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7. Extreme Percutaneous Nephrolithotomy: A Case Series of Procedures Requiring Five or More Access Tracts.

Author

Altschuler, Joshua, Gupta, Kavita, Goel, Shokhi, Ricapito, Anna, Khargi, Raymond, Yaghoubian, Alan J., Gallante, Blair, Khusid, Johnathan A., Shimonov, Roman, Horodyski, Laura, Mason, Matthew, Prakash, Nachiketh S., Atallah, William, Mikhail, David, Marcovich, Robert, and Gupta, Mantu

Subjects
PERCUTANEOUS nephrolithotomy, SURGICAL complications, POSTOPERATIVE period, BLOOD transfusion, REOPERATION
Abstract

Introduction: Percutaneous nephrolithotomy (PCNL) remains the gold standard treatment for patients with complete staghorn stones, for which multiple access tracts may be required. In this study, we describe a series of patients undergoing PCNL with a minimum of five dilated access tracts. Materials and Methods: We performed a multi-institutional retrospective review of 10 patients with complete staghorn stones who underwent PCNL requiring five or more access tracts. We recorded patient demographics, stone characteristics postoperative complications, and stone-free rates (SFRs). The primary endpoint was any postoperative complication. Secondary endpoints included SFR, operative time, and length of stay. SFR was defined as absence of stones or residual fragments <4 mm. Results: A total of 10 patients from two institutions were included. Access tract number ranged from 5 to 11, and median stone volume was 233,042 mm3. Seven patients (70%) experienced postoperative complications, ranging from Clavien II to IVa. Three patients (30%) required blood transfusions. Median operative time was 312 minutes ranging from 180 to 560 minutes. Five patients (50%) were stone-free after the initial procedure. Of those with residual fragments, 4 (40%) required reoperation to be rendered stone-free. Median length of stay was 2.5 days, with a range of 1–6 days. Conclusion: To our knowledge, this is the largest series of patients undergoing PCNL with five or more access tracts reported to date. This study confirms that PCNL with five or more tracts is feasible and relatively safe, albeit with a high rate of complications in the immediate postoperative period. [ABSTRACT FROM AUTHOR]

Published
2024
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11. Evaluation of the Current Status of Artificial Intelligence for Endourology Patient Education: A Blind Comparison of ChatGPT and Google Bard Against Traditional Information Resources.

Author

Connors, Christopher, Gupta, Kavita, Khusid, Johnathan A., Khargi, Raymond, Yaghoubian, Alan J., Levy, Micah, Gallante, Blair, Atallah, William, and Gupta, Mantu

Subjects
GEMINI (Chatbot), CHATGPT, BENIGN prostatic hyperplasia, ARTIFICIAL intelligence, PATIENT education
Abstract

Introduction: Artificial intelligence (AI) platforms such as ChatGPT and Bard are increasingly utilized to answer patient health care questions. We present the first study to blindly evaluate AI-generated responses to common endourology patient questions against official patient education materials. Methods: Thirty-two questions and answers spanning kidney stones, ureteral stents, benign prostatic hyperplasia (BPH), and upper tract urothelial carcinoma were extracted from official Urology Care Foundation (UCF) patient education documents. The same questions were input into ChatGPT 4.0 and Bard, limiting responses to within ±10% of the word count of the corresponding UCF response to ensure fair comparison. Six endourologists blindly evaluated responses from each platform using Likert scales for accuracy, clarity, comprehensiveness, and patient utility. Reviewers identified which response they believed was not AI generated. Finally, Flesch–Kincaid Reading Grade Level formulas assessed the readability of each platform response. Ratings were compared using analysis of variance (ANOVA) and chi-square tests. Results: ChatGPT responses were rated the highest across all categories, including accuracy, comprehensiveness, clarity, and patient utility, while UCF answers were consistently scored the lowest, all p < 0.01. A subanalysis revealed that this trend was consistent across question categories (i.e., kidney stones, BPH, etc.). However, AI-generated responses were more likely to be classified at an advanced reading level, while UCF responses showed improved readability (college or higher reading level: ChatGPT = 100%, Bard = 66%, and UCF = 19%), p < 0.001. When asked to identify which answer was not AI generated, 54.2% of responses indicated ChatGPT, 26.6% indicated Bard, and only 19.3% correctly identified it as the UCF response. Conclusions: In a blind evaluation, AI-generated responses from ChatGPT and Bard surpassed the quality of official patient education materials in endourology, suggesting that current AI platforms are already a reliable resource for basic urologic care information. AI-generated responses do, however, tend to require a higher reading level, which may limit their applicability to a broader audience. [ABSTRACT FROM AUTHOR]

Published
2024
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18. Displacement of Lower Pole Stones During Retrograde Intrarenal Surgery Improves Stone-free Status: A Prospective Randomized Controlled Trial

Author

Yaghoubian, Alan J., primary, Anastos, Harry, additional, Khusid, Johnathan A., additional, Shimonov, Roman, additional, Lundon, Dara J., additional, Khargi, Raymond, additional, Gallante, Blair, additional, Gassmann, Kyra, additional, Bamberger, Jacob N., additional, Chandhoke, Ryan, additional, Zampini, Anna, additional, Atallah, William, additional, and Gupta, Mantu, additional

Published
2023
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19. MP23-10 ASSESSING RENAL DAMAGE CAUSED BY NEW HIGH POWER LASERS DURING URETEROSCOPIC LASER LITHOTRIPSY: A RANDOMIZED TRIAL

Author

Yaghoubian, Alan, primary, Shimonov, Roman, additional, Gallante, Blair, additional, Khargi, Raymond, additional, Lundon, Dara, additional, Khusid, Johnathan, additional, Patel, Manishkumar, additional, Nie, Kai, additional, Xie, Hui, additional, Xi, Jingjing, additional, Zaki, Nicholas, additional, Schulze, Seunghee Kim, additional, Atallah, William, additional, Kyprianou, Natasha, additional, and Gupta, Mantu, additional

Published
2023
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21. The effects of continuing aspirin on blood loss and postoperative outcomes in percutaneous nephrolithotomy

Author

Rosenbluth, Emma, Liaw, Christine W, Bamberger, Jacob N, Omorogbe, Aisosa, Khusid, Johnathan A, Khargi, Raymond, Yaghoubian, Alan J, Ricapito, Anna, Gallante, Blair, Atallah, William M, and Gupta, Mantu

Subjects
Original Article
Abstract

Background: Percutaneous nephrolithotomy (PCNL) is an effective surgery for complex kidney stones yet with inherent bleeding risks. It remains unclear whether aspirin should be discontinued prior to PCNL. We aimed to further substantiate the safety of continuing aspirin during PCNL surgery and to determine whether aspirin status affects postoperative outcomes following PCNL. Methods: We retrospectively queried our endourology database for patients who underwent PCNL from October 2017 to December 2022 at our high-volume tertiary referral center. The three groups were based on aspirin status at the time of PCNL: no aspirin (NA), discontinued aspirin (DA), and continued aspirin (CA). Data collected included demographics, preoperative characteristics, operative parameters, pre and postoperative lab values, transfusions, and complications. Results: A total 648 patients were divided into these study groups: 525 NA patients (81.0%), 55 DA (8.5%), and 68 CA (10.5%). The DA and CA groups were of similar comorbidities, and both were more comorbid at baseline than NA. Postoperative change in lab values and complications did not differ significantly. Rates of postoperative blood transfusion were higher in the CA and DA groups compared to NA and approached statistical significance. There were no significant differences in any postoperative outcomes between the DA and CA groups alone. Conclusions: In patients on chronic aspirin therapy, continuing aspirin appears equally safe to discontinuing aspirin prior to PCNL. Most patients should not forego the benefits of continuous aspirin for the theoretical risk of bleeding. Patients on prolonged aspirin therapy may be more likely than those who are not on chronic aspirin therapy to require blood transfusions. However, regardless of whether aspirin use is stopped, this may be caused by patient comorbidities rather than higher rates of blood loss.

Published
2023

22. Reply by Authors

Author

Yaghoubian, Alan J., primary, Anastos, Harry, additional, Khusid, Johnathan A., additional, Shimonov, Roman, additional, Lundon, Dara J., additional, Khargi, Raymond, additional, Gallante, Blair, additional, Gassmann, Kyra, additional, Bamberger, Jacob N., additional, Chandhoke, Ryan, additional, Zampini, Anna, additional, Atallah, William, additional, and Gupta, Mantu, additional

Published
2023
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23. Understanding the link between kidney stones and cancers of the upper urinary tract and bladder

Author

Mihalopoulos, Meredith, Yaghoubian, Alan, Razdan, Shirin, Khusid, Johnathan A, Mehrazin, Reza, Badani, Ketan K, Sfakianos, John P, Atallah, William M, Tewari, Ashutosh K, Wiklund, Peter, Gupta, Mantu, and Kyprianou, Natasha

Subjects
Review Article
Abstract

Kidney stones are one of the most common renal pathologies. While emerging evidence has implicated a potential association between kidney stones and upper urinary tract cancers (including renal cancer), there is limited understanding as to the common underlying biological pathways functionally linking the etiology of kidney stone formation and the incidence, development, and progression of urinary tract cancers. From a clinical perspective, kidney stone disease can be a barrier to oncologic care due to renal obstruction. From the epidemiological perspective, risk factors associated with both conditions include smoking, alcohol consumption, diet, and gender. Herein, we review the association between renal calculi and malignancy of the upper urinary tract and discuss the current understanding of (a) potential shared mechanisms, and (b) the impact this has on shared therapeutic management of both conditions.

Published
2022

24. PCNL: Tips and tricks

Author

Yaghoubian, Alan, primary, Shimonov, Roman, additional, Khusid, Johnathan, additional, Gallante, Blair, additional, Atallah, William, additional, and Gupta, Mantu, additional

Published
2022
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25. Reverse Trendelenburg Positioning Minimizes Stone Retropulsion During Ureteroscopic Laser Lithotripsy: A Prospective Randomized Study.

Author

Anastos, Harry, Yaghoubian, Alan J., Khusid, Johnathan A., Chandhoke, Ryan A., Lundon, Dara J., Sadiq, Areeba S., Bamberger, Jacob N., Gallante, Blair, Shimonov, Roman, Atallah, William M., and Gupta, Mantu

Subjects
LASER lithotripsy, URINARY calculi, FISHER exact test, LONGITUDINAL method, CHI-squared test, KRUSKAL-Wallis Test
Abstract

Purpose: Retropulsion of stone fragments during ureteroscopic laser lithotripsy (URSLL) remains a challenge for urologists and is associated with increased operative time and reduced stone-free rate (SFR). In this study, we compared the rate of retropulsion of ureteral stones during URSLL between the standard dorsal lithotomy (SDL) position and dorsal lithotomy position with reverse Trendelenburg (RT). Materials and Methods: Patients with ureteral stones requiring surgical intervention between May 2019 and January 2022 were randomized to undergo URSLL in either SDL or RT positions. The primary outcome of this study was stone retropulsion. Secondary outcomes included retropulsion to the kidney, SFR, operative time, 30-day emergency department visits and complications, and the need for conversion from semirigid to flexible ureteroscope. Differences between groups were evaluated using the chi-square test, Fisher exact test, Kruskal–Wallis test, or t-test. Results: A total of 114 patients were included in the study, with 57 patients in each group. There were no differences between groups in terms of baseline demographics or stone characteristics. Retropulsion was significantly less frequent in the RT group (68.4% vs 10.5%, p < 0.01). Similarly, the RT group was favored for lower risk of retropulsion into the kidney (40.4% vs 5.3%, p < 0.01), operative time (43.5 vs 33.0 minutes, p = 0.02), and need for ureteroscope conversion (16.7% vs 2.2%, p = 0.04). There was no difference in the SFR (100% vs 95%, p = 0.49). Conclusions: RT positioning during URSLL for ureteral stones significantly decreases the rate of stone retropulsion, operative time, and the need for conversion from semirigid to flexible ureteroscope. [ABSTRACT FROM AUTHOR]

Published
2023
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35. Reply by Authors

Author

Liaw, Christine W., primary, Khusid, Johnathan A., additional, Gallante, Blair, additional, Bamberger, Jake N., additional, Atallah, William M., additional, and Gupta, Mantu, additional

Published
2021
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