Background: Pelvic procedures with the Hugo™ RAS system maintain a stable setup with minimal variations, and upper urinary tract procedures exhibit significant variability in configurations and approaches. This review investigates the feasibility and safety of the Hugo™ RAS system in upper urinary tract procedure, analyzing the heterogeneous configuration possibilities offered by this multicart robotic platform. Methods: A systematic review was designed following the PICO framework and conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The search was performed in Scopus, PubMed, and Embase, covering studies up to March 12, 2025. The protocol was registered on Open Science Framework prior to data extraction: https://doi.org/10.17605/OSF.IO/T9B4Q . Results: A total of 256 articles were identified. Nineteen studies were analyzed, including 226 patients. The majority were prospective studies ( n = 10, 53%). Fourteen among the 19 studies evaluated robot-assisted partial nephrectomy, one robot-assisted radical nephrectomy (RARN), one nephroureterectomy, one adrenalectomy, and one pyeloplasty. One additional multiprocedure study reported two ureteral reimplantations, one ureteropelvic junction repair, one RARN, and one ureterolithotomy. Significant variations in robotic setup were observed: three robotic arms were used in 36.8% of the studies, while four arms in 52.6% of them. Mean operative time was 93 ± 41 minutes, docking time 7 ± 5.5 minutes, estimated blood loss 150 ± 86.15 mL, with a mean hospital stay of 3 ± 2 days. Conclusion: Hugo™ RAS appears to be an effective robotic platform for upper urinary tract procedure, with high adaptability to the surgical field.
BACKGROUND:Pelvic procedures with the Hugo™ RAS system maintain a stable setup with minimal variations, and upper urinary tract procedures exhibit significant variability in configurations and approaches. This review investigates the feasibility and safety of the Hugo™ RAS system in upper urinary tract procedure, analyzing the heterogeneous configuration possibilities offered by this multicart robotic platform. METHODS:A systematic review was designed following the PICO framework and conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The search was performed in Scopus, PubMed, and Embase, covering studies up to March 12, 2025. The protocol was registered on Open Science Framework prior to data extraction: https://doi.org/10.17605/OSF.IO/T9B4Q. RESULTS:A total of 256 articles were identified. Nineteen studies were analyzed, including 226 patients. The majority were prospective studies (n = 10, 53%). Fourteen among the 19 studies evaluated robot-assisted partial nephrectomy, one robot-assisted radical nephrectomy (RARN), one nephroureterectomy, one adrenalectomy, and one pyeloplasty. One additional multiprocedure study reported two ureteral reimplantations, one ureteropelvic junction repair, one RARN, and one ureterolithotomy. Significant variations in robotic setup were observed: three robotic arms were used in 36.8% of the studies, while four arms in 52.6% of them. Mean operative time was 93 ± 41 minutes, docking time 7 ± 5.5 minutes, estimated blood loss 150 ± 86.15 mL, with a mean hospital stay of 3 ± 2 days. CONCLUSION:Hugo™ RAS appears to be an effective robotic platform for upper urinary tract procedure, with high adaptability to the surgical field.
PURPOSE:The Wisconsin Stone Quality of Life questionnaire (WISQOL) is the first validated stone-specific health-related quality of life (HRQOL) instrument. A six-item short form (WISQOL-SF) has been developed and internally validated, but evaluation of embedded SF scoring in an independent real-world cohort has not yet been performed. We aimed to evaluate embedded WISQOL-SF scoring against the full 28-item WISQOL (WISQOL-FF) in a large independent stone cohort. MATERIALS AND METHODS:We retrospectively identified 2199 patients who completed the WISQOL-FF at the University of Rochester Medical Center between February 2020 and November 2023. Standardized scores (0-100) were calculated for both the WISQOL-FF and WISQOL-SF. Agreement and reliability were assessed using paired comparisons, two one-sided tests for equivalence (±3 points), Cronbach's α, Pearson and Spearman correlations, and intraclass correlation coefficients (ICC). Construct validity was evaluated through subgroup comparisons by stone status, symptoms, emergency department visits, recent trauma, hospitalization, sex, and age. RESULTS:Patients were 49.3% female with a mean age of 58.1 ± 14.9 years. The mean WISQOL-SF score was 78.0 compared with 76.2 for the WISQOL-FF (mean difference +1.8, 95% confidence interval 1.4-2.2, p < 0.001). Despite this statistical difference, equivalence testing confirmed that the scores were equivalent within the prespecified ±3-point margin. Internal consistency was high for both instruments (Cronbach's α: FF = 0.965, SF = 0.917). Agreement was excellent (Pearson r = 0.94, Spearman ρ = 0.90, ICC = 0.93). Both instruments demonstrated consistent discriminant validity, with lower HRQOL scores observed among patients with stones or symptoms, recent emergency visits, trauma, and hospitalization, and higher scores among men and older patients (all ps < 0.001). CONCLUSIONS:Embedded WISQOL-SF scoring demonstrates psychometric performance comparable with the full instrument in a large independent cohort. By reducing completion time from approximately 5 minutes to about 1 minute, the WISQOL-SF offers a practical and efficient tool for assessing HRQOL in patients with kidney stone disease.
OBJECTIVE:To investigate the role of elastin in the progression of recurrent urethral strictures induced by repeated transurethral endoscopic interventions, using a preclinical animal model with translational relevance. METHODS:Urethral strictures were induced in middle-aged male New Zealand White rabbits (n = 6) via endoscopic electrocoagulation (50 W, 600 Hz, 10 seconds) at two sites located 4 cm and 5 cm from the urethral meatus. A subset of animals (n = 3) subsequently underwent repeated urethral dilation (UD) using Foley balloon inflation for 10 minutes. Ultrasound-guided imaging was performed at the preinjury and postinjury time points to assess urethral diameter. Urethral tissues collected 45 days postinjury were processed for Verhoeff's Van Gieson (VVG) staining and elastin fragmentation quantification. Human urethral stricture tissues obtained during urethroplasty were also analyzed using VVG staining and immunostaining for collagen I and elastin. RESULTS:A retrograde urethrogram performed on day 14 post-injury revealed urethral stricture formation at the injury site, with further narrowing observed by day 45. In the electrocoagulation-only group, the urethral cross-sectional area decreased to approximately 5-10 mm2 at the injury site (∼30%-50%), whereas in the electrocoagulation plus UD group, a further reduction, reaching approximately 3-8 mm2 (∼60%-75%) relative to baseline, was observed. VVG-stained histological sections from the electrocoagulation-only group showed elastic fiber fragmentation, degradation, and irregular distribution, whereas the electrocoagulation plus UD group exhibited more severe elastic fiber fragmentation and a nonuniform distribution. The quantification of elastin fragmentation and elastin% showed higher mean values in the electrocoagulation plus UD group than in the electrocoagulation-only group, although the differences were not statistically significant. VVG staining of human urethral stricture tissues demonstrated extensive degradation of the elastic fiber network, and immunostaining revealed colocalized expression of collagen I and elastin. CONCLUSION:This study suggests that elastin degradation is associated with urethral fibrogenesis in recurrent stricture formation following repeated transurethral interventions.
OBJECTIVE:To compare stone ablation volume (AV) and ablation morphology between pulsed thulium:YAG (p-Tm:YAG) and high-power holmium:YAG (Ho:YAG) lasers with different pulse modulation technologies using an in vitro stone model. MATERIALS AND METHODS:BegoStone phantoms (15:6 powder-to-water ratio) were used. A motorized arm applied the laser on the phantoms at a constant speed (0.7 mm/s). Three laser settings were tested: 1.5 J × 5 Hz, 1 J × 20 Hz, and 0.3 J × 50 Hz. For p-Tm:YAG, short pulse (SP) and long pulse (LP) modes were evaluated; for Ho:YAG, SP, LP, Vapor Tunnel™ (VT™), and Virtual Basket™ (VB™) modes were tested. Five 21-mm fissures were created per setting. AV was calculated from fissure width (WOF) and depth (DOF) measured by optical microscopy. RESULTS:A total of 555 measurements were analyzed. At 1.5 J × 5 Hz, p-Tm:YAG (SP) produced the deepest fissures (DOF = 1000 µm vs 523.3-734.3 µm, p < 0.05) and was the only modality with a width-to-depth ratio <1, indicating deeper and narrower fissures. In contrast, p-Tm:YAG (LP) showed DOF and width-to-depth ratios comparable with Ho:YAG. At 1 J × 20 Hz, p-Tm:YAG (LP) generated wider, shallower fissures with a lower AV (11.9 mm³ vs 16.9-19.7 mm³, p < 0.05), whereas Ho:YAG (VB™) demonstrated a comparable AV. At 0.3 J × 50 Hz, p-Tm:YAG (LP) and Ho:YAG (VB™) exhibited similar width-to-depth ratios (1.3-1.4), whereas Ho:YAG (LP) and (VT™) achieved greater AV (7.4-8.0 vs 3.4 mm³; p < 0.05), driven by greater DOF. CONCLUSIONS:p-Tm:YAG and Ho:YAG lasers demonstrated distinct ablation morphologies depending on pulse modulation and laser settings. At intermediate and low-energy settings, p-Tm:YAG (LP) produced wider, shallower fissures, whereas several Ho:YAG modalities achieved greater AV through deeper fissures. Ho:YAG (VB™) showed the most similar ablation morphology to p-Tm:YAG (LP). Whether these differences translate into clinical performance remains to be determined.
BACKGROUND:As the global prevalence of urolithiasis rises, selecting the optimal surgical intervention for large renal stones remains critical. Although percutaneous nephrolithotomy (PCNL) is the standard for stones more than 2 cm, the choice between flexible ureteroscopy (FURS) and mini-PCNL (mPCNL) for these burdens is debated. This systematic review and meta-analysis compares the efficacy and safety of FURS versus mPCNL for kidney stones measuring 2 to 4 cm. METHODS:Following the Preferred Reporting Items of Systematic Reviews and Meta-Analysis guidelines, a comprehensive search of electronic databases identified randomized controlled trials and observational studies comparing FURS and mPCNL in adults with large renal stones of 2 to 4 cm. Primary outcomes included operative time, length of hospital stay, blood loss, hemoglobin drop, stone-free rate (SFR), and overall complication rates. RESULTS:A total of 20 studies involving 2326 patients were included. The pooled analysis revealed no statistical significance in the overall SFR across groups between FURS and mPCNL (mean difference [MD] = 0.98, 95% confidence interval [CI] [0.95; 1.01], p < 0.1330). Conversely, FURS demonstrated a superior safety profile, with significantly shorter hospital stays (MD = -57.10, 95% CI [-84.10; -30.11], p < 0.0001), reduced hemoglobin drop (MD = -0.75, 95% CI [-1.42; -0.07], p = 0.03), and lower blood transfusion rates (risk difference [RD] -0.02, 95% CI [-0.03; -0.01], p = 0.0013). FURS was associated with a statistically significant decrease in the overall complication incidence rates (risk ratio = 0.52, 95% CI [0.41; 0.65], p < 0.0001). CONCLUSION:FURS is a highly effective and safer alternative to mPCNL for managing 2 to 4 cm kidney stones. Although FURS and mPCNL offer close efficacy, FURS significantly minimizes surgical morbidity and hospitalization. The integration of advanced suctioning and laser technologies further positions FURS as a competitive primary treatment for large stone burdens.
OBJECTIVES:To evaluate the technical feasibility, safety profile, and oncologic outcomes of radiofrequency ablation (RFA) in managing locally recurrent renal tumors following partial nephrectomy (PN). DESIGN:A retrospective cohort study. METHODS:A retrospective cohort of 46 patients with post-PN tumor recurrence treated with RFA (April 2017-August 2024) was analyzed, with a median of 58 years and 87.0% male. Baseline characteristics, perioperative data, and follow-up outcomes were collected. Surgical strategies and therapeutic efficacy, including tumor recurrence and incomplete ablation, were evaluated. RESULTS:Among 46 patients (39 with single tumors and 7 with multiple tumors), postoperative pathological evaluation following PN confirmed malignancy in 46 cases, predominantly clear cell carcinomas (91.3%). The median interval between PN and RFA was 42.7 months (interquartile range [IQR]: 15.4-73.3). The median tumor size was 2.1 cm (IQR: 1.6-2.4). The median RENAL nephrometry score for recurrent tumors was 6 (IQR: 5-7). The median procedure time was 19.0 minutes (IQR: 16.0-22.6), with a median postoperative hospital stay of 1 day (IQR: 1-1). With a median follow-up of 29.3 months (IQR: 15.5-64.5), the incidences of severe complications, tumor recurrence, and incomplete ablation were 2.2%, 17.4%, and 10.9%, respectively. Limitations include modest cohort size, retrospective design, and predominant ultrasound guidance potentially affecting targeting accuracy. CONCLUSION:RFA demonstrates safety and efficacy as a nephron-sparing therapeutic option for recurrent renal tumors post-PN. However, the observed risks of incomplete ablation and recurrence underscore the necessity of enhanced postoperative surveillance for those patients.
BACKGROUND:Buccal mucosa graft (BMG) ureteroplasty and pyeloplasty have emerged as effective reconstructive options for complex ureteral and ureteropelvic junction (UPJ) strictures not amenable to primary excision and anastomosis. The advent of the single-port robotic platform enables a retroperitoneal approach while preserving the advantages of robotic reconstruction. We report early outcomes of single-port robot-assisted BMG ureteroplasty and pyeloplasty from a single-center experience. METHODS:We retrospectively reviewed 16 consecutive patients who underwent single-port robot-assisted ureteroplasty or pyeloplasty with BMG between September 2020 and June 2025, performed by a single surgeon. Indications included complex ureteral strictures or redo pyeloplasty. The primary outcome was clinical success, defined as freedom from ureteral stenting and/or percutaneous nephrostomy at 90 days. Perioperative outcomes, complications, and short-term follow-up were analyzed. RESULTS:The cohort had a mean age of 45 ± 14.9 years and a median stricture length of 3 cm (interquartile range [IQR]: 2-3). Most procedures were performed via a retroperitoneal low anterior access (75%). Reconstructive procedures included ureteroplasty (50%), pyeloplasty (43.8%), and combined reconstruction (6.3%). Median operative time was 183 minutes (IQR: 150-215), with minimal blood loss and a median length of stay of 11 hours (IQR: 8-29). At 90 days, 87.5% of patients were stent-free and 93.7% were nephrostomy-free. Thirty-day complications occurred in 25% of patients, predominantly Clavien-Dindo grade IIIa. The median follow-up was 14.5 months (IQR: 4.8-18.5). CONCLUSIONS:Single-port robot-assisted BMG ureteroplasty and pyeloplasty are feasible and effective for complex ureteral and UPJ strictures, including redo cases. This approach offers acceptable perioperative morbidity, favorable short-term functional outcomes, and a high rate of outpatient management using a retroperitoneal approach. Larger prospective studies are warranted to assess long-term durability and comparative effectiveness.
PURPOSE:Benign ureteroenteric anastomotic strictures (UES) are a common late complication after urinary diversion following radical cystectomy. While open revision is considered definitive, endoscopic approaches are increasingly used because of lower invasiveness. This study compares outcomes of open vs endoscopic and laser vs nonlaser endoscopic techniques for benign UES. MATERIALS AND METHODS:A Preferred Reporting Items for Systematic Reviews and Meta-Analyses-compliant search of PubMed, EMBASE, and Scopus was conducted from inception through November 2024 and updated in October 2025. Studies including adults with benign UES after urinary diversion undergoing first-time open, robotic, laparoscopic, or endoscopic intervention were eligible. Definitions of treatment success varied among included studies and generally reflected radiographic patency, symptom resolution, or avoidance of further intervention. Random-effects meta-analyses using generalized linear mixed models pooled success and complication rates. Comparative analyses were limited to double-arm cohorts. Endoscopic techniques were stratified as laser-based or nonlaser, with subgroup analysis by stricture length. RESULTS:A total of 31 studies (858 patients) met the inclusion criteria, including seven comparative cohorts (368 renal units). Open reconstruction demonstrated higher primary patency than endoscopic management (risk ratio [RR] 2.31, 95% confidence interval [CI]: 1.54-3.47, ARD: 53.16%, 95% CI: 44.57-61.74). Major complication rates were similar (RR 1.40, 95% CI: 0.49-4.01, ARD: 0.95, 95% CI:-5.30 to 7.20), while minor complications were more frequent after open revision (RR 2.56, 95% CI: 1.45-4.51, ARD:10.31, 95% CI: 3.23-17.39). Among endoscopic series, pooled success was 58% for both laser and nonlaser techniques, with low complication rates overall. Laser techniques showed greater success for strictures <1 cm. CONCLUSION:Open revision appears to provide higher primary patency, although with greater minor morbidity. Endoscopic management offers a less invasive alternative with moderate success, and laser techniques may benefit selected patients with short strictures. These findings should be interpreted cautiously because of substantial heterogeneity across studies.
INTRODUCTION:A randomized controlled trial was conducted to compare the clinical efficacy of lateral transperitoneal adrenalectomy (LTA) versus posterior retroperitoneoscopic adrenalectomy (PRA) and to explore suitable surgical approaches for different patients. METHODS:This prospective study enrolled 184 adrenal tumor patients treated at our hospital from May 2023 to October 2025. Patients were randomly assigned to the LTA group or PRA group using minimization. Subgroup analyses were performed based on tumor diameter, location, and pathological type to investigate suitable surgical approaches for tumors with different characteristics. The impact of surgeon qualifications on outcomes was examined to indirectly assess the differences in learning curves. Primary outcomes included operative time, laparoscopic operation time, and blood loss. Secondary outcomes included trocar establishment time, number of trocars, transfusion rates, intraoperative complication rates, conversion rates, analgesic requirement grade on postoperative day 1, postoperative antibiotic use, postoperative recovery time of gastrointestinal function, postoperative drainage time, short-term postoperative complication rates, postoperative length of stay, and total hospitalization cost. RESULTS:The LTA and the PRA groups each comprised 92 patients. No significant differences were observed between LTA and PRA for primary outcomes. PRA demonstrated superiority over LTA in the number of trocars (p = 0.006), intraoperative complication rates (p = 0.047), analgesic requirement grade on postoperative day 1 (p = 0.042), postoperative recovery time of gastrointestinal function (p < 0.001), and postoperative drainage time (p < 0.001). When tumor diameter >3 cm, LTA demonstrated superiority in blood loss (p = 0.007) and intraoperative complication rates (p = 0.032). Subgroup analysis showed that LTA had a significantly higher complication rate than PRA (p = 0.027) when treating right adrenal tumors. Surgeon qualifications significantly influenced operative time (p < 0.001), laparoscopic operation time (p = 0.006), and blood loss (p = 0.002) of PRA, but had no apparent effect on perioperative indicators of LTA. CONCLUSION:Both LTA and PRA are safe surgical methods for treating adrenal tumors, but PRA has advantages, especially for right adrenal tumors, where it can significantly reduce the incidence of complications, but it requires a greater technical challenge for the surgeon. For adrenal tumors with a diameter greater than 3 cm, LTA can be considered. Clinicians should comprehensively consider their technical proficiency, patient characteristics, and tumor features when choosing the appropriate surgical method.
PURPOSE:To evaluate the use of shear wave ultrasound elastography (SWUE) in prediction of outcomes of shock wave lithotripsy (SWL) for medium-sized renal stones and to correlate HU and SWUE values with the chemical stone compositions. MATERIALS AND METHODS:A total of 110 patients with medium-sized renal stones were scheduled for SWL and included. The patients were assessed by non-contrast CT and SWUE. The patients were categorized into two groups: Group A, SWL success, included 80 patients; and Group B, SWL failure, included 30 patients. Baseline data, stone characteristics, and kilopascal (kPa) values were assessed and compared in both groups. RESULTS:The mean age of studied patients was 42.44 ± 11.45 and 43.50 ± 13.20 years in Groups A and B, respectively (p = 0.679). The mean body mass index of Group A was 25.41 ± 2.93 and Group B was 26.28 ± 2.74 (p = 0.161). The median (interquartile range [IQR]) of HU of stones was 858.5 (778.0-967.0) in Group A versus 1075.0 (1010.0-1150.0) in Group B (p < 0.001). The median (IQR) of kPa values of renal stones was 10.05 (8.20-13.0) in Group A versus 18.20 (15.60-19.20) in Group B (p < 0.001). The median (IQR) of skin-to-stone distance was 85.50 (80.0-92.0) in Group A versus 96.0 (89.0-105.0) in Group B (p < 0.001). CONCLUSIONS:SWUE could be used as a non-invasive and safe alternative method to detect the hardness of stones and predict the outcomes of SWL and the chemical stone compositions.
BACKGROUND AND OBJECTIVE:The Hood technique, originally developed for robot-assisted prostatectomy, preserves periurethral and periprostatic structures critical for early continence recovery. Radical cystoprostatectomy requires wider pelvic dissection, bladder pedicle control, lymphadenectomy, and intraoperative urethral margin assessment, necessitating modification of the Hood approach. We adapted this continence-preserving dissection to robot-assisted radical cystoprostatectomy (RARC) with intracorporeal neobladder reconstruction. This study describes the technique and reports early feasibility, functional, and oncologic outcomes. PATIENTS AND METHODS:We retrospectively reviewed 40 male patients who underwent RARC with intracorporeal neobladder reconstruction using the Hood technique between 2019 and 2023. Continence was defined as using 0-1 pad/day or complete dryness with clean intermittent catheterization. Pad count, rather than pad weight testing, was used. Daytime and nighttime continence were assessed at standardized postoperative intervals, and time to continence was estimated using Kaplan-Meier analysis. Perioperative outcomes, complications, and oncologic outcomes were analyzed descriptively. RESULTS:The median operative time was 335 minutes, estimated blood loss was 400 mL, and the length of hospital stay was 4 days. Major complications occurred in 7.5% of patients at 30 days and 10% at 90 days. Kaplan-Meier estimates for daytime continence were 36% at 6 weeks, 71% at 3 months, 92% at 6 months, and 92% at ≥12 months; corresponding nighttime continence estimates were 11%, 32%, 42%, and 62%. All surgical margins for urothelial carcinoma were negative. Limitations include the retrospective, single-center design, modest sample size, lack of a comparison group, and use of nonvalidated continence measures. CONCLUSIONS:The Hood technique for RARC with intracorporeal neobladder reconstruction is technically feasible and associated with encouraging early continence recovery without evident short-term adverse oncologic outcomes, supporting further comparative evaluation.
PURPOSE:Severe bleeding following percutaneous nephrolithotomy (PCNL) is uncommon but potentially life-threatening, and the criterion for performing renal arteriography (RA) remains unclear. This study aimed to identify predictors of angiographic outcomes and optimize clinical decision-making in patients with severe post-PCNL bleeding. METHODS:We retrospectively analyzed 75 patients with severe post-PCNL bleeding across multiple centers (2015-2025). Severe bleeding was defined as hemodynamic instability, hemoglobin decrease >35 g/L, or persistent gross hematuria. Patients were categorized as continued conservative treatment (CCT), negative RA with conservative recovery (RAN), or positive RA requiring transcatheter arterial embolization (TAE). Univariable and multivariable logistic regression analyses identified predictors of TAE, and receiver operating characteristic (ROC) analysis assessed discriminative performance. RESULTS:Among 75 patients (65 men, 10 women; mean age 52.7 years), 8 (10.7%) were treated with CCT, 15 (20.0%) had negative RA (RAN), and 52 (69.3%) underwent effective TAE. Baseline demographic and perioperative parameters were comparable among groups, except for tract location, which was significantly associated with embolization (p < 0.001). Nonpapillary tracts were more frequent in the TAE group. In binary logistic regression (TAE vs non-TAE), tract location remained the sole independent predictor of embolization. ROC analysis demonstrated good discrimination (area under the curve = 0.778; 95% confidence interval 0.663-0.893; p < 0.001), with 73.1% sensitivity and 82.6% specificity. CONCLUSION:Nonpapillary tract location independently predicts positive angiography and the need for embolization in severe post-PCNL bleeding. Routine intraoperative documentation of tract site may enhance RA yield, expedite hemostasis, and avoid unnecessary angiography.
Purpose: Postoperative sepsis is a known complication of ureteroscopy, but whether intrarenal pressure (IRP) is indicative of postoperative sepsis remains unclear. Pyelovenous backflow is believed to occur when pressure exceeds 30 mmHg. Despite this, IRP is not routinely monitored during ureteroscopy. The present pilot study was designed to evaluate the relationship between IRP during ureteroscopy and postoperative sepsis. Materials and Methods: Patients undergoing ureteroscopy for kidney stones ( N = 100, 34% male, M = 56 years of age) had IRP continuously measured using the COMET™ II Pressure Guidewire. Three phases of ureteroscopy were identified: baseline (30 seconds before ureteral access sheath placement), post-access sheath placement, and treatment of the kidney stone. Data were analyzed using analysis of variance, odds ratio, risk ratio, and diagnostics statistics at p < 0.05. Results: The 12 patients that developed postoperative sepsis had significantly higher median baseline ( p < 0.04) and treatment phase ( p < 0.02) pressures than non-sepsis patients. The median baseline and treatment phase IRP above 30 mmHg were associated with twice the odds and twice the risk of sepsis compared to cases below this threshold, though these results were not statistically significant. IRP above the 30 mmHg threshold conferred accuracy for 84% of cases at baseline, with relatively high specificity (0.93) and high negative predictive values (0.89), but poor sensitivity (0.17) and positive predictive values (0.25). Older age ( p < 0.03) and history of sepsis ( p < 0.02) were also associated with postoperative sepsis risk. Conclusions: The present study found that baseline IRP was a significant predictor of sepsis following ureteroscopy for nephrolithiasis. These findings suggest that continuous IRP measurement during URS might prove valuable in predicting sepsis risk and may open new avenues for sepsis research.
INTRODUCTION AND OBJECTIVE:Stone diameter, measured in a single dimension, is used for management, billing, and research. Recent evidence has supported the use of stone volume over diameter. The purpose of this study was to compare stone volume and diameter as a predictor for outcomes following percutaneous nephrolithotomy (PCNL). METHODS:A retrospective review was performed on PCNL patients at a single academic institution between January 2017 and June 2022. Preoperative computed tomography scans were analyzed to assess maximal stone diameter and stone volume using both Enterprise Imaging (ENI) and the scalene ellipsoid formula (ELF). Diameters and volumes were compared and analyzed for association with clinical and operative variables. Statistical analysis was performed using Spearman's rho and binary logistic regression (p < 0.05 significant). RESULTS:Among 220 patients, the mean stone diameter was 24.2 mm. The mean stone volume varied by method: 4580 ± 500 mm3 using ENI and 6280 ± 1390 mm3 using the scalene ELF. On univariate analysis, Enterprise and the scalene ELF both significantly correlated with length of stay (ρ = 0.269 and 0.198, respectively, p < 0.001). However, only ENI had a significantly stronger association than diameter in relation to operation time (ρ = 0.516 vs 0.270, p < 0.001). Additionally, only ENI was significantly associated with relative (odds ratio [OR] = 0.9 [0.84-0.95]) and absolute (OR = 0.93 [0.88-0.99]) stone-free status (SFR). Only ENI (OR = 1.08 [1.02-1.15]) and diameter (OR = 1.03 [1.01-1.06]) were significantly associated with any grade of Clavien-Dindo complications. When controlling based on age, gender, body mass index, density, staghorn stones, and stone type on multivariate analysis, only density (OR = 1.002, p = 0.038) and ENI volume (OR = 1.116, p = 0.003) were independent predictors of relative SFR. CONCLUSION:Accurate stone volume assessment correlates more strongly with many pertinent PCNL outcomes than scalene ELF and diameter. Utilization of accurate stone volume in clinical practice could better predict patient outcomes, improve guidelines, and standardize research in high-complexity PCNL.
INTRODUCTION:Holmium laser enucleation of the prostate (HoLEP) is an effective minimally invasive treatment for benign prostatic hyperplasia across a wide range of prostate sizes. However, concerns regarding morcellation efficiency and the need for open cystotomy in very large glands remain barriers to adoption. We evaluated morcellation characteristics across prostate sizes and identified predictors of prolonged morcellation time at a high-volume center. METHODS:We performed a retrospective analysis of an institutional HoLEP registry from January 2021 to April 2026. Patients with preoperative prostate volume and documented morcellation time were included. Morcellation time and efficiency were analyzed by prostate size category. Multivariable linear regression was used to identify factors associated with prolonged morcellation. RESULTS:A total of 2114 patients met inclusion criteria. The median prostate volume was 102 cc (IQR 65-150). The median morcellation time across all cases was 6 minutes and increased progressively with prostate size: <100 cc, 3 minutes; 100-199 cc, 10 minutes; 200-299 cc, 19.5 minutes; 300-399 cc, 29 minutes; and ≥400 cc, 39 minutes (p < 0.001). Prostate size, age, prior benign prostatic hyperplasia surgery, and trilobar anatomy were associated with longer morcellation time. Intraoperative complication rates were low (2.8%) and not significantly associated with prostate size (p = 0.292). Only one patient required open cystotomy for adenoma retrieval following attempted morcellation of a 547 cc prostate. CONCLUSIONS:Morcellation time increases with prostate size but remains efficient even in very large glands. Using a standardized technique, prostates up to 400 cc can be morcellated endoscopically with extremely low conversion rates.
BACKGROUND:Holmium laser enucleation of prostate (HoLEP) is a size-independent procedure for benign prostatic obstruction. However, the predictors of various complications are poorly defined in the literature. OBJECTIVE:We propose a standardized framework for reporting postenucleation complications using a modified Clavien-Dindo (CD) classification. We aim to identify predictors of postoperative complications following HoLEP within this unified framework, integrating both patient- and procedure-related variables. METHODOLOGY:We retrospectively analyzed a prospectively collected database of patients undergoing HoLEP. Complications were stratified according to a modified CD classification framework developed for HoLEP. Predictors were analyzed using multinomial regression, and a heatmap was generated to identify correlations among predictors. RESULTS:A total of 855 patients were included in the study. The median prostate volume was 102 cc. Minor complications were seen in 513 patients (60%), most frequently transient incontinence (37.4%). Major complications occurred in 46 patients (5.4%), primarily bladder neck stenosis (2%) and urethral stricture (2%). Multivariate analysis showed that advancing age (odds ratio [OR] 1.03; p = 0.008), recurrent urinary retention (OR 1.60; p = 0.003), elevated body mass index (BMI) (OR 1.04; p = 0.017), Anticoagulation use (OR 1.44; p = 0.029) and longer operative duration (OR 1.004; p = 0.002) were independent predictors of minor complications. Major complications were associated with smaller prostates (OR 0.93, p = 0.016). Spearman's correlation showed that postoperative incontinence was correlated with advanced age (r = 0.090, p < 0.01), high BMI (r = 0.082, p < 0.05), and longer surgical duration (r = 0.119, p < 0.01). Prostate volume was negatively correlated with postoperative inability to void (r = -0.107, p < 0.01), bladder neck stenosis (r = -0.107, p < 0.01), and urethral stricture (r = -0.102, p < 0.01). Gross hematuria was correlated with anticoagulation use (r = 0.101, p < 0.01) and BMI (r = 0.114, p < 0.01), although neither factor predicted major complications. CONCLUSION:We proposed a standardized framework for reporting complications following endoscopic enucleation of the prostate. Our study also identified predictors of post-HoLEP major and minor complications.
PURPOSE:To evaluate if treating small asymptomatic renal stones with office-based burst wave lithotripsy (BWL) and ultrasonic propulsion (UP) prevents future stone growth, emergency department visits, and surgical procedures for stone care. METHODS:Participants with 2-7 mm asymptomatic renal stones were treated with BWL to break stones and UP to facilitate clearance of fragments. The primary outcome measure was relapse, defined as stone growth, an urgent or emergent medical visit, or operation for the randomized stones of interest within 14 months of the procedure. These events would include visits caused by the treatment and the presence of residual stones. Relapse data from untreated control groups with small stones or fragments from three published contemporaneous studies with similar protocols and 1- to 5-year follow-up were pooled and inverse probability weighted for comparison. The cumulative incidence of relapse was estimated using the Kaplan-Meier method. RESULTS:Between April 2023 and September 2024, 18 participants underwent treatment of 27 asymptomatic small stones; 7 (39%) participants underwent a second BWL procedure to complete treatment. The control group had significantly shorter time to relapse than the treatment group (p = 0.048 by weighted log-rank test). The hazard ratio for relapse in the treatment group, compared with the control group, was less than 0.01 (p < 0.001). There was no relapse in the treated group within 14 months. For comparison, the 1-year relapse rate was 26% in the control group. CONCLUSIONS:In a small feasibility study, no stone-related relapse events occurred within 14 months following treatment of small, asymptomatic renal stones with BWL and UP.
