Lithotripsy Sessions Research Articles

CT-Based AI model for predicting therapeutic outcomes in ureteral stones after single extracorporeal shock wave lithotripsy through a cohort study.

Exploring the efficacy of an artificial intelligence (AI) model derived from the analysis of CT images to precisely forecast the therapeutic outcomes of singular-session extracorporeal shock wave lithotripsy (ESWL) in the management of ureteral stones. A total of 317 patients diagnosed clinically with ureteral stones were included in this investigation. Unenhanced CT was administered to the participants within the initial fortnight preceding the inaugural ESWL. The internal cohort consisted of 250 individuals from a local healthcare facility, whereas the external cohort comprised 67 participants from another local medical institution. The proposed framework comprises three main components: an automated semantic segmentation model developed using 3D U-Net, a feature extractor that integrates radiomics and autoencoder techniques, and an ESWL efficacy prediction model trained with various machine learning algorithms. All participants underwent thorough postoperative follow-up examinations four weeks hence. The efficacy of ESWL was defined by the absence of stones or residual fragments measuring ≤2mm in KUB X-ray assessments. Model stability and generalizability were judiciously validated through a fivefold cross-validation approach and a multi-center external test strategy. Moreover, Shapley Additive Explanations (SHAP) values for individual features were computed to elucidate the nuanced contributions of each feature to the model's decision-making process. The semantic segmentation model we constructed exhibited an average Dice coefficient of 0.88 ± 0.08 on the external testing set. ESWL classifiers built using Support Vector Machine (SVM), Random Forest (RF), XGBoost (XB), and CatBoost (CB) achieved AUROC values of 0.78, 0.84, 0.85, and 0.90, respectively, on the internal validation set. For the external testing set, SVM, RF, XB, and CB predicted ESWL with AUROC values of 0.68, 0.79, 0.80, and 0.83, respectively, with the last one being the optimal algorithm. The radiomics features and auto-encoder features made significant contributions to the decision-making process of the classification model. This investigation unmistakably underscores the remarkable predictive prowess exhibited by a scrupulously crafted AI model using CT images to precisely anticipate the therapeutic results of a singular session of extracorporeal shock wave lithotripsy for ureteral stones.

Comparison of ureteral stone measurements for predicting the efficacy of a single session of extracorporeal shockwave lithotripsy: one-, two-, and three-dimensional computed tomography measurements.

The objective of this study was to compare the value of one-, two- and three-dimensional computed tomography (CT) measurements for predicting the efficacy of a single session of extracorporeal shock wave lithotripsy (ESWL) in patients with a single ureteral stone. A total of 165 patients were included based on the inclusion and exclusion criteria. Different models were constructed using a combination of patients' clinical data and measurements obtained by manual sketching and automated extraction software. Multivariate logistic regression was used to develop the models. Receiver operating characteristic curves were used to assess the performance of the models. There was good interobserver agreement for all measurements in different dimensions (P < 0.001). We also found that hydronephrosis, the largest diameter, the largest area, volume, and mean CT value were significantly greater in the failure group than in the success group (P < 0.01). Furthermore, all sizes and CT measurement values were found to be independent predictors for predicting efficacy after one session of ESWL (P < 0.05). In addition, the multivariate logistic analysis showed that the area under the curve (AUC) for two-dimensional and three-dimensional measurements was superior to that of one-dimensional measurement (P < 0.01). However, when size alone was included as a measurable predictor, there was no significant difference in the AUC among the one-, two-, and three-dimensional measurements (P > 0.05). In summary, after adjusting for clinical data, two- and three-dimensional measurements combining ureteral stone size and CT values were found to be the best predictors of ESWL efficacy, and software-based three-dimensional measurements should be considered to avoid interobserver variability in clinical practice.

Development of a novel CT-based index for predicting the number of extracorporeal shockwave lithotripsy (ESWL) sessions required for successful fragmentation of obstructing pancreatic duct stones

Background & aimExtracorporeal shock wave lithotripsy (ESWL) is used for the treatment of pancreatic duct stones (PDS) in patients with chronic pancreatitis (CP). We aimed to develop a CT based index to predict the required number of ESWL sessions for technical success. MethodsWe retrospectively evaluated patients with PDS secondary to CP who underwent ESWL. Technical success was defined as the complete fragmentation of stones to <3 mm. CT features including PDS size, number, location, and density in Hounsfield units (HU) were noted. We analyzed the relationship between PDS characteristics and the number of ESWL sessions required for technical success. A multiple linear regression model was used to combine size and density into the pancreatic duct stone (PDS) index that was translated into a web-based calculator. ResultsThere were 206 subjects (mean age 38.6 ± 13.7 years, 59.2% male) who underwent ESWL. PDS size showed a moderate correlation with the number of ESWL sessions (r = 0.42, p < 0.01). PDS in the head required a fewer number of sessions in comparison to those in the body (1.4 ± 0.6 vs. 1.6 ± 0.7, p = 0.01). There was a strong correlation between PDS density and the number of ESWL sessions (r = 0.617, p-value <0.01). The PDS index {0.3793 + [0.0009755 x PDS density (HU)] + [0.02549 x PDS size (mm)]} could accurately predict the required number of ESWL sessions with an AUC of 0.872 (p < 0.01). ConclusionThe PDS index is a useful predictor of the number of ESWL sessions needed for technical success that can help in planning and patient counseling.

A Predictive Strategy for Nonsurgical Management of Pancreatic Stones.

We set out to predict whether nonsurgical treatment is likely to succeed in removing pancreatic stones in a given patient and also to determine an optimal maximal number of extracorporeal shock wave lithotripsy (ESWL) sessions for treatment of pancreatolithiasis in that patient. We ascertained the number of ESWL sessions for each of 164 patients undergoing that treatment for pancreatolithiasis between 1992 and 2020. Median follow-up duration was 31 months (range, 0-239), median age was 58 years (22-83), and the male to female ratio was 5.1:1.0. Patients were divided into 2 groups based upon an optimal maximal number of ESWL sessions determined by receiver operating characteristic analysis. Total stone clearance was achieved in 130 of 164 patients (79%). The median number of ESWL sessions was 3 (1-61). Receiver operating characteristic analysis determined 7 to be the optimal maximal number of sessions. Complete clearance was more frequent (87%) among the 131 patients requiring 7 or fewer ESWL sessions than among the 33 undergoing more (48%, P < 0.001). Seventeen patients (52%) undergoing 8 or more sessions still had residual stones. If any pancreatic stones persist after 7 ESWL sessions, we recommend transition to medical or surgical treatments.

Assessment of the dynamics of concentration of biomarkers of acute kidney injury in remote shock wave lithotripsy in children

BACKGROUND: For several decades, remote shock wave lithotripsy has been considered a universally recognized gold standard for the treatment of upper urinary tract concrements. Despite its noninvasiveness, each lithotripsy session causes acute kidney injury which cannot be reliably assessed with traditional indicators used in nephrourology. Currently, new modern indicators found in the urine and serum are thought to be more informative biomarkers. In this paper, we investigated the effectiveness of some of them for possible potentials in the diagnostics of acute kidney injury in remote lithotripsy.&#x0D; AIM: To evaluate changes in acute kidney injury biomarkers during remote shock wave lithotripsy in children.&#x0D; MATERIALS AND METHODS: 54 children with urolithiasis, who had a session of remote shock wave lithotripsy, were enrolled in the study. In all patients, samples of urine and blood serum were taken three times for assessing biomarkers concentration: before lithotripsy session, after 45 min and after 24 h.&#x0D; RESULTS: Statistically significant changes in the concentration of all urine biomarkers (NGAL, L-FABP, TIMP-2, calbindin-D, KIM-1) were registered at the basal level and 45 min after the procedure. A number of markers studied by us in the blood serum showed more significant changes 24 h after the procedure (IL-18, TNF-α). Although IGFBP-1 concentration increased slightly after 45 min, this change was not statistically significant (p 0.781). The level of cystatin C did not increase after lithotripsy.&#x0D; CONCLUSION: The performed analysis of changes in biomarkers concentration has revealed a sufficiently high informative value of biomarkers in assessing the degree of acute kidney injury during remote lithotripsy in children. It also allows to suggest that the studied biomarkers may be promising indicators characterizing such an injury.

To Evaluate the Impact of Ho:YAG Laser Lithotripsy for Ureteroscopic Removal of Proximal and Distal Ureter Calculi.

Background Urinary calculus illness is a prevalent clinical issue encountered by the medical community, particularly urologists, in contemporary society. Laser technologies have been widely accepted as standard modalities for lithotripsy applications. Using the Ho:YAG laser has expanded the range of applications for ureteroscopic stone management (URS), enabling the treatment of bigger stones in all regions of the upper urinary tract. It is noteworthy that ureteroscopy (URS) demonstrates superior rates of stone clearance for distal stones, regardless of their size, with a success rate of 94.5% compared to 74% for other treatment modalities. Significant variation exists in the reported results and problems associated with Ho:YAG laser lithotripsy across different trials, as documented in the literature. The procedure's outcome might vary based on factors such as the size of the stone, the length of impaction, the presence of ureteral damage and granulation, the kind and size of endoscopes used, and the specific energy settings employed by various operators. The present study aimed to evaluate the impact of Ho:YAG laser lithotripsy for ureteroscopic removal of proximal and distal ureter calculi. Methods This prospective observational study was carried out in the Department of Urology at DY Patil Medical College and Hospital, Pune, from March 2021 to March 2023. Patients diagnosed with a case of ureteric stone who opted for URSL during the study period were included. A total of 50 patients who underwent URSL in the urology department were included in this study. These were then grouped into those with proximal ureteral stones and distal ureteral stones. (25 each) Results The study observed that patients diagnosed with proximal ureteral stones had bigger calculi, with a mean stone size of 15mm, in comparison to patients with distal ureteral stones, with a mean stone size of 10mm (P=0.010). The stone burden was significantly higher for proximal ureteral stone patients than those with distal ureteric stones (P=0.010). The average duration of the operating procedure for upper ureter stones was 70 minutes, but for lower stones, the mean operative time was 45 minutes (P<0.001). No statistical significance was seen in the median age of patients between the two groups (P=0.89). The maximum number of cases in the upper stone group were in the age group of 16-30 years, and in the lower stone group was in the age group of 31-45 years. The prevalence of DJ stents at the time of presentation was higher among patients diagnosed with proximal ureteric stones than those with distal ureteric stones, with rates of 28% and 20%, respectively (P=0.508). Full fragmentation was successfully accomplished in all patients within the distal calculus group, accounting for 100% of the cases. At the same time, for proximal ureteric stones, a single laser lithotripsy session resulted in 92% (23 patients) achieving a stone-free status after two weeks. Conclusion The study observed that stone size, burden, and procedure duration were statistically significant among other criteria. Mean age, stone HU, prior DJ stent, and stone-free rate were statistically insignificant. The procedure indicated that Ho:YAG laser lithotripsy has efficacy in treating both proximal and distal ureteral stones, with minimal intraoperative and postoperative complications. None of the complications were due to laser energy.

Predictors of success of conventional ERCP for bile duct stones and need for single-operator cholangioscopy.

Background and study aims The characteristics of difficult stones requiring cholangioscopy-assisted lithotripsy are poorly defined. We sought to determine clinician perception of these characteristics and decision-making in biliary endoscopy. Methods One hundred twenty-four delegates attending an online course were invited to assess 20 clinical stone cases. Each image was graded on a 4-point Likert for: grading of stone difficulty, confidence of clearance with conventional endoscopic retrograde cholangiopancreatography (ERCP) methods, likelihood of needing cholangioscopy-assisted lithotripsy, and confidence of clearance with one session of lithotripsy. An independent reviewer rated each case on largest stone size, stone number, presence of stricture distal to stone, size of stone relative to distal duct size, and acute common bile duct (CBD) angulation < 135°. Multilevel (mixed) statistical methods with a two-level model were utilized with multilevel ordinal logistic regression. Results Stone size and location, stricture and stone diameter:duct ratio impacted perceived procedural difficulty P < 0.01). Stone:duct ratio (< 50% odds ratio [OR] 0.22, P < 0.001), stricture (OR 7.26, P < 0.001) and stone location impacted confidence of clearance with conventional ERCP. Intrahepatic and cystic duct stones were least likely to engender confidence ( P < 0.01). The same factors plus CBD angulation < 135° predicted cholangioscopy requirement ( P < 0.01). Stone number did not influence procedure difficulty or cholangioscopy requirement. Strictures (OR 0.29, P < 0.001) and location, especially intrahepatic (OR 0.42, P < 0.001) impaired confidence in clearance with one cholangioscopy session. Conclusions Ductal anatomy, the presence of a stricture distal to a stone, cystic and intrahepatic stones and stones larger than the distal duct are considered by endoscopists to be significant predictors of requiring cholangioscopy-assisted lithotripsy.

Prospective comparison of extracorporeal shock wave lithotripsy and ureteroscopy in distal ureteral stones.

The optimal treatment modality of distal ureteral stones is controversial. Therefore, we conducted a prospective study to evaluate the efficacy, safety, and cost of early second shock wave lithotripsy (SWL) sessions versus ureterorenoscopy (URS) in patients with distal ureteral stones.This prospective study was conducted in a tertiary hospital from June 2020 to April 2022. Patients who underwent SWL or URS for distal ureteral stones were enrolled in this study. The stone-free rate (SFR), secondary treatment rate, complications, and costs were recorded. Propensity-score matching (PSM) analysis was also performed. A total of 1023 patients were included, of whom 68.4% (700) were treated with SWL and 31.6% (323) with URS. Based on PSM, SWL had an equivalent SFR (87.4% vs. 84.9%,P = 0.325) at one month after SWL and secondary treatment rate (10.7% vs.10.8%,P = 0.958) when compared with URS. Complications were rare and comparable between the SWL and URS groups (6.0% vs. 5.9%,P > 0.05), while the incidence of ureteral injuries (i.e., perforations) was higher in the URS group compared with the SWL group (1.3% vs. 0%,P = 0.019). The hospital stay was significantly shorter (1day vs. 2days,P < 0.001) and the costs considerably less (2000 RMB vs. 25,030 RMB;P < 0.001) in the SWL group compared with the URS group. This prospective study demonstrated that early second SWL sessions had equivalent efficacy in addition to reduced complication rates and costs compared with URS in patients with distal ureteral stones. Our findings may help guide clinical decision making.

Effectiveness of Extracorporeal Shockwave Lithotripsy in Removing Small and Large Stones

Objective: To examined the efficacy of extracorporeal shockwave lithotripsy in the removal of small and large stones. Study Design: Observational prospective study. Place and Duration of Study: Department of Urology, Liaquat University of Medical and Health Sciences, Jamshoro from 1st January 2018 to 31st January 2019. Methodology: Two hundred patients, 139 males and 61 females, who underwent extracorporeal shockwave lithotripsy for stones were enrolled. The participants were separated into two groups based on stone size group A (stones measuring between 1.5 to 2.0 cm) and group B (stones measuring between 2.0 and 2.5 cm). Patients who were pediatric or had co-morbidities were excluded. The number of extracorporeal shockwave lithotripsy sessions and the number of beams per session were determined based on the clearance of the stones, if the radiology report indicated that the stones were completely cleared or if fragments smaller than 2 mm in diameter were present. Results: In group A, only 26 patients had partial clearance while in group B only 2 patients had partial clearance. The majority of the patients in both groups did not report any complications. The most common complaint was isolated haematuria, with 9 (4.5%) patients in the one session group, 16 (8%) in the two session group, and 5 (2.5%) in the three or more session group reporting this symptom Two patients in group A had hematoma along with haematuria, one patient in group A had massive haematuria that required transfusion, and one patient in each group reported having steintrasse with haematuria. In addition, one patient in group A had an isolated hematoma. Conclusion: Extracorporeal shockwave lithotripsy is effective and first-line treatment option for small renal stones. For ureteric stones, the location of stones should be taken into account, as this can have an effect on the stone-free rate and efficacy of extracorporeal shockwave lithotripsy. Keywords: Extracorporeal shockwave lithotripsy (ESWL), Stone removal, Ureteric Stones, Haematuria

What is the ideal interval between repeated shockwaves lithotripsy sessions for renal stones? A randomized controlled trial

What is the ideal interval between repeated shockwaves lithotripsy sessions for renal stones? A randomized controlled trial

Remote shock wave lithotripsy in the treatment of urolithiasis in children: types and possibilities

Introduction. Recently, the prevalence of urolithiasis in pediatric population has been steadily increasing, but up to now there is no any universal technique for treating urolithiasis in children. Among many options for surgical treatment of upper urinary tract urolithiasis, remote lithotripsy occupies one of the leading positions.Purpose. To highlight principles and mechanisms of remote lithotripsy, its indications and contraindications using a systemic review of modern literature for the period of 2001–2021.Material and methods. A systematic review of foreign and domestic literature for the period of 2001–2021 was made. Key words for the search were : urinary stone disease, urolithiasis, remote (shock wave) nephrolithotripsy, fragmentation of stones. 64 full-text articles out of 1339 literature sources are included in the review.Results. On analyzing the obtained results, it has been found out that one session of remote shock wave lithotripsy is effective in more than 90% of cases, if calculus dimensions are less than 20 mm and its density is less than 1200–1500 Hounsfield units. Location of the calculus also plays a role.Conclusion. Remote shock wave lithotripsy is a reasonable option due to a number of facts, the main of which are non-invasive approach and a large percentage of favorable outcomes associated with cleaning the upper urinary tract from stones.

S1759 Management of Bouveret Syndrome: A Case Report

Introduction: Bouveret syndrome is an unusual complication of gallstone disease, causing less than 0.2% of small bowel obstructions. It often requires multidisciplinary approaches for treatment. We present here a unique case report of Bouveret syndrome, managed successfully using Holmium LASER alone. Case Description/Methods: A 74-year-old man presented to our hospital with vomiting, decreased appetite, periumbilical pain and nausea. He denied heartburn, fever, chills or jaundice. His past medical history was significant for cardiomyopathy (EF 35%), atrial fibrillation and ventricular tachycardia with AICD placement. He had been admitted 3 months prior with acute cholecystitis and elevated liver function tests. Due to cardiac comorbidities, he was treated with IV Zosyn, cholecystostomy tube and ERCP with sphincterotomy with improvement and he was discharged. 6 weeks later, a tube check confirmed correct placement of the tube and decompression of the gall bladder. This time, his pain differed from the right upper abdominal pain of prior admission. His tube drainage had reduced considerably in the previous day. Physical examination revealed epigastric and supraumbilical tenderness with no guarding or rebound. The cholecystostomy bag had purulent drainage. WBC count was 11.95 x 10,000/cu.mm; liver enzymes and S. Lipase were normal. CT scan showed a change in the position of a previously seen large gallstone, measuring 3.7 cm in diameter. During the previous admission, it was in the gall bladder neck. At this time, it was occupying the duodenal bulb lumen, indicating development of a cholecystoduodenal fistula, and causing complete obstruction. The surgical team recommended endoscopic treatment due to anticipated friability of the tissue (Figure). Endoscopic evaluation showed complete obstruction of the duodenal bulb by a large smooth stone, not allowing passage of even a guidewire beyond the stone. Lithotripsy was chosen to help relieve the obstruction. 410 micron and 990 micron Holmium LASER probes were used with assistance from Urology, via an antegrade approach from the pylorus through a gastroscope. After 2 sessions of lithotripsy 4 days apart, each breaking through pigmented and calcified stone, the stone passed through the small bowel, relieving the obstruction. Discussion: The patient did not require surgical intervention and has recovered well. This case illustrates the feasibility of Holmium LASER to treat heavily calcified and pigmented gallstones. Holmium LASER should be developed for use in GI Endoscopy.Figure 1.: Gallstone obstructing duodenal bulb; LASER lithotripsy of calcified and pigmented stone; residual ulcer in duodenal bulb after stone passed.

Assessment of the Ideal Time Interval between Repeated Shock Wave Lithotripsy Sessions for Renal Stones

Assessment of the Ideal Time Interval between Repeated Shock Wave Lithotripsy Sessions for Renal Stones

Safety of Minimally Invasive Percutaneous Nephrolithotmy in High Risk Patients in Lateral Position - A Single Center Study

Objective: To assess the safety and efficacy of minimally invasive percutaneous nephrolithotomy with fluoroscopy aided renal access in the lateral position, in patients who were high-risk cases for anesthesia in prone position.&#x0D; Study Design: Prospective observational study.&#x0D; Place and Duration of Study: Armed forces institute of Urology, Rawalpindi, from Jan 2018 to Dec 2019.&#x0D; Methodology: Fifty-three patients with renal stones &gt;1.8cm underwent minimally invasive percutaneous nephrolithotomy with fluoroscopy-guided renal access in the lateral position. All the patients were obese, some had severe ischemic heart disease, few had diabetes mellitus. All the patients were unfit for the prone position.&#x0D; Results: Successful renal access was achieved in all the patients (100%). The mean size of stone was 28 + 13.2 mm, with an average operative time being 55 ± 13.56 minutes and the mean hospital stay was 1.8 ± 2.3 days (range 2-4 days). No visceral or pleural injuries were documented. In addition, only two patients required postoperative transfusion. After procedure, the rate of complete stone clearance initially was 90.6%, which improved to 96% after single session of extracorporeal shockwave lithotripsy (ESWL). Only 2 (3.77%) patients had persistent residual stone fragment.&#x0D; Conclusion: Minimally invasive percutaneous nephrolithotomy with fluoroscopy-guided renal access in the lateral decubitus flank position, is safe and convenient in high-risk patients where prone position is contraindicated.

Прогностичні фактори ефективності екстракорпоральної ударно-хвильової літотрипсії у пацієнтів з уретеролітіазом

The purpose of the work was to study prognostic factors for the effectiveness of extracorporeal shock wave lithotripsy in patients with ureterolithiasis. Materials and methods. The study included 53 patients with ureteral stones up to 2 cm in size. All patients underwent extracorporeal shock wave lithotripsy under ultrasound control, with a pulse rate of 90 per minute and a maximum number of pulses of 2000 per session. The outcome of treatment was evaluated by ultrasound on day 5 after the extracorporeal shock wave lithotripsy session. If there were stone fragments larger than 5 mm, a second extracorporeal shock wave lithotripsy session was performed. Treatment was considered effective in the absence of stone fragments in the urinary tract 4 weeks after extracorporeal shock wave lithotripsy. Results and discussion. The data were analyzed to identify clinical and radiological factors associated with treatment failure. As a result of the treatment, 46 (86.4%) patients were found to have no stones in the urinary tract (the condition is “stone free”), 9 (13.6%) had stone fragments larger than 5 mm 4 weeks after extracorporeal shock wave lithotripsy, and therefore contact ureterolithotripsy was performed. As complications, 7 (13.2%) patients had an exacerbation of chronic pyelonephritis, which required percutaneous nephrostomy. As the results showed, age, gender, body mass index, and Hausfield units did not differ significantly in terms of extracorporeal shock wave lithotripsy results. Factors that significantly affected the prognosis of extracorporeal shock wave lithotripsy success were the size of the stone and skin-stone distance. Body mass index did not significantly affect the outcome of lithotripsy in this study. The stone density index according to computed tomography data is considered by many authors to be a predictor of the effectiveness of fragmentation, but in our study this indicator was not a significant predictor of the effectiveness of extracorporeal shock wave lithotripsy, which allows us to think that there are other factors, namely the features of the internal structure of the stone, which determine its compliance with the shock wave. Conclusion. The size of the stone and the skin-stone distance are prognostic factors that affect the effectiveness of extracorporeal shock wave lithotripsy in patients with ureterolithiasis. Body mass index and stone density in Hausfield units did not significantly affect extracorporeal shock wave lithotripsy outcome in this study

Роль растительных препаратов в литокинетической терапии и метафилактике мочекаменной болезни

Relevance. Urolithiasis is still one of the most widespread and actively progressing diseases. The high incidence of complications from taking chemical drugs has become the main reason for the change in attitudes towards herbal medicines, and now the treatment with herbal medicines is returning again, revealing its benefits based on evidence-based medicine. Phytochemicals have a positive effect on the gut microbiome and are widely used to prevent and treat obesity, liver, intestinal and inflammatory diseases. Materials and methods. The study involved 100 patients with a verified diagnosis of urolithiasis aged 25 to 78 years. The first group included 30 patients who underwent 1-2 sessions of extracorporeal lithotripsy (EBL) or percutaneous nephrolithotripsy (PCNL) for kidney stones up to 20 mm in size. The second group included 70 patients who were diagnosed with calculus during outpatient examination based on ultrasound and X-ray examinations. Each patient group was randomly divided into 2 subgroups. Patients of the subgroup A - A1 and A2 received standard lithokinetic therapy - α-blockers, antispasmodics, adherence to daily urine output of at least 2 liters per day, if necessary, analgesic therapy with non-steroidal anti-inflammatory drugs. Patients of the subgroup B - B1 and B2 received a similar therapy with the addition of dietary supplements Nereus . During the observation period, an assessment of daily diuresis, fluctuations in the pH level of urine, clinical and laboratory studies of biochemical parameters of blood and daily urine, general clinical blood and urine tests, urine culture for flora and the degree of bacteriuria were carried out. To assess the severity of the pain symptom, a 10-point visual analogue pain scale (VAS) was used. Re-examination was performed after 1 and 3 months of treatment. Results. The use of the combined herbal preparation Nereus in lithokinetic therapy and metaphylaxis of urolithiasis reduces the need for analgesic and antispasmodic therapy, promotes an increase in urine output by 37%, maintains urine pH at physiological values, effectively reduces the level of leukocyturia and bacteriuria, accelerates the passage of stones and their fragments from various parts of the urinary tract. In all patients who took the herbal preparation Nereus , there were no undesirable or side effects affecting the quality of life of patients. Conclusions. The study of the efficacy and safety of the drug Nereus in lithokinetic therapy and metaphylaxis of urolithiasis showed a significant effect of the phytocomplex on increasing urine output, eliminating the infectious-inflammatory process and passing stones from the urinary tract, good tolerance and absence of side effects.

Effect of SARS and COVID-19 outbreaks on urology practice and training.

The objective was to investigate the changes in urology practice during coronavirus disease 2019 (COVID-19) pandemic with a perspective from our experience with severe acute respiratory syndrome (SARS) in 2003. Institutional data from all urology centres in the Hong Kong public sector during the COVID-19 pandemic (1 Feb 2020-31 Mar 2020) and a non-COVID-19 control period (1 Feb 2019-31 Mar 2019) were acquired. An online anonymous questionnaire was used to gauge the impact of COVID-19 on resident training. The clinical output of tertiary centres was compared with data from the SARS period. The numbers of operating sessions, clinic attendance, cystoscopy sessions, prostate biopsy, and shockwave lithotripsy sessions were reduced by 40.5%, 28.5%, 49.6%, 44.8%, and 38.5%, respectively, across all the centres reviewed. The mean numbers of operating sessions before and during the COVID-19 pandemic were 85.1±30.3 and 50.6±25.7, respectively (P=0.005). All centres gave priority to cancer-related surgeries. Benign prostatic hyperplasia-related surgery (39.1%) and ureteric stone surgery (25.5%) were the most commonly delayed surgeries. The degree of reduction in urology services was less than that during SARS (47.2%, 55.3%, and 70.5% for operating sessions, cystoscopy, and biopsy, respectively). The mean numbers of operations performed by residents before and during the COVID-19 pandemic were 75.4±48.0 and 34.9±17.2, respectively (P=0.002). A comprehensive review of urology practice during the COVID-19 pandemic revealed changes in every aspect of practice.

Factors to predict shock-wave lithotripsy results in pediatric patients and external validation of a nomogram

ObjectiveTo evaluate the accuracy of the Dogan nomogram in predicting stone-free (SF) rate after a single shock wave lithotripsy (SWL) session and evaluate factors that predict SWL results in children. Patients and methodsThe study included 68 patients under 18 years of age who had been treated with SWL for radiopaque upper urinary tract stones in our tertiary centre from January 2010 to December 2016. The median age is 50(6-207) months and median follow-up period is 9(4-50) months. Patients with known cystine stone disease, abnormal renal anatomy, urinary diversion and multiple stones located in different calyces were excluded like in the original nomogram study. SF status was evaluated by performing plain abdominal radiography and urinary ultrasonography (US) two weeks after each SWL session. Patients who were completely free of stones were considered to be SF. Multiple logistic regression analyses were performed to determine the variables affecting SF status. The bootstrap method with 1000 replicates was used for the external validity of a nomogram developed by Dogan et al. ResultsSF rates for each SWL session were determined as 54.4% (37/68) for the first session, 33.3% (7/21) for the second session and 55.6% (5/9) for the third session. Overall, the SF rate was 72.1% (49/68). Multiple logistic regression analysis showed positive and significant correlations of age and stone size with risk of SWL failure. The external calibration plot showed a nearly good validation with Dogan nomogram to predict SWL failure in first session. ConclusionOur study demonstrates that the Dogan nomogram can be used to predict the stone-free status after one session of SWL in pediatric patients.

Characteristic Curves and Criterion of Critical Difference in Assessing the Informativeness of Markers of Renal Damage in Lithotripsy

Aim of study. Determination of the diagnostic significance of laboratory biomarkers of renal tissue damage in remote nephrolithotripsy in patients with urolithiasis.Material and methods. On the basis of the urology department of the Republican Clinical Hospital (Ufa), 35 patients with urolithiasis were examined, who underwent remote shock wave lithotripsy sessions. The laboratory parameters were determined in patients: the number of erythrocytes, leukocytes in the blood, the level of lipocalin and microalbumin in the urine, as well as alpha2-microglobulin and cystatin C in the blood serum. The control group included 14 healthy donors. To determine the diagnostic efficacy of biomarkers of renal injury, characteristic curves were plotted, and lipocalin level shifts were interpreted taking into account the data on the critical difference criterion value.Results. When studying the urinary level of lipocalin in patients with urolithiasis, it was found that the difference in the concentration of the biomarker in them and in healthy individuals is statistically insignificant (0.68 pg/ml versus 0.4 pg/ml). After the first session of extracorporeal lithotripsy, an increase in urinary excretion of lipocalin by 5 times is noted, after the second - by an additional 1.6 times, and after the third - by another 1.7 times (the differences are statistically significant). To analyze the prognostic efficiency of markers of renal injury, characteristic curves were plotted. The area under the ROC curve for lipocalin varied from 0.77 to 0.80 depending on the number of sessions, which indicates a high diagnostic efficiency of this biomarker. The determination of the criterion of critical difference (CCD) showed that an increase in the level of lipocalin in the urine after the first session of lithotripsy more than 2.1 times is statistically significant. The concentration of the specified biomarker in urine exceeding 4.5 pg/ml, 6 pg/ml and 10 pg/ml after the first, second and third sessions of lithotripsy, respectively, can be considered as a basis for changing treatment tactics (delaying the second procedure) or performing lithotripsy in another way.Conclusion. Urinary lipocalin, associated with neutrophil gelatinase, is an informative biomarker of renal injury in the assessment of complications associated with the lithotripsy procedure.

Progressive Bilateral Childhood Urolithiasis of Rare Etiology: Ultrasound Images and Evidence-Based Therapeutic Recommendations.

Background: Multiple, recurrent and bilateral renal stones causing progressive bilateral urolithiasis is rare during childhood and metabolic disorder such as cystinuria and oxalosis are commonly. The aim of this paper is to report the very rare presentation of hypercalciuria and hypercalciuria with progressive bilateral renal stone disease, with stones predominantly composed of ammonium and phosphate suggesting infective etiology. Patients and methods: A boy with progressive bilateral renal stone disease since early infancy and had been treated by several urologist during the previous three years was studied. He was first referred at the age of five years requesting the opinion about the use of medical therapies and therefore an evidence-based recommendation was made. Results: The boy was initially diagnosed as having bilateral urolithiasis at about the age of two years and during the previous three years with three surgical operations and two lithotripsy sessions. Stone were predominantly composed of ammonium (++++) and phosphate (++++), but they also contained calcium (+++) and uric acid (+). There was evidence of urinary infections with Klebsiella and Enterobacter species suggesting an infective etiology of the stone disease. On referral, Sodium nitroprusside test for cystine was negative and paper chromatography for cystine was also negative. 24-hour urine examination (volume 1600 ml): Calcium 264 mg/24 hr (more than 12 mg/kg/24hr) and oxalate 0.17 g/24 hr (Normal: 0.01-0.04 g /24). Conclusion: Urologists should make an early consultation with a pediatrician expert in renal disorders to provide the necessary medical therapies. Bilateral progressive renal stone disease is rarely caused by infective etiologies alone and the presence of recurrent urinary infections should not lead to ignoring the possibility of metabolic abnormalities.