Journal of endourology最新文献

{"title":"Robotic Approach to Surgery for Pheochromocytoma in Children: A Case Series.","authors":"Chinny Catherine, Ashitosh Pokharkar, Deepak K Kandpal, Priyank Yadav, Aditya Musham, Sujit K Chowdhary","doi":"10.1089/end.2024.0205","DOIUrl":"10.1089/end.2024.0205","url":null,"abstract":"<p><p>Pheochromocytoma is a rare disease in children with incidence of reported as 1 in 10 million children. There are few reported series with clinical follow-up published in literature from the Indian subcontinent; none has reported minimally invasive operation for pheochromocytoma and long-term outcome. These children present with symptoms secondary to increased catecholamine secretion from the adrenal pheochromocytes, of which hypertension is the most common and can be life threatening. Although hypertension in children is almost always secondary to a hidden disease, children with pheochromocytoma may be treated for a while before diagnosis is established. Surgical excision of the tumor is the treatment. Preoperative assessment can be challenging as 10% of the cases may be syndromic with bilateral tumors and associated with multiple endocrine neoplasia. The preoperative stabilization of the child with alpha antagonists, fluid replacement, and beta-blockers are the mainstay of preoperative preparation. Intraoperative disasters are well known in the absence of adequate preparation. Conventional procedure has been the standard surgical approach. Minimally invasive surgery (MIS) in children for pheochromocytoma is evolving. We report a series of five children treated over 5 years by the minimally invasive approach with follow-up details for this period. This study confirms the efficacy of MIS approach in treatment of pheochromocytoma and its ability to produce reliable results in the long term.</p>","PeriodicalId":15723,"journal":{"name":"Journal of endourology","volume":" ","pages":"556-563"},"PeriodicalIF":2.9,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143999637","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":"Characteristic Findings in Aborted Robot-Assisted Radical Prostatectomies.","authors":"Kathryn E Fink, Austin Drysch, Nicole Handa, Mitchell Huang, Sai Kumar, Yutai Li, Chalairat Suk-Ouichai, Kent T Perry, Ridwan Alam, Hiten D Patel, Anugayathri Jawahar, Ashley E Ross","doi":"10.1089/end.2025.0003","DOIUrl":"10.1089/end.2025.0003","url":null,"abstract":"<p><p><b><i>Background:</i></b> In rare instances, patients deemed operative candidates for robot-assisted radical prostatectomy (RARP) have their procedure aborted intraoperatively. Understanding the incidence and factors associated with aborted RARP cases can improve preoperative counseling and intraoperative decision-making. We performed a retrospective analysis of RARP cases performed by high-volume surgeons across our multihospital medical system to characterize the incidence and causes of aborted procedures. <b><i>Methods:</i></b> We queried the Northwestern Electronic Data Warehouse from January 2018 to June 2024 for patients who underwent RARP performed by high-volume surgeons. Aborted procedures were defined as those terminated after anesthesia but before completion. Comparative statistics were used to evaluate clinical, radiologic, and pathologic characteristics between aborted and completed cases. Imaging features of propensity-matched patients with completed or aborted procedures were also analyzed. <b><i>Results:</i></b> Among 3316 RARPs performed by 10 high-volume surgeons, 26 cases (0.7%) were aborted. The leading causes were pelvic lipomatosis (35%), adhesions (27%), and cardiorespiratory events (12%). Higher body mass index (BMI) was significantly associated with aborted operation (30.7 <i>vs</i> 27.8, <i>p</i> = 0.015). Although prior abdominal operations were more frequent in the aborted group (7.7% <i>vs</i> 2.6%), this was not statistically significant (<i>p</i> = 0.2). Perioperative complications occurred in 12% of aborted cases. Four cases were reattempted, with three completed effectively. The apparent diffusion coefficient of perivesical pelvic fat was higher in aborted cases but not statistically significant (<i>p</i> = 0.13). <b><i>Conclusions:</i></b> The incidence of aborted RARP among experienced surgeons is low, accounting for less than 1% of all cases. Pelvic lipomatosis was the most common reason for an aborted procedure and may be recognized preoperatively on imaging. Higher BMI was associated with a significantly higher risk for aborted procedure. When counseling patients, this information could be used to set expectations for the risk of an aborted procedure.</p>","PeriodicalId":15723,"journal":{"name":"Journal of endourology","volume":" ","pages":"564-569"},"PeriodicalIF":2.9,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143811660","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":"Patients Who Catastrophize Pain Experience Increased Pain after Ureteroscopic Laser Lithotripsy with Stent Placement.","authors":"Alan J Yaghoubian, Sarah Razavi, Kavita Gupta, Raymond Khargi, Anna Ricapito, Christopher Connors, Roman Shimonov, Dara Lundon, Blair Gallante, Kyra Gassmann, Johnathan A Khusid, William Atallah, Mantu Gupta","doi":"10.1089/end.2024.0688","DOIUrl":"10.1089/end.2024.0688","url":null,"abstract":"<p><p><b><i>Purpose:</i></b> Pain after ureteroscopic laser lithotripsy with stent placement (URSLL+stent) varies widely between patients. Although stent-specific factors are known to influence symptoms, patient-specific factors remain elusive. The pain catastrophizing scale (PCS) is a validated questionnaire quantifying the degree to which an individual catastrophizes painful stimuli. This study aimed to determine whether PCS score is associated with pain after URSLL+stent. <b><i>Materials and Methods:</i></b> We performed a prospective study of patients undergoing URSLL+stent. Patients completed the PCS preoperatively and were labeled as catastrophizers (CAT), noncatastrophizers (NON), or intermediate catastrophizers (INT). Primary outcome was visual analog scale (VAS) pain score, and secondary outcomes included ureteral stent symptom questionnaire scores, total analgesic pills taken, pain-related health care encounters, and need for opioids. <b><i>Results:</i></b> In total, 100 patients were enrolled, with 94 patients included in the final analysis. Median VAS in postanesthesia care unit was significantly higher for CAT and INT than NON (5.00 <i>vs</i> 5.00 <i>vs</i> 2.00, respectively, <i>p</i> = 0.042). Median VAS on postoperative day (POD)#1 was significantly higher for CAT than INT or NON (5.42 <i>vs</i> 3.0 <i>vs</i> 3.0, <i>p</i> = 0.018), but this difference disappeared by POD#10. CAT used more total tablets of prescribed medications (24.0 <i>vs</i> 15 <i>vs</i> 15 for CAT, INT, and NON, respectively, <i>p</i> = 0.002) and were more likely to require additional prescriptions, including opioids (22.6% <i>vs</i> 12.9% <i>vs</i> 0% for CAT, INT, and NON, respectively, <i>p</i> = 0.008). CAT also generated more unplanned health care encounters (25.8% <i>vs</i> 16.1% <i>vs</i> 3.1% for CAT, INT, and NON, respectively, <i>p</i> = 0.024). <b><i>Conclusion:</i></b> The PCS is a simple, rapid, and cost-free tool that allows urologists to identify patients at risk of poor pain tolerance after URSLL+stent. Further studies are necessary to determine what interventions would best serve patients who catastrophize their pain.</p>","PeriodicalId":15723,"journal":{"name":"Journal of endourology","volume":" ","pages":"532-541"},"PeriodicalIF":2.9,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144005236","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":"Impact of Endoscopic Bladder Outlet Procedures on Medical and Surgical Retreatment: A Large Population Analysis.","authors":"Talia Helman, Dattatraya Patil, Siddharth Marthi, Brendan Browne","doi":"10.1089/end.2024.0741","DOIUrl":"10.1089/end.2024.0741","url":null,"abstract":"<p><p><b><i>Purpose:</i></b> Many men undergo operation for benign prostatic hyperplasia (BPH) with lower urinary tract symptoms (LUTS). Although most procedures relieve symptoms, some patients experience recurrence or persistence. This study explores rates of and factors contributing to medical and surgical retreatment after index BPH procedure. <b><i>Methods:</i></b> This longitudinal, retrospective, population-based cohort study used MarketScan commercial insurance claims data. From 2009, men with BPH/LUTS diagnosis were evaluated for medical and surgical retreatment after index operation. Index procedures included holmium laser enucleation of the prostate (HoLEP), laser ablation of the prostate, and transurethral resection of the prostate grouped as traditional procedures, whereas transurethral microwave thermotherapy (TUMT), transurethral needle ablation, water vapor thermal therapy, and prostatic urethral lift (PUL) were minimally invasive surgical therapies (MISTs). Multivariable Cox hazard models (<i>p</i> < 0.05) were used to determine factors associated with retreatment after index procedure. <b><i>Results:</i></b> We evaluated 10,938 men with median age at diagnosis of 58 years (minimum-maximum 35-65). Five-year surgical retreatment rates were highest for TUMT and PUL (24.5% and 22.3%) and lowest for HoLEP (7%; <i>p</i> < 0.001). One-year medical retreatment rates with bladder outlet medications (i.e., alpha-blockers, 5-alpha reductase inhibitors) were higher after MIST compared with traditional procedures (42.9% <i>vs</i> 27.3%; <i>p</i> < 0.001). <b><i>Conclusion:</i></b> Surgical and medical retreatment rates are higher than previously reported in clinical trials. MIST procedures and older age were predictive of both medical and surgical retreatment after index operation. HoLEP had the lowest rate of retreatment compared with TUMT and PUL, which had the highest.</p>","PeriodicalId":15723,"journal":{"name":"Journal of endourology","volume":" ","pages":"608-616"},"PeriodicalIF":2.9,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144006790","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 the Patient's Perceived Fear and Anxiety During Ambulatory Holmium Laser Enucleation of Prostate: A Prospective, Real-Practice Study from a Single Center.","authors":"Stéphanie Boulet, Alexandre Morin, Marc-Antoine Blais, Samuel Lagabrielle","doi":"10.1089/end.2024.0834","DOIUrl":"10.1089/end.2024.0834","url":null,"abstract":"<p><p><b><i>Background and Objective:</i></b> Ambulatory holmium laser enucleation of prostate (HoLEP) has shown low rates of readmission and postoperative complications. However, the patient's experience has been undervalued. We aimed to measure the patient's perceived fear and anxiety during ambulatory HoLEP. <b><i>Methods:</i></b> We performed a prospective study on patients scheduled for HoLEP at our institution. We excluded patients with cognitive or psychiatric disorders and those who had to be hospitalized. The week preceding the surgery, we administered the Surgical Fear Questionnaire (SFQ) and the Hospital Anxiety and Depression Scale (HADS) by phone. The day following the surgery, we readministered the HADS and asked the patients if they would undergo HoLEP in the same setting. <b><i>Key Findings and Limitations:</i></b> Overall, 70 patients completed the study (mean age 72.3, standard deviation [SD] 6.5 years). The mean SFQ score was 18.4/90 (SD 13.5); the two highest rated items were \"I am afraid of pain after the operation\" and \"I am afraid of unpleasant side effects after the operation.\" with a mean of 3.7/10 and 2.7/10, respectively. For the HADS, the mean preoperative score was 4.6/21 (SD 3.4), and the mean postoperative score was 3.9/21 (SD 3.0), with a mean difference of -0.7 (<i>p</i> = 0.059). The majority (90%) of patients reported they would undergo HoLEP in the same setting. <b><i>Conclusions and Clinical Implications:</i></b> Most patients described low levels of anxiety and fear, and would undergo ambulatory HoLEP again. Given the high satisfaction and low levels of anxiety, widespread adoption of ambulatory HoLEP should be considered. <b><i>Patient Summary:</i></b> Men with benign prostatic hyperplasia, or an enlarged prostate, often need surgery to improve urinary function. We studied the acceptability of same-day discharge surgery for this condition by assessing patients' anxiety, fear, and willingness to repeat the procedure. Most patients described low levels of anxiety and fear, and would undergo ambulatory HoLEP again.</p>","PeriodicalId":15723,"journal":{"name":"Journal of endourology","volume":" ","pages":"617-624"},"PeriodicalIF":2.9,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144003658","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":"Evaluating Long-Term Oncologic Outcomes of Radiofrequency Ablation for T1a Renal Cell Carcinoma with Minimum 10 Years of Follow-Up.","authors":"John Kim, Michael Uy, Alan Cheng, Lamisa Syed, Muaiqel Almuaiqel, Edward Matsumoto, Anil Kapoor, Rahul Bansal","doi":"10.1089/end.2024.0849","DOIUrl":"10.1089/end.2024.0849","url":null,"abstract":"<p><p><b><i>Introduction:</i></b> We aimed to assess long-term outcomes of radiofrequency ablation (RFA) for biopsy-proven renal cell carcinoma (RCC), with a minimum follow-up of 10 years. <b><i>Methods:</i></b> We retrospectively identified patients who underwent RFA for renal masses at our center between 2004 and 2014. All patients who underwent RFA for a single, unilateral renal mass measuring ≤4 cm and had a minimum follow-up of 10 years were included. Our primary outcome was RCC recurrence. Kaplan-Meier curves were used to identify recurrence-free, metastasis-free, cancer-specific, and overall survival rates. Multivariate binary logistic regression was used to determine predictors of recurrence. <b><i>Results:</i></b> A total of 75 patients were included in our study. Median follow-up was 131 months (interquartile range [IQR], 109-151 months). Median tumor size was 2.7 cm (IQR, 2.1-3.3 cm), and the median RENAL nephrometry score was 7 (IQR, 5-8). A total of 70.7% of pathology results showed clear cell RCC. Nine patients experienced RCC recurrence with a median time to recurrence of 54.4 months (IQR, 17.3-70.3 months). Two patients died due to metastatic RCC, and median time to death was 97.5 months (IQR, 55.8-128 months). Overall recurrence-free survival was 88%, and cancer-specific survival was 97%. No patients developed recurrence after 10 years. Univariate and multivariate regression did not identify any predictors of recurrence. <b><i>Conclusion:</i></b> RFA is a safe and effective treatment option for T1a RCC. Rates of recurrence and cancer-specific mortality are low at 10 years postprocedure. No patient or tumor factors were identified as predictors for RCC recurrence.</p>","PeriodicalId":15723,"journal":{"name":"Journal of endourology","volume":" ","pages":"594-600"},"PeriodicalIF":2.9,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144013892","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":"Application of Catheter-Assisted Circulation System in Ureteroscopic Holmium Laser Lithotripsy.","authors":"Zonghai He, Hongbin Gao, Cong Li, Yuhui Luo, Yang Xun, Shaogang Wang","doi":"10.1089/end.2024.0770","DOIUrl":"10.1089/end.2024.0770","url":null,"abstract":"<p><p><b><i>Objective:</i></b> Ureteroscopic lithotripsy (URSL) is the main method for treating ureteral calculi. The scholars used ureteroscopes with dual channels and access sheath to reduce the local temperature and flushing fluid pressure. This study compares the efficacy and safety of ureteral catheter-assisted URSL (UCA-URSL) and traditional URSL in treating ureteral calculi. <b><i>Patients and Methods:</i></b> A cross-regional retrospective case-control study in China, including 217 intention-to-treat patients from the First Affiliated Hospital of Kunming Medical University and Tongji Hospital Affiliated to Tongji Medical College of Huazhong University of Science and Technology, from August 2023 to July 2024. The primary outcome was the temperature of the lithotripsy point. The secondary outcomes included stone-free rate (SFR), operation time, hospital stay, and postoperative complications. <b><i>Results:</i></b> Compared with the traditional URSL group, the catheter-assisted URSL group had a significantly lower lithotripsy point temperature (max, 37.9 ± 2.60°C <i>vs</i> 49.98 ± 5.04°C, <i>p</i> < 0.0001; mean, 32.3 ± 3.25°C <i>vs</i> 38.56 ± 2.70°C, <i>p</i> < 0.0001). In addition, the UCA-URSL group showed higher absolute SFR (immediately, 89.81% <i>vs</i> 53.21%, <i>p</i> < 0.0001; 3 months, 99.07% <i>vs</i> 72.48%, <i>p</i> < 0.0001), and reduced operation time (22.74 ± 7.08 minutes <i>vs</i> 26.40 ± 6.72 minutes, <i>p</i> = 0.0001), postoperative fever rate (1.85% <i>vs</i> 15.60%, <i>p</i> = 0.0003), and ureteral stricture rate (0% <i>vs</i> 3.67%, <i>p</i> = 0.04). <b><i>Conclusions:</i></b> In treating ureteral calculi, UCA lithotripsy shows better safety than traditional URSL. Catheter-assisted URSL can be used to improve traditional URSL.</p>","PeriodicalId":15723,"journal":{"name":"Journal of endourology","volume":" ","pages":"518-524"},"PeriodicalIF":2.9,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144023138","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 Novel ±20° Gravity-Assisted Position for Tip-Bendable Suction Ureteral Access Sheath in Retrograde Intrarenal Surgery: A Multicenter Retrospective Study on Large Stone Management.","authors":"Meng-Hua Wu, Hui Liu, Xin Zheng","doi":"10.1089/end.2025.0053","DOIUrl":"10.1089/end.2025.0053","url":null,"abstract":"<p><p><b><i>Purpose:</i></b> To evaluate the efficacy of combining a tip-bendable suction ureteral access sheath (S-UAS) with gravity-assisted positioning to improve stone-free rates (SFRs) in retrograde intrarenal surgery (RIRS) for upper urinary tract stones (UUTS). <b><i>Methods:</i></b> A multicenter retrospective cohort study was conducted across three urological centers from July 2023 to August 2024. A total of 369 patients with UUTS treated with RIRS using S-UAS were included. Patients were categorized into two groups based on surgical positioning: the ±20° gravity-assisted position group and the standard lithotomy group. SFRs were classified into three grades: Grade A (no residual fragments on CT), Grade B (≤2mm fragments), and Grade C (≤4mm fragments). Key outcomes measured included immediate and 3-month SFR, operative time, and complication rates. Logistic regression analysis was used to identify factors associated with improved SFR. <b><i>Results:</i></b> The ±20° gravity-assisted position group showed a significantly higher immediate Grade-A (71.3% <i>vs</i> 48.1%, <i>p</i> < 0.001) and Grade-B SFR (86.0% <i>vs</i> 67.2%, <i>p</i> < 0.001) compared to the standard lithotomy group. This superiority in Grade-A SFR persisted at 3 months (76.0% <i>vs</i> 49.6%, <i>p</i> < 0.001). The median operative time was shorter in the ±20° gravity-assisted position group (67 <i>vs</i> 71 minutes, <i>p</i> = 0.0032) and the frequency of stone basket use was lower in ±20° gravity-assisted position. Multivariate analysis revealed that the lithotomy position was independently associated with a lower stone-free probability (adjusted odds ratio 0.36, 95% confidence interval 0.17-0.80; <i>p</i> = 0.012). No significant differences were observed in complication rates between the two groups. <b><i>Conclusion:</i></b> The ±20° gravity-assisted position improves immediate SFR in RIRS for UUTS, with shorter operative times. Combining gravity-assisted positioning with S-UAS is an effective strategy to optimize surgical outcomes in RIRS.</p>","PeriodicalId":15723,"journal":{"name":"Journal of endourology","volume":" ","pages":"525-531"},"PeriodicalIF":2.9,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143999356","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 Small Acute Ureteral Stone Protocol: Clinical Outcomes and Relapse Patterns.","authors":"Conrad Bayley, Patrick Albers, Nicholas Dean, Matthew Mancuso, Dariusz Bochinski, Tim Wollin, Shubha De, Ambikaipakan Senthilselvan, Trevor Schuler","doi":"10.1089/end.2024.0883","DOIUrl":"10.1089/end.2024.0883","url":null,"abstract":"<p><p><b><i>Purpose:</i></b> Nephrolithiasis affects approximately 10% of North Americans, placing a significant burden on health care systems. This study evaluates the effectiveness of a novel, virtual Small Acute Ureteral Stone (SAUS) protocol for managing ureteral stones ≤5 mm, aiming to optimize resource utilization and patient care. <b><i>Materials and Methods:</i></b> A retrospective review was conducted on 209 consecutive patients enrolled in the SAUS protocol from June 2018 to May 2019. The protocol included follow-up renal bladder ultrasound and nurse case manager telephone assessment. Patients were followed for a median of 5.4 years, with data collected on stone passage rates, interventions, and long-term outcomes. <b><i>Results:</i></b> The SAUS protocol successfully redirected 53% of patients from urgent clinic visits. Of these, 98% did not necessitate urologic intervention for their small ureteral stone. Overall, 77% of patients showed radiographical confirmation of stone passage, and 74% reported being symptom-free. Only 13% of all patients underwent intervention for their initial ureteral stone. Long-term follow-up revealed that after discharge from our protocol, 67% of patients did not re-present over 5 years, and 90% remained free from urologic intervention. The study's retrospective nature and reliance on electronic medical records may have introduced bias. Patient adherence to follow-up recommendations varied, potentially affecting outcome accuracy. <b><i>Conclusion:</i></b> The SAUS protocol demonstrates effectiveness in virtually managing small ureteral stones, reducing unnecessary clinic visits and interventions. The protocol's success suggests its potential for implementation in similar clinical scenarios, potentially reducing health care costs and improving patient care in urolithiasis management.</p>","PeriodicalId":15723,"journal":{"name":"Journal of endourology","volume":"39 6","pages":"542-548"},"PeriodicalIF":2.9,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144475503","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 Comparative Study of Flexible Navigable Vacuum-Assisted Ureteral Access Sheath and Traditional Ureteral Access Sheath in Retrograde Intrarenal Surgery: Evaluating the Impact of Hydronephrosis on Stone-Free Rate and Complications.","authors":"Ozgur Arikan, Erhan Erdogan, Mehmet Erhan Aydin, Ferhat Yakup Suceken, Mehmet Uslu, Ayberk Iplikci, Emre Burak Sahinler, Cahit Sahin, Asif Yildirim, Kemal Sarica","doi":"10.1089/end.2024.0921","DOIUrl":"https://doi.org/10.1089/end.2024.0921","url":null,"abstract":"<p><p><b><i>Background:</i></b> Retrograde intrarenal surgery (RIRS) is a widely used minimally invasive technique for renal stone management. Recently, flexible navigable vacuum-assisted ureteral access sheaths (FV-UASs) have been introduced to enhance RIRS outcomes. This study aimed to evaluate the efficacy of FV-UAS compared with traditional UAS (T-UAS) in RIRS, with a specific focus on the impact of hydronephrosis. <b><i>Methods:</i></b> A retrospective multicenter study was conducted involving 207 patients undergoing RIRS for renal stones. Patients were divided into two groups based on the type of UAS used: FV-UAS (<i>n</i> = 105) or T-UAS (<i>n</i> = 102). Demographic data, stone characteristics, operative time, complications, and stone-free rates (SFRs) were analyzed. The degree of hydronephrosis was assessed using the Society of Fetal Urology grading system. <b><i>Results:</i></b> The FV-UAS group demonstrated significantly shorter operative times (median: 50 minutes <i>vs</i> 57.5 minutes, <i>p</i> = 0.039) and a higher SFR at 1-week postoperatively (47.6% <i>vs</i> 23.5%, <i>p</i> < 0.001) compared with the T-UAS group. However, there was no significant difference in SFR at 1 month (75.2% <i>vs</i> 68.6%, <i>p</i> = 0.290). Postoperative fever was significantly lower in the FV-UAS group (3.8% <i>vs</i> 18.6%, <i>p</i> = 0.001). Importantly, the degree of hydronephrosis did not significantly impact the outcomes that performed RIRS with FV-UAS. <b><i>Conclusion:</i></b> FV-UAS offers potential advantages over T-UAS in RIRS, including shorter operative times, improved early stone-free status, and reduced postoperative complications. Hydronephrosis did not appear to affect the efficacy of FV-UAS. These findings suggest that FV-UAS may be a valuable tool in optimizing RIRS outcomes.</p>","PeriodicalId":15723,"journal":{"name":"Journal of endourology","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2025-05-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144187068","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}