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To assess the use of miniaturized percutaneous nephrolithotomy (mini-PCNL) for renal stones in children, as well as its safety and efficacy. Seventy-seven patients with more than 15 mm renal stones whose age was less than 15 years were enrolled in this prospective case-controlled study at Al-Ramadi Teaching Hospital, Ar Razi Private Hospital, and Ghazi Al-Hariri Hospital for Surgical Specialties, Anbar and Baghdad, Iraq. The study was conducted from January 2020 to January 2024. The group mentioned above served as group A, and it was compared to the control group (group B), which consisted of 70 adult patients aged 18–60 years. Patients in both groups underwent mini-PCNL. Gender, stone size and location, time of operation, stone-free rate, hemoglobin drop, need for blood transfusion, postoperative fever, associated visceral injury, and need for further interventions such as extracorporeal shock wave lithotripsy or flexible ureteroscopy (ESWL or FURS) were compared in both groups. The age of patients in group A ranged from 8 months to 15 years with a mean (4.30 ± 3.16), while in group B ranged from 18 to 60 years with a mean (36.3 ± 12.0), p-value 0.001. There were no statistically significant differences regarding gender distribution, stone size, and location, p-value > 0.05. The stone-free rate was 87.01% for group A and 88.57% for group B, with no statistical difference, p-value 0.773. Hemoglobin drop was 1.096 ± 0.412 for group A and 1.195 ± 0.110 for group B, p-value 0.046. Blood transfusion was needed in one case in each group with no statistical difference, p-value 0.946. The need for ESWL was 3 cases in group A, and 2 cases in group B, with no statistical difference between the two groups, p-value 0.729. The need for FURS was 4 cases in group A and 3 cases in group B, p-value 0.796. Operative time was 30 to 125 min in group A and 34 to 129 min in group B, p-value 0.941. Postoperative fever was seen in 23 cases in group A and 21 cases in group B, p-value 0.986. Minor liver injury was seen was seen in one case in each group. The use of mini-PCNL for treating renal stones in children is safe and effective as it is associated with a relatively low rate of significant complications and achieves a high stone-free rate. [ABSTRACT FROM AUTHOR]

Background: Renal stone disease is a common medical issue in many regions, leading to significant morbidity and loss of man hours. The disease predominantly affects the economically active population, thus having a socio economic impact. Unlike in the West, where detailed demographic data is available, India lacks comprehensive records on this condition. The prevailing theory is that kidney stones often serve as repositories for bacteria. The question which arises is whether bacterial infection is a precursor to or a result of stone formation. Multiple factors contributing to stone formation have been noted by various researchers. The healthcare burden in the United States alone includes over 185,000 hospital admissions and expenditures surpassing $2 billion annually. Supersaturation of calcium and oxalate in urine, exceeding their solubility limits, have been identified as a primary factor. This study evaluates the bacteriological profile of cultures derived from renal stones and their antibiotic sensitivities to better understand the microbial involvement in stone pathogenesis. Methods: This is a prospective, observational study aimed at analyzing the culture and sensitivity patterns of renal stones obtained from patients undergoing percutaneous and ureteroscopic stone extraction over a period of 18 months. Results: Out of 120 patients studied, 34 patients (28.3%) were culture positive. Of there, coagulase negative staphylococcus isolates noted in 9 patients (26.5%), E. coli was the next most common isolate seen in 8 patients (23.5%). Pseudomonas was noted in 6 patients (17.6%), other organisms in 5 patients (14.7%). Acinetobacter was isolated in 1 patient. Analysis of antibiotic susceptibility showed most of these sensitive to varying degrees to aminoglycosides and ciprofloxacin. Conclusion: In conclusion, culture and sensitivity testing of renal stones is a valuable tool in the management of nephrolithiasis, particularly in patients with recurrent or complicated infections. By identifying the bacterial organisms within the stones and determining their antibiotic susceptibility, clinicians can provide targeted treatment, improve patient outcomes, and reduce the risk of recurrenc. [ABSTRACT FROM AUTHOR]

Objectives: The super-pulsed thulium fiber laser (SP TFL) is a new alternative to high-power holmium laser for intracorporeal lithotripsy. The SP TFL has shown advantages in dusting regimes, but benefits in fragmentation regimes are less understood. The second-generation SP TFL introduces an advanced fragmentation pulse (AFP) sequence to maximize SP TFL's efficiency in fragmentation. This study evaluates safety and efficacy of the SP TFL fragmentation mode in ureteroscopy (URS) and mini percutaneous nephrolithotomy (mini-PCNL). Materials and Methods: The study was conducted in two phases. Safety of a new AFP was compared ex vivo to standard SP TFL fragmentation settings by measuring the dimensions of wounds created in porcine kidney after laser exposure for 0.5, 1.0, and 2.0 s. The resulting wounds were evaluated histologically using nitro blue tetrazolium chloride (NBTC) stain. In the clinical phase, the second-generation SP TFL was used to fragment and extract ureteral and renal stones in 40 patients using ureteroscopic and percutaneous approaches. The stone size, volume, density, laser-on-time, and total energy were recorded for each patient. In addition, the chemical composition, ablation rate, and ablation efficiency were assessed for each stone treatment. Results: The ex vivo mucosa damage profiles caused by AFP were similar to those caused by regular pulses. In clinical phase, the median volume and density for ureteral stones were 0.4 cm3 and 1029 Hounsfield units (HU), for renal stones 1.3 cm3 and 1113 HU, respectively. Different stone types were crushed into fragments suitable for extraction. The mean AFP energy was 3 J and the average power for ureteral stones was 10.5 W, whereas for renal stones it was 28.5 J and 31 W, respectively. The overall complication rate was low in both groups. Conclusion: ST PFL with AFP capability facilitates effective fragmentation of ureteral and renal stones of any composition during URS and mini-PCNL with minimal complication rates. [ABSTRACT FROM AUTHOR]

Background Methods Results Conclusion Percutaneous nephrolithotomy (PCNL) is the recommended treatment for stones >2 cm in size. The majority of PCNL are still conducted with larger telescopes using tracts up to 30F in size. We have conducted a randomized pilot study comparing mini PCNL with our standard 22F PCNL for renal stones between 10 and 25 mm in diameter.Patients were randomized to either PCNL (24F Amplatz sheath/22F nephrosocope) or mini PCNL (18F Amplatz sheath/11F nephroscope). All operations were performed in the modified supine position. Patients were reviewed with imaging to assess stone clearance and complications.Eighteen well matched patients were randomized. All procedures were completed as planned and all were tubeless with no complications. There were no differences in operative time, analgesia requirements or length of stay. Seven of nine (77.75%) standard PCNL were completely stone free at CT review with a 2 mm and a 5 mm fragments in the other patients. Four (44.4%) of the mini PCNL group were stone free, with stone fragments 4–10 mm remaining in the others. 40 patients/arm would be required for an adequately powered study.There was no advantage in using mini PCNL compared to our standard 24F PCNL in this pilot study. There may be benefits in using mini PCNL compared to the more widely used 30F PCNL and it may be a more cost‐effective alternative to laser pyeloscopic stone procedures. [ABSTRACT FROM AUTHOR]

Objectives: Urosepsis currently accounts for half of all post flexible ureterorenoscopy (F-URS) complications, with an incidence of up to 4.3%. It represents a quarter of all septic episodes in adults and 2% of hospital spendings. The primary objective of this study was to define the predictive clinical parameters that increase the risk of urosepsis after F-URS. Subjects/patients (or materials) and methods: This prospective multicentric study evaluated patients who underwent F-URS for calculus between June 2016 and June 2018 in eleven French centers. Clinical, bacteriological, morpho-constitutional stone data, intraoperative information and complications were compared. Risk factors for postoperative urosepsis were identified and analyzed. Results: We included 486 F-URS in 432 patients. The ureter was prepared using a double J stent in 51% of cases, a digital endoscope was used in 56% of patients with a median operative time of 120 min IQR (90–125) and using a sheath in 90% of cases. Postoperative urosepsis was observed in 18 patients (4%) with a median time to onset of 2 days IQR (1–5). The presence of coronary insufficiency: 3 (17%) vs 14 (3%) p = 0.005, a larger stone diameter: 11 cm [9–17] vs 10 cm [8–13] p = 0.02, a positive preoperative urine culture even when treated: 3 (17%) vs 56 (12%) p = 0.04, as well as the final composition of the type IV calculus (carbapatite or struvite) 5 (28%) vs 20 (4%) p < 0.001, were significantly associated with the occurrence of urosepsis. In multivariate analysis, only the presence of a type IV stone (OR = 14.0; p = 0.025) remained significant. Conclusion: Ureteroscopic treatment of a type IV stone (carbapatite or struvite) in a patient should raise concerns about the risk of post-operative urosepsis. When recognized intraoperatively, they should lead to a pyelic urinary sample and prolonged clinical surveillance. [ABSTRACT FROM AUTHOR]

Introduction: This article attempts to provide a comprehensive review of the learning objectives and importance of the supine percutaneous nephrolithotomy (PCNL) technique. Material method: We retrospectively reviewed the cases of Supine PCNL between January 2018 and January 2024. We divided the groups into 3: residents between 2 and 3 years (Group 1), residents between 4 and 5 years (Group 2), and endourologist (Group 3). The 2–3-year resident started to perform PCNL for the first time, while the 4–5-year resident started to perform Supine PCNL for the first time while previously performing prone PCNL. Results: Access, fluoroscopy, and operation time were higher in Group 1, shorter in Group 2, and shortest in Group 3 (p < 0.001). Postoperative length of stay and the need for additional treatment were found to be shorter (p < 0.001), and the stone-free rate (SFR) increased (p < 0.001) from Group 1 to Group 3. The highest complication rates were observed in Group 1 (p = 0.002). SFR rate increased as the number of cases increased in Group 1 patients. Success was stable after 46–60 cases in terms of SFR. In Group 2, the SFR rate was stable after 31–45. cases. The most complications were observed in Group 1 and the least in Group 3. Conclusion: In 2-3-year residents, access time and fluoroscopy time decrease with experience. In 4-5-year residents, due to their expertise in prone PCNL, the operation time and fluoroscopy time decrease with the number of cases performed. SFR is higher after 46–60 cases for 2-3-year residents and 31–45 cases for 4-5-year residents. [ABSTRACT FROM AUTHOR]

Background and Objectives: Retrograde intrarenal surgery (RIRS) is a minimally invasive technique for nephrolithiasis. RIRS is performed via a monitor screen displaying a magnified surgical site. Respiration can affect the stability of the surgical view during RIRS because the kidneys are close to the diaphragm. The purpose of this trial is to compare the effect of anesthesia type on the stability of the surgical view during RIRS between spinal anesthesia and general anesthesia. Materials and Methods: Patients were allocated to the general anesthesia group or spinal anesthesia group. During surgery, movement of the surgical field displayed on the monitor screen was graded by the first assistant on a 10-grade numeric rating scale (0–10). Next, it was also graded by the main surgeon. After surgery, we evaluated the discomfort with the anesthesia method for all patients. Results: Thirty-four patients were allocated to the general anesthesia group and 32 patients to the spinal anesthesia group. The average values of the two surgeons for surgical field oscillation grade showed vision on the monitor screen was more stable in the general anesthesia group than the spinal anesthesia group (3.3 ± 1.6 vs. 5.0 ± 1.6, p < 0.001). The degrees of the inconvenience of the surgery did not differ between the groups (0.7 ± 1.8 vs. 1.6 ± 2.6, p = 0.114), even though more patients reported inconvenience with a grade of 3 or more in the spinal anesthesia group (8.8% vs. 28.1%, p = 0.042). Conclusions: In terms of the visualization of the surgical site, general anesthesia might provide a more stable surgical view during RIRS compared to spinal anesthesia without increasing inconvenience induced by the type of anesthesia. [ABSTRACT FROM AUTHOR]

Background and objective: Recently, the new pulsed thulium:yttrium aluminum garnet (p-Tm:YAG) laser technology has been introduced in endourology for lithotripsy. The aim of this study was to assess and validate the clinical laser performance and safety profile of p-Tm:YAG laser in a series of patients with renal and ureteral stones who underwent flexible ureteroscopy (fURS). Methods: Prospective data were collected for patients who underwent fURS with the p-Tm:YAG laser Thulio (Dornier MedTech Systems GmbH, Wessling, Germany) at our institution by using two different laser fiber core diameters (270 and 200 μm). The primary endpoint of the study was stone-free rate (SFR), and the secondary endpoints were Clavien-Dindo complications grade ≥1 and the comparison between laser fibers of different diameters in all the parameters analyzed. Descriptive statistics relied on medians and interquartile ranges for continuous covariates, and on frequencies and percentages for categorical covariates. After stratification according to fiber types, differences between groups were tested with Wilcoxon and chi-square tests as appropriate. All the analyses and graphics were performed using R software (version 4.2.2). Key findings and limitations: The SFR was 82% at 1-mo follow-up. In six out of 50 procedures (12%), Clavien-Dindo grade I–II complications were recorded. There were no differences regarding all the laser parameters considered between patients who were treated with 270 or 200 μm laser fibers (p > 0.05). Limitations of the study include small sample size in a single center and the lack of comparative groups. Conclusions and clinical implications: In this prospective study of 50 patients who underwent fURS for ureteral and renal stones, the p-Tm:YAG laser Thulio was both effective and safe in a short-term follow-up. More prospective randomized studies in larger populations using different laser sources are required to confirm the clinical laser performance and safety of p-Tm:YAG laser for urinary stones treatment. Patient summary: In this report, we looked at the outcomes for the pulsed thulium:yttrium aluminum garnet laser Dornier Thulio in patients who underwent flexible ureteroscopy for ureteral and renal stones. We found that this new laser technology is effective and safe, representing a good alternative to the other laser machines available for stone lithotripsy. We need more studies with larger populations to establish the superiority of this laser technology over the others.

Abstract We aimed to evaluate the correlation between endoscopic papillary abnormalities (PA) and high renal papilla Hounsfield density (PHD) on CT scan in patients who underwent flexible ureteroscopic treatment (fURS) for renal stones. We retrospectively assessed patients from a prospectively collected database who were treated with fURS for renal stones between May 2016 and October 2020. PHD was measured on preoperative CT-scan by a radiologist blinded from the intraoperative aspect of the papillae. Correlation was examined between high PHD (≥ 43 HU) and PA described in fURS, stone composition, metabolic abnormalities, … Out of 159 consecutive cases, 131 were eligible for analysis with available preoperative CT-scan. Median age was 55 years (IQR 43–67) and median PHD was 40 (IQR 36–45). Eighty patients (61%) had PHD

Background: Complex renal calculi, characterized by their size, location, and composition, pose a significant challenge to urologists due to the potential for complications and the difficulty in achieving complete stone clearance. Conventional percutaneous nephrolithotomy (PCNL) and endoscopic combined intrarenal surgery (ECIRS) are two established techniques for managing these complex renal calculi. Aims and Objectives: The aims and objectives are to compare the effectiveness, safety, and outcomes of PCNL versus ECIRS in managing complex renal calculi in a cohort of 60 cases treated at GMKMCH-Salem. Materials and Methods: A retrospective analysis was conducted on 60 patients with complex renal calculi who underwent either conventional PCNL or ECIRS during a specified period at GMKMCH-Salem. Patient demographics, stone characteristics, procedural details, intraoperative and post-operative parameters, and complications were analyzed and compared between the two treatment groups. Results: The study found that both PCNL and ECIRS techniques were effective in treating complex renal calculi. However, significant differences were observed between the two groups in terms of outcomes. The ECIRS technique exhibited superior outcomes with higher stone clearance rates (P

Early kidney stone detection is essential for the diagnosis and treatment of people who have kidney stones. The objective of this study is to employ deep learning algorithms for renal stone detection, addressing the critical need for early, accurate diagnosis, which can significantly improve patient outcomes and reduce healthcare costs. The paper thoroughly assesses a variety of models, including ResNet, DenseNet, and EfficientNet, for CT images. The limitations of manual identification procedures highlight the urgent need for a more effective automated approach, making this research necessary. Notably, the painstakingly improved DenseNet model achieves a peak accuracy of 0.86, demonstrating its potential superiority. These results convincingly demonstrate the revolutionary power of deep learning, which is poised to revolutionise the detection of renal stones. This fast, trustworthy, and non-invasive method has the potential to advance clinical procedures and significantly improve patient care.

Abstract Purpose The aim of this study is to evaluate the outcomes of retrograde intra renal surgery (RIRS) in the setting of large or multiple stones in children (15 mm, or both. Outcomes included stone free rate (SFR) and complications within 30 days. Results In total, 344 patients were included with 197 and 147 in Groups 1 and 2, respectively. Ureteric access sheaths were more frequently used in Group 2 (39.5% vs. 56.8%, p = 0.021). The operation time was significantly longer in Group 2 (p

Objectives: To report our initial experience of one-stage flexible ureteroscopic lithotripsy(FURL) with 11/13Fr suctioning ureteral access sheath(UAS) and 8.55Fr single-use digital flexible ureteroscope(SDFU) in upper ureteral or renal calculi. Materials and methods: We retrospectively collected the clinical data of 900 adult patients with upper ureteral or renal calculi treated by FURL with 11/13Fr suctioning UAS and 8.55Fr SDFU from January 2022 to April 2024. Demographics, peri- and postoperative outcomes were assessed. Results: In all, 40 of 940 cases(4.26%) failed to introduce UAS and required second-stage FURL because of ureterostenosis and were excluded. Mean stones size of the remaining 900 eligible cases was 1.68 ± 0.58 cm in greatest diameter. There were 228 cases of upper ureteral stone, 456 cases of renal stone and 216 cases of concomitant ureteral and renal calculi. The mean operation time was 52.20 ± 20.21 min and the postoperative hospital stay was 2.87 ± 1.37 days. The stone-free rate of 1 month postoperatively was 89.56% and only 2.44% of patients with residue underwent additional reoperation. The rate of postoperative fever, postoperative pain needing analgesic and slight ureteral mucosal injury were 5.11%, 8.22% and 7.78%, respectively. None of patient suffered from severe complications, such as sepsis or ureteral perforation. Conclusion: It's practical and suitable for the vast majority of adult patients to undergo FURL in single session with 11/13Fr suctioning UAS without preoperative stenting. FURL with 11/13Fr suctioning UAS and 8.55Fr SDFU is feasible, reliable, safe, and efficient in the management of renal stone and upper ureteral stone. [ABSTRACT FROM AUTHOR]

Background: Complete removal of renal stones is crucial for optimal patient outcomes, but recent studies have reported residual stones after retrograde intrarenal surgery (RIRS). This study aimed to identify the associated risk factors to improve patient management and treatment selection. Methods: This cohort study was conducted over 18 months at two hospitals and recruited adult patients with renal stones less than 3 cm. Preoperative assessment included medical history, physical examination, laboratory tests, and radiological imaging. Intraoperative and postoperative data collection and follow-up were conducted to evaluate surgical success and potential complications. Results: A total of 100 patients were included, with a mean age of 45.3 ± 10.7 years and a mean BMI of 26.2 ± 1.4 kg/m2. Approximately 19% of the patients had residual stones after the RIRS procedure. The RUSS score showed good diagnostic performance with an AUC of 0.843, and the optimal cut point was ⩾2.0 with a sensitivity of 52.6% and specificity of 95.1%. Independent predictors of residual stones were multiple sites (OR = 24.98; p = 0.002), multiple stones (OR = 13.62, p = 0.002), stone size of 21–30 mm (OR = 4.91, p = 0.038), lower calyx site (OR = 4.85, p = 0.033), and surgeon experience of fewer than 50 cases (OR = 6.82, p = 0.020), Conclusions: This study identifies several factors associated with residual stones after RIRS for renal stones, including stone size, location, number, and surgeon experience. The study suggests that the RUSS score can be used as a reliable tool for predicting the likelihood of residual stones, which can help clinicians in patient selection and treatment planning. [ABSTRACT FROM AUTHOR]

Background: Complex renal calculi, characterized by their size, location, and composition, pose a significant challenge to urologists due to the potential for complications and the difficulty in achieving complete stone clearance. Conventional percutaneous nephrolithotomy (PCNL) and endoscopic combined intrarenal surgery (ECIRS) are two established techniques for managing these complex renal calculi. Aims and Objectives: The aims and objectives are to compare the effectiveness, safety, and outcomes of PCNL versus ECIRS in managing complex renal calculi in a cohort of 60 cases treated at GMKMCH-Salem. Materials and Methods: A retrospective analysis was conducted on 60 patients with complex renal calculi who underwent either conventional PCNL or ECIRS during a specified period at GMKMCH-Salem. Patient demographics, stone characteristics, procedural details, intraoperative and post-operative parameters, and complications were analyzed and compared between the two treatment groups. Results: The study found that both PCNL and ECIRS techniques were effective in treating complex renal calculi. However, significant differences were observed between the two groups in terms of outcomes. The ECIRS technique exhibited superior outcomes with higher stone clearance rates (P<0.001), shorter operative times (P<0.05), and reduced hospital stays (P<0.05) compared to conventional PCNL. Conclusion: This study demonstrates that ECIRS is a promising alternative to conventional PCNL in the management of complex renal calculi. The ECIRS technique yielded higher stone clearance rates, shorter operative times, and reduced hospital stays, potentially improving patient outcomes and reducing health-care costs. Although our findings show favorable results for ECIRS, the decision between conventional PCNL and ECIRS should be based on individual patient characteristics, surgeon expertise, and resource availability. [ABSTRACT FROM AUTHOR]

Low‐oxalate diets are useful for treating hyperoxaluria in nephrolithiasis patients. This study was unique in examining how a low‐oxalate diet in addition to a standard diet affected hyperoxaluria and renal function tests in nephrolithiasis patients. The effects of a low‐oxalate diet were analyzed by different biochemical tests, that is, anthropometric measurements, blood oxalate test, renal function test, electrolyte profile test, and 24 h urine analysis. For this purpose, 112 patients were divided into 2 groups: Group T1 (Conventional diet) and Group T2 (Low‐Oxalate diet) for 8 weeks. Each group was tested at the initiation and end of the study. Using SPSS, the obtained data from each parameter were statistically analyzed. The results showed that a low‐oxalate diet had a positive effect on patients suffering from nephrolithiasis. Furthermore, after treatment, anthropometric measurement weight (kg) among the control group (T1) was 100.45 ± 5.65 and the treatment group (T2) was 79.71 ± 9.48 kg. The effect of low‐oxalate diet on renal function test: creatinine (g/d) among T1 was 2.08 ± 0.86 and T2 was 1.17 ± 0.13, uric acid(mg/d) among T1 was 437.04 ± 24.20 and T2 was 364.61 ± 35.99, urinary oxalate (mg/d) among T1 was 76.84 ± 10.33 and T2 was 39.24 ± 1.51, respectively. Sodium (mEq/d) among T1 was 156.72 ± 6.37 and T2 was 159.84 ± 6.31, potassium (mEq/d) among T1 was 69.91 ± 15.37 and T2 was 89.21 ± 6.31, phosphorus (g/d) among T1 was 0.96 ± 0.07 and T2 was 0.34 ± 0.27, respectively. This study demonstrated that nephrolithiasis patients with hyperoxaluria benefit from low‐oxalate diets. Hyperoxaluria patients should eat a low‐oxalate diet to use oxalate without affecting metabolism and eliminate it from the kidney without stones. [ABSTRACT FROM AUTHOR]

Spina bifida is a congenital condition that often leads to significant urological complications, including an increased risk of kidney and bladder stones. Performing percutaneous nephrolithotomy (PCNL) on patients with spina bifida presents unique challenges due to the anatomical deformities. We present a case of a spina bifida patient with right staghorn stone and bladder stones in a previously augmented bladder. Simultaneous tubeless supine PCNL and cystolitholapaxy was successfully performed. This case highlights the versatility of the supine position in managing complex stones in patients with spina bifida.

Background. The incidence of kidney stones has been raised all over the world. Nephrolithiasis is the most common cause of illnesses in western countries and has been rising in its incidence in developing countries. PCNL describe the management of large renal calculi when measuring >20 mm and even for smaller ones of lower pole with excellent stone-free rate reach to 98%. Aim. To evaluate the mini-percutaneous nephrolithotomy (mini-PCNL) safety used to cure upper ureteral and renal stones with assessing the complication and procedure outcome in Iraqi patients. Method. This is a prospective study done between October 2022 and September 2023 in Ghazi Al-Hariri for Surgical Specialties Hospital, Medical city, with 100 patients enrolled who underwent mini-PCNL. All patients had upper ureteral and renal stones (size ≥20 mm). The nephroscope tube was utilized. The stones were destroyed by pneumatic lithotripter. Complications and outcomes were determined immediately postoperative via X-ray of the ureters, kidneys and bladder. Ultra-sonography also used to determine safety and efficacy of procedure. Results. The cases mean age was 55.8 ± 12.3 years, and their BMI was 29.5 ± 5.9 kg/m2. The size of mean stone was 22.5 ± 17.9 mm. The stone-free rate (SFR) was 94.7%. The post-operative hospital stay mean was 3.6 ± 2.7 days. The Hb drop mean was 0.6 ± 0.3 g/dL. There were none of our cases had organ trauma or any complications. Thirty cases required additional subsequent extra-corporeal shock wave lithotripsy. Conclusion. The mini-PCNL is effective and safe in cases of upper ureteral and renal stones ≥20 mm. Researches with a larger multi-center cohorts may be needed to validate these techniques.

Objective: There are several factors affecting the success of shockwave lithotripsy (SWL), which is still one of the first-line treatments for renal stones smaller than 2 cm. The aim of this study was to evaluate the effect of thickness and density measurements obtained by computed tomography (CT) for various tissues within the route of shockwaves on the outcome of SWL treatment success. Materials and Methods: The data of 89 patients who underwent SWL for renal pelvic stones smaller than 2 cm between July 2020 and September 2021 were prospectively evaluated. Age, sex, body mass index, stone volume, stone density, skin-to-stone distance, tissue thickness and density, hydronephrosis, number of shockwaves, and SWL success were recorded. Patients were divided into two groups according to SWL success: SWL success and SWL failure groups. Demographic data and CT parameters were compared between the groups. Results: Stone-free status (

Introduction: The aim of this study was to evaluate the safety and efficacy of flexible ureteroscopy using a tip-flexible pressure-controlling ureteral access sheath (TFPC-UAS) for renal stones in children. Methods: Consecutive patients aged 5–18 years with renal stones of diameter 1–3 cm were enrolled between January 2022 and November 2023 at Ganzhou People's Hospital. The patients were treated with flexible ureteroscopy using the TFPC-UAS. The renal pelvic pressure (RPP) parameters were set as follows: control value at −10 mm Hg to 5 mm Hg, warning value at 20 mm Hg, and limit value at 30 mm Hg. The infusion flow rate was set to 100–120 mL/min. A holmium laser (276 μm) was used to fragment the stone at 2.0–2.5 J/pulse with a frequency of 20–30 pulses/s. The cases were analyzed for RPP, operative time, stone-free rate, and complications. Results: A total of 21 consecutive patients were included. Two patients were switched to percutaneous nephrolithotomy owing to sheath placement failure. The RPP was −4.6 ± 2.1 mm Hg. The mean operative time was 56.5 ± 17.1 min. The postoperative hospitalization time was 1.5 ± 0.3 days. The stone-free rates at 1 day and 1 month after surgery were 81.0% and 85.7%, respectively. Residual stones in 2 patients were cleared after extracorporeal shockwave lithotripsy. Three cases of Clavien I complications and one case of Clavien II complications occurred. No major complications (Clavien grade III–V) were observed. Conclusions: Flexible ureteroscopy with a TFPC-UAS is safe and effective for renal stones in children. [ABSTRACT FROM AUTHOR]

Background: Supine percutaneous nephrolithotomy (s-PCNL) offers great benefits from urological and anaesthetic points of view. We present the first evaluation of the outcomes of s-PCNL in Malaysia. Our aim was to explore the safety and efficacy of s-PCNL. Methods: Institutional review board approval was obtained from the National Medical Research Register (NMRR ID-21002225-WLP). We retrospectively reviewed 115 patients with renal pelvis stones who underwent single renal access during s-PCNL between November 2020 and May 2023. Patients who underwent simultaneous ipsilateral or contralateral endourological procedures were included. The data were analysed to determine stone-free rates (SFR), major complication rates, blood transfusion rates, operative times and lengths of hospital stay (LOS). Results: The SFR was higher for the single middle calyceal renal access (MCA) group than for the lower calyceal renal access (LCA) or upper calyceal renal access (UCA) groups (OR: 1.76; 95% confidence interval [CI]: 0.63, 4.92). In total, 0, 1 and 2 patients had major complications in the UCA, MCA and LCA groups, respectively (P = 0.453). One of the 115 patients (0.9%) needed blood transfusion. Subgroup analysis revealed mean operative times of 76.3 min and 78.6 min for patients who underwent sole s-PCNL (PCNL-only group) and those who had simultaneous ipsilateral and contralateral endourological procedures (PCNL-plus group), respectively (P = 0.786). The overall mean LOS was 2.9 days. Conclusion: s-PCNL is a safe and effective alternative treatment for renal stones. We would recommend s-PCNL for patients who require an ipsilateral/contralateral endourological procedure (URS/RIRS) because it is time-efficient. All renal accesses are safe. Single MCA is recommended for complete stone clearance. [ABSTRACT FROM AUTHOR]

Introduction Historically, percutaneous nephrolithotomy (PCNL) in horseshoe kidney (HSK) patients has been performed in the prone position. Nevertheless, thanks to the spread of the supine PCNL technique for patients with urinary stones and normal renal anatomy, some retrospective studies have already reported on supine PCNL and HSK, showing the effectiveness and safety of the procedure. Herein we report our experience with supine PCNL in a subset of patients with urolithiasis. Material and methods Prospective data were collected for all HSK patients who underwent supine PCNL at our institution from June 2016 to June 2023. Stone volume was reported as the volume of a single stone or the sum of the volumes of multiple stones on computed tomography (CT) images. Patients were reported to be stone-free if there were no stones on postoperative non-contrast CT (NCCT) exam. Peri-/postoperative complications were reported according to the Clavien-Dindo classification system. The primary endpoint of the study was stone-free rate (SFR) and the secondary endpoints were Clavien-Dindo complications Grade I or higher. Results A total of 35 patients met the inclusion criteria and were enrolled in the study. Forty-eight procedures were analyzed. SFR was 72.9% at 1-month follow-up. In 11 out of 48 procedures (22.9%) Clavien-Dindo Grade I-II complications were recorded. In one case Clavien-Dindo Grade IIIa complication was observed. Conclusions In this prospective study of 35 HSK patients who underwent 48 procedures, supine PCNL was safe and effective, with minimal morbidity. [ABSTRACT FROM AUTHOR]

Background: Extracorporeal shockwave lithotripsy (ESWL) is a commonly used non-invasive treatment modality for urolithiasis. While fluoroscopy (FS)-guided ESWL has been the traditional approach, the use of ultrasound (USG) guidance has gained traction due to its potential benefits in terms of reduced radiation exposure and improved stone targeting. Aims and Objectives: The aims and objectives are to study the safety and efficacy of extracorporeal shock wave lithotripsy in the management of renal stones, outcomes of overall stone-free rate (SFR), pain intensity, urinary biochemical variables, mean hospital stay, quality of life, and adverse events. Materials and Methods: Patient data from the period of May 2022 to April 2023 were reviewed, including 20 patients who underwent USG-guided ESWL and 20 patients who underwent FS-guided ESWL. Results: Our analysis revealed that the USG-guided ESWL group demonstrated comparable stone fragmentation rates and SFR (P-value) when compared to the FS-guided group. Moreover, radiation exposure was significantly reduced in the USG-guided ESWL group, with a mean total FS time of [55] s compared to [3005] s in the FS-guided group. No significant differences were observed in terms of complications between the two groups. Conclusion: This study highlights the successful implementation of USG-guided ESWL in our institution’s experience, showing comparable outcomes in terms of stone fragmentation rates and SFR, while significantly reducing radiation exposure, also can be considered an effective and safe alternative for the treatment of urolithiasis.

Background and Objectives: Retrograde intrarenal surgery (RIRS) is a minimally invasive technique for nephrolithiasis. RIRS is performed via a monitor screen displaying a magnified surgical site. Respiration can affect the stability of the surgical view during RIRS because the kidneys are close to the diaphragm. The purpose of this trial is to compare the effect of anesthesia type on the stability of the surgical view during RIRS between spinal anesthesia and general anesthesia. Materials and Methods: Patients were allocated to the general anesthesia group or spinal anesthesia group. During surgery, movement of the surgical field displayed on the monitor screen was graded by the first assistant on a 10-grade numeric rating scale (0–10). Next, it was also graded by the main surgeon. After surgery, we evaluated the discomfort with the anesthesia method for all patients. Results: Thirty-four patients were allocated to the general anesthesia group and 32 patients to the spinal anesthesia group. The average values of the two surgeons for surgical field oscillation grade showed vision on the monitor screen was more stable in the general anesthesia group than the spinal anesthesia group (3.3 ± 1.6 vs. 5.0 ± 1.6, p < 0.001). The degrees of the inconvenience of the surgery did not differ between the groups (0.7 ± 1.8 vs. 1.6 ± 2.6, p = 0.114), even though more patients reported inconvenience with a grade of 3 or more in the spinal anesthesia group (8.8% vs. 28.1%, p = 0.042). Conclusions: In terms of the visualization of the surgical site, general anesthesia might provide a more stable surgical view during RIRS compared to spinal anesthesia without increasing inconvenience induced by the type of anesthesia.

Background: Extracorporeal shockwave lithotripsy (ESWL) is a commonly used non-invasive treatment modality for urolithiasis. While fluoroscopy (FS)-guided ESWL has been the traditional approach, the use of ultrasound (USG) guidance has gained traction due to its potential benefits in terms of reduced radiation exposure and improved stone targeting. Aims and Objectives: The aims and objectives are to study the safety and efficacy of extracorporeal shock wave lithotripsy in the management of renal stones, outcomes of overall stone-free rate (SFR), pain intensity, urinary biochemical variables, mean hospital stay, quality of life, and adverse events. Materials and Methods: Patient data from the period of May 2022 to April 2023 were reviewed, including 20 patients who underwent USG-guided ESWL and 20 patients who underwent FS-guided ESWL. Results: Our analysis revealed that the USG-guided ESWL group demonstrated comparable stone fragmentation rates and SFR (P-value) when compared to the FS-guided group. Moreover, radiation exposure was significantly reduced in the USG-guided ESWL group, with a mean total FS time of [55] s compared to [3005] s in the FS-guided group. No significant differences were observed in terms of complications between the two groups. Conclusion: This study highlights the successful implementation of USG-guided ESWL in our institution's experience, showing comparable outcomes in terms of stone fragmentation rates and SFR, while significantly reducing radiation exposure, also can be considered an effective and safe alternative for the treatment of urolithiasis. [ABSTRACT FROM AUTHOR]

The main goal of the study is to evaluate the three stone scoring systems (S.T.O.N.E nephrolithometry scoring system (STONE), Guy's stone score (GSS) and Seoul National University Renal Stone Complexity (S-ReSC)) for the stone-free rate (SFR) of mini-PCNL. We retrospectively analyzed 72 patients who received mini-PCNL from February 2018 to October 2020. The SFR, complication rates, hospitalization days and recurrence rates were analyzed using three stone scoring systems. The result showed statistical significance in the association between scoring system and stone-free (STONE: OR 95%CI 0.409 (0.221–0.759), p = 0.0045; S-ReSC OR 95%CI 0.633 (0.401–0.999), p = 0.0497), but not GSS (OR 95%CI 0.776 (0.397–1.516), p = 0.4581). After adjusting the potential confounding factors, the area under curve (AUC) of STONE, GSS, and S-ReSC was 0.86, 0.78, and 0.81, respectively, and Akaike information criterion (AIC) of STONE, GSS, and S-ReSC was 64.65, 74.89, and 69.92, respectively. The accuracy rate of STONE, GSS, and S-ReSC was 0.81, 0.75, and 0.79, respectively. There was no statistically difference of predicting stone recurrence (p = 0.46, 0.53, 0.86), complications (p = 0.74, 0.51, 0.16) and hospitalization days (p = 0.77, 0.86, 0.87) in STONE, GSS, and S-ReSC, respectively. In conclusion, both the STONE and S-ReSC stone scoring systems are viable for predicting the SFR following mini-PCNL, especially after variable adjustment with the STONE system demonstrating superiority over S-ReSC. [ABSTRACT FROM AUTHOR]

Objective: To correlate the grades of hydronephrosis and the detection of urinary stones by ultrasound imaging. Study Design: Cross-sectional, Retrospective study. Setting: Watim General Hospital, Rawat. Period: Jan 1, 2023 and Mar 31, 2023. Material & Methods: All patients on whom a renal sonogram showed hydronephrosis and nephrolithiasis between Jan-Mar 2023 > 18 years of age and < 70 years of age were included. The data were obtained retrospectively from the ultrasound department records. All patients were scanned while lying flat on their backs. Data regarding hydronephrosis grades and the presence of nephrolithiasis was obtained. Results: There were 248 individuals with hydronephrosis due to nephrolithiasis whose ultrasounds were included in this investigation. All patients had urinary stones and as hydronephrosis progressed from grade 1 to 3, the detection rate of stones increased, before declining in grade 4. Patients with grade 3 hydronephrosis had four times the risk of having urinary stones as grade 4 patients (Odds Ratio = 5.675, 95% Confidence Interval [Cl]=3.345-4.648). Conclusion: The sensitivity of sonography to identify grades of hydronephrosis and identify their underlying causes is of diagnostic importance. Hydronephrosis is often brought on by kidney stones or ureteric calculi, and a higher grade should raise clinical suspicion for the presence of renal calculi. [ABSTRACT FROM AUTHOR]

Objective: National guidelines recommend periprocedural antibiotics before percutaneous nephrolithotomy (PCNL), yet it is not clear which is superior. We conducted a randomized trial to compare two guideline-recommended antibiotics: ciprofloxacin (cipro) vs cefazolin, on PCNL outcomes, focusing on the development of systemic inflammatory response syndrome (SIRS) criteria. Methods: Adult patients who were not considered high risk for surgical or infectious complications and undergoing PCNL were randomized to receive either cipro or cefazolin perioperatively. All had negative preoperative urine cultures. Demographic and perioperative data were collected, including SIRS criteria, intraoperative urine culture, duration of hospitalization, and need for intensive care. SIRS is defined by ≥2 of the following: body temperature <96.8°F or >100.4°F, heart rate >90 bpm, respiratory rate >20 per minute, and white blood cell count <4000 or >12,000 cells/mm3. Results: One hundred forty-seven patients were enrolled and randomized (79 cefazolin and 68 cipro). All preoperative characteristics were similar (p > 0.05), except for mean age, which was higher in the cipro group (64 vs 57 years, p = 0.03). Intra- and postoperative findings were similar, with no difference between groups (p > 0.05), except a longer mean hospital stay in the cefazolin group (2 hours longer, p = 0.02). There was no difference between SIRS episodes in both univariate and multivariate analyses. Conclusions: Despite the relatively broader coverage for urinary tract pathogens with ciprofloxacin, this prospective randomized trial did not show superiority over cefazolin. Our findings therefore support two appropriate options for perioperative antibiotic prophylaxis in patients undergoing PCNL who are nonhigh risk for infectious complications. [ABSTRACT FROM AUTHOR]

Purpose: Three-Dimensional (3D) could help for planning and creating an optimal access route in percutaneous nephrolithotomy (PCNL) procedure by achieving a more accurate approach to the renal collecting system and stone treatment while decreasing the risk of complications. The aim of our study is to compare the efficacy of 3D imaging technique with standard fluoroscopy method as a guiding tool for renal stone location while striving to reduce intra-operative X-ray exposure in the former method. Materials and Methods: This randomised clinical trial enrolled 48 PCNL candidates who were referred to Sina Hospital (Tehran, Iran). Participants were divided into two equal groups of intervention (3D virtual reconstruction) and control, using block randomization method. Age, sex, stone type and location, X-ray exposure during the procedure, stone access accuracy rate and the necessity of blood transfusion during surgery were taken into account. Results: The Mean age of participants (n = 48) was 46.4 ± 4.8 years, 34 (70.8%) were male, 27 (56.3%) had partial staghorn stones and all participants had stones within the lower calyx. The radiation exposure time, stone access time and stone size were 2.99 ± 1.81 seconds, 272.3 ± 108.9 seconds and 23.06 ± 2.28 mm, respectively. In the intervention group, the accuracy rate for lower calyceal stone access was 91.5%. Also, X-ray exposure and time to stone access were significantly lower in the intervention group compared to the controls (P < 0.001). Conclusion: We concluded that the utilization of 3D technology in the pre-operative location of renal calculi in PCNL candidates may result in a significant improvement in the accuracy and time to access the renal calculi, as well as reduction in X-ray exposure. [ABSTRACT FROM AUTHOR]

This study evaluated the clinical value of color Doppler ultrasound-guided percutaneous nephrolithotomy (PCNL) in avoiding bleeding caused by punctured blood vessels. Herein, we retrospectively included patients who underwent color Doppler ultrasound-guided PCNL or PCNL using the conventional channel technique from August 2018 to August 2022. The clinical characteristics of patients during surgery, complications, and hospital stay were recorded and compared. Overall, 228 patients were enrolled, with 126 patients (age, 47.6 ± 13.2 years; men: 57.14%) in the color Doppler ultrasound-guided PCNL group and 102 patients (age, 46.6 ± 12.3 years) in the B-mode ultrasound-guided puncture group. The total operation time (63.5 ± 15.5 vs. 61.3 ± 16.3 min, p = .5236) and stone clearance rate (86.50% vs. 83.33%, p = .7139) were similar between the two groups. However, the puncture time for the color Doppler ultrasound-guided PCNL group was longer than that for the B-mode ultrasound-guided puncture group (5.1 ± 2.3 vs. 2.6 ± 1.6 min, p = .0019). Moreover, the length of postoperative hospital stay in the color Doppler ultrasound-guided PCNL group reduced significantly by ~1 day compared with that in the B-mode ultrasound-guided puncture group (4.5 ± 1.6 vs. 5.6 ± 2.1 days, p = .0087). The blood transfusion rate (1.58% vs. 4.9%, p = .0399), sedation-related adverse event rate (0.79% vs. 2.9%, p = .0332), perineal hematoma incidence (0% vs. 2.94%, p < .0001), and serum decreased hemoglobin levels (12.2 ± 9.7 vs. 23.5 ± 10.1 g/L, p < .001) after color Doppler ultrasound-guided PCNL were significantly lower than those after B-mode ultrasound-guided puncture. The stone clearance rate was similar between the two groups, with a similar operation time. Moreover, color Doppler ultrasound-guided PCNL shortened the postoperative hospital stay and decreased Hb levels, blood transfusion rate, and perineal hematoma incidence. [ABSTRACT FROM AUTHOR]

BACKGROUND: The association between dietary magnesium intake (DMI) and kidney stone (KS) disease is not clear. AIM: To determine the association between DMI and prevalent KS disease defined as self-report of any previous episode of KS. METHODS: We examined The National Health and Nutrition Examination Survey (NHANES) 2011-2018 and used logistic regression analyses adjusting for demographics, BMI, histories of hypertension, diabetes, thiazide use, cigarette smoking, alcohol drinking, relevant dietary and supplemental intakes to determine the independent association between DMI and prevalent KS disease. RESULTS: A total of 19,271 participants were eligible for the final analysis, including 1878 prevalent KS formers. Mean DMI among stone formers was 295.4 mg/day, as compared to 309.6 mg/day among non-stone formers (p=0.02). Higher DMI was strongly associated with lower odds of prevalent KS disease in univariate analysis regardless of when DMI was analyzed as a continuous variable (OR=0.94, 95% CI: 0.89-0.99, p=0.02) or when the extreme quartiles of DMI were compared (OR=0.74, 95% CI: 0.60-0.92, p=0.007). In the multivariable-adjusted regression analysis, those in the highest quartile of DMI compared to the lowest quartile (=379 mg vs. <205 mg) had significantly reduced odds of prevalent KS (OR=0.70, 95% CI: 0.52-0.93, p=0.01). When DMI was analyzed as a continuous variable, there was a trend toward reduced odds of prevalent KS disease with higher DMI (OR=0.92 per 100 mg, 95% CI: 0.84-1.01, p=0.07). CONCLUSIONS: Our study suggests that higher DMI is associated with a reduced risk of KS disease. Future prospective studies are needed to clarify the causal relationship between DMI and KS disease. [ABSTRACT FROM AUTHOR]

Objectives: This study aims to describe the effectiveness of a single-use flexible ureteroscope regarding the time of surgery, stone-free rate, and complications. Material: This prospective work was performed at Basrah Urological Centre for the period March 2022 to April 2023. Sixty-one patients were enrolled in this study after we excluded patients who had ureteral stricture, high blood urea, and untreated urinary tract infection. All patients were selected older than 20 years of age. Patients were operated upon by the same surgeon. Results: This study involved 61 patients of them 23 (37.7%) male and 38 (62.3%) female patients. The mean age of patients was 37.3 years with a standard deviation of 11.1. The average total stone burden was 10.1 ± 3.3 mm, with a range of 7-15 mm. The average stone density was 1000.3 ± 271.5 HU, ranging from 820 to 1411 HU. Conclusion: The present study concluded that the single- use flexible ureteroscope for treating renal stones is effective and causes fewer complications. [ABSTRACT FROM AUTHOR]

Background. Risk factors of postoperative complications during percutaneous nephrolithotomy (PCNL) include stone burden, the preoperative microbiological status of urine, comorbidity, age, operative time, intraoperative level of sterility, and antibiotic prophylaxis. The study aimed to assess the sequelae of these complications. Materials and methods. This retrospective study was conducted on patients treated by PCNL under fluoroscopic guidance for a one-year duration. The demographic data, body mass index, stone burden, stone density, number, duration of surgery, and postoperative complications were recorded. Results. Out of 50 patients, 32 (64 %) developed a fever. White blood cell count was significantly high among those patients. The age of the patients, gender, body mass index, and hospital stay were insignificant variables. Stone burden, prolonged surgery duration, prone position during surgery, and the use of pneumatic lithotripsy were significant variables. Conclusions. Increased stone burden, prolonged duration of surgery, prone position, and pneumatic lithotripsy during PCNL are significant risk factors for developing postoperative complications, mainly fever.

Primary aldosteronism (PA) is associated with urolithiasis as it causes hypercalciuria and hypocitraturia. However, the influence of different subtypes of PA on urinary stone formation remains unclear. This study aimed to evaluate the association between aldosterone-producing adenoma (APA) and the burden of urolithiasis in patients with PA. In the present study, we enrolled 312 patients with PA from a prospectively maintained database, of whom 179 had APA. Clinical, biochemical, and imaging data (including the presence, volume, and density of urinary stones on abdominal computed tomography) were compared between groups, with employment of propensity score matching (PSM) analysis to balance possible confounding factors. Kaplan–Meier analysis was used to estimate the acute renal colic event during follow-up. After PSM for age, sex, serum calcium, phosphate, blood urea nitrogen, creatinine, and uric acid, the APA and non-APA groups had 106 patients each. Patients with APA had higher serum intact parathyroid hormone (iPTH) (79.1 ± 45.0 vs 56.1 ± 30.3, P < 0.001) and a higher prevalence of urolithiasis (27.4% vs 12.3%, P = 0.006) than non-APA patients. During follow-up, a higher incidence of acute renal colic events was noted in the APA group than the non-APA group (P = 0.011); this association remained significant (P = 0.038) after adjustment for age and sex in Cox-regression analysis. Our data suggest that APA is associated with a heavier burden of urolithiasis and higher incidence of renal colic events compared to the non-APA subtype of PA.

The prevalence of renal stones with concomitant UPJO is about 20-30%. Its treatment method is controversial. In this study, a 29-year-old man with UPJO and simultaneous ipsilateral renal stone is presented, who was treated with PCNL following Hellström laparoscopic pyeloplasty.

Background Although it is a valuable option for children with drug-resistant epilepsy, ketogenic diet (KD) therapy is associated with several side effects. The frequency of kidney stones and risk factors for their development in epileptic children receiving KD is unclear. The aim of this study was to determine the frequency and risk factors for the development of renal stones in children receiving KD therapy. Methods A total of 95 patients receiving KD were identified. Of these, seven patients were excluded from the study due to the duration of KD being less than 12 months. The remaining 88 children were enrolled in the study. Results Renal stones were detected in 15 patients (17%), of which 12 (73.3%) received potassium citrate treatment. Two (13.3%) patients needed lithotripsy despite receiving potassium citrate treatment, and one of these, who received potassium citrate treatment for 5 months, developed acute vesicourethral reflux and underwent surgery. No patient discontinued KD due to renal stone development. The serum uric acid concentrations and urine calcium/creatinine ratio did not change significantly over the 24-month follow-up period. Age, gender, etiology, age at seizure onset, duration of KD, mobility status, use of topiramate or zonisamide, and the number of antiepileptic drugs used were not significantly different between patients with and without kidney stones. Conclusion Renal stone appears to be a common adverse effect of KD therapy. Although adequate hydration and potassium citrate treatment are effective in most patients, lithotripsy and surgery may be required in a minority of patients. [ABSTRACT FROM AUTHOR]

Introduction and Objective: The study's primary objective was to compare the laser efficiency and clinical outcomes of two widely used systems, the holmium MOSES laser and the thulium fiber laser (TFL), in managing kidney stones. The secondary outcomes were to evaluate the impact of stone composition on laser efficacy. Methods: We conducted a retrospective review of patients who underwent flexible ureteroscopy (f-URS) for solitary renal calculi between December 2020 and August 2022 at our institution and had a 3-month postoperative CT scan. Patient demographics and stone parameters were recorded, including stone site, size, volume, and density. Intraoperative data were collected and analyzed, including total operative time, ureteroscopy time, lasing time, technique, total energy delivered, and stone composition. All patients underwent a CT scan at 3 months follow-up. We recorded the presence of residual stones and the percentage of stone volume reduction. Ablation efficiency was calculated by dividing the energy utilized (J) by the stone volume (mm3). The ablation speed was calculated by dividing the stone volume (mm3) by the lasing time (seconds). Patients with a stone size <4 mm were deemed stone-free. Results: The MOSES and TFL groups comprised 62 and 49 patients, respectively. There were no significant differences between groups for baseline patient demographics or stone characteristics. The two modalities had comparable total energy, laser time, efficacy, and ablation speeds. No differences were detected in stone-free rates or complications between both groups. When dealing with calcium phosphate stones, we observed that the lasing time was significantly shorter with MOSES than TFL (7.95 vs 10.85 minutes, respectively [p = 0.01]). Conclusions: MOSES and TFL laser systems had comparable efficacy for lithotripsy of renal calculi during f-URS; however, calcium phosphate stones had a longer lasing time with TFL. REB Number: 100210. [ABSTRACT FROM AUTHOR]

Background: An accurate estimation of the stone burden is the key factor for predicting retrograde intra-renal surgical outcomes. Volumetric calculations better stratify stone burden than linear measurements. We developed a free software to assess the stone volume and estimate the lithotrity duration according to 3D-segmented stone volumes, namely the Kidney Stone Calculator (KSC). The present study aimed to validate the KSC's reproducibility in clinical cases evaluating its inter-observer and intra-observer correlations. Methods: Fifty patients that harbored renal stones were retrospectively selected from a prospective cohort. For each patient, three urologists with different experience levels in stone management made five measurements of the stone volume on non-contrast-enhanced computed tomography (NCCT) images using the KSC. Results: the overall inter-observer correlation (Kendall's concordance coefficient) was 0.99 (p < 0.0001). All three paired analyses of the inter-observer reproducibility were superior to 0.8. The intra-observer variation coefficients varied from 4% to 6%, and Kendall's intra-observer concordance coefficient was found to be superior to 0.98 (p < 0.0001) for each participant. Subgroup analyses showed that the segmentation of complex stones seems to be less reproductible. Conclusions: The Kidney Stone Calculator is a reliable tool for the stone burden estimation. Its extension for calculating the lithotrity duration is of major interest and could help the practitioner in surgical planning. [ABSTRACT FROM AUTHOR]

OBJECTIVE: This study investigated the correlation between dental calculi grading and renal stone burden grading. PATIENTS AND METHODS: This study was designed as an observational single-center study and included consecutive patients with radiologically confirmed renal stones at our center between January 2022 and July 2022. These patients were referred to the dentistry clinic for a dental examination to assess dental calculi and oral hygiene. Investigated parameters included demographic characteristics, renal stone location and diameter, urine pH, and dental evaluation findings (teeth brushing habits, oral hygiene, and dental calculi). Renal stone burden grade and dental calculi grade were calculated, and Spearman’s rank-order correlation analysis was used for correlation analyses. RESULTS: Overall, 204 patients were included. The mean patient age was 36.3±15.2. Approximately half of the patients (49.2%) had multiple stones. About 36% of the participants had high-grade dental calculi, while 29.4% had intermediate low-grade dental calculi. Oral hygiene was significantly associated with dental calculi grade (p<0.001). The dental calculi grade was positively and moderately correlated with the renal stone diameter (Spearman’s rho=0.493, p<0.001). Among patients with a renal stone diameter greater than 20 mm, intermediate to high-grade dental calculi were found in 88.4%. This proportion was 49.1% for those with a renal stone diameter smaller than 20 mm. CONCLUSIONS: Dentists should consider the presence of undiagnosed kidney stones in patients with especially intermediate or highgrade dental calculi. Urologists should know that patients with large and multiple kidney stones may have dental calculi. [ABSTRACT FROM AUTHOR]

Objectives: We evaluated the baseline characteristics, and risk factors of renal stone recurrence among Saudi Arabian patients after successful primary stone treatment. Materials and methods: In this cross-sectional comparative study, we reviewed the medical records of patients who presented consecutively with a first renal stone episode from 2015 to 2021 and were followed-up by mail questionnaire, telephone interviews, and/or outpatient clinic visit. We included patients who achieved stone-free status after primary treatment. Patients were divided into two groups: group I (patients with first episode renal stone) and group II (patients who developed renal stone recurrence). The study outcomes were to compare the demographics of both groups and to evaluate the risk factors of renal stone recurrence after successful primary treatment. We used Student's t-test, Mann Whitney test or chi-square (χ2) to compare variables between groups. Cox regression analyses were used to examine the predictors. Results: We investigated 1260 participants (820 males and 440 females). Of this number, 877 (69.6%) didn't develop renal stone recurrence and 383 (30.4%) had recurrence. Primary treatments were percutaneous nephrolithotomy (PCNL), retrograde intrarenal surgery (RIRS), extracorporeal shock wave lithotripsy (ESWL), surgery and medical treatment in 22.5%, 34.7%, 26.5%, 10.3%, and 6%, respectively. After primary treatment, 970 (77%) and 1011 (80.2%) of patients didn't have either stone chemical analysis or metabolic work-up, respectively. Multivariate logistic regression analysis revealed that male gender (OR: 1.686; 95% CI, 1.216-2.337), hypertension (OR: 2.342; 95% CI, 1.439-3.812), primary hyperparathyroidism (OR: 2.806; 95% CI, 1.510-5.215), low fluid intake (OR: 28.398; 95% CI, 18.158-44.403) and high daily protein intake (OR: 10.058; 95% CI, 6.400-15.807) were predictors of renal stone recurrence. Conclusions: Male gender, hypertension, primary hyperparathyroidism, low fluid intake and high daily protein intake increase the risk of renal stone recurrence among Saudi Arabian patients. [ABSTRACT FROM AUTHOR]

Background: Dual-energy computed tomography (DECT) scan has been proposed as an effective modality for determining the chemical composition of renal stone subtypes. Objectives: This study aimed to evaluate and compare the efficacy of DECT in the identification of renal stone type and composition versus biochemical analysis as the gold standard. Materials and Methods: The type of 146 renal stones, removed frompatients by surgery, was determined in amedical laboratory. The stones were then inserted into the kidney of an anthropomorphic Rando phantom, and DECT scans were acquired. The stone type, specified by the scanner software, was compared with the results of biochemical analysis as the gold standard. Results: The DECT scans showed acceptable accuracy in identifying the chemical composition of renal stone subtypes. Based on the comparison of biochemical analysis and DECT results, the accuracy values for cystine, uric acid, and calcium-oxalate stones were 97%, 100%, and 97%, respectively. Conclusion: Based on the present results, DECT could detect pure uric acid, cystine, and calcium-oxalate stone types with high sensitivity. However, formixed stones, the stone type, directly identified by DECT scan, was not reliable. [ABSTRACT FROM AUTHOR]

Background. Risk factors of postoperative complications during percutaneous nephrolithotomy (PCNL) include stone burden, the preoperative microbiological status of urine, comorbidity, age, operative time, intraoperative level of sterility, and antibiotic prophylaxis. The study aimed to assess the sequelae of these complications. Materials and methods. This retrospective study was conducted on patients treated by PCNL under fluoroscopic guidance for a one-year duration. The demographic data, body mass index, stone burden, stone density, number, duration of surgery, and postoperative complications were recorded. Results. Out of 50 patients, 32 (64 %) developed a fever. White blood cell count was significantly high among those patients. The age of the patients, gender, body mass index, and hospital stay were insignificant variables. Stone burden, prolonged surgery duration, prone position during surgery, and the use of pneumatic lithotripsy were significant variables. Conclusions. Increased stone burden, prolonged duration of surgery, prone position, and pneumatic lithotripsy during PCNL are significant risk factors for developing postoperative complications, mainly fever [ABSTRACT FROM AUTHOR]

Urolithiasis is the most common benign urological health condition. It has contributed sizeable burden of morbidity, disability, and medical health expenditure worldwide. There is limited high level of evidence on the efficacy and safety of treatment options of large renal stones. This network meta-analysis has examined the effectiveness and safety of various large renal stone management strategies. Systematic review and network meta-analysis (NMA) study design was employed to summarize comparative randomized controlled trials on humans with a diagnosis of renal stone larger than or equal to 2 cm in size. Our searching strategy was based on the Population, Interventions, Comparison, Outcomes, and Study (PICOS) approach. Medline via PubMed, Embase, Google scholar, SCOPUS, Science Direct, Cochrane library, Web of Science, and ClinicalTrials.gov were searched from inception to March 2023 to find eligible articles. Data extraction, screening, selection and risk of bias assessment were conducted by two independent reviewers. We found ten randomised control trials which consists 2917 patients, nine of them were labeled as low risk and one article was high risk. This network meta-analysis found that SFR was 86% (95% CI 84–88%) for Mini-PCNL, 86% (95% CI 84–88%) for standard PCNL, 79% (95% CI:73–86%) for RIRS, and 67% (95%CI:49–81 for staged URS for management of large renal stone. Overall complication rate was 32% (95% CI 27–38%) for standard PCNL, 16% (95% CI 12–21%) for Mini-PCNL, and 11% (95% CI 7–16%) for RIRS. Mini-PCNL (RR = 1.14 (95% CI 1.01–1.27) and PCNL (RR = 1.13 (95% CI 1.01–1.27)) were statistically associated with a higher SFR compared to RIRS. The pooled mean hospital stays were 1.56 days (95% CI 0.93–2.19) for RIRS, 2.96 days (95% CI 1.78–4.14) for Mini-PCNL, 3.9 days (95% CI 2.9–4.83) for standard PCNL, and 3.66 (95% CI 1.13–6.2) for staged URS. Mini-PCNL and standard PCNL were the most effective treatment options with significant morbidity and length of hospital stay, while RIRS was the safest management option with acceptable SFR, low morbidity, and short hospital stay. [ABSTRACT FROM AUTHOR]

Abstract Background The purpose of this study was to assess the metabolic abnormalities in high-risk stone formers. Methods This was a retrospective observational study done at Tribhuvan University Teaching Hospital, Nepal, over 1-year period. High-risk stone formers were identified and were evaluated with serum chemistries and 24-h urinary chemical evaluation. Stone analysis was also included whenever available. Common metabolic abnormalities and stone analysis results were reported and compared with different studies. Continuous variables were expressed as mean ± SD. Categorical variables were expressed as percentage and proportions. Results During 1 year of period, sixty-five patients had undergone extensive metabolic evaluation, but complete data were available for only forty-six patients. Of the total patients (n = 46), 63% were male (n = 29) and rest (36.9%) were female. Mean age of patients was 34.4 ± 15.1 years. Common reasons for metabolic evaluation were multiple stones (40%), bilateral stones (27%), recurrent stones (17%) and others (16%). Most common stone type was mixed stone with predominant composition being calcium oxalate mono- and dihydrate (62.9%). Twenty-four-hour urinary metabolic evaluation showed hyperoxaluria (32.6%) as most common abnormalities followed by hypocitraturia (21.7%) and hypocalciuria (21.7%). Conclusion Hyperoxaluria and hypocitraturia are common metabolic abnormalities in our patients. These findings help in counselling dietary measures to patients.

Objectives: The study aimed to evaluate quality of nephrolithometric nomograms to predict stone-free rates (SFRs) and complication rates (CRs) in case of minimally invasive percutaneous nephrolithotomy (PNL). In the last decade, nomograms have been introduced to estimate the SFRs and CRs of PNL. However, no data are available regarding their reliability in case of utilization of miniaturized devices. Herein we present a prospective multicentric study to evaluate reliability of Guy’s stone score (GSS), the stone size, tract length, obstruction, number of involved calyces, and essence of stone (S.T.O.N.E.) nephrolithometry score and Clinical Research Office of the Endourological Society (CROES) score in patients treated with minimally invasive PNL. Methods: We evaluated SFRs and CRs of 222 adult patients treated with miniaturized PNL. Patients were considered stone-free if no residual fragments of any size at post-operative unenhanced computed tomography scan. Patients demographics, SFRs, and CRs were reported and analyzed. Performances of nomograms were evaluated with the area under the curve (AUC). Results: We included 222 patients, the AUCs of GSS, CROES score, and S.T.O.N.E. nephrolithometry score were 0.69 (95% confidence interval [CI] 0.61–0.78), 0.64 (95% CI 0.56–0.73), and 0.62 (95% CI 0.52–0.71), respectively. Regarding SFRs, at multivariate binomial logistic regression, only the GSS had significance with an odds ratio of 0.53 (95% CI 0.31–0.95, p=0.04). We did not find significant correlation with complications, with only a trend for GSS. Conclusion: This is the first study evaluating nomograms in miniaturized PNL. They still show good reliability; however, our data showed lower performances compared to standard PNL. We emphasize the need of further studies to confirm this trend. A dedicated nomogram for minimally invasive PNL may be necessary.

Introduction: Renal stone is a common urological problem that has increased over the years. Extracorporeal shock wave lithotripsy (ESWL) is a noninvasive treatment for patients with