Focused UTUC pathways with a risk-stratified approach to diagnostic ureteroscopy: is it the need of the hour? A retrospective cohort analysis.

Introduction: Upper urinary tract urothelial cancer is a rare, aggressive variant of urinary tract cancer. There is often delay to diagnosis and management for this entity in view of diagnostic and staging challenges needing additional investigations and risk stratifications for improved outcomes. In this article, we share our experience in developing a dedicated diagnostic and treatment pathway for UTUC and assess its impact on time lines to radical nephroureterectomy (RNU).

Living with a long-term, indwelling urinary catheter: catheter users' experience.

Purpose: The purpose of this study was to explore the experiences of long-term catheter users within a heterogeneous population.

Subjects And Settings: The sample comprised 27 community-dwelling long-term catheter users. Participants included 14 female users (4 urethral, 10 suprapubic catheter) and 13 male users (6 urethral, 7 suprapubic) between 22 and 96 years of age.

A clinical evaluation of a sensor to detect blockage due to crystalline biofilm formation on indwelling urinary catheters.

Objective: To test the performance and acceptability of an early warning sensor to predict encrustation and blockage of long-term indwelling urinary catheters.

Patients And Methods: In all, 17 long-term indwelling catheter users, 15 'blockers' and two 'non-blockers' (controls) were recruited; 11 participants were followed prospectively until catheter change, three withdrew early and three did not start. Two sensors were placed in series between the catheter and the urine bag at catheter change.

The management of secondary pelvi-ureteric junction obstruction - a comparison of pyeloplasty and endopyelotomy.

Objective: To review our experience in the management of secondary pelvi-ureteric junction obstruction (PUJO) comparing endopyelotomy with pyeloplasty.

Patients And Methods: We retrospectively analysed our database of 58 patients having undergone operative management of PUJO after failed primary management, including 41 with failed pyeloplasty and 17 failed endopyelotomy. Outcomes included mercapto-acetyltriglycine (MAG3) drainage capacity, symptomatic control and need for further intervention.

Does previous failed ESWL have a negative impact of on the outcome of ureterorenoscopy? A matched pair analysis.

This study aims to evaluate the outcome of ureteroscopy/ureterorenoscopy (URS) as a salvage procedure for stones resistant to extracorporeal shock wave lithotripsy (ESWL). Between January 2009 and January 2012, 313 patients with upper tract lithiasis were treated by URS. Among them, 87 (27.

First experiences with the Spanner™ temporary prostatic stent for prostatic urethral obstruction.

Objectives: To assess the ease of insertion and removal of a temporary prostatic stent (the Spanner™) following the use of a prostatic urethral measuring device (the Surveyor™).

Patients And Methods: Patients with bladder outflow obstruction or urinary retention awaiting definitive surgery were fully consented. Data were collected pre- and post-insertion and patients followed-up until definitively treated.

Multi-length or 24 cm ureteric stent? A multicentre randomised comparison of stent-related symptoms using a validated questionnaire.

Unlabelled: WHAT'S KNOWN ON THE SUBJECT? AND WHAT DOES THE STUDY ADD?: One of the suggested factors for stent-related symptoms is that excess distal intravesical stent mass may cause bladder irritation. There is a lack of studies investigating this in a randomised controlled fashion using a validated questionnaire. This study compared two of the most commonly used length of stents (a 30 cm multi-length vs a 24 cm long stent) and showed no significance difference in stent-related symptoms in patients with either of these stents.

The impact of shock wave lithotripsy on male fertility: a critical analysis of existing evidence.

We review the literature about the impact of shock wave lithotripsy (SWL) on male reproduction. Studies investigating the in vitro effect of shock waves on semen samples indicate that spermatozoa are vulnerable to SWL. According to animal studies, intratesticular bleeding is common, but pregnancy rates are not affected by shock waves.

New ureteral stent design does not improve patient quality of life: a randomized, controlled trial.

Purpose: Ureteral stents result in significant morbidity in many patients. Manufacturers have altered stent design and composition to minimize symptoms. The Polaris™ stent is made of a Percuflex® combination, providing a firm proximal aspect with a softer distal aspect to minimize symptoms.

Relief of stent related symptoms: review of engineering and pharmacological solutions.

Purpose: We review the recent publications on developing engineering and pharmaceutical agents to alleviate stent related symptoms, and examine basic science studies that may support a particular approach.

Materials And Methods: Data on randomized controlled trials for relief of stent related symptoms were analyzed. Studies involving engineering and pharmacological agents to resolve stent related morbidity were assessed separately.

Audit of safety, efficacy, and cost-effectiveness of local anaesthetic cystodiathermy.

Introduction: The aim of this study was to audit our experience of cystodiathermy under local anaesthetic (LA) at the time of flexible cystoscopy for recurrent superficial bladder transitional cell carcinoma (TCC).

Patients And Methods: A total of 264 flexible cystoscopies were performed on patients with a past history of TCC. The number and site of recurrences were recorded and selected patients were offered cystodiathermy.

Mentorship in urological laparoscopic surgery: lessons learned.

Objective: To review the results of our experience with a mentorship programme in laparoscopic nephrectomy, set up in 1999 by the British Association of Urological Surgeons Section of Endourology.

Methods: Mentors were contacted in 2007 to submit data on the number of visits and the outcome, which included whether a urologist was able to establish an independent laparoscopic practice and sustain it.

Results: Four urologists acting as mentors reported a total of 164 procedures carried out in the training of 39 urologists during 148 visits.

A comparative study of quality of life issues relating to open versus laparoscopic nephrectomy: a prospective pragmatic study.

Purpose: We determined whether laparoscopic nephrectomy confers improved health related quality of life in the early postoperative period compared with open nephrectomy.

Materials And Methods: Patients undergoing open or laparoscopic nephrectomy were prospectively recruited. Patients completed the Comorbidity Symptom Scale preoperatively as well as the SF-36(R) quality of life health survey and pain visual analog scale preoperatively, and 2 days and 1 month postoperatively.

How successful is the conservative management of pelvi-ureteric junction obstruction in adults?

Objective: To assess the conservative management of pelvi-ureteric junction obstruction (PUJO), according to severity, accepted in paediatric urology but rarely reported in adults.

Patients And Methods: A series of 23 patients (median age 58 years, 17 men and six women) with asymptomatic or minimally symptomatic PUJO were managed conservatively. The patients' age, preference and comorbidities were considered.

Prospective study comparing the bladeless optical access trocar versus Hasson open trocar for the establishment of pneumoperitoneum in laparoscopic renal procedures.

Introduction: To present a single centre prospective randomized study on the use of the bladeless Optiview system (Ethicon Endosurgery, Cincinnati, OH) to create the pneumoperitoneum in laparoscopic renal procedures reporting the results with regards safety, efficacy and complications and comparing it with the Hasson open technique.

Patients And Methods: Sixty patients were randomly recruited, 27 to the open and 33 to the bladeless group at the Bristol Urological Institute, UK. Time to insertion, time to closure and any intraoperative and postoperative complication related to trocar insertion was recorded.

The use of capsaicin in loin pain-haematuria syndrome.

Objective: To highlight the implications of the use of capsaicin in managing loin pain-haematuria syndrome (LPHS).

Patients And Methods: Between February 2002 and February 2007, three patients (one male and two females; mean age 31.7 years) with LPHS were managed with capsaicin and followed up for a period of 8-48 months.

Ureteroscopic management of upper-tract urothelial cancer: an exciting nephron-sparing option or an unacceptable risk?

Purpose: To discuss the merits of the endoscopic management of upper-tract transitional-cell carcinoma (UTTCC). We present original data from our institution over an 8-year period and a review of some of the world literature. A discussion of the overall suitability of this modality for both clinician and patient is presented.

The Italian linguistic validation of the ureteral stent symptoms questionnaire.

Purpose: We validated the Italian version of the Ureteral Stent Symptoms Questionnaire in male and female patients with an indwelling ureteral stent.

Materials And Methods: A double-back translation of the original Ureteral Stent Symptoms Questionnaire was performed by 3 urologists and 4 professional translators. A total of 78 patients (cases) with and 35 healthy subjects without (controls) an indwelling ureteral stent were asked to complete the Italian version of the Ureteral Stent Symptoms Questionnaire and a visual analog scale for pain as well as the International Prostate Symptom Score (men) and Urogenital Distress Inventory-6 plus Incontinence Impact Questionnaire-7 (women).

Antegrade versus retrograde stenting in laparoscopic pyeloplasty.

Purpose: To compare operative times between retrograde and antegrade ureteral stenting as part of laparoscopic pyeloplasty.

Patients And Methods: Laparoscopic pyeloplasty procedures from January 2002 to January 2007 were identified through a prospective database. Procedures on 126 patients were performed using the same transperitoneal technique apart from the method of stent placement, which was performed in either a retrograde manner before laparoscopy or an antegrade manner during the laparoscopic portion of the procedure.

Correlation of upper-tract cytology, retrograde pyelography, ureteroscopic appearance, and ureteroscopic biopsy with histologic examination of upper-tract transitional cell carcinoma.

Purpose: To determine the accuracy of radiographic studies, ureteroscopy, biopsy, and cytology in predicting the histopathology of upper-tract transitional cell carcinoma (TCC).

Materials And Methods: From 1998 to 2006, 46 upper-tract lesions were diagnosed ureteroscopically and underwent nephroureterectomy, and 30 of them were subjected to direct ureteroscopic inspection and biopsy. Fresh samples were delivered to the cytopathology laboratory and histology samples were prepared whenever visible tissue was present.

Developing a strategy to reduce the high morbidity of patients with long-term urinary catheters: the BioMed catheter research clinic.

Objective: To assess the idea of managing patients having problems with long-term catheterization (LTC, normally used when all other methods of bladder management have failed or are unsuitable) in a dedicated clinic, to present a prospective analysis of consecutive new patients attending between February 2002 and October 2006, and to establish the incidence of bladder stones in patients who have recurrent catheter encrustation and blockage.

Patients And Methods: Patients treated with LTC are a large heterogeneous group, mainly consisting of elderly people who have chronic disabilities, and catheter-associated complications occur in > 70% of them. In all, 260 consecutive new patients having problems with LTC were assessed; the evaluation consisted of basic demographics, a detailed history, clinical examination, urine analysis and flexible cystoscopy (FC) via the catheterization route.

Effect of smooth muscle relaxant drugs on proximal human ureteric activity in vivo: a pilot study.

Drugs are increasingly being used to promote stone passage in renal colic. Diclofenac, nifedipine and tamsulosin cause ureteric smooth muscle relaxation in vitro; however, in clinical trials nifedipine and tamsulosin promote stone passage whereas diclofenac has no apparent benefit. We adapted a ureteric pressure transducer catheter in an attempt to compare the human ureteric response to these drugs in vivo.