Search Results (154)

Background/Objective: To describe a novel dual-action pump (DAP) which is hypothesised to reduce mean intrarenal pressure (IRP) and increase irrigation flow during flexible ureterorenoscopy (fURS). The DAP incorporates a low-volume, user-controlled pumping/suctioning unit, to precisely control fluid boluses into the upper urinary tract via a ureterorenoscope and simultaneously draws out an identical volume of the delivered irrigant via a syphoning UAS. This human cadaveric study aims to assess the DAP’s impact on IRP and the irrigant flow rate compared to a traditional UAS. Methods: Twelve fresh frozen human cadaver renal units were studied in situ. An 11/13 UAS was placed under fluoroscopic guidance and a fURS was introduced. Continuous pressure was monitored. The DAP and syphoning UAS were compared to a conventional irrigation system in terms of IRP and irrigant flow at variable irrigant fluid heights and during fluid bolus administration. Results: The mean IRP was reduced by 79–141%. Maximum IRP was reduced by up to 180%. The mean irrigation flow rate was improved by 44–86%. The small sample size of 12 limits the results obtained. Conclusions: The novel DAP system shows promise in reducing intra-renal pressure and improving irrigant flow in flexible ureteroscopy. Full article

Background/Objectives: To evaluate whether adjunctive silodosin improves the stone-free rate (SFR) and clinical outcomes of extracorporeal shock wave lithotripsy (ESWL) for renal calculi. Methods: In this prospective randomised controlled trial, 100 adults with solitary radiopaque non-lower pole renal stones measuring 5–20 mm underwent single-session ESWL and were randomised (1:1) to receive either silodosin 8 mg once daily plus standard care or standard care alone for up to 12 weeks. Participants were followed up for three months. The primary outcome was SFR at three months on follow-up imaging. The secondary outcomes included time to stone clearance, renal colic episodes, analgesic requirement and adverse events. Results: At three months, the SFR was higher in the silodosin group than in the control group (68.0% vs. 50.0%; RR 1.36, 95% CI 0.97–1.90), but this difference did not reach statistical significance (p = 0.067). In a prespecified exploratory subgroup analysis, patients with stones measuring 10–20 mm showed a higher SFR with silodosin than controls (61.8% vs. 34.4%; p = 0.026), whereas no benefit was observed for stones measuring 5–9 mm (p = 0.803). Time-to-clearance analysis using Kaplan–Meier methods suggested earlier confirmed stone clearance in the silodosin group (hazard ratio 1.58, 95% CI 1.02–2.45; log-rank p = 0.036). Silodosin was also associated with fewer renal colic episodes and lower analgesic requirements. No serious drug-related adverse events were observed. Conclusions: This randomised controlled trial did not meet its primary endpoint because adjunctive silodosin did not significantly improve the overall SFR after ESWL. However, a possible benefit was observed in patients with renal stones measuring 10–20 mm, together with improved pain-related outcomes. These findings suggest that silodosin may have a role in selected patients, but the subgroup effects should be considered hypothesis-generating rather than definitive. Full article

Nephrolithiasis is a prevalent urological disorder worldwide, whose pathogenesis involves a complex network of crystal formation, cellular injury, and microenvironmental dysregulation. As a critical mechanism for regulating cellular functions, protein post-translational modifications (PTMs) have been increasingly implicated in multiple facets of kidney stone formation, including crystal–cell interactions, oxidative stress responses, and inflammatory signaling pathways. This review systematically synthesizes the biochemical foundations of PTMs, the molecular microenvironment of nephrolithiasis, and the roles of key modifications such as phosphorylation and acetylation in the pathogenesis of calculi. It further explores the translational potential of PTM detection technologies in clinical practice. Current evidence indicates that PTMs influence the nucleation, growth, and aggregation of crystals by modulating the activity of pro-/anti-lithogenic proteins, the expression of cell adhesion molecules, and inflammatory pathways. Consequently, therapeutic strategies targeting PTMs may offer novel avenues for the prevention and management of kidney stones. Future research should focus on integrating multi-omics approaches with functional validation to elucidate the dynamic regulatory networks of PTMs within the stone microenvironment, thereby advancing the development of precision medicine. Full article

Background: Pancreaticopleural fistula is a rare complication of chronic pancreatitis resulting from pancreatic duct disruption, typically presenting with pleural effusion and predominant respiratory symptoms. Bilateral pleural involvement is exceptionally uncommon and poses significant diagnostic and therapeutic challenges. Case Presentation: A 56-year-old man with a history of chronic alcohol abuse presented with progressive dyspnea and mild epigastric pain. Imaging revealed bilateral pleural effusions, an atrophic pancreas with a markedly dilated main pancreatic duct containing calculi, and a fistulous tract extending from the pancreatic body through the esophageal hiatus into the mediastinum. Magnetic resonance cholangiopancreatography confirmed the diagnosis of chronic calculous pancreatitis complicated by a pancreaticopleural fistula. After unsuccessful conservative management, the patient underwent distal pancreatectomy, resection of the fistulous tract, and Roux-en-Y pancreatojejunostomy. The postoperative course was uneventful, with complete resolution of pleural effusions and sustained clinical improvement. Conclusions: This case highlights the importance of considering pancreaticopleural fistula in patients with unexplained pleural effusions and minimal abdominal symptoms, particularly in the context of chronic pancreatitis. Bilateral involvement, although rare, should not preclude timely diagnosis. Appropriate diagnostic studies by computed tomography, magnetic resonance imaging, and magnetic resonance cholangiopancreatography are crucial for establishing the diagnosis. Surgical management offers definitive treatment in patients with ductal obstruction and calculous disease, resulting in excellent long- term outcomes. Full article

Background/Objectives: Ureteric stents are commonly used in urological procedures. However, they can cause pain; haematuria; voiding symptoms; or stent migration. When stent migration occurs, this can cause a significant impact on the patients’ therapeutic outcomes and may warrant a repeat procedure to retrieve or replace the ureteric stent. This study aims to assess if there are any patient; stent; or operative factors that may increase the risk of stent migration. Methods: This is a single-institute, retrospective cohort study that looked at patient; stent; and operative factors for 828 ureteroscopies and or laser lithotripsy for management of ureteric or intra-renal calculi over a 2-year period. The 828 procedures comprised 655 patients, as some patients had multiple procedures. Results: From the 828 cases, there was a 2.7% incidence of stent migration; all episodes of stent migration were distal migration. Stent migration was more likely among females (odds ratio (OR) = 3.0; 95% confidence interval (CI) [1.2; 7.1]) compared to males; older aged groups (over 65 years) (OR = 2.7; 95% CI [0.9; 7.8]) compared to the young aged group (16–44 years); and those who were obese (OR = 2.1; 95% CI [0.9; 5.0]), had musculocutaneous (MSK) conditions (OR = 2.7; 95% CI [0.9; 8.3]), neurological conditions (OR = 3.3; 95% CI [1.1; 10.0]), and stent dwelling time ≥ month (OR = 2.3; 95% CI [0.9; 6.0]) compared to <1 month. There was no observed association between stent and operative factors. Conclusions: Patient factors such as sex; age; comorbidities; and weight need to be considered by urologists in conjunction with modifiable stent factors to ensure that the decisions are made on an individual basis to try and reduce the risk of stent migration. Full article

In Australian Cattle Dogs (AUCDs), cystinuria was reported to be an autosomal dominant trait caused by a 6 bp deletion in the SLC3A1 gene (type II-A). Here we report an androgen association in this breed. A family of 11 adult AUCDs (five intact and one neutered male and five females) was genotyped for the SLC3A1 c.1095_1100del variant, and urine was examined for concentrations of cystine, ornithine, lysine, and arginine (COLA). Among this family, three males and five females tested heterozygous for the mutation, while all other AUCDs were homozygous for the wild-type allele. The two heterozygous intact males had severe COLA-uria, which decreased markedly after castration. Neither the third heterozygous male with a history of cystine calculi but already castrated nor the five heterozygous females exhibited increased COLA-uria. Heterozygosity for the 6 bp deletion in the SLC3A1 gene was associated with cystinuria in intact male AUCDs, but not in females. Castration of the heterozygous males reduced the cystinuria. Either the type II-A cystinuria in the AUCDs is an androgen-associated dominant trait, or this family also has another type III (androgen-dependent) cystinuria. Larger surveys are needed to further define the type(s) of cystinuria and effects of castration in AUCDs. Full article

Aim: To explore the association between urinary stone cultures and infectious complications following PCNL. Materials and Methods: An observational case–control study was conducted in patients undergoing PCNL. The assessment included demographic parameters, medical history, urinalysis, and urine culture and blood testing. Pre-operatively, urinary stone samples were collected for cultures. Post-operatively, patients were observed for infectious complications such as fever and/or SIRS. Patients were divided into two groups based on the presence or absence of infected renal calculi. Patient characteristics, stone factors, and intra-operative and post-operative findings were studied in relation to stone culture. Descriptive statistics was used to present the data and the SPSS software was used for analysis. Results: From December 2023 to March 2025, a total of 126 patients were included in the study. A total of 16 patients (12.6%) had a positive stone culture. Statistical significance was found upon the comparison of stone culture with gender (p = 0.046), chronic kidney disease (p = 0.002), pre-operative urine culture (p = 0.001), pre-operative haemoglobin (g/dL) (<0.001), pre-operative S. creatinine (mg/dL) (p = 0.038), stone volume (mm³) (p = 0.012), CROES score (p = 0.023), SIRS (p = 0.001), and AKI (p = 0.021). Conclusions: Infected renal calculi identified by positive stone cultures were strongly associated with infective complications such as fever and SIRS following PCNL. E. Coli was the dominant bacteria present in both bladder urine and renal stone culture. The occurrence of infectious complications despite the administration of pre-operative antibiotics highlights the antibiotic resistance patterns noted among the cultured bacteria. The pre-operative factors identified to be associated with a positive stone culture could potentially be used for predicting infected stones, thereby improving outcomes. Full article

Background: Endoscopic retrograde cholangiopancreatography (ERCP) is the primary treatment option for choledocholithiasis. However, this procedure carries an inherent non-negligible risk of complications, requiring precise indications and careful patient selection. Endoscopic ultrasonography (EUS) can verify the presence of bile duct stones prior to ERCP. The current ESGE recommendations permit ERCP in high-risk patients without confirmation; however, several individuals undergo ERCP without evident advantage, indicating a necessity for enhanced stratification. Objectives: We aim to evaluate the rate of EUS-validated choledocholithiasis in patients with suspected common bile duct (CBD) stones and to determine the predictors of residual stones. A secondary objective was to create and internally validate a streamlined scoring system to enhance risk assessment in ESGE high-risk patients. Methods: We conducted a retrospective analysis of patients who had endoscopic ultrasound for suspected choledocholithiasis from January 2023 to December 2024 at a tertiary center. Multivariate logistic regression determined independent predictors of retained calculi. A simplified score was derived from model coefficients and internally validated. Results: Among 438 examined patients, 186 were included and 87 had choledocholithiasis confirmed via EUS. ERCP was conducted in 81 patients and postponed for 6 patients due to contraindications. According to the ESGE criteria, 10 patients (5.4%) were classified as low risk, 92 (49.5%) as intermediate risk, and 84 (45.2%) as high risk for choledocholithiasis. For high-risk individuals, EUS identified stones in 45 (53.5%), while 39 (46.4%) experienced spontaneous clearance. Acute pancreatitis (aOR 0.075), cholangitis (aOR 6.939), and EUS CBD diameter (aOR 1.220 per mm) were independent predictors of stones. The resultant three-component score (−2 to +4 points) demonstrated effective discrimination (AUROC 0.788). A criterion of ≥2 resulted in 85.7% sensitivity and 59.0% specificity. Conclusions: Almost fifty percent of ESGE high-risk patients were not found to have CBD stones during EUS. Integrating EUS data with a straightforward predictive score may enhance risk classification and avert superfluous ERCP procedures. Full article

This paper establishes a rigorous analytical framework for a nonlinear multi-order fractional differential system governed by the generalized $\sigma$-Hilfer operator in weighted Banach spaces. In contrast to existing studies that often treat specific kernels or fixed fractional orders in isolation, our approach provides a unified treatment that simultaneously handles multiple fractional orders, a tunable kernel $\sigma \left(\varsigma \right)$, weighted integral conditions, and a nonlinearity depending on a fractional integral of the solution. By converting the hierarchical differential structure into an equivalent Volterra integral equation, we derive sufficient conditions for the existence and uniqueness of solutions using the Banach contraction principle and Mönch’s fixed-point theorem with measures of non-compactness. The analysis is extended to Ulam–Hyers stability, ensuring robustness under modeling perturbations. A principal contribution is the systematic classification of the system’s symmetric reductions—specifically the Riemann–Liouville, Caputo, Hadamard, and Katugampola forms—all governed by a single spectral condition dependent on $\sigma \left(\varsigma \right)$. The theoretical results are illustrated by numerical examples that highlight the sensitivity of solutions to the memory kernel and the fractional orders. This work provides a cohesive analytical tool for a broad class of fractional systems with memory, thereby unifying previously disparate fractional calculi under a single, consistent framework. Full article

This retrospective diagnostic accuracy study compared radiologist-based qualitative assessments and radiomics-based analyses with an automated artificial intelligence (AI)–based volumetric approach for evaluating changes in kidney stone burden on follow-up CT examinations. With institutional review board approval, 157 patients (mean age, 61 ± 13 years; 99 men, 58 women) who underwent baseline and follow-up non-contrast abdomen–pelvis CT for kidney stone evaluation were included. The index test was an automated AI-based whole-kidney and stone segmentation radiomics prototype (Frontier, Siemens Healthineers), which segmented both kidneys and isolated stone volumes using a fixed threshold of 130 Hounsfield units, providing stone volume and maximum diameter per kidney. The reference standard was a threshold-defined volumetric assessment of stone burden change between baseline and follow-up CTs. The radiologist’s performance was assessed using (1) interpretations from clinical radiology reports and (2) an independent radiologist’s assessment of stone burden change (stable, increased, or decreased). Diagnostic accuracy was evaluated using multivariable logistic regression and receiver operating characteristic (ROC) analysis. Automated volumetric assessment identified stable (n = 44), increased (n = 109), and decreased (n = 108) stone burden across the evaluated kidneys. Qualitative assessments from radiology reports demonstrated weak diagnostic performance (AUC range, 0.55–0.62), similar to the independent radiologist (AUC range, 0.41–0.72) for differentiating changes in stone burden. A model incorporating higher-order radiomics features achieved an AUC of 0.71 for distinguishing increased versus decreased stone burdens compared with the baseline CT (p < 0.001), but did not outperform threshold-based volumetric assessment. The automated threshold-based volumetric quantification of kidney stone burdens provides higher diagnostic accuracy than qualitative radiologist assessments and radiomics-based analyses for identifying a stable, increased, or decreased stone burden on follow-up CT examinations. Full article

Background/Objectives: Obstructive urosepsis mandates rapid source control, yet actionable time-to-decompression (TTD) thresholds and the influence of diversion route remain debated. This review synthesized evidence on TTD, early outcomes, and predictive biomarkers. Methods: Following PRISMA-2020, ten studies met eligibility: three large administrative cohorts and seven clinical series/trials comparing outcomes by TTD and/or initial decompression (retrograde stent [RUS] vs. percutaneous nephrostomy [PCN]) and reporting biomarkers. Results: Delays were consistently harmful. In a national cohort, a TTD of ≥ 2 days increased in-hospital mortality (adjusted OR, 1.29; 95% CI, 1.03–1.63). Another analysis showed mortality of 0.16% with ≤48 h vs. 0.47% when delayed (derived OR, 0.43; p = 0.044). Absence of decompression yielded the highest mortality (19.2% vs. 8.82%; OR, 2.6; 95% CI, 1.9–3.7). Septic shock remained frequent despite low crude mortality in clinical series: 20.8% and 33.3% across two cohorts. Post-decompression urosepsis occurred in 18.7% in a randomized study and was associated with pyonephrosis and higher procalcitonin (PCT). An ED cohort showed that earlier stenting reduced length of stay (≤6 h: 35.6 h vs. 71.6 h, p = 0.01; ≤10 h: 45.7 h vs. 82.4 h, p = 0.04). Modality effects were modest; one cohort reported higher ICU use with PCN vs. RUS (OR, 3.23; 95% CI, 1.24–8.41), likely reflecting confounding by indication. Conclusions: Across designs, timeliness—not device choice—was the dominant determinant of early outcomes. Biomarkers (notably, PCT) and imaging features can prioritize ultra-early decompression. Full article

Integration in non-integer-dimensional spaces (NIDS) is actively used in quantum field theory, statistical physics, and fractal media physics. The integration over the entire momentum space with non-integer dimensions was first proposed by Wilson in 1973 for dimensional regularization in quantum field theory. However, self-consistent calculus of integrals and derivatives in NIDS and the vector calculus in NIDS, including the fundamental theorems of these calculi, have not yet been explicitly formulated. The construction of precisely such self-consistent calculus is the purpose of this article. The integral and differential operators in NIDS are defined by using the generalization of the Wilson approach, product measure, and metric approaches. To derive the self-consistent formulation of the NIDS calculus, we proposed some principles of correspondence and self-consistency of NIDS integration and differentiation. In this paper, the basic properties of these operators are described and proved. It is proved that the proposed operators satisfy the NIDS generalizations of the first and second fundamental theorems of standard calculus; therefore, these NIDS operators form a calculus. The NIDS derivative satisfies the standard Leibniz rule; therefore, these derivatives are integer-order operators. The calculation of the NIDS integral over the ball region in NIDS gives the well-known equation of the volume of a non-integer dimension ball with arbitrary positive dimension. The volume, surface, and line integrals in D-dimensional spaces are defined, and basic properties are described. The NIDS generalization of the standard vector differential operators (gradient, divergence, and curl) and integral operators (the line and surface integrals of vector fields) are proposed. The NIDS generalizations of the standard gradient theorem, the divergence theorem (the Gauss–Ostrogradsky theorem), and the Stokes theorem are proved. Some basic elements of the calculus of differential forms in NIDS are also proposed. The proposed NIDS calculus can be used, for example, to describe fractal media and the fractal distribution of matter in the framework of continuum models by using the concept of the density of states. Full article

Additive Manufacturing (AM) has emerged as a transformative technology for rapid prototyping and fabrication of geometrically complex structures. However, the inherent thermal cycling and rapid solidification in processes such as Selective Laser Sintering (SLS) frequently induce deformation and residual stresses, leading to dimensional deviations and potential premature failure. This paper presents OpenAM-SimCCX, an open-source workflow for finite element-based thermo-mechanical simulation of AM processes using CalculiX 2.21. The framework employs a time-dependent thermo-mechanical model with layer-by-layer element activation to capture key aspects of SLS, including laser–material interaction and scanning strategy effects. Systematic comparisons of different scanning strategies demonstrate clear correlations between path planning, residual stress distributions, and distortion, while computational time analyses confirm the framework’s efficiency. By providing comprehensive documentation, implementation guides, and open repositories, OpenAM-SimCCX offers an accessible and economically viable alternative to commercial software, particularly for academic institutions and small- to medium-sized enterprises. This framework advances open-source simulation tools for AM and promotes broader adoption in both research and industry. Full article

Background/Objectives: The attainment of a stone-free (SF) condition is a fundamental indicator of successful outcomes after flexible ureteroscopy (fURS) for urinary stone disease. External confirmations of preoperative scores remain limited. We externally validated the T.O.HO. and S.T.O.N.E. scores in an independent Japanese cohort and examined calibration, decision curve utility, and threshold-guided use to support personalized planning. Methods: We retrospectively analyzed 361 consecutive patients treated with fURS from March 2018 to August 2023. Postoperative SF status was defined as the absence of residual calculi greater than 2 mm on non-contrast computed tomography performed within three months of surgery. Independent determinants of SF were identified using multivariable logistic regression, predictive performance was quantified by receiver operating characteristic analyses with DeLong’s test, and model calibration and decision curve analysis were additionally assessed. Results: Among the 361 patients, 255 (70.6%) achieved an SF state. A larger stone diameter, the presence of lower-pole calculi, and preoperative pyuria (positive urine WBC) were significant independent predictors of residual fragments. T.O.HO. demonstrated superior discrimination (AUC 0.86) compared with S.T.O.N.E. (AUC 0.77; p < 0.01) and surpassed individual predictors. Both scores showed acceptable calibration. Decision curve analysis demonstrated higher net benefit for T.O.HO. across clinically relevant thresholds. We provide clinically useful cut-offs (e.g., T.O.HO. ≤5: high SF probability; 6: trade-off discussion; ≥7: higher residual risk) to align actions with patient priorities. Conclusions: Beyond discrimination, a calibrated, threshold-aware use of T.O.HO. enables personalized preoperative counseling and shared decision-making, potentially reducing unnecessary staging and enhancing routine fURS planning. Full article