Journal of endourology最新文献

{"title":"Clinical Utility of Ureteral Optical Coherence Tomography for T Staging of Ureteral Cancer: NOCTURN Study.","authors":"Makito Miyake, Takuto Shimizu, Nobutaka Nishimura, Tomoya Ueda, Kazuki Yamamoto, Yuki Oda, Tatsuki Miyamoto, Mitsuru Tomizawa, Takuya Owari, Kota Iida, Kenta Onishi, Shunta Hori, Yosuke Morizawa, Daisuke Gotoh, Yasushi Nakai, Makoto Watanabe, Tomomi Fujii, Nobumichi Tanaka, Kiyohide Fujimoto","doi":"10.1177/08927790251387367","DOIUrl":"https://doi.org/10.1177/08927790251387367","url":null,"abstract":"<p><p><b><i>Objectives:</i></b> One of the major limitations of the current diagnostic techniques for upper urinary tract carcinoma (UTUC) is the risk of both understaging and overstaging, highlighting the need for real-time, high-resolution intraoperative imaging. We evaluated the diagnostic accuracy and safety of ureteral optical coherence tomography (OCT) under ureterorenoscopy for T staging of UTUC. <b><i>Materials and Methods:</i></b> In this study, patients with suspected UTUC were prospectively enrolled. The safety analysis set included 16 patients who underwent ureteral OCT for ureteral tumors. Because two (13%) patients underwent ureterorenoscopic ablation therapy, the diagnostic accuracy analysis set included 14 of 16 patients who had both ureteral OCT data and a final pathological T (pT) stage from surgical specimens. The concordance, underdiagnosis, and overdiagnosis rates were compared between radiographical imaging-based T (cT) and OCT-based T (octT) diagnoses. The primary outcome was the diagnostic accuracy of ureteral OCT in discriminating between pTis/Ta/T1 (non-muscle-invasive UTUC) and T2/T3 (muscle-invasive UTUC) cancers. <b><i>Results:</i></b> Concordance between cT-based and pT-based diagnoses was observed in 11 (79%) of the 14 patients, whereas a higher concordance rate (13/14, 93%) was noted for octT diagnosis. Additionally, the underdiagnosis and overdiagnosis rates of octT were 0% and 7.1%, respectively, which were lower than those of cT (7.1% and 14%, respectively). Although no intraprocedural urinary injury was observed, postprocedural complications included hematuria in five patients (31%), urinary tract pain in two (13%), and urinary tract infection in one patient (6.3%). <b><i>Conclusion:</i></b> Ureteral OCT exhibited a high diagnostic performance in discriminating between non-muscle-invasive UTUC and muscle-invasive UTUC with a safety profile. Further prospective trials with large sample sizes are necessary to determine the true diagnostic value and the wide use of ureteral OCT.</p>","PeriodicalId":15723,"journal":{"name":"Journal of endourology","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2025-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145308183","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> Enhancing Stone Volume Estimation Accuracy: Future Directions.","authors":"Fu-Xiang Lin, Ciyi Guan, Zhan-Ping Xu","doi":"10.1177/08927790251387346","DOIUrl":"https://doi.org/10.1177/08927790251387346","url":null,"abstract":"","PeriodicalId":15723,"journal":{"name":"Journal of endourology","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2025-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145232602","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":"Percutaneous Cystolitholapaxy and Open Cystolithotomy in Exstrophy-Epispadias Complex: A Comparative Approach to Bladder Stone Management.","authors":"Jason Yang, David Heap, Victoria Maxon, Catherine Robey, Mahir Maruf, Chloe Michel, Heather N Di Carlo, John P Gearhart, Chad B Crigger","doi":"10.1177/08927790251384294","DOIUrl":"https://doi.org/10.1177/08927790251384294","url":null,"abstract":"<p><p><b><i>Background:</i></b> Patients with exstrophy-epispadias complex (EEC) often present with attenuated fascia. Currently, there is no direct comparison of outcomes between percutaneous cystolitholapaxy and open cystolithotomy in this specific patient population. Thus, we sought to evaluate the therapeutic efficacy and associated morbidity of both surgical approaches in patients with EEC. <b><i>Methods:</i></b> Patients who underwent either their first percutaneous cystolitholapaxy or open cystolithotomy between 2003 and 2023 were identified using an IRB-approved institutional database of 1512 patients with EEC. <b><i>Results:</i></b> Among 66 patients, 8 (12.12%) underwent percutaneous cystolitholapaxy without augmentation, 31 (46.97%) underwent percutaneous cystolitholapaxy with augmentation, 11 (16.67%) underwent open cystolithotomy without augmentation, and 16 (24.24%) underwent open cystolithotomy with augmentation. Compared with the open approach, the percutaneous approach resulted in shorter operative times: 123 (interquartile ranges [IQR]: 81-151) <i>vs</i> 218 minutes (IQR: 142-281) for patients with augmentation, and 131 (IQR: 115.5-141) <i>vs</i> 196 minutes (IQR: 176.5-287.3) for those without augmentation (<i>p</i> = 0.0002). Hospital stays were shorter with the percutaneous approach: 1 (IQR: 1-1) <i>vs</i> 3 days (IQR: 1-4) with augmentation, and 1.5 (IQR: 1-2) <i>vs</i> 3 days (IQR: 1-4) without augmentation (<i>p</i> = 0.0044). Notably, the percutaneous group had smaller stone volumes (7.15 cm³, IQR: 2.73-24.31 <i>vs</i> 31.04 cm³, IQR: 10.77-107.40, <i>p</i> = 0.0011). Both techniques achieved a 100% stone-free rate (<i>p</i> > 0.99). There were no differences in recurrence (<i>p</i> = 0.20) and cumulative incidence (HR 0.76, 95% confidence interval: 0.39-1.48, <i>p</i> = 0.38) between groups. Postoperative complications revealed that vesicocutaneous fistulas were most common in open surgery without augmentation (<i>n</i> = 5, 45.45%), followed by open with augmentation (<i>n</i> = 1, 6.25%), and none in the percutaneous groups (<i>p</i> = 0.0002). <b><i>Conclusion:</i></b> Percutaneous cystolitholapaxy provided significant advantages for patients with EEC, including shorter operative times and reduced hospital stays, with equivalent stone clearance. Moreover, open cystolithotomy carried a higher risk of vesicocutaneous fistula formation. These findings suggest percutaneous approaches may offer a safer and more efficient alternative for managing bladder stones in patients with EEC.</p>","PeriodicalId":15723,"journal":{"name":"Journal of endourology","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2025-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145199494","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":"X-Ray Free Ultrasound-Guided Percutaneous Nephrolithotomy with Endoscopic Combined Intrarenal Surgery Is Feasible, Effective, and Safe for Staghorn Calculi.","authors":"Austin L Chien, Tyler A On, Irasema C Paster, Connor Hofmann, Lacey E Culpepper, Carly J Deal, Jack R Hannallah, Chiu-Hsieh Hsu, Thomas Chi, David T Tzou","doi":"10.1177/08927790251384209","DOIUrl":"https://doi.org/10.1177/08927790251384209","url":null,"abstract":"<p><p><b><i>Background:</i></b> Percutaneous nephrolithotomy under ultrasound-guided access (US-PCNL) has multiple advantages compared with fluoroscopy. No prospective data currently examine the efficacy of this technique for the management of staghorn stones. Our objective was to determine the safety and effectiveness of US-PCNL for the management of staghorn calculi through a prospective cohort study, using strict definitions of stone free based on postoperative computed tomography (CT) imaging. <b><i>Methods:</i></b> Utilizing a prospective cohort of US-PCNLs performed by a single surgeon between October 2020 and September 2024, data were collected as part of Registry for Stones of the Kidney and Ureter at the University of Arizona. Inclusion criteria were the presence of staghorn stone(s) on preoperative CT imaging, with a staghorn defined as occupying the renal pelvis and either ≥2 calyces (partial staghorn [PS]) or ≥4 calyces (complete staghorn). Patients were excluded if fluoroscopy was used at any point intraoperatively or if they did not undergo a CT within 90 days postop to assess for residual stones. The primary outcomes were complete stone-free rate (SFR), rate of residual fragments <4 mm, and complication rate, with stone-free status and residual fragments measured on postoperative CT scan. <b><i>Results:</i></b> Of 175 PCNLs performed, 56 met inclusion criteria. Among 24 (42.9%) complete and 32 (57.1%) PSs, median aggregate linear dimension was 57.0 mm, with a median S.T.O.N.E. nephrolithometry score of 10. 19/56 (33.9%) patients were completely stone-free Grade A after a single US-PCNL, and 25/56 (44.6%) had residual fragments 4 mm or less (stone-free Grade C). The overall complication rate was 25/56 (44.6%), where the majority (20/25) were minor (Clavien-Dindo 1 and 2) with five patients (8.9%) experiencing Clavien-Dindo ≥3 complications. <b><i>Conclusion:</i></b> Adhering to strict criteria and outcomes, X-ray free US-PCNL can be performed for the treatment of staghorn calculi and shows comparable SFRs to those reported in prior retrospective studies with fluoroscopic PCNL.</p>","PeriodicalId":15723,"journal":{"name":"Journal of endourology","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2025-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145199497","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":"Comparing mFI-5, ASA Class, and mCCI as Predictors of Postoperative Outcomes Following Endoscopic Treatment of BPH.","authors":"Justin James, Charan Mohan, Grace Jun, Jacob Gaines, Tareq Aro, Zeph Okeke, Gregory Mullen, Arun Rai","doi":"10.1177/08927790251384211","DOIUrl":"https://doi.org/10.1177/08927790251384211","url":null,"abstract":"<p><p>While many risk indexes for predicting morbidity following urological surgery have been reported, determining the best ones for clinical use is challenging. A new frailty index (mFI-5) has emerged for endoscopic treatment of benign prostatic hyperplasia (BPH), but its effectiveness for predicting postoperative complications has not been investigated. We compared mFI-5 with the two most commonly used indexes, the American Society of Anesthesiologists (ASA) physical classification and the modified Charlson Comorbidity Index (mCCI), and the total number of comorbidities using the National Surgical Quality Improvement Program (NSQIP) database. We retrospectively queried the 2015-2020 NSQIP datasets for patients who underwent endoscopic treatment for BPH using Current Procedural Terminology and International Classification of Diseases codes. Patients were stratified by procedure type (transurethral resection of prostate [TURP], laser vaporization of prostate [LVP], laser enucleation of prostate [LEP]). Risk indexes were calculated and compared as predictors of postoperative using logistic regression and C-statistics. 38,128 patients were included with a mean age of 71. The overall complication rate was 10.6%. When stratifying based on surgery type, the complication rates were 11.0% for TURP, 10.3% for LVP, and 7.6% for LEP. Discriminatory ability of risk indexes was mostly comparable between risk indexes but differed based on procedure type and postoperative outcome. mCCI was found to be superior in predicting surgical complications for TURP and in predicting unplanned reoperation and increased length of stay for LVP. ASA Class was found to be superior in predicting all-cause complication, unplanned reoperation, and complication for LEP. mFI-5 was not superior to any index in predicting any postoperative outcome. mCCI and ASA Class have utility in predicting postoperative outcomes for LVP and LEP, respectively. Most risk indexes are comparable and therefore can be utilized at the ease of the provider.</p>","PeriodicalId":15723,"journal":{"name":"Journal of endourology","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2025-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145199538","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":"Electromotive Drug Administration in the Porcine Ureter: First <i>In Vivo A</i>pplication for Ureteral Dilation.","authors":"Bruce M Gao, Yi Xi Wu, Seyed Hossein H Sharifi, Seyed Amiryaghoub M Lavasani, Seyedamirvala Saadat, Mark Sarwat Hana, Victor Pham, Erika Martinez-Carcamo, Olga Derbeneva, Aymon Ali, Zachary E Tano, Pengbo Jiang, Roshan M Patel, Jaime Landman, Ralph V Clayman","doi":"10.1177/08927790251383922","DOIUrl":"https://doi.org/10.1177/08927790251383922","url":null,"abstract":"<p><p><b><i>Objective:</i></b> Retrograde intrarenal surgery is limited by the narrow caliber of the human ureter, resulting in both reluctance to deploy larger ureteral access sheaths and, at times, failed primary ureteral access, requiring placement of a ureteral stent and a delayed second procedure. In this study, we sought to evaluate the application of electromotive drug administration (EMDA) to deliver smooth muscle relaxants to the porcine ureter to facilitate acute ureteral dilation. <b><i>Methods:</i></b> Eighteen juvenile female Yorkshire pigs were randomized into three treatment groups (alfuzosin, aminophylline, or isoproterenol; <i>n</i> = 6 per group). Within each animal, one ureter received an intraureteral drug infusion with EMDA, while the contralateral ureter served as a control, receiving 0.9% normal saline (NS). Ureteral size was assessed before and after treatment by passing sequentially larger urethral dilators starting at 10 Fr, with a maximum insertion force of 3.5 N. <b><i>Results:</i></b> Only alfuzosin with EMDA increased ureteral size compared with NS alone (alfuzosin <i>vs</i> NS, 0.8 Fr <i>vs</i> 0.1 Fr, <i>p</i> = 0.031). Neither aminophylline nor isoproterenol with EMDA resulted in a significant increase in ureteral size compared with their respective NS controls (aminophylline <i>vs</i> NS, 0.3 Fr <i>vs</i> -0.6 Fr, <i>p</i> = 0.344; isoproterenol <i>vs</i> NS, 0.1 Fr <i>vs</i> -0.4 Fr, <i>p</i> = 0.125). <b><i>Conclusion:</i></b> In this first report, EMDA-mediated <i>in vivo</i> delivery of alfuzosin into the porcine ureter acutely increased ureteral distensibility.</p>","PeriodicalId":15723,"journal":{"name":"Journal of endourology","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2025-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145191841","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":"One-Year Outcomes of a UK Center Delivering Minimally Invasive Surgery for Bladder Outflow Obstruction Using Local Anesthetic Without Sedation in the Office Setting.","authors":"Sinan Khadhouri, Matthew Turnbull, Lucy Drummond, Ben Dreyer, Hermes Manos, Craig Clelland, Stephanie Guillaumier, Feras Al Jaafari","doi":"10.1177/08927790251378522","DOIUrl":"https://doi.org/10.1177/08927790251378522","url":null,"abstract":"<p><p><b><i>Background:</i></b> Minimally invasive surgical therapies (MISTs) for bladder outflow obstruction are now commonplace in many urological centers, often performed as day case procedures under general anesthetic or local anesthetic (LA) with sedation. Our center has adopted an outpatient clinic LA-only setting to deliver Rezum, Urolift, and iTind using prostatic block and LA gel. We present our 1-year outcomes to determine the feasibility of delivering MIST in this setting. <b><i>Methods:</i></b> We retrospectively audited outcomes, collecting data on patient demographics, pre- and postoperative symptom questionnaires, flowmetry tests, and visual analogue scores (VASs) during the procedure. We compared pre- and postoperative changes using a paired <i>t</i> test, using a <i>p</i> value of <0.05 as significant. <b><i>Results:</i></b> There were 81 procedures performed: 38 (46.9%) Rezum, 22 (27.2%) Urolift, and 21 (25.9%) iTind. The median age was 68 (interquartile range: 63-74). Preoperatively the mean International Prostate Symptom Score (IPSS) was 20.2 (±7), quality of life (QOL) score 4.6 (±1.4), Qmax 10.7 mL/s (±5.3), prostate serum antigen 2.5 (±3.1), and prostate size 48.8 mLs (±20.9). 70.4% of patients were on an α-blocker, and 44.4% on a 5-α-reductase inhibitors (ARI). The mean VAS was 4.3 (±2.8) out of 10. The total immediate postoperative complication rate was 11.1%, all less than Clavien-Dindo III. 91.4% attended the 3-month follow-up. Postoperatively the mean IPSS was 11.3 (±7.1) (44.1% reduction, <i>p</i> < 0.01), the QOL score 2.4 (±1.5) (47.8% reduction, <i>p</i> < 0.01), and the Qmax 13.1 mL/s (±5.5) (22.4% improvement, <i>p</i> < 0.01). Patients on an α-blocker had reduced to 34.6%, and 5ARIs to 13.6%. <b><i>Conclusion:</i></b> We demonstrate the feasibility of delivering MIST under LA alone, without sedation, and report significant improvements in symptom scores and flowmetry outcomes. Patients tolerate the treatment well without sedation and have a short stay for their procedure, enabling the service to be delivered in an outpatient clinic setting, improving inpatient waiting lists and resource allocation to outpatient setting. Further research is required for long-term outcomes, but early results are promising in driving a change in the delivery of MIST.</p>","PeriodicalId":15723,"journal":{"name":"Journal of endourology","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2025-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145080909","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":"Integration of Generative Artificial Intelligence into Urological Practice: A Cross-Sectional Survey Analysis from the EAU Endourology.","authors":"Catalina Solano, Nick Tarazona, Vineet Gauhar, Felipe Pauchard, Mariela Corrales, Alba Sierra Del Rio, Alexandre Danilovic, Jia-Lun Kwok, Etienne-Xavier Keller, Frédéric Panthier, Bhaskar K Somani, Olivier Traxer","doi":"10.1177/08927790251379460","DOIUrl":"https://doi.org/10.1177/08927790251379460","url":null,"abstract":"<p><p>Rapid advancements in artificial intelligence (AI) have significantly impacted health care, notably within the field of urology, where generative AI presents opportunities to enhance patient education, streamline clinical workflows, and support research activities. This prospective, cross-sectional study systematically investigated the adoption of generative AI among urology professionals, exploring usage patterns, perceived benefits, and barriers to broader implementation. The survey was developed by an expert panel from the Endourology Section of the European Association of Urology and collaborators from the Progressive Endourological Association for Research and Leading Solutions. Utilizing a structured survey disseminated internationally, the study collected responses from 243 urology professionals, predominantly specialists and mid-career practitioners from Europe, Latin America, and Asia. Findings indicate substantial engagement with generative AI, with approximately 53% of respondents reporting prior experience using AI tools in clinical practice. Patient education emerged as the most favored application, highlighted by 55% of respondents within the patient interaction category. Clinical decision-making, particularly treatment recommendations (44%), and research support (18%) were other key areas of usage. However, 82% of participants expressed concerns regarding the technical reliability of generative AI, and 76% worried about diagnostic errors. Notably, about 25% of respondents felt no health care functions should be entirely replaced by AI, emphasizing its role as complementary to human expertise rather than a substitute. Primary barriers identified included inadequate training (20%), technical limitations (14%), and insufficient empirical evidence validating effectiveness (12%). Addressing these barriers through targeted training, rigorous validation, and clear regulatory frameworks is essential for fully realizing AI's potential in urological practice.</p>","PeriodicalId":15723,"journal":{"name":"Journal of endourology","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2025-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145075474","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":"Covered Metal Ureteral Stents in the Maintenance Treatment of Refractory Ureteral Stricture: A Prospective, Multi-Center, and Large-Scale Cohort Study with 3-Year Outcomes.","authors":"Mingrui Wang, Rui Zhu, Shicong Lai, Haopu Hu, Yong Zhang, Wenmin Dong, Yigang Zuo, Xianzhong Duan, Wenzeng Yang, Fenghong Cao, Kailong Liu, Hongyao Liu, Xiangyu Che, Weixing Qu, Kexin Xu, Guibin Xu, Tao Xu, Hao Hu","doi":"10.1177/08927790251378453","DOIUrl":"10.1177/08927790251378453","url":null,"abstract":"<p><p><b><i>Introduction:</i></b> Covered metal ureteral stents (CMUSs) have shown promising results for ureteral stricture. However, 3-year outcomes of CMUSs are lacking. This study aimed to evaluate the 3-year efficacy and safety of CMUSs in the maintenance treatment of refractory ureteral stricture (RUS) and explore risk factors for CMUSs-related complications. <b><i>Methods:</i></b> Between August 2018 and July 2021, 321 patients (366 renal ureter units [RUUs]) with RUS who underwent CMUSs implantation surgery were prospectively recruited in this study. A regular 3-year follow-up protocol including serum biochemistry test, abdominal imaging, and ureteral stent syndrome questionnaire was established to analyze ureteral patency and patient's quality of life (QoL). The primary ureteral patency was defined as patent ureters without CMUSs-related complications, while secondary ureteral patency also included those that restored patent after endoscopic interventions. <b><i>Results:</i></b> The study included 105 (32.7%) patients with stone-related benign ureteral stricture (BUS), 90 (28.0%) with nonstone-related BUS, 76 (23.7%) with radiation-induced ureteral stricture (RIUS), and 50 (15.6%) with malignant ureteral stricture. There existed significant differences in mean serum creatinine levels and renal pelvis widths before and after CMUSs implantation (all <i>p</i> < 0.001). Patients' QoL significantly improved at postoperative 12 and 36 months (both <i>p</i> < 0.001). CMUSs-related complications occurred in 95 (26.0%) RUUs, including 24 (6.6%) with end-stent ureteral restenosis, 28 (7.7%) with stent migration, 31 (8.5%) with stent encrustation, 7 (1.9%) with infection, and 5 (1.4%) with ureteral fistula. The 3-year primary and secondary ureteral patency rate was 74.0% and 90.4%, respectively. However, among patients with RIUS, the primary and secondary ureteral patency rates were only 54.7% and 77.4%, respectively. <b><i>Conclusion:</i></b> CMUSs are effective and safe in the 3-year maintenance treatment of RUS. Patients with CMUSs experience long-term improved QoL. However, patients who underwent radiotherapy are susceptible to developing CMUSs-related complications.</p>","PeriodicalId":15723,"journal":{"name":"Journal of endourology","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2025-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145040240","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":"Thulium Fiber Laser: Long Pulse Width as an Independent Risk Factor for Excessive Heat Generation.","authors":"Eric C Riedinger, Mohammad Mohaghegh, Vyacheslav Leshchenko, Tasha Posid, Nitesh Katta, Thomas E Milner, Joel M H Teichman, Bodo E Knudsen","doi":"10.1177/08927790251377787","DOIUrl":"https://doi.org/10.1177/08927790251377787","url":null,"abstract":"<p><p><b><i>Introduction:</i></b> Laser dosimetry selection is utilized to reduce stone retropulsion. Diode-pumped thulium fiber lasers (TFLs) allow for increased pulse energy by lengthening the pulse width. As pulse width lengthens, thermal diffusion has the potential to increase temperature generation outside of an irradiated target. We test the hypothesis that extending the TFL pulse duration longer than the thermal relaxation time poses an independent risk for increased nonspecific heat generation. <b><i>Methods:</i></b> A two-dimensional numerical simulation of TFL thermal confinement was performed. Energy output and pulse duration of the SOLTIVE Premium-SuperPulsed TFL were measured. Pulse energies (1.5 J) were selected for pulse durations shorter and longer than thermal relaxation time. Temperature was measured by thermocouple positioned 1 cm lateral to the fiber tip. We compared temperature increases <i>in vitro</i> for identical dosimetries (1.5 J at 20 Hz for 300 seconds) for short (3.1 ms) <i>vs</i> long (11.8 ms) pulse durations. <b><i>Results:</i></b> TFL thermal confinement time was calculated at 11.4 ms. For any given preset (short or long), pulse width (duration) increased as pulse energy increased. For any given pulse energy, pulse duration was 3 to 4 times longer comparing short <i>vs</i> long presets. For both short and long pulse settings, temperature increased as total energy increased. The maximum temperature achieved for the long pulse width was 79.6°C <i>vs</i> 71.8°C for the short-width arm (<i>p</i> = 0.002). <b><i>Conclusion:</i></b> TFL pulse duration longer than the thermal relaxation time poses an independent risk for increased nonspecific heat generation.</p>","PeriodicalId":15723,"journal":{"name":"Journal of endourology","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2025-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145040238","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}