Types Of Stones Research Articles

한반도 중부지역 고구려 석실분의 고고학적 함의

Koguryo tomb is the empirical data that Koguryo occupied the central Korean Peninsula. The tomb of Koguryo's stone chamber excavated from the central Korean Peninsula, was left by Koguryo residents of the time. In that the central Korean Peninsula is the newly incorporated Koguryo territory, it was expected that stone chambered tombs hereand were possible other interpretation from Koguryo tombs in North Korea or northeastern China. So, this article tried to set the type of Koguryo stone chambered tombs in the central Korean Peninsula and find the archaeological implications inherent in the stone chambered tomb’s type. The types of Koguryo stone chambered tombs are divided based on the chamber planar plan and constructin skill. Since the rectangle tomb’s chamber was wide distribution in the central Korean Peninsula, it can be seen that information about the tomb’s chamber planr planar is shared among the inhabitants of the newly incorporated Koguryo realm. And the construction skill was divided into Koguryo style, localized Koguryo style, and non-Koguryo style, so it can be interpreted the difference of the groups that built tomb’s chambers. Therefore the diversity of tomb’s types suggests that the inhabitants of newly occupied Koguryo was diverse. From these, it can be seen that the spread of residents of Koguryo in the central Korean Peninsula took place in two steps proceeding. The first spread of southward took place between the end of the 4th century and the beginning of the 5th century, and the center of inhabitants was the Chuncheon area of the Bukhan River basin. The second was took place at the end of the 5th century following the invasion of Hanseong, and the descendants of the first Koguryo residents north of the Han River or the native incoporated Koguryo residents, spread along the Han River to various places. Therefore, judging from the aspects of Koguryo tomb’s types, the main bases of Koguryo's southern control can be said to be Chuncheon, Yongin in the southern inland of Gyeonggi-do, and Chungju in the Namhan River basin.

Risk Factors for Common Kidney Stones Are Correlated with Kidney Function Independent of Stone Composition

Introduction: Kidney stone type varies with age, sex, season, and medical conditions. Lower estimate glomerular filtration rate (eGFR) leads to changes in urine chemistry, and risk factors for kidney stones are thought to vary by stone type. We explore the association between eGFR, urine risk factors, and common stone compositions. Methods: This was a retrospective cohort study of 811 kidney stone patients seen at Yale Medicine between 1994 and 2021 with serum chemistries and 24-h urine chemistries matched within 1 year of baseline stone analysis. Patients’ eGFR was calculated using the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) 2021 equation. Demographics and medical history were compared by χ2 tests. 24-h urine chemistries and stone analyses were analyzed by one-way ANOVA. Linear regressions were performed to control for demographics, comorbidities, and stone composition. Results: With lower eGFR, the proportion of calcium stones declined while uric acid (UA) stones increased. On univariable analysis, lower eGFR was associated with lower urine pH, calcium, citrate, UA, magnesium, phosphorus, and ammonium. On multivariable analysis, controlling for age, sex, ethnicity, body mass index, comorbidities, and stone type, these factors remained significant. Stone formers with lower eGFR had elevated supersaturation for UA, but reduced supersaturations for calcium-containing stones. Though urine oxalate was significant on univariable analysis, it was not on multivariable analysis. Conclusion: Changes in urine parameters are strongly correlated with eGFR regardless of stone type. Renal function may play a key role in modulating kidney stone risk factors. Strategies to mitigate stone risk may need to vary with kidney function, especially when patient urine or stone composition data are unavailable.

Predictors of Urosepsis Post Percutaneous Nephrolithotomy at King Abdulaziz Medical City, Riyadh.

The procedure of percutaneous nephrolithotomy (PCNL) is considered a minimally invasive method for removing stones from the kidneys or ureters. PCNLcan cause a wide range of complications, such as urosepsis, a rare but serious complication. A retrospective cohort study of patients who underwent PCNL from the period 2016 to 2022 was conducted at King Abdulaziz Medical City. Data were collected by chart review using the BestCARE system. SPSS version 23 (IBM Corporation, Armonk, NY, USA) was used. Qualitative variables were expressed as percentages and frequencies. The chi-square test was used to compare the qualitative variables. The K-S test was used to check the normality of the data. Quantitative variables were compared between groups using the independent sample t-test and the nonparametric Mann-Whitney test. Fisher's exact test was used to compare categorical variables. A total of 155 patients were included in this study. The mean age of the participants overall was found to be 49. About 108 (69.7%) of the participants were male. Regarding risk factors for urosepsis, diabetes mellitus was found in 54 (34.8%) of the participants. The incidence of urosepsis following PCNLwas found to be 3 (1.9%) of the patients. The most frequently reported indication was found to be unilateral renal stones. The most frequently reported type of stone in the analysis was found to be calcium oxalate in nearly two-thirds 98 (63.2%) of the patients. The incidence of urosepsis among the patients who underwent PCNL was less than 2%. Diabetes mellitus, followed by hypertension, were the most prevalent co-morbidities among the participants. Cefuroxime was the antibiotic of choice when treating patients and following urosepsis.

P53 deacetylation alleviates calcium oxalate deposition-induced renal fibrosis by inhibiting ferroptosis

Calcium oxalate (CaOx) stones are among the most common types of kidney stones and are associated with renal tubular damage, interstitial fibrosis, and chronic kidney disease. The mechanism of CaOx crystal-induced renal fibrosis remains unknown. Ferroptosis, a type of regulated cell death, is characterised by iron-dependent lipid peroxidation, and the tumour suppressor p53 is a key regulator of ferroptosis. In the present study, our results demonstrated that ferroptosis was significantly activated in patients with nephrolithiasis and hyperoxaluric mice as well as verified the protective effects of ferroptosis inhibition on CaOx crystal-induced renal fibrosis. Moreover, the single-cell sequencing database, RNA-sequencing, and western blot analysis revealed that the expression of p53 was increased in patients with chronic kidney disease and the oxalate-stimulated human renal tubular epithelial cell line, HK-2. Additionally, the acetylation of p53 was enhanced by oxalate stimulation in HK-2 cells. Mechanistically, we found that the induction of p53 deacetylation, owing to either the SRT1720-induced activation of deacetylase sirtuin 1 or the triple mutation of p53, inhibited ferroptosis and alleviated renal fibrosis caused by CaOx crystals. We conclude that ferroptosis is one of the critical mechanisms contributing to CaOx crystal-induced renal fibrosis, and the pharmacological induction of ferroptosis via sirtuin 1-mediated p53 deacetylation may be a potential target for preventing renal fibrosis in patients with nephrolithiasis.

A characterisation study of ignimbrites of Tenerife Island employed as building stone

The objective of this study is to evaluate the petrophysical properties of four ignimbrites employed as dimension stones. The natural stone under study is produced in Tenerife Island (Spain) under the commercial brand name of Piedra Chasnera and are differentiated according to their chromatic variety into: brown, violet, grey and green. To assess the suitability for feasible applications, it is essential to have a comprehensive knowledge of its properties. In this respect, mineralogical, petrographic and chemical properties were obtained by X-ray diffraction (XRD), polarisation microscopy (POM) and X-ray fluorescence (XRF). According to the procedure described in the standardised methods, apparent density, open porosity, water absorption at atmospheric pressure, water absorption coefficient by capillary and ultrasound propagation velocity were measured. The four variants of ignimbrites were analysed and classified according to the results obtained. It was found that the properties vary depending on the depth of the stratigraphic volcanic level from which the stone is extracted. From the review of the published data, it can be seen that the test results are within the expected values for this lithotype. A comparison was also made with other types of dimensional stones. The correlation analysis shows that there is a high degree of correlation between the physical properties studied.

Biogenic material design by stone waste treatment with biologically induced mineralization

One of the most widely studied branches of biologically induced mineralization (BIM) processes, microbially induced calcium carbonate precipitation, also known as microbially induced calcite precipitation, can be used as a method for the reinterpretation of waste natural stone particles into a sustainable material. By overcoming the need for synthetic adhesives or energy-consuming firing or sintering procedures for regaining such wastes, a natural and sustainable solution is proposed through certain biological treatment processes. The aim of this study was to determine the main processing variables affecting microbially induced biocement production using waste stone as a scaffold material. Bacillus pasteurii bacteria were used for biological induction of calcite precipitation. A custom-made reactor was designed for controlled incubation and medium injection into the waste stone scaffold. The parameters examined were the particle size of the waste stones, the effect of the stone type on cementation, the urease activity of the bacterial culture, temperature, the pH and flow rate of media, the mechanical strength of cemented scaffolds and water absorption capacity. This research demonstrated a potential solution to the waste generation problem of the global natural stone industry through the treatment of such wastes with BIM for creating a sustainable and biogenic material.

In Vıvo Evaluatıon Of The Chemıcal Composıtıon Of Urınary Stones Usıng Non-Contrast Helıcal Computerized Tomography

ABSTRACT: 
 Aim:
 To determine the density and chemical structure of renal stones by using in vivo low dose helical computerized tomography.
 Methods:
 79 patients with renal or uretheral stones were included in our study who were going to have extracorporeal shock wave lithotripsy (ESWL) or planned to go through urinary stone surgery due to renal stones. All stone densities were measured in Hounsfield Unit by low dose abdominal non-contrast helical computed tomography examination. Marconi MX 8000 CT system with 4 detectors was used for the CT examination. X-Ray diffractometry was used in the analyses of all stones.
 Results:
 The stone type was found to be one type, and mixed stone in 27 patients. The largest group among the mixed stones included whevellite-weddellite stone with 17 patients. Uric acid stones had the smallest, whevellite stones had the highest density. The difference between the density values of uric acid and cystine stones and the other stone types were statistically significant.
 Conclusion:
 Non-contrast helical computed tomography used in the diagnosis can also be used in the in vivo determination of the stone composition. It can be very helpful to define stone compositions by imaging studies to provide suitable therapeutic alternatives.

A Study Toward Automatic Identification of Renal Stone Composition in Single-energy or Ultra-low-dose CT Scan Using Deep Neural Networks

Background: Dual-energy computed tomography (DECT) scan is a non-invasive method for the in vivo identification of renal stone composition. However, DECT scanners have several demerits, including high cost, low accessibility, and high radiation dose to patients. Objectives: The present study aimed to investigate the efficacy of deep neural networks in the classification of renal stone types using single-energy CT imaging. The Taguchi method was used for the optimization of hyperparameters. Patients and Methods: A total of 146 pure renal stone samples were first surgically collected from the patients. The stones were then inserted into a Rando phantom and scanned using a DECT scanner. An ultra-low-dose CT scan was acquired to determine the stone position prior to the DECT scan. The result of chemical analysis was used as the gold standard for determining the stone composition throughout the study. Several neural networks, including ResNet-50, ResNet-18, GoogLeNet, and VGG-19, were used to classify the stone images into three composition groups, including uric acid, calcium oxalate, and cystine. Moreover, the Taguchi method was employed to optimize the network hyperparameters. The signal-to-noise ratio (SNR) was also analyzed to determine the optimal arrangement. Results: In this study, CT scans of 53 uric acid, 55 calcium oxalate, and 38 cystine stones, with diameters of 1 - 3 mm, were acquired. The deep learning findings showed that the ResNet-18 network had the highest accuracy for 120-kVp and 135-kVp CT scanning, while ResNet-50 performed better in 80-kVp CT scanning. The ResNet-50 network showed the best performance of all networks in predicting stone types in 80-kVp scanning, as indicated by its high sensitivity, specificity, and precision. Conclusion: The present results indicated that our deep learning approach could be used for the in vivo determination of renal stone types. Moreover, low-dose or ultra-low-dose single-energy CT scanning is more widely accessible and safer in terms of radiation exposure.

The relationship between patients’ kidney stone type and demographics in Israel: analysis of 10 K patients

To analyze urinary stone composition in Israel and assess the effects of key demographic parameters (gender, age, socioeconomic status, ethnicity, medical history and geographic region) on stone composition. A retrospective review was conducted of stone analysis of 10,633 patients from an HMO Israeli database analyzed by a central laboratory from 2014 to 2019 and subjected to Fourier-transform infrared spectroscopy. Associations between stone composition and different demographic parameters were determined using the Chi-square test. Calcium oxalate (CaOx) monohydrate accounted for 51.9% of the stones. Of the total sample, 5776 stones had one single component (54%), whereas 4857 (46%) had mixed components. Men had a higher frequency of CaOx stones (89.6% vs. 85.6%), whereas women had a higher frequency of calcium phosphate, infection, and cystine stones (27.2%, 17.7%, and 0.9% vs. 17.2%, 7.5%, and 0.5%, respectively). Cystine stones were more abundant in Arabs (1.2% vs. 0.5% in the Jewish population). Lower socioeconomic status was associated with a higher prevalence of calcium phosphate, uric acid, and infection stones and a lower prevalence of CaOx stones. Uric acid stones were associated with medical conditions such as diabetes, hypertension, ischemic heart disease, and obesity (28.3%, 24.9%, 25.7%, and 22.6% vs. 9.6%, 8.4%, 12.3%, and 10.3%, respectively). Stone types were highly influenced by patients' demographics. COM was the most common stone component in either pure or complex form. UA stone prevalence was found to increase with age and was associated with medical conditions such as diabetes, hypertension, ischemic heart disease, and obesity.

INVESTIGATION OF THE GEOTHERMAL RESOURCE POTENTIAL USING GEOELECTRICAL METHOD WITH THE WENNER CONFIGURATION: A CASE STUDY IN LEBONG REGENCY, INDONESIA

In geothermal reservoirs, hydrothermal distribution is significant. The most widely utilized geothermal reservoirs to date are those of hydrothermal systems, which are geothermal systems where the reservoir contains steam, water, or a mixture of both, depending on the pressure and temperature of the reservoir. One of geophysical method that is enough to map subsurface conditions to determine the hydrothermal distribution is the 2-Dimensional Geoelectric method using the Wenner configuration. This method aims to study the variation of rock resistivity below the earth's surface, resulting in a two-dimensional profile of the subsurface resistivity model used to describe the layered subsurface resistivity structure. The results are in the form of 2-Dimensional modeling of the distribution of hydrothermal manifestations with data processing using pyGIMLI (Python Library for Inversion and Modeling in Geophysics) software. In the study area Pungguk Pedaro Village, Bingin Kuning District, Lebong Regency, the Hulusimpang Formation has a high alteration intensity, as evidenced by the weathering in rocks and the micrographic appearance. The types of stones found in this research area include andesite rocks, including sandy gravel, volcanic breccia, tuff, andesite, basalt, basalt-andesite sand, silty sand, and clay. Or rocks derived from acidic magma.

Recycling of Basalt and Limestone Cutting Dust in Concrete Mix Design

Objectives: The goal is to integrate stone cutting waste into the concrete manufacturing industry to reduce environmental degradation. Methods/Analysis: Two types of stone cutting waste (Basalt and limestone) were separately collected from local facilities. An experimental program was conducted to prepare concrete mixes with 10%, 20%, 30%, and 40% replacement of sand by the two types of stone powder. Physical and chemical quality testing was carried out on the water, aggregates, and cement used in the concrete mix. The experiment compared a standard concrete mix (0% replacement) consisting of 6 cylinders and 6 cubes with a mix of 24 cylinders and 24 cubes after 7 days and 28 days. Results: Compression, tension, and stress tests were performed on the produced specimens. Regarding basalt replacement, a 10% replacement showed a higher impact on compressive strength and tension. For limestone, the 10% and 40% replacement fractions exhibited an insignificant reduction in compressive strength, indicating that a 40% replacement of sand with limestone dust is practical for most applications. Replacing sand with stone cutting waste in concrete can bring several benefits to the environment and enhance project feasibility. Even a small fraction of replacement can improve concrete properties. Novelty:Protect natural sand mining causes damage to ecosystems, leading to erosion and loss of biodiversity. Doi: 10.28991/CEJ-2023-09-05-010 Full Text: PDF

Kidney Stone Prevention

Kidney stone disease (KSD) (alternatively nephrolithiasis or urolithiasis) is a global health care problem that affects people in almost all of developed and developing countries. Its prevalence has been continuously increasing with a high recurrence rate after stone removal. Although effective therapeutic modalities are available, preventive strategies for both new and recurrent stones are required to reduce physical and financial burdens of KSD. To prevent kidney stone formation, its etiology and risk factors should be first considered. Low urine output and dehydration are the common risks of all stone types, whereas hypercalciuria, hyperoxaluria, and hypocitraturia are the major risks of calcium stones. In this article, up-to-date knowledge on strategies (nutrition-based mainly) to prevent KSD is provided. Important roles of fluid intake (2.5-3.0 L/d), diuresis (>2.0-2.5 L/d), lifestyle and habit modifications (for example, maintain normal body mass index, fluid compensation for working in high-temperature environment, and avoid cigarette smoking), and dietary management [for example, sufficient calcium at 1000-1200 mg/d, limit sodium at 2 or 3-5 g/d of sodium chloride (NaCl), limit oxalate-rich foods, avoid vitamin C and vitamin D supplements, limit animal proteins to 0.8-1.0 g/kg body weight/d but increase plant proteins in patients with calcium and uric acid stone and those with hyperuricosuria, increase proportion of citrus fruits, and consider lime powder supplementation] are summarized. Moreover, uses of natural bioactive products (for example, caffeine, epigallocatechin gallate, and diosmin), medications (for example, thiazides, alkaline citrate, other alkalinizing agents, and allopurinol), bacterial eradication, and probiotics are also discussed.

Medical Therapy to Facilitate Urinary Stone Passage

Background: Urinary stones are now a worldwide problem due to a rise in occurrence over the past few decades. All racial and cultural groups have experienced this. Complex metabolic and environmental risk factors are both involved in the pathogenetic pathways of stone production. This disease affects roughly 12% of the world's population. Its recurrence rate is about 70% in men and 47% in women. Urinary stones have significantly increased in prevalence over the past 20 years, becoming a global disease. Aim: This review covers literature on the medical therapy of urolithiasis to facilitate urinary stone passage and their mechanism of action in the light of the new data on the diagnosis and different types of urinary tract stones. Method: A preliminary search of related articles was obtained from three online databases PubMed, Sci.hub and Google scholar whichwere used to conduct a systematic evaluation of the literature. Inclusion and exclusion criteria screened the initial search results, and 67 papers were chosen to be appropriate for this literature review following careful reading, analysis, and evaluation. Results: Different methods of medical therapy (phosphodiesterase-5 inhibitors, alpha blockers, calcium blockers, non-steroidal anti-inflammatory drugs and different types of surgical procedures (extracorporeal shock wave lithotripsy, percutaneous nephrolithotomy,ureteroscopy)were thoroughly reviewed but among all of them the expulsion rate to remove the urinary stone was found to be larger and faster in calcium channel blocker (CI 1.33-1.66) and alpha blockers(CI 1.152–7.45). Practical implications: Medical therapies facilitate the urinary-stone passagebut these therapies are not generally used. The choices for treating urinary stones are expanded by these techniques. Patients with big ureteral stones have had better results with medical expulsive therapy.Removing the urinary stones also decreases the chances of other diseases which happened as a result of urinary stone. There are many benefits of medical expulsive therapy which are diverse in nature andthis therapy minimizes the exposure to anesthesia and radiations. Conclusion: Different surgical procedures are used to remove the stones from the urinary passage. Despite of surgical procedures, medical expulsive therapy are more helpful. Alpha-blockers and calcium channel blockers are the main medical expulsive therapies for primary evacuation of urinary tract stones. Keywords: Urolithiasis, Urinary tract stones, Medical expulsive treatment.

Implantación de un programa de mininefrolitotomía percutánea ambulatoria: presentación del protocolo y resultados iniciales

ObjectiveTo present our program for ambulatory mini percutaneous nephrolithotomy and evaluate its initial results. Material and methodsWe analyzed the implementation of the protocol into the clinical practice with the first 30 outpatient mini percutaneous nephrolithotomy cases performed in our center between April 2021 and September 2022. Demographic characteristics, perioperative variables, complications and need for unplanned health care, stone-free rate, stone type and patient satisfaction with the major ambulatory surgery process were collected. ResultsA total of 30 patients with a mean age of 60.2±11.6 years who met the inclusion criteria underwent surgery. The mean stone size was 15mm [range: 5-20]. No intraoperative complications were recorded. All patients except one were discharged the same day of surgery as planned. In the month following discharge, the rate of complications, emergency department revisits or hospital readmissions rates were 0%. Stone-free-rate at 3 months was 83%. Overall satisfaction with the whole perioperative process was assessed with the EVAN-G questionnaire, obtaining 124.3 points out of a maximum of 150, which is equivalent to a 78.6% level of satisfaction. ConclusionAmbulatory mini percutaneous nephrolithotomy can be implemented as a treatment option in centers with experience in endourology, an established major ambulatory surgery unit, and strictly selected patients. Our initial results show an adequate safety profile and high overall satisfaction perceived by patients undergoing the ambulatory approach.

A narrative review on efficacy of homoeopathic medicine Pareira brava in urolithiasis.

Urolithiasis orNephrolithiasis commonly known as renal calculi, kidney stones, or urine calculi, are terms used to describe the disease of renal stones. Since many years, mankind has been afflicted with this condition, which, if left untreated, may progress to End Stage Renal Disease (ESRD). The multiple aetiology and risk factors of renal stone disease affect about 12% of the world's population. Understanding the process of stone production is extremely difficult because there are many different types of stones, including calcium oxalate and calcium phosphate. The conventional medical system has used a variety of medications and procedures, including PCNL and ESWL, to treat urolithiasis. However, the rate of recurrence is remainshigh. Extracts from plants are now utilized to treat kidney stones. There is evidence that homoeopathic medications are employed as curative therapies as well. One of the treatments that homoeopaths usually recommend for kidney stone disease is Pareira Brava. Therefore, use of homoeopathic intervention is attempted in the current review in an effort to shed insight on the evolutionary changes in stone production technology and to lower the recurrence rate.

Production of vaccination videos in India: learnings from a science-art partnership

BackgroundCross-cultural communication, often conceptualized along culture and language dimensions, is an important issue for collaborative teams that include both scientists and artists. Such teams must balance the standardization needs of rigorous scientific methods, on the one hand, with openness for artistic creativity, on the other. The scientific literature does not provide clear guidance on how to structure such collaborations.DiscussionWe created eight videos manipulating the type of appeal, message tone, and gender of the vaccine promoter in a 2 × 2 × 2 between-subjects experiment. The four stages of the filmmaking process were 1) conceptualizing filmmaking and script writing through a scientific lens, 2) pilot testing and finalizing the script, 3) video production and editing, and 4) dissemination. We describe the process and learnings from a collaboration that included filmmakers, researchers, and vaccine experts from India and the United States in producing, disseminating, and evaluating videos that promoted vaccine uptake in Odisha, India.ConclusionsWhen projects require close collaborations between scientists and artists, committing to a unified vision is essential for facilitating open, bidirectional communication and building trust between the partners. Clearly denoting research boundaries ensures that the scientific needs of the project are met while simultaneously welcoming space for the filmmakers’ creativity, fostering a sense of ownership, and enhancing the final product.

STONE ANALYSIS- A 5 YEARS REVIEW

Kidney stones are solid masses that are formed when there are high levels of calcium, oxalate, cystine, or phosphate and too little liquid. There are different types of kidney stones. Calcium oxalate stones are the most common type of kidney stone. Nowadays it is thought that kidney stones are a systemic disorder. The stone composition can differ from a distinct single crystal to a compound mixture of many dissimilar crystals. The epidemiology of kidney stones is evolving. The gender gap has narrowed, and diet, obesity, and environmental factors have been implicated. Understanding of the epidemiology is required to comprehend the degree to which modiable etiological factors are responsible for stone formation and to undertake measures for preventing recurrence. Many methods for stone analysis are available, including dry and wet chemical spot tests, X-ray powder diffraction, Fourier transform infrared (FT-IR) spectroscopy and Raman spectroscopy. The Guidelines on Urolithiasis of the European Association of Urology recommend infrared spectroscopy or X-ray diffraction for kidney stone analysis and consider wet chemical tests as outdated. Have shared our experience with FITR for kidney stones analysis in this article.

LBA01-16 COMPARATIVE ANALYSES AND ABLATION EFFICACY OF THULIUM FIBER LASER BY STONE COMPOSITION

You have accessJournal of UrologyCME1 Apr 2023LBA01-16 COMPARATIVE ANALYSES AND ABLATION EFFICACY OF THULIUM FIBER LASER BY STONE COMPOSITION Jeffrey Johnson, Miyad Movassaghi, David Han, Srinath-Reddi Pingle, Justin Lee, Prakash Gorroochurn, James Williams, Michael Schulster, and Ojas Shah Jeffrey JohnsonJeffrey Johnson More articles by this author , Miyad MovassaghiMiyad Movassaghi More articles by this author , David HanDavid Han More articles by this author , Srinath-Reddi PingleSrinath-Reddi Pingle More articles by this author , Justin LeeJustin Lee More articles by this author , Prakash GorroochurnPrakash Gorroochurn More articles by this author , James WilliamsJames Williams More articles by this author , Michael SchulsterMichael Schulster More articles by this author , and Ojas ShahOjas Shah More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003360.16AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: There is limited data on the ablation settings and photothermal effects of thulium fiber laser (TFL) lithotripsy across various stone compositions. We aim to identify settings by stone type that optimize efficiency and avoid undesirable effects (i.e. charring) during TFL lithotripsy. METHODS: Specimens of calcium oxalate monohydrate, calcium oxalate dihydrate, uric acid, struvite, cystine, carbonate apatite and brushite stones were ablated to ≤1mm residual fragments using 13 settings with the Coloplast© TFL Drive. Pre-ablation mass, post-ablation mass, ablation time and total energy were recorded. Samples were analyzed using FTIR spectroscopy and electron microscopy. RESULTS: Pulse duration impacted ablation effectiveness greatly with 75% of inadequate ablations occurring in medium or long pulse settings. Calcium oxalate dihydrate, cystine, and struvite ablated most efficiently with 0.2J×100Hz, short pulse. Calcium oxalate monohydrate ablated most efficiently with 0.4J×40Hz, short pulse. The average percent of mass lost during ablation was 57%; cystine averaged the highest at 71%. Charring was seen in 40% of stones, mostly in uric acid, cystine, and brushite stones. Electron microscopy of char demonstrated a porous melting effect. FTIR spectroscopy of brushite char demonstrated a chemical composition change to amorphous calcium phosphate. CONCLUSIONS: Our trial is the first in vitro trial on stone ablation efficacy by stone composition. Across all settings and stone types 0.05J×1000Hz was the most effective ablation setting, however this is above our clinically recommended power of <=20 W. When operating in the kidney and using clinically acceptable TFL settings to minimize the risk of thermal injury, we recommend starting with short pulse 0.2J×100Hz and 0.4J×40Hz to cover most stone types, and adjusting the settings based on visual ablation effects intraoperatively and the clinical scenario (e.g. limited irrigation flow, narrow infundibulum). Further investigation is needed to continue to optimize TFL stone treatment settings. Source of Funding: Coloplast © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e1183 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Jeffrey Johnson More articles by this author Miyad Movassaghi More articles by this author David Han More articles by this author Srinath-Reddi Pingle More articles by this author Justin Lee More articles by this author Prakash Gorroochurn More articles by this author James Williams More articles by this author Michael Schulster More articles by this author Ojas Shah More articles by this author Expand All Advertisement PDF downloadLoading ...

MP10-18 DOES VIDEO OF LASER DUSTING IMPROVE ACCURACY OF STONE IDENTIFICATION?

You have accessJournal of UrologyCME1 Apr 2023MP10-18 DOES VIDEO OF LASER DUSTING IMPROVE ACCURACY OF STONE IDENTIFICATION? Juan Sebastian Rodriguez-Alvarez, Prajit Khooblall, Harmenjit Brar, Donald Fedrigon, Manoj Monga, and Smita De Juan Sebastian Rodriguez-AlvarezJuan Sebastian Rodriguez-Alvarez More articles by this author , Prajit KhooblallPrajit Khooblall More articles by this author , Harmenjit BrarHarmenjit Brar More articles by this author , Donald FedrigonDonald Fedrigon More articles by this author , Manoj MongaManoj Monga More articles by this author , and Smita DeSmita De More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003225.18AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Kidney stone analysis to determine composition is important for metabolic management and recurrence prevention. This analysis may be limited with dusting techniques, and many practices require lab outsourcing or additional resources, ultimately increasing healthcare costs. Studies have shown that Urologists have poor accuracy when attempting to identify stone types using simple visualization. We hypothesized that Urologists would more accurately identify stone types using video clips of stone dusting during laser lithotripsy compared to still pictures. METHODS: We obtained representative pictures and videos during 8 ureteroscopies with holmium laser dusting of 4 stone types: calcium oxalate monohydrate (COM), calcium phosphate (CAP), cystine (CY) and uric acid (UA). Laser settings were 0.4 J x 50 Hz across all cases. A Redcap survey was created and sent via email to the members of the Endourological Society. The survey included a picture followed by the corresponding video of each stone being dusted along with Hounsfield units (HU), size and location. Each picture and video included multiple-choice questions about stone composition and confidence level, ranging from 1 (very unsure) to 5 (very confident). Accuracy, confidence levels, and rates of rectification (change from incorrect to correct answer) or reversions (correct to incorrect) after watching videos were analyzed. RESULTS: 187 trained urologists responded to the survey. The accuracy rate of pictures alone was 43.8 % vs. 46.1 % with videos (p=0.27). Correct identification of individual stones was low, with high variability within stone types (Table 1). Video only improved accuracy for one CY stone. Confident answers (level 4 or 5) were more likely with videos than pictures (65.4% vs. 53.7%, respectively; p<0.001). Confident responses were also more likely to be correct than incorrect (66.1% vs. 53.9%, p<0.001). After viewing videos, participants were more likely to rectify their answers, with UA and CY stones having a higher proportion of rectified vs. reverted responses. CONCLUSIONS: Stone identification accuracy is low irrespective of confidence level, picture and video stone visualization, or knowledge of HU. Urologists should be cautious in using endoscopic stone appearance to direct metabolic management. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e121 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Juan Sebastian Rodriguez-Alvarez More articles by this author Prajit Khooblall More articles by this author Harmenjit Brar More articles by this author Donald Fedrigon More articles by this author Manoj Monga More articles by this author Smita De More articles by this author Expand All Advertisement PDF downloadLoading ...

MP05-14 ENHANCED POPCORNING USING POLYANIONIC SOLUTIONS AS IRRIGATION

You have accessJournal of UrologyCME1 Apr 2023MP05-14 ENHANCED POPCORNING USING POLYANIONIC SOLUTIONS AS IRRIGATION Daniel Wong, Alex Shiang, Connor McCormick, Adam Ostergar, Henry Lai, and Kenneth Sands Daniel WongDaniel Wong More articles by this author , Alex ShiangAlex Shiang More articles by this author , Connor McCormickConnor McCormick More articles by this author , Adam OstergarAdam Ostergar More articles by this author , Henry LaiHenry Lai More articles by this author , and Kenneth SandsKenneth Sands More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003216.14AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The goal of popcorning or pop-dusting is to reduce stone fragments to submillimeter size, allowing spontaneous passage through the urinary tract. Polyanionic compounds can dissolve human calcium oxalate kidney stones. We explore the novel application of polyanionic solutions to enhance popcorning efficiency. METHODS: BegoStones with matching size and mass were treated in a 12 mm test tube calyceal model with a 60 W TFL (SOLTIVE, Olympus). 200 mm fiber was introduced into our model calyx through a flexible ureteroscope and positioned 1-2 mm from the stones. Stones were treated at 1.0 J × 40 Hz for 4 minutes with irrigation at 30 ml/min. We compared sodium chloride (NaCl), sodium citrate (Citrate), sodium hexametaphosphate (HMP), and sodium EDTA (EDTA) solutions. The osmolality of all solutions was matched to 0.9% NaCl. The pH for solutions of NaCl, EDTA, HMP, and Citrate was 6.0, 8.3, 6.7, and 8.6 respectively. After treatment, stones were passed through a 1 mm sieve and remaining fragments weighed. The primary outcome was residual stone mass >1 mm. RESULTS: The average remaining stone mass >1 mm after 17 observations with NaCl irrigation was 27.8% (±10.0%). After 15 observations with HMP, Citrate, and EDTA irrigation, the average remaining stone mass >1 mm was 28.9% (±13.4%), 17.5% (±10.5%), and 9.8% (±5.7%) respectively (Figure 1). HMP had no significant effect on residual stone burden compared with NaCl. There was a 37% reduction in residual stone mass when using Citrate compared with NaCl (p=0.008). Using EDTA reduced residual stone mass by 65% compared with NaCl (p<0.001). CONCLUSIONS: Citrate and EDTA show promising results for enhancing the efficacy of popcorning in this in vitro model. Further testing will be required to determine effectiveness on different stone types and safety on urothelium in short duration. Source of Funding: Midwest Stone Institute © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e48 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Daniel Wong More articles by this author Alex Shiang More articles by this author Connor McCormick More articles by this author Adam Ostergar More articles by this author Henry Lai More articles by this author Kenneth Sands More articles by this author Expand All Advertisement PDF downloadLoading ...