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Objective:To assess outcomes of ureteroscopy for treatment of stone disease in the elderly. Ureteroscopy (URS) is an increasingly popular treatment modality for urolithiasis and its applications are ever expanding with the development of newer technologies. Its feasibility and outcomes within the elderly population to our knowledge remain under-reported.Materials and Methods:We examined the patient demographics and surgical outcomes from our prospective database for patients ≥70 years who underwent URS for urolithiasis, in a 5-year period between March 2012 and December 2016.Results:A total of 110 consecutive patients underwent 121 procedures (1.1 procedure/patient) with a mean age of 77.2 years (range: 70-91 years). Stone location was in the kidney/ pelviureteric junction (PUJ) in 29%, ureter in 37% and in multiple locations in 34%. The initial and final stone free rate (SFR) was 88% and 97% respectively. While 73% were done as true day case procedures, 89% patients were discharged within 24 hours. Eleven patients (9%) underwent complications of which 10 were Clavien I/II including acute urinary retention, urinary tract infection, stent symptoms and pneumonia. One patient underwent Clavien IV complication where they needed intensive care unit admission for urosepsis but fully recovered and were discharged home subsequently.Conclusion:Ureteroscopy is a safe and effective method of managing urolithiasis in elderly patients. Although most patients are discharged within 24-hours, consideration needs to be made for patients where social circumstances can impact their discharge planning.

Purpose of Review While ureteroscopy (URS) is a common procedure for ureteric stones, this window between diagnosis and treatment leaves the possibility for a 'negative', 'stoneless' or 'diagnostic' URS. We perform a systematic review to look at the rate of 'negative ureteroscopy' and risk factors associated with it. Recent Findings From a total of 3599 articles and 68 abstracts, 4 studies (1336 patients) were selected. The negative URS rate varied from 4 to 14%. Common predictors seem to be female gender, small stones, radiolucent stones and distal ureteric stones. Summary Although infrequent, negative ureteroscopy should be avoided in patients with ureteric stones by performing a lowdose CT scan on the day of surgery. This should especially be performed for females and those with smaller, radiolucent or distal ureteric stones.

<b><i>Introduction:</i></b> While negative ureteroscopy (URS) can be considered as an unnecessary procedure with medico-legal consequences, this avoids radiation from repeat CT scan and sometimes may be the only way to reassure patients with ongoing symptoms. We wanted to analyze our predictors and results of negative URS for treatment of ureteric stones. <b><i>Methods and Materials:</i></b> Between March 2012 and August 2018, data on consecutive patients with ureteric stones undergoing a primary URS (without a pre-operative stent) were prospectively collected for patient demographics and outcomes. Comparison was done for patients with diagnostic and therapeutic primary URS for ureteric stones. Patients with renal stones were excluded from the study. <b><i>Results:</i></b> A total of 270 patients underwent URS for ureteric stones during the study period of which 35 (13%) had a negative diagnostic URS. The patients who had negative URS were younger (<i>p</i> = 0.001), had smaller stones (<i>p</i> &#x3c; 0.001), and more stones located in the distal ureter or vesico-ureteric junction (VUJ; <i>p</i>= 0.036). None of the patients who underwent negative URS had a postoperative stent inserted or any complications. <b><i>Conclusion:</i></b> Although the rates of negative URS should be as low as possible, it seems to be safe and reassures patients with on-going symptoms. Based on our data, patients with small distal ureteric or VUJ stones should undergo a repeat imaging to avoid this unnecessary procedure. Informed consent, patient counseling, and appropriate up-to-date imaging seem to be key to minimizing negative diagnostic URS.

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Background. High-flow priapism is rare, and bilateral arteriocavernous fistulae formation following trauma is rarer still. Management of high-flow priapism is conservative either through observation, use of ice packs, mechanical decompression, or intracavernosal injection of α-adrenergic agonists, giving temporary results in selected cases. Alternatively, superselective arteriography with embolization is widely accepted. However, intervention needs to be mindful of the potential impact on long-term potency. We report the first case of bilateral arteriocavernous fistulae managed with both Gelfoam and microcoil embolization. Case Study. We present the case of a 35-year-old gentleman who attended the emergency department nine days following a fall from a moped, where he sustained bruising to his perineum, with persistent nonpainful erection. CT angiogram demonstrated bilateral arteriovenous fistulas. Management with superselective catheterisation and embolization with Gelfoam and microcoil was successful with resolution of symptoms. Long-term follow-up has shown return to normal erectile function twelve months following the injury. Outcomes. Concern regarding the effect to long-term erectile function has previously led to delayed bilateral embolization. Selection of embolization material can be tailored to the anatomical features of the fistula to help preserve function.

404 Background: Voided urine cytology has been used as an adjunct in the diagnosis of non-muscle invasive bladder cancer (NMIBC), with a sensitivity and specificity ranging between 13-75% and 76-100% respectively. There is limited data on the accuracy and utility of cytology following BCG therapy. We reviewed the results of cytology in patients undergoing induction and maintenance BCG immunotherapy in our institution. Methods: Newly diagnosed patients who had received induction and maintenance intravesical BCG therapy from 2004 - 2019 were identified from a prospective database and their outcomes reviewed retrospectively. Histopathology results of biopsies / resected specimens and voided urine cytology results were examined for 273 patients. Results: A total of 2567 cytology results and 638 biopsy results were recorded. The average age was 73.2 years and median number of BCG treatments was four (induction followed by three maintenance courses). Median follow up was 38 months. 94 patients (34.4%) had recurrence following BCG therapy. Of those 33 patients (12.1%) had progression to muscle invasive disease. The number of cytology samples per patient after BCG therapy ranged from 1-23 (median 7), with several patients having repeated, potentially unnecessary negative urine cytology. Overall accuracy of cytology (n = 526) was sensitivity 44.2%, specificity 84.7%, PPV 38.9%, NPV 87.3%. Patients that had an erythematous bladder or red patch at flexible cystoscopy underwent subgroup analysis; this gave a very high NPV of 95.9%, with additional sensitivity being 65.5%, specificity 85.9% and PPV 33.3%. Number of positive cytology results (Chi2 = 44.30, P = 0.002), any positive cytology (Chi2 = 27.94, P < 0.001) and positive cytology after induction BCG therapy (Chi2 = 30.381, P < 0.001) were all strongly associated with recurrence. Conclusions: Positive urine cytology in patients undergoing intravesical BCG therapy predicts increased risk of recurrence and has good specificity. We would recommend using voided urine cytology in patients who have an erythematous bladder or red patch at flexible cystoscopy. If the cytology is positive then proceed to biopsy, however, if it is negative continue with surveillance. [Table: see text]

Purpose of Review While ureteroscopy (URS) is a common procedure for ureteric stones, this window between diagnosis and treatment leaves the possibility for a 'negative', 'stoneless' or 'diagnostic' URS. We perform a systematic review to look at the rate of 'negative ureteroscopy' and risk factors associated with it. Recent Findings From a total of 3599 articles and 68 abstracts, 4 studies (1336 patients) were selected. The negative URS rate varied from 4 to 14%. Common predictors seem to be female gender, small stones, radiolucent stones and distal ureteric stones. Summary Although infrequent, negative ureteroscopy should be avoided in patients with ureteric stones by performing a lowdose CT scan on the day of surgery. This should especially be performed for females and those with smaller, radiolucent or distal ureteric stones.