Higher Risk of Repeat Stone Surgery in Stone Formers With Concomitant Bowel Disease: Single-Center Long-Term Analysis.

OBJECTIVE: To identify the need for repeat stone surgery in patients with and without bowel disease. Few studies have compared risks between different types of bowel disease and whether their need for repeat stone surgery differs. METHODS: From our IRB-approved study, we identified patients with and without bowel disease. We categorized patients' bowel disease into 4 categories: inflammatory bowel disease (IBD), bypass procedures, bowel resection, and bowel disease not otherwise specified (eg, irritable bowel syndrome, celiac disease). Differences between patient demographics, stone disease, and recurrent stone events for patients with and without bowel disease were compared using univariate and multivariate survival analyses (SPSS 25). RESULTS: Of all surgical stone patients (2011), 484 (24%) had some type of bowel disease. Compared to patients without bowel disease, patients with bowel disease presented with stones at an older age (62.2 ± 14.5 vs 58.4 ± 15.3 years; P <.001) and were more likely to be female (56 vs 46%; P <.001). Patients with bowel disease required more repeat stone surgery than those without bowel disease (31% vs 23%, P <.001). In multivariate analysis, patients with bypass and bowel resection were associated with more repeat surgery than patients without bowel disease (P <.001, P = .002, respectively). Patients with IBD and bowel disease not otherwise specified did not have higher risk for repeat surgery than patients without bowel disease. CONCLUSION: Surgical stone patients with bowel disease, specifically those with prior bowel resection and bypass, had a higher risk of repeat stone surgery over time than stone formers without bowel disease. DATA AVAILABILITY: The data sets generated and analyzed during the current study are available from the corresponding author on reasonable request.

Quantifying the Educational History of the Endourological Society Fellowship Programs in the United States.

Introduction: We examined the history of the Endourological Society through the lens of its fellowship programs in the United States (U.S.). Methods: A review of the list of fellowship programs published annually in the Journal of Endourology from 1987 to 2015 allowed us to track the growth in fellowship programs over time. We reviewed the Endourological Society fellowship database and the websites for each of the fellowship programs for the names of graduates from each program. A survey was sent to each fellowship program director with a list of their graduates asking them to verify the names and to identify those graduates who had pursued a career in academic urology, and whether they had served as fellowship program director, residency program director or department chairperson. Seventeen of the 52 U.S. program directors (33%) responded to the survey. For those programs that did not respond to the survey each graduate's name was searched via Google, LinkedIn, and/or Doximity to determine if they had pursued a career in academic urology and served in a leadership position. Results: The number of U.S. Endourological Society fellowships has increased from 11 in 1987 to 52 in 2021. Five hundred and seventy-seven fellows have graduated from an Endourological Society Fellowship in the United States from 1987 to 2021. Two hundred and fifty fellows have pursued a career in academic urology (43.3%), 46 have served as fellowship program director (8.0%), 9 as residency program director (1.6%), and 13 have served as department chairperson (2.3%). Conclusions: The progress of the Endourological Society can be directly tied to the historical growth of its fellowship programs and the pursuit of an academic career by many of its graduates leading them to become the current and future educational leaders in the field.

Development and Preliminary Validation of the 6-Item Short Form of the Wisconsin Stone Quality of Life Questionnaire.

OBJECTIVE: To develop a short form of the Wisconsin Stone Quality of Life (WISQOL): 1) identify the smallest subset of items from WSIQOL that accurately predict patients' health-related quality of life (HRQOL), and 2) in a clinical patient population, test these items-grouped together to form the WISQOL-short form (SF) - and assess its convergent validity. MATERIALS AND METHODS: The items for the WISQOL-SF were identified based on classic item analysis theory. Patients who previously completed the original 28-item WISQOL were randomly split into 2 groups of equal size. Scores for the WISQOL were calculated for one group while those for the WISQOL-SF were calculated for the other. Cronbach's alpha coefficients were calculated. Impacts of demographic and clinical factors as well as stone and symptom status at the time of WISQOL completion were examined. RESULTS: Patients (n = 740) who completed the WISQOL between 6/2017 and 11/2021 were included. Patients were 48% male, 54.1 ± 14.6 years old, and had a BMI of 31.2 ± 8.1. After item analysis and reduction, the six items ultimately included in the WISQOL-SF represented 2 of the 4 domains (social and emotional) of the original WISQOL. The internal consistency of the WISQOL-SF was similar to the original (Cronbach's alpha 0.943 vs. 0.973). No differences for health-related quality of life were found between groups (P = .567). CONCLUSION: The WISQOL-SF demonstrated the expected differences for gender and between patients with and without stone-related symptoms at the time of WISQOL completion. The WISQOL-SF showed good consistency and produced similar HRQOL scores to the full-form WISQOL.

Pulse-modulated Holmium:YAG Laser vs the Thulium Fiber Laser for Renal and Ureteral Stones: A Single-center Prospective Randomized Clinical Trial.

PURPOSE: We sought to compare the clinical effectiveness of the pulse-modulated Ho:YAG (holmium:yttrium-aluminum-garnet) laser and the thulium laser fiber for ureteroscopic stone management in a randomized clinical trial. The primary outcome was the ureteroscope time required to adequately fragment stones to 1 mm or less. Secondary outcomes were stone-free rate, complications, subjective surgeon measurement of laser performance, patient related stone quality of life outcomes, and measurements of laser efficiency. MATERIALS AND METHODS: An Institutional Review Board-approved randomized clinical trial was conducted to randomize patients to outpatient treatment with either the Moses 2.0 or thulium laser fiber in a 1:1 manner after stratification into groups based on the maximal diameter of treated stone (3-9.9 mm or 10-20 mm). Patient, stone, and operative parameters were compared using the appropriate categorical/continuous and parametric/nonparametric statistical tests (SPSS 25). RESULTS: From July 16, 2021 to March 11, 2022, 108 patients were randomized and had primary endpoint data available for analysis; 52 patients were randomized to Ho:YAG and 56 patients to thulium laser fiber. Groups were well balanced with no significant differences observed for patient or stone characteristics. Ureteroscope time was not significantly different between modalities (Ho:YAG mean 21.4 minutes vs thulium laser fiber mean 19.9 minutes, P = .60), or within subgroup analysis by stone size, median Hounsfield units, or stone location. There were no significant differences observed in the stone-free rate and complications rate between the 2 lasers. CONCLUSIONS: This randomized clinical trial suggests no significant clinical advantage of one laser technology over the other. Surgeon and institutional preference are the best approach when selecting one or the other.

Ureteroscopy and Shock Wave Lithotripsy Trends from 2012 to 2019 Within the US Medicare Dataset: Sharp Growth in Ureteroscopy Utilization.

Introduction and Objective: Both ureteroscopy (URS) and shock wave lithotripsy (SWL) are cornerstones in the surgical management of urolithiasis in the United States. We hypothesized that URS utilization outpaced SWL utilization in recent years and quantified the magnitude of change over time for caseloads of URS and SWL among urologists from a national Medicare database. Methods: Using the public "Medicare Physician & Other Practitioners" database (https://data.cms.gov), we determined case numbers of SWL (current procedural terminology [CPT] 50590) and URS (CPT 52356 or 52353) from 2012 to 2019. In a subanalysis, we identified "high-volume stone urologists" as those in the upper quartile of case numbers for both SWL and URS in baseline years of either 2012 or 2013 and trended their caseload from 2012 to 2019. Linear estimation models assessed annual rates of change and their statistical significance. Results: In 2012, urologists performed 41,135 SWL procedures vs 21,184 URS. URS overtook SWL in 2017 and by 2019 was the dominant modality (60,063 URS vs 43,635 SWL). Between 2012 and 2019, total URS cases annually increased by 5700 (15%/year, p < 0.001), while the number of SWL cases peaked in 2015 and has since declined on average -1.6%/year (p = 0.020). The number of urologists performing URS steadily rose from 1147 in 2012 to 2809 in 2019, reflecting an additional 246 urologists (21%/year) performing URS annually. The caseload of high-volume stone urologists showed similar trends with average URS cases increasing by 2.9/year/urologist (9.8%/year, p < 0.001) and average SWL cases declining by 0.9/year/urologist (-1.7%/year, p = 0.023). Conclusions: URS utilization has increased dramatically and outpaced SWL utilization from 2012 to 2019 within the Medicare population. URS was increasingly used by both the general urologist population and high-volume stone urologists while SWL utilization has begun to decline.

Clinical Impact of the Institution of Moses Technology on Efficiency During Retrograde Ureteroscopy for Stone Disease: Single-Center Experience.

Objective: To evaluate the clinical benefits of Moses technology compared with the regular mode with the Lumenis® Pulse™ P120H holmium laser during ureteroscopy for stone disease. Patients and Methods: An IRB-approved database of patients with urolithiasis was analyzed for ureteroscopies from January 2020 to December 2020 at an outpatient surgery center. Patients who underwent ureteroscopy with the Lumenis Pulse P120H holmium laser system with the Moses or regular mode were included. Patient characteristics and stone parameters were collected. Operative room parameters were compared, including procedural time, fragmentation/dusting time, lasing time, and total energy used. Complication rates and stone-free rates were also analyzed. Univariate analysis and multiple analysis of covariance controlling for cumulative stone size were performed. Patients with staged procedures were excluded. Results: Of 197 surgical cases, 176 met the inclusion criteria. Moses was utilized in 110 cases and regular mode in 66. There was no difference in cumulative stone size between Moses and regular modes (11.8 ± 7.9 vs 11.6 ± 9.2 mm, p = 0.901). Procedural time (43.5 ± 32.1 vs 39.8 ± 24.6 minutes, p = 0.436), fragmentation/dusting time (20.5 ± 25.3 vs 17.1 ± 16.1 minutes, p = 0.430), lasing time (7.5 ± 11.1 vs 6.7 ± 7.9 minutes, p = 0.570), and total energy used (5.1 ± 6.7 vs 3.8 ± 4.8 kJ, p = 0.093) were also similar. Complications (6.4% vs 6.1%, p = 0.936) and stone-free rates (52.3% vs 65.3%, p = 0.143) did not differ. Conclusion: At our institution, Moses technology did not significantly change the procedural time, fragmentation/dusting time, lasing time, or total energy used. Moreover, there were no differences in complications or stone-free rates. There may be technical benefits to the Moses technology not captured in this analysis.

Disposable Ureteroscopes in Urology: Current State and Future Prospects.

Ureteroscopy is the most common surgical modality for stone treatment. Reusable flexible ureteroscopes are delicate instruments that require expensive maintenance and repairs. Multiple single use ureteroscopes have been developed recently to combat the expensive and time-intensive sterilization and repair of ureteroscopes. Although multiple studies have looked at different aspects of reusable and single use ureteroscopes, there is significant heterogeneity in performance measures and cost between the 2 categories, and neither has a clear advantage. Both can be used successfully, and individual and institution level factors should be considered when deciding which ureteroscope to use.

Transrectal ultrasound guided prostate biopsy performed by supervised junior and senior residents is safe and does not result in inferior outcomes.

PURPOSE: To compare transrectal ultrasound guided prostate biopsy (TRUSBx) cancer detection and complication rates between residents at different levels of training and attending physicians at a single academic center. METHODS: We performed a retrospective review of consecutive series of 623 men undergoing TRUSBx from June 2014 to February 2017. The procedure was performed either by resident physicians under direct supervision by an attending physician or by an attending physician. In total, junior residents, senior residents and attending physicians performed 244, 212, and 167 biopsies, respectively. Prostate cancer detection, 30-day complications, and 30-day hospitalizations rates were the outcomes of interest. We performed multivariable logistic regression analysis to identify predictors of these outcomes and examined the hypothesis that TRUSBx performed by trainees would not be associated with inferior outcomes. RESULTS: There was no statistically significant difference in patient populations between the three groups when stratified by age, BMI, Charleston co-morbidity index, aspirin use, PSA level and palpable nodule on DRE. Prostate cancer was detected in 43.8% of the biopsies and there was no difference in detection rates (P = 0.53), Gleason score (P = 0.11), number of positive cores (P = 0.95), 30-day hospitalization (P = 0.86), and 30-day complication rates (P = 0.67) between TRUSBx performed by trainees and attending physicians. CONCLUSIONS: TRUSBx performed by residents and attending physicians yielded equivalent rates of cancer detection with no significant difference in 30-day complications or 30-day hospitalizations rates. There was no difference in outcomes between junior and senior residents suggesting that with adequate faculty supervision, it is safe for trainees at all levels to perform prostate biopsies.

Digital Identity in Academic Urology: Assessment of Female Pelvic Medicine and Reconstructive Surgery, and Opportunity for Improvement.

INTRODUCTION: We describe the digital identity of academic urologists in FPMRS (Female Pelvic Medicine and Reconstructive Surgery) by assessing their visible online information. METHODS: A Google™ search of SUFU (Society of Urodynamics, Female Pelvic Medicine and Urogenital Reconstruction) board members, past presidents and fellowship directors was completed. Hits on the first page of results were categorized as institutional page, group/society page, ratings site, interview/multimedia, journal article or book, social media, professional profile or another person. Sites were subclassified as physician controllable content or not controllable. Descriptive statistics, comparisons among SUFU roles and site type associations were calculated. RESULTS: First page results contained a median (Q1-Q3) of 11 (10-11) hits with 2 (2-3) institutional pages and 1 (1-2) group/society. Ratings sites were frequent returns, with 4 hits (3-5) in 98% of searches (60). Only 1 (1-1) social media, 1 (1-2) professional profile and 1 (1-2) interview/multimedia hits occurred. Overall 6 (5-7) sites were physician controllable content with all but 1 physician having at least 1 such result. Institutional (correlation coefficient -0.38, p = 0.001) or group/society (-0.34, p = 0.023) pages were associated with fewer ratings sites. Group/society pages were 3.41 times more prevalent (mean 11.7% vs 3.44%, p = 0.009) among SUFU board members, while past presidents had 3.03 (6.8% vs 2.3%, p = 0.046) times more journal articles or books and fellowship directors had 1.43 (25.6% vs 18.6%, p = 0.021) times more institutional pages. CONCLUSIONS: For active SUFU members ratings sites comprise a substantial portion of their search results. More online engagement or social media use could increase the visibility of physician controllable content in their digital identities.