Evaluating the Oncological and Functional Outcomes in 167 Patients Undergoing Laparoscopic Radical Prostatectomy: Could Laparoscopy Still be a Viable Option in Suitable Patients?

Aim: To evaluate the oncological and functional outcomes of 167 patients who underwent laparoscopic radical prostatectomy (LRP). Materials and Methods: The retrospective study included 167 patients who were treated with LRP due to clinically localized prostate cancer between January 2007 and April 2012. Most of the patients were treated with the extraperitoneal approach. Preoperative evaluations included age, serum prostate-specific antigen (PSA) level, and biopsy Gleason score. Perioperative evaluations included duration of operative time and anastomosis time, blood loss (milliliter), and complications. Postoperative evaluations included length of hospital stay and catheterization time. Continence and erectile function were evaluated both pre- and postoperatively. The patients who used no pads or no more than one pad daily and the ones who had only a few urine leakages on effort or exertion were accepted as continent. Postoperative potency was defined as the ability to achieve sexual intercourse with or without the use of PDE-5 inhibitors. Results: Mean age and mean operative time were 62.4 ± 6.0 years and 220.5 ± 45.6 minutes, respectively. Mean anastomosis time was 35.6 ± 9.8 minutes. Mean serum PSA level and mean Gleason score were 17.5 ± 9.97 ng/mL and 6.16 ± 0.42, respectively. Pelvic lymphadenectomy was performed in 94 patients and nerve-sparing procedures in 61 patients. The pathological analysis revealed positive surgical margin in 35 patients (20.9%). Bilateral and unilateral nerve-sparing LRP procedures were performed in 51 (30.5%) and 10 (6%) patients, respectively. At 12 months after surgery, 3 (1.8%) patients were using 2 or more pads per day, 19 (26.4%) patients were satisfied with erection, hardness, and duration of intercourse, and 9 (12.5%) patients had an erection with insufficient hardness and duration. Conclusion: LRP is an acceptable method in localized prostate cancer due to its perioperative and early postoperative results.

Zero ischemia robotic partial nephrectomy: Oncological and functional outcomes of a multicenter study.

BACKGROUND: The functional and oncological outcomes of zero ischemia robotic partial nephrectomy (RPN) procedures were evaluated. METHODS: A total of 56 patients underwent zero ischemia RPN transperitoneally, and their data were collected prospectively. Radius, exo/endophytic, nearness, anterior/posterior, location (R.E.N.A.L.) nephrometry, and PADUA scores were calculated. Patient and tumor characteristics were evaluated. Intra- and perioperative (0-30 days) complications were evaluated by Clavien classification. The change in serum creatinine, and estimated glomerular filtration rates (eGFR) were evaluated during preoperative, immediate postoperative periods, and at postoperative 6th months. RESULTS: The mean age of the patients was 52.2 ± 8.1 (27-75) years. R.E.N.A.L. nephrometry and PADUA scores were 6.1 ± 1.3 and 7.3 ± 1.0, respectively. The duration of surgery was 108.4 ± 18.2 min and estimated blood loss was 166.2 ± 124.7 mL. There were no intraoperative complications in any of the patients. Clavien Grade 1 and 3 complications were seen in 2 patients in the perioperative period. In the perioperative period (1-30 days), one patient required blood transfusion and angiographic intervention due to postoperative bleeding (Clavien Grade 3), and one patient required hospitalisation due to prolonged subileus (Clavien Grade 1) that resolved conservatively. The radiological and pathological tumor sizes were 3.1 ± 1.1 cm and 2.8 ± 1.4 cm, respectively. The surgical margins were positive in two patients with tumour sizes of 1.5 and 4 cm. Neither local recurrence nor distant metastasis was detected, during 33.6 ± 12.3 (3-76) months. There were no statistically significant differences between preoperative eGFR and serum creatinine levels, compared with those of immediate postoperative and postoperative 6th month periods. DISCUSSION: Zero ischemia RPN is a safe and applicable method with acceptable oncological and functional outcomes in small renal tumors and even in selected larger renal tumors.

Learning curve of ThuLEP (Thulium laser enucleation of the prostate): Single-centre experience on initial consecutive 60 patients.

Benign prostatic hyperplasia (BPH) is a common problem among elderly men. Recently, laser prostate enucleations have gained popularity with successful results; however, it requires steep learning curves. The initial 60 cases of ThuLEP performed at our centre were retrospectively enrolled. A 200 W CyberTM Thulium laser (Quanta System, Italy) with 550 µm fibre was used, and a single surgeon highly experienced with transurethral resection performed all procedures. Patients were divided into three consecutive groups. Preoperative variables such as prostate volume, prostate-specific antigen and haemoglobin levels, International Prostate Symptom Score (IPSS), International Index of Erectile Function scores and uroflowmetry parameters were all noted. The enucleated tissue weight, enucleation and morcellation times with efficiencies, hospitalization and catheterization times were calculated. Perioperative complications were also observed. The postoperative 6th month uroflowmetry parameters were evaluated and compared with prior ones. Morcellation and enucleation efficiencies, hospitalization and catheterization times, postoperative IPSS were significantly different between the groups. Complications were also compared between the groups, and only short-term perioperative complications were encountered. We aimed to evaluate initial cases of ThuLEP to provide information for beginners with management of early term possible complications. The learning curve for ThuLEP could be handled after exceeding 20 initial cases.

Alternative Management of a Pediatric Case of Hemorrhagic Cystitis due to BK Virus: Use of Thulium Laser Coagulation.

We report on a pediatric case of hemorrhagic cystitis due to BK virus in a patient with acute lymphoblastic leukemia who had undergone bone marrow transplantation. A very large hematoma that almost completely filled the bladder was aspirated using a morcellator via suprapubic percutaneous access, and a thulium laser was then used to cauterize extensive areas of diffuse uroepithelial bleeding. This combined minimally invasive procedure was successful in clearing the bladder hematoma and achieving hemostasis.

Comparison of Flexible Ureterorenoscopy and Mini Percutaneous Nephrolithotomy in the Management of Multiple Renal Calculi in 10-30 mm Size.

PURPOSE: To evaluate the efficacy and safety of flexible ureterorenoscopy (f-URS) and mini percutaneous nephrolithotomy (mini-perc) in the management of 10-30 millimeter multiple renal stones. MATERIALS AND METHODS: The charts of patients who underwent f-URS or mini-perc for multiple kidney stones between January 2011 and July 2015 were retrospectively analyzed. Patients with multiple 10-30-mm-sized renal stones were enrolled in the study. A total of 374 patients underwent mini-perc and 85 patients met the study inclusion criteria. In the same period, f-URS was performed in 562 patients, and 163 had 10-30-mm multiple renal stones. We selected 85 patients to serve as the control group from this cohort using propensity score matching with respect to the patient's age, ASA score, number, size, and location of stones to avoid potential bias between groups. RESULTS: The mean operation time and fluoroscopy screening time (FST) was significantly longer in the mini-perc group (P = .001 and P = .001, respectively). The mean hospitalization time was 76.9±38.7 hours in the mini-perc group and 25.0±27.7 hours in the f-URS group (P = .001). Post-operative complications, according to the Clavien classification system, were significantly more frequent in the mini-perc group (P = .003). The stone-free rate was 87% in the f-URS group and 83.5% in the mini-perc group (P = .66). CONCLUSION: Our study demonstrated that f-URS and mini-perc were effective treatment options for multiple renal stones 10-30 mm in size. However, f-URS was associated with a significantly lower complication rate, shorter operation time, shorter FST, and shorter hospitalization time.

Comparison of STONE, CROES and Guy's nephrolithometry scoring systems for predicting stone-free status and complication rates after percutaneous nephrolithotomy in obese patients.

In this study, we aim to evaluate the accuracy of STONE (stone size, tract length, obstruction, number of involved calyces, and essence/stone density), Clinical Research Office of the Endourological Society (CROES), and Guy's nephrolithometry scoring systems (NSS) in obese patients. The charts of patients who underwent percutaneous nephrolithotomy (PNL) between June 2008 and June 2016 were retrospectively analyzed. Calculations of the STONE, CROES, and Guy's NSS were performed by a resident who was well informed regarding each NSS. Patients were classified under nine scores according to STONE, four grades according to CROES, and four grades according to Guy's NSS. In total, 248 obese patients were enrolled in the study. Stone size was significantly higher in patients without stone-free status (p = 0.001). In patients who were stone-free and those with residual stones, the mean STONE score was 9.71 and 9.23 (p = 0.160), CROES was 172 and 129 (p = 0.001), and Guy's NSS was 1.67 and 2.75 (p = 0.001). Multivariate regression analysis identified the CROES and Guy's NSS were independent factors for PNL success in obese patients (p = 0.01 and p = 0.01, respectively). The CROES and Guy's NSS showed good accuracy with PNL success (AUC = 0.777 and AUC = 0.844, respectively). None of the three NSS systems were statically associated with a complication rate (p = 0.23 for STONE, p = 0.14 for CROES, and p = 0.51 for Guy's NSS). Our study demonstrated that CROES and Guy's NSS were independent predictors of stone-free rate following PNL in obese patients. Our study also revealed that three of the NSSs were not useful for predicting PNL complications in obese patients.

Skin to calyx distance is not a predictive factor for miniaturized percutaneous nephrolithotomy outcomes

ABSTRACT Objective To evaluate the predictive value of the distance from skin to calyx (SCD) on the outcome and complication rates of patients undergoing mPNL. Materials and Methods Patient's charts, who had undergone mPNL between June 2012 and June 2015, were analyzed retrospectively. Patients who had a preoperative computerized tomography (CT) were enrolled into the study. Two separateurologists evaluated the CT scans and calculated the SCD defined as the distance between the skin and surface/lateral edge of the calyx, which was the preferred site of entry for percutaneous access. The average value of the two measurements was included inthe final analysis to avoid bias. The mean SCD was 75mm. According to the median SCD value, patients were divided into two groups: group 1 (SCD ≤75) and group 2 (SCD >75). Results A total of 140 patients and 130 patients were enrolled in groups 1 and 2, respectively. The mean operation time and the mean fluoroscopy time was significantly longer in group 2 (p:0.004 vs. p:0.021). The rate of blood transfusion was significantly higher in group 1 (6 patients). None of patientsin group 2required blood transfusion (p:0.017). Stone-free status after a single session of mPNL was 67.1% in group 1 and 75.4% in group 2 (p:0.112). After additional procedures, stone-free rates increased to 84.3% and 85.4% in group 1 and group 2, respectively (p:0.802). Conclusion Our study demonstrated that longer SCD was not a predictive factor for stone-free rates after mPNL. However, SCD over 75mm was associated with longer operation time and fluoroscopy time with lower rates of transfusion.

Comparison of CROES, S.T.O.N.E, and Guy's scoring systems for the prediction of stone-free status and complication rates following percutaneous nephrolithotomy in patients with chronic kidney disease.

PURPOSE: To evaluate and compare the accuracy of S.T.O.N.E, Clinical Research Office of the Endourological Society (CROES), and Guy's stone score in patients with chronic kidney disease (CKD) following percutaneous nephrolithotomy (PNL). METHODS: The charts of patients who had undergone a prone percutaneous nephrolithotomy from June 2006 to June 2016 were retrospectively analyzed. Patients accepted as stage 3 and higher according to chronic kidney disease epidemiology collaboration formula, were enrolled into the study. Calculation of the CROES, S.T.O.N.E, and Guy's scoring system (SS) was made as defined in original papers. Patients were categorized into four scores according to CROES, into nine scores according to S.T.O.N.E, and into four scores according to Guy's SS. RESULTS: A total of 303 patients fulfilled the study inclusion criteria. The mean preoperative eGFR and creatinine levels were 47 mL/min and 1.55 mg/dL, respectively. In patients who were stone free and those with residual stones, the mean CROES SS was 179 and 137 (p < 0.001), the mean S.T.O.N.E score was 8.8 and 9.9 (p < 0.001), and the mean Guy's SS was 1.8 and 2.4 (p < 0.001), respectively. Multivariate regression analysis revealed CROES SS was the only scoring system, which had a predictive value for PNL outcome in patients with CKD (p = 0.011) and any of three SS were not useful for predicting PNL complications in patients with CKD. CONCLUSION: Our study demonstrated the CROES SS was the only independent factor in the prediction of PNL outcome in CKD patients. Furthermore, three of the NSSs were not useful for predicting PNL complications in patients with CKD.

Skin to calyx distance is not a predictive factor for miniaturized percutaneous nephrolithotomy outcomes.

OBJECTIVE: To evaluate the predictive value of the distance from skin to calyx (SCD) on the outcome and complication rates of patients undergoing mPNL. MATERIALS AND METHODS: Patient's charts, who had undergone mPNL between June 2012 and June 2015, were analyzed retrospectively. Patients who had a preoperative computerized tomography (CT) were enrolled into the study. Two separateurologists evaluated the CT scans and calculated the SCD defined as the distance between the skin and surface/lateral edge of the calyx, which was the preferred site of entry for percutaneous access. The average value of the two measurements was included inthe final analysis to avoid bias. The mean SCD was 75mm. According to the median SCD value, patients were divided into two groups: group 1 (SCD ≤75) and group 2 (SCD >75). RESULTS: A total of 140 patients and 130 patients were enrolled in groups 1 and 2, respectively. The mean operation time and the mean fluoroscopy time was significantly longer in group 2 (p:0.004 vs. p:0.021). The rate of blood transfusion was significantly higher in group 1 (6 patients). None of patientsin group 2required blood transfusion (p:0.017). Stone-free status after a single session of mPNL was 67.1% in group 1 and 75.4% in group 2 (p:0.112). After additional procedures, stone-free rates increased to 84.3% and 85.4% in group 1 and group 2, respectively (p:0.802). CONCLUSION: Our study demonstrated that longer SCD was not a predictive factor for stone-free rates after mPNL. However, SCD over 75mm was associated with longer operation time and fluoroscopy time with lower rates of transfusion.

Is There A Difference Between Presence of Single Stone And Multiple Stones in Flexible Ureterorenoscopy And Laser Lithotripsy For Renal Stone Burden < 300mm2 ?

ABSTRACT In this study, we aim to evaluate and compare the effectiveness of flexible ureterorenoscopy (f-URS) for solitary and multiple renal stones with <300 mm2 stone burden. Patients' charts who treated with f-URS for kidney stone between January 2010 and June 2015 were reviewed, retrospectively. Patients with solitary kidney stones (n:111) were enrolled in group 1. We selected 111 patients with multiple kidney stones to serve as the control group and the patients were matched at a 1:1 ratio with respect to the patient's age, gender, body mass index and stone burden. Additionally, patients with multiple stones were divided into two groups according to the presence or abscence of lower pole stones. Stone free status was accepted as complete stone clearence and presence of residual fragments < 2 mm. According to the study design; age, stone burden, body mass index were comparable between groups. The mean operation time was longer in group 2 (p= 0.229). However, the mean fluoroscopy screening time in group 1 and in group 2 was 2.1±1.7 and 2.6±1.5 min, respectively and significantly longer in patients with multiple renal stones (P=0.043). The stone-free status was significantly higher in patients with solitary renal stones after a single session procedure (p=0.02). After third month follow up, overall success rate was 92.7% in Group 1 and 86.4% in Group 2. Our study revealed that F-URS achieved better stone free status in solitary renal stones <300 mm2. However, outcomes of F-URS were acceptable in patients with multiple stones.

Bleeding during laparoscopic partial nephrectomy: Can a hemostatic matrix help to improve hemostasis?

OBJECTIVES: To evaluate the possible role of an hemostatic matrix on hemostasis, perioperative outcomes and complications in patients who underwent laparoscopic partial nephrectomy (LPN). MATERIALS AND METHODS: Patients charts were analyzed retrospectively and their demographic characteristics, operative parameters and follow-up results were recorded. Patients were divided into two groups, according to those who used an hemostatic matrix as Group 1 (n = 41) and those who did not used as Group 2 (n = 44). Demographic characteristics of patients, tumor features, operation time, clamping of the renal vessels, ischemia time, suturing of the collecting system, perioperative hemorrhage and complications were evaluated. Histopathological results, surgical margin status, creatinine level and recurrence at the 3rd month of follow up were analyzed. Statistical analyses were performed with SPSS 17.0 and significance was set at p value of < 0.05. RESULTS: The mean RENAL nephrometry score was 5.9 ± 2.0 and the mean tumor size was 35 ± 12 mm. All patients had a single tumor and 44 of them had a tumor in the right kidney. The renal artery was clamped in 79 cases and the mean ischemia time was 20.1 ± 7 minutes. The mean tumor size and the mean RENAL nephrometry score was statistically higher in Group 1 (p: 0.016 and p < 0.001, respectively). Pelvicaliceal repair was more common in Group 1 due to deeper extension of tumors in this group (p: 0.038). In Group 1, less hemorrhage and blood transfusion requirement, with shorter ischemia and operation time was detected. CONCLUSION: The outcomes of the recent study showed that adjunctive use of an hemostatic matrix improves hemostasis and decreases hemorrhagic complications during LPN. Further prospective studies are required to assess the potential role of an hemostatic matrix in LPN.

Is There A Difference Between Presence of Single Stone And Multiple Stones in Flexible Ureterorenoscopy And Laser Lithotripsy For Renal Stone Burden < 300mm2 ?

In this study, we aim to evaluate and compare the effectiveness of flexible ureterorenoscopy (f-URS) for solitary and multiple renal stones with < 300 mm2 stone burden. Patients' charts who treated with f-URS for kidney stone between January 2010 and June 2015 were reviewed, retrospectively. Patients with solitary kidney stones (n:111) were enrolled in group 1. We selected 111 patients with multiple kidney stones to serve as the control group and the patients were matched at a 1:1 ratio with respect to the patient's age, gender, body mass index and stone burden. Additionally, patients with multiple stones were divided into two groups according to the presence or abscence of lower pole stones. Stone free status was accepted as complete stone clearence and presence of residual fragments < 2 mm. According to the study design; age, stone burden, body mass index were comparable between groups. The mean operation time was longer in group 2 (p= 0.229). However, the mean fluoroscopy screening time in group 1 and in group 2 was 2.1±1.7 and 2.6±1.5 min, respectively and significantly longer in patients with multiple renal stones (P=0.043). The stone-free status was significantly higher in patients with solitary renal stones after a single session procedure (p=0.02). After third month follow up, overall success rate was 92.7% in Group 1 and 86.4% in Group 2. Our study revealed that F-URS achieved better stone free status in solitary renal stones < 300 mm2. However, outcomes of F-URS were acceptable in patients with multiple stones.

Laparoscopic Partial Nephrectomy for Renal-Cell Carcinoma During Pregnancy.

BACKGROUND: The incidence of renal-cell carcinoma (RCC) is low during pregnancy. There are different approaches for timing of surgery and treatment modalities for RCC in pregnant women in the literature. To our knowledge, this is the first laparoscopic partial nephrectomy case in a pregnant woman. CASE PRESENTATION: Herein, we present a 34-year-old woman with a renal mass at her 14th gestational week. She was admitted to our clinic after a right renal mass was incidentally diagnosed during routine antenatal ultrasonography. MRI revealed a completely endophytic tumor of 6 × 6.5 × 6.5 cm, located in the upper half of the right kidney. We performed laparoscopic partial nephrectomy in our patient and the postoperative course was uneventful. CONCLUSION: This is the first presented laparoscopic partial nephrectomy case in a pregnant patient. Nephron-sparing surgeries can be performed laparoscopically in appropriate sized renal tumors in suitable pregnant patients.

Efficacy and safety of mini percutaneous nephrolithotomy in obese patients.

PURPOSE: We aimed to evaluate the effect of obesity on surgical outcomes of mini percutaneous nephrolithotomy (Mini-PNL). METHODS: Hundred and eighty two Mini-PNL procedures were performed between May 2013 and January 2015 and their results were evaluated retrospectively. Patients were classified as non-obese (BMI, 18.5-30 kg/m(2)) and obese (≥30 kg/m(2)) groups. Obese and non-obese patients were compared according to pre-operative demographic values, intra-operative surgery techniques and post-operative results. RESULTS: BMI values of 133 patients were lower than 30 kg/m(2) while 49 patient's BMI values were higher than 30 kg/m(2). There were no significant difference between operation time, fluoroscopy time, number of access and access sites when two groups were compared. No significant difference was found in total length of hospital stay, hemoglobin drop, and complication rates. Stone-free rates were 70.7 % in the non-obese and 71.4 % in the obese group (p = 0.9). CONCLUSIONS: Mini-PNL procedure is a safe and effective treatment modality, which should be strongly considered for obese patients with appropriate sized stones.

External Comparison of Recent Predictive Nomograms for Stone-Free Rate Using Retrograde Flexible Ureteroscopy with Laser Lithotripsy.

OBJECTIVE: To assess and compare the applicability of the Resorlu-Unsal Stone Score (RUSS) and the Modified Seoul National University Renal Stone Complexity (S-ReSC) score for flexible ureterorenoscopy (f-URS). PATIENTS AND METHODS: We retrospectively analyzed the hospital files of 719 patients who had been treated with f-URS for kidney stone at two referral centers between July 2012 and December 2015. The RUSS and Modified S-ReSC scores were calculated by the same surgeon for each patient by using imaging methods and were compared as to their predictive capability for postoperative success. RESULTS: A total of 339 patients (168 men and 171 women) with a mean age of 46.5 ± 16.1 (range:1-86) years and a mean body mass index of 27.1 ± 4.1 (range: 12.8-38.5) were included in the study. The mean stone size was 14.4 ± 5.4 (4-40) mm, and the mean stone surface area was 145.3 ± 76.8 (20-658) mm2. The overall stone-free rate was 70.1%. The mean scores were 0.5 ± 0.7 and 1.8 ± 1.1 for the RUSS and Modified S-ReSC, respectively. In the logistic regression analysis, musculoskeletal deformity, stone size, and the RUSS were identified as independent predictive factors affecting stone-free status (p: 0, p: 0.014, p: 0.048, respectively). Among these parameters, the RUSS had the highest predictive capability (area under curve value 0.65, [95% confidence interval 589, 721]). CONCLUSIONS: Stone size, presence of musculoskeletal abnormalities, and the RUSS score are important factors affecting SF status after f-URS. Despite the RUSS being an independent predictive factor for SF status, more comprehensive systems with higher predictive capability are needed for clinical usage and academic reporting.

Effect of Obesity on Prone Percutaneous Nephrolithotomy Outcomes: A Systemic Review.

PURPOSE: With decreased physical activity, growing sedentary lifestyle, and high fat diet, obesity has become a pandemic disease all over the world. In this review, we aim to assess the effect of obesity on prone percutaneous nephrolithotomy.(PNL) outcomes. MATERIALS AND METHODS: We performed a comprehensive review of the published articles in PubMed®, Medline, Scopus, Cochrane database from January 1, 2004 through June 31, 2015, using the key words; body mass index, obesity, morbid obesity, super obese, urolithiasis, nephrolithiasis, percutaneous nephrolithotomy and percutaneous lithotripsy. Original research articles published in English language with accessibility to the full text article were analyzed for our review. RESULTS: At the end of the evaluation, we found 12 articles in English language, analyzing the effect of obesity on prone PNL outcomes. Except one study, eleven studies were evaluated in this review had a retrospective nature without randomization. Stone free status of patients was in a wide range between 49%-90% in obese patients and 41%-90% in morbid obese patients. CONCLUSION: PNL is a safe and effective treatment modality for renal stone(s) in obese and morbid obese patients. However, effect of body mass index on PNL outcomes including operation time, fluoroscopy screening time, hospitalization time, complications and stone free status are still debatable.

Comparison of flexible ureterorenoscopy and mini-percutaneous nephrolithotomy in treatment of lower calyceal stones smaller than 2 cm.

To compare the outcomes of flexible ureterorenoscopy (F-URS) and mini-percutaneous nephrolithotomy (mini-PNL) in the treatment of lower calyceal stones smaller than 2 cm. Patients who underwent F-URS and mini-PNL for the treatment of lower calyceal stones smaller than 2 cm between March 2009 and December 2014 were retrospectively evaluated. Ninety-four patients were divided into two groups by treatment modality: F-URS (Group 1: 63 patients) and mini-PNL (Group 2: 31 patients). All patients were preoperatively diagnosed with intravenous pyelography or computed tomography. Success rates for F-URS and mini-PNL at postoperative first month were 85.7% and 90.3%, respectively. Operation time, fluoroscopy time, and hospitalization time for F-URS and mini-PNL patients were 44.40 min, 2.9 min, 22.4 h, and 91.9 min, 6.4 min, and 63.8 h, respectively. All three parameters were significantly shorter among the F-URS group (p < 0.001). Postoperative hemoglobin drop was significantly lower in F-URS group compared to mini-PNL group (0.39 mg/dL vs. 1.15 mg/dL, p = 0.001). A comparison of complications according to the Clavien classification demonstrated significant differences between the groups (p = 0.001). More patients in the F-URS groups require antibiotics due to urinary tract infection, and more patients in the mini-PNL group required ureteral double J catheter insertion under general anesthesia. Although both F-URS and mini-PNL have similar success rates for the treatment of lower calyceal stones, F-URS appears to be more favorable due to shorter fluoroscopy and hospitalization times; and lower hemoglobin drops. Multicenter and studies using higher patient volumes are needed to confirm these findings.

Simulation of RIRS in soft cadavers: a novel training model by the Cadaveric Research On Endourology Training (CRET) Study Group.

PURPOSE: The aim of the current study was to evaluate the use of fresh-frozen concurrently with embalmed cadavers as initial training models for flexible ureteroscopy (fURS) in a group of urologists who were inexperienced in retrograde intrarenal surgery (RIRS). METHODS: Twelve urologists involved in a cadaveric fURS training course were enrolled into this prospective study. All the participants were inexperienced in fURS. Theoretical lectures and step-by-step tips and tricks video presentations on fURS were used to incorporate the technical background of the procedure to the hands-on-training course and to standardize the operating steps of the procedure. An 8-item survey was administered to the participants upon initiation and at the end of the course. RESULTS: Pre- and post-training scores were similar for each question. All the participants successfully completed the hands-on-training tasks. Mean pre-training duration [3.56 ± 2.0 min (range 1.21-7.46)] was significantly higher than mean post-training duration [1.76 ± 1.54 min (range 1.00-6.34)] (p = 0.008). At the end of the day, the trainers checked the integrity of the collecting system both by endoscopy and by fluoroscopy and could not detect any injury of the upper ureteral wall or pelvicalyceal structures. The functionality of the scopes was also checked, and no scope injury (including a reduction in the deflection capacity) was noted. CONCLUSIONS: The fURS simulation training model using soft human cadavers has the unique advantage of perfectly mimicking the living human tissues. This similarity makes this model one of the best if not the perfect simulator for an effective endourologic training.