Acute kidney injury due to ammonium acid urate stones in a patient with adenovirus gastroenteritis: a case report

Background Adenovirus gastroenteritis is a common cause of diarrhea and vomiting in infants, resulting in prerenal acute kidney injury (AKI). However, postrenal AKI due to urinary stones associated with adenovirus gastroenteritis is extremely rare. Here, we describe postrenal AKI due to obstructive ammonium acid urate stones associated with adenovirus gastroenteritis. Case presentation A previously healthy 6-month-old boy had an 11-day history of severe diarrhea and a 5-day history of vomiting. His stool was positive for adenovirus antigens. We initiated fluid replacement therapy. On the second hospital day, he suddenly developed anuria. Abdominal computed tomography revealed bilateral hydronephrosis, left ureteral stones, and right bladder ureteral junction stones. Laboratory data showed that the creatinine level increased to 1.00 mg/dL. We diagnosed postrenal AKI due to obstructive bilateral urinary stones. Urination with stable urine volume resumed spontaneously after hydration. A few stones were found in the urine, which consisted of ammonium acid urate (> 98%). The serum creatinine level improved to 0.25 mg/dL. He was discharged nine days after admission. Conclusions We suggest that adenovirus gastroenteritis be considered in pediatric patients with postrenal AKI due to urinary stones.

USAGE OF SUPPORTING PAD FOR SUPINE PCNL: A SINGLE CENTER EXPERIENCE

Objective: This study aims to compare the safety, efficacy, and other surgical outcomes of supine PCNLs performed with and without the use of supporting pad. Material & Methods: We enrolled 27 patients who undergone PCNL procedure with supine position for renal stones with all sizes between January - December 2019. Divided into two groups, operated with and without supporting pad, with 13 and 14 patients respectively. Inclusion criteria are patients with renal stones, including staghorn, multiple calyx, and proximal ureteral stones. Meanwhile, pediatric patients under 12 years old, uncorrectable bleeding disorders, active urinary infection, and pregnancy are excluded. Results: Our observation showed no statistically significant difference between the two groups, although blood loss and length of stay in supporting pad showed better results. A statistically significant difference was found in stone-free-rate (P = 0.006) favoring in supine PCNL with supporting pad. Conclusion: Supine PCNL with support padding may be a safe and more effective choice to treat renal stones. Nevertheless, the patient’s anatomic variations may influence this. Thus, a prospective study with a larger population is needed to verify our outcomes.

What is the role of inflammatory markers in predicting spontaneous ureteral stone passage?

Purpose: To investigate the role of inflammatory markers in predicting the spontaneous passage of ureteral stones. Methods: We retrospectively reviewed 279 patients with ureteral stones sized 4–10 mm that were managed conservatively. The patients were divided into two groups: Group 1 consisted of 137 patients who passed the stone spontaneously; Group 2 comprised 142 patients without spontaneous stone passage. The groups were compared using the Mann-Whitney U and chi-square tests. In addition, univariate and multivariate analyses were performed to identify the significance of the parameters. Results: The mean age of the patients was 41.2 years. The patients in Group 1 had a significantly lower mean stone size, white blood cell count and neutrophil count. In addition, stone location, presence of hydronephrosis and history of urolithiasis were significantly different between the groups. Neutrophil percentage, neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio were insignificantly lower in Group 1. In a multivariate analysis, stone size, distal location and hydronephrosis status significantly predicted the spontaneous stone passage. However, inflammatory markers including white blood cell count, neutrophil count and neutrophil-to-lymphocyte ratio could not determine the likelihood of spontaneous stone passage. Conclusion: Our results suggest that inflammatory markers are no meaningful parameters for the prediction of spontaneous stone passage.

ROLE OF ALPHA BLOCKER IN URETERORENOSCOPY.

Objective: To determine the efficacy of alpha blockers in successful management of lower and mid ureteral stones by ureterorenoscopy. Study Design: Comparative prospective study. Place and Duration of Study: Department of Urology, Combined Military Hospital Quetta Pakistan, from Jul 2018 to Dec 2019. Methodology: Total of 150 patients having mid and lower ureteric calculi requiring ureterorenoscopy were divided into two groups. Group A included patients without pre-treatment with alpha blocker was administered before they were subjected to ureterorenoscopy. Study group B included patients who received daily oral dose of alpha blocker, Tamsulosin 0.4 mg twice daily, for 1 week before ureterorenoscopy. Per-operative findings in both the groups were recorded. Results were analyzed by comparing the outcome between both groups in terms of ease of performing procedure, duration of procedure, complications, duration of hospital stay and need for stent placement. Results: Mean operative time was significantly shorter in group B as compared to group A, (15.9 ± 3.81 min vs. 21.9 ± 3.63 min; p≤0.001). Demographic and stone characteristics were comparable between the both groups. Success rate was 74 (98.7%), in group B as compared to 68 (90.7%) in group A, with statistically significant difference (p=0.020). Complications in group B were less frequent 1 (1.3%) vs 7 (9.3%) in group A (p-value=0.027). Conclusion: Use of alpha blockers for one week before performing ureterorenoscopy resulted in fewer complications and made the procedure easier to perform as well.

Comparison of Fragmentation and Dusting Laser Modes for Laser Ureteroscopy Lithotripsy of Ureteral Stones at a Single Center

Background Laser ureteroscopic lithotripsy (URSL) is an efficacious treatment for ureteral stones. There have been few previous studies compared the different energy and frequency settings for URSL in a single center. The fragmentation and dusting laser mode were simultaneously used in our medical center. We compared the efficacy and outcomes of these two laser modalities for the treatment of ureteral stones.Methods Patients who underwent fragmentation or dusting laser URSL for ureteral stones were retrospectively reviewed. The demographic data, stone parameters, perioperative data and stone-free rates were analyzed between the two groups.Results There were a total of 421 patients with ureteral stones who met the study criteria. More patients in the dusting group had multiple ureteral stones and pyuria than in the fragmentation group. The fragmentation group had a better stone free rate and a lower push back rate compared with the dusting group. (82% vs. 71%; 10% vs. 20% respectively, both p<0.05). Multivariate analysis revealed that stone basket use (odds ratio [OR] = 3.026; p<0.001) significantly improved the stone free rate, whereas multiple stones (OR=0.322; p <0.001), upper ureteral stone location (OR=0.098; p=0.002) and pyuria (OR=0.428; p=0.001) significantly decreased the stone free rate. The laser mode used was not significantly related to the stone free rate in the multivariate analysis.Conclusions Both laser modes were effective and safe for ureteral lithotripsy. Risk factors associated with a lower stone free rate were multiple stones, pyuria, upper ureteral stone location and an operation without the use of a stone basket.

Prognostic Factors for the Effectiveness of Extracorporeal Shock Wave Lithotripsy in Patients with Ureterolithiasis

The purpose of the work was to study prognostic factors for the effectiveness of extracorporeal shock wave lithotripsy in patients with ureterolithiasis. Materials and methods. The study included 53 patients with ureteral stones up to 2 cm in size. All patients underwent extracorporeal shock wave lithotripsy under ultrasound control, with a pulse rate of 90 per minute and a maximum number of pulses of 2000 per session. The outcome of treatment was evaluated by ultrasound on day 5 after the extracorporeal shock wave lithotripsy session. If there were stone fragments larger than 5 mm, a second extracorporeal shock wave lithotripsy session was performed. Treatment was considered effective in the absence of stone fragments in the urinary tract 4 weeks after extracorporeal shock wave lithotripsy. Results and discussion. The data were analyzed to identify clinical and radiological factors associated with treatment failure. As a result of the treatment, 46 (86.4%) patients were found to have no stones in the urinary tract (the condition is “stone free”), 9 (13.6%) had stone fragments larger than 5 mm 4 weeks after extracorporeal shock wave lithotripsy, and therefore contact ureterolithotripsy was performed. As complications, 7 (13.2%) patients had an exacerbation of chronic pyelonephritis, which required percutaneous nephrostomy. As the results showed, age, gender, body mass index, and Hausfield units did not differ significantly in terms of extracorporeal shock wave lithotripsy results. Factors that significantly affected the prognosis of extracorporeal shock wave lithotripsy success were the size of the stone and skin-stone distance. Body mass index did not significantly affect the outcome of lithotripsy in this study. The stone density index according to computed tomography data is considered by many authors to be a predictor of the effectiveness of fragmentation, but in our study this indicator was not a significant predictor of the effectiveness of extracorporeal shock wave lithotripsy, which allows us to think that there are other factors, namely the features of the internal structure of the stone, which determine its compliance with the shock wave. Conclusion. The size of the stone and the skin-stone distance are prognostic factors that affect the effectiveness of extracorporeal shock wave lithotripsy in patients with ureterolithiasis. Body mass index and stone density in Hausfield units did not significantly affect extracorporeal shock wave lithotripsy outcome in this study

A Systematic Review on Comparative Analyses between Ureteroscopic Lithotripsy and Shock-Wave Lithotripsy for Ureter Stone According to Stone Size

Background and Objectives: This systematic review and meta-analysis was conducted to analyze the treatment outcomes of shock wave lithotripsy (SWL) and ureteroscopic lithotripsy (URSL) according to the ureteral stone size. Materials and Methods: In this systematic review, relevant articles that compared SWL and URSL for treatment of ureteral stones were identified. Articles were selected from four English databases including Ovid-Medline, Ovid-EMBASE, the Cochrane Central Register of controlled Trials (Central), and Google Scholar. A quality assessment was carried out by our researchers independently using the Scottish Intercollegiate Guidelines Network (SIGN). A total of 1325 studies were identified, but after removing duplicates, there remained 733 studies. Of these studies, 439 were excluded, 294 were screened, and 18 met the study eligibility criteria. Results: In randomized control trial (RCT) studies, URSL showed significantly higher SFR than SWL (p < 0.01, OR= 0.40, 95% CI 0.30–0.55, I² = 29%). The same results were shown in sub-group analysis according to the size of the stone (<1 cm: p < 0.01, OR = 0.40, 95% CI 0.25–0.63; >1 cm: p < 0.01, OR = 0.38, 95% CI 0.19–0.74, I² = 55%; not specified: p < 0.01, OR = 0.43, 95% CI 0.25–0.72, I² = 70%). In the non-RCT studies, the effectiveness of the URSL was significantly superior to that of SWL (p < 0.01, OR = 0.33, 95% CI 0.21–0.52, I² = 83%). Retreatment rate was significantly lower in URSL than in SWL regardless of stone size (p < 0.01, OR = 10.22, 95% CI 6.76–15.43, I² = 54%). Conclusions: Meta-analysis results show that SFR was higher than SWL in URSL and that URSL was superior to SWL in retreatment rate. However, more randomized trials are required to identify definitive conclusions.

Development of prediction models of spontaneous ureteral stone passage through machine learning: Comparison with conventional statistical analysis

Objectives To develop a prediction model of spontaneous ureteral stone passage (SSP) using machine learning and logistic regression and compare the performance of the two models. Indications for management of ureteral stones are unclear, and the clinician determines whether to wait for SSP or perform active treatment, especially in well-controlled patients, to avoid unwanted complications. Therefore, suggesting the possibility of SSP would help make a clinical decision regarding ureteral stones. Methods Patients diagnosed with unilateral ureteral stones at our emergency department between August 2014 and September 2018 were included and underwent non-contrast-enhanced computed tomography 4 weeks from the first stone episode. Predictors of SSP were applied to build and validate the prediction model using multilayer perceptron (MLP) with the Keras framework. Results Of 833 patients, SSP was observed in 606 (72.7%). SSP rates were 68.2% and 75.6% for stone sizes 5–10 mm and <5 mm, respectively. Stone opacity, location, and whether it was the first ureteral stone episode were significant predictors of SSP. Areas under the curve (AUCs) for receiver operating characteristic (ROC) curves for MLP, and logistic regression were 0.859 and 0.847, respectively, for stones <5 mm, and 0.881 and 0.817, respectively, for 5–10 mm stones. Conclusion SSP prediction models were developed in patients with well-controlled unilateral ureteral stones; the performance of the models was good, especially in identifying SSP for 5–10-mm ureteral stones without definite treatment guidelines. To further improve the performance of these models, future studies should focus on using machine learning techniques in image analysis.