Will Hybrid Meetings Replace Face-To-Face Meetings Post COVID-19 Era? Perceptions and Views From The Urological Community

OBJECTIVE To understand the preference and role of 'hybrid' urological meetings compared to face-to-face and online meetings during and after COVID-19 pandemic. The secondary outcome was finding out the most preferable webinar setting. METHODS An online global survey was done between June 06 and July 05, 2020, using SurveyMonkey. The target participants were urology healthcare providers. The survey was disseminated via mailing lists and the Twitter platform. RESULTS A total of 526 urology providers from 56 countries responded to the survey and it was completed by 73.3%. Participants' overall experience was better in a face-to-face meeting, followed by a hybrid and webinar only meeting. While opportunities for networking was identified as high in face-to-face meeting, online webinars were more cost effective, and learning opportunity and reach of audience was higher for hybrid meetings. For online webinar format, Zoom platform was used by 73% and majority (69%) saw it on their laptop or desktop. The preference was for a 1-hour webinar in the evenings with 3-5 speakers. Urology residents rated face-to-face meetings to have better cost-effectiveness when compared to consultants. Post COVID-19, more than half of all respondents would prefer hybrid meetings compared to the other formats. CONCLUSION While there will be a place for face-to-face meetings, COVID-19 situation has led to a preference towards hybrid meetings which is ideal for a global reach in the future. It is plausible that most urological associations will move towards a hybrid model for their meetings. (C) 2021 Elsevier Inc

Influence of webinar based learning on practice of percutaneous nephrolithotomy: Outcomes of a global survey

Background With webinars looking to be the mainstay post-pandemic, it is important to demonstrate if webinars are indeed effective educational tools for professional training and skill acquisition. We aim to demonstrate, via a global survey, the efficacy of webinars on PCNL and how this knowledge transforms clinical practice. Methods A structured online survey covering the following sections: (1) Demographics, (2) PCNL techniques, (3) PCNL equipment, was circulated. The target study population were practicing urologists and residents. Categorical data were presented with counts and percentages, and compared using Chi-square test. Continuous data was analysed with non-parametric methods. Respondents were dichotomised according to attendance of webinars type, attendees of dedicated PCNL webinars (Group A) or attendees of endourological webinars that discussed some aspects of PCNL (Group B). Results A total of 303 respondents participated from 38 countries. 91.7% (n=278) were in Group A with 8.3% (n=25) in Group B. 77.9% were under the age of fifty years while 51.8% had more than 10 years of urology experience. In group A, urologists of all ages, in academic institutions and private practitioners, significantly benefitted in gaining knowledge about the merits of newer devices and the role of suction assisted devices in modern PCNL; Majority of group A also reflected that by attending a dedicated PCNL based webinar they benefited in learning newer positions for PCNL access, especially supine, and how to effectively use laser as energy devices for lithotripsy. In Group B, the only area of benefit was in lasing techniques and the use of newer lasers like the TFL. Conclusion Our survey positively validates the two proposed hypothesis i.e. webinars as a medium of education do benefit practicing urologists in knowledge and the clinical practice domains. Age, experience or place of practice is no barrier to adopting newer mediums of education like webinars

Incidence, predictive factors and oncological outcomes of incidental prostate cancer after endoscopic enucleation of the prostate: a systematic review and meta-analysis

Introduction This systematic review aims at reporting the incidence, predictive factors, and the oncological outcomes of incidental prostate cancer (IPCa) in men who underwent endoscopic enucleation of prostate (EEP). Methods A literature search was performed using the following Medical Subject Heading (MeSH) terms and keywords: Prostatic Neoplasms, Prostate Cancer, Transurethral Resection of Prostate, Prostate resection, Prostate enucleation. Meta-analysis was performed if there were two or more studies reporting the same outcome under the same definition. In case of insufficient data, results were presented in a narrative manner. Results Sixty-one studies were included in qualitative synthesis and 55 were included in meta-analysis. The pooled IPCa rate was 0.08 (95% CI 0.073-0.088). Increasing age, higher preoperative serum prostate-specific antigen (PSA) level, higher preoperative PSA density (PSAD), smaller prostate volume, higher postoperative PSA velocity and lower enucleated prostate weight, were reported to have significant correlation with IPCa. In BPH patients, the mean pre-operative and post-operative PSA levels were 5.58 +/- 1.48 ng/dL and 1.06 +/- 0.27 ng/dL, respectively. In patients with IPCa, the mean pre-operative and post-operative PSA levels were 7.72 +/- 2.90 ng/dL and 2.77 +/- 1.66 ng/dL, respectively. The mean percentage PSA reduction was 82.0% +/- 1.8% for BPH patients and 68.2% +/- 12.1% for IPCa patients. IPCa was most commonly managed by active surveillance (68.7%). Conclusions The pooled incidence of IPCa after EEP was 8%. An absolute post-operative PSA level of 70% should be expected in BPH patients after EEP

Proximal type epithelioid sarcoma of the scrotum: A source of diagnostic confusion that needs immediate attention

Epithelioid sarcoma is a rare soft-tissue sarcoma which classically presents as a subcutaneous or deep dermal mass in distal extremities of adolescents and young adults. A more aggressive proximal or large-cell type has been described in rare cases to occur as a deep soft-tissue mass at proximal body sites which tends to recur and metastasize earlier than the conventional epithelioid sarcoma. The correct diagnosis of this type is essential since these lesions can easily be misdiagnosed as other epithelioid lesions. Its prognostic factors also have not yet been fully investigated. We herein report a case of metastatic proximal-type epithelioid sarcoma arising from the scrotum of a 50-year-old man managed by radical surgery and adjuvant chemotherapy. (c) 2005 Elsevier B.V. All rights reserved

A global knowledge, attitudes and practices survey on anatomical endoscopic enucleation of prostate for benign prostatic hyperplasia among urologists

There is an increasing use of the procedure, anatomical endoscopic enucleation of the prostate, as an alternative to conventional transurethral resection of prostate for surgical treatment of benign prostatic hyperplasia. However, barriers to adoption of this procedure remain and no prior studies explored this important aspect till date. The aim of this study is to identify the predictors and barriers of surgeon-related practices in this area. The study findings may also provide valuable insight into current practice trends worldwide. To achieve the objectives, we conducted an online, cross-sectional, questionnaire-based study between 1st September 2019 and 5th October 2019 to investigate the knowledge, attitudes and practices among urologists worldwide. Our findings showed that the main barriers for adoption of the procedure were lack of mentorship, a steep learning curve, and unavailability of morcellator, bipolar or laser energy sources. Fear of urinary incontinence, bleeding and bladder injury were not major hindrance to adoption of this technique. The results also demonstrated that there will be continued increase in utility of the procedure in the future

Turkish version of the Ureteral Stent Symptoms Questionnaire: linguistic and psychometric validation

Purpose Ureteric stents are frequently used in urology practice and can cause significant impairment in quality of life (QoL). The aim of this study was to validate the Ureteral Stent Symptoms Questionnaire (USSQ) to be used in the evaluation of stent-related symptoms and impairment in QoL in Turkish-speaking patients. Methods After linguistic validation of the original USSQ into Turkish language, the Turkish version of the USSQ (T-USSQ) was self-administered to all participants at week 1 and 4 after stent placement for test-retest reliability and internal consistency and at week 8 (4 weeks after stent removal) for sensitivity to change analysis. Control patients completed the form only once. Additionally male and female patients completed the validated Turkish versions of International Prostate Symptom Score (IPSS) and Marmara Overactive Bladder (mOAB) Symptom Scores, respectively. Results A total of 68 patients with ureteral stents and 37 controls were available for the final analysis. The Cronbach's alpha value was higher than 0.7 at week 1 for all sub-domains except additional problems domain. The test-retest reliability of the T-USSQ was high for all subdomains except the additional problems domain. Relatively high correlation coefficients were found for the visual analog scale for pain, IPSS (for males), mOAB score (for females) with the corresponding USSQ domains, suggesting good convergent validity. Also the T-USSQ could effectively differentiate between patients and controls. Conclusions The T-USSQ is a reliable and robust instrument that can be self-administered to patients of Turkish population with ureteral stent in the clinical applications

Indications, preferences, global practice patterns and outcomes in retrograde intrarenal surgery (RIRS) for renal stones in adults: results from a multicenter database of 6669 patients of the global FLEXible ureteroscopy Outcomes Registry (FLEXOR).

Purpose To collect a multicentric database on behalf of TOWER research group to assess practice patterns and outcomes of retrograde intrarenal surgery (RIRS) for kidney stones. Methods Inclusion criteria: age≥18 years, normal renal/calyceal system anatomy, calculi of any size, number, and position. Study period: January 2018 and August 2021. Stone-free status: absence of fragments>2 mm, assessed post procedure according to the local protocol (KUB X-Ray and/or ultrasound or non-contrast CT scan). Results Twenty centers from ffteen countries enrolled 6669 patients. There were 4407 (66.2%) men. Mean age was 49.3±15.59 years. Pain was the most frequent symptom indication for intervention (62.6%). 679 (10.2%) patients underwent RIRS for an incidental fnding of stones. 2732 (41.0%) patients had multiple stones. Mean stone size was 10.04±6.84 mm. A reusable fexible ureteroscope was used in 4803 (72.0%) procedures. A sheath-less RIRS was performed in 454 (6.8%) cases. Holmium:YAG laser was used in 4878 (73.1%) cases. A combination of dusting and fragmentation was the most common lithotripsy mode performed (64.3%). Mean operation time was 62.40±17.76 min. 119 (1.8%) patients had an intraoperative injury of the ureter due to UAS insertion. Mean postoperative stay was 3.62±3.47 days. At least one postoperative complication occurred in 535 (8.0%) patients. Sepsis requiring intensive care admission occurred in 84 (1.3%) patients. Residual fragments were detected in 1445 (21.7%) patients. Among the latter, 744 (51.5%) patients required a further intervention. Conclusion Our database contributes real-world data to support to a better understanding of modern RIRS practice and outcomes

Nation-wide analysis of the impact of Covid-19 pandemic on daily urology practice in Turkey

Objective To present a nation-wide analysis of the workload of urology departments in Turkey week-by-week during Covid-19 pandemic. Methodology The centres participating in the study were divided into three groups as tertiary referral centres, state hospitals and private practice hospitals. The number of outpatients, inpatients, daily interventions and urological surgeries were recorded prospectively between 9-March-2020 and 31-May-2020. All these variables were recorded for the same time interval of 2019 as well. The weekly change of the workload of urology during pandemic period was evaluated, also the workload of urology and the distributions of certain urological surgeries were compared between the pandemic period and the same time interval of the year 2019. Results A total of 51 centres participated in the study. The number of outpatients, inpatients, urological surgeries and daily interventions were found to be dramatically decreased by the 3rd week of pandemics in state hospitals and tertiary referral centres; however, the daily urological practice were similar in private practice hospitals throughout the pandemic period. When the workload of urology in pandemic period and the same time interval of the year 2019 were compared, a huge decrease was observed in all variables during pandemic period. However, temporary measures like ureteral stenting, nephrostomy placement and percutaneous cystostomy have been found to increase during Covid-19 pandemic compared with normal life. Conclusions Covid-19 pandemic significantly affected the routine daily urological practice likewise other subspecialties and priority was given to emergent and non-deferrable surgeries by urologists in concordance with published clinical guidelines

A giant adrenal pseudocyst: Case report and review of the literature

A 45-year-old woman whose MR images revealed a lobulated, complicated cyst with septations on the superior pole of left kidney underwent retroperitoneoscopic cyst marsupialization. In pathologic examination beneath the atrophic adrenal gland, hyalinized, calcification foci cyst wall without any surrounding epithelium was seen microscopically. It was reported to be adrenal pseudocyst