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Purpose To evaluate the perioperative outcomes of retrograde intra-renal surgery (RIRS) for lower pole stones (LPS) and factors affecting stone-free rate (SFR). Methods Data from 20 centers were retrospectively reviewed. Inclusion criteria were adult patients, normal renal anatomy, and LPS. Exclusion criteria were bilateral surgery, concomitant surgery for ureteral stones. SFR was defined as a single residual fragment (RF) ≤ 2 mm and evaluated 3-months after surgery. A multivariable logistic regression analysis was performed to assess factors associated with RF. Statistical significance was set at p value Results 2946 patients were included. Mean age and stone size were 49.9 years 10.19 mm, with multiple LPS in 61.1% of cases. Total operation and laser time were 63.89 ± 37.65 and 17.34 ± 18.39 min, respectively. Mean hospital stay was 3.55 days. Hematuria requiring blood transfusion and fever/urinary infections requiring prolonged antibiotics occurred in 6.1% and 169 5.7% of cases, while sepsis with intensive-care admission in 1.1% of patients. On multivariate analysis, Multiple stones (OR 1.380), stone size (OR 1.865), and reusable ureteroscopes (OR 1.414) were significantly associated with RF, while Thulium fiber laser (TFL) (OR 0.341) and pre-stenting (OR 0.750) were less likely associated with RF. Conclusions RIRS showed safety and efficacy for LPS with a mean diameter of 10 mm. This procedure can achieve a satisfactory SFR in pre-stented patients with a single and smaller stone, particularly with TFL use.

Purpose: We evaluated stone-free rate and complications after flexible ureteroscopy for renal stones, comparing thulium fiber laser and holmium:YAG laser with MOSES technology. Materials and Methods: Data from adults who underwent flexible ureteroscopy in 20 centers worldwide were retrospectively reviewed (January 2018-August 2021). Patients with ureteral stones, concomitant bilateral procedures, and combined procedures were excluded. One-to-one propensity score matching for age, gender, and stone characteristics was performed. Stone-free rate was defined as absence of fragments >2 mm on imaging within 3 months after surgery. Multivariable logistic regression was performed to evaluate independent predictors of being stone-free. Results: Of 2,075 included patients, holmium:YAG laser with MOSES technology was used in 508 patients and thulium fiber laser in 1,567 patients. After matching, 284 patients from each group with comparable baseline characteristics were included. Pure dusting was applied in 6.0% of cases in holmium:YAG laser with MOSES technology compared with 26% in thulium fiber laser. There was a higher rate of basket extraction in holmium:YAG laser with MOSES technology (89% vs 43%, P < .001). Total operation time and lasing time were similar. Nine patients had sepsis in thulium fiber laser vs none in holmium:YAG laser with MOSES technology (P = .007). Higher stone-free rate was achieved in thulium fiber laser (85% vs 56%, P < .001). At multivariable analysis, the use of thulium fiber laser and ureteral access sheath ≥8F had significantly higher odds of being stone-free. Lasing time, multiple stones, stone diameter, and use of disposable scopes showed significantly lower odds of being stone-free. Conclusions: This real-world study favors the use of thulium fiber laser over holmium:YAG laser with MOSES technology in flexible ureteroscopy for renal stones by way of its higher single-stage stone-free rate. Flexible ureteroscopy (F-URS) is a first-line option for kidney stones up to 2 cm in diameter1,2 and is suitable even for patients with larger stones,3 renal malformations,4 obesity, bleeding diathesis, and calyceal diverticula5 under general and spinal anesthesia,6 with good stone-free rate (SFR) and low morbidity. Over the past 3 decades, holmium laser lithotripsy has been predominantly carried out using standard-power machines (ie, 20 W). More recently, the availability of high power has allowed a wider range of pulse energy, frequency, and power settings to improve lithotripsy.7 In holmium:YAG laser (HL), variations in pulse modulation have introduced the concept of holmium:YAG laser with MOSES technology (HLM), virtual basket, and vapor tunnel allowing for more efficient stone ablation and less retropulsion.8 In vitro studies demonstrated that pulse modulation technology resulted in more efficient stone ablation together with less retropulsion for both hard and soft stones.9,10 Thulium fiber laser (TFL), which emerged in 2018,11 was found in preclinical studies to allow for ablation at twice the speed of HL with 4 times the amount of dust generated.12 Despite a recent single-center randomized clinical trial demonstrating no significant clinical advantage of one technology over the other,13 no direct comparison has been published comparing HLM with TFL in F-URS for renal stones in real-world practice, and much controversy continues to exist among experts in the field.14,15 The purpose of the present study was to evaluate outcomes and complications after F-URS for renal stones, comparing patients who were operated on using HLM vs TFL.

The objective was to evaluate outcomes of retrograde renal surgery for intrarenal stones of any size, number, and position, comparing hard versus soft stones based on their attenuation on computed tomography (Hounsfield Unit-HU). Exclusion criteria; children/adolescents, ureteric stones, renal anomalies, or bilateral surgery. Patients were divided into two groups according to the type of laser employed, i.e. Holmium:YAG (HL) and Thulium fiber laser (TFL). Residual fragments (RF) were defined as > 2 mm. Multivariable logistic regression analysis was performed to evaluate factors associated with RF and RF needing further intervention. 4208 patients from 20 centers were included. 3070 patients were operated on with HL. In HU

Highlights • A rare case of bilateral epididymo-orchitis complicated with bilateral testicular infarction. • Presentation was fever with persistent, unresolved pain and scrotal swelling. • Antibiotic therapy failed to halt disease progression of bilateral testicular ischemia. • Bilateral orchidectomy performed as both testes were not viable, resulting in castration and lifelong testosterone replacement., Introduction Testicular infarction as a result of severe epididymo-orchitis is an uncommon urological emergency, with only a handful of reported cases in literature. We report an even rarer case of bilateral epididymo-orchitis complicated with testicular infarction, resulting in bilateral orchidectomy. Presentation of case 49 year old gentleman presented with fever, persistent, unresolving pain and scrotal swelling of two weeks duration. Despite close clinical monitoring, timely ultrasounds of the testis and antibiotics there was an inexorable progression to bilateral testicular ischemia. Discussion This is only the second reported case of this nature in published literature. Epididymo-orchitis usually responds well to appropriate antibiotic therapy, although progression to testicular infarction is possible. Conclusion Clinical presentation of persistent scrotal pain and oedema in cases of epididymo-orchitis should raise strong suspicion of testicular ischemia or infarction. Despite all efforts, progression to bilateral testicular infarction resulting in castration is a possible catastrophic outcome.

Acute scrotal pain is a common urological emergency where clinical judgement plays pivotal role in making the diagnosis. Scrotal pain secondary to spontaneous pampiniform plexus thrombosis is rare, and we are the first who report in the Asian region.A 50-year-old gentleman presented with left-sided scrotal pain & swelling. The diagnosis of pampiniform plexus thrombosis was confirmed by the ultrasound Doppler. He was treated with anticoagulant and good clinical result was obtained.Uncomplicated thrombosis could be managed non-surgically with good clinical outcome and radiological resolution. Ultrasound doppler remains first-line investigation to establish diagnosis, monitor the progression and treatment outcome. Keywords: Scrotal pain, Pampiniform plexus thrombosis, Ultrasound Doppler, Anticoagulant