Single-Use vs. Reusable Digital Flexible Ureteroscope to Treat Upper Urinary Calculi: A Propensity-Score Matching Analysis

Objective: The purpose of this research was to compare the treatment outcomes and costs of a single-use and reusable digital flexible ureteroscope for upper urinary calculi.Methods: Four hundred forty patients with reusable digital flexible ureteroscope and 151 patients with single-use flexible digital ureteroscope were included in this study. Through exclusion and inclusion criteria and 1:1 propensity-score matching analysis based on baseline characteristics, ultimately, 238 patients (119:119) were compared in terms of treatment outcomes. The cost analysis was based on the costs of purchase, repair, and reprocessing divided by the number of all procedures in each group (450 procedures with reusable digital flexible ureteroscope and 160 procedures with single-use digital flexible ureteroscope).Results: There was no statistical significance in mean operation time (P = 0.666). The single-use digital flexible ureteroscope group has a shorter mean length of hospital stay than the reusable digital flexible ureteroscope group (P = 0.026). And the two groups have a similar incidence of postoperative complications (P = 0.678). No significant difference was observed in the final stone-free rate (P = 0.599) and the probability of secondary lithotripsy (P = 0.811) between the two groups. After 275 procedures, the total costs of a single-use flexible ureteroscope would exceed the reusable flexible ureteroscope.Conclusion: Our data demonstrated that the single-use digital flexible ureteroscope is an alternative to reusable digital flexible ureteroscopy in terms of surgical efficacy and safety for upper urinary calculi. In terms of the economics of the two types of equipment, institutions should consider their financial situation, the number of FURS procedures, the volume of the patient's calculus, surgeon experience, and local dealerships' annual maintenance contract when making the choice.

Analysis of the Application Value of X-Ray Digital Tomographic Fusion Technique in Urinary System Diseases

Objective. To explore the application value of the X-ray digital tomographic fusion technique in the diagnosis of urinary system diseases. Methods. 500 patients with suspected urinary diseases in our hospital were examined by three methods: X-ray digital tomographic fusion imaging (DTS), intravenous pyelography (IVP), and abdominal plain film (KUB), and the image quality before and after tomographic fusion was objectively evaluated. The image quality could be divided into three grades: excellent, good, and poor. Results. The image excellent rate of DTS (88%) was higher than that of IVP (27.5%). The sensitivity of DTS in the diagnosis of renal cyst and space occupying of the bladder was higher than that of IVP ( P < 0.05 ). The accuracy rate of DTS in the diagnosis of urinary calculi was 93.33%, higher than 63.3% of KUB ( P < 0.001 ). The accuracy rate of DTS in the diagnosis of ureteral stricture was 90%, higher than 65% of IVP ( P = 0.03 ). The accuracy of DTS in the diagnosis of hydronephrosis was higher than that of IVP and KUB ( P < 0.05 ). Conclusion. In the examination of urinary system-related diseases, high-definition images can be obtained by timely using sectional fusion technology. Compared with conventional IVP, space occupying lesions such as the bladder and kidney can be displayed more clearly with the help of the tomographic fusion technique, which is helpful to improve the possibility of finding lesions and is of great significance in clinical application.

Pediatric Bladder Stone in Secondary Hospital Care Setting: A Case Report

Bladder Stone is a rare disease accounting for 5% of all urinary calculi. It more common in middle and low-income countries due to nutritional obstacles, water sanitation, and warm climates. Prompt diagnosis and management of pediatric bladder stones are essential for preventing recurrence stones and improving quality of life. It has several surgical approaches. The objective is reporting a child with a bladder stone that came to secondary hospital setting and the best management based on it. This report is qualitative observational study. Material came from direct interview and from medical record. The stone successfully managed with open cystolithotomy.

Preliminary Data on Geochemical Characteristics of Major and Trace Elements in Typical Biominerals: From the Perspective of Human Kidney Stones

The chemical composition of biominerals is essential for understanding biomineral formation and is regarded as an attractive subject in bio-mineralogical research on human kidney stones (urinary calculi). In order to obtain more geochemically interpreted data on biogenic minerals, mineralogical compositions and major and trace element concentrations of sixty-six kidney stone samples derived from kidney stone removal surgeries were measured. Infrared spectroscopy results showed that calcium oxalate monohydrate (COM) and calcium oxalate dihydrate (COD) were the two main mineral components of kidney stones. Geochemical results indicated that major and trace element concentrations were present in the following order: Ca > Mg > Na > K > Zn > Fe > Pb > Ba > Cu > Ti > Mo > Cd > Cr. With the exception of Ca, Mg was the second-most abundant element. Zn exhibited higher concentrations relative to other trace elements, which suggests a potential substitution of calcium by metal ions with a similar charge and radius rather than by metals in kidney stone formation. Pb appeared in significantly higher concentrations than in previous studies, which indicates Pb enrichment in the environment. In order to discern multi-element relationships within kidney stones, principal component analysis was applied. Three principal components (PCs, eigenvalues >1) were extracted to explain 64.4% of the total variance. The first component exhibited positively correlated Na-Zn-Cr-Mo-Cd-Pb, while the second component exhibited more positively weighted Mg-K-Ba-Ti. Fe-Cu demonstrated a positive correlation in the third component. This study suggests that Ca exhibits a preference for uptake by oxalates during human urinary stone crystallization, while other alkali metals and alkaline earth metals precipitate with phosphate.

High-Throughput in vitro Gel-Based Plate Assay to Screen for Calcium Oxalate Stone Inhibitors

<b><i>Objective:</i></b> Kidney stones are a common medical condition that is increasing in prevalence worldwide. Approximately, ∼80% of urinary calculi are composed of calcium oxalate (CaOx). There is a growing interest toward identifying therapeutic compounds that can inhibit the formation of CaOx crystals. However, some chemicals (e.g., antibiotics and bacterial metabolites) may directly promote crystallization. Current knowledge is limited regarding crystal promoters and inhibitors. Thus, we have developed an in vitro gel-based diffusion model to screen for substances that directly influence CaOx crystal formation. <b><i>Materials and Methods:</i></b> We used double diffusion of sodium oxalate and calcium chloride-loaded paper disks along an agar medium to facilitate the controlled formation of monohydrate and dihydrate CaOx crystals. A third disk was used for the perpendicular diffusion of a test substance to assess its influence on CaOx crystal formation. <b><i>Results:</i></b> We confirmed that citrates and magnesium are effective inhibitors of CaOx crystals. We also demonstrated that 2 strains of uropathogenic <i>Escherichia coli</i> are able to promote crystal formation. While the other tested uropathogens and most antibiotics did not change crystal formation, ampicillin was able to reduce crystallization. <b><i>Conclusion:</i></b> We have developed an inexpensive and high-throughput model to evaluate substances that influence CaOx crystallization.

Augmentation uretero-enterocystoplasty for refractory urinary tract dysfunction: a long-term retrospective study

Objectives To report the long-term efficacy and complications of the augmentation uretero-enterocystoplasty (AUEC), including augmentation cystoplasty with simultaneous ureteroplasty and ureteral anti-reflux implantation in a single center. Methods We retrospectively reviewed clinical records, video-urodynamic data, and magnetic resonance urography of 210 patients who underwent the procedure for refractory lower urinary tract dysfunction (LUTD) from 2003 to 2019. International vesicoureteral reflux (VUR) and upper urinary tract dilatation (UUTD) grading systems were applied to assess upper urinary tract function, and post-operative complications were assessed. Results Mean age was 28.1 years, with a mean follow-up time of 57.4 months. A total of 338 ureters were simultaneously re-implanted, and ureteroplasty was performed on all ureters. There was a significant postoperative improvement in the bladder capacity, intravesical pressure, and compliance (P < 0.05). VUR improvement rate was 97.7% and postoperative improvement of UUTD presented in 72.5% ureters. Mean serum creatinine (Scr) level was significantly improved compared to preoperative Scr values (226.0 ± 89.4 μmol/L vs. 217.5 ± 133.9 umol/L, P < 0.05). The 1.0% patients had unacceptably postoperative urinary incontinence and 85.4% preoperative megaureters were improved. Primary complications included metabolic acidosis (9.5%), vesicoureteral anastomosis stenosis (6.2%), persistent VUR (2.7%), urinary calculi (6.6%), and intestinal dysfunction requiring laparotomy (3.3%). Conclusion In the study, a large series of patients treated with a complex surgical procedure was reported. It is novel, as this case series represents patients with aggressive surgical correction of VUR, ureteral tortuosity and upper tract dilation at the time of AC. AUEC was shown to have a positive role in treating patients with refractory LUTD associated with hydronephrosis and ureteral dilatation, stenosis or obstruction, with or without high- or low-pressure VUR. It was effective in improving renal function and protecting the UUT function from further deterioration in most patients with renal insufficiency.

UNDERSTANDING THE ETIOPATHOGENESIS AND PATHOPHYSIOLOGY OF RENAL CALCULI

Calculus (Stone) is a polycrystalline aggregate made up of different quantities of the crystalloid and organic matrix. Urine calculus is a stone-like formation made up of urine salts held together by a colloid matrix or organic elements. It has a nucleus or nidus around which concentric layers of urinary salts are formed, giving it a stone-like appear- ance. Urolithiasis (from Greek oûron, "urine," and lithos, "stone") is a urinary system pathology in which urinary crystalloids clump together anywhere in the urinary tract, from the kidney to the bladder. The kidneys play a critical role in excreting waste products from the body, but various problems can disrupt the urinary system's crucial activ- ities and cause illnesses, one of which is urolithiasis. Urinary calculi are worldwide in distribution but are particu- larly common in some geographic locations such as in parts of the United States, South Africa, India and South- East Asia. Renal calculi are characterised clinically by colicky pain (renal colic) as they pass down along the ureter and manifest by haematuria. This article focuses on the etiopathogenesis of Renal Stone, predisposing factors, and its pathophysiology for a better understanding of the disease so that its formation can be prevented, and the formed calculi can be treated with better knowledge. Keywords: Urinary Stones, Oxalates, Predisposing factors: urinary crystalloids, Hyperoxaluria, Hypercalciuria, Super-Saturation Theory, Nucleation Theory, Randall’s plaque