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Purpose: To compare the visual quality amongst the disposable FLEX-XC1, digital FLEX-XC, and fiberoptic FLEX-X2S flexible ureteroscopes (FUS) and determine whether urologists can distinguish which FUS is in use. Methods: In this prospective survey, 6 patients were prospectively randomized to the disposable FLEX-XC1, digital FLEX-XC, and fiberoptic FLEX-X2S FUS for retrograde intrarenal surgery (RIRS) for nephrolithiasis. Each RIRS was performed by a single-surgeon and recorded. 9 fellowship-trained endourologists were blinded to which FUS was used. They were asked to view the recordings, answer which FUS was used, and fill out a 7-question survey grading parameters from 0 to 5. Statistical analysis was performed with SPSS. ANOVA with Tukey's posthoc analysis confirmed significance defined as p < 0.05. Results: 78%, 89%, and 78% of endourologists correctly identified which FUS was used between the disposable FLEX-XC1, digital FLEX-XC, and fiberoptic FLEX-X2S FUS's respectively. The digital FUS outperformed the others in overall score (p < 0.001). The only visual parameter that was not statistically different amongst FUS's was Laser Activation Interference (p = 0.97). After Tukey's posthoc analysis, the digital FUS outperformed the fiberoptic scope in all parameters except LAI. The disposable FUS outperformed the fiberoptic scope in all parameters except for LAI, tissue interference (TI), and overall impression. The digital FUS was superior to the disposable FUS only in Visual quality (Color) and TI. Conclusions: The majority of fellowship-trained endourologists can distinguish which type of KARL STORZ FUS is in use. The KARL STORZ digital and disposable FUS's outperform the KARL STORZ fiberoptic FUS in nearly all visual parameters. The KARL STORZ disposable FUS is comparable to the KARL STORZ digital FUS except for Visual Quality (Color) and Tissue Interference. Clinical trial registration: This study was approved by the Northwestern Institutional Review Board and was assigned study ID STU00217933. It is also registered under NCT05646069, titled "Evaluation of Novel Disposable Flexible Ureteroscope for the Treatment of Renal Calculi." [ABSTRACT FROM AUTHOR]

Introduction: Holmium laser enucleation of the prostate (HoLEP) is routinely performed with a 24F, 26F, or a 28F scope. Proponents of the larger scopes propose that a bigger sheath size allows for superior flow and visibility leading to a more efficient operation and better hemostasis. Those utilizing the smaller scopes suggest that the smaller sheath is less traumatic, resulting in lower stricture rates and temporary incontinence. We sought to compare outcomes of ambulatory HoLEP using the 24F and 28F laser scope. Materials and Methods: From May 2022 to March 2023, we randomized patients undergoing HoLEP (<200 cm3 in size) 1:1 to either a 24F or 28F scope. The primary outcome was differences in surgical duration between groups (minutes). Secondary outcomes included surgeon scope evaluation and postoperative patient results. Results: There was no difference in patient characteristics in those randomized to 28F (n = 76) vs 24F (n = 76) (p > 0.05) scopes. Procedural duration and efficiencies were not different between groups (all p > 0.05). The 28F scope was associated with improved surgeon-graded irrigation flow and visibility (p < 0.001). Patients treated with the 28F scope were more likely to achieve effective same-day trial of void (SDTOV) (28F 94.3% vs 24F 82.1%, p = 0.048) and have a shorter length of stay (LOS) (28F 7.0 vs 24F 11.9 hours, p = 0.014), however, rates of same-day discharge (SDD) were not statistically different (28F 87.8% vs 24F 78.4%, p = 0.126). There was no difference between the cohorts in rates of 90-day emergency room presentations, re-admissions, complications, or functional ouctomes (p > 0.05). Conclusions: We identified no clear advantage of scope size with regard to intraoperative or postoperative outcomes at 3-month follow-up due to scope size. However, if SDD is part of your postoperative pathway, the 28F scope may shorten LOS and increase rates of effective SDTOV. Clinicaltrials.gov: NCT05308017. [ABSTRACT FROM AUTHOR]

INTRODUCTION: The completion of residency and start of fellowship training marks a critical transition for urologists in the pursuit of subspeciality training. Most graduating urology residents are under contract until June 30, and most fellowships are scheduled to begin on July 1. There has been no investigation into the practical implications of fellowship delays in urology from a trainee perspective. Our research study aimed to investigate the incidence and predictors of delays in fellowship starts. METHODS: Pediatric urology fellows that began their fellowship training between 2019 and 2023 and endourologic fellows that began their fellowship training between 2017 and 2022 were surveyed using SurveyMonkey®. A total of 250 endourology (EU) fellows and 90 pediatric urology (PU) fellows were contacted. RESULTS: A total of 26.0% and 14.3% of EU and PU fellows, respectively, experienced a delay in their training, despite many leaving their residency positions early (33.8% vs. 44.9%, p=0.2097); 11.7% and 8.2% of EU and PU fellows, respectively, experienced delays they reported to be "very stressful" and 9.1% and 4.1%, respectively, found them "somewhat stressful." Delays of 2--4 weeks were experienced by 5.2% and 6.1%, 4--6-week delays by 7.8% and 4.1%, and delays >6 weeks by 2.6% and 0% of EU and PU fellows, respectively (p=0.0007). CONCLUSIONS: Delays in fellowship training do occur at a notable rate, despite nearly half of urology fellows leaving their residency training positions early, with unclear impacts on patient care and resident colleague well-being. This research highlights the importance of fellowship programs considering delaying fellowship starts to mid-July or August, with support of the prior fellow cohorts. [ABSTRACT FROM AUTHOR]

Objectives: To review outcomes for patients with irritable bowel syndrome (IBS) or inflammatory bowel disease (IBD) who undergo holmium laser enucleation of prostate (HoLEP) for bothersome urinary symptoms related to benign prostatic hyperplasia (BPH)., Methods: We performed a retrospective review of patients who had undergone HoLEP by a single surgeon between January 2021 and August 2023. Preoperative, intraoperative, and postoperative characteristics were compared between patients with an ICD-10 diagnosis of IBS or IBD and those without, using Chi-square and paired T -tests as appropriate., Results: Out of 918 men, 24 (2.6%) had a diagnosis of IBS, and 36 (3.9%) had a diagnosis of IBD. There were no differences in age, BMI, preoperative American Urological Association symptoms score (AUASS), preoperative Michigan Incontinence Symptom Index (MISI) score, and history of urinary retention or incontinence. The IBS + IBD cohort had smaller prostates (100.9 vs 124.2 mL, p  = 0.01) and shorter procedure times (57.0 vs 66.5 min, p  = 0.02) than controls. IBS patients were more likely to require anticholinergic therapy at a 3-month follow-up (31% vs 13%, p  = 0.03) and had more postoperative encounters within 90 days of HoLEP (3.7 vs 2.6, p  = 0.01). There were no differences regarding changes in AUASS and MISI scores, same-day trial of void and same-day discharge rates, or complication rates., Conclusion: IBS patients who underwent HoLEP had more symptomatic postoperative courses requiring higher rates of anticholinergic medication use and more provider interactions compared to men without IBS, despite similar AUASS and MISI scores. These trends were not observed in patients with IBD., Competing Interests: Dr. Amy Krambeck is a consultant for Boston Scientific, Wolf, and Storz. She is a data safety monitoring board member of Uriprene. The other authors have no conflict of interests or disclosures., (© The Author(s), 2025.)

Introduction: Conservative management of penetrating renal trauma is emerging, with data originating from centers with variable level of trauma care. This study reviews the outcomes of renal salvage after penetrating trauma at a level I trauma center., Materials and Methods: An institutional review board approved trauma registry at Saint Louis University Hospital was retrospectively analyzed, for patients with penetrating renal trauma from 2009 to 2014. Patients were divided into nephrectomy group (NG) or non-nephrectomy group (non-NG), and compared. A multi-variable analysis was performed to determine predictors of nephrectomy, with cross validation to evaluate the performance of the multi-variable model. Data was analyzed using R version 3.3.2. A p value of < 0.05 was considered as significant., Results: A total of 121 patients were identified with penetrating renal trauma. Gunshot injury was the leading cause of injury (87%). Eighteen (15%) patients required nephrectomy. The overall mean injury severity score (ISS). was 20. High grade (grade 4-5) renal injuries were noted in 41 patients (34%). Among these, 14 patients (34%) underwent a nephrectomy, while 27 patients (66%) were managed conservatively to salvage renal units. CT grade of renal injury was the only predictor of nephrectomy, on multi-variable analysis (OR 17.09 CI 2.75-105.99, p = 0.002). CT grade of injury and injury severity score were predictors of endoscopic intervention on a sub group analysis of non-NG., Conclusions: CT grade of injury predicts nephrectomy after penetrating renal trauma. Conservative management is a feasible option in penetrating renal trauma even with a higher grade of injury.