Beneficial Effect of Heat-Killed Lactic Acid Bacterium Lactobacillus johnsonii No. 1088 on Temporal Gastroesophageal Reflux-Related Symptoms in Healthy Volunteers: A Randomized, Placebo-Controlled, Double-Blind, Parallel-Group Study.

A randomized, placebo-controlled, double-blind, parallel-group clinical study was conducted to examine the effects of ingesting a heat-killed lactic acid bacterium, Lactobacillus johnsonii No. 1088 (LJ88) on temporal gastroesophageal reflux-related symptoms in healthy volunteers. A total of 120 healthy Japanese volunteers of both sexes, aged between 21 and 63 years, whose Frequency Scale for the Symptoms of Gastroesophageal Reflux Disease (FSSG) total score was 8 or greater, but who were not diagnosed with functional dyspepsia according to the Rome IV classification, were enrolled. They were randomly assigned to either the LJ88 or placebo group and instructed to ingest the test food (1 billion heat-killed LJ88 or placebo) once a day for six weeks. Gastroesophageal reflux-related symptoms were evaluated using FSSG scores as a primary endpoint. The Gastrointestinal Symptoms Rating Scale (GSRS), stomach state questionnaire, and serum gastrin concentration were used as secondary endpoints. In the FSSG evaluation, the heartburn score was significantly improved at 6 weeks in the LJ88 group compared to the placebo group. No severe adverse events related to the test food were observed. In conclusion, daily ingestion of heat-killed LJ88 improved temporal heartburn symptoms in non-diseased individuals.

One- versus two-surgeon active stone retrieval procedures for flexible ureteroscopy: An off-site simulator comparative study.

OBJECTIVES: To evaluate the efficacy of the one-surgeon basketing technique compared to the conventional two-surgeon method for flexible ureteroscopy. METHODS: Seven urologists (three trained and four less-trained surgeons) extracted three renal stones using each technique with an off-site simulator. We analyzed the task completion time, the number of times the basket forceps were opened and closed, and unexpected events during stone-catching, for both techniques. RESULTS: There was no significant difference in the total task completion time between the one-surgeon (102.0 [interquartile range 63.5-164.0] s) and two-surgeon (99.5 [interquartile range 75.0-145.3] s) techniques. However, the time it took the trained surgeons to extract all stones was significantly shorter with the one-surgeon than with the two-surgeon technique (19.0 [interquartile range 18.0-20.0] s vs 34.0 [interquartile range 25.0-40.0] s; P = 0.049). Among the less-trained surgeons, the opposite effect was observed, but this difference was not statistically significant (96.5 [interquartile range 61.0-134.5] s vs 64.0 [interquartile range 51.5-77.0] s; P = 0.489). The number of times the forceps were opened and closed during stone-catching was significantly lower with the one-surgeon technique than with the two-surgeon technique (5.0 [interquartile range 4.0-5.0] times vs 9.0 [interquartile range 6.0-14.5] times; P = 0.018). CONCLUSIONS: The one-surgeon technique can offer comparable efficacy to the two-surgeon technique. If surgeons are sufficiently trained, a one-surgeon basketing technique for performing flexible ureteroscopy might become a new technical modality for extracting renal stones.

Prospective evaluation and classification of endoscopic findings for ureteral calculi.

Difficulty in performing ureteroscopic lithotripsy (URSL) depends on endoscopic findings surrounding calculi. In this multicentre prospective cohort study of 185 patients with a single ureteral stone who underwent ureteroscopic lithotripsy registered in the SMART study between January 2014 and February 2017, we established a classification of endoscopic findings and analysed risk factors for ureteral changes. We evaluated endoscopic findings (oedema, polyps, ureteral mucosa-stone adherence, and distal ureteric tightness) based on the SMART classification. Operative time and ureteral injuries were significantly correlated with endoscopic finding grades. Multivariate analyses revealed that mucosa-stone adherence (MSA) was strongly affected by hydronephrosis grade (odds ratio, 12.4; p = 0.022) and the interval before surgery (odds ratio, 1.10; p = 0.012). The cutoff value for MSA was 98 days, with a predictive accuracy of 0.78. Risk factors for distal ureteric tightness were age (odds ratio, 0.96; p = 0.004) and early intervention (odds ratio, 0.90; p = 0.023). The cutoff value was 34 days, with a predictive accuracy of 0.72. In conclusion, appropriate intervention around 34 days (limited to 98 days) after symptom onset is necessary for treating ureteral calculi. Even if intervention passed 98 days post-symptom onset, staged URSL, alternative procedures, and detailed informed consent should be planned in advance, assuming strong MSA.

A Novel Flexible Ureteroscope with Omnidirectional Bending Tip Using Joystick-Type Control Unit (URF-Y0016): Initial Validation Study in Bench Models.

Purpose: The conventional flexible ureteroscope has limited access into the lower calix and often causes biomechanical stress to surgeons. Recently, a novel flexible ureteroscope with an omnidirectional bending tip with a joystick-type control unit (URF-Y0016; Olympus, Japan) was developed. We verified the operability and ergonomics of the URF-Y0016 compared with that of the conventional flexible ureteroscope (URF-P6) in bench models. Materials and Methods: Twenty-five medical students with no experience in performing ureteroscopic manipulation were randomly assigned to URF-Y0016 and URF-P6 leading groups in a crossover study. The task was performed using a simple model as an exploratory experiment and an artificial kidney model as an evaluation experiment. We compared the task completion times of both groups, while the factors influencing task completion time were entered into a multivariate model. The ergonomics of endourology were compared using a validated questionnaire. Results: The task completion time in the URF-Y0016 group was significantly shorter than in the URF-P6 group (p < 0.001). The URF-Y0016 group showed no difference in task completion time between each renal calix, whereas in the URF-P6 group the task completion time in the lower calix was significantly longer than that in other calices (p < 0.001). In multivariate analysis, the model of flexible ureteroscope used significantly influenced the task completion time (p < 0.001). The ergonomics of the URF-Y0016 group were significantly better than those of the URF-P6 group (p = 0.001). Conclusions: URF-Y0016 may offer benefits in ureteroscopy performance over the conventional flexible ureteroscope.

Examining Pediatric Cases From the Clinical Research Office of the Endourological Society Ureteroscopy Global Study.

OBJECTIVE: To evaluate the characteristics and outcomes of ureteroscopy (URS) in children treated in several hospitals participating in the Clinical Research Office of the Endourological Society (CROES) Study, and to present the overall results of pediatric URS compared with adults. PATIENTS AND METHODS: The CROES Study collected data on consecutive patients treated with URS for urolithiasis at each participating center over a 1-year period. The collected prospective global database includes data for 11,885 patients who received URS at 114 centers in 32 countries. Of these URS-treated patients, 192 were ≤18 years old. RESULTS: Of the 114 centers participating in the study, 42% had conducted pediatric URS. Among the pediatric cases, 7 were infants, 53 were small children, 59 were school-aged children, and 73 were adolescents. A considerable number (37%) of the pediatric cases had previously undergone URS treatment. No differences in the surgical outcomes of the adults and children were reported. The URS-treated children had a greater number of positive preoperative urine cultures when compared with adult cases treated. A semirigid scope was used in the vast majority of pediatric cases (85%). According to the present data, within the group of URS-treated children, the younger the child, the more readmissions occurred. CONCLUSION: URS is as efficient and safe in children as it is in adults. The data suggest that readmissions among URS-treated children are associated with age, with the likelihood of readmissions greater among younger age groups.

Complications of Flexible Ureteroscopic Treatment for Renal and Ureteral Calculi during the Learning Curve.

BACKGROUND: The flexible ureterorenoscope (URS) and associated devices have developed rapidly. However, despite its therapeutic benefits, URS may be associated with some complications. To the best of our knowledge, there are no studies discussing the complications of flexURS during the learning curve. METHODS: A retrospective review of the records of patients who underwent flexURS from January 2005 to June 2013 was performed. To compare the complications after the introduction of flexURS, patients were divided into four groups based on the surgeon's training experience, that is, based on the number of cases performed by the surgeon. A total of 219 cases underwent flexURS. Groups 1, 2, 3, and 4 included 35, 50, 50, and 84 cases, respectively. The complications were classified using the Clavien system (I-IV). RESULTS: The mean operation time and stone-free rate were significantly different (p < 0.001, p = 0.013, respectively). The total complication rates were 13.6, 10, 8.3, and 3.2%, respectively (p = 0.068). The more the surgeon's experience, the less was the complication rate. Despite our best efforts, the incidence of urosepsis was not reduced (p = 0.902). CONCLUSIONS: To reduce severe complications, it is necessary to have performed about 100 cases. Increased surgeon experience tended to decrease the risk of severe complications, but the incidence of urosepsis was not reduced.

Construction of penis with two free flaps.

A case of penis construction using two free flaps is presented. The urethra is constructed with an ulnar forearm flap and external coverage is provided with deltoid flap. The biggest disadvantage with radial forearm flap, which is considered to be the most ideal donor flap for penile construction, is its large and unsightly donor scar. The authors have been using deltoid flap for penile construction because its donor scar is concealed under the half-sleeve shirt; however, its biggest disadvantage is its thickness. With the method presented here, an appropriate-size penis can be constructed even in an obese individual whose deltoid flap is thick. Donor scar is almost inconspicuous when the patient is wearing a half-sleeve shirt, because the donor scar on the forearm is 3-cm wide and located on the ulnar side.