Journal of endourology最新文献

Background: Pediatric nephrolithiasis continues to pose a substantial clinical challenge in pediatric urology because of its elevated recurrence rate and elevated morbidity with risk of end-stage renal failure. The management of pediatric nephrolithiasis involves dietary modification, pharmacological therapy, and urological intervention, with the choice of treatment guided by stone size, location, and composition.

Objective: To evaluate the efficacy and safety of mini-percutaneous nephrolithotomy (mini-PCNL) and extracorporeal shock wave lithotripsy (SWL) for the management of renal stones measuring 1-2 cm in pediatrics.

Cases and methods: This prospective, randomized comparative research was conducted at the Department of Urology, Al-Azhar University Hospital, Assiut, Egypt, between December 2022 and November 2024. Sixty children with single renal stones were enrolled, with 30 undergoing SWL and 30 receiving mini-PCNL.

Results: Mini-PCNL achieved a significantly elevated stone-free rate (SFR, 93.33%) in contrast with SWL (33.33%) (p < 0.001). The SWL group also showed a higher rate of auxiliary approaches and retreatment. Overall complication rates were comparable.

Conclusion: Mini-PCNL is more effective than SWL for managing renal stones measuring 10-20 mm in children aged 6 months to 6 years. It provides an elevated SFR and lowers the likelihood of retreatment and hospital readmission, with a comparable safety profile.

Objective: The Glean^® Urodynamics System was developed to enable catheter-free, wireless assessment of lower urinary tract function for use in ambulatory urodynamic testing. This study assesses the performance of the Glean Urodynamics System relative to the Laborie Goby™ conventional urodynamics (UDS) system using a human bladder model.

Methods: Thirty Glean intravesical pressure sensors and 30 air-charged catheters were compared relative to a reference sensor. Three pressure simulations were conducted in the bench-top human bladder model (stepped, sinusoidal, and ramping) on each test device to evaluate rise and fall times, bandwidth, maximum error (accuracy), and linearity. Data are presented as means and standard deviations and compared using independent sample t-tests.

Results: The Glean intravesical pressure sensors showed significantly faster rise time (0.104 seconds) and fall time (0.111 seconds) than the comparator (0.172 and 0.264 seconds, respectively; both, p < 0.001 between groups). The bandwidth of the Glean sensors more closely matched the tested maximum frequency of 5 Hertz (Hz) compared with the comparator (4.978 Hz vs 2.250 Hz; p < 0.001). The maximum error was significantly lower with the Glean sensors than the comparator (6.882 vs 21.549; p < 0.001). Linearity showed that both behaved linearly; however, the Glean sensors performed significantly better (p < 0.001 between groups).

Conclusion: Comparative testing demonstrated equivalent or better performance of the Glean Urodynamics System's intravesical pressure sensors relative to a conventional UDS system's air-charged catheters, including greater bandwidth, increased dynamic response, and reduced maximum error. These results support the superior performance of the Glean Urodynamics System for urodynamic monitoring over a conventional catheter-based UDS system.

Introduction: Despite ergonomic advancements in robotic technology, physical symptoms and discomfort remain significant concerns for urologists, with symptoms increasing with years of practice. Eye symptoms, including accommodation lag, dry eyes, and eye strain, have been reported. This study aims to detail the visual challenges faced by robotic urologists and to further examine what factors could be contributing to these symptoms.

Methods: A 22-item standardized survey developed with the recommendations from the Endourological Society Data Committee was distributed between October 2024 and April 2025. A total of 84 responses were received. Patients who performed no monthly robotic cases (n = 9) and those missing ≥ 5 questions (n = 1) were excluded. The survey addressed demographics, practice patterns, console time, and eye symptoms such as strain, pain, or watering. It also explored symptom timing, impact on postconsole activities, and preventive measures like breaks or eye drops.

Results: The final analysis included data from 74 participants. Overall, 86% of respondents were older than 35 years. Most urologists (81%) had been practicing for more than 5 years, with 84% performing ≥ 3 robotic surgeries monthly. Console times were estimated to be 60-120 minutes for 43% of participants and > 120 minutes for 52%. About 73% used corrective eyeglasses, and 42% reported eye symptoms such as strain, pain, or watering while on the surgical console, which mostly occurred after more than an hour into surgical procedure (90%). Postoperation, 35% experienced headaches and eye fatigue, 30% had difficulties adjusting focus when transitioning from console work to paper/computer work, and 47% reported dry eyes. Over time, 33% observed a progression in symptoms.

Conclusion: This survey highlights the prevalence of eye and vision problems among robotic urologists, underscoring the need for better ergonomic design, effective lighting, and preventive measures.

Background: Endourologic procedures for ureteral/renal stones traditionally rely on fluoroscopic guidance. The necessity of fluoroscopy for safe and effective stone treatment remains controversial.

Objective: To perform a systematic review and meta-analysis to evaluate intraoperative, perioperative, and postoperative outcomes of fluoroless vs fluoroscopy-guided endourologic procedures for kidney and/or ureteral stones.

Materials and methods: Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 guidelines, we searched PubMed, Cochrane Central Register, and Scopus on 13^th November 2025. Inclusion criterion comprised randomized trials comparing fluoroless with fluoroscopy-guided ureteroscopy (URS) or percutaneous nephrolithotripsy (PCNL). Binary outcomes were assessed using the Cochran-Mantel-Haenszel Method with the random effect model and reported as odds ratio (OR), 95% confidence interval (CI), and p-values. Continuous variables were pooled using the inverse variance of the mean difference with a random effect. Statistical significance was set at p < 0.05.

Evidence synthesis: Eighteen randomized studies were included: 7 URS studies (1119 patients) and 11 PCNL studies (1370 patients). For PCNL, fluoroless ultrasound-guided techniques demonstrated superior safety with significantly lower overall complications (OR 0.57, 95% CI 0.42-0.78, p = 0.0004), minor complication- (OR 0.60, 95% CI 0.41-0.86, p = 0.006), and major complication- rates (OR 0.52, 95% CI 0.30-0.88, p = 0.02) compared with fluoroscopy-guided approaches. Stone-free rates (SFRs) were equivalent between groups (OR 1.03, 95% CI 0.77-1.38, p = 0.83). For URS, fluoroless approaches showed comparable overall complications (OR 1.08, 95% CI 0.81-1.45, p = 0.60), major complications, SFR (OR 0.89, 95% CI 0.65-1.19, p = 0.47), and reintervention rates. Flexible fluoroless URS demonstrated fewer minor complications (OR 2.09, 95% CI 1.43-3.06, p < 0.0001). Mean surgical time increased minimally for fluoroless URS (1.60 minutes, p = 0.03).

Conclusions: Fluoroless ultrasound-guided PCNL demonstrates superior safety with maintained efficacy compared with fluoroscopy-guided techniques. Fluoroless URS shows equivalent safety and efficacy with minimal operative time differences. These findings support transitioning from fluoroscopy-dependent to fluoroscopy-optional endourology, aligning with radiation safety principles while maintaining optimal patient outcomes.

Introduction: Recent work has highlighted the renal papillary pathologies present in calcium stone formers. For example, evidence points to ductal plugging being especially damaging to the papillary tissue, and Randall's plaque has been correlated with stone recurrence. The objective of this study was to evaluate the reproducibility of a semiquantitative grading system that can be utilized in the operating room during endoscopic stone removal.

Materials and methods: Clips of endoscopic video of single renal papillae, representing 3 papillae from each of 12 patients (6 majority calcium oxalate stone formers [CaOx SFs] and 6 majority apatite [CaP] SFs), were each triplicated in 3 rotations (original, 90° rotation, and vertical flip). Video clips were assessed by 4 graders who were blinded to any other data. Grades for plugging/dilated ducts, papillary pitting, loss of papillary contour, and Randall's plaque were evaluated for intra- and intergrader reproducibility.

Results: Graders were in almost perfect agreement on ductal plugging in the papillae (kappa = 0.84), and agreement was good with Randall's plaque (kappa = 0.68), moderate for papillary pitting (kappa = 0.56), and weakest for loss of contour scores (kappa = 0.40). There was substantial agreement of sum papillary scores (kappa = 0.65). CaP SFs had higher scores for ductal plugging, pitting, and loss of papillary contour, whereas CaOx SFs had higher scores for Randall's plaque.

Conclusions: In this patient sample, papillary appearance differed between CaOx and CaP stone formers. Some of these differences can be reliably appreciated and quantified using the proposed papillary grading system. The grading system was reproducible across multiple graders and is designed to be used in the operating room in a manner that can be easily integrated into patient care.

Introduction: The Revised Cardiac Risk Index (RCRI) and the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) are well-recognized tools to predict 30-day postoperative cardiac events in noncardiac surgeries. However, their predictive accuracy is yet to be assessed in minimally invasive transurethral prostate surgery. We compared the RCRI- and NSQIP-predicted postoperative cardiac outcomes with the actual incidence of cardiac events after transurethral prostate surgery.

Methods: We conducted a retrospective review of patients who underwent transurethral prostate surgery between July and December of 2022. We assessed for postoperative cardiac events within 30 days, as defined by the seminal cardiac VISION study. The RCRI and NSQIP cardiac event predictions were calculated. Fisher's exact test was used for analysis.

Results: We included 185 patients with an average age of 73 ± 8.4 (standard deviation) years, 86 of whom (46%) had transurethral resection of the prostate, and 99 underwent Holmium Laser Enucleation of the Prostate (54%). Myocardial injury after noncardiac surgery surveillance was needed for 34 patients (18.4%) as per standard practice. No patient had any intraoperative cardiac events. One patient experienced a nonfatal postoperative cardiac event (asystole) within hours of surgery. The 30-day cardiac event prediction by the RCRI was 4.8% of the patient cohort (n ≈ 9), significantly higher than the observed incidence of 0.5% (p = 0.0198). NSQIP predicted that 0.54% of the patient cohort (n = 1) will have a cardiac complication within 30 days, which is not significantly different from the observed cardiac event incidence (p = 1).

Conclusion: The RCRI significantly overestimated the 30-day cardiac risk after transurethral prostate surgery, whereas NSQIP predictions and the observed rate of cardiac events were similar. Utilizing more representative predictive tools helps improve risk stratification and will allow patients and surgeons to make better-informed decisions.

Purpose: This study aimed to evaluate the role of the Mayo adhesive probability (MAP) score in predicting intraoperative and postoperative complications in pediatric patients undergoing mini-percutaneous nephrolithotomy (mPCNL).

Materials and methods: Fifty-three pediatric patients who underwent mPCNL between January 2019 and November 2024 were retrospectively analyzed. Patients were divided into two groups based on MAP scores (<3 and ≥3). Demographic, clinical, laboratory, and radiological data, as well as intraoperative and postoperative complications, were compared.

Results: The mean age was 9.9 ± 4.9 years. Thirty-one patients (58.4%) were in the group with MAP scores <3, whereas 22 patients (41.5%) were in the group with MAP scores ≥3. Intraoperative hemoglobin drop was significantly higher in patients with MAP scores ≥3 (p = 0.003). The transfusion rate and Clavien-Dindo (CD) ≥3 complication rate were significantly higher in the MAP ≥3 group (p = 0.037, p = 0.016, respectively). In contrast, the postoperative fever rate and readmission rate were not associated with MAP score, and no significant differences were observed between the groups.

Conclusion: The MAP score has predictive value for hemoglobin drop, transfusion requirement, and severe postoperative complications (CD ≥3) in pediatric mPCNL cases. Therefore, surgeons can use the MAP score in preoperative risk assessments to implement the necessary precautions to prevent complications.

Introduction: To provide a comprehensive overview of the efficacy and safety of ECIRS procedures in a tertiary referral hospital.

Methods: All ECIRS cases at a tertiary referral center for urolithiasis (Amsterdam UMC) between January 2018 and September 2023 were retrospectively reviewed. Predicted complexity of the operation was stated in Guy's stone score (GSS). Primary outcome was the stone-free rate (SFR) as determined by fragments <4 mm on noncontrast computed tomography (NCCT) at 6 weeks postoperatively. Secondary outcomes included endoscopic SFR and complication rate.

Results: A total of 261 ECIRS procedures were included. Mean age was 54 years, and 58% of patients had a GSS of III or IV. Endoscopic SFR was 80%; however, NCCT showed a radiological SFR of 54%, with SFRs of 78%, 55%, 63%, and 40% for GSS I, II, III, and IV, respectively. Postoperative complications occurred in 23% of cases, with major complications (Clavien-Dindo grade ≥3) in 3.8%. Systemic inflammatory response syndrome developed in 8.0%, and a blood transfusion was administered in 3.8% of patients.

Conclusion: ECIRS is an effective and safe option for the management of complex renal stones, although complete stone clearance was not achieved in all patients in this selected referral population. Endoscopic and radiological SFRs differ significantly, highlighting the impact of imaging modality on outcome interpretation. A higher GSS correlates with a lower SFR and a higher chance of complications.