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Background: Kidney stones are among the most common urological conditions affecting ~9% of the world population. Although some unhealthy diets and unhealthy lifestyles are reportedly risk factors for kidney stone, the association between daily sitting time and kidney stone has not been explored. Materials and Methods: This large-scale, cross-sectional study was conducted using data from the National Health and Nutrition Examination Survey (NHANES) database 2007-2016. Kidney stone history and daily sitting time were retrieved from the questionnaire and 24 hour (h) recall interviews. Logistic regression and subgroup analysis were conducted to investigate the association. The analysis was further stratified by vigorous recreational activity. Results: A total of 19 188 participants aged =20 years with complete information were included in this study. The overall prevalence of kidney stone was 9.6%. Among participants without vigorous recreational activity, a trend towards an increasing prevalence of kidney stone was observed with increased daily sitting time. However, the trend was not observed in individuals who participated in vigorous recreational activity, as they experienced a decreased risk of kidney stone despite having a daily sitting time of 6-8 h (crude model OR=0.659, 95% CI: 0.457-0.950, P=0.028), indicating that vigorous recreational activity may partially attenuate the detrimental effect of prolonged sitting time. Conclusion: Our study revealed an increasing trend of prevalence of kidney stone with increased daily sitting time among the population not performing vigorous recreational activity despite the difference was nonsignificant. Vigorous recreational activity may modify the association between daily sitting time and kidney stone. More prospective cohort studies are warranted to further examine this association. [ABSTRACT FROM AUTHOR]

Upper urinary tract stones are a common urological disease that can be treated by flexible ureteroscopy (FURS) through the natural urinary tract, in addition to extracorporeal shock wave lithotripsy and percutaneous nephrolithotomy. The advantages of FURS are less trauma, faster recovery, and fewer complications, while its disadvantages include poor results of lithotripsy and stone extraction when dealing with larger stones, and prolonged operation time. Over the last two decades, the emergence of new technologies such as FURS combined with negative pressure suction, robot-assisted FURS, and artificially intelligent FURS, coupled with improvements in laser technology (the use of thulium fiber lasers and the invention of single-use flexible ureteroscopes (su-fURS) suitable for primary level application, have significantly increased the global adoption of FURS. This surge in usage holds a promising future in clinical application, benefiting a growing number of patients with renal calculi. Accompanied by changes in technical concepts and therapeutic modalities, the scope of indications for FURS is broadening, positioning it as a potential primary choice for urolithiasis treatment in the future. This review outlines the progress in employing FURS for the treatment of renal calculi in order to generate insights for further research. [ABSTRACT FROM AUTHOR]

The global increase in kidney stone incidence and its complications emphasise the need for effective management. While pharmacists can play a significant role in counselling and guiding patients, their practices in managing patients with kidney stones remain unclear. To explore counselling practices and experiences of pharmacists when dealing with patients with kidney stones and to identify the barriers they face while providing counselling. A qualitative study was performed using semi-structured phone interviews with pharmacists practising in Jordan. Pharmacists were selected using quota sampling from those who took part in a previous study focused on pharmacists' knowledge of kidney stone aetiology and treatment. The COM-B Model of Behaviour Change was used to develop the interview guide and the analytical framework. Interviews were transcribed verbatim and analysed using a deductive thematic approach based on the pre-specified analytical framework. Seven pharmacists (85.7% female; 57.1% working in community pharmacies) were interviewed. Counselling practices of patients with kidney stones were categorised into five themes: (1) Pharmacists' beliefs about patient counselling: perceived importance and desire to improve health through counselling; (2) Most priority patients: Types of patients mostly counselled; (3) Content of kidney stones-specific counselling: patient assessment and recommendations about kidney stones management; (4) Duration of the counselling sessions: time offered and influencing factors; (5) Barriers to patient counselling: patient-related, and pharmacist- and doctor-related challenges. Pharmacists recognise the crucial role of kidney stones counselling but face gaps in their practices, including incomplete dietary education, limited knowledge of medication prescriptions, inconsistent patient-specific approaches, and potential communication challenges. These gaps can be overcome by enhancing training, standardising protocols of kidney stone treatment, promoting interprofessional communication, and improving communication strategies. Future research, including quantitative assessments, is needed to inform strategies that optimise patient counselling practices and facilitate improved outcomes. • Pharmacists counsel patients to gain their trust and achieve health benefits. • Kidney stone counselling involves lifestyle and medication-related recommendations. • Patients' poor belief in pharmacists, and negative attitudes hurdle counselling. • Workload, lack of time and private areas are barriers to providing counselling. [ABSTRACT FROM AUTHOR]

Purpose: Fluoroscopy is usually required during retrograde intrarenal surgery (RIRS). Although fluoroscopy is considered necessary for effective and safe RIRS, there is growing awareness regarding radiation exposure risk to patients and surgeons. We conducted a multicenter-based, randomized, controlled trial to compare the safety and effectiveness of radiation-free (RF) RIRS with radiationusage (RU) RIRS for kidney stone management. Materials and Methods: From August 2020 to April 2022, patients with a unilateral kidney stone (≤20 mm) eligible for RIRS were prospectively enrolled in 5 tertiary medical centers after randomization and divided into the RF and RU groups. RIRS was performed using a flexible ureteroscope with a holmium:YAG laser. The primary end point of this study was the success rate, defined as complete stone-free or residual fragments with asymptomatic kidney stones ≤ 3 mm. The secondary end point of this study was ascertaining the safety of RF RIRS. The success rates were analyzed using a noninferiority test. Results: Of the 140 consecutive randomized participants, 128 patients completed this study (RF: 63; RU: 65). The success rates (78% vs 80%, P [ .8) were not significantly different between the groups. The rate of highgrade (grade 2-4) ureter injury was not significantly higher in the RF group compared to the RU group (RF [ 3 [4.8%] vs RU [ 2 [3.1%], P [ .6). In RF RIRS, the success rate was noninferior compared to RU RIRS (the difference was 2.2% [95% CI, 0.16-0.12]). Conclusions: This study demonstrated that the surgical outcomes of RF RIRS were noninferior to RU RIRS. [ABSTRACT FROM AUTHOR]

This systematic review and meta-analysis aims to identify the main risk factors for nephrolithiasis in Asian populations, with comparisons to European and American populations. Using a comprehensive literature search across PubMed, Science Direct, and ResearchGate, in accordance with the Preferred Reporting Items of Systematic reviews and Meta-Analysis (PRISMA) guidelines, we synthesized data from 11 geographically diverse studies. Our findings reveal substantial population-specific differences in nephrolithiasis risk factors, particularly familial history, water consumption, and smoking patterns. In Asian populations, a 60% increase in risk was associated with a family history of nephrolithiasis. In the meantime, drinking sources also affected nephrolithiasis risk, with the consumption of boiled water being associated with a 25% increase in risk compared to consumption of bottled or mineral water. These findings highlight the importance of tailoring preventive strategies and treatments to specific risk factors, taking into account regional variations, and call for additional research to understand the complex interaction between genetic, environmental, and lifestyle factors in the development of nephrolithiasis. [ABSTRACT FROM AUTHOR]

A calculus is a solid mineral concretion such as a kidney stone, bladder stone, gall stone or stomach stone that forms naturally in a body under certain dietary or environmental conditions. Calculi that form in the gastrointestinal tract are enteroliths and these are often near-spherical objects, sometimes with a hollow centre, with a concentrically layered structure composed of radiating crystals oriented perpendicular to the surface. They are known in the archaeological record but are almost entirely absent from the fossil record, most likely due to them simply not being recognised for what they are. We describe a fossil calculus from the Upper Kimmeridge Clay (Upper Jurassic, c. , 150 million years old) marine deposit at Kimmeridge in Dorset, UK. This is the oldest calculus known from the fossil record with previous confirmed records from the terrestrial Oligocene of Colorado and the marine Upper Cretaceous Chalk of Germany: it extends the temporal range of known calculi in the fossil record by at least 59 million years. Although there are a wide range of potential hosts, the Kimmeridge calculus may have been produced by a large marine reptile. [ABSTRACT FROM AUTHOR]

Roux-en-Y gastric bypass (RYGB) is associated with an increased risk of kidney stone formation. This is not observed after sleeve gastrectomy (SG). Aim of this study was to assess whether preoperative metabolic profiling is helpful in selecting the most optimal bariatric procedure for patients with a kidney stone history. General hospital, the Netherlands. Patients with a kidney stone history and in the run up to bariatric surgery were screened with non-contrast abdominal computed tomography (CT), serum profiling, and 24-hour urine analysis. Those with stones on radiologic imaging and/or high preoperative urinary oxalate were advised to undergo SG instead of RYGB. Pre- and postoperative urine and serum profile differences between both groups were evaluated retrospectively. Postoperatively, RYGB (N = 28, M:F = 8:20) was associated with a 23.5% reduction in urinary volume, a 85% increase in urinary oxalate excretion with a 230% increase in calcium oxalate (CaOx) supersaturation and a 62% decrease in urinary citrate. Although SG (N = 30, M:F = 12:18) was also associated with a reduction in urinary volume, it had no adverse effects on urinary oxalate and citrate excretion, nor on calcium oxalate supersaturation (CaOx-SS). Both RYGB and SG showed favorable effects on postoperative sodium, calcium, uric acid, and phosphate excretion. This study indicates that preoperative metabolic profiling is important to select the optimal bariatric procedure in patients with an a priori increased risk of kidney stone development. These patients should be strongly encouraged to undergo SG instead of RYGB to prevent progressive or recurrent kidney stone disease. • Roux-en-Y gastric bypass (RYGB) in stone formers shows an increase in oxalate excretion in 50% of patients. • Sleeve gastrectomy (SG) in stone formers had no adverse effects on urinary oxalate and citrate excretion. • Both show favorable effects on sodium, calcium, uric acid, and phosphate excretion. • Metabolic profiling helps to select the best bariatric procedure in stone formers. [ABSTRACT FROM AUTHOR]

OBJECTIVE: The purpose of this study was to retrospectively assess the efficacy and safety of percutaneous nephrolithotomy (PCNL) for upper urinary stones using upper pole access (UPA) and other (low or middle) pole access (OPA). MATERIALS AND METHODS: A comprehensive literature review of articles investigating the clinical efficacy and safety of UPA and OPA was performed. The relevant literature was obtained from PubMed, EMBASE, Science Direct, Google Scholar and the Cochrane Library. The primary outcomes, including the stone-free rate, were evaluated using Review Manager 5.4 software. The secondary outcomes (peri- and postoperative complications and operative date) were also compared and analyzed. RESULTS: Ten comparative studies involving 5,290 patients were included in the analysis. The pooled data showed that the UPA group had a stone-free rate (SFR) similar to that of the OPA group [odds ratio (OR) 1.38, 95% confidence interval (CI): 0.94 to 2.03; p=0.22] but a higher incidence of blood transfusion [OR: 1.50; 95% CI: (1.03, 2.19), p=0.04]. There was no statistically significant difference in operative time [mean difference (MD): -7.27; 95% CI: (-25.18, 10.65), p=0.43] or hospital stay [MD: -0.13; 95% CI: (-0.64, 0.37), p=0.60] between the two groups. In addition, the results support that UPA causes fewer complications than OPA. CONCLUSIONS: Our findings suggest that UPA and OPA are both effective treatments for the management of upper urinary stones. Compared to OPA, UPA is associated with less need for blood transfusion and fewer complications. Nevertheless, the findings should be further confirmed by well-designed prospective randomized controlled trials (RCTs) with large samples and strict standards. [ABSTRACT FROM AUTHOR]

Asymtomatic or small renal stones are commonly detected during preoperative evaluations of prospective renal donors owing to the relative high prevalence of renal stones in the Indian population. These stones may lead to serious complications in transplanted kidneys and need to be cleared before transplant. Bench retrograde intrarenal surgery performed during donor nephrectomy can be performed to efficiently clear these stones. This technique is safe, easily reproducible, reduces donor morbidity, and costs without adversely effecting transplant outcomes. [ABSTRACT FROM AUTHOR]

The kidney is an important organ of humans to purify the blood. The healthy function of the kidney is always essential to balance the salt, potassium and pH levels in the blood. Recently, the failure of kidneys happens easily to human beings due to their lifestyle, eating habits and diabetes diseases. Early prediction of kidney stones is compulsory for timely treatment. Image processingbased diagnosis approaches provide a greater success rate than other detection approaches. In this work, proposed a kidney stone classification method based on optimized Transfer Learning(TL). The Deep Convolutional Neural Network (DCNN) models of DenseNet169, MobileNetv2 and GoogleNet applied for classification. The combined classification results are processed by ensemble learning to increase classification performance. The hyperparameters of the DCNN model are adjusted by the metaheuristic algorithm of Gorilla Troops Optimizer (GTO). The proposed TL model outperforms in terms of all the parameters compared to other DCNN models. [ABSTRACT FROM AUTHOR]

Urolithiasis is a common urological condition. Its incidence is increasing. It is one of the commonest urological emergencies, and has important, occasionally life-threatening, differential diagnoses. Treatment of an infected obstructed kidney is a urological emergency, and supportive treatment and swift drainage are paramount. Decision making for the treatment of stones depends upon stone size, site, patient and kidney factors, with active surveillance, ESWL, ureteroscopy and laser stone fragmentation and PCNL all possible options. Metabolic investigation of high-risk stone formers and advice regarding the prevention of stone formation are important. [ABSTRACT FROM AUTHOR]

• New method for diagnosing of the kidney stone. • Integrated Alexnet and ELM (Extreme Learning Machine) network is used for this purpose. • A newly improved version of firebug swarm optimization algorithm is used to optimize network. • The network is applied to the "CT Kidney Dataset" and validated by different research works. The use of CT scan to diagnose kidney stones is among the most accurate ways to confirm the presence of kidney stones in patients. The scan takes photographs inside the body using a computer and an X-ray. The present study proposes a new automatic methodology using an integrated Alexnet and ELM (Extreme Learning Machine) network to deliver more useful outcomes of detection for kidney stone. Afterward, the network is optimized on the basis of a newly improved version of firebug swarm optimization algorithm. The designed network is applied to the "CT Kidney Dataset", and its outcomes are then verified by some different advanced procedures. The final results indicated that the proposed approach has better performance than the other methods. [ABSTRACT FROM AUTHOR]

[Display omitted] • Calcification was identified in Randall's plaque. • Calcification-related proteins were up-regulated in animal and cell models. • HCA reduces calcification-induced apoptosis and oxidative damage. • HCA inhibits cellular calcification and deposition of calcium salts in animals. Ectopic calcification of the renal interstitium as an important cause of renal stone formation. Hydroxycitric acid (HCA), a derivative of citric acid, has antioxidant properties and inhibits the crystallisation of calcium salts.The study found that HCA has an inhibitory effect on calcification and calcium salt deposition in fibroblasts. Additionally, HCA was found to reduce calcification-induced oxidative damage and apoptosis.Animal experiments also showed that HCA reduced calcium salt deposition and expression of calcification-related proteins. Cellular transcriptomic analysis demonstrated that HCA can regulate the changes in cellular transcriptome caused by calcification in culture. HCA can effectively inhibit the calcification of renal interstitial fibroblasts, reducing the risk of stone formation by inhibiting calcification culture-induced apoptosis and calcium salt deposition. Therefore, HCA is a promising alternative drug for inhibiting renal stone formation. [ABSTRACT FROM AUTHOR]

Percutaneous nephrolithotomy (PCNL) is a common procedure for kidney stone removal, involving a small incision in the back and insertion of a nephroscope to extract the stones. Recent advancements include super-mini PCNL, employing smaller instruments for less invasive access to the kidney. However, conventional PCNL often requires tract dilation, which can lead to potential complications. This case report presents the successful application of our surgical technique using the basic principles of PCNL with the aid of a pediatric trocar cystostomy and ultrasound guidance as a new alternative for super-mini PCNL, offering safer access with reduced bleeding risk and shorter recovery. The surgery was performed on a 55-year-old female with bilateral kidney stones, with the stone in the left kidney being larger than the one in the right kidney. The procedure was completed within 60 min without significant postoperative complications. Our new alternative for PCNL offers benefits such as reduced invasiveness, shorter recovery time, decreased risk of complications, and minimal changes in postoperative hemoglobin levels. This new alternative can be performed in developing country hospitals that do not have the expensive PCNL equipment. This new alternative of PCNL with pediatric trocar cystostomy proves to be effective and safe. • Introduction of a Novel Technique • Addressing Technological Limitations. • In regions where advanced PCNL technology is not readily available, particularly for managing large kidney stones (>2 cm), this innovative approach leverages existing hospital resources such as ultrasound and pediatric trocar cystostomy tools. • Successful Implementation • Innovative Use of Pediatric Tools [ABSTRACT FROM AUTHOR]

Decision-making for complex pediatric urinary system stone disease is still a challenge for pediatric urologists. The interest in supine percutaneous nephrolithotomy (PCNL) is increasing among centers to achieve high surgical success rates with less morbidity. Despite advanced retrograde intrarenal surgery armamentarium, percutaneous approaches remain the first-line surgical treatment modality for >2 cm and complex renal stones. There are no comparative studies yet in the literature for pediatric endoscopic combined intrarenal surgery (ECIRS) In this study, we aimed to contribute to the literature by evaluating the safety and efficacy of ECIRS by comparing it with PCNL. Patients under 18 years of age who underwent PCNL and ECIRS for urinary tract stone disease at our Pediatric Urology department between 2012 and 2024 were included. Preoperative (demographic characteristics, stone characteristics, biochemical parameters), perioperative (duration of surgery, number of accesses, lasing and fluoroscopy times, endoscopic and fluoroscopic stone-free rates) and postoperative (hospital stay, urinary tract infection, complication and radiological stone-free rates) parameters were retrospectively evaluated. A total of 68 children [28 (41%) girls and 40 (59%) boys] aged 5 (0–17) years were included in the study. ECIRS was performed in 19 (28%), supine in 28 (41%) and prone PCNL in 21 (30%) patients. Age (p = 0.029), Guy's stone score (p < 0.001), S.T.O.N.E. (p < 0.001), and Seoul National University Renal Stone Complexity (S-ReSC) scores (p = 0.001) for preoperative parameters were found to be higher in ECIRS group over both PCNL methods (Summary Table). However, Clinical Research Office of the Endourological Society (CROES) score was seen lower for ECIRS group patients compared to other groups (p = 0.028). Surgery time (in favor of supine over prone PCNL), fluoroscopy time (in favor of ECIRS and Supine PCNL over Prone PCNL), preferred laser type (prone PCNL group was mostly performed with holmium laser, whereas other groups were balanced between Holmium and Thulium Fiber Laser) and exit strategy (the preferred exit strategy was DJ Stent in most of the ECIRS patients, whereas nephrostomy tube was used in some of the PCNL group) showed significant difference among the groups as perioperative parameters (p = 0.042, <0.001, <0.001, <0.001, respectively). Surgery time was lower for supine PCNL compared to prone PCNL. For postoperative parameters, stone-free rates, complication rates and urinary tract infections were similar between the 3 groups, while a difference was detected in terms of length of hospital stay in favor of ECIRS over both supine and prone PCNL (p = 0.006). The current trial suggests that stone-free and complication rates of ECIRS and supine PCNL were similar in the pediatric complex stone patients. Although, the stones in the ECIRS group we found to be more complex. Also, ECIRS was superior to PCNL in terms of fluoroscopy exposure and hospital stay. With the widespread use of new generation ureteral access sheaths and flexible ureterorenoscopes, ECIRS may have an important role in treatment of complex pediatric kidney stones. [ABSTRACT FROM AUTHOR]

The association between magnesium depletion score (MDS) and kidney stone disease (KSD) remains unknown. This study was designed to investigate the association of MDS with KSD in adults. A total of 19,654 participants were enrolled from the National Health and Nutrition Examination Surveys (NHANES). The MDS was calculated by assessing four aspects, including alcohol assumption, renal function, and use of diuretics and proton pump inhibitor. Multivariable logistic regressions were performed to explore the associations between MDS and the prevalence of KSD. Linear correlations were conducted explore the relationship of testosterone with MDS. In the multivariable logistic regressions with full adjustment for confounding variables, the odds ratio of MDS associating with KSD was 1.28 (95% CI: 1.04–1.58, P = 0.022) in total population, and 1.70 (95% CI: 1.16–2.50, P =0.007) in female participants. Besides, compared to the lowest MDS, the highest MDS was associated with a lower testosterone (β = −16.39, P =0.009) after full adjustment in non-menopause women. This study highlighted a positive correlation of high MDS with KSD in female population, which may be associated low level of serum testosterone. [ABSTRACT FROM AUTHOR]

OBJECTIVE: The aim of the study was to investigate the efficacy of stone baskets combined with flexible ureteroscope holmium laser lithotripsy (FURL) in the treatment of lower calyceal stones (LCS). PATIENTS AND METHODS: A total of 216 patients with LCS who underwent FURL in our hospital were analyzed retrospectively and divided into observation group (n=129, with stone basket) and control group (n=87, without the stone basket), according to whether the stone basket was used during FURL. The operation time, stone size, stone clearance rate, steinstrasse incidence rate and complication rate were collected and analyzed. RESULTS: There were no significant differences between the two groups in preoperative gender, BMI, age, stone size and comorbid diseases (p > 0.05); no significant differences between the two groups in the change of procalcitonin, C-reactive protein, white blood cell count and hemoglobin after the operation (p>0.05); the operation time in the observation group was significantly higher than that in the control group (80.12±8.25 vs. 61.93±6.55, p=0.019); the shortterm stone clearance rate (85.27% vs. 66.67%, p 0.001) and long-term stone clearance rate (95.35% vs. 85.06%, p=0.021) of the observation group were significantly higher than those of the control group; the incidence rate of steinstrasse (0% vs. 8.05%, p<0.001) and overall complications (7.75% vs. 16.09%, p=0.009) in the observation group were significantly lower than those in the control group. CONCLUSIONS: Stone basket combined with FURL is safe and feasible for the treatment of LCS, which can improve the stone clearance rate and reduce the risk of steinstrasse formation after the operation. [ABSTRACT FROM AUTHOR]

Nous présentons ici le cas clinique original d'un jeune homme âgé de 34 ans, atteint de recto-colite hémorragique, et ayant présenté une hypophosphatémie profonde iatrogène secondaire à une perfusion de carboxymaltose ferrique. La fuite rénale de phosphates a été attestée par un taux maximal de réabsorption des phosphates (Tm/DFG) effondré, associé à une augmentation majeure de la concentration sérique de FGF-23. Trois mois plus tard, le patient a, à nouveau, été exploré avec son père, puisque nous avons appris entre temps que les deux hommes présentaient depuis de nombreuses années des calculs rénaux composés de Weddellite et de carbapatite, avec une hypercalciurie marquée. Les explorations ont permis de suspecter une fuite rénale primitive de phosphates à caractère familial de façon sous-jacente, sans toutefois qu'une mutation ne soit mise en évidence au niveau des transporteurs proximaux de phosphates. We describe here the case report of a young man of 34-years old suffering from a haemorrhagic rectocolitis and presenting with marked hypophosphatemia secondary to an infusion of ferric-carboxymaltose. The renal phosphate wasting was asserted by a very low renal maximal reabsorption rate of phosphate associated with a high plasma FGF-23 level. Three months later we explored the patient and his father since we learnt that both of them had suffered from kidney stones for years with marked hypercalciuria. Kidney stones were composed of weddellite and carbapatite. We suspected a familial phosphate renal wasting syndrome but however no mutation of the renal phosphate carriers could be identified. [ABSTRACT FROM AUTHOR]

Objective: Kidney stones are common, tend to recur, and afflict a young population. Despite evidence and recommendations, adoption of reduced-radiation dose CT (RDCT) for kidney stone CT (KSCT) is slow. We sought to design and test an intervention to improve adoption of RDCT protocols for KSCT using a randomized facility-based intervention.Methods: Facilities contributing at least 40 KSCTs to the American College of Radiology dose index registry (DIR) during calendar year 2015 were randomized to intervention or control groups. The Dose Optimization for Stone Evaluation intervention included customized CME modules, personalized consultation, and protocol recommendations for RDCT. Dose length product (DLP) of all KSCTs was recorded at baseline (2015) and compared with 2017, 2018, and 2019. Change in mean DLP was compared between facilities that participated (intervened-on), facilities randomized to intervention that did not participate (intervened-off), and control facilities. Difference-in-difference between intervened-on and control facilities is reported before and after intervention.Results: Of 314 eligible facilities, 155 were randomized to intervention and 159 to control. There were 25 intervened-on facilities, 71 intervened-off facilities, and 96 control facilities. From 2015 to 2017, there was a drop of 110 mGy ∙ cm (a 16% reduction) in the mean DLP in the intervened-on group, which was significantly lower compared with the control group (P < .05). The proportion of RDCTs increased for each year in the intervened-on group relative to the other groups for all 3 years (P < .01).Discussion: The Dose Optimization for Stone Evaluation intervention resulted in a significant (P < .05) and persistent reduction in mean radiation doses for engaged facilities performing KSCTs. [ABSTRACT FROM AUTHOR]

In recent years, the use of opioids in medical practice has come under significant scrutiny. This, in part, is owing to evidence of overprescription and overuse of opioid medications, as well as the unintended consequences and side effects for patients who take these medications. Here, we review the role of opioids and the responsible use of these medications with respect to kidney stone disease and surgical interventions for kidney stones. [ABSTRACT FROM AUTHOR]

To assess the efficacy and safety of various minimally invasive procedures for 10–20 mm pediatric renal stones by Bayesian network meta-analysis (NWA). We searched clinical comparative trials published in Pubmed, Embase, Cochrane Library from inception to 12 April 2020. Two researchers evaluated the quality and extracted data individually. Data was analyzed using STATA and GEMYC R package. The overall network meta-analytic outcome of stone free rate (SFR) in a single session revealed that Retrograde Intrarenal Stone Surgery (RIRS), miniaturized percutaneous nephrolithotomy (mPCNL) and PCNL showed superiority to extracorporeal shockwave lithotripsy (ESWL). Statistical significance was not detected between any intervention from our pooled network analysis of complication rate. SMP was the most likely to ranking in first place to render stone free status, and it also showed the lowest risk possibility of complications. Mini-PCNL had longer operation time and hospitalization than ESWL. The global and loop inconsistency evaluation demonstrated a rather acceptable outcome apart from the comparisons of complication rate between two randomized control studies. Herein, the authors reviewed and explored the optimal management pattern for pediatric 10–20 mm renal stones. This NWA revealed RIRS and mPCNL could render higher SFR without increasing risk of complications compared with ESWL. Although SMP was deemed to be the best choice in our study, the limited source of study and sample size implied the results required to be further validated. In addition, there were still some problems requiring to be underlined for various surgical options. ESWL was inferior to RIRS, mPCNL and PCNL for 10–20 mm pediatric renal stones, among which SMP might be the most ideal option associated with the least possibility of complications and the highest probability of stone clearance. [ABSTRACT FROM AUTHOR]

Objective: To compare the predictive performance of five previously described scoring systems (i.e., S.T.O.N.E., Guy's, Clinical Research Office of the Endourological Society (CROES), the Seoul National University Renal Stone Complexity (S-RESC) and the new Stone Kidney Size (SKS) score) for postoperative outcomes regarding stone-free rate (SFR) and complications in adult patients.Methods: Data from 349 patients who underwent percutaneous nephrolithotomy (PCNL) in three urology departments were analyzed. SKS, S.T.O.N.E., S-ReSC, CROES and Guy's nephrolithometry scoring systems were used to retrospectively calculate predictions for each patient. Univariate and multivariate analyses were performed to evaluate factors associated with SFR and complication rates. Receiver operating characteristic (ROC) curves were generated and areas under curves (AUC) were compared to identify the method with the highest predictive value.Results: Median SKS, S.T.O.N.E., S-ReSC, CROES and Guy's scores were 4, 7, 3, 170.8 and 2, respectively. Overall, SFR was 67.0% (234/349) with a complications rate of 36.7% (128/349). AUCs of each method for predicting stone-free status, highlighted reasonable predictive capabilities with 0.709, 0.806, 0 0.869, 0.207, and 0.735, respectively; however, the S-ReSC scoring system had the best discriminative performance. According to multivariate logistic regression and AUC results, none were effectively capable of predicting complications.Conclusions: All scoring systems correlated significantly with stone-free status; although, S-ReSC appears to have the greatest predictive ability. This method is also relatively easy to implement and highly reproducible. However, none of the methods analyzed are able to accurately predict postoperative complications. [ABSTRACT FROM AUTHOR]

The urolithiasis/nephrolithiasis are a major health problem among the peoples, which could lead to severe clinical complications and kidney failure and most men were affects than women. Fucoxanthin, is an active compound present in brown seaweeds, and has the numerous pharmacological benefits. Present investigation designed to assess the anti-urolithiatic role of Fucoxanthin against ethylene glycol (EG) stimulated calculi in experimental rats. Adult male albino rats were segregated evenly into five groups. Group I: Normal Vehicle. Group II: 0.75% ethylene glycol (EG) in potable water for 4 weeks. Group III: 0.75% EG in potable water + Fucoxanthin (40 mg/kg bodyweight) was administered through orally for 4 weeks. Group IV: 0.75% EG in potable water + Fucoxanthin (80 mg/kg body weight) was supplemented orally for 4 weeks. Group V: 0.75% EG in potable water + Standard drug Cystone (750 mg/kg bodyweight) was supplemented orally for 4 weeks. The rat urine was collected before the anaesthesia. The animals were generally anaesthetized and killed by the cervical dislocation. Kidneys and blood (Plasma) samples were collected and processed for further investigations. The biochemical (BC) markers, renal, stone markers, antioxidants levels and Lipid peroxidation were analysed using plasma and kidney tissue homogenate of both control and investigational animals. Our results revealed that the elevated levels of biochemical markers were observed in lithiatic rats. The renal and stone markers were abnormal in lithiatic rats. The antioxidants were markedly decreased and lipid peroxidation (LPO) was increased in lithiatic rats. The histopathological study confirmed that the Fucoxanthin treatment (80 mg/kg body weight) prevented the damage of tubular membrane and reduced the deposition of calculi in glomeruli of the kidney tissue. Fucoxanthin treatment normalized the biochemical and renal stone markers in the experimental rats. Fucoxanthin treatment restores the antioxidants and decreased the LPO in experimental rats by its anti-urolithiatic properties. [ABSTRACT FROM AUTHOR]

Introduction and Objectives. Percutaneous nephrolithotomy (PCNL) successfully replaced open surgery more than 30 years ago, and it still represents the gold standard in the treatment of large renal stones. Although nowadays, with advancing technology improving many technical aspects, it is considered a safe procedure with a low complication rate, close postoperative management is mandatory. Colon perforation is a rare but severe complication that can occur in specific cases. Materials and Methods. We analyzed 1146 cases, from June 2015 to May 2017, admitted in "Prof. Dr. Th. Burghele" Clinical Hospital based on medical records identified when searching procedure code. Data referring to risk factors such as age, sex, stone location and type, associated diseases, previous surgical history, and also intra and postoperative details were carefully analysed. All of the cases were primarily assessed with complete blood and urine tests. When diagnosed, urinary tract infections were treated with specific antibiotic agents. All available imagistic details were studied before and after the PCNL session for selected cases. Results. 7 cases met our criteria and were diagnosed with colonic injury after PCNL. All suspected cases were assessed imagistically with an abdominal CT scan and managed conservatively as the first intention. Sex distribution revealed five males and two females with a mean age of 52.3 years old. Colonic injuries were diagnosed intra or postoperatively and were most prevalent on the left side. Accessing the pylocaliceal system was performed by puncturing the lower calyx in 6 cases and the middle calyx for technical reasons in one case. When referring to risk factors, a retrorenal colon was diagnosed in two cases. In one case with previous open renal surgery, the right colon was injured. It was only one case of intraperitoneal lesion in which surgical management with temporary colostomy for three months was preferred. Conclusions. Colon perforation is a rare complication related to PCNL with management key being based on early diagnosis. According to other studies, our results reveal that extraperitoneal colon perforations can be successfully managed conservatively, but surgery with a temporary colostomy is the election treatment for intraperitoneal lesions. [ABSTRACT FROM AUTHOR]

Introduction and Objectives. The aim of the study is to evaluate and present the results of flexible ureterorenoscopy with holmium laser lithotripsy as treatment for kidney stone in pelvic ectopic kidney. Materials and Methods. Twelve patients with stones below 2.1 mm located in the pelvic ectopic kidney and treated by flexible ureterorenoscopy between 2012 - 2017 were retrospectively analyzed. Demographic data, stone characteristic and perioperative measurement were collected. Patients with incomplete data in the medical records were excluded. Results. We enrolled in the study seven males and five females with a mean age of 42.5 years (23 - 58 years). All patients were treated by flexible ureterorenoscopy under spinal anesthesia. The mean stone size was 14.9 mm (10 - 21 mm). Five stones were located in the renal pelvis, three in the middle calix and four in the lower calix. Also, in three cases was noted the presence of multiple stones. Eight patients had a double J stent placed before de surgery. The mean operation time was 66.2 minutes (45 - 100 minutes). Mean hospitalization time was 3.4 days (3 - 5 days). Stone free rate was 83.3% after one procedure. Reintervention was necessary in two cases (16.6%). Minor complications as persistent hematuria was observed in two cases (16.6%) and fewer in one case (8.3%). No severe complications were recorded. Conclusions. The use flexible ureterorenoscopy with laser lithotripsy in treatment of small and medium stones occurred in patients with pelvic ectopic kidney is an effective and safe procedure. [ABSTRACT FROM AUTHOR]

Urinary stone disease has an increasing prevalence across the globe, and endoscopic treatment modalities have replaced open surgery. Percutaneous nephrolithotomy (PCNL) is a successful, safe and reliable minimally invasive method in the treatment of renal stones, especially big (≥2 cm) or complex ones. Gaining access is the most critical step of this procedure, which can affect the rest of the operation. Although previously described techniques, eye of the needle and triangulation techniques, are being used for gaining access, urologists (especially novice ones) can still have problems during this step. Some navigation concepts have been developed in order to make the access safer, easier and more successful, however, none of them has been incorporated in daily routine practice till now because of either complicated techniques or requirement of sophisticated equipment. Our hypothesis is that the access point, direction angle and access angle in order to touch a stone during PCNL can be calculated by the data obtained from the computed tomography images with the help of mathematical formulations, namely the theorem of the cosine. [ABSTRACT FROM AUTHOR]

Abstract Struvite stones develop as a result of urinary tract infections by urease-producing bacteria. Here, we report the dynamics of in vitro crystallization of struvite at various pH using single diffusion gel growth technique. Sodium metasilicate gel and ammonium dihydrogen phosphate were used as a medium for growing the struvite crystals. The composition, crystalline nature, and surface morphology of the crystals were studied using FTIR spectroscopy, XRD, TGA, DSC, and SEM. The struvite crystals displayed different morphologies like dendritic, envelope and rectangular shapes at different pH. Crystal faces were different at opposite ends of the crystallographic axis of the struvite crystals. Large X-shaped crystals with dendritic growth having main trunk and branches were observed. SEM revealed the porous internal structure of struvite. The results indicate that pH has a significant effect on the morphology and growth of struvite crystals. The present study will provide evidence for the importance of pathological bio-mineralization and/or crystallization. Graphical abstract fx1 Highlights • In vitro struvite crystallization by single diffusion gel growth technique. • Characterization of struvite by FTIR, XRD, FESEM. • Variation in the morphology and growth of the struvite under different pH. • Struvite crystals displayed different morphologies. • Evidence for pathological biomineralization/crystallization. [ABSTRACT FROM AUTHOR]

Uroliths (urinary stones) are routinely found in both domestic and exotic animals kept under human care. In zoos, Asian small-clawed otters (ASCOs, Aonyx cinereus) have been identified as being particularly prone to this disease. Risk factors are thought to be nutritional; however, recommendations contradict each other, depending on which physiological model was used. Our study aimed to determine the prevalence of uroliths in ASCOs under human care and to evaluate which feeding patterns and nutrients may be linked to their occurrence. Questionnaires were sent to zoos holding ASCOs in North America (AZA), Europe (EAZA), and Japan and Southeast Asia (Asia) asking about diets and medical histories of all ASCOs alive or dead within the last 10 yr. A risk-factor style binary logistic regression was conducted on these data. A total of 94 questionnaires were received; however, only 56 were usable (15.6% return rate), representing 161 otter cases. AZA had the significantly highest incidence of kidney stones (62.8%), followed by EAZA (12.9%) and Asia (9.4%). Age and calcium were risk factors, whereas crude protein and sodium were protective. Therefore, calcium may need to be controlled within their diet. A diet high in fish and crustaceans may be beneficial and is consistent with wild ASCO diets. The feline model may be the best choice out of other models; however, many factors cannot be compared with ASCO, such as urinary pH. [ABSTRACT FROM AUTHOR]

Lactic acid bacteria (LAB) are probiotic organisms and are promising alternatives to manage kidney stone problems. Oxalate digesting LAB was screened from date wastes and date wastewater. LAB was isolated using De Man, Rogosa and Sharpe agar (MRS agar) medium and was subjected to oxalate degradation assay in a calcium oxalate plate. The strain was further subjected to assay for its capacity to tolerate acidic pH value and bile salt. Then, anti-urolithiatic activity assay was carried out by in vitro analysis. Based on preliminary characteristics, among 62 oxalate degrading strains, twenty-four strains exhibited a greater than 10 mm zone. The potent bacterial strains were identified as Lactobacillus cassei, L. acidophilus , L. gasseri and L. fermentum. Isolates from date wastes showed better antagonistic properties towards bacterial pathogens. At 50 µg Calcium oxalate concentration, 75.6 ± 0.865 degradation was achieved by L acidophilus. LAB isolated from date waste showed promising anti-urolithiasis activity. Hence, date waste may serve as a potential source for LAB probiotics to treat hyperoxaluria. [ABSTRACT FROM AUTHOR]

• Computer-aided kidney stone diagnosis from CT images based on deep believe network. • A modified Deep Believe Network (DBN) based on metaheuristic to get higher efficiency. • Using fractional order version of coronavirus herd immunity optimizer to provide the idea. • The method is validated by comparing with some published works from the literature. In this study, a computer-assisted kidney stone diagnosis system based on CT images has been proposed. The method is based on a combination of deep training and metaheuristics. The method aims to provide a customized Deep Believe Network (DBN) based on a fractional version of the coronavirus herd immunity enhancer to provide an efficient and reliable kidney stone diagnosis system. The designed method is then authenticated by running a standard benchmark called a "CT kidney dataset". Subsequently, a comparison is made between the results and some other state-of-the-art methods. Simulations show that the recommended DBN/FO-CHIO outperforms the other studied approaches in terms of efficiency with an accuracy of 97.98%. Moreover, the proposed DBN/FO-CHIO recall outperforms others with 92.99%, demonstrating its excellent accuracy compared to other comparison algorithms. Moreover, the higher specificity of the proposed method compared to the other evaluated approaches indicates its advanced event-independent value. [ABSTRACT FROM AUTHOR]

Background: Urolithiasis is a common condition in the U.S. Patients frequently present to the emergency department (ED) for care, including analgesia and treatments to facilitate stone passage.Objective: With the new evidence concerning the evaluation and treatment of urolithiasis, this review summarizes current literature regarding the ED management of urolithiasis.Discussion: Urolithiasis occurs primarily through supersaturation of urine and commonly presents with flank pain, hematuria, and nausea/vomiting. History, examination, and assessment with several laboratory tests are cornerstones of evaluation. Urinalysis is not diagnostic, but it may be used in association with other assessments. Risk assessment tools and advanced imaging can assist with diagnosis. Computed tomography (CT) is often considered the gold standard. Newer low-dose CT imaging may reduce radiation. Recent studies support ultrasound as an alternate diagnostic modality, especially in pediatric and pregnant patients. Nonsteroidal anti-inflammatory drugs remain first-line therapy, with opioids or intravenous lidocaine reserved for refractory pain. Tamsulosin can increase passage in larger stones but has not demonstrated benefit in smaller stones. Nifedipine and intravenous fluids are not recommended to facilitate passage. Surgical intervention is based upon stone size, duration, and modifying factors. Patients who are discharged should be advised on dietary changes.Conclusion: Urolithiasis is a common disease increasing in prevalence with the potential for significant morbidity. Focused evaluation with history, examination, and testing is important in diagnosis and management. Understanding the clinical features, risk assessment tools, imaging options, and treatment options can assist emergency physicians in the management of urolithiasis. [ABSTRACT FROM AUTHOR]

[Display omitted] • HCA can effectively inhibit CaOx crystal deposition. • HCA can effectively inhibit the lipid deposition and reduce lipid nephrotoxicity. • HCA inhibits lipid nephrotoxicity by activating the PPARα pathway. • HCA has a better inhibition of CaOx crystal formation compared to CA. Kidney stone is a urinary system disease with a high incidence, and effective stone drugs are limited. Hydroxycitric acid (HCA), mainly found in Garcinia cambogia and Hibiscus sabdariffa , can reduce body weight and calcium salt deposition. In this study, we explored the molecular mechanisms of HCA inhibition of renal calcium oxalate (CaOx) deposition and nephrotoxicity in an oxalate-induced cell model and rat model. HCA could effectively inhibit CaOx crystal deposition and reduce crystal adhesion and oxidative damage. Further cellular transcriptomic analysis and in vitro results showed that HCA could stably bind peroxisome proliferator-activated receptor α (PPAR α), thus promoting the expression of downstream oxidative stress molecules and inhibiting calcium ion release and mitochondrial dysfunction, thus reducing oxalate-induced renal lipid peroxidation damage. HCA, a drug with the ability to modulate lipid metabolism and inhibit CaOx formation, may be a therapeutic option for the treatment of oxalate nephropathies. [ABSTRACT FROM AUTHOR]

Introduction and Objectives. Kidney stones in childhood have an increasing incidence in developed countries with high risk of recurrence and a prevalence of around 2%. Experience in standard percutaneous nephrolithotomy (PCNL) and mini-PCNL at the adult patients lead us to use these techniques in the treatment of reno-ureterale stones at the children. The basic concern in children is to minimise the radiation exposure and the need of retreatment. The purpose of this paper is to analyze the efficacy and safety of PCNL and mini- PCNL in pediatric patients. Materials and methods. We prospectively analyzed 12 patients (p) which received mini-PCNL and PCNL for kidney stones in the period January 2014 - March 2017. Results. The mean age of patients was 6.5±4.7 (2-17 years). Gender distribution: 5 girls (41.6%) and 7 boys (58.5%). The distribution of stones by location in the pyelocaliceal system was: renal stone in the ureteropelvic junction (UPJ) in 3 p (25%), multiple urolithiasis in 4 p (33.3%), coraliform stones in 5 p (41.6%). Surgical instruments: nephroscope Karl Stortz 26 Fr., semirigid ureteroscope 9.5 FrKarl Stortz, renal access sheath 30 and 14 Fr, rigid cystoscope 11 Fr., ultrasonic fragmentation stone Calcuson Storz. PCNL was performed at 5 patients (41.66 %) who was diagnosed with coraliform lithiasis. Mini-PCNL was performed in 7 patients (58.34%), who were diagnosed with calculus in UPJ or multiple lithiasis under 1 cm. Conclusions. PCNL and mini-PCNL at pediatric patients are feasible therapeutic options in the treatment of urolithiasis. [ABSTRACT FROM AUTHOR]

Recent advances in RNA interference (RNAi) delivery and chemistry have resulted in the development of more than 20 RNAi-based therapeutics, several of which are now in Phase III trials. The most advanced clinical trials have utilized modifications such as lipid nanoparticles and conjugation to N-acetyl galactosamine to treat liver specific diseases. Recent reports have suggested that reducing endogenous oxalate synthesis by RNAi may be a safe and effective therapy for patients with the rare disease, Primary Hyperoxaluria (PH). Our current understanding of endogenous oxalate synthesis indicates that two enzymes, hydroxyproline dehydrogenase and glycolate oxidase (GO), are suitable targets for oxalate reduction therapy. Our studies in a mouse model of PH type 1 have demonstrated that reducing the expression of either of these enzymes in the liver with RNAi significantly reduces urinary oxalate excretion. Early human phase clinical trials are now under way in PH1 patients with RNAi targeting GO. Future elaboration of other contributors of stone disease and improvement in tissue specific targeting with RNAi may lead to further therapies that target idiopathic stone disease. [ABSTRACT FROM AUTHOR]

Objective To investigate the risk factors of perirenal hematoma (PRH) after flexible ureteroscopic lithotripsy (FURSL). Materials and methods We retrospectively reviewed the medical records of 45 patients who underwent FURSL with a holmium:yttrium–aluminum–garnet laser. We divided all patients in two groups: the PRH group and the non-PRH group. The patient demographic and baseline characteristics, surgical outcomes, and complications were compared and risk factors were identified and analyzed. Results Of the 45 consecutive patients treated with FURSL, four (8.9%) developed PRH. Compared with patients without PRH, patients with PRH had a lower body mass index (BMI; 20.2 ± 3.2 kg/m 2 vs 26.9 ± 5.5 kg/m 2 , p = 0.015), thinner kidney cortex thickness (0.88 ± 0.41 cm vs 1.39 ± 0.41 cm, p = 0.024), and a history of chronic kidney disease (CKD; 75% vs 14.6%, odds ratio = 17.5, confidence interval = 1.55–197.46, p = 0.021). However, patient age, diabetes mellitus, hypertension, liver disease, coronary artery disease, history of urolithiasis, presence of multiple stones, and stone size and location were comparable in both groups. Three patients with PRH were successfully managed with conservative treatment. One patient with PRH underwent an emergency nephrectomy within 1 day but died 2 weeks later despite vigorous resuscitation. Conclusion Among our patients, those with lower BMI, CKD, and a thinner renal cortex had a higher risk of developing PRH after FURSL. Endourologists should have a heightened awareness for potential PRH when treating patients who present with low BMI, CKD, and a thin renal cortex. [ABSTRACT FROM AUTHOR]

Summary Objective Kidney stone disease has become more common among children and young adults. Despite its well-documented success in adults, published success rates of medical expulsive therapy (MET) for pediatric urolithiasis vary widely. Our objective was to determine whether the aggregated evidence supports the use of MET in children. Methods We searched the Cochrane Controlled Trials Register, clinicaltrials.gov , MEDLINE, and EMBASE databases, and recently presented meeting abstracts for reports in any language. In addition, the bibliographies of included studies were then hand-searched. The protocol was prospectively registered at PROSPERO (CRD42013005960). Inclusion criteria were children (aged ≤ 18 years) with urolithiasis treated with medications with the specific goal of increasing spontaneous stone passage rate, including but not limited to alpha-adrenergic blockers (e.g., tamsulosin or doxazosin), calcium channel blockers (e.g., nifedipine), or other adjuvant medications (e.g., steroids or tolterodine). Manuscripts were then assessed and data abstracted in duplicate, with differences resolved by the senior author. Risk of bias was assessed using standardized instruments. Descriptive statistical analyses were performed as appropriate. Results We identified 11,197 studies, five of which (3 randomized controlled trials, 2 retrospective cohorts) were included in the pooled meta-analysis. Although we found little evidence of significant publication bias, we were unable to assess the likelihood of other forms of bias (allocation, selection) for most included studies due to reporting limitations. The pooled results demonstrate that MET significantly increased the odds of spontaneous stone passage (OR 2.21, 95% CI 1.40–3.49). Between-study heterogeneity was not statistically significant ( I 2 = 14%, p = 0.36). Bivariate meta-regression models revealed no significant association between the likelihood of stone passage and study COI ( p = 0.9), study country ( p = 0.7), patient age ( p = 0.4), patient gender ( p = 0.4), duration of follow-up ( p = 0.3), or stone size ( p = 0.7). Side effects of MET were reported to be minimal. Relatively few patients reported any adverse effects at all; the most commonly reported issue was somnolence. Concerns about biases affecting the published outcomes of the included studies exist due to the low quality of the randomized controlled trials reviewed for analysis. However, there was little visual evidence of publication bias noted on the funnel plot, as confirmed by the Begg test ( p = 0.5). Conclusions Consistent with the adult literature, pediatric studies demonstrate that treatment with MET results in increased odds of spontaneous ureteral stone passage and a low rate of adverse events. Although the accumulated literature is limited by inconsistent and/or incomplete reporting, there is nonetheless a clear, cumulative positive effect of MET on stone passage among children. The available evidence thus supports a prominent role for MET in treatment algorithms for pediatric urolithiasis. [ABSTRACT FROM AUTHOR]

Background/Purpose Tubeless mini-percutaneous nephrolithotomy (MPCNL) for treating renal calculi was introduced in response to concerns over the use of adult nephrolithotomy apparatus in small children. However, it is unclear whether tubeless mini-PCNL (MPCNL) is of any benefit in the treatment of children. This study therefore aimed to assess the possible benefits of MPCNL, as compared to standard PCNL, in preschool children. Methods Seventy-eight preschool children under 3 years with renal calculi were randomized into two groups (PCNL and MPCNL). Operative time, hemoglobin decrease, blood transfusion rate, postoperative complications and length of hospital stay in the two groups were statistically compared. Results Recovery time was significantly shorter for patients receiving MPCNL than those treated with standard PCNL (4.6 versus 7.7 days, P < 0.05). Conclusions Treating preschool children with tubeless percutaneous nephrolithotomy has advantages over standard PCNL, including faster recovery and shorter hospital stay. [ABSTRACT FROM AUTHOR]

Copyright of Cukurova Medical Journal / Çukurova Üniversitesi Tip Fakültesi Dergisi is the property of Cukurova University, Faculty of Medicine and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Objective To analyze the success and complication rates of percutaneous nephrolithotomy (PCNL) performed in pediatric patients and to compare outcomes of the patients undergoing primary PCNL with those of patients who had undergone previous open nephrolithotomy. Materials and methods Between 2000 and 2011, PNL procedures were performed in 123 renal units (RU) of 111 children. We compared RU on which previous open surgery had been performed (group 1 RU = 26) on the same kidney with RU that had not been involved in previous surgery (group 2 RU = 97). Patient characteristics, pre- and postoperative hematocrit and creatinin levels, operative time, fluoroscopic screening time, stone free rate, complications and hospitalization time were documented and compared. Results There were no significant differences between the groups in sex, stone burden, pre- and postoperative hematocrit levels. Mean age and pre- and postoperative creatinin levels were significantly higher in group 1 ( p < 0.05). Mean operative time, fluoroscopic screening time and hospitalization times were similar in each group ( p > 0.05). The stone free rates after PCNL were 65.4% in group 1 and 81.4% in group 2 ( p > 0.05). Multiple access rate was higher in group 1; however, this was not statistically significant (27% vs. 15%, p > 0.05). Conclusion PCNL can be performed in pediatric patients who have previously undergone open nephrolithotomy but the success rates may be lower and risk of bowel injury higher. NCCT should be considered preoperatively for patients who have previously undergone open renal surgeries to investigate the presence of retrorenal colons. Our study includes relatively few patients with a history of open surgery and we believe that additional clinical studies with larger numbers of patients are needed to confirm our initial findings. [ABSTRACT FROM AUTHOR]

In this article, the author focuses on a study related to higher solubility of ammonium acid urate (AAU) stones in an alkaline environment which are obtained from bottlenose dolphins. Topics discussed include Nephrolithiasis, alkalization of urine for dissolution of nephroliths, and reverse-phase high performance liquid chromatography. Other topics discussed include optimization of kidney stone prevention, and treatment, and urolithiasis.

Abstract: This study was carried out to produce new herbal beverages from Foeniculum vulgare and Cymbopogon proximus using for inhibiting or preventing calcium oxalate crystals formation. The preliminary chemical composition and phytochemical tests of F. vulgare and C. proximus have been examined. Also, total polyphenols and total flavonoids contents were determined. Our results illustrated that F. vulgare and C. proximus contained average values of 9.5 and 13.25mg GAE/g for total polyphenols, respectively, while the concentration of total flavonoids was 5.25 and 3.5mg QE/g for F. vulgare and C. proximus, respectively. Furthermore, the efficiency of formulated beverages of investigated plants has been studied to elucidate their activities on oxalate induced renal calculi formation and the associated renal injury in rats. Formulated beverages D and E in ratios of 0.5:1.5% and 0.0:2.0% from F. vulgare and C. proximus, respectively, were the most effective treatments to inhibit kidney stone formation which afford 0.53 and 0.39mg/24h for oxalate concentration, respectively, while, calcium content was 1.47 and 1.20mg/24h for beverages D and E, respectively. Also, urinary marker enzymes such as ALP, ACP, and γ-GT were (0.92 and 0.86), (0.73 and 0.71), and (1.67 and 1.47) measured as (U/min/mg protein) for beverages D and E, respectively. In addition, blood urea and serum creatinine were (0.77 and 0.59) and (13.07 and 14.57)mg/dl for beverages D and E, respectively. Malondialdehyde (MDA) levels were estimated as the index of lipid peroxidation of kidney tissues. Finally, light microscopic observations of urinary crystals and histological sections of urolithic kidneys remained like normal rats for treated rats with beverages C, D, and E in ratios of 1.0:1.0%, 0.5:1.5%, and 0.0:2.0% from F. vulgare and C. proximus, respectively. [Copyright &y& Elsevier]

Copyright of Cukurova Medical Journal / Çukurova Üniversitesi Tip Fakültesi Dergisi is the property of Cukurova University, Faculty of Medicine and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Highlights: [•] Patients with unilateral pain-causing kidney stone disease were investigated. [•] Pain to experimental stimuli were comparable on the affected and contra-lateral side. [•] No significant alteration in somatic sensitivity was detected after stone removal. [•] No trophic changes were seen in the muscle/subcutaneous tissue on the affected side. [•] No correlations between pain thresholds/trophic findings and number of colics. [Copyright &y& Elsevier]

Abstract: Urolithiasis is common, with a lifetime prevalence risk of around 10% in the adult population. It is estimated to affect men more commonly with a male/female ratio of 3:1. Multiple factors influence stone formation and these may be intrinsic to the patient, as a result of environmental factors or be a consequence of other pathological processes. Renal colic accounts for up to 1% of all hospital admissions and should be considered in any patient presenting to the surgical team with loin/groin pain. The relevant investigations with regards to blood, urine and imaging tests to diagnose stone disease are discussed. In addition, the absolute indications for urgent intervention are reviewed. Treatment for ureteric stones and renal calculi includes a wide armamentarium of endourological techniques including extracorporeal shock wave lithotripsy (ESWL), ureteroscopy and percutaneous nephrolithotomy (PCNL), if conservative therapy fails. Therapy is guided by anatomical factors, stone factors, previous treatment failures as well as the patient's wishes. Indications, contraindications and complications of the common procedures are discussed. [Copyright &y& Elsevier]

Abstract: Objective: To compare various systems for assessing the risk of recurrent stones, based on the composition of urine. Methods: The relative supersaturation (RSS) of urine, the Tiselius Indices, the Robertson Risk Factor Algorithms (RRFA) and the BONN-Risk Index were compared in terms of the numbers of variables required to be measured, the ease of use of the system and the value of the information obtained. Results: The RSS methods require up to 14 analyses in every urine sample but measure the RSS of all the main constituents of kidney stones. The Tiselius Indices and the RRFA require only seven analyses. The Tiselius Indices yield information on the crystallisation potentials (CP) of calcium oxalate and calcium phosphate; the RRFA also provide information on the CP of uric acid. Both methods provide details on the particular urinary abnormalities that lead to the abnormal CP of that urine. The BONN-Risk Index requires two measurements in each urine sample but only provides information on the CP of calcium oxalate. Additional measurements in urine have to be made to identify the cause of any abnormality. Conclusions: The methods that are based on measuring RSS are work-intensive and unsuitable for the routine screening of patients. The Tiselius Indices and the RRFA are equally good at predicting the risk of a patient forming further stones. The BONN-Risk Index provides no additional information about the causative factors for any abnormality detected. [Copyright &y& Elsevier]

The article focuses on the treatment of postrenal obstruction secondary to bilaterally obstructing ureteral calculi in an Atlantic bottlenose dolphin. It involves cystoscopy for placement of ureteral stent and ureteroscopy for performing intracorporeal lithotripsy. In performing both procedures, the animal is placed in left lateral recumbency and flexible cystoscope is inserted into the bladder of the dolphin for cystoscopy. The calculi is treated through ureteroscopy by pulverizing it first into tiny fragments.

Abstract: Kidney stone disease, or nephrolithiasis, is a common ailment. Among the different risk factors usually associated with nephrolithiasis are dehydration, metabolic defects (especially with regard to calcium and oxalate). The presence of a mineral deposit at the surface of the renal papilla (termed Randall''s plaque) has all been recently underlined. Of note, Randall''s plaque is made of the calcium phosphate, carbapatite, and serves as a nucleus for kidney stone formation. The process by which apatite nanocrystals nucleate and form Randall''s plaque remains unclear. This paper deals with the possible relationship between trace elements and the formation of this mineral. The investigation has been performed on a set of Randall''s plaques, extracted from human kidney stones, through μ-X-ray diffraction and μ-X-ray fluorescence analyses in order to determine the chemical composition of the plaque as well as the nature and the amount of trace elements. Our data provide evidence that Zn levels are dramatically increased in carbapatite of RP by comparison to carbapatite in kidney stones, suggesting that calcified deposits within the medullar interstitium are a pathological process involving a tissue reaction. Further studies, perhaps including the investigation of biomarkers for inflammation, are necessary for clarifying the role of Zn in Randall''s plaque formation. [Copyright &y& Elsevier]

Abstract: Urolithiasis is common, affecting 10% of Caucasian men. Factors affecting stone formation can be intrinsic to the individual and are influenced by environmental factors. Patients presenting with loin/groin pain to the surgical team are common and ureteric colic should be considered in this group. The relevant investigations with regards to blood, urine and imaging tests to diagnose stone disease are discussed. In addition, the absolute indications for urgent intervention are reviewed. Treatment for ureteric stones and renal calculi includes a wide armamentarium of endourological techniques including extracorporeal shock wave lithotripsy, ureteroscopy and percutaneous nephrolithotomy, if conservative therapy fails. Therapy is guided by anatomical factors, stone factors, previous treatment failures as well as the patient’s wishes. Indications, contraindications and complications of the common procedures are discussed. [Copyright &y& Elsevier]

Urinary stone disease has historically been viewed as a disorder of mineral metabolism leading to precipitation of minerals out of the urine. Therefore, the medical management of urinary stones has focused on improving the urinary milieu. A growing body of evidence suggests that both cardiovascular risk factors and cardiovascular disease itself are associated with the development of urinary stones. Although disorders of mineral metabolism and cardiovascular diseases are both systemic conditions, patients frequently present with asymmetric renal calculus disease, suggesting that as yet uncharacterized local mechanisms must contribute to the formation of renal calculi. In this review, we examine the links between cardiovascular disease and nephrolithiasis, and discuss the evidence for potential local factors that contribute to stone disease. [ABSTRACT FROM AUTHOR]