Calculi In Upper Urinary Tract Research Articles

Micropercutaneous nephrostomy for intervention in acute upper urinary tract calculi obstruction with hydronephrosis and infection

To compare the efficacy and advantages of mini percutaneous nephrostomy (MPCN), micropercutaneous nephrostomy (MicroPCN), and retrograde ureteric stenting (RUS) in the treatment of acute upper urinary tract calculi (UUTC) obstruction with hydronephrosis and infection, and verify the safety and indications of clinical application of micropercutaneous nephrostomy. Clinical-epidemiological data of patients with acute upper urinary tract calculi obstruction and infection treated in Ningbo No.2 hospital were retrospectively collected from May 2019 to May 2023. 64 patients (20 patients in MPCN group, 13 patients in MicroPCN group, and 31 patients in RUS group) were eligible for analysis based on inclusion and exclusion criteria. P value < 0.05 was considered statistically significant. There were no significant differences in peri-intervention temperature, multiple infection indicators and complications among the three groups. The nutritional status and peri-intervention coagulation function of patients in MicroPCN and RUS groups were poor, the CRP and proportion of using carbapenem advanced antibiotics were higher. The length of hospital stay and the length of hospital stay after the intervention in MPCN and MicroPCN groups were longer, the length and width of calculi were larger, and the degree of hydronephrosis was heavier. Patients in the MicroPCN group had the worst general condition, the lowest hemoglobin before intervention, the longest withdrawal time of vasoactive drugs. MPCN, MicroPCN, and RUS are safe and effective in relieving acute upper urinary tract calculi obstruction complicated with infection. MicroPCN has more advantages for patients with critical illness or complex obstruction urinary lithiasis.

Mendelian insights: Irritable bowel syndrome as a predictor of upper urinary tract calculi.

Patients with irritable bowel syndrome (IBS) have a notably higher rate of consultations in urology clinics compared to other clinics. They often present with symptoms such as lumbar pain, dysuria, and urinary difficulty that are also associated with upper urinary tract calculi (UUTC). UUTC are the leading cause of nephrectomy in non-oncological cases, early screening for high-risk populations is deemed necessary. We investigated the relationship between IBS and UUTC using a two-sample Mendelian randomization (MR) approach, with the primary analysis conducted using the inverse variance weighting method. To enhance the robustness of our findings, we conducted sensitivity analyses employing Cochran Q test, MR-Egger intercept, and MR-PRESSO. Additionally, we included type 2 diabetes in a multivariate Mendelian randomization analysis for further exploration. Our two-sample MR analysis, employing the inverse variance weighting method, suggested a positive association between IBS and UUTC, with an odds ratio of 1.47, a 95% confidence interval from 1.01 to 2.15, and a P-value of .442. Both weighted median and MR Egger analyses also indicated that IBS may be a risk factor for UUTC, although the results were not statistically significant. The Cochran Q test revealed no evidence of heterogeneity (P > .05). The MR-Egger intercept and MR-PRESSO analyses did not support the presence of pleiotropy (P > .05), and no outliers were detected by MR-PRESSO. Sensitivity analyses reinforce the reliability of our findings. Multivariate MR analysis further confirmed that IBS is a risk confirmed factor for UUTC, with significant results (P < .05). IBS is identified as one of the etiological factors for UUTC, enhancing our understanding of the gut-kidney axis. The specific mechanisms underlying this association warrant further investigation. Clinicians should consider the importance of monitoring for UUTC in patients with IBS.

Clinical Application of CT Imaging Grading System in Upper Urinary Tract Calculi with Kidney Infection.

This study aimed to establish a CT imaging grading system and explore its value in evaluating upper urinary tract calculi associated with kidney infections. CT images of 126 patients with kidney infections caused by upper urinary tract calculi were retrospectively analyzed. The CT grading system was developed based on CT images. CT images were classified into 4 grades. General information, symptoms, and clinical findings of patients in different CT grades were analyzed. With the occurrence of systemic inflammatory response syndrome (SIRS) as the endpoint, univariate and multivariate analysis was conducted to analyze the risk factors of SIRS. Patients with fever or diabetes had higher CT grades, and the following examination data revealed significant differences across the various CT grades (P < 0.05): the white blood cell count, urine leucocytes count, CT1, CT2, maximum body temperature, duration of disease, the proportion of blood neutrophils, the size of stones, and levels of the C-reactive protein and procalcitonin. Only CT grading was statistically significant after multivariate analysis. According to the values of the partial regression coefficient (B), the higher the CT grade, the greater the risk of SIRS. The risk of SIRS was 4.472 times higher with each increment of the CT grade. The CT grade is directly associated with clinical symptoms and the risk of SIRS.

Predicting the Efficacy of Repeated Shockwave Lithotripsy for Treating Patients with Upper Urinary Tract Calculi Using an Artificial Neural Network Model.

To establish a prediction model for repeated shockwave lithotripsy (SWL) efficacy to help choose an appropriate treatment plan for patients with a single failed lithotripsy, reducing their treatment burden. The clinical records and imaging data of 304 patients who underwent repeat SWL for upper urinary tract calculi (UUTC) at the Urology Centre of Shiyan People's Hospital between April 2019 and April 2023 were retrospectively collected. This dataset was divided into training (N = 217; 146 males [67.3%] and 71 females [32.7%]) and validation (N = 87; 66 males [75.9%] and 21 females [24.1%]) sets. The overall predictive accuracy of the models was calculated separately for the training and validation. Receiver operating characteristic (ROC) curves were plotted, and the area under the ROC curve (AUC) was calculated. The normalized importance of each independent variable (derived from the one-way analyses) in the input layer of the artificial neural network (ANN) model for the dependent variable (success or failure in repeat SWL) in the output layer was plotted as a bar chart. This study included 304 patients, of whom 154 (50.7%) underwent successful repeat SWL. Predictive models were constructed in the training set and assessed in the validation set. Fourteen influencing factors were selected as input variables to build an ANN model: age, alcohol, body mass index, sex, hydronephrosis, hematuria, mean stone density (MSD), skin-to-stone distance (SSD), stone heterogeneity index (SHI), stone volume (SV), stone retention time, smoking, stone location, and urinary irritation symptom. The model's AUC was 0.852 (95% confidence interval (CI): 0.8-0.9), and its predictive accuracy for stone clearance in the validation group was 83.3%. The order of importance of the independent variables was MSD > SV > SSD > stone retention time > SHI. Establishing an ANN model for repeated SWL of UUTC is crucial for optimizing patient care. This model will be pivotal in providing accurate treatment plans for patients with an initial unsuccessful SWL treatment. Moreover, it can significantly enhance the success rate of subsequent SWL treatments, ultimately alleviating patients' treatment burden.

Comparison of the One-Step Prone Split-Leg Position to the Traditional Prone Position for Percutaneous Nephrolithotomy: A Single-Center Retrospective Study.

To evaluate the one-step prone split-leg position compared to the traditional prone position for percutaneous nephrolithotomy (PCNL). This study retrospectively analyzed the clinical data for 102 patients with upper urinary tract calculi who underwent PCNL at our hospital from April 2019 to December 2022. All PCNL procedures were performed by the same senior urologist. According to different surgical positions, the patients were divided into a one-step prone split-leg position group (observation group, n = 39) and a traditional bladder lithotomy position followed by prone position group (control group, n = 63). Then, the two groups were compared regarding the time of catheter insertion and channel establishment, channel size, time required for double-J stent placement, total operative time, postoperative hospital stay, stone removal rate, secondary operation rate and postoperative complications. There was no significant difference in the preoperative baseline characteristics of the patients between the two groups (all P > .05). Patients in the observation group had shorter total operative times, higher stone removal rates (76.9% [30/39] vs. 57.1% [36/63], P = .042), and lower secondary operation rates (10.3% [4/39] vs. 28.6% [18/63], P = .029) than those in the control group. There were no significant differences in the time of working channel establishment, channel size, postoperative hospital stay, or postoperative complications between the two groups (all P > .05). The one-step prone split-leg position is a safe and reliable surgical posture for treating upper urinary calculi in PCNL patients. It can not only shorten the overall operation time of PCNL but also improve the stone removal rate of the operation, thus reducing the secondary operation rate of multiple renal stones.

Risk factors of concurrent urinary sepsis in patients with diabetes mellitus comorbid with upper urinary tract calculi.

Urinary sepsis is frequently seen in patients with diabetes mellitus (DM) complicated with upper urinary tract calculi (UUTCs). Currently, the known risk factors of urinary sepsis are not uniform. To analyze the risk factors of concurrent urinary sepsis in patients with DM complicated with UUTCs by logistic regression. We retrospectively analyzed 384 patients with DM complicated with UUTCs treated in People's Hospital of Jincheng between February 2018 and May 2022. The patients were screened according to the inclusion and exclusion criteria, and 204 patients were enrolled. The patients were assigned to an occurrence group (n = 78) and a nonoccurrence group (n = 126). Logistic regression was adopted to analyze the risk factors for urinary sepsis, and a risk prediction model was established. Gender, age, history of lumbago and abdominal pain, operation time, urine leukocytes (U-LEU) and urine glucose (U-GLU) were independent risk factors for patients with concurrent urinary sepsis (P < 0.05). Risk score = 0.794 × gender + 0.941 × age + 0.901 × history of lumbago and abdominal pain - 1.071 × operation time + 1.972 × U-LEU + 1.541 × U-GLU. The occurrence group had notably higher risk scores than the nonoccurrence group (P < 0.0001). The area under the curve of risk score for forecasting concurrent urinary sepsis in patients was 0.801, with specificity of 73.07%, sensitivity of 79.36% and Youden index of 52.44%. Sex, age, history of lumbar and abdominal pain, operation time, ULEU and UGLU are independent risk factors for urogenic sepsis in diabetic patients with UUTC.

Regulatory effect of Pseudomonas aeruginosa mannose-sensitive hemagglutinin on inflammation and immune function in percutaneous nephrolithotomy patients with upper urinary tract calculi complicated with infection.

To study the effect of an injection of Pseudomonas aeruginosa mannose-sensitive hemagglutinin (PA-MSHA) on inflammation and immune function in patients with upper urinary tract calculi complicated by infection who have undergone percutaneous nephrolithotomy. We retrospectively recorded the clinical data of patients with upper urinary tract calculi complicated by infection who have undergone Percutaneous nephrolithotomy(PCNL) in the Department of Urology, 2nd Affiliation Hospital of Kunming Medical University, from March to December 2021. Clinical data include general condition, laboratory index, CT, postoperative body temperature, heart rate, respiration, SIRS, sepsis, etc. Patients were divided into treated and control groups according to whether they had received a preoperative PA-MSHA injection. The two groups were compared for indices of inflammation and complications of infection after PCNL. Pre- and post-operative lymphocyte subsets and immunoglobulin changes were compared. 115 patients were included in the study, including 43 in the treatment group and 72 in the control group. After Propensity Score Matching, 90 patients were divided into treatment (n=35) and control (n=55) groups. The postoperative inflammation index was higher in the treatment group than in the control group (P<0.05). The incidence of postoperative SIRS was higher in the treatment group than control (P<0.05). There were no cases of sepsis in either group. The double-positive T cells lymphocyte subsets were higher in the treatment group than in the control group ((P<0.05). Pre- and post-operative changes in immune function: total T lymphocyte count reduced, NK and NKT cell count increased in the control group, double-positive T cell count increased in the treatment group, IgG, IgA, IgM, complement C3 and C4 count reduced in both groups post-operatively. This study found that patients with upper urinary tract calculi and infection treated with antibiotic-based PA-MSHA before percutaneous nephrolithotomy had an increased inflammatory response after surgery, which may play a role in the prevention and treatment of sepsis. The percentage of double-positive T cells in the peripheral blood was increased after PA-MSHA treatment, which may have an immunomodulatory and protective effect in PCNL patients with stones complicated by infection.

Total tubeless percutaneous nephrolithotomy without artificial hydronephrosis in preschool children: Three case reports.

Indwelling ureteral catheter, double J tube, or nephrostomy tube are routine procedures for percutaneous nephrolithotomy (PCNL) in children. There are a few cases in which PCNL has been performed in children without any additional instruments being left in place. In this study, 3 children were treated for hematuria and complicated with different degrees of urinary tract infection. All of them were diagnosed as upper urinary tract calculi by abdominal computed tomography. Three preschoolers were diagnosed with upper urinary tract calculi before surgery, one with no hydronephrosis and the other 2 with different degrees of hydronephrosis. After preoperative evaluation, all the children successfully completed PCNL without indwelling ureteral catheter, double J tube, or nephrostomy tube. The operation was successful and there were no residual stones observed during postoperative review. The operating times for the children were 33 minutes, 17 minutes, and 20 minutes, and the intraoperative bleeding volumes were 1 mL, 2 mL, and 2 mL. The catheter was removed on the second day after the operation, the postoperative review of the abdominal computed tomography or ultrasound did not indicate any stone residue, and there were no fever, bleeding, and other related complications after the operation. We believe that total tubeless PCNL without artificial hydronephrosis can be achieved in the preschool population.

Serum procalcitonin, C-reactive protein, and neutrophil gelatinase-associated lipocalin in early diagnosis of acute kidney injury after upper urinary tract calculi.

To investigate the value of serum procalcitonin(PCT), C-reactive protein(CRP), and neutrophil gelatinase-associated lipocalin(NGAL) in the early diagnosis of acute kidney injury(AKI) after upper urinary tract calculi(UUTC). The clinical data of 86 patients who underwent UUTC surgery in our hospital from March 2020 to April 2021 were analyzed retrospectively(Approval number: 20211205L, Date: 2021-12-21). Patients were divided into an AKI group (AKI≥7 days after the operation) and a Non-AKI group. PCT, CRP, and NGAL concentrations were compared before and two hours after the operation. Multivariate logistic regression analysis was used to identify risk factors affecting the early occurrence of AKI post-operation. The receiver operating characteristic curve evaluated PCT, CRP, and NGAL in the early AKI diagnosis. A total of 86 patients (30 with AKI and 56 with Non-AKI) were included. Kidney injury molecule-1(KIM-1) and urinary microalbumin(mAlb) concentrations were significantly higher in the AKI group (P<0.05). PCT, CRP, and NGAL concentrations were significantly higher two hours after the operation than before the operation (P<0.05). KIM-1 levels and elevated PCT, CRP and NGAL concentrations affected the establishment of AKI after UUTC. The sensitivity of PCT, CRP, and NGAL in evaluating AKI after UUTC were 81.17%, 84.42%, and 79.02%; the specificity was 62.31%, 71.48%, and 73.32%; and the AUC was 0.812, 0.885 and 0.804 respectively. PCT, CRP, and NGAL concentrations in patients with AKI after UUTC were significantly increased two hours after the operation, which can be used for the early diagnosis of AKI after UUTC operation.

Trends of Urolithiasis in China: A National Study Based on Hospitalized Patients from 2013 to 2018

Introduction: The aim of this study was to explore the chronological trends in clinical features and utilization of healthcare resources for hospitalized patients with urolithiasis in China. Methods: Patients with urolithiasis were extracted from the Hospital Quality Monitoring System, a national database of hospitalized patients in China, based on the International Classification of Diseases, Tenth Revision, codes. Variables including demographic characteristics, comorbidities, treatment modalities for urolithiasis, length of hospital stay, and expenditures were collected and analyzed. Results: Among 79.8 million hospitalized patients, 3.5 million were diagnosed with urolithiasis with an increasing trend (from 3.0% in 2013 to 4.0% in 2018). Most of these patients had upper urinary tract calculi (76.6% in 2013 and 81.7% in 2018). Middle-aged patients (46–65 years) constituted the largest proportion with a stable trend (from 46.9% in 2013 to 48.8% in 2018), while the proportion of older patients (>65 years) showed an increasing trend (from 23.7% in 2013 to 27.4% in 2018). The percentages of gout/hyperuricemia, hypertension, diabetes, and cardiovascular disease among the hospitalized patients with urolithiasis increased steadily, with the sharpest increases in patients from rural areas. Overall, 656,952 patients (18.9%) received surgical interventions for urolithiasis. The proportions of ureteroscopy and extracorporeal shockwave lithotripsy increased steadily during the 6-year study period, with simultaneous decreases in open surgery and percutaneous nephrolithotomy. The median length of hospital stay decreased from 10 days to 8 days. The cost of urolithiasis intervention accounted for 2.0% of the total hospitalization fee in 2013 and increased to 2.7% in 2018. Conclusions: The analysis showed an increasing trend in the percentage of hospitalized patients with urolithiasis, accompanied by an increased percentage of the total hospitalization fee for urolithiasis intervention during the 6-year study period. Based on the increasing trends in the proportion of older patients (>65 years) and percentages of metabolic comorbidities among patients with urolithiasis, an increased burden of urolithiasis on the healthcare system in China is anticipated.

Effect of Precision Health Education on Compliance Behavior after Extracorporeal Shock Wave Lithotripsy.

Objective The aim of this study was to investigate the effects of precision health education on patients' compliance behavior and lithotripsy efficacy after extracorporeal shock wave lithotripsy (ESWL). Methods From June 2018 to September 2018, 104 patients with upper urinary tract calculi who underwent ESWL at Anhui No.2 Provincial People's Hospital were randomly divided into two groups. The observation group (n = 53) was given precision health education guidance after ESWL treatment, while the control group (n = 51) was only informed of precautions after lithotripsy. Postoperative compliance behavior, stone expulsion time, and complications were recorded in both groups. Results The clinical baseline data of the two groups were similar in age, gender, number of stones, size of stones, location of stones, complications, number of lithotripsies, and voltage of lithotripsy between the two groups (P > 0.05). However, compared with the control group, the observation group had better compliance behavior of patients. Furthermore, we divided the patients into three groups based on whether they complied with medical advice. Compared with the noncompliance group (n = 17) and the partial compliance group (n = 23), the stone expulsion time in the complete compliance group (n = 64) was significantly shorter. Also, the number of patients with nausea and vomiting, lacrimation, and cold sweat in the complete compliance group was significantly lower than that in the other groups. Conclusion Precision health education for patients treated with ESWL can significantly enhance the compliance behavior of patients, thereby accelerating the expulsion of stones, improving the efficacy and relieving pain. Precision health education and good compliance behavior complement and reinforce each other.

Risk factors for the development of complications in the surgical treatment of urolithiasis

The prevalence of urolithiasis in the adult population worldwide ranges from 2% to 20% depending on economic, geographical, ethnic, metabolic and genetic aspects. Modern technologies, improvement of medical equipment, and development of surgical methods expand the choice of methods for the treatment of upper urinary tract calculi. However, an increase in treatment options for this pathology may be accompanied by a rise in the number of complications. The article presents an overview of the existing surgical methods for the urolithiasis treatment and complications risk factors. The “gold standard” for removing kidney stones larger than 2 cm in diameter is percutaneous nephrolithotripsy (PCNL). Retrograde intrarenal surgery (RIRS) is recommended for stones less than 2 cm. The methods of choice for surgical treatment of urolithiasis are extracorporeal shock wave lithotripsy (ESWL) and laparoscopic pyelolithotomy. The choice of the method of surgical intervention depends on concomitant diseases, risk factors, as well as the size and location of the calculus.

The impact of watching real-time videos of flexible ureteroscopic lithotripsy on anxiety and depression in patients.

This study examines the effect of intraoperative doctor-patient communication with real-time videos in flexible ureteroscopic lithotripsy on patients' anxiety and depression. Patients with upper urinary tract calculi were randomised into four groups. Group A (n = 29) watched the real-time operation video, but did not accept the relevant explanation during the operation; Group B (n = 31) received an explanation about the operation process during the operation alone. Patients in Group C (n = 33) watched the real-time operation video and received an explanation about the operation process during the operation. Group D (n = 31) neither watched the operation video nor received an explanation about the operation process. The self-rated anxiety and depression scores of the patients were evaluated using the self-rating anxiety scale (SAS) and the self-rating depression scale (SDS) before and after the operation. The clinical and demographic profiles (average age, gender distribution, educational level, body mass index, stone size, the position of stones in each groups, the length of stayand the numbers of severe postoperative complications) of the for groups showed no preoperation difference (P > 0.05). The preoperative anxiety scores and the preoperative depression scores showed no significant difference in the four groups (P > 0.05). The scores of postoperative anxiety and depression in groups A (n = 29), B (n = 31), and C (n = 33) were significantly lower than those in Group D (n = 31), (P < 0. 05). Compared to groups A and B, the scores of anxiety and depression in Group C were significantly decreased (P < 0.05). During flexible ureteroscopic lithotripsy, doctor-patient communication combined with real-time video can significantly reduce patients' postoperative anxiety and depression, and contribute to their physical and mental health recovery.

Rigid ureteroscopic lithotripsy in the lateral decubitus position for upper urinary tract stones

BackgroundThe current study aimed to assess a novel ureteroscopic technique developed for treating upper urinary calculi based on a specially designed lateral decubitus body position that could avoid stone loss by adjusting to the effects of gravity.MethodsThis retrospective study examined patients with upper urinary calculi who were surgically treated from November 2008 to January 2020, using a new body position and a rigid ureteroscope. Clinical outcomes, stone-free rates, operative times and complications were evaluated, and factors that could influence treatment success were determined.ResultsIn total, 1080 patients were included, and 1145 operations were performed. The maximum calculus diameters were 11.22 ± 5.01 mm. Operative times were 48.60 ± 27.44 min. A total of 1042 cases were successfully treated, with a stone-free rate of 91.00%. Multivariate analysis showed that female sex (OR = 2.135, 95% CI 1.332–3.422, P = 0.002), thin scope standby (OR = 1.643, 95% CI 1.074–2.514, P = 0.022), laser lithotripsy (OR = 5.087, 95% CI 2.400–10.785, P = 0.000) and stone size (OR = 0.946, 95% CI 0.912–0.981, P = 0.003) were independently associated with stone-free outcomes. In total, 2 ureteral perforations, 2 ureteric avulsions and 4 urosepsis cases were observed, but were all cured without sequelae.ConclusionsUreteroscopic lithotripsy in the lateral decubitus position is a safe and effective technique for treating upper urinary tract calculi, especially upper ureteral calculi.

Ningmitai capsule promotes calculi expulsion after RIRS for 10\u201320-mm upper urinary stones: a multicenter, prospective, randomized controlled trial

To evaluate the efficacy and safety of the use of Ningmitai capsule as an adjunctive stone expulsion therapy after RIRS. All patients were diagnosed with upper urinary tract calculi measuring 10–20 mm. The patients who successfully underwent RIRS were randomly assigned to the NMT capsule group (Ningmitai capsule, 1.52 g, three times daily) or the control group for 4 weeks based on the random number table method. The primary endpoints were the stone expulsion rate (SER) and stone-free rate (SFR). The average stone expulsion time (SET), average stone-free time (SFT) and complications were recorded. Between July 2, 2019, and December 17, 2020, 220 participants successfully underwent RIRS across 6 centers; 123 of them were randomized according to the exclusion criteria, and 102 (83%) were included in the primary analysis. The SERs on the 3rd, 7th, 14th and 28th days were significantly increased in the NMT capsule group compared with the control group (78.95% vs. 31.11%, 92.98% vs. 55.56%, 94.74% vs. 64.44%, 100% vs. 82.22%, respectively, p < 0.05). The SFRs on the 3rd and 7th days were not different (p > 0.05), while those on the 14th and 28th days were higher in the NMT capsule group (63.16% vs. 24.44% and 92.98% vs. 68.89%, p < 0.05). The average SET and average SFT of the NMT capsule group were remarkably shorter than those of the control group (p < 0.001). During the follow-up period, there were no significant differences in urine RBC counts between the two groups (p > 0.05). The urine WBC counts of the NMT capsule group were significantly lower than those of the control group on the 14th day (p = 0.011), but there was no difference on the 3rd, 7th or 28th day (p > 0.05). The analgesic aggregate of the NMT capsule group was also much lower (p = 0.037). There were no significant differences in adverse events (p > 0.05), and they improved significantly without sequelae. This study indicated that NMT capsules can significantly promote stone clearance and are more effective and safer for upper urinary calculi after RIRS.Trial registration Chinese Clinical Trial Registration No. ChiCTR1900024151.Date of registration June 28, 2019.

Outcome of Extracorporeal Shockwave Lithotripsy as Monotherapy in Upper Urinary Tract Lithiasis

Introduction: Due to its non-invasive nature, extracorporeal shockwave lithotripsy (ESWL) is the preferred treatment modality for uncomplicated renal and ureteral stone &lt; 20 mm in diameter. The success rate of it ranges from 46% to 91% depending on various factors. Objective: To assess the outcome of ESWL as monotherapy in uncomplicated solitary renal and upper ureteric calculus ranging from 10mm to 20mm. Methods: In this retrospective study, the records of 34 patients who underwent Extracorporeal shockwave lithotripsy ESWL inBirat Medical College – Teaching Hospital over a period of one and a half years were reviewed to assess the outcome in terms of stone free rate and complication rate. Results: Mean age of the patients was 30.57±8.44 years and mean calculus size was 14.47±2.68 mm (range 10-20mm). The male and female ratio was 2:1. The success rate was higher for pelvic (83.33%) and upper calyceal (75%) and upper ureteric calculi (75%) compared to other calyces. Clinically significant residual fragment (CSRF) was the most common problem after ESWL (23.33%) at three months after the procedure. Conclusions: The outcome of ESWL as monotherapy for upper urinary tract calculi is acceptable in selected cases three months after the procedure. Keywords: Extracorporeal shockwave lithotripsy; outcome; upper urinary tract calculi.

Nursing Effect of Minimally Invasive Percutaneous Nephrolithotomy in the Treatment of Upper Urinary Tract Calculi

Nursing Effect of Minimally Invasive Percutaneous Nephrolithotomy in the Treatment of Upper Urinary Tract Calculi

Therapeutic effects of flexible ureteroscopy alone and in combination with external physical vibration on upper urinary tract calculi: a randomized controlled trial.

IntroductionUpper urinary tract calculus is a common disease of the urinary system.AimTo compare the therapeutic effects of flexible ureteroscopy alone and in combination with external physical vibration on upper urinary tract calculi.Material and methodsA total of 146 patients were randomly divided into control and experimental groups (n = 73). The control group received flexible ureteroscopy lithotripsy, and the experimental group underwent the same but combined with external physical vibration. The rate of finding stones in the urine on the day after treatment, clearance rate, components of stones, levels of renal function indices blood urea nitrogen (BUN) and serum creatinine (Scr), and incidence of complications were compared. The stone-free rate during 1-year follow-up was analysed by Kaplan-Meier method.ResultsThe rate of finding stones in the urine on the day after treatment was higher in the experimental group (100%) than that in the control group (29.73%) (p < 0.05). The clearance rates on the day, at 1 week, and at 2 weeks after treatment in the experimental group were 71.23%, 87.67%, and 95.89%, respectively, which surpassed those of the control group at corresponding time points (p < 0.05). BUN and Scr levels decreased after treatment in both groups, especially in the experimental group (p < 0.05). The stone-free rate during 1-year follow-up in the experimental group (n = 71 (97.26%)) exceeded that of the control group (n = 61 (83.56%)) (p < 0.05).ConclusionsExternal physical vibration combined with flexible ureteroscopy lithotripsy significantly increased the rate of finding stones in the urine the day after treatment, the clearance rate of upper urinary tract calculi, and the ameliorated renal function and reduced the stone re-formation rate.

Risk factors for diagnosis of Escherichia coli infection after flexible ureteroscope holmium laser lithotripsy by imaging information technology under Nomogram mathematical model

The evaluation value of Nomogram mathematical model was investigated for risk factors of Escherichia coli infection after flexible ureteroscope holmium laser lithotripsy (f-URL) under the diagnosis of imaging information technology. A total of 124 cases with upper urinary tract calculi (UUTC) were selected as the research objects, and they were rolled into an infection group (41 cases) and a control group (83 cases) according to whether Escherichia coli infection occurred after the surgery. The difference of surgical indicators between the two groups was compared, and the Nomogram mathematical prediction model was established based on Logistic regression risk factors. Besides, the predictive ability of the Nomogram mathematical model was analyzed with indicators such as the integrated discrimination improvement (IDI), the area under the curve (AUC), and GiViTI calibration curve band. The results found that age, diabetes, stone size, surgical time, and antibiotic use time were all risk factors for Escherichia coli infection after surgery. The AUC of the different risk factors of the Nomogram mathematical model was between 0.752 and 0.814, the sensitivity was 57.45%, the specificity was 97.96%, the C-index was 0.734 (95% confidence interval (CI): 0.631–0.837). Both the 80% and 95% CI regions of the Giviti calibration curve band did not cross the 45° diagonal bisector, and P = 0.518. Moreover, the Nomogram model showed an increase of 8.9% (95% CI: 0.061–1.1874 and P = 0.043) compared with the Logistic regression analysis model. Therefore, these results indicated that the Nomogram mathematical model can markedly improve the prediction ability of Escherichia coli infection risk after f-URL, which had great value in the assessment and early diagnosis and treatment of Escherichia coli infection after f-URL.

Microbiological Features and Clinical Factors Associated with Empirical Antibiotic Resistance in Febrile Patients with Upper Urinary Tract Calculi.

BackgroundTo investigate the clinical and microbiological features of febrile patients with upper urinary tract calculi and factors that affect empirical antibiotic resistance.MethodsA retrospective analysis was performed on 203 febrile patients hospitalized between January 2011 and December 2016 with antibiotic treatment for urinary tract infections and upper urinary tract calculi at three institutions. We collected and analyzed data, including patients' age, sex, body mass index, underlying diseases, stone-related factors, and the results of urine and blood culture examinations and antibiotic sensitivity tests.ResultsThe male-to-female ratio was 1:2.3. Bacteria were identified in 152 of the 203 patients (74.9%). The most commonly cultured microorganisms included Escherichia coli (44.1%), followed by Enterococci spp. (11.8%), Proteus spp. (8.6%), Streptococcus agalactiae (6.6%), Klebsiella spp. (5.3%), Pseudomonas spp. (4.6%), coagulase-negative Staphylococcus (4.0%), Staphylococcus epidermidis (4.0%), Serratia spp. (2.6%), Enterobacter spp. (0.7%), Acinetobacter spp. (0.7%), and mixed infections (7.2%). Cultured bacterial species showed sex-specific differences. Multivariate analysis revealed that calculi's multiplicity was an independent predictive factor for quinolone resistance (P = 0.008). Recurrent infections were a significant predictor of cefotaxime resistance during multivariable analysis (P = 0.041).ConclusionBased on the present study results, quinolone was not recommended as the empirical treatment in febrile patients with upper urinary tract calculi. Combination antibiotic therapy is recommended in cases of recurrent infections due to the possible occurrence of cefotaxime resistance.