Endoscopic Combined Intrarenal Surgery: best practices and future perspectives.

INTRODUCTION: Endoscopic Combined Intrarenal Surgery (ECIRS) has emerged as a promising technique for the management of large and complex kidney stones, potentially offering advantages over traditional Percutaneous Nephrolithotomy (PCNL). This study aims to evaluate best practices, outcomes, and future perspectives associated with ECIRS. MATERIALS AND METHODS: A comprehensive PubMed search was conducted from 2008 to 2024, using MESH terms and the following key words: "ECIRS" and "Endoscopic Combined Intrarenal Surgery" The search yielded 157 articles, including retrospective cohort studies, two randomized controlled trials (RCTs), and four meta-analyses comparing ECIRS with PCNL. Most important findings were summarized regarding indications, patient positioning, kidney access, tract size, surgical outcomes, and complications. RESULTS: ECIRS demonstrated higher stone-free rate, lower complication rate, and a reduced need for multiple procedures compared to traditional PCNL. Additionally, ECIRS has the potential to integrate new technologies to further enhance outcomes. CONCLUSION: ECIRS demonstrates significant advantages in the management of large kidney stones. Future research should focus on well-designed RCTs to provide robust evidence of its efficacy, safety, and cost-effectiveness, potentially establishing ECIRS as the first option treatment for complex kidney stones.

Risk factors and prediction model for postoperative complications in patients with struvite stones after percutaneous nephrolithotomy and flexible ureteroscopy.

OBJECTIVE: To analyze the risk factors for complications in patients with struvite stones following percutaneous nephrolithotomy (PCNL) or flexible ureteroscopy (fURS), and to establish a nomogram for postoperative complications in patients following PCNL. METHODS: A retrospective analysis was conducted on patients with struvite stones after PCNL and fURS at the Department of Urology, Peking University People's Hospital, from January 2012 to March 2022. The common pathogens and antimicrobial susceptibilities in preoperative midstream urine culture were analyzed. Logistic regression analyses were used to evaluate the risk factors. Receiver-operating characteristic (ROC) curve, calibration plots, and decision curve analysis (DCA) were used to assess the discrimination, accuracy, and practicability of the nomogram. RESULTS: 332 patients with struvite stones received one-stage PCNL or fURS, including 243 cases of PCNL and 89 cases of fURS. 72 patients (21.69%) developed postoperative complications. The most common pathogens in preoperative urine cultures were Escherichia coli, Proteus mirabilis, and Enterococcus faecalis. Multivariate logistic regression analysis showed that preoperative hemoglobin (OR = 0.981, P = 0.042), staghorn stone (OR = 4.226, P = 0.037), and positive preoperative midstream urine culture (OR = 2.000, P = 0.043) were independent risk factors for postoperative complications in patients following PCNL. The nomogram showed good performance in discrimination, accuracy, and applicability. CONCLUSION: Preoperative hemoglobin, staghorn stone, and positive preoperative midstream urine culture were independent risk factors for postoperative complications in patients with struvite stones following PCNL. A nomogram was developed to predict the probability of postoperative complications.

Familial aggregation of urolithiasis: findings from a Nationwide Middle Eastern study.

This study aimed to determine the potential effect of genetic factors and positive family history on the familial aggregation of urolithiasis in Iran. Of the total 44,186 participants in the Iran National Stone Survey (INSS) database, 34,953 individuals who were members of 8629 nuclear families were included in this study. The mean prevalence of urolithiasis was 5.7% [95%CI: 5.5 - 6.0%] in this subpopulation. Familial aggregation of urolithiasis was analyzed in 34,745 participants (99.6% of those originally included) utilizing a multivariable logistic regression with second order generalized estimating equations approach (GEE2) to adjust for sex, age, urbanization status and ethnicity. Recurrence risk ratios (λ) were used to evaluate the degree of familial aggregation. Our multivariable analysis demonstrated a strong familial aggregation of urolithiasis within sibling pairs (λs = 78.35), parent-offspring pairs (λo = 40.12) and spouse pairs (λsp = 21.62). The respective ORs were 5.65 [95%CI: 3.49, 9.14] for siblings, 2.85 [95%CI: 2.20, 3.68] for parents and 1.27 [95%CI: 1.06, 1.54] for spouses. Urinary stone disease tends to aggregate in families with a positive history of urolithiasis in either the parents or siblings. Siblings have a more prominent effect in inducing familial aggregation compared to parents. Despite the prominent role of familial genetic components in urolithiasis aggregation, shared environmental factors appear to partake in this phenomenon to some extent, as suggested by urolithiasis aggregation among spouse pairs.

Ureteroscopy vs laparoscopic ureterolithotomy for large proximal ureteric stone: a randomised trial.

OBJECTIVE: To compare the outcomes of retrograde flexible ureteroscopy (fURS) with retroperitoneal laparoscopic ureterolithotomy (RLU) for large proximal ureteric stones. PATIENTS AND METHODS: A prospective randomised trial was conducted from January 2018 through December 2022 including patients with impacted proximal ureteric stones of 15-25 mm. Patients underwent fURS or RLU. Primary outcome was the stone-free rate. Demographic data, stone features, and complications rates were also compared between groups. RESULTS: A total of 64 patients were enrolled, 32 in each group. The mean impacted stone time was similar between groups, as well as stone size (17 mm) and stone density (>1000 Hounsfield Units). The ureteric stone-free rates between the two groups (93.7% in fURS vs 96.8% in RLU; odds ratio [OR] 0.72, 95% confidence interval [CI] -1.72 to 3.17; P = 0.554), and overall success rates, which take into account residual fragments in the kidney (84.3% in fURS vs 93.7% in RLU; OR 1.02, 95% CI -0.69 to 2.74; P = 0.23), were similar. Operative time was also not statistically significantly different between groups (median 80 vs 82 min; P = 0.101). There was no difference in hospital length of stay. Retropulsion rate was higher with fURS (65.6% vs 3.1%; p < 0.001). Residual hydronephrosis (34.3% each group) and complication rates did no differ according to treatment. CONCLUSION: Flexible URS and RLU are both highly efficient and present low morbidity for large impacted proximal ureteric stone treatment. RLU is not superior to fURS.

Plant-based therapies for urolithiasis: a systematic review of clinical and preclinical studies.

PURPOSE: Urolithiasis, the formation of kidney stones, is a common and severe condition. Despite advances in understanding its pathophysiology, affordable treatment options are needed worldwide. Hence, the interest is in herbal medicines as alternative or supplementary therapy for urinary stone disease. This review explores the use of plant extracts and phytochemicals in preventing and treating urolithiasis. METHODS: Following PRISMA standards, we systematically reviewed the literature on PubMed/Medline, focusing on herbal items evaluated in in vivo models, in vitro studies, and clinical trials related to nephrolithiasis/urolithiasis. We searched English language publications from January 2021 to December 2023. Studies assessing plant extracts and phytochemicals' therapeutic potential in urolithiasis were included. Data extracted included study design, stone type, plant type, part of plant used, solvent type, main findings, and study references. RESULTS: A total of 64 studies were included. Most studies used ethylene glycol to induce hyperoxaluria and nephrolithiasis in rat models. Various extraction methods were used to extract bioactive compounds from different plant parts. Several plants and phytochemicals, including Alhagi maurorum, Aerva lanata, Dolichos biflorus, Cucumis melo, and quercetin, demonstrated potential effectiveness in reducing stone formation, size, and number. CONCLUSIONS: Natural substances offer an alternative or supplementary approach to current treatments, potentially reducing pain and improving the quality of life for urolithiasis patients. However, further research is needed to clarify their mechanisms of action and optimize their therapeutic use. The potential of plant-based therapies in treating urolithiasis is promising, and ongoing research is expected to lead to treatment advancements benefiting patients globally.

Management of Kidney Stones in Pregnancy: A Worldwide Survey of Practice Patterns.

Introduction: Kidney stones in pregnant is not a common emergency, but it is one that is extremely challenging to manage. There exists no previous survey, which maps the different practice patterns adopted. Our aim was to deliver a survey to evaluate the current status of practice patterns across different parts of the world regarding the management of stone disease in pregnancy. Methods: Through an iterative process, 19-item survey was devised. This contained the following five sections: (1) Demographics, (2) General items, (3) Diagnosis and Imaging, (4) Initial management, (5) Surgery. It was disseminated via social media and email chains. Results: A total of 355 responses were collected, and the majority (66.2%) reported no established hospital protocol for stones in pregnancy. Ultrasound was the most popular first line imaging choice (89.9%) but 8% would choose non-contrast CT. The latter was also chosen as second line choicer in 34.6% as opposed to magnetic resonance imaging. A large proportion (42.5%) had requested CT in pregnancy previously. With equivocal ultra sound results, only 19.4% would proceed to ureteroscopy (URS) but 40.9% would opt for CT. Twenty-four-48 hours were the most popular (37.6%) time period to observe before surgical intervention. Ureteral stent and nephrostomy were regarded as equally effective, and 6 weeks was most popular frequency for an exchange. Most do not use fetal heart rate monitoring intraoperatively. A total of 3.94% had previously performed percutaneous nephrolithotomy during pregnancy. Conclusion: Practice patterns vary widely for suspected kidney stones in pregnancy and use of CT appears increasingly popular. This includes when faced with equivocal ultrasound results and instead of proceeding to ureteroscopy. Most hospitals lack an established management protocol for this scenario.

Effects of integrated nursing and psychological intervention on pain relief and patient satisfaction in urinary calculi patients.

OBJECTIVE: We aimed to assess the impact of integrated nursing and psychological intervention on pain intensity and patient satisfaction in individuals with urinary calculi. METHODS: This retrospective study included 94 urological patients from the Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, between January 2020 and June 2022. Participants were divided into a control group (n=48), receiving routine nursing and psychological intervention, and a study group (n=46), receiving integrated nursing and psychological intervention. We compared pain intensity, pain relief rate, patient satisfaction, Numeric Rating Scale (NRS) score, Pittsburgh Sleep Quality Index (PSQI) score, Self-rating Depression Scale (SDS) score, Self-rating Anxiety Scale (SAS) score, and quality of life scores between the groups. RESULTS: The study group had shorter hospital stays and lower hospitalization costs than the control group (both P < 0.05). Pain relief and satisfaction rates were higher in the study group (both P < 0.05). Post-intervention, both groups showed significant reductions in NRS, PSQI, SDS, and SAS scores, with greater reductions in the study group (all P < 0.05). Quality of life scores increased in both groups, more so in the SG (P < 0.05). The study group also had fewer adverse events (P < 0.05). Both groups showed decreased serum creatinine and blood urea nitrogen levels post-intervention, with a more significant decline in the study group (P < 0.05). Education, marital status, and occupation were major factors influencing outcomes in urinary calculi patients. CONCLUSION: Integrated nursing and psychological intervention significantly alleviates pain, improves emotional well-being, enhances sleep quality, increases overall life quality, and contributes to high patient satisfaction among urinary calculi patients.

Predictors of Recurrent Urolithiasis in Iran: Findings from a Nationwide Study.

BACKGROUND: Prevention of urinary stone recurrence is the ultimate goal in urolithiasis patients. In this study, we aimed to investigate the national prevalence rate and possible determinants of increased urolithiasis recurrence risk in a nationwide study in Iran. METHODS: All data regarding stone occurrence and recurrence episodes were extracted from the cross-sectional Iran National Stone Survey (INSS) study, and the possible determinants of recurrence were evaluated in the subset of 2913 patients who had a positive history of at least one episode of urolithiasis. RESULTS: The national prevalence rate of recurrent urolithiasis was 2.6% (95% CI: 2.5, 2.8) in Iran. Moreover, the relative ratio of recurrent stone formers to all stone formers was 39.8% (95% CI: 38.0, 41.6). Our univariable truncated negative binomial regressions suggested that a positive history of urolithiasis in the patient's father (prevalence ratio [PR] [95% CI]=1.83 [1.39, 2.41], P<0.001), mother (PR [95% CI]=1.92 [1.39, 2.66], P<0.001) or brother (PR [95% CI]=1.32 [1.03, 1.69], P=0.026); and residence in urban areas (PR [95% CI]=1.27 [1.04, 1.55], P=0.016) were significant predictors of repetitive recurrence episodes. However, when incorporated into a multivariable truncated negative binomial regression model, the only significant predictors of more frequent recurrence episodes were a positive history in father (PR [95% CI]=1.66 [1.24, 2.22], P<0.001) and mother (PR [95% CI]=1.68 [1.20, 2.36], P=0.002); and urban residence (PR [95% CI]=1.24 [1.01, 1.51], P=0.031). CONCLUSION: Our results indicate that a positive family history of urolithiasis in mother and father and residence in urban areas are the significant predictors of recurrence risk in urolithiasis patients in Iran.

Patients undergoing double J substitution with a pigtail suture stent report a significant decrease of stent-related symptoms. Results from a prospective multicenter longitudinal trial.

PURPOSE: To compare stent-related symptoms (SRS) in patients with double J (DJ) undergoing substitution with a pigtail suture stent (PSS) after ureteroscopy (URS), through the Ureteral Stent Symptom Questionnaire (USSQ). MATERIALS AND METHODS: Patients with DJ undergoing URS for stone treatment were enrolled in this prospective multicenter longitudinal study. The USSQ was submitted thrice: 2 weeks after DJ, 2 weeks after PSS and 4 weeks after PSS removal (baseline). PRIMARY ENDPOINT: to compare Urinary Symptom Index Score and the rate of patients with pain 2 weeks after DJ and PSS. Secondary endpoints: to compare other USSQ scores and single answers 2 weeks after DJ and PSS, and DJ and PSS USSQ scores with baseline. RESULTS: 93 patients were enrolled. 2 weeks Urinary Symptom Index Score (p < 0.001) and the percentage of patients complaining of pain (60.2% vs 88.2%, p < 0.001) were significantly in favour of PSS compared to DJ. 2 weeks scores were significantly improved with PSS compared to DJ: Pain Index (p < 0.001), VAS (p < 0.001), General Health Index (p < 0.001) and Work Performance Index (p < 0.001). All urinary symptoms were significantly decreased with PSS, including renal pain during micturition and pain interfering with life. Pain Index Score (p = 0.622) and VAS (p = 0.169) were comparable to baseline with PSS, while differed with DJ. CONCLUSIONS: Patients undergoing DJ substitution with PSS after URS report a significant decrease of SRS. Urologists may consider positioning PSS after URS in pre-stented patients to reduce the impact of SRS.

[Prevention of recurrence of urolithiasis]. / Rezidivprävention der Urolithiasis.

Urolithiasis is one of the most frequent urological diseases. Identifying the causes of stone formation forms the basis for successful prevention of recurrence. Metabolic diagnostics and measures for prevention of recurrence are based on the assignment of the patient to a low-risk or high-risk group. Analysis of the urinary calculi is an essential prerequisite for identifying patients at risk. The general recommendations on diet and lifestyle are considered to be the basis of treatment. Depending on the type of stone and the individual biochemical risk profile of a patient, these general measures should be supplemented by targeted medical nutrition therapy and pharmacological treatment. Mixed stones can pose a challenge for the treatment and prevention of recurrence. A personalized treatment decision that takes the various components of mixed stones into account could further improve the prevention of recurrence of urolithiasis.

Automatic Urinary Stone Detection System for Abdominal Non-Enhanced CT Images Reduces the Burden on Radiologists.

To develop a fully automatic urinary stone detection system (kidney, ureter, and bladder) and to test it in a real clinical environment. The local institutional review board approved this retrospective single-center study that used non-enhanced abdominopelvic CT scans from patients admitted urology (uPatients) and emergency (ePatients). The uPatients were randomly divided into training and validation sets in a ratio of 3:1. We designed a cascade urinary stone map location-feature pyramid networks (USm-FPNs) and innovatively proposed a ureter distance heatmap method to estimate the ureter position on non-enhanced CT to further reduce the false positives. The performances of the system were compared using the free-response receiver operating characteristic curve and the precision-recall curve. This study included 811 uPatients and 356 ePatients. At stone level, the cascade detector USm-FPNs has the mean of false positives per scan (mFP) 1.88 with the sensitivity 0.977 in validation set, and mFP was further reduced to 1.18 with the sensitivity 0.977 after combining the ureter distance heatmap. At patient level, the sensitivity and precision were as high as 0.995 and 0.990 in validation set, respectively. In a real clinical set of ePatients (27.5% of patients contain stones), the mFP was 1.31 with as high as sensitivity 0.977, and the diagnostic time reduced by > 20% with the system help. A fully automatic detection system for entire urinary stones on non-enhanced CT scans was proposed and reduces obviously the burden on junior radiologists without compromising sensitivity in real emergency data.

Etiology and management of urethral calculi: A systematic review of contemporary series.

Objective: To conduct a systematic literature review on urethral calculi in a contemporary cohort describing etiology, investigation, and management patterns. Methods: A systematic search of MEDLINE and Cochrane Central Register of Controlled Trials (CENTRAL) databases was performed. Articles, including case reports and case series on urethral calculi published between January 2000 and December 2019, were included. Full-text manuscripts were reviewed for clinical parameters including symptomatology, etiology, medical history, investigations, treatment, and outcomes. Data were collated and analyzed with univariate methods. Results: Seventy-four publications met inclusion criteria, reporting on 95 cases. Voiding symptoms (41.1%), pain (40.0%), and acute urinary retention (32.6%) were common presenting features. Urethral calculi were most often initially investigated using plain X-ray (63.2%), with almost all radio-opaque (98.3%). Urethral calculi were frequently associated with coexistent bladder or upper urinary tract calculi (16.8%) and underlying urethral pathology (53.7%) including diverticulum (33.7%) or stricture (13.7%). Urethral calculi were most commonly managed with external urethrolithotomy (31.6%), retrograde manipulation (22.1%), and endoscopic in situ lithotripsy (17.9%). Conclusion: This unique systematic review of urethral calculi provided a summary of clinical features and treatment trends with a suggested treatment algorithm. Management in contemporary urological practice should be according to calculus size, shape, anatomical location, and presence of urethral pathology.

A novel post-percutaneous nephrolithotomy sepsis prediction model using machine learning.

OBJECTIVES: To establish a predictive model for sepsis after percutaneous nephrolithotomy (PCNL) using machine learning to identify high-risk patients and enable early diagnosis and intervention by urologists. METHODS: A retrospective study including 694 patients who underwent PCNL was performed. A predictive model for sepsis using machine learning was constructed based on 22 preoperative and intraoperative parameters. RESULTS: Sepsis occurred in 45 of 694 patients, including 16 males (35.6%) and 29 females (64.4%). Data were randomly segregated into an 80% training set and a 20% validation set via 100-fold Monte Carlo cross-validation. The variables included in this study were highly independent. The model achieved good predictive power for postoperative sepsis (AUC = 0.89, 87.8% sensitivity, 86.9% specificity, and 87.4% accuracy). The top 10 variables that contributed to the model prediction were preoperative midstream urine bacterial culture, sex, days of preoperative antibiotic use, urinary nitrite, preoperative blood white blood cell (WBC), renal pyogenesis, staghorn stones, history of ipsilateral urologic surgery, cumulative stone diameters, and renal anatomic malformation. CONCLUSION: Our predictive model is suitable for sepsis estimation after PCNL and could effectively reduce the incidence of sepsis through early intervention.

Distribution and antimicrobial resistance patterns of urinary pathogens in preoperative midstream urine cultures from Chinese patients with urinary calculi: a meta-analysis.

BACKGROUND AND OBJECTIVE: This study comprehensively evaluates the distribution patterns and antimicrobial resistance profiles of urinary pathogens in Preoperative midstream urine cultures collected from patients with urinary calculi in China over the last two decades. METHODS: A cross-sectional analysis of 41 studies was conducted. A systematic search across various databases, including Wanfang Data, CNKI, SinoMed, Embase, PubMed, and Web of Science, was carried out, covering the time period from 2002 to 2022. Using R 4.2.1 software, a meta-analysis was performed to assess heterogeneity using Cochran's Q test and the I2 statistic. RESULTS: In the analysis of preoperative midstream urine cultures from Chinese patients with urinary calculi, gram-negative bacteria dominated at 69%, with Escherichia coli (43%), Klebsiella pneumoniae (8%), Proteus mirabilis (6%), Pseudomonas aeruginosa (5%), Acinetobacter baumannii (3%), and Enterobacter cloacae (4%) being prominent. Gram-positive organisms included Enterococcus faecalis (9%), Enterococcus faecium (5%), and Staphylococcus aureus (4%). Over time, proportions of Proteus mirabilis, Enterococcus faecalis, and Staphylococcus aureus decreased, while Klebsiella pneumoniae and Pseudomonas aeruginosa increased. Notably, Escherichia coli proportion reduced from 37 to 33% within the last two decades. Antimicrobial resistance analysis indicated declining resistance in E. coli (e.g., co-trimoxazole from 73 to 55%, gentamicin from 64 to 40%), but rising resistance in piperacillin and cefotaxime (34-60%). Enterococcus faecalis exhibited increasing resistance to ampicillin (5-69%), gentamicin (59-94%), and tetracycline (77-89%) over time, while resistance to levofloxacin and ciprofloxacin notably decreased (72-16% and 49-8%, respectively). CONCLUSION: Over the past two decades, the proportion of gram-negative bacteria was declined, while the proportion of gram-positive bacteria increased. Escherichia coli remained the most common pathogen in the urine culture of patients with urinary calculi in China and the resistance of Escherichia coli to commonly used antibiotics increased. Clinicians should select appropriate antibiotics according to the results of urine culture and drug sensitivity test to reduce the occurrence of antibiotic resistance.

Wisely Choosing a Fast-Food Burger Meal Results in Meaningful Reduction in Sodium: Implications for Kidney Stone Patients.

OBJECTIVE: Stone formers trying to limit dietary sodium may be unable to give up fast food. For the classic American hamburger, it is unclear if lower sodium preparations of this item are available and how this could affect sodium intake. We determined the impact of careful selection at national chains. METHODS: Nutritional guides for 14 national chains were analyzed for all beef-based burgers and french fries. A meal was defined as 1 burger and an order of fries. The daily sodium limit (recommended daily sodium allowance [RDA]) was considered to be 2,300 mg. The maximal sodium reduction was defined as the difference between the highest and lowest sodium-containing meals. The Kruskal-Wallis test with Dunn's method was used to compare food items among the chains. RESULTS: Of the total 263 different burgers and 74 different fries, median sodium was 1130 mg (range 180-3520) and 565 mg (range 30-1480), respectively. Mean sodium for burgers at individual chains ranged from a low of 590 mg to a high of 1721 mg (P < .001). The mean sodium for fries at individual chains ranged from a low of 245 mg to a high of 947 mg (P < .001). Post-hoc testing revealed 26 significant differences between pairs of restaurants for sodium content of burgers with P < .05 for each. The median maximal sodium reduction among the different chains was 1925 mg. Depending on the chain, sodium content of 1 meal could be reduced by as little as 830 mg (36% RDA) or as much as 3360 mg (146% RDA) by careful selection. CONCLUSION: Stone formers should be aware of significant variation in sodium content of burgers and fries among chains and within a chain. Wisely selecting just 1 fast-food burger meal can significantly reduce sodium intake.

Has the COVID-19 pandemic affected ureteral stone management in pregnant women? A retrospective single-center study.

INTRODUCTION: This study aimed to evaluate the effect of coronavirus disease (COVID-19) on the patients' referral in the pregnant population and also investigate each treatment approach's advantages and disadvantages for acute renal colic in pregnancy. METHODS: In this retrospective study, we included all pregnant women with ureteral stones referred to a referral center between January 2019 and March 2021. RESULTS: Among 53 pregnant women, 18 (33.9%) were on conservative therapy, which passed the stone without any complications. Double J stent or nephrostomy tube insertion was done for 24 patients (45.2%). Seventeen of these patients (70.8%) presented post-surgical complications, including hematuria (29.2%), pyelonephritis (20.8%), and lower urinary tract symptoms (20.8%). Transurethral lithotripsy (TUL) was done in 11 patients (20.7%). Only one of these patients developed hematuria following TUL. Thus, in our population study, double J stent or nephrostomy insertion was associated with a higher chance of postoperative complications than TUL (p-value = 0.001). Thirty-six patients were referred within 13 months before the entry of COVID-19, while 17 were referred during a similar approximate duration after the COVID-19 entry into the country. Only the initial presentation had a significant difference between these two periods (p-value = 0.034). CONCLUSIONS: When conservative treatment fails, we recommend TUL as the second-line treatment over temporary procedures, such as double J stent or nephrostomy insertion. Of note, in a group of patients with an emergent clinical setting, including active infection, deteriorating renal function, signs of preterm labor, solitary kidney, etc., double J or nephrostomy tube insertion remains the preferred management method for its fast resolution of obstruction and infection. Besides, a decrease in visits with an increase in complicated cases after COVID-19 was observed, maybe due to a delay in referring.

The causal association between smoking, alcohol consumption and risk of upper urinary calculi: insights from a Mendelian randomization study.

Background: The causal link between smoking, alcohol consumption, and upper urinary calculi remains uncertain in observational studies due to confounding factors. To uncover potential causal associations, we utilized two-sample univariable and multivariable Mendelian randomization (MR) methods. Methods: Five risk factors related to lifestyles (cigarettes per day, lifetime smoking index, smoking initiation, drinks per week and alcohol intake frequency) were chosen from the Genome-Wide Association Study (GWAS). Upper urinary calculi were obtained from the FinnGen and United Kingdom Biobank consortium. Inverse-variance-weighted (IVW) was mainly used to compute odds ratios (OR) and 95% confidence intervals (Cl). While diligently scrutinizing potential sources of heterogeneity and horizontal pleiotropy via the rigorous utilization of Cochran's Q test, the MR-PRESSO method, and MR-Egger. Results: The summary OR for upper urinary calculi was 0.6 (IVW 95% CI: 0.49-0.74; p = 1.31 × 10-06) per standard deviation decrease in drinks per week. Interestingly, the genetically predicted alcohol intake frequency was associated with a significantly increased risk upper urinary calculi (OR = 1.27; 95% CI: 1.11-1.45; p = 0.0005). Our study found no association between smoking initiation, the number of cigarettes per day, and the lifetime smoking index and the risk of upper urinary calculi. By adjusting for body mass index and education, estimates of drinks per week remained consistent in multivariate MR analyses, while alcohol intake frequency became non-significant. Conclusion: MR analysis showed that drinks per week was negatively associated with upper urinary calculi, whereas the effect of tobacco on upper urinary calculi was not significant and the detrimental effect of alcohol intake frequency on upper urinary calculi became non-significant after adjusting for BMI and education.

The Consecutive 200 Cases of Endoscopic-Combined Intrarenal Surgery: Comparison between Standard and Miniature Surgeries.

Background and Objectives: Percutaneous nephrolithotomy (PCNL) is still the gold-standard treatment for large and/or complex renal stones. Endoscopic combined intrarenal surgery (ECIRS) was developed with the goal of minimizing the number of access tracts of PCNL while simultaneously improving the one-step stone-free rate (SFR). The aim of this study was to share the experience of the consecutive 200 cases of ECIRS in one institute and analyze surgical outcomes of mini-ECIRS and standard ECIRS. Materials and Methods: We performed ECIRS for 200 adult patients between July 2017 and January 2020. An ECIRS was performed with the patient under general anesthesia in the intermediate-supine position. Surgeries were finished using a tubeless technique with a simple ureteral stent insertion. Results: There were significant differences in the mean maximal stone length (MSL), the variation coefficient of stone density (VCSD), the linear calculus density (LCD), the Seoul National University Renal Stone Complexity (S-ReSC), and the modified S-ReSC scores in stone characteristics, and estimated blood loss (EBL) and operation time in peri-operative outcomes between conventional and mini-ECIRS. After propensity-score matching, there was only a difference in EBL between the two groups. In logistic regression models, MSL [odds ratio (OR) 0.953; 95% confidence interval (CI) 0.926-0.979; p < 0.001], LCD (OR 4.702; 95% CI 1.613-18.655; p = 0.013) were significant factors for the success rate after ECIRS. Conclusions: In patients who underwent a mini-ECIRS, the stones were relatively smaller and less complex, and the operation time was shorter. However, if the size of stones was similar, there was no difference in the success rate, but EBL was lower in mini-ECIRS than in standard surgery.

Drug resistance and influencing factors of biofilm bacteria in upper urinary calculi patients with double J stent indwelling.

OBJECTIVE: To analyze the distribution and drug resistance of biofilm bacteria infected with upper urinary calculi patients with double J stent indwelling, and to explore the influencing factors of Biofilm Bacteria Infections. METHODS: A total of 400 patients with upper urinary calculi who adopted double J stent inserting in our hospital from January 2019 to January 2022 were included. Urine and double J stent samples were collected, pathogen cultures were performed, and then drug sensitivity test analysis was carried out for isolates. Univariate and multivariate logistic regression analyzes were used to analyze the influencing factors of patients with double J stent associated biofilm bacteria infections. RESULTS: A total of 13 strains (3.2%) of biofilm bacteria were detected in urine samples and 168 strains (42%) in double J stent samples (P < 0.05), 95 strains (23.7%) of pathogenic bacteria were separated from urine samples and 117 strains (29.2%) from double J-stent samples (P > 0.05). Escherichia coli were the most common bacteria. There was significantly higher drug resistance observed in biofilm bacteria versus urine-cultured pathogens (P < 0.05). Advanced age, long-term catheterization, inadequate water intake, hypoproteinemia, abnormal renal function, and diabetes mellitus were independent risk factors for biofilm bacteria infection associated with double J stent(P < 0.05). CONCLUSION: Among the upper urinary calculi patients with double J stent indwelling, the positive rate and drug resistance of biofilm bacteria obtained from double J stent were significantly higher than that from urine. More attention should be paid to the factors that influence biofilm bacteria infections.

The value of dual-energy computed tomography (DECT) in the diagnosis of urinary calculi: a systematic review and meta-analysis of retrospective studies.

Objective: Dual-energy computed tomography (DECT) imaging technology opens a new idea and method for analyzing stone composition, which can obtain several quantitative parameters reflecting tissue-related information and energy images different from traditional images. However, the application of DECT in diagnosing urinary calculi remains unknown. This study aims to evaluate the value of DECT in diagnosing urinary calculi by meta-analysis. Methods: PubMed, EMBASE, Web of Science, and the Cochrane Library were searched to articles published from the establishment of the databases to April 18, 2023. We reviewed the articles on the diagnosis of urinary calculi detected by DECT, established standards, screened the articles, and extracted data. Two researchers carried out data extraction and the Cohen's unweighted kappa was estimated for inter-investigator reliability. The quality of the literature was evaluated by the diagnostic test accuracy quality evaluation tool (QUADAS-2). The heterogeneity and threshold effects were analyzed by Meta-Disc 1.4 software, and the combined sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, and diagnostic ratio were calculated. The combined receiver-operating characteristic (ROC) curve was drawn, and the value of DECT in the diagnosis of urinary calculi was evaluated by the area under the curve (AUC). The meta-analysis was registered at PROSPERO (CRD42023418204). Results: One thousand and twenty-seven stones were detected in 1,223 samples from 10 diagnostic tests. The analyzed kappa alternated between 0.78-0.85 for the document's retrieval and detection procedure. The sensitivity of DECT in the diagnosis of urinary calculi was 0.94 (95% CI [0.92-0.96]). The positive likelihood ratio (PLR) of DECT in the diagnosis of urinary stones was 0.91 (95% CI [0.88-0.94]), and the negative likelihood ratio (NLR) was 0.08 (95% CI [0.05-0.11]). The specificity of DECT for detecting urinary calculi was 0.91 (95% CI [0.88-0.94]). The area under the curve of the summary receiver operator characteristic (SROC) was 0.9875. The sensitivity of dual-energy CT in the diagnosis of urinary calculi diameter <3 mm was 0.94 (95% CI [0.91-0.96]). The PLR of DECT in the diagnosis of urinary stones diameter <3 mm was 10.79 (95% CI [5.25 to 22.17]), and the NLR was 0.08 (95% CI [0.05-0.13]). The specificity of DECT for detecting urinary calculi <3 mm was 0.91 (95% CI [0.87-0.94]). The SROC was 0.9772. Conclusion: The DECT has noble application value in detecting urinary calculi.