Purpose:To compare Holmium: YAG laser settings for popcorn lithotripsy and evaluate the impact of MOSES modulation across stone-density groups. Materials and Methods:An in vitro bench model was used with synthetic gypsum stones prepared at three density levels (low, intermediate, and high: mean attenuation was 574, 945, and 2067 HU, respectively). For each trial, five fragments (2.8-3.3 mm) were treated using popcorn technique with Holmium: YAG laser and 272 µm fiber during a 2 min run under standardized irrigation. Five laser settings (0.3 J/80 Hz, 0.5 J/40 Hz, 1.0 J/20 Hz, 1.0 J/30 Hz, and 1.5 J/20 Hz) were tested with and without MOSES mode: each setting-by-modulation condition was repeated six times. The primary endpoint was percent mass reduction; secondary endpoints were residual fragment counts 1-2 and > 2 mm. Results are presented as mean ± SD, and ANOVA was used for comparison. Results:In the low-density group, percent mass reduction was highest overall (65%-86%), with 1.0 J/30 Hz achieving the greatest reduction, MOSES provided no additional benefit (p = 0.6). In the intermediate-density group, the greatest mass reduction was achieved with 1.0 J/30 Hz with MOSES (51% ± 5.9%), and MOSES effects were setting-dependent, and at 1.0 J/30 Hz MOSES reduced total residual fragments (5.3 vs 8.0, p = 0.04). In the high-density group, 1.0 J/30 Hz with MOSES achieved the highest mass reduction (71.5% ± 12.1%) and was associated with improved outcomes (p = 0.037). Secondary analyses of residual fragments generally paralleled these findings. Conclusions:In this in vitro popcorn lithotripsy model, 1.0 J/30 Hz provided the most consistent performance across density groups. MOSES modulation did not improve outcomes in low-density stones but was associated with improved efficiency in intermediate- and high-density stones.

Placenta accreta spectrum (PAS) is a high-risk obstetric condition associated with hemorrhage, urologic injury, and peripartum hysterectomy. Rising cesarean delivery rates continue to increase its prevalence. Variation in surgical management and limited multidisciplinary involvement may contribute to adverse maternal outcomes. To evaluate whether the implementation of a multidisciplinary team (MDT) protocol for PAS was associated with improved perioperative outcomes. This retrospective cohort study included 417 women diagnosed with PAS from 2011 to 2022 at a tertiary center. In 2019, a structured MDT protocol was adopted, incorporating standardized imaging, preoperative conference, routine bilateral ureteral catheter (UC) placement, and on-site urologic support. Outcomes of MDT-managed patients (n = 108) were compared with pre-MDT patients (n = 309). Multivariable logistic regression and generalized linear models adjusted for maternal age, gravidity, prior cesarean delivery, placenta previa, PAS grade, surgical urgency, gestational age, and year of delivery. After adjustment, MDT care was associated with lower odds of urologic injury (aOR 0.34; 95

Purpose:To evaluate the effect of different connector types and commonly used endourologic devices on irrigation fluid flow through the working channel of a flexible ureteroscope. Methods:Irrigation flow was measured under a 200-cm H2O pressure head using three connector types (Tuohy-Borst, UroLok, and Check-Flo) and a standard Y-set connection. Instruments tested included Piranha biopsy forceps, Segura hemisphere basket, Glidewire guidewire, and two laser fibers (200 μm and 365 μm). Each condition was repeated six times. Descriptive statistics were calculated, and one-way ANOVA was used to assess differences between groups. Results:With an empty channel, the standard Y-set connection achieved the highest mean flow (115.8 ± 4.3 mL/min), followed by Tuohy-Borst (113.0 ± 1.6), UroLok (100.2 ± 1.3), and Check-Flo (80.4 ± 0.5) (p < 0.001). Inserting instruments markedly reduced flow. The Piranha forceps and Glidewire guidewire produced the largest reduction (∼96-97%). A larger instrument diameter or the absence of a smooth coating significantly reduced flow across all connectors. With small-caliber instruments, connector design played a greater role: relative flow reduction was greatest with Tuohy-Borst (50.6%) and lowest with Check-Flo (38.0%). In absolute terms, UroLok yielded the highest median flow with laser fibers (38.7 mL/min), followed by Tuohy-Borst (37.5 mL/min) and Check-Flo (34.7 mL/min). Conclusion:Both connector choice and instrument size significantly affect irrigation flow in flexible ureteroscopy. Large-diameter instruments almost abolish flow regardless of connector, whereas with smaller instruments, connector design influences performance. These findings emphasize the importance of selecting optimal connector-instrument combinations to maintain intraoperative visibility.

PURPOSE:Obstructing ureteral stones with urinary tract infection (UTI) represent a urological emergency requiring prompt decompression to prevent sepsis-related morbidity and mortality. Although percutaneous nephrostomy (PCN) is a widely used drainage method, the optimal timing for its insertion remains unclear. This study explored the association between the timing of PCN insertion and clinical outcomes. PATIENTS AND METHODS:A retrospective review of 744 patients who underwent PCN insertion for ureteral stones and UTI between 2011 and 2023. Patients were grouped by time-to-drainage from emergency department arrival: Immediate (<6 hours, n = 241), early (6-24 hours, n = 232), and delayed (>24 hours, n = 271). Infectious status was assessed at presentation, before, and after PCN insertion. Primary outcomes were sepsis, septic shock, and intensive care unit (ICU) admission rates. Multivariable analysis identified predictors of non-immediate drainage. RESULTS:In the immediate drainage group, sepsis rate decreased following PCN insertion (61.4% pre-PCN vs 45.2% post-PCN, p = 0.03), whereas septic-shock rates remained unchanged (23.7% vs 23.2%, p = 0.6). In the early drainage group, sepsis remained unchanged (59.1% vs 59.5%, p = 0.11) after PCN insertion, whereas septic shock increased (12.9% vs 31%, p < 0.001). A similar pattern was observed in the delayed group, with unchanged sepsis (38.7% vs 36.9%, p = 0.14) but increased septic shock rates (7% vs.15.5%, p = 0.001) following PCN insertion. Immediate drainage was associated with shorter hospitalization, fewer ICU admissions, and earlier stone treatment (all p < 0.001). Predictors of non-immediate drainage included night-shift arrival (odds ratio [OR]: 4.846, p < 0.001), female gender (OR: 1.917, p = 0.002), elevated creatinine (OR: 1.262, p = 0.011), and older age (OR: 1.009, p = 0.018). CONCLUSION:Decompression with PCN within 6 hours is associated with significantly improved infectious and clinical outcomes in patients with obstructed, infected kidneys caused by ureteral stones.

BACKGROUND:Segmental ureterectomy (SU) is a kidney-sparing alternative to radical nephroureterectomy (RNU) for upper tract urothelial carcinoma (UTUC) localized to the ureter, yet contemporary comparative data are limited. We aimed to evaluate perioperative, functional, and pathology-adjusted oncologic endpoints between SU and RNU using propensity-score matching. METHODS:We retrospectively reviewed UTUC patients treated at a tertiary referral center (2008-2025), identifying SU (n = 81) and RNU (n = 259) cases. To reduce confounding, we performed 1:1 propensity-score matching on age, gender, comorbidities, and baseline eGFR, yielding 92 matched patients (46 pairs). Because 8 pairs showed no residual malignancy (pT0) on final pathology, the primary adjusted analysis was restricted to 38 pairs (n = 76), with the full 46-pair cohort retained for sensitivity analysis. Primary endpoints were DFS, CSS, and OS. Secondary endpoints included perioperative outcomes, renal function, intravesical recurrence-free survival, and metastasis-free survival. Time-to-event outcomes were analyzed using paired Cox models adjusted for definitive pathological grade and stage, and Kaplan-Meier estimated as secondary analysis. RESULTS:The median follow-up for the matched cohort was 37.1 months (IQR: 14.2-69.0). Baseline tumor characteristics were comparable except for tumor location, with a higher prevalence of nondistal tumors in the RNU group (P < 0.001). In the primary analysis (pathology-adjusted) paired-Cox regression estimated DFS and CSS were similar between SU and RNU (HR 0.63, 95% CI 0.23-1.69, P = 0.358 and HR 0.57, 95% CI 0.2-1.54, P = 0.275, respectively). The adjusted OS was also comparable (HR 0.49, 95% CI 0.16-1.51, P = 0.213), alongside all secondary oncologic endpoints (P > 0.05). In the sensitivity analysis, oncological endpoints did not differ between the groups. Renal function preservation favored SU, with median ΔeGFR +8.8 vs. RNU -11.95 ml/min/1.73 m² (P < 0.001). CONCLUSIONS:SU significantly improved renal preservation without compromising intermediate-term, pathology-adjusted oncologic endpoints vs. RNU. These findings support SU as a kidney-sparing option in selected patients, including those with high-grade disease, adverse features (CIS, LVI, ≥pT2), and nondistal tumors. Further work should refine patient selection and post-SU surveillance.

BACKGROUND:Double-J stents are commonly inserted following ureteroscopy and stone lithotripsy, potentially leading to various urinary and pain-related symptoms and affecting patients' quality of life. This study aimed to compare the impact of soft and firm silicone stents on stent-related symptoms in patients undergoing ureteroscopy and stone lithotripsy. METHODS:After receiving institutional ethical committee approval (SMC 0119-23), we conducted a prospective, randomized, single-blinded trial between 2023-2024. Patients undergoing ureteroscopy and stone lithotripsy were randomized into two groups: those receiving a soft polymer stent (Universa®, Cook Medical, Bloomington, IN, USA) or a firm polymer stent (Percuflex®, Boston Scientific, Marlborough, MA, USA). Symptoms were assessed using the Ureteral Stent Symptoms questionnaire (USSQ), completed upon stent removal, 14 days postoperatively. The primary outcome was the USSQ index score, with secondary outcomes including individual USSQ domain scores. RESULTS:A total of 120 patients completed the questionnaire. The soft-stent group (N.=60) demonstrated significantly lower USSQ index scores (26 vs. 73, P<0.001) and improved outcomes across all USSQ sub-domains (P<0.001) compared to the firm-stent group. A multiple regression model confirmed that using firm stent material independently resulted in higher USSQ index scores (P<0.001) relative to soft stent. Intraoperative and postoperative complication rates were similar between groups. CONCLUSIONS:Using soft ureteral stents results in fewer stent-related symptoms compared to firm stents, offering superior quality of life while maintaining a comparable safety profile. Based on these findings, when placing a ureteral stent following ureteroscopy and stone lithotripsy, a soft stent is recommended.

Previous studies of heterogeneous abdominal procedures have reported higher pulmonary-complication rates after robot-assisted surgery, but whether this applies to nephrectomy is uncertain. We evaluated surgical approach and 30-day postoperative pulmonary complications (PPCs) after partial and radical nephrectomy. We studied 1,503 adults undergoing robotic, laparoscopic, or open nephrectomy from 2008 to 2025. Procedure-stratified logistic regression assessed a prespecified PPC composite. The partial-nephrectomy model included tumor complexity and clinical covariates. Sparse-data and additional sensitivity analyses were performed. Minute-level ventilation data were analyzed descriptively. Overall PPC incidence was 4.5

Segmental ureterectomy (SU) is an established kidney-sparing strategy for upper tract urothelial carcinoma (UTUC), yet few studies have compared the standard open approach to the emerging robotic modality. We performed a clinical outcome and safety evaluation of robotic-assisted SU compared to the traditional open approach. In this retrospective study of 53 patients (40 open, 13 robotic) treated between 2008 and 2025, we assessed perioperative, functional, and oncological parameters. Regarding safety endpoints, robotic SU demonstrated a favorable profile with no significant difference in postoperative complication rates compared to open surgery (15.4

Achieving renal access during percutaneous nephrolithotomy is challenging, with a complication rate of 10–20

Urine leakage (UL) is a recognized complication after partial nephrectomy (PN). This study aimed to determine the incidence of UL and identify key risk factors, including tumor size and surgical approach, to clarify the impact of robotic-assisted, laparoscopic, and open PN on postoperative outcomes. A retrospective review of 785 consecutive clinical T1 PN cases (2012–2022) was undertaken. UL was defined as biochemically confirmed uriniferous drain output ≥ 50 mL day-1 persisting ≥ 3 days. The overall incidence of UL was assessed, and multivariable statistical tests evaluated potential predictors of leakage. (19 events; EPV = 3.8; hypothesisgenerating). Of the 785 patients, 50.7

This study aims to assess the evaluation, management, clinical outcomes and incidence of postoperative hematuria following partial nephrectomy (PNx) for renal tumors. We retrospectively reviewed the medical charts of 936 adult patients who underwent PNx between 2008 and 2023. Patients presenting with hematuria during the first 6 months of surgery were included. Group 1, comprising patients who were treated with early angiography and selective embolization (n = 8), was compared to Group 2, patients who underwent imaging first (US or CTA), followed by angiography and selective embolization (n = 10, “delayed” angiography). 24 (2.6

INTRODUCTION:Pelvic kidney is a congenital anomaly whereby the kidney fails to ascend to its normal anatomical location during early embryonic development. This, in turn, makes traditional surgical approaches for renal calculi challenging. AIMS:To summarize our experience with robotic-assisted pyelolithotomy (RPPK) for pelvic kidney stones. METHODS:A retrospective review of patients who underwent RPPK between 2014 and 2023 was conducted. Demographic data, stone characteristics (size and density), operative details, and postoperative outcomes were collected and analyzed. RESULTS:Four patients underwent RPPK between 2014 and 2023, three of whom were male. The mean age was 51.2 years (range: 45-54), BMI was 26.6 (22.3-32.2). All patients had a right-sided pelvic kidney. Two patients had previously undergone a failed attempt for ureteroscopy and laser lithotripsy. Stone diameter was 27.7 mm (17-35 mm) and estimated density was 1207.5 HU (905-1500 HU). Mean operative time was 265 minutes (200-323 minutes), while time from incision to closure was 142.2 minutes (95-225 minutes). No ureteral stent or surgical drain were left at the conclusion of the procedures. Upper urinary tract correction was not involved in any of the cases. Blood loss was negligible. The length of hospital stay was 2.2 days. No immediate complications were recorded within one week and one-month post-surgery. Mean follow-up length was 7.5 months (3-13 months). CONCLUSIONS:RPPK is safe and effective in the management of pelvic kidney stones. The challenging renal anatomy, as well as stone size and density are not obstacles when it comes to the robotic approach in comparison to other fragmentation methods.

PURPOSE:Percutaneous nephrolithotomy (PCNL) is the gold standard for treating kidney stones >20 mm because of its superior stone-free rates (SFR). However, high-power holmium lasers may challenge this standard. This study evaluates the feasibility, safety, and efficacy of high-power holmium laser retrograde intrarenal surgery (RIRS) for the treatment of kidney stones >20 mm. METHODS:We conducted a retrospective analysis of patients with kidney stones >20 mm treated with either 80W- or 120 W holmium laser RIRS between January 2020 and August 2024. Clinical, intraoperative, and postoperative data were collected. Outcomes included SFR, operative time, complications, and hospital stay. Comparisons between the older-generation (80 W) and newer-generation (120 W) systems were performed using the Mann-Whitney U test and chi-square test, and multivariable analyses identified predictors of non-stone-free status. RESULTS:A total of 118 patients were included: 31 in the older-generation (80 W) group and 87 in the newer-generation (120 W) group. RIRS using the newer-generation 120 W laser was associated with a shorter operative time (66 vs 79 minutes, p < 0.001) and higher SFR at 5 weeks (82.7% vs 58.1%, p = 0.006), 6 months (92% vs 64.5%, p < 0.001), and 1 year (96.5% vs 83.8%, p = 0.016) postoperative evaluations. Complication rates did not differ significantly between groups (5.7% vs 3.2%, p = 0.208). In multivariable analysis, the use of older-generation 80 W laser was an independent predictor of non-stone-free status at both the first (OR 4.4, p = 0.004) and second (OR 8.8, p = 0.001) follow-up visits. CONCLUSIONS:Treatment of renal stones larger than 2 cm with the newer-generation 120 W Ho:YAG laser is effective, with higher SFR rate and shorter operative time, compared to the older-generation 80 W Ho:YAG laser.