Defining minimal invasive surgical therapy for benign prostatic obstruction surgery: Perspectives from a global knowledge, attitude, and practice survey

Objective:To scrutinize the definitions of minimal invasive surgical therapy(MIST)and to investigate urologists’knowledge,attitudes,and practices for benign prostatic obstruction surgeries.Methods:A 36-item survey was developed with a Delphi method.Questions on definitions of MIST and attitudes and practices of benign prostatic obstruction surgeries were included.Urologists were invited globally to complete the online survey.Consensus was achieved when more than or equal to 70%responses were“agree or strongly agree”and less than or equal to 15%responses were“disagree or strongly disagree”(consensus agree),or when more than or equal to 70%responses were“disagree or strongly disagree”and less than or equal to 15%responses were“agree or strongly agree”(consensus disagree).Results:The top three qualities for defining MIST were minimal blood loss(n=466,80.3%),fast post-operative recovery(n=431,74.3%),and short hospital stay(n=425,73.3%).The top three surgeries that were regarded as MIST were Urolift®(n=361,62.2%),Rezum®(n=351,60.5%),and endoscopic enucleation of the prostate(EEP)(n=332,57.2%).Consensus in the knowledge section was achieved for the superiority of Urolift®,Rezum®,and iTIND®over transurethral resection of the prostate with regard to blood loss,recovery,day surgery feasibility,and post-operative continence.Consensus in the attitudes section was achieved for the superiority of Urolift®,Rezum®,and iTIND®over transurethral resection of the prostate with regard to blood loss,recovery,and day surgery feasibility.Consensus on both sections was achieved for EEP as the option with the better symptoms and flow improvement,lower retreatment rate,and better suitable for prostate more than 80 mL.Conclusion:Minimal blood loss,fast post-operative recovery,and short hospital stay were the most important qualities for defining MIST.Urolift®,Rezum®,and EEP were regarded as MIST by most urologists.

Definition, treatment and outcome of residual fragments in staghorn stones

Technological advances in minimally invasive treatment of stone disease and its integration with concomitant clinical practice are amongst the most important achievements in urology.Despite the wealth of information accumulated over the years and the richness of existing literature,the knowledge about the definition,treatment and outcomes of residual stone fragments after percutaneous nephrolithotomy(PNL)is still insufficient.Due to the high stone load a lot of patients with staghorn stones have residual fragments(RFs)after treatment with PNL,which depends on the size of tract,definition of stone free rate(SFR),timing of evaluation and the imaging used.No consensus exists on the imaging modality or their timing in the evaluation of possible RFs.The treatment of residual stones is apparently different depending on the facilities of the department and the preference of the surgeon,which includes active surveillance,shock wave lithotripsy(SWL),retrograde intrarenal surgery(RIRS)or a second look PNL.

Transforming urinary stone disease management by artificial intelligence-based methods:A comprehensive review

Objective:To provide a comprehensive review on the existing research and evidence regarding artificial intelligence(AI)applications in the assessment and management of urinary stone disease.Methods:A comprehensive literature review was performed using PubMed,Scopus,and Google Scholar databases to identify publications about innovative concepts or supporting applications of AI in the improvement of every medical procedure relating to stone disease.The terms“endourology”,“artificial intelligence”,“machine learning”,and“urolithiasis”were used for searching eligible reports,while review articles,articles referring to automated procedures without AI application,and editorial comments were excluded from the final set of publications.The search was conducted from January 2000 to September 2023 and included manuscripts in the English language.Results: A total of 69 studies were identified.The main subjects were related to the detection of urinary stones,the prediction of the outcome of conservative or operative management,the optimization of operative procedures,and the elucidation of the relation of urinary stone chemistry with various factors.Conclusion: AI represents a useful tool that provides urologists with numerous amenities,which explains the fact that it has gained ground in the pursuit of stone disease management perfection.The effectiveness of diagnosis and therapy can be increased by using it as an alternative or adjunct to the already existing data.However,little is known concerning the potential of this vast field.Electronic patient records,containing big data,offer AI the opportunity to develop and analyze more precise and efficient diagnostic and treatment algorithms.Nevertheless,the existing applications are not generalizable in real-life practice,and high-quality studies are needed to establish the integration of AI in the management of urinary stone disease.