Urinary Tract Endoscopy Research Articles

Can COVID-19 pandemic surveillance reduce nosocomial urinary infections in urologic surgery?

Since COVID-19 pandemic spread, strict preventive measures were adopted to reduce the risk of transmission. Antiseptic dispensers for hand hygiene were diffusely available for patients and hospital staff. To investigate the prophylactic role played by the strict antiseptic rules adopted during pandemic, the rates of nosocomial urinary infections in 2019 and 2020 were compared. Patients' clinical pre-operative characteristics, symptoms, fever, and laboratory data were recorded pre- and post-operatively. Urological surgery was classified in five categories: 1. major surgery 2. upper urinary tract endoscopy, 3. lower urinary tract endoscopy, 4. minor surgery, and 5. Nephrostomy and ureteral stenting. Clavien-Dindo complication score was used. Statistical analysis was performed with R 3.4.2 software. Out of 495 patients, 383 (57.1%) underwent surgical intervention in pre-pandemic March-May 2019 period and 212 (42.9%) in the same pandemic 2020 interval. Preoperatively, 40 (14.1%) and 11 (5.2%) and 77 (27.3%) and 37 (17.5%) patients had fever (p < 0.003) and leukocytosis (p < 0.02), in 2019 and 2020 respectively. Urine culture was positive in 29 (10.2%) and 13 (6.2%) patients respectively (p = 0.22). Post-operatively, 54 (19.1%) and 22 (10.4%) patients and 17 (6.1%) and 2 (0.6%) patients showed fever (p < 0.003) and positive urineculture (p < 0.03), in 2019 and 2020 respectively. Preoperative and post-operative clinical and laboratory signs of nosocomial urinary infection showed a statistically significant lower incidence during the pandemic period in 2020. This observation could be ascribed to the strong preventive measures, to the medical staff high adherence to hygiene and the diffuse availability of hand sanitizers.

Paris system in reporting urinary cytology and correlating with follow up histopathological evaluation, in tertiary care hospital

Introduction: Away from diagnostic importance, urinary tract endoscopy is a painful, expensive and time consuming procedure. Now a time, The Paris System for Reporting Urinary Cytology (TPSRUC) has lead to prime changes in the perspective of assessment in urine cytology and pattern of reporting. Our focus in this study was to evaluate the impact of implementing The Paris system in reporting urinary cytology and correlating with follow up histopathological evaluation. Patients &amp; Method: It is a Retrospective study of 6 months duration, from January 2021 to June 2021 using 156 urine samples in Cytology section, Department of pathology at Dhiraj hospital Waghodia. All freshly collected urine specimens were centrifuge, prepared as Thin slides fixed with methanol and stained with Hematoxylin &amp; eosin (H&amp;E) and Papanicolaou stain then evaluated under light microscopy. Results: In total, 156 cytology specimens the sample was composed of 90 (58%) men and 66 (42%) women (the ratio of men to women was 1.4:1).

Is a Safety Guide Wire Necessary for Transurethral Lithotripsy using Semi-Rigid Ureteroscope? Results from a Prospective Randomized Controlled Trial.

Experts recommend us to keep a safety guidewire during the process of upper urinary tract endoscopy, though there is a lack of high-level evidence to support the efficacy and safety of this opinion. This study conducted to compare the outcome of ureteral stone breakage in the presence or absence of safety guidewire. Patients candidate for endoscopic breakage of ureteral stone using a semi-rigid ureteroscope, were randomly assigned in two groups based on keeping a safety guidewire (group1) or removing the guidewire (group2) before the process of breaking ureteral stone by lithoclast. Demographic factors, history of previous stone treatment, kidney function, stone location, symptoms duration and severity were recorded for each patient. Primary outcomes include success rate of stone treatment and secondary outcomes include number of attempts to enter to ureter, success rate of ureteral entry, success rate of stone achievement, stone migration rate and success rate of ureteral stent insertion. The recorded data were entered to the SPSS software and descriptive statistical analysis including power calculation and non-inferiority design for the primary and secondary outcomes, was performed. P-value less than 0.05 was considered significant. From January 2016 till May 2018, 320 patients were randomized with 160 patients in each arm. Considering the cases who were missed due to follow-up loss, there were 153 patients in group 1 and 147 patients in group 2 at the end of the study. Baseline data were equally distributed in both groups. Based on the initial analysis, the studied variables had no significant difference between two groups; though, according to the subgroup analysis of patients with proximal ureter stones, patients in Group 1 had higher rates of ureteral injury comparing to the patients in Group 2 (p=0.03). According to our findings, keeping the safety guidewire through the process of endoscopic stone breakage (stone size: less than 1.5Cm) seems to add no significant benefit to the procedure outcome, while it increases the ureteral injuries in the proximal ureter stones, but not in mid or distal ureter stones.

Ex vivo Comparison of 2 Disposable versus a State-of-the-Art Reusable Ureterorenoscope

Introduction: The success of upper urinary tract endoscopy on one hand and the high cost of purchase and maintenance of the scopes on the other hand have driven the development of disposable digital flexible ureterorenoscopy (fURS). Materials and Methods: We performed an ex vivo comparison of 2 disposable digital fURS from different companies with a state-of-the-art reusable endoscope from another well-established scope manufacturer. The scopes were tested comparing parameters such as instrument handling, irrigation flow, image quality, and deflection. For the disposable scopes, the latter 2 were evaluated both, before and after vigorous stress testing. Results: Expectedly, the most consistent finding among the 3 instruments was the marked decrease on irrigation flow following insertion of a working element, most notably a guidewire. Depth perception and ergonomic handling were comparable in all 3 instruments. Poststress testing revealed a significant loss of upward deflection in both disposable instruments, more so when an auxiliary instrument is inserted into the working channel. However, this did not appear to be the case in downward deflection. Conclusions: To our knowledge, this is the first study that used a vigorous stress testing protocol comparing disposable and reusable fURS. The newer generation disposable scope fared better than the older one. Results are encouraging and indicate that improvements are ongoing and progressing, bringing the quality of disposable scopes to the level that we are used to from our reusable high performance scopes while at the same time avoiding costly damage repairs. Continuous research and evidence-based interpretation of results in the absence of commercial bias are paramount to ensure this ongoing development.

Upper and Lower Urinary Tract Endoscopy Training on Thiel-embalmed Cadavers

To evaluate Thiel-embalmed cadavers as a new training model for urological endoscopy procedures. Twelve urologists performed upper and lower urinary tract endoscopies on 5 different Thiel-embalmed cadavers to evaluate this potentially new training model in urological endoscopic procedural training. Using a 5-point Likert scale, the participants assessed the quality of the tissue and the overall experience of the endoscopy in comparison to a live patient procedure. Thiel-embalmed cadavers have shown to mimic live patient endoscopy of the upper and lower urinary tract in terms of almost identical overall anatomical conditions and manipulation characteristics of the tissue. The mucosa of the urethra and ureters showed similar colors and consistency in comparison to a live patient, whereas bladder mucosa was lacking the visibility of the vessels, thus was unsuitable for identifying any mucosal abnormalities. The flexibility of the muscles allowed for proper patient positioning, whereas the loss of muscle tonus made ureteroscopy more difficult although sufficiently comparable to the procedure done in a live patient. Thiel-embalmed cadavers have already been proven to be a suitable training model for several medical procedures. They are known for preserving tissue color, consistency, and flexibility without the irritant odors or risk of infection, which make them resemble live patients with real-life surgical challenges. The results of our study strongly suggest that despite some minor drawbacks, Thiel-embalmed cadavers are a suitable simulation model for initial training of urethrocystoscopy and ureteroscopy.

LithoVue™: A new single-use digital flexible ureteroscope.

LithoVue™: A new single-use digital flexible ureteroscope.

Suspected venous air embolism during urinary tract endoscopy in a standing horse

Summary During cystoscopy, performed with air insufflation in a standing Argentinian gelding, the horse showed ataxia and fell to the ground with generalised muscular twitching and horizontal nystagmus, tachypnoea and tachyarrhythmia. General anaesthesia was induced. Arterial blood gas-analysis before induction of anaesthesia revealed an increased pH, decreased partial pressure of carbon dioxide and decreased partial pressure of oxygen. Venous air embolism was suspected.

1820 NEW MODIFIED TRAINING MODEL FOR UPPER URINARY TRACT ENDOSCOPY - USING PORCINE URINARY TRACT

You have accessJournal of UrologyStone Disease: SWL, Ureteroscopy or Percutaneous Stone Removal (III)1 Apr 20131820 NEW MODIFIED TRAINING MODEL FOR UPPER URINARY TRACT ENDOSCOPY - USING PORCINE URINARY TRACT Peter Liske, Volker Zimmermanns, and Sven Lahme Peter LiskePeter Liske Pforzheim, Germany More articles by this author , Volker ZimmermannsVolker Zimmermanns Pforzheim, Germany More articles by this author , and Sven LahmeSven Lahme Pforzheim, Germany More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2013.02.2183AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Endourological procedures are of high significance in diagnosis and treatment of upper urinary tract diseases. In order to improve surgical skills it is advisable for the urological surgeon to perform in vitro exercises. So far just two-dimensional training models were available. A new three-dimensional training model using a porcine urinary tract allows to learn and practice endourological techniques close to reality. METHODS The transportable training model consists of a stainless steel torso covered with a neoprene cover. The relief of the retroperitoneum is imitated by a wire grating. The porcine urinary tracts are fixed by use of special granulate material. The urethra is fixed by suturing into a flexible silicone funnel to allow easy access to the urinary tract. All components are easy to clean and provide good hygienic conditions. RESULTS The elastic fixation of the urinary tract allows the use of semirigid and flexible ureterorenoscopes in conditions close to reality. It is possible to prepare the urinary tract with artificial stones to practice the use of holmium laserlithotrypsy. The training model was used successfully in many endourological workshops. So far more than 350 urologists have been trained successfully. CONCLUSIONS The newly developed and modified training model allows to learn and practice endourological techniques close to reality because of its special three-dimensional configuration and the use of porcine urinary tract. It was successfully used in education of urologists. © 2013 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 189Issue 4SApril 2013Page: e748 Advertisement Copyright & Permissions© 2013 by American Urological Association Education and Research, Inc.MetricsAuthor Information Peter Liske Pforzheim, Germany More articles by this author Volker Zimmermanns Pforzheim, Germany More articles by this author Sven Lahme Pforzheim, Germany More articles by this author Expand All Advertisement Advertisement PDF DownloadLoading ...

105 Training of upper urinary tract endoscopy – experience with a new model using porcine urinary tract

105 Training of upper urinary tract endoscopy – experience with a new model using porcine urinary tract

Narrow Band Imaging (NBI) : mise au point sur la technique et expérience initiale pour les tumeurs de la voie excrétrice urinaire supérieure

Endoscopic treatment of upper urinary tract carcinomas (UUTC) is becoming more and more prevalent compared to non-conservative surgery. Our goal was to determine if NBI technology could improve tumour detection. Twenty-seven patients with known or suspected UUTC were prospectively enrolled and treated using the Olympus URF-V flexible ureteroscope. We report 13 new cases (48%) and 14 known cases as follow up (52%). White light and NBI were subsequently performed to examine the upper urinary tract. Visual aspect of the lesions could be compared using both types of light. Biopsies were taken for all apparent lesions prior to vaporization by Holmium laser. Forty-three lesions were detected in 21 patients. Five lesions (14.2%) in four patients were detected through NBI light only among the 35 lesions containing UUTC. Two out of four of these patients were new cases and would not have been diagnosed with white light alone. Three UUTC-treated (8.5%) had extended margins in NBI. Thirteen biopsies (26%) were not valid. Altogether, the tumour detection rate improved by 22.7% in seven patients (25.9%) by using the NBI method. Upper urinary tract endoscopy with NBI light is a new technology that improves visualization of UUCT and enables diagnosis of lesions non visible in white light. This procedure cannot yet be recommended for daily practice and further validation of the technique is required.

THE EFFECT OF FAT AND NON-FAT COMPONENTS OF THE SKIN-TO-STONE DISTANCE ON SHOCKWAVE LITHOTRIPSY SUCCESS

It is the nature of endoscopy to begin with diagnostic applications and then to progress with improvements in technology to therapeutic applications. Retrograde upper urinary tract endoscopy has similar origins. In regard to ureteroscopy, it began with Victor Marshall24 who first described in 1964 the use of a flexible fiberscope placed in the ureter to visualize an obstructing calculus. The therapeutic ureteroscopy of today is based on treating the stone burden by converting it to small passable fragments.4, 23 This progression in technology has continued with the development of new endoscopes and various forms of energy that can be used not only for lithotripsy but also to treat upper tract tumors and ureteral stricture disease.9, 21Current treatment of upper tract calculi is based on focusing shock waves onto a stone and fragmenting it into more easily passable pieces (i.e., Extracorporeal Shockwave Lithotripsy [ESWL]) or on direct endoscopic inspection and conversion of the stone burden into fine dust and small fragments with intracorporeal lithotripsy. Shock wave lithotriptors also have evolved, requiring less anesthesia, in part, because of smaller focal zones and lower delivered energy. With these changes, the indications for treatment have narrowed. Large stones, those associated with high-grade ureteral obstruction, and those for which fluoroscopic localization is difficult, are best treated endoscopically.6 If there is poor fragmentation noted with shock wave lithotripsy, conversion to endoscopic techniques also has a significantly higher success rate with minimal morbidity.19 There has been recent debate on whether most upper tract stones would be treated better in a retrograde endoscopic way, in which there is more certainty of proper fragmentation and clearance.The current treatment algorithm used for those patients with moderately sized, uncomplicated upper urinary tract calculi is based on ESWL monotherapy performed under intravenous sedation. All other stones would represent more complex presentations and should be treated endoscopically.18 If there is a greater anesthetic requirement than intravenous sedation for the shock wave treatment or if placement of a ureteral catheter is required to drain a completely obstructed upper urinary tract, the more definitive endoscopic treatment can be considered rather than pursuing shock wave lithotripsy.The techniques and instrumentation currently used for retrograde ureteroscopic lithotripsy are presented in this article. A large series of ureteroscopic treatments performed with current small-diameter endoscopes also are reviewed. A large, prospectively accrued database of upper urinary calculi treated ureteroscopically with the Holmium laser also is presented to highlight the techniques.

Endoluminal Isoproterenol Irrigation Decreases Renal Pelvic Pressure During Flexible Ureterorenoscopy: A Clinical Randomized, Controlled Study

ObjectivesIrrigation during ureterorenoscopic procedures causes increased pelvic pressure (PP), which may lead to intrarenal backflow with potential harmful consequences. This study aims to investigate PP response to intraluminal administration of isoproterenol (β-agonist; ISO) during flexible ureterorenoscopy. MethodsTwelve patients admitted for retrograde intrarenal stone surgery (RIRS) were included. Patients were randomized to (1) irrigation with saline (n=6) or (2) irrigation with ISO 0.1μg/mL (n=6). Irrigation rate was standardized to 8mL/min. A ureteral catheter was retrogradely placed in the renal pelvis for PP measurements. PP, heart rate (HR), and mean arterial pressure (MAP) were also measured. ResultsBaseline PP was 12.1±4mm Hg in the saline group and 10.3±4mm Hg in the ISO group (p=0.44).In the saline group, PP increased to a mean 33±12mm Hg during ureterorenoscopy. In the ISO group, PP was a mean 19±3mm Hg (p=0.029).During endoscopy, PP peaks as high as 328mm Hg were noted during saline irrigation. The number of pressure peaks above 50mm Hg was minimized dramatically during ISO irrigation (p=0.035). No systemic side effects to ISO irrigation were observed. ConclusionFor the first time, a randomized, controlled human study demonstrates that pharmacologic modulation of the ureter is possible during upper urinary tract endoscopy. The ability to relax ureteral tone during endoscopy may have clinical advantages.

Irrigation with isoproterenol diminishes increases in pelvic pressure without side-effects during ureterorenoscopy: A randomized controlled study in a porcine model

Recently, we showed that endoluminally administered isoproterenol (ISO) inhibits muscle function of the pyeloureter in swine. This may be of value in managing increases in pelvic pressure during upper urinary tract endoscopy. The purpose of this study was to examine the effect of endoluminally administered ISO on increases in pelvic pressure and cardiovascular function during flexible ureterorenoscopy. The study was performed in anaesthetized female pigs. In terms of endoscopic procedures, the pigs were randomized as follows: Group 1, irrigation with 0.1 microg/ml ISO added to saline (n=12); and Group 2, irrigation with saline (n=10). A 5-Fr catheter was retrogradely placed in the renal pelvis and an 8-Fr catheter in the bladder for pressure measurements. Flexible ureterorenoscopy was performed with constant irrigation at a perfusion rate of 8 ml/min. Pelvic, bladder and blood pressure and heart rate were registered continuously. Mean baseline pelvic pressure was identical in both groups: 12+/-2.3 mmHg in Group 1 and 14+/-3.6 mmHg in Group 2 (p=0.26). During ureterorenoscopy, mean pelvic pressure increased to 26+/-2.3 mmHg in Group 1 and to 38+/-3.1 mmHg in Group 2. Hence ISO reduced the pressure increase due to ureterorenoscopy by 42% (p<0.001). Pelvic pressure seemed to be independent of bladder pressure, which showed no difference between the two groups (p=0.067). Blood pressure and heart rate showed no significant differences between the two groups: p=0.425 and p=0.166, respectively. ISO (0.1 microg/ml) added to irrigation fluid significantly reduces the increase in pelvic pressure during ureterorenoscopy in pigs, without concomitant side-effects.

Hematuria esencial unilateral: diagnóstico, tratamiento endoscópico y nuevo algoritmo diagnostico-terapéutico

To perform a long-term evaluation of 15 patients with unilateral essential hematuria, with the aim of determining the causes of bleeding and the response to endoscopic treatment. To design a diagnostic-therapeutic algorithm for patients with unilateral essential hematuria. We retrospectively review the clinical data of 15 patients with unilateral essential hematuria evaluated by rigid ureterorenoscopy (15 cases), flexible ureteropyelocalycoscopy (15 cases) and percutaneous nephroscopy (3 cases). In 4 patients electric fulguration of the pyelocalicial lesions was carried out. 14 of the 15 patients were successfully treated endoscopically. Only one patient presented recurrence of the hematuria. Mean follow-up time was 64 months (4-168 months). No patient suffered any relevant complication secondary to the endoscopic treatment. The cause of bleeding in patients with unilateral essential hematuria is determined only in a few, but endoscopic treatment is successful in a high percentage of cases. We consider that upper urinary tract endoscopy, mainly flexible ureteropyelocalycoscopy, has strongly impacted the diagnosis and treatment of essential unilateral hematuria. We present a new diagnostic-therapeutic algorithm, based on the usefulness of flexible instrumentation.

Improvisation in lower urinary tract endoscopy in a Nigerian tertiary hospital

Improvisation in lower urinary tract endoscopy in a Nigerian tertiary hospital

Reply by the authors

Advancement in flexible ureterorenoscopes (URSs) has expanded the capability of urologists to diagnose and treat most diseases of the upper urinary tract. Since the introduction of the flexible tip in 1983 and the work of Bagley and Rittenberg to determine the optimal tip deflection (175°) necessary to completely explore the intrarenal cavities, the amount of progress in flexible URS technology has increased the access to the intrarenal cavities and, particularly, to the lower pole. In 1994, Grasso and Bagley 1 Grasso M. Bagley D. A 7.5/8.2F actively deflectable, flexible ureteroscope a new device for both diagnostic and therapeutic upper urinary tract endoscopy. Urology. 1994; 43: 435-441 Abstract Full Text PDF PubMed Scopus (105) Google Scholar described and evaluated a two-way deflecting URS with active and passive deflection, and, recently, all manufacturers have provided flexible URSs with complete 270° tip deflection. New-generation flexible ureterorenoscopes are more durable than previous onesUrologyVol. 68Issue 2PreviewTo determine the deterioration in the maximal active deflection and flow capabilities of a new-generation flexible ureteroscope (URS). Full-Text PDF

Endoluminal pelvic perfusion with norepinephrine causes only minor systemic effects and diminishes the increase in pelvic pressure caused by perfusion

To evaluate the effect of endoluminal norepinephrine (NE) on transport pressures of the normal upper urinary tract of the pig and on plasma levels of NE in relation to possible systemic effects. Six anaesthetized pigs weighing approximately 39 kg were studied. Transparenchymally, two 6-F catheters were introduced into the renal pelvis bilaterally to measure pressure and perfusion. Ultrasonic flow probes recorded renal arterial blood flow, and a transurethral 10-F catheter drained the bladder and monitored diuresis. In all six animals, the bilateral pelvic pressure response was examined at increasing perfusion rates (2, 4, 6, 8, 10 and 15 ml/min) and with increasing doses of NE (0, 5, 50 and 100 microg/ml). Arterial blood samples were analysed for NE, epinephrine and blood glucose. The systemic blood pressure, heart rate and electrocardiogram were registered. At all the investigated concentrations, endoluminal NE significantly diminished the increase in pelvic pressure caused by pelvic perfusion at all flow rates. At the lowest concentration of NE, no significant increase in the plasma level of NE was observed and the blood pressure did not increase. During perfusion with 50 and 100 microg/ml NE, plasma levels of NE increased significantly from 487+/-398 to 1798+/-910 and 2961+/-2093 pg/ml, respectively. This was accompanied by significant rises in mean systolic blood pressure from a baseline value of 95+/-10 mmHg to 111+/-20 and 118+/-23 mmHg, respectively. Heart rate, renal arterial blood flow and plasma levels of epinephrine and glucose did not change. Endoluminal NE diminished the increase in pelvic pressure caused by pelvic perfusion even at concentrations too low to cause significant changes in NE plasma levels or systemic effects. Very high NE concentrations in the perfusion fluid caused increased plasma levels and a modest but significant increase in blood pressure. Administration of endoluminal NE may be useful in upper urinary tract stone treatment and endoscopy.

The Fractured Flexible Ureteroscope With Locked Deflection

With technological advances in flexible ureteroscopes upper urinary tract endoscopy has become the standard for diagnosis and treatment of select upper tract stones and urothelial cancers. While flexible scopes have greatly expanded endourological patient care, they require frequent repair. Common malfunctions include loss of deflection, broken optical fibers and working channel damage.1 Fortunately, when these malfunctions occur it is possible to modify or abort a procedure with little risk of complication. We report a case of ureteroscope malfunction in which the ureteroscope locked in a kinked position within the renal pelvis.

Norepinephrine Inhibits the Pelvic Pressure Increase in Response to Flow Perfusion

We evaluated the effects of norepinephrine on transport pressures in the normal upper urinary tract of the pig during increasing perfusion rates. Anesthetized Danish landrace Yorkshire pigs weighing 38 to 40 kg were studied. Transparenchymally 2, 6Fr catheters were introduced into the left renal pelvis for pressure measurements and perfusion, respectively. An ultrasonic flow probe was inserted around the left renal artery to record blood flow. A 10Fr catheter was placed transurethrally for bladder drainage and the bladder was maintained empty during the entire study. In the 5 group 1 pigs the pelvic pressure increase was examined at increasing perfusion rates of the renal pelvis (2, 4, 6, 8, 10 and 15 ml per minute) in response to endoluminal administration of increasing concentrations of norepinephrine (0, 5, 50 and 100 microg/ml) in saline. In the 5 group 2 pigs the pressure flow study was also done 4 times per animal using isotonic saline. Endoluminal norepinephrine had a dose dependent effect on the pressure flow relationship. Perfusion with 5 and 50 microg/ml norepinephrine caused a delayed increase and a decrease in pelvic pressure in response to increasing flow rates, whereas perfusion with 100 microg/ml norepinephrine significantly inhibited and almost eliminated the pressure increase at all perfusion rates compared with saline perfusion. Importantly there were no changes in blood pressure, the heart rate or renal arterial blood flow. In group 2 perfusion with isotonic saline resulted in the same pressure response to increasing flow rates each time. Endoluminal administration of norepinephrine caused a dose dependent inhibition on the pressure phases of the pressure flow relationship of the upper urinary tract in pigs. No systemic changes were observed. These observations may provide a useful adjuvant treatment strategy for upper urinary tract stone treatment and endoscopy.

Virtual reality surgical simulation for lower urinary tract endoscopy and procedures.

To provide a realistic experience of lower urinary tract endoscopic procedures, we have developed and continue to expand a computer-based surgical simulator that incorporates a surgical tool interface with anatomic detail and haptic feedback. Surface-based geometric data for the lower urinary tract were generated from the National Library of Medicine Visible Human dataset. The three-dimensional texture map of the surface geometry was developed from recorded endoscopic video procedures. Geometry and associated texture maps were rendered in real time using the Silicon Graphics Extreme Impacts program. The surgical interface device incorporated all normal ranges of motion and resistance that occur within an actual operative environment. The hands-on endoscopic device attached to the interface device was provided by Circon-ACMI, Inc. Urologic residents evaluated the program for correlation with actual endoscopic procedures. Texture-mapped digitized images provided a close anatomic similarity to actual videoendoscopic images. Virtual endoscopy of the lower urinary tract was reproducible and closely simulated actual visual and tactile endoscopic experience. Virtual reality surgical simulation is feasible for a variety of lower urinary tract procedures. This system coordinates visual perception with appropriate haptic feedback in both longitudinal and rotational axes. These types of procedures may be incorporated into future educational experiences for urologists to introduce new techniques and to provide documentation of surgical experience.