Stone Disease Research Articles

EGS P27 Twice Recurrent Gallstone Ileus Requiring 3 Laparotomies – A Case Report

Abstract Background Gallstone ileus is a well-known and not an uncommon complication of gall stone disease, with standard management being an enterotomy and extraction of the obstructing gallstone with management of the gallbladder and the billio-enteric fistula being deferred to an interval procedure if indicated. Recurrent gallstone ileus are not unheard of, but are quite rare and are the reason cited by the proponents of a single stage procedure. While a single stage procedure is possible - involving an enterotomy as well as a challenging cholecystectomy and the management and closure of a duodenal fistula – more commonly than not it is not performed. Methods Twice recurrent gallstone ileus is extremely rare and on performing a literature review only 1 published case report has been identified. Here we present the case of an 87-year-old Caucasian female, presenting with 3 incidences of gall stone ileus in a 30 day period requiring 3 laparotomies. Initial presentation to our institution was in November 2022 with a CT proven localised Gallbladder perforation. The first presentation with gallstone ileus was on 21/03/2023 with symptoms of bowel obstruction and CT proven obstructing 23mm gallstone 8 cm from the ileocaecal valve as well as pneumobillia and two other stones in the gallbladder. Results The index laparotomy was performed and no transition point was found, and bowel run-through from DJ to ICV revealed no intraluminal gall stones and the caecum was full of fluid. The gallstone had passed into the colon spontaneously and no enterotomy was performed. Two subsequent laparotomies were required due to CT proven incidence of recurrent Gallstone ileus on 30/03/2023 and 20/4/2023, were enterotomies were performed and the obstructing stones extracted each time. An informed decision not to tackle the gallbladder and the duodenal fistula was taken by a consensus of 3 consultant surgeons due to the frailty of our patient. Conclusions Our patient made a meaningful recovery after developing an entero-cutaneous fistula that resolved with conservative management and was discharged home on 15/05/2023. While our patient's frailty and previous gallbladder perforation made the decision not proceed with a cholecystectomy and repair of the duodenal fistula a straightforward one, the incidence of twice recurrent gallstone ileus in the span of a month raises questions as to whether other techniques should be considered in a more fit patient such as a single stage operation or a Cholecystolithotomy.

OGBN P35 The effect of social deprivation in patient outcomes following cholecystectomy

Abstract Background Socio economic status (SES) has shown to impact patient outcomes in different types of cancer. Socio economically deprived populations experience severe as well as complicated gall stone diseases more frequently in comparison with their affluent counterparts (doi: 10.1089/heq.2022.0063). However, the impact of SES on the presentation and outcomes of gallstone disease(GSD) in deprived population is not well studied. Therefore, a study was set up to assess the impact of deprivation in patients presenting with GSD. Methods A retrospective observational study of cholecystectomies in adults in our trust from August 2022 to December 2022 was performed. Patients were assigned into Affluent(AF) and Non-Affluent(NA) groups based on the Index of Multiple Deprivation (https://data-communities.opendata.arcgis.com/datasets/communities::indices-of-multiple-deprivation-imd-2019-1/explore). Data was collected using MS Excel and analysed using IBM SPSS statistics ver 27. Results 100 patients were included from August to December 2022. Male female ratio was 1:3. The five most deprived deciles (NA) had 46 and the five least deprived deciles (AF) had 54 patients. Median age in years was 48 and 52.5 respectively (p = 0.10). The NA deciles had 37 patients referred via the emergency department (ED) and 9 via GP. AF deciles had 34 referrals via ED and 20 via GP (p=0.05). No statistically significant difference was observed in Charlson’s index (p=0.53), operative time (p=0.58) and length of stay (p=0.74) between the groups. There were no conversions to open. Conclusions A higher ratio of patients came via GP referrals in the affluent deciles whereas more patients were referred via the ED in the non affluent deciles. However, there was no statistically significant difference in time to surgery and outcomes between these two groups.

Integrative genome-wide analyses identify novel loci associated with kidney stones and provide insights into its genetic architecture

Kidney stone disease (KSD) is a complex disorder with high heritability and prevalence. We performed a large genome-wide association study (GWAS) meta-analysis for KSD to date, including 720,199 individuals with 17,969 cases in European population. We identified 44 susceptibility loci, including 28 novel loci. Cell type-specific analysis pinpointed the proximal tubule as the most relevant cells where susceptibility variants might act through a tissue-specific fashion. By integrating kidney-specific omics data, we prioritized 223 genes which strengthened the importance of ion homeostasis, including calcium and magnesium in stone formation, and suggested potential target drugs for the treatment. The genitourinary and digestive diseases showed stronger genetic correlations with KSD. In this study, we generate an atlas of candidate genes, tissue and cell types involved in the formation of KSD. In addition, we provide potential drug targets for KSD treatment and insights into shared regulation with other diseases.

Differential expression of urease genes and ureolytic activity of uropathogenic Escherichia coli and Pseudomonas aeruginosa isolates in different nutritional conditions.

Uropathogens have adaptation strategies to survive in the host urinary tract by efficiently utilizing and tolerating the urinary metabolites. Many uropathogens harbour the enzyme urease for the breakdown of urea and the enzymatic breakdown of urea increases the pH and facilitate the struvite crystallization. In this study, the differential urease activity of uropathogenic Escherichia coli and Pseudomonas aeruginosa strains was investigated under different nutritional conditions. The experiments included measurement of growth, pH, urease activity, NH4-N generation and urease gene (ureC) expression among the bacterial strains under different conditions. Further, the implications of urea breakdown on the struvite crystallization in vitro and biofilm formation were also assessed. The study included urease positive isolates and for comparison urease negative isolates were included. Compared to the urease negative strains the urease positive strains formed higher biofilms and motility. The urease positive P. aeruginosa showed significantly higher (p < 0.01) pH and urease activity (A557-A630) compared to E. coli under experimental conditions. Further, supplementation of glucose to the growth media significantly increased the urease activity in P. aeruginosa and in contrast, it was significantly lower in E. coli. The expression profile of urease gene (ureC) was significantly higher (p < 0.001) in P. aeruginosa compared to E. coli and was consistent with the biochemical results of the urease activity under the nutritional conditions. The differential urease activity under two nutritional conditions influenced the biogenic struvite crystallization. It correlated with the urease activity showing higher crystallization rate in P. aeruginosa compared to E. coli. The results highlight the differential urease activity in two common uropathogens under different nutritional conditions that may have significant role on the regulation of virulence, pathogenicity and in the kidney stone disease.

Patient Perspectives on Kidney Stone Surgery: A Content Analysis of Instagram Posts by Patients Versus Surgeons

BackgroundBoth clinicians and patients use social media to post about health care issues such as kidney stone disease, but their perspectives may differ. ObjectiveTo evaluate content and themes regarding kidney stone surgery shared by patients and urologists on Instagram. Design, setting, and participantsA search was performed on Instagram using the term “kidney stone surgery”. The first 100 posts from individuals who were clearly identified as a patient were assessed. We also assessed 100 posts from self-identified urologists. Outcome measurements and statistical analysisA previously published system was applied as a framework for categorizing the information collected. Outcomes of interested included pain, recovery, and costs. Results and limitationsSome 71% of the patients were female and most of their posts (52%) were shared postoperatively. The most common themes covered in patient posts were the need for multiple operative sessions (45%), pain (43%), and recovery (42%). Other themes included activities of daily life (18%), return to work (11%), nervousness (16%), stent issues (31%), stent on a string (5%), diet and prevention (9%), gratitude for health care services (10%), disease recurrence (18%), and costs (10%). Some 94% of the urologists were male and their posts covered the following domains: recovery (11%), stent issues (3%), pain (1%), stent on a string (1%), gratitude for health care services (1%), and recurrence 1%. Among the posts from urologists, 79% included self-promotion and 52% covered new technology. Overall, 10% contained false information. The majority of the posts with surgical images had no clear statement regarding patient consent (97%). ConclusionsKidney stone surgery can affect many areas of a patient’s quality of life. Most of the posts shared by patients were negative. Posts shared by urologists do not reflect the same themes. Moreover, there appears to be poor adherence to European Association of Urology recommendations regarding online professional conduct. Patient summaryMany patients use social media to share their experiences of kidney stone surgery. Posts are largely related to quality-of-life issues and are mostly negative. While urologists also use social media, the content they post on professional accounts is mostly focused on new technology and career promotion.

Idea sprint: generating research priorities for urinary stone disease.

Idea sprint: generating research priorities for urinary stone disease.

Information Requirements of a Self-Care Application for Patients with Kidney Stones Undergoing Extracorporeal Shock Wave Lithotripsy

Introduction: Kidney stones and its treatment, control of possible complications after lithotripsy and prevention of kidney stones recurrence, are the most substantial concerns of patients and physicians. Nowadays, the high capabilities of mobile technologies have become especially important for the prevention and control of diseases and patients' self-care. Use of mobile technologies, applications and smart tools can be a good way to prevent and control kidney stones. The present study was designed to identify the data requirements to design a self-care application for patients with kidney stones undergoing extracorporeal lithotripsy.Material and Methods: This paper is a descriptive study and was performed in Sabalan Hospital in Ardabil affiliated to the Social Security Organization of Iran. A needs assessment questionnaire was designed by reviewing the scientific sources, databases, guidelines and medical records of patients. Ten clinical and technical specialists surveyed the questionnaire.Results: Four main characteristics of demographic data, clinical data, disease monitoring and application capabilities were identified. Familiarity with kidney stone disease, familiarity with treatment methods, familiarity with diet, reminders, interaction with the treating physician were the most important capabilities identified for the application.Conclusion: The findings of the survey showed that all identified items and components scored above average. The identified components were approved by experts and considered necessary.

The association between dietary habits and recurrence of kidney stones: A systematic review and meta-analysis

Link of Video Abstract: https://youtu.be/0RQPy46hlvY Background: Kidney stone disease is a significant global health issue that imposes a substantial burden on both patients and healthcare systems which affects 5-10% of the general population. There are several factors involved in its pathogenesis including insufficient dietary habits and fluid intake. Therefore, we conducted a systematic review and meta-analysis to compare between dietary intake across populations and recurrent urinary tract stones. This systematic review and meta-analysis aims to compare the associations between dietary intake across populations and recurrent kidney stones. Methods: Systematic search up to March 2023 were conducted through PubMed, Scopus, EMBASE. The systematic review was conducted according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Means and standard deviation of the nutrient intakes were extracted in patients with urinary stone disease group and control group. Results: Seven articles were further assessed with two articles were assessed through meta-analysis. Two studies showed that high sodium intake [SMD = 0.29 95% CI = -0.13, 0,71] was found in patient with urinary stone disease, while high water intake [SMD = -0.40 95% CI = -1.14, 0.34] was found in the control group. Conclusion: Animal protein, processed meat, sodium, and sugary beverages were associated with an increased risk of developing urinary stones, whereas vegetable protein and water intake were associated with a decreased risk.

Association of body fat percentage with kidney stone Disease: a cross-sectional and longitudinal study among bus drivers

BackgroundThe association between body fat percentage (BFP) and kidney stone disease (KSD) among bus drivers has not been explored in the existing literature. Thus, this study was conducted to explore the influence of BFP on the risk of KSD as well as KSD development for bus drivers to fill the research gap.MethodsA cross-sectional and longitudinal cohort study was designed. In total, 3433 bus drivers were included in the cross-sectional analyses, and 1864 bus drivers without KSD at baseline and with regular follow-up were included in the longitudinal cohort study.ResultsDuring a median follow-up of 2.9 years, KSD occurred in 15.0% of bus drivers. Multivariate logistic analysis found that each 5% higher BFP was not only significantly related with higher odds of KSD (odds ratio [OR] = 1.48), but also associated with higher odds of developing KSD (OR = 1.27). The risk of prevalent KSD in obesity group based on BFP was 2.47 times of the normal group; and the corresponding risk of developing KSD was 1.61 times. For obesity bus drives with age < 40, the corresponding risk increased to 4.54 times.ConclusionBus drivers were reported to have a high prevalence of KSD as well as development of KSD. As a significant predictive factor for KSD, BFP can be used to monitor and prevent bus drivers from kidney stone formation. Bus drivers in obesity group based on BFP, especially with age < 40 years should become priority subjects for targeted prevention.

Effect of COVID-19 Pandemic on Urology Clinic Attendance: Which Diseases are Important for Patients?

Introduction: We assessed whether there were changes in the characteristics of the patient population attending our urology clinic during the COVID-19 pandemic. &#x0D; Material and Method: Patients attending the general urology clinic of SB-ODU Education and Research Hospital were assessed. Dates from 3 February 2020-10 March 2020 were accepted as before the pandemic, with 11 March 2020-29 May 2020 accepted as after the pandemic. Complaints of patients on attendance were grouped as follows: benign prostate hyperplasia, ureteral diseases, kidney diseases, testis and scrotum diseases, incontinence, bladder diseases, sexually transmitted diseases, penile diseases, emergency urologic problems, sexual problems, urethral diseases, kidney and ureter stones, pediatric diseases and urologic tumors. &#x0D; Results: While 638 patients attended the urology clinic in the 1.5-month period before the pandemic, 398 patients attended in the 2.5-month period after the pandemic. Additionally, 30.9% of patients attending the clinic before the pandemic were women, while this rate fell to 23.6% after the pandemic. After the pandemic, there were statistically significant reductions identified for attendance due to BPH, ureteral diseases, kidney diseases, incontinence, bladder diseases and urethra diseases. There was no significant difference in attendance due to urinary system tumors, pediatric urologic patient group, attendance due to kidney and ureter stones, sexual problems and emergency urology problems. There were increases identified for attendance for testis and scrotum diseases and sexually-transmitted diseases. &#x0D; Conclusion: During the pandemic, the numbers of patients attending the urology clinic significantly reduced. During the pandemic, there were increases identified for attendance at our clinic for testis and scrotum diseases and sexually-transmitted diseases. While attendance reduced for many disease groups, rates of attendance for urologic emergencies, urinary tumors, pediatric patient group, stone disease and sexual problems continued as usual.

Incidence of Fractures after Intravenous Iron: A Retrospective Analysis Comparing Ferric Carboxymaltose and Ferric Derisomaltose

Background: Hypophosphatemia is a frequent side-effect of certain intravenous (i.v.) iron formulations, and a recent meta-analysis of prospective clinical trials reported that 54% of patients treated with ferric carboxymaltose (FCM) develop hypophosphatemia. While the incidence and time-course of hypophosphatemia are well known, the frequency of clinical consequences of these changes is poorly described. FCM infusions cause high intact fibroblast growth factor 23 (iFGF23), which is associated with hypophosphatemia, hyperphosphaturia, hypocalcitriolemia, hypocalcemia, secondary hypoparathyroidism, which is summarized as the ‘6H-syndrome’ that can ultimately result in osteomalacia. The association between treatment with FCM, high iFGF23, osteomalacia with fractures and nephrolithiasis is well documented in multiple case reports. This is not the case for ferric derisomaltose (FDI). Aims: The aim of the present study was to assess the incidence of fractures or radiological signs of osteomalacia and kidney stone in patients treated with FCM or FDI. Methods: Patients treated with FCM or FDI between January 2010 und December 2019 were identified by retrospective assessment of electronic health records of the University Hospital in Innsbruck, which is a large tertiary referral center in Western Austria. Dose, time of infusion, comorbidities and haematological parameters, serum iron parameters as well as markers of mineral metabolism were extracted from the healthcare records of each patient. Radiological and clinical endpoints included fractures, radiological signs of osteomalacia and kidney stone disease after the first infusion of FCM or FDI. The year before the first infusion was used as a control period. Results: In total, 289 patients were included and the median follow-up time was 5.8 years. Mean age was 44.6 years and 184 of 289 patients (64%) were females. In total 179 patients were treated with FCM and 110 patients received FDI. Grouping patients by drug revealed no differences in cumulative iron dose or number of drug applications. At baseline, serum creatinine was significantly lower in FDI-treated patients, but within the normal range for both groups. Mean hemoglobin concentrations were significantly lower in FCM-treated than in FDI-treated patients (95 g/L vs. 109 g/L) with no statistically significant differences in mean ferritin concentrations between groups at baseline. Assessment of treatment response 1-3 months after i.v. iron treatment showed a robust increase in hemoglobin and serum ferritin in both treatment groups. Baseline phosphate was significantly lower in FDI-treated patients with 3.07 mg/dL versus 3.34 mg/dL in the FCM treatment group. In FCM-treated patients a significantly greater change from baseline to 1-3 months after administration was found for phosphorous and calcium (Table 1). Hypophosphatemia was more commonly documented and more severe in FCM-treated patients, who also showed a significant increase in ALP. In a time to event analysis (fracture, osteomalacia and kidney stones) a significantly higher proportion of patients reached the combined endpoint in the FCM treatment group than in FDI-treated patients (Figure 1). Univariate Cox-regression for fractures after the infusion showed a HR of 4.54 for FCM treatment when compared to FDI (p=0.04). In contrast, no difference in fracture incidence was present in the year before the first iron infusion when both treatment groups were compared. Conclusions: In this retrospective analysis the combined event rate of fracture, radiological signs of osteomalacia and kidney stones was significantly higher among patients treated with FCM than after FDI treatment. This finding suggests that the observed changes in markers of mineral metabolism could indicate that FCM treatment is associated with a significantly higher risk of clinically relevant bone complications and kidney stone disease.

Recessive Variants in NEK1 and NEK8 Are Associated with Cystic Kidney and Kidney Stone Disease

Recessive Variants in NEK1 and NEK8 Are Associated with Cystic Kidney and Kidney Stone Disease

Low Expression of Renal Claudin-2 Increases Medullary Pro-Inflammatory Macrophages and Calcification in Nephrectomy Patients with a History of Urinary Stone Disease

Low Expression of Renal Claudin-2 Increases Medullary Pro-Inflammatory Macrophages and Calcification in Nephrectomy Patients with a History of Urinary Stone Disease

Loss of Renal Tubular Claudin-2 Increases Renal Calcification and Urinary Stone Disease

Loss of Renal Tubular Claudin-2 Increases Renal Calcification and Urinary Stone Disease

Clinical Characterization of a Cohort with Suspected Monogenic Stone Disease

Clinical Characterization of a Cohort with Suspected Monogenic Stone Disease

Facility-Level Variation in Care of Veterans with Urinary Stone Disease

Facility-Level Variation in Care of Veterans with Urinary Stone Disease

Mendelian randomisation and colocalization analyses reveal novel drug targets for the prevention of kidney stone disease by modulating serum calcium and phosphate concentrations

Mendelian randomisation and colocalization analyses reveal novel drug targets for the prevention of kidney stone disease by modulating serum calcium and phosphate concentrations

Understanding the Barriers to Preventive Pharmacological Therapy Use in Older Patients With Urinary Stone Disease.

Despite compelling clinical trial evidence and professional society guideline recommendations, prescription rates of preventative pharmacological therapy (PPT) for urinary stone disease are low. We sought to understand how patient- and clinician-level factors contribute to the decision to prescribe PPT after an index stone event. We identified Medicare beneficiaries with urinary stone disease who had a 24-hour urine collection processed by a central laboratory. Among the subset with a urine chemistry abnormality (ie, hypercalciuria, hypocitraturia, hyperuricosuria, or low urine pH), we determined whether PPT was prescribed within 6 months of their collection. After assigning patients to the clinicians who ordered their collection, we fit multilevel models to determine how much of the variation in PPT prescription was attributable to patient vs clinician factors. Of the 11,563 patients meeting inclusion criteria, 33.6% were prescribed PPT. There was nearly sevenfold variation between the treating clinician with the lowest prescription rate (11%) and the one with the highest (75%). Nineteen percent of this variation was attributable to clinician factors. After accounting for measured patient differences and clinician volume, patients had twice the odds of being prescribed PPT if they were treated by a nephrologist (odds ratio [OR], 2.15; 95% CI, 1.79-2.57) or a primary care physician (OR, 1.78; 95% CI, 1.22-2.58) compared to being treated by a urologist. These findings suggest that the type of clinician whom a patient sees for his stone care determines, to a large extent, whether PPT will be prescribed.

Kidney Stone Detection from CT Images Using ALEXNET and Hybrid ALEXNET-RF Models

Nowadays, kidney stone disease is one of the most common health issue which needs more attention for early diagnosis. Several imaging modalities are used for the detection of kidney stone. The gold standard CT scans are valuable for kidney stone detection. For kidney stone detection, machine and deep learning-based algorithms are widely used. In order to enhance the performance of earlier techniques, two techniques are developed. Initially, an AlexNet-based model is developed in this work. By using the enhanced recognition capability of Random Forest (RF), we developed a hybrid AlexNet-RF model. Both the models are tested against Kidney Stone Detection dataset. The performance of the proposed model proved that in terms of accuracy and loss the hybrid AlexNet-RF model secured reliable higher detection rate of approximately 97.1% to 97.5%. This showed that embedding RF in the Softmax layer of AlexNet significantly improves the prediction rate of kidney stone.

Trends of "Artificial Intelligence, Machine Learning, Virtual Reality, and Radiomics in Urolithiasis" over the Last 30 Years (1994-2023) as Published in the Literature (PubMed): A Comprehensive Review.

Purpose: To analyze the bibliometric publication trend on the application of "Artificial Intelligence (AI) and its subsets (Machine Learning-ML, Virtual reality-VR, Radiomics) in Urolithiasis" over 3 decades. We looked at the publication trends associated with AI and stone disease, including both clinical and surgical applications, and training in endourology. Methods: Through a MeshTerms research on PubMed, we performed a comprehensive review from 1994-2023 for all published articles on "AI, ML, VR, and Radiomics." Articles were then divided into three categories as follows: A-Clinical (Nonsurgical), B-Clinical (Surgical), and C-Training articles, and articles were then assigned to following three periods: Period-1 (1994-2003), Period-2 (2004-2013), and Period-3 (2014-2023). Results: A total of 343 articles were noted (Groups A-129, B-163, and C-51), and trends increased from Period-1 to Period-2 at 123% (p = 0.009) and to period-3 at 453% (p = 0.003). This increase from Period-2 to Period-3 for groups A, B, and C was 476% (p = 0.019), 616% (0.001), and 185% (p < 0.001), respectively. Group A articles included rise in articles on "stone characteristics" (+2100%; p = 0.011), "renal function" (p = 0.002), "stone diagnosis" (+192%), "prediction of stone passage" (+400%), and "quality of life" (+1000%). Group B articles included rise in articles on "URS" (+2650%, p = 0.008), "PCNL"(+600%, p = 0.001), and "SWL" (+650%, p = 0.018). Articles on "Targeting" (+453%, p < 0.001), "Outcomes" (+850%, p = 0.013), and "Technological Innovation" (p = 0.0311) had rising trends. Group C articles included rise in articles on "PCNL" (+300%, p = 0.039) and "URS" (+188%, p = 0.003). Conclusion: Publications on AI and its subset areas for urolithiasis have seen an exponential increase over the last decade, with an increase in surgical and nonsurgical clinical areas, as well as in training. Future AI related growth in the field of endourology and urolithiasis is likely to improve training, patient centered decision-making, and clinical outcomes.