Urolithiasis最新文献

To evaluate the efficacy and safety of a Flexible and Navigable Suction Ureteral Access Sheath (FANS) in flexible ureteroscopic lithotripsy (FURL) under local anesthesia for renal stones 2-4 cm. We retrospectively analyzed clinical data from patients with renal stones 2-4 cm who underwent local anesthesia FURL from January 2023 to December 2024. Patients were divided into two groups based on the type of sheath used: FANS or traditional ureter access sheath (T-UAS) group. Demographic data and perioperative indicators were compared. A total of 372 patients were included in the study, with 187 in the FANS and 185 in the T-UAS group. FANS achieved an 78.6% one-time stone-free rate (SFR) (vs. 57.8% in T-UAS, P < 0.001), with significantly lower postoperative fever (2.1% vs. 8.1%) and steinstrasse (1.1% vs. 5.9%). FANS enhances FURL efficacy for 2-4 cm renal stones under local anesthesia, provides an alternative to percutaneous nephrolithotomy (PCNL) for select patients.

This study aimed to evaluate the impact of costovertebral angle (CVA) width on the outcomes of percutaneous nephrolithotomy (PCNL), particularly regarding stone-free rates, bleeding, complication rates, and the need for additional interventions. A total of 181 patients who underwent prone PCNL between January 2018 and July 2024 at a single center were retrospectively analyzed. CVA was measured using preoperative standing direct urinary system X-rays. Patients were categorized into three groups based on CVA: <45°, 45-55°, and > 55°. Operative and postoperative parameters including hemoglobin/hematocrit decrease, transfusion requirement, complications (Modified Clavien-Dindo Classification), stone-free rate, and access type were evaluated and statistically analyzed. Hemoglobin and hematocrit decreases were significantly correlated with narrower CVAs (p = 0.041 for both). No significant relationship was observed between CVA and stone-free status, transfusion need, or complication rates. Although patients with CVA < 45° had a higher rate of complications (38.9%) and greater blood loss, these findings did not reach statistical significance. Intercostal access, more frequently required in patients with narrow CVA, was associated with higher but not statistically significant complication rates. Narrow CVA may pose a greater challenge during PCNL due to limited nephroscope maneuverability, potentially increasing intraoperative bleeding. However, it does not significantly affect overall surgical success or complication rates. CVA can be considered a useful anatomical parameter during preoperative planning, especially when selecting the access route.

On-treatment 24-h urine testing rates are low outside of tertiary care centers. A common criticism is the paucity of evidence demonstrating the optimization of urinary parameters correlates with reduced stone recurrence. Using standard and novel analytic approaches, we sought to evaluate whether improvements in 24-h urine parameters associated with decreased symptomatic stone recurrence. Kidney stone patients who underwent multiple 24-h urine tests and had an initial parameter abnormality were identified from a prospective database. A novel 24-h urine severity score was calculated at both the initial and subsequent tests and used to stratify patients. Negative binomial regression was used to evaluate the impact of analyte changes on stone recurrence. Two hundred patients met inclusion criteria. Low voided volume, hypercalciuria, hyperoxaluria, hypocitraturia and low pH were identified in 56%, 28%, 40%, 49% and 35% respectively. Patients with hypercalciuria and hypocitraturia who consistently normalized these values showed decreased recurrence (p < 0.001). Increasing initial 24-h urine severity scores associated with increased stone recurrence (0.09, 0.18 and 0.31 stone events per year for the lowest, 25-75th and highest quartiles, p < 0.001). On multivariable analysis, severity score improvement or stabilization was associated with reduced risk of recurrence across all quartiles (RRR 0.319 to 0.591, all p < 0.001). Consistent control of 24-h urine parameters was associated with decreased stone recurrence. Not only did novel 24-h urine composite severity scores based on initial 24-h urines independently predict stone recurrence, improvements in this score over time also predicted decreased recurrence.

Subepithelial papillary calcifications, encompassing both Randall's plaques (interstitial) and Randall's plugs(intraluminal), are established niduses for stone formation, yet their distribution and determinants in stone-naïve individuals remain poorly characterized. We hypothesized that subclinical papillary calcifications are present in non-stone-formers and associated with urinary and clinical risk factors similar to those in stone formers. In this retrospective cross-sectional study, we analyzed 50 patients undergoing nephrectomy for renal or upper urinary tract cancer (June 2019-January 2023). Patients with prior stone disease, calcium/vitamin supplementation, or metabolic disorders were excluded. High-resolution micro-computed tomography (micro-CT, 20 μm voxels) quantified mineral-to-parenchyma (M/P) ratios across papillary zones, and osteopontin (OPN) immunohistochemistry was performed on matched sections. Given the 20 μm spatial resolution limit of micro-CT, any papillary tip calcified lesion (PCL) ≥ 1 mm³ was considered clinically relevant; such lesions were present in 46% of kidneys. PCL + patients were older, more frequently hypertensive, and exhibited lower urine volume (median 1200 vs. 1600 mL, p < 0.001), lower urinary citrate (p = 0.002), higher urine specific gravity (p = 0.001), and elevated M/P ratios in the middle medullary zone (p = 0.003). OPN staining was increased in loops of Henle in PCL + cases and correlated with mineral burden. Multivariable analysis identified lower urine volume, higher urinary calcium, and hypertension as independent predictors of PCL (area under curve = 0.93). These findings indicate that PCLs are common in stone-naïve kidneys and are associated with specific urinary and systemic risk factors. Early interventions targeting urine chemistry and vascular health may influence mineral deposition and delay kidney stone development.

To evaluate the predictive value of preoperative NCCT (Non-Contrast Computed Tomography) measured renal parenchyma and pelvic urine densities for the development of systemic inflammatory response syndrome (SIRS) following URS. 1262 patients underwent semi-rigid URS due to ureterolithiasis between January 2008 and August 2023 were screened and 286 patients were included. Patient demographics and NCCT findings (stone size, location, density, hydronephrosis, renal parenchymal density, pelvic urine density) were collected retrospectively. Patients were categorized into two groups based on SIRS development after URS. Pelvic urine and parenchyma densities of the obstructed kidney were compared. A multivariate logistic regression analysis was performed to identify independent predictors of SIRS. The median obstructed kidney cortex mean density was significantly lower in the SIRS (+) group compared to the SIRS (-) group (26.67 [22.33-29.50] vs. 33.33 [27.24-37.75]). Obstructed kidney medulla mean density was also significantly lower in patients with SIRS (24.00 [22.33-27.50] vs. 31.50 [26.24-36.75], p = 0.001). Pelvic urine density was significantly higher in the SIRS-positive group. Stone density (OR = 1.35, % 95 CI: 1.09-1.67, p = 0.006), proximal ureteral location (OR = 5.21, % 95 CI: 1.84-14.7, p = 0.002), cortex mean density (OR = 0.91, % 95 CI: 0.87-0.95, p = 0.001) and pelvic urine density (OR = 1.07, % 95 CI: 1.02-1.12, p = 0.010) were stated as significant predictors. Renal parenchyma and pelvic urine density on pre-operative NCCT can predict SIRS after semi-rigid URS.

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.