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Objective: Unknown etiology Background: The tip-flexible suctioning ureteral access sheath (TFS-UAS) can be bent under flexible ureteroscopes, which facilitates removal of renal stone segments by irrigation and suctioning effects. Small-scale comparative studies found it safer and more efficacious than traditional UAS. However, complications such as renal abscess were not documented after TFS-UAS combined with digital FURS. Case Report: A 57-year-old woman had right lumbar pain that persisted for 1 year. A plain computed tomography (CT) scan revealed multiple renal pelvicalyceal stones (maximum diameter 20×9 mm). She was admitted to undergo elective surgery with a TFS-UAS combined with digital flexible ureteroscopic lithotripsy. The operation was deemed successful and she was given postoperative antibiotics for 2 days before discharge. Eight postoperative days later, she was admitted to the emergency department due to high fever (39.6°C). Plain CT revealed intact double-J stents and no abnormalities. She was readmitted to the urological department to receive antibiotic therapy, which progressed to septic shock (blood pressure 80/50 mmHg) and required immediate transfer to the intensive care unit. Contrast-enhanced CT revealed a right renal abscess. She was promptly resuscitated and given stronger antibiotics. She recovered well and was discharged with 2-week oral levofloxacin treatment. Follow-up ultrasound found no renal abscess. Conclusions: While TFS-UAS with digital FURs is an effective approach for multiple renal stones, there is a risk of postoperative renal abscess, possibly due to altered intrarenal pressure. [ABSTRACT FROM AUTHOR]

Introduction: This study aimed to evaluate the effect of coronavirus disease (COVID-19) on the patients' referral in the pregnant population and also investigate each treatment approach's advantages and disadvantages for acute renal colic in pregnancy. Methods: In this retrospective study, we included all pregnant women with ureteral stones referred to a referral center between January 2019 and March 2021. Results: Among 53 pregnant women, 18 (33.9%) were on conservative therapy, which passed the stone without any complications. Double J stent or nephrostomy tube insertion was done for 24 patients (45.2%). Seventeen of these patients (70.8%) presented post-surgical complications, including hematuria (29.2%), pyelonephritis (20.8%), and lower urinary tract symptoms (20.8%). Transurethral lithotripsy (TUL) was done in 11 patients (20.7%). Only one of these patients developed hematuria following TUL. Thus, in our population study, double J stent or nephrostomy insertion was associated with a higher chance of postoperative complications than TUL (p -value = 0.001). Thirty-six patients were referred within 13 months before the entry of COVID-19, while 17 were referred during a similar approximate duration after the COVID-19 entry into the country. Only the initial presentation had a significant difference between these two periods (p -value = 0.034). Conclusions: When conservative treatment fails, we recommend TUL as the second-line treatment over temporary procedures, such as double J stent or nephrostomy insertion. Of note, in a group of patients with an emergent clinical setting, including active infection, deteriorating renal function, signs of preterm labor, solitary kidney, etc., double J or nephrostomy tube insertion remains the preferred management method for its fast resolution of obstruction and infection. Besides, a decrease in visits with an increase in complicated cases after COVID-19 was observed, maybe due to a delay in referring. [ABSTRACT FROM AUTHOR]

Objective: To investigate the impact of climate and seasonal variations on emergency department (ED) admissions for renal colic, while specifically comparing the differences between individuals with sedentary and non-sedentary lifestyles. Patients and methods: A retrospective, single center study was conducted. Between the years 2017- 2020, medical records of patients admitted to the ED with renal colic, found to harbor ureteric stones on CT scans, were examined. Data on patients' occupational activities was collected through telephone questionnaires. Patients were categorized into two groups: sedentary and active. Precise weather data was obtained from the Israeli Meteorological Service website. The monthly average daily maximum temperatures were calculated. Results: In the final sample of 560 participants, 285 were in the sedentary group, and 275 were in the active group. The study population consisted of 78.1% males and 21.9% females, with consistent gender ratios in both occupational groups. Prevalence of uric acid stones was higher in the sedentary group (p < 0.05). While there was a slight increase in admissions during the summer, seasonal distribution did not significantly differ among occupational groups. The study found no significant differences in admissions across different temperature ranges. Both groups exhibited a pattern of increased referrals during the summer and reduced referrals in the colder winter months. The baseline data revealed notable differences between the sedentary and active groups, particularly in the prevalence of uric acid stones. Conclusions: Climate factors, including temperature and seasonal variations, had limited impact on ED admissions for renal colic in patients with kidney stones, irrespective of their sedentary or active lifestyles. Both groups exhibited similar admission patterns, with a higher rate of admissions during the summer and a lower rate of admissions during the winter. [ABSTRACT FROM AUTHOR]

Background: Unused opioid prescriptions can be a driver of opioid misuse. Our objective was to determine the optimal quantity of opioids to prescribe to patients with acute pain at emergency department discharge, in order to meet their analgesic needs while limiting the amount of unused opioids. Methods: In a prospective, multicentre cohort study, we included consecutive patients aged 18 years and older with an acute pain condition present for less than 2 weeks who were discharged from emergency department with an opioid prescription. Participants completed a pain medication diary for real-time recording of quantity, doses, and names of all analgesics consumed during a 14-day follow-up period. Results: We included 2240 participants, who had a mean age of 51 years; 48% were female. Over 14 days, participants consumed a median of 5 (quartiles, 1–14) morphine 5 mg tablet equivalents, with significant variation across pain conditions (p < 0.001). Most opioid tablets prescribed (63%) were unused. To meet the opioid need of 80% of patients for 2 weeks, we found that those experiencing renal colic or abdominal pain required fewer opioid tablets (8 morphine 5 mg tablet equivalents) than patients who had fractures (24 tablets), back pain (21 tablets), neck pain (17 tablets), or other musculoskeletal pain (16 tablets). Interpretation: Two-thirds of opioid tablets prescribed at emergency department discharge for acute pain were unused, whereas opioid requirements varied significantly based on the cause of acute pain. Smaller, cause-specific opioid prescriptions could provide adequate pain management while reducing the risk of opioid misuse. Trial registration: ClinicalTrials.gov, no. NCT03953534. [ABSTRACT FROM AUTHOR]

Objective: Rare disease Background: Hemangiomas of the adrenal gland are rare benign non-functional tumors arising from the gland's vascular endothelium. Adrenal hemangiomas are rare in clinical settings, often discovered incidentally during an unrelated diagnostic investigation. Case Report: A 39-year-old man presented with a heterogeneous, enhancing 4.56×4.24×3.9-cm mass originating from the right adrenal gland's lateral limb, discovered incidentally on computed tomography (CT) to investigate renal colic. He was routinely followed up for 2 years with serial CT scans; the mass exhibited considerable growth compared with baseline, with a relatively stable appearance with hyperdense soft tissue component, fat, and foci of calcification. Dexamethasone suppression test demonstrated suppressed cortisol response, indicating a non-functional mass. Therefore, laparoscopic right adrenalectomy was performed, owing to the benign nature of the preoperative diagnosis of myelolipoma and mass size. The patient experienced an uneventful recovery, with no perioperative complications. The resected mass was 5×4×4 cm in size and weighed 30 g. Histopathology confirmed adrenal hemangioma. Serial sectioning revealed an encapsulated lesion with heterogeneous solid and cystic surfaces. Light microscopy examination showed dilated and congested vascular channels lined by flattened endothelium. Focal mature adipose tissue was seen. Conclusions: The infrequent occurrence of adrenal hemangiomas and their nonspecific clinical and radiological presentation results in a considerable diagnostic challenge and, often, misdiagnosis. Surgical resection is usually necessary to exclude malignant disease, alleviate pressure-related symptoms, and decrease risk of retroperitoneum hemorrhage. These lesions are associated with a good prognosis. One limitation of this report is the lack of preoperative adrenal magnetic resonance imaging of the incidental adrenal mass. [ABSTRACT FROM AUTHOR]

Background: Urolithiasis is a common condition in daily urological practice. Medical Expulsive Therapy (MET) is non-invasive approach for removal of ureteric stone. In MET, alpha-blocker Tamsulosin is commonly used in treating urolithiasis but it does not address the pathology of inflammation presents in such condition. With addition of low dose Deflazacort as antiinflammatory agent, there may have a potential to improve the pathology and outcome of the treatment. Aims and Objectives: This study aims to find the efficacy of low-dose deflazacort combined with tamsulosin in the MET for distal ureterolithiasis. Materials and Methods: This prospective randomized controlled trial was conducted from December 2022 to December 2023 in Rampurhat Government Medical College and Hospital. A total of 130 patients with ureteric stone ≤10 mm were randomized into two groups. Tamsulosin group received tamsulosin (0.4 mg once daily for 28 days). Deflazacort group received tamsulosin (0.4 mg once daily for 28 days) with deflazacort (12 mg once daily for 10 days). All subjects were reviewed on 14 days and 28 days. Stone expulsion rate, time to stone expulsion, analgesic use, number of colic episodes, and hospitalization were recorded. Adverse effects of drugs were noted. Results: Among 130 patients randomized, 4 patients were lost to follow-up and 8 patients required early intervention. Deflazacort group had similar rate of stone expulsion (88% vs. 80%, P=0.548). There were significantly shorter expulsion time (10.15 days vs. 14.28 days, P<0.001) and less number of colic episodes (33 episodes vs. 21 episodes, P=0.026) and less analgesic requirements (65% vs. 82.5%, P=0.022) in deflazacort group. No significant side effects were noted during the study. Conclusion: Low-dose deflazacort added to tamsulosin provides a significant advantage in ureteric stone expulsion without any extra side effects. With a comparable rate of stone passage, there are more rapid stone expulsion, low analgesic requirement, and less colic episodes when low-dose deflazacort is added to tamsulosin for ureteric stone ≤10 mm. [ABSTRACT FROM AUTHOR]

Renal and genitourinary ultrasound are fundamental resources employed by emergency and critical care healthcare providers to make prompt diagnoses and perform ultrasound-guided procedures. At the bedside, ultrasound can aid in the diagnosis of relevant pathologies, such as post-renal obstruction or kidney stones, and life-threatening conditions such as aortic dissection or hemoperitoneum. A narrative overview was performed, providing an updated review of renal and genitourinary ultrasound for emergency and critical care healthcare providers, emphasizing its advantages and the latest advances in the field. A thorough summary that can be utilized as a guide for emergency and critical care healthcare providers is presented. The daily hemodynamic management of critically ill patients involves the implementation of new protocols, such as VexUS or the evaluation of the renal resistance index. The role of ultrasound in managing acute nephropathy and genitourinary issues is increasingly crucial given its bedside availability, thus this imaging modality not only facilitates the initiation of therapeutic interventions but also provides swift prognostic insights that are vital to provide tailored patient care. As further advances in ultrasound will arise, it is important for healthcare providers to foster the use of these technologies capable of improving patient outcomes. [ABSTRACT FROM AUTHOR]

Objective: To assess the diagnostic efficacy of integrating B-mode and color Doppler capabilities of ultrasound (US) to establish a robust standalone diagnostic tool for the diagnosis of ureteric stones as an alternative to non-contrast-enhanced computed tomography (NCCT). Methods: A total of 140 consecutive patients diagnosed with ureteric stones using NCCT were enrolled. On the same day, US in both B-mode and Color Doppler was performed by an experienced radiologist who was blinded to the NCCT scan results. The diagnostic rate of US for stone detection was recorded. Additionally, baseline patient and stone characteristics were analyzed for their association with the accuracy of stone detection using US. Results: US exhibited a high sensitivity of 91.43%, detecting 128 out of 140 stone foci. Notably, ureteric stones in the proximal and uretero-vesical junction (UVJ) segments were readily identifiable compared to those in the pelvic region (p = 0.0003). Additionally, hydronephrosis enhanced the US's ability to detect stones (p < 0.0001). Conversely, abdominal gases and obesity adversely affected US capabilities (p < 0.0001 and p = 0.009, respectively). Stone side, size, and density showed no statistically significant impact (p > 0.05). Conclusions: US with its color Doppler capabilities could serve as a reliable and safe alternative imaging modality in the diagnostic work up of patients with ureterolithiasis. Factors including stone location, Hydronephrosis, weight and abdominal gases significantly influenced its accuracy. [ABSTRACT FROM AUTHOR]

Aim: To present state of the art on the management of urinary stones from a panel of globally recognized urolithiasis experts who met during the Experts in Stone Disease Congress in Valencia in January 2024. Options of treatment: The surgical treatment modalities of renal and ureteral stones are well defined by the guidelines of international societies, although for some index cases more alternative options are possible. For 1.5 cm renal stones, both m-PCNL and RIRS have proven to be valid treatment alternatives with comparable stone-free rates. The m-PCNL has proven to be more cost effective and requires a shorter operative time, while the RIRS has demonstrated lower morbidity in terms of blood loss and shorter recovery times. SWL has proven to be less effective at least for lower calyceal stones but has the highest safety profile. For a 6mm obstructing stone of the pelviureteric junction (PUJ) stone, SWL should be the first choice for a stone less than 1 cm, due to less invasiveness and lower risk of complications although it has a lower stone free-rate. RIRS has advantages in certain conditions such as anticoagulant treatment, obesity, or body deformity. Technical issues of the surgical procedures for stone removal: In patients receiving antithrombotic therapy, SWL, PCN and open surgery are at elevated risk of hemorrhage or perinephric hematoma. URS, is associated with less morbidity in these cases. An individualized combined evaluation of risks of bleeding and thromboembolism should determine the perioperative thromboprophylactic strategy. Pre-interventional urine culture and antibiotic therapy are mandatory although UTI treatment is becoming more challenging due to increasing resistance to routinely applied antibiotics. The use of an intrarenal urine culture and stone culture is recommended to adapt antibiotic therapy in case of postoperative infectious complications. Measurements of temperature and pressure during RIRS are vital for ensuring patient safety and optimizing surgical outcomes although techniques of measurements and methods for data analysis are still to be refined. Ureteral stents were improved by the development of new biomaterials, new coatings, and new stent designs. Topics of current research are the development of drug eluting and bioresorbable stents. Complications of endoscopic treatment: PCNL is considered the most invasive surgical option. Fever and sepsis were observed in 11 and 0.5% and need for transfusion and embolization for bleeding in 7 and 0.4%. Major complications, as colonic, splenic, liver, gall bladder and bowel injuries are quite rare but are associated with significant morbidity. Ureteroscopy causes less complications, although some of them can be severe. They depend on high pressure in the urinary tract (sepsis or renal bleeding) or application of excessive force to the urinary tract (ureteral avulsion or stricture). Diagnostic work up: Genetic testing consents the diagnosis of monogenetic conditions causing stones. It should be carried out in children and in selected adults. In adults, monogenetic diseases can be diagnosed by systematic genetic testing in no more than 4%, when cystinuria, APRT deficiency, and xanthinuria are excluded. A reliable stone analysis by infrared spectroscopy or X-ray diffraction is mandatory and should be associated to examination of the stone under a stereomicroscope. The analysis of digital images of stones by deep convolutional neural networks in dry laboratory or during endoscopic examination could allow the classification of stones based on their color and texture. Scanning electron microscopy (SEM) in association with energy dispersive spectrometry (EDS) is another fundamental research tool for the study of kidney stones. The combination of metagenomic analysis using Next Generation Sequencing (NGS) techniques and the enhanced quantitative urine culture (EQUC) protocol can be used to evaluate the urobiome of renal stone formers. Twenty-four hour urine analysis has a place during patient evaluation together with repeated measurements of urinary pH with a digital pH meter. Urinary supersaturation is the most comprehensive physicochemical risk factor employed in urolithiasis research. Urinary macromolecules can act as both promoters or inhibitors of stone formation depending on the chemical composition of urine in which they are operating. At the moment, there are no clinical applications of macromolecules in stone management or prophylaxis. Patients should be evaluated for the association with systemic pathologies. Prophylaxis: Personalized medicine and public health interventions are complementary to prevent stone recurrence. Personalized medicine addresses a small part of stone patients with a high risk of recurrence and systemic complications requiring specific dietary and pharmacological treatment to prevent stone recurrence and complications of associated systemic diseases. The more numerous subjects who form one or a few stones during their entire lifespan should be treated by modifications of diet and lifestyle. Primary prevention by public health interventions is advisable to reduce prevalence of stones in the general population. Renal stone formers at "high-risk" for recurrence need early diagnosis to start specific treatment. Stone analysis allows the identification of most "high-risk" patients forming non-calcium stones: infection stones (struvite), uric acid and urates, cystine and other rare stones (dihydroxyadenine, xanthine). Patients at "high-risk" forming calcium stones require a more difficult diagnosis by clinical and laboratory evaluation. Particularly, patients with cystinuria and primary hyperoxaluria should be actively searched. Future research: Application of Artificial Intelligence are promising for automated identification of ureteral stones on CT imaging, prediction of stone composition and 24-hour urinary risk factors by demographics and clinical parameters, assessment of stone composition by evaluation of endoscopic images and prediction of outcomes of stone treatments. The synergy between urologists, nephrologists, and scientists in basic kidney stone research will enhance the depth and breadth of investigations, leading to a more comprehensive understanding of kidney stone formation. [ABSTRACT FROM AUTHOR]

Key Clinical Message: Unilateral renal mucormycosis is a rare infection that should be suspected in patients with recurrent renal infections presenting nonspecific clinical features that do not respond to conventional therapies, especially in impaired immune systems due to related risk factors. Moreover, histopathological examinations should be performed to confirm the diagnosis. For treatment, the preference is that the patient is hospitalized, and surgical intervention and rapid administration of intravenous antifungals for 2–3 weeks are the treatment choices. After discharge, the patient should be followed up with periodic blood urea nitrogen and creatinine levels and, if needed, an imaging modality such as a CT scan or sonography. Renal mucormycosis (RM) is a rare form of mucormycosis infection and is more often in immunocompromised patients with risk factors. Unilateral renal involvement is infrequent in patients and is available as case reports. This condition usually presents with renal colic, fever and chills, and oliguria and has a high mortality rate. Herein, we report a case of unilateral renal mucormycosis presenting with pyelonephritis and acute kidney injury in a 32‐year‐old patient. The patient had numerous urological procedures in previous years due to nephrolithiasis state, which put him in an immunocompromised state. The histopathological examination of the pylocalyceal system revealed a collection of broad non‐septated fungal hyphae branching at 90° accompanied by numerous neutrophils and necrotic tissue in favor of mucormycosis. He was successfully treated with 5 mg/kg/day Liposomal Amphotericin B for 3 weeks, discharged with good general condition, and remained asymptomatic for 3 months after discharge. The diagnosis of RM relies on solid clinical suspicion, which can be authenticated by histopathological examination, and the combination of antifungal therapy and surgical intervention can result in a good outcome. [ABSTRACT FROM AUTHOR]

Introduction: The majority of urological admissions are emergency patients, with a significant percentage being urologist emergency referral cases. There have been few research on this topic, although there are regional variances in the presentation of urological crises. As a result, this research examined a variety of urological emergency presentations and associated therapies. Objective: To estimate the percentage of urological crises and analyze the various types of urological emergencies with the necessary treatment. Materials and methods: Our institution conducted a one-year observational descriptive research in a hospital setting. Results: A total of 11,139 patients were admitted to the urology department, with a considerable number (21.05%) coming via the emergency room. The Department of Medicine accounted for the majority of cross references (22.59%). Renal colic (24.2%) was the most prevalent presentation in the emergency department, followed by acute urine retention (14.7%). Hematuria was the most common presentation in referred patients, accounting for 17.75%, followed by traumatic catheterization (11.97%). The most prevalent urological intervention in referred patients was suprapubic catheterization (27.20%), but in directly admitted cases, it was percutaneous nephrostomy (32.78%). Conclusion: Urological crises account for a large fraction of all urology admissions (27.18%). In our analysis, renal colic was the most prevalent non-traumatic damage, followed by traumatic catheterization. Percutaneous nephrostomy was the most prevalent surgical technique in direct admitted emergency patients, whereas suprapubic catheterization was used in intrahospital emergency referral cases. [ABSTRACT FROM AUTHOR]

Objective: To diagnose, treat, and prevent stone recurrence, it is important to determine the metabolic risk factors that play a role in developing urinary system stone disease in children. This study assessed children with urinary system stones’ clinical, radiological, and metabolic characteristics. Material And Methods: A retrospective study was conducted on the records of pediatric patients who applied to our pediatric outpatient nephrology clinic for various reasons between February 2018 and December 2023 and were diagnosed with urinary system stones. Results: Of the 122 patients with a mean age of 4.40±4.16 years (1 month-17 years), 63 (51.6%) were boys and 59 (48.4%) were girls. In 61.4% of the children, a family history was identified. The most common presenting symptom was abdominal/flank pain or restlessness (47.5%). In 25.4% of the patients, the stones were ≤3 mm (microlithiasis), and most stones were in the upper system. One or more metabolic abnormalities have been detected during urine analysis for 58.2% of patients. The most frequent metabolic abnormalities were hypercalciuria (20.5%) and hypocitraturia (17.2%). In 74.6% of patients, the size of stones decreased or completely disappeared with medical treatment based on underlying metabolic abnormalities, and in 17.2%, they did not change at all. Only eight (6.6%) patients required interventional procedures. Conclusion: Metabolic causes should be investigated first in all children with urinary tract stones. Special medical treatments designed to alter metabolism reduce the need for invasive stone procedures. [ABSTRACT FROM AUTHOR]

Introduction: Acute pain caused by kidney stones is considered one of the most prevalent reasons for referring to treatment centers or hospitals. One of the essential issues in this field, which still has many questions, is the probability of an increase in kidney stone formation during fasting. This study assessed the relationship between kidney stone pain and fasting during Ramadan. Methods: This study conducted a descriptive cross-sectional check on the patients who referred to 3 central urgencies named Imam Khomeini-Shahid Labafi Nejad and Baghiatallah due to Colic pain generated from kidney stones during three periods of time, including before, in, and after Ramadan. Results: The study indicates ureteral stones are more prevalent than kidney stones in patients with Kidney Colic Pain during three periods. Also, it was released that the most amount of Colic pain was experienced by males under 40 years during three periods of time, so there is a significant relevance between the male gender and Renal Colic (P<0.05). A noticeable change in diet and more usage of carbohydrate compounds in addition to high-protein diets was reported here, so there is a significant difference between more carbohydrates and Renal Colic before and after Ramadan (P=0.022). Conclusion: It is specified that factors such as male gender, age under 40, being overweight, high-calorie diet, and low physical activity are the risk factors associated with Renal Colic. Also, this study found that the reception of renal colic patients in Ramadan had no significant difference in another two months. [ABSTRACT FROM AUTHOR]

Objectives: To assess whether age or gender affects ureteric stone management costs, in patients presenting to the Emergency Department (ED) with CT proven ureteric stones. Patients and methods: A retrospective examination was conducted on patients admitted to the ED who were diagnosed with a ureteric stone through CT scans. Data encompassing clinical, laboratory, and imaging parameters were gathered, alongside information on admissions, ED readmissions, surgical procedures, and the overall treatment cost. Comparative analyses were performed on various cost rates in relation to different stone parameters, patient clinical presentations, laboratory results, and personal histories of urolithiasis. Results: From January 2018 to January 2020, 805 patients underwent abdominal CT scans at a single institution's ED and were diagnosed with ureteric stones. Among them, 773 patients met the inclusion criteria, with 78% (609) being males and 22% (169) females. The mean ages for males and females were 49.4 (SD 14.4) and 51.6 (SD 15.7), respectively (p = 0.08). Treatment costs exhibited a direct relationship with age, amounting to 4,025, 5,116, 6,058, and 9,225 US dollars (USD) in the 18–30, 31–50, 51–70, and over 70 age groups, respectively. Female gender was associated with higher treatment costs, averaging 6,831 USD, compared to 5,450 USD in males (p = 0.03). However, there were no significant differences between genders in terms of the type of surgical procedure (p = 0.4) or hospital stay duration (p = 0.1). Conclusions: Age and gender exerted a significant impact on treatment costs, revealing that advanced age and female gender were both correlated with higher direct treatment costs in the care of ureteric stones. [ABSTRACT FROM AUTHOR]

Introduction: Renal colic is frequently treated with opioids; however, narcotic analgesic use can lead to dependence and abuse. We evaluated use trends of opioids and nonsteroidal anti-inflammatory drugs (NSAIDs) for pain management of kidney stones in United States emergency departments (EDs) from 2015 to 2021. Methods: Kidney stone encounters were identified using National Hospital Ambulatory Medical Care Survey data. We applied a multistage survey weighting procedure to account for selection probability, nonresponse, and population weights. Medication use trends were estimated through logistic regressions on the timing of the encounter, adjusted for selected demographic and clinical characteristics. Results: Between 2015 and 2021, there were an estimated 9,433,291 kidney stone encounters in United States EDs. Opioid use decreased significantly (annual odds ratio [OR]: 0.87, p = 0.003), and there was no significant trend in NSAID use. At discharge, male patients were more likely than females (OR: 1.93, p = 0.001) to receive opioids, and Black patients were less likely than White patients (OR: 0.34, p = 0.010) to receive opioids. Regional variation was also observed, with higher odds of discharge prescriptions in the West (OR: 3.15, p = 0.003) and Midwest (OR: 2.49, p = 0.010), compared with the Northeast. Thirty-five percent of patients received opioids that were stronger than morphine. Conclusion: These results suggest improved opioid stewardship from ED physicians in response to the national opioid epidemic. However, regional variation as well as disparities in discharge prescriptions for Black and female patients underscore opportunities for continued efforts. [ABSTRACT FROM AUTHOR]

Background Primary hyperoxalurias (PH) are extremely rare genetic disorders characterized by clinical heterogeneity. Delay in diagnosing these conditions can have detrimental effects on patient outcomes. The primary objective of this study is to assess the current diagnostic delay for PH. Methods This nationwide, observational and retrospective study included patients who received a genetic diagnosis of PH types 1, 2 and 3 between 1 January 2015 and 31 December 2019. Diagnostic delay was defined as the duration between the onset of symptoms and the time of genetic diagnosis. Results A total of 52 patients (34 children and 18 adults) were included in the study, with 40 PH1 (77%), 3 PH2 (6%) and 9 PH3 (17%). At the time of diagnosis, 12 patients (23%) required dialysis. Among the PH1 patients, the predominant symptom at onset in adults was renal colic (79% of cases), whereas symptoms in children were more diverse (renal colic in 17% of cases). The diagnostic delay was significantly shorter in children compared with adults [median (interquartile range)]: 1.2 (0.1–3.0) versus 30 (17–36) years, respectively (P  < .0001). RNA interference was utilized in 23 patients (58%). Five individuals (13%) underwent double liver–kidney transplantation, and five (13%) received isolated kidney transplantation, with lumasiran therapy in four patients. For PH2 and PH3 patients, the diagnostic delay ranges from 0 to 3 years, with renal colic as first symptom in 33% of cases. Conclusion This extensive and recent cohort of PH underscores the considerable delay in diagnosing PH, particularly in adults, even in a country with a dedicated organization for enhancing the overall management of rare diseases. These findings reinforce the imperative for increased awareness among relevant specialties regarding the evaluation of urolithiasis. [ABSTRACT FROM AUTHOR]

Despite similar diagnostic effectiveness for renal colic, computed tomography (CT) is more resource intensive than point-of-care ultrasound (PoCUS). We sought to compare Emergency Department (ED) length of stay (LOS) among patients with renal colic according to imaging modality utilized. We secondarily compared rates of infection, return ED visits, missed significant pathology, and urologic intervention. This was a 12-month (1/1/22–12/31/22) multi-site retrospective cohort study of all patients diagnosed with renal colic who presented to the ED on days when at least one patient had a billable renal PoCUS examination performed. Patients with a history of genitourinary malignancy, pregnancy, renal transplant, hemodialysis, single kidney, prior visit for renal colic in the previous 30 days, or an incomplete workup were excluded. Median ED LOS was compared using a Wilcoxon rank sum test, and the 95% confidence limits for the difference between medians was calculated. Secondary outcomes were compared using a Fisher's Exact test. Of 415 patients screened, 325 were included for analysis: 150 had CT alone, 80 had PoCUS alone, 54 had PoCUS plus CT, and 41 had neither. Median LOS for PoCUS alone was 75.0 (95% CI 39.3–110.7) minutes shorter than CT alone (231.5 vs. 307.0 min, p < 0.0001). Similar rates of infection, return visits, and missed pathology occurred across all groups (p > 0.10). Urologic interventions were higher in the PoCUS plus CT (25.9%) group compared to CT alone (7.3%), PoCUS alone (2.5%), and neither (7.3%), p < 0.0001. Among patients with renal colic, PoCUS was associated with shorter ED LOS compared to CT, without differences in infection rates, return visits, or missed pathology. Patients with PoCUS plus CT had a higher rate of urologic interventions, suggesting PoCUS may have a role in identifying patients who would most benefit from CT. [ABSTRACT FROM AUTHOR]

To evaluate the feasibility of urgent ureteroscopy (uURS) and elective ureteroscopy (eURS) in the management of patients with renal colic due to ureteral stones. Patients who were operated for ureteral stones between September 2020 and March 2022 were determined retrospectively. The patients who were operated within the first 24 h constituted the uURS group, while the patients who were operated after 24 h were classified as eURS. No limiting factors such as age, gender and concomitant disease were determined as inclusion criteria. Patients with bilateral or multiple ureteral stones, bleeding diathesis, patients requiring emergency nephrostomy or decompression with ureteral JJ stent, and pregnant women were not included. The two groups were compared in terms of stone-free rate, complications, and overall outcomes. According to the inclusion–exclusion criteria, a total of 572 patients were identified, including 142 female and 430 male patients. There were 219 patients in the first group, the uURS arm, and 353 patients in the eURS arm. The mean stone size was 8.1 ± 2.6. The stone-free rate was found to be 87.8% (502) in general, and 92 and 85% for uURS and eURS, respectively. No major intraoperative or postoperative complications were observed in any of the patients. Urgent URS can be performed effectively and safely as the primary treatment in patients with renal colic due to ureteral stones. In this way, the primary treatment of the patient is carried out, as well as the increased workload, additional examination, treatment and related morbidities are prevented. [ABSTRACT FROM AUTHOR]

Purpose: First research to evaluate the clinical efficacy and safety of flexible ureteral lithotripsy (FURSL) and percutaneous nephrolithotomy (PCNL) in the treatment of the upper ureteral stone is between 1.5 cm and 2.0 cm in diameter since there is no consensus with such ureteral stone yet. Methods: From December 2018 to October 2022, 104 patients with calculi in the upper ureter received percutaneous nephrolithotomy (PCNL)or flexible ureteroscopic lithotripsy (FURSL) in our institution. The clinical data of the patients in the two groups were retrospectively searched. Stone removal rate, operation time, blood loss, postoperative pain score, postoperative inflammatory factor, postoperative complication rates and ureteral obstruction three months after the operation were compared between the two groups. Results: A total of 104 patients were included in the study. The stone clearance rate and the secondary surgery rate were 88.89% and 7.41% in the FURSL group, the figures were 97.96% and 2.0% in the PCNL group (p = 0.067, 0.497). Regarding ureteral obstruction three months after the operation, there were 2 patients in FURSL group and 0 patients in PCNL group(p = 0.497).Compared to patients in FURSL group, patients in the PCNL group had shorter operation time(PCNL 71.81 ± 18.94 min vs. FURSL 86.80 ± 22.49 min, p = 0.0004), fewer complications(PCNL 20.37% vs. FURSL 6.12%), and lower postoperative inflammatory factor(p = 0.0004), yet they got more hemoglobin drop (PCNL 13.14 ± 9.81 g/L vs. FURSL 4.77 ± 3.55 g/L, p < 0.0001), higher postoperative pain scores(p = 0.0017) in the first three postoperative days and longer hospital stay (PCNL 4.96 ± 1.21 days vs. FURSL 3.60 ± 0.83 days). Conclusion: Both FURSL and PCNL were effective methods for treating upper ureteral stones of 1.5–2.0 cm in diameter given the extremely high stone clearance rate and a very low secondary surgery rate, as long as rare ureteral obstruction in medium-long term observation. Additionally, FURSL can effectively reduce surgical bleeding, postoperative pain, and hospital stay, while PCNL can decrease operation time, the risk of infection, and complications. Therefore, doctors could select suitable surgical treatment for those patients depending on their different clinical situations based on these findings. [ABSTRACT FROM AUTHOR]

Extracorporeal shock wave lithotripsy (ESWL) is a safe and efficient treatment option for urinary stone disease. The overall stone-free rate (SFR) varies significantly. This study aimed to assess the influence of stone size, location, stone density, and skin-to-stone distance (SSD), on the outcome of ESWL. We assessed whether pre-treatment non-contrast-enhanced CT scan (NCCT) confers significant advantages compared to kidney-ureter-bladder film (KUB) only. We reviewed the medical records of 307 cases (165 men, 142 women) with renal and ureteral stones treated consecutively at our institution with ESWL between 2020 and 2023. 44 of these underwent a NCCT. The outcome of ESWL was defined in two ways: visible stone fragmentation on KUB, and the need for further treatment. Overall success of fragmentation was 85% (261 patients). 61% of patients (n = 184) didn't need any further treatment. Stone size and location correlated significantly with treatment outcomes regarding the need for further treatment (p = 0.004) and stone fragmentation (p = 0.016), respectively. Unlike mean SSD (p = 0.462), the mean attenuation value (MAV) significantly correlated with the need for retreatment (p = 0.016). MAV seems to be a better predictor of treatment success (AUC of the ROC curve: 0.729), compared to stone size (AUC: 0.613). The difference between groups (with and without NCCT) in both treatment outcomes did not reach statistical significance. During decision-making, information regarding SSD and MAV can be useful in more dubious scenarios. However, it appears that their inclusion doesn't provide substantial advantages when compared to relying solely on KUB. [ABSTRACT FROM AUTHOR]

Urolithiasis has a seasonal pattern, with an established increase in incidence during the summer months. This study aims to assess the impact of high ambient temperatures on emergency room (ER) visits related to renal colic (RC) in a Middle Eastern country over the past decade. Population data were extracted using the MDClone Big Data platform. We recorded demographic and clinical data on all RC-associated ER visits from January 2012 to April 2023 and calculated the heat index (HI) that combines daily average coastal plane temperatures and humidity percentages. There was a total of 12,770 ER visits (median age 48 years, 9,236 (72%) males). The number of visits increased during the hottest months (July-October), with the highest numbers recorded during August. The number of visits remained stable throughout the study. We identified a linear association between humidity and the incidence of ER visits (p = 0.002), and a non-linear association between ambient temperature (p < 0.0001) and HI (p < 0.0001). There was a direct relationship between high temperatures and ER visits on the same day (risk ratio [RR]: 1.75, p = 0.036), with a 2-day lag (RR: 1.123, p = 0.024). In Conclusion, there is a significant relationship between temperature, humidity, HI, and the number of ER visits due to RC. Adjusted resource allocation and healthcare workforce availability are essential for managing additional cases during heat waves. Clinical implications: Increased demand is expected during heatwaves and within a 2-day lag, emphasizing the importance of proactive strategies to effectively manage RC patients. [ABSTRACT FROM AUTHOR]

An 11-year-old otherwise healthy female presented with renal colic and during computed tomography imaging evaluation, she was found to have a right distal ureteral stone with associated hydroureteronephrosis, medially deviated ureter, and 4-cm solid retroperitoneal mass. The mass was palpable on physical exam and was further categorized with magnetic resonance imaging, ultrasound, and laboratory testing. A multidisciplinary team approach, including pediatric surgery, radiology, oncology, and urology, led to the patient undergoing a right retrograde pyelogram, ureteroscopy with stent placement, and laparoscopic excision of retroperitoneal mass. Her pathology revealed lymphoid hyperplasia with histologic features of Castleman disease. [ABSTRACT FROM AUTHOR]

Background: Renal forniceal rupture (FR) is a unique complication of obstructive uropathy. This study aimed to identify the predictors of FR among patients presenting with renal colic due to obstructing ureteral calculi. Materials and Methods: After obtaining ethics approval, electronic records of patients from three National Guard hospitals in Saudi Arabia were reviewed between 2016 and 2020 to identify patients who presented with renal colic and were diagnosed with FR due to obstructive ureteric stones (FR group). An equivalent number of consecutive patients presenting with renal colic due to obstructing ureteric stones without FR was selected as a control group (non-FR group). Patients were grouped according to age group (<30, 30-40, 41-50, and >50 years), body mass index (BMI) class, gender, comorbidities, grade of hydronephrosis, location of the stone in the ureter, size of the stone (<3 mm, 3-7 mm, and >7 mm), and stone former status. Baseline patients' and stone characteristics were compared, and a regression analysis was performed to identify predictors of FR. Results: A total of 50 patients with FR were identified, and a control group of 50 patients without FR were selected. The baseline patients' and stone demographic characteristics in terms of age (P = 0.42), gender (P = 0.275), BMI (P = 0.672), comorbidity, grade of hydronephrosis (P = 0.201), and stone location (P = 0.639) were comparable between the FR group and the non-FR group. However, the stone size was statistically significant between both groups (P = 0.014). On multivariable analysis, it was found that the stone size was associated with a significantly higher increase in the incidence of FR (odds ratio [OR]: 6.5 [1.235-34.434]; P = 0.027). Furthermore, the age group between 30 and 40 years was potentially at a lower risk for FR (OR: 0.262 [0.069-0.999]; P = 0.049). Conclusion: This multicenter study showed that the stone size 3-7 mm had a six-fold increase in the chance of FR, and the age group between 30 and 40 years is potentially at a lower risk for FR. [ABSTRACT FROM AUTHOR]

Renal colic (RC) is one of the most frequent reasons for presentation to the emergency department (ED) and creates a high economic and medical burden. Management strategies for RC range from waiting for spontaneous passage to surgical intervention. However, factors determining spontaneous stone passage (SSP) are still poorly understood. Therefore, in this study, we aimed to investigate the role of the systemic immune-inflammatory index (SII) in predicting SSP. We retrospectively analyzed the data of 924 patients aged over 18 years, who were diagnosed with RC in our clinic between 1 January 2019, and 30 May 2022, and had ureteral stones of ≤ 10 mm. The patients were divided into two groups according to whether they had SSP. The clinical and laboratory characteristics of the patients in the ED were evaluated. The neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and SII (neutrophil count x platelet count/lymphocyte count) values of the patients were calculated. Stone size and location were also recorded. In the univariate analysis of SSP, a ureteral stone size of ≤ 5 mm (p < 0.001), distal ureteral location (p < 0.001), SII (p < 0.001), NLR (p < 0.001), and PLR (p = 0.036) were significantly correlated with SSP. ROC analysis showed that an SII level < 721.8 (Sensitivity %82.6, Specificity %74.7, p < 0.001) was an independent predictor of SSP. Our findings showed that a low SII level was associated with SSP and could be used as a predictive marker of SSP as a more valuable parameter than NLR. SII and NLR, together with other indicators, are inflammatory markers that can be used in the clinical decision-making process for ureteral stone treatment. [ABSTRACT FROM AUTHOR]

Introduction In this study we aimed to compare the efficacy of mirabegron and silodosin as medical expulsive therapy (MET) for distal ureteric calculus ≤10 mm. Material and methods A total of 114 patients who met the inclusion criteria were prospectively randomised into 2 groups, 58 patients in the silodosin group and 56 patients in the mirabegron group. The drugs were given for a maximum of 4 weeks. The primary endpoint was the stone expulsion rate, and secondary endpoints were stone expulsion time and number of pain episodes. Results There were no statistically significant differences between the two groups in terms of mean age, gender, mean stone size, side, or hydronephrosis. Both groups exhibited similar rates of stone expulsion and expulsion time. Regarding pain management, the frequency of renal colic episodes was significantly lower with mirabegron compared to silodosin (2.3 ±0.2 vs 1.9 ±0.2, P <0.0001). Six patients were excluded from the study due to adverse drug reactions: 4 (6.15%) in the silodosin group (retrograde ejaculation, hypotension) and 2 (3.27%) in the mirabegron group (hypertension). Conclusions In among patients with distal ureteric stones measuring 5–10 mm, mirabegron did not demonstrate superiority in stone expulsion rate or expulsion time compared to silodosin. However, mirabegron significantly reduced the frequency of renal colic episodes. Therefore, mirabegron may be considered a preferable option for medical expulsive therapy for distal ureter stones over silodosin. [ABSTRACT FROM AUTHOR]

Background: Unenhanced low-dose computed tomography of the kidneys, ureter and bladder (CT KUB) is the gold standard diagnostic imaging modality in the assessment of suspected renal colic. As the radiation dose is not negligible, it is important to monitor the diagnostic yield of CT KUBs. The aim of this study is to evaluate the diagnostic yield of CT KUB studies performed for suspected renal colic in patients presenting to the emergency department. Methods: A retrospective review was performed of 500 patients who underwent CT KUB for suspected renal colic over a seven month period from June 2019 to January 2020. Clinical information and imaging was reviewed for each patient. Statistical analysis was performed using GraphPad Prism 8 (GraphPad Software, San Diego, CA, USA). Results: Forty-nine percent of patients in the series were female (248/500) and the mean age was 45. The positivity rate for obstructing ureteral calculus was 34% (169/500). Concerningly, there was a significantly lower positivity rate in females compared to males (19% versus 48%; p < 0.0001) which raises the issue of unnecessary radiation exposure to this cohort. In the 200 female patients who were negative for obstructing urolithiasis, the mean age was 43. Females also had a significantly higher rate of negative CT KUB (62% versus 37%; p < 0.0001) where no underlying alternative pathology was diagnosed. Conclusions: Women are less likely than men to have obstructing urolithiasis on CT KUB for suspected renal colic. This difference is not accounted for by a higher rate of alternative diagnoses among female patients. The findings of this study should prompt clinicians to exercise caution when considering this imaging modality in this patient cohort. [ABSTRACT FROM AUTHOR]

Idiopathic retroperitoneal fibrosis, also known as Ormond's disease, can present as an IgG4-related disease involving the deposition of fibrous tissue in the retroperitoneal space. It is caused by chronic inflammation developing around the abdominal aorta and common iliac arteries. The case report describes a patient hospitalised for complaints of low back pain with positive Goldflam's sign and hydronephrosis, whose abdominal CT scan showed a tumour in the retroperitoneal space pressing on the ureter. Based on histopathological examination and laboratory tests, the patient was diagnosed with idiopathic retroperitoneal fibrosis, most likely related to IgG4. After diagnosis, the patient was initially treated in the urology department for urinary retention and then received treatment with glucocorticosteroids, according to the treatment guidelines for IgG4-dependent disease. [ABSTRACT FROM AUTHOR]

Renal infarction is a rare pathology, which can be life-threatening for the kidney. Its low incidence and non-specific clinical manifestations make it difficult to diagnose, often resulting in delayed or misdiagnosis. Contrast-enhanced CT has a role to play in early positive diagnosis, enabling rapid and effective management. We report the case of a right renal infarction simulating renal colic, with a review of the literature.

Purpose: To evaluate whether computer program-estimated urolith stone volume (SV) was a better predictor of spontaneous passage (SP) compared with program-estimated stone diameter (PD) or manually measured stone diameter (MD), and whether utilizing SV and MD together provided additional value in SP prediction compared with MD alone. Materials and Methods: Retrospective analysis of patients with acute renal colic and single renal/ureteral stone on CT from July 2017 to April 2020. Diameter obtained from radiology reports or manually measured when report not available. Semiautomated stone analysis software (qSAS) was used to estimate SV and PD. ROC analysis was performed to compare accuracy of SV vs MD vs PD in predicting SP by 2, 4, and 6 weeks. Subgroup analysis was performed by stone size (

Abstract To explore the preference for diagnosing and treating renal colic during pregnancy among Chinese urologists. A questionnaire was designed using the Sojump® platform. WeChat, the largest social networking platform in China, was used to distribute the questionnaire to urologists at hospitals of all levels in China. In total, 110 responses were included. Of the respondents, 100.0% used ultrasound to diagnose renal colic during pregnancy, followed by magnetic resonance imaging (17.3%) and low-dose CT (3.6%). Phloroglucinol (80.9%) and progesterone (72.7%) were the most commonly used antispasmodics and analgesics. Opioid analgesics were not commonly used (12.7%). Most of the respondents (63.6%) indicated that no more than 20% of the patients needed surgical intervention. If surgery was unavoidable, 95.5% preferred temporary renal drainage, including ureteral stenting (92.7%) and percutaneous nephrostomy (2.7%). However, some respondents still preferred definitive stone treatment, such as ureteroscopy lithotripsy (3.6%) and percutaneous nephrolithotomy (0.9%). Moreover, there were no differences in the choices of urologists with different professional titles regarding diagnostic tools, most therapeutic medications, or surgical methods (p > 0.05). Ultrasound is the preferred tool for diagnosing renal colic during pregnancy. Low-dose CT is still not widely accepted. Pregnant patients with renal colic are initially treated conservatively. Urologists prefer ureteral stenting when there are clinical indications for intervention.

Objectives: The objective of the study was to evaluate hematuria as a diagnostic test for renal and ureteral stones compared with a noncontrast-enhanced computed tomography (CT) scan (gold standard test) in emergency room patients with acute flank pain. Patients and Methods: In total, 604 patients treated in our emergency department from 2006 to 2011, with a history of flank pain and suspected urolithiasis were included in a retrospective review. All patients were evaluated with a noncontrast-enhanced CT scan and urine analysis. Using the noncontrast CT scan as the gold standard for the evaluation of the presence, number, size, and site (renal or ureteral [upper, middle, and lower]) of the stones, we calculated the sensitivity, specificity, and positive and negative predictive values of hematuria for diagnosing both renal and ureteral stones. Results: Urolithiasis was diagnosed in 388 patients (64%) and 216 patients (36%) had no stones on a noncontrast-enhanced CT scan. The sensitivity, specificity, positive predictive value, and negative predictive value for microhematuria were 77%, 33%, 67%, and 45%, respectively. Microhematuria was more common in patients with ureteral stones only (139 patients) and had a sensitivity of 85% compared to patients with renal stones only (32 patients), with a sensitivity of 55% (P < 0.001). There were no significant differences in the specificity or positive or negative predictive values. Conclusion: Although microhematuria is more sensitive to ureteral stones, the absence of microhematuria does not exclude the possibility of urolithiasis and a noncontrast-enhanced CT scan should be the gold standard diagnostic tool.