Urolithiasis最新文献

To assess the diagnostic accuracy of radiation-free ultrasound-CT (US-CT) fusion imaging for ureteral stone detection in patients scheduled for ureteroscopy (URS). In this prospective study (NCT02539004), adults with a single ureteral stone on non-contrast CT (NCCT) and scheduled for URS were consecutively enrolled. Exclusion criteria included multiple stones, pacemaker, ureteral stent, or nephrostomy tube. On the day of surgery, US-CT fusion (Logiq E9, GE Healthcare) was performed using electromagnetic tracking and prior 3D NCCT data. The primary analysis assessed sensitivity, specificity, accuracy, positive and negative predictive values (PPV; NPV). Secondary analyses stratified outcomes by patient and stone characteristics. Thirty-one patients were enrolled (mean age 52.2 ± 15.1 years; 71% male). Stones were upper ureter in 51% and mid-lower ureter in 49%, mean diameter 6.9 ± 2.1 mm. Twenty-nine patients (93.5%) underwent URS and were evaluable. US-CT fusion yielded 15 true positives (51.7%), 8 true negatives (27.6%), and 6 false negatives (20.7%), with no false positives. Sensitivity, specificity, PPV, NPV, and accuracy were 71.4%, 100%, 100%, 57.1%, and 79.3%, respectively. Sensitivity was highest for SSD > 10 cm (81.8%), BMI ≤ 30 (75.0%), right-sided stones (88.9%), absence of hydronephrosis (83.3%), and size > 5 mm (81.3%); and lowest for size ≤ 5 mm (40.0%) and radiolucent stones (44.4%). NPV ranged from 33.3% for SSD ≤ 10 cm to 75.0% for SSD > 10 cm and right-sided stones. US-CT fusion demonstrated excellent specificity/PPV but moderate sensitivity - useful for confirming, not excluding, stones - and may reduce repeat CT in selected patients, pending validation by larger head-to-head studies defining performance, indications, and cost-effectiveness.

This study aims to evaluate the reliability, quality and readability of ChatGPT-4o responses regarding pediatric urolithiasis. Forty frequently asked questions about pediatric urinary stones were posed to ChatGPT-4o twice, one week apart. The reliability of ChatGPT-4o's responses was assessed using the five-point DISCERN tool (mDISCERN). The overall quality of the responses was evaluated using the Global Quality Scale (GQS). To assess the readability of ChatGPT-4o's responses, multiple metrics were employed, including the Flesch Reading Ease (FRE) score, the Flesch-Kincaid Grade Level (FKGL), the Gunning Fog Index (GFI), the Coleman-Liau Index (CLI), and the Simple Measure of Gobbledygook (SMOG). The median mDISCERN score was 5 (range: 4-5), and the median GQS score was 5 (range: 3-5), indicating high reliability and quality. However, readability metrics suggested a high level of difficulty: FRE (27.98 ± 13.65), FKGL (11.46 ± 1.88), SMOG (14.96 ± 1.64), GFI (17.27 ± 2.37), and CLI (15.60 ± 1.95). Only 2.5% of responses were understandable to individuals with reading skills at a 10-12-year-old level, 37.5% were suitable for college-level readers, and 60% required professional-level comprehension. A moderate correlation was observed between mDISCERN and GQS scores (r = 0.42, p = 0.007), but neither correlated significantly with readability metrics. ChatGPT-4o may provide reliable and high-quality information about pediatric urinary stones; however, the advanced reading level of its responses presents a significant barrier to accessibility for patients and caregivers. Therefore, despite its potential utility, the readability challenge must be addressed to ensure equitable patient education.

Renal injury and calcium oxalate crystal deposition are the core pathological processes of kidney stone formation, and their molecular mechanisms have not been fully elucidated while the clinical intervention methods are limited. Many studies have shown that the intestinal microbiota can produce various metabolites that affect renal function through the gut-kidney axis and participate in the formation of kidney stones. This study aims to identify the microbial metabolites related to kidney stone patients and explore their mechanism of action in kidney stones. Microbiome and metabolome analyses are used to search for microbial-related metabolites in the intestines of kidney stone patients. Using COM crystal-treated TCMK-1 cells as a model, the functions of metabolites are evaluated by detecting cell viability, apoptosis rate, cell-crystal adhesion, reactive oxygen species and MDA levels in vitro. In vivo, a glyoxylate-based kidney stone mouse model is established, and the effects of metabolites on renal function are assessed by HE staining, PAS staining, creatinine and urea nitrogen levels. The effects of metabolites on renal injury and crystal deposition are evaluated by Tunel, Von-Kossa staining, CD44 and OPN level detection. Transcriptional sequencing combined with western blot is used to search and verify the related signaling pathways affected by metabolites. It is found that linoelaidic acid is significantly decreased in kidney stone patients. Supplementing linoelaidic acid in vitro can significantly reduce COM crystal-induced cell apoptosis, crystal adhesion, ROS and MDA levels, and increase cell viability. In kidney stone mice, supplementing linoelaidic acid reduces renal tubular damage, crystal deposition, and improves renal function. Mechanistically, linoelaidic acid upregulates the expression of PPARγ in kidney stones to inhibit the activation of the MAPK signaling pathway. Linoelaidic acid can alleviate renal injury, oxidative stress and crystal deposition by regulating the PPARγ/MAPK signaling pathway, and may be a useful strategy for the treatment of kidney stones.

The primary aim was to assess how various flexible ureteroscopes and ureteral access sheath size combinations affected intra-cavity pressures, under excessive irrigation pressures with a pressure bag. The secondary aim was to determine the maximum irrigation pressure that could be applied while still maintaining safe intra-cavity pressures, when a certain sheath-scope combination had resulted in an unsafe intra-cavity pressure in the initial experiment. An in-vitro setup was used to measure intra-cavity pressures across different flexible ureteroscope (6.3-9.6 Fr; Hugemed, Innovex and WiScope) and sheath size (ClearPetra; inner lumen diameter 9.5-12 Fr, lengths 40 and 50 cm) combinations. A steady irrigation pressure was delivered via a pressure bag pressurised to 360 mmHg, and a urodynamic machine provided real-time readings of intra-cavity pressure. For each combination, the steady-state intra-cavity pressure was recorded. Combinations generating an unsafe intra-cavity pressure (i.e. intra-cavity pressure of more than 30 mmHg) were re-assessed by gradually reducing the irrigation pressure, until intra-cavity pressure recorded reached 30 mmHg. The corresponding irrigation pressure was then recorded, and the experiment was then repeated with this established safe irrigation pressure to confirm that a safe intra-cavity pressure had been achieved. An intra-cavity pressure of 30 mmHg was taken to be the determined safe threshold for intra-cavity pressure. High intra-cavity pressures were observed with smaller sheaths and larger scopes, exceeding 100 mmHg in some combinations. Longer sheaths tended to generate higher pressures than shorter ones. The use of 12 Fr sheaths or 6.3 Fr scopes appeared to be safe regardless of the paired scope or sheath, even under extreme inflow pressure. Scope and sheath combinations have a significant impact on intra-cavity pressure, and inappropriate combinations may lead to unsafely elevated pressures. Larger sheaths and smaller scopes offer safer pressure profiles, even under high flow or high-pressure irrigation.

To determine whether retrograde pyeloperfusion (RP) during percutaneous nephrolithotomy (PCNL) decreases antegrade ureteral stone fragment migration, normal, moderately, and severely hydronephrotic silicone kidney and ureter models were created using deidentified CT images. Two techniques to prevent fragment migration, ureteral access sheath (UAS) and RP via a ureteroscope, were compared to an empty ureter. Two grams of stone fragments were placed into the renal pelvis. Antegrade irrigation and suction were applied for 5 min. The weights of ureteral stone fragments were compared using the Kruskal-Wallis test (p < 0.05 significant). In the normal ureter model, RP significantly reduced ureteral stone fragment migration (0.06±0.03 g) compared to both the UAS (0.32±0.19 g; p = 0.047) and control (0.42±0.11 g; p = 0.009). Similarly, in the moderate hydroureter model, RP significantly reduced ureteral stone fragment migration (0.11±0.06 g) compared to both the UAS (0.68±0.18 g; p = 0.009) and control (0.48±0.15 g; p = 0.016). In the severe hydroureter model, RP reduced ureteral stone fragment migration (0.17±0.12 g) compared to the UAS (1.04±0.29 g; p = 0.026) but was similar to the control (0.65±0.37 g; p = 0.169). RP showed an 85.7% and 81.1% reduction compared to the control and UAS conditions in the normal model, 76.2% and 83.3% reduction in the moderate hydroureter model, and 73.3% and 83.2% reduction in the severe hydroureter model, respectively. Thus, compared to an empty ureter and a UAS, in all ureter models, RP reduced ureteral stone fragment migration by 73.3-85.7%. Retrograde pyeloperfusion should be considered to reduce ureteral stone fragment migration during PCNL when endoscopic combined intrarenal surgery is employed.