Urological Intervention Research Articles

Which combination of medical expulsive therapy is more effective for treatment of distal ureteral stone in adults? A systematic review and network meta-analysis

BackgroundMedical Expulsive Therapy (MET) has been recommended as an established modality for the treatment of distal ureteral stones due to its clearance rate, pain control, and patient satisfaction while having minimal morbidity in comparison to other urologic interventions. In some studies, a combination of medications has been used, which we assessed in this network meta-analysis (NMA).MethodsWe conducted systematic searches in PubMed, Scopus, and Web of Science to identify relevant trials published between 2001 and 2024. We excluded articles that looked at MET for upper ureteral stone passage or after shock wave lithotripsy (SWL). NMA was performed to compare the effect of combination MET on stone expulsion rate (SER), stone expulsion time (SET), and need for analgesia.ResultsWe included 19 studies with 2414 participants. NMA results revealed that the combination MET of α-blockers with PDE-5 inhibitors (OR = 2.7, CI = 1.80,4.05), corticosteroids (OR = 2.7, CI = 1.81,4.13), and phytotherapy (OR: 3.10, CI = 1.62,5.92) were more effective than α-blockers alone in SER. The combination MET of α-blockers with PDE-5 inhibitors (MD: -3.8, CI=-7.0, -0.5) showed significantly lower SET compared to α-blockers alone. Finally, combination MET of α-blockers with PDE-5 inhibitors (MD:1.0, CI = 0.4,1.7) and nifedipine with corticosteroids (MD:1.2, CI = 0.4,1.9) showed a significant decrease in analgesia use.ConclusionsThe combination MET of α-blockers with PDE-5 inhibitors, corticosteroids, and phytotherapy increases the rate of stone clearance 2.7 to 3.1 times more than α-blockers alone. The other benefits of combination MET were lower expulsion time and less analgesia use that needs further studies.

The role of ultrasound combined with water bath in the establishment of animal models of rat urethral stricture

Urinary tract injuries represent a significant clinical challenge, necessitating precise diagnosis and effective treatment strategies. Rat models are preferred for studying urinary tract injuries due to their size, visibility of external genitalia, and robust reproductive and growth capabilities. However, there is a lack of standardized methodologies for evaluating the endpoints of rat urinary tract injury models. This study aimed to investigate the methodology of model establishment, imaging evaluation techniques, and endpoint effectiveness. Twenty-four male Sprague-Dawley rats were randomly assigned to groups, including a blank control group and surgical groups. The surgical groups underwent urethral injury induced by recombinant transforming growth factor-β1 (TGF-β1) solution, followed by the random selection of one surgical group (n = 6) to receive treatment with mesenchymal stem cell (MSC) exosomes. High-frequency ultrasonography using a GE E10 device combined with a water bath method was employed to evaluate the urethral conditions of all rats. Ultrasonographic characteristics were scored for all surgical group rats, and an intergroup analysis was conducted between the surgical group and the control group rats. Statistical analysis was conducted using SPSS 22.0 software. Ultrasonographic assessment revealed significant differences in urethral echogenicity between the normal group and the surgical group, with noticeable changes in urethral morphology post-injury. Histopathological examination confirmed more severe urethral stenosis in the TGF group compared to the MSC group. High-frequency ultrasound could effectively differentiate between the two groups of rats. Additionally, there were significant differences in the scoring of ultrasonographic characteristics between the two groups. Urethral stricture presents a complex challenge in urology, often requiring invasive treatment modalities. The establishment of animal models plays a crucial role in understanding and addressing this condition. TGF-β1 induced fibrosis and MSC therapy represent promising avenues for urethral stricture management. High-frequency ultrasound combined with the immersion method offers a non-invasive and cost-effective approach for evaluating rat urethral stricture models. This study highlights the practicality of high-frequency ultrasound combined with the water bath method in evaluating rat urethral stricture models, as it can effectively differentiate between rats in the pure TGF-β1 induced group and those in the MSC treatment group based on urethral changes. The results underscore the importance of standardized methodologies for model assessment and the potential of non-invasive imaging techniques in preclinical research. Overall, this study contributes to advancing our understanding of urinary system injuries and holds implications for future therapeutic interventions in urology.

Feasibility of robot-assisted system for navigated needle positioning in the PCNL procedure in vitro.

The objective of this study was to explore the feasibility of using the TianJi Robot system for navigated needle positioning in the PCNL procedure in vitro. A pig kidney with a segment of ureter was selected as the in vitro organ model. Iodine contrast agent was infused into the renal pelvis to dilate the renal pelvis and calyx to establish the in vitro hydronephrosis model. Fluoroscopic images were obtained using a 3D C-arm and transferred to the robotic workstation. Three-dimensional reconstructed images were generated and displayed on the monitor screen. The surgeon planned the optimal puncture trajectory on the workstation. After that, the robotic arm was instructed to move to the surgical field. The guiding cannula was placed onto the robotic arm and brought close to the skin. The needle was placed along the guiding cannula. An 18G needle was inserted manually. Finally, a second CBCT scan was performed to validate the needle's location. Three hydronephrosis models were used in the study, and a total of seven target calyces were planned. six target calyces were successfully punctured in one attempt, with a single-puncture success rate of 87.5%. A high single-puncture success rate is achieved using the TianJi Robot system for navigated needle positioning in the PCNL procedure in vitro, marking an innovative step forward in urological interventions.

Assessing surgeon stress during urological interventions: a descriptive study using heart rate variability (uRRology)

Introduction: In a difficult environment like surgery with continuous exposure to stress, surgeon’s health and wellbeing is affected. The heart rate variability (HRV) is a valid stress indicator. This study aims to provide descriptive data regarding stress during urological intervention using HRV.Methods: This prospective, unicentric study, included urological interventions from June to December 2023. Surgeons were surveyed on general characteristic, and surgical skills level. Beat-by-beat heart rate (HR) recorded using POLAR A300® chest belt. HRV were analyzed in time (mean HR and the root mean square of successive differences -RMSSD) and frequency (Fast Fourier Transformation Spectrum High frequency FFT spectrum - HF) domain. Their baseline collected outside the operating room, 3 events during intervention examined: incision, closure, and adverse events. Visual stress and difficulty scale during intervention were completed. The differences between baseline and events were calculated.Results: A total of 171 urological interventions included. Senior surgeons performed 54 (31.58%) and juniors 117(68.42%). During interventions, seniors had significantly higher median difference of HR (incision: -11.92[12.74] bpm versus -2.27[10.99] bpm for juniors, p=<0.0001; closure: -10.73[13.71] bpm, versus -4.18[12.30] bpm for juniors, p=0.0005), lower HF (incision: 0.01[0.07] hz, versus -0.006[0.03] hz for juniors p= <0.0001; closure: 0.02[0.06] hz, versus 0.00[0.02] hz for juniors, p=<0.0001), and lower RMSSD (incision: -3.34[13.09] ms for seniors versus -7.63[10.57] ms for juniors, p=0.0098). No significant difference in RMSSD during closure (p=0.2049).Conclusion: Study demonstrated the possibility to assess HRV in standard medical practice, senior surgeons experienced more physiological changes during interventions.

Do Emergency Department Observation Units Help Prevent Revisits for Patients with Renal Colic?

Renal colic is generally considered a diagnosis appropriate for discharge home once pain is adequately controlled and no other admission criteria are met. The increasing prevalence of ED observation units (EDOU) represent another disposition option for patients with renal colic. In this study, we sought to describe the rates of 14-day revisits for renal colic among patients placed in an EDOU as compared to those discharged from the ED. This is a retrospective observation study of ED patients with renal colic between 2016 and 2024. Adult patients 21years and older with renal colic were included. Patients were excluded if they were admitted to the hospital during their ED visit. The cohort was divided into those who were discharged from the ED and those who were placed in an EDOU. The primary outcome was the rate of 14-day ED revisits for renal colic after discharge. We also describe the rate of 14-day "serious" ED revisits, defined as a revisit that required admission to the hospital or required urological intervention. N=1836 patients were included; 1376 in the ED discharge cohort and 460 in the EDOU cohort. Patients in the ED observation cohort were more likely to have a larger stone size (>5mm), moderate-severe hydronephrosis, and a proximal stone location (ureteropelvic junction or ureteral) but were otherwise demographically similar. The overall rate of 14-day revisits in the cohort was 162 (8.8%), 119 (8.6%) in the discharge cohort and 43 (9.3%) in the EDOU cohort (difference=-0.7%, 95% confidence interval-3.7% to 2.3%). The rate of serious 14-day revisits was 64 (3.8%), 47 (3.4%) in the discharge cohort and 17 (3.7%) in the EDOU cohort (difference=-0.3%, 95% confidence interval-2.2% to 1.7%). We did not identify a difference in 14-day revisits or serious revisits for patients with renal colic who were placed in an EDOU compared to those who were discharged from the ED. However, we found that patients placed in the EDOU had higher-risk stone features (size, location, degree of obstruction), and yet despite this, had similar rates for revisits.

Results of surgical treatment of infective endocarditis complicated by acute heart failure

Objective. To evaluate the results of surgical treatment of infective endocarditis complicated by acute heart failure. Materials and methods. The clinical data of 72 patients with infective endocarditis complicated by preoperative acute heart failure who underwent cardiac surgery at the Amosov National Institute of Cardiovascular Surgery of the National Academy of Medical Sciences of Ukraine from 01.01.2019 to 30.12.2022 were studied. All patients were assigned to functional class IV according to the functional classification of the New York Heart Association. Results. The average duration of infective endocarditis from its first signs (hyperthermia above 38 °C) to diagnosis was 2 months (2; 4 months). Among the causes of infective endocarditis, bronchopulmonary diseases dominated – 24 (33.3%) observations, general surgical interventions – 7 (9.7%) and hospital infection – 7 (9.7%). Urologic surgical interventions caused the development of infective endocarditis in 6 (8.3%) patients, hypothermia in 4 (5.6%), drug addiction in 4 (5.6%), and dental procedures in 1 (1.4%) patient. In 19 (26.4%) patients, the causes of infective endocarditis were not established. In 62 (86.1%) patients, a multi–valve correction was performed, and in 10 (13.9%) – a single–valve correction. The most common were two main options: aortic valve prosthetics in combination with mitral and tricuspid valve surgery in 13 (18.1%) patients and mitral and tricuspid valve surgery in 14 (19.4%) patients. Surgical intervention for combined lesions of the valvular apparatus of the left and right heart was performed in 51 (70.8%) patients with infective endocarditis complicated by acute heart failure. Frequent intracardiac abscessing – in 20 (27.8%) patients with aortic valve lesions and in 9 (12.5%) patients with mitral valve lesions – indicated a high rate of extensive infection spread. Hospital mortality in the surgical treatment of infective endocarditis complicated by acute heart failure was 13.9%. 10 patients died. Conclusions. In 96.1% of patients with infective endocarditis complicated by preoperative acute heart failure, multivalve surgical correction was performed. In the initial acute heart failure in the setting of infective endocarditis, intracardiac abscessing was often recorded: 27.8% in aortic valve lesions and 12.5% in mitral valve lesions. Hospital mortality in the surgical treatment of infective endocarditis complicated by preoperative acute heart failure was 13.9%.

INTEGRATING A VIRTUAL REALITY MASK IN FUNCTIONAL UROLOGICAL SURGERIES UNDER LOCAL ANESTHESIA: A PROSPECTIVE COHORT STUDY ON UTILITY AND SATISFACTION

OBJECTIVESTo evaluate the safety and efficacy of a virtual reality (VR) mask as a distraction tool during minimally invasive functional urological interventions as part of the local anesthesia protocol. METHODSThis is a single-centre prospective observational pilot cohort study which included all consecutive patients undergoing intradetrusor botulinum toxin injection, sacral neuromodulation, and urethral bulking agent injection with combined anesthetic protocol composed by local anesthesia and a VR mask (Hypno VRTM virtual reality mask, Strasbourg, France). Preoperative and postoperative evaluation included the State-Trait Anxiety Inventory (STAI) index. Intraoperatively, a 4-point Likert anxiety rating scale and a visual analog scale (VAS) pain score were assessed. Vital signs were measured preoperative and intraoperatively. Postoperatively, two questionnaires exploring patient satisfaction were administered. The evaluated outcomes were the tolerability of the device and patient’s reported intraoperative pain and anxiety. RESULTSThirty-nine patients were included. Mean age was 64 years. Eleven patients (28%) were affected by neurological conditions. Two patients experienced subjective discomfort. Preoperative and intraoperative mean arterial pressure was 105 and 111 mmHg (p=0.01), respectively. Preoperative and intraoperative mean heart rate was 72 and 75 bpm (p=0.12), respectively. Preoperative and postoperative STAI index were 34.8+-10 and 32.8+-10.3 (p=0.88). Mean Likert anxiety scale value was 2.2+-1.1, mean intraoperative VAS score was 5.3+-2.5. Thirty-four (87%) patients declared themselves satisfied with the surgical procedure and 36 (92.3%) patients would have recommended the same procedure to a relative. CONCLUSIONSVirtual reality mask may play a role in reducing pain and anxiety in minimally-invasive functional urological interventions.

Lower Urinary Tract Symptoms in Mental Illness: A Topic Modeling Approach to Online Mental Health Communities.

This study aimed to provide foundational data to enhance integrated interventions by gaining an in-depth understanding of the perceptions of patients experiencing both mental illness and lower urinary tract symptoms (LUTS), which carry a high risk of comorbidity and potential mutual exacerbation. Data were collected from a large online mental health community in South Korea, active among individuals with mental illness and their families (as of October 21, 2024: 113,060 members and 368,352 posts). Posts containing the keywords 'pee' or 'urine' (a total of 986 posts) were analyzed including their titles, content, and categories. Analyses included word cloud, latent Dirichlet allocation topic modeling, category frequency analysis, and qualitative analysis. The findings indicate that among individuals with mental illness, LUTS are perceived as side effects of psychiatric medications and regarded as inevitable. Many patients attempted self-regulation or discontinuation of medication instead of seeking urological treatment, but these attempts often led to failure. The study revealed that participants used the community to explore the relationship between LUTS and mental illness. LUTS had negative impacts on family and social life, and urinary incontinence exacerbated emotional distress such as self-blame and despair. Patients with mental illness experiencing LUTS often engage in self-regulation or discontinuation of medication. It underscores the need for accurate information and warnings about risks. As these patients endure discomfort and frustration in daily life, symptom deterioration is likely and necessitates proactive urological intervention to improve their quality of life. This study enhances understanding of the impact of co-occurring mental illness and LUTS and highlights the need for proper information and guidance. However, it has limitations including reliance on self-reported data and limited sample representativeness. Future research can address these issues by linking medical diagnoses with objective data and expanding the sample size.

The Stockholm Spinal Cord Uro Study: Changing patterns of urological surgery in a regional prevalence group through 50 years - Outcomes and lessons learned.

To examine the number and types of urological surgical procedures carried out in a regional prevalence population of patients with traumatic spinal cord injury (SCI) during five decades, evaluate objective and patient-reported outcomes and to consider lessons learned for further improvement of surgical treatment in this patient group. In a cross-sectional study of 412 patients with traumatic SCI, one-third had undergone urological surgery through a period of up to 50 years. Data on types of surgery, complications, follow-up and outcomes were collected in a retrospective review of patient files. S-creatinine, S-cystatin-C, renal ultrasound and a questionnaire regarding complications during the preceding year were assembled as part of a yearly follow-up. Descriptive statistics were calculated. Logistic regression was used to determine risk profiles for the incidence of urological surgery. A total of 137 patients had undergone 262 urological surgical interventions. The incidence was highest amongst persons with a cervical-thoracic neurological level of spinal cord lesion and during the first 2 years after SCI. Surgery for urinary stones constituted 29% of all procedures. One-fourth of the patients had undergone 47% of all procedures, notably urinary diversion and ensuing complications, implants and revisions, repeated stone interventions or bladder outlet procedures. After reconstructive surgery functional outcomes and patient-reported satisfaction were generally favourable, but long-term signs of renal complications were frequent. Urological surgery after SCI involves imperative as well as reconstructive procedures, some of which are challenging and call for centralisation to devoted teams. Prospective studies of reconstructive urology are warranted, including more extensive patient-reported outcomes.

Clinical Significance of Perinephric Fluid Collection in Patients with Renal Colic and Urolithiasis: A Retrospective Analysis

Background: Perinephric fluid is commonly identified in patients with renal colic and urolithiasis, especially in cases associated with hydronephrosis. However, its clinical relevance, particularly its impact on treatment decisions and prognosis, is not well established. Methods: This retrospective, single-center study included adult patients who presented to the emergency department (ED) with suspected renal colic between January 2021 and October 2023. Patients underwent ultrasound evaluations, which were analyzed for perinephric fluid, hydronephrosis, stone size, and stone location. Data on patient demographics, laboratory results, and clinical outcomes, including the need for urological interventions, were also collected and analyzed. Multivariate logistic regression was used to assess factors associated with perinephric fluid presence. Results: Of the 509 patients included, 200 (39.3%) had perinephric fluid. Hydronephrosis was significantly associated with perinephric fluid (OR: 4.14, p = 0.007), as were stones located in the proximal (OR: 3.06, p = 0.003) and distal ureter (OR: 2.31, p = 0.018). However, sonographic perinephric fluid did not significantly affect the likelihood of urological intervention, in-hospital complications, sepsis, acute kidney injury (AKI), acute kidney disease (AKD), and prolonged hospital stay. Conclusions: Perinephric fluid is a common finding in patients with renal colic and urolithiasis, particularly in cases involving hydronephrosis and ureteral stones. However, despite its prevalence, sonographic perinephric fluid was not significantly associated with the need for urological intervention, longer hospital stays, or worse clinical outcomes. Further prospective studies are required to clarify its clinical implications fully.

Efficacy and Tolerability of Tadalafil 5mg Once Daily versus Darifenacin for Ureteric Stent Related Symptoms

Abstract Background After almost five decades of internal ureteral stenting, this endourological standard procedure is still associated with a clear side-effect profile. Thus, ureteral stents should be avoided whenever possible, and removed as soon as possible. However, ureteral stenting remains unavoidable in a considerable number of our patients. In these cases, a proper stent length should be chosen, and patients should be informed thoroughly about potential side-effects and treated with a1-blockers or antimuscarinics. Aim of the Work The aim of the present study was to analyze and compare the safety and efficacy of darifenacin versus tadalafil in the relief of ureteric stent related symptoms. Patients and Methods This is a randomized comparative blind cross over study conducted on 150 patients admitted in the department of Urology in Ain Shams University Hospitals, All patients underwent DJ stenting after urological interventions were enrolled in the study, according to inclusion and exclusion criteria, 150 patients were included in The study which were randomly divided one by one in to 2 groups 75 patients each The study was divided into two parts each part last for 3 weeks, in the 1st part of the study Group 1 received Tadalafil 5 mg tab once daily orally and Group 2 received darifenacin 7.5 mg once daily orally and then treatment stopped for one week for wash out of the drug. In the 2nd part of the study the two groups switched as follow: Group 1: received darifenacin 7.5 mg tab once daily orally and Group 2: received Tadalafil 5 mg tab once daily orally. Results Which was proved in the 2nd part of the study after wash out period (one week) as patients in group 1 which was converted to darifenacin 7.5 mg were found better than patients in group 2 which was converted to tadalafil 5 mg as regard sense of incomplete emptying with mean score (1.88 ± 0.88vs 4.24 ± 0.71), regarding frequency there was improvement in group 1 than in group 2 with mean score (1.44 ± 0.83 vs 4.12 ± 0.75), as regard urgency there was improvement in group 1 than in group 2 with mean score (1.8 ± 0.82vs 3.99 ± 0.76), as regard nocturia there was improvement in group 1 than in group 2 with mean score (0.97 ± 0.7vs 3.52 ± 0.78), and as regard pain there was improvement in group 1 than in group 2 with mean score (2.45 ± 0.58vs 2.71 ± 0.65). Conclusion The study showed highly significant improvement of ureteric stent related symptoms in favor of Darifenacin 7.5 mg when compared with tadalafil 5mg. Both of these medications demonstrated a good safety and tolerability profile for medical improvement therapy in patients with ureteric stents.

Extraperitoneal robot-assisted radical prostatectomy by the da Vinci and Versius System: first comparative analysis.

Robotic-assisted surgery (particularly with the da Vinci Surgical System) has revolutionized urological interventions. The advent of the Versius Surgical System introduces a compelling alternative. This study compares outcomes of extraperitoneal robot-assisted radical prostatectomy (eRARP) using da Vinci and Versius, presenting the largest case series to date. A retrospective analysis of 106 consecutive patients undergoing eRARP (July 2021-July 2023) with da Vinci and Versius. Surgical techniques involved extraperitoneal approaches, with a single surgeon ensuring consistency. Baseline characteristics, perioperative outcomes, and pathology results were analyzed. Baseline characteristics were comparable between da Vinci and Versius groups. While no significant differences were observed in overall operative time, estimated blood loss, and length of hospital stay, variations were noted in pelvic lymphadenectomy rates and nerve-sparing procedures. Pathology results revealed no significant disparities in International Society of Urological Pathology (ISUP) grades and positive surgical margins. However, a notable difference emerged in pathological N stage, with Versius showing a higher percentage of positive lymph nodes. This study provides a comprehensive comparative analysis of da Vinci and Versius in eRARP, representing the largest case series to date. While overall outcomes were similar, nuances in lymphadenectomy rates and Pathological N stage merit attention. Ongoing research and longer-term follow-up will refine our understanding, guiding urological surgeons in optimal robotic system selection.

Analysis of a newly developed multidisciplinary program in the Middle East informed by the recently revised spina bifida guidelines.

This paper describes the development and characteristics of a multi-disciplinary spina bifida clinic in Qatar considering the recently revised and globally available Guidelines for the Care of People with Spina Bifida (GCPSB). A retrospective chart review was performed on individuals in Sidra's multidisciplinary spina bifida clinic database from January 2019 to June 2020. Their electronic health records were reviewed for demographics, as well as neurosurgical, urologic, rehabilitation, and orthopedic interventions. There were 127 patients in the database; 117 met inclusion criteria for diagnoses of myelomeningocele, meningocele, sacral agenesis/caudal regression, and/or spinal lipoma. Generally, Qatar is following GCPSB recommendations for multidisciplinary care. Consanguineous relationships, difficulties with access to urological and rehabilitation supplies and equipment, school access, and variable timing of neurosurgical closure were areas that demonstrated differences from GCPSB recommendations due to barriers in implementation. The GCPSB recommendations are applicable in an international setting such as Qatar. Despite a few barriers in implementing some of the recommendations, this new multi-disciplinary spina bifida clinic demonstrates alignment with many of the GCPSB guidelines.

Intraoperative teamwork and occupational stress during robot-assisted surgery: An observational study

Robot-assisted surgery (RAS) differs from traditional OR set-ups in several ways such as operation of technology and obstructed team communication that potentially affect surgical staff's stress experiences. The current study investigates the effects of key intraoperative job demands and resources on mental workload and perceived stress in RAS. We focused on the role of intraoperative teamwork as a resource that potentially reduces occupational stress. Combining standardized expert observations in the OR with healthcare providers' self-reports, the study involved two types of robot-assisted, urological interventions. The sample consisted of 73 observed surgeries and included 242 post-operative surveys on perceived stress and mental workload from surgeons and surgical nurses. Multilevel regression analyses reveal differential effects for stress and workload. Importantly, whereas better surgical teamwork was associated with lower stress, it was unrelated to workload. Our findings provide a nuanced picture of occupational stress in RAS, particularly regarding the role of intraoperative teamwork.

(158) UTILITY OF PRIMARY CARE PHYSICIANS IN A UROLOGY MEN’S HEALTH CLINIC

Abstract Introduction Urology clinics may receive consultation referrals for clinical issues which do not require surgical specialist management. Additionally, with ongoing expansion of therapeutic options in men’s health, referring family medicine physicians may not be aware of all potential treatment modalities. Delayed time from referral to specialist consultation represents a significant issue in Canadian healthcare. Common referrals from general practice for urology assessment includes erectile dysfunction and testosterone deficiency. Multidisciplinary clinics enable access to care for various men’s health concerns where some may not require urologic surgeon specialist intervention. Objective We aim to assess whether men’s health trained primary care providers (PCPs) with foundational training in men’s health working within a multidisciplinary clinic can address common urologic referrals and reduce the need for specialist management of urology clinic referrals. Methods A retrospective chart review was performed involving all patients referred by personal primary care providers to urology who were screened by a urologist as appropriate for initial consultation by a PCP at a multidisciplinary men’s health clinic from January 2022 to January 2023 in Winnipeg, Canada. Patient demographics, medical concern, management, time from referral to treatment, and need for urologist follow-up was captured. There were no inclusion or exclusion criteria. Results A total of 419 patients were identified. Treatment data for all were collected. 331 patients (79%) were managed by an in-house PCP alone and 88 (21%) required urologist consultation following PCP assessment. De novo erectile dysfunction, low testosterone and orchalgia were the most common issues triaged to PCP initial management. Issues managed by PCP also included penile curvature, functional sexual concerns and lower urinary tract symptoms. Male infertility, penile curvature, and orchalgia were the most prevalent conditions requiring subsequent urologist referral. PCPs were able to initiate non-surgical therapies in a majority of patients. In analysis of treatment by primary referral medical concern, 100% of low testosterone, 96% of erectile dysfunction, and 82% of orchalgia were managed at the PCP level alone and did not require urologic surgeon assessment. Conclusions PCPs in a multidisciplinary clinic can provide care for a range of urologic issues and reduce need for urologist consultation. This study demonstrates the utility of PCPs in optimization of urologist consultation. Presenting issues may be predictive of the need for urologist referral. Disclosure No.

(150) GOOGLE TRENDS: TEMPORAL INTEREST IN MALE PENILE ENHANCEMENT AND ASSOCIATIONS BETWEEN MEDIAN INCOME, LITERACY RATES, AND GEOGRAPHIC INTEREST

Abstract Introduction Dermal fillers such as hyaluronic acid (HA) or polylactic acid are seeing recent use in penile enhancement. These have been implicated to cause severe complications requiring urologic reconstructive intervention. Little work has been done to assess the general public’s interest in penile enhancement procedures such as these. Objective We sought to characterize temporal trends in search interest related to both general and specific penile enhancement with the use of Google Trends. Secondly, we characterized search interest based on geographic data and correlated our findings with state-wide average median income and literacy rates. Methods Google Trends was used to extract monthly search volume for 22 terms related to male penile enhancement in the United States between January 1, 2013 and December 31, 2022. Terms were characterized as specific (to penile injections) or generalized (any male enhancement method). Of the 22 terms included, 9 terms provided geographic search data for &amp;gt;10 states. For each search term, the top 3 and bottom 3 rank order was assigned based on a point system. States appearing in either the top or bottom 3 for one or more search term were ordered based on cumulative points and listed accordingly. State-wide yearly median income was collected from the US Census Bureau and averaged over the length of the study period. State-wide literacy rates were collected from the National Center of Educational Statistics and compared to the national average. Search terms were divided into “specific” (n = 10) and “general” (n = 12) categories. Overall trend was observed with a line of best fit. Overall average search volumes for specific and general search terms across the 10-year period was determined using GT data for the respective categories. Relative search volumes for each month over the 10-year period were then averaged within the two categories. Percent changes from the 10-year average were calculated. Results Specific terms showed an increase in proportional volume, with a line of best fit slope of 0.07, while general terms showed a decrease in proportional volume, with a line of best fit slope of -0.22 (fig. 1). States most frequently in the top 3 (Mississippi (42 k), Louisiana (48 k), and Alabama (50 k)) had average 10-year median income below the national median income of 63 k. Literacy rates were 252, 252, and 259, respectively compared to the national average of 264 (Fig. 2). Conversely, states infrequently in the top 3 (Oregon (68 k), Pennsylvania (64 k), and Massachusetts (78 k)) had median incomes slightly higher than the national median income. Literacy rates were 273, 266, and 273, respectively compared to the national average of 264 (Fig. 2). Conclusions Google Trends shows a rising interest in specific terms such as penile injections, whereas generalized interest in penile enhancement has shown a decline in interest. States with higher rates of online interest in penile enhancement often have a median income and literacy rates below the national average. Urologists should be aware of the rising interest in and promotion of specific procedures that may be of harm to their patient populations. Disclosure No.

Endovascular Treatment for Renal Vein Embolism by a Renal Calculus After Percutaneous Nephrolithotomy.

This report presents the endovascular strategies adopted to treat a kidney calculus venous embolism after percutaneous nephrolithotomy and the versatility of endovascular techniques to manage even the most unexpected renovascular complications after urological intervention. According to the literature available in PubMed, Cochrane, SciELO, and Science.gov repositories, this is the first case to our knowledge of renal vein calculus embolism as a complication of percutaneous treatment of kidney stones. A 62-year-old woman underwent percutaneous nephrolithotomy to treat a left kidney 2.8-cm staghorn calculi. The stone cracked, leaving a residual fragment in the ureteropelvic junction. Abdominal computed tomography revealed a 0.9-mm extrarenal calculus located inside the left retroaortic renal vein. Calculus was captured using a basket catheter system through a 6F 45-cm sheath positioned in the left common femoral vein (CFV) and accessed by dissection to safely conclude the calculus extraction by venous cut down. The patient was asymptomatically discharged 48 hours after the endovascular procedure, under a rivaroxaban anticoagulation regimen, with no symptoms or renal function impairment until the 6 months of follow-up. The endovascular strategy proposed in this case was effective for calculus rescue and venous flow restoration. This case reinforces the adaptability of endovascular therapy in an unexpected scenario. A potentially life-threatening extremely rare adverse event following a common urological procedure could be treated with minimally invasive hybrid treatment, preserving renal function and maintaining venous vascular patency. This report may add a discussion of procedures to manage similar events and bring to the literature a possible strategy to solve the problem.

Navigating challenges in anesthesia for robotic urological surgery: a comprehensive guide.

Robotic surgery has emerged as a cornerstone in urological interventions, offering effectiveness and safety for patients. For anesthesiologists, this technological advancement presents a myriad of new challenges, spanning from patient selection and assessment to intraoperative dynamics and post-surgical pain management. This article aims to elucidate these challenges and provide guidance for anesthesiologists in navigating the complexities of anesthesia administration in robotic urological procedures. Through a detailed exploration of patient optimization, team coordination, intraoperative adjustments, and post-surgical care, this article serves as a valuable resource for ensuring the success of such interventions.

1256 Oncological and Urological Outcomes After Total Pelvic Exenteration – Our 10-Year Experience

Abstract Aim Total pelvic exenteration (TPE) is a complex but potentially curative option for advanced pelvic malignancies. This study aims to evaluate long-term outcomes after TPE. Method Between February 2010 and February 2020, 88 patients who underwent TPE at our institution were included. Data extraction was done by retrospective examination of patient records. Incidence of perioperative complications, long-term outcomes and survival were noted. Results The mean age was 62.6 years (29-87 years). Colorectal malignancy (75%) was the most common indication. 63.7% of patients received chemo or radiotherapy or both pre-operatively. Median follow-up was 54 months (33.25 – 80.25 months). At 30 and 90 days, 20.5% and 8% of patients had a Grade 3 complication or above respectively. Complications related to urinary diversion were noted in 10 patients (14 events - 4 urinary leaks, 6 stoma related complications and 4 ileo-ileal anastomotic leaks). The 30- and 90-day mortality rate was 1.1% and 2.3% respectively. At 1, 3, and 5 years, overall survival was 89.8%, 64.8% and 63.6% respectively and cancer specific mortality was 5.7%, 18.2% and 31.8% respectively. Average glomerular filtration rate was 24.2 ml/min/m2 (p&amp;lt;0.0001), 34.1% developing new onset chronic kidney disease 3B or worse and 3.4% requiring haemodialysis. 18.2% of patients required further urological intervention. There was no statistically significant difference in ureteric stricture rates between patients undergoing surgery for recurrent disease (p=0.86) or following prior radiotherapy (p=0.81). Conclusions TPE appears to provide long-term survival in over 60% of patients with advanced pelvic malignancies. Long-term complications are predominantly related to the urinary diversion requiring prolonged urological follow-up.

A novel single-port robotic system in urology: a prospective multicenter single-arm clinical trial evaluating feasibility and efficacy of first 50 cases

ObjectiveThis study aimed to assess the feasibility and safety of the SHURUI single-port robotic surgical system for a range of major urological surgeries. MethodsIn this prospective, multicenter clinical trial, we examined the effectiveness of the SHURUI surgical system in urological interventions. The first 50 patients from four centers in China underwent single-port surgeries including partial nephrectomy, radical prostatectomy, partial adrenalectomy, and pyeloureteroplasty, exclusively by the SHURUI system. The study's primary endpoints focused on the success of surgeries, gauging this by the absence of deviations from planned procedures, the need for additional ports, or re-operations within a 24-hour period post-surgery. Secondary endpoints encompassed a range of surgical metrics, functional outcomes, and patient demographic data. Clinical assessments were conducted before surgery, before discharge, and 1-month following discharge. ResultsThe surgical procedures were executed successfully without requiring intraoperative conversions or transfusions. Both estimated blood loss and operation durations were maintained within satisfactory limits. For each type of surgery, the mean console times and estimated blood loss were 179.8 (SD 39.4) min and 125.6 (SD 126.0) mL for radical prostatectomy, 126.7 (SD 47.8) min and 39.2 (SD 54.4) mL for partial nephrectomy, 112.6 (SD 37.4) min and 20.0 (SD 13.2) mL for partial adrenalectomy, and 148.0 (SD 18.2) min and 18.0 (SD 17.9) mL for pyeloureteroplasty, respectively. Across the cohort, 17 patients experienced a total of 25 adverse events, while 10 postoperative complications, all rated as Clavien–Dindo Grade I, were encountered by eight patients. All patients had shown recovery or improvement from these events before the end of this trial. ConclusionThe SHURUI single-port robotic system demonstrated feasibility and safety in the performance of major urological surgeries. These initial findings highlight the system's potential, though further research and longer follow-up are required to assess long-term outcomes.