Flexible Ureteroscopy as the New Standard for the Management of Renal Transplant Urolithiasis <15 mm: A Single-Center Experience.

Objectives: To determine the safety and efficacy of flexible ureteroscopy in the treatment of transplant urolithiasis. Materials and Methods: We reviewed a single-center series of 2652 patients who underwent surgical treatment for nephrolithiasis at our institution from 2009 to the present day to identify all patients undergoing ureteroscopy for treatment of transplant lithiasis. Results: We identified 18 patients who underwent ureteroscopy for treatment of urolithiasis within the transplanted kidney or ureter. The majority of the procedures were performed using a retrograde approach with flexible ureteroscopy, with one patient undergoing antegrade ureteroscopy and two patients requiring semirigid ureteroscopy. Holmium:yttrium-aluminum-garnet laser lithotripsy was utilized in all but one case, which was performed using basket extraction. There were no intraoperative complications reported. Four patients had small stone fragments on postoperative imaging, three of which were observed. One patient required repeat ureteroscopy for persistent distal ureteral stone. Conclusion: Retrograde ureteroscopy is a feasible, safe, and effective intervention for the treatment of transplant lithiasis. Minimal intraoperative or postoperative complications were reported, and only one patient required additional intervention for residual stone burden.

Evidence That Female Urologists and Urology Trainees Tend to Underrate Surgical Skills on Self-Assessment.

BACKGROUND: Historically low, the proportion of female urology residents now exceeds 25% in recent years. Self-assessment is a widely used tool to track progress in medical education. However, the validity of its results and gender differences may influence interpretation. Simulation of surgical skills is increasingly common in modern residency training and standardizes certain objective tasks and skills. The objective of this study was to identify gender differences in self-assessment of surgeons and trainees when using simulation of surgical skills. METHODS: Medical students, residents, and attending and retired surgeons completed simple interrupted suturing. Assessment was self-rated using previously tested visual analog motion scales. Tasks were video recorded and rated by blinded expert surgeons using identical motion scales. Computer vision motion tracking software was used to objectively analyze the kinematics of surgical tasks. RESULTS: Proportion of female (n = 17) and male (n = 20) participants did not differ significantly by the level of training, P = 0.76. Five expert surgeons evaluated 84 video segments of simple interrupted suturing tasks (mean 3.0 segments per task per participant). Self-assessment correlated well overall with expert rating for motion economy (Pearson correlation coefficient 0.61, P < 0.001) and motion fluidity (0.55, P = 0.002). Women underrated their performance in accordance with mean individual difference of self-assessment and expert assessment scores (Δ SAS-EAS) for both economy of motion (mean ± SEM -1.1 ± 0.38, P = 0.01) and fluidity of motion (-1.3 ± 0.39, P < 0.01). On the same measures, men tended to rate themselves in accordance with experts (-0.16 ± 0.36, P = 0.63; -0.09 ± 0.41, P = 0.82, respectively). Δ SAS-EAS did not differ significantly on any rating scale across levels of training. Expert ratings did not differ significantly by gender for any domain. CONCLUSIONS: Female surgeons and trainees underrate some technical skills on self-assessment when compared with expert ratings, whereas male surgeon and trainee self-ratings and expert ratings were similar. Further work is needed to determine if these differences are accentuated across increasingly difficult tasks.

Laparoscopic Renal Denervation for Uncontrolled Hypertension Due to Medication Intolerance: A Case Report.

Resistant hypertension is challenging to treat, and most patients with the condition fail to achieve blood pressure control, putting them at increased risk for adverse long-term outcomes. We present the case of a 59-year-old woman with resistant hypertension due to intolerance to nearly all antihypertensive medications. After failure to achieve blood pressure control over a 5-year period, with blood pressures as high as 220/110mmHg, the patient underwent surgical treatment with bilateral laparoscopic renal denervation. Immediately after the procedure, as well as at the 1-, 3-, 9-, and 12-month follow-ups, the patient's blood pressure was reduced to the range of 120-140/80-90mmHg.