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.

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.

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.

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.

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.

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.

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.

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.

Layer upon layer: Imaging techniques of bladder matrix stone: A case report.

Matrix lithiasis within the bladder is an extremely rare and diagnostically challenging condition, characterized by its atypical presentation and complex imaging appearance. We report the case of a 69-year-old woman with nonspecific urinary symptoms, including hematuria and abdominal pain. Initial ultrasonography revealed an echogenic lesion on the bladder wall, leading to further investigations using computed tomography (CT) and magnetic resonance imaging (MRI). CT imaging initially delineated the lesion's structure, revealing a complex, multilayered cystic mass. Subsequent MRI provided detailed insights into the internal architecture of the mass, further elucidating its layered structure. Although a parasitic etiology was initially suspected, matrix lithiasis was later confirmed. This case highlights the critical role of a comprehensive imaging strategy in diagnosing rare urological conditions and emphasizes the importance of multimodal imaging in differentiating potential diagnoses.

Prospective study investigating the influence of nutritional intervention on biochemical profiles in patients with recurrent urolithiasis.

BACKGROUND AND OBJECTIVES: Urolithiasis, commonly known as kidney stones, is a condition significantly impacted by dietary habits. The objective of this study is to evaluate the impact of a tailored dietary plan on the crystalluria and biological parameters of patients with different types of kidney stones over a 3-month period. METHODS AND STUDY DESIGN: We conducted a prospective study of 3 months. The study involved patients with recurrent nephrolithiasis. Alongside the medical consultation, a comprehensive dietary survey was performed to assess the patients' nutritional habits. Urinary parameters, including volume, calcium, oxalate, uric acid, and power of hydrogen (pH), were evaluated both before and after the dietary intervention. RESULTS: 69 patients were involved. There were 17 patients diagnosed with cystine lithiasis, 33 with oxalocalcic lithiasis and 19 with uric lithiasis. After 3 months, only 32 patients revisited for follow-up. There were significant changes (p = 0.002 and 0.04) in urine crystalluria for cystinic and uric lithiasis. For the urinary oxalate variation, there was a significant decrease from T1 (before dietary intervention) to T2 (after dietary intervention), with levels dropping from 0.289 ± 0.10 umol/l to 0.215 ± 0.079 umol/l (p = 0.02).Regarding urinary calcium (calciuria), there was a trend toward a decrease from T1 to T2, although the change was not statistically significant, with levels decreasing from 2.42 ± 1.68 umol/l to 2.14 ± 1.62 umol/l (p = 0.1). CONCLUSIONS: Our research underscores the favorable effects of a tailored and well-balanced diet on both the crystalluria and biological parameters of individuals with recurrent lithiasis.

Exploring intradermal sterile water injection as an alternative to natrium diclofenac for kidney-stone related pain relief: A systematic review and meta-analysis of randomized controlled trials.

BACKGROUND: Kidney stone-related pain often presents significant challenges in clinical practice, mainly due to the adverse effects by NSAIDs, which are the current first-line treatment for urolithiasis. Patients presenting with gastrointestinal tract disorders and contraindications toward NSAIDs are particularly susceptible. Intradermal sterile water injection (SWI) has evidently become apparent as one of the promising alternatives, offering rapid pain relief with minimal adverse effects. This purpose of this study to assess the safety and efficacy of SWI in comparison to NSAIDs particularly Natrium Diclofenac in the management of kidney-stone related pain. MAIN BODY: A systematic review and meta-analysis was performed on papers published up to January 2024 obtained from scientific databases, guided by the PRISMA flowchart. The Cochrane risk of bias 2.0 tool was used to assess quality of the included studies. Statistical analyses were then performed using Review Manager 5.4.1 on studies that provide the baseline and complete follow-up numerical outcomes (e.g. mean and standard deviation) required. After screening was done, 3 retrievable studies met the inclusion and exclusion criteria with a total of 770 participants with kidney stone related pain. The result revealed no significant difference in pain reduction between SWI and Natrium diclofenac at 30 min (MD -0.12, 95% CI -0.68 to 0.44) and 60 min (MD -0.23, 95% CI -0.65 to 0.18). Furthermore, patients treated with SWI display a reduced need for rescue analgesia compared to Natrium Diclofenac (OR 0.73, 95% CI 0.36 to 1.49). Adverse events result was more superior in SWI, having lower occurrence when compared to Natrium Diclofenac, although not significant (OR 0.14, 95% CI 0.05 to 0.39). CONCLUSIONS: Intradermal sterile water injection (SWI) appears to be a promising alternative to NSAIDs for kidney stone related pain management, offering comparable efficacy in pain reduction, reduced need for rescue analgesia while maintaining a favorable safety profile. However, further research with larger sample sizes and standardized treatment protocols are required to further validate its safety and efficacy.

Renal Findings in Patients with Thalassemia at Abdominal Ultrasound: Should We Still Talk about "Incidentalomas"? Results of a Long-Term Follow-Up.

We retrospectively collected all ultrasound imaging data of our thalassemia patients over a period of 10 years with the aim of assessing the prevalence and the risk factors of renal stones and cysts. Moreover, we assessed the incidence of renal-cell carcinoma (RCC) among thalassemia patients (133 with thalassemia major (TM) and 157 with thalassemia intermedia (TI)) and its association with demographic and clinical findings. Renal stones were detected in 15.2% of patients. In the multivariable Cox regression analysis, the independent predictors were blood consumption, splenectomy, and proteinuria. Renal cysts were detected in 18.4% of patients. In the multivariable analysis, age emerged as the only independent predictor. After the first detection, 35% of the patients showed changes in the number, size, or grading of renal cysts. During the study period, the crude incidence rate of RCC was 75.9 cases per 100,000 person-years. The most frequent histological subtype (80%) included clear-cell RCC. In total, 80% of patients with RCC had TM and all were positive for hepatitis C virus antibodies. Thalassemia patients are significantly affected by asymptomatic renal diseases such as stones, cysts, and cancer, suggesting the need for regular screening by imaging.

Expression Profiles of Claudin Gene Family Members in Patients With Recurrent Calcium Oxalate Kidney Stones.

INTRODUCTION: In this study, we aimed to evaluate and compare the expression profiles of CLDN gene family members responsible for the mechanism of stone formation in patients with recurrent calcium oxalate stones and in a control group without a history of renal stones. METHODS: Nineteen patients with recurrent calcium oxalate renal calculi who underwent percutaneous nephrolithotomy and 21 control patients without renal calculi who underwent surgery for other reasons were included in the study. The urinary calcium, oxalate, and citrate levels of the patients included in the study, as well as those in the control group, were within normal ranges. They did not have proteinuria in their urine. The biochemical parameters were also within normal limits. Biopsy samples taken from the intact renal cortex parenchymal tissue were consistent. Total RNA was isolated from biopsy samples and expression profiles of target genes (Claudin 1-4, 7, 8, 10, 14, 16, 18, 19) were determined by real-time polymerase chain reaction (PCR). RESULTS: It was determined that CLDN1 gene expression in patients with recurrent calcium oxalate kidney stones was approximately four times higher than in the control group; this difference was statistically significant (p<0.050). CLDN1 expression was also strongly positively correlated with CLDN4 (r=0.642), CLDN7 (r=0.753) and CLDN14 (r=0.651) Conclusions: We thought that CLDN1 overexpression might play a role in the pathogenesis of recurrent calcium oxalate stone formation. CLDN1 together with CLDN2, CLDN4, CLDN7, and CLDN14 are also probably responsible for this pathogenesis.

The complex relationship between vitamin D and kidney stones: balance, risks, and prevention strategies.

The association between vitamin D and kidney stones is characterized by a remarkable multi-dimensional complexity involving numerous physiological and metabolic pathways. Vitamin D is pivotal in maintaining calcium-phosphorus metabolic homeostasis and bone health. However, fluctuations in its intake, whether excessive or insufficient, May potentially increase the risk of kidney stones. Vitamin D exerts its influence on kidney stone formation indirectly by increasing the efficiency of intestinal calcium absorption and regulating renal calcium excretion. Moreover, there is a robust correlation between various states of vitamin D, particularly its active form, 1,25-dihydroxyvitamin D, and the development of numerous kidney stones. This finding underscores the necessity of individualized medical treatment in vitamin D supplementation and kidney stone prevention. When developing treatment strategies, it is essential to consider the patient's genetic background, lifestyle, environmental factors, and overall health. To prevent the formation of kidney stones, it is recommended that patients adopt a comprehensive approach, which May include measures such as moderate sun exposure, dietary modification, moderate exercise, and weight management. These preventive measures are designed to maintain healthy calcium and phosphorus metabolism and reduce kidney stone formation risk. Future studies should aim to elucidate the detailed mechanisms of vitamin D metabolism, individual differences, and the role of genes in this process. Furthermore, the role of lifestyle interventions in preventing kidney stones requires greater attention. Moreover, the implementation of large-scale, long-term prospective studies and randomized controlled trials will facilitate the assessment of the actual effects of diverse vitamin D supplementation strategies, thereby providing a robust scientific foundation for advancing more precise prevention strategies and clinical guidelines.

Ultrathin semirigid retrograde ureteroscopy versus antegrade flexible ureteroscopy in treating proximal ureteric stones 1-2 cm, a prospective randomized multicenter study.

To compare the outcomes of using Ultrathin semirigid retrograde ureteroscopy and antegrade flexible ureteroscopy to treat proximal ureteric stones of sizes 1-2 cm. A prospective randomized multicenter study included patients who had proximal ureteric stones 1-2 cm, amenable for ureteroscopy and laser lithotripsy between August 2023 and February 2024. Two hundred thirty patients were divided evenly into two treatment groups. Group I included patients treated with antegrade flexible ureteroscopy and holmium laser stone fragmentation, and Group II included patients treated with retrograde ultrathin semirigid ureteroscopy. The study groups were compared in terms of patient demographics, stone access success, operation time, reoperation rates, peri-operative complications, and stone-free status. Group I included 114 patients, while Group II included 111. The mean age of the patients was 33.92 ± 10.37 years, and the size of the stones was 15.88 ± 3 mm. The study groups had comparable demographics and stone characteristics. The mean operative time was significantly longer in group I than in group II (102.55 ± 72.46 min vs. 60.98 ± 14.84 min, respectively, P < 0.001). Most reported complications were MCCS grades I and II, with no significant difference between the study groups. The stone-free rate after four weeks was 92.1% and 81.1% for groups I and II, respectively, which increased to 94.7% and 85.6% after eight weeks (P > 0.05). Antegrade flexible ureteroscopy is equivalent to retrograde ultrathin semirigid ureteroscopy in treating proximal ureteric stones regarding stone-free status and procedure-related morbidity. However, the antegrade approach has a longer operative time, greater fluoroscopy exposure, and longer hospital stays.

Different types and numbers metabolic abnormalities and risk of gallbladder stone disease in adults.

Background: Metabolic abnormalities in the body increase the risk of gallbladder stones and their complications, which brings a great economic and social burden. The relationship between different types and amounts of metabolic abnormalities and gallstone risk in different sexes is poorly documented and controversial. Methods: Based on the baseline survey data of the Chinese Multi-Ethnic Cohort (CMEC) study, 4,075 Chinese adults aged 30-79 years with complete abdominal ultrasound results and metabolic index data. Logistic regression model was used to evaluate the correlation between five metabolic abnormalities and gallstones, and to explore the gender difference. Results: The detection rate of gallbladder stones was found to be 7.0%, with a higher rate in women (8.6%) than in men (4.1%). Logistic results showed adjustment odds ratio (ORs) and 95% confidence interval (95% CI) of dysglycemia + hypertension + central obesity in 3 metabolic combinations was 4.459 (1.653, 12.029). The four metabolic combinations, dysglycemia + dyslipidemia + hypertension + central obesity, dysglycemia + dyslipidemia + hypertension + abnormal blood uric acid and dysglycemia + dyslipidemia + central obesity + abnormal blood uric acid adjusted OR and 95%CI were 3.342 (1.459, 7.659), 5.439 (1.555, 19.018) and 2.971 (1.187, 7.435), respectively. Gender-stratified analysis found that "any three or more metabolic abnormalities and their components were associated with gallstone risk, more significantly in women. Conclusion: Different types and amounts of five metabolic abnormalities were associated with the risk of gallstone development, and the differences were more significant in women than men.

Comparative Study of Endoscopic Treatment for Intrahepatic and Common Bile Duct Stones Using Peroral Cholangioscopy.

Objectives: Although peroral cholangioscopy has improved the endoscopic treatment of difficult stones, the treatment of intrahepatic stones remains challenging. The incidence of cholangitis is high when peroral cholangioscopy is used to treat intrahepatic stones. This study aimed to investigate the efficacy and safety of endoscopic treatment with peroral cholangioscopy for intrahepatic and common bile duct stones. Methods: Patients aged ≥20 years, who underwent endoscopic treatment with peroral cholangioscopy for intrahepatic or common bile duct stones at Tottori University Hospital from January 2016 to December 2022, were retrospectively evaluated to determine the efficacy and safety of the treatment. Results: Overall, 70 patients were included in this study: 22 in the intrahepatic stone group and 48 in the common bile duct stone group. Stones were smaller (8 vs. 17.5 mm, p < 0.001) and more numerous (p = 0.016) in the intrahepatic stone group than in the common bile duct stone group. Although the common bile duct stone group exhibited a higher rate of complete stone clearance in the first session, no significant differences were observed in the final results. The intrahepatic stone group had a higher incidence of cholangitis (36% vs. 8%, p = 0.007); however, all cases were mild. Conclusions: Endoscopic treatment with peroral cholangioscopy for intrahepatic stones may be associated with a higher incidence of cholangitis than that for common bile duct stones. Since saline irrigation may contribute to the development of cholangitis, it is important to be aware of intraductal bile duct pressure when performing peroral cholangioscopy.

Clinical Outcomes and Safety Assessment of Flexible Ureteroscopy as an Outpatient Procedure: A Retrospective Single-Center Study.

Nephrolithiasis, or kidney stone disease, is a significant global health issue in urology, requiring effective management strategies. The management of nephrolithiasis through flexible ureteroscopy (fURS) is increasingly gaining acceptance; however, it is associated with significant costs related to consumables, pharmacotherapy, specialized equipment, and general anesthesia (GA). Limited resources and the need to optimize the cost effectiveness ratio have driven the shift to day-case procedures, offering financial and operational benefits and improving patient satisfaction. This outpatient care approach addresses clinical and economic challenges. For same-day discharge, spinal anesthesia (SA) is essential for fURS, as GA does not permit safe immediate discharge. This retrospective study investigates the feasibility of same-day discharge following fURS procedures performed under SA. Analyzing data from 401 patients who underwent 414 fURS procedures between January 2020 and December 2023, this study aims to evaluate whether same-day discharge is a viable option compared to conventional fURS under GA. The primary objectives are to assess the outcomes, including efficacy, stone-free rate (SFR), pain management, and complication rates, in the context of same-day discharge. Additionally, this study seeks to identify patient and kidney stone characteristics that may influence the suitability of one-day fURS under SA. Outcomes will be measured using the Dindo-Clavien (D-C) classification and Visual Analog Scale (VAS) scores post-procedure.

Sheathless RIRS in the era of slim and single use flexible ureteroscopy (ssFURS): Prospective analysis of clinical outcome.

INTRODUCATION: the purpose is to assess the feasibility of sheathless and time-limited retrograde intrarenal surgery (RIRS) using slim and single use flexible ureteroscopy (ssFURS) in view of the stone-free rate (SFR), complication rate and upfront ureteral stenting. METHODS: A prospective, cross-sectional study of patients who underwent RIRS for kidney stones between December 2021 and December 2023 at our tertiary urology center was performed. Patient demographics, clinical presentations and stone characteristics were calculated. The SFR and complication rate were included. RESULTS: Hundred and eighteen patients were included. The median age was 48 (35.7-60.0) years. Diabetes mellitus (DM) was present in 32 patients (27.1%). The median length of the kidney stones was 1.15 (range [0.4-3.0]), and the median width was 1 (range [0.05-3.7]). The pelvi-ureteric junction (PUJ) represented 75 (63.6%) patients. The lower pole stone (LP) consisted of 27 (22.9%) patients. Thirty-seven (31.4%) of the patients had multiple kidney stones. An overall complete SFR after the first session was observed for 94 (79.7%) patients. The second session of complete SFR was observed in 15 patients (12.7%). A median stone length of 1 (0.8-1.5) cm and a median stone width of 0.95 (0.7-1.3) cm were both significantly associated with a complete SFR after the first session (p < 0.001). A single kidney stone in 69 (73.4%) patients was significantly more strongly associated with a complete SFR after the first session than was multiple kidney stones in 25 (26.6%) patients (p = 0.027). Upfront stenting was performed in 74 patients (62.7%). The complete SFR after the first session was significantly greater in patients who underwent upfront stenting (65; 69.1%) than in those who underwent primary ssFURS (29; 30.9%, p = 0.004). CONCLUSION: Sheathless and time-limited RIRS using ssFURS is a feasible and successful procedure with low complication rate.

Two institutes' experience in laparoendoscopic "rendezvous" technique for patients undergoing laparoscopic cholecystectomy for stones in the gallbladder and bile duct: a prospective randomized comparative clinical trial.

There is still disagreement on the best treatment option for cholecystocholedocholithiasis. Although there are some benefits to the single-step procedure, the "laparoendoscopic rendezvous" (LERV) technique that include a lower risk of post-ERCP pancreatitis and a shorter hospital stay, the standard technique is still the two-step approach for clearing the common bile duct (CBD) using ERCP and then performing a laparoscopic cholecystectomy. The purpose of this study was to assess the effectiveness and safety of the LERV technique vs. the standard two-step approach. Four hundred thirty-six patients with symptomatized concomitant stones at both the gall bladder (GB) and the (CBD), at two gastroenterology centers in Zagazig city, Egypt, from January 2010 till April 2022, were analyzed. Patients were randomly divided into two equally groups. The overall length of hospital stay was the primary outcome, and the success of CBD clearance and morbidity, particularly post-ERCP pancreatitis, were the secondary endpoints. The LERV group experienced a significantly shorter hospital stay (median 2(2-8) days compared to 4.5 (4-11) days for the two-stage approach (p < 0.001)). The two groups did not differ in terms of CBD clearing success. Also, there was no significant difference in the number of patients with post-ERCP pancreatitis between the LERV group [14 patients (6.4%)] and the two-stage approach [26 patients (11.9%)] with p value = 0.703. For patients with cholecystocholedocholithiasis, the optimal treatment must be determined by the knowledge and resources that are accessible locally. Our data further supported the idea that treating patients with cholecystocholedocholithiasis in one stage is a safe and successful strategy.