Worldwide survey of flexible ureteroscopy practice: a survey from European Association of Urology sections of young academic urologists and uro-technology groups

Monitoring Intrarenal temperature changes during Ho: YAG laser lithotripsy in patients undergoing retrograde intrarenal surgery: a novel pilot study

Ho: YAG laser lithotripsy is widely used for urinary stone treatment, but concerns persist regarding its thermal effects on renal tissues. This study aimed to monitor intrarenal temperature changes during kidney stone treatment using retrograde intrarenal surgery with Ho: YAG laser. Fifteen patients were enrolled. Various laser power settings (0.8 J/10 Hz, 1.2 J/12 Hz) and irrigation modes (10 cc/min, 15 cc/min, 20 cc/min, gravity irrigation, and manual pump irrigation) were used. A sterile thermal probe was attached to a flexible ureterorenoscope and delivered into the calyceal system via the ureteral access sheath. Temperature changes were recorded with a T-type thermal probe with ± 0.1 °C accuracy. Laser power significantly influenced mean temperature, with a 4.981 °C difference between 14 W and 8 W laser power (p < 0.001). The mean temperature was 2.075 °C higher with gravity irrigation and 2.828 °C lower with manual pump irrigation (p = 0.038 and p = 0.005, respectively). Body mass index, laser power, irrigation model, and operator duty cycle explained 49.5% of mean temperature variability (Adj. R2 = 0.495). Laser power and operator duty cycle positively impacted mean temperature, while body mass index and specific irrigation models affected it negatively. Laser power and irrigation rate are critical for intrarenal temperature during Ho: YAG laser lithotripsy. Optimal settings and irrigation strategies are vital for minimizing thermal injury risk. This study underscores the need for ongoing research to understand and mitigate thermal effects during laser lithotripsy.

Adult Ureteroscopy (A-URS) Checklist: A New Tool To Standardise Reporting in Endourology

Ureteroscopy is increasingly being used for urolithiasis. Technological innovations have been accompanied by wide variations in practice patterns. At the same time, a common finding in many studies, especially systematic reviews, is that the heterogeneity of outcome measurements and lack of standardisation can limit both the reproducibility and generalisability of study findings. While many checklists are available to improve study reporting, there are no ureteroscopy-specific ones. The Adult-Ureteroscopy (A-URS) checklist is a practical aid for both researchers and reviewers for studies in this field. It contains five main sections (study details, preoperative, operative, postoperative, and long term data) and a total of 20 items.

Patient summary

We developed a checklist to improve how studies on ureteroscopy (insertion of a telescope through the urethra to inspect the urinary tract) in adults are reported. This could help in advancing the field and improving patient outcomes, as all the key information is captured.

Randomized comparison of effect of standard antibiotic prophylaxis versus enhanced prophylactic measures on rate of urinary tract infection after flexible ureteroscopy

PURPOSE

To compare the rate of post-flexible ureteroscopy urinary tract infection (UTI) in patients subjected to the standard antibiotic prophylaxis alone versus enhanced prophylactic measures.

METHODS

A prospective randomized controlled study included 256 patients subjected to flexible ureteroscopy (FURS) for ureteral or renal stones from March 2018 to July 2022. Treatment groups included the standard antibiotic prophylaxis group (group 1, n=128) and the enhanced prophylaxis group (group 2, n=128). Patients in group 1 were injected with intravenous fluoroquinolone one hour preoperatively, and oral antibiotics were used for 24 h postoperatively. Patients in group 2 had urine culture ten days before the procedure; antibiotic-culture based was given for positive asymptomatic cases, while the procedure was deferred for active UTI.

RESULTS

The study groups were comparable regarding patient demographics, stone characteristics, operative time, and intraoperative complications. The overall hospitalization time was 1.68 ± 0.81 days. Postoperative, and overall complications were significantly higher in group 1 (15.6% vs. 6.3%, p = 0.04 and 26.6% vs. 17.2%, p = 0.047), respectively. Twenty patients (15.6 %) in the standard prophylaxis group were diagnosed with UTI in comparison to 8 patients (6.3 %) in the enhanced prophylaxis group (p = 0.047).

CONCLUSIONS

Urinary tract infection after FURS could be reduced significantly by utilizing the suggested enhanced prophylactic approach.

Hybrid flexible ureteroscopy strategy in the management of renal stones - a narrative review

The introduction of single-use flexible ureteroscopes (suFURSs) in daily practice tends to overcome the main limitations of reusable ureteroscopes (reFURSs), in terms of high acquisition costs, maintenance, breakages and repairing costs, reprocessing and sterilization, as retrograde intrarenal surgery (RIRS) is promoted as first-line treatment of renal stones in most cases. A hybrid strategy implies having both instruments in the armamentarium of endourology and choosing the best strategy for cost-efficiency and protecting expensive reusable instruments in selected high-risk for breakage cases such as large stones of the inferior calyx, a steep infundibulopelvic angle or narrow infundibulum, or abnormal anatomy as in horseshoe and ectopic kidney. In terms of safety and efficiency, data present suFURSs as a safe alternative considering operating time, stone-free, and complication rates. An important aspect is highlighted by several authors about reusable instrument disinfection as various pathogens are still detected after proper sterilization. This comprehensive narrative review aims to analyze available data comparing suFURSs and reFURSs, considering economic, technical, and operative aspects of the two types of instruments, as well as the strategy of adopting a hybrid approach to selecting the most appropriate flexible ureteroscope in each case.

Endourological management of encrusted ureteral stents: an up-to-date guide and treatment algorithm on behalf of the European Association of Urology Young Academic Urology Urolithiasis Group

Encrustation of ureteral stents can represent a complex challenge. Patients can require multiple intervention types as well as several operative sessions. Our aim was to establish a practical guide for managing such cases as well as an accompanying treatment algorithm. Nearly all cases can now be successfully managed with minimally invasive methods such as ureteroscopy and/or percutaneous nephrolithotomy. Use of a validated tool for grading burden of encrustation is recommended. Careful patient counselling as well as operative planning are of paramount importance. Identifying high risk patient groups such as pregnancy and implementing prevention strategies are also crucial.