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Gender Differences in the Adoption and Utilization of Robotic-assisted Laparoscopic Surgery Among Practicing Urologists: A Study of American Board of Urology Case Logs From 2012-2022 泌尿外科执业医师采用和使用机器人辅助腹腔镜手术 (RALS) 的性别差异：2012-2022年美国泌尿外科委员会病例记录研究》（A Study of American Board of Urology Case Logs from 2012-2022.

IF 2.1 3区医学 Q2 UROLOGY & NEPHROLOGY

Urology

Pub Date : 2025-02-01 DOI: 10.1016/j.urology.2024.10.034

Alexa Steckler , Natalie Passarelli , Alexander Homer , Simone Thavaseelan , Elias Hyams

Objective

To evaluate the differential activity in robotic-assisted laparoscopic surgery (RALS) by urologic surgeon gender.

Methods

This was a retrospective study of American Board of Urology surgical case logs from 2012-2022. The CPT-coded laparoscopic procedures included were Partial Nephrectomy (50543), Radical Nephrectomy (50545, 50546, 50548), Pyeloplasty (50544), and Sacrocolpopexy (57425). Robotic-assisted cases were co-coded with CPT S2900. Univariate analysis and multiple logistic regression analyzed the roles of physician gender and other factors on RALS utilization. A separate analysis was performed for Robotic-Assisted Laparoscopic Prostatectomy (RALP) (55866).

Results

Women performed 10.8% of all procedures and 9.02% of robotic cases. General Urology and Urogynecology and Reconstructive Pelvic Surgery (URPS) had higher concentrations in women. Of the CPT procedures analyzed, women performed the highest percentage of sacrocolpopexies (39.2% of total), 8.09% of which were robotic. In multivariate regression, women surgeons had significantly lower odds of performing a robotic case compared to men (OR 0.803, P <.001). Endourology, Oncology, Pediatric Urology, and URPS subspecialties were associated with RALS. Upward trends were depicted across all physicians (0.012, [0.007, 0.018], P <.001) and for men (0.019, [0.010, 0.029], P = .001). Women showed no significant increase in robotic usage over time (P = .463).

Conclusion

Women have lower odds of participating in robotics, primarily specialize in URPS and their involvement in RALS is skewed toward sacrocolpopexy. As robotics continues to dominate surgical urology, ensuring equitable training opportunities is essential. Research into the roles of mentorship in residency, same-gender patient-physician concordance, practice setting, and recent graduates’ referral patterns is warranted.

目的评估泌尿外科外科医生性别在机器人辅助腹腔镜手术（RALS）中的活动差异：这是一项对美国泌尿外科委员会 2012-2022 年手术病例记录的回顾性研究。CPT编码的腹腔镜手术包括肾部分切除术（50543）、根治性肾切除术（50545、50546、50548）、肾盂成形术（50544）和骶骨整形术（57425）。机器人辅助病例与 CPT S2900 共同编码。单变量分析和多元逻辑回归分析了医生性别和其他因素对 RALS 使用率的影响。对机器人辅助腹腔镜前列腺切除术（RALP）（55866）进行了单独分析：结果：女性实施的手术占所有手术的 10.8%，占机器人手术的 9.02%。普通泌尿外科和泌尿妇科及盆腔整形外科（URPS）的女性比例较高。在分析的 CPT 手术中，女性实施骶骨结节切除术的比例最高（占总数的 39.2%），其中 8.09% 是机器人手术。在多变量回归中，与男性相比，女性外科医生实施机器人手术的几率明显较低（OR 0.803，p结论：女性参与机器人手术的几率较低，她们主要擅长URPS手术，而她们参与的RALS手术偏向于骶骨结节成形术。随着机器人技术继续主导泌尿外科手术，确保公平的培训机会至关重要。有必要对住院医师培训中导师的作用、同性患者与医生的一致性、实践环境以及应届毕业生的转诊模式进行研究。

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引用次数: 0

Trends and Safety of Same-day Discharge for Robot-assisted Laparoscopic Prostatectomy: A Comparison Between the Pre-pandemic and Pandemic Periods From the National Cancer Database 机器人辅助腹腔镜前列腺切除术当天出院的趋势和安全性：来自全国癌症数据库的大流行前与大流行期间的比较。

IF 2.1 3区医学 Q2 UROLOGY & NEPHROLOGY

Urology

Pub Date : 2025-02-01 DOI: 10.1016/j.urology.2024.10.049

Filippo Dagnino , Muhieddine Labban , Brittany Berk , Zhiyu Qian , Daniel Stelzl , Hanna Zurl , Stephan Korn , Giovanni Lughezzani , Nicolò M. Buffi , Alexander P. Cole , Adam S. Kibel , Quoc-Dien Trinh , Kathy G. Niknejad

Objective

To assess and compare the use of same-day discharge (SDD) for robot-assisted laparoscopic prostatectomy (RALP) between the "Pre-pandemic" and "Pandemic" periods and investigate SDD impact on mortality and readmissions.

Materials and Methods

We examined data from the National Cancer Database on men receiving RALP in the “Pre-pandemic” (2018-2019) and “Pandemic” (2020) periods. We analyzed the differences in patient and hospital characteristics between SDD and non-SDD patients. Multivariable logistic regression analysis was performed to evaluate the likelihood of SDD during "Pandemic" versus "Pre-pandemic" periods. Inverse probability treatment weighting (IPTW) was utilized to assess the impact of SDD on 30-day mortality, 90-day mortality, and 30-day readmissions, adjusting for patient and hospital characteristics.

Results

Out of 111,117 men, 8997 (8%) received SDD. Patients with more comorbidities, non-private insurance, and high-risk prostate cancer reported lower SDD rates (P <.001). Higher SDD rates were observed at academic facilities and those in the top RALP volume quartile (P <.001). Patients who underwent RALP during the "Pandemic" period had increased odds of SDD compared to those receiving RALP in the "Pre-pandemic" period (aOR 1.37; 95%CI 1.31-1.45; P <.001). When comparing SDD and non-SDD patient outcomes, after IPTW adjustment, there was no difference in the odds of 30-day mortality (aOR 0.98; 95%CI 0.47-2.01; P = .95), 90-day mortality (aOR 1.09; 95%CI 0.60-1.97; P = .76), or 30-day readmissions (aOR 0.90; 95%CI 0.76-1.06, P = .21).

Conclusion

SDD for RALP increased steadily after pandemic. Identifying factors and necessary resources to standardize SDD for RALP will be crucial for its widespread adoption in the coming years.

目的评估和比较 "大流行前 "和 "大流行 "期间机器人辅助腹腔镜前列腺切除术（RALP）的当日出院（SDD）使用情况，并调查SDD对死亡率和再入院率的影响：我们研究了国家癌症数据库中关于在 "大流行前"（2018-2019 年）和 "大流行"（2020 年）期间接受 RALP 的男性的数据。我们分析了 SDD 和非 SDD 患者在患者和医院特征方面的差异。我们进行了多变量逻辑回归分析，以评估 "大流行 "期间与 "大流行前 "期间发生 SDD 的可能性。利用逆概率治疗加权法（IPTW）评估 SDD 对 30 天死亡率、90 天死亡率和 30 天再入院率的影响，并对患者和医院特征进行调整：在 111,117 名男性患者中，8,997 人（8%）接受了 SDD 治疗。合并症较多、无私人保险和高危前列腺癌患者的 SDD 率较低（p结论：RALP 的 SDD 率稳步上升，但仍低于前列腺癌患者的 SDD 率：大流行后，RALP 的 SDD 稳步增加。确定 RALP SDD 标准化的因素和必要资源对其在未来几年的广泛应用至关重要。

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引用次数: 0

Is Postoperative Voiding Cystourethrogram Routinely Indicated Following Robotic-assisted Laparoscopic Ureteral Reimplantation in Children: Time to Define the New Standards? 儿童机器人辅助腹腔镜输尿管再植术（RALUR）术后是否常规使用 VCUG？是时候定义新标准了吗？

IF 2.1 3区医学 Q2 UROLOGY & NEPHROLOGY

Urology

Pub Date : 2025-02-01 DOI: 10.1016/j.urology.2024.10.063

Ahmed Abdelhalim , Amr Elbakry , Khaled Eldabek , Osama Al-Omar

Objective

To examine the need to routinely obtain voiding cystourethrogram (VCUG) to confirm vesicoureteral reflux (VUR) resolution following robotic-assisted laparoscopic ureteral reimplantation (RALUR) in children.

Methods

A single-center, prospectively maintained database was reviewed for patients <18 years old who underwent RALUR for VUR. Patient charts were reviewed for baseline characteristics and surgical details. Patients were routinely followed up by renal bladder ultrasound at 6-8 weeks and VCUG at 3 months postoperatively. The primary endpoint was radiological success defined as the absence of VUR on postoperative VCUG. The secondary endpoints were clinical success, defined as the absence of postoperative febrile urinary tract infection, postoperative urinary retention, and reoperation for persistent VUR or RALUR complications.

Results

Between 2018 and 2023, 42 children (48 refluxing ureters) underwent extravesical RALUR at the study institution at a mean age of 70.4 + 23.7 months. A majority of 81% were females, and 85.7% had associated bladder and bowel dysfunction. Six patients (14.3%) had bilateral RALUR. Of the ureters, 83.4%(40/48) had grade III or higher VUR, and 20.8%(10/48) had duplex kidneys. Postoperative VCUG was completed in 36(85.7%) patients. Radiological reflux resolution was confirmed in 87.5%(35/40) of ureters. The remaining five ureters had VUR downgrading to grade I or II; all remained asymptomatic, and none required reoperation. One patient required ureteral stenting for 6 weeks for an unidentified unilateral ureteral injury without long-term consequences. Postoperative urine retention requiring short-term catheterization occurred in three patients. The clinical success rate was 97.6%.

Conclusion

After bypassing the learning curve, VCUG is not routinely indicated following RALUR for VUR.

目的研究儿童在接受机器人辅助腹腔镜输尿管再植术（RALUR）后是否需要常规进行 VCUG 检查以确认膀胱输尿管反流（VUR）：对单中心前瞻性维护的数据库中的患者进行审查：2018-2023年间，42名儿童（48名反流输尿管）在研究机构接受了膀胱外RALUR，平均年龄为70.4+23.7个月。81%的患者为女性，85.7%的患者伴有膀胱和肠道功能障碍。六名患者（14.3%）患有双侧 RALUR。在输尿管中，83.4%（40/48）的患者有 III 级或更高的 VUR，20.8%（10/48）的患者有双肾。36 名（85.7%）患者完成了术后 VCUG 检查。87.5%（35/40）的输尿管经放射学检查确认不再反流。其余 5 个输尿管的 VUR 降为 I 级或 II 级；所有患者均无症状，无一需要再次手术。一名患者因不明原因的单侧输尿管损伤而需要进行为期 6 周的输尿管支架植入术，但未造成长期后果。3名患者术后出现尿潴留，需要短期导尿。临床成功率为 97.6%：结论：在绕过学习曲线后，VCUG 并非治疗 VUR 的 RALUR 的常规方法。

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引用次数: 0

Reply to Editorial Comment on “Virtual Reality as an Adjunct to Traditional Patient Counseling in Patients With Newly Diagnosed Localized Prostate Cancer” 对 "虚拟现实技术作为新诊断的局部前列腺癌患者传统咨询的辅助手段 "的答复

IF 2.1 3区医学 Q2 UROLOGY & NEPHROLOGY

Urology

Pub Date : 2025-02-01 DOI: 10.1016/j.urology.2024.11.008

Alan G. Perry, Eric Qualkenbush, Raymond W. Pak, Ram A. Pathak

引用次数: 0

Editorial Comment on “Trends and Safety of Same-day Discharge for Robot-assisted Laparoscopic Prostatectomy: A Comparison Between the Pre-pandemic and Pandemic Periods From the National Cancer Database” 关于 "机器人辅助腹腔镜前列腺切除术当天出院的趋势和安全性：来自全国癌症数据库的大流行前与大流行期间的比较 "的社论评论。

IF 2.1 3区医学 Q2 UROLOGY & NEPHROLOGY

Urology

Pub Date : 2025-02-01 DOI: 10.1016/j.urology.2024.11.015

Mohammed Shahait

引用次数: 0

A Call for the Inclusion and Reporting of Race and Ethnicity Demographics in Artificial Intelligence Research for Prostate Cancer Detection on Magnetic Resonance Imaging 呼吁在磁共振成像前列腺癌检测的人工智能研究中纳入和报告种族和民族人口统计数据。

IF 2.1 3区医学 Q2 UROLOGY & NEPHROLOGY

Urology

Pub Date : 2025-02-01 DOI: 10.1016/j.urology.2024.11.047

Andrewe L. Baca , Christopher Chung , Devaraju Kanmaniraja , Tim Q. Duong , Kara L. Watts

引用次数: 0

HoLEP Safety and Efficacy in Octogenarians: A Retrospective ACS-NSQIP Analysis (2011-2020) 80岁老人HoLEP的安全性和有效性：ACS-NSQIP回顾性分析（2011-2020）。

IF 2.1 3区医学 Q2 UROLOGY & NEPHROLOGY

Urology

Pub Date : 2025-02-01 DOI: 10.1016/j.urology.2024.10.070

Emad Eddin Dalla , Mukund Bhandari , Ahmad Abdelaziz , Shaun Trecarten , Michael Liss , Ahmed M. Mansour

Objective

To evaluate the safety of Holmium laser enucleation of the prostate (HoLEP) in octogenarian compared to non-octogenarian patients.

Methods

A retrospective cohort analysis was performed using the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database from 2011 to 2020. We assessed baseline demographic data, American Society of Anesthesiologists (ASA) score, functional status, and medical comorbidities. Our primary outcome was the incidence of postoperative complications, the need for re-operation, and readmission within 30 days following the procedure between octogenarians and non-octogenarians. A multivariate logistic model was utilized to identify predictors for postoperative complications.

Results

A total of 5305 patients were included. Octogenarians had higher rates of hypertension (69.9% vs 55.5%, P <.001), and bleeding disorders (5.1% vs 2.6%, P <.001). The absolute risk for postoperative complications was low in the 2 groups. However, the octogenarians had higher rates for readmitted (6.1% vs 3.6% P = .006) and to receive perioperative blood transfusion (3.3% vs 0.9% P-value <.001). Multivariable regression analysis showed a significantly lower odds ratio to develop complications in non-octogenarians (OR: 0.698) (95% CI: 0.537, 0.908, [P = .007]).

Conclusion

There was a significant association between octogenarians and the risk of postoperative complications of HoLEP, however, the absolute risk remained low. We believe that operative outcomes for octogenarians can be optimized with careful selection given the low incidence of complications.

目的：评价钬激光前列腺摘除（HoLEP）在80多岁患者中的安全性，并与非80多岁患者进行比较。方法：采用2011 - 2020年美国外科医师学会国家手术质量改进计划（ACS-NSQIP）数据库进行回顾性队列分析。我们评估了基线人口统计数据、美国麻醉医师协会（ASA）评分、功能状态和医疗合并症。我们的主要结果是80岁和非80岁患者术后并发症的发生率、再次手术的需要以及术后30天内再次入院。采用多变量logistic模型确定术后并发症的预测因素。结果：共纳入5305例患者。80多岁老人的高血压患病率更高（69.9%比55.5%,p < 0.001），出血性疾病患病率更高（5.1%比2.6%,p < 0.001）。两组术后并发症的绝对风险均较低。然而，80岁高龄患者的再入院率（6.1% vs 3.6% p = 0.006）和围手术期输血率（3.3% vs 0.9% p = 0.006）较高。结论：80岁高龄患者与HoLEP术后并发症的风险有显著相关性，但绝对风险仍然较低。我们认为，考虑到并发症的低发生率，精心选择八十多岁老人的手术效果可以得到优化。

{"title":"HoLEP Safety and Efficacy in Octogenarians: A Retrospective ACS-NSQIP Analysis (2011-2020)","authors":"Emad Eddin Dalla , Mukund Bhandari , Ahmad Abdelaziz , Shaun Trecarten , Michael Liss , Ahmed M. Mansour","doi":"10.1016/j.urology.2024.10.070","DOIUrl":"10.1016/j.urology.2024.10.070","url":null,"abstract":"<div><h3>Objective</h3><div>To evaluate the safety of Holmium laser enucleation of the prostate (HoLEP) in octogenarian compared to non-octogenarian patients.</div></div><div><h3>Methods</h3><div>A retrospective cohort analysis was performed using the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database from 2011 to 2020. We assessed baseline demographic data, American Society of Anesthesiologists (ASA) score, functional status, and medical comorbidities. Our primary outcome was the incidence of postoperative complications, the need for re-operation, and readmission within 30 days following the procedure between octogenarians and non-octogenarians. A multivariate logistic model was utilized to identify predictors for postoperative complications.</div></div><div><h3>Results</h3><div>A total of 5305 patients were included. Octogenarians had higher rates of hypertension (69.9% vs 55.5%, <em>P </em><.001). The absolute risk for postoperative complications was low in the 2 groups. However, the octogenarians had higher rates for readmitted (6.1% vs 3.6% <em>P  </em>=.007]).</div></div><div><h3>Conclusion</h3><div>There was a significant association between octogenarians and the risk of postoperative complications of HoLEP, however, the absolute risk remained low. We believe that operative outcomes for octogenarians can be optimized with careful selection given the low incidence of complications.</div></div>","PeriodicalId":23415,"journal":{"name":"Urology","volume":"196 ","pages":"Pages 49-54"},"PeriodicalIF":2.1,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142792267","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Significance of Targeted Antimicrobial Prophylaxis Using Rectal-culture Selective Screening Media Prior to Transrectal Prostate Biopsy: A Multicenter, Randomized Controlled Trial 经直肠前列腺活检前使用直肠培养选择性筛选介质进行靶向抗菌预防的意义：一项多中心随机对照试验。

IF 2.1 3区医学 Q2 UROLOGY & NEPHROLOGY

Urology

Pub Date : 2025-02-01 DOI: 10.1016/j.urology.2024.12.018

Takuya Sadahira , Takanori Sekito , Yuki Maruyama , Takaharu Ichikawa , Yuki Kurihara , Hiromasa Shiraishi , Takafumi Sakuma , Moto Tokunaga , Yosuke Mitsui , Norihiro Kusumi , Yusuke Tominaga , Satoshi Katayama , Takehiro Iwata , Shingo Nishimura , Kohei Edamura , Tomoko Kobayashi , Masami Watanabe , Yoshiki Hiyama , Hiroki Yamada , Hiroki Kurata , Koichiro Wada

Objective

To examine whether antimicrobial prophylaxis based on screening rectal cultures using selective media prevented acute bacterial prostatitis following transrectal prostate biopsy (TRPB).

Methods

In this multicenter, randomized controlled trial, we enrolled 403 patients undergoing TRPB with low risks of infectious complications. Patients were randomized into a cultured group (CG) or no cultured group (NCG). In the CG, patients with positive-culture results for fluoroquinolone (FQ)-resistant or extended-spectrum β-lactamase (ESBL)-producing Escherichia coli (E. coli) used piperacillin/tazobactam as prophylaxis, and those with negative-culture results and in the NCG used levofloxacin. The primary endpoint was the incidence of acute prostatitis after TRPB. The secondary endpoint was the accuracy of the selective media.

Results

Of 373 patients (CG, 187; NCG, 186), 67 were positive, and 120 were negative for rectal culture in the CG. The overall incidence of prostatitis after TRPB was 1.1% (n = 4). The incidences in the CG and the NCG were 1.6% (n = 3, all negative-culture cases) and 0.5% (n = 1), respectively, without significant difference (P = .3). No prostatitis occurred in the positive-culture group. The sensitivity and specificity of the levofloxacin-insusceptible selective media were 98.1% and 94.7%, respectively.

Conclusion

Screening with selective media before TRPB in patients with low infectious risks may provide additive value to preventing post-biopsy prostatitis. Piperacillin/tazobactam can be considered when FQ-resistant or ESBL-producing E. coli is detected.

目的：探讨基于选择性培养基筛选直肠培养物的抗菌预防是否能预防经直肠前列腺活检（TRPB）后急性细菌性前列腺炎。方法：在这项多中心随机对照试验中，我们招募了403例接受低风险感染并发症TRPB的患者。患者随机分为培养组（CG）和无培养组（NCG）。在CG中，培养结果为氟喹诺酮（FQ）耐药或产生广谱β-内酰胺酶（ESBL）的大肠杆菌（E. coli）阳性的患者使用哌拉西林/他唑巴坦作为预防措施，培养结果为阴性的患者和NCG中使用左氧氟沙星。主要终点是TRPB后急性前列腺炎的发生率。次要终点是选择性介质的准确性。结果：373例患者(CG， 187例；NCG 186例，阳性67例，CG直肠培养阴性120例。TRPB术后前列腺炎的总发生率为1.1% （n=4）。CG和NCG的发病率分别为1.6% （n=3，均为阴性培养病例）和0.5% (n=1)，差异无统计学意义（P=0.3）。阳性培养组无前列腺炎发生。左氧氟沙星不敏感选择性培养基的敏感性和特异性分别为98.1%和94.7%。结论：低感染风险患者行TRPB前选择性介质筛查对预防活检后前列腺炎具有附加价值。当检测到fq耐药或产生esbl的大肠杆菌时，可考虑使用哌拉西林/他唑巴坦。

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引用次数: 0

Optimizing the Appropriate Mode of the Pulse-modulated Holmium Laser in a Pop-dusting Benchtop Model 脉冲调制钬激光在喷射台式模型中的合适模式优化。

IF 2.1 3区医学 Q2 UROLOGY & NEPHROLOGY

Urology

Pub Date : 2025-02-01 DOI: 10.1016/j.urology.2024.12.032

Koki Tominaga , Takaaki Inoue , Takuma Usuda , Chinnakhet Ketsuwan

Objective

To investigate the effectiveness of different holmium:yttrium-aluminum-garnet (Ho:YAG) laser modes for lithotripsy in the “dusting era” and identify the optimal laser mode for producing stone fragments measuring ≤0.5 mm.

Methods

We used plaster of Paris-made artificial stones crushed into 2-3 mm pieces, weighing 1 g in total. The primary endpoint was the mass of stone fragments ≤0.5 mm produced by different laser modes. The secondary endpoints were size categories, fragment mass, and changes in irrigation fluid temperature. The Lumenis Pulse 120 H Ho:YAG laser, with a 200-μm fiber, was used in 3 modes (Moses contact [MC], Moses distance [MD], and long pulse [LP], all at 0.5 J × 80 Hz). Laser lithotripsy involved a 20-second exposure with a 10-second pause for 15 cycles, conducted 7 times per mode while measuring the maximum irrigation fluid temperatures for each cycle.

Results

The MC mode demonstrated superior performance in producing fragments ≤0.5 mm (P = .0034) compared with the MD mode. No notable differences were observed for other size categories. The MD and LP modes showed higher rates of mass loss in fluid (MD, P = .023; LP, P = .046) compared with the MC mode. In addition, the increase in irrigation fluid temperature was more pronounced in the MD and LP modes than in the MC mode (MD, P = .015; LP, P = .010).

Conclusion

In renal stone lithotripsy during the “dusting era,” the MC mode is preferable for generating smaller stone fragments ≤0.5 mm. These insights are valuable for optimizing stone fragmentation techniques.

目的：探讨“粉尘时代”不同钬钇铝石榴石（Ho:YAG）激光碎石术的有效性，确定产生≤0.5 mm石片的最佳激光碎石术模式。方法：将巴黎制造的人造石石膏粉碎为2 ~ 3 mm，总重1g。主要终点为不同激光模式下产生的碎石块质量≤0.5 mm。次要终点是大小类别、碎片质量和冲洗液温度的变化。采用Lumenis脉冲120H Ho:YAG激光器，光纤长度为200 μm，采用三种模式（摩西接触[MC]、摩西距离[MD]和长脉冲[LP]，频率均为0.5 J × 80 Hz）。激光碎石术包括20秒的曝光，10秒的暂停，15个周期，每种模式进行7次，同时测量每个周期的最高灌洗液温度。结果：MC模式在产生≤0.5 mm的碎片方面优于MD模式（P= 0.0034）。其他大小类别间无显著差异。MD和LP模式显示出更高的流体质量损失率(MD， P= 0.023；LP， P=.046)与MC模式比较。此外，灌溉液温度在MD和LP模式下的升高比MC模式更明显(MD， P= 0.015；台端面应LP, P =)。结论：在“粉尘时代”的肾结石碎石中，MC模式更适合产生≤0.5 mm的较小的结石碎片。这些见解对优化石头破碎技术很有价值。

{"title":"Optimizing the Appropriate Mode of the Pulse-modulated Holmium Laser in a Pop-dusting Benchtop Model","authors":"Koki Tominaga , Takaaki Inoue , Takuma Usuda , Chinnakhet Ketsuwan","doi":"10.1016/j.urology.2024.12.032","DOIUrl":"10.1016/j.urology.2024.12.032","url":null,"abstract":"<div><h3>Objective</h3><div>To investigate the effectiveness of different holmium:yttrium-aluminum-garnet (Ho:YAG) laser modes for lithotripsy in the “dusting era” and identify the optimal laser mode for producing stone fragments measuring ≤0.5mm.</div></div><div><h3>Methods</h3><div>We used plaster of Paris-made artificial stones crushed into 2-3 mm pieces, weighing 1 g in total. The primary endpoint was the mass of stone fragments ≤0.5mm produced by different laser modes. The secondary endpoints were size categories, fragment mass, and changes in irrigation fluid temperature. The Lumenis Pulse 120 H Ho:YAG laser, with a 200-μm fiber, was used in 3 modes (Moses contact [MC], Moses distance [MD], and long pulse [LP], all at 0.5 J × 80 Hz). Laser lithotripsy involved a 20-second exposure with a 10-second pause for 15 cycles, conducted 7 times per mode while measuring the maximum irrigation fluid temperatures for each cycle.</div></div><div><h3>Results</h3><div>The MC mode demonstrated superior performance in producing fragments ≤0.5mm (<em>P</em> =.0034) compared with the MD mode. No notable differences were observed for other size categories. The MD and LP modes showed higher rates of mass loss in fluid (MD, <em>P</em> =.023; LP, <em>P</em> =.046) compared with the MC mode. In addition, the increase in irrigation fluid temperature was more pronounced in the MD and LP modes than in the MC mode (MD, <em>P</em> =.015; LP, <em>P</em> =.010).</div></div><div><h3>Conclusion</h3><div>In renal stone lithotripsy during the “dusting era,” the MC mode is preferable for generating smaller stone fragments ≤0.5mm. These insights are valuable for optimizing stone fragmentation techniques.</div></div>","PeriodicalId":23415,"journal":{"name":"Urology","volume":"196 ","pages":"Pages 75-81"},"PeriodicalIF":2.1,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142898527","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

A Nomogram Predicting Testicular Sperm Extraction Success in Men With Non-obstructive Azoospermia: A Multi-center Study 预测非梗阻性无精子症男性睾丸取精成功率的提名图：一项多中心研究。

IF 2.1 3区医学 Q2 UROLOGY & NEPHROLOGY

Urology

Pub Date : 2025-02-01 DOI: 10.1016/j.urology.2024.10.038

Erman Ceyhan , Mehmet Vehbi Kayra , Eylem Gul Ates , Yalcın Kizilkan , Mesut Altan , Omer Yildirim , Mehmet Hamza Gultekin , Nebil Akdogan , Eray Hasirci , Tufan Cicek , Iyimser Ure , Cem Sah , Aykut Baser , Umit Gul , Hamdi Ozkara , Kadir Emre Akkus , Tahsin Turunc , Andrology Working Group of the Society of Urological Surgery in Turkey

OBJECTIVE

To develop an efficient and easy-to-use nomogram that can predict testicular sperm extraction (TESE) success in men with non-obstructive azoospermia (NOA) by using pre-operative parameters.

MATERIALS AND METHODS

Data of 3093 men who underwent TESE for NOA were included in this study. Demographic data, testis volumes, presence of varicocele, length of infertility, history of previous surgeries, history of genitourinary infections, smoking status, chromosome abnormalities, presence of Y-chromosome microdeletion, family history of infertility, testis biopsy, surgical data, sperm retrieval rate, final pathology obtained at TESE, follicle-stimulating hormone, luteinizing hormone, and testosterone levels were recorded. The primary outcome was to develop an efficient nomogram that can predict the TESE success in men with NOA. The secondary outcomes were identifying the significant pre-operative parameters that are associated with success in TESE.

RESULTS

Sperm retrieval rate was 50.2%(1553/3093). Testis volume, history of varicocelectomy, chromosome abnormalities, and presence of Y-chromosome microdeletion were shown to affect sperm retrieval rate significantly (P <.05). Sperm retrieval success was higher in men with older age, higher testis volume (>10 mL), lower follicle-stimulating hormone level (≤12.92 mIU/mL), lower luteinizing hormone level, and higher testosterone level (P <.05). Only testis volume and patient’s age were associated with successful sperm retrieval in multivariate logistic regression analysis.

CONCLUSION

In men with NOA, high testis volume, old age, low follicle-stimulating hormone level, low luteinizing hormone level, and high testosterone level are advantageous for successful sperm retrieval in TESE. Herein, we present a nomogram that can predict the outcome of TESE in men with NOA with adequate success.

目的利用术前参数，开发一种高效且易于使用的提名图，以预测非梗阻性无精子症（NOA）男性睾丸取精术（TESE）的成功率：本研究纳入了3093名因无精子症而接受睾丸取精术（TESE）的男性数据。研究记录了人口统计学数据、睾丸体积、是否存在精索静脉曲张、不育时间长短、既往手术史、泌尿生殖系统感染史、吸烟状况、染色体异常、是否存在Y染色体微缺失、不育家族史、睾丸活检、手术数据、取精率、睾丸取精最终病理结果、促卵泡激素、促黄体生成素、睾酮水平。主要研究结果是制定一个有效的提名图，以预测无精子症男性的 TESE 成功率。次要结果是确定与 TESE 成功率相关的重要术前参数：取精率为 50.2%（1553/3093）。结果显示，睾丸体积、精索静脉曲张切除术史、染色体异常、Y染色体微缺失显著影响取精率（p10mL），促卵泡激素水平较低（≤12.92mIU/mL），黄体生成素水平较低，睾酮水平较高（p结论：在无精子症男性中，睾丸体积大、年龄大、促卵泡生成素水平低、黄体生成素水平低和睾酮水平高有利于 TESE 取精成功。在此，我们提出了一个提名图，该图可预测 NOA 男性 TESE 的结果，并可获得足够的成功率。

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引用次数: 0