Urolithiasis最新文献

Objectives: To develop a deep learning (DL) model based on computed tomography (CT) images to predict the success of extracorporeal shock wave lithotripsy (SWL) treatment for patients with ureteral stones larger than 1 cm.

Materials and methods: We enrolled 333 patients who underwent SWL treatment for ureteral stones and randomly divided them into training and test sets. A DL model was built based on CT images of ureteral stones to predict SWL outcomes. The predictive efficacy of the DL model was assessed by comparing it with traditional and radiomics models.

Results: The DL model demonstrated significantly better predictive performance in both training and test sets compared to radiomics (training set, AUC: 0.993 vs. 0.923, P < 0.001; test set AUC: 0.982 vs. 0.846, P < 0.001) and traditional models (training set AUC: 0.993 vs. 0.75, P = 0.005; test set AUC: 0.982 vs. 0.677, P < 0.001). Decision curve analysis (DCA) also proved that the DL model brought more benefit in predicting the success of SWL treatment than other methods.

Conclusion: The DL model based on CT images showed excellent ability to predict the probability of success of SWL treatment for patients with ureteral stones larger than 1 cm, providing a new auxiliary tool for clinical treatment decision-making.

To outline the current status of Shock Wave Lithotripsy (SWL) in stone treatment and the changes in the mode of application after the COVID-19 pandemic along with critical factors affecting the clinical practice of this particular procedure. This study targeted national and international urology experts who could share and contribute their experiences and perspectives on SWL practices after COVID-19 era. Approximately 650 urology specialists were invited to participate in the survey based study via Google Forms. Participation was voluntary and 398 of the invited participants completed the survey, yielding an acceptable response rate of approximately 61.23%. This survey highlights significant findings that shed light on the changes in clinical SWL applications. Nearly half of SWL procedures are performed by technicians or nurses instead of experienced urologists, potentially affecting the proper application and outcomes of the procedure. SWL seemed to be applied on a guideline (GL) indications based manner by the majority of the participants. Fluoroscopy remains still as the most commonly used method for radiological assessment, underscoring the necessity to teach sonography applications to younger urologists. Key reasons for the limited clinical application of SWL include the absence of lithotripters in the departments, high lithotriptor costs and significantly lower reimbursement rates compared to PNL and fURS modalities. Finally, an increase in SWL utilization rates has been observed post-COVID-19, highlighting its certain advantages realized during this period. These findings provide important insights into the role of SWL in stone treatment and the main factors influencing its clinical application practices. Although the popularity of SWL in the management of urinary stones is being stated to decline particularly in the last two decades, data obtained in this survey emphasized well that it is still a viable option especially for stones smaller than 15 mm. Our findings highlight the enduring relevance of SWL in contemporary stone therapy protocols in the context of COVID-19, where outpatient, non-invasive procedures are preferred. In addition to the consideration of certain factors affecting the rate of its application in clinical practice, to achieve high success rates with minimal complications in SWL, strategic patient selection and adherence to procedure guidelines seem to be crucial.

To address the limitations in existing urinary stone recurrence (USR) models, including failure to account for changes in 24-hour urine (24U) parameters over time and ignoring multiplicity of stone recurrences, we presented a novel statistical method to jointly model temporal trends in 24U parameters and multiple recurrent stone events. The MSTONE database spanning May 2001 to April 2015 was analyzed. A joint recurrent model was employed, combining a linear mixed-effects model for longitudinal 24U parameters and a recurrent event model with a dynamic first-order Autoregressive (AR(1)) structure. A mixture cure component was included to handle patient heterogeneity. Comparisons were made with existing methods, multivariable Cox regression and conditional Prentice-Williams-Peterson regression, both applied to established nomograms. Among 396 patients (median follow-up of 2.93 years; IQR, 1.53-4.36 years), 34.6% remained free of stone recurrence throughout the study period, 30.0% experienced a single recurrence, and 35.4% had multiple recurrences. The joint recurrent model with a mixture cure component identified significant associations between 24U parameters - including urine pH (adjusted HR = 1.991; 95% CI 1.490-2.660; p < 0.001), total volume (adjusted HR = 0.700; 95% CI 0.501-0.977; p = 0.036), potassium (adjusted HR = 0.983; 95% CI 0.974-0.991; p < 0.001), uric acid (adjusted HR = 1.528; 95% CI 1.105-2.113, p = 0.010), calcium (adjusted HR = 1.164; 95% CI 1.052-1.289; p = 0.003), and citrate (adjusted HR = 0.796; 95% CI 0.706-0.897; p < 0.001), and USR, achieving better predictive performance compared to existing methods. 24U parameters play an important role in prevention of USR, and therefore, patients with a history of stones are recommended to closely monitor for future recurrence by regularly conducting 24U tests.

Urolithiasis is the most prevalent benign urological condition, imposing a significant burden on morbidity, disability, and healthcare costs globally. Despite its impact, comprehensive bibliometric analyses of randomized clinical trials (RCTs) related to urolithiasis, which are essential for advancing evidence-based medical practices, are lacking. This study aimed to examine the global research landscape and trends in RCTs focused on urolithiasis. This study used bibliometric techniques to analyze a selection of RCTs on urolithiasis published between 1979 and 2023. VOSviewer software version 1.6.20 was used to visualize international collaborations and perform a keyword analysis of the included articles. The main objective was to identify key research areas and focal points within the field of urolithiasis RCTs. Between 1979 and 2023, a comprehensive search identified 16,716 research articles on urolithiasis. A total of 693 relevant RCTs were found in the Scopus database. The number of publications has significantly increased over time, indicating a strong positive correlation (R² = 0.9303; P < 0.001). China was the top contributor, with 166 publications (23.95%), followed by the United States, with 130 publications (18.76%). Turkey and Iran contributed 44 (6.35%) and 62 (8.95%) publications, respectively. Citation analysis revealed an average of 28.13 citations per article, an h-index of 70, and a total of 19,493 citations. The co-occurrence analysis highlighted current research trends and key topics in urolithiasis RCTs, including 'comparative effectiveness of surgical and laser techniques and patient outcomes', 'medical expulsive therapy (MET) for ureteral calculi and clinical outcomes', 'systematic reviews and meta-analyses of RCTs investigating urolithiasis', and 'dietary interventions and correlations between stone composition and the risk of recurrence.' The bibliometric analysis provides an overview of research on urolithiasis RCTs. It examines global research trends and identifies new developments in the field. Our review identified key research themes, including systematic reviews and meta-analyses, dietary interventions, medical therapy for the expulsion of ureteral stones, and comparisons of surgical techniques-areas that will remain focal points in future research. This bibliometric analysis is an invaluable resource for researchers, clinicians, and policymakers, providing a complete overview of past and present research trends. Informed decision making can be promoted and guided in future research, ultimately improving management and understanding.

To assess outcomes of supracostal ultrasound guided approach percutaneous nephrolithotomy (SUGA-PNL) and retrograde intrarenal surgery (RIRS) in isolated large volume upper calyceal stones (UCS). This was a prospective randomized study including patients with isolated UCS > 20mm. The patients were randomized into two groups: group (P) (SUGA-PNL) and group (R) (RIRS). Patients' demographics, stones characteristics, operative, and postoperative outcomes essentially the stone free rate (SFR) and complications rate were documented. The stone clearance was defined as no fragments or residual fragments less than 2mm in the one month non contrast CT scan follow up. Eighty-nine patients opted to undergo the procedure according to the preoperative randomization. Four patients, 2 patients from each group, lost to follow up and other 2 patients were excluded from group (R) due to a tight ureter. Both groups were comparable as regards the preoperative demographics and stone characteristics. There were statistically significant differences regarding total operative time, the change in hemoglobin level, and postoperative pain score (P: 0.024, 0.010 and 0.032 respectively). The SFR was 88.1% in group (P) compared to 73.2% in group (R) (P: 0.019). Moreover, it did not differ significantly between both groups regarding the intraoperative and postoperative complications. No visceral and thoracic injuries were documented in group (P). On other side, 6 patients (14.6%) from group (R) had different grades of ureteral injury during access sheath placement. SUGA-PNL is a safe and effective treatment modality for UCS > 20mm with a higher SFR than RIRS.

Remnant cholesterol (RC), a key indicator of dyslipidemia, has been validated as a contributing factor to metabolic and cardiovascular diseases, both of which are closely associated with kidney stones (KS). This study aimed to investigate the association between RC and the risk of KS in Chinese adults. A total of 8,576 KS cases (mean age 55.87, 69.37% male) and 137,523 controls (mean age 54.57, 51.62% male) were included in this case-control study. RC was calculated using the formula: RC = TC-HDL-LDL. KS was ascertained with ultrasound by well-trained physicians. Multivariable logistic and restricted cubic spline (RCS) were applied to investigate the relationship between RC and KS. A total of 146,099 subjects (weighted mean age 54.64 years and 52.66% male) were included with mean RC = 0.8 for controls and RC = 0.72 for KS cases (P < 0.001). The multivariable-adjusted OR for KS occurrence across consecutive quartiles was 1.00 (reference), 1.05 (0.98-1.12), 1.15 (1.07-1.22), and 1.44 (1.35-1.53), respectively. Moreover, each standard deviation increment of RC was associated with a 15% (OR:1.15, 95% CI: 1.12-1.19) higher risk of KS occurrence. RCS showed significant and linear dose-response relationships between RC and KS occurrence (P-overall < 0.001, P-nonlinear = 0.270). The positive associations between RC and KS risk persisted in sensitivity analyses, suggesting the robustness of the results. In this case-control study of Chinese adults, elevated RC was associated with the occurrence of KS.

To evaluate the predictive factors affecting the stone-free rate (SFR) and complications of percutaneous nephrolithotomy (PCN) in the treatment of proximal impacted ureteral stones (PIUS) based on a new scoring standard. The data of 90 patients with PIUS were collected in this retrospective study between January 2015 and June 2023. Univariate and multivariate logistic regression analyses were used to determine factors affecting treatment outcome in terms of SFR and complications. The scoring standard for patients with PIUS was developed based on the univariate logistic regression analyses. In the univariate analysis, stone density (P = 0.015), and stone diameter (P = 0.032) significantly were associated with lower SFR. And degree of hydronephrosis (P = 0.014), Preoperative infection (P = 0.002), and history of lithotripsy (P = 0.045) were associated with occurrence of complications. Multivariate analysis indicated that stone density (P = 0.020), and stone diameter (P < 0.001) were associated with lower SFR; independent risk factors for development of complications were history of lithotripsy (P = 0.024), and preoperative infection (P < 0.001). Additionally, score ≥ 3 was the independent risk factor for both SFR (P < 0.001) and complication rate (P < 0.001). Subgroup analysis shown that there were statistically significant differences between the two groups in terms of stone-free rate (P = 0.032) and complications (P = 0.015). According to the findings of this study, the stone score ≥ 3 was determined as a critical predictive factor of SFR and complications in PIUS patients undergoing PCN based on a new scoring standard. Additionally, PCN has high initial SFR and low complications when dealing with score < 3 PIUS.

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.