Journal of endourology最新文献

{"title":"A Modern Education Theory Approach to Development of a Benchtop Simulation Model for Ultrasound-Guided Percutaneous Nephrolithotomy.","authors":"Ahmed Ghazi, Lauren Shepard, Oscar Li, Carolyn Im, Nathan Schuler, Patrick Saba, Eric Ballon-Landa, Seth K Bechis, Ryan S Hsi, Nicholas Kavoussi, Scott Wiener, David T Tzou, Roger L Sur, Helena C Chang, Thomas Tailly, Justin Ahn, David Bayne, Thomas Chi","doi":"10.1089/end.2024.0618","DOIUrl":"https://doi.org/10.1089/end.2024.0618","url":null,"abstract":"<p><p><b><i>Objective:</i></b> To develop and validate a high-fidelity, nonbiohazardous simulator model for the ultrasound-guided percutaneous nephrolithotomy procedure. <b><i>Methods:</i></b> We employed a systematic framework based on Delphi consensus and modern education theory to design a simulation model. Twelve expert surgeons provided input through a hierarchal task analysis and identified procedural tasks, anatomical landmarks, and potential errors. These were translated into engineering deliverables by a team of biomedical engineers and surgical educators. A prototype was developed using three-dimensional printing and hydrogel molding, followed by expert validation through recorded simulations and subsequent multicenter trails with 48 participants. <b><i>Results:</i></b> A hydrogel prototype with realistic anatomical features was created using results from the Delphi process. It received positive feedback in areas such as anatomy, procedural fidelity, and education effectiveness, with overall high satisfaction ratings. Validation studies showed a significant difference in performance between novices and experts. Residents demonstrated significant skill improvement and retention after repeated simulations. <b><i>Conclusions:</i></b> The developed simulator provides a realistic, effective training tool for urologic education, addressing the need for safer and more accessible surgical training modalities.</p>","PeriodicalId":15723,"journal":{"name":"Journal of endourology","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2024-12-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142882062","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":"Prospective Evaluation of Ureteral Wall Thickness as a Means to Predict Spontaneous Stone Passage: Is It Beneficial?","authors":"Andrei D Cumpanas, Brandon Camp, Candices M Tran, Thao N Vu, Wen-Pin Chen, Kelvin Vo, Rohit Bhatt, Zachary E Tano, Bruce M Gao, Roshan M Patel, Pengbo Jiang, Jaime Landman, Ralph V Clayman","doi":"10.1089/end.2024.0462","DOIUrl":"https://doi.org/10.1089/end.2024.0462","url":null,"abstract":"<p><p><b><i>Purpose:</i></b> Ureteral wall thickness (UWT) was proposed as a potential predictor for spontaneous stone passage (SSP). In earlier studies, the effect could not be isolated from stone size. Accordingly, we sought to determine whether UWT, alone or combined with stone size, could enhance SSP predictability. <b><i>Material and Methods:</i></b> In total, 199 patients with acute renal colic and a single ureteral stone visible on noncontrast computerized tomography (NCCT) who opted for SSP were prospectively enrolled. A reviewer, blinded to the enrollee's stone passage status, analyzed NCCTs for both stone metrics (linear measurements, area, volume, density) and ureteral parameters (UWT at the point of greatest soft-tissue thickness, location, hydronephrosis). Logistic regression models were used to evaluate the relationship between these factors and SSP. <b><i>Results:</i></b> In a univariate analysis, longer (odds ratio [OR] = 0.285; 95% confidence interval [CI]: 0.375-0.608), wider (OR = 0.477; 95% CI: 0.375-0.608), denser (OR = 0.997; 95% CI: 0.995-0.998) stones with larger surface areas (OR = 0.920; 0.890-0.951), larger volumes (OR = 0.984; 95% CI: 0.977-0.990), and greater depth (OR = 0.538; 95% CI: 0.427-0.676), as well as those surrounded by a thicker UWT (OR = 0.665; 95% CI: 0.504-0.878), were less likely to pass spontaneously. In a multivariate analysis, UWT actually lost its significance. Indeed, in the multivariate analysis, only the largest linear stone measurement retained significance (OR = 0.454; 95% CI: 0.343-0.600). <b><i>Conclusion:</i></b> Although significant in a univariate analysis, in a prospective cohort study that adjusted for stone size, UWT lost significance in the multivariate model. SSP of a ureteral calculus was best predicted by its maximum linear measurement.</p>","PeriodicalId":15723,"journal":{"name":"Journal of endourology","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2024-12-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142818245","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Flexible Ureteroscopy Combined with Novel Ultra-Flexible Ureteral Access Sheaths for Treating Allium Stent Encrustation: Initial Experience with 15 Cases.","authors":"Yujun Chen, Heng Yang, Yue Yu, Haibo Xi, Xiaochen Zhou, Gongxian Wang","doi":"10.1089/end.2024.0559","DOIUrl":"https://doi.org/10.1089/end.2024.0559","url":null,"abstract":"<p><p><b><i>Introduction:</i></b> Encrustation significantly affects the lifespan of Allium stents. Currently, there is no established treatment for Allium ureteral stent encrustation. This study introduces a method for treating these encrustations using a flexible ureteroscopy (F-URS) combined with a novel ultra-flexible ureteral access sheath (UF-UAS). <b><i>Methods:</i></b> We retrospectively analyzed patients treated for Allium stent encrustation with UF-UAS from January 2022 to January 2024. Patients with transplanted kidneys were excluded. The UF-UAS features a 10 cm ultra-flexible distal segment, allowing passive deflection beyond 270° during F-URS. This segment, devoid of wire reinforcement, is made of a silicone composite for optimal pliability. The primary endpoints focused on complications such as damage and migration of the Allium stent. <b><i>Results:</i></b> A total of 15 consecutive patients (4 men) underwent the procedure. The cohort included 3, 9, and 3 patients with Allium stents measuring 6, 8, and 10 cm, respectively. Mean preoperative stent dwell time was 19.9 months. Preoperative urine cultures were positive in seven patients. Mean operative time was 33.8 minutes. Three patients (20.0%) required a Double-J stent postoperatively. No instances of Allium stent damage were observed. One patient with ≤2 mm fragments and one patient with 2.1-4 mm fragments within the renal. One patient experienced a 1.5 cm Allium migration one day postoperatively. At 3 months, no Allium migration and increased hydronephrosis were observed. <b><i>Conclusions:</i></b> The novel UF-UAS facilitated the effective and safe removal of stones, encrustations, and biofilms from Allium ureteral stents. This method may extend the stent lifespan and reduce the need for stent exchanges.</p>","PeriodicalId":15723,"journal":{"name":"Journal of endourology","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2024-12-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142779983","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":"Safety and Effectiveness of Urologist-Directed Extracorporeal Shock Wave Lithotripsy for Pancreatolithiasis.","authors":"Ridwan Alam, Yasin Bhanji, Mark N Alshak, Matthew J Rabinowitz, Oscar Li, Gregory A Joice, Hiten D Patel, Jared S Winoker, Brian R Matlaga","doi":"10.1089/end.2024.0402","DOIUrl":"10.1089/end.2024.0402","url":null,"abstract":"<p><p><b><i>Introduction:</i></b> Extracorporeal shock wave lithotripsy (SWL) can be used in conjunction with endoscopic retrograde cholangiopancreatography (ERCP) for the treatment of large (≥5 mm) or impacted pancreatolithiasis. We report our experience demonstrating the safety and effectiveness of urologist-directed SWL for pancreatolithiasis. <b><i>Methods:</i></b> We performed a retrospective review of all patients undergoing SWL for pancreatolithiasis at our institution between 2016 and 2020. We defined a treatment cycle as one in which the patient underwent a predefined number of SWL procedures prior to performance of a post-SWL ERCP. Stone-free status was defined as the absence of stone fragments at post-SWL ERCP. Multivariable logistic regression was performed to determine characteristics associated with stone persistence after a treatment cycle. <b><i>Results:</i></b> There were 44 patients who underwent 59 treatment cycles consisting of 118 pancreatic SWL procedures. Forty-two cycles (71.2%) were staged, and 17 (28.8%) were not staged. The median size of the largest pancreatic stone was 9 mm [IQR 6-11] and was impacted in 38 cases (64.4%). Patients reported pain in 51 cases (86.4%), of which 28 required the use of opioid analgesics. Patients were rendered stone free in 38 cycles (64.4%). Pain improvement was noted in 39 cases (66.1%), and the reduction in opioid use was statistically significant (28 cases vs. 10 cases, <i>P</i> = 0.004). Impacted stones were associated with an increased odds of stone persistence (OR 7.04, 95% CI 1.14-43.43, <i>P</i> = 0.04). <b><i>Conclusions:</i></b> In this joint venture with gastroenterology, we demonstrate that urologist-directed SWL for pancreatolithiasis is safe, effective, and in line with published rates.</p>","PeriodicalId":15723,"journal":{"name":"Journal of endourology","volume":" ","pages":"1415-1420"},"PeriodicalIF":2.9,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142621186","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 Vapor 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":"10.1089/end.2024.0400","url":null,"abstract":"<p><p><b><i>Introduction:</i></b> To compare the clinical outcomes and complication rates of convective water vapor energy ablation (Rezum^®) and prostatic urethral lift (Urolift^®). To identify predictive factors for treatment failures in both treatments. <b><i>Materials & Methods:</i></b> 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. <b><i>Results:</i></b> 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 <i>vs</i> 1.39 ± 3.010 days, <i>p</i> < 0.001) compared with Urolift^®. Rezum^® was associated with more complications compared with Urolift^® (36 [41.9%] <i>vs</i> 10 [16.1%] cases, <i>p</i> < 0.001). Rezum^® had more cases of hematuria (17 [19.8%] <i>vs</i> 4 [6.5%] cases [<i>p</i> = 0.022]) and urinary tract infections (27 [31.4%] <i>vs</i> 3 [4.8%] cases, <i>p</i> < 0.001) compared with Urolift^®. There were no significant differences in Clavien-Dindo Grade 3-5 complications between the interventions. Urolift^® was associated with higher reoperation rates (5 [8.1%] <i>vs</i> 0 [0%] cases, <i>p</i> = 0.010) compared Rezum^®. Rezum^® had higher anticholinergic usage rates compared with Urolift^® post-operation (22 [25.6%] <i>vs</i> 8 [12.9%] cases, <i>p</i> = 0.024). Both interventions showed improvement in the 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, preoperation IPSS ≥16 had 95.7% sensitivity and 38.4% specificity to predict the probability of treatment failures after the interventions. <b><i>Conclusions:</i></b> 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":" ","pages":"1387-1394"},"PeriodicalIF":2.9,"publicationDate":"2024-12-01","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":"Does Incision Location Matter? Analysis of Single-Port Cosmesis in Urologic Reconstructive Surgery.","authors":"Michael Raver, Catherine Implicito, Mason Henrich, Qilin Cao, Katherine Kim, Simon Gelman, Sonam Saxena, Ruth Sanchez De La Rosa, Sharon Seidman, Gregory Lovallo, Ravi Munver, Mubashir Billah, Mutahar Ahmed, Michael Stifelman","doi":"10.1089/end.2024.0322","DOIUrl":"10.1089/end.2024.0322","url":null,"abstract":"<p><p><b><i>Introduction and Objective:</i></b> One potential advantage of single-port (SP) robotic surgery compared with multiport (MP) robotic surgery is improved cosmesis. The only studies in urology patients to suggest this finding did not assess differences based on incision site. Our study evaluated SP, MP, incision location, age, gender, and prior abdominal surgery as predictors of cosmesis and scar consciousness for reconstructive procedures. <b><i>Methods:</i></b> This is a cohort study using an institutional review board-approved prospective genitourinary reconstruction database. Patients at least 3 months from surgery were emailed and called to complete the Consciousness subsection of the Patient Scar Assessment Questionnaire. Bothersome was defined as a score of 11 or greater. Overall consciousness was scored with a single item as \"not conscious\" or \"conscious.\" Pearson's chi-squared, Wilcoxon rank sum, Fisher's exact test, and logistic regression were performed to assess how age, gender, prior surgery, and incision location affect cosmesis. <b><i>Results:</i></b> There were 111 patients (54 MP, 57 SP), of which 27 were SP umbilical, 14 were SP midline nonumbilical, and 16 were SP lower quadrant. On univariate analysis the periumbilical incision had the lowest consciousness. Age was associated with Bother (<i>p</i> = 0.012) and Consciousness (<i>p</i> = 0.002), whereas gender, prior abdominal surgery, and incision site were not significant. On logistic regression, all SP incisions were less likely to be bothered compared with MP, although only SP umbilical was statistically significant (odds ratio [OR] = 0.08, 95% confidence interval [CI]: 0.01,0.38; <i>p</i> = 0.005). Age was also significant on logistic regression for Bother (OR = 0.96, 95% CI: 0.93,0.99; <i>p</i> = 0.005). Gender and prior abdominal surgery were not associated with Bother or Consciousness. <b><i>Conclusions:</i></b> SP periumbilical incisions provide the best outcomes for cosmesis compared with other SP incision sites and MP incisions. This finding should be discussed and taken into account when planning surgical approaches for patients undergoing urinary reconstruction, especially in patients younger than 40 years of age.</p>","PeriodicalId":15723,"journal":{"name":"Journal of endourology","volume":" ","pages":"1364-1371"},"PeriodicalIF":2.9,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142501648","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":" ","pages":"1340-1345"},"PeriodicalIF":2.9,"publicationDate":"2024-12-01","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":"Real-World Safety of Prostate Cancer Focal Therapy: MAUDE Database Analysis.","authors":"Zhiyu Qian, Boyuan Xiao, Filippo Dagnino, Julia Feldman, Jonathan Song, Hanna Zurl, Daniel Stelzl, Stephan Korn, Leonardo Reis, Caroline M Moore, Quoc-Dien Trinh, Alexander P Cole","doi":"10.1089/end.2024.0573","DOIUrl":"10.1089/end.2024.0573","url":null,"abstract":"<p><p><b><i>Objective:</i></b> The aim of this study was to assess the real-world safety profile of medical devices used in focal prostate cancer treatment utilizing the Manufacturer and User Facility Device Experience (MAUDE) database. <b><i>Methods:</i></b> The MAUDE database was searched for reports on high-intensity focused ultrasound (HIFU), cryoablation, laser ablation, and irreversible electroporation (IRE) devices used in prostate cancer treatment from 1993 to 2023. Adverse events were identified and categorized. <b><i>Results:</i></b> We identified 175 reports for HIFU, 1362 for cryoablation, 615 for laser ablation, and 135 for IRE devices, with 28, 284, 126, and 2 respective reports, directly related to prostate cancer treatment. The aggregated data revealed the majority of complications were minor, with 82.5% (<i>n</i> = 363 out of 440 total complications) classified as Clavien-Dindo grade 1 or 2. Common minor complications included erectile dysfunction and urinary retention. Severe complications such as rectal fistulas were noted in HIFU and IRE treatments, along with singular mortality due to pulmonary embolism in cryoablation. <b><i>Conclusions:</i></b> Our analyses from MAUDE reveal that devices used in focal therapy for prostate cancer are predominantly associated with minor complications, underscoring their overall real-world safety profile. However, the occurrence of severe adverse events emphasizes the critical importance of rigorous patient selection and meticulous procedural planning. These findings provide valuable insights into the safety profile of focal therapy devices and contribute to the growing body of evidence on their use in prostate cancer treatment.</p>","PeriodicalId":15723,"journal":{"name":"Journal of endourology","volume":" ","pages":"1406-1412"},"PeriodicalIF":2.9,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142501650","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>In Vitro</i> Comparison of Pulsed-Thulium:YAG, Holmium:YAG, and Thulium Fiber Laser.","authors":"Marie Chicaud, Stessy Kutchukian, Laurent Berthe, Mariela Corrales, Catalina Solano, Luigi Candela, Steeve Doizi, Daron Smith, Olivier Traxer, Frédéric Panthier","doi":"10.1089/end.2024.0424","DOIUrl":"10.1089/end.2024.0424","url":null,"abstract":"<p><p><b><i>Objective:</i></b> To characterize the pulse characteristics and risk of fiber fracture (ROF) of the pulsed-Thulium:YAG (p-Tm:YAG) laser and to compare its ablation volumes (AVs) against Holmium:Yttrium-Aluminium-Garnet (Ho:YAG) laser and Thulium fiber laser (TFL). <b><i>Materials and Methods:</i></b> p-Tm:YAG (100 W-Thulio, Dornier-Medtech^©, Germany) was characterized using single-use 272 μm core-diameter-fibers. p-Tm:YAG characterization included pulse shape, duration, and peak power (PP) studies. ROF was assessed after 5 minutes of continuous laser activation (CLA) at five decreasing fiber bend radii (1, 0.9, 0.75, 0.6, and 0.45 cm). p-Tm:YAG, Ho:YAG (120 W-Cyber-Ho, Quanta^®, USA), and TFL (60 W-TFLDrive, Coloplast^®, Denmark) AVs were compared using a 20-mm linear CLA at 2 mm/second velocity in contact with 20 mm³ hard stone phantoms (HSP) and soft stone phantoms (SSP) (15:3 and 15:5 water to powder ratio, respectively) fully submerged in saline at 0.5 J-20 Hz or 1 J-10 Hz. After CLA, phantoms underwent three-dimensional (3D) micro-scanning (CT) and subsequent 3D segmentation to estimate the AVs, using 3DSlicer^©. Each experiment was performed in triplicate. <b><i>Results:</i></b> p-Tm:YAG presents a uniform pulse profile in all of the available preset modes. PP ranged from 564 to 2199 W depending on pulse mode. No laser fiber fracture occurred at any bend radius. p-Tm:YAG achieved similar mean AVs to TFL and Ho:YAG for HSP (8.96 ± 3.1 <i>vs</i> 9.78 ± 1.1 <i>vs</i> 8.8 ± 2.8 mm³, <i>p</i> = 0.67) but TFL was associated with higher AVs compared with p-Tm:YAG and Ho:YAG (12.86 ± 1.85 <i>vs</i> 10.12 ± 1.89 <i>vs</i> 7.56 ± 2.21 mm³, <i>p</i> = 0.002) against SSP. AVs for HSP increased with pulse energy for p-Tm:YAG and Ho:YAG and (11.56 ± 1.8 <i>vs</i> 6.36 ± 0.84 mm³ and 11.27 ± 1.98 <i>vs</i> 6.34 ± 0.55 mm³, <i>p</i> = 0.03 and <i>p</i> = 0.02), whereas AVs for SSP were similar across laser settings for all laser sources. AVs with TFL were similar across laser settings for both phantom types. <b><i>Conclusion:</i></b> p-Tm:YAG combines intermediate PP between Ho:YAG and TFL, a uniform pulse profile, no ROF with increasing deflection and effective ablation rates. Further clinical studies are needed to confirm these <i>in vitro</i> results.</p>","PeriodicalId":15723,"journal":{"name":"Journal of endourology","volume":" ","pages":"1427-1435"},"PeriodicalIF":2.9,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142288969","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 Residual Stone Fragments on Risk of Unplanned Stone Events Following Percutaneous Nephrolithotomy.","authors":"Denzel Zhu, Kaela Mali, Christopher Carlisi, Galen Cheng, Karen M Doersch, Scott O Quarrier, Rajat K Jain","doi":"10.1089/end.2024.0435","DOIUrl":"10.1089/end.2024.0435","url":null,"abstract":"<p><p><b><i>Purpose:</i></b> Residual stone fragments are common after percutaneous nephrolithotomy (PCNL), however, there is an unclear relationship between the presence of these residual stone fragments and the risk of unplanned stone events (USE). We investigated how the size of the largest residual stone fragment (LRSF) impacts the risk of USE post-PCNL. <b><i>Materials and Methods:</i></b> We conducted a retrospective cohort study of PCNL between 2018 and 2022. Preoperative computed tomography of the abdomen and pelvis (CTAP) imaging and postoperative CTAP imaging were reviewed. The primary outcome was the incidence of postoperative USE, defined as stone-related emergency department visits or unplanned stone procedures. LRSF were stratified by five thresholds (no postoperative stone fragments <i>vs</i> ≥0 mm, <2 <i>vs</i> ≥2 mm, <3 <i>vs</i> ≥3 mm, <4 <i>vs</i> ≥4 mm, and <5 <i>vs</i> ≥5 mm), and Cox regression was used to compare the impact of these thresholds on the risk of USE. <b><i>Results:</i></b> After exclusions, we identified 138 patients who underwent PCNL during the study period; 42 patients had a USE. When applying a 4 mm threshold, 52% of patients with LRSF ≥4 mm experienced USE <i>vs</i> 21% with LRSF <4 mm (log-rank <i>p</i> = 0.0004); similarly, with a 5 mm threshold, 62.5% with LRSF ≥5 mm had such events compared with 21% with LRSF <5 mm (log-rank <i>p</i> < 0.00001). A larger LRSF was associated with a greater risk of having a USE. <b><i>Conclusion:</i></b> After PCNL, larger residual stone fragments, particularly those ≥4 mm, are associated with an increased risk of USE. These results demonstrate the value of identifying residual fragments in predicting USE.</p>","PeriodicalId":15723,"journal":{"name":"Journal of endourology","volume":" ","pages":"1380-1386"},"PeriodicalIF":2.9,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142501649","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}