INTRODUCTION:Urolithiasis affects up to 10% of the population and recurs in more than 50% of cases within ten years. Urinary pH plays a pivotal role in stone prevention, but dipstick testing, the most commonly used method, lacks accuracy, precision and reliability. Only portable digital pH meters classified as medical devices offer superior accuracy, sensitivity, specificity, and resolution, enabling more reliable urinary pH monitoring than dipstick testing. Nevertheless, their comparative cost-effectiveness remains unclear.  Methods: we conducted a systematic review and cost-effectiveness analysis comparing a portable digital pH meter with dipsticks for urinary pH monitoring in recurrent stone formers. Following PrIsMA 2020 guidelines, studies reporting on accuracy, precision, or costs were included. Data were pooled using random-effects models. Cost estimates were derived from the European market sources and adjusted for inflation. Outcomes included analytical validity, cost per effective unit, number needed to treat (NNT), and cost per quality-adjusted life-year (QALy) gained. RESULTS:Thirteen studies involving 2,801 participants were included in the quantitative synthesis. The portable digital pH meter consistently outperformed dipsticks across all evaluated parameters, demonstrating higher explained variance (r2 0.97 vs 0.54), finer resolution (0.1 vs 0.5 pH units), and lower systematic bias (0.06 vs 0.36). The cost per effective unit was lowest for the portable digital pH meter (€ 179) compared with once-daily (€ 354) and twice-daily dipstick testing (€ 708). In compliance-adjusted models, the cost per lithiasis episode prevented was € 590 for the portable digital pH meter vs €1,169 and € 2.337 for dipsticks. In a simulated 1.,000-patient cohort, the portable digital pH meter yielded the lowest total costs (€ 601.376) and the greatest QALy gain (17.84), demonstrating a dominant result, being both more effective and less costly than all alternatives. CONCLUSIONS:The portable digital pH meter demonstrated superior analytical performance and cost-effectiveness compared with dipsticks for urinary pH monitoring. Its broader implementation may enhance preventive strategies, reduce stone recurrence, and decrease the overall healthcare burden associated with recurrent urolithiasis. Considering these findings, the portable digital pH meters may warrant consideration for inclusion in major clinical guidelines on urolithiasis and for reimbursement by healthcare systems, potentially supporting their broader adoption in clinical practice.

BACKGROUND Buried or submucosally embedded double-J (DJ) stents present a rare but technically demanding challenge in endourology, particularly in patients with malignant ureteral obstruction and prior instrumentation. We describe the case of a 72-year-old woman with metastatic bladder cancer who presented with urosepsis and right hydronephrosis. During attempted bilateral stent exchange, the left ureteral orifice and distal stent curl were completely obscured by fibrotic tissue. A combined antegrade-retrograde approach was employed: A guidewire was advanced from the nephrostomy under fluoroscopy, while controlled transurethral resection of the obstructed ureteral orifice permitted exposure and retrieval of the buried stent. A new stent was subsequently placed without complications. This hybrid technique offers an effective solution in cases where traditional retrograde stent retrieval is impossible. CASE SUMMARY A 72-year-old woman presented to the emergency department with a 2-day history of fever, nausea, and worsening malaise. She described progressive left flank discomfort and suprapubic pressure. Her medical history included muscle-invasive bladder carcinoma with metastatic spread to the vertebral column, pelvic bones, and sacrum. She was receiving immunotherapy and had undergone multiple prior chemotherapy cycles. Bilateral ureteral DJ stents had been placed several months earlier due to malignant ureteral obstruction, and a left nephrostomy tube had subsequently been inserted following a prior obstructive episode. On examination, she was febrile and clinically unwell, with left costovertebral angle tenderness. Laboratory tests revealed elevated inflammatory markers and leukocytosis. Computed tomography (CT) imaging demonstrated right-sided hydronephrosis despite the presence of a DJ stent, with the left kidney adequately decompressed through the nephrostomy tube. Urine and blood cultures were obtained, and intravenous antibiotics and hydration were initiated. Despite 48 hours of conservative treatment, the patient showed no clinical improvement. Given the persistent hydronephrosis and the need for source control, the decision was made to perform bilateral stent exchange. CONCLUSION On examination, she was febrile and clinically unwell, with left costovertebral angle tenderness. Laboratory tests revealed elevated inflammatory markers and leukocytosis. CT imaging demonstrated right-sided hydronephrosis despite the presence of a DJ stent, with the left kidney adequately decompressed through the nephrostomy tube. Urine and blood cultures were obtained, and intravenous antibiotics and hydration were initiated. Despite 48 hours of conservative treatment, the patient showed no clinical improvement. Given the persistent hydronephrosis and the need for source control, the decision was made to perform bilateral stent exchange.

Background Minimally invasive surgical therapies (MISTs) for benign prostatic obstruction (BPO) are increasingly popular, but their benefits may be overstated. Patients progressively turn to online sources like YouTube and TikTok for health information, with questionable accuracy and clarity, especially in treatments with unclear benefit–risk profile, such as MISTs. This study aims to evaluate the quality, understandability and reliability of content about MISTs for BPO on YouTube and TikTok. Methods We conducted an independent search on YouTube and TikTok for videos about MISTs for BPO, with prespecified eligibility criteria. Video characteristics (views, likes, duration, publication year, procedures discussed) were collected. For each video, quality, understandability and actionability were assessed using the DISCERN and Patient Education Materials Assessment Tool (PEMAT) A/V instruments. Statistical analyses were performed using the Mann–Whitney U test and Spearman’s rank correlation coefficient (ρ). Results Overall, 100 YouTube and 100 TikTok videos were included. Compared to TikTok, YouTube videos were longer and demonstrated better content quality (DISCERN Q16: U = 6,192, p < 0.001, probability of superiority [PS] = 0.62; total score: U = 6,917, p < 0.001, PS = 0.69) but not understandability (U = 4,823, p = 0.67, PS = 0.48), while actionability scores were low across both platforms. The most frequently discussed procedures were Rezum and Aquablation on YouTube, and UroLift and prostatic artery embolization on TikTok. Across the sample, video quality was modestly associated with longer duration (DISCERN Q16: ρ = 0.48, p < 0.01; total score ρ = 0.53, p < 0.01) and slightly more views and likes. Conclusion YouTube and TikTok videos about MISTs for BPO are of adequate understandability, but with suboptimal quality and actionability. Overall, YouTube videos tend to score significantly higher than TikTok ones.

Catheter-related bladder discomfort (CRBD) is a frequent postoperative complication that significantly impacts the quality of recovery in patients undergoing transurethral surgeries. It manifests as suprapubic pain, an intense urge to void, and bladder spasms due to muscarinic receptor activation. This narrative review provides a comprehensive analysis of CRBD, with a particular focus on bladder spasms in patients treated with transurethral resection of bladder tumors (TURBT) or the prostate (TURP). The review explores the underlying pathophysiology, clinical implications, and evidence-based management strategies, including pharmacological interventions such as antimuscarinics and nerve blocks, as well as non-pharmacological measures.

Background: Ureteroscopic fragmentation and extraction of ureteric stones is one of the most efficient minimal invasive treatment modalities. One of the drawbacks of this procedure, which occurs mainly during the fragmentation of upper ureteric stones, is the migration of proximal stones. Objectives: To study the efficacy and safety of the Stone cone in preventing proximal stone migration during ureteroscopic pneumatic lithotripsy. Patients and Methods: A retrospective data set of forty patients (25 male and 15 female), with symptomatic upper ureteral stones of greater than 7 mm in size, was collected from patients’ records. Patients were allocated into two equal groups: Group A (interventional group) underwent ureteroscopic pneumatic fragmentation using a stone cone, and Group B (control group) underwent ureteroscopic fragmentation without using a stone cone. The data on pre-operative patients, the stones dealt with, and the results of the procedure in both groups were all stated. Results: Pre-treatment patients and stone data (including patient age, gender, stone size, opacity, laterality, duration of symptoms, and degree of pelvicalyceal system dilatation) were comparable in both groups, with no statistically significant difference. The mean stone size was 12.7 mm in group A and 12.5 mm in group B. Stone migration occurred in 0 % in group A and 35% in group B (p=0.004), which led to a stone-free rate of 90% in group A and 60% in group B (p=0.028). Complications were minimal and comparable in both groups, and they were all amenable to conservative treatment. Conclusion: Use of a stone cone as a ureteric occlusive device was reasonably safe, helped prevent proximal stone migration, and led to statistically significant improvement in stone-free rate during pneumatic lithotripsy. Keywords: Ureteroscope, Renal Stone, Pneumatic Lithotripsy, Efficacy, Safety.

The formation of kidney stones is a complex biologic process involving interactions among genetic, anatomic, dietary, and environmental factors. Traditional lithogenic models were based on urine supersaturation in relation to the activity of crystallization promoters and inhibitors. However, modern research has added new principles such as the "renal epithelial cell response" and the role of inflammation and oxidative stress leading to the development of a "multi-hit hypothesis". A strong correlation between urinary stones and kidney damage has been well demonstrated by both cohort and case-control studies. The main contributors to chronic kidney damage associated with urinary stones include crystal deposition within the renal parenchyma, associated comorbidities, repeated obstructive and infectious episodes, as well as the potential adverse effects of stone removal procedures. Most hereditary stones may cause high urinary saturation levels promoting obstruction of the Bellini ducts and consequent glomerulosclerosis and interstitial fibrosis in the cortex. These include hereditary hypercalciurias, primary hyperoxalurias, cystinuria, adenine phosphoribosyltransferase (APRT) deficiency (associated with 2,8-dihydroxyadenine lithiasis) and xanthinuria. Complete distal renal tubular acidosis occurs in childhood and presents deafness, rickets, and a short life expectancy. The incomplete form usually manifests in adulthood, primarily with recurrent urinary lithiasis, and less frequently with nephrocalcinosis. In all stone formers stone analysis and a basic metabolic evaluation, including blood biochemistry, urine sediment examination, urinary pH and culture are mandatory, in contrast high-risk stone formers require a more specific metabolic evaluation, including a 24-hour urine sample to measure calcium, phosphate, citrate, oxalate, uric acid, magnesium, sodium and proteinuria. The morpho compositional analysis of kidney stones offers essential insights beyond merely identifying their predominant chemical component. This approach reveals key aspets of the stone formation, such as nucleation sites, crystal growth patterns, and the presence of specific lithogenic processes. The ideal analytical protocol combines stereoscopic microscopy (StM), scanning electron microscopy with energy-dispersive X-ray spectroscopy (SEM-EDS), and, when necessary, Fourier-transform infrared spectroscopy (FTIR). Recurrence prevention and managing residual fragments require complementary strategies such as lifestyle modifications, dietary interventions, and pharmacological therapies. Among pharmacological options, alkaline citrate salts, particularly potassium citrate, are widely used due to their ability to modify urinary chemistry and inhibit stone formation. Recently, novel molecules have been introduced into the management of renal stone disease. Phytate a naturally occurring polyphosphorylated carbohydrate, exibits a potent inhibitory effect on calcium salt's nucleation, growth, and aggregation. Theobromine, another natural compound, has been shown to effectively inhibit uric acid crystallization. The co-administration of urinary alkalinizing agents, such as potassium citrate, alongside theobromine has been proposed as a therapeutic strategy to optimize uric acid solubility and to reduce the risk of excessive alkalinization and subsequent sodium urate precipitation. Struvite stones are caused by urinary tract infection with urease- producing microorganisms. Their treatment requires specific measures including complete surgical stone removal, short or long-term antibiotic treatment, to maintain urinary acidification to a pH below 6.2, and a urine volume of at least 2 litres/24 hours. L-methionine has been shown to effectively lower urine pH and the relative supersaturation of struvite. An essential aspect of medical management of urinary stone disease is treatment adherence, which depends on perceived benefit, treatment duration, and side effect profile. The side effects of citrate treatment are mild gastrointestinal disorders whereas thiazide diuretics tend to cause hypokalemia-related symptoms and less frequent metabolic and dermatologic side effects. Urease inhibitors for struvite stones and drugs used to enhance cystine solubility are more frequently associated with side effects. The use of smartphone applications can support patients by promoting adequate hydration, adherence to dietary recommendations, and compliance with prophylactic medication. Endoscopic techniques currently play a prevalent role in the removal of renal stones, while extracorporeal shock wave lithotripsy is today marginally used for specific indications. Different technical modalities can be used for percutaneous nephrolithotomy (PCNL), each with its own advantages and disadvntages (standard vs. mini, prone vs. supine, fluoroscopic vs ultrasound-guided). Flexible ureteroscopy or retrograde intrarenal renal surgery (RIRS) has extended its indications due to technological advancements in endoscopes and their accessories. The availability of new laser technologies (thulium fiber laser and pulse-modulated Ho:YAG laser) has enhanced stone fragmentation and dusting capabilities. However, their use exposes the renal parenchyma to high temperatures and pressures which could potentially contribute to renal damage. Factors influencing heat release include laser type and settings, exposure time, stone location, fiber-to-stone distance, irrigation volume and fluid circulation. Reduction of heat release can be achieved by limiting the laser settings to reasonable values or by improving fluid circulation with use of ureteral access sheaths, especially those navigable and equipped with suction. High intrarenal pressure is also closely associated with renal damage. Sustained high pressure or even pressure spikes may increase this risk, highlighting the importance of real-time pressure monitoring through sensors integrated on guidewires, scopes, access sheath and use of innovative platforms regulating irrigation/suction systems. Direct In-Scope Suction (DISS) system was developed to control intrarenal pressure and facilitate the removal of residual fragments. Flexible and Navigable Suction Ureteral Access Sheath (FANS-UAS) is a flexi-bendable UAS equipped with suction capabilities combining mechanical flexibility with continuous irrigation management and stone clearance mechanisms. Ultra-thin scopes (7.5 F) make it easy to perform RIRS without the need for pre-placed double-J stents or with a 9 F sheath achieving more space for stone fragments expulsion or infusion. All these technological advancements have enhanced the efficacy of fURS or RIRS which can be an alternative treatment (salvage fURS) when standard stone management techniques, such as percutaneous nephrolithotomy (PCNL), are contraindicated or fail. Salvage fURS has shown favorable outcomes in complex or high-risk cases, including patients with coagulopathies, morbid obesity, renal anatomical abnormalities (e.g., horseshoe or pelvic kidneys), urinary diversion, calyceal diverticula, and altered urinary tracts. In such scenarios it demonstrated favorable outcomes with stone-free rates ranging from 55.6% to 64% for stones > 2 cm. Although non-invasive, extracorporeal and endoscopic treatments for renal and ureteral stones carry a risk of complications that can be classified according to the Clavien-Dindo system. The complication rate after SWL was estimated at 18.43% for Clavien grade I-II complications (pain, hematuria) and 2.48% for Clavien III-IV complications (hematoma, sepsis). The most frequent complication after RIRS is fever or urinary tract infection observed in 0.2-15% (with 0.1-4.3% of cases of urinary sepsis). Complications after PCNL are more frequent and may include moderate events (hemorrhage requiring transfusion 2-7%, urosepsis 1-2%, bowel injury < 1%) as well as severe events (arteriovenous fistula 0.5-1%, thoracic complications < 1% , loss of access tract 1-3%, death < 0.5%). The risk of bleeding complications is significantly increased in patients on antithrombotic therapy. A personalized, interdisciplinary approach enables optimal decision-making in balancing antithrombotic therapy with surgical safety during urological stone interventions Finally, it must be considered that endourological procedures can be harmful to the surgeons themselves and their team due to exposure to ionizing radiation. For this reason, procedures must be carried out in strict accordance with safety guidelines and regulations to minimize radiation exposure. Safety is vital in any surgical intervention, with efficacy being the next most critical consideration. However, cost-effectiveness should be also considered. Endourology involves high costs largely due to the use of sophisticated equipment that requires frequent renewal due to the continuous rapid technological evolution. Using disposable devices brings numerous benefits but also leads to a further increase in costs. Finally, in the cost-benefit assessment, the rate of reintervention associated with some types of procedures must be considered.

Background: Androgen deprivation therapy (ADT) is a cornerstone treatment for advanced prostate cancer. While effective, traditional injectable luteinizing hormone-releasing hormone (LHRH) agonists are associated with an initial testosterone flare and potential cardiovascular risks. Relugolix is a novel, oral gonadotropin-releasing hormone (GnRH) antagonist developed to provide rapid suppression without a testosterone flare. This review synthesizes the latest evidence on the efficacy, safety, and clinical utility of relugolix. Methods: This non-systematic review was conducted via a search of PubMed and MEDLINE databases up to July 2025 using the terms “relugolix” AND “ADT” OR “Androgen Deprivation Therapy” AND “Prostate Cancer.” Only original studies in English were included.Results: The phase III HERO trial established the superiority of relugolix over leuprolide, demonstrating higher rates of sustained castration (96.7% vs 88.8%) and a significantly faster onset of action. Relugolix also showed a 54% reduction in major cardiovascular adverse events. Furthermore, it exhibited equivalent efficacy to injectable degarelix when combined with radiotherapy, but with more robust testosterone recovery after treatment cessation (52% vs 16%). Real-world data indicates high patient adherence to the oral regimen, and a cost-effectiveness analysis suggests it is a cost-effective option despite a higher drug cost. Conclusions: Relugolix represents a significant advancement in ADT, offering a potent, oral alternative with a rapid onset of action, a superior cardiovascular safety profile, and improved testosterone recovery. It provides clinicians with a valuable option for treating advanced prostate cancer, particularly in patients with cardiovascular comorbidities.

Low-intensity extracorporeal shockwave therapy (Li-ESWT) is gaining attention as a potential treatment for erectile dysfunction (ED). Research indicates that Li-ESWT may promote new blood vessel growth, improving blood flow and endothelial function. This study aims to assess the impact of Li-ESWT on measurable and objective indicators such as nocturnal penile tumescence and rigidity (NPTR). A prospective, nonrandomized single-center study, conducted from January 2022 to January 2024, included 41 men over 18 with ED presented in Urology Outpatient Department. Detailed physical examinations, cardiovascular risk factors, blood tests, and endocrine assessments were collected. Participants were required to have a stable heterosexual partner, at least twelve months of erectile difficulties and no medication for ED for at least one month before enrollment. Each participant completed IIEF-5, EHS questionnaire and an initial evaluation of nocturnal penile tumescence and rigidity (NPTR). After six sessions of Li-ESWT, a follow-up one month later included a re-evaluation with erectile function scales and NPTR. NPTR measurements, using the Rigiscan device, tracked penile circumference, radial rigidity, and frequency and duration of erections. A total of 41 participants (mean age 45.71 ± 10.38 years) were included in the analysis. Key subjective measures, such as IIEF-5 scores (10.60 ± 5.99 vs. 15.13 ± 6.22, p = 0.01) and EHS (p = 0.02), demonstrated significant improvement after treatment. Changes in NPTR parameters following Li-ESWT showed an increase in nocturnal erection frequency (median 3.0 vs. 4.0 times, p = 0.02) and total erection duration (median 24.3 min vs. 64.4 min, p = 0.03) compared to baseline. Additional post-treatment improvements included average erectile rigidity (median 36.54% vs. 51.48%, p = 0.04) and peak rigidity (median 45.13% vs. 62.66%, p = 0.04) at the penile tip. Statistically significant changes were also observed in measurements at the penile base and in the duration of more than 60% rigidity at both the tip and base. Li-ESWT shows potential in enhancing both subjective and objective measures of erectile function in patients with ED. NPTR parameters indicated a notable improvement in nocturnal erections post-treatment. NONE.

The review aims to understand how well patients follow dietary recommendations to prevent kidney stone recurrence and to identify strategies that can enhance their compliance with these dietary guidelines. The review found that adherence to dietary prevention measures for nephrolithiasis is generally low, with only about 30

Current risk-stratification systems for prostate cancer (PCa) do not sufficiently reflect the disease heterogeneity, and digital pathology (DP) combined with artificial intelligence (AI) tools (DP-AI) may offer a solution to this challenge. The aim of this work is to summarize the role of DP-AI for PCa patients treated with radiotherapy (RT), and to point out future areas of research. We conducted (1) a systematic review on the evidence of DP-AI for patients treated with RT and (2) a survey of experts using a modified Delphi method, addressing the current role of DP-AI in clinical and research practice to identify relevant fields of future development. Eleven studies investigated DP-AI in PCa RT, with most using the multimodal AI (MMAI) classifier and four ongoing studies are currently prospectively testing the DP-AI performance. DP-AI showed strong prognostic and predictive performance for endpoints like distant metastasis free survival and overall survival, outperforming traditional risk models and assisting treatment decisions such as androgen deprivation therapy (ADT) duration. Fifty-one and 35 experts responded to round 1 and round 2 of the survey respectively. Questions with ≥75 % agreement were considered relevant and included in the qualitative analysis. Survey results confirmed growing adoption of DP scanners, although regional differences in re-imbursement mechanisms and availability persist, with experts endorsing DP-AI's potential across localized, postoperative, and metastatic settings, though further prospective validation is needed. DP-AI tools show strong prognostic and predictive potential in various PCa by guiding patient stratification and optimising ADT duration in primary RT. Prospective studies and validation in cohorts using modern diagnostic and treatment methods are needed before broad clinical adoption.

Catheter-related bladder discomfort (CRBD) is a common and distressing complication following transurethral urologic procedures such as transurethral resection of the prostate (TURP) and transurethral resection of bladder tumors (TURBT). This prospective observational study investigated the role of preoperative, intraoperative, and postoperative factors in predicting the severity of postoperative bladder spasms. A total of 122 patients were enrolled, and bladder discomfort was assessed using the Visual Analogue Scale (VAS) during their postoperative hospital stay. Most clinical and surgical variables, including anesthesia type, procedure type, catheter type, energy modality, and patient demographics, showed no significant association with bladder discomfort severity. However, catheter balloon volume emerged as a significant predictor, with patients receiving 40 mL balloon volumes reporting higher VAS scores compared to those with smaller volumes (p = 0.003). Additionally, a weak but statistically significant correlation was found between hematocrit drop and VAS scores (rho = 0.18, p = 0.047), suggesting a possible link between intraoperative blood loss and postoperative discomfort. These findings highlight the potential for simple interventions, such as optimizing catheter balloon volume, to alleviate CRBD and enhance postoperative recovery.

Kidney stone disease, or nephrolithiasis, is a prevalent urological condition with variable pathogenesis. Among various factors, urine pH is not only considered to be a more influential factor in stone formation and can aid in the early diagnosis and management of specific stone types such as uric acid, cystine, calcium phosphate and struvite stones, but the role of urine pH in calcium oxalate stones, which comprise most cases, is more complex. Hypocitraturia in routine evaluation is another recognizable factor in lithogenesis, and administration of citrate, a widely used agent in the conservative management of stones. corrects hypocitraturia. Citrate also alkalizes the urine and can therefore be used to dissolve and prevent uric acid stones. However, citrate can induce the formation of insoluble calcium phosphate salts, such as brushite and hydroxyapatite, which can lead to mixed stones and the development of nephrocalcinosis. To address this complexity, innovative treatments that focus on a broader inhibition of lithogenesis with pH-modifying strategies may allow for more comprehensive management. In addition, modern technological tools such as pH meters and pH-tracking mobile applications can offer personalized treatment plans, potentially improving patient outcomes. The current lack of consensus on the standard and optimal management of pH measurement and modification underscores the need for further research and greater collaboration among experts. The development of evidence-based strategies will be essential to improve prevention and nephrolithiasis.

For patients with high-risk non-muscle-invasive bladder cancer (NMIBC) for whom bacillus Calmette-Guerin (BCG) treatment has failed, bladder preservation is a high priority. Immune checkpoint inhibitors have shown promise, but systemic administration is associated with substantial toxicity. In this single-arm phase 2 study, 30 patients with NMIBC after BCG failure were treated with intravesical durvalumab every 6 wk. The maximum tolerated dose in the run-in phase was 1000 mg. In phase 2, the high-grade relapse (HGR)-free rate at 1 yr after completing therapy was 39% (95% confidence interval [CI] 18-59%). HGR-free rates at 1, 3, and 6 mo after completing study treatment were 70% (95% CI 45-85%), 55% (95% CI 31-74%), and 39% (95% CI 18-59%), respectively. At 13 mo after completing enrolment, four patients in phase 2 had experienced progression to stage >= T2; the 1-yr bladder-intact survival rate was 78% (95% CI 57-89%). The only treatment-related adverse event was grade 1 haematuria in five patients (17%). In conclusion, intravesical durvalumab 1000 mg every 6 wk is feasible after BCG failure in patients with high-risk NMIBC, with negligible toxicity and encouraging efficacy. Intravesical durvalumab may be more attractive than systemic administration of immune checkpoint inhibitors and warrants further investigation as a treatment for NMIBC. (c) 2024 European Association of Urology. Published by Elsevier B.V. All rights are reserved, including those for text and data mining, AI training, and similar technologies.

BACKGROUND:Accurate complication reporting in endourology remains challenging, with the Clavien-Dindo Classification and Comprehensive Complication Index being the most commonly used systems. This study aimed to compare surgical outcomes and complication reporting in ureterolithotripsy (URL), percutaneous nephrolithotomy (PCNL), and extracorporeal shock wave lithotripsy (ESWL) using both systems. METHODS:This prospective, single-center, non-interventional study included 473 patients undergoing URL, PCNL, or ESWL from October 2022 to October 2024. Demographic, stone-related, and procedural variables were recorded. Complications were classified using the CDC, and cumulative morbidity was assessed using CCI. Statistical analyses, including univariate and multivariate regression, were performed to identify predictors of higher CCI scores. RESULTS:PCNL was associated with the highest complication rates, including an 11% transfusion rate. ESWL had the lowest complication burden, while URL demonstrated intermediate risk. CCI scores correlated positively with length of stay (LOS; r = 0.47), highlighting its ability to capture overall morbidity. Multivariate analysis identified stone size, operating time, and positive urine culture as significant predictors of higher CCI scores. The CCI provided a more comprehensive representation of morbidity compared to the CDC. CONCLUSIONS:CCI demonstrates superior sensitivity in evaluating postoperative morbidity compared to CDC, particularly in more invasive procedures such as PCNL. Standardized reporting frameworks incorporating CCI may enhance surgical outcome assessment in endourology.

PurposeTo identify laser lithotripsy settings used by experts for specific clinical scenarios and to identify preventive measures to reduce complications.MethodsAfter literature research to identify relevant questions, a survey was conducted and sent to laser experts. Participants were asked for preferred laser settings during specific clinical lithotripsy scenarios. Different settings were compared for the reported laser types, and common settings and preventive measures were identified.ResultsTwenty-six laser experts fully returned the survey. Holmium-yttrium-aluminum-garnet (Ho:YAG) was the primary laser used (88%), followed by thulium fiber laser (TFL) (42%) and pulsed thulium-yttrium-aluminum-garnet (Tm:YAG) (23%). For most scenarios, we could not identify relevant differences among laser settings. However, the laser power was significantly different for middle-ureteral (p = 0.027), pelvic (p = 0.047), and lower pole stone (p = 0.018) lithotripsy. Fragmentation or a combined fragmentation with dusting was more common for Ho:YAG and pulsed Tm:YAG lasers, whereas dusting or a combination of dusting and fragmentation was more common for TFL lasers. Experts prefer long pulse modes for Ho:YAG lasers to short pulse modes for TFL lasers. Thermal injury due to temperature development during lithotripsy is seriously considered by experts, with preventive measures applied routinely.ConclusionsLaser settings do not vary significantly between commonly used lasers for lithotripsy. Lithotripsy techniques and settings mainly depend on the generated laser pulse's and generator settings' physical characteristics. Preventive measures such as maximum power limits, intermittent laser activation, and ureteral access sheaths are commonly used by experts to decrease thermal injury-caused complications.

According to the guidelines of the European Association of Urology (EAU), it is recommended to exclude PSA testing when the expected remaining lifespan is less than 10 years. In this study, we provide a comprehensive analysis of the impact of prostate-specific antigen (PSA) testing on the quality of life of elderly men who are frail. We conducted a comprehensive literature review to identify publications that examine the use of PSA as a screening and prognostic tool for prostatic illnesses in frail men. Our search included the following keywords: Prostate-specific antigen, Frailty, Prostate cancer screening, Hypogonadism, and Benign Prostatic Obstruction (BPO). Prostate-specific antigen (PSA) testing can be used to identify prostate cancer in its early and treatable stages in fragile men with a life expectancy of over 15 years. Additionally, PSA testing allows for the evaluation of the effectiveness of various prostate cancer treatments and the monitoring of testosterone replacement therapy for hypogonadism. PSA is also indicative of the clinical development of patients with benign prostatic obstruction (BPO). Nevertheless, PSA is being extensively provided without individualised patient assessment, contributing to the economic strain on healthcare systems. Conducting a frailty evaluation on men to determine the potential advantages of PSA tests on their quality of life will help minimise avoidable expenses.