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Introduction:Ureteral stents are commonly placed after ureteroscopy. We examined the rate of cystoscopy-based stent removal (CBSR) following ureteroscopy for stone disease and its economic ...

Adult nephrologists often look after patients who have been diagnosed with kidney disease in childhood. This does present unique challenges to the adult nephrologist, who may be unfamiliar with the underlying cause of kidney disease as well as the complications of chronic kidney disease (CKD) that may have accumulated during childhood. This review discusses common causes of childhood CKD, in particular congenital anomalies of the kidney and urinary tract (CAKUT), autosomal dominant tubulointerstitial kidney disease (ADTKD), polycystic kidney disease, hereditary stone disease, nephrotic syndrome and atypical haemolytic uraemic syndrome. The long-term consequences of childhood CKD, such as the cardiovascular consequences, cognition and education as well as bone health, nutrition and growth are also discussed.

Until now, there is no clear guidelines regarding the best procedure in urinary diversion in acute urinary obstruction. We perform a randomized controlled trial research to evaluate the best way in our center

Introduction: Urosepsis is a serious potential complication of ureteroscopic procedures for stone disease, yet the risk factors for this complication are not well characterized. The purpose of this...

Introduction: There are two main mechanisms of stone ablation with long-pulsed infrared lasers: photothermal and photomechanical. Which of them is primary in stone destruction is still a matter of ...

Purpose: Evidence suggests that androgens can be involved in the pathogenesis of renal stones. This study aimed at investigating coding region polymorphisms and CAG repeats in androgen receptor (AR) and their association with active renal calcium stone disease. Materials and Methods: Male patients with calcium kidney stones ( N = 106) with at least two episodes of stone recurrence or size increase during the past 5 years (ASF) were enrolled from December 2008 to April 2009. Control individuals were recruited after matching for age and gender from healthy individuals without current stone or history of stone disease. Genetic sequencing and single strand conformational polymorphism (SSCP) were used to determine AR polymorphisms in the patients and controls. Results: Two polymorphisms were identified in the AR gene: Silent G to A polymorphism in the first exon of the AR gene and C to G polymorphism in intron 4. CAG repeats ranged from 12 to 37. The C/G polymorphism in intron 4 and CAG repeats were associated with the status of active renal calcium stone disease (all p < 0.05). The CC variant of C/G polymorphism was not observed in patients with stone disease. CAG repeats less than 20 and more than 28 were mostly observed in ASF patients ( p < 0.05). Conclusions: CAG repeats and intron 4 C/G polymorphism in the AR gene have an association with renal calcium stone disease.

Purpose of review Artificial intelligence (AI) is the ability of a machine, or computer, to simulate intelligent behavior. In medicine, the use of large datasets enables a computer to learn how to perform cognitive tasks, thereby facilitating medical decision-making. This review aims to describe advancements in AI in stone disease to improve diagnostic accuracy in determining stone composition, to predict outcomes of surgical procedures or watchful waiting and ultimately to optimize treatment choices for patients. Recent findings AI algorithms show high accuracy in different realms including stone detection and in the prediction of surgical outcomes. There are machine learning algorithms for outcomes after percutaneous nephrolithotomy, extracorporeal shockwave lithotripsy, and for ureteral stone passage. Some of these algorithms show better predictive capabilities compared to existing scoring systems and nomograms. Summary The use of AI can facilitate the development of diagnostic and treatment algorithms in patients with stone disease. Although the generalizability and external validity of these algorithms remain uncertain, the development of highly accurate AI-based tools may enable the urologist to provide more customized patient care and superior outcomes.

Introduction and Objectives: Lack of access to urologic specialists is approaching crisis levels as the number of urologists is decreasing, while the demand for urologic care is increasing. The financial implications of this have not been explored. The objective of this study is to examine the impact of access and other patient factors on cost to treat urolithiasis. We hypothesized that markers of poor access would associate with higher costs of surgical encounters for patients presenting with urolithiasis. Methods: A retrospective review of prospectively collected data from the Registry for Stones of the Kidney and Ureter (ReSKU) from September 2015 to July 2018 was conducted to investigate characteristics of surgical patients treated for urinary stone disease. Univariate analysis was performed using the Welch two-sample t-test. Multivariate analysis was performed using logistic regression. Statistical analysis was performed in R version 3.5. Results: When taking into account age, delayed presentation, procedure type, stone size >20 mm, American Society of Anesthesiologists (ASA) code, gender, race, income, distance, urologist density, body mass index, diabetes, infection, education, language, insurance, and stone complexity, patients undergoing percutaneous nephrolithotomy procedure (p

Context: Stone recurrence is frequent in stone formers, and repeated diagnostic and therapeutic procedures in recurrent stone formers place patients and urologists at a significant risk of radiatio...

Objectives: Ureteroscopic ureteral perforations have been reported in up to 6% of cases, with recent studies suggesting a decline to less than 2%. Ureteroscopic perforations are managed with prolon...

Cystinuria is the most common cause of inherited stone disease and is caused by the failure of absorption of filtered dibasic amino acids including cystine in the proximal tubules. It is associated with a very high recurrence rate in affected patients, with the potential for significant morbidity in such patients due to the need for repeated surgical interventions. A multimodal and multispecialty approach in a dedicated centre is the key to improving treatment outcomes and patient adherence to the treatment. This article reviews the latest knowledge on the clinical and diagnostic features and summarises key developments to aid clinicians in diagnosis and management options, together with future directions for the care of these patients.

There are patients suffered prostate cancer and diagnosed with stone disease in urological centres. These cases represent non-standard issue of choosing the optimal surgical treatment. Currently clinical recommendations haven’t described the particular answer for this answer yet. There is also lack of information published in literature foсused on the issue.Aim of the study was to determine the optimal choice of surgical treatment for patients diagnosed with stone disease and prostate cancer.Materials and methods: Retrospective study of patients diagnosed with prostate cancer and stone disease for the period from 2006 to 2019 was performed. Among 2047 in-patient cases of prostate cancer 71 patients with stone disease were included.Results: 49 of 71 (69%) patients diagnosed with stone disease had indications for surgical treatment at the moment of hospitalisation. Stages of prostate cancer in this group were T1-T2 (91,7%) and T3(8,3%). 25 patients (51%) had kidney stone disease, 23 patients (47%) – ureter stone disease and only 1 patient – kidney and ureter stone disease. 37 patients (75%) presented complains related to stone disease, other cases (25%) were asymptomatic. Surgical treatment of stone disease primarily was performed in the majority of cases (72,2%). Surgical treatment of prostate cancer subsequently included radical prostatectomy in most cases 7 (86,1%). Simultaneous surgical treatment of both diseases haven’t performed in this study.Conclusion: The main factors influencing the decision making of optimal surgical treatment for this group of patients were clinical presentation and group of prostate cancer risk.

To evaluate the impact of chronic stone recurrence on an individual's quality of life using the validated Wisconsin Stone Quality of Life (WISQOL) questionnaire. We collected cross-sectional data on patients with kidney stones from 14 institutions in North America. A stone event was defined as renal colic, stone-related procedure or emergency department visit. The regression analyses using general linear models and pairwise comparison determined the impact of the number of stone events on quality of life. The median number of stone events among the 2205 patients who completed the questionnaire was 3 (IQR 1-6). The mean total score was 107.4 ± 28.7 (max 140 points). The number of lifetime stone events was an independent predictor of lower quality of life (p 0.001), specifically, score declined significantly beyond five events. Compared with patients who experienced a single stone event, there was a 0.4, 2.5, and 6.9 point decline in the adjusted mean WISQOL score after 2-5, 6-10, or 10 events, respectively. The cumulative number of lifetime stone events was associated with a lower quality of life when more than five stone events were occurred. These findings underscore the importance of efforts to determine the underlying metabolic etiology of urolithiasis in the recurrent stone former, and the institution of a regimen to place their stone disease in remission.

Diet frequently contributes to patients' urinary stone disease. It is important to determine when this is the case and when it is not, as failure to do so may delay the implementation of other, more appropriate therapies. When diet is thought to be involved, one of two approaches may be taken: (1) provide a general list of all possible dietary factors that influence the risk for all types of stones and let the patient decide which dietary change(s) are needed; or (2) prescribe specific modifications that address each patient's need for change and their personal characteristics (i.e., urinary risk factors, type(s) of stones they have formed, dietary preferences, nutrient needs, etc.). The latter of these approaches is "minimally invasive" and is thus consistent with the goal of other therapies. However, this approach requires a rigorous appraisement of each patient's diet and linkage, when possible, to urinary and other stone risk factors. When the collaboration of a registered dietitian nutritionist or other nutrition professional experienced in dietary assessment is not available, screeners or questionnaires may be useful. Unfortunately, there is no such tool that is validated for identifying dietary stone risk factors. The development of a brief, 40-item, stone-specific food screener is described. While further validation is needed, it may provide the basis for a standardized instrument that could be used more broadly; desired features of such an instrument are described. Patient Summary: Personalized nutrition therapy is useful in mitigating the effects or recurrence risk of many chronic diseases. It is also useful in stone disease, a condition with highly variable risk expression, even among patients who form the same types of stones. A standardized and validated stone-specific dietary assessment tool would be valuable in clinical management and in research studies involving the description of patients' diets and dietary intervention.

Introduction: With a rise in the incidence of stone disease, more research is needed to understand the lifestyle factors associated with it. We evaluate available evidence for association of smokin...

Urolithiasis is a common disease, and is an important health problem that is associated with a great economic burden. The nature of stone disease varies according by dietary and lifestyle factors, including, among others, climate variations. The majority of patients will suffer a new lithiasic episode at some point in their life, unless preventive measures, such as changing lifestyles and dietary habits, are put in place to avoid it. The risk factors involved in lithogenesis should be evaluated in order to reduce recurrences. In the majority of these patients, metabolic changes are observed in the urine that predispose lithogenesis. The kind of evaluation depends on stone composition and on the clinical presentation. A diagnosis of systemic and renal diseases of lithogenic nature can be diagnosed with these studies, and they also enable the adoption of precise prophylactic measures that achieve control of recurrence in a great number of patients.

Background: Urinary system stone disease is an important health problem. It has been reported to have a prevalence of 14.8% in Turkey. The aim of the renal stone removal surgery is to clear the sto...

Urinary tract stone disease is one of the most common pathologies of the modern era with a rising prevalence owing to incidentally detected renal stones from imaging for other reasons. Although there is consensus on active management of symptomatic and asymptomatic stones in high-risk patient groups, conservative management of stones is still controversial. We have reviewed the literature pertaining to conservative management of 3 groups of stones-asymptomatic calyceal stones, staghorn stones, and ureteric stones-and summarized the findings to provide guidance in the conservative management of stones. In the calyceal stone group, our review showed an average spontaneous stone passage rate of 18% (range, 8%–32%) and an average requirement for surgical intervention of 20% (range, 7%–40%), with 62% of patients remaining safely on surveillance over a mean time of 4 years. In the staghorn group, overall disease-specific mortality was noted to be 16% (range, 0%–30%) and chance of renal deterioration was 21% (range, 0%–34.5%), with a mean incidence of infection of 22%. In case of conservatively managed ureteric stones, the rate of spontaneous passage for stones smaller than 5 mm was 75%, compared with 62% for those larger than 5 mm. Based on the position in the ureter, spontaneous passage rates were 49%, 58%, and 68% for proximal, middle, and distal thirds, respectively. Conservative management may be recommended for asymptomatic patients and those who are deemed unfit for any procedures. However, careful patient selection and thorough counseling about the risks of conservative management could make it a suitable option for an appropriate subset of patients.

The prevalence of urolithiasis in humans is increasing worldwide; however, nonsurgical treatment and prevention options remain limited despite decades of investigation. Most existing laboratory animal models for urolithiasis rely on highly artificial methods of stone induction and, as a result, might not be fully applicable to the study of natural stone initiation and growth. Animal models that naturally and spontaneously form uroliths are an underused resource in the study of human stone disease and offer many potential opportunities for improving insight into stone pathogenesis. These models include domestic dogs and cats, as well as a variety of other captive and wild species, such as otters, dolphins, and ferrets, that form calcium oxalate, struvite, uric acid, cystine, and other stone types. Improved collaboration between urologists, basic scientists, and veterinarians is warranted to further our understanding of how stones form and to consider possible new preventative and therapeutic treatment options.

OBJECTIVE To assess the quality and accuracy of online videos about the medical management of nephrolithiasis. MATERIALS AND METHODS To evaluate trends in online interest, we first examined the frequency of worldwide YouTube searches for 'kidney stones' from 2015 to 2020. We then queried YouTube with terms related to symptoms and treatment of kidney stones and analysed English-language videos with >5000 views. Quality was assessed using the validated DISCERN instrument. Evidence-based content analysis of video content and viewer comments was performed. RESULTS Online searches for videos about kidney stones doubled between 2015 and 2019 (P

To evaluate metabolic risk factors in calcium kidney stone formers from two different decades, comparing changes in metabolic profiles over time.A retrospective analysis was performed of calcium kidney stone formers who underwent metabolic evaluation of urolithiasis with 24-hour urine collections at a single institution. There were 309 patients evaluated from 1988 to 1994 (Group A), and 229 patients from 2007 to 2010 (Group B). A comparison between both groups was performed to assess changes in demographics and in metabolic stone profiles.Comparing Group A to Group B, the percentage of females increased from 43 to 56%, obese patients (BMI ≥ 30) increased from 22 to 35%, and patients ≥ 50 years increased from 29 to 47% (allUrolithiasis has increased in females, obese, and older patients, consistent with population-based studies. We report a rising incidence of hypocitraturia and hyperoxaluria in the contemporary cohort, particularly in obese patients and in males, respectively. Further studies are needed to better characterize the metabolic changes corresponding to the increase in stone disease.

The authors aimed to evaluate the factors affecting clinical outcomes of cystine stone disease in children and to understand the change in disease management over time. Between January 1991 and September 2017, the demographic and clinical data of pediatric patients with documented cystine stone disease were retrospectively analyzed. Patients with at least 12-month follow-up were included. Disease management and clinical outcomes were compared between the first and second 35 patients managed during the study's time frame. A total of 70 patients were included. The female to male ratio was 30/40. The mean age and follow-up period was 29.8 ± 40.1 months and 106.5 ± 56 months, respectively. The mean initial procedure number to treat the first stone episode was 2.4 ± 1.6. Single stone and single affected site were significant predictors for stone clearance. Overall, patients underwent a mean of 5.5 procedure during their follow-up. Recurrence was detected in 71.4% (50/70) of patients. Residual fragments and non-compliance to medical treatment after the initial intervention were significant predictors for recurrence within shorter interval period. 31.4% (22/70) of patients had renal atrophy during follow-up. They were older at the initial diagnosis and had average urine pH lower than 7.5. The first 35 patients had more open procedures. Still, they had more recurrence rate and tend to have more renal atrophy. As a conclusion, cystine stone disease has a recurrent course in children. Stone and fragments entirely removed (SaFER) concept with all minimally invasive methods available and strict follow-up should be the basis for any management plan.

To evaluate the feasibility of measuring the intrapelvic pressure (IPP) during f-URS with a wire including a pressure sensor and to assess IPP profiles during the procedure. Patients undergoing f-URS for stone disease were recruited. A wire with pressure sensor was placed in the renal cavities to measure IPP. For these cases, either no ureteral access sheath (UAS) or 10/12 or 12/14-Fr UASs were used according to surgeon discretion. Irrigation was ensured by a combination of a continuous pressure generator set at 80 cmH2O and a hand-assisted irrigation system providing on-demand forced irrigation to provide proper visibility. Pressures were monitored in real time and recorded for analysis. Four patients undergoing five f-URS were included. IPP monitoring was successful in all patients. Mean baseline IPP was 6 cmH2O. During f-URS with only the endoscope in the renal cavities and irrigation pressure set at 80 cmH2O without any forced irrigation, the mean IPP was 63 cmH2O. Mean IPP during laser lithotripsy with the use of on-demand forced irrigation was 115.3 cmH2O. The maximum pressure peaks recorded during this therapeutic period using forced irrigation ranged from 289.3 to 436.9 cmH2O. High IPP levels may be achieved during f-URS with on-demand irrigation systems. The impact of these high pressures on the risk of complications and long-term consequences still need to be evaluated adequately. But, in this preliminary pilot study, IPP could be reliably and conveniently monitored and recorded using a wire with a digital pressure sensor.

Objectives: To analyze factors that can impact the intraoperative and postoperative complications and bleeding after percutaneous nephrolithotomy (PNL) in patients with a solitary kidney. Material and Methods: A prospective hospital-based study that was carried out at the Urology Department, Sohag University Hospital from June 2017 to June 2019. All patients with renal calculi in a solitary kidney were recruited and underwent PNL. Results: 150 patients were enrolled in this study. 93 (62%) patients were males while 57 (38%) patients were females. Initial SFR was achieved in 129 (86%) patients while residual fragments were reported in 21 (14%) patients. 39 (26%) patients had postoperative complications. On univariate analysis, the rate of complications was associated with the complexity of the stones, acute dilatation of the tract, and operative time (P-value = 0.048, 0.004 & 0.023 respectively). On the other hand; there was an association between the number of the accessed tracts and the rate of bleeding and blood transfusion (P-value = 0.008).Conclusion: PNL in solitary kidneys is a challenging procedure; however high SFRs can be achieved with a low rate of significant complications. The complexity of the stones, acute dilatation of the tract, and prolonged operative time are associated with more complications. Multiple tracts have a significant effect on intraoperative bleeding. PNL should be considered by urologists as an effective therapeutic choice for patients presenting with large burden stone disease in a solitary kidney.

The major risk factor for kidney stone disease is idiopathic hypercalciuria. Recent evidence implicates a role for defective calcium reabsorption in the renal proximal tubule. We hypothesized that claudin-2, a paracellular cation channel protein, mediates proximal tubule calcium reabsorption. We found that claudin-2–null mice have hypercalciuria due to a primary defect in renal tubule calcium transport and papillary nephrocalcinosis that resembles the intratubular plugs in kidney stone formers. Our findings suggest that a proximal tubule defect in calcium reabsorption predisposes to papillary calcification, providing support for the vas washdown hypothesis. Claudin-2–null mice were also found to have increased net intestinal calcium absorption, but reduced paracellular calcium permeability in the colon, suggesting that this was due to reduced intestinal calcium secretion. Common genetic variants in the claudin-2 gene were associated with decreased tissue expression of claudin-2 and increased risk of kidney stones in 2 large population-based studies. Finally, we describe a family in which males with a rare missense variant in claudin-2 have marked hypercalciuria and kidney stone disease. Our findings indicate that claudin-2 is a key regulator of calcium excretion and a potential target for therapies to prevent kidney stones.

The gold standard for urologic management of large stone disease traditionally has been percutaneous nephrolithotomy (PCNL). An alternative to PCNL is robotic pyelolithotomy (RP), which continues to gain traction. This study is a retrospective review of ten cases performed over a 2 year period presenting operative outcomes for large stone disease treated with RP. The mean and standard deviation were calculated for age, body mass index, stone volume, stone diameter, pre-operative creatinine, operative time, robot-docked time, length of stay, post-operative creatinine, and estimated blood loss. In addition, results were collected for post-operative complications and secondary procedure requirements. Complete stone clearance was successful in 9 of 10 cases. The average renal function remained stable from a pre-operative creatinine of 0.917 mg/dL to a post-operative creatinine level of 0.943 mg/dL. This case series demonstrates that robotic assisted surgery has practical application when managing large stone disease.

INTRODUCTION AND OBJECTIVES:Homo sapiens have suffered from stone disease since ancient times with the earliest evidence dating to the Stone Age (Mesolithic period). The history of urolithiasis has...

To understand patient and practice-level factors impacting postoperative imaging use after ureteroscopy (URS) for urinary stone disease.The Michigan Urological Surgery Improvement Collaborative's Reducing Operative Complications from Kidney Stones (MUSIC ROCKS) initiative is a consortium of 52 urologists from 11 practices in Michigan. From June 2016 to July 2017, we prospectively collected clinical data for patients undergoing URS for stone treatment by MUSIC ROCKS participants. We measured the proportion of these patients who underwent US, AXR, and/or CT within the first 60 days after their procedure. We then assessed variation in the use of post-URS imaging according to patient characteristics and across MUSIC ROCKS practices.During the 13-month study period, we identified 2850 patients who were treated with URS for stone disease. Overall, only 47.6% of these patients underwent postoperative imaging. AXR was the most common modality used (55.0% of patients), followed by US (21.9%) and CT (11.1%). As shown in the Figure, use of post-URS imaging varied widely across participating practices (23.7%-73.6%; P.01). Imaging receipt did not differ by patient age, gender, or insurance status. However, patients with more comorbidities, renal stones and those with larger stones were more likely to receive post-URS imaging (P.05 for each comparison).Fewer than half of patients in Michigan undergo postoperative imaging after URS for stone disease. Moreover, there is substantial variation across providers in post-URS imaging use. These findings help identify opportunities to improve the quality of care for patients with urinary stone disease in the State.

National military engagement is increasing, both in temperate and subtropical, tropical conditions. Health support must also be prepared for extreme conditions. There are several pathologies whose appearance depends on multiple environmental factors. Urinary tract stone is an asymptomatic disease in most cases, but under heavy physical exertion and some other factors it causes renal colic with an immediate and significant reduction in fighting value. The disease is well diagnosed but currently testing and screening is not a part of the military medical practice. Changed climatic conditions have been assessed for the occurrence of this disease and risk factors have been identified. In our study questionnaire, ultrasonic examination and lab tests were performed at the UN mission in Cyprus and we present the detailed findings. In the study we demonstrate that the chance of incidence of stone disease in a subtropical mission area is fivefold, and we found increased fluid consumption as a protective effect. Based on the results, due consideration should be given to screening for the stone disease and to the recommended detailed training of soldiers.

Urinary tract stones are a general term for stone disease in various parts of the urinary system and are common diseases of the urinary system. According to the location of the stone, it is divided into kidney stones, ureteral stones, bladder stones, urethra stones. Total urinary calculi occur less frequently, usually accompanied by severe clinical symptoms and difficult to treat. A 76-year-old man was admitted to hospital with repeated bladder stones for 7 years, repeated dysuria with frequent urination and dysuria for 2 months. After admission, the patient improved the relevant examination, and the patient was finally diagnosed with total urinary calculi combined with infection. After a series of orderly and effective treatments, especially the completion of the one-stage operation, the patient recovered smoothly and was discharged. Complicated whole-course urolithiasis is relatively rare and a single operation of total urinary calculi is feasible.

Background The United States healthcare landscape has witnessed numerous changes since implementation of the Affordable Care Act coupled with rising prevalence of upper urinary tract stone disease. Data on the economic burden of stone disease during this period are lacking, providing the objective of our study. Materials and Methods Adults diagnosed with stone disease from 2011-2018 were identified from PearlDiver Mariner, a national all-payer database reporting reimbursements and prescription costs for all healthcare encounters. Patients undergoing operative and non-operative care were identified. Time trends in annual expenditures were evaluated. Multivariable analysis evaluated determinants of spending. Results A total of $10B were spent on stone disease management between 2011-2018 (median overall annual expenditure=$1.4B) among 786,756 patients. Inpatient, prescription and outpatient costs accounted for 34.7%, 20.7% and 44.6% of expenditures respectively. 78% of patients were managed non-operatively (total cost=$6.9B). Average overall cost per encounter was $13,587 ($17,102 for surgical vs. $11,174 for non-surgical care). Expenditures on inpatient care decreased significantly over time, while expenditures on prescriptions and outpatient care increased significantly. On multivariable analysis, higher Charlson Comorbidity Index was associated with higher spending, while associations for age, insurance and region varied by treatment modality. Conclusions The economic burden of stone disease management is substantial, dominated by expenditure on non-operative management and outpatient care. Expenditures for prescription and outpatient care are rising, with the only consistent predictor of higher spending being Charlson Comorbidity Index. Spending variation according to demographic, clinical, and geographic factors was evident.

Purpose of Review To highlight and review the application of artificial intelligence (AI) in kidney stone disease (KSD) for diagnostics, predicting procedural outcomes, stone passage, and recurrence rates. The systematic review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) checklist. Recent Findings This review discusses the newer advancements in AI-driven management strategies, which holds great promise to provide an essential step for personalized patient care and improved decision making. AI has been used in all areas of KSD including diagnosis, for predicting treatment suitability and success, basic science, quality of life (QOL), and recurrence of stone disease. However, it is still a research-based tool and is not used universally in clinical practice. This could be due to a lack of data infrastructure needed to train the algorithms, wider applicability in all groups of patients, complexity of its use and cost involved with it. Summary The constantly evolving literature and future research should focus more on QOL and the cost of KSD treatment and develop evidence-based AI algorithms that can be used universally, to guide urologists in the management of stone disease.

To review the latest evidence about intrarenal pressures (IRPs) generated during flexible ureteroscopy (fURS) and mini percutaneous nephrolithotomy (mPCNL) and present tools and techniques to maintain decreased values. fURS and PCNL constitute the primary means of stone treatment. New flexible ureterorenoscopes with small diameter and miniaturized PCNL instruments achieve optimal stone-free rates (SFRs) while decreasing invasiveness and morbidity. Nevertheless, endourologists must remain cognizant regarding the dangers of increased IRPs to avoid complications. Current research presents essential information for urologists regarding this topic. During fURS, using a ureteral access sheath (UAS), we avoid extremely high IRPs with all irrigation types. During mPCNL, pressure remains low, mainly using the purging effect or a vacuum-assisted sheath. Devices of intraoperative IRP measurement and intelligent pressure control have proven their feasibility, accuracy and efficacy. These will have an increasing role to play in the future management of stone disease.

Urolithiasis (UL) is a common health problem in the world and the observed incidence of this disease is increasing in the infantile period. The study included cases of UL diagnosed before the age of two who had a comprehensive analysis for possible etiologic variables and were followed for a minimum of 6 months. Of the 60 patients included in the study, 37 were male, and the male/female ratio was 1.6. The average age at diagnosis is 8.5 +/- 4.5 months. Of the cases diagnosed 41 (68.3%) were before than 1 year of age. The average time for follow-up is 28.9 +/- 22.6 months. There was a family history of stone disease in 41 (68.3%) cases. Twenty-four (40%) patients were treated for dehydration at least once before stone disease was identified. The number of patients presenting with symptoms is 43 (71.7%). Restlessness was noted as the main symptom. In 17 (28.3%) patients, stone disease was found incidentally. Metabolic causes (n: 19, 31.6%) were determined to be the most common underlying cause, followed by UTI-related causes (n: 12, 20%). During the follow-up, 57 (64%) of the stones spontaneously disappeared. The size of 16 (18%) stones reduced, while the size of eleven remained same (13%). Following their absence, nine (15%) of the stones reappeared. The essential strategy is to identify high-risk groups, to closely monitor them, and to take preventative interventions against modifiable conditions such as dehydration if possible.

INTRODUCTION AND OBJECTIVE:Disparities in nephrolithiasis care based on gender, ethnicity and age have been well described. Fewer studies have examined the influence of insurance status in nephroli...

INTRODUCTION AND OBJECTIVE:There is a longstanding belief that intestinal colonization by Oxalobacter formigenes can reduce the risk of oxalate-based stone disease through its capacity to degrade c...

INTRODUCTION AND OBJECTIVE:Over the past 30 years, the field of endourology has seen an explosion of technological advancements that has significantly changed the management of stone disease. We so...

Objective: To evaluate the clinical benefits of Moses technology compared to the regular mode with the Lumenis® Pulse™ P120H holmium laser during ureteroscopy for stone disease. Patients and Method...

Despite high-level evidence supporting the use of pharmacotherapy therapy for the prevention of kidney stones, adherence to medications is often poor because of side-effects, inconvenience and cost. Furthermore, with a desire for more 'natural' products, patients seek dietary and herbal remedies over pharmacotherapy. However, patients are often unaware of the potential side-effects, lack of evidence and cost of these remedies. Therefore, in the present review we examine the evidence for a few of the commonly espoused non-prescription agents or dietary recommendations that are thought to prevent stone formation, including lemonade, fish oil (omega fatty acids), Phyllanthus niruri and the Dietary Approaches to Stop Hypertension (DASH) diet. While the present review includes only a few of the stone-modulating recommendations available to the lay community, we focussed on these four due to their prevalent use. Our goal is not to only dispel commonly held notions about stone disease, but also to highlight the lack of high-level evidence for many commonly utilised treatments.

Research indicates smoking increases the risk of various kidney diseases, although the risk of developing kidney stone disease in non-smokers exposed to secondhand smoke is unknown. This study analyzed a total of 19,430 never-smokers with no history of kidney stone disease who participated in the Taiwan Biobank from 2008 to 2019. They were divided into two groups by secondhand smoke exposure; no exposure and exposure groups; the mean age of participants was 51 years, and 81% were women. Incident kidney stone development was observed in 352 (2.0%) and 50 (3.3%) participants in the no exposure and exposure groups during a mean follow-up of 47 months. The odds ratio (OR) of incident kidney stone was significantly higher in the exposure group than the no exposure group [OR, 1.64; 95% confidence interval (95% CI) 1.21 to 2.23]. Participants with > 1.2 h per week exposure were associated with almost twofold risk of developing kidney stones compared with no exposure (OR, 1.92; 95% CI 1.29 to 2.86). Our study suggests that secondhand smoke is a risk factor for development of kidney stones and supports the need for a prospective evaluation of this finding.

The purpose of this review paper is to describe the 24-h urine collection in terms of its utility, collection process, and common problems with its acquisition. Although 24-h urine collections are standard of care for high-risk stone formers, several nuances in test acquisition including inaccurate urine collections 50% of the time and poor patient compliance limit its potential utility. Compliance in obtaining 24-h urine collections has been shown to be improved in patients who have not undergone surgical treatment of urinary calculi, patients with metabolic stone disease or family history of stone disease, Caucasian ethnicity, and in those with more sedentary occupations. Studies show conflicting data of compliance regarding patient age and gender. Physicians must understand the difficulties regarding 24-h urine collections including patient compliance, variability between collections, and complexities with interpretation to best utilize this tool in guiding clinical management for the treatment of nephrolithiasis.

Raed M Almannie, Abdullah K Alsufyani, Abdullah U Alturki, Mana Almuhaideb, Saleh Binsaleh, Abdulaziz M Althunayan, Mohammed A Alomar, Khalid M Albarraq, Fahad A Alyami Division of Urology, Department of Surgery, College of Medicine and King Saud University Medical City, King Saud University, Riyadh, Saudi ArabiaCorrespondence: Abdullah K AlsufyaniDivision of Urology, Department of Surgery, King Saud University Medical City, King Saud University, Saudi Arabia, King Saud University, Riyadh, 11451, Saudi ArabiaTel +966114692731Fax +966114679493Email abdsuf@gmail.comPurpose: To investigate the relationship between urinary stone type and the type of crystals in the urine.Patients and Methods: This retrospective study involved 485 patients with urinary stones treated at King Saud University Medical City from May 2015 to June 2017. Clinical data were obtained from medical records. Different statistical analysis methods were applied, including basic contingency analysis, analysis of variance, logistic regression, discriminant analysis, partition modeling, and neural network evaluations.Results: Of 485 patients, 47 had crystals detected by urinalysis. The most common type of crystal was calcium oxalate (n = 31), which had the highest association with calcium oxalate stones. Uric acid crystals (n = 8) were associated with uric acid stones. The neural network model used for determining the sensitivity and specificity showed an R-square value of 0.88, with an area under the curve of 0.94 for calcium oxalate, 0.94 for carbonate apatite, and 1.0 for uric acid.Conclusion: The predictive algorithm developed in the present study may be used with a patient’s clinical parameters to predict the stone type. This approach predicts the stone types associated with certain patient characteristics with a high sensitivity and specificity, indicating that the models may be a valuable clinical tool in the diagnosis, management, and monitoring of stone diseases.Keywords: crystalluria, urinary sediment, neural network, urolithiasis, stone disease, urinary crystals

Objective The aim of this study was to assess the impact of intraoperative disruptions on surgeons' workload and performance during percutaneous nephrolithotomy (PCNL). Materials and methods A structured and standardized tool was used to identify disruptions and interferences that occurred during 33 PCNL procedures. The surgical steps during PCNL were divided into four phases: ureteric catheter placement (phase I), puncture and tract dilation (phase II), intra-calyceal navigation and stone fragmentation (phase III), and tube placement (phase IV). Surgeons' workload was evaluated using a validated tool: Surgery Task Load Index (SURG-TLX), and correlated with the mean observed intraoperative disruptions. All operating team members evaluated the teamwork immediately after the procedure. Statistical analysis was performed using SPSS Statistics version 22 (IBM, Armonk, NY). Results A total of 1,897 disturbances were observed, with an average of 57.48 ± 16.36 disruptions per case. The largest number of disruptions occurred during phase III of PCNL (32.06 ± 14.12). The most common cause of the disruption was people entering or exiting the operating room (OR) (29.1 ± 10.03/case), followed by the ringing of phones or pagers (6.42 ± 2.4). The mean observed intraoperative disruptions were significantly associated with the operating surgeon's mental workload, and it had a significant impact on all domains of surgeons' mental workload as measured by SURG-TLX. Compared to other team members, surgeons' assistants experienced an inferior sense of teamwork (r=-0.433; p=0.012). Conclusion Significant intraoperative disruptions were observed during PCNL. They were observed to directly correlate with the surgeon's workload and had a detrimental effect on teamwork. Improving OR dynamics by reducing unnecessary disruptions would help establish an efficient and smooth surgical work environment for safe surgical care.

Background and Aims The history of popes is an untapped treasure for historian of medicine for many reasons including i. number, ii. richness of documents available on their lives, iii. gender homogeneity, iiii. Long lasting lives, v. their affluence, vi. number of archiaters and personal physicians and surgeon of high professional level, viii. lived for many years in the same environment (Rome). Taking into consideration the availability of documents from 1100 onward (10 centuries of European history), popes represent good models to study a. the diseases of popes, b. social medicine, c. history of European universities and beyond, d. the history of hospitals, e. the history of archiaters, and f. the diseases of power. We are studying renal stone disease in popes from St Peter to John Paul II (34-2005). Preliminary results on gouty popes have been presented at ERA-EDTA Congress in Budapest and Milan pointing that out 20 gouty pontiffs 12 were stone formers or died because of its complications and 6 popes died because of non-gouty renal stones. The goal of this study is to provide an historical outline on renal stone disease in gouty and not gouty popes reigning in the years 537-1830 (from Vigilius―the 1st stone former pope―to Pius VIII, the last gouty pope). Methods We have studied history of popes on many books including those authored by von Ranke, von Pastor, de Novaes, Henrion, Paravicini Bagliani, Reardon, Rendina, Ceccarelli and Cosmacini. We have also studied the histories of archiaters of Platina and Marini. Results 25 out 193 popes were found gouty. Their mean age at start of pontiff was 64.6 and 70.6 at death, that nearly correspond to the time-course decline of age-related uric acid excretion. Thirteen of these popes had histories, signs, symptoms, and /or postmortem examination compatible with a diagnosis of renal stone disease. Six of them died with uremia, 4 were hydropics, 6 died because of stroke. In addition we have also outlined the narratives of 14 non gouty popes who had renal stone disease. The last pope affected by renal stone disease was Pius VI (1775-1779) , the last gouty popes was Pius VIII (1829-1830). Conclusion We have excluded from gouty popes Alexander VII erroneously defined gouty by Giuseppe De Novaes in 1815 and also excluded John IX since his gout―hypothesized by Wendy J Reardon in 1971―is not supported by documents. There are a few available specific data on the topic. A fundamental contribution was published by Lorenzo Gualino in 1934. He reported on 19 gouty popes, 12 of whom with histories or signs, or symptoms, and/or postmortem examination confirming renal stone diseaase. He also reported on 8 non gouty popes suffering from or died of renal stone disease. The findings should be matched also with those of Giovanni Ceccarelli (2001) who reported on 11 gouty popes 6 presenting with signs of stones and five dying anuric and/or hydropic. This paper includes on all popes with renal stone disease. Stroke and heart failure in gouty popes are a priority. In the last 2 centuries renal stone disease was no more a papal disease.

OBJECTIVE To determine if medical therapy affects long-term clinical outcomes in uric acid stone formers (UASF). METHODS We identified 53 UASF who had complete stone clearance following stone procedure by computed tomography (CT) and had ≥1 postoperative 24-hour urine collection and a clinical follow-up ≥6 months with a surveillance CT scan. Patients were divided into "adherent to medical therapy" (compliance with potassium citrate ± allopurinol verified by computerized pharmacy data) or nonadherent groups. Primary outcomes were CT stone recurrence rate and need for surgical stone intervention. RESULTS We found 28 of 53 (53%) adherent and 25 of 53 (47%) nonadherent individuals (14 declined medication, 11 intolerant). With median follow-up of 24 months, no significant differences were noted between groups in regards to stone recurrence (32%; P = .99) or in 24-hour urine pH compared to baseline or follow-up (range 5.46-5.62; P = 0.06). Adherent patients, however, had smaller CT stone recurrence sizes (6.3 ± 3.8 vs 11.8 ± 6.2 mm, P = .02), were 28% less likely to require stone surgery compared to those without therapy (P

Introduction: Calculous nephrectomy was a mainstay of treatment of complex upper tract stone disease up until the 1970s, but data on its contemporary utilization in the current era of risi...