Kidney Stone Patients Research Articles

Comparative outcomes and cost of ambulatory PCNL in select kidney stone patients.

Limited hospital resources and access to care during the COVID-19 pandemic led us to implement a quality-improvement study investigating the feasibility, safety, and costs of same-day discharge after PCNL. The outcomes of 53 consecutive first-look PCNL patients included in a same-day discharge protocol during COVID-19 were compared to 54 first-look PCNL patients admitted for overnight observation. Control group had a similar comorbidity profile. Demographics, operative details, 30day outcomes and readmissions, complications, and cost were compared between the two groups. Same-day discharge and one-day admission post-PCNL patients did not have significantly different baseline characteristics. The study group were more likely to have mini-PCNL (81% vs 50%, p < 0.01). Operative characteristics including median pre-operative stone burden (1.4 vs 1.7cm3, p = 0.47) and post-operative stone burden (0.14 vs 0.18cm3, p = 0.061) were similar between the two groups. Clavien-Dindo complication rates were lower in the study group compared to controls (0 vs 7%, p = 0.045). Readmission rates (2 vs 4%, p = 0.569) and ED visits (4 vs 6%, p = 0.662) were similar between the two groups. Total cost ($6,648.92 vs $9,466.07, p < 0.01) was significantly lower and operating margin ($4,475.96 vs $1,742.16, p < 0.01) was significantly higher for the same-day discharge group. Percutaneous nephrolithotomy may be performed in select patients without an increase in short-term complications, ED visits, or readmissions. Patients undergoing mini-PCNL are particularly amenable to same-day discharge, however, standard PCNL patients should not be excluded from consideration. Avoiding overnight admission decreases total cost and increased hospital operating margin.

Integrated analysis of mRNA-seq and miRNA-seq reveals the potential roles of Egr1, Rxra and Max in kidney stone disease.

Nephrolithiasis is one of the most common and frequent urologic diseases worldwide. The molecular mechanism of kidney stone formation is complex and remains to be illustrated. Transcript factors (TFs) that influenced the expression pattern of multiple genes, as well as microRNAs, important posttranscriptional modulators, play vital roles in this disease progression. Datasets of nephrolithiasis mice and kidney stone patients were acquired from Gene Expression Omnibus repository. TFs were predicted from differentially expressed genes by RcisTarget. The target genes of differential-expressed microRNAs were predictedby miRWalk. MicroRNA-mRNA network and PPI network were constructed. Functional enrichment analysis was performed via Metascape and Cytoscape identified hub genes. The assay of quantitative real-time PCR (q-PCR) and immunochemistry and the datasets of oxalate diet-induced nephrolithiasis mice kidneys and kidney stone patients' samples were utilized to validate the bioinformatic results. We identified three potential key TFs (Egr1, Rxra, Max), which can be modulated by miR-181a-5p, miR-7b-3p and miR-22-3p, respectively. The TFs and their regulated hub genes influenced the progression of nephrolithiasis via altering the expression of genes enriched in the functions of fibrosis, cell proliferation and molecular transportation and metabolism. The expression changes of transcription factors were consistent in q-PCR and immunochemistry results. For regulated hub genes, they showed consistent expression changes in oxalate diet-induced nephrolithiasis mice model and human kidneys with stones. The identified and verified three TFs, which may be modulated by microRNAs in nephrolithiasis disease progression, mainly influence biological processes responding to fibrosis, proliferation and molecular transportation and metabolism. The transcript influence showed consistency in multiple nephrolithiasis mice models and kidney stone patients.

Comparison of the effect of miniaturized and standard percutaneous nephrolithotomy on renal function assessed with DMSA scintigraphy

Introduction and objectivesWe aimed to present a clinical study that compares standard and miniaturized percutaneous nephrolithotomy (PNL) effects on kidney function with scintigraphic imaging in primary kidney stone patients. Materials and methodsOne hundred four patients were included in this prospective study between May 2014 and February 2017. Eligible patients were divided into two groups miniaturized PNL (mPNL) and standard PNL (sPNL) with matched-pair analysis (1:1 scenario). Technetium-99m Dimercaptosuccinic Acid cortical scintigraphy imaging was performed before and after the operation. ResultsThere were no differences between the two groups in terms of success rate (mPNL (63.5%) vs. sPNL (71.2%), p=0.403), serum creatinine, glomerular filtration rate, split renal functions pre- and postoperatively (p≥0.05). There was no relationship between the type of operation and new scar formation (p=0.780). The rates of serious complication (grades 3 and 4 according to modified Clavien–Dindo Classification) were higher in sPNL (p=0.034). Stone burden, duration of operation, hemoglobin drop, multiple access, blood transfusion, and angioembolization were higher in patients with scarred kidneys (p<0.001, p=0.008, p=0.004, p<0.001, p=0.003, p=0.001, respectively). In multivariate analysis, only multiple access was found statistically significant for predicting new scar formation (p<0.001, OR: 24.28). ConclusionsMiniaturized and standard PNL are reliable and successful operations for treating large kidney stones. No significant difference was found between the operation types regarding a decrease in renal function.

PEMERIKSAAN CT STONOGRAFI PADA KASUS NEFROLITHIASIS

ABSTRACT&#x0D; Background : CT Stonography is a CT scan tract of the kidney that is usually used to detect the presence of stones in the kidney and other pathologies such as the presence of mass in the kidneys. CT Stonography examination with kidney stones case in Buleleng Regional General Hospital using 5 mm slice thickness. The purpose of this study is to know the examination techniques, the reasons for the use of 5 mm slice thickness, and how to determine the size of kidney stones using CT Stonography in cases of nephrolithiasis at Buleleng Regional General Hospital.&#x0D; Methods : This type of research is qualitative with case study approach. The subjects were 2 radiographers, 1 radiologist, and 1 sending doctor. The location of the research at Radiology Installation Buleleng Regional General Hospital. Data were analyzed using by interactive model.&#x0D; Results : From the results of this study examination of CT Stonography at Buleleng Regional General Hospital uses special preparation of 12 hours of fasting before the examination. Position of supine patient (head first). Area scanning from diaphragm to symphisis pubis. Scan parameters using abdomen protocol, 10 mm slice thickness. The reason for using 10 mm slice thickness is that the image can be reconstructed with a thin slice thickness number from the previous result. How to determine the size of kidney stones in patients CT Stonography at Radiology Installation Buleleng Regional General Hospital is using 3 dimensions because to see from the axial, sagittal, coronal multiplanar so that we can measure from the posterior antero direction (AP), cranio caudal (CC), or laterolaterally taken from the widest distance.&#x0D; Conclusion : Examination CT Stonography with nephrolithiasis cases using the position of supine patients (head first), selection of 10 mm slice thickness on CT stonography examination techniques with nephrolithiasis cases at Radiology Installation Buleleng Regional General Hospital for the results of the image can be reconstructed with the amount of thin slice thickness of the previous results. Determination of the size of kidney stones in patients with CT Stonography at Radiology Installation Buleleng Regional General Hospital is using 3 dimensions because to see from the axial, sagittal, coronal multiplanar so that we can measure from the posterior antero direction (AP), cranio caudal (CC), and laterolateral taken from the widest distance.

Underinsurance And Multiple Surgical Treatments for Kidney Stones

To further elucidate the relationship between low socioeconomic status (SES) and larger, more complex stones requiring staged surgical interventions. Specifically, we aimed to determine if underinsurance (Medicaid, Medicare, and self-pay insurance types) is associated with multiple surgeries within one year. Weperformed a retrospectivelongitudinal analysis of prospectively collected datafrom the California statewide Department of Health Care Access and Information (HCAI) dataset. We includedadult patients who had their first recorded kidney stone encounter between 2009-2018 and underwent at least one urologic stone procedure. We followed these patients within the dataset for one year after their initial surgeryto assess for factors predicting multiple surgical treatments for stones. A total of 156,319 adults were included in the study. The proportions of individuals in private insurance, Medicaid, Medicare and self-pay/indigent groups differed by the presence or absence of additional surgeries (64.0%, 13.5%, 19.4%, and 0.1%, vs. 70.3%, 10.1%, 16.6%, and 0.1%, respectively). Compared to private insurance, Medicaid (1.46 [1.40-1.53] p < 0.001) and Medicare (1.15 [1.10-1.20] p < 0.001) insurance types were associated with significantly greater odds of multiple surgeries, whereas no significant association was seen in the self-pay/indigent insurance type (1.35 [0.83-2.19], p = 1.0). In a statewide, California database from 2009-2018, underinsured adults had higher odds of undergoing a second procedure for kidney stones within one year of initial surgical treatment. This study adds to the expanding body of literature linking suboptimal healthcare access and disparate outcomes for kidney stone patients.

The renal pelvis urobiome in the unilateral kidney stone patients revealed by 2bRAD-M

BackgroundThe pathogenesis of kidney stone disease (KSD) is not fully understood, and potential contributing factors remain to be explored. Several studies have revealed that the urinary microbiome (urobiome) of stone formers was distinct from that of healthy individuals using 16S rRNA gene sequencing, most of which only provided microbial identification at the genus level. 2bRAD sequencing for Microbiome (2bRAD-M) is a novel sequencing technique that enables accurate characterization of the low-biomass microbiome at the species resolution. We aimed to apply 2bRAD-M to profile the renal pelvis urobiome of unilateral kidney stone patients and compared the urobiome with and without stone(s).MethodA total of 30 patients with unilateral stones were recruited, and their renal pelvis urine from both sides was collected. A ureteroscope was inserted into the renal pelvis with stone(s) and a ureteral catheter was placed into the ureteroscope to collect renal pelvis urine. This procedure was repeated again with new devices to collect the urine of the other side. 2bRAD-M was performed to characterize the renal pelvis urobiome of unilateral stone formers to explore whether microbial differences existed between the stone side and the non-stone side.ResultsThe microbial community composition of the stone side was similar to that of the non-stone side. Paired comparison showed that Corynebacterium was increased and Prevotella and Lactobacillus were decreased in the stone side. Four species (Prevotella bivia, Lactobacillus iners, Corynebacterium aurimucosum, and Pseudomonas sp_286) were overrepresented in the non-stone side. 24 differential taxa were also identified between two groups by linear discriminant analysis effect size (LEfSe). Extensive and close connections among genera and species were observed in the correlation analysis. Moreover, a random forest classifier was constructed using specific enriched species, which can distinguish the stone side from the non-stone side with an accuracy of 71.2%.ConclusionThis first 2bRAD-M microbiome survey gave an important hint towards the potential role of urinary dysbiosis in KSD and provided a better understanding of mechanism of stone formation.

Superior calyceal access vs. other calyceal access in percutaneous nephrolithotomy: A systematic review and meta-analysis.

PurposeTo evaluate the superior calyceal access’s performance and safety in relation to other calyceal access during percutaneous nephrolithotomy (PCNL).MethodsThe suggested reporting items for systematic reviews and meta-analysis were used to conduct this meta-analysis (PRISMA). To find pertinent studies for this meta-analysis, we searched PubMed, Embase, Web of Science, and China National Knowledge Infrastructure (CNKI). Operation time and hospital stay are two secondary outcomes, whereas failed stone clearance and complication events are the two major outcomes. Utilizing Stata 15.0, RevMan 5.3, and R 4.0.2, relative data were extracted and evaluated.ResultsThis meta-analysis was based on 16 studies with 8,541 individuals. Pooled results suggested that superior calyceal access could offer fewer failed stone clearance [odds ratio (OR): 0.64, 95% confidence interval (CI), 0.47–0.88, P = 0.006] and lower additional puncture rate (OR: 0.35, 95% CI, 0.24–0.51, P < 0.001) than other calyceal access. No complication difference was found (OR: 1.10, 95% CI, 0.78–1.56, P = 0.57). Superior calyceal access could offer shorter operation time [standard mean difference (SMD): −0.57, 95% CI, −0.98 to −0.15, P = 0.007]. No hospital stay difference was found (SMD: 0.07, 95% CI, −0.09 to 0.22, P = 0.38). Large heterogeneity was detected in stone clearance comparison (I2 = 71%, P < 0.001) and operation time (I2 = 97%, P < 0.001). The stone clearance comparison also identified significant publication bias (P = 0.026). These defects weaken the credibility of the results.ConclusionSuperior calyceal access in PCNL may result in a higher stone clearance rate, a lower rate of subsequent punctures, and a faster operation duration with no increase in postoperative complications or hospital stay for kidney stone patients, despite the significant heterogeneity and publication bias. By conducting bigger randomized controlled studies, this discovery still has to be confirmed.

EPIDEMIOLOGICAL STUDY OF RISK FACTORS OF RENAL STONES FORMATION AMONG PATIENTS ATTENDING IN BLOCK PHC-THANJAVUR DISTRICT Authors

Introduction: Urolithiasis is the third most common and painful disease in the globe, afflicting both men and women. The accumulation of a few minerals and crystalline elements in the renal calculi and urinary bladder are during the process of metabolism. The study's goals were to determine the frequency of risk variables for urinary stone patients. Methods: Across-sectional study had on urinary stone disease in Thanjavur and the surrounding areas. The study included 102 cases, 79 urinary stone patients, and 23 normal patients that all lived in the same area. Results: A total of 102 participants between the ages of 20 - 70 were studied. Thirty-eight percentages of urinary stone patients were over 60 years old. In this study, men accounted for 63 %. It was discovered that kidney stone patients were more prevalent in the age groups 41-70 (77%) and &lt;40 (23%), which was statistically significant (15.5±20.51; p=0.01). Patients with lower education levels (56%) and patients from lower-income areas were found. The non-veg food intake status showed a higher proportion of kidney stone patients with control (68% vs. 13%), which was statistically significant (36.06±28.5; p = 0.005). Conclusion: This study confirms that the urinary stone formation may be due to the various environmental factors. The significant associated with the risk factors between control and urinary stone patients were found. The high burdens of urinary stone formation were observed and their associations of socio-demographic behavioral risk factor and the results have been discussed.

Translation and validation of the Chinese version of Wisconsin Stone Quality of Life questionnaire in patients with kidney stones.

Wisconsin Stone Quality of Life (WISQOL) has been designed specifically for patients with kidney stones. The present study aimed to develop the Chinese version of WISQOL and reach its validation. The WISQOL was translated into Chinese following a standard procedure. Kidney stone patients admitted for surgical treatment were enrolled and fulfilled both WISQOL and SF-36 on the admission day and at one month postoperatively. The internal consistency, inter-domain correlation and convergent validity were analyzed. One hundred twenty-four 124 males and 76 females were enrolled. The total WISQOL Score and SF-36 had significant correlation both preoperatively (r=0.772, P<0.01) and postoperatively (r=0.639, P<0.01). The internal consistency of the Chinese version WISQOL's different domains ranged from 0.766 to 0.959. The value of Spearman rank correlation to assess the convergent validity of different domains ranged from 0.444 to 0.687. The postoperative WISQOL raised about 20% showing a better quality of life. The Chinese version of WISQOL questionnaire was a reliable tool to evaluate the health quality of life in Chinese-speaker patients with kidney stones. To evaluate its test-retest reliability, reliability and validity in a longer term, further studies are required.

Semirigid Ureteroscopy Therapy against Childhood Kidney Stones.

Objective The purpose of the current study was to assess the effectiveness of semirigid ureterorenoscopy (URS) as first-line therapy for early childhood patients with <20 mm stones in the pelvic, middle, or upper calices. Methods In all, 61 pediatric kidney stone patients who had flexible ureteroscopy (fURS) between January 1, 2010, and December 31, 2019, were included in this study. Before fURS, semirigid URS employed the UreTron or holmium: YAG (Ho : YAG) laser was conducted. When semirigid URS was unsuccessful, fURS was used for retrograde intrarenal surgery (RIRS). All participants were monitored clinically for a minimum of three months after each procedure. Results The patient's mean age was 4.52 ± 1.53 years, and 52 (83.61%) participants underwent semirigid URS successfully. Mean procedural duration of semirigid URS was 36.49 ± 7.72 min. The stone-free rate after semirigid URS was 92.16% (47/51). During the postprocedural medical observation, there were no serious adverse effects. Conclusions Based on the present study's findings, semirigid URS is a low-risk, effective therapy for kidney stones in selected pediatric patients.

Association between urine cobalt and prevalence of kidney stones in Americans aged ≥ 20years old.

To determine whether urine cobalt (Co) is associated with the prevalence of kidney stones, we conducted a cross-sectional study of participants (≥ 20years) involved in the National Health and Nutrition Examination Survey (NHANES) between 2007 and 2018. The urine Co level was divided into four groups: 0.02-0.22, 0.22-0.36, 0.36-0.58, and 0.58-37.40μg/L. The independent correlation between urine Co and prevalence of kidney stones was determined by logistic regression analyses. A total of 10,744 participants aged over 20years that were not pregnant were eligible. Among them, 1041 participants reported ever having developed kidney stones. Patients with kidney stones developed significantly higher urine Co than the non-stone participants. The kidney stone patients were more likely to have been smoking ≥ 100 cigarettes in life; have hypertension, diabetes, and cancer; and engage in heavy activity. Multivariate logistic regression indicated a significantly positive relationship between the urine Co level and occurrence of kidney stones (OR 1.059, 95% CI 1.018-1.102, P = 0.00430). Moreover, the outcome remained unchanged after some sophisticated factors were adjusted (OR 1.059, 95% CI 1.001-1.120, P = 0.04635), and kidney stones were significantly related to a higher level of Co (OR (95% CI) = 0.22-0.36μg/L: 1.111 (0.869, 1.421); 0.36-0.58μg/L: 1.392 (1.095, 1.770); 0.58-37.40μg/L: 1.712 (1.351, 2.170), and P for trend < 0.00001). So, urine Co concentration is positively associated with the prevalence of kidney stones. However, more high-quality prospective studies are needed to elucidate the causal correlation between Co level and kidney stones.

Management of Preoperative Anxiety Patients with Progressive Muscle Relaxation Therapy Interventions

Objective: This case study aims to determine nursing care for anxiety in patients with pre-operative kidney stones (ureteroscopy) with progressive muscle relaxation therapy intervention in the Wijaya Kusuma room below the Kardinah Hospital, Tegal City. Method: The method used is a descriptive case study design where the case study sample is pre-operative kidney stone patients. The instrument used was the DASS 42 questionnaire (Depression Anxiety Stress Scale 42). Result: The results of the case study on the third day showed the patient looked calm with vital signs blood pressure 120/70 mmHg, pulse 97x/minute, RR 21x/minute, temperature 36.1°C, a decrease in the results of the DASS questionnaire from before the action 18 to 11. Conclusion: The results of the case study showed a decrease in anxiety in patients with preoperative kidney stones.

Percutaneous nephrolitholapaxy performed under ultrasound and endovisual guidance: evaluation of the factors affecting the immediate outcomes

Introduction. In recent years, ultrasound and endovisual guidance have been introduced into clinical practice when performing percutaneous nephrolitholapaxy.Objective. To identify the most significant factors that influence the frequency of complete elimination of stones and the development of complications in percutaneous nephrolitholapaxy performed under ultrasound and endovisual guidance.Materials and methods. We analyzed the results of the treatment of 515 kidney stone patients who underwent percutaneous nephrolitholapaxy under ultrasound navigation and endovideoscopic guidance using a new method developed by us.Results. The average duration of the operation was 77.2 ± 1.9 min. Most of the operations were performed through one puncture access (95.1%) and in one stage (91.8%) with complete stone elimination in 80.6% of the cases. The degree of decrease in hemoglobin in the postoperative period was only 12.18 ± 0.6 g/l. The frequency of postoperative complications was 29.3%, in most cases there were 1 - 2 severity grades according to Clavien-Dindo. As a result of multivariate regression analysis, independent predictors influencing the frequency of complete stone eradication were the number of stones (p = 0.012), the fact of the presence of staghorn stone (p = 0.016), the number of stages of surgical intervention (p = 0.001). Correlation analysis revealed a statistically significant negative correlation between body mass index and the occurrence of complications (p = 0.005), a positive correlation between the presence of urinary tract infection and the occurrence of complications (p = 0.048), a positive correlation between the grade of blood loss and the occurrence of expectation (р &lt; 0.001).Conclusions. Percutaneous nephrolitholapaxy under ultrasound and endovisual guidance without the use of X-rays is an effective intervention for most patients with kidney stones. Complete stone eradication depends on the number of stones, the presence of staghorn stone, and the number of stages of surgery. The incidence of complications is significantly affected by the body mass index, the presence of urinary infection and the degree of decrease in hemoglobin during surgery.

Post-collection acidification of spot urine sample is not needed before measurement of electrolytes

IntroductionKidney stone formers can have higher oxalate and phosphate salt amounts in their urine than healthy people and we hypothesized that its acidification may be useful. The study aims to compare results of urine concentrations of calcium, magnesium, and inorganic phosphorus in the midstream portion of first voided morning urine samples without (FMU) and with post-collection acidification (FMUa) in kidney stone patients.Materials and methodsThis is a prospective single center study. A total of 138 kidney stone patients with spot urine samples were included in the study. Urine concentrations of calcium, magnesium and inorganic phosphorus were measured with and without post-collection acidification. Acidification was performed by adding 5 µL of 6 mol/L HCl to 1 mL of urine.ResultsThe median age (range) of all participants was 56 (18-87) years. The median paired differences between FMU and FMUa concentrations of calcium, magnesium, and inorganic phosphorus were: - 0.040 mmol/L, 0.035 mmol/L, and 0.060 mmol/L, respectively. They were statistically different: P < 0.001, P < 0.001, P = 0.004, respectively. These differences are not clinically significant because biological variations of these markers are much higher.ConclusionsNo clinically significant differences in urinary calcium, magnesium, and inorganic phosphorus concentrations between FMU and FMUa in patients with kidney stones were found.

Most commonly prescribed blood pressure lowering drug linked with increased risk of skin cancer.

To the Editor, Hydrochlorothiazide (HCTZ) is the most commonly prescribed antihypertensive drug that belongs to a diuretic class.1 It mainly works by increasing the removal of excess water and salts from the body into the urine and by this function it is most widely used alone or in combination with other medications to treat patients with uncontrolled blood pressure and edema that results from numerous medical conditions like heart, Liver and kidney diseases. It also helps treat other ailments like diabetes insipidus, renal tubular acidosis and reduce the risk of kidney stones in patients with high calcium levels in urine. Despite its various uses and benefits, HCTZ comes with a heavy price of undesirable side effects like fatigue, lethargy, gastrointestinal discomfort and is known to cause hyperuricemia and hypokalemia associated with increased blood glucose.2 Furthermore, HCTZ increases the skin sensitivity to sunlight. However, recent research has revealed a more worrisome side effect of HCTZ that needs to be highlighted. In 2017, a nationwide study conducted in Denmark involving more than 70,000 patients with Basal cell carcinoma and 8000 patients with squamous cell carcinoma found a considerably increased risk of developing Non melanoma skin cancer, particularly among the users of HCTZ.3 A recent study also substantiated that a total of 135 squamous cell carcinoma events per 100,000 person years were reported in new users of HCTZ.4 These alarming figures raise a question mark on the safety of HCTZ use. Moreover, HCTZ is now classified as a carcinogenic agent for humans by the International Agency for Research on Cancer and the U.S. Food and Drug Administration has also permitted changes to the HCTZ drug label to warn the health care workers and patients of the risk of non-melanoma skin cancer. 5, 6 Unfortunately in Pakistan, HCTZ is still heavily used as a diuretic and people are not much aware of this new fact. In view of these findings and the fact that HCTZ is among the most generally prescribed drugs in Pakistan, its potential indication of causing skin cancer would impose a serious public health concern so the responsibility lies on the cardiologists, nephrologists and other medical physicians to be aware of this possible hazardous outcome of HCTZ use and should be cautious while prescribing it to patients who are at risk of developing skin cancer or who have had a history of skin cancer.

UP30 - Visceral Adiposity Index in kidney stone patients who have undergone surgery.

UP30 - Visceral Adiposity Index in kidney stone patients who have undergone surgery.

PD05-11 USE OF MINI SIP IT BEHAVIORAL INTERVENTION INCREASES FLUID INTAKE IN PATIENTS WITH KIDNEY STONES

You have accessJournal of UrologyCME1 May 2022PD05-11 USE OF MINI SIPIT BEHAVIORAL INTERVENTION INCREASES FLUID INTAKE IN PATIENTS WITH KIDNEY STONES Necole Streeper, James Marks, Jason Fairbourn, Emily Frith, Edison Thomaz, Nilam Ram, and David Conroy Necole StreeperNecole Streeper More articles by this author , James MarksJames Marks More articles by this author , Jason FairbournJason Fairbourn More articles by this author , Emily FrithEmily Frith More articles by this author , Edison ThomazEdison Thomaz More articles by this author , Nilam RamNilam Ram More articles by this author , and David ConroyDavid Conroy More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002524.11AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Wearable technology is both increasingly prevalent and successfully improving a variety of health behaviors. We previously showed that digital tools are capable of identifying lapses in drinking behavior and delivering just-in-time messages to promote fluid consumption. The purpose of this study was to determine the feasibility, acceptability and impact of mini sipIT, a context-sensitive reminder system that incorporates a connected water bottle and mobile app with text messaging, for kidney stone patients – a population that often has poor adherence to increasing fluid intake for prevention. METHODS: Patients with a history of kidney stones and urine volume less than 2 liters/day were recruited to participate in a 1-month feasibility trial. Patients were given an H2OPal connected water bottle and received hourly text message reminders when they were not meeting fluid intake goals. Perceptions of drinking behavior, intervention acceptability and 24-hour urine volumes were obtained at baseline and after the 1-month mini sipIT behavioral intervention. RESULTS: Patients with a history of kidney stones were enrolled (n = 26, 77% female, age = 50.4 ± 14.2 years). There was a significant increase in 24-hour urine volume at the end of the 1-month mini sipIT behavioral intervention compared to baseline (2006.5 ± 980.8 mL vs. 1352.7 ± 449.9 mL, t (25) = 3.66, p = .001, d = 0.84). 24-hour urine volumes increased at the end of the 1-month trial for 73% of participants. Most participants perceived that mini sipIT intervention helped them to increase their fluid intake (85%) and reach their fluid intake goals (65%). The majority used the connected water bottle and mobile app every day of the intervention (92%). However, 35% of participants reported that carrying the water bottle was cumbersome. CONCLUSIONS: Mini sipIT behavioral intervention is feasible and provides automated lapse-detection that improves fluid intake with a significant increase in 24-hour urine volume. Although patients found the intervention acceptable, reports that carrying the water bottle was cumbersome suggest use of a different water bottle design or multimodal intake monitoring systems may be necessary to reduce patient burden. Digital tools in combination with behavioral science may help to improve adherence to fluid intake recommendations for kidney stone prevention. Source of Funding: Keith and Lynda Harring Fund for Kidney Research at Penn State Health and National Institute of Diabetes and Digestive and Kidney Diseases (R01 DK124469) © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e90 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Necole Streeper More articles by this author James Marks More articles by this author Jason Fairbourn More articles by this author Emily Frith More articles by this author Edison Thomaz More articles by this author Nilam Ram More articles by this author David Conroy More articles by this author Expand All Advertisement PDF DownloadLoading ...

V03-03 ULTRA-LOW-DOSE INTRAOPERATIVE CT IMAGING DURING PCNL

You have accessJournal of UrologyCME1 May 2022V03-03 ULTRA-LOW-DOSE INTRAOPERATIVE CT IMAGING DURING PCNL Xavier Glover, Eric Ballon-Landa, and Mark Sawyer Xavier GloverXavier Glover More articles by this author , Eric Ballon-LandaEric Ballon-Landa More articles by this author , and Mark SawyerMark Sawyer More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002539.03AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Intraoperative CT scan in a hybrid room environment during PCNL has been described internationally to aid in obtaining percutaneous access or to assess for residual stones. The initial description of using a robotic-armed fluoroscopy system (Artis Zeego, Siemens) to assess for residual stones, and then to confirm stone free status, was by Vincentini et al. in 2017. Van den Broek, et al. described the use of intraoperative CT scan during PCNL in a prospective study of 20 patients with a median intraoperative CT scan dose of 6.7 mSv. Our group is the first to report ultra-low-dose (<2 mSv) intraoperative CT scans during PCNL/ECIRS. METHODS: This video demonstrates the technical factors involved in performing supine PCNL/ECIRS. We demonstrate how the Artis Zeego robotic biplane fluoroscopy platform was used to achieve ultra-low-dose intraoperative imaging in a hybrid operating room environment. Intraoperative CT scans are performed using a combination of low-dose protocols and imaging collimation to the level of the kidney to achieve extraordinarily low radiation exposures for patients and clinicians. PCNLs with intraoperative CT imaging are performed as part of an IRB-approved prospective QI study intended to maximize likelihood of complete stone treatment and to reduce radiation exposure. RESULTS: We have successfully ensured stone-free status in kidney stone patients undergoing PCNL/ECIRS by obtaining intraoperative CT imaging. In cases where residual stone is identified and successfully treated, a second scan is then routinely performed. This video demonstrates the first international experience with ultra-low dose intraoperative CT scan. Median intraoperative CT scan dose to date is only 1 mSv. This is 93% lower than the average post-PCNL CT scan performed at our facility (13.6 mSv). To date, we have achieved a total intraoperative effective dose (including standard fluoroscopy) as low as 1.11 mSv. This single-stage treatment of a 2.1 cm kidney stone included percutaneous access by the urologist, routine fluoroscopy, and an intraoperative CT scan that confirmed no residual fragments. CONCLUSIONS: This video has documented the first international experience for ultra-low-dose intraoperative imaging during PCNL. Effective doses are sufficiently low that multiple scans can be obtained, while still achieving significantly lower total dosage than with standard post-operative imaging. Our study is ongoing with the intent to further decrease total radiation exposure related to stone surgery. Source of Funding: None © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e201 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Xavier Glover More articles by this author Eric Ballon-Landa More articles by this author Mark Sawyer More articles by this author Expand All Advertisement PDF DownloadLoading ...

Association of dietary patterns with gut microbiota in kidney stone and non-kidney stone individuals.

The dietary patterns are closely associated with gut microbiota, which has been proved associated with kidney stones. To assess the association among the dietary patterns, gut microbiota, and kidney stones, patients with calcium oxalate stones and participants without kidney stones were recruited in West China Hospital and were divided into the low nephrolithiasis risk (LNR) and high nephrolithiasis risk (HNR) dietary pattern group based on the results of food frequency questionnaires. The genomic DNA of the fecal samples were extracted for 16S ribosomal RNA gene sequencing. The non-kidney stone (NS) group comprised 39 LNR and 45 HNR individuals, while the kidney stone (KS) group consisted of 19 LNR and 50 HNR individuals. The distribution of oxalate in urine (p < 0.01) but not calcium (p = 0.741) was significantly varied among the four groups. Significant difference was found in the dietary patterns of people with KS and NS controls (X2 = 5.744, p = 0.017). Forty-six discriminative bacteria were found among different dietary patterns groups in KS patients and NS controls. Not only gut bacteria such as Pseudomonas, Sphingomonas, Hydrogenoanaerobacterium, Faecalitalea, etc., but also metabolic pathways associated with inflammation, lipid, and mineral metabolism were found more abundant in KS patients with HNR dietary pattern. It is noteworthy that g__Prevotellaceae_UCG_001, g__hgcI_clade, and g__Bradyrhizobium were negatively related to water intake but instead had a positive correlation with salt and meat intake. Our study revealed that gut microbiota with significantly different abundance existed in the HNR dietary patterns compared to the LNR counterparts in both calcium oxalate KS and NS individuals. The dietary patterns may affect the prevention and management of calcium oxalate stones by regulating the homeostasis of gut microbiota.

Metabolic evaluation of the kidney stone patient - the key for personalized metaphylaxis

Kidney stones represent one of the “oldest” diseases and have affected normal people but also great historical characters starting from Ramses II to George W. Bush or Lionel Messi. Despite progress in understanding the pathophysiology of kidney stones, we are witnessing an increase in the incidence and prevalence worldwide. The spread of urinary stones disease is not homogeneous on the planet, its epidemiology is influenced, among other things, by external factors such as geo-climatic conditions. In the United States, the prevalence between 1976-1980 was 3.8%, it increased to 5.7% between 1988-1994, while in late 2010 already reached 8.8% (1). Meanwhile in Europe, given that there are climatic differences, but also in terms of eating habits between different areas, it is expected that the prevalence of urinary stones will differ between countries or regions. In a relatively hot region like Andalusia, according to Arias Vega et al., in people aged 40 to 65 years old, the prevalence of lithiasis in 2016 was 16.4%, while in Europe’s northern regions like Iceland the incidence between 2005-2008 was 138/100.000 according to Edvardsson et al. (2, 3).