Urology Practice最新文献

Introduction: Ultrasound (US) guided supine percutaneous nephrolithotomy (PCNL) is increasingly being adopted. The aim of this study is to assess the safety and efficacy of lower versus non-lower pole access in supine US-guided PCNL.

Methods: This study is a retrospective cohort analysis of 228 patients who underwent single access US-guided supine PCNL between March 2023 and June 2024 and were categorized into lower (n=162), interpolar (n=42) and upper pole (n=21) access categories. Baseline demographics, stone characteristics and intraoperative details were analyzed and compared between the groups. Safety outcomes, including 30-day postoperative total and major complications (based on Clavien-Dindo classification), as well as pain scores, were compared between lower pole access (LPa) and non-LPa access.

Results: Baseline clinical and stone characteristics were comparable between the groups. Non-LPa was more frequently performed on the right side (p=0.04), above 12th rib (p<0.001), into a posterior calyx (p=0.004), and more often followed by stent placement (p=0.01). Major complications occurred in 14% of the patients with upper pole access compared to 2% with LPa (p=0.03) and 5% with interpolar. Additionally, the LPa group had lower rates of total complications compared to upper pole and interpolar (11% vs 19% and 22% respectively, p=0.05). There were two visceral injuries in the interpolar group. VAS pain scores at the recovery room were not different between the groups.

Conclusion: When performing US-guided supine PCNL, LPa has a superior safety profile, resulting in fewer major and total complications compared to non-LPa.

Introduction: Bilateral renal masses (BRM) are classically linked to inherited familial syndromes, often associated with distinct histologies. Current guidelines recommend genetic counseling for all BRM patients, however the utility of genetic testing in BRM patients with apparently sporadic etiology remains unclear. Our objective was to characterize histologic pairings between the index/contralateral renal masses and evaluate the value of genetic testing across histologic subgroups.

Methods: We reviewed 527 patients surgically treated for BRM (2002-2024), and 414 had no evidence of familial etiology. Histologic concordance between the index (first operated) and contralateral renal masses were assessed. Adherence with genetic testing and outcomes were compared across histologic groupings.

Results: Histologic concordance between the index/contralateral masses was observed in most patients: 78% for clear cell, 70% for papillary, and 74% for oncocytic neoplasms. Overall, only 88 patients (21%) were referred for genetic counseling, and germline genetic testing was performed in 53 (13%). Pathogenic variants were only observed in 4 patients, including one hereditary-papillary-renal-carcinoma, two Birt-Hogg-Dubé, and one tuberous sclerosis. No pathogenic variants were observed in the bilateral clear cell group.

Conclusion: Among patients with BRM with apparently sporadic etiology, strong concordance between bilateral histologies was observed. Although guidelines recommend genetic counseling for all BRM patients, our findings suggest that testing was underutilized and diagnostic yield was low, particularly for high-risk mutations (e.g. VHL or FH-deficient RCC). These findings suggest that genetic testing for BRM patients could be considered selectively, prioritizing patients with extrarenal manifestations, family history, young age, or pathology suspicious for hereditary etiology.

Introduction: Kidney stone recurrence can be reduced by implementing AUA medical management guidelines. We assessed whether machine learning (ML) could identify patients at risk for symptomatic kidney stone recurrence events.

Methods: We retrospectively reviewed electronic health records with kidney stone diagnosis over a 16-year period (January 2008 to December 2023). Using historical data from a large integrated health system, we applied supervised ML to build a model that identifies patients at risk for symptomatic recurrence events within 12 months after an initial stone encounter with a urologist. The model used 952 candidate features drawn from both a clinician-curated set of kidney stone-specific factors and a general set of common diagnoses, laboratory results, medications, procedures, and utilization records were used as inputs to the model.

Results: Our model was tested and trained on data collected for 154,876 patients older than 16 years with urinary stone; 1,439,671 unique kidney stone encounters were attributable to this population. The algorithm was trained on 123,900 (80%) and tested on 30,976 (20%) patients. In the test set, the model predicted 1-year risk of symptomatic recurrence with an area under the receiver operating characteristic curve of 0.727.

Conclusions: ML models can effectively discriminate between high and low risk of urinary stone recurrence events.