Purpose of Review: The prevalence of kidney stones is rising and historically carries a preponderance for males. However, recent evidence has questioned whether this gender gap is closing. The aim of this systematic review was to examine this further as well as evaluate possible underlying causes. Recent Findings: Recent evidence confirms the disparity in kidney stone disease between genders is closing. In the modern era, the rise in prevalence among females has been greater, especially in adolescence. Quality of life is also more adversely affected by kidney stone events among females who are also more likely to develop sepsis after endourological surgery. Males, however, are more likely to present with stone events during periods of high ambient temperatures Summary: Recent literature demonstrates a temporal change in the disease burden of KSD among men and women. The latter, especially adolescent females, are more likely to develop KSD in their lifetime compared to previous eras. Determining causation is complex and continued research is warranted.

To compare and evaluate the safety and efficacy of holmium laser enucleation of the prostate (HoLEP) and simple prostatectomy for large prostate burdens, as discussion and debate continue about the optimal surgical intervention for this common pathology. A systematic search was conducted for studies comparing HoLEP with simple prostatectomy [open (OP), robot-assisted, laparoscopic] using a sensitive strategy and in accordance with Cochrane collaboration guidelines. Primary parameters of interest were objective measurements including maximum urinary flow rate (Q max) and post-void residual urine volume (PVR), and subjective outcomes including International Prostate Symptom Score (IPSS) and quality of life (QoL). Secondary outcomes of interest included volume of tissue retrieved, catheterisation time, hospital stay, blood loss and serum sodium decrease. Data on baseline characteristics and complications were also collected. Where possible, comparable data were combined and meta-analysis was conducted. In all, 310 articles were identified and after screening abstracts (114) and full manuscripts (14), three randomised studies (263 patients) were included, which met our pre-defined inclusion criteria. All these compared HoLEP with OP. The mean transrectal ultrasonography (TRUS) volume was 113.9 mL in the HoLEP group and 119.4 mL in the OP group. There was no statistically significant difference in Q max, PVR, IPSS and QoL at 12 and 24 months between the two interventions. OP was associated with a significantly shorter operative time (P = 0.01) and greater tissue retrieved (P < 0.001). However, with HoLEP there was significantly less blood loss (P < 0.001), patients had a shorter hospital stay (P = 0.03), and were catheterised for significantly fewer hours (P = 0.01). There were no significant differences in the total number of complications recorded amongst HoLEP and OP (P = 0.80). The results of the meta-analysis have shown that HoLEP and OP possess similar overall efficacy profiles for both objective and subjective disease status outcome measures. This review shows these improvements persist to at least the 24 month follow-up point. Further randomised studies are warranted to fully determine the optimal surgical intervention for large prostate burdens.

Ureteral access sheaths (UASs) are part of urologist’s armamentarium when performing retrograde intrarenal surgery (RIRS). Recently, the world of RIRS has changed dramatically with the development of three game-changers: thulium fiber laser (TFL), smaller size single use digital flexible ureterosopes and intraoperative intrarenal pressure (IRP) measurement devices. We aimed to clarify the impact of UASs on IRP, complications and SFRs and put its indications in perspective of these three major technological improvements. A systematic review of the literature using the Medline, Scopus and Web of Science databases was performed by two authors and relevant studies were selected according to PRISMA guidelines. Recent studies showed that using a UAS lowers IRP and intrarenal temperature by increasing irrigation outflow during RIRS. Data on the impact of a UAS on SFRs, postoperative pain, risk of infectious complications, risk of ureteral strictures and risk of bladder recurrence of urothelial carcinoma after diagnostic RIRS were inconclusive. Prestenting for at least one week resulted in ureteral enlargement, while the influence of pre-operative administration of alpha-blockers was unclear. Since TFL, smaller single use digital ureteroscopes and devices with integrated pressure-measuring and aspiration technology seemed to increase SFRs and decrease pressure and temperature related complications, indications on the use of a UAS may decrease in the near future.

Purpose of Review: Artificial intelligence (AI) chatbots have emerged as a potential tool to transform urology by improving patient care and physician efficiency. With an emphasis on their potential advantages and drawbacks, this literature review offers a thorough assessment of the state of AI-driven chatbots in urology today. Recent Findings: The capacity of AI-driven chatbots in urology to give patients individualized and timely medical advice is one of its key advantages. Chatbots can help patients prioritize their symptoms and give advice on the best course of treatment. By automating administrative duties and offering clinical decision support, chatbots can also help healthcare providers. Before chatbots are widely used in urology, there are a few issues that need to be resolved. The precision of chatbot diagnoses and recommendations might be impacted by technical constraints like system errors and flaws. Additionally, issues regarding the security and privacy of patient data must be resolved, and chatbots must adhere to all applicable laws. Important issues that must be addressed include accuracy and dependability because any mistakes or inaccuracies could seriously harm patients. The final obstacle is resistance from patients and healthcare professionals who are hesitant to use new technology or who value in-person encounters. Summary: AI-driven chatbots have the potential to significantly improve urology care and efficiency. However, it is essential to thoroughly test and ensure the accuracy of chatbots, address privacy and security concerns, and design user-friendly chatbots that can integrate into existing workflows. By exploring various scenarios and examining the current literature, this review provides an analysis of the prospects and limitations of implementing chatbots in urology.

Ureteroscopy and laser stone fragmentation (URSL) has had recent advancements with the more powerful laser systems with the ability to ‘dust’ and ‘pop-dust’ the stone. We wanted to look at the outcomes of this method for large stones (≥ 15 mm) using our new 100 W holmium laser. Over a period of 16 months (January 2017–April 2018), 50 patients underwent URSL for minimum cumulative stone size of ≥ 15 mm. Data were collected prospectively on patient and stone demographics and outcomes of URSL. The laser setting used was a power of 0.3–0.6 J and a frequency of 20–50 Hz using a long-pulse setting with a 272-µm fiber. Fifty patients underwent 55 URSL procedures (5 bilateral procedures) using dusting and pop-dusting settings. The mean age was 58 years (range 2–88 years) with a male:female ratio of 35:15. The mean single and overall stone size were 10.3 mm (3–23 mm) and 21 mm (range 15–52 mm) with two-thirds of all patients (65%) having multiple stones. The stone location was in the kidney (n = 65, 78%), in the ureter (n = 19, 22%) and 5 patients had bilateral renal stones. With a mean operating time of 51 min, the initial and final SFR were 93 and 98%, respectively. A pre-operative stent, access sheath and a post-operative stent were present in 29 (53%), 34 (62%) and 51 (93%) procedures, respectively. Over a mean hospital stay of 0.6 days (74% day-case procedures), there was one Clavien IV complication related to urosepsis but without any other major or minor complications. Dusting and pop-dusting techniques achieve an excellent SFR with low risk of complications even for large stones. This might set a new benchmark for treating large stones, bilateral or multiple stones in a single setting, without the need for secondary procedures in most cases.