Rajat Jain

Purpose: The purpose of this study was to evaluate demographic and social vulnerability factors associated with completion of electronically distributed Wisconsin Stone Quality-of-Life (WISQOL) questionnaires among patients with nephrolithiasis. Materials and Methods: We retrospectively studied all patients electronically distributed the WISQOL at an outpatient urology clinic from February 2020 to June 2025. The Social Vulnerability Index (SVI) quantified community-level socioeconomic disadvantage. Baseline demographics and SVI were compared between patients who completed at least 1 WISQOL and those who did not. Multivariable logistic regression identified independent predictors of completion, adjusting for age, sex, race, ethnicity, and high social vulnerability, defined as SVI ≥ 75th percentile. Results: Overall, 21,906 WISQOL questionnaires were distributed to 5380 patients. At the encounter level, 5124 questionnaires were completed (23.4%); at the patient level, 2120 patients completed at least 1 WISQOL (39.4%). Completers were older (62.5 vs 59.1 years, P < .001), more often White (93.8% vs 85.5%, P < .001), and more often non-Latinx (97.4% vs 95.5%, P < .001) and had lower SVI (30.9 vs 40.1, P < .001). High SVI was independently associated with lower odds of completion (OR 0.63, 95% CI 0.53-0.76, P < .001). Among completed questionnaires, high-SVI patients reported lower total WISQOL scores (73.4 vs 81.0, P < .001), indicating worse quality of life. Conclusions: Electronic WISQOL completion was low. Higher SVI independently predicted lower completion and worse reported quality of life, suggesting targeted strategies are needed to improve equity in PRO collection among stone patients overall.

Introduction: Operating room (OR) noise during holmium laser enucleation of the prostate (HoLEP), particularly from laser activation, may impair surgical workflow and staff performance. Methods: 84 HoLEP procedures were recorded at three academic institutions between June 2024 and January 2026. Laser platforms included Lumenis Moses 2.0, Quanta Litho 150, Quanta Magneto, and Dornier Thulio. Sound measurements were obtained using a standardized smartphone‐based system during three phases: laser‐off (baseline), idle (not firing), and active lasing. Acoustic metrics included average sound level (LAeq), peak sound level (Lcpeak), and sound levels exceeded for 10%, 50%, and 90% of the recording time (L10, L50, and L90). Background noise correction was performed using baseline measurements to account for ambient noise and isolate laser‐related sound. OR staff completed a validated survey assessing perceived noise burden (0–10 scale). Results: Background‐corrected noise during active lasing differed significantly by platform. Litho demonstrated lower mean noise levels compared to Thulio for LAeq (60.6 vs. 68.2 dB, p = 0.023) and L10 (61.5 vs. 70.6 dB, p = 0.023), while Moses had higher LAeq compared to Litho (63.1 vs. 60.6 dB, p = 0.043). Overall, Litho had the lowest noise levels, whereas Thulio had the highest. Survey responses paralleled these findings. Litho was associated with lower perceived overall effort (2.1 ± 0.9), while Moses demonstrated higher overall effort (3.6 ± 1.2) for communication and concentration (Figure 2). Significant pairwise differences were observed between Moses and Litho (all p < 0.05). Trends were consistent across sites. Conclusions: Noise levels during HoLEP varied by laser technology and correlated with differences in perceived communication and cognitive effort. Litho demonstrated the lowest acoustic burden, while Moses and Thulio had higher noise exposure. These findings highlight the impact of laser selection on the OR environment and intraoperative team performance.

Objective: Holmium laser enucleation of the prostate (HoLEP) has emerged as a gold standard for the surgical treatment of benign prostatic hyperplasia (BPH). Modern pulse‐modulated laser systems aim to improve enucleation efficiency and procedural safety, but no head‐to‐head comparison has been reported between MOSES 2.0 and QUANTA 150. This study provides a direct comparative analysis of perioperative efficiency and safety between these two technologies. Methods: We performed a retrospective analysis of HoLEP procedures performed by a single surgeon between July 2023 and June 2024. Patients were grouped by laser platform (MOSES or QUANTA). The primary outcome was total operative time. Secondary outcomes included enucleation and morcellation parameters, perioperative characteristics, and 30‐day outcomes. Multivariable regression models adjusted for age, Charlson comorbidity index, anticoagulant use, and prostate volume were used to control for confounding. Results: A total of 196 patients were included (132 MOSES, 64 QUANTA). The MOSES cohort had higher comorbidity and anticoagulant use ( p < 0.05). After adjustment, QUANTA was associated with significantly shorter total operative, enucleation, laser, and energy times. Morcellation speed was faster with QUANTA ( p = 0.034), while absolute morcellation time was comparable ( p = 0.08). Enucleation speed was also higher ( p = 0.017), and energy efficiency was similar. Site‐related workflow differences may have contributed to nonoperative time variation. Postoperative outcomes—including LOS, catheter duration, hematuria, retention, and 30‐day events—were similar. Conclusion: Both laser systems demonstrated excellent safety. QUANTA 150 was associated with greater procedural efficiency in this single‐surgeon, dual‐site experience, underscoring the need for further prospective evaluation across practice settings.

Purpose Primary hyperparathyroidism (PHPT) patients who undergo parathyroidectomy (PTX) have significantly reduced rates of kidney stone events based on imaging and patient-reported history. However, there has been limited knowledge on the impact of PTX on stone disease requiring surgical intervention. The aim of this study was to compare the incidence of kidney stone surgery before and after PTX. Methods PHPT patients who underwent PTX from 2015–2023 at our institution were retrospectively reviewed. We evaluated the incidence of kidney stone treatment by shockwave lithotripsy (SWL), ureteroscopy (URS) and percutaneous nephrolithotomy (PCNL) based on CPT codes. Univariate and multivariate analyses were performed to compare the incidence rate before and after PTX. Results We included 1554 patients who underwent PTX and identified 101 kidney stone surgeries. Patients were 75% female, 16% non-white race and had a median age of 63 years (IQR 55–71) at the time of PTX. The median follow-up time was 5.2 years before and 3.3 years after PTX. The incidence of kidney stone surgery in patients pre- vs post-PTX was 80 events/7668 person-years (1.0%) vs 21 events/5318 person-years (0.4%) respectively, (p < 0.0001). Thus, the incidence rate of requiring stone surgery decreased by 2.64 times following PTX (95% CI 1.62–4.50, p < 0.0001). The cases of URS and SWL decreased whereas the cases of PCNL increased (p < 0.02). Conclusion The incidence of stone disease requiring surgical intervention significantly decreased following PTX. It remains critical to screen recurrent stone formers for PHPT, as surgical correction with PTX may help reduce subsequent stone surgeries and associated comorbidities.

Purpose of Review The goal of this paper was to identify the factors contributing to urinary incontinence in patients undergoing holmium laser enucleation of the prostate (HoLEP) for benign prostatic hyperplasia by performing a systematic review of the literature. Recent Findings Our search identified 40 randomized studies. Significant heterogeneity existed in defining urinary incontinence in the literature. Many factors contribute to postoperative incontinence after HoLEP, with surgical technique seeming to play the largest role in determining continence outcomes. Summary Refinement of surgical technique is critical to improving continence outcomes after HoLEP. Standardizing definitions of urinary incontinence will enable more reliable comparisons across studies and facilitate better-informed preoperative counseling. Continued investigation is also essential to develop interventions—whether surgical, behavioral, or pharmacologic—that enhance continence recovery and overall quality of life.

Purpose: The Wisconsin Stone Quality of Life (WISQOL) questionnaire is a survey-based tool that has been used to show worse health-related quality of life due to stone disease. The minimum clinically important difference threshold for determining whether changes in the WISQOL tool are meaningfully significant has not previously been estimated. Our study aimed to determine this threshold using distribution- and anchor-based methods. Materials and Methods: A retrospective single-center cohort of patients at a kidney stone clinic was administered the WISQOL questionnaire at initial and follow-up visits from January 2018 to November 2023. Baseline characteristics and WISQOL standardized scores and subdomain scores were recorded. Distribution-based estimates were calculated at the initial visit and at follow-up. Three anchor questions were used to create a global transition question scale. Cross-sectional, longitudinal within-group, and longitudinal between-group anchor-based estimates were calculated. Results: The cohort included 1197 individuals with both an initial clinic visit and a follow-up visit. The distribution-based minimum clinically important difference estimates ranged from 3.5 to 10.8. Cross-sectional anchor-based estimates ranged from 3.1 to 13.6. Within-group anchor-based estimates for improvement ranged from 8.5 to 10.3 and for deterioration ranged from 3.1 to 6.3. Between-group anchor-based estimates for improvement were 9.1 (adjusted confidence interval [CI]: 7.5–10.8) and for deterioration were 4.2 (adjusted CI: 2.3–6.1). Conclusions: A conservative threshold for clinical significance in total WISQOL score (standardized to scale of 0–100) is a difference of 9 for both improvement and deterioration. These findings can be used to further implement WISQOL in guiding clinical decision-making.

Background: There is no standard analgesic pathway after percutaneous nephrolithotomy. At our institution, an Enhanced Recovery After Surgery (ERAS) pathway was instated that included a preoperative erector spinae plane (ESP) block to improve pain control and minimize opioid usage in the postoperative setting. Materials and methods: At our institution, an ERAS pathway was created for patients undergoing percutaneous nephrolithotomy. This pathway involved a preoperative ESP block and the replacement of opioids with multimodal analgesia. Patient charts were retrospectively reviewed and placed into 2 cohorts: one cohort participated in the ERAS pathway, whereas the other received traditional pain control. The primary outcome evaluated was postoperative morphine equivalents received. Secondary outcomes included nursing pain scores, opioid prescriptions for home, and quality of life. Descriptive statistics were performed by nonparametric Mann-Whitney U and χ ² tests for continuous and categorical variables, respectively. Results: Sixty patients were identified in the ERAS cohort versus 70 in the traditional pain control cohort. There was a statistically significant difference in average postoperative morphine equivalents received (17.0 vs. 39.9, p < 0.01) and average postoperative nursing pain score (2.4 vs. 3.6, p < 0.01). Fifty-three percent (32/60) of patients in the ERAS cohort received an opioid prescription for home compared with 80% (56/70) in the traditional cohort (p < 0.01). There was no significant quality-of-life difference between the groups. No adverse patient events resulted from the block. Conclusions: An ERAS pathway including a preoperative ESP block and multimodal analgesia decreased morphine equivalents received and nursing pain scores. Future randomized prospective studies with the ERAS protocol can be considered.