Journal of endourology最新文献

{"title":"The Second Endourological Society Census Report.","authors":"Ala'a Farkouh, Malone R Locke, D Duane Baldwin, Mordechai Duvdevani, Senthil Nathan, Charles D Scales, Necole M Streeper, Timothy D Averch","doi":"10.1089/end.2024.0512","DOIUrl":"10.1089/end.2024.0512","url":null,"abstract":"<p><p><b><i>Introduction and Objective:</i></b> As part of the Endourological Society's (ES) initiative to continuously enhance the field of endourology, the second annual census was circulated after the World Congress of Endourology and Uro-Technology 2022 (WCET22). <b><i>Methods:</i></b> An anonymous survey was created using Qualtrics XM and was disseminated via email to all ES members (<i>n</i> = 1502) between October 4, 2022, and January 26, 2023. A total of 46 questions were included in the survey and covered different aspects, including demographics, practice patterns, satisfaction, impact of COVID-19, WCET22 attendance, and future opportunities. <b><i>Results:</i></b> A total of 404 (26.9%) ES members (91.8% male and 8.2% female), representing 63 different countries, participated in the survey. Fellowship-trained endourologists constituted 58.9% of respondents, and the most common practice setting was academic (55.2%). The most common practice scope was complex retrograde endoscopy (83.4%), followed by percutaneous nephrolithotomy (79.5%) and medical management of urolithiasis (72.5%). Work schedules were variable, with 51.1% working 40-60 hours/week and 35.3% working >60 hours/week. More than 80% were satisfied with t heir practice; however, 42.4% indicated that COVID-19 made satisfaction worse. Of the participants, 49.5% were satisfied with their compensation, and 7.3% plan to retire within the next 5 years. When asked about the future of endourology, 92.9% had a positive outlook. Of the respondents, only 36.8% attended WCET22, with the most chosen reason for attendance being an interest in learning new research and technology. For lack of attendance, the cost of travel and lodging was reported as a determining factor by 45.4%. <b><i>Conclusion:</i></b> These survey results report important trends within the field of endourology and demonstrate the robust outlook of ES members for the future. By demonstrating important practice patterns and member needs, this information can be used to improve the responsiveness of its members and to continually strengthen the ES.</p>","PeriodicalId":15723,"journal":{"name":"Journal of endourology","volume":null,"pages":null},"PeriodicalIF":2.9,"publicationDate":"2024-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142288971","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":"Clinical Significance of Tumor Location for Ureteroscopic Tumor Grading in Upper Tract Urothelial Carcinoma.","authors":"Satoshi Katayama, Benjamin Pradere, Nico C Grossman, Aaron M Potretzke, Stephen A Boorjian, Alireza Ghoreifi, Siamak Daneshmand, Hooman Djaladat, John P Sfakianos, Andrea Mari, Zine-Eddine Khene, David D'andrea, Nozomi Hayakawa, Kazutoshi Fujita, Axel Heindenreich, Jay D Raman, Mathieu Roumiguié, Firas Abdollah, Alberto Breda, Matteo Fontana, Morgan Rouprêt, Vitaly Margulis, Pierre I Karakiewicz, Motoo Araki, Yasutomo Nasu, Shahrokh F Shariat","doi":"10.1089/end.2024.0335","DOIUrl":"10.1089/end.2024.0335","url":null,"abstract":"<p><p><b><i>Background:</i></b> Although previous literature shows tumor location as a prognostic factor in upper tract urothelial carcinoma (UTUC), there remains uninvestigated regarding the impact of tumor location on grade concordance and discrepancies between ureteroscopic (URS) biopsy and final radical nephroureterectomy (RNU) pathology. <b><i>Methods:</i></b> In this international study, we retrospectively reviewed the records of 1,498 patients with UTUC who underwent diagnostic URS with concomitant biopsy followed by RNU between 2005 and 2020. Tumor location was divided into four sections: the calyceal-pelvic system, proximal ureter, middle ureter, and distal ureter. Patients with multifocal tumors were excluded from the study. We performed multiple comparison tests and logistic regression analyses. <b><i>Results:</i></b> Overall, 1,154 patients were included; 54.4% of those with low-grade URS biopsies were upgraded on RNU. In the multiple comparison tests, middle ureter tumors exhibited the highest probability of upgrading, meanwhile pelvicalyceal tumors exhibited the lowest probability of upgrading (73.7% <i>vs</i> 48.5%, <i>p</i> = 0.007). Downgrading was comparable across all tumor locations. On multivariate analyses, middle ureteral location was significantly associated with a low probability of grade concordance (odds ratio [OR] 0.59; 95% confidence interval [CI], 0.35-1.00; <i>p</i> = 0.049) and an increased risk of upgrading (OR 2.80; 95% CI, 1.20-6.52; <i>p</i> = 0.017). The discordance did not vary regardless of caliceal location, including the lower calyx. <b><i>Conclusions:</i></b> Middle ureteral tumors diagnosed to be low grade had a high probability to be undergraded. Our data can inform providers and their patients regarding the likelihood of undergrading according to tumor location, facilitating patient counseling and shared decision making regarding the choice of kidney sparing <i>vs</i> RNU.</p>","PeriodicalId":15723,"journal":{"name":"Journal of endourology","volume":null,"pages":null},"PeriodicalIF":2.9,"publicationDate":"2024-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142288966","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":"Assessment of Holmium:YAG, Pulsed-Thulium:YAG and Thulium Fiber Lasers for Urinary Stone Ablation. <i>In Vitro</i> Study.","authors":"Alba Sierra, Frederic Panthier, Esther Castillo, Asier Mercadé, Lluís Peri, Antonio Alcaraz, Olivier Traxer, Juan Manuel López, Maria Pilar Luque","doi":"10.1089/end.2024.0349","DOIUrl":"10.1089/end.2024.0349","url":null,"abstract":"<p><p><b><i>Objective:</i></b> To evaluate the ablation speed (AS), laser efficiency and direct thermal lesions during urinary stone lithotripsy with the current available laser technologies: Holmium:YAG (Ho:YAG), pulsed-Thulium:YAG (p-Tm:YAG) and thulium fiber laser (TFL) <i>in vitro</i> using different laser settings. <b><i>Materials and Methods:</i></b> Ho:YAG, p-Tm:YAG, and TFL laser system were used in an <i>in vitro</i> ureteral model with a volume of 125 mm³ Begostone. The following parameters were tested across all laser devices: 0.6J/10 Hz (6 W), 0.6 J/20 Hz (12 W), 1.5 J/10 Hz (15 W), and 1.5 J/20 Hz (30 W), employing short pulse width for all lasers and long pulse width for Ho:YAG and p-Tm:YAG. Ten participants conducted the experimental setup during 3-minutes laser on time, combining the laser technology, settings, and pulse widths, with a total of 20 different combinations. The efficiency, AS and ureteral damage resulting from each intervention were analyzed. <b><i>Results:</i></b> p-Tm:YAG and TFL demonstrated significantly higher efficiency compared with Ho:YAG (0.049 ± 0.02 Δgr/KJ and 0.042 ± 0.01 Δgr/KJ <i>vs</i> 0.029 ± 0.01 Δgr/KJ; <i>p</i> < 0.05). In all laser sources, as the power increases, the AS also increases (<i>p</i> < 0.05). Furthermore, only at high-energy settings (1.5 J) higher frequency led to increase AS (<i>p</i> < 0.05). Both, p-Tm:YAG and TFL exhibited higher AS compared to Ho:YAG (0.64 ± 0.33 Δgr/s and 0.62 ± 0.31 Δgr/s <i>vs</i> 0.44 ± 0.22 Δgr/s; <i>p</i> < 0.05). Regarding ureteral injuries, as the power increases, there is a higher chance of ureteral damage (<i>p</i> = 0.031). No differences were observed between laser technologies (<i>p</i> = 0.828). <b><i>Conclusions:</i></b> Both, p-Tm:YAG and TFL exhibited superior performances during laser lithotripsy compared with Ho:YAG, as they demonstrated higher efficiency and ablation speed. Thermal damage did not appear to be associated with specific laser equipment, but higher grades of lesions are described by increasing power.</p>","PeriodicalId":15723,"journal":{"name":"Journal of endourology","volume":null,"pages":null},"PeriodicalIF":2.9,"publicationDate":"2024-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142119980","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":"Optilume^® Drug-Coated Balloon May Lower the Re-Treatment Rate Postintervention for Challenging Urethral Stricture Disease in Long-Term Follow-Up: A Prospective Cohort Study.","authors":"Zein Alhamdani, Sean Ong, Wenjie Zhong, Peter Chin","doi":"10.1089/end.2024.0318","DOIUrl":"10.1089/end.2024.0318","url":null,"abstract":"<p><p><b><i>Background:</i></b> Urethral stricture disease is a common and at times unsatisfying condition that can lead to complications severely impacting a patient's quality of life (QOL). Open urethroplasty remains the gold standard treatment, however it is an invasive and highly specialized procedure. Strictures between 2 and 4 cm in length have been shown to recur at a rate of 50% within 12 months, a rate that typically decreases with each subsequent treatment. The Laborie Optilume drug-coated balloon (DCB) is the first of its kind developed for adjunct treatment of urethral strictures in men. The DCB initially treats the stricture through balloon dilatation and subsequently aims to prevent recurrence via the localized application of Paclitaxel. Our study assesses the safety and efficacy of the DCB in an Australian population with strictures exceeding 2 cm, who have undergone at least two prior procedures for urethral stricture disease. <b><i>Methods:</i></b> Patients were prospectively recruited from November 2019 to September 2021. International prostate symptom score (IPSS), IPSS QOL, and voiding parameters were collected at baseline, and again at 1, 6, 12, and 18 months. The DCB was applied by a single consultant urologist under rigid cystoscope with shallow direct vision internal urethrotomy with a cold knife prior to application of the DCB. <b><i>Results:</i></b> Seventeen patients were recruited with an average of 7.7 prior urethral procedures for recurrent stricture disease. In total, 76% were stricture free at 30 months follow-up. There were improvements in almost all parameters including max flow, average flow, IPSS, and IPSS QOL scores at 12 and 24 months. There were no complications. <b><i>Conclusion:</i></b> The DCB is a safe and effective method at reducing the rates of recurrence for high-risk stricture disease and can delay or prevent the need for urethroplasty in what remains a very challenging cohort of patients.</p>","PeriodicalId":15723,"journal":{"name":"Journal of endourology","volume":null,"pages":null},"PeriodicalIF":2.9,"publicationDate":"2024-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141906716","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":"Convective Water Vapour Energy Ablation (Rezum®) versus Prostatic Urethral Lift (Urolift®); A 2-Year Prospective Study.","authors":"Yu Xi Terence Law, Wei Jing Kelven Chen, Liang Shen, Kyaw Lin, Chloe Shu Hui Ong, Qi Yang Lim, Gregory Xiang Wen Pek, Woon Chau Tsang, Yi Quan Tan, Jun Yang Chia, King Chien Joe Lee, Wei Jin Chua","doi":"10.1089/end.2024.0400","DOIUrl":"https://doi.org/10.1089/end.2024.0400","url":null,"abstract":"<p><p>Introduction To compare the clinical outcomes and complication rates of Convective Water Vapour Energy Ablation (Rezum®) and Prostatic Urethral Lift (Urolift®). To identify predictive factors for treatment failures in both treatments. Materials & Methods Prospective clinico-epidemiological data of patients who underwent Urolift® or Rezum® in a single institution for Benign Prostatic Hyperplasia (BPH) was collected. The choice of intervention depended on the preference of the patients after patient-centric discussions. Results From October 2019 to October 2022, 86 patients underwent Rezum® and 62 patients underwent Urolift®. Rezum® involved a longer indwelling catheter duration (12.38±5.548 versus 1.39±3.010 days, p<0.001) compared to Urolift®. Rezum® was associated with more complications compared to Urolift® (36 (41.9%) versus 10 (16.1%) cases, p<0.001). Rezum® had more cases of hematuria (17 (19.8%) versus 4 (6.5%) cases (p=0.022)) and urinary tract infections (27 (31.4%) versus 3 (4.8%) cases, p<0.001)), compared to Urolift®. There were no significant differences in Clavien-Dindo Grade 3-5 complications between the interventions. Urolift® was associated with higher re-operation rates (5 (8.1%) versus 0 (0%) cases, p=0.010) compared Rezum®. Rezum® had higher anti-cholinergic usage rates compared to Urolift® post-operation (22 (25.6%) versus 8 (12.9%) cases, p=0.024). Both interventions showed improvement in International Prostate Symptom Score (IPSS), Quality of Life score, and peak velocity flow over the 2 years with no significant difference between the two. Based on receiver operating characteristic curve, pre-operation IPSS ≥ 16 had 95.7% sensitivity and 38.4% specificity to predict the probability of treatment failures after the interventions. Conclusions There was no difference in clinical outcomes of patients who underwent Rezum® and Urolift®. However, patients who had undergone Rezum® faced more minor complications and more required anti-cholinergic medications. Lastly, physicians should note that patients with IPSS≥16 would unlikely benefit from either intervention.</p>","PeriodicalId":15723,"journal":{"name":"Journal of endourology","volume":null,"pages":null},"PeriodicalIF":2.9,"publicationDate":"2024-09-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142288968","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":"RE: Does Blacklight Illumination Improve Speed and Accuracy of Foot Pedal Activation in the Low Light Operating Room?","authors":"Amnuay Kleebayoon, Viroj Wiwanitkit","doi":"10.1089/end.2024.0631","DOIUrl":"https://doi.org/10.1089/end.2024.0631","url":null,"abstract":"","PeriodicalId":15723,"journal":{"name":"Journal of endourology","volume":null,"pages":null},"PeriodicalIF":2.9,"publicationDate":"2024-09-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142288970","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":"Unsupervised Machine Learning to Identify Risk Factors of Pyeloplasty Failure in Ureteropelvic Junction Obstruction.","authors":"Jonathan J Song,Jane Kielhofner,Zhiyu Jason Qian,Catherine Gu,William Boysen,Steven Chang,Douglas Dahl,Jairam Eswara,George Haleblian,Anton Wintner,Daniel A Wollin","doi":"10.1089/end.2024.0264","DOIUrl":"https://doi.org/10.1089/end.2024.0264","url":null,"abstract":"Introduction: In adult patients with ureteropelvic junction obstruction (UPJO), little data exist on predicting pyeloplasty outcome, and there is no unified definition of pyeloplasty success. As such, defining pyeloplasty success retrospectively is particularly vulnerable to bias, allowing researchers to choose significant outcomes with the benefit of hindsight. To mitigate these biases, we performed an unsupervised machine learning cluster analysis on a dataset of 216 pyeloplasty patients between 2015 and 2023 from a multihospital system to identify the defining risk factors of patients that experience worse outcomes. Methods: A KPrototypes model was fitted with pre- and perioperative data and blinded to postoperative outcomes. T-test and chi-square tests were performed to look at significant differences of characteristics between clusters. SHapley Additive exPlanation values were calculated from a random forest classifier to determine the most predictive features of cluster membership. A logistic regression model identified which of the most predictive variables remained significant after adjusting for confounding effects. Results: Two distinct clusters were identified. One cluster (denoted as \"high-risk\") contained 111 (51.4%) patients and was identified by having more comorbidities, such as old age (62.7 vs 35.7), high body mass index (BMI) (26.9 vs 23.8), hypertension (66.7% vs 17.1%), and previous abdominal surgery (72.1% vs 37.1%) and was found to have worse outcomes, such as more frequent severe postoperative complications (7.2% vs 1.0%). After adjusting for confounding effects, the most predictive features of high-risk cluster membership were old age, low preoperative estimated glomerular filtration rate (eGFR), hypertension, greater BMI, previous abdominal surgery, and left-sided UPJO. Conclusions: Adult UPJO patients with older age, lower eGFR, hypertension, greater BMI, previous abdominal surgery, and left-sided UPJO naturally cluster into to a group that more commonly suffers from perioperative complications and worse outcomes. Preoperative counseling and perioperative management for patients with these risk factors may need to be thought of or approached differently.","PeriodicalId":15723,"journal":{"name":"Journal of endourology","volume":null,"pages":null},"PeriodicalIF":2.7,"publicationDate":"2024-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142265158","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":"Testicular Pain Following Laparoscopic Donor Nephrectomy: An Underreported Complication.","authors":"Sae Woong Choi, Hyong Woo Moon, Kang Sup Kim, Yong Sun Choi, Hyuk Jin Cho","doi":"10.1089/end.2024.0454","DOIUrl":"10.1089/end.2024.0454","url":null,"abstract":"<p><p><b><i>Introduction:</i></b> Testicular pain (TP) after laparoscopic donor nephrectomy (LDN) is a relatively underreported complication. This study aimed to investigate the incidence, characteristics, and factors associated with ipsilateral TP after left-sided LDN. <b><i>Materials and Methods:</i></b> This study prospectively collected baseline data and surgical details for all patients who underwent left-sided LDN during the study period. Each patient underwent scrotal ultrasonography 1 month postoperation. Donors were categorized by the level of gonadal vein ligation (level 1 at the renal vein confluence and level 2 at or below the iliac vessel crossing) and the presence or absence of TP. The characteristics of pain and demographics were compared across the groups. <b><i>Results:</i></b> Among 61 male patients who underwent left-sided LDN between March 2017 and December 2018, 54.1% (33/61) experienced ipsilateral TP. TP was more frequent in level 2 donors (64.3%) than in level 1 (45.5%), but the difference was not statistically significant (<i>p</i> = 0.141). Most TP occurred within a week (60.6%), was mild (75.8%), and resolved within 3 months (63.7%). The incidence of varicocele and hydrocele was 32.8% and 34.4%, respectively. The occurrence of TP was not significantly associated with the presence of varicocele or hydrocele and other factors. <b><i>Conclusion:</i></b> More than half of the male donors who underwent LDN experienced TP. The findings emphasize the importance of discussing this potential complication during preoperative counseling. This study found no significant association between TP and the level of gonadal vein ligation or the presence of varicocele, warranting further investigation into the cause of TP.</p>","PeriodicalId":15723,"journal":{"name":"Journal of endourology","volume":null,"pages":null},"PeriodicalIF":2.9,"publicationDate":"2024-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142107987","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":"Does Silodosin Improve Primary Ureteroscopy Access and Outcomes: Meta-Analysis of Randomized Controlled Trials.","authors":"Mohammed Zain Ulabedin Adhoni, Muhammad Haider, Bhaskar Somani, Zubeir Ali","doi":"10.1089/end.2024.0413","DOIUrl":"10.1089/end.2024.0413","url":null,"abstract":"<p><p><b><i>Background:</i></b> Ureteroscopy (URS) is a widely utilized procedure for the management of urinary stones, though failed access due to ureteral orifice tightness or spasms can be a potential outcome. Silodosin, an alpha-1A adrenergic receptor antagonist, has shown promise in recent randomized controlled trials (RCTs) in improving URS outcomes by relaxing ureteral smooth muscle. <b><i>Objective:</i></b> This systematic review and meta-analysis aims to determine whether preoperative administration of silodosin enhances ureteroscopy outcomes, including ureteral access rates, operative time, complication rates, and stone-free rates. <b><i>Methods:</i></b> After PROSPERO registration, a comprehensive search of PubMed, EMBASE, and the Cochrane Library was conducted for RCTs comparing silodosin with placebo or no medication before URS. Data extraction and bias assessment were performed independently by two reviewers. Statistical analysis was undertaken by Review Manager V5.4, employing random-effects models for heterogeneous variables. <b><i>Results:</i></b> Eight RCTs with a total of 892 patients (416 in the silodosin group and 476 in the control group) met the inclusion criteria. Silodosin significantly reduced operative time by 15.74 minutes (<i>p</i> < 0.00001). The access rate was higher in the silodosin group (96.9%) compared with the control group (87.2%)(<i>p</i> = 0.0004). Total complication rates were lower in the silodosin group (14.39% <i>vs</i> 27.47%, <i>p</i> < 0.00001), as were moderate to significant complications (5.0% <i>vs</i> 11.7%, <i>p</i> = 0.003). Stone-free rates were also higher in the silodosin group (92.16% <i>vs</i> 81.5%, <i>p</i> < 0.0001). <b><i>Conclusion:</i></b> Preoperative administration of silodosin significantly improves URS outcomes by reducing operative time, increasing access rates, decreasing complication rates, and enhancing stone-free rates. These findings support the integration of silodosin into clinical practice guidelines for URS, potentially improving procedural efficiency and patient outcomes.</p>","PeriodicalId":15723,"journal":{"name":"Journal of endourology","volume":null,"pages":null},"PeriodicalIF":2.9,"publicationDate":"2024-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142046707","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":"Feasibility and Outcomes of Same-Day Discharge Following Multi-Port Robot-Assisted Radical Prostatectomy.","authors":"Sohrab Ali,Narmina Khanmammadova,Kristene Myklak,Andrew S Afyouni,Daniel Jiang,Mitchell O'Leary,Andre Sanavi,Ashley Gao,Timothy Chu,Ralph Kevin Medina Gomez,Tuan Thanh Nguyen,Catherine Fung,Caroline Nguyen,Mohammed Shahait,David I Lee","doi":"10.1089/end.2024.0497","DOIUrl":"https://doi.org/10.1089/end.2024.0497","url":null,"abstract":"Introduction Robot-assisted radical prostatectomy (RARP) provides much quicker recovery for men than open prostatectomy. In most centers, discharge is planned the morning after surgery. However, after several years, we observed that no routine intervention was required for a majority of men over the first evening. Here, we detail our institution's outcomes for multiport RARP (MP-RARP) with same-day discharge (SDD). Methods After excluding patients with single-port RARP (n=25) and overnight stays (n=30), data from 224 patients (n=224/279, 88.2%) who underwent MP-RARP from May 2021 to September 2023 were collected. All patients were placed on an Enhanced Recovery After Surgery protocol and were given instructions regarding SDD. Patients were considered as SDD if they were discharged on the day of surgery. Data regarding messages and phone calls to healthcare providers, urology clinic, and emergency department visits were recorded for analysis in the week post-surgery. Results The mean (±SD) operative time was 142.5 ± 25.2 minutes, with a mean (±SD) console time of 95.1 ± 25.6 minutes. The median (IQR) estimated blood loss was 50 (50 - 100) mL, and the mean (±SD) length of hospitalization was 163.2 ± 64.6 minutes. No intraoperative complications occurred in this cohort. The median (IQR) patient-reported pain score at one hour after surgery was 3.5 (0 - 7), compared to 2 (0 - 4) at discharge. Of the 145 (64.7%) patients who reported their postoperative pain management, only 50 (34.4%) endorsed using opioids, and of those, 8 (16%) were known chronic opioid users. In the week following surgery, 14 (6.3%) patients had unplanned visits to the healthcare facility. Additionally, 56 (25%) of patients contacted the clinic regarding the postoperative course during the same timeframe. Conclusions SDD after RARP is predictable and safe. SDD helps reduce the costs associated with inpatient stays without compromising surgical outcomes for patients.","PeriodicalId":15723,"journal":{"name":"Journal of endourology","volume":null,"pages":null},"PeriodicalIF":2.7,"publicationDate":"2024-09-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142264899","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}