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Background: Retrograde intrarenal surgery (RIRS) using flexible ureterorenoscopes is a cornerstone approach for renal stone removal, yet it carries a significant risk of postoperative urinary tract infection (UTI). With the emergence of single-use ureterorenoscopes, there is growing interest in their potential to mitigate this risk. This study aimed to compare the postoperative infection rates between single-use and multi-use ureterorenoscopes in RIRS procedures and to identify predictors of postoperative UTI. Methods: Data were collected from 112 consecutive patients who underwent RIRS for renal stones between March 2022 and September 2023. Peri-operative variables including age, gender, body mass index (BMI), stone size, stone location, type of ureterorenoscope, Hounsfield Units (HU), pre-operative hydronephrosis, laboratory analysis, and operative time were evaluated. Univariate and multivariate logistic regression analyses were performed to assess the predictors of postoperative UTI. Results: Of the cohort, 77 surgeries (68.7%) utilized multi-use ureterorenoscopes, while 35 (31.3%) utilized single-use devices. Stone diameter, number of stones, type of ureterorenoscope, and operative time were significant predictors of postoperative UTI in the univariate analysis. Multivariable logistic regression showed that operative time (OR, 1.3; 95% CI, 0.55–0.99; p = 0.03) and type of ureterorenoscope (multi-use vs. single-use) (OR, 1.14; 95% CI, 1.08–1.2; p < 0.001) were independent predictors of postoperative UTI. Conclusions: In conclusion, this study highlights that multi-use ureterorenoscopes and prolonged operative time are associated with an increased risk of postoperative UTI in RIRS procedures. Careful pre-operative evaluation and meticulous patient selection are essential to minimize the occurrence of postoperative UTIs and optimize patient outcomes in RIRS for renal stones.

Background: Check-Mate 274 has demonstrated the disease-free survival (DFS) benefit of adjuvant nivolumab in surgically treated muscle-invasive bladder cancer (MIBC). Since immunotherapy represents an expensive treatment with potential side effects, a better understanding of patient-specific risks of disease progression might be useful for clinicians when weighing the indication for adjuvant nivolumab. Objective: To identify the criteria for risk stratification of disease progression among MIBC patients eligible for adjuvant nivolumab. Materials and methods: A single-institution, prospectively maintained database was queried to identify patients eligible for adjuvant nivolumab according to Check-Mate 274 criteria. To account for immortal bias, patients who died or were lost to follow-up within 3 months of undergoing a radical cystectomy (RC) were excluded. Kaplan–Meier and Cox regression analyses addressed DFS, defined as the time frame from diagnosis to the first documented recurrence or death from any cause, whichever occurred first. Regression tree analysis was implemented to identify criteria for risk stratification. Results: Between 2011 and 2022, 304 patients were identified, with a median follow-up of 50 (IQR 24–72) months. After multivariable adjustment, including NAC as a potential confounder, higher CCI (HR 1.56, 95%CI 1.10–2.21, p = 0.013), T stage (HR 2.06, 95%CI 1.01–4.17, p = 0.046), N stage (HR 1.73, 95%CI 1.26–2.38, p = 0.001) and presence of LVI (HR 1.52, 95%CI 1.07–2.15, p = 0.019) increased the risk of disease recurrence or death. Finally, a two-tier classification was developed. Here, five-year DFS rates were 56.1% vs. 18.1 for low vs. high risk (HR: 2.54, 95%CI 1.79–3.62, p < 0.001). Conclusions: The current risk classification, if externally validated on larger samples, may be useful when weighing the risk and benefit of adjuvant nivolumab treatment and making patients more aware about their disease and about the need for additional treatment after RC. [ABSTRACT FROM AUTHOR]

Purpose: Despite advancements in prostate multiparametric magnetic resonance imaging (mpMRI) and fusion biopsy (FB), the management of incidental prostate cancer (IPCa) after surgery for benign prostatic obstruction (BPO) remains unclear. The aim of this retrospective study is to determine the prevalence of IPCa in our cohort and identify potential predictors for its occurrence. Methods: We enrolled patients underwent TURP or simple prostatectomy for BPO at our high-volume center between January 2020-December 2022. Data on age, pre-operative total PSA (tPSA) and PSA density (PSAd) levels, prostate volume, previous MRI, biopsies, specimen weight, rates of positive tissue slices, ISUP score and three-month tPSA were collected. Results: Of 454 patients with negative digital rectal examination who underwent BPO surgery, 74 patients (16.3%) were found to have IPCa. Of these, 33 patients (44.6%) had undergone previous mpMRI. Among the patients who had mpMRI, 23 had negative mpMRI results for suspected prostate cancer, while 10 had positive mpMRI findings (PIRADS ≥ 3) but no evidence of tumor upon FB. KW analysis indicates that PSAd was statistically associated with higher ISUP score, while at univariable regression analysis negative mpMRI (p = 0.03) was the only potential predictor for IPCa. Conclusions: Among the ISUP groups, PSAd showed a correlation with the tumor, while negative mpMRI was protective against clinically significant PCa. In the era of mpMRI and FB, the IPCa rates found at our center is higher than reported in existing literature and if it were confirmed with further studies, maybe there is a need for expansion in urology guidelines. [ABSTRACT FROM AUTHOR]

Prostate cancer (PCa) surgery has a strong impact on men’s social and sexual lives. For this reason, many patients ask for robotic surgery. To assess the rate of lost patients due to the lack of a robotic platform (RPl) at our center, we retrospectively selected 577 patients who underwent prostate biopsy between 2020 and 2021 who were eligible for radical prostatectomy (RP) (ISUP ≥ 2; age ≤ 70 yr). Patients eligible for surgery who decided to be operated received a phone call interview asking the reason for their choice. Overall, 230 patients (31.7%) underwent laparoscopic-assisted radical prostatectomy (LaRP) at our center, while 494 patients (68.3%) were not treated in our hospital. Finally, 347 patients were included: 87 patients (25.1%) underwent radiotherapy; 59 patients (17%) were already under another urologist’s care; 113 patients (32.5%) underwent robotic surgery elsewhere; and 88 patients (25.4%) followed the suggestion of friends or relatives based on their surgical experience. Despite no surgical technique for RP having shown superiority in terms of oncological or functional outcomes, patients eligible for PCa treatment decided to be operated on elsewhere because of the lack of an RPl. Our results show how the presence of an RPl may increase the case volume of RP by 49% at our center.

Introduction: Hugo Robot-Assisted Surgery (RAS) System has been conceived with enhanced modularity but its role for nephron-sparing surgery setting still remains poorly explored. We aimed to describe our experience in robot-assisted partial nephrectomy (RAPN) with a three-arms setting for the first off-clamp series using the new Hugo RAS System. Methods: Patients were placed on an extended flank position at the margin of the surgical bed with a slightly flexion (45°). The first 11 mm robotic trocar (camera port) was placed along the pararectal line 14 ± 2 cm far from the umbilicus. The pneumoperitoneum was then induced through the AirSeal system (SurgiQuest, Milford, Connecticut, USA©). Two more 8 mm operative robotic ports were placed under direct vision, either 8 ± 1 cm far from optic's port. Two 12 mm laparoscopic ports for bed-assistant were placed between robotic ports. Monopolar curved shears, fenestrated grasper, and large needle driver were used in a three-instruments configuration. Results: Off-clamp RAPN was successfully performed in seven patients with cT1 renal masses using a trans-peritoneal route. Median port placement and docking time was 6 min (IQR, 4–8 min). Hemostasis was achieved through renorraphy using a single transfix stitch with sliding clips technique. There was no need for additional ports placement. No intraoperative complications occurred, no clashing of robotic instruments or between the robotic arms was observed. No technical failures of the system occurred. Median console time was 83 min (IQR, 68–115 min). Median estimated blood loss were 200 ml (IQR, 50–400 ml). All patients were discharged between post-operative day 2 and 3, without the need of hospital readmission. No complications were recorded within the first 30 post-operative days. Conclusions: We performed the first series of off-clamp RAPN using the novel HUGO RAS System. This novel robotic platform showed an easy-friendly docking system, providing excellent perioperative outcomes with a simple three-arms configuration. [ABSTRACT FROM AUTHOR]

Abstract Kinkarakawa-gami wallpapers are unique works of art produced in Japan between 1870 and 1905 and exported in European countries, although only few examples are nowadays present in Europe. So far, neither the wallpapers nor the composing materials have been characterised, limiting the effective conservation–restoration of these artefacts accounting also for the potential deteriogen effects of microorganisms populating them. In the present study, four Kinkarakawa-gami wallpapers were analysed combining physical–chemical and microbiological approaches to obtain information regarding the artefacts’ manufacture, composition, dating, and their microbial community. The validity of these methodologies was verified through a fine in blind statistical analysis, which allowed to identify trends and similarities within these important artefacts. The evidence gathered indicated that these wallpapers were generated between 1885 and 1889, during the so-called industrial production period. A wide range of organic (proteinaceous binders, natural waxes, pigments, and vegetable lacquers) and inorganic (tin foil and pigments) substances were used for the artefacts’ manufacture, contributing to their overall complexity, which also reflects on the identification of a heterogeneous microbiota, often found in Eastern environmental matrices. Nevertheless, whether microorganisms inhabiting these wallpapers determined a detrimental or protective effect is not fully elucidated yet, thus constituting an aspect worth to be explored to deepen the knowledge needed for the conservation of Kinkarakawa-gami over time.

Purpose: In recent years, water vapor thermal therapy (WVTT) has spread as minimally invasive technique in lower urinary tract symptoms due to benign prostatic hyperplasia treatment. Even if its safety and feasibility have been largely proved in young men, nobody has proved the same feasibility and safety in the elderly (men older than 75 years old). Our aim is to compare WVTT safety outcomes in men older than 75 with younger men. Methods: We prospectively collected data on men who underwent water vapor thermal therapy from 2019. We compared data on operative time, number of injections, intra-operative and post-operative complications, reinterventions rate. Results: We enrolled 426 patients; among these, 60 were older than 75 years old, 366 were younger. Our cohorts of patients had similar results in terms of intra-operative and post-operative complications. Operative time accounts about 11 min for both groups (p = 0.535), total number of injections was seven for young men and eight for elderly (p = 0.314). We found no intra-operative complications in elderly men group and only one in the younger group (p = 0.678), while five younger men underwent clot retention, and two elderly men experienced this complication (p = 0.239). Only one transfusion occurred in the elderly group. No differences between groups occurred in terms of length of stay, post-operative urinary retention and reintervention rate, while catheterization time was longer in the elderly men. Conclusion: WVTT is a safe procedure in elderly patients with comparable intra-operative and post-operative complication rate in comparison with younger patients. [ABSTRACT FROM AUTHOR]

Introduction: The economic contribution of medical schools to major urban centres can be substantial, but there is little information on the contribution to the economy of participating communities made by schools that provide education and training away from major cities and academic health science centres. We sought to assess the economic contribution of the Northern Ontario School of Medicine (NOSM) to northern Ontario communities participating in NOSM's distributed medical education programs. Methods: We developed a local economic model and used actual expenditures from 2007/08 to assess the economic contribution of NOSM to communities in northern Ontario. We also estimated the economic contribution of medical students or residents participating in different programs in communities away from the university campuses. To explore broader economic effects, we conducted semi-structured interviews with leaders in education, health care and politics in northern Ontario. Results: The total economic contribution to northern Ontario was $67.1 million based on $36.3 million in spending by NOSM and $1.0 million spent by students. Economic contributions were greatest in the university campus cities of Thunder Bay ($26.7 million) and Sudbury ($30.4 million), and $0.8-$1.2 million accrued to the next 3 largest population centres. Communities might realize an economic contribution of $7300-$103 900 per pair of medical learners per placement. Several of the 59 interviewees remarked that the dollar amount could be small to moderate but had broader economic implications. Conclusion: Distributed medical education at the NOSM resulted in a substantial economic contribution to participating communities. Introduction : Les ecoles de medecine peuvent apporter des avantages economiques importants aux grands centres urbains. On n'en sait guere toutefois sur l'apport economique, pour les communautes participantes, des ecoles qui offrent des cours et de la formation hors des grandes villes et loin des centres universitaires des sciences de la sante. Nous avons voulu evaluer la contribution economique de l'Ecole de medecine du Nord de l'Ontario (EMNO) aux communautes qui participent a ses programmes d'apprentissage distribue. Methodes : Nous avons cree un modele economique local et utilise les depenses reelles de 2007/08 pour evaluer l'apport economique de l'EMNO aux communautes du Nord de l'Ontario. Nous avons aussi estime l'apport economique des etudiants en medecine ou des medecins residents qui participent aux divers programmes offerts dans les communautes eloignees des campus de l'universite. Enfin, pour explorer les repercussions economiques plus vastes, nous avons effectue des entrevues semi-structurees aupres de chefs de file des milieux de l'education, des soins de sante et de la politique dans le Nord de l'Ontario. Resultats : L'apport economique total de l'EMNO s'est chiffre a 67,1 millions de dollars (depenses de l'Ecole, 36,3 millions; depenses des etudiants, 1,0 million). L'apport economique a ete le plus important pour les villes qui hebergent un campus de l'universite, soit Thunder Bay (26,7 millions) et Sudbury (30,4 millions), les 3 centres suivants en importance beneficiant d'un apport de 0,8 a 1,2 million de dollars. Les communautes peuvent realiser des benefices economiques de 7 300 $ a 103 900 $ par paire d'apprenants en medecine par placement. Plusieurs des 59 personnes interviewees ont souligne que le montant des contributions, en argent, peut etre assez petit ou moyen, mais que les repercussions economiques se font sentir a plus grande echelle. Conclusion : L'education medicale distribuee a l'EMNO a apporte une contribution economique substantielle aux communautes participantes., INTRODUCTION The economic contribution of medical schools can be considerable. However, little information exists on the contribution to host cities; most assessments estimate contribution at the state or provincial level. [...]

To address shortages of health professional human resources and overcome cultural barriers, interdisciplinary health care teams in most northern Canadian aboriginal communities include paraprofessionals recruited locally. This paper identifies factors fundamental to effective team functioning, arguing for an extension of the information on interdisciplinary practice included in health science education programs to address this issue. (SM)