Khi Yung Fong

Background: Treatment selection for localized renal cell carcinoma (RCC) has progressed significantly in recent years. Objectives: We aim to describe clinicopathological characteristics and treatment outcomes of clinical stage I RCC patients, and construct machine learning (ML) models for personalized prediction of survival outcomes at various epochs pre- and post-operatively. Design: This is a single-center retrospective study of patients treated for clinical stage I RCC from July 1990 to December 2023. Exclusion criteria included patients with stage II-IV RCC at diagnosis, patients who were not treated (e.g. active surveillance, basic supportive care), and incomplete data. Methods: ML models using extreme gradient boosting were created to predict overall survival (OS), recurrence-free survival (RFS), cancer-specific survival (CSS), and postoperative complications in clinical stage I RCC, with evaluation via concordance-index (C-index) for survival and accuracy metrics for complications. Results: We analyzed 1511 patients. Survival outcomes are in line with contemporary data. Using propensity score matching, radical and partial nephrectomy demonstrated similar perioperative and survival outcomes for clinical stage I tumors. C-indexes for ML model predictions were 0.722 for preoperative OS, 0.745 for postoperative OS, 0.682 for preoperative RFS, 0.763 for preoperative CSS, and 0.847 for postoperative CSS. For postoperative complications, sensitivity was 79.0% and positive predictive value was 75.4%. Conclusion: Drawing data from three decades of RCC management in a tertiary center, ML models offer reasonable predictive power, which can aid preoperative counselling, shared decision-making, and management of patient expectations before and after surgical treatment.

Background: Thulium fiber laser (TFL) and high-power Holmium:Yttrium-Aluminum-Garnet laser (HPHL) are common laser modalities used in flexible ureteroscopy (F-URS). Existing comparisons are imperfect due to lack of randomization, use of obsolete low-power settings, and the recent advent of technologies such as flexible and navigable ureteral access sheaths (FANS). Objectives: To compare the safety and efficacy of TFL versus HPHL for F-URS in renal stones. Design: A PRISMA-compliant literature review was conducted on PubMed, EMBASE, Scopus and for randomized trials or propensity score-matched studies comparing TFL to HPHL in renal stones. Data sources and methods: Primary outcomes were study-defined stone-free rate (SFR), as well as 100% SFR (zero residual fragments). Secondary outcomes were total operation time, all complications, bleeding complications, postoperative fever, and reintervention. Random-effects meta-analyses were performed to generate risk ratios (RRs) or mean differences (MDs). Results: Eight studies (1290 patients) were shortlisted for analysis. Only one utilized FANS; three did not routinely use ureteral access sheaths. Between TFL and HPHL, there was no significant difference in study-reported SFR (RR = 1.17, 95% CI = 0.98–1.40, p = 0.07), 100% SFR (RR = 1.16, 95% CI = 0.90–1.50, p = 0.19), total operation time (MD −1.0 min, 95% CI = −8.8 to 6.8 min, p = 0.75), all complications (RR = 1.01, 95% CI = 0.54–1.87, p = 0.97), bleeding complications (RR = 0.59, 95%CI = 0.01–23.3, p = 0.60), postoperative fever (RR = 1.23, 95% CI = 0.68–2.24, p = 0.27), and reintervention (RR = 0.72, 95% CI = 0.38–1.34, p = 0.15). Conclusion: This meta-analysis of high-quality studies found no significant differences between HPHL and TFL in the trifecta of outcomes—SFR, complications, and reintervention—in F-URS for renal stones. Continued re-evaluation of this field remains a necessity as technological advancements such as FANS and novel lasers continue to emerge.

Introduction: Flexible and navigable suction access sheath (FANS) with flexible ureterorenoscopy (FURS) has demonstrated favourable 30‐day and 3‐month outcomes for renal stones in normal anatomy. We aimed to investigate the long‐term 1‐year safety and efficacy of FANS for renal and ureteric stones in normal or anomalous anatomy. Methods: This prospective multicentre study included adults undergoing FURS with FANS across 11 centres in 9 countries (April 2023 to August 2024), with follow‐up until August 2025. Anatomical outcomes were assessed by contrast CT (or ultrasound if CT not available) at 1 year; stone‐free rate (SFR) was assessed via noncontrast CT at 30 days. The primary aim was to report if altered anatomy, such as pelvicalyceal or pelviureteric or ureteric stricture, occurs at a later stage. Results: Among 288 patients, median age was 55 years, and 4.5% had anomalous renal anatomy. About 49% were prestented. Stones were located only in the kidney (62%), ureter (18%) or both (20.1%). Median stone volume was 725 mm ³ ; median Hounsfield unit was 1100. Most procedures (84%) used a 7.5Fr scope with 10/12 Fr FANS. Regarding exit strategies, 65% were stented, 14% had an overnight ureteric catheter and 21% were tubeless. Mild bleeding occurred in 17% with no postoperative sepsis, transfusions or persistent hematuria. One patient (0.35%) experienced a Grade 1 ureteric injury. On a 30‐day CT, 82% achieved zero residual fragments (Grade A SFR). On 1‐year CT, five patients (1.7%) were diagnosed with ureteric stricture, 9.7% had persistent residual fragments, and 5.6% developed new ipsilateral stones. Of the five patients with strictures, three had a history of ureteric re‐implantation and only one had been prestented. Serum creatinine showed no significant change from baseline. Conclusions: This study reports the longest 1‐year follow‐up data for patients undergoing FURS with FANS to date. The study did not identify a high rate of late anatomical complications after successful FANS deployment in the treatment of renal and ureteric stones. Caution is warranted in patients with a history of ureteral re‐implantation due to elevated risk of stricture formation.

Limited data exist regarding subspeciality variation in the management of stable coronary artery disease within cardiology. In this multinational cross-sectional survey of 618 cardiologists across Asia-Pacific countries, including 233 interventional cardiologists (ICs), we analysed differences in knowledge, attitude and practices of ICs versus non-ICs using Wilcoxon signed-rank tests. Predictors of revascularisation were assessed via logistic regression. Although ICs had better knowledge of the guidelines than non-ICs, they exhibited poorer perception of treatment for stable coronary artery disease. Despite guideline recommendations for medical therapy, ICs were more likely to choose revascularisation across all case scenarios. Interventional subspeciality was the only significant predictor of preferentially choosing revascularisation. Future efforts can be focused on bridging the discrepancy between guidelines and practice.

Purpose: This prospective single center study evaluated the feasibility, perioperative outcomes, and surgeon experience of a novel digital disposable semirigid nephroscope (Redpine ^™ ) during suction mini-percutaneous nephrolithotomy (SM-PCNL) for renal stones. Methods: Between March 2024 and March 2025, 328 patients underwent SM-PCNL using the digital disposable nephroscope across institutions. Inclusion criteria encompassed all consenting patients with renal stones managed via prone/supine SM-PCNL (14–22 Fr suction sheath). The digital disposable scope served initially as a cystoscope to place the guidewire and later used for nephroscopy. Data collected included patient/stone characteristics, operative details (lithotripsy time, access technique), complications (Clavien-Dindo), surgeon satisfaction (5-point Likert scale), and stone-free rate (SFR). SFR was assessed via low-dose CT at 30 days (Grade A: no fragments; Grade B: ≤4 mm fragment). Results: Median stone diameter was 1.7 cm (IQR 1.3–2.3). Median lithotripsy and total operative times were 8 min (IQR 5–16) and 22 min (IQR 20–35), respectively. Intraoperative SFR was 96%. Surgeons reported excellent instrument satisfaction (median Likert score 1/5) for vision, ease of use, and manoeuvrability within the pelvicalyceal system. Complications were rare: major (Clavien ≥ 3) occurred in 0.9% ( n = 3, including colonic injury, pleural injury, sepsis. One case developed lower pole arteriorvenous fistula, managed by arterial angioembolization. At 30 days, SFR was 100%: Grade A (no fragments) in 47.9% ( n = 157) and Grade B (≤ 4 mm fragment) in 52.1% ( n = 171). Reintervention (ESWL) was needed in 1.2% ( n = 4) within 3 months. Scope tip damage occurred in 0.6% ( n = 2). Conclusion: The digital disposable nephroscope demonstrated excellent feasibility and safety in SM-PCNL, facilitating efficient stone clearance time (median 22 min), high SFR, minimal complications, and superior surgeon ergonomics. Its dual cystoscope-nephroscope functionality and plug-and-play design offer significant versatility, supporting its role in advancing minimally invasive PCNL.

Objective: This study aims to evaluate the safety, efficacy and clinical outcomes of elective flexible ureteroscopy using flexible and navigable suction ureteral access sheaths (FANS) in patients with upper tract infectious stones following initial management of systemic urinary tract infections (UTIs). Materials and Methods: We conducted a multicentre prospective analysis of patients with infectious ureteral or kidney stones (struvite or calcium carbonate‐apatite) who underwent flexible ureteroscopy using FANS between March 2024 and March 2025. All patients had prior systemic UTI management with a minimum 6‐week interval before definitive stone treatment. Stone‐free rate was assessed at 30 days using a CT scan. Results: The cohort included 144 patients (median age 51 years, 70.1% female) with a median stone diameter of 1.9 cm. 20.1% had initially received only antibiotic treatment, whereas 79.9% had also received emergency drainage. Forty‐seven patients (32.6%) had emphysematous pyelonephritis at initial presentation. Median operative time was 40 min with a 1‐day hospital stay. Notable findings included zero cases of sepsis and a 29.9% rate of postoperative fever requiring extended antibiotics up to 2 weeks. Zero residual fragments were achieved in 48.6% and a single fragment up to 2 mm in 43.8% of patients (92.4% combined stone‐free rate). Renal function improved at 30 days (median creatinine decrease −15 μmol/L) and 3 months (−18 μmol/L). Fever rate was 29.8% in the emphysematous pyelonephritis subgroup. Conclusions: Elective flexible ureteroscopy using FANS for upper tract infectious stones is feasible for its excellent safety profile with no sepsis cases and high stone‐free rates. FANS technology appears to offer significant advantages in this challenging patient population by mitigating postoperative sepsis due to debris aspiration, reduction of pyelovenous backflow of contaminated irrigation fluids and improved stone fragment evacuation.