Moses RA, Hunter AE, Brandes ER, et al. Patient-reported outcome measures following hyperbaric oxygen therapy for radiation cystitis: early results from the Multicenter Registry for Hyperbaric Oxygen Therapy. J Urol. 2024;211(6):765-774. doi:10.1097/JU.0000000000003929

(Special thanks to Drs Grace Chen and Daniel Garvey at the University of Illinois at Chicago.)

Hyperbaric oxygen therapy is currently the only noninvasive treatment option for recurrent hematuria due to radiation cystitis, which is a common sequelae of pelvic radiation that leads to a significant health care burden with repeated visits. Patient-reported parameters following hyperbaric oxygen treatment are not well studied. The authors of this paper sought not only to better delineate the subjective amount of hematuria and symptom improvement after hyperbaric oxygen therapy but also to determine which specific patient factors are associated with improvement of hematuria.

Nearly 500 patients with radiation cystitis were included in this study, which used prospective data from a multicenter database. The amount and severity of hematuria, lower urinary tract symptoms, and quality of life were measured by 3 validated questionnaires before and after full treatment. Unsurprisingly, hyperbaric oxygen resulted in significant improvements in all 3 measures. The study also demonstrated that patients with higher baseline hematuria scores, smoking history, and radiation for nonprostate cancers were associated with lower chances of improvement with hyperbaric oxygen. This important finding will aid providers in optimal patient selection for hyperbaric oxygen therapy in the future.

Cumpanas AD, Chantaduly C, Morgan KL, et al. Efficient and accurate computed tomography-based stone volume determination: development of an automated artificial intelligence algorithm. J Urol. 2024;211(2):256-265. doi:10.1097/JU.0000000000003766

(Special thanks to Drs Graham Hale and Mahmoud Mima at the University of Illinois at Chicago.)

Stone size has been assessed by various methods over the years, but most either misrepresent the true stone burden or are too cumbersome to be practically deployed. An automated CT-based algorithm that could detect and accurately calculate kidney stone volume would really help urologists. Thanks to those at the University of California, Irvine, this call has been answered.

In this study, a research fellow manually segmented the largest stone on 269 CT scans to determine a ground truth volume. This was compared to volumes calculated using 3 different ellipsoid formulas used in practice and 1 generated by an automated artificial intelligence algorithm that detected, segmented, and calculated kidney stone volumes. The algorithm significantly outperformed the other formulas when comparing calculated stone volume to true volume, DICE score (a measurement of spatial overlap between segmented and true volume pixels), and Hausdorff distance (the maximum distance between segmented and true contours) for stones of all sizes. The artificial intelligence algorithm took between 10 and 15 seconds on an optimized workstation and 1 to 2 minutes on a conventional workstation to complete the task.

The automated algorithm developed for this study could be a precise, efficient, and practical solution to issues historically plaguing stone burden characterization. It may help optimize management decisions and counseling for stone surveillance or surgery and even replace guideline-based linear measurement characterization since not all stones of equal length are of equal burden.

Chung JW, Kang JK, Jung W, et al. The efficacy and safety of radiation-free retrograde intrarenal surgery: a prospective multicenter-based, randomized, controlled trial. J Urol. 2024;211(6):735-742. doi:10.1097/JU.0000000000003920

(Special thanks to Drs Juan Ramon Torres and Simone Crivellaro at the University of Illinois at Chicago.)

As urologists, we’re all about pushing the envelope to provide the best care for our patients. Let’s talk about something that’s been making waves in urologic circles: the possibility of performing intrarenal surgery without radiation. It’s a topic that, for good reason, has been buzzing in operating rooms and at conferences. Picture this: achieving the same stone-free rates we aim for minus the radiation risks. Quite the enticing prospect, right?

This is no longer theoretical. A recent multicenter, randomized controlled trial has given us some solid data to chew on. Over a year and a half, patients with kidney stones manageable by radiation-free retrograde intrarenal surgery were enlisted and split into 2 groups: 1 with the traditional route with radiation and the other with the radiation-free technique. Both methods used flexible ureteroscopy and the holmium:YAG laser, so the only variable was the use of radiation.

The big question was, can we eliminate the radiation and still hit that sweet spot of high success rates? The findings say yes: there was hardly a difference in outcomes between the 2 groups, which is sure to raise some eyebrows. Even on the safety front, the radiation-free method held its own. We’re talking about a significant shift in our standard practice.

By bridging efficacy and safety without radiation, we could be on the cusp of a new norm in intrarenal surgery. You’re as intrigued as we are to see where this could take our field. After all, it’s not only about staying at the forefront of innovation but also about minimizing risks for our patients and ourselves.