Treatment of ureteropelvic junction obstruction and urolithiasis in children with minimally invasive surgery

Background: Ureteropelvic Junction Obstruction (UPJO) is the most common congenital ureteral anomaly. Nowadays, according to the increasing incidence of urolithiasis, 20% of children with UPJO presents urolithiasis. Open pyeloplasty was the standard treatment before the introduction of minimally invasive surgery (MIS). Nevertheless, only scattered experiences on MIS were previously described and universal agreement on the treatment of UPJO plus urolithiasis is still missing. Objective: The study aim was to describe our experience with a series of pediatric patients affected by UPJO and urolithiasis treated with robot-assisted pyeloplasty (RAP) and endoscopic removal of stones using a flexible cystoscope and a stones basket in a singular tertiary referral center. Material and methods: We retrospectively reviewed our data from pediatric patients affected by UPJO and urolithiasis undergoing RAP between April 2013 and December 2019. The analysis was conducted on seven patients. All procedures were performed by one expert robotic surgeon and one endoscopic surgeon skilled in the management of urolithiasis. Results: The mean age was 7 years (IQR 4–16). The median stone area was 77.7 mm two (IQR 50.2–148.4). Most of them (71.4%) presented preoperative symptoms. The median operative time was 110 min (IQR 104–125) with a console time of 90 (IQR 90–105). The median length of stay was 5 days (IQR 4–5). Median follow-up was 16 months (IQR 10–25). Conclusion: RAP with concomitant flexible ureteroscope is a safe and effective option for the simultaneous management of UPJO with urolithiasis with excellent outcomes in children.

The Right Instrument for the Right Purpose: Spreading the Use of Small Caliber Ureteroscope for the Inspection of the Male and Female Urethra

The inspection of the urethra in patients with documented or suspected urethral stricture should be carried out with small caliber ureteroscope of 6/7.5Ch. Different from flexible cystoscope (16Ch) or resectoscope (26Ch), small caliber ureteroscope allows a comprehensive evaluation of the stricture, including its length and the status of the mucosa in its proximity, without injuring or overstretching the urethra. With a small caliber ureteroscope it is also possible to cross the stricture, allowing the evaluation of the proximal urethra, the external urethral sphincter, and the bladder. A 6/7.5Ch ureteroscope also allows estimation of the real caliber of the stricture, providing a useful landmark for further treatment decisions.

The utility of instruments and disposables during endourologic practice among Egyptian urologists

Objective: We aimed to investigate the prevalence of utilization of different endourological instruments and disposables among Egyptian urologists and to see how availability could affect the deviation from the universal standards that might result in reduced patient safety. Patients and method: We surveyed members of the Egyptian Urological Association by a questionnaire evaluating the importance of different instruments and disposables used during ureteroscopy and percutaneous nephrolithotomy. All responses were collected by a commercially available Internet-based survey host ( www.surveymonkey.com ) over 8 weeks. Results: One hundred and fifty-two responses were received. For ureteroscopy, the most mandatory instruments and disposables included the C-arm device (83%), Dormia basket (61%), ureteral stone forceps (58%), pneumatic lithotripter (50%), and regular PTFE guide wire (49%). The instruments and disposables described as optional included 4.5 Fr ureteroscope (74%), flexible ureteroscope (70%), and hydrophilic guidewire (67%). For percutaneous nephrolithotomy, the most mandatory instruments and disposables were pneumatic lithotripter (78%), Alken metal dilator (75%), fascial dilator (45%), and regular PTFE guidewire (42%); while instruments and disposables described as optional included flexible cystoscope (70%), hydrophilic guidewire (67%), balloon dilator (57%), and laser machine (52%). Conclusion: The prevalence of the utilization of newly introduced instruments and disposables is low among Egyptian urologists.

769 Analysing the Change – Outcomes and Benefits of Clinic-Based Removal of Renal Transplant Stents Using A Disposable Cystoscope

Introduction Literature is chock-full of data regarding the “when” of ureteric stent removal after renal transplantation. We have attempted to address the “who”, “where” and “how” components. Method The Isiris disposable scope was used to remove renal allograft stents from 383 patients in the Transplant Clinic from June 2018 to April 2020. An advanced nurse practitioner was trained in the procedure. The learning curve, incidence of complications, benefits and cost implications were studied, and compared with the cohort having stent removal with a traditional flexible cystoscope in theatres. Results There were 14 failures necessitating theatre removal. The transplant-to-stent-removal interval was significantly lower in the clinic cohort with a mean of 38.80 days (95%CI 37.26–40.34) to 46.55 days in theatres (95%CI 43.47–49.62). 11 patients had urgent bedside stent removal. The service was delivered independently by the nurse for 5.3% of the patients in June 2018 and progressed to over 80% by April 2019. Estimated net gain was £919/patient. Conclusions Moving transplant ureteric stent removals from a resource intensive all-day process in theatres to a one-stop event in the clinic is a safe and economical model that can streamline flow in patient pathway and inculcate new skills in other members of the multidisciplinary team.

Randomised Controlled Study to Evaluate the Outcomes between Rigid and Flexible Cystoscopy in Men with Lower Urinary Tract Symptoms Undergoing Diagnostic Cystoscopy

BACKGROUND Cystoscopy is a commonly performed routine outpatient procedure and an essential diagnostic tool in urology. It may be performed using either rigid or flexible cystoscopes. From the clinical perspective, it might appear that flexible cystoscopy causes less discomfort than rigid cystoscopy, but remarkably head-to- head comparisons of these two devices are sparse. We wanted to compare rigid cystoscopy with flexible cystoscopy in men with lower urinary tract symptoms (LUTS), in terms of the post-procedure outcomes defined as discomfort / pain experienced by the patient using the visual analogue score (VAS) scoring and duration of the procedure. METHODS A total of 60 male patients with LUTS were randomised to flexible and rigid cystoscopy groups (N = 30 each group). Cystoscopy was done using appropriate rigid and flexible cystoscope. Post procedure, patient was assessed with VAS scaling for pain. The duration of the procedure and any post-procedure discomfort and complication were also noted. RESULTS The mean age of patients of flexible cystoscopy group was comparable to that of a rigid cystoscopy group (39.43 ± 11.45 vs. 41.7 ± 10.8, P = 0.433). The mean duration (minutes) for flexible cystoscopy was significantly less than that of rigid cystoscopy (8.53 ± 1.81 vs. 9.77 ± 2.14, P = 0.019). The mean VAS score for flexible cystoscopy was significantly less than that of rigid cystoscopy (2.57 ± 0.97 vs. 3.97 ± 1.1, P < 0.0001). There was no significant difference between groups in terms of diagnosis (P = 0.796). Post-procedure complications were also comparable between the two groups. CONCLUSIONS Flexible cystoscopy caused less pain and discomfort as compared to rigid cystoscopy. Duration of procedure was also less for the flexible cystoscope. KEY WORDS Cystoscopy, Flexible Cystoscopy, Lower Urinary Tract Symptoms, Pain, Rigid Cystoscopy

Flexible cystoscopy and laser stone fragmentation via Mitrofanoff stoma: A case series

Objective: This case series aimed to demonstrate that flexible cystoscopy and laser stone fragmentation via a Mitrofanoff stoma is possible and an effective treatment for symptomatic bladder stones in complex patients with inaccessible urethras and challenging anatomy. Patients and methods: We present three cases which were managed in a tertiary centre. The procedure involved using a flexible cystoscope via the Mitrofanoff stoma and laser stone fragmentation without the need for an access sheath. Results: This technique was performed safely and demonstrated successful bladder stone clearance on follow-up, with no postoperative complications. Conclusion: Our case series illustrates a technique that can be performed in this select group of patients in specialist centres with the relevant surgical exposure and expertise. Level of evidence Level 4.