Interdisciplinary planning improves radiologist obtained access for percutaneous nephrolithotomy.

Introduction: Proper antegrade access for percutaneous nephrolithotomy (PCNL) is essential for success but can be challenging. Previous work evaluating access obtained by interventional radiology (IR), largely in the emergent setting, has shown high rates of additional access at the time of PCNL. We hypothesize that efforts to improve pre-procedural communication between urology and IR can impact the utility of the access for subsequent PCNL.

Accuracy of Radiology Reports for Obstructing Ureteral Stone Size in the Emergency Department.

Objective: To evaluate the number of dimensions of obstructing ureteral stones in the emergency department (ED) described in present-day radiology computed tomography reports and assess for measurement discrepancies between radiologist and urologist review.

Methods: We conducted a single-center retrospective study of patients who presented to the ED with unilateral, solitary, obstructing ureteral stones from March 2018 to March 2021. Stone size in each reported dimension recorded by the radiologist was extracted from the chart and then compared to size independently measured by one of our urologists for all 3 stone dimensions.

Linear relationship between absorbed radiation dose and pulse rate during fluoroscopy.

Purpose: To identify the relationship between fluoroscopy pulse rate and absorbed radiation dose. We compared absorbed radiation dose with common proxy measurements such as fluoroscopy time and C-arm reported dose.

Methods: Using a simulated patient model, 60 s fluoroscopy exposures were performed using pulse rates of 30, 8, 4, 2, and 1 pulse(s) per second.

International Alliance of Urolithiasis (IAU) guidelines on the metabolic evaluation and medical management of urolithiasis.

The aim of this study was to construct the fourth in a series of guidelines on the treatment of urolithiasis by the International Alliance of Urolithiasis (IAU) that by providing a clinical framework for the metabolic evaluation, prevention, and follow-up of patients with urolithiasis based on the best available published literature. All recommendations were summarized following a systematic review and assessment of the literature in the PubMed database from January 1976 to June 2022. Each generated recommendation was graded using a modified GRADE methodology.

Obstructing ureteral calculus causing massive hydronephrosis in a renal allograft.

Nephrolithiasis is a rare complication of renal transplantation. Patients with an obstructing calculus in a renal allograft often lack the usual renal colic symptoms, and therefore present with atypical symptoms. Treatment of obstructing calculi is imperative to prevent renal allograft failure and other complications.

Perceptions and Experiences of Gender Equity Among Endourologists.

Only 9.9% of practicing urologists in the United States are women. This percentage is even smaller in leadership positions and high-ranking appointments.

Prospective randomized trial of 2 versus 12-weeks of postoperative antibiotics after percutaneous nephrolithotomy in complex patients with infection-related kidney stones.

Purpose: Treatment of struvite kidney stones requires complete surgical stone removal combined with antibiotic therapy to eliminate urinary tract infections and preventive measures to reduce stone recurrence. The optimal duration of antibiotic therapy is unknown. We sought to determine if 2- or 12-weeks of antibiotics post percutaneous nephrolithotomy (PNL) for infection stones resulted in better outcomes for stone recurrence and positive urine cultures.

Subcapsular hematoma in a solitary kidney: successful conservative management.

Subcapsular renal hematoma (SRH) is an infrequent complication of urologic interventions but can lead to serious consequences in patients with a solitary kidney. We present our experience with conservative management of a patient with a solitary kidney and multiple medical comorbidities who developed a SRH and subsequent renal failure after nephroureteral catheter placement. Literature on the management of this unique clinical scenario is limited.

Urinary Metabolic Disturbances During Topiramate Use and their Reversibility Following Drug Cessation.

Objective: To understand the metabolic disturbances of stone formers currently taking topiramate and to examine the reversibility of these disturbances with cessation of the medication.

Materials And Methods: All progress notes written by 5 endourologists from a single academic center were retrospectively reviewed from January 2010 to July 2020 containing the words "topiramate" or "topamax." Inclusion criteria were age >18 and presence of either a 24-hour urine sample or stone analysis while on topiramate.

Safety During Ureteroscopy: Radiation, Eyes, and Ergonomics.

It is known that urologic surgeons are at risk of work-place injury due to the physical requirements of operating and exposure to hazards. These hazards include radiation, exposure to body fluids, use of laser energy, and orthopedic injury due to the physical nature of operating. The risks that these hazards present can be mitigated by implementing several evidence-based safety measures.

Minimizing radiation dose in management of stone disease: how to achieve 'ALARA'.

Purpose Of Review: Exposure to radiation is known to have adverse effects such as secondary malignancies. Patients with nephrolithiasis are exposed to radiation in the workup and treatment of their condition. Furthermore, exposure to radiation is often repeated due to the high recurrence rate of nephrolithiasis.

Unconventional Use of the Lithoclast to Aid in the Treatment of Large Distal Ureteral Stone Burden in a Patient With a Ureterocele.

Introduction: Large ureteral stone burden can present significant challenges for the urologist to treat. Here we present the retrograde use of the Lithoclast Select, in a dilated distal ureter after incision of a ureterocele.

Methods: The patient is a 64 year-old female with large distal ureteral stone burden, with approximately 15 1-2 cm stones.

Optimizing Outcomes in Urological Surgery: Intraoperative Patient Safety and Physiological Considerations.

Introduction: Intraoperative surgical outcomes are influenced by a wide variety of patient, surgeon and institutional factors. The current literature lacks comprehensive resources that describe best practices in preventing patient safety events and optimizing patient physiology during urological surgery.

Methods: A multidisciplinary panel of subject matter experts (urologists, nurses, anesthesiologists) was convened to evaluate the existing literature, create a white paper and disseminate this to urological providers.

Business and Practice Readiness of Early Career Urologists: an Unmet Need.

Introduction: Business education in surgical residency, defined as contract negotiation, investing, financial planning and information on practice types, is currently lacking, and it is unknown if early career urologists possess this business education. Thus, we investigated how young urologists perceive their business knowledge and which vehicles of education they most prefer.

Methods: A 12-question survey was distributed to all urology residents, fellows and recent graduates to assess their self-reported business preparedness.

Endoscopic diagnosis of renal pseudoaneurysm following ureteroscopy.

Renal pseudoaneurysm following ureteroscopy is a rare cause of hematuria usually diagnosed and treated with angiography and embolization. Here we present a case of a small pseudoaneurysm causing intermittent flank pain and gross hematuria associated with clot retention initially diagnosed during ureteroscopy and subsequently treated with a combined endourologic and endovascular approach.

Contemporary best practice in the management of staghorn calculi.

Staghorn calculi are complex renal stones that occupy the majority of the renal collecting system. These stones are associated with high morbidity and can lead to recurrent urinary tract infections, urosepsis, renal deterioration, and death if left untreated. Managing patients with staghorn calculi can be challenging.

Modeling the Incidence of Secondary Malignancy Related to Ionizing Radiation Use in the Management of Nephrolithiasis.

Objective: To model the risk of secondary malignancy and associated mortality due to ionizing radiation from the evaluation and management of nephrolithiasis.

Methods: A PUBMED-based literature search was performed to identify model inputs, specifically annual incidence of nephrolithiasis sub-stratified by age and gender and radiation exposure associated with nephrolithiasis episodes. Estimates of age and gender specific radiation-induced malignancy and mortality rates were obtained from the BEIR VII Phase 2 report with dose extrapolation using the linear no-threshold model.

Radiation Mitigation Techniques in Kidney Stone Management.

Patients with nephrolithiasis are exposed to significant quantities of ionizing radiation with the potential to cause secondary malignancy. This risk is magnified by the high recurrence rate of nephrolithiasis. In this article, we identify the risks of ionizing radiation as they pertain to patients with nephrolithiasis.

Outcomes of Endourologic Interventions in Patients with Preoperative Funguria.

Funguria is encountered in 1% to 5% of cultured urine specimens and may be a result of specimen contamination, colonization, or invasive infection. The characteristics and outcomes of patients with funguria undergoing endourologic intervention have not been evaluated. Patients with preoperative funguria undergoing endourologic intervention were retrospectively identified.