Stones In Upper Urinary Tract Research Articles

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

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

Influence of preoperative urine culture and bacterial species on urogenital sepsis after ureteral flexible lithotripsy in patients with upper urinary tract stones.

This retrospective study aims to identify risk factors for urogenic sepsis in patients with upper urinary tract stones following ureteral flexible lithotripsy (FURL). Additionally, we analyze the clinical characteristics of bacterial infections post-surgery. A total of 759 patients who underwent FURL at the Urology Department of Zunyi Medical University were included. Univariate and multivariate Logistic regression analyses were conducted to identify independent risk factors for urogenic sepsis post-FURL. The distribution of bacteria based on preoperative urine cultures was also analyzed. Statistical analysis was performed using R4.2.2 software. Of the 759 patients, positive preoperative urine culture, urine nitrite positivity, urine white blood cell count (WBC) ≥ 200 cells/μL, residual stones, and neutrophil-to-lymphocyte ratio (NLR) were found to be independent risk factors for urogenic sepsis after FURL. Among the 164 patients with positive preoperative urine cultures, 32 developed urogenic sepsis post-surgery, with 68.75% having positive preoperative cultures. The leading pathogens causing postoperative urogenic sepsis were Escherichia coli (E. coli), Enterococcus faecium, Proteus mirabilis, and Klebsiella pneumoniae. The probabilities of progression to urogenic sepsis were as follows: E. coli 19% (n = 12), Enterococcus faecium 43% (n = 3), Proteus mirabilis 33.3% (n = 1), and Klebsiella pneumoniae 33.3% (n = 1). The ages of affected patients were 47.17 ± 13.2, 53.7, 41, and 79 years, respectively. Rates of comorbid diabetes were 36.4, 66.7, 50, 100%, with nitrite positivity rates at 72.7, 33.3, 50, 0%. Ten female patients were infected with E. coli, while patients infected with Klebsiella pneumoniae had an NLR of 7.62. Positive preoperative urine culture, urine nitrite positivity, urine WBC ≥ 200 cells/μL, residual stones, and NLR are independent risk factors for urogenic sepsis after FURL. Escherichia coli is the predominant pathogen post-FURL, with notable female prevalence and nitrite-positive urine in infections. Enterococcus faecium infections are associated with diabetes.

Xanthinuria in a familial group of Munchkin cats and an unrelated domestic shorthair cat.

Four confirmed cases of xanthinuria in cats, and one suspected case based on pedigree analysis, were identified. Clinical presentations varied and included haematuria, pollakiuria, dysuria, and urethral and ureteral obstruction. All cats had upper urinary tract uroliths. Diagnosis was obtained through infrared mass spectrometry of uroliths or urine. Clinical signs commenced at 3-8 months of age and reduced in all cats in the medium to long term after the introduction of a protein-restricted diet. Four cats were castrated males and one was a spayed female. Cases consisted of four Munchkin pedigree cats and one unrelated domestic shorthair cat. All four affected Munchkin pedigree cats were related, with three cases full siblings and the fourth case a half-sibling. No connection to the Munchkin pedigree could be established for the domestic shorthair cat. A candidate causative genetic variant (XDH p.A681V) proposed for this cat was excluded in the Munchkin family. All affected cats presented diagnostic challenges and routine urinalysis was insufficient to obtain a diagnosis. Cases of feline xanthinuria may be underdiagnosed due to situations where uroliths cannot be retrieved for analysis and there is an inability to make a diagnosis using crystal morphology alone on routine urinalysis. Metabolic screening of urine may provide an effective mechanism to confirm xanthinuria in suspected cases where uroliths are inaccessible or absent. In this case series, male cats were more common. Their anatomy may increase the risk of lower urinary tract signs and urethral obstruction developing secondary to xanthine urolithiasis. A protein-restricted diet appears to reduce clinical signs as part of long-term management. Four closely related Munchkin cats and one domestic shorthair cat were found with a suspected genetic disease causing high levels of xanthine in their urine. The case series looks at similarities and differences in their clinical signs, as well as difficulties experienced in obtaining a correct diagnosis. All cats had upper urinary tract stones and required metabolic testing of the stones or urine to diagnose. All cats were young when their clinical signs started and were on a high-protein diet. Four cats were desexed males and one was a desexed female. A genetic variant that may have caused the disease in the domestic shorthair cat was ruled out in the Munchkin family. Cases of high xanthine levels in feline urine may be underdiagnosed as the stones may not be accessed for testing. In this case series, male cats were more common. Their anatomy may increase the risk of lower urinary tract signs. A protein-restricted diet appears to reduce clinical signs as part of long-term management.

Impact of timing of urinary drainage on clinical outcomes in patients with obstructive pyelonephritis associated with upper urinary tract stones: a propensity score-matched analysis.

We aimed to assess the impact of the timing of urinary drainage on clinical outcomes in patients with obstructive pyelonephritis (OPN) associated with upper urinary tract (UUT) stones. We retrospectively evaluated the multicenter dataset of 240 patients with OPN associated with UUT stones who underwent urinary drainage. We divided the patients into two groups depending on the timing of urinary drainage; emergency drainage, defined as within 12h from admission, and delayed drainage, defined as between 12 and 48h from admission. The outcomes were the length of hospital stay, time to leukocyte normalization, and time to body temperature normalization. One-to-two propensity score matching (PSM) was applied to minimize the effect of confounders between the two groups. Subsequently, predictive patient factors for emergency drainage were analyzed using the logistic regression model. Only the time from admission to normal body temperature was significantly shorter in the emergency drainage group when compared with the delayed drainage group (median: 2 vs. 3days; p = 0.02), while there was no difference in time from drainage to body temperature normalization between the two groups. On multivariable analysis, high pretreatment C-reactive protein (CRP) was associated with implementing emergency drainage within 12h. The timing of urinary drainage was only associated with the duration of high fever, but it did not affect the postdrainage course. Emergency urinary drainage is more likely to be performed in severe patients, such as high pretreatment CRP.

Recent advances in the treatment of renal stones using flexible ureteroscopys.

Upper urinary tract stones are a common urological disease that can be treated by flexible ureteroscopy (FURS) through the natural urinary tract, in addition to extracorporeal shock wave lithotripsy (ESWL) and percutaneous nephrolithotomy (PCNL). The advantages of FURS are less trauma, faster recovery, and fewer complications, while its disadvantages include poor results of lithotripsy and stone extraction when dealing with larger stones, and prolonged operation time. Over the last two decades, the emergence of new technologies such as FURS combined with negative pressure suction, robot-assisted FURS, and artificially intelligent FURS, coupled with improvements in laser technology (the use of thulium fiber lasers (TFL) and the invention of single-use flexible ureteroscopes (su-fURS) suitable for primary level application, have significantly increased the global adoption of FURS. This surge in usage holds a promising future in clinical application, benefiting a growing number of patients with renal calculi. Accompanied by changes in technical concepts and therapeutic modalities, the scope of indications for FURS is broadening, positioning it as a potential primary choice for urolithiasis treatment in the future. This review outlines the progress in employing flexible ureteroscopy for the treatment of renal calculi in order to generate insights for further research.

Predictive model of nosocomial infection in patients with upper urinary tract stones after flexible ureterorenoscopy with laser lithotripsy: A retrospective study.

To construct a predictive model of nosocomial infection in patients with upper urinary tract (UUT) stones after flexible ureterorenoscopy with laser lithotripsy (FURSLL). Medical records of 196 patients with UUT stones who underwent FURSLL in Suzhou Hospital of Integrated Traditional Chinese and Western Medicine from December 2019 to December 2022 were retrospectively analyzed. Patients were divided into infected group or uninfected group based on the presence of infection during postoperative hospitalization. Univariate and multivariate logistic regressions were used to identify risk factors of postoperative nosocomial infections. A nomogram prediction model was constructed using R software. The predictive ability of the model was assessed using the receiver operating characteristic (ROC) curve. A total of 54 patients (27.6%) developed nosocomial infections after FURSLL. Logistic regression analysis showed that older age, diabetes, preoperative urinary system infection, ureteral stricture, hydronephrosis, double J-stent retention time, and stone diameter were risk factors of nosocomial infection. The nomogram model was constructed based on these risk factors. The ROC showed that the area under the curve (AUC) of the model was 0.930 (95% CI: 0.890-0.970), and the sensitivity and specificity were 92.6% and 81.7%, respectively, indicating that the prediction model was effective. Risk of nosocomial infection in patients with UUT stones after FURSLL is affected by older age, diabetes, preoperative urinary system infection, ureteral stenosis, hydronephrosis, double J-stent retention time, and stone diameter. The nomogram prediction model, constructed based on the above factors, has good predictive value.

Analysis of factors associated with severe bleeding after percutaneous nephrolithotomy and evaluation of interventional embolization efficacy in male patients

Objective: To explore the factors associated with severe bleeding after percutaneous nephrolithotomy (PCNL) in male patients and evaluate the efficacy of interventional embolization. Methods: A retrospective case series study was conducted at Nankai Hospital of Tianjin, China, from January 2018 to October 2021. The clinical data of 230 male patients with upper urinary tract stones were analyzed. The observation indicators included age, hypertension, diabetes, renal function abnormalities, history of preoperative anticoagulant use, stone size, stone type, number of puncture channels, operation time and degree of hydronephrosis. To describe the clinical characteristics of bleeding after percutaneous nephrolithotomy in men, and analyze the factors associated with severe bleeding after PCNL. Single factor analysis was performed using the Chi-square (χ2) test, and multivariate analysis was performed using logistic regression analysis. Results: Univariate analysis showed that diabetes mellitus (χ2=4.90, P=0.027), abnormal renal function (χ2=18.32, P<0.001), history of preoperative oral anticoagulants (χ2=5.10, P=0.024), abnormal bleeding and coagulation function (χ2=8.22, P=0.004) and the number of puncture channels (χ2=22.08, P<0.001) were the related factors affecting bleeding after PCNL. Multivariate logistic regression analysis showed that diabetes mellitus (P=0.032), abnormal renal function (P<0.001), and the number of puncture channels (P<0.001) were the independent risk factors of bleeding after PCNL. Of the 28 patients with bleeding after PCNL, 25 were treated with interventional embolization, with a technical success rate of 100.0% and a clinical success rate of 89.3%. Conclusions: For patients with renal calculi and comorbid diabetes, renal function abnormalities, and multiple punctures, relevant preventive measures should be actively administered before PCNL to reduce the risk of postoperative bleeding. For patients with severe bleeding of the kidney after PCNL, TAE is a safe and effective minimally invasive treatment method.

Multistaged retrograde intrarenal surgery for large renal stones – our institutional experience

Background: Recent advances such as retrograde intrarenal surgery (RIRS) have become an acceptable and widespread technique for upper urinary tract stone management. However, the outcome and complication of staged RIRS for large stone burden (&gt;2.0) still needs to be reported. A total of 150 cases of renal calculi were treated by RIRS in a single center. Among these, 30 had renal stone size larger than 2.0 cm. Aims and Objectives: This study was conducted to present our views, experience, and outcomes of Retrograde Intra Renal Surgery for the Management of Large Renal Stones in Staged Manner using Flexible Ureteroscope with Holmium Laser as energy Source. Materials and Methods: Between March 2020 and January 2022, we admitted 150 patients with upper urinary tract stones who underwent RIRS using 30 Watt Holmium laser lithotripsy in our institute. Post-surgery, all the cases are evaluated in terms of stone free rates (SFR) complications and effectiveness of RIRS. Results: A total of 150 patients having upper urinary tract stones were included in this study (84 male and 66 female patients). All patients underwent RIRS using 30 watt holmium laser lithotripter. The overall SFR was 90.6%. The average stone size was 1.1 cm with average operation time of 100.6 min. Average hospital stay was 2.2 days. The average pain score was 2.1/10 by the Numerical Rating Scale. No major complications (Clavien Dindo III- V) were noted in the study groups. Conclusion: Through our study, we concluded that RIRS for large renal stone management is an effective and safe treatment modality currently.

Impact of the COVID-19 pandemic on intracorporal endoscopic treatment in patients with upper urinary tract stones

Impact of the COVID-19 pandemic on intracorporal endoscopic treatment in patients with upper urinary tract stones

An analysis of stone management over the decade before the COVID-19 pandemic in Germany, France and England.

To understand the implications that the rising upper urinary tract (UUT) stone prevalence in Europe and the increasing burden places on patients and healthcare providers (HCPs), we investigated the evolution of diagnoses and procedures in Germany, France and England over the decade before the coronavirus disease 2019 (COVID-19) pandemic. We identified International Classification of Diseases (ICD)-10 codes related to UUT stones diagnosis and extracted procedure volumes for extracorporeal shockwave lithotripsy (ESWL), ureteroscopy (URS), percutaneous nephrolithotomy and open surgery using national procedure codes from the German Institute for the Hospital Remuneration System, the French Technical Agency of Hospitalisation Information and NHS England Hospital Episode Statistics. We analysed procedures vs hospital diagnoses from 2010 to 2019 and reported results per 100 000 inhabitants. Between 2010 and 2019, ICD-10 N20 codes for calculus of kidney and ureter increased by 8%, 26% and 15% in Germany, France, and England respectively; whereas procedures increased by 3%, 38% and 18%. Of the patients diagnosed with stones, the percentage that received treatment (of any type) differed between countries. In 2019, in Germany 83% of patients diagnosed with stones received treatment, in France 88%, and in England 56%. These figures were relatively stable over the 10-year study period. Over the past decade, the dominant procedure shifted from ESWL to URS, and the average length of stay for URS decreased. Day case procedures increased in France and England (by 68% and 23%), no data were available in Germany. This analysis highlights an increase in stone diagnoses and procedures, and a shift of surgical management. This development may be due to clinical advantages and advanced technology. The continued stone prevalence rise affects patients, hospitals, and HCPs.

Approaches to the Treatment of Patients with Upper Urinary Tract Stones and Comorbid Vascular and Cardiological Pathology

Urinary stone disease (USD) is associated with the formation of sand and calculi in the organs of the urinary system. This is a common chronic pathology, which is characterized by the frequent exacerbations and a severe course. Without timely treatment, USD threatens of the urinary tract blockage and intoxication of the organism. The article emphasizes the importance of carefully the treatment choose of patients with stones of the upper urinary tract and vascular and cardiac pathologies, because these nosologies have common etiological links and are related to age and sex. An analysis of methodological and scientific literature was carried out to study approaches to the treatment of patients with USD with comorbid vascular and cardiac pathologies. Various methods were used, namely: the search for methodological and scientific literature, in particular induction and deduction, comparison, classification, systematization, abstraction and specification, analysis of documentation. The analysis of approaches to the treatment of patients with stones of the upper urinary tract demonstrated that there are two main approaches to treatment – conservative therapy and surgical treatment. Due to a number of reasons, conservative medical treatment can be used only in some cases as the method of choice for the treatment of patients with USD. The use of extracorporeal shock wave lithotripsy (ESWL) for the destruction of stones in the kidneys and ureters significantly increases the effectiveness of treatment of the patients. However, in patients who were operated for cardiovascular pathology, in the case of complete withdrawal of anticoagulant therapy, even for a short period, the risk of complications increases. Therefore, before performing ESWL in such patients, it is recommended to reduce the anticoagulant dose or switch to low-molecular-weight heparins 3-4 days before the planned surgical intervention. During the treatment of patients with calculi of the upper urinary tract and vascular and cardiac pathologies, a careful choice of treatment and the involvement of related specialists are necessary.

Correlation between perioperative characteristics and quality of life measured by IT- WISQOL in patients with upper urinary tract stones

Correlation between perioperative characteristics and quality of life measured by IT- WISQOL in patients with upper urinary tract stones

Urinary shedding of common DNA viruses and their possible association with bladder cancer: a qPCR-based study.

After a decade of human urinary microbiota research, little is known about the composition of the urinary virome and its association with health and disease. This study aimed to investigate the presence of 10 common DNA viruses in human urine and their putative association with bladder cancer (BC). Catheterized urine samples were collected from patients undergoing endoscopic urological procedures under anesthesia. After DNA extraction from the samples, viral DNA sequences were detected using real-time PCR. Viruria rates were compared between BC patients and controls. A total of 106 patients (89 males and 17 females) were included in the study. Fifty-seven (53.8%) were BC patients and 49 (46.2%) had upper urinary tract stones or bladder outlet obstruction. The viruses detected in the urine were human cytomegalovirus (2.0%), Epstein-Barr virus (6.0%), human herpesvirus-6 (12.5%), human papillomavirus (15.2%), BK polyomavirus (15.5%), torque teno virus (44.2%), and JC polyomavirus (47.6%), while no adenoviruses, herpes simplex virus 1 and 2, or parvoviruses were found. There were statistically significant differences in HPV viruria rates between cancer patients and controls (24.5% vs. 4.3%, p=0.032 after adjustment for age and gender). Viruria rates increased from benign to non-muscle-invasive and muscle-invasive tumors. Patients with a history of BC have higher HPV viruria rates than controls. Whether this relationship is a causal one remains to be established by further research.

Totally X-ray-Free Ultrasound-Guided Mini-Percutaneous Nephrolithotomy in Galdakao-Modified Supine Valdivia Position: A Novel Combined Surgery.

We introduced a novel surgery that combines ultrasound guidance, miniaturization and Galdakao-modified supine Valdivia (GMSV) position in percutaneous nephrolithotomy (PCNL) and evaluated the safety and efficacy. This retrospective, single-center study retrospectively reviewed 150 patients who underwent ultrasound-guided mini-PCNL in the GMSV position from November 2019 to March 2022. All perioperative parameters were collected. Stone-free status was defined as no residual stones or clinically insignificant residual fragments (CIRF) &lt;0.4 cm on postoperative day one. Among the 150 patients, the mean age was 56.96 years. The mean stone size was 3.19 cm (427 mm2). The mean S.T.O.N.E. score was 7.61, including 36 patients (24%) with scores ≥9. The mean operative time was 66.22 min, and the success rate of renal access creation in the first attempt was 88.7%. One hundred and forty (93.3%) patients were stone free. The mean decrease in Hemoglobin was 1.04 g/dL, and no patient needed a blood transfusion. Complications included transient hematuria (n = 13, 8.7%), bladder blood clot retention (n = 2, 1.3%), fever (n = 15, 10%) and sepsis (n = 2, 1.3%). Totally X-ray-free ultrasound-guided mini-PCNL in the GMSV position is feasible, safe and effective for patients with upper urinary tract stones, indicating the synergistic and complementary effects of the three novel techniques.

Incremental Healthcare Cost Implications of Retreatment Following Ureteroscopy or Percutaneous Nephrolithotomy for Upper Urinary Tract Stones: A Population-Based Study of Commercially-Insured US Adults.

This study describes the incremental healthcare costs associated with retreatment among adults undergoing ureteroscopy (URS) or percutaneous nephrolithotomy (PCNL) for upper urinary tract stones (UUTS). The IBM® MarketScan® Commercial Database was used to identify adults aged 18-64 years with UUTS treated with URS or PCNL between January 2010 and December 2019. Patients had 12 months of continuous insurance coverage before (baseline) and after (follow-up) the first (index) procedure. The primary outcome was total all-cause healthcare costs measured over the 365-day follow-up period, not inclusive of index costs. Generalized linear models were used to estimate the incremental costs associated with retreatment within 90 (early) or 91-365 days post-index (later) relative no retreatment. The models adjusted for demographics, comorbidities, stone(s) location, treatment setting, procedural characteristics (eg, 1-step vs 2-step PCNL) and index year. Approximately 23% (27,402/119,800) of URS patients were retreated (82% had early retreatments). The adjusted mean total cost was $10,478 (95% CI: $10,281-$10,675) for patients with no retreatment, $25,476 (95% CI: $24,947-$26,004) for early retreatment ($14,998 incremental increase, p<0.01), and $32,868 [95% CI: $31,887-$33,850] for later retreatment ($22,391 incremental increase, p<0.01). Approximately 36% (1957/5516) of PCNL patients were retreated (78% had early retreatments). The adjusted mean total cost was $13,446 (95% CI: $12,659-$14,273) for patients with no retreatment, $37,036 [95% CI: $34,926-$39,145]) for early retreatment ($23,570 incremental increase, p<0.01), and $35,359 (95% CI: $32,234-$38,484) for later retreatment ($21,893 incremental increase, p<0.01). Retreatment during the first year following URS or PCNL was needed in 23% and 36% of patients, respectively, and was associated with an economic burden of up to $23,500 per patient. The high rate of retreatment and associated costs demonstrate there is an unmet need to improve mid- to long-term results in URS and PCNL.

Analysis of the Components of 236 Cases of Urinary Stones in Xinjiang Uyghur Children.

The aim of the study is to explore the relationship between clinical characteristics and urinary calculus in Xinjiang Uyghur children, and to provide clinical basis for the prevention as well as treatment of urinary stone. In total, 236 urinary tract stone samples were collected from pediatric patients from February 2017 to April 2019, and those samples were analyzed by infrared spectroscopy. Stone compositions were compared with demographic data. Among the 236 cases, 166 cases were boys (70.34%) and 70 cases were girls (29.66%), with a male-to-female ratio of 2.37:1. A total of 21 kinds of calculi were detected, including 107 cases with six kinds of simple calculi and 129 cases with 15 kinds of mixed calculi. In this study, magnesium ammonium phosphate hexahydrate was only found in boys, and the difference was statistically significant (6.6 vs. 0.0%, p = 0.037). There were statistical differences in the age distribution of children with ammonium hydrogen urate, calcium oxalate, and other stone components (p < 0.05), while there were no statistical differences in the age distribution of children with apatite carbonate, magnesium ammonium phosphate hexahydrate, and anhydrous uric acid. The results showed that there was a significant difference in the localization of calculi between male and female children (upper urinary tract stones: 78.9 vs. 98.6%, p < 0.001). Uyghur pediatric patients with urolithiasis were young and the majority of stones was mixed, The main components of calculi were ammonium hydrogen urate, calcium oxalate and apatite carbonate, and there are differences in the localization of calculi between genders.

Comparison of Surgical Outcomes between Single-Use and Reusable Flexible Ureteroscopes for Renal Stone Management: A Systematic Review and Meta-Analysis.

Background and Objectives: Disposable flexible ureteroscopes have been widely used because of their cost-effectiveness and higher sterility potential compared with reusable flexible ureteroscopes. This study aimed to compare the surgical outcomes and complication rates in patients who undergo reusable or disposable flexible ureteroscopic stone surgeries (fURS) for urinary stone disease. Materials and Methods: A systematic review and meta-analysis were conducted under the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline. This systematic review was registered with PROSPERO (CRD42022331291). Clinical trials comparing reusable and disposable fURS for stone disease were found from PubMed, EMBASE, Cochrane Library, and the Web of Science up to March 2022. Participants were patients with upper urinary tract stones; the interventions were reusable or disposable fURS. Outcomes, including stone-free rate, operation time, length of hospital stay, and complication rate, were compared for analysis. Results: Overall, 111 studies were identified, but after removing duplicate studies, 75 studies remained. Thirty-two of these studies were excluded. Of the 43 screened studies, 11 met the eligibility criteria. There was no difference in the stone-free rate (SFR) between disposable and reusable fURS (p = 0.14; OR = 1.36; 95% CI, 0.9 to 2.04). For operation time, no difference was identified between reusable and disposable fURS groups (p = 0.12; MD = −5.31; 95% CI, −12.08 to 1.46). For hospital stay, there was also no difference between the two groups (p = 0.61; MD = −0.03; 95% CI, −0.17 to 0.10). There was no significant difference in complication rate between the two groups (p = 0.85; OR = 0.95; 95% CI, 0.56 to 1.61). Conclusions: There were no differences in the SFR, operation time, length of hospital stay, and complication rate between reusable and disposable fURS. Disposable fURS may be a comparable alternative to reusable fURS.

High attenuation value in non-contrast computer tomography can predict pyonephrosis in patients with upper urinary tract stones.

To evaluate whether the higher attenuation value [Hounsfield unit (HU)] in non-contrast CT can predict pyonephrosis in patients with upper urinary tract stones (UTS). Between October 2019 and October 2021, patients with hydronephrosis or pyonephrosis secondary to upper UTS were retrospectively searched in our study. All patients with UTS were treated with percutaneous nephrostomy, percutaneous nephrolithotomy, retrograde ureteral stent or transurethral ureteroscope lithotripsy. We excluded patients treated with extracorporeal shock-wave lithotripsy. Patients whose CT was not performed in our hospital or treated in another hospital were also excluded. Clinical data regarding basic information, clinical feature, Calculi-related indicators, HU values of the renal pelvis, the thick wall of the renal pelvis on CT were collected. Univariate and multivariate logistic analyses were performed. Receiver operative characteristic curves were drawn to predict pyonephrosis. A total of 240 patients with UTS were retrospected in this research, 191 patients had hydronephrosis (Group 1), and 49 patients had hydronephrosis with pyonephrosis (Group 2). The HU value of the renal collecting system in Group 2 (mean, 15.46; range, +1/+30) was significantly higher than that in Group 1 (mean, 5.5; 5 range −6/+24) (P = .02); the receiver operative characteristic curve analysis revealed that the best cut-off value of 9.5 could predict the presence of pyonephrosis, with 71.4% sensitivity and 70.2% specificity (area under the curve = 0.613; 95% CI: 0.514–0.713). In this study, we found the HU attenuation value of the renal collecting system can be used to distinguish pyonephrosis from hydronephrosis in patients with UTS.

Association of Kidney Stones with Upper Tract Urothelial Carcinoma Revealed Incidentally by an Attempt at Percutaneous Nephrolithotomy: About A Case

The applicability of the recommendations of the European Association of Urology (EAU) concerning the diagnostic evaluation of upper urinary tract urothelial carcinoma (UTUC) can sometimes come up against complex clinical features such as the association of upper urinary tract (UUT) stones with UTUC where it is masked by stones thus making its diagnosis difficult. Hence its incidental discovery during the treatment of the stones, thus reflecting a non-recommended diagnostic approach to UTUC. We report a case of UTUC revealed incidentally by an attempt at right percutaneous nephrolithotomy (PCNL) for kidney stones in a 72-year-old Moroccan with history of chronic smoking, extra corporal shock wave lithotripsy (ESWL) for right kidney stone, who consulted at the Military Hospital in Rabat for chronic right low back pain associated with intermittent macroscopic hematuria. In whom the reference diagnostic assessment of UTUC and retrograde pyelography (RP) could not establish the diagnosis. The interest of this case is to insist on the possibility of a coexistence of stones with UTUC in the event of macroscopic hematuria associated with UUT stones. In addition, this case makes it possible to report the limitations of the accuracy of the reference diagnostic assessment of UTUC.

Frequency of Occurrence and Clinical Picture of Urolithiasis on the Background of Benign Prostatic Hyperplasia

The purpose of the study was to identify the frequency of occurrence of urolithiasis against the background of benign prostatic hyperplasia, to find out whether the presence of benign prostatic hyperplasia in a patient affects the frequency of occurrence of urolithiasis, to study the clinical picture to understand whether there is some general or specific clinical picture or some feature inherent in the clinic when occurrence of urolithiasis and benign prostatic hyperplasia are accompanying each other. Materials and methods. The clinical data of 152 patients aged over 45 years who underwent examination and treatment in 2005-2015 at the A. Aliyev Azerbaijan State Institute of Advanced Medical Training and at the Shirvan Medical Diagnostic Center in 2008-2015 were analyzed. Against the background of benign prostatic hyperplasia, 85 (55.92%) patients had upper urinary tract stones. Of these, 52 (34.21%) had kidney stones, and 33 (21.71%) had ureteral stones. Bilateral nephrolithiasis was detected in 16 (10.5%) patients, unilateral – in 36 (23.68%), bilateral ureterolithiasis – in 2 (1.32%), unilateral – in 31 (20.39%) patients. Of 152 patients, bladder stones were detected in 112 (73.4%) patients. The bulk of the examined patients were patients who had bladder stones on the background of benign prostatic hyperplasia. Of these 112 patients, 25 (16.45%) had kidney stones along with cystolithiasis, one (0.89%) had left-sided ureterolithiasis, and one (0.89%) had bilateral nephrolithiasis and left-sided ureterolithiasis. To characterize the clinical signs of infravesical obstruction in benign prostatic hyperplasia, the Guyon classification was applied. Most of the patients – 102 (67.12%) patients according to this classification were at the II stage of benign prostatic hyperplasia. The number of patients at stage I was 29 (19.08%), and at stage III – 21 (13.82%). Results and discussion. In this study in patients over 45 years, nephrolithiasis on the background of benign prostatic hyperplasia was detected in 34.21% of cases, ureterolithiasis on the background of benign prostatic hyperplasia – in 21.71% of cases, cystoliasis on the background of benign prostatic hyperplasia – in 73.4% of cases, and cystolithiasis and upper urinary stones on the background of benign prostatic hyperplasia – in 17.8% of cases. As can be seen from the data presented, the bulk of the examined patients were patients who had bladder stones on the background of benign prostatic hyperplasia. Conclusion. The presence of bladder outlet obstruction and the aggravation of the stage of benign prostatic hyperplasia increase the incidence of cystolithiasis and aggravate the clinical picture of urolithiasis, leading to its complications. At the same time, the presence of concomitant urolithiasis aggravates the clinical picture of benign prostatic hyperplasia, that is, there is a syndrome of mutual weighing of clinical symptoms. There is no general and specific clinical picture in the clinic. There are the same signs and complications that are inherent in both pathologies. Therefore, there is a need for a deeper study of such patients for the correct diagnosis and choice of a rational method of treatment