INTRODUCTION AND OBJECTIVE

The endoscopic management of staghorn calculi is very challenging owing to its complex anatomical configuration. The authors analyzed the clinical efficacy and safety of a single upper pole access PCNL (SUPA-PCNL) for Guy Stone Score (GSS) 3-4 staghorn calculi.

Prospective data collection was done on 56 consecutive patients who with GSS 3-4 staghorn calculi. All cases were treated with a standardized technique of a single upper pole access PCNL in the prone position. The patient demographics, stone characteristics, perioperative and postoperative outcomes were analyzed.

The cohort exhibited diversity in age (51.7+12), gender (male to female ratio of 5.5:4.5) comorbidities, and stone burden (4.82+1.96 cm). SUPA-PCNL demonstrated a high median stonefree rate (99.5%, IQR 90-100) with minimal complications, low blood loss with a of 200cc (IQR 100-300), and median hospital stay of 3.5 days (IQR 3-5). Stone characteristics did not significantly influence outcomes. A subset required secondary treatments (12%, n=7), but overall morbidity was low (16%, n=9): (7% n=4) of which required blood transfusion, and (9% n=5) due to sepsis. The following factors were associated with increased odds of perioperative morbidity: preoperative creatinine >3 mg/dl (OR 4.19 95% Cl 0.59 – 29.71 p=0.152) and a history of endoscopic surgery (OR 7.33 95% Cl 1.20-44.96 p=0.031).

SUPA-PCNL is effective and safe for the treatment of staghorn calculi. In select patients, this approach obviates the need for a multi-tract access or an endoscopically-combined intrarenal surgery (ECIRS).

OBJECTIVE: The aim of this study is to investigate the independent risk factors of benign prostatic hyperplasia (BPH) complicated with bladder stones, and construct a nomogram prediction model for clinical progression of bladder stones in patients with BPH. METHODS: The clinical data of 368 BPH patients who underwent transurethral resection of the prostate in the Second Affiliated Hospital of Zhengzhou University from January 2018 to January 2021 were retrospectively analyzed. Patients with BPH were divided into group 1 (with bladder stones, n=94) and group 2 (without bladder stones, n=274). Univariate and multivariate logistic regression analyses were performed to determine the independent risk factors of bladder stones in patients with BPH. A nomogram model was developed, and the areas under the ROC curve and calibration curve were calculated to assess the accuracy of clinical application. RESULTS: Logistic analysis showed that age (HR:1.075,95%CI:1.032 to 1.120), hypertension (HR:2.801,95%CI:1.520 to 5.161), blood uric acid (HR:1.006,95%CI:1.002 to 1.010), intravesical prostatic protrusion (HR:1.189,95%CI1.119 to 1.264）, prostatic urethral angel（HR:1.127,95%CI:1.078to 1.178）were independent risk factors for bladder stones in patients with BPH. The discrimination of the nomogram model based on independent risk factors to predict the occurrence of bladder stones in patients with BPH was 0.874. CONCLUSION The nomogram model can predict the risk of bladder stones in BPH patients with good differentiation and calibration, which is a good guide for clinical work on BPH patients with high risk of bladder stones.
Humans ; Male ; Prostatic Hyperplasia/complications* ; Nomograms ; Urinary Bladder Calculi/etiology* ; Retrospective Studies ; Risk Factors ; Aged ; Logistic Models ; Middle Aged ; ROC Curve ; Transurethral Resection of Prostate

Objective： To analyze the symptoms, diagnosis and treatment of upper urinary tract calculi patients combined with mild and moderate benign prostatic hyperplasia (BPH) after ureteral stent implantation. Methods： One hundred and six BPH patients who were hospitalized for upper urinary tract calculi and had ureteral stents retained from January 2019 to December 2022 were selected and divided into 2 weeks group and 4 weeks group according to the time of removal of ureteral stents after surgery. Their general clinical data were analyzed and compared. International Prostatic Symptom Scale (IPSS), postoperative ureteral Stent Symptom Questionnaire (USSQ), and incidence of adverse events after ureteral stent removal were recorded before and after removal. Results： The scores of IPSS were significantly increased in all patients, and symptoms in urinary tract had improved significantly after discharge (P<0.05). Compared with the 2 weeks group, the USSQ score of the 4 weeks group was significantly increased (P<0.05). And no significant adverse event was observed in the 2 weeks group after the removal of ureteral sten. Conclusion： IPSS score and USSQ score increased significantly during stent implantation in BPH patients with lithiasis. And complications increased significantly over time. Following thorough clinical assessment, early ureteral stent removal demonstrates both safety and efficacy, representing an optimal therapeutic approach in selected cases.
Humans ; Male ; Prostatic Hyperplasia/surgery* ; Stents ; Ureter/surgery* ; Aged ; Middle Aged ; Urinary Calculi/surgery* ; Ureteral Calculi/surgery*

OBJECTIVES: Urinary calculi are characterized by a high recurrence rate, and patients' adherence to self-management after discharge directly affects health outcomes. Traditional offline follow-up models often face problems such as poor compliance and uneven allocation of medical resources, making it difficult to meet individualized health management needs. Remote follow-up provides a novel solution to optimize long-term management, improve health literacy, and enhance clinical outcomes. This study aims to evaluate the effect of remote follow-up under an intelligent medical collaborative model on quality of life and health-promoting lifestyle in patients with urinary calculi, and to assess its short-term impact on clinical outcomes. METHODS: A total of 118 patients with urinary calculi admitted to a tertiary hospital in Hunan Province between August and November 2024 were recruited and randomly assigned to a control group (n=59) or an intervention group (n=59). The control group received routine departmental follow-up, while the intervention group underwent remote follow-up based on an intelligent medical collaborative model for one month. Assessments were conducted before discharge (T0), 15 days after discharge (T1), and one month after discharge (T2), using the Wisconsin Stone Quality of Life Questionnaire and the Health-Promoting Lifestyle Profile. At T2, the incidence of forgotten ureteral stents (FUS), ureteral stent-related complications, unplanned readmissions, and patient satisfaction were evaluated. RESULTS: No significant differences were observed between groups at T0 in baseline characteristics or outcome measures (all P>0.05). At T1 and T2, the intervention group had significantly higher health-related quality of life scores than the control group (P<0.05). Generalized estimating equation (GEE) analysis showed significant between-group effects (Wald's χ²=22.961, P<0.001), time effects (Wald's χ²=23.065, P<0.001), and interaction effects (Wald's χ²=6.930, P<0.05). Similarly, at T1 and T2, the intervention group scored significantly higher on health-promoting lifestyle than the control group (P<0.05), with significant between-group effects (Wald's χ²=22.936, P<0.001), time effects (Wald's χ²=10.694, P<0.001), and interaction effects (Wald's χ²=18.921, P<0.05). No significant differences were found between groups in the incidence of FUS, ureteral stent-related complications, or unplanned readmissions (all P>0.05). Patient satisfaction was significantly higher in the intervention group (t=4.089, P<0.001). CONCLUSIONS Remote follow-up under an intelligent medical collaborative model helps improve quality of life, promote health-oriented lifestyles, and enhance patient satisfaction among individuals with urinary calculi.
Humans ; Quality of Life ; Male ; Female ; Urinary Calculi/therapy* ; Health Promotion/methods* ; Middle Aged ; Adult ; Follow-Up Studies ; Treatment Outcome

OBJECTIVES: To investigate the incidence of ipsilateral upper urinary tract stones after partial nephrectomy and its risk factors. METHODS: We retrospectively analyzed baseline patient characteristics (age, gender, and body mass index), smoking, alcohol consumption, comorbidities (hypertension, diabetes, hypertriglyceridemia, hyperuricemia, and cardiovascular diseases), preoperative tumor conditions (tumor diameter, multiple foci, location, hemorrhage, necrosis, cystic changes, and endophytic growth), preoperative glomerular filtration rate and intraoperative factors (renal collecting system damage, ischemia time, operation time, surgical approach, and estimated intraoperative blood loss) to identify the risk factors for ipsilateral upper urinary tract stones following partial nephrectomy in our center. RESULTS: The overall incidence of upper urinary tract stones following partial nephrectomy was 7.80% (112/1435). The incidence of ipsilateral upper urinary tract stones was significantly higher than those of contralateral stones (4.95% vs 1.46%, P<0.001) and bilateral stones (4.95% vs 1.39%, P<0.001). Intraoperative damage to the renal collecting system was identified as a significant risk factor for ipsilateral upper urinary tract stones (OR=4.550, 95% CI: 2.237-9.252, P<0.001). Diabetes was a probable risk factor for secondary ipsilateral upper urinary tract stones after partial nephrectomy (OR=2.419, 95% CI: 0.973-6.012, P=0.057). CONCLUSIONS The incidence of ipsilateral upper urinary tract stones after partial nephrectomy is higher than that of contralateral and bilateral stones. Intraoperative renal collecting system damage is a risk factor for secondary ipsilateral upper urinary tract stones after partial nephrectomy.
Humans ; Nephrectomy/methods* ; Retrospective Studies ; Risk Factors ; Male ; Female ; Case-Control Studies ; Middle Aged ; Aged ; Kidney Neoplasms/surgery* ; Adult ; Intraoperative Complications ; Kidney Tubules, Collecting/injuries* ; Propensity Score ; Incidence ; Kidney Calculi/etiology* ; Urinary Calculi/epidemiology*

OBJECTIVES: To investigate the causal relationship between gut microbiota and kidney stones. METHODS: Mendelian randomization analysis was conducted based on data from the MiBioGen consortium gut microbiota GWAS (exposure factors) and the IEU Open GWAS kidney stone dataset ukb-b-8297 (outcome variables) using the inverse variance weighted, MR-Egger regression, weighted median, weighted mode, and simple mode methods. Heterogeneity, pleiotropy, and leave-one-out sensitivity analyses were also performed. In the animal experiment, 12 male SD rats were randomized into control group with saline treatment and kidney stone model group treated with 1% ethylene glycol and 2% ammonium chloride for 28 consecutive days. Urine, blood, and intestinal samples of the rats were collected for testing the changes in renal function and intestinal barrier-related indicators, and kidney and colon pathologies were examined with histological staining and immunohistochemistry. The changes in diversity and abundance of gut microbiota were analyzed using 16S rRNA gene sequencing. RESULTS: Mendelian randomization analysis showed that decreased abundances of Lachnospiraceae NK4A136 group (OR=0.9974, 95% CI: 0.9948-0.9999, P=0.0393) and Gordonibacter (OR=0.9987, 95% CI: 0.9974-0.9999, P=0.0403) were associated with an increased risk of kidney stones without significant heterogeneity or horizontal pleiotropy, and sensitivity analyses suggested robustness of the results. The rat models of kidney stones exhibited significant renal function impairment and calcium oxalate crystal deposition, accompanied by decreased expressions of intestinal barrier-related proteins with lowered intestinal α- and β-diversity indices. Intestinal Gordonibacter abundance was significantly reduced in the rat models while the Lachnospiraceae NK4A136 group did not differ significantly between the control and model groups. CONCLUSIONS Decreased Gordonibacter abundance in gut microbiota is associated with an increased risk of kidney stones. The protective role of the Lachnospiraceae NK4A136 group against kidney stones as suggested by Mendelian randomization analysis fails to be supported by the experimental evidence and awaits further investigation.
Animals ; Kidney Calculi/microbiology* ; Gastrointestinal Microbiome ; Mendelian Randomization Analysis ; Rats, Sprague-Dawley ; Rats ; Male ; Disease Models, Animal ; Intestines/microbiology* ; RNA, Ribosomal, 16S/genetics*

Kidney stones are a urinary system disease with a high incidence,among which calcium oxalate stones are the most common.Metabolic disorders such as hypertension,diabetes,obesity,hyperlipidemia,and hyperuricemia can cause changes in oxalate,uric acid,and pH and calcium ion concentrations in the urine through multiple pathways including inducing oxidative stress and inflammatory responses by generating reactive oxygen species,ultimately affecting the formation of calcium oxalate stones.This article reviews the possible pathways and mechanisms by which metabolic diseases influence the formation of calcium oxalate stones,providing new ideas for the clinical prevention and treatment of calcium oxalate stones.
Humans ; Calcium Oxalate/metabolism* ; Kidney Calculi/etiology* ; Metabolic Diseases/complications*

OBJECTIVES

To describe the demographics of patients undergoing supine PCNL (s-PCNL) and prone PCNL (p-PCNL) at Veterans Memorial Medical Center (VMMC) and to compare different data collected between the two approaches.

Retrospective data collection was done through chart review of patients who underwent supine and prone PCNL at VMMC from 2018 to 2022. Information collected includes patient demographics, clinical profile, stone burden and laterality, surgical technique, hospital days, complications and management.

A total of 176 cases, 132 s-PCNL and 44 p-PCNL, were included. Demographic data show no statistical difference as to age and sex. There is no statistical difference in the stone burden, stone density, and Guy’s stone scores between the two groups. There was no statistical difference in the mean operative time and stone free rates between the two groups. Mean hospital stay was 6.11 days for s-PCNL and 6.76 for p-PCNL, with significant statistical difference in favor of s-PCNL. Complication rates were 15.2% for supine PCNL and 13.6% for prone PCNL. There was no statistical significant difference in Clavien-Dindo complications between the two groups. There was no mortality reported for both groups.

There is an observed increasing trend in the number of supine PCNL versus prone PCNL from 2018 to 2022. Supine PCNL is as effective and safe as prone PCNL. Supine PCNL appears to be more beneficial in terms of hospital stay in days. However, one limitation of the study its being retrospective and collated data which is the cause of the discrepancy in sample population size between the two groups.

Squamous cell carcinoma (SCC) of the kidney is a rare malignancy and has a poor prognosis because it is usually detected and presents at an advanced stage of the disease. Due to lack of studies regarding its clinical course and its radiologic features, it is usually not detected and presents as an incidental finding in histopathologic results. This type of malignancy more often is related to Renal stones secondary to chronic infection, inflammation, and irritation. A 52-year-old Filipino woman was referred to this institution due to flank pain and constant weight loss. The authors administered antibiotics then performed simple nephrectomy on her. A pathologic examination revealed Squamous Cell Carcinoma with Sarcomatoid differentiation. Four months after the operation, patient was readmitted due to lowback pain and generalized weakness which led to a suspicion of a possibility of Bone Metastasis. Patient was offered further workups such as whole abdominal CT scan with contrast and other palliative treatments however she refused and opted to be discharged despite medical advice. Patient then died 2 weeks after being home against medical advice.
Carcinoma, Squamous Cell ; Staghorn Calculi

Currently, the types of kidney stones before surgery are mainly identified by human beings, which directly leads to the problems of low classification accuracy and inconsistent diagnostic results due to the reliance on human knowledge. To address this issue, this paper proposes a framework for identifying types of kidney stones based on the combination of radiomics and deep learning, aiming to achieve automated preoperative classification of kidney stones with high accuracy. Firstly, radiomics methods are employed to extract radiomics features released from the shallow layers of a three-dimensional (3D) convolutional neural network, which are then fused with the deep features of the convolutional neural network. Subsequently, the fused features are subjected to regularization, least absolute shrinkage and selection operator (LASSO) processing. Finally, a light gradient boosting machine (LightGBM) is utilized for the identification of infectious and non-infectious kidney stones. The experimental results indicate that the proposed framework achieves an accuracy rate of 84.5% for preoperative identification of kidney stone types. This framework can effectively distinguish between infectious and non-infectious kidney stones, providing valuable assistance in the formulation of preoperative treatment plans and the rehabilitation of patients after surgery.
Humans ; Kidney Calculi/classification* ; Deep Learning ; Neural Networks, Computer ; Tomography, X-Ray Computed ; Imaging, Three-Dimensional ; Radiomics