Urolithiasis最新文献

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.

Kidney stones are common diseases in the urinary system, characterized by high morbidity and recurrence rates, but effective drug treatments are limited. We chose sodium hexametaphosphate (HMP) to investigate its role in inhibiting calcium oxalate (CaOx) crystallization in vitro and in vivo. We predicted potential targets of HMP using bioinformatics, simulated drug molecular docking, and explored the molecular mechanism of HMP inhibition of CaOx stone formation in a cellular model and hyperoxaluria-induced crystallization rat model. HMP specifically adsorbed on high-energy crystal surfaces, inhibiting the growth of CaOx monohydrate (COM), significantly reducing crystal size, and promoting the conversion to CaOx dihydrate (COD). At higher concentrations, CaOx crystals transformed from micrometer to nanometer scale, achieving complete conversion from COM to COD and almost complete inhibition of CaOx crystal formation. Additionally, HMP significantly reduced oxidative damage caused by high oxalate in NRK-52E cells, decreased reactive oxygen species production, inhibited mitochondrial membrane potential depolarization, and subsequently inhibited cell apoptosis. By integrating the transcriptomic data and the crystallization results, HMP primarily acts by modulating CaOx crystallization, upregulating PPARα to promote fatty-acid transport and β-oxidation, thereby enhancing the expression of downstream antioxidant factors NRF2 and SOD1 and, in turn, attenuating hyperoxaluria-induced renal oxidative injury. The novel drug HMP, combining CaOx crystallization modulation and oxidative stress inhibition, may be a treatment option for kidney stones.

To compare the efficacy of low PRAL dietary intervention against potassium citrate (PCi) extended-release medication in modifying key urinary lithogenic parameters for oxalate calcium calculi formation over a four-week duration. We conducted a three-arm, parallel-group study with 46 participants randomized into a Diet group (n = 14), a Medicine group (n = 16), and a Control group (n = 16). Twenty-four-hour urine samples were collected at baseline, two weeks, and four weeks. Nine primary urinary outcomes were analyzed: Citrate (Cit), Potassium (UK), pH, Oxalate (OX), Calcium (UCa), Sodium (UNa), Chloride (UCl), Urine Volume, and estimated Potential Renal Acid Load (PRAL). Longitudinal changes were assessed using Linear Mixed-Effects Models (LMMs). Baseline characteristics were well-balanced across the three groups (p > 0.05 for most of indicators) except citrate. The LMM analysis revealed that the Medicine group showed statistically significant improvements compared to the Control group in urine potassium and PRAL at two weeks and continued to four weeks (p < 0.001). Urine laboratory tests changes in diet intervention were not significant over time, however, the Diet group showed slight modification of the urine protective factors, such as urine potassium and pH, to alkalinization. Diet intervention no significant changes were observed in urine stone formation potential lithogenic factors including calcium, sodium, chloride, or oxalate. The low-potential renal acid load (PRAL) diet, characterized by higher consumption of vegetables, fruits, and less animal-based proteins, produced gradual but modest improvements in urinary parameters linked to calcium oxalate stone prevention. While prolonged dietary compliance was associated with correcting urine acidification, the dietary intervention exerted only a limited impact on other major lithogenic factors.

To improve the accuracy of our prediction of the spontaneous passage of urinary calculi, we developed a model based on the Swin Transformer model. In this retrospective multicentre study, computed tomography (CT) images of ureteral calculi from January 2019 to December 2023 from our hospital were used as internal training and validation datasets. The samples were split in a 7:3 ratio into an internal training set (N = 278) and internal testing set (N = 120). An external validation set (N = 142) was created using the CT datasets of patients from four different hospitals. Swin Transformer was used to create an ensemble learning-based model approach for predicting the passage of ureteral calculi. For both the internal and external validation sets, performance was assessed using the F1 score, accuracy, specificity, sensitivity, and area under the operating characteristic curve (AUC). A total of 540 urinary CT images were acquired (Internal dataset = 398; multicentre external dataset = 142). The AUC reached 0.873 (95% [CI]: 0.841-0.906), and the external validation set reached 0.784 (95% CI: 0.747-0.820),. The evaluation results of the Swin Transformer model, developed using CT images of urinary calculi, demonstrate that it outperforms models such as ResNet and ConvNeXt. Furthermore, the model outperforms both attending and resident doctors. The predictive power of attending doctors was significantly improved with the aid of the Swin Transformer model. The Swin Transformer model is a generalizable, objective and accurate prediction model for calculi passage based on urinary tract CT images and could help clinicians make better clinical judgements. Trial registration: It was also registered in the Chinese Clinical Trial Registation (registration number: ChiCTR2400086807). Informed consent was waived as this study used retrospectively collected anonymized data.