Urolithiasis最新文献

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.

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.