OBJECTIVE:To evaluate outcomes in cancer patients with ureteral obstruction by comparison of retrograde stenting and percutaneous nephrostomy techniques. METHODS:Systematic review of all studies up to October 2023. Studies were identified from all major databases including MEDLINE, Cochrane, and EMBASE. All comparative studies between retrograde stenting and percutaneous nephrostomy were searched; studies with paediatric populations were excluded. Primary outcomes were procedure and intervention failure rates; secondary outcomes were infection, blockage, displacement, and unplanned exchange rates along with procedure time and length of stay. RESULTS:Eighteen studies with 1228 patients contributed to the summative outcome. Percutaneous nephrostomy was statistically superior to retrograde stenting for procedure failure rate (P <.00001) and intervention failure rate (P =.0004). Retrograde stenting was statistically superior to percutaneous nephrostomy for displacement rates (P = .003), procedure time (P <.00001), and length of stay (P <.00001). Retrograde stenting showed no difference to percutaneous nephrostomy for infection rates (P = .94), blockage rates (P = .93), unplanned exchange rates (P = .48), CONCLUSION: There is no absolute superiority for retrograde stenting or percutaneous nephrostomy for malignant ureteral obstruction. Both techniques have their advantages and disadvantages, with some comparable outcomes; patients are key when selecting the best technique. Larger studies are required to assess the outcomes of both techniques.

Background:Urology has been at the forefront of adopting laparoscopic and robot-assisted techniques to improve patient outcomes. This systematic review aimed to examine the literature relating to the learning curves of major urological robotic and laparoscopic procedures. Methods:In accordance with PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, a systematic literature search strategy was employed across PubMed, EMBASE, and the Cochrane Library from inception to December 2021, alongside a search of the grey literature. Two independent reviewers completed the article screening and data extraction stages using the Newcastle-Ottawa Scale as a quality assessment tool. The review was reported in accordance with AMSTAR (A MeaSurement Tool to Assess systematic Reviews) guidelines. Results:Of 3702 records identified, 97 eligible studies were included for narrative synthesis. Learning curves are mapped using an array of measurements including operative time (OT), estimated blood loss, complication rates as well as procedure-specific outcomes, with OT being the most commonly used metric by eligible studies. The learning curve for OT was identified as 10-250 cases for robot-assisted laparoscopic prostatectomy and 40-250 for laparoscopic radical prostatectomy. The robot-assisted partial nephrectomy learning curve for warm ischaemia time is 4-150 cases. No high-quality studies evaluating the learning curve for laparoscopic radical cystectomy and for robotic and laparoscopic retroperitoneal lymph node dissection were identified. Conclusion:There was considerable variation in the definitions of outcome measures and performance thresholds, with poor reporting of potential confounders. Future studies should use multiple surgeons and large sample sizes of cases to identify the currently undefined learning curves for robotic and laparoscopic urological procedures.

The management of recurrent non-muscle-invasive bladder cancer (NMIBC) typically requires repeated transurethral resections under general anaesthesia. This is costly and results in poor health-related quality-of-life for patients. Outpatient-based laser ablation and diathermy to recurrent tumours could reduce morbidity and cost of managing NMIBC. This systematic review evaluates the safety and efficacy of outpatient-based diathermy or laser ablation for recurrent NMIBC. The EMBASE, MEDLINE and Cochrane Library were searched until June 2020. All studies evaluating the use of outpatient diathermy or laser ablation for NMIBC were included. The quality of evidence and risk of bias were assessed using the GRADE and ROBINS-I tools, respectively. From 1328 studies identified, 17 studies (1584 patients) were included. Overall, the majority of tumours (80%) were low-grade (G1 and G2). Laser ablation and diathermy resulted in a mean recurrence rate of 47% and 40% at 20-31 months follow-up, respectively, with a mean progression rate of 3-11%. Both procedures were well-tolerated with low pain scores (mean score of 1) and low periprocedural complication rates. However, the overall quality of evidence of low. This review demonstrates that both procedures have good short-term efficacy in patients with low-grade NMIBC. The procedures are well-tolerated with low complication rates and importantly, reduce the need for intervention under general anaesthesia. These findings can aid patient counselling regarding less invasive treatment options, avoiding the morbidity of transurethral resection. Future randomised studies with standardised risk stratification and outcome measures are required to add to the quality of evidence.

Early exposure of medical students to surgical skills has been associated with an increased interest in pursuing a career in surgery. This study aimed to investigate the impact of student background on basic laparoscopic skills acquisition and perceived stress to workload during simulation. Students were recruited to a course modelled on the European Basic Laparoscopic Urological Skills (E-BLUS) programme. Students filled out a pre-course demographic survey, and a post-course survey that evaluated perceived stress to workload (SURG-TLX). Pre- and post-course confidence in laparoscopic skills, performance in the course, as well as SURG-TLX parameters were statistically compared for all demographic factors. Twenty-three participants completed the course, fifteen (65%) of which were female. Ten students were junior (first and second year), and thirteen were senior (third year and above). Hobbies were grouped into either requiring hand-eye coordination (n=9), manual dexterity (n=9), or no relevance to surgery (n=5). No significant differences were found in demographic factors for course performance or pre- and post-course confidence. No significant differences were found between male and female students, and between different hobby groups, in all SURG-TLX parameters. Senior students reported a significantly higher Physical Demand of the SURG-TLX compared to juniors (p=0.042). No differences were found in other parameters. Our study showed no correlation between student background (notably sex and stage of medical school) and basic laparoscopic skills acquisition or stress during simulation. We therefore suggest that medical students are provided with more exposure to acquire basic laparoscopic skills regardless of their background. Medical student background is not a discriminator in surgical simulation performance and stress. All medical students, regardless of their sex or stage of medical school, should be given the opportunity to practice laparoscopic skills.

Abstract Objectives The objective of this study is to determine the long‐term efficacy and safety of office‐based Holmium:YAG laser ablation for the treatment of recurrent non‐muscle‐invasive bladder cancer (NMIBC). Methods We retrospectively reviewed the medical records of all consecutive patients who underwent office‐based laser ablation for recurrent bladder cancer between 2008 and 2016. The following data were collected: original histology, date of original histology, date of laser ablation, number of repeat laser ablation procedures required, date of tumor recurrence or progression, number of general anesthesia procedures (transurethral resection or cystodiathermy) required after first laser ablation, and number and severity of complications. Kaplan–Meier survival curves were produced for recurrence‐free survival, progression‐free survival, and overall survival. Results A total of 97 patients, with an average age of 84 (62–98) years and an average Charlson Comorbidity Index of 6.9 (4–13), were included. The median follow‐up was 61 (2–150) months. Fifty‐five (56.7%) patients presented with tumor recurrence, and the median recurrence‐free survival time was 1.69 years (95% CI 1.20–2.25). Only 9 (9.3%) patients had evidence of tumor progression to a higher grade or stage, 8 (89%) of which initially had low‐grade tumors; however, no patient progressed to muscle‐invasive disease. The median progression‐free survival time was 5.70 years (95% CI 4.10–7.60), and the median overall survival time was 7.60 years (95% CI 4.90–8.70). No patient required emergency inpatient admission after laser ablation. Conclusion Office‐based Holmium:YAG laser ablation offers a safe and effective alternative method for treating low‐volume, low‐grade recurrent NMIBC, especially in elderly patients with significant co‐morbidity, while avoiding general anesthesia and inpatient admission.

You have accessJournal of UrologyTransplantation & Vascular Surgery: Renal Transplantation & Vascular Surgery I (PD22)1 Apr 2020PD22-05 RENAL TRANSPLANTATION INTO URINARY DIVERSIONS AND RECONSTRUCTED BLADDERS James Chong*, Rhana Hassan Zakri, Muhammad Shamim Khan, C Geoff Koffman, Nizam Mamode, and Jonathon Olsburgh James Chong*James Chong* More articles by this author , Rhana Hassan ZakriRhana Hassan Zakri More articles by this author , Muhammad Shamim KhanMuhammad Shamim Khan More articles by this author , C Geoff KoffmanC Geoff Koffman More articles by this author , Nizam MamodeNizam Mamode More articles by this author , and Jonathon OlsburghJonathon Olsburgh More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000000872.05AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Renal failure secondary to urological disorders can necessitate urinary diversion or reconstruction either pre or post-kidney transplant. Decision-making regarding timing of diversion/reconstruction may be affected by living (LD) or deceased (DD) donor options. We assessed our kidney transplant outcomes into urinary diversions and reconstructed bladders. METHODS: Single-centre retrospective review of kidney transplants between 1986-2019. Graft and patient survival were calculated, and compared to our general transplant population. RESULTS: 87 patients (mean age 38.2) who had 97 transplants required urinary diversion or reconstruction. 80 of 97 were first transplants. Mean follow-up was 141 months. Cutaneous ureterostomy (CU): 18 transplants (8 LD; 10 DD); 16 CU formed at time of transplant. 1 patient required two sequential transplants; first was diverted to CU 3 years after transplant (for unrecognised neuropathic bladder), the second a planned CU. The other CU was formed 4 years post-transplant for a radiotherapy vesico-vaginal fistula from cervical cancer. Pre-formed ileal conduit (IC): 15 transplants into pre-formed IC (7 LD; 8 DD). 7 of 15 died during follow-up, 4 of 7 with functioning transplant in-situ. Post-transplant IC: 7 transplants into bladder (2 LD; 5 DD) but subsequent IC diversion (5 due to bladder cancer, 1 due to worsening bladder function from spina bifida and 1 from recurrent urosepsis). Reconstructed urinary tract: 57 transplants into augmented bladders using native ureter (4), gastric-segment (1), ileo-caecum (7) and ileum (45). 13 were augmented post-transplant; 2 were undiverted into neo-bladders post-transplant. CONCLUSIONS: Transplantation into urinary diversions and reconstructed bladders appears safe, with similar graft and patient survival to our general transplant population. There has been a significant increase in planned living donor transplant for patients with complex urinary tracts. DD kidney recipients with unsafe bladders may require initial CU before undiversion and reconstruction to prevent complications from a “dry” augment. Source of Funding: None © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 203Issue Supplement 4April 2020Page: e460-e461 Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.MetricsAuthor Information James Chong* More articles by this author Rhana Hassan Zakri More articles by this author Muhammad Shamim Khan More articles by this author C Geoff Koffman More articles by this author Nizam Mamode More articles by this author Jonathon Olsburgh More articles by this author Expand All Advertisement PDF downloadLoading ...

Pneumocystis jirovecii pneumonia (PJP) is a potentially life-threatening infection that occurs in immunocompromised patients. PJP occurs in approximately 5–15% of transplant patients, depending on the transplanted organ and the degree of immunosuppression. In the absence of appropriate treatment, the mortality rate of PJP is 90–100%, and can be as high as 50% despite adequate therapy. Trimethoprim-Sulphamethoxazole (TMP-SMX) is the first choice for the treatment of PJP. Alternative drugs include intravenous Pentamidine, Dapsone, combination of Clindamycin and Primaquine (C+P).