Endoscopic combined intrarenal surgery without ureteral access sheath performed for renal stone after Cohen reimplantation.

Introduction: Endoscopic combined intrarenal surgery after anti-reflux operation is rarely performed. Case presentation: A 37-year-old female was referred to our hospital for treatment of left renal stone. She underwent anti-reflux surgery (Cohen reimplantation) for left vesicoureteral reflux at the age of 10 years. Computed tomography revealed a 17 × 11 mm left inferior calyceal calculus. The patient received retrograde double-J stent insertion under radiographic guidance and underwent ultra-mini endoscopic combined intrarenal surgery without ureteral access sheath. The patient was discharged on postoperative Day 5 with no postoperative complications. Postoperative cystography showed no recurrence of vesicoureteral reflux. One month after the operation, kidney-ureter-bladder radiography and computed tomography scan revealed no residual stones or hydronephrosis. Conclusion: Ultra-mini endoscopic combined intrarenal surgery without ureteral access sheath is an effective method for treating renal stones after Cohen reimplantation.

Association between mesenteric panniculitis and urolithiasis.

BACKGROUND: Mesenteric panniculitis is a rare condition and refers to benign and nonspecific inflammation of mesenteric fat. OBJECTIVES: This study aimed to evaluate the hypothesis of a greater prevalence of mesenteric panniculitis in patients with urolithiasis. MATERIALS AND METHODS: In this cross-sectional study, abdominopelvic CT scans of 500 patients were reviewed for the presence of urolithiasis and mesenteric panniculitis. The inclusion criteria were patients who were referred with acute abdominal pain and were suspected of having urolithiasis or other urinary conditions and who had undergone abdominopelvic CT scan. Subcutaneous fat thickness was measured, and pain intensity was recorded by patient evaluation. RESULTS: Mesenteric panniculitis was found in 10 patients, all of whom (100%) had urinary stones (ureter or kidney or both), and none of them had previous surgeries or known malignancies. The prevalence of panniculitis was significantly greater in the group with urolithiasis. In the urolithiasis group, subcutaneous fat thickness was greater in patients with panniculitis, although the difference was not statistically significant. In the subgroup analysis, pain intensity was not significantly greater in patients with panniculitis. CONCLUSION: Mesenteric panniculitis is more prevalent among patients with urolithiasis, but it seems that it does not change the intensity of the pain.

Baicalin attenuated oxidative stress and inflammation in ethylene glycol-induced urolithiasis in adult male SD rats.

AIMS: Baicalin is a flavonoid derived from the root of the medicinal plant Scutellaria baicalensis Georgi (S. baicalensis) and is known for its various pharmacological properties. This study aimed to investigate the impact of baicalin (BAI) on the occurrence of kidney calcium oxalate crystal formation induced by ethylene glycol in male SD rats. MAIN METHODS: A rat model of renal stones was created and various concentrations of baicalin were used for intervention. Samples of urine, blood, and kidney tissue were taken from the rats, and they were euthanized for biochemical and histopathological examinations. KEY FINDINGS: Our results show that baicalin treatment improved the weight loss induced by ethylene glycol (EG) and ammonium chloride (AC) in rats. Baicalin also reduced the formation of calcium oxalate crystals and protected kidney function in rats with urolithiasis. Furthermore, it lowered the level of malondialdehyde (MDA) and elevated the activity of antioxidant enzymes compared to the stone control group. Additionally, baicalin notably alleviated renal inflammation in rats with urolithiasis. SIGNIFICANCE: The present study attributed clinical evidence first time that claiming the significant antiurolithic effect of baicalin and could be a cost-effective candidate for the prevention and treatment of urolithiasis.

Certain investigation on hybrid neural network method for classification of ECG signal with the suitable a FIR filter.

The Electrocardiogram (ECG) records are crucial for predicting heart diseases and evaluating patient's health conditions. ECG signals provide essential peak values that reflect reliable health information. Analyzing ECG signals is a fundamental technique for computerized prediction with advancements in Very Large-Scale Integration (VLSI) technology and significantly impacts in biomedical signal processing. VLSI advancements focus on high-speed circuit functionality while minimizing power consumption and area occupancy. In ECG signal denoising, digital filters like Infinite Impulse Response (IIR) and Finite Impulse Response (FIR) are commonly used. The FIR filters are preferred for their higher-order performance and stability over IIR filters, especially in real-time applications. The Modified FIR (MFIR) blocks were reconstructed using the optimized adder-multiplier block for better noise reduction performance. The MIT-BIT database is used as reference where the noises are filtered by the MFIR based on Optimized Kogge Stone Adder (OKSA). Features are extracted and analyzed using Discrete wavelet transform (DWT) and Cross Correlation (CC). At this modern era, Hybrid methods of Machine Learning (HMLM) methods are preferred because of their combined performance which is better than non-fused methods. The accuracy of the Hybrid Neural Network (HNN) model reached 92.3%, surpassing other models such as Generalized Sequential Neural Networks (GSNN), Artificial Neural Networks (ANN), Support Vector Machine with linear kernel (SVM linear), and Support Vector Machine with Radial Basis Function kernel (SVM RBF) by margins of 3.3%, 5.3%, 23.3%, and 24.3%, respectively. While the precision of the HNN is 91.1%, it was slightly lower than GSNN and ANN but higher than both SVM linear and SVM -RBF. The HNN with various features are incorporated to improve the ECG classification. The accuracy of the HNN is switched to 95.99% when the DWT and CC are combined. Also, it improvises other parameters such as precision 93.88%, recall is 0.94, F1 score is 0.88, Kappa is 0.89, kurtosis is 1.54, skewness is 1.52 and error rate 0.076. These parameters are higher than recently developed models whose algorithms and methods accuracy is more than 90%.

Association of health-related quality of life with urinary tract infection among kidney stone formers.

Kidney stones and infections significantly affect patients' health-related quality of life (HRQOL); however, the relationship between urinary tract infections (UTIs) and HRQOL in patients with kidney stones remains unclear. This study aimed to investigate the relationship using the validated Chinese version of the Wisconsin Stone Quality of Life questionnaire (C-WISQOL). We prospectively recruited 307 patients with kidney stones to complete the C-WISQOL before and after stone removal. The participants were diagnosed with UTI based on the presence of pyuria or bacteriuria with or without clinical symptoms. The psychometric properties of the C-WISQOL were statistically analyzed. Multivariate linear regression was used to predict the risk factors for impaired HRQOL in patients with stones and UTIs. The questionnaire is a reliable and robust tool for evaluating HRQOL in Chinese-speaking patients with urolithiasis. The UTI and kidney stone co-occurrence was significantly associated with female sex, diabetes mellitus, more previous stone events, higher antibiotic usage, positive stone- or UTI-related symptoms, and postoperative residual stones. The preoperative C-WISQOL scores and improvement in the HRQOL after stone removal in patients clinically diagnosed with UTI were significantly inferior to those in patients without UTI. The regression analyses showed that worse HRQOL was predicted by more previous stone events and positive stone- or UTI-related symptoms. In contrast, the presence of diabetes mellitus and postoperative residual stone fragments predicted a lower improvement in the HRQOL. These findings underscore UTI's harmful impact on perioperative HRQOL in patients with kidney stones and could help strategies benefit those patients.

Enhancing the adsorption capacity of organic and inorganic pollutants onto impregnated olive stone derived activated carbon.

This study presents a sustainable approach to activated carbon production from olive stones in comparison to commercial ones, using various activating agents such as H3PO4, KOH, and ZnCl2, for enhancing the adsorption properties and versatile adsorption capability to remove a range of pollutants including copper ion, methylene blue, and 2,4-Dichlorophenoxyacetic acid from aqueous solutions. The performances of activated carbons across varying conditions such as pollutant concentrations, temperatures, pH levels, and adsorbent amounts were tested. Increased initial pollutant concentrations correlated with higher adsorption capacities. Maximum adsorption capacities were achieved at pH levels of 5, 10, and 2 for Cu, MB, and 2,4-D, respectively. For KOSAC, Cu removal rose from 27 % to 52 %, for ZOSAC, MB removal increased from 39 % to 65 %, and for ZOSAC, 2,4-D removal surged from 33 % to 99 % at varying adsorbent amounts. Model validation was carried out utilizing the kinetic models (PFO, PSO) and isotherm models (Langmuir, Redlich-Peterson). The PFO kinetic model and Langmuir isotherm model proved more suitability for Cu adsorption, whereas PFO and PSO kinetic models, along with Redlich-Peterson isotherm models, were more prominent for MB and 2,4-D adsorption. Thermodynamic analysis revealed that the adsorption of Cu and 2,4-D was exothermic, while MB adsorption was endothermic. By optimization of experimental conditions, the maximum adsorption capacities were attained at 30.34 °C and 297.65 mg L-1 for KOSAC-Cu, 48.62 °C and 269.37 mg L-1 for ZOSAC-MB, and 30.31 °C and 299.02 mg L-1 for ZOSAC-2,4-D sorption. This research highlights ZOSAC's potential as a cost-effective, eco-friendly solution for water treatment, contributing to environmental sustainability and economical feasibility.

Surgical strategies for challenging common bile duct stones in the endoscopic era: A comprehensive review of current evidence.

While endoscopic retrograde cholangiopancreatography (ERCP) remains the primary treatment modality for common bile duct stones (CBDS) or choledocholithiasis due to advancements in instruments, surgical intervention, known as common bile duct exploration (CBDE), is still necessary in cases of difficult CBDS, failed endoscopic treatment, or altered anatomy. Recent evidence also supports CBDE in patients requesting single-step cholecystectomy and bile duct stone removal with comparable outcomes. This review elucidates relevant clinical anatomy, selection indications, and outcomes to enhance surgical understanding. The selection between trans-cystic (TC) vs trans-choledochal (TD) approaches is described, along with stone removal techniques and ductal closure. Detailed surgical techniques and strategies for both the TC and TD approaches, including instrument selection, is also provided. Additionally, this review comprehensively addresses operation-specific complications such as bile leakage, stricture, and entrapment, and focuses on preventive measures and treatment strategies. This review aims to optimize the management of CBDS through laparoscopic CBDE, with the goal of improving patient outcomes and minimizing risks.

Comparison of two methods for treatment of 1-2 cm kidney stones in pediatric patients: mini PCNL and RIRS.

OBJECTIVE: This study aimed to compare the results of retrograde intrarenal surgery (RIRS) and mini-percutaneous nephrolithotomy (mini-PCNL) for the treatment of 1-2 cm kidney stones in pediatric patients. METHODS: The records of patients under the age of 18 years who were diagnosed with unilateral 1-2 cm kidney stones for the first time and underwent endoscopic surgery between February 2008 and April 2022 were retrospectively examined. The patients were divided into two groups: mini-PCNL and RIRS surgery. Parameters such as age, gender, number of stones, side, size and localization were examined. The main endpoint of the study was to compare stone-free rates (SFR) one month after both surgeries. Surgery and fluoroscopy times, postoperative hospital stay, hemoglobin decrease and complication rates were compared between the groups. SFR was evaluated one month after surgery by direct urinary system radiography and USG or CT. RESULTS: A total of 58 patients were included in the study. There were 35 patients in the mini-PCNL group and 23 patients in the RIRS group. Table 1 shows the demographic and clinical characteristics of both groups. There was no significant difference between the groups in terms of age, gender, stone size, location, side and density. Calcium oxalate stones were observed at a higher rate in both groups. Mean fluoroscopy time was higher in the mini-PCNL group (p = 0.001). The mean surgery time was lower in the mini-PCNL group (p = 0.024). The mean hemoglobin decrease was greater in the percutaneous group (p = 0.039). There were no differences between the groups in terms of postoperative hospital stay, complication rates, and SFR one month after surgery. CONCLUSION: Although mini-PCNL seems to be more advantageous in terms of operation time compared to RIRS, it is disadvantageous in terms of average fluoroscopy time, radiation received and average hemoglobin decrease.

Comparative Analysis of Standard Percutaneous Nephrolithotomy (PCNL) and Mini-Percutaneous Nephrolithotomy (Mini-PCNL) for Renal Stones Larger Than 2 cm at a Rural Hospital: A Study Protocol.

Background Percutaneous nephrolithotomy (PCNL) is considered a standard treatment option for large-size renal stones but is associated with drawbacks such as bleeding and prolonged recovery. Mini-PCNL offers a less invasive alternative, but its efficacy compared to standard PCNL for renal stones larger than 2 cm remains under debate. This study aims to compare the efficacy and safety of standard PCNL versus mini-PCNL for renal stone sizes more than 2 cm. Methods This single-centre prospective interventional study will be conducted at Acharya Vinoba Bhave Rural Hospital (AVBRH). The study will include patients 18 to 70 years of age undergoing unilateral PCNL for renal calculi. Patients with renal stones larger than 2 cm will be enrolled. Data on stone-free rate (SFR), operative duration, hospital stay time, surgical site infection, haemoglobin (Hb) drop, need for blood transfusion, and post-surgery fever will be collected and compared between the two procedures. Statistical analysis of data will be performed using descriptive and analytical statistics. Results The study aims to enrol a total of 32 patients. Data analysis will be done using IBM SPSS Statistics for Windows, Version 24 (Released 2016; IBM Corp., Armonk, New York). Conclusion This study will provide valuable insights into the comparative outcome in terms of efficacy and safety of standard PCNL and mini-PCNL for kidney stones larger than 2 cm.

A new alternative to percutaneous nephrolithotomy: A case report.

INTRODUCTION: Percutaneous nephrolithotomy (PCNL) is a common procedure for kidney stone removal, involving a small incision in the back and insertion of a nephroscope to extract the stones. Recent advancements include super-mini PCNL, employing smaller instruments for less invasive access to the kidney. However, conventional PCNL often requires tract dilation, which can lead to potential complications. CASE PRESENTATION: This case report presents the successful application of our surgical technique using the basic principles of PCNL with the aid of a pediatric trocar cystostomy and ultrasound guidance as a new alternative for super-mini PCNL, offering safer access with reduced bleeding risk and shorter recovery. The surgery was performed on a 55-year-old female with bilateral kidney stones, with the stone in the left kidney being larger than the one in the right kidney. The procedure was completed within 60 min without significant postoperative complications. DISCUSSION: Our new alternative for PCNL offers benefits such as reduced invasiveness, shorter recovery time, decreased risk of complications, and minimal changes in postoperative hemoglobin levels. This new alternative can be performed in developing country hospitals that do not have the expensive PCNL equipment. CONCLUSION: This new alternative of PCNL with pediatric trocar cystostomy proves to be effective and safe.

Analysis and Modelling of the Predictive Value of PCT, PLR and NLR for Ureteric Sepsis after Ureteral Stone Surgery: A Retrospective Cohort Study.

OBJECTIVE: This study aimed to analyse the value of procalcitonin (PCT), neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) in predicting postoperative ureteral stone complications of urogenic sepsis. The production of a clinical prediction model could provide additional direction to reduce the likelihood of postoperative urogenital sepsis. METHODS: The clinical data of 520 patients with ureteral stones who underwent surgical treatment from January 2022, to September 2023, in the hospital were retrospectively analysed. The patients were divided into urogenic sepsis group (n = 42) and non-urogenic sepsis group (n = 478) in accordance with the occurrence of urogenic sepsis in the postoperative period. The peripheral blood PCT, PLR and NLR levels were collected within 24 h postoperatively in the two groups. The receiver operating characteristic (ROC) curve was employed to evaluate the predictive value of PCT, PLR and NLR levels for postoperative urogenital sepsis in patients with ureteral stones. RESULTS: Logistic regression analysis showed that PCT (odds ratio (OR) = 4.25, 95% CI: 1.85-9.78), PLR (OR = 4.00, 95% CI: 1.78-9.05) and NLR (OR = 2.29, 95% CI: 1.05-5.01) were risk factors for postoperative complication sepsis in patients with ureteral stones (p < 0.05). The ROC curves showed that the areas under the curve of PCT, PLR and NLR levels alone and in combination for predicting urogenic sepsis complications after emergency ureteral stone surgery were 0.683, 0.692, 0.611 and 0.799, respectively. CONCLUSIONS: Urogenic sepsis leads to increased serum PCT, NLR and PLR levels in patients undergoing surgical treatment for ureteral stones. Physicians should pay close attention to these indices to provide further theoretical support for reducing postoperative urogenic sepsis.

CT-based radiomics for predicting success of shock wave lithotripsy in ureteral stones larger than 1 cm.

PURPOSE: This study aims to investigate the predictive value of CT-based radiomics in determining the success of extracorporeal shock wave lithotripsy (SWL) treatment for ureteral stones larger than 10mm in adult patients. MATERIALS AND METHODS: A total of 301 eligible patients (165/136 successful/unsuccessful) who underwent SWL were retrospectively evaluated and divided into a training cohort (n = 241) and a test cohort (n = 60) following an 8:2 ratio. Univariate analysis was performed to assess clinical characteristics for constructing a nomogram. Radiomics and conventional radiological characteristics of stones were evaluated. Following feature selection, radiomics and radiological models were constructed using logistic regression (LR), support vector machine (SVM), random forest (RF), K nearest neighbor (KNN), and XGBoost. The models' performance was compared using metrics such as the area under the receiver operating characteristic curve (AUC), precision, recall, accuracy, and F1 score. Finally, a nomogram was created incorporating the best image model signature and clinical predictors. RESULTS: The SVM-based radiomics model showed superior predictive performance in both training and test cohorts (AUC: 0.956, 0.891, respectively). The nomogram, which combined SVM-based radiomics signature with proximal ureter diameter (PUD), demonstrated further improved predictive performance in the test cohort (AUC: 0.891 vs. 0.939, P = 0.166). CONCLUSIONS: Integration of CT-derived radiomics and PUD showed excellent ability to predict SWL treatment success in patients with ureteral stones larger than 10mm, providing a promising approach for clinical decision-making.

Endourological society fellowship program: a real contribution to improve surgical outcomes of stone patients treated with ureteroscopy.

PURPOSE: We assessed the impact of the one-year endourological society fellowship program (ESFP) on the achievement of optimal surgical outcomes (OSO) in stone patients treated with ureteroscopy (URS). MATERIALS AND METHODS: We identified 303 stone patients treated with URS from January 2018 to June 2022 by five experienced surgeons (ES). Of those, two attended ESFP. OSO was defined as the presence of residual fragments ≤ 4 mm at 1-month post-operative imaging (Ultrasound + X - Ray or CT scan). Descriptive statistics explored patients' characteristics and the rate of OSO according to the attendance of ESFP. Uni- and multivariate logistic regression analyses (UVA and MVA) tested the impact of stone characteristics, surgical data, ESFP, and imaging technique on the rate of OSO. The LOWESS curve explored the graphical association between stone size and the multivariable-adjusted probability of OSO in the two groups of surgeons. RESULTS: Of 303 patients, 208 (69%) were treated by the two surgeons who attended ESFP. OSO was achieved in 66% and 52% of patients treated by ES with and without ESFP, respectively (p = 0.01). At UVA, ESFP (OR = 1.78; 95% CI = 1.09-2.90), stone diameter (OR = 0.92; 95% CI = 0.88-0.96), stone location (kidney vs. ureter; OR = 0.34; 95% CI = 0.21-0.58), imaging technique (CT scan vs. Ultrasound + X-Ray; OR = 0.28; 95% CI = 0.16-0.47) predicted OSO achievement (all p < 0.05). At MVA analyses, ESFP was associated with OSO (OR = 2.24; 95% CI = 1.29-3.88; p < 0.05), along with the other aforementioned variables. The LOWESS curve showed that the greater the stone size, the greater the difference in OSO in the two groups of surgeons. CONCLUSIONS: ESFP positively affects OSO achievement after URS, especially in patients with a high stone burden.

Assessment of Factors Responsible for Stone-Free Status After Retrograde Intrarenal Surgery.

Aim The study aimed to evaluate the predictive factors that determined stone-free rate (SFR) after retrograde intrarenal surgery (RIRS). Materials and methods This prospective study was conducted on 183 patients undergoing RIRS for renal stones. Patients were categorized into two groups, depending on stone-free status one month following the procedure. SFR was defined as the complete absence of stones or stones <4 mm. The parameters studied included patient demographics, presence of hydronephrosis, presence of preoperative double J-stent, abnormal renal anatomy, and stone characteristics (stone burden, stone number, stone density, stone location, lower pole infundibulopelvic angle, and lower pole renal infundibular length (RIL)). Univariate and multivariate analyses were performed to identify risk factors for residual stones. We assessed the predictive ability of the RIRS score and Resorlu-Unsal stone score (RUSS) for evaluating SFR utilizing receiver operating characteristic (ROC) analysis. Results 183 patients were included in the study with a median age of 51 years. 131 (71.6%) patients were declared stone-free after the procedure. The mean stone size and density were 16.9 SD±7.5 mm and 1038 SD±342 Hounsfield units (HU) respectively. Stone-free patients had lower stone size (14.3 mm vs. 23.6 mm, p<0.01) and stone density (970 HU vs. 1211 HU, p<0.01) compared to non-stone-free patients. Patients with residual stones had steeper lower pole renal infundibulopelvic angle (RIPA) (31.3° vs. 40.7°, p<0.01) and longer RIL (26.6 mm vs. 21.1 mm, p<0.01). Stone multiplicity (p<0.01), lower pole stone location (p<0.01), and renal malformations (p<0.01) were significant influencing factors for residual renal stones after RIRS. Multivariate analysis revealed stone size, stone density (HU), and stone location as independent predictors for SFR after RIRS. Among the scoring systems, the RIRS score had the highest diagnostic accuracy for SFR (area under the curve (AUC): -0.882, 95% CI-0.828-0.936). Conclusion Stone size, stone density (HU), and stone number are important predictors of SFR after RIRS. Lower pole stone location and abnormal renal anatomy play a substantial role in determining SFR after RIRS. In lower pole stones, a long RIL and acute RIPA negatively influence SFR. Additionally, the RIRS score was found to be a better predictor for SFR than the RUSS score.

Verification of surgical factors affecting the efficiency of stone extraction with one-surgeon basketing technique using a f-URSL simulation model.

PURPOSE: Stone extraction is an important treatment option when performing flexible ureteroscopic lithotripsy (f-URSL) for upper urinary stones. We used a f-URSL simulator model to investigate surgical factors affecting the efficacy of stone extraction with the one-surgeon basketing technique. MATERIALS AND METHODS: This simulator-based study involved eight urologists and eight residents. These participants each performed two tasks, with Flexor (Cook Medical) and Navigator (Boston Scientific) ureteral access sheaths, with and without the M-arm (MC Medical) single-use basket holder, and with models representing both left and right kidneys. The two tasks were to touch each renal calix with the ureteroscope, and to extract stones. As outcomes, we recorded the number of times that the ureteroscope became stuck during insertion, the number of times a stone was dropped during removal, the number of times the basket forceps were opened and closed, and the time required to accomplish each task. RESULTS: The ureteroscope became stuck significantly more often when Navigator was used compared with Flexor overall, and for both urologists and residents (all p<0.01). Stones were dropped significantly more often on the ipsilateral side (kidney on the same side as the operator's hand) than on the contralateral side overall (p=0.01), and the basket forceps were opened and closed significantly more often on the ipsilateral side than on the contralateral side both overall and by residents (all p<0.01). CONCLUSIONS: The efficiency of stone extraction during f-URSL with the one-surgeon basketing technique was affected by differences in ureteral access sheath and the kidney side.

Clinical efficacy of laparoscopic cholecystectomy combined with endoscopic papillary balloon dilation in treatment of gallbladder stones with common bile duct stones: A retrospective study.

BACKGROUND: The incidence of cholelithiasis has been on the rise in recent years, but the choice of procedure is controversial. AIM: To investigate the efficacy of laparoscopic cholecystectomy (LC) combined with endoscopic papillary balloon dilation (EPBD) in patients with gallbladder stones (GS) with common bile duct stones (CBDS). METHODS: The clinical data of 102 patients with GS combined with CBDS were selected for retrospective analysis and divided into either an LC + EPBD group (n = 50) or an LC + endoscopic sphincterotomy (EST) group (n = 52) according to surgical methods. Surgery-related indexes, postoperative recovery, postoperative complications, and expression levels of inflammatory response indexes were compared between the two groups. RESULTS: Total surgical time, stone free rate, rate of conversion to laparotomy, and successful stone extraction rate did not differ significantly between the LC + EPBD group and LC + EST group. Intraoperative hemorrhage, time to ambulation, and length of hospitalization in the LC + EPBD group were lower than those of the LC + EST group (P < 0.05). The rate of total complications of the two groups was 9.80% and 17.65%, respectively, and the difference was not statistically significant. No serious complications occurred in either group. At 48 h postoperatively, the expression levels of interleukin-6, tumor necrosis factor-α, high-sensitivity C-reactive protein, and procalcitonin were lower in the LC + EPBD group than in the LC + EST group (P < 0.05). At 3 d postoperatively, the expression levels of aspartate transaminase, alanine transaminase, and total bilirubin were lower in the LC + EPBD group than in the LC + EST group (P < 0.05). CONCLUSION: LC combined with EPBD and LC combined with EST are both effective procedures for the treatment of GS with CBDS, in which LC combined with EPBD is beneficial to shorten the patient's hospitalization time, reduce the magnitude of elevated inflammatory response indexes, and promote postoperative recovery.

First 100 Reported Cases of Supine Percutaneous Nephrolithotomy in Malaysia: An Alternative Effective and Safe Approach to Treat Renal Stones.

Background: Supine percutaneous nephrolithotomy (s-PCNL) offers great benefits from urological and anaesthetic points of view. We present the first evaluation of the outcomes of s-PCNL in Malaysia. Our aim was to explore the safety and efficacy of s-PCNL. Methods: Institutional review board approval was obtained from the National Medical Research Register (NMRR ID-21002225-WLP). We retrospectively reviewed 115 patients with renal pelvis stones who underwent single renal access during s-PCNL between November 2020 and May 2023. Patients who underwent simultaneous ipsilateral or contralateral endourological procedures were included. The data were analysed to determine stone-free rates (SFR), major complication rates, blood transfusion rates, operative times and lengths of hospital stay (LOS). Results: The SFR was higher for the single middle calyceal renal access (MCA) group than for the lower calyceal renal access (LCA) or upper calyceal renal access (UCA) groups (OR: 1.76; 95% confidence interval [CI]: 0.63, 4.92). In total, 0, 1 and 2 patients had major complications in the UCA, MCA and LCA groups, respectively (P = 0.453). One of the 115 patients (0.9%) needed blood transfusion. Subgroup analysis revealed mean operative times of 76.3 min and 78.6 min for patients who underwent sole s-PCNL (PCNL-only group) and those who had simultaneous ipsilateral and contralateral endourological procedures (PCNL-plus group), respectively (P = 0.786). The overall mean LOS was 2.9 days. Conclusion: s-PCNL is a safe and effective alternative treatment for renal stones. We would recommend s-PCNL for patients who require an ipsilateral/contralateral endourological procedure (URS/RIRS) because it is time-efficient. All renal accesses are safe. Single MCA is recommended for complete stone clearance.

Large-scale identification of calcium oxalate stone inhibitory proteins in normal human urine.

Recent evidence has shown that proteins in normal human urine can inhibit calcium oxalate (CaOx) kidney stone formation. Herein, we performed fast protein liquid chromatography (FPLC) to fractionate normal human urinary proteins using anion-exchange (DEAE) and size-exclusion (Superdex 200) materials. FPLC fractions (F1-F15) were examined by CaOx crystallization, growth, aggregation and crystal-cell adhesion assays. The fractions with potent inhibitory activities against CaOx crystals were then subjected to mass spectrometric protein identification. The data revealed that 13 of 15 fractions showed inhibitory activities in at least one crystal assay. Integrating CaOx inhibitory scores demonstrated that F6, F7 and F8 had the most potent inhibitory activities. NanoLC-ESI-Qq-TOF MS/MS identified 105, 93 and 53 proteins in F6, F7 and F8, respectively. Among them, 60 were found in at least two fractions and/or listed among known inhibitors with solid experimental evidence in the StoneMod database (https://www.stonemod.org). Interestingly, 10 of these 60 potential inhibitors have been reported with lower urinary levels in CaOx stone formers compared with healthy (non-stone) individuals, strengthening their roles as potent CaOx stone inhibitors. Our study provides the largest dataset of potential CaOx stone inhibitory proteins that will be useful for further elucidations of stone-forming mechanisms and ultimately for therapeutic/preventive applications.

FIRE Stones: impact of forced diuresis on the residual fragment rate after flexible ureteroscopy for destruction of kidney stones with laser-protocol for a randomized controlled two-parallel group multicenter trial with blinding evaluation.

BACKGROUND: Lithiasis is a common and recurrent disease. Flexible ureteroscopy (fURS) is the cornerstone of laser treatment of kidney stones. Kidney stones destruction requires its laser pulverization into small fragments in order to remove them through the ureter or improve their spontaneous expulsion along the urinary tract. However, most of the time, all the micro-fragments and dust created cannot be extracted using our surgical tools and may stay intra-renally at the end of the procedure. Adjuvant treatments (such as forced diuresis, inversion or mechanical pressure) were previously described to improve the expulsion of stone fragments after extra-corporeal shock wave lithotripsy. Nevertheless, the impact of adjuvant treatment after fURS remains unclear and mainly theoretical. OBJECTIVE: The primary objective is to show that the injection of 40 mg of furosemide in slow intravenous during 10 min, after the procedure, increases the stone-free rate 3 months after a fURS for destruction of kidney stones with laser. METHODS/DESIGN: The study will be a two-parallel group randomized, controlled, multicentric trial with a blinding evaluation. Nine French departments of urology will participate. Patients will be randomized in 2 groups: the experimental group (injection of 40 mg of furosemide at the end of the surgery) and a control one (usual care). Patients will be followed up for 3 months (± 2 weeks) after the surgery. Then, we will perform a low dose abdomino-pelvic CT scan. The primary outcome is the stone-free rate at 3 months. A centralized review of the images will be performed by two specialized radiologists, in a blind and crossed way to allow a homogenization of the results. The secondary outcomes will include the rate of early post-operative urinary tract infection (UTI), the evaluation of post-operative pain, and the safety of the use of furosemide in patients treated by fURS for renal stone laser destruction. As secondary objectives, it is also planned to look at the effect of the prescription of an alpha-blocker as usual treatment on stone-free rate and to assess the agreement between the imaging analysis of the urologist and the specialized radiologist. DISCUSSION: Lithiasis is a public health problem. It affects about 10% of the general population. This prevalence is increasing (multiplied by 3 in 40 years), partly due to changes in the population's eating habits over the years. The lithiasis patient is a patient with a chronic disease requiring annual follow-up and who may suffer from multiple recurrences, with a recurrence rate at 5 years of 50%. Recurrences are partly due to residual fragments left in the kidneys at the end of the operation. Other risk factors for recurrence include dietary hygiene and the presence of an associated metabolic disease. The metabolic blood and urine tests recommended by the Association Française d'Urologie (AFU) can be used to manage these last two problems. As far as residual fragments are concerned, their presence leads to an early recurrence of stones because they form the bed for a new aggregation of crystals in the kidneys. Being able to reduce the rate of residual fragments in patients with the use of furosemide at the end of the intervention therefore seems essential in the management of recurrences in our patients. This will also improve our patients' quality of life. Indeed, lithiasis disease leads to chronic pain associated with acute pain that motivates consultations to the emergency for specialized management. This study is the first to evaluate the impact of forced diuresis with the use of furosemide on the stone-free rate after a fURS for destruction of kidney stone with laser. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT05916963 , first received: 22 June 2023. EU Clinical Trials Register EudraCT Number: 2022-502890-40-00.

Improved Antioxidant Blood Parameters in Piglets Fed Diets Containing Solid-State Fermented Mixture of Olive Mill Stone Waste and Lathyrus clymenum Husks.

Solid-state fermentation represents a sustainable approach for the conversion of agro-industrial wastes into high-added-value feed ingredients. The present study aimed to evaluate the effects of the dietary addition of a solid-state-fermented mixture of olive mill stone waste (OMSW) and Lathyrus clymenum husks (LP) on the antioxidant blood parameters of weaned piglets. Two hundred 35-day-old weaned piglets were allotted into two groups and fed either a control (C) diet or a diet containing 50 g of OMSW-LP per kg (OMSW-LP) for 40 days. Blood samples were collected at 35 and 75 days of age to assess the free radical scavenging activity (FRSA), reduced glutathione (GSH) levels, catalase activity (CAT), protein carbonyls (CARBs), and thiobarbituric acid reactive species (TBARS). The OMSW-LP diet reduced the TBARS (p = 0.049) and CARB contents (p = 0.012) and increased the levels of FRSA (p = 0.005), GSH (p = 0.040), and CAT activity (p = 0.012) in the piglets' blood, likely due to the synergistic action of the antioxidants and bioactive compounds present in the OMSW-LP mixture. Overall, the dietary inclusion of solid-state-fermented OMSW-LP at 50 g/kg could potentially serve a bio-functional purpose since it enhanced the antioxidant blood parameters in this study, a crucial factor for the health and growth of piglets post-weaning.