Session: Global Leaders Share the Evidence

Anil ShresthaNepal Moderator Clearpetra the Sheath of Choice for Lower Pole StonesSFR Assessment: Timing and Modalities

Chinnakhet Ketsuwan Thailand Moderator Intra Renal Pressure Defines Outcomes: Current EvidenceIntrarenal pressure (IRP) is a crucial physiological parameter during endourological interventions, as elevated IRP is closely linked to increased fluid absorption, intrarenal backflow, compromised renal perfusion, and postoperative complications. Experimental studies in animal models have consistently demonstrated a correlation between increased IRP and augmented irrigation fluid absorption, renal parenchymal backflow, and reductions in renal blood flow. Clinical studies have reported baseline IRP values ranging from 14 to 17 mmHg, with transient peristaltic peaks reaching up to 25 mmHg. Notably, IRP frequently surpassed 60 mmHg during endoscopic procedures, particularly when utilizing manual hand-pump irrigation or employing ureteral access sheaths (UAS) with smaller diameters. Significant risk factors identified for sustained elevations of IRP include non-prestented ureters, Asian ethnicity, and omission of UAS placement. Furthermore, elevated IRPs have demonstrated a direct association with infectious adverse events, notably postoperative sepsis. Randomized controlled trials have established that manual hand-pump irrigation generates substantially higher IRPs compared to pressurized irrigation bags. Additionally, serial manual irrigation boluses have been shown to produce prolonged IRP elevations, with maximum peaks exceeding 100 mmHg and durations surpassing 40 seconds. Collectively, both preclinical and clinical evidence underscores the necessity of meticulous intraoperative IRP management during endourological procedures. Strategic optimization of irrigation techniques and appropriate UAS selection are imperative to effectively maintain IRP within safe physiological limits, thereby minimizing the risk of complicationsRole of VR/AR/MR in Endourology and Urolithiasis Renal stone disease is a common urological condition affecting diverse patient populations. Percutaneous nephrolithotomy (PCNL) is widely recognized as the primary treatment for large or complex renal calculi, offering high stone-free rates with low complication profiles. Nevertheless, achieving accurate percutaneous renal access (PCA) remains technically challenging due to anatomical proximity to vital structures and insufficient hands-on training opportunities for urologists. Virtual reality (VR) simulators, such as the PERC Mentor and Uro Mentor, have demonstrated significant improvements in PCA proficiency, operative efficiency, and complication reduction, establishing their validity as effective training platforms. Additionally, mixed reality (MR) and 3D holographic technologies, exemplified by HoloLens, enhance surgical planning and procedural accuracy, particularly in calyceal targeting during PCNL. Recent nationwide training needs assessments have further advocated for the integration of these advanced simulation technologies into urological education curricula. Ultimately, systematic incorporation of VR and MR simulation into residency training holds substantial promise in bridging existing skill gaps, refining surgical competencies, and circumventing ethical concerns associated with traditional methods of surgical education.

Jeff S. ChuehTaiwan Moderator