Search

Purpose: There is a lack of data on the natural history of asymptomatic intrarenal calculi. In this study, we investigate stone-related events (SREs) in patients with untreated intrarenal calculi. We also investigate predictive factors for SREs. Methods: All patients found with an asymptomatic intrarenal calculus on CT kidney, ureter, bladder managed conservatively with interval imaging for ≥6 months were included. Patients were evaluated for any SRE. The rate of event according to calculus size, location, and number of calculi was also analyzed. Multivariate logistic regression analysis was performed to determine significant predictors for SREs. Results: In total, 266 renal units from 177 patients met inclusion criteria. The mean stone size was 4.44 mm (range 1–25 mm). Duration of follow-up was 43.78 ± 26.86 months (range 6–106 months). The overall rate of SREs, including intervention (n = 80) and spontaneous stone passage after ureteral colic (n = 40), was 45.1% (n = 120/266). Stones >5 mm were more likely to lead to an event compared with stones ≤5 mm (odds ratio [OR]: 2.94; p = 0.01). Interpolar stones and stones located in multiple calices were more likely to cause a SRE than lower pole stones (OR: 2.05; p = 0.05 and OR: 2.29; p = 0.03, respectively). Conclusion: In this large series of patients with asymptomatic intrarenal calculi, the incidence of a spontaneous SRE was 45.1% after 41 months. Stone size and stone location were significant predictors for a SRE. Information from this study will enable urologists to accurately risk stratify patients with asymptomatic renal stones. [ABSTRACT FROM AUTHOR]

Introduction: Few studies investigate significant perioperative predictors for long‐term renal allograft survival after second kidney transplant (SKT). We compared long‐term survival following SKT with primary kidney transplant and determined predictors of renal allograft failure after SKT. Methods: Outcomes of all primary or second kidney transplant recipients at a national kidney transplant center between 1993 and 2017 were reviewed. The primary outcomes measurements were renal allograft survival for both first and second kidney transplants. Secondary outcome measurements were incidence of delayed graft function (DGF), incidence of acute rejection (AR), and predictors for renal allograft survival in SKT recipients. Results: In total, there were 392 SKTs and 2748 primary kidney transplants performed between 1993 and 2017. The 1‐, 5‐, and 10‐year death‐censored graft survival for deceased‐donor recipients was 95.3%, 88.7%, and 78.2% for primary kidney transplant and 94.9%, 87.1%, and 74.9% for SKT (P =.0288). Survival of primary renal allograft <6 years (HR 0.6, P =.017), AR episodes (HR 1.6, P =.031), DGF (HR 2.0, P =.005), and HLA‐DR MM (HR 1.7, P =.018) was independent predictors of long‐term renal allograft failure after SKT. Conclusion: These findings may provide important information on long‐term survival outcomes after SKT and for identifying patients at risk for long‐term renal allograft failure after SKT. [ABSTRACT FROM AUTHOR]

Abbreviations & Acronyms ECM extracellular matrix FDM fused deposition modelling MUS mid-urethral sling PCL polycaprolactone POP pelvic organ prolapse PP polypropylene SUI stress urinary incontinence Surgical management of SUI includes the use of MUS. The present findings show that the PCL mesh has similar elastic and viscous mechanical properties to PP, indicating that it can be manipulated similar to PP mesh during implantation surgery and might also provide adequate mechanical support to pelvic floor structures I in vivo i . PCL degrades over a period of 2-3 years,13 and should therefore avoid complications such as chronic pain and erosion2 that have led to worldwide concerns about PP mesh for SUI and prolapse surgery. [Extracted from the article]

Introduction: Some controversy exists regarding necessity for urodynamic evaluation prior to surgical management of stress urinary incontinence (SUI). We aimed to interrogate the role of pre and post-operative urodynamic studies versus clinical assessment in predicting long-term patient reported outcomes of transobturator tape (TOT) placement., Material and Methods: A 100 patient cohort of women post TOT insertion for stress/mixed urinary incontinence 2005-2010, under a single surgeon, was identified. Results of pre and post-operative clinical assessment and urodynamic studies were retrospectively evaluated. Long-term patient reported outcome measures (PROMs) were assessed using the International Consultation on Incontinence Questionnaire (ICIQ) Short Form, Patient Global Impression of Severity (PGI-S) and Patient Global Impression of Improvement (PGI-I) questionnaires. The role of urodynamic studies in predicting postoperative voiding dysfunction, and long-term procedure outcomes was analysed. Statistical correlations were performed using SPSS., Results: Questionnaire response rate was 76/100 (76%) at mean follow-up 9.4 years (7.25-12.75). Mean ICIQ score was 6.32 (1-20). No significant correlations between preoperative pDet QMax and postoperative uroflow/duration of intermittent self catheterisation (ISC), or between preoperative leak-point pressures and outcome were observed. Postoperative urodynamic tests did not reliably predict long-term success in SUI cure. Preoperative clinical urgency was a more reliable predictor of long-term clinical urgency than urodynamic detrusor overactivity. Whilst patients with mixed urinary incontinence at long-term follow-up tended to have the highest (worst) overall ICIQ-SF and ICIQ quality of life score, no studied variables on preoperative CMG were significantly correlated with long-term PROMs., Conclusions: Whilst urodynamic studies provide important baseline bladder function data, prior to mid-urethral sling placement, this study finds no specific value of either pre or postoperative urodynamics in predicting long-term patient reported outcomes of transobturator tape placement., Competing Interests: The authors declare no conflicts of interest, (Copyright by Polish Urological Association.)

Introduction: Knowledge on health economics among urology trainees is not formally assessed. The cost of commonly utilised endourological devices may not be considered by trainees., Aim: The present study was conducted with the aim to assess whether urology trainees were knowledgeable on identification and cost of commonly used disposable devices in the management of nephrolithiasis., Materials and Methods: Forty urology trainees in Ireland were invited to complete a visual online questionnaire on the identification of 10 frequently utilised disposable endourological devices. In addition, trainees were requested to estimate the cost of 12 disposable endourological devices. Responses were stratified according to trainee grade and urological subspecialty of interest. Data are presented as a mean ± standard deviation., Results: The response rate was 70% (28/40). Endourology was the subspecialty of interest in 21% (n= 6). No trainee correctly identified all 10 endourological devices and the mean test score was 5.32 ± 2.28. No trainee accurately estimated the cost for all 12 devices assessed. The cost of endourological devices was underestimated by €67.13 ± €60.76 per device. A total of 54% (n=15) of trainees underestimated the total cost of disposable devices used during standard flexible ureterorenoscopy, laser lithotripsy and JJ stent insertion by €303.66 ± €113.83., Conclusion: Our findings indicate deficiencies in trainee knowledge on endourological devices and their associated costs. Incorporating a health economics module into postgraduate urology training may familiarise trainees with healthcare expenditure within their departments.