Urinary Tract Stones Research Articles

The Effect of Lidan Huashi Pills on the Glutathione Peroxidase Activity and Growth of Calcium Oxalate Crystals in the Kidneys of Rats

Objective: To explore the effects of Lidan Huashi Pills on the glutathione peroxidase (GSH-Px) activity and growth of calcium oxalate crystals in the kidneys of rats. Methods: 30 rats were randomly divided into a blank group, a model group, and an experimental group, with 10 rats in each group. The blank group was free to eat and drink water for 8 weeks; the ethylene glycol method was used for the standard calcium oxalate crystal modeling in the control group and experimental group for 4 weeks. The model group was given free feeding and physiological saline (2 ml/d) by continuous gavage for 4 weeks; the experimental group was given free feeding and Lidan Huashi Pills (450 mg/kg, 2 ml/d) by continuous gavage for 4 weeks. After 4 weeks, all rats were euthanized, and the left kidney was taken for GSH-Px level detection. The right kidney was stained with hematoxylin and eosin (H&E) to observe the formation of calcium oxalate crystals. Results: After 4 weeks of modeling, the urinary calcium levels in the model group and experimental group significantly increased compared to the blank group (868.00 ± 39.29 vs 929.40 ± 33.61, P < 0.05), indicating successful modeling. The urine calcium ion concentration in the experimental group after modeling was significantly lower than that in the model group (929.40 ± 33.61 vs 888.60 ± 25.92, P < 0.05). The grading score of calcium oxalate crystals in the model group was significantly higher than that in the blank group (P < 0.05); the grading score of calcium oxalate crystals in the experimental group was lower than that in the model group, and the difference was not statistically significant (P > 0.05). The GSH-Px activity in the left kidney of the model group was significantly lower than that of the blank group [203.49 (208.21, 144.22) vs 494.91 (431.32, 538.18), P < 0.05); the GSH-Px activity in the left kidney of the experimental group was significantly higher than that of the model group [433.60 (383.86, 504.49) vs 203.49 (208.21, 144.22), P < 0.05). Morphological observation and H&E staining suggest that the formation of right kidney crystals and inflammation in the experimental group are between the blank group and the model group. Conclusion: Lidan Huashi Pills can enhance the serum GSH-Px activity in rats and inhibit the growth of calcium oxalate crystals and inflammatory response in the kidneys, thus playing a role in preventing and treating urinary tract stones.

The Efficacy and Safety of Retrograde Intrarenal Surgery in Elderly Patients: A Propensity Score Matching Study by the RIRSearch Group.

The aim of the study was to evaluate the efficacy and safety of retrograde intrarenal surgery (RIRS) in elderly patients by comparing them with propensity score-matched age-groups. Patients who underwent RIRS to treat upper urinary tract stone disease at seven centers were included in the study and were divided into four groups. The age intervals of the patients in group 1, group 2, group 3, and group 4 were 18-29 years old, 30-49 years old, 50-64 years old, and over 65 years old, respectively. Propensity score matching analysis was used to homogenize the groups in terms of demographic and clinical properties. Operative results, preoperative complications, perioperative complications, postoperative complications, duration of hospitalization time, and stone-free status were compared between groups. A total of 1,017 patients were included in the study. There were 69 (9.9%) patients in group 1, 324 (46.5%) in group 2, 217 (31.1%) in group 3, and 87 (12.5%) in group 4 after propensity score matching. The operation time and postoperative complication rates were significantly different among groups, whereas the hospitalization time, perioperative complication rates, and stone-free status were similar. The operation time was significantly higher in patients over 65 years old (p = 0.001). The postoperative complication rates were significantly higher in group 1 with Clavien I-II complication predominance (p = 0.003). The efficacy and safety of RIRS did not change with aging, and RIRS was an effective option for the treatment of upper urinary system stones in elderly patients.

A Smart Computer Program to Assist Healthcare Providers in Selecting the Best Treatment for Patients with Urinary Stones

Urinary tract stones can obstruct the urinary tract, resulting in severe lower back pain, blood in the urine, vomiting, and painful urination. While small stones can pass naturally through the urine stream, larger ones necessitate fragmentation with shock wave lithotripsy (SWL) or laser ureterorenoscopy (URS) to prevent urinary tract blockage. A smart computer program was developed to predict treatment efficacy and potential complications for individual patients based on factors such as age, health conditions, stone details, and treatment methods, ultimately recommending the most suitable option. Here, I present three case studies and their predicted outcomes.

Zero-echo time MRI: an alternative method for the diagnosis of urinary stones in children.

To evaluate the potential of zero-echo time-magnetic resonance imaging (ZTE-MRI) in the assessment of urolithiasis and compare ZTE-MRI with computed tomography (CT) in pediatric patients. This was a single-center, prospective cross-sectional study conducted between April 2023 and December 2023. 23 patients (12 girls, 11 boys; mean age: 12.3, range 1-18) with urinary tract stones detected on non-enhanced abdominal CT were enrolled. The images were evaluated independently by two radiologists for the presence, and number of stones in the kidneys, ureters, and bladder. In the second session, two radiologists evaluated whether urinary tract stones could be detected by MRI compared to CT, and the maximum diameter of the stones was measured. The CT and MRI results were compared with the Wilcoxon test. The agreement between the results of the observers was examined using Spearman's rho correlation coefficient and the intraclass correlation coefficient. A total of 58 urinary tract stones were detected by CT and 39 of these were detected by MRI. Most of the stones that MRI could not detect were < 5 mm and the detection sensitivity of MRI increased in correlation with stone size (p < 0.001). There was poor intermodality agreement for stones < 5 mm, substantial agreement for stones 5-10 mm, and almost perfect agreement for stones > 10 mm. Interobserver agreement for stone detection on MRI was almost perfect for stones > 10 mm and 5-10 mm and was substantial for stones < 5 mm. ZTE-MRI is a promising modality for detecting urinary stones without radiation exposure in children. Zero-echo time-magnetic resonance imaging is a potential method for identifying urinary stones in children and other populations who are particularly sensitive to radiation. Urinary system stone disease in children is increasing and imaging is needed for managing urolithiasis. Zero-echo time-magnetic resonance imaging (ZTE-MRI) had an accuracy of 81.8% and 93.7% for stones larger than 5 mm and 10 mm, respectively. ZTE-MRI is a potential non-irradiating method for the diagnosis and management of urolithiasis.

Pancake kidney – a rare form of renal malformation in a 7-year-old girl. A case report and a literature review

Renal ectopia and renal fusion belong to a group of congenital anomalies of the kidney and urinary tract that mostly remain asymptomatic and are diagnosed incidentally. Patients with congenital renal anomalies are prone to urinary tract infections and stone formation, and ultimately more likely to develop chronic kidney disease. Pancake kidney is one of the rarest types of renal anomaly, with complete fusion of the superior and inferior poles as well as the middle parts of both kidneys in the pelvic cavity into a pancake-like mass. Imaging studies play a key role in the diagnosis of this anomaly. We present a case of a girl diagnosed with pancake kidney at the age of 8 years. The patient did not present with any alarming symptoms and the suspicion of renal malformation was raised after an abdominal ultrasound, which shew that the left kidney was missing from its typical location. Ultimately, computed tomography allowed for precise imaging of the urinary tract and establishing the diagnosis.

Impact of previously failed extracorporeal shock wave lithotripsy on ureterorenoscopy outcomes in upper urinary tract stones: a prospective comparative study.

We sought to prospectively evaluate the impact of previously failed SWL on subsequent URS outcomes in the treatment of upper urinary tract stones. Between May 2021 and May 2023, one hundred thirty-six patients with proximal ureteral stones < 1.5cm and renal stones < 2.5cm who were candidates for URS were prospectively assigned to a non-SWL group, which included patients without a history of failed SWL before URS, and a post-SWL group, which included patients with a history of failed SWL before URS. The success rate was the primary outcome. The perioperative data of the two groups were compared. The stone-free rate was 83.3% in the post-SWL group versus 81.3% in the non-SWL group, and 8.3% in the post-SWL group versus 9.4% in the non-SWL group had clinically insignificant residual fragments. There was no significant difference in the stone-free rate or success rate between the groups. No significant differences in intraoperative fluoroscopy time, operative time, intraoperative stone appearance, perioperative complications, or the presence of embedded fragments in the ureteral mucosa were detected between the two groups. Compared with patients who underwent primary URS, patients who underwent salvage URS for upper urinary tract stones had similar stone-free rates, success rates, operative times, fluoroscopy times, and complication rates without any significant differences.

Development and validation of a predictive model for double-J stent encrustation after upper urinary tract calculi surgery

The study is aimed to establish a predictive model of double-J stent encrustation after upper urinary tract calculi surgery. We collected the clinical data of 561 patients with indwelling double-J tubes admitted to a hospital in Shandong Province from January 2019 to December 2020 as the modeling group and 241 cases of indwelling double-J tubes from January 2021 to January 2022 as the verification group. Univariate and binary logistic regression analyses were used to explore risk factors, the risk prediction equation was established, and the receiver operating characteristic (ROC) curve analysis model was used for prediction. In this study, 104 of the 561 patients developed double-J stent encrustation, with an incidence rate of 18.5%. We finally screened out BMI (body mass index) > 23.9 (OR = 1.648), preoperative urine routine white blood cell quantification (OR = 1.149), double-J tube insertion time (OR = 1.566), postoperative water consumption did not reach 2000 ml/d (OR = 8.514), a total of four factors build a risk prediction model. From the ROC curve analysis, the area under the curve (AUC) was 0.844, and the maximum Oden index was 0.579. At this time, the sensitivity was 0.735 and the specificity was 0.844. The research established in this study has a high predictive value for the occurrence of double-J stent encrustation in the double-J tube after upper urinary tract stone surgery, which provides a basis for the prevention and treatment of double-J stent encrustation.

Tip bendable suction ureteral access sheath versus traditional sheath in retrograde intrarenal stone surgery: an international multicentre, randomized, parallel group, superiority study

Retrograde intrarenal surgery (RIRS) is the main treatments for upper urinary tract stones. The Ureteral Access Sheath (UAS) serves as a supplementary tool, facilitating direct kidney access during RIRS. High quality of evidence comparing tip bendable suction ureteral access sheath (S-UAS) with traditional UAS in RIRS for the treatment of renal and ureteral stones is lacking. The purpose of the study is to compare the efficacy and safety of S-UAS with traditional UAS in RIRS for the treatment of renal or ureteral stones ≤30mm. An international, multicenter, and superiority randomized controlled trial included 320 intention-to-treat patients across 8 medical centers in China, the Philippines, Malaysia and Turkey from August 2023 to February 2024. The inclusion criteria were patients ≥18 years old with renal or ureteral stones ≤30mm. RIRS was performed using either S-UAS or traditional UAS. The primary outcome was the immediately stone-free rate (SFR). Secondary outcomes included SFR 3 months after operation, operating time, hospital stay, auxiliary procedures, complications (using the Clavien-Dindo grading system), and improvement in the Quality of Life (QoL) score. Differences between proportions [risk difference (RD)]/means [mean difference (MD)] and 95% confidence intervals (CI) were presented. This study is registered at ClinicalTrials.gov: NCT05952635. The S-UAS group demonstrated a significantly higher immediately SFR (81.3% versus 49.4%; RD 31.9%; 95% CI 22.5%-41.7%; p=0.004) compared to the traditional UAS group, as determined by the one-side superiority test. Additionally, the S-UAS group exhibited a higher SFR at 3 months post-operation (87.5% versus 70.0%; RD 17.5%; 95% CI 8.7%-26.3%; p<0.001), lower postoperative fever rate (RD-11.9%; 95% CI-18.7% to-4.9%; p<0.001), reduced use of stone baskets (RD-70.6%; 95% CI-77.8% to-63.5%; p<0.001), and better QoL improvement (MD 7.25; 95% CI 2.21-12.29; p=0.005). No statistically significant differences were observed in operation time, hospital stay, or the need for second-stage RIRS. In RIRS for upper urinary tract stones ≤30mm, S-UAS exhibited superior performance compared to traditional UAS, demonstrating higher SFR, reduced postoperative fever rate, and improved QoL outcomes. S-UAS emerges as a prudent and advantageous alternative to traditional UAS for RIRS. National Natural Science Foundation of China and Guangdong Province, and Zhejiang Medicine and Health Program.

Inflammatory factors and the risk of urolithiasis: a bidirectional Mendelian randomization study.

Urolithiasis is a prevalent condition encountered in urology. Over the past decade, its global incidence has been on an upward trajectory; paired with a high recurrence rate, this presents considerable health and economic burdens. Although inflammatory factors are pivotal in the onset and progression of urolithiasis, their causal linkages remain elusive. Mendelian randomization (MR) is predicated upon genome-wide association studies (GWASs). It integrates bioinformatics analyses to reveal causal relationships between exposures and outcomes, rendering it an effective method with minimized bias. Drawing from a publicly accessible GWAS meta-analysis comprising 8,293 samples, we identified 41 genetic variations associated with inflammatory cytokines as instrumental variables. Outcome data on upper urinary tract stones, which included renal and ureteral stones (9,713 cases and 366,693 controls), and lower urinary tract stones, including bladder and urethral stones (1,398 cases and 366,693 controls), were derived from the FinnGen Consortium R9 dataset. By leveraging the bidirectional MR methodology, we aimed to decipher the causal interplay between inflammatory markers and urolithiasis. Our study comprehensively elucidated the association between genetic inflammatory markers and urolithiasis via bidirectional Mendelian randomization. Post-MR analysis of the 41 genetic inflammation markers revealed that elevated levels of circulating interleukin-2 (IL-2) (OR = 0.921, 95% CI = 0.848-0.999) suggest a reduced risk for renal stone disease, while heightened stem cell growth factor beta (SCGF-β) (OR = 1.150, 95% CI = 1.009-1.310) and diminished macrophage inflammatory protein 1 beta (MIP-1β) (OR = 0.863, 95% CI = 0.779-0.956) levels suggest an augmented risk for lower urinary tract stones. Furthermore, renal stone disease appeared to elevate IL-2 (β = 0.145, 95% CI = 0.013-0.276) and cutaneous T cell-attracting chemokine (CTACK) (β = 0.145, 95% CI = 0.013-0.276) levels in the bloodstream, whereas lower urinary tract stones were linked to a surge in interleukin-5 (IL-5) (β = 0.142, 95% CI = 0.057-0.226), interleukin-7 (IL-7) (β = 0.108, 95% CI = 0.024-0.192), interleukin-8 (IL-8) (β = 0.127, 95% CI = 0.044-0.210), growth regulated oncogene alpha (GRO-α) (β = 0.086, 95% CI = 0.004-0.169), monokine induced by interferon-gamma (MIG) (β = 0.099, 95% CI = 0.008-0.191) and macrophage inflammatory protein 1 alpha (MIP-1α) (β = 0.126, 95% CI = 0.044-0.208) levels. These discoveries intimate the instrumental role of IL-2 in the onset and progression of upper urinary tract stones. SCGF-β and MIP-1β influence the development of lower urinary tract stones. Urolithiasis also impacts the expression of cytokines such as IL-2, CTACK, IL-5, IL-7, IL-8, GRO-α, MIG, and MIP-1α. There is a pressing need for further investigation to ascertain whether these biomarkers can be harnessed to prevent or treat urolithiasis.

Association between heat and upper urinary tract stones morbidity and medical costs: A study in the subtropical humid climate zone

Urolithiasis is a heat-specific disease. Exploring heat-related urolithiasis susceptibility subtypes, economic burden, and modifying factors could assist governments in targeting interventions to reduce the heat-related health risks of urolithiasis morbidity. We collected data on 23,492 patients with upper urinary tract stones (main subtypes of urolithiasis) from 2013 to 2017 in Nanjing, China. We adopted generalized additive quasi-Poisson models to examine the associations between daily mean temperatures and morbidity of upper urinary tract stones, while generalized additive Gaussian models were used to explore the relationships between temperatures and log-transformed medical costs. We examined the modification effects of disease subtypes (kidney and ureteral calculus), sex, and age through stratified analyses and the modification effects of other meteorological factors by introducing interaction terms in the models. We found that short-term summer heat exposure has a statistically significant effect on ureteral calculus morbidity but not on kidney calculus morbidity. For ureter calculus, a 1 °C temperature increase was associated with a 4.36% (95% confidence interval [CI]: 1.94%, 6.83%) increase in daily hospitalization and a 5.44% (95% CI: 2.71%, 8.25%) increase in daily medical costs. The attributable fraction associated with heat (greater than the median value of daily mean temperature, 26.8 °C) was 7.85% (95% empirical confidence interval [eCI]: 3.64%, 11.44%) for hospitalization and 9.36% (95% eCI: 4.91%, 13.14%) for medical costs. The effects of heat on ureter calculus morbidity were significantly higher among the males and those with high sunshine duration than females and those with low sunshine duration. Short-term summer heat exposure was associated with increased morbidity and medical costs of ureteral calculus. Relevant government organizations should take effective intervention measures, including community health education, to reduce the health hazards and economic losses caused by heat.

Досвід лікування конкрементів сечовидільних шляхів у дітей

Aim - to analyze the treatment of children with urolithiasis (urolithiasis), taking into account the location of stones in the urinary tract, their size and density, to select further individual patient management tactics. Materials and methods. The study included 48 patients with single urinary tract stones aged 6 months to 18 years. X-ray structural analysis and determination of the chemical composition was carried out with 39 stone fragments. Results. In 5 (10.4%) patients with calculi in the distal part of the ureter up to 5 mm in size, medical expulsive therapy was started. 17 (35.4%) patients with kidney and ureter calculi measuring 6-14 mm and density up to 900 HU underwent extracorporeal shock wave lithotripsy. In 3 (6.3%) patients with kidney and ureter calculi 6-14 mm in size and with a density of more than 900 HU, ureterorenoscopy (URS) and extraction using a Dormia basket or forceps to capture fragments were performed. 20 (41.7%) children with kidney stones larger than 15 mm or density greater than 1200 HU underwent contact lithotripsy. Contact endovesical lithotripsy was performed in 2 (4.2%) patients with massive calculi in the urinary bladder who underwent cystoplasty for an exstrophy-epispadias malformation. Results of X-ray structural stones analysis: calcium oxalate (wevelite, wedelite) - 31 (79.5%), calcium phosphate (hydroxyapatite) - 5 (12.8%), brushite - 2 (5.1%), cystine - 1 (2.6%). Conclusions. Modern minimally invasive technologies make it possible to remove calculi of any density and localization from the urinary system in a minimally traumatic, effective and sufficiently safe manner, regardless of the age of the child. In the treatment of urolithiasis in children, it is advisable to follow a personalized approach with the step-by-step use of the optimal arsenal of means to remove the stone. The research was carried out in accordance with the principles of the Helsinki declaration. The study protocol was approved by the local ethics committee of the listed institution. Informed consent of children and their parents was obtained for the research. No conflict of interest was declared by the authors.

Advancements in Urolithiasis Treatment: Current Strategies, Future Challenges, and Integrating Traditional Wisdom into Modern Medicine:A Review

Urolithiasis, the formation of urinary tract stones, remains a prevalent and painful condition that affects millions of individuals worldwide. This article explores the current treatment strategies for urolithiasis, including minimally invasive procedures, dietary modifications, and pharmacological interventions. We also address the ongoing challenges in managing this condition, such as the high recurrence rates and potential complications. Looking to the future, we examine the prospects for innovative technologies, including targeted drug delivery and personalized medicine approaches, to enhance urolithiasis treatment. Furthermore, we discuss the promising potential of integrating traditional knowledge and remedies from various cultures into the modern medical system. This integration not only offers new avenues for preventive and curative therapies but also underscores the importance of preserving and respecting the wisdom of traditional healing practices. By exploring both established and emerging treatment options and considering the implementation of traditional knowledge, this article provides a comprehensive overview of the current state of urolithiasis management, future challenges, and potential solutions. It emphasizes the need for a holistic approach that combines the best of modern medicine with the insights of traditional healing systems to improve the quality of care for urolithiasis patients.

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.

Analysis of Risk Factors for Urinary Tract Infections in Pregnant Women: A Retrospective Study.

Urinary tract infections (UTIs) are the most common bacterial infection during pregnancy. This study aimed to investigate the risk factors of UTI during pregnancy. In this study, pregnant women who underwent prenatal examination in our hospital from October 2019 to October 2023 were divided into UTI group and non-UTI group in accordance with whether or not they had a UTI. The general data, clinical data and laboratory indicators of the participants were collected. Multivariate logistic regression was used to analyse the influencing factors of UTI in pregnant women, and the results were shown with odds ratio (OR) and 95% confidence interval (95% CI). A total of 600 pregnant women were included in the study. The results found that 56 women (9.33%) had a combined UTI. The results of midstream urinary bacterial culture in the UTI group showed that Gram-negative bacteria accounted for 60.71% of all detected pathogenic bacteria, and Escherichia coli and Staphylococcus aureus were common strains, accounting for 46.43% and 23.21%, respectively. The proportions of patients in the UTI group who were ≥35 years old, had a high school education or below, had a history of abortion, had gestational diabetes, had ≥three vaginal and anal examinations, had a history of UTI and had urinary tract stones were significantly higher than the non-UTI group (p < 0.05). Multivariate logistic regression analysis showed that age ≥35 years (OR = 9.127; 95% CI: 4.668-17.810; p < 0.001), educational level of high school or lower (OR = 4.184; 95% CI: 2.448-7.160; p < 0.001), gestational diabetes (OR = 3.494; 95% CI: 1.789-6.803; p < 0.001), UTI history (OR = 2.074; 95% CI: 1.114-3.834; p < 0.001) and haemoglobin (Hb) <100 g/L (OR = 8.022; 95% CI: 4.532-14.325; p < 0.001) are risk factors for UTI in pregnant women. The common pathogenic bacteria of pregnant women with UTI are mainly Gram-negative bacteria. Older pregnant women, low educational level, gestational diabetes mellitus, history of UTI and anaemia may be risk factors for UTI in pregnant women.

Differences in Clinical Outcomes between One-Stage and Staged Flexible Ureteroscopy for the Treatment of Upper Urinary Tract Stones.

Upper urinary tract stones (UUTSs) are among the most common types of urinary stones, and their incidence rate has been increasing annually in recent years, seriously affecting the daily lives of patients. This study aimed to compare the treatment efficacy of one-stage and staged flexible ureteroscopic lithotripsy (FURL) for UUTSs. A total of 142 patients with UUTSs admitted to our hospital between December 2019 and March 2023 were selected for retrospective analysis, including 76 patients who received staged FURL (control group) and 66 patients who received one-stage FURL (observation group). The duration of surgery, length of stay, stone clearance rate, incidence of postoperative complications (from postsurgery to discharge), and total hospitalization cost were analyzed in both groups. The visual analog scale (VAS) score and activities of daily living (ADL) score were assessed before surgery (T0), 3 days after surgery (T1), and 7 days after surgery (T2). Patients were followed up for 1 month after surgery, and their quality of life was assessed using the MOS Item Short Form Health Survey (SF-36). There was no difference in the stone clearance rate or incidence of postoperative complications between the two groups (p > 0.05). The operation time, hospitalization time and hospitalization cost in the observation group were 75.58 ± 15.91 min, 4.20 ± 1.24 days and 14312.62 ± 1078.89 yuan, respectively, which were lower than those in the control group (p < 0.05). In addition, the VAS score at T3 was decreased to 1.49 ± 0.70, while the ADL and SF-36 scores were higher in the observation group (p < 0.05). One-stage FURL shortens the duration of surgery and length of stay, reduces hospitalization costs, and improves the quality of life of patients with UUTSs.

Endoscopic combined intrarenal surgery versus percutaneuos nephrolithotomy for complex pediatric stone disease: A comparative analysis of efficacy and safety

INTRODUCTIONDecision-making for complex pediatric urinary system stone disease is still a challenge for pediatric urologists. The interest in supine percutaneous nephrolithotomy (PCNL) is increasing among centers to achieve high surgical success rates with less morbidity. Despite advanced retrograde intrarenal surgery armamentarium, percutaneous approaches remain the first-line surgical treatment modality for >2 cm and complex renal stones. There are no comparative studies yet in the literature for pediatric endoscopic combined intrarenal surgery (ECIRS) OBJECTIVEIn this study, we aimed to contribute to the literature by evaluating the safety and efficacy of ECIRS by comparing it with PCNL. STUDY DESIGNPatients under 18 years of age who underwent PCNL and ECIRS for urinary tract stone disease at our Pediatric Urology department between 2012 and 2024 were included. Preoperative (demographic characteristics, stone characteristics, biochemical parameters), perioperative (duration of surgery, number of accesses, lasing and fluoroscopy times, endoscopic and fluoroscopic stone-free rates) and postoperative (hospital stay, urinary tract infection, complication and radiological stone-free rates) parameters were retrospectively evaluated. RESULTSA total of 68 children [28 (41%) girls and 40 (59%) boys] aged 5 (0-17) years were included in the study. ECIRS was performed in 19 (28%), supine in 28 (41%) and prone PCNL in 21 (30%) patients. Age (p = 0.029), Guy's stone score (p<0.001), S.T.O.N.E. (p<0.001), and Seoul National University Renal Stone Complexity (S-ReSC) scores (p=0.001) for preoperative parameters were found to be higher in ECIRS group over both PCNL methods (Summary Table). However, Clinical Research Office of the Endourological Society (CROES) score was seen lower for ECIRS group patients compared to other groups (p=0.028).Surgery time (in favor of supine over prone PCNL), fluoroscopy time (in favor of ECIRS and Supine PCNL over Prone PCNL), preferred laser type (prone PCNL group was mostly performed with holmium laser, whereas other groups were balanced between Holmium and Thulium Fiber Laser) and exit strategy (the preferred exit strategy was DJ Stent in most of the ECIRS patients, whereas nephrostomy tube was used in some of the PCNL group) showed significant difference among the groups as perioperative parameters (p=0.042, <0.001, <0.001, <0.001, respectively). Surgery time was lower for supine PCNL compared to prone PCNL. For postoperative parameters, stone-free rates, complication rates and urinary tract infections were similar between the 3 groups, while a difference was detected in terms of length of hospital stay in favor of ECIRS over both supine and prone PCNL (p = 0.006). DISCUSSIONThe current trial suggests that stone-free and complication rates of ECIRS and supine PCNL were similar in the pediatric complex stone patients. Although, the stones in the ECIRS group we found to be more complex. Also, ECIRS was superior to PCNL in terms of fluoroscopy exposure and hospital stay. CONCLUSIONWith the widespread use of new generation ureteral access sheaths and flexible ureterorenoscopes, ECIRS may have an important role in treatment of complex pediatric kidney stones.

Utility of the modified 5-item frailty index as a predictor of postoperative febrile urinary tract infection in patients who underwent ureteroscopy with laser lithotripsy

PurposeThis study aimed to assess the effect of the modified 5-item frailty index on perioperative complications and surgical outcomes in patients who underwent ureteroscopy with laser lithotripsy for upper urinary tract stones.MethodsPatients who underwent ureteroscopy with laser lithotripsy for upper urinary tract stones between 2019 and 2022 were reviewed retrospectively. Assessment was performed using the modified 5-item frailty index based on medical history (hypertension, diabetes, heart failure, chronic obstructive pulmonary disease) and functional status. Patients were categorized into the high (≥ 2) and low (≤ 1) modified 5-item frailty index groups based on the frailty score. We compared the perioperative complications and surgical outcomes between the two groups.ResultsSeventy-one (15.8%) and 393 (84.1%) of the 467 patients were classified into the high and low modified 5-item frailty index groups, respectively. The high modified 5-item frailty index group exhibited a significant association with increased febrile urinary tract infections compared to the low modified 5-item frailty index group [≥ 37.8 °C: 15 (20.3%) vs 13 (3.3%), p < 0.001; ≥ 38 °C: 9 (12.2%) vs 7 (1.8%), p < 0.001]. Surgical outcomes, including operative time and stone-free rate, did not differ significantly between the two groups.ConclusionThe modified 5-item frailty index is valuable for predicting postoperative complications, particularly febrile urinary tract infections, after ureteroscopy with laser lithotripsy for upper urinary tract stones. This index allows for practical preoperative risk assessment in patients who underwent ureteroscopy with laser lithotripsy.

Dynamic renal scans as a modality for follow-up of flexible ureteroscopy.

To determine whether dynamic renal scans - DTPA or MAG3 - routinely performed after flexible ureteroscopies (f-URS) could detect the development of an obstruction and thus promote prompt early intervention for kidney preservation. In this retrospective study, with all the data recorded prospectively between April 2010 and October 2023, 250 renal units in 242 patients with upper urinary tract stones (UUTS) who underwent ureterorenoscopy by one surgeon in the same medical center were evaluated. Stone-free rate (SFR) was defined as no residual fragments at all using an intraoperative "triple test". The following characteristics were examined: gender, BMI, age, Hounsfield unit, stone diameter, laterality, renal/ureteral stones, stone-free rate, and auxiliary procedures per renal unit. The Clavien-Dindo classification was used to report complications. Renal units with residual stones were scheduled for a 2nd f-URS. Post- flexible ureteroscopy ureteral obstruction and renal function were detected using renal scan DTPA or MAG-3. The primary outcome was renal/ ureteral obstruction. The mean patient age was 53 years. The mean stone size was 12.3 mm. Stones in renal pelvis, upper, middle and lower calyces were treated in 9.2% (23), 27.6% (69), and 30.8% (77) of cases, respectively; 44% (110) ureteral stones were also treated. The single- and second-session SFRs were 94.8% and 99.7%, respectively. A third auxiliary procedure was needed in one renal unit (0.4%). The mean number of procedures per renal unit was 1.06 (264/250). Ureteral double-J stents were inserted in 53.6% (134) of the cases. In 37 (14.8%) cases, a stent was placed before surgery. Post-operative complications were minor, with readmission and pain control needed in only two patients (0.8%). No avulsion or perforation of the ureters was observed. In six patients with t1/2 between 10-20 minutes, a second renal scan revealed spontaneous improvement and no obstruction in five patients. One patient with large stones and a history of prior ureteroscopy developed a ureteral stricture (0.4%) and needed treatment with laser endoureterotomy. Post-flexible ureteroscopy obstruction due to ureteral stricture is very rare. A routine renal scan post-operatively may be used in potentially high-risk patients.

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

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

PREVALENCE OF URINARY TRACT STONES IN PATIENTS WITH BENIGN PROSTATIC HYPERPLASIA (BPH) UNDERGOING TRANS URETHRAL RESECTION OF THE PROSTATE (TURP) OPERATION

Objective: This study aims to determine the prevalence of urinary tract stones in BPH patients undergoing TURP surgery. Material &amp; Methods: This research is a descriptive study using secondary data with medical records of BPH patients who underwent TURP at Saiful Anwar General Hospital (RSSA) for the period of 2018 – 2022. Results: From the results of the 169 patient samples BPH undergoing TURP, there were 35 samples, who experienced urinary tract stones. The most frequent incidence of urinary tract stones in patients with BPH at the age of 60 – 70 years of 15 samples (42.90 %), with the highest prostate volume being &gt;50 mL, there are 15 samples (42.90 %), and the location of the most urinary tract stone were in the lower urinary tract with the bladder stone type being 30 samples (85.7%). Conclusion: From the results, it can be concluded that the prevalence of urinary tract stones in BPH patients undergoing TURP surgery is 20.7%, which is an absolute indication for TURP. Keywords: Benign prostatic hyperplasia, urinary tract stone, age, prostate volume.