Endourology Research

Endourology is a unique field in urology involving cutting edge technology which provides an opportunity for clinical and basic science research for design and evaluation of the various devices. This subspecialty in urology uses minimally invasive techniques to inspect the urinary tract and perform surgery. The two most common treated conditions are kidney stones, which affect 10.6% of men and 7.1% of women in the United States population, and benign prostatic enlargement, which affects 50% of men at age 60 and older.

Basic Science Research

Laser technology has revolutionized the treatment for urinary stones. Two novel platforms have shown promising results with respect to stone ablation; The Soltive SuperPulsed Laser System (Olympus) uses a thulium fiber laser (TFL) which offers very high frequency (200-400 hz), small diameter fibers, higher absorption coefficient, and better portability. The new Moses 2.0 Holmium laser device (Lumenis) offers higher energy output and a novel laser pulse modulation specifically designed for stone treatment. While both devices have shown promising results, they have not been compared prospectively. This study aimed to compare the stone ablation time between the two lasers.

Urinary tract infections are common among urologic patients. While urine culture is recommended prior to any urological intervention, a patient's prior urine cultures are often considered when choosing empiric antibiotic therapy. Previous studies in non-urologic patients have shown that the concordance between two positive consecutive urine cultures is inversely related to the duration between them.

Patients with urinary foreign bodies or kidney stones often harbor several bacterial strains as a result of biofilm formation. As such, they are more likely to develop infections with different pathogens. This study seeks to evaluate how well previous urine cultures predict the identity and susceptibility of organisms in a patient's subsequent urine cultures among urologic patients.

Initial treatment of urinary stone disease often occurs in the emergency department and frequently includes administration of α-adrenergic receptor blockers (α-blockers) to promote stone passage, commonly referred to as medical expulsive therapy. The presumed mechanism of action of α-blockers is inhibition of smooth muscle contraction in the ureter, facilitating passage of the stone into the bladder. Most recent rigorous systematic review and meta-analysis concluded that its effectiveness is mainly for larger stones. However, since then, several large clinical trials have shown no benefit for this treatment. It is well established that Tamsulosin 0.8 mg is more effective than 0.4 mg in relieving BPH symptoms. However, the effect of increased dose on stone passage rate has not been studied. This study seeks to compare the stone passage rate of ureteral stone with Tamsulosin 0.8 mg vs placebo.

Adonis Hijaz, MD, Irina Jaeger, MD, Jonathan Shoag, MD

Novel minimally invasive therapies like the prostatic urethral lift (PUL) are among the many endoscopic options for the treatment of benign prostatic enlargement and lower urinary tract symptoms (BPE/LUTS). To further understand the relative uptake, complications and retreatment rates of contemporary endoscopic procedures for BPE/LUTS across diverse practice types, we performed a retrospective study of inpatient and ambulatory surgery encounters in the Premier Healthcare database.

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