Defining metabolic activity of nephrolithiasis - Appropriate evaluation and follow-up of stone formers.

Considering the variation in metabolic evaluation and medical management of kidney stone disease, this consensus review was created to discuss the metabolic activity of nephrolithiasis, define the difference between single and recurrent stone formers, and develop a schema for metabolic and radiologic follow-up. A systematic review of the literature was performed to identify studies of metabolic evaluation and follow-up of patients with nephrolithiasis. Both single and recurrent stone formers share many similarities in metabolic profiles.

Antibiotic Utilization Before Endourological Surgery for Urolithiasis: Endourological Society Survey Results.

Introduction: Ureteroscopy (URS) and percutaneous nephrolithotomy (PCNL) are common procedures performed to treat kidney stones. Despite advances in technology/technique, serious infectious complications can occur. To better understand the preoperative antibiotic administration patterns and adherence to guidelines from the American Urological Association (AUA) and the European Association of Urology (EAU), members of the Endourological Society were sent a clinical vignette-based survey to assess the antibiotic use in a variety of pre-URS and pre-PCNL scenarios.

Evaluation of a Novel Single-Use Flexible Ureteroscope.

A novel single-use flexible ureteroscope promises the optical characteristics and maneuverability of a reusable fourth-generation flexible ureteroscope. In this study, the LithoVue Single-Use Digital flexible ureteroscope was directly compared with contemporary reusable flexible ureteroscopes, with regard to optics, deflection, and irrigation flow. Three flexible ureteroscopes such as the LithoVue (Single Use; Boston Scientific), Flex-Xc (Karl Storz, Germany), and Cobra (Richard Wolf, Germany) were assessed for image resolution, distortion, color representation, grayscale imaging, field of view, and depth of field.

Comparison of the Nanopulse Lithotripter to the Holmium Laser: Stone Fragmentation Efficiency and Impact on Flexible Ureteroscope Deflection and Flow.

Introduction: The Nanopulse Lithotripter (NPL; Lithotech Medical, Israel) is a novel intracorporeal device that uses a nanosecond duration electrical discharge through a reusable flexible coaxial probe to endoscopically fragment urinary stones. This device was compared with a holmium laser lithotripsy (HoL) with regard to stone fragmentation efficiency (SFE) and its impact on flexible ureteroscope (URS) deflection and flow of irrigation.

Methods: Using a custom bench model, a 6 mm BegoStone cylindrical phantom (mixture 5:2) was confined under 0.

Should metabolic evaluation be performed in patients with struvite stones?

Previous studies suggested that patients with pure struvite calculi rarely have underlying metabolic abnormalities. Therefore, most of these patients do not undergo metabolic studies. We report our experience with these patients and their response to directed medical therapy.

Digital Tomosynthesis: A Viable Alternative to Noncontrast Computed Tomography for the Follow-Up of Nephrolithiasis?

Objective: Digital tomosynthesis (DT) is a new X-ray-based imaging technique that allows image enhancement with minimal increase in radiation exposure. The purpose of this study was to compare DT with noncontrast computed tomography (NCCT) and to evaluate its potential role for the follow-up of patients with nephrolithiasis in a nonemergent setting.

Methods: A retrospective review of patients with nephrolithiasis at our institution that underwent NCCT and DT from July 2012 to September 2013 was performed.

Use of ureteral access sheaths in ureteroscopy.

The ureteral access sheath (UAS) facilitates the use of flexible ureteroscopy, enabling improved minimally invasive management of complex upper urinary tract diseases. The UAS, which comes in a variety of diameters and lengths, is passed in a retrograde fashion, aided by a hydrophilic coating and other features designed to confer smooth passage into the ureter with sufficient resistance to kinking and buckling. Use of a UAS has the advantage of enabling repeated passage of the ureteroscope while minimizing damage to the ureter, thus improving the flow of irrigation fluid and visualization within the urethra with reductions in operative times, which improves both the effectiveness of the surgery and reduces the costs.

Evaluation of Novel Ball-Tip Holmium Laser Fiber: Impact on Ureteroscope Performance and Fragmentation Efficiency.

Purpose: A novel ball tip (BT) holmium laser fiber has recently been developed, which features a modified rounded tip. The modification is purported to aid in insertion and minimize damage to the ureteroscope working channel. We evaluated this laser fiber with regard to stone comminution, tip degradation, insertional force into the ureteroscope, and impact on ureteroscope deflection.

Combined Endoscopic and Percutaneous Retrieval of a Retained 4-Wire Ureteral Stone Basket.

Complex endourologic procedures may require the use of a combined ureteroscopic and percutaneous approach. Endoscopic removal of a retained 4-wire ureteral stone basket is particularly complex, as broken tines can potentially injure the ureter if the basket is removed in a retrograde manner. The patient in this case presented with a ureteral stone basket embedded within the urothelium of the upper pole of the kidney.

Genitourinary exam skills training curriculum for medical students: a follow-up study of comfort and skill utilization.

Purpose: We developed a genitourinary skills training (GUST) curriculum for incoming third year medical students (MS3) and performed a follow-up study of comfort with and utilization of these skills.

Materials And Methods: GUST consisted of a didactic lecture followed by skills sessions including standardized patient testicular examination (TE) and digital rectal examination (DRE), male and female Foley catheter (MFC and FFC) placement training, suture-knot tying, and a faculty-directed small group learning session. Precourse and postcourse, and 6 and 18 months after the course, MS3 rated comfort with each skill (Likert scale 0-5), and quantified skill usage.

Are multiple cryoprobes additive or synergistic in renal cryotherapy?

Objective: To investigate the relationship between multiple cryoprobes was investigated to determine whether they work in an additive or synergistic fashion in an in vivo animal model because 1.47 mm (17-gauge) cryoprobes have been introduced to the armamentarium for renal cryotherapy.

Methods: Laparoscopic-guided percutaneous cryoablation was performed in both renal poles of 3 pigs using 3 IceRod cryoprobes.

A novel ex-vivo ureteral apparatus for assessing the impact of intraluminal pharmaceutical agents on ureteral physiology.

Background And Purpose: Safe intraluminal access to the ureter and kidney is essential for endourologic procedures. Pharmacologic manipulation of ureteral smooth muscle could conceivably ease access and decrease morbidity. To minimize systemic effects, local intraluminal administration would be optimal, but the urothelium presents a barrier to the passage of medications.

Laparoscopic partial nephrectomy: six degrees of haemostasis.

Objective: • To describe six steps for haemostasis and collecting system closure ('six degrees of haemostasis') that are reproducible and that minimize the two most concerning complications of laparoscopic partial nephrectomy: haemorrhage and urine leakage.

Methods: • A retrospective study of 23 consecutive laparoscopic partial nephrectomy cases performed by a single surgeon between 2005 and 2008 using the 'six degrees of haemostasis' was carried out.

Results: • There were no cases of intraoperative, postoperative or delayed bleeding.

Robotic radical anterior pelvic exenteration: the UCI experience.

Robotic technology may be a promising tool in reduction of morbidity in radical anterior pelvic exenteration for invasive bladder cancer. We report our initial experience with robotic-assisted radical anterior pelvic exenteration in females in an attempt to evaluate the technique's feasibility and outcomes. A retrospective review of our bladder cancer database was performed.

Ice burn: protecting the flank during renal cryotherapy.

Introduction And Objectives: Cryoablation is a viable minimally invasive strategy for the treatment of small renal masses. One of the most common postoperative complaints is pain or paresthesia at the cryoprobe insertion site. The use of a 14-gauge angiocatheter to insulate the flank during renal cryotherapy was investigated.

Bovine serum albumin glutaraldehyde for completely sutureless laparoscopic heminephrectomy in a survival porcine model.

Introduction: Laparoscopic partial nephrectomy (LPN) has not received widespread clinical application because of its technical challenge. Bovine serum albumin glutaraldehyde (BSAG) is a hemostatic agent that is independent of the clotting cascade. We evaluated the use of BSAG as the sole agent for parenchymal and collecting system closure during LPN in a survival porcine model.

In vitro, ex vivo and in vivo isotherms for renal cryotherapy.

Purpose: Preoperative planning for renal cryotherapy is based on isotherms established in gel. We replicated gel isotherms and correlated them with ex vivo and in vivo isotherms in a porcine model.

Materials And Methods: PERC-17 CryoProbes (1.

Sacrifice of accessory pudendal arteries in normally potent men during robot-assisted radical prostatectomy does not impact potency.

Aim: Whether or not sacrificing accessory pudendal arteries (APAs) during radical prostatectomy affects potency has been an ongoing source of concern. Herein, we present our potency results relative to sacrificing APAs in normally pre-potent men following robot-assisted radical prostatectomy (RARP).

Methods: The distribution of APAs and clinical characteristics were prospectively recorded in 200 consecutive patients undergoing RARP with a cautery-free technique.

Impact of pneumoperitoneum on renal cryotherapy.

Purpose: Pneumoperitoneum is known to decrease blood flow to the kidney during laparoscopy. We investigated if this change in blood flow would increase the size of the cryolesion.

Materials And Methods: Twelve Yorkshire swine underwent laparoscopy-guided percutaneous cryoablation of the upper and lower pole of each kidney at four randomized pneumoperitoneum pressures (10, 15, 20, and 25 mm Hg).

Preliminary study of virtual reality and model simulation for learning laparoscopic suturing skills.

Purpose: Repetitive practice of laparoscopic suturing and knot tying can facilitate surgeon proficiency in performing this reconstructive technique. We compared a silicone model and pelvic trainer to a virtual reality simulator in the learning of laparoscopic suturing and knot tying by laparoscopically naïve medical students, and evaluated the subsequent performance of porcine laparoscopic cystorrhaphy.

Materials And Methods: A total of 20 medical students underwent a 1-hour didactic session with video demonstration of laparoscopic suturing and knot tying by an expert laparoscopic surgeon.

Preliminary evaluation of a genitourinary skills training curriculum for medical students.

Purpose: Basic urology training in medical school is considered important for many medical and surgical disciplines. We developed a 2-day intensive genitourinary skills training curriculum for medical students beginning their clinical clerkship training years and evaluated the initial experience with this program.

Materials And Methods: All 94 third-year medical students at the University of California, Irvine were required to participate in a 5.

Prostate weight and early potency in robot-assisted radical prostatectomy.

Objectives: Using an athermal technique for nerve preservation we noted that approximately 40% are potent compared with approximately 60% who are not at 3 months after robot-assisted laparoscopic prostatectomy (RLP). In an attempt to understand this difference, we examine factors potentially influencing potency at 3 months.

Methods: Of 300 consecutive RLPs, we identified 139 men who met preoperative inclusion criteria: age View Article and Find Full Text PDF