Pattern of key opinion leaders talks at major international urological meetings reflects the main differences in flexible ureteroscopy and PCNL diffusion.

OBJECTIVE: To analyze the pattern of speaker activity related to both flexible ureteroscopy (fURS) and percutaneous nephrolithotomy (PCNL) during plenary sessions at the main (endo)urological international meetings over the last 10 years. METHODS: We reviewed the meeting programs of the main endourological international meetings (EAU, AUA, WCE, and SIU) during 2011-2019. We detected all invited speakers at plenary sessions regarding fURS or PCNL. The proportion of fURS and PCNL talks was evaluated yearly during the study period. In order to analyze plenary session speaker composition, we estimated and compared the mean number of talks per speaker according to surgical technique. We also analyzed possible differences in age distribution according to the topic of the talk as well as the presence of young (i.e., < 45 years) speakers. Data were analyzed using descriptive statistics. RESULTS: During the last 10 years, a total of 498 plenary talks were found. Of those, 260 (52.2%), 211 (42.4%), and 27 (5.4%) discussed PCNL, fURS, or both, respectively. PCNL was more frequently discussed at the beginning and the end of the study period. Mean [SD] number of talks per speaker was higher for PCNL (2.9 [3.4] vs 1.6 [1.4], p < 0.001), meaning that a wider variety of speakers was invited to give fURS talks. Speakers discussing fURS were younger (median [interquartile range, IQR] age 48 [44-56] vs 52 [47-60] years, p < 0.001), and a higher proportion of young speakers was observed in the fURS group (26% vs 15% p < 0.001). PCNL speakers were more commonly discussing fURS than fURS speakers discussing PCNL (23% vs 17%, p = 0.43). CONCLUSIONS: We found a wider variety of speakers at fURS plenary sessions as compared to PCNL ones. It is easier and quicker to become an internationally recognized expert in the field of fURS rather than PCNL. PCNL speakers were able to master fURS more frequently than the other way around.

Operator-assisted vs self-achieved basketing during ureteroscopy: results from an in vitro preference study.

OBJECTIVES: A recently introduced device (LithoVue Empower™ or LE, Boston Scientifics, USA) allows the surgeon to directly control the stone-retrieving basket without the need of an assistant during flexible ureteroscopy. We aimed to evaluate the stone-retrieval performance of this device. METHODS: We used a bench-training model for flexible ureteroscopy, the Key-box (K-Box®, Porgès-Coloplast, France), to compare the LE configured with a 1.9F stone-retrieval tipless basket (ZeroTip™, Boston Scientific, USA) and a traditional assistant-maneuvered 1.9F stone-retrieval tipless basket. Seven experienced endo-urologists and seven residents-in-training retrieved a fake stone from three different renal cavities of the K-Box with increasing access complexity first with the traditional basket and then with the LE device. We recorded retrieval time and all the operators filled in the NASA Task Load Index (TLI) for the self-evaluation of their performance. We then compared the use of LE in terms of retrieval time, failure rates, and NASA-TLI scores. RESULTS: Stone retrieval times and failure rates were similar according to the retrieval technique, although residents had non-statistically significant shorter times with the LE. NASA-TLI scores revealed lower frustration (p = 0.03) when LE was used by experienced urologists as compared to the traditional basketing. When stratifying the analyses according to surgical experience, fully trained urologists performed faster stone retrieval and showed lower effort scores than residents-in-training (p < 0.05). CONCLUSIONS: The individually controlled retrieval system is an effective device assisting stone retrieval and does not necessitate specific training among experienced endo-urologists. Young residents might benefit from LE during their learning curve.

Robotic treatment of oligometastatic kidney tumor with synchronous pancreatic metastasis: case report and review of the literature.

BACKGROUND: The management of metastatic Renal Cell Carcinoma (RCC) has changed dramatically in the last 20 years, and the role of surgery in the immunotherapy's era is under debate. Metastatic lesions interesting pancreas are infrequent, but those harbouring from RCC have an high incidence. If metachronous resections are not rare, synchronous resection of primary RCC and its pancreatic metastasis is uncommonly reported, and accounts for a bad prognosis. CASE PRESENTATION: We report the case of a 68 years old woman, who presented hematuria at hospital incoming, with radiological appearance of a 13 cm left renal mass, with a 2.5 cm single pancreatic tail metastasis. Work-up of staging ruled out other distant metastases, urothelial cancer and there was no evidence of inferior vena cava thrombosis. We choose a 5-port trans-peritoneal robotic approach using lazy right lateral decubitus. Synchronous robotic radical nephrectomy and spleen-sparing pancreatic resection was performed. The pancreatic mass was completely enucleated from pancreatic parenchyma using a latero-medial dissection. Peri-operative hemoglobine loss was 2.4 g/dL. Total operative time was 213 min. No post-operative complications were recorded and patient was discharged in 7th post-operative day. Histopathological examination showed a pT2b N0 M1 RCC, Fuhrman grade II, with pancreatic tail metastasis; both, primary and metastatic lesions had the same histological characteristics with negative surgical margins. After 9 months patient had no evidence of disease recurrence at radiological studies. CONCLUSIONS: The rationale for surgical removal of disseminated tumor, followed by immunotherapy, includes improving prognosis and enhancing the potential of an immune-mediated response to systemic treatment. A spleen-sparing procedure can adequately preserve post-operative immunologic capabilities. In our experience, the correct assessment of pre-operative imaging data and surgeon skills in robotic surgery seem to play a key role in the success of these procedures. Robotic surgery seems to enhance the possibility to control multiple vessels encountered during dissection. Such a conservative approach may be helpful in future research aimed at uncovering biological features, and also leading to better targeted preventive interventions and more individualized and effective treatments.

High- and Low-Power Laser Lithotripsy Achieves Similar Results: A Systematic Review and Meta-Analysis of Available Clinical Series.

Purpose: There is no clear evidence that high-power (HP) laser generators perform better than low-power (LP) ones in terms of lithotripsy outcomes. We aimed to perform a systematic review of literature to compare the efficacy outcomes of both HP and LP during ureteroscopic lithotripsy. Materials and Methods: A computerized bibliographic search of the Medline, Embase, and Cochrane databases was performed for all studies reporting perioperative outcomes of HP and LP lithotripsy. Using the methodology recommended by the preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines, we identified 22 nonrandomized noncomparative retrospective studies published between 2015 and 2019 that were eligible for inclusion in this systematic review. Because of the lack of comparative studies, we decided to perform two separate meta-analytic syntheses for LP and HP studies, then we compared them using a Wald-type test. Results: Overall, the selected studies included 6403 patients. Study design, exposure assessment, selection criteria, and outcome of interest were heterogeneous. LP studies were more common (n = 17, 77%), whereas HP studies were more common in the latest inclusion period. Faster lithotripsy (32.9 minutes vs 63.9 minutes, p < 0.01) was observed in HP studies. However, stone volume resulted twofold higher (2604 mm3vs 1217 mm3, p = 0.048) in LP studies. Pooled stone-free rate was similar in both LP and HP studies, 81% and 82%, respectively, p > 0.05. No difference in complication rate was observed between the two groups, p = 0.12. Conclusions: HP laser lithotripsy appears to require shorter operative time, with similar stone-free and complication rates as compared with LP traditional lithotripsy. However, when taking into account stone burden, this advantage seems to be lost, or at least not to be comparable with what observed in laboratory studies. Because of the lack of high-level comparative evidence, further clinical studies are needed to elucidate the benefits of using HP laser generators during ureteroscopic stone treatment.