Treatment Of Urolithiasis Research Articles

Factors associated with success rate of oral force-feeding ammonium chloride administration to acidify urine in goats.

Ammonium chloride is the most common urine acidifier used for urolithiasis treatment and prevention in goats. The objective of this study was to determine a guideline for ammonium chloride administration to acidify urine in goats. A three-period, three-treatment crossover study was conducted in three groups, with 10 female goats in each group. Three dosages of ammonium chloride were used (250, 350, or 450 mg/kg). In each experimental period, ammonium chloride was orally administered for three consecutive days or until the urine pH dropped below 6.5. Urine samples were collected to measure the pH before each administration and 1 day after the last administration. The Cox proportional hazards model was conducted to identify factors associated with the success rate in reducing the urine pH below 6.5 at a time. The dosage of ammonium chloride and period of administration were significantly associated with the success rate (p < 0.001). The success rates during a unit of time for goats receiving 350 mg/kg and 450 mg/kg were greater than that of goats receiving 250 mg/kg. The second and third periods of ammonium chloride administration provided higher success rates during a unit of time compared to the first period. The success rate was also associated with the pretreatment urine pH (p = 0.044). There was a higher success rate for goats with a lower pretreatment urine pH. The recommended ammonium chloride dosage was 350 mg/kg. Periodic use can be considered to achieve better outcomes. The pretreatment urine pH should be measured to anticipate the clinical response.

Management of Pediatric Urolithiasis in an Italian Tertiary Referral Center: A Retrospective Analysis.

Background and Objectives: In recent years, the prevalence of pediatric urolithiasis has increased in North America and Western countries, though it is endemic in developing countries. The aim of this study is to describe the experience of a tertiary pediatric referral center in the surgical management of pediatric urolithiasis. Materials and Methods: We retrospectively reviewed the experience of patients ≤ 16 years old affected by urinary stones who underwent surgery. Results: From April 2021 to September 2023, 31 pediatric patients underwent surgical procedures for stone diseases at our department: 13 preschool-aged (1-5 years) and 18 school-aged (6-16 years) children. During this period, 12 URSs, 17 RIRSs, and 2 PCNLs were recorded. Five patients had residual fragments at first, so three of them underwent a second endourological lithotripsy (2 RIRSs and 1 URS). Complete clearance was finally achieved in 27 patients. The stone composition was evaluated in 25 cases. Conclusions: Numerous innovations in the surgical treatment of pediatric urolithiasis have resulted from the development of smaller devices and new technology. Our results show how, in experienced centers, retrograde and percutaneous lithotripsy are safe and effective procedures for use in pediatric populations.

Analysis, treatment modality and demographic characteristics of urolithiasis patients visiting Korle-Bu Teaching Hospital in Ghana.

Globally urolithiasis is on the rise and gradually becoming a public health concern due to the associated complications. This study reviewed the demographic characteristics, the chemical composition of stones, treatment modality and duration of hospitalisation of urolithiasis patients at Korle-Bu Teaching Hospital, Accra, Ghana. This was a retrospective study conducted between March 2019 and April 2022. Data from consecutive patients treated for urolithiasis were used for this study. Data on demographic characteristics, stones chemical composition, urine factors, urolithiasis treatment modality and duration of hospital stay after therapy were collated and analysed using descriptive and inferential approaches. The age of the patients ranged from 2 to 75 years with a mean of 45 (±13.4). The predominant age group for stone formation was 30-39 years - 52(26.3%). Urolithiasis was common among patients in the formal employment sector: 81(40.9%). All stones had two or more chemical compositions, with the combination of calcium oxalate monohydrate, calcium oxalate dihydrate and uric acid being the predominant stone type: 88(57.5%). Ureteroscopy with semi-rigid and Percutaneous nephrolithotomy were the predominant treatment modalities: 105(53.0%) and 74(37.4%), respectively. Escherichia coli was responsible for most urinary tract infections in urolithiasis patients 8(4.0%) and the least duration of hospital stay after the procedure was associated with the use of semi-rigid ureteroscope as the treatment modality with a median duration of 2 days (1-2 days) with P < 0.0001. Urolithiasis was predominant among professionals in the formal sector. All stones were mixed with Calcium oxalate monohydrate, calcium oxalate dihydrate, and uric acid combination being the majority. Ureteroscopy with semi-rigid and percutaneous nephrolithotomy were the common treatment modality.

Molecular Mechanism of Phytochemicals for the Treatment of Urolithiasis

Molecular Mechanism of Phytochemicals for the Treatment of Urolithiasis

Predictors of febrile urinary tract infection after ureterorenoscopy for urinary stones

Background: Ureterorenoscopy is a frequently used technique for the treatment of urolithiasis which provides high success rates when used under proper indications. Febrile urinary tract infection (FUTI) and urinary sepsis is the most frequent among its scarce complications. It often results secondary to urinary tract obstruction associated with urolithiasis, but also may occur after urinary tract manipulation such as ureterorenoscopy, clinical presentation varies from self-limited fever to the development of septic shock with the need for vasoactive agents or even to the patient’s death. This study has been designed to determine our rate of postoperative FUTI and sepsis after ureterorenoscopy, as well as to identify those factors that have been associated with its development. Method: Prospective study done on 219 patients who underwent ureterorenoscopy for urinary lithiasis in government medical college, Kottayam from February 2021-March 2022. Personal, clinical, surgical and microbiological data were collected. Patients who develop FUTI, urinary sepsis during 30 days following intervention were identified. Statistical analysis will be performed by chi squared test/fishers exact test; logistic regression as appropriate. Results: Our studies show incidence rates of postoperative FUTI in 11% and sepsis in 1.3%. Following statistical analysis, it was discovered that double J urinary diversion, a positive preoperative urine culture, diabetes, prolonged operational time, and intraoperative dilatation were all high-risk factors for the development of UTI after instrumentation. Conclusions: Ureteroscopy-associated urosepsis is a nosocomial infection. With the increasing popularity of ureteroscopic procedures, it is imperative that patients with increased risk are addressed appropriately, and suspected sepsis must be speedily and aggressively managed.

URETERAL STENTING AND URINARY STONE MANAGEMENT : A SYSTEMATIC REVIEW

Introduction: Urolithiasis is a burdensome condition impacting healthcare systems, has seen transformative advancements in ureteroscopy with smaller instruments and laser lithotripsy. While ureteric stenting after ureteroscopy lithotripsy is widely practiced, its necessity in uncomplicated cases remains controversial, with potential complications necessitating further comparative studies for conclusive recommendations. Method: This study followed the 2020 PRISMA guidelines to ensure research alignment with necessary standards for accuracy. Articles were retrieved from databases including PubMed database in November 2023. Result: The search strategy produced a total of 9 results. Upon reviewing the titles and abstracts, we identified 8 papers that met the criteria for inclusion. Initially, 8 articles were excluded from consideration as they were written in a review format. After a thorough evaluation of the full-text papers, we ultimately included five papers in the final analysis, consisting of prospective observational analysis, retrospective studies, and a randomized control trial. Conclusion: Ureteral stents, crucial in urolithiasis treatment, present challenges due to patient discomfort and limited adoption of symptom-reducing strategies, hindered by knowledge gaps and the absence of well-powered trials. Postoperatively, unstented approaches are favored, and the double pigtail stent with an extraction string outperforms standalone stents, offering prompt relief and avoiding additional procedures. In the context of retrograde intrarenal surgery (RIRS) with a ureteral access sheath (UAS), routine preoperative stenting is unnecessary, with no significant impact on stone-free rates (SFR) or complications. Research into an ideal ureteral stent and the resolution of preoperative hydronephrosis after ureteroscopy continues.

Role of Flavonoids in the Treatment of Urolithiasis: A Challenging Herbal Approach

A common condition that puts a huge financial and morbidity burden is kidney stones. Throughout the past 20 years, the frequency of urolithiasis has increased; 5 to 15 % of people globally are affected. Calcium oxalate (CaOx) kidney stones, which form in the renal surfaces, are the most prevalent variety. Several physicochemical processes of urinary stone constituents within tubular cells lead to the complex process of stone generation. Obese people are known to be at an increased risk of developing stones. Nephrolithiasis in women is becoming more common because of metabolic syndrome. Recent years have seen a significant change in the detection and initial treatment of urolithiasis. Calcium oxalate renal stones are the most typical type of stone proclaimed in India. Since medicinal herbs are safer, more efficient, more acceptable culturally, and have fewer side effects than produced pharmaceuticals, they have been used for treatment for millennia. Patients are recommended to follow a low-fat diet and take herbal remedies in addition to fibre from naturally occurring plants. Flavonoids are a type of plant polyphenol that has been linked to several health benefits. Recent research has revealed that plant flavonoids can significantly reduce the formation of kidney stones in vitro and in vivo, which correlates with their anti-inflammatory, antioxidant, diuretic, antibacterial, and other beneficial actions. Thus, the flavonoids or extracts of flavonoid-rich plants associated with anti-urolithiasis activity were evaluated. This article emphasises the use of flavonoid-containing plants or herbs and synthetic medications to cure kidney stones. The epidemiology, mechanism of action, pathophysiology, synthetic and natural treatments for kidney stone development, and ways to reduce stone risks are all covered in this review article.

Comparative analysis of prevalence of metabolic types of urolithiasis in Stavropol Region

Relevance. The treatment and prophylaxis of urolithiasis are one of the urgent problems of modern medicine. In Russia in recent decades a tendency to the increase in urolithiasis prevalence has been noted, and the incidence of urolithiasis varies in different regions. This may be due to lifestyle features and chemical composition of water in different regions of the country.The aim of the study. To analyze the chemical composition of concrements in patients treated for urolithiasis in the Stavropol Region.Methods. Using infrared (IR) spectroscopy 565 concrements were studied. Analysis of the obtained data showed that calcium-oxalate stones were the most common (72.80 %), followed by urate stones (19.40 %) and then phosphate stones (6.09 %). Cystine (0.70 %) and xanthine type stones (0.17 %) are the least common.Conclusions. The preventive measures aimed at restriction of the consumption of food containing high oxalates and purines, as well as use of water low in calcium and with alkaline reaction will decrease the incidence of urolithiasis at the regional level.

Effects of two commercial diets and two supplements on urinary pH in dogs.

Urinary pH manipulation by therapeutic foods or supplements is part of the treatment for urolithiasis. The effectiveness of these diets and supplements should be studied to determine which of these strategies is most effective. To assess the effect of the oral supplementation of potassium citrate, an ammonium chloride solution (Urical) and two dry therapeutic foods-Hill's® Prescription Diet® u/d® Canine (u/d diet) and Royal Canin® Urinary S/O dog (S/O diet)-on a dog's urinary pH at different time points over 8 h. Seven healthy adult male research beagle dogs. A prospective interventional study lasting 31 days. The dogs either received a supplement (potassium citrate or rical) with a dry adult maintenance diet (control diet) or the therapeutic diet (u/d diet or S/O diet). Each treatment had a duration of 2-5 days, with 2- to 4-day washout periods in between. Urinary pH measurements were performed every 2 h between 07h00 and 15h00, with the food being given at 07h00 and 15h00, right after urine collection. The pH measurements obtained in each of the four treatments were compared to control (same dogs fed the control diet exclusively). When compared to the control diet at the same time points, biologically relevant changes in urinary pH (defined as ≥0.5) were: increase with potassium citrate at 7h00 and 13h00; increase with u/d diet at 9h00, 13h00, and 15h00; decrease with S/O diet at 9h00 and 11h00; Urical did not have a detectable effect on urinary pH. The present study confirms that therapeutic foods S/O and u/d, and potassium citrate supplement affected acid-base balance in healthy adult male beagle dogs, with the tested diets being more effective than the administered doses of the tested supplements at influencing urinary pH.

БИОМАРКЕРЫ ОСТРОГО ПОВРЕЖДЕНИЯ ПОЧЕК ПРИ ДИСТАНЦИОННОЙ УДАРНО-ВОЛНОВОЙ ЛИТОТРИПСИИ У ДЕТЕЙ

Despite the fact that remote shock wave lithotripsy is a non-invasive method of surgical treatment of urolithiasis, the issue of diagnosis and possible reduction of the degree of acute kidney injury, the outcome of which is to varying degrees each session, remains relevant. The article represents a bibliographical sources analysis covering an extensive range of modern biomarkers detected in blood and urine tests used to assess the acute kidney injury of various etiologies, including shock wave lithotripsy. The statistical significance, advantages and disadvantages of the described new indicators are analyzed as well as the possibility of their complex application aiming to rather objective assessment of the degree of damage.

Impact of ureteric access sheath use during flexible ureteroscopy: A comparative study on efficacy and safety

ObjectivesThis study evaluates the impact of using an access sheath (AS) during flexible ureteroscopy (fURS) for urolithiasis treatment, focusing on outcomes such as stone-free rate, operation time, and complications. MethodsThis prospective, randomized study was carried out at Badr Hospital, Helwan University, and Ain Shams University hospitals from August 2021 to August 2022. Patients were systematically randomized into two groups (fURS with AS: 33 patients and without AS: 31 patients) and underwent preoperative and postoperative assessments, including lab tests and imaging. Possible procedure-associated risks, such as failed stone access, pain, bleeding, and sepsis, were monitored. ResultsThe two groups were found to be comparable in terms of demographic characteristics or preoperative stone findings (p > 0.05 for all). However, operation duration was shorter in the No Sheath group (79.4 ± 15.3 min vs. 90.4 ± 16.7 min in the Sheath group, p = 0.008). Intraoperative complication rates, including failed access, operation termination, ureteric injury, and bleeding, were comparable in both groups (p > 0.05). Postoperative stone-free rates (78.8% vs. 71.0%, p = 0.305) and mean residual stone size (2.7 ± 3.5 mm vs. 3.1 ± 3.1 mm, p = 0.687) showed no significant differences. ConclusionsThe present study suggests that fURS without an access sheath may offer an efficient and equally effective option for managing upper ureteric and renal stones. However, more studies with larger sample sizes and longer follow-up periods are required to validate these findings and to establish more precise indications for this approach.

Evaluating the anti-urolithiasis potential of Ficus religiosa seed GC MS evaluated phytoconstituents based on their in-vitro antioxidant properties and in-silico ADMET and molecular docking studies

BackgroundUrolithiasis, the deposit of stones in the urinary tract is a pertinent clinical issue in daily practice that imposes a burden on the human health system. Ficus religiosa plant has historically been useful in preventing urolithiasis. There is currently no information on phytochemical profiling that specifies the precise phytochemicals in the seed that are active against urolithiasis.MethodsF. religiosa seeds were extracted with different solvents in increasing order of their polarity by Soxhlet extraction. All the extracts were evaluated for their antioxidant potential. GC–MS profiling of the most potent antioxidant F. religiosa seed extract was done to evaluate the phytoconstituents. To evaluate the pharmacokinetics and drug-likeness properties of these compounds in silico ADMET analysis was done. To comprehend the binding potential of the best ADMET evaluated phytochemicals contained in the F. religiosa seed extract against the several protein targets (matrix metalloproteinases (MMP-2, MMP-9), and Human calcium-sensing receptor (CaSR)) and antioxidant enzymes (Glutathione S-transferase (GST), glutathione-disulfide reductase (GR), glutathione peroxidase (GPX), and superoxide dismutase (SOD)) involved in urolithiasis, multi targets based virtual screening tests were done using Autodock Vina tool.ResultsGC–MS profiling revealed the presence of 53 different compounds. Of all these compounds, based on ADMET analysis 2-Methoxy-4-vinylphenol; 3,5-Di-tert-butylphenol; diethyl benzene-1,2-dicarboxylate; 4-hydroxy-3,5-dimethoxybenzaldehyde; 2-methoxy-4-prop-2-enylphenol; and bis (2-methyl propyl) benzene-1,2-dicarboxylate were found to have best pharmacokinetics and drug-likeness properties. In the autodocking studies, 3,5-Di-tert-butyl phenol is proved to be the best of all in terms of binding energies with the selected targets.ConclusionThe findings of this study suggest a framework for employing F. religiosa seed ethyl acetate extract as a potent herbal treatment for urolithiasis.

A retrospective cohort study, analyzing trends in management of upper urinary tract stones in the adult Israeli population.

To assess trends of surgical intervention in adults with upper urinary tract stones in Israel. A retrospective cohort study utilizing administrative databases held at Clalit Health Services, to identify all adults (⩾18 years) who underwent their first surgical treatment for upper tract urolithiasis. Descriptive statistics were employed to summarize baseline patient demographics and surgical trends were analyzed using the Cochrane-Armitage test for trend. Between 2003 and 2020, 36,624 adult patients were treated surgically for upper tract urinary stones. Mean age was 53.6 years (SD16.1). During the period investigated, the number of insured by Clalit Health Services increased by 25% and the total number of surgically treated stones increased by 98.7%. By type of procedure: Ureteroscopy (URS) increased by 351%, percutaneous nephrolithotripsy (PCNL) increased by 67%, shockwave lithotripsy (SWL) declined by 79%. The number of procedures per 100,000 population grew from to 37.5 in 2003 to 58.05 in 2022. The percentage increase in total number of surgical procedures was 103% and 90% in males and females, respectively. Our findings reveal significant increases in the total number of surgically treated stones over the investigated period. Notably, this increase far outpaced the growth in the number of individuals insured by Clalit Health Services. Further research and interventions are warranted to explore the underlying factors driving these trends and to develop targeted approaches for prevention, early detection, and minimally invasive treatment of upper urinary tract stones in Israel.

Alfuzosin vs. Silodosin in the Improvement of Ureteral Stent-Related Symptoms after Endoscopic Surgical Treatment of Urolithiasis: A Retrospective Comparison

Purpose In this study, we aimed to compare the efficacy of two α-blockers, alfuzosin and silodosin, which have different pharmacological properties despite being uroselective, in the treatment of double-J stent (DJS)-related symptoms. Methodology Fifty-six male patients who underwent DJS implantation and for whom all data were available were included in the study. All patients were asked to complete the validated Turkish version of the Ureteral Stent Symptom Questionnaire (USSQ), international prostate symptom score (IPSS), and international index of erectile function-5 (IIEF-5) the day before stent removal and again one month after stent removal. Statistical analysis of these variables was performed in the groups, and a value of p&lt;0.05 was considered statistically significant. Results Significant decreases in IPSS, IPSS-quality of life, and USSQ scores were observed in both Group A and Group S one month after stent removal compared with before stent removal (p&lt;0.05). Whereas no side effects were observed in the alfuzosin group (Group A), retrograde ejaculation was observed in 8 (25.2%) patients in the silodosin group (Group S) (p=0.006). Furthermore, a statistically significant increase in IIEF-5 score was observed in both groups after stent removal compared with IIEF-5 score with stenting (p&lt;0.05). Conclusion The DJS has a significant impact on patients’ quality of life and should only be used when indicated, not routinely after every endoscopic stone procedure. Considering that silodosin may cause more ejaculation problems than alfuzosin, we believe that both drugs can be used in male patients to resolve DJS-related symptoms.

Объем интраоперационной кровопотери и функциональное состояние почек при различных способах хирургического лечения крупных и сложных камней почек.

Introduction. Despite the development of minimally invasive technological methods for the treatment of urolithiasis, improving the functional state of the kidneys in the postoperative period does not lose its importance at the present time. The decrease and loss of renal function after surgical treatment of complex forms of nephrolithiasis in various ways creates the problem of choosing one or another surgical technique in order to avoid negative results of surgical treatment. modern urology. Purpose of the work: to assess the correlation between the volume of intraoperative blood loss and dynamic changes in glomerular filtration rate (GFR) in the postoperative period with various methods of surgical treatment of large and complex kidney stones. Purpose: to assess the correlation between the volume of intraoperative blood loss and dynamic changes in the GFR in the postoperative period with various methods of surgical treatment of large and complex kidney stones. Materials and methods. The study selected data from 97 patients with urolithiasis, large and complex kidney stones of the urological department of the city hospital No 2 of the city of Nur-Sultan of the Republic of Kazakhstan. The median age was 52 (23–73) years. The average area of a kidney stone was 428.3±36.1 mm2, its average density according to Hounsfield was 1042.9±34.8 HU. All patients were divided into 3 cohort comparison groups according to the method of surgical treatment: percutaneous nephrolithotripsy (PCNL) on prone position (1 group) – 44 patients (45.4%), PCNL on the supine position (2 group) – 29 patients (29.9%), laparoscopic pyelolithotomy (3 group)– 24 patients (24.7%). The median baseline GFR in the 1 group was 91 ml/min/1.73 m2, in the 2 group 95 ml/min/1.73 m2, in the 3 group 101 ml/min/1.73 m2. The average duration of surgical intervention for 1 group was 92.8±6.8 min, for 2 group – 119.6±10.9 min, for 3 group-146.9 ± 6.1 min. The mean blood loss in 1 group was 144.5±9.1 ml, in 2 group 235.3±19.1 ml, in 3 group 43.1±5.2 ml. Results. A decrease in GFR below 60 (ml/min/1.73 m2), corresponding to stage III of chronic kidney disease (CKD), was most pronounced in the 2 group: from 3 (3.1%) cases before surgery to 7 (7.2%) cases in postoperative period. A decrease in GFR below 30 (ml/min/1.73 m2), which corresponds to stage IV CKD, also had negative dynamics in the group of patients with 2 group: from 2 (2.1%) to 3 (3.1%) cases respectively. In the rest of the studied groups, there was no negative dynamics of GFR. A correlation was found between GFR in the postoperative period and intraoperative blood loss (r = 0.410, p&lt;0.001). Conclusions. Surgical treatment of urolithiasis of the kidneys is associated with risks of intraoperative blood loss, the volume of which directly correlates with the deterioration of the functional state of the kidneys in the postoperative period. Reducing the volume of intraoperative blood loss in various surgical methods for the treatment of urolithiasis helps to minimize the risk of developing acute kidney injury in the postoperative period.

Кристаллообразующая активность мочи и методы ее измерения.

ntroduction. Diagnosis and determination of treatment tactics in patients with urolithiasis are based on determining the causes of lithogenesis. At the moment, the standard of examination in patients at high risk of recurrence of urolithiasis is the detection of metabolic disorders based on the results of a biochemical analysis of blood and daily urine, as well as an assessment of the chemical composition of the urinary stone. The violations determined using this approach are a manifestation of the physico-chemical processes of stone formation, the assessment of which is currently practically not performed by urologists, due to the lack of simple diagnostic methods and tools. Materials and methods. The review was conducted on the basis of data published in PubMed databases (https://www.ncbi.nlm.nih.gov/pubmed) and Scientific Electronic Library еLibrary.ru (https://elibrary.ru/), and was limited only to articles in scientific peer-reviewed journals. The search was devoted to the study of the crystal-forming activity of urine, factors affecting the lithogenic properties of urine, as well as methods for assessing the risk of stone formation in the most common metabolic types of urolithiasis. We found 189 sources no older than 10 years (published after 2012) that were relevant to the topic of the review. Conference abstracts, short messages, duplicate publications wereexcluded from them. After that, based on the relevance of the data, reliability of sources, impact factors of journals and the sequence of presentation of the material in the manuscript, 41 articles were selected directly for citation in the review. Also, when writing the review, original articles published before 2012 were used. Results. The analyzed literature sources demonstrated a large number of methods for determining the crystallization properties of urine. However, none of them, in view of the complexity, as well as the ambiguity of the results obtained, have not been widely introduced into clinical practice. In view of this, it is required to develop a simple and informative method for diagnosing the crystal-forming properties of urine, which will increase the percentage of non-reactive urolithiasis. Conclusions. The methods available to doctors for determining the crystal-forming properties of urine are extremely laborious. The development of an easy-to-use and sufficiently accurate real-time determination of the crystallization and anti-crystallization properties of urine, will significantly improve the diagnosis, treatment and metaphylaxis of urolithiasis.

Experience of high polymer gel pad assisted ultrasound monitoring in the treatment of infant urolithiasis during extracorporeal shock wave lithotripsy.

In the extracorporeal shock wave lithotripsy for infants, we used a medical polymer gel pad to assist ultrasonic positioning, so that the ultrasonic probe could be far away from the shock wave energy field. Although not affecting the ultrasonic positioning and monitoring effect, we discussed the protective effect of this method on the ultrasonic probe. A retrospective analysis was made on 21 infants (0-3years old) who received ESWL in our hospital from June 2021 to February 2023. After the stones were accurately located by B-ultrasound before surgery, a 4 * 5 * 10cm medical polymer gel pad was placed between the skin and the ultrasonic probe to keep the ultrasonic probe away from the shock wave energy field. The B-ultrasonic wave source locked the target stone through the gel pad, and the lithotripter Dornier Compact Delta II was used for lithotripsy. The extracorporeal shock wave lithotripsy was completed under the whole process of B-ultrasonic monitoring. All patients completed the surgery under ultrasound monitoring, and there were no abnormalities in the ultrasound probe during the surgery. The average stone size was 0.60 ± 0.21cm, the surgical time was 39.8 ± 13.8min, and the total energy of lithotripsy was 7.41 ± 4.35J. There were no obvious complications in all patients after the surgery. After 2weeks of ultrasound examination, the success rate of lithotripsy in 21 patients reached 85.7%. We believe that the use of the gel pad increases the distance between the ultrasonic probe and the skin, leaving the probe away from the shock wave energy field, avoiding the damage of the shock wave source to the ultrasonic probe, and does not affect the monitoring effect of ultrasound on stones and the success rate of lithotripsy, which is worthy of further promotion in the field of children's urinary stones.

Impacto del uso de la vaina de acceso ureteral durante la ureteroscopia flexible: estudio comparativo de eficacia y seguridad

ObjectivesThis study evaluates the impact of using an access sheath (AS) during flexible ureteroscopy (fURS) for urolithiasis treatment, focusing on outcomes such as stone-free rate, operation time, and complications. MethodsThis prospective, randomized study was carried out at Badr Hospital, Helwan University, and Ain Shams University hospitals from August 2021 to August 2022. Patients were systematically randomized into two groups (fURS with AS: 33 patients and without AS: 31 patients) and underwent preoperative and postoperative assessments, including lab tests and imaging. Possible procedure-associated risks, such as failed stone access, pain, bleeding, and sepsis, were monitored. ResultsThe two groups were found to be comparable in terms of demographic characteristics or preoperative stone findings (P>.05 for all). However, operation duration was shorter in the No Sheath group (79.4±15.3minutes vs. 90.4±16.7minutes in the Sheath group, P=.008). Intraoperative complication rates, including failed access, operation termination, ureteric injury, and bleeding, were comparable in both groups (P>.05). Postoperative stone-free rates (78.8% vs. 71.0%, P=.305) and mean residual stone size (2.7±3.5mm vs. 3.1±3.1mm, P=.687) showed no significant differences. ConclusionsThe present study suggests that fURS without an access sheath may offer an efficient and equally effective option for managing upper ureteric and renal stones. However, more studies with larger sample sizes and longer follow-up periods are required to validate these findings and to establish more precise indications for this approach.

Identification of Two Clusters in Renal Pelvis Urobiome of Unilateral Stone Formers Using 2bRAD-M.

Urolithiasis is a common urological disease with increasing incidence and a high recurrence rate, whose etiology is not fully understood. The application of sequencing and culturomics has revealed that urolithiasis is closely related to the urinary microbiome (urobiome), shedding new light on the pathogenesis of stone formation. In this study, we recruited 30 patients with unilateral stones and collected their renal pelvis urine from both sides. Then, we performed 2bRAD-M, a novel sequencing technique that provides precise microbial identification at the species level, to characterize the renal pelvis urobiome of unilateral stone formers in the both sides. We first found that the urobiome in the stone side could be divided into two clusters (Stone1 and Stone2) based on distance algorithms. Stone2 harbored higher microbial richness and diversity compared to Stone1. The genera Cupriavidus and Sphingomonas were overrepresented in Stone1, whereas Acinetobacter and Pseudomonas were overrepresented in Stone2. Meanwhile, differential species were identified between Stone1 and Stone2. We further constructed a random forest model to discriminate two clusters which achieved a powerful diagnostic potential. Moreover, the urobiome of the non-stone side (Control1/2) was compared with that of the stone side (Stone1/2). Stone1 and Control1 showed different microbial community distributions, while Stone2 was similar to Control2 based on diversity analysis. We also identified differentially abundant species among all groups. We assumed that there might be different mechanisms of how microbiota contribute to stone formation in two clusters. Our findings might assist in the selection of suitable medical treatments for urolithiasis.

Ureteroneocystostomy for treatment of struvite urolithiasis in a ferret.

To assess the clinical outcome of a ferret undergoing a ureteroneocystostomy for treatment of urolithiasis. A 10-month-old spayed female ferret. The ferret was evaluated for straining to urinate and defecate, hematochezia, and a rectal prolapse. Plain radiographs revealed large cystic and ureteral calculi. Clinicopathologic analyses indicated the ferret was anemic with an elevated creatinine concentration. Exploratory laparotomy defined bilateral ureteral calculi that were unable to be successfully moved into the bladder. A cystotomy was performed to remove a large cystic calculus. Serial abdominal ultrasonographic examinations showed progressive hydronephrosis of the left kidney and persistent pyelectasia of the right kidney secondary to bilateral ureteral calculi. This confirmed a left ureteral obstruction secondary to the distal calculus while the right ureter remained patent. A ureteroneocystostomy was performed to allow for left renal decompression. The ferret recovered well despite worsening hydronephrosis of the left kidney in the perioperative period. The ferret was discharged from the hospital 10 days after initial evaluation. At 3-week follow-up, abdominal ultrasonography confirmed resolution of hydronephrosis and ureteral dilation of the left kidney and ureter. A ureteroneocystostomy successfully allowed renal decompression and ureteral patency in a ferret with urolithiasis. To the authors' knowledge, this is the first time this procedure has been reported in a ferret for treatment of a ureteral calculus obstruction and may result in good long-term outcome.