To evaluate the role of three-dimensional (3D) reconstruction in preoperative planning for complex renal tumors.
A well-planned questionnaire was distributed among the attending urologists at an ...international meeting. The questionnaire inquired about demographic data, surgical experience, partial nephrectomy (PN) versus radical nephrectomy (RN), surgical approach, time of ischemia, probability of postoperative urine leakage and positive surgical margins after viewing computed tomography (CT) scans and their respective 3D models of six complex renal tumors. Following the CT scans, attendees were asked to view randomly selected reconstructions of the cases.
One hundred expert urologists participated in the study; 61% were aged between 40 and 60 years. Most of them (74%) were consultants. The overall likelihood of PN after viewing the 3D reconstructions significantly increased (7.1±2.7 vs. 8.0±2.2, p<0.001), the probability of conversion to RN significantly decreased (4.3±2.8 vs. 3.2±2.5, p<0.001), and the likelihood of urine leakage and positive surgical margins significantly decreased (p<0.001). Preference for the open approach significantly decreased (21.2% vs. 12.1%, p<0.001), while selective clamping techniques significantly increased (p<0.001). After viewing the 3D models, low expected warm ischemia time and estimated blood loss were significantly preferred by the respondents (p<0.001). Surgical decision change was significantly associated with performance or participation in more than 20 PNs or RNs annually 3.25 (1.98-5.22) and 2.87 (1.43-3.87), respectively.
3D reconstruction models play a significant role in modifying surgeons' strategy and surgical planning for patients with renal tumors, especially for patients with stronger indications for a minimally invasive and/or nephron-sparing approach.
Abstract Context Enhanced Recovery after Surgery (ERAS) programs are multimodal care pathways that aim to decrease intra-operative blood loss, decrease postoperative complications, and reduce ...recovery times. Objective To overview the use and key elements of ERAS pathways, and define needs for future clinical trials. Evidence acquisition A comprehensive systematic MEDLINE search was performed for English language reports published before May 2015 using the terms “postoperative period,” “postoperative care,” “enhanced recovery after surgery,” “enhanced recovery,” “accelerated recovery,” “fast track recovery,” “recovery program,” “recovery pathway”, “ERAS,” and “urology” or “cystectomy” or “urologic surgery.” Evidence synthesis We identified 18 eligible articles. Patient counseling, physical conditioning, avoiding excessive alcohol and smoking, and good nutrition appeared to protect against postoperative complications. Fasting from solid food for only 6 h and perioperative liquid–carbohydrate loading up to 2 h prior to surgery appeared to be safe and reduced recovery times. Restricted, balanced, and goal-directed fluid replacement is effective when individualized, depending on patient morbidity and surgical procedure. Decreased intraoperative blood loss may be achieved by several measures. Deep vein thrombosis prophylaxis, antibiotic prophylaxis, and thermoregulation were found to help reduce postsurgical complications, as was a multimodal approach to postoperative nausea, vomiting, and analgesia. Chewing gum, prokinetic agents, oral laxatives, and an early resumption to normal diet appear to aid faster return to normal bowel function. Further studies should compare anesthetic protocols, refine analgesia, and evaluate the importance of robot-assisted surgery and the need/timing for drains and catheters. Conclusions ERAS regimens are multidisciplinary, multimodal pathways that optimize postoperative recovery. Patient summary This review provides an overview of the use and key elements of Enhanced Recovery after Surgery programs, which are multimodal, multidisciplinary care pathways that aim to optimize postoperative recovery. Additional conclusions include identifying effective procedures within Enhanced Recovery after Surgery programs and defining needs for future clinical trials.
Purpose During enucleative partial nephrectomy excision is performed adjacent to the tumor edge. To better determine the oncologic propriety of enucleative partial nephrectomy we histologically ...examined the tumor-parenchyma interface. Materials and Methods Archived hematoxylin and eosin stained slides of 124 nephrectomy specimens were rereviewed. We evaluated representative sections of tumor abutting the renal parenchyma and overlying pseudocapsule/perirenal fat were selected at 4 mm2 sectors apportioned 1, 2, 3 and 4 mm, respectively, from the tumor edge. Results Median tumor size was 3.5 cm. Of the tumors 111 were malignant (90%) and 119 (96%) had a pseudocapsule with a median thickness of 0.6 mm. Of malignant and benign tumors 82% and 31%, respectively, had an intrarenal pseudocapsule (p <0.001). Pseudocapsule invasion was noted in 45% of cancers and 15% of benign tumors (p <0.04). Of pT1a cancers 36% showed intrarenal pseudocapsule invasion. No patient had positive surgical margins. Intrarenal pseudocapsule invasion correlated with clear cell renal cell carcinoma histology but not with cancer size, grade, necrosis or margin width. Inflammation, nephrosclerosis, glomerulosclerosis and arteriosclerosis decreased with increasing distance from the tumor edge. At 1 mm changes were moderate to severe in 38%, 32%, 20% and 17% of tumors while at 5 mm changes were mild in 2.5%, 0.8%, 0.8% and 4%, respectively (p <0.001). Mean arteriolar diameter decreased with tumor proximity (p <0.0001). Conclusions Most renal cancers have an intrarenal pseudocapsule. Partial nephrectomy excision adjacent to the tumor edge appears to be histologically safe. Because 18% of cancers lacked a discernible intrarenal pseudocapsule and 25% of pT1a cancers showed intrarenal pseudocapsule invasion, extreme care is needed to avoid positive margins during enucleative partial nephrectomy.
Purpose
To compare the efficacy of Rezūm with a matched cohort of patients undergoing transurethral resection of the prostate (TURP) for catheter-dependent urine retention secondary to benign ...prostate hyperplasia (BPH).
Methods
A retrospective review was performed for consecutive catheter-dependent patients who underwent Rezūm for BPH. Patients were matched and compared with a similar cohort undergoing TURP, using non-inferiority analysis on propensity score-matched patient pairs. Patients were followed up at 1, 3, 6 and 12 months by international prostate symptoms score (IPSS), quality of life (QoL) index, peak flow rate (Qmax) and postvoid residual urine (PVR).
Results
Eighty-one patients undergoing Rezūm were compared with equal number of matched patients who undergoing TURP. Patients undergoing Rezūm experienced significantly shorter operation time (25.5 ± 8.7 vs. 103.4 ± 12.6 min;
p
< 0.001), lower intraoperative bleeding (2.4% vs. 20.7%,
p
< 0.001), shorter hospital stay (1.2 ± 0.9 vs. 2.4 ± 1.3 d,
p
< 0.001) and longer catheter time (12.6 ± 6.0 vs. 2.3 ± 1.2 d,
p
< 0.001), with no need for transfusion. Successful postoperative voiding was comparable between both arms (90.2% vs. 92.7%,
p
= 0.78), respectively. Despite patients undergoing TURP had significantly better voiding outcomes after 1 and 3 months, both groups were comparable after six and 12 months in terms of mean IPSS (11.1 ± 6.4 vs. 10.8 ± 3.4,
p
= 0.71), QoL indices (2.4 ± 1.6 vs. 2.1 ± 2.3,
p
= 0.33) and Qmax (22.0 ± 7.7 v. 19.8 ± 6.9 ml/sec,
p
= 0.06).
Conclusion
This study supports the safety and efficacy of Rezūm in the management of catheter-dependent patients secondary to BPH, with comparable functional outcomes to TURP. Until a randomized clinical comparison is available, long-term data are crucially recommended to compare the recurrence and reoperation rates.
The objective is to assess urologists' awareness of and compliance with available minimally invasive devices (MIDs) for the management of benign prostate hyperplasia (BPH).
An online Internet-based ...survey was sent to urologists through E-mail. Baseline characteristics included age, location and duration of practice, and number of prostatectomies performed in the previous 12 months. Awareness is based on the surgeons' opinions about their advantages and drawbacks.
A total of 308 participants responded to the survey; 87.0% were most aware of Rezūm, followed by Urolift (59.1%), Aquablation (33.1%), and combined temporary implantable nitinol device (iTIND), and Zenflow (17%). In the past 12 months, 84.1% used MIDs in their practice. A total of 47.1% of respondents believe that these devices have comparable outcomes with the traditional interventions, 52.9% are unsure of their long-term benefits, and 71% feel that it is too early to judge. Forty-three percent believe that these devices are reserved only for high-risk patients, and 52% recommend that they should be available in their centers. Most respondents (90.9%) prefer Rezūm, Urolift (28.2%), and Aquablation (12.6%) because they are less invasive, less time-consuming, and have few complications. Interestingly, 59% recommend MIDs to their family members.
Most respondents are more aware of Rezūm, Urolift, and Aquablation than iTIND and Zenflow. In addition, most respondents agree that these MIDs and traditional prostate interventions have comparable outcomes despite the former lacking long-term outcome assessment. High cost and no long-term data may influence the widespread acceptance of these MIDs.
Objective
To prospectively evaluate the feasibility and safety of a novel, second‐generation telementoring interface (Connect™; Intuitive Surgical Inc., Sunnyvale, CA, USA) for the da Vinci robot.
...Materials and Methods
Robotic surgery trainees were mentored during portions of robot‐assisted prostatectomy and renal surgery cases. Cases were assigned as traditional in‐room mentoring or remote mentoring using Connect. While viewing two‐dimensional, real‐time video of the surgical field, remote mentors delivered verbal and visual counsel, using two‐way audio and telestration (drawing) capabilities. Perioperative and technical data were recorded. Trainee robotic performance was rated using a validated assessment tool by both mentors and trainees. The mentoring interface was rated using a multi‐factorial Likert‐based survey. The Mann–Whitney and t‐tests were used to determine statistical differences.
Results
We enrolled 55 mentored surgical cases (29 in‐room, 26 remote). Perioperative variables of operative time and blood loss were similar between in‐room and remote mentored cases. Robotic skills assessment showed no significant difference (P > 0.05). Mentors preferred remote over in‐room telestration (P = 0.05); otherwise no significant difference existed in evaluation of the interfaces. Remote cases using wired (vs wireless) connections had lower latency and better data transfer (P = 0.005). Three of 18 (17%) wireless sessions were disrupted; one was converted to wired, one continued after restarting Connect, and the third was aborted. A bipolar injury to the colon occurred during one (3%) in‐room mentored case; no intraoperative injuries were reported during remote sessions.
Conclusion
In a tightly controlled environment, the Connect interface allows trainee robotic surgeons to be telementored in a safe and effective manner while performing basic surgical techniques. Significant steps remain prior to widespread use of this technology.
Objectives: The present study explores how young urologists in Saudi Arabia are adopting social media as a learning tool and how this new development is shaping as far as learning is concerned.
...Methods: A 18-item online survey via survemonkey.com was conducted. The survey was distributed through email in Saudi Arabia. The survey targeted young urologists and urology residents. The survey design and distribution was performed according to CHERRIES guidelines. Due to the quantitative nature of study data, SPSS software was used to analyze collected data.
Results: A total of 104 young Saudi urologists responded to our survey. Participants were mostly familiar with the use of Twitter (86%), followed closely by YouTube (82%) and then Snapchat and Instagram (73% and 63%, respectively), a large portion (72%) of participants believe that social media has a moderate-to-high influence on their urology knowledge, YouTube was by far the most used source to watch and understand surgical skills, followed by reference books and websites, respectively.
Conclusion: Social media has contributed to the spread of medical information among urology community and outside the urology community as well, with easier spread of medical knowledge to all involved by using social media, an extensive impact is achieved to both physicians and patients as well. For future work, this study should be conducted again, to monitor and compare the progression of usage among urologists.
COVID-19 pandemic influenced the environment, animal health, and food security. Due to reduced human mobility, the air and water quality increased. Other environmental consequences were the personal ...protective types of equipment and their haphazard disposal. Atmospheric pollution could be a cofactor leading to an increased COVID-19 mortality rate. Lockdown, however, caused a reduction in air and water pollution. Noise pollution affects the health of individuals and communities in terms of cardiovascular disorders and sleeping problems. Meanwhile, the COVID-19 lockdown controls human activities that reduce noise pollution. Municipal waste affects the environment. Recycling has been reduced in some countries but not in Saudi Arabia. COVID-19 had a drastic effect on livestock production on national, regional, and global levels, affecting countries’ capacities to prevent and control diseases of animals and increasing global poverty, becoming a threat to the sustainability of global food security and safety. Many lessons have been learned from the COVID-19 pandemic, so it is wise to study and analyze the previous lessons and shed some light on past pandemics such as the Spanish flu to understand the readings and earn experiences. This paper is focused on the interaction between the pandemic and environmental health from the public health concern rather than other health classifications.
Spontaneous ureteric rupture is a very rare condition which usually occurs due to ureteric obstruction caused by obstructing calculi; in our case, the cause was emphysematous pyelitis, which was ...considered the first report in the literature as far as we know.
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