DOI: 10.1089/end.2015.28999.jcl CROES COUNCIL Chairman Jean de la Rosette, M.D. Amsterdam (The Netherlands) Adrian Joyce, M.S. Leeds (UK)
JOIN THE PREMIER RESEARCH OFFICE IN THE FIELD OF ENDOUROLOGY
Stavros Gravas, M.D. Larissa (Greece) Jorge Gutierrez-Aceves, M.D. Winston Salem (USA) Dean Assimos, M.D. Birmingham (USA) Ying-Hao Sun, M.D. Shanghai (China) Tadashi Matsuda, M.D. Osaka ( Japan)
Take part in publications and presentations that offer exposure to your institution Become a member of the global research network of Endourologists Be recognized as a centre of excellence in the field of Endourology
TREASURER John Denstedt, M.D. London (Canada)
EXECUTIVE DIRECTOR Sonja van Rees Vellinga Amsterdam (The Netherlands) [email protected]
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RELEVANT AND NEW DATA GRACE THE CLINICAL RESEARCH OFFICE OF THE ENDOUROLICAL SOCIETY URETEROSCOPY URS STUDY GROUP COLLABORATION Jonathan Cloutier and Olivier Traxer
It is fully recognized that ureteroscopy (URS) is gaining popularity among the urologist community. The trend towards this technology is now perceived in most of the countries and for almost all ureteral and renal stone sizes. As the literature evidence level is still limited, the European guidelines continue to recommend shockwave lithotripsy (SWL) or ‘‘endourology’’ modalities for a kidney stone smaller than 2 cm, and SWL or URS for a ureteral stone [1]. Even with this popularity towards the usage of URS, greater evidence and information are needed. The Clinical Research Office of the Endourological Society (CROES) Study group has started to produce interesting and pertinent evidence due to their large prospective database collected in collaboration with 114 centers in 32 countries. It illustrated very well the interest by every endourologist to better describe this minimally invasive procedure. Their findings are helping physicians to understand what is done in the real-world practice for patients with ureteral and kidney stones. Jean de la Rosette published on behalf of the CROES URS Study group the entirely collected data of 11,885 patients [2]. They showed a low rate of pre-stented patients (19.7% of patients). It is exactly in accordance with the recommendation of the EAU guidelines that do not recommend to pre-stent the patient before a URS [1]. Moreover, what would probably be examined in a near future is the treatment of stone by URS for patients with renal abnormalities and solitary kidney. It is another advantage of this large cohort of patients that provide several renal abnormalities that are rarely observed in real life. It is difficult to publish a study with adequate number of patients with these abnormalities other than doing a multicentric collaboration. Also, they presented a broad range of all the complications following URS including a rate of 0.04% of death. It is raising the concern that URS is maybe considered a minimally invasive and safety procedure with an overall complication rate of 4%, but we should not banalize this technique. We still need to improve data involving the safety and efficiency of this procedure with higher volume cohort to illustrate better the major risks of URS if done with inadvertence. Likewise, Dr. Kandasami published the first large prospective study of the impact of case volume on outcomes of URS for ureteral stones [3]. The median case volume was 67, and it was decided to be the margin between the low- and high-volume centers. The main findings were patients treated in highvolume center had shorter operative time (39.6 vs 48.3 min, p < 0.001), shorter postoperative length of stay (1.8 vs 2.3 days,
JOIN THE PREMIER RESEARCH OFFICE IN THE FIELD OF ENDOUROLOGY
Stavros Gravas, M.D. Larissa (Greece) Jorge Gutierrez-Aceves, M.D. Winston Salem (USA) Dean Assimos, M.D. Birmingham (USA) Ying-Hao Sun, M.D. Shanghai (China) Tadashi Matsuda, M.D. Osaka ( Japan)
Take part in publications and presentations that offer exposure to your institution Become a member of the global research network of Endourologists Be recognized as a centre of excellence in the field of Endourology
TREASURER John Denstedt, M.D. London (Canada)
EXECUTIVE DIRECTOR Sonja van Rees Vellinga Amsterdam (The Netherlands) [email protected]
621
RELEVANT AND NEW DATA GRACE THE CLINICAL RESEARCH OFFICE OF THE ENDOUROLICAL SOCIETY URETEROSCOPY URS STUDY GROUP COLLABORATION Jonathan Cloutier and Olivier Traxer
It is fully recognized that ureteroscopy (URS) is gaining popularity among the urologist community. The trend towards this technology is now perceived in most of the countries and for almost all ureteral and renal stone sizes. As the literature evidence level is still limited, the European guidelines continue to recommend shockwave lithotripsy (SWL) or ‘‘endourology’’ modalities for a kidney stone smaller than 2 cm, and SWL or URS for a ureteral stone [1]. Even with this popularity towards the usage of URS, greater evidence and information are needed. The Clinical Research Office of the Endourological Society (CROES) Study group has started to produce interesting and pertinent evidence due to their large prospective database collected in collaboration with 114 centers in 32 countries. It illustrated very well the interest by every endourologist to better describe this minimally invasive procedure. Their findings are helping physicians to understand what is done in the real-world practice for patients with ureteral and kidney stones. Jean de la Rosette published on behalf of the CROES URS Study group the entirely collected data of 11,885 patients [2]. They showed a low rate of pre-stented patients (19.7% of patients). It is exactly in accordance with the recommendation of the EAU guidelines that do not recommend to pre-stent the patient before a URS [1]. Moreover, what would probably be examined in a near future is the treatment of stone by URS for patients with renal abnormalities and solitary kidney. It is another advantage of this large cohort of patients that provide several renal abnormalities that are rarely observed in real life. It is difficult to publish a study with adequate number of patients with these abnormalities other than doing a multicentric collaboration. Also, they presented a broad range of all the complications following URS including a rate of 0.04% of death. It is raising the concern that URS is maybe considered a minimally invasive and safety procedure with an overall complication rate of 4%, but we should not banalize this technique. We still need to improve data involving the safety and efficiency of this procedure with higher volume cohort to illustrate better the major risks of URS if done with inadvertence. Likewise, Dr. Kandasami published the first large prospective study of the impact of case volume on outcomes of URS for ureteral stones [3]. The median case volume was 67, and it was decided to be the margin between the low- and high-volume centers. The main findings were patients treated in highvolume center had shorter operative time (39.6 vs 48.3 min, p < 0.001), shorter postoperative length of stay (1.8 vs 2.3 days,
