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In today's digital world, with growing population and increasing pollution, unhealthy lifestyle habits like irregular eating, junk food consumption, and lack of exercise are becoming more common, leading to various health problems, including kidney issues. These factors directly affect human kidney health. To address this, we require early detection techniques that rely on text data. Text data contains detailed information about a patient's medical history, symptoms, test results, and treatment plans, giving a complete picture of kidney health and enabling timely intervention. In this research paper, we proposed a range of sophisticated models, such as Gradient Boosting Classifier, Light GBM, CatBoost, Support Vector Classifier (SVC), Random Boost, Logistic Regression, XGBoost, Deep Neural Network (DNN), and an Improved DNN. The Improved DNN demonstrated exceptional performance, with an accuracy of 90 %, precision of 89 %, recall of 90 %, and an F1-Score of 89.5 %. By combining traditional machine learning and deep neural networks, this integrative approach enables the identification of intricate patterns in datasets. The model's data-driven processes consistently update internal parameters, guaranteeing flexibility in response to evolving healthcare settings. This research represents a notable advancement in the progress of creating a more detailed and individualised ability to diagnose kidney stones, which could potentially lead to better clinical results and patient treatment.

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.

Genetic variability persists across diverse populations, and it may impact the characterization of heritable diseases in different ancestral groups. Cystinosis is a metabolic disease caused by pathogenic variants in the CTNS gene causing the cellular accumulation of cystine. We attempted to assess the currently poorly characterized prevalence of cystinosis by employing a population genetics methodology. However, we encountered a significant challenge due to genetic variations across different populations, and the consideration of potential disparities in access to healthcare made our results inconclusive. Pathogenic CTNS variants were identified in a representative global population cohort using The Human Gene Mutation Database (HGMD) and the 1000 Genomes (1 KG) database. The c.124G>A (p.Val42Ile) variant was reported to be pathogenic based on an observation in the white population presenting with atypical phenotypes, but it would be reclassified as benign in the African ancestral group if applying the ACMG allele frequency guideline due to its high allele frequency specifically in this population. Inclusion or exclusion of this c.124G>A (p.Val42Ile) variant results in a significant change in estimated disease prevalence, which can impact the diagnosis and treatment of affected patients with a broad range of phenotypic presentations. This observation led us to postulate that pathogenic manifestations of the disease may be underdiagnosed due to variable expressivity and systemic inequities in access to care, specifically in the African subpopulation. We call for a more cautious and inclusive approach to achieve more equitable care across diverse populations.

A 50-year-old female developed kidney stones on an eroded embolization coil 16 months after percutaneous nephrolithotomy (PCNL) related bleeding complications. Retrograde ureteroscopy and thulium laser lithotripsy was performed to fragment the exposed portion of the coil into clinically insignificant pieces. Thulium laser coil fragmentation remains a potential strategy to remove eroded coils and their associated kidney stones; however, recurrent stone formation on the coil stump may necessitate repeat intervention if this conservative approach is pursued over radical antegrade coil removal. This case highlights the importance of continued surveillance and multidisciplinary management in preventing and treating coil erosion after PCNL.

A 39-year-old man was admitted to our hospital with kidney stones after kidney transplantation. Kidney, ureter, and bladder radiographs showed multiple stones in the transplanted and orthotopic kidneys, which had not been reported previously. Owing to the larger size of the stones in the transplanted kidney, they needed to be removed. Percutaneous nephrolithotomy and ureteroscopy were performed under B-mode ultrasound guidance. The stone measured 1.9 × 1.6 cm and was located under the calyx of the kidney. A titanium laser fiber was used to dissolve the stones, which were subsequently removed. No adverse reactions occurred during or after the surgery. The causes of stone formation included dietary factors, related drugs, improper fluid intake, and urinary tract infections. As neither the donor nor the recipient had a history of kidney stones, we hypothesized that the stones were a new entity that either developed following transplantation or a long-term complication. [ABSTRACT FROM AUTHOR]

This article discusses a case study of a family in Iran who experienced a rare genetic disorder called familial hypomagnesemia with hypercalciuria and nephrocalcinosis (FHHNC). The disorder is caused by a mutation in the CLDN16 gene and results in symptoms such as low levels of magnesium, high levels of calcium in the urine, and the formation of kidney stones. The study highlights the importance of genetic testing and counseling for affected individuals and their families, and provides valuable insights into the genetic basis of this condition. This is the first reported case of the CLDN16 gene mutation in Iran. [Extracted from the article]

Abstract Background For renal stones > 20 mm, percutaneous nephrolithotomy (PNL) offers the best stone clearance rates with acceptable complication rates. This study aimed to compare the efficiency of high-power holmium YAG laser and ballistic lithotripsy during mini-PNL. Methods Data from 880 patients who underwent mini-PNL for renal stones was investigated retrospectively. The study utilized propensity score matching to create two groups: laser lithotripsy (n = 440) and ballistic lithotripsy (n = 440). The groups were matched based on stone size, Guy’s stone score, and stone density. The main objectives of the study were to assess the stone-free rate (SFR), duration of surgery, and complication rates. Results The average age of the population was 51.4 ± 7.1 years, with a mean stone size of 28.6 ± 8.3 mm and a mean stone density of 1205 ± 159 HU. There were no significant differences between the groups. The SFRs of the laser lithotripsy and ballistic lithotripsy were 92.5% and 90.2%, respectively (p = 0.23). The laser lithotripsy group had a notably shorter surgery time (40.1 ± 6.3 min) compared to the ballistic lithotripsy group (55.6 ± 9.9 min) (p = 0.03). Complication rates were similar (p = 0.67). Conclusions Our study shows that a high-power holmium YAG laser provides quicker operation time compared to ballistic lithotripsy. However, ballistic lithotripsy is still an effective and safe option for stone fragmentation during mini-PNL. In places where a high-power holmium YAG laser is not available, ballistic lithotripters are still a safe, effective, and affordable option for mini-PNL.

Abstract Acute kidney injury (AKI) is one of the global health concerns afflicting the human population and urolithiasis (kidney stone), especially the calcium oxalate stone is the most prominent amongst the stone formers with a huge recurrence rate. This study elucidates the ameliorative potential of the tunic of onions against Wistar kidney rats toxified with sodium oxalate. Ethylacetate extract of the tunic of onions otherwise regarded as Onions peel extract (OPE) in this study was prepared to get the flavonol-rich extracts. Adult male Wistar rats received 70 mg/kg body weight sodium oxalate with or without co-treatment with OPE, quercetin or cystone. Biochemical analyses were carried out on the plasma and urine, followed by a histopathological assessment of the kidney. Intoxication with sodium oxalate brought about electrolyte imbalance, nephrotic syndrome (high concentrations of total protein and albumin in the urine and low concentrations in the plasma) reduced renal function (low renal clearance of creatinine and urea) and damage to the kidney as well as fluid accumulation. Treatment with flavonol extract from onion tunic mitigated these deleterious changes as a result of sodium oxalate intoxication. The finding suggests that onion peel has the potential to prevent damage arising from oxalate toxicity in the kidney. Graphical Abstract

Chronic kidney disorder is a global health problem involving the repercussions of impaired kidney function and kidney failure. A kidney stone is a kidney scenario that impairs kidney function. Because this disease is usually asymptomatic, early and quick detection of kidney problems is essential to avoid significant consequences. This study presents an automated detection of Computed Tomography (CT) kidney stone images using an inductive transfer-based ensemble Deep Neural Network (DNN). Three datasets are created for feature extraction from kidney CT images using pre-trained DNN models. After assembling several pre-trained DNNs, such as DarkNet19, InceptionV3, and ResNet101, the ensemble deep feature vector is created using feature concatenation. The Iterative ReliefF feature selection method is used to choose the most informative ensemble deep feature vectors, which are then fed into the K Nearest Neighbor classifier tuned using a Bayesian optimizer with a 10-fold cross-validation approach to detect kidney stones. The proposed strategy achieves 99.8% and 96.7% accuracy using the quality and noisy image datasets, which are superior to other DNN-based and traditional image detection approaches. This proposed automated approach can help urologists confirm their physical inspection of kidney stones, reducing the possibility of human mistakes.

Abstract Objectives The relationship between C-reactive protein (CRP) and the risk of developing kidney stones is unclear, and we aimed to assess the association between CRP and kidney stones in US adults. Methods We used data from NHANES 2007–2010, and we excluded participants who were under 18 years of age and lacked data on CRP and kidney stones. Finally, we included a total of 11,033 participants and performed weighted multivariate regression analysis and subgroup analysis to assess the independent relationship between CRP and kidney stones. Results The mean prevalence of kidney stones among the participants was 9.8%. Notably, as CRP levels increased, the prevalence of kidney stones exhibited a corresponding rise across quartiles (Kidney stones: Quartile 1: 7.59%; Quartile 2: 8.77%; Quartile 3: 9.64%; Quartile 4: 10.89%). CRP was positively associated with the risk of kidney stones (Model 1: OR = 1.09, 95% CI: 1.01–1.18, p = 0.03; Model 2: OR = 1.09, 95% CI: 1.00–1.18, p = 0.03, Model 3: OR = 1.14, 95%CI: 1.02–1.26, p = 0.04). Participants in the highest CRP quartile experienced a 69% increased risk of kidney stones compared to those in the lowest quartile (OR = 1.64, 95% CI: 1.04–2.59, p = 0.03). Notably, interaction tests revealed that gender, BMI, diabetes, hypertension, CKD and smoking or alcohol consumption status did not significantly influence the association between CRP and kidney stones. Conclusions Our findings reveal a significant association between higher CRP levels and an increased risk of kidney stones. In clinical practice, heightened awareness of CRP as a potential biomarker could aid in risk assessment and management strategies for kidney stone patients.

Objective To investigate the association between atherogenic index of plasma (AIP) and kidney stones (KS) occurrence and recurrence.Methods Data were obtained from the National Health and Nutrition Examination Survey (NHANES) 2007–2014. Non-pregnant adults who provided complete information on AIP and KS were included in the analyses. AIP was calculated as log (triglyceride/high-density lipoprotein cholesterol). KS was ascertained with questionnaires. Weighted multivariable logistic regression model and restricted cubic spline (RCS) were applied to examine the associations between AIP and KS occurrence and recurrence.Results A total of 6488 subjects (weighted mean age 43.19 years and 49.26% male) with a weighted mean AIP of 0.66 were included in this study. The multivariable-adjusted OR for nephrolithiasis occurrence across consecutive tertiles was 1.00 (reference), 1.21 (95% CI: 0.90–1.62), and 1.85 (95% CI: 1.39–2.48), respectively. Moreover, each SD increment of AIP was associated with a 50% (OR:1.50, 95% CI: 1.25–1.81) higher risk of nephrolithiasis recurrence. RCSs showed significant and linear dose-response relationships between AIP and nephrolithiasis occurrence (p-overall = 0.006, p-nonlinear = 0.689) and recurrence (p-overall = 0.001, p-nonlinear = 0.848). The positive associations between AIP and nephrolithiasis occurrence and recurrence persisted in sensitivity analyses, suggesting the robustness of the results.Conclusion In the current US nationally representative cross-sectional study, AIP was positively associated with KS occurrence and recurrence.

Oxalate-induced damage to renal tubular epithelial cells (RTECs) is an essential factor in the incident kidney stone, but the specific mechanism is unclear. Recent research has pinpointed interacting areas within the endoplasmic reticulum and mitochondria, called mitochondria-associated membranes (MAMs). These studies have linked endoplasmic reticulum stress (ERS) and oxidative imbalance to kidney disease development. The sigma-1 receptor (S1R), a specific protein found in MAMs, is involved in various physiological processes, but its role in oxalate-induced kidney stone formation remains unclear. In this study, we established cellular and rat models of oxalate-induced kidney stone formation to elucidate the S1R's effects against ERS and apoptosis and its mechanism in oxalate-induced RTEC injury. We found that oxalate downregulated S1R expression in RTECs and escalated oxidative stress and ERS, culminating in increased apoptosis. The S1R agonist dimemorfan up-regulated S1R expression and mitigated ERS and oxidative stress, thereby reducing apoptosis. This protective effect was mediated through S1R inhibition of the CHOP pathway. Animal experiments demonstrated that S1R's activation attenuated oxalate-induced kidney injury and alleviated kidney stone formation. This is the first study to establish the connection between S1R and kidney stones, suggesting S1R's protective role in inhibiting ERS-mediated apoptosis to ameliorate kidney stone formation.

Macrophages play a role in nephrolithiasis, offering the possibility of developing macrophage-mediated preventive therapies. To establish a system for screening drugs that could prevent the formation of kidney stones, we aimed to develop a model using human induced pluripotent stem cell (iPSC)-derived macrophages to study phagocytosis of calcium oxalate monohydrate (COM) crystals. Human iPSCs (201B7) were cultured. CD14+ monocytes were recovered using a stepwise process that involved the use of growth factors and cytokines. These cells were then allowed to differentiate into M1 and M2 macrophages. The macrophages were co-cultured with COM crystals and used in the phagocytosis experiments. Live cell imaging and polarized light observation via super-resolution microscopy were used to visualize phagocytosis. Localization of phagocytosed COM crystals was observed using transmission electron microscopy. Intracellular fluorescence intensity was measured using imaging cytometry to quantify phagocytosis. Human iPSCs successfully differentiated into M1 and M2 macrophages. M1 macrophages adhered to the culture plate and moved COM crystals from the periphery to cell center over time, whereas M2 macrophages did not adhere to the culture plate and actively phagocytosed the surrounding COM crystals. Fluorescence assessment over a 24-h period showed that M2 macrophages exhibited higher intracellular fluorescence intensity (5.65-times higher than that of M1 macrophages at 4.5 h) and maintained this advantage for 18 h. This study revealed that human iPSC-derived macrophages have the ability to phagocytose COM crystals, presenting a new approach for studying urinary stone formation and highlighting the potential of iPSC-derived macrophages as a tool to screen nephrolithiasis-related drugs. [ABSTRACT FROM AUTHOR]

Background: For renal stones > 20 mm, percutaneous nephrolithotomy (PNL) offers the best stone clearance rates with acceptable complication rates. This study aimed to compare the efficiency of high-power holmium YAG laser and ballistic lithotripsy during mini-PNL. Methods: Data from 880 patients who underwent mini-PNL for renal stones was investigated retrospectively. The study utilized propensity score matching to create two groups: laser lithotripsy (n = 440) and ballistic lithotripsy (n = 440). The groups were matched based on stone size, Guy's stone score, and stone density. The main objectives of the study were to assess the stone-free rate (SFR), duration of surgery, and complication rates. Results: The average age of the population was 51.4 ± 7.1 years, with a mean stone size of 28.6 ± 8.3 mm and a mean stone density of 1205 ± 159 HU. There were no significant differences between the groups. The SFRs of the laser lithotripsy and ballistic lithotripsy were 92.5% and 90.2%, respectively (p = 0.23). The laser lithotripsy group had a notably shorter surgery time (40.1 ± 6.3 min) compared to the ballistic lithotripsy group (55.6 ± 9.9 min) (p = 0.03). Complication rates were similar (p = 0.67). Conclusions: Our study shows that a high-power holmium YAG laser provides quicker operation time compared to ballistic lithotripsy. However, ballistic lithotripsy is still an effective and safe option for stone fragmentation during mini-PNL. In places where a high-power holmium YAG laser is not available, ballistic lithotripters are still a safe, effective, and affordable option for mini-PNL. [ABSTRACT FROM AUTHOR]

Peristalsis is a common motion in various biological systems, especially the upper urinary tract, where it plays a pivotal role in conveying urine from the kidneys to the bladder. Using computational fluid dynamics, this study aims to investigate the effect of various peristaltic parameters on the motion of an obstacle through a two‐dimensional ureter. Methodologically, Incompressible Navier–Stokes equations were utilized as the fluid domain's governing equations, and the Dynamic Mesh method (DM) was employed to simulate the peristaltic and obstacle motion. The peristaltic motion was modeled by a sinusoidal contraction wave propagating alongside the ureter at the physiological speed, and the motion of the obstruction through the ureter, which is caused by the fluid forces applied on its surface, was explored using the equation of Newton's second law. Various test cases of different shapes and sizes were supposed as kidney stones to understand the influence of the peristalsis properties on the stone removal process. The results show that the motion of the kidney stone is highly influenced by the gradient pressure force applied to its surface in the fluid domain. Moreover, investigating the effects of the peristaltic physical properties on the obstacle's motion indicates that the stone's motion is dependent on these parameters. Furthermore, this analysis provides insight into the peristaltic motion effects, assisting physicians in developing new medicines to facilitate the kidney stone removal process based on its shape and size. [ABSTRACT FROM AUTHOR]

Percutaneous nephrolithotomy has become the standard procedure for the management of large kidney stones. Compared with other endo-urological techniques, it has a better fragmentation rate in a single session for kidney stones over 20 mm. It is therefore the recommended first-line treatment modality for large kidney stones. Bleeding is a well-known complication of this procedure, often requiring transfusion. In 0.8% of cases, bleeding can be severe, requiring surgical intervention to control hemostasis. Damage to the lumbar artery is a very rare event, and a potential complication. To our knowledge, this is the first report of lumbar artery involvement during percutaneous nephrolithotomy, complicated by severe bleeding and hemodynamic instability, necessitating conversion. Surgical exploration revealed a severed and bleeding lumbar artery. After hemostasis control by coagulation and ligation, the patient became stable. The patient was discharged on D3, where ureteroscopic lithotripsy was planned after collegial discussion with the patient. Based on this experience, it is important for the surgeon to have in mind certain principles and a thorough knowledge of the classic lateral lumbotomy approach to the kidney. [ABSTRACT FROM AUTHOR]

Background: Kidney stones (KSs), in fact, have been considered one of the most ancient and prevalent medical conditions that impact a significant number of human beings all around the world. Such stones can range greatly in size and can be detected in any part of the urinary system, including the kidneys, ureters, or bladder itself. The development of stones is caused by the mineral's crystallization, which then interacts with each other and adheres together. Kidney stone formation can represent a prime medical condition for which there are numerous therapies available, among them natural ones. Recurrence of stones after curing is very common, and strategies available to prevent their reoccurrence or even their development for the first time are numerous, with enhanced fluid consumption or avoiding dehydration being the most important one. Objective: The current review article aims to draw attention to the potential of natural remedies besides lifestyle modification in the management and prevention of KSs. This is not arbitrary but based on real, documented scientific evidence. Method: The natural remedies mentioned in the context of this manuscript were chosen for their availability in almost all nations, or perhaps even in every home. Results: The findings of the present article are very promising and exhibit the potential benefit of natural remedies in addition to shifting to a healthy lifestyle in both the treatment and prevention of KSs. [ABSTRACT FROM AUTHOR]

Magnesium is one of the recommended treatments for calcium stone formers (CSFs) with hyperoxaluria. In this study, we compared the effect of magnesium oxide (MgO) or magnesium citrate (MgCit) with placebo on 24-hour urine (24-U) metabolites and the calcium oxalate supersaturation index (CaOx SS). Methods: In a randomized, double-blind, placebo-controlled clinical trial, 90 CSFs with idiopathic hyperoxaluria were recruited from a tertiary stone prevention clinic. Patients were randomly assigned into three groups: 120 mg MgO, 120 mg MgCit or placebo (supplements were taken three times per day, with meals). Finally, 76 patients were included in the final analysis. Analyses of 24-U were performed at baseline and after eight weeks. Study outcomes included changes in 24-U oxalate, magnesium, citrate, and CaOx SS. Dietary factors were controlled by 24-hour food recalls. Repeated measure ANOVA was used to compare the results. Results: After the intervention, both MgO and MgCit supplements decreased 24-U oxalate excretion (-8.13±16.45 in the MgO group and -16.99±18.02 in the MgCit group) and CaOx SS compared to the placebo, with the effects of MgCit reaching statistical significance (p =0.011 and p =0.010, respectively). An increasing trend was observed for 24-U magnesium and citrate excretion without significant differences among groups. Interestingly, MgCit exhibited a significantly greater inhibitory effect on 24-U oxalate in patients with normal urine magnesium levels (p =0.021). Conclusions: Clinically, both MgO and MgCit reduced 24-U oxalate and CaOx SS compared to placebo. However, MgCit demonstrated a greater effect, especially in patients with normal urine magnesium levels. [ABSTRACT FROM AUTHOR]

The variety of types that appear in kidney stones makes it necessary to describe them to try to understand their formation. The crystalline phases recognized in stones are classified according to their chemical composition. For this reason, a study using X-ray microdiffraction, Raman spectroscopy, SEM/EDX analysis, and cathodoluminescence (CL) is recommended, to identify their composition. In the present study, this was carried out on kidney stones collected from surgeries in hospitals from Spain. The samples were collected in two representative urban centers: one from a large city, Madrid; the other with a mostly rural population, in order to contrast the possible compositions of the kidney stones. In large cities, struvite appears more frequently, although calcium oxalates are very common in both areas. An attempt was made to provide a guide to the most frequent phases, accompanied by four analysis methods that make their identification possible. [ABSTRACT FROM AUTHOR]

Kidney stone is a common and highly recurrent disease in urology, and its pathogenesis is associated with various factors. However, its precise pathogenesis is still unknown. Ferroptosis describes a form of regulated cell death that is driven by unrestricted lipid peroxidation, which does not require the activation of caspase and can be suppressed by iron chelators, lipophilic antioxidants, inhibitors of lipid peroxidation, and depletion of polyunsaturated fatty acids. Recent studies have shown that ferroptosis plays a crucial role in kidney stone formation. An increasing number of studies have shown that calcium oxalate, urate, phosphate, and selenium deficiency induce ferroptosis and promote kidney stone formation through mechanisms such as oxidative stress, endoplasmic reticulum stress, and autophagy. We also offered a new direction for the downstream mechanism of ferroptosis in kidney stone formation based on the "death wave" phenomenon. We reviewed the emerging role of ferroptosis in kidney stone formation and provided new ideas for the future treatment and prevention of kidney stones. [ABSTRACT FROM AUTHOR]

Acute kidney injury (AKI) is one of the global health concerns afflicting the human population and urolithiasis (kidney stone), especially the calcium oxalate stone is the most prominent amongst the stone formers with a huge recurrence rate. This study elucidates the ameliorative potential of the tunic of onions against Wistar kidney rats toxified with sodium oxalate. Ethylacetate extract of the tunic of onions otherwise regarded as Onions peel extract (OPE) in this study was prepared to get the flavonol-rich extracts. Adult male Wistar rats received 70 mg/kg body weight sodium oxalate with or without co-treatment with OPE, quercetin or cystone. Biochemical analyses were carried out on the plasma and urine, followed by a histopathological assessment of the kidney. Intoxication with sodium oxalate brought about electrolyte imbalance, nephrotic syndrome (high concentrations of total protein and albumin in the urine and low concentrations in the plasma) reduced renal function (low renal clearance of creatinine and urea) and damage to the kidney as well as fluid accumulation. Treatment with flavonol extract from onion tunic mitigated these deleterious changes as a result of sodium oxalate intoxication. The finding suggests that onion peel has the potential to prevent damage arising from oxalate toxicity in the kidney. [ABSTRACT FROM AUTHOR]

In this study, we aimed to evaluate the effect of HPL on different parameters by different centers and urologists. While doing this, we evaluated different parameters by comparing HPL(High Power laser) and LPL(Low-power laser). This is an observational, retrospective, comparative, multicentric study of prospectively organised database. A total of 217 patients who underwent RIRS for kidney stones smaller than 2 cm in three different centers were included in the study. The patients were divided into two groups; LPL used (Group1, n:121 patients) and HPL used (Group2, n:96). Propensity score matching was done in the data analysis part. After matching, a total of 192 patients, 96 patients in both groups, were evaluated. There was no difference between the groups regarding age, gender, stone side, and stone location. The stone-free rate on the first day was 80.3% in Group 1, it was 78.1% in Group 2 (p = 0.9). In the third month, it was 90.7% in Group 1 and 87.5% in Group 2 (p:0.7).Hospitalization duration was significantly higher in Group 1. (2.35 ± 2.27 days vs. 1.42 ± 1.10 days; p < 0.001).The operation duration was 88.70 ± 29.72 min in Group1 and 66.17 ± 41.02 min in Group2 (p < 0.001). The fluoroscopy time (FT) was 90.73 ± 4.79 s in Group 1 and 50.78 ± 5.64 s in Group 2 (p < 0.001). Complications according to Clavien Classification, were similar between the groups(p > 0.05). According to our study similar SFR and complication rates were found with HPL and LPL. In addition, patients who used HPL had lower operation time, hospital stay, and fluoroscopy time than the LPL group. Although high-power lasers are expensive in terms of cost, they affect many parameters and strengthen the hand of urologists thanks to the wide energy and frequency range they offer. [ABSTRACT FROM AUTHOR]

Objectives: To assess the effects of percutaneous nephrolithotomy (PCNL) vs retrograde intrarenal surgery (RIRS) for the treatment of renal stones in adults. Methods: We performed a comprehensive search of the Cochrane Library, MEDLINE, Embase, three other databases, trials registries, other sources of the grey literature, and conference proceedings up to 23 March 2023. We applied no restrictions on publication language or status. Screening, data extraction, risk‐of‐bias assessment, and certainty of evidence (CoE) rating using the Grading of Recommendations Assessment, Development and Evaluations (GRADE) approach were done in duplicate by two independent reviewers. This co‐publication focuses on the primary outcomes of this review only. Results: We included 42 trials that met the inclusion criteria. Stone‐free rate (SFR): PCNL may improve SFRs (risk ratio [RR] 1.13, 95% confidence interval [CI] 1.08–1.18; I2 = 71%; 39 studies, 4088 participants; low CoE). Major complications: PCNL probably has little to no effect on major complications (RR 0.86, 95% CI 0.59–1.25; I2 = 15%; 34 studies, 3649; participants; moderate CoE) compared to RIRS. Need for secondary interventions: PCNL may reduce the need for secondary interventions (RR 0.31, 95% CI 0.17–0.55; I2 = 61%; 21 studies, 2005 participants; low CoE) compared to RIRS. Conclusion: Despite shortcomings in most studies that lowered our certainty in the estimates of effect to mostly very low or low, we found that PCNL may improve SFRs and reduce the need for secondary interventions while not impacting major complications. Ureteric stricture rates may be similar compared to RIRS. We expect the findings of this review to be helpful for shared decision‐making about management choices for individuals with renal stones. [ABSTRACT FROM AUTHOR]

Objectives: To explore the optimal laser settings and treatment strategies for thulium fibre laser (TFL) lithotripsy, namely, those with the highest treatment efficiency, lowest thermal injury risk, and shortest procedure time. Materials and Methods: An in vitro kidney model was used to assess the efficacy of TFL lithotripsy in the upper calyx. Stone ablation experiments were performed on BegoStone phantoms at different combinations of pulse energy (EP) and frequency (F) to determine the optimal settings. Temperature changes and thermal injury risks were monitored using embedded thermocouples. Experiments were also performed on calcium oxalate monohydrate (COM) stones to validate the optimal settings. Results: High EP/low F settings demonstrated superior treatment efficiency compared to low EP/high F settings using the same power. Specifically, 0.8 J/12 Hz was the optimal setting, resulting in a twofold increase in treatment efficiency, a 39% reduction in energy expenditure per unit of ablated stone mass, a 35% reduction in residual fragments, and a 36% reduction in total procedure time compared to the 0.2 J/50 Hz setting for COM stones. Thermal injury risk assessment indicated that 10 W power settings with high EP/low F combinations remained below the threshold for tissue injury, while higher power settings (>10 W) consistently exceeded the safety threshold. Conclusions: Our findings suggest that high EP/low F settings, such as 0.8 J/12 Hz, are optimal for TFL lithotripsy in the treatment of COM stones. These settings demonstrated significantly improved treatment efficiency with reduced residual fragments compared to conventional settings while keeping the thermal dose below the injury threshold. This study highlights the importance of using the high EP/low F combination with low power settings, which maximizes treatment efficiency and minimizes potential thermal injury. Further studies are warranted to determine the optimal settings for TFL for treating kidney stones with different compositions. [ABSTRACT FROM AUTHOR]

Background and Objectives: The majority of all kidney stone cases are oxalate urolithiasis with a high risk of recurrence. Beside its widespread occurrence, kidney stones are characterized by severe complications and high treatment costs. Probiotics and herbal medications could be forthcoming therapeutic interventions in the management of oxalate kidney stones. Materials and Methods: The PubMed/MEDLINE database was searched for keywords "Oxalobacter formigenes" AND "Oxalate" OR "oxalate degradation" AND "Lactobacillus" OR "Bifidobacterium" OR "recombinant Lactobacillus" OR "Bacillus subtilis", and "urolithiasis" AND "herbal extract". The search returned 253 results, 38 of which were included in the review. Results: Most of the oxalate-degrading probiotics belong to the Oxalobacter formigenes, Lactobacillus, Bifidobacterium, and Bacillus genus with a minimum dosage of 107 CFU in the form of capsules, sachets, and lyophilized powder. Oxalate concentration in media was 5-50mM with an incubation time ranging from 24h to 14 days. The majority of the studies suggested that probiotic supplementation might be useful for reducing urinary excretion of oxalate and urea and alleviation of stone formation. Different herbal extracts were used on murine models of nephrolithiasis (induced by 0.5-3% ethylene glycol) with reduction of renal inflammation and urinary parameters, and calcium oxalate crystals. Conclusion: Several strains of probiotics and herbal extracts confer protective effects against kidney stone/nephrolithiasis, indicating their promising nature for being considered as elements of preventive / adjuvant therapeutic strategies. [ABSTRACT FROM AUTHOR]

Objective: It is advised to move the stones from the lower calyx to the middle or upper calyx using a nitinol basket. In order to protect the flexible ureterorenoscopy and increase the stone-free rate during retrograde intrarenal surgery. In this descriptive study, we presented a method for moving stones to other calyces where the need for deflection is less, using holmium fiber in cases where the nitinol basket is not available. Materials and Methods: With the "Jab and Pull" method we have described, 32 patients who underwent RIRS for symptomatic (pain or infection) renal lower calyceal stones with a diameter of 4-10 mm in our clinic, between 2012 and 2021 were retrospectively analyzed. Demographic data, stone size, Hounsfield unit, number of stones, opaque non-opaque status, stone localization, infundibulopelvic angle, perioperative-postoperative complications, and control imaging were evaluated. Results: The mean age of the patients was 51.12, and the female-male ratio was equal. The median stone size was 8mm (min:5, max:10), and the Hounsfield unit was 805 (±396.72). 75% (24) of the stones were single and 53.1% (17) were opaque. The median infundibulopelvic angle was 38 (min:19 max:52) degrees. 27 (84.4%) patients achieved stone-free status using this method. The renal lower calyx neck of two patients was too narrow, the stones of two patients were too soft, and the stone of one patient was inaccessible, preventing total success in these patients. Conclusions: In cases where a nitinol basket is needed but cannot be reached during treatment of kidney lower calyx stones, the "jab and pull" method can be considered as an alternative in suitable patients. [ABSTRACT FROM AUTHOR]

Objectives. Type 2 diabetes mellitus (T2DM) commonly complicates kidney stone disease (KSD). Our objective is to investigate the variations in the urinary microbiota between individuals with KSD alone and those with KSD plus T2DM. This exploration could have implications for disease diagnosis and treatment strategies. Methods. During lithotripsy, a ureterscope was employed, and 1 mL of urine was collected from the renal pelvis after bladder disinfection. Sequencing targeting the V3-V4 hypervariable region was performed using the 16S rRNA and Illumina Novaseq platform. Results. The Shannon index showed a significant decrease in the KSD plus T2DM group compared to the KSD-only group (false discovery rate = 0.041). Principal Coordinate Analysis (PCoA) demonstrated a distinct bacterial community in the KSD plus T2DM group compared to the KSD-only group (false discovery rate = 0.027). The abundance of Sphingomonas, Corynebacterium, and Lactobacillus was significantly higher in the KSD plus T2DM group than in the KSD-only group (false discovery rate< 0.05). Furthermore, Enhydrobacter, Chryseobacterium, and Allobaculum were positively correlated with fasting blood glucose and HbA1c values (P < 0.05). Conclusions. The urinary microbiota in the renal pelvis exhibits differences between patients with KSD plus T2DM and those with KSD alone. Further studies employing animal models are necessary to validate these distinctions, potentially paving the way for therapeutic developments based on the urinary microbiota. [ABSTRACT FROM AUTHOR]

Aim: Magnesium (Mg) homeostasis is closely related to calcium (Ca) metabolism. Hypercalcemia inhibits the reabsorption of Mg from the kidneys, leading to hypomagnesemia. Therefore, patients with primary hyperparathyroidism (PHPT) are predisposed to hypomagnesemia. However, there are few studies on the clinical significance of hypomagnesemia in PHPT. The aim of this study was to retrospectively evaluate the association of hypomagnesemia with the clinical outcomes of PHPT. Materials and methods: A retrospective evaluation was made of the data of 538 consecutive patients (478 females, 60 males) diagnosed with PHPT in our center. Results: The mean age of the study population was 56.5 ± 11.66 years. The mean serum Mg level was 2 ± 0.26 mg/dl. Asymptomatic disease was present in 241 (44%) patients. Symptomatic patients with osteoporosis, Ca level ≥11.2 mg/dl, and estimated glomerular filtration rate (eGFR) < 60 mL/min/1.73 m2 had lower levels of Mg (p < 0.05). Hypomagnesemia was detected in 129 of 538 patients (23.9%). The patients with hypomagnesemia had a higher rate of symptomatic disease (80% vs. 48%, p < 0.0001). The serum parathormone (PTH) level was found to be higher in patients with hypomagnesemia and the lumbar and femur T-scores and serum vitamin D levels were lower (p < 0.05). Patients with hypomagnesemia had higher rates of kidney stones (34% vs. 21%, p = 0.003) and osteoporosis (74% vs. 32%, p < 0.001). Multivariate logistic regression analysis revealed that hypomagnesemia had a significant effect on the development of symptomatic disease (OR:6.88, CI 95%: 5.20–11.27, p < 0.001). Conclusions: The current study results demonstrate that hypomagnesemia may be associated with a higher risk of osteoporosis and kidney stones in PHPT patients. Routine evaluation of serum Mg may predict the clinical outcomes of PHPT. [ABSTRACT FROM AUTHOR]

Objectives: The relationship between C-reactive protein (CRP) and the risk of developing kidney stones is unclear, and we aimed to assess the association between CRP and kidney stones in US adults. Methods: We used data from NHANES 2007–2010, and we excluded participants who were under 18 years of age and lacked data on CRP and kidney stones. Finally, we included a total of 11,033 participants and performed weighted multivariate regression analysis and subgroup analysis to assess the independent relationship between CRP and kidney stones. Results: The mean prevalence of kidney stones among the participants was 9.8%. Notably, as CRP levels increased, the prevalence of kidney stones exhibited a corresponding rise across quartiles (Kidney stones: Quartile 1: 7.59%; Quartile 2: 8.77%; Quartile 3: 9.64%; Quartile 4: 10.89%). CRP was positively associated with the risk of kidney stones (Model 1: OR = 1.09, 95% CI: 1.01–1.18, p = 0.03; Model 2: OR = 1.09, 95% CI: 1.00–1.18, p = 0.03, Model 3: OR = 1.14, 95%CI: 1.02–1.26, p = 0.04). Participants in the highest CRP quartile experienced a 69% increased risk of kidney stones compared to those in the lowest quartile (OR = 1.64, 95% CI: 1.04–2.59, p = 0.03). Notably, interaction tests revealed that gender, BMI, diabetes, hypertension, CKD and smoking or alcohol consumption status did not significantly influence the association between CRP and kidney stones. Conclusions: Our findings reveal a significant association between higher CRP levels and an increased risk of kidney stones. In clinical practice, heightened awareness of CRP as a potential biomarker could aid in risk assessment and management strategies for kidney stone patients. [ABSTRACT FROM AUTHOR]

Objectives: Non-alcoholic fatty liver disease (NAFLD) has been linked to an increased risk of kidney stones in prior observational studies, However, the results are inconsistent, and the causality remains to be established. We aimed to investigate the potential causal relationship between NAFLD and kidney stones using two-sample Mendelian randomization (MR). Methods: Genetic instruments were used as proxies for NAFLD. Summary-level data for the associations of exposure-associated SNPs with kidney stones were obtained from the UK Biobank study (6536 cases and 388,508 controls) and the FinnGen consortium (9713 cases and 366,693 non-cases). MR methods were conducted, including inverse variance weighted method (IVW), MR-Egger, weighted median, andMR-PRESSO.MR-Egger Regression Intercept and Cochran's Qtest were used to assess the directional pleiotropy and heterogeneity. Results: cALT-associated NAFLD did not exhibit an association with kidney stones in the Inverse variance weighted (IVW) methods, in both the FinnGen consortium (OR: 1.02, 95%CI: 0.94-1.11, p = 0.632) and the UKBB study (OR: 1.000, 95%CI: 0.998- 1.002, p = 0.852). The results were consistent in European ancestry (FinnGen OR: 1.05, 95%CI: 0.98-1.14, p = 0.144, UKBB OR: 1.000, 95%CI: 0.998-1.002, p = 0.859). IVW MR analysis also did not reveal a significant causal relationship between NAFLD and the risk of kidney stone for the other three NAFLD-related traits, including imaging-based, biopsy-confirmed NAFLD, and more stringent biopsy-confirmed NAFLD. The results remained consistent and robust in the sensitivity analysis. Conclusions: The MR study did not provide sufficient evidence to support the causal associations of NAFLD with kidney stones. [ABSTRACT FROM AUTHOR]

Objective To discuss the correlation between urinary metal elements and kidney stones in Miao population in Guizhou Province since there are few studies on the association between urine metal concentration and the risk of kidney stones in ethnic minorities. Methods In this study, 3 933 Miao people were sampled from the cohort database of natural populations living in ethnic minority areas in southwest China, and the concentrations of urine metals (arsenic, cadmium, cobalt, chromium, copper, iron, mercury, lithium, manganese, molybdenum, nickel, lead, strontium, vanadium and zinc) were detected by inductively coupled plasma mass spectrometry. The urinary metal concentration was divided into four groups: QI, Q2, Q3 and Q4, and the relationship between the exposure of a single metal to the risk of kidney stones was analyzed by binary logistic regression model, and the dose 一 response relationship between the concentration of monometals and the risk of kidney stones was explored by restriction cubic spline. Results The detection rate of kidney stones of Miao ethnic group in Guizhou Province was 20. 59%, the detection rate of male was 18. 27%, and the detection rate of female was 22. 02%. The results of the binary logistic regression model showed that when the covariate was not adjusted. In Miao women, after adjusting the covariate, the QI exposure group was used as the reference, and the chromium Q4 group (OR = 0. 534, 95% CI: 0.337 - 0. 846) was used. Lead Q3 group(OR = 0. 546, 95% CI: 0.400 - 0.745); Lead Q4 group(07, = 0. 657, 95% CI: 0.482 - 0.895) was negatively correlated with the risk of kidney stones. In Miao men, after adjusting for covariates, manganese Q4 group(OR 二 1. 911, 95% CI: 1. 274 -2. 867) was positively correlated with the risk of kidney stones. Further restriction cubic spline analysis showed that there was a dose - response relationship between urine chromium and the risk of kidney stones in Miao women(P < 0. 05). There was no dose - response relationship between urine lead and the risk of kidney stones (P > 0. 05), and in Miao men, there was a dose 一 response relationship between urinary manganese and the risk of kidney stones(P < 0. 05), Conclusion Heavy metals in urine affect kidney stones which supports the view that metal exposure plays a role in the development of kidney stones. [ABSTRACT FROM AUTHOR]

The main objective of this study was to analyze dietary patterns using data-driven approaches and to explore preventive or risk dietary factors for kidney stone disease (KSD). A case–control matching study was conducted in adults (n = 6396) from a suburb of Shanghai. A food frequency questionnaire was used to assess the consumption of various types of food, and B-ultrasound was used to identify kidney stones. Principal component analysis and regression were used to generate dietary patterns and further explore the relationship between dietary patterns and KSD. LASSO regression and post-selection inference were used to identify food groups most associated with KSD. Among males, the "balanced but no-sugary-beverages pattern" (OR = 0.78, p < 0.05) and the "nuts and pickles pattern" (OR = 0.84, p < 0.05) were protective dietary patterns. Among females, "high vegetables and low-sugary-beverages pattern" (OR = 0.83, p < 0.05) and "high-crustaceans and low-vegetables pattern" (OR = 0.79, p < 0.05) were protective dietary patterns, while the "comprehensive pattern with a preference for meat" (OR = 1.06, p < 0.05) and "sugary beverages pattern" (OR = 1.16, p < 0.05) were risk dietary patterns. We further inferred that sugary beverages (p < 0.05) were risk factors and pickles (p < 0.05) and crustaceans (p < 0.05) were protective factors. [ABSTRACT FROM AUTHOR]

Objective To understand the current status of discharge readiness and its influencing factors in patients undergoing local anesthesia percutaneous nephrolithotomy (PCNL) . Methods A survey was conducted on patients undergoing PCNL in urology department using a General Information Questionnaire, Readiness for Hospital Discharge, Quality of Discharge Teaching Scale, Hospital Anxiety and Depression Scale, and Social Support Scale. Results The mean score for discharge readiness in patients undergoing PCNL was 98.43±16.21, with item scores averaging 8.20±1.35. The scores for each dimension were as follows: personal status (7.64±1.9), adaptability (8.35±1.39), and expected support (8.44±1.32) . The quality of discharge guidance, anxiety, depression, and social support were identified as the main factors influencing patients′ self-perceived level of discharge readiness (R~2=0.611, adjusted R~2=0.604, F=80.168, P＜0.001) . Conclusion Patients undergoing local anesthesia percutaneous nephrolithotomy demonstrated a relatively high level of discharge readiness. However, the personal status dimension score was relatively low, indicating a need to enhance perioperative psychological care and discharge guidance to boost patients′ confidence in self-management during the transition period. [ABSTRACT FROM AUTHOR]

Accurate information regarding oxalate levels in foods is essential for managing patients with hyperoxaluria, oxalate nephropathy, or those susceptible to calcium oxalate stones. This study aimed to assess the reliability of chatbots in categorizing foods based on their oxalate content. We assessed the accuracy of ChatGPT-3.5, ChatGPT-4, Bard AI, and Bing Chat to classify dietary oxalate content per serving into low (<5 mg), moderate (5–8 mg), and high (>8 mg) oxalate content categories. A total of 539 food items were processed through each chatbot. The accuracy was compared between chatbots and stratified by dietary oxalate content categories. Bard AI had the highest accuracy of 84%, followed by Bing (60%), GPT-4 (52%), and GPT-3.5 (49%) (p < 0.001). There was a significant pairwise difference between chatbots, except between GPT-4 and GPT-3.5 (p = 0.30). The accuracy of all the chatbots decreased with a higher degree of dietary oxalate content categories but Bard remained having the highest accuracy, regardless of dietary oxalate content categories. There was considerable variation in the accuracy of AI chatbots for classifying dietary oxalate content. Bard AI consistently showed the highest accuracy, followed by Bing Chat, GPT-4, and GPT-3.5. These results underline the potential of AI in dietary management for at-risk patient groups and the need for enhancements in chatbot algorithms for clinical accuracy. [ABSTRACT FROM AUTHOR]

Purpose: The incidence of kidney stone disease has increased worldwide, resulting in high medical costs and social burden. Kidney stone disease shares some common features with the risk factors of cardiovascular diseases (CVDs). We investigated the association between cardiovascular health (CVH) based on the Life’s Essential 8 (LE8) score developed by the American Heart Association and the incidence of kidney stone disease. Methods: We analyzed the data of 29,469 US adults aged 20 years or above from the National Health and Nutrition Examination Survey, 2007–2018. According to the LE8 score, CVH was divided into three categories: poor, intermediate, and ideal. Logistic regression was used to determine the association between CVH and the incidence of kidney stone disease by estimating odds ratios (ORs) and 95% confidence intervals (CIs). Results: The average age of the participants was 48.6 years, and 50% of the participants were women. The numbers of participants with poor, intermediate, and ideal CVH were 4149, 19,782, and 5538, respectively. After adjusting for related confounding factors, ideal CVH was associated with a reduction in the odds of kidney stone occurrence as compared to poor CVH (adjusted OR [aOR]: 0.45, 95% CI: 0.35–0.57, p < 0.001). Moreover, if the ideal CVH metrics was ≥ 6, the odds of kidney stone occurrence decreased by up to 61% (aOR: 0.39, 95% CI: 0.30–0.51). Conclusions: In the present study, ideal CVH, a factor indicative of a healthy lifestyle, was associated with lower odds of kidney stone occurrence. [ABSTRACT FROM AUTHOR]

Objective: Infections in patients with kidney stones after extracorporeal shockwave lithotripsy (SWL) is a common clinical issue. However, the associated factors are unclear. Therefore, we aim to develop and validate a predictive model for infections after SWL in patients with kidney stone. Methods: Between June 2020 and May 2022, consecutive kidney stone patients were enrolled. Of them, 553 patients comprised the development cohort. One hundred sixty-five patients comprised the validation cohort. The data were prospectively collected. The stepwise selection was applied using the likelihood ratio test with Akaike’s information criterion as the stopping rule; A predictive model was constructed through multivariate logistic regression. The performance was evaluated regarding discrimination, calibration, and clinical usefulness. Results: Predictors of infections after SWL in treating kidney stones included older age (OR = 1.026, p = 0.041), female (OR = 2.066, p = 0.039), higher BMI (OR = 1.072, p = 0.039), lower stone density (OR = 0.995, p < 0.001), and higher grade of hydronephrosis (OR = 5.148, p < 0.001). For the validation cohort, the model showed good discrimination with an area under the receiver operating characteristic curve of 0.839 (95% CI 0.736, 0.941) and good calibration. Decision curve analysis demonstrated that the model was also clinically useful. Conclusion: This study indicated that age, gender, BMI, stone density, and hydronephrosis grade were significant predictors of infections after SWL in treating kidney stones. It provided evidence in optimizing prevention and perioperative treatment strategies to reduce the risk of infection after SWL. [ABSTRACT FROM AUTHOR]

Purpose: To compare medium-term stone recurrence between laparoscopic pyelolithotomy (LP) and percutaneous nephrolithotomy (PCNL). Material and methods: 98 patients who underwent PCNL or LP (2015-2019) for large single renal pelvis or staghorn stones (≥ 2 cm) were selected. The stone-free rate was evaluated using a computed tomography scan at one month and then, ultrasonography at six months intervals during the first year and annually thereafter for up to three years. Time-to-stone recurrence was compared using the Kaplan-Meier estimate. Hazard ratio was estimated by Cox regression. Results: The one month stone-free rate was 93.88% in the LP group vs. 79% in the PCNL group (P = .03). The mean overall time-to-stone recurrence was 31 (CI:24-34) months in the LP vs. 28 (CI: 23-32) in the PCNL groups (P = .02). Cox regression analysis showed that PCNL increased the risk of stone recurrence with a hazard ratio of 2.3 (CI: 1.1 - 5.3) compared to the laparoscopy. (p = .03) In subgroup analysis, time-to-stone recurrence in those without previous history of intervention was estimated at 31 (CI: 27 to 35) months in the LP vs. 25 (CI:16 to 34) in PCNL groups (= 0.04). Subanalysis with a BMI cutoff of 25 kg/m² showed an overall time-to-stone recurrence of 34 (CI:30 to 37) months in the LP group and 28 (CI:22 to 33) months in the PCNL group (= 0.04) in those with BMI higher than 25 kg/m². Conclusion: Medium-term time to stone recurrence was in favor of LP compared with PCNL for large single renal pelvis or staghorn stones. [ABSTRACT FROM AUTHOR]

Background: The aim of this study was (1) to explore effect of ureteral access sheath (UAS) use on primary retrograde intrarenal surgery (RIRS) outcomes, short-term kidney functions, radiation exposure, and ureteroscope lifetime (URS-LT) and (2) to reveal factors that predict UAS insertion failure. Materials and Methods: Patients (n = 1318) who underwent RIRS without UAS (Group 1), those who had operation with a <11–13 Fr (Group 2), and those with a ≥11–13 Fr UAS were matched (1:1:2) and compared. Stone-free rate (SFR), intra- and postoperative complications, acute kidney injury (AKI), fluoroscopy time, URS-LT, and UAS insertion failure were the outcomes. Results: SFR, which was highest in Group 3 (75%, 71% and 87.3%, respectively; P = .001), was significantly associated with use of ≥11–13 Fr (odds ratio [OR]: 4.2, P < .001), but was not with use of <11–13 Fr UAS (OR: 1.3, P = .3). Group 3 had less need for auxiliary procedure (15%, 16%, and 7.4%, respectively; P = .03). Five percent of patients had a risk of AKI, but only 0.3% developed AKI. Although UAS use was protective against creatinine increase (OR: 0.65, P = .02), increased risk of AKI was only associated with female gender (OR: 5.5, P < .001). Fluroscopy times were 5, 15, and 87 sn, respectively (P < .001). Short URS-LT was strongly associated with high frequency of lower calix stones (r = −0.94, P = .005), but URS-LT was not correlated with sheathless case rate (r = 0.59, P = .22). UAS insertion success in first attempt was more likely in younger (OR: 0.99, P = .03), hydronephrotic (OR: 3.4, P < .001), and female cases (OR: 1.5, P = .008). But absolute UAS insertion failure was associated with female gender (OR: 2.7, P = .017). Conclusions: Not any UAS use but a higher caliber UAS use may improve SFR and protect against AKI after RIRS. Although UAS insertion failure is seen mostly in men, it may be more challenging in women owing to less efficacy of preoperative Double-J stent. [ABSTRACT FROM AUTHOR]

Patients with Crohn's disease are at increased risk for symptomatic nephrolithiasis. Stones in these patients are most commonly composed of calcium oxalate monohydrate or mixed calcium-oxalate and calcium-phosphate. Precipitation of both minerals depends on urinary pH, calcium, phosphate and oxalate excretion. The present manuscript reports on two patients with Crohn's disease and bowel resection, in whom the onset of symptomatic urolithiasis occurred after repeated infusions of ferric carboxymaltose – a drug, which is known to cause hyperphosphaturia. The present study shows that ferric carboxymaltose-induced hyperphosphaturia can be associated with kidney stone formation and symptomatic urolithiasis, especially in patients treated with calcitriol. Calcitriol has been shown to mitigate ferric carboxymaltose-induced secondary hyperparathyroidism and hyperphosphaturia, but is known to increase urinary calcium excretion. Chemical analysis of recovered stones revealed that they were mixed calcium oxalate and phosphate stones. Ring-like deposition of iron detected by spatially resolved elemental analysis using laser ablation-inductively coupled plasma mass spectrometry, showed that the stones also contained iron. Based on our findings, we propose that patients with inflammatory bowel disease requiring intravenous iron therapy should be carefully monitored for the development of hypophosphatemia and urolithiasis. If hypophosphatemia occurs in such patients, calcitriol should be used with caution.