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Retrograde intrarenal surgery (RIRS) is recognized as an effective intervention for renal stones measuring less than 20 mm. This study aims to assess the efficacy and safety of a novel flexible kidney-fixed position compared to the conventional lithotomy position, focusing on lithotripsy efficiency and stone-free rates (SFR). A total of 100 patients undergoing unilateral RIRS between January 2023 and September 2024 were randomly allocated to either the conventional lithotomy position group or the kidney-fixed position group. Comparative analyses were conducted on demographic data, stone characteristics, intraoperative parameters, kidney movement metrics, and postoperative complications. A total of 97 patients successfully completed the study, with 47 participants assigned to the conventional lithotomy group and 49 to the kidney-fixed group. The kidney-fixed position was associated with a significant reduction in kidney movement (4.00 mm compared to 15.30 mm, p < 0.001) and a decrease in operative time (48.35 min versus 71.72 min, p < 0.001). Additionally, the SFR for stones measuring ≤ 4 mm was significantly higher in the kidney-fixed group (91.84% compared to 68.09%, p = 0.020). The implementation of a flexible kidney-fixed position markedly improves the efficacy of lithotripsy during RIRS, resulting in reduced operative time and an elevated SFR without a corresponding increase in postoperative complications. This technique holds promise for advancing the surgical management of renal calculi, warranting further investigation to substantiate these findings and assess long-term outcomes. [ABSTRACT FROM AUTHOR]

Objective: This study aims to identify the risk factors for systemic inflammatory response syndrome (SIRS) after minimally invasive percutaneous nephrolithotomy (PCNL) with a controlled irrigation pressure and to find which patients undergoing PCNL are likely to develop SIRS under the pressure-controlled condition. Methods: A total of 303 consecutive patients who underwent first-stage PCNL in our institute between July 2016 and June 2018 were retrospectively reviewed. All the procedures were performed with an 18 F tract using an irrigation pump setting the irrigation fluid pressure at 110 mmHg and the flow rate of irrigation at 0.4 L/min. SIRS and sepsis were recorded after PCNL. The demographic data, clinical features, and test results were analyzed. Results: 52 patients (17.2%) developed SIRS and only 3 patients (0.99%) further progressed to severe sepsis. The results of univariate analysis showed that the stone size, operative time, history of DM, the value of glycosylated hemoglobin, history of ipsilateral surgery, preoperative urine culture, Staghorn calculi, pelvic urine culture, stone culture, number of tracts, blood transfusion, and residual stones were found to have a significant correlation with post-PCNL SIRS (p < 0.05). In multivariate analysis, the stone size (OR = 3.743, p = 0.012), preoperative urine culture (OR = 2.526, p = 0.042), pelvic urine culture (OR = 13.523, p < 0.001), the number of access tracts (OR = 8.945, p = 0.002), blood transfusion (OR = 26.308, p < 0.001) were identified as the independent risk factors for post-PCNL SIRS. Conclusion: The stone size (>4cm2), positive preoperative urine culture, positive pelvic urine culture, multiple tracts, receipt of a blood transfusion are the independent risk factors for SIRS under the pressure-controlled condition. More attention should be paid when the PCNL patients have these risk factors. [ABSTRACT FROM AUTHOR]

The purpose of this study is to address the gap in the existing literature regarding the risk factors for systemic inflammatory response syndrome (SIRS) in patients with a solitary kidney who undergo percutaneous nephrolithotomy (PCNL).This retrospective study reviewed the clinical data of 51 patients with solitary kidney stones who underwent PCNL from January 2018 to January 2024.The study evaluated demographic information, stone characteristics, and laboratory data. Among the 51 patients evaluated, 12 (23.5%) developed SIRS. Multivariate analysis showed that a high urinary white blood cell count (p = 0.041; OR, 1.004; 95% CI, 1.000-1.008), prolonged operation time (p = 0.040; OR, 1.054; 95% CI, 1.005–1.107), and postoperative blood leukocyte count (p = 0.031; OR, 1.459; 95% CI, 1.020–2.061) were independent risk factors for SIRS after PCNL in patients with a solitary kidney. Given the unique physiological conditions of patients with solitary kidneys, who face a higher incidence of kidney stones and have lower risk tolerance, the results of this study provide insights into the risk factors for SIRS after PCNL in these patients. By identifying these factors, clinicians can better stratify risk, implement preventive and therapeutic measures in a timely manner, reduce the risk of SIRS, and improve overall patient outcomes. [ABSTRACT FROM AUTHOR]

Bacterial biofilms, structured communities of microorganisms enmeshed in an extracellular matrix, have emerged as significant players in various pathological processes. Renal calculi, commonly known as kidney stones, pose a prevalent medical concern, and recent research has highlighted the potential influence of bacterial biofilms in their formation and persistence. This review explores the development of biofilms on the surface of urinary tract stones and how they create a favorable environment for the colonization of bacteria. This colonization, in turn, can lead to chronic infections, stone enlargement, and recurrent stone formation. This review offers a comprehensive exploration of the dynamic interplay between bacterial biofilms and renal calculi. It emphasizes the role of biofilm-related mechanisms in chronic infections, inflammation, and mineral deposition, underscoring the potential for innovative therapeutic strategies aimed at managing and preventing biofilm-associated renal calculi. [ABSTRACT FROM AUTHOR]

To investigate the role of the intestinal bacterial microbiota in the pathogenesis of calcium oxalate nephrolithiasis in cats, a condition characterized by the formation of kidney stones, it is desirable to identify a sample collection method that accurately reflects the microbiota's composition. The objective of this study was to evaluate the impact of fecal sample collection methods on the intestinal microbiota composition in two cat populations: healthy cats and kidney stone-diseased cats. The study included eighteen cats from the same colony, comprising nine healthy cats and nine cats with spontaneously occurring presumed calcium oxalate kidney stones. Three fecal collection methods were compared: rectal swabs, the collection of fresh stool, and the collection of stool exposed to ambient air for 24 h. The bacterial microbiota was analyzed through the high-resolution sequencing of the V3–V4 region of the 16S rRNA gene. For all cats, within the same individual, a one-way PERMANOVA analysis showed a significant difference between the rectal swabs and fresh stool (p = 0.0003), as well as between the rectal swabs and stool exposed to ambient air for 24 h (p = 0.0003), but no significant difference was identified between the fresh stool and non-fresh stool (p = 0.0651). When comparing the two populations of cats, this study provides seemingly conflicting results. (1) A principal component analysis (PCA) comparison revealed a significant difference in the bacterial composition between the healthy cats and the cats with kidney stones only when the sample was a fresh fecal sample (p = 0.0037). This finding suggests that the intestinal bacteria involved in the pathogenesis of kidney stones in cats are luminal and strictly anaerobic bacteria. Consequently, exposure to ambient air results in a loss of information, preventing the identification of dysbiosis. For clinical studies, non-fresh stool samples provided by owners does not appear suitable for studying the gut microbiota of cats with kidney stones; fresh stool should be favored. (2) Interestingly, the rectal swabs alone highlighted significant differences in the proportion of major phyla between the two populations. These findings highlight the critical importance of carefully selecting fecal collection methods when studying feline gut microbiota. Combining rectal swabs and fresh stool sampling provides complementary insights, offering the most accurate understanding of the gut microbiota composition in the context of feline kidney stone pathogenesis. [ABSTRACT FROM AUTHOR]

Purpose: This study aims to evaluate the efficacy of tip-flexible suctioning ureteral access sheath (TFS-UAS) compared to traditional ureteral access sheath (T-UAS) in flexible ureteroscopic lithotripsy (FURL) for unilateral upper urinary tract calculi. Methods: The study retrospectively compared outcomes from 103 cases using TFS-UAS and 138 using T-UAS treated with FURL for unilateral upper urinary tract calculi from January to October 2023. Assessed parameters included patient demographics, stone characteristics, preoperative urine cultures, ureteral pre-stenting, comorbidities, procedure time, stone-free rate (SFR), utilization of stone retrieval baskets, and postoperative Systemic Inflammatory Response Syndrome (SIRS) rates. The maximum angle of deflection was also measured when the flexible ureteroscope was located in different parts of the TFS-UAS with different diameters in vitro. Results: The TFS-UAS group achieved a higher Immediate SFR (76.70% vs. 63.77%, p = 0.031) and final SFR (89.32% vs. 73.91%, p = 0.003) than the T-UAS group, especially in the lower calyx stones (80.00% vs. 41.18%, p = 0.018) and upper urinary tract calculi with a cumulative diameter of 2 cm or larger (68.97% vs. 42.11%, p = 0.029). Notably, TFS-UAS with a 10 French (F) inside diameter size achieved a higher SFR (88.57% vs. 70.59%, p = 0.041) and a greater deflection angle than the 12.5 F inside diameter size. No significant variations were observed in the operative duration, hospitalization duration and the occurrence of SIRS between the compared cohorts. Conclusion: TFS-UAS significantly improves SFR in FURL treatment of unilateral upper urinary tract calculi, particularly for stones located in the lower calyx or with a cumulative diameter of 2 cm or greater, compared to T-UAS. [ABSTRACT FROM AUTHOR]

Abstract Objective This study aims to identify the risk factors for systemic inflammatory response syndrome (SIRS) after minimally invasive percutaneous nephrolithotomy (PCNL) with a controlled irrigation pressure and to find which patients undergoing PCNL are likely to develop SIRS under the pressure-controlled condition. Methods A total of 303 consecutive patients who underwent first-stage PCNL in our institute between July 2016 and June 2018 were retrospectively reviewed. All the procedures were performed with an 18 F tract using an irrigation pump setting the irrigation fluid pressure at 110 mmHg and the flow rate of irrigation at 0.4 L/min. SIRS and sepsis were recorded after PCNL. The demographic data, clinical features, and test results were analyzed. Results 52 patients (17.2%) developed SIRS and only 3 patients (0.99%) further progressed to severe sepsis. The results of univariate analysis showed that the stone size, operative time, history of DM, the value of glycosylated hemoglobin, history of ipsilateral surgery, preoperative urine culture, Staghorn calculi, pelvic urine culture, stone culture, number of tracts, blood transfusion, and residual stones were found to have a significant correlation with post-PCNL SIRS (p 4cm2), positive preoperative urine culture, positive pelvic urine culture, multiple tracts, receipt of a blood transfusion are the independent risk factors for SIRS under the pressure-controlled condition. More attention should be paid when the PCNL patients have these risk factors.

Abstract Background Symmetric dimethylarginine (SDMA), a sensitive biomarker for detecting renal injury, has not been characterized in goats. Obstructive urolithiasis (OU) is the most common urinary tract disease in male small ruminants. Hypothesis/Objective Establish an SDMA reference interval (RI) in healthy adult goats and describe SDMA concentrations in goats with OU. We hypothesize that the SDMA RI in healthy adult goats will be similar to that of other adult veterinary species and that SDMA can be utilized to assess the renal function of goats experiencing OU. Animals Fifty‐five healthy adult male and female goats from a university herd were enrolled for SDMA RI development. Twenty male and female goats from a university herd were enrolled for validation of the SDMA RI established. Thirteen male goats diagnosed with OU were enrolled. Methods Clinical trial. Serum samples for all animals enrolled were collected and analyzed for SDMA using an immunoassay (IDEXX Laboratories, Inc); goats with OU had additional blood work analyzed (PCV, total solids, and serum biochemistry). Symmetric dimethylarginine and other values in goats with OU were analyzed and compared at specific time points. Results The SDMA RI for healthy, adult goats is 8.03 μg/dL (90% CI 4.81‐11.04) to 25.93 μg/dL (90% CI 22.88‐28.97). There was no correlation identified between serum creatinine and SDMA in goats with OU. Conclusions and Clinical Importance The SDMA RI for adult goats is higher than in other adult large animal species. Use of SDMA in goats with OU is not useful in assessing their renal function.

INTRODUCTION: Renal disorders are becoming increasingly common today. There is a clear correlation between social and economic deprivation and the advancement of many kidney illnesses, as well as premature death. OBJECTIVE: The objective is to reveal trends in the prevalence of renal diseases among the population below the poverty line (BPL) using the Karnataka method. METHODS: The current study is based on the data available on the government-managed website containing details about people who received treatment for several renal diseases under various government health insurance schemes by the BPL population from 2010 to 2020 in Karnataka state, South India. RESULTS: Renal calculi, enlarged prostate, and bladder calculus are the most common renal disorders among BPL communities in the age group of 20–40 years. Regarding renal calculi, there is a consistent increase in cases from 563 in 2010–2011 to a peak of 3901 in 2020–2021, indicating a continuous upward trend. Fluctuations are observed in the case of an enlarged prostate, with variations in the number of cases each passing year. Bladder calculus disease also shows an increasing trend, particularly evident from 2017 to 2018 onward. CONCLUSION: This study found the potential relationship between socioeconomic status and renal diseases among individuals in the BPL segment of Karnataka state. Renal disorders such as calculi, renal failure, and chronic kidney disease exhibit a rising trend over time, whereas diseases such as enlarged prostate and bladder calculus display fluctuations. The findings underscore the urgent necessity for targeted healthcare interventions and awareness programs tailored to BPL communities.

AIM: Urolithiasis is the most prevalent urinary tract disease, posing a global public health concern. The escalating prevalence and recurrence rates of urolithiasis are attributed to lifestyle modifications, such as reduced physical activity and dietary habits. This retrospective study aims to explore the risk factors associated with urolithiasis among individuals diagnosed with this condition. Method: A retrospective hospital-based study involving 60 participants meeting the inclusion criteria was conducted. The participants were selected through convenience sampling from the urology, nephrology, and medical wards at Saveetha Medical College and Hospital. Demographic variables were collected, and the risk factors were assessed using a checklist on one-to-one interviews. Results: The study unveiled that most participants (68%) were male. Eighty percent of participants had the risk factor of decreased water intake, 74% consumed excess tomatoes, 56% had a history of recurrent urinary tract infections, 64% consumed an excessive amount of salt daily, 72% experienced a decreased urine output, 53% had a habit of alcohol consumption, and 45% included milk and milk products in their daily diet. A small percentage (5%) had a family history of urolithiasis. Additionally, 6% were undergoing Siddha treatment. Conclusion: The findings from this study underscore the significant factors contributing to urolithiasis. They can inform public health campaigns to raise awareness about lifestyle modifications, dietary changes, and hydration protocols contributing to kidney stone formation.

Urolithiasis is the most prevalent benign urological condition, imposing a significant burden on morbidity, disability, and healthcare costs globally. Despite its impact, comprehensive bibliometric analyses of randomized clinical trials (RCTs) related to urolithiasis, which are essential for advancing evidence-based medical practices, are lacking. This study aimed to examine the global research landscape and trends in RCTs focused on urolithiasis. This study used bibliometric techniques to analyze a selection of RCTs on urolithiasis published between 1979 and 2023. VOSviewer software version 1.6.20 was used to visualize international collaborations and perform a keyword analysis of the included articles. The main objective was to identify key research areas and focal points within the field of urolithiasis RCTs. Between 1979 and 2023, a comprehensive search identified 16,716 research articles on urolithiasis. A total of 693 relevant RCTs were found in the Scopus database. The number of publications has significantly increased over time, indicating a strong positive correlation (R² = 0.9303; P < 0.001). China was the top contributor, with 166 publications (23.95%), followed by the United States, with 130 publications (18.76%). Turkey and Iran contributed 44 (6.35%) and 62 (8.95%) publications, respectively. Citation analysis revealed an average of 28.13 citations per article, an h-index of 70, and a total of 19,493 citations. The co-occurrence analysis highlighted current research trends and key topics in urolithiasis RCTs, including 'comparative effectiveness of surgical and laser techniques and patient outcomes', 'medical expulsive therapy (MET) for ureteral calculi and clinical outcomes', 'systematic reviews and meta-analyses of RCTs investigating urolithiasis', and 'dietary interventions and correlations between stone composition and the risk of recurrence.' The bibliometric analysis provides an overview of research on urolithiasis RCTs. It examines global research trends and identifies new developments in the field. Our review identified key research themes, including systematic reviews and meta-analyses, dietary interventions, medical therapy for the expulsion of ureteral stones, and comparisons of surgical techniques—areas that will remain focal points in future research. This bibliometric analysis is an invaluable resource for researchers, clinicians, and policymakers, providing a complete overview of past and present research trends. Informed decision making can be promoted and guided in future research, ultimately improving management and understanding. [ABSTRACT FROM AUTHOR]

Purpose: This study aims to evaluate the clinical efficacy of using a tip‑flexible suctioning ureteral access sheath (TFS-UAS) in combination with a traditional ureteral access sheath (T-UAS) and a disposable flexible ureteroscope (DFU) for treating large renal stones (2–4 cm in diameter). Methods: We retrospectively collected clinical data from 238 patients who underwent retrograde intrarenal surgery (RIRS) at Ganzhou People's Hospital between January 2019 and October 2023. The study included 238 patients who met the inclusion criteria, with 125 in the observation group using TFS-UAS and 113 in the control group using T-UAS. We compared differences in the stone-free rate (SFR), complication rates, surgery duration, and average hospital stay between the two groups. Results: All 238 surgeries were successfully completed. The stone-free rates for the observation group at the first and thirtieth day post-surgery were 87.20% and 95.20%, respectively, whereas for the control group, the rates were 73.45% and 85.84%, showing statistically significant differences (P < 0.05). The overall complication rates were 1.6% for the observation group and 14.16% for the control group, also statistically significant (P < 0.001). The surgical times for stone removal were (101.17 ± 25.64) minutes for the observation group and (86.23 ± 20.35) minutes for the control group, with significant differences (P < 0.05). Conclusion: Compared to T-UAS, combining TFS-UAS with DFU for treating renal stones of 2–4 cm diameter, although more time-consuming, resulted in higher SFRs and improved safety. [ABSTRACT FROM AUTHOR]

Background: Symmetric dimethylarginine (SDMA), a sensitive biomarker for detecting renal injury, has not been characterized in goats. Obstructive urolithiasis (OU) is the most common urinary tract disease in male small ruminants. Hypothesis/Objective: Establish an SDMA reference interval (RI) in healthy adult goats and describe SDMA concentrations in goats with OU. We hypothesize that the SDMA RI in healthy adult goats will be similar to that of other adult veterinary species and that SDMA can be utilized to assess the renal function of goats experiencing OU. Animals: Fifty‐five healthy adult male and female goats from a university herd were enrolled for SDMA RI development. Twenty male and female goats from a university herd were enrolled for validation of the SDMA RI established. Thirteen male goats diagnosed with OU were enrolled. Methods: Clinical trial. Serum samples for all animals enrolled were collected and analyzed for SDMA using an immunoassay (IDEXX Laboratories, Inc); goats with OU had additional blood work analyzed (PCV, total solids, and serum biochemistry). Symmetric dimethylarginine and other values in goats with OU were analyzed and compared at specific time points. Results: The SDMA RI for healthy, adult goats is 8.03 μg/dL (90% CI 4.81‐11.04) to 25.93 μg/dL (90% CI 22.88‐28.97). There was no correlation identified between serum creatinine and SDMA in goats with OU. Conclusions and Clinical Importance: The SDMA RI for adult goats is higher than in other adult large animal species. Use of SDMA in goats with OU is not useful in assessing their renal function. [ABSTRACT FROM AUTHOR]

Objective: To compare the efficacy and safety of Extracorporeal Shock Wave Lithotripsy (ESWL) for treating renal calculi under different shock wave pathways. Methods: This study involved a prospective analysis of clinical data obtained from 264 eligible patients with renal stones treated at the Urology Department of Shanxi Bethune Hospital between January 2021 and June 2023. Among these patients, 125 underwent ESWL via the dorsal shock wave pathway (Group A), while 139 patients underwent ESWL via the ipsilateral clavicular midline shock wave pathway (Group B). Preoperatively, all patients underwent non-contrast abdominal CT (NCCT) scans to assess stone count, diameter, CT values, and Skin-to-Stone Distance (SSD). Intraoperatively, ultrasonography was utilized to remeasure SSD and monitor stone fragmentation continuously. The ESWL procedure employed a standardized intermittent stepwise energy escalation technique until treatment completion. Various metrics, including intraoperative Visual Analog Scale (VAS) pain scores, number of shocks, total shock wave energy, stone-free rate (SFR) at 4 weeks post-operation, and postoperative complication rates, were recorded and subjected to statistical analysis. Results: There were no statistically significant differences between the two groups regarding gender, age, BMI, stone count, stone diameter, stone CT values, intraoperative VAS pain scores, and postoperative complication rates (P>0.05). Preoperative SSD was significantly higher in Group B than in Group A (P<0.05), but there were no significant differences in intraoperative SSD between the groups (P>0.05). Group B showed significantly lower total shock wave energy and number of shocks compared to Group A (P<0.05). The stone-free rate (SFR) after 4 weeks did not exhibit significant differences between the groups (P>0.05). However, when the stone diameter was ≥1.3 cm, the SFR at 4 weeks post-operation in Group B was significantly higher than in Group A (P<0.05). Conclusion: ESWL emerges as a safe and efficacious approach for treating renal calculi. Our findings suggest that utilizing the ipsilateral clavicular midline shock wave pathway in ESWL necessitates less shock wave energy and enhances efficiency, particularly in cases with larger stone burdens. [ABSTRACT FROM AUTHOR]

ABSTRACT: Aim: Urolithiasis is the most prevalent urinary tract disease, posing a global public health concern. The escalating prevalence and recurrence rates of urolithiasis are attributed to lifestyle modifications, such as reduced physical activity and dietary habits. This retrospective study aims to explore the risk factors associated with urolithiasis among individuals diagnosed with this condition. Method: A retrospective hospital-based study involving 60 participants meeting the inclusion criteria was conducted. The participants were selected through convenience sampling from the urology, nephrology, and medical wards at Saveetha Medical College and Hospital. Demographic variables were collected, and the risk factors were assessed using a checklist on one-to-one interviews. Results: The study unveiled that most participants (68%) were male. Eighty percent of participants had the risk factor of decreased water intake, 74% consumed excess tomatoes, 56% had a history of recurrent urinary tract infections, 64% consumed an excessive amount of salt daily, 72% experienced a decreased urine output, 53% had a habit of alcohol consumption, and 45% included milk and milk products in their daily diet. A small percentage (5%) had a family history of urolithiasis. Additionally, 6% were undergoing Siddha treatment. Conclusion: The findings from this study underscore the significant factors contributing to urolithiasis. They can inform public health campaigns to raise awareness about lifestyle modifications, dietary changes, and hydration protocols contributing to kidney stone formation. [ABSTRACT FROM AUTHOR]

INTRODUCTION: Renal disorders are becoming increasingly common today. There is a clear correlation between social and economic deprivation and the advancement of many kidney illnesses, as well as premature death. OBJECTIVE: The objective is to reveal trends in the prevalence of renal diseases among the population below the poverty line (BPL) using the Karnataka method. METHODS: The current study is based on the data available on the government-managed website containing details about people who received treatment for several renal diseases under various government health insurance schemes by the BPL population from 2010 to 2020 in Karnataka state, South India. RESULTS: Renal calculi, enlarged prostate, and bladder calculus are the most common renal disorders among BPL communities in the age group of 20–40 years. Regarding renal calculi, there is a consistent increase in cases from 563 in 2010–2011 to a peak of 3901 in 2020–2021, indicating a continuous upward trend. Fluctuations are observed in the case of an enlarged prostate, with variations in the number of cases each passing year. Bladder calculus disease also shows an increasing trend, particularly evident from 2017 to 2018 onward. CONCLUSION: This study found the potential relationship between socioeconomic status and renal diseases among individuals in the BPL segment of Karnataka state. Renal disorders such as calculi, renal failure, and chronic kidney disease exhibit a rising trend over time, whereas diseases such as enlarged prostate and bladder calculus display fluctuations. The findings underscore the urgent necessity for targeted healthcare interventions and awareness programs tailored to BPL communities. [ABSTRACT FROM AUTHOR]

Numerous studies have shown that intestinal and urinary tract flora are closely related to the formation of kidney stones. The removal of probiotics represented by lactic acid bacteria and the colonization of pathogenic bacteria can directly or indirectly promote the occurrence of kidney stones. However, currently existing natural probiotics have limitations. Synthetic biology is an emerging discipline in which cells or living organisms are genetically designed and modified to have biological functions that meet human needs, or even create new biological systems, and has now become a research hotspot in various fields. Using synthetic biology approaches of microbial engineering and biological redesign to enable probiotic bacteria to acquire new phenotypes or heterologous protein expression capabilities is an important part of synthetic biology research. Synthetic biology modification of microorganisms in the gut and urinary tract can effectively inhibit the development of kidney stones by a range of means, including direct degradation of metabolites that promote stone production or indirect regulation of flora homeostasis. This article reviews the research status of engineered microorganisms in the prevention and treatment of kidney stones, to provide a new and effective idea for the prevention and treatment of kidney stones.

Background: Determining the risk factors of stone residual is critical in order to assist urologists in determining the potential results of retrograde intrarenal surgery (RIRS) and whether or not the patient will require further intervention following RIRS. Aim: This study aimed to evaluate the efficacy and safety of RIRS for the treatment of renal stones and to analyze the predictive factors for stone-free rates. Methods: This interventional prospective cohort study was conducted over a period of 18-months from July 2021 to January 2023. Two hundred patients suffering from renal stones were chosen from The Outpatient Clinics of Urology Departments, Helwan University Hospitals and Ain Shams University. Stone-free predictive criteria were evaluated. Results: Stone size, number, and location, as well as surgeon's experience, are crucial indicators of how well a treatment will work. Furthermore, it was discovered that the Resorlu-Unsal stone score (RUSS) was a trustworthy method for estimating the possibility of residual stones following RIRS. Conclusion: Surgeons can use predictive factors of stone-free information to more effectively choose patients for RIRS and modify therapy regimens to maximize results. The results further emphasized how crucial it is to perform RIRS procedures with precise technique and close attention to the patient's and the stone's features in order to reduce the possibility of residual stones. [ABSTRACT FROM AUTHOR]

To determine predictors for missing trifecta in patients who underwent flexible ureteroscopy (FURS) for treatment of renal and upper ureteric calculi. The data of adult patients with renal or upper ureteral stones who underwent FURS from June 2021 through December 2022 were retrospectively reviewed. Stone-free status (no residual stones > 3 mm) was evaluated after 3 months with non-contrast CT. Modified Clavien classification was used to grade complications. A stone-free status after a single intervention of FURS without complications was defined as trifecta. Patients were divided into two groups (trifecta and non-trifecta). Risk factors for missing trifecta were compared between both groups using univariate and multivariate analyses. Three hundred twenty-three patients with mean age 48.9 ± 13 years and mean stone length 16 ± 5.9 mm were included. The trifecta criteria were applicable for 250 patients (71%). On multivariate analysis, risk factors for missing trifecta were stone multiplicity (OR: 3.326, 95%CI: 1.933–5.725) and non-experienced surgeons (OR: 1.819, 95%CI: 1.027–3.220). Multiple stones and performance of FURS by non-experienced surgeons are the independent risk factors for missing trifecta of FURS. [ABSTRACT FROM AUTHOR]

Introduction/Objective: Graft stones in renal transplant recipients pose a unique challenge, finding effective interventions to ensure optimal graft function and patient well-being. Various methods of stone clearance have been described for graft stones, including percutaneous nephrolithotomy (PCNL). While PCNL is a promising approach for managing graft stones, specific outcomes and associated characteristics for this approach have not been comprehensively evaluated before. This study aims to evaluate the safety and efficacy of the use of PCNL as the primary intervention of graft stones by assessing stone-free rates (SFR), treatment impact on graft function, and perioperative complications. Methods: A retrospective clinical audit was performed for all transplants performed in a single center from 2007 to 2022, which included all graft lithiasis patients who were treated with PCNL. Both perioperative parameters and post-operative outcomes were collected. In addition, a systematic review including articles from MEDLINE, Embase, Web of Science yielded 18 full-text articles published between 1/1/2000 and 15/11/2023. The results pertaining to patients who underwent PCNLs for graft stones were cross-referenced and thoroughly evaluated. The review encompassed a comprehensive analysis of clinical data, postoperative outcomes, and procedural details. The protocol for the systematic review was prospectively registered on PROSPERO (CRD42023486825). Results: In our center, 6 graft lithiasis patients were treated with PCNL. The initial SFR was 83.3%. SFR at 3 months and 1 year were both 100.0%. SFR at 3 years was 66.7%. Other centers reported initial SFR of 82.6–100.0% (interquartile range). SFR at 3 months, 1 year, 3 years was not well reported across the included studies. Incidence of graft lithiasis ranged from 0.44%-2.41%. Most common presentations at diagnosis were oliguria/anuria/acute kidney injury and asymptomatic. Reported complications included blood loss, transient hematuria, high urine output, sepsis, and damage to surrounding structures. The most commonly reported metabolic abnormalities in transplant lithiasis patients included hyperuricemia and hyperparathyroidism. Conclusion: PCNL is a practical and efficient choice for addressing graft lithiasis, demonstrating excellent stone clearance and minimal perioperative complications. These findings show the importance of PCNL as a primary intervention in this complex patient population. [ABSTRACT FROM AUTHOR]

Background: Crystallization experiments of renal-calculi-forming compounds (calcium oxalate, calcium phosphates, uric acid) are normally performed by monitoring these processes during periods of time similar to the residence of urine inside the kidney. Nevertheless, cystine requires high supersaturation for its crystallization, and most experiments last for longer periods. It must be considered that at high supersaturation, the inhibitors of crystalline development have poor effects. Methods: The induction time of crystallization (ti) of cystine in experimental conditions similar to those of the formation of cystine renal calculi and the effect of different cystine-binding thiol agents was determined through turbidimetric measurements. We also studied the macro- and microstructure of 30 cystine kidney stones through stereoscopic microscopy and scanning electron microscopy. Results: Under the studied conditions, the ti in absence of crystallization inhibitors was 15 min, and the presence of 9 mM of penicillamine, tiopronin, or N-acetylcysteine totally inhibited crystallization, as their effects relate to the formation of complexes with cystine, although N-acetylcysteine also delayed cystine crystalline development and modified cystine crystal morphology. Cystine stones have traditionally been classified as smooth and rough. The study of their structure shows that all of them begin their formation from a few crystals that generate a compact radial structure. Their subsequent growth, depending on the renal cavity where they are located, gives rise to the rough structure in the form of large blocks of cystine crystals or the smooth structure with small crystals. Conclusions: To prevent the development of cystine renal stones, the formation of small crystals must be avoided by reducing urinary cystine supersaturation, with N-acetylcysteine being the most effective among the studied cystine-binding thiol agents. Also, the removal of cystine crystals through increased water intake and physical activity can be a very important preventive measure. [ABSTRACT FROM AUTHOR]

Background: Limited data have explored the efficacy of super-mini percutaneous nephrolithotomy (SMP) and retrograde intrarenal surgery (RIRS) in managing ≤2 cm renal calculi. This study aims to comprehensively evaluate the safety and effectiveness of SMP compared with RIRS. Methods: This prospective cohort study investigated 210 patients with renal calculi (≤2 cm) undergoing SMP or RIRS, randomly recruited over 4 years. In total, 51.4% underwent SMP and 48.6% underwent RIRS. Results: The mean patient age was 31.3 ± 14.7 years; 56.7% were men, mean stone size of 1.3 ± 0.28 cm, and stone hardness of 1190.1 ± 352.83 Hounsfield units. Pearson's correlation indicated negative correlations for SMP with hospital stays (r = −0.138, p = 0.046), operating time (r = −0.519, p < 0.001), and stone-free rate (SFR) (r = −0.161, p = 0.020); and a positive correlation with a postoperative ureteral catheter (r = +0.389, p < 0.001). With regard to RIRS, the study shows a positive correlation with hospital stay (r = +0.138, p = 0.046), operating time (r = +0.519, p < 0.001), and SFR (r = +0.161, p = 0.020); and a negative correlation with postoperative ureteral catheter (r = −0.389, p < 0.001). Logistic regression, using SMP as the reference, RIRS was associated with β = +0.31, and 1.20 (95% confidence interval [CI], 1.14–1.27, p ≤ 0.001) risk of operation duration and β = +0.37, 1.44 (95% CI, 1.00–2.07, p = 0.047) risk of longer hospital stay. Conclusion: This study investigates the suitability of SMP and RIRS for treating renal calculi ≤2 cm. SMP demonstrated superior efficacy with significantly shorter operating times and reduced hospital stays, suggesting potential advantages for managing lower volume renal stones. [ABSTRACT FROM AUTHOR]

Objective: To report the initial results of an randomized clinical trail comparing the safety and efficacy between 7.5F and 9.2F flexible ureteroscope (FUS) in the management of renal calculi <2 cm. Materials and Methods: Eighty patients were enrolled and received retrograde intrarenal surgery (RIRS) with a different size FUS. The operation results and complications were compared. Results: Two cases in the 7.5F group and four cases in the 9.2F group failed to insert the 12/14F ureteral access sheath (UAS), respectively, and no significant difference (p = 0.396) was noted. However, 10/12F UAS was inserted in the 7.5F group, but not available in the 9.2F group, and thus, the 10/12F UAS inserting rate in the 7.5F group was higher than in the 9.2F group (100% vs 0%, p = 0.014), and the UAS insertion failure rate in 9.2F group was higher than in the 7.5F group (10% vs 0%, p = 0.040). The operation time in 7.5F group was shorter than the 9.2F group (35.60 ± 7.86 vs 41.05 ± 8.14, p = 0.003). Less irrigation was required in 7.5F group (813.93 ± 279.47 mL vs 1504.18 ± 385.31 mL, p = 0.000). The postoperative fever rate in 9.2F group was higher than 7.5F group (20% vs 5%, p = 0.043). There was no significant difference in sepsis (0% vs 2.5%, p = 0.314) between the two groups. No significant difference was noted in hospital stay (0.93 ± 0.49 days vs 1.14 ± 0.64 days, p = 0.099) between the two groups. The final stone-free rate (SFR) in 7.5F group was higher than 9.2F group (95% vs 80%, p = 0.043). Conclusion: The latest 7.5F mini FUS was a reliable instrument in RIRS to keep a good visualization with low requirement of irrigation, low postoperative infection complication, and also a high SFR when compared with the conventional 9.2F FUS. Clinical Trial Registration: NCT05231577. [ABSTRACT FROM AUTHOR]

Background: Hemorrhage is a significant complication associated with mini-percutaneous nephrolithotomy (mini-PCNL). CT angiography (CTA) has emerged as a valuable tool for preoperative assessment of renal vasculature, potentially reducing the risk of hemorrhage during the procedure. Materials and methods: A retrospective analysis was conducted on 100 patients who underwent mini-PCNL for renal calculi between January 2020 and December 2022. Preoperative CTA was performed on all patients to assess renal vascular anatomy. The degree of renal vascularization and presence of aberrant vessels were noted. Mini-PCNL procedures were then performed according to standard techniques. Results: Of the 100 patients, 25 (25%) exhibited aberrant renal vascular anatomy on CTA. The presence of aberrant vessels was associated with a significantly higher risk of intraoperative hemorrhage (p < 0.05). However, among patients with normal renal vascular anatomy, the incidence of hemorrhage was significantly lower. Additionally, patients with aberrant vessels required longer operative times and had higher rates of postoperative complications. Conclusion: Preoperative assessment with CTA provides valuable insights into renal vascular anatomy, allowing for the identification of aberrant vessels that may predispose patients to intraoperative hemorrhage during mini-PCNL. Incorporating CTA into the preoperative workup can aid in surgical planning and risk stratification, potentially reducing the incidence of hemorrhage and improving procedural outcomes. [ABSTRACT FROM AUTHOR]

Background: Kidney stones account for a high proportion of urological emergencies. The main objective of this paper is to evaluate the predictive ability of five scoring systems for overall stone-free status and postoperative complications after percutaneous nephrolithotomy and retrograde ureteroscopy. Materials and methods: This study retrospectively analysed 312 cases of kidney stone patients between January 2021 and May 2022 at our centre. Multivariate logistic regression as well as ROC curves were applied to determine the ability to evaluate each scale to predict stone-free rates and postoperative complications. Results: 179 patients have undergone PCNL. After multivariate logistic regression, the S.T.O.N.E score and history of ipsilateral renal surgery were predictive of stone-free status, and the predictive power of the S.T.O.N.E score was higher than that of history of ipsilateral renal surgery. Grade 1 complications were considered to be related to Guy's score and grade 2 complications were considered to be related to history of diabetes mellitus. 133 patients have undergone f-URS. After multivariate logistic regression analysis, the modified S-ReSC score, RUSS score, and R.I.R.S score were predictive of stone-free status, with the R.I.R.S score being the strongest predictor. Evidence of grade 2 complications was considered to be related to abnormal renal function. Conclusion: For PCNL, the S.T.O.N.E score had the best efficacy in predicting stone-free status, and the Guy's score had the best efficacy in predicting postoperative complications; for f-URS, the R.I.R.S score had the best efficacy in predicting stone-free status, and no scoring system predicted postoperative complications. [ABSTRACT FROM AUTHOR]

Abstract Background To analyze preoperatively the composition of renal calculi using dual-energy computed tomography (DECT) and compare it with reference standard biochemical stone analysis. Methods Eighty-one participants who were diagnosed with renal calculi underwent DECT at 80 kVp and 140 kVp. Spectral analysis was performed, and the energy map generated was used to classify the calculus based on available preset data. Average Hounsfield units (HU) were calculated for the two energy levels, and ratio of HU was derived (DE ratio) and calculus was categorized into different stone compositions. Hounsfield units of each calculus was measured at 120 kVp standard dose CT, and Hounsfield density (HU/largest transverse diameter) was derived. Comparison of results of spectral analysis and DE ratio was done and correlated with the biochemical laboratory analysis as reference standard wherever available. Results Spectral analysis and CT prediction of stone were performed for all 81 patients. CT prediction of stone based on DE ratio into “uric acid,” “struvite,” “calcium oxalate” and “calcium carbonate apatite” was performed. Assessment of stone composition by biochemical analysis was done for 65 patients who eventually underwent PCNL for stone extraction. Both DE ratio and spectral analysis were able to differentiate calculus into various types based on composition with statistically significant p values. However, spectral analysis proved to be marginally better in renal stone characterization particularly for mixed stones. The DE ratio for uric acid stones was derived as 0.9–1.1, 0.9–2.3 for mixed stones and 1.0–2.4 for calcium stones. Conclusions Spectral analysis promises a practical approach to predicting calculus composition preoperatively, thereby avoiding unnecessary surgical intervention.

Objective: To compare fluoroscopy-free retrograde intrarenal surgery (RIRS) with routine RIRS with fluoroscopy for urolithiasis treatment in terms of efficacy and safety. Prospective quasi-experimental study. Hitit University Çorum Erol Olçok Training and Research Hospital, Department of Urology, Çorum, Turkiye August 2019-2020. Materials and Methods: Pre-operative and postoperative data for 98 patients who underwent RIRS using fluoroscopy and 100 patients who underwent RIRS without fluoroscopy were prospectively assessed. Patients who did not provide preoperative consent, were pregnant, or had a clotting disorder, active urinary system infection, or anatomic abnormalities such as ectopic kidney were excluded from the study. In the technique without fluoroscopy, the fluoroscopic device was ready for use in surgery; however, all manipulations were performed by all-seeing access without fluoroscopy. Patients beginning without fluoroscopy who required fluoroscopy were not included in the study. Results: The mean stone size was 18.5±2.31 (5-30) mm (in the fluoroscopy group 17.2±25.3 mm, in the non-fluoroscopy group 19.8±20.9). Stone-free rates were similar between the groups (91% in the fluoroscopy group and 90% in the non-fluoroscopy group) (p=0.683). The mean duration of fluoroscopy use in the fluoroscopy group was 8.76±9.50 s. A Clavien 3b complication (perirenal hematoma) was observed in one patient (in the fluoroscopy group), which regressed with observation. Minor complications were observed in both groups: fever in 7 patients (3.6%), hematuria in 7 patients (3.6%), and steinstrasse in 1 patient (0.5%). Conclusion: Fluoroscopy-free RIRS may be applied effectively and safely by endourologists for patients with urolithiasis, similar to the routine method with fluoroscopy.

To investigate the role of the intestinal bacterial microbiota in the pathogenesis of calcium oxalate nephrolithiasis in cats, a condition characterized by the formation of kidney stones, it is desirable to identify a sample collection method that accurately reflects the microbiota’s composition. The objective of this study was to evaluate the impact of fecal sample collection methods on the intestinal microbiota composition in two cat populations: healthy cats and kidney stone-diseased cats. The study included eighteen cats from the same colony, comprising nine healthy cats and nine cats with spontaneously occurring presumed calcium oxalate kidney stones. Three fecal collection methods were compared: rectal swabs, the collection of fresh stool, and the collection of stool exposed to ambient air for 24 h. The bacterial microbiota was analyzed through the high-resolution sequencing of the V3–V4 region of the 16S rRNA gene. For all cats, within the same individual, a one-way PERMANOVA analysis showed a significant difference between the rectal swabs and fresh stool (p = 0.0003), as well as between the rectal swabs and stool exposed to ambient air for 24 h (p = 0.0003), but no significant difference was identified between the fresh stool and non-fresh stool (p = 0.0651). When comparing the two populations of cats, this study provides seemingly conflicting results. (1) A principal component analysis (PCA) comparison revealed a significant difference in the bacterial composition between the healthy cats and the cats with kidney stones only when the sample was a fresh fecal sample (p = 0.0037). This finding suggests that the intestinal bacteria involved in the pathogenesis of kidney stones in cats are luminal and strictly anaerobic bacteria. Consequently, exposure to ambient air results in a loss of information, preventing the identification of dysbiosis. For clinical studies, non-fresh stool samples provided by owners does not appear suitable for studying the gut microbiota of cats with kidney stones; fresh stool should be favored. (2) Interestingly, the rectal swabs alone highlighted significant differences in the proportion of major phyla between the two populations. These findings highlight the critical importance of carefully selecting fecal collection methods when studying feline gut microbiota. Combining rectal swabs and fresh stool sampling provides complementary insights, offering the most accurate understanding of the gut microbiota composition in the context of feline kidney stone pathogenesis.

Ceftriaxone is widely used in pediatric outpatient care for its efficacy against respiratory and digestive system infections, yet its increasing association with severe immune hemolytic reactions requires heightened vigilance from pediatricians. This report details a rare and severe case of ceftriaxone-induced severe immune hemolytic anemia (IHA), hemolytic crisis, myocardial injury, liver injury, renal calculi, and cholecystolithiasis in a previously healthy 3-year-old child. The child, treated for bronchitis, experienced sudden pallor, limb stiffness, and altered consciousness following the fifth day of ceftriaxone infusion, with hemoglobin (Hb) levels precipitously dropping to 21 g/L. Immediate cessation of ceftriaxone and the administration of oxygen therapy, blood transfusion, intravenous immunoglobulin (IVIG), and corticosteroids led to a gradual recovery. Despite initial improvements, the patient's condition necessitated extensive hospital care due to complications including myocardial injury, liver injury, renal calculi, and cholecystolithiasis. After a 12-day hospital stay and a 3-month follow-up, the child showed complete normalization of Hb and liver function and resolution of calculi. In children, ceftriaxone infusion may trigger severe, potentially fatal, hemolytic reactions. Pediatricians must promptly recognize symptoms such as pallor, limb stiffness, and unresponsiveness, indicative of ceftriaxone-induced severe IHA, and immediately discontinue the drug. Effective management includes timely blood transfusion, respiratory support, IVIG administration, and corticosteroids when necessary, along with rigorous vital signs monitoring. Continued vigilance is imperative, even after cessation of ceftriaxone, to promptly address any residual adverse effects. [ABSTRACT FROM AUTHOR]

Strandings provide valuable information about rare marine organisms and their relationship with their environment. In the southern Gulf of México, specifically on the central coast of Campeche, Mexico, strandings of oceanic cetaceans have rarely been recorded, therefore, biological information has also been scarce. One of such rare stranding cases occurred on September 7, 2022, on the coast of Seybaplaya, Campeche. The specimen was identified as a female of Tursiops truncatus with the morphology features of the oceanic ecotype. The carcass was examined shortly after death, and samples for different analyses were obtained fresh. Tissue samples were collected, and some particular observations were made to define the individual's general health status. Results of the analyses revealed damage in the liver, lungs, and kidneys, probably related to 1) the advanced age of the organism (>35 years), and 2) the presence of persistent organic pollutants. Most importantly, this study contributed two new findings, the first record of the parasite Anisakis and the presence of renal calculi in the oceanic ecotype of T. truncatus in the southern Gulf of Mexico. [ABSTRACT FROM AUTHOR]

Background: Percutaneous nephrolithotomy (PCNL) is a standard procedure to remove and disintegrate large kidney stones. Despite minimal invasiveness, it is associated with significant postoperative pain. Erector spinae plane block (ESPB) is a novel interfacial plane block recently introduced to provide analgesia in acute and chronic pain. The current study was conducted to compare the efficacy of ultrasound (USG) guided ESPB and conventional analgesia (CA) following PCNL. Methodology: After obtaining the institute's ethical committee approval and informed consent, 50 patients were included in the study and were randomized into two equal groups of 25 to receive ESPB with 20 ml of 0.25% bupivacaine or CA. Patients in both groups were given intravenous paracetamol 8th hourly and intravenous tramadol 2mg/kg as rescue analgesia. Results: Both study and control groups were similar in demographic profile. Pain assessment by Visual analogue scale (VAS) scores in the postoperative period were significantly lower at hours of 20min, 40min, and 1,3,6,12 hrs (P<0.0001) and at 9,18 hrs (P<0.05) in the group E, than the control group. The time to first rescue analgesia was observed longer in the ESPB group than in the control group (2.28± 0.58hrs Vs 15.48± 3.17 hrs) (P<0.0001). The average tramadol consumption was less in the ESPB group compared to the control group (139.28±41.36 mg Vs 337.20± 38.66mg) (P< 0.0001). Conclusion: Ultrasound-guided ESPB provides safe and effective postoperative analgesia following PCNL, with decreased VAS scores. ESPB extends the retrieval analgesia time and lessen the requirement for tramadol. [ABSTRACT FROM AUTHOR]

Background: The aim of this study was to evaluate the efficacy and safety of retrograde intrarenal surgery (RIRS) in patients with renal calculi with solitary kidneys (SKs). Materials and Methods: In this retrospective, multicenter study, a matched case–control study was carried out using the data from 522 RIRS patients treated between 2014 and 2021. Patients' demographic data, stone characteristics, operative outcomes, perioperative and postoperative complications, and surgical success were analyzed. All patients were evaluated with noncontrast-enhanced computed tomography (NCCT) preoperatively and 1 month after the surgery. Surgical success was defined as no evidence of remaining residual fragments of <3 mm in the first-month postoperative NCCT images. The case group of 29 patients with SKs (Group 1) treated with RIRS were matched with 76 control patients (Group 2) with bilateral kidneys, who underwent unilateral RIRS by propensity score–matched (PSM) analysis. Results: After PSM analysis, the demographic and clinical data did not differ significantly between the groups. The stone burden was similar between the groups: 733.6 mm3 (range: 50.4–7565.9) versus 991.1 mm3 (range: 201.2–4380.6) (P = .09), respectively. The perioperative complication rates were 13.8% (n = 4) in Group 1 and 11.8% (n = 9) in Group 2 (P = .78). There was no statistically significant difference between the groups for postoperative complication rates (minor complications, classified as Clavien 1 or 2), (6.9% [n = 2] versus 13.2% [n = 10; P = .34]), respectively. Surgical success was 82.8% (n = 24) in Group 1 and 83.6% in Group 2 (P = .92). There was no significant difference between preoperative and postoperative glomerular filtration rate and creatinine values (P = .005). Conclusions: Our results support that RIRS is a safe and effective treatment method in SK patients with similar complication and stone-free rates compared to patients who had bilateral functional kidneys and underwent unilateral RIRS. [ABSTRACT FROM AUTHOR]

Introduction: Kidney stones (renal calculi), are a common urological problem affecting millions worldwide. Madhuca longifolia (M. longifolia), commonly known as Mahua, has a rich history of medicinal use in various traditional systems, including Traditional Chinese Medicine (TCM). This review aims to explore the therapeutic potential of M. longifolia in the management of kidney stones through the lens of TCM. Methods: Examination of the therapeutic efficacy of M. longifolia in the context of TCM for the treatment of kidney stones was undertaken by performing an exhaustive literature review via internet-based databases, such as PubMed, Scopus, and Google Scholar. Keywords such as ''Madhuca longifolia,'' ''Mahua,'' ''kidney stones,'' ''renal calculi,'' ''Pharmacological activity,'' and ''Traditional Chinese Medicine'' were used to ensure the inclusivity of relevant literature. Studies published between 1972 and 2019 were considered. Inclusion criteria were peer-reviewed articles, systematic reviews, focusing on the health impacts of plant-based diets. Information on the subspecies and cultivars of common names and the scientific names was verified using the Plant List (www.theplantlist.org) database. We retrieved and utilised it for the review of 80 articles. Results: The literature review revealed several studies highlighting the potential therapeutic effects of M. longifolia in the management of kidney stones. The bioactive compounds present in M. longifolia, including flavonoids, phenolic compounds, and saponins, exhibit diuretic, anti-inflammatory, and litholytic properties, which contribute to the dissolution and prevention of kidney stones. Furthermore, Madhuca longifolia demonstrates various pharmacognostic activities, reducing the risk of renal damage associated with kidney stone formation. Discussion: Traditional Chinese Medicine recognizes M. longifolia as a valuable botanical resource for the medical management of kidney calculi. It presents a natural and comprehensive strategy for managing the intricacies associated with kidney stones.

Objective: Percutaneous nephrolithotomy (PCNL) is the main method for pyonephrosis or lithotripsy in urology. However, it often comes with high risk, as the inaccurate puncture inevitably causes bleeding, intra- and post-operative complications. So, a new inter-disciplinary approach is needed to perform the puncture more accurately. Methods: 3 signs made of lead were marked onto the skin of the posterior side of the waist of a domestic pig or a patient, which was scanned by computed tomography (CT). Based on the CT images, the computer design and the 3D printing, a navigation template made of the transparent resin material is constructed. They were attached onto the surgical area on pig or patient according to the signs. During the PCNL, with this template, the puncture position, angle and depth were optimized in order to precisely enter the targeted renal pelvis or calices. Results: With the 3D navigation templates, 18G puncture needles were used to enter the renal pelvis upon performing the PCNL on a porcine model and a patient. On the porcine model, the urine outflow was observed with minimal complication. Post-operative CT scans revealed that the needle was located in the renal pelvis. For the patient case, the puncture point was designed to target the calix with stone. No obvious bleeding and complication was found in renal puncture with template. Conclusions: The navigation template was made with the combination of 3D printing, CT images and computer design. This template allows for accurate puncture of the renal pelvis or calix. Surgical improvement in kidney stones and pyonephrosis was observed in porcine model and patient case. In the future, prospective, trandomized, controlled clinical trials are needed to further confirm its advantage.

Introduction: Percutaneous Nephrolithotomy (PCNL) has become the standard of care for large renal calculi. The aim of the surgery is to achieve maximum stone clearance with minimal postoperative complications. Various scoring systems have been described to predict both of these outcomes. S.T.O.N.E. Score and Guy's Stone Score (GSS) are two of the most widely used scoring systems. S.T.O.N.E. Score comprises of Size of the stone, Tract length, degree of Obstruction of the urinary system, Number of stones, and Essence. Aim: To compare the predictive power for stone clearance and postoperative complications of the two scoring systems, namely S.T.O.N.E. Score and GSS. Materials and Methods: This cross-sectional study was conducted at the Department of Genitourinary Surgery at Government Medical College, Kottayam, Kerala, India from March 2019 to August 2020. All patients above 18 years undergoing PCNL were included. A total of 122 patients were studied by calculating the preoperative S.T.O.N.E. Score and GSS and comparing them with post-PCNL stone clearance and complications. The association of both S.T.O.N.E. Score and GSS with stone clearance was estimated by plotting the Receiver Operating Curve (ROC) curve using Statistical Package for Social Sciences (SPSS) version 20, International Business Machines (IBM) SPSS Statistics windows, version 20.0 (Armonk, NY: IBM Corp.). A p-value

Introduction Ureteropelvic junction obstruction is often associated with renal calculus formation. However, there is no report of using robot‐assisted laparoscopic pyeloplasty combined with percutaneous endoscopic surgery for ureteropelvic junction obstruction and renal calculi in a partial duplex system. Case presentation A 19‐year‐old female patient with lower moiety ureteropelvic junction obstruction and renal calculi in a partial duplex system was referred to our hospital because of left lumbar pain, left acute pyelonephritis, and an increase in left renal calculi during follow‐up at the referral hospital. To prevent the complication of percutaneous nephrolithotripsy following pyeloplasty, robot‐assisted laparoscopic pyeloplasty combined with percutaneous endoscopic surgery was performed. Two years after surgery, the patient reported no left lumbar pain. Conclusion The combination of robot‐assisted laparoscopic pyeloplasty and percutaneous endoscopic surgery can be proposed as a safe and less‐invasive treatment option for ureteropelvic junction obstruction and renal calculi in a partial duplex system.

A 51-year-old male with a history of Cacchi-Ricci disease and long-standing infection with various species of Borrelia, Babesia, and Bartonella presented with recurrent symptoms of right-sided flank pain. Numerous renal calculi were identified on imaging. The etiology of the calculi had not been previously elucidated. Symptoms intermittently date back to 2002 when uric acid stones were identified. Subsequent calculi analysis revealed calcium oxalate stones. Despite the commonality of nephrolithiasis in patients with Cacchi-Ricci disease, the extreme number of calculi and recurrent presentation of symptoms persisted despite a plethora of medical evaluations, dietary changes, and hereditary testing. This case raises questions of etiology including possible immune deficiency and whether his uncommon microbial history contributes to recurrent stone formation. [ABSTRACT FROM AUTHOR]

This article analyzes and summarizes the incidence, harm, diagnosis methods, conservative treatment, surgical methods for relieving obstruction and follow-up continuous treatment measures of symptomatic urinary calculi during pregnancy, aiming to provide reference for further study on long-term medical treatment and nursing intervention pattern of the patients with symptomatic urinary calculi during pregnancy. The multidisciplinary collaboration and standardized diagnosis and treatment based on the evidence-base medicine may increase the safety during pregnancy and living quality of pregnant women with symptomatic urinary calculi, moreover provide more theoretical perspectives and research ideas. [ABSTRACT FROM AUTHOR]

Rationale and objectives: Measuring small kidney stones on CT is a time-consuming task often neglected. Volumetric assessment provides a better measure of size than linear dimensions. Our objective is to analyze the growth rate and prognosis of incidental kidney stones in asymptomatic patients on CT. Materials and methods: This retrospective study included 4266 scans from 2030 asymptomatic patients who underwent two or more nonenhanced CT scans for colorectal screening between 2004 and 2016. The DL software identified and measured the volume, location, and attenuation of 883 stones. The corresponding scans were manually evaluated, and patients without follow-up were excluded. At each follow-up, the stones were categorized as new, growing, persistent, or resolved. Stone size (volume and diameter), attenuation, and location were correlated with the outcome and growth rates of the stones. Results: The stone cohort comprised 407 scans from 189 (M: 124, F: 65, median age: 55.4 years) patients. The median number of stones per scan was 1 (IQR: [1, 2]). The median stone volume was 17.1 mm3 (IQR: [7.4, 43.6]) and the median peak attenuation was 308 HU (IQR: [204, 532]. The 189 initial scans contained 291stones; 91 (31.3%) resolved, 142 (48.8%) grew, and 58 (19.9) remained persistent at the first follow-up. At the second follow-up (for 27 patients with 2 follow-ups), 14/44 (31.8%) stones had resolved, 19/44 (43.2%) grew and 11/44 (25%) were persistent. The median growth rate of growing stones was 3.3 mm3/year, IQR: [1.4,7.4]. Size and attenuation had a moderate correlation (Spearman rho 0.53, P <.001 for volume, and 0.50 P <.001 for peak attenuation) with the growth rate. Growing and persistent stones had significantly greater maximum axial diameter (2.7 vs 2.3 mm, P =.047) and peak attenuation (300 vs 258 HU, P =.031) Conclusion: We report a 12.7% prevalence of incidental kidney stones in asymptomatic adults, of which about half grew during follow-up with a median growth rate of about 3.3 mm3/year. [ABSTRACT FROM AUTHOR]

Objective: To formulate clinical consensus recommendations on the presentation, assessment, and management of primary hyperparathyroidism (PHPT) in adults. Methods: Representatives from relevant Australian and New Zealand Societies used a systematic approach for adaptation of guidelines (ADAPTE) to derive an evidence‐informed position statement addressing nine key questions. Results: PHPT is a biochemical diagnosis. Serum calcium should be measured in patients with suggestive symptoms, reduced bone mineral density or minimal trauma fractures, and in those with renal stones. Other indications are detailed in the manuscript. In patients with hypercalcaemia, intact parathyroid hormone, 25‐hydroxy vitamin D, phosphate, and renal function should be measured. In established PHPT, assessment of bone mineral density, vertebral fractures, urinary tract calculi/nephrocalcinosis and quantification of urinary calcium excretion is warranted. Parathyroidectomy is the only definitive treatment and is warranted for all symptomatic patients and should be considered for asymptomatic patients without contraindications to surgery and with >10 years life expectancy. In patients who do not undergo surgery, we recommend annual evaluation for disease progression. Where the diagnosis is not clear or the risk‐benefit ratio is not obvious, multidisciplinary discussion and formulation of a consensus management plan is appropriate. Genetic testing for familial hyperparathyroidism is recommended in selected patients. Conclusions: These clinical consensus recommendations were developed to provide clinicians with contemporary guidance on the assessment and management of PHPT in adults. It is anticipated that improved health outcomes for individuals and the population will be achieved at a decreased cost to the community. [ABSTRACT FROM AUTHOR]

Introduction: Percutaneous Nephrolithotomy (PCNL) has become the standard of care for large renal calculi. The aim of the surgery is to achieve maximum stone clearance with minimal postoperative complications. Various scoring systems have been described to predict both of these outcomes. S.T.O.N.E. Score and Guy's Stone Score (GSS) are two of the most widely used scoring systems. S.T.O.N.E. Score comprises of Size of the stone, Tract length, degree of Obstruction of the urinary system, Number of stones, and Essence. Aim: To compare the predictive power for stone clearance and postoperative complications of the two scoring systems, namely S.T.O.N.E. Score and GSS. Materials and Methods: This cross-sectional study was conducted at the Department of Genitourinary Surgery at Government Medical College, Kottayam, Kerala, India from March 2019 to August 2020. All patients above 18 years undergoing PCNL were included. A total of 122 patients were studied by calculating the preoperative S.T.O.N.E. Score and GSS and comparing them with post-PCNL stone clearance and complications. The association of both S.T.O.N.E. Score and GSS with stone clearance was estimated by plotting the Receiver Operating Curve (ROC) curve using Statistical Package for Social Sciences (SPSS) version 20, International Business Machines (IBM) SPSS Statistics windows, version 20.0 (Armonk, NY: IBM Corp.). A p-value <0.05 was considered statistically significant. Results: The mean age of the subjects was 49.8±12.47 years. A total of 76 males and 46 females were included in the present study. The mean S.T.O.N.E. Score among the study subjects was 7.12±1.57, and the mean GSS was 2.09±0.48. Complete stone clearance was achieved in 96 (78.7%) patients. A total of 22 (18%) patients had postoperative complications. Both scores had a significant association with stone clearance (p<0.001 for both) and postoperative complications (p-value for S.T.O.N.E. Score was 0.019 and GSS was 0.007). Conclusion: Both the S.T.O.N.E. Score and GSS can predict post-PCNL stone clearance and complications with comparable efficacy. [ABSTRACT FROM AUTHOR]

Objectives: To assess the ideal interval between repeated extracorporeal shockwave lithotripsy (SWL) for renal stones. Patient and Methods: Eligible patients with a single renal stone ≤20 mm who required SWL were randomly assigned to one of three groups based on intervals between first and second sessions. Patients underwent the second session after 3, 7, and 14 days in Groups 1, 2, and 3, respectively. Tubular functions were assessed through comparisons of urinary execration of kidney injury molecule-1 (KIM-1), neutrophil gelatinase associated lipocalin (NGAL), and interleukin-18 (IL-18) with pre-SWL values, whereas glomerular function was assessed by comparisons of protein/creatinine ratio with pre-SWL and changes in ipsilateral renal function on isotope scans. Treatment success was assessed by noncontrast CT after 3 months. Results: All demographics of the 166 patients included in the study were comparable between the three groups. There were significant elevations of tubular biomarkers and protein/creatinine ratio after first and second SWL sessions compared with pre-SWL values (p < 0.0001). All tubular biomarkers returned to pre-SWL values at 7 and 14 days after second session, whereas they remained significantly elevated 3 days after second session (p = 0.027, < 0.001 and <0.001 for KIM-1, NGAL, and IL-18, respectively). SWL success was 73.6% in Group 1, 83.7% in Group 2, and 81% in Group 3. A significant decrease in ipsilateral renal split function was observed in Group 1 at the 3-month follow-up. Conclusions: An interval of 7 days is required between SWL sessions when treating renal stones to allow for complete recovery of kidney functions. Clinical Trial Registration: ID: NCT04575480. [ABSTRACT FROM AUTHOR]

Objectives: To compare the safety and efficacy of novel tip-flexible suctioning ureteral access sheath (NTFS-UAS) and traditional ureteral access sheath (T-UAS) combined with flexible ureteroscope for treating unilateral renal calculi. Materials and methods: The clinical data of 214 patients with unilateral renal calculi treated by NTFS-UAS (n = 102) and T-UAS (n = 112) combined with flexible ureteroscope from August 2021 to April 2022 were analyzed retrospectively. Demographic characteristics, stone-related parameters, operative time, stone-free rates (SFR), hospitalization time and complication rate (CR) were analyzed. Result: No significant difference was observed between the two groups in terms of demographic characteristics, stone-related parameters, intraoperative CR, and hospitalization time. The operative time of NTFS-UAS group was significantly shorter than T-UAS group (55.25 ± 11.42 min vs. 59.36 ± 15.59 min; P = 0.028). The NTFS-UAS group obtained significantly higher SFR on 1 day postoperatively (86.3% vs. 75.0%; P = 0.038), and higher SFR on 30 days postoperatively than T-UAS group (91.2% vs. 81.3%; P = 0.037). The hemoglobin loss of NTFS-UAS group (− 0.54 ± 0.69 g/dl) was significantly lower than T-UAS group (− 0.83 ± 0.66 g/dl; P = 0.002). There was a significantly lower incidence of overall CR (11.8% vs. 22.3%; P = 0.041), and infectious CR (8.8% vs. 18.8%; P = 0.037) in the NTFS-UAS group. Conclusion: Compared to T-UAS combined with flexible ureteroscope for treating unilateral renal calculi, NTFS-UAS had superiority in higher SFR on 1 day and 30 days postoperatively. Shorter operation time, lower hemoglobin loss, lower incidences of overall and infectious CR were observed in NTFS-UAS group. Registration number and date: ChiCTR2300070210; April 5, 2023. [ABSTRACT FROM AUTHOR]

Introduction: Calyceal diverticulum (CD) is the outpouching of a calyx into the renal parenchyma, connected by an infundibulum. Often associated with recurrent stones, common surgical options include percutaneous nephrolithotomy (PCNL) or retrograde intrarenal surgery (RIRS). We aim to present the real-world practises and outcomes comparing both approaches and the technical choices made. Materials and methods: Retrospective data including 313 patients from 11 countries were evaluated. One hundred and twenty-seven underwent mini-PCNL and one hundred and eighty-six underwent RIRS. Patient demographics, perioperative parameters, and outcomes were analysed using either T test or Mann–Whitney U test. Categorical data between groups were analysed using the Chi-squared test. Propensity score matching (PSM) was performed matching for baseline characteristics. Subgroup analyses for anomalous/malrotated kidneys and difficult diverticulum access were performed. Results: After PSM, 123 patients in each arm were included, with similar outcomes for stone-free rate (SFR) and complications (p < 0.001). Hospitalisation was significantly longer in PCNL. Re-intervention rate for residual fragments (any fragment > 4 mm) was similar. RIRS was the preferred re-intervention for both groups. Intraoperative bleeding was significantly higher in PCNL (p < 0.032) but none required transfusion. Two patients with malrotated anatomy in RIRS group required transfusion. Lower pole presented most difficult access for both groups, and SFR was significantly higher in difficult CD accessed by RIRS (p < 0.031). Laser infundibulotomy was preferred for improving diverticular access in both. Fulguration post-intervention was not practised. Conclusion: The crux lies in identification of the opening and safe access. Urologists may consider a step-up personalised approach with a view of endoscopic combined approach where required. [ABSTRACT FROM AUTHOR]