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Kidney stones are a common urological disease with an increasing incidence worldwide. Traditional diagnostic methods for kidney stones are relatively complex and time-consuming, thus necessitating the development of a quicker and simpler diagnostic approach. This study investigates the clinical screening of kidney stones using Surface-Enhanced Raman Scattering (SERS) technology combined with multivariate statistical algorithms, comparing the classification performance of three algorithms (PCA-LDA, PCA-LR, PCA-SVM). Urine samples from 32 kidney stone patients, 30 patients with other urinary stones, and 36 healthy individuals were analyzed. SERS spectra data were collected in the range of 450-1800 cm-1 and analyzed. The results showed that the PCA-SVM algorithm had the highest classification accuracy, with 92.9 % for distinguishing kidney stone patients from healthy individuals and 92 % for distinguishing kidney stone patients from those with other urinary stones. In comparison, the classification accuracy of PCA-LR and PCA-LDA was slightly lower. The findings indicate that SERS combined with PCA-SVM demonstrates excellent performance in the clinical screening of kidney stones and has potential for practical clinical application. Future research can further optimize SERS technology and algorithms to enhance their stability and accuracy, and expand the sample size to verify their applicability across different populations. Overall, this study provides a new method for the rapid diagnosis of kidney stones, which is expected to play an important role in clinical diagnostics.

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ETHNOPHARMACOLOGICAL RELEVANCE: The leaves of Quercus dentata Thunb. (QD), a member of the Fagaceae family and genus Quercus, with distributions in China, Japan, Korea, and other regions. As recorded in the Ben Cao Gang Mu (Compendium of Materia Medica) and other classical Chinese medical texts, QD has been traditionally employed in Traditional Chinese Medicine (TCM) for their hemostatic and diuretic effects and has been used to treat urinary stones (Lin Zheng). It is also the main ingredient of the Mishitong capsule (MST), a Chinese patent drug, used for kidney stones and ureteral stones. Nonetheless, the specific active ingredients and the mechanisms of QD in treating kidney stones remain to be elucidated, which is crucial for advancing the scientific understanding and clinical application of this traditional medicine. AIM OF STUDY: This study aimed to identify the active constituents of QD water extract (QDWE), explore its inhibitory effects on kidney stones through in vitro and in vivo studies, and elucidate the underlying mechanisms of the OPN/CD44 axis and the NLRP3 signaling pathway to provide a full understanding of its potential as a novel treatment approach against kidney stones. MATERIALS AND METHODS: The micromolecular components in the supernatant of QDWE (QDS) were analyzed by UPLC-Q-Exactive-Orbitrap-MS and the monosaccharide composition of the macromolecular polysaccharide components in the crude polysaccharide (QDP) was determined by pre-column derivatization in HPLC. The effects of QDWE, QDS and QDP on the shape, size, and structure of calcium oxalate (CaOx) crystals in vitro were explored by XRD, FTIR and SEM. The effects of QDWE, QDS and QDP on CaOx kidney stones in SD rats induced by ethylene glycol and VD3 were compared in vivo. Furthermore, the underlying mechanisms of OPN/CD44 and NLRP3 pathways were investigated by Western blot analysis. RESULTS: There were 32 compounds identified in QDS. The monosaccharide composition ratio of QDP was Man: L-Rha: D-GlcA: D-GalA: D-Glc: D-Gal: L-Ara = 1.01: 22.52: 8.27: 38.61: 3.43: 17.80: 6.38, indicating a mixture of pectin-type acidic heteropolysaccharides. QDP had a more significant inhibitory effect on CaOx crystals in vitro than QDWE, which can inhibit the formation of CaOx monohydrate crystals (COM) and convert them into thermodynamically unstable CaOx dihydrate (COD) crystals. The high dose of QDWE exhibited significant in vivo efficacy (P<0.05), including anti-calculus, diuretic effects, and kidney protection, marked by decreased calcification and stone formation, alongside improved kidney vitality. Furthermore, the protective effects of QDWE were demonstrated to be associated with the OPN/CD44 and NLRP3 pathways. CONCLUSION: The studies identified and analyzed the active constituents of QDWE. Among these, QDP significantly inhibited CaOx crystal generation in vitro and could be a potential component for the treatment of urinary stones in QDWE. Moreover, the results indicated that QDWE had a remarkable therapeutic effect on CaOx stones by modulating the OPN/CD44 axis to affect stone formation and the NLRP3 signaling pathway to mediate inflammation, providing an experimental basis for the mechanism of anti-urinary stone and deep development of QD.

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Gallstone ileus is a rare but potentially serious complication of gallstone disease, which presents as a mechanical intestinal obstruction due to impaction and fistulization of a gallstone, most commonly in the small intestine. Since it usually occurs in elderly patients, the symptoms can be very diverse and with a late presentation. We present the case of a 90-year-old patient with intestinal obstruction and acute abdominal pain who experienced gallstone ileus and underwent surgery, and a few days after being discharged returned with a recurrence of the symptoms, was re-operated, and a second stone was found.

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Introduction Currently, there are no agreed-upon investigations and follow-up guidelines for the conservative management of ureteric stones. This study used common themes identified in previous works to investigate whether there is a consensus amongst urology consultants in the United Kingdom. Methods This was a questionnaire-based survey study. An online questionnaire was disseminated nationally to urological consultants practicing in the United Kingdom to explore a range of common factors. The initial sample size was 81 UK-based urological consultants with an interest in endourology and stone surgery. Of the initial 81, 20 participants did not complete the survey and therefore the final sample size was 61. Descriptive analysis was used to analyze the data. Results Our survey found that the main factors influencing the follow-up of conservatively managed ureteric stones were stone size 98% (60), stone location 92% (56), and the degree of altered renal function 79% (48). Regardless of stone size, most participants chose to follow up at 2-4 weeks with asymptomatic patients requiring imaging with discrepancies about the modality. Regarding biochemical markers, most participants only repeated renal function tests if this was deranged on presentation. Calcium and uric acid levels were checked regularly. Diclofenac was the analgesia of choice 93% (55). Regarding the availability of acute ESWL services, over half (59%) were able to offer acute ESWL within the week. The majority offer services at least three or more lists per week. Conclusion Our results demonstrate that there is still no overarching consensus in the follow-up of conservatively managed ureteric stones. Several factors backed by high-level evidence are already consistent across the population of urology consultants and considered "best practice." However, before any all-encompassing national guidelines are formalized, further studies in the form of randomized control trials will be needed to yield high-level evidence.

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Background: At present, few articles on percutaneous nephrolithotomy (PCNL) for renal calculi and renal pelvic tumors detected by intraoperative biopsy exist, which has provided limited guidance for clinical practice. In this article, we aimed to further study the relationship between renal calculi and renal pelvic tumors. Methods: We retrospectively analyzed the medical records of patients with abnormal mucosal biopsy results who underwent PCNL for kidney stones in the Urology Department of Peking University People's Hospital from January 2011 to November 2021. Results: In total, 2,801 patients underwent PCNL for kidney stones, of whom 69 underwent intraoperative mucosal biopsy. Biopsy results indicated that 8 cases were malignant (11.60%), and 61 cases were benign (88.40%). All malignant cases were renal pelvic carcinoma. Seven were urothelial carcinoma, and one of these was urothelial carcinoma with squamous differentiation. Only one was squamous cell carcinoma. The preoperative information of patients with a malignant mucosa biopsy was analyzed. To provide clinical guidance, an early warning biopsy system was established based on the abnormal mucosa found during the operation. We found that PCNL should be considered if the following risk factors are associated with stones: advanced age, long history of kidney stones, severe hydronephrosis, urinary tract infection, multiple or staghorn stones. Conclusions: Early warning information should be established for patients with kidney stones based on preoperative clinical characteristics and intraoperative mucous membrane observations. An early warning biopsy should be performed for patients with possible tumors to detect tumors in a timely manner and provide early treatment to improve patient prognosis.

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Background: At present, some common bile duct stones (CBDSs) cannot be removed by conventional endoscopic treatment. Percutaneous transhepatic papillary ballooning and extraction (PTPBE) is a promising treatment for CBDSs. This study aimed to evaluate the feasibility and efficacy of PTPBE for removing CBDSs. Methods: From April 2013 to April 2021, 29 patients with CBDSs underwent PTPBE at The First Affiliated Hospital of Zhengzhou University; their clinical data were retrospectively analyzed. The technical success, clinical success, procedure time, radiation dose, 1-year CBDSs recurrence rate, and incidence of early/late complications were recorded, and white blood cell (WBC) counts and alanine aminotransferase (ALT), C-reactive protein (CRP), total bilirubin (TBIL), and carbohydrate antigen-199 (CA-199) levels were compared before the interventional procedure and 1 month later. Results: The CBDSs were successfully removed in 29 patients (the CBDSs in 20 patients were resolved once, and in 9 patients, they were resolved twice). The mean procedure time and radiation dose were 56.38±13.56 minutes and 732.07±262.23 miligray (mGy), respectively. The technical and clinical success rates were both 100%. The incidence of early complications (including pancreatitis and bile duct bleeding) and late complications (reflux cholangitis) was 10.34% and 3.45%, respectively. The WBC (both P<0.01), ALT (both P<0.01), CRP (both P<0.01), CA-199 (both P<0.01), and TBIL (both P<0.01) significantly decreased before PTPBE and 1 month later. Conclusions: PTPBE is a safe and effective alternative solution for elderly patients who cannot undergo or refuse traditional surgical and endoscopic treatments.

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Urinary stone disease (USD) is a prevalent urological condition, ranking as one of the most common urinary tract disorders globally. Various risk factors influence the formation of kidney stones, and recent research indicates a rising prevalence of urolithiasis worldwide, particularly in developing countries. While the morbidity associated with urinary stones has decreased in recent years, long-term complications such as stone recurrence, kidney failure, and uremia continue to burden patients. Understanding the etiologies of urolithiasis, including the role of bacteria, is crucial as they can contribute to stone recurrence. The incidence of urinary tract infection (UTI) stones can be attributed to specific infectious risk factors, socio-demographic factors, and comorbid metabolic disorders. This review article explores the emerging evidence suggesting the involvement of bacteria in USD. It discusses the potential role of microorganisms in non-infection stones and highlights the association between UTIs and urolithiasis. Furthermore, it surveys the relationship between kidney stones and recurrent UTIs and the formation of bacterial biofilms in UTIs. Considering various risk factors, including biochemical stone analysis and the presence of bacteria, is essential for treating patients with infectious stones optimally. This review aims to provide an updated understanding of the association between bacteria and urinary stones in patients with urolithiasis, shedding light on the pathophysiology of urinary stone formation, urinary stone characteristics, and the urinary microbiome in urinary stones.

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Objective: To develop and validate a method for detecting ureteral stent encrustations in medical CT images based on Mask-RCNN and 3D morphological analysis. Method: All 222 cases of ureteral stent data were obtained from the Fifth Affiliated Hospital of Sun Yat-sen University. Firstly, a neural network was used to detect the region of the ureteral stent, and the results of the coarse detection were completed and connected domain filtered based on the continuity of the ureteral stent in 3D space to obtain a 3D segmentation result. Secondly, the segmentation results were analyzed and detected based on the 3D morphology, and the centerline was obtained through thinning the 3D image, fitting and deriving the ureteral stent, and obtaining radial sections. Finally, the abnormal areas of the radial section were detected through polar coordinate transformation to detect the encrustation area of the ureteral stent. Results: For the detection of ureteral stent encrustations in the ureter, the algorithm's confusion matrix achieved an accuracy of 79.6% in the validation of residual stones/ureteral stent encrustations at 186 locations. Ultimately, the algorithm was validated in 222 cases, achieving a ureteral stent segmentation accuracy of 94.4% and a positive and negative judgment accuracy of 87.3%. The average detection time per case was 12 s. Conclusion: The proposed medical CT image ureteral stent wall stone detection method based on Mask-RCNN and 3D morphological analysis can effectively assist clinical doctors in diagnosing ureteral stent encrustations.

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Background and objective: Recently, the new pulsed thulium:yttrium aluminum garnet (p-Tm:YAG) laser technology has been introduced in endourology for lithotripsy. The aim of this study was to assess and validate the clinical laser performance and safety profile of p-Tm:YAG laser in a series of patients with renal and ureteral stones who underwent flexible ureteroscopy (fURS). Methods: Prospective data were collected for patients who underwent fURS with the p-Tm:YAG laser Thulio (Dornier MedTech Systems GmbH, Wessling, Germany) at our institution by using two different laser fiber core diameters (270 and 200 µm). The primary endpoint of the study was stone-free rate (SFR), and the secondary endpoints were Clavien-Dindo complications grade ≥1 and the comparison between laser fibers of different diameters in all the parameters analyzed. Descriptive statistics relied on medians and interquartile ranges for continuous covariates, and on frequencies and percentages for categorical covariates. After stratification according to fiber types, differences between groups were tested with Wilcoxon and chi-square tests as appropriate. All the analyses and graphics were performed using R software (version 4.2.2). Key findings and limitations: The SFR was 82% at 1-mo follow-up. In six out of 50 procedures (12%), Clavien-Dindo grade I-II complications were recorded. There were no differences regarding all the laser parameters considered between patients who were treated with 270 or 200 µm laser fibers (p > 0.05). Limitations of the study include small sample size in a single center and the lack of comparative groups. Conclusions and clinical implications: In this prospective study of 50 patients who underwent fURS for ureteral and renal stones, the p-Tm:YAG laser Thulio was both effective and safe in a short-term follow-up. More prospective randomized studies in larger populations using different laser sources are required to confirm the clinical laser performance and safety of p-Tm:YAG laser for urinary stones treatment. Patient summary: In this report, we looked at the outcomes for the pulsed thulium:yttrium aluminum garnet laser Dornier Thulio in patients who underwent flexible ureteroscopy for ureteral and renal stones. We found that this new laser technology is effective and safe, representing a good alternative to the other laser machines available for stone lithotripsy. We need more studies with larger populations to establish the superiority of this laser technology over the others.

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Background/aim: Early detection and prognosis of sepsis in critically ill children is crucial. The aim of this research was to investigate the prognostic ability of pancreatic stone protein (PSP) in validating sepsis and predicting mortality in a prospective observational study. Materials and methods: In a single-center study, pediatric intensive care unit patients were divided into cohorts of confirmed and suspected sepsis, as well as survivors and nonsurvivors. Patients with positive blood culture growth were considered to have confirmed sepsis, while their negative counterparts were considered to have suspected sepsis. Comparisons were made between complete blood counts, laboratory parameters, mortality indices, and C-reactive protein (CRP), procalcitonin (PCT), and PSP levels. The correlations between PSP and alternative inflammatory markers and mortality indices were then analyzed. The diagnostic and prognostic applicability of PSP for sepsis confirmation and mortality prediction was assessed using receiver operating characteristic curve analysis. Results: PSP levels were significantly elevated in patients with confirmed sepsis and within the nonsurvivor segment. In confirming sepsis and predicting mortality, PSP outperformed CRP and PCT in terms of sensitivity. It had sensitivity of 95% in diagnosing sepsis at a cut-off level of 50 ng/L, with an area under the curve (AUC) of 0.67 (95% CI: 0.52-0.81), and sensitivity of 92% in predicting mortality, with an AUC of 0.71 (95% CI: 0.56-0.83). In addition, PSP showed significant correlations with CRP, PCT, and mortality scores. Conclusion: PSP is emerging as a highly sensitive marker for confirming sepsis and predicting mortality in critically ill pediatric patients. Incorporating the PSP biomarker into routine clinical practice could potentially improve the management of pediatric sepsis.

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Intrauterine contraceptive device (IUCD) is commonly used to prevent unwanted pregnancy. Migration of IUCD into the bladder is a rare complication. We present a case of a 38-year-old woman with a history of IUCD insertion 05 years ago, immediately following her last delivery. She had a history of unplanned pregnancy 05 months following the IUCD insertion. She also complained of lower urinary tract storage symptoms. Clinical examination revealed suprapubic tenderness. Non-contrast abdomino-pelvic CT scan and cystoscopy confirmed the presence of an IUCD in the bladder with an attached stone. Open Cystotomy was performed, successfully removing the bladder stone with the intravesical IUCD. The patient was discharged without complications and reported symptom resolution during follow-up. IUCD migration into the bladder is a rare but clinically significant complication. There should be a high index of suspicion of migration in a patient with unexpected pregnancy associated with urinary complaint following IUCD insertion.

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We have recently reported a set of urinary proteins that inhibited calcium oxalate (CaOx) stone development. However, physicochemical properties that determine their inhibitory activities remained unknown. Herein, human urinary proteins were chromatographically fractionated into 15 fractions and subjected to various CaOx crystal assays and identification by nanoLC-ESI-Qq-TOF MS/MS. Their physicochemical properties and crystal inhibitory activities were subjected to Pearson correlation analysis. The data showed that almost all urinary protein fractions had crystal inhibitory activities. Up to 128 proteins were identified from each fraction. Crystallization inhibitory activity correlated with percentages of Ca2+-binding proteins, stable proteins, polar amino acids, alpha helix, beta turn, and random coil, but inversely correlated with number of Ox2--binding motifs/protein and percentage of unstable proteins. Crystal aggregation inhibitory activity correlated with percentage of stable proteins but inversely correlated with percentage of unstable proteins. Crystal adhesion inhibitory activity correlated with percentage of stable proteins and GRAVY, but inversely correlated with pI, instability index and percentages of unstable proteins and positively charged amino acids. However, there was no correlation between crystal growth inhibitory activity and any physicochemical properties. In summary, some physicochemical properties of urinary proteins can determine and may be able to predict their CaOx stone inhibitory activities.

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INTRODUCTION AND IMPORTANCE: Fournier's gangrene (FG) is a rare necrotizing fasciitis, and it's a urological emergency. Another disease that can cause FG is urethral stones. This case report is prepared to discuss the management of neglected urethral stones and Fournier's Gangrene, as well as its complications. CASE PRESENTATION: A 49-year-old male presented to the emergency room (ER) referred from the public health centre with a swollen and infected scrotum 2 weeks ago. It was worsened 1 day before hospital admission, accompanied by the discharge of pus from the scrotum. The patient also complained presence of intermittent fever, nausea, and vomiting. There was a history of straining when urinating. Physical examination showed a lump at the penis and crepitation at the scrotum. Radiological examination of the kidney ureter and bladder (KUB) x-ray and urethrography showed the presence of gangrenous gas at the scrotum. In this case, we perform open cystostomy, debridement necrotomy, and removal of urethral stone. CLINICAL DISCUSSION: Management of neglected urethral stones and Fournier's Gangrene cases needs to be done immediately to prevent poor outcomes. Necrotomy debridement management is performed immediately as a source of infection. Open cystostomy as a urinary diversion is performed so that urine does not pass through the urethra and the healing process of the urethra can be maximized. CONCLUSION: Controlling the source of infection and urinary diversion is important in cases where neglected urethral stones and Fournier's gangrene are found.

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PURPOSE: To investigate the performance of dynamic 3D diuretic renal scintigraphy using a hybrid whole body CZT SPECT/CT for the evaluation of acute ureteric obstruction in patients with urinary stone disease. METHODS: 20 patients who presented to the Emergency Department with acute renal colic due to urinary stone disease confirmed by means of CT were prospectively included. Three observers evaluated and graded hydronephrosis, hydroureter, perirenal stranding, and thickening of the renal fascia from the CT as well as the renal scintigraphy curves from the dynamic SPECT study. The normalized residual activity from dynamic SPECT was analysed at 16 min in all patients and at 20 min in suspected obstruction. RESULTS: Renal scintigraphy curves showed a sensitivity of 100%, specificity of 93%, PPV 83% and a NPV 100% for obstruction, while normalized residual activity showed a sensitivity of 100%, specificity of 73%, PPV 56% and a NPV 100%. All patients presented at least 2 secondary signs of obstruction on the CT, showing a PPV of only 25% for obstruction. CONCLUSION: Dynamic 3D diuretic renal scintigraphy CZT SPECT/CT provides valuable functional and anatomical information from one single examination. The combination of pathological renogram curves and high normalized residual activity values provide the most valuable imaging information to determine the presence of acute ureteric obstruction. The secondary signs of obstruction observed on CT are not specific and should not be used to confirm or discard obstruction in patients with urinary stone disease. TRIAL REGISTRATION: ISRCTN15338358. Registration date 03/01/2024. Retrospectively registered. https://www.isrctn.com/ISRCTN15338358?q=miguel%20ochoa%20figueroa&filters=&sort=&offset=1&totalResults=2&page=1&pageSize=10.

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INTRODUCTION: This article attempts to provide a comprehensive review of the learning objectives and importance of the supine percutaneous nephrolithotomy (PCNL) technique. MATERIAL METHOD: We retrospectively reviewed the cases of Supine PCNL between January 2018 and January 2024. We divided the groups into 3: residents between 2 and 3 years (Group 1), residents between 4 and 5 years (Group 2), and endourologist (Group 3). The 2-3-year resident started to perform PCNL for the first time, while the 4-5-year resident started to perform Supine PCNL for the first time while previously performing prone PCNL. RESULTS: Access, fluoroscopy, and operation time were higher in Group 1, shorter in Group 2, and shortest in Group 3 (p < 0.001). Postoperative length of stay and the need for additional treatment were found to be shorter (p < 0.001), and the stone-free rate (SFR) increased (p < 0.001) from Group 1 to Group 3. The highest complication rates were observed in Group 1 (p = 0.002). SFR rate increased as the number of cases increased in Group 1 patients. Success was stable after 46-60 cases in terms of SFR. In Group 2, the SFR rate was stable after 31-45. CASES: The most complications were observed in Group 1 and the least in Group 3. CONCLUSION: In 2-3-year residents, access time and fluoroscopy time decrease with experience. In 4-5-year residents, due to their expertise in prone PCNL, the operation time and fluoroscopy time decrease with the number of cases performed. SFR is higher after 46-60 cases for 2-3-year residents and 31-45 cases for 4-5-year residents.

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PURPOSE: To evaluate the therapeutic efficacy and safety of electroacupuncture (EA) combined with extracorporeal shock wave lithotripsy (ESWL) in treating ureteral calculi. METHODS: This prospective randomized controlled trial included 207 patients with ureteral calculi who were randomly allocated to an experimental group that underwent EA plus ESWL (n = 95) and a control group that underwent only ESWL (n = 112). Imaging examinations were performed at 1, 2, and 4 weeks after the operation, followed by comparing the stone-clearance rate, time to first stone expulsion, and incidence of major complications between the two groups. RESULTS: The stone-clearance rates at 1 (59.1 vs. 37%, P = 0.002), 2 (86.4 vs. 59.3%, P = 0.000), and 4 (90.9 vs. 77.8%, P = 0.013) weeks after the operation in the experimental group were significantly higher than those in the control group. The time to first stone expulsion in the experimental group was significantly lower than that in the control group (1.29 ± 1.55 vs. 2.45 ± 3.11 days, respectively; P = 0.001). However, we found no difference in the incidence of major complications between the two groups (15.9 vs. 17.6%, P = 0.754). CONCLUSION: EA-assisted ESWL significantly improved stone clearance and shortened the time to stone expulsion without elevating the complication risk. However, a large-scale multicenter, prospective study is required to corroborate our conclusions.

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OBJECTIVE: To investigate the association between atherogenic index of plasma (AIP) and kidney stones (KS) occurrence and recurrence. METHODS: Data were obtained from the National Health and Nutrition Examination Survey (NHANES) 2007-2014. Non-pregnant adults who provided complete information on AIP and KS were included in the analyses. AIP was calculated as log (triglyceride/high-density lipoprotein cholesterol). KS was ascertained with questionnaires. Weighted multivariable logistic regression model and restricted cubic spline (RCS) were applied to examine the associations between AIP and KS occurrence and recurrence. RESULTS: A total of 6488 subjects (weighted mean age 43.19 years and 49.26% male) with a weighted mean AIP of 0.66 were included in this study. The multivariable-adjusted OR for nephrolithiasis occurrence across consecutive tertiles was 1.00 (reference), 1.21 (95% CI: 0.90-1.62), and 1.85 (95% CI: 1.39-2.48), respectively. Moreover, each SD increment of AIP was associated with a 50% (OR:1.50, 95% CI: 1.25-1.81) higher risk of nephrolithiasis recurrence. RCSs showed significant and linear dose-response relationships between AIP and nephrolithiasis occurrence (p-overall = 0.006, p-nonlinear = 0.689) and recurrence (p-overall = 0.001, p-nonlinear = 0.848). The positive associations between AIP and nephrolithiasis occurrence and recurrence persisted in sensitivity analyses, suggesting the robustness of the results. CONCLUSION: In the current US nationally representative cross-sectional study, AIP was positively associated with KS occurrence and recurrence.

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BACKGROUND: To compare the operative effect and clinical efficacy of the Moses laser mode and the Raykeen holmium laser energy platform powder mode under flexible ureteroscopic lithotripsy in patients with impacted upper ureteral stones. METHODS: From March 2022 to September 2022, 72 patients were divided into a Moses laser group and a Raykeen laser group according to surgical method, with 36 patients in each group. CT and ureteroscopy confirmed that all patients had isolated impacted upper ureteral stones. The stone volume (mm3), stone density (Hu) and severity of hydronephrosis were measured by CT. Postoperative complications were evaluated using the Clavien-Dindo score. RESULTS: There were no complications of ureteral stenosis related to the laser treatment. The operative time and lithotripsy time were lower in the Moses laser group than in the Raykeen laser group (P < 0.05). The stone-free survival rate did not differ significantly between the two groups (P = 0.722). Stone volume was found to be positively correlated with laser energy and lithotripsy time in both groups (P < 0.01). There was no significant correlation between laser energy and lithotripsy time or ureteral stone density (Hu) in the Moses laser group (P > 0.05) or the Raykeen laser group (P > 0.05). CONCLUSIONS: The contact mode of Moses technology and the powder mode of Raykeen laser lithotripsy can be used for the ablation of a single impacted upper ureteral stone. The ablation speed was related to the stone volume and the severity of polyp hyperplasia, not the stone density. We recommend the use of the powdered mode as a therapeutic measure for the treatment of impacted upper ureteral stones in flexible ureteroscopic lithotripsy.

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INTRODUCTION: Patient-centered communication after surgery can enhance patient satisfaction and reduce unplanned clinical contact. However, patients information needs following kidney stone surgery are not well-understood, limiting quality improvement efforts. We aimed to characterize patient-reported needs in and preferences for postoperative communication following kidney stone surgery. METHODS: Patients undergoing common stone procedures were surveyed about the content, volume, and satisfaction with the communication they received after surgery. Patients indicated which information resources they consulted and found most helpful to address their postoperative care questions. RESULTS: Among 52 patients, the majority (75%) identified varying degrees of deficiencies in the communication they received after surgery. Regarding content, respondents were most interested in understanding how their surgery went (90%), the plan for follow-up care (85%), and the specific location of their stone (85%). Regarding volume, respondents consistently indicated interest in intra-operative findings (stone appearance and location) and postoperative care (stent symptoms and location) but the majority did not recall receiving enough information. To address their questions after surgery, respondents most commonly consulted their urologist (71%), discharge paperwork (42%), electronic health record (27%), and the person with whom their urologist spoke after surgery (25%); among these, the majority (54%) reported that their urologist was the single most helpful source of information. CONCLUSIONS: Following kidney stone surgery, patients report unmet communication needs related to specific intraoperative findings and follow-up care. Patients indicate high levels of satisfaction with urologist-provided resources. These exploratory findings support quality improvement efforts to optimize delivery of effective, patient-centered communication after surgery.

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Dietary factors may be implicated in the formation of kidney stones and should be closely monitored. To achieve this aim, patients are routinely assessed by means of generic dietary recall, a tool widely used by authors in a range of extensive patient populations to record food intake; the findings obtained, however, may be skewed due to dietary variations and underestimation of the effect of food additives. Fifty Frequent Kidney Stone Formers (FKSFs, mean age: 54.3 ± 13.9 years) with normal kidney function, absence of comorbidities, and reliable compliance were selected from a total of 68 patients' resident in Sardinia, an Italian island where genetic admixtures have been relatively rare for generations. The study, conducted from 1 January 2020 to 31 December 2023, was aimed at assessing nutritional values based on the meticulous recording of food quantities, quality, and potential modifications related to food preparation. Patients were selected during an initial clinical check-up and all efforts made to ensure they were capable of reliably recording all food and drinks consumed. A seven-day food diary was provided in which food and drink intake and their impact on 24 h urine output was recorded. The following parameters were measured in both foods and urine output: citrates, oxalates, calcium, phosphorous, uric acid, proteins and nitrogen compounds, magnesium, sulfates, potassium, carbohydrates, free fatty acids. Study outcomes established the presence of hypocitraturia, hyperoxaluria, hypercalciuria, and moderately high levels of nitrogen compounds. Univariate analysis followed by multivariate analysis for further confirmation were performed and the following observations made. Citrate intake correlated with citraturia but did not promote oxaluria; calcium intake promoted onset of sulfaturia, azoturia, and ammoniuria, whilst magnesium correlated with magnesiuria but not with oxaluria, calciuria, phosphaturia, and azoturia; sulfate intake elicited onset of azoturia but not kaliuresis; potassium intake promoted oxaluria and protein intake resulted in onset of ammoniuria and azoturia. (A) The chemical composition of urine based on dietary intake is hard to predict without taking into account the presence of dietary and urinary interferents; (B) the geographic isolation of patients studied underlines the importance of epigenetics in maintaining a traditional dietary heritage. (C) Moreover, the widespread use of food additives should consistently be taken into account to ensure a correct diagnosis of FKSF and set up a valid treatment plan.

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