Large Stones Research Articles

The investment component of the development of the agrarian sector of the economy of Ukraine in the conditions of european integration: problems and prospects

The article examines the problems of investment support in the agricultural sector of Ukraine's economy in modern conditions and identifies promising directions for improving the investment climate. It has been established that in the process of creating a market economy in Ukraine and European integration processes, there is a need for complex searches for ways of development and determination of the role and place of the state in these economic transformations. The experience of developed democratic countries shows that there is no single solution to this problem, and the degree of state intervention in the economy of different countries varies. The directions of the transformation of the agrarian-industrial complex in Ukraine since independence have been determined. It has been proven that before the start of the full-scale war, the agricultural sector in Ukraine was one of the most profitable branches of the Ukrainian economy. It contributed to a significant contribution to the GDP and preservation of land resources in a satisfactory condition. A number of problems in the agrarian sector of Ukraine's economy, which inhibit its development, are highlighted: insufficient transparency in matters of land ownership; non-compliance with quality and safety standards established by international organizations; limited investment level; insufficient adaptation of Ukrainian legislation to the requirements of the European Union; the problem of reforming the market and its structure; dependence on state funding; lack of innovative activity; problems in the field of logistics and supplies. The assessment of direct losses in the field of agro-industrial complex and agricultural infrastructure, which were the result of constant attacks by the Russian armed forces, is presented. Among the components of these losses, the largest ones that have become the most financially significant should be indicated: agricultural machinery, finished agricultural products, and grain storages. It is these losses that can be recognized as significant and such that they do not allow us to talk about the rapid improvement of the situation in the agricultural sector of Ukraine and the attraction of investments. The main vectors of increasing the investment attractiveness of the agrarian sector of the Ukrainian economy are given and a list of measures that must be taken to solve the main problems of the agrarian sector of Ukraine during and after the war, as well as improving the investment component of the development of the agrarian sector of the economy and continuing the European integration processes, is presented.

Перкутанная нефролитотрипсия у детей с использованием инструментария миниатюрного размера.

Introduction. Currently, percutaneous nephrolithotripsy is the main treatment for large and coral-like kidney stones in children. The purpose of the study was to increase the effectiveness of percutaneous nephrolithotripsy (PCNL) in children using miniature-sized instruments. Materials and methods. For the period from 2008 to 2019, 320 children aged 1 to 17 years underwent nephrolithotripsy in the pediatric department of the N. Lopatkin Scientific Research Institute of Urology. Depending on the size of the instruments used, patients were divided into 3 groups. The first group included children who underwent surgery using the Mini-PCNL technique (n-211), the second group included patients operated on using the Ultra-Mini-PCNL method (n-16) and the third group included children whose percutaneous intervention was performed using a standard-sized nephroscope (n-93). The intervention was carried out according to the standard method; all patients underwent cystoscopy, catheterization of the ureter, access formation, lithotripsy, lithoextraction and installation of nephrostomy drainage. Results. In the first group of children studied, complete elimination of clinically significant stones (residual stones smaller than 4 mm) after the initial intervention was achieved in 169 (80.1%) pediatric patients. In the second group, there was 13 (81.2%) children. And in the third group, getting rid of stones was achieved in 73 (78.5%) patients. The average time required to perform surgery in all three study groups was comparable and amounted to 45 (40-125) minutes in the first group, 40 (25-85) minutes in the second, and 50 (40-180) minutes in the third group. The final efficacy of percutaneous nephrolithotripsy in children using instruments of various sizes in the first group was 89.6%, in the second – 93.7% and 88.1% in the third study group. The hospital stay after surgical treatment was: 4 (3-12) days for the first group, 3.5 (3-7) and 4.5 (3-17) days for the second and third groups, respectively. The need for additional interventions after PCNL in pediatric patients was in 69 (32.7%) children in the first group, 4 (25%) in the second and 41 (44.1%) in the third group. Conclusion. The use of mini-PCNL, ultra-mini-PCNL can reduce the duration of surgical intervention by 10% and 20%, the hospital stay after PCNL by 11.2% and 22.3%, the need for additional interventions by 11.4% and 19.1%. Can reduce the total number of complications by 10% and 12.2%, respectively, compared with the use of standard-size instruments. The use of Mini-PCNL in children is indicated in the younger and middle age groups, Ultra-Mini-PCNL is indicated for single stones up to 2 cm or as an additional access in the multi-accesses formation.

Sialolithiasis Disease: Clinical Observations of Large Salivary Stones of The Submandibular Salivary Gland

This article presents clinical observations related to large salivary stones that occur in the submandibular salivary gland in salivary stone disease. The author describes several clinical cases in which salivary concretions of unusually large sizes were discovered and studied. The article presents data on the localization of stones, sizes, as well as complications resulting from their presence. The analysis of the presented clinical observations allows us to draw conclusions about the unusual and rare nature of this type of salivary stone disease. A detailed description of clinical cases, including the results of multispiral tomography and orthopantomogram, allows us to better understand the features of the formation and development of large salivary stones in the submandibular salivary gland. This article has practical value for dentists and medical specialists involved in the diagnosis and treatment of salivary stone disease. It provides additional knowledge about possible complications associated with large salivary stones, and also emphasizes the importance of timely detection and removal of such stones to prevent possible complications and improve the quality of life of patients.

Which Laser System is Optimal for Cystolithotripsy of Large Bladder Calculi?

A variety of laser sources are available to treat bladder stones. The aim of this study was to compare time and cost efficiency of the thulium fiber laser (TFL) to four holmium lasers (HLs) with different powers or technologies, including MOSES™ during simulated cystolithotripsy. In a benchtop simulation of laser cystolithotripsy, 25 identical 4-cm BegoStones (calcium oxalate monohydrate consistency) were placed on a grid within a 3D-printed bladder model. Lasers were operated at maximal energy, using a 550 µm fiber. Lasers compared were: 60W TFL, 120W HL with MOSES™, conventional 120W, 100W, and 30W HLs. Five trials were performed for each laser with endpoints of laser time, total time, number of fiber strippings, and total energy. Cost effectiveness was modelled using laser purchase price, fiber, and OR time cost. ANOVA with Tukey's B post hoc was performed to compare outcomes. Spearman's test was used to assess correlation between laser power and procedure time. The laser and total operating times were significantly different between the five systems (p<0.001). The 120W HL with MOSES™ was the fastest with 60.9 min laser and 68.3 min procedure times, while the 30W HL was the slowest with 281.2 min laser and 297.5 min procedure times. The 60W TFL was faster than the 30W HL, but slower than the higher power HLs. Higher laser power was associated with shorter procedure time (Rs=-0.98; p=0.002). When estimating cost per procedure, the MOSES™ HL was the cheapest, but had the highest purchase cost. The TFL was not cost-effective for large bladder stones compared to the 100W HL. When treating large bladder stones, total laser power was highly correlated with laser and procedure times and the TFL was limited by its total power. The most cost-effective laser for use will depend on the case volume.

Combined semirigid and flexible ureterorenoscopy for the treatment of large renal stones.

Ureteroscopy is recognized as a minimally invasive and readily accessible method with low morbidity, favorable outcomes, and rapid post-interventional recovery. Recent advancements in rigid and flexible ureteroscopes have enhanced their efficiency, durability, and capability to accommodate accessory instruments. In this retrospective analysis, we evaluated 75 consecutive patients with large renal stones (stone burden between 2 and 4 cm) treated using a combination of semirigid and flexible ureteroscopy between January 1, 2020, and December 31, 2021. Stone properties and anatomical information were collected from the image archives derived from computed tomography (CT) and/or KUD radiography. Multiple ureteroscopy sessions were required for bigger stones. The length of the hospital stay, operation time, stone-free rate, preoperative and postoperative complications, and complication rates were examined. The average age of the patients was 52.7 years, with a mean stone burden of 31.45 mm. Most stones were in the renal pelvis, followed by the upper calyx. The average operative time was 56.2 minutes. After the initial ureteroscopy session, the stone clearance rate was 76%, which increased to 92% after two ureteroscopy sessions. Complication rates were evaluated using the Clavien-Dindo modified system, with an overall complication rate of 18.4%. Most of the complications were Clavien Grades I and II, with no grade V complication encountered. Large renal stones can be treated by combining semirigid and flexible ureteroscopy to reduce the operative time and protect the flexible ureteroscope.

Steerable Ureteroscopic Renal Evacuation (SURE) for Large Renal Stones: A Multi-Institutional Center Study.

The results of a recent pilot study suggest that steerable ureteroscopic renal evacuation (SURE) is safe and more effective in stone removal than basketing following laser lithotripsy. The objective of this retrospective study was to further assess the safety and efficacy of SURE using the CVAC® Aspiration System (Calyxo, Inc., Pleasanton, CA) in patients with large stone burdens. Patients with a baseline stone burden of ≥10 mm who underwent SURE were identified. Subject demographics, secondary procedures, complications, and stone clearance (defined as percent baseline volume reduction) were evaluated. Sub-analyses were performed to explore patients identified as high-risk for percutaneous nephrolithotomy (PCNL) because 1) they were on anticoagulation or antiplatelet therapy at the time of procedure, or 2) they had limited mobility due to neurological conditions. Identified patients (N=43) had a mean pre-operative stone burden of 29±12 mm and mean stone volume of 3,092±5,002 mm3. Approximately one-half of patients (n=24, 55.8%) had computerized tomography (CT) imaging at follow-up, and of those, eight (33.3%) had no residual stones, 22 (91.7%) had >90% stone clearance, 23 (95.8%) had >80% stone clearance and 24 (100%) had >60% stone clearance. Stone clearance based on baseline stone burden varied between 93.8% and 98.9%. At baseline, 21 patients were anticipated to require staged ureteroscopy; however, only two of those (9.5%) needed secondary procedures. High-risk patients (n=22) were on anticoagulation or antiplatelet therapy (n=12) or had neurologic conditions (n=10). Stone clearance was 97% among patients in the anticoagulated cohort with postoperative CT imaging, and 83% in patients with neurologic conditions. There were no device-related complications and no post-operative admissions. The CVAC® Aspiration System is safe and effective for treating large stone burdens, including in high-risk patients, and may decrease the need for PCNL or secondary procedures.

Fabrication of nanocomplexes for anthocyanins delivery by ovalbumin and differently dense sulphate half-ester polysaccharides nanocarriers: Enhanced stability, bio-accessibility, and antioxidant properties

This study aimed to fabricate novel nanocomplexes for delivery of anthocyanins (ACN) utilizing ovalbumin (OVA) and sulphated-polysaccharides with varying linear charge density (κ-,ι-, λ-carrageenan and dextran sulfate: κC < ιC < λC < DS). Influence of OVA-sulphated-polysaccharides on ACN stability, antioxidant capacity, and bioaccessibility was investigated. Fabricated nanoparticlecosmeticsed superior encapsulation efficiency (94.11–96.2%) and loaded capacity (9.05–9.54%) for ACN. OVA-DS displayed the smallest particle size and turbidity, while OVA-κC-ACN exhibited the largest ones. ζ-Potential of nanoparticles raised with increasing ester-sulfate level in sulphated-polysaccharides. FT-IR, Raman and OVA conformational alterations revealed existence of intermolecular-interactions between ACN and OVA-polysaccharides. DSC and TGA showed considerable thermo-stability of self-assembled (ACN-loaded) OVA-polysaccharides. Spheroid-nanoparticles size increased after ACN-loading in SEM and CLSM. Composite nanocomplexes enhanced ACN stability and antioxidant properties under accelerated degradation conditions and simulated digestion, particularly, OVA-DS-ACN and OVA-λC-ACN. We provide a choice for reinforcing stability of hydrophilic nutraceuticals and improving its applications.

Stone Heterogeneity Index as a New Parameter for Prediction of Shockwave Lithotripsy Outcomes

Background Renal stones are a major public health concern with continuously increasing prevalence. Extracorporeal shock wave lithotripsy (ESWL) which was introduced more than three decades ago as an authentic modality for the treatment of urinary stone disease is considered first choice of treatment for nearly all kind of urinary tract calculi. The outcome of ESWL for renal and ureteral stones depends on many factors, including stone size, Hounsfield Unit (HU), Skin Stone Distance (SSD) and Body Mass Index (BMI). Objective To introduce the concept of Stone Heterogeneity Index (SHI) as a single factor or in combination with other factors that predict the outcome of extracorporeal shock wave lithotripsy for adult patients with renal or ureteral stones. Methods This is a prospective study conducted on 60 Patients with renal and ureteral stones planned to have ESWL sessions attending urology outpatient clinic in Ain shams university and Misr University for Science and Technology hospitals. Results The radiologic heterogeneity of a urinary stone or SHI was independently associated with SWL success in patients with renal and ureteral calculi. SHI in the success group was 246.49 ± 82.13 while in the failure group was 159.20 ± 47.59 with Cutoff point &amp;lt; 183 predicting failure of ESWL outcome. SHI between success and failure groups was statistically significant being higher in success group. (p = 0.000). Conclusion SHI will play a promising role when determining a treatment modality in patients with a urinary stone, and especially when selecting the proper SWL candidates from the patients with a stone of large size or high Mean Stone Density (MSD).

Outcome of Laparoscopic Ureterolithotomy in Comparison to Open Ureterolithotomy for the Treatment of Large and Impacted Upper Ureteric Stone

Background: Ureteric stones are a common clinical issue, often necessitating open ureterolithotomy for large and impacted upper ureteric stones. Despite its success, laparoscopic surgery has gained popularity as an alternative approach, offering potential benefits such as reduced morbidity and shorter hospital stays. This study aims to compare the outcomes of laparoscopic ureterolithotomy with open ureterolithotomy for large impacted stones in the upper ureter. Methods: A prospective quasi-experimental study was conducted from June 2018 to August 2019 at the Department of Urology, Dhaka Medical College Hospital. The study enrolled sixty patients with upper ureteric stones larger than 2 cm. Patients were divided into two groups: Group A underwent laparoscopic ureterolithotomy, while Group B underwent open ureterolithotomy. Demographic data, medical history, examination findings, and investigation reports were recorded for all patients. Post-surgical pain scores, blood loss, complications, and hospital stays were also evaluated. Results: The study compared the outcomes of Group-A and Group-B patients who underwent ureterolithotomy. Group-A had an average age of 49.66 ± 14.70 years, while Group-B's average age was 51.60 ± 11.93 years. There was no significant difference in gender distribution between the groups (p-value 0.371). Group-A had a mean operative time of 2.11 ± 0.41 hours, while Group-B had a mean operative time of 1.60 ± 0.28 hours. Laparoscopic ureterolithotomy resulted in significantly less blood loss (p-value &lt;0.001). Group-A had a lower mean pain score (59.27 ± 8.56) compared to Group-B (75.50 ± 17.34). Laparoscopic ureterolithotomy also required less Pethidine (p-value &lt;0.001). Group-A experienced 6.7% wound infection and 10% UTI, while Group-B had higher rates (26.7% and 33.3% respectively). Urine extravasation occurred in 16.7% of Group-A, on the hand, in Group-B, it was 6.7%. Group-A had a shorter hospital stay (4.17 ± 1.18 days) compared to ........

How can needle ice transport large stones? Twenty‐one years of field observations

AbstractDownslope movements of 12 stones (10–27 cm in diameter) were determined from time‐series images for 21 years on a Japanese alpine debris slope (inclination 12°). The process of stone movements was analysed on the basis of frost heave and soil temperature records, with particular attention to the stone size transported by needle ice and the effect of climate change on stone movements. Soil heaving mainly due to needle‐ice growth occurred 24–85 times yr−1 with an annual maximum and cumulative amounts of 1.8–5.5 cm and 17–58 cm yr−1, respectively. Stones moved downslope at rates of 5–20 cm yr−1 (mean 11.7 cm), the velocity correlating with the stone size, although small stones with a height of less than about 3 cm do not reduce needle‐ice activity very much. On an assumption of a linear relationship between the two variables, needle ice can transport stones with a diameter of as large as 30 cm. Both annual mean air/soil temperatures and needle‐ice activity slightly increased through the monitoring period. Climatic warming may have raised the frequency of needle ice by shortening the snow‐covered period.

Epilithic biofilms of the Eastern Caspian (Aktau region, Kazakhstan) under conditions of falling sea level

Communities of microorganisms that form biofilms on the rocky shores of the Middle Caspian are capable of maintaining the integrity of the coastal landscape in the conditions of sea retreat associated with the ongoing drop in sea level since 1995. Algal-bacterial biofilms developing on rocky substrates of the East Caspian coast within the City of Aktau were studied in autumn (October 2022) and spring (April 2023) seasons. Communities in biotopes with different structure were investigated. It has been established that the most stable and diverse communities with a pronounced vertical structure live in the areas with high sheer cliffs on capes. On flat areas of the coast, which have undergone recent shallowing and are protected from surfing waves by ridges of large stones, less diverse cenoses, demonstrating clear spatial organization. In the shallow open areas of the shore, which are subject to intense wave action, live communities of two types were observed. Both cenoses contained a relatively small number of species, but differed in structure and potential for protecting the coast from erosion. The first of them live in biotopes outside the impact of urban domestic sewage, and are able to protect coastal marl from destruction due to the development of stable, rapidly regenerating complex structural elements. The latter were noted in the conditions of along-shore spreading of untreated domestic wastewater from new city developments located close to the coast. Such biofilms were no longer able to protect marls from being destroyed by waves, and took the form of constantly renewed patches with minimum diversity of components and unstable spatial organization.

Study on compaction characteristics and mechanical performance deterioration of large stone porous asphalt mixes

Large stone porous asphalt mixes (LSPM) have advantages in promoting pavement performance, including cracking resistance, rutting resistance, and moisture susceptibility. Engineering practice demonstrates that performance degradation is crucial and has an impact on the durability and service life of asphalt pavement. Therefore, this paper aims at investigating the damage characteristics of LSPM as well as proposing the corresponding control methods. Firstly, a simulation device is designed to carry out the temperature cooling testing of LSPM in the laboratory. Then, the variation of air void contents in LSPM was analyzed with different testing temperatures, loading times, and freeze–thaw cycles. LSPM macro-mechanical strengths and cracking resistance were measured during freeze–thaw cycles. The outcome demonstrates that different sections cool at various rates and for varying lengths of time. The effective compaction time and compactness are directly related to the ambient temperature. Paving at medium and high temperatures is an efficient way to increase the compactness of LSPM. The testing temperature, loading time, and freeze–thaw cycles have significant influences on the change of air void contents, while the influence of load strength is low. The penetration shear strength decreases as the number of freeze–thaw cycles increases, and the change trend gradually decreases. Freeze-thaw cycles will lessen the anti-cracking performance of LSPM. Strictly regulating construction parameters, air void content, and drainage conditions could increase the LSPM asphalt pavement's durability and service life. The change in pore structure composition is the primary factor influencing the damage performance of LSPM.

ERCP findings provide further justification for a "surgery-first" mindset in choledocholithiasis.

Choledocholithiasis is most often managed in a two-procedure pathway including endoscopic retrograde cholangiopancreatography (ERCP) followed by laparoscopic cholecystectomy (LC). In contrast, a single-stage, surgery-first approach consisting of LC, cholangiogram, and laparoscopic common bile duct exploration (LCBDE) is associated with reduced hospital stays and equivalent morbidity. Despite this, nationwide referral patterns heavily favor ERCP, obscuring those undergoing ERCP with obstructions amenable to simple intraoperative interventions. We hypothesized that most patients had endoscopic findings consistent with simple sludge or small-to-medium stones, which could have been cleared by basic LCBDE maneuvers. We retrospectively reviewed 294 patients > 18yearsold who underwent preoperative ERCP for the management of suspected choledocholithiasis. Exclusion criteria included: failed ERCP, cholangitis, prior cholecystectomy, patient refusal of surgery, or medical conditions precluding surgical candidacy. Stone size was categorized as small (0-4mm), medium (5-7mm), and large (≥ 8mm). At the time of ERCP, 37 (20.1%) patients had sludge only, 96 (52.2%) had stones only, 42 (22.8%) had sludge and stones, and 9 (4.8%) had no stones. Of the 138 patients with any stones, 37 (26.8%) had small stones, 41 (29.7%) medium, 43 (31.2%) large, and 17 (12.3%) had uncharacterizable stones. Overall, 74.3% of patients had findings of sludge, stones (0-7mm), or negative ERCP. The majority of patients who underwent preoperative ERCP for suspected choledocholithiasis had findings that are amenable to simple intraoperative interventions. In fact, over a quarter of the patients had a negative ERCP, sludge, or small stones which would likely be cleared by flushing/glucagon precluding any further instrumentation. While large stones may require more advanced techniques, this represents a small percentage of patients. Surgery-first management for suspected choledocholithiasis can offer an efficient alternative for the majority of patients.

Holmium Laser Enucleation of the Prostate vs Transvesical Single-port Robotic Simple Prostatectomy for Large Prostatic Glands

To compare the perioperative outcomes of transvesical single-port robotic simple prostatectomy (SP-RASP) and holmium laser enucleation of the prostate (HoLEP). A retrospective review was performed of patients undergoing SP-RASP and HoLEP from 2019 to 2022 with preoperative prostatic volume (PPV) >80cm3. Percent of prostate adenoma removed (%PAR) was estimated by specimen weight normalized by PPV. Univariate analysis was performed using chi-square, Fisher exact, and Wilcoxon rank-sum tests. A subgroup analysis with 1:1 matching for PPV was also performed. A total of 50 SP-RASP and 90 HoLEP cases were analyzed. The median (interquartile range) PPV was 169 (128-244)cm3 for SP-RASP and 129 (100-150)cm3 for HoLEP, (P<.01). The median (interquartile range) %PAR was 57(44-68) for SP-RASP vs 51(42-62) for HoLEP (P=.10). Overall, 11(12%) HoLEP and 5(10%) SP-RASP patients experienced complications (P=.51). Same-day discharge occurred in 24(48%) SP-RASP vs 7(8%) HoLEP patients (P<.01). Median foley catheter duration was longer in SP-RASP (6 vs 1day, P<.01) and trial of void was successful at first attempt in >94% (P=.68). Transient de novo incontinence was reported in 24(28%) HoLEP vs 2(5%) SP-RASP (P<.01). No differences in voiding parameters were observed at latest follow up. Subgroup postmatched analysis revealed analogous findings. SP-RASP and HoLEP have similar favorable perioperative outcomes for management of large prostatic adenomas. SP-RASP may be considered in patients unwilling to accept the risk of transient incontinence and in those with unfavorable urethral access, large bladder stone burden, or diverticula.

Intraoperative use of CT-navigation during percutaneous nephrolitholapaxy with the SIEMENS Healthineers’ ARTIS pheno robotic system

Introduction. Percutaneous nephrolitholapaxy (PNL) is the optimal method in the treatment of large or complex renal stones. Surgical equipment and endoscopic equipment, and specialised tools have been constantly developing since the advent of PNL in 1976, increasing success rates with a decrease in the number of complications and morbidity. Owing to the specificity and complexity of the technique, only 11% of urologists in the USA perform PNL, while in Russian Federation no more than 5% of specialists realise it.Objective. To evaluate the possibilities of using a robot-angiograph to create a puncture access.Materials &amp; methods. In the Krasnoyarsk Regional Clinical Hospital in 2021, the first PNL was performed in a patient with a left-sided lower calyx stone using the SIEMENS Healthineers’ ARTIS pheno robotic angiograph in a hybrid operating room. This robotic installation allows the performing of an intraoperative computed tomography examination followed by the construction of a navigation map with a clearly displayed trajectory, length, and angle of inclination of the needle path with automatic positioning of the C-arm.Results. We performed 30 pyelocaliceal punctures using a robotic angiographic installation for PNL. The average age of patients was 56.6 ± 19.0 years. According to MSCT, the lower calyx stone was detected in seven patients, the middle calyx — 13 cases, the upper calyx — seven patients, pelvic stones were recorded in three patients. The density of stones varied from 877 HU to 1356 HU. The use of the ARTIS pheno robotic system allows performing intraoperative 3D modelling to determine the safest pyelocaliceal puncture, followed by PNL, regardless of the stone localisation, the complexity of the anatomy. In addition, a CT-like scans allows you to assess the presence of residual stones during the operation and perform a "second look" not in a delayed manner. This system, unlike all existing types of navigation, allows intraoperative evaluation of the effectiveness (stone-free rate) of surgical treatment.Conclusion. The introduction of this navigation system in PNL will minimise the risks of complications from puncture access, reduce the number of repeated interventions, and minimise undesirable consequences in the postoperative period.

Prediction of Stone Free Rate after Standard Percutaneous Nephrolithotomy using Stone Nephrolithometry Score in Nobel Medical College Teaching hospital – A Prospective Study

Background: Amongst all the modalities of treatment for renal stones, percutaneous nephrolithotomy is preferred treatment for large volume renal stone disease. However, percutaneous nephrolithotomy is associated with the risk of postoperative complications and the problem of stone free status. So, a preoperative classification is necessary to grade the complexity of percutaneous nephrolithotomy and STONE (stone size, tract length, degree of obstruction, number of involved calices, and stone essence) nephrolithometry score is one of such kind.&#x0D; Materials and Methods: This is analytical study conducted at the Department of Urology and Kidney Transplant, Nobel Medical College and Teaching Hospital, Biratnagar, Nepal from January 2020 to July 2020. Total 115 patients were included in the study. These patients were subjected for percutaneous nephrolithotomy. Stone clearance was documented at the end of the surgery; on first postoperative day and at 4 weeks.&#x0D; Results: In our study the stone – free rate was 89.6%. 32 patients experienced complications (27.8%). The STONE (stone size, tract length, degree of obstruction, number of involved calices, and stone essence) score correlated with the postoperative stone – free status (P=0.001). The patients rendered stone free had statistically significant lower scores than the patients with residual stones (6.83 ± 1.83 vs 9.83 ± 2.08, P = 0.001).&#x0D; Conclusion: The STONE (stone size, tract length, degree of obstruction, number of involved calices, and stone essence) nephrolithometry score is a simple and easy tool to apply system for predicting complexity in stone clearance with percutaneous nephrolithotomy.

Percutaneous nephrolithotomy in supine position with less than 24-hour hospital stay; a single-center experience

ABSTRACT Objectives To report our initial experience of day care percutaneous nephrolithotomy (PCNL) with early hospital discharge within less than 24 hours of the procedure. Patients and Methods The files of patients treated with PCNL between 1st January 2020 till 31st December 2022 were retrospectively reviewed. Day care PCNL was defined as the discharge of patients either on the same day or within 24 hours after surgery. Patient age, ASA score, body mass index, stone diameter, laterality, stone burden, Hounsfield unit, and Guy’s score were analyzed. Operative time, size of the access tract, method of lithotripsy, estimated blood loss, and length of hospital stay were also recorded. Postoperative complications were stratified according to the Dindo-Clavien classification. The primary outcome was to evaluate the feasibility and safety of early discharge within 24 hours after PCNL compared to the in-patients who were kept in hospital for at least 2 days after surgery. Results A total of 85 patients underwent PCNL at our center of whom 36 patients were discharged within 24 hours (day care PCNL) of the procedure and 49 patients were kept for at least 2 days (in-patient PCNL). In the day care group, median stone burden was 465 mm2 (360-980) and 18 patients (50%) had Guy’s stone score ≥ III. The median tract size was 24 (13-30) and endoscopic combined intrarenal surgery (ECIRS) was performed in 7 cases in the day care group. Tubeless PCNL was carried out in 88.8% of the day care surgery group compared to 37.5% in the in-patient group (p < 0.0001). The postoperative complication rate was comparable between both groups (13.8% vs 22.4% for day care vs in-patient group, respectively, p = 0.08). Conclusions Day care PCNL is feasible and safe for selected patients including those having large stone burden without increasing the risk of complications or readmission rate.

Prevention of postoperative pyelonephritis in patients after percutaneous nephrolithotripsy for large and coral kidney stones

Background. Improving the results of prevention and treatment of postoperative pyelonephritis, the most frequent complication of percutaneous nephrolithotripsy, is an important task of modern urology.&#x0D; Aim. To determine the effectiveness of using physiotherapeutic procedures (magnetotherapy and laser therapy) for prevention of pyelonephritis development in the postoperative period.&#x0D; Materials and methods. The study included 72 patients with kidney stones of large size who underwent percutaneous nephrolithotripsy. The patients were divided into two groups: group 1 – 44 patients with kidney stone over 2.5 cm (including coral), group 2 – 28 patients with kidney stone over 2.5 cm (including coral) who underwent physiotherapeutic procedures in the perioperative period in combination with antibiotic therapy. All patients underwent percutaneous nephrolithotripsy with preoperative administration of antibacterial therapy. All patients underwent urine and stone culture, as well as laboratory and clinical evaluation of pyelonephritis attack development in the postoperative period.&#x0D; Results. Analysis of histories showed that in group 1, clinical symptoms of pyelonephritis exacerbation were observed more frequently in operated patients than in patients who underwent physical therapy in the perioperative period. The severity and duration of hyperthermia in the group 2 was noted to be not so high and prolonged. The percentage of microflora detection in urine and stone cultures was insignificantly different in both groups. At the same time, the level of leukocytosis in the group 2 in the postoperative period was on average lower, a 3-fold decrease in the frequency of prescribing "reserve" antibacterial drugs was also revealed.&#x0D; Conclusion. In patients with large and coral kidney stones physiotherapeutic procedures can be used in combination with antibacterial therapy for prevention and treatment of pyelonephritis exacerbation in the postoperative period after percutaneous nephrolithotripsy.

Successful endoscopic treatment of multiple large intrahepatic bile duct stones with benign choledochojejunal anastomotic stenosis.

Successful endoscopic treatment of multiple large intrahepatic bile duct stones with benign choledochojejunal anastomotic stenosis.

Development of a SiPM Pixel prototype for the Large-Sized Telescope of the Cherenkov Telescope Array

The Cherenkov Telescope Array (CTA) will be the next generation ground-based gamma-ray observatory. CTA consists of different telescope types of which the largest ones (Large-Sized Telescopes, LSTs) cover the lower energy range, between 20GeV and 200GeV. The first LST is currently being commissioned at the Roque de los Muchachos Observatory, La Palma, Canary Islands. Its camera has 1855 photomultipliers (PMTs) with 1.5 inch cathodes. Silicon Photomultipliers (SiPMs) are increasingly becoming valid alternatives to PMTs also in gamma-ray astronomy. In the context of the LST project, there is an effort to study a novel Advanced Camera, equipped with SiPMs and a completely redesigned electronics based on a fully digital approach. To study and develop solutions on the sensors of these camera, we built a prototype camera module with a fully re-designed pre-amplifying stage and sensor bias control while re-using the digitizing and triggering stages of the existing LST camera module. We report on the design choices made to achieve the highest performance in terms of timing and charge resolution and the laboratory measurements validating those choices.