Urolithiasis最新文献

The flexible and navigable suction ureteral access sheath (FANS-UAS) has increasingly been recognized as a potential game changer for retrograde intrarenal surgery (RIRS). While this innovative technology has demonstrated promising results in adult populations, there is a notable lack of evidence regarding its application in pediatric cases, particularly in comparison to conventional ureteral access sheaths (CUAS). This study aimed to perform a comparative analysis of pediatric kidney stone cases treated with RIRS using FANS-UAS and CUAS. We conducted a retrospective matched pair analysis, matching patients based on preoperative age, stone location, and stone size. After matching, data from 46 patients (23 in each group) were analyzed. The groups were comparable in terms of age, hydronephrosis degree, location and size of the stone (p = 0.543, p = 0.807, p = 0.840, and p = 0.577, respectively). Operation times were shorter in the FANS-UAS group (CUAS: 67.9 ± 21.0 min, FANS-UAS: 50.4 ± 21.1 min, p = 0.007). The initial stone-free rate (SFR) was 65.2% in the CUAS group and 91.3% in the FANS-UAS group, with a statistically significant difference (p = 0.032). However, no significant difference was found regarding the final SFR (p = 0.295). The number and duration of DJ-stents, were significantly higher in the CUAS group (p = 0.006 for both). The FANS-UAS group had a significantly fewer anesthesia sessions (p = 0.001). There were no significant differences in complication rates (p = 0.303). Our findings suggest that FANS-UAS offers significant advantages over CUAS in pediatric RIRS, including higher initial success rates, shorter operation times, reduced anesthesia requirements, and fewer treatment sessions, with comparable safety profiles.

The early stages of kidney crystal formation involve inflammation and hypoxia-induced cell injury; however, the role of the hypoxic response in kidney crystal formation remains unclear. This study investigated the effects of a prolyl hydroxylase domain inhibitor (roxadustat) on renal calcium oxalate (CaOx) crystal formation through in vitro and in vivo approaches. In the in vitro experiment, murine renal tubular cells (RTCs) were exposed to varying roxadustat concentrations and CaOx crystals. CaOx monohydrate (COM) crystal adhesion was evaluated using fluorescent labels, whereas western blotting was used to examine protein expression. Quantitative real-time polymerase chain reaction was used to analyze gene expression changes. Macrophage responses were investigated by co-culturing them with RTCs treated with COM. In the in vivo experiment, C57BL/6J mice were injected with roxadustat or saline for 2 days, followed by glyoxylate for 6 days to induce renal crystal deposition. Biochemical measurements recorded plasma erythropoietin, urinary data, and pH levels. Roxadustat suppressed the adhesion of COM crystals to RTCs and the expression of proinflammatory genes, such as chemokine (C-C motif) ligand 2 (Ccl2) and secreted phosphoprotein 1 (Spp1). Roxadustat decreased the expression levels of Ccl2, tumor necrosis factor (Tnf), and interleukin 6 (Il6) in co-cultured macrophages. In the in vivo experiment, the amount of renal CaOx crystal deposits was significantly lower in the roxadustat-treated group than in the vehicle group. Roxadustat treatment decreased Ccl2, Tnf, and adheision G protein-coupled receptor E1 (Adgre1) expression in the kidneys. Roxadustat reduced kidney inflammation and CaOx crystal deposition, suggesting its potential as a therapeutic option for kidney stone prevention.

To assess the accuracy of Kidney Stone Calculator(KSC), a software designed for surgical planning, in predicting the duration of lithotripsy during flexible ureteroscopy(FURS) when using the novel pulsed-Thulium: YAG(p-Tm: YAG) laser. From February to August 2023, a single-center prospective study was conducted, including patients with kidney or ureteral stones through non-contrast computed tomography(NCCT), who underwent FURS with p-Tm: YAG laser lithotripsy. KSC used three-dimensional segmentation of the stones from NCCT images, along with an interactive user interface for laser settings, to estimate the stone volume(SV) and the lithotripsy duration(LD). The correlation between the estimated(esLD) and effective(efLD) lithotripsy duration was evaluated. A multiple linear regression analysis was conducted to identify preoperative and intraoperative factors affecting discrepancies between esLD and efLD. Twenty-eight patients were included with a median age of 55(48-74) years and 71% of men. Stone were located in the renal cavities(71%), ureter(21%) or both locations(8%). Median maximum stone diameter(MSD) and SV were respectively 14(11-30)mm and 1239(294, 2000)mm³. Nine patients had a SV equal to or greater than 2000mm³. EsLD and efLD did not differ(28 vs. 32 min, p = 0.8892), and were highly and positively correlated(r = + 0.90,p-value = < 0.001). Multivariate analysis indicated that the difference between estimated and effective lithotripsy were correlated with the stone volume(> 2000mm³), the use of ureteral access sheath and for struvite stones. "Kidney Stone Calculator" can accurately estimate LD during FURS with the p-Tm: YAG laser. Variables such as stone volumes over 2000mm³ and stone composition could be integrated the estimation. KSC is the only software that estimates LD with Holmium: YAG, Thulium Fiber and p-Tm: YAG lasers.

The current study aimed to determine the risk factors and define a new scoring system for predicting febrile urinary tract infection (F-UTI) following retrograde intrarenal surgery (RIRS) by using machine learning methods. We retrospectively analyzed the medical records of patients who underwent RIRS and 511 patients were included in the study. The patients were divided into two groups: Group 1 consisted of 34 patients who developed postoperative F-UTI, and Group 2 consisted of 477 patients who did not. We applied feature selection to determine the relevant variables. Consistency subset evaluator and greedy stepwise techniques were used for attribute selection. Logistic regression analysis was conducted on the variables obtained through feature selection to develop our scoring system. The accuracy of discrimination was assessed using the receiver operating characteristic curve. Five of the 19 variables, namely diabetes mellitus, hydronephrosis, administration type, a history of post-ureterorenoscopy (URS) UTI, and urine leukocyte count, were identified through feature selection. Binary logistic regression analysis showed that hydronephrosis, a history of post-URS UTI, and urine leukocyte count were significant independent predictors of F-UTI following RIRS. These three factors demonstrated good discrimination ability, with an area under curve value of 0.837. In the presence of at least one of these factors, 32 of 34 patients (94.1%) who developed postoperative F-UTI were successfully predicted. This new scoring system developed based on hydronephrosis, a history of post-URS UTI, and urine leukocyte count can successfully discriminate patients at risk of F-UTI development after RIRS.

The primary objective of urolithiasis therapy is complete stone removal and highest stone-clearance rates possible to minimize recurrence. A novel approach that employs a magnetic suspension and a magnetic probe for the passive collection and removal of small residual fragments was developed. This study assessed the feasibility of this system in porcine models. Five female domestic pigs underwent retrograde intrarenal surgery under general anaesthesia to assess the new magnetic system. Pre-analysed human calculi were endoscopically inserted and comminuted using lithotripsy. The magnetic suspension was applied, and the magnetic-stone fragment complex was extracted. After nephrectomy, independent blinded pathologists evaluated all the kidneys. Safety and tolerance assessments revealed no adverse events (i.e. no complications on the Clavien-Dindo scale > 1) or complications associated with treatment. This study revealed superficial urothelial damage in all animals, characterized by desquamation and inflammation, caused primarily by the insertion of access sheaths and laser lithotripsy. Residual magnetic particles were observed in the renal pelvis but did not show signs of toxicity even though this study is limited to the acute treatment. No pathological indicators were observed in the hemogram and urinalysis. Overall, the treatment did not cause any significant pathological changes. Preclinical in vivo evaluation of magnetic extraction of small rest fragments in porcine kidneys presents a promising, atraumatic approach for fragments removal. It demonstrated safety, tolerance, and feasibility that warrants clinical investigation. This method has the potential to increase stone-clearance rates with shorter extraction times, offering a possibility for addressing the challenge of urolithiasis in clinical practice.

The purpose of this study is to address the gap in the existing literature regarding the risk factors for systemic inflammatory response syndrome (SIRS) in patients with a solitary kidney who undergo percutaneous nephrolithotomy (PCNL).This retrospective study reviewed the clinical data of 51 patients with solitary kidney stones who underwent PCNL from January 2018 to January 2024.The study evaluated demographic information, stone characteristics, and laboratory data. Among the 51 patients evaluated, 12 (23.5%) developed SIRS. Multivariate analysis showed that a high urinary white blood cell count (p = 0.041; OR, 1.004; 95% CI, 1.000-1.008), prolonged operation time (p = 0.040; OR, 1.054; 95% CI, 1.005-1.107), and postoperative blood leukocyte count (p = 0.031; OR, 1.459; 95% CI, 1.020-2.061) were independent risk factors for SIRS after PCNL in patients with a solitary kidney. Given the unique physiological conditions of patients with solitary kidneys, who face a higher incidence of kidney stones and have lower risk tolerance, the results of this study provide insights into the risk factors for SIRS after PCNL in these patients. By identifying these factors, clinicians can better stratify risk, implement preventive and therapeutic measures in a timely manner, reduce the risk of SIRS, and improve overall patient outcomes.

Purpose: To compare stone clearance and complications between a 'wide' (9 × 50 mm) and 'narrow' shockwave focus (6 × 28 mm) when undertaking shockwave lithotripsy (SWL) in patients with renal or ureteric stones.

Methods: Data from patients undergoing SWL using the dual focus Storz Modulith SLX-F2 lithotripter at a single centre were prospectively collected between February 2018 and September 2020. Patients were matched by stone size, location, and number of treatments. Stone clearance, re-presentation within 31 days, symptoms, complications, and need for post SWL-interventions were compared using McNemar's test.

Results: Patients receiving wide focus SWL (WF-SWL, n = 152) were matched with patients receiving narrow focus SWL (NF-SWL, n = 152). Median stone size was 6 mm; energy delivered to WF-SWL and NF-SWL groups was comparable. Complete stone clearance was achieved in 55% of WF-SWL patients (n = 84) and 41% (n = 63) of NF-SWL patients (p = 0.04). Treatment was considered successful in 74% (n = 113) of WF-SWL cases and 66% (n = 100) of NF-SWL (p = 0.20). No difference in rates of readmission, post-procedural pain, haematuria, urinary tract infections, analgesia or antibiotic requirements were identified.

Conclusion: This service evaluation demonstrates no differences in rates of overall treatment success nor complications on comparing WF-SWL and NF-SWL.

Patient education is effective in reducing the level of anxiety before and after surgery and increasing the level of readiness for discharge. Patient education provided by nurses can be planned and applied individually. Therefore, this study aims to determine the effect of the education in whom a double J stent after ureteroscopy on their pre- and postoperative anxiety and levels of readiness for discharge. This research study is a randomized controlled trial with control and intervention groups, pre- and posttests. This study was conducted between November 2021 and May 2022 in a university hospital in Turkey. The patients were divided at random into two groups, control (n = 61) and intervention (n = 61). The Personal Information Form, State-Trait Anxiety Inventory (STAI-I, STAI-II), Surgery-Specific Anxiety Scale (SSAS), Readiness for Hospital Discharge Scale for Adult Patients-Short Form (RHDS/SF) and Readiness for Hospital Discharge Scale- Adult-Nurse Assesment Short Form (RN-RHDS/SF) were used to collect the data. The mean SSAS and STAI-I scores on the morning of surgery and before discharge were found to be significantly lower in the intervention group than the control group. The mean RHDS/SF and RN-RHDS/SF scores on the before discharge were found to be significantly higher in the intervention group than the control group. It was concluded that the education provided to the patients in whom a double J stent after ureteroscopy reduced pre- and postoperative anxiety and increased the level of readiness for discharge.

Urolithiasis is a prevalent condition in urology, with extracorporeal shock wave lithotripsy (ESWL) serving as a common treatment for kidney stones under 2 cm. The Mayo Adhesion Probability (MAP) score, calculated from perinephric fat characteristics, is traditionally used to assess surgical outcomes but has not been explored in the context of ESWL. This study aims to evaluate the effect of MAP score on the success rate of ESWL. This retrospective study included patients who underwent ESWL for kidney stones between January 2018 and June 2024 at a tertiary care center. Demographic data, stone characteristics, and MAP scores were obtained through CT imaging. ESWL success was defined as either complete stone clearance or a residual fragment less than 4 mm at three months post-procedure. Logistic regression and ROC analysis were employed to identify predictors of treatment success and to determine the optimal MAP score cutoff. A total of 260 patients were analyzed, divided into two groups: MAP score < 3 (n = 154) and MAP score ≥ 3 (n = 106). Patients with a MAP score ≥ 3 had a significantly lower ESWL success rate (49.1%) compared to those with a MAP score < 3 (71.4%; p = 0.001). Multivariate analysis identified MAP score, BMI, and stone size as significant predictors of ESWL success. ROC analysis established a MAP score cutoff of 2, with 76.5% sensitivity and 64.3% specificity. The MAP score is an independent predictor of ESWL success in kidney stone treatment. Preoperative MAP evaluation may improve patient selection and optimize ESWL outcomes.