Patients with nephrolithiasis are at significant risk for increased radiation exposure from the imaging and fluoroscopy used during treatment. The true risks of low radiation exposure remain uncertain. It is important to be aware of these risks to provide better counseling for patients. Urologists must also be familiar with techniques to decrease radiation exposure for patients with nephrolithiasis.

A lithotripter field with broad beam size yields superior stone comminution when compared with narrow beam size under comparable effective acoustic pulse energy both in vivo and in vitro. These findings may facilitate future improvements in lithotripter design to maximize comminution efficiency while minimizing tissue injury.

NPL shows improved SFE compared with HoL. Flow with the 2.0F probe is akin to a stone basket. NPL offers an effective alternative to HoL.

INTRODUCTION AND OBJECTIVES: Payers are increasingly focusing on preventable complications and hospital readmissions as they seek greater value for healthcare dollars. Many renal cancer patients are older, have multiple comorbidities, and are at increased risk for such complications. Measures of patient frailty have been validated in other fields as useful tools that simply and objectively identify patients at risk for complications and readmissions. This study evaluated the predictive value of a frailty index in identifying renal cancer patients at risk for postoperative Clavien III, IV or V complications.METHODS: We identified all patients diagnosed with renal cancer after undergoing open or minimally invasive radical or partial nephrectomy between 2005 and 2013 in the National Surgical Quality Improvement Program database. The modified frailty index (mFI) was calculated for each patient by scoring the presence /absence of comorbid conditions (Table 1). Univariate and multivariable regression analyses were performed to determine whether mFI and other clinical variables could independently predict serious complications.RESULTS: N¼11,755 patients underwent renal cancer surgery and 35.4% had mFI score ¼ 0, 52.5% had mFI¼1, 9.1% had mFI¼2, 2% had mFI¼3, and 0.7% had mFI4. Univariate analysis showed that higher mFI scores were associated with four-fold increased risk of sustaining a Clavien III, IV or V complication (p<0.0001). Higher mFI also predicted for suffering more than one of the 12 measured Clavien 3 complications (p <0.0001). Multivariable regression (Table 2) showed that patients with a frailty index of 1, 2, 3 and 4 had a monotonically increasing odds of suffering a Clavien 3 complication. Prolonged OR time, lower preoperative serum albumin and older age also predicted for increased risk of serious complications and readmissions.CONCLUSIONS: The modified Frailty Index is a simple and objective measure that independently predicts Clavien 3 complications and readmissions in renal cancer patients undergoing open or minimally invasive surgery.