Urolithiasis最新文献

{"title":"Laser versus Mechanical Lithotripsy for Endourological Treatment of Bladder Stones: A Prospective Multicenter Analysis from the EAU-Endourology Bladder Lithiasis Assessment of Surgical Treatment (BLAST) registry.","authors":"Angelo Cormio, Vineet Gauhar, Jaisukh Kalathia, Thomas Herrmann, Amelia Pietropaolo, Khi Yung Fong, Arun Chawla, Carlo Giulioni, Tianyu Li, Zelimkhan Tokhtiev, Giorgio Mazzon, Amish Mehta, Yash Pamecha, Lin Xiong, Ender Cem Bulut, Nariman Gadzhiev, Sohani Dassanayake, Azizbek Shomarufov, Lim Tze Ying Benjamin, Theodoros Tokas, Gunal Ozgur, Luca Boeri, Yunteng Huang, Yasser Gamil Elnagar, Zijie Chai, Bohan Wang, William Lay Keat Ong, Benedikt Becker, Abdul Haseeb, Lazaros Tzelves, Alba Sierra, Thiago Hota, Deepak Ragoori, Wei Zhu, Steffi Kar Kei Yuen, Bhaskar Somani, Daniele Castellani","doi":"10.1007/s00240-026-02077-z","DOIUrl":"10.1007/s00240-026-02077-z","url":null,"abstract":"<p><p>We aim to compare perioperative outcomes, postoperative stone-free rate, complications, and predictors of treatment success in patients undergoing endourological treatment of bladder stones using laser versus mechanical energy. We performed a prospective multicenter analysis from the Bladder Lithiasis Assessment of Surgical Treatment (BLAST) registry. Patients undergoing endourological treatment for bladder stones between May 2025 and September 2025 were included and stratified according to the energy source used for stone fragmentation: laser or mechanical energy, reflecting a pragmatic, category-level comparison of heterogeneous device platforms rather than a device-specific efficacy analysis. Postoperative stone-free rate was assessed at 4-6 weeks and graded from A to D; Grade A indicated complete clearance, while Grade A and B were considered stone-free. Secondary outcomes included operative parameters, complications, hospital stay, and reintervention. Given the observational nature of the study and the observed baseline differences between groups, clinically relevant covariates were incorporated into multivariable regression model with center as a random effect to account for potential confounding. Multivariable logistic regression was used to identify predictors of Grade A stone-free status and 48-hour postoperative complications. Overall, 722 patients from 31 centers were included: 437 underwent laser lithotripsy and 285 mechanical lithotripsy. Patients in the laser group were older, had higher body mass index, more cardiovascular comorbidity, more frequent antithrombotic therapy, slightly larger stones, and more concomitant procedures. Mechanical energy was associated with shorter lithotripsy time (17 vs. 23 min, p < 0.001) and operative time for bladder stone treatment (30 vs. 50 min, p < 0.001). Final Grade A stone-free status was comparable between groups (95.8% vs. 95.2%), and overall stone-free rate exceeded 98% in both cohorts. Overall, 48-hour complications were more frequent in the mechanical group, whereas major early complications were more frequent in the laser group. In center-adjusted mixed-effects analysis, no significant differences were observed between mechanical and laser lithotripsy in stone-free status or postoperative complications. On multivariable analysis, mechanical energy was not independently associated with Grade A stone-free status, while mechanical energy and suction device use were independently associated with higher odds of 48-hour complications. In conclusion, laser and mechanical energy achieved similarly high postoperative stone-free rates. Mechanical energy improved operative efficiency but did not increase the rate of complete clearance. Energy selection should be individualized according to patient characteristics, stone burden, need for fragment evacuation, available technology, and surgeon experience.</p>","PeriodicalId":23411,"journal":{"name":"Urolithiasis","volume":"54 1","pages":""},"PeriodicalIF":2.6,"publicationDate":"2026-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149184815","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":"Thirty-day outcomes of Direct In-Scope Suction (DISS) in real-world practice using magneto, MOSES, and Thulium fiber laser technologies for renal and ureteral stones: an EAU endourology study.","authors":"Vineet Gauhar, Daniele Castellani, Khi Yung Fong, Luis Rico, Pablo Contreras, Christine Joy Garcia Castillo, Jia-Lun Kwok, Esteban Emiliani, Begoña Ballesta Martinez, Arman Tsaturyan, Nariman Gadzhiev, Vigen Malkhasyan, Albert El Hajj, Felicia Hong Seok Kwan, Angelo Cormio, Selçuk Güven, Bogdan Geavlete, Benedict Becker, Lim Tze Ying Benjamin, Marek Zawadzki, Amelia Pietropaolo, Thomas Herrmann, Steffi Kar Kei Yuen, Bhaskar Somani, Carlo Giulioni","doi":"10.1007/s00240-026-02075-1","DOIUrl":"10.1007/s00240-026-02075-1","url":null,"abstract":"<p><p>Direct in-scope suction (DISS) ureteroscopy integrates aspiration through the ureteroscope working channel, but the interaction between suction and contemporary laser platforms is incompletely defined. We prospectively compared MOSES high-power holmium: YAG, thulium fiber laser (TFL), and Magneto holmium: YAG during DISS-assisted flexible ureteroscopy across 16 centres in 14 countries. Adults treated between May and December 2025 underwent baseline and 30-day non-contrast computed tomography (NCCT). The primary efficacy endpoint was zero-residual-fragment stone-free status (ZRF-SFS; Grade A) on 30-day NCCT; Grade B denoted a single residual fragment ≤ 2 mm. Among 502 patients, 146 received MOSES, 198 TFL, and 158 Magneto. Median operative time was 60, 44, and 40 min, and ureteroscopy time 49, 36, and 27 min, respectively (both p < 0.001). Working-channel blockage requiring flushing was most frequent with TFL (7.5%, 17.7%, and 1.3%; p < 0.001), while scope malfunction requiring change was most frequent with MOSES (7.5%, 0.5%, and 0.6%; p < 0.001). Grade A ZRF-SFS was similar (71.0%, 71.2%, and 72.2%), whereas Grade A + B stone-free status was 86.2%, 96.0%, and 98.1%. Laser platform was not independently associated with Grade A clearance; increasing stone volume was the only significant predictor of lower clearance (OR 0.63 per 1 cm³ [1000 mm³], 95% CI 0.46-0.86). Thus, complete CT-confirmed clearance was comparable across platforms, while operative and device-related differences should be interpreted as exploratory because laser allocation and perioperative practice were centre-dependent.</p>","PeriodicalId":23411,"journal":{"name":"Urolithiasis","volume":"54 1","pages":""},"PeriodicalIF":2.6,"publicationDate":"2026-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149183966","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":"Establishing stone composition from pure dust: feasibility and analytic yield of FTIR spectroscopy during suction-assisted flexible ureteroscopy.","authors":"Sarwar Noori Mahmood, Ahmed Sarwar Noori, Arya Sarwar Noori, Hanisk Mohammed Othman","doi":"10.1007/s00240-026-02076-0","DOIUrl":"10.1007/s00240-026-02076-0","url":null,"abstract":"<p><p>The shift toward dust-only flexible ureteroscopy (FURS) prevents routine metabolic stone analysis due to a lack of retrievable fragments. We evaluated the technical success, analytical yield, and composition profile of Fourier-transform infrared (FTIR) spectroscopy performed on stone dust collected via flexible navigable suction access sheaths (FANS). This prospective single-center study included 109 patients undergoing FURS with FANS for upper tract stone disease. The surgeon aspirated the stone dust slurry into a container. Then, the fluid samples collected were sent to the lab to be centrifuged, washed with distilled water to remove any blood/protein artifacts, incubated until dried, and analyzed using FTIR spectroscopy. Dust aspiration reached a 100% analytical yield (109/109 cases), with all samples giving an interpretable FTIR reading. Calcium-based stones were the most common (64.2%, n = 70), consisting of Calcium Oxalate Monohydrate (51.4%, n = 56) and Calcium Oxalate Dihydrate (12.8%, n = 14). Uric Acid was identified in 26 cases (23.9%), followed by Carbonate-Apatite (6.4%, n = 7), Cystine (3.7%, n = 4), and Struvite (1.8%, n = 2). There was a strong relation between pre-operative CT density and the primary dust component (p < 0.001), with Uric Acid stones displaying significantly lower density (611.8 ± 263.2 HU) than Calcium Oxalate Monohydrate (1146.7 ± 335.7 HU). Aspirating stone dust during FURS provides a viable sample for FTIR spectroscopy, challenging the assumption that dust-only lithotripsy is inadequate for stone analysis and demonstrating a feasible, high-yield alternative when solid fragments are unretrievable.</p>","PeriodicalId":23411,"journal":{"name":"Urolithiasis","volume":"54 1","pages":""},"PeriodicalIF":2.6,"publicationDate":"2026-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149168602","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":"Interleukin-37 does not confer protection against stone formation or kidney injury at the peak of disease in a murine calcium oxalate model.","authors":"Nirmal P Bhatt, Theresa T H Nguyen, Ina Rudloff, Bernadette Jones-Freeman, Guy J M Cameron, Gabriel R Rodriguez, Marcel F Nold, Aniruddh V Deshpande, Claudia A Nold-Petry, Malcolm Ronald Starkey","doi":"10.1007/s00240-026-02061-7","DOIUrl":"https://doi.org/10.1007/s00240-026-02061-7","url":null,"abstract":"<p><p>Calcium oxalate (CaOx) stones are the most prevalent form of nephrolithiasis in adults. While murine models of CaOx stone disease are established, many lack translational features for therapeutic evaluation, including in vivo assessment of kidney function and molecular profiling of renal inflammation. We refined the glyoxylate‑induced CaOx mouse model by incorporating non‑invasive transdermal glomerular filtration rate (tGFR) measurements to enable longitudinal assessment of kidney function. This platform was used to investigate the renoprotective role of the anti‑inflammatory cytokine interleukin‑37 (IL‑37). Because mice do not express IL‑37, we used IL‑37 transgenic (IL‑37tg) mice that express the human IL37b isoform. Male wild‑type and IL‑37tg mice received daily intraperitoneal glyoxylate to induce CaOx deposition. Crystal burden and tubular injury were quantified using digital image analysis of whole‑kidney sections. Kidney function was assessed using tGFR and validated by serum creatinine, blood urea nitrogen (BUN), and symmetric dimethylarginine (SDMA). Renal inflammation was profiled using an RT² Profiler PCR Array, with key transcripts validated by qPCR. CaOx deposition peaked on day 6, coinciding with tubular injury and impaired kidney function in both wild‑type and IL‑37tg mice, as evidenced by reduced tGFR and elevated BUN, creatinine, and SDMA. Stone formation triggered a robust inflammatory response, with 46 of 84 genes upregulated > 3‑fold in wild‑type mice. IL‑37 expression did not alter crystal burden, kidney injury, kidney function, or inflammatory gene expression. These findings establish a refined murine CaOx model incorporating kidney function and molecular endpoints and demonstrate that IL‑37 does not confer renal protection in glyoxylate‑induced stone disease.</p>","PeriodicalId":23411,"journal":{"name":"Urolithiasis","volume":"54 1","pages":""},"PeriodicalIF":2.6,"publicationDate":"2026-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13653896/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149172029","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":"Bridging evidence gaps in opioid-sparing postoperative pain control for percutaneous nephrolithotomy: a network meta-analysis identifying optimal strategies.","authors":"Puhan Li, Kai Tao, Zhongyu Jian, Banghua Liao, Yucheng Ma, Kunjie Wang","doi":"10.1007/s00240-026-02072-4","DOIUrl":"10.1007/s00240-026-02072-4","url":null,"abstract":"<p><p>Percutaneous nephrolithotomy (PCNL) is the gold standard for large renal calculi, yet postoperative pain from tract dilation, capsule injury, and inflammation often delays recovery, prolongs hospital stays, and reduces patient satisfaction. Amid the opioid crisis, reliance on opioids for pain control raises concerns over adverse effects like respiratory depression, nausea, and dependence. This has spurred interest in opioid-sparing multimodal strategies, with recent studies suggesting feasibility of opioid-free discharge and comparable relief from NSAIDs with fewer side effects. However, robust comparative evidence remains scarce. This systematic review and network meta-analysis (NMA) evaluates and ranks postoperative analgesic strategies in PCNL, aiming to highlight approaches that may reduce opioid use while improving clinical outcomes in endourology. We searched PubMed, Embase, Web of Science, and Cochrane Library up to March 11, 2025 for RCTs assessing VAS pain in adults undergoing PCNL. Interventions grouped: local anesthesia/nerve blocks, intravenous analgesics, local instillation, intrathecal anesthesia, aromatherapy. Bayesian NMA used ADDIS v1.16.8/R v4.0.5, with MCMC simulations, node-splitting for consistency, SMAA for benefit-risk of VAS (<24h, ≥24h) and complications. 45 RCTs (2,626 patients) formed consistent network without significant inconsistency/heterogeneity. Levobupivacaine outperformed bupivacaine/ropivacaine in VAS reduction (<24h, ≥24h) via erector spinae plane block/local infiltration. Non-opioid analgesics (NSAIDs/paracetamol) showed superior efficacy; opioids excelled short-term but not long-term. IV paracetamol plus LI-levobupivacaine ranked highest in the multicriteria analysis, although the benefit-risk ranking should be interpreted cautiously because the safety component was based on sparse and imprecise data. Limitations: RCT protocol variability (e.g., pain assessment), moderate bias in 21 studies, limited data for high-risk subgroups (e.g., renal impairment, obesity). Comparative safety could not be established because complication data were sparse and estimates were highly imprecise. This NMA supports levobupivacaine and NSAID-based IV analgesics for PCNL pain management, positioning IV-Paracetamol+LI-Levobupivacaine as a leading opioid-sparing multimodal option to address complex pain profiles. These findings encourage safer practices amid opioid concerns, potentially accelerating recovery, shortening stays, and enhancing endourology patient outcomes.Trial registration: PROSPERO CRD42024600872.</p>","PeriodicalId":23411,"journal":{"name":"Urolithiasis","volume":"54 1","pages":""},"PeriodicalIF":2.6,"publicationDate":"2026-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149168623","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 effect of a stress ball on pain, anxiety, satisfaction, and treatment continuation during extracorporeal shock wave lithotripsy: a randomized controlled trial.","authors":"Canan Kanat, Gamze Bozkul, Elife Kettaş Dölek, Gülay Altun Uğraş, Erim Erdem","doi":"10.1007/s00240-026-02057-3","DOIUrl":"10.1007/s00240-026-02057-3","url":null,"abstract":"<p><p>This study aimed to evaluate the effect of a stress ball on pain, anxiety, satisfaction, and treatment continuation among patients undergoing extracorporeal shock wave lithotripsy (ESWL). This prospective, two-arm, randomized controlled trial was conducted at the urology outpatient clinic of a university hospital between May 2025 and May 2026. A total of 50 patients undergoing ESWL for the first time were randomly assigned to the stress ball group (n=25) and the control group (n=25). Patients in the stress ball group were provided with a stress ball during the procedure in addition to routine care, whereas the control group received routine care only. Patients' pain intensity during and after the procedure, as well as satisfaction levels following the procedure, were assessed using a visual analog scale. Anxiety levels before and after the procedure were measured using the State-Trait Anxiety Inventory-State. Patients' continuation to ESWL sessions was recorded. Pain scores during (p=0.001) and after (p<0.001) ESWL were lower in the stress ball group than in the control group. Post-procedure anxiety scores were lower in the stress ball group (p=0.035), whereas satisfaction scores were higher (p=0.011). The rate of continuation to the third ESWL session was higher in the stress ball group (92% vs. 68%, p=0.034). This study found that the use of a stress ball during ESWL reduced patients' pain and anxiety levels while increasing satisfaction and continuation to subsequent ESWL sessions. As a simple, low-cost, and non-pharmacological intervention, stress ball use may improve patient comfort, tolerance of ESWL, and adherence to repeated treatment sessions.Trial Registration: ClinicalTrials.gov, NCT06846723, registered January 28, 2025.</p>","PeriodicalId":23411,"journal":{"name":"Urolithiasis","volume":"54 1","pages":""},"PeriodicalIF":2.6,"publicationDate":"2026-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149167112","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":"Extraction-string ureteral stents and postoperative infection after flexible ureteroscopy: an IPTW-adjusted analysis.","authors":"Jui-Ying Lin, Chun-Te Wu, Kuan-Lin Liu, Cheng-Feng Lin, Hong-Yi Chen, Cheng-Chia Lin","doi":"10.1007/s00240-026-02071-5","DOIUrl":"10.1007/s00240-026-02071-5","url":null,"abstract":"<p><p>Extraction-string ureteral stents facilitate non-cystoscopic removal after ureteroscopy, but concerns remain regarding postoperative infection and accidental dislodgement. We evaluated whether extraction-string stents were associated with postoperative infection after flexible ureteroscopic lithotripsy (fURSL) in a cohort restricted to procedures with the distal Double-J (D-J) stent portion positioned within the bladder. This retrospective observational study included 102 procedures in 92 unique patients: 58 extraction-string and 44 conventional non-string procedures. Postoperative infection was defined as fever > 38 °C or a positive postoperative urine culture during the stent-indwelling period. Propensity scores incorporated age, sex, positive preoperative urine culture, preoperative pyuria, and procedure laterality. Stabilized inverse probability of treatment weights were truncated at the 1st and 99th percentiles; effective sample size was 85.38. Crude postoperative infection occurred in 8/58 (13.8%) extraction-string and 6/44 (13.6%) non-string procedures. After weighting, estimated infection rates were 13.6% and 8.8%, respectively (OR 1.64, 95% CI 0.50-5.44; P = 0.416). Fever, positive postoperative urine culture, postoperative pyuria, and postoperative day 1 pain did not differ significantly. Sensitivity analyses accounting for repeated procedures and propensity-model specification were consistent with the primary analysis. Extraction-string stent use was not significantly associated with postoperative infection after fURSL; however, the limited number of events and wide confidence intervals preclude exclusion of a clinically meaningful difference.</p>","PeriodicalId":23411,"journal":{"name":"Urolithiasis","volume":"54 1","pages":""},"PeriodicalIF":2.6,"publicationDate":"2026-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13645930/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149128526","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":"Slippery when wet: The effect of a novel zwitterionic coating on silicone ureteral stents.","authors":"Ye Jean Lim, Ye Na Diana Lim, Connor A Church, Elijah Haynal, Elizabeth A Baldwin, D Duane Baldwin","doi":"10.1007/s00240-026-02070-6","DOIUrl":"10.1007/s00240-026-02070-6","url":null,"abstract":"<p><p>Silicone ureteral stents provide anti-encrustation properties and patient comfort but are more difficult to insert and remove due to increased surface friction. Applying zwitterionic coatings to silicone stents may reduce friction and facilitate stent placement and removal. This study compared the frictional forces of zwitterionic-coated silicone stents with commercial stents using benchtop models. The static and kinetic frictional forces of five ureteral stents were measured: bare silicone stent without coating (BS), single outer-coated zwitterionic silicone stent (Z1), double-coated (inner and outer) zwitterionic silicone stent (Z2), Black Silicone Filiform stent (\"Black Beauty\") (BB), and Universa Soft stent (US). Friction was assessed with a submerged guidewire model to isolate stent-guidewire friction and a porcine ureteral model to simulate intraoperative stent insertion and removal. Five trials per stent were performed using a force gauge integrated with an Arduino-controlled motor system. Statistical significance was assessed using linear mixed-effects models with stent type and trial as fixed effects and ureter specimen as a random intercept. Pairwise comparisons were adjusted using the Holm method. In the submerged guidewire model, Z2 had 99%, 47%, and 40% lower kinetic friction than BS, BB, and US, respectively. During stent insertion, Z2 had 71%, 43%, and 44% lower kinetic friction than BS, BB, and US, respectively. During stent removal, Z2 had 92%, 58%, and 60% lower kinetic friction than BS, BB, and US, respectively. Linear mixed-effects models demonstrated a significant effect of stent type for all six friction conditions (all p < 0.001). The double-coated (inner and outer) zwitterionic silicone stent (Z2) demonstrated the lowest frictional forces across all testing conditions. Zwitterionic surface modification may therefore reduce friction during silicone stent placement and removal.</p>","PeriodicalId":23411,"journal":{"name":"Urolithiasis","volume":"54 1","pages":""},"PeriodicalIF":2.6,"publicationDate":"2026-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13645972/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149128528","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":"Preoperative CT-based markers and inflammatory parameters as predictors of failed ureteroscopic access in unstented patients with ureteral stones: a prospective single-center cohort study.","authors":"Khaled M Abdelhalim, Esam A Ahmed, Ezzat A Ismail, Isaac S Wasfy","doi":"10.1007/s00240-026-02050-w","DOIUrl":"10.1007/s00240-026-02050-w","url":null,"abstract":"<p><p>Failed ureteroscopic access (FA) in unstented patients remains a significant clinical challenge. We aimed to identify preoperative clinical, laboratory, and CT-based predictors of FA, determine optimal cutoff values, and develop a clinically applicable risk-stratification model. This prospective cohort study enrolled 141 consecutive patients with ureteral stones undergoing unstented ureteroscopy (83 semi-rigid, 58 flexible) at a tertiary center (January 2024-January 2025). Preoperative demographics, pain characteristics, inflammatory markers (TLC, ESR, CRP, procalcitonin), and NCCT parameters (stone size, density, ureteral wall thickness [UWT], perinephric fat stranding [PFS] grade, hydronephrosis grade, HU of hydronephrosis, renal parenchymal thickness) were compared between successful access (SA, n = 112) and failed access (FA, n = 29) groups. Firth's penalized logistic regression, ROC analysis with DeLong comparison, and decision curve analysis (DCA) were performed. FA occurred in 29 patients (20.6%). UWT demonstrated the highest discriminatory power (AUC 0.965; cutoff ≥ 2.7 mm; sensitivity 96.6%, specificity 99.1%), followed by PFS grade (AUC 0.963; cutoff ≥ 2; sensitivity 100%, specificity 89.3%) and procalcitonin (AUC 0.957; cutoff ≥ 0.2 ng/mL). On Firth's penalized multivariate analysis, the primary two-variable Firth model identified UWT (OR 62.20 per mm; p < 0.001) and upper ureteral location (OR 14.27; p = 0.040) as independently associated with failed access (apparent AUC 0.986; 5-fold cross-validated AUC 0.967). The combined model achieved an AUC of 0.997 as an exploratory model with adequate calibration (Hosmer-Lemeshow test, p = 0.936). Exploratory DCA suggested potential net benefit across clinically relevant threshold probabilities. UWT ≥ 2.7 mm and PFS grade ≥ 2 on preoperative NCCT may be useful predictors of FA during unstented ureteroscopy, although these findings require external validation before clinical application. Incorporating these readily measurable CT parameters into a proposed preoperative risk-stratification algorithm may optimise surgical planning and patient counselling.</p>","PeriodicalId":23411,"journal":{"name":"Urolithiasis","volume":"54 1","pages":""},"PeriodicalIF":2.6,"publicationDate":"2026-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149115323","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":"Sex-specific associations of traditional and novel anthropometric indices with incident kidney stone disease: a 10-year longitudinal cohort study.","authors":"Kai Tao, Linhu Liu, Yucheng Ma, Banghua Liao, Xi Jin, Kunjie Wang","doi":"10.1007/s00240-026-02060-8","DOIUrl":"10.1007/s00240-026-02060-8","url":null,"abstract":"<p><p>Excess adiposity and altered body fat distribution are increasingly recognized as important contributors to metabolic disorders, including kidney stone disease (KSD). However, how to best assess obesity-related KSD risk and the temporal relationship remain unclear. This 10-year retrospective longitudinal cohort study included participants undergoing annual health examinations. Data on demographics, KSD, and six anthropometric indices were collected. Cox regression stratified by sex was used. Model 1 examined the associations of baseline indices with 10-year incident KSD, while Model 2 examined the associations of the 5-year mean indices with incident KSD during years 6-10. Kaplan-Meier survival curves compared event-free probability. Restricted cubic spline regression assessed non-linear relationships. Sex-stratified 10-wave cross-lagged panel models examined overall adjacent-wave temporal associations between anthropometric indices and KSD across the ten annual assessments. A total of 24,418 participants were included. In Model 1, high baseline body mass index (BMI) was significantly associated with a higher 10-year risk of KSD among females (HR, 1.35; 95% CI, 1.03-1.78), while waist circumference (WC), waist-to-hip ratio (WHR), BMI, weight-adjusted-waist index (WWI) and body roundness index (BRI) were significantly associated with incident KSD in male participants (all HRs, 1.06-1.11; P<0.001). Survival analysis showed higher event-free probability in females with lower WHR and BMI (all P<0.05), and in males with lower BMI, WHR, WC, WWI, and BRI (all P<0.001). In Model 2, all indices except a body shape index (ABSI) were significantly associated with subsequent 5-year KSD risk in males (all P<0.001), whereas no significant associations in females. Cross-lagged panel analyses suggested significant temporal associations of WC, BMI, WWI, WHR, and BRI with subsequent KSD in males, whereas no such associations were observed in females. Sex-specific anthropometric patterns were observed in relation to KSD. Multiple indices of overall and central adiposity were consistently associated with KSD in males, whereas the associations were less consistent in females. Anthropometric indices alone may therefore be insufficient to characterize KSD risk in females, highlighting the potential contribution of additional metabolic, hormonal, and other sex-specific factors.</p>","PeriodicalId":23411,"journal":{"name":"Urolithiasis","volume":"54 1","pages":""},"PeriodicalIF":2.6,"publicationDate":"2026-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149115343","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}