Urolithiasis

number or safety measures. In patients with estimated glomerular filtration rate (eGFR) < 90 mL/min/1.73 m 2 , Pox increased by 3.25 µmol/L in the placebo group and decreased by -1.7 µmol/L in the OC3 group (p = 0.13). After 24 weeks, eGFR had declined to a greater degree in the placebo than in the OC3 group: -8.00 ± 2.16 versus -2.71 ± 2.50; p = 0.01. OC3 treatment did not reduce urinary oxalate over 24 weeks of treatment compared with placebo in patients with PH. The treatment was well tolerated.

Urolithiasis affects approximately 10% of individuals in Western societies by the seventh decade of life. The most common form, idiopathic calcium oxalate urolithiasis, results from the interaction of multiple genes and their interplay with dietary and environmental factors. To date, considerable progress has been made identifying the metabolic risk factors predisposing to this complex trait, among which hypercalciuria predominates. The specific genetic and epigenetic factors have remained less clear, in part due to the candidate gene and linkage methods available until now, which are inherently low in their power of resolution and in assessing modest effects in complex traits. Even so, this approach, together with investigations of rare, Mendelian forms of urolithiasis associated with various metabolic risk factors has afforded insights into biological pathways that appear to underlie the development of stones in the urinary tract. Monogenic diseases account for a greater proportion of stone formers in childhood and adolescence than in adults. Early diagnosis of monogenic forms of urolithiasis is of importance due to associated renal injury and other potentially treatable disease manifestations, but is often delayed due to lack of familiarity with these rare disorders. Genetic advances in polygenic and monogenic forms of urolithiasis are reviewed.

The conventional technique for percutaneous nephrolithotomy (PNL) ends by placing a nephrostomy tube within the access tract. However, feasibility and safety of tubeless PNL have been widely demonstrated. In this modification, a ureteral stent is usually left in place instead of the nephrostomy tube. The aim of this study is to compare the use of a postoperative indwelling double-J stent versus an overnight-externalized ureteral catheter in patients undergoing tubeless PNL. Sixty-eight patients undergoing tubeless PNL were randomized either for a postoperative double-J stent (group 1) or for an overnightexternalized ureteral catheter (group 2). Outcomes evaluated included postoperative pain, hospital stay length, incidence of hemorrhagic complications, residual lithiasis and urinary leakage. Groups were similar according to age, sex, body mass index and stone burden. There were no significant differences in terms of postoperative pain, incidence of perirenal hematomas, residual lithiasis and urinary leakage. However, patients in group 1 presented longer hospital stays (3.7 ± 1.7 vs. 1.9 ± 0.3 days; p \ 0.001) and greater hematocrit drops (4.9 ± 2.2 vs. 2.1 ± 1.8 %; p \ 0.001). Our results confirm that among patients undergoing tubeless PNL, both alternatives (i.e. leaving a double-J stent or an overnight-externalized ureteral catheter) are reliable and safe. However, further considerations, like the need of double-J stent removal under cystoscopy, need to be taken into account when deciding which modality to use.

The multipurpose medicinal plant, Cola acuminata, was chosen for this investigation. Prominent effects on body weight and weight gain was observed. The toxicity on liver, kidney and heart was correlated with changes in the activity of Aspartate Transaminase (AST) and Alanine Transaminase (ALT), and the concentration of cholesterol, albumin and urea in serum. There was an increase in the neutrophils and decrease in lymphocytes in the blood of all the tested groups and an increase of WBC of two groups only. Cytoplasmic fatty vacuolation or necrosis of the centrilobular hepatocytes catarrhal enteritis with minute erosions of the intestinal epithelium with lymphocytic infiltration in the lamina propria and hemosidrin deposition, shrinkage of the glomerular tufts and dilatation of the proximal convoluted tubules were also seen. In group 3 there were lymphocytic infiltrations, glomerular packing, degeneration or necrosis of the epithelial cells of the renal convoluted tubules. No significant lesions were observed in the heart of the test rats. The vital organs of the control rats remained healthy.

The Spanish version of the Wisconsin Stone Quality of Life (WISQOL) questionnaire was developed and validated. A doubleback translation of the WISQOL was conducted and syntactic amendments were made, resulting in the Spanish version of the WISQOL (S-WISQOL) which then went through a readability analysis. Stone formers from two hospitals in Mexico (Merida and Monterrey) filled in the S-WISQOL and the Short Form 36 (SF36). Convergent validity was assessed by the correlation of both questionnaires. Internal consistency was evaluated by Cronbach's α, and external validity by comparing between centers. The impact of clinical settings on patients' health-related quality of life (HRQOL) scores was tested. Each hospital's institutional review board approved the project and informed consent was obtained from all participants. A total of 87 Spanish-speakers patients completed the S-WISQOL and SF36 and a good correlation was found between both (r = 0.75, p < 0.001). S-WISQOL readability was rated as "easy". Patients from Merida had longer median duration (years) with stones, more stone-related procedures, and hospitalizations, and scored lower on WISQOL (p = 0.006). Internal consistency was good as Cronbach's α coefficients ranged between acceptable and excellent. Stone-related admissions and duration of stones were inversely correlated with S-WISQOL score (-0.254 and -0.283, respectively; p < 0.005) but not to SF36. The S-WISQOL is an internally consistent, reliable, and valid instrument to assess HRQOL in Spanish-speaking patients with kidney stones. The S-WISQOL is generalizable as demonstrated by good external validity among centers. S-WISQOL scores can be added as an outcome for kidney stone treatments.

Sulfonated and fluorescent polymethylsiloxanes (SO3H‐PMS) were synthesized, and their effect as additives on in vitro calcium oxalate (CaOx) crystallization was evaluated. SO3H‐PMS was prepared by hydrosilylation and sulfonation reactions with poly(dimethylsiloxane‐co‐hydrogenmethylsiloxane) (PDMS‐co‐PMHS). Several analytical tools were used to investigate the morphology, crystal structure, and chemical contents of the harvested CaOx crystals. Varying the concentration of SO3H‐PMS induces a transition of CaOx monohydrate (COM) with expanded multilayer and circular stacked‐sheet morphologies as well as of the bipyramidal CaOx dihydrate (COD) crystals in three crystallization procedures. Energy‐dispersive X‐ray spectroscopy (EDS) and XRD allowed detecting the presence of Si (0.2–1.0°wt.‐%), which stems from SO3H‐PMS adsorbed on CaOx, and the selective formation of phases of COM and COD. We demonstrated that the presence of anionic moieties on the SO3H‐PMS backbone and their concentrat...

Renal stone disease is a global problem with a 12% global prevalence. For the management of renal stones percutaneous nephrolithomy (PCNL) is the urological intervention of choice. There have been several instances of post-PCNL urinary tract infection (UTI) despite a sterile pre-operative urine culture. To look into the possible factors that may be associated with such an outcome, we observed 142 patients undergoing PCNL with a prerequisite of sterile pre-operative urine culture, no indwelling double J stents, and no fever episodes within the last seven days of admission for PCNL. Results: 19% of 142 patients suffered post-PCNL UTI. We noted that the presence of multiple stones, stone burden of greater than 3 cm, and perinephric fat stranding in preoperative CT scan of the KUB region were the preoperative factors associated with post-PCNL UTI. Intraoperative factors that were found associated were the size of tract dilatation (16 Fr or greater than 16 Fr), number of renal access tracts, and duration of surgery. We also found that patients with controlled diabetes behaved as the non-diabetic population for the incidence of UTI post-PCNL.

Introduction: A severe kidney infection associated to gas production in the renal parenchyma and/or collecting system is known as emphysematous pyelonephritis. The aim of this study was to assess the effects of urolithiasis on the severity of emphysematous pyelonephritis in a modern cohort of patients and their outcomes. Methods: From 2023 to 2024, a study was conducted for the word "emphysematous pyelonephritis" in all imaging reports at Bharati Hospital and Research Centre. Patients were considered for inclusion if they had computed tomography showing gas in the renal parenchyma or collecting system, no recent urologic instrumentation, and clinical signs of infection. The laboratory and clinical characteristics were taken from patient medical records. Results: Twenty cases in all were identified. Sixty percent of the patients had gas that was confined to the collecting system. Gas was present in the renal parenchyma in four patients (20%) and in the perirenal tissues in four patients (20%). Twelve individuals, or 60% of the total, also had concurrent urolithiasis. DJ stenting, either bilateral or unilateral, was done for every patient. None of the patients needed a nephrectomy right away. There were no deaths. Emphysematous pyelonephritis with urolithiasis was less severe than non-urolithiasis patients. Conclusions: Most of the study's patients had gas confined to the collecting system, and DJ stentning proved to be an effective treatment for them. No patients needed a nephrectomy on emergency basis. Patients with urolithiasis had less severe emphysematous pyelonephritis than those without urolithiasis.

Stone disease is a unique condition that requires appropriate management in a timely manner as it can result in both emergent conditions and long term effects on kidney functions. In this study it is aimed to identify the up-to-date practice patterns related to preoperative evaluation and anesthesia for stone disease interventions during COVID-19 pandemic. The data of 473 patients from 11 centers in 5 different countries underwent interventions for urinary stones during the Covid-19 pandemic was collected and analyzed retrospectively. Information on the type of the stone related conditions, management strategies, anesthesiologic evaluation, anesthesia methods, and any alterations related to COVID-19 pandemic was collected. During the preoperative anesthesia evaluation thorax CT was performed in 268 (56.7%) and PCR from nasopharyngeal swab was performed in 31 (6.6%) patients. General anesthesia was applied in 337 (71.2%) patients and alteration in the method of anesthesia was recorded in 45 (9.5%) patients. A cut-off value of 21 days was detected for the hospitals to adapt changes related to COVID-19. Rate of preoperative testing, emergency procedures, conservative approaches and topical/regional anesthesia increased after 21 days. The preoperative evaluation for management of urinary stone disease is significantly affected by COVID-19 pandemic. There is significant alteration in anesthesia methods and interventions. The optimal methods for preoperative evaluation are still unknown and there is discordance between different centers. It takes 21 days for hospitals and surgeons to adapt and develop new strategies for preoperative evaluation and management of stones.

Currently an evidence-based approach to nephrolithiasis is hampered by a lack of randomized controlled trials. Thus, there is a need for common platforms for data sharing and recruitment of patients to interventional studies. A first step in achieving this objective would be to share practice methods and protocols for subsequent standardization in what is still a heterogeneous clinical field. Here, we present the results of a pilot survey performed across 24 European clinical kidney stone centers. The survey was distributed by a voluntary online questionnaire circulated between June 2017 and January 2018. About 46% of centers reported seeing on average 20 or more patients per month. Only 21% adopted any formal referral criteria. Centers were relatively heterogeneous in respect of the definition of an incident stone event. The majority (71%) adopted a formal follow-up scheme; of these, 65% included a follow-up visit at 3 and 12 months, and 41% more than 12 months. In 79% of centers some kind of imaging was performed systematically. 75% of all centers performed laboratory analyses on blood samples at baseline and during follow-up. All centers performed laboratory analyses on 24-h urine samples, the majority (96%) at baseline and during follow-up. There was good correspondence across centers for analyses performed on 24-h urine samples, although the methods of 24-h urine collection and analysis were relatively heterogeneous. Our survey among 24 European stone centers highlights areas of homogeneity and heterogeneity that will be investigated further. Our aim is the creation of a European network of stone centers sharing practice patterns and hosting a common database for research and guidance in clinical care.

Purpose: To design a simple, cost-effective system for gaining rapid and accurate calyceal access during percutaneous nephrolithotomy (PCNL). The design consists of a low-cost, light-weight, portable mechanical gantry with a needle guiding device. Using C-arm fluoroscopy, two images of the contrast-filled renal collecting system are obtained: at 0-degrees (perpendicular to the kidney) and 20-degrees. These images are relayed to a laptop computer containing the software and graphic user interface for selecting the targeted calyx. The software provides numerical settings for the 3 axes of the gantry, which are used to position the needle guiding device. The needle is advanced through the guide to the depth calculated by the software, thus puncturing the targeted calyx. Testing of the system was performed on 2 target types: 1) radiolucent plastic tubes the approximate size of a renal calyx (5 or 10 mm in diameter, 30 mm in length); and 2) foam-occluded, contrast-filled porcine kidneys. Results: Tests using target type 1 with 10 mm diameter (n = 14) and 5 mm diameter (n = 7) tubes resulted in a 100% targeting success rate, with a mean procedure duration of 10 minutes. Tests using target type 2 (n = 2) were both successful, with accurate puncturing of the selected renal calyx, and a mean procedure duration of 15 minutes. Conclusions: The mechanical gantry system described in this paper is low-cost, portable, light-weight, and simple to set up and operate. C-arm fluoroscopy is limited to two images, thus reducing radiation exposure significantly. Testing of the system showed an extremely high degree of accuracy in gaining precise access to a targeted renal calyx.

Objective: We conducted a study to describe the characteristics of pediatric urolithiasis patients in Zainoel Abidin Hospital, Aceh-Indonesia. Material Methods: Between January 2013 and March 2016, we retrospectively reviewed the medical records of 16 pediatric patients with urolithiasis in Zainoel Abidin Hospital, Aceh-Indonesia. The patients were come from whole Aceh region and the variables are sex, age, family history of stone disease, and stone location. The data were described in graphics and tables. Results: From 16 pediatric urolithiasis patients, 9 patients (56.3%) were males and 7 patients (43.7%) were females. In 2013 there were 4 pediatric urolithiasis patients (1.2%), in 2014 there were 5 (1.6%), and in 2015 there were 3 (2.3%). From January – March 2016 there were 4 pediatric urolithiasis patients (4.5% of all urolithiasis patients). The mean age of all pediatric patients were 7.7 ± 5.5 years (1-17 years). The incidence of urolithiasis for group 5 years of age were 6 p...

Objective: We conducted a study to describe the characteristics of pediatric urolithiasis patients in Zainoel Abidin Hospital, Aceh-Indonesia. Material Methods: Between January 2013 and March 2016, we retrospectively reviewed the medical records of 16 pediatric patients with urolithiasis in Zainoel Abidin Hospital, Aceh-Indonesia. The patients were come from whole Aceh region and the variables are sex, age, family history of stone disease, and stone location. The data were described in graphics and tables. Results: From 16 pediatric urolithiasis patients, 9 patients (56.3%) were males and 7 patients (43.7%) were females. In 2013 there were 4 pediatric urolithiasis patients (1.2%), in 2014 there were 5 (1.6%), and in 2015 there were 3 (2.3%). From January – March 2016 there were 4 pediatric urolithiasis patients (4.5% of all urolithiasis patients). The mean age of all pediatric patients were 7.7 ± 5.5 years (1-17 years). The incidence of urolithiasis for group 5 years of age were 6 p...

The purpose of this research was to look into the traditional approach of preventing and treating kidney stones. According to existing research, kidney stones affect 12% of the global population between the ages of 20 and 30, and men are more likely than women to develop them. However, the most concerning development in recent years is that young children as young as 5 years old are developing kidney stones. As a result, crystals begin to form stones in our kidneys, and these crystals gradually attract additional wastes and chemicals, resulting in a solid known as a kidney stone. A kidney stone might be the size of a grain of sand or the size of a golf ball. Despite contemporary medicine's advancements, the genesis and proliferation of kidney stones continues to be a source of concern for mankind, as information and expertise about kidney stone treatment is lacking. If a person has a kidney stone problem, he or she needs pay a minimum of Rs. If the individual starts using the chemical medicine, which also causes numerous side effects, and he has to take other tablets to control these side effects, there is a miracle ethnomedicinal natural plant accessible to get rid of this condition without any adverse effects. Bryophyllum pinnata is a perennial herb that is commonly used in folk medicine and Ayurveda to treat a variety of ailments, including the breaking and removal of kidney stones.

Macrotyloma uniflorum (Lam.) Verdc., an economically important medicinal plant belongs to the Leguminosae family. Being Afro-Asian origin, the plant has long tradition of uses. It is primarily used for its antiurolithiatic property although it has other medicinal uses. Being Leguminosae member, this plant can form rhizobial nodules and mycorrhizal associations. The rhizobia obtained from this plant are mostly belonged to Bradyrhizobium sp. Although, Rhizobium pusence has also been reported. Microbes as biofertilizers can be used to increase yield of this plant, as well as there is great potential for utilizing the microbes derived from this plant. In this review we aim to describe the plant M. uniflorum - its taxonomic characteristics, economic uses, putative active constituents, and beneficial microflora along with their applications.

Medical records from cats diagnosed with uroliths at nine United States veterinary teaching hospitals from 1980 to 1999, and records of cats with uroliths submitted for analyses to the Minnesota Urolith Center from 1981 to 2000, were evaluated. A 10-fold increase in frequency of upper tract uroliths occurred in cats during the 20-year interval at the nine veterinary teaching hospitals. Calcium oxalate emerged as the predominant mineral type in upper tract uroliths, having increased more than 50-fold during the study period. These results emphasize the need for increased awareness of the occurrence of upper urinary tract uroliths in cats.

In 1908, Drs. George Muller and Alexander Glass made the following statements about uroliths in dogs: ''When the stone is present and causing retention of urine, there is nothing left but to remove the stones by means of an operation called urethrotomy if the stone is lodged in the urethra at the posterior end of the bones of the penis or cystotomy if the stone is located in the bladder.'' 1 One hundred years later, surgery remains a common procedure for rapid removal of uroliths from the lower urinary tract of dogs. Incorporation of intracorporeal laser lithotripsy and extracorporeal shock wave lithotripsy (ESWL) has provided impetus for a paradigm shift in the way veterinarians manage urinary stones, however. These minimally invasive techniques provide a successful alternative to surgical urolith extraction. The term lithotripsy is derived from the Greek words ''lith'' meaning stone, and ''tripsis'' meaning to crush. A lithotriptor is a device for crushing or disintegrating uroliths. ESWL may be used to fragment and remove uroliths from the upper urinary tract, whereas intracorporeal laser lithotripsy may be used to fragment uroliths in the lower urinary tract by urethrocystoscopy. Successful medical application of intracorporeal lithotripsy depended on two technological advances: (1) delivery of energy capable of fragmenting uroliths without damaging adjacent tissue, and (2) cystoscopes capable of entering the narrow urethral

Results of experimental and clinical investigation have confirmed the importance of dietary modifications in medical protocols designed to promote dissolution and prevention of uroliths. The objectives of medical management of uroliths are to arrest further growth and to promote urolith dissolution by correcting or controlling underlying abnormalities. For therapy to be most effective, it must promote undersaturation of urine with lithogenic crystalloids by: (1) increasing the urine solubility of crystalloids, (2) increasing the volume of urine in which crystalloids are dissolved or suspended, and (3) reducing the quantities of lithogenic crystalloids in urine. For example, attempts to increase the solubility of crystalloids in urine often include dietary modifications designed to change pH to create a less favorable environment for crystallization. Increasing dietary moisture is commonly used to increase the volume of urine in which crystalloids are dissolved or suspended. Change in the composition of dietary ingredients is an example of a method to reduce the quantity of lithogenic crystalloids in urine. This article summarizes and applies evidence about nutritional management of urolithiasis derived from experimental and clinical studies of cats and dogs performed at the Minnesota Urolith Center (MUC). How should this information be put into practice? For these studies to be of most benefit to patients, clinicians are encouraged to seek reproducible knowledge derived from properly designed clinical studies. Vigilance is necessary in order not to be misled by unsubstantiated anecdotes and dogmatic This work sponsored in part by an educational grant from Hill's Pet Nutrition, Inc.

Gluten is a concentrated vegetable protein consisting of a composite of the proteins gliadin and glutenin. These exist, conjoined with starch, in the endosperms of some grass-related grains, notably wheat, rye, and barley. Gliadin and glutenin make up about 80% of the protein contained in wheat seed. Since they are insoluble in water, these proteins can be purified by washing away the associated starch. Worldwide, gluten is an important source of nutritional protein, both in foods prepared directly from sources containing it and as an additive to foods otherwise low in protein. Rice protein is a form of concentrated vegetable protein that is made by separating and isolating the protein portion from the carbohydrate portion of rice. It is used in many pet foods as part of the formulation. Rice protein concentrate adds plant proteins that contain little, if any, gluten.

Objective—To confirm that the predominant mineral type in naturally occurring uroliths in ferrets is struvite; to determine whether age, breed, sex, reproductive status, geographic location, season, and anatomic location are risk factors associated with urolith formation in ferrets; to compare features of struvite uroliths in cats with those in ferrets; and to determine whether there is a logical evidence-based rationale for clinical trials of the safety and efficacy of diet-induced dissolution of struvite uroliths in ferrets. Design—Retrospective case-control study. Animals—408 ferrets with uroliths (272 struvite uroliths) from the Minnesota Urolith Center, and 6,528 control ferrets from the Veterinary Medical Database. Procedures—Historical information was obtained about each ferret. The association between proposed risk factors and outcome (struvite urolith formation) was assessed. Results—Sterile struvite was the predominant mineral in uroliths in ferrets. Neutered male ferrets ...

Objective—To compare the efficacy and safety of using 2 commercially available, low-magnesium, urine-acidifying dry foods to dissolve sterile struvite uroliths in cats. Design—Prospective, multicenter, randomized clinical trial Sample—37 cats with presumed struvite uroliths. Procedures—Cats were randomly assigned to be fed 1 of 2 low-magnesium, urine-acidifying dry foods (food A or B). For each cat, physical examination, urinalysis, and abdominal radiography were performed weekly to assess treatment response. Results—32 cats had complete urolith dissolution. Mean ± SD times for a 50% reduction in urolith size (0.69 ± 0.1 weeks) and complete urolith dissolution (13.0 ± 2.6 days) were significantly shorter for cats fed food A, compared with those (1.75 ± 0.27 weeks and 27.0 ± 2.6 days, respectively) for cats fed food B. At study termination, mean ± SD urine pH (6.083 ± 0.105) for cats fed food A was lower than that (6.431 ± 0.109) for cats fed food B. In 5 cats, uroliths did not disso...

Objective—To characterize the efficacy and safety of laser lithotripsy in the fragmentation of urocystoliths and urethroliths for removal in dogs. Design—Prospective case series. Animals—100 dogs with naturally occurring urocystoliths and urethroliths. Procedures—Via cystoscopy, laser lithotripsy was performed to fragment uroliths. Basket retrieval and voiding urohydropropulsion were used to remove fragments. Postprocedural contrast cystography was performed to assess efficacy and safety. In 40 dogs, midstream urine samples were collected just prior to laser lithotripsy (day 0) and on days 1, 3, and 11 after laser lithotripsy to assess inflammation. Results—Urolith removal was complete in 82% of dogs (52/66 with only urocystoliths, 17/17 with only urethroliths, and 13/17 with urocystoliths and urethroliths). Urolith removal was incomplete in 18 dogs; of these dogs, 9, 6, and 3 had urolith fragments ≥ 3 mm, 1 to &lt; 3 mm, and &lt; 1 mm in diameter, respectively. Sex (female) was the...

Objective—To compare efficacy, required resources, and perioperative complications between laser lithotripsy and cystotomy for urolith (ie, urocystoliths and urethroliths) removal in dogs. Design—Retrospective case-control study. Animals—66 dogs with urolithiasis treated by laser lithotripsy (case dogs) and 66 dogs with urolithiasis treated by cystotomy (control dogs). Procedures—Medical records were reviewed. Complete urolith removal rate, resources (ie, duration of hospitalization, procedure time, anesthesia time, procedure cost, and anesthesia cost), and complications (ie, hypotension, hypothermia, incomplete urolith removal, and requirement of an ancillary procedure) were compared between cystotomy group dogs and lithotripsy group dogs. Results—Duration of hospitalization was significantly shorter for lithotripsy group dogs, compared with cystotomy group dogs. Procedure time was significantly shorter for cystotomy group dogs, compared with lithotripsy group dogs. Cost of anesthe...

Objective—To determine frequency of and interval until recurrence after initial ammonium urate, calcium oxalate, and struvite uroliths in cats and whether breed, age, or sex was associated with increased risk for urolith recurrence. Design—Case-control study. Animals—4,435 cats with recurrent uroliths. Procedures—To identify recurrence of uroliths in cats for which uroliths were submitted for analysis at the Minnesota Urolith Center in 1998, the facility&#39;s database was searched for urolith resubmissions from the same cats between 1998 and 2003. Risk factors and differences in mean interval until recurrence were assessed. Results—Of 221 cats with ammonium urate uroliths in 1998, 29 (13.1%) had a first and 9 (4.1%) had a second recurrence. Mean interval until recurrence was 22 and 43 months for the first and second recurrence, respectively. Of 2,393 cats with calcium oxalate uroliths in 1998, 169 (7.1%) had a first, 15 (0.6%) had a second, and 2 (0.1%) had a third recurrence. Mean...

Few studies show that &quot;emergency extracorporeal shockwave lithotripsy (eESWL)&quot; reduces the incidence of ureteroscopy in patients with ureteric calculi. We assess success of eESWL and look to study and identify factors which predict successful outcome. We retrospectively studied patients presenting with their first episode of ureteric colic undergoing eESWL (within 72 h of presentation) over a 5-year period. Patient&#39;s age, gender, stone size and location, time between presentation and ESWL, number of shock waves and ESWL sessions, and Hounsfield units (HU) were recorded. 97 patients (mean age 40 years; 76 males, 21 females) were included. 71 patients were stone free after eESWL (73.2 %) (group 1) and 26 patients failed treatment and proceeded to ureteroscopy (group 2). The two groups were well matched for age and gender. Mean stone size in group 1 and 2 was 6.4 mm and 7.7 mm, respectively, (p = 0.00141). Stone location was 34, 21, and 16 in upper, middle and lower urete...

The treatment of urolithiasis has changed dramatically over the past several decades. Novel technologies have led to new management protocols. Percutaneous chemolysis as a primary or adjuvant treatment for urinary tract stones has widely been neglected. We present our own experience with it and discuss it in the light of an extensive literature review. From a MEDLINE search on percutaneous chemolysis we evaluated the most important studies, a total of 58 articles, 43 case series and 15 review articles. In our unit between 2001 and 2011, 29 patients (mean age 62 years) with infectious staghorn calculi were treated with adjuvant percutaneous chemolysis post-percutaneous nephrolithotripsy. There were 17 women, with 10 complete and 14 partial staghorn stones (mean size 32 mm). Patients were generally deemed at high risk to undergo another procedure in the future. Suby G solution was used following an established protocol. Sixteen patients (55.1 %) were stone free after chemolysis, eight stones showed partial dissolution, half of them with so-called ''insignificant'' residual fragments \4 mm. Patients with residual stones underwent SWL. Mean follow-up was 5.25 years (1-11). One stone-free patient (6 %) and three of eight patients (37.5 %) with residual fragments post local chemolysis, developed new stones during follow-up. The often neglected percutaneous chemolysis represents a significant and effective.

frequencies of hyperoxaluria (25 and 11 %) and phosphaturia (40 and 27 %).There were no differences in age at first stone, incidence of stone recurrence or positive family history (20 and 25 %). The findings demonstrate multiple risk factors for stones in this subgroup. In comparison, the 30 hyperuricosuric men with the highest filtration had a higher incidence of hyperoxaluria (58 %) but fewer (7 %) had a positive family history. Creatinine clearance was raised in 73 %. an excessive protein intake might be a major correctable factor underlying these abnormalities.

frequencies of hyperoxaluria (25 and 11 %) and phosphaturia (40 and 27 %).There were no differences in age at first stone, incidence of stone recurrence or positive family history (20 and 25 %). The findings demonstrate multiple risk factors for stones in this subgroup. In comparison, the 30 hyperuricosuric men with the highest filtration had a higher incidence of hyperoxaluria (58 %) but fewer (7 %) had a positive family history. Creatinine clearance was raised in 73 %. an excessive protein intake might be a major correctable factor underlying these abnormalities.

Nephrolithiasis is a multifactorial disease and it has relation with genetic disorders and environmental factors. Stones are most common in adults and are associated with several metabolic disorders. Calcium oxalate is the most common type of stone. The objective of this study is to evaluate chemical analysis of calculi in our region. Methods: We made a retrospective study on 1,342 patients with evidence of recent formation of renal stones. Laboratory investigation included chemical analysis when the stones were available. Results: 1,342 patients with nephrolithiasis were consulted, among whom only 109 (8.1%) were submitted to chemical analysis of stones. Mean age of those patients were 38.9+13.4 years, and 55 (50.5%) were male. Familial history occurred in 65% of the cases. Calcium oxalate stones were found in 87% of the cases. Hypercalciuria and hyperuricosuria were the most associated metabolic disturb in patients with calcium oxalate and uric acid in the stones (60%). Conclusions: Chemical analysis has demonstrated that calcium oxalate is the most common component found in our region, according to the literature.

ESWL uygulanan üreter üst bölüm taşlı hastalarda işlem sonrasında farklı miktarlarda sıvı alınmasının taştan arınma oranlarına etkisi olup olmadığını araştırmak. Gereç Yöntem: Üroloji polikliniğine radyoopak üreter üst bölüm taşı nedeni ile başvuran ve ESWL planlanan hastalar çalışmaya alındı. Hastaların taş boyutu, ESWL şok sayısı, enerji miktarı, hastaların kiloları ve boyları kaydedildi. İşlem sonrasında hastalar 3 gruba ayrıldı. 1. Gruba günlük 1500 cc, 2. Gruba günlük 3000 cc su ve 3. Gruba günlük 4500 cc su almaları telkin edildi. Hastalar işlemden ortalama 11,8(3-52) gün sonra kontrol edildi. Kontrol DÜSG ile yapıldı. Hastaların taşsız olup olmadıkları kayıt altına alındı. İstatistik değerlendirmesi SPSS 16.0 (Chicago, Illinois, USA) ile yapıldı.

All stones share similar presenting symptoms, and urine supersaturation with respect to the mineral phase of the stone is essential for stone formation. However, recent studies using papillary biopsies of stone formers have provided a view of the histology of renal crystal deposition which suggests that the early sequence of events leading to stone formation differs greatly, depending on the type of stone and on the urine chemistry leading to supersaturation. Three general pathways for kidney stone formation are seen: (1) stones fixed to the surface of a renal papilla at sites of interstitial apatite plaque (termed Randall's plaque), as seen in idiopathic calcium oxalate stone formers; (2) stones attached to plugs protruding from the openings of ducts of Bellini, as seen in hyperoxaluria and distal tubular acidosis; and (3) stones forming in free solution in the renal collection system, as in cystinuria. The presence of hydroxyapatite crystals in either the interstitial or tubule compartment (and sometimes both) of the renal medulla in stone formers is the rule and has implications for the initial steps of stone formation and the potential for renal injury.

Micro-computed tomographic imaging (micro-CT) provides unprecedented information on stone structure and mineral composition. High-resolution micro-CT even allows visualization of the lumens of tubule and/or vessels within Randall's plaque, on stones or in papillary biopsies, thus giving a non-destructive way to study these sites of stone adhesion. This paper also shows an example of a stone growing on a different anchoring mechanism: a mineral plug within the lumen of a Bellini duct (BD plug). Micro-CT shows striking structural differences between stones that have grown on Randall's plaque and those that have grown on BD plugs. Thus, Randall's plaque can be distinguished by micro-CT, and this non-destructive method shows great promise in helping to elucidate the different mechanisms by which small stones are retained in the kidney during the development of nephrolithiasis.

Background: The problem of human kidney stones is currently a common disease. This is due to several variables, including nutrition, genetic factors, and geographic region. Kidney stones can be eliminated in several ways, including laser fragmentation, a safe and minimally harmful method because it does not require surgical intervention.
Objectives: This study compares hard stones and dusting modes of the Holmium: Yttrium-aluminum-garnet (Ho:YAG) laser used for fragmented kidney stones.
Methods: The Ho:YAG laser with a maximum power of 30 W, pulse duration 600 μs, wavelengths 2100 nm, the maximum energy level 5 J with maximum frequency level of 30 Hz, used for lithotripsy in Al-Sadr Medical City in Najaf City, Iraq, at different laser parameters energy pulse and pulse rate of 0.8 J/8 Hz and 1 J/10 Hz, respectively, for 17 samples of kidney stones. The laser is passed by the optical fiber through a thin tube (catheter) that is inserted into the ureter through the urethra to reach the stone.
Results: The calcium oxalate stones are ablated more than uric acid stones at different pulse rates. In addition, the samples that fragmented by Ho:YAG laser with hard stones mode with the energy of 0.8 J and pulse rate of 8 Hz have the highest ablation rates than dusting mode, and the dusting mode with energy 0.8 J and pulse rate 8 Hz have the highest ablation rates than dusting mode with energy 1 J and pulse rate 10 Hz for calcium oxalate stones.
Conclusion: Laser lithotripsy may be a more effective treatment option for calcium oxalate stones than uric acid stones.

Cystinuria is an inherited disorder affecting luminal transport of cystine and dibasic amino acids. Because of the poor solubility of cystine in urine, stone formation in the kidney occurs frequently. Cystinuria is associated with mutations in the SLC3A1 and SLC7A9 genes. Despite the population-specific distribution of mutations in the SLC7A9 genes, there are few genetic data reported for cystinuric patients from the Middle East. Exon 4 of the SLC7A9 gene was sequenced in 21 patients with cystinuria, using the polymerase chain reaction and sequencing methods. A new variation in exon 4 of the SLC7A9 gene was identified, which was insertion of 1 adenine nucleotide between 2 cytosine nucleotides in position c.213-214insA. It seems to be important since it causes frame shift and it may be an important cause to make disease.

frequencies of hyperoxaluria (25 and 11 %) and phosphaturia (40 and 27 %).There were no differences in age at first stone, incidence of stone recurrence or positive family history (20 and 25 %). The findings demonstrate multiple risk factors for stones in this subgroup. In comparison, the 30 hyperuricosuric men with the highest filtration had a higher incidence of hyperoxaluria (58 %) but fewer (7 %) had a positive family history. Creatinine clearance was raised in 73 %. an excessive protein intake might be a major correctable factor underlying these abnormalities.

frequencies of hyperoxaluria (25 and 11 %) and phosphaturia (40 and 27 %).There were no differences in age at first stone, incidence of stone recurrence or positive family history (20 and 25 %). The findings demonstrate multiple risk factors for stones in this subgroup. In comparison, the 30 hyperuricosuric men with the highest filtration had a higher incidence of hyperoxaluria (58 %) but fewer (7 %) had a positive family history. Creatinine clearance was raised in 73 %. an excessive protein intake might be a major correctable factor underlying these abnormalities.

Phyllanthus niruri (Pn) is a plant that has been shown to interfere in the growth and aggregation of calcium oxalate (CaOx) crystals. In the present study we evaluated the eVect of Pn on the preformed calculus induced by introduction of a CaOx seed into the bladder of male Wistar rats. Pn treatment (5 mg/ rat/day) was initiated immediately or 30 days after CaOx seeding and thus in the presence of a preformed calculus. Animals were sacriWced 50 or 70 days after surgery. The resulting calculi were weighed and analyzed by X-ray diVraction, stereomicroscopy and scanning electronic microscopy. Precocious Pn treatment reduced the number (75%, P < 0.05) and the weight (65%, P < 0.05) of calculi that frequently exhibited a matrix-like material on its surface, compared to the untreated CaOx group. In contrast, Pn treatment in the presence of a preformed calculus did not prevent further calculus growth; rather, it caused an impressive modiWcation in its appearance and texture. Calculi from Pn-treated animals had a smoother, homogeneous surface compared to the spicule shape of calculi found in the untreated CaOx group. XRD analysis revealed the precipitation of struvite crystals over the CaOx seed and Pn did not change the crystalline composition of the calculi. This suggests that Pn interfered with the arrangement of the precipitating crystals, probably by modifying the crystal-crystal and/or crystal-matrix interactions. Results suggest that Pn may have a therapeutic potential, since it was able to modify the shape and texture of calculi to a smoother and probably more fragile form, which could contribute to elimination and/or dissolution of calculi.

Objective: To compare the efficacy of Silodosin and Tamsulosin as a medical expulsive therapy given for the conservative management of distal ureteric calculus in terms of Stone Clearance Rate. Patient and Methods: A Prospective Observational Analytical Study was conducted on 120 cases between 18 years and 75 years with Unilateral distal ureteral single calculus (Distal to Iliac vessel crossing) and size less than or equal to 1 cm. The cases of this study were divided into two groups: Group A receiving Silodosin 8 mg tablet once daily and Group B receiving Tamsulosin 0.4mg capsule once daily. Results: There was a significantly higher stone clearance rate of 81.67% in Group A vs 63.33% in Group B. Group A also showed a significant advantage for stone expulsion time. Conclusions: Our data showed that silodosin is more effective than tamsulosin in the management of lower ureteric calculus for stone clearance rates and stone expulsion times.

What's known on the subject? and What does the study add? Current knowledge on the subject of "medical stone management" is available in fractionated form. This study is a comprehensive and critical review of the literature and provides up-to-date information on the subject in concise and precise manner. The study highlights the role of medical therapy in various aspects of stone management, i.e. clearance of existing calculi by medical dissolution and facilitating expulsion, and prevention of recurrence. Urolithiasis is a common problem with a high recurrence rate. Medical therapy directed to relieve agonizing pain, expulsion of stone, dissolution of uric acid and cystine stone and prevention of recurrence. NSAIDs are superior to opioids for renoureteral colic because their use doesn't induce vomiting and there is lesser requirement of rescue analgesia. In randomized trials, anticholinergics were not found to be beneficial. Alpha blockers, particularly tamsulosin, reduce pain and facilitate expulsion of stone and fragments of stone following extracorporeal shock wave lithotripsy (SWL) and ureterorenoscopic lithotripsy. Potassium citrate helps in chemodissolution of uric acid and cystine stones and is useful in prevention of stone recurrence in general and in those who have undergone SWL or percutaneious nephrolithotomy. Other measures for prevention of stone recurrence include fluid and dietary therapy, counteracting underlying metabolic abnormalities using suitable medications, phytotheurapeutic agents and probiotics. Once the role of nanobacteria is established in genesis of urinary stones, anti-nanobacteria therapy holds the promise of opening new horizons for prevention of urinary stones.

Objective: To assess the prediction of stone clearance and complications of percutaneous nephrolithotomy (PCNL) using the 'STONE' nephrolithometry score, assessing stone size, tract length (skin-to-stone distance), degree of obstruction, number of calyces involved and stone essence (density). Patients and methods: This was a prospective study of patients undergoing singletract PCNL while prone, conducted at a university hospital. All patients had noncontrast-enhanced computed tomography within 3 weeks of the procedure. Only patients with a unilateral procedure and radio-opaque stones were included. The five variables of the STONE nephrolithometry score were calculated before the procedure. The stone-free rates were assessed with a plain abdominal film at 4 weeks and complications were graded using the modified Clavien system. Results: In all, 107 patients were included in the final analysis. Overall, 80% of patients were rendered stone-free. Among the individual variables, a larger stone (P = 0.002) and the involvement of multiple calyces (P = 0.04) were associated with residual stones, while tract length (skin-to-stone distance), stone density and presence of hydronephrosis were not. Patients who were rendered stone-free had a statistically significant lower overall STONE score than those with residual stones, at 7.24 vs. 8.14 (P = 0.02). The score also correlated with operative duration, which was significantly

Background: Renal stones, commonly known as kidney stones, are a significant urological condition caused by the crystallization of dietary minerals in the kidneys. Their composition varies and can include calcium oxalate, calcium phosphate, uric acid, cystine, and other minerals. Fourier transform infrared (FTIR) spectroscopy, a semi-quantitative and automated method, is an advanced technique for determining stone composition, aiding in personalized treatment and prevention of recurrence.
Objectives:
The study aims to:
• Analyze the mineral composition of renal stones using FTIR spectroscopy.
• Classify the mineral components of renal stones.
• Study the trends and morphological characteristics of stones.
Methods: This cross-sectional study analyzed 3,789 renal stones received from August 2019 to May 2024. The stones were prepared and analyzed using the Agilent Cary 630 FTIR Analyzer. Data on mineral composition and morphology were collected and processed to identify various mineral trends and stone compositions.
Results: Demographics: 76.3% of stones were from male patients, with the highest incidence in the 31–40 age-group.
Composition: 93.5% of stones were of mixed composition, with calcium oxalate monohydrate being the most prevalent (38.3%).
Rare compositions: Stones with rare compositions, such as xanthine and 2, 8-dihydroxyadenine, were identified, providing insight into specific metabolic disorders.
Conclusion: Fourier transform infrared spectroscopy provides reliable results for stone composition, enabling effective and individualized treatment plans. The predominance of mixed stones underscores the need for multifactorial treatment approaches addressing dietary, metabolic, and infectious factors. Further research, particularly using advanced techniques like genetic testing, may enhance understanding of stone formation.
Keywords: Calcium oxalate, Fourier transform infrared spectroscopy, Nephrolithiasis, Renal stones, Stone composition, Urinary tract stones.

The incidence of urolithiasis increased dramatically during the last decades in adults as well as in children. Today, when a urinary stone is suspected, the imaging modality used most frequently is non-contrast enhanced computed tomography (NCCT). Due to the high sensitivity and specifity, NCCT is regarded as the gold standard. Its major drawback is the high dose of radiation administered with this examination. This is of special concern in children. Children with urinary stones are at high risk for multiple recurrences during their life. NCCT increases the risk for abdominal and pelvic cancer in children significantly. With respect to therapeutic success, however, conventional imaging modalities like ultrasound are not inferior and are without any harm. Therefore, ultrasound is recommended as the primary imaging technique in children by several guidelines. Nevertheless, as could be shown by Tasian et al., ultrasound was the first imaging study in only 24% of children with urolithiasis. NCCT was the modality used most frequently (63%) in the USA between 2003 and 2011. There was a wide regional variation within the USA with highest CT use in the Northwestern and Southern and lowest in the New England states. It is hypothesized that engrained practice patterns and specific local medical resources as well as a lower confidence in ultrasound with its operator dependence are potential reasons. Regarding the fact that ultrasonography is highly reliable in the diagnosis of urolithiasis and is without any harm, it is essential to make all efforts to increase the adherence to the guidelines.

Introduction. Several studies showed an association of overweight and obesity with calcium oxalate stone disease (CaOx). However, there are no sufficient data on the influence of body weight on the course of the disease and the recurrence rate.Patients and Methods.N=100consecutive stone formers with pure CaOx were studied. Different parameters were investigated. According to the BMI, patients were divided into three groups: (1)BMI≤25; (2) BMI 25.1–30; (3)BMI&gt;30.Results.N=32patients showed aBMI≤25,n=42patients showed a BMI of 25.1–30 andn=26patients showed aBMI≥30. The groups differed significantly concerning BMI (by definition), urine pH, and urine citrate. The recurrence rate was not significantly different.Discussion. Our study demonstrated that body weight negatively influences single risk factors in CaOx, but obesity is not a predictor for the risk of recurrence in CaOx.