Search Results (69)

Background/Objectives: In an attempt to combine the benefits of the Holmium:YAG (Ho:YAG) laser and Thulium Fiber Laser (TFL), the “Magneto” mode lowers the peak power of the Ho:YAG laser, generating longer duration pulses. The purpose of this study is to compare the effect of the standard virtual basket (VB) Ho:YAG laser, Magneto Ho:YAG laser and TFL on soft tissue in an ex vivo model. Methods: Two renal units from a female pig were used for the current experiment. Sixteen distinct areas were defined. Each area included three parallel lines, which were made with the three different laser technologies. The VB Ho:YAG laser was used for the first line and the Ho:YAG laser in the “Magneto mode” was used to generate the second line, while the third line was performed with a TFL in short pulse mode. The same laser settings (1 J/10 Hz/10 W) and the same fiber diameter (200 μm) were used for all three laser incisions. The same surgeon performed all incisions with a standardized and repeatable technique, controlling hand speed and distance of laser fiber from kidney surface using the stabilization setup. Sections of the selected areas produced distinct paraffin blocks, each one containing three parallel laser lines. Two independent pathologists evaluated the incision depth, incision width, coagulation depth and carbonization effect of the three different lasers. Results: Although the incision depth and the carbonization effect were comparable between the three lasers, incision width and coagulation depth showed a statistically significant difference. Median incision width was 1.17 (1.04, 1.99) mm for the VB Ho:YAG laser, 1.05 (0.89, 1.50) mm for the Magneto Ho:YAG laser and 0.82 (0.65, 0.88) mm for the TFL (p = 0.001). The coagulation depth was 0.49 (0.41, 0.56) mm for the VB Ho:YAG laser, 0.51 (0.39, 0.59) mm for the Magneto Ho:YAG laser and 0.18 (0.17, 0.23) mm for the TFL (p < 0.001). During post hoc analysis for the three comparisons, the differences between the VB Ho:YAG laser and TFL and between the Magneto Ho:YAG laser and TFL were statistically significant for both parameters. Conclusions: Both the VB and Magneto Ho:YAG lasers produced laser incisions with statistically significant greater incision width and coagulation depth than the TFL on the ex vivo model. Overall, the Magneto Ho:YAG laser was associated with the greatest median coagulation depth. Post Hoc Man–Whitney tests for the three comparisons revealed statistically significant differences only between the VB Ho:YAG laser and TFL and between the Magneto Ho:YAG laser and TFL. This finding could potentially be translated into better haemostasis during endourological soft tissue surgery. The implementation of additional studies, both experimental and clinical ones, is of outmost importance to draw safer conclusions. Full article

Background/Objectives: The optimal surgical approach for kidney stones (KS) measuring 15–20 mm remains debated. RIRS and mini-PCNL are both effective options, but they differ in invasiveness, resource use, and cost. This study aimed to compare perioperative outcomes and hospital costs of RIRS and mini-PCNL using a micro-costing approach. Methods: This retrospective study included patients with KS > 15 mm in diameter who were treated between January 2021 and December 2023 at the Department of Urology, Sapienza University of Rome-Polo Pontino. Clinical parameters, operative time (OT), length of stay (LoS), complications, and stone-free rate (SFR) were compared. Costs were estimated using a micro-costing method, including disposable materials, operating room (OR) time (3.9 EUR/min), imaging, and hospitalization (334 EUR/day). The total cost per treated and per SF patient was calculated for both techniques. Results: A total of 119 patients were analyzed: 62 underwent RIRS, and 57 underwent mini-PCNL. Mean OT was shorter for RIRS (87 vs. 113 min; p < 0.001), and LoS was longer for mini-PCNL (2.24 vs. 1.22 days; p = 0.008). Final SFR was higher for mini-PCNL (94.7% vs. 88.7%; p = 0.043). Complication rates were comparable, with most events classified as Clavien–Dindo I–II. Disposable materials represented the main cost driver (EUR 1097 for RIRS vs. EUR 806 for mini-PCNL). The total cost per treated patient was EUR 3689 for RIRS and EUR 3154 for mini-PCNL (p = 0.009). The cost per SF patient was EUR 4159 for RIRS and EUR 3331 for mini-PCNL (p = 0.007). Conclusions: Both RIRS and mini-PCNL are safe and effective for the management of KS ≥ 15 mm. Mini-PCNL achieves higher SFR and greater cost-efficiency than RIRS. These findings support the use of mini-PCNL as the preferred option in centers with adequate expertise and resources. Full article

Background and Objectives: Aquablation, a robot-assisted, heat-free resection technique, has emerged as a promising minimally invasive surgical therapy (MIST) for benign prostatic hyperplasia (BPH). Its precision and potential for preservation of sexual function distinguish it from traditional surgical options. This systematic review aimed to evaluate the safety profile of Aquablation, with emphasis on perioperative complications and functional outcomes. Materials and Methods: We systematically searched PubMed/MEDLINE, Scopus, and the Cochrane Library through June 2025 in accordance with PRISMA 2020 guidelines (PROSPERO CRD420251074479). Eligible studies included randomized and non-randomized trials of Aquablation in men with BPH, reporting adverse events by type, frequency, or severity. Risk of bias was assessed with ROB-2 and ROBINS-I tools. Results: Forty-seven studies were included, spanning randomized controlled and prospective observational designs. Most complications were minor (Clavien-Dindo grade 1–2). Bleeding was the most frequent perioperative event, with transfusion required in 1–8% of cases, more often in large prostates. Severe complications (grade ≥ 3) were uncommon and usually related to bleeding or urinary retention. Long-term sequelae such as strictures or bladder neck contracture were rare. Compared with transurethral resection of the prostate, Aquablation yielded lower rates of ejaculatory dysfunction (10% vs. 36%), with continence and erectile function largely preserved. Outcomes were comparable to holmium laser enucleation, but Aquablation demonstrated superior ejaculatory preservation. Conclusions: Aquablation demonstrates a favorable safety profile across prostate sizes, with its greatest advantage being preservation of sexual function. While bleeding remains the principal perioperative concern, life-threatening events are rare. Further independent, long-term comparative studies are warranted. Full article

(1) Background: trays are surgery-specific sets of required materials and medical devices, assembled in consultation between manufacturer and user, and provided in a sterile package. (2) Methods: in a high-volume urological center performing 11,920 operations/procedures annually (2023), we prospectively evaluated the effect of trays compared with the standard approach in a comparative study of 64 operations conducted between 29 October and 30 November 2024. The primary endpoints were the amount of operating room (OR) waste (volume/cm³, weight/g) and setup time (minutes). The secondary endpoint was the workflow assessment by nursing staff, rated on a numerical score (0–10) across seven relevant domains. (3) Results: for endourological procedures, setup time was reduced by 35%, operating room (OR) waste by 34%, and waste volume by 19.0%. Workflow was positively rated with a mean score of 9.75/10. For major open procedures, setup time was reduced by 43%, waste weight by 24.8%, and waste volume by 32%. Workflow was positively rated with a mean score of 8.9/10. (4) Conclusions: Trays have a sustainable and significant impact on reducing OR waste, save nursing staff preparation time, and facilitate improved workflow in the operating room. Full article

Background and Clinical Significance: Retained intrarenal foreign bodies are rare adverse events after endourological stone surgery. Guidewire fracture or detachment is uncommon and can trigger infection, obstruction, or encrustation if unrecognized. We report antegrade percutaneous snare retrieval of a retained hydrophilic guidewire tip and provide a concise literature review (seven PubMed-indexed intrarenal cases identified by a structured search) to inform diagnosis, management, and prevention. We also clarify the clinical rationale for an antegrade versus retrograde approach and the sequencing of decompression, definitive stone management, and stenting in the context of sepsis. Case Presentation: A 75-year-old woman with diabetes presented with obstructive left pyelonephritis from ureteral and renal calculi. After urgent percutaneous nephrostomy, she underwent semirigid and flexible ureteroscopic lithotripsy with double-J stenting; the nephrostomy remained. During routine tube removal, the stent was inadvertently extracted. Seven days later she re-presented with fever and flank pain. KUB and non-contrast CT showed a linear 4 cm radiopaque foreign body in the left renal pelvis with dilatation. Under local anesthesia and fluoroscopy, a percutaneous tract was used to deploy a 35 mm gooseneck snare and retrieve the distal tip of a hydrophilic guidewire (Sensor/ZIP-type). Inflammatory markers were normalized; the nephrostomy was removed on day 5; six-week imaging confirmed complete clearance without complications. Conclusions: Retained guidewire fragments should be suspected in postoperative patients with unexplained urinary symptoms or infection. Cross-sectional imaging confirms the diagnosis, while minimally invasive extraction—preferably an antegrade percutaneous approach for rigid or coiled fragments—achieves prompt resolution. This case adds to the seven prior PubMed-indexed intrarenal reports identified in our review, bringing the total to eight, underscoring prevention through pre-/post-use instrument checks, immediate fluoroscopy when withdrawal resistance occurs, and structured device accounting to avoid “never events.” Full article

Urolithiasis is one of the most burdensome urinary tract conditions with a prevalence ranging from 1% to 20%. Approximately half of the patients experience a recurrence, while 10% face multiple stone episodes. Long before the advent of surgical treatment options, herbal therapy, or phytotherapy, had been used for both the prevention and management of urolithiasis. Recently, interest in phytotherapy has been rekindled due to the limitations associated with modern urolithiasis treatment, the limited options for conventional medical therapy, and the added cost of interventions for stones. While research on phytotherapy is still limited, it is ongoing and is yielding promising results. In order to capture the current trend in phytotherapy for urolithiasis, we performed a narrative review from data collected and synthesized from electronic databases, with a specific focus on randomized human studies. Our analysis revealed that the use of various herbal medicines and phytotherapy, either as mixtures or as sole plant extracts, in urolithiasis is on the rise and is mainly utilized as complementary therapy to conventional treatment. Although most studies demonstrate the effectiveness of phytotherapy in reducing stone size and facilitating stone expulsion, several questions regarding specific dosages, mechanisms of action, drug interactions, treatment duration, and types of stones that respond to phytotherapy remain unanswered. This review aims to summarize the current knowledge surrounding the role of phytotherapy in urolithiasis and to determine its role as a primary or complementary treatment alongside traditional treatment options. Ultimately, further research is essential to clarify the abovementioned unresolved issues, overcome the existing challenges, and optimize the best possible phytotherapy strategies and timing for dissolving specific types of stones with these regimens. Full article

Background and Objectives: Congenital urological malformations are among the most frequent causes of pediatric chronic kidney disease. Endoscopic balloon dilation and ureteral stenting can be considered less invasive options compared to conventional surgery for primary obstructive megaureter (POM). Nevertheless, the long-term results and side effects of these methods have not yet been well documented. The purpose of this study is to analyze the effectiveness and safety of the endoscopic treatment of POM in children, with the aim of assisting clinical decision making and improving treatment plans. Materials and Methods: A retrospective longitudinal study was performed at the Pediatric Surgery Department of the “M.S. Curie” Emergency Clinical Hospital for Children in Bucharest between October 2020 and September 2024. Eleven endoscopic interventions were performed in five pediatric patients (four boys and one girl) who had six affected ureters, with a median age of 22 months. The inclusion criteria were retrovesical ureter dilation > 7 mm and no prior surgeries of the ureterovesical junction. Cases with secondary megaureters were excluded from the study. The procedures comprised HPEBD and temporary double-J (DJ) stent placement, with systematic postoperative monitoring. Success was defined as improvements in symptoms, a decrease in hydronephrosis, and the preservation of renal function. Results: A final success rate of 83.3% was achieved with endoscopic treatment. Complications were noted in 73% of cases: Clavien–Dindo Grade I (30%); Clavien–Dindo Grade II (20%); Clavien–Dindo Grade IIIb (50%). The documented complications consisted of balloon rupture, stent migration, restenosis, and febrile urinary tract infections (UTIs). Nonetheless, no major complications were observed. The postoperative monitoring showed that renal function was stable and that hydronephrosis had improved gradually. Conclusions: Endoscopic procedures offer a promising, minimally invasive treatment for POM in children with a good success rate. However, the high complication risk necessitates careful patient selection, post-surgery monitoring, and clear guidelines. Full article

Despite the recent advances in minimally invasive surgery, kidney stones still pose a significant clinical challenge due to their high recurrence rate of 50% in 5–10 years after the first stone episode. Using the methods of geosciences and biology, the GeoBioMed approach treats kidney stones as biogenic minerals, offering a novel perspective on their formation and dissolution processes. In this review, we discuss kidney stones’ structural and mechanical properties as emerging biomarkers of urolithiasis, emphasizing the importance of a comprehensive stone analysis in developing personalized treatment strategies. By focusing on unexplored properties like crystalline architecture, porosity, permeability, cleavage, and fracture, alongside the conventionally used composition and morphology, we show how these stone characteristics influence the treatment efficacy and the disease recurrence. This review also highlights the potential of advanced imaging techniques to uncover novel biomarkers, contributing to a deeper understanding of stone pathogenesis. We discuss how the interdisciplinary collaboration within the GeoBioMed approach aims to enhance the diagnostic accuracy, improve the treatment outcomes, and reduce the recurrence of urolithiasis. Full article

Background and Objectives: Ureteral stents are widely used in the field of urology but can cause varying degrees of side effects. This study utilized a network meta-analysis to evaluate stent-related discomfort (SRD) in patients with alpha-blockers (alfuzosin, tamsulosin, and silodosin), antimuscarinics (solifenacin), beta 3-agonists (mirabegron), and phosphodiesterase 5-inhibitors (tadalafil) versus a placebo. Materials and Methods: Relevant randomized controlled trials (RCTs) from 2006 to 2021 were identified from electronic databases, including PubMed, EMBASE, and the Cochrane Library. The following identifiers were included to assess the urinary symptom score (USS): participants (patients with ureteral stents), interventions (patients who took medication for stent discomfort), and outcomes (comparisons of the Ureteric Stent Symptoms Questionnaire (USSQ)). We also executed an independent quality assessment using the Scottish Intercollegiate Guidelines Network (SIGN). Results: A total of 16 RCTs were identified, and they included 1865 patients. Compared with the placebo, mirabegron (mean difference (MD): −3.87; 95% confidence interval (CI): −10.6–2.35), tadalafil (MD: −4.47; 95% CI: −10.8–1.63), and silodosin (MD: −4.02; 95% CI: −12–4.01) did not show significant differences to the placebo, whereas others did. Alfuzosin, mirabegron, silodosin, solifenacin, and tadalafil were not inferior to tamsulosin in terms of the USS using Bayesian analyses. In the random effect model, P-score tests showed that solifenacin possessed the highest P-score (p = 0.8484); tamsulosin was the second highest (p = 0.7054). As a result of the rank-probability test, solifenacin was also ranked highest in terms of USS, and tamsulosin was ranked second. Conclusions: Compared with the placebo, solifenacin, tamsulosin, and alfuzosin significantly decreased the USS. In our study, solifenacin may be considered the most effective medication for SRD. Full article

Background: Urethral strictures and bladder neck contractures (BNCs) can be significantly morbid for patients and may require intervention for effective urinary drainage. We hypothesized patients with abnormal scarring disorders, such as keloids or hypertrophic scars, are at elevated risks of urethroplasty failure as well as postprocedural urethral strictures and BNCs. Methods: We queried the TriNetX database to determine the risk of urethroplasty failure for patients with abnormal scarring disorders compared to controls. We also investigated the risk of developing urethral strictures and BNCs for patients undergoing various endourology procedures. Results are reported in terms of risk ratio (RR) with 95% confidence interval (CI). Statistical significance was considered when the CI did not include 1.0. Propensity score matching was performed to limit confounding. Notably, TriNetX rounds values < 10 to 10 for patient anonymity (denoted by *). Results: Urethroplasty patients with scarring pathology needed a second procedure more than twice as often (36.2% vs. <17.2%*, RR = 2.1, 95%CI 1.1–4.1). Following cystoscopy, there was no difference in urethral stricture rates for patients with scarring disorders (2.7% vs. 2.6%, RR = 1.1, 95%CI 0.85–1.3). These patients also showed similar rates of BNCs (7.5% vs. 5.3%, RR = 1.4, 95%CI 0.84–2.3) and urethral strictures (5.9% vs. 5.3%, RR = 1.1, 95%CI 0.68–1.8) after transurethral bladder outlet procedures. Conclusions: Patients with scarring disorders showed much higher urethroplasty failure rates. They experienced similar rates of urethral strictures and BNC formation after endoscopic procedures. These novel findings underscore the importance of recognizing abnormal scarring conditions during preoperative assessments, guiding clinicians in counseling patients and tailoring operative interventions. Full article

Background and Objectives: We conducted a systematic review and network meta-analysis to evaluate and compare the perioperative, functional, and oncological outcomes of robot-assisted radical prostatectomy (RARP) and laparoscopic radical prostatectomy (LRP) with open radical prostatectomy (ORP) in patients with prostate cancer. Materials and Methods: A comprehensive literature search was performed in Pubmed, EMBASE, and the Cochrane library for papers published before May 2021. Only studies of patients with prostate cancer that assessed perioperative, functional, and oncological outcomes and reported outcome values were included. We used a Bayesian hierarchical random-effects model to synthesize data from multiple studies, enabling both direct and indirect comparisons of the three surgical approaches (RARP, LRP, ORP) to provide robust estimates of their relative efficacy. This systematic review was registered in PROSPERO (CRD42021282555). Results: A total of 80 studies were finally included in the present study. Biochemical recurrence (BCR) rates were lower for RARP than for ORP (RR 0.713, 95% CrI 0.587–0.869) and LRP (RR 0.672, 95% CrI 0.505–0.895). Compared with ORP, RARP had a significantly lower positive surgical margin (RR 0.893, 95% CrI 0.807–0.985). When compared to ORP, RARP and LRP showed no significant difference in continence (RR 1.057, 95% CrI 0.997–1.124; RR 0.921, 95% CrI 0.845–1.007). When compared to ORP, RARP was significantly more effective on potency (RR 1.201, 95% CrI 1.047–1.402). The potency rate was significantly higher for RARP than for ORP (RR 1.201, 95% CrI 1.047–1.402) and LRP (RR 1.438, 95% CrI 1.191–1.762). There was no difference in the estimated blood loss or the total and major complication rates between RARP, ORP, and LRP. The operation time was longest for LRP. There was no difference in the operation time between RARP and ORP. Conclusions: RARP may be better or comparable to ORP and LRP in terms of oncologic outcomes (PSM and BCR), functional outcomes (potency and incontinence), and perioperative outcomes (EBL, operation time, and total and major complications). Full article

Objectives. A radiation-induced ureteral stricture (RIUS) is a challenging condition in urologic surgery, and the optimal surgical strategy is still a matter of debate. The aim of this study was to report post-operative outcomes of minimally invasive management of this condition from a multi-institutional cohort. Methods. Data of patients with diagnoses of RIUS at five referral robotic centers between January 2017 and December 2022 were retrospectively analyzed. Pre-, intra- and post-operative variables were collected. Recurrence was defined as the presence of flank pain combined with imaging findings for obstruction, and requiring further management. Univariate and multivariate logistic regression models were built to identify predictors of ureteral stricture recurrence. Results. Fifty-three patients with a diagnosis of an RIUS were included. Primary pelvic malignancy was mostly cervical (42%). In 72% of cases (mostly mid-proximal and short strictures) endourological management was attempted, which was deemed successful in 74% of patients at stent removal. The endourology success rate at a median follow-up of 12 months was 59%. Twenty-five patients (47%) were scheduled for robotic surgery. The reconstructive techniques most often performed were end-to-end anastomosis (44%) and ureteral reimplantation (52%). Three low-grade Clavien-Dindo post-operative complications (12%) occurred. Robotic surgery was successful in all cases except one. Considering the entire cohort, eight patients (15%) developed recurrence at a median follow-up of 5 months. All patients with recurrence were managed by permanent drainage. A statistically significant improvement in eGFR with respect to baseline was found at a median follow-up of 12 months (p = 0.007). The univariate logistic regression model identified ureteral stricture length >2 cm (OR 6.4, 95% C.I. 1.1–36.9, p = 0.04) and concomitant chemotherapy (OR 8.9, 95% C.I. 1.6–49.9, p = 0.01) as predictors of recurrence. At multivariate analysis concomitant chemotherapy was confirmed as an independent predictor of recurrence (OR 7.8, 95% C.I. 1.3–49.0, p = 0.03). Conclusions. Endourological management of an RIUS is reasonable for short and mid-proximal ureteral strictures, while robotics is required in almost all the remaining cases. Up to 15% of recurrence develops within 6 months. Re-do reconstructive surgery is rarely performed, even in referral centers. Full article

Background: Nephrolithiasis, or kidney stone disease, presents a significant global health burden, with global incidence rates and treatment practices varying widely. This study aims to discuss the epidemiology, risk factors, treatment modalities, and challenges for nephrolithiasis in the lower half of the World Bank rankings; that is, in low- and lower-middle-income countries. Methods: A comprehensive literature review was conducted using PubMed for each country on the list, focusing on studies published from January 2000 onwards and reporting data on prevalence, risk factors, treatment practices, and economic implications. Results: Nephrolithiasis represents a significant burden for healthcare systems, with noteworthy geographical variability in prevalence possibly dependent on socioeconomic status and gender. Risk factors include dietary habits, climate, pollution, and infectious diseases. Treatment practices in some regions still rely on open surgery due to limited access to advanced endourological techniques, while other regions demonstrate high proactivity in research. The burden is exacerbated by inadequate healthcare infrastructure and training. Conclusions: Addressing nephrolithiasis in challenging economic circumstances requires targeted interventions, including improved access to modern treatment methods, enhanced training for healthcare professionals, and better socioeconomic and environmental conditions. Future research should focus on region-specific strategies and the development of sustainable healthcare solutions. Full article

Background: To retrospectively investigate scatter radiation (SCR) exposure among staff in the endourology operating theatre. Methods: During surgeries under fluoroscopic guidance, five professional groups (urological surgeon [US], surgical nurse [SN], assistant surgical nurse [ASN], anaesthetist [A], and anaesthesia care [AC]) wore real-time dosimeters (Philips DoseAware System) on their head and chest over lead aprons between July 2023 and February 2024. The SCR data were analysed and correlated with procedural and patient factors. Results: In total, 249 procedures were performed, including 86 retrograde intrarenal surgeries and 10 percutaneous nephrolithotomies. Median SCR exposure was 38.81, 17.20, 7.71, 11.58, 0.63, 0.23, 0.12, and 0.15 Microsievert (µSv) for US chest (USC), US head (USH), SN chest (SNC), SN head (SNH), A chest (AC), AC chest (ACC), ASN chest (ASNC), and ASN head (ASNH), respectively. There was a significant correlation between DAP and SCR doses detected by USC, USH, SNC, SNH, AC, and ACC dosimeters (p < 0.05). The median chest-to-eye conversion factor (CECF) was 2.11 for the US and 0.71 for the SN. Conclusions: This study, using real-time dosimetry, is among the first to assess staff occupational SCR exposure in endourology. It highlights a substantial SCR exposure, indicating an occupational health hazard that warrants further investigation. Full article

(1) Introduction: Diagnostic ureteroscopy (URS) is an important component in the workup of upper tract urothelial carcinoma (UTUC). Whether URS was associated with increased recurrence in the bladder was not fully concluded. The current study aimed to evaluate the implication of URS on the incidences of intravesical recurrence following radical nephroureterectomy (RNU) in non-metastatic UTUC patients without prior history of bladder cancer via multi-institutional data. (2) Patients and Methods: Data were obtained from the Clinical Research Office of the Endourology Society Urothelial Carcinomas of the Upper Tract (CROES-UTUC) registry, a prospective, multicentre database. Patients with non-metastatic UTUC treated with RNU were divided into two groups: those undergoing upfront RNU and those having diagnostic URS prior to RNU. Intravesical recurrence-free survival (IVRS) was the primary endpoint, evaluated through Kaplan–Meier analysis and multivariate Cox regression. Cases with adequate follow-up data were included. (3) Results: The analysis included 269 patients. Of these, 137 (50.9%) received upfront RNU and 132 (49.1%) received pre-RNU URS. The URS group exhibited an inferior 24-month IVRS compared to the upfront RNU group (HR = 1.705, 95% CI = 1.082–2.688; p = 0.020). Multivariate analysis confirmed URS as the only significant predictor of IVR (p = 0.019). Ureteric access sheath usage, flexible ureteroscopy, ureteric biopsy, retrograde contrast studies, and the duration of URS did not significantly affect IVRS. (4) Conclusions: Diagnostic URS prior to RNU was found to be associated with an increased risk of IVR in patients with UTUC. The risk was not significantly influenced by auxiliary procedures during URS. Physicians were advised to meticulously evaluate the necessity of diagnostic URS. Full article