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Background: The study assesses the decisional regret following Shared Decision-making (SDM) in patients selecting either early ureteroscopic lithotripsy (URSL) or medical expulsive therapy (MET) for ureteric stones ≤ 1 cm, with the aim to evaluate their decisional Conflict, satisfaction, and regret regarding their opted treatment choices., Methods: Adults aged more than 18 years with one stone up to 1 cm in either ureter were included. After SDM, the patients were allocated into their opted group viz. URSL or MET. Patients in each group were reassessed at "treatment completion". Cambridge Ureteric Stone PROM (CUSP) questionnaire for HRQoL, Decision Regret Scale and the OPTION scale (SDM) were filled at treatment completion., Findings: 111 patients opted for MET, while 396 patients opted for early URSL. Mean stone size was larger in URSL group (7.16 ± 1.63 mm vs. 5.50 ± 1.89; p < 0.001). Decisional conflict was higher in patients opting for URSL (77.3% vs. 57.7%; p < 0.001). Stone-free rate at four weeks was higher in URSL group (87.1%vs68.5%, p < 0.001). Decisional regret was higher in patients opting for MET (33.24 ± 30.89 vs. 17.26 ± 12.92; p = 0.002). Anxiety, was higher in patients opting for MET (6.94 ± 1.89 vs. 5.85 ± 1.54; p < 0.001). Urinary symptoms and interference in patients' travel plans and work-related activities were more in URSL group (6.21 ± 1.57 vs. 5.59 ± 1.46; p < 0.001 and 6.56 ± 1.59 vs. 6.05 ± 1.72; p < 0.001 respectively)., Interpretation: After SDM, decisional regret is higher in patients opting for MET mainly due protracted treatment duration with increased pain and anxiety during the treatment course and the need for additional procedure for attaining stone clearance and the. Despite higher decisional conflict, a larger proportion of patients opt for early URSL with the aim of avoiding anxiety and achieving early stone clearance., (© 2024. The Author(s).)

Objectives: To compare the oncological outcomes of patients with upper tract urothelial carcinoma (UTUC) undergoing kidney-sparing surgery (KSS) with fibre-optic (FO) vs digital (D) ureteroscopy (URS). To evaluate the oncological impact of image-enhancement technologies such as narrow-band imaging (NBI) and Image1-S in patients with UTUC., Patients and Methods: The Clinical Research Office of the Endourology Society (CROES)-UTUC registry is an international, multicentre, cohort study prospectively collecting data on patients with UTUC. Patients undergoing flexible FO- or D-URS for diagnostic or diagnostic and treatment purposes were included. Differences between groups in terms of overall survival (OS) and disease-free survival (DFS) were evaluated., Results: The CROES registry included 2380 patients from 101 centres and 37 countries, of whom 401 patients underwent URS (FO-URS 186 and D-URS 215). FO-URS were performed more frequently for diagnostic purposes, while D-URS was peformed when a combined diagnostic and treatment strategy was planned. Intra- and postoperative complications did not differ between the groups. The 5-year OS and DFS rates were 91.5% and 66.4%, respectively. The mean OS was 42 months for patients receiving FO-URS and 39 months for those undergoing D-URS (P = 0.9); the mean DFS was 28 months in the FO-URS group and 21 months in the D-URS group (P < 0.001). In patients who received URS with treatment purposes, there were no differences in OS (P = 0.9) and DFS (P = 0.7). NBI and Image1-S technologies did not improve OS or DFS over D-URS., Conclusions: D-URS did not provide any oncological advantage over FO-URS. Similarly, no differences in terms of OS and DFS were found when image-enhancement technologies were compared to D-URS. These findings underline the importance of surgeon skills and experience, and reinforce the need for the centralisation of UTUC care., (© 2021 The Authors BJU International published by John Wiley & Sons Ltd on behalf of BJU International.)

Background: Flexible ureteroscopy is an established treatment modality for evaluating and treating abnormalities in the upper urinary tract. Reusable ureteroscope (USC) durability is a significant concern., Objective: To evaluate the durability of the latest generation of digital and fiber optic reusable flexible USCs and the factors affecting it., Design, Setting, Participants: Six new flexible USCs from Olympus and Karl Storz were included. The primary endpoint for each USC was its first repair. Data on patient and treatment characteristics, accessory device use, ureteroscopy time, image quality, USC handling, disinfection cycles, type of damage, and deflection loss were collected prospectively., Intervention: Ureteroscopy., Outcome Measurements and Statistical Analysis: USC durability was measured as the total number of uses and ureteroscopy time before repair. USC handling and image quality were scored. After every procedure, maximal ventral and dorsal USC deflection were documented on digital images., Results and Limitations: A total of 198 procedures were performed. The median number of procedures was 27 (IQR 16-48; 14h) for the six USCs overall, 27 (IQR 20-56; 14h) for the digital USCs, and 24 (range 10-37; 14h) for the fiber optic USCs. Image quality remained high throughout the study for all six USCs. USC handling and the range of deflection remained good under incremental use. Damage to the distal part of the shaft and shaft coating was the most frequent reason for repair, and was related to intraoperative manual forcing. A limitation of this study is its single-center design., Conclusions: The durability of the latest reusable flexible USCs in the current study was limited to 27 uses (14h). Damage to the flexible shaft was the most important limitation to the durability of the USCs evaluated. Prevention of intraoperative manual forcing of flexible USCs maximizes their overall durability., Patient Summary: Current flexible ureteroscopes proved to be durable. Shaft vulnerability was the most important limiting factor affecting durability., (Copyright © 2018 European Association of Urology. Published by Elsevier B.V. All rights reserved.)

Introduction: Retropulsion, defined as unintended migration of a stone under the influence of the fragmentation device in ureteroscopy (URS) procedures, occurs in 2% to 60% of the cases. Antiretropulsive devices (ARDs) have been studied in experimental and small clinical studies. The current study aims at describing the worldwide usage of ARD and the outcomes related to their usage., Methods: The Clinical Research Office of the Endourological Society URS Global Study enrolled 11,885 patients who underwent URS and stone fragmentation for ureteral and/or renal stones. Of the 11,885 treated patients, 9877 were treated for ureteral stones, and data were available on stone migration and ARD use., Results: Of all procedures, 14.5% were performed with the use of an ARD. Less stone migration (-2.0%; p = 0.050), higher stone-free rates (SFRs) (2.8%; p < 0.001), and shorter length of stay (-4.7%; p = 0.001) were observed in the antiretropulsive group., Conclusions: When an ARD is used during URS, less migration, higher SFRs, and shorter length of hospital stay are observed. This effect is independent from baseline differences and corrected for other treatment characteristics.

Objective: To evaluate patients' characteristics, surgical procedure data, and outcomes of ureterorenoscopy (URS) stone treatment in patients with a horseshoe kidney (HSK), ectopic kidney (EK), and malrotated kidney (MK)., Materials and Methods: This study is a subanalysis of the Clinical Research Office of the Endourological Society URS Global Study, which was a prospective multicenter observational study, collecting data on URS stone treatment from consecutive patients over a 1-year period. A total of 114 centers in 32 countries participated. This analysis acuminated on URS stone treatment in the specified renal anomalies: HSK, EK, and MK. For each group, patient characteristics, operation data, and treatment outcomes were evaluated., Results: Of the 11,885 patients included in the Clinical Research Office of the Endourological Society URS study, 43 patients had HSK, 27 EK, and 16 MK. The stone-free rate (SFR) in the HSK group was 77% for renal stones and 85% for ureteral stones. In the HSK group, the intraoperative complication rate was 11.6% and the postoperative complication rate was 7%, including 1 Clavien grade IIIa and 1 IIIb complication. In the EK group, the SFR was 20% for renal stones and 94% for ureteral stones, with an intraoperative complication rate of 14.8% and a postoperative complication rate of 7.4%. One Clavien IVa complication was reported. In the MK group, the SFR was 71% for renal stones and 88% for ureteral stones, with an intraoperative complication rate of 6.3%. No postoperative complications occurred in this group., Conclusion: URS is an effective and safe treatment modality to remove ureteral and renal stones in patients with HSK and MK. The effectiveness of URS for renal stones in EK was low., (Copyright © 2017 Elsevier Inc. All rights reserved.)

Purpose: To compare intra- and post-operative outcomes of endourological live surgical demonstrations (LSDs) and routine surgical practice (RSP) for urinary stones., Methods: Consecutive ureterorenoscopic (URS) and percutaneous (PNL) urinary stone procedures over a 5-year period were reviewed. Procedures were divided into LSDs and RSP. Differences between the groups were separately analysed for URS and PNL. Primary outcomes included intra- and post-operative complication rates and grades. Secondary outcomes were operation time, length of hospital stay, stone-free rate, and retreatment rate. Pearson's Chi-square analysis, Mann-Whitney U test, and logistic and linear regression were used to compare outcomes between LSDs and RSP., Results: During the study period, we performed 666 URSs and 182 PNLs, and 151 of these procedures were LSDs. Among URSs, the overall intra-operative complication rate was 3.2% for LSDs and 2.5% for RSP (p = 0.72) and the overall post-operative complication rate was 13.7% for LSDs and 8.8% for RSP (p = 0.13). Among PNLs, the overall intra-operative complication rate was 8.9% for LSDs and 5.6% for RSP (p = 0.52) and the overall post-operative complication rate was 28.6% for LSDs and 34.9% for RSP (p = 0.40). For both URSs and PNLs, no statistically significant differences in complication grade scores were observed between LSDs and RSP. Operation time was significantly longer for LSD-URS group, but there was no difference between the PNL groups. There were no significant differences in length of hospital stay and stone-free rate. The retreatment rate was higher in the LSD-URS group compared with RSP-URS group but similar between the PNL groups. Multiple logistic regression analyses, adjusting for confounders, revealed no association between LSD and more or less favourable outcomes as compared to RSP., Conclusion: Live surgical demonstrations do not seem to compromise patients' safety and outcomes when performed by specialised endourologists.

Purpose: To describe stone-free rates and complications of ureteroscopic treatment for impacted compared with non-impacted ureteral stones and evaluate predictive variables for impaction., Methods: The Clinical Research Office of the Endourological Society prospectively collected 1 consecutive year of data from 114 centers worldwide. Patients eligible for inclusion were patients treated with ureteroscopy for ureteral stones. Patient characteristics, treatment details, and outcomes were compared with regard to stone impaction. Logistic regression analyses were conducted to explore predictive variables for ureteral stone impaction and to analyse the effect of impaction on outcomes., Results: Of the 8543 treated patients, 2650 (31%) had impacted and 5893 (69%) non-impacted stones. The stone-free rate was 87.1% for impacted stones, which is lower compared with 92.7% for non-impacted stones (p < 0.001). Intra-operative complication rates were higher for impacted stones (7.9 versus 3.0%, p < 0.001). Significantly higher ureteral perforation- and avulsion rates were reported in the impacted stone group compared with the non-impacted stone group. No association between stone impaction and post-operative complications could be shown. Female gender, ASA-score >1, prior stone treatment, positive pre-operative urine culture, and larger stones showed to be predictive variables for stone impaction., Conclusions: Ureteroscopic treatment for impacted stones is associated with lower stone-free rates and higher intra-operative complication rates compared with treatment for non-impacted stones. The predictive variables for the presence of stone impaction may contribute to the identification of stone impaction during the diagnostic process. Moreover, identification of stone impaction may aid the selection of the optimal treatment modality.

Purpose: This study presents a comparison of the international experience with ipsilateral and bilateral ureteroscopy for multiple, bilateral ureteral and renal stones vs single stone treatment. Patient and treatment characteristics and outcomes were compared., Materials and Methods: The CROES (Clinical Research Office of the Endourological Society) Ureteroscopy Global Study includes 114 centers in 32 countries. Patients undergoing bilateral ureteroscopy, ipsilateral ureteroscopy for multiple stones and ureteroscopy for a single stone were examined from January 2010 to October 2012. Intraoperative characteristics and postoperative outcomes were identified for each patient. Inverse probability weighted regression adjustment analyses were done to compare outcomes independent of differences among centers and patient characteristics., Results: The CROES Ureteroscopy Global Study consists of 11,885 patients. A total of 2,153 patients (18.7%) were treated for multiple stones, of whom 1,880 (87.3%) and 273 (12.7%) underwent ipsilateral and bilateral ureteroscopy, respectively. Inverse probability weighted regression adjustment models for bilateral vs ipsilateral ureteroscopy and multiple vs single stone treatments showed that patients with bilateral ureteroscopy and multiple stone treatments had lower stone-free rates, higher re-treatment rates and longer operative times compared to patients who underwent ipsilateral ureteroscopy and single stone treatment. There was no difference in complication rates among bilateral, ipsilateral and single stone ureteroscopy., Conclusions: This study presents a large series of patients who underwent bilateral and ipsilateral ureteroscopy. Our findings suggest a decrease in stone-free rates, increased re-treatment rates, increased operative times and longer hospital stay in patients treated for multiple stones. The treatment of multiple stones and bilateral ureteroscopy are safe compared to single stone treatment and ipsilateral ureteroscopy, respectively., (Copyright © 2017 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.)

Purpose: Double-J stent placement after stone removal by ureteroscopy (URS) is common and recommended in many cases but debatable in others. In this study, the risks and benefits of postoperative Double-J stent placement in URS stone treatment procedures undertaken in current clinical practice are examined., Materials and Methods: The Clinical Research Office of Endourological Society (CROES) URS is a prospective, observational, international multicenter study, in which patients are candidates for URS as primary treatment or after failure of prior treatment for ureteral and renal stones. Baseline, intraoperative, and postoperative data were collected. Predictors and outcomes of postoperative stent placement were analyzed by inverse probability-weighted regression adjustment of the relationship between a Double-J stent placement and outcomes (complications, readmission [including retreatment], and length of hospital stay)., Results: Significant predictors of postoperative Double-J stent placement in URS treatment of ureteral stones were intraoperative complications, impacted stones, operation time, stone burden, age, presence of a solitary kidney, and stone-free rate. In renal stone treatment, the predictors identified included operation time, age, preoperative stent placement, anticoagulant use, presence of a solitary kidney, and intraoperative complications. In both ureteral and renal stone treatment groups, postoperative placement of a Double-J stent resulted in significantly fewer postoperative complications (p < 0.001) compared with patients who did not receive a stent., Conclusions: Patient- and procedure-related variables were identified, which may enable an individualized approach to postoperative stenting, resulting in improved clinical outcomes in urologic stone treatment by URS.

Introduction: We evaluated a new digital single-use flexible ureteroscope, LithoVue™ with respect to deflection, image quality and maneuverability., Methods: A prospective cohort study was conducted in eight tertiary reference centers in Europe in December 2015 and January 2016. All consecutive patients included underwent flexible ureteroscopy and were 18 years or older. Deflection and image quality pre- and post-use and maneuverability were rated with a Likert scale., Results: A total of 40 procedures were performed (five per institution). The indication for FURS was treatment of renal stones in 92.5 % of the cases. Before LithoVue™ usage, the median measured upward and downward deflections were both 270°. Image quality was rated as "very good" in 65 % of cases and "good" in 30 %. Maneuverability was "very good" in 77.5 % and "good" in 17.5 %. At the final evaluation, median upward and downward deflections were both 270°. Image quality was still "very good" in 65 % of cases and "good" in 30 % with no significant difference compared with preoperative data (p = 1). Maneuverability was "very good" in 72.5 % and "good" in 17.5 %, with no significant difference compared with preoperative data (p = 0.92). Two LithoVue™ broke during surgery (5 %): one occurring in extreme deflection with acute infundibulopelvic angle and spontaneous loss of vision for the second one., Conclusion: The LithoVue™ displayed good image quality, active deflection and maneuverability. Further evaluation of surgical outcomes and cost analysis will help to present the best utility of this single-use FURS in current practice.

Objective: To evaluate the characteristics and outcomes of ureteroscopy (URS) in children treated in several hospitals participating in the Clinical Research Office of the Endourological Society (CROES) Study, and to present the overall results of pediatric URS compared with adults., Patients and Methods: The CROES Study collected data on consecutive patients treated with URS for urolithiasis at each participating center over a 1-year period. The collected prospective global database includes data for 11,885 patients who received URS at 114 centers in 32 countries. Of these URS-treated patients, 192 were ≤18 years old., Results: Of the 114 centers participating in the study, 42% had conducted pediatric URS. Among the pediatric cases, 7 were infants, 53 were small children, 59 were school-aged children, and 73 were adolescents. A considerable number (37%) of the pediatric cases had previously undergone URS treatment. No differences in the surgical outcomes of the adults and children were reported. The URS-treated children had a greater number of positive preoperative urine cultures when compared with adult cases treated. A semirigid scope was used in the vast majority of pediatric cases (85%). According to the present data, within the group of URS-treated children, the younger the child, the more readmissions occurred., Conclusion: URS is as efficient and safe in children as it is in adults. The data suggest that readmissions among URS-treated children are associated with age, with the likelihood of readmissions greater among younger age groups., (Copyright © 2016 Elsevier Inc. All rights reserved.)

Context: Retrograde intrarenal surgery has gained substantial popularity worldwide thanks to continuous improvements in technology and techniques, and is now considered one of the first-line treatment options for active removal of renal stones., Objective: To provide a comprehensive synthesis of the main evidences in literature on the current management of kidney stones by means of retrograde intrarenal surgery (RIRS)., Evidence Acquisition: A review of literature has been conducted using search string "retrograde intrarenal surgery OR flexible ureteroscop* OR ureterorenoscop*", without any language restriction; PubMed, Embase, and Scopus databases were searched in November 2016. Exclusion criteria involved manuscripts dealing with paediatric patients, and RIRS for proximal ureteric stones and for upper tract urothelial tumours. Fifty-seven papers were finally included in the analysis., Evidence Synthesis: Technological progress focuses on the miniaturisation of disposables and scopes, as well as on the increase of durability and improvement of the quality of image provided by these instruments. The technique has been in continuous development following the progress in technology. Currently, the main target of RIRS are renal stones 1-2cm in size, even though tertiary centres are pushing the boundaries to the treatment of larger stones. Nomograms predicting surgical outcomes and improving preoperative surgical planning have been developed. RIRS has been shown to be safe and effective in patients with specific conditions such as bleeding diathesis, anatomical malformation, or pregnancy. Cost effectiveness of the approach is still a matter of controversy when compared with other treatment modalities., Conclusions: RIRS is a well-established procedure under constant evolution with advances in technique and technology. It has gained worldwide popularity due to its minimal invasiveness and satisfactory outcomes. Future developments are needed to increase its cost effectiveness and extend its use to a wider range of indications., Patient Summary: In this collaborative review, we have summarised the best evidence in literature with respect to current management of renal stones by means of retrograde intrarenal surgery (RIRS) with flexible ureteroscopy. RIRS has been shown to be a safe and effective treatment modality in a wide spectrum of clinical scenarios; technology and technique are continuously evolving to further push boundaries of its indications and efficacy., (Copyright © 2017 European Association of Urology. All rights reserved.)

Introduction: Although ureteroscopy (URS) has been established as a viable treatment for stones in obese patients, its safety and success has not been fully elucidated. The current study describes the worldwide prevalence of obesity in patients with urolithiasis and examines trends in URS outcomes, safety, and efficacy., Methods: This study utilized the Clinical Research Office of the Endourological Society (CROES) URS Global Study, which was a prospective, multicenter study including 11,885 patients treated with URS for urinary stones at 1 of 114 urology departments across 32 countries. The relationship between body mass index (BMI), diabetes, and creatinine, with retreatment, stone-free rates, complications, and long hospital stay, was examined with a multivariate logistic regression analyses., Results: Of the 10,099 URS patients with BMI data, 17.4% were obese and 2.2% were super obese. Overall, 86.7% patients were stone free and 16.8% required retreatment. Higher BMI was associated with lower stone-free rates, and any deviation from normal weight was associated with higher retreatment rates. In multivariate analysis controlling for several variables including stone size, the association between BMI and lower stone-free rates with higher retreatment rates persisted. Intraoperative complications occurred in 518 (5.1%) patients, and 343 (3.4%) experienced a postoperative complication. Postoperative complications were more frequent in the underweight and super obese subjects, and there was no relationship between BMI and intraoperative complications., Discussion: Although URS for stone disease was found to be an overall safe procedure for obese and super obese patients, efficacy of the procedure may be lower compared with normal-weight subjects and higher retreatment rates may be necessary.

Objective: To compare outcomes of ureteric and renal stone treatment with ureteroscopy (URS) in patients with or without the placement of a preoperative JJ stent., Patients and Methods: The Clinical Research Office of the Endourological Society (CROES) URS Global Study collected prospective data for 1 year on consecutive patients with ureteric or renal stones treated with URS at 114 centres around the world. Patients that had had preoperative JJ stent placement were compared with those that did not. Inverse-probability-weighted regression adjustment (IPWRA) was used to examine the effect of preoperative JJ stent placement on the stone-free rate (SFR), length of hospital stay (LOHS), operative duration, and complications (rate and severity)., Results: Of 8 189 patients with ureteric stones, there were 978 (11.9%) and 7 133 patients with and without a preoperative JJ stent, respectively. Of the 1 622 patients with renal stones, 590 (36.4%) had preoperative stenting and 1 002 did not. For renal stone treatment, preoperative stent placement increased the SFR and operative time, and there was a borderline significant decrease in intraoperative complications. For ureteric stone treatment, preoperative stent placement was associated with longer operative duration and decreased LOHS, but there was no difference in the SFR and complications. One major limitation of the study was that the reason for JJ stent placement was not identified preoperatively., Conclusions: The placement of a preoperative JJ stent increases SFRs and decreases complications in patients with renal stones but not in those with ureteric stones., (© 2015 The Authors BJU International © 2015 BJU International Published by John Wiley & Sons Ltd.)

Purpose: To describe the differences in the treatment and the outcomes of renal stones treated with flexible ureteroscopy (URS) either with or without the support of a ureteral access sheath (UAS)., Methods: The Clinical Research Office of the Endourological Society URS Global Study involved the collection of prospective data from consecutive patients treated with URS at centers around the world over a 1-year period. Baseline characteristics, stone location, treatment details, postoperative outcomes and complications were recorded. Inverse-probability-weighted regression adjustment (IPWRA) analyses were conducted on outcome from patients treated with or without the use of a UAS to determine the impact on stone-free rates (SFRs)., Results: Of 2239 patients treated with flexible URS, 1494 (67 %) patients were treated with the use of a UAS and 745 (33 %) without a UAS. The IPWRA analyses conducted on 1827 patients with complete data and based on treatment and outcome models showed that if URS procedures were performed without the use of an UAS, the average stone-free rate would be 0.504 compared with 0.753 with a UAS. This average treatment effect of 0.248 was not significant (P = 0.604). Using IPWRA analysis on only the treated population in the estimations revealed no significant difference between using and not using a UAS (31 %; ATET: 0.311; P = 0.523)., Conclusions: The study showed no difference in SFR when a UAS was used or not. Whereas UAS did not increase the risk of ureteral damage or bleeding, postoperative infectious complications were reduced.

Purpose: We determined the efficacy and safety of flexible ureterorenoscopy for single intrarenal calculi and further stratified efficacy by stone burden., Materials and Methods: CROES collected prospective data on consecutive patients with urinary stones treated with ureterorenoscopy at 114 centers worldwide for 1 year. Only patients who underwent flexible ureterorenoscopy for a solitary renal stone were included in study. Preoperative and intraoperative characteristics, and postoperative outcomes were evaluated. Relationships between stone size and the stone-free rate, operative time, complications, hospital stay and need for re-treatment were determined., Results: A total of 1,210 patients with a solitary kidney stone less than 10 (52.2%), 10 to 20 (43.2%) and greater than 20 mm (4.6%) were treated with flexible ureterorenoscopy. The stone-free rate negatively correlated with stone size when adjusted for body mass index. Operative time positively correlated with stone size when adjusted for body mass index. The single session stone-free rate was 90% and 80% for stones less than 10 and less than 15 mm, respectively. Patients with stones greater than 20 mm achieved a 30% stone-free rate, more often needed re-treatment and were more often rehospitalized. There was no difference in the overall complication rate by stone size. However, patients with a stone greater than 20 mm showed a higher probability of fever after flexible ureterorenoscopy than those with a smaller stone., Conclusions: Our data indicate that flexible ureterorenoscopy for a single intrarenal stone is a safe procedure. Best results after single session flexible ureterorenoscopy were obtained for stones less than 15 mm., (Copyright © 2015 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.)

Purpose: To examine the effects of antibiotic prophylaxis on postoperative infection rate in patients with negative urine cultures undergoing ureteroscopy (URS)., Patients and Methods: Using the Clinical Research Office of the Endourological Society (CROES) URS Global Study database, patients with a negative baseline urine culture undergoing URS for ureteral stones (n=1141) or kidney stones (n=184) not receiving antibiotic prophylaxis were matched with those who were predefined by risk factors, including gender, American Society of Anesthesiologists (ASA) score, and ureteral stent placement. Patient characteristics, operative data, and postoperative outcomes, including the development of urinary tract infection (UTI) and fever, in the two groups were compared., Results: Antibiotic prophylaxis use differed widely across participating countries (13%-100%). Differences were found between patients who did or did not receive antibiotic prophylaxis regarding the frequency of anticoagulation medication, previous treatment with URS, stone burden, previous presence of kidney stones, duration of current URS, and complications post-URS. The prevalence of fever and UTI was low (≤2.2%) and similar in both groups. Factors predictive of postoperative UTI or fever were female gender, Crohn's and cardiovascular disease, a high stone burden, and an ASA score of II or higher., Conclusions: In patients with a negative baseline urine culture undergoing URS for ureteral or renal stones, rates of postoperative UTI and fever were not reduced by preoperative antibiotic prophylaxis. Female gender and a high ASA score were specific risk factors for postoperative infection in this patient group.

Background: The Clinical Research Office of the Endourological Society (CROES) undertook the Ureteroscopy Global Study to establish a prospective global database to examine the worldwide use of ureteroscopy (URS) and to determine factors affecting outcome., Objective: To investigate the influence of case volume on the outcomes of URS for ureteral stones., Design, Setting, and Participants: The URS Global Study collected prospective data on consecutive patients with urinary stones treated with URS at 114 centres worldwide for 1 yr. Centres were identified as low or high volume based on the median overall annual case volume., Outcome Measurements and Statistical Analysis: Pre- and intraoperative characteristics, and postoperative outcomes in patients at low- and high-volume centres were compared. The relationships between case volume and stone-free rate (SFR), stone burden, complications, and hospital stay were explored using multivariate regression analysis., Results and Limitations: Across all centres, the median case volume was 67; 58 and 56 centres were designated as low volume and high volume, respectively. URS procedures at high-volume centres took significantly less time to conduct. Mean SFR was 91.9% and 86.3% at high- and low-volume centres, respectively (p<0.001); the adjusted probability of a stone-free outcome increased with increasing case volume (p<0.001). Patients treated at a high-volume centre were less likely to need retreatment, had shorter postoperative hospital stay, were less likely to be readmitted within 3 mo, and had fewer and less severe complications. At case volumes approximately >200, the probability of complications decreased with increasing case volume (p=0.02). The study is limited by the heterogeneity of participating centres and surgeons and the inclusion of patients treated by more than one approach., Conclusions: In the treatment of ureteral stones with URS, high-volume centres achieve better outcomes than low-volume centres. Several outcome measures for URS improve with an increase in case volume., Patient Summary: Outcomes following treatment of ureteral stones by ureteroscopy (URS) were studied in a large group of patients at centres worldwide. The proportion of successful procedures (ie, those in which patients became stone free) increased as the annual volume of URS at a hospital increased. Hospital stays were shorter and postoperative complications were less likely at high-volume hospitals. We conclude that for URS, the best outcomes are seen in patients treated at high-volume hospitals., (Copyright © 2014 European Association of Urology. Published by Elsevier B.V. All rights reserved.)

Background: Ureteroscopy has traditionally been the preferred approach for treatment of distal and midureteral stones, with shock wave lithotripsy used for proximal ureteral stones., Objective: To describe the differences in the treatment and outcomes of ureteroscopic stones in different locations., Design, Setting, and Participants: Prospective data were collected by the Clinical Research Office of the Endourological Society on consecutive patients treated with ureteroscopy at centres around the world over a 1-yr period., Intervention: Ureteroscopy was performed according to study protocol and local clinical practice guidelines., Outcome Measurements and Statistical Analysis: Stone location, treatment details, postoperative outcomes, and complications were recorded. Pearson's chi-square analysis and analysis of variance were used to compare outcomes among the different stone locations., Results and Limitations: Between January 2010 and October 2012, 9681 patients received ureteroscopy treatment for stones located in the proximal ureter (n=2656), midureter (n=1980), distal ureter (n=4479), or multiple locations (n=440); location in 126 patients was not specified. Semirigid ureteroscopy was predominantly used for all stone locations. Laser and pneumatic lithotripsy were used in the majority of cases. Stone-free rates were 94.2% for distal ureter locations, 89.4% for midureter locations, 84.5% for proximal ureter locations, and 76.6% for multiple locations. For the proximal ureter, failure and retreatment rates were significantly higher for semirigid ureteroscopy than for flexible ureteroscopy. A low incidence of intraoperative complications was reported (3.8-7.7%). Postoperative complications occurred in 2.5-4.6% of patients and varied according to location, with the highest incidence reported for multiple stone locations. Limitations include short-term follow-up and a nonuniform treatment approach., Conclusions: Ureteroscopy for ureteral stones resulted in good stone-free rates with low morbidity., Patient Summary: This study shows that patients who have ureteral stones can be treated successfully with ureteroscopy with a low rate of complications for the patient., (Copyright © 2014 European Association of Urology. Published by Elsevier B.V. All rights reserved.)

Purpose: To assess the current indications for ureteroscopy (URS) treatment, outcome in terms of stone-free rate, and intra- and postoperative complications using the modified Clavien grading system., Patients and Methods: The Clinical Research Office of the Endourological Society collected prospective data as part of the URS Global Study for consecutive patients treated with URS at centers around the world for 1 year. URS was performed according to study protocol and local clinical practice guidelines. The stone size and location were recorded and postoperative outcome and complications, graded according to the modified Clavien grading system, reported., Results: Between January 2010 and October 2012, 11,885 patients received URS at 114 centers in 32 countries; 1852 had only renal stones, 8676 had only ureteral stones, and 1145 patients had both types of stone. Fragmentation was performed principally using a laser device (49.0%) or a pneumatic device (30.3%); no device was used in 17.9% of the patients. A high stone-free rate (85.6%) was achieved. The large majority of patients did not receive any further treatment for renal or ureter stones (89.4%). The postoperative complication rate was low (3.5%). The most frequent complication was fever (1.8%); a blood transfusion was required in 0.2% of patients. The majority of complications were Clavien grade I or II (2.8% of patients)., Conclusion: URS is an established minimal invasive treatment for urinary stones with a high success rate and low morbidity. Recent advances have expanded the indication for urinary stones, which now ranges from treatment of smaller sized distal ureter stones by semirigid URS to larger sized renal pelvis stones treated by flexible URS.

The aim of the present review was to study factors influencing training and the maintenance of skills in performing ureteroscopy (URS). We searched on the following keywords in the Medline, Embase and Cochrane databases: renal or ureteric stone; ureteroscopy; endourology; educational; training; learning curve; expertise; skill; residency; practice; simulator; and robotics. We have defined, when possible, levels and grades of evidence, based on 2009 recommendations of the Oxford Centre for Evidence-Based Medicine. We found that technological advancement and surgeon experience is a predictive factor for success or complications of URS. Experience may be related to special endourology training, time passed after basic training and the number of procedures performed. Studies suggest that a resident must perform a certain amount of cases to gain proficiency with URS, but there is still a need for well designed studies for the learning curve of URS to be accurately defined. Training models may be useful for training in URS and stone disintegration. Stone centres that provide all the endoscopic treatment options seem to provide the best conditions to ensure a sufficient volume of patients required. Defining minimum requirements for training in URS and for maintaining certification is a major challenge, as is defining the learning curve in URS. Careful curriculum design in high-volume stone centres may be the key to optimizing URS training., (© 2011 THE AUTHORS. BJU INTERNATIONAL © 2011 BJU INTERNATIONAL.)

Purpose: We stratified factors that affect treatment morbidity, compared the outcomes of ureteroscopy procedures from a single department under different conditions, and provided evidence of treatment benefits when ureteroscopy is performed in an expert setting., Patients and Methods: Since the department became a dedicated endourologic center in 2002, we grouped all ureteroscopy procedures into those performed before 2002 (group A) and after 2002 (group B). The modified Clavien classification was used to score morbidity. Independent variables with an influence on postoperative outcomes were studied, including operative time, intraoperative and postoperative complications, and hospitalization time., Results: Of the 248 ureteroscopy procedures performed, 62 comprised group A and 186 comprised group B. Statistical preoperative differences were in the American Society of Anesthesiologists score, patients with diabetes mellitus, cardiovascular disease, and the use of anticoagulants; and the perioperative differences were seen in operative time, hospital stay, and the number of eventful procedures. Group A had a significantly longer operative time and a longer hospital stay compared with group B. The number of failed and eventful procedures are also higher in group A compared with group B. Stone-free rates were similar in both groups., Conclusions: The dedicated setting for ureteroscopy at our center resulted in decreased operative time, more uneventful procedures, and decreased hospitalization time. The modified Clavien morbidity score is a reliable tool for more objective comparisons of morbidity after ureteroscopic stone treatment.

Purpose: Ureteral stents are widely used in many urological procedures. We evaluated the recent literature, providing an update on materials and stent designs, and indications for stent placement and stent complications, including the management of such stent related problems., Materials and Methods: A thorough literature search on ureteral stents was performed. Pertinent new and review/updated articles published in the English literature from 2000 through 2006 were systematically reviewed., Results: Following uncomplicated ureteroscopy or shock wave lithotripsy routine stenting does not appear to affect the stone-free rate. However, stent related morbidity is often seen. Patients at greatest risk for complications are those undergoing bilateral stentless ureteroscopy, those with recent or recurrent urinary tract infections and pregnant patients. The placement of indwelling stents in these patients should be considered. The development of stent materials and designs has been directed toward decreasing stent related morbidity, such as pain, discomfort, bladder irritability, infection and encrustation. Changes in stent design and materials show great promise. Initial evaluations suggest improvements in patient comfort as well as decreased encrustation. Forgotten stents can lead to significant morbidity as a result of severe encrustation. Most cases can be managed endoscopically, often requiring multiple procedures., Conclusions: Stenting is not mandatory after uncomplicated simple ureteroscopy and shock wave lithotripsy. Patients with stents seem to have significantly more bladder and lower urinary tract symptoms than those in whom stents are not placed. However, there is a subgroup of patients who likely benefit from stenting following a procedure because of the increased risk of complications. The ideal ureteral stent biomaterial has yet to be discovered and an area of promising development is the drug eluting stent to prevent infection and encrustation.

Purpose: The goal of treating ureteral calculi is to achieve complete stone clearance with minimal patient morbidity. Shock wave lithotripsy and ureteroscopy have become standards of care for ureteral calculi. However, the optimal choice of treatment depends on various factors, including stone size, composition and location, clinical patient factors, equipment availability and surgeon capability. Indications for and outcomes data on shock wave lithotripsy and ureteroscopy for proximal ureteral calculi were reviewed to provide recommendations on the optimal treatment choice for managing symptomatic ureteral calculi., Materials and Methods: A systematic review was performed based on an English literature search using the MEDLINE database between 1997 and 2005. The key words used were proximal ureteral calculi, ureteroscopy and shock wave lithotripsy., Results: A total of 87 articles were identified, of which 33 were selected for inclusion. Shock wave lithotripsy and ureteroscopy provided an excellent stone-free rate (86% to 90%) for stones less than 10 mm, whereas for larger stones ureteroscopy achieved better outcomes vs shock wave lithotripsy (67% vs 73%). Ureteroscopy was preferred over shock wave lithotripsy in patients with pregnancy or bleeding diathesis., Conclusions: Ureteroscopy provides optimal stone clearance in patients with proximal ureteral calculi more than 10 mm. It is also recommended in patients with contraindications for shock wave lithotripsy. In patients with smaller stones (less than 10 mm) shock wave lithotripsy may be considered a reasonable alternative with outcomes similar to those of ureteroscopy.

Simple Summary: This research investigates whether a diagnostic technique called ureteroscopy (URS), performed before surgery for removing the kidney and ureter, influences the likelihood of cancer recurrence in the bladder in patients with upper tract urothelial carcinoma (UTUC). Data from a multicentre international registry were analysed to compare patients who underwent URS before their surgery with those who did not. The study found that patients who had URS prior to surgery experienced a higher rate of cancer recurrence in the bladder. These results highlight the need for careful consideration of the use of URS in the diagnostic process for UTUC, as it could affect long-term outcomes. This information is crucial for clinicians in optimizing treatment strategies and improving patient care. (1) Introduction: Diagnostic ureteroscopy (URS) is an important component in the workup of upper tract urothelial carcinoma (UTUC). Whether URS was associated with increased recurrence in the bladder was not fully concluded. The current study aimed to evaluate the implication of URS on the incidences of intravesical recurrence following radical nephroureterectomy (RNU) in non-metastatic UTUC patients without prior history of bladder cancer via multi-institutional data. (2) Patients and Methods: Data were obtained from the Clinical Research Office of the Endourology Society Urothelial Carcinomas of the Upper Tract (CROES-UTUC) registry, a prospective, multicentre database. Patients with non-metastatic UTUC treated with RNU were divided into two groups: those undergoing upfront RNU and those having diagnostic URS prior to RNU. Intravesical recurrence-free survival (IVRS) was the primary endpoint, evaluated through Kaplan–Meier analysis and multivariate Cox regression. Cases with adequate follow-up data were included. (3) Results: The analysis included 269 patients. Of these, 137 (50.9%) received upfront RNU and 132 (49.1%) received pre-RNU URS. The URS group exhibited an inferior 24-month IVRS compared to the upfront RNU group (HR = 1.705, 95% CI = 1.082–2.688; p = 0.020). Multivariate analysis confirmed URS as the only significant predictor of IVR (p = 0.019). Ureteric access sheath usage, flexible ureteroscopy, ureteric biopsy, retrograde contrast studies, and the duration of URS did not significantly affect IVRS. (4) Conclusions: Diagnostic URS prior to RNU was found to be associated with an increased risk of IVR in patients with UTUC. The risk was not significantly influenced by auxiliary procedures during URS. Physicians were advised to meticulously evaluate the necessity of diagnostic URS. [ABSTRACT FROM AUTHOR]

To evaluate the efficacy and safety of medical expulsive therapy (MET) for ureteral stones in pediatric patients, Cochrane, PubMed, Web of Science, Scopus, and the reference list of retrieved studies were searched up to September 2022 to identify RCTs on the efficacy of MET. The protocol was prospectively registered at PROSPERO (CRD42022339093). Articles were reviewed, data were extracted by two reviewers, and the differences were resolved by the third reviewer. The risk of bias was assessed using the RoB2. The outcomes, including the stone expulsion rate (SER), stone expulsion time (SET), episode of pain, analgesic consumption, and adverse effects, were evaluated. Six RCTs enrolling 415 patients were included in the meta-analysis. The duration of MET ranged from 19 to 28 days. The investigated medications included tamsulosin, silodosin, and doxazosin. The stone-free rate after 4 weeks in the MET group was 1.42 times that of the control group (RR: 1.42; 95% CI: 1.26–1.61, p < 0.001). The stone expulsion time also decreased by an average of 5.18 days (95% CI: −8.46/−1.89, p = 0.002). Adverse effects were more commonly observed in the MET group (RR: 2.18; 95% CI: 1.28–3.69, p = 0.004). The subgroup analysis evaluating the influence of the type of medication, the stone size, and the age of patients failed to reveal any impact of the aforementioned factors on the stone expulsion rate or stone expulsion time. Alpha-blockers as medical expulsive therapy among pediatric patients are efficient and safe. They increase the stone expulsion rate and decrease the stone expulsion time; however, this included a higher rate of adverse effects, which include headache, dizziness, or nasal congestion. [ABSTRACT FROM AUTHOR]

Ureteric stent insertion following ureteroscopic lithotripsy (URSL) is a common and widely accepted procedure. However, there is no agreement on whether a ureteric stent should be placed following an uncomplicated URSL. Furthermore, the definition of uncomplicated URSL remains debatable. To compare the efficacy, safety, and morbidity of no stent placement with the conventional stent placement after uncomplicated retrograde semirigid URS for a distal ureteric calculus of size ≤1 cm, we compared the corresponding complication rates, emergency visits, secondary interventions, and pain at follow-up. Following an uncomplicated ureteroscopic lithotripsy, 104 patients were randomized into the conventional stented group (CSG) and nonstented group (NSG). Lower urinary tract symptoms and sexual function were evaluated using validated questionnaires (IPSS + IIEF-5 + MSHQ-EjD/FSFI) preoperatively and at 4 weeks during follow-up. Pain scores at follow-up were recorded using a visual analogue scale (VAS). Patients who visited the emergency room or needed secondary interventions before the recommended follow-up time were noted. The Generalized Estimating Equations method was used to explore the difference in change in the domains of IPSS, IIEF-5, MSHQ-EjD, and FSFI between the two groups over time. A significant difference was noted in the following IPSS domains: Frequency, Urgency, Nocturia, Storage Symptoms, Total IPSS Score (p ≤ 0.001), and QoL (p = 0.002); IIEF-5 domains: Overall Score (p = 0.004); MSHQ-EjD domains: Ejaculation Bother/Satisfaction (p ≤ 0.001); and FSFI domains: Lubrication (p ≤ 0.001), Satisfaction (p = 0.006), and Overall Score (p = 0.004). There was no significant difference between the various groups in terms of distribution of emergency visits, readmission and secondary interventions, pain at follow-up (VAS), and need for long-term analgesia. Nonplacement of stents after uncomplicated URS decreases stent-related symptoms and preserves QoL without placing the patient under increased postoperative risk. [ABSTRACT FROM AUTHOR]

Percutaneous nephrolithotomy (PCNL) is the regular surgery for treating large or complex renal stones. Since its first inception, many variations have come in the approach including the modifications of patient position. The prone position is traditionally used, and subsequently, variations in prone and supine technique have been proposed and assessed over time. In an attempt to provide comprehensive information about the strategy applications of patient's position, the present review describes the position-related general basis, and provides a literature review of the pros and cons of various positions from a surgical and anaesthetic point of view. Latest evidence has shown the major advantages of supine PCNL compared with standard prone PCNL to be as follows: optimal cardiovascular and airway control; shorter operation time due to lack of the need for repositioning; opportunity for a combined retrograde approach. However, the prone position provides a broader surface area for percutaneous access; a wider space for manipulating the nephroscope and lithotripters; and opportunity for bilateral simultaneous PCNL. To overcome their respective limitations, various positioning modifications have been proposed. However, most reports are based on case series and/or have not obtained their results in a randomized controlled fashion and/or have not been analysed according to stone complexity and particular body status (e.g. obesity, etc.), thereby limiting the ability to make strong recommendations. One important caveat is that endourology training of supine PCNL would increase supine popularization, and the prone ureteroscopic technique would overcome the difficulty of endoscopic combined intrarenal surgery in the prone position. Thereby, adequate training in the different techniques for PCNL is important for optimizing the indications and treatment outcomes. [ABSTRACT FROM AUTHOR]

Objectives: To determine the stone-free rates and intra- and postoperative complication rates and grades of ureterorenoscopic stone treatment in patients with a solitary kidney. Methods: This study is a subanalysis of the Clinical Research Office of the Endourological Society (CROES) ureterorenoscopy (URS) study, which is a prospective international multicenter observational study. Over a 1-year period, consecutive patients treated with ureterorenoscopy for urinary stones were included. Patients entered in this analysis were those with a solitary functioning kidney. Descriptive data on patient characteristics, stone-free rates, complication rates, and grades were evaluated for three separate groups: patients treated with ureteroscopy for ureteral stones, for renal stones, and a combination of renal and ureteral stones. Results: A total of 301 patients were treated for stones in a solitary kidney; 219 were treated for ureteral stones. In this group, the stone-free rate was 88.6%, with an intraoperative complication rate of 7.4% and postoperative complication rate of 4.1%. Totally, 57 patients were treated for renal stones. In this group, the stone-free rate was 56.4%, with an intraoperative complication rate of 7.0% and postoperative complication rate of 10.5%. There were 25 patients who were treated for renal stones in combination with ureter stones. In this group, the stone-free rate was 60.0%, with an intraoperative complication rate of 12.0% and postoperative complication rate of 10.5%. Within the three groups, 72% of the postoperative complications were classified as Clavien I and II. Conclusions: Ureteroscopy is an effective and safe treatment modality for the removal of ureteral and renal stones in patients with a solitary kidney. Stone location as well as total stone burden seems to be important factors influencing the ability to render patients stone free. Moreover, single session ureteroscopic stone removal was less effective for the treatment of larger renal stones or renal stones in combination with ureteral stones. [ABSTRACT FROM AUTHOR]

Abstract: Objective: To review the incidence, risk factors, and treatment options of intraoperative and postoperative complications of stone basketing in urology with emphasis on certain principles that must be upheld to prevent those complications. Methods: A literature search was performed using the MEDLINE database on stone basketing between 1970 and 2005. Results: Iatrogenic trauma due to retrieval of a stone is well known but the exact incidence is difficult to ascertain. Rarely, stone basketing can cause major trauma to the ureter, such as avulsion or intussusception, requiring open or laparoscopic intervention for ureteral continuity restoration. Mucosal abrasion, ureteral perforation, and stricture formation have also been described as complications of stone basketing. Occasionally, the engaged or broken basket can provoke anxiety even for experienced urologists. Factors that increase the risk of complications, strategies for repair, and techniques for prevention are discussed extensively. Conclusion: Infrequent, surgical misadventures during stone basketing can occur and must be treated appropriately. Careful attention to instrument selection and surgical techniques and awareness of risk factors and type and site of potential injury are essential to reduce these complications. [Copyright &y& Elsevier]

The article focuses on the global ureteroscopy study by the Clinical Research Office of the Endourological Society. The audit concentrates on critical information points that are reasonable enough to provide data variability. Data were included through institutions from 36 countries around the world. The study is endorsed by an unrestricted educational grant from Boston Scientific.