Zero-echo time MRI: an alternative method for the diagnosis of urinary stones in children.

OBJECTIVES: To evaluate the potential of zero-echo time-magnetic resonance imaging (ZTE-MRI) in the assessment of urolithiasis and compare ZTE-MRI with computed tomography (CT) in pediatric patients. MATERIALS AND METHODS: This was a single-center, prospective cross-sectional study conducted between April 2023 and December 2023. 23 patients (12 girls, 11 boys; mean age: 12.3, range 1-18) with urinary tract stones detected on non-enhanced abdominal CT were enrolled. The images were evaluated independently by two radiologists for the presence, and number of stones in the kidneys, ureters, and bladder. In the second session, two radiologists evaluated whether urinary tract stones could be detected by MRI compared to CT, and the maximum diameter of the stones was measured. The CT and MRI results were compared with the Wilcoxon test. The agreement between the results of the observers was examined using Spearman's rho correlation coefficient and the intraclass correlation coefficient. RESULTS: A total of 58 urinary tract stones were detected by CT and 39 of these were detected by MRI. Most of the stones that MRI could not detect were < 5 mm and the detection sensitivity of MRI increased in correlation with stone size (p < 0.001). There was poor intermodality agreement for stones < 5 mm, substantial agreement for stones 5-10 mm, and almost perfect agreement for stones > 10 mm. Interobserver agreement for stone detection on MRI was almost perfect for stones > 10 mm and 5-10 mm and was substantial for stones < 5 mm. CONCLUSION: ZTE-MRI is a promising modality for detecting urinary stones without radiation exposure in children. CLINICAL RELEVANCE STATEMENT: Zero-echo time-magnetic resonance imaging is a potential method for identifying urinary stones in children and other populations who are particularly sensitive to radiation. KEY POINTS: Urinary system stone disease in children is increasing and imaging is needed for managing urolithiasis. Zero-echo time-magnetic resonance imaging (ZTE-MRI) had an accuracy of 81.8% and 93.7% for stones larger than 5 mm and 10 mm, respectively. ZTE-MRI is a potential non-irradiating method for the diagnosis and management of urolithiasis.

First 100 Reported Cases of Supine Percutaneous Nephrolithotomy in Malaysia: An Alternative Effective and Safe Approach to Treat Renal Stones.

Background: Supine percutaneous nephrolithotomy (s-PCNL) offers great benefits from urological and anaesthetic points of view. We present the first evaluation of the outcomes of s-PCNL in Malaysia. Our aim was to explore the safety and efficacy of s-PCNL. Methods: Institutional review board approval was obtained from the National Medical Research Register (NMRR ID-21002225-WLP). We retrospectively reviewed 115 patients with renal pelvis stones who underwent single renal access during s-PCNL between November 2020 and May 2023. Patients who underwent simultaneous ipsilateral or contralateral endourological procedures were included. The data were analysed to determine stone-free rates (SFR), major complication rates, blood transfusion rates, operative times and lengths of hospital stay (LOS). Results: The SFR was higher for the single middle calyceal renal access (MCA) group than for the lower calyceal renal access (LCA) or upper calyceal renal access (UCA) groups (OR: 1.76; 95% confidence interval [CI]: 0.63, 4.92). In total, 0, 1 and 2 patients had major complications in the UCA, MCA and LCA groups, respectively (P = 0.453). One of the 115 patients (0.9%) needed blood transfusion. Subgroup analysis revealed mean operative times of 76.3 min and 78.6 min for patients who underwent sole s-PCNL (PCNL-only group) and those who had simultaneous ipsilateral and contralateral endourological procedures (PCNL-plus group), respectively (P = 0.786). The overall mean LOS was 2.9 days. Conclusion: s-PCNL is a safe and effective alternative treatment for renal stones. We would recommend s-PCNL for patients who require an ipsilateral/contralateral endourological procedure (URS/RIRS) because it is time-efficient. All renal accesses are safe. Single MCA is recommended for complete stone clearance.

Outcomes and considerations for retrograde intrarenal surgery (RIRS) in the setting of multiple and large renal stones (>15 mm) in children: Findings from multicentre and real-world setting.

Purpose: The aim of this study is to evaluate the outcomes of retrograde intra renal surgery (RIRS) in the setting of large or multiple stones in children (<18 years). Materials and Methods: Retrospective analysis was performed of paediatric RIRS cases at nine centres worldwide over a 6-year period. Patients were divided into two groups: Group 1 had a single stone <15 mm. Group 2 had either multiple stones, maximum stone diameter of >15 mm, or both. Outcomes included stone free rate (SFR) and complications within 30 days. Results: In total, 344 patients were included with 197 and 147 in Groups 1 and 2, respectively. Ureteric access sheaths were more frequently used in Group 2 (39.5% vs. 56.8%, p = 0.021). The operation time was significantly longer in Group 2 (p < 0.001). SFR after a single procedure was 84.7% in Group 1 and 63.7% in Group 2. Overall complication rates in Groups 1 and 2 were 7.6% and 33.3%, respectively. The most frequently reported complication in both groups was post-operative fever (4.4% vs. 14%, p = 0.004). The rate of Clavien I/II complications in groups 1 and 2 was 6% and 25.1%, respectively (p < 0.05). The rate of Clavien ≥ III complications in groups 1 and 2 was 1.6% and 8.1%, respectively (p < 0.05). On multivariate analysis, total operation time, stone size and multiplicity were significant predictors of residual fragments. Conclusions: RIRS can be performed in paediatric cases with large and multiple stone burdens, but the complication rate is significantly higher when compared to smaller stones.

Impact of low-oxalate diet on hyperoxaluria among patients suffering from nephrolithiasis.

Low-oxalate diets are useful for treating hyperoxaluria in nephrolithiasis patients. This study was unique in examining how a low-oxalate diet in addition to a standard diet affected hyperoxaluria and renal function tests in nephrolithiasis patients. The effects of a low-oxalate diet were analyzed by different biochemical tests, that is, anthropometric measurements, blood oxalate test, renal function test, electrolyte profile test, and 24 h urine analysis. For this purpose, 112 patients were divided into 2 groups: Group T1 (Conventional diet) and Group T2 (Low-Oxalate diet) for 8 weeks. Each group was tested at the initiation and end of the study. Using SPSS, the obtained data from each parameter were statistically analyzed. The results showed that a low-oxalate diet had a positive effect on patients suffering from nephrolithiasis. Furthermore, after treatment, anthropometric measurement weight (kg) among the control group (T1) was 100.45 ± 5.65 and the treatment group (T2) was 79.71 ± 9.48 kg. The effect of low-oxalate diet on renal function test: creatinine (g/d) among T1 was 2.08 ± 0.86 and T2 was 1.17 ± 0.13, uric acid(mg/d) among T1 was 437.04 ± 24.20 and T2 was 364.61 ± 35.99, urinary oxalate (mg/d) among T1 was 76.84 ± 10.33 and T2 was 39.24 ± 1.51, respectively. Sodium (mEq/d) among T1 was 156.72 ± 6.37 and T2 was 159.84 ± 6.31, potassium (mEq/d) among T1 was 69.91 ± 15.37 and T2 was 89.21 ± 6.31, phosphorus (g/d) among T1 was 0.96 ± 0.07 and T2 was 0.34 ± 0.27, respectively. This study demonstrated that nephrolithiasis patients with hyperoxaluria benefit from low-oxalate diets. Hyperoxaluria patients should eat a low-oxalate diet to use oxalate without affecting metabolism and eliminate it from the kidney without stones.

Missing Renal Stone Diagnosis in Dementia Patients With Recurrent Urinary Tract Infections: A Case Report and Literature Review.

In older adults, diagnosing, treating, and preventing urinary tract infections (UTIs) can be challenging. This case is of an 82-year-old female of white descent, who was admitted to a post-acute care facility following hospitalization for delirium and a UTI. Hypoactive delirium may be the only clinical manifestation of recurrent UTI. Due to challenges in obtaining a history from this patient with dementia, she had to be admitted multiple times for sepsis. During her final hospitalization, a CT scan of the abdomen and pelvis was ordered, which revealed an obstructed kidney stone as the cause of her recurrent UTIs. Recurrent UTIs especially in patients with dementia should prompt further imaging to look for kidney stones. Factors like dehydration and poor oral intake are risk factors for kidney stones, which patients with dementia are susceptible to.

Flexible Ureteroscopy with a Tip-Flexible Pressure-Controlling Ureteral Access Sheath for Renal Stones in Children.

INTRODUCTION: The aim of this study was to evaluate the safety and efficacy of flexible ureteroscopy using a tip-flexible pressure-controlling ureteral access sheath (TFPC-UAS) for renal stones in children. METHODS: Consecutive patients aged 5-18 years with renal stones of diameter 1-3 cm were enrolled between January 2022 and November 2023 at Ganzhou People's Hospital. The patients were treated with flexible ureteroscopy using the TFPC-UAS. The renal pelvic pressure (RPP) parameters were set as follows: control value at -10 mm Hg to 5 mm Hg, warning value at 20 mm Hg, and limit value at 30 mm Hg. The infusion flow rate was set to 100-120 mL/min. A holmium laser (276 µm) was used to fragment the stone at 2.0-2.5 J/pulse with a frequency of 20-30 pulses/s. The cases were analyzed for RPP, operative time, stone-free rate, and complications. RESULTS: A total of 21 consecutive patients were included. Two patients were switched to percutaneous nephrolithotomy owing to sheath placement failure. The RPP was -4.6 ± 2.1 mm Hg. The mean operative time was 56.5 ± 17.1 min. The postoperative hospitalization time was 1.5 ± 0.3 days. The stone-free rates at 1 day and 1 month after surgery were 81.0% and 85.7%, respectively. Residual stones in 2 patients were cleared after extracorporeal shockwave lithotripsy. Three cases of Clavien I complications and one case of Clavien II complications occurred. No major complications (Clavien grade III-V) were observed. CONCLUSIONS: Flexible ureteroscopy with a TFPC-UAS is safe and effective for renal stones in children.

Vertebral Fracture Associated With Extracorporeal Shock Wave Lithotripsy: A Case Report.

Extracorporeal shock wave lithotripsy (ESWL) is considered a safe, reliable, and non-invasive modality for kidney stone management. However, there are well-established complications related to ESWL documented in the literature in the form of renal and extrarenal complications. Skeletal complications related to ESWL are rarely recorded; as far as we know, there is only one documented case report of an ESWL-related burst vertebral fracture seen in an osteoporotic patient, diagnosed as granulomatous spondylitis. Here, we present a novel case of a transverse process fracture of the third lumbar vertebra related to ESWL in a young patient otherwise free from any medical illness.

Ocular radiation exposure is negligible in normal volume endourological practice.

INTRODUCTION: The annual dose limit for radiation exposure to the eye has been reduced recently; the eye is widely recognised as one of the most radiosensitive tissues in the body. There is minimal good quality research as to the radiation dose that the eye receives during endourological surgery and this study aimed to address this. METHODS: A prospective study was performed over an 8-month period at a single large teaching hospital in the UK. Three index procedures were included: ureteric stent insertion, ureteroscopy (URS) and percutaneous nephrolithotomy (PCNL). Surgeons wore a dosimeter on the glabella with fluoroscopy time (FT) and dose area product (DAP) recorded for each case. RESULTS: A total of 404 procedures were included (247 URSs, 150 ureteric stent insertions and 7 PCNLs). Dosimeters were worn by ten surgeons. Mean FTs (URS 20.56s; ureteric stent 18.96s; PCNL 360.67s) and mean DAP (URS 100.82cGy/m2, ureteric stent 119.82cGy/m2 and PCNL 1121.62cGy/m2) were identified with significant intersurgeon variability. No surgeon had a total dosimeter dose >0.00mSv. CONCLUSIONS: The International Commission on Radiological Protection recently reduced the yearly eye dose limit from 150 to 20mSv. Cataractogenesis is no longer considered a typical deterministic effect, with a threshold level below which no effect occurs. Even in higher volume centres, these annual limits are unlikely to be reached. Lead glasses may be considered for surgeons and radiologists with the highest exposure but, for the majority, ocular radiation exposure is negligible.

Supine versus prone percutaneous nephrolithotomy in management of patient with complex renal stone diseases.

OBJECTIVES: Compare the surgical outcomes, safety, stone free rate, hospital stay, and complication of prone and supine PCNL in case of complex renal stone. MATERIALS AND METHODS: This is an observational study conducted in our institute, it consist of 120 patients over the period of 2 years from July 2021 to June 2023, all the patients were divided into two groups: 60 patients underwent modified supine percutaneous nephrolithotomy (PCNL) and remaining 60 patients underwent standard prone PCNL. The measured data included operative time, number of punctures, blood loss, stone-free rate, length of hospital stays, and rate of complications. RESULTS: The two groups were comparable in mean age, male to female ratio, number of punctures, number of tract, size of tract, residual calculi in follow up period, blood transfusion, re-do surgery, chest complication, hospital stay, and postoperative fever and pain. The mean operating time was 1.59 h in supine PCNL and 2.49 h in prone PCNL. The p value was significant (p = 0.001). CONCLUSIONS: By this study we observed that the supine PCNL is associated with statistically significant reduced operating time as compared to conventional prone PCNL with advantages of not putting the patient in prone position. The postoperative complications such as pain and fever were not significant when compared in both groups. We conclude our study and found that, the supine PCNL is an equally effective in treating complex renal stone as compared to prone PCNL.

Comparison of STONE Score, Guy's Stone Score, CROES Nomogram, and Seoul National University Renal Stone Complexity Score in Prognosticating Outcomes of Multiple-Tract Mini-Percutaneous Nephrolithotomy: A Retrospective Study.

Objective  The objective of this study was to compare the STONE score (Size of the stone, Topography or location, degree of Obstruction of the urinary system, Number of stones, and Evaluation of Hounsfield units), Guy's stone score (GSS), Clinical Research Office of the Endourological Society (CROES) nomogram, and Seoul National University Renal Stone Complexity Score (RSCS) in prognosticating multiple tract mini-percutaneous nephrolithotomy (mPCNL) outcome. Methodology This descriptive retrospective analysis was carried out at the Urology Department, Lady Reading Hospital, Peshawar, Pakistan. Male and female patients in the age range of 18-70 years who underwent multiple tract mPCNL for renal stones from July 1, 2021, to June 30, 2023, were included in the analysis. Results  A total of 110 patients were registered. Stone-free status (SFS) was achieved in 78.2% (n=86), and complications were observed in 13.6% (n=15) patients. The odds ratio for STONE score, GSS, CROES scoring system, and RSCS for predicting the SFS was 7.093 (95%CI 2.40-20.89), 9.333 (95%CI 2.92-29.81), 11.70 (95%CI 2.56-53.38) and 3.450 (95%CI 1.25-9.53), respectively. Conclusion  Multiple tract mPCNL is a safe and effective technique for the management of renal stones, producing a high stone-free rate. This study demonstrated adequate efficacy and dependability of the four scoring systems in predicting SFS.

Correlation research demonstrates that an inflammatory diet is a risk factor for calcium oxalate renal stone formation.

BACKGROUND AND AIMS: Previous studies have demonstrated associations between the Dietary Inflammatory Index (DII®), an analytical tool which evaluates the inflammatory potential of the diet according to the pro- and anti-inflammatory properties of its components, and renal stone formation. However, these have not comprehensively addressed important parameters such as stone type, gender, DII scores in stone formers (SFs) and healthy controls (Cs) and associations of DII with urine and blood chemistries. These were adopted as the survey parameters for the present study, the purpose of which was to test whether the contributory role of an inflammatory diet on stone formation could be further confirmed. METHODS: 97 calcium oxalate (CaOx) SFs and 63 Cs, matched for age and gender each completed a semi-quantitative food frequency questionnaire from which nutrient composition was computed. These data were used to calculate the DII® score. To control the effect of energy intake, energy-adjusted DII scores were calculated per 1000 kcal consumed (E-DII™). A single blood sample and two consecutive overnight (8h) urine samples were collected from a subset (n = 59 SFs and n = 54 Cs) of the overall number of particpants (n = 160). These were analysed for renal stone risk factors. Data were analysed using regression models fit in R software. RESULTS: E-DII scores were found to fit the data better than DII, so they were used throughout. E-DII scores were significantly more positive (more pro-inflammatory) in SFs than in controls in the combined gender group (-0.34 vs. -1.73, p < 0.0001) and separately in males (-0.43 vs. -1.78, p = 0.01) and females (-0.26 vs. - 1.61, p = 0.05). In blood, a significant negative correlation was seen between E-DII and HDL cholesterol. In urine significant positive correlations were seen between E-DII and each of calcium (ρ = 0.25, p = 0.02), phosphate (ρ = 0.48, p < 0.001), magnesium (ρ = 0.33, p < 0.0001) and uric acid (ρ = 0.27, p = 0.004) concentrations. A significant negative correlation was seen between E-DII and urinary volume ρ = -0.27, p = 0.003). There was no correlation between E-DII scores and the relative supersaturations of urinary CaOx, calcium phosphate (brushite) and uric acid. CONCLUSIONS: Our findings provide hitherto unreported quantitative evidence in support of the notion that the diet of calcium oxalate renal stone patients is significantly more pro-inflammatory than that of healthy controls.

Evaluation of ChatGPT for Patient Counseling in Kidney Stone Clinic: A Prospective Study.

Introduction: The potential of large language models (LLMs) is to improve the clinical workflow and to make patient care efficient. We prospectively evaluated the performance of the LLM ChatGPT as a patient counseling tool in the urology stone clinic and validated the generated responses with those of urologists. Methods: We collected 61 questions from 12 kidney stone patients and prompted those to ChatGPT and a panel of experienced urologists (Level 1). Subsequently, the blinded responses of urologists and ChatGPT were presented to two expert urologists (Level 2) for comparative evaluation on preset domains: accuracy, relevance, empathy, completeness, and practicality. All responses were rated on a Likert scale of 1 to 10 for psychometric response evaluation. The mean difference in the scores given by the urologists (Level 2) was analyzed and interrater reliability (IRR) for the level of agreement in the responses between the urologists (Level 2) was analyzed by Cohen's kappa. Results: The mean differences in average scores between the responses from ChatGPT and urologists showed significant differences in accuracy (p < 0.001), empathy (p < 0.001), completeness (p < 0.001), and practicality (p < 0.001), except for the relevance domain (p = 0.051), with ChatGPT's responses being rated higher. The IRR analysis revealed significant agreement only in the empathy domain [k = 0.163, (0.059-0.266)]. Conclusion: We believe the introduction of ChatGPT in the clinical workflow could further optimize the information provided to patients in a busy stone clinic. In this preliminary study, ChatGPT supplemented the answers provided by the urologists, adding value to the conversation. However, in its current state, it is still not ready to be a direct source of authentic information for patients. We recommend its use as a source to build a comprehensive Frequently Asked Questions bank as a prelude to developing an LLM Chatbot for patient counseling.

Factors effecting the success of retrograde intrarenal surgery in pediatric patients with renal stones: The experience of two tertiary centres with 368 renal units.

INTRODUCTION AND OBJECTIVES: Currently, in the field of pediatric urology, the primary aim of surgical approaches for the treatment of renal stone disease is to provide a stoneless state through minimally invasive methods, and to prevent the damage that such stones may cause in the urinary system and stone recurrence. The aim of this study was to evaluate the efficacy and safety of RIRS and the factors affecting its success in the surgical treatment of renal stones in pediatric patients. METHODS: Data from 357 pediatric and 368 renal units were collected retrospectively. The recorded parameters were age, gender, location and burden of the stone, and presence of postoperative residual stones. RESULTS: The stone location was the upper pole in 28 (7.6 %) patients, the middle pole in 44 (12 %), the pelvis in 98 (26.6 %), the lower pole in 139 (37.8 %), and multiple locations in 59 (16 %) patients. A stoneless state was achieved in 277 (75.3 %) units, while 91 units (24.7 %) had residual stones at the end of the first month. In the multivariate analysis, the development of residual stones was found to be significantly associated with age (odds ratio [OR], 1.123; p = 0.012) and stone location (OR, 3.142; p = 0.018). DISCUSSION: RIRS is an endourological procedure with a high success rate in the achievement of a stoneless state in both pediatric and adult age groups, with an 82-100 % success rate reported in various studies. A full stoneless state was achieved in 277 (75.3 %) units after the initial RIRS in the present study, and full stone clearance was achieved in 304 units after the second RIRS session, with a success rate of 82.6 %. A limitation of our study is that it was not performed by a single surgeon, and stone samples could not be taken from all patients for stone analysis. CONCLUSION: RIRS has also been associated with a high success rate in the endoscopic treatment of renal stones and is an efficient and safe method with a minimal rate of complications, especially in the pediatric age group.

Glycolate oxidase-1 gene variants influence the risk of hyperoxaluria and renal stone development.

PURPOSE: Oxalate is an excellent calcium ion attractor with great abundance in the human body, and the liver is the major source of oxalate. The Glycolate oxidase-1 (GOX1) gene is solely responsible for the glycolate and glyoxylate metabolism and produces oxalate. This study has been designed to comprehend the association of genetic variants of the GOX1 gene with the risk of hyperoxaluria and renal stone disease in the Indian population. METHOD: The present study is a candidate gene approach prospective case-control study carried out on 300 participants (150 cases and 150 controls) at Muljibhai Patel Urological Hospital, Gujarat, India. Biochemical parameters, including serum levels of calcium, creatinine, parathyroid hormone, and 24-h urine metabolites, were performed. The genotyping of GOX1 gene variants rs6086287, rs2235250, rs2255183, and rs2294303 was performed using a customized TaqMan assay probe by RT-PCR. RESULT: Parathyroid hormone, serum creatinine, and urine metabolites were significantly elevated in nephrolithiasis compared to healthy individuals. All mutated homozygous genotypes GG (rs6086287), TT (rs2235250), GG (rs2255183), and CC (rs2294303) were significantly associated with a high risk of renal stone disease. Individuals diagnosed with hyperoxaluria and carrying TG (rs6086287), AG (rs2255183), and TT (rs2294303) genotypes have a significantly high risk of renal stone disease. Moreover, haplotype analysis and correlation analysis also confirmed the strong association between genetic variants and nephrolithiasis. CONCLUSION: Genetic variants of the GOX1 genes were associated with renal stone disease. In the presence of risk genotype and hyperoxaluria, the susceptibility to develop renal stone disease risk gets modulated.

Risk factors of stone residual after retrograde intrarenal surgery: A prospective cohort study.

BACKGROUND: Complete removal of renal stones is crucial for optimal patient outcomes, but recent studies have reported residual stones after retrograde intrarenal surgery (RIRS). This study aimed to identify the associated risk factors to improve patient management and treatment selection. METHODS: This cohort study was conducted over 18 months at two hospitals and recruited adult patients with renal stones less than 3 cm. Preoperative assessment included medical history, physical examination, laboratory tests, and radiological imaging. Intraoperative and postoperative data collection and follow-up were conducted to evaluate surgical success and potential complications. RESULTS: A total of 100 patients were included, with a mean age of 45.3 ± 10.7 years and a mean BMI of 26.2 ± 1.4 kg/m2. Approximately 19% of the patients had residual stones after the RIRS procedure. The RUSS score showed good diagnostic performance with an AUC of 0.843, and the optimal cut point was ⩾2.0 with a sensitivity of 52.6% and specificity of 95.1%. Independent predictors of residual stones were multiple sites (OR = 24.98; p = 0.002), multiple stones (OR = 13.62, p = 0.002), stone size of 21-30 mm (OR = 4.91, p = 0.038), lower calyx site (OR = 4.85, p = 0.033), and surgeon experience of fewer than 50 cases (OR = 6.82, p = 0.020). CONCLUSIONS: This study identifies several factors associated with residual stones after RIRS for renal stones, including stone size, location, number, and surgeon experience. The study suggests that the RUSS score can be used as a reliable tool for predicting the likelihood of residual stones, which can help clinicians in patient selection and treatment planning.

A comparison of S.T.O.N.E nephrolithometry scoring system, Guy's stone score, and Seoul National University Renal Stone Complexity (S-ReSC) in predicting mini-PCNL stone-free rate.

The main goal of the study is to evaluate the three stone scoring systems (S.T.O.N.E nephrolithometry scoring system (STONE), Guy's stone score (GSS) and Seoul National University Renal Stone Complexity (S-ReSC)) for the stone-free rate (SFR) of mini-PCNL. We retrospectively analyzed 72 patients who received mini-PCNL from February 2018 to October 2020. The SFR, complication rates, hospitalization days and recurrence rates were analyzed using three stone scoring systems. The result showed statistical significance in the association between scoring system and stone-free (STONE: OR 95%CI 0.409 (0.221-0.759), p = 0.0045; S-ReSC OR 95%CI 0.633 (0.401-0.999), p = 0.0497), but not GSS (OR 95%CI 0.776 (0.397-1.516), p = 0.4581). After adjusting the potential confounding factors, the area under curve (AUC) of STONE, GSS, and S-ReSC was 0.86, 0.78, and 0.81, respectively, and Akaike information criterion (AIC) of STONE, GSS, and S-ReSC was 64.65, 74.89, and 69.92, respectively. The accuracy rate of STONE, GSS, and S-ReSC was 0.81, 0.75, and 0.79, respectively. There was no statistically difference of predicting stone recurrence (p = 0.46, 0.53, 0.86), complications (p = 0.74, 0.51, 0.16) and hospitalization days (p = 0.77, 0.86, 0.87) in STONE, GSS, and S-ReSC, respectively. In conclusion, both the STONE and S-ReSC stone scoring systems are viable for predicting the SFR following mini-PCNL, especially after variable adjustment with the STONE system demonstrating superiority over S-ReSC.

Can Perioperative Antibiotic Choice Impact Rates of Infectious Complications After Percutaneous Nephrolithotomy? A Single-Blind, Prospective Randomized Trial.

Objective: National guidelines recommend periprocedural antibiotics before percutaneous nephrolithotomy (PCNL), yet it is not clear which is superior. We conducted a randomized trial to compare two guideline-recommended antibiotics: ciprofloxacin (cipro) vs cefazolin, on PCNL outcomes, focusing on the development of systemic inflammatory response syndrome (SIRS) criteria. Methods: Adult patients who were not considered high risk for surgical or infectious complications and undergoing PCNL were randomized to receive either cipro or cefazolin perioperatively. All had negative preoperative urine cultures. Demographic and perioperative data were collected, including SIRS criteria, intraoperative urine culture, duration of hospitalization, and need for intensive care. SIRS is defined by ≥2 of the following: body temperature <96.8°F or >100.4°F, heart rate >90 bpm, respiratory rate >20 per minute, and white blood cell count <4000 or >12,000 cells/mm3. Results: One hundred forty-seven patients were enrolled and randomized (79 cefazolin and 68 cipro). All preoperative characteristics were similar (p > 0.05), except for mean age, which was higher in the cipro group (64 vs 57 years, p = 0.03). Intra- and postoperative findings were similar, with no difference between groups (p > 0.05), except a longer mean hospital stay in the cefazolin group (2 hours longer, p = 0.02). There was no difference between SIRS episodes in both univariate and multivariate analyses. Conclusions: Despite the relatively broader coverage for urinary tract pathogens with ciprofloxacin, this prospective randomized trial did not show superiority over cefazolin. Our findings therefore support two appropriate options for perioperative antibiotic prophylaxis in patients undergoing PCNL who are nonhigh risk for infectious complications.

Evaluation of the safety and efficiency of color Doppler ultrasound-guided percutaneous nephrolithotomy in clinical practice: results from a retrospective study.

This study evaluated the clinical value of color Doppler ultrasound-guided percutaneous nephrolithotomy (PCNL) in avoiding bleeding caused by punctured blood vessels. Herein, we retrospectively included patients who underwent color Doppler ultrasound-guided PCNL or PCNL using the conventional channel technique from August 2018 to August 2022. The clinical characteristics of patients during surgery, complications, and hospital stay were recorded and compared. Overall, 228 patients were enrolled, with 126 patients (age, 47.6 ± 13.2 years; men: 57.14%) in the color Doppler ultrasound-guided PCNL group and 102 patients (age, 46.6 ± 12.3 years) in the B-mode ultrasound-guided puncture group. The total operation time (63.5 ± 15.5 vs. 61.3 ± 16.3 min, p = .5236) and stone clearance rate (86.50% vs. 83.33%, p = .7139) were similar between the two groups. However, the puncture time for the color Doppler ultrasound-guided PCNL group was longer than that for the B-mode ultrasound-guided puncture group (5.1 ± 2.3 vs. 2.6 ± 1.6 min, p = .0019). Moreover, the length of postoperative hospital stay in the color Doppler ultrasound-guided PCNL group reduced significantly by ∼1 day compared with that in the B-mode ultrasound-guided puncture group (4.5 ± 1.6 vs. 5.6 ± 2.1 days, p = .0087). The blood transfusion rate (1.58% vs. 4.9%, p = .0399), sedation-related adverse event rate (0.79% vs. 2.9%, p = .0332), perineal hematoma incidence (0% vs. 2.94%, p < .0001), and serum decreased hemoglobin levels (12.2 ± 9.7 vs. 23.5 ± 10.1 g/L, p < .001) after color Doppler ultrasound-guided PCNL were significantly lower than those after B-mode ultrasound-guided puncture. The stone clearance rate was similar between the two groups, with a similar operation time. Moreover, color Doppler ultrasound-guided PCNL shortened the postoperative hospital stay and decreased Hb levels, blood transfusion rate, and perineal hematoma incidence.

Dietary Magnesium Intake and Kidney Stone: The National Health and Nutrition Examination Survey 2011-2018.

BACKGROUND: The association between dietary magnesium intake (DMI) and kidney stone (KS) disease is not clear. AIM: To determine the association between DMI and prevalent KS disease defined as self-report of any previous episode of KS. METHODS: We examined The National Health and Nutrition Examination Survey (NHANES) 2011-2018 and used logistic regression analyses adjusting for demographics, BMI, histories of hypertension, diabetes, thiazide use, cigarette smoking, alcohol drinking, relevant dietary and supplemental intakes to determine the independent association between DMI and prevalent KS disease. RESULTS: A total of 19,271 participants were eligible for the final analysis, including 1878 prevalent KS formers. Mean DMI among stone formers was 295.4 mg/day, as compared to 309.6 mg/day among non-stone formers (p=0.02). Higher DMI was strongly associated with lower odds of prevalent KS disease in univariate analysis regardless of when DMI was analyzed as a continuous variable (OR=0.94, 95% CI: 0.89-0.99, p=0.02) or when the extreme quartiles of DMI were compared (OR=0.74, 95% CI: 0.60-0.92, p=0.007). In the multivariable-adjusted regression analysis, those in the highest quartile of DMI compared to the lowest quartile (≥379 mg vs. <205 mg) had significantly reduced odds of prevalent KS (OR=0.70, 95% CI: 0.52-0.93, p=0.01). When DMI was analyzed as a continuous variable, there was a trend toward reduced odds of prevalent KS disease with higher DMI (OR=0.92 per 100 mg, 95% CI: 0.84-1.01, p=0.07). CONCLUSIONS: Our study suggests that higher DMI is associated with a reduced risk of KS disease. Future prospective studies are needed to clarify the causal relationship between DMI and KS disease.