Journal of endourology最新文献

{"title":"Early Continence Recovery after Robot-Assisted Radical Prostatectomy: A Multicenter Analysis on the Role of Prostatic Shape.","authors":"Marco Carilli, Valerio Iacovelli, Marco Sandri, Valerio Forte, Paolo Verze, Gianluigi Califano, Francesco Di Bello, Alessandro Antonelli, Riccardo Bertolo, Andrea Minervini, Fabrizio Di Maida, Anna Cadenar, Sofia Giudici, Roberto Falabella, Sabrina La Falce, Costantino Leonardo, Flavia Proietti, Antonio Luigi Pastore, Yazan Al Salhi, Silvia Secco, Giulio Patruno, Virgilio Michael Ambrosi Grappelli, Antonio Celia, Tommaso Silvestri, Matteo Vittori, Chiara Cipriani, Pierluigi Bove","doi":"10.1089/end.2024.0605","DOIUrl":"https://doi.org/10.1089/end.2024.0605","url":null,"abstract":"<p><p><b><i>Aim:</i></b> The aim of the study was to investigate the relationship between prostatic apical shape and continence recovery after robot-assisted radical prostatectomy (RARP) in a large multicentric cohort. <b><i>Materials and Methods:</i></b> Data of patients who underwent transperitoneal RARP at 10 referral robotic centers between January 2017 and December 2022 were retrospectively analyzed. Patients were stratified into four groups based on the multiparametric magnetic resonance imaging (mpMRI) prostatic apex shape. Pre-, intra-, and postoperative variables were compared. Continence recovery was defined as no pad or 1 safety pad/day. <b><i>Results:</i></b> A total of 822 patients were retrieved and classified as Group A (<i>n</i> = 206), Group B (<i>n</i> = 221), Group C (<i>n</i> = 143), and Group D (<i>n</i> = 252) based on the mpMRI. At baseline, statistically significant differences were found in Charlson's comorbidity index (CCI) (<i>p</i> < 0.001), body mass index (BMI) (<i>p</i> = 0.01), prostatic urethral length (<i>p</i> = 0.008), and membranous urethral length (<i>p</i> = 0.03). In terms of bladder neck-sparing technique, a statistically significant difference was found among groups (<i>p</i> = 0.005). Group D achieved continence significantly earlier than the other groups after RARP, with a median recovery time of 3 months (95% confidence interval [CI]: 3-3), compared with 4 months for all other groups (95% CI: 4-4). Group D showed an earlier continence recovery after RARP with respect to all the other shapes (hazard ratio [HR] = 1.23, 95% CI: 1.05-1.43, <i>p</i> = 0.005). The estimated HR remained unchanged after adjusting by age, BMI, CCI, bladder neck-sparing, nerve-sparing, and presence of median lobe (HR = 1.17, 95% CI: 1.00-1.38, <i>p</i> = 0.046). Cox model showed an association with BMI (HR = 0.97, 95% CI: 0.95-0.99, <i>p</i> = 0.03), bladder neck-sparing (HR = 1.45, 95% CI: 1.24-1.70, <i>p</i> < 0.001), and nerve-sparing (HR = 1.27, 95% CI: 1.11-1.46, <i>p</i> = 0.001). <b><i>Conclusions:</i></b> Our multi-institutional study confirmed that prostatic apical shape has a significant impact on time-to-continence after RARP.</p>","PeriodicalId":15723,"journal":{"name":"Journal of endourology","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2025-02-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143457558","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":"Sustained-Release Rapamycin-Eluting Cobalt-Based Alloy Stent Ameliorates Ureteral Stricture in Mini-Pigs by Regulating TGF-β1/Smad3/mTOR/4EBP1/eIF4E Signaling Pathways.","authors":"Zhiwei Chen, Wei Zhao, Teng Zhang, Tengzhou Ren, Jie Chen, Lang Tian, Sheng Lu, Jie Wu, Yan Wang","doi":"10.1089/end.2024.0458","DOIUrl":"https://doi.org/10.1089/end.2024.0458","url":null,"abstract":"<p><p><b><i>Purpose:</i></b> To assess the feasibility and efficacy of sustained-release rapamycin-eluting metal stent in the repair of thermal injury-induced ureteral stricture in mini-pigs and explore its underlying mechanisms. <b><i>Materials and Methods:</i></b> A total of 18 female mini-pigs were used in this study. At 1 month after effective establishment of ureteral stricture model, they were randomly divided into normal control, model, bare-metal stent, and rapamycin-eluting stent groups. Before and at 4 weeks after stent placement, all animals underwent retrograde ureterography and single-photon emission computed tomography. Histologic examination was performed to assess the histomorphologic changes of the ureteral tissues. Real-time quantitative polymerase chain reaction and Western blot analysis were used to evaluate the expression levels of pro-fibrotic factors, transforming growth factor-beta1 (TGF-β1) and Smad3, as well as mammalian target of rapamycin (mTOR) downstream effectors, 4E binding protein 1 (4EBP1) and eukaryotic initiation factor 4E (eIF4E), in the ureteral stricture tissues. <b><i>Results:</i></b> Four weeks after stent placement, ureteral stricture was significantly ameliorated, and the glomerular filtration rate was significantly improved in the rapamycin-eluting stent group than the model and bare-metal stent groups (all <i>p</i> < 0.05). Pathologic examinations revealed obviously reduced fibroblasts and collagen fibers in the submucosa of the rapamycin-eluting stent group. The mRNA and protein expression levels of TGF-β1, Smad3, 4EBP1, and eIF4E were significantly decreased in the rapamycin-eluting stent group than the model and bare-metal stent groups (<i>p</i> < 0.05), whereas no significant difference was found between the model and bare-metal stent groups, indicating that rapamycin-eluting stent can inhibit fibroblast proliferation and attenuate fibrosis in the ureteral tissues. <b><i>Conclusion:</i></b> Sustained-release rapamycin-eluting stent can effectively ameliorate thermal injury-induced ureteral stricture in mini-pigs. The mechanism may be related to the role of rapamycin in inhibiting TGF-β1 and Smad3 expression, promoting the ureteral tissue remodeling through blocking mTOR, and suppressing 4EBP1 and eIF4E expression in the ureteral tissues. Sustained-release rapamycin-eluting stent deserves further investigation as a potentially effective means of treating iatrogenic ureteral strictures.</p>","PeriodicalId":15723,"journal":{"name":"Journal of endourology","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2025-02-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143408557","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":"An Automated System for Tracking, Recording, and Reminding for Medical Implants (TRACER)-a Pilot Study with Ureteral Stents.","authors":"Han Jie Lee, Jeremy Yong Jie Tay, Shuqin Ye, Pei Fong Khoo, Kelvin Chew How Ho, Gui Feng Tang, Moarie Tan, Sing Yi Chia, Michelle Siok Keow Tan, Lui Shiong Lee","doi":"10.1089/end.2024.0620","DOIUrl":"https://doi.org/10.1089/end.2024.0620","url":null,"abstract":"<p><p><b><i>Background:</i></b> There is an urgent need for a seamless clinical system for tracking implants deployed transiently in patients, to reduce the morbidity related to omission of timely removal. Using a ubiquitous implant of ureteral stents as a pilot project, we developed a novel system (Automated System for Tracking, Recording, and Reminding of Implants [TRACER]) that allows seamless tracking and deployment of reminders to clinicians, without the need for excessive infrastructural overhaul of existing hospital processes. <b><i>Patients and Methods:</i></b> Briefly, TRACER comprises the following: (1) a two-pronged trigger during implant (stent) insertion to associate implant, patient, and physician details; (2) data field verification by an automated algorithm; (3) automated delivery of reminders to clinicians at a predefined time period if needed; and (4) cessation of reminders upon stent removal. To evaluate the efficacy of TRACER, the records of all stents placed between January 2022 and December 2023 were reviewed and compared between manual stent log entries, electronic operative records, and the TRACER dataset. <b><i>Results:</i></b> A total of 1056 ureteral stents were placed through 927 procedures in 713 patients. Fifteen stents could have been omitted from tracking owing to an incomplete trigger during stent insertion (logged by one party rather than two) but were detected by the TRACER system during data validation. Sixty-one (5.9%) stents were identified by TRACER as not removed past the predefined time period; 41 patients (3.9%) were contacted and successfully returned for stent removal. Aside from eight patients transferred to other hospitals for care, the demise of seven patients, and five tumor stents not due for change within the study period, all stents were removed on time. <b><i>Conclusions:</i></b> TRACER is effective, safe, and viable and provides significant savings on manpower. It demonstrates high potential to be scaled and expanded to all implantable devices.</p>","PeriodicalId":15723,"journal":{"name":"Journal of endourology","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2025-02-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143408555","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":"Pfannenstiel Extraction Site Reduces Postoperative Extraction Site Hernias after Robotic Radical Prostatectomy.","authors":"Christine M Van Horn, Minhaj Jabeer, Michael D Felice, Paige Wallner, Dana Alhusseini, Olivia R Copelan, Mouchumi Bhattacharyya, Hiten D Patel, Jeffrey L Ellis, Alex Gorbonos","doi":"10.1089/end.2024.0506","DOIUrl":"https://doi.org/10.1089/end.2024.0506","url":null,"abstract":"<p><p><b><i>Introduction and Objectives:</i></b> Robotic-assisted radical prostatectomy (RARP) is associated with postoperative hernias at the extraction site, in the inguinal region, and at port sites. We explored hernia rates as well as risk factors for extraction site hernias after RARP based on specimen extraction location in this context. <b><i>Patients and Methods:</i></b> We queried a prospectively maintained database of all patients undergoing RARP from November 2006 to June 2023. We collected demographic features, oncologic and pathologic data, 30-day postoperative complications, and postoperative hernia incidence. Specimens were extracted via a midline periumbilical or a Pfannenstiel incision at the conclusion of the case per surgeon preference. Clinically relevant hernias were defined as hernias identified by symptoms or exam findings rather than imaging alone. Univariable and multivariable logistic regressions were used to identify risk factors for postoperative extraction site hernias. <b><i>Results:</i></b> In total, 1465 patients underwent radical prostatectomy. Around 23.7% had specimen extraction via Pfannenstiel incision, whereas 76.3% were via extended midline periumbilical port. Patients with a Pfannenstiel extraction had a lower extraction site hernia rate (0.6% vs 7.4%) and clinically significant hernia rate (10.1% vs 14.5%, <i>p</i> = 0.04). On multivariable logistic regression, Hispanic race and Pfannenstiel extraction site were associated with significantly reduced odds of clinically relevant extraction site hernias. <b><i>Conclusions:</i></b> Use of a separate Pfannenstiel extraction site is associated with reduced risk of postoperative hernias for patients undergoing RARP. Surgeons should consider extracting the prostate via a Pfannenstiel incision during RARP given this potential benefit.</p>","PeriodicalId":15723,"journal":{"name":"Journal of endourology","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2025-02-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143399449","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Feasibility and Short-Term Safety of Hydrogel Spacer before Treatment with Magnetic Resonance Imaging-Guided Transurethral Ultrasound Ablation for Prostate Cancer Treatment.","authors":"Emily Bochner, Victoria Schulte, Yair Lotan, Xiaosong Meng, Daniel N Costa","doi":"10.1089/end.2024.0700","DOIUrl":"https://doi.org/10.1089/end.2024.0700","url":null,"abstract":"<p><p><b><i>Purpose:</i></b> Magnetic resonance imaging (MRI)-guided transurethral ultrasound ablation (TULSA) is a minimally invasive method of ablating prostate cancer (PCa) using ultrasound energy under real-time temperature mapping provided by MRI. Posterior prostate tumors can be challenging to treat with adequate margins because of the proximity of the anterior rectal wall. We report our initial experience with rectal hydrogel spacer (spacer) placement in men undergoing TULSA for PCa treatment. <b><i>Materials and Methods:</i></b> A small cohort of men with spacers placed before TULSA were analyzed. Spacers were recommended in patients with posterior lesions near the rectal wall. Spacers were placed before TULSA with no other significant modifications during treatment day. Anatomical separation from the spacer was evaluated with <i>ad hoc</i> review of pre-/postspacer placement images. <b><i>Results:</i></b> Nine patients underwent TULSA with spacers in place, of which two patients had pre-existing spacers in preparation for radiation before switching to TULSA, and seven had intentional spacer placement because of posterior lesions. Spacers resulted in a median separation between the rectal wall and posterior prostate at the index lesion of 6 mm (interquartile range 3-8). All treatments were completed as planned with no additional artifact introduced because of the spacer. No postoperative complications were attributed to the presence of spacer during TULSA. <b><i>Conclusions:</i></b> We demonstrated that TULSA can be safely performed in patients with both polyethylene glycol-based and hyaluronic acid-based hydrogel rectal spacers. The presence of rectal spacer does not appear to impact thermoablation of targeted lesions and enables wider margins during posterior ablations.</p>","PeriodicalId":15723,"journal":{"name":"Journal of endourology","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2025-02-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143382619","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":"Infection Risk in Patients with Mixed Flora in Urine Cultures Prior to Ureteroscopy.","authors":"Joshua K Kim, Ezra J Margolin, David L Barquin, Rebekah W Moehring, Jodi A Antonelli, Michael E Lipkin, Glenn M Preminger, Charles D Scales, Gary J Faerber, Robert A Medairos","doi":"10.1089/end.2024.0670","DOIUrl":"10.1089/end.2024.0670","url":null,"abstract":"<p><p><b><i>Purpose:</i></b> Urine cultures are routinely used to inform preoperative antibiotic choice and duration prior to endourologic surgery. The presence of mixed flora in preoperative urine cultures holds unclear clinical significance. This study examines infectious outcomes after ureteroscopy in patients with preoperative mixed flora urine cultures. <b><i>Materials and Methods:</i></b> A retrospective cohort study was conducted on adult patients who underwent ureteroscopy with laser lithotripsy between January 2014 and June 2024 who had urine cultures performed within 60 days preoperatively. Patients were categorized into cohorts based on their preoperative urine culture: mixed flora, negative, or positive. Postoperative urinary tract infection rates within 30 days were compared between cohorts, and logistic regression was performed adjusting for demographic and clinical variables. <b><i>Results:</i></b> We identified 5166 patients who underwent ureteroscopy with laser lithotripsy (2139 mixed flora, 1525 negative, 1502 positive). Preoperative antibiotics were used more often in the mixed flora cohort (29%) than in the negative cohort (24%, <i>p</i> = 0.007) but less frequently than in the positive cohort (57%, <i>p</i> < 0.001). Postoperative infections were visualized in 165 patients (8%) in the mixed flora cohort, compared with 88 (6%) in the negative cohort (<i>p</i> = 0.067) and 237 (16%) in the positive cohort (<i>p</i> < 0.001). Multivariable logistic regression demonstrated that positive cultures were associated with an increased risk of infection (odds ratio [OR] = 1.95, 95% confidence interval [CI] = 1.49-2.55, <i>p</i> < 0.001), but negative cultures had a similar risk of infection compared with mixed flora (OR = 0.79, 95% CI = 0.56-1.11, <i>p</i> = 0.177). Within the mixed flora cohort, preoperative antibiotic treatment was not associated with decreased postoperative infection (OR = 0.99, 95% CI = 0.66-1.47, <i>p</i> = 0.964). <b><i>Conclusions:</i></b> While patients with preoperative mixed flora urine cultures received preoperative antibiotics more often than patients with negative urine cultures, they were not at higher risk for postoperative infection. Routine preoperative antibiotic use in patients with mixed flora cultures may not be effective in reducing infectious complications after ureteroscopy.</p>","PeriodicalId":15723,"journal":{"name":"Journal of endourology","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2025-02-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143382621","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 Augmentation Cystoplasty: Outcome of the Anterior and Posterior Approaches.","authors":"Chi-Hang Yee, Mandy H M Tam, Yeuk-Lam Hong, Pui-Tak Lai, Yuk-Him Tam, Eddie S Y Chan, Chi-Kwok Chan, Ka-Lun Lo, Wilson H C Chan, Jeremy Y C Teoh, Peter K F Chiu, Chi-Fai Ng","doi":"10.1089/end.2024.0485","DOIUrl":"https://doi.org/10.1089/end.2024.0485","url":null,"abstract":"<p><p><b><i>Introduction:</i></b> To describe the medium-term outcome of robotic augmentation ileocystoplasty by posterior and anterior approaches in the management of contracted low-capacity bladder from cystitis. <b><i>Materials and Methods:</i></b> Data on consecutive cases of robotic augmentation ileocystoplasty between 2011 and 2021 were prospectively collected and reviewed in our center. Retzius-sparing posterior approach was performed by anastomosis of an M-configuration small bowel plate to the posteriorly located U-shaped cystostomy. Conventional anterior augmentation ileocystoplasty was performed by anastomosis of an S-configuration small bowel plate to the anterior cystostomy. The procedure was as per conventional robotic pelvic surgery setting with the da Vinci Surgical System (Intuitive Surgical, Sunnyvale, CA, USA). Perioperative data and postoperative complications were assessed. Preoperative and postoperative functional outcomes were compared. <b><i>Results:</i></b> Six patients underwent posterior augmentation cystoplasty and 20 patients underwent anterior augmentation cystoplasty with a mean follow-up of 51 ± 26 months. Mean operative time was 274 ± 113 minutes and 267 ± 102 minutes, respectively (<i>p</i> = 0.889), and mean hospital stay was 9.0 ± 9.6 days and 8.3 ± 6.1 days, respectively (<i>p</i> = 0.831). Additional procedures include eight ureteral reimplantations and one ileal interposition. Mean functional bladder capacity (FBC) at 2 years of the two approaches were similar, which were 350.2 ± 126.3 mL (posterior approach) and 310.2 ± 151.4 mL (anterior approach) (<i>p</i> = 0.5936). Overall, FBC before the operation and at 24 months was 68.9 ± 48.2 mL and 318.5 ± 144.8 mL (<i>p</i> = <0.0001), respectively. Analgesic requirement was decreased after the operation (preoperative 19 patients, postoperative 4 patients; <i>p</i> < 0.0001). <b><i>Conclusions:</i></b> Posterior approach of robotic augmentation ileocystoplasty provided an alternate option to expand the bladder capacity for patients with a small contracted bladder. It could provide a similar symptom relief and functional improvement as the anterior approach. The clinical trial number is CRE-2011.454.</p>","PeriodicalId":15723,"journal":{"name":"Journal of endourology","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2025-02-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143390361","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 Efficacy and Complications of Robot-Assisted <i>vs</i> Open Dismembered Ureteral Reimplantation for Primary Obstructive Megaureter.","authors":"Suhaib Abdulfattah, Sahar Eftekharzadeh, Emily Ai, Nicole Kye, Marina Quairoli, Christopher Long, Aseem R Shukla, Arun K Srinivasan, Sameer Mittal","doi":"10.1089/end.2024.0766","DOIUrl":"https://doi.org/10.1089/end.2024.0766","url":null,"abstract":"<p><p><b><i>Introduction and Objective:</i></b> Dismembered ureteral reimplant (DUR) is done to treat primary obstructive megaureter (POM). To describe and compare outcomes between open dismembered ureteral reimplant (ODUR) <i>vs</i> robot-assisted laparoscopic dismembered ureteral reimplant (RALDUR). <b><i>Methods:</i></b> An IRB-approved registry was used to retrospectively identify all patients who underwent DUR for POM between 2015 and 2022. Demographics, preoperative, perioperative, and long-term outcomes were analyzed. <i>p</i>-Values were two sided, and a <i>p</i> < 0.05 was considered significant. <b><i>Results:</i></b> Our cohort consisted of 50 patients: 14 (28%) underwent ODUR, and 36 (72%) underwent RALDUR. Preoperatively, no differences were noted between RALDUR and ODUR in terms of antenatal hydronephrosis (<i>p</i> = 1.00), febrile urinary tract infection (<i>p</i> = 0.09), and reflux grade on preoperative voiding cystourethrogram (<i>p</i> = 0.53). Ipsilateral kidney function was 37% in the RALDUR group compared with 32% in the ODUR, with no difference between them (<i>p</i> = 0.74). RALDUR was associated with a longer procedure time (278 minutes <i>vs</i> 191 minutes, <i>p</i> = 0.001) and a similar rate of ureteral tapering (61% <i>vs</i> 86%, <i>p</i> = 0.18). Both cohorts had similar length of stay (<i>p</i> = 0.33) and IV morphine use (<i>p</i> = 0.84). Postoperatively, only three (6%) had Clavien Dindo grade 3b complications-one in the ODUR group who required percutaneous nephrostomy tube (PCN) placement by IR and two in the RALDUR group, one had a port-site hernia s/p repair, and one had a retained JP drain requiring removal. During follow-up, 34 (94.4%) patients in the RALDUR group had stable/improved hydronephrosis in their most recent ultrasound compared with 14 (100%) in the ODUR. Neither group underwent a reintervention procedure. <b><i>Conclusion:</i></b> RALDUR is shown to have comparable success and efficacy to ODUR. A longer procedure time is reported in RALDUR.</p>","PeriodicalId":15723,"journal":{"name":"Journal of endourology","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2025-02-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143382617","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 Impact of Abdominal Insufflation on the Intraocular Pressure During Robot-Assisted Radical Prostatectomy.","authors":"Amir Khan, Shu Wang, Osamah Saeedi, Amanda Ryan, Mohummad Minhaj Siddiqui","doi":"10.1089/end.2024.0509","DOIUrl":"https://doi.org/10.1089/end.2024.0509","url":null,"abstract":"<p><p><b><i>Introduction and Objective:</i></b> Increased intraocular pressure (IOP) during robot-assisted radical prostatectomy (RARP) is known to occur and may cause in rare cases anterior ischemic optic neuropathy. In this study, we evaluated the impact of abdominal insufflation pressures on IOP during RARP in a cohort of patients undergoing RARP. <b><i>Methods:</i></b> Patients undergoing RARP were recruited for this Institutional Review Board-approved study from January 2019 to October 2022 at our Center. IOP was measured for both eyes using a Tonopen (Reichert, Buffalo, NY) at six time points (T1-T6); preoperatively, in the operating room in supine position under anesthesia without insufflation, at 30^ο Trendelenburg position (T position) without insufflation, at Trendelenburg position with abdominal insufflation at 10 mm Hg, 15 mm Hg, and 20 mm Hg. A mixed effects model was applied to analyze changes in IOP with changes in insufflation pressure, while controlling for age, body mass index (BMI), and systolic blood pressure. <b><i>Results:</i></b> For a total of 28 patients, the mean age and BMI were 61.2 ± 7.4 (SD) years, and 29.0 ± 4.6 kg/m², respectively, while the mean systolic blood pressure was 128.1 mm Hg ± 17.0 mm Hg. The mean IOP at six time points increased from 13.6 mm Hg to 26.8 mm Hg, whereas the mean systolic blood pressure ranged from 132.1 (±17) mm Hg to 130.9 (±18) mm Hg from time points 1-6. On a mixed-effects model, a change in 1 mm Hg of abdominal insufflation pressures was associated with a 0.35 mm Hg increase in IOP (95% confidence interval [CI] = 0.29-0.4) holding all other variables constant. Furthermore, a 1 mm Hg change in systolic blood pressure was associated with a 0.06 mm Hg increase in IOP (95% CI = 0.03-0.09). <b><i>Conclusion:</i></b> Our findings suggest that intra-abdominal insufflation pressure and systolic blood pressure are significantly associated with IOP during RARP after accounting for the correlation of the repeated measures and controlling for age and BMI.</p>","PeriodicalId":15723,"journal":{"name":"Journal of endourology","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2025-02-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143382637","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":"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":"151-156"},"PeriodicalIF":2.9,"publicationDate":"2025-02-01","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}