Smita De

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.

In this month’s issue, Tsai et al

Percutaneous nephrolithotomy (PCNL) is a common technique in the surgical management of renal lithiasis, but it also represents a significant workload for surgeons. Factors such as the patient's position and the type of lithotripter used influence the physical and mental load on the surgeon. The study aimed to identify stressors related to PCNL by comparing the physical and mental workload experienced by urologists during PCNL under different patient positions and using two lithotripters. Four expert endourologists were evaluated when simulating PCNL at four different conditions: prone and supine, using the Lithoclast Master (LM) or Lithoclast Trilogy (LT) devices. Physical load was measured using electromyography, while mental load was analyzed by measuring the heart rate variation (HRV). After each simulation, cylindrical grip strength was evaluated using a Jamar dynamometer, and the Surgery Task Load Index (SURG-TLX) questionnaire was applied. Differences in muscle activation were observed, with greater activation in the LT-Prone position, where the erector spinae reached 27.7%. This was reflected in increased mental, physical, and temporal demands. Similarly, overactivation of the wrist extensor, averaging 229%, was related to back muscle fatigue, when compared to low activation (10%). No significant differences were found in grip strength, while a greater HRV was observed with LT in both positions. We observed differences in physical and mental fatigue related to patient position, the lithotripter used and the surgeon's muscle activation. This pilot study gives insights into conditions that should be considered to enhance urologist performance and prevent injuries during PCNL.

Background: The etiology of benign prostatic hyperplasia (BPH) is not well understood, though recent literature suggests that the urinary tract microbiome may play a role. We aimed to examine the prostatic microbiome in BPH and its associations with patient characteristics.Methods: Men undergoing Holmium Laser Enucleation of the Prostate (HoLEP) were recruited if they were over 18 years old and had no history of prostate cancer, prostate surgery, or pelvic radiation. Exclusion criteria included positive preoperative urine culture, bladder stones, or catheter‐dependence. Patient characteristics including age, prostate‐specific antigen (PSA), American Urological Association symptom score (AUASS), and history of biopsy were recorded. Intraoperatively, prostate tissue was collected from each patient, as well as catheterized urine, urethral swabs, and swabs of the specimen container. Samples underwent DNA extraction, 16S sequencing, and analysis using R statistical software. Associations between bacterial taxonomic diversity and patient characteristics were quantified through Sparcc correlations.Results: Fifty patients were recruited. Mean age, PSA, prostate size, and AUASS were 67.8 years, 4.0 ng/mL, 108.6 g, and 19.4, respectively. After bioinformatic decontamination of prostate samples, alpha and beta diversity analyses indicated that microbiomes from the prostate, urethra, and urine were all distinct (p = 0.001); microbiota from the urine and urethra had higher similarity to each other than that of the prostate. Campylobacter, Caryophanaceae, Enterobacter, and Senegalimassilia positively correlated with prostate size or PSA.Conclusions: The prostatic microbiome is unique and distinct from that of urine and urethra, with several known pathogens positively correlating with prostate size and PSA.

Introduction: Medical management of recurrent kidney stones utilizes 24-hour urine testing to guide counseling and therapy. Poor socioeconomic status is a well-established risk factor for urolithiasis; however, associations are often based on complex statistics not readily accessible in clinical practice. Area Deprivation Index (ADI) is a quantitative measure of socioeconomic status based on United States census variables reflecting neighborhood disadvantage and is reportable in the electronic medical record. This study aimed to characterize relationships between ADI and metabolic risk factors for urolithiasis. Materials and Methods: Retrospective review of patients undergoing percutaneous nephrolithotomy (PCNL) from 2017 to 2022 was performed. Addresses were geocoded to national ADI scores, with the lowest quartile (scores 1-25) representing the least, and the top quartile (76-100) the most disadvantaged. Demographics, comorbidities, 24-hour urine parameters, stone composition, and stone prevention medication prescriptions were evaluated. Results: A total of 1859 patients underwent PCNL during the study period, of whom 900 completed a 24-hour urine study. There were more female and black patients (55.3% vs 42.2% p = 0.032; 16.2% vs 3.9% p < 0.001, respectively) in the most disadvantaged quartile. Patients with a higher ADI were less likely to undergo 24-hour urine testing compared with the least disadvantaged quartile (44.2% vs 63.6%, p < 0.001). Higher ADI score was also associated with lower 24-hour urine volume and citrate. Conclusions: Higher ADI is associated with multiple risk factors for recurrent urolithiasis including lower 24-hour urine study completion rate, low urinary volume, and hypocitraturia. ADI may serve as a simple clinical tool to identify patients in high need of metabolic stone prevention and more comprehensive endourologic care.

Background: National guidelines recommend obtaining prostate gland volume (PGV) prior to benign prostate hyperplasia (BPH) surgery. Measurement of PGV with handheld ultrasound (HUS) probes shows promise.Objective: To compare the reliability of two HUS probes (Butterfly iQ and Clarius C3) to the BPH guideline-recommended imaging (GIm) for both prostate and bladder volumetrics.Methods: Male patients with GIm were randomized to undergo transabdominal HUS PGV with one of the two probes. A subset underwent voided volume measurements with one of the two HUS and a conventional bladder scanner (BS). The reliability of the volume measurements was assessed for each probe via intraclass correlation coefficients (ICCs). We utilized the following standard criteria: ICC < 0.5: poor reliability; 0.5 ≤ ICC < 0.75: moderate reliability; and ICC ≥ 0.75: good reliability.Results: A total of 78 men in the prostate arm (38 Butterfly, 40 Clarius) and 45 in the bladder arm (24 Butterfly, 21 Clarius) were randomized and included in this study. The mean prostate volume based on GIm was larger in the Clarius group (p = 0.044). Other baseline characteristics were similar between groups (p > 0.05). The ICCs were 0.78 (95% CI: 0.62, 0.88) and 0.71 (95% CI: 0.51, 0.83) for the Butterfly and Clarius probes, respectively. Regarding bladder volumetrics, the ICCs were 0.82 (95% CI: 0.19, 0.95), 0.72 (95% CI: 0.44, 0.88), and 0.69 (95% CI: 0.13, 0.87) for the Butterfly, Clarius, and bladder scanner, respectively.Conclusions: The Butterfly iQ demonstrated good reliability for PGV and voided volume measurements, in comparison to moderate reliability for Clarius C3.

Introduction: Anesthesia choice during the procedural management of suspected renal colic during pregnancy may vary based on available resources and patient or provider preferences, as there are no specific recommendations. Our objective was to evaluate whether preterm birth (<37 weeks) was associated with anesthesia type, anesthesia timing by trimester, or procedure type. Methods: We retrospectively identified pregnant patients who required procedural management with ureteral stent, percutaneous nephrostomy (PCN), or ureteroscopy (URS) for suspected renal colic based on laboratory and imaging findings from 2009–2021 at our center. Analyzed data included anesthesia type (local analgesia only, monitored anesthesia care [MAC], spinal anesthesia, or general anesthesia), trimester of procedure, procedure type, and obstetric outcomes including preterm birth. Results: The study cohort included 96 patients who underwent 231 total procedures, including primary URS, PCN, stent, as well as PCN and stent change. The median gestational age was 38.7 (37.1–39.5) weeks, and preterm birth rate was 15.8%. The most common anesthetic used across all procedures and trimesters was MAC. PCN was associated with the use of less invasive analgesia or anesthesia, whereas endoscopic procedures were more commonly performed with spinal or general anesthesia. Using multivariable logistic regression, procedure type was associated with preterm birth, but not anesthesia type or timing by trimester. Conclusions: Anesthesia type and timing were not associated with preterm birth, and selection may be influenced by resources, clinical scenario, or patient and provider preferences.