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Introduction and Objective: As part of the Endourological Society's (ES) initiative to continuously enhance the field of endourology, the second annual census was circulated after the World Congress of Endourology and Uro-Technology 2022 (WCET22). Methods: An anonymous survey was created using Qualtrics XM and was disseminated via email to all ES members (n = 1502) between October 4, 2022, and January 26, 2023. A total of 46 questions were included in the survey and covered different aspects, including demographics, practice patterns, satisfaction, impact of COVID-19, WCET22 attendance, and future opportunities. Results: A total of 404 (26.9%) ES members (91.8% male and 8.2% female), representing 63 different countries, participated in the survey. Fellowship-trained endourologists constituted 58.9% of respondents, and the most common practice setting was academic (55.2%). The most common practice scope was complex retrograde endoscopy (83.4%), followed by percutaneous nephrolithotomy (79.5%) and medical management of urolithiasis (72.5%). Work schedules were variable, with 51.1% working 40–60 hours/week and 35.3% working >60 hours/week. More than 80% were satisfied with t heir practice; however, 42.4% indicated that COVID-19 made satisfaction worse. Of the participants, 49.5% were satisfied with their compensation, and 7.3% plan to retire within the next 5 years. When asked about the future of endourology, 92.9% had a positive outlook. Of the respondents, only 36.8% attended WCET22, with the most chosen reason for attendance being an interest in learning new research and technology. For lack of attendance, the cost of travel and lodging was reported as a determining factor by 45.4%. Conclusion: These survey results report important trends within the field of endourology and demonstrate the robust outlook of ES members for the future. By demonstrating important practice patterns and member needs, this information can be used to improve the responsiveness of its members and to continually strengthen the ES. [ABSTRACT FROM AUTHOR]

Introduction: The thulium fiber laser (TFL) generates a focused beam, which can be transmitted to laser fibers with small core diameters and may facilitate in situ lower-pole lithotripsy. This study compares lithotripsy performance of the 150 and 200 µm TFL in a lower pole benchtop kidney model. Materials and Methods: Using a 3D model printed from an actual kidney, in situ laser lithotripsy was performed on 1 cm lower-pole BegoStones (calcium oxalate monohydrate consistency) using four different settings (all 20W) and two fiber sizes (150 and 200 µm). Procedure time, laser time, total pulse energy, and fiber stripping were compared between the two fibers using an ANOVA or independent t-test. Results: The 150 µm fiber at 0.2 J × 100 Hz had the shortest lasing and procedure time (17.3 and 18.5 minutes) and lowest total pulse energy (20.75 kJ) compared with other study arms (p < 0.001). Overall procedure time, lasing time, and total pulse energy were significantly different between the 8 settings (p < 0.001 for all). At higher frequency (100 and 200 Hz), lasing time was significantly faster compared with 20 and 50 Hz (19.9 vs 27.3 minutes; p < 0.001). Furthermore, the average total procedure time was shorter with 150 µm compared with 200 µm regardless of settings (23.2 vs 29.8 minutes; p < 0.001). Conclusion: The 150 µm fiber results in shorter procedure and lasing time at lower total energy levels during lower-pole in situ lithotripsy. Overall, the fastest setting was 0.2 J and 100 Hz with the 150 µm fiber. Smaller laser fibers can potentially allow more efficient in situ laser lithotripsy with better irrigation and visibility at higher deflection angles. [ABSTRACT FROM AUTHOR]

Introduction: A flexible cystoscope is an indispensable tool for urologists, facilitating a variety of procedures in both the operating room and at bedside. Single-use cystoscopes offer benefits including accessibility and decreased burden for reprocessing. The aims of this study were to compare time efficiency and performance of single-use and reusable cystoscopes. Methods: Ten new Ambu® aScope™ 4 Cysto single-use and two Olympus CYF-5 reusable cystoscopes were compared in simulated bedside cystoscopy and benchtop testing. Ten urologists performed simulated cystoscopy using both cystoscopes in a randomized order. Times for supply-gathering, setup, cystoscopy, cleanup, and cumulative time were recorded, followed by a Likert feedback survey. For benchtop assessment, physical, optical, and functional specifications were assessed and compared between cystoscopes. Results: The single-use cystoscope demonstrated shorter supply-gathering, setup, cleanup, and cumulative times (824 vs 1231 seconds; p < 0.05) but a comparable cystoscopy time to the reusable cystoscope (202 vs 212 seconds; p = 0.32). The single-use cystoscope had a higher image resolution, but a narrower field of view. Upward deflection was greater for the single-use cystoscope (214.50° vs 199.45°; p < 0.01) but required greater force (2.5 × ). The working channel diameter and irrigation rate were greater in the reusable cystoscope. While the single-use cystoscope lacked tumor enhancing optical features, it had higher Likert scale scores for Time Efficiency and Overall Satisfaction. Conclusion: The single-use cystoscope demonstrates comparable benchtop performance and superior time efficiency compared to reusable cystoscopes. However, the reusable cystoscope has superior optical versatility and flow rate. Knowledge of these differences allows for optimal cystoscope selection based on procedure indication. [ABSTRACT FROM AUTHOR]

Introduction: Diagnosing ureteral stones with low-dose CT in patients with metal hardware can be challenging because of image noise. The purpose of this study was to compare ureteral stone detection and image quality of low-dose and conventional CT scans with and without deep learning reconstruction (DLR) and metal artifact reduction (MAR) in the presence of metal hip prostheses. Methods: Ten urinary system combinations with 4 to 6 mm ureteral stones were implanted into a cadaver with bilateral hip prostheses. Each set was scanned under two different radiation doses (conventional dose [CD] = 115 mAs and ultra-low dose [ULD] = 6.0 mAs). Two scans were obtained for each dose as follows: one with and another without DLR and MAR. Two blinded radiologists ranked each image in terms of artifact, image noise, image sharpness, overall quality, and diagnostic confidence. Stone detection accuracy at each setting was calculated. Results: ULD with DLR and MAR improved subjective image quality in all five domains ( p < 0.05) compared with ULD. In addition, the subjective image quality for ULD with DLR and MAR was greater than the subjective image quality for CD in all five domains ( p < 0.05). Stone detection accuracy of ULD improved with the application of DLR and MAR ( p < 0.05). Stone detection accuracy of ULD with DLR and MAR was similar to CD ( p > 0.25). Conclusions: DLR with MAR may allow the application of low-dose CT protocols in patients with hip prostheses. Application of DLR and MAR to ULD provided a stone detection accuracy comparable with CD, reduced radiation exposure by 94.8%, and improved subjective image quality.