Salvage Percutaneous Nephrolithotomy: Analysis of Outcomes Following Initial Treatment Failure

Purpose Percutaneous nephrolithotomy has high potential for morbidity or failure. There are limited data regarding risk factors for failure and to our knowledge no published reports of surgical outcomes in patients with prior failed attempts at percutaneous stone removal. Materials and Methods We identified patients referred to 3 medical centers after prior failed attempts at percutaneous nephrolithotomy. A retrospective chart review was performed to analyze reasons for initial failure and outcomes of salvage percutaneous nephrolithotomy. Outcomes were compared to those in a prospectively maintained database of more than 1,200 patients treated with a primary procedure. Results Salvage percutaneous nephrolithotomy was performed in 31 patients. Unsuitable access to the stone was the reason for failure in 80% of cases. Other reasons included infection, bleeding and inadequate instrument availability in 6.5% of cases each. Compared to patients who underwent primary percutaneous nephrolithotomy those treated with salvage were more likely to have staghorn calculi (61.3% vs 31.4%, p <0.01) and a larger maximum stone diameter (3.7 vs 2.5 cm, p <0.01), and require a secondary procedure (65.5% vs 42.1%, p <0.01). There was no significant difference between the cohorts in the remaining demographics or perioperative outcomes. All patients were deemed completely stone free except one who elected observation for a 3 mm nonobstructing fragment. Conclusions Despite the more challenging nature and prior unsuccessful attempts at treatment, the outcomes of salvage percutaneous nephrolithotomy were no different from those of primary percutaneous nephrolithotomy when performed by experienced surgeons

Promoting the use of the PI-QUAL score for prostate MRI quality: results from the ESOR Nicholas Gourtsoyiannis teaching fellowship

OBJECTIVES: The Prostate Imaging Quality (PI-QUAL) score is a new metric to evaluate the diagnostic quality of multiparametric magnetic resonance imaging (MRI) of the prostate. This study assesses the impact of an intervention, namely a prostate MRI quality training lecture, on the participant's ability to apply PI-QUAL. METHODS: Sixteen participants (radiologists, urologists, physicists, and computer scientists) of varying experience in reviewing diagnostic prostate MRI all assessed the image quality of ten examinations from different vendors and machines. Then, they attended a dedicated lecture followed by a hands-on workshop on MRI quality assessment using the PI-QUAL score. Five scans assessed by the participants were evaluated in the workshop using the PI-QUAL score for teaching purposes. After the course, the same participants evaluated the image quality of a new set of ten scans applying the PI-QUAL score. Results were assessed using receiver operating characteristic analysis. The reference standard was the PI-QUAL score assessed by one of the developers of PI-QUAL. RESULTS: There was a significant improvement in average area under the curve for the evaluation of image quality from baseline (0.59 [95 % confidence intervals: 0.50-0.66]) to post-teaching (0.96 [0.92-0.98]), an improvement of 0.37 [0.21-0.41] (p < 0.001). CONCLUSIONS: A teaching course (dedicated lecture + hands-on workshop) on PI-QUAL significantly improved the application of this scoring system to assess the quality of prostate MRI examinations. KEY POINTS: • A significant improvement in the application of PI-QUAL for the assessment of prostate MR image quality was observed after an educational intervention. • Appropriate training on image quality can be delivered to those involved in the acquisition and interpretation of prostate MRI. • Further investigation will be needed to understand the impact on improving the acquisition of high-quality diagnostic prostate MR examinations

The IDENTIFY study: the investigation and detection of urological neoplasia in patients referred with suspected urinary tract cancer - a multicentre observational study

Objective To evaluate the contemporary prevalence of urinary tract cancer (bladder cancer, upper tract urothelial cancer [UTUC] and renal cancer) in patients referred to secondary care with haematuria, adjusted for established patient risk markers and geographical variation. Patients and Methods This was an international multicentre prospective observational study. We included patients aged ≥16 years, referred to secondary care with suspected urinary tract cancer. Patients with a known or previous urological malignancy were excluded. We estimated the prevalence of bladder cancer, UTUC, renal cancer and prostate cancer; stratified by age, type of haematuria, sex, and smoking. We used a multivariable mixed-effects logistic regression to adjust cancer prevalence for age, type of haematuria, sex, smoking, hospitals, and countries. Results Of the 11 059 patients assessed for eligibility, 10 896 were included from 110 hospitals across 26 countries. The overall adjusted cancer prevalence (n = 2257) was 28.2% (95% confidence interval [CI] 22.3–34.1), bladder cancer (n = 1951) 24.7% (95% CI 19.1–30.2), UTUC (n = 128) 1.14% (95% CI 0.77–1.52), renal cancer (n = 107) 1.05% (95% CI 0.80–1.29), and prostate cancer (n = 124) 1.75% (95% CI 1.32–2.18). The odds ratios for patient risk markers in the model for all cancers were: age 1.04 (95% CI 1.03–1.05; P < 0.001), visible haematuria 3.47 (95% CI 2.90–4.15; P < 0.001), male sex 1.30 (95% CI 1.14–1.50; P < 0.001), and smoking 2.70 (95% CI 2.30–3.18; P < 0.001). Conclusions A better understanding of cancer prevalence across an international population is required to inform clinical guidelines. We are the first to report urinary tract cancer prevalence across an international population in patients referred to secondary care, adjusted for patient risk markers and geographical variation. Bladder cancer was the most prevalent disease. Visible haematuria was the strongest predictor for urinary tract cancer

Circus and Clowns: Creative approach for emotional and mental well-being : Learning from Clowns without Boarders and Circus Cirkör

The number of displaced people around the world today is unprecedented in world history, with a third of those displaced below the age of 18. These children often undergo traumatic experiences which can cause serious mental health issues before and during their flight as well as afterwards when resettling in a new country. In Sweden, they are offered psychological aid in order to better deal with these issues and hence recover. However, due to the cultural stigma attached to mental health problems, psychosocial aid is often ruled out by the child themselves. In addition, up to 30% of these unaccompanied children have been reported to suffer from PTSD, where merely speaking about one's issue can trigger a relapse of the trauma. There is therefore a shortage of pragmatic approaches to help tackle the challenges that these children faces. The aim of this thesis is to investigate how creative programs such as the organisation Clowns without Borders works with unaccompanied refugees and how their methods affect the wellbeing of these children. This thesis explores the effects that laughter and playing has on a child’s well-being using a qualitative field research approach. The research is a contribution to the field of development since it offers new grounds on how to work towards increasing the living standards of resettled displaced persons

Motion analysis of flexible ureteroscopic techniques by urologic surgeons

Thesis: S.M. in Engineering and Management, Massachusetts Institute of Technology, System Design and Management Program, 2020Cataloged from PDF version of thesis. "Due to the condition of the original material, there are unavoidable flaws in this reproduction. We have made every effort possible to provide you with the best copy available. The images contained in this document are of the best quality available"--Disclaimer Notice page.Includes bibliographical references (pages 51-52).Urologic surgeons, in order to surgically remove kidney stones from patients who suffer from this painful condition, perform a common procedure known as flexible ureteroscopy. During this operation, the surgeon will utilize a 3mm-diameter flexible camera passed through the urinary tract to fragment, manipulate, and remove kidney stones. The flexible ureteroscope utilizes a non-intuitive control mechanism including a thumb-actuated lever and various wrist rotations to direct the end effector. Numerous methodologies exist to evaluate, understand, and train proper surgeon movement when operating this device, although the current literature suggests that urologists cannot sufficiently define correct or successful device interaction. In this study, we employed infrared motion capture in combination with standard video analysis to characterize surgeon movement variables in a simulated clinical scenario. A ureteroscopic simulation box was used by 12 practicing urologists at various skill levels to perform a number of ureteroscopic tasks. Demographic, motion, and task-specific data were recorded and analyzed to delineate associations between measures of ureteroscopic efficiency and success. This project suggests that certain surgeon movement data, including measures of economy of motion and wrist rotation, trend with efficient ureteroscopic manipulation and require additional study. These variables could potentially serve as a basis for improvement in device development and urologic surgical training and evaluation.by Daniel Arthur Wollin.S.M. in Engineering and ManagementS.M. in Engineering and Management Massachusetts Institute of Technology, System Design and Management Progra

Antibiotic use and the prevention and management of infectious complications in stone disease

The importance of assessing perioperative urine/stone cultures and providing appropriate antibiotic prophylaxis prior to shock wave lithotripsy (SWL) or endoscopic intervention cannot be minimized. Urinary tract infection (UTI) is the most common complication relating to stone intervention. Adequate assessment of culture data and adherence to appropriate guidelines may prevent the development of UTI and the potential for post-intervention urosepsis. This review outlines the current evidence for prophylaxis in the prevention of UTI and urosepsis, as well as the interpretation of stone culture data to provide an evidence-based approach for the judicious use of antibiotics in urologic stone practic