Urolithiasis最新文献

{"title":"Origin of monosodium urate Randall's plaques.","authors":"Els Van de Perre, Elise Maréchal, Karl Martin Wissing, Jean-Philippe Haymann, Michel Daudon, Emmanuel Letavernier","doi":"10.1007/s00240-025-01743-y","DOIUrl":"https://doi.org/10.1007/s00240-025-01743-y","url":null,"abstract":"<p><p>In 3.4% of Randall's plaques, monosodium urate can be detected. The formation mechanism of these Randall's plaques is unrevealed and the clinical and biochemical characteristics of affected patients are unknown. In this single centre study, we retrospectively analysed the clinical and biochemical characteristics of patients with kidney stone formation related to monosodium urate-containing Randall's plaques (NaUr ^pos RP) and those with stone formation related to \"classical\" Randall's plaques (NaUr ^neg RP). There was a significantly higher urinary calcium and magnesium excretion in the NaUr ^neg RP group (6.09 vs. 4.61 mmol/24 h, p = 0.03 and 4.78 vs. 3.55 mmol/24 h, p = 0.02). There was no significant difference in urinary uric acid excretion or urinary pH between both groups. The NaUr ^pos RP group tended to have more frequent hyperuricemia (71.4 vs. 44.8%, p = 0.08) and to be more frequently male (92.9 vs. 70.1%, p = 0.10) and had higher median age (53.5 vs. 27.5, p < 0.001) and serum creatinine (96.4 vs. 77.0 µmol/L, p < 0.001). Additionally, there was a signal of higher prevalences of hypertension, dyslipidemia, cardiovascular disease and gout in the NaUr ^pos RP group. Different formation mechanisms seem implicated in the formation of NaUr ^pos RP and NaUr ^neg RP - associated kidney stones. We hypothesize a mechanism of interstitial monosodium urate precipitation at the renal papilla driven by high systemic uric acid serum concentration to be involved in NaUr ^pos RP formation. Treatment with xanthine oxidase inhibitors may reduce the risk of recurrent stone formation on this specific Randall's plaque.</p>","PeriodicalId":23411,"journal":{"name":"Urolithiasis","volume":"53 1","pages":"99"},"PeriodicalIF":2.0,"publicationDate":"2025-05-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144151888","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":"UreteroPyeloVisClear catheter: a new frontier in ureteroscopic lithotripsy for ureteral stones.","authors":"Chen Yang, Huang Haiwen, Zeng Xue, Ding Tianfu, Lin Shen, Xiao Bo, Li Jianxing","doi":"10.1007/s00240-025-01769-2","DOIUrl":"https://doi.org/10.1007/s00240-025-01769-2","url":null,"abstract":"<p><p>Conventional semirigid ureteroscopy for ureteral stones faces challenges such as stone retropulsion, poor intraoperative vision, and elevated intrarenal pressure. This study evaluates the safety and efficacy of a novel multi-channel negative pressure suction catheter (UreteroPyeloVisClear Catheter, VCC) in ureteroscopic lithotripsy. To compare the performance of VCC with conventional rigid ureteroscopy, this study evaluated operative time, stone clearance rates, and complication incidence between VCC and traditional semirigid ureteroscopy. A prospective cohort study included 42 patients with ureteral stones (diameter ≤ 2.0 cm), randomized into VCC (n = 21) and traditional (n = 21) groups. The VCC group utilized an integrated negative pressure suction and active water circulation system, while the traditional group used standard semirigid ureteroscopy. The primary outcome was operative time, with secondary outcomes including stone clearance rates, retropulsion incidence, basket utilization, and complication rates. The VCC group demonstrated significantly shorter operative time (39.95 ± 10.24 vs. 53.00 ± 26.95 min, p = 0.001) and reduced basket utilization (5% vs. 57%, p < 0.001). Stone retropulsion rates were lower in the VCC group (5% vs. 14%, p = 0.294), though not statistically significant. Both groups achieved 100% stone-free rates at 1 month. Postoperative pain scores (VCC: 0.90 ± 1.36 vs. traditional: 1.24 ± 1.49) and complication rates (0% vs. 5%) showed no significant differences. The VCC significantly reduces operative time and reliance on auxiliary instruments while maintaining safety and stone-free outcomes. Its innovative design addresses key limitations of traditional ureteroscopy, offering a promising advancement for ureteral stone management.</p>","PeriodicalId":23411,"journal":{"name":"Urolithiasis","volume":"53 1","pages":"97"},"PeriodicalIF":2.0,"publicationDate":"2025-05-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144136343","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":"Laser lithotripsy of a brushite crystalline aggregate stone model: fragment distribution vs. BegoStone and human stones.","authors":"Leilane Glienke, John W Robinson, Timothy L Hall, Khurshid R Ghani, Adam J Matzger, William W Roberts","doi":"10.1007/s00240-025-01771-8","DOIUrl":"https://doi.org/10.1007/s00240-025-01771-8","url":null,"abstract":"<p><p>Laser research is hampered by a lack of accurate stone models that replicate fragmentation during laser lithotripsy. We sought to assess the distribution of stone fragments from laser ablation of new brushite crystalline powder and brushite crystalline aggregate stone models and compare with human stones and BegoStone. Samples of 15:3 and 15:5 BegoStone, powder, and aggregate model stones were tested alongside human CHPD and COM stone samples. All samples were secured and hydrated before Ho: YAG laser energy was delivered (Lumenis P120H) using a 200-micron D/F/L fiber. Lithotripsy was performed by repeatedly translating the fiber automatically through a predetermined grid of points (MATLAB program) until > 50% of each sample was ablated. Fragments were separated by sieving. For each stone type, 70.2-96.9% of the mass of fragments consisted of particles smaller than 0.25 mm. The percentage by mass of fragments greater than 1 mm in trials with 0.8 J x 10 Hz settings was 0.5%, 0.0%, 1.1% and 5.1% for BegoStone 15:3, BegoStone 15:5, powder model, and aggregate model respectively, compared to 5.5% for CHPD and 16.2% for COM. Only the aggregate model, CHPD and COM samples produced fragments > 2 mm. The new aggregate model stone better replicates the fragment distribution of human stones after laser lithotripsy. The method of producing the aggregate model stone - incorporating crystal and chemical components found in urinary stones - holds promise for developing better stone models needed to address a range of important lithotripsy research questions.</p>","PeriodicalId":23411,"journal":{"name":"Urolithiasis","volume":"53 1","pages":"98"},"PeriodicalIF":2.0,"publicationDate":"2025-05-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144136367","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":"Predictive performance of Triple-D, Quadruple-D, and Mayo adhesive probability scores in ESWL for renal stones: a retrospective cohort study.","authors":"Osman Murat Ipek, Erdinc Dincer, Ahmet Halil Sevinc, Burcu Hanci Sevinc, Cengiz Canakci, Orkunt Ozkaptan","doi":"10.1007/s00240-025-01765-6","DOIUrl":"10.1007/s00240-025-01765-6","url":null,"abstract":"<p><p>This study aimed to compare the predictive performance of Triple-D, Quadruple-D, and Mayo Adhesive Probability (MAP) scoring systems in estimating stone-free (SF) status following extracorporeal shock wave lithotripsy (ESWL) in patients with renal stones. This retrospective cohort study was conducted on patients who underwent ESWL between January 2020 and January 2024. Pre-treatment non-contrast computed tomography was used to assess stone characteristics and calculate Triple-D, Quadruple-D, and MAP scores. Patients were categorized into stone-free (SF) and residual stone (RS) groups based on imaging performed three months after treatment. Residual fragments of < 4 mm were defined as SF. The study included 198 patients (60.6% male; mean age 45.5 ± 13.1 years). According to logistic regression analysis, a low MAP score (< 2.5) was the strongest independent predictor of SF status (OR: 15.5; 95% CI: 5.1-47.1; p < 0.001), followed by a high Quadruple-D score (> 1.5) (OR: 7.4; 95% CI: 2.2-24.1; p = 0.001) and low stone density (< 600 HU) (OR: 4.9; 95% CI: 1.1-21.8; p = 0.037). Conversely, a higher number of shockwaves and the need for additional procedures were associated with RS (both p < 0.001). Among the scoring systems, MAP score demonstrated the highest predictive accuracy with an AUC of 0.817, outperforming Quadruple-D (AUC: 0.722) and Triple-D (AUC: 0.639). MAP score was the most powerful and accurate independent predictor of SF status after ESWL, offering superior clinical utility compared to Triple-D and Quadruple-D scores in pre-treatment evaluation.</p>","PeriodicalId":23411,"journal":{"name":"Urolithiasis","volume":"53 1","pages":"96"},"PeriodicalIF":2.0,"publicationDate":"2025-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12098459/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144120961","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":"Safety and efficacy of Silodosin as medical expulsive therapy after shock wave lithotripsy in paediatric patients ‍‍with renal stones.","authors":"Mohammed Lotfi Amer, Mohamed Essam Elkholefy, Heba Dawoud, Mohamed Gaber, Osama Mostafa El-Gamal, Tarek Gameel","doi":"10.1007/s00240-025-01760-x","DOIUrl":"10.1007/s00240-025-01760-x","url":null,"abstract":"<p><p>This study was designed to assess the safety and efficacy of Silodosin as a medical expulsive therapy following shockwave lithotripsy (SWL) in paediatric patients with renal stones. In this prospective randomized controlled study conducted at Tanta University Hospital from January 2022 to March 2024, thirty children with a single de novo radiopaque renal pelvic stone less than 2 cm scheduled for SWL were randomized into two equal groups. Group A (n = 15) received Silodosin 4 mg once daily after the first SWL session, and Group B (n = 15) received a matching placebo. The first dose was administered on the night of the initial SWL session and continued until stone-free status was confirmed, for a maximum of 4 weeks. The stone expulsion time was set as a primary outcome, while the secondary outcomes were one-session stone-free rate (SFR), postoperative pain scores, and Silodosin related adverse events. The results showed that the mean stone expulsion time in group A (11.4 ± 1.8 days) was significantly shorter compared to group B (16.4 ± 1.6 days; P < 0.0001). One-session SFR was 86.6% in Silodosin group compared to 73.3% in Placebo group (P = 0.6). Pain visual analogue scores were significantly lower in group A (2.31 ± 1.75) than in group B (5.08 ± 2.43; P = 0.003). No severe drug-related adverse effects were reported in either group. In conclusion, Silodosin appears to be a safe and effective adjunct to SWL in paediatric patients, significantly reducing stone expulsion time and postoperative pain. Larger studies are needed to confirm these findings.</p>","PeriodicalId":23411,"journal":{"name":"Urolithiasis","volume":"53 1","pages":"95"},"PeriodicalIF":2.0,"publicationDate":"2025-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12092508/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144112258","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":"Letter to the editor regarding the article \"RIRS with FV-UAS vs. MPCNL for 2-3-cm upper urinary tract stones: a prospective study\".","authors":"Recep Burak Degirmentepe","doi":"10.1007/s00240-025-01766-5","DOIUrl":"https://doi.org/10.1007/s00240-025-01766-5","url":null,"abstract":"","PeriodicalId":23411,"journal":{"name":"Urolithiasis","volume":"53 1","pages":"93"},"PeriodicalIF":2.0,"publicationDate":"2025-05-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144086735","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":"Size matters: an in vitro evaluation of flexible vacuum-assisted ureteral access sheaths.","authors":"Aideen Madden, Carlos Altez, Jordi Peña Lueza, Johan Cabrera, Alberto Quarà, Stefano Moretto, Răzvan-Ionut Popescu, Mariela Corrales, Olivier Traxer","doi":"10.1007/s00240-025-01710-7","DOIUrl":"https://doi.org/10.1007/s00240-025-01710-7","url":null,"abstract":"<p><p>Suction in retrograde-intrarenal surgery (RIRS) has been the focus of ongoing innovation. Expanding ranges of flexible vacuum-assisted ureteric access sheaths (FV-UAS) combined with single-use digital flexible ureteroscopes (SU-DFU) produce many potential combinations. This study aims to evaluate the efficacy of these combinations in clearing stone fragments. Three different models of flexible vacuum-assisted ureteric access sheaths were tested: Clear Petra^™ (8.5/9.5Fr, 10-12Fr, 12-14Fr), YiGao^™ (10-12Fr, 12-14Fr) and Innovex^™ (10-12Fr, 12-14Fr). A total of 6 ratio of endoscope-to-sheath diameters (RESDs) (0.53, 0.63, 0.74, 0.79, 0.88 and 0.95) were assessed by using three different single-use digital flexible ureteroscopes (6.3Fr Hugemed^™, 7.5Fr Pusen^™, 9.5Fr Lithovue^™). Two techniques, continuous in-scope suction and pull-out with suction were tested across 5 dust size ranges (63-125, 125-250, 250-500 µm and 0.5-1 mm, 1-2 mm). A combination resulting in a ratio of endoscope-to-sheath diameter of 0.53 offered the best range, with up to 2 mm fragments aspirated with equal success by either method. Maximal stone clearance rates at 10.2 g/min were achieved with the combination of a 7.5Fr Pusen^™ with 12-14F flexible vacuum-assisted ureteric access sheath, with a ratio of endoscope-to-sheath diameter of 0.63 using continuous in-scope suction for fragments 125-250 µm. Continuous in-scope suction emerges as the dominant technique for smaller stone fragments and pull-out with suction as dominant or equivalent for greater fragment sizes. The ratio of endoscope-to-sheath diameter is not the only factor critical to improving stone-free rates. Technique should be adapted according to estimated stone fragment size.</p>","PeriodicalId":23411,"journal":{"name":"Urolithiasis","volume":"53 1","pages":"94"},"PeriodicalIF":2.0,"publicationDate":"2025-05-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144086736","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":"Letter to editor: In-vitro and in-vivo evaluation for anti-urolithiasis potential of ficus racemosa L. bark extract in ethylene glycol induced rat model.","authors":"Qi Xu","doi":"10.1007/s00240-025-01764-7","DOIUrl":"https://doi.org/10.1007/s00240-025-01764-7","url":null,"abstract":"","PeriodicalId":23411,"journal":{"name":"Urolithiasis","volume":"53 1","pages":"91"},"PeriodicalIF":2.0,"publicationDate":"2025-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144079756","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":"What is the role of large language models in the management of urolithiasis?: a review.","authors":"Tunahan Ates, Nezih Tamkac, Ibrahim Halil Sukur, Fesih Ok","doi":"10.1007/s00240-025-01761-w","DOIUrl":"10.1007/s00240-025-01761-w","url":null,"abstract":"<p><p>This review aimed to investigate the role of large language models (LLMs) in clinical decision support, patient counseling, and patient education in the management of urolithiasis. Eleven eligible studies were assessed following a comprehensive search of the Scopus and Web of Science databases. In the realm of clinical decision support, large language models (LLMs), particularly ChatGPT-4, have shown efficacy in areas such as the diagnosis of urolithiasis and initial treatment planning. An evaluation of the models' adherence to the European Association of Urology guidelines revealed that ChatGPT and Perplexity outperformed Bard. For patient counseling, Bing AI exhibited a robust capacity to deliver resource-based information. The studies have yielded conflicting results regarding ChatGPT versions' ability to empathize. In the context of patient education, models such as Claude-3 and ChatGPT-4 have demonstrated the capability to provide accurate and comprehensible answers to patient questions. However, it was noted that the quality of information is occasionally conveyed using complex language. LLMs have considerable potential as assistive tools in the management of urolithiasis; however, their limitations necessitate expert supervision, especially in complex cases. In the future, it is anticipated that these limitations will be mitigated through improved training and integration of these models into clinical practice. Consequently, LLMs should be employed as auxiliary tools rather than primary instruments in clinical decision-making.</p>","PeriodicalId":23411,"journal":{"name":"Urolithiasis","volume":"53 1","pages":"92"},"PeriodicalIF":2.0,"publicationDate":"2025-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144080009","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":"Predictors and associations of complications in ureteroscopy for stone disease using AI: outcomes from the FLEXOR registry.","authors":"Carlotta Nedbal, Vineet Gauhar, Sairam Adithya, Pietro Tramanzoli, Nithesh Naik, Shilpa Gite, Het Sevalia, Daniele Castellani, Frédéric Panthier, Jeremy Y C Teoh, Ben H Chew, Khi Yung Fong, Mohammed Boulmani, Nariman Gadzhiev, Thomas R W Herrmann, Olivier Traxer, Bhaskar K Somani","doi":"10.1007/s00240-025-01763-8","DOIUrl":"10.1007/s00240-025-01763-8","url":null,"abstract":"<p><p>We aimed to develop machine learning(ML) algorithms to evaluate complications of flexible ureteroscopy and laser lithotripsy(fURSL), providing a valid predictive model. 15 ML algorithms were trained on a large number fURSL data from > 6500 patients from the international FLEXOR database. fURSL complications included pelvicalyceal system(PCS) bleeding, ureteric/PCS injury, fever and sepsis. Pre-treatment characteristics served as input for ML training and testing. Correlation and logistic regression analysis were carried out by a multi-task neural network, while explainable AI was used for the predictive model. ML algorithms performed excellently. For intraoperative PCS bleeding, Extra Tree Classifier achieved the best accuracy at 95.03% (precision 80.99%), and greatest correlation with stone diameter(0.21) and residual fragments(0.26). PCS injury was best predicted by RandomForest (accuracy 97.72%, precision 63.50%). XGBoost performed best for ureteric injury (accuracy 96.88%, precision 60.67%). Both demonstrated moderate correlation with preoperative characteristics. Postoperative fever was predicted by Extra Tree Classifier with 91.34% accuracy (precision 58.20%). Cat Boost Classifier predicted postoperative sepsis with 99.15% accuracy (precision 66.38%), and the best overall performance. At logistic regression, postoperative fever/sepsis positively correlated with preoperative urine culture(p = 0.001). ML represents a powerful tool for automatic prediction of outcomes. Our study showed promises in algorithms training and validation on a very large database of patients treated for urolithiasis, with excellent accuracy for prediction of complications. With further research, reliable predictive nomograms could be created based on ML analysis, to serve as aid to urologists and patients in the decision making and treatment planning process.</p>","PeriodicalId":23411,"journal":{"name":"Urolithiasis","volume":"53 1","pages":"89"},"PeriodicalIF":2.0,"publicationDate":"2025-05-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12078356/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144038127","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}