You have accessJournal of UrologyCME1 Apr 2023MP26-17 THE ZIZO ADAPTER: A NOVEL URETEROSCOPE ADAPTER TO IMPROVE SURGICAL FIELD STERILITY AND PROTECT SURGICAL STAFF FROM BIOHAZARD JETS Zizo Al-Daqqaq, Monica Farcas, Kai Fok, and Samir Sami Zizo Al-DaqqaqZizo Al-Daqqaq More articles by this author , Monica FarcasMonica Farcas More articles by this author , Kai FokKai Fok More articles by this author , and Samir SamiSamir Sami More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003254.17AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Ureteroscopy and laser lithotripsy is performed under pressurized irrigation using a ureteroscope adapter for entry and manipulation of fine surgical tools such as laser fibres and nitinol baskets, as well as leak prevention during manipulation. Problems with current adapters include frequent jet-leaks of biohazardous fluids towards medical staff and patients, damage to the adapter from overtightening to stop leaks, and unintended adapter-scope disconnections. Our objective was to develop a novel ureteroscope adapter that eliminates the shortcomings of the market adapters while improving safety and ergonomics. METHODS: A patent and device search was completed to ensure there were no existing alternatives on the market. A literature search followed to confirm that ureteroscopy and laser lithotropsy was the most common laser urology procedure in North America, supporting the need for a safer ureteroscope adapter. Over 15 adapter prototype iterations underwent benchtop testing that mimics operative conditions for ureteroscopy, including appropriate irrigation pressures and realistic tool manipulation. Rigorous tests were performed in excess of typical ureteroscopy cases. This included 100 tool insertions and removals of fine tools like laser fibres and larger 5 French biopsy forceps, accidental disconnection tests, leak tests, and ergonomics assessments. RESULTS: The Zizo adapter was evaluated on frequency of jet leaks, accidental disconnections, and ergonomics, with expert feedback from endo-urologic surgeons. The unique design of the Zizo adapter eliminated 100% of jet-leaks at irrigation pressures exceeding 400mmHg, 100mmHg greater than the typical irrigation pressure during ureteroscopy cases. Jet-leak prevention was sustained with repeated passage of tools such as the holmium laser fibre, both 200 and 365 micron, nitinol baskets, and with larger instruments such as the 5 french biopsy forceps. The Zizo Adapter and its self-sealing valve has improved ergonomics, eliminates biohazardous jet-leaks, and delicately holds surgical tools in place. CONCLUSIONS: The Zizo Adapter is a safe and effective alternative to current ureteroscopy market adapters. The adapter has the potential to improve patient and provider safety, facilitates ease with which ureteroscopy is performed, and saves healthcare dollars by reducing tool damage and costs associated with managing biohazardous leaks. Source of Funding: N/A © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e360 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Zizo Al-Daqqaq More articles by this author Monica Farcas More articles by this author Kai Fok More articles by this author Samir Sami More articles by this author Expand All Advertisement PDF downloadLoading ...

Introduction: Percutaneous microwave ablation (MWA) has emerged as a new energy modality for percutaneous renal tumor ablation with potential advantages over radiofrequency and cryoablation. The goal of our study was to determine MWA outcomes for suspicious renal masses, with a subset analysis for biopsy-proven renal cell carcinoma (RCC) and larger (T1b) tumors.Methods: Studies reporting outcomes of MWA for RCC were identified. Random-effects models with inverse-variance weighting were used to pool outcomes, including technical success rate (TSR), technical efficacy rate (TER), local recurrence rate (LRR), cancer-specific survival rate (CSSR), overall survival rate (OSR), and complications.Results: Among 914 studies captured, 27 studies with 1584 patients (1683 malignant renal tumors) were included. The pooled TSR and TER were 99.6% (95% confidence interval [CI], 98.0%-100%) and 96.2% (95% CI, 93.8%-98.2%). The pooled LRR was 3.2% (95% CI, 1.9%-4.7%). At 1, 3, and 5 years, the pooled CSSRs were 100% (95% CI, 99.4%-100%), 100% (95% CI, 98.4%-100%), and 97.7% (95% CI, 94.5%-99.7%), while pooled OSRs were 99.0% (95% CI, 97.5%-99.9%), 96.0% (95% CI, 93.1%-98.3%), and 88.1% (95% CI, 80.3%-94.2%). The pooled minor and major complication rates were 10.3% (95% CI, 7.1%-13.9%) and 1.0% (95% CI, 0.3%-2.1%). In 204 patients with 208 T1b tumors, the pooled TSR and TER were 100% (95% CI, 96.6%-100%) and 85.2% (95% CI, 71.0%-95.8%). The pooled LRR was 4.2% (95% CI, 0.9%-8.9%). At 1, 3, and 5 years, the pooled CSSRs were 98.2% (95% CI, 88.7%-100%), 97.2% (95% CI, 78.5%-100%), and 98.1% (95% CI, 72.3%-100%). At 1 and 3 years, the pooled OSRs were 94.3% (95% CI, 85.7%-99.6%) and 89.3% (95% CI, 68.7%-100%). The pooled minor and major complication rates were 14.8% (95% CI, 7.4%-23.8%) and 2.6% (95% CI, 0%-7.8%).Conclusions: MWA demonstrated favorable short- to intermediate-term oncologic outcomes with low complication rates, including in the T1b subset, with moderate quality of data and heterogeneity of assessed outcomes. This supports MWA as a safe and effective treatment for RCC and a potential viable option for larger tumors.

Introduction: After nearly four years of Canadian experience with medical assistance in dying (MAID), the clinical volume of organ transplantation following MAID remains low. This is the first Canadian report evaluating recipient outcomes from kidney transplantation following MAID. Methods: This was a retrospective review of the first nine cases of kidney transplants following MAID at a Canadian transplant center Results: Nine patients underwent MAID followed by kidney retrieval during the study period. Their diagnoses were largely neuromuscular diseases. The mean warm ischemic time was 20 minutes (standard deviation [SD] 7). The nine recipients had a mean age of 60 (SD 19.7). The mean cold ischemic time was 525 minutes (SD 126). Delayed graft function occurred in only one patient out of nine. The mean 30-day creatinine was 124 umol/L (SD 52). The mean three-month creatinine was 115 umol/L (SD 29). Conclusions: We report nine cases of kidney transplantation following MAID. The process minimized warm ischemia, resulting in low delayed graft function rates, and acceptable post-transplant outcomes. Further large-scale research is necessary to optimize processes and outcomes in this novel clinical pathway.

You have accessJournal of UrologyTransplantation & Vascular Surgery: Renal Transplantation & Vascular Surgery II (MP52)1 Apr 2020MP52-02 INITIAL EXPERIENCE WITH RENAL TRANSPLANTS AFTER MEDICAL ASSISTANCE IN DYING: FIRST SERIES IN NORTH AMERICA Samir Sami*, Max Levine, Andrew Rasmussen, Alp Sener, and Patrick Luke Samir Sami*Samir Sami* More articles by this author , Max LevineMax Levine More articles by this author , Andrew RasmussenAndrew Rasmussen More articles by this author , Alp SenerAlp Sener More articles by this author , and Patrick LukePatrick Luke More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000000914.02AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: In 2016, Canadian federal legislation was passed creating a regulatory framework for medical assistance in dying (MAiD) for individuals who were suffering from a medically futile condition and foreseeable death. As there is a paucity of literature on transplantation from MAiD donors, we report our unique experience and first reported outcomes in North America. METHODS: We retrospectively analyzed all renal transplant recipients from MAiD donors at London Health Sciences Centre, beginning in 2018. Patients eligible for MAiD underwent circulatory death after administration of life ending therapy and organ procurement was performed as per standard protocol. Ethics approval was obtained to review these outcomes. RESULTS: There were a total of 4 patients who became kidney donors and one kidney-pancreas donor. The indication for MAiD in the donors included 3 with debilitating neurological disease, 1 with heart failure and 1 who previously suffered a significant fall resulting in quadriplegia. Mean donor age was 53.66 ±13.17, median warm ischemia time (WIT) was 17 minutes, and median cold ischemia time (CIT) was 9 hours. One perioperative death occurred due to medical complication unrelated to renal graft function. No delayed graft function was encountered and only two patients experienced slow graft function. Median 30 day creatinine was 108 μmol. CONCLUSIONS: MAiD associated organ donation represents a potential means to increase the donor pool for those awaiting deceased donor organs. The controlled nature of MAiD associated circulatory death has the potential to minimize the deleterious effects of prolonged WIT that may be associated with standard donation after circulatory death. Our institution’s early experience is encouraging, with low WIT, and favorable early graft function results. Ongoing assessment of MAiD outcomes is required to better quantify the quality of these donation opportunities compared to conventional deceased donors. Source of Funding: N/A © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 203Issue Supplement 4April 2020Page: e772-e772 Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.MetricsAuthor Information Samir Sami* More articles by this author Max Levine More articles by this author Andrew Rasmussen More articles by this author Alp Sener More articles by this author Patrick Luke More articles by this author Expand All Advertisement PDF downloadLoading ...

Introduction: Optimizing erectile dysfunction (ED) remains a clinically significant endeavor as insufficient outcomes from oral, injectable and even surgical approaches to treatment remain less than ideal. In this report, we integrate evolving knowledge and provide an algorithmic approach for the clinician to fine-tune management. Methods: We performed a PubMed and Medline search of Erectile Dysfunction treatment optimization, enhanced patient efficacy for ED, and why men fail ED treatment. All relevant papers for the past two decades were reviewed. Results: Establishing the goals and objectives of the patient and partner while providing detailed instructions for treatment can minimize failures and create an environment that allows treatment optimization. A thorough work-up may identify reversible or contributing causes. We identified several areas where treatment of ED could be optimized. These include; management of associated medical conditions, lifestyle improvements, PDE5 inhibitor prescription strategies, management of hypogonadism and the initiation of intracavernosal injection therapy (ICI). Conclusions: In our view, once a man presents for help to the clinician, use of the simple strategies identified in this review to optimize the tolerability, safety and effectiveness of the selected treatment should result in enhanced patient and partner satisfaction, with improved outcomes.

You have accessJournal of UrologyStone Disease: Surgical Therapy V1 Apr 2016MP51-01 SIXTY-DAY OUTCOMES AFTER SURGICAL VS. MEDICAL TREATMENT OF ACUTE RENAL COLIC Taylor Remondini, Samir Sami, Bryce Weber, Dean Wong, Anthony Cook, and Grant Innes Taylor RemondiniTaylor Remondini More articles by this author , Samir SamiSamir Sami More articles by this author , Bryce WeberBryce Weber More articles by this author , Dean WongDean Wong More articles by this author , Anthony CookAnthony Cook More articles by this author , and Grant InnesGrant Innes More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2016.02.456AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Renal colic is a common condition, affecting up to 10% of the population. Recent research suggests that medical expulsive therapy may be less effective in successful passage rates. Therefore we wish to evaluate a large cohort of renal colic patients in a high intervention setting to determine their characteristics and health care burden. METHODS This multicenter administrative database study retrospectively reviewed the all Calgary patients with an ED diagnosis of renal colic between Jan 1, 2014 and Dec 31, 2014. Demographics were captured from the regional ED database, tests and treatments from the order entry database, and ED revisits, admissions and interventions from the discharge abstract database. RESULTS 3104 renal colic visits were studied at 4 hospitals, including 921 (30%) with an index surgical intervention and 2183 (70%) managed medically. 1850 (54%) had confirmed ureteric stones and of these 752 (41%) had surgery at index visit with an additional 137 (8%) having surgery with in 60 days. Patients were more likely to have surgery if had a proximal ureteric stone (P<0.001, OR 2.2), stone larger than 5 mm (P<0.001, OR 4.4), or hydronephrosis (p<0.001, OR 2.3). Within 60 days surgical patients had higher need for readmission (p<0.001, OR 2.2) and emergency visits (p<0.001, OR 1.8). The presence of a proximal stone at index visit was the main risk factor for surgical patients requiring further ED visits, and readmission (p<0.001, OR 1.2). Medically managed patients had a trend toward more surgical procedures (p=0.06, OR 0.74) in the following sixty days and the main risk factor being the presence of a proximal stone (p<0.001, OR 2.9) at index visit. CONCLUSIONS Patients who undergo early surgical intervention for acute renal colic have more hospital visits and less surgical procedures in the following 60-days than medically treated patients; however, outcome differences are driven by stone location. Stone size and the presence of hydronephrosis were deciding factors in need for surgery yet did not lead to more ED visits, admissions or procedures post index visit. Yet proximal stones not only were more likely to have index surgery but also had more ED visits, and admissions post initial procedure. Similarly if a proximal stone is managed medically it is also more likely to require a procedure with in 60 days possibly just delaying the issues with surgery in this cohort. © 2016FiguresReferencesRelatedDetails Volume 195Issue 4SApril 2016Page: e681 Advertisement Copyright & Permissions© 2016MetricsAuthor Information Taylor Remondini More articles by this author Samir Sami More articles by this author Bryce Weber More articles by this author Dean Wong More articles by this author Anthony Cook More articles by this author Grant Innes More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...