Search

Objective: To compare the outcomes of retrograde flexible ureteroscopy (fURS) with retroperitoneal laparoscopic ureterolithotomy (RLU) for large proximal ureteric stones. Patients and Methods: A prospective randomised trial was conducted from January 2018 through December 2022 including patients with impacted proximal ureteric stones of 15–25 mm. Patients underwent fURS or RLU. Primary outcome was the stone‐free rate. Demographic data, stone features, and complications rates were also compared between groups. Results: A total of 64 patients were enrolled, 32 in each group. The mean impacted stone time was similar between groups, as well as stone size (17 mm) and stone density (>1000 Hounsfield Units). The ureteric stone‐free rates between the two groups (93.7% in fURS vs 96.8% in RLU; odds ratio [OR] 0.72, 95% confidence interval [CI] −1.72 to 3.17; P = 0.554), and overall success rates, which take into account residual fragments in the kidney (84.3% in fURS vs 93.7% in RLU; OR 1.02, 95% CI −0.69 to 2.74; P = 0.23), were similar. Operative time was also not statistically significantly different between groups (median 80 vs 82 min; P = 0.101). There was no difference in hospital length of stay. Retropulsion rate was higher with fURS (65.6% vs 3.1%; p < 0.001). Residual hydronephrosis (34.3% each group) and complication rates did no differ according to treatment. Conclusion: Flexible URS and RLU are both highly efficient and present low morbidity for large impacted proximal ureteric stone treatment. RLU is not superior to fURS. [ABSTRACT FROM AUTHOR]

We collected meteorological and urolithiasis-related hospitalization data from four counties in Ganzhou City for 2018–2019 and used the DLNM method to assess the lagged and cumulative effects of temperature on urolithiasis hospitalizations and obtain the total effect after meta-combination. Based on the nonlinear association between temperature and urolithiasis hospitalizations, the relative risk of overall high temperature (30℃) was 2.10 (95% CI: 1.07-4.10). No statistically significant difference (p = 0.07) was observed between males (RR = 2.04, 95% CI: 1.42-2.94) and females (RR = 1.45, 95% CI: 1.09-1.92) for the heat effect, which was higher in the ≥ 60 years age group (RR = 3.18, 95% CI: 1.76-5.76) than in the < 60 years age group (p = 0.007). High temperatures increased the risk of hospitalization for urolithiasis in Ganzhou, China, and the risk was greatest for individuals aged 60 and above, with similar risks observed across counties and genders. [ABSTRACT FROM AUTHOR]

Introduction: Crystalluria is an important indicator of renal stone recurrence. Mechanisms underlying urinary stone formation are still not fully understood and raising interests has been giving to intestinal commensal bacteria for their contribute in maintaining urinary solutes equilibrium. The aim of our phase II study was to examine the administration of potassium citrate, magnesium and probiotics in order to reduce crystalluria. Materials and Methods: Since May 2021, we enrolled 23 patients candidates for ureterorenolithotripsy for calcium oxalate kidney stones with crystalluria and a normal metabolic profile. The analysis was validated by the Institution's Ethical Committee (no. approval STS CE Lazio 1/N-823). At discharge, patients were provided with daily food supplementation for 20 days of 1 billion Lactobacillus paracasei LPC09, 1 billion Lactobacillus plantarum LP01, 1 billion Bifidobacterium breve BR03, potassium (520 mg), citrate (1400 mg), and magnesium (80 mg). Crystalluria was re-assessed at 1, 3, 6, and 12-months follow-up by polarized light microscopy. Results: After one month from the oral supplementation, no patient reported crystalluria; at 3 months, among the 20 participants available for re-evaluation, still no patient reported crystalluria. Instead, crystalluria was reported in three patients (15%) at 6 months, and in five patients (25%) at 12 months follow-up. Conclusions: The oral supplementation with Lactobacillus spp. and Bifidobacterium spp. was found able to reduce the prevalence of crystalluria in a cohort of patients with diagnosis of calcium oxalate kidney stones with crystalluria candidate to ureterorenolithotripsy. [ABSTRACT FROM AUTHOR]

Background: Ureteric stone is responsible for around 20% of urinary tract stones and among them 70% of these are located in distal portion of the ureter. Stone causing ureter obstruction produce inflammatory changes in ureteric wall and prevent spontaneous passage of stone. The objective of the study is to compare the predictive role of procalcitonin and Neutrophil-to-lymphocyte ratio (NLR) for spontaneous passage of stone. Materials and methodology: Total 150 participants having ureteric stone of 4–8 mm, were included in prospective observational study. The patients were followed up for 4 weeks. Spontaneous Stone Passage (SSP) was confirmed with either the patient collecting the stone during urination or by Non-Contrast CT performed at 4 weeks. Blood samples of the patients were analysed and White blood cells, sedimentation, Neutrophile to Lymphocyte (NLR), procalcitonin level compared to analyse predictors of future SSP. Result: The procalcitonin levels of the Spontaneous stone passing SSP (−ve) group (209.05 ± 78.45 pg/ml) were significantly higher than the not passing the SSP (+ve) group (130.76 ± 24.18) (p < 0.001). NLR is significantly higher in the SSP −ve (3.84 ± 0.41) than the SSP +ve (2.18 ± 0.38) group (p < 0.001). In single and multivariate analysis, significant activity was found for procalcitonin in SP +ve group. Conclusion: The findings of the study suggests that high level of procalcitonin, and high NLR have a negative effect on passage of stone. So early intervention can be planned to these patients to prevent complications. [ABSTRACT FROM AUTHOR]

Purpose: To investigate the efficacy and safety of retrograde double J stent (RDJS) placement in the management of complicated obstructive uropathy caused by urolithiasis. Patients and Methods: An observational study done at a tertiary center was implemented in which a total of 27 patients (10 males, 17 females) with average age of 48.74 years (range: 15–88) who underwent RDJS or percutaneous nephrostomy (PCN) between 2017 and 2021 due to complicated obstruction caused by urolithiasis were included. Results: A total of 27 patients (10 males, 17 females) with average age of 48.74 years (range: 15–88) who underwent kidney decompression between 2017 and 2021 due to complicated unilateral or bilateral kidney obstruction caused by ureteral stones were included. Twenty-two patients (81.48%) underwent successful RDJS placement, two patients had RDJS placement then PCN was also placed, and two patients underwent PCN placement. Three patients needed an intensive care unit "ICU" after intervention, two of them were in the ICU before intervention. All septic parameters were normalized within a short period postoperatively. Two patients with failed previous ureteroscopy had a successful RDJS placement. Conclusion: Retrograde DJS placement is a feasible option in the management of complicated cases of obstructive uropathy caused by urolithiasis. Short hospitalization period, low rate of complications and better quality of life are the most prominent advantages of RDJS placement. In the hands of experienced surgeons, RDJS should be offered as the first choice of decompression for obstructive uropathy caused by urolithiasis. [ABSTRACT FROM AUTHOR]

Objective: To investigate the gender gap in the context of stone-related surgery within an Israeli population. Methods: We conducted a retrospective cohort study using administrative databases from Clalit Health Services to identify adults aged 18 and above who had their initial surgical treatment for upper tract urolithiasis. We employed descriptive statistics to outline the baseline patient characteristics, and the Cochran–Armitage test for trend was utilized to analyze surgical trends. Results: Between 2003 and 2020, a total of 36,624 adult patients underwent surgical treatment for upper tract urinary stones. The mean age of patients was 55.01 years (standard deviation (SD) 16.6) for ureteroscopy (URS), 55.05 years (SD 15.1) for percutaneous nephrolithotripsy (PCNL), and 51.07 years (SD 15.1) for shockwave lithotripsy (SWL). When considering the distribution of procedures by gender, males accounted for 69.5% of URS cases, 58.3% of PCNL cases, and 70.6% of SWL cases, whereas females represented 30.5%, 41.7%, and 29.4% of URS, PCNL, and SWL cases, respectively. Across all surgical modalities, the male-to-female ratio exhibited fluctuations without a consistent trend, with both increases and decreases observed. In URS, the ratio saw a modest increase from 1.967 in 2003 to 2.173 in 2020. For PCNL, the ratio initially increased from 2.361 in 2003 to 2.549 in 2014, followed by subsequent fluctuations, but an overarching trend was not apparent. In contrast, for SWL, the ratio decreased from 2.15 in 2003 to 1.32 in 2020, with varying changes in between. Conclusion: This study highlights the dynamic nature of gender gap in stone-related surgery outcomes. While the male-to-female ratio exhibited fluctuations over a 17-year period, no consistent trend emerged. The absence of a clear trend underscores the complex and multifaceted factors influencing the gender gap in urolithiasis. [ABSTRACT FROM AUTHOR]

The primary hyperoxalurias (PH 1, 2, and 3) are rare autosomal recessive disorders of glyoxylate metabolism resulting in hepatic overproduction of oxalate. Clinical presentations that should prompt consideration of PH include kidney stones, nephrocalcinosis, and kidney failure of unknown etiology, especially with echogenic kidneys on ultrasound. PH1 is the most common and severe of the primary hyperoxalurias with a high incidence of kidney failure as early as infancy. Until the recent availability of a novel RNA interference (RNAi) agent, PH care was largely supportive of eventual need for kidney/liver transplantation in PH1 and PH2. Together with the Oxalosis and Hyperoxaluria Foundation, the authors developed a diagnostic algorithm for PH1 and in this report outline best clinical practices related to its early diagnosis, supportive treatment, and long-term management, including the use of the novel RNAi. PH1-focused approaches to dialysis and kidney/liver transplantation for PH patients with progression to chronic kidney disease/kidney failure and systemic oxalosis are suggested. Therapeutic advances for this devastating disease heighten the importance of early diagnosis and informed treatment. [ABSTRACT FROM AUTHOR]

Urolithiasis is the most prevalent benign urological condition, imposing a significant burden on morbidity, disability, and healthcare costs globally. Despite its impact, comprehensive bibliometric analyses of randomized clinical trials (RCTs) related to urolithiasis, which are essential for advancing evidence-based medical practices, are lacking. This study aimed to examine the global research landscape and trends in RCTs focused on urolithiasis. This study used bibliometric techniques to analyze a selection of RCTs on urolithiasis published between 1979 and 2023. VOSviewer software version 1.6.20 was used to visualize international collaborations and perform a keyword analysis of the included articles. The main objective was to identify key research areas and focal points within the field of urolithiasis RCTs. Between 1979 and 2023, a comprehensive search identified 16,716 research articles on urolithiasis. A total of 693 relevant RCTs were found in the Scopus database. The number of publications has significantly increased over time, indicating a strong positive correlation (R² = 0.9303; P < 0.001). China was the top contributor, with 166 publications (23.95%), followed by the United States, with 130 publications (18.76%). Turkey and Iran contributed 44 (6.35%) and 62 (8.95%) publications, respectively. Citation analysis revealed an average of 28.13 citations per article, an h-index of 70, and a total of 19,493 citations. The co-occurrence analysis highlighted current research trends and key topics in urolithiasis RCTs, including 'comparative effectiveness of surgical and laser techniques and patient outcomes', 'medical expulsive therapy (MET) for ureteral calculi and clinical outcomes', 'systematic reviews and meta-analyses of RCTs investigating urolithiasis', and 'dietary interventions and correlations between stone composition and the risk of recurrence.' The bibliometric analysis provides an overview of research on urolithiasis RCTs. It examines global research trends and identifies new developments in the field. Our review identified key research themes, including systematic reviews and meta-analyses, dietary interventions, medical therapy for the expulsion of ureteral stones, and comparisons of surgical techniques—areas that will remain focal points in future research. This bibliometric analysis is an invaluable resource for researchers, clinicians, and policymakers, providing a complete overview of past and present research trends. Informed decision making can be promoted and guided in future research, ultimately improving management and understanding. [ABSTRACT FROM AUTHOR]

Purpose: Patients presenting with ureteral stones and concurrent urinary tract infections require prompt kidney drainage as per standard care guidelines. However, even in patients who are promptly drained and treated with appropriate antibiotics, the mortality rate due to urosepsis has been reported to be nearly 9%. Therefore, Predictive tools for early sepsis detection have become essential. The Neutrophil-to-Lymphocyte Ratio (NLR) and Platelet-to-Lymphocyte Ratio (PLR) are potential biomarkers for predicting infection risk in these patients. Methods: A retrospective cohort analysis involving patients diagnosed with obstructing ureteral stones who underwent urgent stent placement due to suspected urinary tract infection (UTI) in the emergency room (ER) was conducted. The baseline characteristics of patients were age, sex, comorbidities, and urological history. Laboratory data collected during hospitalization included total leukocyte and platelet counts and blood cultures. Ratios were calculated from the serum studies obtained upon admission to the ER. A logistic regression model was utilized to predict the incidence of positive qSOFA score (sepsis prediction score), the need for vasopressors, intensive care unit (ICU) admission, and sepsis, using NLR and PLR as independent variables. Results: Between January 2016 and December 2020, 143 patients with a diagnosis of obstructing ureteral stone were admitted to the ER with a suspected UTI. 11.9% showed a positive qSOFA score, 20.3% required vasopressor support for > 1 h after ureteral stent placement, 28.7% required ICU admission, and 16.8% met sepsis criteria. Sepsis was defined as patients who were qSOFA positive and vasopressors needed for more than 1 h following stent placement. Logistic regression analysis revealed that PLR and positive blood cultures correlated significantly with positive qSOFA scores. Using logistic regression analysis, PLR, NLR, and positive blood culture were each independent predictors of vasopressor requirements, ICU admission, and urosepsis. Conclusions: NLR and PLR may be valuable prognostic markers for predicting urosepsis risk in urolithiasis patients who present with obstructing stones and concern for systemic infection. Their utility may be in helping clinicians in early risk stratification, prompt intervention, and resource allocation. [ABSTRACT FROM AUTHOR]

Struvite (MgNH4PO4·6H2O) is a mineral first identified in 1845. It is being tested for several reasons: (1) it is a problem in liquid wastewater treatment plants; (2) on the other hand, it is recovered from these wastewaters for its phosphorus, magnesium and nitrogen; (3) is the main component of microbial-induced urinary stones. We have recently shown that struvite is ferroelectric and piezoelectric. In this paper, we present the first experimental evidence of the pyroelectric nature of struvite. Using a single-diffusion gel growth technique, we grew struvite crystals as flat, parallel plates. We performed measurements of pyroelectric currents on struvite of this shape, using it as a dielectric of a plate capacitor. The occurrence of pyroelectric effects in struvite was investigated by measuring depolarization currents as a function of temperature. This technique allows the disclosure of ferroelectric/pyroelectric transitions as well as the reconstruction of the ferroelectric loop. We found that the value of the pyroelectric coefficient p attains a maximum of 22 × 10−6 C m−2 K−1 slightly below room temperature, going down to p ≅ 10 × 10−6 C m−2 K−1 at room temperature. This value is comparable to values for other minerals. For example, the pyroelectric polarization coefficient of tourmaline, the mineral for which the pyroelectric effect was first discovered, is 4 × 10−6 C m−2 K−1. This value is 2.5 times lower than that measured for struvite, illustrating struvite's fairly strong pyroelectricity. [ABSTRACT FROM AUTHOR]

Over the past three decades, there has been increasing interest in miniaturized percutaneous nephrolithotomy (mPCNL) techniques featuring smaller tracts as they offer potential solutions to mitigate complications associated with standard PCNL (sPCNL). However, despite this growing acceptance and recognition of its benefits, unresolved controversies and acknowledged limitations continue to impede widespread adoption due to a lack of consensus on optimal perioperative management strategies and procedural tips and tricks. In response to these challenges, an international panel comprising experts from the International Alliance of Urolithiasis (IAU) took on the task of compiling an expert consensus document on mPCNL procedures aimed at providing urologists with a comprehensive clinical framework for practice. This endeavor involved conducting a systematic literature review to identify research gaps (RGs), which formed the foundation for developing a structured questionnaire survey. Subsequently, a two-round modified Delphi survey was implemented, culminating in a group meeting to generate final evidence-based comments. All 64 experts completed the second-round survey, resulting in a response rate of 100.0%. Fifty-eight key questions were raised focusing on mPCNLs within 4 main domains, including general information (13 questions), preoperative work-up (13 questions), procedural tips and tricks (19 questions), and postoperative evaluation and follow-up (13 questions). Additionally, 9 questions evaluated the experts' experience with PCNLs. Consensus was reached on 30 questions after the second-round survey, while professional statements for the remaining 28 key questions were provided after discussion in an online panel meeting. mPCNL, characterized by a tract smaller than 18 Fr and an innovative lithotripsy technique, has firmly established itself as a viable and effective approach for managing upper urinary tract stones in both adults and pediatrics. It offers several advantages over sPCNL including reduced bleeding, fewer requirements for nephrostomy tubes, decreased pain, and shorter hospital stays. The series of detailed techniques presented here serve as a comprehensive guide for urologists, aiming to improve their procedural understanding and optimize patient outcomes. [ABSTRACT FROM AUTHOR]

The aim of this study is to perform proteomic and metabolomic analyses in bilateral renal pelvis urine of patients with unilateral uric acid kidney stones to identify the specific urinary environment associated with uric acid stone formation. Using cystoscopy-guided insertion of ureteral catheters, bilateral renal pelvis urine samples are collected. Liquid chromatography-tandem mass spectrometry (LC-MS/MS) is employed to identify differentially expressed proteins and metabolites in the urine environment. Differentially expressed proteins and metabolites are further analyzed for their biological functions and potential metabolic pathways through Gene Ontology (GO) analysis and Kyoto Encyclopedia of Genes and Genomes (KEGG) enrichment analysis. In the urine from the stone-affected side, eight differential proteins were significantly upregulated, and six metabolites were dysregulated. The uric acid stone urinary environment showed an excess of α-ketoisovaleric acid and 3-methyl-2-oxovaleric acid, which may contribute to the acidification of the urine. Functional and pathway analyses indicate that the dysregulated metabolites are mainly associated with insulin resistance and branched chain amino acid metabolism. [ABSTRACT FROM AUTHOR]

Background: To explore the feasibility and safety of aflexible ureteroscopy with intelligent control of renal pelvic pressure(FUS-ICP) without a post-operative indwelling urinary catheter. Methods: In this retrospective study, we assessed patients with upper urinary tract stones who were treated with FUS-ICP at the Ganzhou People's Hospital from February 2022 to December 2023. Patients were divided into the non-urinary catheter (non-UC) and urinary catheter (UC) groups according to whether an indwelling catheter was used after surgery. Results: In total, 142 patients were included in the study. There was no significant difference in the preoperative general data between the two groups. Patients in the non-UC group performed better than those in the UC group in terms of catheter-related bladder irritation (P = 0.001), the Sedation-Agitation Scale score (P = 0.012), and the numerical rating scale (P = 0.003). The incidences of urinary retention (P = 0.620), urinary tract infection (P = 0.529), and replacement of urethral catheter s (P = 0.438) in the UC group were inferior to those in the non-UC group, but there was no statistical significance. Conclusions: It is feasible and safe to perform FUS-ICP without a post-procedure indwelling urinary catheter. [ABSTRACT FROM AUTHOR]

Background: Dysuria in children can have various etiologies, including ureteric stones, phimosis, congenital obstructive posterior urethral membrane, and neurogenic bladders. However, there have been no reports of vitamin A deficiency (VAD) causing dysuria due to urethral keratosis. Here, we report two cases of urethral keratosis caused by a VAD. Case presentation: An 8-year-old boy (Patient 1) and a 6-year-old boy (Patient 2) presented with multiple episodes of dysuria and epididymitis. Both patients had intellectual disabilities and autism, which prevented voiding cystourethrography. Therefore, the patient was admitted for cystoscopy under general anesthesia. Cystoscopy revealed urethral diastolic dysfunction and a large amount of desquamated epithelium obstructing the urethra in both patients, causing urinary obstruction and dysuria. Catheterization was repeated; however, the symptoms recurred after catheter removal. Although the cause of recurrent urinary obstruction could not be initially identified, an ophthalmologist found Bitot's spots and suggested the possibility of a VAD. Serum vitamin A levels were extremely low in both patients, leading to the diagnosis of urethral keratosis due to VAD. VAD can be attributed to an unbalanced diet resulting from intellectual disabilities or autism. Vitamin A replacement therapy improved both the urethral symptoms and cystoscopic findings. Conclusion: Dysuria due to VAD is extremely rare, and urethral keratosis as a cause of dysuria is likely the first report of its kind worldwide. VAD may develop due to an unbalanced diet in patients with intellectual disabilities or autism. Therefore, it is essential to consider VAD as a potential cause of dysuria in patients with intellectual disabilities and autism. [ABSTRACT FROM AUTHOR]

Purpose: Mirroring global trends, artificial intelligence advances in medicine, notably urolithiasis. It promises accurate diagnoses, effective treatments, and forecasting epidemiological risks and stone passage. This systematic review aims to identify the types of AI models utilised in urolithiasis studies and evaluate their effectiveness. Methods: The study was registered with PROSPERO. Pubmed, EMBASE, Google Scholar, and Cochrane Library databases were searched for relevant literature, using keywords such as 'urology,' 'artificial intelligence,' and 'machine learning.' Only original AI studies on urolithiasis were included, excluding reviews, unrelated studies, and non-English articles. PRISMA guidelines followed. Results: Out of 4851 studies initially identified, 71 were included for comprehensive analysis in the application of AI in urolithiasis. AI showed notable proficiency in stone composition analysis in 12 studies, achieving an average precision of 88.2% (Range 0.65–1). In the domain of stone detection, the average precision remarkably reached 96.9%. AI's accuracy rate in predicting spontaneous ureteral stone passage averaged 87%, while its performance in treatment modalities such as PCNL and SWL achieved average accuracy rates of 82% and 83%, respectively. These AI models were generally superior to traditional diagnostic and treatment methods. Conclusion: The consolidated data underscores AI's increasing significance in urolithiasis management. Across various dimensions—diagnosis, monitoring, and treatment—AI outperformed conventional methodologies. High precision and accuracy rates indicate that AI is not only effective but also poised for integration into routine clinical practice. Further research is warranted to establish AI's long-term utility and to validate its role as a standard tool in urological care. [ABSTRACT FROM AUTHOR]

Background: Perinephric fluid is commonly identified in patients with renal colic and urolithiasis, especially in cases associated with hydronephrosis. However, its clinical relevance, particularly its impact on treatment decisions and prognosis, is not well established. Methods: This retrospective, single-center study included adult patients who presented to the emergency department (ED) with suspected renal colic between January 2021 and October 2023. Patients underwent ultrasound evaluations, which were analyzed for perinephric fluid, hydronephrosis, stone size, and stone location. Data on patient demographics, laboratory results, and clinical outcomes, including the need for urological interventions, were also collected and analyzed. Multivariate logistic regression was used to assess factors associated with perinephric fluid presence. Results: Of the 509 patients included, 200 (39.3%) had perinephric fluid. Hydronephrosis was significantly associated with perinephric fluid (OR: 4.14, p = 0.007), as were stones located in the proximal (OR: 3.06, p = 0.003) and distal ureter (OR: 2.31, p = 0.018). However, sonographic perinephric fluid did not significantly affect the likelihood of urological intervention, in-hospital complications, sepsis, acute kidney injury (AKI), acute kidney disease (AKD), and prolonged hospital stay. Conclusions: Perinephric fluid is a common finding in patients with renal colic and urolithiasis, particularly in cases involving hydronephrosis and ureteral stones. However, despite its prevalence, sonographic perinephric fluid was not significantly associated with the need for urological intervention, longer hospital stays, or worse clinical outcomes. Further prospective studies are required to clarify its clinical implications fully. [ABSTRACT FROM AUTHOR]

Background: This study highlighted the differences between the biochemical compositions of urinary stones from patients with type 1 diabetes versus those with type 2 diabetes. Materials and Methods: This study included patients diagnosed with kidney stones and diabetes who were referred to the Urological Clinic of the Dr. C. I. Parhon Hospital in Iasi from April 2017 to April 2024. We analyzed the spectroscopic stone composition from 128 lithiasis patients treated in our Clinic. In the current study, the distribution of the biochemical composition of stones varied significantly between diabetic patients with type 2 diabetes, who formed primarily mixed uric acid stones, and diabetic patients with type 1 diabetes, who mainly developed pure uric acid stones (p < 0.001). Patients with uric acid stones had significantly higher mean creatinine values than the other stone types (p < 0.001). Urinary pH levels were abnormal for all biochemical subtypes of stones, indicating acidic urine. However, patients with uric acid stones had lower pH values than the group average. From the Kaplan–Mayer analysis, patients with pure uric acid stones had a shorter time to stone recurrence compared to patients with other biochemical types identified. Conclusions: These findings, which highlight the prevalence of pure uric acid stones in patients with type 1 diabetes and the impact of this on the strategy for dissolving pure stones, represent a significant advancement in understanding urinary lithiasis in diabetic patients. [ABSTRACT FROM AUTHOR]

To evaluate the predictive factors affecting the stone-free rate (SFR) and complications of percutaneous nephrolithotomy (PCN) in the treatment of proximal impacted ureteral stones (PIUS) based on a new scoring standard. The data of 90 patients with PIUS were collected in this retrospective study between January 2015 and June 2023. Univariate and multivariate logistic regression analyses were used to determine factors affecting treatment outcome in terms of SFR and complications. The scoring standard for patients with PIUS was developed based on the univariate logistic regression analyses. In the univariate analysis, stone density (P = 0.015), and stone diameter (P = 0.032) significantly were associated with lower SFR. And degree of hydronephrosis (P = 0.014), Preoperative infection (P = 0.002), and history of lithotripsy (P = 0.045) were associated with occurrence of complications. Multivariate analysis indicated that stone density (P = 0.020), and stone diameter (P < 0.001) were associated with lower SFR; independent risk factors for development of complications were history of lithotripsy (P = 0.024), and preoperative infection (P < 0.001). Additionally, score ≥ 3 was the independent risk factor for both SFR (P < 0.001) and complication rate (P < 0.001). Subgroup analysis shown that there were statistically significant differences between the two groups in terms of stone-free rate (P = 0.032) and complications (P = 0.015). According to the findings of this study, the stone score ≥ 3 was determined as a critical predictive factor of SFR and complications in PIUS patients undergoing PCN based on a new scoring standard. Additionally, PCN has high initial SFR and low complications when dealing with score < 3 PIUS. [ABSTRACT FROM AUTHOR]

We performed a systematic review and meta‐analysis to evaluate the benefits and harms of pharmacotherapies for patients with calcium oxalate stones and abnormal urine chemistry. This article is a modified and detailed version of the commentary on Clinical Question 10 described in the Japanese Clinical Practice Guidelines for the Management of Urinary Stones, Third Edition. PubMed and Ichushi Web were searched through August 2020 for articles on pharmacotherapies for calcium oxalate stones (thiazides, citrate preparations, uric acid production inhibitors, and magnesium preparations). Two reviewers independently selected randomized controlled trials reporting reduction of stone recurrence and adverse drug reactions as outcomes and performed data extraction and quality assessment. Meta‐analyses with random effects models and rating of the strength of evidence were performed. Pharmacotherapies were shown to significantly reduce stone recurrence (risk ratio 0.47, 95% confidence interval 0.35–0.63). Meanwhile, the pharmacotherapies increased adverse drug reactions leading to study dropout (risk ratio 2.51, 95% confidence interval 1.09–5.75) and adverse drug reactions/adverse events (risk ratio 1.95, 95% confidence interval 1.07–3.56). The reported adverse drug reactions were, however, mainly minor and did not frequently require discontinuation of medication (2%–16%). The strengths of evidence for both outcomes were rated as moderate, because the risk of bias, indirectness, inconsistency, imprecision, and publication bias were all serious except for one item. The overall strength of evidence across outcomes was therefore determined to be moderate. These results support the conditional recommendation to initiate pharmacotherapies for patients with calcium oxalate stones and abnormal urine chemistry. [ABSTRACT FROM AUTHOR]

Imaging techniques, such as computed tomography (CT) and fluoroscopy, are essential for the diagnosis and treatment of urolithiasis. There is increasing concern regarding the cumulative radiation dose associated with medical imaging and its adverse effects. This study aimed to assess radiation exposure in patients undergoing endoscopic management of urolithiasis and to identify factors associated with increased exposure. A retrospective analysis of all consecutive symptomatic urolithiasis cases who underwent endoscopic surgery over a two-year period at a tertiary referral center was performed. The cumulative radiation dose was recorded per stone episode, and the effective dose (ED) then calculated. Multivariable regression analysis was performed to determine the association between ED and patient, stone, and procedural characteristics. Between January 2020 and December 2021, 250 patients underwent endoscopic intervention for urolithiasis; 71% (n = 178) were male with a median age of 48 years (IQR 35–59). The median stone size was 6 mm (IQR, 5–8 mm) and the median stone volume was 110 mm3 (IQR, 60–206 mm3). Most stones were located in the distal ureter (46%, n = 114). The median ED received per stone episode was 3.99 mSv (IQR 2.9–7 mSv). On multivariable analysis, BMI, number of CT scans performed, CT protocol used, and repeat procedures strongly predicted increased radiation dose (p < 0.01). It is important for urologists to consider the cumulative radiation dosage in patients with urolithiasis. Strategies to minimize exposure, such as avoiding re-imaging, low-dose CTs, and collimation of the region of interest with judicious magnification, should be considered during treatment. [ABSTRACT FROM AUTHOR]

The objective of this study was to compare the clinical efficacy and safety of microchannel percutaneous nephrolithotripsy (MPCNL) with flexible ureteroscopic lithotripsy (FURL) in the treatment of single upper ureteral stones with a diameter of 1–2 cm and high hardness. This study retrospectively analyzed 89 patients diagnosed with a single upper ureteral stone with a 1–2 cm diameter and a computed tomography value > 1000 Hounsfield units. A propensity score matching system matched this study with factors to minimize the effect of baseline differences between patients. Ultimately, 29 patients in each of the two groups were successfully matched. The stone-free rate was marginally higher in the MPCNL group than in the FURL group (93.10% vs. 86.21%), although the difference did not reach statistical significance (P = 0.666). Furthermore, the mean operative time in the MPCNL group, although slightly longer than that in the FURL group, did not demonstrate a statistically significant difference (P = 0.833). However, patients in the MPCNL group exhibited a significantly more substantial decrease in hemoglobin than those in the FURL group (P < 0.001) and a substantially more extended postoperative hospital stay (P < 0.001). Regarding perioperative complications, the incidence of moderate pain was higher in the MPCNL group than in the FURL group (P = 0.037). The difference in overall complication rates between the two groups did not reach statistical significance (P = 0.108). MPCNL and FURL are efficacious surgical procedures for treating single upper ureteral stones with a 1–2 cm diameter and high hardness. [ABSTRACT FROM AUTHOR]

To prospectively investigate the effect of music therapy on patient's anxiety and pain level during retrograde intrarenal surgery under spinal anesthesia. 286 patients aged above 18 years, who underwent Retrograde Intrarenal Surgery (RIRS) under spinal anesthesia for renal or ureteral calculi were evaluated between January 2023 and June 2023 by a prospective, randomized, controlled clinical protocol. Patients were randomized into 2 groups. Group 1 included patients, who listened to music, and Group 2 was comprised of patients, who were not allowed to listen to music. Visual Analog Scale (VAS) results and pain sensation, anxiety level, together with the results of State-Trait Anxiety Inventory (STAI), a self-reported anxiety inventory, were captured. The number of patients, who were randomized to the music group (Group 1) and non-music group (Group 2) was 144 and 142, respectively. Mean heart rate in Group 1 and Group 2 was 60 ± 4.19 and 70 ± 8.36, respectively (p = 0.02), indicative of the fact that mean heart rate was significantly lower in the music group. Heart rate measured post-operatively within the first hour subsequent to the procedure was similar in both groups (p < 0.05). The VAS score was significantly lower in Group 1. STAI score in Group 1 and Group 2 was 45.51 ± 2.968 and 49.16 ± 1.88, respectively. Therefore, there was a statistically significant difference (p < 0.001). Music therapy during the RIRS procedure under spinal anesthesia was associated with a significantly decrease in pain and anxiety scores in patients. [ABSTRACT FROM AUTHOR]

Urolithiasis is a leading urological disorder where accurate preoperative identification of stone types is critical for effective treatment. Deep learning has shown promise in classifying urolithiasis from CT images, yet faces challenges with model size and computational efficiency in real clinical settings. To address these challenges, we developed a non-invasive prediction approach for determining urinary stone types based on CT images. Through the refinement and improvement of the self-distillation architecture, coupled with the incorporation of feature fusion and the Coordinate Attention Module (CAM), we facilitated a more effective and thorough knowledge transfer. This method circumvents the extra computational expenses and performance reduction linked with model compression and removes the reliance on external teacher models, markedly enhancing the efficacy of lightweight models. achieved a classification accuracy of 74.96% on a proprietary dataset, outperforming current techniques. Furthermore, our method demonstrated superior performance and generalizability on two public datasets. This not only validates the effectiveness of our approach in classifying urinary stones but also showcases its potential in other medical image processing tasks. These results further reinforce the feasibility of our model for actual clinical deployment, potentially assisting healthcare professionals in devising more precise treatment plans and reducing patient discomfort. [ABSTRACT FROM AUTHOR]

Urolithiasis, a common and recurrent condition, imposes a significant global health burden. This study investigates the causal relationship between various types of fluid intake and urolithiasis using univariable and multivariable Mendelian randomization (MR) approaches. Genetic data for urolithiasis were obtained from the FinnGen Consortium (n = 400,681), while genetic measures for nine fluid types were sourced from meta-analyses of genome-wide association studies (GWAS). The analysis revealed that genetically predicted coffee intake (OR: 0.571, 95% confidence interval (CI): 0.341–0.958, p = 0.034) and ground coffee intake (OR: 0.219, 95% CI: 0.005–0.923, p = 0.038) were protective factors for upper urinary calculi. Additionally, a standard deviation (SD) increase in tea intake was associated with a 53% reduction in risk (OR: 0.473, 95% CI: 0.320–0.700, p < 0.001). Conversely, milk intake (OR: 1.072, 95% CI: 1.018–1.130) and alcohol intakefrequency (OR: 1.304, 95% CI: 1.083–1.570, p = 0.005) increased the risk of upper urinary calculi. These findings highlight the association of tea with reduced risk of urolithiasis, instead for milk and alcohol intake, in formulating prevention strategies for urolithiasis. [ABSTRACT FROM AUTHOR]

This study assessed the impact of urinary tract anomalies or a history of upper urinary tract surgery (UTAS) on the minimally invasive endoscopic combined intrarenal surgery (mini-ECIRS) outcomes. Data from 1432 patients undergoing ECIRS for urolithiasis at three Japanese tertiary institutions between 2015 and 2021 were analyzed, with patients categorized into those with normal urinary tracts (non-UTAS) and those with UTAS (UTAS). We retrospectively examined the association between the UTAS and perioperative outcomes in mini-ECIRS. Of the 1096 cases in the final analysis, 1035 and 61 were identified as non-UTAS and UTAS, respectively. Stone-free rate (residual fragments > 2 mm, 62.8% vs. 62.7%), operation time (110.5 vs. 115.0 min), and hospital stay duration (5.6 vs. 5.7 days) showed no significant differences between non-UTAS and UTAS. The UTAS group demonstrated significantly higher rates of preoperative pyuria (86.2% vs. 71.1%), preoperative urinary tract infection (32.8% vs. 15.5%), preoperative stenting (52.5% vs. 31.0%), and preoperative nephrostomy (24.6% vs. 9.2%). However, the postoperative fever (26.3% vs. 25.0%) or septic shock (1.9% vs. 0%) were comparable between non-UTAS and UTAS. Stone burden and the number of calyces involved were significantly associated with a low stone-free rate (P < 0.001). Younger age, female sex, solitary stones, number of calyces involved, preoperative urinary tract infection, and absence of preoperative nephrostomy were identified as risk factors for perioperative complications. The UTAS was not associated with stone-free outcomes or perioperative complications. Mini-ECIRS demonstrated comparable stone-free outcomes and safety in patients with UTAS and those with normal urinary tracts. [ABSTRACT FROM AUTHOR]