World Journal of Urology最新文献

{"title":"Comparison of perioperative outcomes between Bricker and Wallace anastomosis techniques in robotic-assisted radical cystectomy with intracorporeal diversion.","authors":"Gabriel L Carreno, Hangcheng Fu, Jamie Messer","doi":"10.1007/s00345-025-05781-4","DOIUrl":"https://doi.org/10.1007/s00345-025-05781-4","url":null,"abstract":"<p><strong>Purpose: </strong>Ureteroileal anastomosis is a critical step in robotic radical cystectomy with intracorporeal ileal conduit for bladder cancer. This study compares perioperative outcomes and complications of Wallace versus Bricker techniques, addressing the limited data available in the robotic-assisted setting.</p><p><strong>Methods: </strong>We retrospectively reviewed 96 bladder cancer patients who underwent robotic cystectomy with intracorporeal diversion (August 2018-July 2024), comparing outcomes between Bricker and Wallace ureteroileal anastomosis techniques. Demographics, perioperative data, and complications were analyzed.</p><p><strong>Results: </strong>Among 96 bladder cancer patients, 72 underwent Bricker and 24 underwent Wallace anastomosis. Demographics were similar between groups (age: p = 0.097; gender: p = 0.204). Operative time was shorter in the Wallace group (246 vs. 260.5 min, p = 0.160), though not statistically significant. Postoperative outcomes were comparable, including rates of hydronephrosis requiring intervention (12.5% vs. 15.8%, p = 0.694). Chronic ureteral strictures occurred only in the Bricker group, although this difference did not reach statistical significance (13.8%, p = 0.055), and urine leaks were observed in two Bricker patients, with none in the Wallace group (p = 0.594). Median length of stay was 7 days for Wallace and 5 for Bricker. There were no significant differences in 30-day or 90-day readmission rates between the two groups.</p><p><strong>Conclusion: </strong>In this single-institution study, Bricker and Wallace anastomoses during robotic cystectomy showed no significant differences in strictures, complications, or readmissions. Wallace showed favorable trends, but these were not statistically significant. Both techniques appear safe; larger studies are needed to assess potential advantages of Wallace.</p>","PeriodicalId":23954,"journal":{"name":"World Journal of Urology","volume":"43 1","pages":"415"},"PeriodicalIF":2.8,"publicationDate":"2025-07-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144576474","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":"Author Correction: Current era HOLEP with MOSES 2.0 technology compared to the gold standard TURP.","authors":"Jamie Michael, Perry Xu, Nick Dean, Meera Ganesh, Kyle Tsai, Nabila Khondakar, Aidan Raikar, Amy Krambeck","doi":"10.1007/s00345-025-05735-w","DOIUrl":"https://doi.org/10.1007/s00345-025-05735-w","url":null,"abstract":"","PeriodicalId":23954,"journal":{"name":"World Journal of Urology","volume":"43 1","pages":"420"},"PeriodicalIF":2.8,"publicationDate":"2025-07-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144585029","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":"Mortality after ureteroscopy in France: results from a French urological association (\"AFU\") survey.","authors":"Mariela Corrales, Steeve Doizi, Olivier Traxer","doi":"10.1007/s00345-025-05725-y","DOIUrl":"https://doi.org/10.1007/s00345-025-05725-y","url":null,"abstract":"<p><strong>Objective: </strong>To identify the risk factors for mortality from URS for stone disease based on a survey conducted by the French Association of Urology (\"AFU\").</p><p><strong>Methods: </strong>The French Association of Urology (\"AFU\") performed a survey asking French urologists to review their past URS series and to report the cases of mortality. French urologists all over France answered this survey. This study was conducted from October 2021 to October 2024. A total of 282 expert urologists from different centers (private or public) responded.</p><p><strong>Results: </strong>A total of 282 French urologists answered the survey. 35 urologists (12.4%) did experience mortality cases after URS and a total of 46 deaths were noted. Median (IQR) age was 69 (25-97) years old. Concerning the comorbidities: 4 patients (15.4%) had diabetes; 3 (11.5%), had urinary diversion; 1 (3.9%), had immunosuppression, and 23 (88.5%) other pathologies. The most frequent cause of death was urosepsis and septic shock. The most frequent URS indication was urinary stone treatment and the median (IQR) stone size was 20mm³ (8-40 mm³). Preoperative double J was found in 31 (67.4%) patients. Median (IQR) operative time was 65 min (20-120 min). Urine culture (UC) was sterile in 10 (21.7%) cases, positive in 23 (50%) cases, and polymicrobial in 13 (28.3%) cases. Preoperative antibiotic treatment was given to all patients with a positive UC, and to only two (15.4%) patients with polymicrobial UC. Antibiotic prophylaxis was given in 37 (80.4%) cases. Postoperative non-steroidal anti-inflammatory drugs (NSAID) were prescribed in 2 (4.3%) cases.</p><p><strong>Conclusion: </strong>Urosepsis and septic shock were the principal cause of death after URS in France. Female gender, elderly patients, infectious stones together with a lack of proper antibiotic prophylaxis/treatment were found to be important risk factors for mortality.</p>","PeriodicalId":23954,"journal":{"name":"World Journal of Urology","volume":"43 1","pages":"418"},"PeriodicalIF":2.8,"publicationDate":"2025-07-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144585033","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":"Comparison of open perineal and robot-assisted reconstruction in vesicourethral anastomotic stenosis.","authors":"Metin Savun, Yunus Çolakoğlu, Harun Özdemir, Emin Taha Keskin, Ramazan Uğur, Mehmet Şahin, Enes Yavuz, Abdulmuttalip Şimşek","doi":"10.1007/s00345-025-05808-w","DOIUrl":"https://doi.org/10.1007/s00345-025-05808-w","url":null,"abstract":"<p><strong>Purpose: </strong>This study aimed to evaluate and compare the patency outcomes and complication rates associated with open perineal versus robot-assisted vesicourethral anastomosis reconstruction techniques.</p><p><strong>Methods: </strong>A retrospective review was conducted of patients who underwent vesicourethral anastomosis reconstruction between July 2017 and January 2024. Data collected included demographic characteristics, prior endoscopic treatment, history of radiotherapy, incontinence status, operative details, and postoperative outcomes. Patency was defined as successful passage of a 16 French cystoscope or a maximum urinary flow rate exceeding 15 mL/s. The incidence of de novo incontinence and complications was also evaluated.</p><p><strong>Results: </strong>This study included 28 patients (open perineal vesicourethral anastomosis reconstruction, n = 18; robot-assisted vesicourethral anastomosis reconstruction, n = 10). The median age was 67 years in both groups (p = 0.524). The median operation time was comparable (120 vs. 150 min, p = 0.175); however, the robot-assisted group experienced significantly reduced blood loss and shorter hospital stay (100 vs. 200 mL, p = 0.001; and 3 vs. 4 days, p = 0.001, respectively). Patency rates were similar between groups (77.8% vs. 80.0%, p = 0.944). The rate of de novo incontinence was significantly lower in the robot-assisted group (16.6% vs. 100%, p = 0.031). Patients with a history of pelvic radiotherapy and preoperative incontinence had higher rates of patency failure (p = 0.007 and p = 0.041, respectively). Postoperative complications were comparable between the groups (p = 0.724); however, patients with patency failure experienced higher complication rates than those without (p = 0.001).</p><p><strong>Conclusion: </strong>Open and robot-assisted vesicourethral anastomosis reconstruction techniques achieved similar patency rates. Nevertheless, the robot-assisted approach offers several advantages, including reduced blood loss, shorter hospitalization, and lower rates of de novo incontinence. A history of pelvic radiotherapy, preoperative incontinence, and postoperative complications were associated with patency failure.</p>","PeriodicalId":23954,"journal":{"name":"World Journal of Urology","volume":"43 1","pages":"413"},"PeriodicalIF":2.8,"publicationDate":"2025-07-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144576473","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":"Holmium laser enucleation of the prostate and strictures: long-term outcomes, stricture characteristics, and risk factors.","authors":"Maximilian Glienke, A Sigle, R Himmelsbach, M F von Bargen, M Schoenthaler, A Özkan, D S Schoeb, K Wilhelm, C Gratzke, A Miernik","doi":"10.1007/s00345-025-05763-6","DOIUrl":"https://doi.org/10.1007/s00345-025-05763-6","url":null,"abstract":"<p><strong>Purpose: </strong>Holmium laser enucleation of the prostate (HoLEP) is a well-established treatment for benign prostatic hyperplasia (BPH). However, long-term data on postoperative urethral strictures remain scarce. This study aimed to evaluate the incidence, anatomical characteristics, timing, and potential pre- and perioperative risk factors for stricture formation following HoLEP.</p><p><strong>Methods: </strong>A retrospective analysis was conducted on 1,724 patients who underwent HoLEP between September 2015 and October 2022. Patients with pre-existing urethral strictures were excluded. Data on demographics, surgical details, and postoperative outcomes were collected. Follow-up was achieved in 1,512 patients (87.7%) over a mean duration of 5.03 years. Urethral and bladder neck strictures requiring intervention were identified through clinical follow-up or structured telephone interviews. Risk factors were assessed using logistic regression.</p><p><strong>Results: </strong>Urethral strictures (US) were found in 5.0% of patients and bladder neck strictures (BNS) in 2.0%. Most US were located in the bulbar urethra (90.7%) and developed within two years postoperatively. Smaller prostate volume and lower PSA were significantly associated with increased stricture risk. BNS risk was additionally linked to shorter operative time, lower laser energy, and less surgeon experience. Strictures were predominantly short-segmented; 21.1% were longer than 2 cm.</p><p><strong>Conclusion: </strong>Stricture formation after HoLEP, though infrequent, remains a relevant long-term complication. Identifying patients at higher risk based on prostate size, catheter use, and surgical parameters can help inform preventative strategies and improve postoperative counseling and outcomes.</p>","PeriodicalId":23954,"journal":{"name":"World Journal of Urology","volume":"43 1","pages":"419"},"PeriodicalIF":2.8,"publicationDate":"2025-07-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144585031","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":"Evaluation of a fluoroscopy-free, ureteral access sheath-free, and stent-free approach to retrograde intrarenal surgery.","authors":"Christopher Connors, Kavita Gupta, Ziv Savin, Raymond Khargi, Adam Geffner, Blair Gallante, William M Atallah, Mantu Gupta","doi":"10.1007/s00345-025-05789-w","DOIUrl":"https://doi.org/10.1007/s00345-025-05789-w","url":null,"abstract":"<p><strong>Purpose: </strong>We sought to evaluate the safety and efficacy of an approach attempting no fluoroscopy (F), ureteral sheaths (US), or stents (S) during retrograde intrarenal surgery (NoFUSS-RIRS) and to compare it to conventional RIRS (C-RIRS).</p><p><strong>Methods: </strong>We prospectively collected data on the first 75 NoFUSS-RIRS procedures in patients with 5-20 mm renal stones and compared them to a cohort of 75 prior patients undergoing C-RIRS which involved fluoroscopy and stent placement. Baseline characteristics, safety outcomes (including Clavien-Dindo complications, ED visits, and readmissions), and CT-determined stone-free rates were compared. Secondary outcomes included the incidence of fluoroscopy and stent utilization.</p><p><strong>Results: </strong>The NoFUSS protocol was successfully implemented in over 90% of patients, with no cases requiring fluoroscopy or ureteral sheaths and only 9.3% requiring a stent. There were no significant differences in baseline or stone characteristics between groups. Median operating room time was significantly shorter in the NoFUSS-RIRS group (46 vs. 64 min, p < 0.001). There were no differences in complications (6.7% vs. 6.7%), ED visits (5.3% vs. 5.3%), or readmissions (2.7% vs. 2.7%) between NoFUSS-RIRS and C-RIRS groups, all p = 1. There were no significant differences in CT-based stone-free rates across all residual fragment (RF) categories including zero RF (NoFUSS-RIRS: 82.7% vs. C-RIRS: 72.7%, p = 0.199), RF < 3 mm, and RF ≥ 3 mm.</p><p><strong>Conclusions: </strong>A NoFUSS-RIRS protocol offers similar stone-free rates compared to C-RIRS with no increase in safety-related outcomes. Moreover, operative costs and radiation exposure to patients and operating room staff can be significantly reduced.</p>","PeriodicalId":23954,"journal":{"name":"World Journal of Urology","volume":"43 1","pages":"414"},"PeriodicalIF":2.8,"publicationDate":"2025-07-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144576490","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 the performance of the large language models DeepSeek-V3, DeepSeek-R1, open AI-O3 mini and open AI-O3 mini high in urology.","authors":"Zijun Yan, Ke-Qin Fan, Qi Zhang, Xinyan Wu, Yuquan Chen, Xinyu Wu, Ting Yu, Ning Su, Yan Zou, Hao Chi, Liangjing Xia, Qiang Cao","doi":"10.1007/s00345-025-05757-4","DOIUrl":"10.1007/s00345-025-05757-4","url":null,"abstract":"<p><strong>Objectives: </strong>We sought to compare how DeepSeek‑V3, DeepSeek‑R1, OpenAI o3‑mini, and OpenAI o3‑mini high handle urological questions, especially in areas such as benign prostatic enlargement, urinary stones, infections, and guideline updates. The intent was to identify how these text‑creation platforms might aid clinical practice without overlooking potential gaps in accuracy.</p><p><strong>Methods: </strong>A set of 34 routinely asked questions plus 25 queries based on newly revised guidelines was assembled. Six board‑certified urologists independently scored each system's replies using a five‑point scale. Questions scoring below a set threshold were reintroduced to the same system, accompanied by critiques, to gauge self‑correction. Statistical analyses focused on total scores, percentage of excellent ratings, and improvements after iterative prompting.</p><p><strong>Results: </strong>Across all 59 queries (34 general plus 25 guideline-based), OpenAI o3-mini high recorded the highest median total score (22 [20-24]), significantly outperforming DeepSeek-R1, DeepSeek-V3 and OpenAI o3-mini (all pair-wise p < 0.01). DeepSeek-R1's accuracy approached that of o3-mini high in patient-counseling items, where their excellent-answer rates were 49% and 57%, respectively. DeepSeek‑V3 achieved solid baseline correctness but made fewer successful corrections on subsequent attempts. Although OpenAI o3‑mini initially produced more concise responses, it showed a surprisingly strong capacity to revise earlier errors.</p><p><strong>Conclusion: </strong>OpenAI o3‑mini high, followed by DeepSeek‑R1, provided the most reliable answers for modern urological concerns, whereas DeepSeek‑V3 exhibited limited adaptability during re‑evaluation. Despite often briefer replies, OpenAI o3‑mini outdid DeepSeek‑V3 in self‑correction. These findings indicate that, when reviewed by a clinician, o3-mini high can serve as a rapid second-opinion tool for outpatient counselling and protocol updates, whereas DeepSeek-R1 may provide a cost-effective alternative in resource-limited settings.</p>","PeriodicalId":23954,"journal":{"name":"World Journal of Urology","volume":"43 1","pages":"416"},"PeriodicalIF":2.8,"publicationDate":"2025-07-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12234633/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144576472","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Rectal spacer use and bowel, urinary, and sexual dysfunction diagnosis and related procedures among men receiving prostate radiotherapy: US county-level analysis.","authors":"James B Yu, Michael R Folkert, Ryoko Sato, Sean Collins, Ryan Hankins, Parthiv Mehta, Samir Bhattacharyya, Emmanuel Ezekekwu, Daniel A Hamstra","doi":"10.1007/s00345-025-05802-2","DOIUrl":"10.1007/s00345-025-05802-2","url":null,"abstract":"<p><strong>Purpose: </strong>Clinical studies demonstrate the protective function of rectal spacers to mitigate side effects of radiotherapy (RT) in prostate cancer (PCa) patients. However, large-scale real- world evidence is lacking. This study evaluates the association between rectal spacer use and the prevalence of bowel, urinary, and sexual dysfunction diagnoses and related procedures among PCa patients receiving RT in the US at the county level.</p><p><strong>Methods: </strong>Medicare 5% and 100% Standard Analytic Files were used to analyze county-level data from January 2015 to March 2024. The sample included adult PCa patients receiving RT. The primary outcome was the county-level proportion of RT patients diagnosed with bowel, urinary, or sexual dysfunctions or undergoing related procedures. The primary explanatory variable was rectal spacer use 1-5 years before diagnosis. Zero-inflated Poisson regression models were used, controlling for county-level characteristics.</p><p><strong>Results: </strong>Among 318,911 PCa patients across 3,168 US counties, the annual prevalence of dysfunction was 2.0% (bowel), 5.6% (urinary), and 1.1% (sexual). Rectal spacer use increased from 4.4 to 18.1% over the study period. A 100-percentage point increase in rectal spacer use at the county level was associated with a 7.1-55.1% reduction in any of three dysfunctions after 1-5 years (all p < 0.05), with similar but weaker trends for related procedures. The strongest association was observed for bowel dysfunction, followed by urinary dysfunction.</p><p><strong>Conclusion: </strong>This large-scale, county-level analysis identifies an association between rectal spacer use and lower prevalence of bowel, urinary, and sexual dysfunction, suggesting potential population-level benefits in PCa RT patients.</p>","PeriodicalId":23954,"journal":{"name":"World Journal of Urology","volume":"43 1","pages":"417"},"PeriodicalIF":2.8,"publicationDate":"2025-07-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12234607/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144585034","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Is perineal urethrostomy a last resort or a viable alternative? Comparative analysis with buccal mucosal graft urethroplasty.","authors":"Yunus Colakoglu, Ali Ayten, Mucahit Gelmis, Abdullah Zilan, Metin Savun, Abdulmuttalip Simsek","doi":"10.1007/s00345-025-05800-4","DOIUrl":"https://doi.org/10.1007/s00345-025-05800-4","url":null,"abstract":"<p><strong>Purpose: </strong>We have aimed to compare perineal urethrostomy (PU) with buccal mucosal graft urethroplasty (BMGU) performed for the management of complex anterior urethral strictures (CAUS) regarding long-term sexual and functional outcomes of the patients.</p><p><strong>Materials and methods: </strong>A total of 109 patients who underwent PU (n = 45) or BMGU (n = 64) between January 2018 and January 2024 were retrospectively reviewed. Patients with posterior urethral strictures, those who underwent staged or different type of urethroplasty, cases that were lost to follow-up, cases followed up for less than 1 year or refused to participate were not included in the study. Turkish validated Urethral Stricture Surgery Patient-Reported Outcome Measure (USS-PROM), International Index of Erectile Function (IIEF-5) and quality of life (EQ-5D and EQ-VAS) questionnaires were applied to the patients to evaluate their functional and erectile functions.</p><p><strong>Results: </strong>Patients who underwent PU were significantly older than those who underwent BMGU [median 64 (45-76) vs. 57 (44-69), respectively, p < 0.001]. Follow-up times of the two groups were similar [PU: median 39 (14-72) vs. BMGU: 42.5 (13-71), p = 0.537]. In the PU and BMGU groups, 86.7% and 89.1% of patients were very satisfied or satisfied with the operation, respectively. The median EQ-VAS score in the PU group was 85 (55-95) points. Maximum urinary flow rate (Qmax) values and postvoid residual urine volume (PVR) measurements were also comparable between the groups.</p><p><strong>Conclusions: </strong>Permanent PU can be recommended for comorbid patients as a first-line treatment with resultant high success and patient satisfaction rates.</p>","PeriodicalId":23954,"journal":{"name":"World Journal of Urology","volume":"43 1","pages":"411"},"PeriodicalIF":2.8,"publicationDate":"2025-07-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144567920","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":"Machine learning models to predict the zero-fragment rate and lower pole access with FANS during flexible Ureteroscopy-an EAU section of endourology study.","authors":"Frédéric Panthier, Daron Smith, Olivier Traxer, Daniele Castellani, Steffi Yuen, Bhaskar Somani, Vineet Gauhar","doi":"10.1007/s00345-025-05798-9","DOIUrl":"10.1007/s00345-025-05798-9","url":null,"abstract":"<p><strong>Introduction: </strong>Suction devices such as flexible and navigable suction ureteral access sheath (FANS) are promising tools to reach the zero-fragment rate (ZFR) after flexible ureteroscopy (FURS) and laser lithotripsy. FANS could especially be useful for lower pole stones (LPS), avoiding postoperative retained stone dust. Using Machine Learning (ML) models, we aimed to predict the ZFR after FURS with FANS and secondarily the possible access to the lower pole (LP).</p><p><strong>Methods: </strong>Data from patients who underwent FURS in 25 centers worldwide were prospectively collected (Aug 2023-Jan 2024). Exclusion criteria were abnormal renal anatomy and ureteral stones. ZFR and LP access were respectively defined as the total absence of residual fragments on computed tomography at 1-month follow-up and the ability to place the FANS into a LP calyx. After data normalization and splitting (training-test (80-20%)), Eight ML models were evaluated to predict separately ZFR and LPS, using binary classification.</p><p><strong>Results: </strong>A total of 390 patients were included with a median age of 49 (36-61)years. The median stone volume was 1440 (1006-2219)mm³. 70,5% and 59% of patients were first time stone formers and pre-stented. The FANS could access the LP in 75,1% of cases. At 1-month, the ZFR was 56,7% (221/390). Above all ML models, ExtraTreesClassifier presented the highest accuracy (0,83), F1-score(0,85) and AUC (0,83) for ZFR prediction from preoperative data. The LP access was best predicted by the RandomForestClassifier (accuracy (0,86), F1-score (0,91) and AUC (0,76)).</p><p><strong>Conclusion: </strong>Based on preoperative data and ML, we can accurately predict the ZFR and LP access during FURS with FANS. Our models could improve the elective indications for FANS utilization.</p>","PeriodicalId":23954,"journal":{"name":"World Journal of Urology","volume":"43 1","pages":"412"},"PeriodicalIF":2.8,"publicationDate":"2025-07-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144567921","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}