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Lemoine S, Dahan P, Haymann JP, Meria P, Almeras C. 2022 Recommendations of the AFU Lithiasis Committee: Medical management - from diagnosis to treatment. Prog Urol 2023; 33:911-953. [PMID: 37918992 DOI: 10.1016/j.purol.2023.08.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 07/27/2023] [Accepted: 08/01/2023] [Indexed: 11/04/2023]
Abstract
The morphological-compositional analysis of urinary stones allows distinguishing schematically several situations: dietary, digestive, metabolic/hormonal, infectious and genetic problems. Blood and urine testing are recommended in the first instance to identify risk factors of urinary stone disease in order to avoid recurrence or progression. The other objective is to detect a potential underlying pathology associated with high risk of urinary stone disease (e.g. primary hyperparathyroidism, primary or enteric hyperoxaluria, cystinuria, distal renal tubular acidosis) that may require specific management. Lifestyle-diet measures are the basis of the management of all stone types, but pharmacological treatments may be required. METHODOLOGY: These recommendations were developed using two methods: the Clinical Practice Recommendation (CPR) method and the ADAPTE method, depending on whether the question was considered in the European Association of Urology (EAU) recommendations (https://uroweb.org/guidelines/urolithiasis) [EAU 2022] and their adaptability to the French context.
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Affiliation(s)
- S Lemoine
- Hospices Civils de Lyon, SFNDT, SP, Lyon, France
| | - P Dahan
- Nephrology Department, Clinique Saint-Exupéry, SFNDT, Toulouse, France
| | - J P Haymann
- Inserm, UMRS 1155 UPMC, Tenon Hospital, SP, Paris, France; Service d'Explorations Fonctionnelles Multidisciplinaires, Tenon Hospital, Paris, France
| | - P Meria
- Service d'Urologie, Hôpital Saint Louis, AP-HP-Centre Université Paris Cité, Paris, France
| | - C Almeras
- UroSud, clinique La Croix du Sud, Quint-Fonsegrives, France.
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2
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Taguchi K. Editorial Comment to Prospective randomized trial of 2 vs 12-weeks of postoperative antibiotics after percutaneous nephrolithotomy in complex patients with infection-related kidney stones. Int J Urol 2022; 29:1558-1559. [PMID: 36305755 DOI: 10.1111/iju.15084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Kazumi Taguchi
- Department of Nephro-urology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
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3
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Chew BH, Reicherz A, Krambeck AE, Miller NL, Hsi RS, Scotland KB, Miller D, Paterson RF, Wong VKF, Semins MJ, Lange D. Prospective randomized trial of 2 versus 12-weeks of postoperative antibiotics after percutaneous nephrolithotomy in complex patients with infection-related kidney stones. Int J Urol 2022; 29:1551-1558. [PMID: 36102630 DOI: 10.1111/iju.15045] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Accepted: 08/24/2022] [Indexed: 11/30/2022]
Abstract
PURPOSE Treatment of struvite kidney stones requires complete surgical stone removal combined with antibiotic therapy to eliminate urinary tract infections and preventive measures to reduce stone recurrence. The optimal duration of antibiotic therapy is unknown. We sought to determine if 2- or 12-weeks of antibiotics post percutaneous nephrolithotomy (PNL) for infection stones resulted in better outcomes for stone recurrence and positive urine cultures. MATERIAL AND METHODS This multi-center, prospective randomized trial evaluated patients with the clinical diagnosis of infection stones. Patients were randomized to 2- or 12-weeks of postoperative oral antibiotics (nitrofurantoin or culture-specific antibiotic) and included if residual fragments were ≤4 mm on computed tomography imaging after PNL. Imaging and urine analyses were performed at 3-, 6-, and 12-months post-procedure. RESULTS Thirty-eight patients were enrolled and randomized to either 2-weeks (n = 20) or 12-weeks (n = 18) of antibiotic therapy post-PNL. Eleven patients were excluded due to residual fragments >4 mm, and 3 patients were lost to follow-up. The primary outcome was the stone-free rate (SFR) at 6 months post-PNL. At 3-, 6-, and 12-months follow-up, SFRs were 72.7% versus 80.0%, 70.0% versus 57.1%, 80.0% versus 57.1% (p = ns), between 2- and 12-week-groups, respectively. At 3-, 6-, and 12-months follow-up, positive urine cultures were 50.0% versus 37.5%, 50.0% versus 83.3%, and 37.5% versus 100% between 2- and 12-week groups, respectively (p = ns). CONCLUSIONS For patients with stone removal following PNL, neither 2-weeks nor 12-weeks of postoperative oral antibiotics is superior to prevent stones and recurrent positive urine cultures.
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Affiliation(s)
- Ben H Chew
- The Stone Centre at Vancouver General Hospital, Department of Urologic Sciences, University of British Columbia, Vancouver, British Columbia, Canada
| | - Alina Reicherz
- The Stone Centre at Vancouver General Hospital, Department of Urologic Sciences, University of British Columbia, Vancouver, British Columbia, Canada
| | - Amy E Krambeck
- Department of Urology, Northwestern University, Chicago, Illinois, USA
| | - Nicole L Miller
- Department of Urology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Ryan S Hsi
- Department of Urology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Kymora B Scotland
- Department of Urology, UCLA David Geffen School of Medicine, Los Angeles, California, USA
| | - David Miller
- Department of Urology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Ryan F Paterson
- The Stone Centre at Vancouver General Hospital, Department of Urologic Sciences, University of British Columbia, Vancouver, British Columbia, Canada
| | - Victor K F Wong
- The Stone Centre at Vancouver General Hospital, Department of Urologic Sciences, University of British Columbia, Vancouver, British Columbia, Canada
| | - Michelle J Semins
- Department of Urology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Dirk Lange
- The Stone Centre at Vancouver General Hospital, Department of Urologic Sciences, University of British Columbia, Vancouver, British Columbia, Canada
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4
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[Follow-up after urolithiasis management]. Urologe A 2022; 61:500-507. [PMID: 35381865 PMCID: PMC9072455 DOI: 10.1007/s00120-022-01816-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/08/2022] [Indexed: 11/02/2022]
Abstract
BACKGROUND Urinary stones often affect younger people. Because the risk of recurrence is high, regular follow-up is important for individuals at risk. OBJECTIVE To summarize the extent of urinary stones and the health and economic impact in the population; to provide recommendations for general and stone-specific follow-up. MATERIALS AND METHODS Analysis and discussion of publications and guideline recommendations. RESULTS The risk of recurrence after a stone attack can be high depending on the risk profile. An initial metabolic workup should be performed promptly after stone therapy. General dietary management should be intensified by stone-specific dietary management depending on the risk profile. Nutritional counseling may be helpful. Imaging after stone therapy is used to monitor the success of treatment and detect recurrences early. Since the risk of recurrence can vary greatly depending on the stone composition, not only the type of imaging but also its frequency should be adjusted accordingly. The same applies to the various stone therapies, which help determine the frequency and type of imaging follow-up. Exact guidelines and cost-effectiveness analyses of follow-up examinations after stone therapy are unfortunately missing. CONCLUSIONS Acute urolithiasis represents an excruciating experience for patients. Accordingly, their willingness to undergo metaphylaxis and follow-up shortly after the event is strong. Since the risk of recurrence after a stone attack can be very high, regular follow-up after stone therapy is essential. The frequency of follow-up should be adapted to the probability of stone recurrence.
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Liu M, Cui Z, Zhu ZW, Gao M, Chen JB, Feng Z, He C, Chen H. Development of a nomogram predicting the infection stones in kidney for better clinical management: A retrospective study. J Endourol 2022; 36:947-953. [PMID: 35166130 DOI: 10.1089/end.2021.0735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
PURPOSE To establish the first comprehensive nomogram for prediction of infection stones before treatment for better perioperative treatment and post-operative prevention of infection stones. METHODS A total number of 461 patients with kidney stones who underwent mini-percutaneous nephrolithotomy (mPCNL) and flexible ureteroscopy (FURS) between January 2019 to March 2021 were retrospectively analyzed. Univariable analysis and multivariable logistic regression analysis were conducted to identify the predictors for infection stones. Furthermore, the nomogram was established as a predicted model for infection stones. RESULTS Among 461 patients with infrared spectroscopy stone analysis, 100 (21.70%) had infection stones and 361 (78.31%) had noninfection stones. Multivariate logistic regression analysis indicated that female (OR 2.816, 95% CI 1.148-6.909, P = 0.024), recurrent kidney stones (OR 8.263, 95% CI 2.295-29.745, P = 0.001), stone burden (OR 6.872, 95% CI 2.973-15.885, P < 0.001), Hounsfield units (HU) (OR 15.208, 95% CI 6.635-34.860, P < 0.001), positive preoperative bladder urine culture (PBUC) (OR 4.899, 95% CI 1.911-12.560, P = 0.001), positive urine leukocyte esterase (ULE) (OR 3.144, 95% CI 1.114-8.870, P = 0.030), urine pH (OR 2.692, 95% CI 1.573-4.608, P < 0.001) and positive urine turbidity (OR 3.295, 95% CI 1.207-8.998, P = 0.020) were predictors for infection stone. CONCLUSIONS For patients with kidney stones, female, recurrent kidney stones, stone burden (>601 mm2), HU (750-1000), positive PBUC, positive ULE, urine pH and positive urine turbidity were predictors for infection stone. We established the first comprehensive model for identifying infection stones in vivo, which is extremely useful for the management of infection stones.
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Affiliation(s)
- Minghui Liu
- Central South University, 12570, changsha,hunan,China, Changsha, China, 410083;
| | - Zhongxiao Cui
- Xiangya Hospital Central South University, 159374, Changsha, Hunan, China;
| | | | - Meng Gao
- Xiangya Hospital Central South University, 159374, hunan changsha, Changsha, China, 410008;
| | - Jin-Bo Chen
- Xiangya Hospital, Central South University, Department of Urology, No. 78, XiangYa Road, ChangSha City, Hunan 410008, China, Changsha, China, 410008;
| | - Zeng Feng
- Department of Urology, Xiangya Hospital, Central South University, Changsha, Hunan 410008, China.changsha, China, 410000;
| | - Cheng He
- Department of Urology, Xiangya Hospital, Central South University, Changsha, Hunan 410008, China. , Changsha, China;
| | - Hequn Chen
- Xiangya Hospital Central South University, 159374, Department of Urology, The Xiangya Hospital, Central South University, Changsha, Hunan 410000, China., Changsha, China, 410008;
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Whelan P, Preminger GM. Case of the Month from Duke University Medical Centre: a complete renal staghorn stone. BJU Int 2021; 128:25-28. [PMID: 34160133 DOI: 10.1111/bju.15360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Patrick Whelan
- Division of Urological Surgery, Duke University Medical Centre, Durham, NC, USA
| | - Glenn M Preminger
- Division of Urological Surgery, Duke University Medical Centre, Durham, NC, USA
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Zheng J, Yu H, Batur J, Shi Z, Tuerxun A, Abulajiang A, Lu S, Kong J, Huang L, Wu S, Wu Z, Qiu Y, Lin T, Zou X. A multicenter study to develop a non-invasive radiomic model to identify urinary infection stone in vivo using machine-learning. Kidney Int 2021; 100:870-880. [PMID: 34129883 DOI: 10.1016/j.kint.2021.05.031] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Revised: 04/15/2021] [Accepted: 05/14/2021] [Indexed: 02/06/2023]
Abstract
Urolithiasis is a common urological disease, and treatment strategy options vary between different stone types. However, accurate detection of stone composition can only be performed in vitro. The management of infection stones is particularly challenging with yet no effective approach to pre-operatively identify infection stones from non-infection stones. Therefore, we aimed to develop a radiomic model for preoperatively identifying infection stones with multicenter validation. In total, 1198 eligible patients with urolithiasis from three centers were divided into a training set, an internal validation set, and two external validation sets. Stone composition was determined by Fourier transform infrared spectroscopy. A total of 1316 radiomic features were extracted from the pre-treatment Computer Tomography images of each patient. Using the least absolute shrinkage and selection operator algorithm, we identified a radiomic signature that achieved favorable discrimination in the training set, which was confirmed in the validation sets. Moreover, we then developed a radiomic model incorporating the radiomic signature, urease-producing bacteria in urine, and urine pH based on multivariate logistic regression analysis. The nomogram showed favorable calibration and discrimination in the training and three validation sets (area under the curve [95% confidence interval], 0.898 [0.840-0.956], 0.832 [0.742-0.923], 0.825 [0.783-0.866], and 0.812 [0.710-0.914], respectively). Decision curve analysis demonstrated the clinical utility of the radiomic model. Thus, our proposed radiomic model can serve as a non-invasive tool to identify urinary infection stones in vivo, which may optimize disease management in urolithiasis and improve patient prognosis.
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Affiliation(s)
- Junjiong Zheng
- Department of Urology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, People's Republic of China; Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, People's Republic of China
| | - Hao Yu
- Department of Urology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, People's Republic of China; Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, People's Republic of China
| | - Jesur Batur
- Department of Urology, the First People's Hospital of Kashi Prefecture, Affiliated Kashi Hospital of Sun Yat-Sen University, Kashi, People's Republic of China
| | - Zhenfeng Shi
- Department of Urology, the People's Hospital of Xinjiang Uyghur Autonomous Region, Xinjiang, People's Republic of China
| | - Aierken Tuerxun
- Department of Urology, the First People's Hospital of Kashi Prefecture, Affiliated Kashi Hospital of Sun Yat-Sen University, Kashi, People's Republic of China
| | - Abudukeyoumu Abulajiang
- Department of Information Technology, the First People's Hospital of Kashi Prefecture, Affiliated Kashi Hospital of Sun Yat-Sen University, Kashi, People's Republic of China
| | - Sihong Lu
- Department of Urology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, People's Republic of China; Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, People's Republic of China
| | - Jianqiu Kong
- Department of Urology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, People's Republic of China; Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, People's Republic of China
| | - Lifang Huang
- Department of Urology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, People's Republic of China; Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, People's Republic of China
| | - Shaoxu Wu
- Department of Urology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, People's Republic of China; Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, People's Republic of China
| | - Zhuo Wu
- Department of Radiology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, People's Republic of China
| | - Ya Qiu
- Department of Radiology, the First People's Hospital of Kashi Prefecture, Affiliated Kashi Hospital of Sun Yat-Sen University, Kashi, People's Republic of China
| | - Tianxin Lin
- Department of Urology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, People's Republic of China; Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, People's Republic of China; State Key Laboratory of Oncology in South China, Guangdong Provincial Clinical Research Center for Urological Diseases, Guangdong, People's Republic of China.
| | - Xiaoguang Zou
- Department of Pharmacy, the First People's Hospital of Kashi Prefecture, Affiliated Kashi Hospital of Sun Yat-Sen University, Kashi, People's Republic of China.
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Torricelli FCM, Monga M. Staghorn renal stones: what the urologist needs to know. Int Braz J Urol 2021; 46:927-933. [PMID: 32213203 PMCID: PMC7527092 DOI: 10.1590/s1677-5538.ibju.2020.99.07] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Accepted: 03/25/2020] [Indexed: 11/22/2022] Open
Abstract
Patients with staghorn renal stones are challenging cases, requiring careful preoperative evaluation and close follow-up to avoid stone recurrence. In this article we aim to discuss the main topics related to staghorn renal stones with focus on surgical approach. Most of staghorn renal stones are composed of struvite (magnesium ammonium phosphate) and are linked to urinary tract infection by urease-producing pathogens. Preoperative computed tomography scan and careful evaluation of all urine cultures made prior surgery are essential for a well-planning surgical approach and a right antibiotics choice. Gold standard surgical technique is the percutaneous nephrolithotomy (PCNL). In cases of impossible percutaneous renal access, anatrophic nephrolithotomy is an alternative. Shockwave lithotripsy and flexible ureteroscopy are useful tools to treat residual fragments that can be left after treatment of complete staghorn renal stone. PCNL can be performed in supine or prone position according to surgeon’s experience. Tranexamic acid can be used to avoid bleeding. To check postoperative stone-free status, computed tomography is the most accurate imaging exam, but ultrasound combined to KUB is an option. Intra-operative high-resolution fluoroscopy and flexible nephroscopy have been described as an alternative for looking at residual fragments and save radiation exposure. The main goals of treatment are stone-free status, infection eradication, and recurrence prevention. Long-term or short-term antibiotic therapy is recommended and regular control imaging exams and urine culture should be done.
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Affiliation(s)
- Fabio C M Torricelli
- Divisão de Urologia, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo, SP, Brasil
| | - Manoj Monga
- Stevan B, Streem Center for Endourology & Stone Disease, Glickman Urological & Kidney Institute, The Cleveland Clinic, Cleveland, OH, USA
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Schneider D, Abedi G, Larson K, Ayad M, Yoon R, Patel RM, Landman J, Clayman RV. In Vitro Evaluation of Stone Fragment Evacuation by Suction. J Endourol 2020; 35:187-191. [PMID: 32791862 DOI: 10.1089/end.2020.0517] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Introduction: Contemporary, flexible stone baskets are unable to extract submillimeter stone fragments at the time of ureteroscopic laser lithotripsy. In this in vitro study, the feasibility of suctioning submillimeter fragments with a standard Luer Lock syringe through the working channel of a flexible ureteroscope was assessed. Materials and Methods: Phantom stones made from industrial plaster were mechanically fragmented into ≤1 and ≤0.5-mm groups. Both stone groups were divided into five preweighed trial samples. Each stone group was then mixed in a beaker filled with normal saline. A standard 10-mL Luer Lock syringe was connected to a fiber-optic ureteroscope with a 1.2-mm working channel. The syringe was then used to suction stone fragments from the beaker. The suctioned stone fragments and the stone fragments remaining in the beaker after removing the overlying solution were separated, centrifuged with supernatant removed, and dried in an incubator set at 33°C for 1 week. Dried weights were recorded. Results: Mean total weights for ≤0.5 and ≤1.0-mm stone groups at baseline were 0.807 and 0.806 g, respectively. The mean percentages of stone fragments suctioned through the ureteroscope for ≤0.5 and ≤1.0-mm groups were 86% and 86%, respectively (p = 0.973). During suctioning, 64% of stones in the ≤0.5-mm group were trapped in either the working channel of the ureteroscope or within the Luer Lock syringe compared with 78% of stones in the ≤1-mm group (p = 0.001) requiring cessation of the procedure to clear the channel. Conclusions: It is feasible to suction submillimeter stone fragments by connecting a Luer Lock syringe to the working channel of a flexible ureteroscope. The limiting factor for removing stone fragments appears to be the small working channel of flexible ureteroscopes as trapping of fragments during suctioning is common and requires time-consuming removal of the endoscope and clearing of the channel.
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Affiliation(s)
- Douglas Schneider
- Department of Urology, University of California, Irvine, Orange, California, USA
| | - Garen Abedi
- Department of Urology, University of California, Irvine, Orange, California, USA
| | - Krista Larson
- Department of Urology, University of California, Irvine, Orange, California, USA
| | - Maged Ayad
- Department of Urology, University of California, Irvine, Orange, California, USA
| | - Renai Yoon
- Department of Urology, University of California, Irvine, Orange, California, USA
| | - Roshan M Patel
- Department of Urology, University of California, Irvine, Orange, California, USA
| | - Jaime Landman
- Department of Urology, University of California, Irvine, Orange, California, USA
| | - Ralph V Clayman
- Department of Urology, University of California, Irvine, Orange, California, USA
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10
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Terry RS, Preminger GM. Metabolic evaluation and medical management of staghorn calculi. Asian J Urol 2019; 7:122-129. [PMID: 32257805 PMCID: PMC7096691 DOI: 10.1016/j.ajur.2019.12.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Revised: 09/10/2019] [Accepted: 10/01/2019] [Indexed: 11/24/2022] Open
Abstract
Staghorn renal calculi are large renal calculi that occupy nearly the entirety of the renal collecting system. They may be composed of metabolic or infection stone types. They are often associated with specific metabolic defects. Infection stones are associated with urease-producing bacterial urinary tract infections. The ideal treatment for staghorn calculi is maximal surgical removal. However, some patients are either unwilling or unable to proceed with that modality of treatment, and therefore other management must be used. One such technique is the metabolic evaluation with directed medical management. Based on contemporary evidence that the majority of staghorn stones are metabolic in etiology, and furthermore that even infection stones are usually associated with metabolic abnormalities, metabolic evaluation with directed medical management is recommended for all staghorn stone formers. The scientific basis of this recommendation is reviewed in the present work.
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Affiliation(s)
- Russell S Terry
- Duke Comprehensive Kidney Stone Center, Division of Urologic Surgery, Duke University Medical Center, Durham, NC, USA
| | - Glenn M Preminger
- Duke Comprehensive Kidney Stone Center, Division of Urologic Surgery, Duke University Medical Center, Durham, NC, USA
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11
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Abstract
Infection stones are complex aggregates of crystals amalgamated in an organic matrix that are strictly associated with urinary tract infections. The management of patients who form infection stones is challenging owing to the complexity of the calculi and high recurrence rates. The formation of infection stones is a multifactorial process that can be driven by urine chemistry, the urine microenvironment, the presence of modulator substances in urine, associations with bacteria, and the development of biofilms. Despite decades of investigation, the mechanisms of infection stone formation are still poorly understood. A mechanistic understanding of the formation and growth of infection stones - including the role of organics in the stone matrix, microorganisms, and biofilms in stone formation and their effect on stone characteristics - and the medical implications of these insights might be crucial for the development of improved treatments. Tools and approaches used in various disciplines (for example, engineering, chemistry, mineralogy, and microbiology) can be applied to further understand the microorganism-mineral interactions that lead to infection stone formation. Thus, the use of integrated multidisciplinary approaches is imperative to improve the diagnosis, prevention, and treatment of infection stones.
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12
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Sorokin I, Pearle MS. Medical therapy for nephrolithiasis: State of the art. Asian J Urol 2018; 5:243-255. [PMID: 30364650 PMCID: PMC6197179 DOI: 10.1016/j.ajur.2018.08.005] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2018] [Revised: 04/08/2018] [Accepted: 07/11/2018] [Indexed: 12/13/2022] Open
Abstract
The prevalence of nephrolithiasis is increasing worldwide. Understanding and implementing medical therapies for kidney stone prevention are critical to prevent recurrences and decrease the economic burden of this condition. Dietary and pharmacologic therapies require understanding on the part of the patient and the prescribing practitioner in order to promote compliance. Insights into occupational exposures and antibiotic use may help uncover individual risk factors. Follow-up is essential to assess response to treatment and to modify treatment plans to maximize therapeutic benefit.
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Affiliation(s)
- Igor Sorokin
- Department of Urology, University of Massachusetts, Worcester, MA, USA
| | - Margaret S Pearle
- Department of Urology, UT Southwestern Medical Center, Dallas, TX, USA.,Charles and Jane Pak Center for Mineral Metabolism and Bone Research, UT Southwestern Medical Center, Dallas, TX, USA
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Manzoor MAP, Singh B, Agrawal AK, Arun AB, Mujeeburahiman M, Rekha PD. Morphological and micro-tomographic study on evolution of struvite in synthetic urine infected with bacteria and investigation of its pathological biomineralization. PLoS One 2018; 13:e0202306. [PMID: 30106992 PMCID: PMC6091953 DOI: 10.1371/journal.pone.0202306] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2018] [Accepted: 07/31/2018] [Indexed: 11/24/2022] Open
Abstract
Pathological biomineralization in the urinary system leads to urolithiasis. Formation of kidney stones involves a series of events during which they undergo morphological and mineralogical changes. We investigated the mineralization of biogenic struvite (in vitro) and examined the transformation of distinct interior and exterior structure of struvite. In vitro crystallization of struvite was performed in the presence of two bacteria that were originally isolated from the kidney stone patients. Morphological evaluation was carried out using SR-μCT as well as FESEM, XRD and FT-IR. Characteristic internal 3-D morphology and porosity of the stones were studied. For comparison, patient derived struvite stones were used. From the results obtained, we report that the presence of bacteria enhances the crystallization process of struvite in vitro. A series of time-resolved experiments revealed that struvite crystals experienced a significant morphologic evolution from pin pointed structure to X-shaped and tabular morphologies. These X-shaped and unusual tabular habits of struvite resembled biogenic morphologies of struvite. SR-μCT showed similarities between the patient derived and the in vitro derived struvite crystals. In conclusion, these experiments revealed that the bacteria play a major role in the specific morphogenesis of struvite and can able to control the nucleation, modulate crystalline phases, and shape of the growing crystal.
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Affiliation(s)
- Muhammed A. P. Manzoor
- Yenepoya Research Centre, Yenepoya (Deemed to be University), Mangalore, Karnataka, India
- Department of Urology, Yenepoya Medical College, Yenepoya (Deemed to be University), Mangalore, Karnataka, India
| | - Balwant Singh
- Technical Physics Division, Bhabha Atomic Research Centre, Indore-Mumbai, India
| | - Ashish K. Agrawal
- Technical Physics Division, Bhabha Atomic Research Centre, Indore-Mumbai, India
| | | | - M. Mujeeburahiman
- Department of Urology, Yenepoya Medical College, Yenepoya (Deemed to be University), Mangalore, Karnataka, India
- * E-mail: (RPD); (MM)
| | - Punchappady-Devasya Rekha
- Yenepoya Research Centre, Yenepoya (Deemed to be University), Mangalore, Karnataka, India
- * E-mail: (RPD); (MM)
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Chew BH, Miller NL, Abbott JE, Lange D, Humphreys MR, Pais VM, Monga M, Krambeck AE, Sur RL. A Randomized Controlled Trial of Preoperative Prophylactic Antibiotics Prior to Percutaneous Nephrolithotomy in a Low Infectious Risk Population: A Report from the EDGE Consortium. J Urol 2018; 200:801-808. [PMID: 29684391 DOI: 10.1016/j.juro.2018.04.062] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/13/2018] [Indexed: 10/17/2022]
Abstract
PURPOSE Single institution studies suggest a benefit of a week of preoperative antibiotics prior to percutaneous nephrolithotomy. These studies are limited by lower quality methodology, such as the inclusion of heterogeneous populations or nonstandard definitions of sepsis. The AUA (American Urological Association) Best Practice Statement recommends less than 24 hours of intravenous antibiotics but to our knowledge no other data exist on the duration or benefit of preoperative antibiotics. Using CONSORT (Consolidated Reporting of Trials) guidelines we sought to perform a rigorous multi-institutional trial to assess preoperative antibiotics in patients in whom percutaneous nephrolithotomy was planned and who were at low risk for infection. MATERIALS AND METHODS This randomized controlled trial enrolled patients undergoing percutaneous nephrolithotomy who were at low risk, defined as negative preoperative urine cultures and no urinary drain. Of the subjects 43 were randomized to nitrofurantoin 100 mg twice daily for 7 days preoperatively while a control arm of 43 received no oral antibiotics. All subjects received perioperative doses of ampicillin and gentamicin. Prone percutaneous nephrolithotomy was performed by urologists blinded to randomization. The primary outcome was the development of sepsis. RESULTS A total of 86 subjects were enrolled. Preoperative patient characteristics were similar in the treatment and control cohorts with a stone size of 19 and 17 mm, respectively (p = 0.47). Intraoperative characteristics also did not differ. The sepsis rate was not statistically different between the treatment and control groups (12% and 14%, respectively, 95% CI -0.163-0.122, p = 1.0). Other infectious parameters and complications were similar, including intensive care admission, fever, hypotension and leukocytosis. CONCLUSIONS Our study demonstrated no advantage to providing 1 week of preoperative oral antibiotics in patients at low risk for infectious complications who undergo percutaneous nephrolithotomy. Perioperative antibiotics according to the AUA Best Practice Statement appear sufficient.
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Affiliation(s)
- Ben H Chew
- University of British Columbia, Vancouver, British Columbia, Canada
| | | | | | - Dirk Lange
- University of British Columbia, Vancouver, British Columbia, Canada
| | | | - Vernon M Pais
- Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire
| | | | | | - Roger L Sur
- University of California-San Diego, San Diego, California.
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Norsworthy AN, Pearson MM. From Catheter to Kidney Stone: The Uropathogenic Lifestyle of Proteus mirabilis. Trends Microbiol 2016; 25:304-315. [PMID: 28017513 DOI: 10.1016/j.tim.2016.11.015] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2016] [Revised: 11/17/2016] [Accepted: 11/28/2016] [Indexed: 12/15/2022]
Abstract
Proteus mirabilis is a model organism for urease-producing uropathogens. These diverse bacteria cause infection stones in the urinary tract and form crystalline biofilms on indwelling urinary catheters, frequently leading to polymicrobial infection. Recent work has elucidated how P. mirabilis causes all of these disease states. Particularly exciting is the discovery that this bacterium forms large clusters in the bladder lumen that are sites for stone formation. These clusters, and other steps of infection, require two virulence factors in particular: urease and MR/P fimbriae. Highlighting the importance of MR/P fimbriae is the cotranscribed regulator, MrpJ, which globally controls virulence. Overall, P. mirabilis exhibits an extraordinary lifestyle, and further probing will answer exciting basic microbiological and clinically relevant questions.
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Affiliation(s)
- Allison N Norsworthy
- Department of Microbiology, New York University Medical Center, New York, NY, USA
| | - Melanie M Pearson
- Department of Microbiology, New York University Medical Center, New York, NY, USA; Department of Urology, New York University Medical Center, New York, NY, USA; Current address: University of Michigan Medical School, Department of Microbiology and Immunology, 5641 Medical Science Building II, 1150 West Medical Center Dr., Ann Arbor, MI 48109-0620, USA.
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Iqbal MW, Shin RH, Youssef RF, Kaplan AG, Cabrera FJ, Hanna J, Scales CD, Ferrandino MN, Preminger GM, Lipkin ME. Should metabolic evaluation be performed in patients with struvite stones? Urolithiasis 2016; 45:185-192. [DOI: 10.1007/s00240-016-0893-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2016] [Accepted: 05/18/2016] [Indexed: 11/28/2022]
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Flannigan R, Choy WH, Chew B, Lange D. Renal struvite stones--pathogenesis, microbiology, and management strategies. Nat Rev Urol 2014; 11:333-41. [PMID: 24818849 DOI: 10.1038/nrurol.2014.99] [Citation(s) in RCA: 135] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Infection stones-which account for 10-15% of all urinary calculi-are thought to form in the presence of urease-producing bacteria. These calculi can cause significant morbidity and mortality if left untreated or treated inadequately; optimal treatment involves complete stone eradication in conjunction with antibiotic therapy. The three key principles of treating struvite stones are: removal of all stone fragments, the use of antibiotics to treat the infection, and prevention of recurrence. Several methods to remove stone fragments have been described in the literature, including the use of urease inhibitors, acidification therapy, dissolution therapy, extracorporeal shockwave lithotripsy, ureteroscopy, percutaneous nephrolithotomy (PCNL), and anatrophic nephrolithotomy. PCNL is considered to be the gold-standard approach to treating struvite calculi, but adjuncts might be used when deemed necessary. When selecting antibiotics to treat infection, it is necessary to acquire a stone culture or, at the very least, urine culture from the renal pelvis at time of surgery, as midstream urine cultures do not always reflect the causative organism.
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Affiliation(s)
- Ryan Flannigan
- The Stone Centre at Vancouver General Hospital, Jack Bell Research Centre, 2660 Oak Street, Vancouver, BC V6H 3Z6, Canada
| | - Wai Ho Choy
- The Stone Centre at Vancouver General Hospital, Jack Bell Research Centre, 2660 Oak Street, Vancouver, BC V6H 3Z6, Canada
| | - Ben Chew
- The Stone Centre at Vancouver General Hospital, Jack Bell Research Centre, 2660 Oak Street, Vancouver, BC V6H 3Z6, Canada
| | - Dirk Lange
- The Stone Centre at Vancouver General Hospital, Jack Bell Research Centre, 2660 Oak Street, Vancouver, BC V6H 3Z6, Canada
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