Development and Validation of a Novel Skills Training Model for PCNL, an ESUT project

Background and aim: The aim of this study is to validate a totally non biologic training model that combines the use of ultrasound and X ray to train Urologists and Residents in Urology in PerCutaneous NephroLithotripsy (PCNL). Methods: The training pathway was divided into three modules: Module 1, related to the acquisition of basic UltraSound (US) skill on the kidney; Module 2, consisting of correct Nephrostomy placement; and Module 3, in which a complete PCNL was performed on the model. Trainees practiced on the model first on Module 1, than in 2 and in 3. The pathway was repeated at least three times. Afterward, they rated the performance of the model and the improvement gained using a global rating score questionnaire. Results: A total of 150 Urologists took part in this study. Questionnaire outcomes on this training model showed a mean 4.21 (range 1-5) of positive outcome overall. Individual constructive validity showed statistical significance between the first and the last time that trainees practiced on the PCNL model among the three different modules. Statistical significance was also found between residents, fellows and experts scores. Trainees increased their skills during the training modules. Conclusion: This PCNL training model allows for the acquisition of technical knowledge and skills as US basic skill, Nephrostomy placement and entire PCNL procedure. Its structured use could allow a better and safer training pathway to increase the skill in performing a PCNL

Holmium laser enucleation of the prostate with Virtual Basket mode: faster and better control on bleeding

Background: To compare clinical intra and early postoperative outcomes between conventional Holmium laser enucleation of the prostate (HoLEP) and Holmium laser enucleation of the prostate using the Virtual Basket tool (VB-HoLEP) to treat benign prostatic hyperplasia (BPH). Methods: This prospective randomized study enrolled consecutive patients with BPH, who were assigned to undergo either HoLEP (n = 100), or VB-HoLEP (n = 100). All patients were evaluated preoperatively and postoperatively, with particular attention to catheterization time, operative time, blood loss, irrigation volume and hospital stay. We also evaluated the patients at 3 and 6 months after surgery and assessed maximum flow rate (Qmax), postvoid residual urine volume (PVR), the International Prostate Symptom Score (IPSS) and the Quality of Life score (QOLS). Results: No significant differences in preoperative parameters between patients in each study arm were found. Compared to HoLEP, VB-HoLEP resulted in less hemoglobin decrease (2.54 vs. 1.12 g/dl, P = 0.03) and reduced operative time (57.33 ± 29.71 vs. 42.99 ± 18.51 min, P = 0.04). HoLEP and VB-HoLEP detrmined similar catheterization time (2.2 vs. 1.9 days, P = 0.45), irrigation volume (33.3 vs. 31.7 l, P = 0.69), and hospital stay (2.8 vs. 2.7 days, P = 0.21). During the 6-month follow-up no significant differences in IPSS, Qmax, PVR, and QOLS were demonstrated. Conclusions: HoLEP and VB-HoLEP are both efficient and safe procedures for relieving lower urinary tract symptoms. VB-HoLEP was statistically superior to HoLEP in blood loss and operative time. However, procedures did not differ significantly in catheterization time, hospital stay, and irrigation volume. No significant differences were demonstrated in QOLS, IPSS, Qmax and PVR throughout the 6-month follow-up. Trial Registration: Current Controlled Trials ISRCTN72879639; date of registration: June 25th, 2015. Retrospectively registred

A Rotating-Tip-Based Mechanical Nano-Manufacturing Process: Nanomilling

We present a rotating-tip-based mechanical nanomanufacturing technique, referred to here as nanomilling. An atomic force microscopy (AFM) probe tip that is rotated at high speeds by out-of-phase motions of the axes of a three-axis piezoelectric actuator is used as the nanotool. By circumventing the high-compliance AFM beam and directly attaching the tip onto the piezoelectric actuator, a high-stiffness arrangement is realized. The feeding motions and depth prescription are provided by a nano-positioning stage. It is shown that nanomilling is capable of removing the material in the form of long curled chips, indicating shearing as the dominant material removal mechanism. Feature-size and shape control capabilities of the method are demonstrated

Impact of COVID-19 on Clinical and Academic Urological Practice: A Survey from European Association of Urology Section of Uro-technology

As situations similar to the coronavirus disease 2019 (COVID-19) pandemic may recur, we must be prepared to react quickly and effectively. It is important that urology departments look after the well-being of their patients, while protecting their staff and continuing with academic/research activities

3-Arylideneindolin-2-ones as inhibitors of MDM2-p53 interaction

The easily available 3-(hetero)arylidene-oxindoles are a privileged scaffold for compounds endowed with a variety of biological properties, mainly antitumor, but also antirheumatic, antibacterial, antifungal, antiangiogenic, chemopreventive, antioxidative. Recently 3-arylidene-oxindoles have been found to inhibit the MDM2-p53 interaction.1 As the interaction between MDM2 and p53 represents a promising target for the development of novel anticancer drugs, we decided to investigate whether compounds with a 3-benzylidene-indolin-2-one scaffold could work as inhibitors of this interaction, by combining both biological assays and docking studies. Here we report the design, synthesis, evaluation of antiproliferative activity and p53 activation of a series of 3-arylidene-oxindoles. Computational studies were used to investigate the ability of our compounds to interact with the p53 binding pocket of MDM2. An induced fit docking (IFD)2 protocol was performed by using the 3LBL crystal structure. Our results demonstrate that Z-isomers are able to mimic the three hot spots residues of p53 occupying the hydrophobic pocket of Trp23 on MDM2. Most of the compounds exhibited a potent antiproliferative activity against IGROV-1 cells and a much lower inhibitory activity against IGROV-1/Pt1 subline lacking p53 function. The differential response of the two ovarian carcinoma cell lines was also reflected in the different susceptibility to apoptosis induced by cytotoxic concentrations (IC80)of the compounds. One of the most potent compounds, chosen to evaluate the therapeutic potential in the treatment of IGROV-1 as tumor xenograft, produced appreciable inhibition of tumor growth (around 65%). The effect was persistent at the end of treatment

"VirtualBasket" ureteroscopic holmium laser lithotripsy: intraoperative and early postoperative outcomes

BACKGROUND: The "VirtualBasket" technology (Cook Medical, Bloomington, IN, USA) is the result of pulse modulation during holmium laser emission: the laser emits part of the energy to create an initial bubble, and a second pulse is emitted when the vapor bubble is at its maximum expansion, so that it can pass through the previously created vapor channel. The aim of this study was to outline the outcomes of the "VirtualBasket" technology in ureteral and renal stones. METHODS: 160 Patients were randomly assigned to holmium laser lithotripsy with or without the "VirtualBasket" technology in ureteric or renal cases (40 per 4 groups). All procedures were performed by four experienced urologists. The Quanta System Cyber Ho 100W laser generator with 365 µm fibers was used for all the ureteral cases, whereas 272 µm fibers were used for all the cases in the renal pelvis. Demographic data, stone parameters, perioperative complications and success rates were compared. A statistical analysis was carried out to assess patients' data and outcomes. All the reported P values were obtained with the two-sided exact method at the conventional 5% significance level. The degree of stone retropulsion was graded on a Likert scale from zero (no retropulsion) to 3 (maximum retropulsion). RESULTS: All groups were comparable in terms of age, and preoperative stone size (ureter stone size: 1.2 vs. 1.1 cm; renal pelvis stone size: 1.55 vs. 1.62 cm). Compared to the regular mode, the "VirtualBasket" technology was associated with significantly lower fragmentation time (mean time for ureteral stones: 20.4 vs. 16.1 minutes, P<0.05; mean time for renal stones: 28.7 vs. 19.8 minutes, P<0.05) and total procedural time (mean time for ureteral stones 49 vs. 35.7 minutes; mean time for renal stones 67.1 vs. 52.4 minutes). There were no significant differences in terms of energy delivered to the stones, intraoperative complications and success rate at 1 month. The "VirtualBasket" technology was associated with significantly lower retropulsion. CONCLUSIONS: The "VirtualBasket" technology is associated with significantly lower fragmentation and procedural times. The reduced fragmentation time is a result of the significantly lower retropulsion of the stones during laser lithotripsy, which improves stone fragmentation efficiency