Search

Amaç: Bu çalışmada 65 yaş üstü hastalarda RIRS'ın etkinlik ve güvenliğini değerlendirmeyi amaçladık.Materyal ve Metod: Kliniğimizde RIRC yapılan 65 yaş üstü 107 hasta retrospektif değerlendirildi. Hastalar hem komplikasyon olup olmasına göre (Grup:1 Komplikasyon yok, Grup 2: Komplikasyon var ) hem de yaşa göre iki gruba (Grup 1:65-74 yaş, Grup 2: 75 yaş ve üzeri) ayrıldı. Taşsızlık oranı, komplikasyon oranı, taş özellikleri, hastanede kalış süreleri açısından gruplar birbirleriyle karşılaştırıldı. Bulgular: Yaşa göre gruplara ayrıldığında grup (65-74 yaş) grup 2 (75 yaş ve üzeri ) arasında American Society of Anesthesiogists skoru, taş boyutu, taş sayısı ve taşın hounsfield ünitesi açısından fark gözlenmedi. Diğer yandan grup 2'nin hastanede kalış süresi ve komplikasyon oranının grup 1'e göre daha fazla olduğu gözlendi. (sırasıyla p değeri 0,01 ve 0,02) Hastalar komplikasyon görülme durumuna göre iki gruba ayrıldı. Grup1 (komplikasyon olmayan) ve grup 2 (komplikasyon olan) arasında ASA skoru, taşın hounsfield ünitesi ve taşsızlık oranında anlamlı fark saptanmadı. (sırasıyla p değeri: 0.127, 0.915, 0.379 )Sonuç: Yaşlı nüfusun dünyada giderek artmasıyla böbrek taşı olan daha çok yaşlı hasta tedavi için başvuracaktır. Bu nedenle çalışmamız sonucunda olduğu gibi RIRS yaşlı hastalarda böbrek taşı tedavisinde etkinlik ve güvenlik açısından yaygın şekilde kullanılabilir., Background: In this study, we aimed to investigate the efficacy and safety of RIRS in patients over 65 years of age.Materials and Methods: 107 patients over 65 who underwent RIRC in our clinic were evaluated retrospectively. The patients were divided into two groups, according to whether there were complications (Group: No complications, Group 2: There are complications) and according to age (Group 1: 65-74 years, Group 2: 75 years and above). The groups were compared with each other regarding stone-free rate, complication rate, stone characteristics, and hospital stay.Results: When divided into groups according to age, no difference was observed between group 1 (65-74 years old) and group 2 (75 years and older) in terms of American Society of Anesthesiogists score, stone size, number of stones, and Hounsfield unit of the stone. On the other hand, it was observed that the hospital stay and complication rate of group 2 were higher than group 1. (p-value 0.01 and 0.02, respectively). The patients were divided into two groups according to whether there were complications. There was no significant difference in ASA score, Hounsfield unit of stone, and stone-free rate between group 1 (without complications) and group 2 (with complications). (p-value respectively: 0.127, 0.915, 0.379 )Conclusion: With the increasing elderly population in the world, more elderly patients with kidney stones will apply for treatment. Therefore, as in our study, RIRS can be widely used in treating kidney stones in elderly patients in terms of efficacy and safety.

Kidney stones affect several biological processes, including urine volume, pH, calcium oxalate, and urates. The aim of the study was to evaluate the antiurolithiatic potential of Parkia biglobosa, Lannea humilis stem bark and KO-888 (Jigsimur). These plants were extracted with methanol using soxhlet extraction. The phytochemical screening was carried out using standard procedures. Renal calculi were induced using ethylene glycol in 55 rats and treated with the extracts and KO-888 for 14 days. The phytochemical contents showed the presence of tannins, saponins, flavonoids, steroids, hydrogen cyanides, glycosides, alkaloids, phenols, and terpenoids with copious concentrations of glycosides, alkaloids, and terpenoids in the plant extracts. While, steroids, hydrogen cyanides, alkaloids, and terpenoids were absent in K0-888 compared to the plant extracts. The MDA level decreased significantly (pLannea humilis and KO-888 at all doses and low dose mixture of Lannea humilis and Parkia biglobosa (50:50). The CAT activity showed a significant (pLannea humilis at a low dose and Parkia biglobosa at a high dose. These antioxidant enzyme effects were less than the standard. The blood urea nitrogen showed a significant (pLannea humilis and KO-888 at all doses, similar to the standard. Hence, they could be used for the protective management of kidney diseases. Keywords: antioxidant, blood urea nitrogen, creatinine, kidney stone, phytochemicals, traditional medicine. Title: ANTIUROLITHIATIC POTENTIAL OF Parkia biglobosa, Lannea humilis STEM BARK METHANOL EXTRACT AND KO-888 TONIC Author: Shuaibu G. B., Ashikaa B. A., Muhammad B. Y., Bamidele T. O., Zaruwa M. Z. International Journal of Recent Research in Life Sciences (IJRRLS) ISSN 2349-7823 Vol. 10, Issue 3, July 2023 - September 2023 Page No: 1-8 Paper Publications Website: www.paperpublications.org Published Date: 10-July-2023 DOI: https://doi.org/10.5281/zenodo.8131116 Paper Download Link (Source) https://www.paperpublications.org/upload/book/ANTIUROLITHIATIC%20POTENTIAL-10072023-4.pdf, International Journal of Recent Research in Life Sciences (IJRRLS), ISSN 2349-7823, Paper Publications, Website: www.paperpublications.org

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

A relationship may exist between selenium and kidney calculi, but there is a lack of research in this field at present. Our study explored the relationship between the serum selenium level and a medical history of adult kidney calculi. We utilized data from the National Health and Nutrition Examination Survey conducted between 2011 and 2016. Participants self-reported their history of kidney stones, while serum selenium levels were measured using inductively coupled plasma dynamic reaction cell mass spectrometry. Our findings indicate a negative correlation between serum selenium levels and the risk of kidney stone history. In the multiple-adjusted model, the lowest serum selenium level group had a higher risk than the other groups. The odds ratio (95% confidence interval) of ever having kidney stones for the highest serum selenium level group was 0.54 (0.33–0.88). In the results of stratified analysis, this relationship was still significant in the groups of women and those 40–59 years. We also found that as a nonlinear dose–response relationship between serum selenium levels and the history of kidney stones disease. In our research, we found that people with higher serum selenium levels had a lower risk of having a history of kidney stones. We concluded that selenium may have a protective effect on kidney stones. In the future, more population studies are needed to explore the relationship between selenium and kidney stones.

The increasing prevalence of urolithiasis in industrialized societies triggered considerable interest in how various species found in urine regulate the nucleation and growth of common kidney stone constituents such as calcium oxalate (CaOx). Yet, the role macromolecules play in kidney stone formation is often overlooked due to their low concentration in urine. In this study, we investigate the nucleation kinetics of CaOx in artificial urine with droplet-based microfluidic induction time measurements at varying concentrations of oxalate and hyaluronic acid (HA), a polysaccharide commonly found in urine. The formation of two pseudo-polymorphic forms of calcium oxalate crystals, calcium oxalate monohydrate (COM) and calcium oxalate dihydrate (COD), are carefully monitored using polarized light microscopy in induction time experiments. COM and COD nucleated concomitantly in artificial urine yet with distinct kinetics. Our results indicate that higher oxalate concentrations favor the formation of COD, the metastable form, over COM, the most stable form. Moreover, COD is also the fastest nucleating form in droplets under studied conditions. Furthermore, increasing the concentration of HA at fixed calcium and oxalate concentrations favored the nucleation of COM. We observed that in droplets where COM nucleated first, COD was not formed within the experimental time scale. However, in the droplets where COD appeared first, COM crystals were also observed later. We hope our findings shed light on the role macromolecules such as HA plays in dictating the pseudo-polymorphic form of CaOx and guide next generation treatments. QC 20220601

Calcium oxalate (CaOx) crystals are the main component of kidney stones. Macrophages have the function of eliminating these crystals, and the underlying mechanism remains unclear. Here, we attempted to determine the role of macrophage-derived exosomes exposed to CaOx crystals in regulating apoptosis of human proximal tubular cells (HK-2). Exosomes (CaOx-Exo) were isolated from CaOx-treated macrophages and then incubated with HK-2 cells. CaOx-Exo treatment reduced cell viability and promoted apoptosis of HK-2 cells. The expression of Caspase-3 and Bax was increased, and Bcl-2 expression was decreased in HK-2 cells following CaOx-Exo treatment. Moreover, CaOx-Exo treatment caused an increase of LC3-II/LC3-I ratio and Beclin-1 expression and a downregulation of p62 in HK-2 cells. GFP-LC3 puncta were increased in HK-2 cells following CaOx-Exo treatment. Additionally, CaOx-Exo-treated HK-2 cells were treated with 3-methyladenine (3-MA) to inhibit autophagy activity. 3-MA treatment weakened the impact of CaOx-Exo on cell viability and apoptosis of HK-2 cells. 3-MA treatment also reduced the LC3-II/LC3-I ratio and Beclin-1 expression and enhanced p62 expression in CaOx-Exo-treated HK-2 cells. In conclusion, these data demonstrated that exosomes derived from CaOx-treated macrophages promote apoptosis of HK-2 cells by promoting autophagy. Thus, this work suggests that macrophage-derived exosomes may play a vital role in CaOx-induced human proximal tubular cell damage.

Chulalongkorn Medical Journal, 67, 1, 063-069

Xin-Yuan Sun,1,* Hui Zhang,2,* Ji-Wang Deng,1,* Bang-Xian Yu,1 Yi-Han Zhang,1 Jian-Ming Ouyang2 1Department of Urology, Guangzhou Institute of Urology, Guangdong Key Laboratory of Urology, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou Medical University, Guangzhou, Guangdong, 510230, People’s Republic of China; 2Department of Chemistry, Institute of Biomineralization and Lithiasis Research, Jinan University, Guangzhou, 510632, People’s Republic of China*These authors contributed equally to this workCorrespondence: Xin-Yuan SunDepartment of Urology, Guangzhou Institute of Urology, Guangdong Key Laboratory of Urology, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou Medical University, Guangzhou, Guangdong, 510230, People’s Republic of ChinaEmail sunxinyuan1985@163.comJian-Ming OuyangDepartment of Chemistry, Institute of Biomineralization and Lithiasis Research, Jinan University, Guangzhou, 510632, People’s Republic of ChinaTel +86-20-85223353Email toyjm@jnu.edu.cnBackground: The interaction between urinary microcrystals and renal epithelial cells is closely related to kidney stone formation. However, the mechanism of cell state changes that affect crystal–cell interaction remains unclear.Methods: This study investigated the relationship between the sulfate group (–OSO3−) content in Porphyra yezoensis polysaccharide (PYP) and the ability to repair damaged cells, as well as the changes in cell adhesion and endocytosis of nano-calcium oxalate monohydrate (COM) crystals before and after PYP repair of damaged renal tubular epithelial cells. The sulfur trioxide–pyridine method was used to sulfate PYP (–OSO3− content of 14.14%), and two kinds of sulfated PYPs with –OSO3− content of 20.28% (SPYP1) and 27.14% (SPYP2) were obtained. The above three PYPs were used to repair oxalate-damaged human proximal tubular epithelial cells (HK-2), and the changes in the biochemical indicators of the cells before and after the repair and the changes in cell adhesion and endocytosis of nano-COM crystals were detected.Results: After repair by PYPs, the cell viability increased, the number of reactive oxygen species decreased, and the reduction of mitochondrial membrane potential and the release of intracellular Ca2+ were suppressed. The cells repaired by PYPs inhibited the adhesion of nano-COM crystals while promoting the endocytosis of the adhered crystals. The endocytosed crystals mainly accumulated in the lysosome. The ability of PYPs to repair cell damage, inhibit crystal adhesion, and promote crystal endocytosis was enhanced when the –OSO3− content increased. Among them, SPYP2 with the highest –OSO3− content showed the best biological activity.Conclusion: SPYP2 showed the best ability to repair damaged cells, followed by SPYP1 and PYP. SPYP2 may become a potential green drug that inhibits the formation and recurrence of calcium oxalate stones.Keywords: Porphyra yezoensis polysaccharide, polysaccharide sulfation, cell repair, adhesion and endocytosis, kidney stone

Background To review the practice patterns for the acceptance of medically complex living kidney donors (MCLKD) among the transplant providers of the international transplant community. Methods We distributed a survey globally, through major international transplantation societies, among nephrologists and transplant surgeons (TS). The survey contained questions regarding potential donors with microscopic hematuria, sickle cell trait, renal cysts, kidney stones, smoking, or illegal drug use. Results There were 239 respondents from 29 countries, including nephrologists (42%) and TS (58%). Although most respondents would investigate microscopic hematuria, one-third of them indicated they would decline these potential donors without investigation. Interestingly, most respondents accepted heavy smokers, intermittent illegal drug users (with advice to quit), and those with incidentally identified kidney stones, remote history of renal colic or simple renal cysts. We found multiple areas of consensus in practice with some interesting differences between nephrologists and TS. Conclusions This survey highlights the practice patterns of the acceptance of MCLKDs among the international community. In the absence of clear guidelines, this survey provides additional information to counsel kidney donors with microscopic hematuria, sickle cell trait, renal cysts, kidney stones, heavy smoking, or illegal drug use.

Hua Jiang,1,2 Lili Li,3 Jing Liu,1 Bin Xu,1 Shuqiu Chen,1 Weidong Zhu,1 Ming Chen1 1Department of Urology, Affiliated Zhongda Hospital of Southeast University, Nanjing, 210009, People’s Republic of China; 2Department of Medical College, Southeast University, Nanjing, 210009, People’s Republic of China; 3Department of Periodontology, The Affiliated Stomatological Hospital of Nanjing Medical University, Nanjing, 210009, People’s Republic of ChinaCorrespondence: Ming Chen; Shuqiu ChenDepartment of Urology, Affiliated Zhongda Hospital of Southeast University, No. 87 Dingjiaqiao, Hunan Road, Gulou District, Nanjing, 210009, People’s Republic of ChinaTel/Fax +86-13913009977; Tel/Fax +86-15951815171Email mingchenseu@126.com; chenshuqiuseu@163.comBackground: Triglyceride–glucose (TyG) index has been considered as the reliable marker of insulin resistance (IR), which is one risk factor of kidney stone. This study aimed to evaluate the TyG index in the occurrence of kidney stones among the United States (US) population.Methods: Participants who received assessment were retrieved from the National Health and Nutrition Examination Survey (NHANES) between 2007 and 2018. The logistic regression analysis was conducted to assess the relationship between the TyG index and kidney stones occurrence. A 1:1 matched-pair analysis was established to optimize the bias in kidney stones by propensity score matching (PSM). The dose–response curve was performed to verify the association between the TyG index and risk of kidney stones.Results: Of the 14,158 eligible enrolled participants, 1346 (9.5%) self-reported a history of kidney stones. All participants were divided into two groups (high TyG index group and low TyG index group) based on the median TyG index. The dose–response curve exhibited a positive non-linear correlation between the TyG index and kidney stones risk. High TyG index was related to increased kidney stones occurrence in participants, with adjusted odds ratios (AOR) of 1.14 (95% confidence intervals (CI): 1.01– 1.30, P = 0.038) compared with the low TyG index subgroup before PSM. After PSM, the risk of kidney stones was 19% higher in the high TyG group compared with the low TyG group (AOR = 1.19, 95% CI: 1.02– 1.38, P = 0.026), and the dose–response curve still showed a positive association between TyG index and kidney stone risk.Conclusion: The TyG index was independently associated with kidney stones and would be a novel biomarker in predicting occurrence for clinical decision.Keywords: kidney stone, triglyceride–glucose index, insulin resistance, cross-sectional, National Health and Nutrition Examination Survey

Hua Jiang,1,2 Lili Li,3 Jing Liu,1 Bin Xu,1 Shuqiu Chen,1 Weidong Zhu,1 Ming Chen1 1Department of Urology, Affiliated Zhongda Hospital of Southeast University, Nanjing, 210009, People’s Republic of China; 2Department of Medical College, Southeast University, Nanjing, 210009, People’s Republic of China; 3Department of Periodontology, The Affiliated Stomatological Hospital of Nanjing Medical University, Nanjing, 210009, People’s Republic of ChinaCorrespondence: Ming Chen; Shuqiu ChenDepartment of Urology, Affiliated Zhongda Hospital of Southeast University, No. 87 Dingjiaqiao, Hunan Road, Gulou District, Nanjing, 210009, People’s Republic of ChinaTel/Fax +86-13913009977; Tel/Fax +86-15951815171Email mingchenseu@126.com; chenshuqiuseu@163.comBackground: Triglyceride–glucose (TyG) index has been considered as the reliable marker of insulin resistance (IR), which is one risk factor of kidney stone. This study aimed to evaluate the TyG index in the occurrence of kidney stones among the United States (US) population.Methods: Participants who received assessment were retrieved from the National Health and Nutrition Examination Survey (NHANES) between 2007 and 2018. The logistic regression analysis was conducted to assess the relationship between the TyG index and kidney stones occurrence. A 1:1 matched-pair analysis was established to optimize the bias in kidney stones by propensity score matching (PSM). The dose–response curve was performed to verify the association between the TyG index and risk of kidney stones.Results: Of the 14,158 eligible enrolled participants, 1346 (9.5%) self-reported a history of kidney stones. All participants were divided into two groups (high TyG index group and low TyG index group) based on the median TyG index. The dose–response curve exhibited a positive non-linear correlation between the TyG index and kidney stones risk. High TyG index was related to increased kidney stones occurrence in participants, with adjusted odds ratios (AOR) of 1.14 (95% confidence intervals (CI): 1.01– 1.30, P = 0.038) compared with the low TyG index subgroup before PSM. After PSM, the risk of kidney stones was 19% higher in the high TyG group compared with the low TyG group (AOR = 1.19, 95% CI: 1.02– 1.38, P = 0.026), and the dose–response curve still showed a positive association between TyG index and kidney stone risk.Conclusion: The TyG index was independently associated with kidney stones and would be a novel biomarker in predicting occurrence for clinical decision.Keywords: kidney stone, triglyceride–glucose index, insulin resistance, cross-sectional, National Health and Nutrition Examination Survey

SUMMARY OBJECTIVE: Mini-percutaneous nephrolithotomy is a recent advancement in the field of kidney stone treatment; however, its role has not been completely established. We aimed to compare the outcomes of initial Mini-percutaneous nephrolithotomy and flexible ureteroscopy. METHODS: A retrospective review of consecutive mini-percutaneous procedures was performed. Inclusion criteria were as follows: all percutaneous nephrolithotomy procedures performed with an access sheath up to 24Fr, kidney stone burdens up to 1550 mm3; and the presence of postoperative computed tomography (for control). The data collected for Mini-percutaneous nephrolithotomy procedures were paired 1:2 with patients treated with flexible ureteroscopy for stones between 100 and 1550 mm3, and with postoperative computed tomography for control. A 14Fr Mini-percutaneous nephrolithotomy set was used. The stone-free rate was defined as the absence of fragments on the control computed tomography, whereas success was limited to 2-mm residual fragments. Statistical analysis was performed using SPSS version 19. RESULTS: A total of 63 patients met the inclusion criteria (42 with flexible ureteroscopy and 21 with mini-percutaneous nephrolithotomy). Demographic data were comparable. The stone-free rate and success were similar between the groups (76.2 vs. 66.7%, p=0.42 and 90.5 vs. 85.7%, p=0.57). The complication rate was also similar (26.1 vs. 9.6%, p=0.188), but Mini-percutaneous nephrolithotomy had longer hospitalization and fluoroscopy time (p=0.001 in both). CONCLUSIONS: Our initial study of Mini-percutaneous nephrolithotomy showed that it is a promising procedure, with outcomes similar to flexible ureteroscopy, but with higher inpatient numbers and fluoroscopy times. A larger study population size and better equipment may improve the outcomes of mini-percutaneous nephrolithotomy.

The aim of this study was to construct the fourth in a series of guidelines on the treatment of urolithiasis by the International Alliance of Urolithiasis (IAU) that by providing a clinical framework for the metabolic evaluation, prevention, and follow-up of patients with urolithiasis based on the best available published literature. All recommendations were summarized following a systematic review and assessment of the literature in the PubMed database from January 1976 to June 2022. Each generated recommendation was graded using a modifed GRADE methodology. Guideline recommendations were developed that addressed the following topics: initial evaluation, metabolic testing, dietary measures, medical management, and follow-up of recurrent stone formers. It was emphasized by the Panel that prevention of new stone formation is as important as the surgical removal of the stones. Although general preventive measures may be efective in reducing stone recurrence rates in some patients, specifc medical and dietary management should be well considered and eventually applied in an individualized manner based on the outcomes of metabolic work-up, stone analysis and some certain patient related factors. A detailed follow-up of each case is essential depending on the metabolic activity of each individual patient.

Kidney diseases are one of the most common diseases worldwide and cause unbearable pain in most people. In this study aims to detecting the cyst and stone in the kidney. For the this purpose, YOLO architecture designs were used for detection of kidney, kidney cyst and kidney stone. The YOLO architecture designs were supported by the explainable artificial intelligence (xAI) feature. CT images in three classes, namely 72 kidney cysts, 394 kidney stones and 192 healthy kidneys were used in the performance analysis part of the YOLO architecture designs. As a result, YOLOv7 architecture design outperformed the YOLOv7 Tiny architecture design. YOLOv7 architecture design achieved the mAP50 of 0.85, precision of 0.882, sensitivity of 0.829 and F1 score of 0.854. Consequently, deep learning based xAI assisted computer aided diagnosis (CAD) system was developed for diagnosis of kidney diseases., Böbrek hastalıkları dünya çapında en yaygın hastalıklardan biridir ve çoğu insanda dayanılmaz ağrılara neden olur. Bu çalışmada böbrekteki kist ve taşın tespiti amaçlanmıştır. Bu amaçla böbrek, böbrek kisti ve böbrek taşı tespiti için YOLO mimari tasarımları kullanılmıştır. YOLO mimari tasarımları açıklanabilir yapay zeka (AYZ) özelliği ile desteklenmiştir. YOLO mimari tasarımlarının performans analizi kısmında 72 böbrek kisti, 394 böbrek taşı ve 192 sağlıklı böbrek olmak üzere üç sınıftaki BT görüntüleri kullanılmıştır. Sonuç olarak, YOLOv7 mimari tasarımı, YOLOv7 Tiny mimari tasarımından daha iyi performans gösterdi. YOLOv7 mimari tasarımı 0.85 mAP50 değerini, 0.882 kesinliği, 0.829 duyarlılığı ve 0.854 F1 skorunu elde etmiştir. Sonuç olarak, böbrek hastalıklarının teşhisi için derin öğrenme tabanlı AYZ destekli bilgisayar destekli tanı (BDT) sistemi geliştirilmiştir.

The present study was designed to evaluate the antiurolithiatic activity of Prosopis farcta (P. farcta) ethanol fruit extract in ethylene glycol (EG) induced urolithiasis in male albino rats. Lithiasis was induced by oral administration of EG 1% in male albino rats for 28 days. Seventy eight male albino rats weighing 250-300g were used and divided into six experimental groups. Group A is a control group received standard rat chow and tap water ad libitum, while, rest of groups namely group B, C, D, E, F animals received 1% EG in water for 28 days, then from day 15 to day 28 in addition to EG administration, group C received cystone, group D, E and F received 100, 200 and 300 mg/kg body weight (B.W.) of ethanol fruit extract of P. farcta respectively. On day 28, blood was collected for serum biochemical (serum uric acid, creatinine, urea, electrolytes measurements, malondialdehyde (MDA) and superoxide dismutase (SOD)) determinations. While urine was collected to microscopic analysis of formed crystals besides the kidney weight/ B.W. ratio and B.W. gain/ loss values were determined. Intermediate dose (200mg/kg B.W.) of P. farcta extract significantly decreased serum creatinine, urea, MDA and non-significantly recovered SOD toward control value in group E as compared to group B, also significant elevation in kidney weight/ B.W. ratio and reduction in B.W. gains in group B occurred as compared with group A. In conclusion: P. farcta fruit extract has potentially therapeutic effects on EG induced kidney stone which can be used as effective antiurolithiatic agent rather than cystone.

Background/aim Open or percutaneous renal stone surgery can have an adverse effect on the collecting system of the kidney. We evaluated retrograde intrarenal surgery outcomes in patients with ≤30 mm renal stones who had open or percutaneous renal stone surgery history. Materials and methods A total of 707 patients who underwent retrograde intrarenal surgery treatment were included in this study. Fifty-six patients had open or percutaneous renal stone surgery history (Group 1) and the remaining did not (Group 2, n = 651). The groups were compared in terms of age, stone size, stone-free rates, and complications. Results The mean age of the patients was 51.16 ± 14.8 and 45.95 ± 14.6 years in Groups 1 and 2, respectively (p = 0.008). The mean stone size was 14.97 ± 6.1 mm and 16.47 ± 6.9 mm in Groups 1 and 2, respectively (p = 0.107). The stone-free rates were 71.4% and 84.1% in Group 1 and 2 respectively and it was significantly higher in Group 2 (p = 0.013). The overall rate of postoperative complications was higher in Group 1 (p = 0.019), but there was no difference between the two groups in terms of Clavien 1–2 and 3–4a complication rates. Conclusion Our results showed that having a history of open or percutaneous renal stone surgery has a negative effect on the success and complication rates in retrograde intrarenal surgery. Therefore, patients should be well informed before this operation.

Background/aim In this study, we aimed to compare the results of prone and Barts “flank-free” modified supine percutaneous nephrolithotomy (PCNL) operations in our clinic. Materials and methods The data from patients that underwent Barts “flank-free” modified supine PCNL (BS-PCNL) (n = 52) between June 2018 and July 2020 and prone PCNL (P-PCNL) (n = 286) between April 2014 and June 2018 were retrospectively evaluated. Of those 286 patients, 104 patients whose sex, age, body mass index, American Society of Anesthesiology score, stone localization, stone size, and hydronephrosis matched the BS-PCNL group in a 1:2 ratio were included in the study. The groups were compared in terms of intraoperative outcome, complication rates, and stone-free rates. Results The mean age of all patients (58 females, 98 males) included in the study was 41.8 ± 15.2 years, and the mean body mass index (BMI) was 24.7 ± 2.9 kg/m2. The mean operation time was significantly shorter in the BS-PCNL group than in the P-PCNL group (80.2 ± 15.1 min vs. 92.4 ± 22.7 min and p = 0.01). There was no significant difference between the two groups in terms of fluoroscopy time, intraoperative complications, postoperative complications, and stone-free rates. Conclusion Our study shows that BS-PCNL is an effective and safe method that significantly reduces the operation time and should be considered as one of the primary treatment options for patients scheduled for PCNL.

Objective:This study aimed to investigate peri-/postoperative effects of three-dimensional measurement of stone size in patients who underwent retrograde intrarenal surgery, where preoperative stone size calculations determine the operation decisions and prognosis. Another aim is to determine a limit value in cm3 for retrograde intrarenal surgery and to predict stone-free status based on this limit value.Materials and Methods:Data of 184 patients were retrospectively analysed. Patients were divided into two groups according to whether the stone-free status was achieved. Postoperative stone-free status and related effective parameters were analysed statistically.Results:No significant difference was found between age, gender, Hounsfield unit, length of hospital stay, secondary retrograde intrarenal surgery, renal unit abnormality, stone side, stone opacity, presence of additional ureteral stone, hydronephrosis and preoperative Double-J stent placement with stone-free rate. Subsequent interventions for residual stones, number of stones, stone sizes in cm2 and cm3 and operation time were determined as parameters that significantly affected the stone-free rate. As a result of the receiver operating characteristic analysis, the threshold stone size was 1.54 cm3.Conclusion:More accurate indications can be determined by calculating the volume of the stone. Retrograde intrarenal surgery success decreases in stones >1.54 cm3 by volume calculation. A different method such as percutaneous nephrolithotomy should be considered with higher preference for stones above this value.

Because the impact of the full-scale substitution of Ca2+ in brushite (CaHPO4·2H2O) with Ni2+ ions has never been systematically explored, it is the focus of this investigation, as it holds potential for use in CaxNi1−xHPO4·nH2O production. These biomaterials have many beneficial characteristics that can be modified to suit diverse applications, including bone tissue regeneration and pharmaceutics. For the present study, NaH2PO4·2H2O, Ca(NO3)2·4H2O, and Ni(NO3)2·6H2O were used in various molar concentrations to obtain the required starting solutions. Previous studies have shown that adding Ni ions in the initial solution below 20% results in the precipitation of monophasic brushite with slight changes in the crystal structure. However, this study confirms that when the Ni ions substitution increases to 20%, a mixture of phases from both brushite and hexaaquanickel(II) hydrogenphosphate monohydrate HNiP (Ni(H2O)6·HPO4·H2O) is formed. The results confirm that the full replacement (100%) of Ca ions by Ni ions results in a monophasic compound solely comprising orthorhombic HNiP nanocrystals. Therefore, a novel technique of HNiP synthesis using the precipitation method is introduced in this research work. These materials are subsequently analyzed utilizing powder X-ray diffraction (XRD), X-ray photoelectron spectroscopy (XPS), thermogravimetric analysis (TGA), and scanning electron microscopy (SEM). The obtained results confirm that the material microstructure is controlled by the Ni/Ca ratio in the starting solution and can be modified to obtain the desired characteristics of phases and crystals.

Background Amiloride is a competitive blocker of the epithelial sodium (Na) channel in the renal collecting duct. It is a less potent diuretic than thiazides or loop diuretics, but is often used in association with its potassium (K)-sparing profile. Whether amiloride has a hypocalciuric effect similar to thiazides remains unclear. Animal studies and experiments on cell lines suggested that amiloride increases calcium (Ca) reabsorption in the distal nephron, but human studies are scarce. Methods We performed a post hoc analysis of a study with 48 healthy males (mean ± standard deviation age, 23.2 ± 3.9 years) who were assigned to a high-Na/low-K diet for 7 days before receiving 20 mg of amiloride orally. Urinary excretions of electrolytes were measured at 3 and 6 h afterwards; we calculated the relative changes in urinary excretion rates after amiloride administration. Results The high-Na/low-K diet led to an expected suppression of plasma renin and aldosterone. Amiloride showed a mild natriuretic effect associated with a decreased kaliuresis. Urinary Ca excretion dropped substantially (by 80%) 3 h after amiloride administration and remained low at the sixth hour. At the same time, fractional excretion of lithium decreased by a third, reflecting an increased proximal tubular reabsorption. Conclusions During a high-Na/low-K diet, amiloride had a strong acute hypocalciuric effect, most probably mediated by increased proximal Ca reabsorption, even though a distal effect cannot be excluded. Further studies should establish if chronic amiloride or combined amiloride/thiazide treatment may decrease calciuria more efficiently and be useful in preventing kidney stones.

Amaç:Bu çalışmanın amacı; yoğun bakım ünitesinde yatan hastaların cinsiyetine ve yaşına göre böbrek taşı insidansı, mortalite durumları, yoğun bakım yatış süreleri ve hastane yatış sürelerini incelemektir. Materyal ve Metod: Bu çalışma retrospektif kesitsel bir çalışma tasarımı olarak yapılmıştır. 2020-2021 tarihleri arasında Sağlık Bilimleri Üniversitesi Şanlıurfa Mehmet Akif İnan SUAM Cerrahi Yoğun Bakım Ünitesi ve Üroloji Kliniği tarafından 10-94 yaş arası yoğun bakım ünitesine yatan 376 hasta ile gerçekleştirilmiştir. Çalışma kapsamına hastaların cinsiyet, yaş, görüntüleme sonuncunda böbrek taş veya kist durumu, mortalite durumu, yoğun bakım yatış süresi, hastane yatış süresi kayıt edilmiştir. Veriler Ki-kare, ANOVA ve bağımsız t-test kullanılarak analiz edilmiştir. Bulgular: Elde edilen bulgulara göre bu çalışmaya katılan hastaların böbrek taşı genel insidansı %7,38 olarak bulunmuştur. Bu çalışma kapsamında kadın hastaların ve erkek hastaların böbrek taşı insidansı incelendiğinde kadın hastalarda %6,45 olarak bulunurken erkek hastalarda %7,60 olarak bulunmuştur. Ancak bu farklılık istatiksel olarak anlamlı bulunmamıştır. Ayrıca yaş ile birlikte böbrek taşı insidansının yükseldiği anlaşılmıştır. Böbrek taşı olanların ölüm oranı %1,9 olarak bulunmuştur. Sonuçlar: Bu çalışma sonunda elde edilen bulgular literatür ile paralellikler göstermektedir. Çalışmanın uygulandığı coğrafyanın ve hasta profilinin farklı olmasından dolayı mevcut verilerin farklı demografik yapı verileri ile desteklenmesi sağlanmıştır., Background: The aim of this study is to examine the incidence of kidney stones, mortality status, length of stay in the intensive care unit and length of hospitalization according to the gender and age of the patients hospitalized in the intensive care unit.Materials and Methods: This study was designed as a retrospective cross-sectional study. Between 2020-2021, Health Sciences University Sanliurfa Mehmet Akif İnan Education Research Hospital was carried out with 376 patients between the ages of 10-94 who applied to the hospital. In the scope of the study, gender, age, renal stone or cyst status as a result of imaging, mortality status, duration of intensive care hospitalization, and hospitalization period of the patients were recorded. Data were analyzed using Chi-square, ANOVA and independent t-test.Results: According to the findings, the overall incidence of kidney stones in the patients participa-ting in this study was found to be 7%. In this study, when the incidence of kidney stones in fema-le and male patients was examined, it was found as 6% in female patients and 8% in male pati-ents. However, this difference was not statistically significant. It has also been understood that the incidence of kidney stones increases with age. The mortality rate of those with kidney stones was found to be 2%.Conclusions: The findings obtained at the end of this study show parallels with the literature. Due to the different geography and patient profile of the study, the existing data were suppor-ted by different demographic data.

ObjectiveIn urology guidelines, endourological treatmentssuch as percutaneous nephrolithotomy (PCNL)and retrograde intrarenal surgery (RIRS) arerecommended for lower pole stones with a diameter of10-20 mm, especially in cases where extracorporealshock wave lithotripsy (SWL) fails or SWL is notappropriate. In this study, we compared the results ofpatients who underwent RIRS and mini percutaneousnephrolithotomy (m-PCNL) for lower pole stones witha diameter of 10-20 mm.Material and MethodThe data of 187 patients (116 RIRS, 71 m-PCNL)who underwent endourological treatment (RIRS orm-PCNL) for 10-20 mm lower pole kidney stonesbetween 2020 and 2022 were retrospectivelyanalyzed. To avoid preoperative biases, propensityscore-matching was applied based on a 1:1 ratio.According to the results of the analysis, 65 patientswho underwent RIRS and 65 patients who underwentm-PCNL were included in the study. Intraoperative(operation time, fluoroscopy time) and postoperativefindings (hospitalization time, drop in hematocrit,stone-free rates, and complications) were comparedbetween the two groups. Postoperative stonedetection of 4 mm or larger was defined as clinicallysignificant residue. Complications were classifiedaccording to the Clavien scoring system and asintraoperative-postoperative.ResultsWhen the two groups were compared in terms ofdemographic characteristics (age, gender, bodymass index) and radiographic stone characteristics(stone size, stone laterality, stone opacity, and stonedensity), no statistically significant difference wasobserved. When the groups were compared in termsof operation time, fluoroscopy time and hospitalizationtime, these periods were statistically significantlyshorter in the RIRS group (p, AmaçÜroloji kılavuzlarında 10-20 mm arası alt pol taşlarındaözellikle ekstrakorporal şok dalga litotripsi(SWL)'nin başarısız olduğu veya SWL'nin uygun olmadığıdurumlarda endoürolojik tedaviler olan perkütannefrolitotomi (PCNL) ve retrograd intrarenal cerrahi(RİRC) önerilmektedir. Bu çalışmada 10-20 mmarası alt pol taşlarında RİRC ile mini perkütan nefrolitotomi(m-PCNL) uygulanan hastaların sonuçlarınıkarşılaştırdık.Gereç ve Yöntem2020 ile 2022 yılları arasında 10-20 mm arası alt polböbrek taşı nedeniyle endoürolojik tedavi (RİRC veyam-PCNL) uygulanan 116’sı RİRC, 71’i m-PCNL olantoplam 187 hastanın dosyaları retrospektif olarak incelendi.Preoperatif yanlılıkları önlemek için 1:1 oranıtemel alınarak eğilim skoru eşleştirmesi (propensityscore-match) uygulandı. Analiz sonucuna göre RİRCuygulanan 65 hasta ve m-PCNL uygulanan 65 hastaçalışmaya dahil edildi. İki grup arasında intraoperatif(operasyon süresi, floroskopi süresi) ve postoperatifbulgular (hastane yatış süresi, hematokrit düşüşü,taşsızlık oranları ve komplikasyonlar) karşılaştırıldı.Operasyon sonrası 4 mm veya daha büyük taşsaptanması klinik anlamlı rezidü olarak tanımlandı.Komplikasyonlar Clavien skorlama sistemine göre veintraoperatif-postoperatif olarak sınıflandırıldı.BulgularHer iki grup, demografik özellikler (yaş, cinsiyet, vücutkitle indeksi), radyografik taş karakteristikleri (taşboyutu, taş lateralitesi, taş opasitesi, ve taş dansitesi)açısından karşılaştırıldığında istatistiksel olarak anlamlıfark gözlenmedi. Operasyon süresi, floroskopisüresi, hastane yatış süresi açısından gruplar karşı-laştırıldığında, RİRC grubunda bu süreler istatistikselolarak anlamlı derecede daha kısaydı (p

Backgound: The composition of stones formed in the urinary tract plays an important role in their management over time. The most common imaging method for the non-invasive evaluation of urinary stones is radiography and computed tomography (CT). However, CT is not very sensitive, and cannot differentiate between all critical stone types. In this study, we propose the application, and evaluate the potential, of a multi-modal (or multi-contrast) X-ray imaging technique called speckle-based imaging (SBI) to differentiate between various types of urinary stones. Methods: Three different stone samples were extracted from animal and human urinary tracts and examined in a laboratory-based speckle tracking setup. The results were discussed based on an X-ray diffraction analysis and a comparison with X-ray microtomography and grating-based interferometry. Results: The stones were classified through compositional analysis by X-ray diffraction. The multi-contrast images obtained using the SBI method provided detailed information about the composition of various urinary stone types, and could differentiate between them. X-ray SBI could provide highly sensitive and high-resolution characterizations of different urinary stones in the radiography mode, comparable to those by grating interferometry. Conclusions: This investigation demonstrated the capability of the SBI technique for the non-invasive classification of urinary stones through radiography in a simple and cost-effective laboratory setting. This opens the possibility for further studies concerning full-field in vivo SBI for the clinical imaging of urinary stones.

Background: The current clinical practice to manage kidney stone requires knowledge of the stone composition. However, it is often difficult to determine the actual stone composition before a stone is operatively removed from the patient. Dual-energy computed tomography (DECT) can predict urinary stone composition, but it is not widely adopted. The purpose of the study was to investigate the use of a second-generation DECT with tin or stannum (Sn) filter for characterising the kidney stones composition. Methods: Thirty-three kidney stones were scanned ex vivo using a dual-source (DS)DECT scanner with dual-energy (DE) mode of 80/140 kVp with and without 4 mm Sn filtration. DE ratio was calculated to determine the kidney stones composition (uric acid, calcium oxalate, calcium phosphate and cystine). The median DE ratio of the stones was compared using Wilcoxon signed rank test and the results were further correlated with semi-quantitative Fourier transform infrared (FTIR) spectroscopy analysis using Kendall’s Tau test with P < 0.05 deemed to be statistically significant. Results: Second-generation DS-DECT could significantly discriminate the stones composition with and without Sn filtration (P < 0.001). The median DE ratio of uric acid, calcium oxalate and cystine stones were significantly higher with Sn filtration than those without filtration (P < 0.05). DECT results revealed significant correlation with FTIR spectroscopy analysis (r = 0.716, P < 0.001). DECT with Sn filtration showed increased performance (100% sensitivity, 0% specificity) than those without filtration (48.5% sensitivity, 0% specificity) in the detection of the kidney stone subtypes. Conclusion: In the second-generation DECT with additional Sn filtration, DECT has shown a significant performance in characterising and discriminating the kidney stone composition. This may improve diagnostic and therapy management in kidney stones cases.

The aim of this work was to determine which part of a double-J ureteral stent (DJ stents) showed the highest tendency to crystal, calculi, and biofilm deposition after ureterorenoscopic-lithotripsy procedure (URS-L) to treat calcium oxalate stones. Additionally, the mechanical strength and the stiffness of DJ stents were evaluated before and after exposure to urine. Obtained results indicated that the proximal (renal pelvis) and distal (urinary bladder) part is the most susceptible for post-URS-L fragments and urea salt deposition. Both, the outer and inner surfaces of the DJ ureteral stents were completely covered even after 7 days of implantation. Encrustation of DJ stents during a 31-day period results in reducing the Young’s modulus by 27–30%, which confirms the loss of DJ stent elasticity and increased probability of cracks or interruption. Performed analysis pointed to the need to use an antibacterial coating in the above-mentioned part of the ureteral stent to prolong its usage time and to prevent urinary tract infection.

Ponco Birowo, Putu Angga Risky Raharja, Harun Wijanarko Kusuma Putra, Reginald Rustandi, Widi Atmoko, Nur Rasyid Department of Urology, Faculty of Medicine, Universitas Indonesia, Cipto Mangunkusumo Hospital, Jakarta 10430, IndonesiaCorrespondence: Ponco BirowoDepartment of Urology, Faculty of Medicine, University of Indonesia, Cipto Mangunkusumo Hospital, Jalan Diponegoro No. 71, Jakarta 10430, IndonesiaTel +62 213923631Fax +62 81 21 3145592Email ponco.birowo@gmail.comAbstract: X-ray-free ultrasound-guided percutaneous nephrolithotomy (PCNL) has been proven to be safe, feasible, and affordable. Kidney dilatation during X-ray-free ultrasound-guided PCNL is mostly using balloon dilators. This report presents our experience of performing X-ray-free ultrasound-guided PCNL in supine position using Alken metal telescopic dilators in a patient with a large kidney stone. A 50-year-old male presented with right complete staghorn stone sized 46× 30× 24 mm (stone burden: 50,985 mm3 with sphere formula) and grade II hydronephrosis. The computed tomography (CT) scan showed no right ureteric stone, kinking, or stenosis. Ureteral catheter and guidewire were placed retrogradely under ultrasound guidance during cystoscopy. Normal saline was pumped via the ureteral catheter to make artificial hydronephrosis thus assisting the process. Kidney dilatation was performed with Alken metal telescoping dilators. Urine flow from the dilators confirmed that our dilator had reached the collecting system. The stone was identified and fragmented with combination of both pneumatic and shock pulse lithotripter. Double J stent and nephrostomy tubes were inserted at the end of the procedure. All of the steps were performed purely under ultrasound guidance. There was no residual stone after the procedure, confirmed by ultrasound, nephroscope, and postoperative X-ray. There was no significant complication during or after the procedure. The patient was discharged on postoperative day two. X-ray-free ultrasound-guided PCNL in supine position using Alken metal telescoping dilators seems to be a feasible, safe, and cost-effective approach in managing kidney stones, including staghorn and large stones.Keywords: kidney stone, PCNL, supine position, ultrasound-guided, X-ray-free

X-ray-free ultrasound-guided percutaneous nephrolithotomy (PCNL) has been proven to be safe, feasible, and affordable. Kidney dilatation during X-ray-free ultrasound-guided PCNL is mostly using balloon dilators. This report presents our experience of performing X-ray-free ultrasound-guided PCNL in supine position using Alken metal telescopic dilators in a patient with a large kidney stone. A 50-year-old male presented with right complete staghorn stone sized 46×30×24 mm (stone burden: 50,985 mm3 with sphere formula) and grade II hydronephrosis. The computed tomography (CT) scan showed no right ureteric stone, kinking, or stenosis. Ureteral catheter and guidewire were placed retrogradely under ultrasound guidance during cystoscopy. Normal saline was pumped via the ureteral catheter to make artificial hydronephrosis thus assisting the process. Kidney dilatation was performed with Alken metal telescoping dilators. Urine flow from the dilators confirmed that our dilator had reached the collecting system. The stone was identified and fragmented with combination of both pneumatic and shock pulse lithotripter. Double J stent and nephrostomy tubes were inserted at the end of the procedure. All of the steps were performed purely under ultrasound guidance. There was no residual stone after the procedure, confirmed by ultrasound, nephroscope, and postoperative X-ray. There was no significant complication during or after the procedure. The patient was discharged on postoperative day two. X-ray-free ultrasound-guided PCNL in supine position using Alken metal telescoping dilators seems to be a feasible, safe, and cost-effective approach in managing kidney stones, including staghorn and large stones., Video abstract Point your SmartPhone at the code above. If you have a QR code reader the video abstract will appear. Or use: https://youtu.be/n-N4oxLXD-4

Objective: In this study we aimed to evaluate the effectiveness of shock wave lithotripsy (SWL) and retrograde intrarenal surgery (RIRC) in treatment of lower pole kidney stones. Material and Methods: The data of 134 patients who underwent SWL or RIRC treatment for lower pole kidney stone between January 2018 and August 2019 were retrospectively reviewed. The groups were compared statistically in terms of demographic characteristics, stone characteristics and stone-free rates. Results: Ninety-two (68.7%) male and 42 (31.3%) female patients were included in the study. Fifty-nine (44.0%) patients had stone in the right kidney and 75 (56.0%) had stone in the left kidney. The mean age of all patients was 47 ± 16 years, stone burden was 94.7 ± 62.0 mm2 and Hounsfield Unit was calculated as 819.5 ± 256.2. There were 73 (54.5%) patients in the SWL group and 61 (45.5%) patients in the RIRC group. Stone-free rates were calculated as 52.1% and 72.1% for SWL and RIRC groups, respectively. Although stone burden was higher in RIRC group than SWL group, stone-free rate was higher (p=0.004 and p=0.018, respectively). Conclusion: When compared with SWL, higher stone-free rates can be achieved with RIRC with lower number of sessions even in cases with higher stone burden.

Introduction Maintaining hydration reduces incidence of kidney stone disease (KSD), chronic kidney disease (CKD) and urinary tract infections (UTIs). Mobile applications (apps) measuring hydration are gaining in usage, allowing users to monitor intake whilst also taking into account the signs and symptoms of dehydration. Our study looked at the water apps in the management and/or prevention of urological disease. Material and methods The original android app store (Google Play Store), and the Apple App Store (iOS App Store) were searched using the term ‘hydration’, ‘fluid’ and ‘water’. All apps from each distribution platform, with a minimum of 100 reviews, were then selected and analysed. Results After identification of 51 applications (13 from Apple App Store, and 38 from Google Play Store), 45 were free to download and 6 were paid (cost range: $2.19–$7.97). While none of the apps facilitated measurement of urine output and colour, 12 mentioned signs and symptoms of dehydration. Furthermore, when calculating required fluid intake, the level of activity was considered by 31 apps. With regards to information provision, only one of the apps included advice or education about urological conditions associated with poor hydration. None of the apps gave advice on hydration related to CKD and UTI. Conclusions Mobile phone apps are a well-established tool for measuring fluid intake. However, they provide little information regarding the importance of hydration, and don’t utilise other measures such as level of activity, urine output or colour. Considering the increasing popularity of fitness and hydration apps in our daily lives, the developers need to make them more comprehensive and informative.

Aim:To compare the results of micro-percutaneous nephrolithotomy (micro-PNL) and retrograde intrarenal surgery (RIRS) for symptomatic renal stones 5-10 mm in diameter.Methods:A total of 86 patients, who underwent RIRS (n=53) and micro-PNL (n=23), were evaluated retrospectively. Urine analysis, serum creatinine level, urine culture and non-contrast computed tomography scan were performed in all patients preoperatively. Kidney stones were opaque in all cases. Unresolved coagulopathy, active urinary infection, morbid obesity, missing data and pregnancy were considered the criteria for exclusion. The groups were compared in terms of operative time, Visual analogue scale score, analgesic requirement, retreatment, transition to other treatment, complication and stone-free rates and length of hospital stay.Results:Both surgical techniques were similar for all parameters except need for analgesics, which was higher in the micro-PNL group (p=0.026). The stone-free rate was 85.7% in the RIRS group and 78.2% in the micro-PNL group (p=0.43).Conclusion:Both methods can be administered as alternative modalities with high success and low complication rates. However, analgesics requirement was higher in micro-PNL group.

Background Urolithiasis is a growing problem worldwide. Many a times, asymptomatic stones are kept under observation. Many herbal preparations are available for the same, but they lack proper scientific documentation. Objective To study the anti-urolithiatic effect of an herbal preparation, Subap Plus (IP) capsules in patients with asymptomatic renal calculi of size ranging from 4 to 9 mm. Material and methods This was a prospective, randomized, double-blind, placebo-controlled clinical trial conducted in a tertiary care hospital in Pune, India. Patients with asymptomatic renal calculi of 4–9 mm size were randomized (1:1, block randomization) to one of the group Subap Plus (treatment group) or placebo (placebo group). The study outcome included change in visual analog scale (VAS), change in the surface area and density of calculi and their expulsion. Statistical analysis was performed using student's t-test and Chi-square test. Results A total of 120 patients were screened and 84 were enrolled who met the eligibility criteria, of which 65 patients completed the trial (treatment, n = 34; placebo, n = 31). The VAS score significantly decreased in the treatment group (6.9–1.8) than placebo group (7.2–6.8) (p, Graphical abstract Fig. A.1 The extract of Crataeva Nurvala, Musa paradasica Linn, Achyranthes aspera Linn and Hordeum Vulgare Linn (SubapPlus) acts at all the phases of stone formation, i.e nucleation , growth , agregation and crystal retention. Image 1

To evaluate the efficacy of a unique imaging software “OptiVision” on the confidence of stone identification using X-ray imaging during shockwave lithotripsy. A total of 57 patients with solitary radio-opaque kidney stones sized

Introduction: One of the most important problems in the supine percutaneous approach to the kidney is the narrow surgical surface area (SSA) in the lumbar region. Herein, the spatial and angular geometric advantages of the U-shaped lumbar pad (U-Pad) used as a new positioning tool for safety and ergonomics in the supine percutaneous approach have been revealed.Materials and Methods: Data of patients who underwent endoscopic combined intrarenal surgery (ECIRS) using the U-Pad for kidney stones between March and September 2021 were prospectively collected. The demographic, preoperative, operative, and postoperative data of patients have been saved. The patients were positioned first with the standard gel pad (group 1) and then with the U-Pad (group 2). Both SSA (X and X+Y, cm(2)) and angular degree (alpha and beta,degrees) calculations were compared. Fluoroscopy images with the same settings (97 kV/3.00 mA) were visually compared. In geometric data, trapezoidal area formula [(upper base + lower base) x height/2] and goniometer were used to compare with paired t-test.Results: ECIRS was performed on 17 patients, 13 men and 4 women, with a median age of 39 (range 32-47). The median body mass index was 26.2 (23.5-29.1). Stone localization and features were recorded. The median SSA was calculated as 35.7 cm(2) in group 1 and 97.3 cm(2) in group 2, and it was calculated that the total SSA increased to 272.5% with a median of 61.6 cm(2) extra surgical area. Similarly, the downward manipulation angle was 32 degrees (alpha degrees) in group 1, whereas it was 60.6 degrees (beta degrees) in group 2, and the median extra motion angle was calculated as 28.6 degrees (89.3%).Conclusion: The U-Pad is a safe and rapid tool in the supine percutaneous approach to the kidney, providing at least two times the extra SSA and manipulation angle.

We aimed to perform a systematic review of randomized trials to summarize the evidence on the safety and stone-free rate after Tubeless percutaneous nephrolithotomy (PCNL) (ureteral stent/catheter, no nephrostomy) compared to Standard PCNL (nephrostomy, with/without ureteral stent/catheter) to evaluate if the tubeless approach is better. The inverse variance of the mean difference with a random effect, 95% Confidence Interval (CI), and p values was used for continuous variables. Categorical variables were assessed using Cochran-Mantel-Haenszel method with the random effect model, and reported as Risk Ratio (RR), 95% CI, and p values. Statistical significance was set at p < 0.05 and a 95% CI. 26 studies were included. Mean operative time was significantly shorter in the Tubeless group (MD-5.18 min, 95% CI - 6.56, - 3.80, p < 0.00001). Mean postoperative length of stay was also significantly shorter in the Tubeless group (MD-1.10 day, 95% CI - 1.48, - 0.71, p < 0.00001). Incidence of blood transfusion, angioembolization for bleeding control, pain score at the first postoperative day, the number of patients requiring postoperative pain medication, fever, urinary infections, sepsis, perirenal fluid collection, pleural breach, hospital readmission, and SFR did not differ between the two groups. Incidence of postoperative urinary fistula was significantly lower in the Tubeless group (RR 0.18, 95% CI 0.07, 0.47, p = 0.0005). This systematic review shows that tubeless PCNL can be safely performed and the standout benefits are shorter operative time and hospital stay, and a lower rate of postoperative urinary fistula. Universita Politecnica delle Marche within the CRUI-CARE Agreement

Urolithiasis is a worldwide spread condition that affects patients' Health-Related Quality of Life (HRQOL), which measurement is an important tool for routine clinical and research practice. Disease-specific HRQOL measures demonstrated to perform better in assessing the effects of specific conditions. A disease-specific questionnaire for kidney stones, the WISQOL, has been validated in different languages, but an Italian version is still missing. Our aim is to produce and validate the Italian version of WISQOL (IT-WISQOL). Patients undergoing any elective treatment for upper urinary tract stones were enrolled. A multi-step process with forward- and back-translation was used to translate WISQOL into Italian. Patients were evaluated within 15 days pre-operatively and then at 30-, 90 days post-operatively and administered both IT-WISQOL and SF-36v2. Post-operative data such as 30 days postoperative complications, late stone-related events, successful status, and stone complexity were collected. Cronbach's α was used to evaluate the internal consistency of IT-WISQOL, while Spearman's rho was used for item and inter-domain correlations and IT-WISQOL with SF-36v2 correlation. We found excellent internal consistency across all domains (α ≥ 0.88), particularly when the total score is considered (α = 0.960). Test-retest reliability showed excellent results for the total questionnaire (Pearson correlation value: 0.85). The Inter-domain association ranged from 0.497 to 0.786. Convergent validity was confirmed by a good correlation with subdomains of the SF-36v2 measures. IT-WISQOL is a reliable tool to measure HRQOL in stone patients. It shows analog characteristics if compared to English WISQOL.

Vajira Medical Journal, 66, 3, 211-220

著者人数: 12名, 形態: カラー図版あり, Number of authors: 12, Physical characteristics: Original contains color illustrations, Accepted: 2021-08-18, 資料番号: PA2210081000

Kidney stone formation is a global health problem with increasing prevalence. Stone formation is a physiochemical process involving crystallization of inorganic salts in the presence of biological constituents in the urinary system. To inhibit kidney stone formation, a better understanding of the underlying physicochemical mechanism of stone formation in the kidney is required. In this thesis, the solubility, nucleation and growth of calcium oxalate (CaOx), the most common inorganic constituent of kidney stones, were studied under different conditions such as ion concentration, pH value, and also the role of inhibitors in water or artificial urine was investigated. The first step towards this work was obtaining the solubility curve of calcium oxalate monohydrate (COM) in the solvent, such as ultrapure water and different buffers, to elucidate the physicochemical conditions which can cause the kidney stone formation (Chapter 2). Beside the solubility study, advanced technology to observe crystal formation in small scale and a very short time was needed. The volume, structure and flow properties inside the kidney inspired us to use microfluidic technology with comparable volume and flow rate. The developed microfluidic devices that mimic pathways in the human kidney were used to study the nucleation and growth of calcium oxalate crystals. The developed devices rendered an alternate perspective to the study of kidney stone formation and showed that microfluidics can provide precise, simple and fast detection of stone formation under various experimental conditions. Initially, the designed microfluidic device allowed us to build a testing platform for the study of nucleation kinetics of CaOx inside isolated environments provided by droplets. Preliminary experiments were performed by dissolving calcium chloride and sodium oxalate in ultrapure water. The aqueous solution, containing the ions, forms the droplet phase and oil were used as the continuous phase. Altering the pH values, as well as increasing the concentration of additives such as magnesium and osteopontin (OPN), were shown to slow down the nucleation kinetics, or even inhibit nucleation (Chapter 3).

Retrograde intrarenal surgery (RIRS) is an innovative and effective method of kidney stones treatment, as it had great influence on the development of endoscopy in urology. The increasing prevalence of urolithiasis together with the rapid development of endourology leads to a rise in the number of procedures related to the disease. Flexible ureteroscopy is constantly being improved, especially regarding the effectiveness and safety of the procedure. The purpose of this study is to evaluate intraoperative and early post-operative complications of RIRS in the treatment of kidney stones. A retrospective analysis of medical records was performed. A series was comprised of 207 consecutive operations performed from 2017 to 2020. Complications occurred in 19.3% (n = 40) of patients. Occurrence according to the Clavien-Dindo scale was: 11.1% for grade I, 5.8% for grade II and 2.4% for grade IV. Infectious complications included SIRS (5.3%, n = 11) and sepsis (2.4%, n = 5). Statistical analysis revealed a correlation between acute post-operative infections and positive midstream urine culture, history of chronic or recurrent urinary tract infections, and increased body mass index (BMI). Furthermore, a significant correlation was observed between pain requiring the use of opioids with BMI over 25. Consequently, history of urinary tract infections, positive pre-operative urine culture, and increased BMI are considered risk factors and require appropriate management.

The aim of this study is to determine whether Platanus orientalis (PO) which has anti-inflammatory, antioxidant and diuretic properties and used in the treatment of kidney stones as traditional folk medicine, will reduce or prevent the stone formation in the urinary system. To simulate the urolithiasis model 0.75% ethylene glycol (EG) and 1% ammonium chloride (AC) were applied to Sprague-Dawley rats. The rats were divided into four groups (n=8). The control group was given standard drinking water for 5 weeks. EG group received 0.75% EG in their drinking water containing 0.75% EG and 1% AC. PO extract (100 mg/kg) was given orally for 5 weeks to the preventive group and for last 2 weeks to the therapeutic group, respectively. At the end of experiment, 24-hour urine and kidney samples were obtained. In urine samples, calcium and citrate levels were decreased and oxalate level was increased in the EG group. In kidney samples myeloperoxidase, caspase-3, N-acetyl-β-glycosaminidase (NAG) activities, malondialdehyde (MDA), 8-hydroxy-2-deoxyguanosine (8-OHdG), tumor necrosis factor-α and interleukin-1β levels were increased while superoxide dismutase activity and glutathione levels were decreased in the EG group. These biochemical parameters returned to control levels in both PO treatment groups. Histological findings also correlate with these results. Our findings are suggested that PO treatments is effective in both preventive and therapeutic groups.

Rationale & Objective The intestinal microbiome may affect urinary stone disease by modulating the amount of oxalate absorbed from the intestine and subsequently excreted in urine. This study sought to explore the association between antibiotics, which alter the intestinal microbiota, and risk for urinary stone disease. Study Design Prospective cohort study. Setting & Participants 5,010 women in the Nurses’ Health Study (NHS) I and II who had collected 24-hour urine samples. Exposures Use of antibiotics during the age range of 40 to 49 (NHS II), 40 to 59 (NHS I), and 20 to 39 years (both cohorts). Outcomes Incident symptomatic urinary stone disease; urine composition. Analytical Approach Cause-specific hazards regression adjusted for age, body mass index, comorbid conditions, thiazide use, and dietary factors. Follow-up was censored at the time of asymptomatic kidney stones, cancer, or death. Results Cumulative use of antibiotics for a total of 2 or more months during the age range of 40 to 49 years (NHS II) and 40 to 59 years (NHS II) was associated with significantly higher risk for developing incident stones compared with no use (pooled HR, 1.48; 95% CI, 1.12-1.96). Similar results were found for the period of 20 to 39 years (pooled HR, 1.36; 95% CI, 1.00-1.84). Results were unchanged after excluding participants who reported urinary tract infection with their stone event or as the most common reason for antibiotic use. Urine composition was generally similar across antibiotic groups except for marginally lower urine pH and citrate values among those taking antibiotics for 2 or more months. Limitations Observational design; lack of information for type of antibiotic used; relatively large span of time between antibiotic use and urine collection. Conclusions Use of antibiotics for more than 2 months in early adulthood and middle age is associated with higher risk for urinary stone disease in later life.

Background The dietary habits and lifestyle changes during the COVID-19 pandemic could affect the urinary risk factors in kidney stone formers. In this study, we investigated the effects of the COVID-19 pandemic on 24-h urine metabolites, as a surrogate for dietary intake, in patients with kidney stones, in Tehran, Iran. Methods We evaluated the medical records of all patients with urolithiasis who visited in our stone prevention clinic from the beginning of COVID-19 in Iran to 1 year later (Feb 2020–Feb 2021) and compared it with the patients’ medical records in the same period a year before COVID-19 (Feb 2019–Feb 2020). Results The results of our stone prevention clinic showed a decrease in the number of visits during COVID-19. Twenty-four-hour urine urea, sodium, and potassium were significantly lower, and 24-h urine magnesium was significantly higher during COVID-19. Higher 24-h urine oxalate was only shown in patients with the first-time visit, whereas lower 24-h urine uric acid and citrate were only shown in patients with the follow-up visits. Conclusions COVID-19 pandemics may change some of the dietary habits of the patients, including lower salt, protein, and fruit and vegetable intake. Although economic issues, restricted access, or sanitation issues may be the reason for the undesirable dietary changes, the importance of a quality diet should be discussed with all patients, as possible. Since the number of patients visited in the stone clinic was lower during COVID-19, virtual visits could be an excellent alternative to motivate patients with kidney stones.

Renal and cardiovascular disorders are very prevalent and associated with significant morbidity and mortality. Among diverse pathogenic mechanisms, the dysregulation of immune and inflammatory responses plays an essential role in such disorders. Consequently, the discovery of Annexin A1, as a glucocorticoid-inducible anti-inflammatory protein, has fueled investigation of its role in renal and cardiovascular pathologies. Indeed, with respect to the kidney, its role has been examined in diverse renal pathologies, including acute kidney injury, diabetic nephropathy, immune-mediated nephropathy, drug-induced kidney injury, kidney stone formation, and renal cancer. Regarding the cardiovascular system, major areas of investigation include the role of Annexin A1 in vascular abnormalities, atherosclerosis, and myocardial infarction. Thus, this review briefly describes major structural and functional features of Annexin A1 followed by a review of its role in pathologies of the kidney and the cardiovascular system, as well as the therapeutic potential of its modulation for such disorders.

Kidney–ureter–bladder (KUB) imaging is a radiological examination with a low cost, low radiation, and convenience. Although emergency room clinicians can arrange KUB images easily as a first-line examination for patients with suspicious urolithiasis, interpreting the KUB images correctly is difficult for inexperienced clinicians. Obtaining a formal radiology report immediately after a KUB imaging examination can also be challenging. Recently, artificial-intelligence-based computer-aided diagnosis (CAD) systems have been developed to help clinicians who are not experts make correct diagnoses for further treatment more effectively. Therefore, in this study, we proposed a CAD system for KUB imaging based on a deep learning model designed to help first-line emergency room clinicians diagnose urolithiasis accurately. A total of 355 KUB images were retrospectively collected from 104 patients who were diagnosed with urolithiasis at Kaohsiung Chang Gung Memorial Hospital. Then, we trained a deep learning model with a ResNet architecture to classify KUB images in terms of the presence or absence of kidney stones with this dataset of pre-processed images. Finally, we tuned the parameters and tested the model experimentally. The results show that the accuracy, sensitivity, specificity, and F1-measure of the model were 0.977, 0.953, 1, and 0.976 on the validation set and 0.982, 0.964, 1, and 0.982 on the testing set, respectively. Moreover, the results demonstrate that the proposed model performed well compared to the existing CNN-based methods and was able to detect urolithiasis in KUB images successfully. We expect the proposed approach to help emergency room clinicians make accurate diagnoses and reduce unnecessary radiation exposure from computed tomography (CT) scans, along with the associated medical costs.

We aimed to examine the association between metabolic syndrome and the risk of kidney stone development in a large-scale community-based cohort. A total of 121,579 participants enrolled in the Taiwan Biobank were analyzed. They were divided into two groups on the basis of presence of metabolic syndrome. The presence of kidney stone disease was defined by self-reported history of kidney stones. The mean age of participants was 50 years old, and self-reported kidney stones were observed in 3446 (10%) and 4292 (5%) participants with metabolic syndrome and without metabolic syndrome, respectively. Higher prevalence of kidney stone disease was found in participants with metabolic syndrome compared to those without metabolic syndrome (odds ratio (OR), 1.32, 95% confidence interval (95% CI), 1.25 to 1.39). In addition, the risk of incident kidney stone development was analyzed in a longitudinal cohort of 25,263 participants without kidney stones at baseline during a mean follow-up of 47 months. Multivariable Cox regression analysis revealed that the risk for incident kidney stone disease was higher in participants with metabolic syndrome than those without metabolic syndrome (hazard ratio, 1.24, 95% CI, 1.04 to 1.49). Our study suggests that metabolic syndrome does increase the risk of kidney stones.

Background and AimsUrolithiasis is characterized by high rates of prevalence and recurrence. Hyperuricemia is related to various diseases. We hope to determine the association between serum uric acid (UA) level and kidney stone (KS).MethodsIn this population-based cross-sectional study, a total of 82,017 Chinese individuals who underwent a comprehensive examination in 2017 were included. The KS was diagnosed based on ultrasonography examination outcomes. Fully adjusted odds ratio (OR) for KS, and mean difference between the two groups were applied to determine the association of UA level with KS.ResultsAmong the 82,017 participants included in this study (aged 18~99 years), 9,435 participants (11.5%) are diagnosed with KS. A proportion of 56.3% of individuals is male. The mean UA level of overall participants is 341.77 μmol/L. The participants with KS report higher UA level than the participants without KS [mean UA level 369.91 vs. 338.11 μmol/L; mean difference (MD), 31.96 (95% CI, 29.61~34.28) μmol/L]. In men, the OR for KS significantly increases from 330 μmol/L UA level. Every 50 μmol/L elevation of UA level increases the risk of KS formation by about 10.7% above the UA level of 330 μmol/L in men. The subgroup analysis for male is consistent with the overall result except for the participants presenting underweight [adjusted OR, 1.035 (0.875~1.217); MD, −5.57 (−16.45~11.37)], low cholesterol [adjusted OR, 1.088 (0.938~1.261); MD, 8.18 (−7.93~24.68)] or high estimated glomerular filtration rate (eGFR) [adjusted OR, 1.044 (0.983~1.108); MD, 5.61 (−1.84~13.36)]. However, no significant association is observed in women between UA and KS either in all female participants or in female subgroups.ConclusionAmong Chinese adults, UA level is associated with KS in a dose-response manner in men but not in women. However, the association becomes considerably weak in male participants with malnutrition status.

Cystinuria is an autosomal recessive disorder in which the renal reabsorption of cystine, arginine, lysine and ornithine are disturbed. The two genes, the pathogenic forms of which are responsible for the disorder, are SLC7A9 and SLC3A1. In this study, we describe a disease that has a new c.916A> T variant (p. K306 *) in exon 5 of the SLC3A1 gene. This variant results in the NMD phenomenon in which the protein product is not produced because of mRNA destruction. In 2020, blood sample of a 41-yr-old man from east Azerbaijan, Iran together with his parents were collected to be studied. PCR and direct sequencing were performed to detect the possible SLC3A1 variant. Whole-gene sequence analysis done by Mutation surveyor Software revealed a novel nonsense homozygous variant in exon 5 of the gene. Parental Sequence Analysis shows that they are heterozygous. According to ACMG guideline, this variant is considered as pathogen. Finding serious mutations can allow rapid screening for cystinuria by analyzing common mutations. It should also be considered as a pathogenic variant in patients’ cystinuria.

To determine whether functionally relevant questions associated with the urinary or gut microbiome and urinary stone disease (USD) can be answered from metagenome-wide association studies (MWAS), we performed the most comprehensive meta-analysis of published clinical MWAS in USD to date, using publicly available data published prior to April 2021. Six relevant studies met inclusion criteria. For alpha-diversity, significant differences were noted between USD status, stone composition, sample type, study location, age, diet, and sex. For beta-diversity, significant differences were noted by USD status, stone composition, sample type, study location, antibiotic use (30 days and 12 months before sampling), sex, hypertension, water intake, body habitus, and age. Prevotella and Lactobacillus in the gut and urinary tract, respectively, were associated with healthy individuals, while Enterobacteriaceae was associated with USD in the urine and stones. Paradoxically, other Prevotella strains were also strongly associated with USD in the gut microbiome. When data were analyzed together, USD status, stone composition, age group, and study location were the predominant factors associated with microbiome composition. Meta-analysis showed significant microbiome differences based on USD status, stone composition, age group or study location. However, analyses were limited by a lack of public data from published studies, metadata collected, and differing study protocols. Results highlight the need for field-specific standardization of experimental protocols in terms of sample collection procedures and the anatomical niches to assess, as well as in defining clinically relevant metadata and subphenotypes such as stone composition. IMPORTANCE Studies focused on the microbiome broadly support the hypothesis that the microbiome influences the onset of chronic diseases such as urinary stone disease. However, it is unclear what environmental factors shape the microbiome in ways that increase the risk for chronic disease. In addition, it is unclear how differences in study methodology can impact the results of clinical metagenome-wide association studies. In the current meta-analysis, we show that age, stone composition, and study location are the predominant factors that associate with the microbiome and USD status. Furthermore, we reveal differences in results based on specific analytical protocols, which impacts the interpretation of any microbiome study.

Calcium oxalate (CaC2O4) is the major component of kidney stone. The acidic osteopontin (OPN) protein in human urine can effectively inhibit the growth of CaC2O4 crystals, thereby acting as a potent stone preventer. Previous studies in bulk solution all attest to the importance of binding and recognition of OPN at the CaC2O4 mineral surface, yet molecular level insights into the active interface during CaC2O4 mineralization are still lacking. Here, we probe the structure of the central OPN fragment and its interaction with Ca2+ and CaC2O4 at the water–air interface using surface‐specific non‐linear vibrational spectroscopy. While OPN peptides remain largely disordered in solution, our results reveal that the bidentate binding of Ca2+ ions refold the interfacial peptides into well‐ordered and assembled β‐turn motifs. One critical intermediate directs mineralization by releasing structural freedom of backbone and binding side chains. These insights into the mineral interface are crucial for understanding the pathological development of kidney stones and possibly relevant for calcium oxalate biomineralization in general., Surface‐specific vibrational spectroscopy was applied to study the structure and interaction of central urinary osteopontin peptide at the air–water interface and during calcium oxalate mineralization. The interfacial peptides show ordered and assembled β‐turn motifs with binding of Ca2+ ions and CaC2O4 minerals, in contrast to the disordered peptide structure in bulk solution.