Relationship of endoscopic lesions of the renal papilla with type of renal stone and 24 h urine analysis

Determinants of renal papillary appearance in kidney stone formers: An in-depth examination

OBJECTIVES

The aim of this study is to investi-gate the association between the urinary metabolic milieu and kidney stone recurrence with a validated papillary evaluation score (PPLA).

MATERIALS AND METHODS

We prospectively enrolled 30 stone for-mers who underwent retrograde intrarenal surgery procedures. Visual inspection of the accessible renal papillae was performed to calculate PPLA score, based on the characterization of ductal plugging, surface pitting, loss of papillary contour and Randall's plaque extension. Stone compositions, 24h urine collections and kidney stone events during follow-up were collected. Relative supersaturation ratios (RSS) for calcium oxalate (CaOx), brushite and uric acid were calculated using EQUIL-2. PPLA score > 3 was defined as high.

RESULTS

Median follow-up period was 11 months (5, 34). PPLA score was inversely correlated with BMI (OR 0.59, 95% CI 0.38, 0.91, p = 0.018), type 2 diabetes (OR 0.04, 95% CI 0.003, 0.58, p = 0.018) and history of recurrent kidney stones (OR 0.17, 95%CI 0.04, 0.75, p = 0.019). The associations between PPLA score, diabetes and BMI were not confirmed after excluding patients with uric acid stones. Higher PPLA score was associated with lower odds of new kidney stone events during follow-up (OR 0.15, 95% CI 0.02, 1.00, p = 0.05). No other significant correla-tions were found.

CONCLUSIONS

Our results confirm the lack of efficacy of PPLA score in phenotyping patients affected by kidney stone disease or in predicting the risk of stone recurrence. Larger, long-term studies need to be performed to clarify the role of PPLA on the risk of stone recurrence.

Design of automatic urine collection system for medical system applications

BACKGROUND: The results of urine tests are often affected by improper midstream urine collection time, urine spilling, and urine pollution, all of which can lead to an increase in the test error. OBJECTIVE: To solve this problem, aiming at improving the toilet environment at the hospitals and public physical examination centers, this paper designs an automatic urine collection system. It can automatically adjust the position of the urine cup with an infrared remote controller, or manually, adjust the position of the urine cup in special situations according to the needs of the user. It also, has an alarm function. METHODS: The overall size and shape are designed based on the squatting pan, suitable for disposable plastic urine cups of different shapes and sizes. It can realize the automatic collection of midstream urine, manual collection in exceptional cases, emergency stops, and rescue calls. RESULTS: Through the trial survey, there was a significant difference between the statistical results of using the device and not using the device (t= 13.937, P= 0.000). 96% of the subjects thought that the design of the system was reasonable, 22% thought that it was inconvenient to use, and 91.7% of the medical staff thought that the system met the sampling requirements. CONCLUSIONS: Therefore, the trial evaluation is satisfactory, and the proposed collection system is suitable for use in hospitals at all levels and public health examination centers with a large amount of inspection.

Endoscopic Papillary Abnormalities and Stone Recognition (EPSR) during Flexible Ureteroscopy: A Comprehensive Review

Introduction: The increasing efficiency of the different lasers and the improved performance of endoscopic devices have led to smaller stone fragments that impact the accuracy of microscopic evaluation (morphological and infrared). Before the stone destruction, the urologist has the opportunity to analyze the stone and the papillary abnormalities endoscopically (endoscopic papillary recognition (EPR) and endoscopic stone recognition (ESR)). Our objective was to evaluate the value for those endoscopic descriptions. Methods: The MEDLINE and EMBASE databases were searched in February 2021 for studies on endoscopic papillary recognition and endoscopic stone recognition. Results: If the ESR provided information concerning the main crystallization process, EPR provided information concerning the origin of the lithogenesis and its severity. Despite many actual limitations, those complementary descriptions could support the preventive care of the stone formers in improving the diagnosis of the lithogenesis mechanism and in identifying high-risk stone formers. Conclusion: Until the development of an Artificial Intelligence recognition, the endourologist has to learn EPSR to minimize the distortion effect of the new lasers on the stone analysis and to improve care efficiency of the stone formers patients.