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    Endourology/Stones: Care utilization for stones growing rapidly in older adults


    • Continuing aspirin does not increase blood loss, the need for blood transfusion, or the occurrence of high-grade complications in patients undergoing PCNL.

    • PCNL is a safe option in elderly patients and associated with stone-free rates similar to those in younger patients.

    • Active stone removal was associated with a decrease in stone-related deaths and possibly prolonged survival in patients with poor performance status, but the investigators noted further study is warranted.

    • Bilateral ureteroscopic stone extraction is safe and effective.

    • When defined by strict computed tomography criteria, stone-free rates of flexible ureteroscopy for renal calculi are “dismal,” but the majority of residual fragments are 2 mm to 4 mm and can be observed as a more cost-effective strategy.

    • Investigators from the University of Washington, Seattle are continuing to improve their novel technique of ultrasonic propulsion of kidney stones.

    • The YouCare Tech fiberoptic ureteroscope had resolution comparable to another fiberoptic ureteroscope (Cobra), but it did not match visualization provided by the LithoVue digital ureteroscope.

    • The LithoVue ureteroscope was safe, had a low failure rate, and may be cost saving with regard to OR time and repair costs, but was found in one study to have limitations with visualization beyond the stricture and with the use of electric cautery.

    • The Pusen single-use ureteroscope was comparable to a reusable ureteroscope and suggested to be a valid method that may decrease maintenance costs.

    • Results of studies investigating causes of unplanned care after ureteroscopy suggest that the development of a clinical care pathway that includes patients on self-pulled stents and pain management may minimize these encounters and improve treatment quality and cost.

    • Mean stone length, mean stone density, stone heterogeneity index, mean stone density-stone heterogeneity index, and variation coefficient of stone density were all identified as predictors of success after shock wave lithotripsy (SWL).

    • An analytic model incorporating nine parameters accurately predicted treatment success and complications after SWL.

    • Performing air removal and appropriate case selection are key to achieving higher success rates in SWL.

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