Up-to-date guidelines on the management of upper tract urothelial carcinoma (UTUC) are continuously published. We aim to assess the variability of diagnosis and treatment strategies in the endoscopic management of UTUC and adherence to European Association of Urology and National Comprehensive Cancer Network guidelines. A 15-question survey was designed to query practitioners on approaches to clinical practice and knowledge about endoscopic treatment indications and techniques. It was emailed to all members of the Endourologic Society through the society’s office, and to all Israeli non-member endourologists. Eighty-eight urologists participated in the survey. Adherence to guidelines on indications for endoscopic management was only 51%. Most of the survey respondents (87.5%) use holmium laser for tumor ablation, and ~50% use forceps for biopsy while the other half use baskets. Only 50% stated that they would use Jelmyto^® for specific indications. Most (80%) indicated that they repeat the ureteroscopy 3 months after the first one, and 52.3% continue with follow-up ureteroscopy every 3 months during the first year after diagnosis. There is vast variability among endourologists in the technical aspects of UTUC, the indications for endoscopic management, and adherence to the available guidelines for managing UTUC.

Background: Malignant ureteral obstruction (MUO) is a sequela of advanced malignant disease that requires renal drainage, with tandem ureteral stents (TUSs) being a viable option. This study aimed to evaluate the TUS failure rate, associated risk factors, and the feasibility of replacing failed TUSs with a new pair of stents. Methods: A retrospective analysis of MUO patients treated with TUS insertion from 2014 to 2022 was conducted. TUS failure was defined as urosepsis, recurrent urinary tract infections, acute kidney failure, or new hydronephrosis on imaging. Cox proportional hazard regression analysis identified the independent predictors of TUS failure. Results: A total of 240 procedures were performed on 186 patients, with TUS drainage failing in 67 patients (36%). The median time to failure was 7 months. Multivariate analysis revealed female gender (OR = 3.46, p = 0.002), pelvic mass (OR = 1.75, p = 0.001), and distal ureteral obstruction (OR = 2.27, p = 0.04) as significant risk factors for TUS failure. Of the failure group, 42 patients (22.6%) underwent TUS replacement for a new pair. Yet, 24 (57.2%) experienced a second failure, with a median time of 4.5 months. The risk factors for TUS second failure included a stricture longer than 30 mm (OR = 11.8, p = 0.04), replacement with TUSs of the same diameter (OR = 43, p = 0.003), and initial TUS failure within 6 months (OR = 19.2, p = 0.006). Conclusions: TUS insertion for the treatment of MUO is feasible and has good outcomes with a relatively low failure rate. Primary pelvic mass and distal ureteral obstruction pose higher risks for TUS failure. Replacing failed TUSs with a new pair has a success rate of 42.8%. Consideration should be given to placing larger diameter stents when replacing failed TUS.

Background: Bilateral nephrolithiasis is typically attributed to systemic metabolic abnormalities reflected in 24 h urine studies. Yet, some individuals form stones exclusively in one kidney over long-term follow-up, while the contralateral kidney remains unaffected. This study aimed to determine whether differences in urinary metabolites can explain persistent unilateral stone formation. Methods: We retrospectively reviewed our 2011–2024 nephrolithiasis database and analyzed 24 h urine compositions obtained under regular diet and daily activity conditions. Patients were classified into three groups: bilateral stone formers (BSF), unilateral stone formers (USF), and past unilateral stone formers (PUSF)—the latter comprising patients whose stone-forming kidney was either resected or non-functioning, with urine reflecting the contralateral, stone-free kidney. Results: The study included 618 patients in the BSF group, 22 in the USF group, and eight in the PUSF group. The median follow-up duration was 83 months. After correction for multiple comparisons, the only difference between the USF and BSF groups that remained significant was higher urinary calcium in the USF group (269 vs. 184 mg/24 h; adjusted p = 0.03). The PUSF group had lower creatinine and uric acid than the other groups, and lower citrate than the USF group (adjusted p < 0.05); the differences in oxalate did not remain significant after correction. Conclusions: Standard 24 h urine parameters, which reflect combined output from both kidneys, did not account for persistent unilateral nephrolithiasis. This suggests that local renal, molecular, or genetic factors, rather than systemic metabolic differences, may underlie this phenomenon.