Resumen Objetivo: Describir el uso de clips de polímero (Hem-o-lok®) para el control vascular renal en nefrectomía simple de donador laparoscópica (NSL) Materiales y Métodos: Realizamos un análisis retrospectivo y descriptivo de las nefrectomías de donador mínimamente invasivas (mano-asistidas y laparoscópicas puras) realizadas entre 2008 y 2020. Se incluyeron pacientes sometidos a NSL en las cuales se utilizaron clips de polímero (Hem-o-lok®) para el control vascular del hilio renal. Resultados: Se realizaron 330 NSL, 183 (55%) fueron mano asistidas y el resto laparoscópicas puras. Se obtuvo un tiempo de isquemia caliente promedio de 3.98 minutos, una pérdida de sangre promedio de 100±140 ml. Cuatro pacientes (1.2%) ameritaron conversión a cirugía abierta debido a lesión vascular. Se registraron 31 (9.3%) complicaciones postoperatorias de las cuales 23 (6.9%) fueron complicaciones menores. No se reportaron muertes ni pérdidas del injerto. Limitantes del estudio: Las principales limitantes del estudio son que se trata de un estudio retrospectivo de un solo centro. Originalidad o valor: Se trata un estudio que cuestiona la contraindicación emitida por la FDA para el uso de clips de polímeros para el control vascular en NSL, al mostrar ser una opción segura y efectiva. Conclusiones: El uso de clips de polímero, específicamente Hem-o-lok®, es un método seguro para el control vascular del hilio renal en nefrectomías laparoscópicas de donador.

Abstract Objective: To describe our experience using polymer clips (Hem-o-lok®) for renal vessel control in laparoscopic living donor nephrectomy (LLDN). Materials and methods: We conducted a retrospective and descriptive analysis from our database of all minimally invasive living donor nephrectomies (hand-assisted and pure laparoscopic) performed from 2008 to 2020 in our institution. We included patients who underwent LLDN using polymer clips (Hem-o-lok®) for vascular control of renal arteries and veins, and whose clinical records were complete. Results: 330 LLDN were performed, 183 (55.5%) were hand-assisted nephrectomies and 147 (44.5%) were pure laparoscopic nephrectomies. Mean warm ischemia time (WIT) was 3.98 minutes and median of estimated blood loss (EBL) was 100±140 ml. Four patients (1.2%) required conversion to an open procedure due to vascular injury. 31 complications (9.3%) were registered, of which 23 (6.9%) were non-life-threatening complications. No deaths nor loss of renal grafts were reported. Limitations: the main drawbacks of this study are its retrospective nature, and that it is limited to only one center. Originality and value: It is a study that questions the contraindication issued by the FDA for the use of polymer clips for vascular control in LLDN, demonstrating its use is a safe and effective option. Conclusion: The use of polymer clips, specifically Hem-o-lok®, is a safe method for vascular control of the renal hilum vessels in laparoscopic living donor nephrectomies.

Abstract The COVID-19 pandemic has forced the modification of medical attention around the world, to reserve the greatest amount of resources for the treatment of patients with SARS-CoV-2 infection. Urology departments, just like the rest of the surgical services, have had to adapt to this situation, reducing the medical attention given to different illnesses and only selecting and attending to emergency consultations, procedures, and surgeries, or to oncologic maladies that cannot be postponed. The aim of the present review was to make recommendations regarding outpatient consultation management and the correct selection of surgeries and procedures. The postponement of the majority of non-urgent procedures should continue until the COVID-19 pandemic is controlled in Mexico.

Resumen La pandemia por COVID-19 ha obligado a modificar la atención médica alrededor del mundo con la finalidad de reservar la mayor cantidad de recursos para la atención de pacientes infectados por el SARS-CoV-2. Los departamentos de urología al igual que el resto de los servicios quirúrgicos han tenido que adaptarse a esta situación disminuyendo la atención de los distintos padecimientos, seleccionando y atendiendo solamente los motivos de consulta, los procedimientos y las cirugías que sean urgentes o por padecimientos oncológicos inaplazables. El objetivo de la siguiente revisión es hacer algunas recomendaciones para el manejo de la consulta externa y la correcta selección de cirugías y procedimientos. La postergación de la mayor parte de los procedimientos no urgentes deberá continuar hasta que la pandemia por COVID-19 en México esté controlada.

Abstract Objective: To know the impact the COVID-19 pandemic has had on the practice of urology in Mexico. Materials and Methods: A survey was conducted on Mexican urologists, utilizing the SURVIO® mobile application, within the time frame of March 16-22, 2020. It consisted of 8 dichotomous, multiple-choice questions on the practice of urology and how it has been affected by the COVID-19 pandemic. Results: A total of 374 questionnaires were received, in which 66% of the respondents stated that the healthcare institution they worked in had already emitted a management protocol for patients with COVID-19, 80% stated that urology consultations had not been reprogrammed or cancelled at their work centers, and 42% did not know which surgeries would be deferred. In addition, digital applications were included among the tools that would be the most widely used for substituting face-to-face consultation. Limitation: The present work has the limitations inherent in a survey. Originality: The present original work describes how the COVID-19 pandemic has impacted the daily urology practice. Conclusions: The COVID-19 pandemic is a challenge for our entire healthcare system. The practice of urology is facing unprecedented changes right now and will continue to do so in the future.

Resumen Objetivo: Conocer el impacto que ha generado la pandemia por COVID-19 en la práctica urólogica en México. Material y Métodos: Se realizó una encuesta a urólogos mexicanos con la aplicación SURVIO® vía web del 16 al 22 de marzo 2020, la cual consistió en 8 preguntas dicotómicas y de opción múltiple sobre la práctica urológica y su afectación por la pandemia de COVID-19. Resultados: Se recibieron un total de 374 respuestas, 66% respondió que la institución en la que laboran ya había emitido un protocolo de manejo para pacientes con COVID-19, el 80% negó que la consulta de urología hubiese sido reprogramada o cancelada en sus centros de trabajo, el 42% desconocía qué cirugías tendrían que ser diferidas y las herramientas que más ocuparán para sustituir la consulta presencial incluyen aplicaciones digitales. Limitante: Se trata de una encuesta con las limitaciones inherentes. Originalidad: Trabajo original el cual nos presenta un panorama de cómo ha impactado la pandemia por COVID-19 la práctica urológica diaria. Conclusiones: La pandemia de COVID-19 representa un reto para todo nuestro sistema de salud. La práctica urológica enfrentará en este momento y en el futuro cambios sin precedentes.

Abstract: Prostate-specific antigen (PSA)-based early detection for prostate cancer is the subject of intense debate. Implementation of organized prostate cancer screening has been challenging, in part because the PSA test is so amenable to opportunistic screening. To the extent that access to cancer screening tests increases in low- and middle-income countries (LMICs), there is an urgent need to thoughtfully evaluate existing and future cancer screening strategies to ensure benefit and control costs. We used Mexico’s prostate cancer screening efforts to illustrate the challenges LMICs face. We provide five considerations for policymakers for a smarter approach and implementation of PSA-based screening.

Resumen : El uso del Antígeno Prostático Específico (APE) para tamizaje para cáncer de próstata sigue siendo tema de amplio debate. La implementación de estrategias de tamiz organizado de cáncer de próstata ha sido un reto en parte porque la prueba de APE se presta para detección oportunista. A medida que aumenta el acceso a las pruebas de detección de cáncer en los países de ingresos bajos y medianos (PIBM), existe la necesidad urgente de evaluar cuidadosamente las estrategias actuales y futuras de detección oportuna de cáncer para garantizar su beneficio y controlar sus costos. Utilizamos los esfuerzos de tamizaje de cáncer de próstata de México para ilustrar los retos para PIBM. Ofrecemos cinco consideracio nes dirigidas a tomadores de decisión que permitan contar con estrategias racionales de implementación de tamizaje para cáncer de próstata basado en el uso de APE.

Abstract: Prostate-specific antigen (PSA)-based early detection for prostate cancer is the subject of intense debate. Implementation of organized prostate cancer screening has been challenging, in part because the PSA test is so amenable to opportunistic screening. To the extent that access to cancer screening tests increases in low- and middle-income countries (LMICs), there is an urgent need to thoughtfully evaluate existing and future cancer screening strategies to ensure benefit and control costs. We used Mexico’s prostate cancer screening efforts to illustrate the challenges LMICs face. We provide five considerations for policymakers for a smarter approach and implementation of PSA-based screening.

Resumen : El uso del Antígeno Prostático Específico (APE) para tamizaje para cáncer de próstata sigue siendo tema de amplio debate. La implementación de estrategias de tamiz organizado de cáncer de próstata ha sido un reto en parte porque la prueba de APE se presta para detección oportunista. A medida que aumenta el acceso a las pruebas de detección de cáncer en los países de ingresos bajos y medianos (PIBM), existe la necesidad urgente de evaluar cuidadosamente las estrategias actuales y futuras de detección oportuna de cáncer para garantizar su beneficio y controlar sus costos. Utilizamos los esfuerzos de tamizaje de cáncer de próstata de México para ilustrar los retos para PIBM. Ofrecemos cinco consideracio nes dirigidas a tomadores de decisión que permitan contar con estrategias racionales de implementación de tamizaje para cáncer de próstata basado en el uso de APE.

ABSTRACT Purpose: To provide data of the incidence and management of common urological malignancies in renal transplant recipients. Materials and Methods: We conducted a retrospective analysis of a prospective database from August 1967 to August 2015. A descriptive analysis of the sample was performed. Results: Among 1256 consecutive RTR a total of 88 patients developed malignancies (7%). There were 18 genitourinary tumors in the 16 patients (20.45 % of all malignant neoplasms), incidence of 1.27%. The most common neoplasm encounter was renal cancer (38.8%), followed by urothelial carcinoma (33.3%). Median follow-up of transplantation was 197 months (R, 36-336). Mean time from RT to cancer diagnosis 89±70 months (R, 12-276). CsA and AZA was the most common immunosuppression regimen in 68.75%. Mean follow-up after diagnosis was 103±72 months (R 10-215). Recurrence free survival rate of 100%. Overall survival of 89.5% of the sample; there were two non-related cancer deaths during follow-up. Conclusions: The incidence of neoplasms in RTR was lower than in other series, with favorable functional and oncologic results after treatment. This suggests that actions to reduce the risk of these malignancies as well as a strict follow-up are mandatory for an early detection and treatment.