Objectives: To assess the success rate and intraoperative complications of flexible ureterorenoscopy (f-URS) in patients with upper urinary tract (UUT) stones using a ureteral access sheath (UAS) without a safety guide wire (SGW). Patients and methods: Between April 2010 and March 2022, 464 renal units in patients with renal stones with and without concomitant ureteral stones (UUT), underwent ureterorenoscopy by one surgeon, and UAS was used in all of them. The primary endpoint was the stone-free rate (SFR). SFR was defined as no residual fragments at all. The following characteristics were examined: age, sex, laterality, renal/ureteral stones, stone diameter, SFR, Hounsfield unit, auxiliary procedures, double-J stent insertion, and intraoperative complications. This study was retrospective, with all the data recorded prospectively. Patients with residual stones were scheduled for the 2nd RIRS. The Clavien-Dindo classification was used to report complications. Results: The mean patient age was 52.9 years. The mean stone size was 13.1 mm. Lower pole, upper and middle calyces, renal pelvis and ureteral stones were found in 51.5% (239), 34.9% (162), 18.3% (85) and 46.9% (218) of cases, respectively. The mean diameter was 8.1 mm, 8 mm, 12.5 mm and 8.1 mm for the lower pole, upper and middle calyces, renal pelvis and ureteral stones, respectively. The single- and second-session SFRs were 90% and 100%, respectively. The mean number of procedures per renal unit was 1.1. Ureteral double-J stents were inserted in 45.7% (212) of patients. In 96 cases, a stent was placed before surgery. Postoperative complications were minor, with no avulsion or perforation of the ureters; readmission and insertion of a DJ stent occurred in one patient. Ureteral stricture developed in one patient (0.2%) and needed treatment with laser ureterotomy. Conclusions: f-URS is a safe and effective mode of surgical management of renal and simultaneous renal and ureteral calculi using the ureteral access sheath without a safety guide wire. A guide wire should not be routinely used in these cases.

Background: Chemotherapy-induced peripheral neuropathy (CIPN) is a common, often debilitating side effect of several chemotherapeutic agents, particularly taxanes and platinum compounds. Current management strategies remain limited, with few agents demonstrating consistent efficacy. Our aim was to evaluate the efficacy and safety of a novel topical cream containing 1% amitriptyline and 0.5% ketamine in alleviating CIPN symptoms in oncology patients. Methods: A prospective observational study was conducted at Barzilai Medical Center following the approval of the local ethics committee. Thirty-seven patients (30 females, 7 males; age 40–75) with CIPN following taxane or platinum-based chemotherapy were treated with a topical cream applied three times daily for 28 weeks. Pain intensity was assessed using the Visual Analog Scale (VAS). Inclusion and exclusion criteria were strictly applied to ensure a homogenous cohort. Results: Initial mean VAS was 7 (range 6–10), which decreased to a final mean VAS of 3 (range 1–7). Two patients withdrew from the study, and 27 out of 35 evaluable patients (77.14%) reported significant symptoms relief. A statistically significant reduction in pain scores (p = 0.00005) was seen in our study. Only mild, transient erythema was reported as a side effect. Conclusions: This is the first clinical evaluation of a topical combination with new concentrations of amitriptyline and ketamine for CIPN. The results suggest this formulation offers a safe and effective option for symptomatic relief. Larger randomized controlled trials and exploration of transdermal delivery systems are warranted to validate these findings and optimize treatment outcomes.

Objective: To determine whether dynamic renal scans – DTPA or MAG3 – routinely performed after flexible ureteroscopies (f-URS) could detect the development of an obstruction and thus promote prompt early intervention for kidney preservation. Patients and methods: In this retrospective study, with all the data recorded prospectively between April 2010 and October 2023, 250 renal units in 242 patients with upper urinary tract stones (UUTS) who underwent ureterorenoscopy by one surgeon in the same medical center were evaluated. Stone-free rate (SFR) was defined as no residual fragments at all using an intraoperative “triple test”. The following characteristics were examined: gender, BMI, age, Hounsfield unit, stone diameter, laterality, renal/ureteral stones, stone-free rate, and auxiliary procedures per renal unit. The Clavien-Dindo classification was used to report complications. Renal units with residual stones were scheduled for a 2nd f-URS. Post- flexible ureteroscopy ureteral obstruction and renal function were detected using renal scan DTPA or MAG-3. The primary outcome was renal/ ureteral obstruction. Results: The mean patient age was 53 years. The mean stone size was 12.3 mm. Stones in renal pelvis, upper, middle and lower calyces were treated in 9.2% (23), 27.6% (69), and 30.8% (77) of cases, respectively; 44% (110) ureteral stones were also treated. The single- and second-session SFRs were 94.8% and 99.7%, respectively. A third auxiliary procedure was needed in one renal unit (0.4%). The mean number of procedures per renal unit was 1.06 (264/250). Ureteral double-J stents were inserted in 53.6% (134) of the cases. In 37 (14.8%) cases, a stent was placed before surgery. Post-operative complications were minor, with readmission and pain control needed in only two patients (0.8%). No avulsion or perforation of the ureters was observed. In six patients with t1/2 between 10-20 minutes, a second renal scan revealed spontaneous improvement and no obstruction in five patients. One patient with large stones and a history of prior ureteroscopy developed a ureteral stricture (0.4%) and needed treatment with laser endoureterotomy. Conclusions: Post-flexible ureteroscopy obstruction due to ureteral stricture is very rare. A routine renal scan post-operatively may be used in potentially high-risk patients.

Objective: To test the employment of the Goldfinger Dissector (GD) to bypass and en bloc stapling of renal hilus without vascular dissection. Thus far no study has experimented the use of this integrated technique. Patients and methods: From July 2002 to October 2020, clinical data were collected from 288 patients who underwent transperitoneal laparoscopic nephrectomies. They were divided into two groups: using GD with en bloc stapling (n = 174, group I) or the separation and ligation method (n = 114, group II) using the same Endo GIA Universal (Vascular) Stapler. Comparative analysis was carried out between the two groups, examining blood loss, operative time, intra and postoperative complications and hospital stay. Results: The mean age was 58.3 and 55.1 years in group I and II, respectively. Ratio of 90/84 and 55/59 males/females was found in group I and II, respectively.Blood loss was 65.5 ml and 188.9 ml, operative time was 156.5 and 189.2 minutes, wound infection occurred in three patients in each group (1.7% and 2.6%), ileus in 4 (2.3%) and 1 (0.87%), atrial fibrillation in 1 (0.57%) and 0%, incisional hernia in 0 (0%) and 2 (1.75%), deep vein thrombosis (DVT) in 0 (0%) and 1 (0.87%), conversion to open surgery in 2 (1.15%) and 5 (4.39%), mean hospital stay 3.5 days and 4 days in group I and II, respectively. Conclusions: Routine use of the GD and en bloc stapling of the renal pedicle in laparoscopic nephrectomy is safe and useful. This technique can decrease blood loss, operative time, and have some benefit in conversion to open surgery.

Objective: To determine whether flexible ureteroscopies (f-URS) affect renal function by performing dynamic renal scans (DTPA or MAG3) pre- and post-operatively. Patients and methods: Between April 2010 and March 2024, 945 renal units underwent ureterorenoscopy, of which 101 renal units with upper urinary tract stones (UUTS) completed a renal scan, either DTPA or MAG3 pre- and post-f-URS. The cases were divided into three groups: worsened (>10%), improved (>10%), or unaffected (stable) renal function (⩽10% change). Patient demographics, imaging data, stone properties, and treatment outcomes were comprehensively evaluated. The evaluation of postoperative complications was performed using the Clavien-Dindo classification. Results: The mean patient age was 53.4 years. The mean stone size was 11.4 mm. Renal pelvis, upper, and middle calyces, and lower pole stones were found in 12.9% (13), 28.7% (29), and 34.7% (35) of cases, respectively. Single- and second-session SFRs were 95% and 99%, respectively. A third auxiliary procedure was needed in one renal unit (1%). The mean number of procedures per renal unit was 1.06 (107/101). The mean renal function pre and post-operatively was 47.3% and 48%, respectively. The majority of patients (94.1%) had unchanged renal function. However, three female patients (3%) had a decline in differential renal function (>10%) while three patients (two males and one female) (3%) had an improvement (>10%). A re-intervention was necessary in one patient, interestingly not among those with declined renal function. Conclusions: Flexible ureteroscopy due to renal or ureteral stones has minimal to no impact on renal function. Renal scans pre- and post-operatively may be used in potentially high-risk patients.