Disposable grasper-integrated flexible cystoscope for ureteral stent removal in transplanted patients; focus on feasibility, safety, and patient experience. Results and micro-cost analysis from a tertiary referral center.

INTRODUCTION & OBJECTIVES: To evaluate ureteral stent removal (SR) using a grasper-integrated disposable flexible cystoscope (giFC-Isiris ®, Coloplast ®) after kidney transplantation (KT), with a focus on feasibility, safety, patient experience, and costs. MATERIAL AND METHODS: All consecutive KT undergoing SR through giFC were prospectively enrolled from January 2020 to June 2023. Patient characteristics, KT and SR details, urine culture results, antimicrobial prescriptions, and the incidence of urinary tract infections (UTI) within 1 month were recorded. A micro-cost analysis was conducted, making a comparison with the costs of SR with a reusable FC and grasper. RESULTS: A total of 136 KT patients were enrolled, including both single and double KT, with 148 stents removed in total. The median indwelling time was 34 days [26, 47]. SR was successfully performed in all cases. The median preparation and procedure times were 4 min [3,5]. and 45 s[30, 60], respectively. The median Visual Analog Scale (VAS) score was 3 [1, 5], and 98.2% of patients expressed willingness to undergo the procedure again. Only one episode of UTI involving the graft (0.7%) was recorded. Overall, the estimated cost per SR procedure with Isiris ® and the reusable FC was 289.2€ and 151,4€, respectively. CONCLUSIONS: This prospective series evaluated the use of Isiris ® for SR in a cohort of KT patients, demonstrating feasibility and high tolerance. The UTI incidence was 0.7% within 1 month. Based on the micro-cost analysis, estimated cost per procedure favored the reusable FC.

The "thinking system" in a new school concept: A rhythmic teaching approach in physical education to develop creativity.

System Thinking is an actual construct supported by several scientific evidence that offer a perspective on how phenomena relate. Rhythm methodology, teaching-learning, and enjoyment in physical education are the main system elements we hypothesize interacting closely to determine direct or mediated effects on motor creativity and rhythmic perceptive capacity. Seventy-six elementary and middle school students (8.9 ± 2.1 years) were randomly assigned to two groups: a) an intervention group that received a physical education lesson based on rhythmic methodology and b) a control group that received conventional lessons without specific rhythmic interventions. Participants were engaged in eight physical education lessons lasting one hour each for eight weeks. Tests and questionnaires were administered before and after the intervention to evaluate motor creativity, rhythmic perception capacity, self-perception and enjoyment. Two lessons were randomly analyzed to identify the teaching style and motor content (moderate and vigorous activity). The main results revealed direct effects on the intervention group's motor creativity (p = 0.001) and its rhythmic perception capacity (p = 0.02). Furthermore, enjoyment mediated the effects of the intervention on motor creativity (p = 0.01). Finally, the results have shown that self-perception does not mediate the effect of rhythmic intervention group on motor creativity and rhythmic perceptive capacity (p > 0.05). A rhythmic methodology proposed by specific multi-teaching styles can involve children and young people in an enjoyable activity with more moderate to vigorous physical activity.

Patients undergoing double J substitution with a pigtail suture stent report a significant decrease of stent-related symptoms. Results from a prospective multicenter longitudinal trial.

PURPOSE: To compare stent-related symptoms (SRS) in patients with double J (DJ) undergoing substitution with a pigtail suture stent (PSS) after ureteroscopy (URS), through the Ureteral Stent Symptom Questionnaire (USSQ). MATERIALS AND METHODS: Patients with DJ undergoing URS for stone treatment were enrolled in this prospective multicenter longitudinal study. The USSQ was submitted thrice: 2 weeks after DJ, 2 weeks after PSS and 4 weeks after PSS removal (baseline). PRIMARY ENDPOINT: to compare Urinary Symptom Index Score and the rate of patients with pain 2 weeks after DJ and PSS. Secondary endpoints: to compare other USSQ scores and single answers 2 weeks after DJ and PSS, and DJ and PSS USSQ scores with baseline. RESULTS: 93 patients were enrolled. 2 weeks Urinary Symptom Index Score (p < 0.001) and the percentage of patients complaining of pain (60.2% vs 88.2%, p < 0.001) were significantly in favour of PSS compared to DJ. 2 weeks scores were significantly improved with PSS compared to DJ: Pain Index (p < 0.001), VAS (p < 0.001), General Health Index (p < 0.001) and Work Performance Index (p < 0.001). All urinary symptoms were significantly decreased with PSS, including renal pain during micturition and pain interfering with life. Pain Index Score (p = 0.622) and VAS (p = 0.169) were comparable to baseline with PSS, while differed with DJ. CONCLUSIONS: Patients undergoing DJ substitution with PSS after URS report a significant decrease of SRS. Urologists may consider positioning PSS after URS in pre-stented patients to reduce the impact of SRS.

Effects of cognitive load and different exercise intensities on perceived effort in sedentary university students: a follow up of the Cubo Fitness Test validation.

Work and intellectually fatiguing environments can significantly influence the health of individuals, which is strictly bound to motor efficiency. In particular, desk workers and university students may have a sedentary lifestyle and a condition of mental fatigue caused by daily routine, which could impair motor efficiency. The assessment is a starting point for enhancing awareness of the individual's psychophysical condition through the perception of one's body motor efficiency, motivating to move towards improvement. This way, a submaximal test based on perceived exertion was developed (Cubo Fitness Test, CFT) and validated in previous studies. Hence, two further studies were employed to enhance the consistency and accuracy of this instrument in different conditions. The first study investigated the internal responsiveness of CFT, evaluating if mental fatigue could affect motor efficiency. The second study investigated which perceived intensity (weak, moderate, strong, or absolute maximum) could be more reliable for applying the CFT (as previous research focused the investigation only on moderate intensity). In the first investigation, participants assessed two stimuli (mental fatigue induced with a Stroop color-word task and a neutral condition based on the vision of a documentary) lasting 60 min each. The quality of psychophysical recovery (total quality recovery) and the mood state (Italian Mood State questionnaire) were evaluated before the stimuli. After the fatiguing or the neutral task, the mood state was newly assessed, together with the evaluation of the workload's characteristics (Nasa TLX) and the CFT motor efficiency. In the second investigation, participants had to perform CFT twice for each at different intensities of Borg's Scale of perceived exertion. Researchers successfully requested to fill out the NASA TLX questionnaire regarding the perceived workload characteristics of CFT, and the reliability of each intensity was assessed. Results seem to enhance the consistency and the accuracy of the instrument. Indeed, findings evidenced that CFT is not influenced by mental fatigue conditions typical of the intellectual work of desk workers and university students for which this test was specifically conceived. Moreover, moderate and strong perceived intensity are the most adequate conditions to assess motor efficiency in these populations.

Single-use digital flexible cystoscope for double J removal versus reusable instruments: a prospective, comparative study of functionality, risk of infection, and costs.

BACKGROUND: The removal of ureteral stent can be performed with disposable or reusable flexible cystoscopes, but limited comparative data are available on functionality, risk of infections, and costs. METHODS: We performed a multicentric, prospective, observational study on patients undergoing in-office ureteral stent removal with Isiris-α® or a reusable Storz™ flexible cystoscope. Study endpoints were the functionality and effectiveness of the devices, the rate of postoperative bacteriuria and UTIs, and the costs of the procedure. RESULTS: A total of 135 patients were included, 80 (59.2%) treated with reusable cystoscopes and 55 (40.8%) with Isiris-α®. No significant baseline differences between groups were detected. Isiris-α® outperformed the reusable device in terms of quality of vision (p 0.001), manoeuvrability (p 0.001), grasper functionality (p < 0.001), and quality of the procedure (p 0.01). Mean procedure time was shorter with Isiris-α® (p < 0.001) due to a shorter instrument preparation time (p < 0.001). No differences were found in terms of perceived patient pain (p 0.34), nor postoperative bacteriuria or symptomatic UTIs. According to our cost analysis, the in-office procedure performed with Isiris-α® was more expensive (+ 137.8€) but was independent from instrument turnover or disinfection. Among limitations of study we acknowledge the lack of randomization, the use of antibiotic prophylaxis in several patients, and the high rate of missing preoperative urine cultures. CONCLUSIONS: Isiris-α® outperforms reusable cystoscopes for in-office ureteral stent removal in terms of total operative time and quality of the procedure, at the cost of being more expensive. No significant differences in postoperative bacteriuria or symptomatic UTIs were found.

Relationships between training dose and record power outputs in professional road cyclists: insights and threats to validity.

Testing short-term (4-8 weeks) correlations between training dose and performance in professional road cyclists can help improve their training and performance. Multilevel mixed-modeling was used to correlate training dose (Time, Edwards' Trimp-eTRIMP, Training Stress Score-TSS, time spent in power output zones-Z1, Z2, Z3, Polarization Index-PI) and Record Power Output (RPO) over 1 minute (RPO1), 5 (RPO5), 20 (RPO20), and 40 minutes (RPO40) across four different time periods: training dose of the previous month with RPOs of the subsequent month (Monthly-analysis); training dose of the 8 weeks preceding All, Grand tours, One-day races with RPOs of these races. In Monthly-analysis, small positive relationships between all the training dose parameters, except for PI, and RPO1, RPO5, RPO20, RPO40 were found (p ≤ 0.001). In Grand tours analysis, Z3 showed a positive association with RPO40 (r: 0.45; p = 0.007, moderate) and was positively related to RPO1 and RPO5 (r between 0.32 and 0.34; p = 0.053-0.059, moderate). PI was small positively related to RPO1 (r = 0.29, p = 0.076, small). In One-day races analysis, eTRIMP was positively related to RPO5 (r = 0.30, p = 0.035, moderate), Z1 negatively related to RPO40 (r = -0.31, p = 0.031, moderate), PI positively related to RPO5 (r = 0.24, p = 0.068, small) and Z2 was negatively related to RPO20 (r = -0.29, p = 0.051, small). A certain degree of responsiveness to training dose exists in professional road cyclists. To improve RPOs an appropriate preparation pattern seems to be increasing high intensity training for Grand Tours and fostering high intensity and overall training load (eTRIMP and TSS) in a more polarized-fashion for one-day races. Systematic and precise data collection during training and racing is highly advocated.

Association between match physical activity and neuromuscular characteristics in youth football.

BACKGROUND: The aim of this study was to examine the associations between maximal and submaximal neuromuscular field tests, match physical activity levels and biological maturation in youth football players. METHODS: Sixty-four football players from under 14 to under 17 age groups were assessed. Players performed a repeated-sprint ability test, counter movement jump, 10-m, and 30-m sprint test, as well as an assessment of peripheral muscle function following a multi-stage incremental (i.e., four intensity levels) change of direction test (COD). Knee extensors peak-torque (PTmax) and the decrement of torque values (dec) were considered as COD outcomes. Physical match activities were tracked by GPS technology, while rate of perceived exertion (RPE) was assessed using the CR10 Börg Scale. Pearson's correlations (90% confidence interval) were used to examine the relationships. RESULTS: Small associations were found between field tests and match activities. The relationships increased from small to moderate for some tests when match data with RPE>5 were considered. The largest associations were found between distance covered <-2.5m·s-2 and both COD PTmax and dec when RPE>5. CONCLUSIONS: The results of the present study provide further evidence of a small-to-moderate association between muscular performance and match work-rate in young football players. Although physical and physiological evaluations fail to precisely estimate the quantity of physical activities performed during matches, it is suggested that they can be utilized to monitor the training effect over time in young football players.

Relationships Between Internal and External Load Measures and Fitness Level Changes in Professional Soccer Players.

Purpose: Understanding the dose-response relationship between internal and external training load with changes in aerobic fitness and intermittent running capacity, during different periods of the season, may help in optimizing training process. The aim of the present study was to investigate the dose-response relationships between load measures and changes in aerobic fitness and intermittent running capacity among a large cohort of professional soccer players. Methods: Training load, aerobic fitness and intermittent running capacity of 52 male adult professional players from 3 elite teams were monitored across an entire season and analyzed employing linear mixed models, with a significance level set at p≤0.05. Results: Relationships between load measures (training and match duration, sRPE-TL, total distance, high and very high-speed running distances) and changes in physical qualities were stronger during the preparation period (PREP) for both aerobic fitness (d= 0.48 to 0.76, p<0.031) and intermittent running capacity (d= 0.46 to 1.89, p<0.046). The magnitude of the relationships reduced during the first competitive period (d= 0.43 to 0.56) and the relationships became trivial in the second competitive period (d= 0.06 to 0.41, p= 0.063 to 0.846). Conclusion: The moderate to large relationships found between all measures of load and changes in physical capacities suggest that training prescription during the PREP was effective in improving players' fitness. During the competitive phase small changes in aerobic and intermittent running capacities were found, highlighting that coaching staff pursue different aims during the competitive period, such as technical and tactical training and recovery.       .

Impact of Ureteral Stent Material on Stent-related Symptoms: A Systematic Review of the Literature.

Context: Ureteral stents are essential implants that are used on a daily basis. Since their invention, advances in stent design have been directed towards alleviating stent-related symptoms. It remains unclear how the material composition of the stent affects stent-related symptoms. Objective: To review the literature and define the clinical impact of ureteral stent material on stent-related symptoms. Evidence acquisition: A literature search of the Embase, MEDLINE (PubMed), and Web of Science databases was conducted on December 17, 2021 to collect articles comparing stent composition materials regarding stent-related symptoms. Thirteen publications met the inclusion criteria, of which only one met the high-quality requirements of the Cochrane Collaboration tool for assessing the risk of bias in randomized trials. Evidence synthesis: Most trials, including the highest quality trial, seem to support that silicone double-J (DJ) stents reduce stent-related symptoms compared to nonsilicone DJ stents. Regarding physical properties, it seems that "soft" or "flexible" DJ stents reduce stent-related symptoms. However, since there was only one high-quality study with a low risk of bias, it is impossible to draw a definitive conclusion owing to the lack of quality data. Conclusions: Silicone DJ stents, and by extension "soft" DJ stents, appear to reduce stent-related symptoms compared to nonsilicone polymers and "hard" DJ stents. No definitive conclusion can be drawn owing to a lack of quality evidence. Creating a standard for measuring and reporting physical stent properties should be the first step for further research. Patient summary: A ureteral stent is a small hollow tube placed inside the ureter to help urine drain from the kidney. We reviewed the literature on the impact of stent material on stent-related symptoms. We found that silicone may reduce stent-related symptoms, but no definitive conclusion can be drawn and further studies are needed.

Promoting Children's Psychomotor Development with Multi-Teaching Didactics.

This group randomized control trial examined the dose-response effect of varied combinations of linear and nonlinear pedagogy (enriched physical education with specific program led by specialist vs. conventional physical education led by generalist) for improving first-grade children's motor creativity, executive functions, self-efficacy, and learning enjoyment. We led three physical education classes per group through 12 weeks of combined instruction, based on linear and nonlinear pedagogy: mostly linear (ML; 80% linear, 20% nonlinear; n = 62); mostly nonlinear (MNL; 20% linear, 80% nonlinear; n = 61); and control (C; conventional teaching from generalists; n = 60). MNL improved in (a) motor creativity ability (DMA; 48.7%, 76.5%, and 47.6% for locomotor, stability, and manipulative tasks, respectively); (b) executive functions (working memory and inhibitory control) for RNG task (14.7%) and task errors (70.8%); (c) self-efficacy (5.9%); and (d) enjoyment (8.3%). In ML, DMA improved by 18.0% in locomotor and 60.9% in manipulative tasks. C improved of 10.5% in enjoyment, and RNG task worsened by 22.6%. MNL improvements in DMA tasks, executive functions, and self-efficacy were significantly better than those in C. ML was better than C in DMA task and in executive functions' task errors. Overall, ML and MNL approaches were more effective than conventional generalist teaching (C), and the MNL combination of 80% nonlinear and 20% linear pedagogy was optimal. We recommend that educators favor the MNL approach.

Peripheral muscle function during repeated changes of direction in professional soccer players.

PURPOSES: To evaluate peripheral muscle function of the knee extensors during repeated changes of direction in professional soccer players by examining differences between competitive levels, periods of the season and playing positions, and to investigate the relationships between peripheral muscle function and physical activities during matches. METHODS: Knee extensor peripheral muscle function (twitch peak torque, PT) of 593 male soccer players from 13 European professional clubs competing at 3 different levels was evaluated 4 times during the season. The main outcomes were PTmax (maximal PT, muscle contractility), MPmax (maximal metabolic power exercise intensity) and PTdec (PT decline, muscle fatigability) obtained during intermittent runs of increasing intensity with multiple changes of direction interspersed with electrically evoked contractions. Relative total and sprint distances covered during a whole match and during short intervals were quantified from a sub-sample. RESULTS: PTmax and MPmax were higher for first than for second division (p < 0.047; d = 0.15-0.23) and Under-19 players (p < 0.007; d = 0.17-0.25). MPmax was lower (p < 0.016; d = 0.23-0.32) and PTdec was higher (p < 0.004; d = 0.26-0.39) in the pre-season compared to all the other time points. MPmax was higher for fullbacks than attackers and defenders (p < 0.041; d = 0.20-0.22). PTdec was higher for defenders than fullbacks, midfielders and wings (p < 0.029; d = 0.21-0.28). PTmax was associated with whole-match relative total distance (p = 0.004; d = 0.26). PTdec was associated with whole-match relative total distance and relative short-interval sprint distance (p < 0.050; d = 0.18-0.22). CONCLUSION: The ability to sustain repeated change of direction efforts at high intensities while preserving peripheral muscle function should be considered an important determinant of soccer physical performance.

Flexible Ureterorenoscopy Versus Shockwave Lithotripsy for Kidney Stones ≤2 cm: A Randomized Controlled Trial.

BACKGROUND: No clear recommendations are available on whether retrograde intrarenal surgery (RIRS) via flexible ureterorenoscopy or shockwave lithotripsy (SWL) should be preferred for kidney stones ≤2 cm, except for lower-pole stones. OBJECTIVE: To compare outcomes between RIRS and SWL. DESIGN, SETTING, AND PARTICIPANTS: This was a single-center randomized controlled trial from March 2015 to May 2018. Patients with a single 6-20-mm kidney stone were enrolled (NCT02645058). INTERVENTION: Patients were randomized to RIRS or SWL. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: The primary endpoint was the single-procedure stone-free rate (SFR) at 1 mo. Two levels of success were set: fragments ≤4 mm (SFR-4) and no residual fragments (SFR-0). Secondary endpoints were the SFR at 6 mo and 1 yr and rates of complications and further treatments. RESULTS AND LIMITATIONS: A total of 138 patients underwent treatment (70 RIRS vs 68 SWL). In comparison to SWL, RIRS SFR results were higher at 1 mo (SFR-4 70.0% vs 45.6%; p = 0.004; SFR-0 50.0% vs 26.5%; p = 0.004) and 6 mo (SFR-4 79.7% vs 63.6%; p = 0.038; SFR-0 59.4% vs 40.9%; p = 0.032). There was no difference in SFR measures between the groups at 1 yr (SFR-4 p = 0.322; SFR-0 p = 0.392). Overall complications were comparable (p = 0.207), but the complication rate for stones >10 mm was higher for the SWL group (p = 0.021). The need for further treatment was comparable (p = 0.368). In terms of patient satisfaction, 86.8% and 77.1% of patients would choose SWL and RIRS again, respectively (p = 0.24). CONCLUSIONS: RIRS achieved better SFRs in comparison to SWL at 1 and 6 mo, but not at 1 yr. The RIRS complication rate was lower for stones >10 mm. SWL remains a viable alternative, especially for 6-10-mm stones, providing comparable results to RIRS in the long term. PATIENT SUMMARY: We compared outcomes for the treatment of kidney stones ≤2 cm with two techniques: flexible ureteroscopy, in which a flexible telescope is passed through the urethra and bladder to reach the ureter between the bladder and kidney; and shockwave lithotripsy, in which shockwaves are applied to the skin over the location of the kidney stone. Ureteroscopy achieved better stone-free results at 1 and 6 months, but not at 1 year.

The UP150: A Multifactorial Environmental Intervention to Promote Employee Physical and Mental Well-Being.

Physical activity (PA) is a major health factor and studies suggest workplaces could promote PA by modifying office design, motivational strategies and technology. The present study aims to evaluate the efficiency of UP150, a multifactorial workplace intervention for the improvement and maintenance of the level of physical fitness (PF) and wellbeing. Forty-five employees were randomly divided into the experimental (EG) and control (CG) groups. The PF was assessed pre-post intervention using the cubo fitness test (CFT), the amount of PA was evaluated using the IPAQ questionnaire and accelerometers while the workload was assessed using the NASA-TLX questionnaire and psycho-physical health by using the SF-12 questionnaire. The EG worked in UP150 offices while the CG worked in their usual offices for 8 weeks. The EG and CG came back 4 weeks after the intervention for CFT retention. The EG improved CFT motor efficiency and the amount of moderate PA, while it reduced mental load. The EG retained reached motor efficiency levels 4 weeks after the intervention. No differences were found in IPAQ. The UP150 demonstrated to be a proactive environment and to be efficient in the promotion of PA, improving PF and mental health while decreasing mental load.

Loop-tail stents fail in reducing stent-related symptoms: results of a prospective randomised controlled trial.

OBJECTIVE: To compare stent-related symptoms (SRS) of loop-tail (LT) and conventional double J (DJ) stents after uncomplicated flexible ureterorenoscopy (fURS), in a prospective randomised controlled single-blind parallel-group study. PATIENTS AND METHODS: Patients undergoing fURS were randomised into two groups: the LT Group received LT stents (Polaris™ Loop) and the DJ Group received conventional DJ stents (Vortek® ). The stent was removed after 4 weeks. The Ureteric Stent Symptom Questionnaire (USSQ) was administered at 2 days, 4 and 8 weeks (baseline evaluation) after stent insertion. The primary endpoint was to compare the Urinary Symptom Index Score of the LT vs DJ groups at 4 weeks after stent insertion. The secondary endpoints were to compare the USSQ domains' subscores at 2 days and 4 weeks after stent insertion, USSQ single answers at 4 weeks, and the 4-week USSQ domains' subscores adjusted for baseline. RESULTS: A total of 68 patients were randomised (34 LT and 34 DJ). The answers given at 4 weeks were not significantly different between the two groups for the Urinary Symptom Index Score (P = 0.982), Pain Index Score (P = 0.169), visual analogue scale (P = 0.276), and all the other domains of the USSQ. At 4 weeks, the single-answer analysis did not find any differences between the groups; the urinary symptoms were all comparable, as was the requirement for pain painkillers (P = 0.684) and pain during sex (P = 0.496). There were also no significant differences for every single domain score for the responses given at 2 days. The same applied to USSQ subscores at 4 weeks adjusted for the 8-week baseline results, which were also comparable. CONCLUSIONS: The study found no differences in terms of SRS between the LT and DJ groups, either at 2 days or 4 weeks after stent insertion, with or without baseline correction.

European Association of Urology Section of Urolithiasis and International Alliance of Urolithiasis Joint Consensus on Retrograde Intrarenal Surgery for the Management of Renal Stones.

BACKGROUND: Retrograde intrarenal surgery (RIRS) has become the preferred treatment modality for nephrolithiasis. However, because of ongoing uncertainties regarding the optimal perioperative management, operative technique, and postoperative follow-up, as well as a lack of standardization for outcome reporting, consensus is needed to achieve more uniform clinical practice worldwide. OBJECTIVE: To develop recommendations for RIRS on the basis of existing data and expert consensus. DESIGN, SETTING, AND PARTICIPANTS: A protocol-driven, three-phase study was conducted by the European Association of Urology Section of Urolithiasis (EULIS) and the International Alliance of Urolithiasis (IAU). The process included: (1) a nonsystematic review of the literature to define domains for discussion; (2) a two-round modified Delphi survey involving experts in this field; and (3) an additional group meeting and third-round survey involving 64 senior representative members to formulate the final conclusions. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: The results from each previous round were returned to the participants for re-evaluation of their decisions during the next round. The agreement threshold was set at 70%. RESULTS AND LIMITATIONS: The panel included 209 participants who developed 29 consensus statements on the following topics of interest: (1) perioperative infection management; (2) perioperative antithrombotic therapy; (3) fundamentals of the operative technique; and (4) standardized outcome reporting. Although this consensus can be considered as a useful reference for more clinically oriented daily practice, we also acknowledge that a higher level of evidence from further clinical trials is needed. CONCLUSIONS: The consensus statements aim to guide and standardize clinical practice and research on RIRS and to recommend standardized outcome reporting. PATIENT SUMMARY: An international consensus on the best practice for minimally invasive surgery for kidney stones was organized and developed by two international societies. It is anticipated that this consensus will provide further guidance to urologists and may help to improve clinical outcomes for patients.

Flexible Ureterorenoscopy under Spinal Anesthesia: Focus on Technique, Results, Complications, and Patients' Satisfaction from a Large Series.

INTRODUCTION: Although spinal anesthesia (SA) may reduce postoperative morbidity, most urologists perform flexible ureterorenoscopy (fURS) under general anesthesia (GA). The objective of our study is to provide technical details, results, complications, and patients' satisfaction with fURS performed under exclusive SA. METHODS: We analyzed all consecutive fURS performed under SA to treat renal stones from March 2011 to February 2017. Details of technique, operative time, outcomes, need for further treatments, complications, and patients' satisfaction were evaluated. RESULTS: Two hundred thirty-four fURS under SA were considered. SA was performed through L2-L3 vertebral interspace in 64.1%. Patients were discharged the same day of surgery. Mean stone burden was 13.5 ± 6.6 mm and mean operative time 76.9 ± 34.6 min. Single-procedure SFR was 69.7%. Further treatments were performed in 22.8%. 96.6% had no anesthesia-related complications. No Clavien-Dindo grade ≥ IIIb complications were noticed. 99.6% of patients were satisfied with SA. No cases of conversion from SA to GA occurred. CONCLUSION: fURS can be performed safely and efficiently under SA, taking into account a few details of the technique. Patients' satisfaction with SA is very high, and complications are rare. Although SA is usually adopted in unfit patients for GA, it may be considered as a viable alternative in fit patients.

Clinical outcomes and temporal trends of immunological and non-immunological rare diseases in adult kidney transplant.

BACKGROUND: Rare diseases (RDs) encompass many difficult-to-treat conditions with different characteristics often associated with end-stage renal disease (ESRD). However, data about transplant outcomes in adult patients are still lacking and limited to case reports/case series without differentiation between immunological/non-immunological RDs. METHODS: Retrospective analysis among all adult kidney transplanted patients (KTs) with RDs (RDsKT group) performed in our high-volume transplantation center between 2005 and 2016. RDs were classified according to the Orphanet code system differentiating between immunological and non-immunological diseases, also comparing clinical outcomes and temporal trends to a control population without RDs (nRDsKT). RESULTS: Among 1381 KTs, 350 patients (25.3%) were affected by RDs (RDsKTs). During a f/up > 5 years [median 7.9 years (4.8-11.1)], kidney function and graft/patient survival did not differ from nRDsKTs. Considering all post-transplant complications, RDsKTs (including, by definition, patients with primary glomerulopathy except on IgA nephropathy) have more recurrent and de-novo glomerulonephritis (14.6% vs. 9.6% in nRDsKTs; p = 0.05), similar rates of de-novo cancers, post-transplant diabetes, dysmetabolism, hematologic disorders, urologic/vascular problems, and lower infectious episodes than nRDsKTs (63.7% vs 72.7%; p = 0.013). Additional stratification for immunological and non-immunological RDsKTs or transplantation periods (before/after 2010) showed no differences or temporal trends between groups. CONCLUSIONS: Kidney transplant centers are deeply involved in RDs management. Despite their high-complex profile, both immunological and non-immunological RDsKTs experienced favorable patients' and graft survival.