Journal of endourology最新文献

{"title":"Longer Preoperative Antibiotic Duration Prior to High-Risk Ureteroscopy Does Not Decrease Infectious Complications.","authors":"Wilson Sui, Heiko Yang, Lejla Pepic, Kevin Chang, Kevin Shee, Ukrit Rompsaithong, David B Bayne, Marshall L Stoller, Thomas Chi","doi":"10.1089/end.2024.0487","DOIUrl":"10.1089/end.2024.0487","url":null,"abstract":"<p><p><b><i>Introduction:</i></b> Postoperative infections after ureteroscopy are common and potentially devastating complications. National and international guidelines recommend treatment of symptomatic positive urine cultures prior to operation, but how to manage patients with asymptomatic colonization remains unclear. In clinical practice, there is wide variation in the choice and duration of antibiotics for these patients. To examine how preoperative antibiotic duration impacts postoperative infection rate, we evaluated our institutional practices and outcomes. <b><i>Materials and Methods:</i></b> Our prospectively collected database was queried for patients undergoing ureteroscopy between 2015 and 2023. Preoperative urine culture results and antibiotic duration/choice were abstracted. Patients included for study were those with a high risk of urinary colonization defined as those with history of neurological insult, bowel diversion, indwelling suprapubic catheter or foley, or a stent/nephrostomy. Our primary outcome was postoperative infection, defined by urinary tract infection (UTI), pyelonephritis, systemic inflammatory response syndrome (SIRS), or fever within 30 days of operation. <b><i>Results:</i></b> A total of 405 patients met our inclusion criteria. Preoperative prophylactic antibiotics were not utilized in 68% of the study cohort, while 11% received less than 3 days or 3-10 days of prophylaxis and the remaining 10% received more than 10 days. The overall rate of UTI or pyelonephritis was 9%, and the SIRS or sepsis rate was 5%. Although receipt of preoperative prophylactic antibiotics of any duration was not predictive of postoperative infectious complications on multivariable analysis, women were associated with a 4.135 (OR: 1.768-9.669, <i>p</i> = 0.001) increased odds of UTI/pyelonephritis compared with men. <b><i>Conclusions:</i></b> In high-risk patients, the duration of preoperative antibiotics prior to ureteroscopy did not reduce postoperative infectious complication rates. Women were the only clinical feature associated with increased risk of UTI/pyelonephritis. Further research is needed to identify alternative interventions to prevent postoperative infectious complications.</p>","PeriodicalId":15723,"journal":{"name":"Journal of endourology","volume":" ","pages":"34-41"},"PeriodicalIF":2.9,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142769447","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":"Editorial Comment on END-0682-OR.R1.","authors":"Jinna Yao, Henry H Woo","doi":"10.1089/end.2024.0781","DOIUrl":"10.1089/end.2024.0781","url":null,"abstract":"","PeriodicalId":15723,"journal":{"name":"Journal of endourology","volume":" ","pages":"71-72"},"PeriodicalIF":2.9,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142750867","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":"The Safety and Feasibility of Aquablation in Patients with Previous Surgery for Benign Prostatic Hyperplasia.","authors":"Desiree E Sanchez, Alireza Ghoreifi, Lorenzo Storino Ramacciotti, Jie Cai, Marissa Maas, Abhishek Venkat, Randall Lee, Andre Luis Abreu, Giovanni E Cacciamani, Leo Doumanian, Inderbir Gill, Andrew Liu-Chen, Mike Nguyen, Rene Sotelo, Mihir M Desai","doi":"10.1089/end.2024.0370","DOIUrl":"10.1089/end.2024.0370","url":null,"abstract":"<p><p><b><i>Objective:</i></b> Aquablation for lower urinary tract symptoms (LUTS) secondary to benign prostatic hyperplasia (BPH) has been adopted to treat a wide range of prostate anatomies including glands up to 150 cc. Patients with recurrence of LUTS after previous BPH procedure often present with variant anatomy, and a paucity of literature exists on the optimal treatment modality for these patients. Herein, we evaluate the safety and feasibility of aquablation in patients with previous BPH surgical history. <b><i>Patients and Methods:</i></b> A prospectively managed single institution database of aquablation patients with BPH/LUTS was queried from August 2020 to December 2022 for patients who failed previous BPH procedures. Patients were divided into two groups: those with and without previous BPH procedure. Primary outcomes were intraoperative and 90-day complications. Secondary outcomes included operative time (OT), number of Aquabeam passes, estimated blood loss, hospital length of stay, and catheter duration. Outcomes were assessed using chi-squared, Wilcoxon rank sum tests, and logistic regression. <b><i>Results:</i></b> A total of 200 patients with BPH/LUTS were treated with aquablation. We identified 26 patients with a history of previous BPH procedures. Patients who underwent previous BPH procedures had smaller prostate volumes (60 cc) compared with treatment-naïve (88 cc) patients, <i>p</i> = 0.016. There was no difference in perioperative and 90-day complications (29% for treatment-naïve <i>vs</i> 17% in the retreatment group, <i>p</i> = 0.32). Most secondary outcomes were the same including OT, but the retreatment group had fewer Aquabeam passes (2 [1-2] <i>vs</i> 2 [2-2] treatment-naïve, <i>p</i> = 0.037) and more additional procedures at follow-up (30% <i>vs</i> 8.3% treatment-naïve, <i>p</i> = 0.005). <b><i>Conclusion:</i></b> Patients with previous BPH interventions remain excellent candidates for aquablation, with similar perioperative and 90-day postoperative outcomes compared with intervention-naïve patients. Aquablation demonstrates efficient tissue ablation without the risk of increased injury or significant blood loss after prior failed BPH procedures.</p>","PeriodicalId":15723,"journal":{"name":"Journal of endourology","volume":" ","pages":"50-55"},"PeriodicalIF":2.9,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142785908","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":"Comparative Outcomes of En-Bloc Holmium Laser Enucleation of the Prostate and Transvesical Robot-Assisted Simple Prostatectomy for the Management of Benign Prostatic Hyperplasia: A Propensity-Matched Analysis.","authors":"Manish Kumar Choudhary, Kaushik P Kolanukuduru, Ahmed Eraky, Almoflihi Mohammed, Neeraja Tillu, Hannah Sur, Lianne Ohayon, Arjun Venkatesh, Arshia Rangchi, Zachary Dovey, Osama Zaytoun, Maurizio Buscarini","doi":"10.1089/end.2024.0601","DOIUrl":"10.1089/end.2024.0601","url":null,"abstract":"<p><p><b><i>Background:</i></b> Holmium laser enucleation of the prostate (HoLEP) and robot-assisted simple prostatectomy (RASP) have emerged as the two surgical treatments of medication-refractory benign prostatic hyperplasia (BPH). The comparative outcomes of en-bloc HoLEP with early apical release and RASP with modified Freyer's technique remain unexplored. <b><i>Methods:</i></b> Between 2018 and 2022, patients with medication-refractory BPH and prostate volume ≥80 g underwent HoLEP or RASP depending on clinical characteristics, patient choice, and surgeon preference. A 1:1 propensity-matched analysis was performed with prostate volume and preoperative International Prostate Symptom Score (IPSS) as the matching variables to eliminate selection bias. Trifecta outcome was defined as complete urinary continence, <i>Q</i>_max >15 mL/second, and no postoperative complications at 3 months. After an initial univariable analysis to predict factors associated with the trifecta outcome, variables with significance levels of ≤0.1 were included in a multivariable model. <b><i>Results:</i></b> Of 416 patients with medication-refractory BPH, 158 underwent HoLEP, whereas 258 underwent RASP. Following matching, 80 patients in each group were included in the analysis. There was no difference in the median postoperative IPSS score, median postoperative <i>Q</i>_max, and continence rate at 3 months. The percentage of patients who attained the trifecta outcome in the HoLEP and RASP groups was 71.25% and 63.75%, respectively (<i>p</i> = 0.4). Patients in the HoLEP group had shorter postoperative stay (HoLEP: 1 [IQR 1-2] <i>vs</i> RASP: 2 [IQR 1-2], <i>p</i> = 0.04) and catheterization time (HoLEP: 2 [IQR 1.75-3] <i>vs</i> RASP: 5 [IQR 5-5], <i>p</i> < 0.001). A multivariable regression did not identify any factors predictive of trifecta outcomes. <b><i>Conclusion:</i></b> Given its comparable efficacy to RASP, HoLEP is the preferred treatment for BPH in large prostates because of its shorter hospital stay and catheterization time. Future randomized controlled trials are required to solidify indications for these treatment modalities and standardize treatment protocols for patients with medication-refractory BPH.</p>","PeriodicalId":15723,"journal":{"name":"Journal of endourology","volume":" ","pages":"57-63"},"PeriodicalIF":2.9,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142729360","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":"Efficacy and Safety of Two Different Approaches in the Drainage of the Upper Urinary Tract in \"Acute Obstructive Uropathy\": A Critical Evaluation.","authors":"Ferhat Yakup Suçeken, Murat Beyatlı, Samet Güngör, Hakan Karaca, Eyüp Veli Küçük, Kemal Sarıca","doi":"10.1089/end.2024.0242","DOIUrl":"10.1089/end.2024.0242","url":null,"abstract":"<p><p><b><i>Aim:</i></b> To compare the results of retrograde ureteral stent (RUS) and percutaneous nephrostomy (PCN) procedures for decompression in patients with acute obstructive pyelonephritis. <b><i>Patients and Methods:</i></b> Medical records of patients undergoing PCN or RUS for emergency urinary diversion because of obstructive pyelonephritis were evaluated retrospectively. Patients with urinary tract obstruction and concurrent fever (≥38°C), pyuria, and costovertebral angle tenderness were included and divided into two groups based on the type of emergency urinary drainage applied (PCN in Group 1) and (RUS in Group 2). Apart from the demographic data and Charlson Comorbidity Index, laboratory and radiologic examination outcomes were well evaluated. <b><i>Results:</i></b> A total of 155 patients including 73 patients (47.1%) undergoing PCN (Group 1) and 82 patients (52.9%) undergoing RUS (Group 2). Although no significant difference was found regarding the demographic characteristics, the operation time, as well as fluoroscopy time, was significantly shorter in Group 1 cases when compared with those in Group 2 (<i>p</i> < 0.0001). The success rate was similar between the two groups, and there was also a significant difference regarding the complication rates in both groups of cases (5.5% <i>vs</i> 7.3%). <b><i>Conclusions:</i></b> Our findings showed that despite similar efficacy and success rates noted between PCN and RUS applications in the emergency drainage of cases presenting with obstructive pyelonephritis, PCN application was found to be advantageous because of shorter operation and fluoroscopy durations. More importantly, this approach was associated with a significantly less need for intensive care during the postoperative period.</p>","PeriodicalId":15723,"journal":{"name":"Journal of endourology","volume":" ","pages":"84-89"},"PeriodicalIF":2.9,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142801070","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 Thulium Fiber Versus High-Power Holmium Laser Lithotripsy Combined with the Flexible and Navigable Suction Access Sheath in Flexible Ureteroscopy for Kidney Stone Disease: A Propensity Score Matched Analysis by the Global FANS Collaborative Group.","authors":"Vineet Gauhar, Olivier Traxer, Khi Yung Fong, Christian Sietz, Ben Hall Chew, Saeed Bin Hamri, Mehmet Ilker Gökce, Nariman Gadzhiev, Steffi Kar Kei Yuen, Vigen Malkhasyan, Deepak Ragoori, Yiloren Tanidir, Bhaskar Kumar Somani, Daniele Castellani","doi":"10.1089/end.2024.0653","DOIUrl":"10.1089/end.2024.0653","url":null,"abstract":"<p><p><b><i>Objective:</i></b> We aim to evaluate stone-free rate (SFR) and complications after flexible ureteroscopy (F-URS) for kidney stones, using a flexible and navigable suction ureteral access sheath (FANS), comparing thulium fiber laser (TFL) and high-power holmium:yttrium-aluminum-garnet laser (HPHL). <b><i>Methods:</i></b> Data from adults who underwent F-URS in 15 centers were prospectively analyzed (August 2023-January 2024). Exclusion criteria were ureteral stones, concomitant bilateral procedures, and renal abnormalities. One-to-one propensity score matching for age, gender, stone location, stone volume, and Hounsfield unit was performed. SFR was assessed using computed tomography scan within 30 days and defined as zero fragments. Data are presented as median (25th-75th quartiles). Multivariable logistic regression was performed to evaluate predictors of SFR. <b><i>Results:</i></b> Of included patients, HPHL was used in 114 patients and TFL in 181 patients. After matching, 96 patients from each group with similar baseline characteristics were included. There was no difference between the groups regarding the use of disposable scopes, lithotripsy mode, and ureteroscopy, lasing and total surgical time. There was no case of sepsis, and blood transfusion was necessary for only one patient in the HPHL group. The incidence of transient fever was similar (3.4% in HPHL <i>vs</i> 3.8% in TFL group). Postoperative day 1 loin pain did not differ significantly. Postoperative stay did not differ significantly [1 [0, 2] in HPHL <i>vs</i> 1 [0, 1] days in TFL group, <i>p</i> = 0.12]. Thirty-day SFR was similar (52.1% for HL <i>vs</i> 64.6% for TFL group, <i>p</i> = 0.11). At multivariable analysis, the use of TFL (odds ratio 1.95, 95% confidence interval 1.01-3.82) was significantly associated with higher odds of being stone-free. <b><i>Conclusions:</i></b> Both lasers are safe and efficacious and can be suitably used for F-URS with FANS with high SFR and minimal complications.</p>","PeriodicalId":15723,"journal":{"name":"Journal of endourology","volume":" ","pages":"42-49"},"PeriodicalIF":2.9,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142828830","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":"Aquablation or Anatomic Endoscopic Enucleation of Prostate?","authors":"Pankaj N Maheshwari, Hussain G Kolsawala","doi":"10.1089/end.2024.0855","DOIUrl":"https://doi.org/10.1089/end.2024.0855","url":null,"abstract":"","PeriodicalId":15723,"journal":{"name":"Journal of endourology","volume":"39 1","pages":"56"},"PeriodicalIF":2.9,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143006430","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":"Editorial Comment on END-2024-0601-OR.R1.","authors":"James E Lingeman","doi":"10.1089/end.2024.0841","DOIUrl":"10.1089/end.2024.0841","url":null,"abstract":"","PeriodicalId":15723,"journal":{"name":"Journal of endourology","volume":" ","pages":"64"},"PeriodicalIF":2.9,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142882080","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":"A Prospective, Randomized, Noninferiority Study to Evaluate the Safety and Effectiveness of Steerable Ureteroscopic Renal Evacuation Compared with Standard Ureteroscopy: 30-Day Results of the ASPIRE Study.","authors":"Brian R Matlaga, Thomas J Mueller, Brett Johnson, Jay Page, J Stuart Wolf, Glenn M Preminger, Loren Jones, Ilya Sobol, Karen Stern, David Cuellar, Kaitlan Cobb, Robert Barsky, Robert Medairos, Charles Marguet, Naren Nimmagadda, Mark White, Michael Levin, Thomas Chi","doi":"10.1089/end.2024.0602","DOIUrl":"10.1089/end.2024.0602","url":null,"abstract":"<p><p><b><i>Purpose:</i></b> We report the first multicenter, prospective, randomized noninferiority controlled trial of steerable ureteroscopic renal evacuation (SURE) for nephrolithiasis treatment. <b><i>Materials and Methods:</i></b> Candidates for laser lithotripsy ≥18 years with ≥1 renal stone ≥7 mm and 7-20 mm stone burden were randomized 1:1 SURE <i>vs</i> ureteroscopy (URS). SURE was performed using the CVAC Aspiration System, a novel steerable irrigation-aspiration catheter. The primary efficacy end point was noninferiority in stone-free rate (SFR) based on zero residual fragments (RFs) 30 days postprocedure on noncontrast computed tomography. Secondary end points were superiority tests, stone clearance (percent stone volume reduction), residual stone volume (RSV), SFR (no RF >2 mm), and SFR (no RF >4 mm) 30 days postprocedure. <b><i>Results:</i></b> Of the subjects, 123 were randomized and 101 qualified for efficacy analysis (SURE 46 <i>vs</i> URS 55). Despite randomization, baseline URS stone volume was higher (SURE 485.0 ± 432.5 mm³ <i>vs</i> URS 713.3 ± 558.5 mm³). The primary noninferiority end point was achieved (SURE SFR 48% <i>vs</i> URS SFR 49%, <i>p</i> = 0.027, -1.3% [90% confidence interval; -18%, 15%]). Stone clearance was significantly higher for SURE <i>vs</i> URS subjects (SURE 96.9 ± 5.6% <i>vs</i> URS 92.9 ± 11.6%, <i>p</i> = 0.036); RSV was significantly lower (SURE 14.3 ± 3 0.9 mm³ <i>vs</i> URS 70.2 ± 144.9 mm³, <i>p</i> = 0.012). SURE stone clearance and RSV were independent of baseline stone volume, but for URS degraded with increasing baseline stone volume. Safety was comparable between groups. <b><i>Conclusions:</i></b> SFR for SURE subjects was noninferior compared with URS subjects; stone clearance and RSV were significantly better with SURE, independent of baseline stone volume.</p>","PeriodicalId":15723,"journal":{"name":"Journal of endourology","volume":" ","pages":"10-18"},"PeriodicalIF":2.9,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142854192","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":"Dr. Jennifer Bjazevic.","authors":"","doi":"10.1089/end.2024.57896.spot","DOIUrl":"10.1089/end.2024.57896.spot","url":null,"abstract":"","PeriodicalId":15723,"journal":{"name":"Journal of endourology","volume":" ","pages":"1"},"PeriodicalIF":2.9,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142915098","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}