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Background: To compare the operative effect and clinical efficacy of the Moses laser mode and the Raykeen holmium laser energy platform powder mode under flexible ureteroscopic lithotripsy in patients with impacted upper ureteral stones. Methods: From March 2022 to September 2022, 72 patients were divided into a Moses laser group and a Raykeen laser group according to surgical method, with 36 patients in each group. CT and ureteroscopy confirmed that all patients had isolated impacted upper ureteral stones. The stone volume (mm3), stone density (Hu) and severity of hydronephrosis were measured by CT. Postoperative complications were evaluated using the Clavien–Dindo score. Results: There were no complications of ureteral stenosis related to the laser treatment. The operative time and lithotripsy time were lower in the Moses laser group than in the Raykeen laser group (P < 0.05). The stone-free survival rate did not differ significantly between the two groups (P = 0.722). Stone volume was found to be positively correlated with laser energy and lithotripsy time in both groups (P < 0.01). There was no significant correlation between laser energy and lithotripsy time or ureteral stone density (Hu) in the Moses laser group (P > 0.05) or the Raykeen laser group (P > 0.05). Conclusions: The contact mode of Moses technology and the powder mode of Raykeen laser lithotripsy can be used for the ablation of a single impacted upper ureteral stone. The ablation speed was related to the stone volume and the severity of polyp hyperplasia, not the stone density. We recommend the use of the powdered mode as a therapeutic measure for the treatment of impacted upper ureteral stones in flexible ureteroscopic lithotripsy. [ABSTRACT FROM AUTHOR]

Stone size and location are key factors in predicting spontaneous stone passage (SSP), but little attention has been paid to the influence of radiological signs of stone impaction (RSSI). This research aims to determine whether RSSI, alongside stone size, can predict SSP and to evaluate the consistency of ureteral wall thickness (UWT) measurements among observers. In this retrospective study, 160 patients with a single upper or middle ureteral stone on acute non-enhanced computed tomography (NCCT) were analysed. Patient data were collected from medical records. Measurements of RSSI, including UWT, ureteral diameters, and average attenuation above and below the stone, were taken on NCCT by four independent readers blind to the outcomes. The cohort consisted of 70% males with an average age of 51 ± 15. SSP occurred in 61% of patients over 20 weeks. The median stone length was 5.7 mm (IQR: 4.5–7.3) and was significantly shorter in patients who passed their stones at short- (4.6 vs. 7.1, p < 0.001) and long-term (4.8 vs. 7.1, p < 0.001) follow-up. For stone length, the area under the receiver operating characteristic curve (AUC) for predicting SSP was 0.90 (CI 0.84–0.96) and only increased to 0.91 (CI 0.85–0.95) when adding ureteral diameters and UWT. Ureteral attenuation did not predict SSP (AUC < 0.5). Interobserver variability for UWT was moderate, with ± 2.0 mm multi-reader limits of agreement (LOA). The results suggest that RSSI do not enhance the predictive value of stone size for SSP. UWT measurements exhibit moderate reliability with significant interobserver variability. [ABSTRACT FROM AUTHOR]

Purpose: This study aims to investigate the predictive value of CT-based radiomics in determining the success of extracorporeal shock wave lithotripsy (SWL) treatment for ureteral stones larger than 10mm in adult patients. Materials and Methods: A total of 301 eligible patients (165/136 successful/unsuccessful) who underwent SWL were retrospectively evaluated and divided into a training cohort (n = 241) and a test cohort (n = 60) following an 8:2 ratio. Univariate analysis was performed to assess clinical characteristics for constructing a nomogram. Radiomics and conventional radiological characteristics of stones were evaluated. Following feature selection, radiomics and radiological models were constructed using logistic regression (LR), support vector machine (SVM), random forest (RF), K nearest neighbor (KNN), and XGBoost. The models' performance was compared using metrics such as the area under the receiver operating characteristic curve (AUC), precision, recall, accuracy, and F1 score. Finally, a nomogram was created incorporating the best image model signature and clinical predictors. Results: The SVM-based radiomics model showed superior predictive performance in both training and test cohorts (AUC: 0.956, 0.891, respectively). The nomogram, which combined SVM-based radiomics signature with proximal ureter diameter (PUD), demonstrated further improved predictive performance in the test cohort (AUC: 0.891 vs. 0.939, P = 0.166). Conclusions: Integration of CT-derived radiomics and PUD showed excellent ability to predict SWL treatment success in patients with ureteral stones larger than 10mm, providing a promising approach for clinical decision-making. [ABSTRACT FROM AUTHOR]

Abstract Background To compare the operative effect and clinical efficacy of the Moses laser mode and the Raykeen holmium laser energy platform powder mode under flexible ureteroscopic lithotripsy in patients with impacted upper ureteral stones. Methods From March 2022 to September 2022, 72 patients were divided into a Moses laser group and a Raykeen laser group according to surgical method, with 36 patients in each group. CT and ureteroscopy confirmed that all patients had isolated impacted upper ureteral stones. The stone volume (mm3), stone density (Hu) and severity of hydronephrosis were measured by CT. Postoperative complications were evaluated using the Clavien–Dindo score. Results There were no complications of ureteral stenosis related to the laser treatment. The operative time and lithotripsy time were lower in the Moses laser group than in the Raykeen laser group (P 0.05) or the Raykeen laser group (P > 0.05). Conclusions The contact mode of Moses technology and the powder mode of Raykeen laser lithotripsy can be used for the ablation of a single impacted upper ureteral stone. The ablation speed was related to the stone volume and the severity of polyp hyperplasia, not the stone density. We recommend the use of the powdered mode as a therapeutic measure for the treatment of impacted upper ureteral stones in flexible ureteroscopic lithotripsy.

Implementing double-J (DJ) stents in urological practice helps to alleviate kidney and ureteral obstruction. The primary causes of neglecting a DJ stent typically involve inadequate counseling and poor patient compliance. Encrustations of neglected DJ stents present a significant challenge. This study aims to report on a neglected DJ stent that persisted for 3 years, presenting as giant bladder and ureteral stones. We report on a 35-year-old male with chief complaints of discomfort in the suprapubic and left flank, along with concurrent micturition leakage. He had a DJ stent implanted to treat his ureteral stone 3 years ago. Advanced imaging showed a left distal ureteral stone (0.7×0.8×1.9 cm), extensive hydronephrosis and hydroureter, and a bladder stone (4.7×3.9×3.2 cm). A left ureterorenoscopy (URS) was done to remove a stone from the end of the ureter, half of a DJ stent and a bladder calculus using cystolitholapaxy. However, the patient underwent a second surgery owing to a residual bladder stone. The patient was discharged from the hospital without any symptoms. A foreign object in the urinary tract, like a DJ stent, may create secondary calculi. Endoscopic treatment could improve the efficacy of treating large bladder stones simultaneously with ureteral stones. As a measure to prevent DJ stent-related complications, it is also essential for healthcare professionals to provide information and follow-up care to patients regarding the use of DJ stents.

Since there is insufficient evidence to determine the best treatment of transurethral laser lithotripsy (TLL) in ureteral stones, this study compared the effectiveness and safety of TLL using high-power (HP) (100 W) and low-power (LP) (20 W) laser settings. All patients with maximally sized ureteral stones who were planned for transurethral holmium laser lithotripsy were enrolled in this open study. One of the two laser setting groups–LP or HP–was allocated to each alternate patient. Using IBM SPSS Statistics 24, the treatment groups were compared for operating time, intraoperative and postoperative problems (up to 1 year), and rates of stone-free recovery. Welch tests were employed to compare continuous data, whereas Fisher’s exact or Chi-square tests were used to assess categorical variables. At P < 0.05, statistical significance was established. A total of 207 individuals were included and preoperative data were comparable between the two groups. The HP group had a considerably greater ablation rate and a significantly shorter procedure duration (42.61 ± 11.74 min) than the LP group (78.56 ± 25.91 min) (P = 0.025). The Overactive Bladder Symptom Score and International Prostate Symptom Score were considerably higher in the HP group than in the LP group. Treatment effectiveness was considerably impacted by the location of the ureteral stone, according to univariate and multivariate logistic regression models. A HP laser setting of up to 100 W greatly shortens the duration of the process for treating ureteral stones without raising the risk of problems.

Aim. To clarify the indications for the use of ureteral stents during retroperitoneoscopic ureterolithotomy (RULT). Materials and methods. We analyzed the results of treatment of 53 patients who underwent RULT for ureteral stone. In 18 (34%) patients, a stent was not placed after the operation (group 1), and in 35 (66.0%) patients, a stent was placed (group 2). Indications for stent placement were determined during surgery. Results. When performing RULT for the treatment of patients with ureteral stones, postoperative complications were not severe, resolved on their own or required a slight increase in therapy in the postoperative period. These complications did not significantly affect the duration of treatment or its results. There were no significant differences in the main clinical and laboratory parameters in both groups 2 weeks after surgery. The incidence of complications was low and did not differ significantly in both groups. Conclusions. No significant differences were found in terms of the immediate results of treatment of patients with ureterolithiasis after RULT, depending on whether a stent was used to drain the ureteral lumen in the patient or not, when a stent was used according to indications. Complications after RULT are infrequent, transient, and require only minimal therapeutic correction. Stenting of the ureter is expected to lead to a significant increase in the duration of surgery. Drainage of the ureter by placing a stent is an absolutely justified procedure in the presence of severe changes in the ureteral wall, manifested by edema of all layers, the presence of mucosal ulcers, as well as perifocal inflammation in the surrounding tissues surrounding the ureter. On the other hand, stenting of the ureter after RPU is not a routine procedure, and in the absence of the above changes, it can be abandoned without any complications.

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

Ureteric duplication is a rare anomaly in the urinary tract, with an incidence of 0.5% to 3%. Bilateral double ureters are even rarer, occurring in 1 of 500 individuals. A 25-year-old man presented with right flank pain and nausea. Physical examination revealed tenderness at the right renal angle. Urinalysis demonstrated microscopic hematuria, and Ultrasound showed enlargement in the lower pole of the right kidney, while the upper pole appeared normal. Intravenous pyelography confirmed bilateral complete ureter duplication. However, after a week of observation, a 5 mm calcium oxalate stone was passed, and this event demonstrated the underlying cause of hydronephrosis in the lower pole of the right kidney. Bilateral complete ureter duplication is a rare anomaly in the urinary tract. To our knowledge, the presence of bilateral complete ureter duplication with a single stone in the right limb of the right double ureter is a unique case that has not been reported in the existing literature.

The objective of this study was to compare the value of one-, two- and three-dimensional computed tomography (CT) measurements for predicting the efficacy of a single session of extracorporeal shock wave lithotripsy (ESWL) in patients with a single ureteral stone. A total of 165 patients were included based on the inclusion and exclusion criteria. Different models were constructed using a combination of patients' clinical data and measurements obtained by manual sketching and automated extraction software. Multivariate logistic regression was used to develop the models. Receiver operating characteristic curves were used to assess the performance of the models. There was good interobserver agreement for all measurements in different dimensions (P < 0.001). We also found that hydronephrosis, the largest diameter, the largest area, volume, and mean CT value were significantly greater in the failure group than in the success group (P < 0.01). Furthermore, all sizes and CT measurement values were found to be independent predictors for predicting efficacy after one session of ESWL (P < 0.05). In addition, the multivariate logistic analysis showed that the area under the curve (AUC) for two-dimensional and three-dimensional measurements was superior to that of one-dimensional measurement (P < 0.01). However, when size alone was included as a measurable predictor, there was no significant difference in the AUC among the one-, two-, and three-dimensional measurements (P > 0.05). In summary, after adjusting for clinical data, two- and three-dimensional measurements combining ureteral stone size and CT values were found to be the best predictors of ESWL efficacy, and software-based three-dimensional measurements should be considered to avoid interobserver variability in clinical practice. [ABSTRACT FROM AUTHOR]

Background and objectives: There is no recommendation on the timing of ureterolithotripsy after the treatment of obstructive acute pyelonephritis (APN). The effect of early and delayed ureterolithotripsy on postoperative urinary tract infection (UTI) and other complications was investigated. Methods: Patients who underwent ureterolithotripsy after obstructive APN treatment between February 2017 and August 2021 were divided into two groups, those operated during hospitalization and those operated within 3 months after discharge. Two groups were compared in terms of stone-free status, postoperative complications, postoperative UTI, and urosepsis rates. Results: Of the 91 patients included in the study, 68 were in the early ureterolithotripsy group, while 23 patients were in the delayed ureterolithotripsy group. The postoperative UTI rate was significantly higher in patients who underwent early ureterolithotripsy (29.4% vs 8.7%, p = 0.045). Patients with postoperative UTI had a higher moderate/severe perinephric fat stranding (PFS) on non-contrast CT at hospital admission (52.2% vs 29.4%, p = 0.048). Among the laboratory parameters, white blood cells were significantly higher in the group with postoperative UTI (21604.5 vs 14728.9, p = 0.042). In the multivariate analysis, early ureterolithotripsy and moderate/severe PFS were independent predictors for postoperative UTI. In the created model, the probability of postoperative UTI after ureterolitripsy after obstructive APN treatment was 3.5% in patients without risk factors, while this rate was 51.9% in patients with both risk factors. Conclusion: There is no consensus on the timing of stone removal after treatment of obstructive APN. Early ureterolithoripsy and moderate/severe perinephric fat stranding on non-contrast CT are risk factors for postoperative UTI. [ABSTRACT FROM AUTHOR]

Introduction: The ureteral stent is one of the most useful devices in urology to remove obstructions that can cause problems for the patient. This study was conducted to determine the effects of lettuce on improving symptoms caused by stents. Methods: This clinical trial was carried out on 60 men with ureteral stones who underwent ureteroscopy and stone fragmentation through the urethra. Urinary symptoms were measured in patients using the USSQ questionnaire at begining and 2 weeks after the intervention. Patients were divided into two groups: tamsulosin and lettuce extract (intervention group), tamsulosin and placebo (control group). Statistical analysis was performed with SPSS software, using appropriate statistical tests with a significance level of 0.05. Results: The mean age of the patients under study was 44.6±14.5 years. In the control group, the mean urinary symptoms index score was 26.64±3.13 at the start and 16.58±2.84 two weeks post-intervention. In the intervention group, the score was 28.27±5.05 at the beginning of the study and 15.68±2.42 two weeks after the intervention. A statistically significant difference was noted within the groups (P=0.001). Nevertheless, no statistically significant difference was detected between the two groups before (P=0.136) and after the intervention (P=0.198). Conclusion: In the comparison of the two groups, lettuce did not demonstrate a significant effect on reducing urinary symptoms in the study subjects after the intervention. This issue can be due to the small sample size, the short duration of the study, the underlying disease of the patients and the type of lettuce planted. Future studies with longer duration are recommended. [ABSTRACT FROM AUTHOR]

Purpose: To compare vapor tunnel (VT) and virtual basket (VB) tools to reduce retropulsion in the treatment of proximal ureteral stones. Methods: Patients with a single proximal ureteral stone were randomly assigned to holmium laser lithotripsy with the use of VT (Group A) or VB (Group B) tool. The 150W holmium:YAG cyber Ho generator was used. We compared operative time, dusting time, need for flexible ureteroscopy due to stone push-up and occurrence of ureteral lesions. The stone-free rate (SFR) and the occurrence of postoperative ureteral strictures were assessed. Results: 186 patients were treated, of which 92 with the VT (49.5%, Group A) and 94 with the VB (50.5%, Group B). Mean stone size was 0.92 vs. 0.91 cm in Groups A vs. B (p = 0.32). Mean total operative time and dusting time were comparable between groups. 7 (7.6%) vs. 6 (6.4%) patients in Groups A vs. B required a flexible ureteroscope because of stone push-up (p = 0.12). Ureteral mucosa lesions were observed in 15 (16.3%) vs. 18 (19.1%) cases in the VT vs. VB group (p = 0.09). 1-Month SFR was comparable (97.8% vs. 95.7%, p = 0.41). We observed one case (1.1%) of postoperative ureteral stricture in the VT group vs. two cases (2.1%) in the VB group (p = 0.19). Conclusions: VT and VB are equally safe and effective tools in reducing retropulsion of ureteral stones. Operative time, dusting time and SFR were comparable. They also equally avoided stone push-up and prevented ureteral lesions, which may later occur in ureteral strictures. [ABSTRACT FROM AUTHOR]

Introduction. Currently, transurethral laser ureterolithotripsy is the standard treatment for ureteral stones. It allows you to achieve complete stone fragmentation in one-stage. We were interested in the possibility of performing ureterolithotripsy using a robotic assistant. In fact, robotic systems in medicine and surgery are becoming more and more relevant every year.Objective. To evaluate the possibilities of robot-assisted transurethral laser ureterolithotripsy, to study its effectiveness and duration in comparison with holmium lithotripsy in standard surgery, as well as to conduct a study and expert evaluation of the symptoms of surgeon fatigue in standard lithotripsy and robot-assisted lithotripsy.Materials & methods. The study was conducted in 2022 and consisted of two stages. The first stage involved the development and testing of a robotic lithotripsy technique using simulators, including the author's fixation device for the ureteroscope. This device allowed to tightly fix the instrument in the "robotic arm", while maintaining the full range of necessary movements. During the second stage (clinical), the results of holmium ureterolithotripsy in standard and robotic surgeries were studied. Patients with ureterolithiasis were divided into two groups: 14 patients — standard lithotripsy and 13 patients — robotic assisted lithotripsy. The selection criteria were the presence of a single ureteral stone accessible to a semi-rigid ureteroscope.Results. According to the results of the study, robot-assisted transurethral holmium ureterolithotripsy has the greatest advantages in terms of the fatigue indicators of the surgeon during surgery. So, no significant difference was found in fragmentation time (1 gram of stone). In standard ureterolithotripsy this indicator was 63.8 min/g, and in robot-assisted ureterolithotripsy it was 57.8 min/g (p < 0.1). When comparing the surgeon's fatigue scores, a significant difference between the two groups was determined. Thus, during standard surgery, the surgeon rated the shoulder numbness score at 3.50 points, while during robot-assisted surgery at 0.17 points (p < 0.01).Conclusion. The study showed that transurethral contact laser ureterolithotripsy with the use of robotic assistant does not increase the surgery time, but the surgeon's fatigue factor is significantly reduced. This may indirectly contribute to reducing the risk of intra- and postoperative complications.

المخلص: أهداف البحث: في هذه المراجعة النظامية والتحليل الشامل، سعى المؤلفون لمعرفة أي من الإجراءات، تفتيت الحصى بالموجات الصدمية خارج الجسم أو تفتيت الحصى بالمنظار البولي، هو الأكثر ملاءمة لعلاج حصى الحالب. طرق البحث: تم إجراء الدراسة الحالية والبحث في قواعد بيانات جوجل سكولار وبوب ميد باستخدام إرشادات بريزما. تم النظر في إجراءات تفتيت الحصى بالموجات الصدمية خارج الجسم مقابل تفتيت الحصى بالمنظار البولي لتحقيق النتائج. قمنا بتقييم مضاعفات كل طريقة، البول الدموي، التمزق، الفشل، إزالة الحصى، توقف الحصى في البداية، وقت العملية، حجم الحصى، الإجراء المساعد، والنتائج الشاملة لتوقف الحصى. تم إجراء التحليل الشامل واختبار التباين وتحليل المجموعة الفرعية والانحدار الميتا وتحليلات الحساسية واختبارات إيجر وإيجر ذو التباين الملساء وتومسون ذو التباين الملساء للكشف عن تحيز النشر لجميع النتائج من الإجراءين.النتائج:حسب عشر دراسات مؤهلة، تم إجراء تحليل شامل لبيانات 1509 مرضى. تم علاج 677 مريضا باستخدام تقنية الصدمات الكهربائية خارج الجسم لتفتيت الحصوات ، وتم علاج الباقي (عدد = 832) باستخدام إجراء تفتيت الحصوات بالمنظار البولي. كانت النتائج على النحو التالي: المضاعفات (معدل الأخطار النسبية = 0.780 ، قيمة الاحتمال = 0.269 ، ك = 13.465 ، قيمة الاحتمال = 0.062، اي2 = 48.011). معدل نسبة الدم في البول (معدل الأخطار النسبية = 0.782 ، قيمة الاحتمال = 0.657 ، ك = 19.056 ، قيمة الاحتمال = 0.001 ، اي2 = 79.01) ، الثقب (معدل الأخطار النسبية = 0.13 ، قيمة الاحتمال = 0.003 ، ك = 0.159 ، قيمة الاحتمال = 0.997 ، اي2 = 0) ، فشل العلاج (معدل الأخطار النسبية = 0.329 ، قيمة الاحتمال = 0.369 ، ك = 22.659 ، قيمة الاحتمال

AbstractObjective Patients with ureteral calculi and systemic inflammatory response syndrome (SIRS) often require emergency drainage, and percutaneous nephrostomy (PCN) and retrograde ureteral stent insertion (RUSI) are the most commonly used methods. Our study aimed to identify the best choice (PCN or RUSI) for these patients and to examine the risk factors for progression to urosepsis after decompression.Methods A prospective, randomized clinical study was performed at our hospital from March 2017 to March 2022. Patients with ureteral stones and SIRS were enrolled and randomized to the PCN or RUSI group. Demographic information, clinical features and examination results were collected.Results Patients (n = 150) with ureteral stones and SIRS were enrolled into our study, with 78 (52%) patients in the PCN group and 72 (48%) patients in the RUSI group. Demographic information was not significantly different between the groups. The final treatment of calculi was significantly different between the two groups (p

We propose an artificial intelligence prediction method for extracorporeal shock wave lithotripsy treatment outcomes by analysis of a wide variety of variables. We retrospectively reviewed the records of 171 patients from between January 2009 and November 2019 that underwent shock wave lithotripsy at Wakayama Medical University, Japan, for ureteral stones shown on preoperative non-contrast computed tomography. This prediction method consisted of stone area extraction, stone analyzing factor extraction from non-contrast computed tomography images, and shock wave lithotripsy treatment result prediction by a non-linear support vector machine for analysis of 15 input and automatic measurement factors. Input factors included patient age, skin-to-stone distance, and maximum ureteral wall thickness, and the automatic measurement factors included 11 non-contrast computed tomography image texture factors in the stone area and stone volume. Permutation feature importance was also applied to the artificial intelligence prediction results to analyze the importance of each factor relating to estimate decision grounds. The prediction performance was evaluated by five-fold cross-validation, it obtained 0.742 of the mean area under the receiver operating characteristic curve. The proposed method is shown by these results to have robust data diversity and effective clinical application. As a result of permutation feature importance, some factors that showed high p-values in the significant difference tests were thought to have a high contribution to the proposed prediction method. Future issues include validation using a larger volume of high-resolution clinical non-contrast computed tomography image data and the application of deep learning. [ABSTRACT FROM AUTHOR]

To investigate the predictive value of hydronephrosis and hydroureter in the detection of ureteral stones using ultrasound, a total of 366 patients suffering from ureteral stones confirmed by ultrasound, computed tomography (CT) and their follow-up treatments were consecutively collected. All the included patients underwent systematic ultrasound scanning of the kidney and ureter. The hydronephrosis and hydroureter in each patient were measured using a digital caliper. Then, receiver operating characteristic (ROC) curve analysis was used to determine the optimal cutoff values for hydronephrosis and hydroureter to predict a ureteral stone’s location and size. The hydronephrosis, hydroureter, and stone size measurements showed good interobserver agreement (P < 0.001). Using the lower border of the sacroiliac joint as a demarcation point, we found larger widths of hydronephrosis and hydroureter in the proximal ureteral stone group than in the distal ureteral stone group (P < 0.001). Additionally, 10.9 mm and 5.9 mm were identified as optimal cutoff values for predicting a distal position (P < 0.001), with no significant difference in their predictive value (P > 0.05). Similar comparisons between groups based on size stratification revealed no significant difference in hydronephrosis between the > 5 mm group and the ≤ 5 mm group. However, the hydroureter was larger in the > 5 mm group than in the ≤ 5 mm group after identifying 6 mm as the best cutoff (P =0.004). In summary, the ultrasound measurement of hydronephrosis and hydroureter may predict the position and size of a possible ureteral stone in patients with colic symptoms. [ABSTRACT FROM AUTHOR]

The risk factors of complications after SWL are not well characterized. Therefore, based on a large prospective cohort, we aimed to develop and validate a nomogram for predicting major complications after extracorporeal shockwave lithotripsy (SWL) in patients with ureteral stones. The development cohort included 1522 patients with ureteral stones who underwent SWL between June 2020 and August 2021 in our hospital. Five hundred and fifty-three patients with ureteral stones participated in the validation cohort from September 2020 to April 2022. The data were prospectively recorded. Backward stepwise selection was applied using the likelihood ratio test with Akaike’s information criterion as the stopping rule. The efficacy of this predictive model was assessed concerning its clinical usefulness, calibration, and discrimination. Finally, 7.2% (110/1522) of patients in the development cohort and 8.7% (48/553) of those in the validation cohort suffered from major complications. We identified five predictive factors for major complications: age, gender, stone size, Hounsfield unit of stone, and hydronephrosis. This model showed good discrimination with an area under the receiver operating characteristic curves of 0.885 (0.872–0.940) and good calibration (P = 0.139). The decision curve analysis showed that the model was clinically valuable. In this large prospective cohort, we found that older age, female gender, higher Hounsfield unit, size, and grade of hydronephrosis were risk predictors of major complications after SWL. This nomogram will be helpful in preoperative risk stratification to provide individualized treatment recommendations for each patient. Furthermore, early identification and appropriate management of high-risk patients may decrease postoperative morbidity. [ABSTRACT FROM AUTHOR]

Although green vegetables are valuable sources of essential elements, and are safe in that they lack harmful elements, they are high in oxalic acid, increasing the risk of urolithiasis. We performed elemental analyses on spinach (Spinacia oleracea L), Malabar nightshade (Basella alba), and water Morning Glory (Ipomoea aquatica), which contain large amounts of oxalic acid, and compared the data to those of Japanese mustard spinach (Brassica rapa var. perviridis), which is the second most commonly consumed green vegetable (after spinach) in Japan. We focused on concentrations of Ca, Mg, and Sr that suppress the formation of ureteral stones (calculi). The calcium concentration in spinach was 6 , 8 8 3 ± 3 6 7 μ g/g in leaves and 2 , 1 9 0 ± 1 5 9. 2 μ g/g in stalks, and the level in Japanese mustard spinach were 1 6 , 3 6 0 ± 9 5 7 μ g/g in leaves and 2 0 , 1 2 0 ± 1 , 2 2 6 μ g/g in stalks. The overall Sr concentration in Japanese mustard spinach was thus 10-fold higher than in spinach, but the Mg concentration was lower than that in spinach. The concentrations of Ca and Sr in Malabar nightshade and water Morning Glory were 3- to 5-fold higher than in spinach. As the former vegetables are consumed much less often than spinach, the risk of urolithiasis is low. We explored how the concentrations of these elements changed after boiling. [ABSTRACT FROM AUTHOR]

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Patients with ureteral calculi and systemic inflammatory response syndrome (SIRS) often require emergency drainage, and percutaneous nephrostomy (PCN) and retrograde ureteral stent insertion (RUSI) are the most commonly used methods. Our study aimed to identify the best choice (PCN or RUSI) for these patients and to examine the risk factors for progression to urosepsis after decompression. A prospective, randomized clinical study was performed at our hospital from March 2017 to March 2022. Patients with ureteral stones and SIRS were enrolled and randomized to the PCN or RUSI group. Demographic information, clinical features and examination results were collected. Patients (n = 150) with ureteral stones and SIRS were enrolled into our study, with 78 (52%) patients in the PCN group and 72 (48%) patients in the RUSI group. Demographic information was not significantly different between the groups. The final treatment of calculi was significantly different between the two groups (p <.001). After emergency decompression, urosepsis developed in 28 patients. Patients with urosepsis had a higher procalcitonin (p =.012) and blood culture positivity rate (p <.001) and more pyogenic fluids during primary drainage (p <.001) than patients without urosepsis. PCN and RUSI were effective methods of emergency decompression in patients with ureteral stone and SIRS. Patients with pyonephrosis and a higher PCT should be carefully treated to prevent the progression to urosepsis after decompression. In this study, we evaluate the best choice (PCN or RUSI) for patients who have ureteral stones and SIRS and to examine the risk factors for progression to urosepsis after decompression. This study found that PCN and RUSI were effective methods of emergency decompression. Pyonephrosis and higher PCT were risk factors for patients to develop to urosepsis after decompression. [ABSTRACT FROM AUTHOR]

Objectives: To examine gender-related differences in the presentation, management, and outcomes of patients admitted to the emergency department ED with ureteral stones. Methods: Retrospective analysis of all patients admitted to the ED at our institution, found to have a ureteral stone on CT. Clinical, laboratory, imaging parameters, and outcomes were collected. Results: 778 patients were admitted with ureteral stones between January 2018 and December 2020. 78% (n = 609) were males and 22% (n = 169) were females. The mean ages were 49.4 (SD 14.4) and 51.6 (SD 15.7) in males and females, respectively (p = 0.08). Female patients presented with a higher body temperature (p = 0.01), pulse rate (p < 0.0001), nausea and vomiting (p < 0.0001), elevated serum C-reactive protein (CRP) (p = 0.002) compared to males. The prevalence of elevated serum creatinine was higher in males (p < 0.0001). Alpha-blockers were recommended on discharge in 54.8% (334) of males, compared to only 29.6% (50) of females (p < 0.0001). Spontaneous stone expulsion was significantly higher in males compared to females (p = 0.01). Conclusions: Our results demonstrate that gender does effect presentation and outcome of patients presenting with renal colic. Females were found to have elevated infectious parameters, more nausea and vomiting and a higher incidence of positive urine cultures. Males admitted to the ED were found to have significantly higher serum creatinine levels. Medical expulsive therapy (MET) with alpha-blockers was prescribed significantly less in female patients, which may have resulted in a lower spontaneous stone expulsion rate. [ABSTRACT FROM AUTHOR]

BACKGROUND: Transureteral lithotripsy (TUL) is one of the most common surgeries in urology, and many TUL procedures have been performed with antibiotics prophylaxis. The present study investigates the effect of antibiotic prophylaxis on the rate of urinary infection after TUL. METHODS: This double-blind, randomized clinical trial was conducted on 158 patients with ureteral stones, with 79 in each group: the prophylaxis cefazolin group (Group A) and the placebo group (Group B). The patients were referred to Imam Hassan Hospital in Bojnurd, Iran. The standard technique of TUL operation was performed using a pneumatic lithoclast and a semirigid 9/8/Fr ureteroscope. The bacterial isolates were identified through growth on EMB agar and blood agar. Antimicrobial sensitivity testing (AST) was carried out by disc diffusion technique. RESULTS: According to our results, 157 patients were eligible for analysis; 79 patients in Group A and 78 patients in Group B. Flank pain and urinary complaints were the most common symptoms. Our findings indicate that cefazolin prophylaxis did not show any significant differences in preventing postoperative infection between the two groups. E. coli accounted for eight 10.1% (8/79) Group A and 9% (7/78) in Group B, respectively. The results of AST for the 15 E. coli strains revealed a high rate of antibiotic resistance against ampicillin (73.3%). CONCLUSION: Our findings indicate that prophylactic antibiotic administration does not demonstrate effectiveness in reducing the infection rate following TUL surgery. Antibiotic prophylaxis is not recommended considering the potential adverse effects, cost implications, risk of antibiotic resistance, and lack of efficacy. [ABSTRACT FROM AUTHOR]

Key Clinical Message: Although anatomical and vascular abnormalities of the horseshoe kidney might be challenging, complete preoperative imaging evaluations and accurate organ‐sparing surgical planning can lead to much lower complications. Horseshoe kidney (HK) is one of the most common renal fusion anomalies. Renal carcinoids are rarely reported in HK patients. Here, we described a rare case of advanced right renal cell carcinoma (RCC) along with proximal left ureter stone in a 41‐year‐old man who presented with a complaint of turbid urine. Early blood tests revealed a blood urea nitrogen of 44 mg/dL and serum creatinine of 1.35 mg/dL. The urine analysis showed microscopic hematuria (6–8 RBCs) and few calcium oxalate crystals. The imaging evaluations revealed an HK anomaly with a solid mass on the right side and a 4 mm stone in the proximal left ureter. The findings suggested RCC which was confirmed by histopathology examination. Consequently, the patient was scheduled for an organ‐preserving open surgery of a right kidney tumor with concomitant left ureterolithotomy. The 16‐month follow‐up showed no urological complications, metastasis, or tumor proliferation. Although the anatomical and vascular abnormalities of HK might be challenging, organ‐sparing surgical treatment should be considered in feasibly resectable tumors. Complete preoperative imaging evaluations to identify the characteristics of HK, as well as accurate surgical planning, can lead to much lower complications. [ABSTRACT FROM AUTHOR]

ObjectiveTo systematically review and quantitively evaluate the efficacy and safety of mirabegron as a medical expulsive therapy for ureteral stones.MethodsWe performed an extensive search of the EMBASE and PubMed databases for studies examining the use of mirabegron as a medical expulsive therapy for ureteral stones. The primary outcome measure assessed was the stone expulsion rate (SER), while the secondary outcomes evaluated were the stone expulsion interval (SEI) and the occurrence of pain episodes during follow-up. Risk ratios (RRs) and mean differences (MDs) with their respective 95% CIs were calculated.ResultsWe included a total of seven studies involving 728 participants. Our analysis revealed a significant increase in the stone expulsion rate (SER) with mirabegron (RR = 1.40; 95% CI = 1.17–1.67; p

Objective: Our goal was to determine whether or not a double-J (DJ) stent insertion is required in cases of ureteral stones based on the absolute white blood cell (WBC) counts, neutrophillymphocyte ratio (NLR), absolute monocyte counts, and other laboratory markers. Materials and Methods: The patients were divided into two groups as those who did (Group 1), and did not (Group 2) need DJ stent insertion. The age, symptoms, diagnosis, hemogram parameters, and treatment results of the patients were evaluated. Results: Forty-nine percent (n=44) of the patients were female and 51% (n=46) were male. The groups did not differ in terms of age and gender (p>0.05). A higher incidence of hematuria was observed in Group 1 (p

Abstract Background Limited information is available regarding the outcome of medical management (MM) of benign ureteral obstruction in cats (BUO). Hypothesis Describe clinical characteristics and outcome of MM of BUO. Animals Seventy‐two client‐owned cats with 103 obstructed kidneys. Methods Medical records of cats diagnosed with BUO between 2010 and 2021 that received >72 hours of MM were retrospectively reviewed. Clinical data, treatment, and outcome were reviewed. Outcome was classified as success, partial success, or failure based on ultrasound findings. Factors associated with outcome were assessed. Results Seventy‐two cats with 103 obstructed kidneys were enrolled. The causes of obstruction were uroliths in 73% (75/103), strictures in 13.5% (14/103), and pyonephrosis in 13.5% (14/103) of affected kidneys. Median serum creatinine concentration at presentation was 4.01 mg/dL (range, 1.30‐21.3 mg/dL). Outcome after MM was considered a success in 30% (31/103), partial success in 13% (13/103), and failure in 57% (59/103) of kidneys. Success was reported in 23% (17/75) of kidneys with uroliths, 50% (7/14) with pyonephrosis, and 50% (7/14) with strictures. Median time to a successful outcome was 16 days (range, 3‐115 days). Distal and smaller uroliths (median length, 1.85 mm) were significantly associated with success (P = .05 and P = .01, respectively). Median survival times were 1188 days (range, 60‐1700 days), 518 days (range, 7‐1812 days), and 234 days (range, 4‐3494 days) for success, partial success, and failure, respectively. Conclusions and Clinical Importance We found a higher success rate for MM of BUO than previously reported. Smaller distal uroliths (

Key Clinical Message Although anatomical and vascular abnormalities of the horseshoe kidney might be challenging, complete preoperative imaging evaluations and accurate organ‐sparing surgical planning can lead to much lower complications. Abstract Horseshoe kidney (HK) is one of the most common renal fusion anomalies. Renal carcinoids are rarely reported in HK patients. Here, we described a rare case of advanced right renal cell carcinoma (RCC) along with proximal left ureter stone in a 41‐year‐old man who presented with a complaint of turbid urine. Early blood tests revealed a blood urea nitrogen of 44 mg/dL and serum creatinine of 1.35 mg/dL. The urine analysis showed microscopic hematuria (6–8 RBCs) and few calcium oxalate crystals. The imaging evaluations revealed an HK anomaly with a solid mass on the right side and a 4 mm stone in the proximal left ureter. The findings suggested RCC which was confirmed by histopathology examination. Consequently, the patient was scheduled for an organ‐preserving open surgery of a right kidney tumor with concomitant left ureterolithotomy. The 16‐month follow‐up showed no urological complications, metastasis, or tumor proliferation. Although the anatomical and vascular abnormalities of HK might be challenging, organ‐sparing surgical treatment should be considered in feasibly resectable tumors. Complete preoperative imaging evaluations to identify the characteristics of HK, as well as accurate surgical planning, can lead to much lower complications.

Acute abdominal pain in pregnant women may complicate the diagnostic process of acute abdominal pain because of anatomical and physiological changes and limitations of computed tomography examinations related to radiation exposure. Here, we present the case of a 35-year-old female in her 10th week of pregnancy who was seen in the emergency department with unilateral abdominal pain and gross hematuria. Ultrasound detected only hydronephrosis and failed to identify ureteral stones, but magnetic resonance imaging revealed a diagnosis of idiopathic renal hemorrhage and intraductal ureteral hematoma, not ureteral stones. Although magnetic resonance imaging for pregnant women has the disadvantages of prolonged scan time and difficulty in image interpretation, no harm or complications to the mother or fetus have been reported. Magnetic resonance imaging may be considered in assessing acute abdominal pain in pregnant women, especially when the diagnosis is uncertain, based on shared decision-making with the patient and assessing the clinical situation and availability.

Giant ureteral stones in young children are extremely rare and their surgical treatment tactics are variable. The present case describes a case of effective and safe endoscopic treatment of giant ureteral stones in a young child. The patient is a 3-year-old male child. Examination findings of abdominal pain and fever verified a left distal ureteric stone up to 30 mm complicated by ureterohydronephrosis. The first treatment stage was ureteral stenting, in which the stone migrated to the middle ureteral third. The second treatment stage was contact ureterolithotripsy with a 9 Ch semi-rigid ureteroscope («Richard Wolf» GmbH, Knittlingen, Germany) and Swiss LithoClast® 2 pneumatic lithotripter («E.M.S. Electro Medical Systems» S.A., Nyon, Suisse), ureteral stenting (2-way PigTail, 4.5 Ch). The third treatment stage in the delayed period was extracorporeal shockwave lithotripsy of the steinstrasse using the Dornier Compact Sigma («Dornier MedTech» GmbH, Weßling, Germany) and stent removal. Residual stones were not revealed according to the follow-up examination. No treatment complications were registered. The multimodal staged treatment of a giant ureteral stone resulted in its complete elimination. Next-step ureteral endoscopy made it possible to identify concomitant pathology of the proximal ureter, which required its evaluation in the delayed period. Ureteral stenting contributed to the restoration of renal function. The result achieved reflects the maximum efficiency and high safety of the surgical technique applied.

The optimal treatment modality of distal ureteral stones is controversial. Therefore, we conducted a prospective study to evaluate the efficacy, safety, and cost of early second shock wave lithotripsy (SWL) sessions versus ureterorenoscopy (URS) in patients with distal ureteral stones. This prospective study was conducted in a tertiary hospital from June 2020 to April 2022. Patients who underwent SWL or URS for distal ureteral stones were enrolled in this study. The stone-free rate (SFR), secondary treatment rate, complications, and costs were recorded. Propensity-score matching (PSM) analysis was also performed. A total of 1023 patients were included, of whom 68.4% (700) were treated with SWL and 31.6% (323) with URS. Based on PSM, SWL had an equivalent SFR (87.4% vs. 84.9%, P = 0.325) at one month after SWL and secondary treatment rate (10.7% vs.10.8%, P = 0.958) when compared with URS. Complications were rare and comparable between the SWL and URS groups (6.0% vs. 5.9%, P > 0.05), while the incidence of ureteral injuries (i.e., perforations) was higher in the URS group compared with the SWL group (1.3% vs. 0%, P = 0.019). The hospital stay was significantly shorter (1 day vs. 2 days, P < 0.001) and the costs considerably less (2000 RMB vs. 25,030 RMB; P < 0.001) in the SWL group compared with the URS group. This prospective study demonstrated that early second SWL sessions had equivalent efficacy in addition to reduced complication rates and costs compared with URS in patients with distal ureteral stones. Our findings may help guide clinical decision making. [ABSTRACT FROM AUTHOR]

Objectives: To examine differences in the presentation, management, and outcomes of patients admitted to the emergency department (ED) with ureteral stones, with prior history of urolithiasis compared to patients with a first stone event. Patients and Methods: Retrospective analysis of patients who visited the ED that were found to have a ureteral stone on CT. Patients were stratified into two groups: without history of urolithiasis (Group 1) and with history of urolithiasis (Group 2). Results: Between 2018 and 2020, 778 patients were admitted with ureteral stones. Patients in group 1 presented with a higher mean serum creatinine (p = 0.02), larger mean stone size (p < 0.0001), and a higher proportion of proximal ureteral stones (p < 0.0001) than patients in group 2. The 30 day readmission rate was significantly higher in group 1 (p = 0.02). Spontaneous stone expulsion was higher in group 2 (p < 0.0001), whereas the need for endourological procedures was higher in group 1 (p < 0.0001). On multivariable analysis serum creatinine (OR 0.264, 95% CI 0.091–0.769, p = 0.01) and stone size (OR 0.623, 95% CI 0.503–0.771, p < 0.0001) were associated with a lower spontaneous stone expulsion rate. History of prior endourological procedures (OR 0.225, OR 0.066–0.765, p = 0.01) was associated with a higher spontaneous stone expulsion rate. Conclusions: Our data suggests that patients who are first time stone formers present with larger and more proximal ureteral stones, with a lower likelihood of spontaneous stone expulsion and a subsequent need for surgical intervention. Previous stone surgery and not previous stone expulsion was found to be a predictor for spontaneous stone passage. [ABSTRACT FROM AUTHOR]

Background: Limited information is available regarding the outcome of medical management (MM) of benign ureteral obstruction in cats (BUO). Hypothesis: Describe clinical characteristics and outcome of MM of BUO. Animals: Seventy‐two client‐owned cats with 103 obstructed kidneys. Methods: Medical records of cats diagnosed with BUO between 2010 and 2021 that received >72 hours of MM were retrospectively reviewed. Clinical data, treatment, and outcome were reviewed. Outcome was classified as success, partial success, or failure based on ultrasound findings. Factors associated with outcome were assessed. Results: Seventy‐two cats with 103 obstructed kidneys were enrolled. The causes of obstruction were uroliths in 73% (75/103), strictures in 13.5% (14/103), and pyonephrosis in 13.5% (14/103) of affected kidneys. Median serum creatinine concentration at presentation was 4.01 mg/dL (range, 1.30‐21.3 mg/dL). Outcome after MM was considered a success in 30% (31/103), partial success in 13% (13/103), and failure in 57% (59/103) of kidneys. Success was reported in 23% (17/75) of kidneys with uroliths, 50% (7/14) with pyonephrosis, and 50% (7/14) with strictures. Median time to a successful outcome was 16 days (range, 3‐115 days). Distal and smaller uroliths (median length, 1.85 mm) were significantly associated with success (P =.05 and P =.01, respectively). Median survival times were 1188 days (range, 60‐1700 days), 518 days (range, 7‐1812 days), and 234 days (range, 4‐3494 days) for success, partial success, and failure, respectively. Conclusions and Clinical Importance: We found a higher success rate for MM of BUO than previously reported. Smaller distal uroliths (<1‐2 mm) were more likely to pass. [ABSTRACT FROM AUTHOR]

Purpose: To develop and validate a nomogram for predicting stone-free failure after shock wave lithotripsy (SWL) guided by ultrasound in patients with ureteral stones. Methods: The development cohort consisted of 1698 patients who underwent SWL guided by ultrasound at our center from June 2020 through August 2021. Multivariate unconditional logistic regression analysis was used for building a predictive nomogram with regression coefficients. An independent validation cohort consisted of 712 consecutive patients from September 2020 through April 2021. The performance of the predictive model was assessed in regard to discrimination, calibration, and clinical usefulness. Results: Predictors of stone-free failure included distal stone location (odds ratio = 1.540, P < 0.001), larger stone size (odds ratio = 1.722, P < 0.001), higher stone density (odds ratio = 1.722, P < 0.001), larger skin to stone distance (SSD) (odds ratio = 1.058, P < 0.001), and higher grade of hydronephrosis (odds ratio = 1.755, P = 0.010). For the validation cohort, the model showed good discrimination with an area under the receiver operating characteristic curve of 0.925 (95% confidence interval, 0.898, 0.953) and good calibration (unreliability test, P = 0.412). Decision curve analysis demonstrated that the model was also clinically useful. Conclusions: This study demonstrated that stone location, stone size, stone density, SSD, and hydronephrosis grade were significant predictors of stone-free failure after SWL guided by ultrasound in patients with ureteral stones. This may guide clinical practice. [ABSTRACT FROM AUTHOR]

Introduction: Abdominal pain is a common complaint in the emergency department. Point-of-care ultrasound (POCUS) is a rapid modality to evaluate for the etiology.Case Report: A teenage male presented with symptoms concerning for appendicitis. POCUS revealed a non-peristalsing, non-compressible, tubular structure containing an echogenic stone. This was determined to be a ureteral stone within a dilated ureter, not appendicitis.Conclusion: We propose a syndromic sonographic approach to right lower quadrant pain (RLQ) that includes the gallbladder, right kidney, bladder, and right adnexa, in addition to RLQ landmarks. This case emphasizes the value of such an approach to avoid diagnostic error.