Young urologists: A career in kidney transplantation? An opportunity to combine research activity with surgical training
in KT, a dedicated YAU working team was designed and created by Dr. Angelo Territo in June 2021, under the umbrella of the EAU and YAU Office. Opportunities for young urologists The YAU KT Working Group aims to support young and promising urologists in the field of KT, in which urologists play crucial roles, and expertise is a fundamental issue. Accordingly, one of the main missions of the YAU KT Working Group is to emphasise the role of urologists in KT among different medical and surgical specialists (general and vascular surgeons, nephrologists, and transplant coordinators). Furthermore, the collaboration with other YAU groups, EAU offices and sections (e.g. ESTU, ERUS, RAKT), and guidelines panel members is carried out in order to potentiate any initiatives on clinical, basic, and translational research in all fields of KT. The YAU KT Working Group promotes research activities and educational projects: • The research activities address several subjects in both conventional open KT and emerging robotic surgery. In particular, studies are conducted on topics such as the urological malignancies in KT recipients, the polycystic renal disease and KT, the learning curve in KT, the use of graft from elderly donors, the urological complication in KT, as well as the use of innovative devices to ensure better graft preservation during KT. Moreover, KT in children represents a more delicate situation due to challenging anatomical aspects. Therefore, the working groups YAU KT and Paediatric Urology (led by Dr. Beatriz Bañuelos Marco (ES)) have joined forces to (Picture 1) present reliable data on various subsets of paediatric KT, such as preoperative assessment, early graft dysfunction, bladder dysfunction & RT etc. • The educational projects are currently focusing on the development of a structured curriculum for open KT and surgical training in high-volume centres, by means of clinical visits or fellowships at the highest volume European centres for KT.
Dr. Angelo Territo Fundació Puigvert, Dept. of Urology, Autonoma University of Barcelona (ES)
The development of surgical skills for young urologists (i.e., < 40 years old) is a collective goal for the European Association of Urology (EAU) and the European School of Urology (ESU). In this regard, EAU and ESU offer many learning resources aimed at preparing the frontrunners in urology. These include scholarship programs, clinical visits, international exchange programs, online education courses, as well as hands-on training courses. In addition, the Young Academic Urologists (YAU) have various working groups which allow young urologists to enhance their academic careers according to their personal interests and future objectives, while also improving their scientific skills, academic network, cooperation, and exploring new ideas and projects. YAU Kidney Transplant Working Group More than 20,000 kidney transplantations (KT) are currently performed each year in Europe. KT remains a challenging task, and it cannot be carried out optimally without the involvement of urologists who have the primary responsibility to take care of the kidney. Given the epidemiological and clinical relevance as well as the important role of urologists
Picture 2: The ideal pathway for a young urologist interested in KT
Conclusion In summary, KT demands specific training that should include theoretical lessons, non-technical skills development, dry-lab simulation, wet-lab simulation (or animal models), and active exposure to all main steps of the procedure in order to gain enough confidence and expertise before starting KT as the first surgeon. However, combining research activity with a surgical training curriculum is a more exciting way of promoting interest in KT. For these reasons, we strongly believe that the world of KT can be inspiring for urologists. There is the unique opportunity to grow up as a surgeon and a researcher at the same time, being exposed to challenging clinical/surgical scenarios and stimulating unexplored issues and/or still open debates. Last but not least, the kidney is urologists’ specialty, thus, kidney transplantation too!
endpoint for the transplant community. In this regard, EAU Sections (ESTU, YAU, ERUS, ESU) are currently working together to propose a standardised training surgical curriculum on KT, considering the available data and the experiences of the main clinical leaders in this field. In our view, this should represent a preliminary step for a structured research pathway. A subsequent validation is needed in real clinical practice, potentially including available dedicated courses that are becoming landmarks for surgeons’ training worldwide (i.e., ORSI Academy, in collaboration with the ERUS RAKT Working Group, headed by Dr. Alberto Breda). In this regard, promotion of involvement in KT among residents and young urologists should be highly supported by our urological communities since trees grow out of seeds. Early career interest in KT should be promoted, which will probably bring short-term clinical visits to various centres around Europe during residency - supported by national and international associations - that end up with fellowship training afterwards. Then, young urologists who have scientific interest in KT, can become a member of the YAU KT working group and help us to shape the KT society. Picture 2 shows the ideal pathway for a young urologist interested in KT.
Proposal for a curriculum in KT and future perspectives
Acknowledgment: a thanksgiving to Dr. Irfan Donmez to contribute in this article.
According to the available evidence, open and robotic KT seem to have a similar learning curve, with approximately 30 cases needed to achieve optimal results in terms of operative time, re- warming/ischemia time, complication rate, and functional outcomes (1). Therefore, the development of a standardised curriculum represents a primary
Saturday, 11 March 12:45 - 13:00 Joint meeting of ESTU, ESUR, USTRS and YAU: Technological and research matters in
Picture 1. YAU Kidney Transplant Working Group (Dr. Romain Boissier, Dr. Alessio Pecoraro, Dr. Angelo Territo, Dr. Thomas Prudhomme, Dr. Riccardo Campi) and Dr. Irfan Donmez (member of the YAU Paediatric Working Group) at EMUC 2022 in Budapest.
kidney transplantation Yellow Area, Amber 3
Experience with a new bladder voiding management system A new indwelling transurethral catheter design may improve tolerability and safety
We determined the initial results, safety, and efficacy of a new Bladder Voiding Management System (CymActive™) which consists of a self-retaining intraurethral catheter, with a patient-controlled magnetic valve that allows cyclical bladder voiding without external appliances. We selected patients with indwelling Foley catheter, and with acute urinary retention due to prostatic obstructive pathology (BPH). They were catheterised with the CymActive™ system. None of whom presented with evidence of neurogenic bladder. We performed uroculture prior to placement of the device, and after its removal. Data was collected from patient’s daily questionnaires, and weekly visits during catheterisation for 30 days. The variables evaluated were: insertions, tolerability, effectivity, and device-associated infections.
Dr. Nicolás Urday Department of Urology, Hospital de Alta Complejidad, Juan Domingo Perón, Formosa (AR)
Figure 2: Methods: general characteristics of the catheter
Co-authors: Naber Kurt*, Yardy George**, Apóstolo Claudio, Wirz Walter, Luco Montero Rogelio, Copes Guillermina; Rainero Federico, Corbetta, Juan Pablo. *Department of Urology, Technical University of Munich, Munich, Germany. **Department of Urology, Ipswich Hospital, Ipswich, United Kingdom. Since 1972, when Lapides and colleagues introduced the clean intermittent catheterisation, there have been a few changes in the way that voiding dysfunction was treated. Urinary tract infections are the most common urological complication with indwelling patients [1]. Bacteria can enter the bladder during insertion of the catheter, through the catheter lumen, or from around the outside of the catheter. “Even with thoroughly aseptic catheter insertion and care, the chance of developing significant bacteriuria is 3 to 10% every day the catheter is indwelling” (Imam) [2]. We tested a new device that could improve the quality of life in patients with urinary voiding problems.
device. In 2/10 the protocol was discontinued due to discomfort. 10/10 showed average PVR of 25 ml at the first control; successful valve openings and closings in ≥ 95% of more than 1,500 voids. 1/10 urinary infections during the trial. "Even with thoroughly aseptic catheter insertion and care, the chance of developing significant bacteriuria is 3 to 10% every day the catheter is indwelling." In conclusions, this pilot experience, demonstrated that CymActive™ is potentially useful and safe for these patients. A major sample will be needed to define better outcomes and characteristics of patients who benefit from this device.
Figure 3: Methods: general characteristics of the catheter
References 1. Lapides J, Diokno AC, Silber SM, et al. Clean, intermittent self-catheterization in the treatment of urinary tract disease. J Urol. 1972;167 (4): 1584–1586, 2002. 2. Catheter-Associated Urinary Tract Infections. Talha H. Imam , MD, University of Riverside School of Medicine.
Ten patients were included in the study. Seven were Foley carriers awaiting prostate surgery, and the remaining three were catheterised for the first time. Of 10/10 successful insertions; 8/10 showed good tolerance to the
Last review/revision Jul 2021 | Modified Sep 2022
Saturday 11 March 18:30 - 18:40 ESIU Meeting: Urogenital infections in urology Yellow Area, Amber 3
Figure 1: Introduction: history of catheterisation.
European Urology Today
28
February/March 2023
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