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Advancements in Minimally Invasive Urological Surgery and Endourology

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A special issue of Journal of Personalized Medicine (ISSN 2075-4426). This special issue belongs to the section "Clinical Medicine, Cell, and Organism Physiology".

Deadline for manuscript submissions: closed (31 December 2022) | Viewed by 14038

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Dr. Dorit E. Zilberman

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Guest Editor

1. Chaim Sheba Medical Center, Tel-Hashomer, Ramat-Gan 52621, Israel
2. Sackler School of Medicine, Tel-Aviv University, Tel-Aviv 69978, Israel
Interests: robotic laparoscopic and endoscopic approaches for benign and malignant urologic conditions; medical and surgical management of stone disease

Special Issue Information

Dear Colleagues,

The past 15 years have seen tremendous advancement in the field of urinary and male genital system surgery. The miniaturization of surgical devices, the introduction of the Da-Vinci robotic system as well as the recruitment of holmium/neodymium lasers for the improvement of surgical outcomes have all led to a significant increase in surgical volumes in general and in organ-preserving surgeries in particular. Thanks to a parallel advancement in the anesthesiology field, cases considered for conservative treatment in the past are now eligible for surgical treatment if they meet the appropriate indications. This Special Issue of Journal of Personalized Medicine will focus on advancements in minimally invasive urological surgery and endourology. Authors are welcome to submit their original research and review articles on laparoscopic and robotic surgery of the prostate, kidney, ureter and urinary bladder, as well as the surgical treatment of nephrolithiasis and benign prostatic enlargement.

Dr. Dorit E. Zilberman
Guest Editor

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Journal of Personalized Medicine is an international peer-reviewed open access monthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2600 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

robotic surgery
laparoscopic surgery
holmium laser
prostatectomy
nephrectomy
cystectomy
ureterectomy
peloplasty
ureteroscopy/uretero-nephroscopy
percutaneous nephrolithotomy

Published Papers (10 papers)

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Research

7 pages, 229 KiB

Open AccessArticle

Reverse Trendelenburg Lithotomy with Certain Inclination Angles Reduces Stone Retropulsion during Ureteroscopic Lithotripsy for Proximal Ureteral Stone

by Shihai Li, Jianchen Wu, Qiang Li and Jiawei Zhang

J. Pers. Med. 2022, 12(12), 2020; https://doi.org/10.3390/jpm12122020 - 7 Dec 2022

Cited by 3 | Viewed by 1528

Abstract

The objective of this study is to investigate how different inclination angles of reverse Trendelenburg lithotomy affect stone retropulsion and stone-free rates during ureteroscopic lithotripsy for proximal ureteral stones. Patients with proximal ureteral stones undergoing ureteroscopic lithotripsy in our institution between January 2019 and December 2020 were included according to predefined criteria. The rigid ureteroscope and Holmium: YAG laser were utilized to perform lithotripsy, and a stone basket was used to keep the stone in place and to avoid retropulsion. Before initiating lithotripsy, the upper part of the patient’s body was tilted up to establish a reverse Trendelenburg posture with appropriate inclination angles. To quantify the stone-free rate, computed tomography was used to evaluate the residual stones in the kidney one month following surgery. Patients’ clinical data were obtained retrospectively, including age, gender, the largest diameter of stone, stone density on computed tomography, and the distance between stone and ureteral pelvic junction, etc. Patients were divided into four groups based on the inclination angles of reverse Trendelenburg lithotomy: 0°, 10°, 20°, and 30°. The chi-square test was used to compare stone retropulsion and stone-free rates between groups. To discover possible determinants of the stone-free rate, logistic regression analyses were used. There were 189 patients that qualified. There were no differences in clinical characteristics between groups (p > 0.05). Multiple comparisons between groups revealed that the 20° and 30° groups had less retropulsion and a greater stone-free rate than the 0° and 10° groups (p < 0.05), whereas there were no significant differences in stone retropulsion or stone-free rates between the 20° and 30° groups or between the 0° and 10° groups (p > 0.05). The inclination angles as well as distance between the stone and ureteral pelvic junction were identified by using logistic regression analyses as the related factors for the stone-free rate. According to our results, the appropriate inclination angles of reverse Trendelenburg lithotomy during ureteroscopic lithotripsy for proximal ureteral stones would help preclude stone retropulsion and increase the stone-free rate. Full article

(This article belongs to the Special Issue Advancements in Minimally Invasive Urological Surgery and Endourology)

9 pages, 247 KiB

Open AccessArticle

Factors Predicting Outcomes of Supine Percutaneous Nephrolithotomy: Large Single-Centre Experience

by Yasmin Abu-Ghanem, Luke Forster, Pramit Khetrapal, Gidon Ellis, Paras Singh, Rohit Srinivasan, Rajesh Kucheria, Anuj Goyal, Darrell Allen, Antony Goode, Dominic Yu and Leye Ajayi

J. Pers. Med. 2022, 12(12), 1956; https://doi.org/10.3390/jpm12121956 - 25 Nov 2022

Cited by 3 | Viewed by 1075

Abstract

Objective: Percutaneous nephrolithotomy (PCNL) is the treatment of choice for large renal calculi. The prone position has been considered the preferred position to obtain renal access. However, the supine position has recently gained popularity, which confers several potential advantages. The current study analyses the prognostic factors for successful supine PCNL procedures in a larger tertiary centre. Subjects: Prospective data were collected from all patients undergoing PCNL in the Galdako modified Valdivia position at our institution between February-2007 and September-2020. Surgical outcomes variables collected included: the rate of Endoscopic-combined intra-renal surgery (ECIRS), operative times, surgical effectiveness (no residuals <2 mm stone fragments) and complications. Results: A total of 592 patients underwent PCNL with a median age of 56 years (IQR: 42–67). The median stone size was 17 mm (IQR: 13–23). Of those, 79% of patients had an effective procedure. Stone size (p < 0.001), location (p < 0.001) and Guys-Stone Score (GSS) (p < 0.001) were associated with effectiveness. A Percutaneous nephrostomy tube was sited at the completion of the procedure in 97.3% of patients and a simultaneous double-J stent in 45.3%. Stent insertion was associated with larger stones (p < 0.001), the performance of ECIRS (p < 0.001) and higher GSS (p < 0.001). The overall complication rate was 21.7%. The main type of complication was an infection in 26.2 of the cases followed by the need for repeated nephrostogram in 12.7%. Conclusions: We demonstrate that PCNL in a high-volume centre is safe and efficacious in the Galdalko modified Valdivia position. Patients with smaller stones in the renal pelvis and a low GSS have the highest chance of a successful procedure. Full article

(This article belongs to the Special Issue Advancements in Minimally Invasive Urological Surgery and Endourology)

7 pages, 674 KiB

Open AccessArticle

Emergency Primary Ureteroscopy for Acute Ureteric Colic—From Guidelines to Practice

by Yasmin Abu-Ghanem, Christina Fontaine, Radha Sehgal, Luke Forster, Neeta Verma, Gidon Ellis, Rajesh Kucheria, Darrell Allen, Paras Singh, Anuj Goyal and Leye Ajayi

J. Pers. Med. 2022, 12(11), 1866; https://doi.org/10.3390/jpm12111866 - 8 Nov 2022

Viewed by 1314

Abstract

Objective: To review the factors that may influence the ability to achieve the present guidelines’ recommendations in a well-resourced tertiary centre. According to current National Institute for Health and Care Excellence (NICE) guidelines, definitive treatment (primary ureteroscopy (URS) or shock wave lithotripsy (ESWL)) should be offered to patients with symptomatic renal colic that are unlikely to pass the stone within 48 h of diagnosis. Methods: Retrospective review of all patients presenting to the emergency department between January and December 2019 with a ureteric or renal stone diagnosis. The rate of emergency intervention, risk factors for intervention and outcomes were compared between patients who were treated by primary definitive surgery vs. primary symptom relief by urethral stenting alone. Results: A total of 244 patients required surgical management for symptomatic ureteric colic without symptoms of urinary infection. Of those, 92 patients (37.7%) underwent definitive treatment by either primary URS (82 patients) or ESWL (9 patients). The mean time for the procedure was 25.5 h (range: 1–118). Patients who underwent primary definitive treatment were likelier to have smaller and distally located stones than the primary stenting group. Primary ureteroscopy was more likely to be performed in a supervised setting than emergency stenting. Conclusions: Although definitive treatment carries high success rates, in a high-volume tertiary referral centre, it may not be feasible to offer it to all patients, with emergency stenting providing a safe and quick interim measure. Factors determining the ability to provide definitive treatment are stone location, stone size and resident supervision in theatre. Full article

(This article belongs to the Special Issue Advancements in Minimally Invasive Urological Surgery and Endourology)

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9 pages, 864 KiB

Open AccessArticle

Primary Definitive Treatment versus Ureteric Stenting in the Management of Acute Ureteric Colic: A Cost-Effectiveness Analysis

by Radha Sehgal, Yasmin Abu-Ghanem, Christina Fontaine, Luke Forster, Anuj Goyal, Darrell Allen, Rajesh Kucheria, Paras Singh, Gidon Ellis and Leye Ajayi

J. Pers. Med. 2022, 12(11), 1773; https://doi.org/10.3390/jpm12111773 - 27 Oct 2022

Viewed by 1053

Abstract

Objectives: To analyze the differences in cost-effectiveness between primary ureteroscopy and ureteric stenting in patients with ureteric calculi in the emergency setting. Patients and Methods: Patients requiring emergency intervention for a ureteric calculus at a tertiary centre were analysed between January and December 2019. The total secondary care cost included the cost of the procedure, inpatient hospital bed days, emergency department (A&E) reattendances, ancillary procedures and any secondary definitive procedure. Results: A total of 244 patients were included. Patients underwent ureteric stenting (62.3%) or primary treatment (37.7%), including primary ureteroscopy (URS) (34%) and shock wave lithotripsy (SWL) (3.6%). The total secondary care cost was more significant in the ureteric stenting group (GBP 4485.42 vs. GBP 3536.83; p = 0.65), though not statistically significant. While mean procedural costs for primary treatment were significantly higher (GBP 2605.27 vs. GBP 1729.00; p < 0.001), costs in addition to the procedure itself were significantly lower (GBP 931.57 vs. GBP 2742.35; p < 0.001) for primary treatment compared to ureteric stenting. Those undergoing ureteric stenting had a significantly higher A&E reattendance rate compared with primary treatment (25.7% vs. 10.9%, p = 0.02) and a significantly greater cost per patient related to revisits to A&E (GBP 61.05 vs. GBP 20.87; p < 0.001). Conclusion: Primary definitive treatment for patients with acute ureteric colic, although associated with higher procedural costs than ureteric stenting, infers a significant reduction in additional expenses, notably related to fewer A&E attendances. This is particularly relevant in the COVID-19 era, where it is crucial to avoid unnecessary attendances to A&E and reduce the backlog of delayed definitive procedures. Primary treatment should be considered concordance with clinical judgement and factors such as patient preference, equipment availability and operator experience. Full article

(This article belongs to the Special Issue Advancements in Minimally Invasive Urological Surgery and Endourology)

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7 pages, 615 KiB

Open AccessArticle

Improving Prostatic Preoperative Volume Estimation and Planning before Laser Enucleation

by Ziv Savin, Snir Dekalo, Haim Herzberg, Reuben Ben-David, Yuval Bar-Yosef, Avi Beri, Ofer Yossepowitch and Mario Sofer

J. Pers. Med. 2022, 12(11), 1761; https://doi.org/10.3390/jpm12111761 - 25 Oct 2022

Cited by 2 | Viewed by 1268

Abstract

We aimed to validate a formula for improving the estimation of prostatic volume by abdominal ultrasound (AUS) prior to transurethral laser enucleation. A total of 293 patients treated for benign prostate hyperplasia (BPH) by laser enucleation from 2019–2022 were included. The preoperative AUS volume was adjusted by the formula 1.082 × Age + 0.523 × AUS − 53.845, which was based on specimens retrieved by suprapubic prostatectomy. The results were compared to the weight of the tissue removed by laser enucleation as determined by the intraclass correlation coefficient test (ICC). The potential impact of preoperative planning on operating time was calculated. The ICC between the adjusted volumes and the enucleated tissue weights was 0.86 (p < 0.001). The adjusted volume was more accurate than the AUS volume (weight-to-volume ratio of 0.84 vs. 0.7, p < 0.001) and even more precise for prostates weighing >80 g. The median operating time was 90 min. The adjusted volume estimation resulted in an overall shorter expected preoperative operating time by a median of 21 min (24%) and by a median of 40 min in prostates weighing >80 g. The adjustment formula accurately predicts prostate volume before laser enucleation procedures and may significantly improve preoperative planning, the matching of a surgeon’s level of expertise, and the management of patients’ expectations. Full article

(This article belongs to the Special Issue Advancements in Minimally Invasive Urological Surgery and Endourology)

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7 pages, 812 KiB

Open AccessArticle

Bladder Oversensitivity Is Associated with Bladder Outlet Obstruction in Men

by Guy Verhovsky, Ilia Baberashvili, Yishai H. Rappaport, Dorit E. Zilberman, Amos Neheman, Jonathan Gal, Amnon Zisman and Kobi Stav

J. Pers. Med. 2022, 12(10), 1675; https://doi.org/10.3390/jpm12101675 - 8 Oct 2022

Cited by 2 | Viewed by 1318

Abstract

Objective: The aim of this study was to assess whether there is an objective association between bladder outlet obstruction (BOO) and abnormal sensation parameters during filling cystometry in men. Methods: This was a prospective study. Consecutive patients referred for urodynamic examination were assessed for eligibility. Patients with permanent catheters, BPH related surgery, neurologic disease, or inability to complete the urodynamic study were excluded. All patients underwent full physical examination, as well as renal and bladder ultrasound including prostate size estimation, post void residual volume, and PSA, and they completed the International Prostate Symptoms Score (IPSS) questionnaire. The cohort was divided into obstructed and un-obstructed groups according to the Bladder Outlet Obstruction Index. Results: Ninety of the 115 patients recruited were obstructed (78%). Obstructed patients had significantly higher PSA, larger prostate volume, and higher IPSS. Detrusor overactivity did not differ between the two groups (45.6% vs. 48.1%, p = 0.83). First, normal, strong, and urgent desires to void were significantly lower in obstructed men: median (IQR) 118 (57–128) vs. 180 (80–200), 171 (85–257) vs. 227 (125–350), 221 (150–383) vs. 307 (180–477), and 276 (197–480) vs. 344 (280–535), respectively. First desire to void (FDV) had the highest area under the curve (AUC = 0.83, 95% CI = 0.76–0.90, p < 0.001) for predicting BOO with a Youden index of 0.78 at 140 mL. Conclusions: Our results suggest that there is a strong association between bladder oversensitivity and BOO in men. Men with FDV <140 mL had a significantly increased probability of being obstructed. These findings may shed a light on the pathophysiological connection between obstruction and enhanced afferent signaling from the bladder. Full article

(This article belongs to the Special Issue Advancements in Minimally Invasive Urological Surgery and Endourology)

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10 pages, 1212 KiB

Open AccessArticle

The Impact of Radiographic, Metabolic and Demographic Characteristics on Kidney Stone Recurrence

by Igal Shpunt, Hadar Pratt Aloni, Nelli Khanukaeva, Pearl Herskovitz, Ishai Dror, Brian Berkowitz, Dan Leibovici and Yaniv Shilo

J. Pers. Med. 2022, 12(10), 1632; https://doi.org/10.3390/jpm12101632 - 2 Oct 2022

Viewed by 1348

Abstract

Urolithiasis is a frequent disease with cited rates of recurrence after initial diagnosis that vary widely and range between 35% and 50%. We assessed the radiographic recurrence rate in patients with urinary stones and its risk factors. We retrospectively identified patients who were diagnosed with urinary stones on non-contrast computed tomography from 2010 to 2011, and underwent another imaging examination at least six months afterwards. We collected patient demographic, clinical, laboratory and radiologic data and compared patients with and without urinary stone recurrence. Ultimately, 237 patients were included in the study; the mean follow-up was 6.7 years; 88 patients (37.1%) had recurrence based on our recurrence criteria. On univariate analysis, the significant parameters for recurrence were baseline serum calcium and uric acid, stone location in the kidney, surgical intervention and stone burden volume. On multivariate analysis, surgical intervention (OR 3.07, p = 0.001), baseline calcium (OR 2.56, p = 0.011), baseline uric acid (OR 1.30, p = 0.021) and stone location in the kidney (OR 2.16, p = 0.012) were associated with higher risk of recurrence. These findings may guide personalized follow-up protocols for patients with urolithiasis based on their risk factors. Full article

(This article belongs to the Special Issue Advancements in Minimally Invasive Urological Surgery and Endourology)

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11 pages, 2129 KiB

Open AccessArticle

The Effects of Surgical Approaches and Enhanced Recovery Protocols on the Cost Effectiveness of Radical Cystectomy

by Eyal Kord, Moshe Leshno and Miki Haifler

J. Pers. Med. 2022, 12(9), 1433; https://doi.org/10.3390/jpm12091433 - 31 Aug 2022

Cited by 2 | Viewed by 1254

Abstract

Enhanced recovery protocols and robotic approaches to radical cystectomy are known to reduce perioperative complications; however, the most cost-effective strategy is unknown. We aim to assess the cost effectiveness of radical cystectomy with different surgical techniques and perioperative treatment protocols. We performed a meta-analysis of studies comparing open radical cystectomy (ORC), robotic assisted radical cystectomy (RARC) using extracorporeal (ECUD) or intracorporeal urinary diversion (ICUD) and enhanced recovery after surgery (ERAS) protocols. Operative time, transfusion, complication, Ileus, length of stay and re-admission rates were extracted. US costs for surgery, treatment, hospitalization and complications were obtained from the literature. Israeli costs were obtained from hospital administrative data. Two cost effectiveness models (US and Israel) were developed. The two most cost-effective strategies in both models were ORC with ERAS and RARC with ICUD and ERAS. RARC with ERAS produced the two most effective strategies with ICUD being dominant over ECUD. All strategies implementing the ERAS protocol were more effective than their parallel non-ERAS strategies. RARC with ICUD and ERAS is cost effective compared to ORC. ERAS protocol improves treatment effectiveness and lowers overall costs. ICUD was shown to be more effective and less costly in comparison to ECUD. Full article

(This article belongs to the Special Issue Advancements in Minimally Invasive Urological Surgery and Endourology)

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10 pages, 1551 KiB

Open AccessArticle

Potential Markers to Reduce Non-Contrast Computed Tomography Use for Symptomatic Patients with Suspected Ureterolithiasis

by Yuval Avda, Igal Shpunt, Jonathan Modai, Dan Leibovici, Brian Berkowitz and Yaniv Shilo

J. Pers. Med. 2022, 12(8), 1350; https://doi.org/10.3390/jpm12081350 - 21 Aug 2022

Viewed by 1495

Abstract

Most patients with ureterolithiasis are managed successfully with conservative treatment. In this context, delineation of clinical risk factors that identify patients with low risk for surgical intervention may reduce use of Non-Contrast Computed Tomography (NCCT). Here, emergency department patient files from a 14-month period were reviewed retrospectively, to identify patients who underwent NCCT and showed a ureteral stone. Demographic, clinical and laboratory information was collected. Patients were grouped to either requiring surgical intervention (Group 1) or having successful conservative management (Group 2). The cohort included 368 patients; 36.1% ultimately required surgical intervention (Group 1) and 63.9% were successfully treated conservatively (Group 2). On univariate analysis, patients who required surgical intervention were older, had longer duration of symptoms, had history of urolithiasis and surgical intervention for urolithiasis and had higher serum creatinine levels. Multivariate analysis identified the following risk factors associated with surgical intervention: creatinine >1.5 mg/dL, duration of symptoms ≥ 1.5 days and age > 45 years. Patients with 0, 1, 2 or 3 of the identified risk factors had 19%, 32%, 53% and 73% likelihood, respectively, of surgical intervention. Incorporating these data may reduce the use of NCCT scans in patients who are likely to pass a stone via conservative management. Full article

(This article belongs to the Special Issue Advancements in Minimally Invasive Urological Surgery and Endourology)

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6 pages, 528 KiB

Open AccessArticle

Changing Trends in Surgical Management of Nephrolithiasis among Young Adults: A 15-Year Population-Based Study

by Dorit E. Zilberman, Tomer Erlich, Nir Kleinmann, Itay M. Sabler, Amos Neheman and Guy Verhovsky

J. Pers. Med. 2022, 12(8), 1345; https://doi.org/10.3390/jpm12081345 - 21 Aug 2022

Cited by 4 | Viewed by 1501

Abstract

Background: Increases in obesity and diabetes rates among all ages have led to a greater prevalence of nephrolithiasis worldwide. We aimed to explore the changing trends in surgical management of nephrolithiasis in young adults over a 15 year period. Methods: We reviewed medical records of military personnel for information on the diagnosis and care of nephrolithiasis before and during active service between 2007–2021, divided into three 5 year periods: 2007–2011, 2012–2016, and 2017–2021. Demographic, clinical, radiological, and surgical data were retrieved for the analysis of changing trends. Results: The records of 1,117,692 recruits yielded 7383 (0.66%) with stone-related surgeries, of whom 1885 were operated during military service. Their median age was 19.6 years (interquartile range [IQR] 16.8–21.2), 829 (70%) were males, and the cohort’s median body mass index was 23.6 (IQR 17.3–26.1). There was a dramatic decline in shock wave lithotripsy (SWL) prevalence (35.1%, 10.4%, and 4.4%, respectively) with a continually increasing prevalence of ureteroscopy (URS)/retrograde intrarenal surgery (RIRS) (62.7%, 88.5%, and 94.6%, p = 0.01). Percutaneous nephrolithotomy (PCNL) procedures have become nearly extinct over time (0.8% in 2017–2021). The number of median-sized stones treated by URS/RIRS increased (7.5 mm, 8.2 mm, and 9.7 mm, p = 0.044), but not those treated by SWL/PCNL. The median length of medical leave for URS/RIRS and PCNL decreased significantly (7 vs. 4 days, p = 0.05 and 10 vs. 6 days, p = 0.036, respectively), with no comparable change for SWL. There was a substantial decline in ancillary procedures in the URS/RIRS groups (9%, 6.8%, and 3.1%, p < 0.01), but not in the SWL/PCNL groups. Conclusions: Advancements in technology and surgical training are leading to the extinction of SWL and the adoption of URS/RIRS as the new standard of care for nephrolithiasis among young adults. Full article

(This article belongs to the Special Issue Advancements in Minimally Invasive Urological Surgery and Endourology)

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