Ureteral Stent Research Articles

Clinical application and efficacy analysis of robot-assisted laparoscopic tumor enucleation combined with tumor aspiration in the treatment of renal hilar angiomyolipoma

BackgroundFor renal hilar angiomyolipoma, general surgical resection is often quite challenging. The aim of this study is to evaluate the safety and efficacy of an innovative robot-assisted laparoscopic strategy that combines tumor enucleation with tumor aspiration in the treatment of renal hilar angiomyolipoma.MethodsThe clinical data of 38 patients with renal hilar angiomyolipoma who went through robotic tumor enucleation combined with tumor aspiration in the Department of Urology, the Affiliated Hospital of Nanjing University Medical School, from December 2019 to December 2022 were retrospectively analyzed. The basic characteristics, the perioperative variables, intraoperative procedures, and postoperative complications were all recorded. Patients were followed up to evaluate the angiomyolipoma recurrence and the renal function by urologic CT or ultrasound and renal function tests.ResultsAll surgeries were successfully completed without conversion to radical nephrectomy or open surgery. One patient developed urinary extravasation 10 days after surgery, and was readmitted to the hospital for transurethral ureteral stenting considering the injury of the renal collecting system. The median operative time was 181.5 (123.8-206.3) min, the warm ischemia time was 20.0 (17.3–24.0) min, the blood loss was 125 (100.0-262.5) ml, and no patients received blood transfusion during and after surgery. The median hospitalization time was 7.0 (6.0–9.0) days, and the duration of indwelling drainage tube was 2.0 (2.0–3.0) days. The serum creatinine (Scr) on the first day, 3 months, and 6 months after surgery were 55.5 (50.8–62.8) µmol/L, 55.5 (48.0–62.0) µmol/L and 54.0 (51.8–63.5) µmol/L, respectively, and there was no significant difference compared with the preoperative level 56.0 (47.8–60.3) µmol/L. All patients were followed up after surgery, and the urinary CT scan or renal color doppler ultrasound, and renal function were reexamined. The median follow-up time of all patients was 19.0 (14.75-33.0) months, and no local recurrence of angiomyolipoma was seen in all patients.ConclusionsThe surgical strategy of robot-assisted laparoscopic tumor enucleation combined with tumor aspiration is safe and effective in the treatment of renal hilar angiomyolipoma.

UROPOT: study protocol for a randomized, double-blind phase I/II trial for metabolism-based potentiation of antimicrobial prophylaxis in the urological tract

BackgroundUrinary tract catheters, including Double-J or ureteral stents, are prone to bacterial colonization forming biofilms and leading to asymptomatic bacteriuria. In the context of asymptomatic bacteriuria, endourological procedures causing mucosa-inducing lesions can lead to severe infections. Antibiotic prophylaxis is warranted, yet its efficacy is limited by biofilm formation on stents. Biofilms promote antibiotic tolerance, the capacity of genetically susceptible bacteria to survive a normally lethal dose of antimicrobial therapy. The UROPOT study evaluates the effectiveness of a first-in-type metabolism-based aminoglycoside potentiation for (i) preventing infectious complications of asymptomatic bacteriuria during mucosa lesion-inducing endourological procedures and (ii) assessing its anti-tolerance efficacy.MethodsThe UROPOT trial is a phase I/II single-center (Lausanne University Hospital (CHUV), Switzerland) randomized double-blinded trial. Over 2 years, patients with asymptomatic Escherichia coli and/or Klebsiella pneumoniae bacteriuria, undergoing endourological procedures, will be randomly allocated to one of three treatment arms (1:1:1 randomization ratio, 30 patients per group) to evaluate the efficacy of mannitol-potentiated low-dose amikacin compared to established standard treatments (ceftriaxone or amikacin standard dose). Patients will be recruited at the CHUV Urology Outpatient Clinic. The primary outcome is the comparative incidence of postoperative urinary tract infections (assessed at 48 h) between the investigational amikacin/mannitol therapy and standard (ceftriaxone or amikacin) antibiotic prophylaxis, defined by specific systemic symptoms and/or positive blood and/or urine culture. Secondary outcomes include assessing microbiological eradication through anti-biofilm activity, sustained microbiological eradication, and mannitol and antibiotics pharmacokinetics in blood and urine. Safety outcomes will evaluate the incidence of adverse events following amikacin/mannitol therapy and postoperative surgical complications at postoperative day 14.DiscussionUROPOT tests a novel antimicrobial strategy based on “metabolic potentiation” for prophylaxis enabling aminoglycoside dose reduction and targeting biofilm activity. The anti-biofilm effect may prove beneficial, particularly in patients who have a permanent stent in situ needing recurrent endourological manipulations strategies in preventing infections and achieving sustained microbiological eradication in pre-stented patients.Trial registrationThe protocol is approved by the local ethics committee (CER-VD, 2023–01369, protocole 2.0) and the Swiss Agency for Therapeutic Products (Swissmedic, 701,676) and is registered on the NIH’s ClinicalTrials.gov (trial registration number: NCT05761405). Registered on March 07, 2023.

Open vs. laparoscopic vs. robotic pouch excision: unveiling the best approach for optimal outcomes.

Despite advantages for patients with ulcerative colitis, Crohn's disease, and familial adenomatous polyposis, restorative proctocolectomy with ileal pouch-anal anastomosis carries a risk of pouch failure, necessitating pouch excision. The traditional open approach is associated with potential complications. Robotic and laparoscopic techniques are emerging, but comparative outcome data are limited. We conducted a retrospective study of consecutive adult patients undergoing robotic, laparoscopic, and open ileal pouch excision at Mayo Clinic, Rochester, MN, between January 2015 and December 2023. We analyzed data on patient characteristics, perioperative variables, and postoperative outcomes, focusing on short-term complications. Statistical analysis included appropriate tests. The study included 123 patients: 23 underwent robotic-assisted pouch excision, 12 laparoscopic, and 82 open. The robotic approach had the longest median operative time (334 ± 170min, p = 0.03). However, it demonstrated significantly lower estimated blood loss than open (150 ± 200ml vs. 350 ± 300ml, p = 0.002) and laparoscopic surgery (250 ± 250ml, p = 0.005). Robotic and laparoscopic groups required fewer preoperative ureteral stents than the open group (p = 0.001). Additionally, the robotic approach utilized fewer pelvic drainages (p < 0.0001) and had a lower rate of lysis of adhesions > 60min compared to open surgery (p = 0.003). Robotic procedures had significantly lower 30-day postoperative complications than the open approach (30.4% vs. 65.9%, p = 0.002) while also demonstrating fewer 30-day reoperations than the laparoscopic group (p = 0.04). Robotic-assisted pouch excision offered significant benefits, including decreased EBL, reduced need for preoperative ureteral stents, and significantly fewer 30-day postoperative complications compared to open surgery.

Tips for percutaneous nephrolithotomy for transplant kidney stone

IntroductionThe management of urinary tract stones, particularly de novo kidney allograft stones, presents unique challenges for kidney transplant recipients because of their prevalence and specific clinical considerations. Here, we describe a case in which percutaneous nephrolithotomy was successfully used to fragment a large kidney allograft stone ≥20 mm in size.Case presentationA 57‐year‐old woman who underwent ureteroureterostomy post simultaneous pancreas–kidney transplantation presented with gross hematuria after 15 years. Computed tomography revealed a 23‐mm stone in the transplanted kidney. Initial attempts at endoscopic combined intrarenal surgery were changed to percutaneous nephrolithotomy because of poor ureter mobility and tortuosity. Stone fragmentation was achieved using pneumatic and ultrasonic lithotripsy. A second procedure using Swiss LithoClast® Trilogy enabled complete stone clearance and ureteral stent placement.ConclusionBy understanding the peculiarities of the percutaneous approach, we demonstrated the safe and effective use of a pneumatic and ultrasonic lithotripter for kidney allograft stone fragmentation.

Predictors of Failed Outcomes in Ureteral Reconstruction: A Real-World Retrospective Study

Background and Objectives: Ureteral reconstruction is aimed at maintaining ureteral patency without the need for long-term catheters like ureteral stents or percutaneous nephrostomies. Different surgical strategies are adopted based on the etiology, the location of the injury, and the severity of the injury. We aimed to analyze the parameters that can predict which patients might not be free from further catheterization after reconstruction. Materials and Methods: This study included patients who underwent ureteral reconstruction from January 2007 to December 2021. The success of ureteral reconstruction was defined as being free from further catheterization after the operation. Results: A total of 184 patients underwent ureteral reconstruction. Malignant disease with ureteral invasion and iatrogenic injuries accounted for 79.9% of the cases. The majority (79.3%) did not have to undergo subsequent interventions. Predictors for a failed result of ureteral reconstruction included a history of radiotherapy (OR = 2.75, p = 0.01), chronic kidney disease (CKD) (OR = 3.42, p &lt; 0.001), and an upper ureteric location of the injury (OR = 5.68, p = 0.042). Conclusions: A history of radiation therapy, an upper third ureteric location of the injury, and CKD were identified as predictors of a failed ureteral reconstruction. Malignant diseases, surgical methods, and repair techniques did not significantly affect the outcome of the operation.

Transvaginal double-layer parallel in-situ suturing for early complex vesicovaginal fistula repair: Case report.

Complex vesicovaginal fistulas (VVFs) with large defects pose significant surgical challenges. Traditional repair methods often require extensive tissue separation and multilayer suturing, risking local blood supply and healing. This study introduces a novel modified transvaginal repair technique that simplifies the procedure while preserving tissue vascularity. It employs double-layer parallel in situ suturing for early repair of complex VVF. A 50-year-old woman was admitted with continuous vaginal urine leakage for 4 days following trauma. Speculum examination revealed a 3-cm longitudinal oval laceration at the 11 o'clock position in the dorsal lithotomy site, with continuous fluid leakage through the fistula. Self-inflicted complex VVF. The patient underwent prophylactic placement of bilateral double-J stents and continuous catheterization, followed by surgical repair using a modified transvaginal technique involving double-layer parallel in situ suturing. Postoperative evaluations showed successful healing with no urinary leakage. The vaginal sutures were removed on day 24, and follow-up at 1 year confirmed no recurrence of the fistula or lower urinary tract symptoms, significantly improving the patient's quality of life. The modified transvaginal repair technique using double-layer parallel in situ suturing is a simple and effective approach for early repair of complex VVF, highlighting its potential for broader clinical application. Future studies with larger cohorts are needed to validate these findings.

Health perceptions of patients with forgotten double-J stent.

In this article, we aimed to determine the health perceptions of the patients who did not apply for double-J stent (DJS) removal on time and evaluate whether health perceptions impact this behavior. Health perceptions of 22 patients who were treated for forgotten double-J stent (FDJS) between January 2017-October 2020 and 25 patients who applied for DJS removal during the given appointment time in the urology department of Elazig Training and Research Hospital and Elazig Fethi Sekin City Hospital were compared using the "Health Perception Scale". Health perception scale scores in the FDJS group and control group were 62-68 (mean = 64.27±1.75) and 63-68 (mean = 65.36±1.55), respectively. With regard to the sub-factors of the scale, control center scores were 21.86±0.77 and 22.08±1.15; precision scores were 16.54±0.80 and 16.56±0.82; importance of health scores were 12.77±0, 92 and 13.32±0.74; and self-awareness points were 13.04 ±0.72 and 13.48±0.58, respectively. There was a statistically significant difference between the health perception scale in total, importance of health, and self-awareness scores between the two groups. At the same time, there was no difference in terms of the control center and precision scores (p∗=0.029, p∗=0.030, p∗=0.028, p=0.460, p=0.951). Patients' and their families' educational status, income levels and lack of follow-up by healthcare professionals play an important role in forgotten DJS cases and patients' perception of health may also have an impact on this behavior.

Symptomatology and level of satisfaction in patients using the double‐J ureteral stent

AbstractBackgroundUreteral stents are used as temporary or permanent drainage measures for intrinsic or extrinsic occlusions of the upper urinary tract. Their use can cause complications such as urinary symptoms, which consequently impact the quality of life. Therefore, the aim of this study was to analyze the symptoms and level of satisfaction of patients who used the double‐J ureteral stent.MethodsThis article is a cross‐sectional study involving 40 volunteers who had previously undergone a urological procedure that required the insertion of a double‐J ureteral stent. Subsequently, they consulted the urology outpatient clinic and answered a questionnaire designed by the authors.ResultsAccording to the results, the average age of the patients was 43 years old, 75% were female, and 42.5% reported comorbidities, with hypertension being the most prevalent. The wired double‐J ureteral stent was used in 72.5% of patients, and the average length of stay was 6 days. 95% of the patients had complaints related to the use of the double‐J ureteral stent, with colicky abdominal pain being the most frequent symptom (77.5%) and hematuria being the most common urinary symptom (65%), followed by dysuria (62.5%) and urgency (52.5%). Analysis of the level of satisfaction showed that 55% of patients were satisfied and 22.5% were dissatisfied. No statistical significance was found between the incidence of symptoms related to the double‐J ureteral stent and the groups analyzed.ConclusionThis study was able to highlight important features of the symptomatology of patients using the double‐J ureteral stent and the repercussions on satisfaction with its use. Furthermore, it was possible to concluded that the experience of using the double‐J ureteral stent was satisfactory for 55% of the patients.

Ureteric stenting outside of the operation theatre: challenges and opportunities.

To evaluate the safety, efficacy, tolerability, and cost-effectiveness of bedside or office-based ureteric stent insertion. Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses-Protocols (PRISMA-P) and A MeaSurement Tool to Assess systematic Reviews (AMSTAR) 2 guidelines, we searched PubMed/the Medical Literature Analysis and Retrieval System Online (MEDLINE), the Excerpta Medica dataBASE (EMBASE), Google Scholar, Cochrane Central Register of Controlled Trials (CENTRAL), and Dimensions for English-language studies from 1978 to April 2023. Inclusion criteria focused on primary ureteric stent placements outside of the operating theatre (OT). A total of 15 studies involving 2072 stents were included. Success rates for correctly positioned stents in bedside or office-based insertions ranged from 60% to 95.8%, with most studies reporting ≥80% success rates. Common failure reasons included impacted stones and difficulty identifying the ureteric orifice. Pain and tolerability were assessed using various methods, with validated tools indicating moderate pain levels, but most patients would undergo the procedure again under local anaesthesia. Complication rates were generally low, with minor complications such as haematuria or postoperative fever being the most common. Procedural costs were significantly lower in non-OT settings, with estimates indicating savings of up to four-fold. Bedside or office-based ureteric stent insertion is a viable alternative to OT procedures, offering high success rates, manageable pain levels, low complication rates, and substantial cost savings. This approach is particularly advantageous in settings with limited OT access, highlighting its potential for broader adoption in urological practice. Future research should focus on standardising pain assessment methods and randomised studies.

Prophylactic ureteral stent in colorectal surgery: a meta-analysis and systematic review.

Accidental ureteric injury during colorectal surgery is a rare but dreadful event. It is associated with a higher risk of urinary tract infection (UTI) and acute kidney injury (AKI). Prophylactic placement of double J stents could improve ureteral identification and decrease the chance of accidental ureteral injury. We searched MEDLINE, Cochrane, Central Register of Clinical Trials, and Web of Science for studies published until March 2024. Odds ratios (ORs) with 95% confidence intervals (CIs) were pooled with a random-effects model. Statistical significance was defined as p < 0.05. Heterogeneity was assessed using the Cochran Q test and I2 statistics, with p-values inferior to 0.10 and I2 > 25% considered significant. Statistical analysis was conducted in RStudio version 4.4.1. Eleven observational studies were included, comprising 71,784 patients. Among them, 11,723 (16.4%) were submitted to a prophylactic ureteral stent while 59,961 (83.6%) were not. There was no significant difference in ureteral injury between the groups (0.66% vs 0.8%; OR 1.45; 95% CI 0.43-4.87; p = 0.552; I2 = 56%). Prophylactic stent placement was associated with an increase in AKI (1.7% vs. 0.56%; OR 1.54; 95% CI 1.24-1.91; p < 0.001; I2 = 44%), operative time (MD 24.8min; 95% CI 4.9-44.8; p = 0.01; I2 = 91%), and a decrease in mortality (OR 0.11; 95% CI 0.05-0.23; p < 0.001; I2 = 42%). No differences were observed in UTI, hematuria, length of hospital stays, and reoperation. In colorectal surgery, prophylactic ureteral stents were associated with increased AKI and operative time. No significant difference was observed in ureteral injury, UTI, hematuria, length of hospital stays, and reoperation.

Is double-J stent mandatory in complete supine percutaneous nephrolithotomy for adult patients with staghorn renal stones?

It is controversial whether double-J (DJ) stent insertion is necessary in tubeless percutaneous nephrolithotomy (PCNL) for patients with staghorn stones. We compared the outcomes of using ureteral catheters and double-J stents in tubeless complete supine PCNL (csPCNL) of staghorn stones. In this analytical cross-sectional study, from May 2008 to August 2022, 123 patients who underwent tubeless csPCNL were assessed. Patients were divided into two groups by either tubeless csPCNL with DJ stent (Group I; n = 23) or totally tubeless just with perioperative ureteral stent (Group II; n = 100). Demographic characteristics, stone-related factors, perioperative and postoperative parameters were compared in groups. Baseline characteristics were comparable in groups. The operative time in group I was significantly longer than group II (68.26 vs. 55.25min, P = 0.05). However, the duration of hospitalization in Group I was shorter than the other group (1.81 vs. 2.37 days, P = 0.03). Stone free rate was notably higher in Group I (90.5% vs. 79.8.0%) with no statistically significant difference. No significant differences were found in major complications. Patients in Group II had a significantly shorter time to return to normal life (6.48 vs. 7.91day; P = 0.043). Multivariable linear regression showed the preoperative creatinine level and stone size can affect the operative time (P = 0.02). In addition, stone number and underlying disease can affect the length of hospital stay (P = 0.007 & 0.030, respectively). Although not inserting a double J stent after csPCNL has acceptable results, because of higher residual rate in staghorn stone which cause more incidence of renal colic, longer time of hospital stay and return to normal life, inserting DJ stent is recommended.

Double J Ureteral stent removal in children non cystoscopically: A preferred innovation.

Objective: To determine the feasibility of non cystoscopic removal of double J ureteral (DJ) stent using a foley catheter with suture in children in terms of success rate, number of attempts required and complications. Study Design: Cross Sectional study. Setting: Department of Pediatric Surgery, Services Hospital, Lahore. Period: August 2022 to August 2023. Methods: All the children who underwent DJ stent placement for any urological procedure were included if DJ stent was seen in the bladder postoperatively. After informed consent, under sedation and aseptic measures, the foley catheter with suture already passed through its eye, was introduced per urethral after adequate lubrication. The foley was given five to six rotations in clockwise direction for right sided and anti-clockwise for left sided stents respectively and pulled out keeping traction on the suture. In case of three failed attempts, a cystoscope was introduced under general anesthesia and the stent was removed. Successful removal, number of attempts needed, time taken, and post removal complications were noted to determine feasibility of the procedure. Results: Out of twenty patients, 17 patients (85%) underwent successful removal of DJ stent. The failure rate was 15% as three patients required cystoscope assisted removal. In 13 patients (76.5%) DJ stent was removed in first attempt, whereas in 4(23.5%) patients it required two attempts. Mean time taken was 8.83±7.33 minutes. Complications were noted in 2 patients (10%). Conclusion: Removal of DJ stent in children without cystoscope, using a foley catheter with suture is a safe and feasible procedure with a high success rate and should be attempted in selected cases.

Does type of anesthesia during procedural management of suspected renal colic during pregnancy have an impact on preterm birth?

Anesthesia choice during the procedural management of suspected renal colic during pregnancy may vary based on available resources and patient or provider preferences, as there are no specific recommendations. Our objective was to evaluate whether preterm birth (<37 weeks) was associated with anesthesia type, anesthesia timing by trimester, or procedure type. We retrospectively identified pregnant patients who required procedural management with ureteral stent, percutaneous nephrostomy (PCN), or ureteroscopy (URS) for suspected renal colic based on laboratory and imaging findings from 2009-2021 at our center. Analyzed data included anesthesia type (local analgesia only, monitored anesthesia care [MAC], spinal anesthesia, or general anesthesia), trimester of procedure, procedure type, and obstetric outcomes including preterm birth. The study cohort included 96 patients who underwent 231 total procedures, including primary URS, PCN, stent, as well as PCN and stent change. The median gestational age was 38.7 (37.1-39.5) weeks, and preterm birth rate was 15.8%. The most common anesthetic used across all procedures and trimesters was MAC. PCN was associated with the use of less invasive analgesia or anesthesia, whereas endoscopic procedures were more commonly performed with spinal or general anesthesia. Using multivariable logistic regression, procedure type was associated with preterm birth, but not anesthesia type or timing by trimester. Anesthesia type and timing were not associated with preterm birth, and selection may be influenced by resources, clinical scenario, or patient and provider preferences.

Medical dissolution of presumptive upper urinary tract struvite uroliths in 6 dogs (2012-2018).

Minimally invasive approaches are the standard for treatment of upper urinary tract uroliths in humans. To describe the medical dissolution of upper urinary tract uroliths in a series of dogs and report clinical outcomes. 6 female dogs (9 kidneys). Retrospective case series. A review of medical records in dogs that underwent medical dissolution of upper urinary tract uroliths utilizing diet, administration of antibiotics, and double-pigtail ureteral stent(s) placement, when indicated, was performed. Medical management was generally continued for 4 weeks beyond urolith dissolution. Information on biochemical, microbiological, imaging, and clinical outcomes before and after dissolution were recorded. Six dogs (9 kidneys) were included with bilateral (3) or unilateral (3) nephrolithiasis, ureterolithiasis, or a combination. A ureteral stent(s) was placed endoscopically in 5/6 dogs (6/9 kidneys) for obstructive ureterolithiasis (n = 5) or a nonobstructive massive nephrolith (n = 1). All dogs had a positive urine culture of Staphylococcus pseudintermedius with a median urine pH of 7.25 (range, 6.5-8) and 4/5 had pyonephrosis. All dogs had initial evidence of urolith dissolution at a median of 1.1 months (range, 0.42-5.9), with complete dissolution of ureteroliths at a median of 3.9 months (range, 1.5-7.6), nephroliths at 5.3 months (range, 1.5-7.6), and lower urinary tract uroliths at 0.87 months (range, 0.42-5.9). Stents were removed in 3/6 once dissolution was documented. The median follow-up time was 519 days (range, 177-2492 days). Medical dissolution and decompression of upper urinary tract struvite uroliths should be considered a minimally invasive treatment for dogs before more invasive options.

Tubeless ureteroenteric anastomosis in robot-assisted radical cystectomy with intracorporeal urinary diversion does not increase the risk of anastomotic stenosis or postoperative complications.

The objective is to demonstrate that omitting ureteral stent placement in robotic intracorporeal urinary diversion does not lead to increased risk of perioperative complications, namely ureteral strictures or anastomotic leaks. We retrospectively reviewed the records of 68 consecutive patients who underwent robotic radical cystectomy with ileal conduit creation or orthotopic neobladder by a single surgeon between January 2020 and September 2023. Chronologically, the first cohort of patients had ureteral stents placed to bridge the ureteroenteric anastomosis, and in the second cohort, stenting was omitted. Cohort 1 consisted of 28 patients with surgeries performed between January 2020 and April 2021, while cohort 2 had 40 patients who underwent surgery from April 2021 to September 2023. The cohorts were well matched with regard to patient age, gender, ASA score and rate of neoadjuvant chemotherapy. The choice of urinary diversion was left to surgeon and patient preference, and there was no significant difference in the proportion of ileal conduits versus orthotopic neobladders within each cohort. Estimated blood loss, total operative time, inpatient length of stay and pathologic T and N staging did not statistically differ between the cohorts. Overall, there was no difference in the rates of postoperative ileus, ureteral stricture, anastomotic leak, infectious complications, and 30-day readmission rates between the groups. Tubeless ureteroenteric anastomosis in patients undergoing robotic radical cystectomy with intracorporeal diversion does not appear to increase the risk of anastomotic strictures or postoperative complications. Further prospective evaluation is warranted.

Utilizing computed tomography-based renal parenchymal volumes to calculate split renal function in patients with ureteral stricture disease.

Evaluation of split renal function (SRF) is critical for guiding surgical treatment decisions for patients with ureteral stricture disease (USD). We aimed to determine whether computed tomography (CT)-based renal parenchymal volumes may be used to predict SRF in patients with USD. We retrospectively reviewed all patients undergoing surgical management for USD at a single institution from October 2021 to January 2024. Patients who had preoperative nuclear medicine scan (NMS) and CT scan with intravenous contrast that were obtained within six weeks of each other were included. Interval between NMS and CT could be longer if the affected renal unit was drained with ureteral stent and/or percutaneous nephrostomy. Volume measurements were obtained using the 3D Region of Interest (ROI) Tool on Visage®7 Enterprise Imaging Platform (Visage Inc., San Diego, USA) by two investigators that were blinded to NMS derived SRF. Intraclass correlation coefficient (ICC) was used to assess consistency between investigators. Predictive accuracy was assessed using Pearson correlation coefficient (r) and linear regression. 40 of 160 patients met inclusion criteria. There was excellent reliability in calculating renal parenchymal volume between raters (ICC = 0.990). There was a strong linear correlation between estimated CT SRF and NMS SRF (r = 0.912, p < 0.00001). A linear regression model found RObservedSRF = -0.013 + 1.015(REstimatedSRF), with r2 = 0.832. CT-derived parenchymal volume analysis may be used to estimate SRF in patients with USD. This may obviate the need to obtain preoperative renal scans for SRF measurement in selected patients when assessing surgical management options.

Clinical case: intraluminal incision and tandem ureteral stenting in obstructive upper urinary tract uropathy

One of the common causes of urinary retention and pain symptom in urological practice is ureteric stricture. Surgery remains the only effective method of treatment. Currently, the modern minimally invasive operations are the most relevant. Minimally invasive high-tech surgery: percutaneous endoureterotomy followed by the installation of tandem stents demonstrates effectiveness in treatment of recurrent strictures of the upper urinary tract.

Surgical management of obstructing ureteral stones during pregnancy: A systematic review of different techniques.

Renal colic is the most common non-obstetric cause of abdominal pain during pregnancy and is associated with a higher risk of complications in these women. When invasive treatment is required, options are temporary drainage with ureteral stent (JJ) or percutaneous nephrostomy (PCN), or immediate definitive treatment with ureteroscopy (URS). Our goal was to review the safety and efficacy of these procedures in treating urolithiasis during pregnancy. Adhering to the PRISMA checklist guidelines, we searched PubMed, Embase, and Scopus databases for articles on the efficacy and complications of the three procedures in pregnant women. The quality of evidence and risk of bias were evaluated using the Critical Appraisal Skills Programme and the Institute of Health Economics tools. We included 45 articles, totaling 3424 interventions in pregnant women - 2188 URS, 719 JJ, and 517 PCN. URS was the most assessed procedure, with stone-free rates comparable to the non-pregnant patients. The most frequent complications were lower urinary symptoms and infections independently of the intervention. Obstetric complications for all interventions included 167 cases of preterm labor, resulting in 24 premature births. No statistically significant differences in post-operative complications were reported between the procedures in the few comparative studies. Despite the absence of high-quality studies, current evidence suggests that URS, JJ, and PCN are all safe and effective during pregnancy. As most patients submitted to temporary drainage require a second procedure post-delivery, primary URS appears more efficient. Therefore, it is the preferred option unless there are indications for temporary drainage.

Indwelling Urological Device Biofilm Composition and Characteristics in the Presence and Absence of Infection

ObjectiveTo characterize microbial biofilms associated with different device types used in the urological field including ureteral stents, sacral neuromodulation (SNM) devices, penile prostheses, and artificial urinary sphincters (AUS). Materials and MethodsData from four studies, each reporting biofilm composition of a particular device type, were pooled and included for inter-device analysis. Studies recruited adults scheduled for ureteral stent, SNM, IPP, or AUS removal/revision. Device (n=115) biofilms and controls were analyzed with multi-omics approaches, and compositions were compared across device types and clinical factors. ResultsMicrobiota present on each device type was distinct from that of perineal, rectal, or urine flora (p<0.01). Biofilm microbial counts (p<0.001) and diversity (p=0.024) differed by device type. Ureteral stents had greater microbial counts than other device types (p<0.001). Staphylococcus, Pseudomonas, Lactobacillus, Ureaplasma were commonly detected across devices. Device biofilms harbored a greater proportion of Proteobacteria phylum, and the rectal, perineal, and urine flora harbored a greater proportion of Firmicutes. Unique microbe-metabolite interaction networks were identified in presence and absence of infection. Antibiotic resistance genes including sul2 (sulfonamide resistance) and rpoB (rifampin resistance) were detected in biofilms across device types. Biofilm reconstitution in vitro differed by device type from which strains were isolated. ConclusionsUreteral stents, sacral neuromodulation devices, penile prostheses, and artificial urinary sphincters harbored unique microbial and metabolite profiles that differed from those of skin, urine, and rectal flora. The findings of this study set the groundwork for investigation of novel strategies to reduce device-associated infection risk within and outside urology. Data availability statementData are available from corresponding author upon reasonable request.

Super-selective renal artery embolization (SRAE) for iatrogenic and traumatic renal hemorrhage

PurposeTo present the radiological and clinical outcomes of super-selective transcatheter renal artery embolization in patients with renal injury hemorrhage, and share our experience.Methods43 patients with renal injury hemorrhage who underwent 46 SRAEs were enrolled in this retrospective review study. Records, images, and outcomes were reviewed. The individual embolic method and its observed effects were investigated.ResultsAngiography showed free extravasation in 25 angiograms, pseudoaneurysm in 15 angiograms, and arteriovenous fistulas in 1 angiogram. Most patients achieved initial clinical success (38/43, 88.4%), and 41 patients achieved final clinical success (41/43, 95.3%). 9/11 patients who adopted empirical embolization achieved initial clinical success (81.8%). In our study, the combination of PVA particles and micro-coils has emerged as the most commonly utilized material combination (24/46, 52.2%). Significant differences in hemoglobin levels were observed before and after the embolization procedure (p = 0.026, 95%CI: 1.03–15.54). Post-embolization clinical follow-up showed no evidence of recurrent hematuria, progression of hematoma, hypertension, and no reflux of the embolic agent.ConclusionThough SRAE showed satisfactory results across a broad range of renal injury hemorrhage, there are still some aspects that need attention: (1) Surgical procedure should be understood, including the surgical site, access routes, and placement of implants, such as double-J stents. (2) In cases where identifying the bleeding point proves challenging, consider the possibility of an accessory renal artery.Trial registrationChinese Clinical Trial Registry ChiCTR2400085050, Registration Date: 30 May 2024, retrospectively, non-randomized.