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Objectives: The main objective of this study is to determine the prevalence and risk factors of urolithiasis among the Saudi population in Makkah region. Methods: A cross-sectional survey was conducted on February 2017 in Makkah region (Makkah, Jeddah, and Taif). Data were obtained through direct interviews with participants, using an 18-questions-self-questionnaire, inquiring about demographic data (age, gender, weight, height, location, and occupation), educational level, history of renal stone disease (symptoms, modality of diagnosis, hospital admission, and previous treatment), and risk factors of stone formation such as family history and daily fluid intake. Results: A total of 1506 individuals were interviewed, including 82% from Makkah, 15.7% from Jeddah, and only 2.3% from Taif. The overall percentage of those diagnosed urolithiasis was 6.2%; including 6.6% males and 5.8% females (P = 0.06). Of those with stones, 5% were medically treated, 1.7% were hospitalized, and 1.2% were surgically managed for stones. There was a positive linear correlation between the prevalence of stones and participants' age group (r = 0.87, P = 0.01). More than 80% of participants were highly educated, which did not impact the prevalence of stones formation (P = 0.14). Urolithiasis was reported by 8.9% obese participants, 5.9% overweight, and 5.4% with normal body mass index (r = 0.68, P = 0.03). When stratified by jobs, stone prevalence significantly increased in retired participants (17.2%) than in workers (8.8%), followed by those without work (7.7%) and finally by students (3.3%) (P < 0.001). There was no significant difference between urolithiasis and type of drinking water (P = 0.62). Conclusion: The prevalence of urolithiasis in the Western region of Saudi Arabia has not changed much since the previous report, which was 30 years ago. It seems that the middle-aged population in their third decade of life, those who are overweight and obese people are at a high risk of developing urolithiasis. [ABSTRACT FROM AUTHOR]

Introduction: Calcium oxalate (CaOx) is the predominate component within renal calculi and can be divided into two subtypes: CaOx-monohydrate (COM) and CaOx-dihydrate (COD). COM and COD form in differing urinary environments, which suggest differential underlying metabolic abnormalities associated with each subtype. We compared clinical and metabolic findings in CaOx stone formers to delineate factors differentiating COD and COM stone formers and the implication this holds in terms of etiology and treatment. Patients and Methods: We identified CaOx stone formers that had passed their stones or had undergone endoscopic extraction between October 2014 and December 2018. Only patients who had a predominant subtype (≥80% COM or COD) and who had a 24-hour urine evaluation before medical management were included. Clinical and metabolic factors were compared in the two subgroups. Results: Out of 157 stone formers, 121 were COM and 36 were COD. COD formers were younger than COM formers with a mean age of 53 ± 16 vs 59 ± 15, respectively (p = 0.038). There were no observable differences in gender, body mass index, hypertension, diabetes mellitus, or hyperlipidemia. COM formers exhibited higher rates of hypocitraturia and hyperoxaluria, p = 0.022 and p = 0.018, respectively. Conversely, COD formers had significantly higher rates of hypercalciuria (47% vs 28%, p = 0.012). Multivariate analysis found hypercalciuria to independently predict COD (p = 0.043) and hyperoxaluria to predict COM stones (p = 0.016). Conclusion: COM formers are more likely to have hyperoxaluria, hypocitraturia, and elevated urinary oxalate levels compared to COD formers. COD formers exhibited higher incidence of hypercalciuria. These data suggest that all CaOx stones are not alike and that distinct metabolic and clinical etiological differences exist that may guide future management and prevention. [ABSTRACT FROM AUTHOR]

Aims: Patients with spinal cord injury (SCI) are at risk of developing renal calculi. This study describes the management of renal calculi among patients with SCI with attention to factors influencing surgical management vs observation. Methods: This retrospective, cohort study identified patients with SCI and renal calculi between 2009 to 2016 from an institutional neurogenic bladder database and detailed the management of their stones. A stone episode was defined as radiographic evidence of new calculi. Results: Of 205 patients with SCI, 34 had renal stones, for a prevalence of 17%. The mean age was 50 years (range 22,77) and most had cervical SCI (n = 22, 65%). There were 41 stone episodes with 98 individual stones identified with a mean stone size of 4.9 mm (range 1‐19). Of the 41 episodes, 10 (24%) underwent surgery after initial diagnosis. Pain was the most common primary indication for surgery (n = 9, 60%). The median time from diagnosis to intervention for all patients was 4 months (interquartile range 1,23). Of the 41 episodes, 31 (76%) were initially observed and among these, 5 ultimately required surgery (16%) while 26 (84%) did not. Of these 26, 12 (46%) stones passed spontaneously and 14 (53%) remained unchanged. The need for surgery correlated with more stone episodes (P = .049). Conclusion: In this cohort of patients with SCI and small, nonobstructing renal stones, 76% (n = 31) were offered observation. Of these observed patients, 84% (n = 26) did not require further intervention at a median of 4 years of follow‐up. [ABSTRACT FROM AUTHOR]

Introduction: This study aimed to investigate the differences in ureterorenal stone appearance after gouty arthropathy between Taiwanese aboriginal and non-aboriginal patients. Methods: Between 2007 and 2015, patients with first diagnoses of ureterorenal stones after diagnosis of gouty arthropathy at Puli Christian Hospital were enrolled in this study. Characteristics, underlying diseases and laboratory data for aboriginal and non-aboriginal patients were recorded. All categorical variables were analysed by χ² test and continuous variables were compared by f-test. Results: A total of 201 patients (66 aboriginal and 135 non-aboriginal) were enrolled in the study. Serum uric acid levels did not differ significantly between aboriginal and non-aboriginal groups. There was a significant difference in the time until ureterorenal stone appearance after gouty arthropathy between aboriginal and non-aboriginal patients (38.0 v 29.3 months, p=0.015). Among males, aboriginal patients exhibited gouty arthropathy at a younger age than non-aboriginal patients (46.0 v 50.2 years, p=0.035). Furthermore, male aboriginal patients exhibited a higher rate of alcoholic hepatitis (26.7% v 12.2%, p=0.046). Conclusion: Among males, aboriginal Taiwanese patients exhibited gouty arthropathy at younger ages than did non-aboriginal Taiwanese because of a higher rate of alcoholic hepatitis. The longer time until stone appearance after gouty arthropathy was attributed to alcoholic diuresis. Decreasing alcohol consumption may postpone or halt the development of gouty arthropathy. [ABSTRACT FROM AUTHOR]

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

Urolithiasis affects pediatric patients with severe acquired brain injury, in whom the role of several clinical variables and of the presence and composition of enteral nutrition has not been investigated. Retrospective chart review on 371 pediatric patients with severe acquired brain injury. We used an essential electronic database to check the association between stones and enteral feeding. We then picked at random paper clinical records until we collected 20 and 20 complete records for patients with/without stones, not matched. With that information, we tested the association of stones with: nutrition facts of enteral formulae (sodium, potassium, calcium, magnesium, phosphorus, proteins, vitamin C); bladder dysfunction, urinary infections, catheterisms, tracheostomy, gallstones, way of feeding; blood and urine exams before stones diagnosis; age, type and severity of injury; prior physical activity, relevant drugs. All patients with stones were fed enterally. At univariate statistics they were older, weighed more, received bigger volumes of hydration and nutrition; they had worse GCS, more UTIs and they alone received catheterisms; their nutrition mixes were richer in sodium. In multivariate logistic regression for stone development, UTIs (OR 11.4, 95% C.I. 1.6–83.4) and higher sodium nutrition content (OR 7.5, 95% C.I. 1.6–34.3) were risk factors; higher GCS (OR 0.66, 95% C.I. 0.43–0.99) and higher calcium nutrition content (OR 0.14, 95% C.I. 0.03–0.73) were protective factors. Besides known risk factors for urolithiasis, including UTIs, catheterisms, worse neurological states, also enteral nutrition was a risk factor, particularly with higher sodium and lower calcium contents. Future studies should test the effect of different sodium/calcium nutrition contents on lithogenesis. • Urinary stones often affect pediatric patients in rehabilitation from brain injury. • We associated stone formation with clinical and enteral nutrition factors. • Clinical risk factors were: enteral nutrition, catheterization, UTIs, worse GCS. • Nutritional risk factors were: higher sodium content, lower calcium content. [ABSTRACT FROM AUTHOR]

Objectives: To compare stone dusting and spontaneous passage vs fragmentation and active fragment retrieval during flexible ureteroscopy (fURS) for renal calculi. Patients and methods: The study included patients who underwent fURS and holmium laser lithotripsy for renal calculi from January 2015 to March 2017. Dusting was done using low energy and high frequency (0.3–0.5 J and 15–20 Hz, respectively), and fragmentation was done with higher energy and lower frequency (1–1.2 J and 6–10 Hz, respectively) and then stone fragments were extracted using a basket. The stone-free rate (SFR) was evaluated after 2 months with non-contrast computed tomography. Operative time, complication rate, SFR, and the need for secondary procedures were compared. Results: The study included 107 consecutive patients, with a mean (SD) age of 49 (13) years. Dusting was performed in 51 patients and fragmentation in 56. The patients' demographics, laboratory tests, preoperative stents, stone and renal characteristics were comparable for both groups. Operative time was significantly shorter for dusting than fragmentation (76 vs 91 min, P = 0.009). Complication rates were comparable between the groups (7.8% for dusting and 8.9% for fragmentation, P = 0.840). The mean hospital stay was comparable for both groups (P = 0.686). The SFR was significantly better in fragmentation group (78.6%) compared with the dusting group (58.6%, P = 0.035). The need for a secondary procedure was 33.3% in the dusting group and 23.3% in fragmentation group (P = 0.244). Conclusions: During fURS for renal stones, the dusting technique had a significantly shorter operation time, whilst the fragmentation technique led to a significantly better SFR. Both techniques have comparable safety, hospital stay, and requirement for secondary procedures. Abbreviations: fURS: flexible ureteroscopy/ureteroscope; ICU: intensive care unit; KUB: plain abdominal radiograph of the kidney, ureter and bladder; NCCT: non-contrast CT; SFR: stone-free rate; SWL: shockwave lithotripsy; UAS: ureteric access sheath [ABSTRACT FROM AUTHOR]

Introduction/Aim: Although prostatic calculi/calcifications are encountered frequently in the urological practice, little is known about the incidence of such lesions, their mechanism of formation, their relationship to other prostate conditions and their clinical significance. The purpose of this study is to describe the characteristics and to investigate the clinical significance of prostatic calcifications (PCs) in patients with chronic bacterial prostatitis (CBP). Materials and methods: This study was conducted between 01/02/2013 and 20/02/2018. The patient population for this study included subjects with or without PCs and a confirmed diagnosis of NIH category II Chronic Bacterial Prostatitis (CBP). Demographics and clinical history of each assessed patient were reviewed. Eligible patients underwent prostatic ultrasound with post-void residual measurement, and the Meares-Stamey “4-glass” test. Symptom severity was measured using the National Institutes of Health Chronic Prostatitis Symptom Index (NIH-CPSI) and the International Prostatic Symptoms Score (IPSS). Antimicrobials were administered to confirmed cases of CBP according to the results of susceptibility tests. After four weeks off-therapy, the NIH-CPSI and IPSS tests were repeated. Variables were compared between patients with and without prostatic calcifications. Results: Ninety-five CBP patients were included in the study. According to the presence of PCs detected by ultrasound examination, patients were divided into two groups: 41 had PCs (group 1) and 54 didn’t (group 2). No significant between-group baseline differences were found regarding age, marital status, prostate volume, the proportion of common CBP pathogens. Concerning highrisk sexual behavior, a significantly higher number of men with PCs practiced anal penetration. Moreover, a significantly higher number of men with PCs had a history of chronic prostatitis relapsing episodes. Microbiological eradication and the complete resolution of clinical symptoms occurred in similar proportions between the two groups. However, intergroup analysis resulted in significantly higher scores of the NIH-CPSI test in group 1, both at the pre-therapy and at the post-therapy time points. Conversely, no IPSS score differences between groups 1 and 2 were found at both pre- and post-therapy time points. Conclusions: Prostatic calcifications do not seem to influence the microbiological outcome of antibacterial treatment. However, the CBP symptoms appear to be more severe in carriers of prostatic calcifications, either before or after antibacterial therapy. [ABSTRACT FROM AUTHOR]

Background: There are abnormalities in vitamin D metabolism in people with calcium nephrolithiasis, but limited data are available on vitamin D status in dogs with calcium oxalate (CaOx) urolithiasis. Objective: To compare serum concentrations of vitamin D metabolites in dogs with and without hypercalciuric CaOx urolithiasis. Animals: Thirty‐eight dogs with (n = 19) and without (n = 19) a history of CaOx urolithiasis and hypercalciuria. Methods: Retrospective cross‐sectional study. Serum 25‐hydroxyvitamin D [25(OH)D], 1,25‐dihydroxyvitamin D [1,25(OH)2D], and 24,25‐dihydroxyvitamin D [24,25(OH)2D] were measured. The ratios of 25(OH)D/24,25(OH)2D and 1,25(OH)2D/25(OH)D were compared between cases and controls. Results: There were no significant differences between cases and controls when comparing 25(OH)D, 24,25(OH)2D, 1,25(OH)2D, or 1,25(OH)2D/25(OH)D. Cases had higher 25(OH)D/24,25(OH)2D (median = 1.40, range = 0.98‐1.58) compared to controls (median = 1.16, range = 0.92‐2.75; P = .01). There was overlap in the ranges for 25(OH)D/24,25(OH)2D between cases and controls, but 6 cases (32%) had ratios above the control dog range. There was a moderate positive correlation between the ratio of 25(OH)D/24,25(OH)2D and urinary calcium‐to‐creatinine ratios (r = 0.40, 95% confidence interval = 0.10‐0.64; P = .01). Conclusions and Clinical Importance: These data suggest that decreased conversion of 25(OH)D to 24,25(OH)2D occurs in a subset of dogs with CaOx urolithiasis. Abnormalities in vitamin D metabolism might contribute to stone risk in dogs. [ABSTRACT FROM AUTHOR]

Copyright of Ciencia, Tecnología y Salud is the property of Ciencia, Tecnologia y Salud and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Objective: Persistent, residual, or recurrent stones after transoral duct surgery are always associated with hilar to intraparenchymal and/or multiple sialolithiasis, causing difficulties in the treatment. This study was performed to assess the value of intraductal lithotripsy in the treatment of persistent, residual, or recurrent sialolithiasis after extended duct surgery in the submandibular gland.Study Design: Retrospective study covering February 2015 to June 2018.Study Setting: Tertiary referral center for salivary gland diseases.Subjects and Methods: After extended ductal surgery, 39 patients presenting with persistent, residual, or recurrent stones were treated. Four patients had persistent stones; 16 had residual stones; and 19 presented with recurrent stones. Among these patients, 50 stones were treated with intraductal pneumatic lithotripsy. Fragmentation rate, stone-free rate, and symptom-free rate after treatment with intraductal lithotripsy were outcome measures.Results: Of the 39 patients, 97.4% became stone-free, and all were symptom-free. Ninety-eight percent of the stones were completely fragmented. For 23.1% of the patients, >1 stone was treated with intraductal lithotripsy. All patients with persistent stones, 93.7% of those with residual stones, and all with recurrent stones became stone-free and symptom-free. No severe complications developed.Conclusions: This study shows that patients presenting with difficult and/or multiple sialolithiasis after extended transoral submandibular duct surgery can be treated with success rates >97%. For multiple sialolithiasis in particular, a multimodal treatment approach with interventional sialendoscopy and intraductal lithotripsy as a central element is a prerequisite for success, as this enables the most difficult part to be performed with high success rates. [ABSTRACT FROM AUTHOR]

Abstract Manmade objects such as buildings, statues and other materials made from cement, brick and stone are subject to mechanical weathering. Windblown sand wears down sharp edges, causing loss of style, features and details. Heat and cold cause expansion cracks that permit water to enter, freeze and or expand, causing more damage. The aggressive environment of the North West coast of Egypt, including sea storms, streams sand to impingement the facades of the summer houses and causes severe staining, peeling and damage to the paints and finishes of the exterior. High maintenance cost of such houses may eventually discourage owners to maintain the style and the architectural integrity of the compounds and villages. Architectural designs utilizing appropriate building and finishing materials which resist the wear and erosion, caused by high speed sand and salt laden air carrying sand particles and sea water droplets, are of vital importance to reduce maintenance cost. This paper investigates the wear rates and erosion mechanism for different finishing materials such as plastic paints (Complico), artificial stone tiles, Pharos stones, Calcium Carbonate natural stones, and fired brick tiles. Tests showed considerable wear rates when the facades are oriented about 60 degrees from the local wind directions. The results indicate a superior performance for the fired brick tiles. Other materials may be used on facades with somewhat different orientations ranging between 45 and 70 degrees from the wind direction. [ABSTRACT FROM AUTHOR]

Tamsulosin is a drug used in Spain since the late 1990s for the treatment of lower urinary tract symptoms associated with benign prostatic hyperplasia. In the early 2000s, antagonists of the a-adrenoreceptor, especially tamsulosin, began to be used off label, in the elimination of kidney stones located in the distal part of the ureter. This presents a-adrenergic receptors that are blocked by tamsulosin, producing relaxation of smooth muscle and inhibition of peristaltic activity and thus facilitating the elimination of stones. Medical expulsive therapy (MET) has been supported by many clinical trials and meta-analyzes performed. Both the American Medical Association of Urology and the European Association of Urology have recommended its use, depending on the size of the stone, but in recent years new clinical trials have appeared that call into question the efficacy of tamsulosin. A retrospective study of the use of tamsulosin in patients with urethral stones is made, determining its efficacy and comparing the results with other studies. [ABSTRACT FROM AUTHOR]

Objective: Aim of the present study was to evaluate the safety and efficacy of Percutaneous Nephrolithotomy (PCNL) in the Galdakao- Modified Supine Valdivia (GMSV) position in order to predict operative time, stone-free rate and onset of complications taking into account comorbidity, stone-related parameters and anatomic upper urinary tract abnormalities. Material and methods: A prospective evaluation of patients who underwent to PCNL in GMSV position for renal stones > 2 cm, from January 2009 to February 2015 was performed. According to the technique, upper urinary tract abnormalities, stone chemical and morphological characteristics, and patients' history were matched with operative outcome, in terms of stone-free, intervention time and incidence of perioperative complications. Results: Seventy-two cases were collected; mean operative time was 105 minutes (DS 41): staghorn stones and the presence of comorbidity resulted statistically significant variables. The complication-rate resulted in line with data showed in literature: hyperpyrexia and hemorrhage were the more frequently complications found. The overall stone-free was reached in 48 patients (67%), and it was influenced by patients’ anatomic abnormalities. Conclusions: In the treatment of renal stones, PCNL may be a safe and effective choice; nevertheless, patients’ anatomic abnormalities or staghorn-stones may influence the outcomes. Thus, a prospective study with a larger population is needed to verify our outcomes.

Objectives: To evaluate our experiences with ureteroscopic treatment of ureteral calculi in pregnancy. Patients and methods: Between April 2006 and October 2013, 41 pregnant women with persistent renal colics and/or hematuria refractory to conservative measures were treated with ureteroscopy. The patients’ mean age was 23 (range 19–37) years. Most of the patients (56.1%) presented in the 2nd trimester. Loin pain and colic were the most common presenting symptoms (90.2%). Twenty-seven patients (65.9%) had an obstruction on the right side. All patients underwent ureteroscopy under epidural anesthesia. Results: Ureteroscopy revealed the presence of ureteric stones in 36 of the 41 cases. The stone size ranged from 5 to 16 (mean 8.9) mm. Distal ureteric stones were found in 29 patients. The pneumatic lithoclast was used for stone fragmentation in 22 of them (75.9%), while the stone was directly extracted in 4 patients. In 3 patients the stone migrated proximally and was not accessible any more. Proximal ureteric stones were detected in 7 of the remaining 12 cases. When attempting to manipulate these stones, they migrated more proximally and became unreachable. In the last 5 patients the entire ureter was free of stones; they only had edema at the ureteric orifice. A long lasting JJ stent was left until the end of the pregnancy in all cases with migrated inaccessible stones. In all patients successfully treated, a JJ stent with dangle extraction strings was left for two weeks. Minor urologic complications were encountered in the form of mild dysuria in 12 cases (29.2%) and mild hematuria in 5 cases (12.2%). All patients completed their pregnancy until full term without any serious obstetric complications requiring intervention. Conclusion: Ureteroscopy is a safe and effective therapeutic option for the treatment of obstructing ureteral stones in pregnancy with stone-free and complication rates comparable to the non-pregnant population.

Objective: To determine the role of the lower pole infundibular parameters as predictors of stone clearance following extracorporeal shock wave lithotripsy (ESWL). Subjects and methods: Between March 2001 and February 2004, 243 renal units in 239 patients with isolated lower calyceal stones were treated by ESWL. Stone-free status was assessed after 3 months by plain X-ray abdomen and a kidney ultrasound scan. Persistent stone fragments ≥6 months after the completion of treatment was defined as residual stone. Radiogaphic parameters were obtained from intravenous urography (IVU). SPSS version 15.0 was utilized for all statistical analysis. Results: The median age of all patients was 38 years (range: 20–70 years). The male to female ratio was 2.1:1. The mean stone size was 1.3 ± 0.7 cm. Overall, 144 renal units (60.9%) had undergone one or two sessions of ESWL, 43 (17.7%) 3, while 46 (18.9%) ≥4 sessions, with mean of 2.1 sessions. Stone-free rates differed significantly between favorable and unfavorable infundibular length (IL), and infundibular width (IW) (p value = 0.01, p = 0.0001, respectively). Infundibulopelvic (IP) angle had no statistically significant effect on stone-free rate (p = 0.1). The effect of stone size on stone-free rate in two groups revealed better overall results in favorable anatomy group than in unfavorable group in stone sizes, 0.5–1.0 cm, 1.1–1.5 cm, 1.6–2 cm and 2.1–2.5 cm (76.7%, 87.5%, 100%, and 56.2% vs. 41.1%, 55.5%, 66.6%, and 50%; p = 0.04, 0.10, 0.10, 0.80, respectively). Conclusions: This study shows that lower infundibular length and width are significant anatomical factors in determining stone clearance following ESWL treatment of lower calyceal stones and these should be assessed before planning the treatment for lower calyceal stones.

Aim: In the last thirty years, the treatment for renal and ureteral calculi has undergone profound variations. The objective of this study has been to evaluate the existence of parameters which can affect the spontaneous expulsion of a symptomatic ureteral stone in a reasonably brief period of time and to identify whether certain parameters such as sex, age, the location and dimension of the stone, the presence of dilation in the urinary tract together with the administered therapy, can be used for a correct clinical management of the patient. Methods: In a period of 9 months, 486 cases of renal colic were registered at emergency department. Results: The cases of renal colic due to ureteral calculus were 188 (38.7%). The patients’ charts, complete of all data and therefore, valid for this research, resulted to be 120 (64%). In the presence of a symptomatic ureteral stone, the correct approach must first of all, focalize on the dimension of the calculus itself; less importance instead, is given to the location, as reported in other studies, the presence of hydroureteronephrosis, sex and the side. Conclusion: In the cases when the pain symptoms cannot be solved by means of the administration of analgesics, it is then reasonable to take into consideration an immediate endourological treatment. If the pain symptoms are promptly solved, an attentive wait of 4 weeks should be considered reasonable in order to allow spontaneous expulsion of the calculus.

Subtidal hard substrate habitats are unique habitats in the marine environment. They provide crucial ecosystem services that are socially relevant, such as water clearance or as nursery space for fishes. With increasing marine usage and changing environmental conditions, pressure on reefs is increasing. All relevant directives and conventions around Europe include sublittoral hard substrate habitats in any manner. However, detailed specifications and specific advices about acquisition or delineation of these habitats are internationally rare although the demand for single object detection for e.g., ensuring safe navigation or to understand ecosystem functioning is increasing. To figure out the needs for area wide hard substrate mapping supported by automatic detection routines this paper reviews existing delineation rules and definitions relevant for hard substrate mapping. We focus on progress reached in German approval process resulting in first hydroacoustic mapping advices. In detail, we summarize present knowledge of hard substrate occurrence in the German North Sea and Baltic Sea, describes the development of hard substrate investigations and state of the art mapping techniques as well as automated analysis routines.

The colonization of microorganisms and their subsequent interaction with stone substrates under different environmental conditions encourage deterioration of materials by multiple mechanisms resulting in changes in the original color, appearance and durability. One of the emerging alternatives to remedy biodeterioration is nanotechnology, thanks to nanoparticle properties such as small size, no-toxicity, high photo-reactivity, and low impact on the environment. This study highlighted the effects of ZnO-based nanomaterials of two bacteria genera isolated from the Temple of Concordia (Agrigento’s Valley of the Temples in Sicily, Italy) that are involved in biodeterioration processes. The antimicrobial activities of ZnO-nanorods (Zn-NRs) and graphene nanoplatelets decorated with Zn-NRs (ZNGs) were evaluated against the Gram positive Arthrobacter aurescens and two isolates of the Gram negative Achromobacter spanius. ZNGs demonstrated high antibacterial and antibiofilm activities on several substrates such as stones with different porosity. In the case of ZNGs, a marked time- and dose-dependent bactericidal effect was highlighted against all bacterial species. Therefore, these nanomaterials represent a promising tool for developing biocompatible materials that can be exploited for the conservation of cultural heritage. These nanostructures can be successfully applied without releasing toxic compounds, thus spreading their usability.

Sialendoscopy is a relatively new technique that offers the potential to be both diagnostic and therapeutic. It follows the principle of gland sparing therapy to manage conditions such as ductal stenoses and sialolithiasis. The procedure is relatively easy to learn and more affordable than the traditional methods of intervention. It is well suited to the African continent in that the equipment is relatively portable and may be taken to peripheral and rural areas, while still providing world-class care and minimal disruption to the patients. We hereby present the evolution of sialendoscopy. [ABSTRACT FROM AUTHOR]

Introduction and Objectives: The management of urolithiasis in patients with horseshoe kidney (HSK) is difficult. Stone formation occurred in 1:5 patients with HSK due to impaired urinary drainage and infections. Percutaneous nephrolithotomy and shock wave lithotripsy can be technically challenging due to altered anatomy. Materials and Methods: We conducted a systematic review of the literature to look at the role of ureteroscopy for stone management in these patients. We searched MEDLINE, PubMed and the Cochrane Library from January 1990 to April 2013 for results of ureteroscopy and stone treatment in HSK patients. Inclusion criteria were all English language articles reporting on ureteroscopy in patients with HSK. Data were extracted on the outcomes and complications. Results: A total of 3 studies was identified during this period. Forty-one patients with HSK underwent flexible ureteroscopy and stone treatment. The mean age was 42 with a male:female ratio nearly 3:1. The mean stone size was 16 mm (range: 3-35 mm). The mean operating time was 86 min with multiple stones seen in 15 patients. All 41 patients had a ureteral access sheath used and flexible ureteroscopy and holmium laser fragmentation done. Thirty-two (78%) patients were stone-free with a mean hospital stay of 1-day. Minor complications (Clavien I or II) were seen in 13 (32%) of which 6 had stent discomfort, 3 needed intravenous antibiotics for

Background and study aims The characteristics of difficult stones requiring cholangioscopy-assisted lithotripsy are poorly defined. We sought to determine clinician perception of these characteristics and decision-making in biliary endoscopy. Methods One hundred twenty-four delegates attending an online course were invited to assess 20 clinical stone cases. Each image was graded on a 4-point Likert for: grading of stone difficulty, confidence of clearance with conventional endoscopic retrograde cholangiopancreatography (ERCP) methods, likelihood of needing cholangioscopy-assisted lithotripsy, and confidence of clearance with one session of lithotripsy. An independent reviewer rated each case on largest stone size, stone number, presence of stricture distal to stone, size of stone relative to distal duct size, and acute common bile duct (CBD) angulation < 135°. Multilevel (mixed) statistical methods with a two-level model were utilized with multilevel ordinal logistic regression. Results Stone size and location, stricture and stone diameter:duct ratio impacted perceived procedural difficulty P < 0.01). Stone:duct ratio (< 50% odds ratio [OR] 0.22, P < 0.001), stricture (OR 7.26, P < 0.001) and stone location impacted confidence of clearance with conventional ERCP. Intrahepatic and cystic duct stones were least likely to engender confidence ( P < 0.01). The same factors plus CBD angulation < 135° predicted cholangioscopy requirement ( P < 0.01). Stone number did not influence procedure difficulty or cholangioscopy requirement. Strictures (OR 0.29, P < 0.001) and location, especially intrahepatic (OR 0.42, P < 0.001) impaired confidence in clearance with one cholangioscopy session. Conclusions Ductal anatomy, the presence of a stricture distal to a stone, cystic and intrahepatic stones and stones larger than the distal duct are considered by endoscopists to be significant predictors of requiring cholangioscopy-assisted lithotripsy., Competing Interests: Conflict of Interest George Webster has received honoraria for teaching and participation on advisory boards for Boston Scientific, Pentax Medical, Olympus Medical and Cook Medical. Amrita Sethi is a consultant for Boston Scientific, Interscope, Medtronic, Olympus. Amrita Sethi has received research support from Boston Scientific and Fujifilm. The remaining authors have no conflict of interest to declare., (The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).)

Background: There is a noteworthy overlap between the clinical picture of biliary acute pancreatitis (AP) and the 2018 Tokyo guidelines currently used for the diagnosis of cholangitis (AC) and cholecystitis (CC). This can lead to significant antibiotic and endoscopic retrograde cholangiopancreatography (ERCP) overuse., Objectives: We aimed to assess the on-admission prevalence of AC/CC according to the 2018 Tokyo guidelines (TG18) in a cohort of biliary AP patients, and its association with antibiotic use, ERCP and clinically relevant endpoints., Methods: We conducted a secondary analysis of the Hungarian Pancreatic Study Group's prospective multicenter registry of 2195 AP cases. We grouped and compared biliary cases (n = 944) based on the on-admission fulfillment of definite AC/CC according to TG18. Aside from antibiotic use, we evaluated mortality, AC/CC/AP severity, ERCP performance and length of hospitalization. We also conducted a literature review discussing each criteria of the TG18 in the context of AP., Results: 27.8% of biliary AP cases fulfilled TG18 for both AC and CC, 22.5% for CC only and 20.8% for AC only. Antibiotic use was high (77.4%). About 2/3 of the AC/CC cases were mild, around 10% severe. Mortality was below 1% in mild and moderate AC/CC patients, but considerably higher in severe cases (12.8% and 21.2% in AC and CC). ERCP was performed in 89.3% of AC cases, common bile duct stones were found in 41.1%., Conclusion: Around 70% of biliary AP patients fulfilled the TG18 for AC/CC, associated with a high rate of antibiotic use. Mortality in presumed mild or moderate AC/CC is low. Each of the laboratory and clinical criteria are commonly fulfilled in biliary AP, single imaging findings are also unspecific-AP specific diagnostic criteria are needed, as the prevalence of AC/CC are likely greatly overestimated. Randomized trials testing antibiotic use are also warranted., (© 2023 The Authors. United European Gastroenterology Journal published by Wiley Periodicals LLC on behalf of United European Gastroenterology.)

Background and study aims Endoscopic nasobiliary drainage is accompanied by a risk of accidental removal of the nasobiliary drainage (NBD) tube, especially through self-removal in elderly patients. We studied the usefulness of an integrated biliary stent and nasobiliary catheter system (UMIDAS NB stent) for biliary drainage in case of accidental NBD tube removal. Patients and methods From April to November 2022, we placed a UMIDAS NB stent in 30 patients with acute cholangitis or obstructive jaundice. We evaluated the plastic stent (PS) position at the time of accidental stent removal and before the planned endoscopic procedure. In addition, we studied the ratio of successful biliary drainage and complications based on the usage of UMIDAS. Results All 11 patients with accidental stent removal exhibited correct PS position in X-ray fluoroscopy. Of the 19 patients with planned NBD tube removal, three had complete PS migration into the common bile duct and three had incomplete migration (the duodenal side flap entered the bile duct). In summary, 80% (24/30) of PS were in the correct position, and all patients had successful biliary drainage and no complications. Conclusions The UMIDAS NB stent might be useful for biliary drainage in patients with a high risk of NBD tube self-removal., Competing Interests: Conflict of Interest The authors declare that they have no conflict of interest., (The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).)

Introduction: Choledocholithiasis is common, with patients usually treated with endoscopic retrograde cholangiopancreatography (ERCP) and subsequent cholecystectomy to remove the presumed source of common bile duct (CBD) stones. However, previous investigations into the management of patients following ERCP have focused on recurrent CBD stones, negating the risks of cholecystectomy. This article appraises the role of cholecystectomy following successful endoscopic clearance of bile duct stones., Methods: Patients undergoing ERCP and CBD clearance for choledocholithiasis at St James's University Hospital January 2015-December 2018 were included. Patients were divided into those who received cholecystectomy and those managed non-operatively. Readmissions, operative morbidity, mortality and treatment costs were investigated., Results: Eight hundred and forty-four patients received ERCP and CBD clearance with 3.9 years follow-up. Two hundred and nine patients underwent cholecystectomy with 15% requiring complex surgery. Three hundred and seventy-three patients were non-operatively managed. Unplanned readmissions occurred in 15% following ERCP, mostly within two years. There was no difference in readmissions between the two groups. Accounting for the entire patient pathway, non-operative management was less expensive., Conclusions: The majority of patients do not require readmission following ERCP for CBD stones, and cholecystectomy did not reduce the risk of readmission. Few patients have recurrent CBD stones, but complex biliary surgery is frequently required. Routine cholecystectomy following ERCP needs to be re-evaluated and a more stratified approach to future risk developed.

Purpose of Review: We aimed to examine the role of low-dose CT (LDCT) in the diagnostic work-up for suspected urolithiasis in pregnancy. We reviewed contemporary urologic recommendations for CT in pregnancy, its utilization for suspected urolithiasis, and explored barriers to its use., Recent Findings: National urologic guidelines and the American College of Obstetricians and Gynecologists recommend the judicious use of LDCT imaging in pregnancy when necessary. We noted inconsistencies in review article management pathways and recommendations for CT imaging for suspected urolithiasis in pregnancy. Overall CT utilization in pregnancy for suspected urolithiasis is low. Proposed barriers to LDCT use in pregnancy include fears of litigation and misperceptions of the harm of diagnostic radiation. Recent advancements in imaging technologies for urolithiasis in pregnancy are limited. More specific diagnostic pathway recommendations from national urologic guideline bodies for when to use LDCT to investigate renal colic in pregnancy may reduce diagnostic and intervention delays., (© 2023. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Xanthinuria is a clinically significant form of urolithiasis in cats with poor clinical outcomes and limited treatment options. In humans, xanthinuria has an autosomal recessive mode of inheritance, with variants in xanthine dehydrogenase (XDH) and molybdenum cofactor sulfurase (MOCOS) responsible for cases. While causative genetic variants have not been identified in the domestic cat, a recessive mode of inheritance has been suggested. DNA was extracted from EDTA-stabilised blood obtained from a Domestic Shorthair cat with clinically confirmed xanthinuria. Whole-genome sequencing and variant assessment in XDH and MOCOS identified XDH:c.2042C>T (XDH:p.(A681V)) as a candidate causative variant for xanthinuria in this cat. The variant is located in a highly conserved part of the molybdenum-pterin co-factor domain, responsible for catalysing the hydroxylation of hypoxanthine to xanthine and uric acid. Variants in this domain of XDH have been shown to disrupt enzyme function and to cause xanthinuria in other species. When assessed in the wider cat population, the variant had an allele frequency of 15.8%, with 0.9% of the animals assessed homozygous for the alternative allele. Cats diagnosed with xanthinuria should be tested for this variant to validate its clinical relevance in the wider population., (© 2023 The Authors. Animal Genetics published by John Wiley & Sons Ltd on behalf of Stichting International Foundation for Animal Genetics.)

Purpose: We performed a systematic review of the literature regarding the diagnosis and treatment of caliceal diverticulum (CD). Methods: The search strategy was conducted according to the Cochrane review guidelines for systematic reviews and Preferred Reporting Items for Systematic reviews and Meta-Analyses checklist. Results: In total 1189 titles and abstracts were reviewed, of which 101 were selected for article evaluation. Of these 101 articles, 40 were selected for inclusion after full article evaluations. In the extracted article, intravenous urography (IVU), rather than CT urography, was the main imaging tool for diagnosis, although many articles had failed to provide any imaging modality information. The extracted articles included 88, 153, and 487 patients who underwent shock wave lithotripsy (SWL), flexible ureteroscopy/retrograde intrarenal surgery (fURS/RIRS), and percutaneous nephrolithotomy (PCNL), respectively. Stone-free rates were 21.3% (SWL), 61.4% (fURS/RIRS), and 83.0% (PCNL). The complication rates were 8.0% (SWL), 3.3% (fURS/RIRS), and 11.9% (PCNL). There was incomplete and inconsistent reporting of even basic clinical parameters, such as the size and location of the CD, number of stones, outcomes, and complications. There was a striking lack of follow-up data, despite a known high recurrence rate. The literature on laparoscopic management was too sparse to analyze. Conclusions: This meta-analysis revealed that there are not enough high-quality studies to evaluate the ideal strategy for the diagnosis and treatment of CDs. This systematic review emphasizes (a) the importance of contrast imaging for CD diagnosis, (b) higher success rates but also higher complication rates in PCNL compared with SWL and FURS, and (c) the need for standardized reporting of outcomes to include complications, number of interventions, symptom resolution, stone clearance, and CD ablation. [ABSTRACT FROM AUTHOR]

This article considers stone pieces from the Holy Sepulchre brought to France in the eleventh century. Recent years have seen a growing awareness of architectural replications of the Holy Sepulchre built throughout the Latin West. Less attention has been devoted to its unmediated translation, namely, transporting its matter. Many French pilgrims who set out for Jerusalem before Urban preached crusade to the East in 1095 returned with stone fragments of the Holy Tomb to commemorate their visit and to consecrate architectural copies. Like the bodily remains of saints, these stone fragments acted as parts signifying the whole: they represented their place of origin and lent authenticity to local monuments. They could also act in unusual ways, attracting cults and prompting narratives, visual representations and staging in the church that announced their significance. [ABSTRACT FROM AUTHOR]

In this work, a noninvasive microwave-based system for monitoring water content of Cultural Heritage stone materials is presented. In particular, by placing a planar resonator in contact with the stone sample, an experimental relationship between resonant frequency and water content is obtained. To verify the suitability of the system, experimental tests are carried out on several types of stones: gentile; leccese; carparo; red brick; and red brick fabricated at high temperatures. The first three types of stones are typically found in Cultural Heritage structures, and they are particularly affected by deterioration and decay phenomena. As for the red bricks, they are found in buildings from the XVII Century. Measurements are performed for five levels of water content of the stone samples, and the empirical relationship between each considered water content level and the corresponding resonance frequency of the patch resonator are derived. To enhance the contact between the planar resonator and the rough surface of the stone, the patch is covered with a thin layer of soft silicon conductor. The obtained results demonstrate the robustness of the presented solution. [ABSTRACT FROM AUTHOR]

Purpose: Percutaneous nephrolithotomy (PCNL) is the preferred surgical treatment for staghorn stones. Two approaches are commonly employed to gain access into the collecting system which consists of either an upper pole (UP) approach or lower pole (LP) approach. However, opinions vary on which approach offers the best access and outcome. In this study, we aim to challenge the traditional paradigm that staghorn stones are most effectively treated through a prone UP approach. We herein report our institutional experience using a prone LP access in PCNL for patients with complete staghorn stones.Methods: Data were prospectively collected over 3 years on 473 PCNL procedures, of which 76 patients had complete staghorn calculi (five or more calyces). Operative and peri-operative outcomes were analyzed to compare a modified LP approach with the more widely accepted UP approach.Results: A total of 59/76 (77.6%) patients had LP access. There was no difference in the ability of completing the surgery utilizing a single tract as opposed to multiple tracts (74.6% of LP patients vs. 76.5% of UP patients). Stone-free rates for LP and UP access were similar (74.5 versus 70.5%, respectively; p = 0.760. Complication rates were lower for LP access vs. UP access (3.4 vs. 23.5%, p = 0.02) with two pulmonary complications in the UP group. Overall median operative time was not significantly different between LP and UP access (112.0 vs. 126.0 min, p = 0.486).Conclusions: Prone LP access demonstrated similar efficacy with decreased morbidity in patients with complete staghorn calculi compared to prone UP access. [ABSTRACT FROM AUTHOR]

Urinary tract stones have afflicted humanity since ancient times. It is characterized by being a very painful disease, which attracted medical attention and consequently its treatment began to be reported in the first medical texts. Some books talk about the famous lithotomy, a procedure with a high degree of mortality. As the years progressed, the practices based on trial and error made the surgical management of this pathology progress. The presence of bladder stones in some famous characters from history is well documented and is exposed in detail in this work we present. [ABSTRACT FROM AUTHOR]

Objective To assess the value of ultrasound, if indicated, supplemented by sialendoscopy, in the diagnosis of sialolithiasis. Study Design Retrospective study. Setting Referring center for salivary gland diseases. Subjects and Methods All patients who presented with a suspected diagnosis of obstructive sialopathy between January 2011 and April 2017 and had not undergone any treatment were retrospectively evaluated. A total of 2052 patients and 2277 glands were included in the study. Ultrasound examinations were carried out initially and followed by sialendoscopy in all cases. Direct demonstration of sialothiasis by sialendoscopy, transoral ductal surgery, and discharge of concrements/observation of fragments during sialendoscopy after extracorporeal shock-wave lithotripsy were regarded as definitive evidence of sialolithiasis. Results Ultrasound had an accuracy, sensitivity, specificity, positive predictive value, and negative predictive value of 94.77%, 94.91%, 94.57%, 96.14%, and 92.89%, respectively, for the diagnosis of sialolithiasis. All false-positive findings were correctly diagnosed, and in all false-negative findings, stones/fragments were visualized by sialendoscopy. Over 95% of the false-negative findings in major salivary glands (64/67) had visible ductal dilation in sonography, and in 73.1%, the stones not detected on ultrasound were located in the distal part of the duct, which is easily accessible with the sialendoscope. Conclusion This study shows that sialolithiasis can be diagnosed using ultrasonography with a high degree of certainty. If supplemented by sialendoscopy, the correct diagnosis could be established in virtually all cases of sialolithiasis. Ultrasound supplemented by sialendoscopy has the potential to serve as an alternative diagnostic standard in the future. [ABSTRACT FROM AUTHOR]

The efficiency of a hybrid patented consolidant (PAASi) and two commercially available hybrid coatings (a consolidant named AlSiX and a hydrophobic product named WS3) properly modified was assessed on a calcarenite substrate. Test routines based on standard recommendations were first applied to evaluate the performances of the consolidant and protective treatments, while the investigation of additional aspects such as penetration depth and interaction with the substrate was achieved by a multi-scale approach based on classic intrusion methods (mercury intrusion porosimetry) and Drilling Resistance Measurement System (DRMS), combined with non-invasive imaging techniques (X-ray computed micro-tomography and neutron radiography) and small angle neutron scattering (SANS). A distinct interaction of the products with the pore network of the stone was quantified in the range 0.007–200 µm. Their effects on capillary water absorption were also visualized with neutron imaging. The suitability of the products on the selected substrate was discussed, highlighting also how the applied routine can support conservation material studies. The results indicated that the Al-Si-based product led to unwanted effects. Alternative application methods and/or curing procedures have to be explored to overtake these undesirable changes. On the contrary, the polyamidoamine-based product seemed to be more suitable for calcarenite substrates conservation. The performances of the hydrophobic coating, when used in combination with consolidants, were strictly influenced by the pre-consolidation of the substrate. [ABSTRACT FROM AUTHOR]