World Congress Of Endourology Research Articles

The Second Endourological Society Census Report.

As part of the Endourological Society's initiative to continuously enhance the field of endourology, the second annual census was circulated after the World Congress of Endourology and Uro-Technology 2022 (WCET22). An anonymous survey was created using Qualtrics XM and was disseminated via email to all Endourological Society (ES) members (n=1,502) between October 4th, 2022, and January 26th, 2023. A total of 46 questions were included in the survey and covered different aspects including demographics, practice patterns, satisfaction, impact of COVID, WCET22 attendance, and future opportunities. A total of 404 (26.9%) ES members (91.8% male and 8.2% female), representing 63 different countries participated in the survey. Fellowship-trained endourologists constituted 58.9% of respondents, and the most common practice setting was academic (55.2%). The most common practice scope was complex retrograde endoscopy (83.4%), followed by percutaneous nephrolithotomy (79.5%) and medical management of urolithiasis (72.5%). Work schedules were variable with 51.1% working 40-60 hours/week and 35.3% working >60 hours/week. More than 80% were satisfied with their practice; however, 42.4% indicated that COVID made satisfaction worse. Of the participants, 49.5% were satisfied with their compensation, and 7.3% plan to retire within the next 5 years. When asked about the future of endourology, 92.9% had a positive outlook. Of the respondents, only 36.8% attended WCET22, with the most chosen reason for attendance being an interest in learning new research and technology. For lack of attendance, cost of travel and lodging was reported as a determining factor by 45.4%. These survey results report important trends within the field of endourology and demonstrate the robust outlook of ES members for the future. By demonstrating important practice patterns and member needs, this information can be used to improve the responsiveness of its members and to continually strengthen the ES.

The Endourological Society Inaugural Census Report.

The Endourological Society, the premier urologic society encompassing endourology, robotics, and focal surgery, is composed of a diverse group of >1300 urologists. However, limited information has been collected about society members. Recognizing this need, a survey was initiated to capture data regarding current member practices, as well as help the Society shape the future direction of the organization. Presented herein is the inaugural Endourological Society census report as the beginning of a continued effort for global improvement in the field of endourology. Using a REDCap® database, an email survey was circulated to the membership of the Endourological Society from May through June 2021. Twenty questions were posed, categorizing member data in terms of epidemiology/demographics, practice patterns, member opinions, and future educational preferences. Responses were received from 534 members, representing 40.3% of membership. Data demonstrated that the average age, gender, race, and ethnicity of the typical Society member respondent is a 48-year-old Caucasian male working in the United States, with a mean of 25 years in practice. Retrograde endoscopy and percutaneous nephrolithotomy were identified as the most common practice skills, and 50% of members are involved in robotics. Importantly, the census confirmed that the World Congress of Endourology and Technology remains popular with Society members as a means of educational advancement. To sustain and advance the Society, information is required to understand the career interests and future educational desires of its members. This inaugural census provides crucial data regarding its membership and how the Society can achieve continued success and adjust its focus. Future census efforts will expand on the initial findings and stratify the data to elucidate changes in the needs of the Society as a whole. Circulating an annual census will allow for continued improvements in the field of endourology and, ultimately, better care for urologic patients.

Committees and Awards of the 39th World Congress of Endourology: WCE 2022

Committees and Awards of the 39^th World Congress of Endourology: WCE 2022

Author Index of 39th World Congress Of Endourology by abstract number

Author Index of 39^th World Congress Of Endourology by abstract number

MP66-09 TRENDS IN FEMALE REPRESENTATION AT HIGH-PROFILE UROLOGY CONFERENCES, 2014-2019

INTRODUCTION AND OBJECTIVE: As the induction of females in medicine reaches parity (51.6%), the proportion of women in urology remains disproportionately low (9.2%). Within academic urology, women hold a minority of leadership positions. One such position of esteem is that of an invited speaker at a major academic conference. We sought to measure female representation at these events and compare their involvement to the overall representation of women in academic urology. METHODS: A cross-sectional analysis was conducted to identify the gender of conference speakers listed in annual scientific programming at urology conferences from 2014 to 2019. Six high profile urology conferences were selected that encompass the many urological subspecialties: American Urologic Association (AUA); Society of Urodynamics, Female Pelvic Medicine and Urogenital Reconstruction; Society of Pediatric Urology; Society of Urologic Oncology; Genitourinary Reconstructive Surgery; World Congress of Endourology. Using published programming, the number of total and female speakers at each conference was recorded from 2014 to 2019, when available. Gender was decided based on traditional naming conventions and in cases of gender ambiguous naming, the specific individual was categorized via search engines. Trends were identified and comparisons were made to the proportion of female urologists practicing at academic centers based on 2018 AUA census data. RESULTS: A total of 29 conferences were reviewed. From 2014 to 2019, female representation increased from 8.8% to 21.4% (p < 0.001). The proportion of female speakers at all recorded conferences ranged from 0% to 40.1%. The average absolute increase was 1.9% each year. In 2018, the proportion of female academic urologist was 12.0%. When using this as a reference, female representation at urologic conferences in 2018 was significantly greater than female representation in academic urology as a whole (16.2% versus 12.0%, respectively) (p=0.014). CONCLUSIONS: Findings exhibit a trend with increasing proportion of female speakers at academic urology conferences from 2014 to 2019. When all 2018 conference speakers were assessed in aggregate, females were actually overrepresented as speakers. Although the proportion of women in academic urology remains low, the overall trend indicates that the proportion of female invited speakers has increased. Future selection of speakers should continue to consider gender disparities, especially at meetings with little to no female representation. Source of Funding: None

Evolution of Technique from Minimally Ischemic to Pure Off-Clamp Partial Nephrectomy: 15-Year Learning Curve and Outcomes of 1083 Patients

Introduction and Objective: There is a growing interest in surgical techniques aimed at minimizing ischemia during partial nephrectomy (PN). The aim of this video is to report surgical tips, perioperative, functional, and oncologic outcomes of first 1083 patients treated with laparoscopic or robotic minimally ischemic1,2 or pure off-clamp (Off-C) PN treated between 2002 and 2015 in a high-volume center. Materials and Methods: Patients were placed in an extended flank position and a four-port or five-port access was performed for laparoscopic or robotic approach, respectively. Hilar vessels were not clamped in any case; pure or hybrid tumor enucleation was the resection technique used. The first case shows a robotic PN with the “sutureless technique” for more exophytic masses, which can also be performed with a laparoscopic approach.3 The second video shows a 4 cm left mesorenal tumor treated with laparoscopic PN after superselective transarterial embolization.4–6 This original technique, first used in 2003, at the beginning of the learning curve, has been no longer used since 2010. The third video shows a robotic PN in a right solitary kidney, affected by a 4.3 cm tumor involving the medial aspect of the upper pole. Small arterial feeders identified or transected during the enucleation of the tumor were selectively coagulated. Two suction devices were used simultaneously to maintain a bloodless surgical field. A point-specific hemostasis was performed before starting a sliding clip renorrhaphy. Results: Overall complication rate was 15.7% with a transfusion rate of 7.8%. Only 4.25% of complications were severe with a Clavien grade equal to or greater than 3. Five-year local recurrence-free survival and cancer-specific survival rates were 98.1% and 98%, respectively. The 5-year risk of severe renal function (RF) deterioration (chronic kidney disease (CKD) stage 4) was 0%, 0.9%, 7.5%, and 10.7% for patients with stages 1, 2, 3A, and 3B CKD, respectively. At multivariable analysis, baseline RF (p = 0.001) and postoperative RF decrease ≥10% (p = 0.048) independently predicted a new onset stage 4 or 5 CKD. Conclusions: Off-C PN is a challenging surgical procedure. At the beginning of learning curve, a stepwise adoption of pure Off-C approach is mandatory and preparing hilar vessels for intermediate and high nephrometry score renal tumors is recommended. Oncologic outcomes were comparable with on-clamp PN series and excellent functional outcomes of our series support Off-C as a first line treatment option in high-volume tertiary referral centers. No competing financial interests exist. Runtime of video: 5 mins 5 secs Presented at the World Congress of Endourology in Cape Town, South Africa, November 2016.

Laser Fiber and Flexible Ureterorenoscope: The “Safety Distance” Concept

Introduction: The costs of flexible ureterorenoscopes (fURS) and their repair oblige the surgeon to know the proper handling of instruments. There is a lack of evidence in the literature about the distance that the laser fiber should have once out from the scope to avoid instrumental damages. We are introducing the “safety distance” concept to preserve the fURS scope from laser energy injuries. Materials and Methods: We performed an in vitro observational study. Seven fURS were tested. The distance from the laser fiber tip and the fURS camera was measured at the first appearance on the endoscopic screen and when the fiber was reaching one-fourth of the screen. Next, to evaluate the impact of the holmium laser bubble according to the different fiber distances, an assessment of the size and shape of the bubble created at the tip of the fiber with the laser activated was done recording the images with an high-speed camera. Different laser setting were used to simulate dusting, fragmentation, and tissue ablation. The laser was activated in saline solution with anything in front, with a phantom of a synthetic soft and hard stone and with a sample of pork kidney. Than maintaining the same energy and frequency, only the pulse length was changed and the diameter of the bubble measured. Results: The first appearance on the screen of the laser tip is different in different scopes. When the laser fiber is out 3 mm from the scope, the energy bubble generated by the holmium laser never hit the scope's tip. In all the scopes, we observed that when the laser fiber was at one-fourth of the screen, it was already out from the scope at least 3 mm. At the same energy and frequency, bubbles generated with long pulse are smaller than those generated with short pulse. Conclusion: Even if there is a big limitation of this study due to the impossibility to measure and to evaluate the damage of the fURS tip surface, we observed that when the laser fiber tip reach one-fourth of the screen, the bubble generated by the laser activation is never rebounding on the camera of the scope. We have called this position the “safety distance.” In difficult cases, if we need to see barely the fiber, we suggest to use long pulse duration and low energy. No competing financial interests exist. Runtime of video: 4 mins 42 secs This video was presented at the World Congress of Endourology, 2016, in Capetown, South Africa, and won Best Video Award of the WCE 2016.

The use of social media in endourology: an analysis of the 2013 World Congress of Endourology meeting.

To examine the use of social media within Endourology by reporting on its utilization during the 2013 World Congress of Endourology (WCE) annual meeting. Two social media platforms were analyzed for this study: Twitter (San Francisco, CA) and LinkedIn (Mountain View, CA). For Twitter, a third-party analysis service (Tweetreach) was used to quantitatively analyze all tweets with the hashtags #WCE2013 and #WCE13 during a 7-day period surrounding the WCE. Two reviewers independently classified tweet content using a predefined Twitter-specific classification system. Tweet sentiment was determined using sentiment analysis software (Semantria, Inc., Amherst, MA). Finally, the penetration of Twitter and LinkedIn within the WCE faculty was assessed by means of a manual search. During the study period, 335 tweets had the hashtag #WCE2013 or #WCE13. Content originated from 68 users resulting in a mean of 47 tweets/day and 4.9 tweets/contributor. Conference-related tweets had a reach of 38,141 unique Twitter accounts and an online exposure of 188,629 impressions. Physicians generated the majority of the content (63%), of which 55.8% were not attending the meeting. More tweets were informative (56.7%) versus uninformative (43.3%), and 17.9% had links to an external web citation. The mean sentiment score was 0.13 (range -0.90 to 1.80); 13.1%, 57.0%, and 29.9% of tweets were negative, neutral, and positive in sentiment, respectively. Of 302 WCE meeting faculty, 150 (49.7%) had registered LinkedIn accounts while only 52 (17.2%) had Twitter accounts, and only 19.2% tweeted during the meeting. Despite a relatively low number of Twitter users, tweeting about the WCE meeting dramatically increased its online exposure with dissemination of content that was mostly informative including engagement with physicians not attending the conference. While half of faculty at WCE 2013 had LinkedIn accounts, their social media footprint in Twitter was limited.

A report from the 29th World Congress of Endourology and SWL (November 30 - December 3, 2011 - Kyoto, Japan)

Kyoto is a city of surprises: from the most beautiful castles and temples known far and wide across the world, to the humblest temples, as beautiful as those appearing in all tourist guides, just hidden away in small lanes among busy traffic of bicycles and pedestrians shopping in markets or attending to their daily business. Add the innumerable tourists busily exploring the city's attractions, although this was not the reason for visiting Kyoto, which was the site of this year's World Congress of Endourology and SWL. Nevertheless, maybe as a compensation, the meeting was held in Kokusaikaikan, literally the International Conference Centre, which is a modern facility in the city outskirts, actually adjoining the Takaragaike park, with a beautiful lake and the mountains, brightly led by the trees' red leaves, just visible through the main hall windows.

Single Port Donor Nephrectomy

In 2007, Rane presented the first single port nephrectomy for a small non-functioning kidney at the World Congress of Endourology. Since that time, the use of single port surgery for nephrectomy has expanded to include donor nephrectomy. Over the next two years the technique was adopted for many others types of nephrectomies to include donor nephrectomy. We present our technique for single port donor nephrectomy using the Gelpoint device. We have successfully performed this surgery in over 100 patients and add this experience to our experience of over 1000 laparoscopic nephrectomies. With the proper equipment and technique, single port donor nephrectomy can be performed safely and effectively in the majority of live donors. We have found that our operative times and most importantly our transplant outcomes have not changed significantly with the adoption of the single port donor nephrectomy. We believe that single port donor nephrectomy represents a step forward in the care of living donors.

Single Port Donor Nephrectomy

In 2007, Rane presented the first single port nephrectomy for a small non-functioning kidney at the World Congress of Endourology. Since that time, the use of single port surgery for nephrectomy has expanded to include donor nephrectomy. Over the next two years the technique was adopted for many others types of nephrectomies to include donor nephrectomy. We present our technique for single port donor nephrectomy using the Gelpoint device. We have successfully performed this surgery in over 100 patients and add this experience to our experience of over 1000 laparoscopic nephrectomies. With the proper equipment and technique, single port donor nephrectomy can be performed safely and effectively in the majority of live donors. We have found that our operative times and most importantly our transplant outcomes have not changed significantly with the adoption of the single port donor nephrectomy. We believe that single port donor nephrectomy represents a step forward in the care of living donors.

Randomized Clinical Trials Presented at the World Congress of Endourology: How Is the Quality of Reporting?

To assess the quality of reporting of randomized controlled trials (RCTs) presented in abstract form at the annual World Congress of Endourology (WCE) and evaluate their course of subsequent publication. All RCTs presented in abstract form at the 2004, 2005, and 2006 WCE annual meetings were identified for review. Quality of reporting was assessed by applying a standardized 14-item evaluation tool based on the Consolidated Standards for the Reporting of Trials (CONSORT) statement. The subsequent publication rate for the corresponding studies by scanning Medline was also evaluated. Appropriate statistical analysis was performed. A total of 94 RCTs (3.5% of 2669) were identified for review: 21 in 2004, 36 in 2005, and 37 in 2006. Overall, 45 (47.3% of the total) were subsequently published as a full length indexed manuscript with a mean time to publication of 16.4 ± 13.2 months. Approximately 61 (60%) identified the study design as RCT in the abstract title. None reported the method of randomization. In studies that reported blinding (seven, 11% of 62), five were double blinded and two single blinded. Adverse events were reported in 38% of cases. Only 10% of the abstracts complied fully with more than 10 items according to our CONSORT-based checklist, whereas the majority of them failed to comply with most of the CONSORT requirements. Although representing a small portion of the overall number of abstracts, there has been a steady increase of presentation of RCTs at the WCE over the assessed 3-year period. Most of the time they are recognized as RCTs in the abstract title. When applying the CONSORT criteria, necessary information to assess their methodologic quality is incomplete in some cases.

Scientific Program for 28th World Congress of Endourology &amp; SWL

Scientific Program for 28^th World Congress of Endourology &amp; SWL

NOTES Performed Using Multiple Ports of Entry: Current Experience and Potential Implications for Urologic Applications

An isolated transgastric port raises serious limitations in performing natural orifice translumenal endoscopic surgery (NOTES) complex procedures in the urology field. In an attempt to overcome these limitations, several solutions has been advanced, such as the hybrid approach (adding a single abdominal port access) or the pure NOTES combined approach (joining multiple natural orifice ports). To review the current state of experimental and clinical results of multiple ports in NOTES, a literature search of PubMed was performed, seeking publications from January 2002 to 2008 on NOTES. In addition, we looked at pertinent abstracts of annual meetings of the American Urological Association, the European Association of Urology, and the World Congress of Endourology from 2007. Multiple ports of entry seem to be necessary, mainly for moderately complex procedures. Thus, we could find studies using the hybrid approach (combination of transgastric or transvaginal access with a single transabdominal port), or using the pure NOTES combined approach (transgastric and transvesical, transvaginal and transcolonic, or transgastric and transvaginal). There is still limited experience in humans using these approaches, and no comparative studies exist to date. It is predictable that for moderately complex procedures, we will need multiple ports, so the transvaginal-transabdominal (hybrid) approach is the most appealing, whereas in a pure NOTES perspective, the transgastric-transvesical approach seems to be the preferred approach. We are waiting for new equipment and instruments that are more appropriate for these novel techniques.

Fate of Abstracts Presented at the World Congress of Endourology: Are They Followed by Publication in Peer-Reviewed Journals?

To estimate the acceptance rate of peer-reviewed journals, to describe the time course of subsequent full publication, and to identify those with characteristics associated with publication of the abstracts presented at the World Congress of Endourology (WCE). All abstracts accepted for presentation at the 2001 and 2002 WCE meetings were identified from the published supplements to the Journal of Endourology. The subsequent publication rate for the corresponding studies was evaluated by scanning MEDLINE for the 5-year period after the meetings. Overall, 20.5% of the abstracts were followed by publication in peer-reviewed journals. Abstracts on transurethral, laparoscopic, and percutaneous procedures had the highest publication rates (25.5%, 25%, and 24.3%, respectively). Studies from North America had the highest publication rate (29.2%). The mean time to publication was 14.6 months. There was an 80% chance that an eventually published abstract was in print 2 years after presentation. The largest number of the reports were published in the Journal of Endourology (75 of 234; 32%), the official publication of the society that sponsors the WCE. Only one fifth of the abstracts presented at the WCE are ultimately published in peer-reviewed journals. Attendees should be aware of this limitation, and scientific committees should be encouraged to be more selective. Although presentation at major urological congresses constitutes an invaluable method for rapid scientific dissemination, abstracts contain data that usually are difficult to access and of questionable validity. In this respect, investigators are encouraged to publish their data.

24th World Congress of Endourology

24th World Congress of Endourology