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Purpose: We evaluated stone-free rate and complications after flexible ureteroscopy for renal stones, comparing thulium fiber laser and holmium:YAG laser with MOSES technology. Materials and Methods: Data from adults who underwent flexible ureteroscopy in 20 centers worldwide were retrospectively reviewed (January 2018-August 2021). Patients with ureteral stones, concomitant bilateral procedures, and combined procedures were excluded. One-to-one propensity score matching for age, gender, and stone characteristics was performed. Stone-free rate was defined as absence of fragments >2 mm on imaging within 3 months after surgery. Multivariable logistic regression was performed to evaluate independent predictors of being stone-free. Results: Of 2,075 included patients, holmium:YAG laser with MOSES technology was used in 508 patients and thulium fiber laser in 1,567 patients. After matching, 284 patients from each group with comparable baseline characteristics were included. Pure dusting was applied in 6.0% of cases in holmium:YAG laser with MOSES technology compared with 26% in thulium fiber laser. There was a higher rate of basket extraction in holmium:YAG laser with MOSES technology (89% vs 43%, P < .001). Total operation time and lasing time were similar. Nine patients had sepsis in thulium fiber laser vs none in holmium:YAG laser with MOSES technology (P = .007). Higher stone-free rate was achieved in thulium fiber laser (85% vs 56%, P < .001). At multivariable analysis, the use of thulium fiber laser and ureteral access sheath ≥8F had significantly higher odds of being stone-free. Lasing time, multiple stones, stone diameter, and use of disposable scopes showed significantly lower odds of being stone-free. Conclusions: This real-world study favors the use of thulium fiber laser over holmium:YAG laser with MOSES technology in flexible ureteroscopy for renal stones by way of its higher single-stage stone-free rate. Flexible ureteroscopy (F-URS) is a first-line option for kidney stones up to 2 cm in diameter1,2 and is suitable even for patients with larger stones,3 renal malformations,4 obesity, bleeding diathesis, and calyceal diverticula5 under general and spinal anesthesia,6 with good stone-free rate (SFR) and low morbidity. Over the past 3 decades, holmium laser lithotripsy has been predominantly carried out using standard-power machines (ie, 20 W). More recently, the availability of high power has allowed a wider range of pulse energy, frequency, and power settings to improve lithotripsy.7 In holmium:YAG laser (HL), variations in pulse modulation have introduced the concept of holmium:YAG laser with MOSES technology (HLM), virtual basket, and vapor tunnel allowing for more efficient stone ablation and less retropulsion.8 In vitro studies demonstrated that pulse modulation technology resulted in more efficient stone ablation together with less retropulsion for both hard and soft stones.9,10 Thulium fiber laser (TFL), which emerged in 2018,11 was found in preclinical studies to allow for ablation at twice the speed of HL with 4 times the amount of dust generated.12 Despite a recent single-center randomized clinical trial demonstrating no significant clinical advantage of one technology over the other,13 no direct comparison has been published comparing HLM with TFL in F-URS for renal stones in real-world practice, and much controversy continues to exist among experts in the field.14,15 The purpose of the present study was to evaluate outcomes and complications after F-URS for renal stones, comparing patients who were operated on using HLM vs TFL.

INTRODUCTION AND OBJECTIVES:Upper calyx access in percutaneous nephrolithotomy (PCNL) is an effective route to achieve access to the whole collecting system in complex kidney stone case or in high ...

INTRODUCTION AND OBJECTIVES: Previous reports have suggested an association between cold temperatures and the prevalence of testicular torsion. We hypothesized there is no association, and we used large-scale national data to evaluate this hypothesis. METHODS: For testicular torsion cases, we used the Pediatric Health Information System (PHIS) database to determine the date and city of a case of testicular torsion from 9/2006 to 7/2015. Cases were identified using ICD-9 diagnosis codes for testicular torsion (608.2) occurring concomitantly with procedure codes for reduction of torsion (63.52). For weather data, we used data from the National Climatic Data Center at the National Oceanic and Atmospheric Administration. For all cities with hospitals in the PHIS database, we determined the maximum and minimum daily atmospheric temperature at the weather station closest to each hospital. We then built cumulative distribution functions and density graphs for the distribution of (a) median daily temperature (calculated from measured temperature maximum and minimum) for cases of testicular torsion, and (b) median daily temperature for all days. Cumulative distribution curves and density graphs were compared using the KolmogorovSmirnov (K-S) test. All analyses were completed using the R software package. RESULTS: 9,126 cases of testicular torsions were identified and 154,542 days of temperature data across all hospital cities over the time period of interest. Days at each temperature across all hospitals and time from 9/2006 to 7/2015 were calculated, as were number of torsions at each temperature. The relative distribution of each temperature is compared in Figure 1, with all days portrayed in red and torsions portrayed in blue. The K-S test for similarity of distribution showed a D statistic of 0.019 (p-value 0.005), indicating the maximum deviation between these two distributions was 1.9%, a nearly imperceptible change. CONCLUSIONS: We therefore concluded that there is no clinically significant difference between the distribution of temperature in the United States and the distribution of temperature related to testicular torsion. We have shown using more than 150,000 individual days in individual cities and more than 9,000 cases of testicular torsion that there is no association between temperature and the prevalence of this disorder. We suggest abandoning this premise. Source of Funding: none

INTRODUCTION AND OBJECTIVES: It is generally hard to differentiate opacities on computerized tomography (CT) imaging e especially at distal ureteral location e as ureteral stones or phleboliths. In such cases the golden standard is to have an ureteroscopic intervention. But there are several features that can be used for differentiation of such opacities prior to an intervention. The primary goal of this study is to look for the efficiency of such trick points on CT. METHODS: The data of patients who were treated with ureteroscopic lithotripsy in our institution between 2011 and 2013 were scanned. Of these patients, the ones who also had phleboliths in CT images were taken as the study group. Opacities in the CT images were evaluated by three urologists. Each patient’s opacities in CT images were analyzed for; traceability of the ureter, ureteral obstruction, tissue rim sign, tail sign, roundness, central lucency, as suggested in the literature. Size and density (in Hounsfied Unit (HU)) of opacities were also compared. RESULTS: On 39.5 % of the incidences urologists could not differentiate the opacity (Table 1). Of all the features that are evaluated on CT, only three signs e rim sign, roundness and tail sign were found to have a significant effect on differentiating opacities as ureteral stones or phleboliths (Table 2). On the other hand apart from literature size and density of the opacities were found to have a place to differentiate phleboliths as they have low density and small volume in 92.8% of the incidences. The area under curve of receiver operating characteristic of opacity size and density were 0.956 and 0.921, respectively. The cut off values for differentiation of opacities for size and density were found to be 327 mm3 and 643 HU, respectively. CONCLUSIONS: It may be possible to differentiate stones and phleboliths by using specific signs but interestingly opacity density and size has also a place for differentiation of such pathologies on computerized tomography. Table 1 Predictability of stone and phleboliths by urologists on CT is given in table