Retrospective Analysis: The Effect of the Seasonal Changes on the Frequency of Urinary System Stone Operations

Background: Urinary system stones are a common clinical disease, with significant differences in incidence and recurrence rates between different countries and regions. The etiology and pathogenesis of urinary system stones have not been fully elucidated, but many studies have found that some bacteria and fungi that are difficult to detect in urine constitute a unique urinary microbiome. This special urinary microbiome is closely related to the occurrence and development of urinary system stones. By analyzing the urinary microbiome and its metabolic products, early diagnosis and treatment of urinary system stones can be carried out. Summary: This article reviews the relationship between the urinary microbiome and urinary system stones, discusses the impact of the microbiome on the formation of urinary system stones and its potential therapeutic value, with the aim of providing a reference for the early diagnosis, prevention, and treatment of urinary system stones. Key Messages: (i) Urinary stones are a common and recurrent disease, and there is no good way to prevent them. (ii) With advances in testing technology, studies have found that healthy human urine also contains various types of bacteria. (iii) Is there a potential connection between the urinary microbiota and urinary stones, and if so, can understanding these connections offer fresh perspectives and strategies for the diagnosis, treatment, and prevention of urinary stones?

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

Background: Urinary stones are now a worldwide problem due to a rise in occurrence over the past few decades. All racial and cultural groups have experienced this. Complex metabolic and environmental risk factors are both involved in the pathogenetic pathways of stone production. This disease affects roughly 12% of the world's population. Its recurrence rate is about 70% in men and 47% in women. Urinary stones have significantly increased in prevalence over the past 20 years, becoming a global disease. Aim: This review covers literature on the medical therapy of urolithiasis to facilitate urinary stone passage and their mechanism of action in the light of the new data on the diagnosis and different types of urinary tract stones. Method: A preliminary search of related articles was obtained from three online databases PubMed, Sci.hub and Google scholar whichwere used to conduct a systematic evaluation of the literature. Inclusion and exclusion criteria screened the initial search results, and 67 papers were chosen to be appropriate for this literature review following careful reading, analysis, and evaluation. Results: Different methods of medical therapy (phosphodiesterase-5 inhibitors, alpha blockers, calcium blockers, non-steroidal anti-inflammatory drugs and different types of surgical procedures (extracorporeal shock wave lithotripsy, percutaneous nephrolithotomy,ureteroscopy)were thoroughly reviewed but among all of them the expulsion rate to remove the urinary stone was found to be larger and faster in calcium channel blocker (CI 1.33-1.66) and alpha blockers(CI 1.152–7.45). Practical implications: Medical therapies facilitate the urinary-stone passagebut these therapies are not generally used. The choices for treating urinary stones are expanded by these techniques. Patients with big ureteral stones have had better results with medical expulsive therapy.Removing the urinary stones also decreases the chances of other diseases which happened as a result of urinary stone. There are many benefits of medical expulsive therapy which are diverse in nature andthis therapy minimizes the exposure to anesthesia and radiations. Conclusion: Different surgical procedures are used to remove the stones from the urinary passage. Despite of surgical procedures, medical expulsive therapy are more helpful. Alpha-blockers and calcium channel blockers are the main medical expulsive therapies for primary evacuation of urinary tract stones. Keywords: Urolithiasis, Urinary tract stones, Medical expulsive treatment.

BackgroundUrinary stones are a common condition with increasing prevalence worldwide. Predicting the type of urinary stones is essential for guiding treatment, yet complex imaging models are not always accessible. This study aims to identify simpler clinical predictors and explore the risk factors for infected urinary stones using statistical and receiver operating characteristic (ROC) analyses.MethodsA retrospective analysis was conducted on 1,067 patients with urinary stones who underwent surgical treatment between 2018 and 2023. Patients were classified into infected and non-infected stone groups based on stone composition. Logistic regression analysis adjusted for age, gender, body mass index (BMI), and serum electrolytes was performed to identify significant predictors, with sensitivity analyses using inverse probability weighting (IPW) to address cohort imbalance. The predictive performance of key factors was assessed using ROC curves.ResultsOf the total cohort, 686 (64.3%) had infectious stones, and 381 (35.7%) had non-infectious stones. Infectious stones were more common in females, younger patients, and those with ureteral stones. Preoperative urine cultures revealed Proteus mirabilis (24.3%) and Escherichia coli (18.2%) as predominant pathogens. Multivariate analysis identified three independent predictors for infectious stones: alkaline urine pH [hazard ratio (HR) 2.54, 95% confidence interval (CI): 1.33–4.88, P<0.001], ureteral stone location (HR 5.60, 95% CI: 2.38–13.17, P<0.001), and absence of diabetes mellitus (HR 4.74, 95% CI: 1.50–15.03, P=0.01). Sensitivity analyses confirmed robustness (adjusted HRs: 2.49, 5.58 and 4.65, respectively). Among these, ureteral stone location had the best predictive performance [area under the curve (AUC) =0.782, sensitivity 84.0%, specificity 71.5%], followed by urine pH (AUC =0.766, sensitivity 79.3%, specificity 68.7%), while diabetes status showed weaker predictive ability (AUC =0.623).ConclusionsAlkaline urine pH and ureteral stone location are strong predictors of infected urinary stones, while diabetes status is less predictive. These findings highlight the importance of integrating simple clinical parameters to improve the preoperative assessment and management of patients with urinary stones, particularly in resource-limited settings.

Backfround. Urinary tract stones are common urological disorders. However, there have been few studies of the stone composition in Central Taiwan. Infrared spectroscopy is a simple procedure used to analyze stones. We conduced this study to evaluate the composition of urinary tract stones using infrared spectroscopy. Methods. Most of the samples (89.8%) were obtained during endourological procedures and extracorporeal shock wave lithotripsies. The stone fragments were analyzed using a standard infrared procedure. The most common spectra were in the 4000-600cm-1 region and a number of bands were identified. Results. There were 1427 stone analyses done from August 15, 1993 through December 31, 1999 in this hospital. Of the patients who had stones removed, 16.8% had kidney stones, 5.5% had bladder stones, and 77.7% had ureteral stones. The results showed that 79.2% of stones were calcium oxalate related, 14% were infectious stones, 43% were uric acid related and 0.4% were cystine. The most frequently found microorganism in urine culture for infectious stones was Proteus mirabilis. Benign prostatic hyperplasia was the major disease associated with urinary bladder stones in men (80%). However, no associated disorders were found in female patients. Foreign bodies within stones were seen in two female patients and one of them was intrauterine device. Infectious stones were predominant in female patients which consisted 60% (120/200) of the stones. Conclusions. A total of 79.2% stones were composed calcium oxalate. Infectious stones were predominantly found in female patients. Urinary bladder stones were frequently seen in older male patients with benign prostatic hyperplasia. Further study of patients with stones should focus on the calcium oxalate because it is the major composition. Women with urinary stones should be carefully examined due to the high possibility of urinary tract infection.

Lifestyle, food intake, and exposure to chemicals are potential risk factors for the development of calcium urolithiasis. Pb, Cd, and Hg have been proved to cause renal illness, and urinary tract stones might be caused by exposure to metals. Therefore, this study aimed to measure the concentration of metals in urinary tract stones and blood simultaneously in urolithiasis patients. Moreover, we intended to determine whether urinary tract stones can be regarded as a biomarker of exposure or an effect marker in a population with environmental exposure to metals. Thirty-five urolithiasis patients (case) and 34 healthy inhabitants (control) were recruited in this study. The contents of Pb, Cd, Cr, Cu, Ni, As, Zn, and Hg were determined in urinary stones and blood in the case and control groups. The most abundant metals were Zn and Cu in blood and Zn and Ni in urinary stones. Significantly higher levels of Zn, Ni, and As were found in calcium phosphate stones than in calcium oxalate or uric acid stones. The majority of metals were not present at consistent levels in both blood and urinary stones, except for Zn. Urinary stones might be explained as providing another metabolic pathway for metal contamination. Moreover, as the metals with the highest content in urinary stones were Ni and Zn, and Ni content was very much higher than in other countries, contamination by Ni should be further taken into consideration if there is any serious contamination in Taiwan.

MP34-03 CAN STATIN USE REDUCE THE RISK OF UPPER URINARY TRACT STONE IN PATIENTS WITH DYSLIPIDEMIA? A NATION-WIDE POPULATION-BASED AND WITH AN 8-YEAR FOLLOW-UP STUDY

MP34-04 INHIBITION OF GLYCOLATE OXIDASE REDUCES URINARY OXALATE EXCRETION IN A MOUSE MODEL OF PRIMARY HYPEROXALURIA TYPE 1

1051 URINARY INCONTINENCE IS AN INDEPENDENT RISK FACTOR FOR UPPER URINARY TRACT STONE: A NATION-WIDE POPULATION-BASED AND WITH AN 8-YEAR FOLLOW-UP STUDY

Objective To analyze the composition of urinary stones in Taizhou of Zhejiang province. Methods Clinical data of 1 022 patients with urinary stones admitted in Taizhou Hospital of Zhejiang province were retrospectively reviewed. The samples of urinary stones were collected and analyzed by infrared spectrophotometry. Results There were 722 males and 300 females with a male to female ratio of 2.4∶1 and with a mean age of (53.4±13.6) years (14-88 years). Among 1 022 patients, the stones with single composition were found in 299 cases (29.3%); the most common single-component was anhydrous uric acid (15.9%), followed by calcium oxalate monohydrate (12.0%). The mixed stones were found in 723 cases (70.7%); the most common mixture was calcium oxalate monohydrate, calcium oxalate dehydrate and carbonate apatite mixture (316 cases, 30.9%). Calcium oxalate (58.9%, 602/1 022) was the most common major component and frequently seen in upper urinary tract stones, followed by uric acid (21.8%, 223/1 022). Uric acid calculi was predominant component in male patients(χ2=30.97, P=0.00), while the rate of infection stones was higher in women (χ2=60.69, P=0.00). The mean age of patients with uric acid stones was 59.4 years, which was older than that with other components (t=7.62, P=0.00). The uric acid stones were more common in upper urinary tract stones(χ2=42.97, P=0.00). The mean age of patients with infection stones was 49 years, which was younger than that with other types of stones(t=4.87, P=0.00). Conclusion Mixed stones with calcium oxalate monohydrate, calcium oxalate dehydrate and carbonate apatite are the predominant urinary stones in Taizhou of Zhejiang province, while the most common single-component stones are anhydrous uric acid stones. Location, age and sex are associated with the types of urinary stones. Key words: Urinary calculi; Stone composition; Spectrum

Many studies, none in northeastern part of Nigeria, investigated the association between serum/plasma vitamin D and nephrolithiasis, with no consistent result, couple with the hot weather (as high as 44oC) in most part of the year in Maiduguri and its surroundings, and assay of vitamin D today is not yet part of evaluation of urinary stone formers in Maiduguri, warrant this study to assess status of vitamin D in urinary tract stone formers in Maiduguri. Patients diagnosed with urinary tract stone disease attending Urology Clinic, University of Maiduguri Teaching Hospital and consented were recruited. The first two who consented were recruited per week for a period of 24 months (1st April 2017 to 31st Match 2019) to cover the seasonal changes in weather for the year. Serum for vitamin D is stored at -20oC for batch analysis. Vitamin D was assayed by ELISA technique (Accu-Bind, 100 North Pointe Drive, Lake Forest, California 92630 USA), other parameters were analyzed weekly using autoanalyzer (Cobas C311, ISN, Roche, Germany). Result indicated 58 (36.2%) of patients had Vitamin D values below the optimal level either having deficiency/insufficiency. Forty-nine (30.6%) showed vitamin D concentration above the optimum level out of which 4 (2.5%) had hypervitaminosis D, while 53 (33.1%) patients had optimal vitamin D values. It showed 17 (10.6%) of patients had hypercalcaemia, however, out of the 114 patients with normocalcaemia, 42 (36.5%) had their values at the upper limit of normal (2.6 mmol/L). It also indicated that though 3 of the hypercalcaemic patients had vitamin D insufficiency, majority (14) are either having optimal level or above optimal vitamin D level. Excessive and prolong exposure to ultraviolet sunlight resulting in raised vitamin D synthesis and action is an important factor associated with urinary tract stone formation in this environment cannot be excluded. The high prevalence of hypercalcaemia in the study cannot be accounted for by raised vitamin D alone, therefore measurement of serum vitamin D (25(OH)D) and PTH in evaluation of urinary tract stone formers in this environment is recommended.

Purpose: We wanted to compare CT urography (CTU) with using multi-detector row CT (MDCT) and intravenous urography (IVU) for diagnosing the causes of hematuria. Materials and Methods: From January 2003 to March 2004, IVU and CTU were obtained in 48 patients. We evaluated the causes of hematuria in 34 of 48 patients. The IVU images were obtained by the conventional method. The CTU images were routinely obtained before intravenous contrast injection, and at 2 and 5 minutes after intravenous contrast injection. In case of delayed excretion of contrast by the kidneys, the delayed CT scans were obtained at 120 minutes after contrast injection. All the CT images, including the axial and 3D coronal reformatted CTUs with using software as well as conventional IVU images, were reviewed by two radiologists working in consensus. We decided if urinary stone existed or not and we looked for the indirect signs such as hydronephrosis or delayed excretion, etc. We also observed if it was possible to determine the mass, ureteral stricture and enhancement of the ureteral wall, etc. We calculated sensitivity, specificity, positive predictive value and negative predictive value for each modality to diagnose urinary stone. We compared the detection rate according to the phases of CTU. Results: We confirmed the presence of urinary tract stones in 27 of 34 patients who had undergone both IVU and CTU. We diagnosed ureteritis in 1, transitional cell carcinoma in 5 and acute pyelonephritis in 1 of the remaining 7 patients. The urinary stones were detected in fifteen patients on both IVU and CTU (15/27, 55.6%). We detected the urinary stones on CTU, but not IVU, in twelve patients (12/27, 44.5%). The sensitivity to detect the urinary stones was 100% (27/27) on CTU and 55.6% (12/27) on IVU respectively. The specificity was 100% (7/7) on IVU and CTU, respectively. The positive predictive value was 100% (15/15) on IVU and 100% (27/27) on CTU, respectively. The negative predictive value was 36.8% (7/19) on IVU and 100% (7/7) on CTU. Precontrast CTU demonstrated the urinary stones in all 27 patients (100%, 27/27). On the other hands, urinary stones were detected in 19 patients (19/27, 70.4%) and 8 patients (8/27, 29.6%) at 2 and 5 minutes on CTU, respectively. Conclusion: CTU is superior to IVU to diagnose the causes of hematuria such as urinary tract stone or extrarenal lesion. Precontrast CTU is the most useful modality for the detection of the urinary tract stone of the other enhanced CTUs.

2053 ASSOCIATION BETWEEN UROLITHIASIS AND FOOD INTAKE BASED ON DATA FROM A JAPANESE NATIONAL SURVEY

Objective To investigate the relationship between urinary calculi formation and dietary factors in Hainan province. Methods From March 2017 to June 2018, 100 patients with urinary calculi in the hospital were selected as the observation group, and 100 non-calculus patients admitted to the hospital were selected as a control group. Questionnaire survey was used to investigate the dietary structure of the subjects and to analyze the correlation with the occurrence of stones. Results Univariate analysis showed that patients with stones and non-calculus patients had sweets. The frequency, sea fish diet, old fire soup, beverage and other dietary habits were significantly different (P<0.05). Logistic regression analysis showed that sea fish diet, sweets, old soup, and beverage were the main risk factors for urinary stones (P< 0.05). Conclusions There is a certain correlation between urinary calculi and dietary factors in Hainan province. It is necessary to pay attention to dietary balance and increase the amount of exercise in time to reduce the risk of urinary calculi. Key words: Urinary Calculi; Diet; HAINAN

Decreased HDL levels are one of diagnosis component of dyslipidemia which is part of the metabolic syndrome. when HDL levels decrease, its role as an anti-atherosclerotic can affect insulin resistance and it can eventually lower urine pH and potentially can cause urinary tract stones formation. The objective of this study is to determine the correlation between HDL Levels and Urine pH in Patients with Urinary Stones. A hospital based cross-sectional study included 52 patients with Urinary Stone who attended urology outpatient clinic in dr. M. Soewandhie General Hospital Surabaya during April-June 2022. HDL levels and Urine pH were recorded. The correlation between HDL levels and urine pH were tested using Spearman’s test. Mean of HDL levels were 44,96±9,109 mg/dL, and urine pH was 5,7692±0,70336. HDL levels was positively correlated with urine pH (r=0,336, p=0,015). There is a significant correlation between HDL levels and urine pH in patients with urinary stones. This is line with the fact that if HDL levels decrease, the urine pH will also decrease due to the influence of insulin resistance on the metabolic syndrome in patients with urinary tract stones.