Background The trauma mortality rate is higher in the elderly compared with younger patients. Ageing is associated with physiological changes in multiple systems and correlated with frailty. Frailty is a risk factor for mortality in elderly trauma patients. We aim to provide evidence-based guidelines for the management of geriatric trauma patients to improve it and reduce futile procedures.Methods Six working groups of expert acute care and trauma surgeons reviewed extensively the literature according to the topic and the PICO question assigned. Statements and recommendations were assessed according to the GRADE methodology and approved by a consensus of experts in the field at the 10th international congress of the WSES in 2023.Results The management of elderly trauma patients requires knowledge of ageing physiology, a focused triage, including drug history, frailty assessment, nutritional status, and early activation of trauma protocol to improve outcomes. Acute trauma pain in the elderly has to be managed in a multimodal analgesic approach, to avoid side effects of opioid use. Antibiotic prophylaxis is recommended in penetrating (abdominal, thoracic) trauma, in severely burned and in open fractures elderly patients to decrease septic complications. Antibiotics are not recommended in blunt trauma in the absence of signs of sepsis and septic shock. Venous thromboembolism prophylaxis with LMWH or UFH should be administrated as soon as possible in high and moderate-risk elderly trauma patients according to the renal function, weight of the patient and bleeding risk. A palliative care team should be involved as soon as possible to discuss the end of life in a multidisciplinary approach considering the patient's directives, family feelings and representatives' desires, and all decisions should be shared.Conclusions The management of elderly trauma patients requires knowledge of ageing physiology, a focused triage based on assessing frailty and early activation of trauma protocol to improve outcomes. Geriatric Intensive Care Units are needed to care for elderly and frail trauma patients in a multidisciplinary approach to decrease mortality and improve outcomes.

Laparotomy incisions provide easy and rapid access to the peritoneal cavity in case of emergency surgery. Incisional hernia (IH) is a late manifestation of the failure of abdominal wall closure and represents frequent complication of any abdominal incision: IHs can cause pain and discomfort to the patients but also clinical serious sequelae like bowel obstruction, incarceration, strangulation, and necessity of reoperation. Previous guidelines and indications in the literature consider elective settings and evidence about laparotomy closure in emergency settings is lacking. This paper aims to present the World Society of Emergency Surgery (WSES) project called ECLAPTE (Effective Closure of LAParoTomy in Emergency): the final manuscript includes guidelines on the closure of emergency laparotomy.

Background Retained surgical sharps (RSS) is a “never event” that is preventable but may still occur despite of correct count and negative X-ray. This study assesses the feasibility of a novel device (“Melzi Sharps Finder®” or MSF) in effective detection of RSS. Methods The first study consisted of determination of the presence of RSS or identification of RSS in an ex-vivo model (a container with hay in a laparoscopic trainer box). The second study consisted of determining presence of RSS in an in-vivo model (laparoscopy in live adult Yorkshire pigs) with 3 groups: C-arm, C-arm with MSF and MSF. The third study used similar apparatus though with laparotomy and included 2 groups: manual search and MSF. Results In the first study, the MSF group had a higher rate of identification of a needle and decreased time to locate a needle versus control (98.1% vs. 22.0%, p < 0.001; 1.64 min ± 1.12vs. 3.34 min ± 1.28, p < 0.001). It also had increased accuracy of determining the presence of a needle and decreased time to reach this decision (100% vs. 58.8%, p < 0.001; 1.69 min ± 1.43 vs. 4.89 min ± 0.63, p < 0.001). In-the second study, the accuracy of determining the presence of a needle and time to reach this decision were comparable in each group (88.9% vs. 100% vs. 84.5%, p < 0.49; 2.2 min ± 2.2 vs. 2.7 min ± 2.1vs. 2.8 min ± 1.7, p = 0.68). In the third study, MSF group had higher accuracy in determining the presence of a needle and decreased time to reach this decision than the control (97.0% vs. 46.7%, p < 0.001; 2.0 min ± 1.5 vs. 3.9 min ± 1.4; p < 0.001). Multivariable analysis showed that MSF use was independently associated with an accurate determination of the presence of a needle (OR 12.1, p < 0.001). Conclusions The use of MSF in this study’s RSS models facilitated the determination of presence and localization of RSS as shown by the increased rate of identification of a needle, decreased time to identification and higher accuracy in determining the presence of a needle. This device may be used in conjunction with radiography as it gives live visual and auditory feedback for users during the search for RSS.

INTRODUCTION AND OBJECTIVE: Some men are candidates for watchful-waiting (WW) or active surveillance (AS) following TRUS biopsy findings of low-grade prostate cancer (PCa) or benign disease. However, there is an unmet clinical need to reliably rule out high-grade PCa (HGPCa) in these men. The SelectMDx test measures urinary mRNA levels of the homeobox C6 (HOXC6) and distal-less homeobox 1 (DLX1) biomarkers and has been clinically validated for detection of HGPCa upon subsequent TRUS biopsy. We investigated the utility of the SelectMDx test to identify HGPCa in a cohort of men who underwent transperineal mapping biopsy (TPMB) after TRUS biopsy by comparing the SelectMDx results to histopathological findings of TPMB. METHODS: In this retrospective study, 105 patients opted for TPMB to confirm the histopathological findings of their initial TRUS biopsies. Post-DRE, first-void urine specimens were collected from each patient prior to TPMB. SelectMDx testing was performed at MDxHealth, blinded with respect to TPMB outcome. Histopathology of each TPMB was independently read by a genitourinary pathologist. HGPCa was defined as ISUP Grade Group (GG) 2. SelectMDx performance characteristics for detection of HGPCa were determined by comparison to TPMB histopathology data. RESULTS: 29 patients on 5ARI and 8 patients failed SelectMDx test were excluded. The remaining 68 patients were included with median age of 63 (IQR 57-68) years and median PSA 5.1 (3.0-7.6) ng/ mL. TRUS biopsy diagnosed 10 (15%) with benign disease, 37 (54%) patients with GG1, and 21 (31%) with GG2. TPMB identified 12 (18%) patients with benign pathology, 26 (38%) with GG1 PCa, and 30 (44%) with HGPCa (23 GG2, 3 GG3 and 4 GG4). For detection of HGPCa, the SelectMDx test yielded sensitivity of 97% (95% C.I. 83-100%), specificity 37% (22-54%), positive predictive value 55% and negative predictive value (NPV) 93%. The single HGPCa identified in a SelectMDx negative patient was GG2. In a logistic regression analysis including age and PSA, SelectMDx was the only significant predictor of HGPCa at TPMB (b [ 1.09 (p [ 0.0037), odds ratio 2.99, AUC [ 0.738). CONCLUSIONS: The SelectMDx urine test demonstrated high sensitivity and NPV for discriminating between patients with HGPCa vs. patients with GG1 or benign disease at biopsy. These results support the use of SelectMDx to help identify men for WW or AS following TRUS biopsy. Study results also support the use of non-invasive tests to help identify men with HGPCa who may benefit from prostate biopsy, thereby reducing over-detection of indolent disease.

You have accessJournal of UrologyCME1 May 2022PD55-10 MOSES 2.0 LASER IMPACT ON INTRAOPERATIVE PARAMETERS Samuel Antoine, Kerri Thurmon, Michael Atwell, Xavier Glover, Miguel Rodriguez-Homs, Fernando Kim, and Rodrigo Donalisio da Silva Samuel AntoineSamuel Antoine More articles by this author , Kerri ThurmonKerri Thurmon More articles by this author , Michael AtwellMichael Atwell More articles by this author , Xavier GloverXavier Glover More articles by this author , Miguel Rodriguez-HomsMiguel Rodriguez-Homs More articles by this author , Fernando KimFernando Kim More articles by this author , and Rodrigo Donalisio da SilvaRodrigo Donalisio da Silva More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002635.10AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The Moses 2.0 laser was introduced to our hospital this year. The pulse-delivery technology increases energy transmission at each working distance. Frequency can be performed as high as 120 Hz which could improve stone dusting times, and energy levels can be performed up to 6 J which could improve fragmentation time. We aimed to evaluate the impact of this technology on patients undergoing ureteroscopy with laser lithotripsy in our hospital cohort. METHODS: We retrospectively analyzed ureteroscopy with laser lithotripsy cases performed at our hospital in 2021. All procedures performed prior to July 1, 2021 were performed with the Moses 1.0 laser, while all subsequent procedures were performed with the Moses 2.0 laser. Variables that were studied included stone density (Hounsfield units, i.e. HU), stone volume (mm3), lasing time, total energy used, stone ablation rate (volume/laser time), energy use rate (J/mm3), intraoperative stone stone-free rate, and complications. Comparisons were made between the Moses 1.0 and 2.0 groups using Student’s t tests. Multiple linear and logistic regression was also performed to evaluate the impact of energy, stone volume, stone density, and laser type on lasing time. A significance level of p-value ≤0.05 was used. RESULTS: There were 82 procedures in this cohort. Statistical results are summarized in Table 1. Overall, the only variable that reached statistical significance with Student’s t tests was the energy use rate with a p-value of 0.05. On regression analysis, the type of laser used did not have a statistically significant impact on lasing time when controlling for the total energy used, stone volume, and stone density, though the coefficient for total energy used was statistically significant with a p <0.001. CONCLUSIONS: The Moses 2.0 laser did deliver more energy per unit stone volume. However, this did not have an impact on lasing time. This remained true when controlling for total energy, stone volume, and density. It is possible that differences in lasing time will become apparent with a larger sample size and more familiarity with the 2.0 laser. Source of Funding: None © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e951 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Samuel Antoine More articles by this author Kerri Thurmon More articles by this author Michael Atwell More articles by this author Xavier Glover More articles by this author Miguel Rodriguez-Homs More articles by this author Fernando Kim More articles by this author Rodrigo Donalisio da Silva More articles by this author Expand All Advertisement PDF DownloadLoading ...

You have accessJournal of UrologyProstate Oncology II & Testis Oncology & Misc. Oncology (V14)1 Sep 2021V14-09 INFECTIOUS OUTCOMES BETWEEN IN-OFFICE TRANSPERINEAL PROSTATE BIOPSIES WITHOUT ANTIBIOTIC PROPHYLAXIS AND TRANSRECTAL PROSTATE BIOPSIES Majdee Islam, Alan Quach, Fernando Kim, and Rodrigo Donalisio Da Silva Majdee IslamMajdee Islam More articles by this author , Alan QuachAlan Quach More articles by this author , Fernando KimFernando Kim More articles by this author , and Rodrigo Donalisio Da SilvaRodrigo Donalisio Da Silva More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002111.09AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: To describe our experience and demonstrate our technique with office-based transperineal biopsy (TPB) without antibiotics compared to transrectal biopsy (TRB) with antibiotics and bowel preparation. The literature elicits comparable cancer detection, time, and cost between the two. As antibiotic resistance increases, antimicrobial stewardship is imperative. METHODS: In our retrospective review, we compared the TPB to TRB in our institution for in-office prostate biopsies with local anesthesia from 2017-2019. Patients had negative urinalysis on day of procedure. A UTI was defined as a positive urine culture within one month of biopsy. RESULTS: Two hundred twenty-two patients met inclusion criteria. Age, race, BMI, pre-procedure PSA, history of UTI, BPH or other GU history were similar between both groups. Two TPB patients (1.8%) had post-procedure UTI; one received oral antibiotics and one received a dose of intravenous and subsequent oral antibiotics. There were no sepsis events or admissions. Six TRB patients (5.4%) had post-procedure UTI; five received oral antibiotics, and one received intravenous antibiotics and required admission for sepsis. One TPB patient (0.9%) had post-procedure retention and required catheterization, while four TRB patients (3.6%) had retention requiring catheterization. No significant difference noted in cancer detection between the two groups. CONCLUSIONS: In-office TPB without antibiotic prophylaxis/bowel prep is comparable to TRB in regard to safety and cancer detection. TPB without antibiotics had a lower infection and retention rate than TRB with antibiotics. Efforts to reduce antibiotic resistance should be implemented into daily practice. Future multi-institutional studies can provide further evidence for guideline changes. Source of Funding: None © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e1168-e1168 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Majdee Islam More articles by this author Alan Quach More articles by this author Fernando Kim More articles by this author Rodrigo Donalisio Da Silva More articles by this author Expand All Advertisement Loading ...

Abstract Background: To describe our experience with office-based transperineal biopsy (TPB) without antibiotics compared to transrectal biopsy (TRB) with antibiotics and bowel preparation. The literature elicits comparable cancer detection, time, and cost between the two. As antibiotic resistance increases, antimicrobial stewardship is imperative. Methods: In our retrospective review, we compared the TPB to TRB in our institution for in-office prostate biopsies with local anesthesia from 06/2017-06/2019. Patients had negative urinalysis on day of procedure. Patients presenting with symptoms concerning for UTI followed by positive urine culture were determined to have a UTI. Results: Two hundred twenty-two patients met inclusion criteria. Age, race, BMI, pre-procedure PSA, history of UTI, BPH or other GU history were similar between both groups. Two TPB patients (1.8%) had post-procedure UTI; one received oral antibiotics and one received a dose of intravenous and subsequent oral antibiotics. There were no sepsis events or admissions. Six TRB patients (5.4%) had post-procedure UTI; five received oral antibiotics, and one received intravenous antibiotics and required admission for sepsis. One TPB patient (0.9%) had post-procedure retention and required catheterization, while four TRB patients (3.6%) had retention requiring catheterization. No significant difference noted in cancer detection between the two groups. Conclusion: In-office TPB without antibiotic prophylaxis/bowel prep is comparable to TRB in regard to safety and cancer detection. TPB without antibiotics had a lower infection and retention rate than TRB with antibiotics. Efforts to reduce antibiotic resistance should be implemented into daily practice. Future multi-institutional studies can provide further evidence for guideline changes.

Renal and urogenital injuries occur in approximately 10-20% of abdominal trauma in adults and children. Optimal management should take into consideration the anatomic injury, the hemodynamic status, and the associated injuries. The management of urogenital trauma aims to restore homeostasis and normal physiology especially in pediatric patients where non-operative management is considered the gold standard. As with all traumatic conditions, the management of urogenital trauma should be multidisciplinary including urologists, interventional radiologists, and trauma surgeons, as well as emergency and ICU physicians. The aim of this paper is to present the World Society of Emergency Surgery (WSES) and the American Association for the Surgery of Trauma (AAST) kidney and urogenital trauma management guidelines.

You have accessJournal of UrologyStone Disease: Surgical Therapy V1 Apr 2018PD53-03 COST ANALYSIS OF UTILIZATION OF DISPOSABLE FLEXIBLE URETEROSCOPES IN HIGH RISK FOR BREAKAGE CASES Wilson Molina, Jason Warncke, Rodrigo Donalisio da Silva, Diedra Gustafson, Leticia Nogueira, and Fernando Kim Wilson MolinaWilson Molina More articles by this author , Jason WarnckeJason Warncke More articles by this author , Rodrigo Donalisio da SilvaRodrigo Donalisio da Silva More articles by this author , Diedra GustafsonDiedra Gustafson More articles by this author , Leticia NogueiraLeticia Nogueira More articles by this author , and Fernando KimFernando Kim More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2018.02.2499AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Flexible ureteroscopy is a mainstay of treatment for proximal ureteral and renal stones. Despite improved imaging and technology, standard ureteroscopes are still fragile with limited life span and costly repairs. We aim to analyze the financial impact of cost of repairs of standard ureteroscopes before and after utilizing disposable flexible ureteroscopes in high risk for breakage cases (HRBC). METHODS We began implementing disposable flexible ureteroscopes (Lithovue®, Boston Scientific) for HRBC on 6/1/2016. HRBC were identified if the stones were 15 to 20 mm in size or located in the lower pole and could not be repositioned to a different calyx. Repair cost data were gathered and compared from 15 months before and after implementing disposable flexible ureteroscopes. The disposable ureteroscopes were compared to our standard non-disposable ureteroscope (Olympus URF-V and URF-V 2). Data from 228 cases before and after were evaluated as well. The cost of disposable flexible ureteroscopes was considered during the analysis. RESULTS In select HRBC, 17 disposable ureteroscopes were used. Implementing disposable flexible ureteroscopes for HRBC resulted in a total cost saving of $52,314 which corresponds to $229 per case. (Tables 1 and 2) CONCLUSIONS Disposable flexible ureteroscopes utilized for select cases can be effective in reducing the total cost of flexible ureteroscopy. The magnitude of savings associated with disposable flexible ureteroscopes could be greater than was reported, as we did not include other miscellaneous costs of standard ureteroscopes including cleaning, sterilization, and storage. © 2018FiguresReferencesRelatedDetails Volume 199Issue 4SApril 2018Page: e1047 Advertisement Copyright & Permissions© 2018MetricsAuthor Information Wilson Molina More articles by this author Jason Warncke More articles by this author Rodrigo Donalisio da Silva More articles by this author Diedra Gustafson More articles by this author Leticia Nogueira More articles by this author Fernando Kim More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Transitional cell carcinoma is the most common type of bladder cancer in the United States. This case report discusses the finding of primary bladder carcinoid tumor (also called well-differentiated neuroendocrine tumor) in a woman with gross hematuria. With only 15-20 reported cases, primary bladder carcinoid is rare and the approach to treatment is unclear. There have been two muscle-invasive cases reported which required more extensive treatment plans. The patient presented in this case underwent complete transurethral resection of the tumor with the recommendation of surveillance cystoscopy every 3 months.

In this article, we report on the long-term follow-up of a microvascular penile replantation resulting from self-inflicted amputation in a schizophrenic patient. An interdisciplinary approach with the involvement of urology, plastic surgery, endocrinology, and psychiatry is imperative for optimal treatment of these catastrophic injuries.

You have accessJournal of UrologyStone Disease: SWL, Ureteroscopy or Percutaneous Stone Removal (I)1 Apr 20131527 DETERMINANTS OF HO:YAG CUMULATIVE LASER ENERGY AND TIME DURING URETEROSCOPIC LASER LITHOTRIPSY Wilson Molina, Giovanni Marchini, Alexandre Pompeo, David Sehrt, Fernando Kim, and Manoj Monga Wilson MolinaWilson Molina Denver, CO More articles by this author , Giovanni MarchiniGiovanni Marchini Cleveland, OH More articles by this author , Alexandre PompeoAlexandre Pompeo Denver, CO More articles by this author , David SehrtDavid Sehrt Denver, CO More articles by this author , Fernando KimFernando Kim Denver, CO More articles by this author , and Manoj MongaManoj Monga Cleveland, OH More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2013.02.3017AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES To investigate the relationship between preoperative non-contrast computed tomography (NCCT) stone characteristics and total Ho:YAG laser time and cumulative laser energy during ureteroscopic (URS) laser lithotripsy. METHODS We retrospectively reviewed patients with ureteral and/or renal stones who underwent URS and Ho:YAG laser lithotripsy between April/10 and May/12 at two tertiary centers. Inclusion criteria were stone size <4 mm; NCCT; operative data including laser time and energy; stone composition. Laser lithotripsy was performed using a Ho:YAG laser (200 or 365 μm fiber); laser settings were set to 0.8J and 8Hz. Fragments <5 mm were considered suitable for removal. Pearson's correlation and regression analysis were performed to evaluate associations between patient and stone characteristics and laser energy and time. Significance was set at p<0.05. RESULTS 100 patients met our inclusion criteria. After controlling for stone size, we found no significant correlation between HU and laser energy (R=0.133, p=0.20). However, the correlation of HU with laser time (R=0.262, p=0.011), and HUD with laser energy (R=0.238, p=0.021) and time (R=0.264, p=0.014) were significant. On univariate analysis, cumulative laser energy had a positive significant association only with stone volume (Fig1A). With the exception of stone composition, all parameters significantly impacted laser energy on multivariate analysis (R2=0.459; table 1). Laser time had a significant positive correlation only with stone volume on univariate analysis (fig1B). Multivariate analysis revealed a significant positive association with stone volume and HUD (R2=0.499). A second regression analysis was performed considering all calcium stone compositions separately and revealed no cumulative laser energy or total laser time difference among the distinct stone compositions. CONCLUSIONS Ho:YAG laser cumulative energy and total time are significantly affected by stone dimensions and hardness. Stone composition does not affect cumulative laser energy and time. Table 1. Univariate and Multivariate Models for cumulative laser energy and total laser time. Laser Energy Univariate Analysis Multivariate Analysis B 95% CI p-value R2 B 95% CI p-value R2 Volume (cm3) 3078.8 2056.6-4100.9 <0.001 0.280 3715.8 2715.0-4715.3 ⁎<0.001 0.459 Location (renal) 652.1 −47.2-1351.4 0.067 0.036 667.3 41.3-1293.3 ⁎0.037 HUD (HU/cm) −39.2 −101.3-23.0 0.214 0.018 65.0 10.6-119.4 ⁎0.020 Fiber (365um) 213.6 −519.2-946.4 0.564 0.004 960.0 328.8-1591.3 ⁎0.003 Calcium Stone −97.4 −1792.8-1598.0 0.909 <0.001 −188.8 −1146.9-1069.3 0.766 Univariate Analysis Multivariate Analysis B 95% CI p-value R2 B 95% CI p-value R2 Volume (cm3) 433.1 305.0-561.2 <0.001 0.329 568.5 437.8 -669.2 ⁎<0.001 0.499 Location (renal) 73.0 −18.3-164.2 0.116 0.027 42.5 −39.3-124.3 0.304 HUD (HU/cm) −1.7 −10.2-6.8 0.698 0.002 13.5 6.4-20.6 ⁎<0.001 Fiber (365um) −6.1 −101.4-89.2 0.900 <0.001 69.4 −13.1-151.9 0.098 Calcium Stone −9.8 −229.9-210.3 0.930 <0.001 1.3 −163.1-165.7 0.987 ⁎ p-value for Calcium Stones vs. Uric Acid stones © 2013 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 189Issue 4SApril 2013Page: e625-e626 Advertisement Copyright & Permissions© 2013 by American Urological Association Education and Research, Inc.MetricsAuthor Information Wilson Molina Denver, CO More articles by this author Giovanni Marchini Cleveland, OH More articles by this author Alexandre Pompeo Denver, CO More articles by this author David Sehrt Denver, CO More articles by this author Fernando Kim Denver, CO More articles by this author Manoj Monga Cleveland, OH More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

You have accessJournal of UrologyStone Disease: SWL, Ureteroscopy or Percutaneous Stone Removal (IV)1 Apr 20131987 TEMPERATURE PROFILE OF LASER LITHOTRIPSY USING AN EX VIVO MODEL Wilson Molina, Igor Silva, David Sehrt, Alexandre Pompeo, Jason Phillips, Elliot Handler, and Fernando Kim Wilson MolinaWilson Molina Denver, CO More articles by this author , Igor SilvaIgor Silva Denver, CO More articles by this author , David SehrtDavid Sehrt Denver, CO More articles by this author , Alexandre PompeoAlexandre Pompeo Denver, CO More articles by this author , Jason PhillipsJason Phillips Denver, CO More articles by this author , Elliot HandlerElliot Handler Denver, CO More articles by this author , and Fernando KimFernando Kim Denver, CO More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2013.02.2406AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Laser lithotripsy is a well-established option for the treatment of urolithiasis. Stone cavitation phenomena are well understood but there is presently a paucity of information regarding the energy spread during the exogenous process. We established an ex vivo model to evaluate the temperature profile of the ureter during laser lithotripsy. METHODS An infrared camera was used for the thermal evaluation of laser lithotripsy in an ex vivo model (Ovis aries). Laser lithotripsy was performed with a Holmium YAG laser and a 400μ fiber with calcium monohydrate stones. Measurements were made on the tip of the laser fiber, the ureteral urothelium, and the external wall of the ureter. Irrigation of saline was varied and results were compared. Data are presented as average ± standard error. RESULTS The laser fiber obtained a maximum temperature of 51.7°C±7.8° during activation. During lithotripsy the ureteral urothelium temperature was recorded as 49.7°±6.7° with irrigation and 112.4°±24.2° without (p=0.048). The external ureteral wall obtained a temperature of 37.4°±2.5° with irrigation and 49.5°±2.3° without (p=0.003). When a noticeable amount of fat surrounded the ureter, the external thermal temperature did not increase (p=0.726). During intentional perforation the urothelium was recorded as 81.8°±8.8° and 145.0°±15.0° with and without irrigation respectively (p=0.003). CONCLUSIONS There is a notable increase in the internal and external ureteral temperature during activation of the Holmium YAG laser however thermal values are well below the threshold for thermal damage with irrigation. Irrigation not only improves endoscopic visualization during lithotripsy but also minimizes tissue heating. This is the first laser lithotripsy thermography study and establishes the framework to evaluate the temperature profile in the future. © 2013 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 189Issue 4SApril 2013Page: e815-e816 Advertisement Copyright & Permissions© 2013 by American Urological Association Education and Research, Inc.MetricsAuthor Information Wilson Molina Denver, CO More articles by this author Igor Silva Denver, CO More articles by this author David Sehrt Denver, CO More articles by this author Alexandre Pompeo Denver, CO More articles by this author Jason Phillips Denver, CO More articles by this author Elliot Handler Denver, CO More articles by this author Fernando Kim Denver, CO More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

You have accessJournal of UrologyKidney Cancer: Localized III1 Apr 20121429 SURGICAL OUTCOMES OF RENAL CRYOABLATION WITH THE RENAL NEPHROMETRY SCORE AND ADJUSTED COMPLEXITY LEVELS Alexandre Pompeo, David Sehrt, Marcelo Wroclawski, Bruno Benigno, Garrett Pohlman, Wilson Molina, and Fernando Kim Alexandre PompeoAlexandre Pompeo Denver, CO More articles by this author , David SehrtDavid Sehrt Denver, CO More articles by this author , Marcelo WroclawskiMarcelo Wroclawski Sao Paulo, Brazil More articles by this author , Bruno BenignoBruno Benigno Sao Paulo, Brazil More articles by this author , Garrett PohlmanGarrett Pohlman Denver, CO More articles by this author , Wilson MolinaWilson Molina Denver, CO More articles by this author , and Fernando KimFernando Kim Denver, CO More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2012.02.1902AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES The RENAL Nephrometry Scoring system was developed to standardize the anatomical reporting of renal masses. A secondary objective of this nomogram was to stratify masses into complexity levels pre-operatively. Presently, there is no reporting of the use of this anatomic classification system for cryoablation. This is the first evaluation of the accuracy of the RENAL Nephrometry Score (RNS), on the surgical outcomes from laparoscopic cryoablation of renal masses. METHODS A total of 105 patients treated from November 2005 to October 2011 who undergone laparoscopic cryoablation of renal masses were reviewed by the RNS. RNS was classified as a low complexity of 4-5, intermediate 6-8 and high complexity 9-12. Surgical outcomes of estimative blood loss (EBL), operative time (ORT), change of creatinine levels, hospital length of stay, intra-operative conversions, and complications were evaluated and compared between the groups. Outcomes are presented as either occurrences with percentages or median with 1st and 3rd quartiles. RESULTS A total of low 23 (21.9%), moderate 56 (53.3%) and high complexity 26 (26.0%) tumors (mean tumor size 2.7 cm) were found (Table 1). There were no tumors classified with a nephrometry 11 or 12 score and only 11(10.5%) tumors were larger than 4 cm. EBL, ORT and complication rates were significant between the groups (p<0.05). Intra-operative complications only occurred in the high complexity group which consisted of a diaphragm injury due to adhesions and a splenic capsule tear. Conversions were caused by a rupture of the tumor after the first freezing cycle in the moderate complexity level and by tumor growth into the renal vessels which was unseen from the most recent available CT in the high complexity level. Table 1. Surgical Outcomes Surgical Outcomes Low Complexity (NS: 4-5) Moderate Complexity (NS: 6-8) High Complexity (NS: 6-8) p-value Cases 23(21.9%) 56(53.3%) 26(26.0%) – EBL, mL 25(25-50) 50(25-100) 50(38-88) 0.017 ORT, min 55(43-63) 58(47-67) 60(53-68) 0.416 Change in Creatinine, mg/dL 0.1(0.0-0.2) 0.1(0.0-0.2) 0.1(0.0-0.2) 0.765 Hospital Length of Stay, d 2(1-2) 2(1-2) 2(2-3) 0.042 Conversion to Partial Nephrectoy 0(0.0%) 1(1.8%) 1(3.8%) 0.629 Complications 0(0.0%) 1(1.8%) 5(19.2%) 0.003 Intra-Operative Complications 0(0.0%) 0(0.0%) 2(16.7%) 0.045 Post-Operative Complications 0(0.0%) 1(1.8%) 3(7.7%) 0.056 CONCLUSIONS The Nephrometry score intended to standardize reporting of renal masses and moreover predict complications rates from treatment. The Nephrometry score has shown validity in cryoablation but a model tailored more for this treatment modality would improve the predictive capability. An apparent shortcoming in the nephrometry score for cryoablation is the limitations of tumor size since the optimal eligibility should be less than 4 cm (T1a). A model based on statistical analysis rather than ease of implementation would further improve this foundational nomogram. © 2012 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 187Issue 4SApril 2012Page: e580 Advertisement Copyright & Permissions© 2012 by American Urological Association Education and Research, Inc.MetricsAuthor Information Alexandre Pompeo Denver, CO More articles by this author David Sehrt Denver, CO More articles by this author Marcelo Wroclawski Sao Paulo, Brazil More articles by this author Bruno Benigno Sao Paulo, Brazil More articles by this author Garrett Pohlman Denver, CO More articles by this author Wilson Molina Denver, CO More articles by this author Fernando Kim Denver, CO More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...