Management Of Stones Research Articles

Is high power holmium lithotripsy (HPLL) a new gold standard for management of bladder stones? Results from a tertiary endourology center

Is high power holmium lithotripsy (HPLL) a new gold standard for management of bladder stones? Results from a tertiary endourology center

441 Oxalate Content and AI Chatbot: Navigating Dietary Management for Hyperoxaluria and Kidney Stones

441 Oxalate Content and AI Chatbot: Navigating Dietary Management for Hyperoxaluria and Kidney Stones

Safety and efficacy of ureteroscopy for the treatment of large impacted proximal ureteralstones

Introduction and objective: Management of large impacted proximal ureteral stones is often challenging due to the presence of mucosal edema, inflammation and angulations of the ureter. Improvements in ureteroscopic technology increased the efficacy and safety of ureteroscopy (URS) as a first-line treatment in large impacted stones in the proximal ureter. The objective of this retrospective study is to evaluate the efficacy and safety of URS for the management of impacted proximal ureteral stones ≥ 10 mm. Material and methods: The medical records of 700 patients with ureteral stones, who underwent ureteroscopy and intracorporeal lithotripsy between January 2016 and Аpril 2024 were retrospectively reviewed. 179 patients had impacted stones ≥ 10 mm located in the proximal ureter – 125 (70%) were stones sized 10÷15 mm and 54 (30%) – stones ≥ 15 mm. URS was performed with 8.6 or 6.4Fr semirigid ureteroscope and Holmium laser. Flexible URS was performed in cases with tortuous ureter or stone retropulsion. Data on patients‘ preoperative characterstics, stone-free rates, operating times, intra- and postoperative complications were analyzed. Results: Patients’mean age was 54.1±12.3 years and mean stone size – 14.7±.4.8 mm. 30 % of the patients had previous unsuccessful shock- wave lithotripsy of the stone. Mean operative time was 45.1±15.7 min min and overall success rate – 85.3%. 66.2% of patients were treated with semirigid URS and 33.8% – with flexible URS. On subgroup analysis patients with stones 10÷15 mm and patients with stones ≥ 15 mm had similar preoperative characteristics. Success rate after a single procedure was higher and operating times significantly shorter in the subgroup of stones sized 10÷15 mm (87.1% vs 71.3%, p=0.159 and 41.3±12.9 vs 53.3±21.3 min, p=0.040,respectively). There were no statistically significant differences between the two subgroups in intraoperative stent JJ placement (34.1% vs 50.0%, p=0.400), stone retropulsion (21.3% vs 23.1%, p=0.847) and overall postoperative complications rate (9.3% vs 0%, p=0.161). Conclusion: The results of this study suggest that URS is a safe and effective treatment for management of patients with large impacted proximal ureteral stones. Larger stone size was a predictor of lower success rate after a single procedure.

Comparative Risks of Post-ERCP Adverse Events in Patients with Asymptomatic and Symptomatic Choledocholithiasis: A Systematic Review and Meta-Analysis.

Endoscopic retrograde cholangiopancreatography (ERCP) is the standard of care for the management of choledocholithiasis but carries risk of complications which may result in significant morbidity and mortality. While currently available guidelines endorse the use of ERCP for the management of symptomatic common bile duct stones, the need for ERCP in incidentally found asymptomatic choledocholithiasis is more controversial, and practice varies on a geographic and institutional level. This systematic review and meta-analysis is conducted to compare post-ERCP adverse events between asymptomatic and symptomatic choledocholithiasis patients. We searched PubMed/Embase/Web of Science databases to include all studies comparing post-ERCP outcomes between asymptomatic and symptomatic choledocholithiasis patients. The primary outcome was post-ERCP pancreatitis (PEP), while secondary outcomes included post-ERCP cholangitis, bleeding, and perforation. We calculated pooled risk ratios (RR) and 95% confidence intervals (CIs) using the Mantel-Haenszel method within a random-effect model. Our analysis included six observational studies, totaling 2,178 choledocholithiasis patients (392 asymptomatic and 1786 symptomatic); 53% were female. Asymptomatic patients exhibited a higher risk of PEP compared with symptomatic patients (11.7% versus 4.8%; RR 2.59, 95% CI 1.56-4.31, p ≤ 0.001). No significant difference was observed in post-ERCP cholangitis, bleeding, or perforation rates between the two groups. Asymptomatic patients with choledocholithiasis appear to have a higher risk of PEP than symptomatic patients, while the risk of other post-ERCP adverse events is similar between the two groups. Interventional endoscopists should thoroughly discuss potential adverse events (particularly PEP) with asymptomatic patients before performing ERCP and utilize PEP-prevention measures more liberally in this subgroup of patients.

Paediatric Renal Stone Management in Africa: A Scoping Review and Analysis of Current Practices.

Renal stones are solid deposits formed from minerals and salts that develop within the kidneys and urinary tract. While the condition is more common among adults, children and even infants can also be affected. There is an increasing incidence of paediatric renal stones in Africa alongside multiple challenges faced in managing the condition. This scoping review aimed to provide an overview of the management modalities of paediatric renal stones in Africa.This study utilised Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) checklist. A systematic search was conducted in three electronic databases: PubMed, African Journal Online (AJOL), and Google Scholar, with 1,180 articles curated. After extensive examination, 10 articles satisfied the inclusion criteria.The review found that calcium oxalate stones were the most prevalent type, accounting for 34.03% of cases, followed by whewellite stones and ammonium urate stones. The most frequent location for stones was the kidney, and the most common symptom was pain. Abdominopelvic ultrasound was the most frequently utilised investigation. Of the 886 patients managed for renal stones, 75.4% were managed surgically, 2.9% medically, and 21.7% spontaneously resolved without intervention.This review identifies opportunities for improving the management of paediatric renal stones in Africa, including the need for standardised diagnostic and treatment protocols and the development of evidence-based guidelines tailored to the African context. Overall, this scoping review provides valuable insights into the patterns and management of paediatric renal stones in Africa and highlights the need for further research to improve the management of this condition in the region.

Comparison of efficacy and safety of open and laparoscopic proximal ureterolithotomy for ureteral stone management: A systematic review and meta-analysis.

Despite advances in non-invasive and minimally invasive techniques, some proximal ureteral stones with impaction require open or laparoscopic surgery. No systematic reviews or meta-analyses have compared the efficacy and safety of open proximal ureterolithotomy and laparoscopic approaches. The aim of this study was to compare the efficacy and safety between open and laparoscopic proximal ureterolithotomy for ureteral stone management. Following the PRISMA guidelines, systematic searches were conducted in five databases (PubMed, Scopus, ScienceDirect, Web of Science, and ProQuest) to identify articles comparing those two surgical approaches. Operative time, blood loss, pain score, hospital stay, recovery time, and complications were collected and compared. Heterogeneity-based meta-analysis with random-effects or fixed-effects models were conducted. Two randomized controlled trials and four observational cohort studies with 386 participants met the criteria. Open surgery had significantly less time than laparoscopic ureterolithotomy (mean difference (MD): 26.63 minutes, 95%CI: 14.32, 38.94; p<0.0001). Intraoperative blood loss (MD: -1.27 ml; 95%CI: -6.64, 4.09; p=0.64) and overall complications (OR: 0.68; 95%CI: 0.41, 1.15; p=0.16) were not significantly different between two approaches. Laparoscopic ureterolithotomy reduced visual analogue scale (VAS) pain scores (MD: -2.53; 95%CI: -3.47, -2.03; p<0.00001), hospital stays (MD: -2.40 days; 95%CI: -3.42 to -1.38 days; p=0.03), and recovery time (MD: -9.67 days; 95%CI: -10.81 to -8.53 days; p<0.00001). In conclusion, open proximal ureterolithotomy had less time, but laparoscopic surgery reduced postoperative pain, hospital stay, and recovery time. Both methods had comparable intraoperative bleeding and complications.

Trends in Opioid and Nonsteroidal Anti-Inflammatory Drug Use for Patients with Kidney Stones in United States Emergency Departments from 2015 to 2021.

Introduction: Renal colic is frequently treated with opioids; however, narcotic analgesic use can lead to dependence and abuse. We evaluated use trends of opioids and nonsteroidal anti-inflammatory drugs (NSAIDs) for pain management of kidney stones in United States emergency departments (EDs) from 2015 to 2021. Methods: Kidney stone encounters were identified using National Hospital Ambulatory Medical Care Survey data. We applied a multistage survey weighting procedure to account for selection probability, nonresponse, and population weights. Medication use trends were estimated through logistic regressions on the timing of the encounter, adjusted for selected demographic and clinical characteristics. Results: Between 2015 and 2021, there were an estimated 9,433,291 kidney stone encounters in United States EDs. Opioid use decreased significantly (annual odds ratio [OR]: 0.87, p = 0.003), and there was no significant trend in NSAID use. At discharge, male patients were more likely than females (OR: 1.93, p = 0.001) to receive opioids, and Black patients were less likely than White patients (OR: 0.34, p = 0.010) to receive opioids. Regional variation was also observed, with higher odds of discharge prescriptions in the West (OR: 3.15, p = 0.003) and Midwest (OR: 2.49, p = 0.010), compared with the Northeast. Thirty-five percent of patients received opioids that were stronger than morphine. Conclusion: These results suggest improved opioid stewardship from ED physicians in response to the national opioid epidemic. However, regional variation as well as disparities in discharge prescriptions for Black and female patients underscore opportunities for continued efforts.

First prospective clinical assessment of the ILY® robotic flexible ureteroscopy platform.

To present the initial prospective clinical assessment of the ILY® robotic ureteroscopy manipulator platform, focusing on its safety and effectiveness. Data gathered from 31 kidney units which underwent elective robotic flexible ureteroscopy (FURS) for renal stone management utilizing the ILY® robotic system. Patient demographics, stone characteristics, surgical durations, perioperative and post-operative complications, and follow-up parameters were collected. Our primary outcome was evaluating the efficacy and safety of the ILY® robotic ureteroscopy for treating kidney stones. Therefore, we analyzed complication rates, surgical durations, and the stone-free rate during follow-up. Our cohort consisted of 29 patients, presenting with 45 stones with a median volume of 736.22 mm3. The median operation time was 85 min, accompanied by 3 min for robot draping, 3.5 min for robot docking, 48 min of console operation, and lasing time of 36.75 min. Post operative stay for all patients was 1 day, while complications were observed in 9.68% of cases. Notably, all complications were classified as CVD (Clavien-Dindo) class 1 due to pain requiring emergency department visit. The stone-free rate achieved was 93.55%, and none of the patient required reoperation for the treated stone. In the first prospective clinical experience of the ILY® robotic FURS, we demonstrated its efficacy and safety. To further investigate its clinical practical value, additional investigations are warranted, including direct comparative analyses with manual flexible ureteroscopy techniques.

Cost-effectiveness of quality improvement intervention to reduce time between CT-detection and ureteroscopic laser fragmentation in acute symptomatic ureteric stones management

ObjectiveTo prospectively assess clinical and cost effectiveness of emergency ureteroscopic laser fragmentation of urinary stones causing symptoms or obstruction.Patients and methods100 consecutive patients with an average (median) age 55.6 (57.5) years and average (median) stone size of 8.2 mm (± 7 mm) between October 2018 and December 2021 who underwent emergency ureteroscopy and laser fragmentation formed the study cohort as part of a clinical service quality improvement. Primary outcome was single procedure stone-free rate and cost-effectiveness. The secondary outcomes were complications, re-admission and re-intervention. A decision analysis model was constructed to compare the cost-effectiveness of emergency ureteroscopy with laser fragmentation (EUL) and emergency temporary stenting followed by delayed ureteroscopy with laser fragmentation (DUL) using our results and success rates for modelling.ResultsSingle procedure stone-free rates (SFR) for EUL and DUL were 85%. The re-intervention rate, re-admission and complication rates of the study cohort (EUL) were 9%, 18%, and 4%, respectively, compared to 15%, 20%, and 5%, respectively for the control cohort (DUL). The decision analysis modelling demonstrated that the EUL treatment option was more cost-efficient, averting £2868 (€3260) per patient for the UK health sector. Total cost of delayed intervention was £7783 (€8847) for DUL in contrast to £4915 (€5580) for EUL.ConclusionsImplementation of quality improvement project based on a reduction in CT detection-to-laser fragmentation time interval in acute ureteric obstruction or symptoms caused by stones had similar clinical effectiveness compared to delayed ureteroscopic management, but more cost-effective.

Percutaneous Nephrolithotomy 500 Cases in High-Risk and Altered Renal Function Test: Our Experience at Tertiary Care Centre

Introduction The study aims to evaluate the results of percutaneous nephrolithotomy (PCNL) in high-risk patients and patients with altered renal function tests (RFT) and complications in the management of renal stones in our hospital. Methods We retrospectively analyzed the outcomes of 500 patients who underwent PCNL between September 2020 and September 2023. We have analyzed data regarding patient details, investigations, PCNL puncture site, operative duration, number of punctures, stone-free rates (SFRs), duration of hospital stay, and complications. Results Out of 500 patients, 384 (76.87%) were males and 116 (23.13%) were females, with a male-to-female ratio of 3.32:1. The average age was 40.8±10.4 (mean±SD) (range: 24 to 74-years). The average operative time was 127±37 min (mean±standard deviation (SD)). The radiation exposure was from 1 min 30 sec to 3 min, with a mean (±SD) of 30 sec. The mean duration of the hospital stay was 2.7±1.6 days. Complete stone clearance was 87%, whereas SFRs defined by no identifiable stone on a plain radiograph or ultrasound or residual fragments &lt;5 mm were 90.93%. The complication rate was 2.2%. Conclusion The usual course of treatment for renal stones larger than 2 cm is PCNL. Significant factors influencing the stone-free rate include stone burden, stone type, PCNL puncture, number of punctures, and operative time. With the development of several lithotripsy procedures and the miniaturization of instruments, PCNL continues to be an excellent therapeutic option for patients with large renal stones, comorbidities, and changed RFT, with tolerable rates of complications.

Comparing Ureteral Catheterization's Impact on Flank Pain Post Ureteroscopic Stone Management

Background: Urolithiasis, or kidney stone disease, is a prevalent condition that poses significant challenges in urological practice. The management of ureteral stones, particularly through ureteroscopy, is a common intervention. The use of short-term ureteral catheterization as a postoperative pain management strategy following ureteroscopic stone removal has been a subject of debate, with limited evidence on its efficacy and necessity. Objective: This study aimed to evaluate the effectiveness of short-term ureteral catheterization in reducing postoperative flank pain compared to non-catheterization in patients undergoing uncomplicated ureterolithotripsy for the management of distal ureteral stones. Methods: A prospective, randomized, controlled trial was conducted at Liaquat National Hospital, Karachi, from January to July 2013, involving 60 patients aged 15-70 years with distal ureteral stones less than 1.0 cm. Patients were randomized into two groups: Group A received short-term ureteral catheterization, and Group B did not. The primary outcome measured was the reduction in mean pain score by at least 4 points from the baseline at every 6-hour interval for the first 24 hours post-procedure. Statistical analysis was performed using SPSS version 25, applying chi-square tests, independent sample t-tests, and Mann-Whitney tests, with a p-value of less than 0.05 considered significant. Results: Both groups demonstrated a significant reduction in pain scores at 12, 18, and 24 hours post-operation. However, there was no significant difference in pain reduction between the catheterized (Group A) and non-catheterized (Group B) groups, with p-values of 0.55 for efficacy in pain reduction. The mean age, stone size, and postoperative hospital stay did not significantly differ between the groups, indicating that short-term ureteral catheterization did not offer additional benefits in managing postoperative pain or recovery. Conclusion: Short-term ureteral catheterization following uncomplicated ureterolithotripsy does not significantly improve pain management compared to non-catheterization. This suggests that routine catheterization may be unnecessary, potentially leading to a paradigm shift in postoperative care for patients undergoing ureteroscopic stone removal. Future studies with larger sample sizes and long-term follow-up are needed to further validate these findings.

Assessing the Efficacy of Mini-PCNL Versus Standard PCNL for Management of Staghorn Calculi &gt;2cm: A Prospective Study in Peshawar

Background: Staghorn stones pose a significant challenge in urology, given their complex nature and potential for causing substantial renal damage. Traditional management has often involved standard percutaneous nephrolithotomy (PCNL), known for its efficacy in stone clearance but also associated with considerable complication rates. Recent advancements have led to the development of mini-PCNL, aiming to reduce these complications while maintaining high stone clearance rates. Objective: This study aims to compare the efficacy, safety, and outcomes of standard and mini-PCNL in the management of staghorn stones, with a focus on complication rates, stone clearance, and hospital stay durations. Methods: A prospective study was conducted at the Institute of Kidney Diseases, Hayatabad, Peshawar, involving 162 patients undergoing PCNL for staghorn stones from January 2020 to December 2023. Patients were categorized into standard PCNL (n=69) and mini-PCNL (n=93) groups based on the procedural approach. Pre-operative, intra-operative, and post-operative data were collected, including patient demographics, stone size and density, operative findings, post-operative complications, and stone clearance rates. Statistical analysis was performed using SPSS version 25. Results: The mini-PCNL group demonstrated a significantly smaller average stone size (26.8 ± 5.8 mm) compared to the standard PCNL group (32.3 ± 10.3 mm, p=0.037). Single tract use was more prevalent in mini-PCNL (87.1%) than in standard PCNL (71.0%, p=0.016). Stone clearance rates were higher in the mini-PCNL group (87.1%) versus the standard group (73.9%, p=0.041). The average hospital stay was shorter for mini-PCNL patients (2.4 ± 1.0 days) compared to those undergoing standard PCNL (3.0 ± 1.1 days, p=0.030). Complications, including post-operative hematuria requiring transfusion, were more common in the standard PCNL group. Conclusion: Mini-PCNL offers a safer and more effective alternative to standard PCNL in the management of staghorn stones, with lower complication rates, higher stone clearance rates, and shorter hospital stays. These findings support the adoption of mini-PCNL as a preferred approach for managing complex renal calculi.

Possible Role of Percutaneous Nephrolithotomy in Management of Pediatric Renal Stones

Possible Role of Percutaneous Nephrolithotomy in Management of Pediatric Renal Stones

Pharmacists’ perspectives and perceived barriers to counselling patients with kidney stones

BackgroundThe global increase in kidney stone incidence and its complications emphasise the need for effective management. While pharmacists can play a significant role in counselling and guiding patients, their practices in managing patients with kidney stones remain unclear. Objective(s)To explore counselling practices and experiences of pharmacists when dealing with patients with kidney stones and to identify the barriers they face while providing counselling. MethodsA qualitative study was performed using semi-structured phone interviews with pharmacists practising in Jordan. Pharmacists were selected using quota sampling from those who took part in a previous study focused on pharmacists’ knowledge of kidney stone aetiology and treatment. The COM-B Model of Behaviour Change was used to develop the interview guide and the analytical framework. Interviews were transcribed verbatim and analysed using a deductive thematic approach based on the pre-specified analytical framework. ResultsSeven pharmacists (85.7% female; 57.1% working in community pharmacies) were interviewed. Counselling practices of patients with kidney stones were categorised into five themes: (1) Pharmacists’ beliefs about patient counselling: perceived importance and desire to improve health through counselling; (2) Most priority patients: Types of patients mostly counselled; (3) Content of kidney stones-specific counselling: patient assessment and recommendations about kidney stones management; (4) Duration of the counselling sessions: time offered and influencing factors; (5) Barriers to patient counselling: patient-related, and pharmacist- and doctor-related challenges. ConclusionsPharmacists recognise the crucial role of kidney stones counselling but face gaps in their practices, including incomplete dietary education, limited knowledge of medication prescriptions, inconsistent patient-specific approaches, and potential communication challenges. These gaps can be overcome by enhancing training, standardising protocols of kidney stone treatment, promoting interprofessional communication, and improving communication strategies. Future research, including quantitative assessments, is needed to inform strategies that optimise patient counselling practices and facilitate improved outcomes.

Holmium Laser Lithotripsy in the Management of Difficult Biliary and Cystic Ductal Stones – A Case Series

Abstract Choledocholithiasis or common bile duct stone (CBDS) presents a unique challenge in the management of biliary stones. The clinical presentation of CBDS varies from asymptomatic CBDS, detected during the evaluation of gallstone disease to sinister presentation, like severe biliary pancreatitis. Asymptomatic liver function test abnormality, biliary colic, dilated common bile duct (CBD) on sonography for pain abdomen, and cholangitis are the part of the spectrum. Based on clinical suspicion and aided by laboratory parameters, the diagnosis is confirmed by modalities such as ultrasonography or magnetic resonance cholangiopancreatography or by endoscopic ultrasound. Endoscopic radiological cholangiopancreatography (ERCP) has evolved as a standard of care over the decades for the management of CBDS and surgical exploration of CBD is rarely resorted. ERCP is followed by laparoscopic cholecystectomy as a definitive treatment to prevent recurrence of CBDS. Multiple factors play a role in the successful extraction of CBDS. Two broad considerations are the size of stone and bilio-duodenal anatomy. Multiple studies have noted that stone size larger than 15 mm requires fragmentation for successful extraction. Mechanical lithotripsy has been cornerstone for the management of such cases. Besides size of stone, morphology and number of stones, narrow CBD (distal to stone), duodenal diverticulum and altered anatomy due to gastroduodenal surgeries pose a challenge in stone extraction and are collectively called difficult CBDS. Multiple modalities notably extracorporeal shortwave lithotripsy, holmium laser (Ho laser) lithotripsy, and electrohydraulic lithotripsy (EHL) have been studied for the fragmentation of large CBDS. Innovation in cholangioscopy and wider availability of peroral single-operator cholangioscope has brought EHL and Ho laser lithotripsy (LL) at forefront of management of difficult CBD stones. We share the experience of Ho LL for CBDS at a tertiary care hospital in Western India. The data of four patients, successfully managed with single-operator cholangioscopy (SoC)-guided Ho LL for indications ranging from large CBDS to residual large cystic duct stump stone has been discussed. These cases emphasize wider clinical application of SoC-guided Ho-LL beyond the size of the stone. Ho LL has revolutionized the management of difficult biliary stone. The major limitation is cost of care and availability of expertise.

Percutaneous nephrolithotomy in case of crossed fused renal ectopia: a case report

Crossed renal ectopia is a rare congenital anomaly that is frequently associated with gastrointestinal, cardiovascular, genital, and bone malformations. To best of our knowledge, there aren't many cases of inferior crossed fused renal ectopia of the right kidney documented in the literature at this time. A case of crossed-fused renal ectopia is presented here. A 32-year-old man arrived at our hospital complaining of pain in the right flank. Diagnosis: We suspected a single right kidney based on abdominal ultrasonography. An inferior left to right crossed-fused ectopic kidney with calculus in the right (normal) renal pelvis was the patient's diagnosis when combined with 3D computed tomography. Interventions: percutaneous nephrolithotomy with DJ stenting. Because the management of renal stone in this uncommon malformation is complicated, a preoperative assessment with contrast computed tomography is required before moving forward with surgery in order to explore a single kidney with calculi and avoid missing the diagnosis of crossed fused renal ectopia.

When a kidney stone becomes a killer

This case report aims to raise awareness of the seriousness of neglecting a kidney stone which can turn into a killer destroying the entire renal parenchyma and lead to radical treatment. The development of new endoscopic techniques such as mini NLPC and ureteroscopy has made it possible to improve the management of kidney stones and even complex corraliform stones. Nephrectomy by lombotomy remains an open surgical technique among others which allows the removal of the diseased kidney to avoid the appearance of complications such as pyelonephritis and pyonephrosis.

Comparison of STONE Score, Guy's Stone Score, CROES Nomogram, and Seoul National University Renal Stone Complexity Score in Prognosticating Outcomes of Multiple-Tract Mini-Percutaneous Nephrolithotomy: A Retrospective Study.

Objective The objective of this study was to compare the STONE score (Size of the stone, Topography or location, degree of Obstruction of the urinary system, Number of stones, and Evaluation of Hounsfield units), Guy's stone score (GSS), Clinical Research Office of the Endourological Society (CROES) nomogram, and Seoul National University Renal Stone Complexity Score (RSCS) in prognosticating multiple tract mini-percutaneous nephrolithotomy (mPCNL) outcome. Methodology Thisdescriptive retrospective analysis was carried out at the Urology Department, Lady Reading Hospital, Peshawar, Pakistan. Male and female patients in the age range of 18-70 years who underwent multiple tract mPCNL for renal stones from July 1, 2021, to June 30, 2023, were included in the analysis. Results A total of 110 patients were registered. Stone-free status (SFS) was achieved in 78.2% (n=86), and complications were observed in 13.6% (n=15) patients. The odds ratio for STONE score, GSS, CROES scoring system, and RSCS for predicting the SFS was 7.093 (95%CI 2.40-20.89), 9.333 (95%CI 2.92-29.81), 11.70 (95%CI 2.56-53.38) and 3.450 (95%CI 1.25-9.53), respectively. Conclusion Multiple tract mPCNL is a safe and effective technique for the management of renal stones, producing a high stone-free rate. This study demonstrated adequate efficacy and dependability of the four scoring systems in predicting SFS.

Endoscopic Management of Difficult Biliary Stones: An Evergreen Issue.

Choledocholithiasis is one of the most common indications for endoscopic retrograde cholangiopancreatography (ERCP) in daily practice. Although the majority of stones are small and can be easily removed in a single endoscopy session, approximately 10-15% of patients have complex biliary stones, requiring additional procedures for an optimum clinical outcome. A plethora of endoscopic methods is available for the removal of difficult biliary stones, including papillary large balloon dilation, mechanical lithotripsy, and electrohydraulic and laser lithotripsy. In-depth knowledge of these techniques and the emerging literature on them is required to yield the most optimal therapeutic effects. This narrative review aims to describe the definition of difficult bile duct stones based on certain characteristics and streamline their endoscopic retrieval using various modalities to achieve higher clearance rates.

Ureteral stricture formation after endoscopic removal of obstructing stones: could it be predicted with well-assessed radiological parameters?

The possible role of well-assessed radiological parameters in the prediction of ureteral stricture formation in cases with impacted obstructive ureteral calculi has been evaluated. 46 adult patients with or without ureteral stricture formation after ureteroscopic stone management were included. In addition to stone size and some certain radiological parameters including ureteral wall thickness (UWT) of the involved ureter at the impacted stone site was also measured and noted on computed tomography (CT) images. Parameters were evaluated in two subgroups of cases, namely: Group 1: patients in whom a ureteral stricture formed after endoscopic stone removal and Group 2: patients normal ureteral anatomy without any stricture formation. The possible relationship between the UWT values and degree of hydronephrosis (HN) with subsequent stricture formation was comparatively evaluated. All of the stones were proximal ureteral calculi in both groups. Both the degree of HN and proximal ureteral diameter (PUD) parenchymal was higher in cases with stricture formation. In addition, mean parenchymal thickness was lower and mean values of UWT measurements at the stone site were 3.70 ± 0.97mm and 2.17 ± 0.26mm in Groups 1 and 2, respectively. A cutoff value 2.49mm for UWT was found to be highly predictive for stricture formation. UWT value calculated at the obstructing stone site was found to be predictive enough for the likelihood of ureteral stricture formation with high sensitivity and specificity . This evaluation along with some other radiological parameters may enable the urologists to follow such cases on this aspect with necessary measures taken.