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Resumen Contexto y objetivos Esta es la primera encuesta nacional que evalua los programas de la residencia de Urologia en Grecia. El objetivo principal de este estudio es evaluar el nivel de confianza y la percepcion de los residentes griegos de Urologia respecto a su programa educativo y detectar las areas susceptibles a ser mejoradas. Material y metodos Se elaboro una encuesta de 51 preguntas a traves de una plataforma electronica y fue respondida por 91 de 104 residentes griegos desde marzo de 2019 hasta mayo de 2019. Se utilizo el test exacto de Fisher, el test de chi-cuadrado y el test de Kruskal-Wallis, con una significacion estadistica establecida en p = 0,05. Resultados La satisfaccion global de la formacion quirurgica obtuvo una media de 6/10, independientemente de la jornada laboral, de trabajar en un departamento universitario, el ano de posgrado (postgraduate year) o el numero de residentes en el centro. La mayoria de los residentes no habia realizado ninguna ecografia escrotal ni estudios de flujo-presion, pero estaba familiarizado con la ecografia de vias urinarias (KUB). La insercion del cateter doble J y la cistoscopia eran procedimientos conocidos para los residentes. El 70,4% de los residentes senalaron la burocracia como un problema importante. El 80,2% no habia realizado ninguna litotricia extracorporea por ondas de choque, y el 58,2% de los residentes habia realizado menos de 10 ureteroscopias. Solo en el ultimo ano, los residentes realizaron mas de 10 procedimientos de reseccion transuretral de tumor vesical y de reseccion transuretral de la prostata. La mayoria de los residentes mencionaron que rara vez realizaban los pasos basicos de muchos procedimientos urologicos por via abierta o laparoscopica. Sorprendentemente, el 59,3% de los residentes no habia publicado ningun estudio sometido a revision por pares en revistas cientificas. El 44% afirmo rara vez sentirse satisfecho con su trabajo y el 59,3% reporto la sensacion de agotamiento (burnout) ocasional. La tasa de respuesta alcanzo el 87,5%. Conclusiones Teniendo en cuenta los resultados de esta encuesta, las autoridades reguladoras deberian aunar esfuerzos para establecer un plan de estudios estructurado de formacion clinica, quirurgica y de investigacion en Urologia en toda Europa.

Background and objectives This is the first national survey assessing Greek Urology residency programs. The main objective of this study is to assess the level of confidence and perception of Greek Urology residents regarding their educational program and detect areas of improvement. Material and methods A 51-question survey was developed via an electronic platform and answered by 91 out of 104 Greek residents from March 2019 until May 2019. Fisher's exact test, chi-squared test and Kruskal–Wallis test were used with statistical significance set at p = .05. Results The median overall satisfaction regarding surgical training was 6/10 regardless of working schedule, working in a University Department, PGY or number of residents in clinic. Most residents have not performed any scrotal ultrasound or pressure-flow-studies; however, they are more familiar with KUB ultrasound. Double-J stent insertion and cystoscopy were common procedures for residents. Bureaucracy was reported as a major issue by 70.4% of residents. ESWL has not been performed by 80.2% of residents, 58.2% residents performed less than 10 ureteroscopies, and only the last year trainees performed more than 10 TURBT and TURP. Most residents mentioned to rarely perform basic steps in many open or laparoscopic urological procedures. Surprisingly, 59.3% of residents have not published any study in peer-reviewed journals. Regarding satisfaction, 44% rarely feel satisfied at work and 59.3% sometimes suffer from burnout. Response rate reached 87.5%. Conclusions Considering the results from this survey, regulatory authorities should join forces to establish a structured curriculum of clinical, surgical and research training in Urology across Europe.

The wide availability of cross-sectional imaging is responsible for the increased detection of small, usually asymptomatic renal masses. More than 50 % of renal cell carcinomas (RCCs) represent incidental findings on noninvasive imaging. Multimodality imaging, including conventional US, contrast-enhanced US (CEUS), CT and multiparametric MRI (mpMRI) is pivotal in diagnosing and characterizing a renal mass, but also provides information regarding its prognosis, therapeutic management, and follow-up. In this review, imaging data for renal masses that urologists need for accurate treatment planning will be discussed. The role of US, CEUS, CT and mpMRI in the detection and characterization of renal masses, RCC staging and follow-up of surgically treated or untreated localized RCC will be presented. The role of percutaneous image-guided ablation in the management of RCC will be also reviewed.

Objective To evaluate the difference between the PSA density (PSAD) calculated with 3 imaging modalities and the PSAD of the radical prostatectomy specimen. Materials and methods The PSAD of 60 men with clinically localized prostate cancer was calculated with transabdominal ultrasound (TAUS), transrectal ultrasound (TRUS), and computed tomography (CT) before radical retropubic prostatectomy, and was compared with the PSAD of the surgical specimen using the paired t -test. The relationship of the real prostate volume and the difference between the PSAD calculated with the 3 imaging modalities and that of the PSAD of the specimen was analyzed using Pearson's correlation coefficient. Finally, the sensitivity of PSAD calculated with the examined imaging modalities and the specimen was also studied. Results The mean difference between the PSAD calculated by each one of the 3 imaging modalities and the PSAD of the specimen was −0.01 ng/ml/cm 3 ( P = 0.28) for TAUS, 0.01 ng/ml/cm 3 ( P = 0.37) for TRUS, and −0.03 ng/ml/cm 3 ( P = 0.001) for CT. This difference has not been shown to depend on the real prostate volume according to Pearson's correlation coefficient, which was 0.056 ( P = 0.673) for TAUS, −0.014 ( P = 0.917) for TRUS, and 0.184 ( P = 0.159) for CT. The sensitivity of PSAD calculated with TAUS, TRUS, and CT was 58.3%, 65%, and 45%, respectively, while that of the specimen was 70%. Conclusions Although PSAD showed a moderate sensitivity, TRUS and TAUS are the imaging modalities that calculate it closer to the real PSAD of the specimen.

Objectives Initial publications on postchemotherapy laparoscopic retroperitoneal lymph node dissection (LRPLND) have described significant intraoperative and postoperative morbidities. This report reviewed the complication rate with additional experience. Methods A retrospective review of the medical records of 16 consecutive patients who underwent postchemotherapy LRPLND by a single surgeon from September 1996 to September 2005 was performed. The evaluation included tumor type, clinical stage, pathologic stage, and intraoperative and postoperative complications. Results Postchemotherapy LRPLND was successfully performed in 14 (87.5%) of 16 patients. Seven patients (43.8%) developed complications and 2 (12.5%) required open conversion. The most complications occurred during the postoperative period and were classified as minor. Of the total patient population, 25% had minor postoperative complications. The median hospital stay was 2 days. No patient who underwent the procedure died. All intraoperative complications were vascular injuries and occurred during the first half of the series (1996 to 2000). In the second half of the series (2000 to 2005), no complications during the operative period and no vascular or major complications occurred. No retroperitoneal recurrence was noted during a mean follow-up of 32.7 months (range 5 to 108). One patient developed distant recurrence and underwent successful salvage chemotherapy. Conclusions Postchemotherapy LRPLND remains a challenging, but feasible, operation. With greater experience, the incidence of complications and morbidity can be reduced.

Objectives Percutaneous renal tumor cryoablation is being evaluated as a treatment option for small renal tumors. However, when tumors are located centrally, involvement of the collecting system by the radiographic iceball can occur. We reviewed our series of computed tomography (CT)-guided percutaneous renal tumor cryoablation to identify those cases in which there appeared to be involvement of the collecting system by the radiographic iceball and to determine any clinical sequelae of such involvement. Methods Retrospective review of the medical records identified 6 patients who had undergone CT-guided percutaneous renal tumor cryoablation with evidence of collecting system involvement. Measurements of the tumor size, size of the radiographic iceball, and the size of the immediate postprocedure “cryozone” (region of apparent treatment on contrast-enhanced CT) were obtained from the preprocedure, intraprocedure, and immediate postprocedure CT scans. Follow-up imaging was obtained beginning at 3 to 6 months. Results Six patients were identified who met the inclusion criteria and had at least 3 months of documented follow-up. Despite the apparent involvement of the collecting system during the cryoablation procedure, no patient developed clinical signs or symptoms or radiographic evidence of a urine leak or fistula formation. Furthermore, no evidence of ureteral narrowing or stricture formation has been found to date, with a mean follow-up of 167.7 days (range 90 to 288). Conclusions We observed no clinically appreciable urine leaks despite what appeared to be obvious involvement of the collecting system by the radiographic iceball. However, care should be exercised to avoid this insult when possible until additional research has confirmed its safety.

fi c apid technological developments and global communication in the past two decades have evolutionized the surgical sciences. Advances in ptics and instrumentation encouraged a leap from raditional open operating techniques to the minially invasive surgeries of today. Urology has been t the forefront of these innovations, introducing ndourologic techniques into everyday practice to reat a myriad of genitourinary ailments. Patients ave embraced these novel approaches as they ave addressed concerns of postoperative pain, osmesis, and convalescence. However, inherent limitations with some advanced inimally invasive techniques have restricted uniersal mastery by urologists. For example, laparocopic urologic surgery has been relatively slow to be ncorporated into general practice. Two-dimensional isualization, restricted maneuverability, and dampned tactile feedback, present challenges to surgeons rained in traditional open approaches. Although eneral surgery has the cholecystectomy and gyneology has the tubal ligation, urology lacks a simple aparoscopic platform for acquiring the requisite kill. The learning curve for urologic laparoscopy is ong, necessitating significant training and continued xposure. The advent of computer-assisted robotic systems as provided a potential solution to address these imitations. They also open the door for developing ovel, until now impossible, procedures. Morever, the rapid expansion of Internet resources and odern audiovisual media has allowed for realime guidance and remote surgical assistance. This eview addresses the background, advances, and ontinuing challenges associated with robotic surical systems and telesurgery.

To evaluate, in an animal model, differences in wound healing and scar formation in healthy urethra and bladder neck incised with the erbium (Er):yttrium-aluminum-garnet (YAG) and holmium (Ho):YAG lasers.In each of 18 domestic pigs, three 1-cm-long incisions were made, two at the bladder neck and one in the mid-urethra, using either the Er:YAG laser (9 pigs) or the Ho:YAG laser (9 pigs). In each laser group, 3 animals were killed on postoperative days 0, 6, and 14. The width of collateral damage, as evidenced by coagulation necrosis and granulation tissue at the wound base, and the incision depth were evaluated during tissue analysis.The collateral damage with the Er:YAG laser at postoperative day 0, 6, and 14 was 20 +/- 5, 900 +/- 100, and 430 +/- 100 microm, respectively. The collateral damage with the Ho:YAG laser was 660 +/- 110, 2280 +/- 700, and 1580 +/- 250 microm, respectively. The amount of granulation tissue was significantly less (P0.05) at all time points with the Er:YAG laser. Similarly, the incision depths for the Er:YAG and Ho:YAG laser at postoperative day 6 (1100 +/- 200 microm versus 1500 +/- 300 microm, respectively) and 14 (670 +/- 140 microm versus 1240 +/- 140 microm, respectively) were also significantly less (P0.05) for the Er:YAG laser group, indicating faster healing of the wound created.In this in vivo animal study, incisions in the urethra and bladder neck made with the Er:YAG laser healed faster and with less scar formation than incisions made with the Ho:YAG laser.

Objectives: Neoadjuvant chemotherapy has been used to improve outcome after cystectomy or for selection for bladder preservation in patients with bladder cancer. We have shown encouraging results using docetaxel and cisplatin in patients with advanced urothelial cancer. We are reporting the results of a phase II study using this combination as neoadjuvant treatment in patients with muscle invasive bladder cancer. Methods: Fifty patients were treated with docetaxel and cisplatin at 75mg/m 2 every 3 weeks for 3 cycles prior to cystectomy. Median follow-up was 70.2 months. Results: Chemotherapy was well tolerated. 5-year survival and progression-free survival (PFS) were 51.92% (95% confidence intervals [CI]: 37.76–66.08) and 52.47% (95%CI: 37.99–66.95). Multivariate analysis showed that clinical stage (cT) ≤ 3a was associated with improved 5-year survival (86.42% vs. 40.81%, p =0.027). Forty one patients underwent cystectomy. No tumor was found in 15 cases (36.6%). 5-year survival was 60.34% (95%CI: 52.2–68.48) and PFS was 57.11% (95%CI: 41.29–72.93). Absence of residual tumor was associated with improved 5-year survival (93.33% vs. 40.72%, p =0.031). Conclusions: Neoadjuvant chemotherapy with docetaxel and cisplatin is feasible and produced high pathological complete remission rate and excellent outcome in patients with no residual tumor.

Objectives To provide information about the long-term efficacy of transvesical prostatectomy from a contemporary series of patients. When comparing minimally invasive procedures with open prostatectomy, the data for the latter are usually provided from old studies or from recent ones performed in developing countries. However, this procedure is still used frequently for large-size prostates. Methods During a 5-year period, 232 patients with large (greater than 75 g) prostates underwent open transvesical prostatectomy for symptomatic benign prostatic hyperplasia. Patient charts were retrospectively reviewed for preoperative and postoperative International Prostate Symptom Scores, postvoid residual urine volumes, maximal flow rates, early and late postoperative complications, and the need for reoperation. The preoperative International Prostate Symptom Score, postvoid residual urine volume, and maximal flow rate were compared with the corresponding postoperative data at 8 to 12 months and at the last follow-up visit. Results Complete data evaluation was possible for 151 patients, with a mean follow-up of 41.8 ± 15.6 months. Improvement in International Prostate Symptom Score, postvoid residual urine volume, and maximal flow rate was statistically significant (P

Objectives To analyze complications of abdominal laparoscopic surgery of the urinary tract at a single institution during a 5-year period. Methods From 1996 to 2000, we identified 894 abdominal laparoscopic procedures performed at a single institution: 600 nephrectomies (live donor, simple, radical, nephroureterectomy, and partial), 112 pyeloplasties, 61 renal biopsies, 35 retroperitoneal lymph node dissections, 31 renal cyst ablations, 18 adrenalectomies, and 37 other abdominal procedures. The charts were retrospectively reviewed for complications, which were classified as operative, postoperative, or medical. Complications were correlated with patient age and American Society of Anesthesiologists score. Statistical analysis was performed with Fisher's exact test and chi-square tests. Results A total of 118 complications (13.2%) occurred. Two patients (0.2%) died. As a result of operative complications, the procedure of 13 patients (1.5%) was converted to an open one. As a result of postoperative complications, 13 (1.5%) underwent operative and 6 (0.7%) nonoperative intervention. The most common intraoperative complications were vascular (n = 23), adjacent organ (n = 10), and bowel (n = 9) injuries. The most common postoperative complications were neuromuscular pain (n = 12), hematoma (n = 11), urine leak (n = 7), and wound infection (n = 7). The differences in the annual complication rates for all procedures did not attain statistical significance (P = 0.5). Among all procedures, excluding live donor nephrectomy, complications of any kind correlated with a greater patient American Society of Anesthesiologists score (P = 0.01). Conclusions Rather than decreasing, the overall incidence of laparoscopic complications did not change significantly during a 5-year period at our institution. The factors contributing to this observation likely included the progression of inexperienced individual surgeons through the learning curve, the introduction of new, more sophisticated laparoscopic procedures, and stable rates of patient comorbidity. This experience may represent the average complication rate for urologic laparoscopy at a large-volume, academic training center.

Extrapulmonary small cell carcinoma is an infrequent tumor that can occur in various organs. Although a few sporadic reports about extrapulmonary small cell carcinoma have been published, much remains to be uncovered about the clinical features, optimal treatment, and natural history. We present a case of small cell carcinoma of the epididymis with retroperitoneal recurrence, an exceedingly rare tumor with behavior and treatment not well characterized. Multimodal therapy with chemotherapy and retroperitoneal lymph node dissection was necessary to manage this aggressive disease.

If the final pathologic examination reveals a carcinoid tumor of the kidney, additional evaluation to rule out another occult primary tumor site is necessary. If the primary origin of the tumor is confirmed to be from the kidney, additional evaluation is required for the detection of metastasis. Renal carcinoid tumors are extremely rare; however, both primary and metastatic renal carcinoid tumors have been reported. We report a case of a 40-year-old woman with primary carcinoid of the kidney and metastatic disease in the liver not evident by computed tomography and magnetic resonance imaging but identified by somatostatin receptor scintigraphy.