Prevention, diagnosis, and treatment of urolithiasis in geriatric patients - differences, similarities and caveats in comparison to the general population.

PURPOSE OF REVIEW: Purpose of the review is to address management and prevention of urolithiasis in elderly patients examining the dynamic interplay between general measures, dietary adjustments, lifestyle modifications, and targeted pharmacological and/ or surgical interventions. The goal is to provide understanding of the evolving strategies required for effective urolithiasis prevention in the geriatric population. RECENT FINDINGS: Age-specific diagnostic considerations are necessary because urolithiasis in the elderly population is characterized by bigger stones, greater peri-operative risks, and heightened symptom severity. When comorbidities are present, conservative treatments - especially analgesia - provide difficulties. Surgical procedures prove to be safe and effective, with complication rates and practical application comparable to younger cohorts. Prevention approaches that include lifestyle changes and the investigation of novel pharmaceutical options such as sodium-dependent glucose co-transporter 2 (SGLT-2)-inhibitors are promising in the management of urolithiasis in the elderly population. SUMMARY: Our review offers a thorough investigation of urolithiasis in the elderly population, elucidating distinct clinical manifestations, complex diagnostic issues, and treatment implications. The safety and effectiveness of ureteroscopy in older patients, as well as the possible prophylactic function of SGLT-2-I, offer crucial insights for clinicians. Subsequent studies are necessary to enhance age-specific therapies, addressing the distinct obstacles presented by urolithiasis in the elderly population within this rapidly growing demographic.

Paediatric stone management: innovations and standards.

PURPOSE OF REVIEW: The aim of this study was to discuss current trends and recent developments in the surgical management of paediatric urolithiasis. RECENT FINDINGS: Medical expulsive therapy (MET) is considered as an option for the treatment of children with ureter stones. Extracorporeal shockwave lithotripsy (SWL) remains as a first option for majority of kidney stones and upper ureter stones. Advances in endourology have led to increased adoption of retrograde intrarenal surgeries (RIRS) and percutaneous nephrolithotomy (PCNL/mini-PCNL/ultra-mini-PCNL/micro-PCNL). SUMMARY: Management of paediatric stone disease has developed significantly in the past decade. However, the evidence in the literature remains disproportional to these advances. Well designed multicentric studies are still needed to compare effectiveness and safety of these procedures.

UROLITHIASIS IN FOXES: ASSESSMENT OF 65 UROLITH SUBMISSIONS TO THE MINNESOTA UROLITH CENTER FROM 1981 TO 2021.

This article summarizes urinary stone submissions from foxes in human care to the Minnesota Urolith Center over 40 years. A previous report documented the analysis of uroliths from foxes that were submitted between 1981 and 2007.13 New data compiled from 2008 to 2021 included an additional 38 stones submitted from foxes, totaling 65 fox urolith submissions from 1981 to 2021. Struvite and cystine uroliths were most common, with the remainder comprised of calcium phosphate, calcium oxalate, compound, mixed, or miscellaneous material. Most stones were submitted from male foxes. Seventy-two percent of the stones were urocystoliths, and from 2010 to 2021, most stones were diagnosed antemortem and removed surgically. More than half of the stones were submitted from red foxes (Vulpes vulpes) and fennec foxes (Vulpes zerda). Urolithiasis in foxes may be an underrecognized condition, and data from this study suggest that clinicians should consider routine urinalysis and diagnostic imaging as part of the preventive medicine program for fox species, especially red foxes and fennec foxes.

Future perspectives of flexible ureteroscopy.

PURPOSE OF REVIEW: In the recent past, there were numerous and promising technological developments in the field of endourology leading to tremendous changes in the management of urolithiasis. This review will try to weave ancient stone therapy with the very modern advent of flexible ureteroscopy and recent developments in robotic systems. RECENT FINDINGS: In the broad field of flexible ureteroscopy for stone surgery, new disposable scopes have been developed and established. The use of robotic instruments is also a new and interesting concept. Additionally, clinical research on the understanding of laser features leads to a specific and appropriate use of lasers for lithotripsy, both holmium, and nowadays also interestingly thulium. SUMMARY: Disposable, digital flexible ureteroscopes for the treatment of both ureteric and kidney stones are taking an essential role in the medical field. Until recently, the clinically relevant laser systems for stone surgery during ureteroscopy are mainly based on Holmium laser YAG (Ho:YAG) devices, but a new thulium variant with promising features is giving interesting results. Additional research in laser features will guide to a better, more effective and safer treatment algorithm. Robotic technologies are promising but their definitive role still needs to be determined.

The Evidence Paradox of the Effectiveness between the Paediatric and Adult Stone-Forming Population: A Narrative Review.

AIM/OBJECTIVE: To identify trends in the evidence base regarding the effectiveness of using α-blockers in children versus adults and compare outcomes. METHODS: A literature search up using the key words including urolithiasis/renal/ureteric stone in children/paediatric population, medical expulsive treatment (MET), α-blocker/alfuzosin/tamsulosin/doxazosin. Included were randomized or controlled clinical trials in paediatric stone formers (aged ≤18 years). Outcome measures for assessment included the overall stone expulsion rate, expulsion time, the number of pain episodes and adverse drug effects and/or reactions. Further comparison of efficacy levels using respective studies from the adult population was performed in order to identify trends, similarities and differences. RESULTS: A total of 8,259 articles were identified. Full text evaluation was possible for 28 articles. Although the picture is clearer in the paediatric group, the lack of reproducible results in adults certainly poses serious questions about data collection, analysis and interpretation in each individual study. The apparent paradox is due to the methodological differences between studies. CONCLUSION: The effectiveness of α-blockers and other medication as MET needs to be studied in multi-institutional, double-blind, placebo-controlled studies that would aim to prove superiority to placebo in contemporary clinical situations, with realistic end points and standardized outcome measure determination.

[Cystine urolithiasis: recommendations for diagnosis, treatment and recurrence prevention]. / Cistinska urolitijaza: preporuke za dijagnostiku, lijecenje i prevenciju recidiva.

Cystine lithiasis is a diagnostic and therapeutic challenge. This consensus document has outgrown of discussion of experts in nephrology and urology. It is our hope that this document will be of use for all physicians who are facing this disturbing type of urolithiasis. So far, in our national literature there have been no comprehensive documents dealing with this entity and we believe that not only nephrologists and urologists will benefit, but also specialists in internal medicine and general practitioners.

Acute bilateral ureteral obstruction secondary to guaifenesin toxicity.

Several medications or their metabolites have been associated with urolithiasis, although overall they remain an infrequent cause of urolithiasis. Guaifenesin stones were originally reported as complexed with ephedrine, and subsequent reports have demonstrated pure guaifenesin stones, occurring after long term abuse. We report a case of a 23-year-old male who ingested a large, one time dose of guaifenesin, resulting in acute bilateral ureteral obstruction, which, to our knowledge, is the first such reported case in the literature.

Korean Society of Endourology and Robotics (KSER) recommendation on the diagnosis, treatment, and prevention of urolithiasis.

This article provides evidence-based recommendations and expert opinions to aid urologists in making optimal decisions regarding managing urolithiasis in various clinical scenarios. The most frequently asked questions by urologists in their clinical practice have been collected and answered in the form of FAQs; based on the latest evidence and expert opinions. The natural history of urolithiasis is divided into active treatment and silent phases, with the active treatment stage divided into typical and special situations and peri-treatment management. The authors address 28 key questions, offering practical guidance for the proper diagnosis, treatment, and prevention of urolithiasis in clinical practice. This article is expected to be served as a valuable resource for urologists.

International Alliance of Urolithiasis (IAU) guidelines on the metabolic evaluation and medical management of urolithiasis.

The aim of this study was to construct the fourth in a series of guidelines on the treatment of urolithiasis by the International Alliance of Urolithiasis (IAU) that by providing a clinical framework for the metabolic evaluation, prevention, and follow-up of patients with urolithiasis based on the best available published literature. All recommendations were summarized following a systematic review and assessment of the literature in the PubMed database from January 1976 to June 2022. Each generated recommendation was graded using a modified GRADE methodology. Guideline recommendations were developed that addressed the following topics: initial evaluation, metabolic testing, dietary measures, medical management, and follow-up of recurrent stone formers. It was emphasized by the Panel that prevention of new stone formation is as important as the surgical removal of the stones. Although general preventive measures may be effective in reducing stone recurrence rates in some patients, specific medical and dietary management should be well considered and eventually applied in an individualized manner based on the outcomes of metabolic work-up, stone analysis and some certain patient related factors. A detailed follow-up of each case is essential depending on the metabolic activity of each individual patient.

[Anatrophic nephrolithotomy: is it really an obsolete procedure?]. / Nefrolitotomía anatrófica:?verdaderamente un procedimiento obsoleto?

Since the introduction of extracorporeal shock wave lithotripsy and the various modalities of endoscopic surgery, the number of open procedures for the treatment of urolithiasis has decreased dramatically. The use of these techniques in the management of easier cases leaves no doubt, but there is still some controversy about what should be the best treatment option for the largest and most complex staghorn calculi. Anatrophic nephrolithotomy is still considered the gold standard for the treatment of such lithiasis. This paper presents in detail the key technical points to consider during its performance.

[Diagnosis and treatment of urolithiasis in combination with infravesical obstruction in presenile and senile patients].

The analysis of the results of examination and treatment of 510 urolithiasis patients with organic infravesical obstruction (IVO) treated in the urological clinic of M. F. Vladimirsky Moscow Regional Research Clinical Institute and in the urological department of Zhukovsky city hospital from 1995 to 2009 made it possible to arrive at the following conclusions: the above patients have obstruction symptoms in 100% cases, irritative symptoms--in more than 2/3 of the patients; combined use of low invasive, endoscopic and open methods reestablishes urodynamics of the lower urinary tract in more than 90% patients; the decision on the treatment policy and techniques depends on severity of clinical symptoms caused by IVO and urolithiasis as well as disturbance of upper and lower urinary tract urodynamics. In adequate choice of the patients and correct indications combined use of low invasive, endoscopic and open methods provides good treatment effect in patients with IVO and urolithiasis.

Urolithiasis in a Deceased Donor Kidney Transplant Recipient: Case Report.

Urolithiasis is a rare complication among kidney transplant recipients, with an incidence of 0.4% to 4.4%. Saudi Arabia has a very hot environment for most of the year, which has been linked to an increased incidence of nephrolithiasis. Additionally, animal protein consumption promotes stone development. Saudi Arabia has 2.5 times the number of stone formation indications as the rest of the world. Several features of urolithiasis and stone composition have already been discussed. The most frequent stone composition is calcium oxalate, followed by uric acid. We discuss the case of a 35-year-old Indian male brain death donor who presented after an automobile accident and had no history of chronic illness. One of his kidneys was transplanted into a female patient. She complained with flank pain and dysuria numerous times after transplant, which turned out to be a urinal track infection. She thereafter developed hematuria with burning micturition, and tests revealed that she had a large renal bladder stone as well as several pelvic kidney stones. The patient received lithotripsy and the stone was removed, and her kidney function was restored.

Diagnostic examination of the child with urolithiasis or nephrocalcinosis.

Urolithiasis and nephrocalcinosis are more frequent in children then currently anticipated, but still remain under- or misdiagnosed in a significant proportion of patients, since symptoms and signs may be subtle or misleading. All children with colicky abdominal pain or macroscopic hematuria should be examined thoroughly for urolithiasis. Also, other, more general, abdominal manifestations can be the first symptoms of renal stones. The patients and their family histories, as well as physical examination, are important initial steps for diagnostic evaluation. Thereafter, diagnostic imaging should be aimed at the location of calculi but also at identification of urinary tract anomalies or acute obstruction due to stone disease. This can often be accomplished by ultrasound examination alone, but sometimes radiological methods such as plain abdominal films or more sensitive non-enhanced computed tomography are necessary. Since metabolic causes are frequent in children, diagnostic evaluation should be meticulous so that metabolic disorders that cause recurrent urolithiasis or even renal failure, such as the primary hyperoxalurias and others, can be ruled out. The stone is not the disease itself; it is only one serious sign! Therefore, thorough and early diagnostic examination is mandatory for every infant and child with the first stone event, or with nephrocalcinosis.

[Update of the 2Sk guidelines on the diagnostics, treatment and metaphylaxis of urolithiasis (AWMF register number 043-025) : What is new?] / Aktualisierung der S2k-Leitlinie zur Diagnostik, Therapie und Metaphylaxe der Urolithiasis (AWMF Registernummer 043-025) : Was ist neu?

The increase of medical knowledge and technical innovations together with the demographic change represent a challenge for the new conception of guidelines and clinical studies. The present S2k guidelines, which are exclusively concerned with kidney and ureteral stones, should support the treatment of urolithiasis in hospitals and private practices and provide information on urolithiasis for patients. Increasing interdisciplinary collaboration in stone treatment is also demonstrated in the number of professional and working groups participating in the update of the new guidelines. The present S2k guidelines emerged from a consensus process and demonstrate the current recommendations in step with actual practice. They provide decision-making guidance for diagnostics, treatment and metaphylactic measures based on expert opinions and available published fundamental evidence from the literature.

[The practice guideline 'Urolithiasis' (first revision) from the Dutch College of General Practitioners; a response from the perspective of urology]. / De standaard 'Urinesteenlijden' (eerste herziening) van het Nederlands Huisartsen Genootschap; reactie vanuit de urologie.

The Dutch College of General Practitioners has made a useful revision of its practice guideline 'Urolithiasis', in which new imaging techniques and medical treatment modalities are implemented. Sonography is useful but CT has now become the gold standard imaging technique. CT images should be examined by both the radiologist and the urologist. Therefore, requests for CT should preferably be made by urologists. This guideline should focus more on the differential diagnosis of urolithiasis in the acute phase, and in particular on aortic aneurysm in the elderly patient. Complaints of irritative micturition should be considered to indicate a distal localization ofa ureteral stone rather than a urinary tract infection. When prescribing selective alpha-1 blocking agents, the doctor should inform the patient that both retrograde ejaculation and orthostatic hypotension are side effects.

[Summary of the practice guideline 'Urolithiasis' (first revision) from the Dutch College of General Practitioners]. / Samenvatting van de standaard 'Urinesteenlijden' (eerste herziening) van het Nederlands Huisartsen Genootschap.

The Dutch College of General Practitioners has revised the practice guideline 'Urolithiasis'. In the acute phase, violent colic pain is treated with diclophenac or morphine. In the post-acute phase, imaging diagnostics are performed. Initially this is ultrasound examination and, ifindicated, an x-ray of the abdomen and at a later stage, a CT scan. The recommendation to consider the use oftamsulosin in the post acute phase is new. This alpha-1 blocking agent can enhance expulsion of the stone and contribute to the relief of pain.

[Urolithiasis and nephropathy complicated with gout].

Urolithiasis is a clinically important complication of gout. For effective prevention of this complication, it is necessary to comprehend the factors known to be important in its development. Our analysis of stones in gout patients revealed that the incidence of common calcium salt stones was over 60%, while that of uric acid stones was only about 30%. This implies that the disruption of uric acid metabolism promotes not only uric acid stones but also calcium salt stones. Twenty-four per cent of gout patients showed acidic urine throughout the day. Urinary management, which consists of hydration and alkalization of urine, is indispensable along with control of the serum urate level in the treatment of gout.

[The recommendations of the S2k guideline for the diagnosis, therapy and metaphylaxis of urolithiasis provide a safe course of action for ureterorenoscopic stone treatment - results of the BUSTER study]. / Die Empfehlungen der S2k-Leitlinie zur Diagnostik, Therapie und Metaphylaxe der Urolithiasis bilden einen sicheren Handlungskorridor für die ureterorenoskopische Steintherapie ­ Ergebnisse der BUSTER-Studie.

BACKGROUND: Given the high incidence, prevalence and rate of recurrence, urolithiasis stone treatment at a high stone-free rate should have a low complication rate. The German S2k guideline (GS2k-GL) for the diagnostic testing, therapy and metaphylaxis of urolithiasis provides recommendations for the first and second choice for stone treatment, depending on stone location and size. Ureterorenoscopy (URS) is the treatment of first choice for most stones. URS is only the second option for renal stones > 20 mm and proximal ureteric stones ≤ 10 mm. The objective was to examine the impact of using URS as the stone treatment of first or second choice on the endpoints stone-free rate and severity of complications. PATIENTS/METHODS: The multicentric prospective observational study "Evaluation of ureteroroscopic stone treatment - results with regard to complications, quality of life and the stone-free rate" (BUSTER) standardised recorded perioperative data from 307 patients who had undergone ureterorenoscopic stone treatment from January to April 2015 at 14 German urological clinics. Treatment decisions were not affected by the study protocol. RESULTS: In the univariate analysis, the stone-free rate for ureteric stones was significantly higher when URS was the treatment of first choice (OR 2.21, 95 % CI 1.11 - 4.40, p = 0.027). After adjustment for age, BMI, ASA score, preoperative ureteral stenting, stone location and size, presence of multiple stones, experience of the surgeon, acute or elective URS and operating time, the application of URS as treatment of first choice had no significant effect on the stone-free rate (OR 2.048, 95 % CI 0.890 - 4.710, p = 0.092). After adjustment for stone location and size as well as ureteral stenting following URS, the application of URS as treatment of first choice had no significant influence on the severity of complications (OR 1.019, 95 % CI 0.347 to 2.993; p = 0.973). CONCLUSION: On the basis of our data, URS proved to be a safe and effective stone treatment procedure regardless of the degree of guideline conformity. Although the stone-free rate was higher with URS as treatment of first choice, the results of URS as treatment of second choice were not significantly worse. The recommendations of the GS2k-GL offer a safe guide for ureterorenoscopic stone treatment. The tendency for higher stone-free rates in URS as a treatment of first choice should be examined in further studies.

[Megacalycosis as a diagnostic problem in children]. / Megacalicosis jako problem diagnostyczny u dzieci.

Megacalycosis is an uncommon, congenital renal abnormality, characterized by nonobstructive dilatation of the renal calyces with normal renal pelvis, ureter and bladder. This condition is due to underdevelopement or hypoplasia of Malpighie's pyramids. It usually occurs unilateraly as the isolated anomaly with strong male predominance. Megacalycosis itself does not impair the renal function but it can be the cause of urinary tract infections and calculus formation. This congenital defect is incidentally found by urography during the examination for urolithiasis or urinary tract infections or calculus formation. The images on radograms can be confused with obstructive or refluxing hydronephrosis or postinflamtory changes typical for pyelonephritis chronica. In case of megacalycosis surgical treatment is unnecessary. Patients with this condition should be followed-up with ultrasound and prevention of urinary tract infections or urolithiasis. Here we would like to report on the case of megacalycosis in a ten-year-old girl reffered to our deprtament due to UTI. Diagnosis of megacalycosis was established by typical urography findings: dilatation of renal calyces, no distention or obstruction of renal pelvic and ureter. The renal function was normal. No evidence of abnormality in cystoureterogram and uroflowmetry test was detected.

[Ultrasound imaging of stones dislocation in urinary tract after lithotripsy treatment in children with urolithiasis]. / Ultrasonograficzne obrazowanie przemieszczania sie zlogów w ukladzie moczowym po zabiegach litotrypsji u dzieci z kamica moczowa.

The aim of the study was to establish the usefulness of ultrasound examination for imaging of stones dislocation in urinary tract after lithotripsy treatment. The study group included 335 children with urolithiasis treated in our Clinic since 1994 until 2005y. In the group were 295 (88%) children with nephrolithiasis and 40 (12%) children with ureterolithiasis. In the whole group 335 children there were performed 619 lithotripsy procedures--545 kidney and 74 ureter units. The ultrasound examinations were performed in each patient before, on the first and second day of the treatment and two months after using the Hitachi EUB 315 with 5Mhz transducer. In the ultrasound examinations after lithotripsy treatment: in 596/619 (96,3%) cases imaging of stones dislocation in urinary tract and urinary retention was possible.