Soc. Int. Urol. J., Volume 4, Issue 6 (November 2023) – 11 articles , Pages 435-498

Endourology occupies an important place in modern urological practice. Compared with conventional surgery, it offers improved safety and patients experience less severe postoperative effects. Its use requires a certain level of equipment and technical skills. In many developed countries, it has been established for years and its practice has become routine. In Africa, it is still not very practical or even non-existent in certain reference centers. This survey conducted among the heads of urology departments or training coordinators in African referral centers defines the current practice of endourology. According to the needs and perspectives identified, it is important, if not essential, to create services or reference centers specializing in endourology. The role of these centers will be to take care of patients and train urologists in technical skills. The creation of a sub-regional and international network could contribute to the development of this practice. Multi-stakeholder cooperation (inter-state, with non-governmental organizations, companies or corporations) is also necessary. Full article

Background: Micro-ultrasound is a novel, high-resolution imaging modality that aims to improve the accuracy of prostate cancer diagnosis compared with TRUS-guided biopsy. While traditional ultrasound systems operate at 8 to 12 MHz, micro-ultrasound operates at 29 MHz, allowing enhanced recognition of microstructures with 300% higher resolution. Micro-ultrasound can potentially identify and target in real-time suspicious lesions, improving sensitivity and the negative predictive value for clinically significant prostate cancer. It may be a low-cost alternative to multiparametric magnetic resonance imaging (mpMRI) in the detection of prostate cancer. Methods: A systematic review and meta-analysis was performed comparing the diagnostic performance of micro-ultrasound-guided prostate biopsies with mpMRI-targeted prostate biopsies in the detection of clinically significant prostate cancer. PubMed, EMBASE, SCOPUS, and Cochrane CENTRAL databases were searched to identify relevant studies published up to July 2022. Results: A total of 15 studies were included for the systematic review, with 12 of those studies being included for the meta-analysis. The pooled sensitivity and specificity for micro-ultrasound-guided biopsies detecting clinically significant prostate cancer were 89% (95% CI 83 to 93) and 31% (95% CI 23 to 40) respectively (I² = 0%). In comparison, the pooled sensitivity and specificity for mpMRI-targeted biopsies detecting clinically significant prostate cancer were 86% (95% CI 73 to 93) and 32% (95% CI 18 to 50) respectively (I² = 16%). There was no statistically significant difference in the sensitivity or specificity between micro-ultrasound and mpMRI. Subgroup analysis found no difference in MRI subgroups based on blinding (P = 0.383). Conclusion: Micro-ultrasound-guided biopsies are comparable to mpMRI targeted biopsies with no difference in the detection of clinically significant prostate cancer between the 2 modalities. Large, multicentre, prospective studies are required to further substantiate the use of micro-ultrasound as an alternative to or in conjunction with mpMRI in the detection of prostate cancer. Full article

Objectives: To determine the impact of a criteria-led discharge initiative (CLD) on the hospital length of stay of patients undergoing a robotic-assisted laparoscopic prostatectomy (RALP). Methods: This is a cohort study of prospectively collected data completed at a major tertiary hospital from December 2017 to August 2020. The CLD initiative consists of 4 criteria: clinical haemodynamic stability (heart rate < 100 beats/minute, systolic blood pressure > 100 mmHg), a drain output of less than 50 mL, flatulence or bowel movement, and the ability to tolerate an oral diet. The primary outcome was hospital length of stay for patients before and after the introduction of CLD. Results: One hundred men undergoing RALP before the implementation of the CLD initiative were compared to 118 men undergoing RALP following the implementation of CLD. The patients had similar baseline demographic features. There was a significant difference found in hospital LOS with the pre-CLD group LOS (mean = 1.8 days, SE = 0.12) being longer than the LOS in the post-CLD group (mean = 1.4 days, SE = 0.09, P = 0.015). There were no significant between-group differences in the proportion of patients discharged on the first postoperative day and the 30-day readmission rate. Conclusion: Within our study population, we have demonstrated that the introduction of CLD was associated with reduced hospital LOS with no increase in adverse events. These findings support the need for the development of CLD in other conditions. Full article

Inequity in cancer care access among LATAM countries is huge. Experience with gastrointestinal tumors in Latin America has shown care disparities can be reduced by equalizing access to high-quality medical knowledge in a context of a multidisciplinary environment for medical discussions. Here, we describe our experience of working with virtual genitourinary multidisciplinary tumor boards (vGUMDT), including how the virtual board has helped with clinical decision-making. We describe vGUMDT’s experience and the importance of basing clinical decision-making in the consultant’s own center, reducing the need for referrals. In total, 345 cases were presented. The majority were prostate cancer cases, and the median age of patients was 64 years. Five participating centers were in Buenos Aires, 7 were in other cities in Argentina (Neuquén, Mendoza, Formosa, Salta, Santa Fé, Entre Ríos, Córdoba), and 3 centers were located in other countries in South America (Perú, Colombia, and Paraguay). Median distance from treating center to vGUMDT headquarters was 1289.8 km. A few patients (n = 60, 17.3%) were referred to the Alexander Fleming Cancer Institute or tertiary health care centers for surgery or systemic therapy, and a minority of cases were referred for radiotherapy. Multidisciplinary virtual experiences, such as vGUMDT, should be carefully addressed by health care decision-makers, given their popularity and their demonstrated cost-effectiveness. Full article

Objectives: The objective of this study was to determine the publication rate of abstracts presented at the Société Internationale d’Urologie (SIU) Congress and to analyse the characteristics associated with conversion to publication. Methods: All abstracts from the 36th Congress of the Société Internationale d’Urologie were identified from the published 2016 abstract book. A PubMed search was performed using key words and author names to identify published journal articles corresponding with the presented abstracts. Results: The conversion rate of presented abstracts to publication by April 2022 was 30.73% (224 of 729). Many abstracts were published prior to presentation (35.27%, 79 of 224). The average time to publication of abstracts published post presentation was 16.88 months. The majority of abstracts were presented in urology-specific journals (66.96%, 150 of 224). Publishing journals had an average impact factor of 3.068 with Urology (18 of 224) and World Journal of Urology (8 of 224) being the most common journals. Moderated ePosters had the highest conversion rate to publication (39.59%), whilst Unmoderated Videos had the lowest (11.32%). The abstract book assigned presentation topic groups to the moderated ePoster category; the most published abstract topic was sexual function (68.75%, 11 of 16). Conclusions: The conversion rate of abstracts presented at the SIU to publications in peer-reviewed journals has shown improvement since previous reports; however, it remains lower than the rates associated with other major urological conferences. Almost 70% of presented abstracts do not convert to publication and this should be considered when incorporating abstract findings into clinical practice. Full article

Background: Despite vast scientific evidence supporting health-awareness in the prevention and treatment outcome of cancer, studies comparing the effectiveness of different educational methods in in raising patients’ health-awareness are lacking. Objectives: We present and evaluate a new patients’ decision-making aid—an educational method based on staging mock medical appointments at a urological office. Materials and Methods: Four different “real-life scenarios” addressing prostate, kidney, bladder, and testicular cancers were prepared and played out by health professionals. The participants (n = 181) who observed the scenes were asked to fill in a questionnaire prepared by the authors. Results were then analysed statistically; P-value < 0.05 was considered significant. Results: A statistically significant difference was found in assessing the intelligibility of the presented material depending on the participants’ level of education and where they lived (e.g., village, town, city). According to 95% of the participants, the educational method provided during our meeting contributed to a significant increase in their knowledge of cancer. Moreover, 89% expressed their need for further education. Conclusion: Building patients’ health-awareness by health professionals is important and may influence therapy outcome. The effectiveness and perception of our method by patients require further research and evaluation; however, the presented results seem promising. Full article