Urolithiasis最新文献

Previous observational studies have highlighted a significant link between dyslipidemia and kidney stones. However, whether plasma lipid composition directly influences kidney stone formation and the extent to which inflammatory proteins mediate this relationship remain uncertain. This study utilizes genetic variation data from the recent genome-wide association studies to analyze 179 plasma lipids and 91 inflammatory proteins in relation to kidney stones. By applying a two-sample Mendelian randomization (MR) approach, we systematically investigated the potential causal effects of plasma lipids on kidney stones and assessed the mediating role of inflammatory proteins through a two-stage MR analysis. The findings revealed that specific phosphatidylcholines (PC) (including PC(14:0_18:1), PC(16:0_20:2), PC(16:1_18:0), and PC(18:0_18:3)) exhibited positive causal associations with kidney stone risk, while sterol esters (27:1/18:0) demonstrated stone risk-reducing effects. Among inflammatory proteins, monocyte chemoattractant protein 2 and tumor necrosis factor ligand superfamily member 14 (TNFSF14) were associated with increased kidney stone risk, whereas Axin-1, macrophage colony-stimulating factor 1, C-X-C motif chemokine 10, interleukin-5, and urokinase-type plasminogen activator (uPA) correlated with reduced risk. Further mediation analysis revealed that TNFSF14 and uPA may serve as mediators in the relationship between the plasma lipidome and kidney stone formation. This study provides insights into the mechanisms by which plasma lipid metabolism influences kidney stone development through inflammatory regulatory networks. These findings lay a theoretical foundation for lipidomics- and inflammation-based biomarker risk prediction, as well as targeted intervention strategies for kidney stone prevention.

Urinary tract infection (UTI) is a common and serious complication after percutaneous nephrolithotomy (PCNL).This study develops and validates the PuRass scoring system to predict the risk of UTI, including urinary sepsis, after PCNL and support personalized clinical Management. A retrospective analysis of 293 PCNL patients was conducted, incorporating multiple risk factors, including gender, age, diabetes, preoperative white blood cell count, urine analysis and culture results, stone size and type, and the degree of hydronephrosis. Significant risk factors were identified through meta-analysis and integrated into PuRass, with each factor weighted according to its odds ratio (OR) value to establish a quantitative risk assessment model. Results showed that gender, age, diabetes, elevated white blood cell count, and positive urine analysis and culture results significantly increased the risk of post-PCNL UTI. The PuRass model demonstrated excellent predictive performance in ROC curve analysis, achieving 90% sensitivity and 89.4% specificity, with an optimal threshold of 8.5 points. Early intervention strategies based on PuRass effectively reduced infection rates and hospital stays in high-risk patients. This study indicates that PuRass provides a reliable tool for predicting and managing post-PCNL UTI. Future multicenter studies will further validate its clinical applicability and explore its integration with emerging technologies to enhance postoperative management.

Urinary stones, one of the most common emergency conditions, traverse the ureter, urine flow is obstructed, resulting in hydronephrosis and severe pain. However, vessel wall calcifications or phleboliths are frequently observed in abdominal and pelvic regions and distinguishing them from urinary stones can be challenging. This study was performed to implement deep learning techniques, specifically utilizing the UROAID (UROlothiasis AssIsted Diagnosis system) model, to detect urinary stones within the urinary tract. Noncontrast abdominopelvic computed topographies (CT) performed on adult patients at the emergency departments of the two tertiary academic hospitals were collected. The ROI Extraction and KUB Segmentation algorithms were a modified version of Uro-UNETR. The 3D labelling map and 3D stone classification were individual outputs that were then merged with the results from the Urinary System Estimation module in the UROAID detection module. In total, the CT scans of 6659 patients were included in the study. An accuracy of 0.9585 and an F1 score of 0.9605 were achieved using an ensemble model alongside a stone classification module that we also proposed to further improve the performance. The detection rate of UROAID for stones by location was highest for stones in the kidney, with a rate of 99.0%, followed by the proximal ureter (99.1%), middle ureter (98.0%), distal ureter (96.4%), and urinary bladder (91.3%). This study designed UROAID, an ensemble model of a segmentation-based stone detection module and a stone classification module, to follow the process of a radiologist accurately diagnosing urinary stones.

This study revisits the physical principles of gravity-based irrigation in flexible ureteroscopy (fURS), assessing the effects of bag height, reference level, working channel occupancy, bag depletion, and drip chamber configuration on irrigation flow and pressure. An in vitro model was constructed with two 3-L saline bags connected to a Y-end system and a LithoVue™ fURS. Flow rates (mL/min) were measured at five heights (0-200 cm H₂O) using three reference levels: bag top, outflow, and drip chamber. Four working channel conditions were tested (free, 150 μm laser fiber, 200 μm fiber, and 1.9 Fr basket). Additional experiments examined bag volumes (3 L to near empty) and drip chamber content (air vs. fluid). Irrigation pressure at the ureteroscope tip was recorded via a water column. Flow increased proportionally with bag height and was lowest when referenced from the bag top. Channel occupancy markedly reduced flow, with no measurable flow at 0 cm when referenced from the top. Bag depletion and drip chamber air content had negligible influence, even in empty bags. Pressure recordings revealed a negative pressure in depleting bags, and the bag top correlated most closely with ureteroscope pressure. This confirms that gravity irrigation follows hydrostatic principles. Bag height and channel occupancy are the primary determinants of flow, whereas bag volume and drip chamber configuration exert minimal influence. The saline bag top best reflects irrigation pressure and should be the reference level. Negative pressures of 7-8 cm H₂O in depleting bags minimally affected flow but may impact intrarenal pressure.

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.

The aim of this study was to identify preoperative and perioperative predictors of radiation exposure during retrograde intrarenal surgery and to develop a scoring system to estimate intraoperative fluoroscopy time. Data from 753 patients who underwent retrograde intrarenal surgery for renal stones were obtained from a multicenter database. All procedures were performed under general anesthesia using fluoroscopy. Fluoroscopy time, recorded in seconds, was the primary outcome. Ordinal regression analysis was applied to evaluate the association between clinical variables and fluoroscopy duration. A predictive score was developed based on statistically significant factors. The performance of the score was tested using receiver operating characteristic curve analysis and a calibration plot.The mean fluoroscopy time was 58 seconds, while the median was 5 seconds. In 140 procedures, fluoroscopy time exceeded 120 seconds. Six parameters were independently associated with longer fluoroscopy use: absence of preoperative ureteral stenting, low stone density (<1000 Hounsfield units), small stone burden (<250 cubic millimeters), multiple stone localizations, failure of ureteral access sheath insertion, and use of large-caliber sheaths (≥10-12 French). Each parameter was assigned a weighted value, generating a score ranging from 0 to 15. The scoring system demonstrated excellent discriminatory ability (area under the curve: 0.901). A score of 10 or more predicted fluoroscopy duration above 120 seconds with 87.5% sensitivity and 86.2% specificity.The RIRSearch Score is a practical tool for anticipating prolonged radiation exposure before retrograde intrarenal surgery. Surgeons may use this model to minimize unnecessary fluoroscopy and enhance occupational safety.

This study aims to evaluate the discriminative ability of the S.T.O.N.E. score for residual fragments following ureteroscopy and laser lithotripsy in patients with surgically confirmed impacted ureteral stones. We retrospectively analyzed 272 adult patients who underwent laser lithotripsy via semirigid ureteroscopy for impacted ureteral stones between January 2019 and January 2025. Preoperative computed tomography imaging was used to calculate the S.T.O.N.E. score, incorporating five parameters: stone size, location, hydronephrosis, number, and Hounsfield Unit value. Statistical analyses included ROC curve analysis and logistic regression to identify predictors of residual fragments. Among 272 patients, 202 (74.3%) achieved stone-free status, while 70 (25.7%) had residual fragments. Residual stone group had significantly higher median stone size, stone burden, Hounsfield Unit value, ureteral wall thickness, and hydronephrosis grade (all p < 0.001). Proximal location was more frequent in the residual stone group (p = 0.008). The S.T.O.N.E. score was significantly higher in residual stone group (p < 0.001). ROC analysis demonstrated good discriminative ability (AUC: 0.767; p < 0.001), with an optimal cut-off of > 9 provided optimal sensitivity (78%) and specificity (61%). In multivariate logistic regression, both the S.T.O.N.E. score (OR: 2.008; p < 0.001) and proximal/mid-ureteral stone location (OR: 4.107 and 3.543, respectively) were identified as independent predictors of residual fragments. The S.T.O.N.E. score is a reliable predictor of surgical outcomes in impacted ureteral stones treated with ureteroscopy and laser lithotripsy, and proximal or mid-ureteral locations are independently associated with lower stone free rate. These findings may support the integration of anatomical and composite scoring parameters into preoperative planning to optimize patient-specific surgical strategies.