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Ability to predict the risk of intraoperative adverse events (IOAEs) for patients undergoing partial nephrectomy (PN) can be of great clinical significance.To develop and internally validate a preoperative nomogram predicting IOAEs for robot-assisted PN (RAPN).In this observational study, data for demographic, preoperative, and postoperative variables for patients who underwent RAPN were extracted from the Vattikuti Collective Quality Initiative (VCQI) database.IOAEs were defined as the occurrence of intraoperative surgical complications, blood transfusion, or conversion to open surgery/radical nephrectomy. Backward stepwise logistic regression analysis was used to identify predictors of IOAEs. The nomogram was validated using bootstrapping, the area under the receiver operating characteristic curve (AUC), and the goodness of fit. Decision curve analysis (DCA) was used to determine the clinical utility of the model.Among the 2114 patients in the study cohort, IOAEs were noted in 158 (7.5%). Multivariable analysis identified five variables as independent predictors of IOAEs: RENAL nephrometry score (odds ratio [OR] 1.13, 95% confidence interval [CI] 1.02-1.25); clinical tumor size (OR 1.01, 95% CI 1.001-1.024); PN indication as absolute versus elective (OR 3.9, 95% CI 2.6-5.7) and relative versus elective (OR 4.2, 95% CI 2.2-8); Charlson comorbidity index (OR 1.17, 95% CI 1.05-1.30); and multifocal tumors (OR 8.8, 95% CI 5.4-14.1). A nomogram was developed using these five variables. The model was internally valid on bootstrapping and goodness of fit. The AUC estimated was 0.76 (95% CI 0.72-0.80). DCA revealed that the model was clinically useful at threshold probabilities5%. Limitations include the lack of external validation and selection bias.We developed and internally validated a nomogram predicting IOAEs during RAPN.We developed a preoperative model than can predict complications that might occur during robotic surgery for partial removal of a kidney. Tests showed that our model is fairly accurate and it could be useful in identifying patients with kidney cancer for whom this type of surgery is suitable.

The COVID-19 Pandemic has caused unprecedented global challenges, including significant socioeconomic disruptions and the closure of schools and universities in almost all countries. Understanding the role of culture in shaping individual and societal responses to the Pandemic is crucial. This review article examines the applicability of Hofstede's cultural dimensions framework in devising effective COVID-19 control strategies. The article provides an overview of each dimension and its impact on the implementation of COVID-19 control strategies. It also includes a case analysis of four countries - India, the United Kingdom, the United States of America, and Poland - to illustrate the interplay between culture and COVID-19 control strategies. The insights provided by Hofstede's framework and the case analysis demonstrate that cultural differences can significantly impact the success of COVID-19 control strategies. By taking these differences into account, governments and public health authorities can improve the effectiveness of their COVID-19 control measures.

With advancements in surgical technology along with procedural techniques, this article throws light on the latest developments and applications of artificial intelligence (AI), extended reality, 3D (three-dimensional) printing and robotics in percutaneous nephrolithotomy (PCNL).This review highlights the applications of AI in PCNL over the past 2 years. Mostly studies have been reported on development of machine learning (ML) based predicting models and identification of stone composition using deep learning convolutional neural network (DL-CNN). But owing to the complexity of the models and lack of generalizability, it is still not incorporated in the routine clinical practice. Extended reality based simulation and training models have enabled trainees to enhance their skills and shorten the learning curve. Similar advantages have been reported with the use of 3D printed models when used to train young and novice endourologists to improve their skills in percutaneous access (PCA). Applications of robotics in PCNL look promising but are still in nascent stages.Future research on PCNL should focus more on generalizability and adaptability of technological advancements in terms of training and improvement of patient outcomes.

To conduct a comparative, non-randomised study to assess the feasibility of mini-Endoscopic combined Intra Renal Surgery(ECIRS) using supine Mini-Percutaneous nephrolithotomy (PCNL) access (16 Fr) in Galdakao Modified Supine Valdivia(GMSV) position for managing proximal large volume impacted ureteral calculi as ambulatory day-care surgery vis-a-vis standalone ureteroscopy with push-back PCNL, if needed. The primary aim was to study the outcomes and stone-free rates. Secondary aim was to compare the intra-operative and short-term post-operative complications.Data of sixty patients undergoing ECIRS(Group 1) from January 2016 to December 2019 were collected prospectively in a non-randomized fashion from a single centre after ethics committee approval. A matched-paired analysis was performed with retrospectively collated data of 60 patients undergoing standard ureteroscopy / pushback PCNL(Group 2) using analysis of variance, Fisher's exact test, and Chi-square test. P0.05 was considered statistically significant.GROUP 1 patients had a significantly shorter procedure time vs GROUP 2 (42.1 ± 11.2 minutes vs 52.1 ± 13.7 minutes, p0.001). GROUP 1 (59/60) patients had an overall single-stage (SFR) of 98.3% which was significantly higher than single-stage SFR of 83% in GROUP 2 (50/60) (p0.002). GROUP 2 patients had a higher incidence of fever (10 vs 4, p=0.01). However, there were no cases of sepsis in either group. Rest of the complications were comparable for both the need for ancillary procedures was significantly higher in GROUP 2 (10% vs 1.7%, p0.001). Patients were discharged on same day in both groups.The findings of our study suggest that, in large and impacted proximal ureteric stones, combined minimally-invasive endoscopic approach offers the best option to render the patient stone-free by a single intervention. With better intra- and post-operative outcomes and safety profile, Mini-ECIRS may be considered as an ambulatory procedure in this setting.

We performed a systematic review and meta-analysis to investigate the use of machine learning techniques for predicting stone-free rates following Shockwave Lithotripsy (SWL). Eight papers (3264 patients) were included. Two studies used decision-tree approaches, five studies utilised Artificial Neural Networks (ANN), and one study combined a variety of approaches. The summary true positive rate was 79%, summary false positive rate was 14%, and Receiver Operator Characteristic (ROC) was 0.90 for machine learning approaches. Machine learning algorithms were at least as good as standard approaches. Further prospective evidence is needed to routinely apply machine learning algorithms in clinical practice.

To compare perioperative outcomes following robot-assisted partial nephrectomy (RAPN) in patients with age ≥ 70 years to age 70 years.Using Vattikuti Collective quality initiative (VCQI) database for RAPN we compared perioperative outcomes following RAPN between the two age groups. Primary outcome of the study was to compare trifecta outcomes between the two groups. Propensity matching using nearest neighbourhood method was performed with trifecta as primary outcome for sex, body mass index (BMI), solitary kidney, tumor size and Renal nephrometery score (RNS).Group A (age ≥ 70 years) included 461 patients whereas group B included 1932 patients. Before matching the two groups were statistically different for RNS and solitary kidney rates. After propensity matching, the two groups were comparable for baselines characteristics such as BMI, tumor size, clinical symptoms, tumor side, face of tumor, solitary kidney and tumor complexity. Among the perioperative outcome parameters there was no difference between two groups for operative time, blood loss, intraoperative transfusion, intraoperative complications, need for radical nephrectomy, positive margins and trifecta rates. Warm ischemia time was significantly longer in the younger age group (18.1 min vs. 16.3 min, p = 0.003). Perioperative complications were significantly higher in the older age group (11.8% vs. 7.7%, p = 0.041). However, there was no difference between the two groups for major complications.RAPN in well-selected elderly patients is associated with comparable trifecta outcomes with acceptable perioperative morbidity.

Background. Forgotten ureteral stents (FUS) and stent-related symptoms (SRS) lead to increased postprocedural emergency department visits and add to the psychological and financial burden of the patients. Purpose. To review the usage and benefits of ureteral stent tracking and symptom monitoring through a single smartphone-based application (App) platform with 2-way clinician-patient communication. This study also compared the features with other smartphone apps used for stent tracking. Materials and Methods. 100 patients were included in this single-center prospective study conducted between September 2019 and December 2019. Patients who had metallic or long-term indwelling stents, noncomprehensible patients, and those not willing to share their data were excluded from the study. Results. Of 100 patients, 92 downloaded the Urostentz application, and 72 (78.2%) patients answered the pictorial symptom questionnaire. Symptom score analysis suggested that 62 patients (86.1%) had stent-related symptoms of which 3 required readmission and underwent early stent removal. The mean stent duration was 17.2 + 3.5 days (range: 11–23 days), with 69% of patients having their stent removed on the scheduled date and 25% of patients requesting a change of their appointment via the App. Conclusion. In this study, there was no case of FUS encountered. The “Urostentz” App is a freely available patient safety stent tracking application that provides a secure and simplified interface, which can significantly reduce the incidence of FUS and provide digital remote assistance in the management of stent-related symptoms.

Rosai-Dorfman Disease (RDD) is an idiopathic lymphohisticyocytic disorder characterized clinically by massive painless cervical lymphadenopathy, fever and weight loss. Extranodal involvement has been recognized. Central nervous system (CNS) manifestations are rare. Intracranial localization of the disease without involvement of other sites is very rare and needs to be differentiated from various mimicking lesions especially meningioma. A radiological and histological confirmation followed by complete resection of the lesion is the treatment of choice.

The clinical course of COVID-19 has been complicated by secondary infections, including bacterial and fungal infections. The rapid rise in the incidence of invasive mucormycosis in these patients is very much concerning. COVID-19-associated mucormycosis was detected in huge numbers during the second wave of the COVID-19 pandemic in India, with several predisposing factors indicated in its pathogenesis. This study aimed to evaluate the epidemiology, predisposing factor, cumulative mortality and factors affecting outcomes among the coronavirus disease COVID-19-associated mucormycosis (CAM).A multicenter retrospective study across three tertiary health care centers in Southern part of India was conducted during April-June 2021.Among the 217 cases of CAM, mucormycosis affecting the nasal sinuses was the commonest, affecting 95 (44%) of the patients, orbital extension seen in 84 (38%), pulmonary (n = 25, 12%), gastrointestinal (n = 6, 3%), isolated cerebral (n = 2) and disseminated mucormycosis (n = 2). Diabetes mellitus, high-dose systemic steroids were the most common underlying disease among CAM patients. The mucormycosis-associated case-fatality at 6 weeks was 14%, cerebral or GI or disseminated mucormycosis had 9 times higher risk of death compared to other locations. Extensive surgical debridement along with sequential antifungal drug treatment improved the survival in mucormycosis patients.Judicious and appropriate management of the predisposing factor and factors affecting mortality associated with CAM with multi-disciplinary approach and timely surgical and medical management can be much helpful in achieving a successful outcome.

Objective: This article aimed to study the prevalent practices in the treatment and follow-up of urethral strictures. Moreover, the article aimed to investigate the present opinion among urologists as the treatment practices for urethral stricture disease are mostly dependent on the treating surgeon’s expertise and preference in the absence of widely followed standard guidelines. Methods: A questionnaire was formulated based on the responses from experts. From October to December 2020, all members of the urological society of India received a mailed questionnaire on a web-based survey platform. Practicing urologists from across the country are among its members. Results: A total of 2554 urologists were contacted by mail, and 282 (11%) urologists provided a response. The majority were doing 5 to 15 urethroplasties a year. A newly diagnosed short segment bulbar urethral stricture would be a candidate for a visualized internal urethrotomy (VIU), according to 69.5% of urologists. Recurrence after one attempt at VIU prompted 80% to switch to urethroplasty as the next choice. During preoperative evaluation, 100% of respondents wanted a retrograde urethrogram, 74% deemed micturating cystourethrogram necessary, and 60% wanted a urethroscopy. At discharge, the majority preferred silicone Foley catheters, and the preferred size was 16F (54%). The patients were discharged with both suprapubic catheter and Foley in situ by most urologists. During follow-up, 60.99% wanted uroflowmetry, and the duration of follow-up varied. Conclusion: This survey on urethral stricture management amongst urologists shows that there is wide variation in the management of stricture urethra. This survey underscores the need for large-scale, long-term studies to formulate a guideline for the management of urethral stricture disease, thereby bringing uniformity in the care provided.

To compare perioperative outcomes following retroperitoneal robot-assisted partial nephrectomy (RPRAPN) and transperitoneal robot-assisted partial nephrectomy (TPRAPN).With this Vattikuti Collective Quality Initiative (VCQI) database, study propensity scores were calculated according to the surgical access (TPRAPN and RPRAPN) for the following independent variables, i.e., age, sex, side of the surgery, RENAL nephrometry scores (RNS), estimated glomerular filtration rate (eGFR) and serum creatinine. The study's primary outcome was the comparison of trifecta between the two groups.In this study, 309 patients who underwent RPRAPN were matched with 309 patients who underwent TPRAPN. The two groups matched well for age, sex, tumor side, polar location of the tumor, RNS, preoperative creatinine and eGFR. Operative time and warm ischemia time were significantly shorter with RPRAPN. Intraoperative blood loss and need for blood transfusion were lower with RPRAPN. There was a significantly higher number of intraoperative complications with RPRAPN. However, there was no difference in the two groups for postoperative complications. Trifecta outcomes were better with RPRAPN (70.2% vs. 53%, p 0.0001) compared to TPRAPN. We noted no significant change in overall results when controlled for tumor location (anteriorly or posteriorly). The surgical approach, tumor size and RNS were identified as independent predictors of trifecta on multivariate analysis.RPRAPN is associated with superior perioperative outcomes in well-selected patients compared to TPRAPN. However, the data for the retroperitoneal approach were contributed by a few centers with greater experience with this technique, thus limiting the generalizability of the results of this study.

Double ureteral stents are amongst the commonest procedures performed in urology. However, there are complications such as infection, and encrustation associated with its use, together with uncomfortable lower urinary tract symptoms (LUTS). The latter are known as stent related symptoms (SRS) and are commonly reported in the scientific literature. SRS mentioned in literature are urgency, frequency, dysuria, haematuria, pain in the suprapubic and flank region. These can result in decreased sexual activity, reduced work performance, as well as decreased quality of life (QoL) in more than two-third of the patients. Drugs still hold the key in reducing the morbidity related to the ureteral stents.In terms of monotherapy, Alpha blockers as well as Antimuscarinics are effective in reducing SRS. Role of Mirabegron in the field is currently gaining importance. However, combination therapy reaches better outcomes than monotherapy alone while in cases with sexual dysfunction along with stent related symptoms, PDE5-I are better than other options. The role of complementary therapy for SRS with natural remedies is promising but needs to be assessed further. More randomized studies and laboratory trials are necessary to analyse possible alternative treatments for SRS that can heavily affects patients’ quality of life.

Purpose of Review To highlight and review the application of artificial intelligence (AI) in kidney stone disease (KSD) for diagnostics, predicting procedural outcomes, stone passage, and recurrence rates. The systematic review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) checklist. Recent Findings This review discusses the newer advancements in AI-driven management strategies, which holds great promise to provide an essential step for personalized patient care and improved decision making. AI has been used in all areas of KSD including diagnosis, for predicting treatment suitability and success, basic science, quality of life (QOL), and recurrence of stone disease. However, it is still a research-based tool and is not used universally in clinical practice. This could be due to a lack of data infrastructure needed to train the algorithms, wider applicability in all groups of patients, complexity of its use and cost involved with it. Summary The constantly evolving literature and future research should focus more on QOL and the cost of KSD treatment and develop evidence-based AI algorithms that can be used universally, to guide urologists in the management of stone disease.

INTRODUCTION AND OBJECTIVE:Introduction and objective: To minimize stent-related symptoms (SRS), the distal part of the conventional double J (DJ) stent was replaced and a modified complete intra-u...

Endobronchial ultrasound‐guided transbronchial needle aspiration (EBUS‐TBNA) is preferred for evaluating malignant lymph nodes and staging of lung cancer. Nevertheless, larger tissue samples are increasingly needed, particularly for molecular analysis. We describe the feasibility, technical details, and complications of EBUS‐guided transbronchial cryo‐node biopsy (TBCNB) in four patients with mediastinal adenopathy. The samples obtained by EBUS‐TBCNB in all cases were adequate for histopathological examination (HPE) and immunohistochemistry (IHC) staining. In case 1, HPE showed non‐caseating epithelioid granuloma with giant cells and fibrosis consistent with sarcoidosis. Case 2 was diagnosed with adenocarcinoma with positivity for ROS1(D4D6). Case 3 showed features of metastatic adenocarcinoma from the breast (positive for Her2, ER, and GATA3). Case 4 was diagnosed with tuberculosis (necrotizing granuloma in histopathology, stain with Ziehl–Neelsen that showed few rod‐shaped bacilli). Only one patient had minimal bleeding at the puncture site controlled with cold saline. There were no adverse events such as major bleeding, pneumomediastinum, or pneumothorax., We describe the feasibility, technical details, and complications of endobronchial ultrasound‐guided transbronchial cryo‐node biopsy (EBUS‐TBCNB) in four patients with mediastinal adenopathy.

Objective To compare stent-related symptoms (SRS) associated with conventional ureteric JJ stent (CUS) placement and SRS associated with placement of a modified complete intra-ureteric stent (CIUS) with extraction suture, designed to minimize SRS, using the validated Ureteral Stent Symptom Questionnaire (USSQ). Materials and methods We randomized 124 patients who had undergone uncomplicated ureteroscopic lithotripsy into a CIUS and a CUS placement group. USSQ scores were evaluated on postoperative days 1 and 7 (just before stent removal) and 4 weeks after stent removal (control values). Pain scores on a visual analogue scale (VAS) after stent removal were also recorded. Subdomain analysis of all SRS and stent-related complications were also compared. Results No significant intergroup differences were found in the domain scores for urinary symptoms (P = 0.74), pain (P = 0.32), general health (P = 0.27), work (P = 0.24), or additional problems (P = 0.29). However, a statistically significant difference was noted in VAS scores (P = 0.015). Analysis of subdomains of USSQ item scores showed the CIUS group had significantly better scores for urge incontinence (1.21 vs 1.00; P ≤ 0.001), discomfort on voiding (2.07 vs 1.50; P ≤ 0.001), difficulties with respect to light physical activity (1.131 vs 1.00; P ≤ 0.001), fatigue (1.84 vs 1.57; P = 0.002), feeling comfortable (3.68 vs 3.16; P = 0.003), need for extra help (1.96 vs 1.00; P ≤ 0.001), and change in duration of work (4.27 vs 1.86; P ≤ 0.001). However, the patients in the CIUS group were sexually inactive for the time during which the stent was indwelling (mean: 7.34 days). There was no difference in complication rates between the two groups. Conclusion The use of a CIUS with strings after Ureteroscopy decreases SRS.

Recent advances in artificial intelligence (AI) have certainly had a significant impact on the healthcare industry. In urology, AI has been widely adopted to deal with numerous disorders, irrespective of their severity, extending from conditions such as benign prostate hyperplasia to critical illnesses such as urothelial and prostate cancer. In this article, we aim to discuss how algorithms and techniques of artificial intelligence are equipped in the field of urology to detect, treat, and estimate the outcomes of urological diseases. Furthermore, we explain the advantages that come from using AI over any existing traditional methods.

Objective: To develop a decision support system (DSS) for the prediction of the postoperative outcome of a kidney stone treatment procedure, particularly percutaneous nephrolithotomy (PCNL) to serv...

Objective To understand the preference and role of ‘hybrid’ urological meetings compared to face-to-face and online meetings during and after COVID-19 pandemic. The secondary outcome was finding out the most preferable webinar setting. Methods An online global survey was done between June 06 and July 05, 2020, using SurveyMonkey. The target participants were urology healthcare providers. The survey was disseminated via mailing lists and the Twitter platform. Results A total of 526 urology providers from 56 countries responded to the survey and it was completed by 73.3%. Participants’ overall experience was better in a face-to-face meeting, followed by a hybrid and webinar only meeting. While opportunities for networking was identified as high in face-to-face meeting, online webinars were more cost effective, and learning opportunity and reach of audience was higher for hybrid meetings. For online webinar format, Zoom platform was used by 73% and majority (69%) saw it on their laptop or desktop. The preference was for a 1-hour webinar in the evenings with 3-5 speakers. Urology residents rated face-to-face meetings to have better cost-effectiveness when compared to consultants. Post COVID-19, more than half of all respondents would prefer hybrid meetings compared to the other formats. Conclusion While there will be a place for face-to-face meetings, COVID-19 situation has led to a preference towards hybrid meetings which is ideal for a global reach in the future. It is plausible that most urological associations will move towards a hybrid model for their meetings.

The COVID-19 pandemic has had a significant impact on all domains of urology. Annual educational conferences by prominent urological bodies were suspended, due to the inability of conventional conference to adhere to social distancing stipulations. Innovative methods of healthcare delivery were therefore required to mitigate some of financial, health, training and research implications. Webinars is now a very popular method of communication and dissipation of knowledge with increasing adoption in medical education, training and also has been included in the curriculum of elite universities. The term ‘webinar’ is a combination of web and seminar, meaning a presentation, lecture, or workshop that is transmitted over the web. Webinars have proven to be convenient, flexible, cost-effective and reduce the carbon footprint. Furthermore, it is likely that webinars have a wider global audience reach and individual delegates have the ability to access more meetings from the comfort of their homes. The Urology community has been one of more prominent adopters of webinars in delivering educational activity during the pandemic. An estimated 400 urology webinars have been listed on DocMeetings since the onset of the COVID-19 pandemic. However, webinar is not without limitations. The didactic nature of webinars allows for minimal interpersonal interaction and constructive debate with the audience. It is however likely with potential technological advancements this going to be less of an issue in the future. It seems that the journey of webinars has just begun and will have an impact on training, education, communication and conferences for the foreseeable future.

Introduction: Treatment of nonmuscle invasive bladder cancer (NMIBC) usually requires piecemeal resection of the tumor. En bloc resection emerges as a promising technique for small bladder tumors

Introduction During the COVID-19 led lockdown, a reliable system to monitor ureteral stent insertion and timely removal became an important facet of their use. This study looks at the use of ‘Urostentz’ smart�phone application (app) for stent procedures and whether it improved patient communication and safety during the lockdown. Material and methods The ‘Urostentz’ app was used for patients who underwent ureteric stent after ureteroscopy (URS) or percutaneous nephrolithotomy (PCNL) procedure. It is a smartphone app devel�oped to improve patient safety, facilitate data collection, and provide an efficient interface to simplify ureteral stent tracking and patient communication. It also helps clinicians track stent-related symptoms (SRS) and provide digital remote assistance. Results A total of 33 patients registered with a mean age of 47.8 years (range:18–80) and a male: female ratio of 4.5:1. Of these, 29 (87.9%) used the Urostentz app, and 55.2% had SRS. The number of effective communication episodes ranged from 1–7/patient. Based on the symptoms and communication, stent was removed during lockdown (n = 2), within 1 week of lockdown lifted (n = 24) and within 2 weeks of lockdown lifted (n = 5). None of the patients suffered any stent-related complications and there were no cases of forgotten stents or readmissions despite the lockdown and lack of communication using standard practices. Conclusions The Urostentz app proved to an effective medium of communication to provide guidance and personalized digital remote healthcare. It also allowed prompt removal of stents avoiding prolonged stent symptoms or forgotten stents. Such apps can have a much wider application in the post-COVID-19-era to reduce unnecessary post-procedural visits and reduce health care costs.