Journal of endourology最新文献

{"title":"Development and Initial Evaluation of a Cost-Effective Force Sensor for Ureteroscopic Application.","authors":"Bruce M Gao, Jacob C Tsai, Andrei D Cumpanas, Jaime Altamirano-Villarroel, Seyedamirvala Saadat, Victor Pham, Evan Grohs, Yi Xi Wu, Zachary E Tano, Sohrab N Ali, Pengbo Jiang, Roshan M Patel, Jaime Landman, Ralph V Clayman","doi":"10.1089/end.2024.0315","DOIUrl":"10.1089/end.2024.0315","url":null,"abstract":"<p><p><b><i>Purpose:</i></b> Retrograde intrarenal surgery is the gold-standard treatment for most kidney stones. During ureteroscopy, ureteral access sheath insertion at forces greater than 8.0 Newtons (N) risks high-grade ureteral injury. To monitor force, our institution utilizes a unique, Bluetooth-equipped device (i.e., the University of California-Irvine Force Sensor). Given the unique nature of the force sensor, we sought to develop an inexpensive and accessible force sensor based on Boyle's law and the specific amount of force required to compress an occluded 1.0 mL syringe. <b><i>Materials and Methods:</i></b> We evaluated three brands of 1.0 mL syringes. After setting the plunger at 1.0 mL, the syringe was occluded, and the syringe plunger was compressed. The syringe volume was recorded when the applied force on the plunger reached 4.0 N, 6.0 N, and 8.0 N. Multiple trials were performed to assess reliability and reproducibility. A method for applying this clinically was also developed. <b><i>Results:</i></b> The precise force thresholds identified for a 1.0 mL Luer-Lok™ Syringe (Becton Dickinson, Franklin Lakes, NJ) were 0.30 mL for 4.00 N, 0.20 mL for 6.00 N, and 0.15 mL for 8.00 N. The 1.0 mL Tuberculin Syringe and 1.0 mL Luer Slip Syringe were less precise, but compression from 1.0 to 0.40 mL, 0.25 mL, and 0.20 mL corresponded to force sensor readings that did not exceed 4.00 N, 6.00 N, and 8.00 N, respectively. <b><i>Conclusions:</i></b> Based on volume changes, 4.00 N, 6.00 N, and 8.00 N of force can be reliably and reproducibly achieved using an occluded 1.0 mL syringe.</p>","PeriodicalId":15723,"journal":{"name":"Journal of endourology","volume":null,"pages":null},"PeriodicalIF":2.9,"publicationDate":"2024-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141450628","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":"HoLEP Learning Curve-Resident Perspective: Survey of Senior Residents from High-Volume Tertiary Center.","authors":"Jaya Sai S Chavali, Marcelino E Rivera, James E Lingeman","doi":"10.1089/end.2024.0054","DOIUrl":"10.1089/end.2024.0054","url":null,"abstract":"<p><p><b><i>Objective:</i></b> We aim to report the learning curve and experience performing holmium laser enucleation of the prostate (HoLEP) from a resident standpoint trained at a tertiary high-volume center. <b><i>Methods:</i></b> An electronic survey was distributed to 10 surveyees that included recently graduated chief residents trained at Indiana University in the past 3 years i.e., between 2020 and 2022 with a 100% response rate. The questionnaire focused on HoLEP training experience based on a recently established mentorship curriculum in training the residents through each individual step of the surgery. <b><i>Results:</i></b> The average learning curve for performing HoLEP was reported to be greater than 25 cases with 50% of the residents reporting >50 cases to master the technique. The surgical difficulty of steps of the HoLEP were rated on a subjective scale of 1-5: 1 = very easy, 2 = easy, 3 = neutral, 4 = hard, and 5 = very hard. The common challenging steps in decreasing the order of difficulty as reported are performing apical enucleation, joining anterior and posterior planes, and dividing anterior commissure with a mean rating of 3.5, 3.1, and 3.1, respectively. The most difficult aspect of the surgery to master was performing apical dissection (60%). Comparing operative parameters for HoLEP with transurethral resection of the prostate in aspects of resection volume and times, 70% of candidates reported it better for HoLEP whereas 20% had similar times for both procedures. A total of 90% of the residents felt confident to offer HoLEP as part of their practice without the need for any further training. Regarding the initial challenge of including HoLEP surgery in practice, the majority (60%) reported difficulty with equipment set up in their practice while 20% reported difficulty maintaining efficient operating room (OR) times and turnover. <b><i>Conclusion:</i></b> We believe HoLEP can be performed immediately after residency training and incorporated into practice with high volume, repeated exposure to HoLEP surgery throughout residency based on study results. The average learning curve reported for performing HoLEP was greater than 25 cases.</p>","PeriodicalId":15723,"journal":{"name":"Journal of endourology","volume":null,"pages":null},"PeriodicalIF":2.9,"publicationDate":"2024-07-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141432105","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-2024-0124-OR.R1.","authors":"Clinton D Bahler","doi":"10.1089/end.2024.0439","DOIUrl":"10.1089/end.2024.0439","url":null,"abstract":"","PeriodicalId":15723,"journal":{"name":"Journal of endourology","volume":null,"pages":null},"PeriodicalIF":2.9,"publicationDate":"2024-07-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141450629","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":"Surgical Stone Trends from 2013 to 2021 in the US Medicare Population: Before and after the COVID-19 Pandemic.","authors":"Emily Serrell, Ali S Antar, Erik Buinevicius, Shuang Li, Christopher Haas, Margaret Knoedler, Daniel Gralnek, Kristina L Penniston, Stephen Y Nakada","doi":"10.1089/end.2024.0063","DOIUrl":"10.1089/end.2024.0063","url":null,"abstract":"<p><p><i><b>Introduction and Objective:</b></i> In early 2020, as the SARS-Cov-2 (COVID-19) pandemic progressed, many institutions limited nonurgent surgical care. This coincided with a decade-long trend of increasing percutaneous nephrolithotomy (PCNL) and ureteroscopy (URS) and decreasing shock wave lithotripsy (SWL) for surgical management of urolithiasis. Herein, we evaluate temporal stone surgery rates and surgeon volumes in the Medicare population and suggest how COVID-19 contributed to them. <i><b>Methods:</b></i> Retrospective analysis was conducted using the \"Medicare Physician & Other Practitioners\" database containing data from January 2013 to December 2021. Adult patients who underwent stone surgery were included. We evaluated surgeon characteristics and changes in case volumes over time adjusted for population. <i><b>Results:</b></i> In 2013, urologists performed 68,910 stone surgeries: SWL 42,903 (62%); URS 25,321 (37%); PCNL 686 (1%). Over the next 8 years, there was an average annual increase in URS (+13%) and PCNL (+13%) and decrease in SWL (-2%). In 2020, there was a 14% reduction in all stone cases: SWL (-25%); URS (-6%); PCNL (-8%). By 2021, case volumes recovered to pre-2020 levels, though SWL remained low: SWL 33,974 (34%); URS 64,541 (64%); PCNL 1764 (2%). From 2013 to 2021, the number of urologists performing SWL decreased (1718 to 1361) while URS and PCNL providers doubled (1,347 to 2,914 and 28 to 76, respectively). <i><b>Conclusions:</b></i> From 2013 to 2021, there was an increase in URS and PCNL and a decrease in SWL in the US Medicare population. The COVID-19 pandemic was associated with a decline in stone surgeries, particularly SWL. By 2021, PCNL and URS case numbers increased significantly with a smaller increase in SWL.</p>","PeriodicalId":15723,"journal":{"name":"Journal of endourology","volume":null,"pages":null},"PeriodicalIF":2.9,"publicationDate":"2024-07-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141317405","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":"Optimizing Colon Identification by Window Setting Modulation on Noncontrast Computed Tomography Prior to Percutaneous Nephrolithotomy.","authors":"Snir Dekalo, Ziv Savin, Noam Bar-Yaakov, Haim Herzberg, Yuval Bar-Yosef, Galit Aviram, Ofer Yossepowitch, Mario Sofer","doi":"10.1089/end.2024.0254","DOIUrl":"10.1089/end.2024.0254","url":null,"abstract":"<p><p><b><i>Background:</i></b> Preoperative identification of the bowel on imaging is essential in planning renal access during percutaneous nephrolithotomy (PCNL) and avoiding colonic injury. We aimed this study to assess which noncontrast computed tomography (NCCT) window setting provides the optimal colonic identification for PCNL preoperative planning. <b><i>Methods:</i></b> Ten urologic surgeons (four seniors, six residents) reviewed 22 images of NCCT scans in both abdomen and lung window settings in a randomized blinded order. Colonic area delineation in each image was performed using a dedicated, commercially available area calculator software. A comparison of the marked colonic area between the abdomen and lung window settings was performed. <b><i>Results:</i></b> Overall, the mean marked colonic area was greater in the lung window compared with the abdomen window (8.82 cm² vs 7.4 cm², respectively, <i>p</i> < 0.001). Switching the CT window from abdomen to lung increased the identified colonic area in 50 cases (50%). Intraclass correlation showed good agreement between the senior readers and among all readers (0.92 and 0.87, respectively). Similar measurements of the colonic area in both abdomen and lung windows were observed in 26/44 (60%) of the seniors cases and in 7/66 (10%) of the resident cases (<i>p</i> = 0.002). <b><i>Conclusion:</i></b> Lung window solely or in combination with abdomen window appears to provide the most accurate colonic identification for preoperative planning of PCNL access and potentially reduce the risk of colonic injury. This pattern is more evident among young urologists, and we propose to introduce it as a standard sequence in PCNL preplanning.</p>","PeriodicalId":15723,"journal":{"name":"Journal of endourology","volume":null,"pages":null},"PeriodicalIF":2.9,"publicationDate":"2024-07-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141450630","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 for \"Do we Really Need Stone and Metabolic Urine Analysis?","authors":"Sara L Best","doi":"10.1089/end.2024.0383","DOIUrl":"10.1089/end.2024.0383","url":null,"abstract":"","PeriodicalId":15723,"journal":{"name":"Journal of endourology","volume":null,"pages":null},"PeriodicalIF":2.9,"publicationDate":"2024-07-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141317404","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":"Novel Robotic Platforms for Robot-Assisted Laparoscopic Surgery in Urology: A Narrative Review.","authors":"Panagiotis Kallidonis, Kristiana Gkeka, Vasileios Tatanis, Paraskevi Katsakiori, Theofanis Vrettos, Evangelos Liatsikos","doi":"10.1089/end.2023.0732","DOIUrl":"10.1089/end.2023.0732","url":null,"abstract":"<p><p>Robot-assisted surgery (RAS) has been integrated into clinical practice to overcome several limitations of conventional open or laparoscopic surgery. After the expiration of the long key patent period of Intuitive Surgical, various robotic systems (RSs) have been developed aiming at improving certain characteristics of the first robotic platform, the Da Vinci RS. This narrative review provides an overview of the current RSs used in urology along with the initial results from their application in urologic procedures. Nine robotic platforms are being analyzed regarding their unique characteristics as well as their efficacy, safety, feasibility, and outcomes in urologic, oncological, or non-oncological operations. The main barrier to the wide application of RAS has been the increased cost that refers to both acquisition and maintenance costs. Besides, the health inequality resulting from the lack of expert robotic surgeons and the difficulty of performing robot-assisted procedures in provincial hospitals should be overcome. However, large properly designed comparative studies are required to establish the role of newly introduced RSs. In addition, urologists should keep abreast of new developments and research in robot-assisted urologic procedures.</p>","PeriodicalId":15723,"journal":{"name":"Journal of endourology","volume":null,"pages":null},"PeriodicalIF":2.9,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140957884","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 Significance of Stone Culture in the Incidence of Sepsis: Results from a Prospective, Multicenter Study on Infections Post Flexible UreteroreNescopy (I-FUN) and Laser Lithotripsy for Renal Stones.","authors":"Daniele Castellani, Carlo Brocca, Virgilio De Stefano, Giorgio Mazzon, Antonio Celia, Andrea Bosio, Glauco Bertello, Eugenio Alessandria, Luigi Cormio, Runeel Ratnayake, Andrea Vismara Fugini, Tonino Morena, Yiloren Tanidir, Tarik Emre Sener, Simon Choong, Stefania Ferretti, Andrea Pescuma, Salvatore Micali, Nicola Pavan, Alchiede Simonato, Vineet Gauhar, Andrea Benedetto Galosi","doi":"10.1089/end.2024.0182","DOIUrl":"10.1089/end.2024.0182","url":null,"abstract":"<p><p><b><i>Objective:</i></b> Sepsis is the most serious complication of flexible ureteroscopy (F-URS) and laser lithotripsy. We assessed the influence of positive stone culture (SC) on major infectious complications (sepsis, septic shock). <b><i>Methods:</i></b> This prospective study enrolled adult patients deemed suitable for F-URS and laser lithotripsy from nine centers (January 2022-August 2023). Inclusion criteria were as follows: kidney stone(s), preoperative midstream urine culture (MSUC), stone(s) assessed at computed tomography scan, and SC. Exclusion criteria were as follows: bilateral procedures, ureteral stones, and children. Group 1 included patients with sterile SC. Group 2 included patients with positive SC. Data are presented as median (interquartile range). A multivariable logistic regression analysis was performed to evaluate factors associated with having a positive SC. <b><i>Results:</i></b> In total, 293 patients were included. Median age was 51.0 (24) years. There were 167 (57.0%) males. Group 2 included 32 (2.5%) patients. Group 2 patients were significantly older [75.0 (14) <i>vs</i> 51.0 (23) years, <i>p</i> = 0.02]. Stone features were similar. Major infectious complications were higher in Group 2 (15.6% <i>vs</i> 0.4%). One patient died because of sepsis in Group 2. Two out of 6 (33.3%) patients with major infectious complications had the same pathogen in MSUC and SC. In the multivariable regression analysis, diabetes (OR 3.23), symptomatic urinary infections within 3 months before operation (OR 4.82) and preoperative stent/nephrostomy (OR 2.92) were factors significantly associated with higher odds of positive SC. <b><i>Conclusions:</i></b> Patients with positive SC have a higher incidence of major infectious complications after F-URS lithotripsy. SC should be performed whenever feasible because there is a poor correlation between MSUC and SC.</p>","PeriodicalId":15723,"journal":{"name":"Journal of endourology","volume":null,"pages":null},"PeriodicalIF":2.9,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141317407","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":"Selection of Convolutional Neural Network Model for Bladder Tumor Classification of Cystoscopy Images and Comparison with Humans.","authors":"Ju Young Lee, Yong Seong Lee, Jong Hyun Tae, In Ho Chang, Tae-Hyoung Kim, Soon Chul Myung, Tuan Thanh Nguyen, Jae Hyeok Lee, Joongwon Choi, Jung Hoon Kim, Jin Wook Kim, Se Young Choi","doi":"10.1089/end.2024.0250","DOIUrl":"10.1089/end.2024.0250","url":null,"abstract":"<p><p><b><i>Purpose:</i></b> An investigation of various convolutional neural network (CNN)-based deep learning algorithms was conducted to select the appropriate artificial intelligence (AI) model for calculating the diagnostic performance of bladder tumor classification on cystoscopy images, with the performance of the selected model to be compared against that of medical students and urologists. <b><i>Methods:</i></b> A total of 3,731 cystoscopic images that contained 2,191 tumor images were obtained from 543 bladder tumor cases and 219 normal cases were evaluated. A total of 17 CNN models were trained for tumor classification with various hyperparameters. The diagnostic performance of the selected AI model was compared with the results obtained from urologists and medical students by using the receiver operating characteristic (ROC) curve graph and metrics. <b><i>Results:</i></b> EfficientNetB0 was selected as the appropriate AI model. In the test results, EfficientNetB0 achieved a balanced accuracy of 81%, sensitivity of 88%, specificity of 74%, and an area under the curve (AUC) of 92%. In contrast, human-derived diagnostic statistics for the test data showed an average balanced accuracy of 75%, sensitivity of 94%, and specificity of 55%. Specifically, urologists had an average balanced accuracy of 91%, sensitivity of 95%, and specificity of 88%, while medical students had an average balanced accuracy of 69%, sensitivity of 94%, and specificity of 44%. <b><i>Conclusions:</i></b> Among the various AI models, we suggest that EfficientNetB0 is an appropriate AI classification model for determining the presence of bladder tumors in cystoscopic images. EfficientNetB0 showed the highest performance among several models and showed high accuracy and specificity compared to medical students. This AI technology will be helpful for less experienced urologists or nonurologists in making diagnoses. Image-based deep learning classifies bladder cancer using cystoscopy images and shows promise for generalized applications in biomedical image analysis and clinical decision making.</p>","PeriodicalId":15723,"journal":{"name":"Journal of endourology","volume":null,"pages":null},"PeriodicalIF":2.9,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141321005","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":"Spotlight on Yasser A. Noureldin, MD, MSc, PhD, FEBU.","authors":"","doi":"10.1089/end.2024.33779.spot","DOIUrl":"https://doi.org/10.1089/end.2024.33779.spot","url":null,"abstract":"","PeriodicalId":15723,"journal":{"name":"Journal of endourology","volume":null,"pages":null},"PeriodicalIF":2.9,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141626905","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}