Journal of endourology最新文献

{"title":"Laparoscopic <i>vs</i> Robotic Adrenalectomy: A Systematic Review and Meta-Analysis.","authors":"Lijian Gan, Jiyue Wu, Feilong Zhang, Haoyuan Cao, Zhen Li, Zihao Gao, Huawei Cao, Zejia Sun, Wei Wang","doi":"10.1177/08927790251363614","DOIUrl":"https://doi.org/10.1177/08927790251363614","url":null,"abstract":"<p><p><b><i>Objective:</i></b> Comparing the safety and effectiveness of robot-assisted laparoscopic adrenalectomy (RA) <i>vs</i> laparoscopic adrenalectomy (LA) in various adrenal tumors. <b><i>Methods:</i></b> We conducted this systematic review and meta-analysis of the primary outcomes of interest according to the PRISMA and AMSTAR guidelines. Five databases were systematically searched, including Medline, PubMed, Cochrane Library, Scopus, and Web of Science. The search time frame was set from database creation to January 2025. <b><i>Results:</i></b> There were 45 studies, including 7225 patients. Compared with LA, RA was superior in terms of estimated blood loss (EBL) [weighted mean difference (WMD) = -20.89, 95% confidence interval or CI (-28.51, -13.28), <i>P</i> < 0.01], length of stay (LOS) [WMD = -0.28, 95% CI (-0.40, -0.17), <i>P</i> < 0.01], bowel recovery time [WMD = -0.54, 95% CI (-0.82, -0.27), <i>P</i> < 0.01], conversion [odds ratio (OR) = 0.39, 95% CI (0.25, 0.60), <i>P</i> < 0.01], and total complications [OR = 0.70, 95% CI (0.57, 0.86), <i>P</i> < 0.01]. The two surgical groups were comparable in terms of operative time (OT), transfusion, readmission, Clavien-Dindo I-II complications, and Clavien-Dindo >II complications. Subgroup analyses found that compared with transperitoneal LA (TLA), robot-assisted TLA was superior in terms of EBL [WMD = -22.51, 95% CI (-39.04, -5.98), <i>P</i> < 0.01] and total complications [OR = 0.60, 95% CI (0.39, 0.90), <i>P</i> < 0.05]. The two surgical groups were comparable in terms of OT and LOS. Compared with retroperitoneal LA (RLA), robot-assisted RLA was superior in terms of OT [WMD = 18.74, 95% CI (5.89, 31.58), <i>P</i> < 0.01] and EBL [WMD = -21.41, 95% CI (-36.85, -5.97), <i>P</i> < 0.01]. The two surgical groups were comparable in terms of LOS, and total complications. For pheochromocytomas (PHEOs), RA was superior in terms of EBL, LOS, and intraoperative hemodynamic instability. For large adrenal tumors (≥5 cm), RA was superior in terms of OT, EBL, and LOS. For obesity, RA was superior in terms of EBL. The two surgical groups were comparable in terms of OT, LOS, conversion, and total complications. <b><i>Conclusion:</i></b> Robot-assisted laparoscopic procedure is superior to conventional laparoscopic procedure in the treatment of adrenal tumors, particularly for patients with large adrenal tumors (≥5 cm), obesity, and PHEOs.</p>","PeriodicalId":15723,"journal":{"name":"Journal of endourology","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2025-07-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144753532","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":"Increased Risk of Kidney Stones in Transgender Women and Gender-Diverse Adults on Gender-Affirming Hormone Therapy: Insights from a Large Database Study.","authors":"Eve Frangopoulos, Ziv Savin, Kavita Gupta, Vinay Durbhakula, Blair Gallante, William M Atallah, Mantu Gupta","doi":"10.1177/08927790251363612","DOIUrl":"https://doi.org/10.1177/08927790251363612","url":null,"abstract":"<p><p><b><i>Introduction:</i></b> Transgender and gender-diverse (TGD) individuals represent a growing yet underrepresented group in medical literature. Estrogen and antiandrogens are essential in feminizing gender-affirming hormone therapy (f-GAHT) for individuals assigned male at birth (AMAB). This study examines f-GAHT effects on <i>de novo</i> nephrolithiasis risk in TGD individuals AMAB. <b><i>Methods:</i></b> This big data study utilizes medical records from the National Institutes of Health's <i>All of Us</i> database. The cohort includes patients AMAB who self-identified as non-binary, female, transgender women or had a relevant gender diagnosis. The cohort was divided into f-GAHT and non-f-GAHT groups. Cumulative incidence was calculated for each group. Participants were subdivided into estrogen-only f-GAHT (e-f-GAHT) and combined estrogen and antiandrogen f-GAHT (c-f-GAHT) groups. Univariate, unweighted multivariate, and weighted propensity score multivariate analyses were used to explore the association between nephrolithiasis and GAHT. <b><i>Results:</i></b> A total of 777 patients AMAB met our inclusion and exclusion criteria. The cumulative incidences of kidney stones were 10.3% and 4.8% in the f-GAHT and non-f-GAHT groups, respectively (<i>p</i> = 0.01). Kidney stone odds were 2.53 and 2.76 times greater in the unweighted and weighted regressions for f-GAHT compared with non-f-GAHT patients (<i>p</i> = 0.044 and <i>p</i> < 0.001, respectively). C-f-GAHT was associated with kidney stones in a weighted model (odds ratio [OR]: 2.63, 95% confidence interval [CI]: 1.44, 4.97, <i>p =</i> 0.002), whereas e-f-GAHT was not (OR = 1.88, 95% CI: 0.85, 4.32, <i>p</i> = 0.13). <b><i>Conclusions:</i></b> We observed a greater <i>de novo</i> incidence of nephrolithiasis among patients on f-GAHT. Antiandrogen therapy may work synergistically with estrogen to increase nephrolithiasis risk. Patients AMAB should be counseled about increased risk when starting f-GAHT, particularly if antiandrogens are included.</p>","PeriodicalId":15723,"journal":{"name":"Journal of endourology","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2025-07-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144742245","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":"Flexible Ureteroscopy and Laser Lithotripsy Using a Flexible and Navigable Ureteral Access Sheath Are Equally Safe and Effective whether Done in a Sitting or a Standing Position: A Multicenter Study by European Association of Urology-Endourology and the Flexible and Navigable Suction Access Sheath Collaborative Group.","authors":"Khi Yung Fong, Bhaskar Somani, Patrick Juliebø-Jones, Daniele Castellani, Chin Tiong Heng, Jia-Lun Kwok, Chu-Ann Chai, Wissam Kamal, Chinnakhet Ketsuwan, Kremena Petkova, Boyke Soebhali, Marek Zawadzki, Saeed Bin Hamri, Mohamed Elshazly, Yi Quan Tan, Pablo Nicolas Contreras, Lazaros Tzelves, Andreas Skolarikos, Steffi Yuen, Olivier Traxer, Vineet Gauhar","doi":"10.1177/08927790251364288","DOIUrl":"https://doi.org/10.1177/08927790251364288","url":null,"abstract":"<p><p><b><i>Introduction:</i></b> Flexible ureteroscopy (FURS) using the flexible and navigable suction ureteral access sheath (FANS) is a novel technique for treatment of kidney stones. We aimed to compare outcomes of FURS with FANS in the sitting vs standing position. <b><i>Patients and Methods:</i></b> We analyzed adult patients from 21 centers who underwent FURS with FANS, divided according to whether the surgeon operated in a sitting or standing position. Baseline demographics, operative parameters, and 30-day outcomes were compared. Multivariable logistic regression was used to identify potential predictive factors for zero residual fragments (ZRF). <b><i>Results:</i></b> There were 457 patients in the sitting group and 247 patients in the standing group. In the sitting group, more patients had the surgical procedure under general anesthesia (<i>p</i> = 0.022). Disposable scopes were preferred in the standing group (<i>p</i> < 0.001). Median lasing and ureteroscopy time were significantly shorter in the siting group, but there was no difference in total surgical time (median 45 vs 46 minutes, <i>p</i> = 0.102). A larger but nonsignificant percentage of grade 1 access sheath insertion injuries were reported in the standing position. Multivariable logistic regression analysis showed that stone volume (odds ratio [OR]: 0.82, 95% confidence interval [CI]: 0.72-0.93, <i>p</i> = 0.003) and operative time (OR: 0.99, 95% CI 0.99-1.00, <i>p</i> = 0.002) but not surgeon position (OR: 1.04, 95% CI: 0.75-1.44, <i>p</i> = 0.82) were significant predictors of ZRF. Procedural safety was not compromised significantly. <b><i>Conclusions:</i></b> FURS with FANS is equally safe and effective in the sitting and standing positions. This study provides the impetus to improve FURS ergonomics, especially with the move toward its use in complex and large stones.</p>","PeriodicalId":15723,"journal":{"name":"Journal of endourology","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2025-07-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144742244","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":"Calcium Oxalate Monohydrate and Dihydrate Stone Formers: Differing Surgical Recurrence Rates and Metabolic Profiles in a Large Cohort.","authors":"Tzach Aviv, Sagi A Shpitzer, Nadav Loebl, Leor Perl, Abd E Darawsha, Yaron Ehrlich, Dmitry Enikeev, David Lifshitz","doi":"10.1177/08927790251364280","DOIUrl":"https://doi.org/10.1177/08927790251364280","url":null,"abstract":"<p><p><b><i>Background:</i></b> Calcium oxalate (CaOx) stones have a lower recurrence rate compared with other stone types. However, their high prevalence results in a substantial clinical and economic burden. Calcium oxalate monohydrate (COM) and dihydrate (COD) are the main CaOx stone subtypes. The clinical significance of the presence of COM or COD is not certain. This study aims to evaluate the surgical recurrence rates and metabolic profiles of different CaOx stone subtypes. <b><i>Patients and Methods:</i></b> A retrospective analysis of surgically treated patients with an available stone composition analysis performed between 2013 and 2022 in a large health care provider database. Data were analyzed for as much as 5 years from the initial surgery. Demographic, metabolic, and surgical characteristics were collected. Stones were classified based on their dominant component (>50%). Patients with COM stones were compared with those with COD stones. <b><i>Results:</i></b> The study cohort included 16,091 patients with stone analysis. Of these, 13,018 (80.9%) had CaOx stones, classified into COM (10,891; 83.7%) and COD (2127; 16.3%) groups. Compared with COM patients, COD patients were significantly younger (<i>p</i> < 0.01) and had fewer comorbidities. COD patients exhibited significantly higher urine calcium levels (242 mg/day <i>vs</i> 156 mg/day, <i>p</i> < 0.01) and lower citrate levels (377 mg/day <i>vs</i> 402 mg/day, <i>p</i> = 0.03). Conversely, COM patients had higher sodium excretion (161 mg/day <i>vs</i> 144 mg/day, <i>p</i> < 0.01). The 5-year surgical recurrence rate was 47% higher in COD patients compared with COM patients (14.3% <i>vs</i> 9.8%; hazard ratio (HR) = 1.53, 95% confidence interval: 1.33-1.76, <i>p</i> < 0.001). Additionally, COD patients required more repeat surgeries on average (1.45 <i>vs</i> 1.34, <i>p</i> = 0.04). A dominant COD composition was a significant predictor for 5-year surgical recurrence (HR = 1.69, 1.38-2.07, <i>p</i> < 0.001). <b><i>Conclusions:</i></b> CaOx stone subtypes exhibit distinct metabolic characteristics and surgical recurrence rates. COD patients are more likely to experience surgical stone recurrence. Therefore, patients with a dominant COD stone composition may require a more comprehensive metabolic workup and closer follow-up.</p>","PeriodicalId":15723,"journal":{"name":"Journal of endourology","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2025-07-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144731589","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":"Single-Center Experience of Robot-Assisted Nephrectomy and Venous Tumor Thrombectomy: Indications, Surgical Strategies, and Long-Term Outcomes.","authors":"Qingbo Huang, Kan Liu, Cheng Peng, Zhi Li, Xinran Chen, Qilong Jiao, Qingjiang Xu, Jialong Song, Zhuo Jia, Liangyou Gu, Shichao Li, Guodong Zhao, Shuanglei Li, Haiyi Wang, Xiaohui Ding, Qiuyang Li, Feng Duan, Hauchun Khoo, Baojun Wang, Xu Zhang, Xin Ma","doi":"10.1177/08927790251363235","DOIUrl":"https://doi.org/10.1177/08927790251363235","url":null,"abstract":"<p><p><b><i>Purpose:</i></b> To introduce the indications and surgical strategies of robot-assisted nephrectomy and venous tumor thrombectomy (RA-N-VTT) and to assess the long-term outcomes in a high-volume, single-center setting. <b><i>Materials and Methods:</i></b> We retrospectively enrolled 309 patients with renal tumors and venous tumor thrombus who underwent a robotic procedure in our center between June 2013 and December 2023. To better define the indications and surgical strategies for RA-N-VTT, we proposed the Chinese People's Liberation Army General Hospital (PLAGH) classification system, incorporating three modifications to the Mayo Clinic classification system. Specifically, thrombus within the left renal vein was divided into levels 0a and 0b based on the landmark of superior mesenteric artery. Retrohepatic inferior vena cava thrombus was reclassified using the first and second portal hepatis as landmarks. In addition, level IV thrombus was subclassified into levels IVa and IVb, depending on whether it entered the atrium. Long-term perioperative surgical and survival outcomes were analyzed. <b><i>Results:</i></b> All operations were effectively completed, except for six patients converted to open procedure. There were significant differences in perioperative outcomes among patients with different PLAGH levels of thrombus (<i>p</i> < 0.001). With a median follow-up of 47.8 months, the median overall survival (OS) and progress-free survival of all patients were 75.4 and 44.7 months, respectively. Multivariable analysis identified that distant metastasis and tumor grade were independent risk factors for OS, as well as PLAGH classification (<i>p</i> < 0.05). <b><i>Conclusions:</i></b> Our results indicated that RA-N-VTT is safe and feasible. The PLAGH classification system effectively guides robotic surgical planning and provides acceptable surgical and survival outcomes in selected patients.</p>","PeriodicalId":15723,"journal":{"name":"Journal of endourology","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2025-07-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144731590","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":"<i>Letter:</i> Comment on \"Is Outpatient Totally Tubeless Standard Percutaneous Nephrolithotomy Safe and Efficacious?\"","authors":"Guglielmo Mantica, Francesco Chierigo","doi":"10.1177/08927790251363553","DOIUrl":"https://doi.org/10.1177/08927790251363553","url":null,"abstract":"","PeriodicalId":15723,"journal":{"name":"Journal of endourology","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2025-07-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144731588","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":"Perioperative Outcomes of Robot-Assisted Partial Nephrectomy with MP1000 Surgical System <i>vs</i> da Vinci Xi Surgical System and Evaluation of the MP1000 Learning Curve.","authors":"Honglei Wang, Ziyu Dong, Radheshyam Gupta, Tao Xu, Jianzhang Li, Dexin Ding, Yangyang Xu, Lichen Teng, Pengyu Guo, Jinqiao Li, Yongliang Sun, Yuchen Bao, Ziqi Wang, Wanhai Xu","doi":"10.1089/end.2024.0870","DOIUrl":"https://doi.org/10.1089/end.2024.0870","url":null,"abstract":"<p><p><b><i>Objective:</i></b> To compare the perioperative outcomes between the MP1000 and da Vinci Xi surgical systems in robot-assisted partial nephrectomy (RAPN) and examine the MP1000 learning curve. <b><i>Methods:</i></b> In this prospective single-center study, 90 patients undergoing RAPN were equally allocated to the MP1000 (<i>n</i> = 45) or da Vinci Xi (<i>n</i> = 45) groups. Perioperative outcomes were analyzed, and the learning curve was assessed for MP1000 group operative times. <b><i>Results:</i></b> All procedures were completed without positive surgical margins. Significant discrepancies were observed in operation time, docking time, and estimated blood loss (<i>p</i> < 0.05). Postoperative estimated glomerular filtration rate (day 2), length of stay, and complication rate showed no significant differences. The cumulative sum curve was best fit by the equation <math><mrow><mo> </mo><mi>y</mi><mo>=</mo><mo>-</mo><mn>0.0002</mn><mrow><msup><mrow><mi>x</mi></mrow><mn>4</mn></msup></mrow><mo>+</mo><mn>0.0568</mn><mrow><msup><mrow><mi>x</mi></mrow><mn>3</mn></msup></mrow><mo>-</mo><mn>3.6013</mn><mrow><msup><mrow><mi>x</mi></mrow><mn>2</mn></msup></mrow><mo>+</mo><mn>69.011</mn><mi>x</mi></mrow></math>, and <math><mrow><mrow><msup><mrow><mi>R</mi></mrow><mn>2</mn></msup></mrow><mo>=</mo><mn>0.8806</mn></mrow></math>, with peak at case 13, and is subsequently delineated into a learning group (1-13 cases) and a skilled group (14-45 cases). The two groups exhibited comparable baseline characteristics. <b><i>Conclusion:</i></b> The MP1000 system is effective for partial nephrectomies, with all cases completed effectively. Meanwhile, surgeons with prior experience using the da Vinci Xi system achieve proficiency with the MP1000 after 13 procedures.</p>","PeriodicalId":15723,"journal":{"name":"Journal of endourology","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2025-07-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144718002","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":"<i>Letter:</i> Reply to Letter to the Editor on \"Trifecta of Same-Day Discharge after Single-Port Robotic-Assisted Simple Prostatectomy\".","authors":"Hakan Bahadir Haberal, Luca Lambertini, Matteo Pacini, Giulio Avesani, Fabio Maria Valenzi, Muhannad Aljoulani, Ruben Calvo Sauer, Juan Ramon Torres-Anguiano, Simone Crivellaro","doi":"10.1177/08927790251363253","DOIUrl":"https://doi.org/10.1177/08927790251363253","url":null,"abstract":"","PeriodicalId":15723,"journal":{"name":"Journal of endourology","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2025-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144715083","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":"Endoscopic Evaluation of Ureteral Stone Impaction Highlights Significant Variability in Definitions Between Endourologists.","authors":"Jared S Winoker, Brendan Yi, Robert Chang, Raymond Khargi, Jonathan Khusid, William Atallah, Mantu Gupta, Dima Raskolnikov, Alexander Small, Charan Mohan, Gregory Mullen, Sarah Razavi, Tareq Aro, Christopher Hartman, David Hoenig, Zeph Okeke, Arthur Smith, Arun Rai","doi":"10.1177/08927790251362867","DOIUrl":"https://doi.org/10.1177/08927790251362867","url":null,"abstract":"<p><p><b><i>Introduction:</i></b> Previous studies attempting to predict impaction on CT have relied on various criteria without a gold standard for comparison. Intraoperative single-surgeon estimations of impaction have been unvalidated and subjective. This study aimed to investigate surgeon perspectives and variability in estimating ureteral stone impaction based on a curated ureteroscopy video catalog. <b><i>Methods:</i></b> A catalog of 35 primary ureteroscopy cases was distributed to a group of fellowship-trained endourologists. All videos featured visual inspection of tissue around the stone, attempted passage of a guidewire adjacent to the stone, and an attempt to dislodge the stone with gentle nudging of the scope. Participants independently rated impaction on two different scales: continuous (0-9) and categorical (none/mild/moderate/severe). After a first pass, participants rated the videos in a new, random order. Inter- and intrarater agreement across both rating systems was evaluated. <b><i>Results:</i></b> In total, 35 videos were evaluated by 13 endourologists. Overall, 13/35 videos had strong agreement (>70%) on the degree of impaction (6 none, 7 severe), and only 2 of these had 100% agreement (1 none, 1 severe). Continuous scale ratings mirrored the categorical ratings for the none and severe impaction cases. There were no cases with consensus agreement of mild or moderate impaction. More than one-third (12/35) of videos had at least one vote for each of the four severity categories, indicating stark disagreement between surgeons on what constitutes impaction. <b><i>Conclusions:</i></b> There is significant variability among endourologists regarding the definition and severity of stone impaction. When strong agreement occurs, it is when a stone is deemed to be severely impacted or not impacted. Further work is needed to create a standardized definition of impaction based on objective endoscopic criteria. A tripartite classification system may be the most appropriate manner of grouping ureteral stones based on impaction.</p>","PeriodicalId":15723,"journal":{"name":"Journal of endourology","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2025-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144715084","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":"Illuminating Gaps in Laser Education in Urology Residency Programs.","authors":"Kyle R DeRoma, Raymond Lanzafame, Greg Adey, Lori B Lerner","doi":"10.1177/08927790251360267","DOIUrl":"https://doi.org/10.1177/08927790251360267","url":null,"abstract":"<p><p><b><i>Purpose:</i></b> Urologists utilize numerous laser technologies. The American Urological Association (AUA) has an online laser education module, but no standardized program curriculum is required. We sought to understand gaps in knowledge surrounding laser technologies in the AUA New England (NE) Section to inform decisions around the annual Residents Skills Course and overall resident education. <b><i>Methods:</i></b> An anonymous questionnaire assessing basic laser information and attitudes was created. All academic urology training programs in NE (<i>n</i> = 12) were invited. Responders were encouraged to give their best guess rather than confer or look up answers. <b><i>Results:</i></b> A total of 62% of residents (<i>n</i> = 72) and 62 attendings from the 12 NE programs participated. The most common laser technology uses were nephrolithiasis, urothelial cancer, prostate, strictures, and skin. Faculty varied as regards which diseases residents should apply lasers, be trained in, and show competence. Residents felt less confident in their baseline knowledge as compared with attendings, but most in both groups rated their knowledge lower after completing the questionnaire. Knowledge of the nominal optical hazard distance for each wavelength was negligible. Some respondents could not differentiate between laser wavelength, depth of penetration, Joules, Hertz, or Watts; and very few could explain the difference between standard holmium and Moses, and thulium (solid state) <i>vs</i> thulium fiber. <b><i>Conclusions:</i></b> Gaps in knowledge surrounding laser technologies are significant. Urologists acknowledge deficiencies, yet only 25% to 32% are very likely to seek information on their own. Standardized laser education that is frequently updated and delivered will improve overall knowledge and reduce the risk for patient harm.</p>","PeriodicalId":15723,"journal":{"name":"Journal of endourology","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2025-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144715085","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}