Ejaculatory Preserving Holmium Laser Enucleation of the Median Lobe: Preserving Sexual Function While Improving Urinary Outcomes.

Objective: To evaluate perioperative outcomes related to sexual and urinary function in patients who underwent a holmium laser enucleation of the prostate (HoLEP) with selective laser enucleation of the median lobe.

Materials And Methods: We retrospectively reviewed the first 450 HoLEP cases by a single surgeon from April 2019 to March 2022. Fifty-five patients with intravesical-prostatic protrusion or high bladder neck without obstructing lateral lobes underwent selective enucleation of the median lobe of the prostate.

Percutaneous Nephrolithotomy Access: A Meta-Analysis Comparing Access by Urologist Radiologist.

Percutaneous nephrolithotomy is a minimally invasive procedure indicated for the management of staghorn calculi or renal calculi >2.0 cm. Percutaneous renal access is a critical step in this procedure and can be performed by either urologists or interventional radiologists.

Using Peritumor and Intratumor Vascularity on Preoperative Imaging to Predict Fuhrman Grade Histology of Renal Tumors.

To investigate if peritumor and/or intratumor vasculature is associated with high-grade tumor histology for renal cell carcinoma. A retrospective review at a tertiary care facility was performed of patients who underwent radical nephrectomy or partial nephrectomy for a renal tumor between January 2015 and December 2020. Data of tumor characteristics were collected from final pathology reports.

Initial Experience Performing "Cautery-Free Waterjet Ablation of the Prostate".

Herein, we describe our initial experience performing waterjet ablation of the prostate without electrocautery. A retrospective review of patients undergoing Aquablation for benign prostatic hyperplasia between February and September 2019 was performed. A standardized perioperative protocol for optimizing hemostasis was implemented.

How I do it: Aquablation in very large prostates (> 150 mL).

Aquablation has been well-studied in prostates sizes up to 150 mL. Recently, American Urological Association guidelines distinguish surgical interventions for men with large prostates (80 mL-150 mL) and now very large prostates (> 150 mL). Readers will gain an understanding of how to use Aquablation in the very large prostate size category.

Facility-Level Variation in Use of Locoregional Therapy for Metastatic Prostate Cancer.

Introduction: We sought to understand patient- and institution-level factors associated with use of locoregional therapy for newly diagnosed metastatic prostate cancer in the era before the availability of evidence supporting its efficacy.

Methods: We queried the National Cancer Database to identify patients diagnosed with metastatic prostate adenocarcinoma (stage M1) between 2004 and 2017. We assessed patient factors associated with definitive local therapy with radiotherapy or radical prostatectomy using multilevel logistic regression accounting for clustering within institutions.

Comparison of Management and Outcomes of Symptomatic Urolithiasis During the COVID-19 Pandemic to a Comparative Cohort.

Objective: To analyze the clinical presentation and outcomes for patients who presented with symptomatic urolithiasis during the initial months of the COVID-19 pandemic.

Methods: We retrospectively reviewed Emergency Department (ED) presentations from a Philadelphia healthcare system for symptomatic urolithiasis between March and June 2020 and compared these with presentations for the same time period from the year prior. Patient demographics, stone characteristics, management, and clinical outcomes were compared between the 2 years.

"En-Bloc" Enucleation With Early Apical Release Compared to Standard Holmium Laser Enucleation of the Prostate: A Retrospective Pilot Study During the Initial Learning Curve of a Single Surgeon.

Objective: To compare operative efficiency of Holmium laser enucleation of the prostate (HoLEP) using both the standard multi-incisional approach and en-bloc enucleation with early apical release during the initial learning curve.

Materials And Methods: We retrospectively reviewed the initial 95 consecutive men who underwent HoLEP between April 2019 and September 2020 by a single surgeon. We compared patient demographics, and pre-, intra-, and post-operative metrics between both groups.

Men with lower urinary tract symptoms secondary to BPH undergoing Aquablation with very large prostates (> 150 mL).

Introduction: The AUA guidelines for benign prostatic hyperplasia distinguish treatments based upon prostate volume (PV), particularly for very large prostates (> 150 mL). While the clinical outcomes and benefits of Aquablation have been studied for men with average and large prostates, it is unknown whether this technology can be used for very large prostates.

Materials And Methods: Men with PV > 150 mL undergoing Aquablation were identified retrospectively from four North American hospitals.

Endourological management of a rare radiopaque ritonavir-composed urinary calculus.

Protease inhibitors are a source of nephrolithiasis in HIV + patients, and these stones are described as not detected by CT. While urinary stones are commonly associated with certain protease inhibitors, stones composed of ritonavir are rare. We present the case of a 58-year-old female on ritonavir-boosted atazanavir who presented to our clinic complaining of gross hematuria and flank pain secondary to a ureteral stone.

Improving Compliance with 24-H Urine Collections: Understanding Inadequacies in the Collection Process and Risk Factors for Poor Compliance.

Purpose Of Review: The purpose of this review paper is to describe the 24-h urine collection in terms of its utility, collection process, and common problems with its acquisition.

Recent Findings: Although 24-h urine collections are standard of care for high-risk stone formers, several nuances in test acquisition including inaccurate urine collections 50% of the time and poor patient compliance limit its potential utility. Compliance in obtaining 24-h urine collections has been shown to be improved in patients who have not undergone surgical treatment of urinary calculi, patients with metabolic stone disease or family history of stone disease, Caucasian ethnicity, and in those with more sedentary occupations.

Investigating Fluid Intake in an Underserved Community: What Factors Are Associated with Low Urine Volume on 24-Hour Urine Collection?

Stone prevention is dependent on high fluid intake, with evidence that low urine volume (LUV) can promote nephrolithiasis in the absence of other metabolic abnormalities. Herein, we investigate patient-related factors associated with LUV on initial 24-hour urine collection in an underserved population. A retrospective chart review was performed of patients treated by a single surgeon for nephrolithiasis from August 2014 to January 2019.

Prescribing Trends in Post-operative Pain Management After Urologic Surgery: A Quality Care Investigation for Healthcare Providers.

Objective: To assess prescribing and refilling trends of narcotics in postoperative urology patients at our institution. Although the opioid epidemic remains a public health threat, no series has assessed prescribing patterns across urologic surgery disciplines following discharge.

Methods: All urologic surgeries were retrospectively reviewed from May 2017-April 2018.

Persistent Lower Urinary Tract Symptoms After Prostatic Urethral Lift Successfully Treated with Water Jet Ablation of the Prostate: A Case Report and Review of the Literature.

We describe a patient who underwent waterjet ablation of the prostate after an unsuccessful prostatic urethral lift (PUL) procedure. After PUL, our patient had incomplete bladder emptying with a postvoid residual of 600 mL. Urodynamic study of the bladder suggested detrusor underactivity.

Dual-Energy CT for Urinary Stone Evaluation.

Purpose Of Review: Conventional CT imaging is an excellent tool for the diagnosis of nephrolithiasis however is limited in its ability to detect stone composition. Dual-energy CT (DECT) scans have demonstrated promise in overcoming this limitation. We review the current utility of DECT in nephrolithiasis.

Aquablation for the Treatment of Benign Prostatic Hyperplasia in a Large Volume Prostate with an Intravesical Median Lobe.

Aquablation is a relatively new minimally invasive technology for the treatment of benign prostatic hyperplasia (BPH) that has shown significant promise in its clinical efficacy and utility. Larger prostates or prostates with a median lobe are a common limitation to other minimally invasive treatment options. There is evidence that Aquablation maintains efficacy for larger prostates and prostates with an intravesical median lobe.

A Critical Appraisal of the American College of Surgeons Medically Necessary, Time Sensitive Procedures (MeNTS) Scoring System, Urology Consensus Recommendations and Individual Surgeon Case Prioritization for Resumption of Elective Urological Surgery During the COVID-19 Pandemic.

Purpose: Resumption of elective urology cases postponed due to the COVID-19 pandemic requires a systematic approach to case prioritization, which may be based on detailed cross-specialty questionnaires, specialty specific published expert opinion or by individual (operating) surgeon review. We evaluated whether each of these systems effectively stratifies cases and for agreement between approaches in order to inform departmental policy.

Materials And Methods: We evaluated triage of elective cases postponed within our department due to the COVID-19 pandemic (March 9, 2020 to May 22, 2020) using questionnaire based surgical prioritization (American College of Surgeons Medically Necessary, Time Sensitive Procedures [MeNTS] instrument), consensus/expert opinion based surgical prioritization (based on published urological recommendations) and individual surgeon based surgical prioritization scoring (developed and managed within our department).

Nonalcoholic Fatty Liver Disease Is an Independent Risk Factor for Nephrolithiasis in Women: Findings from NHANES III.

To determine if radiologically diagnosed nonalcoholic fatty liver disease (NAFLD) is an independent risk factor for nephrolithiasis using data from National Health and Nutrition Examination Survey III (NHANES III). NHANES III participants aged 20-74 years who underwent hepatobiliary ultrasound were classified as with NAFLD (moderate or severe hepatic steatosis in absence of other known causes of liver disease;  = 2498) or without NAFLD (controls;  = 9361). Risk of nephrolithiasis caused by NAFLD was estimated using logistic regression with propensity score adjustment.

Multidisciplinary management of adult cloacal exstrophy complications: A challenging case of nephrolithiasis and abdominal wall extrusion of a catheterizable ileal pouch.

Cloacal exstrophy is a rare congenital syndrome which comprises multiple genitourinary, gastrointestinal and musculoskeletal anomalies. The long-term effects following childhood cloacal exstrophy management is poorly characterized in living adults. In this report, a 42-year-old female born with cloacal exstrophy presented after numerous prior surgical reconstructions with abdominal extrusion of a catheterizable ileal pouch and bilateral staghorn calculi.

Factors Associated With Compliance With 24-Hour Urine Collection.

Objective: To identify how demographic factors, stone-associated medical comorbidities, and treatment predict compliance with 24-hour urine collection.

Materials And Methods: A retrospective medical record review of patients treated for urolithiasis between August 2014 and March 2017 was performed. Patient demographics, medical characteristics, stone factors, type of treatment, and compliance data were included for patients requested to submit a collection.

Use of Google Trends to Track Online Behavior and Interest in Kidney Stone Surgery.

Objective: To explore internet search trends data as a unique resource for monitoring online health information-seeking behavior. We utilized Google trends to sample population interest and search inquiries into surgical treatment options of kidney stones, and we examined the relative frequency of searches across the United States.

Methods: Google trends was queried via the Google Insights for Search (http://google.

Endoscopic Management of Ureteral Strictures: an Update.

Purpose Of Review: This review focuses on the role of endoscopic treatment of ureteral stricture disease (USD) in the era of minimally invasive surgery.

Recent Findings: There is a relative paucity of recent literature regarding the endoscopic treatment of USD. Laser endopyelotomy and balloon dilation are associated with good outcomes in treatment-naïve patients with short (< 2 cm), non-ischemic, benign ureteral strictures with a functional renal unit.

Contemporary use trends and survival outcomes in patients undergoing radical cystectomy or bladder-preservation therapy for muscle-invasive bladder cancer.

Background: The current study was performed to examine temporal trends and compare overall survival (OS) in patients undergoing radical cystectomy (RC) or bladder-preservation therapy (BPT) for muscle-invasive urothelial carcinoma of the bladder.

Methods: The authors reviewed the National Cancer Data Base to identify patients with AJCC stage II to III urothelial carcinoma of the bladder from 2004 through 2013. Patients receiving BPT were stratified as having received any external-beam radiotherapy (any XRT), definitive XRT (50-80 grays), and definitive XRT with chemotherapy (CRT).

Extracorporeal Shock Wave Therapy: Current Perspectives and Future Directions.

Purpose Of Review: Since its introduction, extracorporeal shock wave lithotripsy (ESWL) has undergone a variety of changes; however, it remains one of the most utilized treatment modalities for urolithiasis. The goal of this review is to provide the practicing urologist an update on contemporary trends, new technologies, and related controversies in utilizing ESWL for stone treatment.

Recent Findings: ESWL use has come under scrutiny with a shift in focus to cost-effectiveness and healthcare outcomes.

Factors Associated with Compliance in Submitting 24-Hour Urine Collections in an Underserved Community.

Purpose: Patients living in underserved areas do regularly express an interest in stone prevention; however, factors limiting participation, aside from obvious cost considerations, are largely unknown. To better understand factors associated with compliance with submitting 24-hour urine collections, we reviewed our patient experience at the kidney stone clinic at a hospital that provides care for an underserved urban community.

Materials And Methods: A retrospective chart review of patients treated for kidney and/or ureteral stones between August 2014 and May 2016 was performed.