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Purpose To evaluate the perioperative outcomes of retrograde intra-renal surgery (RIRS) for lower pole stones (LPS) and factors affecting stone-free rate (SFR). Methods Data from 20 centers were retrospectively reviewed. Inclusion criteria were adult patients, normal renal anatomy, and LPS. Exclusion criteria were bilateral surgery, concomitant surgery for ureteral stones. SFR was defined as a single residual fragment (RF) ≤ 2 mm and evaluated 3-months after surgery. A multivariable logistic regression analysis was performed to assess factors associated with RF. Statistical significance was set at p value Results 2946 patients were included. Mean age and stone size were 49.9 years 10.19 mm, with multiple LPS in 61.1% of cases. Total operation and laser time were 63.89 ± 37.65 and 17.34 ± 18.39 min, respectively. Mean hospital stay was 3.55 days. Hematuria requiring blood transfusion and fever/urinary infections requiring prolonged antibiotics occurred in 6.1% and 169 5.7% of cases, while sepsis with intensive-care admission in 1.1% of patients. On multivariate analysis, Multiple stones (OR 1.380), stone size (OR 1.865), and reusable ureteroscopes (OR 1.414) were significantly associated with RF, while Thulium fiber laser (TFL) (OR 0.341) and pre-stenting (OR 0.750) were less likely associated with RF. Conclusions RIRS showed safety and efficacy for LPS with a mean diameter of 10 mm. This procedure can achieve a satisfactory SFR in pre-stented patients with a single and smaller stone, particularly with TFL use.

Introduction: flexible ureteroscopy is a minimally invasive surgical technique used for the treatment of renal lithiasis. Postoperative urosepsis is a rare but potentially fatal complication. Traditional models used to predict the risk of this condition have limited accuracy, while models based on artificial intelligence are more promising. The objective of this study is to carry out a systematic review regarding the use of artificial intelligence to detect the risk of sepsis in patients with renal lithiasis undergoing flexible ureteroscopy. Methods: the literature review is in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA). The keyword search was performed in MEDLINE, Embase, Web of Science and Scopus and resulted in a total of 2,496 articles, of which 2 met the inclusion criteria. Results: both studies used artificial intelligence models to predict the risk of sepsis after flexible uteroscopy. The first had a sample of 114 patients and was based on clinical and laboratory parameters. The second had an initial sample of 132 patients and was based on preoperative computed tomography images. Both obtained good measurements of Area Under the Curve (AUC), sensitivity and specificity, demonstrating good performance. Conclusion: artificial intelligence provides multiple effective strategies for sepsis risk stratification in patients undergoing urological procedures for renal lithiasis, although further studies are needed. RESUMO Introdução: a ureteroscopia flexível é uma técnica cirúrgica minimamente invasiva utilizada para o tratamento de litíase renal. A urosepse pós-operatória é uma complicação rara, mas potencialmente fatal. Os modelos tradicionais utilizados para prever o risco dessa condição apresentam precisão limitada, enquanto modelos baseados em inteligência artificial são mais promissores. O objetivo desse estudo é realizar uma revisão sistemática a respeito do uso de inteligência artificial para detecção do risco de sepse em pacientes com litíase renal submetidos à ureteroscopia flexível. Métodos: a revisão de literatura está de acordo com o Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA). A busca com palavras-chave foi realizada no MEDLINE, Embase, Web of Science e Scopus e resultou no total de 2.496 artigos, dos quais 2 se enquadraram nos critérios de inclusão. Resultados: os dois estudos utilizaram modelos de inteligência artificial para predizer o risco de sepse após utereroscopia flexível. O primeiro teve uma amostra de 114 pacientes e foi baseado em parâmetros clínicos e laboratoriais. O segundo teve uma amostra inicial de 132 pacientes e foi baseado em imagens de tomografia computadorizada no pré-operatório. Ambos obtiveram boas medidas de Area Under the Curve (AUC), sensibilidade e especificidade, demonstrando boa performance. Conclusão: a inteligência artificial fornece múltiplas estratégias eficazes para estratificação do risco de sepse em pacientes submetidos a procedimentos urológicos para litíase renal, ainda que mais estudos sejam necessários.

We induced experimental nephrolithiasis in female rats using ethylene glycol (EG) and ammonium chloride (AC). We investigated the effects of carvacrol, an essential oil with antioxidant and anti-inflammatory properties, on nephrolithiasis using histopathology, immunohistochemistry and biochemistry. We used 40 female rats divided into four equal groups: control group, administered olive oil; carvacrol group, administered carvacrol in olive oil; nephrolithiasis group, administered EG and AC to induce experimental nephrolithiasis; treatment group with induced nephrolithiasis and administered carvacrol in olive oil. We observed no significant difference in crystal accumulation in the treatment group compared to the nephrolithiasis group. We found a significant reduction in hydropic degeneration of tubules and degree of inflammatory cell infiltration of intertubule areas. We also found a significant reduction in immunohistochemical staining of macrophage- and monocyte-specific antigens. Carvacrol treatment reversed the induced nephrolithiasis, increased malondialdehyde and urea, and decreased levels of glutathione peroxidase and catalase. Although carvacrol did not decrease crystal accumulation, it reduced pathological and biochemical damage, and improved kidney function by lowering the serum urea level.

Kidney stone disease (KSD) is a prevalent condition associated with high morbidity, frequent recurrence, and progression to chronic kidney disease (CKD). The etiology is multifactorial, depending on environmental and genetic factors. Although monogenic KSD is frequent in children, unbiased prevalence data of heritable forms in adults is scarce. Within 2 years of recruitment, all patients hospitalized for urological kidney stone intervention at our center were consecutively enrolled for targeted next generation sequencing (tNGS). Additionally, clinical and metabolic assessments were performed for genotype–phenotype analyses. The cohort comprised 155 (66%) males and 81 (34%) females, with a mean age at first stone of 47 years (4–86). The diagnostic yield of tNGS was 6.8% (16/236), with cystinuria (SLC3A1, SLC7A9), distal renal tubular acidosis (SLC4A1), and renal phosphate wasting (SLC34A1, SLC9A3R1) as underlying hereditary disorders. While metabolic syndrome traits were associated with late-onset KSD, hereditary KSD was associated with increased disease severity in terms of early-onset, frequent recurrence, mildly impaired kidney function, and common bilateral affection. By employing systematic genetic analysis to a less biased cohort of common adult kidney stone formers, we demonstrate its diagnostic value for establishing the underlying disorder in a distinct proportion. Factors determining pretest probability include age at first stone (

To examine the dynamic changes in the formative factors of nephrolithiasis and the final micromorphological changes in an obesity-initiated metabolic syndrome (MS) rat model.Forty five-week-old male Sprague-Dawley (SD) rats were randomly divided into four groups: the regular diet group (RD), high-fat diet group (HFD), regular diet with drug (ethylene glycol and ammonium chloride) group (RDD), and high-fat diet with drug group (HFDD). A dynamic assessment of MS components (body weight (BW), body length (BL), Lee's index (LI), blood glucose (BG), total cholesterol (TC), and triglycerides (TGs)) and stone-forming factors (urinary pH, urinary calcium, and urinary oxalate acid) was carried out. In addition, the levels of oxidative stress (OS) markers (CAT, SOD, TAC, GSH-PX, and MDA) were measured, and histological analysis was carried out at the end of 16 weeks.MS-related parameters, such as BW, LI, BG, TC, and TG, were significantly higher in HFD-fed rats than in RD-fed rats (Our results suggest that male SD rats with MS are prone to developing nephrolithiasis. Validation in an

Calcium oxalate (CaOx) uroliths are common in dogs. Humans with CaOx urolithiasis exhibit alterations of the urinary and urogenital microbiomes that might mediate urolith formation. Detection of urogenital microbes associated with CaOx in dogs could inform disease pathophysiology.To identify compositional differences in the urogenital microbiome of Miniature Schnauzers with and without CaOx uroliths.Nineteen midstream, voided urine samples from Miniature Schnauzers with (n = 9) and without (n = 10) a history of CaOx urolithiasis.Analytical cross-sectional study. Microbial DNA was extracted from previously frozen urine samples and sequenced for the bacterial 16S rRNA V3-V4 hypervariable regions. Diversity and composition of microbial populations were compared between urolith formers and controls.Alpha and beta diversity measures were similar between groups. Five individual bacterial taxa differed in abundance (indicator values0.5 and P .05): Acinetobacter, 2 Geobacillus variants, and Hydrogenophaga were overrepresented in the urine of urolith formers, and Sphingopyxis was overrepresented in controls. Two distinct subtypes of urine microbial composition were observed based on beta diversity measures, independent of urolith status, and other clinical variables.Although we did not detect a difference in the overall urogenital microbial composition between groups, observed differences in individual bacterial taxa might be clinically relevant. For example, Acinetobacter was overrepresented in urolith formers and is associated with CaOx urolithiasis in humans. Two unique clusters of the microbiome were identified, independent of urolith status, which may represent distinct urotypes present in Miniature Schnauzers.

To assess the use of intraoperative IV ketorolac (Toradol) on the peri-operative total morphine milligram equivalent (MME) requirements of patients undergoing ureteroscopy for nephrolithiasis.Patients undergoing ambulatory ureteroscopy for nephrolithiasis were randomized to receive ketorolac at time of anesthesia induction. Patients and surgeons were blinded to treatment. Intraoperative, postoperative and combined MME were calculated. Multivariable regression was used to identify independent predictors of MME requirement. Complications were recorded.A total of 94 patients were analyzed following randomization. There were 46 patients in the treatment arm and 48 patients in the control arm. There were no statistically significant differences in gender, age, BMI, operative length or baseline pain medication use between groups (P.05). Patients in the treatment arm required lower intraoperative MME when compared to the control arm (17.1 vs 24, P.01). There were no statistically significant differences in the postoperative MME requirements between groups. The combined peri-operative MME was lower in the treatment arm compared to the control arm (22.2 vs 30.4, P.02). Ketorolac use was an independent predictor of lower MME use on multivariable analysis (beta coefficient -5.1, P.01). There was no statistically significant difference with regards to complication numbers between the treatment arms.Ketorolac during ureteroscopy is associated with a 37% reduction in narcotic requirement and is an independent predictor of decreased peri-operative narcotic needs. These findings show that intra-operative use of ketorolac effectively reduces narcotic requirements and should be considered independently or as part of a multimodal pain control protocol, unless otherwise contraindicated.

In 2018, the Endourology Disease Group for Excellence (EDGE) published a prospective trial comparing dusting versus basketing during ureteroscopy. One hundred fifty-nine patients were included in the original analysis, which found no difference in stone-free rate at 3months. We report the intermediate and long-term outcomes of patients included in the original trial. Two analyses were performed. At 1-year, a retrospective chart review was performed, and data collected on stone episodes, Emergency Department (ED) visits, hospital admissions and surgical interventions. To obtain long-term outcomes, the four sites with the largest initial accrual were included in a second phase of data collection with updated analyses. The patients from those sites were contacted, re-consented, and data were collected on stone surgical interventions, stone episodes, stone recurrences on imaging, emergency department (ED) visits, and hospital admissions for stone-related care since their original procedure. One-year follow-up data were collected in 111 of the original 159 (69.8%) patients from the nine sites. There were no statistically significant differences in the number of painful episodes, ED visits, hospital admissions, or surgical interventions. 94 patients from four sites were included in the long-term analysis. There were no statistically significant differences in surgical interventions, painful stone episodes, stone recurrence on imaging, ED visits or hospitalizations for stone-related events between the two groups. Long-term outcomes of dusting versus basketing during ureteroscopy indicate that there are no significant differences in clinical outcomes between the two surgical modalities.

In hypoparathyroidism (HypoPT), calcium supplementation is virtually always required, although the disease is likely to be associated with an increased risk of nephrolithiasis. The use of calcium citrate (Ca-Cit) theoretically could have a positive impact on the nephrolithiasis risk because citrate salts are used to reduce this risk. Our objective was to evaluate the potential therapeutic advantage of Ca-Cit in comparison with calcium carbonate (CaCO3) in HypoPT, on nephrolithiasis risk factors, as well as to their ability to maintain desirable serum calcium levels. We also evaluated these preparations on quality of life (QOL). This randomized, double-blind, crossover trial recruited 24 adults with postsurgical chronic hypoparathyroidism at Campus Bio-Medico University of Rome. Participants were randomized 1:1 to Ca-Cit or CaCO3 for 1 month and then crossed over to the other treatment for another month. The primary outcomes were changes in albumin-adjusted serum calcium and in ion activity product of calcium oxalate levels (AP[CaOx] index). Secondary efficacy outcomes included changes in SF-36 survey score, fatigue score, constipation, and adverse events. No difference in terms of AP(CaOx) index was observed between the two groups. However, Ca-Cit was associated with a significant reduction in the oxalate/creatinine ratio compared with CaCO3 (-2.46 mmol/mol [SD 11.93] versus 7.42 mmol/mol [SD 17.63], p = 0.029). Serum calcium and phosphorus concentration was not different between the two calcium preparations. Ca-Cit was associated with less constipation (p = 0.047). No difference was found in QOL scores. Although Ca-Cit did not modify the AP(CaOx) index when compared with CaCO3, it was associated with a reduction in urinary oxalate excretion that could have a potential beneficial effect on nephrolithiasis risk. These results are likely to have clinical implications in HypoPT, particularly those who do not tolerate CaCO3 and those affected by nephrolithiasis. A longer-term experience is needed to confirm these findings. (c) 2022 The Authors. Journal of Bone and Mineral Research published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research (ASBMR).

SUMMARY OBJECTIVE: The aim of this study was to evaluate the predictive factors for success following percutaneous nephrolithotomy in the supine position. METHODS: Patients who underwent percutaneous nephrolithotomy in the supine position from June 2011 to October 2018 were evaluated. Age, sex, body mass index, the American Society of Anesthesiologists physical status classification, hemoglobin level, number of previous surgeries, stone size, and the Guy’s Stone Score were analyzed. Success was considered if no fragments were observed on the computed tomography scan on the first postoperative day. Univariate and multivariate analyses were performed to determine significant parameters. RESULTS: We evaluated 961 patients; of them, 483 (50.2%) underwent previous stone-related surgery, and 499 (51.9%) had Guy’s Stone Score 3 or 4. The overall success rate in a single procedure was 40.7%, and complication rate was 13.7%. The univariate analysis showed that the maximum diameter of the stone (25.10±10 mm; p

Objective Hereditary factors are the main cause of pediatric nephrolithiasis (NL)/nephrocalcinosis (NC). We summarized the genotype–phenotype correlation of hereditary NL/NC in our center, to evaluate the role of genetic testing in early diagnosis. Methods The clinical data of 32 NL/NC cases, which were suspected to have an inherited basis, were retrospectively analyzed from May 2017 to August 2020. The trio-whole exome sequencing was used as the main approach for genetic testing, variants were confirmed by Sanger sequencing, and pathogenicity analysis according to protein function was predicted with custom-developed software. Results Causative monogenic mutations were detected in 24 of 32 NL/NC patients, and copy number variation was detected in one patient. A summary of manifestations in patients with inherited diseases revealed a significant degree of growth retardation, increased urinary excretion of the low-molecular weight protein, hypercalciuria, electrolyte imbalances, and young age of onset to be common in heredity disease. In addition, some patients had abnormal renal function (3 ppm 25). The most frequent pathology identified was distal renal tubular acidosis (with inclusion of SLC4A1, ATP6V1B1, and ATP6VOA4 genes), followed by Dent disease (CLCN5 and OCRL1 genes), primary hyperoxaluria (PH) (AGXT and HOGA1 genes) and Kabuki syndrome (KMT2D gene), which was more likely to present as NC or recurrent stone and having a higher correlation with a specific biochemical phenotype and extrarenal phenotype. Conclusion The etiology of NL/NC is heterogeneous. This study explored in depth the relationship between phenotype and genotype in 32 patients, and confirmed that genetic testing and clinical phenotype evaluation enable the precision medicine approach to treating patients.

Objectives : To estimate the prevalence of nephrolithiasis in people with disabilities (PWD), while accounting for known kidney stone disease risk factors. Methods : We used answers to the disability and kidney disease questionnaires from the 2013-2016 cycles of the National Health and Nutrition Examination Survey (NHANES), a nationally representative cross-sectional survey by the Centers for Disease Control, to calculate nephrolithiasis prevalence by functional disability type. We additionally estimated the total US population of stone formers with disabilities and compared disability prevalence between stone formers and non-stone formers. Multivariate logistic regression models were built using known correlates of nephrolithiasis. Results : 34.7% (CI: 30.5-39.1%) of United States stone-formers are PWD. The prevalence of nephrolithiasis in PWD is 16.1% (CI: 14.4-18.0) in comparison to 9.2% (CI: 8.3-10.3) in people without disabilities. PWD have significantly elevated odds of nephrolithiasis (un-adjusted OR: 1.91 CI: 1.55-2.36). Adjusting for age, gender, race, diabetes, hypertension, and obesity, odds of nephrolithiasis remains elevated in PWD overall (adjusted OR: 1.46 95% CI: 1.17-1.83) and in all disability domains. Conclusions : One in 3 people with nephrolithiasis are PWD. Odds of nephrolithiasis are increased in PWD even after adjustment for multiple known risk factors in all disability domains. PWD are known to be a unique population that can face significant health disparities, but there is a dearth of studies that estimate urologic disease prevalence within this group. Future urologic research should incorporate disability status to explore potential disparities.

Introduction: Metastatic prostate cancer is an advanced-stage prostate cancer that has spread to distant sites or to the lymph nodes. Prostate cancer is one of the most common types of cancer. Typical symptoms are dysuria, blood in the urine or semen and painful ejaculation. Case report: We present the case of a 62-year-old male who was admitted for examination due to dull periumbilical pain and significant weight loss. X- ray imaging revealed a left-sided perivesical ureterolith. Ultrasonography showed retroperitoneal lymphadenopathy with bilateral obstructive uropathy, second degree dilatation of the duct system of the right kidney and third degree of the left kidney, without determining signs of nephrolithiasis. Due to hydronephrosis, he was redirected for the placement of a double-J stent, which was performed successfully on the right side. Computed tomography and magnetic resonance imaging of the abdomen and pelvis revealed pathologically enlarged lymph nodes and sclerotic changes in the pelvic bones. Magnetic resonance imaging showed enlarged left lobe of the prostate and obliterated border between the central and peripheral zones with disruption of the posterolateral external fibromuscular sheath and part of the stroma. A prostate biopsy was performed, and biopsy sample came back positive for cancer. Blood test results showed significantly elevated (477ng/mL) prostate- specific antigen. The patient was scheduled for bilateral subcapsular orchidectomy. Conclusion: We presented a case report of metastatic prostate cancer with atypical clinical presentation of bilateral nephrolithiasis. Comprehensive diagnostics is crucial to determine valid diagnosis and to start appropriate treatment.

BackgroundIdiopathic calcium nephrolithiasis (ICN) is a common condition with a complex phenotype influenced by both environmental and genetic factors. In our study we investigated the association of allelic variants with the history of nephrolithiasis.MethodsWe genotyped and selected 10 candidate genes potentially related to ICN from 3046 subjects participating in the INCIPE survey cohort (Initiative on Nephropathy, of relevance to public health, which is Chronic, possibly in its Initial stages, and carries a Potential risk of major clinical End-points), a study enrolling subjects from the general population in the Veneto region in Italy.ResultsOverall, 66 224 variants mapping on the 10 candidate genes were studied. A total of 69 and 18 variants in INCIPE-1 and INCIPE-2, respectively, were significantly associated with stone history (SH). Only two variants, rs36106327 (chr20:54 171 755, intron variant) and rs35792925 (chr20:54 173 157, intron variant) of the CYP24A1 gene were observed to be consistently associated with ICN. Neither variant has been previously reported in association with renal stones or other conditions. Carriers of CYP24A1 variants showed a significant increase in the ratio of 1,25 (OH)2 vitamin D to 25 (OH) vitamin D compared with controls (P = .043). Although not associated with ICN in this study, the rs4811494 CYP24A1 variant that was reported to be causative of nephrolithiasis was very prevalent in heterozygosity (20%).ConclusionOur data suggest a possible role for CYP24A1 variants in the risk of nephrolithiasis. Genetic validation studies in larger sample sets will be necessary to confirm our findings.

The renal stone found in the natural mummy of an anonymous nobleman dating to 19

Introdução: A nefrolitíase é uma patologia de alta prevalência. Possui importante morbidade por complicações agudas, relacionadas a obstrução de vias urinárias e quadros de insuficiência renal, bem como quadros infecciosos que podem evoluir à sepsis. Classicamente seu tratamento é cirúrgico e tem-se a nefrolitotomia percutânea (NPC) como padrão ouro para cálculos renais maiores que 2 cm. Relato de caso: Paciente masculino, 48 anos, com repetidos quadros de infecção urinária. A investigação foi realizada com exames laboratoriais e de imagem. Possui sobrepeso, hipertensão leve, sem outras comorbidades. Apresentando cálculo coraliforme, complexo à esquerda, foi submetido a abordagem endoscópica combinada, ureteroscópica e percutânea em posição supina modificada, com completa extirpação de cálculos, com alta no segundo dia de pós-operatório, retornando em 45 dias para retirada de duplo jota, com boa evolução.

Staghorn calculi account for about 4% of presenting renal stones in developed countries, are source of recurrent urinary tract infection, and may be eventually treated by surgical stone removal. A 55-year-old female with a history of staghorn renal calculi and recurrent urinary tract infections presented with a left flank and lower abdominal pain following recent left robotic partial nephrectomy and nephrolithotomy. Contrast-enhanced computed tomography (CT) of the abdomen demonstrated a large left-sided retroperitoneal fluid collection with a few dropped renal stones in the dependent portion of the collection. The patient treated with early percutaneous drainage of the collection and antibiotic treatment and responded well clinically. The clinical and imaging presentation of a rare case of retroperitoneal abscess formation caused by dropped renal stones is described in this study. Imaging, particularly ultrasound and CT, plays a key role in detecting the dropped renal stones and can help with differential diagnosis and treatment plans.

We launched a retrospective cohort study to explore the interactions among serum uric acid (UA), urine UA, and stone types.Clinical characteristics of urolithiasis patients in Beijing Tsinghua Changgung Hospital from October 2015 to August 2017 were retrospectively collected. Participants were categorized according to the quartiles of SUA and UUA respectively. Logistic regression model was built to identify the relationship between stone composition and UA level. Cubic spline was fitted to explore the correlation between 24-h urine UA and serum UA.718 hospitalized patients (51.1 ± 14.3 years, male 63.4%) with urinary calculi were included. Higher serum UA is associated with male, alcohol use, multiple serum and urine electrolytes (e.g. potassium, chloride, calcium, phosphorus), and lower estimated glomerular filtration rate. The risk of UA stone and carbonate apatite stone was associated with serum UA while the risk of calcium oxalate (CaOx) stone and ammonium magnesium hexahydrate (AMH) was dependent on urine UA. In the unadjusted model (Model 1), higher risks of UA stones were observed in the third quartile (OR 3.26, 95% CIs 1.63-6.53, P = 0.001) and the fourth quartile (OR 3.55, 95% CIs 1.78-7.08, P 0.001) of serum UA compared with the first quartile. The risks of carbonate apatite stone were lowered in the third (OR 0.48, 95% CIs 0.31-0.73, P = 0.001) and fourth quartile (OR 0.40, 95% CIs 0.42-0.98, P = 0.042) of serum UA. The risk of CaOx stone was increased in the fourth quartile (OR 2.14, 95% CIs 1.15-3.99, P = 0.017) while the risk of AMH stone was decreased in the third (OR 0.46, 95% CIs 0.22-0.94, P = 0.034) and fourth quartile (OR 0.35, 95% CIs 0.16-0.78, P = 0.009) of urine UA. The elevated risks of UA stones in high levels of serum UA were demonstrated in the adjusted model (Model 2). An M-shaped association was found between serum UA and urine UA in our population.Serum UA and urine UA might cast different impact on urinary calculus composition. Proper control of the parameters should be considered based on different predisposing factors in individual patients.

Nephrolithiasis is a classic indication for parathyroidectomy in primary hyperparathyroidism patients; however, the effects of parathyroidectomy on nephrolithiasis recurrence are not well studied. The aim was to determine effect of parathyroidectomy on time to first nephrolithiasis recurrence and recurrence rate per patient-years.A retrospective cohort study of patients diagnosed with primary hyperparathyroidism and at least one episode of nephrolithiasis was performed. The patients were divided into observation, presurgery, and postsurgery groups. Endpoints were time to first recurrence of nephrolithiasis and average recurrence rate per patient-years.The cohort was comprised of 1,252 patients. In addition, 334 (27%) patients underwent parathyroidectomy and 918 (73%) were observed. The surgical and nonsurgical groups differed significantly in age, sex, Charlson, calcium, and primary hyperparathyroidism level. Overall recurrence rate was 31.3%. The 5-, 10-, and 15-year recurrence-free survival rates were 74.4%, 56.3%, 49.5%, respectively (presurgery), 82.4%, 70.9%, 62.8%, respectively (postsurgery; P.0001), and 86.3%, 77.7%, and 70.6%, respectively (observation). The presurgery group had an increased risk of first recurrence compared with the observation group (hazard ratio 1.89; 95% confidence interval, 1.44-2.47). The average recurrence rates among all surgical patients who recurred were 1 event per 4.3 patient-years presurgery versus 1 event per 6.7 patient-years postsurgery (P = .0001).Recurrent nephrolithiasis is a significant problem in patients with primary hyperparathyroidism. Parathyroidectomy prolongs the time to first recurrence and decreases the number of re-recurrences over time but does not eliminate recurrences. Observation may also be a reasonable approach in selected patients.

Introduction: Nephrolithiasis is one of the most common prevalent diseases in the human population, with a high recurrence rate. Although the prophylaxis effect of potassium citrate in renal calculi is well known, its therapeutic effect of melting kidney stones is not well-understood. This study aims to evaluate the therapeutic effect of potassium citrate on rats with nephrolithiasis. Methods: Thirty, 4 to 6-week-old, male and female Wistar rats weighing 200±11 g were studied. After a one-week acclimatization period, the rats were randomly assigned into three groups using a computer-generated randomization list: Group A (control group), Group B (ethylene glycol receivers), Group C (treatment group) for four weeks. For further pathologic examinations of the urinary system, two rats, including a male and a female, were randomly selected from each group and were sacrificed. Their urinary system, including kidneys, ureters, bladder, and urethra, was extracted for pathology and serologic examinations. Results: The ethylene glycol group demonstrated Bowman's capsule hemorrhage and glomeruli size decrement in microscopic examination compared to control subjects. Although the changes were present in the mice of simultaneous exposure to Potassium Citrate and ethylene glycol, their extent was much less in the treatment group. Conclusion: Although histopathologic studies suggested that potassium citrate may prevent rat ethylene glycol in stone formation, radiologic examinations were inconclusive.

Purpose of review The coronavirus disease 2019 (COVID-19) pandemic led to a drastic change in healthcare priorities, availability of resources and accommodation of different needs and scenarios. We sought to review the effect of the pandemic on different aspects of nephrolithiasis. Recent findings The pandemic resulted in a significant impact on management of patients with nephrolithiasis around the world. A significant decrease in patient presentation and differences in strategies of management to truncate exposure and surgery time and expedite patient discharge deferring definitive management has been noted. Moreover, new safety measures such as COVID-19 PCR testing prior to surgery and limiting any intervention for COVID-19 positive patients to only life-saving scenarios has been implemented. Different emergency triaging proposals are being used, mainly including high risk patients with septic shock or complete obstruction/renal injury. Moreover, the emergence of telehealth has changed outpatient practice dramatically with a significant adoption to minimize exposure. Lastly, the effect of COVID-19 on renal physiology has been described with significant potential to cause morbidity from immediate or delayed acute kidney. No physiological effect on stone formation has yet been described, and transmission through urine is rare. Summary The COVID-19 pandemic has markedly shifted the treatment of nephrolithiasis in many ways, including emergency triage, outpatient care, and definitive management. Although various approaches and algorithms proposed are meant to optimize management in the time of the pandemic, further studies are required for validation.

Background: To evaluate the safety, efficacy and cost of paravertebral block anesthesia for ureteral stones patients undergoing ureteroscopic lithotripsy. Methods: Four hundred and eighty-two patients who underwent ureteroscopy for unilateral ureteral stones were incorporated into our retrospective study. A propensity-matched comparison in patients with paravertebral nerve block anesthesia (PVB) group and general anesthesia (GA) group was performed. Intraoperative hemodynamic parameters, operative time, visual analog scale for pain, stone-free rate, anesthetic cost and postoperative hospital stay were compared between the two groups. Results: Sixty-one GA cases were propensity matched to 61 PVB cases. In the PVB group, all the procedures were completed successfully without anesthesia conversion. Significantly less intraoperative severe hypotensive (P = 0.002) and arrhythmia (P

The objective: to analyze the effectiveness and safety of mini-percutaneous nephrolithotripsy (mPCNL) compared to standard percutaneous nephrolithotripsy (sPCNL) in the treatment of nephrolithiasis. Materials and methods. The study analyzed the results of treatment of 1021 patients with solitary (10–30 mm), coral-like and multiple kidney stones for the period from 2016 to 2022. Patients were divided into two groups: sPCNL (500 patients) and mPCNL (521 patients). The average age of patients in both groups was 44.5±15 years. The results of treatment in both groups were compared with each other according to the following parameters: stone-free rate (SFR), duration of surgery, presence of complications, and length of postoperative hospital stay. Results. Both methods are highly effective in the surgical treatment of nephrolithiasis. At the same time, the duration of the operation in the mPCNL group was longer than in the sPCNL group (81.0±15.5 min vs. 69.1±13.9 min; p0.05) and in treatment of coral-like (90.1% vs. 77.3%; p, Мета дослідження: проведення аналізу ефективності та безпеки виконання міні-перкутанної нефролітотрипсії (мПНЛ) із стандартною черезшкірною нефролітотрипсією (сПНЛ) при лікуванні нефролітіазу. Матеріали та методи. У досліджені проаналізовано результати лікування 1021 пацієнта із солітарними (10–30 мм), коралоподібними та множинними каменями нирок за період 2016-2022 рр. Хворі були розподілені на дві групи: сПНЛ (500 пацієнтів) та мПНЛ (521 пацієнт). Середній вік пацієнтів обох груп становив 44,5±15 року. Результати лікування в обох групах порівнювались між собою за такими показниками: стан вільний від каміння (SFR), тривалість операції, наявність ускладнень та терміни післяопераційного перебування в лікарні. Результати. Обидві методики є високоефективними в хірургічному лікуванні нефролітіазу. При цьому тривалість операції в групі мПНЛ була більшою, ніж у групі сПНЛ (81,0±15,5 хв проти 69,1±13,9 хв; p0,05), так і при лікуванні коралоподібного (90,1% проти 77,3%; р

The objective:to analyze the effectiveness and safety of mini-percutaneous nephrolithotripsy (mPCNL) compared to standard percutaneous nephrolithotripsy (sPCNL) in the treatment of nephrolithiasis. Materials and methods.The study analyzed the results of treatment of 1021 patients with solitary (10–30 mm), coral-like and multiple kidney stones for the period from 2016 to 2022. Patients were divided into two groups: sPCNL (500 patients) and mPCNL (521 patients). The average age of patients in both groups was 44.5±15 years. The results of treatment in both groups were compared with each other according to the following parameters: stone-free rate (SFR), duration of surgery, presence of complications, and length of postoperative hospital stay. Results.Both methods are highly effective in the surgical treatment of nephrolithiasis. At the same time, the duration of the operation in the mPCNL group was longer than in the sPCNL group (81.0±15.5 min vs. 69.1±13.9 min; p The postoperative SFR after mPCNL was generally higher (96.4% vs. 91.8%; p=0.002) both in the treatment of solitary stones (98.5% vs. 97.4%; p>0.05) and in treatment of coral-like (90.1% vs. 77.3%; p The postoperative hemoglobin decrease was smaller in the mPCNL group (1.1±0.34 g/dL vs. 2.1±0.26 g/dL; p Conclusions.Mini-percutaneous nephrolithotripsy (m-PCNL) has been proven to be a safe and effective method of nephrolithiasis treatment. Compared with standard percutaneous nephrolithotripsy (sPCNL), patients after mPCNL have a higher SFR, a lower frequency of postoperative complications and duration of postoperative stay in the hospital. An increase operation time by mPCNL is associated with a decrease in the diameter of the tube.

Urolithiasis is one of the most common urological conditions (30–45 %), peaking in the 4th–6th decades of life. About 50 % of patients have one recurrent episode of nephrolithiasis during their lifetime, and among the operated patients, more than 10–15 % of individuals report recurrences with the need for repeated surgical treatment. Increasing the incidence of nephrolithiasis in the world requires the development of new and improvement of existing methods of surgical treatment, which would be characterized by a high level of efficiency and low invasiveness with minimal complications and postoperative rehabilitation. The use of a combination of percutaneous nephrolithotripsy and flexible ureteronephrolithotripsy, especially in complex cases of urolithiasis, can increase the safety and improve the treatment of nephrolithiasis by combining the positive qualities of both methods. Aim. To summarize the data of the world scientific literature on the treatment of nephrolithiasis by studying a combination of percutaneous nephrolithotripsy and retrograde or antegrade flexible intrarenal surgery based on the evaluation of their effectiveness and safety. Materials and methods. The literature review was conducted using the databases PubMed, Google Scholar, Web of Science and Scopus for the period 2015–2022. The following keywords were used for the search: surgical treatment of nephrolithiasis, endoscopic combined intrarenal surgery (ECIRS), percutaneous nephrolithotomy, retrograde intrarenal surgery, simultaneous use of flexible ureterorenoscopy and percutaneous nephrolithotomy, simultaneous use of flexible ureterorenoscopy and percutaneous nephrolithotripsy. Conclusions. The use of ECIRS increases the effectiveness of one-stage treatment of nephrolithiasis with minimal complications and reduces the number of re-operations required. Treatment of complex forms of nephrolithiasis may be a priority for ECIRS. The main disadvantages of ECIRS are the need for simultaneous operation of two operating surgeons and the availability of two sets of endoscopic equipment, which make this procedure expensive., Сечокам’яна хвороба (СКХ) – один із найпоширеніших урологічних патологічних станів (30–45 %), пік якого припадає на четверте – шосте десятиліття життя. Майже 50 % пацієнтів надалі мають один повторний епізод нефролітіазу, а серед прооперованих хворих понад 10–15 % визначають часті рецидиви з необхідністю повторних оперативних лікувань. Збільшення рівня захворюваності на нефролітіаз у світі зумовлює необхідність розроблення нових і вдосконалення наявних методів хірургічного лікування, що будуть характеризуватися високим рівнем ефективності, малоінвазивністю при мінімальних ускладненнях і терміні післяопераційної реабілітації. Використання комбінації перкутанної нефролітотрипсії та гнучкої уретеронефролітотрипсії, особливо при складних випадках сечокам’яної хвороби, може підвищити безпечність і покращити результати лікування нефролітіазу шляхом поєднання позитивних якостей обох методик. Мета роботи – узагальнити відомості світової наукової літератури, що присвячена лікуванню нефролітіазу, шляхом вивчення комбінації перкутанної нефролітотрипсії та ретроградної або антеградної гнучкої інтраренальної хірургії на основі оцінювання їхньої ефективності та безпечності. Матеріали та методи. Огляд літератури здійснили, використавши бази даних PubMed, Google Scholar, Web of Scienсe та Scopus за період 2015–2022 рр. Для пошуку застосовували ключові слова: surgical treatment of nephrolithiasis (хірургічне лікування нефролітіазу), endoscopic combined intrarenal surgery (ендоскопічна комбінована інтраренальна хірургія, ЕКІРХ), percutaneous nephrolithotomy (перкутанна нефролітотрипсія), flexible uretero-renoscopy (гнучка уретерореноскопія), retrograde intrarenal surgery (ретроградна інтраренальна хірургія), simultaneous use of flexible ureterorenoscopy and percutaneous nephrolithotomy (симультанне використання гнучкої уретерореноскопії та перкутанної нефролітотрипсії). Висновки. Використання ЕКІРХ підвищує ефективність одноетапного лікування нефролітіазу при мінімальному рівні ускладнень, зменшує кількість необхідних повторних операцій. Пріоритетним напрямом використання ЕКІРХ може бути лікування складних форм нефролітіазу. Основні недоліки ЕКІРХ полягають у необхідності одночасної роботи двох оперуючих хірургів і необхідності двох комплектів ендоскопічного обладнання, що роблять цю процедуру доволі дорогою.

RESUMEN Se describe el caso de un varón de 68 años con antecedente de hipertensión arterial no tratada, diagnosticada un año antes, que ingresó con un cuadro de anasarca, debilidad muscular y disnea al reposo. Los primeros exámenes realizados mostraron hipopotasemia severa, alcalosis metabólica, litiasis renal y vesical y enfermedad renal crónica. La tomografía abdominal reveló una tumoración suprarrenal derecha, hidronefrosis bilateral y litiasis renal y vesical. Con la sospecha de hiperaldosteronismo primario se completó el estudio, con la determinación de relación aldosterona/concentración de renina directa, que resultó alta. El estudio metabólico arrojó hipercalciuria e hiperuricosuria y la gradiente transtubular de potasio mayor de 7. El paciente fue sometido a tratamiento quirúrgico con nefrectomía derecha, sin embargo, falleció en el postoperatorio inmediato, por shock hipovolémico e insuficiencia respiratoria. SUMMARY We report the case of a 68-year-old male with a history of non-treated arterial hypertension diagnosed the previous year that was admitted with anasarca, muscle weakness and dyspnea at rest. The first laboratory exams showed severe hypopotassemia, metabolic alkalosis, renal and gallbladder lithiasis and chronic renal disease. The abdominal tomography revealed a right suprarenal tumor, bilateral hydronephrosis and renal and gallbladder lithiasis. Under the suspicion of primary hyperaldosteronism, the diagnosis was confirmed with the determination of the relationship between aldosterone/direct renin concentration, which was high. The metabolic study showed hypercalciuria and hyperuricosuria and the potassium trans tubular gradient was above 7. The patient underwent right nephrectomy, nonetheless, died at the immediate post-operatory period due to a hypovolemic shock and respiratory failure.

Normocalcemic primary hyperparathyroidism (PHPT) is a newer phenotype of PHPT defined by elevated PTH concentrations in the setting of normal serum calcium levels. It is increasingly being diagnosed in the setting of evaluation for nephrolithiasis or metabolic bone diseases. It is important to demonstrate that PTH values remain consistently elevated and to measure ionized calcium levels to make the diagnosis. A diagnosis of normocalcemic disease is one of exclusion of secondary forms of hyperparathyroidism, including vitamin D deficiency, renal failure, medications, malabsorption, and hypercalciuria. Lack of rigorous diagnostic criteria and selection bias of the studied populations may explain the different rates of bone and renal complications. The natural history still remains unknown. Caution should be used in recommending surgery, unless clearly indicated. Here we will review the diagnostic features, epidemiology, clinical presentation, natural history, medical and surgical management of normocalcemic PHPT.

The persistent rise in kidney stone prevalence in recent decades has prompted much speculation as to the causes. There has been some discussion about the effect of heat on nephrolithiasis. Here, we review recent data and postulate that heat may play a role in stone formation on a large scale and among African-Americans in particular.African-Americans are the race/ancestry group with faster rates of increasing incidence and prevalence of kidney stones. We make the observation that urban heat islands in the United States have resulted in part from the effects of redlining, a practice of systematic segregation and racism in housing that led to the development of neighborhoods with substantial disparities in environmental conditions.In this thought experiment, we propose that the disproportionate rise in the prevalence of nephrolithiasis in minoritized populations correlates with increased temperatures specifically in neighborhoods adversely affected by the practice of redlining. We discuss phenomena in support of this hypothesis and ongoing work to test this theory.

Introduction and Objective: Guidelines from the American Urological Association (AUA) and American College of Radiology (ACR) recommend that patients with suspected nephrolithiasis undergo low-dose CT of the kidney, ureter, and bladder (LD CT KUB) as opposed to higher dose conventional imaging. We hypothesized that even at institutions with established LD protocols, higher dose imaging is common. Materials and Methods: We identified four academic medical centers where LD CT KUB protocols were implemented to yield an effective dose (EDose) consistent with national guidelines. Fifty consecutive adult patients who underwent CT KUB specifically for the evaluation of nephrolithiasis were retrospectively reviewed at each site. Patient age, sex, body mass index (BMI), imaging location, and EDose (millisieverts [mSv]) were recorded. Results: Two hundred patients with a mean age of 54 years were identified. Forty-six patients (23%) underwent CT KUB with an EDose ≤4 mSv, accounting for 10% to 48% of each institution's cohort. One hundred sixteen patients had a BMI

The 2022 International Task Force guidelines for chronic hypoparathyroidism will be published within several months in the Journal of Bone and Mineral Research. These guidelines update the original guidelines published in 2016, and include new information from literature published since then. Chronic postsurgical hypoparathyroidism is now defined as lasting for at least 12 months after surgery, rather than 6 months. Chronic postsurgical hypoparathyroidism may be predicted by serum PTH

Hypoparathyroidism, despite the conventional therapy with calcium and active vitamin D, can lead to skeletal and nonskeletal abnormalities. Chronic hypoparathyroidism is associated with a significant reduction in bone remodeling, increases in areal and volumetric bone density, and improvement in trabecular microarchitecture and in trabecular bone score. Regardless of these advantages in bone mass and microarchitecture, recent data suggest an increased vertebral fracture risk in patients with nonsurgical hypoparathyroidism. Moreover, chronic hypoparathyroidism can lead to abnormalities in multiple organ systems, including the neurological, cardiovascular, renal, neuropsychiatric, ocular, and immune systems. Nephrocalcinosis, nephrolithiasis, and renal insufficiency, as well as decreased quality of life and cataracts, are common in patients with hypoparathyroidism. An increased incidence of hospitalization due to infections and a greater risk of cardiovascular diseases are observed in patients with hypoparathyroidism, particularly in those with nonsurgical disease. All these abnormalities may be because of the disease itself or complications of therapy. We herein reviewed the skeletal and nonskeletal consequences of hypoparathyroidism in patients conventionally managed with calcium and active vitamin D.

Large microbial communities reside in the gut as an endogenous organ and interact with the host physiology through symbiotic relationships, affecting health. Recent advances in high-throughput sequencing techniques have made it possible to better understand these complex microbial communities and their effects on hosts. Animal and clinical studies have provided considerable evidence to show that the microbiota plays an important role in chronic kidney disease, acute kidney injury, nephrolithiasis, and kidney transplantation by altering the functions of the intestinal barrier, regulating local and systemic inflammation, controlling production of metabolic components, and affecting immune responses. Although the exact mechanism underlying the microbial shift and its impact on disease progression remains uncertain, the kidney-gut interaction clearly plays a significant role in onset and progression of kidney disease and, therefore, holds promise as a therapeutic target. Here, we review recent literature pertaining to the bidirectional relationship between microbes and humans in various kidney diseases and discuss the future direction of microbial research in nephrology.

Renal stones are the third most common problem affecting about 10% of global population. The management of nephrolithiasis has undergone a complete transformation since the 1980s. Percutaneous nephrolithotomy (PCNL) has established itself an effective and safe technique that delivers high stone-free rate as well as overall shorter treatment time. We aim to compare the outcome of mini-PCNL with standard-PCNL in patients presenting with renal stones. In all, 90 patients fulfilled the selection criteria and randomized into two groups. Group A underwent mini-PCNL whereas Group B underwent standard-PCNL. Pre-operative hemoglobin level was recorded. Duration of procedure as well as drop in hemoglobin level was also recorded. A kidney, ureter, and bladder (KUB) X-ray was performed to confirm the presence of of stone and stone-free status. The mean age of patients in mini-PCNL group was 43.11 years and in standard-PCNL group, it was 36.91 years. The mean stone size in patients of mini-PCNL group was 29.53 mm and 31.58 mm in standard-PCNL group. The mean duration of renal stone in mini-PCNL group was 1.91 years and that in standard-PCNL group 1.80 years. The mean operative time in mini-PCNL group was 59.56 min and 61.22 min in standard-PCNL group. The mean fall in hemoglobin in mini-PCNL group was 0.38 g/dL and that in standard-PCNL group 0.51 g/dL. In mini-PCNL group, stone clearance was observed in 42 (93.3%) patients, while in standard-PCNL group, it was observed in 45 (100%) patients. This difference was insignificant (P > 0.05). Mini-PCNL and standard-PCNL have no significant differences in terms of outcome, operative time, and stone clearance, although fall in hemoglobin level was less in mini-PCNL group, which showed less blood loss in this group, thereby making it a more appropriate method for renal stone removal.

Limited evidence exists on the effect of xanthine oxidase inhibitors in nephrolithiasis patients on iron status markers, beyond their effects on urate. The aim of this study was to investigate whether allopurinol therapy was associated with a significant impact on parameters related to iron status, in patients with renal stones. Allopurinol treatment was associated with a nonsignificant decline in serum uric acid. There were no significant differences in serum levels of transferrin and ferritin after treatment with allopurinol compared to pre-treatment levels. A non-significant fall in serum levels of haptoglobin was registered. The drug was associated with a significant rise in serum iron levels. Serum uric acid and iron did not show a significant correlation with any parameter in the study. Allopurinol exerted an overall non-significant effect on iron metabolism in nephrolithiasis patients, save for serum iron, this entails lack of untoward effects in populations with-iron related conditions.

Introduction: Currently, there are multiple intracorporeal lithotripters available for use in percutaneous nephrolithotomy (PCNL). This study aimed to evaluate the efficiency of two novel lithotripters: Trilogy and ShockPulse-SE. Materials and Methods: This is a prospective multi-institutional randomized trial comparing outcomes of PCNL using two novel lithotripters between February 2019 and June 2020. The study assessed objective measures of stone clearance time, stone clearance rate, device malfunction, stone-free rates, and complications. Device assessment was provided through immediate postoperative survey by primary surgeons. Results: There were 100 standard PCNLs completed using either a Trilogy or ShockPulse-SE lithotrite. Using quantitative Stone Analysis Software to estimate stone volume, the mean stone volume was calculated at 4.18 ± 4.79 and 3.86 ± 3.43 cm3 for the Trilogy and ShockPulse-SE groups, respectively. Stone clearance rates were found to be 1.22 ± 1.67 and 0.77 ± 0.68 cm3/min for Trilogy vs ShockPulse-SE (p = 0.0542). When comparing Trilogy to ShockPulse-SE in a multivariate analysis, total operative room time (104.4 ± 48.2 minutes vs 121.1 ± 59.2 minutes p = 0.126), rates of secondary procedures (17.65% vs 40.81%, p = 0.005), and device malfunctions (1.96% vs 34.69%, p

Background Polymorphisms of the vitamin D receptor (VDR) are associated with calcium oxalate (CaOx) nephrolithiasis in humans. Objectives To investigate the association between VDR polymorphisms and susceptibility to CaOx urolithiasis in dogs. Animals Thirty‐five dogs with CaOx urolithiasis were compared with 40 stone‐free dogs. Methods This was a case‐control study. Two VDR gene polymorphisms (rs851998024 and rs852900542) were detected by specific TaqMan real‐time polymerase chain reaction assay, and their relationship with serum 1,25‐dihydroxyvitamin D, serum and urinary electrolyte concentrations was evaluated. Results The distribution of the rs852900542 polymorphism was significantly different between the case and the control dogs (x 2 = 6.369, P = .04). Dogs with a CC or CT genotype had an increased risk of CaOx stones than those with the TT genotype (odds ratio = 3.82, 95% confidence interval 1.04‐13.98). The CaOx dogs with the TT genotype had a significantly lower urinary calcium‐to‐creatinine ratio than the CT+CC genotypes. 1,25‐(OH)2D concentrations did not differ between the cases and the controls (308.7 ± 217.4 vs 286.7 ± 185.1 pg/mL, P = .45). Conclusions and Clinical Importance This finding suggests that vitamin D metabolism might play a role in CaOx stone formation in dogs.

Hydroxycitrate (HCA) is a derivative of citric acid, and previous studies of HCA have revealed its ability to inhibit the formation of calcium oxalate crystals in vitro. To date, there has been little evidence proving that HCA has the same effectiveness in vivo. The present study was designed to investigate the ameliorating effect of HCA on calcium oxalate deposition and renal impairment in a male rat model. Male Sprague-Dawley rats were randomly divided into four groups: a control group, a model group (glyoxalic acid), a CA group (glyoxalic acid + CA), and an HCA group (glyoxalic acid + HCA). Kidney stone formation was induced by injection of glyoxalic acid (60 mg/kg). The results showed that serum and urinary parameters were significantly improved by HCA treatment. In addition, differences in the formation of calcium oxalate crystals between groups were observed, and HCA was superior to CA in inhibiting crystal accumulation. The ultrastructure of renal tubules and glomeruli occurred in the model group, and the above lesions were significantly reduced in the HCA group. Both OPN and SOD expression levels were promoted by HCA, while CA only promoted OPN. In this article, we provided data on whether HCA affected kidney stones and the expression levels of OPN and SOD in a male rat model.

Background: We aimed to analyze the effectiveness of albumin to globulin ratio (AGR) in predict ing postoperative febrile urinary tract infection (fUTI) after ureteroscopic lithotripsy (URS) and retrograde intrarenal surgery (RIRS). Methods: From January 2013 to May 2018, 332 patients underwent URS and RIRS. The rate of postoperative fUTI and risk factors for postoperative fUTI were analyzed using logistic regression. Patients were divided into postoperative fUTI and non-postoperative fUTI (non-fUTI) groups. AGR with other demographic and perioperative data were compared between the two groups to pre dict the development of fUTI after URS. Results: Of the 332 patients, postoperative fUTI occurred in 41 (12.3%). Preoperative pyuria, mi croscopic hematuria, diabetes mellitus, hypoalbuminemia, and hyperglobulinemia were more prevalent in the fUTI group. Patients in the fUTI group had larger stone size, lower preoperative AGR, longer operation time, and longer preoperative antibiotic coverage period. In a multivariable logistic analysis, preoperative pyuria, AGR, and stone size were independently correlated with postoperative fUTI (p

Introduction: Stenting in the ureter following RIRS (Retrograde Intrarenal Surgery) and stone removal is recommended to prevent edema and colic pain. This study aims to find the optimal time for ureteral stent removal after RIRS with fewer complications. Methods: This study was run under Tehran University of Medical Sciences Ethical Committee (IR.TUMS.VCR.REC.1398.750). In this retrospective study, demographic and clinical information of patients from 2013 to 2019 were investigated. The patients were classified based on the duration of ureteral catheter placement: group A less than 24h, group B 24-72h and group C Removed after 72h. Results: From our 80 patients who met inclusion criteria in A and B groups, urologists had to insert a DJ stent for 16 of 19 (84%) (Due to pain and hydronephrosis) and 9 of 27 patients (33%), respectively. In group C, however; only 5 (15%) in 33 patients required DJ stent following the removal of the simple ureteral catheter. Hence, 84% of the patients with a simple ureteral catheter for over 72h in their ureter did not need re-stenting (P-value < 0.001). Conclusions: We concluded that the optimal time of stenting for a simple ureteral catheter is 72 hours. Catheter removal after this time would lead to the least complications.

Objective: We compared the success and complication rates of retrograde intrarenal surgery (RIRS) performed with semi-rigid ureterorenoscopy (srURS) or flexible ureterorenoscopy (fURS) for isolated renal pelvic stones. Materials and Methods: A total of 247 patients who underwent RIRS with fURS (n=179; group 1) or srURS (n=68; group 2) were included in this study. Various factors related to patients, stones and surgical procedures were evaluated retrospectively. Results: There was no difference between the patient groups according to mean age (49.12 +/- 1.10 years vs 49.59 +/- 1.60 years, p=0.745), gender distribution (p=0.152), mean hounsfield unit values (941 +/- 31.41 vs 1036 +/- 44.47 p=0.077), and mean hospitalization time (3.57 +/- 0.19 days vs 4.59 +/- 0.57, p=0.224). In group 1, the mean stone size (14.5 +/- 0.73 mm vs 15.5 +/- 0.62 mm, p=0.019) was statistically lower and the operative time (79.73 +/- 3.38 min vs 70.65 +/- 8.61, p=0.041) was statistically higher than those of group 2. The overall success rate in group 1 and group 2 was 93.9% and 63.6%, respectively (p

Urinary stone disease (USD) is a common pathology with the formation of calculi in the kidneys, ureter, and bladder. Besides the family history, hyperparathyroidism, hypo- and hypervitaminosis of vitamin D, hypercalciuria, and hyperoxaluria are the high risk factors for USD development. This is due primarily to the activation of bone resorption with increased hypercalciuria. It is known that in the urine of every person there is a small amount of urea, inorganic salts, uric acid, creatinine and other substances. The main reason for the formation of calculi is a certain metabolic disorder, which leads to the formation of insoluble salts from which stones are formed – urates, phosphates, oxalates, etc. One of the unsolved problems in the metaphylaxis of USD is the treatment and prevention of osteoporosis which is comorbid with it, since calcium and vitamin D preparations are widely used for the prevention and treatment of osteoporosis. Osteoporosis and arterial calcification often coincide in the nature of the manifestation, which indicates an imbalance in the redistribution of calcium with a predominant direction in the vascular the wall. Vitamin K2 deficiency is closely related to the process of vascular calcification. In the cardiovascular system, with the use of vitamin K antagonists or vitamin K deficiency, calcification of the endothelium of blood vessels occurs. The effect of osteocalcin protein on stone formation processes is controversial. For example, some researchers have found that high serum level of Glaprotein is associated with a lower risk of kidney stones. Based on the results of a daily urinalysis study, the EAU Guidelines (2022) updated the recommendations on metaphylactic USD regarding the benefit/harm of additional calcium and vitamin D use in patients with nephrolithiasis depending on the type of crystalluria. The absence of recommendations for the management of patients with combined pathologies (USD, osteoporosis, cardiovascular diseases) prompts a comprehensive assessment of common risk factors, as well as the formation of programs and algorithms for early diagnosis and the development of recommendations for the prevention and avoidance of complications. Based on the literature analysis, it was established that today the issue of choosing the optimal management for diagnosis and treatment of USD and osteoporosis is still very controversial and ambiguous. There is a necessity for detailed study of this problem, the development of a complex differentiated approach to diagnosis and treatment of patients., Сечокам’яна хвороба (СКХ) – поширена патологія з утворенням конкрементів у нирках, сечоводі та сечовому міхурі. До високого ризику СКХ окрім сімейного анамнезу належать гіперпаратиреоз, гіпо- та гіпервітаміноз вітаміну D, гіперкальціурія та гіпероксалурія. Це зумовлено насамперед активацією кісткової резорбції з посиленням гіперкальціурії. Відомо, що у сечі кожної людини є невелика кількість сечовини, неорганічних солей, сечової кислоти, креатиніну та інших речовин. Основною причиною утворення конкрементів є певне порушення обміну речовин, що й призводить до утворення нерозчинних солей, з яких і формуються камені – урати, фосфати, оксалати тощо. Одним з невирішених питань метафілактики СКХ є лікування і профілактика коморбідного з нею остеопорозу, оскільки для профілактики і лікування останнього використовують препарати кальцію і вітаміну D. Остеопороз та кальцифікація артерій часто збігаються за характером прояву, що вказує на дисбаланс у перерозподілі кальцію з переважним спрямуванням в судинну стінку. З процесом кальцифікації судин тісно пов’язаний дефіцит вітаміну K2. У серцево судинній системі при застосуванні антагоністів вітаміну К або дефіциті вітаміну К відбувається кальцифікація ендотелію кровоносних судин. Вплив білка остеокальцину на процеси каменеутворення дискутується. Наприклад, в деяких дослідженнях було встановлено, що високий рівень Gla-білка в сироватці крові пов’язаний із меншим ризиком утворення каменів у нирках. За результатами дослідження добового аналізу сечі в EAU Guidelines (2022 р.) було оновлено рекомендації щодо метафілактики СКХ відносно питання користі/шкідливості додаткового вживання кальцію та вітаміну D у пацієнтів з нефролітіазом залежно від виду кристалурії. Відсутність рекомендацій щодо менеджменту пацієнтів із поєднаними патологіями (СКХ, ОП, серцево-судинні захворювання) спонукає до проведення комплексного оцінювання спільних факторів ризику, а також формування програм та алгоритмів щодо ранньої діагностики та розроблення рекомендацій щодо профілактики та попередження ускладнень. На підставі проведеного аналізу літератури встановлено, що на сьогодні питання вибору оптимальної тактики діагностики та лікування СКХ і остеопорозу все ще залишається дуже дискусійним та неоднозначним. Виникла необхідність поглибленого вивчення цієї тематики, розроблення комплексного диференційованого підходу до діагностики та лікування пацієнтів.

Urinary stone disease (USD) is a common pathology with the formation of calculi in the kidneys, ureter, and bladder. Besides the family history, hyperparathyroidism, hypo- and hypervitaminosis of vitamin D, hypercalciuria, and hyperoxaluria are the high risk factors for USD development. This is due primarily to the activation of bone resorption with increased hypercalciuria. It is known that in the urine of every person there is a small amount of urea, inorganic salts, uric acid, creatinine and other substances. The main reason for the formation of calculi is a certain metabolic disorder, which leads to the formation of insoluble salts from which stones are formed – urates, phosphates, oxalates, etc. One of the unsolved problems in the metaphylaxis of USD is the treatment and prevention of osteoporosis which is comorbid with it, since calcium and vitamin D preparations are widely used for the prevention and treatment of osteoporosis. Osteoporosis and arterial calcification often coincide in the nature of the manifestation, which indicates an imbalance in the redistribution of calcium with a predominant direction in the vascular the wall. Vitamin K2 deficiency is closely related to the process of vascular calcification. In the cardiovascular system, with the use of vitamin K antagonists or vitamin K deficiency, calcification of the endothelium of blood vessels occurs. The effect of osteocalcin protein on stone formation processes is controversial. For example, some researchers have found that high serum level of Glaprotein is associated with a lower risk of kidney stones. Based on the results of a daily urinalysis study, the EAU Guidelines (2022) updated the recommendations on metaphylactic USD regarding the benefit/harm of additional calcium and vitamin D use in patients with nephrolithiasis depending on the type of crystalluria. The absence of recommendations for the management of patients with combined pathologies (USD, osteoporosis, cardiovascular diseases) prompts a comprehensive assessment of common risk factors, as well as the formation of programs and algorithms for early diagnosis and the development of recommendations for the prevention and avoidance of complications. Based on the literature analysis, it was established that today the issue of choosing the optimal management for diagnosis and treatment of USD and osteoporosis is still very controversial and ambiguous. There is a necessity for detailed study of this problem, the development of a complex differentiated approach to diagnosis and treatment of patients.

Diabetes mellitus is a risk factor for nephrolithiasis. A recent observational study found that in patients with type 2 diabetes (T2D), SGLT2 inhibitor use was associated with a 49% lower risk of nephrolithiasis compared with GLP-1 receptor agonists. Aim: we examined the association between nephrolithiasis and the SGLT2 inhibitor empagliflozin, using existing data from randomized clinical trials. Methods: we pooled data from 15 081 T2D patients randomized to empagliflozin (n = 10 177) or placebo (n = 4904) from 20 phase I-IV trials, including the large cardiovascular outcome trial, EMPA-REG OUTCOME. Incident urinary tract stone events were captured using a predefined collection of MedRA terms. A sensitivity analysis using a narrower definition was also performed. Incidence rate ratios (IRR) and 95% CIs were calculated using the relative risk estimate, stratified by study. Results: the median exposures to study drug were 543 days (placebo) and 549 days (empagliflozin); 183 patients experienced an incident urolithiasis during follow-up (placebo, 79; empagliflozin, 104), yielding annual incidence rates of 1.01 vs 0.63 events/100 patient-years in the 2 respective groups. The IRR was 0.64 (95% CI, 0.48-0.86), in favor of empagliflozin. In the sensitivity analysis, the results were similar (IRR, 0.62 [95% CI, 0.45-0.85]). Conclusion: compared with placebo, empagliflozin therapy was associated with an approximate 40% reduced risk of urinary tract stone events in T2D patients. The underlying mechanisms are unknown but may involve altered lithogenic profile of the urine. Dedicated randomized prospective clinical trials are warranted to confirm these initial observations in patients with and without T2D., Сахарный диабет является фактором риска нефролитиаза. Недавнее обсервационное исследование показало, что у пациентов с сахарным диабетом (СД) 2-го типа использование ингибиторов натрийзависимого котранспортера глюкозы 2 типа (НЗКТГ-2) было связано с более низким (на 49%) риском нефролитиаза, по сравнению с агонистами рецепторов глюкагоноподобного пептида-1(ГПП-1). Цель: мы изучили связь между нефролитиазом и применением ингибитора НЗКТГ-2 эмпаглифлозина, используя имеющиеся данные рандомизированных клинических исследований. Методы: мы объединили данные относительно 15 081 пациента с СД 2-го типа, рандомизированного в группу эмпаглифлозина (n=10 177) или плацебо (n=4904) во время 20 испытаний фазы I–IV, включая обширное исследование результатов для сердечно-сосудистой системы EMPA-REG OUTCOME. Случаи образования камней в мочевыводящих путях были зарегистрированы с помощью определенных терминов MedRA. Также был проведен анализ чувствительности с использованием более узкого определения. Коэффициенты частоты (КЧ) и 95 % ДИ были рассчитаны с использованием оценки относительного риска, стратифицированной по исследованию. Результаты: средняя экспозиция к исследуемому препарату составила 543 дня (плацебо) и 549 дней (эмпаглифлозин); у 183 пациентов возникали случаи уролитиаза во время дальнейшего наблюдения (плацебо, 79; эмпаглифлозин, 104), что соответствует годовой частоте 1,01 против 0,63 события / 100 пациенто-лет в 2 соответствующих группах. КЧ составил 0,64 (95 % ДИ, 0,48–0,86) в пользу эмпаглифлозина. При анализе чувствительности результаты были похожими (КЧ, 0,62 [95 % ДИ, 0,45–0,85]). Вывод: по сравнению с плацебо терапия эмпаглифлозином у пациентов с СД 2-го типа была связана со снижением риска образования камней в мочевыводящих путях примерно на 40 %. Базовые механизмы не установлены, но могут включать изменения литогенного профиля мочи. Специальные рандомизированные проспективные клинические испытания оправданы для подтверждения этих начальных наблюдений у пациентов с СД 2-го типа и без него., Цукровий діабет є фактором ризику нефролітіазу. Недавнє обсерваційне дослідження показало, що у пацієнтів із цукровим діабетом (ЦД) 2-го типу використання інгібіторів натрійзалежного котранспортера глюкози 2-го типу. (НЗКТГ-2) було пов’язано з нижчим (на 49 %) ризиком нефролітіазу порівняно з агоністами рецепторів глюкагоноподібного пептиду-1(ГПП-1). Мета: ми вивчили зв’язок між нефролітіазом та застосуванням інгібітора НЗКТГ-2 емпагліфлозину, використовуючи наявні дані рандомізованих клінічних досліджень. Методи: ми об’єднали дані щодо 15 081 пацієнта із ЦД 2-го типу, рандомізованого до групи емпагліфлозину (n = 10 177) або плацебо (n = 4904) під час 20 випробувань фази I-IV, включаючи велике дослідження результатів для серцево-судинної системи EMPA-REG OUTCOME. Випадки утворення каменів у сечовивідних шляхах були зареєстровані за допомогою попередньо визначених термінів MedRA. Також було проведено аналіз чутливості з використанням вужчого визначення. Коефіцієнти частоти (КЧ) та 95 % ДІ були розраховані з використанням оцінки відносного ризику, стратифікованої за дослідженням. Результати: середня експозиція до досліджуваного препарату становила 543 дні (плацебо) та 549 днів (емпагліфлозин); у 183 пацієнтів виникали випадки уролітіазу під час подальшого спостереження (плацебо, 79; емпагліфлозин, 104), що відповідає річній частоті 1,01 проти 0,63 події/100 пацієнто-років у 2 відповідних групах. КЧ становив 0,64 (95 % ДІ, 0,48–0,86) на користь емпагліфлозину. Під час аналізу чутливості результати були подібними (КЧ, 0,62 [95 % ДІ, 0,45–0,85]). Висновок: у порівнянні з плацебо терапія емпагліфлозином у пацієнтів із ЦД 2-го типу була пов’язана зі зниженням ризику утворення каменів у сечовивідних шляхах приблизно на 40 %. Базові механізми цього не встановлені, але можуть включати зміни літогенного профілю сечі. Спеціальні рандомізовані проспективні клінічні випробування є виправданими для підтвердження цих початкових спостережень у пацієнтів із ЦД 2-го типу та без нього.

Data on predictors and methods for resolving the complications of surgical treatment of staghorn nephrolithiasis are presented. New information on the features of the morphological and functional state and individual platelet reactivity in patients undergoing surgical treatment is described. Thrombotic and hemorrhagic complications, intra- and postoperative bleeding, as well as prediction of PNL results in patients with staghorn stones are also discussed.

A comprehensive literature search, systematic review and meta-analysis of the published data comparing standard percutaneous nephrolithotomy versus minimally invasive percutaneous nephrolithotomy to provide updated guidelines in the endourological management of renal stone disease.

Trefoil Factor 1 (TFF1) is considered to be able to inhibit the formation of kidney stone. However, genetic variants in TFF1 and corresponding function in kidney stone development are still not well studied. In this study, the discovery set including 230 cases and 250 controls was used to analyze the association between seven tagSNPs of TFF1 gene and the nephrolithiasis risk. Further evaluation was confirmed by the validation set comprising 307 cases and 461 controls. The consequences of the two-stage case–control study indicated that individuals with the rs3761376 A allele have significantly increased nephrolithiasis risk than those with the GG genotypes [adjusted odds ratio (OR) = 1.35, 95% confidence interval (CI) = 1.05–1.73]. Moreover, we also carried out a stratified analysis and found the increased nephrolithiasis risks at A allele among males, overweight individuals, no hypertensive individuals, nondiabetic individuals, smokers, and drinkers. In the following functional experiments, the notably lower expression of TFF1 was exhibited by the vectors carrying A allele compared with those carrying G allele in both luciferase (P = 0.022) and expression vectors (P = 0.041). In addition to tissue detection, we confirmed a significant inverse association of rs3761376 G > A and TFF1 gene expression (P TFF1 rs3761376 may serve as a potential biomarker to predict the risk of nephrolithiasis.

Objective: Percutaneous nephrolithotomy (PCNL) is the treatment of choice for large renal calculi. The prone position has been considered the preferred position to obtain renal access. However, the supine position has recently gained popularity, which confers several potential advantages. The current study analyses the prognostic factors for successful supine PCNL procedures in a larger tertiary centre. Subjects: Prospective data were collected from all patients undergoing PCNL in the Galdako modified Valdivia position at our institution between February-2007 and September-2020. Surgical outcomes variables collected included: the rate of Endoscopic-combined intra-renal surgery (ECIRS), operative times, surgical effectiveness (no residuals

OBJECTIVE: This study aimed to evaluate the efficacy and safety of percutaneous nephrolithotomy in elderly patients (≥65 years) with kidney stones > 2 cm in size.PATIENTS AND METHODS: Patients aged ≥65 years who underwent percutaneous nephrolithotomy for kidney stones between January 2015 and January 2022 were included in this study. Patient profiles, preoperative stone data, operative information, and postoperative complications were reviewed. We applied the Guys Stone score to predict the net results of percutaneous nephrolithotomy.RESULTS: Percutaneous nephrolithotomy was performed on 128 geriatric patients. Of these patients, 68 (53.1%) were male and 60 (46.9%) were female. The mean age was 69.87 ± 7.06 (65–80) years. The mean stone size was 28.7 ± 6.5 mm (22–46 mm). The mean operative time was 90.33 ± 40.56 min and fluoroscopy time was 5.16 ± 2.81 min. The reentry catheter was removed after an average of 3.21 ± 1.82 days. The mean duration of hospital stay was 3.17 ± 2.19 days. The stone-free survival rate was 90.6%. Transfusion was performed in four (3.1%) patients due to hemorrhage, and urine extravasation from the re-entry tract occurred in eight (6.2%) patients, and this required Double j-stent placement. When the four Guys stone score groups were compared, there was a statistically significant difference in stone-free rates (p = 0.001).CONCLUSIONS: According to our results, percutaneous nephrolithotomy is a safe and effective treatment option for nephrolithiasis in the elderly, with high stone-free and acceptable complication rates., AMAÇ: Bu çalışmada böbrek taşı > 2 cm olan yaşlı hastalarda (≥65 yaş) perkütan nefrolitotominin etkinlik ve güvenilirliğinin değerlendirilmesi amaçlanmıştır. HASTALAR VE YÖNTEM: Ocak 2015 ile Ocak 2022 tarihleri ​​arasında böbrek taşı nedeniyle perkütan nefrolitotomi uygulanan 65 yaş ve üzeri hastalar bu çalışmaya dahil edildi. Hasta profilleri, ameliyat öncesi taş verileri, ameliyat bilgileri ve ameliyat sonrası komplikasyonlar gözden geçirildi. Perkütan nefrolitotominin net sonuçlarını tahmin etmek için Guys Stone skorunu uyguladık. BULGULAR: 128 geriatrik hastaya perkütan nefrolitotomi uygulandı. Bu hastaların 68'i (%53,1) erkek, 60'ı (%46,9) kadındı. Ortalama yaş 69.87 ± 7.06 (65-80) yıldı. Ortalama taş boyutu 28.7 ± 6.5 mm (22-46 mm) idi. Ortalama ameliyat süresi 90.33 ± 40.56 dk ve floroskopi süresi 5.16 ± 2.81 dk idi. Yeniden giriş kateteri ortalama 3.21 ± 1.82 gün sonra çıkarıldı. Ortalama hastanede kalış süresi 3.17 ± 2.19 gündü. Taşsız sağkalım oranı %90.6 idi. Dört hastada (%3.1) kanama nedeniyle transfüzyon yapıldı ve sekiz hastada (%6.2) yeniden giriş yolundan idrar ekstravazasyonu meydana geldi ve bu, Double j-stent yerleştirilmesini gerektirdi. Dört Guys taş skor grubu karşılaştırıldığında, taşsızlık oranlarında istatistiksel olarak anlamlı bir fark vardı (p = 0.001). SONUÇ: Sonuçlarımıza göre, perkütan nefrolitotomi, yaşlılarda nefrolitiazis için yüksek taşsızlık ve kabul edilebilir komplikasyon oranları ile güvenli ve etkili bir tedavi seçeneğidir.

Introduction: retrograde intrarenal surgery (CRIR) is an evolving tool. Its learning curve is not well established, despite the common use of flexible ureteroscopes today. Our aim is to estimate the number of procedures needed for one to perform RIRS consistently. Material and Methods: a urology resident had his first 80 RIRS for nephrolithiasis analyzed quantitatively and qualitatively. The procedures were divided into 4 groups containing 20 surgeries each (I to IV), according to their order, for comparison. Results: there was no difference in stone sizes between groups. All qualitative variables varied significantly between groups (p

Aim: In this study, it was aimed to evaluate the quality of percutaneous nephrolithotomy (PCNL) surgery videos published on YouTube.Material and Method: A search was made by entering the keywords ‘percutaneous nephrolithotomy' in the youtube search engine. Video quality was measured using the Journal of the American Medical Association Benchmark Score (JAMAS), Global Quality Score (GQS) and modified DISCERN score. Two reviewers developed the PCNL Specific Score (PCNLSS) to estimate the technical quality for every stages of surgery. Video power index (VPI) was used to determine video popularity. Results: One hundred and thirteen videos had the inclusion criteria were counted in the study. The median VPI, JAMAS, modified DISCERN, GQS and PCNLSS scores were 3.01, 1, 2, 2 and 4, respectively. Videos with audio narration had significantly higher VPI, JAMAS, modified DISCERN, GQS and PCNLSS scores (p=0.001, p, Amaç: Bu çalışmada YouTube'da yayınlanan perkütan nefrolitotomi (PCNL) cerrahisi videolarının kalitesinin değerlendirilmesi amaçlanmıştır.Gereç ve Yöntem: Youtube arama motoruna perkütan nefrolitotomi anahtar kelimeleri girilerek arama yapıldı. Video kalitesi, Journal of the American Medical Association Benchmark Score (JAMAS), Global Quality Score (GQS) ve modifiye DISCERN skoru kullanılarak ölçüldü. İki ürolog, ameliyatın her aşaması için teknik kaliteyi değerlendirmek için PCNL Spesifik Skorunu (PCNLSS) geliştirdi. Video popülerliğini belirlemek için video güç indeksi (VPI) kullanıldı.Bulgular: Dahil edilme kriterlerine karşılayan 113 video çalışmaya dahil edildi. Medyan VPI, JAMAS, modifiye DISCERN, GQS ve PCNLSS skorları sırasıyla 3.01, 1, 2, 2 ve 4 idi. Sesli anlatıma sahip videoların VPI, JAMAS, modifiye DISCERN, GQS ve PCNLSS puanları anlamlı olarak daha yüksekti (sırasıyla p=0,001, p