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    A clinical evaluation of the new digital single-use flexible ureteroscope (UscopePU3022): An international prospective multicentered study
    (Polish Urological Association, 2018) Johnston, Thomas James; Baard, Joyce; de la Rosette, Jean J. M. C. H.; Doizi, Steeve; Giusti, Guido; Knoll, Thomas; Proietti, Silvia; Brehmer, Marianne; Emiliani, Esteban; Perez-Fentes, Daniel; Osther, Palle Jorn Sloth; Seitz, Christian; Neal, Naomi; Turney, Ben; Hasan, Mudhar; Traxer, Olivier; Wiseman, Oliver
    Introduction We assessed the clinical performance of a new digital single-use flexible ureteroscope (UscopePU3022). Material and methods A prospective cohort study was carried out across 11 centers (July-Oct. 2017). The UscopePU3022 was assessed regarding ease of insertion; deflection, image quality, maneuverability and overall performance using either a visual analog* or Likert scale. Results A total of 56 procedures were performed in 11 centers (16 surgeons) with the indication being renal stones in 83%. The median score for ease of scope insertion was 10 (3-10). Intraoperative maneuverability was rated as 'good' in 38% and 'very good' in 52%. Visual quality was rated as 'poor or bad' in 18%, 'fair' in 37% and 'good very good' in 43%. Two scopes failed intraoperatively (4%). Preoperative and postoperative median upward and downward deflection was 270 degrees. Compared to standard flexible ureteroscopy (f-URS) maneuverability was rated as 'equivalent' in 30% and 'better' in 60%; visual quality was 'worse' in 38% and 'equivalent or better' in 62%; limb fatigue scores were 'better' in 86%; and overall performance was 'worse' in 55% and 'equivalent or better' in 45%. Conclusions UscopeTM3022 performed well with regards to maneuverability, deflection and limb fatigue and appears to be at least non-inferior to standard f-URS with regards to these parameters. Poor image quality is a concern for UscopePU3022 with it receiving a low overall performance rating when compared to standard f-URS. Despite this it scored highly when investigators were asked if they would use it in their practice if it was cost-effective to do so.
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    Consensus statement addressing controversies and guidelines on pediatric urolithiasis
    (2024) Güven, Selçuk; Tokas, Theodoras; Tozsin, Atınç; Haid, B.; Lendvay, Thomas Sean; Sılay, Mesrur Selçuk; Mohan, Chandra Vamsi; Cansino, Jose Ramon; Saulat, Sherjeel; Straub, Manuela; Bujons Tur, Anna; Akgül, Burak; Samotyjek, J.; Lusuardi, L.; Ferretti, Stefania; Çavdar, Ömer Faruk; Ortner, G.; Sultan, Sajid; Choong, Simon; Micali, Salvatore; Saltirov, Ilya; Sezer, Ali; Netsch, Christopher; de Lorenzis, Elisa; Çakır, Ömer Onur; Zeng, Guohua; Gözen, Ali Sedar; Bianchi, Giampaolo; Jurkiewicz, Beata; Knoll, Thomas; Rassweiler, Jens; Ahmed, Kamran; Sarıca, Kemal
    Purpose: We aimed to investigate controversial pediatric urolithiasis issues systematically, integrating expert consensus and comprehensive guidelines reviews. Methods: Two semi-structured online focus group meetings were conducted to discuss the study’s need and content, review current literature, and prepare the initial survey. Data were collected through surveys and focus group discussions. Existing guidelines were reviewed, and a second survey was conducted using the Delphi method to validate findings and facilitate consensus. The primary outcome measures investigated controversial issues, integrating expert consensus and guideline reviews. Results: Experts from 15 countries participated, including 20 with 16+ years of experience, 2 with 11–15 years, and 4 with 6–10 years. The initial survey identified nine main themes, emphasizing the need for standardized diagnostic and treatment protocols and tailored treatments. Inter-rater reliability was high, with controversies in treatment approaches (score 4.6, 92% agreement), follow-up protocols (score 4.8, 100% agreement), and diagnostic criteria (score 4.6, 92% agreement). The second survey underscored the critical need for consensus on identification, diagnostic criteria (score 4.6, 92% agreement), and standardized follow-up protocols (score 4.8, 100% agreement). Conclusion: The importance of personalized treatment in pediatric urolithiasis is clear. Prioritizing low-radiation diagnostic tools, effectively managing residual stone fragments, and standardized follow-up protocols are crucial for improving patient outcomes. Integrating new technologies while ensuring safety and reliability is also essential. Harmonizing guidelines across regions can provide consistent and effective management. Future efforts should focus on collaborative research, specialized training, and the integration of new technologies in treatment protocols.
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    Conventional white light imaging-assisted transurethral resection of bladder tumour (TURBT) versus IMAGE1S-assisted TURBT in non-muscle-invasive bladder cancer patients: Trial protocol and 18 months results
    (Springer, 2022) de la Rosette, Jean J. M. C. H.; Martov, Alexeyb; Hurle, Rodolfo; Favre, Gabriel; Mamoulakis, Charalampos; Castanheira de Oliveira, Manuel; Stenzl, Arnulf; Linares-Espinós, Estefania; Trelles Guzmán, Carlos R.; Gravas, Stavros; Knoll, Thomas; Boz, Mustafa Yücel; Herrmann, Thomas; del Pilar Laguna Pes, Maria
    Purpose White light (WL) is the traditional imaging modality for transurethral resection of bladder tumour (TURBT). IMAGE1S is a likely addition. We compare 18-mo recurrence rates following TURBT using IMAGE1S versus WL guidance. Methods Twelve international centers conducted a single-blinded randomized controlled trial. Patients with primary and recurrent non-muscle-invasive bladder cancer (NMIBC) were randomly assigned 1:1 to TURBT guided by IMAGE1S or WL. Eighteen-month recurrence rates and subanalysis for primary/recurrent and risk groups were planned and compared by chi-square tests and survival analyses. Results 689 patients were randomized for WL-assisted (n = 354) or IMAGE1S-assisted (n = 335) TURBT. Of these, 64.7% had a primary tumor, 35.3% a recurrent tumor, and 4.8%, 69.2% and 26.0% a low-, intermediate-, and high-risk tumor, respectively. Overall, 60 and 65 patients, respectively, completed 18-mo follow-up, with recurrence rates of 31.0% and 25.4%, respectively (p = 0.199). In patients with primary, low-/intermediate-risk tumors, recurrence rates at 18-mo were significantly higher in the WL group compared with the IMAGE1S group (31.9% and 22.3%, respectively: p 0.035). Frequency and severity of adverse events were comparable in both treatment groups. Immediate and adjuvant intravesical instillation therapy did not differ between the groups. Potential limitations included lack of uniformity of surgical resection, central pathology review, and missing data. Conclusion There was not difference in the overall recurrence rates between IMAGE1S and WL assistance 18-mo after TURBT in patients with NMIBC. However, IMAGE1S-assisted TURBT considerably reduced the likelihood of disease recurrence in primary, low/intermediate risk patients. Registration ClinicalTrials.gov Identifier NCT02252549 (30-09-2014).
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    European association of urology guidelines office rapid reaction group: An organisation-wide collaborative effort to adapt the European Association of Urology Guidelines recommendations to the coronavirus disease 2019 era
    (Elsevier, 2020) Ribal, Maria Jose; Cornford, Philip; Briganti, Alberto; Knoll, Thomas; Gravas, Stavros; Babjuk, Marek; Harding, Christopher; Breda, Alberto; Bex, Axel; Rassweiler, Jens J.; Gezen, Ali Serdar; Pini, Giovannalberto; Liatsikos, Evangelos; Giannarini, Gianluca; Mottrie, Alex; Subramaniam, Ramnath; Sofikitis, Nikolaos; Rocco, Bernardo Maria Cesare; Xie, Li-Ping; Witjes, J. Alfred; Mottet, Nicolas; Ljungberg, Boerje; Roupret, Morgan; Laguna, Maria Pilar; Salonia, Andrea; Bonkat, Gernot; Blok, Bertil F. M.; Turk, Christian; Radmayr, Christian; Kitrey, Noam David; Engeler, Daniel S.; Lumen, Nicolaas; Hakenberg, Oliver W.; Watkin, Nick; Hamid, Rizwan; Olsburgh, Jonathon; Darraugh, Julie; Shepherd, Robert; Smith, Emma-Jane; Chapple, Christopher R.; Stenzl, Arnulf; Van Poppel, Hendrik; Wirth, Manfred; Sonksen, Jens; N'Dow, James
    The coronavirus disease 2019 (COVID-19) pandemic is unlike anything seen before by modern science-based medicine. Health systems across the world are struggling to manage it. Added to this struggle are the effects of social confinement and isolation. This brings into question whether the latest guidelines are relevant in this crisis. We aim to support urologists in this difficult situation by providing tools that can facilitate decision making, and to minimise the impact and risks for both patients and health professionals delivering urological care, whenever possible. We hope that the revised recommendations will assist urologist surgeons across the globe to guide the management of urological conditions during the current COVID-19 pandemic.
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    European association of urology section of urolithiasis and international alliance of urolithiasis joint consensus on retrograde intrarenal surgery for the management of renal stones
    (Elsevier B.V., 2022) Zeng, Guohua; Zhao, Zhijian; Mazzon, Giorgio; Pearle, Margaret; Choong, Simon; Skolarikos, Andreas; Denstedt, John; Seitz, Christian; Olvera Pasada, Daniel; Fiori, Cristian; Bosio, Andrea; Papatsoris, Athanasios; Méndez Probst, Carlos Enrique; Perez Fentes, Daniel; Ann Git, Kah; Wu, Qinghui; Wiseman, Oliver; Emiliani, Esteban; Farahat, Yasser; Gökçe, Mehmet İlker; Giannakopoulos, Stilianos; Goumas Kartalas, Ioannis; Somani, Bhaskar; Knoll, Thomas; de la Rosette, Jean J. M. C. H.; Zhong, Jiehui; Vinicius Maroccolo, Marcus; Saltirov, lliya; Chew, Ben; Wang, Kunjie; Lahme, Sven; Giusti, Guido; Ferretti, Stefania; Yong Cho, Sung; Geavlete, Petrisor; Cansino, Ramon; Kamphuis, Guido M.; Smith, Daron; Matlaga, Brian R.; Ghani, Khurshid D.; Bernardo, Norberto; Silva, Andres D.; Ng, Anthony C.F.; Yang, Sixing; Gao, Xiaofeng; Traxer, Olivier; Miernik, Arkadiusz; Liatsikos, Evangelos; Priyakant Parikh, Kandarp; Duvdevani, Mordechai; Celia, Antonio; Yasui, Takahiro; Aquino, Albert; Alomar, Mohammad; Choonhaklai, Vorapot; Erkurt, Bulent; Glass, Jonathan; Sriprasad, Seshadri; Osther, Palle J.; Keeley, Francis X.; Preminger, Glenn M.; Cepeda Delgado, Marcos; Beltran Suarez, Edgar; Ye, Zhangqun; Sarica, Kemal
    Background: Retrograde intrarenal surgery (RIRS) has become the preferred treatment modality for nephrolithiasis. However, because of ongoing uncertainties regarding the optimal perioperative management, operative technique, and postoperative follow-up, as well as a lack of standardization for outcome reporting, consensus is needed to achieve more uniform clinical practice worldwide. Objective: To develop recommendations for RIRS on the basis of existing data and expert consensus. Design, setting, and participants: A protocol-driven, three-phase study was conducted by the European Association of Urology Section of Urolithiasis (EULIS) and the International Alliance of Urolithiasis (IAU). The process included: (1) a nonsystematic review of the literature to define domains for discussion; (2) a two-round modified Delphi survey involving experts in this field; and (3) an additional group meeting and third-round survey involving 64 senior representative members to formulate the final conclusions. Outcome measurements and statistical analysis: The results from each previous round were returned to the participants for re-evaluation of their decisions during the next round. The agreement threshold was set at 70%. Results and limitations: The panel included 209 participants who developed 29 consensus statements on the following topics of interest: (1) perioperative infection management; (2) perioperative antithrombotic therapy; (3) fundamentals of the operative technique; and (4) standardized outcome reporting. Although this consensus can be considered as a useful reference for more clinically oriented daily practice, we also acknowledge that a higher level of evidence from further clinical trials is needed. Conclusions: The consensus statements aim to guide and standardize clinical practice and research on RIRS and to recommend standardized outcome reporting. Patient summary: An international consensus on the best practice for minimally invasive surgery for kidney stones was organized and developed by two international societies. It is anticipated that this consensus will provide further guidance to urologists and may help to improve clinical outcomes for patients.