Comparison of Moses laser and Raykeen laser in patients with impacted upper ureteral stone undergoing flexible ureteroscopic holmium laser lithotripsy.

BACKGROUND: To compare the operative effect and clinical efficacy of the Moses laser mode and the Raykeen holmium laser energy platform powder mode under flexible ureteroscopic lithotripsy in patients with impacted upper ureteral stones. METHODS: From March 2022 to September 2022, 72 patients were divided into a Moses laser group and a Raykeen laser group according to surgical method, with 36 patients in each group. CT and ureteroscopy confirmed that all patients had isolated impacted upper ureteral stones. The stone volume (mm3), stone density (Hu) and severity of hydronephrosis were measured by CT. Postoperative complications were evaluated using the Clavien-Dindo score. RESULTS: There were no complications of ureteral stenosis related to the laser treatment. The operative time and lithotripsy time were lower in the Moses laser group than in the Raykeen laser group (P < 0.05). The stone-free survival rate did not differ significantly between the two groups (P = 0.722). Stone volume was found to be positively correlated with laser energy and lithotripsy time in both groups (P < 0.01). There was no significant correlation between laser energy and lithotripsy time or ureteral stone density (Hu) in the Moses laser group (P > 0.05) or the Raykeen laser group (P > 0.05). CONCLUSIONS: The contact mode of Moses technology and the powder mode of Raykeen laser lithotripsy can be used for the ablation of a single impacted upper ureteral stone. The ablation speed was related to the stone volume and the severity of polyp hyperplasia, not the stone density. We recommend the use of the powdered mode as a therapeutic measure for the treatment of impacted upper ureteral stones in flexible ureteroscopic lithotripsy.

Optimizing the outcome of non-pre-stented flexible ureteroscopic lithotripsy regarding the quality of life, when to remove the stent?

OBJECTIVES: To investigate the safety of short-term stenting following flexible ureteroscopic lithotripsy (fURL) for patients without preoperative stents. Retaining double-J stent for 1-2 weeks after fURL is a common practice. At present, data on short-term stenting after non-pre-stented fURL is still lacking. METHODS: 182 patients who met inclusion criteria were retrospectively divided into the 2-days group (2-day removal, 76 cases) and the 1-week group (1-week removal, 106 cases). The study endpoint was stent-associated adverse symptoms assessed by follow-up and completed validated questionnaires on postoperative days (POD) 7 and 12. A postoperative imaging review was performed 1 month after the surgery. RESULTS: No statistical differences were found in the patients' demographic and stone-related characteristics. The 2-days group showed fewer urinary tract symptoms and lower scores on the ureteral stent symptom questionnaire on POD 7: less backache during urination (p = 0.004), less hematuria (p = 0.031), less frequent urination (p = 0.004), lower urinary symptoms index (p < 0.001), lower general health index (p < 0.001), and lower performance index (p < 0.001). There were no significant differences in fever (p = 0.372), visual analogue scale score (p = 0.760), and painkiller requirements (p = 0.160) on POD 7. The average general health score and work performance score remained significantly higher in the 1-week group patients at 5 days after removal compared to the 2-days group patients at 5 days after removal. (p < 0.001, p = 0.005). Five patients in the 2-days group and 15 patients in the 1-week group returned to the emergency department for additional treatments. No patient required rehospitalization. Stone-free rates were 85.5% in the 2-days group and 80.2% in the 1-week group (p = 0.499), respectively, and none of the patients got aggravating hydronephrosis. CONCLUSIONS: Compared to the common 1-week stent removal option, short-term stenting after non-pre-stented fURL is safe, which can enhance the patient's quality of life.

Application of 11/13Fr suctioning ureteral access sheath and 8.55Fr single-use digital flexible ureteroscope in one-stage flexible ureteroscopic lithotripsy: an initial experience of 900 cases.

OBJECTIVES: To report our initial experience of one-stage flexible ureteroscopic lithotripsy(FURL) with 11/13Fr suctioning ureteral access sheath(UAS) and 8.55Fr single-use digital flexible ureteroscope(SDFU) in upper ureteral or renal calculi. MATERIALS AND METHODS: We retrospectively collected the clinical data of 900 adult patients with upper ureteral or renal calculi treated by FURL with 11/13Fr suctioning UAS and 8.55Fr SDFU from January 2022 to April 2024. Demographics, peri- and postoperative outcomes were assessed. RESULTS: In all, 40 of 940 cases(4.26%) failed to introduce UAS and required second-stage FURL because of ureterostenosis and were excluded. Mean stones size of the remaining 900 eligible cases was 1.68 ± 0.58 cm in greatest diameter. There were 228 cases of upper ureteral stone, 456 cases of renal stone and 216 cases of concomitant ureteral and renal calculi. The mean operation time was 52.20 ± 20.21 min and the postoperative hospital stay was 2.87 ± 1.37 days. The stone-free rate of 1 month postoperatively was 89.56% and only 2.44% of patients with residue underwent additional reoperation. The rate of postoperative fever, postoperative pain needing analgesic and slight ureteral mucosal injury were 5.11%, 8.22% and 7.78%, respectively. None of patient suffered from severe complications, such as sepsis or ureteral perforation. CONCLUSION: It's practical and suitable for the vast majority of adult patients to undergo FURL in single session with 11/13Fr suctioning UAS without preoperative stenting. FURL with 11/13Fr suctioning UAS and 8.55Fr SDFU is feasible, reliable, safe, and efficient in the management of renal stone and upper ureteral stone.

Efficacy and Postoperative Infection following Super Mini Percutaneous Nephrolithotomy vs Flexible Ureteroscopy for Diabetic Nephrolithiasis: A Comparative Analysis and Risk Factors for Postoperative Infectious Complications.

Objective: To compare the efficacy and postoperative infection rate of super mini percutaneous nephrolithotomy (SMP) and flexible ureteroscopic lithotripsy (FURL) in patients with diabetic nephrolithiasis and to explore the risk factors associated with postoperative infection following these two procedures. Methods: The medical history and surgery details of 252 patients with diabetic nephrolithiasis who underwent lithotripsy in our hospital between January 2018 and May 2023, including 144 SMP and 108 FURL, were reviewed and compared. Perioperative outcomes were compared between the two groups. Logistic regression was performed to identify the significant risk factors for infection after each procedure. Results: SMP achieved a higher stone-free rate (SFR) on postoperative day 1 and postoperative day 30 compared with FURL (p < 0.05). The mean operative time was shorter in SMP (p < 0.01). FURL was associated with less hemoglobin drop (p < 0.01) and shorter length of stay (p < 0.01). The incident rate of systemic inflammatory response syndrome (SIRS) was higher after SMP (p = 0.019), while the incident rate of urinary tract infection (UTI) was higher after FURL (p = 0.021). Overall postoperative infection and sepsis rates were similar between the two procedures. Logistic regression analysis revealed that gender odds ratio [OR]: 0.225, 95% confidence interval [CI]: 0.079-0.639), HbA1c (OR: 3.516, 95% CI: 1.841-6.716), and operation time (OR: 1.037, 95% CI: 1.008-1.066) were independent risk factors for infection after FURL, while operation time (OR: 1.063, 95% CI: 1.022-1.106) and HbA1c (OR: 7.443, 95% CI: 2.956-18.742) significantly predicted SMP-associated infections. Conclusion: In diabetic patients, SMP demonstrated higher SFR and shorter operation time, whereas FURL was associated with less bleeding and shorter hospitalization. SMP had a higher incident rate of SIRS and FURL had a higher incident rate of UTI. Elevated HbA1c and prolonged operative duration increased infection risk after both procedures, while female gender was an additional risk factor for FURL-related infections.

Actively extracting kidney stones combined dusting technique can improve SFR of moderate-complexity kidney stones in fURL.

PURPOSE: To evaluate the necessity and effectiveness of actively extracting kidney stones with different complexity that have been visually dusted in flexible ureteroscopic lithotripsy (fURL). METHODS: We retrospectively reviewed the medical records of patients who underwent fURL with dusting technique in established hospitals. A total of 535 cases were divided into the dusting group or the dusting plus basketing group according to the use of stone basket. Their characteristics and operative parameters were collected and analyzed. We used the R.I.R.S. scoring system to classify the complexity of kidney stones and divided these kidney stones into three subgroups, namely, mild-, moderate-, and severe-complexity group. And then, the effectiveness of stone basket in these subgroups was analyzed. RESULTS: Although using a stone basket significantly reduced re-operation rate (17.8% in dusting group versus 10.2% in dusting plus basketing group, p = 0.013), no significant difference on stone-free rate (SFR) and overall incidence of complications were noticed between groups. After we classified the complexity of kidney stones using the R.I.R.S. scoring system, we found a stone basket was helpful to improve SFR in kidney stones with moderate-complexity that had been visually dusted in fURL (73.5% in dusting group versus 87.3% in dusting plus basketing group, p = 0.002) but had limited influence on SFR in mild (93.8% in dusting group versus 92.6% in dusting plus basketing group, p = 0.783) or severe (28.5% in dusting group versus 34.0% in dusting plus basketing group, p = 0.598)-complexity kidney stones. CONCLUSION: The use of stone basket should be encouraged in moderate-complexity kidney stones which can be visually dusted in fURL.

The effect and safety assessment of monitoring ethanol concentration in exhaled breath combined with intelligent control of renal pelvic pressure on the absorption of perfusion fluid during flexible ureteroscopic lithotripsy.

PURPOSE: Previously, we designed a ureteral access sheath with the capability of renal pelvic pressure (RPP) measurement and a medical perfusion and aspiration platform, allowing for the intelligent control of RPP. However, the effect of different RPP levels on perfusion fluid absorption remains unclear. This randomized controlled trial aimed to investigate the effects of exhaled ethanol concentration monitoring and intelligent pressure control on perfusion fluid absorption during flexible ureteroscopic lithotripsy. METHODS: Eighty patients scheduled for flexible ureteroscopic lithotripsy were randomly divided into four groups. In groups A, B, and C, the RPPs were set at 0, - 5, and - 10 mmHg, respectively. Group D was regarded as the controls with unfixed RPP. Isotonic saline containing 1% ethanol was used as the irrigation fluid, with an average irrigation flow rate of 100 mL/min. The primary outcome of this study was the absorption of perfusion fluid that was calculated based on the exhaled ethanol concentration. The secondary outcomes included duration of operation and amounts of perfusion fluid used. Postoperative complications, pre- and postoperative renal function, infection markers, and blood gas analysis were also recorded for safety assessment. RESULTS: In all, 76 patients were involved in this study, whose demographic characteristics and preoperative conditions were comparable among groups. Under the same perfusion flow rate, the groups with fixed RPP exhibited reduced absorption of perfusion fluid, duration of operation, and perfusion volume. In particular, the lowest values were observed in group C (RPP = - 10 mmHg). In contrast to the unfixed RPP group, no considerable difference were observed in levels of BUN, Scr, WBC, CRP, and blood gas values among the fixed RPP groups. Moreover, postoperative complications showed no significant difference among groups. CONCLUSION: In flexible ureteroscopic lithotripsy, the groups with fixed RPP had less absorption of perfusion fluid and perfusion volume, shorter duration of surgery, and higher safety than the unfixed group.

Retrospective study of single-use digital flexible ureteroscopic lithotripsy versus miniaturized percutaneous nephrolithotomy for 1.5-2.5cm lower pole renal stones.

PURPOSE: Retrospective analysis was performed on the clinical information of patients with 1.5-2.5 cm lower pole renal stones treated by single-use digital flexible ureteroscopic lithotripsy (fURS) and miniaturized percutaneous nephrolithotomy (MPCNL) in affiliated hospital of the Nantong University from January 2020 to December 2022. To compare the safety and efficacy of single-use fURS and MPCNL in the treatment from 1.5cm to 2.5cm lower pole renal stones. METHODS: Clinical information of 141 patients were collected and divided into single-use fURS group and MPCNL group according to their treatment methods, including 83 patients in the single-use fURS group and 58 patients in the MPCNL group. Baseline data, data on the clinical characteristics of stones, laboratory examination data, operation time, and postoperative data of the two groups were collected. Statistical analysis was made on the collected data to analyze the differences and causes between the two groups of patients. RESULTS: There was no significant difference in the baseline data and preoperative clinical features of 141 patients between the two groups (P > 0.05). In comparison of postoperative serum indexes, the drop values of hemoglobin and creatinine in single-use fURS group were lower than those in MPCNL group, and the difference was statistically significant (P < 0.05). The stone free rate was higher in the MPCNL group than in the single-use fURS group on the first day after surgery. At the 1st month after surgery, the two groups were similar. At 3rd month after surgery, the single-use fURS group was slightly higher than the MPCNL group, with no statistical significance (P > 0.05). The total complication rate in single-use fURS group was slightly lower than that in MPCNL group, but there was no statistical significance (P > 0.05). CONCLUSIONS: Single-use fURS has similar safety and efficacy to MPCNL in the treatment of 1.5-2.5cm lower pole renal stones. Single-use fURS may be a new option for the treatment of these stones.

A Comparative Analysis between Flexible Ureteroscopic Lithotripsy and Tubeless Percutaneous Nephrolithotomy in the Treatment of >15 mm Non-Obstructing Proximal Ureteral Stones.

BACKGROUND: The proper surgical modality for large non-obstructing proximal ureteral stones is disputed. We compare effectiveness and safety of flexible ureteroscopic lithotripsy (FURL) and tubeless percutaneous nephrolithotomy (TPNL) in treatment of upper ureteral stones larger than 1.5 cm. METHODS: We reviewed the medical records of patients who performed FURL or TPNL for upper ureteral stones between June 2016 and November 2018. Comparative analysis was conducted regarding demographic parameters, stone free rate, postoperative pain and complications. RESULTS: This study included 58 patients treated with FURL and 60 patients treated with TPNL owing to upper ureteral stones larger than 1.5 cm. Stone size was similar in the FURL and TPNL groups (17.6 ± 2.6 vs. 18.0 ± 2.1 mm, p = 0.194). The overall 3-month stone clearance rate was 95.8% for FURL versus 96.0% for TPNL (p = 0.575). There was no difference between the FURL and TPNL groups for hospital stay (p = 0.280) and postoperative complications. On the other hand, patients treated with FURL had longer operative time (p = 0.012) and less postoperative pain (p = 0.008). CONCLUSIONS: Both surgical techniques were considered feasible and effective surgical procedures in the treatment of large upper ureteral stones.

A comparative study of flexible ureteroscopic lithotripsy for upper urinary tract stones in patients with prior urosepsis following emergency drainage via retrograde ureteral stent or percutaneous nephrostomy.

BACKGROUND: Patients with urosepsis associated with upper urinary tract stones require further stone management after emergency drainage. OBJECTIVE: To evaluate the safety and efficacy of elective flexible ureteroscopic lithotripsy (F-URSL) for upper urinary tract stones in patients with prior urosepsis who have undergone emergency drainage using retrograde ureteral stent(RUS) or percutaneous nephrostomy (PCN). METHOD: Between January 2017 and December 2021, clinical data were collected for 102 patients who underwent elective F-URSL following emergency drainage for urosepsis caused by upper ureteral or renal stones. The patients were categorized into two groups based on the drainage method used: the RUS group and the PCN group. The collected data included patient demographics, stone parameters, infection recovery after emergency drainage, and clinical outcomes post F-URSL. Subsequently, the data underwent statistical analysis. RESULTS: A total of 102 patients were included in the statistical analysis, with 58 (56.86%) in the RUS group and 44 (43.14%) in the PCN group. Among the patients, 84 (82.35%) were female and 18 (17.65%) were male, with an average age of 59.36 years. Positive urine cultures were observed in 71 (69.61%) patients. Successful drainage was achieved in all patients in both groups, and there were no significant differences in the time required for normalization of white blood cell count (WBC) and body temperature following drainage. Additionally, all patients underwent F-URSL successfully, and no statistically significant differences were observed between the two groups in terms of operative time, stone-free rates, postoperative fever, and postoperative hospital stay. CONCLUSION: Both RUS and PCN have been established as effective approaches for managing urosepsis caused by upper urinary tract stones. Furthermore, the impact of these two drainage methods on the subsequent management of stones through elective F-URSL has shown consistent outcomes.

Flexible ureteroscopic lithotripsy with a suctioning ureteral access sheath for removing upper urinary calculi under local anesthesia.

Objectives: We aimed to probe the safety and effectiveness of flexible ureteroscopic lithotripsy (FURL) with a suctioning ureteral access sheath (S-UAS) for removing upper urinary calculi under local anesthesia (LA). Materials and methods: The clinical data of 56 patients with upper urinary calculi treated by FURL with an S-UAS under LA during the period between September 2019 and November 2022 were analyzed retrospectively. For LA, intramuscular pethidine (1.0-2.0 mg/kg) and phenergan (25 mg) were administered 30 min prior to surgery, and oxybuprocaine hydrochloride gel was administered through the urethra at the start of the surgery. The S-UAS and flexible ureteroscope were used for FURL. Demographic characteristics, stone-related parameters, and clinical outcomes were analyzed. Result: A total of 66 procedures were performed successfully on 46 patients (Group A), who underwent unilateral surgeries, and on 10 patients (Group B) who underwent same-session bilateral surgeries. All 56 patients were operated upon without altering the anesthesia strategy, and none required additional analgesia. The mean stone sizes of the Group A and Group B patients were 20.24 ± 5.45 mm and 29.40 ± 3.89 mm, respectively. The mean operative times of the two groups were 53.04 ± 13.35 min and 90.00 ± 15.81 min, respectively. In Group A, the stone-free rates (SFRs) were 76.1% (35/46) and 85.1% (40/46) at postoperative day 1 and day 30, respectively. In Group B, the SFRs were 80.0% (16/20) and 85.0% (17/20), respectively. Four (8.7%) patients in Group A suffered complications such as fever, stent pain, urosepsis, and steinstrasse. In Group B, one (10%) patient suffered from fever. Conclusion: FURL, combined with an S-UAS under LA, is a feasible option and provides satisfactory clinical outcomes for appropriately selected patients.

Vacuum-assisted dedusting lithotripsy in the treatment of kidney and proximal ureteral stones less than 3 cm in size.

PURPOSE: This study aimed to compare the outcomes of vacuum-assisted dedusting lithotripsy (VADL) using flexible vacuum-assisted ureteral access sheath (FV-UAS) versus traditional flexible ureteroscopic lithotripsy (fURL) in patients with kidney or proximal ureteral calculi less than 3 cm in size. METHODS: A total of 371 patients who successfully underwent fURL treatment were enrolled. These patients were divided into traditional fURL group and VADL group. Outcomes of both groups were compared using 1:1 propensity score-matched analysis. Stratified analyses based on stone size and location were also conducted. RESULTS: Finally, 103 well-matched patients in each group were identified. No septic shock or death occurred. The immediate stone-free rate (SFR) and follow-up SFR of VADL group were significantly higher (78.6% vs. 50.5%, p < 0.001; 94.2%% vs. 75.7%, p < 0.001). No difference was observed in postoperative fever rate (2.9% vs. 3.9%, p = 1.000) and duration of lithotripsy (37.7 ± 20.1 min vs. 40.3 ± 18.9 min, p = 0.235). For patients with stones ≤ 2 cm in size, the immediate SFR and follow-up SFR in VADL group were higher (86.7% vs. 60.6%, p < 0.001; 96.0% vs. 83.1%, p = 0.010). The same trend was observed in the 2-3 cm subgroup (57.1% vs. 28.1%, p = 0.023; 89.3% vs. 59.4%, p = 0.009). Although the in situ fragmentation strategy was employed more frequently in VADL group for lower pole stones, the SFR was still higher. Subgroup analyses did not reveal any significant differences in either infectious complications or duration of lithotripsy. CONCLUSION: VADL technique can significantly improve the postoperative SFR for the patients with kidney or proximal ureteral stones less than 3 cm in size treated by flexible ureteroscope.

Omnidirectional (Flexible) Ureteral Access Sheath: Safety, Efficacy, and Initial Experience Report.

Background: Recently a novel omnidirectional (OD) ureteral access sheath (UAS) has been developed. By retrospectively reviewing and comparing the flexible ureteroscopic lithotripsy (FURL) cases in our institution with either a conventional Cook UAS or an OD UAS in the past year, we shared our experience of the safety, efficacy, and relevant issues on the usage of OD UAS. Materials and Methods: The medical history and surgery details of 199 patients with kidney stones or ureterojunctional stones who underwent FURL in Xinhua Hospital, including 61 Cook UAS and 138 OD UAS, were reviewed and compared. The maximal deflection angle was measured by steering four different types of ureteroscopes to bend the OD UAS in different states. Result: The deflection angle of OD UAS was ∼110° to 130° free load, and 90° to 130° when loaded with different instruments. The stone burden and position were similar in two groups. Given a similar prestent ratio and operation time, the OD UAS group achieved a higher single-session stone-free rate (SFR) (63.9% vs 94.2%, p < 0.0001) at 1-month follow-up evaluated by a CT scan. Conclusion: OD UAS is a novel device with high safety and efficacy. The unique flexible design allows it to bend with the ureteroscope and enter renal calices and be set close to the stone. Combined with the suction port, OD UAS contributes greatly to dealing with large-burden kidney stones, shortens operation time, and improves single-session SFR.

Case report: Crossed fused renal ectopia with stones: A surgical challenge overcome by robotic surgery.

BACKGROUND: Crossed fused renal ectopia (CFRE) is an extremely rare congenital anomaly of the urinary tract that is prone to stone formation. The surgical treatment of CFRE with stones is challenging due to anatomical abnormalities. MATERIALS AND METHODS: Right kidney stones were treated by flexible ureteroscopic lithotripsy (FURSL) and left kidney stones were treated by robotic surgery. RESULTS: The authors present an unreported case of bilateral renal stones in a patient with CFRE, which was successfully treated by robotic pyelolithotomy combined with FURSL. The procedure was manoeuverable, and the stone-free rate was satisfactory. CONCLUSIONS: CFRE with stones (S-shaped kidney) present a surgical challenge due to anatomical abnormalities and a high stone burden. The authors recommend robotic pyelolithotomy with or without FURSL as a viable treatment option for stones with similar anatomical abnormalities.

Effect of Flexible Ureteroscopic Lithotripsy on Surgical Outcomes, Renal Function and Quality of Life of Patients with 2-3 cm Renal Calculi.

AIM: This retrospective study aims to analyse the effect of flexible ureteroscopic lithotripsy (FURSL) on the surgical outcome, renal function (RF) and quality of life (QoL) of patients with 2-3 cm renal calculi. METHODS: A total of 111 patients with renal calculi (2-3 cm) admitted from January 2019 to May 2022 were selected. Among them, 55 patients who underwent minimally invasive percutaneous nephrolithotomy (PCNL) were set as the control group and 56 patients treated with FURSL served as the research group. The control group consisted of 29 males and 26 females aged (43.31 ± 6.49) years on average. The research group consisted of 31 males and 25 females, with a mean age of (42.46 ± 7.44) years. Parameters such as surgical outcomes (stone clearance rate, bleeding volume, operation time and postoperative recovery time), incidence of adverse reactions (ARs: Gross hematuria, fever, urinary tract infection (UTI) and urinary tract injury), RF (blood urea nitrogen (BUN) and serum creatinine (Scr)), pain degree and QoL were compared. RESULTS: No significant difference in the stone clearance rate was found between the groups. Compared with the control group, the research group had statistically longer operation time, less bleeding, postoperative recovery time, and incidence of ARs and pain and obviously higher QoL. BUN and Scr differed insignificantly between the groups before and after surgery. CONCLUSIONS: FURSL can accelerate postoperative recovery in patients with 2-3 cm renal calculi, lower the risk of postoperative ARs, mitigate pain and improve QoL without significantly affecting RF.

Clinical Characteristics and Risk Factors of Systemic Inflammatory Response Syndrome after Flexible Ureteroscopic Lithotripsy.

OBJECTIVES: Flexible ureteroscopic lithotripsy (FURL), as a common method for treating upper urinary tract calculi, has the risks of complications such as infection and bleeding. Especially, systemic inflammatory response syndrome (SIRS) after FURL may induce multiple organ dysfunction threatening the lives of patients. We aimed to investigate the clinical characteristics and risk factors of SIRS after FURL. METHODS: A total of 157 upper urinary tract calculus patients treated with FURL from January 2018 to December 2019 were enrolled, and clinical outcomes and complications were analyzed. Patients were divided into SIRS group (n = 31) and non-SIRS group (n = 126) according to the presence or absence of SIRS after FURL. Their clinical data were compared by univariate analysis, and the factors with statistically significant difference were incorporated into LASSO logistic regression analysis. The model was visualized using a nomogram, and model discrimination and accuracy were verified. RESULTS: The results of univariate analysis indicated that there were significant differences in gender, average stone size, preoperative urinary white blood cell count, surgery time and postoperative stone bacterial culture between the two groups. The results of LASSO logistic regression analysis showed that the above factors were independent risk factors for patients with SIRS. The C-index of the SIRS risk prediction model was 0.992. The area under the ROC curve of this model was 0.944 (95% CI: 0.913-0.997), the sensitivity was 97.9%, and the specificity was 95.8%. The average absolute error between actual and predicted risk probabilities was 0.028. The model for predicting the risk of SIRS had good discrimination and high consistency with the actual observed value. CONCLUSIONS: Females, larger stones, higher preoperative urinary white blood cell count, longer surgery time and postoperative positive stone bacterial culture are independent risk factors of SIRS after FURL for upper urinary tract calculi.

The Clinical Efficacy of Percutaneous Nephrolithotomy and Flexible Ureteroscopic Lithotripsy in the Treatment of Calyceal Diverticulum Stones: A Meta-Analysis.

BACKGROUND: The clinical efficacy of percutaneous nephrolithotomy (PCNL) and flexible ureteroscopic lithotripsy (FURL) in the treatment of calyceal diverticulum stones (CDs) remains controversial. We performed a meta-analysis to assess the clinical efficacy of PCNL and FURL in the treatment of CDs. METHODS: We searched a number of relevant electronic databases including China National Knowledge Infrastructure (CNKI), MEDLINE, PubMed, Web of Science, EMBASE, and Cochrane Library until January 31, 2022. STATA 15.1 software was used to analyze all data for this article. The quality of these studies was assessed by the Newcastle-Ottawa Scale (ranged from 0 to 9 stars). RESULTS: Finally, we selected 11 high-quality studies in our meta-analysis,which containing 486 patients. Meta-analysis showed that PCNL had higher stone-free rate [OR=3.55, 95% CI: 2.07 -6.10, P = 0.000], symptom-free rate [OR=3.56, 95% CI: 1.51 -8.38, p= 0.004], while it was slightly inferior to the FURL in bleeding volume [SMD = 1.27, 95% CI: (0.67,1.87), P = 0.000], hospital stay [SMD =2.86, 95% CI: 1.75-3.97, P = 0.000] and complication rate [OR =1.92, 95% CI: 1.10-3.33, P = 0.021], and there was no significant difference in operative time [SMD = -0.011, 95% CI: (-0.41,0.39), P = 0.957]. CONCLUSION: PCNL is safe and effective in the treatment of CDs, which can be considered as the first choice for the clinical treatment of CDs.

Effectiveness and safety of retrograde intrarenal surgery (RIRS) vs. percutaneous nephrolithotomy (PCNL) in the treatment of isolated kidney stones.

OBJECTIVE: To compare the effectiveness and safety of retrograde intrarenal surgery (RIRS) and percutaneous nephrolithotomy (PCNL) in the treatment of isolated kidney stones. METHODS: A retrospective analysis was performed on 99 patients with isolated kidney stones treated in our hospital. Patients were divided into a flexible cystoscope group (FCG, n=48, receiving RIRS) and a nephoscopy group (NG, n=51, receiving PCNL) according to the operation methods. The two groups were compared in terms of the operative time, intraoperative bleeding, length of hospitalization, time to bowel function recovery, cost of hospitalization, one-session stone clearance, postoperative incidence of massive hemorrhage, postoperative 1-year recurrence rate, and levels of hemoglobin, urinary kidney injury molecule-1 (Kim-1), cysteine protease inhibitor C (Cys-C), interleukin (IL)-6, IL-10, cortisol (Cor), white blood cells (WBC) and C-reactive protein (CRP). RESULTS: The two groups exhibited significant differences in operation time, intraoperative bleeding, hospital stay, time to bowel function recovery and medical costs (P < 0.05). The NG had a single session stone clearance rate of 88.24% and a total stone clearance rate of 98.04%, which were higher than 70.83% and 83.33%, respectively, in the FCG (P < 0.05). The incidence of postoperative hemorrhage in the NG was 15.69%, which was higher than 2.08% in the FCG (P < 0.05). The postoperative 1-year recurrence rate was 9.80% in the NG and 6.25% in the FCG (P > 0.05). The hemoglobin level of the NG was lower than that of the FCG at 1 day after surgery, and the decrease in the NG were greater than that in the FCG (P < 0.05). The levels of Kim-1 in the NG were higher than those in the FCG at 48 h postoperatively. The levels of Cys-C in the NG were lower than those in the FCG at 12 h, 24 h, 48 h and 72 h postoperatively (P < 0.05). The NG showed higher levels of IL-6, Cor, WBC and CRP, and lower level of IL-10 as compared with the FCG at 6 h, 12 h, 24 h, 48 h, and 72 h postoperatively (P < 0.05). The levels of IL-10 in both groups at different time points after surgery were higher than those before surgery, and the levels of IL-6, Cor, WBC and CRP in both groups at 6 h, 12 h, 24 h, and 48 h after surgery were higher than those before surgery (P < 0.05), whereas there was no significant difference in IL-6, Cor, WBC and CRP at 72 h after surgery as compared with those before surgery (P > 0.05). CONCLUSION: Both RIRS and PCNL were effective in the treatment of isolated kidney stones, so the surgical methods should be specifically selected in clinical practice according to individual patient conditions.

The impact of watching real-time videos of flexible ureteroscopic lithotripsy on anxiety and depression in patients.

PURPOSE: This study examines the effect of intraoperative doctor-patient communication with real-time videos in flexible ureteroscopic lithotripsy on patients' anxiety and depression. METHODS: Patients with upper urinary tract calculi were randomised into four groups. Group A (n = 29) watched the real-time operation video, but did not accept the relevant explanation during the operation; Group B (n = 31) received an explanation about the operation process during the operation alone. Patients in Group C (n = 33) watched the real-time operation video and received an explanation about the operation process during the operation. Group D (n = 31) neither watched the operation video nor received an explanation about the operation process. The self-rated anxiety and depression scores of the patients were evaluated using the self-rating anxiety scale (SAS) and the self-rating depression scale (SDS) before and after the operation. RESULTS: The clinical and demographic profiles (average age, gender distribution, educational level, body mass index, stone size, the position of stones in each groups, the length of stayand the numbers of severe postoperative complications) of the for groups showed no preoperation difference (P > 0.05). The preoperative anxiety scores and the preoperative depression scores showed no significant difference in the four groups (P > 0.05). The scores of postoperative anxiety and depression in groups A (n = 29), B (n = 31), and C (n = 33) were significantly lower than those in Group D (n = 31), (P < 0. 05). Compared to groups A and B, the scores of anxiety and depression in Group C were significantly decreased (P < 0.05). CONCLUSION: During flexible ureteroscopic lithotripsy, doctor-patient communication combined with real-time video can significantly reduce patients' postoperative anxiety and depression, and contribute to their physical and mental health recovery.

Efficiency and Clinical Outcomes of Moses Technology with Flexible Ureteroscopic Laser Lithotripsy for Treatment of Renal Calculus.

OBJECTIVE: The aim of the study was to compare the efficiency and clinical outcomes of Moses contact mode (MCM) and regular dusting mode (RDM) during flexible ureteroscopic lithotripsy (FURL) for treatment of renal calculus. METHODS: This retrospective analysis examined 216 patients with renal calculus who underwent FURL with MCM or RDM between March 2015 and January 2020. Stone characteristics, including size, volume, and density, were collected. Laser parameters, including laser type, laser working time, laser pause time, and foot-pedal use, were automatically recorded by the lithotripter work panel. The percentages of laser working time and laser pause time, stone fragmentation efficiency (SFE; volume/laser working time), postoperative complications, including fever and acute renal failure (ARF), stone-free rate (SFR), and the need for auxiliary procedures were determined. RESULTS: There were no significant differences in preoperative demographic and stone characteristics between the MCM group and the RDM group. The MCM group had a shorter laser working time (4.99 ± 1.06 vs. 5.94 ± 0.96 min, p < 0.001) and a greater SFE (137.86 [163.78-114.38] versus 114.94 [132.06-101.34] mm3/min, p < 0.001), which shortened the overall operative time (18.39 ± 5.13 vs. 21.17 ± 6.78 min, p = 0.001). There were no differences in postoperative complications, including fever and ARF, SFR (86.8 vs. 85.3%, p = 0.743), and auxiliary procedures between the 2 groups. CONCLUSIONS: Using Moses laser technology with FURL significantly reduced laser working time and increased SFE, which shortened overall operative time. Urologists should consider this new instrument for the clinical management of renal calculus.

Systemic Inflammatory Response Syndrome Combined with Pre- and Postoperative White Blood Cell Ratio Is a Better Criterion to Identify Septic Shock Patients After Flexible Ureteroscopic Lithotripsy.

Objective: To find out a better criterion to identify septic shock patients after flexible ureteroscopic lithotripsy (FUL). Materials and Methods: In total, 2364 patients who underwent the FUL procedure were enrolled in the study. The demographics and preoperative results of laboratory tests of the patients were collected. The postoperative white blood cell (WBC), systemic inflammatory response syndrome (SIRS), and quick sequential (sepsis-related) organ failure assessment score (qSOFA) were assessed 2 hours after FUL. The predictive efficacy was measured by sensitivity, specificity, positive and negative predictive value, and area under the receiver's operating characteristic curve (AUROC). Results: A total of 15 (0.63%) patients developed septic shock. There were 86 (3.64%) patients who were SIRS positive and 69 (2.92%) patients who were qSOFA positive. The pre- and postoperative WBC ratios in septic shock patients and normal patients were 2.50 ± 1.55 and 0.69 ± 0.24, respectively (p < 0.001). For sensitivity and negative predictive value, all reached 100%. For specificity, qSOFA was 97.70%, SIRS was 96.98%, and SIRS combining pre- and postoperative WBC ratio (the new criterion) was 99.79%. The new criterion had statistically significant higher specificity than SIRS or qSOFA (p < 0.001 for both), but when comparing SIRS and qSOFA, it had statistically insignificant specificity (p = 0.142). For positive predictive value, qSOFA was 21.73%, SIRS was 17.44%, and the new criterion was 75%. qSOFA and SIRS had similar AUROC (0.989 for qSOFA and 0.985 for SIRS), both lower than the new criterion (AUROC: 0.999). Conclusions: SIRS combined with pre- and postoperative WBC ratio has a much better specificity and positive predictive value than SIRS or qSOFA alone. It has 99.79% specificity and 75% positive predictive value, and as high as 100% sensitivity and negative predictive value.