Urolithiasis最新文献

Non-contrast computed tomography (NCCT) is a mainstay in the diagnosis of urolithiasis, with multiple markers on NCCT used to predict the likelihood of stone passage and to assist in pre-operative planning. Ureter wall thickness (UWT) is one such parameter, however studies evaluating inter-observer agreement and comparing to native ureteral tissue are lacking. We aim to provide the first comparison of UWT from healthy human ureters with UWT measured on NCCT; and to evaluate for inter-observer variability on NCCT measurement. Human ureters were collected from consenting adults at the time of radical nephrectomy. The pathological UWT (pUWT) was compared to the median radiological UWT (rUWT) of three independent blinded observers. Statistical analysis was performed with Wilcoxon matched pairs signed rank test, intraclass correlation co-efficient and Bland-Altmann analysis. Samples from 23 patients were compared with a mean pUWt 2.1mm (range: 0.89-4.11mm) and rUWT of 1.30mm (range: 1-3.52mm). There was significant variation between median rUWT and pUWT (1.3mm vs 2.1mm, p=0.0005) with rUWT underestimating pUWT by a mean of 0.72mm. The intraclass correlation co-efficient of <0.50 suggests poor intra-reader reliability with limits of agreement on Bland-Altmann analysis of 2.5mm. This study represents the first comparison of pathological and radiological UWT in human ureteric tissue. There is a significant variation in pathological and radiological measurements, with high interobserver variability.

This prospective study evaluated the impact of normalized energy utilization on clinical outcomes and complications in endourological stone surgery. Between January 2024 and April 2025, 478 consecutive patients undergoing holmium: YAG laser lithotripsy were enrolled. Stone characteristics, energy parameters, operative outcomes, and complications were prospectively recorded. Normalized energy values (J/mm³) were calculated as total energy divided by stone volume. The primary endpoint was complication development. Mean normalized energy was 22.5 ± 13.1 J/mm³ (range: 5.8-72.4). High-density stones (> 1000 HU) and lower calyceal locations required significantly higher energy (p < 0.001 and p = 0.012, respectively). ROC analysis identified 25 J/mm³ as the optimal threshold for predicting complications (AUC = 0.792, sensitivity 75.8%, specificity 70.5%). Energy utilization above 25 J/mm³ increased complication risk 4.25-fold (95% CI: 2.05-8.82, p < 0.001), while energy above 30 J/mm³ significantly increased severe papillary damage risk (68.5% vs. 25.3%, p < 0.001). In multivariate analysis, normalized energy > 25 J/mm³ (OR: 4.25, p < 0.001), prolonged operative time (OR: 1.02, p = 0.018), and high stone density (OR: 2.54, p = 0.017) were independent risk factors for complications. Overall stone-free rate was 83.7%. This study establishes evidence-based energy thresholds for safe laser lithotripsy, demonstrating that normalized energy monitoring can guide surgical decision-making and reduce complications in endourological stone surgery.

This retrospective study investigated the impact of metformin initiation on 24-hour urine parameters in patients with diabetes with urolithiasis. Utilizing the Medicare-Litholink database, we analyzed 427 patients who started metformin between two 24-hour urine collections conducted less than 18 months apart. To isolate the effect of metformin on urinary parameters as a surrogate marker of stone growth, we excluded patients taking other oral hypoglycemics or medications known to alter urine composition. Our longitudinal analysis revealed no statistically significant changes in key urinary parameters, including supersaturation of calcium oxalate, supersaturation calcium phosphate, and supersaturation of uric acid. Urine volume showed a significant, albeit clinically minor, increase (2.1 to 2.2 L/day, p = 0.0074). Time-dependent analysis comparing short-term (< 100 days) and long-term (> 296 days) metformin use also showed no significant impact on urine chemistry. Similarly, when controlling dosage of metformin ([Formula: see text]1000 mg/day or > 1000 mg/day) we found no significant impact on urine chemistry. These findings suggest that metformin use is not significantly associated with reduced urinary stone risk factors in patients with diabetes and urolithiasis, thus, failing to support its use among urolithiasis patients with new onset diabetes.

This study aimed to evaluate the predictive value of the Mayo Adhesive Probability (MAP) score for extracorporeal shock wave lithotripsy (ESWL) success in patients with proximal ureteral stones. We retrospectively analyzed 216 patients who underwent ESWL for isolated proximal ureteral stones between March 2020 and May 2025. Demographic and radiological parameters, including stone size, stone density, skin-to-stone distance, and MAP score, were recorded. The MAP score was calculated using non-contrast computed tomography by assessing posterior perinephric fat thickness and perinephric fat stranding. Treatment success was defined as no ureteral stone; residual fragments ≤ 4 mm were permitted only if located in the kidney after the ESWL procedure at 3-month follow-up. Logistic regression analysis was performed to identify independent predictors of ESWL success. The overall ESWL success rate was 63%. Patients with a MAP score < 3 achieved significantly higher success rates than those with a MAP score ≥ 3 (76.9% vs. 45.3%). In multivariate logistic regression analysis, stone size > 10 mm (odds ratio [OR] 0.340, 95% confidence interval [CI] 0.179-0.647), MAP score ≥ 3 (OR 0.266, 95% CI 0.140-0.507), and a prolonged interval between computed tomography and ESWL (OR 0.956, 95% CI 0.927-0.985) were identified as independent predictors of reduced success. A higher MAP score, larger stone size, and longer pre-treatment interval are associated with lower ESWL success in proximal ureteral stones. MAP scoring provides a simple, reproducible, imaging-based tool that may assist in patient selection and support treatment planning.