Purpose To characterize the appearance of normal and malignant upper urinary tract lesion appearance under narrow-band imaging (NBI) using the new URF-V digital flexible ureteroscope (DFU), and to determine if NBI, when used in conjunction with white light (WL), could improve detection of malignancy. Patients and methods NBI and WL were performed in 27 patients at our university teaching hospital, 14 with known cases of upper urinary tract transitional-cell carcinoma (UUT-TCC) as follow-up (group A), and 13 patients with first-suspicion of cancer (group B). Full renal collecting system examination was performed first under WL and then under NBI by a single urologist. Biopsies were taken from all detected lesions using the biopsy forceps and sent for examination by a pathologist who was blinded to the gross description of the lesion. Pathology interpretations were then compared with the corresponding WL and NBI images. Holmium laser vaporization was performed for all apparent lesions. Results Subjectively, NBI significantly improved the endoscopic visualization of the tumors, providing a detailed description of their limits and vascular architecture. Objectively, five additional tumors (14.2%) in four patients, as well the extended limits of three tumors (8.5%) in three patients were detected by NBI when findings by WL imaging were considered normal. Conclusion This is one of the first reports regarding NBI for UUT-TCC. From this study, we recommend this technology as a valuable diagnostic method, because it considerably improves tumor detection rate by 22.7% compared with WL.

Narrow-band imaging digital flexible ureteroscopy in detection of upper urinary tract transitional-cell carcinoma: initial experience.

The aim of this paper was to give a complete overview of all published complications associated with ureteroscopy and their according management and prevention in current urological practice. This review was registered in PROSPERO with registration number CRD42018116273. A bibliographic search of the Medline, Scopus, Embase and Web of Science databases was performed by two authors (V.D.C. and E.X.K.). According to the Population, Intervention, Comparator, Outcome (PICO) study design approach and Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) standards, a consensus between these authors was found relating to the thematic structure of this review. Ureteral stent discomfort, ureteral wall injury and stone migration are the most frequently reported complications. The worst complications include urosepsis, multi-organ failure and death. Incidence rates on these and other complications varied extensively between the reviewed reports. Ureteroscopy seems to be associated with more complications than currently reported. The present overview may help urologists to prevent, recognize and solve complications of ureteroscopy. It may also stimulate colleagues to perform prospective studies using standardized systems for classifying complications. These are warranted to compare results among different studies, to conduct meta-analyses, to inform health care workers and to counsel patients correctly about possible risks of ureteroscopy.

Complications of ureteroscopy: a complete overview

The aim of the present paper was to review the literature on all available ureteral access sheaths (UASs) with their indications, limitations, risks, advantages and disadvantages in current modern endourological practice. Two authors searched Medline, Scopus, Embase and Web of Science databases to identify studies on UASs published in English. No time period restriction was applied. All original articles reporting outcomes or innovations were included. Additional articles identified through references lists were also included. Case reports, editorials, letters, review articles and meeting abstracts were excluded. A total of 754 abstracts were screened, 176 original articles were assessed for eligibility and 83 articles were included in the review. Based on a low level of evidence, UASs increase irrigation flow during flexible ureteroscopy and decrease intrapelvic pressure and probably infectious complications. Data were controversial and sparse on the impact of UASs on multiple reinsertions and withdrawals of a ureteroscope, stone-free rates, ureteroscope protection or damage, postoperative pain, risk of ureteral strictures, and also on its cost-effectiveness. Studies on the benefit of UASs in paediatrics and in patients with a coagulopathy were inconclusive. In the absence of good randomized data, the true impact of UASs on surgery outcome remains unclear. The present review may contribute to the evidence-based decision-making process at the individual patient level regarding whether or not a UAS should be used.

Systematic review of ureteral access sheaths: facts and myths.

An International Collaborative Consensus Statement on En Bloc Resection of Bladder Tumour Incorporating Two Systematic Reviews, a Two-round Delphi Survey, and a Consensus Meeting.

&NA; How robotics could help shape the future of surgical care

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The future of robotic surgery.

Improved Durability of Flex-Xc Digital Flexible Ureteroscope: How Long Can You Expect It to Last?

The aim of the study was to observe similarities and differences regarding surgical safety and prognosis between en bloc bipolar resection and monopolar transurethral resection of bladder tumors (TURBTs) in medium size papillary non-muscle invasive bladder tumors (NMIBTs). A total of 90 patients with papillary bladder tumors presenting a diameter between 1 and 3 cm were equally divided and alternatively assigned for en bloc bipolar ablation (the study group) and conventional TURBT (the control group). During one year, every three months, the follow-up was performed and the protocol included urinary cytology and cystoscopy. Similar mean patients' age and tumor diameter were determined in both groups. In the study group, it was noticed an important reduced rate of obturator nerve reflex adverse event that caused bladder wall perforation. In addition, comparing the results between the two groups, the following aspects were observed in the study arm: decreased mean operation time (13.4 versus 19.7 minutes), hemoglobin level drop (0.28 versus 0.76 g∕dL), catheterization period (1.9 versus 2.8 days) and hospital stay (2.3 versus 3.1 days). A total of 41 and respectively 40 patients completed the 12 months follow-up protocol. After one year, the en bloc group presented a significantly lower recurrence rate, superior surgical safety, decreased perioperative morbidity and faster recovery. Therefore, the en bloc surgery approach presented a better oncological prognosis due to the reduced heterotopic NMIBT recurrences up to one year.

Bipolar en bloc tumor resection versus standard monopolar TURBT - which is the best way to go in non-invasive bladder cancer?

Objectives To evaluate semirigid retrograde ureteroscopy complications on a significant series of patients and to establish the factors associated with the occurrence of intraoperative complications. Patients and methods Between June 1994 and June 2013, 8150 semirigid ureteroscopic procedures for ureteral lithiasis were performed in 7456 patients. We used semirigid ureteroscopes(8 9.8F Wolf, 8 and 10F Storz, Olympus Endoeye digital 8.5 9.9F). Lithotripsy was done with pneumatic, electrohydraulic or Ho:YAG laser lithotripters. The preoperative parameters including gender, calculi location and size, impaction, degree of hydronephrosis, stone number and associated malformation as well as intraoperative aspects (stone extractors, fragmentation devices, operative time and surgeon experience) were evaluated in relation with complication rate. Results The stone-free rate after a single ureteroscopic procedure was 90.9%. Intraoperative incidents occurred in 348 cases (4.3%). The overall rate of intraoperative complications was 2.8% (228 cases). These were represented by lesions of the ureteral mucosa (139 cases), perforation (58 cases), bleeding (16 cases), ureteral avulsion (3 cases) and extra-ureteral stone migration (12 cases). Statistical analysis shows a significant association between the complication rate on the one hand and stone size, location and impaction,operative time and surgeon experience on the other hand. Conclusions Due to technological advances and increased experience, the semirigid retrograde ureteroscopic treatment of ureteral lithiasis increased efficacy, while the incidence of intraoperative complications decreased. Most of these complications are minor and can be managed by conservative approach.

Intraoperative complications after 8150 semirigid ureteroscopies for ureteral lithiasis: risk analysis and management.

Introduction Roboflex Avicenna represents a new device for flexible ureteroscopy, able to provide an efficient lithotripsy for renal calculi, Bucharest being the fourth place in the world where such a device is already in use Material and methods The study was prospective and included a number of 132 patients equally randomized which underwent standard flexible ureteroscopy and robotic flexible ureteroscopy for renal calculi between July and February 2016 All the procedures were performed with aStorz XC flexible ureteroscope in association with Avicenna Roboflex Stone fragmentation was performed using a Dornier Medilas 20H, Holmium Laser of 20 watt power and 21 µm wavelength Results The mean age was 48 years (range 26-77 years) and the mean stone size was 21 cm (range 11-36 cm) for the first group (FURS), while for the second one (robotic FURS) the mean age was 51 years (range 25-74 years) and the mean stone size was 24 cm (range 10-37 cm) The fragmentation time of the stones was better for robotic FURS (37 min versus 39 min) After 3 months, the stone free rate was 894% versus 924%, that representing a performance of the robotic technique over the classical one In some cases were noticed residual fragments smaller than 3 mm, in 136% of patients who underwent FURS, respectively in 121% of robotic FURS cases Conclusions The robotic treatment of kidney stones represents a comparative alternative to flexible ureteroscopy, with overall similar outcomes

Robotic Flexible Ureteroscopy Versus Classic Flexible Ureteroscopy in Renal Stones: the Initial Romanian Experience.

BPH remains one of the most common disease that the urologist has to manage. The last decade brought numerous new techniques, aiming to improve the minimally invasive approach to BPH, but none had, for the moment, changed the place of TURP as the gold standard treatment for medium sized prostates.

Based on a large personal experience, the authors present a study in which TURP is used for prostates over 80ml, the cutoff point set by the guidelines of the European Association of Urology. The rationale for this study is that many situations require minimally invasive treatment, based on the express request of the patient, other conditions that makes open surgery very difficult or impossible, or the need for a quick discharge in an overcrowded service. The aim of the study was to prove that TURP is safe and effective even in larger prostates. The technique used is basically the classic one, with minor tactical alterations in some cases. Some cases required a two-stage approach, but offered good functional results after the first stage. The results proved that, with a good technique, a skilled urologist might achieve the same results by using TURP or open surgery for large sized prostates.

D. Georgescu

Papers

Improved Durability of Flex-Xc Digital Flexible Ureteroscope: How Long Can You Expect It to Last?

Bipolar en bloc tumor resection versus standard monopolar TURBT - which is the best way to go in non-invasive bladder cancer?

Intraoperative complications after 8150 semirigid ureteroscopies for ureteral lithiasis: risk analysis and management.

Robotic Flexible Ureteroscopy Versus Classic Flexible Ureteroscopy in Renal Stones: the Initial Romanian Experience.

TURP for BPH. How large is too large