Endourologic Procedures of the Upper Urinary Tract and the Effects on Intrarenal Pressure and Temperature.

Introduction: Endourologic procedures, including ureteroscopy (URS) and percutaneous nephrolithotomy (PCNL), are associated with an elevation in intrarenal pressures (IRPs) and irrigation temperatures. Recent research has focused on methods to reduce IRP and irrigation temperatures, with the ultimate goal to limit the consequences associated with these deviations. The purpose of our study is to provide a narrative review on the effects of endourologic procedures on pressure and temperature and provide recommendations to minimize these changes. Methods: A literature review was performed using PubMed. The search was limited to English human and nonhuman studies. Abstracts were reviewed for inclusion in our narrative review. Results: Human and animal models suggest that URS and PCNL are associated with peak IRPs above a "safe" threshold. Strategies to minimize pressures focus on minimizing irrigation flow into the upper tract and maximizing flow out of the system. High IRP has been associated with postoperative pain and infectious complications. Elevated irrigation temperatures are associated with high-power lasers during URS. Strategies to minimize irrigation temperatures focus on maximizing irrigation flow during laser activation and minimizing thermal energies associated with lithotripsy. Conclusions: Rises in pressure and irrigation temperatures associated with endourologic procedures are becoming increasingly recognized in the urologic community. Human studies examining "safe" thresholds for IRP and irrigation temperatures are limited. Temperature- and pressure-sensing technologies will aid in identifying the clinical consequences of elevated IRPs and irrigation temperatures, resulting in strategies to minimize them.

HIVinfo and ClinicalInfo.

HIVinfo and ClincalInfo are useful resources for both health-care professionals and consumers to use in better understanding one of the biggest health care challenges of the late twentieth century and early twenty-first century. HIV/AIDS and its treatment has changed over the past four decades and this resource has changed accordingly. Today, HIVinfo and ClinicalInfo serve as leading resources in medical information. This article examines both HIVinfo and ClinicalInfo, free government resources available in both English and Spanish, and why those digital resources are important to both health-care workers and those working outside of health care.

Are urologic surgeons performing robot-assisted radical prostatectomy at the University of Alberta meeting surgical quality performance benchmarks? The PROCURE-02 quality assurance study.

INTRODUCTION: Robot-assisted radical prostatectomy (RARP) is a standard of care primary treatment for men with clinically localized prostate cancer (CLPC). The 2010 Canadian Urological Association (CUA) consensus guideline examining surgical quality performance for radical prostatectomy suggested benchmarks for surgical performance. To date, no study has examined whether Canadian surgeons are achieving these benchmarks. We determined the proportion of University of Alberta (UA) urologic surgeons achieving the CUA surgical quality performance outcome (SQPO) benchmarks. METHODS: A retrospective quality assurance analysis of prospectively collected data from the PROstate Cancer Urosurgery Repository of Edmonton (PROCURE) was performed. Men who underwent RARP for CLPC between September 2007 and May 2018 by one of seven surgeons were analyzed. SQPO were an unadjusted pT2-R1 resection rate <25%, blood transfusion rate <10%, rectal injury rate <1%, and 90-day mortality rate <1%. Descriptive statistics were used to determine the proportion of surgeons achieving the benchmarks. RESULTS: Data were evaluable for 2821 men. Seven of seven (100%) surgeons achieved a blood transfusion rate <10%, rectal injury rate <1%, and 90-day mortality rate <1%. However, only six of seven surgeons achieved an unadjusted pT2-R1 resection rate <25%; one surgeon had an unadjusted pT2-R1 resection rate of 27.9%. Limitations include the lack of centralized pathology review for surgical margin status by a dedicated genitourinary pathologist. CONCLUSIONS: UA surgeons are achieving the CUA SQPO benchmarks for blood transfusion, rectal injury, and perioperative mortality. However, not all UA urologists are achieving a pT2-R1 resection rate <25%. Surgical quality performance initiatives designed to improve cancer control may be warranted.

Impact of LUTS on urine volume in stone formers The impact of lower urinary tract symptomatology on urine volumes in stone formers.

INTRODUCTION: We aimed to determine if there is a correlation between International Prostate Symptom scores (IPSS) and 24-hour urine collection volumes, as patients experiencing lower urinary tract symptoms (LUTS) may have impaired ability to increase fluid intake for stone prevention. METHODS: We conducted a single-centre, retrospective review was performed of stone-formers presenting from 2014-2016. Inclusion criteria were completion of an IPSS questionnaire and a 24-hour urine collection. Exclusion criteria included symptomatic stone or urinary tract infection at time of IPSS completion, inadequate 24-hour collection, or incomplete IPSS questionnaire. RESULTS: A total of 131 patients met inclusion criteria. Stratification by IPSS severity into mild (0-7), moderate (8-19), and severe (20-35) yielded groups of n=96, 28, and 7, respectively. Linear regression modelling did not reveal a correlation between IPSS score and volume (p=0.10). When compared to those with adequate urine volumes (>2 L/day, n=65), low-volume patients (<1 L/day, n=10) had a significantly higher total IPSS (11.7 vs. 6.1; p=0.036). These groups showed significant differences in their responses to questions about incomplete emptying (p=0.031), intermittency (p=0.011), and stranguria (p=0.0020), with higher scores noted in the low urine output group. CONCLUSIONS: This study is the first to examine the correlation between IPSS and 24-hour urine volume. Though our data does not show a linear relationship between urine output and IPSS, those with lower urine volumes appear to have worse self-reported voiding symptoms when compared to those with adequate volumes (>2 L/day) for stone prevention. The overall number of patients in our study is relatively small, which may account for the lack of a relationship between IPSS and 24-hour urine volumes.