Urolithiasis最新文献

To assess the use of miniaturized percutaneous nephrolithotomy (mini-PCNL) for renal stones in children, as well as its safety and efficacy. Seventy-seven patients with more than 15 mm renal stones whose age was less than 15 years were enrolled in this prospective case-controlled study at Al-Ramadi Teaching Hospital, Ar Razi Private Hospital, and Ghazi Al-Hariri Hospital for Surgical Specialties, Anbar and Baghdad, Iraq. The study was conducted from January 2020 to January 2024. The group mentioned above served as group A, and it was compared to the control group (group B), which consisted of 70 adult patients aged 18-60 years. Patients in both groups underwent mini-PCNL. Gender, stone size and location, time of operation, stone-free rate, hemoglobin drop, need for blood transfusion, postoperative fever, associated visceral injury, and need for further interventions such as extracorporeal shock wave lithotripsy or flexible ureteroscopy (ESWL or FURS) were compared in both groups. The age of patients in group A ranged from 8 months to 15 years with a mean (4.30 ± 3.16), while in group B ranged from 18 to 60 years with a mean (36.3 ± 12.0), p-value 0.001. There were no statistically significant differences regarding gender distribution, stone size, and location, p-value > 0.05. The stone-free rate was 87.01% for group A and 88.57% for group B, with no statistical difference, p-value 0.773. Hemoglobin drop was 1.096 ± 0.412 for group A and 1.195 ± 0.110 for group B, p-value 0.046. Blood transfusion was needed in one case in each group with no statistical difference, p-value 0.946. The need for ESWL was 3 cases in group A, and 2 cases in group B, with no statistical difference between the two groups, p-value 0.729. The need for FURS was 4 cases in group A and 3 cases in group B, p-value 0.796. Operative time was 30 to 125 min in group A and 34 to 129 min in group B, p-value 0.941. Postoperative fever was seen in 23 cases in group A and 21 cases in group B, p-value 0.986. Minor liver injury was seen was seen in one case in each group. The use of mini-PCNL for treating renal stones in children is safe and effective as it is associated with a relatively low rate of significant complications and achieves a high stone-free rate.

In addition to the fact that the significance of the nephrolitometric scoring systems (NSSs) remains unclear, no study has been conducted to assess the effectiveness of these scoring systems in percutaneous nephrolithotomy (PNL) performed in the supine position. We aimed to compare the CROES, Guy's scoring system (GSS), S.T.O.N.E., and S-ReSC NSSs for success and complications in patients undergoing supine mini-PNL (m-PNL). The prospectively recorded data of the patients who underwent supine m-PNL was reviewed retrospectively, and a total of 112 patients were included in the study. Demographic, operation, post-procedure data, and CROES, GSS, S.T.O.N.E., and S-ReSC scores were assessed and compared between the stone-free (SF) and residuel groups. There were significant differences between the SF and residual groups in terms of mean CROES, S.T.O.N.E., and S-ReSC scores (p = 0.003, p = 0.009, and p = 0.015, respectively). Similarly, there were significant differences between the grades of these scoring systems and the success of the procedure (p = 0.035, p = 0.007, and p = 0.007, respectively). However, the GSS was insignificant. The area under curve values in ROC analysis of CROES, S.T.O.N.E., and S-ReSC NSSs were 0.695, 0.665, and 0.656, respectively (p = 0.003, p = 0.011, and p = 0.017, respectively). No statistically significant difference was found between the grades of all four NSSs and the complication rates. The study showed a strong correlation between CROES, STONE, and S-ReSC NSSs in predicting SF status after supine m-PNL. However, none of the NSSs could predict the complications.

Imaging techniques, such as computed tomography (CT) and fluoroscopy, are essential for the diagnosis and treatment of urolithiasis. There is increasing concern regarding the cumulative radiation dose associated with medical imaging and its adverse effects. This study aimed to assess radiation exposure in patients undergoing endoscopic management of urolithiasis and to identify factors associated with increased exposure.A retrospective analysis of all consecutive symptomatic urolithiasis cases who underwent endoscopic surgery over a two-year period at a tertiary referral center was performed. The cumulative radiation dose was recorded per stone episode, and the effective dose (ED) then calculated. Multivariable regression analysis was performed to determine the association between ED and patient, stone, and procedural characteristics.Between January 2020 and December 2021, 250 patients underwent endoscopic intervention for urolithiasis; 71% (n = 178) were male with a median age of 48 years (IQR 35-59). The median stone size was 6 mm (IQR, 5-8 mm) and the median stone volume was 110 mm³ (IQR, 60-206 mm³). Most stones were located in the distal ureter (46%, n = 114). The median ED received per stone episode was 3.99 mSv (IQR 2.9-7 mSv). On multivariable analysis, BMI, number of CT scans performed, CT protocol used, and repeat procedures strongly predicted increased radiation dose (p < 0.01).It is important for urologists to consider the cumulative radiation dosage in patients with urolithiasis. Strategies to minimize exposure, such as avoiding re-imaging, low-dose CTs, and collimation of the region of interest with judicious magnification, should be considered during treatment.

The objective of this study was to compare the clinical efficacy and safety of microchannel percutaneous nephrolithotripsy (MPCNL) with flexible ureteroscopic lithotripsy (FURL) in the treatment of single upper ureteral stones with a diameter of 1-2 cm and high hardness. This study retrospectively analyzed 89 patients diagnosed with a single upper ureteral stone with a 1-2 cm diameter and a computed tomography value > 1000 Hounsfield units. A propensity score matching system matched this study with factors to minimize the effect of baseline differences between patients. Ultimately, 29 patients in each of the two groups were successfully matched. The stone-free rate was marginally higher in the MPCNL group than in the FURL group (93.10% vs. 86.21%), although the difference did not reach statistical significance (P = 0.666). Furthermore, the mean operative time in the MPCNL group, although slightly longer than that in the FURL group, did not demonstrate a statistically significant difference (P = 0.833). However, patients in the MPCNL group exhibited a significantly more substantial decrease in hemoglobin than those in the FURL group (P < 0.001) and a substantially more extended postoperative hospital stay (P < 0.001). Regarding perioperative complications, the incidence of moderate pain was higher in the MPCNL group than in the FURL group (P = 0.037). The difference in overall complication rates between the two groups did not reach statistical significance (P = 0.108). MPCNL and FURL are efficacious surgical procedures for treating single upper ureteral stones with a 1-2 cm diameter and high hardness.

Patients' beliefs about their illness are of central importance in understanding how a person adjusts to their condition and adheres to self-management recommendations. No previous studies have set out to quantitatively examine Illness beliefs in patients with kidney stones (KS). 112 patients with radiological confirmation of KS (59% male, mean (x̄) age = 50.1 years [sd14.15 years], 50.5% previous surgical treatment) attending for clinical consultation completed the Brief-Illness Perception Questionnaire alongside a range of demographic and illness related variables. Template analysis was undertaken on the free text responses of patients' beliefs about what had caused their KS. Almost a third (31.2%) of patients did not know what had caused their KS. Of those who cited a cause, dietary factors, fluid intake, medical risk factors (e.g. Inflammatory bowel disease), genetics, and psychological factors were ranked as the most important. Patients generally believed they had a reasonable understanding of KS (x̄=6.32 [sd3.21]), but reported poor levels of personal control over their KS (x̄=2.90 [sd2.93]) and high confidence in the effectiveness of treatments (x̄=8.64 [sd1.90]). Patients with a recurrence believed KS had a significantly greater impact on their life (z=-2.56, p = 0.01) and had greater emotional consequences (z=-2.77, p < 0.01). Perceptions of poor personal control over KS and a strong belief in medical/surgical treatment was evident regardless of first or recurrent stone, gender, age, previous surgical management of KS or time since diagnosis. Results highlight the need to actively increase patients' perceptions of personal control in the management and prevention of KS.

Kidney stones are the most common urinary system diseases, and early identification is of great significance. The purpose of this study was to use routine urine and blood detection indices to build a deep learning (DL) model to identify the presence of kidney stones in the early stage. A retrospective analysis was conducted on patients with kidney stones who were treated at West China Hospital of Sichuan University from January 2020 to June 2023. A total of 1130 individuals presenting with kidney stones and 1230 healthy subjects were enrolled. The first blood and urine laboratory data of participants at our hospital were collected, and the data were divided into a training dataset (80%) and a verification dataset (20%). Additionally, a long short-term memory (LSTM)-based adaptive feature weighting model was trained for the early identification of kidney stones, and the results were compared with those of other models. The performance of the model was evaluated by the area under the subject working characteristic curve (AUC). The important predictive factors are determined by ranking the characteristic importance of the predictive factors. A total of 17 variables were screened; among the top 4 characteristics according to the weight coefficient in this model, urine WBC, urine occult blood, qualitative urinary protein, and microcyte percentage had high predictive value for kidney stones in patients. The accuracy of the kidney stone (KS-LSTM) learning model was 89.5%, and the AUC was 0.95. Compared with other models, it has better performance. The results show that the KS-LSTM model based on routine urine and blood tests can accurately identify the presence of kidney stones. And provide valuable assistance for clinicians to identify kidney stones in the early stage.

To prospectively investigate the effect of music therapy on patient's anxiety and pain level during retrograde intrarenal surgery under spinal anesthesia. 286 patients aged above 18 years, who underwent Retrograde Intrarenal Surgery (RIRS) under spinal anesthesia for renal or ureteral calculi were evaluated between January 2023 and June 2023 by a prospective, randomized, controlled clinical protocol. Patients were randomized into 2 groups. Group 1 included patients, who listened to music, and Group 2 was comprised of patients, who were not allowed to listen to music. Visual Analog Scale (VAS) results and pain sensation, anxiety level, together with the results of State-Trait Anxiety Inventory (STAI), a self-reported anxiety inventory, were captured. The number of patients, who were randomized to the music group (Group 1) and non-music group (Group 2) was 144 and 142, respectively. Mean heart rate in Group 1 and Group 2 was 60 ± 4.19 and 70 ± 8.36, respectively (p = 0.02), indicative of the fact that mean heart rate was significantly lower in the music group. Heart rate measured post-operatively within the first hour subsequent to the procedure was similar in both groups (p < 0.05). The VAS score was significantly lower in Group 1. STAI score in Group 1 and Group 2 was 45.51 ± 2.968 and 49.16 ± 1.88, respectively. Therefore, there was a statistically significant difference (p < 0.001). Music therapy during the RIRS procedure under spinal anesthesia was associated with a significantly decrease in pain and anxiety scores in patients.

Objective: This study aimed to evaluate the accuracy and effectiveness of renal pelvic pressure (RPP) control during flexible ureteroscopic perfusion at various sites.

Methods: 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 100 ml/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 1 min.

Results: 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.

Conclusion: The UAS-based pressure monitoring technology can accurately and reliably monitor and control RPP within a set range.

The objective of this study is to compare the outcomes and complications of retroperitoneal and transperitoneal laparoscopic pyelolithotomy (RLP and TLP, respectively) in the treatment of large kidney stones. In this retrospective cohort effort, data of all patients who underwent laparoscopic pyelolithotomy for renal pelvic stone (N = 273) in three referral urology hospitals were retrieved. Operation duration, length of hospital stay, postoperative stone-free rate, hemoglobin (Hb) and creatinine (Cr) changes and complications were compared between the two groups before and after propensity score matching. A total of 199 TLP and 74 RLP cases were examined. Stone size was significantly higher in the TLP vs. RLP group (29.8 ± 10.9 vs. 26.5 ± 8.8 mm; P = .022). Length of operation and hospital stay were comparable (P = .672 and P = .396, respectively). Rate of conversion to open surgery, postoperative blood transfusion rate, postoperative urinary leakage, postoperative stone-free rate, Hb drop and Cr change were similar between the two groups (P = .348, 0.190, 0.828, 0.411, 0.780 and 0.134, respectively). Postoperative fever was significantly more prevalent in TLP compared to RLP (21.6% vs. 0.0%, respectively; P < .001). Propensity score matched analyses showed similar results in all aspects; particularly demonstrating higher postoperative fever in TLP compared to RLP (18.9% vs. 0.0%, respectively; P < .001). RLP can be considered as an alternative to TLP; especially owing to a lower chance of postoperative fever.

Aim: Extracorporeal Shock Wave Lithotripsy (ESWL) is a commonly used method for the noninvasive treatment of kidney stones. However, achieving optimal treatment outcomes and minimizing potential damage to the kidney necessitates careful consideration for the total amount of energy utilized. This study aims to investigate whether urine pH and urine specific gravity have an impact on the total amount of energy applied during SWL.

Patients and methods: Between January 2023 and December 2023, 129 patients with renal stones underwent SWL in our department using the Storz Medical Modulith Inline lithotripter. Stone-free rates, complications, and the impact of patient, urine, and stone characteristics on energy use were analyzed. Urine samples were analyzed for pH and specific gravity. Stone characteristics, including size, HU, and skin-to-stone distance, were recorded. The obtained data were evaluated regarding the possible relationship between the total energy amount (determined as a risk factor) and the age, BMI, urine pH, urine specific gravity, stone size, HU, and skin-to-stone distance by using the Pearson correlation coefficient. p-value of < 0.05 was considered statistically significant.

Results: Evaluation of our findings revealed a negative linear relationship between total amount of energy used and the urine pH, indicating a decrease in the total energy amount as urine pH shifts towards alkaline values (p = 0.038; p < 0.05). However, no statistically significant relationship was observed between age, BMI, urine specific gravity, stone size, HU, and skin-to-stone distance and the total energy amount.

Conclusions: Our findings demonstrated a significant relationship between urine pH and the total amount of energy applied during SWL sessions, suggesting the need for further prospective research to better understand the possible association between these two parameters. Such investigations could contribute to the development of more reasonable and effective strategies for kidney stone treatment in an attempt to minimize the potential kidney damage.