Search

This study assessed the impact of urinary tract anomalies or a history of upper urinary tract surgery (UTAS) on the minimally invasive endoscopic combined intrarenal surgery (mini-ECIRS) outcomes. Data from 1432 patients undergoing ECIRS for urolithiasis at three Japanese tertiary institutions between 2015 and 2021 were analyzed, with patients categorized into those with normal urinary tracts (non-UTAS) and those with UTAS (UTAS). We retrospectively examined the association between the UTAS and perioperative outcomes in mini-ECIRS. Of the 1096 cases in the final analysis, 1035 and 61 were identified as non-UTAS and UTAS, respectively. Stone-free rate (residual fragments > 2 mm, 62.8% vs. 62.7%), operation time (110.5 vs. 115.0 min), and hospital stay duration (5.6 vs. 5.7 days) showed no significant differences between non-UTAS and UTAS. The UTAS group demonstrated significantly higher rates of preoperative pyuria (86.2% vs. 71.1%), preoperative urinary tract infection (32.8% vs. 15.5%), preoperative stenting (52.5% vs. 31.0%), and preoperative nephrostomy (24.6% vs. 9.2%). However, the postoperative fever (26.3% vs. 25.0%) or septic shock (1.9% vs. 0%) were comparable between non-UTAS and UTAS. Stone burden and the number of calyces involved were significantly associated with a low stone-free rate (P < 0.001). Younger age, female sex, solitary stones, number of calyces involved, preoperative urinary tract infection, and absence of preoperative nephrostomy were identified as risk factors for perioperative complications. The UTAS was not associated with stone-free outcomes or perioperative complications. Mini-ECIRS demonstrated comparable stone-free outcomes and safety in patients with UTAS and those with normal urinary tracts. [ABSTRACT FROM AUTHOR]

Management of large pediatric kidney calculi (PKC) is challenging. This study aimed to evaluate the efficacy and safety of miniature endoscopic combined intrarenal surgery (mini-ECIRS) for PKC. We retrospectively analyzed mini-ECIRS in 16 pediatric patients undergoing kidney stone treatment between November 2014 and October 2023 to determine its safety, efficacy, and associated outcomes. The median age was 50.50 (interquartile range: 36.75, 84.75) months, and the mean stone size was 21.63 ± 11.65 mm. The stone-free rate was 81.25%. The median decrease in hemoglobin level on the day after surgery was 1.10 (0.80, 1.55), and no patient required a blood transfusion. The median number of general anesthesia procedures was 2.00 (2.00, 2.00). Postoperative complications included fever in two patients and difficulty in removing the ureteral stent in one patient. In this cohort, five patients underwent pre-stenting under general anesthesia before mini-ECIRS. Age was significantly lower in the pre-stenting group than in the non-pre-stenting (P < 0.01); however, there were no significant differences in operative time, stone-free rate, total number of general anesthesia procedures, hemoglobin loss, or postoperative hospital stay between the groups. Mini-ECIRS was found to be a safe and efficient treatment method with a high stone removal rate in pediatric patients. [ABSTRACT FROM AUTHOR]

Objectives: This study aimed to investigate the influence of tract location on surgical outcomes in endoscopic combined intrarenal surgery (ECIRS), considering the location of residual stones. Methods: From January 2015 to December 2021, 1417 consecutive patients underwent ECIRS in three hospitals. After excluding patients with preoperative percutaneous nephrostomy, intended multi‐stage procedures, those with a tract in the renal pelvis, and those with multiple tracts, 1000 patients were retrospectively analysed by comparing three groups based on tract location: group 1 (upper calyx), group 2 (middle calyx), and group 3 (lower calyx). A multivariate logistic regression model was implemented to assess whether the tract location independently affected the stone‐free status. Results: Patient characteristics were significantly different among the groups in terms of age, stone laterality, presence of calyceal stones, and hydronephrosis. There were no differences in stone‐free rate (SFR) among the three groups. Multivariate analysis indicated that the tract location (group 1 or 2 compared with group 3) did not significantly affect the stone‐free status (odds ratio = 1.4, 0.9–1.9, p = 0.066). Surgical duration significantly varied among the groups, with the shortest time observed in group 1. Organ injury was observed exclusively in group 1 (1.13%). Residual fragments were predominantly found in the lower calyx, with the calyx associated with the tract being the second most common location. Conclusions: Tract location does not significantly affect SFR. To improve the SFR, observation of the lower calyx and tract placement is important. [ABSTRACT FROM AUTHOR]

Objectives: This study compares intrapelvic pressure (IPP) during retrograde intrarenal surgery with various single‐use flexible ureteroscopes (f‐URS) in an artificial kidney model. Methods: We created an artificial kidney model with a pressure sensor using a bladder evacuation device. The model was completely closed and the only backflow was on the side of the ureteroscope inside the ureteral access sheath (UAS). We tested five single‐use f‐URSs (LithoVue, Wiscope, PU3022A, PU3033A, and AXIS) with six different types of UAS (9.5/11.5–14/16 Fr). Using the automatic irrigation system, 30 s of irrigation was performed at various pressures (40–180 mmHg) and steady‐state IPP was recorded. IPP was compared between the five single‐use f‐URSs. IPP cutoff value was determined at 30 mmHg. The diameter of the endoscope tip and the curved and shaft parts were also measured and recorded. Results: The diameters of all parts were significantly different between single‐use f‐URSs. The maximum IPP tended to be higher in ureteroscopes with larger diameters of the proximal parts (curved part/shaft part). In LithoVue and Uscope PU3022A f‐URSs, the maximum IPP did not exceed 30 mmHg when UAS ≥12/14 Fr was used. In AXIS and Wiscope f‐URSs, it did not exceed the cutoff value when the UAS ≥11/13 Fr was used. In Uscope PU3033A f‐URS, it did not exceed 30 mmHg when the UAS ≥10/12 Fr was used. Conclusions: Maximum IPP tended to be higher in f‐URSs with larger diameters of the proximal part and the appropriate size of the UAS differed between various single‐use f‐URSs. [ABSTRACT FROM AUTHOR]

Introduction: Patients with benign prostatic hyperplasia are usually treated with 5α-reduced inhibitors (5ARIs) such as finasteride and dutasteride. However, studies on the influence of 5ARIs on sexual function have been controversial. In this study, we evaluated the impact of dutasteride treatment for erectile function in patients with once-negative prostate biopsy and benign prostate hyperplasia. Patients and methods: 81 patients with benign prostate hyperplasia were enrolled in a one-armed prospective study. They were administrated 0.5 mg/day of dutasteride for 12 months. Patient characteristics and changes of International Prostate Symptom Score (IPSS) and International Index of Erectile Function (IIEF)-15 scores at baseline and 12 months after dutasteride administration were examined. Results: The mean ± standard deviation (SD) age of the patients was 69.4 ± 4.9 years and the prostate volume was 56.6 ± 21.3 mL, respectively. The mean ± SD prostate volume and PSA levels were decreased 25.0 and 50.9%, respectively, after 12 months of dutasteride administration. IPSS total, voiding subscore, storage subscore, and quality of life score significantly improved after 12 months of dutasteride administration. No statistically significant change in IIEF-total score from 16.3 ± 13.5 to 18.8 ± 16.0 (p = 0.14), IIEF-EF score from 5.1 ± 6.9 to 6.4 ± 8.3 (p = 0.13) were observed. There was no decrease in erectile function severity. Conclusion: Twelve months administration of dutasteride for patients with BPH improved urinary function and did not increase the risk of sexual dysfunction. [ABSTRACT FROM AUTHOR]