Search

Objectives: To evaluate the effects of inserting a Foley catheter after ureteroscopy (URS) and JJ stent placement on pain scores, voiding patterns, biochemical parameters and postoperative complications., Patients and Methods: A randomised clinical trial (1:1) with adult patients following unilateral URS + JJ stent placement was planned. In Group A, no Foley catheter was placed, in Group B, a Foley catheter was placed following URS + JJ stent placement. The primary objective was to evaluate effect of placing a Foley catheter on International Prostate Symptom Score (IPSS), Ureteric Stent Symptom Questionnaire (USSQ) score and postoperative biochemical parameters. The secondary objective was to evaluate postoperative complications., Results: A total of 112 patients were included (56/group). A ureteric access sheath was used in each patient. Patients had similar demographic and surgical parameters. The pre- and postoperative biochemical analyses including white blood cell count, C-reactive protein, procalcitonin and creatinine levels were similar between the two groups. The IPSS were similar between the two groups. All the subdomains of the USSQ were similar between two groups except Total Body Pain score, which was lower in Group B. The visual analogue scale scores were similar. Complications were all Clavien-Dindo Grade I and II, and the complication rate was 5.4% and 8.9% in Group A and B, respectively., Conclusion: Placing a Foley catheter following URS + JJ stent placement did not show significant effects on postoperative biochemical parameters and voiding symptoms. However, a Foley catheter lowered the Total Body Pain score on the USSQ without having significant effects on VAS scores. The practice of placing a Foley catheter following URS and JJ stent placement should be based on surgeon's preference keeping in mind the potential positive effect on pain scores., (© 2024 The Author(s). BJU International published by John Wiley & Sons Ltd on behalf of BJU International.)

Introduction: There is a gap in the available literature and guidelines concerning the optimal approach for treating allograft stones, which currently include external shockwave lithotripsy, ureteroscopy and laser lithotripsy, or percutaneous nephrolithotomy. The objective of this systematic review was to evaluate the safety and effectiveness of URS as a treatment option for patients in this scenario., Evidence Acquisition: A comprehensive search of the literature was conducted until August 2023. Only original articles written in English were considered for inclusion. This review has been registered in PROSPERO (registration number CRD42023451154)., Evidence Synthesis: Eleven articles were included (122 patients). The mean age was 46.9±9.5 years, with a male-to-female ratio of 62:49. The preferred ureteral reimplantation technique was the Lich-Gregoire. The mean onset time was 48.24 months. Acute kidney injury, urinary tract infections and fever were the most frequent clinical presentations (18.3% each), followed by hematuria (10%). The mean stone size measured 9.84 mm (±2.42 mm). Flexible URS was preferred over semirigid URS. The stone-free rate stood at 83.35%, while the overall complication rate was 13.93%, with six (4.9%) major complications reported. Stones were mainly composed of calcium oxalate (42.6%) or uric acid (14.8%). Over an average follow-up period of 30.2 months, the recurrence rate was 2.46%. No significant changes in renal function or allograft loss were reported., Conclusions: URS remains an efficient choice for addressing de-novo allograft urolithiasis, offering the advantage of treating urinary stones with a good SFR and a low incidence of complications. Procedures should be performed in an Endourology referral center.

Introduction: To develop a predictive model incorporating stone volume along with other clinical and radiological factors to predict stone-free (SF) status at ureteroscopy (URS)., Material and Methods: Retrospective analysis of patients undergoing URS for kidney stone disease at our institution from 2012 to 2021. SF status was defined as stone fragments < 2 mm at the end of the procedure confirmed endoscopically and no evidence of stone fragments > 2 mm at XR KUB or US KUB at 3 months follow up. We specifically included all non-SF patients to optimise our algorithm for identifying instances with residual stone burden. SF patients were also randomly sampled over the same time period to ensure a more balanced dataset for ML prediction. Stone volumes were measured using preprocedural CT and combined with 19 other clinical and radiological factors. A bagged trees machine learning model with cross-validation was used for this analysis., Results: 330 patients were included (SF: n = 276, not SF: n = 54, mean age 59.5 ± 16.1 years). A fivefold cross validated RUSboosted trees model has an accuracy of 74.5% and AUC of 0.82. The model sensitivity and specificity were 75% and 72.2% respectively. Variable importance analysis identified total stone volume (17.7% of total importance), operation time (14.3%), age (12.9%) and stone composition (10.9%) as important factors in predicting non-SF patients. Single and cumulative stone size which are commonly used in current practice to guide management, only represented 9.4% and 4.7% of total importance, respectively., Conclusion: Machine learning can be used to predict patients that will be SF at the time of URS. Total stone volume appears to be more important than stone size in predicting SF status. Our findings could be used to optimise patient counselling and highlight an increasing role of stone volume to guide endourological practice and future guidelines., (© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Introduction: The wide use of high-power laser has changed the landscape of ureteroscopy and lasertripsy (URSL). We wanted to look at the role and outcomes of high-power holmium:yttrium-aluminum-garnet laser for URSL in pediatric stone disease. Methods: A prospective analysis of consecutive pediatric patients treated with "Dusting and Pop-dusting" using a high-power laser was done between January 2016 and March 2022. The project was registered with our audit committee. Data were analyzed for patient demographics, stone characteristics, operative details, procedural outcomes, and complications. Stone-free rate (SFR) was defined as fragments ≤2 mm on postoperative ultrasound imaging 2-3 months after the procedure. Results: A total of 35 patients underwent 43 procedures (1.2 procedure/patient) during the study period with a mean age of 9.4 years (range 1-16 years) and a male:female ratio of 13:22. The stone location was in the kidney in 32 (91.4%) patients of which 8 were in multiple renal locations. The mean stone size was 18 mm (range 10-39 mm), with the pre- and post-stent rates of 37% and 56%, respectively. An access sheath was used in 19 (44%) procedures. The overall SFR on ultrasound scan was 94% ( n  = 33) with no procedural complications noted in our series and a mean length of stay of 0.9 days. Conclusion: Pediatric URSL using a high-power laser achieves a high SFR even for large and multiple renal stones with no complications noted in our prospective series. Parents must, however, be counseled about the need for staged procedures, which might be needed for large stones.

Purpose: To prospectively evaluate the rate and associated risk factors of early infectious complications after ureterorenoscopy for urolithiasis., Methods: After ethical committee approval, 400 therapeutic retrograde ureterorenoscopy procedures between August 3, 2020 and November 24, 2021 were included for analysis in a single-center study. Postoperative infection was defined as an afebrile urinary tract infection, fever (≥ 38 °C) with pyuria (≥ 300 WBC/μL) or proven urinary pathogen, and urosepsis. The primary outcome was the rate of infectious complications after ureterorenoscopy. Secondary outcomes were the perioperative factors that increased the risk of infectious complications within 30 days of surgery using univariate and multivariate logistic regression analysis., Results: Twenty-nine of four hundred (7.3%) patients developed an infectious complication within 30 days after ureterorenoscopy. Ten (2.5%) patients developed an afebrile urinary tract infection, eight (2.0%) developed fever with pyuria, five (1.3%) febrile urinary tract infection, and six (1.5%) urosepsis. On univariate analysis, preoperative stent-type JFil ® pigtail suture stent was significantly associated with the dependent variable (p < 0.001). On multivariate logistic regression analysis, older age (OR 1.035; 95% CI 1.006-1.070; p = 0.02) was found to be significantly associated with developing a postoperative infectious complication., Conclusions: A 7.3% rate of postoperative infectious complications and 1.5% urosepsis rate were observed after therapeutic ureterorenoscopy, without the need of intensive care admission. The only significant risk factors were preoperative stent type (JFil ® pigtail suture stent) on univariate analysis, and older age on multivariate logistic regression analysis. Further multicentric prospective observational data are needed in this field., (© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Context: While kidney stone disease is common and ureteroscopy (URS) is perceived as minimally invasive, there is mortality associated with treatment., Objective: The aim of this review was to ascertain the number of mortalities from URS for stone disease over the past three decades, identify relevant patient risk factors and predictors of mortality, and summarise the key recommendations so that similar instances can be avoided, and lessons can be learnt., Evidence Acquisition: A systematic literature search was conducted following Cochrane and Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) methodology for English-language article reporting on data from 1990 to December 2020. Data collated from each study included patient and stone characteristics, number of mortalities, and cause of death., Evidence Synthesis: Fifteen studies met our inclusion criteria and revealed a total of 72 mortalities from ten countries. The age range of reported patients varied from 21 to 89 yr, with over 60% being above 65 yr of age and 97% with some comorbidity. Based on available data, death reports in females were three times more than those in males. The stone size ranged from 10 to 38 mm. Treatment of larger stones corresponded to a longer operative time, with procedural duration varying from 30 to 120 min. Of the reported causes of mortality in 42 patients, the aetiology was sepsis in over half of the patients, with other causes being cardiac-related, respiratory-related, multiorgan failure, and haemorrhagic complications., Conclusions: Although the reported URS mortality rate seems to be low, there has been a rise in deaths over the past decade. Efforts must be made to have preoperative urine culture, and reduce operative time and stage procedures in patients with a large stone burden. Care must be taken in patients with robust preoperative assessment, intraoperative techniques, and postoperative monitoring for early detection of complications with interdisciplinary management of complex cases., Patient Summary: We reviewed the risk factors associated with postureteroscopy mortality and ways to minimise this. Evidence shows that although reported mortality remains low, there seems to be an increase in mortality in the past decade and urologists must remain vigilant of this., (Copyright © 2021 European Association of Urology. Published by Elsevier B.V. All rights reserved.)

Background: Primary ureteroscopy (P-URS) has been shown to be as safe and as efficacious as preoperative stent insertion followed by a delayed ureteroscopy (D-URS). However, studies are of limited patient cohort., Methods: A prospective study comparing P-URS and laser fragmentation for ureteric stones to those who received a stent insertion followed by D-URS and stone fragmentation., Results: A total of 367 consecutive patients were included. P-URS was conducted on 235 patients and D-URS on 132 patients. There was no overall difference between patient or stone demographics between the 2 groups, although there were more proximal ureteric and pelvi-ureteric junction stones in the preoperative stent group. The mean operative times were comparable with a stone free rate of 97 and 94% in the preoperative stent and no-stent groups, respectively. The overall complication rates were comparable., Conclusion: The current study provides evidence for the feasibility, safety, and efficacy of P-URS for ureteric calculi in a publicly funded healthcare setting with results comparable to those patients with a preoperative stent and delayed procedure. Therefore, cumulatively, P-URS could lead to less hospitalization, length of stay, stent-related morbidity, and ultimately will be more cost-effective., (© 2020 The Author(s). Published by S. Karger AG, Basel.)

Purpose of Review: Routine ureteroscopy (URS) for stone disease is performed under a general anaesthesia. However, controversy exists on the role of loco-regional anaesthesia and the outcomes associated with it. Here we review the challenges, outcomes and complications of loco-regional anaesthesia for URS. A Cochrane style review was performed in accordance with the preferred reporting items for systematic reviews and meta-analyses guidelines to evaluate the outcomes of loco-reginal anaesthesia for URS in stone disease, including all English language articles from January 1980 and December 2019., Recent Findings: Twenty-one studies (1843 procedures) with a mean age of 46 years and a male : female ratio of 1.2 : 1 underwent URS under loco-regional anaesthesia. The mean stone size was 9 mm (range:4-21 mm) and except five papers, all other papers included stones in the ureter of which the majority were in the distal ureter. The conversion to general anaesthesia was needed in 2.7% patients (range 1-21%) across studies, with a stone free rate of 48-100%. The complication rate varied from 1.4 to 36%. Although the intraoperative complications included ureteric injury (n = 21) or perforation (n = 4), the postoperative complications included fever (n = 37), urinary tract infection (n = 20), haematuria (n = 4), urosepsis (n = 4) and others (n = 7)., Summary: The present systematic review shows that local anaesthetic URS is a potential alternative to general anaesthetic URS in carefully selected patients. Randomised controlled trials with subgroup analysis are required to further assess whether loco-regional anaesthesia URS is noninferior to general anaesthesia URS and might help determine if the former approach should become more widespread.

Purpose: To compare the outcomes (stone free rate and complications) of renal stone treatment with and without the use of ureteral access sheath (UAS). The worldwide use of UAS has risen over the last decade; however, questions still remain on the safety and outcomes with its use. We wanted to look at the role of UAS for treatment of consecutive renal stones over a 7-year period., Methods: The outcomes of flexible ureteroscopy and stone treatment (FURS) for renal stones with and without the use of UAS was prospectively compared from March 2012 to July 2018. Patients were divided into two groups: group-1 where UAS was used for stone treatment and group-2 where a UAS was not used. Data were collected prospectively on consecutive patients for demographics, stone size, location and number, pre and post-operative stent usage, operative time duration, stone free rate (SFR), length of stay and complications., Results: During the study period, 338 patients underwent FURS for renal stones, of which a UAS was used for 203 (60%) patients. The mean age of patients was 56 years (range 2-89 years) with a male:female ratio of 204:134. The mean cumulative stone size and the mean number of stones was 16.5 ± 10.8 mm and 11.37 ± 8.08 mm (P < 0.001), and 2.17 ± 1.99 and 1.66 ± 1.50 (P = 0.009) for groups 1 and 2 respectively. The pre and post-operative stent insertion rates were similar in the two groups. The procedural time was longer in group-1 (54.8 ± 25.8 min) compared to group-2 (41.3 ± 22.2 min) (P < 0.001). The SFR for group-1 (88%) was slightly lower than group-2 (94%) although this was not statistically significant (P = 0.07). There were no intra-operative complications in either of the groups. Post-operative complications were seen in eight patients in group-1 (7 Clavien I/II and 1 Clavien IVa) and two patients in group-2 (Clavien I) (P = 0.19)., Conclusion: The use of UAS for renal stones is safe with no intra-operative complications noted in our series. Good stone-free rates were obtained for large and multiple renal stones with a small risk of minor complications post-operatively.

Purpose of Review: To present the latest evidence related to the impact of ureteroscopy (URS) and percutaneous nephrolithotomy (PCNL) on the renal function., Recent Findings: Our review suggests that the overall renal function is not detrimentally affected by endourological interventions (URS, PCNL). This is however influenced by the preoperative renal function, presence of comorbidities such as diabetes and hypertension. For PCNL procedures, tract multiplicity, preoperative UTI, and postoperative bleeding also contribute to a decline in renal function. This review suggests that endourological interventions do not adversely affect renal function and tend to improve it in patients who do not have a poor renal function prior to the procedure. Several factors including poor preoperative renal function, diabetes, hypertension, and multiple percutaneous tracts appear to predispose patients to declining renal function after procedure, and these patients should be counseled for and followed up appropriately.

Purpose of Review: To present the latest evidence related to the predictors of urinary tract infections (UTIs) and urosepsis after ureteroscopy (URS) for stone disease., Recent Findings: Our review suggests that almost half of all post-URS complications are related to infectious complications although reported rates of urosepsis were low. The use of antibiotic prophylaxis, treatment of pre-operative UTI, and low procedural time seem to reduce this risk. However, the risk is higher in patients with higher Charlson comorbidity index, elderly patients, female gender, long duration of pre-procedural indwelling ureteric stents and patients with a neurogenic bladder and with high BMI. Infectious complications following ureteroscopy can be a source of morbidity and potential mortality. Although majority of these are minor, efforts must be taken to minimise them especially in high-risk patients. This includes the use of prophylactic antibiotics, limiting stent dwell and procedural time, prompt identification and treatment of UTI and urosepsis, and careful planning in patients with large stone burden and multiple comorbidities.

Background: Elective treatment of ureteric stones is needed after emergency drainage of urosepsis., Objective: We wanted to look at the outcomes of elective ureteroscopic stone treatment in patients with prior sepsis and emergency drainage via retrograde ureteric stent (RUS) or percutaneous nephrostomy (PCN)., Design, Setting, and Participants: Data of all patients who underwent elective ureteroscopy (URS) for stone disease over 5 yr (March 2012-December 2016) were prospectively collected., Intervention: Elective URS following previous emergency RUS or PCN., Outcome Measurements and Statistical Analysis: Outcomes were collated for consecutive patients who underwent emergency drainage for urosepsis secondary to stone disease, followed by elective URS. Data was collected regarding patient demographics, stone parameters, and clinical outcomes. Statistical analysis was performed using SPSS version 24., Results and Limitations: In total, 76 patients underwent 82 elective procedures (six underwent bilateral URS) with a male to female ratio of 1:2 and a mean age of 57 yr. Emergency decompression was achieved via RUS in 63 (83%) and PCN in 13 (17%) patients. A positive urine culture on presentation was obtained in 26 (34%) patients, and 27 (36%) patients were admitted to the intensive care unit (ICU). The mean single and overall stone size was 8.6 (2-23) and 10.8 (2-32) mm, respectively. The mean operating time was 42 (5-129) min with stone-free rate (SFR) of 97% (n=74). There were three (4%) complications in total, of which two patients developed urinary tract infection needing intravenous antibiotics (Clavien II) and a third developed sepsis (Clavien IV) needing ICU admission. There was no difference in ureteroscopic lithotripsy outcomes (operative time, complications, or SFR) on comparing initial RUS or PCN, admission to ICU or ward, positive or negative urine culture result, presence of single or multiple stones, and between American Society of Anaesthesiologists (ASA) grade of patients. The ASA grade of patients was a significant predictor of day case procedures (p=0.001)., Conclusions: Elective URS achieved excellent outcomes in patients who previously presented with obstructing calculi and sepsis needing emergency decompression. Overnight inpatient admission was needed in some patients with a higher ASA grade., Patient Summary: In this report, we look at the outcomes of planned ureteroscopy procedures for stone disease in patients with previous urosepsis. These patients with previous emergency drainage for urosepsis had excellent outcomes from their planned ureteroscopic surgery. This information will help in preoperative patient optimisation and counselling., (Copyright © 2018 European Association of Urology. Published by Elsevier B.V. All rights reserved.)

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.

Ureteroscopy and laser stone fragmentation (URSL) has had recent advancements with the more powerful laser systems with the ability to 'dust' and 'pop-dust' the stone. We wanted to look at the outcomes of this method for large stones (≥ 15 mm) using our new 100 W holmium laser. Over a period of 16 months (January 2017-April 2018), 50 patients underwent URSL for minimum cumulative stone size of ≥ 15 mm. Data were collected prospectively on patient and stone demographics and outcomes of URSL. The laser setting used was a power of 0.3-0.6 J and a frequency of 20-50 Hz using a long-pulse setting with a 272-µm fiber. Fifty patients underwent 55 URSL procedures (5 bilateral procedures) using dusting and pop-dusting settings. The mean age was 58 years (range 2-88 years) with a male:female ratio of 35:15. The mean single and overall stone size were 10.3 mm (3-23 mm) and 21 mm (range 15-52 mm) with two-thirds of all patients (65%) having multiple stones. The stone location was in the kidney (n = 65, 78%), in the ureter (n = 19, 22%) and 5 patients had bilateral renal stones. With a mean operating time of 51 min, the initial and final SFR were 93 and 98%, respectively. A pre-operative stent, access sheath and a post-operative stent were present in 29 (53%), 34 (62%) and 51 (93%) procedures, respectively. Over a mean hospital stay of 0.6 days (74% day-case procedures), there was one Clavien IV complication related to urosepsis but without any other major or minor complications. Dusting and pop-dusting techniques achieve an excellent SFR with low risk of complications even for large stones. This might set a new benchmark for treating large stones, bilateral or multiple stones in a single setting, without the need for secondary procedures in most cases.

Introduction: While negative ureteroscopy (URS) can be considered as an unnecessary procedure with medico-legal consequences, this avoids radiation from repeat CT scan and sometimes may be the only way to reassure patients with ongoing symptoms. We wanted to analyze our predictors and results of negative URS for treatment of ureteric stones., Methods and Materials: Between March 2012 and August 2018, data on consecutive patients with ureteric stones undergoing a primary URS (without a pre-operative stent) were prospectively collected for patient demographics and outcomes. Comparison was done for patients with diagnostic and therapeutic primary URS for ureteric stones. Patients with renal stones were excluded from the study., Results: A total of 270 patients underwent URS for ureteric stones during the study period of which 35 (13%) had a negative diagnostic URS. The patients who had negative URS were younger (p = 0.001), had smaller stones (p < 0.001), and more stones located in the distal ureter or vesico-ureteric junction (VUJ; p= 0.036). None of the patients who underwent negative URS had a postoperative stent inserted or any complications., Conclusion: Although the rates of negative URS should be as low as possible, it seems to be safe and reassures patients with on-going symptoms. Based on our data, patients with small distal ureteric or VUJ stones should undergo a repeat imaging to avoid this unnecessary procedure. Informed consent, patient counseling, and appropriate up-to-date imaging seem to be key to minimizing negative diagnostic URS., (© 2019 S. Karger AG, Basel.)

Management of stone disease in solitary kidney remains a difficult treatment entity for the urologist. The challenge exists to deliver high clearance while maintaining strong safety profile. Twelve eligible studies were included, comprising a total of 693 patients with a male:female ratio of 2:1. Overall, 114 (16.4%) complications were reported. No fatalities were reported in any of the studies. Clavien III complications were recorded in less than 0.5% of the patients. This review confirms the effectiveness, safety, and reliability of this technique for this unique cohort of patients., (Copyright © 2018 Elsevier Inc. All rights reserved.)

Purpose: To look at the bibliometric publication trends on 'Urolithiasis' and aspects of treatment and training associated with it over a period of 16 years from 2000 to 2015. To this end, we conducted this study to look at the publication trends associated with urolithiasis, including the use of simulation, laser technology, and all types of interventions for it., Materials and Methods: We performed a systematic review of the literature using PubMed over the last 16 years, from January 2000 to December 2015 for all published papers on 'Urolithiasis'. While there were no language restrictions, English language articles and all non-English language papers with published English abstracts were also included. Case reports, animal and laboratory studies, and those studies that did not have a published abstract were excluded from our analysis. We also analyzed the data in two time periods, period-1 (2000-2007) and period-2 (2008-2015)., Results: During the last 16 years, a total of 5343 papers were published on 'Urolithiasis', including 4787 in English language and 556 in non-English language. This included papers on URS (n = 1200), PCNL (n = 1715), SWL (n = 887), open stone surgery (n = 87), laparoscopic stone surgery (n = 209), pyelolithotomy (n = 35), simulation in Endourology (n = 82), and use of laser for stone surgery (n = 406). When comparing the two time periods, during period 2, the change was +171% (p = 0.007), +279% (p < 0.001), and -17% (p = 0.2) for URS, PCNL, and SWL, respectively. While there was a rise in laparoscopic surgery (+116%), it decreased for open stone surgery (-11%) and pyelolithotomy (-47%). A total of 82 papers have been published on simulation for stone surgery including 48 papers for URS (67% rise in period-2, p = 0.007), and 34 papers for PCNL (480% rise in period-2, p < 0.001). A rising trend for the use of laser was also seen in period 2 (increase of 126%, p < 0.02, from 124 papers to 281 papers)., Conclusions: Published papers on intervention for Urolithiasis have risen over the last 16 years. While there has been a steep rise of URS and minimally invasive PCNL techniques, SWL and open surgery have shown a slight decline over this period. A similar increase has also been seen for the use of simulation and lasers in Endourology.

Objective: To assess the "body mass index" (BMI) (weight and length) of 12 flexible ureteroscopes (digital and fiber optic) along with the light cables and camera heads, to make the best use of our instruments., Materials and Methods: Twelve different brand-new flexible ureteroscopes from four different manufacturers, along with eight camera heads and three light cables were evaluated. Each ureteroscope, camera head, and light cable was weighted; the total length of each ureteroscope, shaft, handle, flexible end-tip, and cable were all measured., Results: According to our measurements (in grams [g]), the lightest ureteroscope was the LithoVue (277.5 g), while the heaviest was the URF-V2 (942.5 g). The lightest fiber optic endoscope was the Viper (309 g), while the heaviest was the Cobra (351.5 g). Taking into account the entirety of the endoscopes, the lightest ureteroscope was the Lithovue and the heaviest was the Wolf Cobra with the Wolf camera "3 CHIP HD KAMERA KOPF ENDOCAM LOGIC HD" (1474 g). The longest ureteroscope was the URF-P6 (101.6 cm) and the shortest was the LithoVue (95.5 cm); whereas the Viper and Cobra had the longest shaft (69 cm) and URF-V had the shortest shaft (67.2 cm). The URF-V2 had the longest flexible end-tip (7.6 cm), while the LithoVue had the shortest end-tip (5.7 cm) in both directions (up/down), while the URF-V had the shortest upward deflection (3.7 cm)., Conclusions: Newer more versatile digital endoscopes were lighter than their traditional fiber optic counterparts in their entirety, with disposable endoscope having a clear advantage over other reusable ureteroscopes. Knowing the "BMI" of our flexible ureteroscopes is an important information that every endourologist should always take into consideration.

Purpose: To analyze the bibliometric publication trend on the application of "Artificial Intelligence (AI) and its subsets (Machine Learning–ML, Virtual reality–VR, Radiomics) in Urolithiasis" over 3 decades. We looked at the publication trends associated with AI and stone disease, including both clinical and surgical applications, and training in endourology. Methods: Through a MeshTerms research on PubMed, we performed a comprehensive review from 1994–2023 for all published articles on "AI, ML, VR, and Radiomics." Articles were then divided into three categories as follows: A-Clinical (Nonsurgical), B-Clinical (Surgical), and C-Training articles, and articles were then assigned to following three periods: Period-1 (1994–2003), Period-2 (2004–2013), and Period-3 (2014–2023). Results: A total of 343 articles were noted (Groups A-129, B-163, and C-51), and trends increased from Period-1 to Period-2 at 123% (p = 0.009) and to period-3 at 453% (p = 0.003). This increase from Period-2 to Period-3 for groups A, B, and C was 476% (p = 0.019), 616% (0.001), and 185% (p < 0.001), respectively. Group A articles included rise in articles on "stone characteristics" (+2100%; p = 0.011), "renal function" (p = 0.002), "stone diagnosis" (+192%), "prediction of stone passage" (+400%), and "quality of life" (+1000%). Group B articles included rise in articles on "URS" (+2650%, p = 0.008), "PCNL"(+600%, p = 0.001), and "SWL" (+650%, p = 0.018). Articles on "Targeting" (+453%, p < 0.001), "Outcomes" (+850%, p = 0.013), and "Technological Innovation" (p = 0.0311) had rising trends. Group C articles included rise in articles on "PCNL" (+300%, p = 0.039) and "URS" (+188%, p = 0.003). Conclusion: Publications on AI and its subset areas for urolithiasis have seen an exponential increase over the last decade, with an increase in surgical and nonsurgical clinical areas, as well as in training. Future AI related growth in the field of endourology and urolithiasis is likely to improve training, patient centered decision-making, and clinical outcomes. [ABSTRACT FROM AUTHOR]

Introduction The treatment of kidney stone disease (KSD) has evolved significantly with the introduction of minimally invasive endourological techniques. Advancements in technology, particularly the transition from fibreoptic to digital and single use systems and the development of smaller-diameter instruments, has improved intraoperative view and efficacy in stone treatment. The miniaturization in single-use scopes represent a recent innovation, offering potential benefits, especially in challenging cases. However, there is limited evidence on their safety and clinical outcomes. This study aims to evaluate the efficacy and safety of stone treatment using a single-use 7.5 Fr flexible ureteroscope. Material and methods Consecutive patients with urinary stones undergoing flexible ureteroscopy with a 7.5 Fr single-use flexible ureteroscope across five tertiary endourology centers were included. Data on patient demographics, stone characteristics, intra- and postoperative outcomes were prospectively collected and analyzed. Procedures were performed by experienced endourology surgeons following standard protocols. Results 50 patients with a mean age of 54.5 years (IQR: 25–65.8) and a male to female ratio of 34:16 underwent flexible ureteroscopy (FURS). Mean cumulative stone size was 18.9 mm (SD ±10.9 mm) with a mean stone volume of 2031.2 mm3 (SD ±2869.4 mm3 ) and mean Hounsfield units of 1087.4 (SD ±384.9). 36 (72%) had multiple stones and a bilateral FURS was performed in 9 cases (18%). 24 patients (48%) had a preoperative stent inserted. A ureteral access sheath was used in 22 (44%) cases and 46 (92%) patients had a postoperative stent inserted. The median operative time was 60min (IQR: 53–90), 32 patients (64%) were stone free after the first procedure (SFR for <2 cm and ≥2 cm stones was 85.2% and 36.2% respectively), perioperative and postoperative complications (Clavien ≤II) were observed in 3 patients (6%). Conclusions This multicentric study demonstrates the safety and efficacy of using the 7.5Fr single-use flexible ureteroscope for urinary stone treatment. While the results are promising, larger studies are needed to validate these findings further. [ABSTRACT FROM AUTHOR]

Objective: In this review, we investigated the current literature to find out which artificial stones (AS) are available in endourology, and in which experimental and training schemes they are used. Materials and Methods: A systematic review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. Twenty-one out of 346 studies met our inclusion criteria and are presented in the current review. The inclusion criteria were the existence of AS and their use for laboratory and training studies. Results: There is a wide variety of materials used for the creation of AS. BegoStone powder (BEGO USA, Lincoln, Rhode Island) and plaster of Paris™ were used in most of the studies. In addition, Ultracal-30 (U. S. Gypsum, Chicago, IL) was also used. Other materials that were used as phantoms were AS created from plaster (Limbs and Things, UK), standardized artificial polygonal stone material (Chaton 1028, PP13, Jet 280; Swarovski), model stones consisting of spheres of activated aluminum (BASF SE, Ludwigshafen am Rhein, Deutschland), Orthoprint (Zhermack, Badia Polesine, Italy), and a combination of plaster of Paris, Portland cement, and Velmix (calcium sulfate powder). Many experimental settings have been conducted with the use of AS. Our research demonstrated nine studies regarding testing and comparison of holmium: yttrium–aluminum–garnet laser devices, techniques, and settings. Six studies were about extracorporeal shock wave lithotripsy testing and settings. Three experiments looked into treatment with percutaneous nephrolithotomy. Additionally, one study each investigated imaging perioperatively for endourological interventions, stone bacterial burden, and obstructive uropathy. Conclusion: AS have been used in a plethora of laboratory experimental studies. Independent of their similarity to real urinary tract stones, they present a tremendous potential for testing and training for endourological interventions. [ABSTRACT FROM AUTHOR]

Purpose: To highlight and compare experts' laser settings during endoscopic laser treatment of upper tract urothelial carcinoma (UTUC), to identify measures to reduce complications, and to propose guidance for endourologists. Methods: Following a focused literature search to identify relevant questions, a survey was sent to laser experts. We asked participants for typical settings during specific scenarios (ureteroscopy (URS), retrograde intrarenal surgery (RIRS), and percutaneous treatment). These settings were compared among the reported laser types to find common settings and limits. Additionally, we identified preventive measures commonly applied during surgery. Results: Twenty experts completed the survey, needing a mean time of 12.7 min. Overall, most common laser type was Holmium–Yttrium–Aluminum–Garnet (Ho:YAG) (70%, 14/20) followed by Thulium fiber laser (TFL) (45%, 9/20), pulsed Thulium–Yttrium–Aluminum–Garnet (Tm:YAG) (3/20, 15%), and continuous wave (cw)Tm:YAG (1/20, 5%). Pulse energy for the treatment of distal ureteral tumors was significantly different with median settings of 0.9 J, 1 J and 0.45 J for Ho:YAG, TFL and pulsed Tm:YAG, respectively (p = 0.048). During URS and RIRS, pulse shapes were significantly different, with Ho:YAG being used in long pulse and TFL in short pulse mode (all p < 0.05). We did not find further disparities. Conclusion: Ho:YAG is used by most experts, while TFL is the most promising alternative. Laser settings largely do not vary significantly. However, further research with novel lasers is necessary to define the optimal approach. With the recent introduction of small caliber and more flexible scopes, minimal-invasive UTUC treatment is further undergoing an extension of applicability in appropriately selected patients. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate outcomes of flexible ureteroscopy for renal stones by comparing hard versus soft stones based on their attenuation on computed tomography (Hounsfield Units—HU). Methods: Patients were divided into two groups according to the type of laser employed [Holmium:YAG (HL) or Thulium fiber laser (TFL)]. Residual fragments (RF) were defined as > 2 mm. Multivariable logistic regression analysis was performed to evaluate factors associated with RF and RF needing further intervention. Results: 4208 patients from 20 centers were included. In whole series, age, recurrent stones, stone size, lower pole stones (LPS), and multiple stones were predictors of RF at multivariable analysis and LPS and stone size with RF requiring further treatment. HU and TFL were associated with lesser RF and RF requiring an additional treatment. In HU < 1000 stones, recurrent stones, stone size, and LPS were predictors of RF at multivariable analysis, whereas TFL was less likely associated with RF. Recurrent stones, stone size, and multiple stones were predictors of RF requiring further treatment, while LPS and TFL were associated with lesser RF requiring further treatment. In HU ≥ 1000 stones, age, stone size, multiple stones, and LPS were predictors of RF at multivariable analysis, while TFL was less likely associated with RF. Stone size and LPS were predictors of RF requiring further treatment, whereas TFL was associated with RF requiring further treatment. Conclusion: Stone size, LPS, and use of HL are predictors of RF after RIRS for intrarenal stones regardless of stone density. HU should be considered an important parameter in predicting SFR. [ABSTRACT FROM AUTHOR]

Advances in laser technology and surgical telescopic systems have propelled retrograde intrarenal surgery (RIRS) to the forefront as a viable alternative to percutaneous nephrolithotomy (PCNL). Currently, RIRS is being increasingly utilized as a treatment option, even for kidney stones larger than 2 cm. In this narrative review, we aimed to take a snapshot of current practice in renal stone treatment and the latest technological and technical developments and to evaluate the efficacy of RIRS in larger renal stones. With low complication rates and acceptable stone-free rates, RIRS offers patients a less invasive option with favorable outcomes. There are insufficient data comparing PCNL with RIRS using a new-generation high-power laser and suctioning ureteral access sheath (UAS). Further studies with novel lasers and UAS could provide superiority in terms of RIRS. It is crucial to take into account various patient-specific considerations, such as stone location and burden, when deciding on the appropriate treatment approach. [ABSTRACT FROM AUTHOR]

Jo et al. described that E. Coli was the most common species causing UTIs in patients without indwelling catheters, while in catheterized patients, Enterobacter and Enterococcus species were mostly isolated. As previously mentioned, a strong relationship exists between KSD and UTIs, and indeed, stone formers are at a higher risk of developing UTIs over their lifetimes [[12]]. The outcomes of the paper suggest that stone-free status after FURSL could help to reduce UTI recurrence in the majority of patients. Urinary tract infections (UTIs) are common pathologies that can affect patients of every age and background. [Extracted from the article]

The use of lasers in endourology has grown exponentially, leading to technological advancement and to miniaturization of the procedures. We aim to provide an overview of the lasers used in endourology and the associated future perspectives. Using MEDLINE, a non-systematic review was performed including articles between 2006 and 2023. English language original articles, reviews and editorials were selected based on their clinical relevance. Guidelines recommend ureteroscopy in case of stones <2 cm and a percutaneous approach for renal stones ≥2 cm. High-power holmium (Ho:YAG) lasers and the new thulium fibre laser (TFL) may change the future, offering shorter procedures for complex stones, with good outcomes. Increased intrarenal temperature associated with these new technologies may be overcome with adaptive strategies and optimal settings. For upper-tract urothelial carcinoma (UTUC), the combination of laser techniques and these new lasers may reduce the risk of stenosis and allow for a more accurate tumour ablation, potentially reducing the recurrence rates. Laser enucleation procedures are gaining a major role in benign prostate enlargement (BPE), especially in patients with larger prostates or under anticoagulant therapy. However, the superiority of one laser over the other has not been established yet, and the choice of technique is mainly deferred to the surgeon's expertise. In conclusion, lasers will further expand their horizon in endourology, allowing for instrument adaptation to challenging anatomy. Prospective, randomized clinical trials are however needed to confirm available results and to provide the optimal settings for each pathology. [ABSTRACT FROM AUTHOR]

Background. The study aimed to assess whether the eradication of kidney stones might result in a substantial reduction in the onset of recurrent UTIs. Methods. We selected all the patients who underwent ureteroscopy (URS) for stone disease between 2012 and 2021, with either a history of recurrent UTIs (rUTIs), urosepsis or pre-operative positive urine culture (UC). Data included patient demographics, microbiological data, stone parameters, stone-free and infection-free rates (SFR and IFR, respectively) at follow-up, defined as fragments <2 mm at imaging and the absence of symptoms and urine-culture-proven UTI. Results. Overall, 178 patients were selected. The median age was 62 years. The median cumulative stone size was 10 mm (7–17.25), and the commonest locations were the lower pole (18.9%) and proximal ureter (14.9%). The overall stone-free rate at follow-up was 89.3%. The IFR at 3 months was 88.3%. As follow-up duration increased, the IFR reduced to 85.4%, 74.2%, 68% and 65% at 6, 12, 18 and 24 months, respectively. Patients who had infection recurrence were more likely to present stone persistence or recurrence compared to those who were infection-free at follow-up (20% vs. 4.4%, p = 0.005). Conclusions. SFR after URS is a significant predicting variable for the likelihood of infection-free status at follow-up in patients with an rUTI or positive UC at the time of URS. [ABSTRACT FROM AUTHOR]

Aim: To assess and compare the outcomes associated with ureteroscopy and laser fragmentation (URSL) for extremes of age group (≤10 and ≥80 years). Methods: Retrospective consecutive data were collected from two European centres for all paediatric patients ≤10 undergoing URSL over a 15-year period (group 1). It was compared to consecutive data for all patients ≥80 years (group 2). Data were collected for patient demographics, stone characteristics, operative details, and clinical outcomes. Results: A total of 168 patients had 201 URSL procedures during this time (74 and 94 patients in groups 1 and 2 respectively). The mean age and stone sizes were 6.1 years and 85 years, and 9.7 mm and 13 mm for groups 1 and 2 respectively. While the SFR was slightly higher in group 2 (92.5% versus 87.8%, p = 0.301), post-operative stent rate was also significantly higher in the geriatric population (75.9% versus 41.2%, p = 0.0001). There was also no significant difference in pre-operative stenting (p = 0.886), ureteric access sheath use (UAS) (p = 0.220) and post-operative complications. Group 1 had an intervention rate of 1.3/patient as compared to 1.1/patient in group 2. The overall complications were 7.2% and 15.3% in groups 1 and 2 respectively (0.069), with 1 Clavien IV complication related to post-operative sepsis and brief ICU admission in group 2. Conclusion: The paediatric population had a marginally higher incidence of repeat procedure, but the overall SFR and complications were similar, and post-operative stent insertion rates were much better compared to geriatric patients. URSL is a safe procedure in the extremes of age groups with no difference in the overall outcomes between the two groups. [ABSTRACT FROM AUTHOR]

Ureteral stents are useful devices in urological surgery. The main objective of a ureteric stent is to allow passage of urine and reduce early or late complications related to obstruction in the urinary tract. Despite their widespread use, there is a general lack of knowledge and awareness in stent composition and indication of application. We represented a synthesis of our extensive research over materials, coatings and shapes available on the market and then analyzed the main characteristics and peculiarities of ureteral stents. We have also focused our attention over the side effects and complication that must be considered when placing a ureteral stent. Encrustation, microbial colonization, stent-related symptoms and patient's history must always be evaluated when there is the need for a ureteral stent. The perfect stent should have many characteristics including easy insertion and removal, easy manipulation, resistance to encrustation and migration, lack of complications, biocompatibility, radio-opacity, biodurability, affordability (cost-effectiveness), tolerability and optimal flow characteristics. Nevertheless, further research and studies need to be done to provide more information about stent composition and efficacy in vivo. In this narrative review, we covered the basic information and main characteristics of ureteral stents, in order to help clinicians choose the appropriate device needed for a given situation. [ABSTRACT FROM AUTHOR]

Several mobile healthcare (mHealth) apps are available in various marketplaces, but there is still concern about their accuracy, data safety, and regulation. The goal of this review was to critically analyze the mobile apps created for education, diagnosis, and medical and surgical treatment of patients with kidney stone disease (KSD), as well as to assess the level of data security, the contribution of physicians in their development and adherence to the Food and Drug Administration (FDA) and Medical Device Regulation (MDR) guidance. A comprehensive literature search was performed using PubMed (September 2022), in the Apple App Store and Google Play store using relevant keywords and inclusion criteria. Information was extracted for the name of the app, primary and additional functionalities, release and last update, number of downloads, number of marks and average rating, Android/ iOS compatibility, initial and in-app payments, data safety statement, physician involvement statement, and FDA/MDR guidance. A total of 986 apps and 222 articles were reviewed, of which based on the inclusion, 83 apps were finally analyzed. The apps were allocated to six categories about their primary purpose: education (n=8), fluid trackers (n=54), food content description and calculators (n=11), diagnosis (n=3), pre- and intra-operative application (n=4), and stent trackers (n=2). Of these apps, the number of apps supported for Android, iOS, and both of them were 36, 23, and 23, respectively. Despite a wide range of apps available for KSD, the participation of doctors in their development, data security, and functionality remains insufficient. Further development of mHealth should be carried out properly under the supervision of urological associations involving patient support groups, and these apps must be regularly updated for their content and data security [ABSTRACT FROM AUTHOR]

Objective: The objective of this study was to evaluate a new concept in flexible ureteroscopy: instrumental dead space (IDS). For this purpose, various proximal working channel connector designs, as well as the impact of ancillary devices occupying the working channel were evaluated in currently available flexible ureteroscopes. Design and methods: IDS was defined as the volume of saline irrigation needed to inject at the proximal connector for delivery at the distal working channel tip. Because IDS is related to working channel diameter and length, proximal connector design, as well as occupation of working channel by ancillary devices, these parameters were also reviewed. Results: IDS significantly varied between flexible ureteroscope models, ranging from 1.1ml for the Pusen bare scopes, to 2.3ml for Olympus scopes with their 4-way connector (p<0.001). Proximal connector designs showed a high degree of variability in the number of available Luer locks, valves, seals, angles, and rotative characteristics. The measured length of the working channel of bare scopes ranged between 739 and 854mm and significantly correlated with measured IDS (R2 = 0.82, p<0.001). The coupling of scopes with an alternative ancillary proximal connector and the insertion of ancillary devices into the working channel significantly reduced IDS (mean IDS reduction of 0.1 to 0.5ml; p<0.001). Conclusions: IDS appears as a new parameter that should be considered for future applications of flexible ureteroscopes. A low IDS seems desirable for several clinical applications. The main factors impacting IDS are working channel and proximal connector design, as well as ancillary devices inserted into the working channel. Future studies should clarify how reducing IDS may affect irrigation flow, intrarenal pressure, and direct in-scope suction, as well as evaluate the most desirable proximal connector design properties. [ABSTRACT FROM AUTHOR]

Objective: To analyze the pattern of speaker activity related to both flexible ureteroscopy (fURS) and percutaneous nephrolithotomy (PCNL) during plenary sessions at the main (endo)urological international meetings over the last 10 years. Methods: We reviewed the meeting programs of the main endourological international meetings (EAU, AUA, WCE, and SIU) during 2011–2019. We detected all invited speakers at plenary sessions regarding fURS or PCNL. The proportion of fURS and PCNL talks was evaluated yearly during the study period. In order to analyze plenary session speaker composition, we estimated and compared the mean number of talks per speaker according to surgical technique. We also analyzed possible differences in age distribution according to the topic of the talk as well as the presence of young (i.e., < 45 years) speakers. Data were analyzed using descriptive statistics. Results: During the last 10 years, a total of 498 plenary talks were found. Of those, 260 (52.2%), 211 (42.4%), and 27 (5.4%) discussed PCNL, fURS, or both, respectively. PCNL was more frequently discussed at the beginning and the end of the study period. Mean [SD] number of talks per speaker was higher for PCNL (2.9 [3.4] vs 1.6 [1.4], p < 0.001), meaning that a wider variety of speakers was invited to give fURS talks. Speakers discussing fURS were younger (median [interquartile range, IQR] age 48 [44–56] vs 52 [47–60] years, p < 0.001), and a higher proportion of young speakers was observed in the fURS group (26% vs 15% p < 0.001). PCNL speakers were more commonly discussing fURS than fURS speakers discussing PCNL (23% vs 17%, p = 0.43). Conclusions: We found a wider variety of speakers at fURS plenary sessions as compared to PCNL ones. It is easier and quicker to become an internationally recognized expert in the field of fURS rather than PCNL. PCNL speakers were able to master fURS more frequently than the other way around. [ABSTRACT FROM AUTHOR]

Introduction Urinary tract calculi are commonly treated with ureteroscopy and laser stone fragmentation (URSL). The composition of calculi depends on underlying patient factors. Stones associated with metabolic or infectious conditions are sometimes thought to be more difficult to treat. This analysis explores whether the composition of calculi impacts on stone-free and complication rates. Material and methods A prospectively maintained database of patients undergoing URSL between 2012-2021 was used to explore records for patients with uric acid (Group A), infection (Group B) and calcium oxalate monohydrate (Group C) calculi. Patients who had undergone URSL to treat ureteric or renal calculi were included. Patient demographics, stone parameters and operative details were collected, with the principal outcomes being stone-free rate (SFR) and associated complications. Results A total of 352 patients were included (58 Group A, 71 Group B and 223 Group C patients) and had their data analysed. SFR was >90% for all three groups and a single Clavien-Dindo grade III complication was noted. No significant differences were found between the groups for complications, SFR and day case rates. Conclusions This cohort of patients demonstrated that outcomes were similar for three different types of urinary tract calculi, which form for differing reasons. URSL appears to be an effective, safe treatment for all stone types with comparable results. [ABSTRACT FROM AUTHOR]

Introduction Shock wave lithotripsy (SWL) is a well-established treatment for kidney stone disease (KSD) and despite its decreased popularity in the past, it has now gained renewed interest due to its minimally invasive nature and good outcomes, especially in the face of COVID-19 pandemic. The aim of our study was to perform a service evaluation to analyse and identify quality of life (QoL) changes [using Urinary Stones and Intervention Quality of Life (USIQoL) questionnaire] after repeat SWL treatments. This would enable a greater understanding of SWL treatment and reduce the current gap of knowledge regarding patient specific outcomes in the field. Material and methods Patients affected by urolithiasias underwent SWL treatment between September 2021 and February 2022 (6 months), were included in the study. A questionnaire was given to the patients in each SWL session and consisted of three main topic areas: a domain on Pain and Physical Health, on Psycho-social Health and on Work (see appendix below). Patients also completed a Visual Analogue Scale (VAS) in relation to the pain related to the treatment. Data from the questionnaires were collected and analysed. Results A total of 31 patients filled in two or more surveys, with a mean age of 55.8 years. On repeat treatments, pain and physical health domain was significantly better (p = 0.0046), psycho-social health domain was significantly better (p <0.001), work domain was significantly better (p = 0.009) and a correlation [on Visual Analog Scale (VAS)] was observed between pain decreasing in subsequent SWL procedures. Conclusions Our study found that the choice of SWL to treat KSD does improve a patient's QoL. This could be related to improvement of physical health, psychological and social wellbeing, and ability to work. Higher QoL and low pain scores are observed in relation to repeat SWL treatment and are not directly associated to stone-free status. [ABSTRACT FROM AUTHOR]

Ureteral access sheaths (UASs) are part of urologist's armamentarium when performing retrograde intrarenal surgery (RIRS). Recently, the world of RIRS has changed dramatically with the development of three game-changers: thulium fiber laser (TFL), smaller size single use digital flexible ureterosopes and intraoperative intrarenal pressure (IRP) measurement devices. We aimed to clarify the impact of UASs on IRP, complications and SFRs and put its indications in perspective of these three major technological improvements. A systematic review of the literature using the Medline, Scopus and Web of Science databases was performed by two authors and relevant studies were selected according to PRISMA guidelines. Recent studies showed that using a UAS lowers IRP and intrarenal temperature by increasing irrigation outflow during RIRS. Data on the impact of a UAS on SFRs, postoperative pain, risk of infectious complications, risk of ureteral strictures and risk of bladder recurrence of urothelial carcinoma after diagnostic RIRS were inconclusive. Prestenting for at least one week resulted in ureteral enlargement, while the influence of pre-operative administration of alpha-blockers was unclear. Since TFL, smaller single use digital ureteroscopes and devices with integrated pressure-measuring and aspiration technology seemed to increase SFRs and decrease pressure and temperature related complications, indications on the use of a UAS may decrease in the near future. [ABSTRACT FROM AUTHOR]

Introduction: The burden of kidney stone disease has risen, and several treatment options now exist. We wanted to evaluate the preference and treatment choices based on the information provided for management of hypothetical 8 and 15 mm renal stone, and factors that influenced their decision. Materials and Methods: An online questionnaire to investigate trends in decision-making for two hypothesized scenarios of asymptomatic kidney stones (8 and 15 mm) was formatted online in Microsoft Forms and posted on social media (Facebook) in Europe. The ethical approval was obtained from the University Ethics Committee, and data were collected from general public between September and November 2020. Results: A total of 476 participants of different age and background answered the survey with a male:female ratio of 1:2.7. The age groups were categorized as 18–25 years (n = 149), 26–49 years (n = 192), and 50+ years (n = 135). In the 8 mm scenario, 107 of the 476 participants (22.5%) chose observation, 249 (52.3%) chose extracorporeal shockwave lithotripsy (SWL) and 120 (25.2%) opted for ureteroscopy (URS). In the 15 mm scenario, 194 participants chose SWL treatment (40.8%), 216 (45.4%) URS, and 66 (13.9%) preferred percutaneous nephrolithotomy. The influencing factors were success rate, complication risk and invasiveness of the procedure. On comparison to 8 mm stone, while stent avoidance and activity limitation were considered less important with 15 mm stone (p < 0.001), complication rates were considered more important (p < 0.001). Conclusion: More than one treatment choice for kidney stones often exists and clinicians must take patient choice into account via an informed decision-making process. While some might accept a higher risk of invasiveness and complications for higher stone-free rate, others might have a more conservative approach to this. It is about time that urologists take patient priorities and concerns into account and perhaps use Patient Reported Outcome Measures in addition to clinical outcomes when comparing treatment success. [ABSTRACT FROM AUTHOR]

Background: Although paediatric ureteroscopy is widely performed, there is still a lack of data and outcomes in early childhood. In this two-centre study, we compared the outcomes of ureteroscopy for stone disease management in early and late childhood and provide outcomes for the same. Methods: Data was retrospectively collected on consecutive patients from two tertiary paediatric endo-urology European centres over a 15-year period (2006–2021). Patients were split into two groups, namely, early childhood (age ⩽ 9 years) and late childhood (age 9 to ⩽16 years). Outcomes including stone-free rate (SFR) and complications were compared between these two groups. Results: A total of 148 patients underwent 184 procedures (1.2 procedure/patient) during the study period (66 in early childhood and 82 in late childhood). The mean age in early and late childhood groups were 5.6 and 13.3 years, and a male: female ratio of 1.6:1 and 1.1:1, respectively. The SFR and complications in early and late childhood groups were 87.8% and 90.2% (p = 0.64) and 5.7% and 4.1%, respectively. Conclusion: Paediatric ureteroscopy and laser stone fragmentation achieves good results in both early and late childhood with comparable SFRs, although the complications and need for second procedure were marginally higher in the early childhood group. Our study would set up a new benchmark for patient counselling in future, and perhaps this needs to be reflected in the paediatric urolithiasis guidelines. [ABSTRACT FROM AUTHOR]

Introduction: Ureteroscopy and laser stone fragmentation [flexible ureteroscopy and laser lithotripsy (FURSL)] has risen over the last two decades. Laser technology has also evolved over the time, shifting from low- to high-power lasers with the addition of MOSES technology that allows for 'dusting and pop-dusting' of stones. The aim of the study was to look at the outcomes of FURSL in lower pole stones (LPS) using low- and high-power lasers. Patient and Methods: In this study, we compared the outcomes of low-power holmium laser (group A, 20 W) and high-power holmium laser (group B, including both 60 W MOSES integrated system and 100 W lasers) for all patients with LPS treated with laser lithotripsy. Data were collected for patient demographics, stone location, size, pre- and postoperative stent, length of stay, complications and stone free rate (SFR). Results: A total of 284 patients who underwent FURSL procedure for LPS were analysed (168 group A, 116 group B). Outcomes showed that compared with group A, group B had a higher SFR (91.6% versus 96.5%, p = 0.13) and shorter operative time (52 versus 38 min, p < 0.001). The median length of stay was <24 h in all groups (day-case procedures). The complication rate was comparable between the two groups but with more infectious complications (n = 7) noted in group A compared with group B (n = 3) (p = 0.53). Conclusion: Compared with low-power laser, the use of high-power laser for LPS significantly reduced the use of ureteral access sheath (UAS), postoperative stent and procedural time. Although non-statistically significant, the SFR was higher in the high-power group even for relatively larger stone sizes, which was also reflected in a reduction of sepsis-related complication rates with these lasers. [ABSTRACT FROM AUTHOR]

Objective: To present a well-organized review about ureteral access sheath impact on ureteral injury. Materials and Methods: Systemic search on literature was done. Total of 3766 studies observed by two urologists and results were unified. A Prisma diagram was used for eliminating irrelevant studies and at the end of elimination process 28 studies were found eligible for this review. Results: Not only clinical studies but also comparative experimental animal studies show that there is no significant data to claim that ureteral access sheath insertion causes more ureteral injury. Pre-stented patients were found to be at lower risk for ureteral injury. Risk of progression to ureteral injury seems to be low even if ureteral injury occurs with insertion of ureteral access sheath. Conclusion: Summary of studies' results indicate that use of ureteral access sheath doesn't increase ureteral injury. This review may help understanding safety profile of ureteral access sheath on evidence-based level. There is not enough data to make a statement that ureteral access sheath prevents ureteral injury. [ABSTRACT FROM AUTHOR]

Introduction: With an increase in the prevalence of kidney stone disease (KSD), there has been a universal drive to develop reliable and user-friendly tools such as grading systems and predictive nomograms. An atlas of scoring systems (SS), grading tools, and nomograms in Endourology is provided in this article. Methods: A comprehensive search of world literature was performed to identify nomograms, grading systems, and classification tools in endourology related to KSD. Each of these was reviewed by the authors and has been evaluated in a narrative format with details on those that are externally validated and their respective citation count on google scholar. Results: A total of 54 endourological tools have been described in our atlas of endourological SS, grading tools, and nomograms. Of the tools, 23 (43%) have been published in the past 3 years showing an increasing interest in this area. This includes five for percutaneous nephrolithotomy, six for flexible ureteroscopy, three for semi-rigid ureteroscopy (URS), nine for extracorporeal shockwave lithotripsy, two for stent encrustations, three for intraoperative appearance at the time of URS, and three to classify intraoperative ureteric injury. There were three tools for renal colic assessment, one each for prediction of future stone event, stone classification, and stone impaction and two for need of emergency intervention in ureteral stone. Two tools are related to stone recurrence, whereas six are related to postprocedural complications. There are now two tools for simulation in endourology and five for patient-reported outcome measures. Conclusions: A number of reliable and established tools currently exist in endourology. Each of these offers their own respective advantages and disadvantages. Although nomograms and SS can help in the decision making, these must be tailored to individual patients based on their specific clinical scenarios, expectations, and informed consent. [ABSTRACT FROM AUTHOR]

Introduction: Although pediatric ureteroscopy has been increasingly performed, the evidence for its use in pediatric lower pole stones (LPS) is sparce. In this study we look at the effectiveness and outcomes of flexible ureteroscopy and laser lithotripsy (FURSL) in the management of LPS for a pediatric population. Materials and Methods: Data were collected from two large European tertiary endourology centers that specialize in pediatric kidney stone management. The study was registered as an audit at the respective hospitals. All data were cross-checked and analyzed using electronic operative notes, discharge records, laboratory systems, and patient correspondence. The inclusion criteria were patients ≤16 years with LPS having an FURSL procedure. Results: A total of 57 pediatric patients underwent FURSL for LPS. The mean age was 10.1 ± 4.7 years (range: 1–16.9 years) with a male–female ratio of 2:3. The mean single stone size was 9.45 ± 3.9 mm (range: 3–20 mm) and 31 (54.4%) had multiple stones. A preoperative stent was present in 18 (31.6%) patients and a postoperative stent or ureteral catheter was left behind in 32 (56.1%) patients. The initial and final stone-free rates were 82.4% and 98.2%, respectively, with 1.19 procedures per patient performed to be stone free. Although there were no intraoperative complications, there were only four (7%) minor complications (Clavien I) noted that were all simple urinary infections. No long-term complications were noted. Conclusion: Flexible ureteroscopy and lasertripsy achieve excellent outcomes for treatment of pediatric LPS. Although some patients might need a second procedure for complete stone clearance, FURSL may be considered as the first-line treatment of LPS. [ABSTRACT FROM AUTHOR]

Encrustation of ureteral stents can represent a complex challenge. Patients can require multiple intervention types as well as several operative sessions. Our aim was to establish a practical guide for managing such cases as well as an accompanying treatment algorithm. Nearly all cases can now be successfully managed with minimally invasive methods such as ureteroscopy and/or percutaneous nephrolithotomy. Use of a validated tool for grading burden of encrustation is recommended. Careful patient counselling as well as operative planning are of paramount importance. Identifying high risk patient groups such as pregnancy and implementing prevention strategies are also crucial. [ABSTRACT FROM AUTHOR]

Urological organizations publish detailed evidence-based guidelines to support the urologists in the management of urolithiasis. Our objective was to provide clear guidance on the management of urolithiasis, compare the American Urological Association (AUA) and European Association of Urologists (EAU) guidelines, and present an algorithm for different clinical scenarios. The latest AUA and EAU guidelines on urolithiasis were evaluated for the level of evidence and grade of recommendation. All recommendations on management of urolithiasis (surgical and medical management) were reviewed and included. Both the organizations provide guidance for initial patient assessment, imaging requirements, and therapeutic options, including surgical intervention and medical therapy. In addition, these guidelines provide advice for managing specific patient groups, including pediatric patients and pregnant patients. Although there is a general concordance between both the groups, differences exist particularly for recommended modality of surgical intervention depending on stone location and size. Although both the guidelines were broadly similar, we also highlighted the variations in the level of evidence and grade of recommendation. Although these guidelines provide a valuable evidence-based framework to support the management of urinary tract stones, their implementation must be tailored to individual patient needs and available resources. [ABSTRACT FROM AUTHOR]