Urethroscopic holmium:YAG laser epilation of urethral diverticular hair follicles following hypospadias repair.

Urethral hair and diverticula are well described long-term complications following urethroplasty or hypospadias repair. Endoscopic laser ablation is an uncommonly reported treatment option for a symptomatic hair-bearing urethra, and holmium laser hair epilation has not been previously reported in the literature. We report the first case of urethroscopic holmium laser ablation of urethral diverticular hair follicles and the outcome.

Dual-energy computed tomography with advanced postimage acquisition data processing: improved determination of urinary stone composition.

Introduction: The characterization of urinary calculi using noninvasive methods has the potential to affect clinical management. CT remains the gold standard for diagnosis of urinary calculi, but has not reliably differentiated varying stone compositions. Dual-energy CT (DECT) has emerged as a technology to improve CT characterization of anatomic structures.

High definition laparoscopy: objective assessment of performance characteristics and comparison with standard laparoscopy.

Introduction: High definition (HD) digital imaging represents a major advance in endoscope technology. The development of the charge-coupled device chip and its location at the distal end of the endoscope allows for image capture and digitization, as well as specific light filtration and processing. We assessed the capability of HD technology combined with digital imaging to provide improved image quality and enhanced spatial three-dimensional positioning.

Renal stone assessment with dual-energy multidetector CT and advanced postprocessing techniques: improved characterization of renal stone composition--pilot study.

Purpose: To prospectively evaluate the capability of noninvasive, simultaneous dual-energy (DE) multidetector computed tomography (CT) to improve characterization of human renal calculi in an anthropomorphic DE renal phantom by introducing advanced postprocessing techniques, with ex vivo renal stone spectroscopy as the reference standard.

Materials And Methods: Fifty renal calculi were assessed: Thirty stones were of pure crystalline composition (uric acid, cystine, struvite, calcium oxalate, calcium phosphate, brushite), and 20 were of polycrystalline composition. DE CT was performed with a 64-detector CT unit.

Impact of long-term potassium citrate therapy on urinary profiles and recurrent stone formation.

Purpose: Potassium citrate therapy has become one of the cornerstones of medical stone management. We elucidated the long-term effects of potassium citrate on urinary metabolic profiles and its impact on stone formation rates.

Materials And Methods: We performed a retrospective cohort study in patients treated at the Comprehensive Kidney Stone Center at our institution between 2000 and 2006.

Radiation exposure in the acute and short-term management of urolithiasis at 2 academic centers.

Purpose: Diagnostic imaging has a central role in the evaluation and management of urolithiasis. A variety of modalities are available, each with benefits and limitations. Without careful consideration of imaging modalities in quantity and type patients may receive excessive doses of radiation during initial diagnostic and followup evaluations.

Assessment of citrate concentrations in citrus fruit-based juices and beverages: implications for management of hypocitraturic nephrolithiasis.

Background And Purpose: Dietary intake of citrate in the form of citrus juices (eg, lemonade, orange juice) will enhance urinary citrate excretion, a valuable benefit for patients with hypocitraturic calcium oxalate nephrolithiasis. While information on citrate concentrations in select citrus juices is available, data on citrate concentrations of commercially available beverages (juice and otherwise) are limited. Using nuclear magnetic resonance spectroscopy (1H NMR), we report citrate concentrations of several beverages to help guide dietary recommendations aimed at increasing urinary citrate excretion and correcting hypocitraturia.

Use of the Escape nitinol stone retrieval basket facilitates fragmentation and extraction of ureteral and renal calculi: a pilot study.

Background And Purpose: Advances in ureteroscope and stone basket design have catapulted ureteroscopy to the forefront of surgical stone management; however, persistent problems such as stone migration continue to challenge urologists. The Escape nitinol stone retrieval basket (Boston Scientific, Natick, MA) is a stone basket designed to capture calculi and facilitate simultaneous laser lithotripsy in situ. We report our initial experience with the Escape basket for the management of urinary calculi and compare the use of this device with other methods of optimizing ureteroscopic stone management.

Evaluation of a new multi-basket load-release ureteral stent.

Introduction: A multi-basket ureteral stent was tested and modified to assess feasibility of load-release features intended to release stone(s) if resistance is encountered during stent removal.

Methods: Three versions of the stent were evaluated: (1) unaltered stent, (2) one strand of each basket partially cut to 50%, or 75% (3) tube between baskets longitudinally slit. One of the baskets was filled with multiple 3-4-mm stones or a single large 6-mm stone to 20Fr diameter.

Trainees do not negatively impact the institutional learning curve for robotic prostatectomy as characterized by operative time, estimated blood loss, and positive surgical margin rate.

Objectives: We evaluated the learning curves and perioperative outcomes of an experienced laparoscopic surgeon and his trainees to assess our structured teaching program.

Methods: We retrieved 383 patients undergoing robot-assisted laparoscopic prostatectomy (RALP) from our database. Trainees completed a structured teaching program and were categorized as early (days 0 to 232), mid (days 566 to 797), and late (days 825 to 1218) according to the time period in which they were working with the mentor.

The future of lasers in urology.

The use of laser applications in urology has undergone significant advances over the past 20 years. Laser technology is now used in a wide variety of procedures, and has become the primary treatment modality or standard of care for many urologic conditions. Despite these advances, a number of challenges still face laser utilization in urologic practice.

Holmium laser for stone management.

The efficiency and safety profile of the holmium laser has made this tool a versatile multi-purpose instrument for use in the endoscopic treatment of a wide variety of urologic disorders, in particular urinary calculi. Herein we review holmium laser physics, current endourologic laser lithotripsy applications, and the performance of new low power holmium laser devices.