Clinical characteristics of adult cases with urolithiasis from Turkey: A regional epidemiological study.

OBJECTIVE: To evaluate the metabolic and clinical characteristics of adult cases with stone disease from a regional part of Turkey. METHODS: The study included 2348 adult patients with sonography and/or computed tomography-proven urinary stones. All cases were given a questionnaire about the epidemiological features of urolithiasis. Aside from the type and severity of stoneforming risk factors, both patient (age, gender, BMI, associated comorbidities, first onset of stone disease, positive family history, educational level) and stone-related (size, number, location, chemical composition, previous stone attacks) factors have been thoroughly assessed. The data were evaluated in multiple aspects to outline the epidemiological features. RESULTS: The overall mean age value of the cases was 43.3 years, and the M/F ratio was 1.34. The first onset of the disease was found to vary between 15-57 years, with a mean value of 32.4 years. While most of the stones were located in kidney and ureter, calcium-containing stones constituted the most common type (CaOx 69%, CaOxPO4 7%). More than 42% of the cases suffered from multiple stone attacks; positive family history was present in 31.6%. Among the associated comorbidities, hypertension was the most common pathology (45.8%), and the BMI index value was >30 in 31.3% of the cases. 57.7% of the patients had just one stone attack, and 42.2% had recurrent stone formation. CONCLUSIONS: Our findings clearly show that important implications may be extracted from epidemiologic data acquired from local scale research to implement an effective preventative program and closely monitor the patients.

Comparison of Two Centers' Experience in Pediatric Supine and Prone Miniaturized Percutaneous Nephrolithotomy with Propensity Match Analysis.

Introduction: Percutaneous nephrolithotomy (PNL) is the treatment of choice in children with complex and large stones. With the experience gained from adult practice, supine PNL is increasingly performed in children as well. We aimed to evaluate the comparative results of prone and supine mini-PNL (m-PNL) performed for large/complex stones in children. Patients and Methods: The study included children who underwent supine and prone m-PNL at two centers between September 2019 and 2022. Patients were divided into two groups with a 1:1 ratio to index supine m-PNL and prone m-PNL cases for the size, number, location of the stones, degree of hydronephrosis, and age. Operative related parameters, success, and complication rates are being discussed on a procedure-based manner. Results: Forty-two patients (21 supine and 21 prone) were included. The mean age was 9.6 ± 4 years and mean stone size was 28.8 ± 13.6 mm. Regarding the operative data, the mean duration of procedure time was 65.7 ± 17.8 minutes in supine group, whereas 86.9 ± 19.0 minutes in prone group (p = 0.001). Fluoroscopy time was shorter in supine group (p = 0.027). Tubeless PNL was performed in 11 cases of prone group (52%), whereas this number was 18 (86.7%) in supine group (p = 0.019). Stone-free rates were similar in both groups (supine m-PNL: 90.5%, prone m-PNL: 85.7%, p = 0.634). Complications were minor in nature in most of the cases of both groups, which resolved with supportive measures in a short period of time. However, there was a statistically significant difference regarding the location and number accesses between two groups (p = 0.008). Simultaneous flexible ureterorenoscopy was performed in eight patients in the supine PNL group (<0.001). Conclusions: Our current findings and the highly limited data reported in the literature indicate that as an established minimal invasive treatment alternative m-PNL procedure in supine position can also be performed with similar success and complication rates in pediatric population.

Contemporary minimal invasive surgical management of stones in children.

Objective: Pediatric urolithiasis has been more common over the past 20 years, and urologists have unique challenges in managing it surgically because this particular demographic is recognized as one of the high-risk categories for stone recurrence. Given this reality, care focuses on maintaining renal function, achieving total stone-free status, and most importantly avoiding stone recurrences. In this presented article, we aimed to make a comprehensive review of the current minimally invasive treatment of pediatric kidney stone disease. Methods: We evaluated the results of 74 studies following a comprehensive PubMed search till February 2023. This article was written by making use of current urology guidelines. Results: Considering the reported occurrence of metabolic issues in up to 50% of cases in addition to the anatomic anomalies (about 30% of cases), the treatment of pediatric urolithiasis necessitates a full metabolic and urological examination on an individual basis. Timely management of metabolic imbalances and obstructive diseases is necessary. In addition to encouraging proper fluid consumption, it is advisable to improve urine volume and consider using medical therapeutics to raise urinary citrate levels. The location, content, and size of the stone(s), the morphology of the collecting system, the presence of urinary tract infection, as well as the presence of any obstruction, should all be taken into consideration while deciding on the best surgical procedure. Conclusion: All modern endourological methods are now used in the safe and efficient care of pediatric urolithiasis as a consequence of the obvious advancements in instrument technology and expanding expertise derived from adult patients. Other minimally invasive procedures, such as ureterorenoscopy and percutaneous nephrolithotomy, require more expertise and can be successfully applied with careful management for an excellent stone-free rate with minimal morbidity. Of these procedures, shock wave lithotripsy is still the first choice in the majority of cases with upper tract calculi. Open surgery will still be the therapy of choice for pediatric patients with complicated and big stones as well as anatomical anomalies.

Dose-dependant preventive effect of a herbal compound on crystal formation in rat model.

INTRODUCTION: To analyze the dose-dependent preventive effect of a plant-based herbal product on the new crystal formation in a rat model. MATERIALS AND METHODS: A total of 42 rats were divided into 7 groups and zinc discs were placed into the bladder of rats to provide a nidus for the development of new crystal formation: Group 1: control, Group 2: 0.75 percent ethylene glycol (EG); Group 3: 0.75 percent EG plus 0.051 ml of the compound; Group 4: 0.75 percent EG plus 0.179 ml of the compound; Group 5: 0.75 percent EG plus 0.217 ml of the compound; Group 6: 0.75 percent EG plus 0.255 ml of the compound; Group 7 0.75 percent EG plus 0.332 of the compound). The analysis and comparison focused on the disc weights, changes in urinary oxalate and calcium levels, urinary pH, and the histopathologic evaluation of the inflammatory changes in the bladder after 14 days. RESULTS: According to the evaluation of discs placed in the bladders of the animals, animals receiving the herbal compound on a dose-dependent basis showed a limited increase in the disc weights values after 14 days, despite a considerable increase in animals receiving EG alone (p = 0.001). Further evaluation of the increase in disc weights on a dose-dependent basis in different subgroups (from Groups 3 to 7) demonstrated that the limitation of crystal deposition began to be more prominent as the dose of herbal compound increased. This effect was more evident particularly in comparisons between group 7 and others, according to LSD multiple comparison tests (p = 0.001). As anticipated, there has been no discernible change in the weight of the discs in the control group. Although urinary calcium levels in animals of Groups 2, 6, and 7 were significantly higher than the other groups, we were not able to demonstrate a close correlation between urinary oxalate levels and the increasing dose levels. Even though mean urine pH levels were statistically considerably higher in Group 3, there was no statistically significant correlation between the oxalate and calcium levels between all groups, and no association was seen with the administration of herbal agents. The transitional epithelium between the three groups of animals' bladder samples did not exhibit any appreciable difference according to pathological analysis. CONCLUSIONS: In this animal model, the treatment of the compound was successful in lowering the amount of crystal deposition surrounding the zinc discs, most noticeably at a dosage of 0.332 ml, three times per day.

Can additional variables be used to predict stone-free rates following retrograde intrarenal surgery? Anticoagulants and parenchyma thickness: a detailed examination.

The purpose of this article is to identify the factors that predict the success of retrograde intrarenal surgery (RIRS), with a focus on the effect of renal parenchymal thickness and anticoagulant use on stone-free rates. From February 2014 to April 2022, cases of kidney stones treated with RIRS at our clinic were retrospectively screened. The study included 642 cases meeting all inclusion and exclusion criteria. The patients who were observed to be stone free after a single session of RIRS were assigned to Group F, while those with residual fragments were assigned to Group R. Group F comprised 472 patients, while Group R included 170 patients. The two groups have compared certain preoperative and postoperative laboratory and radiological parameters. The infundibulopelvic angle was significantly more acute in Group R (45.63 ± 16.25 vs. 49.28 ± 15.36, p = 0.011) while patients in Group F tended to have thicker parenchyma (27.39 ± 8.38 vs. 22.88 ± 5.56, p < 0.001). In our analysis of multivariate logistic regression, stone size (OR: 1.074, 1.037-1.113; p < 0.001), lower calyceal location (OR: 0.550, 95% CI 0.364-0.831; p = 0.005), multiple numbers of stones (OR 0.254, 95% CI 0.166-0.389; p = < 0.001), the value of parenchymal thickness (OR 0.911, 95% CI 0.882-0.941; p = < 0.001) and more importantly use of anticoagulants/antiplatelets (OR 0.557, 95% CI 0.333-0.933; p = 0.026) appeared to be independent predictors of stone-free status after RIRS. Further evaluation of the data revealed that the cut-off value of the renal parenchymal thickness for an effective stone-free status in a ROC curve analysis was 24.5 with 62.9% sensitivity and 56.8% specificity (area under curve value: 0.654 [95% CI 0.608-0.699, p < 0.001]). The endourologist may be able to make more informed decisions by evaluating renal parenchymal thickness in addition to patient-related factors like anticoagulant use, which we find significantly affects outcomes, along with the stone and renal anatomy-related factors.

Minipercutaneous Nephrolithotomy in the Management of Large and Complex Renal Calculi in Children: How Effective Is It?

Purpose: To evaluate the efficacy and safety of minipercutaneous nephrolithotomy (PCNL) in the management of large and complex calculi in children. Patients and Methods: From May 2017 to April 2021, a total of 41 pediatric cases were diagnosed with large/complex renal stones (partial-total staghorn) and following a detailed biochemical evaluation and thorough radiological examination (plain abdominal radiograph, urinary ultrasound, noncontrast and/or computed tomography), all cases underwent mini-PCNL procedure for the minimal invasive management of these calculi. Preoperative, intraoperative, and postoperative data were analyzed and reported in detail. Results: A total of 41 procedures were performed in 26 boys and 15 girls (male/female = 1.73). While the age of the kids ranged from 2.5 to 10 years (mean 6.74 ± 2.76), mean size of the stones was 16.28 ± 3.43 mm (range 11-24) with a mean stone density value of 816 HU (range 550-1350). Evaluation of the success rates in terms of complete stone clearance on postoperative day 1 revealed that while 73.2% (30/41), residual fragments have been noted in 11 cases (26.8%). Size of the residual fragments ranged from 2 to 7 mm (mean 4.3). Of those children, 10 cases required flexible ureteroscopy for stone removal, and in 1 case, placement of Double-J was adequate for spontaneous passage. During a 3-month follow-up, the stone-free rate (SFR) increased to 100% without any residual fragment left. Conclusions: Mini-PCNL with holmium laser lithotripsy is an effective and safe treatment alternative in the minimal invasive management of large/complex kidney stones in children with high SFRs.

Comparison of dusting and fragmentation methods in the flexible ureteroscopic treatment of kidney lower calyx stones.

To compare the long-term stone-free status of patients who underwent fragmentation of stones followed by active basketing versus stone dusting and spontaneous passage following flexible ureteroscopic treatment for lower calyceal stones. The dusting or fragmentation methods were randomly assigned to patients who were scheduled to undergo RIRS for only renal lower calyceal stones between February 2019 and May 2022, prospectively. Stone-free rates were determined after 3 months by non-contrast computed tomography and patient demography; preoperative and postoperative follow-up data of both groups were evaluated comparatively. While the fragmentation method was applied in 32 patients, the dusting method was applied in the remaining 31 cases. The two groups did not differ significantly regarding the demographic data and laboratory findings. Mean stone size was similar in both groups of cases. Operation time was significantly longer for fragmentation (93.23 ± 27.20 vs 78.43 ± 30.08, p = 0.045) and evaluation of the success rates after 3 months did show that patients in the dusting group had a higher rate of stone-free status when compared with the other group of cases (65.6 vs 87.1%, p = 0.043). Lastly, postoperative fever rates were not significantly different between the two groups (12.5 vs 9.7%, p = 0.518). Our findings showed that dusting the lower calyceal stones during fURS would reveal higher stone-free rates during long-term follow-up periods, and the mean operation time will be shorter in these patients.

Radiologic evaluation of children prior to SWL: to what extent they are exposed to radiation?

The objective of this study is to evaluate the average radiation exposure in children with renal stones before SWL treatment. Mean radiation exposure values were evaluated in 110 children before SWL treatment. While some children referred to the emergency department (ED) with colic pain, remaining cases referred to outpatient department (OD). Although low-dose NCCT was performed in ED; KUB and abdominal sonography were first performed in other cases referring to OD where CT has been applied if needed. The type of imaging modality used and the mean radiation exposure were evaluated and comparatively evaluated with respect to the department referred, patient as well as stone related parameters. 49 children referred to ED and 61 children referred to OD. Mean stone size was 7.24 ± 0.29 mm. 62 cases had opaque stones. Mean radiation exposure values were higher in children referring to ED than the other cases. However, there was no significant difference between the two groups regarding the mean number of KUB, IVU and sonographic evaluation performed prior to SWL management. There was a significant correlation between the mean radiation exposure and the stone size as well degree of hydonephrosis in a positive manner. Although a significant correlation was present between the mean radiation exposure and stone opacity in a negative manner; there was no correlation with respect to the other related parameters. Unnecessary use of X-ray based imaging modalities in children could be effectively avoided using KUB and US combination beginning from the diagnostic phase of stone disease.

Functional and morphological recovery of solitary kidneys after drainage. Double J stent placement vs emergency ureteroscopy: which one is reasonable?

The purpose of the study was to evaluate the functional and morphological recovery of solitary kidneys following the relief of obstruction by two different approaches. Data of 65 adult patients with acute renal failure in obstructed solitary kidney were evaluated. Depending on the type of emergent decompression procedure while 34 patients were treated with a double J stent placement only 31 patients underwent ureteroscopic lithotripsy with double J stent placement. Following these procedures, in addition to the amount of excreted urine during the first 24 h, changes in the serum creatinine levels and the degree of hydronephrosis were noted and evaluated during the first week of follow-up after intervention. Evaluation of the urine output values during the first 24-h period revealed a statistically significant difference in favour of ureteroscopic lithotripsy. Serum creatinine levels in terms of the mean change in serum creatinine values and also percentage of the changes revealed no statistically significant change between two groups. Comparative evaluation of the change in the degree of hydronephrosis between baseline and post-procedural seventh day values revealed a statistically significant decrease in favour of ureteroscopic lithotripsy. Lastly, there was a statistically insignificant but meaningful difference with respect to the percent of change in the degree of hydronephrosis between two group of cases. Although temporary decompression of the obstructed solitary kidney by placing a double J stent may relieve the obstruction to a certain extent; emergent ureteroscopic lithotripsy could be applied as a reasonable alternative where adequate experience and technical availability are present.

Comparison of long-term efficacy of desmopressin lyophilisate and enuretic alarm for monosymptomatic enuresis and assessment of predictive factors for success: a randomized prospective trial.

PURPOSE: We compared the long-term success of desmopressin sublingual lyophilisate formulation and enuretic alarm therapy in children with primary monosymptomatic nocturnal enuresis, and determined predictive factors for treatment success. MATERIALS AND METHODS: A total of 142 children with primary monosymptomatic nocturnal enuresis were randomized to receive treatment consisting of desmopressin or enuretic alarm for 6 months. Treatment compliance and response were reviewed monthly in each patient using a 30-day bed-wetting diary. Outcomes were assessed according to International Children's Continence Society criteria, and success rates at 6 and 12 months were compared for desmopressin and enuretic alarm. Additional intention to treat analyses were performed, considering cases with missing data as failures. Possible demographic factors predicting success were investigated by logistic regression analysis. RESULTS: Overall 4 children (5.2%) in the desmopressin group and 20 (30.7%) in the enuretic alarm group withdrew after randomization. Based on patients who completed 6 months of treatment, success (more than 90% reduction in wet nights per month) was achieved in 76.8% and 61.8% of children in the desmopressin and enuretic alarm groups, respectively. At 12 months 77.8% of those receiving desmopressin and 75% of those treated with enuretic alarm had success. However, long-term success rate was significantly higher with desmopressin (68.8% vs 46.2%) if intention to treat population was considered. Multivariate analysis revealed treatment group, severity of enuresis and monthly income as independent predictors of cure at 6 months. CONCLUSIONS: In compliant patients desmopressin lyophilisate and enuretic alarm provided equivalent success at the end of treatment and after extended followup. Alarm therapy had a high rate of early withdrawal from therapy and consequently lower rates of success on intention to treat analyses. Severe enuresis (more than 5 wet nights weekly) is an important predictive factor for cure after first-line treatment.

Minimum 1.5-year results of "surgeon-tailored" transvaginal mesh repair for female stress urinary incontinence and pelvic organ prolapse.

OBJECTIVE: To evaluate our minimum 1.5-year results with "surgeon-tailored" polypropylene mesh (STPM) in stress urinary incontinence treatment and the impact of concomitant pelvic organ prolapse repair on functional outcomes. METHODS: All patients who were treated for stress urinary incontinence and pelvic organ prolapse using STPM between 2006 and 2010 were reviewed. Fifty-two patients received transobturator midurethral sling alone. Concomitant pelvic organ prolapse repair was performed in 74 (67 cystocele, 14 rectocele). Pre- and postoperative evaluation included subjective assessment of the impact of voiding and prolapse symptoms with International Consultation on Incontinence-Short Form and Prolapse Quality of Life (P-QOL) questionnaires, uroflowmetry, and urodynamic studies when necessary. Surgical outcomes at the last follow-up and complications were compared between the transobturator midurethral sling and transobturator midurethral sling + pelvic organ prolapse repair groups. RESULTS: One-hundred eighteen women were available for analysis. With a mean follow-up of 33.4 and 41.2 months for transobturator midurethral sling and transobturator midurethral sling + pelvic organ prolapse repair groups, stress urinary incontinence was cured in 86.4% and 81.1% of the patients, respectively. Preoperative urge symptoms resolved in 53.8% and 62.5%, and de novo urge symptoms developed in 22% and 15% of patients with respect to study groups. Pelvic organ prolapse was cured in 98.6% patients, with a significant improvement in all domains of the P-QOL questionnaire at the last follow-up. Vaginal mesh erosions were detected in 11 (14.8%) patients with concomitant pelvic organ prolapse repair. CONCLUSION: STPM may represent a cost-effective option for stress urinary incontinence treatment. Concomitant pelvic organ prolapse repair with STPM does not affect incontinence outcomes and provides high anatomic success and patient satisfaction in the long term. However, mesh-related complications with this approach is a major concern that deserves further investigation of risk factors and better definition of patient selection criteria.