Efficacy and safety of 3D printing-assisted percutaneous nephrolithotomy in complex renal calculi

This study evaluated the efficacy and safety of 3D printing technology combined with percutaneous nephrolithotomy in the treatment of complex renal calculi. Ninety patients with complex renal calculi were randomly divided into a 3D printing group (45 patients) and a control group (45 patients). In the 3D printing group, a patient-specific 1:1 3D printing model was established based on the patient's thin-layer CT scanning data. A 3D printing model was used for preoperative communication between doctors and patients. Preoperative puncture training, channel design, residual stone prediction, and percutaneous nephrolithotomy were performed under the guidance of a 3D printing model and B-ultrasound. The control group was treated with the conventional B-ultrasound-guided puncture method. Results suggest that there was a statistically significant difference between the two groups (P < 0.05). The overall score of the doctor-patient communication objects in the 3D printing group was 19.32 ± 1.57 points, and in the control group, it was 14.51 ± 2.13 points. The operation time of the 3D printing group was 103.21 ± 13.49 min, and that of the control group was 126.12 ± 25.87 min. The calculi clearance rate of the 3D printing group was 96%, while that of the control group was 80%. The incidence of postoperative complications was 6.67% in the 3D printing group and 22.22% in the control group. Compared with traditional percutaneous nephrolithotomy, 3D printing technology combined with percutaneous nephrolithotomy can significantly enhance the effectiveness of doctor–patient communication, shorten operation time, reduce operation bleeding, improve the stone clearance rate, reduce the incidence of complications and shorten the length of hospital stay. The proposed method is thus a safe and effective method to treat complex renal calculi.

An Epidemiological Study of Kidney Calculi in Western Guangdong

Objective: To investigate the risk factors of kidney calculi in its high prevalence areas of western Guangdong, and provide the proper prevention measures. Methods: A cross-sectional survey was conducted among individuals in Maoming, western Guangdong. Univariate and Poisson regression analyses were applied to investigate the influence of the epidemiology, lifestyle, and environmental factors on renal calculi. Risk ratios with 95% confidence interval were used to estimate the association between the investigated factors and the prevalence of renal calculi. Results: 500 questionnaires were sent out and 481 valid questionnaires were recycled. Among 481 respondents, 84 had renal calculi with a prevalence rate of 17.46%. Univariate regression analysis showed statistically significant differences in the prevalence of renal calculi among different groups of sex, ages, family history of kidney calculi, diet and drinking habit. Poisson regression analysis showed that daily water intake and drinking boiled water were protective factors, while male, family history of kidney calculi, diet high in protein, sugar, vitamin C and calcium were risk factors. Additionally, high sugar diet was not statistically significantly associated with the occurrence of renal calculi. Conclusion: The occurrence of kidney calculi in western Guangdong is closely related to demographic characteristics of individuals, living and dietary habits of the resident populations.

Primary renal leiomyosarcoma: A rare case report

Leiomyosarcoma of the kidney is a rare type of adult renal sarcoma. Here, we presented a case of a 68-year-old female who had a past history of bilateral renal calculi 3 years back with hydronephrotic changes, now presented to the OPD with complaints of abdominal pain for the past few months. On further evaluation, a heterogeneously enhancing necrotic mass was identified in the right kidney measuring 7.5 cm in the greatest dimension. A right radical nephrectomy with left Double J stenting was done. From histopathological and immunohistochemical staining, it was diagnosed as leiomyosarcoma.

16S rRNA Gene Sequencing Reveals Altered Composition of Gut Microbiota in Postoperative Individuals With Renal Stones

BackgroundRenal stones are a common urological disease with high prevalence and recurrence rates. Characterizing gut microbiome profiles of first-onset renal calculi patients, both before and after surgery, may provide valuable insights and identify potential biomarkers for the disease. MethodsWe explored the associations between the gut microbiome and renal stone formation using 16S ribosomal RNA (rRNA) gene sequencing. In brief, 20 patients were recruited, and information on health and eating habits within the previous 1-3 months was collected upon admission.ResultsA total of 493 OTUs were detected in 40 specimens, with an average of 67,888 ± 827 reads per sample. The results of OUT-based PLS-DA analysis showed significant differences between RS1 and RS2 groups, with a significantly higher level of OTU7 in the RS2 group. Taxonomy‑based comparisons of the gut microbiome showed differences in the flora composition, with the prevalence of Enterobacteriales, Enterobacteriaceae, Gammaproteobacteria, and Escherichia being higher in the RS2 group and the prevalence of Pseudomonadaceae, Pseudomonadales, and Pseudomonas being higher in the RS1 group.ConclusionsThese data strongly suggest that the gut microbiome affects kidney stone formation, and these findings may provide new insights for the prevention, diagnosis, and treatment of renal stones.

Efficacy of Tamsulosin as Compared to Placebo, in Reducing Post Operative Flank Pain during Voiding, in Patients with Ureteric Stent

Objective: To evaluate the efficacy of tamsulosin in reducing post operative flank pain during voiding, in patients with ureteric stent. Study Design: This is a Randomized control trial (RCT) study. Place and Duration: Study carried out at Department of Urology, Jinnah Post Graduate Medical Centre, Hospital, Karachi, Pakistan, from June 2016 to November 2016. Methodology: 60 patients aged between 15 – 45years, undergone placement of ureteric stent to treat ureteric and renal calculi and have pain score >4, were included in the study. Divided into two groups ‘group A’ and ‘group B’. In group ‘A’ and group ‘B’ Tamsulosin and Placebo was given respectively in patients with ureteric stent and reduction in post-operative flank pain was measured and compared. Tamsulosin was given post operatively when NPO is broken after 2 hours – 6 hours. Patients having uretral trauma, patients having BPH, patient underwent TURP or TURBT, patent having urinary tract infection and patients with pregnancy or lactating females were excluded. All patients were received intravenous antibiotic (Ceftrixone 1gr). Also all patients were receive oral analgesic (diclofenic sodium 50mg BID) and antispasmodics (Drotaverine 80mg BID). Patients were discharged after 24 hours. Postoperatively stent related flank pain during voiding was assessed via Pain Scale. Results: 60 Patients who got operated for ureteric stent. In group ‘A’ there were 21 males (70%) and 9 females (30%), the mean age of group A was 35.67±5.99 as In group ‘B’ there were of 21 males (70%) and 9 females (30%) and mean age of group B was 35.04±6.42 (Table 1). Mean Pain score in ‘Group A’ (Tamsulosin) in week 1, 2, 3, 4, 5, 6 was 4.1, 3.5, 2.9, 2.3, 1.9, 1.3 respectively as shown in Table 2. Mean Pain score in ‘group B’ (Placebo) in week1, 2, 3, 4, 5, 6 was 6.9, 6.3, 5.9, 5.6, 5, 4.2 respectively as shown in Table 2. Average pain score in ‘group A’ and ‘group B’ came out to be 2.67 and 5.64 respectively (P value 0.005). Conclusion: Alpha blockers reduces the post-operative flank pain and voiding complaints in patients with ureteric stent. Our study shows that the efficacy of Tamsulosin in reducing post-operatice flank pain in patients with uretercic stent is better than placebo.

Association between aortic calcification and the presence of kidney stones: calcium oxalate calculi in focus

Purpose The current research is aimed at analyzing the relationship between kidney stone (KS) and abdominal aortic calcification (AAC) and the relationship between KS components and AAC. Methods This is a retrospective, case–control study. Kidney stone formers (KSFs) were treated at the Department of Urology, West China Hospital, Sichuan University for urological calculus disease from January 2014 to January 2020. Matched non-stone formers (non-SFs) were drawn from the same hospital for routine health examination from January 2018 to February 2019. Research-related information was collected and reviewed retrospectively from the hospital’s computerized records. AAC were evaluated using available results of computed tomography imaging and abdominal vascular ultrasound. The relationships of AAC between KSFs and non-SFs were compared. The composition of renal calculi was analyzed by Fourier-transform infrared spectrophotometer. KSFs were divided into AAC groups and non-AAC based on AAC. The relationship of the composition of renal calculi between AAC and non-AAC were compared. The independent-sample t test, the chi-squared test and binary logistics regression were performed. Results Altogether, 4516 people were included, with 1027 KSFs and 3489 non-SFs. There were no significant differences in the laboratory parameters between KSFs and non-SFs. The association between the presence of AAC and KS was significant in multivariable model 2 [adjusting hypertension, diabetes mellitus, fasting blood glucose, uric acid, serum triglyceride (TG), serum calcium, and urine pH] (OR 5.756, 95% CI 4.616–7.177, p < 0.001). The result of KSFs showed that calcium oxalate calculi (CaOx) was significantly associated with AAC in multivariable model 3 (adjusting age, hypertension, diabetes mellitus, drinking history, smoking history, and TG) (OR 1.351, 95% CI 1.002–1.822, p = 0.048). Conclusions The current study pioneered the revelation of the relationship between CaOx and AAC. Through an elimination of the confounding factors, the study demonstrated that KS and AAC were connected.

Contrast Agent Mimicking Calculi in Entrapped Calyx. A Report of a Case

Urolithiasis is a common condition, and it represents a large number of hospital visits. Under the term infundibulopelvic dysgenesis, many conditions amongst a spectrum of congenital disorders of the pelvicalyceal system are described. Retrograde intrarenal surgery (RIRS) is an effective and safe treatment modality in the management of urinary system stone disease. Fluoroscopic imaging is a cornerstone in endourology. Herein, we present a case where we diagnosed an obstructed calyx during RIRS for renal calculi and operated on it. In this extraordinary case, contrast agent was trapped in the calyx mimicking a renal stone and that was the reason that we discovered the infundibular stenosis. The patient, 24 h after the operation, left the hospital without any complications reported.

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

Role of routine urine culture in predicting asymptomatic bacteriuria in pregnancy and the prevalence of asymptomatic bacteriuria in pregnant women - Our experience

Asymptomatic bacteriuria (ASB) in pregnancy can flare into frank pyelonephritis and sepsis if untreated due to the low immunity. Apart from causing morbidity in mothers it affects the foetus by increasing the incidence of prematurity and IUGR. The present study was undertaken to determine the prevalence of ASB in the pregnant women attending Ante natal clinic and the significance of routine urine culture. : Total 310 pregnant women attending the antenatal OPD were enrolled in the study over a period of 10 months. Inclusion criteria included all pregnant women attending antenatal OPD without any urinary symptoms or history of fever. Exclusion criteria included frank UTI symptoms like fever, dysuria, increased frequency of urine, any history of intake of antibiotics, any urinary tract anomaly or renal calculi. Their midstream urine sampling was collected and subjected to both microscopy and culture sensitivity; standard microbiological method was used. The prevalence of ASB was found to be 11.29% and was maximum in second trimester (54.2%). The study revealed routine urine culture is a sensitive test to diagnose ASB. The commonest bacterium isolated was Escherichia coli (51.4% cases) and the most effective antibiotic was Nitrofurantoin. The neonatal outcomes are discussed in the text while no perinatal deaths were recorded during the period of study. No direct association of asymptomatic bacteriuria with anaemia and preeclampsia was found, but odds ratio was more than one. The study highlights that asymptomatic bacteriuria is a common occurrence in pregnant women, including urine culture as a part of routine investigation in antenatal patients can help diagnose this condition. Prompt treatment of ASB can prevent any obstetric complication arising from the flareup of asymptomatic bacteriuria in pregnancy and thus reduce maternal and foetal morbidity.