Unilateral Renal Stones Research Articles

Incidence of metabolic syndrome in patients with unilateral or bilateral staghorn renal stones and its impact on percutaneous nephrolithotomy outcomes

BackgroundTo evaluate the incidence of metabolic syndrome (MetS) in patients with unilateral and bilateral staghorn calculi (SC) and evaluate the impact on the outcome of percutaneous nephrolithotomy (PCNL).MethodsThe clinical data of patients who underwent PCNL for the treatment of SC between 2019 and 2022 were retrospectively reviewed. SC was divided into unilateral and bilateral. The incidence of MetS was compared between the patients with unilateral SC and the patients with bilateral SC, and the impact on the outcome of PCNL was assessed.ResultsA total of 1778 patients underwent PCNL between 2019 and 2022. After screening computed tomography, 379 patients were confirmed to have SC, finally, leaving 310 patients with follow-up and complete data to be included in the study. Eighty-four had bilateral SC and 226 had unilateral SC. The patients with bilateral SC had a significantly higher body mass index and higher rates of complete staghorn stones and metabolic syndrome. Higher body mass index, hypertension, diabetes mellitus, hyperlipidaemia, and MetS were present in 62.58%, 44.84%, 21.94%, 60.65% and 27.42% of all patients, respectively. The number of MetS components remained significantly associated with bilateral SC. Specifically, when the number of MetS components increases from 0 to 3–4, the likelihood of developing bilateral staghorn calculi increases by 21.967 times. Eighty-five patients with MetS( +) had a higher rate of overall complications (number (N)(%), 29 (34.12) vs.33 (14.46), P < 0.001) and a comparable stone-free rate to 225 MetS(-) patients. Multivariable analysis confirmed that hyperlipidaemia (P = 0.044, odds ratio [OR] = 1.991, 95% confidence interval [CI] 1.020–3.888) and MetS (P = 0.005, OR = 2.427, 95% CI 1.316–4.477) were independent risk factors for overall complications.ConclusionsMetS is correlated with the formation of bilateral SC and is the main predictor for complications of PCNL especially for low-grade complications (I-II).

Flexible ureteroscopy and laser lithotripsy in unilateral multiple renal stones

Background and Objectives: To identify the factors contributing to stone-free rates and postoperative complications of flexible ureteroscopy and laser lithotripsy in unilateral multiple renal stones. Methods: A total of 20 patients had retrograde intrarenal surgery procedures to treat unilateral multiple renal stones, less than 50 mm collectively were reviewed from May 2021 to December 2021. Stone numbers were calculated, and stone size was measured as the cumulative stone diameter of all intrarenal stones. The clinical insignificant residual stones were defined as the absence of stone fragments &lt;4 mm in the kidney at the end of the procedures. Baseline patient characteristics, operation time, hospital stay, stone-free rates, and complications were recorded. Results: Retrograde intrarenal surgery was performed on 20 patients (12 males and 8 females). The overall success rate was 80%. Depending on the sizes of the stones, patients with stones &lt;20 mm had a stone-free rate of 100% (10/10 patients) and patients with stone size? 20mm had a stone-free rate of 60% (6/10) with a (p &lt; 0.003). The number of stones per renal unit was two in 13 patients with a stone-free rate of (92.3%), three in 7 patients, and a stone-free rate was (57.1%) with a (p= 0.06). Postoperative complications were encountered in 4 patients (20%), and all were treated conservatively. Conclusions: Retrograde intrarenal surgery provides a satisfactory stone-free rate with a low complication rate when treating multiple renal stones. However, the success rate, stone-free rate, and the number of sessions significantly depend on the size and the number of stones.

Detection of Renal Stones by Ultrasonography

Background: Kidney stones also known as renal stones are hard deposits made of minerals that develop in the urinary system or kidneys. Numerous symptoms, including excruciating pain in the lower back, abdomen, or groin, nausea, and vomiting, can be brought on by renal stone. Objective: To evaluate the accuracy of ultrasonography for the presence, location, and site of stones in patients with acute renal colic Methods: This research was conducted in the radiology department of the Jalal Pur Diagnostic Centre. Data were acquired from October 2022 to March 2023.100 patients were included in the study. Patient-informed permission was acquired following the ethical standards outlined by the research committee. Results. The study shows that 74% of patients have unilateral renal stones while 26% have bilateral renal stones. About 43 people had urolithiasis on the left side. The majority of stones were present in the lower pole of the kidney. Conclusion: Ultrasonography can be utilized as a primary evaluation technique in patients presenting with acute renal colic. Males are most commonly affected by renal stones than females and patients between the ages of 31 and 45 are the most usually affected.

Comparison between the Outcomes of Standard Percutaneous Nephrolithotomy (S-PCNL) and Mini-Percutaneous Nephrolithotomy (M-PCNL) while Treating Renal Calculi

Background: In urology, the most common disorder is represented as renal stones. Renal stones have 10% of humans reporting complaints. Their recurrence rate is very high, exhibiting approximately 70 percent recurrence rate. There have been significant advancements made in the treatment of renal stones. PCNL can be used in situations where renal stones are between 10-20 millimeters in the lower pole of a kidney and larger than 20 millimeters. Objective: This study was performed to compare the outcomes of S-PCNL and M-PCNL while treating renal calculi. Study design: A randomized control trial Place and Duration This study was conducted in Karachi Institute of Kidney Diseases Karachi from February 2022 to February 2023 Methodology: There were a total of 50 people included in this research who were equally divided into 2 groups. All of the participants were having a single unilateral renal stone which was &lt;3cm in size. All of the included people were aged 18 years or older. Each patient underwent a physical examination as well as laboratory investigations which included urine culture, CBC, liver function, urinalysis, coagulation profile, and kidney function. There were certain imaging studies that included pelvic and abdominal ultrasonography, kidney–urinary bladder X-ray (KUB), and either intravenous pyelography (IVP) or computed tomography urinary tract (CTUT).

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.

MP23-10 ASSESSING RENAL DAMAGE CAUSED BY NEW HIGH POWER LASERS DURING URETEROSCOPIC LASER LITHOTRIPSY: A RANDOMIZED TRIAL

You have accessJournal of UrologyCME1 Apr 2023MP23-10 ASSESSING RENAL DAMAGE CAUSED BY NEW HIGH POWER LASERS DURING URETEROSCOPIC LASER LITHOTRIPSY: A RANDOMIZED TRIAL Alan Yaghoubian, Roman Shimonov, Blair Gallante, Raymond Khargi, Dara Lundon, Johnathan Khusid, Manishkumar Patel, Kai Nie, Hui Xie, Jingjing Xi, Nicholas Zaki, Seunghee Kim Schulze, William Atallah, Natasha Kyprianou, and Mantu Gupta Alan YaghoubianAlan Yaghoubian More articles by this author , Roman ShimonovRoman Shimonov More articles by this author , Blair GallanteBlair Gallante More articles by this author , Raymond KhargiRaymond Khargi More articles by this author , Dara LundonDara Lundon More articles by this author , Johnathan KhusidJohnathan Khusid More articles by this author , Manishkumar PatelManishkumar Patel More articles by this author , Kai NieKai Nie More articles by this author , Hui XieHui Xie More articles by this author , Jingjing XiJingjing Xi More articles by this author , Nicholas ZakiNicholas Zaki More articles by this author , Seunghee Kim SchulzeSeunghee Kim Schulze More articles by this author , William AtallahWilliam Atallah More articles by this author , Natasha KyprianouNatasha Kyprianou More articles by this author , and Mantu GuptaMantu Gupta More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003248.10AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The high power Holmium (Ho:YAG) and thulium fibre lasers (TFL) generate enough heat in surrounding fluid to cause renal cellular damage, yet the degree to which this occurs has yet to be quantified. We aim to establish a relative safety profile of the TFL and Ho:YAG by quantifying the degree of renal damage during ureteroscopic laser lithotripsy (URSLL). METHODS: This is an ongoing randomized controlled trial of patients undergoing URSLL with unilateral non-obstructing renal stones. Patients are randomized to undergo URSLL with either the TFL or Ho:YAG laser. Each patient’s urine is collected immediately pre-op (V1), 1 hour post-op (V2), and 10 days post-op (POD#10, V3). Samples are analyzed by enzyme-linked immunosorbent assay (ELISA) for the following biomarkers: Kidney injury molecule-1 (KIM-1), Neutrophil gelatinase-associated lipocalin (NGAL), and β2-microglobulin (β2M), then normalized to urine creatinine. Primary outcome is degree of renal injury based on urinary biomarker changes. RESULTS: To date 26 patients (16 TFL, 10 Ho:YAG) have been included. Baseline patient and stone characteristics were similar. Relative to controls, both lasers caused pronounced rises in biomarkers in the immediate postoperative period with a trend back towards baseline by postoperative day 10 (Figure 1). However, the Ho:YAG laser caused a persistent rise in NGAL at 10 days. In terms of percent change from baseline, there were no significant differences between cohorts for any of the biomarkers (Figure 2). CONCLUSIONS: Our pilot analysis suggests that there is notable laser-induced renal parenchymal damage for both TFL and Ho:YAG. The renal damage safety profile appears similar for both lasers. Source of Funding: This work was funded in part by a grant from the New York Academy of Medicine © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e309 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Alan Yaghoubian More articles by this author Roman Shimonov More articles by this author Blair Gallante More articles by this author Raymond Khargi More articles by this author Dara Lundon More articles by this author Johnathan Khusid More articles by this author Manishkumar Patel More articles by this author Kai Nie More articles by this author Hui Xie More articles by this author Jingjing Xi More articles by this author Nicholas Zaki More articles by this author Seunghee Kim Schulze More articles by this author William Atallah More articles by this author Natasha Kyprianou More articles by this author Mantu Gupta More articles by this author Expand All Advertisement PDF downloadLoading ...

Hounsfield Units (HU) as a Predictor of Stone Clearance after Percutaneous Nephrolithotomy (PCNL)

Objective: To compare the outcomes of percutaneous nephrolithotomy (PCNL) in patients with renal stones with high (≥700) versus low (&lt;700) HU. Patients and Methods: A total of 200 patients having age 18 to 60 years, with diagnosis of unilateral renal stone disease, having stone size 2 to 4 cm in diameter on non-contrast computed tomography (NCCT) of Urology Unit of Ibn e Sina Hospital and Research Institute Multan were included. The study duration was May-2021 to July-2021. NCCT was done pre-operatively in every patient to measure Hounsfield units (HU). Post-procedural X-ray KUB was done 2 weeks after the surgical procedure to determine the stone clearance in every patient. Results: Mean age was 45.79±11.17 Years. Mean duration of disease of patients included in this study was 8.78±8.59 months. Mean stone size in patients included in this study was 3.11±0.61 cm. On comparison of stone clearance rate between the patients having high-HU versus low-HU, stone clearance was found in 61 (72.6%) patients having low HU value and in 105 (90.5%) patients having high HU value (p-value 0.001). Conclusion: HU-value ≥700 is a significant predictor of success rate of percutaneous nephrolithotomy (PCNL) in patients having renal stone disease. Keywords: Renal Stone Disease, Percutaneous nephrolithotomy, Hounsfield units (HU).

A single centre experience of percutaneous nephrolithotomy in infants and its long-term outcomes

Renal stones in infants requiring Percutaneous nephrolithotomy (PCNL) is rare. There is insufficient literature on the long-term implications of PCNL in growing kidneys of these children. To review our experience of PCNL amongst infants i.e., < 1year of age and to analyse the safety and efficacy of this procedure and assess its long-term renal outcomes. This was a retrospective analysis of a prospectively maintained data base between 2005 and 2020. All infants with unilateral renal stones >12mm underwent PCNL. Changes in the serum creatinine, estimated glomerular filtration rate and renal size prior to the PCNL and at the last follow up were monitored. The demographics, clinical profile, operative details, post-operative complications and follow up data were collated and analyzed. 86 children were diagnosed with renal stones of whom, 24 infants met our inclusion criteria and were included in the review. The average age was 9.75 months with fever being the commonest presenting symptom. Five infants were diagnosed with metabolic abnormalities, hypercalciuria being the commonest. Majority of the infants (22) had single stones and the lower calyx was the commonest site (50%). The mean stone burden was 19.5mm. The stone free rate was 91% during the primary PCNL, which increased to 100% after re-do PCNL. The overall complication rate was 16% which was graded by the modified Clavien Dindo scale for surgical complications. The median follow up period was 144 months and average age at the last follow up was 10.5 years. At the last follow up, a mean serum creatinine of 0.4mg/dl, mean estimated glomerular filtration rate of 98ml/min/1.72m2 and a mean renal size of 8.3cm was recorded, which was comparable to that of a normal child, thus signifying no deterioration of renal functions and renal growth. Three children showed the presence of cortical scars on an isotope scan at follow up. However, all the 24 operated renal units demonstrated preserved renal functions. PCNL performed during infancy does not hinder the growth potential of the kidney. Each of the 24 children achieved the target renal size and estimated glomerular filtration rate corresponding to the duration and body size at the end of the follow-up. Thus, PCNL in infants <1 year of age is safe and effective with no adverse effects at long term follow-up.

MO116COMPARISON OF THE CHARACTERISTICS BETWEEN UNILATERAL AND BILATERAL RENAL STONES AND THEIR ASSOCIATION WITH KIDNEY INJURY IN CHINESE POPULATION

Abstract Background and Aims Urinary stone disease (USD) has been associated with increased risk for chronic kidney disease (CKD) and end-stage renal disease (ESRD) in Western populations. However, the comparison of metabolic disorders between unilateral and bilateral renal stones and their association with CKD have not been fully examined. It is also unclear whether there is an increased risk for kidney tubular injury makers such as N-acetyl-ß-D-glucosaminidase (NAG) and alpha-1-microglobulin (α1-MG) in different stone formers. Method We performed a cross-sectional study of 10,281 participants in rural China in 2014. All subjects underwent a renal ultrasound to detect USD; stone formers were grouped into one or two sides of USD by ultrasound exams. CKD was defined as a decreased estimated glomerular filtration rate (eGFR, &amp;lt;60mL/min/1.73m2) and/or albuminuria (ACR≥30mg/g). Increased urine NAG and α1-MG were defined as the values of NAG and α1-MG above the 75th percentile of the sample distribution. Results The mean age of the study population was 55.4±10.0 years; 47.1% were males. Among all participants, 4.9% (n=507) had unilateral renal stone, and 0.7% had bilateral renal stones. The proportion of CKD in non-stone formers, unilateral and bilateral renal stones were 11.0%, 19.2%, and 29.7%, respectively (p for trend&amp;lt;0.001). Bilateral renal stone formers tend to have a higher proportion of hypertension and diabetes. In multivariate analyses after adjustment for multiple confounders, bilateral renal stones were significantly associated with an increased risk of decreased eGFR (OR 3.38; 95% CI 1.05-10.90), albuminuria (OR 3.01; 95% CI 1.76-5.13), CKD (OR 3.18; 95% CI 1.88-5.36), increased NAG (OR 1.95; 95% CI 1.21-3.16) and α1-MG (OR 2.54; 95% CI 1.56-4.12) compared with non-stone formers. Conclusion In the present study, bilateral renal stone formers tend to have a higher proportion of metabolic disorders and are also associated with a higher risk of CKD and kidney tubular injury. Further studies are needed to confirm the increased risk for ESRD.

Clinical efficacy and safety analysis of retrograde intrarenal stone surgery for treatment of upper urinary calculi

Objective To evaluate efficacy and safety of retrograde intrarenal stone surgery for treatment of upper urinary calculi. Methods The clinical data of 640 patients with upper urinary tract calculi treated by retrograde intrarenal stone surgery (RIRS) in Renmin Hospital of Wuhan University from April 2016 to January 2019 were retrospectively analyzed. There were 424 males and 216 females. The awerage age was (46.2±12.8) years old, ranging 18 to 76 years old. The maximum diameter of the stone is (1.4±0.7) cm, ranging 0.6-3.2 cm. There were 126 cases with inferior calculi and 514 cases with non-lurgical calculi. There were 196 cases with unilateral ureteral calculi, 118 unilateral ureteral calculi cases with renal calculi, 236 cases with unilateral renal stones, and 90 cases with double kidney stones. 104 cases were placed with double J tube before operation and 496 cases were not placed before operation. There were 8 cases of horseshoe kidney, 30 cases of isolated kidney with renal insufficiency, 4 cases of pelvic ectopic kidney with dysplasia, 6 cases of congenital ureteral malformation and 2 cases of sponge kidney. Preoperative average hemoglobin was (133.2±5.6)g/L, ranging 126-188 g/L.And average serum creatinine was (84.4±12.2)μmol/L, ranging 74-242μmol/L before operation. All patients were treated with general anesthesia under the lithotomy position. The ureteroscopy combined with holmium laser lithotripsy was performed.The 200μm fiber was used, which the parameters were set as 12-45 W(0.5-1.5 J/10-30 Hz). The stone baskets were used to take stones according to actual conditions. The operation was performed by doctors of the same qualifications. Results All patients underwent successful operation. The mean operation time was (45.6±14.6)min. The average postoperative hospitalization was (4.8±1.5)d. The postoperative serious complication rate was 0.9%, including(2 cases of sepsis and 1 case of subcapsular hematoma. Of the 640 patients, 596 were admitted to the hospital for a double J tube and 44 were lost of follow-up. 552 patients met the stone removal criteria, 44 patients did not meet the stone removal criteria for other treatments, such as extracorporeal shock wave lithotripsy, ureteroscopy or observed regularly. The stone-free rate (SFR) was 92.6% (552/596) after 1-3 months. On the first postoperative day, serum creatinine was (76.0±10.6)(58-156) μmol/L, and postoperative hemoglobin was (126.4±9. 6)(120-176) g/L. There was no significant difference in preoperative and postoperative hemoglobin (t=2.02, P=0.064). Preoperative and postoperative creatinine (t=64.76, P<0.05) was statistically significant. Meanwhile, the stone size (χ2=29.569, P<0.05) and position (χ2=44.949, P<0.05) versus SFR the impact was statistically significant. Multivariate regression analysis showed that stone size was not an independent risk factor for stone clearance (P=0.639). The stone position was an independent risk factor for stone clearance (P=0.013). Conclusions RIRS is a reliable treatment for small and medium calculi patients of the upper urinary tract. The curative effect of stone removal is clear, the complications are few, the safety is high. However, there are certain limitations to the efficacy in the treatment of large stones and lower calculi. Lower calculi is the independent risk factor for the treatment of efficacy. Key words: Ureteroscopes; Flexible ureteroscopy; Holmium laser lithotripsy; Upper urinary calculi; Clinical efficacy

Punctures versus shocks: a comparison of renal functional and structural changes after percutaneous nephrolithotomy and shockwave lithotripsy for solitary renal stone

Objective: To evaluate renal functional and structural changes following percutaneous nephrolithotomy and shockwave lithotripsy for solitary non-obstructing non-staghorn renal stone. Materials and methods: Patients with solitary unilateral non-staghorn renal stones who were planned for percutaneous nephrolithotomy (20 patients) and shockwave lithotripsy (20 patients) were prospectively evaluated for renal functional and structural changes 60 days after the procedure and complete clearance of stones. Tc99-dimercaptosuccinic acid was used to assess cortical scarring and Tc99-diethylenetriamine pentaacetic acid and Tc99-levo levo ethylecysteine were used for glomerular filtration rate calculations, respectively. Results: The mean stone size was 24.4 mm and 13.7 mm in the percutaneous nephrolithotomy group and the shockwave lithotripsy group, respectively. No new cortical scars developed in either of the groups on Tc99-dimercaptosuccinic acid scan. Both the treated and untreated kidneys showed an overall insignificant fall in glomerular filtration rate in both the groups. The number of patients showing significant deterioration in the individual glomerular filtration rate in both the treated and untreated renal unit was more in the shockwave lithotripsy group. Conclusion: Both percutaneous nephrolithotomy and shockwave lithotripsy are comparable in terms of adverse effects on renal parenchyma and renal function. Level of evidence: Not applicable for this multicentre audit.

Treatment of Complex Renal Calculi by Digital Flexible Ureterorenoscopy Combined with Single-Tract Super-Mini Percutaneous Nephrolithotomy in Prone Position: A Retrospective Cohort Study.

BackgroundAdvances in percutaneous nephrolithotomy (PCNL) have resulted in smaller devices that cause less trauma and bleeding, while flexible ureterorenoscopy (f-URS) allows access to any calyces. These methods are often used in isolation, but used in combination they may improve treatment of complex renal calculi. This study assessed the effectiveness and complications of f-URS combined with super-mini-PCNL (SMP) to treat complex renal calculi.Material/MethodsA retrospective cohort analysis was made of patients with unilateral complex renal stones treated between March 2013 and December 2016. Patients were grouped according to surgical procedure: SMP (SMP Group), f-URS holmium laser lithotripsy (f-URS Group), and combined SMP and f-URS (Combined Group). The postoperative complications and complete stone-free rate were analyzed and compared among the 3 groups.ResultsA total of 140 patients with complex renal stones were included: 40 patients in the SMP Group, 55 in the f-URS Group, and 45 in the Combined Group. The complete stone-free rate 3 days after the procedure was 77.5% in the SMP Group, 78.2% in the f-URS Group, and 97.8% in the Combined Group (p=0.010). The operation time, intraoperative blood loss, and hospitalization time of the Combined Group were all significantly lower than those in the SMP Group but higher than those in the f-URS Group. The follow-up was 9 months (range, 6–12 months). There were no medium-term complications reported.ConclusionsSMP combined with f-URS holmium laser lithotripsy in the prone position is an effective treatment for complex renal calculi.

Short-term changes in renal function in children and adolescents undergoing extracorporeal shock wave lithotripsy.

Aim To identify short-term effects of extracorporeal shock wave lithotripsy (ESWL) on renal function in children and adolescents with single kidney stones. Methods In a 4-year period 30 children (15 boys and 15 girls) from 10 to 18 years of age were treated for unilateral renal stones with ESWL. Inclusion criteria were: up to 18 years of age, kidney stone (from 4 to 20 mm in diameter) visible on X-ray, first ESWL treatment, unilateral lithotripsy treatment without previous kidney surgery, patients without infravesical obstruction, patients without proven urinary infection, repeated use of one (the same) analgesic, patients without anticoagulant and antihypertensive therapy, patients without use of nephrotoxic drugs prior to and during the treatment, normal blood pressure, non-pregnancy patients with normal renal function. Serum enzymes (alkaline phosphatase, lactate dehydrogenase), cystatin C, serum and urine electrolytes (sodium, potassium, chloride), and urine neutrophil gelatinase-associated lipocalin (uNGAL) were tested before, on the first and fifth day after the treatment. Results An increase of alkaline phosphatase and lactate dehydrogenase was statistically significant on day 1 (p<0.05) and values returned to normal on day 5. Serum cystatin C level was also significantly increased during the first four days after ESWL treatment (p<0.05) and returned to baseline on post-treatment day 5. There was a statistically significant difference in the level of uNGAL in urine before and 24 hours after ESWL treatment (p<0.05). Conclusion The ESWL is a safe and curative procedure for the treatment of kidney stones in children and adolescents with no evidence of serious adverse effects on renal function.

Management of unilateral staghorn renal stones with concurrent urinary tract infections by retroperitoneal laparoscopic pyelolithotomy with prolonged renal posterior lower segment incision.

The present study evaluated the effectiveness and safety of the removal of unilateral staghorn renal stones with concurrent infections by retroperitoneal laparoscopic pyelolithotomy (RLP) with prolonged renal posterior lower segment incision. Patients with staghorn renal stone and concurrent urinary tract infection (UTI) who underwent RLP with prolonged renal posterior lower segment incision as the primary, one-session treatment at our institution between March 2014 and December 2017 were retrospectively reviewed. Routine laboratory tests were performed and the patients received broad-spectrum intravenous antibiotics from at least 3 days prior to the operation. All patients were examined pre-operatively by urinary ultrasonography, computed tomography or intravenous urography. UTI was confirmed by laboratory tests with or without radiographic evidence by an experienced urologist. All patients (18 females and 10 males) successfully underwent the procedures and there was no conversion to open surgery in any case. The mean age was 57.0±10.81 years (age range, 40–74 years) and the mean calculus size was 3.3±0.79 cm. The mean operation time, warm ischemia time and post-operative hospital stay were 114.4±12.09 min, 28.1±4.23 min and 5.8±1.42 days, respectively. The mean hemoglobin drop on day 3 following surgery was 0.5±0.38 g/dl and there was no requirement for blood transfusion in any patient. The mean change of serum creatinine levels between pre-operative baseline and post-operative day 3 or post-operative month 6 was 6.0±20.03 or −4.5±15.13 µmol/l, respectively. The stone-free rate was 100% at 3 days and at 6 months. Mild post-operative complications (Grade I or II) occurred in 6 patients, including temporary and constant elevated body temperature (>38.5°C). No severe complications, including urine leakage, sepsis, residual stones requiring auxiliary procedures, were noted and there were no circumstances requiring further surgical intervention in any of the patients. In conclusion, RLP with prolonged renal posterior lower segment incision is an effective and safe procedure for patients with staghorn renal stones and concurrent UTI, and its feasible application as a single-session monotherapy is particularly convenient considering the financial and medical situation, as well as the patients' preference.

28] Retrograde intra-renal surgery as a treatment modality for unilateral renal calyceal stones of 1–2 cm

ObjectiveTo evaluate the safety and efficacy of retrograde intrarenal surgery (RIRS) as a treatment modality for renal calyceal stones measuring 1–2 cm.

Impact of personalized three-dimensional -3D- printed pelvicalyceal system models on patient information in percutaneous nephrolithotripsy surgery: a pilot study.

ABSTRACTObjective To investigate the impact of personalized three dimensional (3D) printed pelvicalyceal system models on patient information before percutaneous nephrolithotripsy surgery.Material and Methods Patients with unilateral complex renal stones with indicatation of percutaneous nephrolithotripsy surgery were selected. Usable data of patients were obtained from CT scans as Digital Imaging and Communications in Medicine (DICOM) format. Mimics software version 16.0 (Materialise, Belgium) was used for segmentation and extraction of pelvicalyceal systems. DICOM format were converted to Stereolithography file format. Finally, fused deposition modeling was used to create plasticine 3D models of pelvicalyceal systems. A questionnaire was designed for patients to assess personalized 3D models effect on patient’s understanding their conditions before percutaneous nephrolithotripsy surgery (PCNL). The day before surgery, each patient was seen by a urologist to deliver information about surgery. Questionnaire forms were asked to patients complete before and after presentation of 3D models and the results of the questions were compared.Results Five patient’s anatomically accurate models of the human renal collecting system were successfully generated. After the 3D printed model presentation, patients demonstrated an improvement in their understanding of basic kidney anatomy by 60% (p=0.017), kidney stone position by 50% (p=0.02), the planned surgical procedure by 60% (p=0.017), and understanding the complications related to the surgery by 64% (p=0.015). In addition, overall satisfaction of conservation improvement was 50% (p=0.02).Conclusion Generating kidney models of PCSs using 3D printing technology is feasible, and understandings of the disease and the surgical procedure from patients were well appreciated with this novel technology.

Flexible ureteroscopy for renal stone without preoperative ureteral stenting shows good prognosis.

PurposeTo clarify the outcome of flexible ureteroscopy (fURS) for management of renal calculi without preoperative stenting.MethodsA total of 171 patients who received 176 fURS procedures for unilateral renal stones were reviewed. All procedures were divided into two groups depending on whether they received ureteral stenting preoperatively. Baseline characteristics of patients, stone burden, operation time, stone-free rates, and complications were compared between both groups.ResultsSuccessful primary access to the renal pelvis was achieved in 104 of 114 (91.2%) patients without preoperative stenting, while all procedures with preoperative stenting (n = 62) were successfully performed. A total of 156 procedures were included for further data analysis (56 procedures in stenting group and 100 in non-stenting group). No significant differences was found regardless of a preoperative stent placement in terms of stone-free rate (73.2% with stenting vs. 71.0% without, P = 0.854), operative time (70.4 ± 32.8 with stenting vs. 70.2 ± 32.1 without, P = 0.969).ConclusionsfURS for management of renal stone without preoperative ureteral stenting are associated with well outcome in short term follow-up. Our study may help patients and doctors to decide if an optional stent is placed or not.

Impact of Three-Dimensional Printed Pelvicaliceal System Models on Residents' Understanding of Pelvicaliceal System Anatomy Before Percutaneous Nephrolithotripsy Surgery: A Pilot Study.

To investigate the impact of three-dimensional (3D) printed pelvicaliceal system models on residents' understanding of pelvicaliceal system anatomy before percutaneous nephrolithotripsy (PCNL). Patients with unilateral complex renal stones indicating PCNL were selected. Usable data of patients were obtained from CT-scans in Digital Imaging and Communications in Medicine (DICOM) format. Mimics software version 16.0 (Materialise, Belgium) was used for segmentation and extraction of pelvicaliceal systems (PCSs). All DICOM-formatted files were converted to the stereolithography file format. Finally, fused deposition modeling was used to create plasticine 3D models of PCSs. A questionnaire was designed so that residents could assess the 3D models' effects on their understanding of the anatomy of the pelvicaliceal system before PCNL (Fig. 3). Five patients' anatomically accurate models of the human renal collecting system were effectively generated (Figs. 1 and 2). After presentation of the 3D models, residents were 86% and 88% better at determining the number of anterior and posterior calices, respectively, 60% better at understanding stone location, and 64% better at determining optimal entry calix into the collecting system (Fig. 5). Generating kidney models of PCSs using 3D printing technology is feasible, and the models were accepted by residents as aids in surgical planning and understanding of pelvicaliceal system anatomy before PCNL.

Serum Level of Vitamin D3 and Renal Stone in Children

Background: Due to high prevalence of vitamin D insufficiency in Iranian children, researchers found a low level of vitamin D among patients with nephrolithiasis. Objectives: Since previous studies showed hyper-vitaminosis D in patients with renal stone, the current study aimed to clarify this paradox. Materials and Methods: In this cross-sectional study, 100 pediatric patients with renal stone referred to Pediatric Urology and Nephrology Clinic of Baqiyatallah Hospital in Tehran, Iran, in 2014 were selected using a simple sampling method. The serum level of vitamin D3 was measured in a laboratory and the correlation between vitamin D3 and other variables were evaluated. Results: One-hundred pediatric patients, 64% male and 36% female, with renal stone were evaluated. The serum level of vitamin D and calcium had no significant difference between male and female patients. Four patients had vitamin D deficiency, 31 patients had vitamin D insufficiency and others had sufficient levels of vitamin D. There was a direct significant correlation between the level of vitamin D and calcium serum level. Family history of renal colic did not affect the serum levels of vitamin D and calcium. The serum level of vitamin D was significantly higher in patients with bilateral renal stone compared to patients with unilateral renal stone. Conclusions: Serum levels of vitamin D in children with urinary stones were low. The level of vitamin D deficiency was significantly correlated with disease severity and serum level of calcium.

Clearance rates of residual stone fragments and dusts after endoscopic lithotripsy procedures using a holmium laser: 2-year follow-up results.

To investigate the spontaneous clearance rates of remnant particles following miniaturized percutaneous nephrolithotomy (mini-PCNL) and retrograde intrarenal surgery (RIRS). Among 624 patients who underwent mini-PCNL or RIRS at our institution from 2011 to 2015, we collected data of 247 patients with 2years of follow-up. Of these, we included 148 patients with unilateral renal stones between 10 and 30mm, as well as remnant particles after surgery. The size criteria of dusts and residual fragments (RFs) were, respectively, <1 and <3mm. After excluding 22 patients, 126 patients (RFs=21, dusts=98, and both RFs and dusts=7) were analyzed. Mean age was 56.5 (±14.4) years, and mean stone size was 19.5 (±12.5) mm. The mean follow-up period was 18.5 (±12.9) months. In patients whose remnant particles were naturally eliminated following lithotripsy, the mean stone passage time was 9.0 (±9.3) months in the dusts and 13.9 (±11.1) months in the RFs groups (P=0.135). Remnant particles disappeared in 42 out of 105 patients (40.0%) in dusts and 7 out of 28 patients (25.0%) in RFs groups (P=0.187). The size of dusts and RFs increased, respectively, in 18.1% (19/105) and 28.6% (8/28) of patients with remnant particles during the follow-up period. The presence of dusts and RFs was poor prognostic factors in patients underwent renal stone surgery using a holmium laser. Complete residual stone removal by using a basket or dusts eradication by irrigation for an adequate time during surgery can be a good surgical strategy.