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Objective: To assess the impact of kidney stone disease (KSD) and its treatment on the health‐related quality of life (HRQOL) of high‐risk stone formers with hyperparathyroidism, renal tubular acidosis, malabsorptive disease, and medullary sponge kidney. Patients and Methods: The Wisconsin Stone Quality of Life questionnaire was used to evaluate HRQOL in 3301 patients with a history of KSD from 16 institutions in North America between 2014 and 2020. Baseline characteristics and medical history were collected from patients, while active KSD was confirmed through radiological imaging. The high‐risk group was compared to the remaining patients (control group) using the Wilcoxon rank‐sum test. Results: Of 1499 patients with active KSD included in the study, the high‐risk group included 120 patients. The high‐risk group had significantly lower HRQOL scores compared to the control group (P < 0.01). In the multivariable analyses, medullary sponge kidney disease and renal tubular acidosis were independent predictors of poorer HRQOL, while alkali therapy was an independent predictor of better HRQOL (all P < 0.01). Conclusions: Among patients with active KSD, high‐risk stone formers had impaired HRQOL with medullary sponge kidney disease and renal tubular acidosis being independent predictors of poorer HRQOL. Clinicians should seek to identify these patients earlier as they would benefit from prompt treatment and prevention. [ABSTRACT FROM AUTHOR]

Objectives: To assess the effects of percutaneous nephrolithotomy (PCNL) vs retrograde intrarenal surgery (RIRS) for the treatment of renal stones in adults. Methods: We performed a comprehensive search of the Cochrane Library, MEDLINE, Embase, three other databases, trials registries, other sources of the grey literature, and conference proceedings up to 23 March 2023. We applied no restrictions on publication language or status. Screening, data extraction, risk‐of‐bias assessment, and certainty of evidence (CoE) rating using the Grading of Recommendations Assessment, Development and Evaluations (GRADE) approach were done in duplicate by two independent reviewers. This co‐publication focuses on the primary outcomes of this review only. Results: We included 42 trials that met the inclusion criteria. Stone‐free rate (SFR): PCNL may improve SFRs (risk ratio [RR] 1.13, 95% confidence interval [CI] 1.08–1.18; I2 = 71%; 39 studies, 4088 participants; low CoE). Major complications: PCNL probably has little to no effect on major complications (RR 0.86, 95% CI 0.59–1.25; I2 = 15%; 34 studies, 3649; participants; moderate CoE) compared to RIRS. Need for secondary interventions: PCNL may reduce the need for secondary interventions (RR 0.31, 95% CI 0.17–0.55; I2 = 61%; 21 studies, 2005 participants; low CoE) compared to RIRS. Conclusion: Despite shortcomings in most studies that lowered our certainty in the estimates of effect to mostly very low or low, we found that PCNL may improve SFRs and reduce the need for secondary interventions while not impacting major complications. Ureteric stricture rates may be similar compared to RIRS. We expect the findings of this review to be helpful for shared decision‐making about management choices for individuals with renal stones. [ABSTRACT FROM AUTHOR]

Objectives: To explore the optimal laser settings and treatment strategies for thulium fibre laser (TFL) lithotripsy, namely, those with the highest treatment efficiency, lowest thermal injury risk, and shortest procedure time. Materials and Methods: An in vitro kidney model was used to assess the efficacy of TFL lithotripsy in the upper calyx. Stone ablation experiments were performed on BegoStone phantoms at different combinations of pulse energy (EP) and frequency (F) to determine the optimal settings. Temperature changes and thermal injury risks were monitored using embedded thermocouples. Experiments were also performed on calcium oxalate monohydrate (COM) stones to validate the optimal settings. Results: High EP/low F settings demonstrated superior treatment efficiency compared to low EP/high F settings using the same power. Specifically, 0.8 J/12 Hz was the optimal setting, resulting in a twofold increase in treatment efficiency, a 39% reduction in energy expenditure per unit of ablated stone mass, a 35% reduction in residual fragments, and a 36% reduction in total procedure time compared to the 0.2 J/50 Hz setting for COM stones. Thermal injury risk assessment indicated that 10 W power settings with high EP/low F combinations remained below the threshold for tissue injury, while higher power settings (>10 W) consistently exceeded the safety threshold. Conclusions: Our findings suggest that high EP/low F settings, such as 0.8 J/12 Hz, are optimal for TFL lithotripsy in the treatment of COM stones. These settings demonstrated significantly improved treatment efficiency with reduced residual fragments compared to conventional settings while keeping the thermal dose below the injury threshold. This study highlights the importance of using the high EP/low F combination with low power settings, which maximizes treatment efficiency and minimizes potential thermal injury. Further studies are warranted to determine the optimal settings for TFL for treating kidney stones with different compositions. [ABSTRACT FROM AUTHOR]

Objectives: To understand the implications that the rising upper urinary tract (UUT) stone prevalence in Europe and the increasing burden places on patients and healthcare providers (HCPs), we investigated the evolution of diagnoses and procedures in Germany, France and England over the decade before the coronavirus disease 2019 (COVID‐19) pandemic. Methods: We identified International Classification of Diseases (ICD)‐10 codes related to UUT stones diagnosis and extracted procedure volumes for extracorporeal shockwave lithotripsy (ESWL), ureteroscopy (URS), percutaneous nephrolithotomy and open surgery using national procedure codes from the German Institute for the Hospital Remuneration System, the French Technical Agency of Hospitalisation Information and NHS England Hospital Episode Statistics. We analysed procedures vs hospital diagnoses from 2010 to 2019 and reported results per 100 000 inhabitants. Results: Between 2010 and 2019, ICD‐10 N20 codes for calculus of kidney and ureter increased by 8%, 26% and 15% in Germany, France, and England respectively; whereas procedures increased by 3%, 38% and 18%. Of the patients diagnosed with stones, the percentage that received treatment (of any type) differed between countries. In 2019, in Germany 83% of patients diagnosed with stones received treatment, in France 88%, and in England 56%. These figures were relatively stable over the 10‐year study period. Over the past decade, the dominant procedure shifted from ESWL to URS, and the average length of stay for URS decreased. Day case procedures increased in France and England (by 68% and 23%), no data were available in Germany. Conclusion: This analysis highlights an increase in stone diagnoses and procedures, and a shift of surgical management. This development may be due to clinical advantages and advanced technology. The continued stone prevalence rise affects patients, hospitals, and HCPs. [ABSTRACT FROM AUTHOR]

As small residual fragments are thought to represent a "nidus" of stone re-growth, it is of utmost importance to render patients with infection stones completely stone-free [1]. Case Presentation This case report outlines the treatment regimen in a patient with severe, recurrent, hitherto treatment-refractory struvite stones using a combination of endourological surgery and intraluminal lavage with Renacidin. Case of the month from Lillebaelt hospital, University Hospital of South Denmark, Denmark: Renacidin® - still a useful adjunct to endoscopic surgery for complex renal struvite stone disease Keywords: kidney stone; chemolysis; ureteroscopy; infection stones; renacidin EN kidney stone chemolysis ureteroscopy infection stones renacidin 437 440 4 09/16/22 20221001 NES 221001 Abbreviations ECIRS endoscopic combined intrarenal surgery ICU intensive care unit Introduction Renal infection stones constitute a particular treatment challenge because of the combination of large stone burden and associated UTI with urease-producing bacteria. [Extracted from the article]

Kidney stone disease is endemic. Extracorporeal shockwave lithotripsy was the first major technological breakthrough where focused shockwaves were used to fragment stones in the kidney or ureter. The shockwaves induced the formation of cavitation bubbles, whose collapse released energy at the stone, and the energy fragmented the kidney stones into pieces small enough to be passed spontaneously. Can the concept of microbubbles be used without the bulky machine? The logical progression was to manufacture these powerful microbubbles ex vivo and inject these bubbles directly into the collecting system. An external source can be used to induce cavitation once the microbubbles are at their target; the key is targeting these microbubbles to specifically bind to kidney stones. Two important observations have been established: (i) bisphosphonates attach to hydroxyapatite crystals with high affinity; and (ii) there is substantial hydroxyapatite in most kidney stones. The microbubbles can be equipped with bisphosphonate tags to specifically target kidney stones. These bubbles will preferentially bind to the stone and not surrounding tissue, reducing collateral damage. Ultrasound or another suitable form of energy is then applied causing the microbubbles to induce cavitation and fragment the stones. This can be used as an adjunct to ureteroscopy or percutaneous lithotripsy to aid in fragmentation. Randall's plaques, which also contain hydroxyapatite crystals, can also be targeted to pre-emptively destroy these stone precursors. Additionally, targeted microbubbles can aid in kidney stone diagnostics by virtue of being used as an adjunct to traditional imaging methods, especially useful in high-risk patient populations. This novel application of targeted microbubble technology not only represents the next frontier in minimally invasive stone surgery, but a platform technology for other areas of medicine.

Objectives: To evaluate the utility of kidney injury test (KIT) assay urinary biomarkers to detect kidney stones and quantify stone burden. Patients and Methods: A total of 136 spot urine samples from 98 individuals, with and without kidney stone disease, were processed in a predefined assay to measure six DNA and protein markers in order to generate a risk score for the non‐invasive detection of nephrolithiasis. From this cohort, 56 individuals had spot, non‐timed urine samples collected at the time of radiographically confirmed kidney stones, and 54 demographically matched, healthy controls without kidney stone disease also provided spot, non‐timed urine samples. Sixteen individuals with persistent stone disease had more than one urine sample. Using a proprietary microwell‐based KIT assay, we measured cell‐free DNA (cfDNA), methylated cfDNA, clusterin, creatinine, protein and CXCL10. A KIT stone score was computed across all markers using the prior locked KIT algorithm. The KIT stone score, with a scale of 0 to 100, was then correlated with demographic variables, kidney stone burden, obstructive kidney stone disease, and urine solutes in 24‐h urine collections. Results: The scaled KIT stone score, a composite of all six biomarkers, readily discriminated individuals with current or prior radiographically confirmed kidney stones from healthy controls without kidney stone disease (P < 0.001). In individuals with nephrolithiasis, KIT stone score also correlated with radiologically measured stone size (P = 0.017) and differentiated patients with a clinical radiological diagnosis of obstructive nephrolithiasis associated with upper renal tract dilatation (P = 0.001). Stone burden as assessed by KIT stone score, however, did not correlate with the any of the traditional measures of 24‐h urine solutes or the 24‐h urine supersaturation levels. In patients with persistent stone disease, where multiple urine samples were collected over time and after different interventions, the use of KIT stone score could non‐invasively track stone burden over time through a spot urine, non‐timed urine sample. Conclusions: A random, spot urine‐based assay, KIT stone score, can non‐invasively detect, quantify and monitor current stone burden, and may thus minimize radiographic exposure for kidney stone detection. The KIT stone score assay may also help monitor stone recurrence risk for patients with nephrolithiasis, without the requirement for 24‐h urine collections. [ABSTRACT FROM AUTHOR]

Objective: To estimate the cost of kidney stone disease (KSD) in England. Patients and Methods: We conducted a retrospective cohort study of patients with KSD, referred to a metabolic stone clinic between 1990 and 2007 using electronic records of patients with KSD in a tertiary referral centre, to determine cost using UK National Health Service (NHS) tariff, with subsequent extrapolation to the entire England population. Those with no documentation and <5 years follow‐up were excluded. The outcome measure was calculation of cost (as per 2018 NHS tariff) presented as lower and higher estimates for: per episode; total within the cohort; and estimation of initial, 5‐,10‐ and 15‐year costs for the cohort and total population in England. Linear regression was used to examine for significant predictors of per episode and total cost. Results: A total of 781 patients were included in the study after 1000 records were screened for inclusion, with a mean follow‐up of 19 years. The mean (SD) overall costs per episode were between £1277 (1724) and £2887 (2492). Total initial costs for the cohort were between £950 842 and £2 336 442, rising to between £1.43 million and £3.02 million at 15 years of follow‐up. Estimated cost in 2010 in England alone was between £190 million and £324 million. Conclusion: KSD is a costly disease, comparable to the combined cost of prostate and bladder cancer in UK. [ABSTRACT FROM AUTHOR]

Objectives: To evaluate the long‐term outcomes of patients undergoing observation of asymptomatic renal calculi and identify factors associated with stone‐related events. Patients and Methods: Patients with asymptomatic renal calculi electing active surveillance of their stones were retrospectively reviewed. Patients underwent annual ultrasonography and clinical visits with standardised questions regarding the development of symptoms or complications from calculi. Spontaneous stone passage, stone growth, development of stone‐related symptoms, and requirement for intervention during follow‐up were deemed as stone‐related events. Results: Between 2007 and 2017, 293 patients were reviewed to evaluate the natural history of asymptomatic renal calculi. The mean follow‐up was 4.2 years. Overall incidences of spontaneous passage, stone growth, development of stone‐related symptoms, and requirement of intervention were 32.1%, 16.7%, 28.3% and 12.3%, respectively. Stones >5 mm and lower pole stones were significantly less likely to pass spontaneously. Patients with diabetes mellitus (DM), hyperuricaemia or non‐lower calyceal stone were more likely to experience stone growth. Stones >5 mm or non‐lower pole stones were more likely to become symptomatic. Significant predictors of surgical intervention were stone size (>5 mm) and patients' age (>60 years). Primary therapy was extracorporeal shockwave lithotripsy in 33 patients and flexible ureteroscopy in three. Conclusion: The natural history of asymptomatic renal stones rarely requires intervention, although they do have a slightly higher rate of symptomatic events and growth over the intermediate term. In particular, patients with stones >5 mm, DM, hyperuricaemia, or non‐lower calyceal stones are at higher risk of developing stone‐related events, and should therefore be recommended for regular follow‐up. [ABSTRACT FROM AUTHOR]

Objective To evaluate the protective effects of selenium with vitamins A, C and E (selenium ACE, i.e. antioxidants), verapamil (calcium channel blocker), and losartan (angiotensin receptor blocker) against extracorporeal shockwave lithotripsy ( ESWL)-induced renal injury. Patients and Methods A randomised controlled trial was conducted between August 2012 and February 2015. Inclusion criteria were adult patients with a single renal stone (<2 cm) suitable for ESWL. Patients with diabetes, hypertension, congenital renal anomalies, moderate or marked hydronephrosis, or preoperative albuminuria (>300 mg/L) were excluded. ESWL was performed using the electromagnetic DoLiS lithotripter. Eligible patients were randomised into one of four groups using sealed closed envelopes: Group1, control; Group 2, selenium ACE; Group 3, losartan; and Group 4, verapamil. Albuminuria and urinary neutrophil gelatinase-associated lipocalin ( uNGAL) were estimated after 2-4 h and 1 week after ESWL. The primary outcome was differences between albuminuria and uNGAL. Dynamic contrast-enhanced magnetic resonance imaging was performed before ESWL, and at 2-4 h and 1 week after ESWL to compare changes in renal perfusion. Results Of 329 patients assessed for eligibility, the final analysis comprised 160 patients (40 in each group). Losartan was the only medication that showed significantly lower levels of albuminuria after 1 week ( P < 0.001). For perfusion changes, there was a statistically significant decrease in the renal perfusion in patients with obstructed kidneys in comparison to before ESWL ( P = 0.003). These significant changes were present in the control or antioxidant group, whilst in the losartan and verapamil groups renal perfusion was not significantly decreased. Conclusions Losartan was found to protect the kidney against ESWL-induced renal injury by significantly decreasing post- ESWL albuminuria. Verapamil and losartan maintained renal perfusion in patients with post- ESWL renal obstruction. [ABSTRACT FROM AUTHOR]

Objective To develop and internally validate a preoperative nomogram for predicting stone-free status ( SF) after flexible ureteroscopy ( fURS) for renal stones, as there is a need to predict the outcome of fURS for the treatment of renal stone disease. Patients and Methods We retrospectively analysed 310 fURS procedures for renal stone removal performed between December 2009 and April 2013. Final outcome of fURS was determined by computed tomography 3 months after the last fURS session. Assessed preoperative factors included stone volume and number, age, sex, presence of hydronephrosis and lower pole calculi, and ureteric stent placement. Multivariate logistic regression analysis with backward selection was used to model the relationship between preoperative factors and SF after fURS. Bootstrapping was used to internally validate the nomogram. Results Five independent predictors of SF after fURS were identified: stone volume ( P < 0.001), presence of lower pole calculi ( P = 0.001), operator with experience of >50 fURS ( P = 0.026), stone number ( P = 0.075), and presence of hydronephrosis ( P = 0.047). We developed a nomogram to predict SF after fURS using these five preoperative characteristics. Total nomogram score (maximum 25) was derived from summing individual scores of each predictive variable; a high total score was predictive of successful fURS outcome, whereas a low total score was predictive of unsuccessful outcome. The area under the receiver operating characteristics for nomogram predictions was 0.87. Conclusion The nomogram can be used to reliably predict SF based on patient characteristics after fURS treatment of renal stone disease. [ABSTRACT FROM AUTHOR]

Study Type - Prognosis (cohort series) Level of Evidence 2b What's known on the subject? and What does the study add? Epidemiologic studies have shown that warmer climates are associated with increased incidence of nephrolithiasis. Many hypothesize that this is due to dehydration and lower urine volumes. The current study of stone formers reports that greater temperatures are associated with significant increases in urine calcium which may shed light on the mechanism underlying the increased stone incidence associated with increased ambient temperature. OBJECTIVE To understand the effects of temperature, humidity and season of year on 24-h urine composition in patients with nephrolithiasis., PATIENTS AND METHOD A retrospective review was performed of patients evaluated at four metabolic stone clinics., Multivariate linear regression models examined the relationship between mean temperature, average humidity, season of year and 24-h urine composition., Multivariate models adjusted for known risk factors for stone disease., Mean temperature and average humidity data were obtained from http://www.weatherunderground.com based on patient-provided addresses., RESULTS A total of 599 patients were included in the study, comprising 239 women and 360 men with a mean age of 53.6 years ( sd 15.0)., Mean temperature was 16.9 °C ( sd 4.8, range −21.1 to 38.3 °C) and average humidity was 58.1% ( sd 23.5, range 11-100%)., On multivariate linear regression, increasing temperature was associated with increasing urine calcium (β= 11.3, 95% CI 2.2-20.0), super-saturation of calcium oxalate (β= 0.6, 95% CI 0.2-0.9), super-saturation of calcium phosphate (β= 0.14, 95% CI 0.03-0.2), and decreasing urine sodium (β=−5.2, 95% CI −10.3 to −0.1)., As seasons become warmer (i.e. from winter to autumn to spring to summer), changes were increased urine volume (β= 0.09, 95% CI 0.01-0.2) and decreased super-saturation of calcium phosphate (β=−0.2, 95% CI −0.3 to −0.03)., There were no associations between quintile of humidity and any 24-h urine constituents., CONCLUSIONS Increasing temperature may increase stone risk by increasing urine excretion of calcium, and the super-saturation of calcium oxalate and calcium phosphate., These findings were independent of humidity and of season of year., This appears to be related to a physiological impact of temperature itself, rather than to geographic location. [ABSTRACT FROM AUTHOR]

OBJECTIVE To present our experience with 454 patients who had tubeless percutaneous nephrolithotomy (TPCNL) over last 3 years. PATIENTS AND METHODS From September 2004 to August 2007, all patients aged >14 years and undergoing PCNL were considered for TPCNL. Exclusion criteria were the presence of pyonephrosis, matrix calculi, significant bleeding or residual stone burden and need for three of more percutaneous accesses. These patients had a nephrostomy tube placed after PCNL (control group). The remaining patients undergoing TPCNL (study group) had antegrade ureteric stenting. Demographic and perioperative data were compared retrospectively. RESULTS Of 840 patients who had PCNL during the study period, 454 had TPCNL. The two groups had comparable demographic data except for a smaller stone burden (322.8 vs 832.2 mm2) and fewer staghorn calculi (94 vs 154) in patients undergoing TPCNL ( P < 0.001). The mean number of tracts per renal unit and operative duration were statistically higher in patients undergoing standard PCNL (1.5 vs 1.1, and 68.8 vs 52.2 min, respectively). The decrease in haemoglobin, complication and stone-free rates were comparable. TPCNL was associated with less postoperative pain, analgesia requirement and earlier discharge ( P < 0.001). CONCLUSIONS TPCNL can be used with a favourable outcome and no increase in complications in selected patients, with the potential advantages of decreased postoperative pain, analgesia requirement and hospital stay. Its application can be extended to patients with a solitary kidney, previous ipsilateral open surgery, raised serum creatinine level, in the presence of three renal accesses or supracostal access, and in patients undergoing bilateral synchronous PCNL or contralateral endourological stone treatment. [ABSTRACT FROM AUTHOR]

OBJECTIVE To define incidence of renal matrix calculi in patients undergoing percutaneous nephrolithotomy (PCNL), and describe its clinical, laboratory and radiological features; we also studied the efficacy of PCNL in managing this rare entity. PATIENTS AND METHODS We retrospectively reviewed the records of 1368 PCNLs performed from April 2003 to March 2008, and identified 17 patients (mean age 44.3 years; 11 women and six men) having matrix calculi. The patients’ clinical, laboratory and radiological features were studied, and the perioperative outcome and follow-up data analysed. RESULTS Flank pain was commonest mode of presentation (15) followed by recurrent urinary tract infection (five). Pyuria was present in 14 patients and urine culture showed significant growth in 10. A plain X-ray showed a small radio-opaque calculus (10 renal units) and faint laminated calcification (four). Intravenous urography showed a filling defect and non-visualized system in nine and five patients, respectively. Non-contrast computed tomography and magnetic resonance urography diagnosed calculi in two and one patient, respectively, on haemodialysis. PCNL was abandoned initially in four patients due to pyonephrosis. The mean hospital stay was 3.4 days and decrease in haemoglobin was 0.89 g/dL. One patient developed sepsis. Of 11 stones analysed, two were composed entirely of proteins and the remaining nine had crystalline components. At a mean follow-up of 12.6 months, no patients had recurrence of stone. CONCLUSIONS Matrix calculi occurred in 1.24% of patients undergoing PCNL. Although considered radiolucent, plain X-ray showed a small radio-opaque calculi or faint laminated calcifications in 10 of 17 patients. PCNL rendered patients stone-free with minimum morbidity. [ABSTRACT FROM AUTHOR]

OBJECTIVES To investigate the intrarenal mRNA expression of monocyte chemoattractant protein-1 (MCP-1) and interleukin-6 (IL-6) in patients with nephrolithiasis, and to evaluate whether their expression is associated with renal function, as oxidative stress and inflammation are involved in the pathogenesis of nephrolithiasis. PATIENTS, SUBJECTS AND METHODS Renal biopsies from near the stone, and blood and 24-h urine specimens were collected from 29 patients with nephrolithiasis. Control renal tissues were taken from non-cancerous and cancerous portions of nephrectomy from six patients with renal cancers, and control 24-h urine samples were obtained from 30 healthy subjects. Corrected creatinine clearance, urinary N-acetyl-β-glucosaminidase activity and 8-hydroxy-deoxyguanosine (8-OHdG) were determined. The mRNA expressions of MCP-1 and IL-6 in the tissues were measured by real time reverse transcription-polymerase chain reaction. RESULTS Patients with nephrolithiasis had significantly greater renal tubular damage and oxidative stress than the healthy controls. Intrarenal mRNA expressions of MCP-1 and IL-6 in stone-adjacent renal tissues were significantly lower than in cancerous renal tissues, but not statistically different from that in non-cancerous renal tissues. In stone-adjacent renal tissues, the mRNA level of MCP-1 was significantly higher than that of IL-6, but their expressions were significantly correlated with each other. Histological examination showed that the number of infiltrated leukocytes corresponded well with the intrarenal mRNA levels of MCP-1 and IL-6. Patients with nephrolithiasis and compromised renal function had significantly higher intrarenal mRNA levels of MCP-1 and IL-6 than those with preserved renal function. Also, the mRNA levels in patients with severe renal tubular damage were significantly greater than in those with less renal tubular damage. There was no association between intrarenal mRNA expression and urinary 8-OHdG. CONCLUSION Nephrolithiasis was associated with low-grade intrarenal inflammation. A greater intrarenal mRNA expression of MCP-1 and IL-6 was associated with enhanced renal impairment. Thus, expression of MCP-1 and IL-6, at least in part, contributed to the progression of nephrolithiasis. [ABSTRACT FROM AUTHOR]

Objective To fractionate renal-stone matrix proteins, identify the presence of oxalate-binding protein and assess its effect in a calcium oxalate (CaOx) crystal growth system. Materials and methods Proteins were isolated from the matrix of kidney stones containing CaOx as the major constituent, using EDTA as a demineralizing agent. The solubilized proteins were subjected to cellulose-column chromatography by eluting with increasing sodium chloride concentrations in Tris-HCl buffer. Three protein fraction peaks were eluted, i.e. fraction I in buffer, fraction II in 0.05 mol/L NaCl in buffer and fraction III in 0.3 mol/L NaCl in buffer. The protein fractions were tested for their effects on CaOx crystal growth. Results All three fractions had maximum CaOx binding activity at pH 7.4 but fraction II also had activity at pH 4.5. Fraction I promoted in vitro CaOx crystal growth, while fractions II and III were inhibitory. When fraction I was further separated on a Sephadex G-200 column, two protein fractions (Ia and Ib) were obtained. Fraction Ia protein had high and fraction Ib low CaOx-binding activity. Fraction Ia had a molecular weight of 48 kDa on gel electrophoresis and Western blotting. The 48 kDa protein did not cross-react with crystal matrix protein antibody, band-3 protein antibody, or albumin. The protein promoted CaOx crystal growth, with an optimum temperature of 37 °C and pH 6.5. The inhibitory effect of citrate on crystal growth was significantly lower in the presence of the 48 kDa protein. The protein promoted nucleation and aggregation of CaOx crystals in the in vitro crystallization system at pH 6.5, whereas fraction Ib (29 kDa) inhibited both nucleation and aggregation. Using the 48 kDa antibody, the yield of the protein from the stone matrix was 32% by EDTA extraction and only 3% with other methods. The protein was also detected in the nucleus and mitochondria, and in other matrix fractions of calcium phosphate and uric acid stones.... [ABSTRACT FROM AUTHOR]

Introduction: Ureteroscopy has dramatically changed the management of ureteral calculi. RIRS provided significantly higher stone-free rate (86.5% vs 67.7%) and lower retreatment rate compared with ESWL (60% vs 8%). Analysis showed that stone size, location, composition, number, renal malformations, and lower pole infundibulopelvic angle had significant influence on the stone-free rate (86%) after RIRS. Material and method: This is a case report study of n = 1. Result: A 48-year-old woman who was admitted into our hospital with bilateral flank pain and fever. Physical examination showed bilateral costovertebral angle tenderness. She was previously treated by ESWL for bilateral kidney stones in 2011 and semi-rigid URS for left ureteral stone in 2013. A non-contrast CT urography was performed, which showed right lower calyceal stones (11.4 × 10.7 mm; 7.4 × 6.6 mm), right distal ureteral stone (18.5 × 5.5 mm), left lower calyceal stones (21.4 × 13.1 mm; 6.6 × 6 mm), left ureterovesico junction stone (3.3 × 1.9 mm). We performed bilateral semi-rigid URS to clean ureteral stones, combine with bilateral RIRS through a ureteral access sheath to disintegrate lower calyceal stones using Ho: YAG wasintroduced the fragments were removed using nitinol tip-less basket. No prior stenting was performed in this patient during the initial assessment of the left pelviocalyces, the lower calyx containing the stone could not be identified. On a more detail inspection, a membrane was found to be covering the lower calyx orifice (Fig. 1), Ho: YAG fulguration was done on this membrane which then revealed already fragmented stones in the minor calyx (Figs 2,3). Conclusion: RIRS could be performed successfully without prior stenting in already dilated ureters due distal ureteral stone obstruction and RIRS could also manage anatomical anomaly which has caused failure of stone clearance during previous ESWL treatment. [ABSTRACT FROM AUTHOR]

Introduction: Staghorn stone disease is still a present challenge in an ever developing urology specialty. Open surgery or percutaneous nephrolithotomy (PCNL) are the standard treatment modalities to treat this particular stone. To undergo these procedures safely a patient needs to have a good cardiac tolerance. Major technological progress has been achieved for retrograde intrarenal surgery [(flexible URS)], with improved deflection mechanisms, better durability, and recently, digital optical systems. Shockwave lithotripsy and RIRS are available treatment modalities for renal calculi. However ESWL and flexible ureterorenoscopy (f-URS) may be preserved specifically to manage smaller and simpler stones. Material and method: This is case report study of n = 1. Result: A 46-year-old man was admitted into our hospital with bilateral flank pains and dyspnea. His serum creatinine at admission was 4.8 mg/dL and uric acid 12.8 mg/dl. A-non contrast CT urography was performed, the result showed right kidney stone (26.1 mm × 15.2 mm) and left kidney stone (36.0 mm × 41.5 mm). his comorbidities included gouty arthritis and congestive heart failure with ejection fraction 20%. His cardiac tolerance to undergo open surgery is classified as high risk. Th us other procedures with less morbidity and quick completion allowance should be considered. Two sessions of ESWL were performed bilaterally without significant disintegration of his stones. Th en bilateral kidney stones disintegration using Holium YAG laser through semirigid URS and JJ stent insertions were performed and followed by bilateral f-URS procedure showed significant disintegration and reduction of his bilateral stone sizes. Two more session of ESWL were performed and a post treatment non contrast CT urography showed that his right kidney has been cleared of stone fragments while residual stone fragments were visible in his right kidney. The whole procedures were performed in a period of 18 months due patient's poor compliance to treatment schedules and uric acid management, his serum uric acid ranged between 9.1-13.4. Conclusion: Multi modalities, multiple sessions of ESWL, URS, and F-URS, can be utilized safely and effectively in this patient with severe cardiac comorbidity, while invasive surgery is considered high risk and ESWL alone could not disintegrate his stones. However patient's compliance is the limiting factor of the success of his treatment. [ABSTRACT FROM AUTHOR]

Objectives To determine if levels of inter-α-trypsin inhibitor (IαTI)-trimer differ in normal individuals based on age, gender or hormonal status, as the regulation of calcium oxalate (CaOx) crystallization inhibitors, e.g. by sex steroids, could be a mechanism contributing to the differences in CaOx urolithiasis between the sexes. Subjects and methods Voided urine samples were collected from normal males and females. In Experiment 1 samples were grouped by gender and age, i.e. paediatric (PED) ≤ 10 years, male (M) 21, female (F) 14; young adult (YGAD) 20–30 years, M 23, F 18; adults (AD), 35–50 year, M 25, F 13; adults aged ≥ 60 years (> 60), M 24, F 16 (totals, M 93, F 61). In Experiment 2 samples were grouped by gender, age and hormonal status, i.e. PED, M 24, F 17; AD, M 24, F 22; > 60 and not on hormonal therapy, M 23, F 30; M > 60 and on androgen deprivation therapy (ANDEP) 18; and F > 60 on oestrogen supplementation, F+EST, 18 (total M 89, F 85). Levels of urinary IαTI-trimer were determined by immunoblotting and enhanced chemiluminescence, and relative densities of the bands determined. Results In both experiments the relative levels of IαTI-trimer were 2–7 times higher in M-PED than in all other groups of males ( P ≤ 0.007). Among adult males, IαTI-trimer levels were similar in all groups, including ANDEP ( P ≥ 0.9). There were no differences in the relative levels of IαTI-trimer among any of the groups of females, regardless of age or hormonal status ( P ≥ 0.7). Conclusions In males a decrease in IαTI-trimer was associated with the onset of adulthood and entry into the ‘stone-forming years’. Females did not show this decrease, and neither sex showed an increase in IαTI-trimer in the > 60 group, when the incidence of CaOx urolithiasis is supposedly declining. While changes in urinary... [ABSTRACT FROM AUTHOR]