Kidney Ureter 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.

Retrospective study on pain management pathway for patients with suspected renal/ ureteric colic in a U.K. accidents and emergency department: A quality improvement project

Background In acute settings around the globe, renal/ureteric colic remains one of the most common diagnoses for patients presenting with loin-to-groin pain. Even though management spans from medical expulsive therapies to surgical options, pain as a significant component of a patient’s presentation must be dealt with quickly, decisively, and safely, as it can be excruciating and its effects on overall health are dire. This study aimed to explore compliance with the National Institute for Health and Care Excellence (NICE) guidelines for pain management in patients with suspected renal/ureteric colic. It includes the use of nonsteroidal anti-inflammatory drugs (NSAIDs), intravenous paracetamol, and opioids as first-, second-, and third-line analgesics, respectively, and does not offer antispasmodics. In the event of deviations from the standard, the aim was to put in corrective measures, followed by re-exploration of compliance with patient care. Methods This study involved a single healthcare facility with the study type being retrospective before interventions and prospective after interventions. In the first cycle, we retrieved and analysed 78 patients records whom had been suspected to have renal/ureteric colic between July and September 2022. The inclusion criteria were documented complaints of “flank/loin-to-groin pain” and diagnosis prior to performing diagnostic tests. We surveyed the first-, second-, and third-line painkillers issued, and whether an antispasmodic was given. We collected and entered data into a Microsoft Excel file and correlated it with NICE standards. Having found deviations from the standard, we conducted interventions, allowed time for clinicians to adapt, and re-explored compliance using patient case records [n=58] between February and May 2023. Results In the 1st cycle, 78 patients were suspected of having renal/ureteric colic. M: F = 1.2:1. Non-contrast computerized tomography of the kidney ureters and bladder (NC-CTKUB) confirmed 87% of patients with stones and 3% had no stones. NC-CTKUB was not performed in 9% of patients because they were young, and urinalysis showed no microscopic hematuria. One patient had discharged against medical advise before the NC-CTKUB was performed. Compliance with the NICE pain management guidelines for suspected renal/ureteric colic was full in 23% of cases but unsatisfactory in 78% of cases. In the 2nd cycle, M: F = 1.5:1, NC-CTKUB was not re-audited, as the first cycle study yielded excellent results, and our action plan resulted in an NICE pain management compliance rate of 56%. Although our interventions resulted in improvements of more than twice the initial results, work still needs to be performed. Conclusion Clinicians’ ability to correctly diagnose renal/ureteric colic is remarkable. However, the pain management compliance rate indicates room for improvement. This may be due to the limited awareness of the NICE guideline or the fact that the clinical team has an affinity for certain analgesics compared to others. We propose the need to consider select variables to existing standard guidelines to enhance compliance for improved patient care.

Genetically Modified Porcine Kidneys Have Sufficient Tissue Integrity for Use in Pig-to-Human Xenotransplantation.

We sought to determine if genetically modified porcine kidneys used for xenotransplantation had sufficient tissue integrity to support long-term function in a human recipient. Kidney transplantation remains the best available treatment for patients with end-stage kidney disease. However, a shortage of available donor human kidneys prevents many patients from achieving the benefits of transplantation. Xenotransplantation is a potential solution to this shortage. Recent pre-clinical human studies have demonstrated kidneys from genetically modified pig donors can be transplanted without hyperacute rejection and are capable of providing creatinine and other solute clearance. It is unknown whether the porcine kidneys would tolerate the relatively higher resting blood pressure in an adult human recipient compared with the pig donor or non-human primate (NHP) recipients used in translational studies. Furthermore, previous experience in NHPs raised concerns about the tissue integrity of the porcine ureter and post-xenotransplant growth of the porcine kidney. Kidneys recovered from porcine donors with 10 gene edits were transplanted into decedent brain-dead recipients who were not eligible for organ donation. Decedents underwent bilateral native nephrectomy before transplant and were followed for 3 to 7 days. Standard induction and maintenance immunosuppression was used as previously reported. Vital signs, including blood pressure, were recorded frequently. Kidney xenografts were assessed daily, serially biopsied, and were measured at implantation and study completion. Three decedents underwent successful xenotransplantation. Subcapsular hematomas developed, requiring incision of the xenograft capsules to prevent Page kidney. Blood pressures were maintained in a physiologic range for adult humans (median arterial pressures (MAP) 108.5mmHg (Interquartile Range (IQR): 97-114mmHg), 74mmHg (IQR: 71-78mmHg), and 95mmHg (IQR: 88-99mmHg, respectively) and no bleeding complications or aneurysm formation was observed. Serial biopsies were taken from the xenografts without apparent loss of tissue integrity despite the lack of a capsule. Ureteroneocystotomies remained intact without evidence of urine leak. Xenograft growth was observed, but plateaued, in 1 decedent with increased volume of the left and right xenografts by 25% and 26%, respectively, and in the context of human growth hormone levels consistently less <0.1ng/ml and insulin-like growth factor 1 levels ranging from 34-50ng/ml. The findings of this study suggest kidneys from 10-gene edited porcine donors have sufficient tissue integrity to tolerate xenotransplantation into a living human recipient. There was no evidence of anastomotic complications, and the xenografts tolerated needle biopsy without issue. Xenograft growth occurred but plateaued by the study end; further observation and investigation will be required to confirm this finding and elucidate underlying mechanisms.

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.

Evaluation of positioning accuracy, radiation dose and image quality: artificial intelligence based automatic versus manual positioning for CT KUB.

Recent innovations are making radiology more advanced for patient and patient services. Under the immense burden of radiology practice, Artificial Intelligence (AI) assists in obtaining Computed Tomography (CT) images with less scan time, proper patient placement, low radiation dose (RD), and improved image quality (IQ). Hence, the aim of this study was to evaluate and compare the positioning accuracy, RD, and IQ of AI-based automatic and manual positioning techniques for CT kidney ureters and bladder (CT KUB). This prospective study included 143 patients in each group who were referred for computed tomography (CT) KUB examination. Group 1 patients underwent manual positioning (MP), and group 2 patients underwent AI-based automatic positioning (AP) for CT KUB examination. The scanning protocol was kept constant for both the groups. The off-center distance, RD, and quantitative and qualitative IQ of each group were evaluated and compared. The AP group (9.66±6.361 mm) had significantly less patient off-center distance than the MP group (15.12±9.55 mm). There was a significant reduction in RD in the AP group compared with that in the MP group. The quantitative image noise (IN) was lower, with a higher signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR) in the AP group than in the MP group (p<0.05). Qualitative IQ parameters such as IN, sharpness, and overall IQ also showed significant differences (p< 0.05), with higher scores in the AP group than in the MP group. The AI-based AP showed higher positioning accuracy with less off-center distance (44%), which resulted in 12% reduction in RD and improved IQ for CT KUB imaging compared with MP.

Clinical analysis of 80 patients with oblique vaginal septum syndrome

Objective: To investigate the clinical features, diagnosis and treatment of oblique vaginal septum syndrome (OVSS). Methods: The clinical data of 80 patients with OVSS admitted to The Second Hospital of Hebei Medical University from July 2005 to July 2023 were retrospectively analyzed. According to the classification system of OVSS proposed by Female Genital Anomalies Study Group, Chinese Obstetricians and Gynecologists Association in 2021, the patients were divided into four groups. The clinical manifestations, accompanied urinary system abnormalities, diagnosis and treatment methods and treatment outcomes were observed. Results: According to the above classification system, among the 80 patients with OVSS, 35 patients (44%, 35/80) were categorized as type Ⅰ, 33 patients (41%, 33/80) were categorized as type Ⅱ, 2 patients (3%, 2/80) were categorized as type Ⅲ and 10 patients (13%, 10/80) were categorized as type Ⅳ. The main onset symptom of patients was periodic abdominal pain (70%, 56/80), vaginal bleeding (20%, 16/80), dysuria or fecal impaction (15%, 12/80), vaginal mucopurulent discharge (10%, 8/80). The morbidity of combined urinary system abnormalities was 88% (70/80), and the most common urinary system abnormality was ipsilateral renal agenesis (81%, 65/80). Bilateral kidneys were normal in 13% (10/80) patients, and 6% (5/80) were combined with other urinary system abnormalities. A total of 74 patients underwent vaginal oblique septectomy or septum excision. Five of the 10 patients with type Ⅳ underwent hysterectomy on the cervical atresia side, 4 patients received hysteroscopy combined with cervicoplasty+oblique septotomy or septum excision, and one patient selected delayed menstruation. Two patients underwent laparoscopic resection of the dysplasia kidney and ectopic ureter which opening to the vagina. Eleven patients with endometriosis cyst, hydrosalpinx or empyema underwent laparoscopic surgery. Conclusions: The main symptom of type Ⅰ and Ⅳ patients is abdominal pain, while the main symptom of type Ⅱ and Ⅲ patients is bleeding. Magnetic resonance imaging (MRI) has advantages in the evaluation of complex OVSS, and MRI is recommended before operation to exclude other axial reproductive tract dysplasia and complex urinary system dysplasia. If there is leakage of urine, vaginal discharge or complex deformity, it is necessary to multidisciplinary discussion and formulate a reasonable surgical plan. The first treatment is related to the prognosis of patients especially children, and should be highly valued.

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.

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.

Where does it come from? A large pelvi-abdominal mass with points to ponder

Ureteral leiomyosarcoma is a very rare aggressive retroperitoneal malignancy with limited possibility of an accurate pre-operative diagnosis. Incidence of ureter leiomyosarcoma is extremely rare. Hence, there is paucity of reported cases in the literature. We present a case of a 60-year-old postmenopausal woman presenting with abdominal distension and discomfort. This was initially reported as a malignancy arising from left ovary, as the lesion had apparent convergence toward left adnexal region and the left ovary was not seen separately. In addition, there was moderate hydronephrosis of the left kidney and left ureter was not separately made out from the lesion. Leiomyosarcoma should be considered as a differential diagnosis in cases of ureter stricture and retroperitoneal tumors causing ureteric obstruction.

Comparing outcomes of single-use vs reusable ureteroscopes: a systematic review and meta analysis.

Flexible ureterolithotripsy is a frequent urological procedure, usually used to remove stones from the kidney and upper ureter. Reusable uretero-scopes were the standard tool for that procedure, but recent concerns related to sterility and maintenance and repair costs created the opportunity to develop new technologies. In 2016, the first single-use digital flexible ureteroscope was introduced. Since then, other single-use ureteroscopes were developed, and studies compared them with the reusable ureteroscopes with conflicting results. The purpose of this study is to describe the literature that compares the performance of single-use and reusable flexible ureteroscopes in retrograde intrarenal surgery for urinary stones. A Systematic Review was performed in October 2022 in accordance with the Cochrane Handbook and the Preferred Reporting Items for Systematic Reviews and MetaAnalyses (PRISMA). A search in MEDLINE, EMBASE, Web of Science, Google Scholar and LILACS retrieved 10,039 articles. After screening, 12 articles were selected for the Meta-Analysis. No differences were found in stone-free rate (OR 1.31, CI 95% [0.88, 1.97]), operative time (MD 0.12, CI 95% [-5.52, 5.76]), incidence of post-operative fever (OR 0.64, CI 95% [0.22, 1.89]), or incidence of post-operative urinary tract infection (OR 0.63 CI 95% [0.30, 1.32]). No differences were observed in the studied variables. Hence, the device choice should rely on the availability, cost analysis and surgeons' preference.

Causal associations between prostate diseases, renal diseases, renal function, and erectile dysfunction risk: a 2-sample Mendelian randomization study.

Previous observational studies have found a potential link between prostate disease, particularly prostate cancer (PCa), and kidney disease, specifically chronic renal disease (CKD), in relation to erectile dysfunction (ED), yet the causal relationship between these factors remains uncertain. The study sought to explore the potential causal association between prostate diseases, renal diseases, renal function, and risk of ED. In this study, 5 analytical approaches were employed to explore the causal relationships between various prostate diseases (PCa and benign prostatic hyperplasia), renal diseases (CKD, immunoglobulin A nephropathy, membranous nephropathy, nephrotic syndrome, and kidney ureter calculi), as well as 8 renal function parameters, with regard to ED. All data pertaining to exposure and outcome factors were acquired from publicly accessible genome-wide association studies. The methods used encompassed inverse variance weighting, MR-Egger, weighted median, simple mode, and weighted mode residual sum and outlier techniques. The MR-Egger intercept test was utilized to assess pleiotropy, while Cochran's Q statistic was employed to measure heterogeneity. We employed inverse variance weighting MR as the primary statistical method to assess the causal relationship between exposure factors and ED. Genetically predicted PCa demonstrated a causal association with an elevated risk of ED (odds ratio, 1.125; 95% confidence interval, 1.066-1.186; P < .0001). However, no compelling evidence was found to support associations between genetically determined benign prostatic hyperplasia, CKD, immunoglobulin A nephropathy, membranous nephropathy, nephrotic syndrome, kidney ureter calculi, and the renal function parameters investigated, and the risk of ED. The risk of ED is considerably amplified in patients diagnosed with PCa, thereby highlighting the importance of addressing ED as a significant concern for clinicians treating individuals with PCa. This study's strength lies in validating the PCa-ED association using genetic analysis, while its limitation is the heterogeneity in study results. The results of this study suggest a potential link between PCa and a higher risk of ED.

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.

Renal tubular function and morphology revealed in kidney without labeling using three-dimensional dynamic optical coherence tomography

Renal tubule has distinct metabolic features and functional activity that may be altered during kidney disease. In this paper, we present label-free functional activity imaging of renal tubule in normal and obstructed mouse kidney models using three-dimensional (3D) dynamic optical coherence tomography (OCT) ex vivo. To create an obstructed kidney model, we ligated the ureter of the left kidney for either 7 or 14 days. Two different dynamic OCT (DOCT) methods were implemented to access the slow and fast activity of the renal tubules: a logarithmic intensity variance (LIV) method and a complex-correlation-based method. Three-dimensional DOCT data were acquired with a 1.3 upmum swept-source OCT system and repeating raster scan protocols. In the normal kidney, the renal tubule appeared as a convoluted pipe-like structure in the DOCT projection image. Such pipe-like structures were not observed in the kidneys subjected to obstruction of the ureter for several days. Instead of any anatomical structures, a superficial high dynamics appearance was observed in the perirenal cortex region of the obstructed kidneys. These findings suggest that volumetric LIV can be used as a tool to investigate kidney function during kidney diseases.

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.

ANALISIS KUALITAS CITRA ANATOMI MSCT UROGRAPHY DENGAN VARIASI INTERATIVE MODEL RECONTRUCTION (IMR)

Background: The urinary system consists of two kidneys and ureters, urinary bladder, and urethra. Various modalities in radiology can be used to radiologically detect abnormalities in the urinary system, one of which is MSCT. MSCT Urography with tracking technique can identify urolithiasis in the ureters. Iterative reconstruction is used to reduce the dose received by the patient without reducing image quality. Iterative Model Reconstruction (IMR) is the second-generation IR algorithm from the previous generation, namely iDose (Philips Healthcare). This study aims to determine the optimal anatomy image quality with IMR variations on non-contra Urography MSCT images using tracking techniques.&#x0D; Methods: This type of research is an experiment with data obtained from a comparison of the quality of anatomical images from tracking images with IMR variations. Place of data collection at the Radiology Installation of RSUD RAA Soewondo Pati. Time for data collection From 2022. An assessment of the quality of the anatomical images was carried out by 2 radiologists. Data analysis was carried out using the Friedman statistical test method. The level of significance (level of significance) is 95% or α&gt; 0.05 and is done by assessing the p-value. For a significant level of assessment p &lt;0.05 then Ho is rejected and p&gt; 0.05 then Ho is accepted.&#x0D; Results: There are differences in information on each anatomy of the renal parenchyma, pelvic calices, ureters, and perirenal space in the use of IMR variations. The results showed that the optimal IMR variation value was IMR 3 with a mean rank value of 2.7. Increasing the use of IMR levels reduces noise and increases spatial resolution, so that IMR level 3 has the best assessment of anatomical information.&#x0D; Conclusions: We recommend that the non-contrast MSCT Urography examination with the Tracking Technique use IMR 3 which can produce optimal anatomical image information on the kidney parenchyma, pelvic calices, ureters, and perirenal space.

Computed Tomography Urography: State of the Art and Beyond.

Computed Tomography Urography (CTU) is a multiphase CT examination optimized for imaging kidneys, ureters, and bladder, complemented by post-contrast excretory phase imaging. Different protocols are available for contrast administration and image acquisition and timing, with different strengths and limits, mainly related to kidney enhancement, ureters distension and opacification, and radiation exposure. The availability of new reconstruction algorithms, such as iterative and deep-learning-based reconstruction has dramatically improved the image quality and reducing radiation exposure at the same time. Dual-Energy Computed Tomography also has an important role in this type of examination, with the possibility of renal stone characterization, the availability of synthetic unenhanced phases to reduce radiation dose, and the availability of iodine maps for a better interpretation of renal masses. We also describe the new artificial intelligence applications for CTU, focusing on radiomics to predict tumor grading and patients' outcome for a personalized therapeutic approach. In this narrative review, we provide a comprehensive overview of CTU from the traditional to the newest acquisition techniques and reconstruction algorithms, and the possibility of advanced imaging interpretation to provide an up-to-date guide for radiologists who want to better comprehend this technique.