The Effect of Pre-Stenting on Bleeding-Related Complications Following Ureteroscopy in Patients on Anticoagulation or Antiplatelet Therapy.

The American Urological Association guidelines state that continuing anticoagulant (AC) and antiplatelet (AP) agents during ureteroscopy (URS) is safe. Through a multi-institutional retrospective study, we sought to determine whether pre-stenting in patients on AP or AC was associated with fewer URS bleeding-related complications. A series of 8614 URS procedures performed across three institutions (April 2010 to September 2017) was electronically reviewed for AC/AP use at time of URS.

Evaluation of Renal Function Recovery After Holmium Laser Enucleation of the Prostate in Patients with Chronic Kidney Disease.

Holmium laser enucleation of the prostate (HoLEP) has become a new surgical gold standard treatment for benign prostatic hyperplasia (BPH). It is known that untreated BPH can lead to bladder outlet obstruction (BOO). A positive correlation exists between BOO and chronic kidney disease (CKD), but stability or recovery of renal function after HoLEP remains unknown.

Mini-Percutaneous Nephrolithotomy Outcomes in the Obese Population: A Retrospective Review.

Mini-percutaneous nephrolithotomy (PCNL) has gained popularity over the last decade due to its stone-free rate comparable to traditional PCNL but with decreased risk of complications. While the data on mini-PCNL has been favorable thus far, no study today has evaluated outcomes in obese patients. All patients undergoing mini-PCNL at our institution since we began its use in 2019 were included in this study.

Impact of American Society of Anesthesiologists score on postoperative holmium enucleation of the prostate outcomes and complications.

Introductions: The American Society of Anesthesiologists Physical Status Classification System (ASA) is a validated risk stratification method for patients undergoing surgery. There is an increased prevalence of benign prostatic hyperplasia and comorbidities in our aging population. The role of ASA related to postoperative complications in patients undergoing holmium laser enucleation of the prostate (HoLEP) has not been described.

Determining the threshold of acute renal parenchymal damage for intrarenal pressure during flexible ureteroscopy using an in vivo pig model.

Purpose: To identify a threshold for intrarenal pressure (IRP), that if exceeded, will result in renal parenchymal damage. Herein, we attempt to identify an IRP threshold by subjecting in vivo porcine kidneys to various levels of extreme pressurized irrigation. Our objective was not to simulate ureteroscopy treatment, but to attempt identify a threshold of IRP injury.

Cost-Effectiveness of 90-day Single-use Flexible Cystoscope Trial: Single Center Micro-Costing Analysis and User Satisfaction.

Objective: To evaluate cost-effectiveness and user satisfaction of a single-use flexible cystoscope at a tertiary care center we conducted a 90-day trial. Single-use flexible cystoscope advancements have introduced alternative options to reusable scopes. However, there is a paucity of cost-effectiveness and provider satisfaction studies examining the implementation of a hospital-based transition to single-use cystoscopes.

Outcomes of octogenarians undergoing holmium laser enucleation of prostate.

Purpose: Holmium laser enucleation of prostate (HoLEP) is an effective surgical procedure in men with BPH. Due to the increase in the use of medical therapy for BPH related lower urinary symptoms more octogenarians are presenting in a delayed fashion with significant symptoms and urinary retention. We evaluate the feasibility and safety of octogenarians undergoing HoLEP.

A Randomized Trial Evaluating the Use of a Smart Water Bottle to Increase Fluid Intake in Stone Formers.

Objective: The aim of this study is to evaluate if the use of a smart water bottle improves urine volume in stone forming patients.

Methods: Adults with nephrolithiasis and low urine volume (<1.5 L) documented on a 24-hour urinalysis (24 hr U) were randomized to receive either standard dietary recommendations to increase fluid intake (DR arm), or DR and a smart water bottle (HidrateSpark®; Hydrate Inc.

Laser fiber degradation following holmium laser enucleation of the prostate utilizing Moses technology versus regular mode.

Purpose: We sought to objectively compare laser fiber degradation for holmium laser enucleation of the prostate (HoLEP) cases performed with 550 μm standard fibers versus 550 μm Moses 2.0 fiber in BPH mode on a macroscopic and microscopic level.

Methods: We prospectively collected outcomes for 50 standardized HoLEP cases using 550 μm Moses fiber with 2.

Expanded Criteria Same Day Catheter Removal After Holmium Laser Enucleation of the Prostate.

Holmium laser enucleation of the prostate (HoLEP) is a highly effective treatment of benign prostatic hyperplasia (BPH). Technical advances and improved hemostatic properties of holmium lasers have allowed for increased efficiency and outcomes. Same day catheter removal after HoLEP was described at our institution in 2020 after a 30-patient pilot trial.

Contemporary Outcomes for Patients Undergoing Concurrent Surgeries at the Time of Holmium Laser Enucleation of the Prostate Before and After Moses 2.0 BPH Mode.

Outcomes of holmium laser enucleation of the prostate (HoLEP) for benign prostatic hyperplasia has been well studied. As comfort with the procedure has improved, the number of concurrent surgeries performed with HoLEP has increased. Technology and technique optimization have safely transitioned HoLEP toward same-day catheter removal and discharge.

Comparison of Perioperative Outcomes and Clinical Characteristics of Calcium, Matrix and Struvite Stones From a Single Institution.

Objective: To define risk factors and perioperative outcomes for matrix stones and compare these outcomes with struvite and calcium stone cohorts.

Methods: A retrospective cohort study comparing matrix stones (n=32), struvite stones (n=23) and a matched, calcium stone control group (n=32) was performed. Two-way ANOVA was used to compare the groups for continuous variables.

Comparison of Efficiency, Safety, and Surgeon Satisfaction in Four Commercial Morcellators.

Holmium laser enucleation of the prostate (HoLEP) is a size-independent treatment option for the management of benign prostatic hypertrophy. Although advancements in laser technology have led to clinical improvements in the enucleation portion of HoLEP, the morcellation aspect of HoLEP is often the rate-limiting step. We sought to compare efficiency and surgeon satisfaction in four commercial morcellators.

A Cost Comparison of Holmium Laser Enucleation of the Prostate with and without Moses™.

Introduction: Holmium laser enucleation of the prostate (HoLEP) is a size-independent treatment option for the treatment of benign prostatic hyperplasia. HoLEP has been shown to have excellent improvements in prostate symptom scores and maximum flow rates that have been durable for 2 decades. However, the steep learning curve associated with HoLEP has prevented its widespread adoption.

Ambulatory Percutaneous Nephrolithotomy May Be Cost-Effective Compared to Standard Percutaneous Nephrolithotomy.

Coronavirus disease 2019 (COVID-19) changed the practice of medicine in America. During the March 2020 lockdown, elective cases were canceled to conserve hospital beds/resources resulting in financial losses for health systems and delayed surgical care. Ambulatory percutaneous nephrolithotomy (aPCNL) has been shown to be safe and could be a strategy to ensure patients receive care that has been delayed, conserve hospital resources, and maximize cost-effectiveness.

Understanding holmium laser enucleation of the prostate (HoLEP) recovery: Assessing patient expectations and understanding.

Introduction: Although holmium laser enucleation of the prostate (HoLEP) is a highly effective surgery, there is a variable recovery period where patients may experience hematuria, dysuria, or urinary incontinence (UI). Despite preoperative consultation, there is a paucity of literature examining the effectiveness of physician-patient communication in preparing the patient for the postoperative recovery period. We sought to examine recovery expectations as a patient-reported outcome (PRO) metric for HoLEP.

Comparison of cost-effectiveness and postoperative outcomes following integration of a stiff shaft glidewire into percutaneous nephrolithotripsy.

Aims: To analyze the cost effectiveness of integrating a stiff shaft glidewire (SSGW) in percutaneous nephrolithotripsy (PCNL) relative to standard technique (ST). This is prudent because healthcare providers are experiencing increased pressure to improve procedure-related cost containment.

Methods: ST for PCNL at our institution involves a hydrophilic glidewire during initial percutaneous access and then two new stiff shaft wires.

Holmium Laser Enucleation of Prostate: What is the True Rate of Postoperative Opioid Use?

Objectives: To determine if patients were obtaining opioids after HoLEP from other sources - despite our opioid-free postoperative pathway - we utilized a national prescription drug monitoring program (PDMP) to review all patients who underwent HoLEP at our institution.

Methods: We performed a retrospective review of all HoLEPs completed by two fellowship-trained surgeons. We utilized a national PDMP to determine the true rate of postoperative opioid use.

A case of ureteral fungal mass removal in a patient taking empagliflozin.

With increased use of sodium-glucose co-transporter 2 (SGLT2) inhibitors as antidiabetic agents, the risk of serious fungal urinary tract infection (UTI) may be increased. We present the case of a 67-year-old Caucasian female who was admitted for emphysematous pyelitis and found to have a fungal ball in the renal pelvis. Candida glabrata was cultured and the patient was managed with percutaneous nephrostomy tube placement and antifungal treatment.

Contemporary practice patterns of transurethral therapies for benign prostate hypertrophy: results of a worldwide survey.

Purpose: To perform a global survey to identify contemporary practice patterns of transurethral therapies for benign prostatic hypertrophy.

Methods: A REDCap survey was distributed to the ~ 3500 members of the Endourological Society. Surgeons completed demographic information and then selected the BPH therapies they perform 10 cases/year.

Multi-Institutional Prospective Randomized Control Trial of Novel Intracorporeal Lithotripters: ShockPulse-SE Trilogy Trial.

Currently, there are multiple intracorporeal lithotripters available for use in percutaneous nephrolithotomy (PCNL). This study aimed to evaluate the efficiency of two novel lithotripters: Trilogy and ShockPulse-SE. This is a prospective multi-institutional randomized trial comparing outcomes of PCNL using two novel lithotripters between February 2019 and June 2020.

Comparison of Newly Optimized Moses Technology Standard Holmium:YAG for Endoscopic Laser Enucleation of the Prostate.

The purpose of this study was to describe our initial experience of using a newly optimized Moses technology that is part of the second-generation Moses platform specifically designed for holmium laser enucleation of the prostate (M-HoLEP) and compare it with patients undergoing HoLEP using standard holmium:YAG technology (S-HoLEP). We retrospectively collected data on patients who underwent M-HoLEP and compared it with the last 50 patients in whom we performed S-HoLEP. Specifically, we compared preoperative symptom scores for lower urinary tract symptoms (LUTS) and erectile dysfunction (ED), preoperative objective voiding metrics, as well as intraoperative characteristics, perioperative characteristics, postoperative complications, postoperative symptom scores for LUTS and ED, and postoperative objective voiding metrics.