A 1.9 mm Trilogy lithotripter in mini percutaneous nephrolithotomy Description of technique and case outcomes.

Introduction: We aimed to evaluate the novel use of a 1.9 mm Trilogy lithotripter probe with varying locations and composition of renal stones.

Methods: We prospectively enrolled patients to undergo mini percutaneous nephrolithotomy (mPCNL) procedures using the 1.

Advancements in Performance of Percutaneous Nephrolithotomy in Ambulatory Surgery Centers: Outcomes and Lessons From 1250+ Cases.

Objective: To evaluate the safety and efficacy of routine ambulatory percutaneous nephrolithotomy (PCNL) in a freestanding ambulatory surgical center.

Methods: Patients were treated between 2015 and 2022 by one of three experienced endourologists in Maryland. The surgery center is free-standing, with the nearest hospital approximately 10 minutes away.

Robot-assisted vs ultrasonography-guided transversus abdominis plane (TAP) block vs local anaesthesia in urology: results of the UROTAP randomized trial.

Objectives: To prospectively analyse robotically administered transperitoneal transversus abdominis plane (robot-assisted transversus abdominis plane [RTAP]) compared with both ultrasonography-guided transversus abdominis plane (UTAP) and local anaesthesia (LA) with regard to pain control and narcotic use in patients undergoing robot-assisted prostatectomy (RARP) or robot-assisted partial nephrectomy (RAPN).

Subjects/patients And Methods: Patients undergoing RARP or RAPN were randomized in a single-blind 2:2:1 fashion to RTAP:UTAP:LA, with the study powered to evaluate superiority of UTAP to LA and non-inferiority of RTAP to UTAP. We compared time to deliver the block, operating room time, postoperative pain scores using the visual analogue scale, and intra-operative and postoperative analgesia consumption.

Is metformin use associated with changes in urinary parameters in stone formers?

Introduction: Diabetes mellitus (DM) is associated with an increased risk of nephrolithiasis and is often treated with metformin. The relationship between metformin and nephrolithiasis formation remains unclear, as studies have demonstrated conflicting results.

Methods: We conducted a cross-sectional analysis of stone-forming patients at our stone clinic prior to the initiation of stone-directed medical management.

The impact of metabolic syndrome components on urinary parameters and risk of stone formation.

Purpose: To investigate the relationship between metabolic syndrome (MS) and urinary abnormalities in stone-forming patients. Additionally, to delineate whether severity of urinary derangements is impacted by the number of co-occurring MS components.

Methods: Stone-forming patients who underwent initial metabolic workup prior to medical intervention at a comprehensive stone clinic were retrospectively reviewed and included in the study.

Ultrasound-Guided Access in a Malrotated Kidney: Optimally Safe and Effective.

Management of renal calculi in a patient with kidney malrotation can be difficult because of complexity and alteration of collecting system anatomy. Pyelolithotomy, whether open, laparoscopic, or robotic, has been shown to be an effective method of stone removal in this patient population; however, it is not always ideal because of its invasiveness and increased morbidity. Ideally, a percutaneous approach may be less invasive, and if feasible, it can optimize patient safety and stone-free status.

Deceived by a CT Scan: The Case of the Misrepresented Stone Size.

CT has become the gold standard for radiographic evaluation of urolithiasis. CT is highly sensitive for detecting kidney stones and provides valuable information regarding stone size, composition, location, and overall stone burden. Although CT can provide reliable estimations of stone size, we have encountered an instance in which it can be deceiving.

A qualitative study of microaggressions against African Americans on predominantly White campuses.

Background: Pierce's (The Black seventies: an extending horizon book, 1970) conception of "subtle and stunning" daily racial offenses, or microaggressions, remains salient even 50 years after it was introduced. Microaggressions were defined further by Sue and colleagues (Am Psychol 62:271, 2007), and this construct has found growing utility as the deleterious effects of microaggressions on the health of people of color continues to mount. Microaggressions are common on campuses and contribute to negative social, academic, and mental health outcomes.

Novel treatment of upper tract urothelial carcinoma in situ with docetaxel in BCG refractory patients.

Introduction: Patients with upper-tract carcinoma in situ (UT-CIS) that have failed treatment with BCG are recommended for radical nephroureterectomy (RNU). We describe a cohort of patients with BCG-refractory UT-CIS that were treated with docetaxel, a novel agent in the approach to topical therapy.

Methods: Patients with pathologically proven UT-CIS from 2012 to 2020 with an imperative indication for organ preservation and history of BCG-refractory disease were included.

Infected Renal Cyst: Elusive Diagnosis and Percutaneous Management.

Benign renal cysts are relatively common in older adults, usually found incidentally on CT. However, an infected renal cyst is a rare complication. While a course of antibiotic therapy is generally the first-line treatment, indications for definitive operative intervention include chronic pain, recurrent urinary tract infection, hematuria, abscess formation, and/or impaired renal function.

Extravesical Ectopic Ureteral Calculus Obstruction in a Completely Duplicated Collecting System.

Complete ureteral duplication is uncommon and occasionally associated with ureteral stone obstruction. Even rarer is ectopic insertion of a ureter into the urethra. We describe a case of a 75-year-old man with a history of robot-assisted laparoscopic prostatectomy and complete unilateral duplicated collecting system with a ureteral stone obstructing an ectopic ureter inserting into the urethra.

Addressing microaggressions in racially charged patient-provider interactions: a pilot randomized trial.

Background: Racial bias in medical care is a significant public health issue, with increased focus on microaggressions and the quality of patient-provider interactions. Innovations in training interventions are needed to decrease microaggressions and improve provider communication and rapport with patients of color during medical encounters.

Methods: This paper presents a pilot randomized trial of an innovative clinical workshop that employed a theoretical model from social and contextual behavioral sciences.

Do patients with Stage 3-5 chronic kidney disease benefit from ischaemia-sparing techniques during partial nephrectomy?

Objective: To analyse whether selective arterial clamping (SAC) and off-clamp (OC) techniques during robot-assisted partial nephrectomy (RPN) are associated with a renal functional benefit in patients with Stage 3-5 chronic kidney disease (CKD).

Patients And Methods: The change in estimated glomerular filtration rate (eGFR) over time was compared between 462 patients with baseline CKD 3-5 that underwent RPN with main arterial clamping (MAC) (n = 375, 81.2%), SAC (n = 48, 10.

The Impact of Obesity in Patients Undergoing Robotic Partial Nephrectomy.

As the prevalence of obesity increases worldwide, an increasing proportion of surgical candidates have an elevated body mass index (BMI), with associated metabolic syndrome. Yet there exists limited evidence regarding the effect of elevated BMI on surgical outcomes in robotic surgeries. We examined whether obese patients had worse perioperative outcomes and postoperative renal function after robotic partial nephrectomies (RPNs).

Reevaluating Warm Ischemia Time as a Predictor of Renal Function Outcomes After Robotic Partial Nephrectomy.

Objective: To explore whether variation of warm ischemia time (WIT) is associated with functional and perioperative outcomes following robotic partial nephrectomy (RPN).

Materials And Methods: Six hundred sixty eight patients, each with 2 kidneys, undergoing RPNs for a cT1 tumor were identified from a U.S.

Is Off Clamp Always Beneficial During Robotic Partial Nephrectomy? A Propensity Score-Matched Comparison of Clamp Technique in Patients with Two Kidneys.

Objective: The majority of patients undergoing partial nephrectomy (PN) present with a clinical T1a tumor with both kidneys present. Some groups have advocated using off-clamp (Off-C) techniques to eliminate warm ischemia whenever possible, even when elective. We evaluated whether Off-C technique during robotic PN (RPN) provides any functional benefit over main arterial clamping (MAC) in these patients.

Predictors of Medical and Surgical Complications After Robot-Assisted Partial Nephrectomy: An Analysis of 1139 Patients in a Multi-Institutional Kidney Cancer Database.

Introduction: Previous robot-assisted partial nephrectomy (RAPN) studies have identified various predictors of overall and major postoperative complications, but few have evaluated the specific role of these factors in the development of medical and surgical complications. In this study, we present an analysis of the modifiable and nonmodifiable variables influencing medical and surgical complications in a contemporary series of patients who underwent RAPN and were followed in a prospectively maintained, multi-institutional kidney cancer database.

Methods: A retrospective review of all patients who underwent RAPN at four institutions between 2008 and 2015 was performed.

R.E.N.A.L. Nephrometry Score Predicts Non-neoplastic Parenchymal Volume Removed During Robotic Partial Nephrectomy.

Objective: To assess the association between the R.E.N.

Selective arterial clamping does not improve outcomes in robot-assisted partial nephrectomy: a propensity-score analysis of patients without impaired renal function.

Objectives: To assess the benefit of selective arterial clamping (SAC) as an alternative to main renal artery clamping (MAC) during robot-assisted partial nephrectomy (RAPN) in patients without underlying chronic kidney disease (CKD).

Patients And Methods: Our study cohort comprised 665 patients without impaired renal function undergoing MAC (n = 589) or SAC (n = 76) during RAPN from four medical institutions in the period 2008-2015. We compared complication rates, positive surgical margin (PSM) rates, and peri-operative and intermediate-term renal functional outcome between 132 patients undergoing MAC and 66 undergoing SAC after 2-to-1 nearest-neighbour propensity-score matching for age, sex, body mass index, RENAL nephrometry score, tumour size, baseline estimated glomerular filtration rate (eGFR), American Society of Anesthesiologists (ASA) score, Charlson comorbidity index (CCI) and warm ischaemia time (WIT).

The impact of computer use on therapeutic alliance and continuance in care during the mental health intake.

Advances in information technology within clinical practice have rapidly expanded over recent years. Despite the documented benefits of using electronic health records, which often necessitate computer use during the clinical encounter, little is known about the impact of computer use during the mental health visit and its effect on the quality of the therapeutic alliance. We investigated the association between computer use and quality of the working alliance and continuance in care in 104 naturalistic mental health intake sessions.

Interpersonal complementarity in the mental health intake: a mixed-methods study.

The study examined which socio-demographic differences between clients and providers influenced interpersonal complementarity during an initial intake session; that is, behaviors that facilitate harmonious interactions between client and provider. Complementarity was assessed using blinded ratings of 114 videotaped intake sessions by trained observers. Hierarchical linear models were used to examine how match between client and provider in race/ethnicity, sex, and age were associated with levels of complementarity.