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To establish a safer and more efficient treatment strategy with mini-endoscopic combined intrarenal surgery (ECIRS), the present study aimed to develop models to predict the outcomes of mini-ECIRS in patients with renal and/or ureteral stones. We retrospectively analysed consecutive patients with renal and/or ureteral stones who underwent mini-ECIRS at three Japanese tertiary institutions. Final treatment outcome was evaluated by CT imaging at 1 month postoperatively and stone free (SF) was defined as completely no residual stone or residual stone fragments ≤ 2 mm. Three prognostic models (multiple logistic regression, classification tree analysis, and machine learning-based random forest) were developed to predict surgical outcomes using preoperative clinical factors. Clinical data from 1432 ECIRS were pooled from a database registered at three institutions, and 996 single sessions of mini-ECIRS were analysed in this study. The overall SF rate was 62.3%. The multiple logistic regression model consisted of stone burden ( P  < 0.001), number of involved calyces ( P  < 0.001), nephrostomy prior to mini-ECIRS ( P  = 0.091), and ECOG-PS ( P  = 0.110), wherein the area under the curve (AUC) was 70.7%. The classification tree analysis consisted of the number of involved calyces with an AUC of 61.7%. The random forest model showed that the top predictive variable was the number of calyces involved, with an AUC of 91.9%. Internal validation revealed that the AUCs for the multiple logistic regression model, classification tree analysis and random forest models were 70.4, 69.6 and 85.9%, respectively. The number of involved calyces, and a smaller stone burden implied a SF outcome. The machine learning-based model showed remarkably high accuracy and may be a promising tool for physicians and patients to obtain proper consent, avoid inefficient surgery, and decide preoperatively on the most efficient treatment strategies, including staged mini-ECIRS.

Mini-endoscopic combined intrarenal surgery (ECIRS) offers improved advantages in the treatment of renal stones. However, the factors influencing the operative time remain poorly understood. This study aimed to identify the factors that enhance treatment planning and minimize complications. Clinical data from consecutive patients who underwent mini-ECIRS for renal stones and achieved a stone-free status between 2015 and 2021 at three high-volume centers in Japan were analyzed. The final treatment outcome was evaluated by computed tomography imaging at postoperative 1 month, and a successful outcome was defined as complete stone-free or residual stone fragments < 4 mm. Logistic and linear regression models were used to predict the operative duration of mini-ECIRS. An operative time of ≥ 120 min was significantly associated with punctured pole and body mass index (BMI), and septic shock was only observed in patients with operative times of ≥ 120 min. The multivariate model for the operative time for mini-ECIRS identified five clinical factors: punctured pole, number of stones, number of involved calyces, BMI, and preoperative nephrostomy. We believe these findings will help surgeons and patients plan suitable treatment strategies, predict the additional need for a second mini-ECIRS or retrograde intrarenal surgery alone, and avoid severe complications.

Background AUS implantation is the standard treatment recommended by the European Urological Association and American Urological Association guidelines to treat stress urinary incontinence due to intrinsic sphincter deficiency. AUS implantation following a neobladder construction or urethroplasty has been previously reported; however, there are only a few reports on patients who have undergone both procedures.This report presents a unique case of a patient who underwent artificial urinary sphincter (AUS) implantation after undergoing both urethroplasty and ileal neobladder construction. Case presentation A 76-year-old male with a history of urethral stricture and ileal neobladder construction was referred to our department because of persistent stress urinary incontinence. A pressure-regulating balloon was placed in the left lower abdomen, where the peritoneum remained intact. The AUS was activated and urinary continence was restored approximately seven weeks post-surgery. In addition to standard usage instructions, the patient was advised on timed voiding and deactivation during the night and in the event of fever. Urinary incontinence significantly improved, and the effectiveness was maintained without complications one year post-surgery. Device infection and urethral erosion are critical complications that should be considered during AUS implantation. We focused on the site of AUS implantation and perioperative infection control to solve this problem. Conclusion AUS implantation was performed in the patient who underwent both urethroplasty and ileal neobladder construction. We felt that meticulous measures during and after the perioperative period are necessary to prevent urethral erosion and device infection.

This study aimed to develop a prediction model for the operative time of flexible ureteroscopy (fURS) for renal stones. We retrospectively evaluated patients with renal stones who had been treated successfully and had stone-free status determined by non-contrast computed tomography (NCCT) 3 months after fURS and holmium laser lithotripsy between December 2009 and September 2014 at a single institute. Correlations between possible factors and the operative time were analyzed using Spearman's correlation coefficients and a multivariate linear regression model. The P value < 0.1 was used for entry of variables into the model and for keeping the variables in the model. Internal validation was performed using 10,000 bootstrap resamples. Flexible URS was performed in 472 patients, and 316 patients were considered to have stone-free status and were enrolled in this study. Spearman's correlation coefficients showed a significant positive relationship between the operation time and stone volume (ρ = 0.417, p < 0.001), and between the operation time and maximum Hounsfield units (ρ = 0.323, p < 0.001). A multivariate assessment with forced entry and stepwise selection revealed six factors to predict the operative time of fURS: preoperative stenting, stone volume, maximum Hounsfield unit, surgeon experience, sex, and sheath diameter. Based on this finding, we developed a model to predict operative time of fURS. The coefficient of determination (R2) in this model was 0.319; the mean R2 value for the prediction model was 0.320 ± 0.049. To our knowledge, this is the first report of a model for predicting the operative time of fURS treatment of renal stones. The model may be used to reliably predict operative time preoperatively based on patient characteristics and the surgeons' experience, plan staged URS, and avoid surgical complications.

To investigate the efficacy and safety of a second-generation bipolar transurethral electro vaporization of the prostate (B-TUVP) with the new oval-shaped electrode for large benign prostatic enlargement (BPE) with prostate volume (PV) ≥100ml. 100 patients who underwent second-generation B-TUVP with the oval-shaped electrode for male lower urinary tract symptom (LUTS) or urinary retention between July 2018 and July 2020 were enrolled in this study. The patients' characteristics and treatment outcome were retrospectively compared between patients with PV <100ml and ≥100ml. 17/41 (41.5%) cases of PV ≥100ml and 24/59 cases (40.7%) of PV <100ml were catheterised due to urinary retention. The duration of post-operative catheter placement and hospital-stay of PV ≥100ml (3.1±1.3 and 5.6±2.3 days) were not different from PV <100ml (2.7±1.2 and 5.0±2.4 days). In uncatheterised patients (N = 59), post-void residual urine volume (PVR) significantly decreased after surgery in both groups, however, maximum uroflow rate (Qmax) significantly increased after surgery only in PV <100ml but not in PV ≥100ml. Voiding symptoms and patients' QoL derived from International Prostate Symptom Score (IPSS), IPSS-QoL (IPSS Quality of Life Index) and BPH Impact Index (BII) scores, significantly improved after B-TUVP in both groups. Catheter free status after final B-TUVP among patients with preoperative urinary retention was achieved in 18/24 (75.0%) and 14/17 (82.1%) cases in patient with <100ml and ≥100ml, respectively. There was no significant difference in post-operative Hb after B-TUVP, which was 97.0±5.4% of baseline for PV <100ml and 96.9±6.1% for PV ≥100ml and no TUR syndrome was observed. This is the first study investigating short-term efficacy and safety of second-generation B-TUVP with the oval-shaped electrode on large BPE. B-TUVP appears to be effective and safe for treating moderate-to-severe lower urinary tract symptoms and urinary retention in patients with large BPE.

Introduction Testicular injury with a tunica albuginea tear is typically reconstructed by primary closure. We herein describe the successful use of a tunica vaginalis flap for reconstruction of a ruptured testis for which primary closure was not possible. Case presentation A 21‐year‐old man visited our hospital with scrotal swelling after a baseball struck his left testis. Magnetic resonance imaging and ultrasonography indicated a left tunica albuginea tear, and emergency surgery was performed. Primary closure of the tunica albuginea was impossible since a tight closure could cause secondary damage. A vascular pedicle flap was prepared by shaping the tunica vaginalis to replace the tunica albuginea. He was discharged 2 days postoperatively. Ultrasonography showed normal size and blood flow in the ruptured testis at the 2‐week and 3‐month follow‐up. Conclusion A testicular vaginalis flap should be considered when primary closure is difficult in cases of testicular rupture with tunica albuginea damage.

Objectives. To retrospectively compare the operative and clinical outcomes of flexible ureteroscopic lithotripsy (fURSL) with stone extraction performed either by a surgeon (SE) who manipulates the retrieval basket or by having the surgical assistant (AE) manipulate the retrieval basket with the aim of clarifying which method provides a greater stone-free postoperative status. Methods. The study group consisted of patients who underwent fURSL with SE or AE at our institution between April 2015 and December 2016. Demographic, clinical, stone, and operative variables were compared between the two groups. Multivariate logistic regression was used to identify risk factors associated with a stone-free and non-stone-free status postoperatively. Results. Our analysis included 196 cases of renal stones treated using fURSL, with 109 who underwent AE and 87 who underwent SE. The rate of stone-free status was higher for the SE group (90.8%) than for the AE group (61.5%; P<0.001). The method of extraction was identified as an independent predictor of stone-free status (P<0.001, odds ratio (SE compared to AE), 9.133, 95% confidence interval, 3.736–22.322). Conclusion. The stone-free rate is improved by having the surgeon perform the stone extraction as part of the fURSL procedure.

This paper describes a case of renal pelvic cancer with a complete duplication of the renal pelvis and ureter, which is substantially rare. A 76-year-old man was referred to the hospital because of gross hematuria for 2 years. A tumor was detected in the upper right kidney using enhanced computed tomography and magnetic resonance imaging scan, and the downstream ureter was suspected to open into the prostate. Retrograde ureteroscopy via the ectopic ureter orifice showed a hemorrhagic papillary tumor consistent with imaging findings. Laparoscopic radical nephroureterectomy was performed and the prostate was preserved because the tumor was only in the renal pelvis. Histopathological examination showed the tumor as a high-grade urothelial carcinoma. There was no sign of recurrence at one and a half years after operation. Ureteroscopy was effective in detecting an upper urinary tract tumor, even via ectopic ureter orifice, and preserving the prostate was possible.

Introduction Management of a complicated urethral stricture is a urological challenge. We present a case of a complicated urethral stricture successfully treated using augmented anastomotic urethroplasty. Case presentation A 48‐year‐old man visited our department for the treatment of urethral stricture, for which repeated transurethral procedures had failed. The operative view revealed that the urethral lumen was, in fact, completely obliterated over a 30‐mm segment. We proceeded with augmented anastomotic urethroplasty. After the excision of the obliterated lesion, the ventral half of the bulbar urethral ends was anastomosed and their dorsal half was subsequently augmented via buccal mucosa spread and then fixed to the corpus cavernosa. There has been no indication of recurrence, 4 months after the procedure. Conclusion Augmented anastomotic urethroplasty is a useful technique for repairing a complicated bulbar stricture. Urologists should understand appropriate indications for each treatment method so as to not make cases more complicated to treat.