Journal of endourology最新文献

{"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":"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":"370-374"},"PeriodicalIF":2.9,"publicationDate":"2025-04-01","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":"Economic Burden of Imaging and Interventions in Endourology: A Worldwide Cost Analysis from European Association of Urology Young Academic Urology Endourology and Urolithiasis Working Party.","authors":"Amelia Pietropaolo, Etienne Xavier Keller, Tarik Emre Sener, B M Zeeshan Hamed, Arman Tsaturyan, Eugenio Ventimiglia, Patrick Juliebø-Jones, Christian Beisland, Ioannis Mikoniatis, Lazaros Tzelves, Vincent De Coninck, Frederic Panthier, Michael Chaloupka, Ewa Bres-Niewada, Alba Sierra Del Rio, Laurian Dragos, Nariman Gadzhiev, Anil Shrestha, Azimdjon Tursunkulov, Khurshid R Ghani, Chinnakhet Ketsuwan, Alexandre Danilovic, Felipe Pauchard, Hatem Kamkoum, Johan Cabrera, Mariela Corrales, Yazeed Barghouthy, Jia-Lun Kwok, Theodoros Tokas, Catalina Solano, Pablo Nicolas Contreras, Saeed Bin Hamri, Naeem Bhojani, A Carolien Bouma-Houwert, Thomas Tailly, Otas Durutovic, Bhaskar K Somani","doi":"10.1089/end.2024.0673","DOIUrl":"10.1089/end.2024.0673","url":null,"abstract":"<p><p><b><i>Background and Objective:</i></b> The cost of imaging and interventions in the surgical field varies between countries and sometimes within different regions of the same country. Procedural cost takes into account equipment, consumables, operating room, surgical, anesthetic and nursing teams, radiology, medications, and hospital stay. Health care systems therefore face an incredible burden related to investigations and surgical procedures. The aim of this study was to collect costs of imaging and interventions for kidney calculi across different hospitals and health care systems in the world. <b><i>Methods:</i></b> An online shared Google spreadsheet was created by the European Association of Urology Young Academic Urology urolithiasis group. The survey consisted of the cost of four radiological imaging (ultrasound of the urinary tract [USS], plain X-ray radiography of the abdomen including kidneys, ureter, and bladder [XRKUB], noncontrast-enhanced computerized tomography [CTKUB], and contrast-enhanced CT with urographic phase [CTU]) and seven interventions (endoscopic laser treatment of renal stones, ureteroscopic treatment or extraction of ureteral stones, percutaneous nephrolithotomy (PCNL), insertion of ureteral stent, diagnostic ureteroscopy, and cystolitholapaxy). A chosen representative from each country collected and collated the data, and this was converted to Euros (€). <b><i>Key Findings and Limitations:</i></b> Data were collected from 32 countries, which include Turkey, Armenia, Nepal, Uzbekistan, Brazil, Chile, Qatar, Peru, Israel, Singapore, Thailand, Colombia, Argentina, Saudi Arabia, Asia, North America, 15 countries from the European continent, and the United States. The mean cost of USS, XRKUB, CTKUB, and CTU was 51.3 € (range: 2-160 €), 27.1 € (range: 2.5-187 €), 105.8 € (range: 19-405 €), and 171.5 € (range: 19-674 €), respectively. Similarly, the cost of endoscopic laser treatment of renal stones, ureteroscopic treatment/extraction of ureteral stones, PCNL, insertion of ureteral stent, diagnostic ureteroscopy, and cystolitholapaxy was 1942.6 € (range: 100-7887 €), 1626.8 € (range: 80-9787 €), 2884.6 € (range: 110-12642 €), 631 € (range: 110-2787 €), 861.6 € (range: 3-2667 €), and 876 € (range: 19-3457 €), respectively. Wide differences in cost between countries were found within the study. <b><i>Conclusions and Clinical Implications:</i></b> This study highlights the significant economic impact of kidney stone management on health care systems worldwide. There seem to be significant disparities between costs, and this study shows the social and economic inequalities in health care access, which can differ significantly between private and public health care. These results can aid policymakers to address these disparities and perhaps to learn from other health care providers.</p>","PeriodicalId":15723,"journal":{"name":"Journal of endourology","volume":" ","pages":"389-398"},"PeriodicalIF":2.9,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143527821","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":"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":"343-348"},"PeriodicalIF":2.9,"publicationDate":"2025-04-01","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":"Dr. Jason Lee, MD, MHPE, FRCSC.","authors":"","doi":"10.1089/end.2025.63321.spot","DOIUrl":"10.1089/end.2025.63321.spot","url":null,"abstract":"","PeriodicalId":15723,"journal":{"name":"Journal of endourology","volume":" ","pages":"335"},"PeriodicalIF":2.9,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143604935","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":"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":"364-369"},"PeriodicalIF":2.9,"publicationDate":"2025-04-01","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":"Leadership and Speaker Diversity in the Endourological Society: A Retrospective Study 2017-2019 and 2023.","authors":"Marianne Brehmer, Sara Best, Jean Joseph, Zeph Okeke, Kymora B Scotland, Brian Matlaga, Michelle J Semins","doi":"10.1089/end.2024.0470","DOIUrl":"10.1089/end.2024.0470","url":null,"abstract":"<p><p>A commitment to diversity and inclusivity within an organization can influence its success. The Endourological Society convened a task force to assess its baseline diversity and inclusivity. The aim of this investigation was to determine diversity across various spaces of the Society to better define imbalances and aid in long-term strategic planning. This task force assessed the Society's annual World Congress of Endourology and Technology programming from 2017 to 2019 and 2023 as well as leadership over the lifetime of the Society. In all programming areas, there was a domination of male speakers, predominantly those from North America. Similarly, women are largely underrepresented in Society leadership across the executive board, board of directors, committee chair positions, and Society award winners, although representation has increased since 2019. Based on these findings a diversity, equity, inclusion committee was established to actively work on increasing and supporting demographic diversity.</p>","PeriodicalId":15723,"journal":{"name":"Journal of endourology","volume":" ","pages":"426-430"},"PeriodicalIF":2.9,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143492241","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":"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":"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":"381-388"},"PeriodicalIF":2.9,"publicationDate":"2025-04-01","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":"Initial Urological Surgery Using a New Domestic Single-Port Surgical Robotic System.","authors":"Lin Zhang, Huiqin Zhou, Zhiyong Wen, Hang Zheng, Kun Yang, Xinghuan Wang","doi":"10.1089/end.2024.0822","DOIUrl":"10.1089/end.2024.0822","url":null,"abstract":"<p><p><b><i>Purpose:</i></b> To determine the feasibility and safety of a new domestic single-port surgical robot in urologic partial nephrectomy and radical prostatectomy, as measured by the primary metric outcome (surgical success rate). In addition, this study measured important perioperative surgical outcomes, such as operative time, blood loss, postoperative length of stay, docking time, and thermal ischemia time, and reported pathologic data using the surgical robot. <b><i>Materials and Methods:</i></b> This prospective, single-center, single-group clinical study was conducted between August 2023 and October 2023. One surgeon used a new domestic single-port surgical robot (EDGE SP1000) to perform six urologic procedures, including three partial nephrectomies and three extraperitoneal radical prostatectomies. Perioperative data were prospectively recorded, early oncologic outcomes were assessed based on the surgical margin status, and equipment ergonomic comfort was assessed using the National Aeronautics and Space Administration Task Load Index (NASA-TLX). <b><i>Results:</i></b> All six procedures were effectively completed without conversion to open surgery, laparoscopy, or use of multiport robots. The average total operation time was 207.92 ± 32.42 minutes, estimated blood loss was 100 mL (10-900 mL), and postoperative hospital stay was 8.67 ± 1.33 days. The average docking time was 16.25 ± 5.68 minutes, and warm ischemia time was 17.00 ± 2.65 minutes. None of the patients required perioperative blood transfusion. All pathologic examination margins were negative. No serious perioperative complications occurred (Clavien-Dindo grade 3). The surgeon reported that the device was comfortable to use, with a NASA-TLX score of 35.67 ± 4.23. <b><i>Conclusions:</i></b> It is safe and feasible to perform urologic procedure using the EDGE single-port endoscopic surgical robot (EDGE SP1000) control system.</p>","PeriodicalId":15723,"journal":{"name":"Journal of endourology","volume":" ","pages":"375-380"},"PeriodicalIF":2.9,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143657342","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":"Classifying Renal Pyelocaliceal System: A Complete Literature Overview of All Existing Classification Approaches.","authors":"Ali Talyshinskii, Patrick Juliebø-Jones, B M Zeeshan Hameed, Lazaros Tzelves, Amelia Pietropaolo, Bhaskar Kumar Somani","doi":"10.1089/end.2024.0693","DOIUrl":"10.1089/end.2024.0693","url":null,"abstract":"<p><p><b><i>Introduction:</i></b> Our comprehension of the actual diversity of kidney pyelocaliceal system (PCS) is lacking and many crucial features have been overlooked in the existing literature on this subject. The purpose of this review is to provide a concise summary of the current understanding of the structure of the pelvicalyceal system, considering both anatomical and surgical perspectives, as well as to highlight any limitations or inconsistencies in these approaches. <b><i>Material and Methods:</i></b> A full review of all the literature on the anatomical and surgical methods used to classify pelvicalyceal system was conducted in several databases in August 2024. This included all the articles that talked about classifications for the whole pelvicalyceal system, minor calyces, and morphometric measurements within the pelvicalyceal system. <b><i>Results:</i></b> Despite over a century of studying this anatomical zone and numerous approaches, some classifications still rely on pelvic branching or the division site related to the renal sinus. However, no single classification has incorporated both aspects. In addition, despite the consensus regarding the number of minor calyces, there are many approaches to determining their orientation. Finally, researchers have described a sufficient number of morphometric measurements within the pelvicalyceal system, considering their prognostic value before endourological interventions and their correlation with individual patterns of the structure of pelvicalyceal system. However, these measurements often lead to contradictions in interpreting the anatomical favorability of the same pelvicalyceal system using different approaches. <b><i>Conclusion:</i></b> Despite the numerous approaches to identify pelvicalyceal system from both morphological and surgical perspectives, there are significant gaps in our understanding of the real anatomy of the renal cavity that, even after more than a century, remain unanswered. There needs to be more correlation of anatomy with modern minimally invasive clinical interventions for stone disease.</p>","PeriodicalId":15723,"journal":{"name":"Journal of endourology","volume":" ","pages":"405-417"},"PeriodicalIF":2.9,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143556975","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":"Fluoroless Ureteroscopy Under Local Anesthetic Gel: Experience from a Canadian Tertiary Referral Center.","authors":"Tarek Benzouak, Ahmad Alshammari, Abdulmalik Addar, Fadl Hamouche, Abdullah Alahmari, Sébastien Belliveau, Michael Maalouf, Rakan Al Haidey, Sero Andonian, Nada Mohamed, Anne Yin, Nader Fahmy","doi":"10.1089/end.2024.0667","DOIUrl":"10.1089/end.2024.0667","url":null,"abstract":"<p><p><b><i>Introduction:</i></b> Flexible ureteroscopy (URS) is the backbone of diagnosing upper urinary tract pathologies. Recent advancements in scope design have led to smaller, more maneuverable scopes with enhanced precision. The aim of this study was to assess feasibility of fluoroless URS under a local anesthetic (LA) gel. <b><i>Patients and Methods:</i></b> A prospective cohort study was performed at a Canadian tertiary care center. All patients booked for a diagnostic URS were included in this study. All patients were given intraurethral local lidocaine gel and instructed to signal if discomfort was encountered. Data collected include age, gender, indications of URS, history of URS, ureteral stenting, comorbidity index, and the use of a guidewire, as well as pain using a visual analog scale. <b><i>Results:</i></b> A total of 61 URSs using LA were performed on 38 patients. The majority of patients were men (68.9%). Indications for URS were to rule out upper tract urothelial cancer (47.5%), stricture (32.8%), or urolithiasis (19.7%). The average pain score, as rated by the visual analog scale, was 2.05 (standard deviation = 2.037). Only one patient did not want to continue his URS under LA. Guidewire use was associated with an average increase of 1.87 in pain score when compared with freehand URS (β = 1.869, standard error [SE] = 0.610, t = 3.063, <i>p</i> = 0.004, r_partial = 0.398). Male patients reported a 1.38 decrease in pain scores compared with female patients (β = -1.380, SE = 0.615, t = -2.244, <i>p</i> = 0.029, r_partial = -0.302). <b><i>Conclusions:</i></b> LA URS was well tolerated in our patient population. Randomized controlled trials on URS with LA vs general or spinal anesthesia are needed to broaden its use, increase accessibility, and improve health care resource utilization.</p>","PeriodicalId":15723,"journal":{"name":"Journal of endourology","volume":" ","pages":"349-355"},"PeriodicalIF":2.9,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143557036","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}