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Rationale: Extracorporeal shock wave lithotripsy (ESWL) is widely considered the primary approach for managing urinary tract stones. This study aimed to assess the predictive factors associated with non-contrast computed tomography (NCCT)-based parameters of upper urinary stones in relation to the outcomes of ESWL., Materials and Methods: A systematic search was conducted in PubMed, ScienceDirect, Web of Science, and Cochrane Library to identify all relevant studies published up to June 3, 2023. Several NCCT-based parameters to predict ESWL outcomes, comprised of mean stone density (MSD), skin-to-stone distance (SSD), and stone size, were extracted and analyzed using Review Manager software., Results: Out of 979 publications screened, a total of 39 publications, involving 7869 patients, were enrolled in the analysis. The pooled estimate demonstrated significant differences between MSD, and stone size between successful and failure of stone fragmentation groups, in which lower values of these parameters are associated with successful ESWL outcomes., Conclusion: The results from the current study suggested that lower NCCT parameters, notably MSD, SSD, and stone size, are significantly associated with successful ESWL outcome. However, additional large-scale prospective studies are required to utilize these parameters effectively, and the optimal cutoff value should be determined., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Association of University Radiologists. Published by Elsevier Inc. All rights reserved.)

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

Objective: To assess the efficacy and safety of flexible ureteral lithotripsy (FURL) for treating upper urinary tract calculi in patients ≥80 years. Methods: This study retrospectively analyzed the clinical data of 297 elderly patients who underwent FURL for unilateral upper urinary tract calculi at Beijing Hospital from January 2019 to September 2023. Patients were divided into elderly group (≥80 years) and low-middle aged group (≥60-<80 years). Propensity score matching (PSM) was used to match preoperative clinical data of patients. After PSM, the basic, perioperative and postoperative data of the two groups were compared. Results: After PSM, 116 patients were enrolled, including 58 patients in each group. The age [ M ( Q 1 , Q 3 )] of elderly group was 83.0 (81.0, 86.0) years, which included 29 males. The age of low-middle aged group was 69.5 (64.8, 74.0) years, which included 33 males. The duration of postoperative hospitalization [ M ( Q 1 , Q 3 )] in elderly group was longer than that in low-middle aged group [2 (1, 3) d vs 1 (1, 2) d, P =0.002]. Serious postoperative complications occurred in 3 cases in the elderly group and 1 case in the low-middle aged group, respectively, without surgical intervention. There was no significant statistical difference in stone-free rate (SFR) [79.3% (46/58) vs 84.5% (49/58)], operation time [ M ( Q 1 , Q 3 ), 70.0 (48.3, 100.0) vs 65.0 (46.5, 101.2) min] and postoperative complication rate [25.9% (15/58) vs 22.4% (13/58)] between two groups (all P >0.05). Conclusions: In the treatment of upper urinary tract calculi in patients ≥80 years, the SFR, operation time and postoperative complication rate of FURL are comparable to those in low-middle aged elderly patients. FURL has good safety and effectiveness in the treatment of upper urinary tract calculi in patients ≥80 years.

The incidence of urinary calculi in children has been increasing annually,and most of the cases are upper urinary tract stones.At present,surgery is the main way to treat upper urinary tract stones in children.With the gradual development of minimally invasive techniques in surgery,percutaneous nephrolithotomy,retrograde intrarenal surgery,and extracorporeal shock wave lithotripsy have become the main methods for treating upper urinary tract stones in children.We reviewed the current progress in surgical treatment of upper urinary tract stones in children and provided prospects for future treatment options.

Objective: Rising upper urinary tract calculus (UUTC) cases demand effective treatment. FUL, while efficient, poses infection risks and SIRS. This study explores CHR, NLR, and U-HBP as potential SIRS predictors post-FUL in UUTC patients, aiming to improve early detection and enhance SIRS management., Methods: A retrospective analysis was conducted on data from 216 UUTC patients who underwent FUL between April 2020 and April 2023. Occurrence of SIRS post-FUL was studied. Patients were categorized into SIRS and non-SIRS groups. CHR, NLR, and U-HBP levels were compared. Predictive value of CHR, NLR, and U-HBP for SIRS was assessed. Univariate and multivariate logistic regression analyses identified SIRS influencing factors., Results: In a study involving 216 patients undergoing Flexible Ureteroscopic Holmium Laser Lithotripsy (FUL), Systemic Inflammatory Response Syndrome (SIRS) occurred in 20.83% of cases. Patients with SIRS exhibited significantly elevated levels of C-reactive protein to High-density lipoprotein cholesterol ratio (CHR) (9.26 ± 2.17 vs. 3.89 ± 0.92), Neutrophil to Lymphocyte Ratio (NLR) (5.21 ± 0.98 vs. 2.62 ± 0.49), and Urinary Heparin Binding Protein (U-HBP) (3.01 ± 0.51 ng/L vs. 1.22 ± 0.19 ng/L) compared to the non-SIRS group. Multivariate analysis identified factors such as infected stones (OR = 3.294), stone size ≥ 30 mm (OR = 2.034), CHR ≥ 8.76 (OR = 4.554), NLR ≥ 3.74 (OR = 3.951), and U-HBP ≥ 1.55 ng/L (OR = 4.884) as significant predictors for SIRS. These findings emphasize the pivotal role of these biomarkers and stone characteristics in predicting inflammatory responses post-FUL surgery., Conclusion: This study establishes the predictive power of elevated C-reactive protein to High-density lipoprotein cholesterol ratio (CHR), Neutrophil to Lymphocyte Ratio (NLR), and Urinary Heparin Binding Protein (U-HBP) levels for Systemic Inflammatory Response Syndrome (SIRS) post Flexible Ureteroscopic Holmium Laser Lithotripsy (FUL) in upper urinary tract calculi patients. Stone characteristics, including infected stones and stone size ≥ 30 mm, are also key indicators of SIRS. These findings offer crucial insights for effective post-operative management, enhancing outcomes in urinary calculi treatment.

Purpose: During endoscopic stone surgery, Holmium:YAG (Ho:YAG) and Thulium Fiber Laser (TFL) technologies allow to pulverize urinary stones into fine particles, ie DUST. Yet, currently there is no consensus on the exact definition of DUST. This review aimed to define stone DUST and Clinically Insignificant Residual Fragments (CIRF)., Methods: Embase, MEDLINE (PubMed) and Cochrane databases were searched for both in vitro and in vivo articles relating to DUST and CIRF definitions, in November 2023, using keyword combinations: "dust", "stones", "urinary calculi", "urolithiasis", "residual fragments", "dusting", "fragments", "lasers" and "clinical insignificant residual fragments"., Results: DUST relates to the fine pulverization of urinary stones, defined in vitro as particles spontaneously floating with a sedimentation duration ≥ 2 sec and suited for aspiration through a 3.6Fr-working channel (WC) of a flexible ureteroscope (FURS). Generally, an upper size limit of 250 µm seems to agree with the definition of DUST. Ho:YAG with and without "Moses Technology", TFL and the recent pulsed-Thulium:YAG (pTm:YAG) can produce DUST, but no perioperative technology can currently measure DUST size. The TFL and pTm:YAG achieve better dusting compared to Ho:YAG. CIRF relates to residual fragments (RF) that are not associated with imminent stone-related events: loin pain, acute renal colic, medical or interventional retreatment. CIRF size definition has decreased from older studies based on Shock Wave Lithotripsy (SWL) (≤ 4 mm) to more recent studies based on FURS (≤ 2 mm) and Percutaneous Nephrolithotomy(PCNL) (≤ 4 mm). RF ≤ 2 mm are associated with lower stone recurrence, regrowth and clinical events rates. While CIRF should be evaluated postoperatively using Non-Contrast Computed Tomography(NCCT), there is no consensus on the best diagnostic modality to assess the presence and quantity of DUST., Conclusion: DUST and CIRF refer to independent entities. DUST is defined in vitro by a stone particle size criteria of 250 µm, translating clinically as particles able to be fully aspirated through a 3.6Fr-WC without blockage. CIRF relates to ≤ 2 RF on postoperative NCCT., (© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Background: Recurrent and complex stone disease may be considered a challenging disease. In 2018, the Calculus group of the SIU (Italian Society of Urology) set itself the goal of establishing the minimum requirements for a center that could continuously manage urolithiasis pathology, named a Stone Center. In this study we present the results of a pilot survey carried out in 2019 with the aim of drawing a map of the situation of Italian urological centers dealing with urinary stones., Methods: A total of 260 national urology departments dealing with urolithiasis surgery were contacted for this study. A survey was issued to each of the centers to determine the number of patients treated for urinary stones and the amount of procedures performed per year: 1) extracorporeal shock wave lithotripsy ESWL; 2) ureterorenoscopy URS; 3) retrograde intrarenal surgery RIRS; 4) percutaneous nephrolithotomy PCNL., Results: Out of 260 centers contacted, 188 fulfilled the survey. Outcomes were quite variable, with approximately 37% of the centers lacking a lithotripter, and 46% of those that did have it performing fewer than 100 treatments per year. In terms of endoscopic procedures, more than 80% of the centers contacted performed URS or RIRS; however, when it came to percutaneous lithotripsy, these numbers dropped significantly; 33% of the centers contacted did not perform PCNL, and of those who did, 18% had less than 5 years of experience as a center., Conclusions: Our survey shows a very heterogeneous national picture about urolithiasis treatments. Our goal is to create national paradigms to be able to define stone centers where the patient suffering from complex urinary stones can find a network of professionals with an adequate armamentarium suitable for the management of their pathology.

Introduction: Ureteroscopy (URS) can be proposed as first-line therapy for the management of pelvic stones from 10 to 20 mm and for lower ureteric stones in children. However, little is known about the success and the morbidity of URS in young children. Ureteroscopic treatment may present matters in young children because of the small size of the pediatric kidney and the small size of the collecting system., Objective: To assess safety and efficacy of URS for the treatment of urinary stones in children aged of 5 years or less., Study Design: After the institutional ethical board approval was obtained, we conducted a retrospective, analytic, multicentric study that included all URS performed between January 2016 and April 2022 in children aged of 5 years or less. In this non-comparative case series, anonymized pooled data were collected from 7 tertiary care centers of pediatric patients. Endpoints were the one-session SFR at 3 months and per and postoperatives complications. Descriptive statistics were applied to describe the cohort., Results: Eighty-three patients were included. For them, 96 procedures were performed at the median age of 3.5 years (IQR: 0.8-5) and median weight of 14 Kg (6.3-23). Median stone size was 13 mm (4-45). There were 65 (67 %) renal stones treated with flexible URS, most of which were in the renal pelvis (30 %) and in the lower calix (33 %). A ureteral access sheath was used in 91 % procedures. Preoperative ureteral stent was placed in 52 (54 %) of patients. None of patients had ureteral dilatation. The single-session SFR was 67.4 % (56.3 and 89.2 % for flexible URS and semi-rigid URS respectively) and children require 1.4 procedures to achieve complete stone clearance. The overall complication rate was 18.7 %, most of them were minor (Clavien I-II). Intraoperative perirenal extravasation (Clavien IIIb) due to forniceal rupture was documented in 6.2 % of cases, related to an increased intrapelvic pressure (IPP) performed in a closed pelvicalyceal system., Discussion: Pediatric urologists should be aware of forniceal rupture based on the presence of extravasation of contrast during endourological procedures especially when they have difficulties to reach lower caliceal stone in small patient., Conclusion: URS in patients aged of 5 years or less, is a complex minimally invasive procedure with reasonable efficacy and low morbidity. Intrarenal stones treated by RIRS in young children carries the risk of additional procedures to complete stone clearance., Competing Interests: Conflict of interest The authors declare that they have no conflicts of interest., (Copyright © 2023. Published by Elsevier Ltd.)

Background: The prevalence of kidney stones tends to increase worldwide due to dietary and climate changes. Disease management involves a high consumption of healthcare system resources which can be reduced with primary prevention measures and prophylaxis of recurrences. In this field, collaboration between general practitioners (GPs) and hospitals is crucial., Methods: a panel composed of general practitioners and academic and hospital clinicians expert in the treatment of urinary stones met with the aim of identifying the activities that require the participation of the GP in the management process of the kidney stone patient., Results: Collaboration between GP and hospital was found crucial in the treatment of renal colic and its infectious complications, expulsive treatment of ureteral stones, chemolysis of uric acid stones, long-term follow-up after active treatment of urinary stones, prevention of recurrence and primary prevention in the general population., Conclusions: The role of the GP is crucial in the management and prevention of urinary stones. Community hospitals which are normally led by GPs in liaison with consultants and other health professional can have a role in assisting multidisciplinary working as extended primary care.

Introduction: The worldwide incidence of pediatric urinary stone disease (PUSD) is increasing. However, there is no commensurate data on whether this translates to an increasing need for surgical intervention for PUSD, given the role of conservative management., Objective: We aimed to evaluate the trends and outcomes of clinically significant PUSD, using administrative databases to identify patients surgically treated for PUSD., Study Design: This retrospective population-based cohort study assessed the incidence and trends of surgically treated PUSD and outcomes in Ontario, Canada in patients <18 years of age who underwent their first PUSD procedure between 2002 and 2019 utilizing administrative databases held at the Institute of Clinical Evaluative Sciences (ICES). We assessed the incidence of surgically treated PUSD, demographics, initial surgical treatment and imaging modality, and risk factors for repeat intervention within 5 years. Statistical analyses summarized demographics, surgical trends, and logistic regression was used to identify risk factors for repeat surgical intervention., Results: We identified 1149 patients (mean age 11.3 years), with 59.6% older than 12 years. There was a decrease in the number of PUSD procedures performed per year that was close to statistical significance (p = 0.059) and a trend towards increased utilization of ureteroscopy (URS) compared with Shockwave Lithotripsy (SWL). In addition, there was a significant increase in the proportion of females surgically treated with PUSD (p = 0.001). In the 706 patients followed for 5 years, 17.7% underwent a repeat procedure within 6 months, while 20.4% underwent a repeat procedure from 6-months to 5 years. Renal stone location (OR 2.79, 95% confidence interval (CI) 1.62-4.80, p = 0.0002) and index SWL (OR 1.66, 95% CI 1.20-2.31, p = 0.0025) were risk factors for repeat surgical intervention within the first 6-months. There was an increasing utilization of ultrasound (US) compared to computerized tomography (CT) (p = 0.0008)., Discussion: Despite the literature reporting increasing PUSD incidence, we observed a non-significant decrease in the number of surgical PUSD procedures performed. Exclusion of those treated conservatively may explain our results. The increase in the proportion of females treated reflects the narrowing gender gap in stone disease. A trend towards increased URS utilization was observed and re-intervention rates were similar to previous studies., Conclusion: The overall rate of surgically treated PUSD did not show an increasing trend in Ontario, Canada from 2002 to 2019. URS was the most common surgical treatment modality, with a corresponding decline in SWL rates. PUSD was associated with a high surgical re-intervention rate within 6 months., Competing Interests: Conflict of interest None., (Copyright © 2023 Journal of Pediatric Urology Company. Published by Elsevier Ltd. All rights reserved.)

Background: The novel pulsed thulium:yttrium-aluminum-garnet (p-Tm:YAG) laser was recently introduced. Current studies present promising p-Tm:YAG ablation efficiency, although all are based on non-human stone models or with unknown stone composition. The present study aimed to evaluate p-Tm:YAG ablation efficiency for stone dust from human urinary stones of known compositions., Methods: Calcium oxalate monohydrate (COM) and uric acid (UA) stones were subjected to lithotripsy in vitro using a p-Tm:YAG laser generator (Thulio®, Dornier MedTech GmbH, Germany). 200 J was applied at 0.1 J × 100 Hz, 0.4 J × 25 Hz or 2.0 J × 5 Hz (average 10W). Ablated stone dust mass was calculated from weight difference between pre-lithotripsy stone and post-lithotripsy fragments > 250 µm. Estimated ablated volume was calculated using prior known stone densities (COM: 2.04 mg/mm 3 , UA: 1.55 mg/mm 3 )., Results: Mean ablation mass efficiency was 0.04, 0.06, 0.07 mg/J (COM) and 0.04, 0.05, 0.06 mg/J (UA) for each laser setting, respectively. This translated to 0.021, 0.029, 0.034 mm 3 /J (COM) and 0.026, 0.030, 0.039 mm 3 /J (UA). Mean energy consumption was 26, 18, 17 J/mg (COM) and 32, 23, 17 J/mg (UA). This translated to 53, 37, 34 J/mm 3 (COM) and 50, 36, 26 J/mm 3 (UA). There were no statistically significant differences for laser settings or stone types (all p > 0.05)., Conclusion: To our knowledge, this is the first study showing ablation efficiency of the p-Tm:YAG laser for stone dust from human urinary stones of known compositions. The p-Tm:YAG seems to ablate COM and UA equally well, with no statistically significant differences between differing laser settings., (© 2023. The Author(s).)

Introduction: Shared decision making (SDM) in surgical specialties was demonstrated to diminish decisional regret, decisional anxiety and decisional conflict. Urolithiasis guidelines do not explicit patient preference to choose treatment. The aim of this review article was to perform a systematic evaluation of published evidence regarding SDM in urinary stone treatment., Methods: A systematic review in accordance PRISMA checklist was conducted using the MEDLINE (PubMed) database. Inclusion criteria were studies that evaluated stone treatment preferences. Reviews, editorials, case reports and video abstracts were excluded. ROBUST checklist was used to assess quality of the studies., Results: 188 articles were obtained. After applying the predefined selection criteria, seven articles were included for final analysis. Six out of seven studies were questionnaires that propose clinical scenarios and treatment alternatives. The last study was a patient preference trial. A general trend among included studies showed a patient preference towards the least invasive option (SWL over URS). The main reasons to choose one treatment over the other were stone-free rates, risk of complications and invasiveness., Discussion: This review provides an overview of the patients' preferences towards stone treatment in small- and medium-sized stones. There was a clear preference towards the least invasive management strategy. The main reason was less invasiveness. This is opposed to the global trends of performing more ureteroscopies and less SWL. Physicians played a pivotal role in counselling patients. SDM should be encouraged and improved. The main limitation of this study is the characteristics of the included studies., (© 2023. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Extracorporeal shock wave lithotripsy (ESWL) is a minimally invasive technique for the fragmentation of urinary tract stones using shock waves under fluoroscopic and/or ultrasound guidance. ESWL results depend on the indication (stone size/composition, clinical context) and also on how it is performed. The stone structure, nature and density (Hounsfield units; evaluated by CT without contrast agent) influence the fragmentation achieved by ESWL. The upper size limit of kidney stones has been lowered to 15mm (1.68cm 3 ) due to the increased risk of steinstrasse with larger sizes and the potential need of anesthesia and ureteral stenting. Conversely, the development of endourological technologies allows a finer stone fragmentation and/or better elimination, thus reducing the risk of steinstrasse and decreasing the potential number of sessions or additional interventions. METHODOLOGY: These recommendations were developed using two methods: the Clinical Practice Recommendations method (CPR) and the ADAPTE method, depending on whether the question was considered in the European Association of Urology (EAU) recommendations (https://uroweb.org/guidelines/urolithiasis [EAU 2022]) and their adaptability to the French context., (Copyright © 2023 Elsevier Masson SAS. All rights reserved.)

Endoscopic observation is performed during treatments by flexible ureteroscopy to differentiate in situ between renal papillary abnormalities and stones based on their concordance with Daudon's morphological/composition descriptions adapted to endoscopy. These intraoperative visual analyses are now an integral part of the urinary stone disease diagnostic approach in addition to the morphological/structural and spectrophotometric analysis that remains the reference exam, but that loses information on the stone component representativeness due to the development of in situ laser lithotripsy. These are the first practical recommendations on the endoscopic description of renal papillae and stones. METHODOLOGY: These recommendations were developed using two methods: the Clinical Practice Recommendations (CPR) and the ADAPTE method, depending on whether the question was considered in the European Association of Urology (EAU) recommendations (https://uroweb.org/guidelines/urolithiasis [EAU Guidelines on urolithiasis. 2022]) and their adaptability to the French context., (Copyright © 2023 Elsevier Masson SAS. All rights reserved.)

The acute situation, caused by an obstructive stone, is defined by a renal colic that may be uncomplicated, complicated, or at risk in specific conditions. Its management may be medical or require interventional treatment by extracorporeal shockwave lithotripsy, endoscopic removal, or ureteroscopy. METHODOLOGY: These recommendations were developed using two methods, the Clinical Practice Recommendations (CPR) and the ADAPTE method, in function of whether the question was considered in the European Association of Urology (EAU) recommendations (https://uroweb.org/guidelines/urolithiasis) [EAU Guidelines on urolithiasis. 2022] and whether they could be adapted to the French context., (Copyright © 2023 Elsevier Masson SAS. All rights reserved.)

This paper analyzed the clinical data, diagnosis and treatment of 4 asymptomatic patients with ureteral calculi without hydrops in our hospital from October 2018 to January 2019, and comprehensively discussed the previous literature. The 4 patients in this group had no obvious clinical symptoms, no positive stones were found in the B-ultrasound of the urinary system, and no hydroureter and hydroureter of the affected side was found. Urinary CT scan confirmed ureteral stones. They were all located in the lower ureter, and the stones obstructed the lumen. The stones were round and smooth, and there was no obvious hyperplasia and edema in the surrounding mucosa. The lithotripsy was completed in the first-stage operation, and the DJ catheter was left behind for one month after the operation. Based on the clinical diagnosis and treatment process of the 4 cases of asymptomatic calculi in this group and the analysis of previous studies, these patients were mostly detected by imaging examinations or other systematic imaging examinations during the regular review of urinary calculi. Ureteral stones with obstruction did not necessarily have stone-related symptoms. The onset of renal colic involved an increase in intraluminal pressure, related stimulation of nerve endings, smooth muscle spasms caused by stretching of the ureteral wall, and systemic changes in cytokines and related hormones. Cascade reactions, etc., were associated with the movement of stones down. Ureteral stones without hydrops were mostly located in the lower ureter, which had a certain buffering effect on obstructive pressure. Asymptomatic ureteral calculi could also induce irreversible damage to renal function, and the proportion of damage increased with the diameter of the stone. Patients with a history of urinary calculi, especially those with asymptomatic stones for the first time, should be paid attention to during clinical follow-up. At present, there are few research reports on asymptomatic and non-accumulating ureteral calculi. We analyze the clinical diagnosis and treatment process and characteristics of this group of patients combined with previous literature to provide a reference for the diagnosis and treatment of such patients.

Purpose: To evaluate whether stone dust can be obtained from all prevailing stone composition types using the novel pulsed thulium:YAG (p-Tm:YAG), including analysis of stone particle size after lithotripsy., Methods: Human urinary stones of 7 different compositions were subjected to in vitro lithotripsy using a p-Tm:YAG laser with 270 µm silica core fibers (Thulio ® , Dornier MedTech GmbH ® , Wessling, Germany). A cumulative energy of 1000 J was applied to each stone using one of three laser settings: 0.1 J × 100 Hz, 0.4 J × 25 Hz and 2.0 J × 5 Hz (average power 10 W). After lithotripsy, larger remnant fragments were separated from stone dust using a previously described method depending on the floating ability of dust particles. Fragments and dust samples were then passed through laboratory sieves to evaluate stone particle count according to a semiquantitative analysis relying on a previous definition of stone dust (i.e., stone particles ≤ 250 µm)., Results: The p-Tm:YAG laser was able to produce stone dust from lithotripsy up to measured smallest mesh size of 63 µm in all seven stone composition types. Notably, all dust samples from all seven stone types and with all three laser settings had high counts of particles in the size range agreeing with the definition stone dust, i.e., ≤ 250 µm., Conclusion: This is the first study in the literature proving the p-Tm:YAG laser capable of dusting all prevailing human urinary stone compositions, with production of dust particles ≤ 250 µm. These findings are pivotal for the broader future implementation of the p-Tm:YAG in clinical routine., (© 2023. The Author(s).)

Objective: To evaluate the efficacy and safety of superpulse thulium laser lithotripsy in the intracavitary treatment of urinary calculi. Methods: From May 2021 to July 2022, patients diagnosed with urinary calculi were screened in four medical centers. Those who met the criteria were treated with superpulse thulium fiber laser under endoscope. The patients' perioperative conditions were recorded. The main effective index was stone-free rate (SFR) 4 weeks after operation, the main safety index was the failure rate of the experimental instruments during operation, and the secondary safety index was the incidence rate of perioperative complications. Results: A total of 76 eligible patients completed superpulse thulium fiber laser lithotripsy, with an average age of (52.0±11.1) years, 54 males and 22 females. There were 31 renal stones, 43 ureteral stones and 2 bladder stones. Percutaneous nephrolithotomy was performed in 17 patients. Ureteroscopy lithotripsy/flexible ureteroscopy lithotripsy was performed in 57 patients and transurethral bladder lithotripsy was in 2 patients. The lithotripsy time of all patients was (50.9±31.4) minutes. There was no failure of experimental instruments during the operation. Six patients refused follow-up examination after operation. The incidence of postoperative adverse events was 61.8% (47/76). One patient needed hospitalization due to inguinal hernia after operation, and the rest were classified as Clavien-dindo grade 1-2. The SFR was 94.3% (66/70) at 4 weeks after operation. Conclusion: It is effective and safe to use superpulse thulium fiber laser in the treatment of urinary calculi.

Purpose of Review: The prevalence of uric acid (UA) urolithiasis contributes significantly to global disease burden, due to high rates of recurrence and diagnostic challenges. Dissolution therapy plays a valuable role in the conservative management of UA calculi, reducing the requirement for surgical intervention. This review summarises the existing evidence for the efficacy of medical dissolution of uric acid urolithiasis., Recent Findings: A systematic search was conducted of worldwide literature according to PRISMA methodology and Cochrane standards for systematic review. Studies were included if they reported outcome data for the administration of medical therapy for the dissolution of UA calculi. A total of 1075 patients were included in the systematic review. Complete or partial dissolution of UA calculi was observed in 80.5% of patients (865/1075 patients), with 61.7% (647/1048 patients) achieving complete dissolution and 19.8% (207/1048 patients) achieving partial dissolution. A discontinuation rate of 10.2% (110/1075 patients) was noted, and 15.7% (169/1075 patients) required surgical intervention. Dissolution therapy is a safe and effective method of conservatively managing uric acid stones in the short term. Despite the significant disease burden of UA calculi, current guidelines are limited by deficiencies in the existing body of research. Further research should be undertaken to develop evidence-based clinical guidelines for diagnosis, treatment, and prevention of UA urolithiasis., (© 2023. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Objective: The correlation of the degree of hydronephrosis and computed tomography (CT) value of calculi with the efficacy of ureteroscopic lithotripsy (URSL) in patients with upper urinary tract infectious calculi was explored., Methods: The clinical data of 152 patients with upper urinary tract infectious calculi and on URSL in Shanghai Baoshan District Wusong Central Hospital from November 2019 to November 2021 were collected for retrospective analysis. All patients received CT examination before surgery. According to the therapeutic effect of URSL, all patients were divided into the non-calculi group (NCG, n = 101) and residual calculi group (RCG, n = 51), which were compared in terms of the degree of hydronephrosis and CT value of calculi. Then, the correlation of the degree of hydronephrosis and CT value of calculi with the efficacy of URSL in patients was analysed., Results: No significant difference in clinical data was found between the groups ( p > 0.05). Patients in the NCG group had lower degree of hydronephrosis than those in the RCG group ( p < 0.05), and the NCG had lower CT value of calculi ( p < 0.001). Spearman rank correlation analysis showed that the degree of hydronephrosis in patients with upper urinary tract infectious calculi was negatively correlated with the efficacy of URSL (r = -0.676, p < 0.001), and the CT value of calculi in such patients was negatively correlated with the efficacy of URSL (r = -0.795, p < 0.001)., Conclusions: The degree of hydronephrosis and CT value of calculi were negatively correlated with the efficacy of URSL. Both can be used to predict clinical efficacy and have clinical guiding value for the formulation of treatment plans in patients with urinary tract infectious calculi., Competing Interests: The authors declare no conflict of interest., (© 2023 The Author(s).)

Purpose: The aim of this study is to evaluate the factors affecting treatment success in patients who underwent Shock wave lithotripsy (SWL) for ureter stones and to investigate the effect of Storz Medical Lithotripsy Index (SMLI) on treatment effectiveness in ureteric stones., Method: Prospective data were collected on patients undergoing SWL treatment for ureter stones between January 2013 and May 2021. Stone location, number, and size were determined with Non contrast CT (NCCT) for all patients. All patients underwent SWL with a Storz Modulith SLK lithotripsy machine with local anaesthesia. The total amount of energy applied to the stone was calculated using the Storz Medical Lithotripsy Index (SMLI). All patients were evaluated for stone-free status by X-ray at least 2 weeks after treatment. The success of the procedure was defined as the patient being completely stone free (SF) or detection of residual fragments < 4 mm that did not require further treatment Results: A total of 1199 patients with ureter stones were included in the study. The mean age of the patients was 43.11 ± 10.65 (18-73), and the mean BMI was 27.87±8.12(19.02-38.65). During SWL, 89.3% of patients demonstrated excellent pain tolerance (1070/1199). A total of 119 patients could not tolerate pain during SWL (10.7%). Treatment success was associated with fewer treatment sessions (2.04±1.64 vs. 2.50 ± 1.48; p < 0.001), smaller stone size (7.35±2.99 vs. 9.02 ± 3.81; p < 0.001) and higher SMLI/stone size (29.70 ± 17.48 vs. 24.98±16.01; p < 0.001). In the univariate and multivariate regression analysis, the factors affecting the success of the treatment were the number of sessions (OR: 1.147), stone size (OR: 1.112), SMLI/stone size (OR: 1.115) and pain tolerance (OR: 0.740)., Conclusion: In the treatment of ureteral stones with SWL, number of sessions, stone size, SMLI/stone size, and pain tolerance are the factors affecting success. SMLI per stone size is a statistically significant factor for predicting SWL success.

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.

Objectives: During holmium:yttrium-aluminum-garnet (holmium:YAG) laser lithotripsy to break urinary stones, urologists frequently see flashes of light. As infrared laser pulses are invisible, what is the source of light? Here we studied the origin, characteristics, and some effects of flashes of light in laser lithotripsy., Methods: Ultrahigh-speed video-microscopy was used to record single laser pulses at 0.2-1.0 J energy lasered with 242 µm glass-core-diameter fibers in contact with whole surgically retrieved urinary stones and hydroxyapatite (HA)-coated glass slides in air and water. Acoustic transients were measured with a hydrophone. Visible-light and infrared photodetectors resolved temporal profiles of visible-light emission and infrared-laser pulses., Results: Temporal profiles of laser pulses showed intensity spikes of various duration and amplitude. The pulses were seen to produce dim light and bright sparks with submicrosecond risetime. The spark produced by the intensity spike at the beginning of laser pulse generated a shock wave in the surrounding liquid. The subsequent sparks were in a vapor bubble and generated no shock waves. Sparks enhanced absorption of laser radiation, indicative of plasma formation and optical breakdown. The occurrence and number of sparks varied even with the same urinary stone. Sparks were consistently observed at laser energy >0.5 J with HA-coated glass slides. The slides broke or cracked by cavitation with sparks in 63 ± 15% of pulses (1.0 J, N = 60). No glass-slide breakage occurred without sparks (1.0 J, N = 500)., Conclusion: Unappreciated in previous studies, plasma formation with free-running long-pulse holmium:YAG lasers can be an additional physical mechanism of action in laser procedures., (© 2023 Wiley Periodicals LLC.)

In North America, ureteroscopy has become the most popular treatment modality for upper urinary tract urinary calculi. Herein we describe our technique for the treatment of renal stones with flexible ureteroscopy and high-power holmium laser lithotripsy. We discuss preoperative planning, intraoperative strategies, and laser settings for a high-frequency dusting technique with the goal to provide optimal patient outcomes.

Objective: To assess the impact of a Virtual Reality Device (VRD, HypnoVR, Strasbourg, France) on patient-reported pain and anxiety during extracorporeal shockwave lithotripsy (ESWL)., Materials and Methods: We enrolled 30 patients submitted to ESWL for urinary stones. Patients with either epilepsy or migraine were excluded. ESWL procedures were performed using the same lithotripter (Lithoskop; Siemens, AG Healthcare, Munich, Germany) at a frequency of 1 Hz delivering 3000 shock waves per procedure. The VRD was installed and started 10 minutes before the procedure. Tolerability of pain and treatment-related anxiety represented the primary efficacy outcomes and were evaluated using: (1) a visual analogue scale (VAS), (2) the short version of the McGill pain questionnaire (MPQ), and (3) the short version of the surgical fear questionnaire (SFQ). Secondary outcomes were VRD ease of use and patient satisfaction., Results: Median (IQR) age was 57 (51-60) years and body mass index (BMI) was 23 (22-27) kg/m 2 . Median (IQR) stone size was 7 (6-12) mm with a median (IQR) density of 870 (800-1100) HU. Stone location was kidney in 22 (73%), and ureter in 8 (27%) patients. Median (IQR) extra time for installation was 6.5 (4-8) minutes. Overall, 20 (67%) patients were at their first ESWL treatment. Side effects were experienced by only 1 patient. Comprehensively, 28 (93%) patients would recommend and would use VRD again during ESWL., Conclusion: VRD application during ESWL is safe and feasible. The initial report from patients is positive in terms of pain and anxiety tolerance. Further comparative studies are needed., (Copyright © 2023 Elsevier Inc. All rights reserved.)

Introduction: Stent encrustation is one of the most difficult problems that can lead to difficulties in stent removal, while ureteral obstruction can lead to renal failure. Despite the search for various preventive measures, it still remains unresolved., Aim: To study the effect of Blemaren on stent encrustation in patients with calcium-containing and uric acid stones after ureteroscopy with lithotripsy., Materials and Methods: A total of 60 patients with ureteral stones who underwent ureteroscopy with lithotripsy in A.V. Vishnevsky National Medical Research Center of Surgery from January to August 2022, were included in the study. In all cases ureteral stents 6 Ch were placed at the end of the procedure. Patients with uric acid and calcium oxalate stones (n=48) were randomized into two groups: in the main group (n=20), they were prescribed Blemaren up to the stent removal. In the control group (n=28), patients did not receive additional therapy. To determine the severity of incrustation, we used our own classification, where the percentage of lithogenic deposits relative to the lumen of the stent was calculated. Visual assessment and microscopic examination of the removed stents were performed on days 30+/-4.1 and 60+/-7.3., Results: In patients of both groups, the severity of encrustation on the 30th day after stent placement was low (up to 30%). There were no significant differences between the groups (p=0.421). The main changes were detected 60 days after stent placement. Microscopic study revealed significant differences between two groups. In patients who did not receive Blemaren, microscopic signs of encrustation of the proximal curl of the stent occurred 2.5 times more often than in the main group (p=0.001)., Conclusions: 1. The number of encrusted stents in patients with calcium oxalate and uric acid stones who did not receive Blemaren significantly increases after two months. 2. Upper urinary tract drainage with a stent for a period of more than 2 months is possible if clinically necessary, however, preventive measures to reduce the risk of encrustation should be applied.

Different international associations have proposed their own guidelines on urolithiasis. However, the focus is primarily on an overview of the principles of urolithiasis management rather than step-by-step technical details for the procedure. The International Alliance of Urolithiasis (IAU) is releasing a series of guidelines on the management of urolithiasis. The current guideline on shockwave lithotripsy (SWL) is the third in the IAU guidelines series and provides a clinical framework for urologists and technicians performing SWL. A total of 49 recommendations are summarized and graded, covering the following aspects: indications and contraindications; preoperative patient evaluation; preoperative medication; prestenting; intraoperative analgesia or anesthesia; intraoperative position; stone localization and monitoring; machine and energy settings; intraoperative lithotripsy strategies; auxiliary therapy following SWL; evaluation of stone clearance; complications; and quality of life. The recommendations, tips, and tricks regarding SWL procedures summarized here provide important and necessary guidance for urologists along with technicians performing SWL. PATIENT SUMMARY: For kidney and urinary stones of less than 20 mm in size, shockwave lithotripsy (SWL) is an approach in which the stone is treated with shockwaves applied to the skin, without the need for surgery. Our recommendations on technical aspects of the procedure provide guidance for urologists and technicians performing SWL., (Copyright © 2022. Published by Elsevier B.V.)

Objectives: To report the results of a clinical audit conducted by the British Association of Urological Surgeons (BAUS) of ureteric stone care pathways, with results reported with reference to national quality standards., Patients and Methods: The BAUS conducted a clinical audit of all patients presenting as an emergency to 107 hospitals in England during November 2020 with ureteric stones. All patients were followed up until 31 March 2021 and the inpatient and outpatient management received was recorded., Results: Data for 2192 patients across 117 units were submitted. The median (interquartile range [IQR]) number of patients per unit was 16 (9-27); 70% of patients were male and the median (IQR) patient age was 46 (34-59) years. Initial management was conservative treatment for 70% of patients. Overall, primary shockwave lithotripsy was performed in 34% of patients and primary ureteroscopy in 23% of cases when surgical intervention was required to treat the stone. However, 40% of patients in whom active intervention was appropriate underwent placement of a temporizing ureteric stent rather than undergo definitive surgical intervention at the outset. Female patients were less likely to have a computed tomography (CT) scan of the kidneys, ureters and bladder performed within 24 h of presentation (13% vs 7.3% for men [chi-squared P = 0.01]) and to be given correct analgesia (66% vs 73% for men [chi-squared P = 0.03]). Patients aged 60 years or older were also significantly less likely to be offered nonsteroidal anti-inflammatory drug analgesia appropriately. In total, 87% of patients had their calcium measured within the last 2 years and 73% of patients had evidence of being offered stone prevention diet and fluid advice., Conclusions: The audit demonstrates that the National Institute of Health and Care Excellence Quality Standards are both measurable and achievable. However, there was considerable variation in the delivery of these standards, including with regard to sex and age, highlighting inequalities for patient care across the UK., (© 2022 BJU International.)

The aim of this study is to evaluate the usefulness of microureteroscopy (m-URS) in the treatment of renal and ureteral stones in children younger than 3 years of age. A retrospective analysis of pediatric patients aged < 3 years with upper urinary tract calculi who underwent lithotripsy was performed. The children were divided into the m-URS group (4.85 F, n = 41) and the ureteroscopy (URS) group (4.5/6.5 F, n = 42) according to the type of ureteroscope used. The mean age of the patients was 23.5 ± 10.7 months in the m-URS group and 20.6 ± 7.1 months in the URS group (P = 0.212). The success rate of one-stage surgery was 80.5% (33/41) for m-URS and 38.1% (16/42) for URS (P < 0.001). The success rates of m-URS were 60.0%, 69.2%, and 91.3% for stones located in the renal pelvis/calix, upper ureter, and mid-lower ureter, respectively. Eight children in the m-URS group and 26 children in the URS group underwent the second-stage ureteroscopic surgery. The mean operation time was 50 (30-60) min in the m-URS group and 40 (34-60) min in the URS group (P = 0.287). The complication rates were 4.9% and 7.1% in the m-URS and URS groups, respectively (P = 1.000). The stone-free rate at 1 month after lithotripsy was 87.8% in the m-URS group and 83.3% in the URS group (P = 0.563). The mean anesthesia session was 2.1 in the m-URS group and 2.5 in the URS group (P = 0.002). M-URS can effectively reduce the number of anesthesia sessions and is considered an alternative treatment for upper urinary tract calculi in selected pediatric patients younger than 3 years of age., (© 2023. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Background: Absolute polycythemia can be primary or secondary. Erythropoietin-producing diseases (for example, hypoxia) are the major cause of secondary polycythemia. There are reports of polycythemia secondary to hydronephrosis. However, to our knowledge, there is no report on polycythemia secondary to hydronephrosis due to a urinary stone. Herein, we present a case of polycythemia with an elevated erythropoietin level in a patient with a urinary stone and unilateral hydronephrosis., Case Presentation: A 57-year-old Japanese man presented with polycythemia and an elevated erythropoietin level. Erythropoietin accumulation was not due to erythropoietin secretion by a tumor as no obvious lesions were detected on contrast-enhanced computed tomography. Abdominal ultrasonography revealed a stone in the left urinary tract and renal hydronephrosis, and 2 weeks later, the patient underwent transurethral ureterolithotripsy without complications. Blood tests 2 weeks after transurethral ureterolithotripsy showed that the erythropoietin level had declined. Hemoglobin concentration decreased from 20.8 mg/dL before and immediately after transurethral ureterolithotripsy to 15.8 mg/dL 3 months after transurethral ureterolithotripsy. This case was diagnosed as erythropoietin elevation due to unilateral hydronephrosis with a urinary stone, resulting in polycythemia., Conclusions: Hydronephrosis is a common disease but is not often associated with polycythemia. Further studies are required to elucidate the mechanism and implications of elevated erythropoietin production in hydronephrosis., (© 2023. The Author(s).)

Holmium laser lithotripsy is currently the optimum standard for surgical treatment of upper urinary calculi. This study aims to evaluate the clinical efficacy and safety of Moses compared with conventional holmium laser lithotripsy for the treatment of patients with upper urinary calculi. We conducted a systematic search using multiple databases (PubMed/Medline, Scopus, Web of Science, and ClinicalTrials.gov) until June 2022. Clinical trials comparing Moses and conventional holmium laser lithotripsy were included. Analysis was performed using RevMan version 5.4.4 software. Four studies with 892 patients were included. There were no significant differences regarding stone-free rate (mean difference [MD] 1.19, 95% CI 0.54, 2.64, p = 0.66), operative time (MD - 9.31, 95% CI - 21.11, 2.48, p = 0.12), fragmentation time (MD - 1.71, 95% CI - 11.81, 8.38, p = 0.74), total energy used (MD 1.23, 95% CI - 0.44, 2.90, p = 0.15), auxiliary procedures (MD 0.38, 95% CI 0.08, 1.90, p = 0.24), and overall complications (odds ratio [OR] 0.70, 95% CI 0.30, 1.66, p = 0.42) between the groups. However, the laser working time (MD - 0.94, 95% CI - 1.20, - 0.67, p < 0.001) of Moses technology was shorter than that of conventional technology. Moses technology has similar outcomes to regular technology in terms of safety and efficacy. Given the higher operating costs of the Moses technology, further study is required to determine whether there are benefits to this new technology., (© 2023. The Author(s), under exclusive licence to Springer-Verlag London Ltd., part of Springer Nature.)

Objectives: To determine if management of ureteric stones in the UK changed during the coronavirus disease 2019 (COVID-19) pandemic and whether this affected patient outcomes., Patients and Methods: We conducted a multicentre retrospective study of adults with computed tomography-confirmed ureteric stone disease at 39 UK hospitals during a pre-pandemic period (23/3/2019-22/6/2019) and a period during the pandemic (the 3-month period after the first severe acute respiratory syndrome coronavirus-2 case at individual sites). The primary outcome was success of primary treatment modality, defined as no further treatment required for the index ureteric stone. Our study protocol was published prior to data collection., Results: A total of 3735 patients were included (pre-pandemic 1956 patients; pandemic 1779 patients). Stone size was similar between groups (P > 0.05). During the pandemic, patients had lower hospital admission rates (pre-pandemic 54.0% vs pandemic 46.5%, P < 0.001), shorter mean length of stay (4.1 vs 3.3 days, P = 0.02), and higher rates of use of medical expulsive therapy (17.4% vs 25.4%, P < 0.001). In patients who received interventional management (pre-pandemic 787 vs pandemic 685), rates of extracorporeal shockwave lithotripsy (22.7% vs 34.1%, P < 0.001) and nephrostomy were higher (7.1% vs 10.5%, P = 0.03); and rates of ureteroscopy (57.2% vs 47.5%, P < 0.001), stent insertion (68.4% vs 54.6%, P < 0.001), and general anaesthetic (92.2% vs 76.2%, P < 0.001) were lower. There was no difference in success of primary treatment modality between patient cohorts (pre-pandemic 73.8% vs pandemic 76.1%, P = 0.11), nor when patients were stratified by treatment modality or stone size. Rates of operative complications, 30-day mortality, and re-admission and renal function at 6 months did not differ between the data collection periods., Conclusions: During the COVID-19 pandemic, there were lower admission rates and fewer invasive procedures performed. Despite this, there were no differences in treatment success or outcomes. Our findings indicate that clinicians can safely adopt management strategies developed during the pandemic to treat more patients conservatively and in the community., (© 2022 The Authors. BJU International published by John Wiley & Sons Ltd on behalf of BJU International.)

The shockwave lithotripsy is an established modality for the treatment of urinary stone disease. The aim of the study was to present our modified shockwave lithotripsy (SWL) technique, a shockwave propulsion lithotripsy (SWPL) technique, for the treatment of lower pole renal stones and compare its clinical outcomes with the standard SWL technique. An evaluation of a prospectively collected database including 168 patients divided into two groups and treated with ultrasound-guided SWL (n = 80) and SWPL (n = 88) were included in our study. The data were collected between January 2016 and December 2021. Patients older than 18 years old with single lower pole stones sized up to 2 cm were included in the study. SWPL was associated with significant higher SFR compared to standard SWL (85.2 vs. 62.5%, p = 0.001) and required less applied shockwaves (2151 vs. 2502, p = 0.001). Most of the patients in both groups underwent only one SWL session. Overall, a 7.1% complication rate (12 out of 168 patients) was reported, with no difference between groups. In conclusion, our proposed SWPL technique was aimed to overcome difficulties associated with the gravity and anatomic specificities of the lower pole, increased SFR and decreased the need for additional treatment., (© 2022. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Although stone disease is an important health problem with high incidence and recurrence rates, it is a preventable disease. Attitudes and practices of urologists regarding the prevention of recurrence continue to be a subject of debate. In this context, an online survey study was conducted involving 305 urologists from 57 different countries. The first 7 questions collected demographic data about the urologists and the remaining 23 questions were about the recurrence and metabolic evaluation, medical treatment, and follow-up of urinary stone disease. Most urologists (85.2%) thought that metabolic examination was important. Approximately one-third of the participants (34.1%) performed 24-hour urine analysis and stone analysis was ordered by 87.5% of the urologists. Metabolic analysis was performed for all patients by 14.7% of the participants. For pediatric patients this rate was 68.5%, and for adults with recurrence the rate was 81.6%. Reasons cited by the urologists for not performing metabolic analysis included not feeling confident doing so (18.3%), having limited facilities in their hospital (26.5%), having an excessive daily workload (31.8%), patient-related factors (27.5%), and referring patients to other departments for metabolic evaluation (20.9%). Although majority of the responding urologists do consider the metabolic analysis as vital important, they seemed not to be willing to perform these tests with the same degree of enthusiasm in their daily practice. Our results show that urologists need support in performing and interpreting 24-hour urine analysis, improving their knowledge levels, and communicating with patients. Urology residency training should focus more on the prevention of urinary stone recurrence in addition to the surgical training., (© 2022. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Objective: To evaluate the clinical efficacy of extracorporeal shock wave lithotripsy (ESWL) for urinary calculi and precautions of postoperative complications., Methods: 90 patients with urinary calculi at our hospital were randomly recruited between July 2019 and July 2020 and were allocated (1 : 1) to receive either ESWL (observation group) or conventional surgery (control group). Clinical efficacy was the primary endpoint, whereas adverse events were the secondary endpoint., Results: The operation time, early activity time, and hospitalization time of the observation group were significantly lower than those of the control group ( P < 0.05). ESWL resulted in less postoperative pain in patients versus conventional surgery ( P < 0.05). ESWL was associated with a significantly higher total clinical efficacy (97.78%) versus conventional surgery (82.22%) ( P < 0.05). The eligible patients given ESWL had a lower incidence of complications (11.12%) versus those given conventional surgery (31.12%) ( P < 0.05)., Conclusion: Hematuria prevention requires precise localization of stones as well as adjustment of pulse energy and the number of impacts due to stone changes. Precautions against renal colic necessitate complete comminution of stones intraoperatively, more postoperative water intake, moderate exercise, or injection of antispasmodic drugs and cathartics for pain relief. Nausea and vomiting precautions require preoperative recording of previous medical history and corresponding treatment, intraoperative real-time adjustment of voltage pulse frequency, and duration depending on the magnitude of intraoperative reaction. Urinary tract infection prevention requires preoperative prevention and proper postoperative anti-infection and anti-inflammatory treatment, along with enough water intake and bed rest. Other precautions include thorough comminution of the calculi, proper anti-infection and anti-inflammatory treatment, no early exercise or excessive activity after surgery, and proper postoperative care. ESWL is effective in treating patients with urinary calculi with a simple, safe, and quick operation and a low incidence of adverse events, as it effectively reduces the incidence of complications, accelerates the recovery of patients and improves their quality of life., Competing Interests: All authors declared that they have no financial conflict of interest., (Copyright © 2022 Dazhao Zhang et al.)

Introduction and Objectives: To investigate factors affecting SWL outcomes, validate three current nomograms (Kim JK, Triple D and S3HoCKwave) and compare the predictive ability of the nomograms for SWL outcomes in upper urinary tract stones., Patients and Methods: Medical records of patients with renal and proximal ureteral stones treated with SWL between March 2013 and October 2020 were retrospectively reviewed. Factors affecting SWL success were analyzed with multivariate logistic regression analysis and the three predictive scoring systems compared with the area under the curve (AUC)., Results: A total of 580 patients were included in our study. The overall stone free rate was 61% and 144/580 patients (24.8%) were stone free after one session. In multivariate logistic regression analysis, stone location at upper calyx (OR:2.988; 95%Cl: 1.350-6.612; p = 0.007), middle calyx (OR:3.036; 95%Cl: 1.472-6.258; p = 0.003), and lower calyx (OR:2.131; 95%Cl: 1.182-3.839; p = 0.012), as well as number of stones (OR:1.663; 95%Cl: 1.140-2.425; p = 0.008), maximum diameter of stone (OR:1.156; 95%Cl: 1.098-1.217; p < 0.001) and maximum Hounsfield Unit (OR:1.001; 95%Cl: 1.001-1.002; p < 0.001) were independent risk factors of SWL failure. The AUCs of the Kim JK, Triple D and S2HoCKwave scores for predicting SWL success were 0.678, 0.548, and 0.626 respectively., Conclusions: Stone location, number, maximal diameter, and maximum HU were independent predictive factors for SWL outcome in the treatment of upper urinary tract stones. Current nomograms, "Kim JK nomogram", "Triple D score" and "S3HoCKwave score" can predict treatment success after SWL, but all of them have poor discrimination according to AUC analysis., (Copyright © 2022 AEU. Published by Elsevier España, S.L.U. All rights reserved.)

One of the most important problems encountered in cattle breeding is urethral urolithiasis. Urolithiasis can be treated using various methods, but they all carry risks. Thus, a continuous search is being carried out for alternatives in this field. This study aimed to treat urethral urolithiasis in male cattle using pneumatic lithotripsy, a minimally invasive method. The urethra and penile tissues of 20 male cattle of different ages and breeds were obtained from slaughterhouse materials and measured before determining the probe diameters and lengths. The study included 9 male cattle (2 Simmental hybrids, 1 Zavot hybrid, 1 Brown, and 5 Simmental), between 4 months and 2 years of age, diagnosed with urethral urolithiasis. A modified lithotripsy apparatus was used for the pneumatic disintegration of urinary stones. The localization of urinary stones in the urethra was determined by palpation and catheterization. After laying the animal in a lateral position, a lithotripsy probe of appropriate length and diameter was advanced from the external urethral orifice to the site of localization. Once the probe came into contact with the stone, a vibration of 125 bar was applied until the stone was broken. The probe was removed, and the urethral channel was washed with 0.1% iodine solution to remove the shredded urethral stones. Uncomplicated recovery was achieved in all treated cases. In conclusion, pneumatic lithotripsy provided successful results in treating urolithiasis and can be used as an alternative surgical method in cattle. Moreover, the low cost is an additional advantage to breeders., (© 2022. The Author(s), under exclusive licence to Springer Nature B.V.)

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.)

Introduction: It is acknowledged that the COVID-19 pandemic has had a major impact on health care services around the globe with possible worse outcomes. It has resulted in stretch of resources with canceled or delayed procedures. Patients with urinary calculi have also suffered the negative impact. This systematic review aims to assess the impact of the early COVID-19 pandemic on the presentation and management of urinary calculi around the globe. Methods: We reviewed the impact of early COVID-19 on the clinically important aspects of stone disease using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) methodology. We searched Medline, Embase, and Central databases using themes of COVID-19 OR Sars-Cov-2 OR pandemic OR coronavirus AND kidney stone, urinary calculi, urolithiasis, and similar allied terms. Inclusion criteria were studies with data on both pre- and COVID-19 period covering one or more of eight clinical domains. Results: Our search returned 231 studies, after removal of duplicates, of which 18 studies were included for analysis. The number of patients presenting to hospital declined by 21%-70% at the beginning of the pandemic, whereas majority of studies reported increased associated complications. There are mixed reports in terms of delay to presentation and use of conservative management. There was a consistent trend toward reduction in elective procedures with wide variations (shockwave lithotripsy 38%-98%, percutaneous nephrolithotomy 94%-100%, and ureteroscopy 8%-98%). There was a trend toward increased nephrostomy insertion with the onset of the pandemic. Conclusion: This review demonstrated the differences in the number of patients presenting to hospital, complication rates, and management of urinary calculi, including surgical interventions, with the onset of the COVID-19 pandemic. It offers baseline global information that would help understand the impact of early pandemic, variations in practices, and be useful for future comparisons.

Objective: The aim of the investigation was to determine the influence of such parametric characteristics of the stone such as size and volume on the duration of tulium laser disintegration of the urinary stone and to determine which of these parameters is more effective to use like prognostic criterion for the duration of the planned surgical intervention in the percutaneous nephrolithotripsy., Materials and Methods: Overall 52 patients (27 females and 25 males) with an average age of 56,9 (25-79) years participated in the present study. All patients underwent percutaneous nephrolithotripsy with disintegration of the kidney stone by thulium energy. Inclusion criteria were: stone size more or equal 2 cm, stone density >1100 HU. Exclusion criteria were: patients with a single kidney, urinary tract divertions, coagulopathy. The average operation time was 30 (15-100) minutes, with an average puncture time of 3.15 (1-10) minutes and lithotripsy time of 28 (14-98) minutes. To determine the volume we used the method of automatic lithometry according to CT data using the software: Vitrea ver. 4.1.52. The size of the stone was determined by the longest length in one of the plane. During the study it was found that the average size of the stone was 28.25 (20-58) mm and the average volume was 2579.4 (250-9990) mm3. To confirm our assumption, we decided to determine the dependence of the time of disintegration of the stone on the size and volume of the stone. For this purpose, we graphically presented the correlation of these parameters., Results: We have drawn 2 graphs reflecting the dependence of lithotripsy time parameters on the size and volume characteristics of the stone. As a result of comparing these parameters we found that size is a prognostically less reliable predictor of lithotripsy time, and is not characterized by a linear distribution, in contrast to the stone volume., Conclusions: Thereby, the main stereoscopic characteristic of a stone is a volume, which should be the primary guide in selecting the preferred method of treatment as well as in predicting the operative time and associated risks.

Objective. To investigate the efficacy and safety of the oblique supine lithotomy during percutaneous nephrolithotomy (PCNL) to treat upper urinary calculi. Methods. Clinical data were retrospectively analyzed for 371 patients with upper urinary calculi who underwent PCNL at The First Affiliated Hospital of Guangzhou University of Chinese Medicine from January 2017 to October 2020. Based on different positions, patients were divided into the observation group (oblique supine lithotomy position, 155 cases, Group 1) or control group (prone position, 216 cases, Group 2). Groups were compared for effectiveness, complications, bleeding, surgical time, clinical indicators, and hospitalization time. Results. There were no significant differences in the clinical baseline data between the two groups ( p > .05). However, the stone-free rate for patients was significantly higher in the observation than in the control group ( p < .05). Both operation time and hospital stay time were significantly lower in the observation versus the control groups ( p < .05). No significant differences were observed for complications or amount of blood loss ( p > .05). Conclusion. In patients with upper urinary calculi, percutaneous nephrolithotomy in the oblique supine lithotomy position has a higher stone-free rate than the prone position. This approach can shorten the operation and provide better comfort and quicker recovery to the patients. A further advantage is that there is no difference in safety and blood loss between the prone position and the oblique lithotomy position.

Objective: To examine the effects of care fragmentation, or the engagement of different health care systems along the continuum of care, on patients with urinary stone disease., Methods: All-payer data from the 2016 Healthcare Cost and Utilization Project (HCUP) State Databases from Florida (FL) and New York (NY) were used to identify a cohort of adult patients with an emergency department visit for a diagnosis of urolithiasis, who subsequently re-presented to an index or non-index hospital for renal colic and/or urological intervention. Patient demographics, regional data, and procedural information were collected and 30-day episode-based costs were calculated. Multivariable logistic and gamma generalized linear regression were utilized to identify predictors of receiving subsequent care at an index hospital and associated costs, respectively., Results: Of the 33,863 patients who experienced a subsequent encounter related to nephrolithiasis, 9593 (28.3%) received care at a non-index hospital. Receiving subsequent care at the index hospital was associated with fewer acute care encounters prior to surgery (2.5 vs 2.7; P <.001) and less days to surgery (29 vs 42; P < .001). Total episode-based costs were higher in the non-index setting, with a mean difference of $783 (Non-index: $13,672, 95% CI $13,292-$14,053; Index: $12,889, 95% CI $12,677 - $13,102; P < .001)., Conclusion: Re-presentation to a unique healthcare facility following an initial diagnosis of urolithiasis is associated with a greater number of episode-related health encounters, longer time to definitive surgery, and increased costs., (Copyright © 2022 Elsevier Inc. All rights reserved.)

Background: Urinary stones often affect younger people. Because the risk of recurrence is high, regular follow-up is important for individuals at risk., Objective: To summarize the extent of urinary stones and the health and economic impact in the population; to provide recommendations for general and stone-specific follow-up., Materials and Methods: Analysis and discussion of publications and guideline recommendations., Results: The risk of recurrence after a stone attack can be high depending on the risk profile. An initial metabolic workup should be performed promptly after stone therapy. General dietary management should be intensified by stone-specific dietary management depending on the risk profile. Nutritional counseling may be helpful. Imaging after stone therapy is used to monitor the success of treatment and detect recurrences early. Since the risk of recurrence can vary greatly depending on the stone composition, not only the type of imaging but also its frequency should be adjusted accordingly. The same applies to the various stone therapies, which help determine the frequency and type of imaging follow-up. Exact guidelines and cost-effectiveness analyses of follow-up examinations after stone therapy are unfortunately missing., Conclusions: Acute urolithiasis represents an excruciating experience for patients. Accordingly, their willingness to undergo metaphylaxis and follow-up shortly after the event is strong. Since the risk of recurrence after a stone attack can be very high, regular follow-up after stone therapy is essential. The frequency of follow-up should be adapted to the probability of stone recurrence., (© 2022. The Author(s).)

Background: Steinstrasse, is described as array of stone pieces in the ureter following extracorporeal shock wave lithotripsy (SWL). It is well-recognized, transient event. Steinstrasse clears spontaneously, however about 6% require intervention. Spontaneous steinstrasse without prior history of SWL is a rare occurrence and only few case reports are published in literature. Objective of the study was to assess the aetiology and management issues of large spontaneous steinstrasse in our centre., Method: From February 2017 to March 2019, 684 patients underwent SWL for renal or ureteric stones. Twenty-eight patients presented with steinstrasse of which nine patients had no prior history of SWL. Detailed clinical profile and management issues have been discussed., Result: Among the nine patients of spontaneous steinstrasse, there were six males and three females. Mean age of the patients was 39 years (±13 years SD). Bilateral large spontaneous steinstrasse was seen in one out of nine patients. Seven patients had associated renal stones. Five patients presented with obstructive uropathy and three out of them had urosepsis as initial presentation. Ureterolithotomy and percutaneous nephrolithotomy were commonly performed procedures for stone clearance. Metabolic work was done in all cases in follow up period. Three patients had hypercalciuria and hypocitraturia suggestive of renal tubular acidosis., Conclusion: Large spontaneous steinstrasse is uncommon case scenario. It can be subtle in presentation and yet have significant patient consequence in terms of renal function and infection. Prompt management is essential to preclude permanent loss of renal function. Metabolic evaluation is indispensable in such cases.