A Prospective Multi-institutional Study Using a Novel Safety Valve for the Prevention of Catheter Balloon Inflation Injury of the Urethra.

PURPOSE: We prospectively assessed the ability of a novel transurethral catheterization safety valve to prevent urethral catheter balloon injury in a multi-institutional clinical setting. MATERIALS AND METHODS: A prospective, multi-institution study was conducted. The safety valve was introduced for urinary catheterization in 6 hospital groups (4 in Ireland; 2 in the UK). The safety valve allows fluid in the catheter system to vent through a pressure relief valve if attempted intraurethral inflation of the catheter's anchoring balloon occurs. Device usage was studied over a 12-month period, with data recorded using a 7-item data sticker containing a scannable QR code. "Venting" through the safety valve during catheterization was indicative of prevention of a urethral injury. An embedded 3-month study was conducted in 3 centers, with any catheter balloon injuries occurring during catheterization without safety valve use referred to the on-call urology team recorded. Health economic analyses were also performed. RESULTS: During the overall 12-month device study phase, 994 urethral catheterizations were performed across study sites. Twenty-two (2.2%) episodes of safety valve venting were recorded. No urethral injuries occurred in these patients. In the embedded 3-month study, 18 catheter balloon injuries were recorded in association with catheterizations performed without the safety valve. Based on confirmed and device-prevented urethral injuries, the injury rate for urethral catheterization without safety valve use was calculated to be 5.5/1,000 catheterizations. CONCLUSIONS: The safety valve has the potential to eliminate catheter balloon injury if widely adopted. It represents a simple, effective, and innovative solution to this recurring problem applicable to all patient cohorts.

Outcome of acute epididymo-orchitis: risk factors for testicular loss.

PURPOSE: Acute epididymo-orchitis (AEO) is a common urological condition characterised by pain and swelling of the epididymis which can affect men of any age. The aetiology and to some extent the management of the patient differ between paediatric and young and older adult groups. METHODS: A retrospective analysis was performed at the University Hospital Limerick from 2012 to 2016. Hospital In-Patient Enquiry (HIPE) data were obtained for all patients diagnosed with orchitis, epididymitis, epididymo-orchitis or testicular abscess over this 5-year period. RESULTS: 140 patients were identified, the age range was 0-89, median age 35.6. These were then split into 3 clinical groups, pre-pubertal (Group 1, 0-15-year-olds), sexually active young men (Group 2a, 16-35-year-olds) and men over 35 (Group 2b). Nine patients had an abscess on ultrasound investigation. There was a significant correlation between the presence of an abscess and the need for an orchidectomy (2 patients, P = 0.035). Two patients were reported as having an atrophic testis following AEO and both were in Group 2b. CONCLUSION: Overall, 7/131 (5%) patients had loss or atrophy of a testicle following an episode of AEO. Nineteen patients had further readmissions with AEO (14%).

The recurrent urinary tract infection health and functional impact questionnaire (RUHFI-Q): design and feasibility assessment of a new evaluation scale.

INTRODUCTION: We aim to design a tool to assess the impact of recurrent urinary tract infection (rUTI) on quality of life (QoL) in adult women, given the notable absence of an established instrument for this purpose. MATERIALS AND METHODS: Best practice guidelines in health-related survey design were reviewed. A literature review informed creation of an interview guide. Following ethical approval, 10 female patients (23-38 years) with rUTI were invited to participate in phase 1 of questionnaire design; all agreed. Individual semi-structured interviews were conducted exploring the impact of rUTI on patients' QoL. Interviews were repeated with 5 staff members (3 urology nurses and 2 consultant urologists). Responses were recorded and thematic analysis performed, to inform the design of a new questionnaire. A further 10 patients were recruited to assess feasibility of completion. RESULTS: All participants found available questionnaires unfit for assessment of rUTI-related QoL. Multiple themes emerged as integral to an rUTI questionnaire, including: frequency of UTIs, duration of symptoms, time to full recovery, specific symptoms of UTI, constitutional symptoms, impact on work/education, impact on leisure activities, impact on interpersonal relationships, impact on sexual relationships, psychological aspects and implications of treatment. Data saturation was reached. Based on responses, the Recurrent Urinary tract infection Health and Functional Impact Questionnaire (RUHFI-Q) was drafted, comprising 10 domains and 16 items. CONCLUSIONS: We propose a novel self-administered questionnaire, the RUHFI-Q, as an instrument to standardize evaluation of the QoL impact of rUTI in a population of premenopausal women. Further validation studies are in progress.

Direct mechanical characterization of prostate tissue-a systematic review.

BACKGROUND: Direct mechanical characterization of tissue is the application of engineering techniques to biological tissue to ascertain stiffness or elasticity, which can change in response to disease states. A number of papers have been published on the application of these techniques to prostate tissue with a range of results reported. There is a marked variability in the results depending on testing techniques and disease state of the prostate tissue. We aimed to clarify the utility of direct mechanical characterization of prostate tissue in identifying disease states. METHODS: A systematic review of the published literature regarding direct mechanical characterization of prostate tissue was undertaking according to PRISMA guidelines. RESULTS: A variety of testing methods have been used, including compression, indentation, and tensile testing, as well as some indirect testing techniques, such as shear-wave elastography. There is strong evidence of significant stiffness differences between cancerous and non-cancerous prostate tissue, as well as correlations with prostate cancer stage. There is a correlation with increasing prostate stiffness and increasing lower urinary tract symptoms in patients with benign prostate hyperplasia. There is a wide variation in the testing methods and protocols used in the literature making direct comparison between papers difficult. Most studies utilise ex-vivo or cadaveric tissue, while none incorporate in vivo testing. CONCLUSION: Direct mechanical assessment of prostate tissue permits a better understanding of the pathological and physiological changes that are occurring within the tissue. Further work is needed to include prospective and in vivo data to aid medical device design and investigate non-surgical methods of managing prostate disease.

Hospital burden of long-term genitourinary and gastrointestinal toxicity after radical radiotherapy for prostate cancer.

INTRODUCTION: Treatment options for prostate cancer (PCa) include radical radiotherapy (RT) and radical prostatectomy, both of which have comparable oncological outcomes. The aim of this study was to investigate the hospital burden of long-term genitourinary and gastrointestinal toxicity among patients with PCa who were treated with radiotherapy at our institution. METHODS: The radiotherapy department database was used retrospectively to identify all patients who underwent radiotherapy for PCa from January 2006 to January 2008. The patient administration system from each public hospital in the region was interrogated and all patient points of contact were recorded. Minimum follow up was 5 years. Individual patient charts were reviewed and factors that might influence outcomes were documented. RESULTS: We identified 112 patients. The mean age at diagnosis was 66 (44-76) and the median PSA was 12.1 (3.2-38). The mean duration of follow-up was 7.8 yrs. Twenty-three patients (20%) presented to the Emergency Department (ED) with late onset toxicity. Nine patients had more than 2 ED attendances. Twenty-five patients (22%) were investigated for genitourinary toxicity. Forty-seven patients (42%) underwent investigation for gastrointestinal side-effects and 45% of these required argon therapy (21/47). CONCLUSION: We found a significant hospital burden related to the management of gastrointestinal and genitourinary toxicity post radical radiotherapy for prostate cancer. As health care reforms gain momentum, policy makers must take into account the considerable longitudinal health care cost related to radiotherapy. It is also important that patients are counselled carefully in relation to potential long-term side-effects.

Assessing the impacts of land use on downstream water quality using a hydrologically sensitive area concept.

Understanding the relationship between land use and water quality is essential to improve water quality through carefully managing landscape change. This study applies a linear mixed model at both watershed and hydrologically sensitive areas (HSAs) scales to assess such a relationship in 28 northcentral New Jersey watersheds located in a rapidly urbanizing region in the United States. Two models differ in terms of the geographic scope used to derive land use matrices that quantify land use conditions. The land use matrices at the watershed and HSAs scales represent the land use conditions in these watersheds and their HSAs, respectively. HSAs are the hydrological "hotspots" in a watershed that are prone to runoff generation during storm events. HSAs are derived using a soil topographic index (STI) that predicts hydrological sensitivity of a landscape based on a variable source area hydrology concept. The water quality indicators in these models are total nitrogen (TN), total phosphorus (TP) and total suspended solids (TSS) concentrations in streams observed at the watershed outlets. The modeling results suggest that presence of low density urban land, agricultural land and wetlands elevate while forest decreases TN, TP and/or TSS concentrations in streams. The watershed scale model tends to emphasize the role of agricultural lands in water quality degradation while the HSA scale model highlights the role of forest in water quality improvement. This study supports the hypothesis that even though HSAs are relatively smaller area compared to watershed, still the land uses within HSAs have similar impacts on downstream water quality as the land uses in entire watersheds, since both models have negligible differences in model evaluation parameters. Inclusion of HSAs brings an interesting perspective to understand the dynamic relationships between land use and water quality.

A novel technique for establishing soil topographic index thresholds in defining hydrologically sensitive areas in landscapes.

Hydrologically sensitive areas (HSAs) are useful for analyzing a watershed. However, correct delineation of HSAs is critical for conducting such analysis. Scientifically defensible methods for delineating HSAs are lacking. The objectives of this study are to identify threshold soil topographic indices (STIs) based on the relationship between the observed soil moisture and the calculated STI in two sites using a trellis plot approach, and validate the identified threshold STIs in delineating HSAs in 15 watersheds in North Central New Jersey based on a linear mixed modeling of the relationship between land use and water quality at the watershed and HSA scales. Field soil moisture data are collected during April, May, June, July, August, and September for three years at Christie Hoffman Park and Fairview Farm in Central New Jersey. The linear mixed models assess the relationship between land use metrics in terms of percentages of land uses and three water quality indicators including total suspended solids, total nitrogen and total phosphorus in streams at both watershed and HSA scales. Trellis plot analyses based on a polynomial regression model of order of two to four identify the threshold STIs ranging from nine to 15 for delineating HSAs. The linear mixed modeling results indicate that the relationships between land use and three water quality indicators at the HSA scales are similar to their relationships at the watershed scale. The predictive powers of these HSA and watershed scale models are very similar. These results suggest that it is appropriate for policymakers and watershed managers to use HSAs rather than entire watersheds to characterize watersheds and devise management strategies to optimize resource uses. The novel technique developed in this study can be used in other parts of the world.

Understanding the relationship of land uses and water quality in Twenty First Century: A review.

Rising food, housing and energy demand of increasing population creates an immense pressure on water resources, especially on water quality. The water quality around the globe is degrading primarily due to intense agricultural activities associated with rapid urbanization. This study attributes to cause of water quality problem, indices to measure water quality, methods to identify proper explanatory variables to water quality and it's processing to capture the special effect, and finally modeling of water quality using identified explanatory variables to provide insights. This would help policymakers and watershed managers to take necessary steps to protect water quality for the future as well as current generation. Finally, some knowledge gaps are also discussed which need to be addressed in the future studies.

Application of analytical hierarchy process for effective selection of agricultural best management practices.

In this study an analytical hierarchy process (AHP) was used for ranking best management practices (BMPs) in the Saginaw River Watershed based on environmental, economic and social factors. Three spatial targeting methods were used for placement of BMPs on critical source areas (CSAs). The environment factors include sediment, total nitrogen, and total phosphorus reductions at the subbasin level and the watershed outlet. Economic factors were based on total BMP cost, including installation, maintenance, and opportunity costs. Social factors were divided into three favorability rankings (most favorable, moderately favorable, and least favorable) based on area allocated to each BMP. Equal weights (1/3) were considered for the three main factors while calculating the BMP rank by AHP. In this study three scenarios were compared. A comprehensive approach in which environmental, economic, and social aspects are simultaneously considered (Scenario 1) versus more traditional approaches in which both environmental and economic aspects were considered (Scenario 2) or only environmental aspects (sediment, TN, and TP) were considered (Scenario 3). In Scenario 1, only stripcropping (moderately favorable) was selected on all CSAs at the subbasin level, whereas stripcropping (49-69% of CSAs) and residue management (most favorable, 31-51% of CSAs) were selected by AHP based on the watershed outlet and three spatial targeting methods. In Scenario 2, native grass was eliminated by moderately preferable BMPs (stripcropping) both at the subbasin and watershed outlet levels due the lower BMP implementations cost compared to native grass. Finally, in Scenario 3, at subbasin level, the least socially preferable BMP (native grass) was selected in 100% of CSAs due to greater pollution reduction capacity compared to other BMPs. At watershed level, nearly 50% the CSAs selected stripcropping, and the remaining 50% of CSAs selected native grass and residue management equally.

Repurposing spent biomass of vetiver grass used for stormwater treatment to generate biochar and ethanol.

Stormwater pollution is a key factor contributing to water quality degradation, posing substantial environmental and human health risks. Although stormwater retention ponds, also referred to as wet ponds, are commonly implemented to alleviate stormwater challenges by reducing peak flow and removing suspended solids, their effectiveness in removing heavy metals and nutrients is limited. This study evaluated the performance of floating treatment platforms (FTPs) featuring vetiver grass (Chrysopogon zizanioides), a non-invasive, nutrient- and metal-accumulating perennial grass, in removing heavy metals (Cu, Pb, and Zn) and nutrients (P and N) in stormwater retention ponds. Furthermore, the potential for utilizing the spent vetiver biomass for generating biochar and bioethanol was investigated. The study was conducted in a greenhouse setup under simulated wet and dry weather conditions using pond water collected from a retention pond in Stafford Township, New Jersey, USA. Two FTPs with vetiver (vegetated FTPs) were compared with two FTPs without vetiver (non-vegetated FTPs), which served as controls. Results showed that the removal of heavy metals and nutrients by the FTPs with vetiver was significantly higher (p < 0.05) than the FTPs without vetiver. Notably, vetiver showed resilience to stormwater pollutants and hydroponic conditions, displaying no visible stress symptoms. The biochar and bioethanol generated from the spent vetiver exhibited desirable yield and quality, without raising concerns regarding pollutant leaching, indicated by very low TCLP and SPLP concentrations. This study provides compelling evidence that the implementation of vetiver-based FTPs offers a cost-effective and environment-friendly solution for mitigating stormwater pollution in retention ponds. Furthermore, the utilization of vetiver biomass for biofuel and biochar production supports clean production and fostering circular economy efforts.

Evaluating the capabilities of watershed-scale models in estimating sediment yield at field-scale.

Many watershed model interfaces have been developed in recent years for predicting field-scale sediment loads. They share the goal of providing data for decisions aimed at improving watershed health and the effectiveness of water quality conservation efforts. The objectives of this study were to: 1) compare three watershed-scale models (Soil and Water Assessment Tool (SWAT), Field_SWAT, and the High Impact Targeting (HIT) model) against calibrated field-scale model (RUSLE2) in estimating sediment yield from 41 randomly selected agricultural fields within the River Raisin watershed; 2) evaluate the statistical significance among models; 3) assess the watershed models' capabilities in identifying areas of concern at the field level; 4) evaluate the reliability of the watershed-scale models for field-scale analysis. The SWAT model produced the most similar estimates to RUSLE2 by providing the closest median and the lowest absolute error in sediment yield predictions, while the HIT model estimates were the worst. Concerning statistically significant differences between models, SWAT was the only model found to be not significantly different from the calibrated RUSLE2 at α = 0.05. Meanwhile, all models were incapable of identifying priorities areas similar to the RUSLE2 model. Overall, SWAT provided the most correct estimates (51%) within the uncertainty bounds of RUSLE2 and is the most reliable among the studied models, while HIT is the least reliable. The results of this study suggest caution should be exercised when using watershed-scale models for field level decision-making, while field specific data is of paramount importance.

Revealing the sources of arsenic in private well water using Random Forest Classification and Regression.

Exposure to arsenic through private drinking water wells causes serious human health risks throughout the globe. Water testing data indicates there is arsenic contamination in private drinking water wells across New Jersey. To reduce the adverse health risk due to exposure to arsenic in drinking water, it is necessary to identify arsenic sources affecting private wells. Private wells are not regulated by any federal or state agencies through the Safe Drinking Water Act and therefore information is often lacking. To this end, we have developed machine learning algorithms including Random Forest Classification and Regression to decipher the factors contributing to higher arsenic concentration in private drinking water wells in west-central New Jersey. Arsenic concentration in private drinking water wells served as a response variable while explanatory variables were geological bedrock type, soil type, drainage class, land use/cover, and presence of orchards, contaminated sites, and abandoned mines within the 152.4-meter (500 ft) radius of each well. Random Forest Classification and Regression achieved 66 % and 55 % prediction accuracies for arsenic concentration in private drinking water wells, respectively. Overall, both models identify that bedrock, soil, land use/cover, and drainage type (in descending order) are the most important variables contributing to higher arsenic concentration in well water. These models further identify bedrock subgroups at a finer scale including Passaic Formation, Lockatong Formation, Stockton Formation contributing significantly to arsenic concentration in well water. Identification of sources of arsenic contamination in private drinking water wells at such a fine scale facilitates development of more targeted outreach as well as mitigation strategies to improve water quality and safeguard human health.

Evaluation of targeting methods for implementation of best management practices in the Saginaw River Watershed.

Increasing concerns regarding water quality in the Great Lakes region are mainly due to changes in urban and agricultural landscapes. Both point and non-point sources contribute pollution to Great Lakes surface waters. Best management practices (BMPs) are a common tool used to reduce both point and non-point source pollution and improve water quality. Meanwhile, identification of critical source areas of pollution and placement of BMPs plays an important role in pollution reduction. The goal of this study is to evaluate the performance of different targeting methods in 1) identifying priority areas (high, medium, and low) based on various factors such as pollutant concentration, load, and yield, 2) comparing pollutant (sediment, total nitrogen-TN, and total phosphorus-TP) reduction in priority areas defined by all targeting methods, 3) determine the BMP relative sensitivity index among all targeting methods. Ten BMPs were implemented in the Saginaw River Watershed using the Soil and Water Assessment Tool (SWAT) model following identification of priority areas. Each targeting method selected distinct high priority areas based on the methodology of implementation. The concentration based targeting method was most effective at reduction of TN and TP, likely because it selected the greatest area of high priority for BMP implementation. The subbasin load targeting method was most effective at reducing sediment because it tended to select large, highly agricultural subbasins for BMP implementation. When implementing BMPs, native grass and terraces were generally the most effective, while conservation tillage and residue management had limited effectiveness. The BMP relative sensitivity index revealed that most combinations of targeting methods and priority areas resulted in a proportional decrease in pollutant load from the subbasin level and watershed outlet. However, the concentration and yield methods were more effective at subbasin reduction, while the stream load method was more effective at reducing pollutants at the watershed outlet. The results of this study indicate that emphasis should be placed on selection of the proper targeting method and BMP to meet the needs and goals of a BMP implementation project because different targeting methods produce varying results.

Quantifying the potential impacts of climate change on irrigation demand, crop yields, and green water scarcity in the New Jersey Coastal Plain.

Climate change has significant implications for irrigated agriculture and global food security. Understanding how altered precipitation patterns and magnitudes, coupled with rising growing season temperatures, affect irrigation demand and crop production is a prerequisite for formulating effective water resources management strategies. This study evaluated the effects of near-term climate change (centered on 2035) on irrigation demand, green water scarcity, and row crop yields in a major agricultural watershed in southern New Jersey, USA. Downscaled precipitation and temperature from six General Circulation Models (GCMs) for two representative concentration pathways (RCP-4.5 and 8.5) from the Coupled Model Intercomparison Project Phase 5 (CMIP5) were used to drive the Soil and Water Assessment Tool hydrological model. Temperature and precipitation increases resulted in greater surface runoff, lateral flow, groundwater recharge, and total streamflow. Seasonal ET for corn is projected to alter between -3.0 % to 0.5 %, with irrigation demand between -17 % to -1 %, and yield ranges between -4 % to +9 % depending on the GCMs in the RCP-4.5 scenario, with similar patterns projected by RCP-8.5 scenario. For soybean, the simulation also indicates a declining trend of ET and irrigation demand while increasing yield. Increasing yield for both crops is attributed to changes in agronomic management practices combined with genetically improved cultivars and higher soil fertility due to CO2 fertilization. Green water scarcity analysis under future climate change for corn and soybean display a decreased soil moisture stress due to increased water use efficiency resulting from reduced stomatal conductance under elevated CO2 concentration.

Outcomes of Mini-Percutaneous Nephrolithotomy in Children and Adolescents: A 10-Year Single-Centre Experience From Kuwait.

The current study retrospectively reviewed data for all children and adolescents who underwent mini-percutaneous nephrolithotomy (PCNL) at Ibn Sina Hospital and Sabah Al Ahmad Urology Centre in Kuwait over 10 years. Accordingly, the 40 patients underwent mini-PCNL. Among them, 21 patients (52.5%) had varying degrees of hydronephrosis, with mild to moderate severity accounting for nearly half of them, whereas six (15%) had multiple stones. The median operative time was 54.5 (43.3-64) minutes. Moreover, 11 patients needed flexible ureteroscopy (URS) and double-J (DJ) ureteric stent, and one patient required DJ ureteric stent only. None of the cases developed intraoperative bleeding. The median hospital stay of the included patients was three (2.3-4) days. Residual stone was observed in 11 patients (27.5%), with a median size of 3 (2 to 7) mm. The incidence of postoperative complications was 27.5% (n = 11 patients), with three patients experiencing postoperative bleeding (7.5%) and eight patients developing a fever (20%). All patients had mild postoperative pain. However, no leakage, sepsis, or pelvic injury occurred. None of the patients required revision. In conclusion, mini-PCNL was a safe and effective procedure in children and adolescents with renal stones.

Active Surveillance for Renal Angiomyolipoma Less Than 4 Centimeters: A Systematic Review of Cohort Studies.

The aim of this review is to evaluate the current evidence regarding the best management in terms of active surveillance of angiomyolipoma (AML) cases less than 4 cm, particularly the optimal timing of active surveillance. In addition, we aimed to describe their initial size, clinical presentation, and growth rates. The present systematic review included prospective and retrospective studies that evaluated and followed up patients with AML through active surveillance. Studies were retrieved through an online bibliographic search of the Medline database via PubMed, SCOPUS, Web of Science, and Cochrane Library from their inception to January 2022. Seven studies were included in the present systematic review. Concerning the active surveillance protocol, only four studies describe the frequency of active surveillance and the utilized imaging modality. Some studies followed up lesions by ultrasound annually for two to five years, while other studies followed-up patients twice for the first year, then annually for a median follow-up period of 49 (9-89) months. The used modalities were ultrasound, CT, and magnetic resonance imaging (MRI). Notably, the incidence of spontaneous bleeding was consistent across the included studies (ranging from 2.3 - 3.1%), except for one study which showed an incidence rate of 15.3%. In terms of the need for active treatment, the rate of active treatment was slightly higher in some studies than the others. However, this variation could not be considered clinically relevant to favor one surveillance strategy over the other. We concluded that active surveillance is the first line of management in all small asymptomatic ALMs. ALMs less than 2 cm do not require active surveillance. The current published literature suggested that active surveillance for two years may provide the same benefits as a five-year surveillance strategy, with fewer radiation hazards and less socioeconomic burden.

A retrospective cohort study of bladder cancer following the COVID-19 pandemic: Are patients presenting with more aggressive disease?

Background: The COVID-19 pandemic has resulted in delays in the treatment of patients with urological malignancies. The management of bladder cancer (BC) in particular poses a significant challenge given the recurrent nature of the disease and the intense follow-up regime required for many cases. The aim of this study was to evaluate potential changes in the presentation and operative management of BC in our hospital following the pandemic. Materials and methods: This is a retrospective cohort study. Potential BC cases were identified through the histopathology database between March 2019 and February 2021. Details were obtained on patient demographics, procedure type such as biopsy, resection or excision, grade and stage of BC. Cases were divided into two groups: period one (pre-COVID between March 2019 and February 2020) and period two (post-COVID between March 2020 and February 2021). Results: A total of 207 procedures for confirmed BC were performed during the study period, 126 in period one and 81 in period two. New cases accounted for 52.4% (n = 66) and 53.1% (n = 43) of cases during periods one and two respectively. There was a higher rate of invasive disease (43.2% vs 26.2%) as well as high grade disease (47.4% vs 35.8%) in period two than in period one. Conclusion: Fewer BC procedures were performed in the COVID period. The higher rate of more advanced stage and grade of disease seen in period two suggests patients are presenting later. This should be considered when allocating resources in the management of non-COVID related diseases. Further studies are needed to assess the long-term impact of COVID-19 on bladder cancer outcome.

Super-Mini Percutaneous Nephrolithotomy for Nephrolithiasis: A Systematic Review and Meta-Analysis.

We aimed to conduct a systematic review and meta-analysis to summarize the current evidence regarding the role of super-mini percutaneous nephrolithotomy (SMP), which refers to a 7-Fr nephroscope placed through a tract sized 10-14 Fr, in treating renal stones and compare its outcomes with the standard mini-percutaneous nephrolithotomy (PCNL) techniques. A systematic literature search was conducted on the Medline database via PubMed and SCOPUS until May 2022 to retrieve the relevant studies. The titles and abstracts of unique records were screened for eligibility, followed by the full-text screening of potentially eligible abstracts. Data extraction was performed by two independent reviewers. The risk of bias assessment was conducted based on the study design. Open Meta (Analyst) and Review Manager 5.4 were used to perform all analyses. A total of 14 studies (n = 4,323 patients) were included, with two randomized controlled trials, one single-arm trial, and 11 cohort studies. The stone-free rate (SFR) of SMP was 91.4%. The pooled analysis showed no significant difference between SFR in mini-PCNL (mean difference (MD) = 1.03, 95% confidence interval (CI) = (0.99, 1.06), p = 0.12) and flexible ureteroscopy (MD = 0.84, 95% CI = (0.4, 1.76), p = 0.65]. On the other hand, SMP had a better SFR rate when compared with retrograde intrarenal surgery (MD = 1.3, 95% CI = (1.01, 1.66), p = 0.04). The pooled mean operative time of SMP was 49.44 minutes (95% CI = (41, 57.88), p < 0.001), which was longer than mini-PCNL (MD = 1.92, p < 0.001) and shorter than ureteroscopy (MD = -17.17, p < 0.00001). In the SMP group, the postoperative complications included fever (>38°C), pain, and hematuria, with an incidence of 7.6%, 2.3%, and 3.4%, respectively. The mean length of hospital stay after SMP was 2.4 days (95% CI = (2.17, 2.7), p < 0.001). The current evidence suggests that SMP is a safe and effective technique in the management of renal stones in both children and adults.

A Prospective Multi-Institutional Evaluation of Iatrogenic Urethral Catheterization Injuries.

OBJECTIVES: To perform a multi-institutional investigation of incidence and outcomes of urethral trauma sustained during attempted catheterization. PATIENTS & METHODS: A prospective, multi-center study was conducted over a designated 3-4 month period, incorporating seven academic hospitals across the UK and Ireland. Cases of urethral trauma arising from attempted catheterization were recorded. Variables included sites of injury, management strategies and short-term clinical outcomes. The catheterization injury rate was calculated based on the estimated total number of catheterizations occurring in each center per month. Anonymised data were collated, evaluated and described. RESULTS: Sixty-six urethral catheterization injuries were identified (7 centers; mean 3.43 months). The mean injury rate was 6.2 ± 3.8 per 1000 catheterizations (3.18-14.42/1000). All injured patients were male, mean age 76.1 ± 13.1 years. Urethral catheterization injuries occurred in multiple hospital/community settings, most commonly Emergency Departments (36%) and medical/surgical wards (30%). Urological intervention was required in 94.7% (54/57), with suprapubic catheterization required in 12.3% (n = 7). More than half of patients (55.56%) were discharged with an urethral catheter, fully or partially attributable to the urethral catheter injury. At least one further healthcare encounter on account of the injury was required for 90% of patients post-discharge. CONCLUSIONS: This is the largest study of its kind and confirms that iatrogenic urethral trauma is a recurring medical error seen universally across institutions, healthcare systems and countries. In addition, urethral catheter injury results in significant patient morbidity with a substantial financial burden to healthcare services. Future innovation to improve the safety of urinary catheterization is warranted.