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Background: Intraoperative adverse events (iAEs) are surgical and anesthesiologic complications. Despite the availability of grading criteria, iAEs are infrequently reported in the surgical literature and in cases for which iAEs are reported, these events are described with significant heterogeneity. Objective: To develop Intraoperative Complications Assessment and Reporting with Universal Standards (ICARUS) Global Surgical Collaboration criteria to standardize the assessment, reporting, and grading of iAEs. The ultimate aim is to improve our understanding of the nature and frequency of iAEs and our ability to counsel patients regarding surgical procedures. Design, setting, and participants: The present study involved the following steps: (1) collecting criteria for assessing, reporting, and grading of iAEs via a comprehensive umbrella review; (2) collecting additional criteria via a survey of a panel of experienced surgeons (first round of a modified Delphi survey); (3) creating a comprehensive list of reporting criteria; (4) combining criteria acquired in the first two steps; and (5) establishing a consensus on clinical and quality assessment utility as determined in the second round of the Delphi survey. Outcome measurements and statistical analysis: Panel inter-rater agreement and consistency were assessed as the overall percentage agreement and Cronbach's α. Results and limitations: The umbrella review led to nine common criteria for assessing, grading, and reporting iAEs, and review of iAE grading systems led to two additional criteria. In the first Delphi round, 35 surgeons responded and two criteria were added. In the second Delphi round, 13 common criteria met the threshold for final guideline inclusion. All 13 criteria achieved the consensus minimum of 70%, with agreement on the usefulness of the criteria for clinical and quality improvement ranging from 74% to 100%. The mean inter-rater agreement was 89.0% for clinical improvement and 88.6% for quality improvement. Conclusions: The ICARUS Global Collaboration criteria might aid in identifying important criteria when reporting iAEs, which will support all those involved in patient care and scientific publishing. Patient summary: We consulted a panel of experienced surgeons to develop a set of guidelines for academic surgeons to follow when publishing surgical studies. The surgeon panel proposed a list of 13 criteria that may improve global understanding of complications during specific procedures and thus improve the ability to counsel patients on surgical risk. © 2022 European Association of Urology

The coronavirus has challenged all medical systems worldwide. Herein both waves of COVID-19 (coronavirus disease 2019) in spring and autumn 2020 differ principally. Whereas Europe was hit by the first wave more or less unprepared, which was aggravated by the high virulence of COVID-19, the second wave is characterized by a much higher contagiosity of the virus with very high incidences. On the other hand the virus has attenuated, which is reflected by the significantly lower incidence-related mortality rate. However, the overall increasing number of infected patients represents again a great challenge for the medical management of the disease. France and Spain are doing better in comparison to Germany and Italy this time. The absolute number of deaths per week is higher than during the peak of the first wave. However, urologists in these countries have also experienced greater restrictions in their activities in the second shutdown than in Germany, where there is only a reduction of beds to between 75 and 90%. Mostly all levels are operated. Of importance for Germany, however, is the plateau on a high level for several weeks probably due to the reduced efficacy of a light lock-down. This finally resulted in a total lock-down in mid-December 2020. Subsequently in Germany some hospitals are also reaching their limits with similar consequences for the departments of urology facing a 50% reduction of beds and operating only level III and IV indications. Nevertheless, the management of urologic patients during the COVID-19 pandemic is carried out in Europa on a high standard. Therefor the risk of secondary harm to our patients is expected to be rather minimal in the long run.Das Coronavirus hat weltweit die Medizin vor große Herausforderungen gestellt. Dabei unterscheiden sich die beiden COVID-19-Wellen („coronavirus disease 2019“) im Frühjahr und Herbst 2020 grundsätzlich. Während die erste Welle Europa sehr unvorbereitet traf und sich das Virus durch eine hohe Virulenz auszeichnete, ist die zweite Welle im Herbst von einer hohen Kontagiosität des Virus mit sehr hohen Inzidenzen geprägt. Dabei findet sich aber eine deutlich abgeschwächte Virulenz, was sich in der niedrigeren inzidenzbezogenen Mortalitätsrate widerspiegelt. Andererseits stellt die insgesamt hohe Anzahl betroffener Patienten erneut hohe Anforderungen an die medizinische Versorgung. Im Vergleich schneiden Frankreich und Spanien bei der Bewältigung der zweiten Welle deutlich besser ab als Deutschland und Italien. So liegt die absolute Mortalität pro Woche in Deutschland trotz vergleichbar geringerer Inzidenz über den Werten der ersten Welle. Allerdings waren die Urologischen Kliniken in diesen Ländern auch von dem schärferen zweiten Lockdown mehr betroffen als dies in Deutschland aktuell der Fall ist, wo eine Bettreduktion zwischen 75 und 90 % besteht und immer noch alle Level operiert werden. Entscheidend für Deutschland ist aber das jetzt beobachtete mehrwöchige Plateau auf hohem Niveau, wohl bedingt durch den nur beschränkten Lockdown light. Die wieder steigenden Zahlen führten zum totalen Lockdown Mitte Dezember. Damit kommen auch in Deutschland Kliniken an ihre Grenzen, was auch entsprechende Auswirkungen auf die Situation in den Urologischen Kliniken hat mit ebenfalls 50%iger Reduktion der Operationskapazität und Reduktion auf nur Level-III- bis -IV-Eingriffe. Dennoch ist das Management urologischer Patienten inzwischen europaweit von hoher Qualität und Umsicht, so dass langfristige Sekundärschäden für unsere Kranken eher selten zu erwarten sind.

Background: The European School of Urology (ESU) and EAU Section of Uro-Technology (ESUT) started hands-on-training (HOT) sessions in 2007 along with structured European Basic Laparoscopic Urological Skills (EBLUS) examinations in 2013. EBLUS includes an online theoretical course, HOT by expert tutors on a set of dry-lab exercises, and finally a standardised examination for skill assessment and certification. Objective: To analyse the results and predictors of success from the EBLUS examinations that were conducted during the European Urology Residents Education Programme (EUREP) and other international and national dedicated ESU events. Design, setting, and participants: ESU has been delivering EBLUS courses and examinations over the past 6 yr (2013–2018) in more than 40 countries worldwide. Trainees were asked about their laparoscopic background (procedures assisted/performed) and about the availability of HOT or simulator/box trainer in their facility. Apart from the online theoretical course, 4 HOT tasks [(1) peg transfer, (2) pattern cutting, (3) single knot tying, and (4) clip and cut] with its quality assessment of depth perception, bimanual dexterity, and efficiency were a part of the assessment and were considered critical to pass the EBLUS examination. Results and limitations: A total of 875 EBLUS examinations were delivered (EUREP, n = 385; other ESU events, n = 490), with complete data available for 533 (61%) participants among which 295 (55%) passed the examinations. Pass rate increased on a yearly basis from 35% to 70% (p < 0.001) and was similar between EUREP (56%) and other ESU/ESUT events (55%). The significant predictors of success were passing tasks 1 [odds ratio (OR): 869.9, 95% confidence interval (CI): 89.6–8449.0, p < 0.001] and 2 (OR: 3045.0, 95% CI: 99.2–93 516.2, p < 0.001) of the examinations. A limitation of EBLUS was its inability to provide more advanced training such as wet-lab or cadaveric training. Conclusions: Over the past few years more trainees have passed the European Basic Laparoscopic Urological Skills (EBLUS) examinations. Trainees who spend more time on laparoscopic procedures demonstrated a better performance and pass rate. We found almost no difference between the EBLUS results collected from EUREP and other ESU/ESUT events, which confirms the robustness of the training and examinations conducted worldwide. Patient summary: Training in laparoscopy helps trainees pass the European Basic Laparoscopic Urological Skills (EBLUS) examinations, reflected by an increase in the pass rate over the past 6 yr. Our results also confirm the robustness of EBLUS training and examinations worldwide. This paper highlights the robustness of European Basic Laparoscopic Urological Skills (EBLUS) which is now adopted for laparoscopic urology training throughout the world. It shows a growing popularity and preparedness of trainees in laparoscopy, with better examination results for trainees with more exposure to laparoscopy. © 2019

The coronavirus disease 2019 (COVID-19) pandemic is unlike anything seen before by modern science-based medicine. Health systems across the world are struggling to manage it. Added to this struggle are the effects of social confinement and isolation. This brings into question whether the latest guidelines are relevant in this crisis. We aim to support urologists in this difficult situation by providing tools that can facilitate decision making, and to minimise the impact and risks for both patients and health professionals delivering urological care, whenever possible. We hope that the revised recommendations will assist urologist surgeons across the globe to guide the management of urological conditions during the current COVID-19 pandemic. (C) 2020 European Association of Urology. Published by Elsevier B.?V. All rights reserved.

In order to evaluate the potential prognostic/predictive role of androgen receptor (AR) expression in non-muscle-invasive bladder cancer (NMIBC), and whether it may represent a therapeutic target, we conducted a systematic search of the literature using ‘androgen receptor or AR’, ‘testosterone’, ‘bladder cancer’ and ‘non-muscle invasive bladder cancer or NMIBC’ as keywords. Eleven studies met the inclusion/exclusion criteria. No significant association was found between AR status and patients’ gender (p=0.232), tumor size (p=0.975), tumor stage (p=0.237), tumor grade (p=0.444), tumor multicentricity (p=0.397), concomitant CIS (p=0.316) and progression of disease (p=0.397). On the other hand, relative lack of AR expression was significantly correlated to recurrent disease (p=0.001). Evidence for a direct correlation between AR expression and recurrence-free survival of patients with NMIBC indicate ARs as potential markers of BC behavior; moreover, the finding of a role of androgen blockade therapy in improving survival highlights the potential clinical application of this pathway, which deserves to be further explored.

L’articolo illustra una nuova carta geologica in scala 1/2000 della Rupe di San Leo, che è una spettacolare e delicata forma del rilievo posta al centro della Coltre della Val Marecchia. La Rupe è costituita da una successione epiligure che comprende i calcari della F.ne di San Marino e le arenarie della F.ne di Monte Fumaiolo, mentre il substrato della Rupe è costituito da unità liguri prevalentemente argillose. Per mostrare la geometria tridimensionale degli ammassi rocciosi che compongono la Rupe, alla carta geologica 1/2000 sono stati aggiunti dieci line-drawing dei confini geologici affioranti nelle pareti perimetrali. Dall’interpretazione dei dati rilevati sono stati ricavati caratteri stratigrafici inediti e una ben definita cronologia di deformazione. L’elemento tettonico più interessante è la grande faglia distensiva a basso angolo, di origine gravitativa, che affiora alla base delle pareti W, S ed E della Rupe. La faglia di San Leo fa parte di un sistema riconoscibile dal Monte Fumaiolo a Perticara, Torriana, Verucchio e San Marino. Il rilevamento e la datazione di questo sistema di faglie è essenziale per ricostruire la cinematica della coltre della Val Marecchia.

The European Urology Residents Education Programme hands-on training format provides a framework on how to design courses with precourse material, a 1:1 trainee/tutor ratio, 60-min training slots, and dedicated training protocols. Our paper demonstrates the continued collaboration of the European School of Urology with national societies and the wider dissemination of simulation training worldwide. © 2018 European Association of Urology Background: The European School of Urology (ESU) started the European Urology Residents Education Programme (EUREP) in 2003 for final year urology residents, with hands-on training (HOT) added later in 2007. Objective: To assess the geographical reach of EUREP, trainee demographics, and individual quality feedback in relation to annual methodology improvements in HOT. Design, setting, and participants: From September 2014 to October 2017 (four EUREP courses) several new features have been applied to the HOT format of the EUREP course: 1:1 training sessions (2015), fixed 60-min time slots (2016), and standardised teaching methodology (2017). The resulting EUREP HOT format was verified by collecting and prospectively analysing the following data: total number of participants attending different HOT courses; participants’ age; country of origin; and feedback obtained annually. Results and limitations: A total of 796 participants from 54 countries participated in 1450 HOT sessions over the last 4 yr. This included 294 (20%) ureteroscopy (URS) sessions, 237 (16.5%) transurethral resection (TUR) sessions, 840 (58%) basic laparoscopic sessions, and 79 (5.5%) intermediate laparoscopic sessions. While 712 residents (89%) were from Europe, 84 (11%) were from non-European nations. Of the European residents, most came from Italy (16%), Germany (15%), Spain (15%), and Romania (8%). Feedback for the basic laparoscopic session showed a constant improvement in scores over the last 4 yr, with the highest scores achieved last year. This included feedback on improvements in tutor rating (p = 0.017), organisation (p < 0.001), and personal experience with EUREP (p < 0.001). Limitations lie in the difficulties associated with the use of an advanced training curriculum with wet laboratory or cadaveric courses in this format, although these could be performed in other training centres in conjunction with EUREP. Conclusions: The EUREP trainee demographics show that the purpose of the course is being achieved, with excellent feedback reported. While European trainees dominate the demographics, participation from a number of non-European countries suggests continued ESU collaboration with other national societies and wider dissemination of simulation training worldwide. Patient summary: In this paper we look at methodological improvements and feedback for the European Urology Residents Education Programme hands-on-training over the last 4 yr. © 2018 European Association of Urology

Objective: To evaluate the variability of subjective tutor performance improvement (Pi) assessment and to compare it with a novel measurement algorithm: the Pi score. Materials and Methods: The Pi-score algorithm considers time measurement and number of errors from two different repetitions (first and fifth) of the same training task and compares them to the relative task goals, to produce an objective score. We collected data during eight courses on the four European Association of Urology training in Basic Laparoscopic Urological Skills (E-BLUS) tasks. The same tutor instructed on all courses. Collected data were independently analysed by 14 hands-on training experts for Pi assessment. Their subjective Pi assessments were compared for inter-rater reliability. The average per-participant subjective scores from all 14 proctors were then compared with the objective Pi-score algorithm results. Cohen's κ statistic was used for comparison analysis. Results: A total of 50 participants were enrolled. Concordance found between the 14 proctors' scores was the following: Task 1, κ = 0.42 (moderate); Task 2, κ = 0.27 (fair); Task 3, κ = 0.32 (fair); and Task 4, κ = 0.55 (moderate). Concordance between Pi-score results and proctor average scores per participant was the following: Task 1, κ = 0.85 (almost perfect); Task 2, κ = 0.46 (moderate); Task 3, κ = 0.92 (almost perfect); Task 4 = 0.65 (substantial). Conclusion: The present study shows that evaluation of Pi is highly variable, even when formulated by a cohort of experts. Our algorithm successfully provided an objective score that was equal to the average Pi assessment of a cohort of experts, in relation to a small amount of training attempts. © 2018 The Authors BJU International © 2018 BJU International Published by John Wiley & Sons Ltd

In this study we combine observations and analytical data from largescale (10-100s of m-thick and 100 m2-extensive), siliciclastic and carbonate MTD/MTCs belonging to the Oligocene - Miocene foredeep and wedge-top successions of the Northern Apennines and the Paleocene - Eocene Friuli basin of the northwestern Dinarides (Italy and Slovenia), to discuss the deformation processes critical to the emplacement of submarine landslides. We focus on the identification of meso-scale structures, used as diagnostic kinematic indicators of local paleotransport directions. These structures, represented by linear-planar and complexshaped elements such as tabular shear zones and detached slump-type folds, are the product of ductile-plastic deformation developed at relatively low-confining pressure that involves water-saturated, un- to poorly-lithified sediments, along with liquefaction/fluidization processes. Their final appearance is thus mainly controlled by the mechanical-rheological behavior of deformed sediments, and eventually by tectonic fabrics inherited from deeper structural levels of deformation. Due to this parallelism these structures have been termed and classified accordingly. They reflect strain partitioning due to differential movements within the slide mass, which is in turn controlled by the overall landslide typology. Due to the parallelism with classified tectonic structures and structural associations, we have thus redefined and classified accordingly meso-scale kinematic indicators in ancient MTD/MTCs.