Under pressure: irrigation practice patterns during flexible ureteroscopy.

Introduction: Irrigation parameters during flexible ureteroscopy (fURS) may impact patient outcomes, yet there are limited data on current practice patterns of irrigation methods and parameter selection. We assessed the common irrigation methods, pressure settings, and situations that present the most problems with irrigation among worldwide endourologists. Methods: A questionnaire on fURS practice patterns was sent to Endourology Society members in January 2021. Responses were collected through QualtricsXM over a 1-month period. The study was reported according to the Checklist for Reporting Results of Internet E-Surveys (CHERRIES). Surgeons were from North America (the United States and Canada), Latin America, Europe, Asia, Africa, and Oceania. Results: Questionnaires were answered by 208 surgeons (response rate 14%). North American surgeons accounted for 36% of respondents; 29% Europe, 18% Asia, and 14% Latin America. In North America, the most common irrigation method was the pressurized saline bag using a manual inflatable cuff (55%). Saline bag (gravity) with a bulb or syringe injection system was the most common method in Europe (45%). Automated systems were the most common method in Asia (30%). For pressures used during fURS, the majority of respondents used 75-150 mmHg. The clinical scenario which had the greatest issue with adequate irrigation was during biopsy of urothelial tumor. Conclusion: There is variation in irrigation practices and parameter selection during fURS. North American surgeons primarily used a pressurized saline bag, in contrast to European surgeons who preferred a gravity bag with a bulb/syringe system. Overall, automated irrigation systems were not commonly used.

Single-use flexible ureteroscopes: how to choose and what is around the corner?

PURPOSE OF REVIEW: The pace of technology development with single-use endoscopy has led to a range of disposable ureteroscopes. We review the development of single-use scopes, deconstruct the basic design and functional characteristics of available devices, and discuss future directions for next-generation platforms. RECENT FINDINGS: Currently available devices are differentiated on the basis of several core features. The optical, deflection and irrigation characteristics are marginally different with no device clearly superior in every category. Studies comparing single-use ureteroscopes in patients linked to outcomes are limited. The incorporation of next-generation technologies into these platforms include sensors to monitor intrarenal pressure and temperature, suction of fluid and fragments, and computer vision for artificial intelligence. SUMMARY: Each ureteroscope has specific features that may be advantageous in different circumstances. Single-use devices could transform the ureteroscope from a visual conduit to a transformative surgical instrument that improves outcomes and reduces complications.

Small cell lung cancer initially presenting with acute urinary retention: A case report.

This case study discusses a patient presenting with urinary retention presumed secondary to benign prostatic hyperplasia (BPH). Suspicion for an underlying problem was raised when a second instance of urinary retention occurred after undergoing medical treatment and TUVP to correct BPH. Extensive workup resulted in diagnosis of small cell lung carcinoma with metastases and discovery of a large metastatic mass in the rectovesical pouch. The mass caused obstructive uropathy and renal failure which was managed with stenting and an indwelling catheter. Further investigation by practitioners may be required in patients whose urinary symptoms do not improve after standard BPH treatments.