Purpose: To evaluate the impact of the COVID-19 pandemic lifestyle change on couples of reproductive age and on their desire for parenthood.
Materials and methods: A quantitative correlational ...research study, based on a web survey, was conducted among Italian men and women in heterosexual stable relationships, aged between 18 and 46 years. The self-administered Italian version questionnaire was created using Google Forms and posted on chats and social networks.The mood of participants before and during the quarantine was assessed using a scale from 1 to 10 (1 = no wellbeing; 10 = total wellbeing). Couples' quality of life and their reproductive desire were evaluated.
Results: 1482 respondents were included: 944 women (63.7%) and 538 men (36.3%). A significant trend toward reduced mean wellbeing scores during the quarantine, compared to before, was found (p < .01). From 18.1% participants who were planning to have a child before the pandemic, 37.3% abandoned the intention, related to worries of future economic difficulties (58%) and consequences on pregnancy (58%). Of 81.9% who did not intend to conceive, 11.5% revealed a desire for parenthood during quarantine than before (p < .01), related to will for change (50%) and need for positivity (40%). 4.3% of these actually tried to get pregnant. Stratifying by age, a trend toward older ages was found in the desire for parenthood before and during the COVID-19 pandemic (p < .05).
Conclusions: COVID-19 pandemic is impacting on the desire for parenthood. It is unknown whether these findings will result in a substantial modification of birth rate in the near future.
Objective To evaluate perioperative results of open (OPN), laparoscopic (LPN), and robot-assisted partial nephrectomies (RAPN) and to identify predictive factors of Trifecta achievement for clinical ...T1b renal tumors in a multicenter prospective dataset. Methods Data of 285 patients who had OPN (133), LPN (57), or RAPN (95) for cT1b renal tumors were extracted from the RECORd Project. High-volume centers were defined as ≥50 overall cases of partial nephrectomy per year. Trifecta was defined as simultaneous absence of perioperative complications, negative surgical margins, and ischemia time <25 minutes. Results The 3 groups had comparable body mass index, preoperative hemoglobin, creatinine and estimated glomerular filtration rate, tumor clinical diameter, and growth pattern. LPN and RAPN were more frequently exclusive of high-volume centers. RAPN showed significantly lower median estimated blood loss compared with OPN and LPN. Trifecta was achieved in 62.4%, 63.2%, and 69.5% of OPN, LPN, and RAPN ( P = NS) cases. Median warm ischemia time (WIT) was significantly shorter during OPN than during LPN and RAPN. RAPN had significantly shorter WIT compared with LPN. RAPN was significantly less morbid than OPN regarding intraoperative and postoperative complications. LPN (1.9%) and RAPN (2.5%) showed a lower rate of positive margins compared with OPN (6.8%) ( P = NS). At multivariable analysis, exophytic tumor growth pattern, estimated blood loss, and high-volume centers were significant predictive factors for Trifecta achievement. Conclusion Clinically, T1b renal tumors suitable for NSS can be safely treated by LPN or RAPN in high-volume centers. RAPN allows for significantly lower WIT and estimated blood loss with higher rate of Trifecta achievement compared with LPN.
The impact of resection technique on partial nephrectomy outcomes is controversial. The aim of this study was to evaluate the pattern of resection techniques during partial nephrectomy and the impact ...on perioperative outcomes, acute kidney injury, positive surgical margins and the achievement of the Trifecta (negative surgical margins, no perioperative Clavien-Dindo grade 2 or greater surgical complications and no postoperative acute kidney injury).
We prospectively collected data on consecutive patients with cT1-2N0M0 renal masses treated with partial nephrectomy at a total of 16 referral centers from September 2014 to March 2015. After partial nephrectomy the resection technique was classified by the surgeon as enucleation, enucleoresection or resection according to the SIB (Surface-Intermediate-Base) margin scores 0 to 2, 3 or 4 and 5, respectively. Multivariable logistic regression analysis was done to evaluate the potential impact of the resection technique on postoperative surgical complications, positive surgical margins, acute kidney injury and Trifecta achievement.
Overall 507 patients were included in analysis. The resection technique was classified as enucleation in 266 patients (52%), enucleoresection in 150 (30%) and resection in 91 (18%). The resection technique (enucleoresection vs enucleation and resection) was the only significant predictor of positive surgical margins. Tumor complexity, surgical approach (open and laparoscopic vs robotic) and resection technique (enucleoresection vs enucleation) were significant predictors of Clavien-Dindo grade 2 or greater surgical complications. The surgical approach (open and laparoscopic vs robotic), the resection technique (enucleoresection vs enucleation) and warm ischemia time were significantly associated with postoperative acute kidney injury and Trifecta achievement.
Resection techniques significantly impact surgical complications, early functional outcomes and positive surgical margins after partial nephrectomy of localized renal masses.
Take Home Message A standardized reporting system of nephron-sparing surgery resection techniques is lacking. The surface–intermediate–base scoring system represents a formal reporting instrument to ...assist in interpretation of reported data and to facilitate comparisons in the urologic literature.
Objective
To describe our step‐by‐step technique for robotic intracorporeal neobladder configuration, including the stages of conception, development and exploration of this surgical innovation, ...according to the Idea, Development, Exploration, Assessment, Long‐term follow‐up (IDEAL) Collaboration guidelines.
Patients and Methods
The Florence robotic intracorporeal neobladder (FloRIN) was performed employing the following main surgical steps: isolation of 50 cm of ileum; bowel anastomosis; urethro‐ileal anastomosis creating an asymmetrical ‘U’‐shape (30 cm distally and 20 cm proximally to anastomosis), ileum detubularisation; posterior wall reconfiguration as an ‘L’; bladder neck reconstruction; anterior folding of the posterior plate to reach the 12 o'clock position; uretero‐enteral ‘orthotopic’ bilateral anastomosis. The conception and development of the FloRIN followed the IDEAL guidelines recommended stages: Phase 1 (simulation) involved the neobladder robotic configuration using silicone models. Phase 2a (development) aimed to reproduce the configuration in an open fashion in one patient, and then in the first three robotic procedures. Phase 2b (exploration) consisted of the technique standardisation in 15 consecutive robotic approaches. Phase 2a and 2b included urodynamics and imaging assessment of the patients treated.
Results
From February 2016 to September 2017 FloRIN was performed in 18 patients. Comparing the first three (Phase 2a) with the subsequent 15 patients (Phase 2b), the median (interquartile range IQR) reconstruction operating time was 260 (220–340) vs 160 (150–210) min, respectively. Postoperative surgical complications occurred in four of the 18 patients (22.1%), including one surgical Clavien–Dindo Grade III and three Grade I, postoperative medical Clavien–Dindo Grade II complications occurred in three (16.7%) patients. On urodynamic examination (available in nine 50% patients) the median (IQR) reservoir cystometric capacity, compliance, and post‐void residual were 240 (220–267) mL, 18 (12.5–19.8) mL/cmH2O, and 0 (0–50) mL, respectively. Ultrasonography showed no Grade ≥2 vesico‐ureteric reflux.
Conclusion
We describe the FloRIN configuration, showing its technical feasibility with acceptable time efficiency. The first cases studied had good reservoir capacity, low pressure with no reflux, and complete voiding.
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