Article: PCNL vs. two staged RIRS for kidney stones greater than 20 mm: systematic review, meta-analysis, and trial sequential analysis - Minerva Urology and Nephrology 2024 February;76(1):31-41 - Minerva Medica - Journals

As a safe approach to the upper urinary tract, flexible ureteroscopic lithotripsy (fURL) is a widely accepted treatment for nephrolithiasis. Sometimes, this technique can rely on the natural expulsion of stones, increasing the risk of infections and stone recurrence. To mitigate these issues, some studies tried to use a suctioning ureteral access sheath (S-UAS). A systematic review was conducted across multiple databases for trials comparing S-UAS with traditional (T-UAS) in retrograde intrarenal surgery (RIRS). The primary endpoint was the stone-free rate (SFR), while adverse effects, operative time, fever rate, and hospital stay were analyzed as secondary outcomes. We retrieved 8 articles, encompassing a total of 2,255 patients, with 978 in the S-UAS group and 1,247 in the T-UAS group. Our analysis revealed a higher SFR in the S-UAS group after 1 day, and also at later time points (one or three months) (OR 3.79; 95% CI 1.70–8.46; p = 0.001; I2 = 89.2%) and (OR 1.98; 95% CI 1.52–2.59; p < 0.001; I2 = 0%), respectively. Regarding surgical complications, we observed a lower incidence in the S-UAS group (OR 0.37; 95% CI 0.26–0.51; p < 0.001; I2 = 0%), as well as a reduced fever rate (OR 0.34; 95% CI 0.24–0.48; p < 0.001; I2 = 0%) and a shorter length of hospital stay (MD -0.11; 95% CI -0.16 to -0.05; p < 0.001; I2 = 39.6%). No differences were found in the operative time between both approaches (MD -2.49; 95% CI -7.62–2.65; p < 0.343; I2 = 88.3%). Our study suggests that using S-UAS in RIRS may enhance the SFR, and also reduce both complications and hospital stay. This systematic-review and meta-analysis was prospectively registered on PROSPERO under protocol CRD42024543084.

Introduction: flexible ureteroscopy is a minimally invasive surgical technique used for the treatment of renal lithiasis. Postoperative urosepsis is a rare but potentially fatal complication. Traditional models used to predict the risk of this condition have limited accuracy, while models based on artificial intelligence are more promising. The objective of this study is to carry out a systematic review regarding the use of artificial intelligence to detect the risk of sepsis in patients with renal lithiasis undergoing flexible ureteroscopy. Methods: the literature review is in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA). The keyword search was performed in MEDLINE, Embase, Web of Science and Scopus and resulted in a total of 2,496 articles, of which 2 met the inclusion criteria. Results: both studies used artificial intelligence models to predict the risk of sepsis after flexible uteroscopy. The first had a sample of 114 patients and was based on clinical and laboratory parameters. The second had an initial sample of 132 patients and was based on preoperative computed tomography images. Both obtained good measurements of Area Under the Curve (AUC), sensitivity and specificity, demonstrating good performance. Conclusion: artificial intelligence provides multiple effective strategies for sepsis risk stratification in patients undergoing urological procedures for renal lithiasis, although further studies are needed.

Fundamento. A escolha da especialidade médica é complexa e multifatorial. A importância dos diferentes fatores varia mundialmente e está associada a diferentes valores e sistemas de educação. O objetivo do estudo é identificar os fatores que determinam essa escolha no Brasil. Métodos. Um questionário foi enviado, via internet (eletronic mail), para graduandos dos seis anos do curso de medicina, solicitando informações demográficas e a avaliação de fatores que influenciam na escolha da especialidade médica. Resultados. A idade média foi de 22 anos. Quanto à influência de familiares, 42,5% dos alunos têm pelo menos um médico como parente próximo, sendo as especialidades mais comuns desse parente: Pediatria, Ginecologia e Obstetrícia e Oftalmologia. A quantidade de respondentes que declararam certeza da carreira a ser seguida ao entrar na faculdade foi 19%, enquanto essa certeza foi de 22,2% na ocasião da pesquisa. Afinidade pela especialidade e estilo de vida foram fatores avaliados como importantes ou muito importantes por mais de 95% dos respondentes. Urgência em ganhar dinheiro rápido, tempo curto de residência, alto rendimento inicial e influência familiar foram os fatores avaliados como menos importantes pelos respondentes na escolha de sua especialidade. Quase metade dos respondentes (49,7%) descartaram uma especialidade que cogitaram fortemente, as principais razões para isso foram ter descoberto não ter afinidade pela especialidade pela qualidade de vida. Conclusões. Afinidade e estilo de vida são os fatores determinantes da escolha e da rejeição de especialidade médica em nosso meio.