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Background: Children's urinary system stones may develop from environmental, metabolic, anatomical, and other causes. Our objective is to determine the recurrence and prognosis, demographic, clinical, and etiological characteristics of children with urolithiasis., Methods: Medical records of patients were evaluated retrospectively. Patients' demographic data and medical history, serum/urine biochemical and metabolic analysis, blood gas analysis, stone analysis, imaging findings, and medical/surgical treatments were recorded., Results: The study included 364 patients (male 187). Median age at diagnosis was 2.83 (IQR 0.83-8.08) years. The most common complaints were urinary tract infection (23%) and urine discoloration (12%). Sixty-two percent had a family history of stone disease. At least one metabolic disorder was found in 120 (88%) of 137 patients having all metabolic analyses: hypercalciuria was found in 45%, hypocitraturia in 39%, and hyperoxaluria in 37%. Anatomical abnormalities were detected in 18% of patients. Of 58 stones analyzed, 65.5% were calcium and 20.6% were cystine stones. Stone recurrence rate was 15% (55/364). Older age (> 5 years), family history of stone disease, stone size (≥ 5 mm), and urinary system anatomical abnormalities were significantly associated with stone recurrence (p = 0.027, p = 0.031, p < 0.001, and p < 0.001, respectively). In adjusted logistic regression analysis, stone size ≥ 5 mm (OR 4.85, 95% CI 2.53-9.3), presence of urinary system anatomical abnormalities (OR 2.89, 95% CI 1.44-5.78), and family history of stone disease (OR 2.41, 95% CI 1.19-4.86) had increased recurrence rate., Conclusions: All children with urolithiasis should be evaluated for factors affecting stone recurrence. Children at higher risk of recurrence need to be followed carefully., (© 2024. The Author(s).)

Evaluate urinary stone components' epidemiological features in urolithiasis individuals and explore potential correlations between stone components and patients' clinical characteristics. A retrospective analysis of urinary stone compositions in 496 patients from a northern Taiwan medical center (February 2006 to October 2021) was conducted. We investigated associations between sex, age, body mass index (BMI), hypertension, diabetes mellitus (DM), hyperlipidemia (HLP), gout, coronary artery disease (CAD), cerebral vascular accident (CVA), chronic kidney disease (CKD), habits, urine pH, and three main stone groups: calcium oxalate (CaOx), calcium phosphate (CaP), and uric acid (UA). Males accounted for 66.5% of cases, with a male-to-female ratio of 1.99:1. Males were negatively associated with CaP stones (OR 0.313, p < 0.001) and positively with UA stones (OR 2.456, p = 0.009). Age showed a negative correlation with CaOx stones (OR 0.987, p = 0.040) and a positive correlation with UA stones (OR 1.023, p < 0.001). DM had a protective effect against CaP stones (OR 0.316, p = 0.004). Gout had a positive association with UA stones (OR 2.085, p = 0.035). Smoking was adversely associated with UA stones (OR 0.350, p = 0.018). Higher urine pH was a risk factor for CaP stones (OR 1.641, p = 0.001) and a protective factor against UA stones (OR 0.296, p < 0.001). These results may provide insights into the pathogenesis of urinary stones and the development of preventative strategies for high-risk populations. Further research is required to confirm and expand upon these findings., (© 2024. The Author(s).)

This cross-sectional study aimed to explore the knowledge, attitudes, and practices (KAP) regarding urinary system stones among the general public in Chengdu, China. Conducted between January and June 2023, this research targeted individuals undergoing physical examinations at the Health Management Center of Sichuan Provincial People's Hospital. Structured questionnaires were administered to collect demographic information and assess KAP related to urinary system stones. Following meticulous scrutiny, 1014 valid questionnaires were retained for analysis. The computed scores for knowledge, attitude, and practice were 9.36 ± 4.23 (possible score range 0-17), 37.75 ± 7.20 (possible score range 11-55), and 30.77 ± 4.00 (possible score range 10-50), respectively. These outcomes suggested insufficient knowledge and moderately positive attitudes and practices among the participants. Structural Equation Modeling (SEM) analysis revealed a direct impact of knowledge on attitude (β = 0.967, P < 0.001), with attitude subsequently exerting a direct influence on practice (β = 0.167, P < 0.001). This indicated an indirect impact of knowledge on practice. Additionally, there was a direct effect of knowledge on practice (β = 0.167, P < 0.001). In conclusion, the general populace in Chengdu exhibited insufficient knowledge and moderate attitudes and practices concerning urinary stones. These findings underscore the imperative for targeted educational interventions aimed at enhancing public awareness and fostering positive attitudes and practices toward urinary stone prevention and management., (© 2024. The Author(s).)

To investigate the relationship between several factors and urinary stone as well as different stone compositions. To guide the diagnosis, treatment, and prevention of urinary stone recurrence. We used bidirectional Mendelian randomization to analyze the causal relationship between hypertension and urinary stones, diabetes and urinary stones, and body mass index (BMI) and urinary stones. We retrospectively analyzed the medical records of patients with urinary stones admitted to a tertiary care hospital in Chongqing, China, from July 2015 to October 2022. Patients were included when they were first diagnosed with urinary stones. The odds ratio of calculi on hypertension estimated by inverse variance weighted was 8.46 (95%CI: 4.00-17.90, P = 2.25 × 10-8). The stone composition analysis showed that there were 3101 (67.02%) mixed, 1322 (28.57%) calcium oxalate monohydrate, 148 (3.20%) anhydrous uric acid, 16 (0.35%) magnesium ammonium phosphate hexahydrate, 11 (0.24%) dicalcium phosphate dihydrate, 10 (0.22%) carbonate apatite, 8 (0.17%) L-cystine, 4 ammonium uric acid (0.09%), and 7 other stone types (0.15%). Mendelian randomization studies have proven that urinary stones may be a potential risk factor for hypertension, while there is no causal relationship between diabetes and stones, BMI, and stones. Our retrospective study has shown that urinary stone components are closely associated with sex, age, hypertension, diabetes, and BMI. It is reasonable to suspect that treating a single stone component is ineffective in preventing recurrence. We also found that the peak incidence of urinary stones was at the most active stage of most people's working lives., Competing Interests: The authors have no funding and conflicts of interest to disclose., (Copyright © 2024 the Author(s). Published by Wolters Kluwer Health, Inc.)

Objective: This study aimed to quantitatively analyze the calculi components of upper urinary tract calculi and to explore the relationship between calculus components, demographic characteristics, and underlying diseases., Patients and Methods: Clinical data of 1,495 patients with upper urinary tract calculi were retrospectively collected. The calculi were divided into simple calcium oxalate, calcium oxalate mixed, calcium phosphate mixed, uric acid, magnesium ammonium phosphate, and other components. Statistical software SPSS 22.0 was used to analyze the differences between the stone compositions and various factors. The influencing factors (p < 0.05) were analyzed using multiple logistic regression analysis., Results: Among 1,495 patients with upper urinary tract calculi, simple calcium oxalate calculi were the most common component (39.7%), followed by calcium oxalate mixed calculi (30.4%), uric acid calculi (13.6%), calcium phosphate mixed calculi (10.4%), magnesium ammonium phosphate calculi (5.8%) and other component calculi (0.1%). Univariate analysis revealed statistically significant differences in stone composition according to gender, age, and hyperuricemia (p < 0.05). Multiple logistic regression analysis showed that compared to men, the odds ratio (OR) values of calcium oxalate mixed stones, calcium phosphate mixed stones, and magnesium ammonium phosphate stones in women were 1.61, 2.50, and 4.17, respectively (p < 0.001). Compared with elderly patients, the OR values of calcium phosphate mixed stones in young and middle-aged patients were 3.14 and 2.70, respectively (p < 0.05)., Conclusions: Patients with different stone components had different demographic characteristics, and stone components were significantly different between gender and age. Calcium oxalate mixed stones were more common in females, and calcium phosphate mixed stones and magnesium ammonium phosphate stones were more common in females, young patients, and middle-aged patients.

Purpose: This study aimed to investigate the influence of surgical intervention on recurrence risk of upper urinary tract stone and compare the medical burden of various surgical procedures., Methods: This study analyzed data from patients with upper urinary tract stone extracted from a national database of hospitalized patients in China, from January 2013 to December 2018. Surgical recurrence was defined as patients experience surgical procedures for upper urinary tract stone again with a time interval over 90 days. Associations of surgical procedures with surgical recurrence were evaluated by Cox regression., Results: In total, 556,217 patients with upper urinary tract stone were included in the present analysis. The mean age of the population was 49.9 ± 13.1 years and 64.1% were men. During a median follow-up of 2.7 years (IQR 1.5-4.0 years), 23,012 patients (4.1%) had surgical recurrence with an incidence rate of 14.9 per 1000 person-years. Compared to patients receiving open surgery, ESWL (HR, 1.59; 95% CI 1.49-1.70), URS (HR, 1.38; 95% CI 1.31-1.45), and PCNL (HR, 1.11; 95% CI 1.06-1.18) showed a greater risk for surgical recurrence. Patients receiving ESWL had the shortest hospital stay length and the lowest cost among the 4 procedures., Conclusions: Compared with open surgery, ESWL, URS, and PCNL are associated with higher risks of surgical recurrence for upper urinary tract stone, while ESWL showed the least medical burden including both expenditure and hospital stay length. How to keep balance of intervention efficacy and medical expenditure is an important issue to be weighed cautiously in clinic practice and studied more in the future., (© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

The current report aimed to evaluate the characteristics of stone composition in 3637 renal and ureteral calculi patients in a single center while clarifying its relationship with sex, age, and time. Out of 3637 cases of upper urinary tract stones, stone specimens were analyzed retrospectively. There were 2373 male patients aged 6 months-87 years, with an average age of 44.73 ± 15.63 years, and 1264 female patients aged 4 months-87 years, with an average age of 46.84 ± 16.00 years. The male-female ratio was 1.88:1. Five hundred twelve patients had ureteral calculi, and 3125 had renal calculi. The SPSS software helped analyze the relationship between renal and ureteral calculi composition and sex, age, and time. Stone composition demonstrated 2205 cases of calcium oxalate stones (60.6%), 518 carbonate apatite (14.2%), 386 uric acids (10.6%), 232 magnesium ammonium phosphate (6.4%), 117 calcium phosphate (3.2%), 76 cystine (2.1%), 47 sodium urate (1.3%), 31 others (0.9%), and 25 ammonium urate (0.7%) cases. The overall male-to-female sex ratio was 1.88:1. Stones in the upper urinary tract were significantly more frequent in men than in women between the ages of 31 and 60. However, such stones were significantly more frequent in women than men over 80 (P < .05). Cystine, Sodium urate, Carbonated apatite, and uric acid indicated significant differences between different age categories (all P < .001). Stone composition analyses revealed that the frequency of calcium oxalate calculi has increased annually, while cystine and carbonated apatite incidences have dropped annually over the past decade. The components of renal and ureteral calculi vary significantly based on age and sex, with calcium oxalate calculi being more frequent in men while magnesium ammonium phosphate stones are more frequent in female patients. The age between 31 and 60 years is the most prevalent for renal and ureteral calculi in men and women., Competing Interests: The authors have no funding and conflicts of interest to disclose., (Copyright © 2024 the Author(s). Published by Wolters Kluwer Health, Inc.)

Urolithiasis, or the formation of calculi in the urinary system, represents a prevalent urological condition frequently encountered among individuals aged 30 to 55 years. An in-depth analysis of the composition of these calculi holds significant promise in shedding light on the underlying etiological and pathogenic factors contributing to this ailment. The primary objective of this study was to delineate the principal components comprising urinary system calculi within a cohort of patients who sought medical intervention at a tertiary grade A hospital located in Baoding City. Furthermore, our investigation entailed a comprehensive examination of the physical and morphological characteristics exhibited by these calculi. In this study, a total of 2307 individuals afflicted with urinary system calculi were recruited as participants, and a corresponding number of 2307 calculous specimens were subjected to thorough examination. The specimens were examined using infrared spectroscopy. We collected and examined patient data including gender, age, location of the calculi, employment status, residential area, and other factors. The middle-aged demographic exhibited a conspicuous predilection for urinary system calculi, wherein a notable gender disparity was observed, with a male-to-female ratio of 1.63 to 1. Among the enrolled patients, kidney calculi were prevalent in 1270 cases, ureteral calculi were documented in 983 cases, and bladder calculi were encountered in 46 instances. Notably, the principal components comprising these calculi were identified as calcium oxalate and apatite, while uric acid and ammonium magnesium phosphate were comparatively less frequently encountered. Furthermore, the analysis of calculus composition across patients residing in distinct geographical regions did not reveal any statistically significant variations. The identification of components within upper urinary tract calculi plays a pivotal role in elucidating the root causes of calculus formation. This valuable information empowers healthcare professionals, particularly nursing staff, to provide personalized dietary and health guidance to patients, thereby enhancing the quality of care and promoting more effective management of this condition., Competing Interests: The authors have no conflicts of interest to disclose., (Copyright © 2024 the Author(s). Published by Wolters Kluwer Health, Inc.)

Proper analysis of urinary stone composition is a cornerstone for diagnosis, targeted treatment and recurrence prevention of urolithiasis. The aim of this study was to determine the composition, frequency and distribution of mixed stones according to gender and age of patients. A total of 42,519 urinary stones from 30,311 men and 12,208 women submitted between January 2007 and December 2020 were studied. Most urinary calculi consisted of two components (50.9%), followed by stones of a single constituent (27.1%) and three-component stones (21.9%), while four-component stones were only rarely identified (0.1%). Among all stones, 49.8% consisted of whewellite (COM), weddellite (COD), and mixtures of COM and COD, 33.8% were pure carbonate apatite (CA) and mixtures of CA with COM and/or COD, while 7.6% were composed of uric acid anhydrous (UAA), uric acid dihydrate (UAD), and mixed UAA and UAD. The remaining 8.8% of calculi were rare single-component stones and rare mixtures of various constituents. The number of stone components was inversely associated with age (p < 0.001). The proportion of men decreased significantly with the number of stone constituents, from 3.01:1 for single-component stones to 1.0:1 for four-component urinary calculi (p < 0.001). The vast majority of urinary calculi consisted of two or more components in varying proportions. While age was inversely associated with the number of stone constituents, the proportion of women increased significantly from single-component to four-component urinary calculi. A significant proportion of mixed stones could present a challenge for diagnosis and targeted recurrence prevention., (© 2024. The Author(s).)

Objectives: The purpose of this study was to determine changes in urolith trends and factors associated with different urolith types in dogs from the Republic of Ireland and Northern Ireland between 2010 and 2020., Materials and Methods: A laboratory database was searched for canine urolith submissions between 2010 and 2020. Trends in urolith composition between 2014 and 2020, and associations between patient characteristics with each urolith type were evaluated., Results: A total of 1162 submissions were included. Struvite (39.0%), calcium oxalate (27.8%) and compound (10.2%) were the most prevalent uroliths. Calcium oxalate urolith (CaOx) incidence significantly increased from 27.8% to 31.2% and that of struvite significantly decreased from 41.7% to 33.0% between 2014 and 2020. Struvite uroliths were overrepresented among females compared to males (odds ratio 8.7, 95% confidence interval 6.6 to 11.5). Males (odds ratio 9.6, 95% confidence interval 6.9 to 13.3) and dogs >7 years of age (odds ratio 4.1, 95%, confidence interval 3.0 to 5.4) were more likely to have CaOx while males (odds ratio 9.6, 95% confidence interval 5.3 to 17.8) and dogs ≤7 year of age, purine uroliths (odds ratio 3.0, 95% confidence interval 1.8 to 5.0). Incidence was higher in bichon frise (odds ratio 1.7, 95% confidence interval 1.3 to 2.4) and Yorkshire terrier (odds ratio 2.8, 95% confidence interval 1.9 to 4.1) for CaOx and higher in shih-tzu for compound uroliths (odds ratio 1.7, 95% confidence interval 1.1 to 2.7) compared to the remaining reported breeds., Clinical Significance: Factors associated with different uroliths were similar to the ones previously reported. Proportion of CaOx submissions increased and that of struvite decreased over the study period which was in agreement with the changes identified in other European countries., (© 2023 British Small Animal Veterinary Association.)

Background: Urinary tract problems are a common complaint in small animal medicine and urolithiasis is considered to be an important cause of urinary tract disease in dogs. In this study the main aim was to investigate whether the occurrence of cystine urolithiasis increased during a five-year period. A second aim was to evaluate possible risk-factors as breed, age and gender. This study also evaluated how urine specific gravity, pH and level of cystine in urine responded to preventive strategies. Medical records of dogs with urolithiasis presented at nine Norwegian animal clinics and one animal hospital between 2015 and 2020 were retrospectively reviewed., Results: The incidence of cystine uroliths increased significantly during the five study years (R 2  = 0.72, P = 0.0199). Dogs with cystine uroliths were significantly younger (5.0 years (n = 84, 95% CI [4.4-5.6])) when they were diagnosed with cystine uroliths compared to dogs with other types of uroliths (8.1 years (n = 255, 95% CI[7.8-8.5]) P < < 0.0001). Cystine levels in urine were increased in 93% of the dogs with cystine urolithiasis. Cystinuria decreased significantly after neutering (P < 0.0001). Breeds most commonly affected with cystine urolithiasis in this study were Staffordshire bull terrier, Danish Swedish farmdog and Chihuahua., Conclusions: The results from this study supports a suggested genetic basis for cystine urolithiasis as described in previous studies. Neutering is considered an important part of preventing reoccurrence since cystine values decreased significantly after neutering., (© 2023. The Author(s).)

Background and Objectives : Urinary tract stones have long been a common ailment afflicting the population, with a high incidence and a wide distribution across different age groups. Effectively preventing the occurrence of urinary tract stones is of paramount importance. The primary aim of this study is to investigate the correlations between individual characteristics, water consumption habits, dietary habits, exercise habits, and the occurrence of urinary tract stones in a Taiwanese population. Materials and Methods: This study is cross-sectional research conducted over one month in 2022. One hundred eligible urinary stone cases were recruited through physician screening at outpatient clinics, and an additional one hundred samples from surgical outpatients without urinary tract stones were included as the control group. A questionnaire survey was employed to gather information on demographic variables, dietary habits, water consumption, and exercise habits of the cases. Descriptive statistics, chi-square tests, and logistic regression were used to explore the impact of relevant factors on urinary stone formation. Results: The analysis results revealed that among the demographic variables, males exhibited a higher risk of contracting urinary tract stones than females, and the majority of cases fell within the 40- to 49-year-old age group. Unhealthy lifestyle habits such as smoking and betel nut chewing also demonstrated a higher susceptibility to urinary tract stones. A logistic regression analysis showed that individuals who engaged in physical activity more than three times per week and those with inadequate water intakes had a higher risk of developing urinary tract stones. Conclusions: There is a close relationship between lifestyle and urinary tract stones. It is recommended that individuals continue to hydrate adequately during exercise.

Objectives: To understand the implications that the rising upper urinary tract (UUT) stone prevalence in Europe and the increasing burden places on patients and healthcare providers (HCPs), we investigated the evolution of diagnoses and procedures in Germany, France and England over the decade before the coronavirus disease 2019 (COVID-19) pandemic., Methods: We identified International Classification of Diseases (ICD)-10 codes related to UUT stones diagnosis and extracted procedure volumes for extracorporeal shockwave lithotripsy (ESWL), ureteroscopy (URS), percutaneous nephrolithotomy and open surgery using national procedure codes from the German Institute for the Hospital Remuneration System, the French Technical Agency of Hospitalisation Information and NHS England Hospital Episode Statistics. We analysed procedures vs hospital diagnoses from 2010 to 2019 and reported results per 100 000 inhabitants., Results: Between 2010 and 2019, ICD-10 N20 codes for calculus of kidney and ureter increased by 8%, 26% and 15% in Germany, France, and England respectively; whereas procedures increased by 3%, 38% and 18%. Of the patients diagnosed with stones, the percentage that received treatment (of any type) differed between countries. In 2019, in Germany 83% of patients diagnosed with stones received treatment, in France 88%, and in England 56%. These figures were relatively stable over the 10-year study period. Over the past decade, the dominant procedure shifted from ESWL to URS, and the average length of stay for URS decreased. Day case procedures increased in France and England (by 68% and 23%), no data were available in Germany., Conclusion: This analysis highlights an increase in stone diagnoses and procedures, and a shift of surgical management. This development may be due to clinical advantages and advanced technology. The continued stone prevalence rise affects patients, hospitals, and HCPs., (© 2023 The Authors. BJU International published by John Wiley & Sons Ltd on behalf of BJU International.)

Introduction:  The aim of the study is to explore the relationship between clinical characteristics and urinary calculus in Xinjiang Uyghur children, and to provide clinical basis for the prevention as well as treatment of urinary stone., Materials and Methods:  In total, 236 urinary tract stone samples were collected from pediatric patients from February 2017 to April 2019, and those samples were analyzed by infrared spectroscopy. Stone compositions were compared with demographic data., Results:  Among the 236 cases, 166 cases were boys (70.34%) and 70 cases were girls (29.66%), with a male-to-female ratio of 2.37:1. A total of 21 kinds of calculi were detected, including 107 cases with six kinds of simple calculi and 129 cases with 15 kinds of mixed calculi. In this study, magnesium ammonium phosphate hexahydrate was only found in boys, and the difference was statistically significant (6.6 vs. 0.0%, p  = 0.037). There were statistical differences in the age distribution of children with ammonium hydrogen urate, calcium oxalate, and other stone components ( p  < 0.05), while there were no statistical differences in the age distribution of children with apatite carbonate, magnesium ammonium phosphate hexahydrate, and anhydrous uric acid. The results showed that there was a significant difference in the localization of calculi between male and female children (upper urinary tract stones: 78.9 vs. 98.6%, p  < 0.001)., Conclusion:  Uyghur pediatric patients with urolithiasis were young and the majority of stones was mixed, The main components of calculi were ammonium hydrogen urate, calcium oxalate and apatite carbonate, and there are differences in the localization of calculi between genders., Competing Interests: None declared., (Thieme. All rights reserved.)

Background: Pediatric urinary stone disease (USD) is a costly medical problem. This study aims to assess the clinical characteristics and outcomes of common and rare causes of pediatric USD., Methods: A retrospective descriptive cohort study included all children < 13 years of age with confirmed USD admitted to the Children's University Hospital in Damascus, Syria, from January 2013 to December 2019. The study sample was divided into two groups based on etiologies: common and rare causes groups., Results: We evaluated 235 patients; 147 of them were males, and the male-to-female ratio was 1.7:1. The common causes group consisted of 203 patients (mean age 3.52 ± 3.66 years) and mainly included metabolic disorders (45.5%) and anatomical abnormalities (22.3%), while the rare causes group included 32 cases (mean age 4.93 ± 4.08 years), 12 patients with uric acid stones (37.5%), 7 patients with cystinuria (21.9%), and primary hyperoxaluria in 5 patients (15.6%). In addition, 39.6% of study patients were born to consanguineous marriages. Sixty-two patients developed AKI, and eleven patients had chronic kidney disease (CKD). Patients with rare causes were more likely to have AKI, CKD, bilateral stones, and recurrent stones (P-value < 0.05). Stone analysis was performed on 83 patients, and the main stone types were calcium oxalate (34.9%), uric acid (14.4%), and struvite stones (12%). Surgery was the most performed treatment in 101 patients (56.7%)., Conclusion: Patients with rare causes of pediatric USD are at a higher risk for severe complications and require early diagnosis and management. The high rate of uric acid stones in our society requires further evaluation for possible underlying causes. A higher resolution version of the Graphical abstract is available as Supplementary information., (© 2023. The Author(s), under exclusive licence to International Pediatric Nephrology Association.)

Background: The COVID-19 pandemic has changed the number of patients seeking medical help from the emergency service (ES) with non-COVID complaints, consequencing in postponed presentations of different surgical and medical situations. Acute urinary stone disease is one of these situations and needs to be investigated in terms of the effect of COVID-19 on its presentation to the ES., Methods: In this observational, retrospective, and single-center study, we scanned each abdominopelvic computed tomography requested in ES for possible acute urolithiasis during 1 year before and after the outbreak of COVID-19. We searched to state the number of abdominopelvic computed tomographies applied and the number of ratifying urinary stone positivity. We enrolled patients' gender, age, stone location, and stone size. We also recorded C-reactive protein, leukocyte count, and creatinine and noted how long the patients suffering from pain, the duration until the intervention, and the management option selected for each case., Results: Total number of abdominopelvic computed tomographies performed was 1089. Of these, 517 were pre-pandemic and 572 were peri-pandemic. The number of pre and peri-pandemic stone-positive scans were, respectively, 363 (70.2%) and 379 (66.2%) (P=0.643). The females' percentage in the COVID-19 period (37.2%) was significantly lower than in the pre-pandemic period (54.3%) (P=0.013). The median size of ureter stones of the pre and peri-pandemic groups were, respectively, 4.8 mm and 3.9 mm depicting no significant difference (P=0.197). No significant difference was sighted between the pre and peri-pandemic groups concerning stone locations, blood parameters, painful duration, treatment options, and time to intervention., Conclusion: The COVID-19 pandemic resulted in neither sicker nor fewer patients suffering from acute ureteric colic in the ES.

Introduction: Urolithiasis (UCD) is the most common and most expensive urological disease in all regions of the planet. The study of the prevalence of types of urinary stones in different areas of the country and the world plays an important role in predicting the burden on the health care system as a whole and the urological community, including in terms of calculating the probability of recurrence of the disease, even against the background of effective metaphylactic therapy., Purpose: in connection with the above, we made an attempt to assess the prevalence of various types of urinary stones in various regions of the Russian Federation, Belarus, Kazakhstan and the dynamics of changes in the composition of urinary stones depending on age and gender., Materials and Methods: the study is based on data from a study of the chemical composition of 6787 urinary stones, presented by INVITRO in an anonymized form for the period 2018-2021. The study of the chemical composition of stones was carried out by infrared spectroscopy and/or X-ray diffraction., Results: The prevalence of one-, two- and multi-component urinary stones of the adult population and children in both sexes of the Russian Federation, the Republics of Kazakhstan and Belarus was estimated. Separate regularities in the distribution of the component composition of stones in each region, with age and gender, were noted., Conclusion: The study of the composition of urinary stones is important in choosing an adequate tactic for metaphylactic treatment.

The objective of the study is to discuss the question, "how did physicians come to grasp some facts in the absence of scientific experimentation and medical technology?" within the framework of examples from Ahı? Ahmed Çelebi's fifteenth century Turkish treatise on the urinary calculus. Çelebi's monograph on the urinary calculus in the kidneys and the bladder written in Turkish in Arabic alphabet is transliterated and studied within the framework of the medical theory of the period. The sample information for this study was randomly chosen. Examples of epidemiological information, diets against urinary calculus formation, diagnoses of kidney and urinary bladder calculi, and symptomatic therapies noted in Çelebi's treatise are discussed, with results briefly compared with today's data. The study of Çelebi's treatise shows that it was possible to reach some medical facts with the methods of the period.

The causality between the urinary sodium-potassium ratio and upper urinary calculi has not been clarified and easily affected by confounders. We performed two-sample and multivariable Mendelian randomization (MR) analysis to evaluate the potential causal role of the urinary sodium-potassium ratio in upper urinary calculi. Data of the urinary sodium-potassium ratio (N = 326,938), upper urinary calculi (N = 337,199), and confounding factors including BMI (N = 336,107), ever-smoke (N = 461,066), hypertension (N = 218,754), diabetes (N = 218,792), and alcohol intake frequency (N = 462,346) were obtained from the IEU OpenGWAS Project database. The inverse-variance weighted (IVW), weighted median, and MR-Egger methods were used to estimate MR effects. The MR-Egger intercept test, Cochran's Q test, MR-PRESSO, leave-one-out method, and funnel plot were used for sensitivity analysis. A causal relationship was found between the urinary sodium-potassium ratio and upper urinary calculi (OR = 1.008, 95% CI = 1.002-1.013, P = 0.011). FinnGen data supported this conclusion (OR = 2.864, 95% CI = 1.235-6.641, P = 0.014). The multivariable Mendelian randomization analysis result showed that after adjusting for the effects of five confounders, the urinary sodium-potassium ratio was still positively correlated with upper urinary calculi (OR = 1.005, 95% CI = 1.001-1.009, P = 0.012). This study demonstrated a positive causal association between the urinary sodium-potassium ratio and upper urinary calculi using MR analysis. Timely identification of changes in urine composition and dietary regulation of sodium and potassium intake could greatly reduce the incidence of future urinary calculi., (© 2023. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Purpose: To estimate the current lifetime prevalence of urolithiasis at the national level in Iran and investigate the potential influential demographic factors in different geographical areas.   Materials and methods: An epidemiological study was conducted between October 2020 and November 2022 in 31 provinces of Iran at the national level. Data was obtained through telephone interviews with households. Items in the interview included questions about the current and past episodes of urolithiasis, family history of urolithiasis, and demographic and environmental variables of potential interest in urolithiasis.   Results: A total of 44186 participants were investigated from 31 provinces of Iran. The overall percentage of those with lifetime prevalence of urolithiasis was 6.6%, including 7.9% for males and 5.3% for females (P<.001). In addition, with regard to the residential location, men were 53% (7.9% vs. 5.2%) more susceptible than women to urinary stones in urban areas and 36% (7.8% vs. 5.7%) more susceptible in rural areas. Out of 31 provinces, the Sistan-baluchistan province had the highest lifetime prevalence (15.6%) and the Golestan province had the lowest (2.1%). The lifetime prevalence of urolithiasis in the rural areas was 6.8% versus 6.5% in the urban areas (P=.29). Regarding age differentiation, the lifetime urolithiasis prevalence has increased up to the age of 70 years. In addition, the most prominent increase in the lifetime prevalence was observed in the age range of 20 to 60 years (from 0.9% to 11.8%). The ethnicity with the highest lifetime prevalence rate of urolithiasis was the Baluch ethnicity (18%).   Conclusion: generally, 6.6% of Iranian population suffers from urinary stones during their lifetime. Urolithiasis prevalence has increased 0.06% annually compared to the latest national study that took place 15 years ago. This increasing trend seems to be less prominent than other countries. According to our findings, urinary stones are more prevalent in men than in women and in the third to sixth decade of life regardless of gender. Baluch ethnicity is associated with the highest lifetime prevalence rate of urolithiasis and there is no significant difference between rural and urban areas. However, the ratio of male to female risk of urolithiasis is higher in urban areas compared to rural areas.

Objective: Proton pump inhibitors are widely used as treatment of acid-related disorders. They are considered safe although their long-term use has been associated with some adverse effects including an increased propensity for urinary calculi formation. The aim of this study was to systematically review available data from studies evaluating the association of PPIs and nephrolithiasis., Materials and Methods: We searched two electronic databases (PubMed and EMBASE) for cohort studies or case-control studies evaluating the relationship between treatment with proton pump inhibitors and the risk of stone formation published up to 31 October 2022. The overall association of PPIs and urinary calculi was analyzed using a random effects model (RevMan5). The quality of the included studies was assessed using the Newcastle-Ottawa Quality Assessment Scale., Results: A total of 550 studies were retrieved; 7 were selected by title and abstract screening; after removal of duplicates, 4 records were evaluated by full-text examination. An additional study was retrieved by handsearching the references included in screened studies. In the unadjusted analysis, the odds of urinary calculi were greater in subjects taking PPIs compared to controls (unadjusted OR = 2.10, 95% CI 1.74-2.52, p < 0.00001). The pooled odds ratio of two case-control studies confirmed that use of PPIs increased the odds of urinary calculi compared with non-use (OR 2.44, 95% CI 2.29 to 2.61). Pooled analysis of three cohort studies evaluating incident nephrolithiasis showed an overall hazard ratio estimate of 1.34 (95% CI = 1.28-1.40). One study found lower urinary citrate and urinary magnesium levels in subjects exposed to PPIs. The Newcastle-Ottawa Quality Assessment Scale scores ranged between 6 and 8., Conclusions: PPIs showed an association with urinary calculi in patients included in the studies included in this review. If these data will be confirmed in adequately powered randomized trials, clinicians may consider limiting the long-term use of PPIs, to avoid unnecessary prolongation of treatment. Urinary magnesium and citrate should be evaluated in renal stone forming patients taking PPIs to supplement their intake when requested.

China has been the first country to be affected by the COVID-19 outbreak. The pandemic resulted in significant disruption of Health Care Services worldwide, and this effect on treatments for urinary stones is currently unclear. This is the first retrospective study involving three tertiary referral centers for urolithiasis across China. We evaluated surgical volumes and peri-operative outcomes of procedures delivered for upper urinary tract stones. We compared trimester prior to restrictions for COVID-19 (October 1st, 2019 to December 31st, 2019, period A), during restrictions (February 1st, 2020 to March 31st, 2020, period B), and afterword (April 1st, 2020 to June 31st, 2020, period C). A total of 2,543 procedures have been carried out. We observed a loss of 743 cases during period B (-29.2%) and 201 during period C (-7.9%). Percutaneous surgery showed the worst reduction, with 507 mini-PCNLs delivered in period A, 168 in period B (-60.8%), and 389 (-18.3%) in period C (p = 0.001). A worst trend was shown for standard PCNLs with 84 procedures carried out in period A, 5 in period B (-95.2%), and 9 (-89.2%) in period C (p = 0.001). Retrograde surgery also decreased, from 420 cases in period A to 190 cases in period B (-54.8%). An increment was however seen in period C when 468 cases have been carried out (+ 11.4%, p = 0.008). In term of SFRs, a difference was noticed for RIRSs, being 69.2%, 80.5%, and 69.3% during three periods (p = 0.045) and semirigid ureteroscopies (90.3%, 97.1%, and 84.8%, p = 0.013). Charlson's Comorbidity Score could not show any difference between groups as well as no differences in term of post-operative complications have been noticed., (© 2022. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

This paper represents the first result of an active collaboration between the University of Sannio and the San Pio Hospital (Benevento, Italy), started in the 2018, that aims to a detailed mineralogical investigation of urinary stones of patients from Campania region. Herein, selected human bladder stones have been deeply characterized for clinical purposes and environmental biomonitoring, focusing on the importance to evaluate the concentration and distribution of undesired trace elements by means of microscopic techniques in the place of conventional wet chemical analyses. A rare bladder stone with a sea-urchin appearance, known as jackstone calculus, were also investigated (along with bladder stones made of uric acid and brushite) by means a comprehensive analytical approach, including Synchrotron X-ray Diffraction and Simultaneous Thermal Analyses. Main clinical assumptions were inferred according to the morpho-constitutional classification of bladder stones and information about patient's medical history and lifestyle. In most of the analyzed uroliths, undesired trace elements such as copper, cadmium, lead, chromium, mercury and arsenic have been detected and generally attributable to environmental pollution or contaminated food. Simultaneous occurrence of selenium and mercury should denote a methylmercury detoxification process, probably leading to the formation of a very rare HgSe compound known as tiemannite., (© 2021. The Author(s), under exclusive licence to Springer Nature B.V.)

Objective: To investigate risk factors of urinary calculi in men with gout., Method: A study was conducted at a tertiary hospital in Beijing from October 2016 to January 2020. Male gouty patients were included. Logistic regression was used to establish the association between patients' characteristics and urinary stone disease. A cluster analysis was performed to identify distinct phenotypes of gout based on nine common comorbidities., Result: The prevalence of calculi was 23.6% among 454 patients. Longer disease courses and comorbid dyslipidemia were associated with an increased risk of urinary calculi, with an OR of 2.76 (95% CI 1.40-5.64) (p = 0.004) for patients with a disease course of 10 years or longer compared with those with a disease course of gout shorter than 1 year, and an OR of 1.71 (95% CI 1.04-2.88) (p = 0.039) for patients with dyslipidemia. Three clinical phenotypes were recognized. Cluster C1 consists of patients with large body mass index, dyslipidemia, and abnormal liver function. The prevalence of stone was 23.2%. Patients in cluster C2 had fewer comorbidities and the lowest stone risk (13.5%). Cluster C3 had more cardiovascular comorbidities and the highest prevalence of stone (47.1%)., Conclusion: Longer disease course and dyslipidemia contribute to stone risk in men with gout. Three distinct phenotypes represent distinct pathophysiological mechanisms underlying stone occurrence, which would help us to optimize gout management. Key points • Patients with gout have higher risks for urinary stones. This study found that longer disease courses and comorbid dyslipidemia were associated with an increased risk of urinary calculi in largely untreated young men with uncontrolled gout. • This study reveals three distinct phenotypes of gout based on comorbidities. Among all, the group with more cardiovascular comorbidities has the highest prevalence of stones., (© 2022. The Author(s), under exclusive licence to International League of Associations for Rheumatology (ILAR).)

The prevalence of urolithiasis is steadily increasing worldwide in both genders. Diet and lifestyle, such as the rising prevalence of obesity and other metabolic syndrome traits, are considered key factors in this trend. Gender differences as a result of interventional therapy for urolithiasis have not been observed. However, iatrogenic injury to the male urethra is considered the most common reason for urethral strictures after endourologic (stone) therapy. In contrast, sepsis, as the major cause of urinary stone-related mortality, is more frequently reported in women after ureterorenoscopy and percutaneous nephrolithotomy. There are also differences in the frequency of various types of stones between men and women. Calcium oxalate and uric acid stones are more commonly observed in men, while carbonate apatite and struvite are diagnosed more often in women. Urinary stone analysis is therefore paramount for successful recurrence prevention. Diagnosis is based on the assignment of patients to the low-risk or high-risk group. The medical nutrition and pharmacological measures for the therapy of the respective type of stone are based on the risk factors in 24 h urine samples. A personalized approach that accounts for gender differences could further improve treatment, and recurrence prevention decisions for urinary stones., (© 2022. The Author(s), under exclusive licence to Springer Medizin Verlag GmbH, ein Teil von Springer Nature.)

With the rising incidence of urinary stone disease, web searches for stone treatments are increasing. Google Trends (GT) data for a 10-year period and during the coronavirus disease 2019 (COVID-19) pandemic were used to investigate the trend variations for the most popular minimally invasive stone therapies based on time and region. GT can create a line graph that shows how interest in various territories has risen or decreased over time. Search terms were generated for extracorporeal shockwave lithotripsy (SWL), percutaneous nephrolithotomy (PCNL), retrograde intrarenal surgery (RIRS), ureterorenoscopy (URS), and laparoscopic pyelolithotomy/ureterolithotomy. Using the "global" inquiry category, the data were included "worldwide" from January 1, 2009 to December 31, 2021. In recent years, Google and YouTube searches for total minimally invasive stone treatments have increased. RIRS, URS, and PCNL trends revealed a substantial rise in the regression analysis ( p  < 0.05), but SWL trends showed a significant reduction ( p  < 0.05). RIRS was the main intervention with interest growing most over time. Web searches for stone treatments decreased in the first period of the COVID-19 pandemic. To a rising degree of involvement, patients and physicians from all over the world utilize the internet to search for minimally invasive stone operations. RIRS, URS, and PCNL are becoming more popular in web trends and SWL still has the highest trend despite the decline in popularity recently. The number of trustworthy web-based tools about stone treatments should be increased, and patients and physicians should be directed to these sources.

Objective: To reassess the trends in upper urinary tract (UUT) stone disease burden and management in the UK during the last 5 years., Methods: The present paper is our third quinquennial analysis of trends in the management of renal stones in England. Data were collected using the Hospital Episode Statistics database for the years 2015-2020 inclusive. These were then analysed, summarized and presented., Results: The number of UUT stone episodes increased by 2.2% from 86 742 in 2014-2015 to 88 632 in 2019-2020 but annual prevalence remained static at 0.14%. The number of UUT stone episodes in those of working age has remained static but increased by 9% for patients aged > 60 years (from 27 329 to 29 842). The number of shockwave lithotripsy (SWL) treatments decreased by 6.8%. There was a further increase in the use of ureteroscopy (URS) between 2015 and 2020 of 18.9%. Within this subgroup, flexible URS had the most rapid increase in use, with a rise of 20.4% from 7108 to 8558 recorded cases. Over the 20-year period from 2000 to 2020 there was a remarkable 257% increase in URS cases. There was a further decline in open surgery for UUT stone disease by 40%. Stone surgery day-case numbers have increased by 14.7% (from 31 014 to 35 566), with a corresponding decline in the number of bed days of 14.3%. Emergency cases increased by 40%, while elective cases saw a slight increase of 1.9%., Conclusion: The present study shows a plateauing in the prevalence of UUT stone disease in England in the last 5 years, with a move towards day-case procedures and an increase in the proportion of emergency work. For the first time in England, URS has overtaken SWL as the most common procedure for treating UUT stone disease, which might reflect patients' or physicians' preference for a more effective definitive treatment., (© 2022 BJU International.)

In the process of urinary stone formation, several heavy metals and trace elements (HMTE) have been identified among the major constituents of the calculi. The micro-elements within the stones cannot be identified by ordinary laboratory analytical techniques, the latter can only detect the major crystalline component. The objective of the present study was to evaluate the different types of HMTE (no. 22) and their concentrations within the urinary stones. The stone samples were obtained from patients living in different geographical locations (10 countries: 5 Western and 5 non-Western). The number of retrieved stones after open or endoscopic procedures was 1177. The concentrations of the 22 HMTE in the stones were assessed by inductively coupled plasma optical emission spectrometry (ICP-OES). The statistical data were analyzed using Kruskal-Wallis, one-way ANOVA, and SPSS software (version 20). The biochemical stone analysis showed that calcium oxalate was present as a major component in 650 patients (55.2%), calcium phosphate in 317 (26.9%), and uric acid and cystine stones in 210 (17.8%). The analyzed stones showed the presence of HMTE in different concentrations. Significantly higher concentrations of 17 elements (Al, As, Ba, B, Ca, Cd, Co, Cr, Cu, Fe, Mn, Ni, Pb, S, Se, Sr, and Zn) were noted in all stones. Seven elements (Al, As, Se, Sr, Fe, Zn, and Ni) were present in higher concentrations in calcium-based stones. In comparison, eight elements (Mg, B, Ba, Cd, Se, Pb, Sr, and Zn) in higher concentrations were associated with phosphate-based stones. Both uric acid and cystine stones had a higher concentration of sulfur. The concentrations of HMTE in calcium phosphate stones were higher than in calcium oxalate and uric acid stones. Calculi obtained from patients living in western countries contained higher levels of 13 HMTE (B, Ba, Ca, Cd, Co, Cu, Fe, K, Mg, Mo, P, Pb, and Se) than those in non-western countries. The age of calculi-forming patients from non-western countries was younger than those living in western countries. These results may indicate the role of many significant heavy metals and trace elements in the pathogenesis of urinary stone formation. The types and contents of HMTE within urinary stones differ from one country to another. The conventional stone analysis techniques cannot either identify the stone micro-elements or the concentrations of HMTE, so a specific and additional instrument such as the ICP-OES is necessary. Further research work on the urinary stone micro-elemental structure could lead to a new strategy for the prevention of stone formation and recurrence., (© 2022. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

To investigate how the risk factors of metabolic diseases affect urinary stone composition, particularly uric acid (UA) stones. Overall, 583 patients with data on urinary stone composition were retrospectively analyzed and classified into UA and nonUA stone formers according to the presence of the UA component. Various factors were compared between both groups. Participants were categorized according to age, glucose level, HbA1c level, and estimated glomerular filtration rate (eGFR) into subgroups, and the incidence of UA stone was compared. Overall, 137 UA stone formers (23.5%) and 446 nonUA stone formers (76.5%) were included. Mean age and male-to-female ratio were higher in the UA group than in the nonUA group. The rates of diabetes mellitus (DM), hypertension, chronic kidney disease, and coronary artery disease, all of which were associated with differences in urinary stone composition, were higher in the UA group than in the nonUA group. The UA group exhibited lower mean eGFR and higher glucose and HbA1c levels. Similarly, the UA group had higher mean UA levels and predictably lower urinary pH. In subgroup analysis, higher age, glucose level, HbA1c level, and lower eGFR were associated with an increased risk of UA stone formation. In the multivariate logistic regression analysis, the UA group showed a significantly higher age (P < .001), DM frequency (P = .049), and HbA1c level (P = .032), but significantly lower eGFR than the nonUA group (P < .001). Age and DM were independent risk factors for UA urolithiasis, implying a relationship between urinary stone composition and metabolic diseases. Additionally, renal function and HbA1c level were risk factors for UA stones., Competing Interests: The authors of this work have no funding and conflict of interest to disclose., (Copyright © 2022 the Author(s). Published by Wolters Kluwer Health, Inc.)

Purpose: Stone composition can provide valuable information for the diagnosis, treatment and recurrence prevention of urolithiasis. The aim of this study was to evaluate the distribution of urinary stone components and the impact of different crystal forms according to gender and age of patients in Germany., Methods: A total of 45,783 urinary stones submitted from 32,512 men and 13,271 women between January 2007 and December 2020 were analyzed by infrared spectroscopy. Only the first calculus obtained per patient was included in the analysis., Results: The most common main stone component was calcium oxalate (CaOx) (71.4%), followed by carbonate apatite (CA) (10.2%) and uric acid (UA) (8.3%). Struvite (2.1%), brushite (1.3%), protein (0.5%) and cystine (0.4%) stones were only rarely diagnosed. CaOx (75%) and UA stones (81%) were more frequently obtained from men than women (p < 0.001). Weddellite (COD) and uric acid dihydrate (UAD) were more common in younger ages than whewellite (COM) and anhydrous uric acid (UAA), respectively, in both men and women. The ratios of COM-to-COD and UAA-to-UAD calculi were approximately 4:1 and 8:1, respectively. The peak of stone occurrence was between the ages of 40 and 59 years., Conclusion: Stone composition is strongly associated with gender and age. The peak incidence of calculi in both women and men was in the most active phase of their working life. The distinction between different crystal forms could provide clues to the activity and mechanisms of lithogenesis. Further research is needed in understanding the causative factors and the process of stone formation., (© 2022. The Author(s).)

Background: Urinary stones usually start at a young age and tend to recur. Therefore, preventing stone occurrence and recurrence in young people is crucial. We aimed to investigate the association between subcutaneous adipose tissue, visceral adipose tissue, and stone episodes in young people., Methods: We retrospectively studied patients aged below 40 years with kidney or ureteral stones. Data on demographic and metabolic characteristics, urolithiasis history, subcutaneous fat area (SFA), and visceral fat area (VFA) were collected. We evaluated the association between SFA or VFA and the occurrence or recurrence of stone episodes using binary logistic regression and Poisson regression analyses., Results: In total, 120 patients were included. Abdominal obesity, overweight or obesity, dyslipidemia, metabolic syndrome, SFA, and VFA increased with the number of stone episodes (all p < 0.05). The increase in SFA was independently associated with episode occurrence (p = 0.015). Patients with an SFA > 97 cm 2 had a higher risk of episode occurrence. SFA and VFA accumulation were independently associated with episode recurrence (all p < 0.05), and SFA had a stronger association than VFA did., Conclusions: In young people, SFA accumulation is an independent and early risk factor for the occurrence and recurrence of stone episodes. Subcutaneous fat could be a convenient and effective indicator to assess the risk of stone episodes before the development of metabolic disorders., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Ye, Xiao, Liu, Qiao, Zhao, Ji, Fan, Li and Wang.)

Background: Although hepatitis B virus (HBV) is a recognized risk factor for renal diseases, little is known about HBV infection in individuals with upper urinary calculi (UUC). We investigated the relationship between chronic HBV infection and UUC., Methods: We retrospectively analysed data from 1399 patients who were discharged from the Department of Urology (2017-2018). The diagnosis of UUC was determined using urinary tract ultrasonography or computed tomography, and HBV infection was evaluated by a positive hepatitis B surface antigen (HBsAg) test. Data on patients with and without UUC and HBsAg-positive and HBsAg-negative patients were compared by univariate and multivariate analyses., Results: Data on chronic HBV infection and UUC were available for 1062 patients, including 514 who presented with UUC and 548 who did not. Overall, 5.8% of total patients, 8.0% of UUC patients and 3.8% of non-UUC patients had chronic HBV infection. UUC patients (41/514) had a significantly higher prevalence of HBsAg positivity (OR 2.175; 95% CI 1.267-3.734; P = 0.004) than non-UUC patients (21/548). After stratifying by sex, the relative odds of HBsAg positivity were statistically significant in men (OR 2.156; 95% CI 1.162-4.003; P = 0.015) but not in women (OR 2.947; 95% CI 0.816-10.643; P = 0.099). The incidence of urinary pH > 6 and staghorn stones was significantly higher in HBsAg-positive UUC patients than in HBsAg-negative UUC patients., Conclusion: This is the first study to demonstrate that chronic HBV infection is strongly associated with UUC, at least in men. The urinary pH > 6 and staghorn stones were more common in UUC patients with chronic HBV infection., (© 2022. The Author(s).)

Introduction: The recurrence rate of paediatric urolithiasis was less reported, especially in Asians. Our aim was to verify the symptomatic recurrence rate of Chinese paediatric urolithiasis and to determine the predictive factors for stone recurrence., Materials and Methods: We performed a retrospective review of children who presented with first upper urinary tract calculi from June 2014 to September 2019. For the follow-up, we generated Kaplan-Meier plots with time to stone recurrence and Cox proportional hazard regression analyses were applied. The recurrence was defined as a new symptomatic stone on ultrasound and/or computerized tomography., Results: A total of 230 children with a median age of 5 yr (IQR 4-8) were included. Calcium oxalate was found in 72% of stones, and calcium apatite was found in 32% of stones. After a median follow-up of 39.5 months, 34 (14.8%) children had stone recurrence. Median time to stone recurrence was 31 months. Among them, 31 (91.2%) required surgical intervention. Older children (P < 0.01), higher BMI (HBM) (P < 0.01) and higher stone burden (P < 0.01) were shown to be associated with stone recurrence in the univariate analysis. The multivariate Cox regression analysis showed that children with stone burden > 2 cm 3 had a higher risk of recurrence (HR 4.84, 95%CI 2.28-10.3). Children with HBM had an increased recurrence rate compared to normal BMI children (HR 2.99, 95%CI 1.36-6.56)., Conclusions: The symptomatic recurrence rate of paediatric urolithiasis in Chinese is not as high as that reported in Caucasians. HBM and higher stone burden are associated with higher recurrence rates., Competing Interests: Conflicts of interest We confirm that there are no known conflicts of interest associated with this publication; We confirm that the manuscript has been read and approved by all named authors and that there are no other persons who satisfied the criteria for authorship but are not listed., (Copyright © 2021. Published by Elsevier Ltd.)

Objectives: This study was aimed to assess the distribution and frequency of uroliths in cats as well as to evaluate gender-, age-, and breed-specific differences., Material and Methods: 3629 uroliths from cats in Germany were analyzed by infrared-spectroscopy during the period 2016-2020. The majority (3300) of the uroliths originated from purebred cats of 22 breeds., Results: Uroliths were prevalent in the order of male neutered (45.3 %), female spayed (35.3 %), male intact (7.4 %), and female intact cats (6.3 %). Median age of the cats with uroliths was 7 years, although it varied slightly depending on types of the urolith. The most frequent uroliths were calcium oxalate (59.5 %), followed by struvite (33.7 %), ammonium urate (2 %), calcium phosphate (1.7 %), cystine (0.7 %) and xanthine (0.4 %). Males (59.4 %) and females (59.2 %) showed nearly identical prevalence of calcium oxalates, whereas it significantly diverged in castrated (60.2 %) versus intact animals (54.4 %; p = 0.01). With regard to struvites, male cats (32.6 %) were less prone than females (35.4 %; p = 0.08) while intact cats (38.2 %) significantly outnumbered the castrated cohorts (33.1 %; p = 0.02). The prevalence for calcium oxalate uroliths increased by 6.6 % during the study period, contrasting a decrease of 5.5 % for struvites. Some breeds (> 10 individuals) showed significantly higher propensities than others for urolith formation. Calcium oxalates were significantly more frequent in British shorthair cats (85.2 %), Ragdoll (75 %), Scottish fold (74.1 %) and Persians (72.4 %). Struvites were prevailing in Norwegian forest cats (48.5 %), British longhair (41.7 %), European shorthair (41.7 %) and Siberian forest cats (36.8 %). Siamese cats had the significantly highest percentage of cystine uroliths (16 %)., Conclusions and Clinical Relevance: The occurrence of urine calculi in cats from Germany was found to be most frequent for calcium oxalate and struvite types. We also found breed-, age-, gender- specific differences in addition to variations depending on the neutering status of the animals., Competing Interests: Die Autoren sind Angestellte (D. Breu) bzw. Eigentümer/Geschäftsführer (E. Müller) des Labors LABOKLIN GmbH & Co. KG, bei dem die Analysen durchgeführt wurden., (Thieme. All rights reserved.)

Background: The U.S. health care landscape has witnessed numerous changes since implementation of the Affordable Care Act coupled with rising prevalence of upper urinary tract stone disease (SD). Data on the economic burden of SD during this period are lacking, providing the objective of our study. Materials and Methods: Adults diagnosed as having SD from 2011 to 2018 were identified from PearlDiver Mariner, a national all-payer database reporting reimbursements and prescription costs for all health care encounters. Patients undergoing operative and nonoperative care were identified. Time trends in annual expenditures were evaluated. Multivariable analysis evaluated determinants of spending. Results: A total of $10 billion were spent on SD management between 2011 and 2018 (median overall annual expenditure = $1.4 billion) among 786,756 patients. Inpatient, prescription, and outpatient costs accounted for 34.7%, 20.7%, and 44.6% of expenditures, respectively. Seventy-eight percent of patients were managed nonoperatively (total cost = $6.9 billion). The average overall cost per encounter was $13,587 ($17,102 for surgical vs $11,174 for nonsurgical care). Expenditures on inpatient care decreased significantly over time, while expenditures on prescriptions and outpatient care increased significantly. On multivariable analysis, a higher Charlson Comorbidity Index (CCI) was associated with higher spending, while associations for age, insurance, and region varied by treatment modality. Conclusions: The economic burden of SD management is substantial, dominated by expenditure on nonoperative management and outpatient care. Expenditures for prescription and outpatient care are rising, with the only consistent predictor of higher spending being CCI. Spending variation according to demographic, clinical, and geographic factors was evident.

Objectives: Up to 0.3% of Japanese have hypouricaemia. Most cases appear to result from a hereditary disease, renal hypouricaemia (RHUC), which causes exercise-induced acute kidney injury and urolithiasis. However, to what extent RHUC accounts for hypouricaemia is not known. We therefore investigated its frequency and evaluated its risks by genotyping a general Japanese population., Methods: A cohort of 4993 Japanese was examined by genotyping the non-functional variants R90H (rs121907896) and W258X (rs121907892) of URAT1/SLC22A12, the two most common causative variants of RHUC in Japanese., Results: Participants' fractional excretion of uric acid and risk allele frequencies markedly increased at lower serum uric acid (SUA) levels. Ten participants (0.200%) had an SUA level ≤2.0 mg/dl and nine had R90H or W258X and were likely to have RHUC. Logistic regression analysis revealed these URAT1 variants to be significantly and independently associated with the risk of hypouricaemia and mild hypouricaemia (SUA ≤3.0 mg/dl) as well as sex, age and BMI, but these URAT1 variants were the only risks in the hypouricaemia population (SUA ≤2.0 mg/dl). W258X was only a risk in males with SUA ≤3.0 mg/dl., Conclusion: Our study accurately reveals the prevalence of RHUC and provides genetic evidence for its definition (SUA ≤2.0 mg/dl). We also show that individuals with SUA ≤3.0 mg/dl, especially males, are prone to RHUC. Our findings will help to promote a better epidemiological understanding of RHUC as well as more accurate diagnosis, especially in males with mild hypouricaemia., (© The Author(s) 2021. Published by Oxford University Press on behalf of the British Society for Rheumatology.)

The aim of the study was to investigate the epidemiological characteristics of stone components in patients with urolithiasis and analyze the associations between stone components with patients' clinical characteristics. A total of 7126 patients with urolithiasis between July 2005 and June 2020 were retrospectively analyzed. In this research, calcium oxalate stones (74.6%) accounted for the highest proportion, followed by infection stones (11.8%), uric acid (10.6%), brushite (2.0%), and others (1.1%). The change in trend in the composition of urinary stones revealed that the proportion of uric acid declined steadily, while the content of infection stones increased gradually over 15 years. The results also suggested that stone composition was significantly associated with PM2.5, gender, age, BMI, diabetes, hypertension, CCVD, alcohol consumption, albumin, creatinine, WBCHP, leukocyte, urine pH, nitrite and urine culture (P < 0.05). However, there was no significant correlation between stone composition with smoking, WBC and NEU% (P > 0.05). Our study concluded that calcium oxalate represented the highest proportion, followed by infection stones, uric acid, brushite, and others. The proportion of uric acid declined steadily, while the infection stones increased gradually. Furthermore, the factors influencing the formation of urinary calculi are PM2.5, gender, age, BMI, diabetes, hypertension, CCVD, alcohol consumption, albumin, creatinine, WBCHP, leukocyte, urine pH, nitrite and urine culture. Collectively, these results may provide clues to establish effective prevention and management strategies for urinary calculi., (© 2021. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Objective: To determine the risk of postpartum urinary stone disease in women with a history of stone disease during pregnancy. Methods: Using the Optum ® de-identified Clinformatics ® Datamart we identified pregnant women with urinary stone disease in the United States between January 2003 to December 2017 by standardized International Classification of Diseases Ninth and Tenth Editions (ICD-9 and ICD-10), and Current Procedural Terminology code criteria. We limited the cohort to include women without evidence of urinary stone disease before pregnancy. We abstracted patient demographic characteristics, clinical risk factors for stone disease, and data for urinary stone disease encounters and related procedures after pregnancy. Encounters occurring within 1 year of pregnancy were excluded. Cox proportional hazard models were used to analyze for significance. Results: We identified a total of 1,395,783 pregnant women with a median postpartum follow-up of 4.0 years, including 5971 (0.4%) women with a urinary stone during pregnancy. Of these, 736 ( 12.3% ) had an additional urinary stone diagnosis claim after pregnancy, compared with 13,275 (0.95%) women without a history of stone disease during pregnancy ( p  < 0.0001). In multivariable proportional hazards models urinary stone disease during pregnancy (hazards ratio 12.8, 95% confidence interval [11.8-13.8]) was independently associated with a higher hazard of urinary stone disease after pregnancy. Conclusion: Women with urinary stone disease during pregnancy were more likely to present with recurrent urinary stone disease after pregnancy. Given the one in eight chance of needing further care, women with history of stone disease during pregnancy may benefit from risk counseling, surveillance, or secondary prevention efforts in the postpartum period.

Data directly demonstrating the relationship between urinary oxalate (UOx) excretion and stone events in those with enteric hyperoxaluria (EH) are limited. Therefore, we assessed the relationship between UOx excretion and risk of kidney stone events in a retrospective population-based EH cohort. In all, 297 patients from Olmsted County, Minnesota were identified with EH based upon having a 24-h UOx ≥40 mg/24 h preceded by a diagnosis or procedure associated with malabsorption. Diagnostic codes and urologic procedures consistent with kidney stones during follow-up after baseline UOx were considered a new stone event. Logistic regression and accelerated failure time modeling were performed as a function of UOx excretion to predict the probability of new stone event and the annual rate of stone events, respectively, with adjustment for urine calcium and citrate. Mean ± standard deviation age was 51.4 ± 11.4 years and 68% were female. Median (interquartile range) UOx was 55.4 (46.6-73.0) mg/24 h and 81 patients had one or more stone event during a median follow-up time of 4.9 (2.8-7.8) years. Higher UOx was associated with a higher probability of developing a stone event (P < 0.01) and predicted an increased annual risk of kidney stones (P = 0.001). Estimates derived from these analyses suggest that a 20% decrease in UOx is associated with 25% reduction in the annual odds of a future stone event. Thus, these data demonstrate an association between baseline UOx and stone events in EH patients and highlight the potential benefit of strategies to reduce UOx in this patient group., Background: Data directly demonstrating the relationship between urinary oxalate (UOx) excretion and stone events in those with enteric hyperoxaluria (EH) are limited., Methods: We assessed the relationship between UOx excretion and risk of kidney stone events in a retrospective population-based EH cohort. In all, 297 patients from Olmsted County, Minnesota were identified with EH based upon having a 24-h UOx ≥40 mg/24 h preceded by a diagnosis or procedure associated with malabsorption. Diagnostic codes and urologic procedures consistent with kidney stones during follow-up after baseline UOx were considered a new stone event. Logistic regression and accelerated failure time modeling were performed as a function of UOx excretion to predict the probability of new stone event and the annual rate of stone events, respectively, with adjustment for urine calcium and citrate., Results: Mean ± SD age was 51.4 ± 11.4 years and 68% were female. Median (interquartile range) UOx was 55.4 (46.6-73.0) mg/24 h and 81 patients had ≥1 stone event during a median follow-up time of 4.9 (2.8-7.8) years. Higher UOx was associated with a higher probability of developing a stone event (P < 0.01) and predicted an increased annual risk of kidney stones (P = 0.001). Estimates derived from these analyses suggest that a 20% decrease in UOx is associated with 25% reduction in the annual odds of a future stone event., Conclusions: These data demonstrate an association between baseline UOx and stone events in EH patients and highlight the potential benefit of strategies to reduce UOx in this patient group., (© The Author(s) 2020. Published by Oxford University Press on behalf of ERA-EDTA. All rights reserved.)

Introduction: Urolithiasis is one of the most common urological diseases, which affect at least 3% of the population., Aim: To study the epidemiology of urolithiasis in the European part of the Russian Federation and to determine the composition of urinary stones in order to understand the pathogenetic mechanisms of urinary stones formation., Materials and Methods: Urinary stone were obtained from 2888 patients with urolithiasis and the composition of kidney stones was analyzed using the method of infrared spectroscopy., Results: The predominance of oxalate stones was seen in kidney stones with mixed composition (83%) and the prevalence of uric acid stones (54%) was revealed in "pure" kidney stones. Urinary stones with a predominance of oxalates had significantly less impurities (12,4%) than stones with a predominance of uric acid, phosphates and carbonates with average amount of impurities more than 24%. Conslusion. The analysis of stone composition with a consideration of pathogenic factor showed that disorders of calcium metabolism in the population of the European part of the Russian Federation prevailed (88%).

As the epidemiology of urolithiasis is constantly evolving, analyzing the composition of stones is crucial to better understand the determinants of lithogenesis. The aim of this study was to describe the composition of stones of pediatric patients in a tertiary center. Clinical and metabolic data from all pediatric patients with at least one stone that was analyzed by Fourier transformed infrared spectroscopy (FTIR) in the Hospices Civils de Lyon between 2013 and 2017 were retrospectively collected. A total of 111 patients (sex ratio 1.4:1) were included; their median ([IQR]) age was 7.5 (3.1-10.5) years. The main component of stones was calcium oxalate (weddellite for 34 (31%) stones, whewellite 23 (21%)), calcium phosphate (carbapatite 32 (29%), brushite 6 (5%), amorphous calcium phosphate 3 (3%)), struvite 5 (5%), cystine 4 (4%), uric acid 2 (2%), and ammonium acid urate 2 (2%). A total of 20 (18%) stones were pure and 24 (22%) were infectious. Carbapatite stones were the most frequent in patients < 2 years and calcium oxalate stones in patients > 2 years old. Metabolic abnormalities (most frequently hypercalciuria) were found in 50% of tested patients and in 54% of patients with infectious stones. Congenital anomalies of the kidney and/or urinary tract (CAKUT) or neurogenic bladder were present in 9/24 (38%) patients with infectious stones and 12/16 (76%) patients with bladder stones.Conclusion: This study confirms that calcium oxalate stones are the most frequent among pediatric patients, which could reflect the nutritional habits of predisposed patients. In contrast, infectious stones are less frequent and occur mostly in association with anatomic or metabolic favoring factors., (© 2021. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Urinary stone disease is a common condition. We investigated the usefulness of medical treatment for infants with urinary stones 5 mm or smaller. The study included 197 infants (86 girls and 111 boys) with urolithiasis ≤ 5 mm who were referred to our Department of Nephrology between 2014 and 2016. Infants with metabolic or anatomical risk factors requiring medical treatment were excluded from the study. We retrospectively reviewed urine and serum metabolic profiles and compared stone resolution rates in patients who did and did not receive treatment. The mean age at diagnosis was 5.2 months (range, 14 days to 12 months). The most common complaint was restlessness (n = 92, 46.7%), and 49 infants (24.9%) were asymptomatic. Multiple stones were detected in 166 infants (84.3%). Hypomagnesuria, hypocitraturia, and hypercalciuria were present in 25.3, 19.7, and 18.7% of patients, respectively. Stones < 3 mm (microlithiasis) were detected in 97 infants (49.2%), and 100 (50.8%) patients had 3-5 mm stones. In total, 130 infants (66.5%) received regular treatment and 67 (33.5%) were not treated. Stone resolution was significantly higher in the group receiving K-citrate treatment at the 6th month follow-up, while there were no significantly difference between the two groups at the 12th month control. No previous studies have investigated treatment outcomes in infants with 3-5 mm urinary stones. According to our results, K-citrate treatment may accelerate the resolution of the stone in infants with stones smaller than 5 mm., (© 2021. The Author(s), under exclusive licence to Springer-Verlag GmbH, DE part of Springer Nature.)

To compare the chemical composition of the upper and lower urinary tract stones in Congolese patients, and to identify factors associated with the different types of stones. Stones from 119 patients originating from the upper tract and 75 from the lower tract were analyzed by infrared spectrophotometry. Among 119 patients with upper tract stones, age ranged from 10 to 81 years with a mean (SD) of 45.8 (13.6) years; males were the majority (55.5%). The main types of stones identified were whewellite (79%). For the 75 patients with lower apparatus stones, age ranged from 4 to 87 years with a mean (SD) of 51.6 (21.6) years; the majority were males (89.3%). The main types of stones were whewellite (44%) and anhydrous uric acid (22.7%). Overall, the factors associated with calcium oxalate included: site [4.95 (95% CI 2.35-10.44)] and diameter [3.03 (95% CI 1.45-6.25)]; patient's place of residence [0.05 (95% CI 0.01-0.29)] was associated with calcium phosphate. Infection stones were associated with; site [0.19 (95% CI 0.06-0.63)] and diameter [0.10 (95% CI 0.03-0.38)]. Finally, age 0.26 (95% CI 0.09-0.71) and stone site [0.23 (95% CI 0.07-0.68)] were associated with uric stones. The epidemiological and chemical profile of upper and lower tract stones were different. Several factors were associated with the chemical and crystalline composition of stones in the Democratic Republic of Congo., (Copyright © 2021 Société francophone de néphrologie, dialyse et transplantation. Published by Elsevier Masson SAS. All rights reserved.)

Purpose: To evaluate the distribution and dynamic trends in constituents of urinary stones in China., Materials and Methods: The composition of 23,182 stones were analyzed and then recorded between January 2011 and December 2019. The characteristics in terms of stone patient's gender, age and calendar year were analyzed., Results: Most stones (22,172, 95.64%) had several crystal components, among which 40.25% (8925/22,172) were mixtures with infection components. Calcium oxalate (CaOx) and uric acid (UA) stones were more commonly encountered in men, but calcium phosphate (CaP), magnesium ammonium phosphate (MAP) and carbonate apatite (CA) stones were more prevalent in women (p < 0.05). In males, the proportion of CaOx stones increased up to the age of 40, but subsequently decreased (p < 0.001). Interestingly, females showed an inverse trend regarding CaOx stones (p < 0.001). The proportion of UA stones increased with age (p < 0.001), and CA stones most frequently were recorded at age 20-49. Over the past 9 years, UA, CA, and MAP stones increased over time, whereas there was a tendency for CaOx stones to decrease (p < 0.05)., Conclusions: The scarcity of pure stones and a certain proportion of mixtures with infection stone components (e.g., mixtures of CaOx and CA) suggest that treatment directed against a single stone component is insufficient for effective recurrence prevention. Age and gender were significant determinants of stone composition, and according to the observed chronological trends, it seems that in the future, more UA, CA and MAP stones and fewer CaOx stones may be encountered in the studied population., (© 2021. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Background: Urolithiasis is a common and often recurrent problem in dogs., Objective: To evaluate trends in urolith composition in dogs and to assess risk factors for urolithiasis, including age, breed, sex, neuter status, urolith location, and bacterial urolith cultures., Sample Population: A total of 10 444 uroliths and the dogs from which they were obtained., Methods: The laboratory database at the UC Davis Gerald V. Ling Urinary Stone Analysis Laboratory was searched for all urolith submissions from dogs between January 2006 and December 2018. Mineral type, age, breed, sex, neuter status, urolith location, and urolith culture were recorded. Trends were evaluated and variables compared to evaluate risk factors., Results: Calcium oxalate (CaOx) and struvite-containing uroliths comprised the majority of all submissions from dogs, representing 47.0% and 43.6%, respectively. The proportion of CaOx-containing uroliths significantly decreased from 49.5% in 2006 to 41.8% in 2018 (P = .006), with no change in the proportion of struvite-containing urolith submissions. Cystine-containing uroliths comprised 2.7% of all submissions between 2006 and 2018 and a significant nonlinear increase in this mineral type occurred over time (1.4% of all submissions in 2006 to 8.7% in 2018; P < .001). Of all cystine-containing uroliths, 70.3% were from intact male dogs. Age, breed, and sex predispositions for uroliths were similar to those previously identified., Conclusions and Clinical Importance: Although calcium oxalate- and struvite-containing uroliths continue to be the most common uroliths submitted from dogs, a decrease in the proportion of CaOx-containing uroliths and an increase in the proportion of cystine-containing uroliths occurred during the time period evaluated., (© 2021 The Authors. Journal of Veterinary Internal Medicine published by Wiley Periodicals LLC on behalf of American College of Veterinary Internal Medicine.)

Background: Urolithiasis is an important upper and lower urinary tract disease in cats that results in morbidity and mortality., Objective: To describe trends in composition of uroliths in cats and evaluate risk factors related to age, breed, sex, urolith location, and bacterial urolith cultures., Sample Population: A total of 3940 uroliths and the cats from which they were obtained., Methods: The database of the UC Davis Gerald V. Ling Urinary Stone Analysis Laboratory was searched for all urolith submissions from cats between January 2005 and December 2018. Mineral type, age, breed, sex, and urolith location and culture results were recorded. Trends were evaluated and variables compared to evaluate risk factors., Results: A significant decrease in the proportion of calcium oxalate (CaOx)-containing uroliths occurred over time (P = .02), from 50.1% (204/407) of all submissions in 2005 to 37.7% (58/154) in 2018. In contrast, the proportion of struvite-containing uroliths increased significantly (P = .002), from 41.8% (170/407) in 2005 to 54.5% (84/154) in 2018. The proportion of CaOx-containing uroliths in the upper urinary tract was significantly higher compared to the proportion of other urolith types in the upper urinary tract. Urate-containing uroliths were the third most common type (361/3940, 9.2%). Overall, sex and age predispositions were similar to those reported previously., Conclusions and Clinical Importance: The decrease in the proportion of CaOx-containing uroliths and increase in the proportion of struvite-containing uroliths warrants investigation. Further education regarding the efficacy of medical dissolution of struvite-containing uroliths is recommended., (© 2021 The Authors. Journal of Veterinary Internal Medicine published by Wiley Periodicals LLC on behalf of American College of Veterinary Internal Medicine.)

Urolithiasis is a common urinary disease with high recurrence. The risk factor for the recurrence of calculi is not very clear. The object of the present study was to evaluate the association between calculi composition and urine component and analyse the risk factor for the recurrence of urolithiasis. In this study, a total of 223 patients with calculi and healthy control were enrolled, and the components of the calculi and urina sanguinis collected before surgery were analysed. Of the 223 patients, 157 were males and 66 were females. According to the stone composition, the case group was subdivided into three groups. 129 patients had single calcium oxalate stones, 72 had calcium oxalate stones mixed with other stones and 22 had other type of stones excluding calcium oxalate stones. Urine biochemicals were analysed and the associations were found between the chemicals in each group. Multivariate logistic analysis demonstrated that reduced urinary magnesium and uric oxalic acid were independent risk factors when comparing all cases with normal controls. Only decreased urinary magnesium was found to be a risk factor comparing the single calcium oxalate group with normal control group. Low level of urinary magnesium and uric oxalic acid were found to be risk factors comparing the mixed calcium oxalate group with normal control group. No risk factor was found comparing the other stone group with normal control group. In conclusion, there were clear relationships between stone components and urine chemicals. Urine chemicals might be risk factors to predicate the occurrence of urolithiasis.