PURPOSE:Iatrogenic ureteral strictures (US) after endoscopic treatment for urolithiasis represent a significant healthcare concern. However, high-quality evidence on the risk factors associated with US is currently lacking. We aimed to develop a consensus statement addressing the definition, risk factors, and follow-up management of iatrogenic US after endoscopic treatment for urolithiasis. METHODS:Utilizing a modified Delphi method, a steering committee developed survey statements based on a systematic literature review. Then, a two-round online survey was submitted to 25 experts, offering voting options to assess agreement levels. A consensus panel meeting was held for unresolved statements. The predetermined consensus threshold was set at 70%. RESULTS:The steering committee formulated 73 statements. In the initial survey, consensus was reached on 56 (77%) statements. Following in-depth discussions and refinement of 17 (23%) statements in a consensus meeting, the second survey achieved consensus on 63 (86%) statements. This process underscored agreement on pivotal factors influencing US in endoscopic urolithiasis treatments. CONCLUSIONS:This study provides a comprehensive list of categorized risk factors for US following endoscopic urolithiasis treatments. The objectives include enhancing uniformity in research, minimizing redundancy in outcome assessments, and effectively addressing risk factors associated with US. These findings are crucial for designing future clinical trials and guiding endoscopic surgeons in mitigating the risk of US.

We aimed to accurately determine ureteral stricture (US) rates following urolithiasis treatments and their related risk factors. We conducted a systematic review and meta-analysis following the PRISMA guidelines using databases from inception to November 2023. Studies were deemed eligible for analysis if they included ≥ 18 years old patients with urinary lithiasis (Patients) who were subjected to endoscopic treatment (Intervention) with ureteroscopy (URS), percutaneous nephrolithotomy (PCNL), or shock wave lithotripsy (SWL) (Comparator) to assess the incidence of US (Outcome) in prospective and retrospective studies (Study design). A total of 43 studies were included. The pooled US rate was 1.3

Las personas con cistinuria pueden experimentar eventos recurrentes de litiasis debido a la relativa insolubilidad de la cistina en el pH fisiológico de la orina, lo que resulta en deterioro de la función renal. El pHmetro Lit-Control® es un dispositivo médico que permite la automedición precisa del pH de la orina. El objetivo principal de este estudio fue comparar la usabilidad del pHmetro Lit-Control® con las tiras reactivas para la automonitorización domiciliaria del pH urinario por parte de pacientes con cistinuria, y su satisfacción general con cada herramienta. Se incluyeron 28 pacientes (9 mujeres y 19 varones, de 19 a 76 años), que fueron asignados aleatoriamente a monitorizar su pH urinario con tiras reactivas (n = 17) o el pHmetro Lit-Control® (n = 11). Después de 6 meses de uso, la satisfacción con los 2 métodos fue similarmente alta, pero los pacientes calificaron (en una escala de 0 a 10) mejor el pHmetro en términos de facilidad de aprendizaje (media ± DE, 8,11 ± 0,60 vs. 7,06 ± 1,18; p = 0,038), facilidad de preparación (8,22 ± 0,67 vs. 7,25 ± 1,18; p = 0,034) y facilidad de uso (8,22 ± 0,67 vs. 7,25 ± 1,39; p = 0,062). En general, los pacientes no alcanzaron los objetivos de alcalinización (pH entre 7,0 y 8,0). El pHmetro Lit-Control® demostró ser un dispositivo fácil de usar que puede facilitar el control del pH urinario en los pacientes con cistinuria. Queda justificado un estudio prospectivo para evaluar la correlación entre la monitorización del pH de la orina, una estrategia de tratamiento por objetivo y la recurrencia de los cálculos de cistina. Individuals with cystinuria can experiment recurrent lithiasis events due to the relative insolubility of cystine at physiological urine pH, resulting in renal function decline. The Lit-Control® pH Meter is a medical device that accurately allows urine pH self-monitoring. The main objective of this study was to compare the usability of the Lit-Control® pH Meter with the reactive strips for self-monitoring of urinary pH at home by patients with cystinuria, and their overall satisfaction with each tool. We included 28 patients (9 females and 19 males, age 19-6 years), who were randomly assigned to monitor their urine pH with reactive strips (n = 17) or the Lit-Control® pH Meter (n = 11). After six months of use, the satisfaction with the two methods was similarly high, but the patients rated (0-10 scale) the pH meter better in terms of ease of learning (mean ± SD, 8.11 ± 0.60 vs. 7.06 ± 1.18; P=.038), ease to prepare (8.22 ± 0.67 vs. 7.25 ± 1.18; P = 0.034), and ease of use (8.22 ± 0.67 vs. 7.25 ± 1.39; P=.062). Overall, patients did not reach the alkalinization goals (pH between 7.0 and 8.0). The Lit-Control® pH Meter demonstrated to be an easy-to-use device that can facilitate urinary pH control by cystinuric patients. A prospective study is warranted to assess the correlation between urine pH monitoring, a treat to target approach, and the recurrence of cystine stones.

Si bien la ureteroscopia flexible es una técnica establecida, a día de hoy no existen datos sobre la influencia del sexo del paciente en los resultados y complicaciones. El objetivo de este estudio es evaluar el papel que desempeña el sexo en la realización de la ureteroscopia flexible a partir de una serie grande de pacientes. Este estudio analizó retrospectivamente los datos del registro multicéntrico FLEXOR de los pacientes tratados de cálculos renales con CRIR desde enero de 2018 hasta agosto de 2021. Se analizaron los datos demográficos, las características de los cálculos, los hallazgos perioperatorios, los resultados y las complicaciones, y se compararon entre grupos estratificados según el sexo. Un total de 6.669 pacientes fueron incluidos, el 66,1% eran varones y el 33,9% mujeres. Las características de los cálculos eran comparables entre los grupos. Las mujeres presentaron tasas significativamente más elevadas de fiebre y urocultivo positivo (12 frente a 8% y 37 frente a 34%). Además, las mujeres tuvieron una estancia hospitalaria ligeramente más larga (3,8 vs. 3,5 días; p < 0,001) y más fragmentos residuales después del procedimiento (23,03 vs. 20,97; p = 0,032). Las complicaciones globales fueron ligeramente superiores en las mujeres (15,74 frente a 14%; p = 0,042), debido principalmente a las tasas de fiebre (6,9 frente a 5,7%); el riesgo de sepsis fue similar en ambos grupos. Según un análisis multivariante, los cálculos de mayor tamaño, múltiples y localizados en el polo inferior parecen tener un efecto negativo en la incidencia de los cálculos residuales y las complicaciones. Nuestro estudio de la vida real a nivel mundial refleja que el sexo femenino puede estar correlacionado con unas tasas ligeramente mayores de fragmentos residuales y complicaciones generales de bajo grado. Sin embargo, siguiendo las normas asistenciales adecuadas, la CRIR puede realizarse con seguridad en mujeres sin aumentar la tasa de sepsis. As well established flexible ureteroscopy (RIRS). There is still no evidence if gender can have any influence on the outcomes and complication when performing This study aims to evaluate the role that gender has in performing flexible ureteroscopy from a large series of patients. This study retrospectively analyzed patients who underwent RIRS for renal stones from January 2018 to August 2021 within the multicentric FLEXOR registry. Demographics, stone characteristics, perioperative findings, results and complications were analyzed and compared between gender groups. A total of 6669 patients were included, 66.1% were male and 33.9% were female. Stone characterictis was comparable between groups. Female patients had significant higher fever and positive urine culture rates (12% vs. 8% and 37% vs. 34%). Also, females had a slight longer hospital stay (3.8 vs. 3.5 days; P < 0.001) and more residual fragments after the procedure (23.03% vs. 20.97 (P = 0.032). Overall complications were slightly significantly higher in women (15.74% vs. 14% (P = 0.042)) mainly at the expense of fever rates (6.9% vs. 5.7%) whereas the risk of sepsis was similar in both groups. A multivariate analysis showed that larger stone size, multiple and lower pole stones seem to have a negative impact in the incidence of residual stones and complications. Our real life global study reflects that female gender may have a correlation with a slightly increased residual fragment rate and overall low grade complications. However, women can safely be treated with RIRS with no increased the rate of sepsis with appropriate care.

Aim: To measure the temperature dynamics at the renal surface and within the urinary tract when using Ho:YAG and Tm:YAG lasers for tissue ablation. Materials and methods: Porcine kidneys were used. Both types of lasers with different configurations and fiber sizes were used through a flexible ureteroscope. The temperature at the renal surface was recorded using a thermal camera while the intrarenal temperature was measured using two thermal probes, the first one at the ureteropelvic junction and the second one at the calyx used for lasering. Temperature was determined at 0.5-1-3-5 and 10 minutes. Results: Recordings at the ureteropelvic junction and calyx revealed significant increases when using Tm:YAG with the 273 mu m (10 W to 50 W) (p <= 0.02) and 550 mu m (10 W) fiber (p = 0.04). With Ho:YAG there was a significant increase when using 273 mu m (at 10 W and 20 W) (p <= 0.03) and 365 mu m (10 W) fibers (p = 0.04). Regarding fiber size there was a significant difference when using Tm:YAG (at 20 W and 40 W) (p < 0.05). The thermal camera recorded a mean increase of 8 degrees C in the UPJ while the remaining areas of the kidney did not undergo significant changes. Conclusions: Temperature changes were greater when using the Ho:YAG laser with respect to Tm:YAG at similar power settings for tissue ablation. The greatest temperature increase was recorded at the UPJ from where the heat dissipated throughout the kidney. (c) 2022 Published by Elsevier Espana, S.L.U. on behalf of AEU.

BACKGROUND AND OBJECTIVES:Individuals with cystinuria can experiment recurrent lithiasis events due to the relative insolubility of cystine at physiological urine pH, resulting in renal function decline. The Lit-Control® pH Meter is a medical device that accurately allows urine pH self-monitoring. The main objective of this study was to compare the usability of the Lit-Control® pH Meter with the reactive strips for self-monitoring of urinary pH at home by patients with cystinuria, and their overall satisfaction with each tool. PATIENTS AND METHODS:We included 28 patients (9 females and 19 males, age 19-76 years), who were randomly assigned to monitor their urine pH with reactive strips (n = 17) or the Lit-Control® pH-meter (n = 11). RESULTS:After six months of use, the satisfaction with the two methods was similarly high, but the patients rated (0-10 scale) the pH meter better in terms of ease of learning (mean ± SD, 8.11 ± 0.60 vs. 7.06 ± 1.18; P = 0.038), ease to prepare (8.22 ± 0.67 vs. 7.25 ± 1.18; P = 0.034), and ease of use (8.22 ± 0.67 vs. 7.25 ± 1.39; P = 0.062). Overall, patients did not reach the alkalinization goals (pH between 7.0 and 8.0). CONCLUSIONS:The Lit-Control® pH Meter demonstrated to be an easy-to-use device that can facilitate urinary pH control by cystinuric patients. A prospective study is warranted to assess the correlation between urine pH monitoring, a treat to target approach, and the recurrence of cystine stones.

Medir la dinámica de la temperatura en la superficie renal y dentro de la vía urinaria al usar los láseres Ho:YAG y Tm:YAG para la ablación tisular. Se utilizaron riñones porcinos. Ambos tipos de láseres con diferentes configuraciones y tamaños de fibras se usaron a través de un ureteroscopio flexible. La temperatura en la superficie renal fue registrada mediante una cámara termográfica mientras que la intrarrenal fue medida a través de dos termómetros, el primero en la unión pieloureteral y el segundo en el cáliz elegido para el uso del láser. La temperatura fue determinada a los 0,5-1-3-5 y 10 minutos. Los registros en la unión pieloureteral y en el cáliz revelaron incrementos significativos al usar el Tm:YAG con la fibra de 273 μm (10 W a 50 W) (p ≤ 0,02) y de 550 μm (10 W) (p = 0,04). Con el Ho:YAG se registró un incremento significativo al usar fibras de 273 μm (a 10 W y 20 W) (p ≤ 0,03) y de 365 μm (10 W) (p = 0,04). Respecto al tamaño de las fibras, hubo una diferencia significativa al usar el Tm:YAG (a 20 W y 40 W) (p < 0,05). La cámara termográfica registró un incremento medio de 8 °C en la unión pieloureteral mientras que el resto del riñón no sufrió cambios significativos. Los cambios de temperatura fueron mayores al usar el láser Ho:YAG respecto al Tm:YAG a configuraciones de poder similares para la ablación tisular. El mayor incremento de temperatura fue registrado en la unión pieloureteral desde donde el calor se disipaba al resto del riñón. To measure the temperature dynamics at the renal surface and within the urinary tract when using Ho:YAG and Tm:YAG lasers for tissue ablation. Porcine kidneys were used. Both types of lasers with different configurations and fiber sizes were used through a flexible ureteroscope. The temperature at the renal surface was recorded using a thermal camera while the intrarenal temperature was measured using two thermal probes, the first one at the ureteropelvic junction and the second one at the calyx used for lasering. Temperature was determined at 0.5-1-3-5 and 10 minutes. Recordings at the ureteropelvic junction and calyx revealed significant increases when using Tm:YAG with the 273 μm (10 W to 50 W) (p ≤ 0.02) and 550 μm (10 W) fiber (p = 0.04). With Ho:YAG there was a significant increase when using 273 μm (at 10 W and 20 W) (p ≤ 0.03) and 365 μm (10 W) fibers (p = 0.04). Regarding fiber size there was a significant difference when using Tm:YAG (at 20 W and 40 W) (p < 0.05). The thermal camera recorded a mean increase of 8 °C in the UPJ while the remaining areas of the kidney did not undergo significant changes. Temperature changes were greater when using the Ho:YAG laser with respect to Tm:YAG at similar power settings for tissue ablation. The greatest temperature increase was recorded at the UPJ from where the heat dissipated throughout the kidney.

PURPOSE OF REVIEW:Urologists are at significant risk due to radiation exposure (RE) from endourological procedures for stone disease. Many techniques described have shown a reduction of RE. The purpose of this article is to review available protocols to decrease RE during such procedures and provide tips and tricks for their implementation.RECENT FINDINGS:Several low-radiation and radiation-free protocols for percutaneous nephrolithotomy and flexible ureteroscopy have been described as an attempt to reduce RE during surgery. Beginning with specific checklists to ensure adequate C-arm usage, fluoroless procedures are based on endoscopic assessment, tactile guidance, and use of ultrasound to avoid fluoroscopy. A specific preoperative checklist and low radiation or complete fluoroless radiation endourological procedures have shown to be effective, feasible, and safe. It is recommended for urologists to be aware of the risks of RE and apply the "ALARA" (As Low As Reasonably Achievable) protocols.

OBJECTIVE To present our simplified biplanar fluoroscopic puncture technique, its reduction in the fluoroscopic screening time as well as outcomes and the initial experience for percutaneous nephrolithotomy. METHODS We performed a retrospective review of 136 patients operated with our simplified 0-90 degrees puncture technique for percutaneous nephrolithotomy between 2015 and 2018. All patients were classified by stone complexity with Guy's nephrolithometric stone score. The stone-free rate was evaluated by nonenhanced computerized tomography, and residual stones were defined as fragments >= 2 mm. Complications were divided according to the Clavien-Dindo classification. RESULTS One hundred and thirty-six patients were operated with our puncture technique; 121 patients were performed in supine and 15 in the prone position. Fifty-one were men, and 85 were women with an overall mean age of 44.36 +/- 13.23 years. The overall stone-free rate was 62.5%, and 83.8 % after an ancillary procedure. The mean fluoroscopy screening time was 69.47 +/- 7.1 and 6 +/- 4.1 seconds for the total surgical procedure and the percutaneous puncture, respectively. Complications were present in 25.7%, and no grade IV and V complications were present. CONCLUSION Our first case series with the 0-90 degrees simplified fluoroscopic puncture technique shows a similar stone-free rate and safety profile but a low fluoroscopic screening time compared to the most common previously reported fluoroscopic puncture techniques non-focused on low radiation protocols. Further studies are required to evaluate the reproducibility, external validation, and the learning curve of our simplified 0-90 degrees technique. (C) 2020 Elsevier Inc.

espanolOBJETIVOS: El pH urinario es un factor decisivo en varias patologias, en consecuencia, un marcador informativo empleado en las decisiones de tratamiento. Aunque ampliamente utilizada, la tira reactiva puede no ser lo suficientemente acurada o precisa para la toma de decisiones clinicas y otras metodologias mas robustas deben ser consideradas. En este estudio,comparamos las mediciones de pH cuando usamos un dispositivo medico portatil y diferentes tiras reactivas. MATERIALES Y METODOS: Se probaron cuatro marcas de tiras reactives de pH y un medidor de pH, Lit-Control® pH Meter, utilizando soluciones tampon comerciales con siete valores de pH distintos que representan el rango fisiologico de pH en orina (4.66; 5.0; 5.5; 6.0;7.0; 7.5; 8.0). Se realizo un analisis estadistico para evaluar la correlacion de los valores medidos versus los reales, junto con las medidas de validez como resolucion,precision y exactitud. RESULTADOS: Las medidas de validez indicaron la superioridad del medidor de pH portatil, con una reduccion de la dispersion de los datos y valores mas exactos. Ademas, el analisis de correlacion demuestra que los valores de pH obtenidos con el medidor de pH fueron los mas cercanos a los valores de pH reales de los tampones. CONCLUSION: El estudio comparativo detallado presentado aqui revela la superioridad de un medidor portatil de pH frente algunas de las marcas comerciales de tiras reactivas mas ampliamente usadas en las practica clinica. El Lit-Control® pH Meter representa una alternativa fiable cuando se necesita un monitoreo del pH urinario, como puede suceder durante la deteccion de enfermedades o la monitorizacion del tratamiento a nivel clinico, asi como durante el autocontrol domiciliario del paciente, bajo supervision profesional. EnglishOBJETIVOS: El pH urinario es un factor decisivo en varias patologias, en consecuencia, un mar-cador informativo empleado en las decisiones de trata-miento. Aunque ampliamente utilizada, la tira reactiva puede no ser lo suficientemente acurada o precisa para la toma de decisiones clinicas y otras metodologias mas robustas deben ser consideradas. En este estudio, comparamos las mediciones de pH cuando usamos un dispositivo medico portatil y diferentes tiras reactivas. MATERIALES Y METODOS: Se probaron cuatro marcas de tiras reactives de pH y un medidor de pH, Lit-Con-trol® pH Meter, utilizando soluciones tampon comercia-les con siete valores de pH distintos que representan el rango fisiologico de pH en orina (4.66; 5.0; 5.5; 6.0; 7.0; 7.5; 8.0). Se realizo un analisis estadistico para evaluar la correlacion de los valores medidos versus los reales, junto con las medidas de validez como resolu-cion, precision y exactitud. RESULTADOS: Las medidas de validez indicaron la superioridad del medidor de pH portatil, con una re-duccion de la dispersion de los datos y valores mas exactos. Ademas, el analisis de correlacion demuestra que los valores de pH obtenidos con el medidor de pH fueron los mas cercanos a los valores de pH reales de los tampones. CONCLUSION: El estudio comparativo detallado pre-sentado aqui revela la superioridad de un medidor por-tatil de pH frente algunas de las marcas comerciales de tiras reactivas mas ampliamente usadas en las practica clinica. El Lit-Control® pH Meter representa una alter-nativa fiable cuando se necesita un monitoreo del pH urinario, como puede suceder durante la deteccion de enfermedades o la monitorizacion del tratamiento a ni-vel clinico, asi como durante el autocontrol domiciliario del paciente, bajo supervision profesional.

Objective: To report the outcomes of percutaneous nephrolithotomy (PCNL) in horseshoe kidneys (HSK) in 12 institutions worldwide and evaluate the impact of patient position during operation. Methods: We carried out a retrospective analysis of PCNL procedures performed between 2008 and 2018 in patients with HSK. Pre-, peri-, and postoperative data were collected, and a subgroup analysis was performed according to patient position. Success was defined as an absence of >4-mm fragments. Values of p < 0.05 were considered significant. Results: We analyzed 106 procedures. The transfusion, complication, and immediate success rates (ISRs) were 3.8%, 17.5%, and 54.7%, respectively. The final success rate (FSR) increased to 72.4% after a mean of 0.24 secondary procedures. Logistic regression showed that higher body mass index (BMI) and stone size were significantly associated with residual fragments ≥4 mm. Sixty-seven patients (63.2%) were treated in prone and 39 (36.8%) in supine position. The prone group had a significantly higher BMI than the supine group (30.1 vs 27.7, p = 0.024). The transfusion, complication, and ISRs between the prone and supine groups were 4.5% vs 2.6% (p = 0.99), 16.9% vs 18.4% (p = 0.99), and 52.5% vs 69.2% (p = 0.151), respectively. Surgical time was significantly longer in the prone group (126.5 vs 100 minutes, p = 0.04). Upper pole was the preferred access in 80.3% of the prone group and 43.6% of the supine group (p < 0.001). The prone group had significantly more Clavien 2 complications than the supine (p = 0.013). The FSR in the prone and supine groups increased to 66.1% and 82.1% after 0.26 and 0.21 secondary procedures, respectively. No complications higher than Clavien 3 occurred. Conclusion: PCNL in patients with HSK is safe and effective with a low complication rate. Higher BMI and stone size negatively impacted outcomes. Supine PCNL may be an option for treating kidney stones in patients with HSK.

Treatment of urolithiasis has evolved greatly as retrograde intrarenal surgery (RIRS) has gained popularity nowadays being a gold standard therapy for renal stones up to 2 cm. Endourological procedures are traditionally fluoroscopic guided; thus, an increasing concern is the harm of radiation exposure, especially in the pediatric population. Therefore, performing fluoroless RIRS should be a feasible option for pediatric urologists. Herein, we describe the technique of totally fluoroless RIRS in presented patients and the tips to avoid radiation use at most.