Urolithiasis最新文献

{"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}

{"title":"Assessing the predictive value of scoring systems for stone-free success outcomes in pediatric mini percutaneous nephrolithotomy: a comprehensive retrospective analysis.","authors":"Adem Altunkol, Ergün Alma, Hakan Anıl, Mert Hamza Özbilen, Buğra Aksay, Mehmet Eflatun Deniz","doi":"10.1007/s00240-025-01762-9","DOIUrl":"https://doi.org/10.1007/s00240-025-01762-9","url":null,"abstract":"<p><p>Kidney stone disease is relatively uncommon in pediatric populations, although its incidence has been steadily increasing in endemic regions. Mini-percutaneous nephrolithotomy (mini-PCNL), considered the most suitable approach for the treatment of large kidney stones, offers a minimally invasive option with fewer complications. This study evaluates the predictive accuracy of the STONE, Guy's Stone Score, and stone-kidney size (SKS) scoring systems in determining stone-free rates following pediatric mini-PCNL procedures. In this retrospective analysis, data were reviewed from 79 individuals younger than 18 who received mini-PCNL treatment from January 2021 to June 2024. Patients were evaluated as residual group and stone-free group. The diagnostic performance of the nomograms in detecting residual stones was evaluated using ROC analysis, and predictive factors for stone-free success were identified through logistic regression modeling. Guy's score (cut-off 1.5) had 79.3% sensitivity, 70% specificity, and AUC 0.817. The STONE score (cut-off 5.5) showed 69% sensitivity, 68% specificity, and AUC 0.741. SKS score (cut-off 3.5) resulted in 62.1% sensitivity, 78% specificity, and AUC 0.768. Logistic regression found stone size (OR: 1.137, p < 0.001) and volume (OR: 1.001, p < 0.001) were linked to stone-free success. Guy's score (OR: 5.438, p < 0.001), STONE score (OR: 1.741, p < 0.001), and SKS (OR: 3.972, p < 0.001) were strong predictors, but in multivariate analysis, only Guy's score (OR: 3.701, p = 0.010) remained significant. The results of our study demonstrate that the Guy's stone score is the most reliable prognostic tool for predicting stone-free success in pediatric patients undergoing mini-PCNL. Moreover, variables such as stone size and volume exert a substantial influence on the surgical outcomes.</p>","PeriodicalId":23411,"journal":{"name":"Urolithiasis","volume":"53 1","pages":"90"},"PeriodicalIF":2.0,"publicationDate":"2025-05-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144029644","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":"Kidney stones and oxidative stress. Types of papillary renal calculi.","authors":"F Grases, A Costa-Bauzá","doi":"10.1007/s00240-025-01746-9","DOIUrl":"10.1007/s00240-025-01746-9","url":null,"abstract":"<p><p>Reactive oxygen species can promote the formation of kidney stones, and this process requires the participation of cells associated with the renal papilla. Here, we present a revised interpretation of the characteristics of the different types of renal papillary stones and the possible pathways responsible for their formation. We examined kidney stones from a biobank that contains 15,000 stones and identified five different types of papillary stones. Type I stones are calcium oxalate monohydrate (COM) stones that clearly have Randall's plaque but have no renal tubules near the stone-tissue junction. Type II stones are COM stones that have Randall's plaque and calcified renal tubules around the stone-tissue junction. Type III stones are calcium oxalate dihydrate (COD) stones that have a stone-tissue junction and calcified renal tubules. Type IV stones are COM stones containing important deposits of uric acid and/or Na or K urates that occur around stone-tissue junction, together with apatite phosphate, and may also contain bacterial imprints. Type V stones are small COM calculi that have no hydroxyapatite deposits at the stone-tissue junction. Oxidative stress of papillary tissues can generate heterogeneous nucleants that promote the crystallization of calcium phosphate and calcium oxalate, and urine composition determines the type of papillary stone ultimately develops. An active immune response can limit or prevent the development of these stones by eliminating the intra-tissue hydroxyapatite deposits or promoting the regeneration of the outer uroepithelium.</p>","PeriodicalId":23411,"journal":{"name":"Urolithiasis","volume":"53 1","pages":"88"},"PeriodicalIF":2.0,"publicationDate":"2025-05-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12075020/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144034132","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":"Increased risk of upper tract urothelial carcinoma in patients with kidney stones: a large-scale analysis of the UK biobank.","authors":"Hachem Ziadeh, Adam Calaway, Sanjay Gupta, Donald Bodner, Jason R Brown, Fredrick R Schumacher, Chen-Han Wilfred Wu","doi":"10.1007/s00240-025-01758-5","DOIUrl":"https://doi.org/10.1007/s00240-025-01758-5","url":null,"abstract":"<p><p>Kidney stone disease is a common and increasingly prevalent condition, with its incidence rising by 70% over the past two decades in the U.S. Lodgment of stones within the ureteral wall can cause urothelial injury, triggering inflammation, edema, and obstruction. Chronic inflammation has been linked to cancer development, contributing to tumorigenesis through cellular transformation, proliferation, invasion, angiogenesis, and metastasis. Studies suggest that recurrent nephrolithiasis can lead to a range of complications, including an increased risk of urinary tract cancer. This study investigates the association between kidney and ureteral stones and upper tract urothelial carcinoma (UTUC) risk using data from 502,144 individuals in the UK Biobank. We bidirectionally examined the presence of kidney stones and UTUC, applying a chi-square test to compute the odds ratio and assess statistical significance. A history of kidney stones was noted in 13,016 individuals, while 489,128 were stone-free. Among 511 UTUC cases, 50 had a history of kidney stones, whereas 461 were isolated UTUC. In contrast, 12,966 individuals had kidney stones without UTUC, and 488,667 were free of both conditions. Statistical analysis revealed an increased risk of UTUC in individuals with kidney stones [OR = 4.09 (95% CI 3.05-5.48), p < 0.001], indicating strong statistical significance. Our study demonstrates a fourfold increased risk of UTUC in individuals with a history of kidney stones. These findings highlight a significant association between kidney stones and UTUC, underscoring the need for further research on clinical management and cancer surveillance.</p>","PeriodicalId":23411,"journal":{"name":"Urolithiasis","volume":"53 1","pages":"87"},"PeriodicalIF":2.0,"publicationDate":"2025-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143997469","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":"Commentary on\"Evaluating the natural history of incidentally recognized clinically silent nephrolithiasis in healthy adults: an updated systematic review with meta-analysis\".","authors":"Zheng Wang, Jinxing Huang, Xierzhati Aizezi","doi":"10.1007/s00240-025-01759-4","DOIUrl":"https://doi.org/10.1007/s00240-025-01759-4","url":null,"abstract":"","PeriodicalId":23411,"journal":{"name":"Urolithiasis","volume":"53 1","pages":"86"},"PeriodicalIF":2.0,"publicationDate":"2025-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144016512","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":"Assessment of a novel bendable-tip ureteral access sheath with integrated suction: an in vitro study.","authors":"Mario Basulto-Martínez, John Denstedt","doi":"10.1007/s00240-025-01753-w","DOIUrl":"https://doi.org/10.1007/s00240-025-01753-w","url":null,"abstract":"<p><p>Surgical management of urinary stones has significantly evolved with the advent of extracorporeal shockwave lithotripsy, flexible ureterorenoscopy (fURS), and percutaneous nephrolithotomy. For lower pole stones larger than 1 cm, the choice between fURS and miniaturized percutaneous nephrolithotomy remains debated. fURS with ureteric access sheaths (UAS) is a widely utilized technique, but fragment clearance is challenging in unfavorable anatomical conditions and/or lower pole stones. This study compares a novel flexible suction UAS (FANS) with a standard UAS in an in vitro model of lower pole stones. An in vitro experiment was conducted using an anatomical model of the urinary tract with artificial stones simulating complex 1-cm lower pole stones. Fourteen procedures were performed using either a 12/14 Fr diameter standard UAS or FANS. Every experiment was performed by a single surgeon using a 8.4 Fr single-use digital flexible ureteroscope and holmium:YAG laser set at 0.5 J, 25 Hz, and short pulse with a 272 μm fiber. Operative times, stone clearance rates, lasering times, were recorded and the residual stone masses (> 2 mm) was quantified. Complete stone clearance was achieved in 5 out of 7 procedures using FANS while no complete stone clearance was achieved using the standard UAS. The median laser time [27:33 (26:06-28:24) vs 24:02 (21:25-25:04) mm:ss, p = 0.017] and total energy output energy [20663 (19,575-21,325) vs 18,270 (16,069-18,931) J, p = 0.017] were significantly lower in the FANS group (p = 0.017), and the operative time was comparable. This in vitro experiment suggests that fURS with novel FANS may improve stone clearance and improve laser efficiency when compared to the standard UAS, without increasing operative times. Further clinical trials are warranted to confirm these findings.</p>","PeriodicalId":23411,"journal":{"name":"Urolithiasis","volume":"53 1","pages":"85"},"PeriodicalIF":2.0,"publicationDate":"2025-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144047318","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":"Correction: Advances in the mechanism of urinary proteins in calcium oxalate kidney stone formation.","authors":"Mingcheng Shi, Xiaozhe Su, Heng Xiang, Qianlin Song, Sixing Yang","doi":"10.1007/s00240-025-01729-w","DOIUrl":"https://doi.org/10.1007/s00240-025-01729-w","url":null,"abstract":"","PeriodicalId":23411,"journal":{"name":"Urolithiasis","volume":"53 1","pages":"84"},"PeriodicalIF":2.0,"publicationDate":"2025-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144050334","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}