Kidney Ureter Bladder Research Articles

Retroperitoneal ancient schwannoma presenting as left flank pain and moderate unilateral hydronephrosis: A case report and literature review.

Benign ancient retroperitoneal schwannomas (BARS) exhibit abdominal masses and flank pain to incidental findings at more advanced stages. Histopathological and immunohistochemical analysis is essential for confirmation of benign nature. Our patient was misdiagnosed as ureteric colic, highlighting the need to consider BARS in differential diagnosis to prevent complications like hydronephrosis. Ancient schwannomas are usually benign neoplasms that originate from Schwann cells of peripheral nerves. We present a novel case of a 24-year-old young male with left flank pain and nausea which was initially thought to be left ureteric colic. However, in-depth imaging and biopsy revealed a retroperitoneal mass. The definitive diagnosis was narrowed down to Benign Retroperitoneal Ancient Schwannoma (BARS) via immunohistochemistry and histopathological analysis. This often marble-shaped S100 protein-positive tumor is an under-recognized and potential cause of hydronephrosis if localized near the renal structures. In addition, the retroperitoneal location with infrarenal abdominal aortic adherence is another rare peculiarity in the present case that demands prompt diagnosis and surgical excision to avoid any cardiovascular sequelae such as hypotension and abdominal pain, as indicated by the natural history of growth of this benign tumor. Therefore, timely excision of this benign tumor prior to its further proliferation is paramount. We initially planned laparoscopic removal but adopted excision via laparotomy because of the proximity of the vital structures. The postoperative course of the patient was uneventful and subsequently the patient's presenting complaint of left abdominal flank pain greatly improved. The patient was advised to undergo follow-up computed tomography scan of kidney ureter bladder and RFT evaluation 6 months postsurgery which indicated no evidence of recurrence or iatrogenic complications. The diagnosis and management of the present case share valuable experiences for similar future cases worldwide.

Demonstrating the Efficacy of Dual Energy Computer Tomography with Gemstone Spectral Imaging Software to Determine Mixed and Single Composition ex vivo Urolithiasis.

To assess the capability of determining the mixed chemical composition of urinary stones using spectral imaging properties of Dual Energy Computed Tomography (DECT) Gemstone Spectral Imaging (GSI) software. Twenty-six single and 24 mixed composition ex vivo urinary stones with known chemical composition determined by Fourier-transform infrared spectroscopy (FTIR) prior to this project were scanned with DECT imaging and GSI in vitro. The major components of the stones included Uric Acid (UA), Calcium Oxalate (CaOx), Calcium Phosphate (CaP), Magnesium Ammonium Phosphate (MAP), and Cystine (Cys). A histogram to display the distribution of the effective atomic number (Z-eff) of each pixel of the tested area, spectral curve (40-140 keV, with 10 keV interval) and Hounsfield Units (HU) of each stone scanned was provided with analysis of monochromatic images at 140 keV in the axial plane. The overall pooled sensitivity, specificity, and accuracy of DECT for identifying major stone composition were 0.802, 0.831, and 0.807, respectively, with a 95% confidence interval. Accuracy was 100% for identifying UA and Cys stones. DECT is a superior imaging modality when compared to low dose computed tomography kidney ureter bladder scans. It allows for improved characterization of major components of urinary stones, in an accurate, non-invasive approach to pre-treatment. This can translate to urologists having greater confidence in determining patient suitability for medical or surgical management of their renal stones, in clinical practice.

Could radiological parameters help to predict the failure of ureteral access sheath placement

To identify the radiological parameters which may help to predict the success of ureteral access sheath (UAS) placement during retrograde intrarenal surgery (RIRS).The study included 49 patients in whom failure ureteral access sheath placement in RIRS and 49 control group patients who were successfully placement between January 2023 and December 2023. The age, gender, body mass index (BMI), non-contrast computed tomography (NCCT), and kidney ureter bladder (KUB) radiographs were compared between the two groups. Measurements of the anteroposterior (ap) diameter of the pelvic inlet, anteroposterior diameter of the pelvic outlet, interspinous distance diameter were taken from non-contrast computed tomography (NCCT), while pelvic anteroposterior diameter and pelvic lateral diameter were measured from kidney ureter bladder (KUB) radiography. There were no significant differences between the groups in age, gender, body mass index, ap pelvic inlet diameter, ap pelvic outlet, and interspinous distance diameter. However, a statistically significant difference was found between the pelvic ap diameter and pelvic lateral diameter values measured on the KUB radiography. The values for pelvic ap diameter and pelvic lateral diameter measured in the KUB radiographs can be used to predict the likelihood of UAS passage during RIRC procedures. However, further studies with larger patient groups are needed to establish a cut-off value.

Renal colic

Renal colic accounts for 5-10% of all emergency department visits, making it acommon condition in acute medicine. The typical clinical presentation is an early indication of urolithiasis. Diagnostic measures include laboratory tests, ultrasound, and low-dose noncontrast computed tomography (CT) scans. Kidney, ureter, bladder (KUB) plain film radiography has been widely replaced by low-dose noncontrast CT with similar radiation dosage. In special patient groups such as children or pregnant women, ionizing radiation should be avoided if possible. General measures involve pain management (non-steroidal anti-inflammatory agents, opioids) and empirical antibiotic treatment for suspected bacterial infection. Depending on the location/size of the stone, pharmacological stone expulsion therapy may be considered. In cases of obstructive pyelonephritis or acute renal insufficiency, early urinary drainage (JJ stent/nephrostomy) is recommended. Definitive stone removal may be performed primarily in some cases (rather small and rather distal ureterolithiasis). It is common to schedule stone removal as asecondary intervention.

CASE SERIES AND REVIEW ON THE MANAGEMENT OF BLADDER CALCULI CAUSED BY IUD MIGRATION

Objective: Comparing two cases of the management of bladder calculi caused by Intra Uterine Device (IUD) migration with other similar cases worldwide. Case(s) Presentation: A forty-eight-year-old woman diagnosed by Abdominal Non-contrast Computed Tomography (NCCT), already done IUD extraction through the bladder approach also hysteroscopy to evaluate the position from the womb side, and continued with the stone removal by vesicolithotripsy. The second case revealed a bladder stone with IUD tail presence based on Kidney Ureter Bladder (KUB), performed vesicolithotomy, and IUD was found attached to the stone. Both patients’ conditions improved after surgeries. IUD migration into the bladder causes perforation, stone formation, and Urinary Tract Infection (UTI). NCCT, KUB, and Ultrasonography can be used as imaging modalities for initial screening when IUD migration is suspected. Discussion: The managements consist of open cystolithotomy, transurethral grasping forceps, or minimally invasive laparoscopy. Open and laparoscopic surgery should be considered for the IUD removal with partial penetration due to vesicouterine fistula and high-risk stone removal, especially for the large stone with IUD embedded inside. Conclusion: Minimally invasive methods are efficient, safe, and frequently preferred for the bladder stone caused by IUD migration. Keywords: Bladder stone, IUD, migration.

Predicting osteoporosis from kidney-ureter-bladder radiographs utilizing deep convolutional neural networks

Osteoporosis is a common condition that can lead to fractures, mobility issues, and death. Although dual-energy X-ray absorptiometry (DXA) is the gold standard for osteoporosis, it is expensive and not widely available. In contrast, kidney-ureter-bladder (KUB) radiographs are inexpensive and frequently ordered in clinical practice. Thus, it is a potential screening tool for osteoporosis. In this study, we explored the possibility of predicting the bone mineral density (BMD) and classifying high-risk patient groups using KUB radiographs. We proposed DeepDXA-KUB, a deep learning model that predicts the BMD values of the left hip and lumbar vertebrae from an input KUB image. The datasets were obtained from Taiwanese medical centers between 2006 and 2019, using 8913 pairs of KUB radiographs and DXA examinations performed within 6 months. The images were randomly divided into training and validation sets in a 4:1 ratio. To evaluate the model's performance, we computed a confusion matrix and evaluated the sensitivity, specificity, accuracy, precision, positive predictive value, negative predictive value, F1 score, and area under the receiver operating curve (AUROC). Moderate correlations were observed between the predicted and DXA-measured BMD values, with a correlation coefficient of 0.858 for the lumbar vertebrae and 0.87 for the left hip. The model demonstrated an osteoporosis detection accuracy, sensitivity, and specificity of 84.7 %, 81.6 %, and 86.6 % for the lumbar vertebrae and 84.2 %, 91.2 %, and 81 % for the left hip, respectively. The AUROC was 0.939 for the lumbar vertebrae and 0.947 for the left hip, indicating a satisfactory performance in osteoporosis screening. The present study is the first to develop a deep learning model based on KUB radiographs to predict lumbar spine and femoral BMD. Our model demonstrated a promising correlation between the predicted and DXA-measured BMD in both the lumbar vertebrae and hip, showing great potential for the opportunistic screening of osteoporosis.

Towards the establishment of national diagnostic reference levels for abdomen, KUB, and lumbar spine x-ray examinations in Sri Lanka: a multi-centric study

Diagnostic reference levels (DRLs) and achievable doses (ADs) provide guidance to optimise radiation doses for patients undergoing medical imaging procedures. This multi-centre study aimed to compare institutional DRLs (IDRLs) across hospitals, propose ADs and multi-centric DRLs (MCDRLs) for four common x-ray examinations in Sri Lanka, and assess the potential for dose reduction. A prospective cross-sectional study of 894 adult patients referred for abdomen anteroposterior (AP), kidney-ureter-bladder (KUB) AP, lumbar spine AP, and lumbar spine lateral (LAT) x-ray examinations was conducted. Patient demographic information (age, sex, weight, BMI) and exposure parameters (tube voltage, tube current-exposure time product) were collected. Patient dose indicators were measured in terms of kerma-area product (PKA) using a PKA meter. IDRLs, ADs, and MCDRLs were calculated following the International Commission on Radiological Protection guidelines, with ADs and MCDRLs defined as the 50th and 75th percentiles of the median PKA distributions, respectively. IDRL ranges varied considerably across hospitals: 1.42–2.42 Gy cm2 for abdomen AP, 1.51–2.86 Gy cm2 for KUB AP, 0.83–1.65 Gy cm2 for lumbar spine AP, and 1.76–4.10 Gy cm2 for lumbar spine LAT. The proposed ADs were 1.82 Gy cm2 (abdomen AP), 2.03 Gy cm2 (KUB AP), 1.27 Gy cm2 (lumbar spine AP), and 2.21 Gy cm2 (lumbar spine LAT). MCDRLs were 2.24 Gy cm2 (abdomen AP), 2.40 Gy cm2 (KUB AP), 1.43 Gy cm2 (lumbar spine AP), and 2.38 Gy cm2 (lumbar spine LAT). Substantial intra- and inter-hospital variations in PKA were observed for all four examinations. Although ADs and MCDRLs in Sri Lanka were comparable to those in the existing literature, the identified intra- and inter-hospital variations underscore the need for dose reduction without compromising diagnostic information. Hospitals with high IDRLs are recommended to review and optimise their practices. These MCDRLs serve as preliminary national DRLs, guiding dose optimisation efforts by medical professionals and policymakers.

Choosing Wisely audit: CT KUB ordering in emergency department renal colic presentations.

Our aim was to safely reduce unnecessary CT KUBs (kidneys, ureters, bladder) in patients with renal colic. This was a before and after intervention observational study of 74 patients in April 2023 and 57 patients in October 2023. Seventy-five per cent of patients with suspected renal colic underwent a CT KUB in the pre-audit period. Following education, an update in the ED Renal Colic Policy, electronic medical record ordering and short stay pathway, a re-audit was undertaken in October 2023 resulting in an absolute reduction of 15% of CT KUBs ordered. Audit interventions can reduce unnecessary CT KUBs in renal colic.

Optimal duration of medical expulsive therapy for lower ureteral stones: a critical evaluation

To evaluate the optimal duration of Medical Expulsive Therapy (MET) application for distal ureteric stones on a time period based manner. 89 patients with 5–10 mm distal ureter stones received tamsulosin (0.4 mg) for MET and diclofenac sodium (75 mg) for analgesia. Patients were evaluated once a week for 4 weeks. Radiologic stone passage was evaluated by kidney ureter bladder (KUB) and ultasonography where non-contrast computed tomography (NCCT) was also performed if needed. While 23 cases (28.4%) were SF after first week, 23 were SF (28.4%) after 2 weeks, 9 cases (11.1%) after 3 and lastly 7 cases (8.6%) became SF after four weeks. Nineteen (23.5%) cases were not SF after 4 weeks. A positive relationship was found between the time period elapsed for stone passage and ureteral wall thickness (UWT) along with the degree of hydronephrosis. In addition, mean number of renal colics and emergency department (ED) visits were found to be higher in patients passing stones in the 4th week along with the ones who could not despite MET. SFR for distal ureteric stones sizing 5–10 mm was higher within the first 3 weeks under MET application. Thus, waiting for a longer period of time may result in increased analgesic and unnecessary MET treatment with increased risk of emergency department visits and additional costs as well. We believe that other options could be considered in such cases who are not SF at the end of the first 3 weeks.

Identification of kidney stones in KUB X-ray images using VGG16 empowered with explainable artificial intelligence

A kidney stone is a solid formation that can lead to kidney failure, severe pain, and reduced quality of life from urinary system blockages. While medical experts can interpret kidney-ureter-bladder (KUB) X-ray images, specific images pose challenges for human detection, requiring significant analysis time. Consequently, developing a detection system becomes crucial for accurately classifying KUB X-ray images. This article applies a transfer learning (TL) model with a pre-trained VGG16 empowered with explainable artificial intelligence (XAI) to establish a system that takes KUB X-ray images and accurately categorizes them as kidney stones or normal cases. The findings demonstrate that the model achieves a testing accuracy of 97.41% in identifying kidney stones or normal KUB X-rays in the dataset used. VGG16 model delivers highly accurate predictions but lacks fairness and explainability in their decision-making process. This study incorporates the Layer-Wise Relevance Propagation (LRP) technique, an explainable artificial intelligence (XAI) technique, to enhance the transparency and effectiveness of the model to address this concern. The XAI technique, specifically LRP, increases the model's fairness and transparency, facilitating human comprehension of the predictions. Consequently, XAI can play an important role in assisting doctors with the accurate identification of kidney stones, thereby facilitating the execution of effective treatment strategies.

Determining the Stone Free Rate of Retrograde Intrarenal Surgery. Which Radiological Technique? RIRSearch Study Group

ObjectiveTo evaluate the sensitivity and specificity of ultrasonography and kidney ureter bladder radiography(KUB) for the determination of stone free status of retrograde intrarenal surgery(RIRS) according to different stone free status definitions. Materials and methodsThe patients who underwent RIRS between September 2021 and September 2022 were prospectively included in the study. All patients underwent a KUB radiography, urinary system ultrasonography and non-contrast abdominal tomography(NCCT) at the postoperative first month of the surgery. The sensitivity, specificity, negative predictive factor, and positive predictive factor of ultrasonography and KUB on evaluating the stone free rate were analyzed according to different stone free status definitions. ResultsA total of 178 patients were included in the study. The stone free rates according to stone free definitions as; residual stone<4mm,<2mm and no residual stone were 79.2%,64.0% and 56.7%,respectively. According to its definition as a residual stone<4mm, the sensitivity and specificity of ultrasonography were 64.9% and 84.3%,respectively. The sensitivity of ultrasonography was 57.1% and 52.5% as the definitions were residual stone<2 mm and no residual stone,respectively. Addition of KUB to USG slightly increased the sensitivity but did not change the specificity. ConclusionUltrasonography had high specificity but low sensitivity for evaluating stone free status after RIRS and addition of KUB did not increase the diagnostic efficacy. Although USG may be used in daily practice, it may overestimate the stone free status and NCCT must be used during the clinical trials to document the exact stone free rates of RIRS.

Selective angioembolization in symptomatic renal angiomyolipoma: A series of four cases along with review of literature

Abstract The management of renal angiomyolipoma (R-AML) should be characterized on the basis of symptoms and/or the presence of associated risk factors of hemorrhage. In total, four cases of large symptomatic R-AML were visited in our urology out-patient department within the 9-month period. They underwent selective angioembolization (SAE) and were followed up for at least 3 months. Case 1—A 40-year-old female with bilateral R-AML, largest 4 cm × 8 cm × 9 cm lesion on right kidney. Postangioembolization, she underwent a right partial nephrectomy and is in further follow-up with contrast-enhanced computed tomography of the kidney ureter bladder (KUB) region (CECT KUB). Case 2—A 36-year-old female had bilateral large R-AML associated with active bleeding and perinephric hematoma on her right side and underwent urgent SAE. Follow-up CECT KUB revealed bilateral large AML with no evidence of perinephric hematoma. Now, we are planning for a bilateral partial nephrectomy. Case 3—A 52-year-old female with symptomatic 54 × 53 mm left mid-pole R-AML. She developed postembolization syndrome and managed it conservatively. Follow-up CECT KUB revealed a marked reduction of the left R-AML lesion (1 cm × 1 cm). Case 4—A 41-year-old female with 44 mm × 40 mm exophytic upper pole right R-AML with active bleed underwent urgent SAE. Follow-up CECT KUB revealed right kidney AML lesion size reduction (27 mm × 28 mm) with no perinephric hematoma. SAE is better suited for AML with acute hemorrhage or patients with multiple comorbidities or multiple AML lesions. For large AMLs, SAE can also be used before surgery to decrease the size of tumors and the possibilities of procedural difficulty for nephron-sparing surgery.

Ureteral Access Sheath Assisted Percutaneous Antegrade Ureteroscopic Lithotripsy for Impacted Ureteral Calculus

We retrospectively evaluated the safety and effectiveness of ureteral access sheath-assisted percutaneous antegrade ureteroscopic lithotripsy in treating ureteral calculus. Between January 2016 and April 2022, 28 patients with ureteral calculus received ureteral access sheath-assisted percutaneous antegrade ureteroscopic lithotripsy. At postoperative 1 month, a plain computed tomography (CT) and kidney ureter bladder X-ray (KUB) were performed to assess stone fragmentation and hydronephrosis. According to postoperative imaging, stone-free was defined as residual fragments 4 mm or less on KUB and 2 mm or less on CT. The mean stone size was 16.3 mm (3-43 mm). The mean stone volume was 1.91 ml (0.13-6.1 ml). The mean operative time was 140 min (60-222 min). Stone-free rate (SFR) was 89.3% on KUB, and 82.1% on CT. Three patients (10.7%) had postoperative fever greater than 38.5°C. There were no complications of grade III or higher according to the modified Clavien-Dindo classification. In the Ellenbogen classification, improvement was observed in hydronephrosis of Grade II or lower. Improvement was also observed in cases with Grade III hydronephrosis. However, due to the presence of residual renal atrophy, there was no change in the classification. The preoperative eGFR was 63 ml/min/1.73 m² (36-101 ml/min/1.73 m²) and the postoperative eGFR was not improved. We conclude that ureteral access sheath-assisted percutaneous antegrade ureteroscopic lithotripsy is effective for treating impacted ureteral calculus.

Does KUB play a role in the diagnosis of bladder bowel dysfunction?

Kidney ureter bladder radiography (KUB) is widely used for the evaluation of constipation in children with bladder and bowel dysfunction (BBD); however, there is varying evidence to support its routine diagnostic use. One drawback to KUB is radiation exposure. The dangers of radiation in children are well-documented, and per As Low As Reasonably Achievable, non-beneficial radiation should be avoided. This risk is especially high in children who undergo repeated imaging in the follow up of constipation treatment. We sought to assess the utility of KUB in diagnosing children with BBD by comparing it to four diagnostic tests and/or validated instruments: the Dysfunctional Voiding Symptom Score (DVSS), Rome IV criteria, rectal diameter on ultrasound (RD), and the Bristol Stool Form Score (BSFS). We prospectively enrolled a cohort of patients presenting to an academic pediatric urology practice with symptoms of BBD. Severity of stool burden on KUB (mild, moderate, or severe), RD on ultrasound (≥3.4cm), DVSS, Rome IV, and BSFS were obtained for each patient. All imaging was interpreted by a pediatric radiologist and pediatric urologist. Primary outcomes were the association between the four diagnostic tests and KUB stool burden. Bivariate analysis of all individual variables versus KUB was performed, as well as multivariate regressions to determine if multiple measures were predictive of KUB stool burden when combined. Between October 2020 and May 2022, 50 patients were enrolled. All children were under the age of 18, with a median age of 8 years (IQR 3-13). 38% were male. Median BMI-for-age-percentile was 80.8 (IQR 50.3-98.3). When comparing individual variables to KUB in bivariate analyses, it was found that RD on ultrasound is predictive of significant stool burden on KUB (p=0.03). No other individual variables were predictive. In the multivariate analyses, no combination of tests was found to be predictive of KUB. We compared the effectiveness of four commonly used diagnostic tests in children with BBD to validate the use of KUB. In conclusion, our results support the use of RD on ultrasound as a non-radiating alternative to KUB to assess stool burden. Data also suggest that KUB for fecal load does not correlate with urinary (DVSS) or bowel (Rome IV, BSFS) symptoms in BBD, and that symptoms scores should still be used independently for diagnosis and monitoring of treatment response. In conclusion, KUB has a limited role in the diagnosis of BBD.

Establishment of diagnostic reference levels in computed tomography in two large hospitals in Oman.

This study aimed to estimate diagnostic reference levels (DRLs) for the most frequent computed tomography (CT) imaging examinations to monitor and better control radiation doses delivered to patients. Seven CT imaging examinations: Head, Chest, Chest High Resolution (CHR), Abdomen Pelvis (AP), Chest Abdomen Pelvis (CAP), Kidneys Ureters Bladder (KUB) and Cardiac, were considered. CT dosimetric quantities and patient demographics were collected from data storage systems. Local typical values for DRLs were calculated for CTDIvol (mGy), dose length product (DLP) (mGy·cm) and effective doses (mSv) were estimated for each examination. The calculated DRLs were given as (median CTDIvol (mGy):median DLP (mGy·cm)): Head: 39:657; Chest: 13:451; CHR: 6:228; AP: 12:578; CAP: 20:807; KUB: 7:315, and Cardiac: 2:31. Estimated effective doses for Head, Chest, CHR, AP, CAP, KUB and Cardiac were 1.3, 12.7, 6.3, 12.5, 18.1, 5.8 and 0.8mSv, respectively. The estimated DRLs will act as guidance doses to prevent systematic excess of patient doses.

Design and Validation of a Deep Learning Model for Renal Stone Detection and Segmentation on Kidney-Ureter-Bladder Images.

Kidney-ureter-bladder (KUB) imaging is used as a frontline investigation for patients with suspected renal stones. In this study, we designed a computer-aided diagnostic system for KUB imaging to assist clinicians in accurately diagnosing urinary tract stones. The image dataset used for training and testing the model comprised 485 images provided by Kaohsiung Chang Gung Memorial Hospital. The proposed system was divided into two subsystems, 1 and 2. Subsystem 1 used Inception-ResNetV2 to train a deep learning model on preprocessed KUB images to verify the improvement in diagnostic accuracy with image preprocessing. Subsystem 2 trained an image segmentation model using the ResNet hybrid, U-net, to accurately identify the contours of renal stones. The performance was evaluated using a confusion matrix for the classification model. We conclude that the model can assist clinicians in accurately diagnosing renal stones via KUB imaging. Therefore, the proposed system can assist doctors in diagnosis, reduce patients' waiting time for CT scans, and minimize the radiation dose absorbed by the body.

A randomized comparative study of flexible ureterorenoscopy versus mini-percutaneous nephrolithotomy for treatment of renal stones 2 cm or less

Abstract Background Flexible ureterorenoscopy (fURS) and mini-percutaneous nephrolithotomy (mPCNL) have been increasingly used for the treatment of renal stones. However, current guidelines do not recommend one modality over the other. The aim of this study is to compare the safety and efficacy of treatment with fURS versus mPCNL for renal stones sized 2 cm or less. Materials and methods A prospective, randomized, comparative study was conducted between January 2019 and July 2021 at 3 tertiary care urology centers. Inclusion criteria were adult patients with renal stone(s) ≤ 2 cm with inappropriateness or failure of extracorporeal shock-wave lithotripsy. Subjects were assigned to 1 of 2 treatment groups, either mPCNL or fURS. Two primary outcomes were assessed: (1) initial success rate, defined as the absence of clinically significant residual fragments (&gt;2 mm) on kidney ureter bladder X-ray and ultrasound on the first postoperative day; and (2) complications, which were reported according to the Modified Clavien-Dindo classification system. Secondary outcomes included final success rate, defined as the absence of clinically significant residual fragments on noncontrast computed tomography on the 90th postoperative day; operative time; auxiliary procedures and blood transfusion rates; hemoglobin drop; and length of hospital stay. Results One hundred and eighteen procedures were analyzed (59 in each group). The initial success rate of the mPCNL group (93%) was significantly higher than that of the fURS group (70%). Complications occurred more frequently with mPCNL than fURS (44.1% vs. 18.6%, respectively). Final success rate, operative time, and length of hospital stay were comparable between the 2 groups. Conclusions Mini-percutaneous nephrolithotomy is more effective than fURS as a single-step treatment for renal stones &lt;2 cm because of its higher initial success rate and lower auxiliary procedure rate. However, mPCNL results in significantly higher complication rates than fURS.

Correlation analysis between renal anatomical factors and residual stones after an ultrasound-guided PCNL.

To predict the factors of residual stones after percutaneous nephrolithotomy (PCNL) by analyzing the characteristics of the renal anatomical structure in intravenous urography, so as to make a reasonable operation plan, reduce the risk of residual stones in PCNL, and improve the stone-free rate (SFR). A retrospective study was performed between January 2019 and September 2020 for patients treated with PCNL. According to the results of a kidney ureter bladder review after PCNL, 245 patients were divided into a residual stone group (71 patients, stone size >4 mm) and a stone-free group (174 patients, stone size ≤4 mm). An independent sample t-test was used to analyze the age, the length and width of channel calices, the angle between the channel calices and the involved calices, and the length and width of the involved calices. The gender, the channel types, the number of channels, the degree of hydronephrosis, and the number of involved calices were analyzed by using the chi-square test. A score of p < 0.05 was considered statistically significant. At the same time, logistic regression analysis was carried out to explore the independent influencing factors of the SFR after PCNL. A total of 71 patients developed residual stones after surgery. The overall residual rate was 29.0%. The width of the channel calices (p = 0.003), the angle between the channel calices and the involved calices (p = 0.007), the width of the involved calices (p < 0.001), the channel types (p = 0.008), and the number of involved calices (p < 0.001) were all significantly correlated with residual stones after PCNL. Logistic regression analysis showed that the width of the channel calices (p = 0.003), the angle between the channel calices and the involved calices (p = 0.012), the width of the involved calices (p < 0.001), the channel types (p = 0.008), and the number of involved calyces (p < 0.001) were all independent influencing factors of the SFR after PCNL. A larger caliceal neck width and angle can reduce the risk of residual stones. The more calyces that are involved, the higher the risk of residual stones. There was no difference between F16 and F18, but F16 had a higher SFR than F24.

MP23-01 A RANDOMISED CONTROLLED STUDY COMPARING STANDARD TUBELESS PCNL &amp; TUBELESS MINI-PCNL FOR RENAL STONES LESS THAN 2 CM

You have accessJournal of UrologyCME1 Apr 2023MP23-01 A RANDOMISED CONTROLLED STUDY COMPARING STANDARD TUBELESS PCNL & TUBELESS MINI-PCNL FOR RENAL STONES LESS THAN 2 CM Aditya Yelikar Aditya YelikarAditya Yelikar More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003248.01AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: PCNL has become a standard minimally invasive treatment for renal stones. Tubeless PCNL is associated with less morbidity. Miniaturisation of instruments leads decrease morbidity of procedure. We compared standard tubeless PCNL to Miniperc tubeless PCNL for morbidity and stone free rates in order to improve outcomes of PCNL with minimal morbidity. METHODS: Our study included 100 patients, 50 patients in group 1 (standard tubeless PCNL) & 50 patients in group 2 (tubeless mini PCNL) , with single renal stone less than 2 cm. Patients with CKD, solitary kidney, ectopic kidney and previous diversion were excluded. Tract was dilated upto 24 Fr in group 1 & upto 16 Fr in group 2. No percutaneous nephrostomy was kept. Post operative pain score was monitored at 12 and 24 hours. Additional analgesia was given if needed. Hemoglobin was measured pre operatively & on post op day 1. Stone clearance was checked with ultrasonography & XRay KUB (kidney-ureter-bladder). Total Operative time , pain score, analgesic requirement, haemoglobin drop, complications (bleeding, fever, urinary leak, urosepsis, hydro or pneumothorax) and stone free rate were compared. RESULTS: Miniperc operative time was longer than standard PCNL (45±10 vs 35±8 mins. p<0.001). Median pain score at 12 and 24 hours was more in group 1 than in group 2 (6±1 VS 4±1, p<0.0001 and 3±1 vs 2±1, p<0.001). Post operative hemoglobin drop was more in group 1 than in group 2 (0.95±0.2 VS 0.6±0.1, p<0.0001). Stone clearance in group 1 was 100% while in group 2 it was 95%. There was no significant difference in complications between the two groups. CONCLUSIONS: Both Standard tubeless PCNL & tubeless Mini PCNL are effective for renal stones less than 2 cm. Operative time is more in tubeless Mini PCNL whereas pain score, analgesics requirement and hemoglobin drop are more in standard tubeless PCNL comparatively. Stone clearance in both groups is comparable and more than 95%. Source of Funding: Nil © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e306 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Aditya Yelikar More articles by this author Expand All Advertisement PDF downloadLoading ...

Comparison between Retrograde Flexible Ureteroscopy and Percutaneous Nephrolithotomy for the Treatment of Renal Stones of 2-4 cm.

Background and objectives: Renal stones are widespread, with a lifetime prevalence of 10% in adults. Flexible ureteroscopy enables urologists to treat lower calyx stones or even complex renal stones through the natural orifice and achieve an acceptable stone-free rate. Hence, we analyzed the effectiveness and safety of FURS versus PCNL in treating renal stones between 20 and 40 mm in diameter. Materials and methods: We retrospectively analyzed 250 consecutive patients with large renal solitary stones (stone burden between 2 and 4 cm) from 1 January 2019 to 31 December 2020. The patients were divided into two groups: group 1 (125 patients), in which the patients were treated by a retrograde flexible ureteroscopic approach, and group 2 (125 patients), in which we used percutaneous nephrolithotomy. Stone characteristics and anatomical data were observed based on the computed tomography (CT) and/or KUB (Kidney-ureter-Bladder) radiography imaging archive. Results: The mean stone burden was 26.38 ± 4.453 mm in group 1 and 29.44 ± 4.817 mm in group 2. The stone-free rate after the first ureteroscopy was higher for the PNL(percutaneous nephrolithotomy) group (90.4%) than the F-URS group (68%). After two sessions of ureteroscopy, the SFR was 88.8% in the first group, and after three procedures, the SFR rose to 95.2%. The overall complication rate was higher in group 1 than in group 2 (18.4% vs. 16.8%), but without statistical relevance (p &gt; 0.5). Furthermore, we encountered more grade III and IV complications in the PNL group (8.8% vs. 4.8%, p &lt; 0.05). Conclusion: Flexible ureteroscopy proves to be efficient in treating renal stones over 2 cm. However, the patients must be informed that more than one procedure might be necessary to overcome the entire stone burden.