Play it safe: renal function after bilateral flexible ureteroscopy for kidney stones.

PURPOSE: We searched for perioperative renal function deterioration risk factors in patients that underwent bilateral flexible ureteroscopy (fURS) for kidney stones. METHODS: From August 2016 to February 2020, symptomatic patients > 18 years old with bilateral kidney stones up to 20 mm in each side were prospectively studied. Serum creatinine samples were collected on admission to surgery, immediate postoperative (IPO), on POD 3, 10, and 30. Estimated glomerular filtration rate (eGFR) was calculated using Chronic Kidney Disease Epidemiology Collaboration equation (CKD-EPI) without a race coefficient. RESULTS: Thirty patients underwent bilateral fURS. Comparing to preoperative eGFR, median IPO and POD3 eGFR (p < 0.001) were significantly lower, and POD10 (p = 0.092) and POD30 (p = 0.648) were similar to preoperative eGFR. During follow-up, 22/30 (73.3%), 14/30 (46.7%), and 7/30 (23.3%) of the patients presented a decrease > 10% eGFR, > 20% eGFR, and > 30% eGFR, respectively. Multivariate analysis demonstrated that lower preoperative eGFR is a risk factor for eGFR < 60 mL/min/1.73 m2, p = 0.019 [1.021-1.263; 1.136]; ASA > 1 is a risk factor for decrease of eGFR > 10%, p = 0.028 [1.25-51.13; 8.00]; longer operative time is a risk factor for decrease of eGFR > 20%, p = 0.042 [1.00-1.05; 1.028]; and operative time ≥ 120 min is a risk factor for decrease of eGFR > 30%, p = 0.026 [0.016-0.773; 0.113]. CONCLUSIONS: Renal function suffers a reversible decrease after bilateral fURS. Our study suggests that adequate selection of patients and maintaining operative time < 120 min are relevant factors in preventing acute renal function deterioration following bilateral fURS.

High-risk patients for septic shock after percutaneous nephrolithotomy.

PURPOSE: to identify risk factors for urinary septic shock in patients who underwent percutaneous nephrolithotomy (PCNL). MATERIALS AND METHODS: Data from PCNL procedures performed between January 2009 and February 2020 were retrospectively analyzed. The study included all patients over 18 years old with kidney stones larger than 15 mm who underwent PCNL. Patients who underwent mini-PCNL or combined surgeries, such as ureteroscopy or bilateral procedures, were not included in the study. Logistic regression was conducted to determine the risk factors for urinary septic shock within 30 days post-operation in patients who underwent PCNL. RESULTS: Urinary septic shock was observed in 8 out of the 1,424 patients analyzed (0.56%). The presence of comorbidities, evaluated using the Charlson Comorbidity Index (CCI) (OR 1.46 [CI 95% 1.15-1.86], p=0.01), larger stones (41.0 mm [IQR 30.0-47.5 mm] vs. 24.0 mm [IQR 17.0-35.0 mm], OR 1.03 [CI 95% 1.01-1.06], p=0.04), and a positive preoperative urine culture (OR 8.53 [CI 95% 1.71-42.45], p < 0.01) were shown to significantly increase the risk of postoperative urinary septic shock. Patients with a CCI > 2, larger stones (≥ 35 mm), and a positive preoperative urine culture were at even higher risk of urinary septic shock (OR 15.40 [CI 95% 1.77-134.21], p=0.01). CONCLUSION: Patients with larger stones, positive preoperative urine culture, and a higher CCI are at risk for urinary septic shock after PCNL. These findings are of utmost importance for optimizing the perioperative care of these patients to prevent life-threatening complications.

Postoperative antibiotic prophylaxis for percutaneous nephrolithotomy and risk of infection: a systematic review and meta-analysis.

PURPOSE: The aim of this study is to perform a high-quality meta-analysis using only randomized controlled trials (RCT) to better define the role of postoperative antibiotics in patients undergoing percutaneous nephrolithotomy (PCNL). MATERIALS AND METHODS: A literature search for RCTs in EMBASE, PubMed, and Web of Science up to May 2023 was conducted following the PICO framework: Population-adult patients who underwent PCNL; Intervention-postoperative antibiotic prophylaxis until nephrostomy tube withdrawal; Control-single dose of antibiotic during the induction of anesthesia; and Outcome-systemic inflammatory response syndrome (SIRS) or sepsis and fever after PCNL. The protocol was registered on the PROSPERO database (CRD42022361579). We calculated odds ratios (OR) and 95% confidence intervals (CI). A random-effects model was employed, and the alpha risk was defined as < 0.05. RESULTS: Seven articles, encompassing a total of 629 patients, were included in the analysis. The outcome of SIRS or sepsis was extracted from six of the included studies, while the outcome of postoperative fever was extracted from four studies. The analysis revealed no statistical association between the use of postoperative antibiotic prophylaxis until nephrostomy tube withdrawal and the occurrence of SIRS/sepsis (OR 1.236, 95% CI 0.731 - 2.089, p=0.429) or fever (OR 2.049, 95% CI 0.790 - 5.316, p=0.140). CONCLUSION: Our findings suggest that there is no benefit associated with the use of postoperative antibiotic prophylaxis until nephrostomy tube withdrawal in patients undergoing percutaneous nephrolithotomy (PCNL). We recommend that antibiotic prophylaxis should be administered only until the induction of anesthesia in PCNL.

One week pre-operative oral antibiotics for percutaneous nephrolithotomy reduce risk of infection: a systematic review and meta-analysis.

PURPOSE: The aim of this meta-analysis is to assess the efficacy of extended dose of preoperative antibiotics to reduce infectious risk in patients undergoing percutaneous nephrolithotomy (PCNL). MATERIALS AND METHODS: A literature search for prospective case-control studies or randomized controlled trials was done. PICO framework was used. POPULATION: adult patients that underwent to PCNL; Intervention: extended dose preoperative antibiotic prophylaxis before PCNL; Control: short dose preoperative antibiotic prophylaxis before PCNL; and Outcome: systemic inflammatory response syndrome (SIRS) or sepsis, fever after PCNL and positive intraoperative urine and stone culture. This meta-analysis was registered in PROSPERO database under the number: CRD42022359589. RESULTS: Three RCT and two prospective studies (475 patients) were included. SIRS/sepsis outcome was retrieved from all studies included. Seven days preoperative oral antibiotics for PCNL was a protective factor for developing SIRS/sepsis (OR 0.366, 95% CI 0.234 - 0.527, p < 0.001). There was no statistical association between seven-day use of antibiotics and fever (OR 0.592, 95% CI 0.147 - 2.388, p = 0.462). Patients who received seven days preoperative antibiotics had lower positive intraoperative urine culture (OR 0.284, 95% CI 0.120 - 0.674, p = 0.004) and stone culture (OR 0.351, 95% CI 0.185 - 0.663, p = 0.001) than the control group. CONCLUSION: one week of prophylactic oral antibiotics based on local bacterial sensitivity pattern plus a dose of intravenous antibiotics at the time of surgery in patients undergoing PCNL reduces the risk of infection.

Single-use flexible ureteroscopes: update and perspective in developing countries. A narrative review.

Flexible ureteroscopy is a well-established method for treatment of urinary stones but flexible ureteroscopes are expensive and fragile devices with a very limited lifetime. Since 2006 with the advent of digital flexible ureteroscopes a great evolution has occurred. The first single-use flexible ureteroscope was launched in 2011 and new models are coming to the market. The aim of this article is to review the characteristics of these devices, compare their results with the reusable devices and evaluate the cost-benefits of adopting single-use flexible ureteroscopes in developing countries. MATERIALS AND METHODS: an extensive review of articles listed at PubMed and published between 2000 and 2021 was performed. RESULTS: Single-use flexible ureteroscopes have a shaft with 65 to 68cm length and weight between 119 and 277g. Their deflection goes up to 300 degrees. Their stone-free rates vary between 60 and 95% which is comparable to reusable scopes and operative times ranges from 54 to 86 minutes which are lower when compared to reusable flexible scopes. Their costs vary between 800 and 3180 US dollars. CONCLUSION: single-use flexible ureteroscopes are lighter and have superior quality of image when compared to fiberoptic ones. There are no definite data showing a higher stone-free rate or less complications with the use of single-use flexible ureteroscopes. Each institution must perform a cost-benefit analysis before making the decision of adopting or not such devices depending on the local circumstances.

Understanding urologic scientific publication patterns and general public interests on stone disease: lessons learned from big data platforms.

PURPOSE: To analyse patterns of stone disease online information-seeking behaviours in the United States and to correlate with urological literature publication aspects. METHODS: To compare Relative Search Volume (RSV) among different twelve preselected urologic keywords we chose "United States" as country and "01/01/2009-31/12/2018" as time range on Google Trends (GT). We defined "ureteroscopy" as a reference and compared RSV against it for each term. RSV was adjusted and normalized in a scale 0-100. Trend presence was evaluated by Mann-Kendall Test and magnitude by Sen's Slope Estimator (SS). Weather influence on RSV was also investigated by comparison of the ten hottest versus ten coldest states. Pearson correlation analysis was performed between number of Pubmed publications and RSV for each term over time. RESULTS: We found an upward tendency (p < 0.01) for most terms. Higher temporal trends were seen for "kidney stone" (SS = 0.36), "kidney pain" (SS = 0.39) and "tamsulosin" (SS = 0.21). Technical treatment terms had little search volumes and no increasing trend. States with hotter weather showed higher mean RSV for "kidney stone" than colder ones. There was little correlation between GT and Pubmed for most terms, with the exception of "kidney stone" (R = 0.89; p < 0.01), "URS" (R = 0.81; p < 0.01), and "laser lithotripsy" (R = 0.74; p = 0.01). CONCLUSION: There was a significant increase in online search for medical information related to stone disease. Citizens tend to look for generic terms related to symptoms or the disease itself. States with hotter weather show higher RSV than colder states. There is a discrepancy between public and medical community medical terms.

Comparing public interest on stone disease between developed and underdeveloped nations: are search patterns on google trends similar?

OBJECTIVE: The big data provided by Google Trends may reveal patterns in health information-seeking behavior on population from Brazil and United States (US). Our objective was to explore and compare patterns of stone disease online information-seeking behaviors in both nations. MATERIALS AND METHODS: To compare Relative Search Volume (RSV) among different urologic key words we chose "US" and "Brazil" as country and "01/01/2009 - 31/12/2018" as time-range. The final selection included 12 key words in each language. We defined "ureteroscopy" as a reference and compared RSV against it for each term. RSV was adjusted by the reference and normalized in a scale from 0-100. Trend presence was evaluated by Mann Kendall Test and magnitude by Sen's Slope (SS) Estimator. RESULTS: We found an upward trend (p<0.01) in most of the researched terms in both countries. Higher temporal trends were seen for "Kidney Stone" (SS=0.36), "Kidney Pain" (SS=0.39) and "Tamsulosin" (SS=0.21) in the US. Technical treatment terms had little search volumes and no increasing trend. "Kidney Stent" and "Double J" had a significant increase in search trend over time and had a relevant search volume overall in 2018. In Brazil, "Calculo Renal", "Colica Renal", "Dor no Rim" and "Pedra no Rim" had a significant increase in RSV (p<0.001). More common and popular terms as "Kidney Stent" and "Tamsulosin" were highly correlated with "Kidney Pain" and "Kidney Stone" in both countries. CONCLUSIONS: In the last decade, there was a significant increase in online search for medical information related to stone-disease. Population from both countries tend to look more for generic terms related to symptoms, the disease, medical management and kidney stent, than for technical treatment vocabulary.

Effect of a low-calorie diet on 24-hour urinary parameters of obese adults with idiopathic calcium oxalate kidney stones.

PURPOSE: to evaluate the effect of low-calorie diet on 24-hour urinary metabolic parameters of obese adults with idiopathic calcium oxalate kidney stones. MATERIALS AND METHODS: Adult idiopathic calcium oxalate stone formers, with body mass index (BMI) ≥30kg/m2 and a known lithogenic metabolic abnormality, were submitted to low-calorie diet for twelve weeks. After enrolment, anthropometric measures, serum exams, 24-hour urinary metabolic parameters and body impedance were collected one month prior to dietary intervention and at the end of twelve weeks. Correlations between weight loss, waist circumference loss, fat loss and variation in 24-hour urinary lithogenic parameters and calcium oxalate urinary supersaturation (CaOx SS) as per Tiselius equation were analysed. RESULTS: From January 2017 to January 2018, 39 patients were enrolled to participate in this study. Median (range) prescribed diet was 1300 (1100-2100) Kcal/day. Mean age was 51.7±11.0 (29-68) years old and 69.2% were female. 30.8% of the participants shifted from obesity to BMI < 30kg/m2 and none to BMI < 25kg/m2. A significant correlation was found between baseline 24-hour urinary oxalate and weight (p=0.018) and BMI (p=0.026). No correlation was found between variation of weight, waist circumference, fat mass and 24-h urinary stone risk factors or CaOx SS. CONCLUSIONS: Short-term modest weight loss induced by twelve weeks of low-calorie diet is not associated with a decrease of 24-hour urinary lithogenic parameters in idiopathic calcium oxalate stone formers. Calcium oxalate urinary stone formation is probably multifactorial and driven by other factors than weight.

Does previous standard percutaneous nephrolithotomy impair retrograde intrarenal surgery outcomes?

PURPOSE: The objective of this study is to evaluate the impact of a previous standard percutaneous nephrolithotomy (PCNL) on the outcomes of retrograde intrarenal surgery (RIRS). MATERIALS AND METHODS: Outcomes of RIRS performed from January 2017 to January 2020 in adult patients with residual stone fragments ≤20mm after a standard PCNL (Post-PCNL) and symptomatic adult patients with kidney stones ≤20mm (Control) were prospectively studied. Stone-free rate (SFR) was evaluated on a postoperative day 90 non-contrast computed tomography. Surgical complications based on Clavien-Dindo classification during the 90 days of follow-up were recorded. RESULTS: Outcomes of 55 patients and 57 renal units of the post-PCNL group were compared to 92 patients and 115 renal units of the control group. SFR was lower in post-PCNL group than in control (28/57, 49.1% vs. 86/115, 74.8%, p < 0.001). Overall complications were more frequent in post-PCNL group (p=0.004). Infundibula strictures were identified and incised with laser in 15/57 (26.3%) renal units of the post-PCNL group. Thirteen renal units had infundibulum stricture at the site of previous percutaneous tract (13/15; 86.7%, p=0.004) and one renal unit had three infundibula strictures. Postoperative complications were not affected by the treatment of infundibula strictures (p=0.198). CONCLUSIONS: Previous standard PCNL significantly impairs the outcomes of RIRS. Infundibula strictures can be found in 26.3% of the patients with residual stone fragments after standard PCNL for large burden kidney stones. The main site of infundibulum stricture after standard PCNL is the infundibulum of the entry calyx.

Endoscopic guided PCNL in the prone split-leg position versus supine PCNL: a comparative analysis stratified by Guy's stone score.

INTRODUCTION: The optimal patient positioning for percutaneous nephrolithotomy (PCNL) based on the complexity of stone burden is not yet defined. Thus, we aimed to evaluate the intraoperative parameters, effectiveness and complications of patients undergoing PCNL between the endoscopic-guided prone split-leg PCNL (ePSL) and the supine PCNL by stratifying patients according to Guy's stone score (GSS). MATERIALS AND METHODS: A retrospective chart review was conducted of patients undergoing PCNL at two high-volume tertiary referral centers. At one center, patients underwent PCNL using the ePSL technique, while at the second center, patients underwent PCNL in supine. Patient demographics and stone characteristics, operative details, complications and effectiveness were compared between groups. The impact of obesity was also investigated. RESULTS: Of 830 subjects, a total of 449 (54%) underwent PCNL in ePSL and 381 (46%) in supine. The ePSL group had a greater mean age and body mass index. No statistical differences were found in gender, serum chemistry and Charlson comorbidity index. After stratifying patients by GSS, the differences in baseline stone burden between PSL and supine lost significance and both groups could be compared. Complications were not statistically different between both groups. Univariate analysis demonstrated that multiple tracts and lower pole access were more prevalent in supine. In addition, for GSS1-3, ePSL was correlated with reduced operative time, radiation exposure, length of hospital stay and need for secondary procedure. Multivariate analysis correlated ePSL with lower radiation exposure and need for secondary procedures (p = 0.01). In comparison to the whole trial population, the same tendencies were appreciated for obese cohort. CONCLUSIONS: This is the first report focusing on the performance differences between ePSL and supine PCNL stratified by GSS. Both techniques are safe, with a low rate of complications. For GSS1-3, ePSL reduces radiation exposure and requires less need for both multiple access and secondary procedure.

Predictors of surgical complications of nephrectomy for urolithiasis.

OBJECTIVES: Nephrectomy due to stone disease may be a challenging procedure owing to the presence of significant inflammation and infection, involving high complication rate. The objective of our study was to identify predictors for complications of nephrectomy for urolithiasis. PATIENTS AND METHODS: A retrospective review of 149 consecutive patients > 18y submitted to simple nephrectomy for urolithiasis from January 2006 to July 2012 was performed. Clinical data, computed tomography findings and pathology report were analyzed. Postoperative complications were categorized based on Clavien - Dindo classification. Logistic multivariate regression models assessed the predictors for surgical complications of nephrectomy for urolithiasis. RESULTS: Eighty-three (55.7%) patients were submitted to laparoscopic nephrectomy and 66 (44.2%) to open procedure. Conversion to open surgery was necessary in 19.2% (16 / 83). On univariable analysis, higher preoperative chronic kidney stage (p = 0.02), Charlson comorbidity index ≥ 2 (p = 0.04), higher ASA score (p = 0.001), urgency due to sepsis (p = 0.01), kidney size ≥ 12 cm (p = 0.006), renal and perirenal abscess (p = 0.004 and 0.002 respectively) and visceral adhesion (p = 0.04) were associated with Clavien - Dindo score > 1. On multivariate analysis, higher ASA score (p = 0.01), urgency due to sepsis (p = 0.03), kidney size ≥ 12 cm (p = 0.04) and preoperative abscess (p = 0.04) remained significantly associated with complications. End - stage renal disease with dialysis was needed post - operatively in 3.4% (5 / 144) of patients. CONCLUSIONS: We identified that higher ASA score, urgency due to sepsis, kidney size ≥ 12 cm and preoperative abscess were associated with Clavien - Dindo score > 1.

Computed tomography window affects kidney stones measurements.

OBJECTIVES: Measurements of stone features may vary according to the non-contrast computed tomography (NCCT) technique. Using magnified bone window is the most accurate method to measure urinary stones. Possible differences between stone measurements in different NCCT windows have not been evaluated in stones located in the kidney. The aim of this study is to compare measurements of kidney stone features between NCCT bone and soft tissue windows in patients submitted to retrograde intrarenal surgery (RIRS). MATERIALS AND METHODS: Preoperative and 90th postoperative day NCCT were performed in 92 consecutive symptomatic adult patients (115 renal units) with kidney stones between 5 mm to 20 mm (< 15 mm in the lower calyx) treated by RIRS. NCCT were evaluated in the magnified bone window and soft tissue window in three axes in a different time by a single radiologist blinded for the measurements of the NCCT other method. RESULTS: Stone largest size (7.92±3.81 vs. 9.13±4.08; mm), volume (435.5±472.7 vs. 683.1±665.0; mm3) and density (989.4±330.2 vs. 893.0±324.6; HU) differed between bone and soft-tissue windows, respectively (p<0.0001) 5.2% of the renal units (6/115) were reclassified from residual fragments > 2 mm on soft tissue window to 0-2 mm on bone window. CONCLUSION: Kidney stone measurements vary according to NCCT window. Measurements in soft tissue window NCCT of stone diameter and volume are larger and stone density is lesser than in bone window. These differences may have impact on clinical decisions.

Current trends of percutaneous nephrolithotomy in a developing country.

INTRODUCTION: To present the current practice patterns on percutaneous nephrolithotomy (PCNL) in a developing country. MATERIALS AND METHODS: A survey was offered to Brazilian urologists during the II International Endourology Symposium held in Sao Paulo, in 2015. The first seven questions were related to demographic data while the 20 remaining were directed to urologists who performed PCNL. RESULTS: From 250 participants, 100 replied to the survey, 81% performed PCNL and 60.4% of performers had been in practice for less than 15 years. Eighty-one percent were trained in the prone position and 64% in supine. PCNL was learned during the residency in 66.7% and 2.5% had fellowship training. Prone position was the preferred decubitus for simple or complex calculi, though for obese patients there was no difference. Younger surgeons prefer supine while older surgeons prefer prone. The access was obtained by the surgeon in all cases, 96.3% use fluoroscopy and 3.7% prefer ultrasonography. Forty-seven percent use ultrasonic lithotripters and 4.1% laser. For kidney drainage, 71.6% place a nephrostomy tube. Double J stent is left in 77%. The postoperative image method was CT for 50%. Colonic injury was reported by 25%, predominantly in the senior group without statistically difference between positions. CONCLUSIONS: From a selected group of urologists, we observe that Brazilian urologists usually gain their own access for PCNL guided by fluoroscopy. They predominantly prefer the prone position, use fascial dilators, ultrasonic lithotripters and place a nephrostomy tube when exiting the kidney. Fellowship programs, ultrasonography, flexible nephoscopy and tubeless procedures could be encouraged.

Accuracy of ultrasonography for renal stone detection and size determination: is it good enough for management decisions?

OBJECTIVES: To determine the sensitivity and specificity of ultrasonography (US) for detecting renal calculi and to assess the accuracy of US for determining the size of calculi and how this can affect counselling decisions. MATERIALS AND METHODS: We retrospectively identified all patients at our institution with a diagnosis of nephrolithiasis who underwent US followed by non-contrast computed tomography (CT) within 60 days. Data on patient characteristics, stone size (maximum axial diameter) and stone location were collected. The sensitivity, specificity and size accuracy of US was determined using CT as the standard. RESULTS: A total of 552 US and CT examinations met the inclusion criteria. Overall, the sensitivity and specificity of US was 54 and 91%, respectively. There was a significant association between sensitivity of US and stone size (P < 0.001), but not with stone location (P = 0.58). US significantly overestimated the size of stones in the 0-10 mm range (P < 0.001). Assuming patients with stones 0-4 mm in size will be selected for observation and those with stones ≥5 mm could be counselled on the alternative of intervention, we found that in 14% (54/384) of cases where CT would suggest observation, US would lead to a recommendation for intervention. By contrast, when CT results would suggest intervention as management, US would suggest observation in 39% (65/168) of cases. An average of 22% (119/552) of patients could be inappropriately counselled. Stones classified as 5-10 mm according to US had the highest probability (43% [41/96]) of having their management recommendation changed when CT was performed. The use of plain abdominal film of kidney, ureter and bladder and US increases sensitivity (78%), but 37% (13/35) of patients may still be counselled inappropriately to undergo observation. CONCLUSIONS: Using US to guide clinical decision-making for residual or asymptomatic calculi is limited by low sensitivity and inability to size the stone accurately. As a result, one in five patients may be inappropriately counselled when using US alone.

Nephron-sparing surgery for treatment of reninoma: a rare renin secreting tumor causing secondary hypertension.

MAIN FINDINGS: A 25-year-old hypertensive female patient was referred to our institution. Initial workup exams demonstrated a 2.8 cm cortical lower pole tumor in the right kidney. She underwent laparoscopic partial nephrectomy without complications. Histopathologic examination revealed a rare juxtaglomerular cell tumor known as reninoma. After surgery, she recovered uneventfully and all medications were withdrawn. Case hypothesis: Secondary arterial hypertension is a matter of great interest to urologists and nephrologists. Renovascular hypertension, primary hyperadosteronism and pheocromocytoma are potential diagnosis that must not be forgotten and should be excluded. Although rare, chronic pyelonephritis and renal tumors as rennin-producing tumors, nephroblastoma, hypernephroma, and renal cell carcinoma might also induce hypertension and should be in the diagnostic list of clinicians. Promising future implications: Approximately 5% of patients with high blood pressure have specific causes and medical investigation may usually identify such patients. Furthermore, these patients can be successfully treated and cured, most times by minimally invasive techniques. This interesting case might expand knowledge of physicians and aid better diagnostic care in future medical practice.

Use of biological Glue (Bioglue®) in laparoscopic partial nephrectomy: a study in pigs.

INTRODUCTION: Partial nephrectomy is the standard of care for localized renal tumors. However, bleeding and warm ischemia time are still controversial when laparoscopic surgeries are carried out. Herein, we aim to compare the outcomes from laparoscopic partial nephrectomy with and without the use of biological glue with purified bovine albumin and glutaraldehyde (BioGlue ®). MATERIALS AND METHODS: Twenty-four kidneys of 12 pigs were used in this study. A pre-determined lower pole segment was resected (3 cm x 1 cm) and one of two different hemostatic techniques was performed. In one kidney, hemostatic ″ U suture ″ (poliglecaprone 3.0) was performed and in the contra-lateral kidney, only the biological glue was applied. Data recorded was comprised of warm ischemia time (seconds) and estimated blood loss (mL) for each procedure. In cases of bleeding after glue administration, a complementary suture was done. RESULTS: Mean warm ischemia time was 492.9 ± 113.1 (351-665) seconds and 746 ± 185.3 (409-1125) seconds for biological glue and suture groups, respectively. There was a positive significant difference in terms of warm ischemia favoring the biological glue group over the suture group (p<0.001). Mean blood loss was 39.4 (0-115) mL for the biological glue group and 39.1 (5-120) mL for the suture group (p=0.62). CONCLUSION: Biological glue is an important tool for laparoscopic partial nephrectomies. It is effective for hemostatic control in selected cases, and it can be used in combination with the traditional suture techniques.

Dyslipidemia and kidney stone risk.

PURPOSE: We studied the impact of dyslipidemia on 24-hour urinalysis and stone composition. MATERIALS AND METHODS: We retrospectively identified patients with nephrolithiasis who underwent 24-hour urinalysis and lipid profile evaluation within 3 months. Patients were divided into groups based on total cholesterol, high density lipoprotein, nonhigh density lipoprotein and triglycerides. The groups were compared based on demographic data, diabetes, hypertension and each component of 24-hour urinalysis and stone composition. Multivariate analysis and linear regression were performed to control for potential confounders, including age, gender, body mass index, diabetes and hypertension. RESULTS: A total of 2,442 patients with a mean age of 51.1 years were included in study. On multivariate analysis patients with high total cholesterol had significantly higher urinary potassium and calcium, those with low high density lipoprotein or high triglycerides had significantly higher urinary sodium, oxalate and uric acid with lower pH, and those with high nonhigh density lipoprotein had higher urinary sodium and uric acid. Regarding stone composition, high total cholesterol and triglycerides were significantly associated with a higher uric acid stone rate (p = 0.006 and <0.001, respectively). Linear regression showed a significant association of nonhigh density lipoprotein with higher urinary sodium (p = 0.011) and uric acid (p <0.001) as well as triglycerides and higher uric acid (p = 0.017), and lower urinary pH (p = 0.005). CONCLUSIONS: There is a link between dyslipidemia and kidney stone risk that is independent of other components of metabolic syndrome such as diabetes and obesity. Specific alterations in the patient lipid profiles may portend unique aberrations in urine physicochemistry and stone risk.