[Phytoprophylaxis of complications after extracorporeal lithotrips].

AIM: To evaluate the efficiency of the drug phytolysin (capsules) in the prevention of complications after extracorporeal lithotripsy. MATERIALS AND METHODS: A total of 15 patients diagnosed with urolithiasis and chronic pyelonephritis in the latent phase were treated. The predominant localization of radiopaque stones no larger than 20 mm in size was the collecting system. The piezoelectric lithotripsy (1-2 sessions) was performed, followed by the administration of the herbal drug Phytolysin in the dosage form of a capsule. The follow-up was carried out after 14- and 30-days using laboratory, ultrasound and x-ray methods. RESULTS: In the postoperative period, there were no cases of the pyelonephritis, which may result from a short-term disturbance of the upper urinary tract urodynamics due to the passage of stone fragments. The antibacterial, antispasmodic, diuretic and anti-inflammatory effects of Phytolysin ensured positive changes in laboratory and bacteriological tests, contributed to the prevention of postoperative complications after extracorporeal lithotripsy (renal colic, pyelonephritis), and contributed to maintaining renal blood flow within normal limits and significantly reduced the time to stone-free status. CONCLUSIONS: Our results justify the feasibility of using phytolysin in capsules in patients with urolithiasis after extracorporeal lithotripsy. The dosage form in capsules eliminates the undesirable effects associated with the specific smell and taste, that patients noted when using phytolysin in the form of a paste.

Effect of acupressure on pain intensity and physiological indices in patients undergoing extracorporeal shock wave lithotripsy: a randomized double-blind sham-controlled clinical trial.

BACKGROUND: Despite the widespread use of extracorporeal shock wave lithotripsy (ESWL) as a treatment for kidney stones, it is essential to apply methods to control pain and improve patient comfort during this procedure. Therefore, this study aimed to investigate the effect of acupressure at the Qiu point on pain intensity and physiological indices in patients undergoing ESWL. METHODS: This randomized, sham-controlled clinical trial was conducted at the Shahid Beheshti Educational-medical Center in Hamadan City (western Iran) from May to August 2023. Seventy-four eligible patients were split into intervention (n = 37) and sham (n = 37) groups. Ten minutes before lithotripsy, the intervention group received acupressure at the Qiu point, while the sham group received touch at a neutral point. The primary outcomes were pain intensity measured by the Visual Analog Scale (VAS) and physiological indices such as blood pressure and heart rate at baseline, 1, 10, 20, 30, 40, and 50 min after the intervention. The secondary outcomes included lithotripsy success and satisfaction with acupressure application. RESULTS: The analysis of 70 patients showed no significant differences in the demographic and clinical information of the patients across the two groups before the study (P > 0.05). Generalized estimating equations revealed that the interaction effects of time and group in pain and heart rate were significant at 30 and 40 min (P < 0.05). The results of this analysis for systolic blood pressure revealed a significant interaction at 30 min (P = 0.035). However, no significant interaction effects were found for diastolic blood pressure changes (P > 0.05). CONCLUSIONS: Acupressure at the Qiu point positively impacts pain in patients undergoing ESWL treatment and increases their satisfaction. However, these results for physiological indices require further studies. Thus, acupressure can be considered a simple, easy, and effective option for pain management in patients during this procedure. TRIAL REGISTRATION: [ https://en.irct.ir/trial/69117 ], identifier [IRCT20190524043687N4].

Effect of acupressure on pain among older female patients undergoing extracorporeal shock wave lithotripsy: A randomized controlled clinical trial.

BACKGROUND AND AIM: Urinary stones are highly prevalent among older people. Extracorporeal lithotripsy is one of the commonly used treatment methods, but it causes pain. Acupressure is a non-pharmacological therapeutic method that is effective in relieving pain among patients with various health conditions. This study aimed to investigate the effect of acupressure on pain among female older people undergoing extracorporeal lithotripsy. METHOD: This randomized controlled clinical trial was conducted on 66 older female patients undergoing extracorporeal lithotripsy. They were enrolled in the study through convenient sampling and were assigned to the intervention and control groups through the block randomization method. The intervention group underwent acupressure for 16 min which was repeated twice with an interval of 20 min, but the control group received only touch without any pressure for the same period. The McGill Pain Questionnaire and Visual Analogue Scale were completed 60 min before the intervention and immediately after lithotripsy. FINDINGS: Before the intervention, no statistically significant difference in the quality and intensity of pain between the two groups was observed (p > 0.05). However, after acupressure, the mean scores of quality and intensity of pain decreased significantly (p < 0.001) in the intervention group compared with the control group. CONCLUSION: Acupressure as a complementary and alternative medicine can reduce pain and suffering among older people undergoing extracorporeal lithotripsy. It can be included in the routine therapeutic measures for relieving pain and suffering during noninvasive methods for older people and reducing their need for medication use and avoiding related pharmacological side effects.

Measuring quality of life in patients with kidney stone disease: is it the future in endourology?

PURPOSE OF REVIEW: Kidney stone disease is recognized to negatively impact quality of life. This pertains to acute episodes, surgical interventions and even during asymptomatic periods. Over time there has been increased attention towards assessing this subjective parameter, including as a determinant of treatment success. Our aim was to evaluate the current status and emerging trends in this field. RECENT FINDINGS: Patient groups most affected appear to be recurrent stone formers, cystine stone formers, women, younger populations, non-Caucasians and low-income populations. Several stone specific patient reported outcome measures are now available of which, WISQol has been implemented the most in clinical research studies. More invasive interventions such as percutaneous nephrolithotomy impede quality of life to greater extent than alternatives such as shockwave lithotripsy. SUMMARY: There are certain patient groups who are more vulnerable to the negative impact of kidney stone disease on their quality of life. Urologists can improve patient care by recognizing these particular populations as well as by implemented patient reported outcome measures in their routine clinical practice and when performing research.

Effect of moxibustion on ureteral stent-related symptoms after ureteroscopic lithotripsy. / 艾灸对URL术后输尿管支架管综合征的影响.

OBJECTIVES: To observe the clinical efficacy of moxibustion combined with western medication on ureteral stent-related symptoms after ureteroscopic lithotripsy (URL). METHODS: One hundred and fifty patients with upper urinary tract calculus implanted with ureteral stents after URL were randomly divided into a moxibustion group (50 cases, 1 case dropped out), a placebo moxibustion group (50 cases, 3 cases dropped out) and a blank control group (50 cases). No intervention was performed in the blank control group. On the basis of oral administration with tamsulosin hydrochloride sustained release capsule (starting from the first day after surgery, once a day, 0.2 mg each time, continuously for 4 weeks), in the moxibustion group, moxibustion was operated at Guanyuan (CV 4) and bilateral Shenshu (BL 23); the sham-moxibustion was delivered at the same acupoints in the placebo moxibustion group, once daily, 6 times a week, for 15 min in each treatment. The duration of treatment was 4 weeks. Before treatment, and after 1, 2 and 4 weeks of treatment, the scores of lower urinary tract symptoms, body pain, general health, work performance and satisfaction of sexual matters were compared among the 3 groups. The tract calculus clearance rate, urinary infection and the oral administration of painkillers were compared after 4 weeks of treatment in the 3 groups. RESULTS: The scores of lower urinary tract symptoms, body pain and general health after 1 week of treatment, and the scores of lower urinary tract symptoms, body pain, general health and work performance after 2 and 4 weeks of treatment were lower than those before treatment in the 3 groups (P<0.01). The scores of lower urinary tract symptoms and body pain in the moxibustion group after 1, 2 and 4 weeks of treatment were lower than those in the blank control group and the placebo moxibustion group (P<0.01, P<0.05) respectively. The score of general health in the moxibustion group was lower than that in the blank control group after 1 week of treatment (P<0.01), and lower than those of the blank control group and the placebo moxibustion group after 2 and 4 weeks of treatment (P<0.01, P<0.05). Regarding the score of work performance, it was lower in the moxibustion group after 1 and 2 weeks of treatment compared with those in the blank control group (P<0.05, P<0.01), and lower than those of the blank control group and the placebo moxibustion group after 4 weeks of treatment (P<0.01, P<0.05). The tract calculus clearance rate in the moxibustion group was 95.9% (47/49), higher than that in the blank control group (80.0%, 40/50, P<0.05). The proportion of oral administration of painkillers in the moxibustion group (28.6%, 14/49) and the placebo moxibustion group (40.4%, 19/47) was lower than that in the blank control group (76.0%, 38/50, P<0.01) respectively. CONCLUSIONS: Moxibustion combined with western medication relieves lower urinary tract symptoms and body pain, and accelerate the recovery of general health and work performance in the patients after URL.

Comparing the effect of peri-operative antibiotic prophylaxis only with continuous low-dose antibiotic treatment on the incidence of urinary tract infection and stent related-symptoms in patients undergoing Double-J (DJ) stent insertion following transurethral lithotripsy (TUL).

PURPOSE: There are some controversial data about the peri operative use of antibiotics after double-J (DJ) insertion. This study aimed to compare the rates of urinary tract infections (UTI) and stent-related symptoms (SRSs) in patients who received only perioperative antibiotic prophylaxis and those given continuous low-dose antibiotic therapy for the entire stent-indwelling time following transurethral lithotripsy (TUL). METHODS: In this randomized clinical trial 178 patients received intravenous antibiotic prophylaxis (ciprofloxacin 400 mg) before the TUL and then randomly divided into two groups to either receive no antibiotic treatment after procedure (group A, 90 patients) or to additionally receive a continuous low-dose antibiotic treatment with one ciprofloxacin 500 mg every 12 h for 3 days and then ciprofloxacin 250 mg once daily for the entire stent-indwelling time (group B, 88 patients). The rates of UTIs, SRSs and incidence of drug side-effects were evaluated in groups. RESULTS: A total of 7 patients had positive urine culture [group A: 4 (4.4%) vs. group B: 3 (3.4%); P = 0.722]. Only 1 patient in group B had febrile UTI in the mean duration of indwelling stent in situ. The rate of SRSs was 92.2% and 89.8% in Group A and B, respectively, with no significant difference (P = 0.609). A total of 4 patients in Group B complained of gastrointestinal side effects of ciprofloxacin. CONCLUSION: Continuous low-dose antibiotic treatment has no role in reducing the incidence of UTIs and SRSs during the indwelling time of ureteral stents compared with the peri-operative antibiotic prophylaxis only.

Analysis of the Efficacy and Safety of PCNL and ESWL in Patients with Complicated Upper Urinary Tract Renal Calculi.

Objective: This study aimed to investigate the clinical efficacy and safety of combining percutaneous nephrolithotomy (PCNL) with extracorporeal shock wave lithotripsy (ESWL) for the treatment of patients with complicated upper urinary calculi. Methods: We employed a randomized controlled experimental design to examine data from patients diagnosed with complex upper urinary tract renal calculi at our hospital from April 2019 to March 2020. A total of 98 eligible patients were included in the study. To ensure the integrity of the research, we computerized and randomized the patient data according to the study's protocol. Subsequently, we divided the patients into two groups: a control group (n = 49) that received ESWL as the treatment modality and an experimental group (n = 49) that underwent a combined treatment approach involving both PCNL and ESWL. Following the completion of the treatments, we analyzed stone clearance rates and other outcome indicators. Additionally, we carefully documented any post-treatment adverse events to evaluate patient safety comprehensively. Results: The experimental group exhibited a higher stone clearance rate compared to the control group. Comparison of visual Analog Scale/Score (VAS) pain scores, operation time, and hospitalization time revealed statistically significant differences (P < .05), with the experimental group showing slightly worse performance than the control group. After treatment, both groups experienced varying degrees of complications, with the experimental group demonstrating fewer complications, a statistically significant result (P < .05). Conclusions: Extracorporeal shock wave lithotripsy significantly improved stone clearance rates in patients with complex upper urinary tract renal calculi. Simultaneously, it positively impacted surgical outcomes and reduced the incidence of post-treatment adverse events. This intervention offers clinical benefits.

PPARG: A Novel Target for Yellow Tea in Kidney Stone Prevention.

Kidney stones are a common urological disorder with increasing prevalence worldwide. The treatment of kidney stones mainly relies on surgical procedures or extracorporeal shock wave lithotripsy, which can effectively remove the stones but also result in some complications and recurrence. Therefore, finding a drug or natural compound that can prevent and treat kidney stones is an important research topic. In this study, we aimed to investigate the effects of yellow tea on kidney stone formation and its mechanisms of action. We induced kidney stones in rats by feeding them an ethylene glycol diet and found that yellow tea infusion reduced crystal deposits, inflammation, oxidative stress, and fibrosis in a dose-dependent manner. Through network pharmacology and quantitative structure-activity relationship modeling, we analyzed the interaction network between the compounds in yellow tea and kidney stone-related targets and verified it through in vitro and in vivo experiments. Our results showed that flavonoids in yellow tea could bind directly or indirectly to peroxisome proliferator-activated receptor gamma (PPARG) protein and affect kidney stone formation by regulating PPARG transcription factor activity. In conclusion, yellow tea may act as a potential PPARG agonist for the prevention and treatment of renal oxidative damage and fibrosis caused by kidney stones.

Does addition of aromatherapy and music help to reduce pain and anxiety during shockwave lithotripsy compared to standard analgesia alone? A randomised controlled trial.

PURPOSE: To assess the effect of aromatherapy with lavender oil alone, and in combination with music, on pain and anxiety during extracorporeal shockwave lithotripsy for kidney stones. METHODS: This was a single-centre prospective, randomised controlled trial. The subjects were block randomised into 3 study groups, Group 1: Control; Group 2: Aromatherapy only; Group 3: Aromatherapy and music. All subjects were given patient-controlled intravenous alfentanil as standard analgesia. The primary outcome measures were pain and anxiety scores using visual analogue scale (VAS) and State-Trait Anxiety Inventory. RESULTS: Ninety patients were recruited and randomised prospectively into Group 1 (n = 30), Group 2 (n = 30), and Group 3 (n = 30). For pain outcome, both Group 2 and Group 3 showed a trend towards lower mean VAS pain scores of 2.73 in both groups compared to the control with a mean VAS score of 3.50, but it was not statistically significant (p = 0.272). There was no significant difference in anxiety scores between groups post-treatment. CONCLUSIONS: Our study was unable to show a significant improvement in pain relief and anxiety when aromatherapy with lavender oil was added to standard analgesia alone during shockwave lithotripsy. There was also no difference when aromatherapy was combined with music.

A randomized, double-blind, placebo-controlled clinical trial of the use of hydroxycitric acid adjuvant to shock wave lithotripsy therapy in patients with calcium stones. Stone fragmentation results.

Our objective was to improve the results of extracorporeal shock waves lithotripsy using hydroxycitric acid (HCA) like adjuvant therapy. Double blind randomized clinical trial using hydroxycitric acid versus placebo (ID NCT05525130). Multicenter study of adjuvant exposure to a food supplement with hydroxycitric acid (HCA), vs. placebo in patients with calcium oxalate and calcium phosphate lithiasis with indication for extracorporeal shock wave lithotripsy (ESWL). 81 patients were included in the study to compare the effect of HCA versus placebo. Stone fragmentation, the main efficacy variable. Other variables analyzed were stone size, Hounsfield Unit Stone and tolerability. Statistical study with SPSS, statistical significance p ≤ 0.05. Eighty-one patients were included, 40 in the intervention group with HCA and 41 in the control group with placebo. The average stone area was 174,36 mm2 (SD: 32,83 mm2) and the average hardness was 1128,11 (SD: 257,65), with no statistically significant differences between groups. Significant statistical differences were obtained in the analysis of the population by intention to treat and by protocol of the main variable, no fragmentation vs. fragmentation where 100% of the patients, who were given ESWL and took HCA, presented fragmentation while 17% of the patients with placebo did not reach fragmentation (p = 0.03). The adjuvant use of HCA in patients for whom ESWL has been indicated, facilitates stone fragmentation in all cases, which is not achieved in up to 17% of the patients who did not use HCA. We recommend the use of HCA in patients prior to shock wave treatment to improve their fragmentation in calcium stones.

Early experience of intravascular lithotripsy in unprotected calcified left main coronary artery disease.

BACKGROUND: Treatment of unprotected severely calcified left main coronary artery (LMCA) disease is a complex interventional procedure. Intravascular lithotripsy (IVL) and rotational atherectomy (RA) are safe and effective methods of treating coronary calcification in the non-LMCA setting. This retrospective analysis assessed the feasibility of IVL versus RA in unprotected LMCA disease. METHODS: We analyzed IVL and RA procedures performed at a large tertiary hospital in the Northeast of England from January 1, 2019 to April 31, 2022. Major safety and efficacy endpoints were procedural and angiographic success, defined by stent delivery with <50 % residual stenosis and without clinical or angiographic complications, respectively. Another important clinical endpoint was the composite of major adverse cardiac events (MACE) at 1 year. RESULTS: From 242 patients, 44 had LMCA IVL, 81 had LMCA RA and 117 had non-LMCA IVL. Patients with LMCA disease were older and more likely to have aortic stenosis. IVL was a second-line or bailout technique in 86.4 % LMCA and 92.2 % non-LMCA cases. Procedural and angiographic success rates were ≥ 84 % across all groups (p > 0.05). In 3 LMCA IVL and 3 LMCA RA cases arrhythmias and cardiac tamponade complicated the procedures respectively. At 1 year, MACE occurred in 10/44 (22.7 %) LMCA IVL, 16/81 (19.8 %) LMCA RA and 25/117 (21.4 %) cases (p > 0.05). CONCLUSION: In our single center retrospective analysis, IVL is feasible in unprotected calcified LMCA as a second-line and third-line adjuvant calcium modification technique. Its use in unprotected calcified LMCA disease should be formalized with the undertaking of large randomized controlled trials.

The initial experience of 4.5/6.5 Fr ureteroscopic laser lithotripsy under topical intraurethral anesthesia supplemented by preoperative and intraoperative medications.

PURPOSE: To assess the safety and effectiveness of the 4.5/6.5 Fr ureteroscopic laser lithotripsy (URSL) under topical intraurethral anesthesia (TIUA) compared to spinal anesthesia (SA). METHODS: A retrospective study was conducted on 47 (TIUA: SA = 23:24) patients receiving 4.5/6.5 Fr URSL from July 2022 to September 2022. For the TIUA group, atropine, pethidine, and phloroglucinol were used apart from lidocaine. In the SA group, patients received lidocaine and bupivacaine. We compare the two groups including stone-free rate (SFR), procedure time, anesthesia time, overall operative time, hospital stay, anesthesia failure, intraoperative pain, need for additional analgesia, cost, and complications. RESULTS: The conversion rate in the TIUA group was 4.35% (1/23). SFR was 100% in both groups. Surgical waiting time and anesthesia time were longer in the SA group (P < 0.001). There were no statistical differences in operational time and intraoperative pain. Patients developed grade 0-1 ureteral injuries. Post-surgical time out of bed was noticeably faster in the TIUA group (P < 0.001). The post-operative complication rate including vomiting and back pain was lower in the TIUA group (P = 0.005). CONCLUSION: TIUA had an equal surgical success rate and controlled patients' intraoperative pain as SA. It was superior in terms of TIUA's patient admission, waiting time for surgery, anesthesia time, post-operative time out of bed, low complications, and costs, especially for females.

Kidney stone disease.

Kidney stone disease is rapidly increasing with a strong relationship to metabolic syndrome. This review gives a brief overview of the current state and current treatment modalities. Increasing use of CT and ultrasound scans leads to increased diagnosis of asymptomatic kidney stones, which rarely require treatment. The trend in stone treatment goes towards endoscopic lithotripsy which together with ESWL enables a personalised approach. Obstructive stones with infection require urgent intervention to reduce mortality. Increased fluid intake, dietary changes as well as potassium citrate supplements are the most important elements in stone prevention in the common idiopathic stone disease.

A Comparison of Boron Supplement and Tamsulosin as Medical Expulsive Therapy for Urinary Stones After Extracorporeal Shock Wave Lithotripsy: a Randomized Controlled Clinical Trial.

Treatment with alpha-blockers has been used in many studies to facilitate stone clearance after extra-corporeal shock wave lithotripsy (ESWL), based on mediating ureteral wall relaxation. Ureteral wall edema is another barrier against the stone passage. We aimed to compare the effectiveness of boron supplement (due to its anti-inflammatory effect) and tamsulosin in the passage of stone fragments after ESWL. Eligible patients after ESWL were randomly assigned to two groups and were treated with boron supplement (10 mg/BD) or tamsulosin (0.4 mg per night) for 2 weeks. The primary outcome was the stone expulsion rate according to the remained fragmented stone burden. The secondary outcomes were the time of stone clearance, pain intensity, drug side effects, and the need for auxiliary procedures. In this randomized control trial, 200 eligible patients were treated with boron supplement or tamsulosin. Finally, 89 and 81 patients in the two groups completed the study, respectively. The expulsion rate was 46.6% in the boron and 38.7% in the tamsulosin group, which there was no statistically significant difference between the two groups (p = 0.003), as well as the time of stone clearance (7.47 ± 22.4 vs 6.52 ± 18.45, days, p = 0.648, respectively), after 2-week follow-up. Moreover, pain intensity was the same in both groups. No Significant side effects were reported in the two groups. Boron supplement could be effective as adjuvant medical expulsive therapy after ESWL with no significant side effects in short-term follow-up. Iranian Clinical Trial Registration number and date of registration: IRCT20191026045244N3, 07/29/2020.

Effect of creatine supplementation on kidney stones recurrence in an athlete: a case report.

INTRODUCTION: Several studies examined the effects of creatine monohydrate supplementation on renal function, but no previous study has investigated its effects on kidney stones in humans. OBSERVATION: A renal ultrasound in a healthy young athlete (without a known renal morphological anomaly, normal kidney function, normal phospholipid and uric acid data) revealed a kidney stone of 11 mm in the lower right calyx. Extracorporeal shock wave lithotripsy was applied in order to break the down stone. Twentyone days later, a follow-up renal ultrasound showed the absence of stones in the kidney. One week later, the athlete started creatine monohydrate supplementation for two months. Fourteen months after stopping creatine monohydrate supplementation, a third renal ultrasound confirmed the absence of stones in the kidney. CONCLUSION: Two months of creatine monohydrate supplementation in an athlete with a history of kidney stones could not be associated with kidney stone recurrence in the long run.

Phytotherapy as ancillary treatment after urinary stone lithotripsy in pediatric age.

AIM: Small stone fragments (NSRF) may be observed after mini-invasive lithotripsy. A 3-components herbal extract drug was tested in young patients presenting NSRF to assess efficacy, safety and tolerability. MATERIAL AND METHODS: Patients aged 6-18 years, treated by endo-urological procedures in 5-year period, were randomly divided in 2 groups. Group A received a 3-components phytotherapic composed of Herniaria hirsuta and Peumus boldus plus water oral intake for 12 days/month in 3 months. Group B had no adjuvant phytotherapy. Group A and B were divided in 2 subgroups, according to persistence of NSRF. Patients were evaluated after the endo-urological procedure (Time 0), at 3-months therapy (Time 1) and after 3-months follow-up (Time 2). Persistence or development of new micro-lithiasis, adverse effects and urological check were registered. RESULTS: Thirty-four patients were enrolled (Group A=15, Group B=19). Two patients were excluded. In Group A, 6 patients were stone free at Time 0 and had no recurrence, while 7 patients (53.8%) had NSRF at Time 0, reduced to 3 (23.0%) and to 2 (15.4%) at Time 1 and 2 respectively. In Group B, 11 patients (57.9%) presented NSRF at Time 0, reduced to 8 (42.1%) and 7 (36.8%) at Time 1 and 2. The difference was significant (Time 1 p=0.006, Time 2 p=0.009). No adverse effects were reported. DISCUSSION AND CONCLUSIONS: The drug was effective in preventing new stones development and reducing significantly stone fragments persisting after endo-urological lithotripsy in children, with optimal tolerability and no adverse effects. KEY WORDS: Arbutin, Boldine, Phytotherapy, Pediatrics, Umbelliferone, Urinary tract stones.

[Long-term efficacy evaluation of coated metal stent implantation for ureteroscopic lithotripsy related refractory ureteral stricture].

OBJECTIVE: To comprehensively evaluate the long-term efficacy and safety of coated metal stent implantation for ureteroscopic lithotripsy related refractory ureteral stricture (URL-rUS). METHODS: Electronic medical records of 30 patients (31 affected renal units) receiving coated metal stent implantation for URL-rUS from Sept. 2018 to Aug. 2021 at Peking University People' s Hospital were reviewed for analysis. Coated metal stents were implanted in retrograde approach via ureteroscope. Last outpatient follow-up was set as endpoint. Baseline information, stricture characteristics and decompression strategy before coated metal stent implantation were retrospectively collected. Serum creatinine (Scr) concentration and renal pelvis width (RPW) were used as renal function indicators. Peri-operative and long-term complications and according outcomes were recorded. For the patients who had double J tubes implanted for drainage before operation, Ureteral Stent Symptom Questionnaire (USSQ) was applied to evaluate the stent-related discomforts and quality of life (QoL) before and after surgery. Data analysis was conducted with SPSS (version 25.0; SPSS, Chicago, IL, USA). RESULTS: Totally 30 patients with 31 affected renal units were included. All the patients previously underwent unsuccessful traditional endoscopic balloon dilation or endoureterotomy before receiving coated metal stent implantation. The mean age was (45.5±9.3) years old. The median follow-up time were 14 (6-36) months. All coated metal stents were successfully placed with a median duration of 60 (30-195) min. No severe peri-operative complications occurred. At endpoint, 28 (90.3%) sides of coated metal stents remained unobstructed with a longest indwelling time of 36 months. Causes of failures included stent migration (1 case, 3.2%), encrustation (1 case, 3.2%) and repeated stent related urinary tract infection (1 case, 3.2%). When compared with the baseline, significant reductions were observed in both Scr concentration and RPW at endpoint [(90.7±19.5) mmol/L vs. (83.1±18.5) µmol/L, P < 0.01, for Scr; (2.5±1.3) cm vs. (1.9±0.8) cm, P < 0.01, for RPW], indicating good preservation of renal function and remission of hydronephrosis. For 26 patients with double J stents before operation, significant reduction of USSQ average score (100.4±6.6 vs. 82.1±4.9, P < 0.01) evidenced better life quality preserving ability of coated metal stent versus double J stent. CONCLUSION: Coated metal stent implantation is a safe and minimally invasive management of ureteral stricture providing a satisfying long-term patency rate, after which the patients' quality of life and renal function could be both improved. This method could serve as a promising alternative long-term maintenance treatment option for patients with URL-US, especially when traditional endoscopic interventions failed.

Stone disease in low- and middle-income countries: could augmented reality have a role in its management?

Urolithiasis is a global phenomenon. Cystolithiasis is common in parts of Africa due to low protein intake and dehydration from endemic diarrhoeal illnesses. Nephrolithiasis is less prevalent than in high-income countries, probably due to a variety of lifestyle issues, such as a more elemental diet, higher physical activity, and less obesity. Although renal stones are less common in low- and middle-income countries (LMICs), the social and economic impacts of nephrolithiasis are still considerable; many stones present late or with complications such as upper urinary tract obstruction or urosepsis. These may lead to the development of chronic kidney disease, or end-stage renal failure in a small proportion of cases, conditions for which there is very poor provision in most LMICs. Early treatment of nephrolithiasis by the least invasive method possible can, however, reduce the functional consequences of urinary stone disease. Although extracorporeal lithotripsy is uncommon, and endoscopic interventions for stone are not widespread in most of Africa, percutaneous nephrolithotomy and ureteroscopic renal surgery are viable techniques in those regional centres with infrastructure to support them. Longitudinal mentoring has been shown to be a key step in the adoption of these minimally invasive procedures by local surgeons, something that has been difficult during the coronavirus disease 2019 (COVID-19) pandemic due to travel restriction. Augmented reality (AR) technology is an alternative means of providing remote mentoring, something that has been trialled by Urolink, the MediTech Trust and other global non-governmental organisations during this period. Our preliminary experience suggests that this is a viable technique for promulgating skills in LMICs where appropriate connectivity exists to support remote communication. AR may also have long-term promise for decreasing the reliance upon short-term surgical visits to consolidate competence, thereby reducing the carbon footprint of global surgical education.

"RotaTripsy": Combination of Rotational Atherectomy and Intravascular Lithotripsy in Heavily Calcified Coronary Lesions: A Case Series.

Heavily calcified coronary lesions increase the complexity of percutaneous coronary interventions (PCI) and represent a challenge for interventional cardiologists. They are an important cause of stent underexpansion and poor clinical outcome. Nowadays, there are different dedicated devices which enhance the chances of success. Rotational atherectomy is the first-line modality which permits to cross balloons or stents through severe calcified lesions. However, when circumferential deep calcium plaques exist may not be enough to achieve adequate expansion of these devices. In these cases, the complementary use of intracoronary lithotripsy ("RotaTripsy") can be an effective approach that further modifies the calcified plaque and enables optimal stent implantation. We present the first case series undergoing PCI using "RotaTripsy" technique.

The role of extracorporeal shock wave lithotripsy in the treatment of chronic pancreatitis.

Pain is the most frequent symptom in chronic pancreatitis (CP) and has an important impact on quality of life. One of its major pathophysiological mechanisms is ductal hypertension, caused by main pancreatic duct stones and/or strictures. In this article, we focus on extracorporeal shock wave lithotripsy (ESWL) as a treatment for main pancreatic duct stones, which have been reported in >50% of CP patients. ESWL uses acoustic pulses to generate compressive stress on the stones, resulting in their gradual fragmentation. In patients with radiopaque obstructive main pancreatic duct (MPD) stones larger than 5 mm, located in the pancreas head or body, ESWL improves ductal clearance, thereby relieving pain and improving quality of life. In case of insufficient ductal clearance or the presence of an MPD stricture, ESWL can be followed by endoscopic retrograde cholangiopancreatography (ERCP) to increase success rate. Alternatively, direct pancreaticoscopy with intracorporeal lithotripsy or surgery can be performed.