INTRODUCTION

Urinary stone disease remains a significant global and national health concern. This underscores the need for measures to improve disease outcomes. The development and implementation of clinical practice guidelines for urolithiasis was deemed essential due to variations in practice, the evolving urologic field with its emerging interventions, which may have significant cost implications.

The CPG was developed following the GRADE Adolopment method, the CORE GRADE Approach and the GRADE Evidence to Decision framework, and utilized the Technical Manual for Clinical Practice Guideline Development of the Department of Health (2nd edition). The guideline development group was organized after review and management of the members' conflict of interest declarations. Clinical questions were prioritized and a systematic search and synthesis of the relevant literature to answer the questions was done. Considering the balance of benefits and harms, certainty of the evidence, cost and cost effectiveness, accessibility, acceptability and feasibility of the interventions, the guideline panel developed recommendations by consensus.

The CPG addresses eleven priority clinical questions involving diagnosis and treatment of acute flank pain due to suspected urolithiasis among adults, minimally invasive treatment of nephrolithiasis measuring 1-2 cm and the use of alpha blockers after ESWL through twelve recommendations and one good practice statement.

The Philippine CPG on the management of urolithiasis in adults provides actionable recommendations to address important clinical questions on the diagnosis and management of urinary stone disease. The full text of the clinical practice guideline may be viewed and downloaded from https://doh.gov.ph/dpcb/doh-approved-cpg/

BACKGROUND

Staghorn calculi are complicated renal stones that are frequently linked to hydronephrosis, a parameter that can have a major impact on the results of surgery. Percutaneous nephrolithotomy (PCNL) is widely recognized as the gold standard for treating large kidney stones and staghorn calculi. Data on the effect of preoperative hydronephrosis on PCNL perioperative outcomes is still limited.

This study aimed to investigate the association between preoperative hydronephrosis and perioperative outcomes among patients undergoing PCNL in a tertiary government hospital in Manila.

A single-center prospective cohort study was conducted, involving 90 patients diagnosed with staghorn calculi and scheduled for elective PCNL. Patients were categorized into two groups based on the presence or absence of moderate-to-severe hydronephrosis as determined by preoperative imaging. Perioperative outcomes, including total operative time, access time, lithotripsy time, and perioperative complications such as bleeding and sepsis, were evaluated. Data were analyzed using linear and logistic regression models to assess associations between hydronephrosis and perioperative outcomes.

The presence of hydronephrosis was associated with a statistically significant reduction in access time (p = 0.036), likely due to the dilation of renal structures facilitating easier entry. However, hydronephrosis was linked to a borderline significant reduction in lithotripsy rate (p = 0.051), indicating potential challenges in stone fragmentation. No significant association was found between hydronephrosis and total operative time or perioperative complications, such as bleeding and sepsis.

While hydronephrosis may make kidney access and other technical aspects of PCNL easier, it may also make stone fragmentation more difficult. Larger stone size and stone location were significant predictors of longer operative times and slower lithotripsy rates, underscoring their critical role in surgical outcomes.

BACKGROUND: Urolithiasis is a widespread disease with a high prevalence worldwide. This study aims to evaluate the disease burden of urolithiasis and its trends from 1990 to 2021 globally, based on the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021 database. METHODS: The numbers and age-standardized rates (ASRs) of incidence, disability-adjusted life years (DALYs), and mortality of urolithiasis were extracted from GBD 2021 to represent the disease burden. Joinpoint regression analyses were conducted to assess the temporal trends in the burden of urolithiasis. The male-to-female ASR ratio indices were used to evaluate sex disparities. Additionally, we explored the relationship between the ASR ratio and the sociodemographic index (SDI). RESULTS: The total numbers of incidence, DALY, and mortality of urolithiasis were 105,983,780 cases (95% uncertainty interval [UI] = 88,349,356-128,645,155 cases), 693,444 cases (95% UI = 567,765-850,490 cases), and 17,672 cases (95% UI = 13,932-21,241 cases), respectively, in 2021. There is an increasing trend in the number of these measures globally, whereas the ASRs have decreased over the past 30 years. The age-standardized incidence rate (ASIR) and age-standardized mortality rate (ASMR) were significantly higher in males than in females in 2021. The sex disparities in the age-standardized DALY rate (ASDR) and ASMR of urolithiasis were negatively correlated with the SDI. In 2021, the ASIR of urolithiasis was 964.70 (95% UI = 801.26-1175.09) per 100,000 people in China, which is much lower than the global average (1242.84 [95% UI = 1034.94-1506.99] per 100,000 people). Compared with the global average, a more pronounced decline in ASIR was observed in China from 1793.16 (1446.0-2235.14) in 1990 to 964.70 (801.26-1175.09) per 100,000 people in 2021. CONCLUSIONS Urolithiasis poses a significant healthcare burden worldwide. More robust global and national strategies are warranted to address the prevention and treatment, especially in low SDI countries and regions.
Humans ; Urolithiasis/mortality* ; Male ; Female ; Incidence ; Global Burden of Disease ; Disability-Adjusted Life Years ; Adult ; Middle Aged ; Risk Factors ; Sex Factors

OBJECTIVES: To explore the association between Chinese visceral adiposity index (CVAI) and the risk of nephrolithiasis. METHODS: This cross-sectional study analyzed data from 78 438 Chinese adults who underwent ultrasound examinations during health screening at the Health Examination Center of Affiliated Hospital of Yangzhou University. Participants were divided into quartiles (Q1-Q4 groups) based on CVAI. Multivariate logistic regression models were utilized to evaluate the association between CVAI and nephrolithiasis risk, followed by subgroup analyses to further explore potential relationships. The performance of CVAI in predicting the risk of nephrolithiasis was evaluated using receiver operating characteristic (ROC) curves. RESULTS: Increased CVAI was significantly associated with a higher risk of nephrolithiasis, with prevalence rising from 3.36% in the Q1 group to 10.67% in the Q4 group (P<0.01). In adjusted models, CVAI was positively correlated with the prevalence rate of nephrolithiasis (OR=1.002, 95%CI: 1.001-1.004, P<0.01). The risks of nephrolithiasis in the Q2, Q3, and Q4 groups were 1.196-fold (95%CI: 1.069-1.338, P<0.01), 1.260-fold (95%CI: 1.109-1.433, P<0.01), and 1.316-fold (95%CI: 1.125-1.539, P<0.01) higher than in the Q1 group, respectively. Subgroup analysis revealed that CVAI was positively associated with the risk of nephrolithiasis in male participants, individuals aged <60 years, the hypertension group, populations with or without diabetes mellitus, and the normal body mass index subgroup. Genders and age had an interaction effect on the correlation between CVAI and the risk of nephrolithiasis development (both P<0.05). The ROC curve analysis demonstrated that CVAI exhibited superior predictive efficacy compared to waist circumference, body mass index, visceral adiposity index, weight-adjusted waist index, cardiometabolic index and body shape index, with an area under the curve of 0.622. CONCLUSIONS In Chinese adults, CVAI is positively associated with the risk of nephrolithiasis development, which may serve as a potential predictive marker for nephrolithiasis.
Humans ; Nephrolithiasis/etiology* ; Male ; Female ; Middle Aged ; Cross-Sectional Studies ; Adult ; Intra-Abdominal Fat ; Risk Factors ; China/epidemiology* ; Adiposity ; Aged ; Logistic Models ; Obesity, Abdominal/epidemiology* ; East Asian People

Human ; Diagnostic Tests, Routine ; Urolithiasis ; Urologists

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*

This paper discusses the diagnostic and therapeutic approach to a patient with concomittant serious clinical conditions such as bilateral nephrolithiasis, and possible dual primary malignancies of the kidney and the urinary bladder.

A 62-year-old male presented with gross hematuria. Radiographic imaging revealed a large urinary bladder mass, bilateral hydronephrosis due to obstructive nephrolithiases, and a left solid renal mass. After appropriate cardiopulmonary optimization, the authors opted to do a preliminary transurethral resection of the bladder tumor. This was followed by staged therapies with right ultrasound-guided PCNL; a left partial nephrectomy with nephrolithotomy, and radical cystectomy with ileal conduit. Unfortunately, the patient did not survive the multiple surgeries and expired. The chronology of the various therapeutic procedures in cases of synchronous serious clinical conditions of the urinary tract such as nephrolithiasis, renal and bladder neoplasms need to be individualized and will dictate the outcome of the entire therapy.