BACKGROUND: The COVID-19 pandemic disrupted all routine health care services in 2020. To date, data regarding adjustment and coverage of surgical backlog in the post-COVID era actually remains scarce. The aim of this study was to compare the number of urological procedures coded between 2019 and 2021 in public and private institutions to (i) quantify the variation in surgical activity linked to the shutdown in 2020 and (ii) study the adjustment of procedures over the year 2021.
METHODS: This is a comprehensive retrospective analysis of all urological surgeries coded between January 1, 2019 and December 31, 2021 in France. Data were extracted from the open access dataset of the national Technical Agency for Information on Hospital Care (ATIH) website. In total, 453 urological procedures were retained and allocated in 8 categories. Primary outcome was the impact of COVID-19 analyzed by the 2020/2019 variation. The secondary outcome was the post-COVID catch-up analyzed by the 2021/2019 variation.
RESULTS: Surgical activity in public hospitals dropped by 13.2% in 2020 compared to 7.6% in the private sector. The most impacted areas were functional urology, stones and BPH. Incontinence surgery did not recover at all in 2021. BPH and stone surgeries were far less impacted in the private sector, with even explosive activity in 2021, post-COVID period. Onco-urology procedures were roughly maintained with a compensation in 2021 in both sectors.
CONCLUSIONS: The recovery of surgical backlog was much more efficient in the private sector in 2021. The pressure on the health system associated to the multiple COVID-19 waves may generate a gap between public and private surgical activity in the future.
METHODS:

BACKGROUND: Greenhouse gas (GHG) emissions are a serious environmental issue. The healthcare sector is an important emitter of GHGs. Our aim was to assess the environmental cost of teleconsultations in urology compared to face-to-face consultations.
METHODS: Prospective study of all patients who had a remote teleconsultation over a 2-week period during COVID-19 pandemic. Main outcome was the reduction in CO2e emissions related to teleconsultation compared to face-to-face consultation and was calculated as: total teleconsultation CO2e emissions-total face-to-face consultation CO2e emissions. Secondary outcome measures were the reduction in travel distance and travel time related to teleconsultation.
RESULTS: Eighty patients were included. Face-to-face consultations would have resulted in 6699km (4162 miles) of travel (83.7km (52 miles) per patient). Cars were the usual means of transport. CO2e avoided due to lack of travel was calculated at 1.1 tonnes. Teleconsultation was responsible for 1.1kg CO2e while face-to-face consultation emitted 0.5kg of CO2e. Overall, the total reduction in GHGs with teleconsultation was 1141kg CO2e, representing a 99% decrease in emissions. Total savings on transport were 974 € and savings on travel time were 112h (1.4h/patient).
CONCLUSIONS: Teleconsultation reduces the environmental impact of face-to-face consultations. The use of teleconsultation in our urology departments resulted in the avoidance of more than 6000km of travel, equivalent to a reduction of 1.1 tonnes of CO2e. Teleconsultation should be considered for specific indications as the healthcare system attempts to become greener.
METHODS: 3.

BACKGROUND: Our purpose was to assess the efficacy of low intensity extracorporeal shock waves (SW) for the treatment of organic erectile dysfunction (ED).
METHODS: A systematic review of the literature published between 2000 and 2020 was conducted using the PRISMA methodology. We used Medline data with the following key words (MesH): \"extracorporeal shock wave therapy\"; \"erectile dysfunction\"; \"sexuality\".
RESULTS: Nineteen articles were selected: thirteen randomised controlled trial and six meta-analyses. Most of them studied vascular etiology. Low intensity SW is beneficial ED is evaluated by the IIEF, EHS scores and penile hemodynamic.
CONCLUSIONS: SW may have a theoretical impact on the vascular etiology of organic DE. Their use in this context is supported by the European Society of urology and the European Society of sexual medecine. However, there are discrepancies in current data to establish a protocol to follow in daily practice.

BACKGROUND: With the COVID-19 outbreak activities of urology departments have been limited to non-deferrable procedures impacting the daily program of residents in urology. We assessed the psychological impact of the lockdown on Belgian residents in urology and their resounding on the quality of the training.
METHODS: A self-administered anonymous questionnaire assessing the risk of burnout in a pandemic situation and its impact on the quality of the training was e-mailed to the members of the European Society of Residents in Urology of Belgium (ESRU-B). We used the Copenhagen Burnout Inventory score which assesses the different dimensions of burnout (personal (CBIP), professional (CBIPro), relational (CBIR)). Several questions evaluating impact on residents\' health and apprehension of the future were included. The survey lasted for 5 days. Comparison of parameters before and during the coronavirus crisis was made using paired samples t-test or Chi2 test were.
RESULTS: Fifty percent (62/126) of the ESRU-B members replied to the questionnaire. If 93% of the responders reported a negative impact on the quality of their practical training (CI95=[0.07-1.10]; P=0.83), 56% and 61.7% reported a positive impact of the crisis on their life and on their theoretical training respectively. Burnout risk scores were significantly reduced (P<0.001) for each dimension 7.26 to 3.40 (CBIP), 9.02 to 4.35 (CBIPro) and 4.42 to 3.03 (CBIR) respectively.
CONCLUSIONS: Despite a negative impact on the daily work quality, the decrease in activity induced by the lockdown did not have a negative psychological impact on Belgian residents in urology but stress the opportunity to review the current training system to be better balanced between practice and theoretical formation.

BACKGROUND: As a result of the COVID-19 pandemic in France, all non-emergency surgical activity has been cancelled since March 12, 2020. In order to anticipate the reinstatement of delayed interventions, surgical activity reduction analysis is essential. The objective of this study was to evaluate the reduction of urological surgery in adult during the COVID-19 pandemic compared to 2019.
METHODS: The data regarding urological procedures realized in the 8 academic urological departments of Parisians centres (AP-HP) were compared over two similar periods (14-29 March 2019 and 12-27 March 2020) using the centralized surgical planning software shared by these centres. Procedure title, type of surgery and outpatient ratio were collected. The interventions were sorted into 16 major families of urological interventions.
RESULTS: Overall, a 55% decrease was observed concerning urological procedures over the same period between 2019 and 2020 (995 and 444 procedures respectively). Oncology activity and emergencies decreased by 31% and 44%. The number of kidney transplantations decreased from 39 to 3 (-92%). Functional, andrological and genital surgical procedures were the most impacted among the non-oncological procedures (-85%, -81% and -71%, respectively). Approximatively, 1033 hours of surgery have been delayed during this 16-day period.
CONCLUSIONS: Lockdown and postponement of non-urgent scheduled urological procedures decisions has led to a drastic decrease in surgical activity in AP-HP. Isolated kidney transplantation has been stopped (national statement). Urologists must anticipate for lockdown exit in order to catch-up delayed surgeries.
METHODS: 3.

BACKGROUND: The COVID-19 outbreak in France is disturbing our health system. Urologists in training who are already known to have burnout, are in the front line to face this disease. The aim of our study was to assess the psychological impact of COVID-19 pandemic on young French urologists in training.
METHODS: A self-administered anonymous questionnaire evaluating the pandemic added stress, and its negative impact on work and training quality, was e-mailed to the members of the French Association of Urologists in Training (AFUF). The association includes all French junior and senior residents. The survey lasted 3 days. Multivariable analyses using logistic regression was performed to identify the predictive factors.
RESULTS: Two hundred and seventy-five (55.5%) of the 495 AFUF members responded to the questionnaire. More than 90% of responders felt more stressed by the pandemic. Fellows and senior residents were more likely to feel that the crisis had an important impact on their work quality (OR=1.76, IC95=[1.01-3.13]), even more when COVID 19 patients were present in their department (OR=2.31, IC95=[1.20-4.65]). Past medical history of respiratory disease (OR=2.57, IC95=[1.31-5.98]) and taking in charge COVID19 patients (OR=1.85, IC95=[0.98-3.59]) were additional risk factors.
CONCLUSIONS: COVID19 pandemic has a negative impact on young French urologists in training and on their work and training quality. Managing their psychosocial well-being during this time is as important as managing their physical health.
METHODS: 3.

BACKGROUND: Urological recommendations never focused on prevention and treatment of urinary tract infections related to endo-ureteral material.
METHODS: We conducted an evaluation of French professional practices in May 2019 in the aim of highlighting the important heterogeneity of practices using a Survey Monkey inquiry.
RESULTS: One-hundred-and-seventy-five urologists answered the inquiry, as to say 13% of French urologists. Questions regarding the management of pre-surgical polymicrobial urine sample, medical and surgical management of pyelonephritis on endo-ureteral material and regarding the need to diagnose and treat asymptomatic bacteriuria before endo-ureteral stent removal are the main points a majority of French urologists felt uncomfortable with.
CONCLUSIONS: This study evaluated French practices in 2019. The diversity of the answers highlights the need for new recommendations on these subjects of daily practice. Future recommendations should allow their homogenization based on the existing evidence-based data.

OBJECTIVE: The objective of this study is to assess the correlation between the urinary incontinence results of the ICIQ-SF, and those obtained in the 1-hour and 24-hour pad tests, in a sample of men that underwent prostatectomy.
METHODS: A prospective observational study was carried out in patients from the Integrated Management Area of Vigo (EOXI de Vigo) who underwent prostatectomy and suffered from urinary incontinence in the post-surgery period. Loss of urine was assessed by means of the 1-hour and 24-hour pad tests and the ICIQ-SF. A comparative analysis of the questionnaire findings was performed for both urinary incontinence tests.
RESULTS: A correlation is observed between the ICIQ-SF and the amount of urine loss in the 1-hour and the 24-hour pad tests. However, the severity of urine loss established by instruments is less consistent. The 24-hour pad test is the one that obtained better correlation with the ICIQ-SF.
CONCLUSIONS: The ICIQ-SF should be validated in a male population after prostatectomy in order to reinterpret the severity values observed in the different instruments studied.
METHODS: 4.

BACKGROUND: Growing robotic surgery requires new skills for OR professionals. In the heart of the robotic surgery team, the Operating Room nurse has a preponderant role whether circulating, scrub nurse or surgical assistant. How does the OR robotic nurse train? Beyond the technique, what does robotic imply in the OR?
METHODS: Analysis of the literature with the terms \"scrub nurse\" and \"robotic surgery\" in the PUBMED search engine, and exchanges with OR nurses involved in robotic surgery.
RESULTS: The definition of the different OR nurses\' roles in robotic surgery shows specific skills to acquire. OR nurses\' training is heterogeneous. Communication in the OR is a major stake in robotic surgery.
CONCLUSIONS: Mastery of the robotic tool is essential and the expertise of the OR nurses must be sought to ensure a safe care of patients. Communication appears to be one of the major issues. OR staff training should be standardized, such as regular practice. OR nurses\' work is evolving with technique.

BACKGROUND: The aim of this study was to determine the prevalence of anatomic variations (renal, vascular and urological) and acquired renal pathologies in living kidney donor candidates (LKDC).
METHODS: This is a retrospective study of all LKDC referred to our center between April 2003 and September 2014. Of the 491 LKDC, 189 were initially excluded for medical reasons (n=140) or others reasons (n=49), without undergoing a radiological assessment. In total, 302 had a radiological assessment (angio-CT or MRI) in anticipation of the donation and 226/302 (73.5%) could donate a kidney.
RESULTS: One or more anatomical variations and/or acquired abnormalities were observed in 178/302 (58.9%) of the LKDC. The most frequent were arterial variations or abnormalities (multiple arteries, fibrodysplasia, aneurysms, stenosis≥70%) which where observed in 39.3% of the LKDC, followed by the venous abnormalities (27.8%). Kidney stones were observed in 5.6% of the LKDC and the urinary abnormalities (duplication/ureteral bifidity) were found in 3% of the LKDC. No malignant tumour was diagnosed, while 4 benign tumours (1.3%) were identified, and one of them required additional investigations.
CONCLUSIONS: We found a high prevalence of anatomical variations and acquired abnormalities in a population of LKDC. However, these findings resulted in the exclusion of only 4% of the candidates, because they did not contraindicate the donation or, in most of cases, the contralateral kidney could be used.
METHODS: 3.