Extracorporeal shock wave lithotripsy (SWL) can be used in conjunction with endoscopic retrograde cholangiopancreatography (ERCP) for the treatment of large (≥5 mm) or impacted pancreatolithiasis. We report our experience demonstrating the safety and effectiveness of urologist-directed SWL for pancreatolithiasis. We performed a retrospective review of all patients undergoing SWL for pancreatolithiasis at our institution between 2016 and 2020. We defined a treatment cycle as one in which the patient underwent a predefined number of SWL procedures prior to performance of a post-SWL ERCP. Stone-free status was defined as the absence of stone fragments at post-SWL ERCP. Multivariable logistic regression was performed to determine characteristics associated with stone persistence after a treatment cycle. There were 44 patients who underwent 59 treatment cycles consisting of 118 pancreatic SWL procedures. Forty-two cycles (71.2%) were staged, and 17 (28.8%) were not staged. The median size of the largest pancreatic stone was 9 mm [IQR 6-11] and was impacted in 38 cases (64.4%). Patients reported pain in 51 cases (86.4%), of which 28 required the use of opioid analgesics. Patients were rendered stone free in 38 cycles (64.4%). Pain improvement was noted in 39 cases (66.1%), and the reduction in opioid use was statistically significant (28 cases vs. 10 cases, = 0.004). Impacted stones were associated with an increased odds of stone persistence (OR 7.04, 95% CI 1.14-43.43, = 0.04). In this joint venture with gastroenterology, we demonstrate that urologist-directed SWL for pancreatolithiasis is safe, effective, and in line with published rates.

This study aims to assess the outcomes of ultrasonography (US)-guided minimally invasive percutaneous nephrolithotomy (PCNL) in the treatment of pediatric urolithiasis. A retrospective analysis was conducted on 176 patients with pediatric renal and upper ureteral lithotripsy who underwent PCNL between August 2006 and July 2022. The cohort comprised 110 men and 66 women, with ages ranging from 6 months to 16 years. Postoperative stone clearance was evaluated using kidney, ureter, and bladder radiograph or US, categorizing stones less than 4 mm as clear. Postoperative complications were graded according to the Clavien-Dindo classification, with grades I and II considered minor and III and IV classified as major. Among the patients, 152 underwent unilateral renal operation, whereas 24 underwent bilateral renal operation. The average operation duration was 67.41 minutes (range: 15-195 minutes). The mean duration of nephrostomy tube removal was 3.79 days, and the mean postsurgical hospital stay was 5.97 days. A total of 146 patients experienced a decrease in hemoglobin concentration post operation, with an average drop of 10.57 g/dL (range: 0.5-37.8 g/dL). Initial stone-free rate (SFR) was achieved in 85.5% (171/200) of cases, and the final SFR was 92.50% (185/200). The postoperative rate of minor complications was 8.54% (17/199), whereas major complications occurred in 12.06% (24/199) of cases. During the 6-month to 11-year follow-up period, 19 patients presented with combined stones, and of these 4 presented with ipsilateral stone recurrence who underwent PCNL treatment. Calcium oxalate was identified as the most common stone component. US-guided minimally invasive PCNL demonstrated excellent SFR and an acceptable complication rate in the management of pediatric urolithiasis. Furthermore, it offers the advantage of minimizing potential risks associated with radiation exposure during the procedure.

To analyze the influencing factors of ureteral stenosis after ureteroscopic holmium laser lithotripsy. The clinical data of 427 patients treated with ureteroscopic holmium laser lithotripsy were selected, and the patients were divided into two groups based on the presence or absence of ureteral stenosis after the operation. Univariate and multivariate logistic regression were used to analyze the independent risk factors for postoperative ureteral stenosis, and R software and regression coefficients were used to construct a predictive model. After a 1-year follow-up of 427 patients, 28 patients (6.56%) developed ureteral stenosis; univariate analysis showed that the occurrence of ureteral stenosis after subureteral holmium laser lithotripsy was related to stone diameter, stone incarceration, degree of hydronephrosis, holmium laser injury of mucosa, and operation time ( < 0.05); further logistic regression analysis showed that a large stone diameter, stone incarceration, and moderate to severe hydronephrosis were independent risk factors for ureteral stenosis after ureteroscopic holmium laser lithotripsy ( < 0.05); According to H-L deviation degree and area under receiver operating characteristic curve test, the results show that the model has high accuracy ( = 2.475, = 0.613) and differentiation (0.875 [95% confidence interval or CI: 0.817-0.919]), and the external verification of the nomogram prediction model was carried out by the verification group. The results showed that the prediction probability of the calibration curve was close to the actual probability and had a good consistency (area under the curve: 0.873 [95 CI: 0.822-0.914]). The established nomogram model exhibits high accuracy and discriminative ability. It can effectively identify high-risk groups, enabling timely prevention of ureteral stenosis and minimizing the risk of postoperative ureteral stenosis.

To compare the clinical outcomes and complication rates of convective water vapor energy ablation (Rezum) and prostatic urethral lift (Urolift). To identify predictive factors for treatment failures in both treatments. Prospective clinico-epidemiological data of patients who underwent Urolift or Rezum in a single institution for benign prostatic hyperplasia (BPH) was collected. The choice of intervention depended on the preference of the patients after patient-centric discussions. From October 2019 to October 2022, 86 patients underwent Rezum, and 62 patients underwent Urolift. Rezum involved a longer indwelling catheter duration (12.38 ± 5.548 1.39 ± 3.010 days, < 0.001) compared with Urolift. Rezum was associated with more complications compared with Urolift (36 [41.9%] 10 [16.1%] cases, < 0.001). Rezum had more cases of hematuria (17 [19.8%] 4 [6.5%] cases [ = 0.022]) and urinary tract infections (27 [31.4%] 3 [4.8%] cases, < 0.001) compared with Urolift. There were no significant differences in Clavien-Dindo Grade 3-5 complications between the interventions. Urolift was associated with higher reoperation rates (5 [8.1%] 0 [0%] cases, = 0.010) compared Rezum. Rezum had higher anticholinergic usage rates compared with Urolift post-operation (22 [25.6%] 8 [12.9%] cases, = 0.024). Both interventions showed improvement in the International Prostate Symptom Score (IPSS), quality of life score, and peak velocity flow over the 2 years with no significant difference between the two. Based on receiver operating characteristic curve, preoperation IPSS ≥16 had 95.7% sensitivity and 38.4% specificity to predict the probability of treatment failures after the interventions. There was no difference in clinical outcomes of patients who underwent Rezum and Urolift. However, patients who had undergone Rezum faced more minor complications and more required anti-cholinergic medications. Lastly, physicians should note that patients with IPSS ≥16 would unlikely benefit from either intervention.

Optical tracking (OT) has shown potential in assessing surgical skill but has yet to be evaluated for endoscopic urologic surgery. We sought to evaluate the potential for OT to distinguish expert and trainee surgeons during flexible ureteroscopy (fURS) for kidney stone treatment in both simulated and live surgical settings. We performed OT analysis of six surgeons performing stone localization during fURS in two settings. In the first setting, surgeons were tasked with fiducial localization in three separate kidney phantoms during fURS. In the second setting, surgeons performed stone localization via fURS in five separate patients. Surgeons were categorized as "expert" ( = 3, endourologist, average case volume of >100 fURS per year) or trainee ( = 3, trainee, <100 fURS per year). OT metrics were recorded for both settings using the Microsoft HoloLens 2© as the surgeons viewed the surgical monitor during fURS. Standard OT metrics of experts and trainees were compared, and included: area of eye gaze movement, gaze distance traveled, number of gaze fixation points, percentage of gaze fixation dwell time, and number of saccades. In the simulated setting, the average time for stone localization was greater for trainees compared to experts (318 seconds 52 seconds, < 0.01). Additionally, the mean area of eye gaze movements with area of interest (AOI) was greater for trainees compared to experts (1430 cm 1060 cm, < 0.01). The total gaze distance traveled was also greater for trainees compared to experts (1480 cm 730 cm, < 0.01). In the live surgical setting, average time for stone localization was similar for trainees and experts (74 seconds 51 seconds, = 0.05). The total area of eye gaze movements in AOI was greater for trainees compared to experts (700 cm 30 cm, < 0.01). Additionally, the total gaze distance traveled was greater for trainees compared to experts (14,000 cm 680 cm, < 0.01). This suggests more varied and less point specific concentration on the surgical screen by trainees. There was no difference in percentage of gaze fixation dwell time and number of saccades between experts and trainees in either setting. OT analysis can objectively distinguish surgical experience between experts and trainee surgeons performing fURS in both simulated and live surgical settings. These findings may play a role in future surgical training and skills assessment.

The aim of this study was to assess the real-world safety profile of medical devices used in focal prostate cancer treatment utilizing the Manufacturer and User Facility Device Experience (MAUDE) database. The MAUDE database was searched for reports on high-intensity focused ultrasound (HIFU), cryoablation, laser ablation, and irreversible electroporation (IRE) devices used in prostate cancer treatment from 1993 to 2023. Adverse events were identified and categorized. We identified 175 reports for HIFU, 1362 for cryoablation, 615 for laser ablation, and 135 for IRE devices, with 28, 284, 126, and 2 respective reports, directly related to prostate cancer treatment. The aggregated data revealed the majority of complications were minor, with 82.5% ( = 363 out of 440 total complications) classified as Clavien-Dindo grade 1 or 2. Common minor complications included erectile dysfunction and urinary retention. Severe complications such as rectal fistulas were noted in HIFU and IRE treatments, along with singular mortality due to pulmonary embolism in cryoablation. Our analyses from MAUDE reveal that devices used in focal therapy for prostate cancer are predominantly associated with minor complications, underscoring their overall real-world safety profile. However, the occurrence of severe adverse events emphasizes the critical importance of rigorous patient selection and meticulous procedural planning. These findings provide valuable insights into the safety profile of focal therapy devices and contribute to the growing body of evidence on their use in prostate cancer treatment.

To compare the surgical results of retroperitoneal (RP) robot partial nephrectomy (PNx) using either a single-port robot (SP) or a multi-port robot (MP). We retrospectively reviewed all RP robotic PNx performed at a single institution from September 2021-when the SP robot was introduced to the institution-through April 2023. In total, 125 patients underwent the surgery; 81 patients were treated with surgery using a MP robot whereas 44 patients were treated with surgery using a SP. All MP surgeries were performed with da Vinci Xi (Intuitive, Sunnyvale, California, USA), while all SP surgeries were performed with da Vinci SP (Intuitive, Sunnyvale, California, USA). We performed a propensity score-matching (PSM) analysis of these 125 patients. There was no significant difference between the two groups after PSM. In terms of operation time, that for MP was 103.68 ± 21.89 minutes whereas that for SP was 95.43 ± 32.22 minutes (-value = 0.164). Meanwhile, in terms of console time, that for MP was 70.95 ± 21.92 minutes whereas that for SP was 64.14 ± 32.06 minutes (-value = 0.248). In terms of estimated blood loss was 90.91 ± 91.06 mL in MP and 92.27 ± 104.30 mL in SP (-value = 0.948). Lastly, there was a statistically significant difference in warm ischemic time, as it was 17.18 ± 6.56 minutes in MP and 13.82 ± 4.59 in SP (-value = 0.007). There were no statistically significant differences between MP and SP in any other surgical outcomes. SP robot RP PNx demonstrated comparable outcomes to those achieve using MP procedures. This means SP robot RP PNx can be considered a preferable and more convenient surgical approach than conventional methods, particularly when dealing with small renal masses located in the posterior side of the kidney.

Digital flexible ureteroscopes (DFUs) play a crucial role in endourological procedures, and scope breakages are often avoidable with proper measures in place. We aimed to evaluate the effect of mandatory training on DFU durability and to assess the influence of various factors on instrument damage. Mandatory training involving instructional videos on DFU care was introduced for all processing and operating room staff handling DFUs. Only certified personnel were allowed to handle DFUs, with meticulous usage documentation. The average annual usage of each DFU was compared pre and post program implementation. We examined factors such as patient demographics, procedure details, and operator experience impacting scope life using negative binomial regression. The average usage of DFU increased by 21%, from 6.38 to 7.74 cases. We found that post-graduate year stood out as a significant predictive factor (estimate = 3.28, = 0.04). Moreover, the streamlined model revealed that previous ureteral-stent use (estimate = 0.94, < 0.001), struvite stones (estimate = 3.08, = 0.01), and a higher number of stones (estimate = 0.11, = 0.04) were associated with an increased number of procedures before DFU breakage, whreas in situ lithotripsy in the lower calyx was associated with a reduced number of procedures before DFU breakage (estimate = -1.11, = 0.003). Implementing a mandatory training program showed an increase in DFU durability by 21%, suggesting a potential reduction in annual repair and replacement costs by the same percentage. Furthermore, outcomes were more favorable when experienced practitioners conducted treatments, especially in cases involving struvite stones.

Residual stone fragments are common after percutaneous nephrolithotomy (PCNL), however, there is an unclear relationship between the presence of these residual stone fragments and the risk of unplanned stone events (USE). We investigated how the size of the largest residual stone fragment (LRSF) impacts the risk of USE post-PCNL. We conducted a retrospective cohort study of PCNL between 2018 and 2022. Preoperative computed tomography of the abdomen and pelvis (CTAP) imaging and postoperative CTAP imaging were reviewed. The primary outcome was the incidence of postoperative USE, defined as stone-related emergency department visits or unplanned stone procedures. LRSF were stratified by five thresholds (no postoperative stone fragments ≥0 mm, <2 ≥2 mm, <3 ≥3 mm, <4 ≥4 mm, and <5 ≥5 mm), and Cox regression was used to compare the impact of these thresholds on the risk of USE. After exclusions, we identified 138 patients who underwent PCNL during the study period; 42 patients had a USE. When applying a 4 mm threshold, 52% of patients with LRSF ≥4 mm experienced USE 21% with LRSF <4 mm (log-rank = 0.0004); similarly, with a 5 mm threshold, 62.5% with LRSF ≥5 mm had such events compared with 21% with LRSF <5 mm (log-rank < 0.00001). A larger LRSF was associated with a greater risk of having a USE. After PCNL, larger residual stone fragments, particularly those ≥4 mm, are associated with an increased risk of USE. These results demonstrate the value of identifying residual fragments in predicting USE.

One potential advantage of single-port (SP) robotic surgery compared with multiport (MP) robotic surgery is improved cosmesis. The only studies in urology patients to suggest this finding did not assess differences based on incision site. Our study evaluated SP, MP, incision location, age, gender, and prior abdominal surgery as predictors of cosmesis and scar consciousness for reconstructive procedures. This is a cohort study using an institutional review board-approved prospective genitourinary reconstruction database. Patients at least 3 months from surgery were emailed and called to complete the Consciousness subsection of the Patient Scar Assessment Questionnaire. Bothersome was defined as a score of 11 or greater. Overall consciousness was scored with a single item as "not conscious" or "conscious." Pearson's chi-squared, Wilcoxon rank sum, Fisher's exact test, and logistic regression were performed to assess how age, gender, prior surgery, and incision location affect cosmesis. There were 111 patients (54 MP, 57 SP), of which 27 were SP umbilical, 14 were SP midline nonumbilical, and 16 were SP lower quadrant. On univariate analysis the periumbilical incision had the lowest consciousness. Age was associated with Bother ( = 0.012) and Consciousness ( = 0.002), whereas gender, prior abdominal surgery, and incision site were not significant. On logistic regression, all SP incisions were less likely to be bothered compared with MP, although only SP umbilical was statistically significant (odds ratio [OR] = 0.08, 95% confidence interval [CI]: 0.01,0.38; = 0.005). Age was also significant on logistic regression for Bother (OR = 0.96, 95% CI: 0.93,0.99; = 0.005). Gender and prior abdominal surgery were not associated with Bother or Consciousness. SP periumbilical incisions provide the best outcomes for cosmesis compared with other SP incision sites and MP incisions. This finding should be discussed and taken into account when planning surgical approaches for patients undergoing urinary reconstruction, especially in patients younger than 40 years of age.

One advantage of supine percutaneous nephrolithotomy (sPCNL) is the ability to access anterior as well as posterior calyces, but the safety and efficacy of anterior calyceal entry has never been investigated to our knowledge. We prospectively evaluated patients scheduled for sPCNL comparing anterior and posterior calyceal access. After Institutional Review Board approval, we prospectively enrolled 100 consecutive patients undergoing sPCNL from February to September 2023. Primary outcomes included intraoperative complications, blood transfusions, 30-day complication rates, and emergency department (ED) visits or readmissions. Secondary outcomes included stone-free rates (SFR). Seventy-six patients had anterior calyceal entry and 24 had posterior. No significant differences were found in terms of baseline demographics (age, body mass index), stone characteristics (location, density, complexity), or intraoperative features (operative time, location of access). Safety outcomes, including intraoperative complications (1% 4%), blood transfusions (3% 8%), 30-day complication rates (17% 21%), and ED visits (1% 0) or readmissions (11% 21%) were comparable between groups. Overall SFRs were equivalent (86% 90%). We found that anterior and posterior accesses in sPCNL offer similar safety and efficacy, with no significant differences in complications or SFRs. Surgeons can select either approach based on patient anatomy and surgical needs without concern for increased complications. Further research is necessary to confirm these findings and guide best practices for calyx selection in sPCNL.

To characterize the pulse characteristics and risk of fiber fracture (ROF) of the pulsed-Thulium:YAG (p-Tm:YAG) laser and to compare its ablation volumes (AVs) against Holmium:Yttrium-Aluminium-Garnet (Ho:YAG) laser and Thulium fiber laser (TFL). p-Tm:YAG (100 W-Thulio, Dornier-Medtech, Germany) was characterized using single-use 272 μm core-diameter-fibers. p-Tm:YAG characterization included pulse shape, duration, and peak power (PP) studies. ROF was assessed after 5 minutes of continuous laser activation (CLA) at five decreasing fiber bend radii (1, 0.9, 0.75, 0.6, and 0.45 cm). p-Tm:YAG, Ho:YAG (120 W-Cyber-Ho, Quanta, USA), and TFL (60 W-TFLDrive, Coloplast, Denmark) AVs were compared using a 20-mm linear CLA at 2 mm/second velocity in contact with 20 mm hard stone phantoms (HSP) and soft stone phantoms (SSP) (15:3 and 15:5 water to powder ratio, respectively) fully submerged in saline at 0.5 J-20 Hz or 1 J-10 Hz. After CLA, phantoms underwent three-dimensional (3D) micro-scanning (CT) and subsequent 3D segmentation to estimate the AVs, using 3DSlicer. Each experiment was performed in triplicate. p-Tm:YAG presents a uniform pulse profile in all of the available preset modes. PP ranged from 564 to 2199 W depending on pulse mode. No laser fiber fracture occurred at any bend radius. p-Tm:YAG achieved similar mean AVs to TFL and Ho:YAG for HSP (8.96 ± 3.1 9.78 ± 1.1 8.8 ± 2.8 mm, = 0.67) but TFL was associated with higher AVs compared with p-Tm:YAG and Ho:YAG (12.86 ± 1.85 10.12 ± 1.89 7.56 ± 2.21 mm, = 0.002) against SSP. AVs for HSP increased with pulse energy for p-Tm:YAG and Ho:YAG and (11.56 ± 1.8 6.36 ± 0.84 mm and 11.27 ± 1.98 6.34 ± 0.55 mm, = 0.03 and = 0.02), whereas AVs for SSP were similar across laser settings for all laser sources. AVs with TFL were similar across laser settings for both phantom types. p-Tm:YAG combines intermediate PP between Ho:YAG and TFL, a uniform pulse profile, no ROF with increasing deflection and effective ablation rates. Further clinical studies are needed to confirm these results.

To investigate preoperative predictors of surgical success for patients undergoing robotic ureteral reconstruction (RUR) for management of distal ureteral strictures. We retrospectively reviewed our multi-institutional Collaborative of Reconstructive Robotic Ureteral Surgery database to identify all consecutive patients undergoing RUR for surgical repair of distal ureteral strictures between 04/2012 and 12/2022. Procedures included refluxing reimplant (58.5%), side to side reimplant (18.0%), ureteroureterostomy (12.7%), non-refluxing reimplant (6.3%), buccal mucosa ureteroplasty (2.8%), and appendiceal bypass ureteroplasty (1.7%). Patients were grouped according to whether they were surgically successful. Preoperative variables between both groups were compared using chi-square tests. All variables with associations of < 0.2 underwent a binary logistic regression analysis to determine predictive variables of success for RUR ( ≤ 0.05 considered statistically significant). Overall, 284 patients met inclusion criteria. Univariate analysis showed obesity ( = 0.03), smoking history ( = 0.10), abdominopelvic radiation history ( = 0.14), immunocompromised state ( = 0.12), and ureteral rest ( = 0.01) were notable preoperative factors ( < 0.2). Binary logistic regression analysis further revealed the odds of surgical success in patients with obesity was 0.32 times (CI: 0.12-0.83, = 0.02) the odds of success for patients without obesity. The odds of surgical success in patients who underwent preoperative ureteral rest was 4.2 times (CI: 1.51-11.77, < 0.01) the odds of success for patients who did not undergo preoperative ureteral rest. Preoperative factors including obesity and ureteral rest may affect surgical success of RUR for management of distal ureteral strictures.

Guidelines for benign prostate hyperplasia (BPH) interventions are volume based. The degree to which different imaging modalities actually correlate to treated volume is not known for BPH. The present study compares the accuracy of preoperative ultrasound, computed tomography (CT), magnetic resonance imaging (MRI), and MRI-transitional zone (TZ) to BPH enucleation weight. A retrospective review of patients who underwent enucleation for BPH and had preoperative transrectal ultrasound (TRUS), CT, and/or MRI was performed. Total prostate volumes were measured for CT, MRI, and TRUS; MRI-TZ volume was also measured. The primary outcome was difference between enucleated pathology weight in grams and preoperative imaging volume. Differences between enucleation and imaging volume for each modality were calculated with one-way analysis of variance, with Tukey's honest significance test to determine pairwise significance (RStudio V1.2). From January to October 2020, there were 114 preoperative imaging studies available for 95 patients. Thirty-four (30%) of the studies were TRUS, 46 (40%) were CT, and 34 (30%) were MRI. MRI-TZ most accurately predicted enucleation volume on multivariate analysis (F-statistic -value < 0.001). Preoperative imaging was greater than enucleation volume by a median of 46 cc for TRUS, 51 cc for CT, 53 cc for MRI, and 14 cc for MRI-TZ. Pairwise significance was reached for MRI-TZ over CT (-adj < 0.001), MRI-TZ over MRI (-adj < 0.001) and MRI-TZ over US (-adj = 0.03). Enucleation volume for BPH was most accurately predicted by TZ volume on MRI compared with total prostate volume on CT, TRUS, and MRI. MRI total volume was not superior to CT total volume. Focusing on MRI-TZ volume rather than total prostate volume may more accurately stratify patients for BPH treatment. In experienced hands, median enucleation volume is within 14 cc of MRI-TZ volume.

Robot-assisted radical prostatectomy (RARP) provides much quicker recovery for men than open prostatectomy. In most centers, discharge is planned the morning after operation. However, after several years, we observed that no routine intervention was required for a majority of men over the first evening. Here, we detail our institution's outcomes for multiport RARP (MP-RARP) with same-day discharge (SDD). After excluding patients with single-port RARP ( = 25) and overnight stays ( = 30), data from 224 patients ( = 224/279, 88.2%) who underwent MP-RARP from May 2021 to September 2023 were collected. All patients were placed on an Enhanced Recovery After Surgery protocol and were given instructions regarding SDD. Patients were considered as SDD if they were discharged on the day of operation. Data regarding messages and phone calls to health care providers, urology clinic, and emergency department visits were recorded for analysis in the week postoperation. The mean (±standard deviation [SD]) operative time was 142.5 ± 25.2 minutes, with a mean (±SD) console time of 95.1 ± 25.6 minutes. The median (interquartile range [IQR]) estimated blood loss was 50 (50-100) mL, and the mean (±SD) length of hospitalization was 163.2 ± 64.6 minutes. No intraoperative complications occurred in this cohort. The median (IQR) patient-reported pain score at 1 hour after operation was 3.5 (0-7), compared with 2 (0-4) at discharge. Of the 145 (64.7%) patients who reported their postoperative pain management, only 50 (34.4%) endorsed using opioids, and of those, 8 (16%) were known chronic opioid users. In the week after operation, 14 (6.3%) patients had unplanned visits to the health care facility. Additionally, 56 (25%) of patients contacted the clinic regarding the postoperative course during the same time frame. SDD after RARP is predictable and safe. SDD helps reduce the costs associated with inpatient stays without compromising surgical outcomes for patients.

As part of the Endourological Society's (ES) initiative to continuously enhance the field of endourology, the second annual census was circulated after the World Congress of Endourology and Uro-Technology 2022 (WCET22). An anonymous survey was created using Qualtrics XM and was disseminated via email to all ES members ( = 1502) between October 4, 2022, and January 26, 2023. A total of 46 questions were included in the survey and covered different aspects, including demographics, practice patterns, satisfaction, impact of COVID-19, WCET22 attendance, and future opportunities. A total of 404 (26.9%) ES members (91.8% male and 8.2% female), representing 63 different countries, participated in the survey. Fellowship-trained endourologists constituted 58.9% of respondents, and the most common practice setting was academic (55.2%). The most common practice scope was complex retrograde endoscopy (83.4%), followed by percutaneous nephrolithotomy (79.5%) and medical management of urolithiasis (72.5%). Work schedules were variable, with 51.1% working 40-60 hours/week and 35.3% working >60 hours/week. More than 80% were satisfied with t heir practice; however, 42.4% indicated that COVID-19 made satisfaction worse. Of the participants, 49.5% were satisfied with their compensation, and 7.3% plan to retire within the next 5 years. When asked about the future of endourology, 92.9% had a positive outlook. Of the respondents, only 36.8% attended WCET22, with the most chosen reason for attendance being an interest in learning new research and technology. For lack of attendance, the cost of travel and lodging was reported as a determining factor by 45.4%. These survey results report important trends within the field of endourology and demonstrate the robust outlook of ES members for the future. By demonstrating important practice patterns and member needs, this information can be used to improve the responsiveness of its members and to continually strengthen the ES.