Urolithiasis最新文献

{"title":"Beyond complications: the mayo adhesive probability (MAP) score as an imaging biomarker of surgical complexity in percutaneous nephrolithotomy.","authors":"Yusuf Arikan, Ali Eroğlu, Muhammet Yildirim, Ulaş Can Erdoğan, Enes Dumanli, Huseyin Onder, Mehmet Zeynel Keskin","doi":"10.1007/s00240-026-02044-8","DOIUrl":"https://doi.org/10.1007/s00240-026-02044-8","url":null,"abstract":"<p><p>The Mayo Adhesive Probability (MAP) score was originally developed to predict adherent perinephric fat in partial nephrectomy. Its role in percutaneous nephrolithotomy (PNL) remains poorly characterized. We aimed to investigate whether MAP score is associated with markers of procedural difficulty and perioperative outcomes in patients undergoing PNL. We retrospectively evaluated 556 consecutive adult patients who underwent PNL between 2020 and 2025. MAP scores were calculated using preoperative non-contrast computed tomography and patients were categorized into low-MAP (< 3) and high-MAP (≥ 3) groups. Procedural difficulty markers included prolonged operative time (> 120 min), multiple access tracts (≥ 2), postoperative hemoglobin decrease ≥ 2 g/dL, residual stone fragments > 4 mm, secondary intervention, tubeless drainage, and trifecta failure. Trifecta failure was defined as the presence of residual stones, postoperative complications, or need for secondary intervention. Multivariable logistic regression analyses were adjusted for age, sex, stone size, stone density, Guy's score ≥ 3, hydronephrosis grade, and skin-to-stone distance. Among 556 patients, 310 had MAP scores < 3 and 246 had MAP scores ≥ 3. Patients with MAP ≥ 3 had significantly longer operative times (107.8 ± 47.7 vs. 97.7 ± 38.0 min, p = 0.007), greater hemoglobin decrease (2.17 ± 1.22 vs. 1.67 ± 1.07 g/dL, p < 0.001), higher rates of multiple access tracts (18.7% vs. 9.7%, p = 0.003), residual stones (35.0% vs. 22.6%, p = 0.002), Clavien-Dindo grade ≥ II complications (26.0% vs. 17.4%, p = 0.018), and trifecta failure (44.3% vs. 29.8%, p < 0.001). On multivariable analysis, MAP ≥ 3 independently predicted prolonged operative duration (OR 1.82, 95% CI 1.12-2.94, p = 0.015), hemoglobin decrease ≥ 2 g/dL (OR 2.42, 95% CI 1.62-3.60, p < 0.001), residual stones (OR 1.79, 95% CI 1.17-2.75, p = 0.007), trifecta failure (OR 1.75, 95% CI 1.17-2.61, p = 0.006), and Clavien-Dindo grade ≥ II complications (OR 1.43, 95% CI 1.05-2.17, p = 0.008). MAP score was not independently associated with secondary intervention, tubeless drainage, or overall postoperative complications. A high MAP score is independently associated with several markers of procedural difficulty during PNL, including prolonged operative time, clinically significant bleeding, residual stones, trifecta failure, and clinically relevant complications. These findings suggest that MAP score may function as an imaging biomarker of procedural burden and may complement existing stone-complexity scoring systems in preoperative risk stratification.</p>","PeriodicalId":23411,"journal":{"name":"Urolithiasis","volume":"54 1","pages":""},"PeriodicalIF":2.6,"publicationDate":"2026-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148892451","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":"Vacuum-assisted versus conventional percutaneous sheaths in pediatric supine mini-PCNL: a comparative analysis.","authors":"Bilge Turedi, Ali Sezer, Mehmet Serkan Ozkent, Mustafa Bilal Hamarat, Kemal Sarica","doi":"10.1007/s00240-026-02051-9","DOIUrl":"https://doi.org/10.1007/s00240-026-02051-9","url":null,"abstract":"<p><p>Vacuum-assisted access sheaths have recently gained interest in percutaneous stone surgery; however, data regarding their use in pediatric patients remain limited. This study compared the perioperative and postoperative outcomes of vacuum-assisted and conventional percutaneous access sheaths in pediatric patients undergoing supine mini-percutaneous nephrolithotomy. Medical records of children younger than 18 years who underwent supine mini-percutaneous nephrolithotomy between January 2022 and January 2026 were retrospectively reviewed. Patients with anatomical anomalies, bilateral procedures, multiple access tracts, or endoscopic combined intrarenal surgery were excluded. A total of 51 patients were included and divided into two groups according to sheath type: conventional percutaneous access sheaths (n = 27) and vacuum-assisted ClearPetra sheaths (n = 24). Baseline demographic and stone characteristics were comparable between the groups. Mean operative time was shorter in the vacuum-assisted group (57.6 ± 21 vs. 65.6 ± 24 min, p = 0.232), whereas fluoroscopy time was slightly longer (74.2 ± 65 vs. 60.6 ± 44 s, p = 0.387); neither difference reached statistical significance. Stone-free rates were comparable between the conventional and vacuum-assisted groups (85.2% vs. 91.7%, p = 0.473). Overall complication rates were low and similar (25.9% vs. 16.7%, p = 0.541). A lower rate of postoperative fever was observed in the vacuum-assisted group; however, this difference did not reach statistical significance (4.2% vs. 18.5%, p = 0.112). All cases resolved with medical treatment. No aspiration-related morbidity was observed. No statistically significant differences in operative or postoperative outcomes were observed between vacuum-assisted access using the ClearPetra sheath and conventional access sheaths in pediatric patients undergoing supine mini-percutaneous nephrolithotomy. Larger prospective studies are needed to determine whether vacuum-assisted access provides clinically meaningful advantages.</p>","PeriodicalId":23411,"journal":{"name":"Urolithiasis","volume":"54 1","pages":""},"PeriodicalIF":2.6,"publicationDate":"2026-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148892512","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":"Regional practice patterns and perceptions of ureteral stricture after ureteroscopy for ureteral stones: A survey study and expert recommendations.","authors":"Manaf Al Hashimi, Yasser Farahat, Ahmed Harraz, Vineet Gauhar, Amr Elsawy, Widi Atmoko","doi":"10.1007/s00240-026-02042-w","DOIUrl":"https://doi.org/10.1007/s00240-026-02042-w","url":null,"abstract":"<p><p>Ureteral stricture is a potentially serious complication following ureteroscopy (URS) for ureteral stones. In the absence of clear guideline recommendations, practices regarding risk factors, prevention, surveillance, and management remain heterogeneous. This study aimed to evaluate multinational urologists' perceptions and real-world practices related to post-URS ureteral strictures and to develop expert consensus recommendations. A multinational, web-based survey was distributed to practicing urologists worldwide through professional networks and platforms. The questionnaire assessed respondent demographics, URS case volume, perceived incidence and risk factors, preventive strategies, laser settings, postoperative surveillance, and management approaches. Data were analyzed using question-specific denominators. Expert consensus recommendations were developed through a structured Delphi process. A total of 362 urologists from 66 countries participated, with 80.1% performing > 50 URS procedures annually. Most respondents (56.0%) reported a low ureteral stricture incidence (1-2%), although 54.1% perceived an increasing trend. Only 39.0% consistently informed patients preoperatively about this risk. Prolonged stone impaction was identified as the most important risk factor, followed by surgeon experience. Most respondents (65.3%) believed pre-stenting reduces stricture risk. Postoperative imaging practices varied considerably, with 49.4% performing surveillance selectively in high-risk cases. Endoscopic treatment was perceived to have limited long-term success, with many patients ultimately requiring reconstructive surgery. Post-URS ureteral stricture remains an uncommon but clinically relevant complication influenced by procedural and surgeon-related factors. Considerable variability in practice highlights the need for standardized, evidence-based recommendations. The expert consensus developed in this study provides practical guidance to optimize patient outcomes.</p>","PeriodicalId":23411,"journal":{"name":"Urolithiasis","volume":"54 1","pages":""},"PeriodicalIF":2.6,"publicationDate":"2026-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148881582","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":"Novel non-contrast computed tomography parameters for predicting spontaneous stone passage and surgical requirement in ureteral stones: The role of ureteral wall thickness and dilatation ratio.","authors":"Yasin Aktaş, Arda Tongal, Ali Nihat Gökcan, Oğuzhan Ertan, Adem Tunçekin, Hakan Türk","doi":"10.1007/s00240-026-02033-x","DOIUrl":"https://doi.org/10.1007/s00240-026-02033-x","url":null,"abstract":"<p><p>We investigated the predictive value of standard non-contrast computed tomography (NCCT) measurements, the ureteral dilatation ratio (DDR) and intraluminal urine stasis markers, for spontaneous stone passage (SSP) versus surgical intervention in patients with ureteral stones. We also evaluated ureteral wall thickness (UWT) as a practical clinical marker. This retrospective study included 461 patients diagnosed with ureteral stones via NCCT. Patients were categorised into two groups based on clinical outcomes: the spontaneous passage group (MET; n = 229) and the endoscopic surgery group (URS; n = 232). Stone volume, stone density (HU), UWT, DDR and intraluminal urine attenuation values were measured for all patients. Independent risk factors were identified using a multivariate logistic regression model and clinical cut-off values were determined via ROC curve analysis. Stone volume, density, UWT and hydronephrosis grade were all significantly higher in the URS group. Multivariate regression analysis revealed that increased UWT (OR: 5.03, 95% CI: 3.66-6.90; p < 0.001) was the strongest independent predictor of surgery. Higher DDR (OR: 1.88; p = 0.003), advanced hydronephrosis, stone volume, and density also increased surgical risk. A UWT cut-off ≥ 2.97 mm predicted surgery with 84.8% sensitivity and 84.3% specificity (AUC: 0.872). A DDR cut-off > 1.79 yielded 81.7% specificity and 40.4% sensitivity. UWT weakly correlated with stone volume (r = 0.145), indicating wall thickening reflects an inflammatory response rather than a mere mechanical consequence. UWT is a superior predictor of SSP failure, supported by increased DDR as a highly specific complementary risk factor. These parameters could help clinicians to identify patients who would benefit from early surgical counselling and intervention rather than prolonged conservative management.</p>","PeriodicalId":23411,"journal":{"name":"Urolithiasis","volume":"54 1","pages":""},"PeriodicalIF":2.6,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148875609","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":"Physiologic age modifies the association between visceral fat predominance and urinary calcium excretion in adults with nephrolithiasis.","authors":"Xiaoming Cong, Jingya Chen, Jie Han, Liulin Li, Ping Zhou, Yan Xu","doi":"10.1007/s00240-026-02049-3","DOIUrl":"https://doi.org/10.1007/s00240-026-02049-3","url":null,"abstract":"<p><p>Although adiposity is associated with kidney stone disease, the relationship between abdominal fat distribution and urinary calcium excretion remains unclear. We investigated whether the CT-derived visceral-to-subcutaneous fat ratio (VSR) was associated with 24-hour urinary calcium excretion and whether physiologic age modified this association. This retrospective cross-sectional study included 308 adults with nephrolithiasis who underwent preoperative CT, stone removal, and postoperative metabolic evaluation. Participants were stratified into prespecified younger (men aged < 50 years and premenopausal women) and older (men aged ≥ 50 years and postmenopausal women) physiologic-age groups. Multivariable linear regression assessed the association between VSR and urinary calcium excretion and its modification by physiologic age. Results showed that VSR was not associated with urinary calcium excretion in the overall cohort, but its association differed significantly by physiologic age (P for interaction < 0.001). Among younger participants, each 1-unit higher VSR was associated with 2.07 mmol/day greater urinary calcium excretion (95% CI, 1.23-2.90), whereas no significant association was observed in the older group. These findings suggest that the metabolic relevance of visceral fat predominance differs by physiologic age, with a significant association observed only in younger adults. Prospective studies are needed to confirm these findings and determine their clinical implications.</p>","PeriodicalId":23411,"journal":{"name":"Urolithiasis","volume":"54 1","pages":""},"PeriodicalIF":2.6,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148875627","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":"Machine learning for predicting stone-free rate after retrograde intrarenal surgery: Comparison with the T.O.HO. score.","authors":"Hüseyin Mert Durak, Adem Sancı, Emre Hepşen, Metin Yığman, Kubilay Sarıkaya, Ahmet Nihat Karakoyunlu","doi":"10.1007/s00240-026-02039-5","DOIUrl":"https://doi.org/10.1007/s00240-026-02039-5","url":null,"abstract":"<p><p>Urolithiasis remains a significant clinical burden, and accurately predicting stone-free status after retrograde intrarenal surgery (RIRS) is essential for optimizing patient counseling and surgical planning. This study compared the predictive performance of a machine learning-based Random Forest (RF) model with the T.O.HO. scoring system, a traditional prediction tool designed for flexible ureteroscopy. A total of 452 patients who underwent RIRS for renal or proximal ureteral calculi at a single tertiary center were retrospectively analyzed. Preoperative demographic and radiological variables were collected, and postoperative stone-free status was assessed at the third week using KUB radiography or non-contrast CT when clinically indicated. The T.O.HO. score was calculated for each patient. The RF model was trained on 70% of the dataset and tested on the remaining 30%, using only preoperative variables, with model optimization performed within the training set using 5-fold cross-validation, and predictive performance evaluated through accuracy, sensitivity, specificity, F1-score, and receiver operating characteristic (ROC) analysis. The T.O.HO. score showed limited but statistically significant discrimination in this cohort. Higher T.O.HO. values were associated with a lower likelihood of postoperative stone-free status, indicating an inverse relationship between the score and surgical success. When interpreted accordingly for stone-free status prediction, the T.O.HO. score yielded an AUC of 0.615 (95% CI 0.556-0.674). In contrast, the RF model showed higher apparent internally validated discrimination, achieving an AUC of 0.843, an accuracy of 87.5%, a sensitivity of 98.1%, and a specificity of 53.1%. Feature importance analysis indicated that stone thickness, preoperative nephrostomy, stone length, stone width, and age contributed most significantly to the model's predictive ability. Overall, these findings suggest that a machine learning-based approach may provide complementary individualized risk stratification for postoperative stone-free status after RIRS when used alongside established clinical judgment and existing scoring systems. However, this model was developed and evaluated using internal validation only, and external prospective validation is required before its clinical implementation can be considered.</p>","PeriodicalId":23411,"journal":{"name":"Urolithiasis","volume":"54 1","pages":""},"PeriodicalIF":2.6,"publicationDate":"2026-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148866511","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":"Two decades of kidney stone interventional trials on clinicaltrials.gov: a registry-based landscape analysis of design, endpoints, and dissemination.","authors":"Yadong Lu, Donovan Watson, Jathin Bandari, Scott O Quarrier","doi":"10.1007/s00240-026-02048-4","DOIUrl":"10.1007/s00240-026-02048-4","url":null,"abstract":"<p><p>Despite major advances in kidney-stone management, the clinical-trial landscape in nephrolithiasis has not been systematically characterized. We performed a 20-year registry-based landscape analysis of interventional kidney-stone trials, focusing on trial design, primary endpoint selection, infrastructure, and dissemination. ClinicalTrials.gov was searched for interventional kidney-stone trials with primary completion dates between June 23, 2005 and June 23, 2025. Trials were categorized by lead sponsor type, study design, center status, intervention category, and primary endpoint domain. Temporal trends in primary endpoint selection were assessed by registration era. Publication status, ClinicalTrials.gov results posting, and intervals from registration to results posting, study start to publication, and primary completion to publication were evaluated among completed trials. A total of 57 trials met inclusion criteria. Most had an academic lead sponsor (49/57, 86.0%), were randomized (43/57, 75.4%), completed (51/57, 89.5%), single-center (38/57, 66.7%) and US-based (53/57, 93.0%). Medical/pharmacologic interventions were most common (33/57, 57.9%), followed by procedural/device-based (17/57, 29.8%) and preventive/behavioral/other interventions (7/57, 12.3%). Primary endpoints most often focused on stone-related efficacy (25/57, 43.9%), followed by pain/quality-of-life/patient-reported outcomes (16/57, 28.1%), complication/safety outcomes (9/57, 15.8%), and operational/resource-use outcomes (7/57, 12.3%). By registration era, stone-related efficacy endpoints declined from 69% in 2005-2015 to 23% in 2016-2025, while pain/quality-of-life endpoints increased from 15% to 39%. Female representation averaged 43.3%, with a median of 47.9%. In the 2-year publication-mature cohort, 39 of 49 trials (79.6%) were published; among all 51 completed trials, 41 (80.4%) were published. Median registration-to-results and study-start-to-publication intervals were 45 and 48 months, respectively, while the median primary-completion-to-publication interval was 15 months. Within ClinicalTrials.gov, interventional kidney-stone trials remain largely academic and single-center, reflecting active but fragmented research infrastructure within this registry. Although stone-related efficacy remains the dominant primary endpoint, recent trials show increasing emphasis on patient-centered primary outcomes. A persistent unpublished fraction and publication commonly occurring more than one year after primary completion highlight the need for multicenter collaboration, standardized patient-centered endpoints, and timely dissemination.</p>","PeriodicalId":23411,"journal":{"name":"Urolithiasis","volume":"54 1","pages":""},"PeriodicalIF":2.6,"publicationDate":"2026-08-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148860378","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":"Retrograde ureteral catheterization in percutaneous nephrolithotomy may be omitted in selected patients: a randomized controlled trial.","authors":"Shoule Wang, Baorong Feng, Haoyuan Liu, Yan Yang, Wen Zhong","doi":"10.1007/s00240-026-02040-y","DOIUrl":"10.1007/s00240-026-02040-y","url":null,"abstract":"<p><p>To evaluate the feasibility, safety, and efficacy of percutaneous nephrolithotomy (PCNL) performed without retrograde catheterization in the split-leg prone position in selected patients, a single-center, randomized controlled trial was carried out. 140 consecutive patients with renal stones > 2.0 cm were randomly assigned to either no ureteral catheterization split-leg prone position (NUC-SLP) group or the traditional position (TP) group, and underwent PCNL. The primary outcome was first access time. Secondary outcomes included operative time, anesthesia time, stone free rate (SFR), complications, and costs. It was noted in the RCT that, median first access time was comparable between the NUC-SLP and TP groups (10.5 [9.2, 12.5] min vs. 10.5 [8.5, 11.89] min; mean difference (MD) 0.66 min, 95% confidence interval (CI) -0.29 to 1.6; p > 0.05). The NUC-SLP group had shorter anesthesia time (77.07 ± 14.47 vs. 95.83 ± 12.22 min; MD -18.76 min, 95% CI -23.24 to -14.29; p < 0.001) and lower costs (22,053.76 ± 2,473.46 vs. 23,499.81 ± 3,863.34 Chinese Yuan (CNY), MD -1446.05 CNY, 95% CI -2531.86 to -360.23; p = 0.009). No significant difference was observed in the immediate or 1-month SFR, operative time or complications. In conclusion, retrograde ureteral catheterization may be omitted in selected patients undergoing PCNL, which simplifies the procedure, and reduces medical costs. Nevertheless, the applicability of these findings is constrained by the highly selective nature of the patient cohort (non-complex cases) and the substantial expertise of the senior endourologists, who are specifically adept at ultrasound-guided renal access and split-leg prone PCNL. Further multicenter studies involving surgeons with different levels of experience are required to validate these findings and define the optimal selection criteria.ClinicalTrials.gov: NCT06750913; April 8, 2026.</p>","PeriodicalId":23411,"journal":{"name":"Urolithiasis","volume":"54 1","pages":""},"PeriodicalIF":2.6,"publicationDate":"2026-08-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148857861","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":"Advancement speed and sheath caliber influence peak axial insertion force and ureteral injury during ureteral access sheath placement: an ex vivo porcine study.","authors":"Tianfu Ding, Zheng Xu, Daxun Luo, Yubao Liu, Jianxing Li","doi":"10.1007/s00240-026-02043-9","DOIUrl":"https://doi.org/10.1007/s00240-026-02043-9","url":null,"abstract":"<p><p>To evaluate the effects of ureteral access sheath (UAS) caliber and manually applied target advancement speed on peak axial insertion force and visible ureteral injury in an ex vivo porcine repeated-measures model. Bilateral kidney-ureter specimens from 15 pigs yielded 30 ureters. Ureters were allocated by calculator-generated random numbers to 10/12, 11/13, or 12/14 Fr UAS groups (10 ureters per caliber). Each ureter underwent three insertions, one under each target-speed condition (0.5, 1.0, and 2.0 cm/s), in randomized order, yielding 90 force measurements. Specimens were stored in normal saline at 4°C and tested within 6 h. Peak force was analyzed using a mixed repeated-measures factorial model. Visible injury was graded by three blinded senior urologists using the Post-Ureteroscopic Lesion Scale (PULS).UAS caliber (F[2,27]=38.49, P<0.001), target speed (F[2,54]=66.36, P<0.001), and the caliber × target-speed interaction (F[4,54]=8.31, P<0.001) significantly influenced peak force. Median force increased from 3.35 (IQR 2.24-3.40) N at 0.5 cm/s to 6.39 (5.85-6.76) N at 2.0 cm/s for 10/12 Fr UASs and from 4.87 (4.06-5.28) N to 7.24 (6.53-7.36) N for 11/13 Fr UASs; the speed effect was attenuated for 12/14 Fr UASs. Visible injury occurred in 0/30 (0%), 4/30 (13.3%), and 7/30 (23.3%) observations at 0.5, 1.0, and 2.0 cm/s, respectively (Cochran Q P=0.035). The 0.5 versus 2.0 cm/s paired comparison was significant after Holm adjustment (P=0.047). In exploratory generalized estimating equations, peak force was associated with visible injury (odds ratio per 1 N, 1.62; 95% CI 1.08-2.41; P=0.019), although the model was unadjusted and force distributions overlapped.UAS caliber, target advancement speed, and their interaction influenced peak insertion force. Visible injury increased across target-speed conditions, but a single peak-force value did not define a universal injury threshold. Slow, controlled advancement and use of the smallest clinically appropriate UAS remain prudent.</p>","PeriodicalId":23411,"journal":{"name":"Urolithiasis","volume":"54 1","pages":""},"PeriodicalIF":2.6,"publicationDate":"2026-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148841320","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":"Staghorn uric acid stones: oral chemolysis outcomes and development of a nomogram for treatment success.","authors":"Vigen Malkhasyan, Ali Talyshinskii, Bhaskar Kumar Somani, Vineet Gauhar, Nariman Gadzhiev, Dmitry Pushkar","doi":"10.1007/s00240-026-02036-8","DOIUrl":"10.1007/s00240-026-02036-8","url":null,"abstract":"<p><p>Oral chemolysis is an established non-surgical treatment for uric acid nephrolithiasis, but prospective data on its efficacy in staghorn calculi remain limited. This prospective study included 51 patients who underwent oral chemolysis with citrate mixtures. Baseline clinical, laboratory, and native computed tomography parameters were analyzed. Treatment response was assessed by follow-up imaging at 1, 3, and 6 months. The primary endpoint was complete stone dissolution. Logistic regression was used to identify independent predictors and develop a predictive nomogram. Complete stone dissolution was achieved in 33 patients (64.7%). Surgical treatment was required in 17 patients (33.3%). One patient (2.0%) discontinued therapy due to worsening comorbidities, did not undergo surgery, and was included in the final analysis as a treatment failure. Patients with complete dissolution had lower stone density and smaller baseline stone volume than non-responders. In multivariate analysis, both stone density and baseline stone volume independently predicted complete dissolution. Each 100 HU increase in stone density reduced the odds of complete dissolution (OR 0.42; 95% CI 0.18-0.98; p = 0.046), as did each 1 cm³ increase in baseline stone volume (OR 0.86; 95% CI 0.76-0.97; p = 0.011). The nomogram demonstrated good discriminatory performance, with an AUC of 0.796. Oral chemolysis may be an effective non-surgical option for selected patients with suspected staghorn uric acid nephrolithiasis, and baseline stone density and volume may help predict treatment success.Trial registration: ClinicalTrials.gov, NCT07162974, August 19, 2025.</p>","PeriodicalId":23411,"journal":{"name":"Urolithiasis","volume":"54 1","pages":""},"PeriodicalIF":2.6,"publicationDate":"2026-08-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148819714","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}