Percutaneous Nephrolithotomy for De Novo Urolithiasis After Kidney Transplantation: A Systematic Review of the Literature

Introduction and Objective: Renal transplantation is the treatment for end-stage renal disease that offers better quality of life and survival. Among the possible complications that might affect allografts, urolithiasis might have severe consequences, causing acute kidney injury (AKI) or septic events in immunocompromised patients. Allograft stones might be treated with percutaneous nephrolithotomy (PCNL). The aim of this Cochrane style review was to assess the safety and efficacy of PCNL in patients with renal transplant. Methods: A comprehensive search in the literature was performed including articles between July 1982 and June 2023, with only English original articles selected for this review. Results: The final review encompassed nine articles (108 patients). The mean age was 46.4 ± 8.7 years, with a male:female ratio of 54:44. The average time from transplantation to urolithiasis onset was 47.54 ± 23.9 months. Predominant symptoms upon presentation were AKI (32.3%), followed by urinary tract infection and fever (24.2%), and oliguria (12.9%). The mean stone size was 20.1 ± 7.3 mm, with stones located in the calices or pelvis (41%), ureteropelvic junction (23.1%), or proximal ureter (28.2%). PCNL (22F-30F) was more frequently performed than mini-PCNLs (16F-20F) (52.4% vs 47.6%). Puncture was guided by ultrasound (42.9%), fluoroscopy (14.3%), or both (42.9%). The stone-free rate (SFR) and complication rates were 92.95% (range: 77%-100%) and 5.5%, respectively, with only one major complication reported. Postoperatively, a ureteral stent and nephrostomy were commonly placed in 47%, with four patients needing a second look PCNL. During an average follow-up of 32.5 months, the recurrence rate was 3.7% (4/108), and the mean creatinine level was 1.37 ± 0.28 mg/dL. Conclusions: PCNL remains a safe and effective option in de novo allograft urolithiasis, allowing to treat large stones in one-step surgery. A good SFR is achieved with a low risk of minor complications. These patients should be treated in an endourology center in conjunction with the renal or transplant team.

Fluid dynamics within renal cavities during endoscopic stone surgery: does the position of the flexible ureteroscope and ureteral access sheath affect the outflow rate?

PURPOSE

To evaluate the impact of ureteroscope position within renal cavities as well as different locations of the tip of the ureteral access sheath (UAS) on fluid dynamics during retrograde intrarenal surgery (RIRS).

MATERIALS AND METHODS

A prospective observational clinical study was performed. Measurements with a flexible ureteroscope placed in the upper, middle and lower calyces were obtained with the tip of the UAS placed either 2 cm below the pyelo-ureteric junction (PUJ), or at the level of the iliac crest.

RESULTS

74 patients were included. The outflow rates from the middle and upper calyxes were statistically significantly higher compared to the lower calyx, both with the UAS close to the pyelo-ureteric junction and at the iliac crest. When the UAS was withdrawn and positioned at the level of the iliac crest, a significant decrease in outflow rates from the upper (40.1 ± 4.3 ml/min vs 35.8 ± 4.1 ml/min) and middle calyces (40.6 ± 4.0 ml/min vs 36.8 ± 4.6 ml/min) and an increase in the outflow from the lower calyx (28.5 ± 3.3 ml/min vs 33.7 ± 5.7 ml/min) were noted.

CONCLUSIONS

Our study showed that higher fluid outflow rates are observed from upper and middle calyces compared to lower calyx. This was true when the UAS was positioned 2 cm below the PUJ and at the iliac crest. Significant worsening of fluid dynamics from upper and middle calyces was observed when the UAS was placed distally at the level of the iliac crest. While the difference was statistically significant, the absolute change was not significant. In contrast, for lower calyces, a statistically significant improvement was documented.

Digital health innovations in urology: telemedicine, wearables, and mobile applications - a systematic review of literature

PURPOSE OF REVIEW

There are enough publications on the use of telemedicine, wearable devices, and mobile applications in urology; however, their collective impact on urological care has not been adequately studied. This review seeks to address this deficiency by providing a descriptive analysis of the recent use of telemedicine, wearable technology, and mobile applications in urology as well as elucidating their associated challenges.

RECENT FINDINGS

There are studies that were dedicated to the use of telemedicine, wearables, and mobile apps in urology according to inclusion criteria, respectively. They were successfully implemented in different urological subfields, such as urogynecology, endourology, pediatric urology, and uro-oncology, and led to time safety, remote monitoring, and better patient awareness. However, several concerns also exist, such as issues with data safety, measurement deviations, technical limitations, and lack ofquality.

SUMMARY

Telemedicine, wearables, and mobile apps have already shown their potential in urological practice. However, further studies are needed to expand both our understanding of their current state and their potential for further development and clinical use.

Potential of AI-Driven Chatbots in Urology: Revolutionizing Patient Care Through Artificial Intelligence

PURPOSE OF REVIEW

Artificial intelligence (AI) chatbots have emerged as a potential tool to transform urology by improving patient care and physician efficiency. With an emphasis on their potential advantages and drawbacks, this literature review offers a thorough assessment of the state of AI-driven chatbots in urology today.

RECENT FINDINGS

The capacity of AI-driven chatbots in urology to give patients individualized and timely medical advice is one of its key advantages. Chatbots can help patients prioritize their symptoms and give advice on the best course of treatment. By automating administrative duties and offering clinical decision support, chatbots can also help healthcare providers. Before chatbots are widely used in urology, there are a few issues that need to be resolved. The precision of chatbot diagnoses and recommendations might be impacted by technical constraints like system errors and flaws. Additionally, issues regarding the security and privacy of patient data must be resolved, and chatbots must adhere to all applicable laws. Important issues that must be addressed include accuracy and dependability because any mistakes or inaccuracies could seriously harm patients. The final obstacle is resistance from patients and healthcare professionals who are hesitant to use new technology or who value in-person encounters. AI-driven chatbots have the potential to significantly improve urology care and efficiency. However, it is essential to thoroughly test and ensure the accuracy of chatbots, address privacy and security concerns, and design user-friendly chatbots that can integrate into existing workflows. By exploring various scenarios and examining the current literature, this review provides an analysis of the prospects and limitations of implementing chatbots in urology.

Adverse events related to accessory devices used during ureteroscopy: Findings from a 10-year analysis of the Manufacturer and User Facility Device Experience (MAUDE) database

Objectives

The objective of this study was to evaluate adverse events and device events related to accessories used during ureteroscopy (URS).

Materials and methods

Analysis was performed of the records available in the Manufacturer and User Facility Device Experience database in the United States. Information was collected on characteristics of problem, timing, manufacturer verdict, successful completion of planned surgery, prolonged anaesthesia and injury to patient or staff.

Results

Five-hundred seventy-one events related to URS accessories were recorded. These were associated with the following devices: baskets (n = 347), access sheath (n = 86), guidewires (n = 78), balloon dilators (n = 27), ARDs (n = 17) and ureteral catheters (n = 16). Of the events, 12.7% resulted in patient injuries. Forty-eight per cent of the events resulted in prolonged anaesthesia, but the planned surgery was successfully completed in 78.4% of all cases. Collectively, the manufacturers accepted responsibility due to actual device failure in only 0.5% of cases. Common problems for baskets were failure to deploy (39.5%) and complete detachment of basket head (34.6%) and partial breakage of the basket head (12.4%). Of the basket group, 4.3% required open or percutaneous surgery to remove stuck basket. Full break of the body of the access sheath occurred in 41.9% and complete ureteral avulsion in 3.5%. For balloon dilators, there was a burst in 37% of cases. Broken guidewires were associated with 11.5% requiring repeat intervention for retrieval and 6.4% required JJ stent due to perforation to the collecting system. No injuries to operating staff were recorded with accessory usage.

Conclusion

Accessories used during URS are fragile. Potential for serious injury does exist as a direct result of their use. Surgeons should familiarise themselves with these events and how they can be prevented.

Smart Diagnosis of Urinary Tract Infections: is Artificial Intelligence the Fast-Lane Solution?

PURPOSE OF REVIEW

Artificial intelligence (AI) can significantly improve physicians' workflow when examining patients with UTI. However, most contemporary reviews are focused on examining the usage of AI with a restricted quantity of data, analyzing only a subset of AI algorithms, or performing narrative work without analyzing all dedicated studies. Given the preceding, the goal of this work was to conduct a mini-review to determine the current state of AI-based systems as a support in UTI diagnosis.

RECENT FINDINGS

There are sufficient publications to comprehend the potential applications of artificial intelligence in the diagnosis of UTIs. Existing research in this field, in general, publishes performance metrics that are exemplary. However, upon closer inspection, many of the available publications are burdened with flaws associated with the improper use of artificial intelligence, such as the use of a small number of samples, their lack of heterogeneity, and the absence of external validation. AI-based models cannot be classified as full-fledged physician assistants in diagnosing UTIs due to the fact that these limitations and flaws represent only a portion of all potential obstacles. Instead, such studies should be evaluated as exploratory, with a focus on the importance of future work that complies with all rules governing the use of AI. AI algorithms have demonstrated their potential for UTI diagnosis. However, further studies utilizing large, heterogeneous, prospectively collected datasets, as well as external validations, are required to define the actual clinical workflow value of artificial intelligence.

Miniaturization of flexible ureteroscopes: a comparative trend analysis of 59 flexible ureteroscopes

The purpose of this review is to analyze the trend in miniaturization of flexible ureteroscopes over the past decades, identify the advantages and disadvantages, and determine the correlation of individual parameters with release period. Flexible ureteroscopes mentioned in the literature or those commercially available were searched. To minimize the search bias, the instruments were grouped by release date time periods of < 2000 year, 2000-2009, 2010-2019, and 2020 onwards. The final review included only those instrument models for which data on tip size, overall shaft, working length and channel size had been determined. The correlation among features investigated as well as with release period was also determined. 59 models of flexible ureteroscopes (26 fiber optic and 33 digital scopes) were included. Among the different features investigated among fiber optic endoscopes, only the sizes of the distal tip and overall shaft positively correlated with each other. In contrast to their fiber optic counterparts, a strong positive correlation was observed between tip and channel sizes, whereas negative correlation was found between channel size and overall shaft size and working length of digital scopes. Only distal tip of fiber optic flexible ureteroscopes and overall shaft of digital endoscopes were significantly reduced over their evolution. With the development of technology, there has been an improvement of flexible ureteroscopes and one of the indicators of this trend is a decrease in their size. With a definite trend towards miniaturization over the past decades, a significant correlation was observed in tip size and overall shaft for fiber optic and digital endoscopes, respectively.

Perceptions and Practice Patterns of Urologists Relating to Intrarenal Pressure During Ureteroscopy: Findings from a Global Cross-Sectional Analysis

Objectives: To explore beliefs and practice patterns of urologists regarding intrarenal pressure (IRP) during ureteroscopy (URS). Methods: A customized questionnaire was designed in a 4-step iterative process incorporating a systematic review of the literature and critical analysis of topics/questions by six endourologists. The 19-item questionnaire interrogated perceptions, practice patterns, and key areas of uncertainty regarding ureteroscopic IRP, and was disseminated via urologic societies, networks, and social media to the international urologic community. Consultants/attendings and trainees currently practicing urology were eligible to respond. Quantitative responses were compiled and analyzed using descriptive statistics and chi-square test, with subgroup analysis by procedure volume. Results: Responses were received from 522 urologists, practicing in six continents. The individual question response rate was >97%. Most (83.9%, 437/515) respondents were practicing at a consultant/attending level. An endourology fellowship incorporating stone management had been completed by 59.2% (307/519). The vast majority of respondents (85.4%, 446/520) scored the perceived clinical significance of IRP during URS ≥7/10 on a Likert scale. Concern was uniformly reported, with no difference between respondents with and without a high annual case volume (p = 0.16). Potential adverse outcomes respondents associated with elevated ureteroscopic IRP were urosepsis (96.2%, 501/520), collecting system rupture (80.8%, 421/520), postoperative pain (67%, 349/520), bleeding (63.72%, 332/520), and long-term renal damage (26.1%, 136/520). Almost all participants (96.2%, 501/520) used measures aiming to reduce IRP during URS. Regarding the perceived maximum acceptable threshold for mean IRP during URS, 30 mm Hg (40 cm H2O) was most frequently selected [23.2% (119/463)], with most participants (78.2%, 341/463) choosing a value ≤40 mm Hg. Conclusions: This is the first large-scale analysis of urologists' perceptions of ureteroscopic IRP. It identifies high levels of concern among the global urologic community, with almost unanimous agreement that elevated IRP is associated with adverse clinical outcomes. Equipoise remains regarding appropriate IRP limits intraoperatively and the most appropriate technical strategies to ensure adherence to these.

New Technologies in Endourology and Laser Lithotripsy: The Need for Evidence in Comprehensive Clinical Settings

Flexible ureteroscopy (fURS) with laser lithotripsy is currently the gold standard surgical treatment for ureteral and kidney stones with a maximum diameter of 2 cm [...].

Oligometastatic carcinoma prostate - An overview of the last decade

Introduction

Oligometastatic prostate cancer (OMPC) has gained profound interest lately due to its different tumor biology and our ability to use multimodality therapy for cure or prolonged survival. Selecting the appropriate patient for treatment has become the aim of treating urologists, medical oncologists, and radiation oncologists. Through this review, we try to highlight the management of OMPC in light of recent literature.

Methods

Literature search was performed on Pubmed, Scopus and Embase using keywords "Oligometastatic", " Prostate Cancer" using operators such as "And" & "Or". Relevant articles were screened and all the latest articles on this emerging entity were included in this review.

Results

All trials relevant to oligometastatic prostate cancer defining the role of surgery, radiotherapy and systemic therapy were included and appropriate inferences were drawn. Relevant studies were compiled in tabular form for this article.

Conclusion

The current standard of care of management for OMPC remains systemic therapy on the lines of hormone-sensitive metastatic prostate cancer. The evolving role of surgery, and radiotherapy along with systemic therapy is highlighted in this article.

Selection and Outcomes for Dissolution Therapy in Uric Acid Stones: A Systematic Review of Literature

PURPOSE OF REVIEW

The prevalence of uric acid (UA) urolithiasis contributes significantly to global disease burden, due to high rates of recurrence and diagnostic challenges. Dissolution therapy plays a valuable role in the conservative management of UA calculi, reducing the requirement for surgical intervention. This review summarises the existing evidence for the efficacy of medical dissolution of uric acid urolithiasis.

RECENT FINDINGS

A systematic search was conducted of worldwide literature according to PRISMA methodology and Cochrane standards for systematic review. Studies were included if they reported outcome data for the administration of medical therapy for the dissolution of UA calculi. A total of 1075 patients were included in the systematic review. Complete or partial dissolution of UA calculi was observed in 80.5% of patients (865/1075 patients), with 61.7% (647/1048 patients) achieving complete dissolution and 19.8% (207/1048 patients) achieving partial dissolution. A discontinuation rate of 10.2% (110/1075 patients) was noted, and 15.7% (169/1075 patients) required surgical intervention. Dissolution therapy is a safe and effective method of conservatively managing uric acid stones in the short term. Despite the significant disease burden of UA calculi, current guidelines are limited by deficiencies in the existing body of research. Further research should be undertaken to develop evidence-based clinical guidelines for diagnosis, treatment, and prevention of UA urolithiasis.

The technological future of percutaneous nephrolithotomy: a Young Academic Urologists Endourology and Urolithiasis Working Group update

PURPOSE OF REVIEW

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).

RECENT FINDINGS

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.

SUMMARY

Future research on PCNL should focus more on generalizability and adaptability of technological advancements in terms of training and improvement of patient outcomes.

Retrograde Intrarenal Surgery in Children: Evolution, Current Status, and Future Trends

Introduction: Incidence of urolithiasis in children has increased in recent years and with technological advancements and miniaturization of surgical instruments, pediatric urologists have acquired an impressive arsenal for their treatment. Retrograde intrarenal surgery (RIRS) has gained widespread popularity as it is a natural extension of semirigid ureteroscopy and can be done through natural orifice minimizing the morbidity of percutaneous access. The aim of this narrative review is to describe how RIRS has evolved over the decades in children and if the age-related anatomical difference impacts reported outcomes especially stone-free rate (SFR) and complications. Materials and Methods: An electronic literature search from inception to October 15, 2021 was performed using Medical Subject Heading terms in several combinations on PubMed, EMBASE, and Web of Science without language restrictions. A total of 2022 articles were founded and 165 articles were full-text screening. Finally, 2 pediatric urologists included 51 articles that summarize the available literature regarding the development and use of RIRS in children. Results: RIRS as of today is well established as a superior modality for all stones in all locations compared with extracorporeal shockwave lithotripsy both in children and adults. The passive dilation has decreased the need of active ureteral dilation, but the need to perform prestenting is not defined yet. Regarding the use of the ureteral access sheath, the literature tends to lean toward its placement in most cases, but we do not know its long-term effects over the growth of children. Finally, the SFR has increased as the experience of pediatric urologists increases, as well as the number of complications has decreased. Conclusion: RIRS in pediatrics has crossed many milestones, yet many areas need further research and larger data are required to make RIRS the procedure of choice for renal stone management in children across all age groups.

Factors Affecting the Usage of Wearable Device Technology for Healthcare among Indian Adults: A Cross-Sectional Study

BACKGROUND

Wearable device technology has recently been involved in the healthcare industry substantially. India is the world's third largest market for wearable devices and is projected to expand at a compound annual growth rate of ~26.33%. However, there is a paucity of literature analyzing the factors determining the acceptance of wearable healthcare device technology among low-middle-income countries.

METHODS

This cross-sectional, web-based survey aims to analyze the perceptions affecting the adoption and usage of wearable devices among the Indian population aged 16 years and above.

RESULTS

A total of 495 responses were obtained. In all, 50.3% were aged between 25-50 years and 51.3% belonged to the lower-income group. While 62.2% of the participants reported using wearable devices for managing their health, 29.3% were using them daily. technology and task fitness (TTF) showed a significant positive correlation with connectivity (r = 0.716), health care (r = 0.780), communication (r = 0.637), infotainment (r = 0.598), perceived usefulness (PU) (r = 0.792), and perceived ease of use (PEOU) (r = 0.800). Behavioral intention (BI) to use wearable devices positively correlated with PEOU (r = 0.644) and PU (r = 0.711). All factors affecting the use of wearable devices studied had higher mean scores among participants who were already using wearable devices. Male respondents had significantly higher mean scores for BI (p = 0.034) and PEOU (p = 0.009). Respondents older than 25 years of age had higher mean scores for BI (p = 0.027) and Infotainment (p = 0.032).

CONCLUSIONS

This study found a significant correlation with the adoption and acceptance of wearable devices for healthcare management in the Indian context.

Role of three dimensional (3D) printing in endourology: An update from EAU young academic urologists (YAU) urolithiasis and endourology working group

The management of nephrolithiasis has been complemented well by modern technological advancements like virtual reality, three-dimensional (3D) printing etc. In this review, we discuss the applications of 3D printing in treating stone disease using percutaneous nephrolithotomy (PCNL) and retrograde intrarenal surgery (RIRS). PCNL surgeries, when preceded by a training phase using a 3D printed model, aid surgeons to choose the proper course of action, which results in better procedural outcomes. The 3D printed models have also been extensively used to train junior residents and novice surgeons to improve their proficiency in the procedure. Such novel measures include different approaches employed to 3D print a model, from 3D printing the entire pelvicalyceal system with the surrounding tissues to 3D printing simple surgical guides.

Transforming healthcare through a digital revolution: A review of digital healthcare technologies and solutions

The COVID-19 pandemic has put a strain on the entire global healthcare infrastructure. The pandemic has necessitated the re-invention, re-organization, and transformation of the healthcare system. The resurgence of new COVID-19 virus variants in several countries and the infection of a larger group of communities necessitate a rapid strategic shift. Governments, non-profit, and other healthcare organizations have all proposed various digital solutions. It's not clear whether these digital solutions are adaptable, functional, effective, or reliable. With the disease becoming more and more prevalent, many countries are looking for assistance and implementation of digital technologies to combat COVID-19. Digital health technologies for COVID-19 pandemic management, surveillance, contact tracing, diagnosis, treatment, and prevention will be discussed in this paper to ensure that healthcare is delivered effectively. Artificial Intelligence (AI), big data, telemedicine, robotic solutions, Internet of Things (IoT), digital platforms for communication (DC), computer vision, computer audition (CA), digital data management solutions (blockchain), digital imaging are premiering to assist healthcare workers (HCW's) with solutions that include case base surveillance, information dissemination, disinfection, and remote consultations, along with many other such interventions.

Telemedicine and Telehealth in Urology: Uptake, Impact and Barriers to Clinical Adoption

Telemedicine has great potential in urology as a strong medium for providing patients with continuous high-quality urological care despite the hurdles involved in its implementation. Both clinicians and patients are crucial factors in determining the success of tele-consults in terms of simplicity of use and overall satisfaction. For it to be successfully incorporated into routine urological practice, rigorous training and evidence-based recommendations are lacking. If these issues are addressed, they can provide a significant impetus for future tele-consults in urology and their successful deployment, even beyond the pandemic, to assure safer and more environment-friendly patient management.

Telemedicine and Telehealth in Urology-What Do the 'Patients' Think About It?

Telemedicine is the delivery of healthcare to patients who are not in the same location as the physician. The practice of telemedicine has a large number of advantages, including cost savings, low chances of nosocomial infection, and fewer hospital visits. Teleclinics have been reported to be successful in the post-surgery and post-cancer therapy follow-up, and in offering consulting services for urolithiasis patients. This review focuses on identifying the outcomes of the recent studies related to the usage of video consulting in urology centers for hematuria referrals and follow-up appointments for a variety of illnesses, including benign prostatic hyperplasia (BPH), kidney stone disease (KSD), and urinary tract infections (UTIs) and found that they are highly acceptable and satisfied. Certain medical disorders can cause embarrassment, social exclusion, and also poor self-esteem, all of which can negatively impair health-related quality-of-life. Telemedicine has proven beneficial in such patients and is a reliable, cost-effective patient-care tool, and it has been successfully implemented in various healthcare settings and specialties.

Application of Virtual Reality, Augmented Reality, and Mixed Reality in Endourology and Urolithiasis: An Update by YAU Endourology and Urolithiasis Working Group

The integration of virtual reality (VR), augmented reality (AR), and mixed reality (MR) in urological practices and medical education has led to modern training systems that are cost-effective and with an increased expectation toward surgical performance and outcomes. VR aids the user in interacting with the virtual environment realistically by providing a three-dimensional (3D) view of the structures inside the body with high-level precision. AR enhances the real environment around users by integrating experience with virtual information over physical models and objects, which in turn has improved understanding of physiological mechanisms and anatomical structures. MR is an immersive technology that provides virtual content to interact with real elements. The field of urolithiasis has adapted the technological advancements, newer instruments, and methods to perform endourologic treatment procedures. This mini-review discusses the applications of Virtual Reality, Augmented Reality, and Mixed Reality in endourology and urolithiasis.

Legal and Ethical Consideration in Artificial Intelligence in Healthcare: Who Takes Responsibility?

The legal and ethical issues that confront society due to Artificial Intelligence (AI) include privacy and surveillance, bias or discrimination, and potentially the philosophical challenge is the role of human judgment. Concerns about newer digital technologies becoming a new source of inaccuracy and data breaches have arisen as a result of its use. Mistakes in the procedure or protocol in the field of healthcare can have devastating consequences for the patient who is the victim of the error. Because patients come into contact with physicians at moments in their lives when they are most vulnerable, it is crucial to remember this. Currently, there are no well-defined regulations in place to address the legal and ethical issues that may arise due to the use of artificial intelligence in healthcare settings. This review attempts to address these pertinent issues highlighting the need for algorithmic transparency, privacy, and protection of all the beneficiaries involved and cybersecurity of associated vulnerabilities.

Professional roles of female urologists: A webinar-based survey of perceptions and obstacles to career development

BACKGROUND

Urology, traditionally a maledominated specialty, keeping pace with the quickly changing gender landscape, has been characterized by waves of feminization. This study aims to understand the perspectives of women urologists on the obstacles to their career development, and the impact of such hurdles on their professional roles in urological education, practice, and leadership.

METHODS

119 female urology residents/consultants were surveyed via a webinar-based platform, covering relevant questions on domains of Academia, Mentorship, Leadership, Parenting, and Charity. Statistical analysis was done using frequency distribution based on the responses.

RESULTS

46.8% of the respondents felt that there is an under-representation of women in academia. 'Having a good mentor' was the most important factor for a novice to succeed in academia (68%). The most important trait in becoming a good leader was 'good communication skills' (35%), followed by 'visionary' (20%). The greatest challenge faced by leaders in the medical field was considered as 'time management' (31.9%). Only 21.2% of the participants felt difficulty in having a work-personal life balance, whereas 63.8% of them found it difficult only 'sometimes'. As a working parent, 'the guilt that they are not available all the time' was considered the most difficult aspect (59.5%), and 'more flexible schedule' was needed to make their lives as a working parent easier (46.8%). 34% of the respondents were affiliated with some charitable organizations. The biggest drive to do charity was their satisfaction with a noble cause (72.3%).

CONCLUSIONS

Need for increased encouragement and recruitment of females into urology, and to support and nurture them in their career aspirations.

Music reduces patient-reported pain and anxiety and should be routinely offered during flexible cystoscopy: Outcomes of a systematic review

Objective: To conduct a systematic review of the literature to assess whether music reduces the use of analgesics and anxiolytics during flexible cystoscopy.

Methods: The systematic review was performed in line with the Cochrane guidelines and Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) checklist. The databases searched included the Medical Literature Analysis and Retrieval System Online (MEDLINE), Scopus, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Clinicaltrials.gov, the Excerpta Medica dataBASE (EMBASE), Cochrane library, Google Scholar, and Web of Science from inception of the databases to February 2020. The primary outcome measure was the effect of music on pain and anxiety, and secondary outcome measures were patient heart rate and blood pressure.

Results: The initial search yielded 234 articles and after going through titles and abstracts, four studies (399 patients, 199 in the music group and 200 in no music group) were included for the final review. There were three randomised controlled trials and one prospective study published between 2014 and 2017. These studies were done in China, the USA and Italy, with the study duration between 9 and 24 months. All patients had 2% topical lignocaine jelly given per-urethra before the procedure. The choice of music was classical in three studies and a mixture of different music types in one study. Three of the four studies showed significantly reduced pain and anxiety with the use of music for flexible cystoscopy procedures. Heart rate was noted to be higher for the no music group, reflecting a higher pain perceived by these patients.

Conclusion: The present review showed that listening to music was associated with reduced anxiety and pain during flexible cystoscopy. Listening to music is therefore likely to increase procedural satisfaction and willingness to undergo the procedure again, considering repeated flexible cystoscopy is often needed for surveillance. As music is simple, inexpensive and easily accessible, it should be routinely offered to patients for outpatient and office-based urological procedures.

Abbreviations: IQR: interquartile range; NRS: numerical rating scale; PTSD: post-traumatic stress disorder; RCT: randomised control trial; STAI: State–trait Anxiety Inventory; VAS: visual analogue scale

The Ascent of Artificial Intelligence in Endourology: a Systematic Review Over the Last 2 Decades

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.

Computational flow analysis of a single peristaltic wave propagation in the ureter

BACKGROUND AND OBJECTIVE

The bladder receives the urine from the kidney and ureter. The series of peristaltic waves facilitate urine transport to the bladder. The peristaltic flow in the ureter is associated with fluid trapping and material reflux, which may cause an increase in bladder pressure. It is difficult to visualize the complex peristalsis phenomenon, in the ureter using image and radiography experiments. A numerical simulation will help in the understanding of urine bolus formation and its effect on the ureter wall.

METHODS

A three-dimensional computational fluid dynamic analysis is carried out to understand the flow physics associated with bolus formation and the effect of reflux on the ureter. ANSYS-CFX, a commercially available computational dynamics package is used to simulate the peristalsis. A single sinusoidal peristaltic wave traveling along a circular tube will yield the velocity, pressure, wall shear stress distributions inside the ureter.

RESULTS

The propagation of the peristaltic wave results in the backflow of urine near the inlet at the beginning of the flow. As the wave propagates towards the outlet, the flow rate decreases. It is observed that pressure distribution along the ureter axis will deteriorate towards the outlet. The contraction produces a very high-pressure gradient which causes the urine backflow. The trapping and the bolus formation cause a significant rise in bolus pressure, simultaneously developing negative pressure at the contraction neck.

CONCLUSIONS

The effect of peristalsis on the ureter biofluid dynamic behavior of the ureter is visualized in this study. It is established that the peristaltic contraction results in high-pressure formation at the bolus and negative pressure at the neck. It was found to be a maximum of 1.1 Pa at the bolus center and -1.13 Pa at the neck region. At the ureter pelvis junction, a higher wall shear of 0.095 Pa is observed as the wave starts to propagate. The velocity vectors show that the trapping of urine causes reflux and results in an adverse pressure gradient near the wall. A maximum pressure gradient of 485 Pa/meter was observed at the contraction of the ureter wall.

Engineering and clinical use of artificial intelligence (AI) with machine learning and data science advancements: radiology leading the way for future

Over the years, many clinical and engineering methods have been adapted for testing and screening for the presence of diseases. The most commonly used methods for diagnosis and analysis are computed tomography (CT) and X-ray imaging. Manual interpretation of these images is the current gold standard but can be subject to human error, is tedious, and is time-consuming. To improve efficiency and productivity, incorporating machine learning (ML) and deep learning (DL) algorithms could expedite the process. This article aims to review the role of artificial intelligence (AI) and its contribution to data science as well as various learning algorithms in radiology. We will analyze and explore the potential applications in image interpretation and radiological advances for AI. Furthermore, we will discuss the usage, methodology implemented, future of these concepts in radiology, and their limitations and challenges.

The role of data science in healthcare advancements: applications, benefits, and future prospects

Data science is an interdisciplinary field that extracts knowledge and insights from many structural and unstructured data, using scientific methods, data mining techniques, machine-learning algorithms, and big data. The healthcare industry generates large datasets of useful information on patient demography, treatment plans, results of medical examinations, insurance, etc. The data collected from the Internet of Things (IoT) devices attract the attention of data scientists. Data science provides aid to process, manage, analyze, and assimilate the large quantities of fragmented, structured, and unstructured data created by healthcare systems. This data requires effective management and analysis to acquire factual results. The process of data cleansing, data mining, data preparation, and data analysis used in healthcare applications is reviewed and discussed in the article. The article provides an insight into the status and prospects of big data analytics in healthcare, highlights the advantages, describes the frameworks and techniques used, briefs about the challenges faced currently, and discusses viable solutions. Data science and big data analytics can provide practical insights and aid in the decision-making of strategic decisions concerning the health system. It helps build a comprehensive view of patients, consumers, and clinicians. Data-driven decision-making opens up new possibilities to boost healthcare quality.

Association of Kidney Stone Disease (KSD) with Primary Gastrointestinal Surgery: a Systematic Review over Last 2 Decades

PURPOSE OF REVIEW

We aim to provide an up-to-date literature review to further characterise the association of kidney stone disease (KSD) with gastrointestinal (GI) surgery. As KSD is associated with significant morbidity, it is important to quantify and qualify this association to provide better care and management for the patient subgroup.

OBJECTIVE

To perform a systematic review of the existing literature to evaluate the association of KSD following GI surgery.

METHODS

A literature search was performed of the following databases: MEDLINE, EMBASE, Scopus, Google Scholar, Key Urology, Uptodate and Cochrane Trials from January 2000 to June 2020.

RECENT FINDINGS

A total of 106 articles were identified, and after screening for titles, abstracts and full articles, 12 full papers were included. This involved a total of 9299 patients who underwent primary GI surgery. Over a mean follow-up period of 5.4 years (range: 1-14.4 years), 819 (8.8%) developed KSD, varying from 1.2 to 83% across studies. The mean time to stone formation was approximately 3 years (range: 0.5-9 years). In the 4 studies that reported on the management of KSD (n = 427), 38.6% went on to have urological intervention. There is a high incidence of KSD following primary GI surgery, and after a mean follow-up of 3 years, around 9% of patients developed KSD. While the GI surgery was done for obesity, inflammatory bowel disease or cancer, the risk of KSD should be kept in mind during follow-up, and prompt urology involvement with metabolic assessment, medical and or surgical management offered as applicable.

Application of Artificial Intelligence-Based Classifiers to Predict the Outcome Measures and Stone-Free Status Following Percutaneous Nephrolithotomy for Staghorn Calculi: Cross-Validation of Data and Estimation of Accuracy

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 serve as a promising tool to provide counseling before an operation. Materials and Methods: The overall procedure includes data collection and prediction model development. Pre-/postoperative variables of 100 patients with staghorn calculus, who underwent PCNL, were collected. For feature vector, variables and categories including patient history variables, kidney stone parameters, and laboratory data were considered. The prediction model was developed using machine learning techniques, which include dimensionality reduction and supervised classification. Multiple classifier scheme was used for prediction. The derived DSS was evaluated by running the leave-one-patient-out cross-validation approach on the data set. Results: The system provided favorable accuracy (81%) in predicting the outcome of a treatment procedure. Performance in predicting the stone-free rate with the Minimum Redundancy Maximum Relevance feature (MRMR) treatment extracting top 3 features using Random Forest (RF) was 67%, with MRMR treatment extracting top 5 features using RF was 63%, and with MRMR treatment extracting top 10 features using Decision Tree was 62%. The statistical significance using standard error between the best area under the curves (AUCs) obtained from the Linear Discriminant Analysis (LDA) and MRMR. The results obtained from the LDA approach (0.81 AUC) was statistically significant (p = 0.027, z = 2.21) from the MRMR (0.64 AUC) (p = 0.05). Conclusion: The promising results of the developed DSS could be used in assisting urologists to provide counseling, predict a surgical outcome, and ultimately choose an appropriate surgical treatment for removing kidney stones.

Emerging Data on the Safety and Efficacy of Transurethral Water Vapour Therapy for Benign Prostatic Hyperplasia

Benign prostate disease is a disease of prevalence and over 25% of men affected by bothersome lower urinary tract symptoms (LUTS) as a result of it will require surgical intervention during their lifetime. While transurethral resection of the prostate (TURP) has served as the cornerstone treatment for many years, there now exist a multitude of minimally invasive alternatives including the Rezum system. The latter is a novel form of transurethral water vapour therapy, which is attracting increasing attention. It utilizes convective water vapour energy (WAVE) and thereby radiofrequency (RF) in order to generate heat energy. Early studies have demonstrated promising results. To date there have been 12 studies published on Rezum, however only one randomized trial. This review offers an overview and evaluation of this emerging evidence.

Contemporary application of artificial intelligence in prostate cancer: an i-TRUE study

Artificial intelligence (AI) involves technology that is able to emulate tasks previously carried out by humans. The growing incidence, novel diagnostic strategies and newer available therapeutic options have had resource and economic impacts on the healthcare organizations providing prostate cancer care. AI has the potential to be an adjunct to and, in certain cases, a replacement for human input in prostate cancer care delivery. Automation can also address issues such as inter- and intra-observer variability and has the ability to deliver analysis of large volume datasets quickly and accurately. The continuous training and testing of AI algorithms will facilitate development of futuristic AI models that will have integral roles to play in diagnostics, enhanced training and surgical outcomes and developments of prostate cancer predictive tools. These AI related innovations will enable clinicians to provide individualized care. Despite its potential benefits, it is vital that governance with AI related care is maintained and responsible adoption is achieved.

Big Data Analytics in urology: the story so far and the road ahead

Artificial intelligence (AI) has a proven record of application in the field of medicine and is used in various urological conditions such as oncology, urolithiasis, paediatric urology, urogynaecology, infertility and reconstruction. Data is the driving force of AI and the past decades have undoubtedly witnessed an upsurge in healthcare data. Urology is a specialty that has always been at the forefront of innovation and research and has rapidly embraced technologies to improve patient outcomes and experience. Advancements made in Big Data Analytics raised the expectations about the future of urology. This review aims to investigate the role of big data and its blend with AI for trends and use in urology. We explore the different sources of big data in urology and explicate their current and future applications. A positive trend has been exhibited by the advent and implementation of AI in urology with data available from several databases. The extensive use of big data for the diagnosis and treatment of urological disorders is still in its early stage and under validation. In future however, big data will no doubt play a major role in the management of urological conditions.

Can the Use of Serial Multiparametric Magnetic Resonance Imaging During Active Surveillance of Prostate Cancer Avoid the Need for Prostate Biopsies?-A Systematic Diagnostic Test Accuracy Review

CONTEXT

The role of multiparametric magnetic resonance imaging (mp-MRI) during active surveillance (AS) of prostate cancer needs evaluation. It remains unclear whether mp-MRI can replace prostate biopsies completely during AS.

OBJECTIVE

To evaluate the diagnostic performance of mp-MRI for disease progression in men on AS for prostate cancer.

EVIDENCE ACQUISITION

This systematic review was performed in accordance with the Cochrane Handbook and the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA). Cross-sectional studies that evaluate the diagnostic performance of mp-MRI (index test) for disease progression compared with systematic and targeted prostate/template biopsies or a composite of this (reference standard) were included. A meta-analysis was performed using STATA with "metandi" and "midas" commands.

EVIDENCE SYNTHESIS

Seven studies with 800 patients were included in this systematic review. The pooled pathological progression rate was 27%. The pooled sensitivity and specificity of mp-MRI for disease progression were 0.61 (95% confidence interval [CI]: 0.46-0.74) and 0.78 (95% CI: 0.54-0.91), respectively. Adjusting for a prevalence of disease progression of 30% results in a positive predictive value of 0.43 (95% CI: 0.39-0.46) and a negative predictive value of 0.81 (95% CI: 0.78-0.84). Significant heterogeneity was observed. The meta-regression analysis did not demonstrate any significant outliers.

CONCLUSIONS

It is not possible to supplant prostate biopsies with mp-MRI in AS protocols with the current level of evidence. There is significant institutional variation in the diagnostic performance of mp-MRI during AS. Institutions must internally audit the diagnostic performance of mp-MRI in the AS setting. AS protocols must be based on local diagnostic performance, rather than on international AS protocols that may have limited applicability at individual settings.

PATIENT SUMMARY

In this review, we explored the accuracy of multiparametric magnetic resonance imaging in diagnosing disease progression for patients who were enrolled in active surveillance programmes for prostate cancer.

Correlation of Operative Time with Outcomes of Ureteroscopy and Stone Treatment: a Systematic Review of Literature

PURPOSE OF REVIEW

To present the latest evidence related to the impact of increased operative times in retrograde intrarenal surgery and identify possible important factors that can facilitate ureteroscopy procedures.

RECENT FINDINGS

Ureteroscopy constitutes the mainstay treatment of renal stones and is characterized by a huge variation in techniques and instrumentation. It has been suggested that increased operative times can mitigate the outcomes of the procedures by increasing complication rates. Nevertheless, little is known about the time limits, above which complications are likely to occur. Furthermore, complication rates in different procedure durations have not yet been assessed. Prolonged operative times are linked to increased complication rates in ureteroscopy. Stone complexity, patient risk factors, surgeon experience, bilateral surgery, and instrumentation constitute important factors that can hamper or facilitate a procedure and should be taken into account beforehand. Keeping procedural times below 90 min can dissuade potential predicaments and achieve improved stone-free rates.