Single Stone Research Articles

Safety of single-use flexible ureteroscopy for dusting of upper urinary tract calculi in children

BackgroundFlexible ureteroscopy offers numerous advantages, such as increased reach, superior stone-free rate, reduced risk of bleeding, minimal surgical trauma, and faster recovery time. There are few studies discussing the effectiveness of single-use flexible ureteroscopy in children, and none so far have addressed its safety. This study aims to evaluate the effectiveness and safety of a single-use flexible ureteroscope for treating upper urinary tract stones in children.MethodsThis study included children with single upper urinary tract stones measuring less than 2 cm who underwent single-use flexible ureteroscopy between October 2020 and January 2023. We assessed the following patient characteristics: age, gender, stone type, size, position, pre and postoperative stent placements, use of a ureteral access sheath, stone-free rate, operation duration, and the rate of complications. A patient was considered stone-free if there were no residual stone particles larger than 3 mm after surgery.ResultsFlexible ureteroscopy and holmium laser lithotripsy were undertaken for 44 participants, with an average age of 8.5 years (range: 2–16 years). The typical stone size was 14 mm (range: 6–20 mm). The average operation time was 74 min (range 35–110 min). Ureteral access sheaths were used in 81.8% (36 out of 44) of procedures. After a single FURS session, 86.36% (38 out of 44) of patients achieved stone-free status. Postoperative JJ stent application was noted in 86.4% (38 out of 44) of patients. Complications were categorized using the Calvien system, revealing that 25% (11 out of 44) of patients experienced mild hematuria, colic, and low-grade fever (Calvien I). No severe side effects like mucosal avulsion or ureteral perforation were reported.ConclusionIn the short-term, single-use flexible ureteroscopy is a safe and effective method for managing single renal and proximal ureteric stones, measuring 2 cm or less, in children.

The relationship between stone-free and patient position in retrograde intrarenal surgery: a randomized prospective study

PurposeResidual fragments not removed with urinary stone surgery may become symptomatic. In this context, this study was carried out to investigate the effect of performing retrograde intrarenal surgery, which is conventionally performed in the lithotomy position, in the modified lithotomy position (Trend-side) on stone-free rates following the surgery.MethodsThis prospective study consisted of 100 patients with a single kidney stone smaller than 2 cm between 2021 and 2023. These patients were randomized into two groups of 50 patients each to be operated on in the conventional lithotomy and Trend-side positions. Variables were compared using independent t test for continuous variables and chi-square test for categorical variables.ResultsThere was no significant difference between the lithotomy and Trend-side position groups in terms of preoperative size, density, location of the stone, and hydronephrosis degree. Stone-free rate was 72% (n = 36) in the lithotomy group and 92% (n = 46) in the Trend-side group. Hence, there was a significant difference between the groups in the stone-free rate in favor of the Trend-side group (p = 0.009). Fragmentation time was statistically significantly shorter in the Trend-side group than in the lithotomy group (34 ± 17 min vs. 43 ± 14 min; p = 0.006). There was no significant difference between the groups in postoperative complication rates.ConclusionPerforming retrograde intrarenal surgery in the Trend-side position shortened the duration of fragmentation compared to the lithotomy position and was associated with higher stone-free rates. In conclusion, the Trend-side position can be safely preferred in patients undergoing retrograde intrarenal surgery due to kidney stones.

Exploring the association between multiple factors and urolithiasis: A retrospective study and Mendelian randomization analysis.

To investigate the relationship between several factors and urinary stone as well as different stone compositions. To guide the diagnosis, treatment, and prevention of urinary stone recurrence. We used bidirectional Mendelian randomization to analyze the causal relationship between hypertension and urinary stones, diabetes and urinary stones, and body mass index (BMI) and urinary stones. We retrospectively analyzed the medical records of patients with urinary stones admitted to a tertiary care hospital in Chongqing, China, from July 2015 to October 2022. Patients were included when they were first diagnosed with urinary stones. The odds ratio of calculi on hypertension estimated by inverse variance weighted was 8.46 (95%CI: 4.00-17.90, P = 2.25 × 10-8). The stone composition analysis showed that there were 3101 (67.02%) mixed, 1322 (28.57%) calcium oxalate monohydrate, 148 (3.20%) anhydrous uric acid, 16 (0.35%) magnesium ammonium phosphate hexahydrate, 11 (0.24%) dicalcium phosphate dihydrate, 10 (0.22%) carbonate apatite, 8 (0.17%) L-cystine, 4 ammonium uric acid (0.09%), and 7 other stone types (0.15%). Mendelian randomization studies have proven that urinary stones may be a potential risk factor for hypertension, while there is no causal relationship between diabetes and stones, BMI, and stones. Our retrospective study has shown that urinary stone components are closely associated with sex, age, hypertension, diabetes, and BMI. It is reasonable to suspect that treating a single stone component is ineffective in preventing recurrence. We also found that the peak incidence of urinary stones was at the most active stage of most people's working lives.

A comparison between vapor tunnel and virtual basket for the treatment of proximal ureteral stones using holmium:YAG laser (Cyber Ho): which is the best tool to reduce retropulsion?

To compare vapor tunnel (VT) and virtual basket (VB) tools to reduce retropulsion in the treatment of proximal ureteral stones. Patients with a single proximal ureteral stone were randomly assigned to holmium laser lithotripsy with the use of VT (Group A) or VB (Group B) tool. The 150W holmium:YAG cyber Ho generator was used. We compared operative time, dusting time, need for flexible ureteroscopy due to stone push-up and occurrence of ureteral lesions. The stone-free rate (SFR) and the occurrence of postoperative ureteral strictures were assessed. 186 patients were treated, of which 92 with the VT (49.5%, Group A) and 94 with the VB (50.5%, Group B). Mean stone size was 0.92 vs. 0.91cm in Groups A vs. B (p = 0.32). Mean total operative time and dusting time were comparable between groups. 7 (7.6%) vs. 6 (6.4%) patients in Groups A vs. B required a flexible ureteroscope because of stone push-up (p = 0.12). Ureteral mucosa lesions were observed in 15 (16.3%) vs. 18 (19.1%) cases in the VT vs. VB group (p = 0.09). 1-Month SFR was comparable (97.8% vs. 95.7%, p = 0.41). We observed one case (1.1%) of postoperative ureteral stricture in the VT group vs. two cases (2.1%) in the VB group (p = 0.19). VT and VB are equally safe and effective tools in reducing retropulsion of ureteral stones. Operative time, dusting time and SFR were comparable. They also equally avoided stone push-up and prevented ureteral lesions, which may later occur in ureteral strictures.

Undrained shear strength of soft clay reinforced with encapsulated stone dust columns

PurposeThe stone dust column was used to strengthen the sample and had a significant effect on improving the shear strength of the kaolin clay. The application of stone columns, which can improve the overall carrying capacity of soft clay as well as lessen the settlement of buildings built on it, is among the most widespread ground improvement techniques throughout the globe. The performance of foundation beds is enhanced by their stiffness values and higher strength, which could withstand more of the load applied. Stone dust is a wonderful source containing micronutrients for soil, particularly those derived from basalt, volcanic rock, granite and other related rocks. The aim of this paper is to evaluate the properties of soft clay reinforced with encapsulated stone dust columns to remediate problematic soil and obtain a more affordable and environmentally friendly way than using other materials.Design/methodology/approachIn this study, the treated kaolin sample's shear strength was measured using the unconfined compression test (UCT). 28 batches of soil samples total, 12 batches of single stone dust columns measuring 10 mm in diameter and 12 batches of single stone dust columns measuring 16 mm in diameter. Four batches of control samples are also included. At heights of 60 mm, 80 mm and 100 mm, respectively, various stone dust column diameters were assessed. The real soil sample has a diameter of 50 mm and a height of 100 mm.FindingsTest results show when kaolin is implanted with a single encased stone dust column that has an area replacement ratio of 10.24% and penetration ratios of 0.6, 0.8 and 1.0, the shear strength increase is 51.75%, 74.5% and 49.20%. The equivalent shear strength increases are 48.50%, 68.50% and 43.50% for soft soil treated with a 12.00% area replacement ratio and 0.6, 0.8 and 1.0 penetration ratios.Originality/valueThis study shows a comparison of how sample types affect shear strength. Also, this article provides argumentation behind the variation of soil strength obtained from different test types and gives recommendations for appropriate test methods for soft soil.

Laser Lithotripsy for the Management of Ureteric Calculus

Urinary calculi are important problem in urology field. Ureteral stones can cause obstructive uropathy and subsequent deterioration of renal function. The minimal invasive approaches become the major source of treatment modalities with the development of lithotripsy technology. A prospective cross sectional hospital study was conducted in the Urology Department of a tertiary care hospital in Kathmandu for a period of one year (September 2022 to August 2023). A total of 118 patients attending Urology OPD and undergoing laser lithotripsy were included in the study. Ureteroscopic procedure was done using a 6.5 Fr (Wolf Inc., Germany) semirigid ureteroscope under direct endoscopic vision and once the stone was visible, fragmentation was done using Ho-YAG laser. The mean age of the patients was 35.36 ± 11.65 years with male preponderance (58.5%). The common presenting symptom was flank pain and ureteric calculus was more common in the left side (49.2%). Upper ureteric calculus (60.2%) and single stone (83.9%) were more common. Stone size <10 mm (54.2%) and density more than 1000 HU (87.3%) were more common. Stone retropulsion was seen in 16.1% cases and 78% had no post operative complications. SFR in Xray KUB was 94.9% and in USG was 78.8%. The association of SFR in Xray KUB and USG among different variables - male and female patients, patients with stone size < and ≥ 10 mm, stone density < and ≥ 1000 HU and sites (upper, middle and lower) was statistically not significant. The laser lithotripsy technique was found to be effective and safe for ureteric calculus with high SFR.

Clinicopathological Study of Helicobactor Pylori Infection and Gastric Carcinoma at a Tertiary Care Hospital in Kathmandu

Urinary calculi are important problem in urology field. Ureteral stones can cause obstructive uropathy and subsequent deterioration of renal function. The minimal invasive approaches become the major source of treatment modalities with the development of lithotripsy technology. A prospective cross sectional hospital study was conducted in the Urology Department of a tertiary care hospital in Kathmandu for a period of one year (September 2022 to August 2023). A total of 118 patients attending Urology OPD and undergoing laser lithotripsy were included in the study. Ureteroscopic procedure was done using a 6.5 Fr (Wolf Inc., Germany) semirigid ureteroscope under direct endoscopic vision and once the stone was visible, fragmentation was done using Ho-YAG laser. The mean age of the patients was 35.36 ± 11.65 years with male preponderance (58.5%). The common presenting symptom was flank pain and ureteric calculus was more common in the left side (49.2%). Upper ureteric calculus (60.2%) and single stone (83.9%) were more common. Stone size <10 mm (54.2%) and density more than 1000 HU (87.3%) were more common. Stone retropulsion was seen in 16.1% cases and 78% had no post operative complications. SFR in Xray KUB was 94.9% and in USG was 78.8%. The association of SFR in Xray KUB and USG among different variables - male and female patients, patients with stone size < and ≥ 10 mm, stone density < and ≥ 1000 HU and sites (upper, middle and lower) was statistically not significant. The laser lithotripsy technique was found to be effective and safe for ureteric calculus with high SFR.

Outcomes and considerations for retrograde intrarenal surgery (RIRS) in the setting of multiple and large renal stones (>15 mm) in children: Findings from multicentre and real-world setting.

The aim of this study is to evaluate the outcomes of retrograde intra renal surgery (RIRS) in the setting of large or multiple stones in children (<18 years). Retrospective analysis was performed of paediatric RIRS cases at nine centres worldwide over a 6-year period. Patients were divided into two groups: Group 1 had a single stone <15 mm. Group 2 had either multiple stones, maximum stone diameter of >15 mm, or both. Outcomes included stone free rate (SFR) and complications within 30 days. In total, 344 patients were included with 197 and 147 in Groups 1 and 2, respectively. Ureteric access sheaths were more frequently used in Group 2 (39.5% vs. 56.8%, p = 0.021). The operation time was significantly longer in Group 2 (p < 0.001). SFR after a single procedure was 84.7% in Group 1 and 63.7% in Group 2. Overall complication rates in Groups 1 and 2 were 7.6% and 33.3%, respectively. The most frequently reported complication in both groups was post-operative fever (4.4% vs. 14%, p = 0.004). The rate of Clavien I/II complications in groups 1 and 2 was 6% and 25.1%, respectively (p < 0.05). The rate of Clavien ≥ III complications in groups 1 and 2 was 1.6% and 8.1%, respectively (p < 0.05). On multivariate analysis, total operation time, stone size and multiplicity were significant predictors of residual fragments. RIRS can be performed in paediatric cases with large and multiple stone burdens, but the complication rate is significantly higher when compared to smaller stones.

Современное оперативное лечение пациентов с камнями почек размером до 2 см и сопутствующей ИБС.

Introduction. While providing urological care to patients suffering with nephrolithiasis, prior attention is to be paid to choosing the appropriate surgical approach. Assessment of risk for commorbidities such as coronary artery disease (CAD) should affect the choice of surgical technique. The treatment tactics for such comorbid patients have not been sufficiently developed and are poorly covered in the scientific literature. An appropriate choice of surgical technique is not presented. Aim: to study the effectiveness and safety of high-tech surgical lithotripsy techniques in comorbid patients with CAD, taking into account the functional state of the cardiovascular system. Materials and methods. The study is retrospective, multicenter. Subject of the study: adult patients suffering from nephrolithiasis (single kidney stones 15-20 mm) and concomitant CAD (200 people); control group - similar patients without CAD (190 people). The examined groups were distinguished according to the surgical intervention performed (extracorporeal shock wave nephrolithotripsy, percutaneous nephrolithotripsy, transurethral nephrolithotripsy) and concomitant CAD. Primary endpoint: Stone-free rate, which was determined using ultrasound scanning and Х-ray techniques. The frequency of achieving the endpoint, the number of stages of surgical treatment, and the frequency of complications were also assessed. Results. In terms of the frequency of achieving Stone-free rate, all contact lithotripsy techniques were comparable in effectiveness, which in all groups exceeded 85%. Neither the presence of CAD nor chronic heart failure (CHF) affected the results. With extracorporeal shock wave lithotripsy, the presence of CAD did not in any way affect the likelihood of achieving a stone-free rate, however, with CHF, the percentage of complete sanitation of the urinary tract from stones decreased to 53.8%, which seems unacceptable for clinical work. When using extracorporeal shock wave lithotrypsin against the background of CHF in «mono mode», the average number of stages is significantly higher (2.79) than with contact techniques (&lt;1.05). There is a clear inverse relationship between CHF, the number of stages of surgical treatment on the one hand, and the frequency of achieving stone-free rate on the other hand. Postoperative pyelonephritis more often develops in comorbid patients after contact lithotripsy techniques (up to 26.0%). Postoperative bleeding and cardiac risks occurred sporadically, mainly in the same situation – contact nephrolithotripsy in a patient with CHF. Conclusion. The more severe the patient’s comorbidities are, the more indications he has for immediate surgical treatment of nephrolithiasis. Of course, only if he is compensated for coronary artery disease. Percutaneous nephrolithotripsy is the method of choice. For small (&lt;2 cm) stones, a mini-approach should be preferred, giving a better safety approach.

Occupational hazard in urolithiasis patients in Qatar: a single-center cross-sectional study.

Urolithiasis is one of the most prevalent urological diseases and is associated with a substantial economic burden. Its prevalence varies according to geographical location. Qatar is a Middle Eastern country located in the Afro-Asian Stone Belt. It has a dry and hot climate, which may predispose individuals working in these environments to form kidney stones (KSs). A population sample of 4204 patients was categorized into five occupational classes. The frequencies and correlations of these occupations with KS formation were calculated. Among the total cases, 2000 presented with KSs, with the majority being of Asian descent (49%), followed by individuals of Middle Eastern descent (35.1%). Technicians accounted for 35.15% of KS cases followed by clerks (29.2%) and executives (14.6%). Among KS cases, 44% had a single stone, 30% had multiple stones, and 26% had two stones. In comparing both KS and non-KS groups, age, gender, occupation, and race were significantly associated with KS formation (p-value < 0.05), while BMI did not show any significant correlation (p-value > 0.05). Asian males aged 31-40, working as technicians, were significantly more prone to urolithiasis. In comparing age, BMI, and gender with stone characteristics, only age was found significantly associated with stone size (p-value < 0.05). Occupation showed an impact on all studied stone characteristics. Clerks and technicians presented more frequently with stones within the 11-15 mm range, while executives more frequently presented with smaller stones (p-value < 0.001). Stone density was more frequently < 500 HU in workers, technicians and housewives and > 500 HU in executives and clerks (p-value < 0.001). Our findings revealed an elevated risk of urolithiasis among certain occupational groups, particularly technicians, who frequently work outdoors in high-temperature environments. Alternatively, the sedentary nature of clerical and executive positions can also contribute to the risk of urolithiasis.

Determinants of Partial Stone Clearance after Mini-PCNL in the Pediatric Population

Abstract: Background: The prevalence of renal stones in pediatric population is increasing in Pakistan, to minimize the adverse outcomes of renal stone disease accurate diagnosis and proper management is necessary. Objective: This study aim to evaluate the risk factors of partial stone clearance after mini-PCNL in the pediatric population of Pakistan. Materials and Methods: This is a retrospective, cross-sectional study conducted at Godhra Hospital, Karachi, during 2021, patients diagnosed with single or multiple renal stones requiring PCNL were enrolled in the study, Guy’s stone score was used as a prediction method for complete clearance. SPSS version 22 was used to analyze the data, chi-square test was used to assess the significance of the data keeping a p-value ≤0.05 as significant. The risk estimation was analyzed with the help of the odds ratio test. Result: A total of 234 participants with mean age of 6.4 ± 4.8 years were enrolled. Stone clearance was reported 203 (86.7%) and 31 (13.2%) residual fragments. 09 (3.8%) out of the residual stone group needed intervention for complete clearance while the remaining were reported as stone free after 4 weeks with METs. The mean residual stone size was 0.7 ± 0.3, upon assessing the determinants maximum patients had Staghorn (&gt; 4) cms stone size with 7 (2.9%) of patients out of 13 (5.5%). The odds of having partial clearance were reportedly positive with 2.34 in staghorn ≥ 4cms stone size and 1.62 in Grade IV Guy’s stone score. Conclusion: Stone size ≥ 4.0 cm and staghorn calculi present in all calyces are independent risk factors for partial stone clearance after Mini-PCNL.

The Effect of Scrap Tires and Reclaimed Asphalt Pavement on the Behavior of Stone Columns

The objective of this investigation is to understand how to use waste tires to surround stone pillars and mix gravel with recycled asphalt pavement (RAP) and stone pillars to provide an environmentally friendly and cost-effective weak layer improvement method. To study the behavior of such stone columns, experiments were conducted in units consisting of a single stone column with recycled asphalt pavement as filling material and a single stone column covered with old tires. To test the effect of different mixing ratios, rapeseed content was selected from 0% to 100%. Elasticity tests were conducted on cladded and nonclad stone column samples. Furthermore, direct shear tests were conducted on samples with different ratios of gravel and rapeseed mixtures. The results of the load-bearing capacity test show that the cover of the stone columns with old tires can significantly increase the load-bearing capacity. Replacing 25% of natural stone column aggregates with RAP increases the load capacity. But as the percentage of RAP in the mixture increases from 25% to 100%, the loading capacity decreases. Another advantage is the reinforced stone column. From the point of view of ecology, an advantage is the use of recyclable materials.

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.

A retrospective comparison of Sun’s tip-flexible semirigid ureterorenoscopy, super-mini percutaneous nephrolithotomy and flexible ureteroscopy applied to treat upper urinary tract calculi

BackgroundThis retrospective study was conducted to compare the safety and efficacy of Sun’s tip-flexible semirigid ureterorenoscopy (tf-URS), super-mini percutaneous nephrolithotomy (SMP) and flexible ureteroscopy (FURS) in treating upper urinary tract calculi, including upper ureteral or renal calculi.MethodsWe included patients with upper ureteral calculi or renal calculi 1.0–2.0 cm in size, who underwent tf-URS, SMP or FURS, respectively. The indicators reflecting safety and efficacy were compared among the three surgical techniques.ResultsSMP presented with higher single stone crushing success rate, but longer operation time and postoperative hospital stay, more blood loss, and higher postoperative pain score compared with FURS and tf-URS (P < 0.05). The hospitalization cost of tf-URS group was lower than that of SMP and FURS groups (P < 0.05). The incidence of postoperative fever in tf-URS group was significantly higher than that in SMP group (P < 0.05). No significant difference was found in mucosal injury, perirenal hematoma, and stone-free rate at 3 months after surgery (P > 0.05).Conclusionstf-URS and FURS have the advantages in minimal invasion, hospitalization cost, patient comfort, and hospital stay while SMP has higher stone-free rate. These three surgical techniques are safe, reliable and complementary, which should be selected according to the actual situation.

Digital cholangioscopy-assisted, direct visualization-guided, radiation-free, endoscopic retrograde intervention for cholelithiasis: technical feasibility, efficacy, and safety.

Nonradiation, digital cholangioscope (DCS)-assisted endoscopic intervention for cholelithiasis has not been widely performed. For this study, we aimed to report the feasibility, efficacy, and safety of an established DCS-guided lithotomy procedure. Data relating to biliary exploration, stone clearance, adverse events, and follow-up were obtained from 289 patients. The choledocholithiasis-related outcomes via the DCS-guided procedure were subsequently compared to those via conventional endoscopic retrograde cholangiopancreatography (ERCP). Biliary access was achieved in 285 patients. The technical success rate for the exploration of the common bile duct, the cystic stump, the hilar ducts, and secondary radicals was 100%. Moreover, the success rates were 98.4%, 61.7%, and 20.7%, for the exploration of the cystic duct, complete cystic duct, and gallbladder, respectively. Suspicious or confirmed suppurative cholecystitis, cholesterol polyps, and hyperplastic polyps were detected in 42, 23, and 5 patients, respectively. Stone clearance was achieved in one session in 285 (100%), 11 (100%), 13 (100%), 7 (100%), 6 (100%), and 3 (14.3%) patients with choledocholithiasis and hepatolithiasis, cystic duct stump stones, nondiffuse located intrahepatic lithiasis, a single cystic duct stone, a single gallbladder stone, and diffuse located intrahepatic lithiasis, respectively. Complete stone clearance for diffuse intrahepatic lithiasis was achieved in 19 (90.5%) patients, and fractioned re-lithotomy was performed in 16 (76.2%) patients. One patient developed mild acute cholangitis, and 12 developed mild pancreatitis. Stones recurred in one patient. Compared with conventional ERCP, DCS-guided lithotomy has the advantages of clearing difficult-to-treat choledocholithiasis and revealing concomitant biliary lesions, and this technique has fewer complications and a decreased risk of stone recurrence. The technical profile, efficacy, and safety of nonradiation-guided and DCS-guided lithotomy are shown in this study. We provide a feasible modality for the endoscopic removal of cholelithiasis.

Incidence and Outcome of Iatrogenic Gallbladder Perforation during Laparoscopic Cholecystectomy in a Tertiary Care Hospital

Introduction: in developing countries, patients getting admitted into hospital is influenced by gallbladder stone. In this study, the incidence and outcome of iatrogenic gallbladder perforation during laparoscopic cholecystectomy was observed and studied for further development in this sector in a tertiary care hospital. Aim of the study: The aim of this study was to find out the incidence and outcome of iatrogenic gallbladder perforation during laparoscopic cholecystectomy. Methods: This prospective observational study was conducted in Department of Surgery, Combined Military Hospital (CMH) Dhaka, Bangladesh during the period from June 2018 to November 2018. This study had institutional review board approval and informed consent for 100 patients age range 31-70 years (mean 50.3±10.6) in gallbladder perforation group and in no perforation group the range was 25 to 62 years (mean 47.9±12.3). The patients went through laparoscopic cholecystectomy through four port and gallbladder was removed through hepigastric port. The ultrasonographic report of all patients were collected. Result: In the present study, majority 86 patients were found normal body weight (BMI 18.5-24.9 kg/m2) but female patients were high in number of affected list, 14(73.7%) in gallbladder perforation group and 56(69.1%) in no perforation group. A single stone is mainly found in no perforation group which is 32(39.5%). Multiple stone is found less in both of the groups respectively. Staying in the hospital was also higher in gallbladder group in comparison with no perforation group. Conclusion: According to the study, perforation in gallbladder due to laparoscopic cholecystectomy is not deniable (19%). This can result in peroperative pain and more stay in hospital.

Predicting stone composition via machine-learning models trained on intra-operative endoscopic digital images

ObjectivesThe aim of this study was to use deep learning (DL) of intraoperative images of urinary stones to predict the composition of urinary stones. In this way, the laser frequency and intensity can be adjusted in real time to reduce operation time and surgical trauma.Materials and methodsA total of 490 patients who underwent holmium laser surgery during the two-year period from March 2021 to March 2023 and had stone analysis results were collected by the stone laboratory. A total of 1658 intraoperative stone images were obtained. The eight stone categories with the highest number of stones were selected by sorting. Single component stones include calcium oxalate monohydrate (W1), calcium oxalate dihydrate (W2), magnesium ammonium phosphate hexahydrate, apatite carbonate (CH) and anhydrous uric acid (U). Mixed stones include W2 + U, W1 + W2 and W1 + CH. All stones have intraoperative videos. More than 20 intraoperative high-resolution images of the stones, including the surface and core of the stones, were available for each patient via FFmpeg command screenshots. The deep convolutional neural network (CNN) ResNet-101 (ResNet, Microsoft) was applied to each image as a multiclass classification model.ResultsThe composition prediction rates for each component were as follows: calcium oxalate monohydrate 99% (n = 142), calcium oxalate dihydrate 100% (n = 29), apatite carbonate 100% (n = 131), anhydrous uric acid 98% (n = 57), W1 + W2 100% (n = 82), W1 + CH 100% ( n = 20) and W2 + U 100% (n = 24). The overall weighted recall of the cellular neural network component analysis for the entire cohort was 99%.ConclusionThis preliminary study suggests that DL is a promising method for identifying urinary stone components from intraoperative endoscopic images. Compared to intraoperative identification of stone components by the human eye, DL can discriminate single and mixed stone components more accurately and quickly. At the same time, based on the training of stone images in vitro, it is closer to the clinical application of stone images in vivo. This technology can be used to identify the composition of stones in real time and to adjust the frequency and energy intensity of the holmium laser in time. The prediction of stone composition can significantly shorten the operation time, improve the efficiency of stone surgery and prevent the risk of postoperative infection.

Molecular detection of &lt;i&gt;Salmonella typhi&lt;/i&gt; from gallbladder tissue of cholecystitis patients and its relation to gallstone formation

&lt;p&gt;The gallbladder is often colonized by &lt;italic&gt;Salmonella&lt;/italic&gt; during typhoid fever, and cholelithiasis contributes to many factors one of them is cholecystitis, which results from bacterial infections. This study aims to detect &lt;italic&gt;Salmonella typhi&lt;/italic&gt; in the tissue of the gallbladder and find out its role in cholelithiasis. A total of 55 patients undergoing clinical and ultrasound examination were enrolled in this study, 43 with cholelithiasis and 12 without cholelithiasis, in which the gallbladder was taken as part of the surgical treatment for morbid obesity. DNA from tissue was extracted using QIAamp DNA Mini kit (Qiagen GmbH, Hilden, Germany) according to the manufacturer's recommendations; primer sets were used in this study that targeted &lt;italic&gt;fliC&lt;/italic&gt; and &lt;italic&gt;SopB&lt;/italic&gt; genes. A considerable number of cholelithiasis patients, 35 (81%), presented with multiple stone formation, while 8 (18.6%) presented with single stone formation. As many as 43 (78.1%) of cases presented with chronic cholecystitis, while only 12 (21.8%) of cases presented with acute cholecystitis by sonographic gallbladder; out of 55 samples, 10 (18.1%) were positive for the &lt;italic&gt;fliC&lt;/italic&gt; gene in amplification of 367 bp. All 10 positive samples for &lt;italic&gt;Salmonella typhi&lt;/italic&gt; showed gallbladder stone formation. However, out of 10 positive tissue samples for &lt;italic&gt;Salmonella typhi&lt;/italic&gt; 10 (100%), of them were positive for the &lt;italic&gt;SopB&lt;/italic&gt; gene. The findings in this study add to the body of knowledge around the occurrence rate of &lt;italic&gt;Salmonella typhi&lt;/italic&gt; in gallbladder tissue samples obtained from patients with cholecystitis.&lt;/p&gt;

Robot-assisted transurethral holmium ureterolithotripsy

Introduction. Currently, transurethral laser ureterolithotripsy is the standard treatment for ureteral stones. It allows you to achieve complete stone fragmentation in one-stage. We were interested in the possibility of performing ureterolithotripsy using a robotic assistant. In fact, robotic systems in medicine and surgery are becoming more and more relevant every year.Objective. To evaluate the possibilities of robot-assisted transurethral laser ureterolithotripsy, to study its effectiveness and duration in comparison with holmium lithotripsy in standard surgery, as well as to conduct a study and expert evaluation of the symptoms of surgeon fatigue in standard lithotripsy and robot-assisted lithotripsy.Materials &amp; methods. The study was conducted in 2022 and consisted of two stages. The first stage involved the development and testing of a robotic lithotripsy technique using simulators, including the author's fixation device for the ureteroscope. This device allowed to tightly fix the instrument in the "robotic arm", while maintaining the full range of necessary movements. During the second stage (clinical), the results of holmium ureterolithotripsy in standard and robotic surgeries were studied. Patients with ureterolithiasis were divided into two groups: 14 patients — standard lithotripsy and 13 patients — robotic assisted lithotripsy. The selection criteria were the presence of a single ureteral stone accessible to a semi-rigid ureteroscope.Results. According to the results of the study, robot-assisted transurethral holmium ureterolithotripsy has the greatest advantages in terms of the fatigue indicators of the surgeon during surgery. So, no significant difference was found in fragmentation time (1 gram of stone). In standard ureterolithotripsy this indicator was 63.8 min/g, and in robot-assisted ureterolithotripsy it was 57.8 min/g (p &lt; 0.1). When comparing the surgeon's fatigue scores, a significant difference between the two groups was determined. Thus, during standard surgery, the surgeon rated the shoulder numbness score at 3.50 points, while during robot-assisted surgery at 0.17 points (p &lt; 0.01).Conclusion. The study showed that transurethral contact laser ureterolithotripsy with the use of robotic assistant does not increase the surgery time, but the surgeon's fatigue factor is significantly reduced. This may indirectly contribute to reducing the risk of intra- and postoperative complications.

Evaluation of intra-operative trans-urethral endoscopic management of possible open transvesical prostatectomy complications

ObjectiveTo evaluate the benefits of using transurethral cystoscope and resectoscope for managing possible complications that may occur during open transvesical prostatectomy operation.BackgroundOpen transvesical or retropubic prostatectomy remains, in less technologically developed countries, the standard option for treatment of complicated large benign prostatic hyperplasia. Complications rate with open prostatectomy procedures, especially post-operative bleeding and urinary incontinence, represent a real challenge facing urologists. Hopefully, recent advances in endourology section helped greatly in management of complicated benign prostatic hyperplasia and also offered a tool to deal with possible open prostatectomy complications.Patients and methodsIn a prospective study, fifty (50) male patients with complicated large benign prostatic enlargement associated with large single or multiple bladder stones with stone burden ≥ 3cm3 planned to undergo transvesical prostatectomy divided randomly into two groups. Group (A) included 25 patients who underwent standard T.V.P. and group (B) included 25 patients in whom diagnostic urethro-cystoscopy and a mono-polar resectoscope were used pre- and post-prostatic adenoma enucleation. Patients had follow-up evaluation visits at 1, 3 and 6 months postoperatively to evaluate IPSS, post-void urine estimation, Qmax., and quality of life.ResultsA total of 50 patients were divided equally into two groups. Group (A) included 25 patients who underwent standard transvesical prostatectomy, while group (B) included 25 patients who underwent initial diagnostic urethro-cystoscopy, then bilateral ureteric catheter insertion, followed by prostatic apical demarcation using a monopolar resectoscope. Finally, transurethral hemostasis of the prostatic bed is done after standard transvesical adenoma enucleation. Mean operative time in group (A): 48.3 ± 12.4 min. while in group (B): 68.9 ± 14.1 min (p < 0.001), Hemoglobin deficit in group (A): 2.8 ± 1.1 g/dl. while in group (B): 1.1 ± 0.39 g/dl. (p < 0.001). Enucleated prostate volume in group (A): 89.2 ± 16.1g, while in group (B): 91.2 ± 17.2g (p = 0.673). Post-operative IPSS, Post-void residual urine and Qmax showed insignificant differences between the two groups.ConclusionTrans-urethral endoscopically assisted transvesical prostatectomy provides more safety and fewer morbidities and complications rate compared to standard T.V.P.