Endoscopic Urological Surgery Research Articles

Bacteriophage therapy and prevention of infectious and inflammatory complications after endoscopic urologic surgery

Relevance. Given the growing antibiotic resistance of pathogens of urologic infection to antimicrobial drugs, one of the urgent problems is the search for alternative methods of antimicrobial prevention of infectious and inflammatory complications after surgical interventions, as well as an adequate therapy regimen during the postoperative period. Bacteriophage preparation is an alternative method for the treatment and prevention of infectious and inflammatory urological diseases.Objective. To determine an effective method for preoperative antimicrobial prevention of infectious and inflammatory complications in patients with kidney stones subjected to percutaneous nephrolithotripsy (PNLT).Methods. The study included 90 patients with coralloid or multiple large kidney stones who underwent PNLT. Before PNLT, all patients underwent bacteriological urinalysis in order to determine sensitivity not only to antibiotics and bacteriophage preparations. Urine sampling was performed for further microbiological cultural examination during renal pelvic puncture on the 3rd and 7th days after PNLT. Depending on the technique of perioperative prophylaxis, three groups of 30 were formed. Group 1 patients were intravenously injected with 1000 mg of ciprofloxacin throughout the operation and then intravenously dipped with 1000 mg once a day for 3–5 days. Group 2 received intramuscular cefotaxime + sulbactam (1.0+0.5) twice a day 2 h before surgery intramuscularly once. In group 3, patients received oral mycobacteriophage 40 ml polyvalent purified orally 1 h before surgery and 40 ml orally 3 times a day for 3–5 days after surgery.Results. In all three groups, the development of infectious complications in patients was assessed: acute pyelonephritis, systemic inflammatory reaction syndrome (SERS) or urosepsis. No serious infectious or inflammatory complications were observed in any group during the early postoperative period. The development of CVD after PNLT was noted on the 1st–3rd postoperative day (in 26.6 %, 20 and 20 % of patients of the 1st, 2nd and 3rd groups, respectively). However, on the 4th–7th day after PNLT, normal blood parameters (leukocytes, rod-shaped neutrophils), temperature, and general well-being were noted.Conclusion. The same effectiveness of different antimicrobial regimens for preventing infectious and inflammatory complications after PNLT was similar. Bacteriophage preparations are effective and can prevent infectious and inflammatory complications following PNLT. The development of CVD after PNLT on the 1st–3rd day after surgery cannot be correlated only with the antimicrobial drugs used and the method of their administration (intravenously, intramuscularly and orally). Most likely, the development of CVD is associated with operational injury.

Evaluation of Optical Tracking to Distinguish Surgeon Experience During Endoscopic Stone Surgery.

Introduction and Objectives: Optical tracking (OT) has shown potential in assessing surgical skill but has yet to be evaluated for endoscopic urologic surgery. We sought to evaluate the potential for OT to distinguish expert and trainee surgeons during flexible ureteroscopy (fURS) for kidney stone treatment in both simulated and live surgical settings. Methods: We performed OT analysis of six surgeons performing stone localization during fURS in two settings. In the first setting, surgeons were tasked with fiducial localization in three separate kidney phantoms during fURS. In the second setting, surgeons performed stone localization via fURS in five separate patients. Surgeons were categorized as "expert" (n = 3, endourologist, average case volume of >100 fURS per year) or trainee (n = 3, trainee, <100 fURS per year). OT metrics were recorded for both settings using the Microsoft HoloLens 2© as the surgeons viewed the surgical monitor during fURS. Standard OT metrics of experts and trainees were compared, and included: area of eye gaze movement, gaze distance traveled, number of gaze fixation points, percentage of gaze fixation dwell time, and number of saccades. Results: In the simulated setting, the average time for stone localization was greater for trainees compared to experts (318 seconds vs 52 seconds, p < 0.01). Additionally, the mean area of eye gaze movements with area of interest (AOI) was greater for trainees compared to experts (1430 cm2 vs 1060 cm2, p < 0.01). The total gaze distance traveled was also greater for trainees compared to experts (1480 cm vs 730 cm, p < 0.01). In the live surgical setting, average time for stone localization was similar for trainees and experts (74 seconds vs 51 seconds, p = 0.05). The total area of eye gaze movements in AOI was greater for trainees compared to experts (700 cm2 vs 30 cm2, p < 0.01). Additionally, the total gaze distance traveled was greater for trainees compared to experts (14,000 cm vs 680 cm, p < 0.01). This suggests more varied and less point specific concentration on the surgical screen by trainees. There was no difference in percentage of gaze fixation dwell time and number of saccades between experts and trainees in either setting. Conclusions: OT analysis can objectively distinguish surgical experience between experts and trainee surgeons performing fURS in both simulated and live surgical settings. These findings may play a role in future surgical training and skills assessment.

Assessment of the Efficacy of Nalbuphine as an Adjuvant to Intrathecal Bupivacaine in Endoscopic Urological Surgeries for the Prolongation of Postoperative Analgesia.

Background In anaesthesiology, intrathecal drugs play pivotal roles in spinal anaesthesia. Despite their ability to induce a high sensory block, bupivacaine alone may not be adequate for postoperative analgesia. It often requires a substantial dose of postoperative rescue analgesia to manage pain effectively. Thus, we studied the efficacy of nalbuphine 1.5 mg injected intrathecally as an adjuvant in endoscopic urological surgery. Materials and methods Sixty patients undergoing endoscopic urological surgery were equally divided into two study groups: group B (injection 0.5% hyperbaric bupivacaine 15 mg (3 ml) plus sterile NS 0.15 ml) and group N (injection 0.5% hyperbaric bupivacaine 15 mg (3 ml)+nalbuphine 1.5 mg (0.15 ml)). The first appearance of the sensory and motor blockages and duration required to attain complete sensory and motor threshold was noted. All vitals were recorded. After surgery, it was recorded when the patient first needed rescue analgesia (injection paracetamol 1 gm IV). Any adverse effects were recorded and addressed. The statistical analysis was conducted using IBM SPSS Statistics for Windows, V. 22.0 (IBM Corp., Armonk, NY), with p<0.05 indicating significance in both groups' operations. Results Intrathecal nalbuphine as an adjuvant caused an earlier onset of sensory and motor inhibition, delayed two-segment regression, and prolonged postoperative anaesthesia. The control group experienced sensory block at 3.33±0.61 minutes, while the nalbuphine group had a mean onset of 2.66±0.92 minutes (p=0.001). The patient who received nalbuphine had a mean regression time of 119.60±14.549 minutes, whereas the bupivacaine group had a mean regression time of 88.43±17.196 minutes. Group N had a considerably longer duration of postoperative analgesia, lasting 264.97 minutes, compared to group B's 198.50 minutes (p<0.001). Intrathecal nalbuphine did not influence vital indicators such as heart rate, respiration rate, and oxygen saturation. Conclusion To conclude, endoscopic urological surgery patients who received a subarachnoid block with 1.5 mg (0.15 ml) of nalbuphine hydrochloride with 0.5% hyperbaric bupivacaine 15 mg (3 ml) had longer postoperative pain relief than those who received 3 ml of intrathecal bupivacaine (15 mg). Urinary retention and pruritus were absent. Intrathecal nalbuphine with hyperbaric 0.5% bupivacaine is deemed safe with minimal side effects in endoscopic urology surgery.

Comparison of two different doses of hyperbaric bupivacaine with fentanyl for spinal anaesthesia in elderly patients undergoing routine endoscopic urological surgery: A randomized controlled study

Comparison of two different doses of hyperbaric bupivacaine with fentanyl for spinal anaesthesia in elderly patients undergoing routine endoscopic urological surgery: A randomized controlled study

Prevalence of left ventricular diastolic dysfunction in asymptomatic patients undergoing routine endoscopic urological surgery under regional anaesthesia-A prospective, observational study.

Prevalence of left ventricular diastolic dysfunction in asymptomatic patients undergoing routine endoscopic urological surgery under regional anaesthesia-A prospective, observational study.

Clinical practice standard and specifications for wireless intelligent ultra high-definition endoscopic surgery in urology

The wireless intelligent ultra-high-definition endoscope adopts a high speed wireless image transmission chip to achieve low-latency wireless transmission, storage,annotation and analysis of high-definition images with a resolution above 4K, thereby constructing a wireless connection, wireless transmission, high-definition image display, intelligent information exchange, and image intelligent analysis endoscopic system. It has the advantages of high clarity, easy connection, small size, and high degree of intelligence, which expands the application scenarios and target population of traditional endoscopic surgery. The wireless intelligent ultra-high-definition endoscope would bring profound changes to the minimally invasive treatment of urological diseases.

Assessment of the rate of practice of endoscopic urological surgery in three selected healthcare facilities in Douala, Cameroon

Assessment of the rate of practice of endoscopic urological surgery in three selected healthcare facilities in Douala, Cameroon

Comparison of Glycine Versus Sterile Water Use in Transurethral Resection of the Prostate: A Cross Sectional Study

Introduction All endoscopic surgery in urology needs irrigant fluid for clear visibility and to wash out the blood and debris. Glycine 1.5% is widely accepted but sterile water is cheaper and easily available. All types of irrigants are responsible to cause electrolyte disturbance to different degrees. In our study, we compare the glycine 1.5% with sterile water as irrigant fluid. Materials and Methods In this prospective observational study, 64 patients were included with 31 patients in the sterile group and 33 patients in the Glycine group. Hemoglobin, sodium, potassium was analyzed postoperatively after 6 hours. Weight of prostate, resection volume, the volume of fluid, and resection time was calculated. Results There were changes in the parameter of hemoglobin and sodium but were not statically significant whereas the change in potassium was statically significant in both groups. Conclusion Sterile water is a safe inexpensive and easily available fluid for TURP as compared to glycine 1.5%. The study did not show any significant difference in using both fluids our sample size was small so needs a similar study with a large sample size to confirm the observation.

SC124 - Hidden incision endoscopic surgery (HIDES) in pediatric urology: initial experience in a single center

SC124 - Hidden incision endoscopic surgery (HIDES) in pediatric urology: initial experience in a single center

"Killing two birds with one stone": endoscopic management of PUJ and VUJ obstructions with a renal stone in a congenital solitary kidney

SUMMARY We report on the diagnosis and management of a 25-year-old female with a congenital solitary kidney associated with simultaneous pelviureteric (PUJ) and vesicoureteric (VUJ) junction obstructions complicated by a lower pole renal stone. The patient was successfully managed completely endoluminally over two procedures with the use of double-J stents and a laser fibre to incise the VUJ and perform endopyelotomy at the PUJ followed by extraction of the stone. This case demonstrates the efficacy and minimal invasive endoscopic urological surgery even in the face of numerous pathologies, which traditionally required more invasive procedures. Keywords: solitary kidney, pelviureteric junction obstruction, vesicoureteric junction obstruction, renal calculus, endoscopy

Variations in Perioperative Antibiotic Prescriptions Among Academic Urologists After Ambulatory Endoscopic Urologic Surgery: Impact on Infection Rates and Validation of 2019 Best Practice Statement

ObjectiveTo evaluate adherence to the American Urologic Association (AUA) best practice statement guidelines regarding antibiotic duration in the perioperative setting for endoscopic urologic surgery. We assessed concordance to these guidelines among adult urologists at a single academic institution and its correlation with postoperative positive urine cultures as it relates to the revised 2019 best practice statement. MethodsWe performed a retrospective review of all adult endoscopic ambulatory urologic surgeries performed over an 18-month period by urologists at our institution. Patient demographics, pre- and postoperative urine cultures, operative details, stent or foley use, and antibiotic prescriptions were reviewed. Chi-squared and linear regression analyses were done. ResultsThree hundred thirty patients were included for analysis. Sixty-two percent of patients were prescribed postoperative antibiotics, for an average of 4 days. Trimethoprim/Sulfamethoxazole and fluroquinolones were most often prescribed (43% and 38%, respectively). Intraoperative stent placement, positive urine culture within 30 days prior to surgery, and a positive urine culture within 1 year prior to surgery predicted antibiotic prescription. No significant differences were seen in rates of positive postoperative urine culture rates between cohorts that received antibiotics postoperatively vs those who did not. ConclusionsAt our academic institution, we observed poor concordance with the AUA best practice statement for perioperative antibiotic prescription after ambulatory endoscopic urologic surgery. Rates of positive postoperative cultures were low and not associated with receipt or duration of antibiotic prescription at the time of surgery, supporting minimal use of antibiotics for most endoscopic cases.

Reducing Postoperative Opioids for Outpatient Endoscopic Urological Surgery: A Resident Driven Quality Improvement Initiative.

Opioid dependency has become a public health crisis in the United States and surplus prescriptions of opioids after surgery may be contributing to this problem. This resident driven quality improvement initiative sought to study the prescribing patterns of opioids for patients undergoing outpatient urological surgery at our institution, reduce prescriptions where possible and monitor patient outcomes. A chart review and telephone survey were conducted of patients undergoing outpatient endourological surgery. Type and quantity of narcotics prescribed were identified, and patients were surveyed on quantity of medication consumed. Physicians were then counseled on prescribing quantities closer to the average amounts reportedly used by patients. After 30 days we assessed emergency room visits, readmissions and telephone calls related to pain. Before our initiative patients were prescribed an average of 156.6 morphine milligram equivalents (median 150) after endourological surgery. Patients reported using between 0-37.5 morphine milligram equivalents, with 71% reporting using no narcotics. Following 30 days of surgeon advisement, the average prescription decreased to 38.6 morphine milligram equivalents (median 0), representing a 75.3% reduction. Following reductions there were no significant differences in emergency room visits, telephone calls, readmissions or rate of drug refills. Resident driven quality improvement initiatives can lead to reductions in the prescription of surplus opioids after certain types of urological surgery. These efforts can play an important role in reducing the supply of available narcotics at the local level.

Postoperative Delirium after Urological Surgery: A Literature Review

Purpose: We aimed to thoroughly search and identify studies referring to risk factors associated with postoperative delirium (POD) in patients undergoing open as well as en-doscopic urological surgery. Methods: The review after a systematic literature search included 5 studies. Results: The incidence of POD was reported to be between 7.8 and 30% depending on the type of the urologic surgery, while in the majority of the studies the onset happened on the first postoperative day and the symptoms lasted 3 ± 0.8 days. Seventeen different risk factors for POD were identified and presented in detail. Conclusion: The Mini-Mental State Examination score and older age were significantly associated with the development of POD. However, the Confusion Assessment Method is very well validated against the diagnosis of delirium from the specialists.

Intrathecal ropivacaine vs bupivacaine in endoscopic urological surgeries: a double blind randomized controlled trial

Aims: To compare sensory, motor effects and haemodynamic stability of 2ml intrathecal isobaric ropivacaine (0.75%) with 3ml hyperbaric bupivacaine (0.75%) in patients undergoing endoscopic urological surgery. Study Design: Randomized controlled trial involving 142 patients undergoing transurethral resection of prostate (TURP) and URS (urethroscopy) in a tertiary care hospital, India. Methods and materials: Patients were randomly allocated to, Group 1 (3ml of 0.5% (15mg) hyperbaric bupivacaine) and Group 2 (2ml of 0.75% isobaric ropivacaine(15mg)). Onset and highest level of sensory block, onset and duration of motor block, quality of anaesthesia and muscle relaxation, haemodynamic parameters and adverse effects if any were studied. Statistical analysis used: Unpaired t-test was used to test continuous variables and chi square test/Fisher’s exact test for categorical variables. Results: The mean of highest sensory block, 2 segment regression of sensory block and time for sensory level to regress below T10 was significantly more in group 1 compared to group 2 (P Conclusion: Ropivacaine provides comparable quality of sensory block but has slower onset and significantly shorter duration of motor block compared to hyperbaric bupivacaine.

Natural orifice transluminal endoscopic surgery in urology: The Chinese experience

ObjectiveTo describe the Chinese experience of natural orifice transluminal endoscopic surgery (NOTES) in urology. MethodsFrom December 2008 to May 2017, 35 animal experiments and 305 clinical surgeries of NOTES or natural orifices specimen extractions (NOSE) were performed in China. The animal experiments included five kidney biopsies, 24 nephrectomies and six partial nephrectomies. The clinical surgeries included 12 transvaginal NOSE (TV-NOSE), 266 hybrid transvaginal NOTES (TV-NOTES) and 27 pure TV-NOTES. The TV-NOSE procedure was performed in five transumbilical laparoendoscopic single-site (U-LESS) nephrectomies, four suprapubic-assisted laparoendoscopic single-site surgery (SA-LESS) nephroureterectomies, and three laparoscopic radical cystectomies. The hybrid TV-NOTES procedure included 210 nephrectomies, 31 adrenalectomies, eight nephroureterectomies, 13 partial nephrectomies, and four heminephrectomies. The pure TV-NOTES procedure included five renal cyst decortications and 22 nephrectomies. ResultsA total of 29 animal experiments were successfully performed. One partial nephrectomy was converted to standard laparoscopic surgery. Two kidney biopsies and two nephrectomies were unsuccessful. A total of 297 clinical surgeries were successfully performed. Six patients who underwent hybrid TV-NOTES were converted to open surgery. Two patients who underwent pure TV-NOTES were converted to SA-LESS. There were 22 major complications, 16 occurred intraoperatively and six postoperatively. The mean visual analog score (VAS) of 48 h after the operation was 2.5 points in TV-NOSE, 2.3 points in hybrid TV-NOTES and 1.7 points in pure TV-NOTES. The mean follow-up of 50.6 (3.0–87.0) months showed that all patients were in good condition. The umbilicus scars were nearly invisible in TV-NOSE and hybrid TV-NOTES. The vaginal incision healed well. ConclusionsTV-NOSE and TV-NOTES are feasible, safe, and effective with little injury, low pain, fast recovery, and good cosmetic outcomes in properly selected patients. They are worth consideration for urological clinical practice.

MASSIVE IRRIGATION DURING ENDOSCOPIC UROLOGIC SURGERY NORMAL SALINE VERSUS DISTILLED WATER; A PROSPECTIVE RANDOMIZED TRIAL

Background: Benign prostatic hyperplasia is the most prevalent non-malignant prostate disease affecting over 50% of the aging male population. Transurethral prostate resection (TURP) is the standard reference (i.e. the most effective endoscopic surgical procedure for this disorder). Aim of the study: To compare the effectiveness and safety of normal saline vs sterile distilled water in massive irrigation in urological endoscopic surgery (TURP) as regards electrolytedisturbance (Na+ level), serum creatinine and occurrence of TURP syndrome. Patients and Methods: This study included fifty male patients with benign prostatic hyperplasia, aging 50-70 years old, admitted to operating room in Ain Shams University hospitals for TURP. The patients were divided into two equal groups, Group 1: underwent endoscopic urological surgery (TURP) with normal saline wash using bipolar resectoscope, Group 2: underwent endoscopic urological surgery (TURP) with distilled water wash using monopolar resectoscope. Results: The current study showed significant decrease in serum Na+ level in distilled water group than in normal saline group in both postoperative and 24 hr later. Also, we found significant decrease in hemoglobin level at 24hr postoperative in distilled water group compared to saline group.Conclusion: Our results demonstrate that normal saline wash during TURP causes less drop-in serum sodium and Hb level, less fluid overload, less incidence of TURP syndrome and decreased need for blood transfusion than using distilled water as irrigant.

1096 - The mid-long-term follow up after transvaginal natural orifice transluminal endoscopic surgery in urology

1096 - The mid-long-term follow up after transvaginal natural orifice transluminal endoscopic surgery in urology

Virtual Reality Distraction during Endoscopic Urologic Surgery under Spinal Anesthesia: A Randomized Controlled Trial.

Sedation protocols during spinal anesthesia often involve sedative drugs associated with complications. We investigated whether virtual reality (VR) distraction could be applied during endoscopic urologic surgery under spinal anesthesia and yield better satisfaction than pharmacologic sedation. VR distraction without sedative was compared with pharmacologic sedation using repeat doses of midazolam 1–2 mg every 30 min during urologic surgery under spinal anesthesia. We compared the satisfaction of patients, surgeons, and anesthesiologists, as rated on a 5-point prespecified verbal rating scale. Two surgeons and two anesthesiologists rated the scale and an overall score was reported after discussion. Thirty-seven patients were randomized to a VR group (n = 18) or a sedation group (n = 19). The anesthesiologist’s satisfaction score was significantly higher in the VR group than in the sedation group (median (interquartile range) 5 (5–5) vs. 4 (4–5), p = 0.005). The likelihood of both patients and anesthesiologists being extremely satisfied was significantly higher in the VR group than in the sedation group. Agreement between the scores for surgeons and those for anesthesiologists was very good (kappa = 0.874 and 0.944, respectively). The incidence of apnea was significantly lower in the VR group than in the sedation group (n = 1, 5.6% vs. n = 7, 36.8%, p = 0.042). The present findings suggest that VR distraction is better than drug sedation with midazolam in terms of patient’s and anesthesiologist’s satisfaction and avoiding the respiratory side effects of midazolam during endoscopic urologic surgery under spinal anesthesia.

Noninvasive treatment of intraperitoneal urinary system perforations with percutaneous placement of a peritoneal drainage catheter

Intraperitoneal urinary system perforation is a rare but serious complication of endoscopic urologic surgery. Percutaneous placement of a peritoneal drainage catheter is already mainly used for diagnostic purposes. We present our experience with percutaneous drainage catheters for conservative management of intraperitoneal urinary system perforations occurring during endoscopic urologic surgery with close monitorization in selected cases. Urinary system perforations had developed in 21 (0.8%) of 2603 patients undergoing endoscopic urologic surgery at our department in 2014–2016. The perforation was intraperitoneal in only 5 (0.19) of all the patients. A percutaneous peritoneal drainage catheter with the guidance of ultrasonography was placed in four of the patients. Conservative management by draining excess fluid with a drainage catheter percutaneously placed under close monitorization was successful in four out of five patients with urinary system perforation occurring during endoscopic urologic surgery. The remaining patient was treated successfully with open laparotomy because of fulminant evidence of peritonitis. Our findings and experience may suggest that conservative management of intraperitoneal urinary system perforations occurring during endoscopic urologic surgery by percutaneous drainage catheter under close monitorization is feasible in carefully selected patients.

A guidewire on your fingertip: A novel innovative technique

ObjectiveWe aimed to describe a novel method to attain direction and control of the guidewire at the fingertip. This will serve to allow for ease of guidewire placement during open and combined open and endoscopic surgery. Subjects and methodsOver a gloved hand, a ureteric catheter is placed over the index finger, with the distal tip over the distal end of the index finger. Thereafter, adhesive tape is applied over the ureteric catheter (over the proximal, and middle phalanges) to allow for ease of flexion of the index finger. A second glove is then covered over the first one, with care not to rotate or dislodge the fixated ureteric catheter. A small hole is cut at the distal end of the glove, at the tip of the ureteric catheter to allow the guidewire to exit. The guidewire is advanced easily and can now be directed using the ‘loaded’ fingertip. ResultsAn easily manipulated system of guidewire insertion, with fingertip mobility and dexterity is obtained utilizing everyday consumables in a simple to perform fashion. ConclusionA simple, novel method to allow flexibility and stress-free maneuvering to pass a guidewire, in open or combined open and endoscopic urological surgery is described.