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  1. Ong Lay Keat W, Lechmiannandan S, Manoharan D, Lee SB, Nagalingam P
    Int J Surg Case Rep, 2020;73:161-163.
    PMID: 32688238 DOI: 10.1016/j.ijscr.2020.07.013
    INTRODUCTION: Testicular infarction as a result of severe epididymo-orchitis is an uncommon urological emergency, with only a handful of reported cases in literature. We report an even rarer case of bilateral epididymo-orchitis complicated with testicular infarction, resulting in bilateral orchidectomy.

    PRESENTATION OF CASE: 49 year old gentleman presented with fever, persistent, unresolving pain and scrotal swelling of two weeks duration. Despite close clinical monitoring, timely ultrasounds of the testis and antibiotics there was an inexorable progression to bilateral testicular ischemia.

    DISCUSSION: This is only the second reported case of this nature in published literature. Epididymo-orchitis usually responds well to appropriate antibiotic therapy, although progression to testicular infarction is possible.

    CONCLUSION: Clinical presentation of persistent scrotal pain and oedema in cases of epididymo-orchitis should raise strong suspicion of testicular ischemia or infarction. Despite all efforts, progression to bilateral testicular infarction resulting in castration is a possible catastrophic outcome.

  2. Emiliani E, Sanz-Gómez I, Somani B, Tailly T, Castellani D, Traxer O, et al.
    Actas Urol Esp (Engl Ed), 2023 Nov;47(9):581-587.
    PMID: 37369300 DOI: 10.1016/j.acuroe.2023.06.008
    INTRODUCTION AND OBJECTIVES: As well established flexible ureteroscopy (RIRS). There is still no evidence if gender can have any influence on the outcomes and complication when performing. This study aims to evaluate the role that gender has in performing flexible ureteroscopy from a large series of patients.

    METHODS: This study retrospectively analyzed patients who underwent RIRS for renal stones from January 2018 to August 2021 within the multicentric FLEXOR registry. Demographics, stone characteristics, perioperative findings, results and complications were analyzed and compared between gender groups.

    RESULTS: A total of 6669 patients were included, 66.1% were male and 33.9% were female. Stone characteristics was comparable between groups. Female patients had significant higher fever and positive urine culture rates (12% vs. 8% and 37% vs. 34%). Also, females had a slight longer hospital stay (3.8 vs. 3.5 days; P 

  3. Castellani D, Fong KY, Lim EJ, Chew BH, Tailly T, Emiliani E, et al.
    J Urol, 2023 Aug;210(2):323-330.
    PMID: 37126223 DOI: 10.1097/JU.0000000000003504
    PURPOSE: We evaluated stone-free rate and complications after flexible ureteroscopy for renal stones, comparing thulium fiber laser and holmium:YAG laser with MOSES technology.

    MATERIALS AND METHODS: Data from adults who underwent flexible ureteroscopy in 20 centers worldwide were retrospectively reviewed (January 2018-August 2021). Patients with ureteral stones, concomitant bilateral procedures, and combined procedures were excluded. One-to-one propensity score matching for age, gender, and stone characteristics was performed. Stone-free rate was defined as absence of fragments >2 mm on imaging within 3 months after surgery. Multivariable logistic regression analysis was performed to evaluate independent predictors of being stone-free.

    RESULTS: Of 2,075 included patients, holmium:YAG laser with MOSES technology was used in 508 patients and thulium fiber laser in 1,567 patients. After matching, 284 patients from each group with comparable baseline characteristics were included. Pure dusting was applied in 6.0% of cases in holmium:YAG laser with MOSES technology compared with 26% in thulium fiber laser. There was a higher rate of basket extraction in holmium:YAG laser with MOSES technology (89% vs 43%, P < .001). Total operation time and lasing time were similar. Nine patients had sepsis in thulium fiber laser vs none in holmium:YAG laser with MOSES technology (P = .007). Higher stone-free rate was achieved in thulium fiber laser (85% vs 56%, P < .001). At multivariable analysis, the use of thulium fiber laser and ureteral access sheath ≥8F had significantly higher odds of being stone-free. Lasing time, multiple stones, stone diameter, and use of disposable scopes showed significantly lower odds of being stone-free.

    CONCLUSIONS: This real-world study favors the use of thulium fiber laser over holmium:YAG laser with MOSES technology in flexible ureteroscopy for renal stones by way of its higher single-stage stone-free rate.

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