Stone Density Research Articles

Predictive factors of stone-free rate and complications in patients with proximal impacted ureteral stones undergoing percutaneous nephrolithotomy: based on a new scoring standard.

To evaluate the predictive factors affecting the stone-free rate (SFR) and complications of percutaneous nephrolithotomy (PCN) in the treatment of proximal impacted ureteral stones (PIUS) based on a new scoring standard. The data of 90 patients with PIUS were collected in this retrospective study between January 2015 and June 2023. Univariate and multivariate logistic regression analyses were used to determine factors affecting treatment outcome in terms of SFR and complications. The scoring standard for patients with PIUS was developed based on the univariate logistic regression analyses. In the univariate analysis, stone density (P = 0.015), and stone diameter (P = 0.032) significantly were associated with lower SFR. And degree of hydronephrosis (P = 0.014), Preoperative infection (P = 0.002), and history of lithotripsy (P = 0.045) were associated with occurrence of complications. Multivariate analysis indicated that stone density (P = 0.020), and stone diameter (P < 0.001) were associated with lower SFR; independent risk factors for development of complications were history of lithotripsy (P = 0.024), and preoperative infection (P < 0.001). Additionally, score ≥ 3 was the independent risk factor for both SFR (P < 0.001) and complication rate (P < 0.001). Subgroup analysis shown that there were statistically significant differences between the two groups in terms of stone-free rate (P = 0.032) and complications (P = 0.015). According to the findings of this study, the stone score ≥ 3 was determined as a critical predictive factor of SFR and complications in PIUS patients undergoing PCN based on a new scoring standard. Additionally, PCN has high initial SFR and low complications when dealing with score < 3 PIUS.

Risk factors of hematoma after SWL for renal calculi: analysis from RCTs and a literature review.

To identify risk factors of perinephric hematoma following extracorporeal shockwave lithotripsy (SWL) for renal calculi through combined analysis of two randomized controlled trials. This post-hoc analysis included adult patients with solitary renal calculi ranging from 5 to 15mm, treated with SWL between 2016 and 2022. All patients received cross-sectional imaging (either non-contrast computer tomography scan or magnetic resonance imaging) two days post-SWL to assess the presence and severity of perinephric hematoma. Among 573 patients analyzed, 173 (30.9%) developed perinephric hematoma by Day 2 post-SWL. Multivariate logistic regression identified higher total energy delivered (odds ratio [OR] = 1.533, p = 0.003), higher mean stone density (OR = 2.603, p = 0.01), higher maximal stone density (OR = 3.578, p = 0.03), and lower pole stone location (OR = 1.545, p = 0.029) were risk factors for the development of hematoma. Conversely, the stepwise ramping protocol was a protective factor for hematoma formation. (OR = 0.572, p = 0.042). This study elucidates key factors influencing the risk of perinephric hematoma post-SWL, highlighting the importance of procedural adjustments such as the stepwise ramping protocol to reduce complications. These insights call for targeted patient and treatment strategy optimization to enhance SWL safety and efficacy.

External validation of Ito’s nomogram and T.O.HO. scoring system in flexible ureterorenoscopy

PurposeThis study aims to assess stone-free rates after flexible ureterorenoscopy (fURS) using the T.O.HO. (Tallness, Occupied lesion, Hounsfield unit evaluation) scoring system and Ito’s nomogram.Materials and methodsIn the study conducted with 484 patients, the following parameters were analyzed: age, sex, comorbidities, hospitalization, affected side, extracorporeal shock wave lithotripsy (ESWL) history, stone length, stone density, number of stones, location, and presence of hydronephrosis.ResultsMultivariate logistic regression analysis revealed that stone length, stone number, and lower pole stone location were associated with the prediction of stone-free status. The cut-off value for Ito’s score was determined to be 13.5 points, with an AUC of 0.792 (sensitivity, 0.609; specificity, 0.821) and a 95% confidence interval of (0.752–0.832) (Fig. 1). The cutoff for the T.O.HO. score was 6.5 points, with an AUC of 0.744 (sensitivity 0.738, specificity 0.602) and a 95% confidence interval of (0.699–0.789).ConclusionIn conclusion, T.O.HO. scoring system and the Ito’s nomogram are promising tools to predict stone-free status (SFS) after fURS in preoperative evaluation. In addition, the success of scoring systems in predicting SFS preoperatively appears promising and offers a potentially valuable approach.

Lower Pole Stones Are Associated with Low Stone-Free Rates in Retrograde Intrarenal Surgery: A Myth or Fact? – A Matched Case-Control Study from the RIRSearch Group

Introduction: There are conflicting results in the literature regarding the efficacy of retrograde intrarenal surgery (RIRS) in lower pole stones. This study aimed to evaluate RIRS outcomes in lower pole stones by forming matched case-control groups. Methods: The data of 491 patients who were diagnosed with kidney stones and underwent RIRS were retrospectively included in the study. A total of 209 patients with lower pole stones (Group 1) and 282 patients with pelvic stones (Group 2) were matched at a 1:1 ratio in terms of stone burden, stone density, preoperative double-J stenting status, and a previous history of shock wave lithotripsy, yielding 159 patients in each group. A computed tomography scan was performed to evaluate the stone-free status. The primary outcome was stone-free status 1 month after RIRS. Results: After case-control matching, the median age was 49 years (interquartile range [IQR]: 40–58) in Group 1 and 50 years (IQR: 35–60) in Group 2 (p = 0.388). The median stone burden values of Group 1 and Group 2 were 415.3 mm3 (IQR: 176.1–858.2) and 503.3 mm3 (IQR: 282.5–864), respectively (p = 0.100). After RIRS, stone-free status was achieved by 126 of the 159 (79.2%) in Group 1 and 133 of the 159 (83.6%) patients in Group 2 (p = 0.387). The groups were similar in terms of perioperative complications (4.4% in Group 1 and 3.8% in Group 2, p = 0.777), postoperative complications (13.8% in Group 1 and 10.3% in Group 2, p = 0.393), and median operation time (60 min in both, p = 0.230). A longer median fluoroscopy time was noted in Group 1 compared to Group 2 (26 s and 3 s, respectively, p = 0.013). Conclusions: Stone-free rates and complications were comparable between the patients with lower pole and pelvic stones after RIRS. However, lower pole stones are associated with longer fluoroscopy time. RIRS can be performed effectively for the treatment of lower pole stones.

Comparison of Moses laser and Raykeen laser in patients with impacted upper ureteral stone undergoing flexible ureteroscopic holmium laser lithotripsy

BackgroundTo compare the operative effect and clinical efficacy of the Moses laser mode and the Raykeen holmium laser energy platform powder mode under flexible ureteroscopic lithotripsy in patients with impacted upper ureteral stones.MethodsFrom March 2022 to September 2022, 72 patients were divided into a Moses laser group and a Raykeen laser group according to surgical method, with 36 patients in each group. CT and ureteroscopy confirmed that all patients had isolated impacted upper ureteral stones. The stone volume (mm3), stone density (Hu) and severity of hydronephrosis were measured by CT. Postoperative complications were evaluated using the Clavien–Dindo score.ResultsThere were no complications of ureteral stenosis related to the laser treatment. The operative time and lithotripsy time were lower in the Moses laser group than in the Raykeen laser group (P < 0.05). The stone-free survival rate did not differ significantly between the two groups (P = 0.722). Stone volume was found to be positively correlated with laser energy and lithotripsy time in both groups (P < 0.01). There was no significant correlation between laser energy and lithotripsy time or ureteral stone density (Hu) in the Moses laser group (P > 0.05) or the Raykeen laser group (P > 0.05).ConclusionsThe contact mode of Moses technology and the powder mode of Raykeen laser lithotripsy can be used for the ablation of a single impacted upper ureteral stone. The ablation speed was related to the stone volume and the severity of polyp hyperplasia, not the stone density. We recommend the use of the powdered mode as a therapeutic measure for the treatment of impacted upper ureteral stones in flexible ureteroscopic lithotripsy.

Efficacy Of Retrograde Intra-Renal Surgery For The Treatment Of Large Renal Stone Burdens: A SingleCenter Experience

Background: Retrograde intra-renal surgery (RIRS) has gained popularity as a result of technological advances. Although widely used, the literature on its feasibility for the treatment of large renal stone burdens is limited. This study aimed to assess the efficacy of RIRS for the treatment of large renal stone burdens.. Materials and Methods: Fifty-five patients with stone burdens ≥21 mm and treated with RIRS between November 2019 and October 2021 were evaluated for patient demographics, stone characteristics, and stonefree rates (SFR). Patients were divided into three groups according to stone burdens (21–30 mm, 31–40 mm, and &gt;40 mm). A standard protocol for surgery and chemoprophylaxis was followed. The SFR was determined if there were no residual stones or fragments on follow-up images. All these patients were followed up on for a minimum of 3 months. Results: The mean age of patients was 54.11 ± 11.75 years. The mean stone burden and mean stone density were 32.36 ± 10.20 mm and 966 ± 337 HU, respectively. The mean cumulative endoscopy time was 142.0 ± 74.7 minutes per case. Endoscopy time was longer for stone densities &gt;1000 HU. The overall SFR was 78.2%, with an average of 1.58 sessions of RIRS. SFRs for 21–30 mm, 31–40 mm, and &gt;40 mm groups were 92.9%, 68.8%, and 54.5%, respectively. Conclusion: RIRS is an effective therapeutic option for treating stone burdens of 21–30 mm with overall SFR of 92.9%. When the stone burden exceeds 30 mm, RIRS should only be offered to individuals who are not candidates for other therapeutic options. To better counsel the patient for a staged approach, stone hardness (HU-Hounsfield units) should be considered in surgery planning

CT-Based Predictors of Spontaneous Ureteral Stone Passage.

To assess CT-scan based parameters, particularly ureteral wall thickness (UWT), in predicting spontaneous ureteral stone passage. Cross-sectional, analytical study. Place and Duration of the Study: Section of Urology, Department of Surgery, The Aga Khan University Hospital, Karachi, Pakistan, from June to November 2023. Patients with symptomatic, single, radio-opaque, unilateral ureteral stones having size ≤10 mm with normal kidney functions, diagnosed by non-contrast CT-scan KUB, and treated by conservative option for four weeks were enrolled. Clinical and radiological predictors for stone passage (SP), including stone size, area, laterality, location, density, degree of hydronephrosis, maximal UWT at the stone site, and ureteral diameter and density above and below the stone, were evaluated. Binary logistic regression analysis was employed to identify predictors of stone passage. Receiver operating characteristic (ROC) curve was used to find the optimal cut-off for UWT. Among 34 eligible patients, 22 (64.7%) passed their stones spontaneously. Patients who passed had smaller stone size and area and lesser UWT. Stone location, laterality, degree of hydronephrosis, stone density, ureteral wall diameter, and density above and below stones were not associated with SP. Multivariate analysis revealed maximum UWT as the independent predictor of SP, with a cut-off of 1.95 mm and an accuracy of 0.94. UWT was the single most convincing factor for the spontaneous passage of ureteral stone in this study. By applying UWT's optimal cut-off value, it might be an extremely significant tool when taking decisions in daily practice. Ureteral wall thickness, Medical expulsive therapy, Non-contrast computed tomography.

Ureteroscopy vs laparoscopic ureterolithotomy for large proximal ureteric stone: a randomised trial.

To compare the outcomes of retrograde flexible ureteroscopy (fURS) with retroperitoneal laparoscopic ureterolithotomy (RLU) for large proximal ureteric stones. A prospective randomised trial was conducted from January 2018 through December 2022 including patients with impacted proximal ureteric stones of 15-25 mm. Patients underwent fURS or RLU. Primary outcome was the stone-free rate. Demographic data, stone features, and complications rates were also compared between groups. A total of 64 patients were enrolled, 32 in each group. The mean impacted stone time was similar between groups, as well as stone size (17 mm) and stone density (>1000 Hounsfield Units). The ureteric stone-free rates between the two groups (93.7% in fURS vs 96.8% in RLU; odds ratio [OR] 0.72, 95% confidence interval [CI] -1.72 to 3.17; P = 0.554), and overall success rates, which take into account residual fragments in the kidney (84.3% in fURS vs 93.7% in RLU; OR 1.02, 95% CI -0.69 to 2.74; P = 0.23), were similar. Operative time was also not statistically significantly different between groups (median 80 vs 82 min; P = 0.101). There was no difference in hospital length of stay. Retropulsion rate was higher with fURS (65.6% vs 3.1%; p < 0.001). Residual hydronephrosis (34.3% each group) and complication rates did no differ according to treatment. Flexible URS and RLU are both highly efficient and present low morbidity for large impacted proximal ureteric stone treatment. RLU is not superior to fURS.

Assessment of Factors Responsible for Stone-Free Status After Retrograde Intrarenal Surgery.

Aim The study aimed to evaluate the predictive factors that determined stone-free rate (SFR) after retrograde intrarenal surgery (RIRS). Materials and methods This prospective study was conducted on 183 patients undergoing RIRS for renal stones. Patients were categorized into two groups, depending on stone-free status one month following the procedure. SFRwas defined as the complete absence of stones or stones <4 mm. The parameters studied included patient demographics, presence of hydronephrosis, presence of preoperative double J-stent, abnormal renal anatomy, and stone characteristics (stone burden, stone number, stone density, stone location, lower pole infundibulopelvic angle, and lower pole renal infundibular length (RIL)). Univariate and multivariate analyses were performed to identify risk factors for residual stones. We assessed the predictive ability of the RIRS score and Resorlu-Unsal stone score (RUSS) for evaluating SFR utilizing receiver operating characteristic (ROC) analysis. Results 183 patients were included inthe study with a median age of 51 years. 131 (71.6%) patients were declared stone-free after the procedure. The mean stone size and density were 16.9 SD±7.5 mm and 1038 SD±342 Hounsfield units (HU) respectively. Stone-free patients had lower stone size (14.3 mm vs. 23.6 mm, p<0.01) and stone density (970 HU vs. 1211 HU, p<0.01) compared to non-stone-free patients. Patients with residual stones had steeper lower pole renal infundibulopelvic angle (RIPA) (31.3° vs. 40.7°, p<0.01) and longer RIL(26.6 mm vs. 21.1 mm, p<0.01). Stone multiplicity (p<0.01), lower pole stone location (p<0.01), and renal malformations (p<0.01)were significant influencing factors for residual renal stones after RIRS. Multivariate analysis revealed stone size, stone density (HU), and stone location as independent predictors for SFR after RIRS. Among the scoring systems, the RIRS score had the highest diagnostic accuracy for SFR (area under the curve (AUC): -0.882, 95% CI-0.828-0.936). Conclusion Stone size, stone density (HU), and stone number are important predictors of SFR after RIRS. Lower pole stone location and abnormal renal anatomy play a substantial role in determining SFR after RIRS. In lower pole stones, a long RIL and acute RIPA negatively influence SFR. Additionally, the RIRS score was found to be a better predictor for SFR than the RUSS score.

Three-dimensional structural tomography and thermal characterization of the kidney stones and gallstones to know the temperature disintegration

The present study aimed to carry out a structural and thermal characterization of kidney and gallstones to reinforce knowledge aimed at their possible reduction or disintegration. Densities of 36 body stones at different dimensions, obtained by assessments of mass and volume, and structural features of the stones identified by 3D tomographic analysis. The density of kidney stones was greater than that of gallstones, at 0.0025 gr/cm3 > 0.0020 gr/cm3. DTA and TG curves of kidney stones showed minimal structural changes after 200 °C, with initial mass loss and release of carbon dioxide at 458 °C resulting in 66 % mass loss and the transformation of C2H2CaO5. Gallstones are composed mainly of cholesterol (C27H46O). Cholesterol gallstones have a relatively low density and are susceptible to potentially disintegrating within the human body. Kidney stones require high temperatures above 400 °C for their size reduction, which is why partial intracorporeal thermal disintegration may not be feasible.

Predicting the Efficacy of Repeated Shockwave Lithotripsy for Treating Patients with Upper Urinary Tract Calculi Using an Artificial Neural Network Model.

To establish a prediction model for repeated shockwave lithotripsy (SWL) efficacy to help choose an appropriate treatment plan for patients with a single failed lithotripsy, reducing their treatment burden. The clinical records and imaging data of 304 patients who underwent repeat SWL for upper urinary tract calculi (UUTC) at the Urology Centre of Shiyan People's Hospital between April 2019 and April 2023 were retrospectively collected. This dataset was divided into training (N = 217; 146 males [67.3%] and 71 females [32.7%]) and validation (N = 87; 66 males [75.9%] and 21 females [24.1%]) sets. The overall predictive accuracy of the models was calculated separately for the training and validation. Receiver operating characteristic (ROC) curves were plotted, and the area under the ROC curve (AUC) was calculated. The normalized importance of each independent variable (derived from the one-way analyses) in the input layer of the artificial neural network (ANN) model for the dependent variable (success or failure in repeat SWL) in the output layer was plotted as a bar chart. This study included 304 patients, of whom 154 (50.7%) underwent successful repeat SWL. Predictive models were constructed in the training set and assessed in the validation set. Fourteen influencing factors were selected as input variables to build an ANN model: age, alcohol, body mass index, sex, hydronephrosis, hematuria, mean stone density (MSD), skin-to-stone distance (SSD), stone heterogeneity index (SHI), stone volume (SV), stone retention time, smoking, stone location, and urinary irritation symptom. The model's AUC was 0.852 (95% confidence interval (CI): 0.8-0.9), and its predictive accuracy for stone clearance in the validation group was 83.3%. The order of importance of the independent variables was MSD > SV > SSD > stone retention time > SHI. Establishing an ANN model for repeated SWL of UUTC is crucial for optimizing patient care. This model will be pivotal in providing accurate treatment plans for patients with an initial unsuccessful SWL treatment. Moreover, it can significantly enhance the success rate of subsequent SWL treatments, ultimately alleviating patients' treatment burden.

ESWL EFFICACY FOR VARIOUS DENSITY STONES (HU) ON PLAIN CT SCAN

Extracorporeal Shock Wave Lithotripsy (ESWL) is a keystone in the harmless management of urinary tract stones, offering a viable alternative to surgical mediation for patients pained by urolithiasis. Objectives: The study aims to find the ESWL efficacy for various density stones (HU) on plain CT scans. Methods: This observational study was conducted at CMH Lahore from February 17, 2024, to May 16, 2024. Data were collected from 180 patients suffering from renal stones. Males represented 60% (108 patients), while females 40% (72 patients). Predominantly, stones were located in the renal pelvis (45%), followed by the upper ureter (30%) and lower ureter (25%). The mean stone size was 10 mm, ranging from 5 to 20 mm, with a corresponding mean stone density of 900 Hounsfield Units (HU) as measured on Plain CT Scan. Results: Data were collected from 180 patients. The mean age of the patients was 50.98±2.34 years. There were 60% male and 40% female patients. According to stone location, 45% are located at the renal pelvis, 30 at the upper ureter and 25% at the lower ureter. A mean reduction in the stone size of 65% post-treatment underscores the procedure's ability to facilitate stone disintegration. Stone-free rates varied based on stone density, with higher rates observed for stones with lower densities: 85% for stones ≤ 700 HU, 75% for stones &gt; 700 HU and ≤ 1000 HU, and 65% for stones &gt; 1000 HU. Conclusion: It is concluded that an accurate assessment of stone density and ESWL score is vital in directing treatment decisions and upgrading outcomes for patients going through ESWL for urinary stones. These findings highlight the importance of personalised treatment approaches and the potential of the ESWL score as an essential tool in clinical practice.

Factors affecting the success and perioperative complications of retrograde intrarenal surgery: a retrospective clinical analysis

Background and objective: Many factors are presumed to have an impact on the results of retrograde intra renal surgery. In the current study, our objective was to actuate the possible factors influencing the stone-free rates and complications post lone-session retrograde intrarenal surgery for renal calculi. Stone-free rates Methods: Overall 200 patients who undergone retrograde intra renal surgery between January 2019 and March 2022 were evaluated, retrospectively. Success was decided if there were no residual fragments on pain X-ray and ultrasonography. Patient demographics, stone characteristics, perioperative data were assessed and analyzed to actuate predictive factors influencing stone-free rates and perioperative morbidities. Results: Two hundred patients with a mean age of 41.12±14.37 years were evaluated. The mean stone size was 1.815 ± 2.107 millimeters (mm), mean stone density was 969.63 ± 345.307 Hounsfield unit. The immediate SFR was (76.8±0.42) while the final SFR (single session) was 87.9±0.46. Thirty-seven patients (18.5%) developed complications, the preponderance of them 86% were minor complications (Clavien grade I and II). In multivariate regression analysis, multiple renal stones and ureteral access sheath use were constitute to be statically significant predictors of stone-free status. Moreover, multivariate regression analysis revealed that operative time, lasing time and stone opacity stones were statistically significant factors influencing perioperative complications. Conclusion: Success rates inversely related to stones number and ureteral access sheath usage. While prolonged operation time, lasing time, and higher stone density could be a more reliable predictor of perioperative complication development.

Computed Tomography Findings in the Evaluation of Urolithiasis

Background: Urolithiasis, or the formation of urinary tract stones, is a prevalent condition that affects individuals worldwide, predominantly impacting middle-aged and elderly demographics. Computed tomography (CT) has emerged as a superior diagnostic tool for urolithiasis due to its high sensitivity and specificity, offering detailed insights into the size, location, density, and composition of stones. Objective: The objective of this study was to evaluate the efficacy of unenhanced computed tomography in the diagnosis and characterization of urinary tract stones, focusing on their size, location, and associated clinical symptoms. Methods: A cross-sectional study was conducted at the Diagnostic Center of CMH Hospital Lahore over four months, involving 70 patients with suspected or confirmed urolithiasis. Participants were selected using non-probability convenient sampling and underwent 128-slice MDCT imaging without contrast. Data collection included demographic information, clinical symptoms, and CT findings regarding stone characteristics. The ethical standards adhered to the Declaration of Helsinki, with all participants providing informed consent. Results: The study comprised 74.3% male and 25.7% female participants, with the highest prevalence of urolithiasis observed in the 30-40 year age group (32.9%). CT imaging detected stones in 95.7% of the participants, with a significant incidence of smaller stones (1-5 mm) at 31.4%. Hydronephrosis was noted in 85.7% of cases, and hydroureter in 54.3%. The most common stone density ranged from 500-1000 HU (41.4%), and stones were more frequently located on the right side (32.9%). Conclusion: Unenhanced CT proved to be a highly effective diagnostic tool for assessing urinary tract stones, providing essential data on stone size, density, and location, as well as associated clinical symptoms. This modality enhances the ability to tailor treatment strategies effectively, thereby improving patient outcomes.

Variation coefficient of stone density and renal cortical thickness: the parameters evaluating non-contrast computed tomography imaging for predict extracorporeal shock wave lithotripsy success.

The stone density (SD) is not the same in all parts of the stone due to the heterogeneous nature of the stone and the shock wave (SW) passes through tissues of many different densities until it reaches the stone. These factors affect the success of Extracorporeal Shock Wave Lithotripsy (ESWL). We aimed to evaluate the effect of the Variation Coefficient of Stone Density (VCSD) and Renal Cortical Tickness (RCT) on the success of ESWL. Between 2020 and 2023, 510 patients who underwent ESWL were divided into 2 groups treatment success (n:304) and treatment failure (n:206). Non-Contrast Computed Tomography (NCCT) imaging values of hydronephrosis degree of the kidney, stone location, stone volume (SV), stone-skin distance (SSD), SD, Standard deviation of Stone Density (SDSD), VCSD, RCT, Soft-Tissue Thickness (STT), Muscle Thickness (MT) were analyzed. VCSD value was obtained by dividing SDSD by SD. Along the SW, tissues were divided into three components: kidney (renal cortex), muscle and other soft tissues. RCT, MT and SSD were measured at three different angles (0°, 45°, and 90°) and these 3 lengths were averaged. In univariate analysis, Body Mass Index (BMI), SV, SD, VCSD, SSD, RCT and STT were demonstrated to affect ESWL success. In multivariate analysis, low BMI, SV, SD, RCT and large VCSD were significant independent predictors of ESWL success. Among these parameters, VCSD had the highest prediction accuracy, followed by SD, SV, RCT and BMI, respectively. This study demonstrated that VCSD value and RCT are predictive parameters in determining the treatment of patients with urinary calculi and selecting suitable ESWL candidates.

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 &lt;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 &lt; and ≥ 10 mm, stone density &lt; 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 &lt;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 &lt; and ≥ 10 mm, stone density &lt; 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.

Efficacy of Aspiration-Assisted Ureteral Access Sheath (ClearPETRA) in Retrograde Intrarenal Surgery.

Backgrounds: In the renal intrarenal stone surgery (RIRS) procedure, ureteral access sheath (UAS) is still used in the majority of surgeries to both protect the flexible ureteroscope (FURS) and reduce intrarenal pressure. ClearPETRA is a new UAS that has an integrated aspiration port. We aimed to evaluate the clinical outcomes and effectiveness of Aspiration-Assisted UAS (ClearPETRA) in the RIRS procedure. Methods: One thousand six hundred twenty patients who underwent RIRS between January 2021 and January 2024 were evaluated retrospectively and 512 patients were included in the study. According to stone size, patients with stones less than 2 cm and those with stones between 2 and 3 cm were analyzed separately. Patient's demographic data, stone size, body mass index, Extracoporeal Shockwave Lithotripsy (ESWL) history, stone side, stone density (Hounsfield Unit), operation time, stone-free rate (SFR), and the number of patients with sepsis were recorded. SFR was evaluated with kidney urinary bladder 3 months after surgery for opaque calculi. Nonopaque calculi patients were evaluated with noncontrast computed tomography 3 months after surgery. In the postoperative evaluation, patients with stones less than 4 mm were evaluated as SFR. P value of <0.01 was considered statistically significant. Results: Patient's demographic data, stone characteristics, and history of ESWL were similar in the ClearPETRA and UAS groups (P > .05). A total of 328 patients who underwent RIRS for stones less than 2 cm were included (80 ClearPETRA, 248 UAS). Length of hospital stay, operation time, SFR, secondary intervention, or postoperative sepsis (P ≥ .01) were similar in both groups. The incidence of postoperative fever was statistically significantly lower in the ClearPETRA group (P = .006). A total of 184 patients who underwent RIRS for stones between 2 and 3 cm were included (42 ClearPETRA, 142 UAS). In the ClearPETRA group, operation time was statistically significantly shorter (P = .002), SFR was statistically significantly higher (P = .003), and the number of fever and sepsis were statistically significantly less (P = .003 and 0.002, respectively). Conclusion: We found that ClearPETRA reduces the likelihood of postoperative fever after RIRS surgeries. Moreover, we can say that the use of ClearPETRA in RIRS, especially for stones larger than 2 cm, reduces the operation time, increases the SFR, and also reduces sepsis rates.

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.

Can shear wave elastography predict the success of shock‑wave lithotripsy used in renal stones treatment? A prospective study

ObjectiveTo evaluate the usage of shear wave elastography (SWE) in the prediction of the success rate of shock‑wave lithotripsy (SWL) treatment of renal stones.Patients and methodsIn the present study, SWL was performed for 100 patients presented with renal stones in the duration from May 2022 to August 2023. The patients were divided into 2 groups SWL responders and non-responders. The study compared between the 2 groups in terms of baseline parameters of the patients as age, sex, body mass index (BMI), stone size, stone location, stone density (HU), skin-to-stone distance (SSD), the degree of hydronephrosis and the stone elastography values.ResultsThere was no statistically significant relation between stone-free rate and degree of obstruction (p = 0.628), stone size (p = 0.390) upper calyceal location (p = 0.17), middle calyceal location (p = 0.66), and renal pelvis location (p = 1.0). Nevertheless, a statistically significant relation was found as regards lower calyceal location, stone density (HU), and stone Elastography values using multivariate analysis.ConclusionsMeasurement of stone density by shear wave elastography (SWE) can be used as an alternative to HU in decision-making before SWL. SWL success depends mainly on stone site, HU, and SWE values.