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Item A case of ureteral fungal mass removal in a patient taking empagliflozin(SpringerLink, 2021-11) Woloshuk, Andre; Lee, Matthew; Assmus, Mark; Agarwal, Deepak; Krambeck, Amy; Large, Tim; Urology, School of MedicineWith increased use of sodium-glucose co-transporter 2 (SGLT2) inhibitors as antidiabetic agents, the risk of serious fungal urinary tract infection (UTI) may be increased. We present the case of a 67-year-old Caucasian female who was admitted for emphysematous pyelitis and found to have a fungal ball in the renal pelvis. Candida glabrata was cultured and the patient was managed with percutaneous nephrostomy tube placement and antifungal treatment. The fungal ball persisted and required surgical removal with ureteroscopy and basket extraction. Fungal balls can be a difficult sequelae of UTIs requiring a combination of antifungal and surgical intervention for definitive management.Item The Uniform grading tooL for flexIble ureterorenoscoPes (TULIP-tool): a Delphi consensus project on standardised evaluation of flexible ureterorenoscopes(Wiley, 2023) Henderickx, Michaël M. E. L.; Hendriks, Nora; Baard, Joyce; Wiseman, Oliver J.; Scotland, Kymora B.; Somani, Bhaskar K.; Şener, Tarik E.; Emiliani, Esteban; Dragos, Laurian B.; Villa, Luca; Talso, Michele; Hamri, Saeed Bin; Proietti, Silvia; Doizi, Steeve; Traxer, Olivier; Chew, Ben H.; Eisner, Brian H.; Monga, Manoj; Hsi, Ryan S.; Stern, Karen L.; Leavitt, David A.; Rivera, Marcelino; Wollin, Daniel A.; Borofsky, Michael; Canvasser, Noah E.; Ingimarsson, Johann P.; El Tayeb, Marawan M.; Bhojani, Naeem; Gadzhiev, Nariman; Tailly, Thomas; Durutovic, Otas; Nagele, Udo; Skolarikos, Andreas; Schout, Barbara M. A.; Beerlage, Harrie P.; Pelger, Rob C. M.; Kamphuis, Guido M.; Urology, School of MedicineObjective: To develop a standardised tool to evaluate flexible ureterorenoscopes (fURS). Materials and methods: A three-stage consensus building approach based on the modified Delphi technique was performed under guidance of a steering group. First, scope- and user-related parameters used to evaluate fURS were identified through a systematic scoping review. Then, the main categories and subcategories were defined, and the expert panel was selected. Finally, a two-step modified Delphi consensus project was conducted to firstly obtain consensus on the relevance and exact definition of each (sub)category necessary to evaluate fURS, and secondly on the evaluation method (setting, used tools and unit of outcome) of those (sub)categories. Consensus was reached at a predefined threshold of 80% high agreement. Results: The panel consisted of 30 experts in the field of endourology. The first step of the modified Delphi consensus project consisted of two questionnaires with a response rate of 97% (n = 29) for both. Consensus was reached for the relevance and definition of six main categories and 12 subcategories. The second step consisted of three questionnaires (response rate of 90%, 97% and 100%, respectively). Consensus was reached on the method of measurement for all (sub)categories. Conclusion: This modified Delphi consensus project reached consensus on a standardised grading tool for the evaluation of fURS - The Uniform grading tooL for flexIble ureterorenoscoPes (TULIP) tool. This is a first step in creating uniformity in this field of research to facilitate future comparison of outcomes of the functionality and handling of fURS.