values, along with stream flows. The study emphasizes how long‐term data from experimental sites are key to understanding the non‐linear flux‐storage interactions in catchments and the “memory effects” that govern the evolution of, and recovery from, droughts. This is invaluable both in terms of (a) giving insights into hydrological behaviours that will become more common water resource management problems in the future under climate change and (b) providing extreme data to challenge hydrological models.
Low rainfall and runoff (a) in a Scottish experimental catchment in (b) 2017‐2018 are assessed in relation to (c) storage changes.
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BFBNIB, FZAB, GIS, IJS, KILJ, NLZOH, NUK, OILJ, SBCE, SBMB, UL, UM, UPUK
Background
Only a few studies have compared the outcomes of robotic partial nephrectomy (RPN) and open partial nephrectomy (OPN). This study aimed to compare perioperative and oncologic outcomes of ...RPN and OPN.
Methods
The data of all patients who underwent partial nephrectomy from 2006 to 2014 in six academic departments of urology were retrospectively collected. Perioperative outcomes were compared between OPN and RPN patients. Cancer-specific survival (CSS) and recurrence-free survival (RFS) were estimated using the Kaplan–Meier method and compared using the log-rank test.
Results
The study included 1800 patients: 937 who underwent RPN and 863 who underwent OPN. The patients in the robotic group had smaller tumors (33.1 vs. 39.9 mm;
p
< 0.001) but comparable RENAL scores (6.8 vs. 6.7;
p
= 0.37). The complication rate was higher in the OPN group (28.6 vs. 18 %;
p
< 0.001). The OPN patients had greater estimated blood loss (359.5 vs. 275 ml;
p
< 0.001) and more frequent hemorrhagic complications (12.1 vs. 6.9 %;
p
< 0.001). The robotic approach was associated with a shorter warm ischemia time (WIT 15.7 vs. 18.6 min;
p
< 0.001) and a shorter hospital of stay (4.7 vs. 10.1 days;
p
< 0.001). In the propensity score-weighted analysis, the inverse probability of treatment weighting adjusted odds ratio for the risk of complication after OPN versus RPN was 2.11 (95 % confidence interval, 1.53–2.91;
p
< 0.001). After a median postoperative follow-up period of 13 months for OPN and 39 months for RPN (
p
< 0.001), CSS and RFS were similar in the two groups. In the multivariate analysis, RPN showed an impact on the occurrence of a complication but had no effect on WIT or RFS.
Conclusion
In this study, RPN was less morbid than OPN, with lower complications, less blood loss, and a shorter hospital of stay. The intermediate-term oncologic outcomes were similar in the two groups.
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EMUNI, FIS, FZAB, GEOZS, GIS, IJS, IMTLJ, KILJ, KISLJ, MFDPS, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, SBMB, SBNM, UKNU, UL, UM, UPUK, VKSCE, ZAGLJ
Objective
To evaluate the ability of neoadjuvant axitinib to reduce the size of T2 renal cell carcinoma (RCC) for shifting from a radical nephrectomy (RN) to a partial nephrectomy (PN) indication, ...offering preservation of renal function.
Patients and Methods
Patients with cT2aN0NxM0 clear‐cell RCC, considered not suitable for PN, were enrolled in a prospective, multicentre, phase II trial (AXIPAN). Axitinib 5 mg, and up to 7–10 mg, was administered twice daily, for 2–6 months before surgery, depending on the radiological response. The primary outcome was the number of patients receiving PN for a tumour <7 cm in size after neoadjuvant axitinib.
Results
Eighteen patients were enrolled. The median (range) tumour size and RENAL nephrometry score were 76.5 (70–98) mm and 11 (7–11), respectively. After axitinib neoadjuvant treatment, 16 tumours decreased in diameter, with a median size reduction of 17% (64.0 vs 76.5 mm; P < 0.001). The primary outcome was considered achieved in 12 patients who underwent PN for tumours <7 cm. Sixteen patients underwent PN. Axitinib was tolerated in the present study, as has been previously shown in the metastatic setting. Five patients had grade 3 adverse events. Five patients experienced Clavien III–V post‐surgery complications. At 2‐year follow‐up, six patients had metastatic progression, and two had a recurrence.
Conclusion
Neoadjuvant axitinib in cT2 ccRCC is feasible and, even with a modest decrease in size, allowed a tumour shrinkage <7 cm in 12 cases; however, PN procedures remained complex, requiring surgical expertise with possible morbidity.
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BFBNIB, FZAB, GIS, IJS, KILJ, NLZOH, NUK, OILJ, SBCE, SBMB, UL, UM, UPUK
Objective
To assess the impact of hospital volume (HV) and surgeon volume (SV) on perioperative outcomes of robot‐assisted partial nephrectomy (RAPN).
Patients and Methods
All consecutive patients ...who underwent a RAPN from 2009 to 2015, at 11 institutions, were included in a retrospective study. To evaluate the impact of HV, we divided RAPN into four quartiles according to the caseload per year: low HV (<20/year), moderate HV (20–44/year), high HV (45–70/year), and very high HV (>70/year). The SV was also divided into four quartiles: low SV (<7/year), moderate SV (7–14/year), high SV (15–30/year), and very high SV (>30/year). The primary endpoint was the Trifecta defined as the following combination: no complications, warm ischaemia time (WIT) <25 min, and negative surgical margins.
Results
In total, 1 222 RAPN were included. The mean (sd) caseload per hospital per year was 44.9 (26.7) RAPNs and the mean (sd) caseload per surgeon per year was 19.2 (14.9) RAPNs. The Trifecta achievement rate increased significantly with SV (69.9% vs 72.8% vs 73% vs 86.1%; P < 0.001) and HV (60.3% vs 72.3% vs 86.2% vs 82.4%; P < 0.001). The positive surgical margins (PSM) rate (P = 0.02), length of hospital stay (LOS; P < 0.001), WIT (P < 0.001), and operative time (P < 0.001), all decreased significantly with increasing SV. The PSM rate (P = 0.02), LOS (P < 0.001), WIT (P < 0.001), operative time (P < 0.001), and major complications rate (P = 0.01), all decreased significantly with increasing HV. In multivariate analysis adjusting for HV and SV (model 3), HV remained the main predictive factor of Trifecta achievement (odds ratio OR 3.70 for very high vs low HV; P < 0.001), whereas SV was not associated with Trifecta achievement (OR 1.58 for very high vs low SV; P = 0.34).
Conclusion
In this multicentre study HV and SV both greatly influenced RAPN perioperative outcomes, but HV appeared to have a greater impact than SV.
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BFBNIB, DOBA, FZAB, GIS, IJS, IZUM, KILJ, NLZOH, NUK, OILJ, PILJ, PNG, SAZU, SBCE, SBMB, UILJ, UKNU, UL, UM, UPUK
A randomized trial showed that overall survival with sunitinib alone was noninferior to overall survival with sunitinib after nephrectomy among patients with metastatic renal-cell carcinoma.
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