TRUSTED: The Paired 3D Transabdominal Ultrasound and CT Human Data for Kidney Segmentation and Registration Research

Inter-modal image registration (IMIR) and image segmentation with abdominal Ultrasound (US) data has many important clinical applications, including image-guided surgery, automatic organ measurement and robotic navigation. However, research is severely limited by the lack of public datasets. We propose TRUSTED (the Tridimensional Renal Ultra Sound TomodEnsitometrie Dataset), comprising paired transabdominal 3DUS and CT kidney images from 48 human patients (96 kidneys), including segmentation, and anatomical landmark annotations by two experienced radiographers. Inter-rater segmentation agreement was over 94 (Dice score), and gold-standard segmentations were generated using the STAPLE algorithm. Seven anatomical landmarks were annotated, important for IMIR systems development and evaluation. To validate the dataset's utility, 5 competitive Deep Learning models for automatic kidney segmentation were benchmarked, yielding average DICE scores from 83.2% to 89.1% for CT, and 61.9% to 79.4% for US images. Three IMIR methods were benchmarked, and Coherent Point Drift performed best with an average Target Registration Error of 4.53mm. The TRUSTED dataset may be used freely researchers to develop and validate new segmentation and IMIR methods.Comment: Alexandre Hostettler, and Toby Collins share last authorshi

Definition of a Structured Training Curriculum for Robot-assisted Radical Cystectomy with Intracorporeal Ileal Conduit in Male Patients: A Delphi Consensus Study Led by the ERUS Educational Board

Robot-assisted radical cystectomy (RARC) continues to expand, and several surgeons start training for this complex procedure. This calls for the development of a structured training program, with the aim to improve patient safety during RARC learning curve. A modified Delphi consensus process was started to develop the curriculum structure. An online survey based on the available evidence was delivered to a panel of 28 experts in the field of RARC, selected according to surgical and research experience, and expertise in running training courses. Consensus was defined as ≥80% agreement between the responders. Overall, 96.4% experts completed the survey. The structure of the RARC curriculum was defined as follows: (1) theoretical training; (2) preclinical simulation-based training: 5-d simulation-based activity, using models with increasing complexity (ie, virtual reality, and dry- and wet-laboratory exercises), and nontechnical skills training session; (3) clinical training: modular console activity of at least 6 mo at the host center (a RARC case was divided into 11 steps and steps of similar complexity were grouped into five modules); and (4) final evaluation: blind review of a video-recorded RARC case. This structured training pathway will guide a starting surgeon from the first steps of RARC toward independent completion of a full procedure. Clinical implementation is urgently needed

Training centers: An essential step to developing skills in urolaparoscopy

Choosing laparoscopy is an important investment for urologists, and it must be learned from basic principles to advance skills through a steep learning curve; the caseload is made of frequent but very demanding procedures. In training centers, scholars are confronted with real-life conditions through large animal models. For about 1500 urologists, the European Institute of Tele Surgery has offered such a program for a decade. We evaluate its impact through a self-administered, Internet-hosted questionnaire. Individual data concern number and type of courses attended, skill level and type of practice before training, and expectations at registration. Personal benefit is evaluated through the delay before starting routine laparoscopy or the major procedures volume facing open counterparts. The ability of this program to meet scholar's expectations is reflected by eventual need for further training or by trainee suggestions. In spite of 85% cumulated satisfaction index, further developments must improve practical training: clear, reproducible stepwise protocols, repeated under supervision in animal models today and hopefully in augmented reality simulators tomorrow. The knowledge transfer and companionship made of theoretical and practical lessons followed by a straight supervised application represent an essential model for gaining proficiency. © 2009 Current Medicine Group, LLC References and Recommended Reading.SCOPUS: ar.jinfo:eu-repo/semantics/publishe

Urodynamic Parameters and Continence Outcomes in Asymptomatic Patients with Ileal Orthotopic Neobladder: A Systematic Review and Metanalysis

Introduction: The orthotopic neobladder is the type of urinary diversion (UD) that most closely resembles the original bladder. However, in the literature the urodynamic aspects are scarcely analysed. Objective: To provide the first systematic review (SR) on the urodynamic (UDS) outcomes of the ileal orthotopic neobladders (ONB). Continence outcomes are also presented. Methods: A PubMed, Embase and Cochrane CENTRAL search for peer-reviewed studies on ONB published between January 2001–December 2022 was performed according to the Preferred Reporting Items for Systematic Review and Meta-analysis (PRISMA) statement. Results and Conclusion: Fifty-nine manuscripts were eligible for inclusion in this SR. A great heterogeneity of data was encountered. Concerning UDS parameters, the pooled mean was 406.2 mL (95% CI: 378.9–433.4 mL) for maximal (entero)cystometric capacity (MCC) and 21.4 cmH2O (95% CI: 17.5–25.4 cmH2O) for Pressure ONB at MCC. Postvoid-residual ranged between 4.9 and 101.6 mL. The 12-mo rates of day and night-time continence were 84.2% (95% CI: 78.7–89.1%) and 61.7% (95% CI: 51.9–71.1%), respectively.Despite data heterogeneity, the ileal ONB seems to guarantee UDS parameters that resemble those of the native bladder. Although acceptable rates of daytime continence are reported the issue of high rates of night-time incontinence remains unsolved. Adequately designed prospective trials adopting standardised postoperative care, terminology and methods of outcome evaluation as well as of conduction of the UDS in the setting of ONB are necessary to obtain homogeneous follow-up data and to establish UDS guidelines for this setting

Laparoscopic partial nephrectomy for large renal masses : results of a European survey

To evaluate the perioperative effectiveness of laparoscopic partial nephrectomy (LPN) for large (4-7 cm) renal masses, with a review of the experience of six European advanced laparoscopic centres

“Urethral-Sparing” Robotic Radical Prostatectomy: Critical Appraisal of the Safety of the Technique Based on the Histologic Characteristics of the Prostatic Urethra

Background: The prostatic urethra (PU) is conventionally resected during robot-assisted radical prostatectomy (RALP). Recent studies demonstrated the feasibility of the extended PU preservation (EPUP). Aims: To describe the histologic features of the PU. Methods: The PU was evaluated using cystoprostatectomy and RALP specimens. Cases of PU infiltration by prostate cancer or distortion by benign hyperplastic nodules were excluded. The thickness of the chorion and distance between the urothelium and prostate glands were measured. Prostate-specific antigen expression in the PU epithelium was evaluated with immunohistochemistry. Descriptive statistics were used. Results: Six specimens of PU were examined. Histologically, the following layers of the PU were observed: (1) urothelium with basal membrane, (2) chorion, and (3) prostatic peri-urethral fibromuscular tissue. The chorion measures between 0.2 and 0.4 mm. There is not a distinct urethral muscle layer, but rather muscular fibers that originate near the prostatic stroma and are distributed around the PU. This muscular tissue appears to be mainly represented in the basal and apical urethra, but not in the middle urethra. The mean distance between the chorion and prostatic glands is 1.74 mm, with significant differences between base of the prostate, middle urethral portion, and apex (2.5 vs. 1.49 vs. 1.23 mm, respectively). PSA-expressing cells are abundant in the PU epithelium, coexisting with urothelial cells. Conclusions: The exiguity of thickness of the PU chorion, short distance from glandular tissue, and coexistence of PSA-expressing cells in the epithelium raise important concerns about the oncologic safety of EPUP

“Bordeaux Neobladder”: First Evaluation of the Urodynamic Outcomes

Background: The intracorporeal orthotopic modified-Y “Bordeaux“ neobladder (iYNB) was first described in 2016. No urodynamic evaluation of this neobladder has yet been performed. Objective: To present the urodynamic features of the iYNB and incontinence-specific health-related quality of life (HRQoL) outcomes. Design, setting, and participants: We prospectively assessed 26 patients operated between September 2018 and November 2020. Surgical procedure: Robotic radical cystectomy for malignant disease of the bladder and iYNB, performed by a single surgeon, were used. Measurements: Three months after surgery and in November 2021, consenting patients underwent clinical evaluation and multichannel urodynamic study (UDS). The incontinence quality of life (I-QoL) questionnaire was used to evaluate HRQoL. Continence was classified into day- and nighttime, and clinically defined as the use of zero pads. A descriptive statistical analysis was performed. Results and limitations: The mean age at surgery was 65.4 yr. The mean follow-up period was 27 mo (12–38). The mean time for the neobladder reconstruction was 192 min (110–340). The mean maximum capacity was 431 cm3 (range 200–553). The mean postvoid residual was 101.6 ml (0–310), and the rate of clean intermittent catheterization was 17.6%. With the exception of a significant reduction in the volume of the first sensation of bladder fullness, no other statistically significant changes in the UDS parameters of both the storage and the voiding phase were observed over time. Day- and nighttime continence rates were 58.8% and 23.5%, respectively. The mean postoperative I-QoL score was 103.3 (89–110). Limitations include the small number of patients and short follow-up. Conclusions: The UDS evaluation of iYNB demonstrates that both the volumetric and the pressure characteristics are acceptable and may enhance quality of life. Prospective studies with larger numbers of patients and longer follow-up are needed to further evaluate the iYNB. Patient summary: The “Bordeaux“ neobladder provides acceptable urodynamic outcomes. It is associated with high levels of health-related quality of life and good rates of continence in patients