Stone Characteristics Research Articles

The Significance of Stone Culture in the Incidence of Sepsis: Results from a Prospective, Multicenter Study on Infections Post Flexible UreteroreNescopy (I-FUN) and Laser Lithotripsy for Renal Stones.

Objective: Sepsis is the most serious complication of flexible ureteroscopy (F-URS) and laser lithotripsy. We assessed the influence of positive stone culture (SC) on major infectious complications (sepsis, septic shock). Methods: This prospective study enrolled adult patients deemed suitable for F-URS and laser lithotripsy from nine centers (January 2022-August 2023). Inclusion criteria were as follows: kidney stone(s), preoperative midstream urine culture (MSUC), stone(s) assessed at computed tomography scan, and SC. Exclusion criteria were as follows: bilateral procedures, ureteral stones, and children. Group 1 included patients with sterile SC. Group 2 included patients with positive SC. Data are presented as median (interquartile range). A multivariable logistic regression analysis was performed to evaluate factors associated with having a positive SC. Results: In total, 293 patients were included. Median age was 51.0 (24) years. There were 167 (57.0%) males. Group 2 included 32 (2.5%) patients. Group 2 patients were significantly older [75.0 (14) vs 51.0 (23) years, p = 0.02]. Stone features were similar. Major infectious complications were higher in Group 2 (15.6% vs 0.4%). One patient died because of sepsis in Group 2. Two out of 6 (33.3%) patients with major infectious complications had the same pathogen in MSUC and SC. In the multivariable regression analysis, diabetes (OR 3.23), symptomatic urinary infections within 3 months before operation (OR 4.82) and preoperative stent/nephrostomy (OR 2.92) were factors significantly associated with higher odds of positive SC. Conclusions: Patients with positive SC have a higher incidence of major infectious complications after F-URS lithotripsy. SC should be performed whenever feasible because there is a poor correlation between MSUC and SC.

Management of deceased and living kidney donor with lithiasis: a multicenter retrospective studyon behalf of the renal transplant group of the Spanish urological association.

To maximize the availability of suitable grafts and ensure effective management, several reports have demonstrated successful outcomes when using kidney grafts with urolithiasis. This multicenterstudy reports onthe management and long-term outcomes of kidney transplantation using renal grafts with lithiasis. Retrospective data from three Spanish hospitals were analyzed for kidney transplants involving grafts with nephrolithiasis performedbetween December 2009 and August 2023. The study included adult patients, excluding those with incomplete records. It evaluated stone characteristics, complications, and outcomes in recipientsand in living kidney donors. Out of 38 analyzed kidney transplants, 57.9% were cadaveric and 42.1% were from living kidney donors. Most diagnoses were incidental during donor evaluation, with an average stone size of 7.06mm. After follow-up (median 26months), all recipients but one had functioning grafts, and there were no stone recurrences in bothrecipients andliving kidney donors. Conservative management was adopted in 28 cases, while 10 cases required ex-vivo flexible ureterorenoscopy for stone removal. Following conservative management, 5 patients needed additional treatments for stone-related events. Kidneys with lithiasis can be considered for transplantation in selected cases, resulting in good functional outcomes with no stone recurrence in recipients or living donors.

Exploring the potential of combined B-mode features and color Doppler ultrasound in the diagnosis of ureteric stone as an alternative to ionizing radiation exposure by computed tomography.

To assess the diagnostic efficacy of integrating B-mode and color Doppler capabilities of ultrasound (US) to establish a robust standalone diagnostic tool for the diagnosis of ureteric stones as an alternative to non-contrast-enhanced computed tomography (NCCT). A total of 140 consecutive patients diagnosed with ureteric stones using NCCT were enrolled. On the same day, US in both B-mode and Color Doppler was performed by an experienced radiologist who was blinded to the NCCT scan results. The diagnostic rate of US for stone detection was recorded. Additionally, baseline patient and stone characteristics were analyzed for their association with the accuracy of stone detection using US. US exhibited a high sensitivity of 91.43%, detecting 128 out of 140 stone foci. Notably, ureteric stones in the proximal and uretero-vesical junction (UVJ) segments were readily identifiable compared to those in the pelvic region (p = 0.0003). Additionally, hydronephrosis enhanced the US's ability to detect stones (p < 0.0001). Conversely, abdominal gases and obesity adversely affected US capabilities (p < 0.0001 and p = 0.009, respectively). Stone side, size, and density showed no statistically significant impact (p > 0.05). US with its color Doppler capabilities could serve as a reliable and safe alternative imaging modality in the diagnostic work up of patients with ureterolithiasis. Factors including stone location, Hydronephrosis, weight and abdominal gases significantly influenced its accuracy.

Successful treatment of staghorn stones with flexible ureteroscopy and thulium fiber laser (TFL) lithotripsy: initial experience with 32 cases

PurposeTo investigate the efficacy and safety of flexible ureteroscopy with thulium fiber laser lithotripsy for management of renal staghorn stones.Materials and MethodsThirty-two patients with staghorn stones were recruited. Stone characteristics including: width, length, volume and density were analyzed. Ablation speed, laser efficacy and laser activity were recorded. The primary outcome was to assess stone free rate after the procedure using spiral CT scan.ResultsThe median stone volume was 7339 (3183–53838) mm3. Median operative and lasing time were 135 (70–200) and 117 (50–180) minutes, respectively. The mean total energy delivered was 63.9 ± 30 KJ with a median ablation speed of 1.3 (0.5–4.9) mm3/sec. Mean laser efficacy was 7.5 ± 3.6 Joules/mm3. A total of 12 complications occurred in 8 patients (25%). The median hospital stay was 7 (3.5–48) hours and 30 patients (93.7%) were discharged on the same day of surgery. After the first session, seventeen patients (53%) were stone free with no residual fragments while six (19%) patients had residuals £ 2 mm. Nine patients (28%) had residuals > 2 mm with median residual size of 4 (3–9) mm. A second intervention was required in 4 cases.The overall stone free rate after completion of treatment was 65.6%.ConclusionFlexible ureteroscopy with thulium fiber laser lithotripsy is a safe and effective treatment option for staghorn stones with stone free rate comparable to standard PCNL with advantages of minimal morbidity, minimal blood loss and shorter hospital stay.

Effect of access sheath diameter used in percutaneous nephrolithotomy on renal function: a prospective randomized study.

We aimed to determine the effect of the access sheath diameter used in percutaneous nephrolithotomy (PNL) on renal function. We also investigated the predictors of impaired renal function. Data were prospectively collected from patients who underwent PNL from December 2020 to December 2021. The patients were randomized into two groups according to access sheath diameter: Group 1 (22 Fr, n = 44) and Group 2 (28 Fr, n = 44). Relative renal function (RRF) was calculated by technetium-99m dimercaptosuccinic acid scintigraphy, and glomerular filtration rate (GFR) was calculated by diethylenetriamine pentaacetic acid scintigraphy. A difference of 5% or more in RRF was considered a significant functional change. Preoperative and postoperative Kidney Injury Molecule-1 (KIM-1) levels were measured. Preoperative demographic data and stone characteristics were similar between the groups. There were also no statistically significant differences between the groups in terms of scar development, changes in RRF, GFR, or KIM-1/creatinine (Cr) (p > 0.05). Significant deterioration in RRF was detected in a total of six (6.8%) patients, three in each group. The factors predicting loss of function were analyzed by regrouping the patients without loss of function as Group A (n = 82) and those with loss as Group B (n = 6). Only stone volume was statistically significant in multivariate analysis (p = 0.002). Access sheath diameter had no significant effect on renal function after PNL. However, the stone volume was found to independently correlate to a loss of renal function after PNL.

Safety and efficacy of ambulatory tubeless mini-percutaneous nephrolithotomy in the management of 10-25 mm renal calculi A retrospective study.

This study aimed to assess the safety and efficacy of ambulatory minipercutaneous nephrolithotomy (mini-PCNL) in a totally tubeless exit (without a nephrostomy tube or an internal stent) and tubeless exit (without a nephrostomy tube but with an internal stent) for the treatment of renal calculi 10-25 mm in size. We conducted a retrospective analysis of patients who underwent mini-PCNL at our institution between September 2018 and September 2022. The study included a cohort of 95 patients diagnosed with renal calculi measuring 10-25 mm. All patients underwent a computed tomography (CT) renal colic scan preoperatively, on postoperative day one (POD 1), and at three-month followup. Patient demographics and outcome parameters were recorded, including stone characteristics, operative time, hospital stay, stone-free rate (SFR), complication rates, and subsequent emergency room (ER) visits. Patients were considered stone-free if they had no fragments or residual fragments measuring <4 mm. The median maximum stone diameter was 16 mm (10-25 mm). Twenty-nine patients (30.5%) had multiple renal calculi. The median operative time was 64 (38-135) minutes. Eighty-six patients (90.5%) underwent a totally tubeless procedure, without a nephrostomy tube or an internal stent. All patients were discharged home on the same operative day with a median hospitalization time of six hours. Seven (7.4%) postoperative ER visits were recorded, and two (2.1%) led to hospital readmission. The frequency of grade I, II, and III Clavien-Dindo complications were 18 (18.9%), one (1.1%), and one (1.1%), respectively. The SFR on POD 1 and three-month followup was 73.7% and 92.6%, respectively. Two patients in the study required retreatment. Ambulatory tubeless mini-PCNL is a safe and effective treatment option for 10-25 mm renal stones. Experienced institutions can safely adopt ambulatory mini-PCNL as a treatment option without an increased risk of postoperative complications, ER visits, or hospital readmissions.

Factors affecting the success and perioperative complications of retrograde intrarenal surgery: a retrospective clinical analysis

Background and objective: Many factors are presumed to have an impact on the results of retrograde intra renal surgery. In the current study, our objective was to actuate the possible factors influencing the stone-free rates and complications post lone-session retrograde intrarenal surgery for renal calculi. Stone-free rates Methods: Overall 200 patients who undergone retrograde intra renal surgery between January 2019 and March 2022 were evaluated, retrospectively. Success was decided if there were no residual fragments on pain X-ray and ultrasonography. Patient demographics, stone characteristics, perioperative data were assessed and analyzed to actuate predictive factors influencing stone-free rates and perioperative morbidities. Results: Two hundred patients with a mean age of 41.12±14.37 years were evaluated. The mean stone size was 1.815 ± 2.107 millimeters (mm), mean stone density was 969.63 ± 345.307 Hounsfield unit. The immediate SFR was (76.8±0.42) while the final SFR (single session) was 87.9±0.46. Thirty-seven patients (18.5%) developed complications, the preponderance of them 86% were minor complications (Clavien grade I and II). In multivariate regression analysis, multiple renal stones and ureteral access sheath use were constitute to be statically significant predictors of stone-free status. Moreover, multivariate regression analysis revealed that operative time, lasing time and stone opacity stones were statistically significant factors influencing perioperative complications. Conclusion: Success rates inversely related to stones number and ureteral access sheath usage. While prolonged operation time, lasing time, and higher stone density could be a more reliable predictor of perioperative complication development.

Comparison of percutaneous nephrolithotripsy combined with retrograde intrarenal surgery and multi-tract percutaneous nephrolithotripsy for octopus stone: A propensity score-matching study.

To compared the effectiveness and safety of single standard mini percutaneous nephrolithotripsy (SM-PCNL) combined with retrograde intrarenal surgery (RIRS) and multiple standard mini percutaneous nephrolithotomy (MSM-PCNL) in the treatment of octopus stone of 2 to 4 cm. The clinical data of SM-PCNL combined with RIRS and MSM-PCNL for octopus stone with a 2 to 4 cm diameter from October 2019 to December 2022 were analyzed retrospectively, and propensity score matching was used to screen patients. The matched patients were paired, and the operation time, complications, postoperative pain, tubeless rate, stone-free rate (SFR), and postoperative hospital stay were further compared between the 2 groups. 88 patients underwent SM-PCNL combined with RIRS (combined group), and 143 patients underwent MSM-PCNL (multiple channel group). After matching analysis, there were 49 patients in each group, and there was no significant difference in the general preoperative data between the 2 groups. The perioperative complications and stone-free rate were no statistical difference. In postoperative pain (4.00 ± 0.74 vs 5.00 ± 0.74, P = .00), tubeless rate (44.90% vs 20.41%, P = .01), hemoglobin drop (9.38 ± 7.48 vs 14.22 ± 7.69, P = .01), postoperative hospital stay (3.37 ± 1.09 vs 5.08 ± 1.29, P = .00), the combined group was significantly better than the multiple channel group. Regarding operation time, the combined group was more than the multiple channel group (103.27 ± 27.61 vs 78.39 ± 19.31, P = .000). For octopus stone with a diameter of 2 to 4 cm, the effectiveness and safety of SM-PCNL combined with RIRS were similar to those of MSM-PCNL The surgeon should carefully evaluate the patient's physical condition, stone characteristics, and expectations before the operation and assist the patient in choosing an appropriate plan.

Endoscopic combined intrarenal surgery versus percutaneuos nephrolithotomy for complex pediatric stone disease: A comparative analysis of efficacy and safety

INTRODUCTIONDecision-making for complex pediatric urinary system stone disease is still a challenge for pediatric urologists. The interest in supine percutaneous nephrolithotomy (PCNL) is increasing among centers to achieve high surgical success rates with less morbidity. Despite advanced retrograde intrarenal surgery armamentarium, percutaneous approaches remain the first-line surgical treatment modality for >2 cm and complex renal stones. There are no comparative studies yet in the literature for pediatric endoscopic combined intrarenal surgery (ECIRS) OBJECTIVEIn this study, we aimed to contribute to the literature by evaluating the safety and efficacy of ECIRS by comparing it with PCNL. STUDY DESIGNPatients under 18 years of age who underwent PCNL and ECIRS for urinary tract stone disease at our Pediatric Urology department between 2012 and 2024 were included. Preoperative (demographic characteristics, stone characteristics, biochemical parameters), perioperative (duration of surgery, number of accesses, lasing and fluoroscopy times, endoscopic and fluoroscopic stone-free rates) and postoperative (hospital stay, urinary tract infection, complication and radiological stone-free rates) parameters were retrospectively evaluated. RESULTSA total of 68 children [28 (41%) girls and 40 (59%) boys] aged 5 (0-17) years were included in the study. ECIRS was performed in 19 (28%), supine in 28 (41%) and prone PCNL in 21 (30%) patients. Age (p = 0.029), Guy's stone score (p<0.001), S.T.O.N.E. (p<0.001), and Seoul National University Renal Stone Complexity (S-ReSC) scores (p=0.001) for preoperative parameters were found to be higher in ECIRS group over both PCNL methods (Summary Table). However, Clinical Research Office of the Endourological Society (CROES) score was seen lower for ECIRS group patients compared to other groups (p=0.028).Surgery time (in favor of supine over prone PCNL), fluoroscopy time (in favor of ECIRS and Supine PCNL over Prone PCNL), preferred laser type (prone PCNL group was mostly performed with holmium laser, whereas other groups were balanced between Holmium and Thulium Fiber Laser) and exit strategy (the preferred exit strategy was DJ Stent in most of the ECIRS patients, whereas nephrostomy tube was used in some of the PCNL group) showed significant difference among the groups as perioperative parameters (p=0.042, <0.001, <0.001, <0.001, respectively). Surgery time was lower for supine PCNL compared to prone PCNL. For postoperative parameters, stone-free rates, complication rates and urinary tract infections were similar between the 3 groups, while a difference was detected in terms of length of hospital stay in favor of ECIRS over both supine and prone PCNL (p = 0.006). DISCUSSIONThe current trial suggests that stone-free and complication rates of ECIRS and supine PCNL were similar in the pediatric complex stone patients. Although, the stones in the ECIRS group we found to be more complex. Also, ECIRS was superior to PCNL in terms of fluoroscopy exposure and hospital stay. CONCLUSIONWith the widespread use of new generation ureteral access sheaths and flexible ureterorenoscopes, ECIRS may have an important role in treatment of complex pediatric kidney stones.

Prospective Evaluation of Extracorporeal Shockwave Lithotripsy in Renal and Upper Ureteric Stone Treatment: Clinical Assessment and Results.

Extracorporeal shockwave lithotripsy (ESWL) is a widely accepted non-invasive treatment for renal and upper ureteric stones smaller than 2 cm due to its safety and efficacy. Despite advancements in minimally invasive techniques, extracorporeal shockwave lithotripsy remains an important modality. This prospective observational study aimed to evaluate the outcomes of ESWLin managing renal and upper ureteric stones measuring less than 2 cm in terms of stone clearance. In a study conducted at a university-affiliated tertiary care hospital, 119 patients with renal and upper ureteric stones underwent extracorporeal shockwave lithotripsy over a 12-month period. Data on patient demographics, stone characteristics, treatment procedures, and complications were collected. Follow-up assessments were performed at two-week intervals for up to two months post-treatment. The mean age of patients was 39.78 years, with a mean stone size of 1.2 cm. Right kidney stones were more prevalent (61.3% [n=76]). Complications included fever (19.3% [n=23]), gross haematuria (24.3% [n=29]), and steinstrasse (21.8% [n=26]). The success rate of extracorporeal shockwave lithotripsy was 81.5% (n=97), with 18.5% (n=22) of patients requiring surgical intervention due to incomplete fragmentation or residual fragments >4 mm. Stone size and density played significant roles in treatment success. Despite advancements in minimally invasive techniques, ESWLretains its significance as a noninvasive and effective treatment option for renal and upper ureteric stones smaller than 2 cm. Its success depends on various factors, including the stone site, size, and composition. ESWL offers advantages such as minimal morbidity, shorter hospital stays, and better patient compliance. Complications such as steinstrasse are manageable with conservative measures or ancillary procedures. While ESWL may be losing ground in some cases, its noninvasive nature and favourable outcomes make it a valuable option in the armamentarium for stone management.

Holmium:yttrium-aluminium-garnet laser with MOSES technology is more efficient than thulium fibre laser in supine mini-percutaneous nephrolithotomy.

To address the paucity of literature comparing outcomes achieved with utilisation of the high-power holmium:yttrium-aluminium-garnet (Ho:YAG) laser with MOSES technology vs those achieved with the thulium fibre laser (TFL) in mini-percutaneous nephrolithotomy (PCNL). A retrospective review was performed of patients undergoing supine mini-PCNL between August 2021 and May 2023. Exclusion criteria were urinary diversion, simultaneous utilisation of >1 laser platform, use of any other form of fragmentation, and ureteric stones. The Ho:YAG platform (Lumenis Pulse P120H™ with MOSES technology, 120W; Boston Scientific®) and the TFL (Soltive SuperPulsed Thulium Fibre [SPTF], 60W; Olympus®) were compared. Data on stone-free rate (SFR) were determined by computed tomography performed on the first postoperative day and presented as absence of stone fragments, no fragments larger than 2 mm, or no fragments larger than 4 mm. A total of 100 patients met the inclusion criteria, 51 mini-PCNLs with the Ho:YAG laser and 49 with the SPTF laser. No significant differences in demographics or stone characteristics were detected between the two groups. The Ho:YAG laser utilised less energy and time, resulting in higher ablation efficiency (P < 0.05) and less total operating time (P < 0.05). Overall, there was no difference in SFR in any category between the Ho:YAG group and the SPTF group (no fragments: relative risk [RR] 0.81, 95% confidence interval [CI] 0.59-1.12, P = 0.21; fragments <2 mm: RR 0.86, 95% CI 0.67-1.10, P = 0.23; fragments <4 mm: RR 0.96, 95% CI 0.80-1.15, P = 0.67). Although we observed an equivalent postoperative SFR, this study supports a shorter operating time and greater intra-operative laser efficiency with the Ho:YAG laser over the SPTF laser in mini-PCNL.

Factors associated to hemoglobin decrease after percutaneous nephrolithotomy: a retrospective study.

This study aims to determine the preoperative and perioperative risk parameters associated with a decrease in hemoglobin (Hb) in patients undergoing percutaneous nephrolithotomy (PCNL). We collected prospective data of consecutive patients who underwent PCNL from January 2018 to December 2022. The median decrease in post-operative hemoglobin levels compared to pre-operative was found to be 1.5 g/dl. This value was the cut-off value that divided the sample into two groups. Group 1 has a decrease in Hb levels that is higher or equal to the cutoff, group 2 has a decrease in Hb levels that is lower than the cut-off. All preoperative, stone characteristics and perioperative factors were recorded. A total of 273 patients were included in the study, 141 in Group 1 and 132 in Group 2. The mean age of Group 1 was significantly higher (55.48 ± 8.73 vs 45.9 ± 10.75 years, p < 0.05). The mean bleeding of Group 1 was significantly higher (285.85 ± 113.68 vs 135 ± 77.54 ml, p < 0.05). There was a significant difference in mean operation time between groups (86.35 ± 32.05 vs 64.89 ± 27.83 min, p < 0.05). Multivariate analysis showed that the variables age, comorbid diabetes mellitus, intraoperative bleeding amount, and operation time had a significant relationship with Hb reduction in patients undergoing PCNL (p < 0.05). Older age, comorbid diabetes mellitus, large amounts of intraoperative bleeding, and longer operating time are factors associated with PCNL-related postoperative hemoglobin decrease.

Murujuga: Dynamics of the Dreaming — A long and short history of this cultural landscape with reference to rock art, stone features, excavations and historical sites recorded across the Dampier Archipelago between 2014 and 2018 Edied by JoMcDonald and KenMulvaney. The Centre for Rock Art Research + Management (CRAR+M) Monograph 2, UWA Publishing, 2023 ISBN: 9781760802554. pp.775. AUD120.00.

Murujuga: Dynamics of the Dreaming — A long and short history of this cultural landscape with reference to rock art, stone features, excavations and historical sites recorded across the Dampier Archipelago between 2014 and 2018 Edied by JoMcDonald and KenMulvaney. The Centre for Rock Art Research + Management (CRAR+M) Monograph 2, UWA Publishing, 2023 ISBN: 9781760802554. pp.775. AUD120.00.

New infundibulopelvic angle measurement method can predict stone-free rates following retrograde intrarenal surgery.

To enhance the accuracy of predicting stone-free rates after retrograde intrarenal surgery, we devised a novel approach to assess the renal infundibulopelvic angle. We conducted a retrospective review of patient records for those who underwent retrograde intrarenal surgery for renal stones between April 2018 and August 2019. Patient demographics, stone characteristics, and perioperative data were recorded. Subsequently, we introduced a modified angle measurement called the pelvic stone angle and evaluated its predictive performance for stone-free rates by comparing it with the traditional method in scoring systems. A total of 43 individuals were included in this study. Notable differences in stone burden and Hounsfield unit measurements were found between stone-free and non-stone-free patients. The pelvic stone angle demonstrated a good model fit when used in scoring systems, performing equally well as the conventional approach. The area under the receiver operating characteristic curve for the R.I.R.S. scoring system using the pelvic stone angle and the conventional approach did not show a significant difference. In conclusion, the predictive ability of the pelvic stone angle for stone-free rates was comparable to the old measurement method. Moreover, scoring systems using the pelvic stone angle exhibited a better model fit than those using the conventional approach.

Microbiological Characteristics of Kidney Stones in Patients With Urolithiasis

Microbiological Characteristics of Kidney Stones in Patients With Urolithiasis

RESEARCH OF THE STRENGTH OF CEMENT STONE BASED ON THE WATER VAPOR CONDENSATE OF FLUE GAS

The production of cement causes significant emissions of greenhouse gases, in particular CO2, which leads to global warming. The development of methods of disposal of these ages is an urgent task. The paper examines the possibility of using steam condensate from the flue gases of cement production as a raw material for obtaining cement stone. The mechanical characteristics of the cement stone made with the use of flue gas vapor condensate and in accordance with the characteristics of the cement stone made on tap water were determined. It was established that the cement stone obtained with the use of steam gas condensate has the best mechanical properties. The resulting cement has higher flexural strength than tap water cement, and cement stone has higher flexural and compressive stresses. At the same time, the fragility of cement stone made from mixed condensate of flue gas steam remained the same as in cement stone made using tap water.

Super-mini PCNL (SMP) with suction versus standard PCNL for the management of renal calculi of 1.5 cm–3 cm: a randomized controlled study from a university teaching hospital

PurposeTo assess the safety and efficacy of super-mini PCNL (SMP, 14 Fr) when compared to standard PCNL (sPCNL, 24–30 Fr) in the management of renal calculi of size ranging from 1.5 to 3 cm.MethodsFrom February 2021 to January 2022, a total of 100 patients were randomized to either SMP group or sPCNL group in a 1:1 ratio (50 in each group) using computer-generated simple randomization. Demographic data, stone characteristics, operative times, perioperative complications, blood transfusions, postoperative drop in haemoglobin, postoperative pain, duration of hospital stay and stone-free rates were compared between the two groups.ResultsMean stone volume (2.41 cm2 vs 2.61 cm2) and stone-free rates (98% vs 94%, p = 0.14) were similar in both the SMP and sPCNL groups, respectively. The SMP group had significantly longer mean operative times (51.62 ± 10.17 min vs 35.6 ± 6.8 min, p = 0.03). Intraoperative calyceal injury (1/50 vs 7/50, p = 0.42) and mean postoperative drop in haemoglobin (0.8 ± 0.7 g/dl vs 1.2 ± 0.81, p = 0.21) were lower in the SMP group, but not statistically significant. SMP group showed significantly lower mean postoperative pain VAS scores (5.4 ± 0.7 vs 5.9 ± 0.9, p = 0.03) and mean duration of hospital stay (28.38 ± 3.6 h vs 39.84 ± 3.7 h, p = 0.0001). Complications up to Clavien grade 2 were comparable, with grade ≥ 3 complications higher in the standard group, but not statistically significant.ConclusionSuper-mini PCNL is equally effective as standard PCNL in treating renal calculi up to 3 cm, with significantly reduced postoperative pain and duration of hospital stay and lower risk of Clavien grade ≥ 3 complications, although with higher operative times.

Computed Tomography Findings in the Evaluation of Urolithiasis

Background: Urolithiasis, or the formation of urinary tract stones, is a prevalent condition that affects individuals worldwide, predominantly impacting middle-aged and elderly demographics. Computed tomography (CT) has emerged as a superior diagnostic tool for urolithiasis due to its high sensitivity and specificity, offering detailed insights into the size, location, density, and composition of stones. Objective: The objective of this study was to evaluate the efficacy of unenhanced computed tomography in the diagnosis and characterization of urinary tract stones, focusing on their size, location, and associated clinical symptoms. Methods: A cross-sectional study was conducted at the Diagnostic Center of CMH Hospital Lahore over four months, involving 70 patients with suspected or confirmed urolithiasis. Participants were selected using non-probability convenient sampling and underwent 128-slice MDCT imaging without contrast. Data collection included demographic information, clinical symptoms, and CT findings regarding stone characteristics. The ethical standards adhered to the Declaration of Helsinki, with all participants providing informed consent. Results: The study comprised 74.3% male and 25.7% female participants, with the highest prevalence of urolithiasis observed in the 30-40 year age group (32.9%). CT imaging detected stones in 95.7% of the participants, with a significant incidence of smaller stones (1-5 mm) at 31.4%. Hydronephrosis was noted in 85.7% of cases, and hydroureter in 54.3%. The most common stone density ranged from 500-1000 HU (41.4%), and stones were more frequently located on the right side (32.9%). Conclusion: Unenhanced CT proved to be a highly effective diagnostic tool for assessing urinary tract stones, providing essential data on stone size, density, and location, as well as associated clinical symptoms. This modality enhances the ability to tailor treatment strategies effectively, thereby improving patient outcomes.

Comparison of safety and efficacy of tubeless vs. conventional mini percutaneous nephrolithotomy in patients with Escherichia coli bacteriuria.

To evaluate the safety and efficacy of tubeless percutaneous nephrolithotomy (PCNL) in patients with Escherichia coli (E. coli) bacteriuria. We conducted a retrospective review of 84 patients with E. coli bacteriuria who underwent PCNL. Patients were divided into two groups according to whether a nephrostomy tube is placed at the end of the procedure. Preoperative clinical data, surgical outcomes, and postoperative complications were compared. Then, regression analysis of factors predicting success rate of PCNL in patients with E. coli bacteriuria was performed. After PCNL, residual fragments ≤ 4mm were considered as success. At baseline, the two groups were similar with regard to age, gender, BMI, underlying disease, hydronephrosis, stone characteristics, and urinalysis. Postoperative fever occurred in 1 patient (3.8%) in the tubeless PCNL group, and in 5 patients (8.6%) in the conventional PCNL group (p > 0.05). There were no significant differences in terms of successful rate, decrease in hemoglobin, pain scores, blood transfusion, and hospitalization expenses. However, the tubeless PCNL group had significantly shorter operative time (60 vs. 70min, p = 0.033), indwelling time of catheter (2 vs. 4 days, p < 0.001), and hospital stays (3 vs. 5 days, p < 0.001) than the conventional PCNL group. In the analysis of factors predicting success, the stone diameter, stone burden, and operative time were associated with success rate of PCNL. It is safe and effective to perform tubeless PCNL in patients with E. coli bacteriuria. Compared to conventional PCNL, tubeless PCNL accelerates patient recovery and shortens hospital stays.

Effective Method of Improving the Performance Properties of Wall Products On the Basis of the Gypsum Binder

The basis of the conducted research was the goal of modifying composite gypsum-containing binders for the manufacture of wall products with increased water resistance, strength, frost resistance, and durability by developing a hydrophobizing solution for processing products based on gypsum binder. The article presents the results of research on the modification of artificial gypsum stone with a developed hydrophobizing chemical solution based on calcium polysulfide and titanium dioxide. Comparative indicators of water absorption of original and solution-impregnated samples, which were exposed to the frontal influence of water, are given. The water absorption of the modified samples is within 9...21% and does not change after the frontal impact of rain. Indicators of chemical resistance of impregnated samples in solutions of magnesium sulfate, urea, acetic and oxalic acids, which are characteristic components for aggressive environments of livestock complexes, food and chemical industry, are presented. The test results of the samples showed that the developed chemical solution provides a chemical resistance factor of 0.7, that is, they are chemically stable in such environments. It is shown that, depending on the number of applied layers of the solution or the time of impregnation, hydrophobization gives high indicators of the softening coefficient of the products, which is in the range of 0.6...0.82. The research results showed that thanks to the developed hydrophobizing solution, the construction and technical characteristics of the artificial gypsum stone are significantly increased. Wall products made of this material have high operational characteristics, and it is advisable to use them both indoors and outdoors.