SLAP Trial: Shock Wave Lithotripsy and Mechanical Percussion Therapy Post ESWL for Renal Calculi.

Effect of Alkaline Citrate Therapy on Clearance of Residual Renal Stone Fragments after Extracorporeal Shock Wave Lithotripsy in Sterile Calcium and Infection Nephrolithiasis Patients

Objective To compare the clinical efficacy of laparoscopic cystolithotomy and electro-resectoscopic holmium laser lithotripsy for the treatment of bladder stone. Methods Sixty-one cases with complicated bladder stones in our hospital from January 2014 to March 2017 were chosen.And all patients were randomly divided into the study group (29 cases)and the control group (32 cases). The study group was treated with laparoscopic cystolithotomy, while the control group was treated with electro-resectoscopic holmium laser lithotripsy.The operation time, the time of indwelling catheter, the rate of stone clearance and postoperative complications rate were compared between the two groups. Results There was no significant difference between the two groups in the time of indwelling catheter and hospitalization(P>0.05). The operation time of the study group was shorter than that of the control group(P<0.05). The rate of stone clearance of the study group was higher than that of the control group(P<0.05). The incidence of urinary tract infection, urethral stricture and other complications in the study group were lower than those in the control group(P<0.05). Conclusions The laparoscopic cystolithotomy has many advantages, such as short operation time, less complications, higher stone clearance rate, and so on. It is worthy of clinical application. Key words: Urinary Bladder Calculi; Lithotripsy, Laser; Lasers, Solid-State; Holmium; Laparoscopy; Electrosurgery

Focused Ultrasound to Expel Calculi from the Kidney: Safety and Efficacy of a Clinical Prototype Device

Objective To investigate the clinical efficacy of retroperitoneal laparoscopic pyelolithotomy for single renal pelvic calculi(>3 cm). Methods Eighty cases with large and single renal pelvic calculi in our hospital were divided into a control group and an experimental group from Angust 2013 to Angust 2015. Patients in the control group were treated with single channel percutaneous nephrolithotomy, whereas those in the experimental group were treated with retroperitoneal laparoscopic pyelolithotomy. The operation duration, bleeding volume, recovery time of intestinal tract, drainage time, hospital stay, hospitalization expenses of the two groups were observed and compared. The percentage of patients using painkillers, rate of stone clearance and the incidence of complications were compared between the two groups. Results Percentage of patients using painkillers in the experimental group was 5.00%, less than that in the control group, which was 22.50%(P<0.05). The rate of stone clearance in the experimental group was 100%, higher than that in the control group, which was 82.50%(P<0.05). The operation duration and hospitalization expenses in the experimental group were longer and higher than those in the control group (P<0.01). The amount of bleeding, recovery time of intestinal tract, drainage time and hospital stay in experimental group were less than those in control group(P<0.01). The incidence of complications in the experimental group was less than that in the control group(P<0.01). Conclusion Retroperitoneal laparoscopic pyelolithotomy is effective for large and single renal pelvic calculi, with advantages of higher removal rate, less bleeding, shorter hospital stay and less postoperative complications. Key words: Penal pelvis calculi; Laparoscopy; PCNL

There are several positions in the operation of percutaneous nephrolithotomy (PCNL), such as prone position, supine position, flank position, and modified supine position for PCNL, but the supine and prone positions are the main two choices for several years. However, there is still discrepancy on the optimal position for PCNL. Therefore, we performed this meta-analysis to evaluate safety and efficacy of the supine versus the prone position in PCNL for renal calculi. We searched MEDLINE, SCOPUS, and the Cochrane database libraries to look for relevant studies. All eligible controlled trials comparing supine versus prone positions for treating renal calculi were included in the meta-analysis. The main outcome of efficacy (stone-free rate, mean operative time, and hospitalization time) and safety (complication, blood transfusions) were assessed by using Review Manager 4.2 software. We calculated the estimate of effect associated with the two positions according to the heterogeneity using random-effects or fixed-effects models. Thirteen studies (six randomized controlled trials and seven retrospective studies) with a total of 6881 patients contributed to this meta-analysis. The meta-analysis indicated/suggested that PCNL in the prone position was associated with a higher rate of stone clearance than PCNL in the supine position (odds ratio [OR]: 0.74; 95% confidence interval [CI]: 0.65, 0.84; p < 0.00001). A shorter mean operative time was observed in the supine groups (weighted mean difference [WMD]: -18.27; 95% CI: -35.77, -0.77; p = 0.04). Compared with the prone position, there was also a lower incidence of blood transfusions in the supine groups (WMD: 0.73; 95% CI: 0.56, 0.95; p = 0.02). No difference was observed between the positions with regard to the hospital stay (WMD: -0.14; 95% CI: -0.76, 0.47; p = 0.65) and complications (OR: 0.88; 95% CI: 0.76, 1.02; p = 0.10). Compared with the prone position, the PCNL in the supine position has a slightly lower rate of stone clearance, albeit shorter mean operative time, and lower incidence of blood transfusions. The meta-analysis suggests that the PCNL in the supine position is a promising alternative.

Predictors of lower pole renal stone clearance after extracorporeal shock wave lithotripsy.

Objective To explore the clinical efficacy of the modified ureteral rigid holmium laser lithotripsy for the treatment of upper ureteral calculi. Methods A total of 115 patients with unilateral unilateral ureteral stones (the distances from stones to the ureteropelvic junction≤5 cm) were selected from May 2015 to May 2017 in the Urology Department of the First Hospital of Shanxi Medical University. The modified ureteral lithotripsy (modified group, 72 cases) and traditional ureteral lithotripsy (control group, 43 cases) were performed respectively. Modified group:Inlet valve and outlet valve of ureteroscope were connected to water inlert and vacuum extractor respectively by tee joint. Patients were in the dorsal elevated and oblique supine position. Ureteroscope was catheterized with the guiding of plugging device. Operator controlled the speed of water ingress. 200 μm-fine-fiber was used during lithotripsy. After adequate drainage, furosemide was intravenous injected.There was no significant difference in age, sex, stone side, degree of hydronephrosis, distance between stones from ureteropelvic junction and stone size (P>0.05). One-stage stone clearance rate and drift rate were compared between two groups. Results The stone clearance rate was 93.06% (67/72) in the modified group and 62.79% (27/43) in the control group. The difference between the two groups was statistically significant (χ2=16.52, P<0.05). The drift rate in modified group was 5.56% (4/72), and that in the control group was 41.86% (18/43). There was a statistically significant difference between the two groups (χ2=22.94, P<0.05). There was no ureteral perforation, ureteral avulsion and other serious complications during intraoperative or postoperative period. Conclusion When the improved method is used to treat upper ureteral stones, stones do not easily migrate into the renal pelvis. The clearance rate of stones in the first stage is high, and it is safe, convenient, and feasible. It is particularly suitable for primary hospitals without soft ureteroscopes. Key words: Ureteral stone; Ureteroscope; Modification

The objective was to determine the efficiency of extracorporeal shockwave lithotripsy (ESWL) in clearing stones from renal units with impaired function. Thirty-five patients with poorly functioning kidneys determined by intravenous urogram and 99mtechnetium diethylene triamine pentacetic acid renal dynamic scan underwent ESWL. Stone clearance was assessed at 3 months and compared with that in normally functioning kidneys. The study group was divided into two subgroups. Those with split glomerular filtration rate (GFR) of the concerned kidney between 10 and 20 ml/min were in group 1. Group 2 consisted of patients with split GFR between 20 and 30 ml/min. A control group (group 3) was formed from patients with urolithiasis and normally functioning kidneys. The overall retreatment rate was 84.4%. The overall stone clearance rate in the study group was 34.2% while it was 57.7% in the control group. The stone clearance rate in group 2 was 40%. The difference in stone clearance rate between the study and control groups was statistically significant (P=0.023) but that between group 2 and the control group was not (P=0.159). The incidence of steinstrasse between the study group 2 and control group was not statistically significant (P=0.408). The clearance rate for ureteral stones was comparable in all the three groups. The stone-free rate and rate of steinstrasse for renal stones in kidneys with moderately impaired function were comparable to normally functioning kidneys. However, kidneys with severely impaired function had poor results. The clearance rate for ureteral stones was not influenced by the impairment of renal function.

Objective To summary our experiences in percutaneous nephrolithotomy for treating the caliceal diverticular calculi and postoperative outcome with technical modification.Methods A retrospective review was performed on 34 patients with caliceal diverticular calculi who underwent percutaneous nephrolithotomy between January 2009 and June 2013.The patients were divided into 2 groups.In group A (1 1patients),stones were removed and diverticular neck was incised.In group B (23 patients),fulguration of diverticular wall was performed after the stone removal and diverticular neck incision.Group A had 11 cases including 4 male and 7 female with average age (36.7± 16.0) years.Mean size of stone was (1.8±0.4) cm.Mean maximum diameter of diverticulum was (2.3±0.5) cm.Group B had 23 cases including 10 male and 13 female with average age (40.1±12.0) years.Mean size of stone was (1.9±0.6) cm.Mean maximum diameter of diverticulum was (2.3±0.8) cm.There were no significant difference in stone size and maximum diameter of diverticulum within two groups (P＞0.05).The following parameters such as operative time,drop in hemoglobin,stone clearance,complication rate and ablation rate of diverticulum were compared between two groups.Results In group A,average operative time was (62.7±11.7) min.Mean hemoglobin dropping was (12.0t9.7) g/L.Stone clearance rate was 90.9％ (10/11) and overall complications rate was 18.2％ (2/11).The ablation rate of diverticulum was 63.6％ (7/11).In group B,average operative time was (76.3±21.6) min.Mean Hemoglobin reducing was (12.9±16.7) g/L.Stone clearance rate was 91.3％(21/23) and overall complication rate was 21.7％.The ablation rate of diverticulum was 91.3％ (21/23).There was no significant difference in stone clearance and complication rate between two groups.It seemed that the operativc timc in group B was longer than that in group A.However,no significant difference was found (P＞0.05).The ablation rate of diverticulum in group B was significantly higher than that in group A (P＜0.05).Conclusion In percutaneous nephrolithotomy treatment for caliceal diverticular calculi,fulguration to diverticular wall is an effective method to achieve diverticular obliteration and reduce possibility of stone recurrence. Key words: Caliceal diverticular calculi; Percutaneous nephrolithotomy; Diverticulum fulguration

To compare the safety and efficacy of four different surgical approaches for the treatment of complex non-hydronephrotic renal stones. A total of 88 patients with complex non-hydronephrotic renal stones, who underwent surgical treatment at Xiangtan Central Hospital from January 2022 to December 2023, were included in this study. The patients were divided into two groups based on their CT values. Group 1 (CT ≥ 1,000) included 22 patients who underwent puncture-assisted single standard percutaneous nephrolithotomy (PCNL) with a laser for stone fragmentation and retrieval (experimental group), and 12 patients who underwent multi-standard percutaneous nephrolithotomy (control group). Group 2 (CT < 1,000) included 21 patients who underwent puncture-assisted single standard PCNL combined with ureteroscopic laser lithotripsy (experimental group), and 33 patients who underwent transurethral ureteroscopic laser lithotripsy (control group). The surgical variables including intraoperative blood loss, operative time, hospital stay, stone clearance rate, and postoperative complications were recorded. Statistical analysis was performed using chi-square test or Fisher's exact test for categorical data, and t-test for continuous data. The two groups were comparable in terms of age, sex, BMI, hypertension, coronary heart disease, diabetes, and preoperative white blood cell count (P > 0.01). In both CT ≥ 1,000 and CT < 1,000 groups, the experimental group had significantly less intraoperative blood loss, shorter operative time, and shorter hospital stay compared to the control group (P < 0.01). In the CT ≥ 1,000 control group, the stone clearance rate was higher, and two cases of postoperative bleeding (considered arteriovenous fistula) were managed with interventional embolization. In the CT < 1,000 control group, the stone clearance rate was lower, and three cases of postoperative fever (with a maximum temperature of 39.5°C) required an extended antibiotic course for 7 days before discharge. For complex non-hydronephrotic renal stones, a CT value ≥ 1,000 should be treated with single standard PCNL using a puncture-assisted method; a CT value < 1,000 is better treated with a combination of puncture-assisted single standard PCNL and ureteroscopic laser lithotripsy, with higher safety and efficacy.

Percutaneous nephrolithotomy (PCNL) is the preferred treatment for large renal stones, yet variability in outcomes arises from patient-specific factors and institutional practices. Understanding complications and predictors of success is essential to improving procedural efficacy. This study aimed to evaluate stone clearance rates, complications classified using the Clavien-Dindo system, and predictors of PCNL outcomes, with a focus on improving lower calyx stone clearance. A retrospective analysis was conducted on 422 PCNL procedures performed from July 2021 to December 2023 at the Institute of Kidney Disease, Hayatabad Medical Complex, Peshawar, Pakistan. Patient demographics, stone characteristics, and postoperative outcomes were analyzed. Stone clearance rates were calculated, and complications were categorized by severity. Associations between patient and stone characteristics and outcomes were tested using Chi-square analysis, with significance set at p < 0.05. A total of 422 PCNL cases were analyzed, with an overall stone-free rate of 75.82% (320/422). The average patient age was 45.39 ± 12.43 years, with male patients comprising 56.87% of the cohort and a mean BMI of 27.82 ± 4.21 kg/m². Hypertension (21.43%), diabetes mellitus (18.95%), and chronic kidney disease (7.11%) were notable comorbidities. Stones averaged 3.21 ± 1.13 cm in size, predominantly composed of calcium oxalate (35.55%), and were most frequently located in the upper calyx (28.44%). Postoperative outcomes revealed a 21.33% complication rate, with 16.59% classified as minor (Clavien-Dindo Grades I-II) and 4.74% as major (Grades III-IV). Follow-up data showed that 11.83% of patients had residual stone fragments, and 9.48% experienced delayed complications, primarily minor. Stone size and location significantly influenced outcomes, with clearance rates of 80.00% for 2-3 cm stones versus 65.57% for stones >3 cm (p = 0.155). Lower calyx stones had markedly reduced clearance rates (50.00%, p < 0.001) compared to upper (75.00%) and mid-calyx (70.00%) stones, while stones in multiple locations also showed poor clearance (57.69%, p = 0.001). Key predictors of complications included higher BMI and prolonged operative times, emphasizing the need for tailored approaches, technical refinements, and institutional audits to optimize outcomes for anatomically or clinically complex cases. This study highlights the high efficacy of PCNL in managing large renal stones, achieving a stone-free rate of 75.82%. However, the findings underscore the significant challenges associated with lower calyx stones and larger stone sizes, both linked to reduced clearance rates. The Clavien-Dindo classification of complications shows that while minor complications are more frequent, major complications remain a concern, especially in patients with elevated BMI or prolonged operative times. To optimize outcomes, this study recommends refining surgical techniques and adopting technological advancements to improve lower calyx clearance, implementing institutional audits to standardize practices, and personalizing treatment strategies through preoperative risk stratification. Future multicenter prospective studies are needed to validate these findings, further explore predictors of outcomes, and develop comprehensive care protocols addressing anatomical and patient-specific challenges in PCNL procedures.

A Randomized Controlled Trial of Ultrasonic Propulsion-Facilitated Clearance of Residual Renal Stone Fragments vs Observation.

The use of unhealthy food and a sedentary lifestyle increases daily health problems. Renal stones are one among others. Endourology promises the minimum complications and the highest stone clearance rate. Indications of the two procedures overlap micro-PCNL and RIRS. The objective was to evaluate stone clearance and complication rate of micro-PCNL and RIRS for lower pole renal stones. The research design of this study was a randomized trial and was done after approval of the ethical review committee. The sampling technique was consecutive sampling at the Urology department. Patients included in the study according to inclusion criteria were 96 in number. Randomization into two groups (RIRS vs micro-PCNL) was done by even odd method. All the procedure was done by a single senior urologist. Their ratio among males and females was 2:1. Mean LOS in the RIRS group was 2.89±0.86 days and in the micro-PCNL group 2.58±0.65 days (p=0.047). The complication rate in the RIRS group was 6.2% and 8.3% in micro-PCNL (p=0.695). Mean post-operative haemoglobin was 12.30±1.07 g/dL among the RIRS group and among the micro-PCNL group it was 11.21±1.08 g/dL (p<0.001). There was an average haemoglobin drop in the micro-PCNL group of 1.09±0.01 g/dL. 75% clearance of stone after one session was achieved in the RIRS group while 79.2% was achieved in the micro-PCNL group (p=0.627). Length of hospital stay (LOS) and stone clearance rate (SFR) were similar in both groups with insignificant statistical differences. There is a need to conduct more studies with a large number of study participants and involving multi-centers.

Altered mental status (AMS) is a common presentation in the emergency department (ED). A previous study revealed 78% electroencephalogram (EEG) abnormalities, including nonconvulsive seizure (NCS; 5%), in ED patients with AMS. The objective of this study was to assess the impact of EEG on clinical management and outcomes of ED patients with AMS. This was a randomized controlled trial at two urban teaching hospitals. Adult patients (≥18 years old) with AMS were included. Excluded patients had immediately correctable AMS (e.g., hypoglycemia) or were admitted before enrollment. Patients were randomized to routine care (control) or routine care plus EEG (intervention). Research assistants used a scalp electrode set with a miniature, wireless EEG device (microEEG) to record standard 30-minute EEGs at presentation, and results were reported to the ED attending physician by an off-site epileptologist within 30 minutes. Primary outcomes included changes in ED management (differential diagnosis, diagnostic work-up, and treatment plan from enrollment to disposition) as determined by surveying the treating physicians. Secondary outcomes were length of ED and hospital stay, intensive care unit (ICU) requirement, and in-hospital mortality. A total of 149 patients were enrolled (76 control and 73 intervention). Patients in the two groups were comparable at baseline. EEG in the intervention group revealed abnormal findings in 93% (95% confidence interval [CI] = 85% to 97%), including NCS in 5% (95% CI = 2% to 13%). Using microEEG was associated with change in diagnostic work-up in 49% (95% CI = 38% to 60%) of cases and therapeutic plan in 42% (95% CI = 31% to 53%) of cases immediately after the release of EEG results. Changes in probabilities of differential diagnoses and the secondary outcomes were not statistically significant between the groups. An EEG can be obtained in the ED with minimal resources and can affect clinical management of AMS patients.

The Endothelin-Converting Enzyme-1/Endothelin-1 Pathway Plays a Critical Role in Inflammation-Associated Premature Delivery in a Mouse Model