Determining the Safety Threshold for the Passage of a Ureteral Access Sheath in Clinical Practice Using a Purpose-Built Force Sensor.

Purpose: Ureteral injury is a frequent complication of ureteral access sheath deployment. We sought to define the safe threshold of force for the passage of a ureteral access sheath using a novel ureteral access sheath force sensor.

Materials And Methods: Ureteral access sheath-force sensor measurements were recorded in 210 renal units.

Long-Term Antibiotic Treatment Prior to Laparoscopic Nephrectomy for Xanthogranulomatous Pyelonephritis Improves Postoperative Outcomes: Results from a Multicenter Study.

Purpose: Xanthogranulomatous pyelonephritis is a destructive bacterial infection typically necessitating nephrectomy. We hypothesized that long-term preoperative antibiotics would facilitate laparoscopic nephrectomy by reducing the renal inflammation.

Materials And Methods: We reviewed the records of all patients with histologically confirmed xanthogranulomatous pyelonephritis at 3 University of California institutions between 2005 and 2018.

Ureteroscopic Doppler Ultrasonography: Mapping Renal Blood Flow from Within the Collecting System.

Herein we provide the first report regarding porcine renal forniceal, papillary, and infundibular blood flow at the urothelial level using a novel ureteroscopic Doppler transducer. Nephroureteroscopy was performed on 11 female Yorkshire pigs to map the forniceal, papillary, and infundibular blood flow. A Doppler transducer was mounted to a 3F 120 cm catheter; the probe was passed through the working channel of a flexible ureteroscope.

A New Technique for Percutaneous Nephrolithotomy Using Retrograde Ureteroscopy and Laser Fiber to Achieve Percutaneous Nephrostomy Access: The Initial Case Report.

Percutaneous nephrolithotomy (PCNL) serves as the gold standard minimally invasive procedure to remove large renal stones. The puncture is made from the skin to the chosen calix under fluoroscopic guidance, although this remains a challenging technique. We describe the initial case of retrograde holmium laser acquired nephrostomy access.

Correction to: Unintended consequences of decreased PSA-based prostate cancer screening.

In the original publication, part of funding information was missed.

Laser Endoscopic X-Ray-Guided Intrarenal Tract: Comparison Among Renal Access Modalities in the Porcine Kidney.

Laser endoscopic X-ray-guided intrarenal tract (LEXIT) is a recently described holmium laser retrograde access technique for creating percutaneous access during a percutaneous nephrolithotomy. We compared bleeding, ease of access, and the time to achieve access for each of the following three modalities: LEXIT, retrograde Lawson puncture wire, and antegrade 18-gauge nephrostomy needle access in the porcine kidney. Eight pigs underwent an average of five nephrostomy accesses per kidney under simultaneous laparoscopic vision at 5 mm Hg insufflation pressure.

Ureteral Access Sheath Deployment: How Much Force Is Too Much? Initial Studies with a Novel Ureteral Access Sheath Force Sensor in the Porcine Ureter.

Ureteral injuries can occur during ureteral access sheath (UAS) deployment. The force exerted during deployment and the amount of force that results in ureteral injury is yet to be accurately quantitated. In this feasibility study, we developed and then tested a novel force-sensing device in our animal laboratory to identify the threshold force that results in a porcine ureteral injury.

A New Twist on an Old Technique: Lawson Retrograde Endoscopic-Guided Nephrostomy Access for Percutaneous Nephrolithotomy in Prone Split-Leg Position.

A minority of urologists performing percutaneous nephrolithotomy (PCNL) achieve their own nephrostomy access. In an effort to simplify the access part of PCNL, we herein describe our initial experience with endoscopic-guided retrograde percutaneous access in the prone split-leg position. After informed consent, a confirmed negative urine culture, and 1 week pretreatment with tamsulosin, four carefully selected PCNL patients underwent endoscopic-guided retrograde access in a prone split-leg position using the Lawson catheter.

Pilot Assessment of Immersive Virtual Reality Renal Models as an Educational and Preoperative Planning Tool for Percutaneous Nephrolithotomy.

Background: Percutaneous nephrolithotomy (PCNL) requires the urologist to have detailed knowledge of the stone and its relationship with the renal anatomy. Immersive virtual reality (iVR) provides patient-specific three-dimensional models that might be beneficial in this regard. Our objective is to present the initial experience with iVR in surgeon planning and patient preoperative education for PCNL.

Unintended consequences of decreased PSA-based prostate cancer screening.

Background: In May 2012, the US Preventive Services Task Force issued a grade D recommendation against PSA-based prostate cancer screening. Epidemiologists have concerns that an unintended consequence is a problematic increase in high-risk disease and subsequent prostate cancer-specific mortality.

Materials And Methods: To assess the effect of decreased PSA screening on the presentation of high-risk prostate cancer post-radical prostatectomy (RP).

Renal mass biopsy: an oncological conundrum.

Purpose Of Review: We evaluate the reasons that the majority of urologists infrequently biopsy a T1a small renal mass (SRM).

Recent Findings: The majority of urologists report that a renal mass biopsy will not change their management in patients with a SRM given concerns of safety and efficacy of the biopsy. However, when comparing the safety and efficacy of SRM biopsy with neoplasms in all other major organ systems (all of which require biopsy prior to treatment), renal mass biopsy results are favorable.

Medical impulsive therapy (MIT): the impact of 1 week of preoperative tamsulosin on deployment of 16-French ureteral access sheaths without preoperative ureteral stent placement.

Introduction And Objectives: Medical expulsive therapy is based on pharmacologic ureteral relaxation. We hypothesized this concept may facilitate the deployment of the large 16 French (F) ureteral access sheath (UAS) when patients are intentionally pre-treated with oral tamsulosin, i.e.

Evaluation and Comparison of Contemporary Energy-Based Surgical Vessel Sealing Devices.

Introduction: We evaluated and compared five currently available energy-based vessel sealing devices to assess typical surgical metrics.

Methods: We tested Caiman 5 (C5), Harmonic Scalpel Ace Plus (HA), Harmonic Ace +7 (HA7), LigaSure (LS), and Enseal G2 (ES) on small (2-5 mm), medium (5.1-7 mm), and large (7.

Ureteroscopic holmium laser-assisted retrograde nephrostomy access: a novel approach to percutaneous stone removal.

Introduction And Objectives: Percutaneous nephrolithotomy remains a challenging procedure primarily due to difficulties obtaining access. Indeed, few urologists obtain their own access due to difficulties using a fluoroscopic or ultrasonic based antegrade puncture technique. Herein we report the first experience using holmium laser energy to obtain access in a retrograde fashion.

Crowdsourcing Evaluation of Ureteroscopic Videos Using the Post-Ureteroscopic Lesion Scale to Assess Ureteral Injury.

Introduction And Objectives: We hypothesized that crowdsourcing assessments could be applied to the Postureteroscopic Lesion Scale (PULS) for ureteral injury.

Methods: At a single institution, we prospectively digitally recorded 14 ureters at the terminal portion of standard ureteroscopic procedures. Each recording was reviewed by 10 global experts to determine a mean PULS score.

Predictors of Complications After Percutaneous Image-Guided Renal Cryoablation for T1a Renal Cortical Neoplasms.

Purpose: To determine the incidence and predictors of major complications in patients undergoing percutaneous cryoablation (PCA) for small renal masses.

Methods: We performed a retrospective analysis of patients undergoing PCA from 2005 to 2012. We analyzed demographic, radiographic, and complication data.

Cost-Free Laser Caging in the Operating Room.

We have assembled a three-step process for securing and presetting the functional length of the laser fiber to be used for ureteroscopic lithotripsy. For this process, three components are required: a sterile piece of adhesive, an empty guidewire casing with a pre-attached Luer-Lok™ fitting, and a SureSeal adapter. The only additional piece of equipment for this arrangement not routinely used during ureteroscopy is the sterile adhesive strip.

Delayed Nephropleural Fistula After Percutaneous Nephrolithotomy.

Pleural effusions due to pleural injury following supracostal percutaneous nephrolithotomy (PCNL) occur in upwards of 15% of patients; however, these effusions are invariably diagnosed immediately postoperative or during the hospital stay. Herein, we report our initial experience with a delayed nephropleural fistula. A 52-year-old female underwent an uneventful supracostal right PCNL staghorn stone procedure and was discharged on postoperative day 1.

Salvage Percutaneous Cryoablation for Locally Recurrent Renal-Cell Carcinoma After Primary Cryoablation.

Background: The management of locally recurrent renal-cell carcinoma (RCC) following cryoablation remains a clinical dilemma. There is limited data regarding the management of locally recurrent disease in the setting of patients who have failed initial percutaneous cryoablation (PCA). We evaluate and report our experience with salvage PCA for local recurrence following renal cryoablation failure.

Ureteroscopy with conscious sedation for distal ureteric calculi: 10-year experience.

Introduction: Distal ureteroscopy for stone extraction is a common procedure that is generally performed with spinal or general anesthesia. We retrospectively reviewed all distal ureteroscopy performed for ureteric stone extraction with conscious sedation at our institution over a 10-year period to determine its efficacy and safety.

Methods: A retrospective chart review was performed of all distal ureteroscopy performed for calculus removal from 2004 to 2014.

Angiomyolipoma with caval extension and regional nodal involvement: Aggressive behaviour or just rare natural history? Case report and review of literature.

Renal angiomyolipoma (AML) is predominantly a non-aggressive benign tumour. Cases of more aggressive AMLs are present in the literature. We present 2 cases of aggressive AML behaviour.