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Objective: The incidence of urolithiasis in pediatrics increases to 4-10% annually. One of the methods for treating urolithiasis is ureteroscopy (URS). The small anatomy in pediatrics often makes the initial URS unsuccessful. Alpha blockers, a drug that can relax the ureteral muscles, is a therapy that can be considered before URS is carried out. The objective of this study is to evaluate the efficacy of preoperative tamsulosin for URS access in pediatrics. Materials and Methods: We conducted a search using four databases, including PubMed, EBSCO, Cochrane Library, and ProQuest. This study includes randomized controlled trials (RCTs), retrospective and prospective studies, which compared the efficacy of preoperative alpha blockers and placebo or non-placebo controls in pediatrics undergoing ureteroscopy. The outcome of interest was the success rate of URS access and the duration of surgery. Results: A total of 120 studies were identified from a database search. There were 3 studies included in this review involving 235 patients. The meta-analysis was conducted using a random-effects model. The results of the metaanalysis showed that alpha blockers provided a successful rate of ureteroscopy access in pediatric patients (Odds ratio (OR) 2.73; 95% confidence interval (CI) 1.52 up to 4.91; p=0.0008). Duration of surgery did not show significant results (Mean difference (MD) 3.46; 95% CI -3.59 up to 10.50; p=0.34). Conclusion: Preoperative administration of tamsulosin may increase the success rate of ureteroscopy access in pediatric patients. [ABSTRACT FROM AUTHOR]

Copyright of Journal of Tepecik Education & Research Hospital / İzmir Tepecik Eğitim ve Araştırma Hastanesi Dergisi is the property of Logos Medical Publishing and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Study Design: Case Report. Objective: Sialoliths are a cause of Sialolithiasis affecting an estimated 12 in 1000 adult population. The patient's presentation vary from being asymptomatic to pain with swelling and purulent discharge if accompanied with a infection. Giant sialoliths greater than 15 mm are rare. The purpose of the article is to document and educate clinicians on the management of giant sialoliths with possible sparing of the salivary gland. Methods: This report documents a patient with a sialolith measuring 45 mm in the widest diameter removed using a trans-oral approach. Results: The patient presented with an intra-oral sialolith which was asymptomatic except for the hard swelling felt cervically. Clinical examination and radiographic imaging was adequate for a diagnosis and the fact that there was no tenderness over the glandular area a decision to spare the gland was made. Conclusion: There are few reports of giant sialoliths and majority present with sialadenitis. In this case it was rare for the stone to have reached this size with hardly any symptoms. In patients where the gland has not been affected clinicians may consider sparing it and remove only the sialolith to reduce the morbidity and risks associated with glandular excision. [ABSTRACT FROM AUTHOR]

Introduction The aim of this article was to determine a predictive factor by examining the patient's characteristics and the stone to predict the ureteral stone spontaneous passage. Material and methods A total of 200 patients aged 18-55 who were referred with middle and distal ureter ureteral stones between 5-7 mm were analyzed retrospectively. Patients were randomized as 50 spontaneous stone passage positive (SSPP) and 50 negative patients. Body mass index (BMI), waistto-hip ratio (WHR), stone size, ureter length, ureter diameter, stone Hounsfield unit value (SHU), ureteral wall thickness (UWT), kidney parenchymal thickness (KPT), kidney parenchymal density, neutrophil-lymphocyte ratio (NLR) and thrombocyte-lymphocyte ratio (TLR) values were recorded. Results The average SHU of the SSPP group was 579 and 970 in the negative group (p: 0.000). While the mean was 1.7 mm in the UWT SSPP group, it was 2.4 mm in the negative group (p: 0.000). SHU and UWT were statistically significantly different in univariate and multivariate logistic regression analyses. WHR values were 39.6 and 29.3 for SSPP and the negative group, respectively (p: 0.032). The ureter diameter was 7.6 mm for the SSPP group and 8.9 mm in the negative group (p: 0.01). Conclusions Low SHU value is related to the ureteral stone's positive spontaneous passage, and the increase of UWT is inversely related to the spontaneous passage. WHR is higher in people who can passage ureteral stones. A narrow ureter diameter is correlated with spontaneous stone passage. Ureter length, KPT, and kidney parenchymal density were not associated with spontaneous passage. [ABSTRACT FROM AUTHOR]

There has been a subjective increase in the number of patients presenting for tonsil stones to our pediatric otolaryngology clinic. This may be related to frequent viewing of videos on the social media application, TikTok, pertaining to tonsil stones. [ABSTRACT FROM AUTHOR]

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

Aim: We aimed to evaluate our phytobezoar cases who were followed up and treated due to mechanical obstruction in our clinic. Materials and Methods: The fles of acute abdomen or ileus patients who were followed up in the Elazığ Training and Research Hospital General Surgery Clinic between January 2013 and January 2018 were evaluated retrospectively. Patients whose data were not available and who were followed up and treated for non-phytobezoar ileus and acute abdomen were excluded from the study. Nine patients meeting the inclusion criteria were reviewed retrospectively. Demographic data (age, gender) of the patients, previous surgical histories, comorbidites, whether there is gastric or intestinal bezoar, treatment options and complications were recorded. Numerical data are given as median (minimum - maximum values); categorical data are given as n (%) for statistical evaluation. Results: Three of the patients were female (33.4%) and 6 were male (66.7%).The median age of all patients was 71(25--78) years. Seven of the patient had previous surgical intervention history (77.8%) (5 had gastric surgery and 2 had other abdominal surgery history), 2 (22.2%) had no previous surgical intervention history. Two of the patients (22.2%) whom endoscopic intervention was performed for with gastric bezoar, operated for intestinal obstruction due to migration of gastric bezoar.One of the patients (11.1%) whom had no surgical intervention history had primary intestinal bezoar and one (11.1%) had concomitant intestinal bezoar with gastric bezoar. Conclusion: Mechanical obstruciton due to bezoars, must be kept in mind in patients who had perivous gastric surgery history and habitual eating disorders.Not only the exploration of the target area but also whole exploration must be done.Close follow up for migration is important for the gastric bezoars after endoscopic interventions. [ABSTRACT FROM AUTHOR]

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

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

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

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

The article dedicate to the problem of failure of extracorporeal shockwave lithotripsy in patients with ureterolithiasis and reveal the changes which appear in the ureter in the location of the stone. The aim. Analysis of the results of treatment in patients, suffering ureteric stones, using the ureterolithotripsy procedure after failure extracorporeal shockwave lithotripsy. Materials and methods. In 137 patients with ureteric stones, whom ureterolithotripsy procedure after failure extracorporeal shockwave lithotripsy was conducted, the symptoms of the disease, the diagnostic methods value, efficacy of surgical treatment and reasons of the failure of previous method of treatment were analyzed. Results. In 135 patients endoscopic removal of stones has been succeeded, in 2 patients because of total obliteration of the ureter, uretero-ureteral anastomosis has been performed. If the symptoms, with are characteristic of ureterolithiasis, persists up to one week stones don't cause significant macroscopic changes to the ureter wall. If the stone persists in the ureter longer than a week we identified local appearing of oedema. Long-term (more than two months) ureteric stone persistence increase the risk of intramucosal «ingrowth» of the calculi greatly. Conclusion. The URS and ESWL are high effective and minimal invasive methods of surgical intervention for patients with ureterolithiasis, guaranteeing high level of postoperative «stone free rate». Prolongation of the stone insertion time in the ureter causes the ureteric wall changes, complicating performance of minimal invasive interventions (ureterolithotripsy and extracorporeal shock-wave lithotripsy) and reduce its efficacy. [ABSTRACT FROM AUTHOR]

Objective: Stones of the urinary system occur in children at varying prevalence depending on the changing environment, diet, and genetic factors. The aim of this study was to evaluate patients with urinary tract stones in terms of surgical treatment indications, treatment methods and outcomes, and complications. Material and Methods: Patients who were treated for urinary tract stones between January 2009 and December 2013 were retrospectively evaluated. Patients' age, sex, etiology, size, location, and number of their existing stones, the treatment method, stone-free rates, and postoperative complications were recorded. Results: A total of 505 patients were evaluated. The mean age of the patients at the time of diagnosis was 55.8±52.2 (0--216) months. Of the 505 cases, 157 (31%) underwent surgery. The mean age of the patients was 63.6±55.2 (0--216) months. There was a statistically significant difference between the sizes of the stones found in patients receiving medical treatment and those who underwent surgery (p<0.05). There was no statistically significant difference between the surgical method and the number of patients with residual stones (p>0.05). In postoperative checks, there was no statistically significant difference between the size and location of the existing residual stone and the surgical method (p>0.05). Conclusion: Stone disease of the urinary system is an important health concern in children. Determining the etiology, identifying surgical indications, and performing surgery using appropriate procedures play a key role in the treatment of the disease. [ABSTRACT FROM AUTHOR]

Copyright of Journal of Tepecik Education & Research Hospital / İzmir Tepecik Eğitim ve Araştırma Hastanesi Dergisi is the property of Logos Medical Publishing and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Due to the aging population, the number of completely bedridden individuals is expected to increase, and such individuals are at high risk of developing urinary calculi. This retrospective study included 32 consecutive bedridden patients, who had undergone endoscopic lithotripsy between 2010 and 2019, and aimed to identify the treatment outcomes of endoscopic lithotripsy for bedridden patients. A total of 45 endoscopic lithotripsies were performed to treat stones (median cumulative diameter, 24 mm). The stone-free rate (SFR) < 4 mm and complete SFR (0 mm) were achieved in 81% and 63% of patients, respectively. Postoperatively, 10 patients (22%) developed symptoms of systemic inflammatory response syndrome, and three patients (7%) had bloodstream infections. Except for one patient (3%) having a retained ureteral stent ultimately died from septic shock, drainage tube-free discharge was achieved in all patients. The 2-year cumulative incidence of stone-related events, and overall mortality rate, were 18% and 27%, respectively. Endoscopic lithotripsy is well tolerated and is associated with a high success rate, even with severe comorbidities and a relatively large stone burden. Physicians should consider performing endoscopic lithotripsy in bedridden patients with symptomatic urinary calculi regardless of their relatively short life expectancy and the remote risk of perioperative mortality. [ABSTRACT FROM AUTHOR]

Multiple intraglandular sialolithiasis for stones deep in the glandular parenchyma may require submandibulectomies, especially if sialendoscopic facilities are unavailable. We describe a gland-sparing intraoral sialolithotomy approach for both hilar and intraparenchymal multiple sialoliths. Nine patients with obstructive sialadenitis resulting from multiple sialoliths in both the deep hilar region and the submandibular gland parenchyma were selected for this study. Ultrasonography and computer tomography (CT) scans were performed to determine the location, number and sizes of the calculi and the distance between hilar and intraparenchymal sialoliths. All sialoliths were removed via gland-sparing, intraoral sialolithotomy. In all, 27 stones were found in the 9 patients. The hilar and deeper sialoliths were 4.5–11 and 0.8–4.5 mm, respectively, in diameter. The largest distance between the hilar and intraparenchymal sialoliths was 28.3 mm. Sialoliths in the hilar region were excised through an intraoral incision before deeper intraparenchymal stones were eased out of the same incision site. Postoperative follow-up imaging verified complete sialolith removal. Therefore, submandibular gland multiple sialoliths in the hilum and parenchyma can be successfully removed via an intraoral sialolithotomy under general anesthesia, thereby preserving the gland and restoring its secretory function. [ABSTRACT FROM AUTHOR]

Importance: For patients with painful chronic pancreatitis, surgical treatment is postponed until medical and endoscopic treatment have failed. Observational studies have suggested that earlier surgery could mitigate disease progression, providing better pain control and preserving pancreatic function.Objective: To determine whether early surgery is more effective than the endoscopy-first approach in terms of clinical outcomes.Design, Setting, and Participants: The ESCAPE trial was an unblinded, multicenter, randomized clinical superiority trial involving 30 Dutch hospitals participating in the Dutch Pancreatitis Study Group. From April 2011 until September 2016, a total of 88 patients with chronic pancreatitis, a dilated main pancreatic duct, and who only recently started using prescribed opioids for severe pain (strong opioids for ≤2 months or weak opioids for ≤6 months) were included. The 18-month follow-up period ended in March 2018.Interventions: There were 44 patients randomized to the early surgery group who underwent pancreatic drainage surgery within 6 weeks after randomization and 44 patients randomized to the endoscopy-first approach group who underwent medical treatment, endoscopy including lithotripsy if needed, and surgery if needed.Main Outcomes and Measures: The primary outcome was pain, measured on the Izbicki pain score and integrated over 18 months (range, 0-100 [increasing score indicates more pain severity]). Secondary outcomes were pain relief at the end of follow-up; number of interventions, complications, hospital admissions; pancreatic function; quality of life (measured on the 36-Item Short Form Health Survey [SF-36]); and mortality.Results: Among 88 patients who were randomized (mean age, 52 years; 21 (24%) women), 85 (97%) completed the trial. During 18 months of follow-up, patients in the early surgery group had a lower Izbicki pain score than patients in the group randomized to receive the endoscopy-first approach group (37 vs 49; between-group difference, -12 points [95% CI, -22 to -2]; P = .02). Complete or partial pain relief at end of follow-up was achieved in 23 of 40 patients (58%) in the early surgery vs 16 of 41 (39%)in the endoscopy-first approach group (P = .10). The total number of interventions was lower in the early surgery group (median, 1 vs 3; P < .001). Treatment complications (27% vs 25%), mortality (0% vs 0%), hospital admissions, pancreatic function, and quality of life were not significantly different between early surgery and the endoscopy-first approach.Conclusions and Relevance: Among patients with chronic pancreatitis, early surgery compared with an endoscopy-first approach resulted in lower pain scores when integrated over 18 months. However, further research is needed to assess persistence of differences over time and to replicate the study findings.Trial Registration: ISRCTN Identifier: ISRCTN45877994. [ABSTRACT FROM AUTHOR]

Aim: A proper percutaneous renal access is the most crucial step in the procedure. This retrospective study aims to compare the efficacy and safety of monoplanar and biplanar access in PCNL operations. Material and Methods: The study included a total of 72 patients with single kidney stones larger than 20 mm in diameter, who underwent PCNL surgery between September 2016 and May 2018. The patients were divided into two groups monoplanar access (Group 1) and biplanar access group (Group 2). There were 38 and 34 patients in Groups 1 and 2, respectively. Stone and urinary system characteristics, operation parameters and postoperative findings of all patients were recorded. Results: There was no statistically significant difference between two groups in terms of mean age, sex and kidney stone size. Mean operation duration was 64.3 ± 21.7 minutes in group 1 and 61.8 ± 27.4 minutes in group 2 (p=0.494). A statistically significant difference was observed between the groups in terms of mean fluoroscopy time, which was 3.46±1.24 minutes in group 1 and 4.45±1.57 in group 2 (p=0.008). The mean puncture time was significantly lower in group 1 (p=0.042). The stone-free rate was 78.9% and 82.3% in groups 1 and 2, respectively (p=0.87). There was no statistically significant difference between the groups in terms of complications (p=0.72). Conclusion: Both access techniques have been found to similar success and complication rates in PCNL operations. However, the fluoroscopy duration and puncture time are shorter in cases where monoplanar access is established; which may be effective in preferring this technique. [ABSTRACT FROM AUTHOR]

Introduction: Natural language processing (NLP) is an emerging tool which has the ability to automate data extraction from large volumes of unstructured text. One of the main described uses of NLP in radiology is cohort building for epidemiological studies. This study aims to assess the accuracy of NLP in identifying a group of patients positive for ureteric stones on Computed Tomography - Kidneys, Ureter, Bladder (CT KUB) reports.Methods: Retrospective review of all CT KUB reports in a single calendar year. A locally available NLP tool was used to automatically classify the reports based on positivity for ureteric stones. This was validated by manual review and refined to maximize the accuracy of stone detection.Results: A total of 1874 CT KUB reports were identified. Manual classification of ureteric stone positivity was 36% compared with 27% using NLP. The accuracy of NLP was 85% with a sensitivity of 66% and specificity of 95%. Incorrect classification was due to misspellings, variable syntax, terminology, pluralization and the inability to exclude clinical request details from the search algorithm.Conclusions: Our NLP tool demonstrated high specificity but low sensitivity at identifying CT KUB reports that are positive for ureteric stones. This was attributable to the lack of feature extraction tools tailored for analysing radiology text, incompleteness of the medical lexicon database and heterogeneity of unstructured reports. Improvements in these areas will help improve data extraction accuracy. [ABSTRACT FROM AUTHOR]

Objectives: To perform a systematic review and network meta-analysis comparing stone-free rates following retrograde intrarenal surgery (RIRS), extracorporeal shock wave lithotripsy (SWL), and percutaneous nephrolithotomy (PCNL) treatments of renal stones. Materials and methods: Clinical trials comparing RIRS, SWL, and PCNL for treatment of renal stones were identified from electronic databases. Stone-free rates for the procedures were compared by qualitative and quantitative syntheses (meta-analyses). Outcome variables are shown as risk ratios (ORs) with 95% credible intervals (CIs). Results: A total of 35 studies were included in this network meta-analysis of success and stone-free rates following three different treatments of renal stones. Six studies compared PCNL versus SWL, ten studies compared PCNL versus RIRS, fourteen studies compared RIRS versus SWL, and five studies compared PCNL, SWL, and RIRS. The quality scores within subscales were relatively low-risk. Network meta-analyses indicated that stone-free rates of RIRS (OR 0.38; 95% CI 0.22–0.64) and SWL (OR 0.12; 95% CI 0.067–0.19) were lower than that of PCNL. In addition, stone-free rate of SWL was lower than that of RIRS (OR 0.31; 95% CI 0.20–0.47). Stone free rate of PCNL was also superior to RIRS in subgroup analyses including ≥ 2 cm stone (OR 4.680; 95% CI 2.873–8.106), lower pole stone (OR 1.984; 95% CI 1.043–2.849), and randomized studies (OR 2.219; 95% CI 1.348–4.009). In rank-probability test, PCNL was ranked as No. 1 and SWL was ranked as No. 3. Conclusions: PCNL showed the highest success and stone-free rate in the surgical treatment of renal stones. In contrast, SWL had the lowest success and stone-free rate. [ABSTRACT FROM AUTHOR]

Background: The development of ureteral calculi after Yang-Monti ileal ureter reconstruction has not been reported. This study was performed to explore the safety and effectiveness of ureteroscopy combined with laser lithotripsy in the treatment of ipsilateral lower ureteral calculi and lower calyceal calculi after Yang-Monti ileal ureter reconstruction.Case Presentation: A 48-year-old man was admitted to our hospital with ipsilateral distal ureteral calculi and ipsilateral lower calyceal calculi. One year prior to this admission, the patient had undergone Yang-Monti ileal ureter reconstruction due to long-segment ureteral stenosis. After conservative treatment failed, we used a rigid ureteroscope with a holmium laser to break up the distal ureteral calculi, and successfully removed the renal calculi with a digital flexible ureteroscope and basket extractor.Conclusion: The successful outcome of the present case suggests that ureteroscopy combined with laser lithotripsy is a valuable option for the management of urinary calculi following Yang-Monti ileal ureter reconstruction. [ABSTRACT FROM AUTHOR]

Objective: The aim of this study was to retrospectively evaluate our experience on open cystolithotomy and intracorporeal cystolithotripsy in children with bladder stones. Material and Methods: A total of 23 children with bladder stones were treated at our center between 2007 and 2016. Transurethral removal with basket catheter, transurethral cystolithotripsy / percutaneous cystolithotripsy with laser or open cystolithotomy approaches were preferred. The patients were evaluated according to the operation technique, stone burden, and complications, and compared with each other in terms of these criteria. Results: Three girls and 20 boys, ranging in age from 1 to 16 years were evaluated. Stone sizes ranged from 5 to 50 mm. We preferred transurethral cystolithotripsy in 7 patients, percutaneous cystolithotripsy in 4 patients, open cystolithotomy in 8 patients and transurethral removal with basket catheter in 4 patients. Twenty (87%) patients had no complications. Complications occurred in three patient consisting of a mucosal laceration in one patient and lower urinary tract obstruction due to residual stones in the postoperative period in two patients. The average stone size was 22.6±12 mm in all patients who underwent open cystolithotomy and 16 ± 9.04 mm in patients where the other methods were used. Conclusion: We believe that open cystolithotomy is the most effective treatment method, especially for stones greater than 2 cm. [ABSTRACT FROM AUTHOR]

Background: Extracorporeal shock wave lithotripsy (ESWL) is considered as the method of choice for treatment of most stone diseases. The present study aims to evaluate radiation dose received by patients undergoing ESWL. Methods: In total, 46 patients from both genders were referred to the Shohadaye Ashayer hospital of Khorramabad, Iran and were included in the present study. Patients were positioned in anteroposterior (AP) projection and along 30° anterior oblique (AO) projection upon the X-ray fluoroscopy table and exposures were conducted. Thermoluminescent dosimeters (TLDs) were used for radiation dose measurements. To evaluate the entrance surface dose (ESD), each TLD chip was taped on back of patient at the entrance surfaces of the X-ray beam. Results: The mean number of stones in each patient was 1.4. The stone sizes ranged from 7 to 29 mm, and a mean of 3200 pulses were need for each patient. The mean ESD in the postero-anterior (PA) and oblique X-ray beam entrance were obtained at 12.04 and 68.84 mGy, respectively. There was linear correlation between patient dose with fluoroscopy time, tube current (mA), tube potential (kVp) and patient position (P < 0.001); however, we found no strong correlation between patient dose with patient body mass (P = 0.837), number of shock wave pulses (P = 0.089), stone size (P = 0.773) and locations (P = 0.463). Conclusion: The data obtained in the current study are comparable with information available in the literature. They emphasized that ESWL exposes patients to much more radiation compared to those from conventional radiography and is in the range of computed tomography (CT) procedures. Therefore, following safety guidelines is recommended. [ABSTRACT FROM AUTHOR]

Purpose: Comparison of efficiency and reliability of percutaneous nephrolithotomy (PNL) and retrograde intrarenal surgery (RIRS) in treatment of multicalyceal and multiple renal stones in the same renal unit. Materials and Methods: Between 2011 and 2015, records of patients who underwent surgery for renal stone were retrospectively reviewed. Patients who had multiple stones located in different calices in the same renal unit were included. The patients that underwent PNL and RIRS were defined as Group I and Group II, respectively. Patient criteria (age,sex); the stone characteristics; time of procedure, fluoroscopy and hospitalization; stone-free and complication rates of groups were evaluated between the treatment groups. Result: There were no significant differences in terms of age, gender, BMI, laterality, number of stones, number of stone localization, hounsfield units and surface area characteristics of the stone between the PNL (n = 47) and RIRS (n = 35) groups (P = .558, P = .278, P = .375, P = 0.051, P = .053, P = .064, P = .642, P = .080, respectively). Stone free rate was 59.6% (n=28) in PNL, and 88.6% (n=31) in RIRS (P=.004). 1st or 2nd degree complications according to Modified Clavien Classification developed in 10 patients (21.3%) in Group I and 1 patient (2.9%) in Group II (P = .015). The 3A or 3B complications were similar in groups (P = .077). Time of procedure, fluoroscopy and hospitalization were significantly lower in Group II (P < .001, P < .001 and P < .001, respectively). Conclusion: RIRS is more effective and more reliable procedure than PNL with higher stone-free and lower complication rates in treatment of multicalyceal and multiple stone in the same renal unit. [ABSTRACT FROM AUTHOR]

Purpose: To compare the pain status and stone free rates of flexible ureterorenoscopy (F-URS) versus mini-percutaneous nephrolithotomy (mini-PNL) for the treatment of 1-to 2-cm renal stones. Materials and Methods: This study was retrospectively designed with match paired method. Between January 2013 and December 2016, 387 patients underwent stone surgery for renal stones, 45 patients underwent FURS and 45 patients underwent mini-PNL. 90 patients were divided into two groups according to the surgical procedures. Group 1 patients underwent F-URS, and Group 2 patients underwent mini-PNL. During the intraoperative and postoperative periods, pain management for all patients was standardized. Pain scores were determined using a visual analogue scale (VAS) completed at 2, 6, 12 and 24 hours postoperatively. The stone free status, hemoglobin levels, fluoroscopy time (FT), operation time (OT), hospitalization time (HT), return to work time (RWT), and complications were noted for each patient. Results: Of all patients, the mean age was 41.1 ± 12.1 years and the mean stone size was 13.9 ± 2.9 mm. The VAS scores were significantly higher in the mini-PNL group at 2, 6, 12 and 24 hours (P < .05). The stone-free status and complication rates were similar between the two groups (P > .05); however, the hemoglobin decreases and the fluoroscopy, operation, hospitalization and return to work times were higher in the mini-PNL group than in the F-URS group (P < .05). Conclusion: F-URS is less painful than mini-PNL for the treatment of 1- to 2-cm renal stones. However, the stone free rate is similar between the two procedures while mini-PNL is superior in terms of fluoroscopy, operation, hospitalization and return to work duration. We think that F-URS is more comfortable and less painful than mini-PNL and achieves a similar stone free rate for the treatment of 1- to 2-cm renal stones. [ABSTRACT FROM AUTHOR]

Abstract Background To retrospectively compare the composition of urinary tract stones formed by Uyghur children from the southern (Kashgar) and northern (Urumchi) parts of the Xinjiang region. Methods The chemical composition of urinary tract calculi formed by 855 Uyghur children from the two regions in Xinjiang (366 Kashgar and 489 Urumchi) was compared retrospectively. Stone composition was determined by infrared spectroscopy. Factors that might have been of relevance for the findings such as age, gender, stone location and geographic region were also considered. Results Kashgar children were younger than Urumchi children (2.8 ± 2.7 vs. 4.3 ± 3.7 years, p < 0.001). Although ammonium urate was the dominant stone component in the whole population, calcium oxalate was most common in children from Urumchi. The mean occurrence of ammonium urate, calcium oxalate and uric acid differed significantly between stones formed by Kashgar and Urumchi children (52.5% vs. 29.2%, 18.9% vs. 29.4%, 12.3% vs. 20.9%; respectively, p < 0.001). Renal stones were less frequently recorded in Kashgar children than in Urumchi children (65.8% vs. 91.6%, p < 0.001). Interestingly, bladder stones were more common in children from Kashgar (28.4% vs. 3.7%; p < 0.001). Conclusion Uyghur children from the southern part of Xinjiang apparently had a more serious form of stone disease than children from the northern part and the occurrence of stones dominated by ammonium urate stones was extremely high in children from the southern part of the region. [ABSTRACT FROM AUTHOR]

Introduction: Formation of stone in the urinary tract, kidney, ureter and bladder is called as Urolithiasis. Formation of urinary stones is very common. About 5-15% population are affected with urinary stone, and, therefore, causes high morbidity in comparison to the above types of stone formation. Shock wave lithotripsy and ureteroscopy along with conservative treatments are the most common approaches for the treatment of calculi, although considered as expressive in one hand, and on the other hand, such interventions may lead to complications. Therefore, alternative medicines give a second thought for the treatment of urolithiasis because it avoids surgical interventions. Here we present a case study for the successful treatment of urolithiasis by a homoeopathic medicine Lycopodium clavatum in a 43 years old male. Case Profile: A 43-year-old male patient with intense pain in the right loin for 5-6 days, increased frequency of urination, ineffectual urination, severe pain during urination, and finally with the pain score was 9, was considered for treatment in the present study. Based on his complete case history, Lycopodium clavatum at potencies of 0/1 to 0/6 was prescribed to him. Conclusion: Correct homoeopathic organ specific or constitutional formulation(s) selected based on specific important symptoms can also be efficacious in diseases such as ureteric stone. Constitutional medicine Lycopodium clavatum is usually prescribed when the patient is with right side pain with ureteric stone and it is justified in the present case report. Randomized control trial is suggested to ascertain the results obtained in the present study i.e. successful treatment of urolithiasis with the constitutional homeopathic formulation Lycopodium clavatum. [ABSTRACT FROM AUTHOR]

Introduction: Several different modalities are available for ureteral stone fragmentation. From them pneumatic and holmium: yttrium-aluminum-garnet (Ho: YAG) lithotripsy have supportive outcomes. In this study we studied 250 subjects who had ureteroscopic pneumatic lithotripsy (PL) or laser lithotripsy (LL). Methods: Two-hundred fifty patients with ureteral stones underwent ureteroscopic lithotripsy (115 subjects in the PL group, 135 subjects in the LL group) from August 2010 to April 2016. The purpose of this investigation was to evaluate stone-free rate (SFR), mean operation time (MOT), mean hospital stay (MHS), stone migration and complications. Results: Two groups were similar in age, gender, mean size of stones, side of stone, and complications. There was a statistical difference in terms of SFR, stone migration and MHS in favor of the LL group (P . 0.05, P . 0.05 respectively), and MOT in favor of the PL group (P . 0.05). Conclusion: Both the PL and LL techniques were effective and safe for ureteral stones, however a slightly higher SFR was found in the LL group. [ABSTRACT FROM AUTHOR]

To evaluate the efficiency and safety of preoperative double-J stent placement for patients undergoing ureteroscopic lithotripsy. Eligible studies were identified from electronic databases (PubMed, Embase, the Cochrane Central Register of Controlled Trials, and the Cochrane Database of Systematic Reviews). All analyses were performed by the Review Manager 5.3 (The Cochrane Collaboration, Oxford, UK). Stone-free rate (SFR) was regarded as primary outcome. Second outcomes, including operation time, complication rates as well as major complication rates were also assessed. A total of 11,239 patients (2605 with and 8634 without preoperative stent) from nine retrospective studies were included. Our pooled analysis showed that SFR was significantly higher in patients with a preoperative stent than those without a stent (OR 1.60, 95% CI 1.19-2.15, p = 0.002). Operation time was not significantly different between stented and non-stented groups (OR − 0.89, 95% CI − 5.79-4.01, p = 0.72). No significant differences of complication rates were observed between stented and non-stented groups (OR 0.94, 95% CI 0.67-1.33, p = 0.73). Furthermore, major complication rates were not significantly different between two groups, either (OR 1.07, 95% CI 0.43-2.70, p = 0.88). Generally, preoperative double-J stent placement significantly improved SFR of patients undergoing ureteroscopic lithotripsy. Operation time, complication rates, as well as major complication rates, were similar between stented and non-stented groups. However, the effect of preoperative double-J stent placement for different locations and burden of stones is unclear, more high-quality studies should be anticipated. [ABSTRACT FROM AUTHOR]

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

Purpose Patients with obstructing ureteral stones typically experience sudden onset, severe pain. We examined the use of the NIH (National Institutes of Health) PROMIS® (Patient-Reported Outcome Measurement Information System) pain instruments in patients with acute ureteral stones. Materials and Methods PROMIS pain measures were obtained from a complete cohort of patients who presented to a subspecialty kidney stone clinic after emergency department discharge. Patients were followed longitudinally through the course of care. Raw scores were translated into population normed T-scores with a T-score of 50 indicating the mean pain population in the United States. Objective and patient centered factors were evaluated with reference to T-score thresholds for pain intensity with 60 equal to 1 SD above the mean and pain interference with 70 equal to 2 SD. Results Multivariable logistic regression in 650 patients demonstrated an absent association between pain scores and stone size or location. Pain scores were associated with patient age, gender and emergency department pain scores (p <0.05). Initial stone surgery was predicted by a stone size less than 4 mm (OR 0.14, 95% CI 0.07–0.3), greater than 6 mm (OR 19.1, 95% CI 0.22–39.58), proximal location (OR 1.75, 95% CI 1.34–2.3) and pain intensity greater than 60 (OR 7.03, 95% CI 3.63–13.6) but not pain interference (p <0.001). Failed attempted stone passage was less likely for stones less than 4 mm (OR 0.26, 95% CI 0.14–0.48, p <0.001) and more likely for proximal stones (OR 1.61, 95% CI 1.21–2.14, p <0.01) and pain intensity greater than 60 (OR 2.74, 95% CI 1.23–6.07, p <0.05). Conclusions PROMIS pain scores are independent of stone size and location. Attention to emergency department discharge symptom control offers the potential to improve patient care. PROMIS pain intensity is an independent predictor of surgical intervention in patients with ureteral stones 1 cm or less. [ABSTRACT FROM AUTHOR]

Introduction and objectives: Percutaneous nephrolithotomy remains a challenging procedure primarily due to difficulties obtaining access. Indeed, few urologists obtain their own access due to difficulties using a fluoroscopic or ultrasonic based antegrade puncture technique. Herein we report the first experience using holmium laser energy to obtain access in a retrograde fashion.Methods: After a pretreatment week of tamsulosin 0.4 mg/day (one center only) and following a documented sterile urine, a total of ten patients underwent retrograde holmium laser-assisted endoscopic-guided nephrostomy access in a prone split leg position.Results: In nine of ten patients, ureteroscopic guided, holmium laser access via an upper pole posterior calyx was achieved. In one patient, the laser tract could not be safely dilated and antegrade endoscopic and fluoroscopic guided access was performed. The mean operative time was 202 min; the mean fluoroscopy time was 32 s (6/9 cases). The mean pre-operative stone volume was 14,420 mm3. CT imaging on post-operative day 1 revealed 6/6 patients had residual stone fragments with total mean volume of 250 mm3 (96% reduction); there were no residual fragments in three patients who were evaluated with non-CT radiographic imaging (KUB). There was a single complication requiring angioembolization due to a subcapsular hematoma with associated secondary tearing of an inter-polar vessel remote from the nephrostomy site.Conclusions: Holmium laser-assisted endoscopic-guided retrograde access in a prone split-leg position was successfully performed at two institutions. The accuracy of nephrostomy placement and lessening of fluoroscopy time are two potential benefits of this approach. [ABSTRACT FROM AUTHOR]

Introduction: Ureteral colic has a lifetime prevalence of 10%–15% and is one of the most common emergency urologic presentations. Current European Association of Urology recommends conservative management for “small” (<6 mm) ureteral stones if active removal is not indicated. It is important to understand the natural history of ureteral stone disease to help counsel patients with regard to their likelihood of stone passage and anticipated time frame with which they could be safely observed. We aimed to conduct a systematic review to better establish the natural history of stone expulsion. Methodology: Literature search was performed using Cochrane and PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) guidelines. Outcome measures were patient and stone demographics, expulsion rates, expulsion times, and side effect of the medication. A cumulative analysis, with subgroup analysis, was performed on stone location and size. The results were depicted as percentages and an intention-to-treat basis was used. Results: The literature search identified 70 studies and a total of 6642 patients, with a median age of 46 and range of 18–74 years. Overall, 64% of patients successfully passed their stones spontaneously. About 49% of upper ureteral stones, 58% of midureteral stones, and 68% of distal ureteral stones passed spontaneously. Almost 75% of stones <5 mm and 62% of stones ≥5 mm passed spontaneously. The average time to stone expulsion was about 17 days (range 6–29 days). Nearly 5% of participants required rehospitalization due to a deterioration of their condition and only about 1% of patients experienced side effects from analgesia provided. Conclusion: We believe this current review is the largest study for the evaluation of natural history of ureteral stones. The evidence suggests that ureteral stones will pass without intervention in 64% of patients, however, this varies from nearly 50%–75% depending on the size and location, in the span of 1–4 weeks. [ABSTRACT FROM AUTHOR]

In this review, a simplified straightforward algorithmic approach to the metabolic evaluation and treatment of the at-risk or recurrent urolithiasis patient is provided. Eight diagnoses and eight therapies are provided, which cover over 95% of renal stone disease. [ABSTRACT FROM AUTHOR]

Purpose There is scant evidence in the literature to support dusting vs active basket extraction during ureteroscopy for kidney stones. We prospectively evaluated and followed patients to determine which modality produced a higher stone-free rate with the fewest complications. Materials and Methods Members of the Endourologic Disease Group for Excellence research consortium prospectively enrolled patients with a renal stone burden ranging from 5 to 20 mm in this study. A holmium laser was used and all patients were stented postoperatively. Ureteral access sheaths were used in 100% of basketing cases while sheaths were optional when dusting. The primary study outcome was the stone-free rate at 6 weeks as determined by x-ray and ultrasound. Results A total of 84 and 75 patients were enrolled in the basketing and dusting arms, respectively. Stones in the dusting group were significantly larger (mean ± SD stone area 96.1 ± 65.3 vs 63.3 ± 46.0 mm 2 , p <0.001). The stone-free rate was significantly higher in the basketing group on univariate analysis (74.3% vs 58.2%, p = 0.04) but not on multivariate analysis (1.9 OR, 95% CI 0.9–4.3, p = 0.11). In patients who underwent a basketing procedure operative time was 37.7 minutes longer than in those treated with a dusting procedure (95% CI 23.8–51.7, p <0.001). There was no statistically significant difference in complication rates, hospital readmissions or additional procedures between the groups. Conclusions The stone-free rate was higher for active basket retrieval of fragments at short-term followup on univariate analysis but not on multivariate analysis. There was no difference in postoperative complications or procedures. The 2 techniques should be in the armamentarium of the urologist. [ABSTRACT FROM AUTHOR]

Purpose The relative supersaturation of calcium oxalate, calcium phosphate and uric acid is used clinically in kidney stone prevention. The magnitude of the association between relative supersaturation and stone risk requires further quantification. Materials and Methods We performed a cross-sectional study using 24-hour urine collections from the NHS (Nurses' Health Study) I and II, and HPFS (Health Professionals Follow-up Study) cohorts to quantify the association between the relative supersaturation of calcium oxalate, calcium phosphate and uric acid, and the likelihood of stone formation. Results The OR of being a stone former was 5.85 (95% CI 3.40–10.04) in NHS I, 6.38 (95% CI 3.72–11.0) in NHS II and 6.95 (95% CI 3.56–13.6) in HPFS for the highest category of calcium oxalate relative supersaturation compared with less than 1.0. The OR of being a stone former was 1.86 (95% CI 0.94–3.71) in NHS I, 4.37 (95% CI 2.68–7.10) in NHS II and 3.59 (95% CI 2.04–6.31) in HPFS for the highest category of calcium phosphate relative supersaturation compared with less than 1.0. For uric acid relative supersaturation the OR of being a stone former was 4.30 (95% CI 2.34–7.90) in NHS I and 2.74 (95% CI 1.71–4.40) in NHS II for the highest relative supersaturation category compared with less than 1.0. In HPFS the uric acid relative supersaturation was not significantly associated with the likelihood of stone formation. Conclusions The likelihood of being a stone former increases with higher relative supersaturation of calcium oxalate and calcium phosphate in men and women, and with higher relative supersaturation of uric acid in women. [ABSTRACT FROM AUTHOR]

Purpose To help rein in surgical spending there is growing interest in the application of payment bundles to common outpatient procedures like ureteroscopy and shock wave lithotripsy. However, before urologists can move to such a payment system they need to know where episode costs are concentrated. Materials and Methods Using claims data from Michigan Value Collaborative we identified patients who underwent ureteroscopy or shock wave lithotripsy at hospitals in Michigan from 2012 to 2015. We then totaled expenditures for all relevant services during the 30-day surgical episodes of these patients and categorized component payments (ie those for the index procedure, subsequent hospitalizations, professional services and postacute care). Finally we quantified the variation in total episode expenditures for ureteroscopy and shock wave lithotripsy across hospitals, examining drivers of this variation. Results A total of 9,449 ureteroscopy and 6,446 shock wave lithotripsy procedures were performed at 62 hospitals. Among these hospitals there was threefold variation in ureteroscopy and shock wave lithotripsy spending. The index procedure accounted for the largest payment difference between high vs low cost hospitals (ureteroscopy $7,936 vs $4,995 and shock wave lithotripsy $4,832 vs $3,207, each p <0.01), followed by payments for postacute care (ureteroscopy $2,207 vs $1,711 and shock wave lithotripsy $2,138 vs $1,104, each p <0.01). Across hospitals the index procedure explained 68% and 44% of the variation in episode spending for ureteroscopy and shock wave lithotripsy, and postacute care payments explained 15% and 28%, respectively. Conclusions There exists substantial variation in ambulatory surgical spending across Michigan hospitals for urinary stone episodes. Most of this variation can be explained by payment differences for the index procedure and for postacute care services. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the viability and biocompatibility of a novel, patented bioadhesive system for intrarenal embedding and retrieval of residual fragments after endoscopic lithotripsy. Complete stone clearance via active removal of residual fragments (RF) after intracorporeal laser lithotripsy may be time-consuming and fail in many cases. Therefore, the novel adhesive has been developed and evaluated for the first time in an in vivo pig model in the present work.Methods: Four female domestic pigs underwent flexible ureteroscopy (RIRS) or percutaneous nephrolithotomy (PNL) under general anesthesia (8 kidneys, 4 × RIRS, 4 × PNL) evaluating the bioadhesive system. Interventions: RIRS without adhesive system (sham procedure, kidney I); 3 × RIRS using the bioadhesive system (kidneys II-IV); and 4 × PNL using the bioadhesive system (V-VIII). We endoscopically inserted standardized human stone probes followed by comminution using Ho:YAG lithotripsy. The bioadhesive (kidney II-VIII) was then applied and the adhesive-stone fragment complex extracted. After nephrectomy, all kidneys were evaluated by two independent, blinded pathologists. Endpoints were the procedure’s safety and adhesive system’s biocompatibility.Results: We observed no substantial toxic effects. We were able to embed and remove 80-90% of fragments. However, because of the pig’s hampering pyelocaliceal anatomy, a quantified, proportional assessment of the embedded fragments was compromised.Conclusions: For the first time, we demonstrated the proven feasibility and safety of this novel bioadhesive system for embedding and endoscopically removing small RF in conjunction with a lack of organ toxicity in vivo. [ABSTRACT FROM AUTHOR]

Objectives: To present the safety and efficacy of fluoroscopy-free ultrasound-guided PCNL for the treatment of renal calculi in pediatric patients of all ages.Methods: 30 children with mean age of 5 years (6 months-12 years) underwent totally ultrasound-guided PCNL from March 2013 to August 2016. The pyelocalyceal system was punctured in prone position using only ultrasonography guidance, and the tract was dilated using a single shot dilation technique. No fluoroscopy was used during any of the stages of renal access. The procedure was performed using adult-sized instruments.Results: The mean stone size was 27.1 ± 8.7 mm. Mean access time was 4.3 ± 2 min. Mean nephroscopic time was 34.6 ± 15.2 min. Mean hospital stay of patients was 3 days (range 2-5). 21 patients were stone-free after the procedure (70% success rate). Only four patients out of 30 experienced postoperative complications.Conclusions: The results of this study showed that fluoroscopic-free ultrasound-guided PCNL in pediatric patients of all ages is safe, highly efficient, and minimizes potential radiation exposure risks associated with the procedure. [ABSTRACT FROM AUTHOR]

Aim: The aim of this study is to compare the outcomes of miniaturized percutaneous nephrolithotomy (mini-perc) and retrograde intrarenal surgery (RIRS) in management of renal stones with a diameter <15 mm. Materials and Methods: This was an open-label prospective study that included a total of 80 cases underwent mini-perc (n = 40) and RIRS (n = 40) between July 2014 and August 2017. The primary outcome objective was stone-free rate, retreatment rate, complications, hospital stay, operative time, and reduction in hemoglobin level. Data were analyzed using SPSS version 16.0 Software. Results: Overall, 80 patients were enrolled in this study. The mean age was 40.12 and 38.20 years, and the mean stone size was 1.15 and 1.30 cm in mini-perc and RIRS group, respectively. Majority of the study participants were males. Overall, mini-perc and RIRS had stone clearance rates of 100% and 95.4%, respectively. Two patients required retreatment in RIRS group. The duration of hospital stay and the rate of complication was similar in both the groups. Operative duration was more in RIRS group. Decrease in hemoglobin level was more in mini-perc group. Conclusions: Results demonstrated that both modalities were associated with high stone clearance rates with minimal complications. RIRS was associated with less reduction in hemoglobin and could be used as standard treatment modality for small renal calculi. [ABSTRACT FROM AUTHOR]

Purpose: Burst wave lithotripsy (BWL) is a new technology in development to fragment urinary stones. Ultrasonic propulsion (UP) is a separate technology under investigation for displacing stones. We measure the effect of propulsion pulses on stone fragmentation from BWL. Materials and Methods: Two artificial stone models (crystalline calcite, BegoStone plaster) and human calcium oxalate monohydrate (COM) stones measuring 5 to 8 mm were subjected to ultrasound exposures in a polyvinyl chloride tissue phantom within a water bath. Stones were exposed to BWL with and without propulsion pulses interleaved for set time intervals depending on stone type. Fragmentation was measured as a fraction of the initial stone mass fragmented to pieces smaller than 2 mm. Results: BegoStone model comminution improved from 6% to 35% (p < 0.001) between BWL and BWL with interleaved propulsion in a 10-minute exposure. Propulsion alone did not fragment stones, whereas addition of propulsion after BWL slightly improved BegoStone model comminution from 6% to 11% (p < 0.001). BegoStone model fragmentation increased with rate of propulsion pulses. Calcite stone fragmentation improved from 24% to 39% in 5 minutes (p = 0.047) and COM stones improved from 17% to 36% (p = 0.01) with interleaved propulsion. Conclusions: BWL with UP improved stone fragmentation compared with BWL alone in vitro. The improvement was greatest when propulsion pulses are interleaved with BWL treatment and when propulsion pulses are applied at a higher rate. Thus, UP may be a useful adjunct to enhance fragmentation in lithotripsy in vivo. [ABSTRACT FROM AUTHOR]

Purpose: Nephrolithiasis is an increasingly common ailment in the United States. Ureteroscopic management has supplanted shockwave lithotripsy as the most common treatment of upper tract stone disease. Ureteral stricture is a rare but serious complication of stone disease and its management. The impact of new technologies and more widespread ureteroscopic management on stricture rates is unknown. We describe our experience in managing strictures incurred following ureteroscopy for upper tract stone disease. Materials and Methods: Records for patients managed at four tertiary care centers between December 2006 and October 2015 with the diagnosis of ureteral stricture following ureteroscopy for upper tract stone disease were retrospectively reviewed. Study outcomes included number and type (endoscopic, reconstructive, or nephrectomy) of procedures required to manage stricture. Results: Thirty-eight patients with 40 ureteral strictures following URS for upper tract stone disease were identified. Thirty-five percent of patients had hydronephrosis or known stone impaction at the time of initial URS, and 20% of cases had known ureteral perforation at the time of initial URS. After stricture diagnosis, the mean number of procedures requiring sedation or general anesthesia performed for stricture management was 3.3 ± 1.8 (range 1–10). Eleven strictures (27.5%) were successfully managed with endoscopic techniques alone, 37.5% underwent reconstruction, 10% had a chronic stent/nephrostomy, and 10 (25%) required nephrectomy. Conclusions: The surgical morbidity of ureteral strictures incurred following ureteroscopy for stone disease can be severe, with a low success rate of endoscopic management and a high procedural burden that may lead to nephrectomy. Further studies that assess specific technical risk factors for ureteral stricture following URS are needed. [ABSTRACT FROM AUTHOR]

Objective: To determine how sheath and endoscope size affect intrarenal pelvic pressures and risk of postoperative infectious complications comparing “Mini” vs “Standard” percutaneous nephrolithotomy (PCNL). Materials and Methods: Uropathogenic Escherichia coli were grown and 109 of them were instilled into the porcine renal pelvis through retrograde access for 1 hour. Percutaneous access utilized a 14/16F 20 cm ureteral access sheath for the Mini arm and a 30F sheath for the Standard arm. Nephroscopy was simulated utilizing either an 8/9.8F semirigid ureteroscope or 26F nephroscope for 1 hour while intrarenal pelvic pressure was continuously monitored. Blood and tissue cultures of kidney, liver, and spleen biopsies were plated and incubated and positive cultures were confirmed with polymerase chain reaction. Results: Intrapelvic pressures were higher in the Mini group, 18.76 ± 5.82 mm Hg vs 13.56 ± 5.82 mm Hg (p < 0.0001). Time spent above 30 mm Hg was greater in the Mini arm, 117.0 seconds vs 66.1 seconds (p = 0.0452). All pigs had positive kidney tissue cultures whereas spleen cultures were positive in 100% and 60% of pigs in the Mini and Standard arms, respectively (p = 0.0253); 90% and 30% had positive liver tissue culture in the Mini and Standard arms, respectively (p = 0.0062). Blood cultures were positive in 30% of pigs in the Mini arm compared with none in the Standard arm (p = 0.0603). Conclusion: Mini-PCNL was associated with higher intrarenal pressures and higher risk of end organ bacterial seeding in the setting of an infected collecting system. This suggests a higher potential for infectious complications in a clinical setting. [ABSTRACT FROM AUTHOR]

Background Percutaneous procedures to treat common bile duct (CBD) stones typically require access via intrahepatic bile ducts. This study aimed to describe the outcomes of a percutaneous transcystic approach that expelled the CBD stones into the duodenum after percutaneous transcystic balloon dilation of the ampulla (PTCBDA) for high-risk patients who present with acute cholecystitis and CBD stones. Methods Patients diagnosed with acute cholecystitis and CBD stones who were deemed too high-risk for surgery or general anesthesia and were treated with PTCBDA and CBD stone removal between March 2010 and November 2015 were included for further analysis. Patients underwent emergency percutaneous transhepatic gallbladder drainage under ultrasound. Staged PTCBDA and CBD stone expulsion were performed. Outcomes evaluated included the success rate, causes of failure, and complications. Results Eighteen patients met the inclusion criteria. CBD stones were successfully expelled in 16 patients. A second procedure was performed in one patient because of residual stones. The procedure failed in two patients because their stones were large. One patient developed bile peritonitis and underwent percutaneous catheter drainage. Discussion Percutaneous transcystic anterograde expulsion of CBD stones may be a feasible and effective method for treating high-risk surgical patients with acute cholecystitis and co-existing CBD stones. [ABSTRACT FROM AUTHOR]

OBJECTIVE: To determine the frequency of stone-free rate after extracorporeal shockwave lithotripsy (ESWL) and its relationship with Hounsfield Units (HUs) of renal calculi. METHODOLOGY: This observational study was carried out at the Department of Urology, Sindh Institute of Urology and Transplantation (SIUT), Karachi, Pakistan, from June 2015 to December 2015. All patients were evaluated for serum creatinine, coagulation profile, urinalysis and culture and imaging studies including non-contrast computed tomography (NCCT). All were evaluated with X-ray and ultrasound KUB at six weeks of ESWL session. Patients with residual fragments more than 4 mm in size were offered another session of ESWL. In case of persistent stone fragments more than 4 mm in size, stones were labeled as ESWL-refractory and alternative treatment options offered. RESULTS: A total of 139 patients were included in this study. The mean age was 40.0 ± 8.9 years and 91 (65.47%) were males. The mean stone size and mean HUs of all patients were 12.7 ± 3.6 mm and 616.9 ± 304.3, respectively. On last follow-up, out of 139, 95 (68.3%) patients were in stone-free group and 44 (31.6%) in residual stone group, with a mean HUs value of 565 ± 62.1 and 905 ± 61.7, respectively (p=0.001). The mean HUs of stone-free group was significantly lower than that of residual stone group. CONCLUSION: Our findings suggest that the HU measurement of renal calculi on pretreatment NCCT might be helpful in predicting stone-free rate after ESWL. [ABSTRACT FROM AUTHOR]

Objective: To test whether duplicate imaging relates to a lack of information sharing among providers, we measured the association between emergency department (ED) switching during a kidney stone episode and receipt of a repeat computed tomography (CT) scan.Methods: Using the MarketScan Commercial Claims and Encounters Database, we identified adults between the ages 18 and 64 with an ED visit for a diagnosis of kidney stones. Among patients who had an abdominal or pelvic CT scan at their initial encounter, we then determined the subset that made an ED revisit within 30 days of their first, distinguishing between those to the same vs a different ED. Finally, we fit multivariable logistic regression models to estimate the risk of receiving a repeat CT scan associated with ED switching.Results: Twelve percent of patients who received a CT scan at their initial ED encounter had a revisit within 30 days of discharge. One-third of their revisits were made to a different ED than the index one. Duplicate CT scans were obtained at nearly 40% of all revisits. On multivariable analysis, the risk of receiving a repeat CT was 12% higher if this revisit was made to a different ED (risk ratio, 1.12; 95% confidence interval, 1.03-1.21; P = .010).Conclusion: Our study reveals that ED switching during an acute kidney stone episode is associated with higher levels of repeat CT imaging. These findings support the role of better health information exchange among providers to help reduce waste in the health-care system. [ABSTRACT FROM AUTHOR]