David Musheyev, Alexander Pan, Abdo E Kabarriti, Stacy Loeb, James F Borin
Introduction: Kidney stones are common and morbid conditions in the general population with a rising incidence globally. Previous studies show substantial limitations of online sources of information regarding prevention and treatment. The objective of this study was to examine the quality of information on kidney stones from artificial intelligence (AI) chatbots. Methods: The most common online searches about kidney stones from Google Trends and headers from the National Institute of Diabetes and Digestive and Kidney Diseases website were used as inputs to four AI chatbots (ChatGPT version 3.5, Perplexity, Chat Sonic, and Bing AI). Validated instruments were used to assess the quality (DISCERN instrument from 1 low to 5 high), understandability, and actionability (PEMAT, from 0% to 100%) of the chatbot outputs. In addition, we examined the reading level of the information and whether there was misinformation compared with guidelines (5 point Likert scale). Results: AI chatbots generally provided high-quality consumer health information (median DISCERN 4 out of 5) and did not include misinformation (median 1 out of 5). The median understandability was moderate (median 69.6%), and actionability was moderate to poor (median 40%). Responses were presented at an advanced reading level (11th grade; median Flesch-Kincaid score 11.3). Conclusions: AI chatbots provide generally accurate information on kidney stones and lack misinformation; however, it is not easily actionable and is presented above the recommended reading level for consumer health information.
导言:肾结石是普通人群中的常见病和多发病,其发病率在全球范围内呈上升趋势。先前的研究表明,有关预防和治疗的在线信息来源存在很大的局限性。本研究旨在考察人工智能(AI)聊天机器人提供的肾结石相关信息的质量:方法:谷歌趋势(Google Trends)中有关肾结石的最常见在线搜索和美国国家糖尿病、消化道疾病和肾脏疾病研究所(National Institute of Diabetes and Digestive and Kidney Diseases)网站的标题被用作 4 个人工智能聊天机器人(ChatGPT 3.5 版、Perplexity、Chat Sonic 和 Bing AI)的输入信息。我们使用经过验证的工具来评估聊天机器人输出的质量(DISCERN工具,从1低到5高)、可理解性和可操作性(PEMAT,从0到100%)。此外,我们还检查了信息的阅读水平以及与指南相比是否存在错误信息(5 点李克特量表):结果:人工智能聊天机器人一般都能提供高质量的消费者健康信息(DISCERN 中位数为 4 分,满分为 5 分),并且不包含错误信息(中位数为 1 分,满分为 5 分)。可理解性的中位数为中等(中位数为 69.6%),可操作性为中等至较差(中位数为 40%)。回复的阅读水平较高(11 年级;Flesch-Kincaid 评分中位数为 11.3):结论:人工智能聊天机器人提供的肾结石信息基本准确,没有错误信息;但是,这些信息不容易操作,而且高于消费者健康信息的建议阅读水平。
{"title":"Quality of Information About Kidney Stones from Artificial Intelligence Chatbots.","authors":"David Musheyev, Alexander Pan, Abdo E Kabarriti, Stacy Loeb, James F Borin","doi":"10.1089/end.2023.0484","DOIUrl":"10.1089/end.2023.0484","url":null,"abstract":"<p><p><b><i>Introduction:</i></b> Kidney stones are common and morbid conditions in the general population with a rising incidence globally. Previous studies show substantial limitations of online sources of information regarding prevention and treatment. The objective of this study was to examine the quality of information on kidney stones from artificial intelligence (AI) chatbots. <b><i>Methods:</i></b> The most common online searches about kidney stones from Google Trends and headers from the National Institute of Diabetes and Digestive and Kidney Diseases website were used as inputs to four AI chatbots (ChatGPT version 3.5, Perplexity, Chat Sonic, and Bing AI). Validated instruments were used to assess the quality (DISCERN instrument from 1 low to 5 high), understandability, and actionability (PEMAT, from 0% to 100%) of the chatbot outputs. In addition, we examined the reading level of the information and whether there was misinformation compared with guidelines (5 point Likert scale). <b><i>Results:</i></b> AI chatbots generally provided high-quality consumer health information (median DISCERN 4 out of 5) and did not include misinformation (median 1 out of 5). The median understandability was moderate (median 69.6%), and actionability was moderate to poor (median 40%). Responses were presented at an advanced reading level (11th grade; median Flesch-Kincaid score 11.3). <b><i>Conclusions:</i></b> AI chatbots provide generally accurate information on kidney stones and lack misinformation; however, it is not easily actionable and is presented above the recommended reading level for consumer health information.</p>","PeriodicalId":15723,"journal":{"name":"Journal of endourology","volume":null,"pages":null},"PeriodicalIF":2.9,"publicationDate":"2024-07-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141603733","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Ali Sezer, Bilge Türedi, Onur Kucuktopcu, Mustafa Bilal Hamarat, Burak Yilmaz, Rasim Güzel, Kemal Sarica
Introduction: Ultrasound (US)-guided puncture has the benefits of avoiding radiation and limiting the risk of visceral injury. We aimed to evaluate the results of two different renal access techniques during pediatric supine mini percutaneous nephrolithotomy (smPCNL) in a comparative manner. Patients and Methods: Data obtained from pediatric patients undergoing smPCNL by single surgeon between September 2021 and 2023 were reviewed retrospectively. Children were divided into two groups namely; biplanar 0°-90° fluoroscopy (Group-F) and US-fluoroscopy combined (Group-C). In all cases, preoperative, operative, and postoperative findings were recorded. Success was defined as the determination of either no (complete stone-free status) or < 4 mm residual fragments (CIRF) on US and X-ray (postoperative 3rd month) images. Complications were evaluated according to modified Clavien-Dindo classification. Results: Data of 54 patients with a mean age of 8.6 years (Group-F = 30, Group-C = 24) are reviewed. In addition to the similar success rates in both groups (Group-F = 86.7% Group-C = 87.5% p = 0.928), similar minor complications were noted in the majority of the cases. No child required transfusion and/or angioembolization. Although the fluoroscopy and operation time were lower in Group-C, the difference was not statistically significant. Conclusion: US-fluoroscopy combined access technique can be applied with similar success and complication rates in pediatric smPCNL. Ultimately, as experience is gained, this technique may lower radiation exposure, although this was not observed in the current study.
{"title":"Renal Access in Pediatric Supine Miniaturized Percutaneous Nephrolithotomy: Comparative Evaluation of Ultrasound-Fluoroscopy Combined and Biplanar (0°-90°) Fluoroscopic Techniques.","authors":"Ali Sezer, Bilge Türedi, Onur Kucuktopcu, Mustafa Bilal Hamarat, Burak Yilmaz, Rasim Güzel, Kemal Sarica","doi":"10.1089/end.2024.0181","DOIUrl":"10.1089/end.2024.0181","url":null,"abstract":"<p><p><b><i>Introduction:</i></b> Ultrasound (US)-guided puncture has the benefits of avoiding radiation and limiting the risk of visceral injury. We aimed to evaluate the results of two different renal access techniques during pediatric supine mini percutaneous nephrolithotomy (smPCNL) in a comparative manner. <b><i>Patients and Methods:</i></b> Data obtained from pediatric patients undergoing smPCNL by single surgeon between September 2021 and 2023 were reviewed retrospectively. Children were divided into two groups namely; biplanar 0°-90° fluoroscopy (Group-F) and US-fluoroscopy combined (Group-C). In all cases, preoperative, operative, and postoperative findings were recorded. Success was defined as the determination of either no (complete stone-free status) or < 4 mm residual fragments (CIRF) on US and X-ray (postoperative 3rd month) images. Complications were evaluated according to modified Clavien-Dindo classification. <b><i>Results:</i></b> Data of 54 patients with a mean age of 8.6 years (Group-F = 30, Group-C = 24) are reviewed. In addition to the similar success rates in both groups (Group-F = 86.7% Group-C = 87.5% <i>p</i> = 0.928), similar minor complications were noted in the majority of the cases. No child required transfusion and/or angioembolization. Although the fluoroscopy and operation time were lower in Group-C, the difference was not statistically significant. <b><i>Conclusion:</i></b> US-fluoroscopy combined access technique can be applied with similar success and complication rates in pediatric smPCNL. Ultimately, as experience is gained, this technique may lower radiation exposure, although this was not observed in the current study.</p>","PeriodicalId":15723,"journal":{"name":"Journal of endourology","volume":null,"pages":null},"PeriodicalIF":2.9,"publicationDate":"2024-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141603734","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Guglielmo Mantica, Giovanni Drocchi, Carlo Terrone
{"title":"Reply Letter to Dr Victor DR et al. on: Preoperative α1-Blockers Impact on Outcomes of Patients Undergoing Ureteroscopy with Ureteral Access Sheaths: A Systematic Review and Meta-Analysis.","authors":"Guglielmo Mantica, Giovanni Drocchi, Carlo Terrone","doi":"10.1089/end.2024.0455","DOIUrl":"10.1089/end.2024.0455","url":null,"abstract":"","PeriodicalId":15723,"journal":{"name":"Journal of endourology","volume":null,"pages":null},"PeriodicalIF":2.9,"publicationDate":"2024-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141603735","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Purpose: This study aims to report our experience in the treatment of children with retrocaval ureter (RCU) using laparoscopic ureteral reconstruction surgery. Patients and Methods: We retrospectively collected clinical data from 10 pediatric patients with RCU who underwent laparoscopic surgery at our hospital from April 2010 to April 2022. All patients underwent comprehensive preoperative radiological assessment and were diagnosed with RCU, subsequently undergoing laparoscopic ureteral reconstruction. Patient demographics, surgical data, and postoperative outcomes were recorded. Regular follow-ups were conducted postoperatively, evaluating clinical symptoms and radiological results. Results: The median age of the 10 patients was 8.8 years (range, 6-14 years). All surgeries were successfully performed laparoscopically without the need for open conversion, with an average surgical time of 153.3 minutes (range, 120-243 minutes). Intraoperative bleeding was minimal and no blood transfusions were required. No intraoperative complications were observed. The average hospital stay for the patients was 5.3 days (range, 4-7 days) and the Double-J (D-J) stent was removed 6 weeks postoperatively. Follow-up ultrasound results at 3 and 6 months postoperatively showed a reduction in renal pelvic dilatation, and all patients experienced significant relief of clinical symptoms related to flank and abdominal discomfort. Conclusion: Laparoscopic reconstruction for RCU demonstrates good feasibility and effectiveness in pediatric patients, offering a minimally invasive treatment option for the management of RCU in children.
{"title":"Laparoscopic Ureteral Reconstruction in Children with Retrocaval Ureter: A Modern Single Center Retrospective Study.","authors":"Changkun Mao, Yongsheng Cao, Tao Zhang","doi":"10.1089/end.2024.0027","DOIUrl":"10.1089/end.2024.0027","url":null,"abstract":"<p><p><b><i>Purpose:</i></b> This study aims to report our experience in the treatment of children with retrocaval ureter (RCU) using laparoscopic ureteral reconstruction surgery. <b><i>Patients and Methods:</i></b> We retrospectively collected clinical data from 10 pediatric patients with RCU who underwent laparoscopic surgery at our hospital from April 2010 to April 2022. All patients underwent comprehensive preoperative radiological assessment and were diagnosed with RCU, subsequently undergoing laparoscopic ureteral reconstruction. Patient demographics, surgical data, and postoperative outcomes were recorded. Regular follow-ups were conducted postoperatively, evaluating clinical symptoms and radiological results. <b><i>Results:</i></b> The median age of the 10 patients was 8.8 years (range, 6-14 years). All surgeries were successfully performed laparoscopically without the need for open conversion, with an average surgical time of 153.3 minutes (range, 120-243 minutes). Intraoperative bleeding was minimal and no blood transfusions were required. No intraoperative complications were observed. The average hospital stay for the patients was 5.3 days (range, 4-7 days) and the Double-J (D-J) stent was removed 6 weeks postoperatively. Follow-up ultrasound results at 3 and 6 months postoperatively showed a reduction in renal pelvic dilatation, and all patients experienced significant relief of clinical symptoms related to flank and abdominal discomfort. <b><i>Conclusion:</i></b> Laparoscopic reconstruction for RCU demonstrates good feasibility and effectiveness in pediatric patients, offering a minimally invasive treatment option for the management of RCU in children.</p>","PeriodicalId":15723,"journal":{"name":"Journal of endourology","volume":null,"pages":null},"PeriodicalIF":2.9,"publicationDate":"2024-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141603731","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Damien Gibson, Ramesh Shanmugasundaram, George McClintock, Cecile Pham, Anthony Hutton, Nari Ahmadi, Mohan Arianayagam, Martin Elmes, Ruban Thanigasalam, Norbert Doeuk, Bill Papadopoulos, Tru Ngo, Prem Rathore, Kris Rasiah, James Thompson, Peter Aslan, Patrick-Julien Treacy, Scott Leslie
Purpose: This case series describes the experiences and outcomes of multiple Australian surgeons performing robotic-assisted bladder diverticulectomy (RABD), highlighting the procedural effectiveness and safety, for both benign and malignant indications for diverticulectomy. Methods: Outcomes were analyzed from 13 experienced Australian urologists who performed RABD between 2016 and 2023. Retrospective analysis was performed on prospectively collected data, which included patient demographics, diverticulum characteristics, surgical approaches, and post-operative outcomes. Surgical techniques included the extravesical and intravesical approaches, with the focus on maintaining oncological principles in cases of malignancy. Results: A total of 28 patients underwent RABD, with the majority being male and a mean age of 63.9 years. All surgeons utilized a four-port transperitoneal approach and opted for the extravesical dissection of the diverticular neck; one case utilized both an extravesical and a trans-diverticular approach. Functional outcomes demonstrated symptomatic resolution in patients with nonmalignant diverticula, whereas oncological outcomes indicated clear margins in 90% of malignant cases. The average length of the procedure was 106 minutes, with minimal blood loss and a mean hospital stay of 2.67 days. Early complications occurred in 14% with the majority Clavien-Dindo grade II. Conclusion: Robotic bladder diverticulectomy, predominantly via the transperitoneal extravesical approach, has emerged as a safe, effective, and reliable surgical intervention for both malignant and nonmalignant bladder diverticula. The consistent surgical approach and excellent outcomes demonstrated in this case series reinforce the procedure's potential as a safe option, even in the setting of malignancy within a diverticulum.
{"title":"Robotic-Assisted Bladder Diverticulectomy: Indications, Technique, and Outcomes-A Case Series.","authors":"Damien Gibson, Ramesh Shanmugasundaram, George McClintock, Cecile Pham, Anthony Hutton, Nari Ahmadi, Mohan Arianayagam, Martin Elmes, Ruban Thanigasalam, Norbert Doeuk, Bill Papadopoulos, Tru Ngo, Prem Rathore, Kris Rasiah, James Thompson, Peter Aslan, Patrick-Julien Treacy, Scott Leslie","doi":"10.1089/end.2024.0209","DOIUrl":"10.1089/end.2024.0209","url":null,"abstract":"<p><p><b><i>Purpose:</i></b> This case series describes the experiences and outcomes of multiple Australian surgeons performing robotic-assisted bladder diverticulectomy (RABD), highlighting the procedural effectiveness and safety, for both benign and malignant indications for diverticulectomy. <b><i>Methods:</i></b> Outcomes were analyzed from 13 experienced Australian urologists who performed RABD between 2016 and 2023. Retrospective analysis was performed on prospectively collected data, which included patient demographics, diverticulum characteristics, surgical approaches, and post-operative outcomes. Surgical techniques included the extravesical and intravesical approaches, with the focus on maintaining oncological principles in cases of malignancy. <b><i>Results:</i></b> A total of 28 patients underwent RABD, with the majority being male and a mean age of 63.9 years. All surgeons utilized a four-port transperitoneal approach and opted for the extravesical dissection of the diverticular neck; one case utilized both an extravesical and a trans-diverticular approach. Functional outcomes demonstrated symptomatic resolution in patients with nonmalignant diverticula, whereas oncological outcomes indicated clear margins in 90% of malignant cases. The average length of the procedure was 106 minutes, with minimal blood loss and a mean hospital stay of 2.67 days. Early complications occurred in 14% with the majority Clavien-Dindo grade II. <b><i>Conclusion:</i></b> Robotic bladder diverticulectomy, predominantly via the transperitoneal extravesical approach, has emerged as a safe, effective, and reliable surgical intervention for both malignant and nonmalignant bladder diverticula. The consistent surgical approach and excellent outcomes demonstrated in this case series reinforce the procedure's potential as a safe option, even in the setting of malignancy within a diverticulum.</p>","PeriodicalId":15723,"journal":{"name":"Journal of endourology","volume":null,"pages":null},"PeriodicalIF":2.9,"publicationDate":"2024-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141446297","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Shuichi Morizane, Ahmed A Hussein, Hiroshi Yamane, Ryutaro Shimizu, Ryoma Nishikawa, Yusuke Kimura, Noriya Yamaguchi, Katsuya Hikita, Masashi Honda, Khurshid A Guru, Atsushi Takenaka
Introduction and Hypothesis: Robot-assisted radical nephroureterectomy (RANU) has emerged as a valid alternative to open or laparoscopic nephroureterectomy in recent years. However, different types of robotic platforms can limit surgical maneuvers in various ways. This study aimed to describe the surgical procedure and demonstrate RANU's technical feasibility and safety using the Hugo robot-assisted surgery (RAS) system. Materials and Methods: Using the Hugo RAS system, we reported data from the first five consecutive patients who underwent RANU at Tottori University Hospital. We adjusted the docking angles of the four independent arm carts in each case and performed a complete RANU via a transperitoneal approach. We collected patients' sociodemographic and perioperative data, including complications, and compared them retrospectively with data obtained using the da Vinci surgical system. Results: Arms positions were modified after the first patient to be placed all at the back of the patient. Median overall operative time was 283 minutes (203-377) and the median time using the robotic system was 187 minutes (121-277). The median estimated blood loss was 20 mL (5-155). None of the patients required a blood transfusion and none suffered postoperative complications of Clavien-Dindo grade ≥3. These outcomes were similar to those obtained with the da Vinci Xi system. Conclusion: This series represents the first report of RANU executed using the novel Hugo RAS system. Our proposed arm-setup will assist other surgeons and help ensure safe implementation of RANU on the Hugo platform.
{"title":"Initial Experience and Surgical Setup of Robot-Assisted Nephroureterectomy Using the Hugo Robot-Assisted Surgery System.","authors":"Shuichi Morizane, Ahmed A Hussein, Hiroshi Yamane, Ryutaro Shimizu, Ryoma Nishikawa, Yusuke Kimura, Noriya Yamaguchi, Katsuya Hikita, Masashi Honda, Khurshid A Guru, Atsushi Takenaka","doi":"10.1089/end.2024.0287","DOIUrl":"10.1089/end.2024.0287","url":null,"abstract":"<p><p><b><i>Introduction and Hypothesis:</i></b> Robot-assisted radical nephroureterectomy (RANU) has emerged as a valid alternative to open or laparoscopic nephroureterectomy in recent years. However, different types of robotic platforms can limit surgical maneuvers in various ways. This study aimed to describe the surgical procedure and demonstrate RANU's technical feasibility and safety using the Hugo robot-assisted surgery (RAS) system. <b><i>Materials and Methods:</i></b> Using the Hugo RAS system, we reported data from the first five consecutive patients who underwent RANU at Tottori University Hospital. We adjusted the docking angles of the four independent arm carts in each case and performed a complete RANU via a transperitoneal approach. We collected patients' sociodemographic and perioperative data, including complications, and compared them retrospectively with data obtained using the da Vinci surgical system. <b><i>Results:</i></b> Arms positions were modified after the first patient to be placed all at the back of the patient. Median overall operative time was 283 minutes (203-377) and the median time using the robotic system was 187 minutes (121-277). The median estimated blood loss was 20 mL (5-155). None of the patients required a blood transfusion and none suffered postoperative complications of Clavien-Dindo grade ≥3. These outcomes were similar to those obtained with the da Vinci Xi system. <b><i>Conclusion:</i></b> This series represents the first report of RANU executed using the novel Hugo RAS system. Our proposed arm-setup will assist other surgeons and help ensure safe implementation of RANU on the Hugo platform.</p>","PeriodicalId":15723,"journal":{"name":"Journal of endourology","volume":null,"pages":null},"PeriodicalIF":2.9,"publicationDate":"2024-07-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141563460","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Akin S Amasyali, Toby Clark, Natalie Chen, Ala'a Farkouh, Daniel Jhang, Kai Wen Cheng, Ruby Kuang, D Daniel Baldwin, Arthur Goyne, Elizabeth Baldwin, Zhamshid Okhunov, D Duane Baldwin
Introduction: The thulium fiber laser (TFL) generates a focused beam, which can be transmitted to laser fibers with small core diameters and may facilitate in situ lower-pole lithotripsy. This study compares lithotripsy performance of the 150 and 200 µm TFL in a lower pole benchtop kidney model. Materials and Methods: Using a 3D model printed from an actual kidney, in situ laser lithotripsy was performed on 1 cm lower-pole BegoStones (calcium oxalate monohydrate consistency) using four different settings (all 20W) and two fiber sizes (150 and 200 µm). Procedure time, laser time, total pulse energy, and fiber stripping were compared between the two fibers using an ANOVA or independent t-test. Results: The 150 µm fiber at 0.2 J × 100 Hz had the shortest lasing and procedure time (17.3 and 18.5 minutes) and lowest total pulse energy (20.75 kJ) compared with other study arms (p < 0.001). Overall procedure time, lasing time, and total pulse energy were significantly different between the 8 settings (p < 0.001 for all). At higher frequency (100 and 200 Hz), lasing time was significantly faster compared with 20 and 50 Hz (19.9 vs 27.3 minutes; p < 0.001). Furthermore, the average total procedure time was shorter with 150 µm compared with 200 µm regardless of settings (23.2 vs 29.8 minutes; p < 0.001). Conclusion: The 150 µm fiber results in shorter procedure and lasing time at lower total energy levels during lower-pole in situ lithotripsy. Overall, the fastest setting was 0.2 J and 100 Hz with the 150 µm fiber. Smaller laser fibers can potentially allow more efficient in situ laser lithotripsy with better irrigation and visibility at higher deflection angles.
{"title":"Is Bigger Better? Comparison of 150 µm and 200 µm Thulium Fiber for <i>In Situ</i> Lower-Pole Lithotripsy.","authors":"Akin S Amasyali, Toby Clark, Natalie Chen, Ala'a Farkouh, Daniel Jhang, Kai Wen Cheng, Ruby Kuang, D Daniel Baldwin, Arthur Goyne, Elizabeth Baldwin, Zhamshid Okhunov, D Duane Baldwin","doi":"10.1089/end.2024.0223","DOIUrl":"10.1089/end.2024.0223","url":null,"abstract":"<p><p><b><i>Introduction:</i></b> The thulium fiber laser (TFL) generates a focused beam, which can be transmitted to laser fibers with small core diameters and may facilitate <i>in situ</i> lower-pole lithotripsy. This study compares lithotripsy performance of the 150 and 200 µm TFL in a lower pole benchtop kidney model. <b><i>Materials and Methods:</i></b> Using a 3D model printed from an actual kidney, <i>in situ</i> laser lithotripsy was performed on 1 cm lower-pole BegoStones (calcium oxalate monohydrate consistency) using four different settings (all 20W) and two fiber sizes (150 and 200 µm). Procedure time, laser time, total pulse energy, and fiber stripping were compared between the two fibers using an ANOVA or independent <i>t-test</i>. <b><i>Results:</i></b> The 150 µm fiber at 0.2 J × 100 Hz had the shortest lasing and procedure time (17.3 and 18.5 minutes) and lowest total pulse energy (20.75 kJ) compared with other study arms (<i>p</i> < 0.001). Overall procedure time, lasing time, and total pulse energy were significantly different between the 8 settings (<i>p</i> < 0.001 for all). At higher frequency (100 and 200 Hz), lasing time was significantly faster compared with 20 and 50 Hz (19.9 <i>vs</i> 27.3 minutes; <i>p</i> < 0.001). Furthermore, the average total procedure time was shorter with 150 µm compared with 200 µm regardless of settings (23.2 <i>vs</i> 29.8 minutes; <i>p</i> < 0.001). <b><i>Conclusion:</i></b> The 150 µm fiber results in shorter procedure and lasing time at lower total energy levels during lower-pole <i>in situ</i> lithotripsy. Overall, the fastest setting was 0.2 J and 100 Hz with the 150 µm fiber. Smaller laser fibers can potentially allow more efficient <i>in situ</i> laser lithotripsy with better irrigation and visibility at higher deflection angles.</p>","PeriodicalId":15723,"journal":{"name":"Journal of endourology","volume":null,"pages":null},"PeriodicalIF":2.9,"publicationDate":"2024-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141498163","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Maya Srinath, Zorawar Singh, Maia Hare, Leah Beland, Tareq Aro
Objective: To characterize the trends in female representation in the endourology fellowship match compared with the urology residency match. Materials and Methods: Available deidentified match data from 2017 to 2022 was obtained from the American Urological Association and Endourology Society annual census data. We evaluated gender-specific participation in the urology residency and endourology fellowship match and compared differences in the trends over the last 6 years. Results: Between the years 2017 and 2021, there were a total of 313 applicants for a fellowship in endourology, and of those, only 8.6% were women. In that same time period, a significantly larger number of women (27.1%) participated in the urology residency match (p = 0.0002). When specifically examining the endourology applicant trend, there is no significant increase in participation (R = 0.7, p = 0.35) between 2017 and 2021, as compared with the significant increase in total number of applicants (R = 7.1, p = 0.04). However, in the urology match, there has been a constant and significant increase in both female (R = 13.7, p = 0.03) and total applicants (R = 27, p = 0.04) between 2017 and 2022. Conclusions: Although there has been an overall increase in the number of applicants to urology, the number of women in endourology fellowship has not increased at a commensurate rate. In light of these findings, it is the responsibility of the endourology community to identify social and systemic barriers for women in this field and advocate for change.
{"title":"Endourology Fellowship: More Than a Stone's Throw Away for Women.","authors":"Maya Srinath, Zorawar Singh, Maia Hare, Leah Beland, Tareq Aro","doi":"10.1089/end.2023.0601","DOIUrl":"10.1089/end.2023.0601","url":null,"abstract":"<p><p><b><i>Objective:</i></b> To characterize the trends in female representation in the endourology fellowship match compared with the urology residency match. <b><i>Materials and Methods:</i></b> Available deidentified match data from 2017 to 2022 was obtained from the American Urological Association and Endourology Society annual census data. We evaluated gender-specific participation in the urology residency and endourology fellowship match and compared differences in the trends over the last 6 years. <b><i>Results:</i></b> Between the years 2017 and 2021, there were a total of 313 applicants for a fellowship in endourology, and of those, only 8.6% were women. In that same time period, a significantly larger number of women (27.1%) participated in the urology residency match (<i>p</i> = 0.0002). When specifically examining the endourology applicant trend, there is no significant increase in participation (<i>R</i> = 0.7, <i>p</i> = 0.35) between 2017 and 2021, as compared with the significant increase in total number of applicants (<i>R</i> = 7.1, <i>p</i> = 0.04). However, in the urology match, there has been a constant and significant increase in both female (<i>R</i> = 13.7, <i>p</i> = 0.03) and total applicants (<i>R</i> = 27, <i>p</i> = 0.04) between 2017 and 2022. <b><i>Conclusions:</i></b> Although there has been an overall increase in the number of applicants to urology, the number of women in endourology fellowship has not increased at a commensurate rate. In light of these findings, it is the responsibility of the endourology community to identify social and systemic barriers for women in this field and advocate for change.</p>","PeriodicalId":15723,"journal":{"name":"Journal of endourology","volume":null,"pages":null},"PeriodicalIF":2.9,"publicationDate":"2024-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141468420","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Elizabeth N Bearrick, Bridget L Findlay, Anthony Fadel, Aaron M Potretzke, Katherine T Anderson, Boyd R Viers
Objective: To characterize our single institutional experience with robotic and open uretero-enteric stricture (UES) repair. Materials and Methods: We queried our ureteral reconstructive database for UES repair between 01/2017 and 10/2023. Patients with <3 months follow-up were excluded. Prior to surgery, patients underwent ureteral rest (4 weeks) with conversion to nephrostomy tube. Clinical characteristics, complications, reconstructive success (uretero-enteric patency), need for repeat intervention, and renal function were assessed in patients undergoing open and robotic UES reconstruction. Results: Of 50 patients undergoing UES repair during the study period, 45 were included for analysis due to complete follow-up (34 [76%] robotic and 11 [24%] open repair). UES repair was performed in 50 renal units a median of 13 months (interquartile range 7-30) from index surgery, and most often involved the left renal unit (34/50; 68%). Compared with robotic, open cases were significantly more likely to have undergone open cystectomy (100% vs 68%, p = 0.04), have longer strictures (median 4 vs 1 cm, p < 0.001), require tissue substitution (27% vs 3%, p = 0.04), and have lengthier postoperative hospitalization (5 vs 2 days, p < 0.001). There was no significant difference in total operative time (410 vs 322 minutes) or 30d major complications (18% vs 21%). At a follow-up of 13 months, per patient reconstructive success was 100% (11/11) for open and 97% (33/34) for robotic, respectively. Conclusion: In select patients with short UES unlikely to require advanced reconstructive techniques, a robotic-assisted approach can be considered. Careful patient selection is associated with limited morbidity and high reconstructive success.
摘要总结我们单个机构在机器人和开放式输尿管肠管狭窄(UES)修复方面的经验:我们在输尿管重建数据库中查询了 2017 年 1 月至 2023 年 10 月期间的 UES 修复情况。随访<3个月的患者被排除在外。手术前,患者进行了输尿管休息(4周),并转换为肾造瘘管。对接受开放式和机器人输尿管ES重建术的患者的临床特征、并发症、重建成功率(输尿管-肠管通畅率)、重复干预需求和肾功能进行了评估:在研究期间接受 UES 修复术的 50 名患者中,有 45 人因随访完整而纳入分析(34 人[76%]接受机器人修复术,11 人[24%]接受开放式修复术)。在50个肾单位进行了UES修复术,中位时间为手术后13个月(IQR 7-30),最常涉及的是左肾单位(34/50;68%)。与机器人手术相比,开放手术病例更有可能接受过开放性膀胱切除术(100% vs 68%,P=0.04),狭窄时间更长(中位 4 cm vs 1 cm,P=0.04):对于一些不太需要先进重建技术的短膀胱尿道患者,可以考虑采用机器人辅助方法。对患者的精心选择可降低发病率,提高重建成功率。
{"title":"Open and Robotic Uretero-enteric Stricture Repair: Early Outcomes and Complications.","authors":"Elizabeth N Bearrick, Bridget L Findlay, Anthony Fadel, Aaron M Potretzke, Katherine T Anderson, Boyd R Viers","doi":"10.1089/end.2024.0021","DOIUrl":"10.1089/end.2024.0021","url":null,"abstract":"<p><p><b><i>Objective:</i></b> To characterize our single institutional experience with robotic and open uretero-enteric stricture (UES) repair. <b><i>Materials and Methods:</i></b> We queried our ureteral reconstructive database for UES repair between 01/2017 and 10/2023. Patients with <3 months follow-up were excluded. Prior to surgery, patients underwent ureteral rest (4 weeks) with conversion to nephrostomy tube. Clinical characteristics, complications, reconstructive success (uretero-enteric patency), need for repeat intervention, and renal function were assessed in patients undergoing open and robotic UES reconstruction. <b><i>Results:</i></b> Of 50 patients undergoing UES repair during the study period, 45 were included for analysis due to complete follow-up (34 [76%] robotic and 11 [24%] open repair). UES repair was performed in 50 renal units a median of 13 months (interquartile range 7-30) from index surgery, and most often involved the left renal unit (34/50; 68%). Compared with robotic, open cases were significantly more likely to have undergone open cystectomy (100% <i>vs</i> 68%, <i>p</i> = 0.04), have longer strictures (median 4 <i>vs</i> 1 cm, <i>p</i> < 0.001), require tissue substitution (27% <i>vs</i> 3%, <i>p</i> = 0.04), and have lengthier postoperative hospitalization (5 <i>vs</i> 2 days, <i>p</i> < 0.001). There was no significant difference in total operative time (410 <i>vs</i> 322 minutes) or 30d major complications (18% <i>vs</i> 21%). At a follow-up of 13 months, per patient reconstructive success was 100% (11/11) for open and 97% (33/34) for robotic, respectively. <b><i>Conclusion:</i></b> In select patients with short UES unlikely to require advanced reconstructive techniques, a robotic-assisted approach can be considered. Careful patient selection is associated with limited morbidity and high reconstructive success.</p>","PeriodicalId":15723,"journal":{"name":"Journal of endourology","volume":null,"pages":null},"PeriodicalIF":2.9,"publicationDate":"2024-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141432106","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Evaluating the Performance of ChatGPT in Urology: Comment.","authors":"Amnuay Kleebayoon, Viroj Wiwanitkit","doi":"10.1089/end.2024.0373","DOIUrl":"10.1089/end.2024.0373","url":null,"abstract":"","PeriodicalId":15723,"journal":{"name":"Journal of endourology","volume":null,"pages":null},"PeriodicalIF":2.9,"publicationDate":"2024-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141468421","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}