Urological Survey Urolithiasis/Endourology Re: Adverse Events Resulting from Lasers Used in Urology A. M. Althunayan, M. A. Elkoushy, M. M. Elhilali and S. Andonian Division of Urology, Department of Surgery, McGill University Health Center, McGill University, Montreal, Quebec, Canada, and Department of Urology, Suez Canal University, Ismailia, Egypt J Endourol 2014; 28: 256e260.
Abstract available at http://jurology.com/ Editorial Comment: The authors queried 2 databases for reported adverse events associated with lasers used by urologists. A number of adverse events were attributed to equipment failure. However, some may also have been influenced by the surgeon, particularly fiber tip breakage. Eye injuries were reported with use of neodymium:YAG, potassium-titanyl-phosphate and diode lasers, which underscores the importance of using protective eyewear. Some of the adverse events were devastating and resulted in mortality. Urologists must be cognizant of these risks, be aware of the possibility of defective equipment and practice proper technique when using laser energy. Dean G. Assimos, MD
Suggested Reading Knudsen BE, Pedro R, Hinck B et al: Durability of reusable holmium:YAG laser fibers: a multicenter study. J Urol 2011; 185: 160. Sea J, Jonat LM, Chew BH et al: Optimal power settings for holmium:YAG lithotripsy. J Urol 2012; 187: 914. Mues AC, Teichman JM and Knudsen BE: Evaluation of 24 holmium:YAG laser optical fibers for flexible ureteroscopy. J Urol 2009; 182: 348.
Re: Predicting Urinary Stone Composition Based on Single-Energy Noncontrast Computed Tomography: The Challenge of Cystine F. C. Torricelli, G. S. Marchini, S. De, K. G. Yamac¸ake, E. Mazzucchi and M. Monga Stevan B. Streem Center for Endourology and Stone Disease, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio, and Division of Urology, Hospital das Clinicas, University of Sao Paulo Medical School, Sa˜o Paulo, Sa˜o Paulo, Brazil Urology 2014; 83: 1258e1263.
Abstract available at http://jurology.com/ Editorial Comment: The superb accuracy of noncontrast computerized tomography for detection of kidney stones is unquestioned. However, predicting stone composition presents some hurdles, including discriminating between uric acid and cysteine stones. Dual energy computerized tomography has been used for this purpose,1 although the results have been inconsistent. Perhaps
0022-5347/15/1931-0170/0 THE JOURNAL OF UROLOGY® © 2015 by AMERICAN UROLOGICAL ASSOCIATION EDUCATION
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www.jurology.com
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RESEARCH, INC.
http://dx.doi.org/10.1016/j.juro.2014.10.030 Vol. 193, 170-172, January 2015 Printed in U.S.A.
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future refinements of this technique will prevail. In the interim one should use clinical information such as urine pH (typically low in uric acid stone formers) and microscopic examination of the urine for hexagonal crystals (an indicator of cystinuria) to facilitate case management. Dean G. Assimos, MD 1. Matlaga BR, Kawamoto S and Fishman E: Dual source computed tomography: a novel technique to determine stone composition. Urology 2008; 72: 1164.
Suggested Reading Toepker M, Kuehas F, Kienzl D et al: Dual energy computerized tomography with a split bolusda 1-stop shop for patients with suspected urinary stones? J Urol 2014; 191: 792.
Re: Safety, Minimization, and Awareness Radiation Training Reduces Fluoroscopy Time during Unilateral Ureteroscopy L. R. Weld, U. O. Nwoye, R. B. Knight, T. S. Baumgartner, J. S. Ebertowski, M. T. Stringer, M. C. Kasprenski and K. J. Weld Department of Urology, San Antonio Military Medical Center, Fort Sam Houston, San Antonio, Texas Urology 2014; 84: 520e525.
Abstract available at http://jurology.com/ Editorial Comment: Decreasing or eliminating radiation exposure with diagnostic imaging and during therapeutic procedures has been emphasized in recent years. The authors demonstrate that implementation of an educational program aimed at reducing radiation exposure was successful. One must still recognize when it is necessary to use fluoroscopy to avert complications and improve outcomes. Dean G. Assimos, MD
Suggested Reading Deters LA, Dagrosa LM, Herrick BW et al: Ultrasound guided ureteroscopy for the definitive management of ureteral stones: a randomized, controlled trial. J Urol 2014; 192: 1710. Blair B, Huang G, Arnold D et al: Reduced fluoroscopy protocol for percutaneous nephrostolithotomy: feasibility, outcomes and effects on fluoroscopy time. J Urol 2013; 190: 2112. Kokorowski PJ, Chow JS, Strauss KJ et al: Prospective systematic intervention to reduce patient exposure to radiation during pediatric ureteroscopy. J Urol, suppl., 2013; 190: 1474.
Laparoscopy/New Technology Re: One- vs 4-Week Stent Placement after Laparoscopic and Robot-Assisted Pyeloplasty: Results of a Prospective Randomised Single-Centre Study € hle, P. Stucki and A. Mattei H. Danuser, C. Germann, N. Pelzer, A. Ru Klinik fu¨r Urologie, Luzerner Kantonsspital, Lucerne, Switzerland BJU Int 2014; 113: 931e935.
Abstract available at http://jurology.com/
Abstract available at http://jurology.com/ Editorial Comment: The authors queried 2 databases for reported adverse events associated with lasers used by urologists. A number of adverse events were attributed to equipment failure. However, some may also have been influenced by the surgeon, particularly fiber tip breakage. Eye injuries were reported with use of neodymium:YAG, potassium-titanyl-phosphate and diode lasers, which underscores the importance of using protective eyewear. Some of the adverse events were devastating and resulted in mortality. Urologists must be cognizant of these risks, be aware of the possibility of defective equipment and practice proper technique when using laser energy. Dean G. Assimos, MD
Suggested Reading Knudsen BE, Pedro R, Hinck B et al: Durability of reusable holmium:YAG laser fibers: a multicenter study. J Urol 2011; 185: 160. Sea J, Jonat LM, Chew BH et al: Optimal power settings for holmium:YAG lithotripsy. J Urol 2012; 187: 914. Mues AC, Teichman JM and Knudsen BE: Evaluation of 24 holmium:YAG laser optical fibers for flexible ureteroscopy. J Urol 2009; 182: 348.
Re: Predicting Urinary Stone Composition Based on Single-Energy Noncontrast Computed Tomography: The Challenge of Cystine F. C. Torricelli, G. S. Marchini, S. De, K. G. Yamac¸ake, E. Mazzucchi and M. Monga Stevan B. Streem Center for Endourology and Stone Disease, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio, and Division of Urology, Hospital das Clinicas, University of Sao Paulo Medical School, Sa˜o Paulo, Sa˜o Paulo, Brazil Urology 2014; 83: 1258e1263.
Abstract available at http://jurology.com/ Editorial Comment: The superb accuracy of noncontrast computerized tomography for detection of kidney stones is unquestioned. However, predicting stone composition presents some hurdles, including discriminating between uric acid and cysteine stones. Dual energy computerized tomography has been used for this purpose,1 although the results have been inconsistent. Perhaps
0022-5347/15/1931-0170/0 THE JOURNAL OF UROLOGY® © 2015 by AMERICAN UROLOGICAL ASSOCIATION EDUCATION
170
j
www.jurology.com
AND
RESEARCH, INC.
http://dx.doi.org/10.1016/j.juro.2014.10.030 Vol. 193, 170-172, January 2015 Printed in U.S.A.
LAPAROSCOPY/NEW TECHNOLOGY
171
future refinements of this technique will prevail. In the interim one should use clinical information such as urine pH (typically low in uric acid stone formers) and microscopic examination of the urine for hexagonal crystals (an indicator of cystinuria) to facilitate case management. Dean G. Assimos, MD 1. Matlaga BR, Kawamoto S and Fishman E: Dual source computed tomography: a novel technique to determine stone composition. Urology 2008; 72: 1164.
Suggested Reading Toepker M, Kuehas F, Kienzl D et al: Dual energy computerized tomography with a split bolusda 1-stop shop for patients with suspected urinary stones? J Urol 2014; 191: 792.
Re: Safety, Minimization, and Awareness Radiation Training Reduces Fluoroscopy Time during Unilateral Ureteroscopy L. R. Weld, U. O. Nwoye, R. B. Knight, T. S. Baumgartner, J. S. Ebertowski, M. T. Stringer, M. C. Kasprenski and K. J. Weld Department of Urology, San Antonio Military Medical Center, Fort Sam Houston, San Antonio, Texas Urology 2014; 84: 520e525.
Abstract available at http://jurology.com/ Editorial Comment: Decreasing or eliminating radiation exposure with diagnostic imaging and during therapeutic procedures has been emphasized in recent years. The authors demonstrate that implementation of an educational program aimed at reducing radiation exposure was successful. One must still recognize when it is necessary to use fluoroscopy to avert complications and improve outcomes. Dean G. Assimos, MD
Suggested Reading Deters LA, Dagrosa LM, Herrick BW et al: Ultrasound guided ureteroscopy for the definitive management of ureteral stones: a randomized, controlled trial. J Urol 2014; 192: 1710. Blair B, Huang G, Arnold D et al: Reduced fluoroscopy protocol for percutaneous nephrostolithotomy: feasibility, outcomes and effects on fluoroscopy time. J Urol 2013; 190: 2112. Kokorowski PJ, Chow JS, Strauss KJ et al: Prospective systematic intervention to reduce patient exposure to radiation during pediatric ureteroscopy. J Urol, suppl., 2013; 190: 1474.
Laparoscopy/New Technology Re: One- vs 4-Week Stent Placement after Laparoscopic and Robot-Assisted Pyeloplasty: Results of a Prospective Randomised Single-Centre Study € hle, P. Stucki and A. Mattei H. Danuser, C. Germann, N. Pelzer, A. Ru Klinik fu¨r Urologie, Luzerner Kantonsspital, Lucerne, Switzerland BJU Int 2014; 113: 931e935.
Abstract available at http://jurology.com/
