ABSTRACT Introduction: Dismembered open pyeloplasty described by Anderson and Hynes is the “gold standard” for the treatment of ureteropelvic junction obstruction. The aim of our study was to compare the results of open (OP) vs laparoscopic (LP) vs robotic (RALP) pyeloplasty. Material and Methods: A multicenter prospective review was conducted of pyeloplasty surgeries performed at five high-volume centers between 2014 and 2018. Demographic data, history of prenatal hydronephrosis, access type, MAG3 renogram and differential renal function, surgery time, length of hospital stay, and complication rate (Clavien-Dindo) were recorded. Access type was compared using the Kruskal-Wallis, Chi-square, or Fisher's exact tests. Results: A total of 322 patients were included: 62 OP, 86 LP, and 174 RALP. The mean age was 8.13 (r: 1-16) years, with a statistically significant lower age (mean 5 years) in OP (p < 0.001). There were no significant differences in the distribution of the side affected. Operative time was 110.5 min for OP, 140 min for LP, and 179 min for RALP (p < 0.0001). Hospital stay was significantly shorter in the RALP group than in the other groups (p < 0.0001). There were no differences in postoperative complications and reoperations between the three groups. Conclusions: Minimally invasive surgery for the management of UPJO in children is gaining more acceptance, even in patients younger than 1-year-old. Operative time continues to be significantly shorter in OP than in LP and RALP. Hospital stay was shorter in RALP compared to the other techniques. No differences were found in complication rates, type of complications, and reoperation rate.

Abstract The Coronavirus (COVID-19) pandemic, typified as such in March 2020 by the World Health Organization (WHO), has exceeded the capacity of health systems to aid victims, and triggered a radical change in medical research, and in the monitoring of the enrollment for clinical trials in urologic fields around the world. Last year, almost 90% of clinical sites closed patient enrollment, while at the same time, researchers around the world initiated almost 1000 COVID-19 clinical trials. This catastrophic pandemic has allowed us to expand our medical knowledge exponentially. The global urological community has created and published an infinity of scientific articles: establishing guideline reactions for diagnosis, treatment, and follow-up of the different urologic conditions across all areas of the field, reporting the experiences at urology services, and putting forward new strategies. The Confederación Americana de Urología (CAU) has promoted international collaborative projects that have led to gaining insight into how the Latin American Urology Services faced the pandemic, including the challenges, strengths, and the areas of opportunity for urologic care. It also allowed us to increase the number and quality of publications. Also, we have created new virtual platforms and international networks to exchange our knowledge. We have as well transformed this social, economic and health crisis brought upon us by COVID-19, into a source of opportunities for the growth and promotion of research in Latin America. Urologic patients, require researchers to work on favoring their goals. A collaborative network, the established and coordinated protocols, the safety of patients and researchers, assertive and constant communication, and effective technology use, are the essential tools to resume institutional investigation under these critical conditions.

Resumen La pandemia del coronavirus (COVID-19), tipificada como tal en marzo de 2020 por la Organización Mundial de la Salud (OMS), ha superado la capacidad de los sistemas de salud para ayudar a las víctimas y ha desencadenado un cambio radical en la investigación médica y en el seguimiento de los registros para ensayos clínicos en campos urológicos de todo el mundo. El año pasado, casi el 90 % de los sitios clínicos cerraron la inscripción de pacientes, mientras que, al mismo tiempo, investigadores de todo el mundo iniciaron casi 1000 ensayos clínicos de COVID-19. Esta pandemia catastrófica nos ha permitido ampliar exponencialmente nuestro conocimiento médico. La comunidad urológica mundial ha creado y publicado una infinidad de artículos científicos: estableciendo pautas de reacción para el diagnóstico, tratamiento y seguimiento de las diferentes condiciones urológicas en todas las áreas del campo, reportando las experiencias en los servicios de urología y proponiendo nuevas estrategias. La Confederación Americana de Urología (CAU) ha impulsado proyectos de colaboración internacional que han permitido conocer cómo los Servicios de Urología de América Latina enfrentaron la pandemia, incluidos los desafíos, las fortalezas y las áreas de oportunidad para la atención urológica. También nos permitió aumentar el número y la calidad de las publicaciones. Además, hemos creado nuevas plataformas virtuales y redes internacionales para intercambiar nuestro conocimiento. También hemos transformado esta crisis social, económica y de salud que nos ha traído el COVID-19, en una fuente de oportunidades para el crecimiento y fomento de la investigación en América Latina. Los pacientes urológicos, requieren que los investigadores trabajen en favor de sus objetivos. Una red colaborativa, los protocolos establecidos y coordinados, la seguridad de pacientes e investigadores, la comunicación asertiva y constante, y el uso efectivo de la tecnología, son las herramientas esenciales para retomar la investigación institucional en estas condiciones críticas.

ABSTRACT Purpose: To explore the current situation faced by Latin American urology departments during the COVID-19 Outbreak in terms of knowledge, actions, prioritization of urology practices, and implementation of internal clinical management protocols for inpatients and outpatients. Material and Methods: A non-validated, structured, self-administered, electronic survey with 35 closed multiple choice questions was conducted in Spanish, Portuguese, Italian, and English and Deutsch versions from April 1st to April 30th, 2020. The survey was distributed through social networks and the official American Confederation of Urology (CAU) website. It was anonymous, mainly addressed to Latin American urologists and urology residents. It included 35 questions exploring different aspects: 1) Personal Protective Equipment (PPE) and internal management protocols for healthcare providers; 2) Priority surgeries and urological urgencies and 3) Inpatient and outpatient care. Results: Of 864 surveys received, 846 had at least 70% valid responses and were included in the statistical analyses. Surveys corresponded to South America in 62% of the cases, Central America and North America in 29.7%. 12.7% were residents. Regarding to PPE and internal management protocols, 88% confirmed the implementation of specific protocols and 45.4% have not received training to perform a safe clinical practice; only 2.3% reported being infected with COVID-19. 60.9% attended urgent surgeries. The following major uro-oncologic surgeries were reported as high priority: Radical Nephrectomy (RN) 58.4%, and Radical Cystectomy (RC) 57.3%. When we associate the capacity of hospitalization (urologic beds available) and percentage of high-priority surgery performed, we observed that centers with fewer urological beds (10-20) compared to centers with more urological beds (31-40) performed more frequently major urologic cancer surgeries: RN 54.5% vs 60.8% (p=0.0003), RC 53.1% vs 64.9% (p=0.005) respectively. Conclusions: At the time of writing (May 13th 2020) our data represents a snapshot of COVID-19 outbreak in Latin American urological practices. Our findings have practical implications and should be contextualized considering many factors related to patients and urological care: The variability of health care scenarios, institutional capacity, heterogeneity and burden of urologic disease, impact of surgical indications and decision making when prioritizing and scheduling surgeries in times of COVID-19 pandemic.

ABSTRACT Introduction: Since World Health Organization (WHO) declared COVID-19 as a global pandemic, urology services have developed strategies to prioritize and not to differ urgent and oncological patient's medical attention, in order to optimize resources and decrease infection probability among staff and patients. This unprecedented situation has generated a decrease in assistance and academic activities in most medical residences. The aim of this manuscript is to evaluate the impact of this health crisis on training programs through a survey addressed to urology medical residents. Materials and Methods: Cross sectional designed study, with multiple-choice non validated survey answered online by residents. Questionnaire was developed through the CAU EDUCACION platform. Results: A total of 148 responses from 18 countries coming from Latin America and Spain answering the survey. Of total, 82% answered that the activity of their urology department was significantly reduced, attending only urgent surgical pathologies, 15 % that, the urology activity has been closed completely and the staff was assigned to COVID-19 patients care, 3% continue with the regular clinic activity. Likewise, 75% stated that their surgical training has been completely affected, 93% receive urological information through tools such as Skype, ZOOM meeting, Cisco Webex, being Webinar modality the most used. Despite technological boom, 65% answered their academic training has been partially or completely affected. Most of the surveyed residents consider that period of residence should be extended to retrieve the educational targets. Conclusion: This unprecedented reality is negatively impacting the heterogeneous residency programs that American Confederation of Urology (CAU) nucleates. It is necessary to continue with technological innovation and allocate time and resources to easily generate accessible tools to favor the training of future urologists.

ABSTRACT Purpose: To evaluate safety, efficacy and functional outcomes after open vesicourethral re - anastomosis using different approaches based on previous urinary continence. Materials and Methods: Retrospective study of patients treated from 2002 to 2017 due to vesicourethral anastomosis stricture (VUAS) post radical prostatectomy (RP) who failed endoscopic treatment with at least 3 months of follow-up. Continent and incontinent patients post RP were assigned to abdominal (AA) or perineal approach (PA), respectively. Demographic and perioperative variables were registered. Follow-up was completed with clinical interview, uroflowmetry and cystoscopy every 4 months. Success was defined as asymptomatic patients with urethral lumen that allows a 14 French flexible cystoscope. Results: Twenty patients underwent open re-anastomosis for VUAS after RP between 2002 and 2017. Mean age was 63.7 years (standard deviation 1.4) and median follow-up was 10 months (range 3 – 112). The approach distribution was PA 10 patients (50%) and AA 10 patients (50%). The mean surgery time and median hospital time were 246.2 ± 35.8 minutes and 4 days (range 2 – 10), respectively with no differences between approaches. No significant complication rate was found. Three patients in the AA group had gait disorder with favorable evolution and no sequels. Estimated 2 years primary success rate was 80%. After primary procedures 89.9% remained stenosis - free. All PA patients remained incontinent, and 90% AA remained continent during follow-up. Conclusion: Open vesicourethral re - anastomosis treatment is a reasonable treatment option for recurrent VUAS after RP. All patients with perineal approach remained incontinent while incontinence rate in abdominal approach was rather low.

Objectives: To analyze the correlation between preoperative variables in patients with kidney cancer and subsequent finding of bad prognosis factors. Methods: Retrospective cohort study reviewing the charts of all patients undergoing surgery at the HIBA between June 1988 and April 2003. 555 patients were included, registering age, gender, and clinical presentation. Pathology reports were classified following WHO for histology, Furhman for tumor grade, and AJCC for tumor stage. Intrarenal disease was defined as tumors ≤ T2; the rest of the tumors were considered extrarenal. Statistical analysis was performed using the Statistic 7 Software, performing Students t test, proportions comparison test, chi-square test, and odds ratio. Results: Mean age was 58.8 years (r: 20-94), 388 (69.9%) patients were males and 167 (30.1%) females. 209 (37.7%) were smokers or ex-smokers. 256 (46.1%) tumors were incidentally diagnosed, 299 (53.9%) were symptomatic. The right kidney was affected more often (54.6%), and 2.3% were bilateral synchronic tumors. Grade II was the most frequent grade (62.2%). T1 was the predominant TNM with 273 patients (49.2%). Mean tumor size was 6.7 cm, with 5.54 cm for the intrarenal tumors and 8.67 cm for the extrarenal (Student t test p <0.00001). 49.6% (127) of the 256 asymptomatic patients have extrarenal tumors, in comparison with only 26.4% (79) of the 299 symptomatic patients (chi-square p <0.00001). Ninety-two (44%) of the 209 smokers had extrarenal tumors in comparison with 114 (32.9%) of the non-smokers. Conclusions: We may say that patients having a symptomatic renal tumor have between 2 and 3 times more probability to have non organ-confined disease at the time of surgery. This also increases, although in smaller amounts, between smokers and older than 70 years patients. The presence of a tumor greater than 7 cm almost triplicates of the possibility of extrarenal involvement.

Objetivo: Analizar la correlación existente entre factores preoperatorios en pacientes con cáncer de riñón, y el hallazgo posterior de factores de mal pronostico. Métodos: Estudio de cohorte retrospectiva, con revisión de historias clínicas de pacientes operados entre junio de 1988 y abril 2003 en el HIBA. Se seleccionaron 555 pacientes, de los cuales se tomaron edad, sexo y forma de presentación. Las anatomías patológicas fueron clasificadas según el W.H.O. para histología, Fuhrman para grado tumoral, y segun la A.J.C.C. para estadio tumoral. Se consideraron tumores con enfermedad intrarrenal (EIR) a aquellas con enfermedad menor a T2, siendo extrarrenales (EER) los restantes. Los datos fueron evaluados estadísticamente con el Student T test, Test de comparaciones de proporciones, Test Chi-Cuadrado y el Odds Ratio. Se utilizo el software Statistic 7 para la realización de los test descriptos. Resultados: La edad promedio fue de 58,8 anos (r:20-94), 388 (69,9%) hombres y 167 (30,1%) mujeres. Del total, 209 (37,7%) eran tabaquistas o ex-tabaquistas. En forma incidental se presentaron 256 (46,1%) y 299 (53,9%) en forma sintomática. El riñón derecho fue el mas afectado (54,6%), y 2,3% fueron sincrónicos bilaterales. El 85,4% (474) eran carcinomas de células claras. El grado tumoral mas frecuente fue el II con un 62,2%. El TNM que predomino fue el T1 con 273 pacientes(49,2). La media de tamaño tumoral fue de 6,7cm. Siendo para los EIR de 5,54 cm, mientras que los EER fue de 8,67 cm. (Student T test, p<0,00001). De los 256 pacientes sintomáticos, el 49,6% (127) presentaron EER, mientras que de los 299 sintomáticos solo el 26,4% (79) (Chi² p<0,00001). De los 209 pacientes tabaquistas, 92 (44%) presentaron EER, mientras que de los 346 no tabaquistas 114 (32,9%) se presentaron de este modo. Conclusión: Podemos decir que los pacientes portadores de tumor renal sintomático tienen entre 2 y 3 veces mas probabilidades de tener enfermedad no confinada al riñón en el momento de la cirugía. Esto también aumenta, aunque en menor medida en tabaquistas y mayores de 70 anos. La presencia de un tumor mayor de 7 cm casi triplica la posibilidad de EER.