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Purpose To evaluate the perioperative outcomes of retrograde intra-renal surgery (RIRS) for lower pole stones (LPS) and factors affecting stone-free rate (SFR). Methods Data from 20 centers were retrospectively reviewed. Inclusion criteria were adult patients, normal renal anatomy, and LPS. Exclusion criteria were bilateral surgery, concomitant surgery for ureteral stones. SFR was defined as a single residual fragment (RF) ≤ 2 mm and evaluated 3-months after surgery. A multivariable logistic regression analysis was performed to assess factors associated with RF. Statistical significance was set at p value Results 2946 patients were included. Mean age and stone size were 49.9 years 10.19 mm, with multiple LPS in 61.1% of cases. Total operation and laser time were 63.89 ± 37.65 and 17.34 ± 18.39 min, respectively. Mean hospital stay was 3.55 days. Hematuria requiring blood transfusion and fever/urinary infections requiring prolonged antibiotics occurred in 6.1% and 169 5.7% of cases, while sepsis with intensive-care admission in 1.1% of patients. On multivariate analysis, Multiple stones (OR 1.380), stone size (OR 1.865), and reusable ureteroscopes (OR 1.414) were significantly associated with RF, while Thulium fiber laser (TFL) (OR 0.341) and pre-stenting (OR 0.750) were less likely associated with RF. Conclusions RIRS showed safety and efficacy for LPS with a mean diameter of 10 mm. This procedure can achieve a satisfactory SFR in pre-stented patients with a single and smaller stone, particularly with TFL use.

Context Ureteral stent-related symptoms (SRSs) are very common and may potentially influence the quality of life and functional capacity of patients. It remains unclear whether mirabegron has a place in the treatment of SRSs. Objective To summarize the evidence of mirabegron for the treatment for SRSs in adult patients. Evidence acquisition A systematic review of literature was performed using the PubMed, Embase, and Google Scholar databases. Studies published up to June 2021 that met the search terms (“mirabegron” OR “B3-agonist”) AND (“stent-related symptoms” OR “stent-related discomfort” OR “stent”) were considered. References from relevant sources were examined to identify additional sources for this review. Relevant studies were selected according to Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. The revised Cochrane tool “RoB 2” was used to assess the quality of included randomized clinical trials. Evidence synthesis Eight studies were selected for final quantitative and qualitative synthesis. The Ureteral Stent Symptom Questionnaire (USSQ) body pain score was significantly improved by mirabegron in five studies, although a pooled data analysis did not reveal any significant changes. The USSQ urinary symptom score was significantly improved by mirabegron in four independent studies as well as in the corresponding meta-analysis, while no changes were found in two studies. International Prostate Symptom Score was improved significantly by mirabegron in three independent studies as well as in the corresponding meta-analysis. The USSQ general health and the quality of life score were improved significantly by mirabegron on meta-analysis. Conclusions Mirabegron may have a beneficial effect on pain and urinary symptoms due to ureteral stents, although the evidence is based on low-quality studies. Patient summary In this report, we looked at the evidence of mirabegron for the treatment of ureteral stent-related symptoms. We found that mirabegron can potentially alleviate pain and bothersome urinary symptoms due to ureteral stents.

Ureteral stents are an indispensable part of any (endo-) urologic practice. Despite the widely demonstrated advantages of stents, they also carry a considerable risk of side effects and complications, such as urinary symptoms, pain, hematuria, decreased quality of life, stent-related infection, and encrustation. Multiple pathways in preventing or mitigating these side effects and complications and improving stent efficacy have been and are being investigated, including stent architecture and design, biomaterials, and coatings. This article provides an update on currently researched and available stents as well as future perspectives.

Objectives: To determine which flexible ureterorenoscopy program would be most cost-efficient in our center, a cost efficiency analysis and a formula to assess cost efficiency feasibility of a hybr...

Purpose To evaluate the decompression of the pelvicalyceal system between urologists and radiologists. Methods A survey was distributed to urologists and to radiologists comparing double-J stent (DJS), percutaneous nephrostomy (PN) and primary ureteroscopy (URS) for three clinical scenarios (1-febrile hydronephrosis; 2-obstruction and persistent pain; 3-obstruction and anuria) before and after reading literature The survey included perception on radiation dose, cost and quality of life (QoL). Results Response rate was 40% (366/915). 93% of radiologists believe that DJS offers a better QOL compared to 70.6% of urologists (p = 0.006). 28.4% of urologists consider PN to be more expensive compared to 8.9% of radiologists (p = 0.006). 75% of radiologists believe that radiation exposure is higher with DJS as opposed to 33.9% of urologists. There was not a difference in the decompression preference in the first scenario. After reading the literature, 28.6% of radiologists changed their opinion compared to 5.2% of urologists (p < 0.001). The change favored DJS. In the second scenario, responders preferred equally DJS and they did not change their opinion. In the third scenario, 41% of radiologists chose PN as opposed to 12.6% of urologists (p < 0.001). After reading the literature, 17.9% of radiologists changed their opinion compared to 17.9% of urologists (p < 0.001), in favor of DJS. Although the majority of urologists (63.4%) consistently perform primary URS, only 3, 37 and 21% preferred it for the first, second and third scenarios, respectively. Conclusion The decision on the type of drainage of a stone-obstructing hydronephrosis should be individualized.

Introduction and Objective: Catheter-associated urinary tract infections are a major cause of patient morbidity and mortality. Despite many attempts to design biomaterials that might reduce the ris...

Purpose: The aim of the current systematic review and meta-analysis is to provide an answer on which is the most appropriate approach for the management of the lower pole stones with a maximal dimension of 2 cm or less. Materials and Methods: A systematic review was conducted on PubMed (R), SCOPUS (R), Cochrane and EMBASE (R). The PRISMA guidelines and the recommendations of the EAU Guidelines office were followed. Retrograde intrarenal surgery, shock wave lithotripsy and percutaneous nephrolithotomy were considered for comparison. The primary end point was the stone-free rate. Results: A total of 15 randomized controlled trials were eligible. Percutaneous nephrolithotripsy and retrograde intrarenal surgery have higher stone-free rates in comparison to shock wave lithotripsy and require fewer re-treatment sessions. Operative time and complications seem to favor shock wave lithotripsy in comparison to percutaneous nephrolithotripsy, but this takes place at the expense of multiple shock wave lithotripsy sessions. Retrograde intrarenal surgery seems to be the most efficient approach for the management of stones up to 1 cm in the lower pole. Conclusions: The pooled analysis of the eligible studies showed that the management of lower pole stones should probably be percutaneous nephrolithotripsy or retrograde intrarenal surgery to achieve stone-free status over a short period and minimal number of sessions. For stones smaller than 10 mm, retrograde intrarenal surgery is more efficient in comparison to shock wave lithotripsy. The decision between the 2 approaches (percutaneous nephrolithotripsy or retrograde intrarenal surgery) should be individual, based on the anatomical parameters, the comorbidity and the preferences of each patient.

Purpose: Stone burden has been reported as an independent predictor of stone-free rate after percutaneous nephrolithotomy (PCNL); however no consensus exists on a standardized method for measuring ...

Introduction: Urolithiasis in solitary kidney (SK) presents significant management dilemma as any insult to the kidney or its drainage can lead to significant morbidity. The treatment options include shock wave lithotripsy (SWL), percutaneous nephrolithotomy (PCNL), and ureteroscopy (URS). Our aim was to conduct a systematic review of literature on all available endourologic techniques reporting on the management of stones in an SK. Materials and Methods: We conducted a systematic review according to the Cochrane and PRISMA checklist for all English-language articles from inception to December 2018. All studies with a minimum of 10 patients that reported on endourologic management (SWL, PCNL, or URS) were included. Data were extracted for patient and stone demographics, outcomes including stone-free rate (SFR), adverse events, and renal function. Results: After an initial search of 553 articles, 27 were included for the final review (10 PCNL, 1 mini-PCNL, 9 URS, 1 SWL, and 6 comparative studies). The choice of treatment seemed to be based on stone size, with PCNL, URS, and SWL offered for mean stone sizes between 25-50, 10-28, and 12-15 mm, respectively. PCNL, URS, and SWL were reported in 1445, 792, and 186 patients, respectively, with a final SFR of 67%-97.7%, 43%-100%, and 73%-80% and a complication rate of 26.4%, 15%, and 16.7% across the three groups. The renal function deterioration was reported in 4/16 PCNL studies and in 1/15 URS studies, while it remained unaffected in the SWL study. Conclusions: Our review shows a rise of endourologic techniques in the management of stones in SK. Although PCNL was used for larger stones, it had a higher risk of major complications, including blood transfusion. While a good SFR was obtained for patients irrespective of the treatment modality, the selected intervention needs to be balanced with its safety profile and the need for ancillary procedures.

INTRODUCTION AND OBJECTIVE:The use of antibiotics before shock wave lithotripsy (SWL) varies greatly globally. Guidelines have been hampered by reliance on limited evidence summaries and data for t...

INTRODUCTION: The highest in quality data in the literature which compared mini percutaneous nephrolithotripsy (mPCNL), retrograde intrarenal surgery (RIRS) and shock wave lithotripsy (SWL) for the management of lower pole stone (LPS) with a maximal diameter ≤20 mm were investigated by means of systematic review (SR) and meta-analysis. EVIDENCE ACQUISITION: A SR of the literature was conducted on PubMed, Cochrane, SCOPUS and EMBASE in January 2020. The study complied with the PRISMA statement and recommendations of the EAU Guidelines office. Only randomized controlled trials (RCTs) comparing retrograde intrarenal surgery (RIRS), shock wave lithotripsy (SWL) and mini-percutaneous nephrolithotripsy (mPCNL) were selected for the meta-analysis. The endpoints were the efficacy of each modality, measured by stone-free rate (SFR), operative time and retreatment rate and the safety of each method, based on hospitalization time and complications. Subgroup analyses for stones with a maximal diameter

Percutaneous nephrolithotomy (PCNL) is the current gold standard for the treatment of large and complex renal stone disease. It is a complex procedure that requires skill and experience. The most challenging step and key requisite of a successful PCNL is establishing optimal access to the renal collecting system with imaging modalities. To increase safety and efficacy in this crucial step, and with ongoing advancements in current technology, several aids have been developed to assist the urologist and help accurately guide the needle to the target. The goal of this systematic review was to identify and discuss these innovations.

Use of α-blockers for medical expulsive therapy (MET) has been the subject of huge debate in urology. Moreover, there have been a number of randomized controlled trials with differing results. We conducted a systematic review and meta-analysis of randomized controlled trials investigating the efficacy of α-blockers for MET. This review confirms there is a role for α-blockers in MET for ureteric stones specifically in stones >5 mm and distal ureteric stones, which is associated with improved stone expulsion. However, there is a slight increase in risk of nonsignificant side effects.

Background Kidney autotransplantation (KAT) is the ultimate way to salvage kidneys with complex renovascular, ureteral, or malignant pathologies that are not amenable to in situ reconstruction. A minimally invasive approach could broaden its adoption. Objective To describe operative technique, perioperative complications, and early functional outcomes of robot-assisted kidney autotransplantation (RAKAT). Design, setting, and participants Retrospective review of prospectively collected data regarding consecutive patients undergoing RAKAT between March 2017 and February 2018 at two university hospitals. Intervention RAKAT. Outcome measurements and statistical analysis Technical feasibility, perioperative complications, and early functional results. Results and limitations Seven patients underwent RAKAT (three male and four female; five left and two right; one totally intracorporeal) for complex ureteral strictures (n = 5), severe left renal vein nutcracker (n = 1), and loin pain hematuria syndrome (n = 1). Two patients underwent bench vascular reconstruction and one patient underwent ex vivo flexible ureterorenoscopy. No patient needed open conversion. Median operative and console time was 370 and 255 min, respectively, with median vascular and ureteral anastomosis time of 28 and 23 min, respectively. Median warm, cold, and rewarming ischemia time was 2, 178, and 44 min, respectively. One major postoperative complication occurred—wound dehiscence needing wound revision (grade 3b). Median hospital stay was 5 d. At 3 mo, all patients were free of indwelling stents, pain, or hematuria. Median serum creatinine at 3 mo was 0.80 mg/dl and median calculated autotransplant glomerular filtration rate did not drop significantly. Conclusions RAKAT is feasible, safe, and results in good functioning of the autotransplant in selected patients with complex ureteral strictures, loin pain hematuria, or severe nutcracker syndrome. Larger studies with longer follow-up are needed to confirm these findings and to test whether RAKAT is feasible for other KAT indications. Patient summary We describe the first series worldwide of a minimally invasive technique for kidney autotransplantation. Robot-assisted kidney autotransplantation is a safe and feasible approach to prevent nephrectomy for intractable symptoms in selected patients with complex ureteral or renal pathology.

Miniaturized instrumentation used for endoscopic treatment of urinary stone disease in children has been readily adopted in clinical practice. However, there is a need to optimize and individualize the surgical approach according to the patient's age, body habitus, and stone characteristics. Promising novel equipment and techniques will continue to advance the surgical care of these children.To review the literature regarding surgical and shockwave lithotripsy (SWL) treatment of urinary stone disease in children and provide an overview on future treatment innovations.We conducted a nonsystematic review of the literature using the PubMed database. The search focused on the most recent two decades to provide a contemporary overview of surgical outcomes.Although SWL use has proportionally decreased over time, it remains an important treatment option for kidney stones2cm and upper ureteral calculi, with success rates between 49% and 97%. Rigid/semirigid ureteroscopy is the first-line therapy for distal ureteral stones and has success rates comparable to SWL for upper ureteral stones. Success rates between 80% and 100% are achieved with retrograde intrarenal surgery (RIRS) for kidney stones2cm but may require pre-stenting in smaller children. Mini percutaneous nephrolithotomy (PNL) is the most efficient technique for treating kidney stones in children. Micro-PNL and ultramini-PNL are valuable alternatives, especially for smaller renal stones.Modern endoscopic treatment options together with SWL allow personalized management of stone disease in the pediatric population. Future technical improvements on the horizon offer the promise of increasing the efficiency of current procedures while minimizing complications.Miniaturization of the instruments used for treatment of stone disease in children provides a variety of options for clinical practice. Rather than routinely using a single technique, personalized treatment is recommended to increase the success of each procedure.

Objective. To investigate whether the visualization modality (ultrasound or fluoroscopy) used during shockwave lithotripsy (SWL) affects the clinical outcome in those instances where both imaging modalities are optional. Methods. Between November 2014 and July 2016, 114 patients with radiopaque upper urinary tract calculi were randomly assigned to an ultrasound- or fluoroscopy-guided SWL group in a prospective, open-label, single-center study. A standardized SWL protocol was used. The stone-free rate and the positive outcome rate (stone-free or asymptomatic residual fragments ≤ 4 mm) were compared. Results. The stone-free rate was 52% in the ultrasound-guided group compared to 42% in the fluoroscopy-guided group (p = 0.06) and the positive outcome rate was 79% in the ultrasound-guided group compared to 70% in the fluoroscopy-guided group (p = 0.28). These results were not significantly different but proved to be noninferior based on a Wilson confidence interval of independent proportions (noninferiority limit 10%). The mean number of SWL sessions was not significantly different (p = 0.4). Conclusion. Our study demonstrated that the clinical results of ultrasound-guided SWL were not inferior to the results of fluoroscopy-guided SWL, while no ionizing radiation is needed.

We evaluated the surgical and functional outcomes, and the effect of the learning curve of nontransecting anastomotic repair for short bulbar and posterior urethral strictures.A total of 75 patients were treated with nontransecting anastomotic repair for short bulbar strictures in 55 and for posterior strictures in 20. Surgical morbidity was scored using the Clavien-Dindo classification at 3 months. Sexual function was measured using SHIM (Sexual Health Inventory for Men) scoring preoperatively and postoperatively. Post-void dribbling before and after nontransecting anastomotic repair was also determined. To evaluate the learning curve outcomes were evaluated in patients 1 to 25, 26 to 50 and 51 to 75.Median followup was 30 months. Stricture recurred in 6 patients (8%), all diagnosed within 7 months after nontransecting anastomotic repair. Median operative time was 95 minutes and median hospital stay was 2 days. In 61 patients (81.3%) no surgical morbidity was recorded. Five (6.7%), 6 (8%) and 3 patients (4%) experienced a grade 1, 2 and 3b complication, respectively. Seven of 32 (21.9%) and 2 of 42 evaluable patients (4.7%) reported de novo erectile dysfunction and post-void dribbling, respectively, 3 months after nontransecting anastomotic repair. No difference in outcomes was observed among the 3 patient groups.Nontransecting anastomotic repair appears to be safe without a substantial learning curve effect. Patient counseling about possible surgical complications and transient erectile dysfunction is important.

Objective To evaluate Thiel-embalmed cadavers (TEC) as a training model for percutaneous nephrolithotomy (PCNL), more specifically for ultrasound (US)-guided supine endoscopic combined intrarenal surgery (ECIRS). Subjects and Methods Thirteen urologists (nine experienced endourologists, four fellows/residents) performed an US-guided supine ECIRS procedure on a TEC. The model was evaluated by way of a questionnaire (5-point Likert scale). Descriptive statistical analysis was performed and results were graphically presented using divergent bar graphs. Results US images were appreciated as lifelike in all aspects. Although distention of the collecting system was not ideal in one out of three TEC, US visualisation of the distended calyces during puncture was good. Skin penetration was more difficult and less realistic in TEC, while kidney puncture and dilatation were deemed very realistic. Ureteric and collecting system anatomy and consistency were similar to real life, although the mucosa appeared paler. US needle guidance was perceived as excellent. Overall, needle puncture assessment was realistic and useful as a training tool. Overall quality and satisfaction of TEC in US-guided supine ECIRS was good to excellent and comparable to a real-life procedure. Overall appropriateness of the TEC model was considered excellent for both initial and advanced supine PCNL training. Conclusion Despite the minor drawbacks of tough skin and non-ideal collecting system dilatation during ureteroscopy, the TEC model was considered good to excellent as a training model for US-guided PCNL, in particular, US-guided needle puncture of the kidney during supine ECIRS.

Introduction and hypothesis Foreign body (FB) erosion is now recognized as a major long-term complication following previous incontinence surgery. The aim of our systematic review was to ascertain the outcomes of endoscopic management in synthetic sling/mesh erosion following previous gynaecological surgery. Methods A systematic review in line with PRISMA and Cochrane guidelines was conducted for all English language articles between 1996 and December 2018 for all articles reporting on endoscopic surgical management for eroded FB following previous sling/mesh procedure for incontinence. Results Our search produced 931 articles of which 20 articles (198 patients) were included in our review; 149 (75%) had tension-free vaginal tapes (TVT) or tension-free obturator tapes (TOT) as their initial procedure. The site of mesh erosion was the bladder in 134 patients (68%) of which 12 (6%) were in the bladder neck. Urethral mesh erosion was seen in 63 patients (32%) across all studies. The treatment of eroded mesh was by laser and endoscopic excision using an electrode loop or laparoscopic scissors in 108 (55%) and 90 (45%) patients respectively. The initial/final success rate with laser and endoscopic excision was 67%/92% and 80%/98% respectively. The overall complication rates were 24% and 28% in laser and endoscopic groups respectively of which 21% in each group were stress urinary incontinence. Conclusions Endoscopic management of FB erosion is an effective minimally invasive technique with good outcomes and minimal morbidity. Management with the use of holmium laser is gaining momentum and could be attempted before open surgical removal. There is a need for comparative data between open surgical excision and endoscopic excision to help better describe the patient’s most likely to benefit from the endoscopic technique.

INTRODUCTION AND OBJECTIVES:Percutaneous nephrolithotomy (PCNL) has been demonstrated to be a challenging procedure that requires specific training and a certain learning curve before reaching comp...

The present study assessed the efficacy of hyperbaric oxygen therapy in reducing symptoms of radiation cystitis, a specific type of iatrogenic injury to the bladder, by systematic review of recent literature. The MEDLINE, Embase and Web of Science databases were searched using combinations of the terms "radiation," "cystitis" and "hyperbaric oxygen" to identify articles evaluating patients with radiation cystitis, treated with hyperbaric oxygen therapy. Only recent (

Introduction: Over time, the incidence of nephrolithiasis has risen significantly, and patient populations have become increasingly complex. Our study aimed to determine the impact of changes in patient demographics on percutaneous nephrolithotomy (PCNL) outcomes. Methods: A retrospective analysis of a prospectively collected database was carried out from 1990–2015. Patient demographics, comorbidities, stone and procedure characteristics were analyzed. Multivariate logistic regression was used to evaluate differences in operative duration, complications, stone-free rate, and length of stay. Results: A total of 2486 patients with a mean age of 54±15 years, body mass index (BMI) of 31±8, and stone surface area of 895±602 mm2 were analyzed; 47% of patients had comorbidities, including hypertension (22%), diabetes mellitus (14%), and cardiac disease (13%). Complication rate was 19%, including a 2% rate of major complications (Clavien grade III–V). There was a statistically significant increase in patient age, BMI, and comorbidities over time, which was correlated with an increased complication rate (odds ratio [OR] 1.15; p=0.010). The overall transfusion rate was 1.0% and remained stable (p=0.131). With time, both OR duration (mean Δ 16 minutes; p

Ronney Abaza Mehran Abolbashari Ahmad Abolyosr Ashraf Abou-Elela Omar Aboumarzouk Jose Benito Abraham Peter Acher Alex Acosta-Miranda Samiran Adhikary Ramez Adrawis Anshuman Agarwal Mayank Agarwal Madhu Agrawal Sachin Agrawal Rajesh Ahlawat Tom Ahlering Hanjong Ahn Sascha Ahyai Murat Akand Naeem Akhter Joseph Akornor Yilmaz Aksoy Abdulla Al Naimi Azan Al Saadi Husain Alenezi Bachmann Alexander Samih Al-Hayek Gerasimos Alivizatos Erdal Alkan Ahmed Al-Kandari Peter Alken Khaled Al-Kohlany Mohamad Allaf Seth Alpert Hernan Altamar Bulent Altay Serkan Altinova Fatih Altunrende Mario Alvarez-Maestro Theodore Anagnostou Anastasios Anastasiadis James Anderson Kevin Anderson Sero Andonian Cassio Andreoni Yoichi Arai Marco Arap Athanasios Argyropoulos Angela Arlen Abdullah Armagan Noel Armenakas Don Arnold II Monish Aron William Aronson Nicola Arrighi Amir Arsanjani Murat Arslan Montserrat Arzoz John Asplin Mohamed Atalla Mutlu Ates Hammad Ather Ali Fuat Atmaca Fatih Atug Brian Auge Riccardo Autorino Timothy Averch Emin Aydur Ali Ayyildiz Abdel-Rahmene Azzouzi Richard Babayan Christian Bach Thorsten Bach Gopal Badlani Herman Bagga Demetrius Bagley Badrulhisham Bahadzor Mevlana Balbay D. Baldwin Gaurav Bandi Yige Bao Shivadev Bapat Caner Baran Eric Barret John Barry Jay Basillote Mehmet Baykara Selahattin Bedir Dina Bedretdinova Frank Begun Darren Beiko Jakob Ben-Chaim Karim Bensalah Brian Benway Aaron Berger Sara Best Akshay Bhandari Mahendra Bhandari Shiv Bhanot Sam Bhayani Naeem Bhojani Giampaolo Bianchi Hemant Bid Pierre Bigot JOURNAL OF ENDOUROLOGY Volume 29, Number 4, April 2015 a Mary Ann Liebert, Inc. Pp. 490–494 DOI: 10.1089/end.2015.1512

The mineral composition of a urinary stone may influence its surgical and medical treatment. Previous attempts at identifying stone composition based on mean Hounsfield Units (HUm) have had varied success. We aimed to evaluate the additional use of standard deviation of HU (HUsd) to more accurately predict stone composition.We identified patients from two centers who had undergone urinary stone treatment between 2006 and 2013 and had mineral stone analysis and a computed tomography (CT) available. HUm and HUsd of the stones were compared with ANOVA. Receiver operative characteristic analysis with area under the curve (AUC), Youden index, and likelihood ratio calculations were performed.Data were available for 466 patients. The major components were calcium oxalate monohydrate (COM), uric acid, hydroxyapatite, struvite, brushite, cystine, and CO dihydrate (COD) in 41.4%, 19.3%, 12.4%, 7.5%, 5.8%, 5.4%, and 4.7% of patients, respectively. The HUm of UA and Br was significantly lower and higher than the HUm of any other stone type, respectively. HUm and HUsd were most accurate in predicting uric acid with an AUC of 0.969 and 0.851, respectively. The combined use of HUm and HUsd resulted in increased positive predictive value and higher likelihood ratios for identifying a stone's mineral composition for all stone types but COM.To the best of our knowledge, this is the first report of CT data aiding in the prediction of brushite stone composition. Both HUm and HUsd can help predict stone composition and their combined use results in higher likelihood ratios influencing probability.

Objectifs L’auto-transplantation renale robot-assistee (ATRRA) est une technique operatoire employee en ultime recours a visee d’epargne nephronique, dans de nombreuses indications : renovasculaire, ureterales et tumorales. Contrairement a l’uretero-ileoplastie, elle a l’avantage d’une approche mini-invasive. L’objectif de cette etude etait de decrire les resultats perioperatoires et fonctionnels precoces des patients ayant eu une ATRRA. Methodes Il s’agit d’une une etude retrospective qui a inclus tous les patients ayant eu une ATRRA entre mars 2017 et fevrier 2020 dans deux centres hospitaliers universitaires. Les donnees concernant l’indication operatoire, la technique chirurgicale, les complications, la duree d’hospitalisation et les resultats a moyen terme ont ete recueillis. Resultats Dix-neuf patients ont eu une ATRRA (sept hommes et douze femmes). L’âge median etait de 40 ans (IQR : 26–47). Les indications etaient : stenose de l’uretere (n = 13), douleurs lombaires chronique (n = 5), syndrome de nutcracker (n = 1). La duree mediane operatoire etait de 350 minutes (IQR : 260–394) avec une ischemie chaude de 4 min et « tiede » (rewarming time) de 51 min (43–74). Les pertes sanguines etaient estimees a 50 cm3 (2–150). Le taux de complications globales etait de 10 %, la duree mediane d’hospitalisation de 5 jours. La creatininemie mediane a la sortie et a trois mois a ete respectivement de 76 et 70 μmol/L. A 3 mois, tous les patients ont ete sevres de sonde ureterale et ne presentaient pas de douleurs. Conclusion L’ATRRA est un traitement efficace chez des patients avec des lesions de l’uretere ou des anomalies vasculaires complexes, avec de bons resultats fonctionnels a moyen terme.

Summary Purpose To identify risk factors associated with recurrent kidney stones in a paediatric cohort in a Belgian tertiary centre. Study design and methods Medical records of children with the first episode of urolithiasis between 1998 and 2016, followed at Ghent University Hospital initially and at least one-year follow-up were retrospectively reviewed. Patient characteristics, past medical history, presenting symptoms, the results of laboratory investigations and the applied management strategy were analysed. The significant variables from the univariate analysis were integrated into a backward conditional multivariate model. Results Ninety-seven children were included in the analysis, of which 33 (34%) presented with at least one episode of stone recurrence. In the univariate analysis, body mass index (BMI) > 85th percentile and asymptomatic stones at initial presentation were associated with 1.8 and 0.1 times lower risk of recurrent stones, respectively (p = 0.020, 95% confidence interval (CI):0.368–8.749 and p = 0.017, 95% CI:0.014–0.921). In contrast, immobilization resulted in a 10-times higher risk (p = 0.002, 95% CI:1.968–50.005) and the need for technical intervention was associated with a 3.2- times higher risk (p = 0.017, 95% CI:1.297–8.084) of developing recurrent stones. On multivariate analysis only BMI >85th percentile was associated with a 15 times lower risk of stone recurrence (p = 0.030, 95% CI:0.006–0.739). Discussion A possible explanation of reduced risk in patients with a BMI > 85th percentile may lie in a different metabolic profile. Immobilization as a risk factor can be explained by calcium metabolism, which is influenced by immobilization due to fractures, paralysis or motor disability because it causes resorption of the skeleton resulting in elevated blood calcium levels. This study showed that patients who presented without symptoms when the stones first occurred were less likely to have recurring kidney stones compared with patients with symptoms at initial presentation. When technical intervention was needed, we believe this is partly due to a larger stone burden, however we could not find an evidence-based explanation. The institutional protocol, which allowed to create a database with a limited number of patients, was lost to follow-up. Despite the retrospective setting some data were missing. There might also be a bias because the patients were followed-up at a tertiary centre. Possibly, our conclusions cannot be generalized toward the entire paediatric population. Conclusion Of all the factors investigated in our cohort, BMI >85 th percentile and asymptomatic stones are associated with a lower risk of stone recurrence. Conversely, immobilized patients and those who require technical intervention at initial presentation may benefit from an intense follow-up after the first episode of urolithiasis.

Kidney stone disease (KSD) affects millions of people worldwide and has an increasing incidence. Social media (SoMe) and search engines are both gaining in usage, while also being used by patients to research their conditions and aid in managing them. With this in mind, many authors have expressed the belief that SoMe and search engines can be used by patients and healthcare professionals to improve treatment compliance and help counseling and management of conditions such as KSD. We wanted to determine whether SoMe and search engines play a role in the management and/or prevention of KSD.The databases MEDLINE, Embase, CINAHL, Scopus, and Cochrane Library were used to search for relevant English language literature from inception to December 2017. Results were screened by title, abstract, and then full text, according to the inclusion and exclusion criteria. The data were then analyzed independently by the authors not involved in the original study.After initial identification of 2137 records and screening of 42 articles, 10 studies met the inclusion and exclusion criteria. The articles included focused on a variety of SoMe forms, including two articles each on twitter, YouTube, smartphone apps, and Google search engine and one article on Google insights and Google analytics. Regarding patient centered advice, while two articles covered advice on dietary, fluid intake, and management options, two additional articles each covered advice on fluid advice and management options only, while no such advice was given by three of the SoMe published articles.SoMe and search engines provide valuable information to patients with KSD. However, while the information provided regarding dietary aspects and fluid management was good, it was not comprehensive enough to include advice on other aspects of KSD prevention.

Introduction: Ureteral colic has a lifetime prevalence of 10%–15% and is one of the most common emergency urologic presentations. Current European Association of Urology recommends conservative management for “small” (

Kidney stone disease involves the aggregation of stone-forming salts consequent to solute supersaturation in urine. The development of novel therapeutic agents for this predominantly metabolic and biochemical disorder have been hampered by the lack of a practical pre-clinical model amenable to drug screening. Here, Drosophila melanogaster, an emerging model for kidney stone disease research, was adapted as a high-throughput functional drug screening platform independent of the multifactorial nature of mammalian nephrolithiasis. Through functional screening, the therapeutic potential of a novel compound commonly known as arbutin that specifically binds to oxalate, a key component of kidney calculi, was identified. Through isothermal titration calorimetry, high-performance liquid chromatography and atomic force microscopy, arbutin was determined to interact with calcium and oxalate in both free and bound states, disrupting crystal lattice structure, growth and crystallization. When used to treat patient urine samples, arbutin significantly abrogated calculus formation in vivo and outperformed potassium citrate in low pH urine conditions, owing to its oxalate-centric mode of action. The discovery of this novel antilithogenic compound via D. melanogaster, independent of a mammalian model, brings greater recognition to this platform, for which metabolic features are primary outcomes, underscoring the power of D. melanogaster as a high-throughput drug screening platform in similar disorders. This is the first description of the use of D. melanogaster as the model system for a high-throughput chemical library screen. This article has an associated First Person interview with the first authors of the paper., Summary: Chemical library screens using Drosophila melanogaster as a model of nephrolithiasis can be performed in a high-throughput and efficient manner, leading to candidate drugs with clinical potential in kidney stone patients.

Ever since the ureteral stent design was fitted with a curl on both sides to prevent it from migrating up or down the ureter some 40 years ago, its use has gained tremendous momentum, aiding in the rise and evolution of endourology and has confidently kept its place in modern time urology. Over the past four decades, several designs, coating and biomaterials have been developed, trying to reduce infection, encrustation and other stent related symptoms. As the ideal stent has not yet been discovered, different ways of helping patients with their complaints have been researched. This review will cover these aspects of stent use in urolithiasis. (C) 2018 Editorial Office of Asian Journal of Urology. Production and hosting by Elsevier B.V.

Patients with urinary tract abnormalities are at an increased risk of stone formation. Percutaneous nephrolithotomy (PCNL) plays an important role in the treatment of this patient population; however, outcomes are less well defined compared with patients with normal urinary tract anatomy. Our objective was to evaluate the influence of urinary tract abnormalities on intraoperative and postoperative outcomes with PCNL.We report on a single-center prospective database of 2284 consecutive PCNLs in 1935 patients from 1990 to 2012. For the purposes of this analysis, patients were categorized by the presence or absence of a urinary tract abnormality. Multivariable analyses were used to identify independent predictors of the length of hospital stay, operative time, complications, and residual stones at discharge and 3 months.A urinary tract abnormality was present in 14.4% (n=330) of the cohort. On univariable analysis, patients with urinary tract abnormalities were more likely to present with urinary tract infection (28% vs 19%, P0.001) and less likely to present with hematuria (13% vs 19%, P0.02). On multivariable regression, a urinary tract abnormality was predictive of residual stone at discharge, need for a secondary procedure, but did not increase the risk of residual stone at 3 months or the development of complications. Operative time and hospital stay were only moderately prolonged.Patients with urinary tract abnormalities who undergo PCNL have a higher risk of residual stones at discharge and need for secondary procedures, but comparable complication rates, operative time, and hospital stay.

Urolithiasis is a frequent problem causing a significant clinical, psychological and socio-economic burden. Analgesia remains the most important element in the medical treatment of renal colic. Nonetheless, both NSAIDs and opiates have a side effect profile which can cause further complications. As such, the use of desmopressin for renal colic has received increased attention in the last two decades. This paper provides an overview of current evidence on the use of desmopressin as an analgesic strategy in renal colic.

Key Points: Question: What is the association of decision aids vs usual care with shared decision-making in men deciding whether to undergo prostate cancer screening? Findings: This systematic review and meta-analysis of 19 randomized clinical trials comparing decision aids for prostate cancer screening (12781 men) found that decision aids are probably associated with a small reduction in decisional conflict and are possibly associated with an increase in knowledge. Decision aids are possibly not associated with whether physicians and patients discuss prostate cancer screening and are possibly not associated with actual screening decisions. Meaning: Randomized clinical trials have failed to provide compelling evidence for the use of decision aids for men contemplating prostate cancer screening that have, up to now, undergone rigorous testing to determine their outcome. Importance: US guidelines recommend that physicians engage in shared decision-making with men considering prostate cancer screening. Objective: To estimate the association of decision aids with decisional outcomes in prostate cancer screening. Data Sources: MEDLINE, Embase, PsycINFO, CINAHL, and Cochrane CENTRAL were searched from inception through June 19, 2018. Study Selection: Randomized trials comparing decision aids for prostate cancer screening with usual care. Data Extraction and Synthesis: Independent duplicate assessment of eligibility and risk of bias, rating of quality of the decision aids, random-effects meta-analysis, and Grading of Recommendations, Assessment, Development and Evaluations rating of the quality of evidence. Main Outcomes and Measures: Knowledge, decisional conflict, screening discussion, and screening choice. Results: Of 19 eligible trials (12781 men), 9 adequately concealed allocation and 8 blinded outcome assessment. Of 12 decision aids with available information, only 4 reported the likelihood of a true-negative test result, and 3 presented the likelihood of false-negative test results or the next step if the screening test result was negative. Decision aids are possibly associated with improvement in knowledge (risk ratio, 1.38; 95% CI, 1.09-1.73; I-2=67%; risk difference, 12.1; low quality), are probably associated with a small decrease in decisional conflict (mean difference on a 100-point scale, -4.19; 95% CI, -7.06 to -1.33; I-2=75%; moderate quality), and are possibly not associated with whether physicians and patients discuss prostate cancer screening (risk ratio, 1.12; 95% CI, 0.90-1.39; I-2=60%; low quality) or with men's decision to undergo prostate cancer screening (risk ratio, 0.95; 95% CI, 0.88-1.03; I-2=36%; low quality). Conclusions and Relevance: The results of this study provide moderate-quality evidence that decision aids compared with usual care are associated with a small decrease in decisional conflict and low-quality evidence that they are associated with an increase in knowledge but not with whether physicians and patients discussed prostate cancer screening or with screening choice. Results suggest that further progress in facilitating effective shared decision-making may require decision aids that not only provide education to patients but are specifically targeted to promote shared decision-making in the patient-physician encounter. This systematic review and meta-analysis of 19 randomized clinical trials estimates the association of decision aids with decisional outcomes in prostate cancer screening.

Technical innovations in all aspects of percutaneous nephrolithotomy have changed the field considerably. The current review is aimed at reporting on the most recent advancements in the field of percutaneous nephrolithotomy. Improvements in CT imaging and the possibility of 3D rendering have dethroned the intravenous pyelogram as gold standard for pre-operative imaging. Where gaining access in the lower pole in prone position with telescopic metal dilators, placing a 30F tract used to be standard, the plethora of alternatives provides the trained surgeon with a large armamentarium to tackle any obstacle. Novel lithotripters appear more efficient than their predecessors and with tubeless PCNL gaining some momentum, ambulatory PCNL is slowly but surely becoming feasible rather than fictional.

posted, were excluded. Program directors’ (PD) accounts were identified based on names, photos, and content relevance. For each program, the Klout Score, a measure of influence akin to journal impact factors, was assessed, and a 1-month sample of content from each program was reviewed. A subgroup analysis was performed between programs with higher vs lower Twitter impact. RESULTS: Of 123 programs, 35 (28.5%) had Twitter profiles and 24 (19.5%) had been active within 14 days. Median account age was 18 months. Mean (range) number of Tweets, followers, and friends (accounts followed by program) was 227 (1-1697) Tweets, 164 (4-661) followers, and 288 (8-1724) friends. Among active accounts, mean posting frequency was 15 Tweets/month. The median (range) Klout score was 28 (1-46). Of 123 PDs, 22 (17.9%) had identifiable profiles. Programs with PDs on Twitter were more likely to have profiles (p

Several anatomic and clinical factors have been implicated in the failure rates of shock wave lithotripsy (SWL), including the attenuating effects of bony structures. We designed an in vitro model that incorporates the lumbar spine, including vertebral bodies and transverse processes along the pathway of shockwaves, to mimic the clinical scenario during SWL of upper ureteral stones. We hypothesized that the presence of bone structures in the SWL pathway significantly affects the fragmentation rate.An ordnance gelatin (OG) model was conceptualized and created to allow a pig's lumbar spine to be embedded within it. Artificial urinary calculi weighing 2 ± 0.1 g (1.2-cm diameter) were prepared using BegoStone plaster. The trial was divided into two arms: group 1 models had OG only and served as the control and group 2 models had the bone embedded in the gelatin with stone wells placed above the transverse processes. Twenty-four stones per group were subjected to SWL using the STORZ MODULITH SLX-F2 lithotripter, using the same treatment parameters. Fragments were sieved through 2- and 4-mm filters, and the fragmentation coefficients (FC) were calculated. The Mann-Whitney test was used to compare FC between the two groups.The mean fragmentation rate of group 1 was statistically significantly higher compared with group 2 using a 4-mm sieve (43% vs 0.62%, p 0.001) and the 2-mm filter (18% vs 0.52%, p 0.001).The presence of bone structures dramatically reduces the fragmentation rate of phantom stones using an OG in vitro model. The OG model is inexpensive and simple to use to simulate clinical situations during SWL.

Several scoring systems have recently emerged to predict stone-free rate (SFR) and complications after percutaneous nephrolithotomy (PCNL). We aimed to compare the most commonly used scoring systems (Guy's stone score, S.T.O.N.E. nephrolithometry, and CROES nomogram), assess their predictive accuracy for SFR and other postoperative variables, and develop a risk group stratification based on these scoring systems.We performed a retrospective review of patients who have had a PCNL at four academic institutions between 2006 and 2013. Primary outcome was SFR within 3 weeks of the surgery and secondary outcomes were operative time (OT), complications, and length of stay (LOS). We performed chi-squared, t-test, logistic, linear, and Poisson regressions, as well as receiver operating characteristics curve with area under the curve (AUC) calculation.We identified 586 patients eligible for analysis. Of these, 67.4% were stone free. Guy's, S.T.O.N.E., and CROES score were predictive of SFR on multivariable logistic regression (odds ratio [OR]: 1.398, 95% confidence interval [CI]: 1.056, 1.852, p = 0.019; OR: 1.417, 85% CI: 1.231, 1.631, p 0.001; OR: 0.993, 95% CI: 0.988, 0.998, p = 0.004) and have similar predictive accuracy with AUCs of 0.629, 0.671, and 0.646, respectively. On multivariable linear regression, only S.T.O.N.E. was an independent predictor of longer OT (β = 14.556, 95% CI: 12.453, 16.660, p 0.001). None of the scores were independent predictors of postoperative complications or a longer LOS. Poisson regression allowed for risk group stratification and showed the S.T.O.N.E. score and CROES nomogram to have the most distinct risk groups.The three evaluated scoring systems have similar predictive accuracy of SFR. S.T.O.N.E. has additional value in predicting OT. Risk group stratification can be used for patient counseling. Further research is needed to identify whether or not any is superior to the others with regard to clinical usefulness and predictive accuracy.

The introduction of radiofrequency ablation (RFA) into other fields of surgery has fueled the interest to study its application in small renal masses (SRM). Some controversies remain, however, regarding its oncologic efficacy. We review technical factors and tissue characteristics that influence treatment success, discuss the evaluation of treatment success by post-treatment imaging and histopathology, and highlight intermediate-term oncologic outcomes of recent, larger RFA series.A search of the MEDLINE database regarding the treatment of SRM by RFA was performed from 2003 through August 2009. For the purpose of describing technical factors and tissue characteristics that influence treatment success and the evaluation of treatment success by imaging and histopathology, articles were selected when they provided detailed descriptions of one or more of these items. For the analysis of oncologic outcomes, the selection was limited to series in which a minimum of 20 patients were treated and that provided effectiveness based on follow-up imaging.Technical evolutions and correct patient/tumor selection have led to increasingly higher success rates being achieved by RFA. Even though tumor skipping has been described in preclinical studies and early clinical studies, this does not seem to influence final success. Indeed, a 8.6% re-treatment rate has to be taken into account. Accepting this, the final ablative success rate is 93.8% at intermediate-term follow-up. Complications after RFA are less frequent and more often minor compared with surgical series.The present analysis reveals that RFA achieves a high intermediate-term ablative success rate when accepting a 8.6% reablation rate. Complication rates are low and mostly minor. Those facts render RFA an attractive minimally invasive treatment for SRM, especially in the growing elderly patient population with multiple comorbidities. Long-term follow-up data are expected to confirm the role of RFA in the management of SRM.