Urolithiasis Research Articles

AI-Augmented Kidney Stone Composition Analysis with Auto-Release Improves Quality, Efficiency, Cost–Effectiveness, and Staff Satisfaction

Abstract Background We sought to evaluate key performance indicators related to an internally developed and deployed artificial intelligence (AI)-augmented kidney stone composition test system for potential improvements in test quality, efficiency, cost-effectiveness, and staff satisfaction. Methods We compared quality, efficiency, staff satisfaction, and financial data from the 6 months after the AI-augmented laboratory test system was deployed (test period) with data from the same 6-month period in the previous year (control period) to determine if AI-augmentation improved key performance indicators of this laboratory test. Results In the 6 months following the deployment (test period) of the AI-augmented kidney stone composition test system, 44 830 kidney stones were analyzed. Of these, 92% of kidney stones were eligible for AI-assisted interpretation. Out of these AI-eligible stones, 45% were able to be auto-released by the AI-augmented test system without human secondary review. Furthermore, the new AI-augmented kidney stone test system resulted in an apparent 40% reduction in incorrect laboratory results. Additionally, the new AI-augmented test system improved laboratory efficiency by 20%, improved staff satisfaction, and reduced the average analysis cost per kidney stone by $0.23. Conclusions The AI-augmented test system improved test quality, efficiency, cost-effectiveness and staff satisfaction related to this kidney stone composition test.

A Prospective, Randomized, Noninferiority Study to Evaluate the Safety and Effectiveness of Steerable Ureteroscopic Renal Evacuation Compared with Standard Ureteroscopy: 30-Day Results of the ASPIRE Study.

Purpose: We report the first multicenter, prospective, randomized noninferiority controlled trial of steerable ureteroscopic renal evacuation (SURE) for nephrolithiasis treatment. Materials and Methods: Candidates for laser lithotripsy ≥18 years with ≥1 renal stone ≥7 mm and 7-20 mm stone burden were randomized 1:1 SURE vs ureteroscopy (URS). SURE was performed using the CVAC Aspiration System, a novel steerable irrigation-aspiration catheter. The primary efficacy end point was noninferiority in stone-free rate (SFR) based on zero residual fragments (RFs) 30 days postprocedure on noncontrast computed tomography. Secondary end points were superiority tests, stone clearance (percent stone volume reduction), residual stone volume (RSV), SFR (no RF >2 mm), and SFR (no RF >4 mm) 30 days postprocedure. Results: Of the subjects, 123 were randomized and 101 qualified for efficacy analysis (SURE 46 vs URS 55). Despite randomization, baseline URS stone volume was higher (SURE 485.0 ± 432.5 mm3 vs URS 713.3 ± 558.5 mm3). The primary noninferiority end point was achieved (SURE SFR 48% vs URS SFR 49%, p = 0.027, -1.3% [90% confidence interval; -18%, 15%]). Stone clearance was significantly higher for SURE vs URS subjects (SURE 96.9 ± 5.6% vs URS 92.9 ± 11.6%, p = 0.036); RSV was significantly lower (SURE 14.3 ± 3 0.9 mm3 vs URS 70.2 ± 144.9 mm3, p = 0.012). SURE stone clearance and RSV were independent of baseline stone volume, but for URS degraded with increasing baseline stone volume. Safety was comparable between groups. Conclusions: SFR for SURE subjects was noninferior compared with URS subjects; stone clearance and RSV were significantly better with SURE, independent of baseline stone volume.

KidneyNet: A Novel CNN-Based Technique for the Automated Diagnosis of Chronic Kidney Diseases from CT Scans

This study presents KidneyNet, an innovative computer-aided diagnosis (CAD) system designed to identify chronic kidney diseases (CKDs), such as kidney stones, cysts, and tumors, in CT scans. KidneyNet utilizes a convolutional neural network (CNN) structure consisting of eight convolutional layers, three pooling layers, a flattening layer, and two fully connected layers. Small filters enhance computational efficiency by reducing the number of parameters and minimizing the risk of overfitting compared to larger filters. The model captures more complex and abstract features as data move through the layers. The initial layers identify basic patterns, while the deeper layers focus on more intricate representations. KidneyNet aims to enhance the efficiency and accuracy of kidney disease diagnosis. Additionally, the model incorporates the gradient-weighted class activation mapping (Grad-CAM) algorithm, which helps to pinpoint affected areas in the scans. This feature improves interpretability, allowing clinicians to identify which regions the model deemed significant for detecting abnormalities such as tumors, cysts, or stones. Through extensive testing on a CT kidney dataset, KidneyNet demonstrated impressive performance metrics, with 99.88% accuracy, 99.92% specificity, 99.76% sensitivity, 99.58% precision, and an F1 score of 99.67%, outperforming existing models. This approach alleviates the diagnostic burden on radiologists and promotes early detection, potentially saving lives. This study highlights the critical role of advanced imaging analysis in addressing kidney conditions and emphasizes KidneyNet’s capability to deliver precise and cost-effective diagnoses.

Robot-Assisted Pyelolithotomy in Pelvic Kidney

Background/Objectives: Pelvic kidney is a congenital anomaly characterized by the kidney’s failure to ascend to its normal anatomical location during early embryonic development. This anomaly complicates traditional surgical approaches for renal calculi due to the kidney’s atypical positioning and associated anatomical challenges. We sought to summarize our experience with robotic-assisted pyelolithotomy (RPPK) for pelvic kidney stones. Methods: A retrospective review of patients who underwent RPPK was conducted between 2014 and 2023. Demographic data on stone characteristics, operative details, and postoperative outcomes were analyzed. Results: Four patients (three male; mean age—51.2 years with a range of 45–54; mean BMI—26.6 with a range of 22.3–32.2) underwent RPPK. All had a right-sided pelvic kidney; two had prior failed ureteroscopy. The mean stone diameter was 27.7 mm (range: 17–35); the mean density was 1207.5 HU (range: 905–1500). The mean operative time was 265 min (range: 200–323); the time from incision to closure was 142.2 min (range: 95–225). No ureteral stents or drains were used. Blood loss was negligible. The mean hospital stay was 2.2 days. No immediate complications were recorded. The mean follow-up was 11.75 months (range: 3–30). Conclusions: RPPK is safe and effective for managing pelvic kidney stones. Challenging renal anatomy stone size and density are not obstacles to the robotic approach unlike other fragmentation methods

Simulation of the temperature distribution of kidney stones induced by thulium fiber laser and Ho: YAG laser lithotripsy.

Simulation studies on temperature distribution in laser ablation help predict ablation rates, laser settings, and thermal damage. Despite the limited number of reported numerical studies on the temperature distribution of kidney fluid, there is no simulation study for kidney stone temperature distribution. We employ a numerical approach to study the kidney stone temperature distribution and predict ablation rates, which is an important parameter for clinical lithotripsy. The study looked at how the thulium fiber laser and the Ho:YAG laser differ in terms of temperature profile and ablation depth of kidney stones like calcium oxide monohydrate. The ablation depth increased from 152.7µm to 489.7µm when the TFL laser (operated at 10Hz repetition rate and 1ms pulse width) fluence increased from 764J/cm2 to 1146J/cm2. Correspondingly, the depth increased from 21µm to 68µm for the Ho: YAG laser operated at 3Hz and 0.22ms pulse width. We attribute this to an increase in temperature with laser energy. We further investigated the effect of pulse width on ablation depth by considering three different TFL pulse widths: 0.5ms, 0.75ms, and 1ms. There was a decrease in ablation depths from 402.5µm to 242.6µm when the pulse width increased from 0.5ms to 1ms. Because of lower water absorption coefficients, the Ho:YAG laser (70mJ/10Hz) produced a smaller ablation depth and temperature profile than the thulium fiber laser (70mJ/10Hz). Experimental results from the literature validated the simulation. We found that the Ho:YAG laser worked better for ablation when it was set to 0.2J/100Hz for the Ho:YAG laser and 0.4J/50Hz for the TFL laser, which were clinical laser settings that we found in the literature. This indicates that, in addition to laser absorption by water, the laser parameters also significantly influence temperature distribution and ablation.

Evaluating the Effectiveness of Shockwave Lithotripsy vs Ureteroscopic Lithotripsy for Treatment of Renal Stones: A Prospective Cohort Study

Evaluating the Effectiveness of Shockwave Lithotripsy vs Ureteroscopic Lithotripsy for Treatment of Renal Stones: A Prospective Cohort Study

Whole exome sequencing reveals heparan sulfate proteoglycan 2 (HSPG2) as a potential causative gene for kidney stone disease in a Thai family

Kidney stone disease (KSD) is a prevalent and complex condition, with an incidence of 85 cases per 100,000 individuals in Thailand. Notably, over 40% of cases are concentrated in the northeastern region, indicating a potential genetic influence, which is supported by genetic mutations reported in several families by our research group. Despite this, the genetic basis of KSD remains largely unknown for many Thai families. This study aimed to identify the genetic mutation responsible for KSD in a specific Thai family, the UBRS131 family, which includes four affected individuals. Whole exome sequencing was performed, and variant filtering using the VarCards2 program identified 10 potentially causative mutations across 9 genes. These mutations were subjected to segregation analysis among family members and screened in 180 control and 179 case samples using real-time PCR-HRM or PCR-RFLP techniques. Prioritization of these variants using GeneDistiller identified the p.Asp775Glu mutation in the heparan sulfate proteoglycan 2 (HSPG2) gene as the likely causative mutation for KSD in this family. The Asp775 residue is highly conserved across vertebrates, and structural analysis suggests that the Glu775 substitution may disrupt the formation of two crucial hydrogen bonds, potentially altering the mutant protein’s configuration. Immunohistochemistry confirmed the presence of perlecan (HSPG2 protein) in the proximal tubules in nephrons. These findings highlight the significant role of the HSPG2 gene in familial KSD within this study family.

A Modified Ultra-Mini-Percutaneous Nephrolithotomy (mUMP) Can Achieve Renal Stone-Free Rates Comparable to Conventional Tubeless Percutaneous Nephrolithotomy (tPCNL) for Certain Stone Sizes and Characteristics

Objective: To compare stone free rate results from modified ultra-mini-percutaneous nephrolithotomy (mUMP) and conventional tubeless percutaneous nephrolithotomy (tPCNL). Materials and Methods: The present study was a retrospective cohort study in renal stone patients admitted at Sunpasitthiprasong Hospital, Thailand, between 2013 and 2021 by excluding patients with pregnancy, uncorrectable coagulopathy, and active urinary tract infection. Data was collected from 317 patients that matched criteria of patient characteristics, stone characteristics, intraoperative data, and surgical outcomes. The primary and secondary outcome were analyzed by assessing the stone-free rate immediately post-operative, within 24 hours, and at four weeks follow-up. This included perioperative data and subgroup analysis based on stone size of 20 mm or less and more than 20 mm. Results: The group was separated into tPCNL with 184 patients and mUMP with 133 patients. The results of primary and secondary outcome of stone-free rates immediately post-operative and at follow up in tPCNL was 74.5% and 75% and in mUMP was 85% and 86.5%. When comparing stone size in subgroups of 20 mm or less, it was 100% in tPCNL and 95.5% in mUMP, however in the group of more than 20 mm stone, tPCNL was 71.3% and mUMP was 68.9%. Conclusion: The mUMP is a safe and effective treatment compared to conventional tPCNL for stones of 20 mm or less. Furthermore, the mUMP group patients experienced less post-operative pain, shorter hospital stays, reduction of blood transfusions needs, lower irrigation volume required, and less postoperative urinary tract infection. Keywords: Endoscopes; Kidney; Kidney calculi; Percutaneous lithotripsy; Percutaneous nephrostomy; Nephrolithotomy

Research trends and frontiers on risk factors of urinary stones: a bibliometric analysis from 2010 to 2023

Background and objective The occurrence of urinary stone disease (USD) is associated with several factors. However, no conclusive results have been reached regarding the treatment of USD risk factors. This study conducted a detailed bibliometric analysis of USD risk factors to determine research hotspots and provide future development directions. Methods Articles and reviews on the USD risk factors published between 2010 and 2023 were retrieved from the Web of Science Core Collection. Co-occurrence and collaboration analyses of countries, institutions, authors, journals, references, and keywords were conducted using CiteSpace, VOSviewer, and R-Bibliometrix. Results A total of 436 articles on USD risk factors were included in the study. China and the United States have emerged as the leading countries in this field, with the Mayo Clinic having the highest amount of publication output. Among all the authors, Ferraro PM had the highest number of publications, while Taylor EN was the highly cited author. The journal with the highest number of publications was UROLITHIASIS. Scales reported the reference with the highest burst strength. The current citation themes in research on USD risk factors were ‘multifaceted relationship’ and ‘kidney stone disease recurrence’. ‘Medical-management’ was identified as a major keyword, indicating future research hotspots. Conclusion This study employed bibliometric methods to conduct a comprehensive visual analysis of USD risk factors to show publication trends and popular topics in this area over the past decade. The results provide a valuable reference for future research on the risk factors of USD.

Bidirectional associations among gallstone disease, non-alcoholic fatty liver disease, kidney stone disease.

A body of evidence has suggested bidirectional relationships among gallstone disease (GSD), non-alcoholic fatty liver disease (NAFLD), and kidney stone disease (KSD). However, the results are inconsistent, and studies on this topic in China are relatively few. Our goal is to explore the bidirectional associations among these three diseases through a multicenter study, systematic review, and meta-analysis. To explore the bidirectional associations among these three diseases through a multicenter study, systematic review, and meta-analysis. The results may help to investigate the etiology of these diseases and shed light on the individualized prevention of these three diseases. Subjects who participated in physical examinations in Beijing, Tianjin, Chongqing in China were recruited. Multivariable logistic regression was employed to explore the bidirectional relationships among GSD, KSD, and NAFLD. Systematic review and meta-analysis were initiated to confirm the epidemiologic evidence from previous observational studies. Furthermore, trial sequential analysis (TSA) was conducted to evaluate whether the evidence was sufficient and conclusive. Significant bidirectional associations were detected among the three diseases, independent of potential confounding factors. The pooled results of the systematic review and meta-analysis also corroborated the aforementioned results. The combined evidence from the multicenter study and meta-analysis was significant [pooled odds ratio (OR) = 1.42, 95%CI: 1.16-1.75, KSD → GSD; pooled OR = 1.48, 95%CI: 1.31-1.67, GSD → KSD; pooled OR = 1.31, 95%CI: 1.17-1.47, GSD → NAFLD; pooled OR = 1.37, 95%CI: 1.26-1.50, NAFLD → GSD; pooled OR = 1.28, 95%CI: 1.08-1.51, NAFLD → KSD; pooled OR = 1.21, 95%CI: 1.16-1.25, KSD → NAFLD]. TSA indicated that the evidence was sufficient and conclusive. The present study presents relatively sufficient evidence for the positive bidirectional associations among GSD, KSD, and NAFLD. The results may provide clues for investigating the etiology of these three diseases and offer a guideline for identifying high-risk patients.

Based on network pharmacology, the mechanism of Dioscin in alleviating renal tubular epithelial cell injury induced by calcium oxalate crystals was explored.

The commencement of kidney stone formation involves a crucial initial phase characterized by injury to renal tubular cells caused by calcium oxalate (CaOx). Dioscin (Dio) has been acknowledged for its potent anti-inflammation and anti-apoptotic properties; nevertheless, the impact and underlying Investigation into the molecular basis underlying the action of Dioscin in mitigating inflammation and apoptotic induced by exposure to calcium oxalate crystals in renal tissues remain unexplored.To comprehend the precise mechanism of Dioscin in the treatment of crystalline nephropathy, we conducted experiments utilizing a murine model of CaOx crystal deposition, induced by intraperitoneal administration of glyoxylate. An in vitro model was constructed using HK-2 cells exposed to calcium oxalate monohydrate (COM). To evaluate the effect of Dioscin on calcium oxalate crystal deposition by ROS assay, Western blotting, immunohistochemistry, Periodic Acid-Schiff staining (PAS) staining, hematoxylin-eosin (H&E) staining. Using network pharmacology and molecular docking methods, we explored the molecular mechanism of Dioscin in the treatment of CaOx-induced renal tubular epithelial cell injury. Subsequently, we conducted experiments to verify our findings.We observed a significant protective effect of Dioscin treatment against kidney oxidative stress and inflammation induced by CaOx. Then we predicted through network pharmacology that Dioscin exerts its anti-apoptotic effect through the NF-kappa B signaling pathway. Then we verified in vitro and in vivo that administration of Dioscin can alleviate the elevation of TLR4 and activation of the NF-kappa B signaling pathway induced by calcium oxalate, as well as attenuate renal apoptosis. Instead, the beneficial impact of this protection of Dioscin was reversed after overexpression of the TLR4.Dioscin has the potential to alleviate the activation of the NF-kappa B signaling pathway through TLR4, thereby exerting anti-inflammatory and anti-apoptotic effects. This study provides new ideas for the prevention and treatment of kidney stones.

Kidney stone analysis: an EAU section of urolithiasis (EULIS) survey on current practices and perspectives worldwide.

To investigate the current thoughts and perspectives on kidney stone analysis amongst urologists and urology residents worldwide. In October 2022 an online survey supported by the EULIS was circulated amongst urologists and urology residents worldwide. The survey was based on the current EAU guidelines regarding stone analysis and its role in urolithiasis management. Responses were collected until February 2023. The survey was completed by 351 urologists (75.4%) and 115 urology residents (24.7%). 49.1% of the participants stated that performing kidney stone analysis was of utmost importance in every patient. 91.8% were of the opinion that stone analysis changes KSD management. 62.3% of the participants declared to adhere to the guidelines. 44.7% aim to perform stone analysis in first-time stone formers. 1 out of 11 does not send stones for kidney stone analysis at all. Urologists that pursued an additional endo-urology sub-specialism performed stone analysis more frequently compared to those who were not endo-urologists. Although majority of urologists consider stone analysis an essential part of kidney stone management, in reality the practice patterns regarding stone analysis deviate from the EAU guidelines. Our aim should be to bridge the knowledge gap regarding stone analysis, foster collaboration to streamline logistics regarding stone analysis and enhance the quality of care we provide for kidney stone patients.

Development and Validation of a Nomogram for Predicting Systemic Inflammatory Response Syndrome Following Percutaneous Nephrolithotomy.

Objective: To develop and validate a nomogram for predicting the occurrence of systemic inflammatory response syndrome (SIRS) following percutaneous nephrolithotomy (PCNL), aiming to enhance clinical decision-making and treatment planning. Methods: Clinical data of 1,047 patients undergoing PCNL at a single-center hospital between 2017 and 2023 were retrospectively analyzed. Independent risk factors influencing SIRS occurrence were identified through multi-variable logistic regression analysis, and a predictive model was constructed. The model's accuracy and reliability were evaluated through internal training and validation set. Results: Multi-variable regression analysis identified six key predictive factors: gender, diabetes, urine culture results, stone surface, staghorn stones, and operative time, leading to the establishment of a nomogram predictive model. Internal validation and validation set data demonstrated the model's high predictive accuracy and reliability, with areas under the receiver operating characteristic curve of 0.718 and 0.723, respectively. Conclusions: A nomogram predictive model for assessing SIRS following PCNL was successfully developed and validated. This model provides clinicians with a valuable tool for personalized treatment planning and implementing preventive measures.

Mini-endoscopic combined intrarenal surgery (mini-ECIRS) for complex urolithiasis.

To miniaturize endourological procedures, mini-Endoscopic Combined Intrarenal Surgery (mini-ECIRS) has emerged as a promising alternative in the treatment of complex kidney and ureteral stones. To date, some data available in the literature have shown good outcomes regarding effectiveness and safety. This study aimed to evaluate the results and postoperative complications of mini-ECIRS in our series. A prospective analysis of consecutive patients who underwent mini-ECIRS at our center between June 2022 and March 2024 was performed. Demographic characteristics were collected, and the patients were divided according to de Guy's Stone Score (GSS). The stone-free rate (SFR) was classified into the grades according to non-contrast abdominal computed tomography 4 weeks after the procedure: Grade A (no stones), Grade B (< /= 2mm fragments), and Grade C (2.1-4mm fragments). 60 patients were included and enrolled in the study. The median stone volume was 3352 mm3 (2602-4573) and the median stone density was 1054 HU (774-1284). SFR Grade A was achieved in 48 patients (80%) and Grade C in 12 patients (20%). Thirteen patients (21.7%) presented Clavien-Dindo Grade I-II complications. When we divided the patients into two groups according to the GSS classification, GSS 1-3 presented significantly fewer postoperative complications and higher SFR. Mini-ECIRS is a safe and effective procedure for treating of complex renal and ureteral stones. Patients with GSS 4 are more likely to need a second look procedure and present a higher probability of postoperative complications. Larger and randomized studies are required to confirm these favorable outcomes.

Special Considerations in the Treatment of Idiopathic Intracranial Hypertension.

To review the management of Idiopathic Intracranial Hypertension (IIH) with co-existing conditions affecting therapy: obesity, sulfa allergy, nephrolithiasis, and pregnancy. The IIH-WT trial showed that bariatric surgery is currently the most effective method for obese patients with IIH to lose weight, leading to normalization of CSF pressure in many cases. Allergy to sulfonamide antibiotics does not preclude the use of acetazolamide; rather, penicillin allergy or multiple drug allergies are the strongest predictor of a hypersensitivity reaction. Carbonic anhydrase inhibitors should be avoided in individuals with a personal history of nephrolithiasis; the risk of renal stones increases with concomitant use of other medications with the potential for nephrolithiasis. Glucagon-like peptide-1 receptor antagonists (GLP-1RA) are promising non-surgical weight loss options although preliminary studies have not demonstrated considerable impact on papilledema, headache or vision. Women with IIH have high rates of pregnancy complications partly related to obesity. Recommendations for weight gain or loss during gestation are controversial. Recent studies show better outcomes in obese women who maintain or lose weight while pregnant including gestational diabetes, pre-eclampsia and emergency caesarian section. Progress continues in the search for the cause and best treatments for IIH. Larger multicenter trials of GLP-1RA are needed to determine their efficacy.

Kidney stone disease: Practice patterns among urologists in Canada.

Despite kidney stone disease (KSD) guidelines, high-quality evidence for KSD management in Canada is lacking. We aimed to assess Canadian urologists' practice patterns, preferences, and barriers in managing KSD. A cross-sectional survey was distributed to Canadian urologists via the Canadian Urological Association (CUA), Quebec Urological Association (QUA), and Canadian Endourology Group (CEG), as well as directly to urology departments nationwide. Descriptive statistics were used to analyze the results. Of 93 respondents, 47% were from academic centers, 43% from community hospitals, and 10% from mixed/private settings. Most performed over 75 ureteroscopies and fewer than 25 percutaneous nephrolithotomies (PCNLs) annually (67% and 58%, respectively). Holmium:YAG (Ho:YAG) lasers were available in 85% of hospitals, thulium fiber laser (TFL) in 70%, and Ho:YAG with Moses effect lasers in 28%. Preferred surgical devices included the TFL (74.5%), followed by the Ho:YAG laser (24.2%) and Ho:YAG with Moses effect laser (21.7%). Endourology fellowship-trained urologists (53%) were more likely to perform their own PCNL access (90% vs. 23%, p<0.001), metabolic workup (73% vs. 48%, p=0.02), and felt more comfortable prescribing prophylactic and medical treatment for KSD (86% vs. 50%, p<0.01) compared to non-endourology fellowship-trained colleagues. Metabolic workup was delegated to nephrologists or specialized clinics by 38%, mainly due to lack of time (25%) and expertise (25%). Additionally, 71% lacked access to multidisciplinary KSD clinics, with 76% believing such clinics would be beneficial. The study highlights variability in KSD management practices and barriers. Addressing these issues could improve KSD care in Canada and inform future guidelines.

Validation of the Patient Activation Measure in kidney stone disease patients.

We aimed to validate the Patient Activation Measure (PAM) within a kidney stone disease (KSD) population, determine the variability of patient activation within this population, and characterize relationships between activation and variables such as health literacy, quality of life, and demographics. This cross-sectional study includes individuals 18 years or older followed for KSD at University of Montreal Hospital Center. Demographic data and responses for the PAM, Wisconsin Stone Quality of Life scale, and health literacy questionnaire (HLQ) were acquired. Females and those with poor medication adherence were found to have significantly lower activation. The HLQ dimensions "Actively managing my health," "Navigating the healthcare system," and "Understand health information well enough to know what to do" were associated with significantly higher activation. Rasch analysis revealed an item reliability of 0.81, a person reliability of 0.98, and a Cronbach's alpha of 0.88. Regarding item fit, only item 1 (When all is said and done, I am the person who is responsible for taking care of my health) fit poorly with the model. Principle component analysis revealed evidence of a second dimension, accounting for 9.0% of the variation in observed responses. Female sex and poor medication adherence were associated with significantly lower activation. Aspects of health literacy concurring with the precise definition of "activation" were associated with significantly higher PAM scores. The PAM was found to have good person and item reliability, and good internal consistency; however, principal component analysis revealed that construct validity is possibly threatened by multidimensionality.

Chronic Kidney Disease of Unknown Etiology: A Global Health Threat in Rural Agricultural Communities—Prevalence, Suspected Causes, Mechanisms, and Prevention Strategies

Chronic Kidney Disease of Unknown Etiology (CKDu) is a worldwide hidden health threat that is associated with progressive loss of kidney functions without showing any initial symptoms until reaching end-stage renal failure, eventually leading to death. It is a growing health problem in Asia, Central America, Africa, and the Middle East, with identified hotspots. CKDu disease mainly affects young men in rural farming communities, while its etiology is not related to hypertension, kidney stones, diabetes, or other known causes. The main suspected causal factors are heat-stress, dehydration, exposure to agrochemicals, heavy metals and use of hard water, infections, mycotoxins, nephrotoxic agents, altitude, and genetic factors. This review gives an overview of CKDu and sheds light on its medical history, geographic distribution, and worldwide prevalence. It also summarizes the suspected causal factors, their proposed mechanisms of action, as well as the main methods used in the CKDu prior detection and surveillance. In addition, mitigation measures to reduce the burden of CKDu are also discussed. Further investigation utilizing more robust study designs would provide a better understanding of the risk factors linked to CKDu and their comparison between affected regions.

Benign Glomus Tumor of the Urinary Bladder: A Case Report and Literature Review.

Glomus tumor is a rare neoplasm, typically found in superficial soft tissues and extremities, particularly in the subungual region. However, it can also occasionally affect deep soft tissue or viscera, such as the bladder, albeit infrequently. Our patient was a 51-year-old man presenting with recurrent hematuria of unknown etiology, accompanied by a blood clot that resolved spontaneously after 1 day. Abdominal computed tomography revealed multiple calculi in the right kidney, whereas cystoscopy showed mucosal edema on the left side of the bladder. A magnetic resonance image of the bladder identified an ovoid mass on the left side, measuring approximately 3.1 cm × 2.7 cm × 2.1 cm. This mass demonstrated a slightly increased signal intensity on T2-weighted images and an intermediate signal intensity on T1-weighted images. These findings suggested a malignant tumor in the urinary bladder with a nonfunctional right kidney. The patient underwent laparoscopic surgery to remove the right kidney and part of the bladder. Histologically, the tumor primarily consisted of round cells and abundant eosinophilic or pale cytoplasm. Immunohistochemical staining demonstrated diffuse positivity for smooth muscle actin and vimentin, and focal positivity for synaptophysin. The final pathological diagnosis was a bladder glomus tumor. At 15 months after resection, the patient was in good health with no recurrence or metastasis. The clinical manifestations and imaging features of bladder glomus tumors can pose diagnostic challenges for urologists. Therefore, it is imperative to consider this tumor in the differential diagnosis of bladder tumors and to enhance the understanding among urologists and pathologists regarding this entity.

Development of Prediction Models for Severe Pain and Urinary Symptoms after Ureteroscopy with Ureteral Stent Placement: Results from the STENTS Study and Initial Validation of Pain Interference.

We developed prediction models for severe pain and urinary symptoms after ureteroscopy with ureteral stent placement. The development cohort included 424 adults and adolescents enrolled in the multicenter STENTS prospective cohort study who underwent ureteroscopy with stent placement for urinary stones. The validation cohort was an independent prospective cohort of 115 adults. The outcomes were severe pain intensity and pain interference, measured by PROMIS, and severe urinary symptoms, measured by the Ureteral Stent Symptom Questionnaire. The top quartile of symptoms on postoperative days 1 and 3 were defined as severe. Generalized estimating equation models were used to predict severe symptoms on postoperative days 1, 3, 5, and 7-9 in the development cohort and severe pain interference on days 1 and 7 in the validation cohort. Female sex, younger age, higher body mass index, baseline pain interference and number of chronic pain conditions, renal stone location, and history of anxiety predicted severe pain. In the development cohort, the C-statistics were 0.83 (95% CI 0.80-0.85) for severe pain interference and 0.82 (95% CI 0.79-0.84) for severe pain intensity. A model in which baseline urinary symptoms replaced pain interference had excellent discrimination for severe urinary symptoms (C-statistic 0.83; 95% CI 0.81-0.85). In the validation cohort, the C-statistic was 0.7 for severe pain interference (95% CI 0.54-0.78). Preoperative characteristics accurately predicted severe pain and urinary symptoms after ureteroscopy with stent placement. Upon further validation, these models could guide clinical decisions to improve surgical outcomes.