Journal of endourology最新文献

{"title":"Newly Developed Hydronephrosis in Patients Following Ureteroscopy: Who Is at Risk?","authors":"Golena Fernandez Moncaleano, Sabir Meah, Suprita Krishna, Anna Jhonson, Jerison Ross, Elaina Shoemaker, Stephanie Daignault, Richard Sarle, David Wenzler, Brian Seifman, Wilson Sui, Khurshid Ghani, Casey Dauw","doi":"10.1177/08927790251366898","DOIUrl":"10.1177/08927790251366898","url":null,"abstract":"<p><p><b><i>Introduction and Objective:</i></b> Imaging rates are low after ureteroscopy in the United States. Detecting postoperative hydronephrosis is important to minimize patient morbidity, and predicting patients at greatest risk for new postoperative hydronephrosis could inform imaging guidelines. We used data from a clinical registry to understand new-onset postoperative hydronephrosis and associated risk factors after ureteroscopy and stone intervention. <b><i>Methods:</i></b> Using the Michigan Urological Surgery Improvement Collaborative registry, we retrospectively identified all ureteroscopy for urolithiasis between July 2020 and June 2023. We included patients without hydronephrosis on preoperative CT or ultrasound. New postoperative hydronephrosis was defined as hydronephrosis seen between postoperative days 29 and 60 following ureteroscopy. We compared demographic and clinical variables from patients with new postoperative hydronephrosis with patients who did not develop hydronephrosis. Logistic regression was performed to evaluate risk factors for new postoperative hydronephrosis. <b><i>Results:</i></b> Preoperative imaging was available for 4742 patients across 31 urology practices, of which 1066 also had postoperative imaging within 29 to 60 days of surgery. New postoperative hydronephrosis was seen in 87 (8.2%) patients. Among them, 51 patients (58.6%) had transient hydronephrosis, 6 (6.9%) strictures, 5 (5.7%) residual stones, 2 (2.3%) hematomas, and 23 (26.4%) did not have information available. Silent hydronephrosis was present in seven patients (0.66%). Factors associated with new postoperative hydronephrosis included location of the stone (kidney <i>vs</i> ureter), greater stone size, use of ureteral access sheath, ureteral stent placement after surgery, longer stent dwell time, and the presence of residual stones. After adjustment, renal location of the largest stone was found to be an independent predictor of developing postoperative hydronephrosis. <b><i>Conclusions:</i></b> Postoperative hydronephrosis in patients without preoperative hydronephrosis occurs 1 in 13 patients who had both pre and postoperative studies after ureteroscopy. More than half of these cases are transient, and silent postoperative hydronephrosis is rare. These data support a goal-directed approach to imaging rather than routine imaging for all patients.</p>","PeriodicalId":15723,"journal":{"name":"Journal of endourology","volume":" ","pages":"759-765"},"PeriodicalIF":2.8,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144804242","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Mastering HoLEP: Learning Curves and Perioperative Complications in Holmium Laser Enucleation of the Prostate.","authors":"Maximilian Glienke, Arif Özkan, August Sigle, Dominik Stefan Schoeb, Konrad Wilhelm, Martin Schoenthaler, Maximilian Ferry von Bargen, Christian Gratzke, Arkadiusz Miernik","doi":"10.1177/08927790251360022","DOIUrl":"10.1177/08927790251360022","url":null,"abstract":"<p><p><b><i>Introduction:</i></b> Holmium laser enucleation of the prostate (HoLEP) is an established surgical technique for treating benign prostatic enlargement with bladder outlet obstruction. Although HoLEP offers advantages such as reduced hospital stays and lower complication rates compared with traditional transurethral resection of the prostate, it presents a steep learning curve for surgeons. The number of procedures required to achieve proficiency remains debated, with estimates differing widely. This study aims to analyze the HoLEP learning curve beyond 200 cases, evaluating perioperative efficiency and complication rates in high-volume surgeons. <b><i>Materials and Methods:</i></b> A retrospective analysis was conducted on 1724 HoLEP procedures performed between 2015 and 2022 by six surgeons, three of whom had performed over 200 cases each. Key parameters assessed included operative time, enucleation efficiency, energy use, and complication rates. Statistical analyses included univariate and multivariate regression models to identify predictors of postoperative complications and efficiency improvements. <b><i>Results:</i></b> The mean patient age was 70.48 years, with an average prostate volume of 93.43 g. The mean operative time was 80.68 minutes, with significant efficiency improvements correlating with increased surgeon experience (<i>p</i> < 0.001). Complication rates, including bleeding necessitating coagulation (4.7%) and urinary retention (9.3%), decreased significantly beyond 350 cases. Learning curves demonstrated a nonlinear reduction in complications and a continuous increase in surgical efficiency, with operative proficiency plateauing after approximately 350 procedures. <b><i>Conclusion:</i></b> Contrary to previous studies suggesting HoLEP proficiency after 50 to 60 cases, our findings indicate ongoing improvements beyond 200 cases, with stable complication rates achieved after 350 procedures. Structured mentorship programs and simulation-based training could facilitate faster learning and enhance patient outcomes.</p>","PeriodicalId":15723,"journal":{"name":"Journal of endourology","volume":" ","pages":"849-855"},"PeriodicalIF":2.8,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144626473","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Development and Validation of the Diameter and Sinus Score, a Novel Model to Predict Trifecta Failure for Robot-Assisted Partial Nephrectomy: A Multicenter Retrospective Study.","authors":"Yuto Hattori, Kosuke Kobayashi, Hiromichi Nakagawa, Yusuke Hama, Kimihiko Masui, Shigeki Arizono, Noboru Shibasaki, Koji Inoue, Kazuhiro Okumura, Mutsushi Kawakita, Toshinari Yamasaki","doi":"10.1177/08927790251364230","DOIUrl":"https://doi.org/10.1177/08927790251364230","url":null,"abstract":"<p><p><b><i>Objectives:</i></b> To evaluate and restratify each component of the RENAL score and develop a novel model to predict the difficulty of robot-assisted partial nephrectomy. <b><i>Subjects and Methods:</i></b> This retrospective multicenter study included 847 patients with localized renal-cell carcinoma, including 401 in the development cohort and 446 in the validation cohort. Multivariate logistic regression analysis was performed on the subdivided variable of the RENAL score to develop a novel model. The predictive performance of the novel model was evaluated by external validation using the receiver operating characteristic curve and area under the curve (AUC). <b><i>Results:</i></b> The trifecta achievement rates in the development and validation cohorts were 71.8% and 74.9%, respectively. Multivariate analysis of the development cohort revealed that the R and N components of the RENAL score were significantly associated with trifecta failure. The R score was restratified into three categories of diameter score (<30 mm, 0 point, 30-49 mm, 1 point; ≥50 mm, 2 points), and the N score was restratified into four categories of sinus score (not in contact, 0 point; touching the sinus, 1 point; simple protrusion, 2 points; complex protrusion, 3 points). The sum of the diameter and sinus (DS) scores was developed. In the external validation cohort, the AUC of the DS score was 0.73 (95% confidence interval [CI]: 0.68-0.78), higher than that of the RENAL score (0.68, 95% CI: 0.62-0.73, <i>p</i> = 0.048) and SPARE model (0.69, 95% CI: 0.64-0.75, 0.06). The interobserver concordance for the DS score using Cohen's weighted kappa was considered excellent (κ = 0.94 [95% CI: 0.92-0.95]). <b><i>Conclusions:</i></b> We developed a simple and novel model comprising only two components. External validation revealed that its predictive performance was better than that of the RENAL score.</p>","PeriodicalId":15723,"journal":{"name":"Journal of endourology","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144784402","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Factors Influencing Oxalate Synthesis in Healthy Volunteers.","authors":"Sonia Fargue, John Knight, Naim M Maalouf, Robert A Oster, Joseph J Crivelli, Dean G Assimos, Kyle D Wood","doi":"10.1177/08927790251360011","DOIUrl":"10.1177/08927790251360011","url":null,"abstract":"<p><p><b><i>Introduction:</i></b> Urine oxalate excretion influences the risk of calcium oxalate kidney stone formation and has been reported to positively correlate with body mass index (BMI) and body weight. The two major sources of urine oxalate are dietary oxalate absorption and endogenous oxalate synthesis (EOS). In this study, we investigated the association between EOS, as estimated by oxalate content of 24-hour urine collected while consuming an ultra-low oxalate diet, and measures of body size and composition. <b><i>Methods:</i></b> An analysis of prospectively performed studies conducted on adults consuming ultra-low oxalate diets between January 2018 and January 2025 at the University of Alabama at Birmingham was undertaken. All participants (<i>n</i> = 88) were healthy and had no history of kidney stone disease, hypertension, or diabetes. Participants underwent anthropomorphic measurements, and body composition was measured by bioelectrical impedance analysis. Urinary oxalate was measured by ion chromatography coupled to mass spectrometry. <b><i>Results:</i></b> Total urinary oxalate was positively correlated with body weight, BMI, lean body muscle mass, appendicular lean muscle mass, waist-to-hip ratio, and urinary creatinine excretion. There was no significant correlation between urinary oxalate excretion and body fat or age. Urinary oxalate excretion was different in males and females, even after adjusting for measures of lean body composition. <b><i>Discussion:</i></b> This analysis of low oxalate controlled diet studies in healthy participants suggests lean body mass, not body fat, is the major driver of EOS. This study also highlights that oxalate synthesis in lean body compartments is different in males and females.</p>","PeriodicalId":15723,"journal":{"name":"Journal of endourology","volume":" ","pages":"815-821"},"PeriodicalIF":2.8,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12494182/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144642737","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Infection Risk in Patients with Mixed Flora in Urine Cultures Prior to Ureteroscopy.","authors":"Joshua K Kim, Ezra J Margolin, David L Barquin, Rebekah W Moehring, Jodi A Antonelli, Michael E Lipkin, Glenn M Preminger, Charles D Scales, Gary J Faerber, Robert A Medairos","doi":"10.1089/end.2024.0670","DOIUrl":"10.1089/end.2024.0670","url":null,"abstract":"<p><p><b><i>Purpose:</i></b> Urine cultures are routinely used to inform preoperative antibiotic choice and duration prior to endourologic surgery. The presence of mixed flora in preoperative urine cultures holds unclear clinical significance. This study examines infectious outcomes after ureteroscopy in patients with preoperative mixed flora urine cultures. <b><i>Materials and Methods:</i></b> A retrospective cohort study was conducted on adult patients who underwent ureteroscopy with laser lithotripsy between January 2014 and June 2024 who had urine cultures performed within 60 days preoperatively. Patients were categorized into cohorts based on their preoperative urine culture: mixed flora, negative, or positive. Postoperative urinary tract infection rates within 30 days were compared between cohorts, and logistic regression was performed adjusting for demographic and clinical variables. <b><i>Results:</i></b> We identified 5166 patients who underwent ureteroscopy with laser lithotripsy (2139 mixed flora, 1525 negative, 1502 positive). Preoperative antibiotics were used more often in the mixed flora cohort (29%) than in the negative cohort (24%, <i>p</i> = 0.007) but less frequently than in the positive cohort (57%, <i>p</i> < 0.001). Postoperative infections were visualized in 165 patients (8%) in the mixed flora cohort, compared with 88 (6%) in the negative cohort (<i>p</i> = 0.067) and 237 (16%) in the positive cohort (<i>p</i> < 0.001). Multivariable logistic regression demonstrated that positive cultures were associated with an increased risk of infection (odds ratio [OR] = 1.95, 95% confidence interval [CI] = 1.49-2.55, <i>p</i> < 0.001), but negative cultures had a similar risk of infection compared with mixed flora (OR = 0.79, 95% CI = 0.56-1.11, <i>p</i> = 0.177). Within the mixed flora cohort, preoperative antibiotic treatment was not associated with decreased postoperative infection (OR = 0.99, 95% CI = 0.66-1.47, <i>p</i> = 0.964). <b><i>Conclusions:</i></b> While patients with preoperative mixed flora urine cultures received preoperative antibiotics more often than patients with negative urine cultures, they were not at higher risk for postoperative infection. Routine preoperative antibiotic use in patients with mixed flora cultures may not be effective in reducing infectious complications after ureteroscopy.</p>","PeriodicalId":15723,"journal":{"name":"Journal of endourology","volume":" ","pages":"808-814"},"PeriodicalIF":2.8,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143382621","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Multicenter Review of Obstetric Management and Complications of Ureteroscopy During Pregnancy.","authors":"Perry J Xu, Nick Dean, Kyle Tsai, Justin Lee, Ezra Margolin, Michael Schulster, Vishnu Ganesan, Jodi Antonelli, Deepak Agarwal, Mark Assmus, Matthew Lee, Robert Medairos, Ojas Shah, Amy Krambeck","doi":"10.1177/08927790251364880","DOIUrl":"https://doi.org/10.1177/08927790251364880","url":null,"abstract":"<p><p><b><i>Introduction and Objectives:</i></b> Managing nephrolithiasis during pregnancy requires collaboration between obstetricians and urologists. When surgical intervention is needed, ureteroscopy (URS) is a safe and effective; however, limited data exist on obstetric (OB) management and complications of URS during pregnancy. This multicenter study aimed to clarify OB practice patterns and complications of URS in pregnant patients. <b><i>Methods:</i></b> A multicenter retrospective review of pregnant patients who underwent URS with fellowship-trained endourologists at seven institutions from 2015 to 2024 was performed. We recorded patient demographics, indications for URS, preoperative workup, intraoperative details, perioperative OB involvement, fetal monitoring (FM) practices, and postoperative OB complications within 30 days. <b><i>Results:</i></b> We identified 72 cases of URS during pregnancy. Mean maternal age was 30 years, and mean gestational age was 23.5 weeks. Preoperative imaging was performed in all cases, with ultrasound used in 70/72 (97%). No intraoperative complications were noted. OB involvement and FM varied among institutions-one site required perioperative OB presence with FM, five sites performed FM case-by-case, and one site required pre- and postoperative nonstress tests (NST). FM was done in 11/72 cases, while intraoperative FM was performed in 16/72 cases. OB was present in 13/72 cases. OB complications occurred in eight cases. There were no cases of preterm labor in the immediate perioperative; however, three cases had postoperative admissions with spontaneously resolving contractions and abnormal NST. The two cases of preterm labor requiring C-section at 27 weeks were linked to OB comorbidities. <b><i>Conclusions:</i></b> URS is safe in pregnancy in the care of urologists who are experienced in stone disease. OB management and FM during URS are heterogeneous across institutions. In this multicenter series, there were no cases of preterm labor. Cases of early contractions and abnormal NST resolved spontaneously. Standardization of OB practice patterns during URS could be beneficial and incorporated in further guideline development.</p>","PeriodicalId":15723,"journal":{"name":"Journal of endourology","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144784403","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Challenges and Wonders of the Festschrift.","authors":"Jaime Landman, Chandru Sundaram","doi":"10.1177/08927790251364721","DOIUrl":"https://doi.org/10.1177/08927790251364721","url":null,"abstract":"","PeriodicalId":15723,"journal":{"name":"Journal of endourology","volume":"39 8","pages":"757-758"},"PeriodicalIF":2.8,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144956548","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"No Injury Observed in Kidneys Treated with Burst Wave Lithotripsy in Therapeutically Anticoagulated Pigs.","authors":"Thomas M Shelton, Bret A Connors, Marcelino E Rivera, James E Lingeman, Michael R Bailey, James C Williams","doi":"10.1089/end.2024.0466","DOIUrl":"10.1089/end.2024.0466","url":null,"abstract":"<p><p><b><i>Introduction:</i></b> Current American Urological Association guidelines recommend that patients with acute obstructive kidney stone requiring continuous anticoagulation/antiplatelet therapy should not be treated by shockwave lithotripsy or percutaneous nephrolithotomy because of the risk of catastrophic renal hemorrhage possible with those techniques. Currently, ureteroscopy is the only recommended surgical treatment. We evaluated if burst wave lithotripsy (BWL) could be used in these cases by treating pigs with BWL while undergoing anticoagulation therapy. <b><i>Materials and Methods:</i></b> Six pigs (31-37 kg) were given 200 units/kg porcine heparin, and then the right kidney of each animal was treated with a dose of BWL (18,000 ultrasound pulses at 10 Hz, 20 cycles/pulse, peak positive pressure of 12 MPa) known to fracture kidney stones. The contralateral kidney served as a control. Therapeutic anticoagulation was confirmed by evaluating activated partial thromboplastin time (aPTT). Microhematuria was checked by urine test strips. Kidneys were subsequently evaluated for hemorrhagic injury via MRI. <b><i>Results:</i></b> aPTT was significantly elevated (>100 seconds) throughout the entire treatment period (<i>p</i> = <0.001) indicating therapeutic anticoagulation. Gross hematuria was not observed in any of the pigs. After BWL, microhematuria averaged 145.8 red blood cells (RBC)/μL in the BWL-treated kidney and 48 RBC/μL in the control kidneys, and there was no statistically significant difference noted in microhematuria rates between the two groups (<i>p</i> = 0.16). Hemorrhagic injury measured only 0.10 ± 0.02% of the tissue in the BWL-treated kidneys and 0.12 ± 0.04% in the control side, with a paired difference of -0.03 ± 0.05%, showing no significant difference (<i>p</i> = 0.58). <b><i>Conclusions:</i></b> A typical clinical dose of BWL causes no hemorrhagic injury to the kidney even during therapeutic anticoagulation therapy. This result suggests that BWL should be safe to use in patients with stone undergoing anticoagulation/antiplatelet therapy.</p>","PeriodicalId":15723,"journal":{"name":"Journal of endourology","volume":" ","pages":"804-807"},"PeriodicalIF":2.8,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143006363","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Calcium Oxalate Monohydrate and Dihydrate Stone Formers: Differing Surgical Recurrence Rates and Metabolic Profiles in a Large Cohort.","authors":"Tzach Aviv, Sagi A Shpitzer, Nadav Loebl, Leor Perl, Abd E Darawsha, Yaron Ehrlich, Dmitry Enikeev, David Lifshitz","doi":"10.1177/08927790251364280","DOIUrl":"10.1177/08927790251364280","url":null,"abstract":"<p><p><b><i>Background:</i></b> Calcium oxalate (CaOx) stones have a lower recurrence rate compared with other stone types. However, their high prevalence results in a substantial clinical and economic burden. Calcium oxalate monohydrate (COM) and dihydrate (COD) are the main CaOx stone subtypes. The clinical significance of the presence of COM or COD is not certain. This study aims to evaluate the surgical recurrence rates and metabolic profiles of different CaOx stone subtypes. <b><i>Patients and Methods:</i></b> A retrospective analysis of surgically treated patients with an available stone composition analysis performed between 2013 and 2022 in a large health care provider database. Data were analyzed for as much as 5 years from the initial surgery. Demographic, metabolic, and surgical characteristics were collected. Stones were classified based on their dominant component (>50%). Patients with COM stones were compared with those with COD stones. <b><i>Results:</i></b> The study cohort included 16,091 patients with stone analysis. Of these, 13,018 (80.9%) had CaOx stones, classified into COM (10,891; 83.7%) and COD (2127; 16.3%) groups. Compared with COM patients, COD patients were significantly younger (<i>p</i> < 0.01) and had fewer comorbidities. COD patients exhibited significantly higher urine calcium levels (242 mg/day <i>vs</i> 156 mg/day, <i>p</i> < 0.01) and lower citrate levels (377 mg/day <i>vs</i> 402 mg/day, <i>p</i> = 0.03). Conversely, COM patients had higher sodium excretion (161 mg/day <i>vs</i> 144 mg/day, <i>p</i> < 0.01). The 5-year surgical recurrence rate was 47% higher in COD patients compared with COM patients (14.3% <i>vs</i> 9.8%; hazard ratio (HR) = 1.53, 95% confidence interval: 1.33-1.76, <i>p</i> < 0.001). Additionally, COD patients required more repeat surgeries on average (1.45 <i>vs</i> 1.34, <i>p</i> = 0.04). A dominant COD composition was a significant predictor for 5-year surgical recurrence (HR = 1.69, 1.38-2.07, <i>p</i> < 0.001). <b><i>Conclusions:</i></b> CaOx stone subtypes exhibit distinct metabolic characteristics and surgical recurrence rates. COD patients are more likely to experience surgical stone recurrence. Therefore, patients with a dominant COD stone composition may require a more comprehensive metabolic workup and closer follow-up.</p>","PeriodicalId":15723,"journal":{"name":"Journal of endourology","volume":" ","pages":"822-828"},"PeriodicalIF":2.8,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144731589","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Accurate Assessment of Interval Change in Stone Burden Among Patients with Medullary Sponge Kidney: A Volumetric Approach.","authors":"Andrei D Cumpanas, Aymon Ali, Eman N Chaudhri, Mariah C Hernandez, Candices M Tran, Thao N Vu, Yezan F Hadidi, Bruce M Gao, Zachary E Tano, Sohrab N Ali, Roshan M Patel, Jaime Landman, Ralph V Clayman","doi":"10.1177/08927790251366899","DOIUrl":"10.1177/08927790251366899","url":null,"abstract":"<p><p><b><i>Introduction:</i></b> Medullary sponge kidney (MSK) and nephrocalcinosis (NC) are radiographically characterized by the formation of innumerable intrarenal concretions. Accurate determination of disease progression is challenging given the large and typically sporadic calcific burden, limiting the utility of traditional manual linear measurements on non-contrast computerized tomography (NCCT). Progression of stone size or quantity is an important predictor of morbidity in recurrent stone formers. As such, among these patients, we sought to test the accuracy of serial NCCT reports indicating a \"stable/unchanged\" stone burden against actual stone volume measurements using 3-dimensional Slicer®. <b><i>Materials and Methods:</i></b> 20 MSK/NC patients with a \"stable/unchanged\" stone burden report between January 2018 and September 2023 were retrospectively enrolled in this study. A second group of 50 patients with a single stone was also evaluated during the same time period. Volumetric stone burden measurements were completed by a physician reviewer with over 200 hours of experience with 3D Slicer®. The reviewer was blinded to the dates of the NCCT. Based on volume measurements, we determined the failure to detect a 15%, 25%, or 50% increase in stone volume. A two-tailed chi-square test was used to compare the two patient groups. <b><i>Results:</i></b> The mean time between paired NCCTs was 15.23 months ±8.58. In 49% of MSK patients, the \"stable/unchanged\" stone burden report was incorrect. Indeed, among these patients, there was a median stone growth of 297 mm³ (IQR: 128.88-745.55 mm³). An increase in stone burden of 15%, 25%, or 50% was missed in 49%, 39%, and 20% of cases, respectively. In contrast, for the single-stone patients the rate of \"stable/unchanged\" stone burden misclassification was significantly lower, with an increase in stone burden of 15%, 25%, or 50% being missed in 24%, 9%, and 7% of cases, respectively. <b><i>Conclusion:</i></b> NCCT volumetric progression of nephrolithiasis at a mean time of 15 months among MSK patients was misread as \"stable/unchanged\" stone disease in almost half of our patients.</p>","PeriodicalId":15723,"journal":{"name":"Journal of endourology","volume":" ","pages":"766-771"},"PeriodicalIF":2.8,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144804241","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}