Journal of endourology最新文献

{"title":"Aspiration Technologies in Flexible Ureteroscopic Urolithiasis Treatment: A Disruptive Concept in Pursuit of a Stone-Free Future.","authors":"Eve Frangopoulos, Ziv Savin, Ralph V Clayman, Vinay Durbhakula, William M Atallah, Aymon Ali, Jamie Landman, Mantu Gupta","doi":"10.1177/08927790251364285","DOIUrl":"10.1177/08927790251364285","url":null,"abstract":"<p><p><b><i>Introduction:</i></b> Endoscopic innovation has played a pivotal role in advancing retrograde intrarenal surgery (RIRS). Integration of aspiration technology into flexible ureteroscopes (fURS), termed direct in-scope suction (DISS), and into ureteral access sheaths (s-UAS) are the most recent and rapidly progressing advancements. Aspiration technologies aim to augment stone-free rates (SFR) associated with traditional RIRS and may provide an alternative to retrograde management of large calculi typically managed with percutaneous nephrolithotomy (PCNL). This systematic and narrative review aims to consolidate the current evidence on aspiration devices used in RIRS. <b><i>Methods:</i></b> Using the Covidence platform, a literature search was conducted including the PubMed and Web of Science databases from inception to October 2024. This systematic review was registered in PROSPERO (CRD42024613059). Studies were categorized based on level of evidence and included randomized controlled trials (RCTs), comparative observational studies, and large-scale prospective studies; papers were excluded due to expired technology or absence of a traditional fURS comparator group. <b><i>Results:</i></b> Literature search yielded 232 articles. Following exclusion and manual review, 11 studies (1 RCT, 8 comparative cohort studies, and 2 large-scale observational studies) were selected for analysis. Assessing level 1 evidence, immediate and final SFRs were significantly higher in s-UAS groups. S-UAS was also superior to traditional fURS in achieving superior SFR for the management of renal calculi with level 3 evidence. <b><i>Conclusion:</i></b> Early studies utilizing contemporary aspiration technologies demonstrated superior efficacy and efficiency with respect to immediate SFR and operative times in patients undergoing fURS for renal stones between 1 and 2 cm compared with traditional fURS. Future studies adhering to standardized SFR criteria with postoperative thin-slice (2 mm) noncontrast computed tomography scanning is warranted to more precisely assess the effectiveness of aspiration technology-associated SFR values.</p>","PeriodicalId":15723,"journal":{"name":"Journal of endourology","volume":" ","pages":"829-840"},"PeriodicalIF":2.8,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144789297","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":"Niche No More? Mapping US Trends and Regional Disparities in Holmium Laser Enucleation of the Prostate from 2018 to 2022.","authors":"Jennifer Robles, Young E Shin, Sirikan Rojanasarot, Nicole L Miller","doi":"10.1089/end.2025.0188","DOIUrl":"10.1089/end.2025.0188","url":null,"abstract":"<p><p><b><i>Introduction:</i></b> The clinical benefits of holmium laser enucleation of the prostate (HoLEP) for managing benign prostatic hyperplasia (BPH) are well-documented. However, HoLEP was performed in less than 5% of all BPH surgeries in the United States (US) prior to 2016, with large regional gaps in care. This study assessed temporal trends and geographic distribution of HoLEP utilization and providers in the US from 2018 to 2022. <b><i>Methods:</i></b> Claims data from Definitive Healthcare (2018-2022) were used to identify urologists who performed HoLEP and assess utilization across the US. HoLEP rates were calculated by dividing patients who underwent HoLEP by total patients with BPH who underwent any procedure for BPH. Active HoLEP surgeons were defined as those who performed ≥10 annual HoLEP procedures. Regional patient concentration was calculated by dividing patients with BPH by active HoLEP surgeons. Utilization trends over time were analyzed through Cochran-Armitage tests. <b><i>Results:</i></b> HoLEP utilization in the US increased by 52% between 2018 and 2022. The number of urologists performing HoLEP rose by 16%, from 386 in 2018 to 451 in 2022, while active HoLEP surgeons increased by 43% (106 to 151). High-volume surgeons performed 40.8% of all HoLEP cases in 2018 and 57.6% in 2022. States with ≥1 active HoLEP surgeon increased from 32 to 34, leaving 33% of states without a single active surgeon. The West (1050) and Northeast (786.3) had the highest BPH patient-to-surgeon ratios in 2018 and 2022, respectively, while the South had the best ratio and the most surgeons. <b><i>Conclusions:</i></b> HoLEP utilization has increased significantly, highlighting the growing demand in the US. Almost a third of states still lack access to an active HoLEP surgeon, and the high ratio of patients per provider in regions like the Northeast indicates a need for facilitating the dissemination of expertise to ensure equitable access to HoLEP.</p>","PeriodicalId":15723,"journal":{"name":"Journal of endourology","volume":" ","pages":"781-787"},"PeriodicalIF":2.8,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144528153","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":"Rock Solid Measurements: A Comparison of Three Methods of Kidney Stone Volume Assessment.","authors":"Grant Sajdak, D Daniel Baldwin, Ala'a Farkouh, Ruben Crew, Katya Hanessian, Kai Wen Cheng, Uy Lae Kim, Jammie-Lyn Quines, Akin S Amasyali, Sikai Song, Zhamshid Okhunov, D Duane Baldwin","doi":"10.1177/08927790251359973","DOIUrl":"10.1177/08927790251359973","url":null,"abstract":"<p><p><b><i>Introduction and Objective:</i></b> Renal stone volume is an important variable for treatment selection and predicting surgical outcomes. However, the standardized and optimal method for stone volume assessment has not been identified. The purpose of this study was to evaluate and compare three methods of volume assessment: the scalene ellipsoid formula, three-dimensional (3D) slicer, and Enterprise Imaging. <b><i>Methods:</i></b> A bench top model was created including a torso and kidney based on an actual patient computed tomography (CT). Five kidney stone sets of varying sizes were implanted and scanned using a 64 slice CT scanner. Ten blinded reviewers used the scalene ellipsoid formula, 3D slicer, and Enterprise Imaging to measure kidney stone volume for each stone set. Using these measurements, the methods were compared for inter-rater reliability, accuracy, speed, validity, and convenience. Significance was determined by the Friedman test in addition to using Tukey's <i>post hoc</i> and analysis of variance where appropriate. <b><i>Results:</i></b> All three techniques had high inter-rater reliability (intraclass correlation coefficient >0.98). The mean relative error for Enterprise Imaging (4.9%) was significantly lower than 3D slicer (10.2%; <i>p</i> < 0.001) and the scalene ellipsoid formula (43.8%; <i>p</i> < 0.001). When performed by an expert, Enterprise Imaging (17.8 seconds) was faster than the scalene ellipsoid formula (25.2 seconds; <i>p</i> = 0.006) and both were faster than 3D slicer (196.6 seconds; <i>p</i> < 0.001). Each method was determined to be internally consistent and valid (α > 0.9; <i>R</i>² > 0.98, respectively). Enterprise Imaging was determined to be significantly more convenient (<i>p</i> < 0.001) than both the scalene ellipsoid formula and 3D slicer. <b><i>Conclusion:</i></b> In this study, Enterprise Imaging was a more accurate and efficient tool to measure stone volume. Clinicians can utilize Enterprise Imaging to efficiently determine stone volume and to better select treatment and predict operative and postoperative outcomes.</p>","PeriodicalId":15723,"journal":{"name":"Journal of endourology","volume":" ","pages":"856-861"},"PeriodicalIF":2.8,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144667732","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparative Analysis of 30- and 90-Day Outcomes of Aquablation vs Other Surgical Treatments for Benign Prostatic Hyperplasia.","authors":"Isabella S Florissi, Taylor Kohn, Dianelis G Pupo, Liam Nugent, Mark N Alshak, Pranjal Agrawal, Naren Nimmagadda","doi":"10.1177/08927790251364272","DOIUrl":"10.1177/08927790251364272","url":null,"abstract":"<p><p><b><i>Background:</i></b> Short-term outcomes of Aquablation as the treatment for benign prostatic hyperplasia (BPH) have not been well characterized. The aim of this analysis was to compare rates of 30- and 90-day complications following Aquablation with those after transurethral resection of prostate (TURP), UroLift, holmium laser enucleation of the prostate (HoLEP), and laparoscopic simple prostatectomy (SP). <b><i>Methods:</i></b> Using the TriNetX Research database, a collaborative claims and electronic medical record research network of 79 large health care organizations, we conducted a propensity-matched retrospective cohort study of all patients who underwent Aquablation (Current Procedural Terminology [CPT] 0421T or Healthcare Common Procedure Coding System ((HCPCS) C2596), TURP (CPT 52601), UroLift (CPT 52441), HoLEP (CPT 52649), or laparoscopic SP (CPT 55866, 55867) between the dates of January 1, 2017, and December 31, 2023. We performed a propensity score matching for age at time of operation, diabetes, hypertension, obesity, and Prostate Specific Antigen (PSA) range to determine the relative risk of developing the following outcomes at 30- and 90-days postoperatively: visit to the emergency department, hospital readmission, catheter re-insertion, and urinary tract infection. <b><i>Results:</i></b> Prior to matching, data were available for 1054 Aquablation, 18,945 TURP, 3966 UroLift, 5200 HoLEP, and 5369 laparoscopic SP patients; 53% of Aquablation cases were performed in 2023. After matching Aquablation to each other procedure, the cohorts ranged in size from 1048 to 1054. At 30 and 90 days postoperatively, patients who underwent Aquablation were more likely to be readmitted to the hospital and require catheter re-insertion than most operative cohorts. When eliminating from the analysis patients who underwent Aquablation in 2023, the association between Aquablation and readmission did not persist. <b><i>Conclusions:</i></b> Patients undergoing Aquablation may experience higher rates of hospital readmission at 30 and 90 days postoperatively than most other surgical BPH cohorts, which may be because of the learning curve associated with the procedure or applying the procedure to larger prostate volumes.</p>","PeriodicalId":15723,"journal":{"name":"Journal of endourology","volume":" ","pages":"862-870"},"PeriodicalIF":2.8,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144799195","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":"Robotic-Assisted Electromagnetic Guidance Improves Success of Percutaneous Access for Nephrolithotomy: A Study of Novices and Experts.","authors":"Christopher C Ballantyne, Kevin M Wymer, Nancy L Sehgel, Ben H Chew, Fuad F Elkhoury, Sri Sivalingam, Matthew D Dunn, Michael S Borofsky, Mitchell R Humphreys","doi":"10.1177/08927790251368775","DOIUrl":"10.1177/08927790251368775","url":null,"abstract":"<p><p><b><i>Introduction:</i></b> Percutaneous nephrolithotomy (PCNL) has been a mainstay treatment for large stone burdens since the 1980s, historically offering improved stone-free rates over retrograde intrarenal surgery (RIRS). Gaining optimal access into the renal collecting system can be challenging, requiring advanced skills or interventional radiology assistance. The learning curve for fluoroscopic and ultrasonography access can be steep, with only a minority of PCNL access performed by urologists in the United States. This study compares robotic-assisted electromagnetic (EM) guidance to traditional fluoroscopy for obtaining percutaneous renal access between cohorts of novice and expert urologists. <b><i>Methods:</i></b> Ten novices and five expert urologists used robotic-assisted EM guidance to obtain access in a modified supine position compared with using fluoroscopy in a traditional prone position in human cadavers. Primary success was defined as papillary access. Performance metrics, including number of puncture attempts, time to access, radiation exposure, and participant confidence, were compared between novices and experts. <b><i>Results:</i></b> Robotic-assisted EM guidance improved success rates for both novices (100% <i>vs</i> 70%) and experts (93% <i>vs</i> 87%) compared with fluoroscopy. Novices showed greater accuracy using robotic assistance (97% <i>vs</i> 37%). The number of insertion attempts decreased with robotic guidance for both groups (novices: 3.42 ± 0.44 <i>vs</i> 1.47 ± 0.19; experts: 2.13 ± 0.36 <i>vs</i> 1.40 ± 0.24; <i>p</i> < 0.002). EM guidance (<i>p</i> < 0.05) and experience (<i>p</i> < 0.05) significantly reduced the time from needle insertion to access (novices: 12.86 ± 2.41 minutes <i>vs</i> 4.49 ± 0.96 minutes; experts: 4.90 ± 1.40 minutes <i>vs</i> 4.09 ± 1.12 minutes). Radiation exposure was notably lower with EM guidance (novices, 1.12 ± 0.17 mGy <i>vs</i> 4.86 ± 0.70 mGy; experts, 0.69 ± 0.12 mGy <i>vs</i> 4.11 ± 1.21 mGy; <i>p</i> < 0.001). Novices felt more confident (5[3-5] <i>vs</i> 2[1-4], <i>p</i> < 0.001) and at ease (5[3-5] <i>vs</i> 2.75[1-3], <i>p</i> < 0.001) with EM guidance. <b><i>Conclusion:</i></b> Robotic-assisted EM guidance improves percutaneous access success, reduces attempts and radiation exposure, and enhances novice confidence and accuracy. This technology could enable urologists to more effectively and safely perform PCNL, especially for less experienced practitioners.</p>","PeriodicalId":15723,"journal":{"name":"Journal of endourology","volume":" ","pages":"772-780"},"PeriodicalIF":2.8,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144821511","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 Legacy of Dr. James Lingeman: Perspectives from a Former Fellow.","authors":"Mitchell R Humphreys","doi":"10.1177/08927790251364999","DOIUrl":"https://doi.org/10.1177/08927790251364999","url":null,"abstract":"","PeriodicalId":15723,"journal":{"name":"Journal of endourology","volume":"39 8","pages":"755-756"},"PeriodicalIF":2.8,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144956530","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 and Laser Lithotripsy Using a Flexible and Navigable Ureteral Access Sheath Are Equally Safe and Effective whether Done in a Sitting or a Standing Position: A Multicenter Study by European Association of Urology-Endourology and the Flexible and Navigable Suction Access Sheath Collaborative Group.","authors":"Khi Yung Fong, Bhaskar Somani, Patrick Juliebø-Jones, Daniele Castellani, Chin Tiong Heng, Jia-Lun Kwok, Chu-Ann Chai, Wissam Kamal, Chinnakhet Ketsuwan, Kremena Petkova, Boyke Soebhali, Marek Zawadzki, Saeed Bin Hamri, Mohamed Elshazly, Yi Quan Tan, Pablo Nicolas Contreras, Lazaros Tzelves, Andreas Skolarikos, Steffi Yuen, Olivier Traxer, Vineet Gauhar","doi":"10.1177/08927790251364288","DOIUrl":"10.1177/08927790251364288","url":null,"abstract":"<p><p><b><i>Introduction:</i></b> Flexible ureteroscopy (FURS) using the flexible and navigable suction ureteral access sheath (FANS) is a novel technique for treatment of kidney stones. We aimed to compare outcomes of FURS with FANS in the sitting vs standing position. <b><i>Patients and Methods:</i></b> We analyzed adult patients from 21 centers who underwent FURS with FANS, divided according to whether the surgeon operated in a sitting or standing position. Baseline demographics, operative parameters, and 30-day outcomes were compared. Multivariable logistic regression was used to identify potential predictive factors for zero residual fragments (ZRF). <b><i>Results:</i></b> There were 457 patients in the sitting group and 247 patients in the standing group. In the sitting group, more patients had the surgical procedure under general anesthesia (<i>p</i> = 0.022). Disposable scopes were preferred in the standing group (<i>p</i> < 0.001). Median lasing and ureteroscopy time were significantly shorter in the siting group, but there was no difference in total surgical time (median 45 vs 46 minutes, <i>p</i> = 0.102). A larger but nonsignificant percentage of grade 1 access sheath insertion injuries were reported in the standing position. Multivariable logistic regression analysis showed that stone volume (odds ratio [OR]: 0.82, 95% confidence interval [CI]: 0.72-0.93, <i>p</i> = 0.003) and operative time (OR: 0.99, 95% CI 0.99-1.00, <i>p</i> = 0.002) but not surgeon position (OR: 1.04, 95% CI: 0.75-1.44, <i>p</i> = 0.82) were significant predictors of ZRF. Procedural safety was not compromised significantly. <b><i>Conclusions:</i></b> FURS with FANS is equally safe and effective in the sitting and standing positions. This study provides the impetus to improve FURS ergonomics, especially with the move toward its use in complex and large stones.</p>","PeriodicalId":15723,"journal":{"name":"Journal of endourology","volume":" ","pages":"841-848"},"PeriodicalIF":2.8,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144742244","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":"High-Power Lasers Induce Dose-Dependent Acute Kidney Injury.","authors":"Mantu Gupta, Kavita Gupta, Roman Shimonov, Raymond Khargi, Anna Ricapito, Blair Gallante, Christopher Connors, Dara Lundon, Manishkumar Patel, Seunghee Kim-Schulze, William Atallah, Natasha Kyprianou, Alan J Yaghoubian","doi":"10.1089/end.2025.0036","DOIUrl":"10.1089/end.2025.0036","url":null,"abstract":"<p><p><b><i>Introduction and Objective:</i></b> High-powered lasers have been hypothesized to cause kidney injury; however, no human studies have confirmed or quantified this damage. Our objective was to identify and quantify damage and explore factors affecting degree of injury in patients undergoing retrograde intrarenal surgery (RIRS) with thulium fiber laser (TFL) and Holmium:YAG (Ho:YAG) lasers. <b><i>Methods:</i></b> Patients undergoing RIRS for unilateral nonobstructing renal stones were randomized to receive lithotripsy with either a 60 W SuperPulse TFL or 120 W pulse-modulated Ho:YAG laser. A control group of patients undergoing RIRS without laser use were used for comparison. Urine samples were collected at 3 time points as follows: preoperative, 1 hour postoperative, and 10 days postoperative. Samples were analyzed using ELISA for key biomarkers-kidney injury molecule-1, neutrophil gelatinase-associated lipocalin (NGAL), and β2-microglobulin-normalized to urine creatinine. Primary outcome was the extent of renal injury based on biomarker elevation. <b><i>Results:</i></b> Ninety-one patients with similar baseline patient and stone characteristics were randomized (46 TFL, 45 Ho:YAG). Both lasers led to significant biomarker elevation, which trended toward but did not reach baseline by postoperative day 10. The Ho:YAG laser resulted in a sustained increase in NGAL at 10 days. Multivariate analysis demonstrated that injury is dose dependent on total laser energy used (<i>p</i> < 0.001, <i>p</i> = 0.006) and worse in older patients (<i>p</i> = 0.009) and in those with metabolic syndrome (<i>p</i> = 0.002), with slower recovery in both these groups, but not with the type of laser used. Multiple levels of the nephron are involved. <b><i>Conclusions:</i></b> There is notable kidney injury induced by both SuperPulse TFL and pulse-modulated Ho:YAG lasers in a dose-dependent manner, but the 2 lasers do not differ in the degree of injury. Injury occurs at multiple levels. Age and metabolic syndrome affect the amount of injury and recovery from injury. Further studies evaluating factors that can mitigate damage from high-energy lasers are needed.</p>","PeriodicalId":15723,"journal":{"name":"Journal of endourology","volume":" ","pages":"794-803"},"PeriodicalIF":2.8,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144181803","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":"Office-Based Ureteral Stenting Using a Single-Use Flexible Cystoscope Under Local Anesthesia: A Two-Center Prospective Study on Feasibility and Patient Experience.","authors":"Federico Zorzi, Fabio Traunero, Victoria Jahrreiss, Giulio Rossin, Andrea Piasentin, Tommaso Cai, Paolo Umari, Giovanni Liguori, Bhaskar Somani, Amelia Pietropaolo, Michele Rizzo","doi":"10.1177/08927790251363615","DOIUrl":"https://doi.org/10.1177/08927790251363615","url":null,"abstract":"<p><p><b><i>Introduction:</i></b> To evaluate the feasibility, safety, and patient satisfaction of Double-J (DJ) ureteral stenting using a flexible cystoscope under local anesthesia (LA). <b><i>Materials and Methods:</i></b> We analyzed prospectively collected data from all patients who underwent DJ stent insertion or replacement using flexible single-use cystoscope under LA between February 2022 and September 2024 at two tertiary referral centers. Failure was defined as the inability to effectively complete the scheduled stent insertion or replacement. Pain was assessed using the Visual Analog Scale, whereas overall patient satisfaction and willingness to undergo future ureteral stenting under LA were also recorded. <b><i>Results:</i></b> A total of 189 consecutive procedures were performed, including 131 (69.3%) unilateral and 31 (16.5%) bilateral DJ replacements and 22 (11.6%) unilateral and 5 (2.6%) bilateral DJ insertions. The median patient age was 76 years (interquartile range [IQR] 66-80), the median Charlson Comorbidity Index was 8 (IQR 6-12), and the median hospital stay was 0 days (0-0.25). Technical failure occurred in 13 cases (7.3%). Causes of failure were DJ encrustation, urethral stricture, or inability to identify the ureteral orifice (9 cases, 69.2%). These cases were effectively managed by percutaneous nephrostomy (PNS) or stent placement under sedation. Four (30.8%) procedures were interrupted because of pain felt by patients. Complications included one case of stent migration necessitating ureteroscopy, three cases necessitating PNS placement, and 10 grade 2 complications (5.6%). Overall, 170 patients (89.9%) expressed willingness to undergo the same procedure under LA in the future. <b><i>Conclusion:</i></b> These results demonstrate that DJ stenting using a flexible cystoscope under LA in an outpatient setting is a feasible, safe, and well-tolerated procedure. It offers a high success rate with a low incidence of minor complications.</p>","PeriodicalId":15723,"journal":{"name":"Journal of endourology","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2025-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144784404","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":"Laparoscopic <i>vs</i> Robotic Adrenalectomy: A Systematic Review and Meta-Analysis.","authors":"Lijian Gan, Jiyue Wu, Feilong Zhang, Haoyuan Cao, Zhen Li, Zihao Gao, Huawei Cao, Zejia Sun, Wei Wang","doi":"10.1177/08927790251363614","DOIUrl":"https://doi.org/10.1177/08927790251363614","url":null,"abstract":"<p><p><b><i>Objective:</i></b> Comparing the safety and effectiveness of robot-assisted laparoscopic adrenalectomy (RA) <i>vs</i> laparoscopic adrenalectomy (LA) in various adrenal tumors. <b><i>Methods:</i></b> We conducted this systematic review and meta-analysis of the primary outcomes of interest according to the PRISMA and AMSTAR guidelines. Five databases were systematically searched, including Medline, PubMed, Cochrane Library, Scopus, and Web of Science. The search time frame was set from database creation to January 2025. <b><i>Results:</i></b> There were 45 studies, including 7225 patients. Compared with LA, RA was superior in terms of estimated blood loss (EBL) [weighted mean difference (WMD) = -20.89, 95% confidence interval or CI (-28.51, -13.28), <i>P</i> < 0.01], length of stay (LOS) [WMD = -0.28, 95% CI (-0.40, -0.17), <i>P</i> < 0.01], bowel recovery time [WMD = -0.54, 95% CI (-0.82, -0.27), <i>P</i> < 0.01], conversion [odds ratio (OR) = 0.39, 95% CI (0.25, 0.60), <i>P</i> < 0.01], and total complications [OR = 0.70, 95% CI (0.57, 0.86), <i>P</i> < 0.01]. The two surgical groups were comparable in terms of operative time (OT), transfusion, readmission, Clavien-Dindo I-II complications, and Clavien-Dindo >II complications. Subgroup analyses found that compared with transperitoneal LA (TLA), robot-assisted TLA was superior in terms of EBL [WMD = -22.51, 95% CI (-39.04, -5.98), <i>P</i> < 0.01] and total complications [OR = 0.60, 95% CI (0.39, 0.90), <i>P</i> < 0.05]. The two surgical groups were comparable in terms of OT and LOS. Compared with retroperitoneal LA (RLA), robot-assisted RLA was superior in terms of OT [WMD = 18.74, 95% CI (5.89, 31.58), <i>P</i> < 0.01] and EBL [WMD = -21.41, 95% CI (-36.85, -5.97), <i>P</i> < 0.01]. The two surgical groups were comparable in terms of LOS, and total complications. For pheochromocytomas (PHEOs), RA was superior in terms of EBL, LOS, and intraoperative hemodynamic instability. For large adrenal tumors (≥5 cm), RA was superior in terms of OT, EBL, and LOS. For obesity, RA was superior in terms of EBL. The two surgical groups were comparable in terms of OT, LOS, conversion, and total complications. <b><i>Conclusion:</i></b> Robot-assisted laparoscopic procedure is superior to conventional laparoscopic procedure in the treatment of adrenal tumors, particularly for patients with large adrenal tumors (≥5 cm), obesity, and PHEOs.</p>","PeriodicalId":15723,"journal":{"name":"Journal of endourology","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2025-07-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144753532","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}