Cases Of Stones Research Articles

Asuhan Keperawatan Pada Pasien Dengan Batu Ginjal Post Operasi Extended Pyelolitotomi Kiri Dan Ganti Dj Stent Dengan Intervensi Mobilisasi Dini Untuk Mengurangi Intensitas Nyeri Di Ruang Anggrek C Rumah Sakit Umum Kabupaten Tangerang

Nephrolithiasis is the formation of hard material resembling stones originating from minerals and salts in the kidneys. Risk factors for kidney stones are frequent holding in urine, obesity, lack of drinking, urinary tract infections, and heredity. The prevalence of kidney stones in Indonesia is 6 per 1000 population or 1,499,400 people suffer from kidney stones. Various medical procedures can be performed to treat kidney stone cases, one of which is surgery. Post-operative kidney stone patients generally complain of pain and experience physical immobility problems related to the presence of surgical wounds. Nurses play a role in providing nursing care by carrying out pain management and carrying out early mobilization to train the muscle system and nervous system after surgery. The aim of writing this scientific paper is to be able to apply the theory and concept of applying early mobilization to reduce pain intensity in patients with Kidney Stones Post Surgery Extended Left Pyelolithotomy and Replace DJ Stent in Anggrek C Room, Tangerang General Hospital. The writing method used is a case study with a nursing care approach. Based on the results of the study and data analysis, 3 nursing diagnoses were found, namely: pain, physical immobility disorders, and risk of infection. After intervention and evaluation for 3 x 24 hours, data was obtained that the problem of pain and physical immobility disorders was partially resolved, this was indicated by a decrease in pain intensity and increased movement of the patient's extremities, while the problem of risk of infection had not been resolved so the intervention was continued. Nurses are expected to be able to carry out comprehensive assessments, make appropriate diagnoses, plan interventions, carry out evaluations and follow-up

Therapeutic effects of probiotics and herbal medications on oxalate nephrolithiasis: a mini systematic review.

The majority of all kidney stone cases are oxalate urolithiasis with a high risk of recurrence. Beside its widespread occurrence, kidney stones are characterized by severe complications and high treatment costs. Probiotics and herbal medications could be forthcoming therapeutic interventions in the management of oxalate kidney stones. The PubMed/MEDLINE database was searched for keywords "Oxalobacter formigenes" AND "Oxalate" OR "oxalate degradation" AND "Lactobacillus" OR "Bifidobacterium" OR "recombinant Lactobacillus" OR "Bacillus subtilis", and "urolithiasis" AND "herbal extract". The search returned 253 results, 38 of which were included in the review. Most of the oxalate-degrading probiotics belong to the Oxalobacter formigenes, Lactobacillus, Bifidobacterium, and Bacillus genus with a minimum dosage of 107 CFU in the form of capsules, sachets, and lyophilized powder. Oxalate concentration in media was 5-50mM with an incubation time ranging from 24h to 14 days. The majority of the studies suggested that probiotic supplementation might be useful for reducing urinary excretion of oxalate and urea and alleviation of stone formation. Different herbal extracts were used on murine models of nephrolithiasis (induced by 0.5-3% ethylene glycol) with reduction of renal inflammation and urinary parameters, and calcium oxalate crystals. Several strains of probiotics and herbal extracts confer protective effects against kidney stone/nephrolithiasis, indicating their promising nature for being considered as elements of preventive / adjuvant therapeutic strategies.

Cholecystectomy clip-induced biliary stone: Case report and literature review

Abstract Migration of cholecystectomy surgical clip into the common bile duct with subsequent stone formation is a rare phenomenon, one which may lead to complications including obstruction, pain, nausea, vomiting and fever. The mechanism of migration is largely unknown but may result from a combination of factors including necrosis, intra-abdominal pressure or poor surgical technique with migrated clip serving as a nidus for stone formation. We present a 55-year-old woman with clip-induced stone impacted at the distal common bile duct 12 years post-cholecystectomy and a review of the literature related to cholecystectomy clip stone formation. In addition, we reviewed relevant English language case reports and literature reviews by searching PubMed using search terms ‘stone’, ‘clip’, ‘cholecystectomy’ and ‘biliary’. There was no limit to the date of publication. Our study found 68 unduplicated cases of clip-induced stones which had a wide range of onset and presenting systems. Further research is needed to identify risk factors, methods of prevention and benefits of early detection screening.

Nonpapillary Prone Endoscopic Combined Intrarenal Surgery (ECIRS): Five-Year Experience and Outcomes from a High-Volume Center.

Endoscopic combined intrarenal surgery (ECIRS) provides simultaneous retrograde and percutaneous access to the upper urinary tract. The purpose of this study is to present revised data, tips and tricks, and technique modifications arising from our five-year experience with ECIRS. The data of 62 patients who underwent nonpapillary prone ECIRS from January 2019 to November 2023 were prospectively collected. All cases were performed in the prone position. Inclusion criteria were complex stone cases with stones in multiple calyces requiring either multiple accesses or multiple sessions to achieve stone-free status. Patients' mean age was 54.4 ± 12.39 years, while the mean stone size was 39.03 ± 13.93 mm. The mean operative time was 51.23 ± 17.75 min. Primary and final stone-free rates were 83.8% and 90.3%, respectively. In total, nine patients presented with postoperative complications, which were all Grade II ones. The holmium-YAG laser type during retrograde lithotripsy was associated with significantly shorter operative times compared to the thulium fiber laser. Nonpapillary prone ECIRS is a feasible, safe, and efficient approach for patients with specific stone and anatomy characteristics. The implementation of more, higher-evidence studies is of utmost importance so that safer conclusions can be drawn.

A Scarce Case of Sarcomatoid Bladder Carcinoma and Bladder Stone in a 58-Year-Old Man: A Case Report

BACKGROUND: Sarcomatoid bladder carcinoma is scarcely found, with most cases of bladder carcinoma due to bladder stone as a risk factor consisting of squamous cell carcinoma. Only 221 cases were reported between 1973 and 2004 of sarcomatoid bladder cancer. Therefore, this case report brings out sarcomatoid bladder carcinoma and its clinical relevance. CASE DESCRIPTION: A 58 years old Indonesian man experienced gross hematuria for 3 months, and thus finally brought to the Emergency Room (ER) where he was initiated urinary catheter and given intravenous (IV) fluid along with analgesic parenterally. Emergency abdominal radiograph assessment and blood test were made. Abdominal radiograph assessment suggests a 6 x 6 cm opacity in the bladder and several urolithiasis in the pelvic cavity. Ureum and creatinine increased in the blood test procedure. Based on the characteristic appearance and radiological findings, a diagnosis of vesicolithiasis was made. Following the diagnosis, the patient was urgently operated on (Open vesicolithotomy), and during the stone removal, there was a tangled polyp-like mass found buried underneath the stone. Histological findings of mass and surrounding lymph nodes were made and histopathologically stated the mass was sarcomatoid carcinoma of the bladder and it had metastated to lymph node and pelvic region. CONCLUSION: Considering hematuria in urolithiasis is frequent, the clinician should be aware of any tumor findings especially when the hematuria is massive thus emergency urolithotomy should be considered immediately.

Analysis on Chemical Composition of Urinary Calculi and Evaluation on Metabolic Disturbance in 1080 Uyghur, Kazakh and Han Nationality Patients of Xinjiang

Urinary stones pose a significant health concern globally. The incidence rates vary and are influenced by diverse factors. Despite advancements in the treatment modalities, increasing rate of urinary stones necessitates the development of stone prevention strategies and understanding of metabolic risk factors. Objective: To determine the relationship between chemical composition of urinary calculi and evaluation on metabolic disturbance in 1080 Uyghur, Kazakh and Han patients of Xinjiang. Methods: The stone composition of 1080 patients and analysis of 24-h urine and serum biochemistry results of 775 cases was evaluated by infrared spectroscopic analysis and automatic biochemical machine respectively. Results: Among 644 cases of urinary stones, calcium oxalate stones (409 cases) and mixed type stones (436 cases) were predominant. Metabolic disturbances were found in 643 cases (82.97%) out of 775 patients, showing various urinary abnormalities like hyperuricosuria, hyperoxaluria, hyper-phosphaturia, hyper-cystinuria, hypercalciuria, hypomagnesuria, hypocitraturia, and reduced urine volume (<2000ml in 407 cases). Conclusions: Urinary calculi have intimate connection with metabolic evaluation. Metabolic evaluation and composition of urinary calculi have great significance in treatment and prevention of urinary calculi.

Analysis of the Efficacy of Flexible Ureteroscopy and Rigid Ureteroscopy with Holmium Laser Lithotripsy in the Treatment of Upper Ureteral Stones in the Elderly

Objective: To compare the clinical efficacy of rigid ureteroscopy and flexible ureteroscopy with holmium laser lithotripsy in elderly patients with upper ureteral stones. Methods: 12 elderly cases of upper ureteral stones were selected and divided into two groups according to the type of surgery. The control group and the observation group adopted rigid ureteroscopic holmium laser lithotripsy and flexible ureteroscopic holmium laser lithotripsy, respectively. General observation indicators, laboratory indicators, and short-term efficacy-related indicators of surgery were compared between the two groups. Results: The operation time, ambulation time, and hospitalization time of the observation group were shorter than those of the control group, and the intraoperative blood loss was less than that of the control group (P < 0.05). There was no significant difference in the total primary/secondary stone clearance rate, postoperative complications, and disease recurrence rate after six months of follow-up in the two groups (P > 0.05). Conclusion: Compared with rigid ureteroscopic holmium laser lithotripsy, flexible ureteroscopic holmium laser lithotripsy for elderly patients with upper ureteral stones is more conducive to shortening the treatment and postoperative recovery time, and simultaneously, it causes no severe complications and is worthy of promotion.

Bladder stone in pregnancy: a rare encounter

Bladder stones are rare and account for approximately 5.0% of all urinary tract stones. The presence of bladder stones places the pregnancy at risk for adverse outcomes including recurrent urinary tract infections, preterm labour, and obstructed labour. Prompt and accurate diagnosis requires a high degree of suspicion and judicious use of diagnostic imaging given the higher risks of radiation exposure. Treatment ranges from conservative to more invasive approaches. Thus, management needs to be individualized to the patient with careful consideration of the potential adverse effects. We report a case of bladder stone in mid-pregnancy that was treated by open cystolithotomy.

The Characteristics Of Kidney Stone Patients And Their Management At Dr. Pirngadi Medan General Hospital In 2016

Kidney stones are formation of new crystals of urine solution in the urinary tract due to changes in the saturation of substances in the urine. Incidence of lidney stones increased over three decades The prevalence of kidney stones occurs in 0.3% of cases in North Sumatra. From the results of a preliminary survey at RSUD Dr. Pirngadi Medan in 2016, the number of kidney stone patients was 81 people. This is a descriptive study using a retrospective case study design to determine the characteristics of kidney stone patients and their management at Dr. Pirngadi Medan General Hospital in 2016. Data were taken from medical record of patients woth kidney stones diagnosed in Agustus - September 2017 and analyyzed and presented in tables. we found that the incidence of kidney stones was higher in male (56,2%) than in female (43%)., with the highest incidence in the 46-52 year age group (26,25%) and the lowest in the >70 age group, and the majority of patients had no history family with kidney stones (83.8%). Based on education, the highest proportion of patients is at senior high school (78,8%) and the lowest proportion at the college level (5%). Highest incidence found in enterpreneur (32,5%) followed ny housewives (30%) and driver was the lowest (1,2%). Management of kidney stones chategorized by medication in 16 people (20%), and surgery in 64 people (80%) The highest characteristics based on educational background were the group with Senior High School graduates, and the majority of sufferers had self-employed jobs.. Complete data regarding kidney stone cases is needed for future larger descriptive epidemiological studies

Giant Bladder Lithiasis: About 3 Cases in the Urology Department of Sominé Dolo Mopti Hospital (Mali)

Bladder stones represent approximately 5% of all urinary stones. They are common in developing countries, rare in industrialized countries and exceptional in the absence of associated lower tract pathology. In humans, urinary stasis is the essential factor in the formation of bladder stones. We report three cases of giant stones, operated in the urology department of the Sominé Dolo hospital in Mopti Mali by cystolithotomy. These stones weighed 292, 160 and 158 grams respectively. The causes of these stones were, for the first and second patients, sclerosis of the bladder neck, and for the third patient, a stricture of the urethra. The postoperative course was simple. These observations highlight a late consultation in a society where questions relating to the urogenital sphere remain a taboo.

Causal effects of circulating lipids and lipid-lowering drugs on the risk of urinary stones: a Mendelian randomization study.

Previous studies have yielded conflicting findings regarding the association between circulating lipids and lipid-lowering drugs with urinary stones, and the causal relationship between the two remains inconclusive. This study aimed to assess the causal relationship between circulating lipids (Triglycerides [TG], low-density lipoprotein cholesterol [LDL-C], high-density lipoprotein cholesterol [HDL-C], apolipoprotein A [APOA], apolipoprotein B [APOB] and Pure hypercholesterolaemia), lipid-lowering drugs (HMGCR [HMG-CoA reductase] inhibitors and PCSK9[Proprotein Convertase Subtilisin/Kexin Type 9] inhibitors) and the risk of urinary stones, using genetic data. Genetic instrumental variables (GIVs) for circulating lipids and lipid-lowering drugs were obtained from the UK Biobank and existing literature. Outcome data were extracted from a genetic association database with 3,625 urinary stone cases and 459,308 controls. Two-sample MR analysis, employing the TwoSampleMR software package in R 4.2.3, was conducted to assess the associations between multiple exposures. The primary outcome was determined using the inverse variance weighted (IVW) method for the causal relationship between exposure and outcome, while additional methods such as MR-Egger, weighted median, simple mode, and weighted mode were utilized as supplementary analyses. Robustness of the Mendelian Randomization (MR) analysis results was assessed through leave-one-out analysis and funnel plots. The MR analysis revealed a significant association between elevated TG levels per 1 standard deviation and the occurrence of urinary stones (odds ratio [OR]: 1.002, 95% confidence interval [CI]: 1.000-1.003, P = 0.010). However, no significant association was observed between factors other than TG exposure and the risk of urinary stone occurrence across all methods(LDL-C: [OR], 1.001; 95% [CI], 1.000-1.003, P=0.132;HDL-C: [OR], 0.999; 95% [CI], 0.998-1.000, P=0.151;APOA:[OR] being 1.000 (95% [CI], 0.999-1.001, P=0.721;APOB: [OR] of 1.001 (95% [CI], 1.000-1.002, P=0.058;Pure hypercholesterolaemia: [OR] of 1.015 (95% [CI], 0.976-1.055, P=0.455) and lipid-lowering drugs (HMGCR inhibitors: [OR], 0.997; 95% [CI], 0.990-1.003, P=0.301 and PCSK9 inhibitors:[OR], 1.002; 95% [CI], 1.000-1.005, P=0.099). Our findings provide conclusive evidence supporting a causal relationship between an increased risk of urinary stones and elevated serum TG levels. However, we did not find a significant association between urinary stone occurrence and the levels of LDL-C, HDL-C, APOA, APOB, Pure hypercholesterolaemia and lipid-lowering drugs.

Systematic Appraisal of Guidelines for the Diagnosis and Treatment of Choledocholithiasis.

To systematically evaluate the methodological quality of the current up-to-date guidelines pertaining to choledocholithiasis, we conducted a comprehensive analysis of key recommendations and corresponding evidence, focusing on the heterogeneity among these guidelines. Systematic searches across various databases were performed to identify the latest guidelines. The identified guidelines, which met the inclusion criteria, underwent evaluation using the Appraisal of Guidelines for Research and Evaluation II (AGREE II) tool. The key recommendations and evidence from the included guidelines were extracted and reclassified using the Oxford Centre for Evidence-Based Medicine (OCEBM) grading system, and the obtained results were analyzed. Nine guidelines related to choledocholithiasis were included in this study, out of which 4 achieved an overall standardized score of more than 60%, indicating their suitability for recommendation. Upon closer examination of the main recommendations within these guidelines, we discovered significant discrepancies concerning the utilization of similar treatment techniques for different diseases or different treatment methods under comparable conditions, and discrepancies in the recommended treatment duration. High-quality research evidence was lacking, and some recommendations either failed to provide supporting evidence or cited inappropriate and low-level evidence. The quality of guidelines pertaining to choledocholithiasis is uneven. Recommendations for the treatment of choledocholithiasis demonstrate considerable disparities among the guidelines, particularly regarding the utilization of endoscopic retrograde cholangiopancreatography as a treatment method and the management approaches for difficult stone cases. Improvements by guideline developers for these factors contributing to the heterogeneity would be a reasonable approach to further update the guidelines for cholangiolithiasis.

Habitual fish oil supplementation, genetic susceptibility of kidney stones and the risk of new-onset kidney stones

We aimed to assess the association between habitual fish oil use and new-onset kidney stones in participants with different levels of genetic risks of kidney stones. 477,311 participants free of kidney stones at baseline from the UK Biobank cohort were included. Fish oil use was collected by both food frequency questionnaires and 24-h dietary recalls. A genetic risk score (GRS) for kidney stones was calculated based on 20 single-nucleotide polymorphisms associated with kidney stones. The primary outcome was new-onset kidney stones. During a median follow-up of 12.0 years, 5,637 cases of kidney stones were documented. Participants with high genetic risks of kidney stones had a higher risk of new-onset kidney stones (vs. low or intermediate risks; adjusted HR, 1.52; 95 %CI:1.44-1.60). Compared with non-users, habitual use of fish oil was associated with a lower risk of new-onset kidney stones (adjusted HR, 0.84, 95 %CI, 0.78-0.92) in participants with low or intermediate genetic risks, but not in those with high genetic risks of kidney stones (adjusted HR, 1.02, 95 %CI, 0.93-1.12; P-interaction =0.001). Among those with low or intermediate genetic risks of kidney stones, compared with fish oil constant nonusers, the adjusted HRs (95 %CI) for kidney stones were 0.89 (0.75-1.06), 0.72 (0.58-0.90), and 0.79 (0.64-0.97), for fish oil occasional users, modestly constant users, and moderately and highly constant users (P for trend = 0.001), respectively. Habitual fish oil use was associated with a lower risk of new-onset kidney stones in participants with low or intermediate genetic risk of kidney stones.

The represented image of a gift: The case of the Taltal flake stones.

The represented image of a gift: The case of the Taltal flake stones.

Mendelian Randomization Analysis of Genetic Proxies of Thiazide Diuretics and the Reduction of Kidney Stone Risk

Clinical trial data have called into question the efficacy of thiazide diuretics for the prevention of kidney stones. To identify whether there is an association between genetic proxies of thiazide diuretics and the risk of kidney stones. This genetic association study undertook a mendelian randomization analysis of derived exposures and outcomes from genome-wide association study summary statistics. Genetic proxies of thiazide diuretics were derived from the International Consortium for Blood Pressure. Kidney stone cases and controls were derived from the Million Veteran Program, UK Biobank, and the FinnGen study. These cross-sectional designs do not report a duration of follow-up. Data analysis was performed in May 2023. Genetic proxies of thiazide diuretics were genetic variants in the thiazide-sensitive sodium chloride cotransporter gene associated with systolic blood pressure. Genetic proxies of β-blockers and systolic blood pressure served as negative controls. The main outcome was the odds of kidney stones. The secondary outcomes were serum laboratory values relevant to the treatment of kidney stones. The main analysis included up to 1 079 657 individuals, including 50 832 kidney stone cases and 1 028 825 controls. In a meta-analysis of all cohorts, genetic proxies of thiazide diuretics were associated with a lower odds of kidney stones (OR, 0.85; 95% CI, 0.81-0.89; P < .001). Genetic proxies of β-blockers (OR, 1.02; 95% CI, 0.96-1.07; P = .52) and systolic blood pressure (OR, 1.00; 95% CI, 1.00-1.01; P = .49) were not associated with kidney stones. Genetic proxies of thiazide diuretics were associated with higher serum calcium (β [SE], 0.051 [0.0092]; P < .001) and total cholesterol (β [SE], 0.065 [0.015]; P < .001), but lower serum potassium (β [SE], -0.073 [0.022]; P < .001). In this genetic association study, genetic proxies of thiazide diuretics were associated with reduced kidney stone risk. This finding reflects a drug effect over the course of a lifetime, unconstrained by the limited follow-up period of clinical trials.

An observational study on spectrum of complications in gallstone disease in Western Maharashtra

Gallbladder calculus prevalence exhibits significant regional disparities, affecting public health. This study aimed to assess the incidence of complications in diagnosed cases of gallbladder stones using a prospective observational approach. Methods encompassed comprehensive history-taking, clinical examinations, imaging, and biochemical markers' analysis. In this study encompassing 238 cases of symptomatic gallstones, a comprehensive analysis revealed that 31.9% of patients presented with complications. Among these, choledocholithiasis emerged as the most prevalent complication, affecting 13.45% of the cases. Acute cholecystitis and gallstone pancreatitis were also significant complications, occurring in 10.9% and 6.7% of the cases, respectively. Noteworthy is the consistent alignment between clinical diagnoses and imaging findings, highlighting the accuracy and reliability of the diagnostic process. Turning to the exploration of management modalities, the data showcased laparoscopic cholecystectomy as the predominant surgical intervention. Both early and delayed laparoscopic cholecystectomies were frequently performed, reflecting the versatility of this approach in addressing symptomatic gallstone cases. However, it is essential to note that an overall 6% conversion rate from laparoscopic to open cholecystectomy was observed, underscoring the importance of adaptability in surgical strategies. These findings not only contribute to a deeper understanding of the prevalence and complications associated with symptomatic gallstones but also emphasise the significance of accurate diagnostic measures and the need for surgical flexibility in managing these cases. The results presented in this study offer valuable insights that can inform clinical decision-making and enhance the overall management of patients presenting with symptomatic gallstones

Application of tip-bendable ureteral access sheath in flexible ureteroscopic lithotripsy: an initial experience of 224 cases.

During the last decades, the advent of flexible ureteroscopic lithotripsy has revolutionized the management of upper urinary tract stones. We designed a patented tip-bendable ureteral access sheath to facilitate stone clearance. Our current study reported our initial experience of 224 cases. The study is a descriptive, retrospective analysis. The initial 224 cases, operated consecutively by one surgeon during 16 months, were reviewed. The novel tip-bendable ureteral access sheath was applied in the procedure. Demographics, laboratory tests, and peri- and postoperative findings (operation duration, stone-free rate (SFR), utilization of flexible instruments and complications) were analyzed. The median age of the patients was 56 years and the mean stones size was 2.3 ± 1.3cm. There were 63 cases of upper ureteral stone, 93cases of renal stone and 68 cases of ureteral-renal stones. The mean operative time was 69.2 ± 65.2min. The immediate stone-free rate was 76.8% and the 1 month post-operative stone-free rate was 97.3%. Most cases(95.5%)were success in single session. Two patient experienced post-operative fever. There was no unplanned readmission. The frequency of post-operative complications was estimated at 0.89% (Clavien I). Flexible ureteroscopic lithotripsy with tip-bendable ureteral access sheath is a safe and effective procedure, which can achieve excellent stone clearance.

Lifestyle and Diet as Risk Factors for Urinary Stone Formation: A Study in a Taiwanese Population.

Background and Objectives: Urinary tract stones have long been a common ailment afflicting the population, with a high incidence and a wide distribution across different age groups. Effectively preventing the occurrence of urinary tract stones is of paramount importance. The primary aim of this study is to investigate the correlations between individual characteristics, water consumption habits, dietary habits, exercise habits, and the occurrence of urinary tract stones in a Taiwanese population. Materials and Methods: This study is cross-sectional research conducted over one month in 2022. One hundred eligible urinary stone cases were recruited through physician screening at outpatient clinics, and an additional one hundred samples from surgical outpatients without urinary tract stones were included as the control group. A questionnaire survey was employed to gather information on demographic variables, dietary habits, water consumption, and exercise habits of the cases. Descriptive statistics, chi-square tests, and logistic regression were used to explore the impact of relevant factors on urinary stone formation. Results: The analysis results revealed that among the demographic variables, males exhibited a higher risk of contracting urinary tract stones than females, and the majority of cases fell within the 40- to 49-year-old age group. Unhealthy lifestyle habits such as smoking and betel nut chewing also demonstrated a higher susceptibility to urinary tract stones. A logistic regression analysis showed that individuals who engaged in physical activity more than three times per week and those with inadequate water intakes had a higher risk of developing urinary tract stones. Conclusions: There is a close relationship between lifestyle and urinary tract stones. It is recommended that individuals continue to hydrate adequately during exercise.

To Evaluate the Impact of Ho:YAG Laser Lithotripsy for Ureteroscopic Removal of Proximal and Distal Ureter Calculi.

Background Urinary calculus illness is a prevalent clinical issue encountered by the medical community, particularly urologists, in contemporary society. Laser technologies have been widely accepted as standard modalities for lithotripsy applications. Using the Ho:YAG laser has expanded the range of applications for ureteroscopic stone management (URS), enabling the treatment of bigger stones in all regions of the upper urinary tract. It is noteworthy that ureteroscopy (URS) demonstrates superior rates of stone clearance for distal stones, regardless of their size, with a success rate of 94.5% compared to 74% for other treatment modalities. Significant variation exists in the reported results and problems associated with Ho:YAG laser lithotripsy across different trials, as documented in the literature. The procedure's outcome might vary based on factors such as the size of the stone, the length of impaction, the presence of ureteral damage and granulation, the kind and size of endoscopes used, and the specific energy settings employed by various operators. The present study aimed to evaluate the impact of Ho:YAG laser lithotripsy for ureteroscopic removal of proximal and distal ureter calculi. Methods This prospective observational study was carried out in the Department of Urology at DY Patil Medical College and Hospital, Pune, from March 2021 to March 2023. Patients diagnosed with a case of ureteric stone who opted for URSL during the study period were included. A total of 50 patients who underwent URSL in the urology department were included in this study. These were then grouped into those with proximal ureteral stones and distal ureteral stones. (25 each) Results The study observed that patients diagnosed with proximal ureteral stones had bigger calculi, with a mean stone size of 15mm, in comparison to patients with distal ureteral stones, with a mean stone size of 10mm (P=0.010). The stone burden was significantly higher for proximal ureteral stone patients than those with distal ureteric stones (P=0.010). The average duration of the operating procedure for upper ureter stones was 70 minutes, but for lower stones, the mean operative time was 45 minutes (P<0.001). No statistical significance was seen in the median age of patients between the two groups (P=0.89). The maximum number of cases in the upper stone group were in the age group of 16-30 years, and in the lower stone group was in the age group of 31-45 years. The prevalence of DJ stents at the time of presentation was higher among patients diagnosed with proximal ureteric stones than those with distal ureteric stones, with rates of 28% and 20%, respectively (P=0.508). Full fragmentation was successfully accomplished in all patients within the distal calculus group, accounting for 100% of the cases. At the same time, for proximal ureteric stones, a single laser lithotripsy session resulted in 92% (23 patients) achieving a stone-free status after two weeks. Conclusion The study observed that stone size, burden, and procedure duration were statistically significant among other criteria. Mean age, stone HU, prior DJ stent, and stone-free rate were statistically insignificant. The procedure indicated that Ho:YAG laser lithotripsy has efficacy in treating both proximal and distal ureteral stones, with minimal intraoperative and postoperative complications. None of the complications were due to laser energy.

Inverse association of glucosamine use and risk of new-onset kidney stones in UK adults with less sedentary time

ObjectiveTo assess the association of different sedentary behaviors and glucosamine use with the risk of kidney stones and examine the modification of genetic risk of kidney stones on this association. Methods473,225 participants free of kidney stones at baseline from the UK Biobank were included. Total sedentary time was calculated as the sum of the duration of TV-watching, driving, and non-occupational computer using. The primary outcome was new-onset kidney stones. ResultsDuring a median follow-up of 12.0 years, 5528 cases of kidney stones were documented. All major sedentary behaviors and total sedentary time were significantly positively related to the risk of kidney stones (All P for trend<0.05). Participants with total sedentary time ≥ 3.5 h/day had a significantly higher risk of new-onset kidney stones (vs. <3.5 h/day [tertile 1]; HR, 1.18; 95%CI,1.10–1.27). Compared with non-users, participants who regularly used glucosamine had a significantly lower risk of new-onset kidney stones in those with total sedentary time < 3.5 h/day (HR, 0.72; 95%CI,0.59–0.86), but not in those with total sedentary time ≥ 3.5 h/day (HR, 0.99; 95%CI,0.91–1.08; P-interaction = 0.001). Among participants with total sedentary time < 3.5 h/day, there was a dose-response relationship of glucosamine use with new-onset kidney stones (P for trend<0.001). Genetic risks of kidney stones did not significantly modify the association. ConclusionsTV-watching, driving and non-occupational computer using were all positively associated with the risk of new-onset kidney stones. Glucosamine use was associated with a lower risk of new-onset kidney stones in participants with total sedentary time < 3.5 h/day, following a dose-response relationship.