Primary Stones Research Articles

International Alliance of Urolithiasis (IAU) guidelines on the management of pediatric urolithiasis.

The aim of this study was to construct the sixth in a series of guidelines on the treatment of urolithiasis by the International Alliance of Urolithiasis (IAU) that by providing a clinical framework for the management of pediatric patients with urolithiasis based on the best available published literature. All recommendations were summarized following a systematic review and assessment of literature in the PubMed database from January 1952 to December 2023. Each generated recommendation was graded using a modified GRADE methodology. Recommendations are agreed upon by Panel Members following review and discussion of the evidence. Guideline recommendations were developed that addressed the following topics: etiology, risk factors, clinical presentation and symptoms, diagnosis, conservative management, surgical interventions, prevention, and follow-up. Similarities in the treatment of primary stone episodes between children and adults, incorporating conservative management and advancements in technology for less invasive stone removal, are evident. Additionally, preventive strategies aiming to reduce recurrence rates, such as ensuring sufficient fluid intake, establishing well-planned dietary adjustments, and selective use pharmacologic therapies will also result in highly successful outcomes in pediatric stone patients. Depending on the severity of metabolic disorders and also anatomical abnormalities, a careful and close follow-up program should inevitably be planned in each pediatric patient to limit the risk of future recurrence rates.

Haplotype-resolved genome assembly for tetraploid Chinese cherry (Prunus pseudocerasus) offers insights into fruit firmness.

Chinese cherry (Prunus pseudocerasus) holds considerable importance as one of the primary stone fruit crops in China. However, artificially improving its traits and genetic analysis are challenging due to lack of high-quality genomic resources, which mainly result from difficulties associated with resolving its tetraploid and highly heterozygous genome. Herein, we assembled a chromosome-level, haplotype-resolved genome of the cultivar 'Zhuji Duanbing', comprising 993.69Mb assembled into 32 pseudochromosomes using PacBio HiFi, Oxford Nanopore, and Hi-C. Intra-haplotype comparative analyses revealed extensive intra-genomic sequence and expression consistency. Phylogenetic and comparative genomic analyses demonstrated that P. pseudocerasus was a stable autotetraploid species, closely related to wild P. pusilliflora, with the two diverging ~18.34 million years ago. Similar to other Prunus species, P. pseudocerasus underwent a common whole-genome duplication event that occurred ~139.96 million years ago. Because of its low fruit firmness, P. pseudocerasus is unsuitable for long-distance transportation, thereby restricting its rapid development throughout China. At the ripe fruit stage, P. pseudocerasus cv. 'Zhuji Duanbing' was significantly less firm than P. avium cv. 'Heizhenzhu'. The difference in firmness is attributed to the degree of alteration in pectin, cellulose, and hemicellulose contents. In addition, comparative transcriptomic analyses identified GalAK-like and Stv1, two genes involved in pectin biosynthesis, which potentially caused the difference in firmness between 'Zhuji Duanbing' and 'Heizhenzhu'. Transient transformations of PpsGalAK-like and PpsStv1 increase protopectin content and thereby enhance fruit firmness. Our study lays a solid foundation for functional genomic studies and the enhancement of important horticultural traits in Chinese cherries.

A Rocky Road: Bladder Stones in the Augmented Exstrophy-Epispadias Complex Patient

ObjectivesTo determine the rate of stone formation amongst patients of the exstrophy-epispadias complex with augmentation cystoplasty. We hypothesize that bowel segment choice influences the rate of stone formation after bladder augmentation and the rate of complications from bladder stone surgery. MethodsAn IRB approved institutional database of 1512 exstrophy-epispadias patients was reviewed retrospectively. Patients that had a history of bladder augmentation and were seen at our institution between 2003 and 2023 were included. ResultsOut of 259 patients, bladder stones developed in 21.6% (56), of which the bowel segment used was colon in 147 patients and ileum in 100. Stones formed in 19% of colon augments compared to 29% ileal augments, however this was not statistically significant (p=0.07). The most common primary stone component was dahllite, followed by struvite for all augments. The median time to stone treatment after augmentation was 4.14 years (0.75-31). 74% of patients had a recurrence that required a second surgery. The median time from first to second surgery and second to third surgery was 1.4 years and 2.22 years, respectively. Bladder stone surgery complications occurred in 14% of patients, vesicocutaneous fistula being the most common, and complications did not differ by augment type. Median follow up after first stone intervention was 6.07 years (0-19.5). ConclusionThe treatment of bladder stones in the exstrophy-epispadias complex remains challenging. Interventions to prevent recurrence are crucial as the majority of patients will require two or more stone surgeries in their lifetime.

Recurrent Sialolithiasis following Intraoral Deep Hilar/Intraparenchymal Stone Removal from Wharton’s Duct

(1) Background: Submandibular gland (SMG) sialolithiasis treatment has shifted significantly, favouring minimal invasiveness. Nonetheless, transoral stone removal remains viable for distal, deep hilar, and intraparenchymal stones. However, data are limited regarding recurrence and revision surgery; (2) Patients/Methods: This retrospective study included 226 patients with SMG stones treated using Wharton’s duct slitting and marsupialisation over nine years; 138 had deep hilar or intraparenchymal stones, while 88 had distal stones. Of the former group, 18 experienced symptom recurrence post-surgery, 12 with stones and 6 with duct stenosis; (3) Results: Of the 126 patients without recurrent stones, 71% were male and 29% were female. Their mean age was 51.02 ± 9.36 years. The stones of the 126 patients without recurrence had a diameter of 8.3 mm ± SD: 4 mm, which was significantly smaller than those of the patients who experienced recurrence (13.8 mm ± SD: 2.4 mm; p < 0.05). The mean estimated stone growth recurrence rate was 8.4 ± SD: 1.8 mm per year. A secondary operation was performed 34 ± SD: 14.7 months after the first. Of the patients with recurrence, 91.7% were treated under general anaesthesia. The preferred treatment for 58.4% of patients was intraoral revision operation; the remainder underwent total gland resection. The mean follow-up period was 43 ± SD: 18 months; (4) Conclusions: The rate of revision surgery was relatively low. In recurrent SMG sialolithiasis, new stones may grow faster than the primary stones, which are already larger than those in patients without recurrence. The slitting and marsupialisation of Wharton’s duct can treat recurrent cases.

Evaluation of risk factors for recurrent renal stone formation among Saudi Arabian patients: Comparison with first renal stone episode.

We evaluated the baseline characteristics, and risk factors of renal stone recurrence among Saudi Arabian patients after successful primary stone treatment. In this cross-sectional comparative study, we reviewed the medical records of patients who presented consecutively with a first renal stone episode from 2015 to 2021 and were followed-up by mail questionnaire, telephone interviews, and/or outpatient clinic visit. We included patients who achieved stone-free status after primary treatment. Patients were divided into two groups: group I (patients with first episode renal stone) and group Ⅱ (patients who developed renal stone recurrence). The study outcomes were to compare the demographics of both groups and to evaluate the risk factors of renal stone recurrence after successful primary treatment. We used Student's t-test, Mann Whitney test or chi-square (x2) to compare variables between groups. Cox regression analyses were used to examine the predictors. We investigated 1260 participants (820 males and 440 females). Of this number, 877 (69.6%) didn't develop renal stone recurrence and 383 (30.4%) had recurrence. Primary treatments were percutaneous nephrolithotomy (PCNL), retrograde intrarenal surgery (RIRS), extracorporeal shock wave lithotripsy (ESWL), surgery and medical treatment in 22.5%, 34.7%, 26.5%, 10.3%, and 6%, respectively. After primary treatment, 970 (77%) and 1011 (80.2%) of patients didn't have either stone chemical analysis or metabolic work-up, respectively. Multivariate logistic regression analysis revealed that male gender (OR: 1.686; 95% CI, 1.216-2.337), hypertension (OR: 2.342; 95% CI, 1.439-3.812), primary hyperparathyroidism (OR: 2.806; 95% CI, 1.510-5.215), low fluid intake (OR: 28.398; 95% CI, 18.158-44.403) and high daily protein intake (OR: 10.058; 95% CI, 6.400-15.807) were predictors of renal stone recurrence. Male gender, hypertension, primary hyperparathyroidism, low fluid intake and high daily protein intake increase the risk of renal stone recurrence among Saudi Arabian patients.

Fractional order adaptive hunter-prey optimizer for feature selection

Proposing a reliable feature selection approach is the primary stone for endorsing the prediction performance; therefore, this paper proposes an enhanced optimization technique to identify the features of diverse datasets. The proposed approach employs the memory dependency of the fractional calculus operators to boost the agents’ motion during the diversification and the intensification of the hunter-prey optimization algorithm (HPO). Moreover, a chaotic sine map is applied to balance the transition between the exploitation and exploration cores, aiming to improve further convergence. As a result, a novel variant named fractional adaptive HPO (F-AHPO) is proposed as a modified feature selection (FS) model. The proposed algorithm’s applicability and performance are validated by using various UCI datasets. For the purpose of evaluating the proposed approach performance, its results are assessed and demonstrated versus a set of state-of-art techniques representing the literature. The results show the high ability of F-AHPO to enhance classification accuracy by removing irrelevant features. F-AHPO provides better results than other methods based on several performance measures.

Prevalence of Stone Disease and Procedure Trends in the United States

To evaluate the prevalence of stone disease and procedure trends among US commercial and Medicare populations. Retrospective analyses for a US commercial population and Medicare population were conducted using the Merative MarketScan Commercial Database and Medicare Standard Analytic File (5% sample), respectively. Patients aged 18+ were included if they had an encounter in any setting with a primary stone diagnosis or stone procedure (ureteroscopy [URS], percutaneous nephrolithotomy (PCNL), or shockwave lithotripsy [SWL]) between 2011 and 2019. Analyses were conducted at the patient level. Over the study time horizon, the prevalence of stone disease showed a small yet statistically significant decrease in the commercial population (1.04%-1.01%; P<0.0001) and a statistically significant increase in the Medicare population (1.84%-2.34%; P<0.0001). URSprocedure volumes increased by 22.6% (P<0.0001) in the commercial population and by 56.6% (P<0.0001) in the Medicare population over the study period. Similarly, PCNLprocedure volumes increased by 17.4% (P<0.0001) in the commercial population and 27.5% (P<0.0001) in the Medicare population. Procedure volumes for SWL decreased by 26.9% in the commercial population (P<0.0001) and by 3.8% in the Medicare population although the results were not statistically significant. The prevalence of stone disease showed a small decrease in the US commercial population and an increase in the Medicare population over the study time horizon. In both populations, increasing procedure volumes were observed for URS and PCNL while decreasing volumes were observed for SWL.

Microbiological profile of bile culture and its antimicrobial susceptibility pattern in endo-biliary stented patients undergoing cholecystectomy

Background: The vast majority of common bile duct (CBD) stones was secondary, formed within the gall bladder (GB) and migrates down the cystic duct into CBD or rarely due to primary stones formed in CBD. Intra-operative bile culture prevents development of infectious complications and guide selection of future appropriate antibiotic prophylaxis. Hence, this study focussed on investigation of microbiological profile of routine bile cultures in endo-biliary stenting patients undergoing cholecystectomy.Methods: In this study, 50 patients with CBD stone(s) were undergone endoscopic retrograde cholangio-pancreatography (ERCP) followed by stenting and then cholecystectomy (either laparoscopically or open). GB extraction was done in a sterile bag and after opening sterile bag; bile was collected and sent for microbiological culture and sensitivity for analysis.Results: Most of the cases had cholelithiasis with choledocholithiasis (38.0%) which were significantly higher than other diagnosis (Z=2.51; p&lt;0.05) and there was no significant association found between surgical site infections and bile culture positivity of studied patients (Z=9.61; p&lt;0.0001). Among 35 patients with positive bile cultures, E. coli in 26 patients followed by Klebsiella species in 5 patients were the most prevalent bacteria isolates and over all, colistin (91.4%) and tigecycline (91.4%) were found as sensitive antibiotics. Also, certain strains of multi drug resistance E. coli in 6 patients were resistant to gentamicin/amikacin only sensitive to tigecycline and colistin, which was high.Conclusions: Most prevalent isolates microorganism is gram negative bacteria that were mostly gut bacteria and the incidence of post ERCP infection is high and drug resistance among the causative organism is common.

Efficacy of Flexible Ureteroscopic Lithotripsy and Percutaneous Nephrolithotomy in the Treatment of Complex Upper Urinary Tract Nephrolithiasis.

Objective A case-control study was conducted to compare the efficacy and prognostic factors of flexible ureteroscopic lithotripsy (FURL) and percutaneous nephrolithotomy (PCNL) when treating complex upper urinary tract renal calculi based on a retrospective cohort study. Methods The study period was from October 2019 to December 2021. A retrospective study was carried out on 100 patients with complicated upper urinary tract nephrolithiasis who underwent surgery in the Urology Department of our hospital. They were assigned into two groups: FURL and PCNL groups. The intraoperative blood loss, operation time, hematuria duration, hospital stay, primary stone removal rate, incidence of intraoperative and postoperative complications, VAS score, level of inflammatory factors, and micturition function were compared. According to the postoperative prognosis, the patients were reassigned into two groups: good prognosis group (n = 38) and poor prognosis group (n = 106). The factors related to poor prognosis after FURL and PCNL were screened, and multivariate loglistic regression analysis was adopted to determine the risk factors. Results The primary stone clearance rate in the PCNL group was significantly higher than that in the FURL group, and there was no significant difference in the incidence of intraoperative and postoperative complications between the two groups (P > 0.05). The intraoperative blood loss and the duration of hematuria in the PCNL group were significantly shorter than those in the FURL group, and the operation time and postoperative hospital stay in the FURL group were longer than those in the FURL group. The postoperative VAS score in the study group was significantly lower than that in the control group (P < 0.05). The levels of CRP, IL-1, TNF-α, and NF-κB in both groups decreased after operation, and the level of inflammatory factors in the PCNL group was significantly lower than that in the FURL group (P < 0.05). The indexes of IPSS and Qmax in the PCNL group were significantly lower than those in the control group 3 months after operation. The index of micturition function in the PCNL group was significantly lower than that in the FURL group. Preoperative use of immunosuppressant, preoperative stone fever, positive preoperative urine culture, preoperative urinary leukocyte count ≥ 544 × L, intraoperative urinary opacity, and pus fur were significantly correlated with poor prognosis of ureteral patients (P < 0.05). Preoperative stone fever, high preoperative urinary leukocyte count, intraoperative urinary turbidity, and suppurative fur were independent risk factors for postoperative SIRS in patients with ureteral calculi. Conclusion PCNL is effective when treating complex upper urinary tract renal calculi. Compared with FURL, PCNL can remarkably reduce intraoperative blood loss and hematuria duration, can enhance micturition function, and will not remarkably increase the incidence of intraoperative and postoperative complications, high safety. High white blood cell count in urine before operation, fever due to stone before operation, turbid urine, and purulent fur during operation are independent risk factors for postoperative adverse outcome in patients with complex upper urinary tract renal calculi. Patients should be fully treated before surgery.

Application of CTU-Assisted Doppler Ultrasound Puncture in Nontube Percutaneous Nephrolithotomy, Its Effect on Patients' Complications, and Its Clinical Value.

Objective To research the application of CTU-assisted Doppler ultrasound puncture in uncatheterized PCNL, its influence on patients' complications, and its clinical value in a case-control study. Methods One hundred and forty-four patients who went through percutaneous nephrolithotomy (PCNL) from March 2019 to June 2021 in our hospital were arbitrarily assigned into the CTU group (n = 72) and CT plain scan group (n = 72). CTA+CTU was adopted to determine the puncture passage in the CTU group, and CT scan was employed in the CT group. The intraoperative blood loss, postoperative blood loss, operation time, hospital stay, primary stone removal rate, and the incidence of intraoperative and postoperative complications were compared. The visual analogue score (VAS) was employed to assess the degree of postoperative wound pain. Results The first-stage stone removal rate in the CTU group was 95.83% (69/72), which was remarkably higher compared to the CT plain scan group, which was 81.94% (59/72), and the difference was statistically significant (P < 0.05). The overall rates of intraoperative complications were 6.94% (5/72) in the CTU group and 18.06% (13/72) in the CT plain scan group, respectively, which exhibited great differences (P < 0.05). In addition, the overall rates of intraoperative complications were 2.78% (2/72) in the CTU and 13.89% (10/72) in the CT plain scan group, respectively, and the difference was statistically significant (P < 0.05). The operation time and postoperative hospital stays in the CTU group were remarkably shorter compared to the CT group, and the difference was statistically significant (P < 0.05). The intraoperative and postoperative blood loss of CTU group displayed obvious less than that of the CT group, and the difference was statistically significant (P < 0.05). The VAS were compared 24 hours after surgery. After operation, the VAS of 24 hours after operation in the CTU group (0.92 ± 0.12) were remarkably lower compared to the CT group (1.22 ± 0.15), and the difference was statistically significant (P < 0.05). Discussion. PCNL is constantly being optimized by CTU-assisted Doppler ultrasound puncture to improve stone clearance rates, reduce postoperative bleeding, be less painful, provide rapid recovery, and provide safe and feasible results. It is therefore worthwhile to standardize and then widely promote it in clinical practice.

PD50-10 EVALUATING THE ENCRUSTATION FEATURES DUE TO THE SHORT-TERM URETERAL STENT PLACEMENT USING MICRO-COMPUTED TOMOGRAPHY: THE RESULTS FROM A PROSPECTIVE STUDY

You have accessJournal of UrologyCME1 May 2022PD50-10 EVALUATING THE ENCRUSTATION FEATURES DUE TO THE SHORT-TERM URETERAL STENT PLACEMENT USING MICRO-COMPUTED TOMOGRAPHY: THE RESULTS FROM A PROSPECTIVE STUDY Shinji Fukui, Takashi Yoshida, Kuniko Takemoto, and Hidefumi Kinoshita Shinji FukuiShinji Fukui More articles by this author , Takashi YoshidaTakashi Yoshida More articles by this author , Kuniko TakemotoKuniko Takemoto More articles by this author , and Hidefumi KinoshitaHidefumi Kinoshita More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002621.10AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: To evaluate the short-term encrustation formation and encrustation volume of the ureteral stent, focusing on the major stone components (i.e., calcium oxalate and calcium phosphate). METHODS: Eighty-four patients requiring ureteral stent placement after retrograde intrarenal surgery (RIRS) were enrolled. After stent removal on postoperative day 14, the encrustation volume on the stent surface was measured by micro-computed tomography. Of the 84 patients, 71 were eligible for this study, excluding seven patients with no encrustation, two patients with uric acid (1 patient) and cystine (1 patient), and four patients with no available data. The encrustation volume was evaluated by micro-CT, and the stone components and the component ratio were determined using infrared spectroscopy. RESULTS: All included patients had encrustation in the inner lumen of the stent. Compared to this, encrustation on the outer surface was observed only in 3 (4.2%) patients (p <0.001). Sixty-seven patients (94%) had calcium oxalate as the primary stone component, 42 (62%) of whom had pure calcium oxalate. Four patients (6%) had pure calcium phosphate as the primary stone component, three of whom had mixed stone with calcium phosphate. Cases with calcium oxalate showed a higher prevalence of stone components than those with calcium phosphate (p <0.001). However, cases with calcium phosphate stone had a significantly greater median inner encrustation volume compared to those with calcium oxalate stone (3.66 mm3 vs. 1.11 mm3; p <0.001). There was no difference observed in the encrustation volume on the outer surface between the two stone components (p=0.86). In multivariate analysis, crystalluria (p=0.013) and primary calcium phosphate component (p <0.001) were significantly associated with the increased total encrustation volume on the stent. CONCLUSIONS: This study revealed that the encrustation volume on the stent was significantly greater for calcium phosphate compared to calcium oxalate with the short-term indwelling ureteral stent. Thus, early stent removal may be recommended for patients with calcium phosphate stones. Source of Funding: No source of funding © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e840 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Shinji Fukui More articles by this author Takashi Yoshida More articles by this author Kuniko Takemoto More articles by this author Hidefumi Kinoshita More articles by this author Expand All Advertisement PDF DownloadLoading ...

Is there a place for extracorporeal shockwave lithotripsy (ESWL) in the endoscopic era?

This retrospective study aimed to evaluate whether there was still a place for ESWL therapy in the endourological era. From 1988 to 2018, ESWL therapy was performed with 3 successive types of lithotripters in our hospital. From 1988 to 1998, the electrohydraulic lithotripter NS-15 was used, and the electromagnetic lithotripter HK-V was put to use in 1999. Since 2010, the electromagnetic lithotripter HK-Vm has been used. Over the 30-year period, 16,969 urolithiasis patients underwent ESWL therapy, including 124 paediatric cases and 178 special cases. The stone clearance rate (SCR) and postoperative complications in the 3 lithotripter groups were recorded and analysed. The SCR was estimated by ultrasonography or plain X-ray, while the complications were recorded by the modified Clavien grading system. The primary stone clearance rate (pSCR) of ureteral and renal stones was significantly improved in the HK-Vm group compared with the NS-15 and HK-V groups. The final stone clearance rate (fSCR) of lower calyx stones was considerably higher in the HK-Vm group (55.9%) than in the NS-15 (41.1%) and HK-V (44.1%) groups. Most complications were grade I and II, while the incidence of grade III and above complications was less than 3%. Additionally, the fSCR in paediatric and special cases ranged from 66.5% to 83.5%, with no record of severe complications. As our data showed, ESWL was effective and safe for most urolithiasis patients, including paediatric patients and special cases. Therefore, ESWL is still the major treatment option in the current endourological era.

Huge primary vaginal stone protruding through vaginal orifice damaging the hymen and associated with vesicovaginal fistula and urinary bladder stone: Case Report

Background: vaginal stone (VS) is a rare condition with non-specific presentation, different predisposing factors and can affect different age groups. Its diagnosis is usually incidental and needs high index of suspicion. Case summary: we reported a case of 29 years old single lady presented with continuous urine leak for more than one year. Ultrasound study (USS) showed urinary bladder (UB) stone. Gynecological examination revealed huge VS damaging the hymen as it extended distal to the level of hymen, cystoscopy showed big UB stone and vesicovaginal fistula (VVF). VS extracted, UB stone removed by open vesicolithotomy (VL) and VVF was planned to be repaired after three months. To our knowledge this is the first VS that compromise the intactness of the hymen. Conclusion: This case demonstrate primary VS due to VVF associated with UB stone causing hymen damage. Key Words: Vaginal stone, urinary bladder stone, vesicovaginal fistula, hymen. Abbreviations: VS; vaginal stone. USS; ultrasound study. UB; urinary bladder. VVF; vesicovaginal fistula. VL; vesicolithotomy. CT; computed tomography. MRI; magnetic resonance imaging.

A single center study that evaluates the preclinical use of a newly developed software and moving bed system to facilitate the spontaneous excretion of residual fragments after primary stone treatment (RIRS or PCNL)

PurposeWe developed a Postural Drainage Lithotripsy System (PDLS) that uses the patient's computed tomography urography (CTU) data to reconstruct the three-dimensional figure of the renal pelvis, provides an individualized inversion and overturning angle and uses gravity to remove residual fragments (RFs). The purpose of this study was to investigate PDLS in the treatment of renal RFs.MethodsA stone with a diameter of 4.0 mm was placed in the upper, middle, and lower calyx of the renal model. A total of 60 trials were applied to 20 renal models. The movement trajectory, passage rate, and postural drainage angle of calculi during the treatment of PDLS were observed.ResultsAll of the stones in 60 trials were observed to move during treatment, and 53/60 (88%) were relocated successfully to the renal pelvis. The passage rate of the upper calyx was 14/20 (70%), that of the middle calyx was 20/20 (100%), and that of the lower calyx was 19/20 (95%).ConclusionsPDLS can provide individualized inversion and reversal angles and remove stones from the renal model. More clinical trials are needed to verify the above view and evaluate its efficacy.

Stones and Moans: Higher Number of Nephrolithiasis Related Encounters Increases the Odds of Opioid Misuse

ObjectiveTo evaluate the association between kidney stones and risk of subsequent opioid misuse. MethodsThe Healthcare Cost and Utilization Project's (HCUP) inpatient, ambulatory, and emergency department databases from 4 states were queried to identify associations with a primary diagnosis code related to kidney stones followed by a diagnosis of opioid abuse, dependence, or overdose between 2005, and 2015. Logistic regression was performed to determine the strength and significance of the relationship between number of primary kidney stone episodes and subsequent diagnosis of opioid misuse. ResultsThe final cohort included 783,929 patients across 4 states. On multivariable analysis the number of primary stone encounters (PSE) was strongly associated with the risk of developing an opioid-related disorder (ORD) when adjusting for relevant covariates (odds ratio 1.3). Patients seen in the emergency department (OR 1.4) and those treated in Iowa (OR 2.9) were at higher risk for ORD than those seen in different contexts or states. Younger age increased the strength of this association. Higher income (OR 0.7) and non–white race (OR 0.7) reduced the risk of ORD, while a diagnosis of chronic pain (OR 3.5) increased risk. ConclusionRisk of subsequent diagnosis of ORD is increased in patients who have multiple episodes of care related to kidney stones.

Comparison between OPEN STONE SURGERY vs PERCUTENOUS NEPHROLITHOTOMY in Management of Renal Stones By Using S.T.O.N.E Nephrolithometry Scoring System

Abstract Background In spite of Percutaneous nephrolithotomy (PCNL) became the first-line treatment option for patients with large and complex renal stones, there still remains a need of using open stone surgery (OSS) for removal of stones as a second or third line of treatment option. To date, 3 scoring systems have been proposed utilizing different metrics including the Guy’s Stone Score, S.T.O.N.E. nephrolithometry and the Clinical Research Office of the Endourological Society (CROES) nomogram, and that used to assess and estimate the treatment success rate. Aim of the Work To evaluate and compare between OSS and PCNL in the management of renal stones by using the S.T.O.N.E. nephrolithometry scoring system to predict and assess the stone free rate and the correlation with peri-operative complications in that two procedures. Patients and Methods A total 100 patients who need surgical intervention for renal stones were treated with OSS (35 pa ents) and PCNL (65 pa ents) from January 2019 ll the end of October 2019, were invited to participate in the present study. This was a multicenter, comparative, prospective cohort controlled study. This study was controlled by the standard results recorded in the previous literatures. Only adult(&amp;gt;18 ys. Old) patients with renal stone size ≥ 20mm were involved in the study. Peri-operative and follow-up data included stone free rate and complications were collected for all patients and were compared between both procedures. S.T.O.N.E nephrolithometry scoring systems was applied to preoperative non-contrast computed tomography(CTUT) for all cases and compared the results of both procedures. Stone-free rate was diagnosed using early postoperative kidney, ureter, bladder X-rays(KUB) and another CTUT on the postoperative day30. Results There was a significant difference between the PCNL group and the OSS group in the primary stone free rate (90% and 97.5% respec vely, p-value=0.021), peri-operative major complications (3% and 14.3% respectively, p-value=0.033), opera ve me (123.46 ± 34.61 and 175.71 ± 55.10 respec vely, p-value=0.000) and postopera ve hospital stay (3.52 ± 0.84 and 5.23 ± 1.00 respec vely, p-value=0.000), while there was no significant difference in the intra-opera ve bleeding requiring blood transfusion (10.8% and 14.3% respec vely, pvalue=0.124). S.T.O.N.E score showed a significant difference between PCNL and OSS groups ( 7 (6-11) and 10 (7-12) respectively, p-value=0.000) and it also had a significant rela on with the outcome SFR (p-value=0.000) a er both PCNL and OSS(r= -0.581 and r= -0.567 respec vely), the higher the score, the lower the SFR and the higher the possibility of OSS choice. While this score had on relation with the peri-operative complications. Conclusion The S.T.O.N.E. nephrolithometry score was predictive of the stone-free status in both surgical procedures (PCNL and OSS) and can be used as an formal guidance for surgical planning and patient counseling. This score would be classified into two categories “low” score range from 5 to 8 recommend PCNL procedure with expec ng SFR of 88% to 97% and “high” score range from 9 to 12 recommend Open Stone Surgery with expec ng SFR of 90% to 96%, to reach the most acceptable results for each procedures to sa sfy the patient and the doctor. The S.T.O.N.E score was not associated with the peri-operative complications in both procedures.

Sexual Dysfunction in Patients With Urinary Bladder Stones but no Bladder Outlet Obstruction.

Objective: To explore the correlates of sexual dysfunction and lower urinary tract symptoms (LUTS) in male patients with urinary bladder stones and to determine the effect of stone extraction on recovery of sexual function.Materials and Methods: A total of 87 male patients with primary bladder stones were studied from January 2015 to May 2016. All patients underwent pneumatic lithotripsy for bladder stones. Sexual dysfunction was assessed based on sexual function assessment scales. The relationship of bladder stones with sexual dysfunction or LUTS was assessed using a two-sample t-test. Postoperative improvement of sexual function was assessed by repeated measures Analysis of Variance (ANOVA).Results: Forty-one patients had primary bladder stones and 46 had secondary stones from the kidneys. Eighty-three of 87 patients (95%) had sexual dysfunction; 79 patients (91%) had both sexual dysfunction and LUTS. There was a significant association between bladder stones and sexual dysfunction, between sexual dysfunction and LUTS, and between bladder stone and LUTS (p < 0.05). There was no significant association between the course of illness, size and number of bladder stones, or urinary tract infection with sexual function (p > 0.05). In addition, among 83 patients with both bladder stone and sexual dysfunction, 61 patients (73%) had benign prostatic hyperplasia (BPH) and 22 patients (27%) had no BPH. On postoperative evaluation at 3 months, sexual dysfunction scores were significantly improved in 77 patients (88.5%)Conclusion: Patients with bladder stones have a high incidence of sexual dysfunction, particularly those with co-existing LUTS and BPH. About 1/3 patients without BPH had sexual dysfunction and surgical removal of bladder stones significantly improved sexual function and LUTS.

MP19-01 DEVELOPMENT OF THE SHORT FORM OF THE WISCONSIN STONE QUALITY OF LIFE (WISQOL) QUESTIONNAIRE FOR ASSESSING THE HEALTH-RELATED QUALITY OF LIFE OF PATIENTS WITH UROLITHIASIS

You have accessJournal of UrologyHealth Services Research: Practice Patterns, Quality of Life and Shared Decision Making II (MP19)1 Sep 2021MP19-01 DEVELOPMENT OF THE SHORT FORM OF THE WISCONSIN STONE QUALITY OF LIFE (WISQOL) QUESTIONNAIRE FOR ASSESSING THE HEALTH-RELATED QUALITY OF LIFE OF PATIENTS WITH UROLITHIASIS Kristina L. Penniston, Shuang Li, and Stephen Y. Nakada Kristina L. PennistonKristina L. Penniston More articles by this author , Shuang LiShuang Li More articles by this author , and Stephen Y. NakadaStephen Y. Nakada More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002004.01AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The 28-item Wisconsin Stone Quality of Life questionnaire (WISQOL) is a self-administered, health-related quality of life (HRQOL) instrument for assessing the impact of urolithiasis. Prior reports confirm the WISQOL′s reliability, validity, and responsiveness. Its use has helped to identify specific HRQOL decrements after or between stone events. To address needs of large clinical studies and long-term monitoring, for which efficiency competes with precision, we developed a short-form (SF) version of the WISQOL. METHODS: We use the WISQOL in our clinical stone practice. Patients are invited to complete it at every appointment. Data for this study were from patients (n=704) who completed the WISQOL between 6/2017 and 2/2020 at a Urology Clinic appointment with either the primary stone surgeon or a nurse practitioner. Responses missing >1 item (n=196) were excluded. Remaining patients were 53% female, 54±15 y, and mixed for stone history (min-max, 1 to >50 lifetime stone events). Nearly half (49%) had current stones; 30% were experiencing stone-related symptoms or had done so in the past 4 weeks. We calculated WISQOL total and domain scores. We used item analysis and factor analysis to evaluate all 28 WISQOL items. RESULTS: Items with item-total correlation coefficients <0.84 were eliminated (n=20). Of the 8 remaining items, linear regression analysis and cross loading identified 6 that best predicted total WISQOL scores (p<0.001), representing 2 of the 4 WISQOL domains (D1, social; and D2, emotional). Using these items, 80% of patients placed in the same quantile for total score as with the original WISQOL. Item-score correlation coefficients (original vs WISQOL-SF) ranged from 0.84-0.93; correlation with total score was 0.95 (p<0.001 for all comparisons, fig.). The WISQOL-SF Cronbach α-coefficient was 0.94 compared to 0.97 for the original WISQOL. Of patients misplaced for quantile by the WISQOL-SF, 32 and 30% were patients with stones and/or stone symptoms at the time; they tended to score higher for HRQOL with the WISQOL-SF. CONCLUSIONS: We produced the WISQOL-SF, a 6-item version of the WISQOL suitable for efficient assessments. While more testing is needed, the WISQOL-SF appears best suited for long-term follow up of HRQOL in stones. Source of Funding: None © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e327-e327 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Kristina L. Penniston More articles by this author Shuang Li More articles by this author Stephen Y. Nakada More articles by this author Expand All Advertisement Loading ...

The effectiveness of extracorporeal shock wave lithotripsy for lower calyx stones in children

Introduction. According to current clinical guidelines, the use of extracorporeal shock wave lithotripsy (ESWL) for lower calyx stones is indicated when their size is less than 1 cm. This is due to the low efficiency and high frequency of repeated procedures for larger stones.Purpose of the study. To examine the results of ESWL usage in the treatment of children with lower calyx stones of various sizes.Materials and methods. ESWL was performed on 33 children with lower calyx stones during 2013 - 2018 yrs. Patients were divided into 2 groups: Group I - 24 (72.7%) patients with primary stones, Group II - 9 (27.3%) patients after ESWL of kidney pelvis stones that migrated to the lower calyx. Both groups are divided into subgroups: a - children with stones less than 1 cm and b - with stones more than 1 cm. ESWL was performed under general anesthesia and ultrasound guidance. In all patients after ESWL we used the inversion technique. The result was considered positive in case of the complete elimination of stones was achieved.Results. After the first ESWL session, stone-free status was achieved in 21/33 (63.6%) patients of all groups, after the second ESWL session in 26/33 (78.8%), after 3 sessions - 30/33 (90.9%). In subgroups Ia and IIa, there were 14/22 (63.6%) children after the first ESWL with complete elimination of calculi, and after subsequent sessions, the success rate was 90.9% (20/22 calculi). After the first ESWL session in subgroups Ib and IIb, complete elimination of stones was achieved in 7/11 (63.6%) children, after repeated sessions in 10/11 (90.9%) children.Conclusions. ESWL demonstrates a high efficiency in the treatment of lower calyx stones less and more than 1 cm, both after the first and third sessions, and in the treatment of primary and residual (migrated) stones.

A randomized prospective study: assessment of transient ureteral stenting by mono-J insertion after primary URS and stone extraction (FaST 3)

To compare the outcome of a short-term insertion of a mono-J catheter for 6 h following ureteroscopic stone removal to a conventional double-J catheter. This single-center academic study (Fast Track Stent study 3) evaluated stenting in 108 patients with urinary calculi after ureterorenoscopy. Patients were prospectively randomized into two study arms before primary ureterorenoscopy: (1) mono-J insertion for 6 h after ureterorenoscopy and (2) double-J insertion for 3–5 days after ureterorenoscopy. Study endpoints were stent-related symptoms assessed by an ureteral stent symptom questionnaire (USSQ) and reintervention rates. Stone sizes and location, age, operation duration, BMI, and gender were recorded. Of 67 patients undergoing ureterorenoscopy, 36 patients were analyzed in the double-J arm and 31 patients in the mono-J arm. Mean operation time was 27.5 ± 1.3 min versus 24.0 ± 1.3 min, and stone size was 5.2 mm versus 4.5 mm for mono-J versus double-J, respectively (p = 0.06 and p = 0.15). FaST 3 was terminated early due to a high reintervention rate of 35.5% for the mono-J group and 16.7% for the double-J group (p = 0.27). One day after ureterorenoscopy, USSQ scores were similar between the study arms (Urinary Index: p = 0.09; Pain Index: p = 0.67). However, after 3–5 weeks, the Pain Index was significantly lower in those patients who had a double-J inserted after ureterorenoscopy (p = 0.04). Short-term insertion of mono-J post-ureterorenoscopy results in similar micturition symptoms and pain one day after ureterorenoscopy compared to double-J insertion. The reintervention rate was non-significant between the treatment groups most likely due to the early termination of the study (p = 0.27). Ethics approval/Trail Registration: No. 18-6435, 2018