Search

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]

Technological advancements in the medical field are often slow and expensive, sometimes due to complexities associated with pre-clinical testing of medical devices and implants. There is therefore a growing need for new test beds that can mimic more closely the in vivo environment of physiological systems. In the present study, a novel bladder model was designed and fabricated with the aim of providing a pre-clinical testing platform for urological stents and catheters. The model is collapsible, has a Young's modulus that is comparable to a biological bladder, and can be actuated on-demand to enable voiding. Moreover, the developed fabrication technique provides versatility to adjust the model's shape, size, and thickness, through a rapid and relatively inexpensive process. When compared to a biological bladder, there is a significant difference in compliance; however, the model exhibits cystometry profiles during priming and voiding that are qualitatively comparable to a biological bladder. The developed bladder model has therefore potential for future usage in urological device testing; however, improvements are required to more closely replicate the architecture and relevant flow metrics of a physiological bladder. [ABSTRACT FROM AUTHOR]

Introduction and Objective: Renal transplantation is the treatment for end-stage renal disease that offers better quality of life and survival. Among the possible complications that might affect allografts, urolithiasis might have severe consequences, causing acute kidney injury (AKI) or septic events in immunocompromised patients. Allograft stones might be treated with percutaneous nephrolithotomy (PCNL). The aim of this Cochrane style review was to assess the safety and efficacy of PCNL in patients with renal transplant. Methods: A comprehensive search in the literature was performed including articles between July 1982 and June 2023, with only English original articles selected for this review. Results: The final review encompassed nine articles (108 patients). The mean age was 46.4 ± 8.7 years, with a male:female ratio of 54:44. The average time from transplantation to urolithiasis onset was 47.54 ± 23.9 months. Predominant symptoms upon presentation were AKI (32.3%), followed by urinary tract infection and fever (24.2%), and oliguria (12.9%). The mean stone size was 20.1 ± 7.3 mm, with stones located in the calices or pelvis (41%), ureteropelvic junction (23.1%), or proximal ureter (28.2%). PCNL (22F–30F) was more frequently performed than mini-PCNLs (16F–20F) (52.4% vs 47.6%). Puncture was guided by ultrasound (42.9%), fluoroscopy (14.3%), or both (42.9%). The stone-free rate (SFR) and complication rates were 92.95% (range: 77%–100%) and 5.5%, respectively, with only one major complication reported. Postoperatively, a ureteral stent and nephrostomy were commonly placed in 47%, with four patients needing a second look PCNL. During an average follow-up of 32.5 months, the recurrence rate was 3.7% (4/108), and the mean creatinine level was 1.37 ± 0.28 mg/dL. Conclusions: PCNL remains a safe and effective option in de novo allograft urolithiasis, allowing to treat large stones in one-step surgery. A good SFR is achieved with a low risk of minor complications. These patients should be treated in an endourology center in conjunction with the renal or transplant team. [ABSTRACT FROM AUTHOR]

Introduction With the introduction of novel treatment options for benign prostatic hyperplasia (BPH), decision making regarding surgical management has become ever more complex. Factors such as clinical exposure, equipment availability, patient characteristics and hospital setting may affect what treatment is offered and an informed patient choice. The aim of this study was to investigate how urologists help patients make decisions regarding BPH management and whether their practice would differ if they were the patient themselves. Material and methods A 52-question survey presenting hypothetical clinical scenarios was distributed to European urologists and trainees/residents online and in person. In each scenario, regarding treatment options for BPH, the participant considered themselves firstly as the treating clinician and secondly as the patient themselves. Details regarding the participants’ clinical experience, awareness of treatment options and exposure to these options were obtained. Results There were 139 participants; 69.8% of whom were consultants, with 82.1% of participants having practiced urology for more than 5 years. A total of 59.7% of urologists consider themselves BPH specialists. Furthermore, 93.5% of those surveyed had performed transurethral resection of the prostate (TURP), whilst procedures performed the least by participants were minimally invasive surgical therapy (MIST) options. Only 17.3% had seen and 1.4% had performed all of the treatment options. When considering themselves as a patient within standard practice, there was a preference for HoLEP amongst participants. Conclusions The majority of urologists surveyed had minimal experience to newer BPH techniques and MIST, suggesting that more exposure is required. A higher rate of HoLEP was chosen as a treatment option for urologists themselves as a patient than what they would choose as an option for their patients. [ABSTRACT FROM AUTHOR]

Background: In vitro studies have shown that the holmium Modulated Optics Enhancement Systems (MOSES) technology can lead to an increase in the efficacy of lithotripsy and a reduction of retropulsion, but clinical evidence comparing it to non-MOSES technology is still scarce. We did a comparison of ureteoroscopy and laser stone fragmentation (URSL) between Holmium:YAG laser with MOSES versus non-MOSES technologies. Methods: Patient data and outcomes were prospectively collected and analyzed regarding patient demographics, stone parameters, and clinical outcomes. Patients undergoing URSL with standard holmium laser without MOSES technology (Group 1) were compared to holmium laser with MOSES (Group 2) using the same clinical laser settings (0.4–1 J, 20–40 Hz) with dusting and pop-dusting technique. The independent t -test, Mann–Whitney U test, and Chi-squared test were used, with a p -value of < 0.05 as significant. Given the different sizes of the cohorts, we performed a propensity score 1:1 matched analysis. Results: A total of 206 patients (1:1 matched) with a male:female ratio of 94:112 and a median age of 56 (range: 39–68) years were analyzed. Groups 1 and 2 were matched for ureteric stones (27.7% and 22.3%, p = 0.42), pre-stenting (37% and 35%, p = 0.66), the mean number of stones (1.76 ± 1.3) and (1.82 ± 1.4, p = 0.73), and ureteral access sheath use (37% and 35%, p = 0.77) respectively. While there was no significant statistical difference in clinical outcomes, the stone size was slightly larger in Group 2, 14.8 ± 10.8 mm vs 11.7 ± 8.0 mm, for a lower operative time 42.7 ± 30.6 min versus 48.5 ± 25 min, lower perioperative complication rates 3.9% versus 4.9% and a higher stone-free rate 90.3% versus 87.4%. Conclusion: While the use of MOSES technology was slightly beneficial for the treatment of stones in terms of clinical outcomes, this was not statistically significant. As this debate continues, there is a need for high-quality randomized studies to show if there is a true difference in these outcomes. Plain language summary: We compare the outcomes of ureteroscopy and laser stone fragmentation (URSL), using Holmium:YAG laser with MOSES vs Non-MOSES technology: It is a prospective single-centre propensity score-matched analysis using similar laser settings It is a single-centre propensity score-matched analysis using similar laser settings. While the use of MOSES technology was slightly beneficial for treatment of stones in terms of clinical outcomes, this was not statistically significant. As this debate continues, there is a need for high quality randomized studies to show if there is a true difference in these outcomes. [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]

Background/aim: Management of asymptomatic kidney stones is an ongoing debate with follow-up and treatment guidelines based on low-level evidence. Our aim was to evaluate current management of asymptomatic urinary stones. Materials and methods: A 70-question survey was designed in collaboration with European Association of Urology, Young Academic Urologists, Section of Uro-Technology and Section of Urolithiasis groups and distributed. Responders filled out hypothetical scenarios from 2 perspectives, either as treating physicians, or as patients themselves. Results: A total of 212 (40.01%) responses were obtained. Median responder age was 39 years. 75% of responders were interested in urolithiasis". 82.5% had never experienced a renal colic, 89.6% had never undergone urolithiasis treatment. Overall, as the kidney stone scenarios got more complicated, the invasiveness of the treatment preference increased. As "the physician", responders preferred the conservative option in all situations more than they would choose as "the patient". For ureteral stones, conservative approach was most preferred for small stones and ureteroscopy became more preferred as the stone size increased. For smaller kidney stones, the most preferred follow-up schedule was 4-6 monthly, whereas for larger and complicated stones it was 0-3 monthly from both perspectives respectively. For all ureteral stone scenarios, 0-4 weekly follow-up was mostly preferred. Interestingly, having had a renal colic was an independent predictor of an interventional approach, whereas having had an intervention was an independent predictor of a conservative approach. Conclusion: Current treatment and follow-up patterns of asymptomatic urinary stones are in agreement with international guidelines on symptomatic stones. In most of the urolithiasis situations urologists chose a conservative approach for their patients compared to what they would prefer for themselves. Conversely, urologists, in the scenarios as "the patient", would like to have a more frequent follow-up schedule for their stones compared to how they would follow-up their patients. [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]

Purpose: On February 6, 2018, the European Atomic Energy Community reduced the annual equivalent dose limit for the lens from 150 to 20 mSv/year, because of its association with cataracts at low radiation doses. Our aim was to estimate the radiation doses received by the lens during endourologic procedures that require fluoroscopy. Materials and Methods: Multicenter study including prospective data of annual eye dosimeters between 2017 and 2020. Four endourologists used an eye dosimeter in endourologic procedures that require fluoroscopy (ureteroscopy, retrograde intrarenal surgery, and percutaneous nephrolithotomy). Surgeons 1 and 2 wore leaded glasses; surgeon 1 also used the as low as reasonably achievable (ALARA) protocol. Descriptive statistical analysis using SPSS 25.0 was conducted. Results: Surgeons 1, 2, 3, and 4 performed a median of 159, 586, 102, and 129 endourologic procedures per year, respectively, for a total of 641, 2340, 413, and 350 procedures between 2017 and 2020. The median annual dose of lens radiation exposure was 0.16, 1.18, 3.79, and 1.42 mSv per year, respectively, which corresponds to 0.001, 0.009, 0.024, and 0.012 mSv per procedure. The two surgeons who used leaded glasses registered a lower radiation dose per procedure (0.001 vs 0.027). Similarly, the urologist who used the ALARA protocol registered the lowest lens radiation dose compared with the three surgeons who did not use it (0.001 vs 0.023). Conclusions: The endourologists who participated in this study effectively comply with current guidelines on radiation exposure to the lens. Registered eye lens radiation does not seem to be related to the number of procedures but rather to the use of leaded glasses and the ALARA protocol. [ABSTRACT FROM AUTHOR]