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

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Asian Journal of Urology 2024年第1期11卷 55-64页

作者： Bryan kwun-Chung Cheng Steffi kar-kei Yuen Daniele Castellani Marcelo Langer Wroclawski Hongda Zhao Mallikarjuna Chiruvella Wei-Jin Chua Ho-Yee Tiong Yiloren Tanidir Jean de la Rosette Enrique Rijo Vincent Misrai Amy krambeck Dean S.Elterman bhaskar k.somani Jeremy Yuen-Chun Teoh Vineet Gauhar Department of Surgery United Christian HospitalHong KongChina S.H.Ho Urology Centre Department of SurgeryPrince of Wales HospitalThe Chinese University of Hong KongHong KongChina Department of Urology University Hospital“Ospedali Riuniti”and Polytechnic University of Marche RegionAnconaItaly Hospital Israelita Albert Einstein Sao PauloSPBrazil BP—A Beneficencia Portuguesa de Sao Paulo Sao PauloSPBrazil Faculdade de Medicina do ABC Santo AndreSPBrazil Department of Urology Asian Institute of Nephrology and UrologyHyderabadTGIndia Department of Urology National University HospitalSingapore Department of Urology Marmara University School of MedicineIstanbulTurkey Department of Urology Medipol Mega University HospitalIstanbul Medipol UniversityIstanbulTurkey Department of Urology Hospital Quiron BarcelonaBarcelonaSpain Department of Urology Clinique PasteurToulouseFrance Department of Urology Indiana University School of MedicineIndianapolisINUSA Division of Urology Department of SurgeryUniversity Health NetworkUniversity of TorontoTorontoCanada Department of Urology University Hospital Southampton NHS TrustSouthamptonUK Department of Urology Ng Teng Fong General HospitalNUHSSingapore

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.

关键词： Benignprostate hyperplasia Minimalinvasive surgical therapy Surgery Bladderoutlet obstruction

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Education and training evolution in urolithiasis:A perspective from European School of Urology

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Asian Journal of Urology 2023年第3期10卷 281-288页

作者： Vaki Antoniou Vineet Gauhar Panagiotis kallidonis Andreas Skolarikos Domenico Veneziano Evangelo Liatsikos bhaskar k.somani University Hospital Southampton SouthamptonUK Department of Urology Ng Teng Fong General Hospital(NUHS)SingaporeSingapore Department of Urology University of PatrasGreece The Smith Institute for Urology Northwell HealthNew YorkUSA

Objective:With the worldwide increase in urolithiasis prevalence,the present study aimed to delineate and summarise recent evolutions in training for the management of urolithiasis.Methods:A PubMed search using the key words“simulation”,“training”,“ureteroscopy”,“RIRS”,“URS”,“percutaneous nephrolithotomy”,“PCNL”,“virtual reality”,“augmented reality”,“artificial intelligence”,“healthcare”,“curriculum”,and“assessment”was used to examine how education and training in urolithiasis have adapted over recent years.Focus was placed on the role of high-and low-fidelity simulation models,virtual reality and artificial intelligence,and standardised assessment and curriculum.Results:This review supports the necessity to incorporate technology,simulation,and other skill enhancement training modalities into surgical training.However,these cannot solely replace mentored training with an experienced professional supervisor.Whilst technological and simulation advancements are likely to prove increasingly important in urolithiasis training,it is just as important for stratification of robust curricula with validated assessment.We also propose a pathway for future training.Conclusion:Endourology subspeciality training programmes have successfully incorporated simulation model-based training for skill acquisition,refinement,and improving operative outcomes.Success is achieved by maintaining a delicate balance between machine and in person mentor-based training.A trainee-centred model that follows the proposed curriculum could aid this balance for the future generation of trainees.

关键词： Ureteroscopy Laser kidney calculi Simulation Education Curriculum Artificial intelligence

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Diagnosing upper tract urothelial carcinoma: A review of the role of diagnostic ureteroscopy and novel developments over last two decades

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Asian Journal of Urology 2024年第2期11卷 242-252页

作者： Paul Gravestock Daniel Cullum bhaskar somani Rajan Veeratterapillay Urology Department Freeman HospitalNewcastle Upon TyneUK Department of Urology University Hospital SouthamptonSouthamptonUK

Objective: The role of ureteroscopy in the diagnosis of upper tract urothelial carcinoma is yet to be fully determined. We aimed to provide an up to date evaluation of its role and the emerging technologies in the field.Methods: A literature search of the last two decades (from 24th May, 2001 to 24th May, 2021) was carried out identifying 147 papers for potential inclusion within this narrative review.Results: Diagnostic ureteroscopy is undeniably useful in its ability to visualise and biopsy indeterminate lesions, and to risk stratify malignant lesions that may be suitable for kidney sparing surgery. However, an increased risk of intravesical recurrence following nephroureterectomy when a prior diagnostic ureteroscopy has been performed, inadequate sampling at biopsy, complications from the procedure, and difficult ureteric access are all potential drawbacks. Furthermore, whilst generally an accurate diagnostic procedure, it risks missing carcinoma in-situ lesions. Despite this, evidence shows that routine use of ureteroscopy changes the management of patients in a large proportion of cases, preventing unnecessary surgery or facilitating kidney sparing surgery. The overall rate of complications is low, and improved biopsy techniques and the use of tissue biomarkers for improved staging and grading are encouraging. The risks of delays to definitive management and post-ureteroscopy intravesical recurrence do not seem to affect survival, and trials are in progress to determine whether intravesical therapy can mitigate the latter. Further promising techniques are being investigated to improve shortcomings, particularly in relation to improved diagnosis of carcinoma in situ and preoperative staging.Conclusion: Ureteroscopy has a role in the diagnosis of upper tract malignancy, though whether it should be used routinely is yet to be determined.

关键词： Ureteroscopy Carcinoma Transitional cell Ureteralneoplasms Urinary bladder neoplasms Carcinomainsitu Biopsy

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Transurethral resection of bladder tumor: A systematic review of simulator-based training courses and curricula

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Asian Journal of Urology 2024年第1期11卷 1-9页

作者： Panagiotis kallidonis Angelis Peteinaris Gernot Ortner kostantinos Pagonis Costantinos Adamou Athanasios Vagionis Evangelos Liatsikos bhaskar somani Theodoros Tokas Department of Urology University Hospital of RionPatrasGreece Department of Urology and Andrology General Hospital Hall I.T.Hall in TirolAustria Medical University of Vienna ViennaAustria Department of Urology University Hospital Southampton NHS Foundation TrustSouthamptonUK

Objective:Transurethral resection of bladder tumor is one of the most common everyday urological procedures.This kind of surgery demands a set of skills that need training and experience.In this review,we aimed to investigate the current literature to find out if simulators,phantoms,and other training models could be used as a tool for teaching urologists.Methods:A systematic review was performed according to the Preferred Reporting Items for Systematic reviews and Meta-Analyses statement and the recommendations of the European Association of Urology guidelines for conducting systematic reviews.Fifteen out of 932 studies met our inclusion criteria and are presented in the current review.Results:The UroTrainer(karl Storz GmbH,Tuttlingen,Germany),a virtual reality training simulator,achieved positive feedback and an excellent face and construct validity by the participants.The inspection of bladder mucosa,blood loss,tumor resection,and procedural time was improved after the training,especially for inexperienced urologists and medical students.The construct validity of UroSim®(VirtaMed,Zurich,Switzerland)was established.SIMBLA simulator(Samed GmbH,Dresden,Germany)was found to be a realistic and useful tool by experts and urologists with intermediate experience.The test objective competency model based on SIMBLA simulator could be used for evaluating urologists.The porcine model of the Asian Urological Surgery Training and Education Group also received positive feedback by the participants that tried it.The Simulation and Technology Enhanced Learning Initiative Project had an extraordinary face and content validity,and 60%of participants would like to use the simulators in the future.The 5-day multimodal training curriculum“Boot Camp”in the United kingdom achieved an increase of the level of confidence of the participants that lasted months after the project.Conclusion:Simulators and courses or curricula based on a simulator training could be a valuable learning tool for any surgeon,and there is no doubt that they sh

关键词： Simulator Train Curriculum Transurethral resection Vaporesection Laser Bladder

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Role of simulation in kidney stone disease:A systematic review of literature trends in the 26 years

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World Journal of Nephrology 2023年第4期12卷 104-111页

作者： Carlotta Nedbal Victoria Jahrreiss Clara Cerrato Amelia Pietropaolo Andrea Galosi Domenico Veneziano Panagiotis kallidonis bhaskar k.somani Department of Urology University Hospital Southampton NHS Foundation TrustSouthampton SO166YDUnited Kingdom Department of Urology Azienda Ospedaliero-Universitaria delle MarchePolytechnic University of MarcheAncona 60121Italy Department of Urology The Smith Institute for UrologyNorthwell HealthNew YorkNY 11042United States Department of Urology University of PatrasPatras 26500Greece

BACkGROUND Minimally invasive techniques for treatment of urinary stones requires expertise,experience and endoscopic skills.Simulators provide a low-stress and low-risk environment while providing a realistic set-up and training opportunities.AIM To report the publication trend of‘simulation in urolithiasis’over the last 26 years.METHODS Research of all published papers on“Simulation in Urolithiasis”was performed through PubMed database over the last 26 years,from January 1997 to December 2022.Papers were labelled and divided in three subgroups:(1)Training papers;(2)Clinical simulation application or surgical procedures;and(3)Diagnostic radiology simulation.Each subgroup was then divided into two 13-year time periods to compare and identify the contrast of different decades:period-1(1997-2009)and period-2(2010-2022).RESULTS A total of 168 articles published on the application of simulation in urolithiasis over the last 26 years(training:n=94,surgical procedures:n=66,and radiology:n=8).The overall number of papers published in simulation in urolithiasis was 35 in Period-1 and 129 in Period-2,an increase of+269%(P=0.0002).Each subgroup shows a growing trend of publications from Period-1 to Period-2:training papers+279%(P=0.001),surgical simulations+264%(P=0.0180)and radiological simulations+200%(P=0.2105).CONCLUSION In the last decades there has been a step up of papers regarding training protocols with the aid of various simulation devices,with simulators now a part of training programs.With the development of 3D-printed and high-fidelity models,simulation for surgical procedure planning and patients counseling is also a growing field and this trend will continue to rise in the next few years.

关键词： kidney calculi Urolithiasis Simulation Ureteroscopy Percutaneous nephrolithotomy Artificial intelligence

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Incidence of urinary incontinence followingendoscopic laser enucleation of the prostate byen-bloc and non-en-bloc techniques:a multicenter,real-world experience of 5068 patients

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Asian Journal of Andrology 2024年第3期26卷 233-238页

作者： Daniele Castellani Vineet Gauhar khi Yung Fong Mario Sofer Moisés Rodríguez Socarrás Azimdjon N Tursunkulov Lie kwok Ying Sarvajit Biligere Ho Yee Tiong Dean Elterman Abhay Mahajan Mark Taratkin Sorokin Nikolai Ivanovich Tanuj Pal Bhatia Dmitry Enikeev Nariman Gadzhiev Mohammed Taif Bendigeri Jeremy Yuen-Chun Teoh Marco Dellabella Fernando Gómez Sancha bhaskar kumar somani Thomas Reinhard William Herrmann Urology Unit IRCCS INRCAAncona 60127Italy Urology Unit Marche University HospitalLe Marche Polytechnic UniversityAncona 60126Italy Departmentof Urology Ng Teng Fong General HospitalSingapore 609606Singapore Yong Loo Lin School of Medicine National University of SingaporeSingapore 117597Singapore Department of Urology Tel Aviv Sourasky Medical CenterAffiliated to the Sackler School of MedicineTel Aviv UniversityTel Aviv 6423906Israel Department of Urology and Robotic Surgery ICUA-Clínica CEMTROMadrid 28701Spain Urology Division AkfaMedline HospitalTashkent 100211Uzbekistan Advanced Urology Gleneagles HospitalSingapore 258499Singapore Department of Urology National University HospitalSingapore 119228Singapore Divisionof Urology Department of SurgeryUniversity of TorontoOntarioToronto M5G 2C4Canada Department of Urology Mahatma Gandhi Mission’s Medical College andHospitalAurangabad 431003India Institute for Urology and Reproductive Health Sechenov UniversityMoscow119435Russian Federation Department of Urologyand Andrology Lomonosov Moscow State UniversityMoscow 119992Russian Federation Department of Urology Sarvodaya Hospital and Research CentreFaridabadHaryana 121006India Department of Urology Medical University of ViennaVienna 1090Austria Department of Urology Saint-Petersburg State University HospitalSaint-Petersburg 199034Russian Federation Department of Urology Asian Institute of Nephrology and UrologyHyderabad 500082India S.H.Ho UrologyCentre Department of SurgeryFaculty of MedicineThe Chinese University of Hong KongHong Kong 96H2+Q9China Department of Urology University HospitalsSouthampton NHS TrustSouthampton SO166YDUnited Kingdom Department of Urology Cantonal Hospital Thurgau AGFraunfeld 8500Switzerland.

We aim to evaluate the incidence of incontinence following laser endoscopic enucleation of the prostate(EEP)comparing en-bloc(Group 1)versus 2-lobe/3-lobe techniques(Group 2).We performed a retrospective review of patients undergoing EEP for benign prostaticenlargement in 12 centers between January 2020 and January 2022.Data were presented as median and interquartile range(IQR).Univariable and multivariable logistic regression analysis was performed to evaluate factors associated with stress urinary incontinence(SUI)and mixed urinary incontinence(MUI).There were 1711 patients in Group 1 and 3357 patients in Group 2.Patients in Group 2were significantly younger(68[62–73]years vs 69[63–74]years,P=0.002).Median(interquartile range)prostate volume(PV)wassimilar between the groups(70[52–92]ml in Group 1 vs 70[54–90]ml in Group 2,P=0.774).There was no difference in preoperativeInternational Prostate Symptom Score,quality of life,or maximum flow rate.Enucleation,morcellation,and total surgical time weresignificantly shorter in Group 1.Within 1 month,overall incontinence rate was 6.3%in Group 1 versus 5.3%in Group 2(P=0.12),and urge incontinence was significantly higher in Group 1(55.1%vs 37.3%in Group 2,P<0.001).After 3 months,the overall rate ofincontinence was 1.7%in Group 1 versus 2.3%in Group 2(P=0.06),and SUI was significantly higher in Group 2(55.6%vs 24.1%in Group 1,P=0.002).At multivariable analysis,PV and IPSS were factors significantly associated with higher odds of transient SUI/MUI.PV,surgical time,and no early apical release technique were factors associated with higher odds of persistent SUI/MUI.

关键词： benign prostatic hyperplasia en-bloc enucleation endoscopic enucleation of the prostate laser therapy stress urinaryincontinence urge urinary incontinence

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Ureteroscopy and stones:Current status and future expectations

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World Journal of Nephrology 2014年第4期3卷 243-248页

作者： Anna E Wright Nicholas J Rukin bhaskar k.somani Department of Urology New Cross Hospital Department of Urology University Hospital Southampton NHS Trust

Urolithaisis is becoming an ever increasing urological,nephrological and primary care problem.With a lifetime prevalence approaching 10% and increasing morbidity due to stone disease,the role of ureteroscopy and stone removal is becoming more important.We discuss the current status of stone disease and review the ever increasing role that ureteroscopy has to play in its management.We discuss technological advances that have been made in stone management and give you an overview of when,how and why ureteroscopy is the most common treatment option for stone management.We touch on the role of robotic ureteroscopy and the future of ureteroscopy in the next 10 years.

关键词：尿石症肾脏治疗方法临床分析

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Radiation protection measures during endourological therapies

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Asian Journal of Urology 2023年第3期10卷 215-225页

作者： Lazaros Tzelves Patrick Juliebø-Jones Ioannis Manolitsis Themistoklis Bellos Ioannis Mykoniatis Marinos Berdempes Titos Markopoulosa Michael Lardas Belthangady M.Zeeshan Hameed Panagiotis Angelopoulos Amelia Pietropaolo bhaskar somani Ioannis Varkarakis Andreas Skolarikos nd Department of Urology National and Kapodistrian University of AthensSismanogleion HospitalAthensGreece Young Academic Urologists(YAU) Urolithiasis&Endourology Working Party6846 Arnhemthe Netherlands Department of Urology Haukeland University HospitalN-5021 BergenNorway Department of Urology Faculty of Health SciencesSchool of MedicineAristotle University of Thessaloniki54124 ThessalonikiGreece Department of Urology Kasturba Medical College ManipalManipal Academy of Higher EducationManipal 576104India Department of Urology University Hospital Southampton NHS TrustSouthamptonUK

Objective The objective of this narrative review was to search the existing literature for studies reporting measures to minimize radiation use during endoscopic management of stone disease and present ways of reducing the exposure of both patients and operating room staff.Methods A literature review in PubMed was performed to identify studies describing protocols or measures to reduce radiation received during endourological procedures from January 1970 to August 2022.Eligible studies were those that reported outcomes for ureteroscopy or percutaneous nephrolithotripsy regarding measures to minimize radiation doses used intraoperatively,performed either in real-life theatres or using phantoms.Both comparative and non-comparative studies were deemed eligible.Results Protection can be achieved initially at the level of diagnosis and follow-up of patients,which should be done following an algorithm and choice of more conservative imaging methods.Certain protocols,which follow principles for minimized fluoroscopy use should be implemented and urologists as well as operating room staff should be continuously trained regarding radiation damage and protection measures.Wearing protective lead equipment remains a cornerstone for personnel protection,while configuration of the operating room and adjusting X-ray machine settings can also significantly reduce radiation energy.Conclusion There are specific measures,which can be implemented to reduce radiation exposure.These include avoiding excessive use of computed tomography scans and X-rays during diagnosis and follow-up of urolithiasis patients.Intraoperative protocols with minimal fluoroscopy use can be employed.Staff training regarding dangers of radiation plays also a major role.Use and maintenance of protective equipment and setting up the operating room properly also serve towards this goal.Machine settings can be customized appropriately and finally continuously monitoring of exposure with dosimeters can be adopted.

关键词： Endourology Radiation Fluoroless ureteroscopy Percutaneous nephrolithotripsy As low as reasonably achievable

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Definition, treatment and outcome of residual fragments in staghorn stones

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Asian Journal of Urology 2020年第2期7卷 116-121页

作者： Osman Ermis bhaskar somani Thomas Reeves Selcuk Guven Pilar Laguna Pes Arun Chawla Padmaraj Hegde Jean de la Rosette Istanbul Medipol University School of MedicineDepartment of UrologyIstanbulTurkey University Hospital Southampton NHS Trust Department of UrologySouthamptonUK kasturba Medical College Manipal Academy of Higher EducationDepartment of UrologyManipalIndia

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.

关键词： Urolithiasis Stone management Staghorn Percutaneous nephrolithotomy Residual fragments Staghorn stones

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