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Background: Up until recently, the first-line therapy for kidney stones larger than 2 cm was percutaneous nephrolithotomy (PCNL). Although PCNL has good clearance rates for kidney stones, there are morbidity and mortality issues to consider, which can extend the length of hospitalization. In the management of kidney stones of significant size, recent investigations have demonstrated that retrograde intrarenal surgeries (RIRS) can be an efficient and safer option. Objective: This paper contributes to conduct a cross-sectional study of patients in Iraq with stones in renal calculi who underwent treated according to use of retrograde surgery. Patients and methods: This paper presented to a cross-sectional study of patients in Iraq with stones in renal calculi who underwent treated according to use of retrograde surgery, which was on renal calculi patients in comparison between men and women which have men groups with 45 cases and women 45 cases. This paper has examined all data of demographic characteristics into renal calculi outcomes related to RIRS operative patients Holmium laser lithotripsy by SPSS program, which conduct for all data was extracted in the study between 18th January 2021 to 25th April 2022 in different hospitals in Iraq. Results and discussion: As technology developed, flexibility ureterorenoscopy as laser fragmentation in renal lithiasis became an efficient and less invasive method for treating this ailment. In most published series on this issue, problems from hematuria have been documented in 28% of cases among women, by severe complications corresponding with failed insertion of a sheath into 34% of the cases. In contrast, the research by Aboumarzouk assessed the total number of RIRS problems at 10%, with most of these issues being mild if adjusted to this categorization, which the researchers are not doing in their study. The outcomes of our series confirm that RIRS is a reliable and secure method for treating kidney stones under 2 cm. Effectiveness rates ranging from 71.6 percent (for a single surgery) and 93.4% (for retreatment) were found when the findings were analysed. Conclusions: In conclusion, this paper was shown changes of results in comparison between the men group and women group, where it was shown almost of man got high injuries in compare with women, although this study found success of applied RIRS with Holmium laser lithotripsy operation which apply on both kinds of group. With these findings, this study resulted that RIRS with Holmium laser lithotripsy considers more safety and effective to treat all patients of kidney stones and should be taken into consideration as a substitute for PCNL in certain circumstances

Primary hyperoxalurias are a devastating family of diseases leading to multisystem oxalate deposition, nephrolithiasis, nephrocalcinosis and end-stage renal disease. Traditional treatment paradigms are limited to conservative management, dialysis and combined transplantation of the kidney and liver, of which the liver is the primary source of oxalate production. However, transplantation is associated with many potential complications, including operative risks, graft rejection, post-transplant organ failure, as well as lifelong immunosuppressive medications and their adverse effects. New therapeutics being developed for primary hyperoxalurias take advantage of biochemical knowledge about oxalate synthesis and metabolism, and seek to specifically target these pathways with the goal of decreasing the accumulation and deposition of oxalate in the body., Primary hyperoxalurias are a devastating family of diseases that eventually lead to end-stage renal disease. In this Review, Shee and Stoller discuss current treatment paradigms for primary hyperoxalurias, new therapeutics and their mechanisms of action, and future directions for novel research in the field., Key points Primary hyperoxalurias (PHs) are a devastating family of rare, autosomal-recessive genetic disorders that lead to multisystem oxalate deposition, nephrolithiasis, nephrocalcinosis and end-stage renal disease.Traditional treatment paradigms are limited to conservative management, dialysis and inevitably transplantation of the kidney and liver, which is associated with high morbidity and the need for lifelong immunosuppression.New therapeutics being developed for PHs take advantage of biochemical knowledge about oxalate synthesis and metabolism to specifically target these pathways, with the goal of decreasing the accumulation and deposition of plasma oxalate in the body.New therapeutics can be divided into classes, and include substrate reduction therapy, intestinal oxalate degradation, chaperone therapy, enzyme restoration therapy and targeting of the inflammasome.Lumasiran, a mRNA therapeutic targeting glycolate oxidase, was the first primary hyperoxaluria-specific therapeutic approved by the European Medicines Agency and the FDA in 2020.Future work includes further clinical trials for promising therapeutics in the pipeline, identification of biomarkers of response to PH-directed therapy, optimization of drug development and delivery of new therapeutics.

Tekleberhan Berhe, Seid Mohammed Hassen, Fitsum Gebreegziabher Gebrehiwot, Ferid Ousman Mummed, Feysel Hassen Issack, Masresha Solomon Dino, Sena Sefera Akkasa, Getachew Adamu Zerihun, Kaleab Habtemichael Gebreselassie Urology Unit, Department of Surgery, St. Paul’s Hospital Millennium Medical College, Addis Ababa, EthiopiaCorrespondence: Ferid Ousman MummedUrology Unit, Department of Surgery, St. Paul’s Hospital Millennium Medical College, Swaziland St., Addis Ababa, EthiopiaTel +251904650705Email sarson.fo@gmail.comIntroduction: A supernumerary kidney is an extremely rare congenital anomaly, defined as the presence of one or more extra kidneys. Thus far, there have been less than 100 cases reported in the medical literature. It has its capsule, vascular supply, and collecting system. It frequently causes diagnostic challenges in clinical practice. The supernumerary kidney can be symptomatic due to the presence of stone.Case Presentation: We present a case of a 19-year-old male patient who came to our clinic with the complaint of abdominal pain. On computed tomography urography (CTU), he was found to have a caudally located left fused supernumerary kidney with a separate vascular supply. Both left kidneys had a separately draining calyceal systems uniting at the left renal pelvis and drained by a single ureter. Multiple left renal stones (largest measures 4cm x 2.2cm) in both kidneys were also seen. The stones were removed surgically by doing pyelolithotomy and radial nephrolithotomy. The patient was doing well during follow-up visits with the improvement of abdominal pain.Conclusion: Supernumerary kidney is a very rare congenital renal anomaly. This case is even unique, because of the fused supernumerary kidney and the presence of a single left renal pelvis and ureter. Imaging is very essential for planning surgical intervention. Stones in such kidneys can be managed with nephrolithotomy and/or pyelolithotomy.Keywords: accessory kidney, congenital anomalies, fused kidney, renal calculi, nephrolithotomy, pyelolithotomy

Introduction: Hydronephrosis is usually caused by an underlying medical condition or risk occasionally as congenital blockage, unilateral obstructive uropathy, kidney stones, UTIs, tissue scarring, blood clots, neuromuscular problems, Cancer or BPH and pregnancy. This current study was directed to determine the etiological factors and prevalence causes of Hydronephrosis Material and Methods: A Retrospective study was conducted at two private health care setups in Gujranwala, Pakistan. After Informed consent data was collected over period of 8 Months Jan 2020 to Sep 2020. Data was analysed on SPSS version 20 frequencies and percentages were mentioned. Aetiological factors of Hydronephrosis were evaluated on ultrasound. Results: This study included 213 patients, with those aged 41-50 years (45%) having the highest prevalence of hydronephrosis. Gender Includes 30% females and 70% males. About 86% had Hydronephrosis in Unilateral kidney and 13% in bilateral kidneys. The grading of Hydronephrosis was found as highest in Grade2: 122 (57.3%). The causes of Hydronephrosis were observed on Ultrasound and found most prevalent cases of Calculi 60%, 13% females had Hydronephrosis due to Pregnancy, 8.9% males had Hydronephrosis due to Benign Prostatic Hyperplasia. Conclusion: The study concluded that Renal Calculi are the most prevalent cause of Hydronephrosis followed Pregnancy and BPH., {"references":["Leo MM, Langlois BK, Pare JR, Mitchell P, Linden J, Nelson KP, et al. Ultrasound vs. computed tomography for severity of hydronephrosis and its importance in renal colic. Western Journal of Emergency Medicine. 2017;18(4):559.","Konda R, Sakai K, Ota S, Abe Y, Hatakeyama T, Orikasa S. Ultrasound grade of hydronephrosis and severity of renal cortical damage on 99mtechnetium dimercaptosuccinic acid renal scan in infants with unilateral hydronephrosis during followup and after pyeloplasty. 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Evaluation of the Causes of Abdominal Right Upper Quadrant Pain using Ultrasound: Abdominal Right Upper Quadrant Pain using Ultrasound. THE THERAPIST (Journal of Therapies & Rehabilitation Sciences). 2022:03-6.","Alshoabi SA, Alhamodi DS, Alhammadi MA, Alshamrani AF. Etiology of Hydronephrosis in adults and children: Ultrasonographic Assessment in 233 patients. Pakistan Journal of Medical Sciences. 2021;37(5):1326.","Akram H, John A, Ali A, Jamil M, Rasheed L. Role of CT-KUB for Detection of Obstructive and Non-Obstructive Hydronephrosis on The Basis of Frequency of Calculi: CT-KUB for Detection of Obstructive and Non-Obstructive Hydronephrosis on The Basis of Frequency of Calculi. Pakistan BioMedical Journal. 2022:32-5.","Dare G, Akhtar M, Chaudhary S. Unilateral hydronephrosis in adults: etiology, clinical presentations and management. International Surgery Journal. 2019;6(6):2028-31.","Watson WJ, Brost BC. Maternal hydronephrosis in pregnancy: poor association with symptoms of flank pain. American journal of perinatology. 2006;23(08):463-6.","Farr A, Ott J, Kueronya V, Margreiter M, Javadli E, Einig S, et al. The association between maternal hydronephrosis and acute flank pain during pregnancy: a prospective pilot-study. The Journal of Maternal-Fetal & Neonatal Medicine. 2017;30(20):2417-21.","Braga LH, McGrath M, Farrokhyar F, Jegatheeswaran K, Lorenzo AJ. Society for Fetal Urology Classification vs urinary tract dilation grading system for prognostication in prenatal hydronephrosis: a time to resolution analysis. The Journal of urology. 2018;199(6):1615-21.","Fernbach S, Maizels M, Conway J. Ultrasound grading of hydronephrosis: introduction to the system used by the Society for Fetal Urology. Pediatric radiology. 1993;23(6):478-80.","Onen A. Grading of hydronephrosis: an ongoing challenge. 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[EN] Throughout their lives, 3 in 20 men and up to 2 in 20 women develop renal calculi at some stage. Renal calculi are solid masses that originate in the kidneys but can develop along the urinary tract. They appear when solutes from urine crystalise to form calculi. Calculus formation is related to diet, urinary tract infections and medications. In most cases, renal calculi can result in excruciating pain and agony. Moreover, although it does not lead to kidney failure, recurrent renal calculi can result in a functional loss of the kidney. With the help of convolutional neural networks, image preprocessing, data augmentation and Python, TensorFlow, and Keras libraries, we have built a classification model to detect renal calculi from abdominal CT scans. Consequently, we go through an iterative process of adjusting the models and preprocessing techniques to improve their performance. Finally, we compare the best performing model against industry-standard architectures such as VGG16, VGG19, ResNet and Xception. We conclude that our model outperforms the industry-standard CNNs, but it is not ready to become a medical application., [ES] Los cálculos renales son masas sólidas de cristales que pueden formarse en los riñones y desarrollarse a lo largo del tracto urinario. Uno de los métodos para comprobar y diagnosticar un cálculo renal es a través de un TAC abdominal. Por ello, hemos desarrollado un modelo que utiliza redes neuronales convolucionales para clasificar imágenes de TAC abdominal. Nuestras dos clases son cálculos detectados y no detectados. Pasamos por los pasos de preprocesamiento, aumento de datos de las imágenes, diseño y construcción de los modelos. A continuación, los revisamos y los ajustamos para mejorar su rendimiento. Por último, los comparamos con los modelos más avanzados, como VGG16 y Xception.

Numerous metagenome-wide association studies (MWAS) for urolithiasis have been published, leading to the discovery of potential interactions between the microbiome and urolithiasis. However, questions remain about the reproducibility, applicability and physiological relevance of these data owing to discrepancies in experimental technique and a lack of standardization in the field. One barrier to interpreting MWAS is that experimental biases can be introduced at every step of the experimental pipeline, including sample collection, preservation, storage, processing, sequencing, data analysis and validation. Thus, the introduction of standardized protocols that maintain the flexibility to achieve study-specific objectives is urgently required. To address this need, the first international consortium for microbiome in urinary stone disease — MICROCOSM — was created and consensus panel members were asked to participate in a consensus meeting to develop standardized protocols for microbiome studies if they had published an MWAS on urolithiasis. Study-specific protocols were revised until a consensus was reached. This consensus group generated standardized protocols, which are publicly available via a secure online server, for each step in the typical clinical microbiome–urolithiasis study pipeline. This standardization creates the benchmark for future studies to facilitate consistent interpretation of results and, collectively, to lead to effective interventions to prevent the onset of urolithiasis, and will also be useful for investigators interested in microbiome research in other urological diseases., Metagenome-wide association studies have led to the discovery of potential interactions between the microbiome and urolithiasis, but a lack of standardization has raised questions about the reproducibility, applicability and physiological relevance of metagenome-wide association study data. This Consensus Statement describes the formation of the first international consortium for microbiome in urinary stone disease — MICROCOSM — and the outcomes of a consensus meeting to develop standardized protocols for microbiome studies and generate a data repository, which are both publicly available via a secure online server.

We aimed to explore whether a single-day of fasting (SDF) increase emergency room (ER) visits due to renal colic (RC). We elected to concentrate on Yom-Kippur (i.e.: SDF), the holiest day in Judaism. Food and liquid consumption is prohibited during this day for 25 h, and an estimated 50–70% fasting rate is observed. SDF always takes place between mid-September and mid-October during which the temperature in the Middle-East ranges between 19 and 30 °C. ER visits for RC between 01/2012 and 11/2019 were reviewed, and the Gregorian days on which SDF occurred were retrieved. The number of ER visits for RC was compared between SDF and the surrounding days/months as well as to another single-day "standard" holiday (SDSH) that precedes SDF in 10 days and is not associated with fasting. Of 11,717 ER visits for RC, 8775 (74.9%) were males. Male:Female ratio was 3:1. The mean daily number of ER visits for RC during the 3 days following SDF was 6.66 ± 2.49, significantly higher compared with the mean annual daily visits (4.1 ± 2.27, p p = 0.032), and the mean daily visits during September (5.06 ± 2.659, p = 0.005), and October (4.78 ± 2.23, p p = 0.207; p = 0.13, respectively). It was lower compared to SDF, however statistically insignificant (p = 0.285). A single-day fasting may increase ER visits for RC. The mechanism underlying this phenomenon is unknown.

Objectives: To compare the outcomes of standard- and mini-percutaneous nephrolithotomy (PCNL) for the treatment of staghorn stones. Patients and Methods: The data of consecutive adult patients who underwent PCNL for the treatment of staghorn stones, between July 2015 and December 2019 from three hospitals, were retrospectively reviewed. All cases were performed in a prone position under fluoroscopic guidance. The nephrostomy tracts were dilatated to 30 F in standard-PCNL and to 18–20 F in mini-PCNL. Stones were fragmented with pneumatic lithotripsy in both groups. Fragments were removed with forceps in the standard-PCNL, while they were evacuated through the sheath using the vacuum clearance effect in mini-PCNL. A ureteric stent was inserted after mini-PCNL, while a nephrostomy tube was inserted after standard-PCNL. Results: The study included 153 patients; 70 underwent standard-PCNL and 83 underwent mini-PCNL. The stone-free rates of PCNL monotherapy were comparable for both groups (83% for mini-PCNL and 88.6% for standard-PCNL, P = 0.339). The incidence (12% vs 24.3%, P = 0.048) and severity of complications were significantly lesser with mini-PCNL (P = 0.031). Standard-PCNL was associated with increased rate of blood transfusion (12.9% vs 2.4%, P = 0.013) and a significant decrease in haemoglobin (P = 0.018). Hospital stay was significantly longer for standard-PCNL than mini-PCNL (median stay of 6 vs 3 days, P

Purpose To assess if autosegmentation-assisted radiomics can predict disease burden, hydronephrosis, and treatment strategies in patients with renal calculi. Methods The local ethical committee-approved, retrospective study included 202 adult patients (mean age: 53 ± 17 years; male: 103; female: 99) who underwent clinically indicated, non-contrast abdomen-pelvis CT for suspected or known renal calculi. All CT examinations were reviewed to determine the presence (n = 123 patients) or absence (n = 79) of renal calculi. On CT images with renal calculi, each kidney stone was annotated and measured (maximum dimension, Hounsfield unit (HU), and combined and dominant stone volumes) using a HU threshold-based segmentation. We recorded the presence of hydronephrosis, number of renal calculi, and treatment strategies. Deidentified CT images were processed with the radiomics prototype (Radiomics, Frontier, Siemens Healthineers), which automatically segmented each kidney to obtain 1690 first-, shape-, and higher-order radiomics. Data were analyzed using multiple logistic regression analysis with areas under the curve (AUC) as output. Results Among 202 patients, only 28 patients (18%) needed procedural treatment (lithotripsy or ureteroscopic stone extraction). Gray-level co-occurrence matrix (GLCM) and gray-level run length matrix (GLRLM) differentiated patients with and without procedural treatment (AUC 0.91, 95% CI 0.85–0.92). Higher-order radiomics (gray-level size zone matrix – GLSZM) differentiated kidneys with and without hydronephrosis (AUC: 0.99, p 0.85.

Oncostatin M (OSM), a member of the IL-6 family of cytokines, has important roles in renal diseases. The relationship between OSM and kidney stone disease, however, remains unclear. To investigate the roles of OSM in the development of kidney stone disease, we generated a mouse model of renal crystal formation using OSM receptor β (OSMRβ)-deficient mice (OSMRβ−/− mice). There were fewer renal crystal deposits in OSMRβ−/− mice than in wild-type (WT) mice. Crystal-binding molecules (osteopontin, annexin A1, and annexin A2), inflammatory cytokines (TNF-α and IL-1β), and fibrosis markers (TGF-β, collagen 1a2, and α-smooth muscle actin) were also decreased in the kidneys of OSMRβ−/− mice compared with those in WT mice. Immunofluorescence staining showed that OSMRβ was expressed in renal tubular epithelial cells (RTECs) and renal fibroblasts in the model of renal crystal formation. In the cultured RTECs and renal fibroblasts, OSM directly induced the expression of crystal-binding molecules and fibrosis markers. Expressions of inflammatory cytokines were increased by stimulation with OSM in cultured renal fibroblasts. OSM may promote the formation of renal crystal deposits by directly acting on RTECs and renal fibroblasts to produce crystal-binding molecules and inflammatory cytokines.

Better understanding of molecular mechanisms for kidney stone formation is required to improve management of kidney stone disease with better therapeutic outcome. Recent kidney stone research has indicated critical roles of a group of proteins, namely ‘stone modulators’, in promotion or inhibition of the stone formation. Nevertheless, such information is currently dispersed and difficult to obtain. Herein, we present the kidney stone modulator database (StoneMod), which is a curated resource by obtaining necessary information of such stone modulatory proteins, which can act as stone promoters or inhibitors, with experimental evidence from previously published studies. Currently, the StoneMod database contains 10, 16, 13, 8 modulatory proteins that affect calcium oxalate crystallization, crystal growth, crystal aggregation, and crystal adhesion on renal tubular cells, respectively. Informative details of each modulatory protein and PubMed links to the published articles are provided. Additionally, hyperlinks to other protein/gene databases (e.g., UniProtKB, Swiss-Prot, Human Protein Atlas, PeptideAtlas, and Ensembl) are made available for the users to obtain additional in-depth information of each protein. Moreover, this database provides a user-friendly web interface, in which the users can freely access to the information and/or submit their data to deposit or update. Database URL:https://www.stonemod.org.

Objective: To compare the effectiveness and safety of standard percutaneous nephrolithotomy (sPCNL) and super-mini PCNL (SMP). Patients and Methods: A total of 150 patients presenting with renal calculi of

Background Percutaneous nephrolithotomy is traditionally performed in the prone or supine position. We report the first case of percutaneous nephrolithotomy in sit position under local infiltration anesthesia. Case summary A 69-year-old male presented with left flank pain. Kidney B ultrasound and computed tomography scan showed multiple left renal calculi and hydronephrosis. He had a long history of chronic obstructive pulmonary disease, with severe ventilatory and cardiac dysfunction, and cannot tolerate the prone or supine position. The patient received the surgery in sit position under local infiltration anesthesia. The operative time was 1 h. The visual analogue scale score during the surgery was 3. The patient had no intraoperative and postoperative complications. The postoperative plain radiography showed no residual stone fragments. Conclusions We believe that in high-risk patients who need to undergo PCNL, a combination of sit position and local infiltration anesthesia is an alternative method.

Objective: To review the outcomes of a consecutive cohort of 1000 patients with renal stones managed with mini-percutaneous nephrolithotomy at our institute. Study Design: Prospective observational study. Place and Duration of Study: Armed Forces Institute of Urology Rawalpindi, Pakistan, from Jan 2016 to Dec 2018. Methodology: Surgery was carried out under general anesthesia in prone position. Access was made by single step dilatation by 14-17 French sheath, pneumatic lithoclast was used for stone disintegration and fragments removed. Foley and ureteric catheters were removed following morning of surgery after confirming stone clearance on plain X-Ray kidney ureter and bladder. Results: Mean stone size was 3.1 ± 2.1cm (2-6). Upper pole access was utilized in 398 (39.8%) while lower pole in 587 (58.7%) cases. Mean operative time was 67 ± 15.4 minutes (45-120) while the mean hospital stay was 22 ± 13.2 hours (20-120). A complete clearance rate of 93.3% was achieved as assessed by plain X-Ray kidney ureter & bladder. Residual stones were treated with either shock wave lithotripsy or redo mini-Percutaneous Nephrolithotomy. 910 (91%) of patients were discharged within 24 hours of surgery. Conclusion: Mini Percutaneous nephrolithotomy was found as a safe and feasible alternative contemporary established technique for treatment of nephrolithiasis which can be offered as a day case surgery except for complete staghorn calculi.

The risk of kidney stone presentations increases after hot days, likely due to greater insensible water losses resulting in more concentrated urine and altered urinary flow. It is thus expected that higher temperatures from climate change will increase the global prevalence of kidney stones if no adaptation measures are put in place. This study aims to quantify the impact of heat on kidney stone presentations through 2089, using South Carolina as a model state. We used a time series analysis of historical kidney stone presentations (1997–2014) and distributed lag non-linear models to estimate the temperature dependence of kidney stone presentations, and then quantified the projected impact of climate change on future heat-related kidney stone presentations using daily projections of wet-bulb temperatures to 2089, assuming no adaptation or demographic changes. Two climate change models were considered—one assuming aggressive reduction in greenhouse gas emissions (RCP 4.5) and one representing uninibited greenhouse gas emissions (RCP 8.5). The estimated total statewide kidney stone presentations attributable to heat are projected to increase by 2.2% in RCP 4.5 and 3.9% in RCP 8.5 by 2085–89 (vs. 2010–2014), with an associated total excess cost of ~ $57 million and ~ $99 million, respectively.

Background and Objectives: To clinically validate the computed tomography (CT)-based three-dimension (3D) model for treatment planning and intraoperative navigation of ureteropelvic junction obstruction (UPJO) complicated with renal calculi. Materials and Methods: We retrospectively collected the data of 26 patients with UPJO and renal calculi who were surgically treated in our institution from January 2019 to December 2021. Before surgery, 3D models based on preoperative CT scans were constructed in all patients. Additionally, the patients were divided into three groups according to the results of 3D models, distinguished by different treatment of renal calculi, that is, left untreated (1), pyelolithotomy (2), and endoscopic lithotomy (3). The quantitative analysis of renal calculi parameters, and perioperative and follow-up data were compared. Results: The mean number of involved renal calyces (p = 0.041), and the mean maximum cross-sectional area (p = 0.036) of renal stones were statistically different among the three groups. There were no significant differences among the three groups in the mean operative time, mean estimated blood loss, mean pararenal draining time, and mean hospital stay. The intraoperative stone clearance rates were 100% (11/11) and 77.8% (7/9) in group 2 and group 3, respectively. The trends of increased estimated glomerular filtration rate and decreased creatinine on the average levels after surgery were observed, although these changes were not statistically significant. At a mean follow-up of 19.4 ± 6.4 months, the overall surgical success rate of the UPJO was 96.2% (25/26), and the overall success rate of renal calculi removal was 80.8% (21/26). Renal stones in 66.7% (4/6) of patients in group 1 spontaneously passed out. Conclusions: Preoperative 3D CT models have exact clinical value in the surgical planning and intraoperative navigation of UPJO patients complicated with renal calculi.

Background: The transperitoneal laparoscopic nephrectomy provides an optimal working space. It facilitates orientation by extending identifiable anatomic landmarks. The study evaluates the safety, outcome, and complications of the procedure. Materials and Methods: A total of 84 patients with benign nonfunctioning kidney admitted from April 1, 2015 to March 31, 2019 in the Department of Urology, MGM Medical College and Hospital, Navi Mumbai, India were considered for study purposes. The exclusion criteria of the study included uncorrected coagulopathy, active urinary tract infection, pregnancy, and severe cardiopulmonary disease. Preoperative imaging included digital X-ray, kidney ureter bladder, ultrasonography, intravenous pyelogram, computed tomography, intravenous urogram, micturating cystourethrogram, and diethylenetriaminepentaacetic acid renal scan. All operated patients were evaluated for intraoperative and postoperative complications. Results: The mean age of patients was 40.76 years. Of 84 patients, 60 were men and 24 were women. Patients had complaints of ipsilateral flank pain 76 (90.47%), lower urinary tract symptoms 34 (30.95%), and hematuria 18 (21.42%). Causes of benign nonfunctioning kidney were obstructive uropathy secondary to stone in 62 patients (73.81%) followed by neglected pelvic ureteric junction obstruction in 8 (9.53%), renal tuberculosis in 6 (7.14%), chronic pyelonephritis in 6 (7.14%), and renovascular hypertension in 2 (2.38%) patients. Seven patients required conversion to open surgery, secondary to adhesions in four patients, instrument failure in one case, and bleeding in two cases. The mean stay of the patient in the hospital was 4.38 days. Various types of complications occurred in five patients: colonic injury in one, wound infection in three, and incisional hernia in one. Conclusion: Transperitoneal laparoscopic nephrectomy is an effective procedure with minimal morbidity, hospital stay, rapid recovery, and better cosmesis making this the gold standard technique for nephrectomy.

Introduction: Renal stone disease has been affecting people for centuries. Percutaneous nephrolithotomy is one of the five interventions offered to a patient with renal stone. With the continuous development of noninvasive or minimally invasive techniques, these surgical procedures have been refined over time. This study was conducted to find the success rate of percutaneous nephrolithotomy in renal stone using Guy’s score and complication by Modified Clavien score. Methods: This descriptive cross-sectional study was done among 114 patients who underwent percutaneous nephrolithotomy in a tertiary care hospital, from September 2016 to December 2018 after receiving ethical approval from the Institutional Review Committee. Convenient sampling was done. All patients were informed about the potential benefits and risks of the percutaneous nephrolithotomy procedure and patients signed an informed written consent form. Point estimate at 95% Confidence Interval was calculated along with frequency and proportion. Statistical analysis was done by using Statistical Package for Social Sciences version 22.2. Results: Forty-six (40.3%) patients had Guy’s stone score I, 43 (37.71%) patients had a score of II, 15 (13.6%) patients had a score of III and 10 (8.77%) patients had a score of IV. The success rates of stone clearance were 97.8 %, 95.3%, 80% and 50% for Guy’s stone score 1, 2, 3 and 4 respectively. A total of 114 patients were enrolled in the study out of which 66 were male and 48 were female. Eighteen patients experienced some form of complications out of which 3 patients needed surgical intervention with Modified Clavien score of III. Conclusions: Using Guy’s scoring system for percutaneous nephrolithotomy we evaluated the success rate. It is reproducible, easy and proves to be a useful tool to counsel patients about stonefree rate and prognosis for the surgical procedure. Modified Clavien score was helpful in evaluating complication rate.

Nephrolithiasis is a common disease affecting almost all populations, with an increasing prevalence over the past decades. Previous studies revealed several functional polymorphisms associated with the pathogenesis of nephrolithiasis. However, data on Asian populations are limited. In this study, three candidate polymorphisms were selected from previous studies to investigate the correlations with nephrolithiasis in a Taiwanese population. In total, 454 nephrolithiasis patients were recruited from Kaohsiung Medical University Hospital, with SNP frequency for 1513 subjects of general population from the Taiwan Biobank (TWB) as a genotypic reference. Results revealed that subjects with minor TT genotype at rs1256328 (alkaline phosphatase, liver/bone/kidney (ALPL)) have higher susceptibility to nephrolithiasis (odds ratio (OR) = 2.03, p = 0.0013). In addition, subjects carrying the minor AA genotype at rs12654812 (regulator of G protein signaling 14 (RGS14)) have higher susceptibility to nephrolithiasis (OR = 1.91, p = 0.0017). Among nephrolithiasis patients, subjects with GG at rs7627468 (calcium-sensing receptor (CASR)) have lower pH level in urine (p = 0.0088). Importantly, rs7627468 is associated with the expressions of IQCB1 and EAF2. rs12654812 could influence the expression of RGS14 itself, MXD3, and FGFR4. In summary, this study successfully validated the genetic roles of rs1256328 and rs12654812 in human nephrolithiasis.

BACKGROUND ESWL is suitable for stones smaller than 2 cm situated in upper and middle calyx. The routine insertion of DJ stents during ESWL of renal calculi is controversial. Some studies support the role of DJ stents in facilitating stone passage and preventing renal colic whereas other reports claim that stent causes significant lower urinary tract symptoms, hematuria, urinary tract infection and can even lower the stone-free rate. METHODS This is a prospective study conducted among 81 patients each in stented and non stented group who underwent ESWL for renal calculus. The primary outcome measured was stone fragmentation .The secondary outcomes measured were renal colic, urinary tract infection, steinstrasse and stent related LUTS. RESULTS Stone fragmentation rates in stented and non-stented groups were 91.4% and 86.4% respectively (p-value > 0.05). Ureteric colic in the stented group was only 14.8% but 45.7% in the non-stented group had ureteric colic (p-value

Background Subcutaneous ureteral bypass (SUB) device placement is an increasingly popular treatment option for decompression of ureteral obstruction in cats. Mineralization occlusion of the device occurs in a minority of cases but is the most common complication. Objective To evaluate a 2% tetrasodium ethylenediaminetetraacetic acid (tEDTA) solution for treatment of mineralization occlusion in cats with SUBs. Animals Six client-owned cats (8 obstructed devices). Methods Case series. Each cat was found to have device occlusion based on a combination of ultrasound examination, SUB irrigation, and failure to identify another cause of device obstruction. Each SUB was drained, irrigated using sterile saline, and infused with 1-2 mL of 2% tEDTA solution. Success was defined as normalization of flow during subsequent ultrasound visualization while irrigating. The volume and frequency of tEDTA instillations, time to achieve device patency, follow-up biochemical and ultrasound findings, and future reobstruction events were recorded. Results Resolution of mineralization was documented in all 8 SUBs. Reobstruction events occurred in 2 cats, all of which resolved after additional tEDTA infusions, but 1 cat ultimately required device exchange at 356 days from the first tEDTA infusion. In 1 cat, a single infusion was prematurely discontinued because of persistent pelvic dilatation after 1.25 mL of tEDTA had been instilled. No complications were observed. Conclusions and clinical importance Tetrasodium EDTA infusions can be safely considered as a treatment option for mineralized SUB devices in cats. This solution was easily infused, well tolerated, and avoided the need for SUB device exchange in the majority of cats in which it was used.

Objective: Renal collecting system macroscopically consists of minor calyx, major calyx, renal pelvis and ureter. Stone in renal collecting system is a common presentation in everyday urological practice. The prevalence of renal calculi ranges from 4% to 20% in different geographical distribution. Anatomical variation in renal collecting system plays a significant role in formation of calculi in its parts. The large extra renal pelvis leads to stagnation of urine for longer durations and formation of stones. The stone free rate after percutaneous nephrolithotomy and extra corporeal shock wave lithotomy is significantly related to anatomical factors, particularly the type of renal pelvis and dimensions (length and width) of lower infundibulum. Previous authors described the morphology of pelvicalyceal system in a highly variable manner and the available anatomical description of pelvicalyceal system is contradictory and incomplete. Hence an attempt has been made to provide the precise anatomy of pelvicalyceal system in adult human kidneys. Methods: We studied 196 formalin embalmed kidneys to note the number of infundibulum, major and minor calyces. The location and shape of pelvis were also studied. Results: The intra-renal pelvis was narrow and had funnel shaped appearance in 95 of total 196 (48.5%) specimens, and the extra-renal pelvis was dilated as balloon shaped in 43 of 196 (21.9%) specimens. In 41 (20.9%) specimens, the renal pelvis was having partially intra- and extra-renal in location. Bilateral symmetry was found in only 27.1% of 196 renal collecting systems. The length of lower infundibulum was more than 22 mm in 19 (9.7%) of 196 cases which directly affects the stone clearance rate during open and endoscopic surgeries on pelvicalyceal system. Conclusion: This study provides the accurate morphological details of the shape and dimensions of renal pelvicalyceal system to help the urologists and nephrologists. Keywords: Renal pelvis, Morphology, Pelvicalyceal system, Urologists, Renal calculi, Intra-renal pelvis

Objective To assess the long-term outcome of simultaneous treatment of a single renal cyst and ipsilateral stones with transurethral flexible ureteroscopy (FURS) lithotripsy and internal cyst drainage. Methods Patients who underwent simultaneous treatment with FURS lithotripsy and internal cyst drainage in our institution between July 2014 and September 2017 were enrolled. The cyst wall was identified endoscopically and a 1–3-cm window was created in the wall using a holmium laser. The proximal end of a double-J stent was placed in the cystic cavity to facilitate internal drainage. Results Thirteen patients underwent simultaneous treatment. No intraoperative complications with Clavien grading score >2 were noted in any patients. Mean stone burden and cyst diameter were 1.6 (range: 0.9–2.5) cm and 5.8 (range: 3.0–7.1) cm, respectively. Stone-free rates after single and complementary procedures were 84.6% and 92.3%, respectively. During the mean 33.1-month follow-up period (range: 17–54 months), seven patients (53.8%) achieved full resolution of renal cysts, five patients (38.5%) maintained >50% size reduction, and one patient (7.6%) experienced recurrence at 18 months postoperatively. Conclusions FURS with a holmium laser may constitute a safe and effective alternative procedure for simultaneous treatment of a single renal cyst and ipsilateral stones.

Background: The introduction of endourological procedures such as percutaneous nephrolithotomy and extracorporeal shock wave lithotripsy have led to a revolution in the management of nephrolithiasis. But in large sized staghorn calculi with branching, laparoscopic pyelolithotomy has a role and in recent years, retroperitoneal laparoscopic pyelolithotomy (RPPL) approach has been reported as a feasible alternative in various series. Aims and Objectives: To study the safety and efficacy of retroperitoneal laparoscopic pyelolithotomy (RPPL) in management of renal calculi bigger than 4 cm. Methods: This prospective study was conducted from January 2017 to June 2020 at the Department of Surgery, SKIMS Medical College, Bemina, Srinagar, Kashmir, India. The study included a total of 20 cases with the diagnosis of solitary renal pelvic calculi sized 4 cm and above. Results: There were 16 males and 4 females. The mean operative time was 107 min (range 86min-124 min) and the approximate mean blood loss was above 98.2 ml (range 74 ml – 144ml). Stone clearance was achieved in 18 cases and 2 cases were converted to the open procedure due to technical difficulties. Conclusion: Retroperitoneal laparoscopic pyelolithotomy (RPPL) is a safe, simple and feasible option that can be recommended for management of large sized staghorn renal calculi, if proper logistics and skilled personnel are available.

Introduction: This work reports a patient with recurrent renal calculi subjected to three surgeries in half a year to be in the same position, and the high-throughput sequencing data showed different species in the renal pus and urine samples, which suggested that partial renal infection or stone formation can be judged by the bacteria in urine. Patient concerns: The female patient aged 43 years was referred to the authors’ department on April 13, 2020, due to left waist pain and fever for 3 days. Diagnosis: Kidney stones and hydronephrosis were determined by a urinary system computed tomography scan. Interventions: On April 20, 2020 and June 15, 2020, the patient was successfully treated with left percutaneous nephrolithotomy twice under general anesthesia. An investigation on the health and eating habits of the patient within 6 months was completed at the last admission. The components of the second renal calculus sample were analyzed with an infrared spectrum analyzer. The third renal stone (renal pus, triplicates) was subjected to microbial metagenome sequencing, and urine samples before and after surgery were subjected to 16S RNA sequencing by SEQHEALTH (Wuhan, China). Outcomes: After percutaneous nephrolithotomy, the left kidney stones were basically cleared, stone analysis revealed that the main components were calcium oxalate monohydrate, silica, and a small amount of calcium oxalate dehydrate. Although the urine samples exhibited differences, the renal pus and urine sample shared a single species. Conclusion: It is not clear that the prospects of partial renal infection or stone formation can be judged by the bacteria in urine.

Background: The incidence of kidney stones is increasing in the US population. Oxalate, a major factor for stone formation, is degraded by gut bacteria reducing its intestinal absorption. Intestinal O. formigenes colonization has been associated with a lower risk for recurrent kidney stones in humans. In the current study, we used a clinical trial of the eradication of Helicobacter pylori to assess the effects of an antibiotic course on O. formigenes colonization, urine electrolytes, and the composition of the intestinal microbiome. Methods: Of 69 healthy adult subjects recruited, 19 received antibiotics for H. pylori eradication, while 46 were followed as controls. Serial fecal samples were examined for O. formigenes presence and microbiota characteristics. Urine, collected serially fasting and following a standard meal, was tested for oxalate and electrolyte concentrations. Results: O. formigenes prevalence was 50%. Colonization was significantly and persistently suppressed in antibiotic-exposed subjects but remained stable in controls. Urinary pH increased after antibiotics, but urinary oxalate did not differ between the control and treatment groups. The O. formigenes-positive samples had higher alpha-diversity and significantly differed in Beta-diversity from the O. formigenes-negative samples. Specific taxa varied in abundance in relation to urinary oxalate levels.Conclusions: These studies identified significant antibiotic effects on O. formigenes colonization and urinary electrolytes and showed that overall microbiome structure differed in subjects according to O. formigenes presence. Identifying a consortium of bacterial taxa associated with urinary oxalate may provide clues for the primary prevention of kidney stones in healthy adults.

Introduction: Percutaneous Nephrolithotomy (PCNL) is a procedure of choice for large renal calculi. It is a common urological procedure. PCNL can be performed in various positions. Aim: To determine the surgical outcomes in patients undergoing PCNL in supine and prone positions. Materials and Methods: A cohort study was conducted on patients with renal and upper ureteral stones who underwent PCNL in either prone or supine position between August 2019 to August 2020 at Urology Department, JSS Hospital, Mysuru. Supine PCNL was done in the flank Free Oblique Supine Modified Lithotomy (FOSML) position. All the procedures were performed under fluoroscopy guidance. Surgical outcomes including operative time, length of hospital stay, Stone Free Rate (SFR), radiation dose, and postoperative complications were evaluated. The collected data was tabulated and frequency (n) and percentage (%) analysis was performed. The Chi-square test was used to find the level of significance. Results: A total of 70 patients were included in the study and out of which 35 patients were in the supine (46.37±14.73 years, 28 males and 7 females) and 35 patients (47.54±12.45 years, 23 males and 12 females) were in the prone PCNL groups. Statistically significant difference was observed in the mean operating time in the supine and prone PCNL groups (81.43 vs 127.71 minutes; p-value=0.001), with a higher stone-free rate (94.29% vs 91.43%; p-value=0.643) observed in the supine PCNL group. One patient in supine group had postoperative sepsis and one patient in prone group had bleeding requiring transfusion. The Visual Analog Scale (VAS) score in supine PCNL was (5.08±0.32) less than in prone group (8.03±0.40) (p-value

Background To evaluate the feasibility, safety, applied value and efficacy of enhanced recovery after surgery (ERAS) for PCNL for the treatment of renal calculi. Although the ERAS is applied for many urological diseases, its application in percutaneous nephrolithotripsy (PCNL) is still limited. Methods This was a prospective study of patients admitted to hospital January and December 2018 and who were only diagnosed with renal calculi and excepted for serious or uncontrollable basic diseases and patients with multiple operation history and medication history. Patients were randomized 1:1 to the ERAS and traditional operation groups starting on the day before operation and end on the day of discharge. Each group was 118 cases. The stone clearance rate, visual analogue scale (VAS) pain score, the occurrence of perirenal hematoma and effusion, the incidence of extravasation of urine, the incidence of fever, bleeding and blood transfusion, and postoperative hospital stay were observed. Results The stone clearance rates were similar between the two groups (ERAS: 93.2% (109/117) vs. traditional: 89.8% (106/118), P = 0.800). The operation time was similar in the two groups (ERAS: 54 ± 12 vs. traditional: 58 ± 11 min, P = 0.656). VAS pain score that was 0.79 ± 0.76 in the ERAS group at 4 h after surgery and was significantly lower than 2.79 ± 0.98 in the traditional group (P P = 0.573). There were no difference in costs (21,348 ± 2404 vs. 21,597 ± 2293 RMB, P = 0.529). Conclusions ERAS perioperative management in PCNL was feasible, was without additional complications, and had well economic and social benefits. It is worth of clinical promotion and application.

Percutaneous nephrolithotomy (PCNL) is feasible in the extremely elderly patients. However, there were higher rate of complications and longer hospitalizations. The case presented is a 95-year-old female who was admitted to the hospital and was diagnosed with multiple stones in the right kidney and upper ureter with right renal effusion and infection, urosepsis, and chronic bronchitis. After sufficient preoperative preparation, small-tract PCNL under vacuum suctioning was performed using the left lateral position under combined lumbar spinal and epidural anesthesia. The patient recovered and was discharged smoothly on schedule. Good clinical and social effects have achieved.

The study purpose was to investigate the effect of Phaseolus Vulgaris (PV) on urinary biochemical parameters among patients with kidney stones. We conducted a randomized controlled study among 60 patients with kidney stones (size &lt, 10 mm) in the nephrology unit of both government and private hospitals, Al-Ahsa. Urinary volume, calcium, magnesium, potassium, oxalate, uric acid, and power of hydrogen (pH) were assessed before and after the intervention of giving 250 g of PV consumption as an extract thrice weekly (2.2 L to 2.5 L per week) for 6 weeks, which was compared with control. A &lsquo, t&rsquo, test was used with the significance at 5%. Mean score of age was 44.5 &plusmn, 10.16 in PV group and 43.73 &plusmn, 9.79 in control. Four (13.3%) and two (6.7%) had family history of kidney stones. Body mass Index (BMI) mean was 26.44 &plusmn, 2.7 and 26.36 &plusmn, 2.65 in pre and post-test, respectively, which were significant (p = 0.01017). There were significant changes (p = 0.000) in urine volume from 1962 &plusmn, 152.8 to 2005 &plusmn, 148.8, calcium 205.4 &plusmn, 11.99 to 198.4 &plusmn, 12.52, potassium 44.07 &plusmn, 3.66 to 52.15 &plusmn, 4.37, oxalate 37.12 &plusmn, 5.38 to 33.02 &plusmn, 5.71, and uric acid 6.88 &plusmn, 0.7 to 6.31 &plusmn, 0.58. In conclusion, PV is effective management for the patients with kidney stones as it increases the urinary volume and enhances the elimination of small kidney stones.

Objective To identify the correlation between demographic factors and upper urinary tract stone composition in the Thai population. Method A retrospective observational study of first-time upper urinary tract stone former patients aged over 18 years who underwent stone surgery was performed in a tertiary referral university hospital from January 2013 to May 2018. Collected data included demographic information and stone composition information, which were analysed by the Fourier Transform-Infrared Spectroscopy (FTIR) method. The correlation between the demographic factors and major upper urinary tract stone composition was analysed using Fisher's exact test. Results A total of 480 patients were included in this study. The stones were 319 (66.5%) renal calculi and 161 (33.5%) ureteric calculi. There were 248 (51.7%) single composition stones and 232 (48.3%) mixed composition stones. The major stone compositions were 288 (60.0%) calcium oxalate (CaOx), 125 (26.0%) calcium phosphate (CaP), 40 (8.3%) uric acid (UA), 19 (4.0%) magnesium ammonium phosphate (MAP), five (1.0%) cystine, and three (0.6%) ammonium hydrogen urate (AHU). Gender was correlated with the major stone composition. In females, a correlation was found between the major stone composition and age, diabetes mellitus (DM), and glomerular filtration rate (GFR). The study showed no significant correlation between the major stone composition and dyslipidemia (DLP), hypertension (HT), gout, and body mass index (BMI) in both genders. Conclusion Gender, age, DM, and GFR were the factors affecting the stone composition., Renal system; Physiology; Urology; Evidence-based medicine; Internal medicine; Health informatics; Health promotion; Upper urinary tract stone; Stone composition; Stone component; Urolithiasis; Renal calculi; Ureteric calculi; Renal stone; Ureteric ston.

Background Urolithiasis is a worldwide urological problem with significant contribution of genetic factors. Pakistan, which resides within the Afro-Asian stone belt, has a high reported prevalence (12%) of urolithiasis. Osteopontin (SPP1) is a urinary macromolecule with a suggested critical role in modulating renal stone formation, genetic polymorphisms of which may determine individual risk of developing urolithiasis. However, results of previous studies regarding SPP1 polymorphisms and susceptibility to urolithiasis have apparent inconsistencies with no data available for local population. Methods A total of 235 urolithiasis patients and 243 healthy controls, all of Pakistani ancestry, underwent genotyping for six SPP1 genetic polymorphisms in an effort to investigate potential association with urolithiasis using indigenous candidate gene association study design. Further, a comprehensive meta-analysis following a systematic literature search was also done to ascertain an evidence based account of any existent association regarding SPP1 promoter polymorphisms and risk of developing urolithiasis. Results Three SPP1 promoter polymorphisms, rs2853744:G > T, rs11730582:T > C and rs11439060:delG>G, were found to be significantly associated with risk of urolithiasis in indigenous genetic association study (OR = 3.14; p = 0.006, OR = 1.78; p = 0.006 and OR = 1.60; p = 0.012, respectively). We also observed a 1.68-fold positive association of a tri-allelic haplotype of these SPP1 promoter polymorphisms (G-C-dG) with risk of urolithiasis (OR = 1.68; p = 0.0079). However, no association was evident when data were stratified according to gender, age at first presentation, stone recurrence, stone multiplicity, parental consanguinity and family history of urolithiasis. The overall results from meta-analysis, which included 4 studies, suggested a significant association of SPP1 rs2853744:G > T polymorphism with susceptibility of urolithiasis (OR = 1.37; p = 0.004), but not for other SPP1 polymorphic variants analyzed. Conclusions In conclusion, we report significant association of 3 SPP1 polymorphisms with urolithiasis for the first time from South Asia, however, this association persisted only for SPP1 rs2853744:G > T polymorphism after meta-analysis of pooled studies. Further studies with a larger sample size will be required to validate this association and assess any potential usefulness in diagnosis and prognosis of renal stone disease.

Due to the aging population, the number of completely bedridden individuals is expected to increase, and such individuals are at high risk of developing urinary calculi. This retrospective study included 32 consecutive bedridden patients, who had undergone endoscopic lithotripsy between 2010 and 2019, and aimed to identify the treatment outcomes of endoscopic lithotripsy for bedridden patients. A total of 45 endoscopic lithotripsies were performed to treat stones (median cumulative diameter, 24 mm). The stone-free rate (SFR)

Xanthogranulomatous pyelonephritisis (XGP) is a rare and aggressive form of chronic urinary tract infection. The most common microorganism is Proteus but other microorganisms have been described in the literature. In this article, we describe a sixty-year-old male who presented with urosepsis and sever thrombocytopenia secondary to Fusobacterium nucleatum urinary tract infection which led to poorly functioning XGP. The rarity of the microorganism and the devastating clinical course encourages us to report it as anaerobes don't usually cause UTI but unusual microorganism should be suspected if the clinical course is atypical or if urinary tract abnormalities are present.

Objectives To demonstrate the importance of carrying out the urinary sediment study with the correct interpretation and crystals typification as a clinical laboratory diagnostic tool, as well as the elaboration of protocols that determine the need to realize this type of microscopic urinary sediment examination routinely. Case presentation Elderly male patient with no personal or family history of interest that presented with left iliac fossa fixed and non-irradiated pain lasting three days. This is the first time that he suffered pain episodes of this type. The urine analysis reveals proteinuria, hematuria and the sediment shows abundant flat and hexagonal crystals, typical of cystine. Amino acid analysis confirms the finding, showing high dibasic amino acids and cystine concentrations. Conclusions The study of the urinary sediment by the clinical laboratory reveals the presence of a case of cystinuria due to the appearance of their pathognomonic crystals at an advanced age and without a previous history. The case reported in this paper is of interest for clinical laboratory practice, as it demonstrates the utility of urine sediment examination in the diagnosis of a genetic disease that manifests as a simple renal colic.

Objective This study aimed to present our experience of concomitant management of renal calculi and recurrent ureteropelvic junction obstruction (UPJO) with percutaneous nephrolithotomy (PCNL) and antegrade balloon dilation. Methods We retrospectively reviewed 31 patients who underwent PCNL and antegrade balloon dilation for treatment of renal calculi and recurrent UPJO. The inclusion criterion was the presence of UPJO after failed pyeloplasty with ipsilateral renal calculi. Success was defined as achievement of both symptomatic and radiographic resolution of any stones and obstruction. Results All operations were successful without grade III or higher postoperative complications. A stone-free status was observed in all patients and the overall success rate of the procedure was 87.1% (27/31). The success rate of the procedure was significantly higher in patients with mild or moderate preoperative hydronephrosis (96%) than in those with high-grade preoperative hydronephrosis (50%). Moreover, the success rate of the procedure was lower in patients with poor preoperative renal function (0%) than in those with good or moderate renal function (93.1%). Conclusion Combined PCNL and antegrade balloon dilation management represents a safe and effective approach for patients with renal calculi and recurrent UPJO after failed pyeloplasty.

Objective: This study was conducted to evaluate the efficacy and safety of Miniperc (MIP) XS (7.5 Fr) nephroscope in the treatment of renal stones up to 20 mm. Methods: This was a prospective study that enrolled 65 patients with limited stone burden in calyx or pelvis, which were treated with MIP XS. Primary outcomes included stone-free rates (SFRs), operative time, length of postoperative hospital stay, requirement of analgesic postsurgery, decline in hematocrit, stent requirement, and complications and requirement of ancillary procedure. Results: The mean stone size was 17.46 ± 2.9 mm. The patients were treated with MIP XS and had a mean operative time of 38.63 ± 8.4 min, 1.74% drop in hematocrit levels postsurgery and 96.9% SFRs. The length of hospital stay was 55.48 ± 4.6 h. Postoperative fever and nephrostomy leakage occurred in 9 and 1 patients, respectively. Six cases required some drainage procedure (double-J stent/nephrostomy). No patient required blood transfusion. Conclusion: This study showed that MIP XS could be considered as an effective treatment option in the treatment of renal stones up to 20 mm as it scores in all the standard parameters used to measure percutaneous nephrolithotripsy outcomes.

Renal calculi are common, with male predilection and androgen exposure potentially increasing the risk of renal calculi. Systemic effects of androgen deprivation therapy (ADT) have been observed but the influence of ADT on renal calculi in prostate cancer (PCa) patients is not fully understood. We conducted this population-based study to evaluate the impact of ADT on the subsequent risk of renal calculi. We used the National Health Insurance Research Database of Taiwan to analyze the incidences of renal calculi in ADT patients and non-ADT patients from 2001 to 2013. In total, 3309 patients with PCa were selected. After matching with 1:1 propensity-score analysis, 758 ADT patients with 758 matched non-ADT controls were enrolled in the final analysis. Demographic characteristics were analyzed and Cox regression analysis for calculating the hazard ratios (HR) was performed for the subsequent risk of renal calculi. Finally, 186 (186/1516, 12.3%) patients with diagnosed renal calculi were detected. ADT patients had a lower risk of subsequent renal calculi with an adjusted HR of 0.38 (7% vs. 17.5%, 95% confidence interval (CI) 0.28&ndash, 0.53, p &lt, 0.001) in comparison with the non-ADT group. The Kaplan&ndash, Meier curve showed significant differences of cumulative incidences of renal calculi. In conclusion, ADT patients had approximately one-third lower risk of subsequent renal calculi. Further studies are warranted to evaluate the clinical significance.

Background: A minority of urologists performing percutaneous nephrolithotomy (PCNL) achieve their own nephrostomy access. In an effort to simplify the access part of PCNL, we herein describe our initial experience with endoscopic-guided retrograde percutaneous access in the prone split-leg position. Case Presentation(s): After informed consent, a confirmed negative urine culture, and 1 week pretreatment with tamsulosin, four carefully selected PCNL patients underwent endoscopic-guided retrograde access in a prone split-leg position using the Lawson catheter. In all the four patients, we achieved endoscopic-guided retrograde upper pole access in the prone split-leg position. A single Clavien 3B complication occurred. Total fluoroscopy time for the PCNL averaged 162 seconds (51–283). Complete stone-free rate at 1 week based on CT scan was 25%, and a stone-free rate defined as

Postoperative bleeding is a dangerous complication after percutaneous nephrolithotomy (PCNL). Pseudoaneurysm, arteriovenous fistula, and arterial laceration are the three most common causes of post-PCNL bleeding. Subcostal artery bleeding is a rare cause. We herein present a clinical case involving a 43-year-old man who presented with right renal complex calculi and was managed by PCNL in the prone position using an inferior calyceal puncture approach. Intermittent extreme bleeding occurred 1 day postoperatively, and immediate renal angiography was performed. However, we found no sign of a pseudoaneurysm, arteriovenous fistula, or arterial laceration. Another well-trained and experienced doctor also found no pseudoaneurysm, arteriovenous fistula, or arterial laceration. After adjusting the catheter position, subcostal artery bleeding finally appeared and was successfully controlled by coils. This finding indicates that subcostal artery damage is one cause of post-PCNL bleeding. We suggest that clinicians should carefully and patiently perform angiography and/or embolization to avoid misdiagnosis and mistreatment.

Prolonged inflammation or irritation due to renal calculi can induce glandular metaplasia of the urothelium and even malignant neoplasm. Primary adenocarcinoma in pelvicalyceal system is a rare tumor in such patients. Here, a case of carcinoembryonic antigen (CEA) positive primary tubulovillous adenocarcinoma in pelvicalyceal system is reported. A 57-year-old male with right abdominal pain and microscopic hematuria and the history of nephrolithotomy for recurrent renal calculi referred to our center. Radiological findings showed well-defined lobulated mass with calcification in interpolar region of right kidney extending up to pelvicalyceal system along with calculi in pelvicalyceal system and ureter with moderate hydroureteronephrosis. Laparoscopic right radical nephrectomy was performed. Histopathological examination revealed tubulovillous adenocarcinoma of renal pelvicalyceal system with CEA positivity. Patient was asymptomatic and had no recurrence after one and a half years. Primary tubulovillous adenocarcinoma in renal pelvis though rare, is usually associated with intestinal metaplasia of urothelium induced by prolonged chronic inflammation and renal calculi.

Objective: Urolithiasis remains a global problem. Despite the availability of numerous methods, no definite therapeutic agent has been yet introduced for the prevention or treatment of kidney stones. In this study, we evaluated the possible preventive effects of aqueous extract of Cichorium intybus L. (chicory) flowers on ethylene glycol-induced renal calculi in rats. Materials and Methods: A total of 24 Wistar rats were randomly divided into four groups and were treated for 30 days. Group A received drinking tap water, while groups B, C, and D were administered with 1% ethylene glycol for induction of calcium oxalate stone formation. Rats in groups C and D received intraperitoneal injections of the aqueous extract of chicory flowers (50 and 200 mg/kg, respectively) since the first day of the experiment. The urine volume, urine pH, and urinary levels of oxalate, citrate, calcium, uric acid, and creatinine as well as serum levels of calcium, uric acid, and creatinine were measured. After 30 days, the rats' kidneys were removed and prepared for histological evaluation of calcium oxalate deposits. One-way analysis of variance (ANOVA), followed by Tukey's test, was performed, using SPSS version 20. Results: The number of calcium oxalate crystals was significantly higher in group B (ethylene glycol-only treated animals), compared to group A (control), group C (50 mg/kg of aqueous extract), and group D (200 mg/kg of aqueous extract) (p0.05), and creatinine (p0.05), and urine volume (p

Objective: To assess the effect of diuretics with shockwave lithotripsy (SWL) on the treatment of renal and upper ureteric calculi. Patients and methods: Adult patients with a solitary non-obstructive radio-opaque renal or upper ureteric calculus with normal renal function were included. They were prospectively randomised to receive either SWL with placebo or SWL with diuretics (40 mg parenteral furosemide) in a double-blind manner with a sample size of 48 patients in each arm. The primary outcomes were the SWL success and failure rates. The secondary outcomes were the number of shocks and sessions. Results: Complete fragmentation was achieved in 89.6% of the patients in the furosemide arm as compared to 81.3% in the placebo arm. Clearance was achieved in 77.1% of the patients in the furosemide arm as compared to 70.8% in the placebo arm. The number of shocks and the number of sessions were higher in the placebo arm. These differences were not statistically significant. Conclusion: The use of diuretics along with SWL treatment of renal and upper ureteric calculi does not show a statistically significant improvement in fragmentation or clearance. Keywords: Diuretics, Renal calculi, Shockwave lithotripsy, Ureteric calculi

Objective: To study the postoperative trauma of the retroperitoneal laparoscopic intrasinusal pyelolithotomy (RLIP) and percutaneous nephrolithotomy (PCNL). Methods: A total of 118 patients who were diagnosed with single pelvis calculus in Shanghai Punan Hospital of Pudong New District between September 2013 and February 2017 were selected and randomly divided into RLIP group and PCNL group who received retroperitoneal laparoscopic intrasinusal pyelolithotomy and percutaneous nephrolithotomy respectively. The removal of the stones was observed 1 week and 4 weeks after surgery, and 3mL of cubital venous blood was collected 3 d and 7 d after operation to detect the renal function indicators, inflammatory markers and stress indicators. Results: The stone removal success rate of RLIP group 1 week and 4 weeks after operation were significantly higher than those of PCNL group, serum BUN, Scr and Cys-C contents as well as eGFR levels were not significantly different between RLIP group and PCNL group 3 d and 7 d after operation, and serum Cor, NE, HSP70, NO, IL-6, hs- CRP, TNF-α and PGE2 contents of RLIP group 3 d and 7 d after operation were significantly lower than those of PCNL group. Conclusion: RLIP is significantly better than PCNL in stone removal and causes significantly less postoperative trauma than PCNL.

Background: Preventing the recurrence of episodes of stone formation is the focus of interest for patients. This retrospective study aimed to determine the prevalence of metabolic abnormalities and anatomical alterations of the genitourinary tract in patients with recurrent urolithiasis. Methods: Patients who had recurrent renal calculi were included. Laboratory assessment was performed on two 24-hour samples of urine. The first 24-hour urine was a random specimen and the second was obtained after the patient had been on a sodium-, oxalate- and calcium-restricted diet for at least one week. The patients with hypercalciuria further underwent fasting and calcium load testing and were assessed in terms of parathyroid hormone levels. Urine culturing was conducted to rule out urinary tract infection. All patients were evaluated with ultrasound and intravenous pyelography for any anatomical abnormalities. Results: A total of 30 patients (20 male and 10 females) were included in the study. The most frequently found metabolic alterations were hypercalciuria, low urinary volume, urinary tract infection and hyperoxaluria. Anatomic alterations were found in 26.5% of patients, mainly in the form of renal cysts, pelvi-ureteric junction obstructions, horse shoe kidneys and atrophic kidney. Conclusions: 80% of patients with recurrent stone disease had some measure of metabolic abnormality to account for the disease. The use of two 24-hour urine samples significantly improved the detection rate of metabolic abnormalities compared to a single sample. The major limitation of this study was the small number of patients as well as the short study duration. [Arch Clin Exp Surg 2017; 6(2.000): 81-85]

Shun-Ku Lin,1,2,* Jui-Ming Liu,3,* Ying-Hsu Chang,4 Yuan-Tien Ting,5 See-Tong Pang,4 Ren-Jun Hsu,6–8 Po-Hung Lin4,9 1Institute of Traditional Medicine, School of Medicine, National Yang-Ming University, 2Department of Chinese Medicine, Taipei City Hospital, Ren-Ai Branch, Taipei, 3Division of Urology, Department of Surgery, Taoyuan General Hospital, Ministry of Health and Welfare, 4Division of Urology, Department of Surgery, Chang Gung Memorial Hospital at Linkou, Taoyuan, 5Division of Urology, Department of Surgery, Chang Bing Show Chwan Memorial Hospital, Changhua, 6Biobank Management Center of the Tri-Service General Hospital, 7Department of Pathology and Graduate Institute of Pathology and Parasitology, the Tri-Service General Hospital, 8Graduate Institute of Life Sciences, National Defense Medical Center, Taipei, 9Graduate Institute of Clinical Medical Science, College of Medicine, Chang Gung University, Taoyuan, Taiwan, Republic of China *These authors contributed equally to this work Background: Urolithiasis is a common urinary tract disease worldwide. It has been connected to systemic diseases, including hypertension, diabetes mellitus, metabolic syndrome, and cardiovascular disease. In the current study, we aimed to evaluate the relationship between urolithiasis and the complications of acute myocardial infarction (AMI). Materials and methods: Data were obtained from the Longitudinal Health Insurance Database 2005 of the National Health Insurance Research Database. All AMI cases, both those who were hospitalized and those who were treated in the emergency department, were identified using the International Classification of Diseases, ninth revision, Clinical Modification (ICD-9-CM) code. Results: A total of 37,052 patients with urinary calculi and 148,209 control subjects were enrolled in this study. The average follow-up period was 9.51years. The risk of AMI was higher among patients with urolithiasis (adjusted hazard ratio [aHR] 1.07, 95% confidence interval [95% CI] 1.03–1.13). We detected a significant association between urolithiasis and intubation (aHR 1.53, 95% CI 1.36–1.73), intensive care unit treatment (aHR 1.22, 95% CI 1.13–1.32), heart failure (aHR 1.59, 95% CI 1.42–1.78), shock (aHR 1.53, 95% CI 1.32–1.77), and arrhythmias (aHR 1.18, 95% CI 1.06–1.33). Furthermore, certain medical treatments for urolithiasis were found to be related to myocardial infarction (MI). Nonsteroidal anti-inflammatory drugs (NSAIDs) were significantly associated with a high risk of AMI. In contrast, allopurinol, thiazide diuretic, potassium-sparing diuretics, and a-blockers have negative association with AMI. Conclusion: Urolithiasis had a significantly increased risk of endotracheal intubation and heart failure following AMI. In addition, urolithiasis was also associated with a high risk of intensive care unit treatment, shock, and arrhythmias after AMI. Medical treatments for urolithiasis may decrease the risk of MI, except the use of NSAIDs. Keywords: urolithiasis, renal calculi, acute myocardial infarction, National Health Insurance Research Database, endotracheal intubation, heart failure

Shun-Ku Lin,1,2,* Jui-Ming Liu,3,* Ying-Hsu Chang,4 Yuan-Tien Ting,5 See-Tong Pang,4 Ren-Jun Hsu,6–8 Po-Hung Lin4,9 1Institute of Traditional Medicine, School of Medicine, National Yang-Ming University, 2Department of Chinese Medicine, Taipei City Hospital, Ren-Ai Branch, Taipei, 3Division of Urology, Department of Surgery, Taoyuan General Hospital, Ministry of Health and Welfare, 4Division of Urology, Department of Surgery, Chang Gung Memorial Hospital at Linkou, Taoyuan, 5Division of Urology, Department of Surgery, Chang Bing Show Chwan Memorial Hospital, Changhua, 6Biobank Management Center of the Tri-Service General Hospital, 7Department of Pathology and Graduate Institute of Pathology and Parasitology, the Tri-Service General Hospital, 8Graduate Institute of Life Sciences, National Defense Medical Center, Taipei, 9Graduate Institute of Clinical Medical Science, College of Medicine, Chang Gung University, Taoyuan, Taiwan, Republic of China *These authors contributed equally to this work Background: Urolithiasis is a common urinary tract disease worldwide. It has been connected to systemic diseases, including hypertension, diabetes mellitus, metabolic syndrome, and cardiovascular disease. In the current study, we aimed to evaluate the relationship between urolithiasis and the complications of acute myocardial infarction (AMI). Materials and methods: Data were obtained from the Longitudinal Health Insurance Database 2005 of the National Health Insurance Research Database. All AMI cases, both those who were hospitalized and those who were treated in the emergency department, were identified using the International Classification of Diseases, ninth revision, Clinical Modification (ICD-9-CM) code. Results: A total of 37,052 patients with urinary calculi and 148,209 control subjects were enrolled in this study. The average follow-up period was 9.51years. The risk of AMI was higher among patients with urolithiasis (adjusted hazard ratio [aHR] 1.07, 95% confidence interval [95% CI] 1.03–1.13). We detected a significant association between urolithiasis and intubation (aHR 1.53, 95% CI 1.36–1.73), intensive care unit treatment (aHR 1.22, 95% CI 1.13–1.32), heart failure (aHR 1.59, 95% CI 1.42–1.78), shock (aHR 1.53, 95% CI 1.32–1.77), and arrhythmias (aHR 1.18, 95% CI 1.06–1.33). Furthermore, certain medical treatments for urolithiasis were found to be related to myocardial infarction (MI). Nonsteroidal anti-inflammatory drugs (NSAIDs) were significantly associated with a high risk of AMI. In contrast, allopurinol, thiazide diuretic, potassium-sparing diuretics, and a-blockers have negative association with AMI. Conclusion: Urolithiasis had a significantly increased risk of endotracheal intubation and heart failure following AMI. In addition, urolithiasis was also associated with a high risk of intensive care unit treatment, shock, and arrhythmias after AMI. Medical treatments for urolithiasis may decrease the risk of MI, except the use of NSAIDs. Keywords: urolithiasis, renal calculi, acute myocardial infarction, National Health Insurance Research Database, endotracheal intubation, heart failure

Highlights • Malignant rhabdoid tumor of the kidney in adult patients are extremely rare and have the worst prognosis of all renal tumors. • The histological features and immunohistochemical staining may aid in confirming the diagnosis of these tumors. • It is necessary to consider this entity in front of renal masses when such type of renal tumor is encountered in adult patients., Introduction Malignant rhabdoid tumor (MRT) is one of the most aggressive and lethal malignancies in pediatric oncology, MRT of the kidney is an uncommon renal tumor in children and it’s extremely rare in adult patients. With only seven previously reported adult cases in the English-literature, to our knowledge this is the first case that is associated with renal calculi. Presentation of case We present the case of a 65-year-old man with an MRT arising in a solitary kidney with multiple enlarged lymph nodes that compressing the inferior vena cava. Discussion Malignant rhabdoid tumor of the kidney was originally described as a “rhabdomyosarcomatoid” variant of Wilm’s tumor due to the resemblance of cells to rhabdomyoblasts, now this type of tumor is recognized as distant and unique malignant renal tumor. It affects usually children before the age of 2 years. Tumor tissue sampling is required to make the diagnosis of MRTK, based on either nephrectomy, core biopsy, or autopsy specimens. There is no established standard of care due to the paucity of cases. Surgery is considered to be the first choice of treatment if possible. Conclusion This case report reinforces the importance of recognizing this entity in the adult population, and discuss the possible treatment options of this rare and highly aggressive tumor.

Kidney stone disease (nephrolithiasis) is a major clinical and economic health burden with a heritability of ~45–60%. We present genome-wide association studies in British and Japanese populations and a trans-ethnic meta-analysis that include 12,123 cases and 417,378 controls, and identify 20 nephrolithiasis-associated loci, seven of which are previously unreported. A CYP24A1 locus is predicted to affect vitamin D metabolism and five loci, DGKD, DGKH, WDR72, GPIC1, and BCR, are predicted to influence calcium-sensing receptor (CaSR) signaling. In a validation cohort of only nephrolithiasis patients, the CYP24A1-associated locus correlates with serum calcium concentration and a number of nephrolithiasis episodes while the DGKD-associated locus correlates with urinary calcium excretion. In vitro, DGKD knockdown impairs CaSR-signal transduction, an effect rectified with the calcimimetic cinacalcet. Our findings indicate that studies of genotype-guided precision-medicine approaches, including withholding vitamin D supplementation and targeting vitamin D activation or CaSR-signaling pathways in patients with recurrent kidney stones, are warranted., Kidney stones form in the presence of overabundance of crystal-forming substances such as Ca2+ and oxalate. Here, the authors report genome-wide association analyses for kidney stone disease, report seven previously unknown loci and find that some of these loci also associate with Ca2+ concentration and excretion.

The aim of this study is to compare the effectiveness and the relative risk of postoperative fever between percutaneous nephrolithotomy and retrograde intrarenal surgery for the treatment of renal stones. At the Cannizzaro Hospital in Catania, a total 168 patients with one or more renal stones underwent one of more interventions, resulting in 177 independent records; 62 records related to PCNL treatment and 115 records involved RIRS treatment. To assess the relationship between patient and stone characteristics on the one hand and stone-free rate and the incidence rate of postoperative fever on the other, a generalized additive logistic models was used. We found that stone burden, defined in terms of stone diameter, the number of stones and stone density, is a significant predictor for the success of the intervention. Furthermore, PCNL treatment was significantly less successful for stone in the middle calyx, whereas RIRS obtained significantly lower success rate for stone in the lower calyx that had a sharp infundibular angle. Importantly, for renal stones with a diameter up to 2 cm, RIRS has a very similar success rate compared to PCNL. Stones with a diameter larger than 2 cm are best treated by PCNL. Across the two treatments, older patients and men have lower incidence rate of postoperative fevers. The fact that RIRS has much lower postoperative fever rates for male and younger patients compared to PCNL, means that RIRS could be the treatment of choice for small and midsized stones for such patients.