Stone Location Research Articles

Indications for Submandibulectomy Within a 20-Year Period.

Purpose: Different pathologies of the submandibular gland are an indication of submandibular gland excision-ranging from inflammatory causes and sialolithiasis to malignant tumors. The purpose of this study was to get an overview of the different indications for submandibular gland excision. Methods: The main goal of this study was to evaluate the different indications for submandibular gland excision during a 20-year period. In addition, epidemiological information and therapy concepts were investigated with a special focus on Tumor Lymph nodes Metastasis (TNM) classification and recurrence rate. Procedures during which the submandibular gland was removed while not being the primary cause for surgery (eg, neck dissection in Level Ib) were not included. Results: During the period of observation, 359 submandibular gland excisions were performed. The most common cause for submandibular gland excision was sialolithiasis (n = 129) with intraparenchymal stone localization. Up next were inflammatory causes (n = 115) in particular chronic submandibular sialadenitis followed by only a few cases of Sjögren's syndrome, sarcoidosis, and tuberculosis. In 115 cases, surgery was performed for tumors of the submandibular gland, with 88 of them being benign and 27 malignant. Malignancies were then divided into lymphomas (n = 9) and primary salivary gland malignancies (n = 18). Conclusion: This retrospective study of a large cohort of patients displays a representative overview of the indications for submandibular gland excision. Sialolithiasis was the most common underlying cause of gland excision. The malignancy rate in our cohort was lower than described in the literature.

Is traditional stone clinic the optimal use of NHS resources?

There is no clear guidance on the efficacy of stone follow-up. NICE have been unable to make recommendations with current published evidence. The aim of this study was to understand the patient journey resulting in surgical intervention, and whether traditional stone follow-up is effective. A retrospective review of patients undergoing ureteroscopy (URS) or percutaneous nephrolithotomy (PCNL) over a 3year period identified 471 patients who underwent these procedures to treat stone disease. Records were interrogated for the following: symptoms, mechanism of booking, reason for intervention, stone size, stone location, risk factors and previous follow-up. Of 471 patients who underwent intervention, 168 were booked from stone clinic follow-up (36%). Of these, 96% were symptomatic and 4% were asymptomatic. When risk factors were removed, this figure was reduced to 1%. Sepsis rate for emergency admissions differs between those followed up (13%) versus new presentations (19)%. There was no statistically significant difference in the outpatient imaging frequency between patients booked from an emergency admission (80% having imaging every 6months) and those from the clinic (82%). Our Hospital provides on average 650 stone clinic appointments a year with a cost of £93,000. Given the low rate of intervention in patients with asymptomatic renal stones, a symptomatic, direct-access emergency stone clinic could be a better model of care and use of NHS resources. Urgent research is required in this area to further assess if this is the case.

Ultrasound accuracy in evaluating renal calculi in Maysan province.

Renal calculi are a common clinical presentation. While ultrasound (US) is a widely used imaging modality for kidney stone diagnosis due to its accessibility and lower cost, its accuracy compared to computerized tomography (CT), the gold standard, remains understudied. This cross-sectional study evaluated the diagnostic accuracy of ultrasound for detecting and characterizing kidney stones compared to computed tomography (CT). Fifty-six patients with suspected kidney stones based on flank pain underwent abdominal ultrasound to assess stone presence, size, location, and the severity of any hydronephrosis (kidney swelling). These findings were then confirmed with a subsequent non-contrast CT scan. There was a fair agreement between US and CT (Kappa = 0.368) for detecting the stone location. The US could not detect 7 (12.5%) stones, being less sensitive in the middle and upper calyx compared to CT. There was a fair agreement between the US and CT (Kappa = 0.394) for detecting the severity of hydronephrosis. The US was less sensitive to moderate and severe hydronephrosis compared to CT. The abdominal ultrasound demonstrated excellent reliability for stone size measurement (intraclass correlation = 0.924), with CT measurements only slightly larger on average (mean difference 0.9 mm). Although abdominal ultrasound provides reliable stone size assessment, its capacity to accurately localize stones and assess hydronephrosis severity is limited.

The impact of stone position and location on the microbiome of a marble statue

Microbial proliferation and biodeterioration constitutes a serious threat towards the preservation of stone monuments and relics. Geometry and exposure have been recently pinpointed as important factors determining the microbiome organization in stone monuments. In this work, the impacts of position and location on the microbial communities and their predicted metabolical and ecological profiles on a marble statue were studied. We sampled various epilithic stone biofilms from the Brotero statue (Coimbra’s UNESCO World Heritage site) and studied them by Next-generation Sequencing of the V3/V4 and the ITS2 regions, and bioinformatic analyses. We verified that statue location/heights have a more relevant impact than position/sides on the microbiome, and that Fungal and Chlorophyta communities showed a more diverse and less stable structural organization than Bacteria. Thus, while sub-aerial biofilms were mainly colonized by selective groups of extremophilic microorganisms, our results highlight that this specificity is more pronounced in prokaryotes. Bacterial metabolic functional distribution patterns were found to be distinct and adapted according to statue heights, while fungi displayed a strong domination of various types of saprotrophs. In addition to various “degraders” present in all samples, lower statue areas displayed strong connections with nitrogen fixators, while high and middle zones displayed stronger correlations with nitrogen and sulfur cycle bacteria. Moreover, biodeterioration at these sites can be promoted by biodeteriogenic cyanobacteria, bacteria linked to biogeochemical cycles, microcolonial Fungi and Chlorophyta able to thrive under hostile environments. In addition, mutualistic and competitive relationships between taxonomic groups were detected, that will require additional focus on future studies.

Factors effecting the success of retrograde intrarenal surgery in pediatric patients with renal stones: The experience of two tertiary centres with 368 renal units

Currently, in the field of pediatric urology, the primary aim of surgical approaches for the treatment of renal stone disease is to provide a stoneless state through minimally invasive methods, and to prevent the damage that such stones may cause in the urinary system and stone recurrence. The aim of this study was to evaluate the efficacy and safety of RIRS and the factors affecting its success in the surgical treatment of renal stones in pediatric patients. Data from 357 pediatric and 368 renal units were collected retrospectively. The recorded parameters were age, gender, location and burden of the stone, and presence of postoperative residual stones. The stone location was the upper pole in 28 (7.6%) patients, the middle pole in 44 (12%), the pelvis in 98 (26.6%), the lower pole in 139 (37.8%), and multiple locations in 59 (16%) patients. A stoneless state was achieved in 277 (75.3%) units, while 91 units (24.7%) had residual stones at the end of the first month. In the multivariate analysis, the development of residual stones was found to be significantly associated with age (odds ratio [OR], 1.123; p=0.012) and stone location (OR, 3.142; p=0.018). RIRS is an endourological procedure with a high success rate in the achievement of a stoneless state in both pediatric and adult age groups, with an 82-100% success rate reported in various studies. A full stoneless state was achieved in 277 (75.3%) units after the initial RIRS in the present study, and full stone clearance was achieved in 304 units after the second RIRS session, with a success rate of 82.6%. A limitation of our study is that it was not performed by a single surgeon, and stone samples could not be taken from all patients for stone analysis. RIRS has also been associated with a high success rate in the endoscopic treatment of renal stones and is an efficient and safe method with a minimal rate of complications, especially in the pediatric age group.

Analysis of Perioperative Events in Bilateral vs Unilateral Staged Percutaneous Nephrolithotomy

Introduction: Kidney stones are a common medical condition that impact approximately 10% of US population. Management of stone disease is based on size and location of stones. Percutaneous nephrolithotomy (PCNL) is typically indicated in patients with large renal stone burden (typically >2 cm) or complex anatomy. In the setting of complex stones, multiple, staged PCNLs are required. We hypothesize that there is no significant difference in the perioperative change in lab values in bilateral PCNLs compared to unilateral PCNLs.
 Methods: The data was gathered by retrospectively reviewing the electronic medical record of 50 patients in the IU health system who underwent planned staged PCNLs between January and December 2018. We identified patients who underwent both bilateral and unilateral staged procedures. Data for BMI, sex, ethnicity, hemoglobin, estimated glomerular filtration rate (GFR) (typically formula CKD-EPI or MDRD), urine and stone cultures, stone composition, and bilaterality vs. unilaterality was collected. Two-tailed T-tests were performed to analyze data between bilateral and unilateral cases.
 Results: We identified a total of 50 patients, 19 men vs. 31 women; 9 men and 10 women underwent bilateral PCNLs, while 11 men and 20 women had unilateral PCNLs. BMI ranged from 14.2 to 62.3, and age ranged from 15 to 81. Significant differences were found between the changes in hemoglobin levels in patients who underwent bilateral PCNLs when compared to unilateral PCNLs (p value 0.018). No significant differences were noted when comparing changes of estimated GFR, BMI, age or any other variables.
 Conclusion: Patients who underwent bilateral staged PCNLs demonstrated a greater drop in perioperative hemoglobin compared to unilateral PCNLs without an increase in blood transfusion. This finding suggests that Bilateral PCNLs requiring multiple stages are safe in complex stone patients.

Analyzing 80 cases of conventional percutaneous nephrolithotomy A Retrospective Study

Objective: The goal of this study is to provide information on the safety and efficacy of percutaneous nephrolithotomy as a kidney stone treatment method in tertiary care facilities. Material and methods: A retrospective study was out from June 2022 to July 2023 at the urology department of the Ikd Peshawar This retrospective study included all patients who had percutaneous nephrolithotomy in the urology unit between June 2022 and July 2023. We analysed data that was retrospectively collected from the medical record system using IBM SPSS version 28. Results: The study included 80 patients, with 67.3% being male and 32.7% being female. A kidney stone history was present in 55% of the patients. As a result of pre-operative ultrasound, 54.3% of patients had several stones, 40.1% had one stone, 3.7% had staghorn stones, 1.2% had a duplex system, and 0.6% (n=1) had a horseshoe kidney. The majority (60%), with stone sizes between 15 and 30 mm, were less than 15 mm, while a sizable minority (16.7%) were larger than 30 mm. Stones were most often found in the renal pelvis (46.3% of cases), lower pole (18.5% of cases), pelvis and lower pole together (16.3% of cases), and staghorn (7.3%). The average hemoglobin level dropped by 1.1 g/dl between pre- and post-operative measurements, from 12.9 g/dl to 11.8 g/dl. Conclusion: A high clearance rate and manageable complication rate may be achieved using percutaneous nephrolithotomy, an efficient treatment for a variety of stone sizes and locations in the kidneys that are abnormal

Risk factors of stone residual after retrograde intrarenal surgery: A prospective cohort study.

Complete removal of renal stones is crucial for optimal patient outcomes, but recent studies have reported residual stones after retrograde intrarenal surgery (RIRS). This study aimed to identify the associated risk factors to improve patient management and treatment selection. This cohort study was conducted over 18 months at two hospitals and recruited adult patients with renal stones less than 3 cm. Preoperative assessment included medical history, physical examination, laboratory tests, and radiological imaging. Intraoperative and postoperative data collection and follow-up were conducted to evaluate surgical success and potential complications. A total of 100 patients were included, with a mean age of 45.3 ± 10.7 years and a mean BMI of 26.2 ± 1.4 kg/m2. Approximately 19% of the patients had residual stones after the RIRS procedure. The RUSS score showed good diagnostic performance with an AUC of 0.843, and the optimal cut point was ⩾2.0 with a sensitivity of 52.6% and specificity of 95.1%. Independent predictors of residual stones were multiple sites (OR = 24.98; p = 0.002), multiple stones (OR = 13.62, p = 0.002), stone size of 21-30 mm (OR = 4.91, p = 0.038), lower calyx site (OR = 4.85, p = 0.033), and surgeon experience of fewer than 50 cases (OR = 6.82, p = 0.020). This study identifies several factors associated with residual stones after RIRS for renal stones, including stone size, location, number, and surgeon experience. The study suggests that the RUSS score can be used as a reliable tool for predicting the likelihood of residual stones, which can help clinicians in patient selection and treatment planning.

Prevalence and predictors of stone passage after double J stenting for symptomatic ureteral stones: a cross-sectional, real-life study.

To evaluate the rate of and predictors of stone passage (SP) after urgent retrograde stenting for symptomatic ureteral stones. We retrospectively analysed data from 249 consecutive patients presenting to the emergency department for symptomatic ureteral stones and treated with retrograde stenting. Demographic, clinical and laboratory characteristics were collected. Stones parameters were collected before stenting and SP was evaluated at 1month with computerized tomography. Descriptive statistics and logistic regression models tested the association between predictors and SP. Overall, median (IQR) age and stone diameter were 56 (45-68) years and 7.1 (4.4-9.8) mm, respectively. Stones were located in the proximal, mid and distal ureter in 102 (41.0%), 48 (19.3%) and 99 (39.8%) cases. SP was observed in 65 (26.2%) individuals. Stone diameter (3.2 vs. 7.7mm, p < 0.001) and stone density (416 vs. 741, p < 0.001) were lower and a higher rate of distal stones (76.9% vs. 26.7%, p < 0.001) was found in the SP group compared to that with persistent stones. Multivariable logistic regression analysis showed that distal ureteral stone location (OR 7.9, p < 0.01) and lower HU (OR 0.9, p < 0.01) were associated with SP, after accounting for stone volume. Patients with a distal stone of 500 HU had a 75% probability of SP. Stone passage occurred in 26% of patients with indwelling stent due to symptomatic ureteral stones. Lower stone density and distal stone location were independent predictors of stone passage. Patients with these criteria should be managed with follow-up imaging and stent removal instead of ureteroscopy.

Urolithiasis in children; The importance of stone localization in treatment and follow-up.

To evaluate the demographic, etiologic, treatment, and follow-up differences in stones according to their location within the kidney. This retrospective study comprised 337 patients with urolithiasis between 2015 and 2019. Patients were classified into 2 groups according to stone location as lower pole stones (LPS) and upper-middle pole stones (UMPS). The patient's data were recorded at 3-month intervals for one year. One hundred and eighty-three (54.3%) female and 154 (45.7%) men were included in the study. One hundred and twenty-nine (38.3%) of the stones were in the LPS and 208 (61.7%) in the UMPS. UMPS was more common in patients aged > 12months (p < 0.01). At least one metabolic risk factor was present in 93 (72.1%) patients with LPS and 164 (78.4%) with UMPS. The most common urinary metabolic risk factors were hyperoxaluria (31.8%) in patients with LPS and hypocitraturia (34.1%) in patients with UMPS. ROC analysis results showed that cut-off values of 5.5mm for LPS and 6.1mm for UMPS did not provide improve with medical treatment. At the 6- and 12-month follow-ups, the improvement rates were higher in the UMPS group than in the LPS group (p < 0.05). During the follow-up, recurrence was detected in 43 patients: 29% of patients with LPS and 5.8% of patients with UMPS (p < 0.01). Patients with small stones can be followed up. Surgical treatment may be considered for small stones in the LPS. In addition, the risk of recurrence is higher in patients with LPS, and close follow-up is required.

Do Stone Characteristics and Laser Fiber Size Affect Ho: YAG Laser Time and Energy During Ureteroscopy?

To assess the correlation of attenuation value measured as HU in Non-contrast computed tomography, stone size, location, fibre size and stone composition with Holmium: yttrium-aluminium garnet (Ho: YAG) laser parameters including, cumulative laser energy and final laser time. We prospectively analyzed 118 patients undergoing flexible/semirigid ureteroscopy and Holmium: YAG laser lithotripsy from October 2022 to October 2023 at Mogadishu Urological Centre. Our study parameters encompass preoperative stone characteristics determined in NCCT (stone size, attenuation value, and stone location), fibre size, cumulative laser energy and time, overall operative time, and postoperative stone composition analysis. There were 118 patients eligible for our prospective study. In the logistic regression model for retrograde intrarenal surgery with a fibre size of 272μm, cumulative laser energy showed a significant difference among stone size, location, fibre size, and calcium oxalate stones (P > 0.05). However, no significant difference was noticed in the attenuation value (P = 0.078) (R2 = 0.053). Our analysis showed a positive significance among all the parameters (P < 0.05) for laser time. In logistic regression for a rigid ureteroscope with a fibre size of 365μm, cumulative laser energy showed a significant difference between the location stone and fibre size (P < 0.05) (R2 = 0.09). However, no significant difference was seen among stone size, attenuation value, and calcium oxalate stones (P > 0.05). For laser time, our analysis showed a positive significance among all parameters except the calcium oxalate stones, which showed no significant difference (P > 0.05). Our study showed that stone location, hardness, and fibre size are the most critical factors influencing the outcome of Ho: YAG laser parameters. The study revealed that CaOMH stones require more time to disintegrate into smaller ones, while PH-dependent stones such as carbonate apatite may require less time to fragment.

PREDICTORS OF FAILURE OF ENDOSCOPIC RETROGRADE CHOLANGIOPANCREATOGRAPHY IN CLEARING BILE DUCT STONES DURING INDEX PROCEDURE - A PROSPECTIVE STUDY.

Common bile duct (CBD) stones are known to complicate 10-15% of gallstone diseases. Endoscopic retrograde cholangiopancreatography (ERCP) is the therapeutic modality of choice for bile duct clearance in CBD stones but may fail to achieve stone clearance. This prospective study was done to identify the predictors of failure of CBD clearance with ERCP. This prospective study was done to identify the predictors of failure of CBD clearance with ERCP. All consecutive patients with bile duct stones undergoing ERCP at a tertiary care center were prospectively included from October 2020 to October 2021. The study's primary outcome was to identify and analyze factors that could predict the failure of complete CBD clearance. A total of 120 patients (50.8% males, median age: 53.5 years) were included in the final analysis. Successful clearance of CBD stones during the index procedure was achieved in 70% of patients. At a cut-off stone diameter of >10.5 mm and CBD diameter of >12.5 mm, the AUC was 0.890 and 0.884, respectively, to predict failed clearance of CBD. On multivariate analysis, stone diameter ≥15 mm [odds ratio (OR) 16.97, 95% confidence interval (CI): 1.629-176.785], location of stones in hepatic ducts (OR 7.74, 95%CI: 2.041-29.332), presence of stricture distal to stone (OR 6.99, 95%CI: 1.402-34.726) and impacted stone (OR 21.61, 95%CI: 1.84-253.058) were independent predictors of failed bile duct clearance. Stone size and location are independent predictors of failed bile duct clearance. The endoscopist should consider these factors while subjecting a patient to biliary ductal clearance to plan additional intervention. • Failure to clear bile duct stones in the index ERCP can be seen in 15-20% of cases, and identifying the factors associated with failure is important. • A prospective analysis was conducted to identify and analyze the factors that could predict the failure of complete CBD clearance. • The present study reported a successful clearance of CBD stones during the index procedure in only 70% of patients. • A stone diameter ≥15 mm, location of stones in hepatic ducts, presence of stricture distal to stone, and impacted stone were independent predictors of failed bile duct clearance.

Evaluation of Factors Influenced on the Effectiveness of Percutaneous Nephrolithotomy.

Generally, there are many methods for the treatment of urinary stones, of which percutaneous nephrolithotomy (PCNL) is a minimally invasive and highly effective method, and now become the first-line management for urinary stones, especially in the cases of complex stones and staghorne calculi. Accurate assessment of stone location, stone morphology, degree of hydronephrosis as well as urinary system abnormalities is extremely important in the percutaneous nephrolithotomy strategy. The aim of this study was to evaluate the S.T.O.N.E score as well as other factors that influenced the effectiveness of PCNL. Descriptive study on 71 patients with kidney stones, who underwent multi-slice CT scan of the urinary system before PCNL and then PCNL at Hanoi Medical University Hospital from July 2022 to July 2023. All patients received the informed consent and agreed to participate in the study. The factors included the stone area, the track length (from the skin surface to the stone central), the degree of urinary tract dilatation, the number of involved calyces, the density of stone, the renal parenchyma thickness, the ureteral wall thickness and fat infiltration measured on MSCT non-contrast phase. These factors were used to predict the effectiveness of PCNL including the stone clearance rate (SCR) and the operation time. The mean age of the patient group was 53.8±12.3. The male/female ratio was 1.54. There was a significant difference (p<0.05) between the following factors and the operation time: the stone area (<400, 400-799, 800-1599 and >1600 mm2), the degree of urinary tract dilatation (no or might and moderate or severe dilatation), the number of involved calyces (≤ 2, 3 and staghorne calculi), the renal parenchyma thickness (<18 mm and ≥18mm). In contrast, there were no significant differences between the following factors and the surgery time (p>0.05): the track length (<100 and ≥100 mm), and the stone density (<950 and ≥950 HU). Regarding the S.T.O.N.E score (included five factors: Size, Track length, Obstruction, Number of involved calyces, and Evaluation of stone density), there was a strong correlation between S.T.O.N.E score and the surgery time (p<0.001, r=0.94), and the SCR (p=0.001, r=-0.97). The evaluation of these factors played an important role in the prediction of the effectiveness of PCNL.

Characteristics of Kidney Stone Patients with Stonography CT Scan Without Contrast

Kidney stones are one of the problems that are often found in the field of urology. The composition of stones formed varies and the location of kidney stones is generally in the minor calyx, major calyx, and renal pelvis. Examination to be able to establish a diagnosis, one of which is by CT Scan examination. Management of kidney stones depends on the characteristics of the kidney stones found. So further research is needed to determine the characteristics of kidney stones to provide appropriate management and prevent recurrence. The descriptive design research design used secondary data with 115 samples. The results showed that the number of patients was more male by 83 people (72.2%), kidney stones obtained were as many as 62 (53.9%), patients had right kidney stones measuring &gt;9mm (79%), and as many as 68 (59.1%) patients had left kidney stones measuring &gt;9mm (73.5%), and most of the casein did not suffer from hydronephrosis.

Influence of tract location on the outcomes of endoscopic combined intrarenal surgery: A retrospective analysis of 1000 cases.

This study aimed to investigate the influence of tract location on surgical outcomes in endoscopic combined intrarenal surgery (ECIRS), considering the location of residual stones. From January 2015 to December 2021, 1417 consecutive patients underwent ECIRS in three hospitals. After excluding patients with preoperative percutaneous nephrostomy, intended multi-stage procedures, those with a tract in the renal pelvis, and those with multiple tracts, 1000 patients were retrospectively analysed by comparing three groups based on tract location: group 1 (upper calyx), group 2 (middle calyx), and group 3 (lower calyx). A multivariate logistic regression model was implemented to assess whether the tract location independently affected the stone-free status. Patient characteristics were significantly different among the groups in terms of age, stone laterality, presence of calyceal stones, and hydronephrosis. There were no differences in stone-free rate (SFR) among the three groups. Multivariate analysis indicated that the tract location (group 1 or 2 compared with group 3) did not significantly affect the stone-free status (odds ratio = 1.4, 0.9-1.9, p = 0.066). Surgical duration significantly varied among the groups, with the shortest time observed in group 1. Organ injury was observed exclusively in group 1 (1.13%). Residual fragments were predominantly found in the lower calyx, with the calyx associated with the tract being the second most common location. Tract location does not significantly affect SFR. To improve the SFR, observation of the lower calyx and tract placement is important.

Factors influencing the efficacy of ultrasound-guided extracorporeal shockwave lithotripsy in the treatment of ureteral stones: a retrospective study.

The aim of the study was to analyze the factors influencing the efficacy of ultrasound-guided extracorporeal shockwave lithotripsy (ESWL) in the treatment of ureteral stones. The clinical data of 8102 patients (6083 men and 2019 women) who presented with ureteral stones were retrospectively analyzed. All the patients were treated with ultrasound-guided ESWL. The stone-free rate (SFR) was calculated to evaluate the effect of ESWL. The characteristics of the patients and their stones, and the ESWL parameters applied were compared to identify the factors affecting the treatment outcomes. The SFR and that following one ESWL session were 94.6% (7663/8102) and 75.4% (6107/8102), respectively. Multivariate analysis showed that stone location (OR 0.656, p < 0.001), stone size (OR 1.103, p < 0.001), and degree of hydronephrosis (OR 1.952, p < 0.001) independently affected SFR; and age (OR 1.005, p = 0.022), stone location (OR 0.729, p < 0.001), stone size (OR 1.103, p < 0.001), degree of hydronephrosis (OR 1.387, p = 0.001), maximum energy level(OR 0.691, p < 0.001) independently affected SFR following one session. Ultrasound-guided ESWL is effective in all levels of ureteral stones. Large stone size and moderate hydronephrosis are correlated with treatment failure. Ultrasound-guided ESWL may be the first choice for distal ureteral stones.

Stone clearance rate in patients treated with open surgery versus percutaneous nephrolithotomy for the management of staghorn renal calculi.

Background: Urinary calculi, particularly staghorn renal calculi, pose a significant health challenge. Percutaneous nephrolithotomy (PCNL) and open surgery are two distinct surgical interventions employed for treating staghorn renal calculi. This study aimed to compare the stone clearance rates of patients undergoing open surgery versus percutaneous nephrolithotomy at the Department of Urology, Sindh Institute of Urology and Transplantation (SIUT) in Karachi, Pakistan. Methodology: A prospective cohort study was conducted from February 8th to August 7th, 2019. Patients aged 18 to 60 years, diagnosed with staghorn renal calculi, were included. Patients with other renal stones and untreated urinary tract infections were excluded. The study enrolled 230 patients, divided into two groups: Group I underwent percutaneous nephrolithotomies, and Group II underwent open surgery. Stone clearance was assessed through post-surgery X-ray KUB. Results: The mean age of participants was 44.99 years, with a balanced gender distribution. Both PCNL and open surgery achieved stone clearance rates of 68.7%, with significantly higher rates observed in the PCNL group (74.8% vs. 62.6%, p = 0.04). Stratification by age, gender, illness duration, and stone location did not yield substantial variations in stone clearance rates. Conclusion: PCNL demonstrated a superior stone clearance rate compared to open surgery in the treatment of staghorn renal calculi. This finding highlights the potential of PCNL as a more effective intervention for addressing this challenging urological condition.

Intraoperative gaze guidance with mixed reality.

Efficient communication and collaboration are essential in the operating room for successful and safe surgery. While many technologies are improving various aspects of surgery, communication between attending surgeons, residents, and surgical teams is still limited to verbal interactions that are prone to misunderstandings. Novel modes of communication can increase speed and accuracy, and transform operating rooms. A mixed reality (MR) based gaze sharing application on Microsoft HoloLens 2 headset that can help expert surgeons indicate specific regions, communicate with decreased verbal effort, and guide novices throughout an operation is presented. The utility of the application is tested with a user study of endoscopic kidney stone localization completed by urology experts and novice surgeons. Improvement is observed in the NASA task load index surveys (up to 25.23%), in the success rate of the task (6.98% increase in localized stone percentage), and in gaze analyses (up to 31.99%). The proposed application shows promise in both operating room applications and surgical trainingtasks.

Effective and Economical Option of Anesthesia in Retrograde Intrarenal Surgery.

There is only limited data in the literature showing the effect of anesthesia methods on the success of retrograd intrarenal surgery. The aim of this study was to compare and evaluate retrograd intrarenal surgery cases performed under spinal and general anesthesia in terms of effectiveness, cost, hospitalization time and complications. A total of 337 patients who underwent retrograd intrarenal surgery due to kidney stones between 2014 and 2019 were retrospectively evaluated. In our study, the patients were divided into two groups according to the anesthesia method administered: Group 1 consisted of 172 patients who received spinal anesthesia and Group 2 comprised 165 patients administered general anesthesia. Both groups were compared in terms of demographic data, localization and size of stone, radiographic stone density, operation time, complications, need for postoperative analgesia, length of hospitalization, and stone free rate. The cost of general anesthesia was significantly higher compared to that of spinal anesthesia (p < 0.001). The analgesia application administered within the first six postoperative hours was significantly higher in the general anesthesia group (p < 0.001). In other findings, there was no statistically significant difference between the two groups. Retrograd intrarenal surgery can be performed with similar safety and effectiveness under both general and spinal anesthesia. However, spinal anesthesia seems to be more advantageous due to the patients' lower need for analgesics in the early postoperative period and the lower cost of the anesthetics used.

Extracorporeal shock wave lithotripsy: Prematurely falling out of favour? A 7year retrospective study from an Australian high-volume centre.

The aim of this study is to audit 7years of data with a 3year follow up from a high-volume stone centre performing extracorporeal shock wave lithotripsy (ESWL) to evaluate efficacy in stone clearance compared to existing knowledge and understand reasons for this performance. Patients who received ESWL treatment for renal or proximal ureteric stones at a single centre between January 2012 and January 2019 (to allow minimum 3year follow up) were retrieved. A retrospective analysis was performed cross referencing for stone size, location, treatment and need for further procedures. Ethical approval was granted through Metro North HHS HREC, Queensland, Australia. A total of 1930 patients met inclusion criteria. Fifty-seven percent (n = 1100) underwent left-sided ESWL, compared to 43% (n = 830) on the right. Stone size and location were both statistically significant to treatment outcome. Small stones (<1cm) had an overall clearance rate of 81.9%, medium stones (1-2cm) had a clearance rate of 60.6% and stones (>2cm) had a clearance rate of 31.3%. Small stones in an upper calyx had the highest clearance rate (87.5%, n = 120). Allowing for two procedures, 89% of stones were treated successfully. ESWL remains a legitimate option for the treatment of small and medium sized renal calculi. ESWL stone clearance rates at our centre are higher than published elsewhere and serve as proof to its efficacy. X-ray imaging on the day of the procedure, heavy consultant input and frequent intra-operative imaging are cited as key reasons for success. Further research is warranted to elucidate factors affecting stone clearance rate and to enable more standardised outcomes. Further investment may be required into ESWL provisions in most Australian states and especially in Queensland to enable its continued use in contrast to developing endourological techniques.