Treatment Of Stones Research Articles

Impact of emergency computed tomography on treatment and time to treatment for renal colic.

The aim of this study was to evaluate the utilization and impact of emergency computed tomography (CT) on the management of renal colic, focusing on treatment decisions, time to treatment and the subsequent need for additional emergency department (ED) visits. Retrospective analysis of patient visits to the ED in Helsingborg with a diagnosis of urolithiasis (ICD codes N20-23) between July 1, 2019 and June 30, 2020. Results: Out of 64,263 visits, 1.4% (880) visits were related to urolithiasis, involving 612 patients. Emergency CT (within 24 h) was performed in 43% of the cases, with an additional 9% undergoing CT at a subsequent emergency visit. Radiological confirmation of kidney or ureteral stone was found in 324 patients, of which 63% (204) required no treatment. Comparison between patients who underwent emergency CT and those who did not, revealed a significantly shorter time to treatment and closure in the emergency CT group. The median time to treatment was 28 days for those with an emergency CT and 59 days for those without (P < 0.001), acute surgery excluded. The median time to closure was 31 days for emergency CT compared to 37 days without emergency CT (P < 0.010), acute surgery excluded. In this study, the use of emergency CT shortened the time to treatment and rendered the patient stone free earlier compared to deferred diagnostics, with a note of caution that emergency CT may have led to increased surgical treatments for stones that might otherwise have passed spontaneously. gov Identifier: NCT06535711.

Analysis of the efficacy of multidisciplinary integration based on 3D reconstruction technology for the treatment of gout stone.

This study investigates the efficacy of multidisciplinary fusion therapy based on 3D reconstruction technology for the treatment of gouty stone by comparing the efficacy of multidisciplinary fusion therapy with pharmacologic therapy. This study is a cohort study.Patients who underwent gout stone surgery at the Affiliated Hospital of Qingdao University from November 2020 to November 2022 were included in this study, totaling 85 to form the MDT surgery group, and matched among gout stone patients in the outpatient clinic during the same period to form the medication group. Patients in the 2 groups were followed up for 6 months to compare baseline and follow-up data. Both groups experienced a decrease in uric acid levels and an increase in SF-36 scores during follow-up. After adjusting for confounders, multifactorial logistic regression showed that the uric acid attainment rate of patients in the MDT surgery group was 4.011 times higher than that of the drug group (OR: 4.011, 95% CI: 1.595, 10.086, P = 0.003); the proportion of patients with an increase in SF-36 in the MDT surgery group was 4.976 times higher than that of the drug group (OR: 4.976, 95% CI: 2.243, 11.040, P < 0.001); the proportion of patients treated with high-dose medication in the MDT surgery group was 1.8% of that of patients in the drug group (OR: 0.018, 95% CI: 0.002, 0.148, P < 0.001); and the proportion of patients in the MDT surgery group who developed frequent gout was 2.8% of that in the drug group (OR: 0.028 95% CI: 0.003, 0.2398, P = 0.001). the proportion of patients in the MDT surgery group who developed abnormal liver function was 0.317 times higher than that in the drug group (OR: 0.317, 95% CI: 0.121, 0.831, P = 0.019). The multidisciplinary integration of 3D reconstructive techniques for gout stone treatment resulted in an increase in uric acid compliance, a decrease in the frequency of gout and the appearance of liver impairment; and a greater benefit in terms of improvement in the quality of life of the patients after treatment.

Advancements in Nanomedicine for the Diagnosis and Treatment of Kidney Stones

Advancements in Nanomedicine for the Diagnosis and Treatment of Kidney Stones

Clinical Efficacy and Outcomes of Electro-Pneumatic Intracorporeal Lithotripsy in the Management of Sialolithiasis.

This study aims to evaluate the clinical efficacy of electro-pneumatic intracorporeal lithotripsy for the treatment of salivary gland stones. A prospective cohort study of patients diagnosed with obstructive salivary gland syndrome, where basket-assisted sialendoscopy alone failed to remove the calculi. This study was conducted at the "Queen Maria" Military Hospital in Brașov, Romania, and a private practice, between February 2023 and May 2024. A total of 29 patients with salivary calculi were treated using the SialoLither device (Hidromed), which operates on the electro-pneumatic principle. The number of sessions required for complete stone removal, the duration of each session, and the number of ballistic impulses applied were recorded. Statistical analyses, including the Mann-Whitney U test and multiple linear regression, were conducted to assess the relationship between stone size, location, and treatment outcomes. Complete removal was achieved in 72.4% of patients after a single session, with 100% success after 3 sessions. The average number of impulses was 13.9 (±4.25), with no significant difference in outcomes between the parotid and submandibular glands (P > .05). The total duration varied, with a mean time of 89.97 (±54.89) minutes. Complications were minimal, with only 2 cases of minor epithelial damage. Electro-pneumatic intracorporeal lithotripsy is a highly effective, minimally invasive technique for managing salivary calculi, offering a safe and efficient alternative to traditional surgical methods.

Impact of Anesthesia Type on Stone Clearance and Morbidity in Ureteroscopy: General Versus Spinal Anesthesia

Anaesthesiologists prefer regional anesthesia for ureterorenoscopy to prevent difficulties after the procedure, whereas surgeons prefer general anesthesia in order to prevent ureteral damage. However, limited comparative data exist regarding the outcomes of these anesthesia techniques in ureteroscopy-assisted stone clearance Objective: To compare spinal and general anesthesia regarding efficacy, safety, and patient outcomes during ureteroscopy for ureteric stones. Methods: This quasi-experimental study included 90 patients aged between 20-60 years in total were chosen. Using a semi-rigid ureteroscope (8/8.4 fr), all individuals had ureteroscopic treatment for ureteric stones. Equal numbers of 45 patients were divided between the two groups. General anesthesia was administered to Group A, and spinal anesthesia was provided to Group B. The participants' demographic data, hospital stays, operating times, stone removal rates, and intra- and post-operative problems were all recorded. Data on intraoperative parameters, stone clearance, and postoperative complications were collected and analysed using SPSS 23.0. Results: General anesthesia significantly reduced the dilatation time (104.01 ± 12.772 vs. 130.552 ± 22.532 sec, p &lt; 0.001) and time to reach the stone (126.68 ± 12.592 vs. 137.602 ± 17.841 sec, p &lt; 0.001) compared to spinal anesthesia. However, no significant differences were observed in lithotripsy time, operation time, stone-free rates, or postoperative complications between the two groups. Patients in the GA group reported higher VAS scores and an increased frequency of nausea/vomiting after surgery. Conclusion: General anesthesia reduced the time for dilatation and stone access but showed no significant advantages in lithotripsy time, operation time, stone-free rates, or complications.

Which combination of medical expulsive therapy is more effective for treatment of distal ureteral stone in adults? A systematic review and network meta-analysis

BackgroundMedical Expulsive Therapy (MET) has been recommended as an established modality for the treatment of distal ureteral stones due to its clearance rate, pain control, and patient satisfaction while having minimal morbidity in comparison to other urologic interventions. In some studies, a combination of medications has been used, which we assessed in this network meta-analysis (NMA).MethodsWe conducted systematic searches in PubMed, Scopus, and Web of Science to identify relevant trials published between 2001 and 2024. We excluded articles that looked at MET for upper ureteral stone passage or after shock wave lithotripsy (SWL). NMA was performed to compare the effect of combination MET on stone expulsion rate (SER), stone expulsion time (SET), and need for analgesia.ResultsWe included 19 studies with 2414 participants. NMA results revealed that the combination MET of α-blockers with PDE-5 inhibitors (OR = 2.7, CI = 1.80,4.05), corticosteroids (OR = 2.7, CI = 1.81,4.13), and phytotherapy (OR: 3.10, CI = 1.62,5.92) were more effective than α-blockers alone in SER. The combination MET of α-blockers with PDE-5 inhibitors (MD: -3.8, CI=-7.0, -0.5) showed significantly lower SET compared to α-blockers alone. Finally, combination MET of α-blockers with PDE-5 inhibitors (MD:1.0, CI = 0.4,1.7) and nifedipine with corticosteroids (MD:1.2, CI = 0.4,1.9) showed a significant decrease in analgesia use.ConclusionsThe combination MET of α-blockers with PDE-5 inhibitors, corticosteroids, and phytotherapy increases the rate of stone clearance 2.7 to 3.1 times more than α-blockers alone. The other benefits of combination MET were lower expulsion time and less analgesia use that needs further studies.

The effect of laparoscopic cholecystectomy combined with laparoscopic transcystic common bile duct exploration in treatment of cholecystolithiasis combined with choledocholithiasis.

This study aims to compare the efficacy of laparoscopic cholecystectomy combined with laparoscopic transcystic common bile duct exploration (LTCBDE), laparoscopic common bile duct exploration (LCBDE), and endoscopic retrograde cholangiopancreatography (ERCP) in the treatment of gallbladder stones with common bile duct stones. We conducted a retrospective comparative analysis based on surgical time, intraoperative blood loss, postoperative recovery metrics, total hospitalization costs, gastrointestinal quality of life index (GIQLI) before and after surgery, and the incidence of postoperative complications. No significant differences were found among the three groups in terms of the surgical success rate, first stone clearance rate, intraoperative blood loss, incidence of postoperative complications, and stone recurrence rate (p > 0.05). The LTCBDE group had shorter surgical time, earlier time to get out of bed, earlier first flatus time, shorter postoperative hospital stays, and earlier removal of abdominal drainage tube compared to the LCBDE and the ERCP + LC groups (all p < 0.05). The average hospitalization cost was also lower in the LTCBDE group (p < 0.05). LTCBDE for the treatment of gallbladder stones with common bile duct stones leads to faster recovery and improved quality of life. It is safe and effective, making it a method worthy of promotion.

Associations between 25-hydroxyvitamin D/calcium/alkaline phosphatase levels and the risk of developing kidney stones: Results from NHANES (2013-2018)-based and Mendelian randomization studies.

This study explores the relationship between 25-hydroxyvitamin D/calcium/alkaline phosphatase (ALP) levels and kidney stone development via cross-sectional and Mendelian randomization (MR) analyses. We used data from the National Health and Nutrition Examination Survey (NHANES) 2013 to 2018 to explore the associations of 25(OH)D metabolite, calcium, and ALP levels with kidney stone development, LDSC analysis to determine the associations between their genetically predicted levels and kidney stone development, and MR analysis to determine the causality of those relationship via genome-wide association studies (GWASs). The cross-sectional study revealed a relationship between ALP levels and kidney stone development (Model 1: OR = 1.004, 95% CI = 1.001-1.007, P = .005; Model 2: OR = 1.004, 95% CI = 1.001-1.007, P = .007; Model 3: OR = 1.003, 95% CI = 1.001-1.006, P = .011) in both men and women. LDSC analysis also revealed a genetic correlation between ALP concentrations and kidney stone development (ukb-b-18372: rg = 0.296, P = 1.45E-04; GCST90044237: rg = 0.157, P = .004). The results of both MR analyses demonstrated that kidney stones cause elevated ALP levels (IVW: OR = 2.233, 95% CI = 1.113-4.480, P = .024, preliminary analysis; OR = 1.003, 95% CI = 1.000-1.005, P = .025, validation analysis). MR analysis also revealed that elevated serum calcium levels increased the risk of developing kidney stones (IVW: OR = 1.002, 95% CI = 1.000-1.003, P = 4.258E-04, preliminary analysis; OR = 1.592, 95% CI = 1.365-1.858, P = 3.367E-09, validation analysis). Our study strongly supports a positive association between kidney stone development and ALP levels. Although observational studies did not reveal an association between calcium levels and kidney stone development, MR analysis suggested a positive association between calcium levels and kidney stone development. Our study provides new and more reliable evidence and research directions for the prevention, diagnosis and treatment of kidney stones.

Flexible Vacuum-assisted Ureteral Access Sheath for Treating Impacted Ureteral Stones.

To evaluate the feasibility and safety of using the novel flexible vacuum-assisted ureteral access sheath (FV-UAS) in flexible ureteroscopy (F-URS) treatment of impacted non-distal ureteral stones. We analyzed data from patients who underwent FV-UAS treatment for impacted non-distal ureteral stones between January 2022 and September 2023. Perioperative parameters were evaluated, including operative time, ureteral injury, and complications. The FV-UAS have a 10 cm passive deflection segment at the distal end of the ureteral access sheath that can bend following the deflection of the F-URS, while also being connected to a vacuum device for aspiration. A total of 62 consecutive patients (35 females) were included. Mean (range) patient age was 50.0 (29-75) years. Mean (range) largest stone size was 13.8 (9-16) mm. Mean (range) total time was 34.2 (18-46) min. In 57 patients (91.9%), no residual stones were detected in the renal, while 5 patients (8.1%) had residual stones smaller than 4 mm. A 5-tier classification quantified ureteral injury severity at stone impaction sites: grade 0 (n=10); grade 1 (n=47); grade 2 (n=5); grade 3 and 4 (n=0). Nine patients (14.5%) underwent placement of two double-J stent. Two patients (3.2%) developed postoperative fever requiring antibiotics and conservative management. Mean (range) postoperative hospital stay was 1.2 (1-2) day. At the 3-month follow-up, no ureteral strictures had occurred. No additional surgical interventions were necessary during follow-up. The use of the FV-UAS for the treatment of impacted non-distal ureteral stones is a safe and effective surgical method.

A comparison on safety and efficacy between 24 Fr versus 18 Fr pneumatic balloon dilators for percutaneous treatment of renal stones between 10 and 20mm: results from a contemporary cohort.

To assess differences in safety and efficacy between 24 and 18 Fr pneumatic balloon dilators for percutaneous nephrolithotripsy (PCNL) of renal stones between 10 and 20mm. Patients were randomized to dilatation with a 24 Fr (Group A) versus 18 Fr (Group B) Ultraxx pneumatic dilator (Cook Medical®). In all procedures percutaneous puncture was performed under ultrasound guidance. In both groups the Holmium: YAG Cyber Ho laser generator was used (Quanta System®). Stone-free rate (SFR) and postoperative complications were assessed. 42 and 44 patients were assigned to Groups A and B, respectively. Preoperative features were comparable. Mean stone size was 17.8 vs. 16.6mm in Group A vs. B (p = 0.21). SFR was 95.2% in Group A and 95.4% in Group B (p = 0.19). Postoperative gross haematuria was observed in 5 vs. 2 cases in Group A vs. B (p = 0.04). Mean haemoglobin drop at first postoperative day (POD) was higher in Group A (2.4 vs. 1.1mg/dl, p = 0.04), while comparable at third POD. Blood transfusion was required in 2 cases in Group A and 1 case in Group B. No patients required embolization. No significant difference was observed in terms of postoperative pain and urinary infection. 24 and 18 Fr pneumatic dilators are both effective to access renal cavity during PCNL for the treatment of renal stones between 10 and 20mm. Gross haematuria rate and mean haemoglobin decrease at first POD were significantly higher with 24 Fr dilator, but with no differences in the need for blood transfusions and renal embolization.

Real time monitoring of intrarenal pressures while using the flexible and navigable suction ureteral access sheath.

To report on in-vivo intrarenal pressure (IRP) during flexible ureteroscopy for treatment of kidney stones while using the novel flexible and navigable suction ureteral access sheath (FANS). A retrospective observational analysis was performed for 25 patients undergoing routine flexible ureteroscopy for treatment of renal stones between February 2024 and June 2024 from two centres in Canada. The LithoVue Elite™ ureteroscope (Boston Scientific Corp., Marlborough, MA, USA) with pressure sensing capability was used together with the Clearpetra® Ureteral Access Sheath System (Well Lead Medical Co. Ltd., Guangzhou, China) for all cases. Irrigation was via a pressure bag set at 250mmHg where possible and the access sheath was connected to wall suction at 200mmHg. Median and maximum IRP, as well as the distribution of cumulative procedure times according to various IRP ranges were analyzed. The median age of the patients was 56 years, with a median BMI of 26.7kg/m2. The median (Interquartile range {IQR}) IRP for all the cases was 22.0 (15.0-36.5) mmHg, with a median (IQR) procedure time of 35.9 (16.4-54.8) minutes. The IRP remained below 40mmHg in 76.2% of the total time in all procedures, and was below 60mmHg in 94.1% of the time. Significant variables associated with lower IRP were having a prior endourological procedure, pre-stenting, larger ureteral access sheath size and use of pre-operative alpha blocker. Age, BMI and total stone volume did not significantly affect IRP. Low intrarenal pressures can be achieved with the use of FANS, even with higher irrigation pressures. Alpha blocker use, larger sheath size, prior endourological procedures and pre-stenting are all associated with lower IRP.

Mini-percutaneous nephrolithotomy using the new Cyber Ho generator with Magneto technology: the first clinical experience in the treatment of renal stones between 10 and 20 mm.

Mini-percutaneous nephrolithotomy using the new Cyber Ho generator with Magneto technology: the first clinical experience in the treatment of renal stones between 10 and 20 mm.

An assessment of the efficacy and safety of balloon nephrostomy traction in minimizing postoperative bleeding of percutaneous nephrolithotomy: a randomized controlled clinical trial.

Percutaneous nephrolithotomy (PCNL) as an established procedure for treatment of large kidney stones, can trigger life threatening complications. Postoperative hemorrhaging is one of the main complications of PCNL. This study investigates the effectiveness of balloon nephrostomy in reducing hemorrhage in the postoperative phase of PCNL. A total of 102 patients underwent routine PCNL and then they were randomly allocated to intervention and control groups. For the intervention group, a balloon nephrostomy tube was inserted under guidance of fluoroscopy, gentle traction was applied on the nephrostomy and then it was fixed to skin under mild traction. A conventional nephrostomy tube was inserted in the control group without additional traction. Blood loss was estimated by hemoglobin drop in the first 24h after surgery. Hemoglobin level drop was the primary endpoint of interest. Secondary endpoints were postoperative complications and were compared between treatment groups. The mean first 24-hour hemoglobin drop was 0.9 ± 0.2mg/dL in the intervention group and 2.1 ± 0.2mg/dL in the control group which was statistically significant (< 0.001). Although blood transfusion was more common in the control group (8% versus 0%), it was not statistically significant. There were no statistically significant differences between intervention and control groups regarding the postoperative complications. In conclusion, the results of the present study show the effectiveness of the application of balloon nephrostomy in decreasing PCNL postoperative bleeding without considerable complication. IRCT20160406027253N2.

Semi-closed-circuit vacuum-assisted mini percutaneous cystolithotomy (vamPCL) in the pediatric population: Initial experience of a novel technique in native and augmented bladders.

Bladder stones (BS) in children are a rare condition and represent 1-5% of all urinary tract stones. With advances in miniaturized endoscopes and intracorporeal lithotripters, percutaneous cystolithotomy has been demonstrated to be an effective, safe and quick technique, despite the longer operative time. This limitation may be overcome by a semi-closed-circuit vacuum-assisted technology (vamPCL), characterized by a continuous inflow and a suction-controlled outflow (ClearPetra®). To assess the safety and efficacy of a vamPCL characterized by continuous inflow and suction-controlled outflow to treat bladder stones in pediatric patients with native or augmented bladder. From January 2021 up to December 2023, we prospectively collected variables on consecutive vamPCL procedures (Fig.) The stone-free rate (SFR) was defined as absence of stones or residual fragment <5mm diagnosed with ultrasound. Six patients with a median age of 139 months (55-212) were recruited for the study. Three patients (50%) with the initial diagnosis of extrophy-epispadia complex had an augmented bladder, whereas of the remaining three (50%) with an initial diagnosis of anorectal malformation two had an augmented bladder. All patients had a Mitrofanoff conduit opening on the right flank, except for one (16%) with umbilical access. The mean cumulative stone size was 24mm±14,2. The mean operating time was 78,3min±14,7. One procedure was interrupted after 90min due to the overall size (>50mm). Stone removal was achieved only via suction in all cases. All vamPCL procedures were completed without intraoperative complications. Fever for 24h (1/6; 16%) was the only post-operative complication. The mean stay of the suprapubic catheter was 3.4 days±1,5 and of the trans-Mitrofanoff catheter was 9.3 days±4,5. The SFR was confirmed in all the cases with US performed after 2 months. Only one male patient (16%) had recurrent stones after 8 months and he is waiting for second surgery. Mean follow-up was 7.2 months±9,4. In the present study we demonstrated that vamPCL is safe and feasible in selected cases especially in those with augmented bladder. To our knowledge, this manuscript is the first to present the use of the ClearPetra® for the treatment of bladder stones. To our knowledge, this manuscript is the first to present the use of the ClearPetra® for the treatment of bladder stones. The vamPCL seems to be sustainable, safe and feasible for bladder stones treatment in selected children.

Chemoenzymatic synthesis of Tamsulosin.

Several chemoenzymatic pathways have been developed for the stereoselective production of the drug tamsulosin. The interest in the exclusive synthesis of its (R)-enantiomer lies in the greater activity compared to that displayed by its (S)-counterpart for the treatment of kidney stones and benign prostatic hyperplasia disease. Using different types of biocatalysts such as lipases, alcohol dehydrogenases and transaminases, three complementary strategies have been studied to introduce chirality into a key synthetic precursor. The first approach involved the lipase-catalyzed kinetic resolution of a racemic amine precursor, although low conversions and selectivities were found. A second strategy consisted in the synthesis of a chiral alcohol intermediate through a bioreduction proccess catalyzed by ADHs, with the identification of stereocomplementary redox enzymes capable of producing both enantiomers. The (S)-alcohol, obtained with ADH-A from Rhodococcus ruber, was subsequently converted into the corresponding amine through a telescoped approach. Alternatively, transaminases were also employed for the biotransamination of the previously studied intermediate ketone, which led directly to the enantiopure (R)-amine in high yield. Finally, the active pharmaceutical ingredient was prepared in enantiopure form and in 49% overall yield from the ketone precursor by a two-step sequential transformation of the chiral amine building block. These findings highlight the importance and versatility of enzyme catalysis for the stereoselective synthesis of drugs.

Comparison of Tubeless Mini Percutaneous Nephrolithotomy and With Tubed Mini Percutaneous Nephrolithotomy for Kidney Stones: A Prospective Study

Introduction: Renal stone disease is a prevalent condition with a high recurrence rate, significantly impacting patients’ quality of life. Different modalities of renal surgery are using globally. Mini Percutaneous nephrolithotomy (PCNL) is an effective treatment for renal stones. Due to the significant pain and morbidity after Percutaneous nephrolithotomy because of nephrostomy tubes, various modifications of Percutaneous nephrolithotomy are being performed. Aims: To compare the safety and efficacy of tubeless mini Percutaneous nephrolithotomy against tubed mini Percutaneous nephrolithotomy. Methods: It is prospective Hospital study conducted from July 2021 to December 2022 at Nobel Medical College. total 100 patients under inclusion criteria were divided into two groups: 50 in Group A (tubed mini Percutaneous nephrolithotomy) and 50 in Group B (tubeless mini Percutaneous nephrolithotomy) alternatively. The 2 groups were compared for Clavien Dindo grading of complications in Percutaneous nephrolithotomy analgesic requirements, hospital stay and time of operative procedure. Data was analysed by using the chi-square test for qualitative variables and the student t test for quantitative variables. A P value 0.05 was considered significant. Ethical clearance was obtained from institutional review committee. Results: The mean age was similar between groups (Group A: 35.44 years; Group B: 36.26 years). Complications were comparable, with postoperative pyrexia being the most common in both groups. However, Group B demonstrated significantly shorter hospital stays (80% discharged within 2 days vs. 30% in Group A) and lower analgesic requirements (p &lt; 0.05). Conclusion: Tubeless mini Percutaneous nephrolithotomy is a safe and effective alternative for selected patients, offering reduced hospital stays and lower analgesic needs compared to tubed mini Percutaneous nephrolithotomy.

Stone-free Rate of Ultrasound-assisted and Fluoroscopy-guided Extracorporeal Shockwave Lithotripsy for Radiopaque Renal Stones

Background: Extracorporeal shock wave lithotripsy (ESWL) has been a widely accepted method for treating urinary stones since the early 1980s. ESWL is the preferred non-invasive treatment for renal stones that are smaller than 1.5 cm. Ultrasound and fluoroscopy are used during ESWL operations to visualize the fragmentation. Objective: To determine the Stone-free rate of ultrasound-assisted and fluoroscopy-guided extracorporeal shockwave lithotripsy for radiopaque renal stones. Methodology: A prospective cohort study was conducted at the Sindh Institute of Urology and Transplantation from 25th February to 25th August 2022, including 75 participants per group with renal stones &lt;1.5 cm, radio-opaque kidney stones, and consented patients. Both groups were treated using identical lithotripters with ultrasound and fluoroscopy for stone localization. Post-lithotripsy, X-ray or ultrasound assessed stone clearance. Frequency and percentages were calculated for variables like age, gender, and stone-free rates. Mean values and deviations were computed. The Chi-Square test analysed categorical variables. Paired sample statistical analysis evaluated differences in stone size and clearance, with p-values &lt;0.05 deemed statistically significant. Results: Within group A, 53 patients (70.7%) exhibited no stones, whereas in group B, 45 patients (60%) were devoid of stones. These findings suggest that group A surpassed group B in terms of achieving stone-free statuses. Conclusion: Our research findings indicate that ultrasound-assisted extracorporeal shockwave lithotripsy achieved a stone-free rate of 70.7%, surpassing the stone-free rate of 60% achieved by fluoroscopy-guided extracorporeal shockwave lithotripsy for radiopaque renal stones.

EFFICACY OF WHIRLPOOL MECHANISM IN RETRIEVAL OF STONE FRAGMENTS (HYDRODYNAMIC STONE RETRIEVAL THROUGH PERCUTANEOUS NEPHROLITHOTOMY) COMPARED TO FORCEPS IN MINI-PERCUTANEOUS NEPHROLITHOTOMY (MINI-PCNL)

Mini-percutaneous nephrolithotomy (mini-PCNL) is a widely adopted technique for the treatment of renal stones, offering minimal invasiveness and high success rates. Efficient retrieval of stone fragments is critical for surgical success. This study compares the efficacy and safety of the whirlpool mechanism versus forceps retrieval during mini-PCNL in a tertiary care hospital in Pakistan. Objective: To evaluate the stone clearance rates, operative time, hospital stay, and complications associated with the whirlpool mechanism compared to forceps retrieval in mini-PCNL. Methods: This prospective randomized controlled trial included 90 patients undergoing mini-PCNL at the Institute of Kidney Diseases (IKD), Peshawar. Patients were randomly assigned into two groups: Group A (whirlpool mechanism) and Group B (forceps retrieval), with 45 patients each. Data on stone clearance rates, operative time, hospital stay, and complications were collected and analyzed using SPSS version 26, with a p-value ≤0.05 considered significant. Results: The stone clearance rate was significantly higher in Group A (91.1%) compared to Group B (77.8%, p=0.042). Operative time was slightly longer in Group A (90.6 ± 12.4 minutes) than in Group B (82.3 ± 10.7 minutes, p=0.032). Group A demonstrated a shorter hospital stay (2.8 ± 0.6 days) compared to Group B (3.4 ± 0.7 days, p=0.021). Complication rates, including bleeding, infection, and urinary leaks, were low and comparable between the groups. Conclusion: The whirlpool mechanism significantly enhances stone clearance rates and shortens hospital stays compared to forceps retrieval, with a comparable safety profile. These findings support the adoption of the whirlpool mechanism as a preferred method for stone fragment retrieval during mini-PCNL, particularly in resource-limited settings.

Formation and Herbal Prevention for Kidney Stone

Medicinal plants have been valued for millennia for their therapeutic properties in preventing various ailments. Kidney stones and urinary calculi are increasingly prevalent due to changes in lifestyle such as industrialization and poor nutrition. In India, calcium oxalate kidney stones are the most common. This article examines the prevalence, types, and treatments for kidney stones, with a focus on the use of medicinal herbs. Medicinal herbs have been used for centuries because they are safer, more effective, culturally acceptable, and have fewer adverse effects compared to manufactured medications. Patients with kidney stones are advised to consume a low-fat diet and incorporate fibers from naturally occurring plants and herbal treatments into their regimen. The article outlines steps to maximize the potential of medicinal plants in dissolving kidney stones. Combining herbal remedies with allopathic treatments is suggested as an effective approach to address all issues associated with kidney stones. This integrated treatment method can leverage the strengths of both systems, providing a holistic and effective solution for kidney stone patients. The purpose of this article is to emphasize the benefits and applications of herbs in the treatment of urinary stones, advocating for their use alongside conventional medical treatments.

Stone-event-free survival after retrograde intrarenal surgery: is the stone-free-status so relevant for the future outcomes?

The primary aim of stone treatment is to achieve stone-free status. Residual fragments can cause stone growth, recurrence, urinary tract infections, and ureteric obstruction. Our goal was to describe the natural history of stone burden after retrograde intrarenal surgery (RIRS) based on stone-free status (SFS), evaluating stone growth and stone-events. We retrospectively reviewed data from patients who underwent RIRS at a tertiary care center between October 2014 and September 2019. The stone burden was assessed by measuring the maximum diameter (mm) and volume (mm3). Patients were divided into four groups according to SFS-(A) absolute stone-free, no stones on non-contrast-enhanced computed tomography (NCCT); (B) relative stone-free with ≤ 2mm fragments, (C) relative stone-free with 2.1-4mm fragments, and (D) residual fragments > 4mm. Our main outcomes were stone growth over time (defined as an increase in diameter compared to first postoperative measurement) and incidence of stone-related events (pain or additional intervention to treat symptoms, obstruction, or removing fragments). A total of 98 patients were included in the study-42 were classified as absolute stone-free (Group A), 20 were categorized as relatively stone-free (Groups B and C), and 36 had a residual stone burden with fragments larger than 4mm (Group D) on postoperative NCCT. There was a significant difference in the number of stones among the groups (p < 0.001). The pre-operative stone volume differed significantly among the groups (p = 0.003). Group A had the lowest median total stone volume (551.3mm3). Twenty patients (20.4%) developed stone-events during a mean follow-up period of 62.3months (± 26.0). Stone-event-free survival differed significantly between the groups (p = 0.028), with Group D demonstrating a higher incidence of stone-related events post-RIRS compared to the other groups. Sixteen patients (16.3%) had renal colic requiring a hospital visit across all groups. Thirteen patients (13.3%) required re-intervention (3 patients belonged to Group A, 1 to Group B, 2 to Group C, and 7 to Group D). Group D shows a higher rate of stone-related events post-RIRS. Ensuring complete stone-free status after RIRS is crucial for treatment success. Other factors should be considered in the management, including ensuring compliance with general preventive measures and stone-specific pharmacological treatments to prevent recurrence.