Nadya York

Randomized Controlled Trial Comparing Three Different Modalities of Lithotrites for Intracorporeal Lithotripsy in Percutaneous Nephrolithotomy

PURPOSE To compare the efficiency (stone fragmentation and removal time) and complications of three models of intracorporeal lithotripters in percutaneous nephrolithotomy (PCNL). MATERIALS AND METHODS Prospective, randomized controlled trial at nine centers in North America from 2009 to 2016. Patients were randomized to one of three lithotripter devices: the Cyberwand, a dual-probe ultrasonic device; the Swiss Lithoclast Select, a combination pneumatic and ultrasonic device; and the StoneBreaker, a portable pneumatic device powered by CO2 cartridges. Since the StoneBreaker lacks an ultrasonic component, it was used with the LUS-II ultrasonic lithotripter to allow fair comparison with combination devices. RESULTS Two hundred seventy patients were enrolled, 69 were excluded after randomization. Two hundred one patients completed the study: 71 in the Cyberwand group, 66 in the Lithoclast Select group, and 64 in the StoneBreaker group. The baseline patient characteristics of the three groups were similar. Mean stone surface area was smaller in the StoneBreaker group at 407.8 mm2 vs 577.5 mm2 (Lithoclast Select) and 627.9 mm2 (Cyberwand). The stone clearance rate was slowest in the StoneBreaker group at 24.0 mm2/min vs 28.9 mm2/min and 32.3 mm2/min in the Lithoclast Select and Cyberwand groups, respectively. After statistically adjusting for the smaller mean stone in the StoneBreaker group, there was no difference in the stone clearance rate among the three groups (p = 0.249). Secondary outcomes, including complications and stone-free rates, were similar between the groups. CONCLUSIONS The Cyberwand, Lithoclast Select, and the StoneBreaker lithotripters have similar adjusted stone clearance rates in PCNL for stones >2 cm. The safety and efficacy of these devices are comparable.

Risks associated with drug treatments for kidney stones

Introduction: Renal stones are one of the most painful medical conditions patients experience. For many they are also a recurrent problem. Fortunately, there are a number of drug therapies available to treat symptoms as well as prevent future stone formation. Areas covered: Herein, we review the most common drugs used in the treatment of renal stones, explaining the mechanism of action and potential side effects. Search of the Medline databases and relevant textbooks was conducted to obtain the relevant information. Further details were sourced from drug prescribing manuals. Recent studies of drug effectiveness are included as appropriate. Expert opinion: Recent controversies include medical expulsive therapy trials and complex role of urinary citrate in stone disease. Future directions in research will involve new medical therapies for stone prevention, for example new drugs for hyperoxaluria.

Outcomes of Holmium Laser Enucleation of the Prostate in the Re-Treatment Setting

Purpose: Holmium laser enucleation of the prostate can also be applied in the re‐treatment setting when other benign prostatic hyperplasia therapies fail. We compared outcomes in men who underwent holmium laser enucleation of the prostate in the primary vs the re‐treatment setting. Materials and Methods: We retrospectively reviewed the records of 2,242 patients who underwent holmium laser enucleation of the prostate at a total of 4 academic hospitals between 2003 and 2015. Patient demographics, and operative and perioperative outcomes were compared between re‐treatment and primary holmium laser enucleation of the prostate. Results: Of the 360 of 2,242 men (16%) who underwent re‐treatment holmium laser enucleation of the prostate the procedure was done for residual urinary symptoms in 71%. The most common primary procedure was transurethral resection of the prostate in 42% of cases. Mean time between prior benign prostatic hyperplasia surgery and re‐treatment was 68 months (range 1 to 444). There were no significant differences in age, prostate size, AUA (American Urological Association) symptom score or average flow rate between the cohorts. Perioperatively, re‐treatment holmium laser enucleation of the prostate was associated with significantly shorter operative time, reduced blood loss, lower specimen weight and shorter length of stay. The AUA symptom score improved in both groups, although it remained higher in men who underwent re‐treatment (6.5 vs 5.0, p <0.001). The likelihood of clot retention (4.7% vs 1.8%, p = 0.01) and urethral stricture (3.3% vs 1.5%, p = 0.043) was slightly higher in the re‐treatment group. Conclusions: Immediate perioperative outcomes of holmium laser enucleation of the prostate performed in the re‐treatment setting were no different from those in the primary setting. While re‐treatment was associated with an increased likelihood of clot retention, urethral stricture and higher AUA symptom score, these minimal differences must be considered against the overall favorable symptom improvement across both cohorts.

A Survey of Morcellator Preference and Cost Comparison of the Lumenis VersaCut and Wolf Piranha Morcellators

OBJECTIVE To evaluate operating room (OR) costs associated with the 2 available morcellators in the United States in a matched cohort and to determine benign prostatic hyperplasia surgeons morcellator preference. MATERIALS AND METHODS Patients from 2013, the last year our institution exclusively used the VersaCut device, were matched 1:1 with the most recent patient cohort, utilizing the Wolf Piranha morcellator. Cost of morcellation including the expense of OR time and disposable instrument costs were calculated. A survey to the Endourological Society e-mail listserv was sent to determine morcellator preference. RESULTS We identified 142 patients who underwent holmium laser enucleation of the prostate in 2013. When compared with the VersaCut group, morcellation efficiency (4.4 vs 7.0 g/min, P <.01) and expense of OR time (

Comprehensive Costs Associated with Fiberoptic and Digital Flexible Ureteroscopes at a High Volume Teaching Hospital

1420.80 vs

MP19-14 MECHANISTIC EVIDENCE THAT PAPILLARY PITS OCCUR SECONDARY TO DISLODGEMENT OF RANDALL’S PLAQUE ATTACHED STONES

992.21, P <.005) both favored the Piranha morcellator system even when the costs of disposable instruments were factored into the analysis (

PD21-09 TRUE STONE FREE RATES OF FLEXIBLE URETEROSCOPY FOR RENAL CALCULI UTILIZING STRICT CT CRITERIA

1338.81 vs

MP90-03 INVESTIGATING SMART WATER BOTTLE TECHNOLOGY AS A CLINICAL TOOL FOR STONE FORMERS

1637.50, P <.05). A total of 126 urologists responded to the survey. Of these, 56 (44.5%) perform transurethral prostate enucleations, which included 48 (86%) holmium. More endourologists use the VersaCut (n = 33, 59%) than the Piranha (n = 24, 43%) morcellator. Qualities that impacted the preference of morcellator included the preferred device is safer, faster, easier to use, reusable, and less expensive. CONCLUSION We identified a significant improved efficiency and improved cost savings utilizing the Piranha morcellator even when controlling for disposable costs. Of the endourologists who responded to the survey, less than half perform transurethral enucleation. Morcellator preference is largely based on safety, efficiency, and ease of use, whereas cost and reusablility were of lesser importance.

PD23-08 TRUE COST OF MORCELLATION: COMPARISON OF THE LUMENIS® VERSACUT™ AND WOLF PIRANHA MORCELLATORS

Introduction: Modern flexible ureteroscope ownership costs are considerable. Most prior estimates focus exclusively on repair costs, likely underestimating overall costs, including those of acquisition and reprocessing. Furthermore, to our knowledge no prior cost analyses focus on the latest generation digital flexible ureteroscope, which may differ due to unique purchase and repair prices. We sought to gain greater insight into the comprehensive costs associated with modern flexible ureteroscope use, particularly the difference between digital and fiberoptic models. Methods: Data on use and repair of fiberoptic Storz Flex‐X2 and digital Flex‐Xc flexible ureteroscopes from 2011 to 2015 were reviewed. List prices and repair costs were obtained from Storz. Per case reprocessing costs were estimated, accounting for disposables, reagents and labor. Maintenance costs were estimated by combining cost of repairs and reprocessing. Analyses were performed at list pricing and standard discount rates. Global flexible ureteroscope costs were calculated to account for the cost of acquisition, repair and maintenance of a new scope during its first 100 uses. Results: Global costs associated with digital flexible ureteroscope ownership were 1.3 to 1.4 times greater than fiberoptic on a per case basis (

V11-05 RENAL CALYCEAL DIVERTICULUM WITH STONES - SINGLE-STAGE PERCUTANEOUS APPROACH

1,008/