Kidney Stone Size Research Articles

Comparison of automated kidney stone size measurement and volumetry in photon counting CT compared to 3rd generation dual energy CT and physically measurements - an ex vivo study.

This ex vivo study aimed to compare a newly developed dual-source photon-counting CT (PCCT) with a 3rd generation dual-source dual-energy CT (DECT) for the detection and measurement (stone lengths and volumetrics) of urinary stones. 143 urinary stones with a known geometry were physically measured and defined as reference values. Next, urinary stones were placed in an anthropomorphic abdomen-model and were scanned with DECT and PCCT. Images were read by two experienced examiners and automatically evaluated using a specific software. DECT and PCCT showed a high sensitivity for manual stone detection of 97.9% and 94.4%, and for automatic detection of 93.0% and 87.4%, respectively. Compared to that uric acid and xanthine stones were recognized slightly worse by DECT and PCCT with manual stone detection (93.3% and 82.2%), and with automatic detection (77.8% and 60.0%). All other stone entities were completely recognized. By comparing the maximum diameter of the reference value and DECT, Pearson-correlation was 0.96 (p < 0.001) for manual and 0.97 (p < 0.001) for automatic measurement, and for PCCT it was 0.94 (p < 0.001) for manual and 0.97 (p < 0.001) for automatic measurements. DECT and PCCT can also reliably determine volume manually and automatically with a Pearson-correlation of 0.99 (p < 0.001), respectively. Both CTs showed comparable results in stone detection, length measurement and volumetry compared to the reference values. Automatic measurement tends to underestimate the maximum diameter. DECT proved to be slightly superior in the recognition of xanthine and uric acid stones.

Computed tomographic characterization of urinary stones in patients with urolithiasis from Southeast Mexico

Urolithiasis (UL) is a severe public health concern in southeastern Mexico. Computed tomography (CT) is the first-line diagnostic method for patients with suspected UL. The present study aimed to characterize stones in the entire urinary system using CT and to contribute to personalized treatment in patients with UL. Patients >18 years of age with suspected UL were enrolled. Characteristics of UL included stone size, location (kidney, ureters, and bladder), composition of the stone in Hounsfield units (HU), presence of staghorn stone(s), and obstructive uropathy. Patients were stratified according to sex and age to determine whether stone size and HU were dependent on hormonal factors in females and on prostatic hyperplasia in males. The Mann–Whitney U test was used to compare median values. Frequencies are expressed as percentages and were analyzed using the Mantel–Haenszel chi-squared test. A total of 1150 patients were included in this study, of whom 744 (64.7 %) had UL in only 1 anatomical location in the urinary system, and 406 (35.3 %) had stones in ≥2 anatomical locations. Localization and stone size differed between males and females (p < 0.05). Additionally, males exhibited differences in HU (p = 0.024) and frequency of obstructive uropathy (p = 0.10) when stratified according to age (≤50 and > 50 years). In addition, females exhibited statistical differences in HU (p = 0.010) and kidney stone size (p = 0.047) dependent on age (≤47 and > 47 years). In conclusion, findings suggest that HU and stone size differ in different anatomical structures of the urinary system. In addition, differences in stone size and composition may be associated with age and sex.

Residual fragment size following retrograde intrarenal surgery: a critical evaluation of related variables.

Given the limited data on the predictive factors of residual kidney stone size after flexible ureteroscopy (fURS), this study aims to investigate the variables affecting residual stone size. The medical records of 642 patients without complications being treated for kidney stones with fURS between July 2014 and May 2022 were reviewed retrospectively, and the information of the 170 patients in whom residual stones were found was recorded. In addition to patient-specific factors and stone characteristics, length of postoperative hospital stay, postoperative fever, and preoperative antiaggregant use were evaluated. Of the 170 patients ultimately included in the study. The mean age was 51.56 (± 14.70). The mean stone size was 14.01mm (± 5.75), the mean residual stone size was 7.04mm (± 2.51), and the mean stone density was 829 Hounsfield units (± 395.06). The mean infundibulopelvic angle (IPA) was 49.37º (± 15.37), and 41.2% of the stones were non-opaque. The mean parenchymal thickness was 22.88mm (± 5.55). 34 patients were on antiaggregant therapy. Preoperative stone size increases in stone density and decreases in IPA were found to be correlated with increase residual stone size (p < 0.001, p < 0.001, and p < 0.001, respectively). In addition, larger residual stones were observed after the fURS procedure in patients using anticoagulants and those without hydronephrosis (p = 0.02 and p = 0.016, respectively). Use of reliable predictive factors to forecast residual stone size after fURS may help to inform those treated and enable urologists to design rational surgical strategies.

Evaluation of the Role of MSCT in the Diagnosis of Ureteral Kidney Stones

A study of 100 patients with ureteral kidney stones, in which 66 cases of kidney stones and 68 cases of ureteral stones were taken with 128 slices of computerized tomography at Hanoi Medical University Hospital from September 2019 to the end of January 2020. Results: male/female ratio was 1.7/1. The mean age was 51.2 ± 11.7. The rate of renal function decline (creatinine increase) was 18%. The supersonic, X-ray, and Multi-slice Computer Tomography (MSCT) detected stones in 89%, 84%, and 100% of cases, respectively, including 32% of kidney stones, 34% of ureteral stones, 34% of stones in both kidneys and ureters, 63.6% kidney stones in many positions. Patients with two or more stones accounted for 78.8% and the average kidney stone size was 15.5 ± 10.9 mm. Ureteral stones in the upper third accounted for 54.4%, one stone accounted for 77.9%, and the average size of ureteral stones was 9.1 ± 3.6 mm. Complications of nephrolithiasis caused by stones account for 82%, and grades II and III are the most common. Complications of ureteral dilatation due to stones accounted for 51%, perirenal fat infiltration accounted for 24% and 32% of cases of drug excretion lasted more than 1 hour. Conclusion: MSCT plays an important role in diagnosing urinary stones and assessing renal function before treatment.

Outcomes in Lower Pole Kidney Stone Management Using Mini-Percutaneous Nephrolithotomy Compared With Retrograde Intra Renal Surgery: A Randomized Controlled Trial.

Background Because of the anatomical properties of the inferior calyx, lower pole stones are difficult to remove through the ureter, even if the stones are fragmented. Retrograde intra-renal surgery (RIRS) is typically employed to treat the smaller lower pole stones (1.0-2.0 cm) while percutaneous nephrolithotomy (PCNL) is primarily used to treat the larger diameter stones or when RIRS has failed to clear the stones. This study was conducted to compare mini-PCNL and RIRS for the management of lower pole kidney stones in terms of stone clearance. Material and methods This randomized control trial was conducted in the Department of Urology, Shaikh Zayed Hospital, Lahore from October 2020 to December 2022. A total of 150 patients between the ages of 18 and 80 years with a kidney stone size of 10-20 mm at the lower pole were included. Patients with positive urine culture, anatomical abnormalities, uncontrolled diabetes (hemoglobin{Hb}A1c >9%), and undergone previous renal surgery were excluded. Group A patients were treated with mini-PCNL, while group B patients were managed with RIRS. Follow-up visits were planned four weeks postoperatively with CT KUB (computed tomography of kidneys, ureters, and bladder) plain to assess stone clearance. Results The mean age in group A was 43.27 ± 13.86 years, while in group B was 45.32 ± 14.14 years. Out of 150 patients, 102 (68.0%) were males and 48 (32.0%) were females. Mean size of the stone was 15.30 ± 2.21 mm. Stone clearance after mini-PCNL was found in 69 (92.0%) patients and after RIRS in 59 (78.67%) patients (p-value = 0.021). Mean hospital stay after RIRS was 1.1 ± 0.09 days, while it was 2.3 ± 0.64 days after mini-PCNL (p-value < 0.001). Two (2.67%) patients in the mini-PCNL group developed bleeding postoperatively. The stone clearance rate in older patients (51 to 80 years) was significantly higher in the mini-PCNL group than RIRS group. Similarly, the stone clearance rate in female patients and in patients with larger stones (16 to 20 mm) was found to be higher in mini-PCNL group as compared to the RIRS group. Conclusion This study concluded that both mini-PCNL and RIRS are safe and efficient techniques for treating lower pole kidney stones with a size of 11-15 mm. However, mini-PCNL has a higher stone clearance rate compared to RIRS in the treatment of stones larger than 15 mm in size. This study further suggested that patients treated with mini-PCNL had a longer hospital stay compared to patients treated with RIRS.

Kidney stone classification using deep learning neural network

Kidney stones are the common problem in the healthcare system. It is rapidly increasing day by day and becomes a global health crisis in worldwide. Various deep learning algorithms are used for classificationof stone in kidney area. The computer aided design approach can be used for assist doctor for finding out the stone in kidney area. For kidney transplantation and dialysis, a proper treatment is required. It is important to have reliable techniques for predicting kidney stone size atits early stages. Different machine learning (ML) algorithmsare given excellent results in predicting stone. In this paper, clinicaldata is used for predicting of stone in kidney. If data have some missing values, data unbalancing problem then machine learning algorithms assist to solve this problem in which includes data preprocessing, a technique for managing missing values, data aggregation, feature extraction and prediction of result by evaluating values. In this study, deep learning algorithm for classification of kidney stone sizes automatically on the patient’s dataset is used. A total of 1000 patient’s dataset are used for finding out kidney stone size i.e., large or small. The binary classification algorithm is used for classification of stone size. We observed that our model gives best result for classification of kidney stone image size.

Формула оценки размера камня (ФОРК) почки у детей разных возрастных групп.

Introduction. The choice of surgical treatment with kidney stone disease directly depends on the size of the kidney stones. According to clinical guidelines for the treatment of urolithiasis in children, the size of a kidney stone in adult patients is used to determine tactics. Normally, the longitudinal size of the kidney of a child, for example, 1-3 years old, is 2 times smaller than that of an adult, and the width of the child's ureter is 37% less than the width of the adult's ureter. But anatomical and age differences in children (infant, preschool, school and adolescence) are not taken into account. Existing prognostic nomograms for urolithiasis (Dogan, Onal, CMUN, SKS, Guy's Stone Score, S.T.O.N.E, and CROES) that are validated for use in children also do not take this into account. Thus, the size of a kidney stone, as a criterion for choosing an effective and safe method of surgical treatment, needs to be clarified. The purpose of the study: to define the concept of a large kidney stone in children of different age groups. Materials and methods. We analyzed clinical guidelines, domestic and foreign publications on the use of «kidney stone size» in children of different ages and the principles of substantiation of the term large kidney stone. 320 histories of percutaneous nephrolitholopaxy (PNL) from 2008-2019 were retrospectively and perspectively analyzed. aged from 1 to 17 years, the average age of patients is 6.6 years. The average calculus size was 26 (15-58) mm. Number of patients in different age groups: toddlers 1-3 y/o – 73, pre-school child 3-5 y/o. – 71, school child 6-12 y/o – 79, adoloscents 12-18 y/o – 97. By type of calculus: single –125 (39.1%), multiple – 68 (21.3%), K1, K2 – 46 (14.3%), K3, K4 – 81 (25.3%). The weight of the patients ranged from 8–94 kg, the average weight was 21 kg, the height was from 73–180 cm, and the average height was 120 cm. The length of the child's kidney depends on his age, the formula for calculating the length of the kidney (cm) = 6.79 + 0.22 x age (g)) Result. KSS-CDA: Kidney stone size in children different ages was proposed: KSS-CDA = (stone size (mm)/the kidney length (mm))*100%. KSS-CDA makes the interpretation of the size of kidney stones in children from different age groups objective. The definition of "Large" kidney stone is used if the size of the stone is 20% or more of the longitudinal size of the kidney in children. For example, a child is 1 year 7 months old, the stone is 15 mm, the length of the kidney is 69 mm. The SSEF is 21.74%, this kidney stone can be described as «large». The «medium» stone size is 10-20% (6-14 mm), small &lt;10% (6 mm). Conclusion. The presented study is the first in domestic and foreign literature, during which the age characteristics of children were taken into account. The reason for the reduction in the lower limit of kidney stone size used to select surgical treatment in children compared with current recommendations was explained. For the first time, KSS-CDA allows to standardize an objective criterion for determining large, medium and small kidney stones in children different ages. The prospective use of FORK in the future will allow adapting clinical guidelines and nomograms for KSD in children.

Kidney stone risk reduction and size reduction utilizing medical plants

Kidney stone risk reduction and size reduction utilizing medical plants

Kidney stone risk reduction and size reduction utilizing medical plants

Kidney stones are not only a widespread problem now, but have been for centuries. Many of the plants used historically have now been found to be effective in reducing risk and reducing stone size in modern clinical trials. Both reducing stone size and reducing recurrence of stones after removal are important. Certain medical plants have been shown to slow the formation of calcium oxalate crystals. Several of these medical plants also have antioxidant and antimicrobial effects. The plants with the best clinical trials and supporting preclinical data showing effectiveness in reducing kidney stone formation and recurrence are Nigella sativa (black cumin seed), Dolichos biflorus (horse gram), Crataeva nurvala (varuna bark), and Tribulus terrestris (Gokshura). Some of these medical plants have been compared to tamsulosin (Flomax®) and potassium citrate for safety and effectiveness. Reviewed here are 11 medical plants with good clinical data, as well as 24 more plants with preclinical data or historical use.

In vivo investigation of the inhibitory effect of Peganum harmala L. and its major alkaloids on ethylene glycol-induced urolithiasis in rats

Ethnopharmacological relevancePeganum harmala L. is a traditional medicinal plant used for centuries in folk medicine. It has a wide array of therapeutic attributes, which include hypoglycemic, sedative, anti-inflammatory, and antioxidant properties. The fruit decoction of this plant was claimed by Avicenna as traditional therapy for urolithiasis. Also, P. harmala seed showed a clinical reduction in kidney stone number and size in patients with urolithiasis. Aim of the studyIn light of the above-mentioned data, the anti-urolithiatic activities of the seed extracts and the major β-carboline alkaloids of P. harmala were investigated. Materials and methodsExtraction, isolation, and characterization of the major alkaloids were performed using different chromatographic and spectral techniques. The in vivo anti-urolithiatic action was evaluated using ethylene glycol (EG)-induced urolithiasis in rats by studying their mitigating effects on the antioxidant machinery, serum toxicity markers (i.e. nitrogenous waste, such as blood urea nitrogen, uric acid, urea, and creatinine), minerals (such as Ca, Mg, P, and oxalate), kidney injury marker 1 (KIM-1), and urinary markers (i.e. urine pH and urine output). ResultsTwo major alkaloids, harmine (P1) and harmalacidine HCl (P2), were isolated and in vivo evaluated alongside the different extracts. The results showed that P. harmala and its constituents/fractions significantly reduced oxidative stress at 50 mg/kg body weight, p.o., as demonstrated by increased levels of glutathione (GSH), glutathione reductase (GR), glutathione peroxidase (GPx), and catalase (CAT) in kidney homogenate as compared to the EG-treated group. Likewise, the total extract, pet. ether fraction, n-butanol fraction, and P1, P2 alleviated malondialdehyde (MDA) as compared to the EG-treated group. Serum toxicity markers like blood urea nitrogen (BUN), creatinine, uric acid, urea, kidney injury molecule-1 (Kim-1), calcium, magnesium, phosphate, and oxalate levels were decreased by total extract, pet. ether fraction, n-butanol fraction, P1, and P2 as compared to the EG-treated group. Inflammatory markers like NFκ-B and TNF-α were also downregulated in the kidney homogenate of treatment groups as compared to the EG-treated group. Moreover, urine output and urine pH were significantly increased in treatment groups as compared to the EG-treated group deciphering anti-urolithiatic property of P. harmala. Histopathological assessment by different staining patterns also supported the previous findings and indicated that treatment with P. harmala caused a gradual recovery in damaged glomeruli, medulla, interstitial spaces and tubules, and brown calculi materials as compared to the EG-treated group. ConclusionThe current research represents scientific evidence on the use of P. harmala and its major alkaloids as an effective therapy in the prevention and management of urolithiasis.

Percutaneous nephrolithotomy and laparoscopic surgery efficacy and renal function outcomes for large and complex renal calculi

Abstract Background There is limited published evidence regarding the incidence of intraoperative and postoperative events and the effect of percutaneous nephrolithotomy (PCNL) in supine and prone positions and laparoscopic pyelolithotomy on kidney function in patients with large and complex calculi. Materials and methods We evaluated the surgical outcomes of 97 patients with large and complex kidney stones. The patients were divided into 3 groups: those who underwent PCNL in the prone position, PCNL in the supine position, and pyelolithotomy by laparoscopy and retroperitoneoscopy. General surgical outcomes, size of residual stones, stone-free rate, glomerular filtration rate (GFR), and split GFR obtained from Tc-99m renal dynamic scintigrams were analyzed. Results Percutaneous nephrolithotomy in the prone position was correlated with improved function of the affected kidney. In the supine PCNL group, none of the analyzed indicators demonstrated a significant difference. Dynamic nephroscintigrams revealed negative changes in terms of accumulation and secretion of the affected kidney. A slight decrease in creatinine clearance was noted. However, positive dynamics in split GFR and secretory index were seen in this group. The laparoscopic group showed positive results in all analyzed parameters. However, full assessment of the function of the affected kidney in this group was limited due to restricted use of laparoscopic pyelolithotomy for complex stones. Conclusions Percutaneous nephrolithotomy in the prone position resulted in the most favorable renal functional outcomes for patients with high-grade renal calculi, whereas a laparoscopic approach may be preferred for patients with stones of lower grades. The most significant factors that adversely affected renal function were intraoperative bleeding volume, kidney stone size and density, and body mass index.

Urinary Microbial and Metabolomic Profiles in Kidney Stone Disease.

BackgroundKidney stones or nephrolithiasis is a chronic metabolic disease characterized by renal colic and hematuria. Currently, a pathogenetic mechanism resulting in kidney stone formation remains elusive. We performed a multi-omic study investigating urinary microbial compositions and metabolic alterations during nephrolithiasis.MethodUrine samples from healthy and individuals with nephrolithiasis were collected for 16S rRNA gene sequencing and liquid chromatography-mass spectroscopy. Microbiome and metabolome profiles were analyzed individually and combined to construct interactome networks by bioinformatic analysis.ResultsDistinct urinary microbiome profiles were determined in nephrolithiasis patients compared with controls. Thirty-nine differentially abundant taxa between controls and nephrolithiasis patients were identified, and Streptococcus showed the most significant enrichment in nephrolithiasis patients. We also observed significantly different microbial compositions between female and male nephrolithiasis patients. The metabolomic analysis identified 112 metabolites that were differentially expressed. Two significantly enriched metabolic pathways, including biosynthesis of unsaturated fatty acids and tryptophan metabolism, were also identified in nephrolithiasis patients. Four potentially diagnostic metabolites were also identified, including trans-3-hydroxycotinine, pyroglutamic acid, O-desmethylnaproxen, and FAHFA (16:0/18:2), and could function as biomarkers for the early diagnosis of nephrolithiasis. We also identified three metabolites that contributed to kidney stone size. Finally, our integrative analysis of the urinary tract microbiome and metabolome identified distinctly different network characteristics between the two groups.ConclusionsOur study has characterized important profiles and correlations among urinary tract microbiomes and metabolomes in nephrolithiasis patients for the first time. These results shed new light on the pathogenesis of nephrolithiasis and could provide early clinical biomarkers for diagnosing the disease.

Phytotherapy in urological benign disease: A systematic review

AbstractWhat is the state of knowledge on the use of phytotherapy in the following urological benign diseases: prostatic hyperplasia, erectile dysfunction, male infertility, urolithiasis and low‐urinary tract symptoms? Supplements derived from natural products are used in medicine alone or in combination with drugs. In urology, there are many products used for symptom management in benign conditions. The aim of this review was to investigate the use of herbal medicines to treat benign urological diseases. A systematic review was conducted using the PubMed, CINAHL, Cochrane Library, Embase and Scopus (2010–2021) databases. The inclusion criteria were studies describing the use of phytotherapeutic strategies to treat adult patients with urological diseases. Quality assessments were performed using the Grades of Recommendation, Assessment, Development and Evaluation (GRADE) approach. Nineteen studies were included in this systematic review: 13 randomized controlled trials, 3 pilot studies, 1 quasi‐experimental study, 1 retrospective observational study and 1 post hoc analysis. Phytotherapeutic agents used to treat benign prostatic hyperplasia included royal jelly, Viola odorata, Echium amoenum, Physalis alkekengi, soy isoflavones, Serenoa repens, Trigonella foenum‐graecum, lycopene and selenium. Tribulus terrestris is widely used to treat erectile dysfunction and male infertility. Lycopene, Korean ginseng berries, Indian ginseng and Curcuma improve sperm characteristics and motility. Lupeol therapy reduces kidney stone size, improving urolithiasis symptoms and accelerating the expulsion of small stones. No standard of care has been established for the use of phytotherapeutic agents to manage patients with symptomatic urological disorders. Although randomized controlled trials were the most common study type in our review, the sample sizes were limited, and the study duration and follow‐up periods were often very short.

Effect of a three-dimensional (3D) printed kidney model on patient understanding of the percutaneous nephrolithotomy procedure: a preliminary study.

Three-dimensional (3D) printed anatomical models can provide cognitive anatomical information. We aimed to study the effect of a 3D printed kidney model on patient understanding of kidney anatomy and the percutaneous nephrolithotomy (PCNL) procedure as well as the overall patient satisfaction with the model. Seven patients who underwent PCNL were enrolled in the study. Personalized 3D printed kidney models were constructed based on the patients' computed tomography images. Patients completed two questionnaires regarding their understanding and satisfaction with the use of the 3D printed kidney model before and after using the model during informed consent. The mean age of the study population was 58.0years. Comparison of patient understanding and satisfaction between the two questionnaires showed a general trend toward better understanding and improved satisfaction with use of 3D printed kidney models. Statistically significant results were seen for understanding of kidney anatomy, stone size, procedure, and satisfaction (p values 0.046, 0.025, 0.046, and 0.046, respectively). Five of the seven patients (71.4%) answered that the model was very useful. However, none of the patients answered that the cost was appropriate. In the current study, patients showed improved understanding of the kidney anatomy and the PCNL procedure and higher satisfaction with using the 3D printed kidney model during informed consent. With further studies using larger patient numbers and decreased production cost, using 3D printed kidney models has the potential to be a useful adjunct for patient understanding during PCNL.

Manual kidney stone size measurements in computed tomography are most accurate using multiplanar image reformatations and bone window settings

Computed tomography in suspected urolithiasis provides information about the presence, location and size of stones. Particularly stone size is a key parameter in treatment decision; however, data on impact of reformatation and measurement strategies is sparse. This study aimed to investigate the influence of different image reformatations, slice thicknesses and window settings on stone size measurements. Reference stone sizes of 47 kidney stones representative for clinically encountered compositions were measured manually using a digital caliper (Man-M). Afterwards stones were placed in a 3D-printed, semi-anthropomorphic phantom, and scanned using a low dose protocol (CTDIvol 2 mGy). Images were reconstructed using hybrid-iterative and model-based iterative reconstruction algorithms (HIR, MBIR) with different slice thicknesses. Two independent readers measured largest stone diameter on axial (2 mm and 5 mm) and multiplanar reformatations (based upon 0.67 mm reconstructions) using different window settings (soft-tissue and bone). Statistics were conducted using ANOVA ± correction for multiple comparisons. Overall stone size in CT was underestimated compared to Man-M (8.8 ± 2.9 vs. 7.7 ± 2.7 mm, p < 0.05), yet closely correlated (r = 0.70). Reconstruction algorithm and slice thickness did not significantly impact measurements (p > 0.05), while image reformatations and window settings did (p < 0.05). CT measurements using multiplanar reformatation with a bone window setting showed closest agreement with Man-M (8.7 ± 3.1 vs. 8.8 ± 2.9 mm, p < 0.05, r = 0.83). Manual CT-based stone size measurements are most accurate using multiplanar image reformatation with a bone window setting, while measurements on axial planes with different slice thicknesses underestimate true stone size. Therefore, this procedure is recommended when impacting treatment decision.

Correlation Between CT-Based Bone Mineral Density and Kidney Stone Size and Their Association with 24-Hour Urinalysis Biometrics in Patients with Urinary Stones

Background: The association between chronic nephrolithiasis and several systemic conditions has been established in previous studies. Patients with recurrent urinary stones generally experience more urinary calcium loss, resulting in a lower bone mineral density (BMD). Dual-energy X-ray absorptiometry (DEXA) is the standard imaging method for diagnosing a low BMD. However, imaging imposes significant cost and radiation burden on patients. Objectives: We aimed to assess the relationship between 24-hour urinalysis biometrics and bone mineral content, retrieved from non-contrast computed tomography (CT) imaging, which is routinely preformed for urinary stone patients as a primary evaluation. Patients and Methods: The sample population for this retrospective study included urinary stone patients, undergoing percutaneous nephrolithotomy (PCNL) during 2015-2019, with available 24-hour urinalysis and CT imaging records. Stone size was defined as the maximum stone diameter on the CT image. BMD for each subject was also calculated at the vertebral L1 level, with CT attenuation measured in Hounsfield units (HU). According to the literature, a cutoff value of 160 HU was selected to distinguish normal BMD from low BMD. Results: The present results showed a significant association between the stone size and BMD (P &lt; 0.05). Moreover, patients with a low BMD had a higher urinary calcium excretion in the 24-hour urinalysis (P &lt; 0.05). Evaluation of urine chemical composition and stone size demonstrated a significant association between hypercalciuria and urinary stone volume (P &lt; 0.05). Conclusion: A low BMD detected by CT imaging in patients with urinary stones is associated with abnormal 24-hour urinalysis biometrics and larger stones; therefore, it should be properly assessed.

Correlation of Stone Size and Urine Leukocytes in Nephrolithiasis Patients at Ulin General Hospital Banjarmasin

Abstract: Nephrolithiasis (Kidney Stone) is a condition where there is stone in the kidney that are formed due to disturbance of the balance between solubility and deposition of salt in urine. This study was aim to determine the correlation between stone size and urine leukocytes in nephrolithiasis patients. This study was conducted at the Ulin General Hospital in Banjarmasin by taking data on medical records for the 2017-2018 period. This study used a cross-sectional retrospective approach with an analytic method. Samples were obtained using total sampling technique based on inclusion and exclusion criteria. A total of 34 nephrolithiasis patients were obtained that met the inclusion and exclusion criteria. The highest proportion of stone size was &gt;20 mm (47.07%). The highest proportion of urine leukocytes was +3 (38.23%). Data were analyzed using the Spearman correlation test and showed p = 0.774 and r = 0.051. There was no significant correlation between stone size and urine leukocytes in nephrolithiasis patients at Ulin General Hospital Banjarmasin. Keywords: Nephrolithiasis, kidney stone size, urine leukocytes.

Size and volume of kidney stones in computed tomography: Influence of acquisition techniques and image reconstruction parameters

PurposeComputed tomography (CT) is routinely used to assess suspected urolithiasis. Information obtained from CT include presence, location and size of stones, with the latter frequently determining treatment strategy. While there is consensus regarding measurements procedures of kidney stones, influence of radiation dose and reconstruction techniques on stone measurements are unknown. The purpose of this study was to systematically evaluate the influence of these technical determinants on kidney stone size measurements. Method47 kidney stones of different composition were scanned using a 64-row-multi-detector CT in a 3D-printed, semi-anthropomorphic phantom. Reference stone sizes were measured manually with a digital caliper (Man-M). Stones were imaged with 2 and 10 mGy CTDI. Images were reconstructed using filtered-back-projection, hybrid-iterative and model-based-iterative reconstruction algorithms (FBP, HIR, MBIR) in combination with different kernels and denoising levels. All stones underwent semi-automatic, threshold-based segmentation for computation of maximum diameter and volume. Statistics were conducted using ANOVA ± correction for multiple comparisons. ResultsOverall stone size as compared to manual measurements was overestimated in CT (10.0 ± 3.1 vs. 8.8 ± 2.9 mm, p < 0.05) yet showing a good correlation (R2 = 0.66). Radiation dose and denoising levels did not significantly influence measurements (p > 0.05). MBIR and sharp kernels showed closest agreement with Man-M (9.3 ± 3.1 vs. 8.8 ± 2.9 mm, p < 0.05). Differences within single stones were as high as 40 % (e.g. Man-M: 5.9 mm, CT: 7.3–12.0 mm). ConclusionsCT-based measurements of kidney stone size appear unaffected by radiation dose and denoising technique, whereas reconstruction algorithms and kernels demonstrate a relevant impact on size measurements. Smallest differences were found using MBIR with a sharp kernel.

Secondary signs on preoperative CT as predictive factors for febrile urinary tract infection after ureteroscopic lithotripsy

BackgroundFebrile urinary tract infection (UTI) is one of the most common complications after ureteroscopic lithotripsy (URS). We evaluated the effect of secondary signs on preoperative computed tomography (CT) for febrile UTI after URS.MethodsIn total, 182 patients who underwent URS for ureteral stones from January 2013 to December 2015 were retrospectively included in this study. These patients were divided into two groups according to the presence of postoperative febrile UTI after URS. We compared the clinical factors, stone factors, and secondary signs between the groups. Predictive factors for febrile UTI after URS were analyzed using a multivariate logistic regression model.ResultsFebrile UTI occurred in 26 of the 182 patients. In univariate analysis, presence of comorbid chronic kidney disease (CKD) and stone size were significantly different between UTI and non-UTI groups. Among secondary signs, presence of hydroureter, perinephric fat stranding, periureteral fat stranding, and tissue rim sign were significantly different between the groups. In multivariate logistic regression analysis, comorbid CKD, stone size, perinephric fat stranding, and tissue rim sign were independent predictive factors for febrile UTI after URS.ConclusionThis study demonstrated that secondary signs including perinephric fat stranding and tissue rim sign on preoperative CT, CKD, and stone size are independent predictive factors for febrile UTI after URS.

Comparison of Intravenous Ibuprofen with Intravenous Ketorolac in Renal Colic Pain Management; A Clinical Trial.

BackgroundChoosing a proper medication for pain management of patients with acute renal colic has been a challenge for physicians treating these patients.ObjectivesThe present study was performed with the aim of comparing intravenous (IV) ibuprofen and IV ketorolac in pain management of these patients.MethodsIn the present double-blind clinical trial study, patients suspected with renal colic presented to the emergency department were randomly divided into 2 groups receiving IV ibuprofen or IV ketorolac and were compared regarding effectiveness (pain reduction 15, 30, and 60 minutes after injection), treatment success, and possible side effects.ResultsIn total, 240 patients suspected with renal colic with the mean age of 27.38 ± 12.32 years were randomly divided into 2 groups of 120 individuals treated with IV ketorolac or ibuprofen (66.4% male). The two groups were in a similar condition regarding age (P = 0.56), sex (P = 0.78) history of kidney stone (P = 0.40), vital signs (P > 0.05), stone size (P = 0.73), stone location (P = 0.13), and pain severity on admission (P = 0.32). 15, 30, and 60 minutes after drug injection, pain severity in the ketorolac group was significantly higher than the group receiving ibuprofen (P < 0.0001 for all comparisons), yet these differences were not clinically significant. Fifteen minutes after the injection, the rate of treatment success was significantly higher in the group receiving IV ibuprofen (P < 0.0001). After 60 minutes, the number of completely relieved cases reached 37 (30.8%) patients in the ketorolac group and 83 (69.1%) patients in the ibuprofen group. No significant difference was seen in side effects between the two groups (P = 0.35).ConclusionsThe findings of the present study show that ibuprofen is a more rapid acting drug compared to ketorolac in controlling pain caused by renal colic. In addition, its rate of complete relief from pain was twice as much as that of ketorolac. Since the side effects observed for ibuprofen in the present study were very mild, it is suggested to use this drug in treatment and pain control of renal colic patients.