Lower Retreatment Rate Research Articles

Comparing stand-alone endovascular embolization versus stereotactic radiosurgery in the treatment of arteriovenous malformations with Spetzler-Martin grades I–III: a propensity score matched study

BackgroundArteriovenous malformations (AVMs) are uncommon cerebral lesions that can cause significant neurological complications. Surgical resection is the gold standard for treatment, but endovascular embolization and stereotactic radiosurgery (SRS) are viable...

Clinical Characteristics of Punctate Hyperfluorescence Spots in the Fellow Eye of Patients with Unilateral Macular Neovascularization with No Drusen.

Objectives: To assess the clinical characteristics of patients with macular neovascularization (MNV) with no drusen in the fellow eye, we investigated the incidence of MNV in fellow eyes and the outcomes of intravitreal aflibercept (IVA) monotherapy in MNV eyes of patients with unilateral MNV with a punctate hyperfluorescence spot (PHS) in the fellow eye. Methods: We retrospectively studied 58 treatment-naïve patients with unilateral MNV with no drusen in the fellow eye. Patients were classified into a PHS group (n = 29) or no-PHS group (n = 29) based on the presence of PHS. We evaluated the incidence of MNV in the fellow eye, and the retreatment rate after initiation of three monthly aflibercept injections over one year. Results: Fellow eyes in the PHS group had a thicker choroid (p < 0.05) and higher prevalence of pachychoroid pigment epitheliopathy (PPE) (p < 0.001). MNV eyes in the PHS group had a thicker choroid (p = 0.09). The PHS group had a lower retreatment rate (p < 0.05) and required fewer injections (p < 0.05) than the no-PHS group. MNV developed in one eye in both the PHS and no-PHS groups, and both cases occurred in areas of hypofluorescence on indocyanine green angiography within the PPE area before the onset of MNV. Conclusions: The PHS group frequently exhibited pachychoroid disease characteristics and responded better to IVA monotherapy than the no-PHS group. These groups may represent distinct populations of patients with unilateral MNV with no drusen in the fellow eye.

WATER versus WATER II 5-year update: Comparing Aquablation therapy for benign prostatic hyperplasia in 30-80-cm3 and 80-150-cm3 prostates.

This study aims to compare the long-term outcomes of Aquablation for small-to-moderate (30-80 cm3) prostates with the outcomes for large (80-150 cm3) prostates at 5-year follow up. The Waterjet Ablation Therapy for Endoscopic Resection of Prostate Tissue (WATER; NCT02505919) is a prospective, double-blind, international clinical trial encompassing 116 patients, examining Aquablation versus transurethral resection of the prostate (TURP) for LUTS/BPH in prostates sized between 30 and 80 cm3. In parallel, WATER II (W-II; NCT03123250), a prospective, multicentre, single-arm international clinical trial, explores Aquablation outcomes in prostates ranging from 80 to 150 cm3. Baseline parameters and 60-month outcomes were scrutinized using statistical analyses, including Students' t test, Wilcoxon tests for continuous variables, and Fisher's test for binary variables. There is a significant improvement in International Prostate Symptom Score (IPSS) from baseline to 60 months in both WATER (22.9 to 7.0) and WATER II (23.2 to 6.8) (P= 0.852). Urinary flow rate (Qmax) increased in both groups from baseline to 60 months (WATER: 9.4 to 17.3cc/s; WATER II: 8.7 to 17.1cc/s) (P= 0.933). Immediate and sustained enhancements were observed in IPSS and Qmax. At 5years, a notable percentage of patients in both groups were BPH medication-free (WATER: 99%; WATER II: 94%) (P= 0.0517) and free from surgical retreatment (WATER: 95%; WATER II: 97%) (P= 0.508). The 5-year follow-up affirms that Aquablation therapy exhibits sustained outcomes, minimal irreversible complications, and low retreatment rates for treating LUTS/BPH, irrespective of prostate volume ranging from 30 to 150 cm3.

Efficacy of Tailored Treatment Strategies for Chronic Subdural Hematoma Based on Hematoma Characteristics and Volume: A Retrospective Observational Study

We assessed the effectiveness of a treatment strategy based on hematoma characteristics and volume. From September 2022 to December 2023 (the Study period), a 2-center retrospective observational study of initial chronic subdural hematoma was performed. The baseline period was from January 2018 to December 2019. Patients were classified into the high and low retreatment rate groups (Groups H and L, respectively). During the Study period, Group H was treated with drainage and middle meningeal artery embolization, while Group L was treated with drainage or middle meningeal artery embolization alone. During the Baseline period, all the patients were treated with drainage alone. The primary and secondary endpoints were group retreatment rates and severe procedure-related complications requiring surgical intervention and permanent sequelae, respectively. Fifty-two patients were included during the Study period (31 in Group H and 21 in Group L) and 53 during the Baseline period (32 in Group H and 21 in Group L). Three (5.8%) and 9 (17.0%) patients required retreatment in the Study and Baseline periods, respectively (P= 0.12). One (3.2%) and 9 (28.1%) patients in Group H required retreatment during the Study and Baseline periods, respectively (P= 0.01). Similarly, 2 patients (9.5%) and no patient in Group L required retreatment during the Study and Baseline periods, respectively (P= 0.49). No severe complications were reported throughout. Chronic subdural hematoma treatment strategies that consider to hematoma volume and characteristics have the potential to identify and reduce treatment rates in cases with high retreatment rates.

Clinical Outcome of Pipeline Embolization Device with and without Coil to Treat Intracranial Aneurysm: A Systematic Review and Meta-Analysis.

The use of a Pipeline Embolization Device (PED) in combination with coils (PEDC) to treat intracranial aneurysms remains unclear as to whether it offers significant benefits for the patients since the results have varied. This study aimed to investigate the clinical outcome of PEDC compared to PED in treating intracranial aneurysms. We systematically searched the articles from PubMed, Web of Science, and the Cochrane Library databases published before January 25, 2024. We selected studies comparing PEDC vs. PED to treat intracranial aneurysms. Patients treated with PEDC but using dense coiling were excluded from the study. The clinical outcomes observed in this meta-analysis were intraprocedural complications, postoperative complications (stenosis, stroke, hemorrhage, mortality), favorable outcome (mRS ≤ 2), complete occlusion rate, and retreatment rate. Forest plot was used to analyze pooled Odds Ratio (OR) of clinical outcomes. A total of 3001 subjects from nine observational studies were included. PEDC was mainly used to treat larger aneurysms. PEDC has a significantly higher complete occlusion rate at 6 months [OR= 2.66, 95% CI(1.26, 5.59), p= 0.01], a lower retreatment rate [OR= 0.18, 95% CI(0.05, 0.07), p= 0.010], higher stroke-related complications [OR= 1.66, 95% CI(1.16, 2.37), p= 0.005], and higher hemorrhage-related complications [OR= 1.98, 95% CI(1.22, 3.21), p = 0.005]. There was no significant difference in intraprocedural complications, stenosis-related complications, mortality, favorable outcomes, and complete occlusion at the end of the study. No randomized controlled trials have been performed comparing PEDC and PED. Considering that all the included studies were observational, the patients' baseline characteristics were not completely balanced. This meta-analysis study showed that PEDC in large intracranial aneurysms induces a faster complete occlusion rate at 6 months and a lower retreatment rate. However, it increases the risk of stroke-related postoperative complications, and the faster complete aneurysm occlusion rate found in this study did not correlate with a reduction in long-term aneurysm or distal artery ruptures. Thus, this study suggests the need to find a better strategy to improve long-term hemorrhage-related complications in large intracranial aneurysms. F = female; FDDs = flow-diverter devices; M = male; NOS = Newcastle-Ottawa Scale; PED = pipeline embolization device; PEDC = pipeline embolization device in combination with coils.

Clinical Characteristics of Unilateral Macular Neovascularization Patients with Pachydrusen in the Fellow Eye.

Background/Objectives: To approach the clinical properties of pachydrusen that differ from conventional drusen, we investigated the incidence of macular neovascularization (MNV) in fellow eyes and the treatment outcomes of intravitreal aflibercept (IVA) in MNV eyes of unilateral MNV patients with pachydrusen in the fellow eye. Methods: We retrospectively studied 261 consecutive patients with treatment-naïve unilateral MNV. Patients were classified into four groups according to the type of drusen in the fellow eye: the pachydrusen group (n = 49), the soft drusen group (n = 63), the subretinal drusenoid deposit (SDD) group (n = 24), and the no drusen group (n = 125). The development of the MNV in the fellow eye was evaluated for five years, and the retreatment proportion after three monthly aflibercept injections was evaluated for one year. Results: The choroidal thickness in the fellow eyes and MNV eyes was the greatest in the pachydrusen group (all p < 0.001). The 5-year incidence of MNV in the pachydrusen group was similar to that in the soft drusen group and no drusen group. The pachydrusen group had a lower retreatment rate than the other groups did (pachydrusen group: 46.4%; soft drusen group: 78.1%; SDDs: 87.5%; no drusen group: 83.3%). Conclusions: Unilateral MNV patients with pachydrusen in the fellow eye had a lower retreatment rate (46.4%/1 year); therefore, aflibercept monotherapy using the PRN regimen is one of the preferred treatment methods for MNV patients with pachydrusen in the fellow eye.

Transepithelial phototherapeutic keratectomy for treatment-resistant recurrent corneal erosion syndrome

BackgroundTo evaluate the efficacy and safety of trans-epithelial phototherapeutic keratectomy (TE-PTK) as a treatment for recurrent corneal erosion syndrome (RCES) in patients with symptoms refractory to conventional treatments.MethodsAll patients who received TE-PTK treatment for RCES had failed 3 or more conventional treatments and were reviewed, and if met criteria, approved by healthcare workers of the British Columbia public health authority (Medical Services Plan (MSP). A retrospective chart review and telephone survey were conducted at the Pacific Laser Eye Centre (PLEC). Exclusion criteria were ocular co-morbidities potentially affecting treatment efficacy.ResultsThis study included 593 eyes of 555 patients (46.2% male; 50.9 ± 14.2 years old) who underwent TE-PTK. The leading identified causes of RCES were trauma (45.7%) and anterior basement membrane dystrophy (44.2%). The most common pre-PTK interventions were ocular lubricants (90.9%), hypertonic solutions (77.9%), and bandage contact lenses (50.9%). Thirty-six eyes had undergone surgical interventions such as stromal puncture, epithelial debridement, or diamond burr polishing. Post-PTK, 78% of patients did not require any subsequent therapies and 20% required ongoing drops. Six patients (1.1%) reported no symptom improvement and required repeat TE-PTK for ongoing RCES symptoms after initial TE-PTK. All 6 eyes were successfully retreated with TE-PTK (average time to retreatment was 11.3 ± 14.9 months). There was no significant difference in best corrected visual acuity pre- vs. post-operatively. The mean post-operative follow-up was 60.5 months (range: 5–127 months).ConclusionTE-PTK has a good efficacy and safety profile for treatment-resistant RCES. The third-party public health–reviewed nature of this study, the low recurrence rate of RCES, and the low PTK retreatment rate suggest that TE-PTK might be considered for wider use in the management of RCES.

Retreatment for Lower Urinary Tract Symptoms After Water Vapor Thermal Therapy

ObjectivesTo identify predictors of retreatment for symptomatic recurrence among men who undergo water vapor thermal therapy (WVTT; Rezum, Boston Scientific, Marlborough, MA, USA), a minimally invasive surgical treatment for lower urinary tract symptoms (LUTS) secondary to benign prostatic hyperplasia (BPH). MethodsWe retrospectively reviewed patients treated with WVTT at a single institution from August 2017 to February 2022. Patients who underwent a second BPH procedure for persistent or recurrent LUTS within 2 years of original treatment were compared to the remaining cohort who did not undergo retreatment. Multivariate analysis was used to assess for predictors of retreatment. ResultsData was obtained from 192 patients. 10 (5%) patients were retreated. The retreatment cohort had smaller prostate volumes (50.4 + 18.2 cc vs 48.5 + 35.7 cc; p=0.003) and received a greater number of water vapor injections (4.4 + 1.8 vs 5.2 + 3.9; p<0.001). At 6 month follow-up, total International Prostate Symptom Score (IPSS; 10.13 ± 7.40 vs 18.5 ± 11.55, p=0.044) and voiding sub-scores (4.59 ± 4.39 vs 9.5 ±7.84, p=0.006) were significantly worse in the retreatment group. On multivariate analysis, >1 treatment per lobe was independently associated with increased risk of retreatment (HR 8.509, 95% CI [1.109 – 65.293]; p=0.039). ConclusionsWVTT has a low retreatment rate. Men who required retreatment received more injections and showed worsened voiding symptom scores 6 months postoperatively. Decreasing the number of injections may help reduce treatment failure rates.

700 Flow-redirection Intraluminal Device (FRED) System for the Management of Intracranial Aneurysms: A Systematic Review and Metanalysis

INTRODUCTION: Multiple FDs are available for clinical use. Over the years, the FDs technology has improved considerably. However, overall complications and safety issues using FRED have not been evaluated in detail. Studies comprehensively investigating the clinical and technical events in FRED usage to treat IAs are not available. The purpose of this study is to investigate the outcome, overall complication rates, occlusion rate, retreatment, thromboembolic, and hemorrhagic complications for different patient cohorts treated with FRED flow diverter. METHODS: The following descriptors were used for the search: Flow-Redirection Intraluminal Device (FRED) system for the treatment of Intracranial aneurysms, Intracranial aneurysms, and Complication with no constraints applied was searched. Two authors independently revived and identified the studies, and two independent review authors extracted the data. A random-effect model was used to pool data, and the results were reported (odds ratios and 95% CI); heterogeneity was reported as I2. RESULTS: Nine studies were included in the final analysis, which involved retrospectively and prospectively collected data on 1167 patients. The use of FRED was associated with a rate of occlusion of 85% (95% confidence interval [CI] 79.5%–90.9%). Low retreatment rate of 2.5% (95% CI 1.0%–4.6%), low thromboembolic complication rate of 4.9% (95% CI 3.0%–7.31%), low hemorrhagic complication rate of 1.35% (95% CI 0.7%–2.0%). The mortality rate was 4% (95% CI 0.8%–2.1%). An overall good outcome was 95.1% (95% CI 92.1%–97.4%), and poor outcome was 4.8% (95% CI 2.5%–7.8%). CONCLUSIONS: The available evidence suggests that FRED offers favorable results for the management of intracranial aneurysms, results in high occlusion rate and low complication rates

Postoperative outcome and influencing factors of strabismus surgery in infants aged 1–6 years

PurposeTo evaluate the postoperative outcome of strabismus surgery performed in children aged 1–6 years by investigating the change of the preoperative angle of deviation (AOD), elevation in adduction, best-corrected visual acuity (BCVA) and refractive error.MethodsRetrospective chart review of 62 children who received strabismus surgery between January 2018 and December 2021 at the Department of Ophthalmology and Optometry of the Medical University of Vienna. Age, sex, type of strabismus, AOD, BCVA, refractive error and visual acuity were evaluated with respect to the postoperative outcome.ResultsMean follow-up was 13.55 ± 11.38 months with a mean age of 3.94 ± 1.97 years (range: 1.0–6.0) at time of surgery. 74.19% of patients (n = 46) had isolated or combined esotropia, 12.90% (n = 8) had isolated or combined exotropia and 12.90% (n = 8) had isolated strabismus sursoadductorius. Mean preoperative AOD of 15.69 ± 16.91°/15.02 ± 14.88° (near/distance) decreased to 4.00 ± 9.18°/4.83 ± 7.32° (near/distance) at final follow-up (p < 0.001). BCVA improved from 0.26 ± 0.26/0.25 ± 0.23 (left/right) to 0.21 ± 0.25/0.20 ± 0.23 (left/right) (p = 0.038). There was no significant change regarding refractive error (p = 0.109) or elevation in adduction (p = 0.212). Success rate which was defined as a residual AOD of less than 10° was 74.19% (n = 46). In 3.23% (n = 2) retreatment was necessary.ConclusionStrabismus surgery in infants was shown to have a satisfactory outcome with a low retreatment rate. Surgical success rate was not linked to age, sex, type of strabismus or the preoperative parameters AOD, refractive error and visual acuity in this study.

One and done: Feasibility and Safety of Primary Ureteroscopy in a Pediatric Population

Pediatric urolithiasis has been increasing at rate of 4-10% annually in the United States, most notably within adolescents and females. A significant number of patients will require surgical management of their stones. Primary ureteroscopy (URS) affords the opportunity to treat stones under a single anesthetic with lower re-treatment rates or anatomical and stone characteristic limitations compared to shockwave lithotripsy. Previous studies evaluating primary URS have been largely underpowered, are limited by stone location, and/or are not representative of the stone population in the United States. Primary study outcomes were the success of primary URS and patient characteristics associated with success. Secondary outcomes were the stone-free rate (SFR), 30-day emergency department (ED) visits, 30-day readmissions, and complications. We performed a retrospective cohort study of patients less than 18 years of age from 2011 to 2023 who underwent primary URS. Patients were excluded if a ureteral stent was placed prior to URS or diagnostic URS was performed. A successful primary URS was considered if access to the ureter was obtained and treatment of the stone(s) completed. In failed primary URS, a ureteral stent was placed for staged management. A total of 196 patients were included and primary URS was performed or attempted on 224 renal units. The median age was 15.8 (IQR 13.4-16.9) years and median follow up 8.4 (IQR 1.1-24.6) months. The success rate of primary URS was 79%. No significant characteristics were appreciated for successful primary URS based on: overall age, <14 vs>14 years of age, sex, body mass index, history of stones, history of endourologic procedures, preoperative alpha blockade, location of stone(s), multiple stones, type of URS, or acute treatment. In successful primary URS, the SFR was 88% with stone size (p=0.0001) the only predictor of having residual stones. The 30-day ED rate was 21.4%, 30-day unplanned readmission rate was 12.5%, and complication rate was 7.5%. No long-term complications were appreciated. Our success of primary URS compares favorably to previously published literature. Our SFR rate, 30-day ED visits, 30-day unplanned readmission, and complication rates are similar to other studies. Limitations of the study are its retrospective design, selection bias, and intermediate follow-up. Primary URS can be completed safely in the majority of pediatric patients without any patient characteristics associated with success. We advocate for primary URS when possible due to the excellent SFR and potential of treating stones under a single anesthetic.

Ureteroscopy and lasertripsy with pop dusting using high power holmium laser for large urinary stones > 15mm: 6.5-year prospective outcomes from a high-volume stone center.

Ureteroscopy and stone lasertripsy (URSL) is a recognized technique for treatment of urinary tract stones. Holmium:Yag laser has been successfully used for this purpose for the last two decades. More lately, pulse modulation with Moses technology and high power lasers have been introduced with the result of faster and more efficient stone lasertripsy. Pop dusting is a two-stage combined treatment using a long pulse Ho:YAG laser, initially in contact mode with the stone 'dusting' (0.2-0.5J/40-50Hz) followed by non-contact mode 'pop-dusting' (0.5-0.7J/20-50Hz). We wanted to look at the outcomes of lasertripsy for renal and ureteric stones using a high-power laser machine. Over a period of 6.5years (January 2016-May 2022), we prospectively collected data for patients undergoing URSL for stones larger than 15mm treated using high power Ho:YAG laser (60W Moses or 100W laser). Patient parameters, stone demographics and outcomes of URSL were analyzed. A total of 201 patients, underwent URSL for large urinary stones. In 136 patients (61.6%) stones were multiple and the mean single and cumulative stone size was 18mm and 22.4mm respectively. A pre- and post-operative stent was placed in 92 (41.4%) and 169 (76%) respectively. The initial and final stone free rate (SFR) were 84.5% and 94% respectively and 10% patients underwent additional procedure to achieve stone free status. 7 (3.9%) complications were recorded, all related to UTI/sepsis, with 6 Clavien II and 1 Clavien IVa complication. Dusting and pop-dusting has shown to be successful and safe with the ability to treat large, bilateral or multiple stones with low retreatment and complication rates.

MP51-14 RE-TREATMENT FOR LOWER URINARY TRACT SYMPTOMS (LUTS) AFTER WATER VAPOR THERMAL THERAPY

You have accessJournal of UrologyCME1 Apr 2023MP51-14 RE-TREATMENT FOR LOWER URINARY TRACT SYMPTOMS (LUTS) AFTER WATER VAPOR THERMAL THERAPY Vi Nguyen, Michelle C. Leach, Clara Cerrato, Mimi V. Nguyen, and Seth K. Bechis Vi NguyenVi Nguyen More articles by this author , Michelle C. LeachMichelle C. Leach More articles by this author , Clara CerratoClara Cerrato More articles by this author , Mimi V. NguyenMimi V. Nguyen More articles by this author , and Seth K. BechisSeth K. Bechis More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003299.14AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Water vapor thermal therapy (Rezum, Boston Scientific, Marlborough, MA, USA) has become increasingly used as a minimally invasive surgical treatment for LUTS due to benign prostatic hyperplasia (BPH) with a low re-treatment rate. We sought to identify predictors of re-treatment or symptom recurrence. METHODS: We retrospectively reviewed patients treated with water vapor thermal therapy at a single institution from August 2017 to February 2022. Patient demographics, pre- and peri-operative data, and international prostate symptom scores (IPSS) were evaluated. Patients who underwent a second BPH procedure (“re-treatment”) for persistent or recurrent LUTS within 2 years of original treatment were compared to the remainder of the cohort who did not undergo re-treatment. Multivariate analysis (MVA) was used to assess for predictors of re-treatment. RESULTS: Data from 192 consecutive patients undergoing water vapor thermal therapy were collected and analyzed. 10 (5%) patients were re-treated. Men in the re-treatment cohort had smaller prostate volumes (48.5 vs 50.4, p=0.003) and received a greater number of water vapor injections (5 vs 4, p<0.001). Baseline IPSS score or median lobe treatment was not associated with re-treatment (Table 1a). At 6-month follow-up, total IPSS (10.13 vs 18.5, p=0.044) and IPSS voiding sub-scores (4.59 vs 9.5, p=0.006) were significantly worse in the re-treated group (Table 1b). On MVA, ≥3 total treatments (>1 per lobe) during an initial Rezum procedure were independently associated with increased risk of re-treatment (HR 8.51, p=0.039). Increasing prostate volume, catheter duration, and treatment of the median lobe were not significantly associated with an increased risk of re-treatment in these patients (Table 1c). CONCLUSIONS: We found that water vapor thermal therapy has a good performance with a low re-treatment rate, consistent with larger published studies. Men who did require re-treatment of their LUTS from BPH tended to receive more vapor injections and showed significant worsening of voiding symptom scores around 6 months post-operatively. Decreasing the number of vapor injections when possible may help further reduce treatment failure rates. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e698 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Vi Nguyen More articles by this author Michelle C. Leach More articles by this author Clara Cerrato More articles by this author Mimi V. Nguyen More articles by this author Seth K. Bechis More articles by this author Expand All Advertisement PDF downloadLoading ...

Safety and efficacy of extracorporeal shock wave lithotripsy vs. flexible ureteroscopy in the treatment of urinary calculi: A systematic review and meta-analysis.

This study aims to compare the safety and efficacy of extracorporeal shock wave lithotripsy (SWL) and flexible ureteroscopy lithotripsy (f-URS) in treating urinary tract stones. We systematically searched PubMed, Embase, and Cochrane for literature comparing SWL with f-URS. The primary outcomes we focused on were stone-free rate (SFR) and complications; the secondary outcomes were operation time, hospital stay, retreatment rate, number of sessions, and auxiliary procedures rate. We used ReviewManager version 5.4.1 and STATA version 14.2 for meta-analysis. Seventeen studies with a total of 2,265 patients were included in the meta-analysis, including 1,038 patients in the SWL group and 1,227 patients in the f-URS group. The meta-analysis indicated that patients in the f-URS group had higher SFR than those in the SWL group [odds ratio (OR): 2.00, 95% confidence interval (CI): 1.29-3.12, p = 0.002]. In addition, we found no significant difference in complications (OR: 1.08, 95% CI: 0.85-1.37) between the two treatments. Also, we found that the retreatment rate and the auxiliary procedure rate in the f-URS group were significantly lower than those in the SWL group (OR: 0.08, 95% CI: 0.02-0.24, p < 0.00001; OR: 0.30, 95% CI: 0.11-0.83, p = 0.02). Moreover, the number of sessions in the f-URS group was significantly lower than that in the SWL group [mean difference (MD): -1.96, 95% CI: -1.55 to -0.33, p = 0.003]. However, the operation time and hospital stay in the f-URS group were significantly longer than those in the SWL group (MD: 11.24, 95% CI: 3.51-18.56, p = 0.004; MD: 1.14, 95% CI: 0.85-1.42, p < 0.00001). For 1-2-cm urinary stones, f-URS can achieve a higher SFR than SWL while having a lower retreatment rate, number of sessions, and auxiliary procedure rate. For urinary stones <1 cm, there was no significant difference in SFR between SWL and f-URS groups. The SWL group has a shorter operative time and hospital stay than the f-URS group.

Defining minimal invasive surgical therapy for benign prostatic obstruction surgery: Perspectives from a global knowledge, attitude, and practice survey

ObjectiveTo scrutinize the definitions of minimal invasive surgical therapy (MIST) and to investigate urologists’ knowledge, attitudes, and practices for benign prostatic obstruction surgeries. MethodsA 36-item survey was developed with a Delphi method. Questions on definitions of MIST and attitudes and practices of benign prostatic obstruction surgeries were included. Urologists were invited globally to complete the online survey. Consensus was achieved when more than or equal to 70% responses were “agree or strongly agree” and less than or equal to 15% responses were “disagree or strongly disagree” (consensus agree), or when more than or equal to 70% responses were “disagree or strongly disagree” and less than or equal to 15% responses were “agree or strongly agree” (consensus disagree). ResultsThe top three qualities for defining MIST were minimal blood loss (n=466, 80.3%), fast post-operative recovery (n=431, 74.3%), and short hospital stay (n=425, 73.3%). The top three surgeries that were regarded as MIST were Urolift® (n=361, 62.2%), Rezum® (n=351, 60.5%), and endoscopic enucleation of the prostate (EEP) (n=332, 57.2%). Consensus in the knowledge section was achieved for the superiority of Urolift®, Rezum®, and iTIND® over transurethral resection of the prostate with regard to blood loss, recovery, day surgery feasibility, and post-operative continence. Consensus in the attitudes section was achieved for the superiority of Urolift®, Rezum®, and iTIND® over transurethral resection of the prostate with regard to blood loss, recovery, and day surgery feasibility. Consensus on both sections was achieved for EEP as the option with the better symptoms and flow improvement, lower retreatment rate, and better suitable for prostate more than 80 mL. ConclusionMinimal blood loss, fast post-operative recovery, and short hospital stay were the most important qualities for defining MIST. Urolift®, Rezum®, and EEP were regarded as MIST by most urologists.

SMART Registry: Safety and Performance of the Penumbra SMART COIL System for Patients With Intracranial Aneurysms 4 mm and Smaller.

The Penumbra SMART COIL System includes a novel generation of embolic coils composed of complex and WAVE shape properties with varying levels of softness. To assess safety and efficacy of the SMART COIL System through a 1-year follow-up in patients with small intracranial aneurysms. This subset analysis of the SMART Registry, a prospective, multicenter study, includes patients with small intracranial aneurysms (≤4 mm) treated with the SMART COIL System. Registry end points include retreatment rates through 1 year, procedural device-related serious adverse events, and adequate occlusion postprocedure. Of 905 enrolled patients with aneurysms, 172 (19.0%) had small (≤4 mm) aneurysms (75.6% female; mean age 57.2 ± 13.4 years). 30.8% (53/172) of small aneurysms were ruptured, of which 50.9% (27/53) had Hunt and Hess ≥3. 79.5% (132/166) were wide-necked. Stent-assisted coiling and balloon-assisted coiling were performed in 37.2% (64/172) and 22.1% (38/172) of patients, respectively. The mean packing density for very small aneurysms was 44.9 (SD 25.23). Raymond Class I and Class II were achieved in 89.5% (154/172) postprocedure and 97.2% (137/141) at 1 year. The retreatment rate through 1 year was 5.6% (8/142), and the recanalization rate was 7.1% (10/141). The periprocedural device-related serious adverse event rate was 2.9% (5/172). Intraprocedural aneurysm rupture occurred in 0.8% of patients. This analysis suggests that the SMART COIL System is safe and efficacious in small aneurysms with satisfactory occlusion rates and low rates of rupture or rerupture. At 1 year, patients had low retreatment rates and good clinical outcomes.

Aneurysm treatment with the Woven EndoBridge (WEB) device in the combined population of two prospective, multicenter series: 5-year follow-up

BackgroundEvaluating a new endovascular treatment for intracranial aneurysms must not only demonstrate short-term safety and efficacy, but also evaluate longer-term outcomes (eg, delayed complications, anatomical results, retreatment). The current analysis...

Safety and Clinical Effectiveness of Pipeline Shield Device for Intracranial Aneurysms in an Australian Cohort (SCOPE‐AUS)

Background The Pipeline Flex Embolization Device (PED) with Shield Technology (PED‐Shield) is a third‐generation flow diverting stents with surface modification designed to reduce platelet adhesion and thrombogenicity. We report the long‐term safety and effectiveness of the PED‐Shield in the treatment of unruptured intracranial aneurysms in an Australian cohort. Methods SCOPE‐AUS (Safety and Clinical Effectiveness Of Pipeline Shield Embolization Device for Treatment of Intracranial Aneurysms in Australia) is a multicenter, single‐arm, retrospective study of patients with unruptured intracranial aneurysms treated with the PED‐Shield flow diverting stents at 3 high‐volume neurointervention centers in Australia between May 1, 2015, and June 30, 2018, evaluating safety and efficacy. The primary outcome was neurologic adverse event or neurologic‐related death at 1 year, and the secondary outcome was long‐term complete aneurysm occlusion. Results A total of 238 patients (mean age 55.8±11.0 years, 73.1% [174/238] female) and 278 aneurysms were treated via 247 procedures. Two (0.7%) aneurysms were retreated during the 18‐month follow‐up. Overall occlusion rates at 18 months or at last follow‐up imaging were 92.5% (233/252). There were 35 (14.7%) total primary end point events. The 12‐month neurologic morbidity and mortality rates were 3.8% (9/238) and 1.3% (3/238), respectively. For the subgroup of internal carotid artery aneurysms, mortality (0.7%) and morbidity (2.0%) rates were low, and the complete occlusion rate was 92.5% (147/155). Conclusions In this multicenter study, which includes a wide variety of both distal bifurcation and proximal unruptured intracranial aneurysms, the occlusion rates and safety outcomes of the PED‐Shield flow diverting stent demonstrate a high proportion of complete aneurysm occlusion, extremely low retreatment rates, and low complication rates.

Long-Term Outcomes After Vaginal and Laparoscopic Mesh Hysteropexy for Uterovaginal Prolapse: A Parallel Cohort Study (eVAULT).

Data on long-term mesh hysteropexy outcomes are limited. This study provides 7-year data from the original VAULT (Vaginal and Laparoscopic Mesh Hysteropexy for Uterovaginal Prolapse Trial) study. The aim of this study was to compare long-term outcomes and success for laparoscopic sacral hysteropexy (LSHP) and vaginal mesh hysteropexy (VMHP). This multicenter, prospective parallel cohort was an extension to the initial VAULT study. Subjects were contacted, and informed consent was obtained. We collected baseline demographics and the latest Pelvic Organ Prolapse-Quantification examination data from chart review and conducted telephone interviews to update demographic information and collect Pelvic Floor Distress Inventory Short-Form, Patient Global Impression of Improvement, prolapse reoperation/pessary use, and complications. Surgical success was defined as no bulge symptoms, satisfaction score of "very much better" or "much better," and no reoperation/pessary use. Five of 8 original sites enrolled 53 subjects (LSHP n = 34 and VMHP n = 19). The LSHP group was younger (67 vs 74, P < 0.01), but there were no differences in parity, body mass index, menopause, race, insurance, tobacco use, or Charlson Comorbidity Index. The median subjective follow-up was 7.3 ± 0.9 years. Composite success was 82% LSHP versus 74% VMHP. Pelvic Floor Distress Inventory Short-Form composite scores were similar at baseline and improved for both groups (P < 0.01) with lower bother observed in the LSHP group (20.8 vs 43.8, P = 0.01). There were no differences in complications. Over 7 years after surgery, LSHP and VMHP have high success, low retreatment, and low complication rates that did not differ between groups. Although there is a trend toward better anatomic support in the LSHP group, these findings were not significant and we are underpowered to detect a difference.

Safety and efficacy of percutaneous nephrolithotomy in patients with neurogenic bladder

To assess the efficacy and morbidity of percutaneous nephrolithotomy (PNLT) in the treatment of renal stones in patients with neurogenic lower urinary tract dysfunction (NLUTD). Retrospective, monocentric study including all patients with NLUTD who had undergone PNLT between 2005 and 2017. Pre-operative clinical data (neurological condition, voiding mode, preoperative urine culture…), peri-operative and post-operative data (success and morbidity) were collected from the patients' charts. Success was defined by the absence of residual fragment (RF), on imaging or intraoperative endoscopy. Partial efficacy was defined by the presence of RF lower than 4mm. Early complications were reported according to the Clavien-Dindo classification. In all, 53 PNLTs were performed, in 35 patients, mostly with spinal cord injury. The success and partial efficacy rates were 66.0% and 71.7% respectively. The failure rate was correlated with increased stone burden (P=0.03), increased size of the largest stone (P=0.02), and the presence of complex stones (P<0.02). The rate of early complications was 41.5%, with 27.3% major, mostly septic, and bleeding. The retreatment rate within 3 years was 41.5%. In patients with NLUTD, PNLT allows a high success rate, but with a significant rate of retreatment and infectious complications. However, NLPC remains the gold standard in this population, especially for renal stones larger 20mm, allowing a higher success rate than ureteroscopy and a lower retreatment rate.