Audit of the Acute Management of Renal Colic in District Hospitals Within a National Health Service Trust.

INTRODUCTION: Renal colic is a prevalent acute urological emergency caused by urinary stones and commonly manifests as severe loin pain. This audit assesses the management of acute renal colic at a National Health Service (NHS) Trust in the West Midlands, England, comparing practices against the National Institute for Clinical Excellence (NICE) and the British Association of Urological Surgeons (BAUS) guidelines. METHOD: This retrospective audit reviewed 417 patients with suspected renal colic over a month. Data collected included patients' demographics, time to complete CT scan, laboratory investigations requested and management modalities. Patients assessed were either admitted through the Emergency Department, Surgical Assessment Unit, or previously admitted for other conditions on the wards. The audit benchmarked against NICE and BAUS guidelines, focusing on diagnostic timeliness and management, including essential blood investigations. Data analysis performed using SPSS (IBM Corp., Armonk, NY, USA) included descriptive statistics and Chi-square tests, with significance set at p < 0.05. RESULTS: A total of 417 patients met the inclusion criteria. The average age of patients was 47.4 years with slightly higher male population (51.1%). The diagnostic rate for renal or ureteric stones using computed tomography of the kidneys, ureters, and bladder (CT-KUB) was 41.2%. The positive detection rate was significantly higher in males (54%) compared to females (27.5%) while females have more alternate diagnosis than males (13.7% vs 6.1%). The average completion time of CT-KUB was nine hours with 7.7% of patients having their CT-KUB beyond the 24-hour benchmark. Most patients (48%) were managed conservatively with analgesia, 32% received tamsulosin as medical expulsive therapy and others had interventions like ureteric stent insertion (9.3%), nephrostomy (6.4%) or primary ureteroscopy (4.1%). CONCLUSION: The audit of renal colic management at our centre revealed a 41.2% diagnostic rate for renal or ureteric stones via CT-KUB, with a significantly higher rate in males than females. Diagnostic delays were minimal, with only 7.7% of scans exceeding 24 hours. Conservative management was common, however non-steroidal anti-inflammatory drugs (NSAIDs) were underutilized despite guideline recommendations. There was a notable gender disparity in diagnostic and alternate findings rates. The results showed the need for adherence to pain management protocols and highlight the effectiveness of existing renal colic protocol, while also pointing to potential areas for improvement in treatment uniformity and guideline adherence.

Mini-percutaneous nephrolithotomy vs flexible ureteroscopy for 1-2 cm lower pole renal stones: a randomised controlled trial.

OBJECTIVE: To compare the safety and efficacy of flexible ureteroscopy (f-URS) and ambulatory tubeless mini-percutaneous nephrolithotomy (mini-PCNL) in the treatment of 1-2 cm lower calyceal renal stones. PATIENTS AND METHODS: Patients who underwent f-URS and mini-PCNL for the treatment of 1-2 cm lower calyceal renal stones between October 2020 and November 2023 were evaluated in a randomised controlled trial. A total of 72 patients were included in the study. All patients underwent a computed tomography renal colic scan preoperatively, on postoperative Day 1 (POD 1), and at 3 months follow-up. We compared perioperative outcomes, including operative time and hospital stay. Additionally, we evaluated follow-up outcomes, such as the stone-free rate (SFR) and complications. All patients were discharged home on the same operative day. RESULTS: There were no significant differences in preoperative baseline data between the two surgical groups. A significantly longer median operative time was reported in the mini-PCNL group (P = 0.04). The median hospital stay was 5 h and 4 h in the mini-PCNL and f-URS groups, respectively (P = 0.14). On POD 1, the SFR, defined as the absence of residual fragments measuring 0 cm, was 50% for mini-PCNL vs 11.1% for f-URS (P < 0.001). When a total cut-off of <4 cm was utilised, the SFR was 75% in the mini-PCNL group vs 22.2% in the f-URS cohort (P < 0.001). At 3 months follow-up, the SFR remained favourable for mini-PCNL at 72.2% vs 37.1% for f-URS (P = 0.003), with a cut-off of 0 cm, and it increased to 86.1% for mini-PCNL vs 65.7% for f-URS (P = 0.04) when a total cut-off of <4 cm was applied. There was no significant difference in postoperative complications between the two groups. Two patients (5.7%) in the f-URS group required re-treatment. CONCLUSIONS: Ambulatory tubeless mini-PCNL and f-URS are effective treatment options for 1-2 cm lower calyceal renal stones. Both techniques have a comparable hospital stay and complication rates, with a significantly better SFR with mini-PCNL.

Impact of Extracorporeal Shock Wave Lithotripsy (ESWL) on Kidney Length and Corticomedullary Differentiation in Patients With Renal Stones: A Case-Control Study.

Background The effect of extracorporeal shock wave lithotripsy (ESWL) on kidney morphology was evaluated sonographically in patients with renal stones. This study aimed to investigate the effects of ESWL on the kidneys after consecutive sessions. Methods This case-control study included adult participants from December 2018 to August 2022 in three major centers of ESWL treatment. Data were collected from 392 patients (336 treated with ESWL and 56 in the control group). Data were analyzed using SPSS Statistics (IBM Corp., Armonk, USA). Both binary logistic regression and generalized linear regression were applied to determine the factors that predicted the effect of ESWL on kidney length (KL) and cortico-medullary differentiation (CMD). Results The overall effect of ESWL treatment on patients with renal stones was observed in 19.9% disturbed CMD, and 11.6% decreased parenchymal thickness. KL was significantly decreased in patients exposed to ESWL compared to controls (9.103 vs.10.291 cm, p-value < .001). KL decreased significantly as the number of ESWL sessions increased (r = -.209, p-value < .001). After adjustment, the frequencies of ESWL and hydronephrosis were significantly associated with CMD distortion. Patients who were exposed to more than one ESWL session had 2.64 increased odds of distorted CMD as compared to controls (AOR=2.64, 95% CI = 1.040-6.683), and those with hydronephrosis had 1.70 increased odds of distorted CMD as compared to controls (AOR=1.70, 95% CI = 1.188-2.434). Conclusion ESWL significantly affected the renal length and CMD in patients with renal stones. The frequency of ESWL sessions significantly decreased KL and disturbed CMD in patients with renal stones. The outcome was not affected by the number of stones.

Outcomes and complications of percutaneous nephrolithotomy as primary versus secondary procedure for kidney stones: a prospective cohort study.

Introduction: Currently, percutaneous nephrolithotomy (PCNL) is the gold standard of treatment for large renal stones. The high prevalence of urolithiasis is associated with a high recurrence rate increasing the risk of re-intervention. This study aimed to compare the effectiveness and complications of PCNL among patients with previous therapeutic interventions for renal stones. Methods: Between August 2018 and September 2023, 245 patients were prospectively enrolled in this study and who underwent PCNL for renal stones at our institution. We compared patients who had no previous renal surgery (group 1: n=171) with those who had a history of open renal surgery (group 2: n=45) or previous PCNL on the ipsilateral kidney (group 3: n=31). All patients underwent surgery in the Galdakao-modified Valdivia position. Data on stone characteristics and perioperative and postoperative parameters were collected. Technical features, success rates and morbidity were analyzed and compared between the groups. Results: The fluoroscopy time was significantly longer in the group of patients with previous open surgery than in groups 1 and 3 (161.47±52.44, 223.05±33.29, 172.27±30.51 sec, P<0.001). Similarly, the operative time was longer in group 2 (138.20±38.86 min, P<0.001). The immediate stone-free rates in groups 1, 2, and 3 were 74.8%, 72.1%, and 77.4%, respectively (P=0.945). At 1-month, these rates increased to 98.8%, 96.2% and 96.8%, respectively (P=0.857). No difference was detected between the groups in terms of complication rate. The average Hb variation was 1.08±0.82, 1.34±1.01 and 0.94±0.69 g/dl for groups 1, 2 and 3, respectively(P=0.082). Hospital stay was longer in group 2 than in groups 1 and 3 (2.17±1.03, 2.53±1.22, 1.88±1.00 days, P=0.07), respectively. Conclusion: PCNL in patients with a history of renal surgery was associated with longer fluoroscopy and operative time. However, the success and morbidity rates as a secondary procedure were similar to those of PCNL in patients with no previous intervention.

Is double-J stent mandatory in complete supine percutaneous nephrolithotomy for adult patients with staghorn renal stones?

BACKGROUND: It is controversial whether double-J (DJ) stent insertion is necessary in tubeless percutaneous nephrolithotomy (PCNL) for patients with staghorn stones. We compared the outcomes of using ureteral catheters and double-J stents in tubeless complete supine PCNL (csPCNL) of staghorn stones. METHODS: In this analytical cross-sectional study, from May 2008 to August 2022, 123 patients who underwent tubeless csPCNL were assessed. Patients were divided into two groups by either tubeless csPCNL with DJ stent (Group I; n = 23) or totally tubeless just with perioperative ureteral stent (Group II; n = 100). Demographic characteristics, stone-related factors, perioperative and postoperative parameters were compared in groups. RESULTS: Baseline characteristics were comparable in groups. The operative time in group I was significantly longer than group II (68.26 vs. 55.25 min, P = 0.05). However, the duration of hospitalization in Group I was shorter than the other group (1.81 vs. 2.37 days, P = 0.03). Stone free rate was notably higher in Group I (90.5% vs. 79.8.0%) with no statistically significant difference. No significant differences were found in major complications. Patients in Group II had a significantly shorter time to return to normal life (6.48 vs. 7.91 day; P = 0.043). Multivariable linear regression showed the preoperative creatinine level and stone size can affect the operative time (P = 0.02). In addition, stone number and underlying disease can affect the length of hospital stay (P = 0.007 & 0.030, respectively). CONCLUSION: Although not inserting a double J stent after csPCNL has acceptable results, because of higher residual rate in staghorn stone which cause more incidence of renal colic, longer time of hospital stay and return to normal life, inserting DJ stent is recommended.

Link Between Obstructive Sleep Apnea and Kidney Stones: NHANES 2015-2018 and Mendelian Randomization.

Purpose: The prevalence of Obstructive Sleep Apnea (OSA) is high, and there are many complications. Few studies have reported the relationship between OSA and kidney stones. The purpose of this study is to explore whether people at risk of OSA will increase the risk of kidney stones. Methods: This was a cross-sectional study, and information was collected through the National Health and Nutrition Examination Survey conducted from 2015 to 2018. Multiple logistic regression analyses were employed to calculate the odds ratios (ORs) and their 95% confidence intervals (CIs) for the link between obstructive sleep apnea and the presence of kidney stones. Additionally, to assess causality and reduce observational biases, five distinct two-sample Mendelian randomization techniques were applied. Results: Following the adjustment for relevant confounders, findings indicated a statistically significant correlation between obstructive sleep apnea (OSA) and higher prevalence of kidney stones (OR = 1.29; 95% CI: 1.00-1.66). Additionally, using the inverse-variance weighted approach in Mendelian randomization, results suggested a genetic predisposition to OSA might be causally linked to an elevated risk of developing kidney stones (OR: 1.00221, 95% CI 1.00056-1.00387). Conclusion: OSA promotes the formation of kidney stones, and the treatment and management of OSA can improve or mitigate the occurrence of kidney stones.

Impacts of urinary tract anomalies or history of upper urinary tract surgery on outcome of mini-ECIRS (endoscopic combined intrarenal surgery).

This study assessed the impact of urinary tract anomalies or a history of upper urinary tract surgery (UTAS) on the minimally invasive endoscopic combined intrarenal surgery (mini-ECIRS) outcomes. Data from 1432 patients undergoing ECIRS for urolithiasis at three Japanese tertiary institutions between 2015 and 2021 were analyzed, with patients categorized into those with normal urinary tracts (non-UTAS) and those with UTAS (UTAS). We retrospectively examined the association between the UTAS and perioperative outcomes in mini-ECIRS. Of the 1096 cases in the final analysis, 1035 and 61 were identified as non-UTAS and UTAS, respectively. Stone-free rate (residual fragments > 2 mm, 62.8% vs. 62.7%), operation time (110.5 vs. 115.0 min), and hospital stay duration (5.6 vs. 5.7 days) showed no significant differences between non-UTAS and UTAS. The UTAS group demonstrated significantly higher rates of preoperative pyuria (86.2% vs. 71.1%), preoperative urinary tract infection (32.8% vs. 15.5%), preoperative stenting (52.5% vs. 31.0%), and preoperative nephrostomy (24.6% vs. 9.2%). However, the postoperative fever (26.3% vs. 25.0%) or septic shock (1.9% vs. 0%) were comparable between non-UTAS and UTAS. Stone burden and the number of calyces involved were significantly associated with a low stone-free rate (P < 0.001). Younger age, female sex, solitary stones, number of calyces involved, preoperative urinary tract infection, and absence of preoperative nephrostomy were identified as risk factors for perioperative complications. The UTAS was not associated with stone-free outcomes or perioperative complications. Mini-ECIRS demonstrated comparable stone-free outcomes and safety in patients with UTAS and those with normal urinary tracts.

Longitudinal Incidence of Kidney/Urinary Stones in Individuals With Severe Motor and Intellectual Disabilities.

OBJECTIVE AND RATIONALE: To investigate the longitudinal incidence of kidney/urinary stones in patients with severe motor and intellectual disabilities and explore health burden events in patients with stone formation. METHODS: This was a retrospective, observational study. We identified patients with severe motor and intellectual disabilities who had the following: 1) admission to our hospital wards for >10 years; 2) two or more assessments for stone formation by ultrasonography or computed tomography; and 3) absence of kidney/urinary stones in the first imaging study. The Kaplan-Meier method was used to analyze the cumulative incidence of kidney/urinary stones. Recurrent urinary tract infections, hydronephrosis, renal dysfunction, and death were identified as health burdens. RESULTS: Among the 41 patients (19 men, 22 women; median age, 28 years; range, 8-50 years), stone formation was detected in 11 (27%) patients during the observation period. The cumulative incidence rate of stone formation was 9.8% (95% confidence interval, 3.8-23.9) and 18.7% (95% confidence interval, 9.2-35.7) at five and 10 years, respectively. Death was frequently observed in patients with stone formation; six (55%) of the 11 patients with stone formation died during the follow-up period; two (15%) died among the other 30 patients without stone formation. However, only one patient with stone formation died in a renal event; the causal relationship between the stone formation and the deaths was not clarified. CONCLUSION: The longitudinal incidence of kidney/urinary stones was higher in patients with severe motor and intellectual disabilities than in the general population. Considering the difficulty of patients with severe motor and intellectual disabilities in conveying their symptoms, regular assessment of the kidney using abdominal imaging may be recommended.

The association between novel negative pressure ureteroscopic lithotripsy combined with flexible ureteroscopy versus percutaneous nephrolithotomy on stone-free rates: implications for clinical practice and policy.

The correlation between novel negative pressure ureteroscopic lithotripsy (NP-URL) combined with flexible ureteroscopy (FU) and percutaneous nephrolithotomy (PCNL) on stone-free rates (SFR) remains unclear. There is a lack of evidence from Chinese populations regarding the relationship between SFR and NP-URL combined with FU (NP-URL-FU) versus PCNL. We aimed to assess the association between NP-URL-FU and PCNL on SFR. We conducted a cohort study involving 166 participants with 2-4 cm kidney stones. Data on SFR (7 days and 2 months) were collected from all participants. Logistic regression analysis was used to substantiate the research objectives. NP-URL-FU versus PCNL showed an 86% decrease in the 7-day SFR (OR = 0.14, 95% CI 0.07-0.29). The results remained stable even after adjusting for potential confounders. However, no statistically significant association was found between the surgical method and the 2-month SFR. Further exploratory subgroup analyses showed no significant interactions, with all P values > 0.05. Among patients with 2-4 cm kidney stones, NP-URL-FU was associated with a lower risk of incident 7-day SFR than PCNL. However, no statistically significant difference was found in the long-term stone removal rate. Therefore, NP-URL-FU may be a viable alternative surgical option for patients seeking minimally invasive procedures.

Effect of flexible cystoscopy combined with flexible ureteroscopy on short-term outcomes in patients with complex renal stones.

OBJECTIVE: To investigate the short-term efficacy of combining flexible cystoscopy with flexible ureteroscopy in the treatment of complex renal stones. METHODS: The medical records of 145 patients with complex renal stones admitted to Yan'an People's Hospital from February 2020 to February 2022 were retrospectively analyzed. Among these, 65 patients treated with flexible ureteroscopy alone constituted the control group. The research group consisted of 81 patients receiving both flexible cystoscopy and flexible ureteroscopy. Outcomes compared between the two groups included stone removal rate, operative time, time to ambulation, hospitalization duration, and intraoperative bleeding. Logistic regression analysis was used to assess the risk of stone retention. RESULTS: In the research group, the stone removal rate was 85.19% and the residual stone rate was 14.81%, compared to a stone removal rate of 70.77% and a residual rate of 29.23% in the control group, with a statistically significant difference (P<0.05). The research group had a significantly longer operative time than the control group (P<0.05). However, intraoperative bleeding and hospitalization duration were significantly lower in the research group (P<0.05). There was no statistically significant difference in time to ambulation between the groups (P>0.05). Multivariate logistic regression analysis identified multiple stones (OR=3.581, P=0.013) as an independent risk factor for residual stones, while stone location outside the lower calyx (OR=0.305, P=0.021) and treatment with combined flexible cystoscopy and ureteroscopy (OR=0.398, P=0.160) were independent protective factors against residual stones. The area under the curve for predicting stone retention based on the number of stones, stone location, and treatment modality were 0.647, 0.642, and 0.606, respectively. CONCLUSION: The combination of flexible cystoscopy and flexible ureteroscopy in treating patients with complex renal stones significantly improves the stone clearance rate and postoperative patient recovery.

The association of glyphosate exposure with kidney stones in American adults: A nationally representative cross-sectional study.

OBJECTIVE: Glyphosate has been ubiquitously present in our living environment due to its efficient herbicidal ability, but its association with the prevalence of kidney stones remains uncertain. This study aims to explore the impact of glyphosate exposure on kidney stones and to investigate the mediating effects of some serologic indicators. Furthermore, we attempt to identify the specific populations at greater risk of exposure. METHODS: This is a cross-sectional study of the U.S. adult population examining the association between glyphosate exposure and kidney stones based on data from the 2013-2018 National Health and Nutrition Examination Survey (NHANES). We implemented multi-model-adjusted logistic regression and smoothed curve fitting to explore the connection between them. Further subgroup analyses were conducted to confirm the magnitude of exposure risk in specific populations. Mediation effects analysis served to provide insight into the underlying mechanisms of the link. RESULTS: A total of 4302 participants' health data were ultimately analyzed, and the prevalence of kidney stones was 10.85 %. Participants with the highest urinary glyphosate(uGLY) content(Q3) had a higher prevalence of kidney stones compared with participants with the lowest uGLY content(Q1) (OR=1.70, 95 %CI: 1.10-2.63). Smoothed curve fitting revealed a linear positive association between ln-transformed uGLY and kidney stones (OR=1.21,95 %CI:1.08-1.37, LLR=0.291), and this exposure-outcome effect was at greater risk in men (OR=1.24,95 %CI: 1.05-1.46), non-Hispanic whites (OR=1.29, 95 %CI: 1.09-1.53), and hypertensive groups (OR=1.23,95 %CI: 1.05-1.44). Serum biochemical markers HDL, ALP, and serum glucose partially mediated the correlation between glyphosate and kidney stones (2.44-4.20 %). CONCLUSION: Glyphosate exposure is significantly associated with the prevalence of kidney stones. In men, non-Hispanic whites, and hypertensive populations, the management of glyphosate exposure should be emphasized, and appropriate protective strategies may be beneficial in reducing the burden of kidney stones. More high-quality clinical inquiries and animal toxicology experiments are still required to verify the reliability of our findings and their underlying mechanisms.

Laparoscope combined with ureteroscope in the treatment of bile duct stones and cholecystolithiasis in a child: a case report and literature review.

Cholecystolithiasis combined with bile duct stones is more and more common in children, but the surgical treatment is still controversial. We report on a 3-year-old boy, who underwent laparoscope combined with ureteroscope for choledocholithiasis with cholecystolithiasis. This combination therapy offers the possibility to treat pediatric patients with cholecystolithiasis and bile duct stones in low-resource settings where ERCP experience and child-specific surgical instruments are not available. Additionally, a comprehensive review of previous studies was conducted to summarize the surgical treatments. The surgical treatment of children should be made according to the specific situation to maximize the success of the operation and reduce the risk.

Selenium participates in the formation of kidney stones by alleviating endoplasmic reticulum stress and apoptosis of renal tubular epithelial cells.

Objectives: To investigate the role of selenium and selenium-containing proteins in the etiology and pathogenesis of kidney stones.Methods: The HK-2 cell line was subjected to supersaturation oxalate treatment to establish an in vitro model of calcium oxalate kidney stones, while SD rats were administered with ethylene glycol to establish an in vivo model of calcium oxalate kidney stones. qPCR analysis was employed to investigate the alterations in selenoproteins within the models, and subsequently, genes exhibiting significant changes were identified. Subsequently, based on the functions of these genes, their regulatory effects on endoplasmic reticulum stress (ERS) and apoptosis during the disease progression were examined both in HK-2 cells and rat kidneys. Finally, Selenomethionine (SeMet) supplementation was introduced to explore its therapeutic potential for kidney stone management.Results: The involvement of Selenoprotein K in the pathogenesis of calcium oxalate kidney stone disease has been confirmed, exhibiting significant alterations. Manipulation of its expression levels through overexpression and knockdown techniques resulted in a corresponding reduction or increase in oxidative stress, ERS, and apoptosis within renal tubular epithelial cells. SelK regulates ERS and apoptosis by controlling the IRE1-ASK1-JNK pathway. In addition, SeMet treatment, which contains selenium, effectively reduced the levels of oxidative stress, ERS, and apoptosis in vivo and in vitro models, thereby alleviating tubular epithelial cell damage and reducing the formation of kidney stones in experimental rats.Discussion: Selenium is involved in the occurrence and development of kidney stones by regulating oxidative damage to renal tubular epithelial cells. The results suggest that dietary selenium supplementation in daily life may be of great significance for the prevention and treatment of kidney stones.

Clinical, Diagnostic, and Metabolic Characteristics Associated with Nephrolithiasis in the Black Women's Health Study.

Background/Objectives: Nephrolithiasis (kidney stones) is a frequently occurring urologic condition resulting in significant patient morbidity and healthcare costs. Despite the higher prevalence of metabolic risk factors for nephrolithiasis among Black women, there have been few epidemiologic studies of kidney stones focusing on this group. Methods: We describe demographic and health characteristics, diagnostics, and metabolic profiles of US Black women with self-reported kidney stones. The women were participants in the Black Women's Health Study (BWHS), a large prospective cohort of US Black women (median age 38 years) begun in 1995. Results: Among the 2750 BWHS participants who completed an online supplemental questionnaire assessing urologic health, 201 women reported nephrolithiasis. Of this number, 62% had completed ≥ 16 years of education, and 82% reported access to health care. Overall, 39% reported experiencing ≥ 2 stones in their lifetime, and 29% required surgery to treat the condition. Thirty-two percent reported having completed a metabolic evaluation, while 70% had undergone a CT scan to diagnose nephrolithiasis. The frequency of metabolic evaluation increased with the number of metabolic components reported: 3% (0 components) to 43% (3-4 components). Conclusions: Our findings are consistent with reports of lower rates of metabolic evaluation among Black patients despite their having multiple risk factors for nephrolithiasis. Further study is needed to identify the barriers and facilitators of metabolic and diagnostic workup of nephrolithiasis in Black women.

Effectiveness and safety of a new clip for delivery using a duodenoscope for bleeding after endoscopic sphincterotomy.

Background and study aims Hemostasis for post-endoscopic sphincterotomy (post-EST) bleeding involves no standard strategy. New clips designed for delivery using the duodenoscope (SureClip, Micro-Tech, Nanjing, China) have been utilized for gastrointestinal bleeding hemostasis and bleeding prevention after polypectomy and papillectomy. We retrospectively analyzed the effectiveness and safety of SureClip for post-EST bleeding. Patients and methods Of 608 patients with endoscopic sphincterotomy (EST), 41 cases (6.7%) experienced post-EST bleeding from 2019 to 2023. Of these patients, 24 underwent hemostasis by SureClip, and the success rate of complete hemostasis and complication by hemostasis by SureClip was analyzed. Results In 12 and 12 patients with urgent and delayed bleeding, 11 (91.7%) and 11 (91.7%) had successful hemostasis, respectively. In addition, missed patients achieved complete hemostasis with additional transcatheter arterial embolization and balloon compression, respectively. No complications were observed, including perforation, pancreatitis, and clipping bile duct and pancreatic duct by mistake. Conclusions Hemostasis with SureClip is safe, effective, and not expensive for post-EST bleeding. It could be the first choice for hemostasis in patients with post-EST bleeding refractory to balloon compression.

S100A9 promotes renal calcium oxalate stone formation via activating the TLR4-p38/MAPK-LCN2 signaling pathway.

OBJECTIVES: To explore the role of S100A9 protein in renal calcium oxalate (CaOx) stone formation. METHODS: CaOx nephrocalcinosis mice were established via intraperitoneal injection of glyoxylate. They were treated with S100A9 deficiency, Paquinimod, or p38 MAPK-IN-1. Vonkossa staining was conducted to observe the deposition of CaOx crystals. Renal expression of inflammation, macrophage polarization, and injury markers was detected using immunohistochemistry and qPCR. Effects of S100A9 on renal tubular epithelial cells (HK-2) were explored by transcriptome sequencing. The mechanism of how S100A9 regulated lipocalin 2 (LCN2) was studied through Western Blot. Flow cytometry was performed to detect the influence of LCN2 on macrophages polarization. RESULTS: S100A9 deficiency inhibited the renal deposition of CaOx crystals in nephrocalcinosis mice. S100A9 upregulated the expression of LCN2 in HK-2 cells via activating the TLR4-p38/MAPK pathway. LCN2 promoted the migration and M1 polarization of macrophages. S100A9 deficiency downregulated the renal expression of LCN2, IL1-ß, Kim-1, F4/80, and CD80 in nephrocalcinosis mice. Paquinimod and p38 MAPK-IN-1 both inhibited the renal deposition of CaOx crystals and downregulated the expression of LCN2, IL1-ß, Kim-1, F4/80, iNOS, and CD68 in nephrocalcinosis mice. CONCLUSIONS: S100A9 promotes renal inflammatory injury by activating the TLR4-p38/MAPK-LCN2 pathway and then contributes to CaOx stone formation.

Effects of dexamethasone on the EC50 of remifentanil combined with dexmedetomidine achieving analgesia during pancreatic extracorporeal shockwave lithotripsy: a prospective, randomized and controlled study.

BACKGROUND: In addition to their classic genomic effects, glucocorticoids also manifest rapid non genomic effects. We speculate that dexamethasone has the potential prompt onset of analgesic effects. The objective of this study is to investigate the influence of a single preoperative dose of dexamethasone on the half maximal effective concentration (EC50) of remifentanil when combined with dexmedetomidine for pain relief during pancreatic extracorporeal shockwave lithotripsy (P-ESWL). METHODS: A total of 60 patients undergoing P-ESWL were enrolled and randomized at 1:1 ratio into the dexamethasone (DXM) group and the placebo group. Before anesthesia induction, patients in DXM group received an intravenous injection of 8 mg dexamethasone, while subjects in placebo group received an equal dose of physiological saline. Monitored anesthesia care (MAC) was performed based on remifentanil in combination with dexmedetomidine. Remifentanil was administered by TCI with an initial target concentration of 2.5 µg/mL for both groups. A positive response was defined as that VAS score > 3 by the patient at any time during the procedure. Subsequent target concentrations were adjusted by Dixon up-down sequential method, where dose modifications were performed by 0.3 ng/mL intervals, based on the response of the previous patient. The EC50 of remifentanil for pain relief during P-ESWL treatment was calculated using Dixon's up-and-down method. Hemodynamic variables, oxygen saturation and adverse events were also recorded. RESULTS: Dixon up-and-down method revealed that the EC50 of remifentanil was significantly higher in placebo group (2.65 ± 0.28 ng/mL) than in DXM group (2.02 ± 0.23 ng/ml) (P < 0.001). Hemodynamic parameter exhibited a significant decrease in mean arterial pressure (MAP) and heart rate (HR) before and after induction in placebo group; however, data of the two groups were comparable (P>0.05). Less adverse events occurred in DXM group, including the incidence of postoperative nausea and vomiting (PONV) and analgesia requirement with in the first 24 h following the procedure at ward. CONCLUSION: Dexamethasone exerted analgesic effects with a rapid onset, and patients received dexamethasone 8 mg preoperative had a lower required EC50 of remifentanil during P-ESWL. It is also associated with reduced PONV in addition to reduced postoperative analgesic consumption in the first postoperative 24 h. TRIAL REGISTRATION: Registered in the Chinese Clinical Trial Registry (ChiCTR2300078171) on 30/11/2023.

What patients with kidney stones believe about their condition.

Patients' beliefs about their illness are of central importance in understanding how a person adjusts to their condition and adheres to self-management recommendations. No previous studies have set out to quantitatively examine Illness beliefs in patients with kidney stones (KS). 112 patients with radiological confirmation of KS (59% male, mean (x̄) age = 50.1 years [sd14.15 years], 50.5% previous surgical treatment) attending for clinical consultation completed the Brief-Illness Perception Questionnaire alongside a range of demographic and illness related variables. Template analysis was undertaken on the free text responses of patients' beliefs about what had caused their KS. Almost a third (31.2%) of patients did not know what had caused their KS. Of those who cited a cause, dietary factors, fluid intake, medical risk factors (e.g. Inflammatory bowel disease), genetics, and psychological factors were ranked as the most important. Patients generally believed they had a reasonable understanding of KS (x̄=6.32 [sd3.21]), but reported poor levels of personal control over their KS (x̄=2.90 [sd2.93]) and high confidence in the effectiveness of treatments (x̄=8.64 [sd1.90]). Patients with a recurrence believed KS had a significantly greater impact on their life (z=-2.56, p = 0.01) and had greater emotional consequences (z=-2.77, p < 0.01). Perceptions of poor personal control over KS and a strong belief in medical/surgical treatment was evident regardless of first or recurrent stone, gender, age, previous surgical management of KS or time since diagnosis. Results highlight the need to actively increase patients' perceptions of personal control in the management and prevention of KS.

Microchannel percutaneous nephrolithotomy versus flexible ureteroscopic lithotripsy for the treatment of 1-2 cm high hardness single upper ureteral stones: a propensity score-matched study.

The objective of this study was to compare the clinical efficacy and safety of microchannel percutaneous nephrolithotripsy (MPCNL) with flexible ureteroscopic lithotripsy (FURL) in the treatment of single upper ureteral stones with a diameter of 1-2 cm and high hardness. This study retrospectively analyzed 89 patients diagnosed with a single upper ureteral stone with a 1-2 cm diameter and a computed tomography value > 1000 Hounsfield units. A propensity score matching system matched this study with factors to minimize the effect of baseline differences between patients. Ultimately, 29 patients in each of the two groups were successfully matched. The stone-free rate was marginally higher in the MPCNL group than in the FURL group (93.10% vs. 86.21%), although the difference did not reach statistical significance (P = 0.666). Furthermore, the mean operative time in the MPCNL group, although slightly longer than that in the FURL group, did not demonstrate a statistically significant difference (P = 0.833). However, patients in the MPCNL group exhibited a significantly more substantial decrease in hemoglobin than those in the FURL group (P < 0.001) and a substantially more extended postoperative hospital stay (P < 0.001). Regarding perioperative complications, the incidence of moderate pain was higher in the MPCNL group than in the FURL group (P = 0.037). The difference in overall complication rates between the two groups did not reach statistical significance (P = 0.108). MPCNL and FURL are efficacious surgical procedures for treating single upper ureteral stones with a 1-2 cm diameter and high hardness.

Relation between Urine Cytological Findings and Renal Function in Patients with Kidney Stones in Taif, Saudi Arabia.

Background and Objectives: Urine serves as a vital diagnostic fluid, and urine cytology analysis plays a crucial role in identifying urinary system illnesses such as bladder cancer and kidney stones. The Paris System for Reporting Urinary Cytology establishes a uniform method for diagnosing urinary tract cancer. This study aimed to provide valuable insights that can inform diagnostic strategies related to kidney stones and ultimately improve patient outcomes via the early detection of the cellular changes associated with kidney stones and their relation to kidney function tests. Materials and Methods: A comparative study was conducted and comprised two groups: group 1, consisting of 50 patients diagnosed with kidney stones, and group 2, comprising 50 patients diagnosed with other kidney diseases. Renal function tests and urinalysis (via the PAP staining of urine cellular deposits to detect nuclear changes) were performed, and the results were analyzed. Results: There was a statistically significant increase in urinary red blood cells, white blood cells, and nuclear reactive atypical changes in urinary sediments of kidney stone patients compared to the patients without stones, while there was a decrease in the estimated glomerular filtration rate (eGFR). eGFR showed a 96.7% specificity in detecting cases with nuclear reactive atypia. Conclusions: eGFR emerges as a reliable diagnostic marker for the comprehensive assessment of kidney stones, particularly when associated with nuclear atypia. The significant correlation between the indicators of chronic kidney disease, such as decreased eGFR, and the presence of kidney stones emphasizes the urgent need for efficient diagnostic practices.