International Alliance of Urolithiasis (IAU) guideline on staghorn calculi management.

BACKGROUND: The stone burden based management strategy reported in the guidelines published by different associations is well known for a long time. Staghorn calculi, representing the largest burden and most complex stones, is one of the most challenging cases to practicing urologists in clinical practice. The International Alliance of Urolithiasis (IAU) has released a series of guidelines on the management of urolithiasis. PURPOSE: To develop a series of recommendations for the contemporary management management of staghorn calculi and to provide a clinical framework for urologists treating patients with these complex stones. METHODS: A comprehensive literature search for articles published in English between 01/01/1976 and 31/12/2022 in the PubMed, OVID, Embase and Medline database is performed. A series of recommendations are developed and individually graded following the review of literature and panel discussion. RESULTS: The definition, pathogenesis, pathophysiology, preoperative evaluation, intraoperative treatment strategies and procedural advice, early postoperative management, follow up and prevention of stone recurrence are summarized in the present document. CONCLUSION: A series of recommendations regarding the management of staghorn calculi, along with related commentary and supporting documentation offered in the present guideline is intended to provide a clinical framework for the practicing urologists in the management of staghorn calculi.

Outcomes of Mini-Percutaneous Nephrolithotomy in Children and Adolescents: A 10-Year Single-Centre Experience From Kuwait.

The current study retrospectively reviewed data for all children and adolescents who underwent mini-percutaneous nephrolithotomy (PCNL) at Ibn Sina Hospital and Sabah Al Ahmad Urology Centre in Kuwait over 10 years. Accordingly, the 40 patients underwent mini-PCNL. Among them, 21 patients (52.5%) had varying degrees of hydronephrosis, with mild to moderate severity accounting for nearly half of them, whereas six (15%) had multiple stones. The median operative time was 54.5 (43.3-64) minutes. Moreover, 11 patients needed flexible ureteroscopy (URS) and double-J (DJ) ureteric stent, and one patient required DJ ureteric stent only. None of the cases developed intraoperative bleeding. The median hospital stay of the included patients was three (2.3-4) days. Residual stone was observed in 11 patients (27.5%), with a median size of 3 (2 to 7) mm. The incidence of postoperative complications was 27.5% (n = 11 patients), with three patients experiencing postoperative bleeding (7.5%) and eight patients developing a fever (20%). All patients had mild postoperative pain. However, no leakage, sepsis, or pelvic injury occurred. None of the patients required revision. In conclusion, mini-PCNL was a safe and effective procedure in children and adolescents with renal stones.

Super-Mini Percutaneous Nephrolithotomy for Nephrolithiasis: A Systematic Review and Meta-Analysis.

We aimed to conduct a systematic review and meta-analysis to summarize the current evidence regarding the role of super-mini percutaneous nephrolithotomy (SMP), which refers to a 7-Fr nephroscope placed through a tract sized 10-14 Fr, in treating renal stones and compare its outcomes with the standard mini-percutaneous nephrolithotomy (PCNL) techniques. A systematic literature search was conducted on the Medline database via PubMed and SCOPUS until May 2022 to retrieve the relevant studies. The titles and abstracts of unique records were screened for eligibility, followed by the full-text screening of potentially eligible abstracts. Data extraction was performed by two independent reviewers. The risk of bias assessment was conducted based on the study design. Open Meta (Analyst) and Review Manager 5.4 were used to perform all analyses. A total of 14 studies (n = 4,323 patients) were included, with two randomized controlled trials, one single-arm trial, and 11 cohort studies. The stone-free rate (SFR) of SMP was 91.4%. The pooled analysis showed no significant difference between SFR in mini-PCNL (mean difference (MD) = 1.03, 95% confidence interval (CI) = (0.99, 1.06), p = 0.12) and flexible ureteroscopy (MD = 0.84, 95% CI = (0.4, 1.76), p = 0.65]. On the other hand, SMP had a better SFR rate when compared with retrograde intrarenal surgery (MD = 1.3, 95% CI = (1.01, 1.66), p = 0.04). The pooled mean operative time of SMP was 49.44 minutes (95% CI = (41, 57.88), p < 0.001), which was longer than mini-PCNL (MD = 1.92, p < 0.001) and shorter than ureteroscopy (MD = -17.17, p < 0.00001). In the SMP group, the postoperative complications included fever (>38°C), pain, and hematuria, with an incidence of 7.6%, 2.3%, and 3.4%, respectively. The mean length of hospital stay after SMP was 2.4 days (95% CI = (2.17, 2.7), p < 0.001). The current evidence suggests that SMP is a safe and effective technique in the management of renal stones in both children and adults.

Dusting versus fragmentation for renal stones during flexible ureteroscopy.

Objectives: To compare stone dusting and spontaneous passage vs fragmentation and active fragment retrieval during flexible ureteroscopy (fURS) for renal calculi. Patients and methods: The study included patients who underwent fURS and holmium laser lithotripsy for renal calculi from January 2015 to March 2017. Dusting was done using low energy and high frequency (0.3-0.5 J and 15-20 Hz, respectively), and fragmentation was done with higher energy and lower frequency (1-1.2 J and 6-10 Hz, respectively) and then stone fragments were extracted using a basket. The stone-free rate (SFR) was evaluated after 2 months with non-contrast computed tomography. Operative time, complication rate, SFR, and the need for secondary procedures were compared. Results: The study included 107 consecutive patients, with a mean (SD) age of 49 (13) years. Dusting was performed in 51 patients and fragmentation in 56. The patients' demographics, laboratory tests, preoperative stents, stone and renal characteristics were comparable for both groups. Operative time was significantly shorter for dusting than fragmentation (76 vs 91 min, P = 0.009). Complication rates were comparable between the groups (7.8% for dusting and 8.9% for fragmentation, P = 0.840). The mean hospital stay was comparable for both groups (P = 0.686). The SFR was significantly better in fragmentation group (78.6%) compared with the dusting group (58.6%, P = 0.035). The need for a secondary procedure was 33.3% in the dusting group and 23.3% in fragmentation group (P = 0.244). Conclusions: During fURS for renal stones, the dusting technique had a significantly shorter operation time, whilst the fragmentation technique led to a significantly better SFR. Both techniques have comparable safety, hospital stay, and requirement for secondary procedures. Abbreviations: fURS: flexible ureteroscopy/ureteroscope; ICU: intensive care unit; KUB: plain abdominal radiograph of the kidney, ureter and bladder; NCCT: non-contrast CT; SFR: stone-free rate; SWL: shockwave lithotripsy; UAS: ureteric access sheath.