Can Perioperative Antibiotic Choice Impact Rates of Infectious Complications After Percutaneous Nephrolithotomy? A Single-Blind, Prospective Randomized Trial.

National guidelines recommend periprocedural antibiotics before percutaneous nephrolithotomy (PCNL), yet it is not clear which is superior. We conducted a randomized trial to compare two guideline-recommended antibiotics: ciprofloxacin (cipro) cefazolin, on PCNL outcomes, focusing on the development of systemic inflammatory response syndrome (SIRS) criteria. Adult patients who were not considered high risk for surgical or infectious complications and undergoing PCNL were randomized to receive either cipro or cefazolin perioperatively.

Endoscopic Stone Composition Identification: Is Accuracy Improved by Stone Appearance During Laser Lithotripsy?

Objective: To evaluate if videos during laser lithotripsy increase accuracy and confidence of stone identification by urologists compared to still pictures.

Methods: We obtained representative pictures and videos of 4 major stone types from 8 different patients during ureteroscopy with holmium laser lithotripsy. A REDCap survey was created and emailed to members of the Endourological Society.

Delineating the Role of the Urinary Metabolome in the Lithogenesis of Calcium-Based Kidney Stones.

Objective: To delineate the role of the urinary metabolome in the genesis of urinary stone disease (USD).

Methods: Untargeted metabolomics was utilized in comparative analyses of calcium-based stones (CBS) and spot urine samples from patients with a history of USD with or without urinary stone activity based on radiologic imaging. Stone and urine metabolomes were stratified by composition and radiographic stone-activity, respectively.

SKOPE-Study of Ketorolac vs Opioid for Pain after Endoscopy: A Double-Blinded Randomized Control Trial in Patients Undergoing Ureteroscopy.

Purpose: Pain is the leading cause of unplanned emergency department visits and readmissions after ureteroscopy, making postoperative analgesic stewardship a priority given the current opioid epidemic. We conducted a double-blinded, randomized controlled trial, with noninferiority design, comparing nonsteroidal anti-inflammatory drugs to opiates for postoperative pain control in patients undergoing ureteroscopy for urolithiasis.

Materials And Methods: Patients were randomized and blinded to either oxycodone (5 mg) or ketorolac (10 mg), taken as needed, with 3 nonblinded oxycodone rescue pills for breakthrough pain.

Learning From Those who Learned: A Survey of Fellowship Trained HoLEP Surgeons and Their Current Practice Patterns.

Objective: To gain insight from the experience of learning Holmium laser enucleation of the prostate (HoLEP), teaching HoLEP, and the current HoLEP practice patterns of fellowship-trained endourologists.

Methods: Surveys were electronically distributed to United States (U.S.

Carbachol and Nicotine in Prefrontal Cortex Have Differential Effects on Sleep-Wake States.

The role of the brainstem cholinergic system in the regulation of sleep-wake states has been studied extensively but relatively little is known about the role of cholinergic mechanisms in prefrontal cortex in the regulation of sleep-wake states. In a recent study, we showed that prefrontal cholinergic stimulation in anesthetized rat can reverse the traits associated with anesthesia and restore a wake-like state, thereby providing evidence for a causal role for prefrontal cholinergic mechanisms in modulating level of arousal. However, the effect of increase in prefrontal cholinergic tone on spontaneous sleep-wake states has yet to be demonstrated.

Utility of stone volume estimated by software algorithm in predicting success of medical expulsive therapy.

Introduction: We sought to assess the accuracy of using stone volume (SV) estimated with a software algorithm as a predictor for stone passage in a trial of medical expulsive therapy (MET).

Methods: We identified patients with ureteral stones discharged from the emergency department on MET. Patients with infection, non-ureteral stones, or needing immediate surgical intervention were excluded.

Removal of Large Primary Vaginal Calculus Using the Nephroscope and Endoscopic Ultrasonic Lithotrite: A Case Report.

Vaginal calculi are rare and can grow quite large if they remain undetected. Vaginal stones are caused by the pooling of urine in the vagina and can be classified as either primary or secondary, depending on the absence or presence, respectively, of a nidus. Primary stones without any urethrovaginal or vesicovaginal fistula are even more uncommon but appear to be more commonly reported in incontinent women with significant physical disabilities.

Does "MyChart" Benefit "My" Surgery? A Look at the Impact of Electronic Patient Portals on Patient Experience.

Purpose: Electronic patient portals can be beneficial in providing direct engagement and clarity to avoid unnecessary extra provider encounters. In this study we assessed whether portal usage among endourology patients affected telephone call frequency, unscheduled physician visits, emergency department presentations and complication rates.

Materials And Methods: We conducted a retrospective chart review of patients undergoing elective endourology procedures by a single surgeon at a tertiary urology center from July 2017 to July 2018.

Comparison of automated irrigation systems using an in vitro ureteroscopy model.

Introduction: Two automated irrigation systems have been released for use during endoscopic procedures such as ureteroscopy: the Cogentix RocaFlow® (CRF) and Thermedx FluidSmart® (TFS). Accurate pressure control using automated systems may help providers maintain irrigation pressures within a safe range while also providing clear visualization. Our objective was to directly compare these systems based on their pressure accuracy, pressure-flow relationships, and fluid heating capabilities in order to help providers better utilize the temperature and pressure settings of each system.

The cost of operating room delays in an endourology center.

Introduction: This study sought to characterize delays and estimate resulting costs during nephrolithiasis surgery.

Methods: Independent observers documented delays during ureteroscopy (URS) and percutaneous nephrolithotomy (PCNL) procedures. Fifty index cases over a period of three months was considered sufficient to observe the generalizable trends.

Nephrolithiasis and Polycystic Ovary Syndrome: A Case-Control Study Evaluating Testosterone and Urinary Stone Metabolic Panels.

Introduction: Both elevated testosterone and polycystic ovary syndrome (PCOS) have been speculated as possible risk factors for kidney stone formation; however, the details of this potential relationship with regards to 24-hour urine metabolic panels and stone composition have not previously been characterized.

Methods: A total of 74 PCOS patients were retrospectively identified and matched with a cohort of female stone formers at a 3 : 1 ratio (by age and BMI). All patients had 24-hour urinary metabolic panels and stone compositions.

Postoperative Emergency Department Visits After Urinary Stone Surgery: Variation Based on Surgical Modality.

Urinary stone disease is responsible for more than 1 million emergency department (ED) visits annually. There is increasing regulatory and cost pressure to reduce unplanned episodes of care, particularly after elective surgery. However, the frequency of ED visits in the early postoperative period after different modalities of stone surgery is not well characterized.

Current use of medical expulsive therapy among endourologists.

Introduction: We aimed to characterize current practice patterns among endourologists on medical expulsive therapy (MET) for treatment of ureteral calculi.

Methods: An online survey was administered to Endourological Society members. Respondents' MET usage, index case management, and awareness of recent guidelines and literature were compared based on international status, practice setting, interval since training, and endourological fellowship training.