Landman J, Clayman RV, Cumpanas AD, et al. Initial clinical experience with a novel robotically assisted platform for combined mini-percutaneous nephrolithotomy and flexible ureteroscopic lithotripsy. J Urol. 2024;212(3):483-493. doi:10.1097/JU.0000000000004079

Special thanks to Drs Grace Chen and Simone Crivellaro at the University of Illinois at Chicago.

The field of urology advances through the passion of innovators, and this prospective clinical trial documenting the first in-human use of the novel MONARCH robotic platform for mini-percutaneous nephrolithotomy and flexible ureteroscopy is an excellent demonstration of that. Once technology is developed, it must be tested for safety and efficacy. Urologists at the University of California–Irvine have successfully pioneered this platform, completing 12 of 13 procedures using this combined system with an admirable 98% stone volume reduction. Complications were noted to be infrequent and low grade. An additional feature of this platform that merits mention is the improved percutaneous access into the kidney due to real-time ureteroscopic monitoring of the renal puncture and dilation process.

As a whole, robotic platforms represent a boon for the field due to improved surgeon ergonomics, better visualization, and in the best of cases, improved clinical outcomes. The widespread success and adoption of robotic platforms are dependent on the perceived benefit relative to the cost of the system, which first requires proof of concept. While not every robotic platform will have its time in the sun, this first-use feasibility study showcases the enormous potential that the MONARCH has in expanding the availability of safe percutaneous renal access to the urology community at large.

Sorensen MD, Dunmire B, Thiel J, et al. Randomized controlled trial of ultrasonic propulsion–facilitated clearance of residual kidney stone fragments vs observation. J Urol. Published online August 14, 2024.doi:10.1097/JU.0000000000004186

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

As urologists know well, procedures for kidney stones often leave behind tiny fragments, some of which may end in future unplanned interventions. However, not all residual fragments warrant an additional surgery, creating a common dilemma for both urologists and patients. Ultrasonic propulsion, a noninvasive and innovative approach that is performed in awake patients, could tip the scales in favor of proactive treatment. It employs a handheld imaging and therapy transducer to reposition stone fragments and facilitate passage.

This prospective controlled trial reports data from 82 patients with residual stone fragments of size less than 5 mm after an intervention randomly assigned to ultrasonic propulsion treatment or observation after a follow-up of 3 years. Only one-fifth of patients receiving ultrasonic propulsion had an urgent unscheduled visit, additional surgery for stone fragments, or stone growth on follow-up imaging compared with half who were observed. Nearly two-thirds of the ultrasonic propulsion patients passed fragments within 3 weeks vs only 5% of those observed.

This study presents a compelling argument that ultrasonic propulsion on residual stone fragments facilitates their passage and provides a real long-term benefit to patients. Its avoidance of anesthesia, radiation, and potential office-based platform make it an attractive possibility for managing small stones and residual fragments before they become symptomatic.

Conduit C, Lewin J, Hong W, et al. Pseudoephedrine for ejaculatory dysfunction after retroperitoneal lymph node dissection in testis cancer. BJU Int. Published online July 23, 2024. doi:10.1111/bju.16481

Special thanks to Drs Mohamad Abou Chakra and Samuel Ohlander at the University of Illinois at Chicago.

Over 50% of patients with testis cancer have oligospermia before any therapy, and ejaculatory dysfunction remains a major side effect of retroperitoneal lymph node dissection. Anejaculation, whether due to retrograde ejaculation or failure of emission, further compromises the fertility potential of cancer survivors.

This study examined the use of pseudoephedrine for ejaculatory dysfunction after retroperitoneal lymph node dissection. Ejaculatory dysfunction was observed in more than half of patients, and almost half underwent a bilateral template. If retrograde ejaculation was detected, 60 mg pseudoephedrine was administered every 6 hours the day before attempted semen collection, followed by 2 doses at 6:00 AM and 30 to 60 minutes prior to ejaculation. About 70% of patients with ejaculatory dysfunction received pseudoephedrine, and 18% achieved a sperm count greater than 39 million per ejaculate and had a semen volume greater than 1.5 mL.

Pseudoephedrine was found to be safe and had modest efficacy in selected cases of ejaculatory dysfunction with a retrograde ejaculation component among testis cancer survivors, evidenced by improvements in sperm count and volume in some men. These enhancements impact fertility, sexual satisfaction, and perceptions of masculinity.