Epidemiology of urolithiasis in Asia

Therapeutic potential of seaweeds and their biofabricated nanoparticles in treating urolithiasis: A review

Urolithiasis affects a significant portion of the global population, causing discomfort and pain. Unfortunately, effective drugs to treat this disorder are currently unavailable due to multiple mechanisms and an incomplete understanding of its causes. Consequently, drugs with multiple targets could be a safer and more effective remedy for treating urolithiasis. Moreover, the current treatment options are expensive and come with a risk of complications and stone recurrence. Therefore, an alternative treatment that can prevent stone recurrence and reduce associated symptoms is necessary. Seaweeds are a rich source of beneficial metabolites, like antioxidants, anti-inflammatory, analgesic, and enzyme-inhibitory properties. Advances in nanotechnology hold great promise for improving the therapeutic potential of these metabolites. However, the use of nanoparticles for treating urolithiasis has yet to be explored well, and only a few reports exist on the use of terrestrial plant-based nanoparticles. This review examines the therapeutic properties of seaweed bioactive compounds and their possible applications in treating urolithiasis. We propose that seaweeds could be an excellent source of essential dietary minerals and other bioactive compounds with multiple targets to treat renal calculus naturally. Additionally, the review highlights the potential of nanomedicine in treating urolithiasis, proposing seaweed-based nanoparticles as a promising treatment option.

Association analysis of dry heat or wet cold weather and the risk of urolithiasis hospitalization in a southern Chinese city

To analyze the relationship between hot or cold, and wet or dry interacting weather, and urolithiasis-related hospitalizations. Distributed lag nonlinear model for time series design was used to build exposure-response curves for the association of daily mean temperature and relative humidity with urolithiasis-related hospitalizations. Cut-off values were determined for temperature, humidity, and dichotomous categories to define heat-cold and wet-dry meteorological conditions. Based on a total of 38,184 urolithiasis-related hospitalizations from 2018 to 2019 in Ganzhou as a large prefecture-level city in southern China, dry-heat weather during the hot season (May to September) increased the risk of urolithiasis-related hospitalizations (relative risk [RR]: 1.17, 95% confidence interval [CI]: 1.02, 1.35), with the most pronounced effects in those aged 21-40 years and male. Wet-cold weather in the cold season (December to February) increased the risk of urolithiasis-related hospitalizations in the total population (RR: 1.58, 95% CI: 1.20, 2.07). The effect was significant in the 21-60 years old age and both genders groups. Both dry-heat weather in the hot season and wet-cold weather in the cold season could trigger urolithiasis.

Discrete element method-based simulation system for predicting natural stone evacuation pathways in patients with urolithiasis

Urolithiasis is a globally prevalent disease with high incidence and recurrence rates and is often accompanied by severe pain. Its ideal treatment is spontaneous stone passage, avoiding the invasiveness associated with surgery. However, the mechanisms underlying spontaneous stone passage remain unclear. Therefore, in this study, we developed a kidney stone trajectory prediction simulation system using the discrete element method (DEM) to elucidate spontaneous passage mechanisms by analyzing and visualizing stone trajectories within the kidney. We compared this simulation system with experiments using a three-dimensional kidney replica of patients with urolithiasis to optimize critical DEM parameters, including the collision margin ε, friction coefficient Cf, and restitution coefficient Cr. The reliability of these optimized parameters was validated using kidney shapes that differed from those used in the optimization experiments. The simulation system with optimized parameters consistently demonstrated high fidelity to the experimental results, regardless of kidney shape, initial stone position, or stone size. These findings demonstrate the reliability of the simulation system, underscoring its potential contribution to developing new and effective treatments for urolithiasis by improving the accuracy of stone trajectory predictions.

CASR, CLDN 14, ALPL & SLC34A1 genes are associated with the risk of nephrolithiasis in Egyptian children

BACKGROUNDS

The pathophysiology of nephrolithiasis is complex, influenced by both environmental and genetic factors. Calcium is the most prevalent metabolite present in the stone matrix. Stimulating the basolateral calcium sensing receptor (CASR) in the renal tubules leads to an increase in claudin-14 expression, reducing paracellular calcium permeability and increasing urinary Ca2+ excretion. Alkaline phosphatase (ALPL) hydrolyzes the pyrophosphate to free phosphate, proposing its potential role in nephrolithiasis development. Solute carrier family 34 member 1 (SLC34A1) encodes Na+-Pi cotransporter 2a, playing a key role in renal absorption of phosphate. We aimed to detect the risk of CASR, CLDN14, ALPL, and SLC34A1 gene polymorphisms on the development of nephrolithiasis in the Egyptian children.

METHODS

We enrolled 143 children diagnosed with nephrolithiasis and 112 healthy controls. Real-time polymerase chain reaction analysis of CASR (rs1801725 G/T & rs73186030 C/T), CLDN14 (rs219780 C/T & rs199565725 AC/del), ALPL (rs149344982 A/G, rs1976403 A/C & rs1256328 C/T), and SLC34A1 (rs11746443 G/A) single-nucleotide polymorphisms (SNPs) were performed.

RESULTS

We observed that children carrying the T allele of CASR rs1801725, CLDN14 rs219780, and ALPL rs1256328 SNPs were at a greater risk of nephrolithiasis compared to the control group (p = 0.003, p < 0.001, and p = 0.001, respectively). The children with the del allele of CLDN14 rs199565725 and the ALPL rs1976403 C allele had a significantly higher risk of developing nephrolithiasis compared to the control group (p = 0.007 & p = 0.001, respectively). The individuals who have the A allele of ALPL rs149344982 and SLC34A1 rs11746443 had a significantly higher risk of nephrolithiasis compared to the control group (p < 0.001). We found that CLDN14 rs219780 CT, ALPL rs149344982 AG, ALPL rs1256328 TT, and SLC34A1 rs11746443 GA genotypes were the final predictors of nephrolithiasis in children (p < 0.05). Individuals with ATAT and GTAT haplotypes had approximately a 29- and 19-fold increased risk of nephrolithiasis.

DISCUSSION

Nephrolithiasis is a complex disease caused by genetic and environmental factors. It would be beneficial if, among patients with recurrent kidney stones, the nephrologists could identify patients at high risk who would benefit from personalized therapy, a controlled lifestyle, and regular check-ups using the necessary investigation. There are several gene polymorphisms that were identified as the risk factor for developing nephrolithiasis. We found that CASR rs1801725 G/T, CLDN14 rs199565725 AC/del & rs219780 C/T, ALPL rs149344982 A/G, rs1976403 A/C & rs1256328 C/T, SLC34A1 rs11746443 G/A were associated with an increased risk of nephrolithiasis in Egyptian children. The study limitations include a lack of detailed information on nephrolithiasis risk factors such as diet and body mass index.

CONCLUSION

CLDN14 rs219780 CT, ALPL rs149344982 AG, ALPL rs1256328 TT, and SLC34A1 rs11746443 GA genotypes were the final predictors of nephrolithiasis in children.

Predictive value of machine learning model based on CT values for urinary tract infection stones

Preoperative diagnosis of infection stones presents a significant clinical challenge. We developed a machine learning model to predict urinary infection stones using computed tomography (CT) values, enabling in vivo preoperative identification. In this study, we included 1209 patients who underwent urinary lithotripsy at our hospital. Seven machine learning algorithms along with eleven preoperative variables were used to construct the prediction model. Subsequently, model performance was evaluated by calculating AUC and AUPR for subjects in the validation set. On the validation set, all seven machine learning models demonstrated strong discrimination (AUC: 0.687-0.947). Additionally, the XGBoost model was identified as the optimal model significantly outperforming the traditional LR model. Taken together, the XGBoost model is the first machine learning model for preoperative prediction of infection stones based on CT values. It can rapidly and accurately identify infection stones in vitro, providing valuable guidance for urologists in managing these stones.

A New Perspective on Gas Chromatography-Mass Spectrometry Urinary Metabolomic Analysis and Efficient Risk Assessment of Urolithiasis: Morning Urine Organic Acid Profiles

INTRODUCTION

Urolithiasis is characterized by a high morbidity and recurrence rate, primarily attributed to metabolic disorders. The identification of more metabolic biomarkers would provide valuable insights into the etiology of stone formation and the assessment of disease risk. The present study aimed to seek potential organic acid (OA) biomarkers from morning urine samples and explore new methods based on machine learning (ML) for metabolic risk prediction of urolithiasis.

METHODS

Morning urine samples were collected from 117 healthy controls and 156 urolithiasis patients. Gas chromatography-mass spectrometry was used to obtain metabolic profiles. Principal component analysis and ML were carried out to screen robust markers and establish a prediction evaluation model.

RESULTS

There were 25 differential metabolites identified, such as palmitic acid, l-pyroglutamic acid, glyoxylate, and ketoglutarate, mainly involving arginine and proline metabolism, fatty acid degradation, glycine, serine, and threonine metabolism, glyoxylate and dicarboxylic acid metabolism. The urinary OA markers significantly improved the performance of the ML model. The sensitivity and specificity were up to 87.50% and 84.38%, respectively. The area under the receiver operating characteristic curve (AUC) was significantly improved (AUC = 0.9248).

CONCLUSION

The results suggest that OA profiles in morning urine can improve the accuracy of predicting urolithiasis risk and possibly help understand the involvement of metabolic perturbations in metabolic pathways of stone formation and to provide new insights.

Machine Learning Models Decoding the Association Between Urinary Stone Diseases and Metabolic Urinary Profiles

Background: Employing advanced machine learning models, we aim to identify biomarkers for urolithiasis from 24-h metabolic urinary abnormalities and study their associations with urinary stone diseases. Methods: We retrospectively recruited 468 patients at Peking Union Medical College Hospital who were diagnosed with urinary stone disease, including renal, ureteral, and multiple location stones, and had undergone a 24-h urine metabolic evaluation. We applied machine learning methods to identify biomarkers of urolithiasis from the urinary metabolite profiles. In total, 148 (34.02%) patients were with kidney stones, 34 (7.82%) with ureter stones, and 163 (34.83%) with multiple location stones, all of whom had detailed urinary metabolite data. Our analyses revealed that the Random Forest algorithm exhibited the highest predictive accuracy, with AUC values of 0.809 for kidney stones, 0.99 for ureter stones, and 0.775 for multiple location stones. The Super Learner Ensemble Method also demonstrated high predictive performance with slightly lower AUC values compared to Random Forest. Further analysis using multivariate logistic regression identified significant features for each stone type based on the Random Forest method. Results: We found that 24-h urinary magnesium was positively associated with both kidney stones and multiple location stones (OR = 1.195 [1.06-1.3525] and 1.3258 [1.1814-1.4949]) due to its high correlation with urinary phosphorus, while 24-h urinary creatinine was a protective factor for kidney stones and ureter stones, with ORs of 0.9533 [0.9117-0.996] and 0.8572 [0.8182-0.8959]. eGFR was a risk factor for ureter stones and multiple location stones, with ORs of 1.0145 [1.0084-1.0209] and 1.0148 [1.0077-1.0223]. Conclusion: Machine learning techniques show promise in revealing the links between urological stone disease and 24-h urinary metabolic data. Enhancing the prediction accuracy of these models leads to improved dietary or pharmacological prevention strategies.

Potassium sodium hydrogen citrate intervention on gut microbiota and clinical features in uric acid stone patients

The high recurrence rate of renal uric acid stone (UAS) poses a significant challenge for urologists, and potassium sodium hydrogen citrate (PSHC) has been proven to be an effective oral dissolution drug. However, no studies have investigated the impact of PSHC on gut microbiota and its metabolites during stone dissolution therapy. We prospectively recruited 37 UAS patients and 40 healthy subjects, of which 12 patients completed a 3-month pharmacological intervention. Fasting vein blood was extracted and mid-stream urine was retained for biochemical testing. Fecal samples were collected for 16S ribosomal RNA (rRNA) gene sequencing and short chain fatty acids (SCFAs) content determination. UAS patients exhibited comorbidities such as obesity, hypertension, gout, and dyslipidemia. The richness and diversity of the gut microbiota were significantly decreased in UAS patients, Bacteroides and Fusobacterium were dominant genera while Subdoligranulum and Bifidobacterium were poorly enriched. After PSHC intervention, there was a significant reduction in stone size accompanied by decreased serum uric acid and increased urinary pH levels. The abundance of pathogenic bacterium Fusobacterium was significantly downregulated following the intervention, whereas there was an upregulation observed in SCFA-producing bacteria Lachnoclostridium and Parasutterella, leading to a significant elevation in butyric acid content. Functions related to fatty acid synthesis and amino acid metabolism within the microbiota showed upregulation following PSHC intervention. The correlation analysis revealed a positive association between stone pathogenic bacteria abundance and clinical factors for stone formation, while a negative correlation with SCFAs contents. Our preliminary study revealed that alterations in gut microbiota and metabolites were the crucial physiological adaptation to PSHC intervention. Targeted regulation of microbiota and SCFA holds promise for enhancing drug therapy efficacy and preventing stone recurrence. KEY POINTS: • Bacteroides and Fusobacterium were identified as dominant genera for UAS patients • After PSHC intervention, Fusobacterium decreased and butyric acid content increased • The microbiota increased capacity for fatty acid synthesis after PSHC intervention.

Traditional uses, phytochemistry, pharmacology, and nutraceutical potential of horse gram (Macrotyloma uniflorum): A systematic review

Macrotyloma uniflorum is known for being a rich source of protein, fat, fiber, carbohydrates, vitamins, and micronutrients. Since ancient times, it has been used as a pulse and traditional remedy in the Himalayan Mountains for curing kidney and bladder stones, bronchitis, asthma, piles, leukoderma, and heart diseases. Horse gram contains bioactive compounds such as phenolic acids, flavonoids, and tannins, which contribute to its health advantages. These bioactive compounds demonstrated antioxidant, antidiabetic, anti-inflammatory, anticarcinogenic, antimicrobial, antidiarrheal, and neuroprotective effects. These horse gram products are now considered superfoods and are widely utilized in worldwide cuisines. Horse gram and its crude extracts or fractions have been shown to exhibit a wide range of in vivo and in vitro pharmacological and nutraceutical properties. However, there is currently a scarcity of structure-activity investigations of isolated compounds and mechanistic research on this species. This review demonstrates that horse gram, despite its traditional usage by diverse cultures, has a profusion of bioactive chemicals with a wide range of biological effects that might be employed as biopharmaceuticals and adopted by nutraceutical industries. This study focuses on the thorough phytochemistry, folk medicinal applications, and pharmacological properties of this versatile legume plant. Furthermore, we discussed the value of plants as a source of functional foods and nutraceuticals.

Clinical efficacy and safety of the superpulse thulium fiber laser and holmium laser for ureteroscopic lithotripsy in the treatment of upper urinary tract calculi: a randomized, positive control, blinded, single-center clinical study {1}

BACKGROUND

Kidney stone disease is a common problem. The holmium: yttrium-aluminum-garnet (HO:YAG) laser is currently the gold standard laser for ureterorenoscopic (URS) lithotripsy. Recently, the superpulse thulium fiber laser (SP TFL) has shown potential as a substitute for the HO:YAG laser. We aim to compare and evaluate the clinical efficacy and safety of the HO:YAG laser and SP TFL in the treatment of upper urinary calculi in this trial.

METHODS

In this randomized, positive control, blinded management, single-center clinical study, patients with upper urinary calculi will be randomized (1:1) to the experimental group (SP TFL group) or the control group (HO:YAG laser group). Patients in both groups will undergo URS lithotripsy under general anesthesia, and according to the results of randomization, the patients will be treated with an SP TFL (trial group) or a holmium laser (control group). The primary outcome is the stone-free rate at 30 ± 7 days after surgery. The secondary outcomes include the duration of surgery, the duration of laser use, the length of postoperative hospital stay, postoperative clinical indicators, total hospitalization costs, the second-stage stone clearance rate, perioperative complications, the average hemoglobin change, and the mean white blood cell count change.

DISCUSSION

This study aims to evaluate and compare the clinical efficacy and safety of the SP TFL and HO:YAG for URS lithotripsy in the treatment of upper urinary calculi. TRIAL REGISTRATION {2A AND 2B}: chictr.org.cn ChiCTR2300076893. Registered on October 24, 2023, with ChiCTR ( https://www.chictr.org.cn/bin/project/edit?pid=206827 ). PROTOCOL VERSION {3}: August 15, 2023 (V.20230815).

Urine Sediment Detection Algorithm Based on Channel Enhancement and Deformable Convolution

Urine sediment detection is a vital method in clinical urine analysis for evaluating an individual's kidney and urinary system health, as well as identifying potential diseases. Nevertheless, urine sediment images exhibit the characteristic of diverse shapes for the same category of targets. These characteristics pose a considerable challenge to the accurate identification of the visible components within the images. We approach urine sediment detection as an object detection task and have introduced the specialized YOLOv7-CSD algorithm for this purpose. In particular, we have integrated channel enhancement feature pyramid network (CE-FPN) and selective kernel (SK) into the YOLOv7 model to address the issue of model confusion in classifying and identifying tasks caused by the feature aliasing effects of feature pyramid network (FPN). Furthermore, we enhance the efficient layer aggregation networks (ELAN) network by adding a second channel, enabling the model to acquire a more extensive set of feature information. On top of this, we introduce the deformable convolutional v3 (DCNv3) operator, allowing the model to dynamically adjust its receptive field, addressing the issue of variable shapes. Tested on the USE dataset and a dataset for urine crystals, YOLOv7-CSD achieves accuracies of 92.8 % and 89.6 % , respectively.

Association between ambient temperature and hospitalizations for urolithiasis in four counties of Ganzhou, China

We collected meteorological and urolithiasis-related hospitalization data from four counties in Ganzhou City for 2018-2019 and used the DLNM method to assess the lagged and cumulative effects of temperature on urolithiasis hospitalizations and obtain the total effect after meta-combination. Based on the nonlinear association between temperature and urolithiasis hospitalizations, the relative risk of overall high temperature (30℃) was 2.10 (95% CI: 1.07-4.10). No statistically significant difference (p = 0.07) was observed between males (RR = 2.04, 95% CI: 1.42-2.94) and females (RR = 1.45, 95% CI: 1.09-1.92) for the heat effect, which was higher in the ≥ 60 years age group (RR = 3.18, 95% CI: 1.76-5.76) than in the < 60 years age group (p = 0.007). High temperatures increased the risk of hospitalization for urolithiasis in Ganzhou, China, and the risk was greatest for individuals aged 60 and above, with similar risks observed across counties and genders.

Mitochondrial dysfunction and NLRP3 inflammasome: key players in kidney stone formation

The mitochondrion serves as a critical intracellular organelle, engaging in essential roles in the regulation of energy production, oxidative stress management, calcium homeostasis, and apoptosis. One such disease that has been particularly associated with these functions is kidney stone disease (KSD), specifically calcium oxalate (CaOx). It is underpinned by oxidative stress and tissue inflammation. Recent studies have shed light on the vital involvement of mitochondrial dysfunction, the nucleotide-binding domain and leucine-rich repeat containing protein 3 (NLRP3) inflammasome, endoplasmic reticulum stress and subsequent cell death in CaOx crystal retention and aggregation. These processes are pivotal in the pathogenesis of kidney stone formation. This review focuses on the pivotal roles of mitochondria in renal cell functions and provides an overview of the intricate interconnectedness between mitochondrial dysfunction and NLRP3 inflammasome activation in the context of KSD. It is essential to recognise the utmost significance of gaining a comprehensive understanding of the mechanisms that safeguard mitochondrial function and regulate the NLRP3 inflammasome. Such knowledge carries significant scientific implications and opens up promising avenues for the development of innovative strategies to prevent the formation of kidney stones.

Neph-ex: a 3D printed interventional radiology training tool for nephrostomy exchange

OBJECTIVES

Fluoroscopic guided procedures are a mainstay for interventional radiology (IR) procedures. Practice is needed for the novice to interpret fluoroscopic images and simultaneously perform the procedure hands-on as well as control the foot pedal to screen. We describe the development of a training simulation model which simulates the human kidney, ureter, and bladder.

METHODS

Stereolithography (SLA) 3D print technology using SLA resin and Anycubic SLA printer were employed. A plastic tubing was used to connect the 3D printed kidney and bladder as the ureter. This simulation model permits fluoroscopic guided filling of "pelvicalyceal system" with contrast as well as ureteric stenting, guidewire, and drainage catheter manipulation. Effectiveness of the model to attain skills for nephrostomy exchange and ureteric stenting was obtained via questionnaire from trainees prior to and after utilizing the model.

RESULTS

The 3D printing simulation model of the kidney, ureter, and bladder system enables trainees to perform nephrostomy exchange, nephrostogram, and antegrade stenting. Participants felt more confident to perform the procedures as they were more familiar with the procedure. Besides that, participants felt their wire and catheter manipulation skills have improved after using the simulation model.

CONCLUSIONS

Neph-ex simulation model is safe and effective for hands-on training in improving proficiency of fluoroscopy-guided nephrostomy exchange and antegrade ureteric stenting.

ADVANCES IN KNOWLEDGE

As of our knowledge, there are no commercially available simulation models for fluoroscopic guided nephrostomy exchange and ureteric stent deployment. No article on nephrostomy exchange simulation model has been published before.

Association of single nucleotide genetic polymorphisms of vitamin D receptor and calcium-sensitive receptor with calcium-containing kidney stones in Chinese Dai populations: a prospective multi-center study

PURPOSE

To evaluate the association between vitamin D receptor (VDRs) and calcium-sensitive receptor (CaSR) gene polymorphisms and calcium-containing kidney stones (CCKS) in Dai populations.

METHODS

A total of 160 CCKS patients and 87 healthy controls were included in this study. CCKS was confirmed using urological computed tomography (CT), plain abdominal radiograph, or surgical lithotomy. Stone samples obtained during surgery were analyzed using infrared spectroscopy. Venous blood and 24-h urine samples were collected and analyzed using Sanger sequencing and high-performance liquid chromatography, respectively. Genetic variants in the VDR gene (rs7975232, rs2228570, rs731236, and rs1544410) and CaSR gene (rs7652589, rs1801725, and rs1042636) were identified through sequence analysis.

RESULTS

Analysis of genotype and allele frequencies revealed that the rs7975232 polymorphism in the VDR gene and the rs7652589 allele in the CaSR gene were significantly associated with CCKS. Furthermore, patients carrying the AC and AA genotypes of rs7975232 showed a higher incidence of hypocitraturia compared to those with other genotypes (p < 0.05). The AA and GG genotypes of rs1042636 and the AA genotype of rs7652589 were significantly associated with hypercalciuria (p < 0.05).

CONCLUSION

CCKS in this study population may be closely related to hypocitraturia caused by the VDR locus rs7975232 polymorphism and hypercalciuria caused by the CaSR locus rs1042636 and rs7652589 polymorphism.

Safety of flexible ureteroscopic lithotripsy with 365 μm fibers of Ho: YAG laser: a short-term follow-up

Our previous study first reported the efficacy of FURL using 365 μm fibers with holmium: yttrium aluminum garnet (Ho: YAG) laser lithotripsy. This study evaluates the 16-week safety of this procedure. A prospective cohort study was conducted, and the clinical characteristics of patients who underwent FURL using 365 μm fibers with Ho: YAG laser were retrospectively collected. Descriptive statistics were reported, and logistic regression analysis was conducted to identify risk factors influencing the stone-free rate (SFR). Infection-related laboratory parameters, including white blood cell count (WBC), procalcitonin (PCT), and C-reactive protein (CRP), were collected. Regression analysis was conducted to identify risk factors for the development of urosepsis post-surgery. Additionally, a 16-week follow-up was conducted in outpatient clinics, and kidney function was assessed. A total of 274 patients participated in this study. The 4-week stone-free rate (SFR) following FURL with 365 μm fibers of Ho: YAG laser was significantly associated with stone size and composition. No severe complications were observed following FURL procedures. There were no significant differences in white blood cell count (WBC), C-reactive protein (CRP), and procalcitonin (PCT) in peripheral blood before and after FURL procedures. Urosepsis was diagnosed in 1.82% of patients. Preoperative white blood cell count (WBC) in urine and preoperative urine culture results were identified as significant risk factors. Kidney function remained stable at 4 and 16 weeks following FURL. This prospective cohort study demonstrated the high safety of FURL with 365 μm fibers of Ho: YAG laser, as infection-related parameters during the perioperative period showed no significant differences, and kidney function remained stable throughout the 16-week follow-up.

SGLT2 Inhibitors and Their Effect on Urolithiasis: Current Evidence and Future Directions

Urolithiasis (UL) is increasingly prevalent due to rising cardiorenometabolic diseases, posing significant management challenges despite advances in urological techniques. Sodium-glucose cotransporter-2 (SGLT2) inhibitors, primarily used for type 2 diabetes mellitus, chronic kidney disease, and heart failure, have emerged as a potential novel approach for UL treatment. These inhibitors may help reduce the risk of urolithiasis, particularly in patients with diabetes, by improving glycemic control and altering urinary chemistry, which are crucial factors in stone formation. However, the changes in urinary composition induced by SGLT2 inhibitors might also increase the risk of uric acid stone formation. This review evaluates the potential of SGLT2 inhibitors in managing UL, highlighting both the benefits and the risks. While these inhibitors show promise in reducing new and recurrent urinary stones in patients with diabetes, data on their effects in patients without diabetes who form stones are limited. Current human evidence largely comes from post hoc analyses of randomized controlled trials (RCTs) and large-scale database studies, with only one study providing detailed stone composition data. Experimental studies in animal models and cell lines have focused on calcium oxalate (CaOx) stones, showing that SGLT2 inhibitors specifically target CaOx stone formation and related renal inflammation. Although primarily studied for CaOx stones, their potential impact on other calcium-containing stones, such as calcium phosphate, remains promising. Further research is needed to explore their therapeutic potential and optimize treatment strategies.

SMYD2 Promotes Calcium Oxalate-Induced Glycolysis in Renal Tubular Epithelial Cells via PTEN Methylation

Background/Objectives: Damage to renal tubular cells (RTCs) represents a critical pathological manifestation in calcium oxalate (CaOx) stone disease, but the underlying mechanism remains elusive. Energy metabolism reprogramming is a vital influencer of RTC survival, and SMYD2 is a histone methylation transferase that has been extensively implicated in various metabolic disorders. Hence, this research aimed to identify whether SMYD2 induces the reprogramming of energy metabolism in RTCs exposed to CaOx nephrolithiasis. Methods: Kidney samples were obtained from patients who underwent laparoscopic nephrectomy for non-functioning kidneys caused by nephrolithiasis. The glyoxylate-induced CaOx stone mice model was established and treated with AZ505. The SMYD2-knockout HK-2 cell line was constructed. Histological changes were evaluated by HE, VK, Tunel, Masson stainings. The molecular mechanism was explored through co-immunoprecipitation and western blotting. Results: The results found that SMYD2 upregulation led to energy reprogramming to glycolysis in human kidney tissue samples and in mice with CaOx nephrolithiasis. We also identified the substantial involvement of glycolysis in the induction of apoptosis, inflammation, and epithelial-mesenchymal transition (EMT) in HK-2 cells caused by calcium oxalate monohydrate (COM). In vivo and in vitro results demonstrated that SMYD2 inhibition reduces glycolysis, kidney injury, and fibrosis. Mechanistically, SMYD2 was found to promote metabolic reprogramming of RTCs toward glycolysis by activating the AKT/mTOR pathway via methylated PTEN, which mediates CaOx-induced renal injury and fibrosis. Conclusions: Our findings reveal an epigenetic regulatory role of SMYD2 in metabolic reprogramming in CaOx nephrolithiasis and associated kidney injury, suggesting that targeting SMYD2 and glycolysis may represent a potential therapeutic strategy for CaOx-induced kidney injury and fibrosis.

Heatwave and upper urinary tract stones morbidity: effect modification by heatwave definitions, disease subtypes, and vulnerable populations

As heatwave occurs with increased frequency and intensity, the disease burden for urolithiasis, a heat-specific disease, will increase. However, heatwave effect on urolithiasis subtypes morbidity and optimal heatwave definition for urolithiasis remain unclear. Distributed lagged linear models were used to assess the associations between 32 defined heatwave and upper urinary tract stones morbidity. Relative risk (RR) and attributable fraction (AF) of upper urinary tract stone morbidity associated with heatwave of different intensities (low, middle, and high) were pooled by meta-analysis. Optimal heatwave definition was selected based on the combined score of AF, RR, and quasi-Akaike Information Criterion (QAIC) value. Stratified analyses were conducted to investigate the modification effects of gender, age, and disease subtypes. Association between heatwave and upper urinary tract stones morbidity was mainly for ureteral calculus, and AF was highest for low-intensity heatwave. This study's optimal heatwave was defined as average temperature > 93rd percentile for ≥ 2 consecutive days, with AF of 7.40% (95% CI: 2.02%, 11.27%). Heatwave was associated with ureteral calculus morbidity in males and middle-aged adults. While heatwave effect was statistically insignificant in females and other age groups. Managers should develop appropriate definitions to address heatwave based on regional characteristics and focus on heatwave effects on urolithiasis.

Prevention and Management of Urolithiasis With Parsley and Barley Among the Hail Population, Saudi Arabia: Is It Fact or Not?

BACKGROUND

Urolithiasis is one of the most common urinary tract diseases. It is a multifactorial condition involving both environmental and metabolic aspects. Dietary changes and lifestyle modifications are crucial for managing and preventing urolithiasis. Barley and parsley have been utilized as a complementary treatment to manage urolithiasis, which may be helpful in managing and preventing this disease.

METHODOLOGY

This was a community-based cross-sectional study conducted to determine the effects of parsley and barley in managing urolithiasis among the population of Hail, Saudi Arabia by an electronic questionnaire. All responses were kept confidential. Statistical analyses were conducted using SPSS version 22 (Chicago, IL: SPSS Inc.).

RESULTS

A total of 395 participants completed the questionnaire, with ages ranging from 18 years to more than 60 years; nearly half of them were females. Only 37 (9.4%) had a history of renal disease but 182 (46.1%) had a family history of renal stones. Regarding the frequency of barley and parsley used in the management of renal stones, 162 (41%) respondents used barley, while 176 (44.6%) of them used parsley to treat or prevent kidney stones. Factors associated with the use of barley and parsley in the management of renal stones were older age, female gender, non-healthcare staff, those with renal disease history, and family history of renal stones.

CONCLUSION

The results showed that among the Hail population, non-conventional therapies are more commonly used for treating renal stones than medical treatment. There were multiple factors associated with using barley and parsley to manage urolithiasis. Additional research is needed to gain a clearer understanding of the safety and effectiveness of non-conventional therapies, such as barley and parsley, in managing urolithiasis.

External validation of Ito's nomogram and T.O.HO. scoring system in flexible ureterorenoscopy

PURPOSE

This study aims to assess stone-free rates after flexible ureterorenoscopy (fURS) using the T.O.HO. (Tallness, Occupied lesion, Hounsfield unit evaluation) scoring system and Ito's nomogram.

MATERIALS AND METHODS

In the study conducted with 484 patients, the following parameters were analyzed: age, sex, comorbidities, hospitalization, affected side, extracorporeal shock wave lithotripsy (ESWL) history, stone length, stone density, number of stones, location, and presence of hydronephrosis.

RESULTS

Multivariate logistic regression analysis revealed that stone length, stone number, and lower pole stone location were associated with the prediction of stone-free status. The cut-off value for Ito's score was determined to be 13.5 points, with an AUC of 0.792 (sensitivity, 0.609; specificity, 0.821) and a 95% confidence interval of (0.752-0.832) (Fig. 1). The cutoff for the T.O.HO. score was 6.5 points, with an AUC of 0.744 (sensitivity 0.738, specificity 0.602) and a 95% confidence interval of (0.699-0.789).

CONCLUSION

In conclusion, T.O.HO. scoring system and the Ito's nomogram are promising tools to predict stone-free status (SFS) after fURS in preoperative evaluation. In addition, the success of scoring systems in predicting SFS preoperatively appears promising and offers a potentially valuable approach.

Outcomes and Complications of Percutaneous Nephrolithotomy (PCNL): A Single-Center Experience

BACKGROUND

Urolithiasis is extremely prevalent in Pakistan, with percutaneous nephrolithotomy (PCNL) emerging as the primary treatment modality over traditional open surgery. Despite its effectiveness, PCNL is associated with a risk of complications and residual stones. There is limited data on PCNL outcomes from Southern Punjab, necessitating an evaluation of its efficacy and safety in this region.

METHODS

We conducted a retrospective analysis of 399 patients who underwent PCNL at a tertiary care hospital in Muzaffargarh, Pakistan, between October 2016 and September 2022. Detailed preoperative assessments, surgical procedures, and postoperative outcomes were reviewed. Stone clearance and complication rates were assessed, and factors influencing these outcomes were analyzed.

RESULTS

The median age of the study population was 39 years, with a male predominance. Stone clearance was achieved in 80.45% (321) of cases, with higher success rates observed in lower pole punctures. Complications occurred in 2% (13) of patients, predominantly hydrothorax following upper pole puncture. Patients with comorbidities had a higher risk of complications (P = 0.097). Residual stones were more common in staghorn stones and larger stone sizes (>3-4 cm). The median operative time was 60 minutes, shorter than reported in the literature, reflecting surgical expertise.

CONCLUSION

PCNL is an effective and safe treatment option for urolithiasis in Southern Punjab, Pakistan, with favorable stone clearance rates and low complication rates. Tailoring treatment strategies based on patient characteristics and optimizing surgical techniques are essential for improving outcomes in this population.

Investigation and quantification of composition variability in urinary stone analysis

PURPOSE

To investigate the variability in urinary stone composition analysis due to sampling and suggest potential solutions.

MATERIALS AND METHODS

We collected 1,135 stone fragments from 149 instances that had undergone a stone removal at Hanoi Medical University Hospital from January 2022 to August 2022. Each fragment was ground into fine powder and divided into separate specimens if the amount was abundant. For composition analyzing every specimen, Fourier transform infrared spectroscopy was performed. The composition of a given fragment was the average of its belonging specimens. The variability in composition was assessed on the fragment level (i.e., between fragments of an instance). We defined an instance as "significantly variable" if the maximum difference in any composition across its belonging fragments was equal to or greater than a given threshold.

RESULTS

On average, there were 7.6±3.3 stone fragments per instance and 2.3±0.5 specimens per fragment. We found that the variability could be substantial on the fragment level. Eighty-nine (69.5%) and 70 (54.7%) out of 128 multiple-component instances were significantly variable if the threshold was set at 20% and 30%, respectively. The variability of an instance on the fragment level was correlated with the size of fragment and the number of components.

CONCLUSIONS

Our study demonstrated the significant variability in urinary stone composition and showed that it correlated with the size and the impurity of samples. Mapping denotation while sampling and analyzing as well as reporting the composition of individual fragments could be valuable to reduce potential variability.

Prevalence and clinical significance of incidental findings in chest and abdominopelvic CT scans of trauma patients; A cross-sectional study

BACKGROUND

Imaging may inadvertently reveal pathologies unrelated to their performing purpose, known as incidental findings (IF). This study aimed to assess the prevalence, clinical significance, and documentation of IFs in chest and abdominopelvic computed tomography (CT) scans of trauma patients.

METHODS

This observational study was conducted at two urban level-1 trauma centers from March 2019 through April 2022. Official radiology reports of trauma patients who underwent chest and/or abdominopelvic CT scans at the emergency department (ED) were explored, and IF were extracted. Predictive factors of the presence of IFs and their documenting were investigated.

RESULTS

Out of 656 chest and 658 abdominopelvic CT scans, 167 (25.37%) and 212 (32.31%) scans harbored at least one IF, respectively. Patients with IFs tended to be of higher age and female in both chest (age: 48 [IQR: 35-62] vs. 34 [IQR: 25-42.5]; female: 31.14% vs 14.66%, p < 0.001 for both) and abdominopelvic CT scans (age: 41 [IQR: 30-57.5] vs 33 [IQR: 25-43], female: 26.42% vs. 13.96%, p < 0.001 for both). As for documentation of significant IFs, only 49 of 112 chest IFs (43.8%) and 55 of 176 abdominopelvic IFs (31.3%) were documented. Investigating factors associated with documentation of clinically significant IFs, shorter length of hospital stay (1.5 (IQR: 0-4) vs. 3 (IQR: 2-8), p = 0.003), and discharging by ED physicians (documentation rate: 13.2% vs 42.6%, p < 0.001) were associated with poorer documentation of IFs only in abdominopelvic scans.

CONCLUSION

CT imaging in ED trauma patients often reveals incidental findings, especially in older patients. Over 50% of these findings are clinically significant, yet they are frequently ignored and not documented. Physicians need to be more vigilant in recognizing and documenting these incidental findings and informing patients of the need for further evaluation.

Success rate and complications of performing elective ureteroscopy in <1 week versus over 1 week from renal colic initiation in ureteral stones larger than 6 mm

Background

The aim of this study was to compare the outcomes, success rate, and complications of performing elective ureteroscopy at different times: <1 week from renal colic initiation (early) and more than 1 week from renal colic initiation (late) in patients with ureteral stone larger than 6 mm.

Materials and Methods

This comparative observational study was conducted on 338 consecutive patients. Patients were evaluated in two groups: patients who underwent ureteroscopy in <1 week (A) and patients who underwent ureteroscopy in more than 1 week (B) from renal colic initiation. Helical unenhanced computed tomography was used to assess the size, location, and hardness of stone for all patients. Operation success was defined as complete clearance of stone with no stone residue (stone free) at 2-week postoperative ultrasonography with no need to further interventions. Operation data were collected using medical records, and postoperative complications were investigated at 2 weeks postoperative follow-up visits.

Results

Group A included 165 patients and Group B included 173 patients. The overall mean stone size was 8.60 ± 1.12 mm: for Group A 9.13 ± 0.94 mm and for Group B 8.10 ± 1.04 mm (P < 0.001). Stone residues were found in 11 patients: 9 in Group A (5.4%) and 2 in Group B (1.1%) (P = 0.026). Nine patients needed repeated ureteroscopy: 8 (4.8%) in Group A and 1 (0.6%) in Group B (P = 0.015). A double-J stent was used for 85 (51.5%) patients in Group A and 66 (38.2%) patients in Group B (P = 0.016). Major intraoperative complications did not happen in any patients. Fifty-three (32.1%) patients in Group A and 28 (16.2%) patients in Group B suffered from postoperative complications (P = 0.001).

Conclusion

Our study revealed that performing elective ureteroscopy with an interval of more than 1 week from the onset of renal colic in combination with medical treatments was associated with less need for double-J stent placement, less need for repeated ureteroscopy, and fewer postoperative complications compared to performing elective ureteroscopy in <1 week from the renal colic onset in nonemergent patients with ureteral stone larger than 6 mm. Although the rate of ureteroscopy failure was higher among the patients who underwent ureteroscopy in <1 week from their renal colic initiation, there was no statistically significant relationship between performing ureteroscopy in <1 week and an increased risk for ureteroscopy failure.

Urine cadmium and urolithiasis: A systematic review and meta-analysis

Exposure to cadmium may increase risk of urolithiasis, but the results remain inconclusive. This systematic review and meta-analysis aimed to access the association between cadmium exposure and urolithiasis. We searched Medline/PubMed, Embase, Web of Science Core Collection, and Cochrane Central for studies. The primary outcome was the incidence of urolithiasis compared to reference groups. We used relative risk as the summary effect measure. This meta-analysis included eight observational studies and divided into 39 study populations. Among 63,051 subjects, 5018 (7.96%) individuals had urolithiasis. The results indicated that people with an increment of 0.1 μg/g creatinine in urinary cadmium had a 2% increased risk of urolithiasis (pooled relative risk [RR], 1.02; 95% confidence interval [CI], 1.01-1.03) and there is no difference in the risk of urolithiasis in high and low cadmium exposure levels. Meanwhile, people with an increment of 0.1 μg/L in urinary cadmium had a 4% increased risk of urolithiasis (pooled RR, 1.04; 95% CI, 1.02-1.07). Our findings also showed similar associations in both sex, different region (Sweden, China, and Thailand), general and occupational population. The results indicate that cadmium exposure was significantly associated with an elevated risk of urolithiasis. Therefore, it is imperative to take steps to minimize cadmium exposure.

Exploring the incidence and characteristics of urolithiasis in the central region of Saudi Arabia: Insights from a prominent medical center

Introduction

Urolithiasis is a common and recurrent condition with a rising global incidence. Stones typically develop in the upper urinary tract, primarily the kidneys. Various factors such as age, gender, diet, fluid intake, climate, occupation, genetics, and metabolic diseases influence stone formation. Stones can vary in size and location, causing obstruction, urine stasis, and complications such as infection. The prevalence of urolithiasis in Saudi Arabia has significantly increased in recent decades, and the study aims to determine the current prevalence and composition trends of urolithiasis, guide treatment and prevention strategies, as well as understand predictors of occurrence and recurrence.

Materials and Methods

It is a retrospective cohort study where the data was collected in the time frame of 2015-2021. The study was conducted in the Department of Surgery and the Division of Urology at King Abdulaziz Medical City in Riyadh, Kingdom of Saudi Arabia.

Results

The study reveals significant trends in the sociodemographic profile and clinical aspects of urolithiasis patients. With a higher incidence among males (68.5%). Stone compositions predominantly consist of calcium oxalate (67.8%) and uric acid (19.7%), while site distribution shows the left kidney as the most common location (36.5%). Notably, hypertensive patients exhibit a significant association with stone site (P = 0.014). Encouragingly, the majority of patients do not experience reoccurrence (91.6%), and the study demonstrates an increasing recurrence rate with subsequent visits. The relatively shorter hospital stays (55.9% with 1-day stays) indicate efficient management, and this knowledge can aid in optimizing patient care.

Conclusion

This study sheds light on the multifaceted nature of urolithiasis by examining various facets. Low recurrence rate of kidney stones offers positive prospects for effective initial management. The shorter hospital stays, suggest advancements in medical practices, enhancing patient convenience and healthcare resource optimization. Investigating the underlying causes behind the observed stone compositions yield insights into potential preventive strategies. Furthermore, extended studies examining the impact of lifestyle modifications and medical interventions on stone recurrence could contribute to refined treatment protocols. These findings can guide healthcare professionals in optimizing patient care, preventive strategies, and future research endeavors.

Urinary stone analysis and clinical characteristics of 496 patients in Taiwan

Evaluate urinary stone components' epidemiological features in urolithiasis individuals and explore potential correlations between stone components and patients' clinical characteristics. A retrospective analysis of urinary stone compositions in 496 patients from a northern Taiwan medical center (February 2006 to October 2021) was conducted. We investigated associations between sex, age, body mass index (BMI), hypertension, diabetes mellitus (DM), hyperlipidemia (HLP), gout, coronary artery disease (CAD), cerebral vascular accident (CVA), chronic kidney disease (CKD), habits, urine pH, and three main stone groups: calcium oxalate (CaOx), calcium phosphate (CaP), and uric acid (UA). Males accounted for 66.5% of cases, with a male-to-female ratio of 1.99:1. Males were negatively associated with CaP stones (OR 0.313, p < 0.001) and positively with UA stones (OR 2.456, p = 0.009). Age showed a negative correlation with CaOx stones (OR 0.987, p = 0.040) and a positive correlation with UA stones (OR 1.023, p < 0.001). DM had a protective effect against CaP stones (OR 0.316, p = 0.004). Gout had a positive association with UA stones (OR 2.085, p = 0.035). Smoking was adversely associated with UA stones (OR 0.350, p = 0.018). Higher urine pH was a risk factor for CaP stones (OR 1.641, p = 0.001) and a protective factor against UA stones (OR 0.296, p < 0.001). These results may provide insights into the pathogenesis of urinary stones and the development of preventative strategies for high-risk populations. Further research is required to confirm and expand upon these findings.

Effects of the Surgical Ligation of the Ureter in Different Locations on the Kidney over Time in the Rat Model

Purpose

To evaluate the effects of the surgical ligation of the ureter in different locations on the kidney over time in the rat model.

Methods

A total of 155 rats were enrolled and randomly divided into the case (n = 150) and control (n = 5) groups. The case group included three separate groups (fifty rats in each group) that underwent surgical ureteral ligation at the proximal, middle, and distal ureter. The laboratory tests, and tumor necrosis factor α (TNF-α), were measured in groups. The pathological evaluation for glomerular changes, tubular dilation, interstitial fibrosis, and interstitial infiltration of the inflammatory cells following the obstruction was performed (severity of tubular atrophy categorized too mild (+), moderate (++), and severe (+++)). To compare the continuous variables between the groups and between the measurement times, the analysis of variance (ANOVA) was used.

Results

Our results revealed that the creatinine four weeks after the obstruction was significantly higher in the proximal group obstruction (p value: 0.046). The three groups had no significant differences regarding urine creatinine, serum sodium, and serum TNF (p value: 0.261). Obstruction did not change the glomerular morphology in three intervention groups after six weeks. The commencing of severe tubular atrophy in proximal, middle, and distal ureteral obstruction was at weeks three, four, and six, respectively.

Conclusion

The location of ureteral obstruction is also crucial in deciding to intervene to relieve the complete ureteral obstruction. Severe tubular damage occurs in weeks three, four, and six in proximal, middle, and distal ureteral obstruction, respectively.

Assessment of Urinary Stone Chemical Compositions and Prevalence of Metabolic Disorders Among Urolithiasis Patients in Northern Sri Lanka: A Prospective Study

Introduction Urolithiasis, a common urological disorder affecting the global population, demonstrates geographical diversity due to factors such as water quality, climate variations, health conditions, and dietary habits. This study, conducted in Northern Sri Lanka, examines urinary stone compositions and assesses the prevalence of metabolic disorders among urolithiasis patients. Methods This prospective cross-sectional study, conducted at Jaffna Teaching Hospital, Jaffna, Sri Lanka, from July 2022 to June 2023, focused on surgically treated urolithiasis patients. Institutional ethical clearance was obtained. Patient details and investigational findings were collected through questionnaires and data extraction forms. Stone analysis utilized Fourier transform infrared spectroscopy, and a detailed metabolic evaluation of a 24-hour urine collection sample was carried out. Results This study followed 153 surgically treated urolithiasis patients, primarily male (64.3%), with a mean age of 48.64. Ureteric colic (48.4%) was common, with kidney stones (45.8%) prevalent; 57.52% had recurrent stones. Diabetes mellitus (DM; 23.5%) was the top comorbidity. Calcium oxalate monohydrate (COM) stones (78.4%) were the most frequent, followed by uric acid (12.4%). COM predominated in the 40-59 age group. There was no significant gender-stone type association. A total of 86.9% had metabolic abnormalities, notably hypocitraturia (60.1%). Moreover, 23% had both hypocitraturia and hypomagnesuria. Some metabolic disorders showed gender differences, with a marginal age-metabolic disorder association (p < 0.061). Urine oxalate levels were normal, with higher variability in males. Conclusion Middle-aged males with urolithiasis commonly presented with ureteric colic and predominantly had COM stones. Recurrent stones were common, often accompanied by metabolic abnormalities such as hypocitraturia and hypomagnesuria, with DM as the primary comorbidity.

Cell death‑related molecules and targets in the progression of urolithiasis (Review)

Urolithiasis is a high‑incidence disease caused by calcium oxalate (mainly), uric acid, calcium phosphate, struvite, apatite, cystine and other stones. The development of kidney stones is closely related to renal tubule cell damage and crystal adhesion and aggregation. Cell death, comprising the core steps of cell damage, can be classified into various types (i.e., apoptosis, ferroptosis, necroptosis and pyroptosis). Different crystal types, concentrations, morphologies and sizes cause tubular cell damage via the regulation of different forms of cell death. Oxidative stress caused by high oxalate or crystal concentrations is considered to be a precursor to a variety of types of cell death. In addition, complex crosstalk exists among numerous signaling pathways and their key molecules in various types of cell death. Urolithiasis is considered a metabolic disorder, and tricarboxylic acid cycle‑related molecules, such as citrate and succinate, are closely related to cell death and the inhibition of stone development. However, a literature review of the associations between kidney stone development, metabolism and various types of cell death is currently lacking, at least to the best of our knowledge. Thus, the present review summarizes the major advances in the understanding of regulated cell death and urolithiasis progression.

The prevalence and distribution of risk factors for depression and emotional mental disorders in the elderly in Indonesia

BACKGROUND

Depression is a mental health disorder. The prevalence of mental health disorders in the elderly is high.

AIMS

This study was to determine the mental status depression and emotional of the elderly based on their characteristics.

METHODS

This study was a further analysis of Basic Health Research 2018 data. The population was all households from all districts/cities in 33 provinces in Indonesia with a cross-sectional design. The sample was all elderly, with a total sample of 82,304,000 people. The respondents included young elderly (60-69 years), middle elderly (70-79 years), and old elderly (>80 years).

RESULT

Depression is experienced by most of elderly aged 60 to 69 years as many as 3,756,384 respondents (59.72%), females as many as 3,885,191 respondents (61.77%), living in urban areas, as many as 3,147,131 respondents (50.03%), graduated from elementary school as many as 2,052,22 respondents (32.63%), not working as many as 3,535,241 respondents (56.21%), and quintile one expenditure level as many as 1,532,358 respondents (24.36%).

CONCLUSIONS

Emotional disorders of depression in elderly are due to the adaptation process to physical and psychosocial changes. Family support is a must to improve elderly's quality of life on mental health aspects, especially depression. Furthermore, better treatment by medical personnel is required.

Pharmacists' perspectives and perceived barriers to counselling patients with kidney stones

BACKGROUND

The global increase in kidney stone incidence and its complications emphasise the need for effective management. While pharmacists can play a significant role in counselling and guiding patients, their practices in managing patients with kidney stones remain unclear.

OBJECTIVE(S)

To explore counselling practices and experiences of pharmacists when dealing with patients with kidney stones and to identify the barriers they face while providing counselling.

METHODS

A qualitative study was performed using semi-structured phone interviews with pharmacists practising in Jordan. Pharmacists were selected using quota sampling from those who took part in a previous study focused on pharmacists' knowledge of kidney stone aetiology and treatment. The COM-B Model of Behaviour Change was used to develop the interview guide and the analytical framework. Interviews were transcribed verbatim and analysed using a deductive thematic approach based on the pre-specified analytical framework.

RESULTS

Seven pharmacists (85.7% female; 57.1% working in community pharmacies) were interviewed. Counselling practices of patients with kidney stones were categorised into five themes: (1) Pharmacists' beliefs about patient counselling: perceived importance and desire to improve health through counselling; (2) Most priority patients: Types of patients mostly counselled; (3) Content of kidney stones-specific counselling: patient assessment and recommendations about kidney stones management; (4) Duration of the counselling sessions: time offered and influencing factors; (5) Barriers to patient counselling: patient-related, and pharmacist- and doctor-related challenges.

CONCLUSIONS

Pharmacists recognise the crucial role of kidney stones counselling but face gaps in their practices, including incomplete dietary education, limited knowledge of medication prescriptions, inconsistent patient-specific approaches, and potential communication challenges. These gaps can be overcome by enhancing training, standardising protocols of kidney stone treatment, promoting interprofessional communication, and improving communication strategies. Future research, including quantitative assessments, is needed to inform strategies that optimise patient counselling practices and facilitate improved outcomes.

Understanding formation processes of calcareous nephrolithiasis in renal interstitium and tubule lumen

Kidney stone, one of the oldest known diseases, has plagued humans for centuries, consistently imposing a heavy burden on patients and healthcare systems worldwide due to their high incidence and recurrence rates. Advancements in endoscopy, imaging, genetics, molecular biology and bioinformatics have led to a deeper and more comprehensive understanding of the mechanism behind nephrolithiasis. Kidney stone formation is a complex, multi-step and long-term process involving the transformation of stone-forming salts from free ions into asymptomatic or symptomatic stones influenced by physical, chemical and biological factors. Among the various types of kidney stones observed in clinical practice, calcareous nephrolithiasis is currently the most common and exhibits the most intricate formation mechanism. Extensive research suggests that calcareous nephrolithiasis primarily originates from interstitial subepithelial calcified plaques and/or calcified blockages in the openings of collecting ducts. These calcified plaques and blockages eventually come into contact with urine in the renal pelvis, serving as a nidus for crystal formation and subsequent stone growth. Both pathways of stone formation share similar mechanisms, such as the drive of abnormal urine composition, involvement of oxidative stress and inflammation, and an imbalance of stone inhibitors and promoters. However, they also possess unique characteristics. Hence, this review aims to provide detailed description and present recent discoveries regarding the formation processes of calcareous nephrolithiasis from two distinct birthplaces: renal interstitium and tubule lumen.

Accurate prediction of pure uric acid urinary stones in clinical context via a combination of radiomics and machine learning

PURPOSE

Oral chemolysis is an effective and non-invasive treatment for uric acid urinary stones. This study aimed to classify urinary stones into either pure uric acid (pUA) or other composition (Others) using non-contrast-enhanced computed tomography scans (NCCTs).

METHODS

Instances managed at our institution from 2019 to 2021 were screened. They were labeled as either pUA or Others based upon composition analyses, and randomly split into training or testing data set. Several instances contained multiple NCCTs which were all collected. In each of NCCTs, individual urinary stone was treated as individual sample. From manually drawn volumes of interest, we extracted original and wavelet radiomics features for each sample. The most important features were then selected via the Least Absolute Shrinkage and Selection Operator for building the final model on a Support Vector Machine. Performance on the testing set was evaluated via accuracy, sensitivity, specificity, and area under the precision-recall curve (AUPRC).

RESULTS

There were 302 instances, of which 118 had pUA urinary stones, generating 576 samples in total. From 851 original and wavelet radiomics features extracted for each sample, 10 most important features were ultimately selected. On the testing data set, accuracy, sensitivity, specificity, and AUPRC were 93.9%, 97.9%, 92.2%, and 0.958, respectively, for per-sample prediction, and 90.8%, 100%, 87.5%, and 0.902, respectively, for per-instance prediction.

CONCLUSION

The machine learning algorithm trained with radiomics features from NCCTs can accurately predict pUA urinary stones. Our work suggests a potential assisting tool for stone disease treatment selection.

Composition analysis of renal and ureteral calculi in a single center in northern China in the past decade

The current report aimed to evaluate the characteristics of stone composition in 3637 renal and ureteral calculi patients in a single center while clarifying its relationship with sex, age, and time. Out of 3637 cases of upper urinary tract stones, stone specimens were analyzed retrospectively. There were 2373 male patients aged 6 months-87 years, with an average age of 44.73 ± 15.63 years, and 1264 female patients aged 4 months-87 years, with an average age of 46.84 ± 16.00 years. The male-female ratio was 1.88:1. Five hundred twelve patients had ureteral calculi, and 3125 had renal calculi. The SPSS software helped analyze the relationship between renal and ureteral calculi composition and sex, age, and time. Stone composition demonstrated 2205 cases of calcium oxalate stones (60.6%), 518 carbonate apatite (14.2%), 386 uric acids (10.6%), 232 magnesium ammonium phosphate (6.4%), 117 calcium phosphate (3.2%), 76 cystine (2.1%), 47 sodium urate (1.3%), 31 others (0.9%), and 25 ammonium urate (0.7%) cases. The overall male-to-female sex ratio was 1.88:1. Stones in the upper urinary tract were significantly more frequent in men than in women between the ages of 31 and 60. However, such stones were significantly more frequent in women than men over 80 (P < .05). Cystine, Sodium urate, Carbonated apatite, and uric acid indicated significant differences between different age categories (all P < .001). Stone composition analyses revealed that the frequency of calcium oxalate calculi has increased annually, while cystine and carbonated apatite incidences have dropped annually over the past decade. The components of renal and ureteral calculi vary significantly based on age and sex, with calcium oxalate calculi being more frequent in men while magnesium ammonium phosphate stones are more frequent in female patients. The age between 31 and 60 years is the most prevalent for renal and ureteral calculi in men and women.

Molecular mechanism of Rhizoma Polygonati in the treatment of nephrolithiasis: network pharmacology analysis and in vivo experimental verification

Rhizoma Polygonati (RP) is the dried rhizome of the liliaceous plant. It has anti-inflammatory and anti-apoptosis effects. But its role in kidney stones has not been studied. The purpose of this study was to verify the effect of RP in the treatment of nephrolithiasis through network pharmacological analysis and in vivo experiments. The active compounds and protein targets of RP, as well as the potential targets of the nephrolithiasis were searched from the database. The protein-protein interaction (PPI) network diagram and the drug-compounds-targets-disease network were constructed. The enrichment analysis was performed by Gene Ontology (GO) enrichment and Kyoto Encyclopedia of Genes and Genomes (KEGG). Subsequently, the effect of RP on the prevention and treatment of nephrolithiasis was experimentally validated in vivo. Animal experiments showed that RP ameliorates renal function and reduced crystal deposition in a mouse model. It may act through anti-inflammation and anti-apoptosis. Our study showed that RP could prevent and treat nephrolithiasis by inhibiting apoptosis and inflammation, which provided a new efficacy and clinical application for RP.

Dysregulated palmitic acid metabolism promotes the formation of renal calcium-oxalate stones through ferroptosis induced by polyunsaturated fatty acids/phosphatidic acid

The pathogenesis of renal calcium-oxalate (CaOx) stones is complex and influenced by various metabolic factors. In parallel, palmitic acid (PA) has been identified as an upregulated lipid metabolite in the urine and serum of patients with renal CaOx stones via untargeted metabolomics. Thus, this study aimed to mechanistically assess whether PA is involved in stone formation. Lipidomics analysis of PA-treated renal tubular epithelial cells compared with the control samples revealed that α-linoleic acid and α-linolenic acid were desaturated and elongated, resulting in the formation of downstream polyunsaturated fatty acids (PUFAs). In correlation, the levels of fatty acid desaturase 1 and 2 (FADS1 and FADS2) and peroxisome proliferator-activated receptor α (PPARα) in these cells treated with PA were increased relative to the control levels, suggesting that PA-induced upregulation of PPARα, which in turn upregulated these two enzymes, forming the observed PUFAs. Lipid peroxidation occurred in these downstream PUFAs under oxidative stress and Fenton Reaction. Furthermore, transcriptomics analysis revealed significant changes in the expression levels of ferroptosis-related genes in PA-treated renal tubular epithelial cells, induced by PUFA peroxides. In addition, phosphatidyl ethanolamine binding protein 1 (PEBP1) formed a complex with 15-lipoxygenase (15-LO) to exacerbate PUFA peroxidation under protein kinase C ζ (PKC ζ) phosphorylation, and PKC ζ was activated by phosphatidic acid derived from PA. In conclusion, this study found that the formation of renal CaOx stones is promoted by ferroptosis of renal tubular epithelial cells resulting from PA-induced dysregulation of PUFA and phosphatidic acid metabolism, and PA can promote the renal adhesion and deposition of CaOx crystals by injuring renal tubular epithelial cells, consequently upregulating adhesion molecules. Accordingly, this study provides a new theoretical basis for understanding the correlation between fatty acid metabolism and the formation of renal CaOx stones, offering potential targets for clinical applications.

Non-Coding RNAs in Kidney Stones

Nephrolithiasis is a major public health concern associated with high morbidity and recurrence. Despite decades of research, the pathogenesis of nephrolithiasis remains incompletely understood, and effective prevention is lacking. An increasing body of evidence suggests that non-coding RNAs, especially microRNAs (miRNAs) and long non-coding RNAs (lncRNAs), play a role in stone formation and stone-related kidney injury. MiRNAs have been studied quite extensively in nephrolithiasis, and a plethora of specific miRNAs have been implicated in the pathogenesis of nephrolithiasis, involving remarkable changes in calcium metabolism, oxalate metabolism, oxidative stress, cell-crystal adhesion, cellular autophagy, apoptosis, and macrophage (Mp) polarization and metabolism. Emerging evidence suggests a potential for miRNAs as novel diagnostic biomarkers of nephrolithiasis. LncRNAs act as competing endogenous RNAs (ceRNAs) to bind miRNAs, thereby modulating mRNA expression to participate in the regulation of physiological mechanisms in kidney stones. Small interfering RNAs (siRNAs) may provide a novel approach to kidney stone prevention and treatment by treating related metabolic conditions that cause kidney stones. Further investigation into these non-coding RNAs will generate novel insights into the mechanisms of renal stone formation and stone-related renal injury and might lead to new strategies for diagnosing and treating this disease.

Ultrasound accuracy in evaluating renal calculi in Maysan province

Renal calculi are a common clinical presentation. While ultrasound (US) is a widely used imaging modality for kidney stone diagnosis due to its accessibility and lower cost, its accuracy compared to computerized tomography (CT), the gold standard, remains understudied. This cross-sectional study evaluated the diagnostic accuracy of ultrasound for detecting and characterizing kidney stones compared to computed tomography (CT). Fifty-six patients with suspected kidney stones based on flank pain underwent abdominal ultrasound to assess stone presence, size, location, and the severity of any hydronephrosis (kidney swelling). These findings were then confirmed with a subsequent non-contrast CT scan. There was a fair agreement between US and CT (Kappa = 0.368) for detecting the stone location. The US could not detect 7 (12.5%) stones, being less sensitive in the middle and upper calyx compared to CT. There was a fair agreement between the US and CT (Kappa = 0.394) for detecting the severity of hydronephrosis. The US was less sensitive to moderate and severe hydronephrosis compared to CT. The abdominal ultrasound demonstrated excellent reliability for stone size measurement (intraclass correlation = 0.924), with CT measurements only slightly larger on average (mean difference 0.9 mm). Although abdominal ultrasound provides reliable stone size assessment, its capacity to accurately localize stones and assess hydronephrosis severity is limited.

The first epidemiology of urolithiasis in Northern Vietnam: Urinary stone composition, age, gender, season, and clinical features study

OBJECTIVES

The aim of this study is to analyze the compositions of urinary stones and investigate their distributions in different ages, genders, seasons, and clinical features of Northern Vietnamese patients.

METHODS

A total of 231 patients with urinary stones from Northern Vietnam were collected and analyzed composition from 1/2021-12/2022. For all patients, age, sex, stone location, stone side, urine pH, and hospitalized date (month) were collected.

RESULTS

Kidney stones are more frequently found in men than women with the male: female urinary stones ratio in this study being 1.96:1. The highest stone prevalence appeared between 60 and 69 years old. The most common stone composition was calcium oxalate, followed by calcium phosphate, uric acid, struvite, and cysteine. Mix stones of CaOx and CaP were more prevalent than pure stones. Males submitted more CaOx, CaP, and UA stones, whereas females were susceptible to infectious stones. Stones were more frequently found on the left side of the upper urinary tract (51.9%) than on the right side (27.3%) and lower urinary tract (7.8%). Cultural tendency leads to a smaller number of stones during the Lunar new year (February), and Ghost month (August).

Computed tomographic characterization of urinary stones in patients with urolithiasis from Southeast Mexico

Urolithiasis (UL) is a severe public health concern in southeastern Mexico. Computed tomography (CT) is the first-line diagnostic method for patients with suspected UL. The present study aimed to characterize stones in the entire urinary system using CT and to contribute to personalized treatment in patients with UL. Patients >18 years of age with suspected UL were enrolled. Characteristics of UL included stone size, location (kidney, ureters, and bladder), composition of the stone in Hounsfield units (HU), presence of staghorn stone(s), and obstructive uropathy. Patients were stratified according to sex and age to determine whether stone size and HU were dependent on hormonal factors in females and on prostatic hyperplasia in males. The Mann-Whitney U test was used to compare median values. Frequencies are expressed as percentages and were analyzed using the Mantel-Haenszel chi-squared test. A total of 1150 patients were included in this study, of whom 744 (64.7 %) had UL in only 1 anatomical location in the urinary system, and 406 (35.3 %) had stones in ≥2 anatomical locations. Localization and stone size differed between males and females (p < 0.05). Additionally, males exhibited differences in HU (p = 0.024) and frequency of obstructive uropathy (p = 0.10) when stratified according to age (≤50 and > 50 years). In addition, females exhibited statistical differences in HU (p = 0.010) and kidney stone size (p = 0.047) dependent on age (≤47 and > 47 years). In conclusion, findings suggest that HU and stone size differ in different anatomical structures of the urinary system. In addition, differences in stone size and composition may be associated with age and sex.

Antibacterial properties and urease suppression ability of Lactobacillus inhibit the development of infectious urinary stones caused by Proteus mirabilis

Infectious urolithiasis is a type of urolithiasis, that is caused by infections of the urinary tract by bacteria producing urease such as Proteus mirabilis. Lactobacillus spp. have an antagonistic effect against many pathogens by secreting molecules, including organic acids. The aim of the study was to determine the impact of Lactobacillus strains isolated from human urine on crystallization of urine components caused by P. mirabilis by measuring bacterial viability (CFU/mL), pH, ammonia release, concentration of crystallized salts and by observing crystals by phase contrast microscopy. Moreover, the effect of lactic acid on the activity of urease was examined by the kinetic method and in silico study. In the presence of selected Lactobacillus strains, the crystallization process was inhibited. The results indicate that one of the mechanisms of this action was the antibacterial effect of Lactobacillus, especially in the presence of L. gasseri, where ten times less P. mirabilis bacteria was observed, compared to the control. It was also demonstrated that lactic acid inhibited urease activity by a competitive mechanism and had a higher binding affinity to the enzyme than urea. These results demonstrate that Lactobacillus and lactic acid have a great impact on the urinary stones development, which in the future may help to support the treatment of this health problem.

Evaluating the performance of ChatGPT in answering questions related to urolithiasis

PURPOSE

ChatGPT is an artificial intelligence (AI) program with natural language processing. We analyzed ChatGPT's knowledge about urolithiasis whether it can be used to inform patients about urolithiasis.

METHODS

Frequently asked questions (FAQs) about urolithiasis on the websites of urological associations and hospitals were analyzed. Also, strong recommendation-level information was gathered from the urolithiasis section of the European Association of Urology (EAU) 2022 Guidelines. All questions were asked in order in ChatGPT August 3rd version. All answers were evaluated separately by two specialist urologists and scored between 1 and 4, where 1: completely correct, 2: correct but inadequate, 3: a mix of correct and misleading information, and 4: completely incorrect.

RESULTS

Of the FAQs, 94.6% were answered completely correctly. No question was answered completely incorrectly. All questions about general, diagnosis, and ureteral stones were graded as 1. Of the 60 questions prepared according to the EAU guideline recommendations, 50 (83.3%) were evaluated as grade 1, and 8 (13.3%) and 2 (3.3%) as grade 3. All questions related to general, diagnostic, renal calculi, ureteral calculi, and metabolic evaluation received the same answer the second time they were asked.

CONCLUSION

Our findings demonstrated that ChatGPT accurately and satisfactorily answered more than 95% of the questions about urolithiasis. We conclude that applying ChatGPT in urology clinics under the supervision of urologists can help patients and their families to have better understanding on urolithiasis diagnosis and treatment.

predictive model of nosocomial infection in patients with upper urinary tract stones after flexible ureterorenoscopy with laser lithotripsy: A retrospective study

Objectives

To construct a predictive model of nosocomial infection in patients with upper urinary tract (UUT) stones after flexible ureterorenoscopy with laser lithotripsy (FURSLL).

Methods

Medical records of 196 patients with UUT stones who underwent FURSLL in Suzhou Hospital of Integrated Traditional Chinese and Western Medicine from December 2019 to December 2022 were retrospectively analyzed. Patients were divided into infected group or uninfected group based on the presence of infection during postoperative hospitalization. Univariate and multivariate logistic regressions were used to identify risk factors of postoperative nosocomial infections. A nomogram prediction model was constructed using R software. The predictive ability of the model was assessed using the receiver operating characteristic (ROC) curve.

Results

A total of 54 patients (27.6%) developed nosocomial infections after FURSLL. Logistic regression analysis showed that older age, diabetes, preoperative urinary system infection, ureteral stricture, hydronephrosis, double J-stent retention time, and stone diameter were risk factors of nosocomial infection. The nomogram model was constructed based on these risk factors. The ROC showed that the area under the curve (AUC) of the model was 0.930 (95% CI: 0.890-0.970), and the sensitivity and specificity were 92.6% and 81.7%, respectively, indicating that the prediction model was effective.

Conclusions

Risk of nosocomial infection in patients with UUT stones after FURSLL is affected by older age, diabetes, preoperative urinary system infection, ureteral stenosis, hydronephrosis, double J-stent retention time, and stone diameter. The nomogram prediction model, constructed based on the above factors, has good predictive value.

Prevalence of urolithiasis in China: a systematic review and meta-analysis

OBJECTIVE

To estimate the pooled prevalence, as well as the spatial and temporal distribution, of urolithiasis among subjects in China.

MATERIALS AND METHODS

We conducted a comprehensive search of both Chinese and English databases to retrieve literature pertaining to the prevalence of urolithiasis in the indigenous Chinese population. A random-effects meta-analysis model was employed to calculate the pooled prevalence of urolithiasis. Subgroup analyses were conducted based on factors such as time, region, gender, and sample size. Prevalence and spatial distribution maps were created based on provinces and latitude/longitude coordinates.

RESULTS

A total of 46 studies conducted in 22 provinces across China were included in this meta-analysis and the pooled prevalence of urolithiasis, kidney stones, ureteric calculi, urethral and bladder stones were 8.1% (95% confidence interval [CI] 5.6-11.1%), 7.8% (95% CI 5.8-10.0%), 3.2% (95% CI 0.6-5.7%), 0.5% (95% CI 0.1-0.9%). Most of the urolithiasis prevalence screening in China was concentrated between 100° E and 120° E, with higher rates observed in low latitude areas. Subgroup analysis of kidney stones revealed that Guangdong (12.7%) and Guangxi (10.3%) had the highest prevalence, with the eastern developed area exhibiting higher rates compared to the west. The prevalence in males was higher than in females (odds ratio 1.67, 95% CI 1.46-1.92), although the gender gap has significantly reduced since 2006. Moreover, a greater sample size is associated with a decreased prevalence of urolithiasis.

CONCLUSIONS

The prevalence of urolithiasis is increasing in China, and there are noteworthy regional or provincial disparities in occurrence. It is worth noting that the current number of screening studies in some areas is insufficient. Additional investigations with appropriate sample sizes should be supplemented in time.

Deciphering Multi-target Pharmacological Mechanism of Cucurbita pepo Seeds against Kidney Stones: Network Pharmacology and Molecular Docking Approach

BACKGROUND

Urolithiasis is a prevalent condition with significant morbidity and economic implications. The economic burden associated with urolithiasis primarily stems from medical expenses. Previous literature suggests that herbal plants, including Cucurbita pepo, have lithotriptic capabilities. C. pepo is an annual, herbaceous, widely grown, and monoecious vegetative plant known for its antioxidants, fibers, and fatty acids. Recent studies on C. pepo seeds have shown therapeutic potential in reducing bladder stones and urodynamic illnesses, like kidney stones. However, the precise molecular and pharmacological mechanisms are unclear.

OBJECTIVE

In this research, we employed network pharmacology and molecular docking to examine the active compounds and biological mechanisms of Cucurbita pepo against kidney stones.

METHODS

Active constituents were obtained from previous studies and the IMPPAT database, with their targets predicted using Swiss target prediction. Kidney stone-associated genes were collected from DisGeNET and GeneCards. The active constituent-target-pathway network was constructed using Cytoscape, and the target protein-protein interaction network was generated using the STRING database. Gene enrichment analysis of C. pepo core targets was conducted using DAVID. Molecular docking was performed to identify potential kidney stone-fighting agents.

RESULTS

The findings revealed that Cucurbita pepo contains 18 active components and has 192 potential gene targets, including AR, EGFR, ESR1, AKT1, MAPK3, SRC, and MTOR. Network analysis demonstrated that C. pepo seeds may prevent kidney stones by influencing disease-related signaling pathways. Molecular docking indicated that key kidney stone targets (mTOR, EGFR, AR, and ESR1) effectively bind with active constituents of C. pepo.

CONCLUSION

These findings provide insight into the anti-kidney stone effects of Cucurbita pepo at a molecular level. In conclusion, this study contributes to understanding the potential of Cucurbita pepo in combating kidney stones and lays the foundation for further research.

Genes polymorphism as risk factor of recurrent urolithiasis: a systematic review and meta-analysis

INTRODUCTION

Urolithiasis is one of the most prevalent diseases worldwide. Its prevalence is rising, both in developing and developed countries. It is known that genetic factors play big roles in the development of urolithiasis. One of the suspected factors is gene polymorphism. This study aims to find an accurate estimate of the association between genetic polymorphism and the risk of recurrent urolithiasis.

METHODS

A systematic review and meta-analysis were performed on 12 studies from 3 databases that investigated gene polymorphism as an risk factor of urolithiasis. The review was done using Review Manager® version 5.3.

RESULTS

Insignificant heterogenicity was found in this study. Populations from Asia and the Middle East are more likely to experience recurrent urolithiasis. Additionally, variation in the VDR and urokinase genes, particularly in the Asian population, increases the risk of developing recurrent urolithiasis.

CONCLUSIONS

Gene polymorphisms have significant roles in the development of urolithiasis, especially in the Middle Eastern region.

Vascular calcification on the risk of kidney stone: a meta-analysis

BACKGROUND

The association between vascular calcification (VC) and kidney stone is still inconclusive. Therefore, we conducted a meta-analysis to estimate the risk of kidney stone disease in subjects with VC.

METHODS

To identify publications from related clinical studies, we performed a search on PubMed, Web of Science, Embase, and Cochrane Library databases from their inceptions until 1 September 2022. According to obvious heterogeneity, a random-effects model was used to calculate the odds ratios (ORs) and corresponding 95% confidence intervals (CIs). Subgroup analysis was conducted trying to dissect the effects of VC in different segments and population regions in predicting kidney stone risk.

RESULTS

Seven articles were included with a total number of 69,135 patients, of which 10,052 have vascular calcifications and 4728 have kidney stones. There was a significantly higher risk of kidney stone disease in participants with VC versus control (OR = 1.54, 95% CI: 1.13-2.10). Sensitivity analysis confirmed the stability of the results. VC can be separated into abdominal, coronary, carotid, and splenic aortic calcification while pooled analysis of abdominal aorta calcification did not indicate a significant higher kidney stone risk. An obvious higher risk of kidney stone was observed in Asian VC patients (OR = 1.68, 95% CI: 1.07-2.61).

CONCLUSION

Combined evidence of observational studies suggested patients with VC may be associated with an increased risk of kidney stone disease. Despite the predictive value was relatively low, it is still worth noting that patients with VC are under the threat of kidney stone disease.

Influence of stone load on the outcome of same-session flexible ureteroscopy for bilateral upper urinary tract stones: a multicenter retrospective study

Purpose

This study aimed to evaluate the efficacy and safety of same-session flexible ureteroscopy (fURS) for the treatment of bilateral upper urinary tract stones and to examine the influence of stone load on the outcome of same-session fURS, stratifying by total diameter of stones (TDS) ≤30 mm vs. >30 mm.

Patients and methods

We retrospectively reviewed all cases of same-session fURS performed for bilateral upper urinary tract stones at four institutions between January 2017 and September 2020. All patients were divided into two groups based on TDS, ≤30 mm and >30 mm. Data on patient demographics, stone characteristics, surgical results, and complications were collected and analyzed for differences between the two groups. Stone-free rate (SFR) was defined as patients endoscopically stone-free or with radiological fragments <2 mm of each renal unit.

Results

A total of 121 patients with bilateral upper urinary tract stones underwent same-session fURS, consisting of 73 patients in the TDS ≤ 30 mm group and 48 patients in the TDS > 30 mm group. The mean bilateral stone size was 28.2 ± 12.2 mm (range: 9.1-38.4 mm), with a mean operating time of 97.1 ± 39.6 min (range: 19-220 min). The SFR was 54.5% after the first fURS, and SFR increased to 97.5% after re-fURS for residual stones. The operation time for the TDS > 30 mm group was longer than that of the TDS ≤ 30 mm group (85.1 ± 36.5 vs. 115.4 ± 37.4 min, p < 0.001). The SFR after the first fURS was significantly lower in the TDS > 30 mm group than in the TDS ≤ 30 mm group (25.0% vs. 73.9%, p < 0.001). Although there was no statistically significant difference in overall SFR between the two groups (93.7% vs. 100%, p = 0.060), the rate of re-fURS for residual stones was higher in the TDS > 30 mm group than in the TDS ≤ 30 mm group (75% vs. 26%, p < 0.001). There were no significant differences in length of hospital stay (LOS) (2.2 ± 0.7 vs. 2.3 ± 1.0, p = 0.329) or complication rate (10.9% vs. 14.6%, p = 0.582) between the two groups.

Conclusion

The results suggested that same-session fURS can be effectively performed with a low complication rate. A higher SFR after the first fURS can be achieved in the case of bilateral upper urinary tract stones with TDS ≤ 30 mm, and priority should be given to same-session fURS.