Introduction:Radical cystectomy or trimodal therapy are treatment options for non-metastatic bladder cancer. However, there is limited evidence guiding post-treatment follow-up regimens, resulting in variations in care. Objective:A Swiss consensus meeting aimed to identify gaps in follow-up strategies and subsequently tailoring follow-up protocols after curative treatment for bladder cancer. Methods:A consensus meeting including participants from urology, oncology, radiation oncology, neuro-urology, international advisors, and patient representatives was held. 19 pre-formulated questions addressing follow-up duration, frequency, and modalities after radical cystectomy or trimodal therapy for bladder cancer were discussed and voted by participants. Results:42 experts from 22 institutions participated in the meeting. Agreement was reached on several important elements of oncological and functional follow-up like risk-adapted follow-up and regular usage of patient reported outcome measures (PROMs) and 3 novel personalized follow-up schedules were suggested, balancing oncological surveillance, and monitoring functional complications. Conclusion:We agreed on 3 newly developed Swiss follow up schedules for patients with bladder cancer who underwent cystectomy or trimodal therapy with curative intent; these protocols include stage-specific recommendations for type and timing of investigations to detect relapse combined with balanced measures to monitor functional complications such as PROMS and specific clinical examinations. These protocols will be evaluated in a prospective national multicentric cohort study.
Background: Technical advancements and intrarenal pressure are synergistic in improving perioperative outcomes during flexible ureteroscopy (FURS). Mismanaged intra-renal pressure (IRP) has negative consequences and it is associated with an increased risk of sepsis, bleeding, pelvicalyceal fluid extravasation, and even collecting system injuries and acute as well as chronic renal failure. The cornerstone of a safe FURS is the ability to continuously monitor IRP to avoid elevation of IRP above the normal range of 10 mmHg. Objectives: This scoping review aims to report the current state of real-time IRP monitoring in in vivo clinical studies and the various monitoring methods and technology to understand how this may be best used in daily clinical practice. Eligibility criteria: A systematic literature search was conducted. Only in vivo clinical studies published in English documenting IRP measurement methodologies during semirigid or flexible ureteroscopy for urolithiasis management were included. Results: Out of 1326 retrieved papers, 17 studies met the inclusion criteria, comprising 2 randomized controlled trials, 2 retrospective studies, and 13 observational studies. Current noninvasive IRP monitoring devices include ureteric catheters placed retrogradely or via percutaneous tubing and connected to pressure transducers, amplified by cardiology-used pressure sensing systems or urodynamic systems, automated pressure-regulating systems, pressure sensing guidewires, and IRP sensing flexible ureteroscopes. The review revealed significant variations in IRP measurement methods, reporting units, and irrigation techniques. Notably, elevated IRP above 30 mmHg was consistently associated with increased postoperative complications, including sepsis. Conclusion: Current clinical studies have only ascertained that increased IRP above 40 mmHg positively correlates with infectious complications and postoperative pain. No standardized values are available to predefine safe thresholds in practice. With the availability of noninvasive tools for IRP monitoring, future research should focus on multicenter studies to establish reference ranges and best practices for IRP management, ultimately improving patient outcomes in endourological procedures.
To assess the 30-day stone-free rate and peri-operative outcomes of flexible ureteroscopy (FURS) with flexible and navigable suction ureteral access sheaths (FANS) in adults undergoing same-sitting bilateral retrograde intrarenal surgery (SSB-RIRS). Prospectively data of 115 adult patients with bilateral kidney stone disease undergoing SSB-RIRS across 14 global centers between July 2023 and March 2024 were analyzed. Patient demographics, stone characteristics and operative outcomes were recorded. A low-dose non contrast CT scan was performed at 30 days to assess the stone-free rate and clinical outcomes. Overall bilateral zero residual fragment(ZRF) was 42.6
