Stone Characteristics Research Articles

Efficacy analysis of tip-flexible suction access sheath during flexible ureteroscopic lithotripsy for unilateral upper urinary tract calculi.

This study aims to evaluate the efficacy of tip-flexible suctioning ureteral access sheath (TFS-UAS) compared to traditional ureteral access sheath (T-UAS) in flexible ureteroscopic lithotripsy (FURL) for unilateral upper urinary tract calculi. The study retrospectively compared outcomes from 103 cases using TFS-UAS and 138 using T-UAS treated with FURL for unilateral upper urinary tract calculi from January to October 2023. Assessed parameters included patient demographics, stone characteristics, preoperative urine cultures, ureteral pre-stenting, comorbidities, procedure time, stone-free rate (SFR), utilization of stone retrieval baskets, and postoperative Systemic Inflammatory Response Syndrome (SIRS) rates. The maximum angle of deflection was also measured when the flexible ureteroscope was located in different parts of the TFS-UAS with different diameters in vitro. The TFS-UAS group achieved a higher Immediate SFR (76.70% vs. 63.77%, p = 0.031) and final SFR (89.32% vs. 73.91%, p = 0.003) than the T-UAS group, especially in the lower calyx stones (80.00% vs. 41.18%, p = 0.018) and upper urinary tract calculi with a cumulative diameter of 2cm or larger (68.97% vs. 42.11%, p = 0.029). Notably, TFS-UAS with a 10 French (F) inside diameter size achieved a higher SFR (88.57% vs. 70.59%, p = 0.041) and a greater deflection angle than the 12.5F inside diameter size. No significant variations were observed in the operative duration, hospitalization duration and the occurrence of SIRS between the compared cohorts. TFS-UAS significantly improves SFR in FURL treatment of unilateral upper urinary tract calculi, particularly for stones located in the lower calyx or with a cumulative diameter of 2cm or greater, compared to T-UAS.

The effects of pretreatment oral hydration on extracorporeal shockwave lithotripsy outcomes: A randomized controlled trial.

We sought to investigate the effects of pretreatment oral hydration on the outcomes of extracorporeal shockwave lithotripsy (ESWL). Patients who undergoing ESWL for a single radio-opaque renal or proximal ureteric calculus ≤2 cm in size were randomized into two groups. The oral hydration group (OHG) administered 600 ml of water before ESWL, while the control group (CG) did not. The urine was held during ESWL to create a full bladder induced hydronephrosis. Both groups received the same ESWL protocol at four-week intervals and a maximum of three sessions. The primary outcome was stone-free rate (SFR) at 12 weeks and the secondary outcomes were the total number of shockwaves and the number of ESWL sessions. A total of 154 patients completed the study, 77 patients in each group; both groups were comparable in demographic data and stone characteristics. The SFR was 84.4% in the OHG and 68.8% in the CG group (p=0.036). Stone fragmentation in OHG was significantly higher than CG, 75.3% vs. 58.4% (p=0.040). OHG had more cases of artificial hydronephrosis (55.8% vs. 27.3%, p=0.001) and higher urine volume (375 [148] ml vs. 230 [110] ml, p<0.001). There were no statistically significant differences in the total number of shockwaves and the number of ESWL sessions. The auxiliary procedures in OHG were less than CG (15.6% vs. 31.2%, p=0.049). Pretreatment oral hydration, together with holding urine during ESWL, has increased stone disintegration and SFR. This simple and safe technique improves the ESWL outcomes.

Identifying Anthropogenic Versus Natural Submerged Prehistoric Landscapes: Two Case Studies from the Sicilian Channel

In submerged landscapes, distinguishing anthropogenic features versus natural ones is often challenging. We have developed a set of criteria to validate the identification of submerged anthropogenic remains that include examining the geological context, sea-level considerations, associated archaeological finds (including coastal survey), and documenting the broader archaeological context. Furthermore, our experience demonstrates that, while progress has been made in applying remote-sensing technologies to detect anthropogenic features on the seabed, there is no substitute for direct, visual assessment by an underwater archaeologist for verification of their anthropogenic status. We have applied these criteria to examine two published case studies detailing suspected anthropogenic stone features on the seabed in the Sicilian Channel. Our examination has led us to conclude that both localities are not anthropogenic features. The Pantelleria Vecchia Bank features represent natural outcrops on a submerged paleo-landscape that were shaped by depositional and erosional processes during transgression and regression periods. The suspected Lampedusa cultic site comprises natural features that are located on a submerged neo-landscape formed due to erosion and retreat of the coastal cliff since the mid-Holocene, when the sea level reached its present level.

056. Impacted CBD Stones in Ampula Vater Evacuated by Transduodenal Approach in A 48-year-old Patient at Prof. Dr. IGNG Ngoerah Hospital in 2024

Background: Cholecystolithiasis and choledocholithiasis are common biliary disorders that can lead to significant complications if left untreated. Among these complications, the formation of impacted CBD stones, particularly at the Ampulla of Vater, poses a unique clinical challenge. The Ampulla of Vater is the anatomical site where the common bile duct (CBD) and pancreatic duct converge, and its obstruction can lead to biliary colic, cholangitis, or pancreatitis. Urgent stone removal is critical for improving the patient’s condition. Case: A 48-year-old male patient presents to the emergency department with right upper abdominal pain since 10 days ago accompanied with icteric sclera since 10 days ago. There was nausea and vomiting when eating high-fat foods. The stools were brownish in color, the urine color was similar to tea color. The patient regularly takes UDCA 3 x 250 mg IO, simvastatin 1 x 20mg IO, curcuma 3 x1 tab IO, lansoprazole 2 x 30mg IO. Physical examination showed icteric eyes, jaundice, liver enlargement 2 fingers below costae arch with positive Murphy's sign. Complete blood examination showed leukocytosis, decreased hemoglobin, hypokalemia, as well as increased direct bilirubin, total bilirubin, and indirect bilirubin. BOF result showed sentinel loop on the right umbilical region suspected inflammatory process. MRI impression of choledocholithiasis causing dilatation of EHBD and IHBD proximal aspect without signs of cholangitis, hepatomegaly, simple cyst of left kidney (Bosniak I). Abdominal ultrasound with the conclusion of cholecystitis with dilatation and thickening of the ductus cysticus wall suspicious of inflammation, dilatation of the right and left IHBD, common hepatic duct, to the proximal common biliary duct, the presence of distal obstruction cannot be evaluated because it is covered by intestinal shadows, mild prostatic hypertrophy accompanied by prostate calcification. After Cholecystectomy and Explore CBD transduodenal, the patient was placed with thoracic drain with good outcome. Conclusion: The transduodenal approach to evacuating impacted CBD stones at the Ampulla of Vater is a valuable technique that can yield excellent outcomes in select cases. This case report underscores the importance of a tailored approach based on individual patient anatomy and stone characteristics.

Evaluation of the Impact of Body Mass Index on the Outcomes of Supine Percutaneous Nephrolithotomy

Objective: This study aimed to evaluate the impact of obesity on the outcomes of supine percutaneous nephrolithotomy (PCNL) in a tertiary care center. Understanding surgical outcomes in obese patients, given their rising prevalence and urolithiasis risk, is crucial for optimizing treatment strategies. Materials and Methods: This retrospective study included data from 256 patients aged 18 and older who underwent PCNL in the Galdakao-Valdivia position between July 2021 and July 2024 at a tertiary care hospital. Patients were categorized into three groups based on their body mass index (BMI): normal weight (BMI: 18-24.9 kg/m²), overweight (BMI: 25-29.9 kg/m²), and obese (BMI: 30-34.9 kg/m²). Demographic data, stone characteristics, operative time, fluoroscopy time, hospital stay, nephrostomy duration, stone-free rates (SFR), and complications were analyzed and compared across the three groups. Results: There was no significant difference between the groups regarding age, sex, stone laterality, location, or size (p&gt;0.05). Median BMI values were significantly different between the groups (p&lt;0.001). The stone-free rates were 79.2%, 77%, and 75% for the normal, overweight, and obese groups, respectively (p&gt;0.05). No significant differences were found in operative time, fluoroscopy time, hospital stay, or nephrostomy time among the groups (p&gt;0.05). Minor and major complication rates were similar across all groups (p&gt;0.05). Conclusion: Obesity does not appear to significantly impact the outcomes of supine PCNL, including operative time, stone-free rates, or complication rates. These findings suggest that with experienced surgeons, supine PCNL is a safe and effective treatment option for obese patients, though further prospective studies are needed to confirm these results.

Supracostal ultrasound guided approach percutaneous nephrolithotomy (SUGA-PNL) versus retrograde intrarenal surgery for large volume isolated upper calyceal stones: a prospective randomized analysis

To assess outcomes of supracostal ultrasound guided approach percutaneous nephrolithotomy (SUGA-PNL) and retrograde intrarenal surgery (RIRS) in isolated large volume upper calyceal stones (UCS). This was a prospective randomized study including patients with isolated UCS > 20mm. The patients were randomized into two groups: group (P) (SUGA-PNL) and group (R) (RIRS). Patients’ demographics, stones characteristics, operative, and postoperative outcomes essentially the stone free rate (SFR) and complications rate were documented. The stone clearance was defined as no fragments or residual fragments less than 2mm in the one month non contrast CT scan follow up. Eighty-nine patients opted to undergo the procedure according to the preoperative randomization. Four patients, 2 patients from each group, lost to follow up and other 2 patients were excluded from group (R) due to a tight ureter. Both groups were comparable as regards the preoperative demographics and stone characteristics. There were statistically significant differences regarding total operative time, the change in hemoglobin level, and postoperative pain score (P: 0.024, 0.010 and 0.032 respectively). The SFR was 88.1% in group (P) compared to 73.2% in group (R) (P: 0.019). Moreover, it did not differ significantly between both groups regarding the intraoperative and postoperative complications. No visceral and thoracic injuries were documented in group (P). On other side, 6 patients (14.6%) from group (R) had different grades of ureteral injury during access sheath placement. SUGA-PNL is a safe and effective treatment modality for UCS > 20mm with a higher SFR than RIRS.

Comparative Analysis of Safety and Efficacy Between Anterior and Posterior Calyceal Entry in Supine Percutaneous Nephrolithotomy.

Introduction: One advantage of supine percutaneous nephrolithotomy (sPCNL) is the ability to access anterior as well as posterior calyces, but the safety and efficacy of anterior calyceal entry has never been investigated to our knowledge. We prospectively evaluated patients scheduled for sPCNL comparing anterior and posterior calyceal access. Materials and Methods: After Institutional Review Board approval, we prospectively enrolled 100 consecutive patients undergoing sPCNL from February to September 2023. Primary outcomes included intraoperative complications, blood transfusions, 30-day complication rates, and emergency department (ED) visits or readmissions. Secondary outcomes included stone-free rates (SFR). Results: Seventy-six patients had anterior calyceal entry and 24 had posterior. No significant differences were found in terms of baseline demographics (age, body mass index), stone characteristics (location, density, complexity), or intraoperative features (operative time, location of access). Safety outcomes, including intraoperative complications (1% vs 4%), blood transfusions (3% vs 8%), 30-day complication rates (17% vs 21%), and ED visits (1% vs 0) or readmissions (11% vs 21%) were comparable between groups. Overall SFRs were equivalent (86% vs 90%). Conclusion: We found that anterior and posterior accesses in sPCNL offer similar safety and efficacy, with no significant differences in complications or SFRs. Surgeons can select either approach based on patient anatomy and surgical needs without concern for increased complications. Further research is necessary to confirm these findings and guide best practices for calyx selection in sPCNL.

True Triaxial Crack Stress Thresholds and Deformation Characteristics of Cement Stone Subjected to Sulfuric Acid Corrosion

True Triaxial Crack Stress Thresholds and Deformation Characteristics of Cement Stone Subjected to Sulfuric Acid Corrosion

Evaluating the role of urine chemistry in shock wave lithotripsy outcomes.

Extracorporeal Shock Wave Lithotripsy (ESWL) is a commonly used method for the noninvasive treatment of kidney stones. However, achieving optimal treatment outcomes and minimizing potential damage to the kidney necessitates careful consideration for the total amount of energy utilized. This study aims to investigate whether urine pH and urine specific gravity have an impact on the total amount of energy applied during SWL. Between January 2023 and December 2023, 129 patients with renal stones underwent SWL in our department using the Storz Medical Modulith Inline lithotripter. Stone-free rates, complications, and the impact of patient, urine, and stone characteristics on energy use were analyzed. Urine samples were analyzed for pH and specific gravity. Stone characteristics, including size, HU, and skin-to-stone distance, were recorded. The obtained data were evaluated regarding the possible relationship between the total energy amount (determined as a risk factor) and the age, BMI, urine pH, urine specific gravity, stone size, HU, and skin-to-stone distance by using the Pearson correlation coefficient. p-value of < 0.05 was considered statistically significant. Evaluation of our findings revealed a negative linear relationship between total amount of energy used and the urine pH, indicating a decrease in the total energy amount as urine pH shifts towards alkaline values (p = 0.038; p < 0.05). However, no statistically significant relationship was observed between age, BMI, urine specific gravity, stone size, HU, and skin-to-stone distance and the total energy amount. Our findings demonstrated a significant relationship between urine pH and the total amount of energy applied during SWL sessions, suggesting the need for further prospective research to better understand the possible association between these two parameters. Such investigations could contribute to the development of more reasonable and effective strategies for kidney stone treatment in an attempt to minimize the potential kidney damage.

Difficult choledocholithiasis. Literature review

The incidence of stones in the common bile duct in patients with symptomatic gallstone disease varies significantly and depends on age, ranging from 5% to 33%. In 85—90% of cases, choledocholithiasis is effectively treated with endoscopic papillotomy (EPT) and lithoextraction, which is currently considered the standard method for managing this pathology. However, in 10—15% of cases, choledocholithiasis is technically challenging for endoscopic treatment, requiring alternative methods and specialized equipment. This research examines the epidemiological aspects related to the increasing detection rate of choledocholithiasis, which is attributed to advancements in modern diagnostic techniques. Particular emphasis is placed on etiological factors such as genetics, obesity, and dietary habits that enhance bile lithogenicity. The pathogenesis section elucidates the mechanisms underlying primary and secondary stone formation in the bile ducts and their physiological impacts, including such complications as acute cholangitis, biliary sepsis, cholestatic hepatitis, and biliary cirrhosis of the liver. Distinct focus is placed on the criteria for difficult choledocholithiasis, encompassing stone characteristics, location, altered biliary anatomy, and the patient’s general condition. Diagnostic techniques include laboratory and instrumental investigations, particularly ultrasound, magnetic resonance cholangiopancreatography, endoscopic retrograde cholangiopancreatography, and endoscopic ultrasound. The treatment section emphasizes the importance of timely stone removal to prevent complications. Modern treatment options are discussed, including both conservative and surgical methods such as endoscopic procedures and laparoscopic surgeries. The significance of an interdisciplinary approach to the diagnosis and treatment of choledocholithiasis and its many manifestations is emphasized. Difficult choledocholithiasis remains a relevant issue in hepatobiliary surgery, and its effective treatment requires an individualized and multidisciplinary approach, involving endoscopic and laparoscopic technologies.

Morphological Evaluation and Phenolic Content of Wild Prunus cerasifera Ehrh. Fruits from Slovenia

Wild fruit species offer significant nutritional, environmental, and economic benefits. Among them, Prunus cerasifera Ehrh. (myrobalan) stands out for its resilience and nutrient-rich fruits, traditionally consumed fresh or dried. This study aimed to assess the morphological and biochemical diversity of 21 wild P. cerasifera accessions from Slovenia, focusing on 18 fruit and stone traits, including size, shape, color, and phenolic compounds such as total monomeric anthocyanins and total phenolic content (TPC). The objective was to identify genotypes with potential for cultivation and food production or as parental components in breeding programs. The results showed variability in fruit length (2.19–2.82 cm), width (2.18–2.99 cm), weight (67.98–150.30 g), firmness, and juiciness, with notable differences in stone characteristics. Phytochemical analysis revealed a wide range of TPC (277–1756 mg/100 g) and anthocyanin levels (0–710 mg/100 g), with higher concentrations in darker fruits. Statistical analysis compared PAM and AGNES clustering methods, finding that PAM with five clusters and AGNES with two clusters provided similar insights. The study emphasized variability in morphological and chemical traits among clusters, with specific accessions showing particularly valuable traits, such as accession RK13, which had high TPC and anthocyanins and a non-adherent stone.

Robotic pyelolithotomy for the treatment of large renal stones: a single-center experience over seven years.

Urolithiasis prevalence varies globally between 1-20%, influenced by regional factors. Robotic pyelolithotomy (RPL) presents an interesting alternative to PCNL, considered the gold standard for symptomatic stones smaller than 20 mm, as it carries a risk of significant complications. However, studies on RPL are limited, especially in anatomically complex cases, where RPL proves to be particularly useful. The study aims to update and review outcomes of RPL in a high-volume robotic center. A retrospective analysis of 153 patients treated with RPL for staghorn kidney stones at a single center from February 2016 to December 2023 was conducted. Data including demographics, preoperative renal function, stone characteristics, operative and postoperative outcomes, and costs were collected. Stone-free rates (SFR) and complications were assessed at follow-up intervals up to 12 months post-surgery. The study showed an initial 3-month stone-free rate (SFR) of 93.5%, which decreased to 83.5% at 12-months. This trend may reflect new stone formation rather than procedure failure. Sub-analysis revealed a significant difference in SFR between patients with pelvic and pyelocalyceal stones at each follow-up. Multivariate regression analysis identified in the pyelocalyceal group that higher BMI and larger stones were associated with higher failure rates at both 6 and 12 months. RPL is a safe and effective treatment for large renal stones, offering a high SFR and low complication rate. It is particularly beneficial in cases with complex anatomy or requiring concurrent renal procedures. However, patient selection is crucial, considering factors like stone location and size. Further research is needed to compare RPL with other treatment methods.

Monitoring and preservation of stone cultural heritage using a fuzzy model for predicting salt crystallisation damage

In this study, a fuzzy model is presented for predicting the possibility of degradation due to salt crystallisation cycles. The formalization of the proposed model has been based on the multivariable approach which considers environmental data (such as temperature, solar radiation, wind speed, rain quantity, relative humidity), characteristic inflection points of specific salts and stone features derived from laboratory characterizations (including mechanical properties, porosity, and mineralogical composition). Modeling results have been compared with experimental data elaborations acquired by monitoring a semi-confined archaeological site situated in the city of Cagliari (Munatius Irenaus cubicle), revealing substantial alignment in the degradation kinetics trends. Moreover, the achieved outcomes show the remarkable capability to identify salt crystallisation phenomenon type (efflorescence or subflorescence).

Exploring the competency of the comprehensive complication index over the clavien-dindo classification in standard percutaneous nephrolithotomy: a call for better complication reporting.

The Comprehensive Complication Index (CCI) was introduced in 2013 to overcome the limitations of the Clavien-Dindo Classification (CDC) in grading postoperative complications. The objective of this study to assess the predictive value of the CDC and the CCI for postoperative course in patients undergoing standard adult percutaneous nephrolithotomy (PCNL). A retrospective analysis of 320 renal units that underwent standard PCNL between July 2021 - April 2023 was conducted. The CDC and CCI systems assessed complications occurring within the first 30 days after surgery. A second CCI score was calculated only on the highest CDC grade, and this score was referred to as the noncumulative CCI. A comparative analysis was conducted to determine the predictive efficacy of both evaluation methods regarding the postoperative course. The postoperative complication rate was 23.1% (74/320). Eight patients (2.5%) experienced multiple complications, resulting in a higher total CCI score than the noncumulative CCI (p = 0.010). Correlation analysis revealed that the CCI correlated with the length of hospital stay (LOS) more precisely than the noncumulative CCI (CCI: r = 0.335; p = 0.004 vs. noncumulative CCI: r = 0.325; p = 0.005). Compared with patients with a single complication, those with multiple complications had similar demographics, preoperative stone characteristics, and intraoperative features. Cumulative CCI proves to be a more effective predictor of LOS and complication burden in standard PCNL than CDC. Hence, using CCI to evaluate complications after PCNL may be a more appropriate approach.

Sheathless RIRS in the era of slim and single use flexible ureteroscopy (ssFURS): Prospective analysis of clinical outcome.

the purpose is to assess the feasibility of sheathless and time-limited retrograde intrarenal surgery (RIRS) using slim and single use flexible ureteroscopy (ssFURS) in view of the stone-free rate (SFR), complication rate and upfront ureteral stenting. A prospective, cross-sectional study of patients who underwent RIRS for kidney stones between December 2021 and December 2023 at our tertiary urology center was performed. Patient demographics, clinical presentations and stone characteristics were calculated. The SFR and complication rate were included. Hundred and eighteen patients were included. The median age was 48 (35.7-60.0) years. Diabetes mellitus (DM) was present in 32 patients (27.1%). The median length of the kidney stones was 1.15 (range [0.4-3.0]), and the median width was 1 (range [0.05-3.7]). The pelvi-ureteric junction (PUJ) represented 75 (63.6%) patients. The lower pole stone (LP) consisted of 27 (22.9%) patients. Thirty-seven (31.4%) of the patients had multiple kidney stones. An overall complete SFR after the first session was observed for 94 (79.7%) patients. The second session of complete SFR was observed in 15 patients (12.7%). A median stone length of 1 (0.8-1.5) cm and a median stone width of 0.95 (0.7-1.3) cm were both significantly associated with a complete SFR after the first session (p < 0.001). A single kidney stone in 69 (73.4%) patients was significantly more strongly associated with a complete SFR after the first session than was multiple kidney stones in 25 (26.6%) patients (p = 0.027). Upfront stenting was performed in 74 patients (62.7%). The complete SFR after the first session was significantly greater in patients who underwent upfront stenting (65; 69.1%) than in those who underwent primary ssFURS (29; 30.9%, p = 0.004). Sheathless and time-limited RIRS using ssFURS is a feasible and successful procedure with low complication rate.

MORPHOLOGICAL AND YIELD-RELATED POMOLOGICAL CHARACTERIZATION OF INTRODUCED OLIVE (OLEA EUROPEA) CULTIVARS IN RAINFED AREA OF POTHOWAR PUNJAB

This study aims at pomological characterizing of 09 olive cultivars planted in the field area of Barani Agricultural Research Institute (BARI), Chakwal to estimate genetic variability in Ottobratica, Hamdi, FS-17, Gerboi, Arbequina, Persia, Nabali, Koroneiki and Earlik. Following pomological traits: fruit and stone weight (g), fruit and stone size (cm), fruit and stone shape index (length/width) and flesh to stone ratio were studied. Data for studied traits were collected in 2019 according to the International olive council descriptor. A significant genetic difference was noticed in the morphological characteristics of both fruit and stone. Different pomological characters were expressed by each cultivar. A wide range of variation was noticed in fruit weight (1.33-5.57g), stone weight (0.20-0.63g) and flesh/stone ratio (0.90-4.96). Based on their fruit shape, studied cultivars were classified into two groups i.e., ovoid and elongate. However, no significant difference was recorded for the stone shape, as all the studied cultivars had the same elongated stone shape. Concerning the fruit size, high fruit size (4-6g) was observed in FS-17, Hamdi, Earlik and Persia whereas Koroneiki, Nabali and Gerboi had the smallest ones (&gt;2g). Based on our results, Earlik, Hamdi and FS-17 are suggested to be more appropriate for table olive production. Thus, an evaluation of genetic diversity through this study can help in the varietal development of olive for table and oil purposes.

Experimental study on the deformation and failure characteristics of cement stone under true triaxial stress state

The cement stone is widely utilized to fill the gap between the formation and the casing in wells. A clear understanding of the deformation and failure mode of cement stone under true triaxial stress state is necessary to ensure the safety and stability of wells. To analyze the three-dimensional deformation and failure characteristics of cement stone, the loading paths with constant Lode angle were employed in conducting true triaxial tests on cement stone. The stress-strain curve and failure mode of cement stone are first analyzed. Then, the three-dimensional deformation characteristics are discussed in meridian and deviatoric planes. Both peak strength and deformability increase with minimum principal stress, but show a tendency to increase and then decrease with intermediate principal stress coefficient. With the increase of minimum principal stress and intermediate principal stress coefficient, the failure mode of cement stone transforms from brittle to ductile behavior. Under elastic stage, the strain path in the meridian plane is a straight line, and is under constant Lode angle within the deviatoric plane. Due to the existence of plastic strain, the strain path in the meridian plane displays a downward convex shape. The strain path in the deviatoric plane deviates from the reference of constant Lode angle for stress, directly reflecting the Lode angle dependence of deformation. Both deformation and failure characteristics of cement stone are dominated by the three-dimensional stress state. Besides, deformation of cement stone is closely related to the failure characteristics of cement stone.

Ultrathin semirigid retrograde ureteroscopy versus antegrade flexible ureteroscopy in treating proximal ureteric stones 1-2cm, a prospective randomized multicenter study.

To compare the outcomes of using Ultrathin semirigid retrograde ureteroscopy and antegrade flexible ureteroscopy to treat proximal ureteric stones of sizes 1-2cm. A prospective randomized multicenter study included patients who had proximal ureteric stones 1-2cm, amenable for ureteroscopy and laser lithotripsy between August 2023 and February 2024. Two hundred thirty patients were divided evenly into two treatment groups. Group I included patients treated with antegrade flexible ureteroscopy and holmium laser stone fragmentation, and Group II included patients treated with retrograde ultrathin semirigid ureteroscopy. The study groups were compared in terms of patient demographics, stone access success, operation time, reoperation rates, peri-operative complications, and stone-free status. Group I included 114 patients, while Group II included 111. The mean age of the patients was 33.92 ± 10.37years, and the size of the stones was 15.88 ± 3mm. The study groups had comparable demographics and stone characteristics. The mean operative time was significantly longer in group I than in group II (102.55 ± 72.46min vs. 60.98 ± 14.84min, respectively, P < 0.001). Most reported complications were MCCS grades I and II, with no significant difference between the study groups. The stone-free rate after four weeks was 92.1% and 81.1% for groups I and II, respectively, which increased to 94.7% and 85.6% after eight weeks (P > 0.05). Antegrade flexible ureteroscopy is equivalent to retrograde ultrathin semirigid ureteroscopy in treating proximal ureteric stones regarding stone-free status and procedure-related morbidity. However, the antegrade approach has a longer operative time, greater fluoroscopy exposure, and longer hospital stays.

Clinical Outcomes and Safety Assessment of Flexible Ureteroscopy as an Outpatient Procedure: A Retrospective Single-Center Study.

Nephrolithiasis, or kidney stone disease, is a significant global health issue in urology, requiring effective management strategies. The management of nephrolithiasis through flexible ureteroscopy (fURS) is increasingly gaining acceptance; however, it is associated with significant costs related to consumables, pharmacotherapy, specialized equipment, and general anesthesia (GA). Limited resources and the need to optimize the cost effectiveness ratio have driven the shift to day-case procedures, offering financial and operational benefits and improving patient satisfaction. This outpatient care approach addresses clinical and economic challenges. For same-day discharge, spinal anesthesia (SA) is essential for fURS, as GA does not permit safe immediate discharge. This retrospective study investigates the feasibility of same-day discharge following fURS procedures performed under SA. Analyzing data from 401 patients who underwent 414 fURS procedures between January 2020 and December 2023, this study aims to evaluate whether same-day discharge is a viable option compared to conventional fURS under GA. The primary objectives are to assess the outcomes, including efficacy, stone-free rate (SFR), pain management, and complication rates, in the context of same-day discharge. Additionally, this study seeks to identify patient and kidney stone characteristics that may influence the suitability of one-day fURS under SA. Outcomes will be measured using the Dindo-Clavien (D-C) classification and Visual Analog Scale (VAS) scores post-procedure.

Outcomes and complications of percutaneous nephrolithotomy as primary versus secondary procedure for kidney stones: A prospective cohort study

Introduction: Currently, percutaneous nephrolithotomy (PCNL) is the gold standard of treatment for large renal stones. The high prevalence of urolithiasis is associated with a high recurrence rate increasing the risk of re-intervention. This study aimed to compare the effectiveness and complications of PCNL among patients with previous therapeutic interventions for renal stones. Methods: Between August 2018 and September 2023, 245 patients were prospectively enrolled in this study and who underwent PCNL for renal stones at our institution. We compared patients who had no previous renal surgery (group1: n=171) with those who had a history of open renal surgery (group2: n=45) or previous PCNL on the ipsilateral kidney (group 3: n=31). All patients underwent surgery in the Galdakaomodified Valdivia position. Data on stone characteristics and perioperative and postoperative parameters were collected. Technical features, the success rates and morbidity were analysed and compared between the groups. Results: The fluoroscopy time was significantly longer in the group of patients with previous open surgery than in groups 1 and 3 (161.47±52.44, 223.05±33.29, 172.27±30.51sec, P&lt;0.001). Similarly, the operative time was longer in group 2 (138.20±38.86 min, P&lt;0.001). The immediate stone-free rates in groups 1, 2, and 3 were 74.8%, 72.1%, and 77.4%, respectively(P=0.945). At 1- month, these rates increased to 98.8%, 96.2% and 96.8%, respectively (P=0.857). No difference was detected between the groups in terms of complication rate. The average Hb variation was 1.08±0.82, 1.34±1.01 and 0.94±0.69 g/dL for groups 1, 2 and 3, respectively(P=0.082). Hospital stay was longer in group 2 than in groups 1 and 3 (2.17±1.03, 2.53±1.22, 1.88±1.00 d, P=0.07), respectively. Conclusion: PCNL in patients with a history of renal surgery was associated with longer fluoroscopy and operative time. However, the success and morbidity rates as a secondary procedure were similar to those of PCNL in patients with no previous intervention.