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BACKGROUND: The COVID-19 pandemic drastically reduced opportunities for surgical skill sharing between high-income and low to middle-income countries. Augmented reality (AR) technology allows mentors in one country to virtually train a mentee in another country during surgical cases without international travel. We hypothesize that AR technology is an effective live surgical training and mentorship modality. METHODS: Three senior urologic surgeons in the US and UK worked with four urologic surgeon trainees across the continent of Africa using AR systems. Trainers and trainees individually completed post-operative questionnaires evaluating their experience. RESULTS: Trainees rated the quality of virtual training as equivalent to in-person training in 83% of cases (N = 5 of 6 responses). Trainers reported the technologys visual quality as acceptable in 67% of cases (N = 12 of 18 responses). The audiovisual capabilities of the technology had a high impact in the majority of the cases. CONCLUSION: AR technology can effectively facilitate surgical training when in-person training is limited or unavailable. more...

The medical and surgical management of kidney stones is one of the most common functions of the urologist. Management choices are often nuanced, involving the decision to embark on one surgical plan among several options. As the wider medical community critically evaluates the care we provide to an increasingly diverse population, it will be important to examine patient outcomes with a particular focus on ensuring equitable care. This review examines the influence of social parameters on the care of kidney stone patients. The dearth of literature in this area warrants rigorous studies on the relationship between race as well as socioeconomic status and the management of kidney stone disease. more...

Background: Urinary tract infections (UTIs) are among the most prevalent bacterial infections. With many patients turning to the Internet as a health resource, this study seeks to understand public engagement with online resources concerning recurrent UTIs (rUTIs), assess their reliability, and identify common questions/concerns about rUTIs. Methods: Social media analysis tool BuzzSumo was used to calculate online engagement (likes, shares, comments, views) with information on rUTIs. The reliability of highly engaged articles was evaluated using the DISCERN questionnaire. Highly engaged categories were entered as keywords in Google Trends to quantify search interest. To categorize patient-specific concerns, a database containing anonymously collected patient questions about rUTIs was created. Results: BuzzSumo revealed four search categories: general information, treatment, causes, and herbal remedies. DISCERN scores indicated moderate reliability overall; however, the "herbal remedies" category demonstrated poor reliability despite high engagement. Google Trends analysis highlighted "causes" and "treatment" searches as highest in relative interest. The 10 most popular categories of concern were antibiotics, microbiome, vaccines, prevention, pelvic pain, sex, testing, symptoms, diet/lifestyle, and hormones. Conclusions: People living with rUTIs demonstrate key concerns and often seek information online, yet articles with high engagement often contain unreliable information. Healthcare professionals may consider counteracting misinformation by providing evidence-based information online about rUTIs. [ABSTRACT FROM AUTHOR] more...

(1) Background: Indwelling ureteral stents are commonly used urological devices to maintain ureteral patency, yet they have been associated with complications such as infections. Some studies have shown that bacteria adhere to and create an antimicrobial-resistant biofilm on stents. One factor that may impact biofilm formation is the original condition informing stent placement, such as kidney stones and renal allografts. Both kidney stones and renal allografts are independently associated with infection, yet the differential stent microbiomes of these populations remain poorly characterized. Our objective was to characterize these microbiomes in order to inform urological health practice and help prevent ureteral stent-associated infections. (2) Methods: Stents were collected from kidney stone and renal transplant recipients undergoing routine cystoscopic stent removal. Microbial DNA was extracted from stents and analyzed using 16S Next Generation Sequencing. Descriptive statistics, alpha diversity, and beta diversity methods were used for statistical analysis. (3) Results: The microbiome of ureteral stents in kidney stone and transplant patients is composed of unique species, each with different biofilm-forming abilities. (4) Conclusions: Our findings demonstrate that the microbiome of stents differs based on preceding condition. It is important to conduct future studies that explore this microbiome further to understand what type of stent-associated infection someone may develop based on their initial condition. [ABSTRACT FROM AUTHOR] more...

The article focuses on questioning the necessity of stone analysis and 24-hour urine testing in managing renal stone disease. Topics include the limitations of 24-hour urine analysis, such as variability in results and patient inconvenience, the challenges of conducting reliable stone composition analysis, and the argument for using empiric treatment over routine testing for most kidney stone patients. more...

Purpose: Flank pain associated with stone disease is typically caused by a stone that obstructs urine flow. However, it is plausible that nonobstructing kidney stones may still cause pain. We performed a multicenter, observational trial to evaluate whether treatment of small nonobstructing calyceal stones improves pain and kidney stoneespecific health-related quality of life. Materials and Methods: Patients aged 18 years or older with nonobstructing renal stone(s) up to 10 mm in longest diameter and moderate to severe pain were recruited. All participants completed 3 questionnaires: the Brief Pain Inventory (BPI), the Patient-Reported Outcomes Measurement Information System pain interference form 6a, and the Wisconsin Stone Quality of Life questionnaire. Thereafter, all participants underwent ureteroscopy for renal stone treatment. All 3 questionnaires were repeated at 2, 6 to 8, and at 12 weeks postprocedure. The primary outcomes were change in preoperative to 12-week postoperative mean BPI score and worst BPI pain score. Results: A total of 43 patients with nonobstructing kidney stones and associated flank pain were recruited. All stones were removed. Preoperatively, BPI scores for mean pain and worst pain were 5.5 and 7.2, respectively which decreased to 1.8 and 2.8 respectively at 12 weeks postoperatively. Wisconsin Stone Quality of Life questionnaire mean score increased from 70.4 to 115.3 at 12 weeks postoperatively. A total of 86% and 69% of patients had at least a 20% and 50% reduction in their mean pain scores, respectively. Conclusions: This study determined that patients benefit significantly from the removal of calyceal nonobstructing kidney stones for at least 12 weeks with a reduction in pain and an increase in quality of life. Therefore, surgical removal of these stones in this patient population should be offered as a treatment option. [ABSTRACT FROM AUTHOR] more...

Objective: To develop a standardised tool to evaluate flexible ureterorenoscopes (fURS). Materials and Methods: A three‐stage consensus building approach based on the modified Delphi technique was performed under guidance of a steering group. First, scope‐ and user‐related parameters used to evaluate fURS were identified through a systematic scoping review. Then, the main categories and subcategories were defined, and the expert panel was selected. Finally, a two‐step modified Delphi consensus project was conducted to firstly obtain consensus on the relevance and exact definition of each (sub)category necessary to evaluate fURS, and secondly on the evaluation method (setting, used tools and unit of outcome) of those (sub)categories. Consensus was reached at a predefined threshold of 80% high agreement. Results: The panel consisted of 30 experts in the field of endourology. The first step of the modified Delphi consensus project consisted of two questionnaires with a response rate of 97% (n = 29) for both. Consensus was reached for the relevance and definition of six main categories and 12 subcategories. The second step consisted of three questionnaires (response rate of 90%, 97% and 100%, respectively). Consensus was reached on the method of measurement for all (sub)categories. Conclusion: This modified Delphi consensus project reached consensus on a standardised grading tool for the evaluation of fURS – The Uniform grading tooL for flexIble ureterorenoscoPes (TULIP) tool. This is a first step in creating uniformity in this field of research to facilitate future comparison of outcomes of the functionality and handling of fURS. [ABSTRACT FROM AUTHOR] more...

Objectives: To investigate global changes in ureters at the transcriptional, translational and functional levels, both while stents are indwelling and after removal and recovery, and to study the effects of targeting pathways that play a potential role. Methods: Pig ureters were stented for varying amounts of time (48 h, 72 h, 14 days) and the impact on peristalsis, dilatation and hydronephrosis were assessed. RNAseq, proteomic, histological and smooth muscle (SM) function analyses were performed on ureteric and kidney tissues to assess changes induced by stenting and recovery. Pathway analysis was performed using Ingenuity Pathway Analysis software. To study the impact of possible interventions, the effects of erythropoeitin (EPO) and a Gli1 inhibitor were assessed. Results: Stenting triggers massive ureteric dilatation, aperistalsis and moderate hydronephrosis within 48 h. Pathways associated with obstruction, fibrosis and kidney injury were upregulated by stenting. Increased expression of GLI1, clusterin‐α (a kidney injury marker) and collagen 4A2 (a fibrosis marker) was found in stented vs contralateral unstented ureters. EPO did not improve peristalsis or contraction force but did decrease non‐purposeful spasming seen exclusively in stented ureters. Tamsulosin administration increased contractility but not rate of peristalsis in stented ureters. Conclusions: Ureters respond to stents similarly to how they respond to an obstruction, that is, with activation of pathways associated with hydronephrosis, fibrosis and kidney injury. This is driven by significant dilatation and associated ureteric SM dysfunction. EPO and tamsulosin induced mild favourable changes in SM physiology, suggesting that targeting specific pathways has potential to address stent‐induced complications. [ABSTRACT FROM AUTHOR] more...

Introduction: The novel coronavirus disease (COVID-19) pandemic has had a significant impact on the care of patients with urolithiasis. Recommendations and prioritization of endourologic surgical procedures vary among regions, and a comprehensive overall international directive is needed. We used the Delphi method to obtain international consensus on managing urolithiasis patients during the pandemic. Methods: A three-round Delphi process was used to elicit expert consensus (53 global key opinion leaders within the Endourological Society from 36 countries) on an extensive survey on management of endourologic patients in a pandemic. Questions addressed general management, inpatient and outpatient procedures, clinic visits, follow-up care, and best practices for suspension and resumption of routine care. Results: Consensus was achieved in 64/84 (76%) questions. Key consensus findings included the following: consultations should be delivered remotely when possible. Invasive surgical procedures for urolithiasis patients should be reserved for high-risk situations (infection, renal failure, etc.). To prevent aerosolization, spinal anesthesia is preferred over general, whenever feasible. Treatment of asymptomatic renal stones should be deferred. Primary definitive treatment of obstructing or symptomatic stones (both renal and ureteral) is preferred over temporizing drainage. Extracorporeal shockwave lithotripsy should be continued for obstructive ureteral stones. There was consensus on treatment modalities and drainage strategies depending on location and size of the stone. Conclusion: International endourologist members of the Endourological Society participated in this Delphi initiative to provide expert consensus on management of urolithiasis during a pandemic. These results can be applied currently and during a future pandemic. [ABSTRACT FROM AUTHOR] more...

A commitment to diversity and inclusivity within an organization can influence its success. The Endourological Society convened a task force to assess its baseline diversity and inclusivity. The aim of this investigation was to determine diversity across various spaces of the Society to better define imbalances and aid in long-term strategic planning. This task force assessed the Society's annual World Congress of Endourology and Technology programming from 2017 to 2019 and 2023 as well as leadership over the lifetime of the Society. In all programming areas, there was a domination of male speakers, predominantly those from North America. Similarly, women are largely underrepresented in Society leadership across the executive board, board of directors, committee chair positions, and Society award winners, although representation has increased since 2019. Based on these findings a diversity, equity, inclusion committee was established to actively work on increasing and supporting demographic diversity. more...

Background Kidney stone formers need to navigate an overwhelming amount of information for acute stone management and stone recurrence prevention. Artificial intelligence (AI) chatbots may be uniquely equipped to support stone formers in this process. UroGPT™ (Dornier Medtech, Wessling, Germany) is an AI chatbot developed to answer kidney stone-related questions and help kidney stone formers manage their care. The aim of this study is to evaluate the perceived usefulness and ease of use of UroGPT™ among kidney stone formers. Methods A pre-survey and a post-survey were designed to assess participants' experiences with their sources of kidney stone-related information before using UroGPT™, and their experiences using UroGPT™, respectively. Results In all, 626 and 260 participants participated in the pre- and post-survey, respectively. Among post-survey participants, 190 (73.08%) strongly agreed that using UroGPT™ makes it easier for them to get the information they need about kidney stones, 183 (70.38%) strongly agreed that they are satisfied with UroGPT™ for improving their understanding of kidney stones, and 218 (83.85%) strongly agreed that they find UroGPT™ easy to use. UroGPT™ achieved a total Net Promoter Score (NPS) of +75.77. Conclusion This study found that UroGPT™ is generally easy to use and useful for kidney stone formers. A high NPS indicates the potential for UroGPT™ to be widely adopted in kidney stone former communities., Competing Interests: Human subjects: Consent for treatment and open access publication was obtained or waived by all participants in this study. University of California Los Angeles (UCLA) Institutional Review Board issued approval IRB#23-000249. The study was deemed exempt on 9/20/24 by the UCLA Institutional Review Boards. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2025, Huang et al.) more...

Introduction and objectives With the continuous growth of social media platforms, an increasing number of individuals are turning to them as their main source of medical information. This article aims to pinpoint the most widely accessed online resources on kidney stone pain among those who suffer from kidney stones and to assess the reliability, understandability, quality, and actionability of their content. Materials and methods The social media analysis platform BuzzSumo was employed to identify pertinent articles and assess their engagement levels. The DISCERN instrument was utilized to evaluate the quality of the top 10 most popular articles, while online software for determining reading grade levels was used to assess article readability. Additionally, the PEMAT (Patient Education Material Assessment Tool) was employed to gauge the actionability and understandability of these articles. Results The BuzzSumo results were obtained through four search categories: "passing stones," "home remedies," "stent pain," and "back pain." DISCERN exhibited a mean article score of 2.67/5, indicating low quality. The average reading grade level for articles was 10.4, with a median of 10. PEMAT results indicated an average understandability score of 60%, signifying that most articles were not easily understandable, and an average actionability score of 31%, indicating a lack of actionable steps in the majority of articles to improve health outcomes. Conclusions Online resources about kidney stone pain were found to have shortcomings, including content with a reading level higher than average, and a lack of actionable solutions for improving overall health., Competing Interests: Human subjects: All authors have confirmed that this study did not involve human participants or tissue. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Hernandez et al.) more...