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 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.