Ureteral calculi account for approximately 20–40% of urinary tract stone diseases, second only to renal calculi. Retrograde ureteroscopic laser lithotripsy is a widely used minimally invasive procedure, offering rapid recovery and low complication rates. However, postoperative anxiety remains a clinical concern. A descriptive cross-sectional study was conducted on 165 patients undergoing retrograde ureteroscopic laser lithotripsy at Thong Nhat Hospital between March and September 2023. The prevalence and severity of postoperative anxiety were assessed using standardized measures. Postoperative anxiety was identified in 95.15% of patients, predominantly at a mild level. Mild and moderate anxiety were observed in 83.64% and 11.51% of cases, respectively, with a mean score of 4.53 ± 2.58. The most common concerns included fear of complications (84.8%), postoperative pain (66.1%), and indwelling JJ stent placement (43.6%). Postoperative anxiety was highly prevalent among patients undergoing retrograde ureteroscopic laser lithotripsy, although generally mild in severity. These findings underscore the importance of comprehensive perioperative counseling and psychological support to reduce patient anxiety and enhance recovery outcomes.

The urinary calcium-to-citrate (Ca/Cit) ratio has emerged as a useful indicator of lithogenic risk in older children; however, no reference data exist for infants and toddlers. This study aimed to evaluate whether the spot Ca/Cit ratio can distinguish stone-forming from non-stone-forming children under 24months of age and to assess its diagnostic performance compared with conventional urinary markers. This retrospective single-center study included 181 children aged 1-24months who underwent metabolic evaluation and ultrasonography at their first presentation to a tertiary pediatric nephrology clinic between 2012 and 2024. Based on urinary calcium excretion and ultrasonographic findings, participants were categorized as normocalciuric stone-free controls (n = 57), hypercalciuric stone-formers (n = 29), or non-hypercalciuric stone-formers (n = 95). Spot urine calcium, citrate, and related biochemical ratios were analyzed. The diagnostic accuracy of the Ca/Cit ratio for predicting stones was assessed using receiver operating characteristic (ROC) analysis. The Ca/Cit ratio differed significantly across groups, with the highest levels observed in hypercalciuric stone-formers (0.46mg/mg) compared with controls (0.17mg/mg; p < 0.001) and non-hypercalciuric stone-formers (0.31mg/mg; p < 0.001). A Ca/Cit threshold > 0.23mg/mg (≈ 1.10mmol/mmol) demonstrated moderate diagnostic ability for stone detection (AUC 0.695; 95% CI 0.613-0.785), yielding 66.1% sensitivity and 63.2% specificity. Age showed no meaningful correlation with Ca/Cit values. Normocalciuric stone-free children provided an age-appropriate reference distribution for Ca/Cit ratios. In infants and toddlers evaluated for suspected urinary stone disease, the Ca/Cit ratio offers moderate discriminatory power and may serve as a practical adjunctive marker of stone risk. A ratio > 0.23mg/mg (≈ 1.10mmol/mmol) appears to indicate increased lithogenic potential. Larger prospective studies are needed to validate reference intervals and refine clinically applicable cut-off values for this young age group.

To assess variation in surveillance imaging practices in various clinical contexts among patients with urinary stone disease (USD) from a large cohort of U.S. Veterans. We identified adults age ≥18 years within the Veterans Health Administration Corporate Data Warehouse with an index surgical procedure related to USD or an index emergency department (ED) visit with a primary diagnosis of USD between 2010 and 2018. We then explored three clinical periods for use of surveillance imaging: 30-180 days and 180-540 days post-surgery and 90-540 days post-ED visit. We estimated multilevel logistic regression models to identify factors associated with receipt of surveillance imaging. We calculated median odds ratios (MORs) to quantify the amount of variation in imaging procedures by facility. Among 35,248 patients who met the inclusion criteria, 10,095 underwent a surgical procedure, and 25,153 had an ED visit. Probabilities of obtaining postoperative imaging 30-180 days post-surgery by facility ranged from 8.4% to 58.5%; from 6.8% to 35.4% for 180-540 days post-surgery; and from 6.1% to 20.5% for 90-540 days post-ED. The greatest between-facility variation occurred 30-180 days post-surgery (MOR: 1.81 [95% confidence interval], 1.66-2.04). There was also wide variation in the type of post-surgical imaging. Combination imaging, X-ray, and ultrasound were the most common imaging modalities obtained in the 30-180 day period for percutaneous nephrolithotomy, shockwave lithotripsy, and ureteroscopy, respectively. Among patients with USD, the use of surveillance imaging after surgical procedure and in the post-ED visit setting remains low, with substantial variation across facilities.

Diagnosis and Management of Urinary Stone Disease in Pregnancy: Integrating Current Guidelines with Emerging Evidence.

This study aims to evaluate the characteristics of patients with urinary stone disease before and during the pandemic and to assess the impact of the pandemic on diagnosis-to-treatment intervals and treatment outcomes. Medical records, laboratory values and radiological images of patients who underwent ureterolithotripsy, retrograde intrarenal surgery and percutaneous nephrolithotomy for ureteral and renal stones before and during the pandemic were retrospectively analysed. Pregnant women and patients under the age of 18 were excluded from the study. The patients' demographic data, number of stones, stone size, stone location, hydronephrosis, impacted stones, creatinine levels, duration of surgery, stone-free rates, hospital stay, complication rates and diagnosis-to-treatment intervals before and during the pandemic were compared. A total of 162 patients with ureteral stones and 129 patients with kidney stones were included in the study. During the pandemic, complication rates and diagnosis-to-treatment intervals were considerably higher in patients with kidney and ureteral stones. Furthermore, the presence of impacted stones for ureteral stones and the presence of hydronephrosis for kidney stones emerged as predictors of complications. During the pandemic, delays were observed in the diagnosis and treatment of patients with both renal and ureteral stones. This delay negatively affected the patients' clinical characteristics at presentation (hydronephrosis) and surgical outcomes (complication rates). Therefore, patients with urolithiasis should be prioritised in exceptional situations, such as pandemics.

Objective:Urolithiasis is a multifactorial disease that causes symptomatology and needs to be managed depending on various clinical parameters. In this study, we aimed to investigate clinical factors for early operation in patients with uncomplicated symptomatic urolithiasis.Materials and Methods:Medical records of 148 patients who underwent ureterorenoscopic lithotripsy (URS) within 6 weeks of diagnosis of urolithiasis were retrospectively reviewed. The patients were divided into two groups: those operated early (≤3 days, n = 80) and those operated late (≥4 days, n = 68). Data, including age, sex, body mass index, degree of pain assessed with Visual Analog Scale (VAS), radiological and laboratory examinations at the time of admission, along with perioperative surgical data, were recorded.Results:110 (74.3%) males and 38 (25.7%) females with a median age of 38 years were operated on for uncomplicated ureteral stones. Median time from diagnosis to ureteroscopic intervention was 3 days. Among clinical factors, only the number of readmissions to the emergency room, the mean white blood cell count, the level of microscopic hematuria, and VAS scores of pain at the initial diagnosis were significantly higher in the early operated group (P < 0.05).Conclusions:Pain is a major clinical factor resulting in earlier URS in uncomplicated upper urinary tract stone disease. First admission to the emergency room due to renal colic with multiple readmissions after diagnosis, high level of microscopic hematuria, and white blood cell counts appear to be significant pain-related factors for earlier operation.

Human Doctors or AI? Evaluating Patient Satisfaction in Urinary Stone Disease Consultations.

Editorial Comment on: "Laboratory Abnormalities Associated With the Use of Preventive Pharmacological Therapy for Urinary Stone Disease".

Background:Urolithiasis is a prevalent urological condition with high recurrence rates. Increasing evidence links metabolic syndrome (MetS) and its components to urinary stone disease, but the relationship between MetS and stone recurrence, including the roles of stone composition, residual fragments, urinary biochemistry, and lifestyle factors, remains underexplored.Objectives:To investigate the association between MetS components and urinary stone recurrence in a retrospective cohort, with emphasis on stone composition, surgical residual fragments, urinary biochemical parameters, and lifestyle factors.Design:A single-center retrospective case–control study.Methods:We enrolled 542 patients with urinary stones (2019–2020) and followed them for up to 5 years (median follow-up 48 months). Baseline demographic, metabolic, lifestyle, urinary biochemical, surgical, and stone composition data were collected. Kaplan–Meier and Cox regression analyses were used to evaluate recurrence-free survival and independent predictors of recurrence.Results:During follow-up, 211 patients (39%) experienced recurrence. The prevalence of MetS was significantly higher in the recurrence group (46.9% vs 28.7%). Cox regression identified hypertension (hazard ratio (HR) 1.31, 95% CI 1.04–1.65), hyperglycemia (HR 1.29, 1.01–1.64), hypertriglyceridemia (HR 1.38, 1.08–1.77), and residual fragments (HR 1.89, 1.47–2.43) as independent predictors. Stone composition analysis revealed higher recurrence in uric acid (52.3%), struvite (59.3%), and cystine (63.6%) stones compared with calcium oxalate (34.0%). Adverse urinary profiles (low pH, hypocitraturia, hyperuricosuria) and lifestyle factors (low fluid intake, high salt, high animal protein) were also associated with recurrence. Kaplan–Meier analysis showed shorter recurrence-free survival in patients with MetS (log-rank p < 0.001).Conclusion:MetS and its components are independently associated with a higher risk of urinary stone recurrence. Stone composition, residual fragments, urinary biochemistry, and lifestyle factors further modify recurrence risk. These findings underscore the importance of comprehensive risk stratification and metabolic management in patients with urolithiasis.Trail registration:Not applicable.

Reply to Editorial Comment on "Laboratory Abnormalities Associated With the Use of Preventive Pharmacological Therapy for Urinary Stone Disease".

prevalence of mesenteric panniculitis in patients with urinary system calculi and identify factors, such as hydronephrosis and calculus location, that might be associated with the presence of mesenteric panniculitis. Materials and Methods: In this retrospective observational study, the prevalence of mesenteric panniculitis was determined in 692 patients with urolithiasis using non-contrast-enhanced computed tomography imaging between 2017 and 2020. The grade of hydronephrosis and the level of urinary calculi were recorded for each patient, and statistical analysis was performed to assess the link between these features and mesenteric panniculitis. Results: The prevalence of mesenteric panniculitis in patients with urolithiasis was 6.35% and it was associated with the presence of hydronephrosis. It was more common in patients who had both ureterolithiasis and nephrolithiasis with no statistically significant difference regarding in age, gender, or the presence of either only nephrolithiasis or only ureterolithiasis. Conclusion: Mesenteric panniculitis is more common in patients with both ureterolithiasis and nephrolithiasis and can be easily diagnosed with non-contrast computed tomography imaging. Because the mesentery and urinary system share a common lymphatic drainage system, increased lymphatic drainage due to hydronephrosis has been shown to contribute to the development of mesenteric panniculitis.

Urinary stone disease (USD) is a growing global health concern, yet its prevalence and burden in Mexico remain poorly characterized. Limited epidemiological data hinder public health planning and the development of preventive strategies. To provide a comprehensive assessment of USD prevalence, geographic distribution, and associated risk factors in Mexico, and to explore the influence of socioeconomic, environmental, and healthcare determinants. A two-phase study was conducted, including (1) an ecological analysis of the 2018 Health and Nutrition National Survey (n = 43,070) and official national datasets, and (2) a systematic review of English- and Spanish-language literature, including gray literature (2012-2024). Correlations between USD prevalence and human development, income inequity, healthcare access, diet quality, and climate were analyzed. Risk factors and metabolic abnormalities were extracted and pooled from included studies. Nationwide USD prevalence was 33.2 per 1,000 persons, peaking in adults aged 50-70 years. The highest prevalence occurred in Yucatan (72.2), Mexico City (61.5), and the Gulf Coast (Tabasco and Veracruz). Obesity [OR 1.69], type 2 diabetes [OR 1.68], and hypertension [OR 2.04] were significantly associated with USD. Prevalence correlated with lower human development (r = -0.39), higher income inequity (r = 0.49), poverty (r = 0.37), limited healthcare access (r = -0.39), poor diet quality (r = -0.42), and higher temperatures (average r = 0.47; maximum r = 0.44). The systematic review (16 studies, n = 3,073) identified metabolic syndrome (52%), obesity (46%), hypocitraturia (59%), and hypercalciuria (37%) as common risk factors. USD affects millions of Mexicans, with marked geographic and socioeconomic disparities. The disease burden is likely underestimated, creating significant clinical, economic, and public health challenges. Urgent strategies targeting prevention, early detection, equitable access to care, and modifiable risk factors are essential to reduce morbidity, recurrence, and societal impact.

Laboratory Abnormalities Associated With the Use of Preventive Pharmacological Therapy for Urinary Stone Disease.

Urinary stone disease is a common and recurrent condition that can lead to complications such as urosepsis or urinary tract obstruction, which may progress to chronic kidney disease. Effective management requires close collaboration between urologists and nephrologists. Urologists manage acute episodes and perform the appropriate surgical procedures, whereas nephrologists conduct second-line metabolic assessments and implement targeted preventive strategies. Stone morpho-constitutional analysis and therapeutic patient education are essential pillars of care. Multidisciplinary meetings enhance coordination and clinician training. At Edouard Herriot Hospital, a structured pathway coordinated by an advanced practice nurse exemplifies the benefits of an integrated, patient-centred approach.

An overview of the urinary stone's disease in north of Tunisia over the past decade.

The aim was to study the characteristics of the gut microbiota (GM) in urinary stone disease (urolithiasis) in comparison with healthy volunteers (HV), to identify bacteria whose content changes affect the risk of developing urolithiasis, as well as to establish threshold values for these indicators. Material and methods . The composition of GM in 35 patients with urolithiasis and 31 healthy volunteers was conducted using the method of gas chromatography-mass spectrometry (GCMS) of fecal samples; subsequent statistical analysis of the obtained results was performed to identify the bacteria whose changes in abundance are associated with the risk of urolithiasis. Results. In the group of patients with urolithiasis, an increase in the numbers of the following bacteria was noted: Alcaligenes spp. / Klebsiella spp., C. hystolyticum / S. pneumonia, Bacillus cereus, Clostridium perfringens, Clostridium difficile. The GM composition in patients with urolithiasis differed depending on the type of urinary stones: in case of oxalate urolithiasis, there was an increase of opportunistic bacteria Peptostreptococcus anaerobius 18623 and Clostridium perfringens, while in uric acid urolithiasis, a decrease in healthy microbiota representatives Propionibacterium jensenii and Clostridium propionicum was observed. An increase in the number of Peptostreptococcus anaerobius 18623 over 37996×105 cells/g and/or a decrease in the number of Clostridium propionicum to fewer than 2178×105 cells/g were associated with increased risk of urolithiasis. Conclusions. The GM of patients with urolithiasis significantly differs from the GM of healthy volunteers. The composition of GM varies depending on the type of urinary stones. An increase in the amount of Peptostreptococcus anaerobius 18623 and/or a decrease in the amount of Clostridium propionicum in GM can be considered as potential risk factors of urolithiasis.

From Heterogeneity to Precision in Urinary Stone Disease: Who to Test, When, and with What.

Daily use of Thulium Fiber Laser (TFL) in urinary stone disease: what to expect from pre-set parameters? A prospective international study

Lasers and safety in urology.

BackgroundUrinary stones are a multifactorial disease. In recent years, the role of microorganisms in its pathogenesis has attracted considerable attention. Although studies have suggested that certain microbes present in the gut and urine are associated with the formation of urinary stones, the current criteria for stone classification are not rigorous enough. Therefore, this study aimed to analyze the gut and urinary microbiota composition via 16S rRNA sequencing in patients with pure CaOx, pure UA, and pure Inf stones. By integrating these microbiota data with clinical data, we constructed machine learning models and evaluated their diagnostic value in distinguishing stone types.MethodsA total of 81 patients with urinary stones (including 30 with pure CaOx stones, 31 with pure UA stones, and 20 with pure Inf stones) and 26 healthy volunteers were enrolled. Stool and urine samples were collected from each participant and subjected to 16S rRNA sequencing to obtain microbiota data and characterize the gut and urinary microbiota profiles of patients with different stone types. We further integrated microbiota and clinical data, such as age, gender and BMI, using LASSO feature selection and six machine learning algorithms (e.g. SVM, Random Forest and XGBoost) to create prediction models for stone type. Model performance was evaluated through cross-validation.ResultsResults showed enrichment of Paramuribaculum, Muribaculum, Mesorhizobium, and Acinetobacter in the gut of CaOx stone patients, with concurrent urinary enrichment of Enterococcus. Patients with UA stones demonstrated an increase in the abundance of Massilioclostridium in the gut and an increase in the abundance of Fenollaria, Anaerococcus, Enterococcus and Escherichia in the urine. Patients with Inf stones showed no differentially abundant gut taxa compared to healthy volunteers, but did exhibit urinary enrichment of Escherichia. The predictive model, which was based on urinary microbiota and clinical data, demonstrated excellent performance. The AUC was 0.922, 0.866 and 0.913 for the SVM, Random Forest and XGBoost models, respectively.ConclusionThis study reveals that different types of stone are characterized by distinct compositions of microbiota. Machine learning models based on microbiota and clinical data can predict urinary stone types noninvasively. This provides novel insights into the microecological mechanisms of urinary stones and opens up new avenues for clinical diagnosis.