Complications and device failures associated with urolift: Findings from the MAUDE database.

INTRODUCTION: Urolift is an established intervention for symptoms of bladder outflow obstruction caused by benign prostate enlargement. Reported advantages include its minimally invasive profile, short learning curve and feasibility as a day case procedure. Our aim was to use a national registry as a means to evaluate the nature of complications and device failures that have been documented to occur. METHODS: Retrospective review was performed of the US Manufacturer and User Facility Device Experience (MAUDE) database, a prospective register, which contains voluntarily submitted adverse events associated with surgical devices. Information collected include event timing, underlying cause, procedural completion, complications and mortality status. RESULTS: Between 2016 and 2023, 103 device failures, 5 intra-operative complications and 165 post-operative complications (early: 151, late: 14) were registered. The commonest device problem (56%, n = 58) was failure of the implant to deploy with subsequent requirement for complete replacement. There were 50 cases of documented urosepsis. 62 patients with post operative haematuria were registered including 12 that underwent emergency embolisation. Other complications included stroke (n = 5), pulmonary embolism (n = 3) and necrotising fasciitis (n = 1). Twelve ITU admissions were registered. In the reports, 22 cases were filed that recorded a hospital stay of 7 days or more. Eleven deaths were captured in the database over the study period. CONCLUSION: While urolift is recognised as less invasive intervention compared to alternatives such as transurethral resection of the prostate, serious adverse events have been reported to occur including death. Our findings can provide learning points for surgeons and allow for improved patient counselling and treatment planning accordingly.

Ureteroscopy for Stone Disease in Extremely Elderly Patients (≥85 Years): Outcomes and Lessons Learned.

Introduction: The volume of surgeries including ureteroscopy (URS) performed for urolithiasis is increasing. This includes for the elderly population. The aim of this study was to evaluate the outcomes of URS in extremely elderly patients and identify any lessons that could be learned for clinical practice and treatment planning. Materials and Methods: Retrospective analysis was performed of consecutive patients aged 85 years and older undergoing URS between 2010 and 2022 at our tertiary center. Uni- and multivariable logistic regression analyses were performed to identify possible risk factors for complications. Survival analysis, stratified by age-adjusted Charlson Comorbidity index (ACCI), was performed using the Kaplan-Meier method as well as the log-rank test. Results: Sixty-four URS procedures were performed on 51 patients (mean age 88 years, range 85-97). Mean ACCI score was 7 (range 4-13) and most patients were American Society Anesthesiologists 3 (78%). Mean operative time and hospital stay were 60 minutes (range 15-120) and 2 days (range 0-6), respectively. At 3-month follow-up imaging, 92% were stone free (zero fragments). Intraoperative complication rate was 14% and in three cases (5%), early termination of the procedure was necessary. Eight patients (13%) suffered a complication before discharge. Eighteen patients (28%) had documented late complications after their surgery. The complication rate when combining early and late adverse events was 41%. One year mortality rate was 23%. Multivariable regression analysis revealed that operation time and ACCI >7 were significant predictors of complications after surgery. Survival probability was significantly worse in those patients with ACCI >7 (p = 0.0083). Conclusion: The morbidity burden of URS in the extremely elderly is higher than for other population groups. Risk should be considered carefully and implementation of ACCI can aid this process. High scores should prompt strong consideration of a conservative approach. Operation time should be kept to a minimum wherever possible.

Current Status of Ureteric Stents on Extraction Strings and Other Non-cystoscopic Removal Methods in the Paediatric Setting: A Systematic Review on Behalf of the European Association of Urology (EAU) Young Academic Urology (YAU) Urolithiasis Group.

Ureteric stents are an important tool in urology and have a wide range of indications. While they offer a number of advantages, limitations remain despite modern advancements. These include discomfort, migration and encrustation. Standard removal is via cystoscopy but in the paediatric setting this mandates general anaesthetic, which holds disadvantages. Alternative removal methods include use of extraction strings and magnetic retrieval devices, which can be performed in the outpatient setting. This systematic review evaluates the safety and efficacy of different non-cystoscopic methods for stent removal in the paediatric setting.