Urinary Tract Calculi Research Articles

Development and Implementation of an Evidence-Based Electronic Request Bundle for Metabolic Screening in Patients With Urinary Tract Calculi

Development and Implementation of an Evidence-Based Electronic Request Bundle for Metabolic Screening in Patients With Urinary Tract Calculi

Efficacy analysis of tip-flexible suction access sheath during flexible ureteroscopic lithotripsy for unilateral upper urinary tract calculi.

This study aims to evaluate the efficacy of tip-flexible suctioning ureteral access sheath (TFS-UAS) compared to traditional ureteral access sheath (T-UAS) in flexible ureteroscopic lithotripsy (FURL) for unilateral upper urinary tract calculi. The study retrospectively compared outcomes from 103 cases using TFS-UAS and 138 using T-UAS treated with FURL for unilateral upper urinary tract calculi from January to October 2023. Assessed parameters included patient demographics, stone characteristics, preoperative urine cultures, ureteral pre-stenting, comorbidities, procedure time, stone-free rate (SFR), utilization of stone retrieval baskets, and postoperative Systemic Inflammatory Response Syndrome (SIRS) rates. The maximum angle of deflection was also measured when the flexible ureteroscope was located in different parts of the TFS-UAS with different diameters in vitro. The TFS-UAS group achieved a higher Immediate SFR (76.70% vs. 63.77%, p = 0.031) and final SFR (89.32% vs. 73.91%, p = 0.003) than the T-UAS group, especially in the lower calyx stones (80.00% vs. 41.18%, p = 0.018) and upper urinary tract calculi with a cumulative diameter of 2cm or larger (68.97% vs. 42.11%, p = 0.029). Notably, TFS-UAS with a 10 French (F) inside diameter size achieved a higher SFR (88.57% vs. 70.59%, p = 0.041) and a greater deflection angle than the 12.5F inside diameter size. No significant variations were observed in the operative duration, hospitalization duration and the occurrence of SIRS between the compared cohorts. TFS-UAS significantly improves SFR in FURL treatment of unilateral upper urinary tract calculi, particularly for stones located in the lower calyx or with a cumulative diameter of 2cm or greater, compared to T-UAS.

RECURRENT INFECTION CAUSED BY NON-ABSORBABLE POST-CESAREAN SUTURES LEADING TO BLADDER CALCULUS: CASE REPORT AND REVIEW OF THE LITERATURE

Background: Bladder stones are a rare pathological condition in women, often secondary to any etiology. Further investigations are required to identify the various factors involved in their formation and the complications they cause. For a woman, the appearance of a bladder stone following a predisposing factor, in particular an intra-vesical foreign body is a source of recurrent urinary tract infections and calculus, manifested by dysuria and hypogastric heaviness. This study aimed to describe the case of the formation of a bladder calculus from the presence of a non-absorbable suture. Case presentation: The case of a 30-year-old woman with a bladder stone causing several recurrent urogenital infections despite years of medical treatment is reported. After several additional para-clinical investigations, an ultrasound diagnosis of a bladder stone with pre-renal failure was established. The patient underwent a median exploratory laparotomy below the umbilicus for surgical management, followed by an open cystolithotomy with the extraction of a large bladder stone on which an old suture was implanted, probably as a result of the previous cesarean section. Conclusion: Bladder stones are rare, but relatively rare in our environment, with limited diagnostic resources. In this case, it appears that the non-absorbable suture was inadvertently placed in the bladder during the cesarean section, which has unfortunately contributed to recurrent urogenital infections and the formation of bladder calculus.

Micropercutaneous nephrostomy for intervention in acute upper urinary tract calculi obstruction with hydronephrosis and infection

To compare the efficacy and advantages of mini percutaneous nephrostomy (MPCN), micropercutaneous nephrostomy (MicroPCN), and retrograde ureteric stenting (RUS) in the treatment of acute upper urinary tract calculi (UUTC) obstruction with hydronephrosis and infection, and verify the safety and indications of clinical application of micropercutaneous nephrostomy. Clinical-epidemiological data of patients with acute upper urinary tract calculi obstruction and infection treated in Ningbo No.2 hospital were retrospectively collected from May 2019 to May 2023. 64 patients (20 patients in MPCN group, 13 patients in MicroPCN group, and 31 patients in RUS group) were eligible for analysis based on inclusion and exclusion criteria. P value < 0.05 was considered statistically significant. There were no significant differences in peri-intervention temperature, multiple infection indicators and complications among the three groups. The nutritional status and peri-intervention coagulation function of patients in MicroPCN and RUS groups were poor, the CRP and proportion of using carbapenem advanced antibiotics were higher. The length of hospital stay and the length of hospital stay after the intervention in MPCN and MicroPCN groups were longer, the length and width of calculi were larger, and the degree of hydronephrosis was heavier. Patients in the MicroPCN group had the worst general condition, the lowest hemoglobin before intervention, the longest withdrawal time of vasoactive drugs. MPCN, MicroPCN, and RUS are safe and effective in relieving acute upper urinary tract calculi obstruction complicated with infection. MicroPCN has more advantages for patients with critical illness or complex obstruction urinary lithiasis.

Intelligent control of pressure based on ureteral access sheaths: renal pelvic pressure during flexible ureteroscope perfusion at different sites.

This study aimed to evaluate the accuracy and effectiveness of renal pelvic pressure (RPP) control during flexible ureteroscopic perfusion at various sites. Flexible ureteroscopy for the intelligent control of RPP was based on a ureteral access sheath (UAS) that integrated pressure measurement and suction functions (with automatic adjustment). Eleven consecutive patients with indurating nephrostomy tubes were enrolled. The nephrostomy tube was connected to a disposable invasive blood pressure sensor. The RPP was zeroed after the pressure stabilized. The flow rate and control value were set at 100ml/min and - 5 mmHg, respectively. An 8.5 Fr flexible ureteroscope was irrigated at the renal pelvis, as well as the upper, middle, and lower calyces of the kidney for 1min. All 11 patients with upper urinary tract calculi underwent successful UAS placement. Pressures measured by the sheath and fistula during perfusion were - 5.07 ± 1.41 and - 4.89 ± 1.07 mmHg at the renal pelvis, -5.16 ± 1.36 and - 5.12 ± 1.32 mmHg at the upper calyces, -4.98 ± 0.87 and - 5.39 ± 1.01 mmHg at the middle calyces, as well as -4.95 ± 1.56 and - 5.64 ± 1.24 mmHg at the lower calyces, respectively. There were no significant differences in pressure between the sheath and fistula groups or in sheath and fistula pressures among parts. The RPP fluctuated; however, all values were within the safe limit of 20 mmHg. The UAS-based pressure monitoring technology can accurately and reliably monitor and control RPP within a set range.

Mendelian insights: Irritable bowel syndrome as a predictor of upper urinary tract calculi.

Patients with irritable bowel syndrome (IBS) have a notably higher rate of consultations in urology clinics compared to other clinics. They often present with symptoms such as lumbar pain, dysuria, and urinary difficulty that are also associated with upper urinary tract calculi (UUTC). UUTC are the leading cause of nephrectomy in non-oncological cases, early screening for high-risk populations is deemed necessary. We investigated the relationship between IBS and UUTC using a two-sample Mendelian randomization (MR) approach, with the primary analysis conducted using the inverse variance weighting method. To enhance the robustness of our findings, we conducted sensitivity analyses employing Cochran Q test, MR-Egger intercept, and MR-PRESSO. Additionally, we included type 2 diabetes in a multivariate Mendelian randomization analysis for further exploration. Our two-sample MR analysis, employing the inverse variance weighting method, suggested a positive association between IBS and UUTC, with an odds ratio of 1.47, a 95% confidence interval from 1.01 to 2.15, and a P-value of .442. Both weighted median and MR Egger analyses also indicated that IBS may be a risk factor for UUTC, although the results were not statistically significant. The Cochran Q test revealed no evidence of heterogeneity (P > .05). The MR-Egger intercept and MR-PRESSO analyses did not support the presence of pleiotropy (P > .05), and no outliers were detected by MR-PRESSO. Sensitivity analyses reinforce the reliability of our findings. Multivariate MR analysis further confirmed that IBS is a risk confirmed factor for UUTC, with significant results (P < .05). IBS is identified as one of the etiological factors for UUTC, enhancing our understanding of the gut-kidney axis. The specific mechanisms underlying this association warrant further investigation. Clinicians should consider the importance of monitoring for UUTC in patients with IBS.

Clinical Application of CT Imaging Grading System in Upper Urinary Tract Calculi with Kidney Infection.

This study aimed to establish a CT imaging grading system and explore its value in evaluating upper urinary tract calculi associated with kidney infections. CT images of 126 patients with kidney infections caused by upper urinary tract calculi were retrospectively analyzed. The CT grading system was developed based on CT images. CT images were classified into 4 grades. General information, symptoms, and clinical findings of patients in different CT grades were analyzed. With the occurrence of systemic inflammatory response syndrome (SIRS) as the endpoint, univariate and multivariate analysis was conducted to analyze the risk factors of SIRS. Patients with fever or diabetes had higher CT grades, and the following examination data revealed significant differences across the various CT grades (P < 0.05): the white blood cell count, urine leucocytes count, CT1, CT2, maximum body temperature, duration of disease, the proportion of blood neutrophils, the size of stones, and levels of the C-reactive protein and procalcitonin. Only CT grading was statistically significant after multivariate analysis. According to the values of the partial regression coefficient (B), the higher the CT grade, the greater the risk of SIRS. The risk of SIRS was 4.472 times higher with each increment of the CT grade. The CT grade is directly associated with clinical symptoms and the risk of SIRS.

A novel infrared spectroscopy marker for assessing the postoperative infection risk in patients with upper urinary tract calculus

The aim of this study is to evaluate the ability of infrared wavenumber of calculus to predict postoperative infection in patients with upper urinary tract calculus (UUTC), and to establish a predictive model based on this. From March 2018 to March 2023, 480 UUTC patients from Fujian Provincial Hospital were included in this study. The infrared-wavenumbers related infection score (IR-infection score) was constructed by univariate analysis, multicollinearity screening, and Lasso analysis to predict postoperative infection. Continually, the Delong test was used to compare the predictive power between the IR-infection score and traditional indicators. Afterward, we performed urine metagene sequencing and stone culture to prove the correlation between calculus toxicity and IR-infection score. Finally, logistic regression was used to build a nomogram. IR-infection score composed of four independent wavenumbers could precisely predict postoperative infection (AUCvalidation cohort = 0.707) and sepsis (AUCvalidation cohort = 0.824). IR-infection score had better predictive ability than commonly used clinical indicators. Moreover, metagenomics sequencing and calculus culture confirmed the correlation between IR-infection score and calculus toxicity (all P < 0.05). The nomogram based on the IR-infection score had high predictive power (all AUCs > 0.803). Our study first developed a novel infrared spectroscopy marker and nomogram, which can help urologists better predict postoperative infection in UUTC patients.

Development and validation of a predictive model for double-J stent encrustation after upper urinary tract calculi surgery

The study is aimed to establish a predictive model of double-J stent encrustation after upper urinary tract calculi surgery. We collected the clinical data of 561 patients with indwelling double-J tubes admitted to a hospital in Shandong Province from January 2019 to December 2020 as the modeling group and 241 cases of indwelling double-J tubes from January 2021 to January 2022 as the verification group. Univariate and binary logistic regression analyses were used to explore risk factors, the risk prediction equation was established, and the receiver operating characteristic (ROC) curve analysis model was used for prediction. In this study, 104 of the 561 patients developed double-J stent encrustation, with an incidence rate of 18.5%. We finally screened out BMI (body mass index) > 23.9 (OR = 1.648), preoperative urine routine white blood cell quantification (OR = 1.149), double-J tube insertion time (OR = 1.566), postoperative water consumption did not reach 2000 ml/d (OR = 8.514), a total of four factors build a risk prediction model. From the ROC curve analysis, the area under the curve (AUC) was 0.844, and the maximum Oden index was 0.579. At this time, the sensitivity was 0.735 and the specificity was 0.844. The research established in this study has a high predictive value for the occurrence of double-J stent encrustation in the double-J tube after upper urinary tract stone surgery, which provides a basis for the prevention and treatment of double-J stent encrustation.

582 A Re- Audit of the Metabolic Screening for Patients with Urinary Tract Calculi and the Implementation of an Electronic Requesting Bundle

582 A Re- Audit of the Metabolic Screening for Patients with Urinary Tract Calculi and the Implementation of an Electronic Requesting Bundle

Efficacy and safety of flexible ureteral lithotripsy for upper urinary tract calculi in patients aged 80 years and older

Objective: To assess the efficacy and safety of flexible ureteral lithotripsy (FURL) for treating upper urinary tract calculi in patients ≥80 years. Methods: This study retrospectively analyzed the clinical data of 297 elderly patients who underwent FURL for unilateral upper urinary tract calculi at Beijing Hospital from January 2019 to September 2023. Patients were divided into elderly group (≥80 years) and low-middle aged group (≥60-<80 years). Propensity score matching (PSM) was used to match preoperative clinical data of patients. After PSM, the basic, perioperative and postoperative data of the two groups were compared. Results: After PSM, 116 patients were enrolled, including 58 patients in each group. The age [M (Q1, Q3)] of elderly group was 83.0 (81.0, 86.0) years, which included 29 males. The age of low-middle aged group was 69.5 (64.8, 74.0) years, which included 33 males. The duration of postoperative hospitalization [M (Q1, Q3)] in elderly group was longer than that in low-middle aged group [2 (1, 3) d vs 1 (1, 2) d, P=0.002]. Serious postoperative complications occurred in 3 cases in the elderly group and 1 case in the low-middle aged group, respectively, without surgical intervention. There was no significant statistical difference in stone-free rate (SFR) [79.3% (46/58) vs 84.5% (49/58)], operation time [M (Q1, Q3), 70.0 (48.3, 100.0) vs 65.0 (46.5, 101.2) min] and postoperative complication rate [25.9% (15/58) vs 22.4% (13/58)] between two groups (all P>0.05). Conclusions: In the treatment of upper urinary tract calculi in patients ≥80 years, the SFR, operation time and postoperative complication rate of FURL are comparable to those in low-middle aged elderly patients. FURL has good safety and effectiveness in the treatment of upper urinary tract calculi in patients ≥80 years.

Predicting the Efficacy of Repeated Shockwave Lithotripsy for Treating Patients with Upper Urinary Tract Calculi Using an Artificial Neural Network Model.

To establish a prediction model for repeated shockwave lithotripsy (SWL) efficacy to help choose an appropriate treatment plan for patients with a single failed lithotripsy, reducing their treatment burden. The clinical records and imaging data of 304 patients who underwent repeat SWL for upper urinary tract calculi (UUTC) at the Urology Centre of Shiyan People's Hospital between April 2019 and April 2023 were retrospectively collected. This dataset was divided into training (N = 217; 146 males [67.3%] and 71 females [32.7%]) and validation (N = 87; 66 males [75.9%] and 21 females [24.1%]) sets. The overall predictive accuracy of the models was calculated separately for the training and validation. Receiver operating characteristic (ROC) curves were plotted, and the area under the ROC curve (AUC) was calculated. The normalized importance of each independent variable (derived from the one-way analyses) in the input layer of the artificial neural network (ANN) model for the dependent variable (success or failure in repeat SWL) in the output layer was plotted as a bar chart. This study included 304 patients, of whom 154 (50.7%) underwent successful repeat SWL. Predictive models were constructed in the training set and assessed in the validation set. Fourteen influencing factors were selected as input variables to build an ANN model: age, alcohol, body mass index, sex, hydronephrosis, hematuria, mean stone density (MSD), skin-to-stone distance (SSD), stone heterogeneity index (SHI), stone volume (SV), stone retention time, smoking, stone location, and urinary irritation symptom. The model's AUC was 0.852 (95% confidence interval (CI): 0.8-0.9), and its predictive accuracy for stone clearance in the validation group was 83.3%. The order of importance of the independent variables was MSD > SV > SSD > stone retention time > SHI. Establishing an ANN model for repeated SWL of UUTC is crucial for optimizing patient care. This model will be pivotal in providing accurate treatment plans for patients with an initial unsuccessful SWL treatment. Moreover, it can significantly enhance the success rate of subsequent SWL treatments, ultimately alleviating patients' treatment burden.

Clinical efficacy of mini-percutaneous nephrolithotomy versus retrograde intrarenal surgery for the management of upper urinary tract calculus (1–2.5 cm) in children ≤10 years of age

With improvements in endoscopic surgery, open surgical procedures for urinary system stones have cleared the path for the use of less invasive treatment modalities in patients with pediatric kidney stone disease. Extracorporeal shock wave lithotripsy (ESWL), percutaneous nephrolithotomy (PCNL), and retrograde intrarenal surgery (RIRS) are among the treatment options available. To prospectively evaluate the outcomes of mini-percutaneous nephrolithotomy and retrograde intrarenal surgery (RIRS) for children ≤10 years of age with upper urinary tract calculus (1-2.5cm). Sixty pediatric patients with single or multiple renal stones (1-2.5cm in diameter) were collected prospectively and equally divided into two groups to undergo RIRS or mini-PCNL. The operative and postoperative outcomes of both groups were analyzed. The groups' mean ages and genders were comparable. The mean stone size for the RIRS group was 1.86cm and 1.69cm for the PCNL group (P=0.449). The PCNL group had statistically longer mean fluoroscopy and hospitalization times. The stone-free rates (SFRs) after a single procedure were 27 (90%) in the PCNL group and 25 (83.33%) in the RIRS group (P=0.706). The UAS was placed in 13 (43.33%) patients in the RIRS group. In the RIRS group, 14 (46.67%) children required preoperative DJ stent application to passively dilate the ureteric orifice. As regard post DJ stenting, 13 (46%) cases applied DJ in the mini PCNL group. major complications were observed in either group. Minor complication (Clavien 1-3) rates were 16.66% and 13.33% for the PCNL and RIRS groups, respectively. There were no differences found between the RIRS and mini-PCNL groups regarding operative time. The mean cost of RIRS was $703.96 and $537.03 for the mini-PCNL. According to the results of this study, mini-PCNL and RIRS are effective procedures for treating renal stones in children up to 2.5cm with comparable success and complication rates. Hospital stay, radiation exposure, and fluoroscopy time are significantly lower in RIRS than in the mini PCNL technique. Although RIRS is effective, a major disadvantage is the greater requirement for JJ stent insertion either before or after the procedure and the consequent need for a second procedure for removal.

Fluid absorption during flexible ureteroscopy with intelligent control of renal pelvic pressure: a randomized controlled trial.

To investigate fluid absorption and its influencing factors during flexible ureteroscopy with intelligent control of renal pelvic pressure (RPP). A total of 80 patients with upper urinary tract calculi underwent flexible ureteroscopy with intelligent control of RPP by pressure-measuring ureteral access sheath and were randomly divided into four groups. The RPP of Groups A, B, and C were set at -5, 0 and 5mmHg, respectively. Conventional flexible ureteroscopy with uncontrolled pressure served as control Group D. The perfusion flow rate was set at 100ml/min in the four groups, with 20 patients in each group. The fluid absorption was measured by 1% ethanol every 10min. Operation time, stone-free rate, and complications were recorded. Seventy-three patients were finally included in the RCT. The general and preoperative data of the patients were comparable between the groups. The fluid absorption of Groups A, B, and C was significantly less than that of Group D (P < 0.01). Fluid absorption and operation time were positively correlated, and the correlation coefficients R were 0.864, 0.896, 0.918, and 0.947, respectively (P < 0.01). The fluid absorption of patients with vomiting, fever and ureteral injury was greater than that of patients without complications in the four groups (P < 0.01). In different groups, fluid absorption was greater in patients with ureteral injury Post-Ureteroscopic Lesion Scale (PULS) 1-3 than in noninjured patients (P < 0.01). Flexible ureteroscopy with intelligent control of RPP effectively reduces the absorption of perfusion fluid. Operation time and ureteral injury are also key factors affecting perfusion fluid absorption. NCT05201599; August 11, 2021.

Safety of single-use flexible ureteroscopy for dusting of upper urinary tract calculi in children

BackgroundFlexible ureteroscopy offers numerous advantages, such as increased reach, superior stone-free rate, reduced risk of bleeding, minimal surgical trauma, and faster recovery time. There are few studies discussing the effectiveness of single-use flexible ureteroscopy in children, and none so far have addressed its safety. This study aims to evaluate the effectiveness and safety of a single-use flexible ureteroscope for treating upper urinary tract stones in children.MethodsThis study included children with single upper urinary tract stones measuring less than 2 cm who underwent single-use flexible ureteroscopy between October 2020 and January 2023. We assessed the following patient characteristics: age, gender, stone type, size, position, pre and postoperative stent placements, use of a ureteral access sheath, stone-free rate, operation duration, and the rate of complications. A patient was considered stone-free if there were no residual stone particles larger than 3 mm after surgery.ResultsFlexible ureteroscopy and holmium laser lithotripsy were undertaken for 44 participants, with an average age of 8.5 years (range: 2–16 years). The typical stone size was 14 mm (range: 6–20 mm). The average operation time was 74 min (range 35–110 min). Ureteral access sheaths were used in 81.8% (36 out of 44) of procedures. After a single FURS session, 86.36% (38 out of 44) of patients achieved stone-free status. Postoperative JJ stent application was noted in 86.4% (38 out of 44) of patients. Complications were categorized using the Calvien system, revealing that 25% (11 out of 44) of patients experienced mild hematuria, colic, and low-grade fever (Calvien I). No severe side effects like mucosal avulsion or ureteral perforation were reported.ConclusionIn the short-term, single-use flexible ureteroscopy is a safe and effective method for managing single renal and proximal ureteric stones, measuring 2 cm or less, in children.

Composition analysis of 1,495 cases of upper urinary tract calculi: the role of age and gender.

This study aimed to quantitatively analyze the calculi components of upper urinary tract calculi and to explore the relationship between calculus components, demographic characteristics, and underlying diseases. Clinical data of 1,495 patients with upper urinary tract calculi were retrospectively collected. The calculi were divided into simple calcium oxalate, calcium oxalate mixed, calcium phosphate mixed, uric acid, magnesium ammonium phosphate, and other components. Statistical software SPSS 22.0 was used to analyze the differences between the stone compositions and various factors. The influencing factors (p < 0.05) were analyzed using multiple logistic regression analysis. Among 1,495 patients with upper urinary tract calculi, simple calcium oxalate calculi were the most common component (39.7%), followed by calcium oxalate mixed calculi (30.4%), uric acid calculi (13.6%), calcium phosphate mixed calculi (10.4%), magnesium ammonium phosphate calculi (5.8%) and other component calculi (0.1%). Univariate analysis revealed statistically significant differences in stone composition according to gender, age, and hyperuricemia (p < 0.05). Multiple logistic regression analysis showed that compared to men, the odds ratio (OR) values of calcium oxalate mixed stones, calcium phosphate mixed stones, and magnesium ammonium phosphate stones in women were 1.61, 2.50, and 4.17, respectively (p < 0.001). Compared with elderly patients, the OR values of calcium phosphate mixed stones in young and middle-aged patients were 3.14 and 2.70, respectively (p < 0.05). Patients with different stone components had different demographic characteristics, and stone components were significantly different between gender and age. Calcium oxalate mixed stones were more common in females, and calcium phosphate mixed stones and magnesium ammonium phosphate stones were more common in females, young patients, and middle-aged patients.

Abstract 832: Gender differences in urinary tract cancer susceptibility associated with radon in water: A population based study from Finland

Abstract Background: Radon as a common source of environmental radiation, while its carcinogenic effect on urinary tract cancer has not been fully investigated. Methods: Men and women who have continuously lived in Finland from year 1987 onward and reached 40+ years old at the beginning of 2017 were followed up for urinary tract cancer, including bladder cancer (ICD-O 3 code C67) and kidney cancer (C64-C66 and C68) for 5 years until the end of 2021. The residential location and type of buildings of the cohort members were traced from year 1987 until 2016 annually and linked to the average cumulative exposure of radon concentration in well water on municipality level. Newly diagnosed UTC cases were identified based on the Finnish cancer register. Pre-existing health conditions, such as hypertension, diabetes, chronic kidney disease, calculus of kidney and lower urinary tract, family history of cancer, as well as socioeconomic factors were ascertained from multiple registry databases. Data were analyzed with Cox proportional hazards model conditional on birth cohorts and adjusted with available covariates. Findings: Among 1,019,331 men and 1,192,960 women with 30-years average radon exposure, 4206 and 2226 urinary tract cancer cases were diagnosed during follow-up period from 2017 until correspondingly. Men with higher radon exposure (&amp;gt;500 Bq/m3) had about 14% higher risks of UTC in total (HR 1.14, 95% CI 1.07-1.21), 19% higher risks of bladder cancer (HR 1.19, 95%CI 1.09-1.32), 10% higher risks of kidney cancer (HR 1.10, 95%CI 1.02-1.20) comparing with lower exposed samples. Women with higher radon exposure had about 1% higher risks of UTC in total (HR 1.01, 95%CI 0.93-1.10), 3% higher risks of bladder cancer (HR 1.03, 95%CI 0.88-1.22), 1% higher risks of kidney cancer (HR 1.01, 95%CI 0.92-1.11). In the sub-population who only lived in houses during the 30-years exposure period, men with higher radon exposure had about 24% higher risks of UTC (HR 1.24, 95% CI 1.12- 1.36), 30% higher risks of bladder cancer (HR 1.30, 95%CI 1.12-1.51), 20% higher risks of kidney cancer (HR 1.20, 95%CI 1.06-1.36). No significant association was observed in women who only lived in houses during exposure period. Conclusions: For men, higher radon exposure was significantly associated with elevated risks of UTC. No significant association was observed in women. Further investigates were needed to explore the mechanisms of gender differences in UTC susceptibility associated with radon exposure. Keywords: Radon, Radiation, Cancer, Urinary tract cancer, Kidney cancer, Bladder cancer Citation Format: Peng Yunzhi Li. Gender differences in urinary tract cancer susceptibility associated with radon in water: A population based study from Finland [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 1 (Regular Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(6_Suppl):Abstract nr 832.

Laparoscopic management of double moiety: A case report with review of literature

Duplication of the ureter is one of the most common anomalies of the urinary tract. Ureterocele is a developmental anomaly with cystic dilation of the distal aspect of the ureter and is often associated with some urological anomaly, such as a duplicated system or stenotic ureteric orifice. Early detection of these anomalies during the antenatal period has dramatically increased due to advances in imaging technology. However, a few undiagnosed adults also exist. It may remain asymptomatic but may cause repeated urinary tract infections or calculi. This is a case report of a 47-year-old female who had bilateral duplex collecting systems with right ureterocele. The patient had a recurrent urinary tract infection. She underwent cystoscopic deroofing and a laparoscopic right total nephrectomy. Congenital anomalies of the urogenital system should be considered in patients with chronic or recurrent infections. Multimodal imaging techniques such as ultrasonography, computed tomography, or magnetic resonance imaging should be used to confirm the diagnosis, especially before surgical management. The rationale for reporting this case is to highlight this rare condition and the feasibility of its minimally invasive therapy.

A retrospective comparison of Sun’s tip-flexible semirigid ureterorenoscopy, super-mini percutaneous nephrolithotomy and flexible ureteroscopy applied to treat upper urinary tract calculi

BackgroundThis retrospective study was conducted to compare the safety and efficacy of Sun’s tip-flexible semirigid ureterorenoscopy (tf-URS), super-mini percutaneous nephrolithotomy (SMP) and flexible ureteroscopy (FURS) in treating upper urinary tract calculi, including upper ureteral or renal calculi.MethodsWe included patients with upper ureteral calculi or renal calculi 1.0–2.0 cm in size, who underwent tf-URS, SMP or FURS, respectively. The indicators reflecting safety and efficacy were compared among the three surgical techniques.ResultsSMP presented with higher single stone crushing success rate, but longer operation time and postoperative hospital stay, more blood loss, and higher postoperative pain score compared with FURS and tf-URS (P < 0.05). The hospitalization cost of tf-URS group was lower than that of SMP and FURS groups (P < 0.05). The incidence of postoperative fever in tf-URS group was significantly higher than that in SMP group (P < 0.05). No significant difference was found in mucosal injury, perirenal hematoma, and stone-free rate at 3 months after surgery (P > 0.05).Conclusionstf-URS and FURS have the advantages in minimal invasion, hospitalization cost, patient comfort, and hospital stay while SMP has higher stone-free rate. These three surgical techniques are safe, reliable and complementary, which should be selected according to the actual situation.

Feasibility of Simultaneous Bilateral Endoscopic Surgery in Prone Split-Leg Position for Bilateral Upper Urinary Tract Calculi: A Pilot Study

Introduction: We explored the viability of simultaneous bilateral endoscopic surgery (SBES) in the prone split-leg position for managing bilateral calculi. Methods: We retrospectively reviewed 72 patients who underwent SBES, with procedures involving ureteroscopy (URS) and contralateral percutaneous nephrolithotomy (PNL) simultaneously, in prone split-leg position. Results: Operative times averaged 109.38 ± 30.76 min, with an average hospital stay of 7.79 ± 3.78 days. The bilateral stone-free rate (SFR) was 70.83%, while URS and PNL demonstrated comparable unilateral SFR (83.33% and 79.17%, respectively). Receiver operating characteristics curves for predicting unilateral residual fragments yielded an area under the curve of 0.84 (URS) and 0.81 (PNL) with respective cutoff values of stone diameter of 11.55 mm and 23.52 mm. Fifty-seven (79.17%) and 15 (20.83%) patients encountered grade 0–1/2 complications, with no severe complications (grade 3–5) recorded. No significant changes in blood count or renal function were observed post-SBES. Conclusions: SBES in the prone split-leg position is a viable option for managing bilateral upper tract urolithiasis. Larger scale studies are needed to further assess safety and efficacy in various positions.