Search Results (49)

Background and Clinical Significance: Spontaneous renal forniceal rupture is an uncommon complication of obstructive uropathy and is classically associated with ureteric calculi rather than distal urinary retention. Bilateral retention-related rupture appears to be exceptionally rare and may be diagnostically challenging when renal function begins to improve after bladder decompression; Case Presentation: An 82-year-old man with a history of prostate cancer treated five years earlier with external beam radiotherapy and androgen deprivation therapy presented with acute abdominal pain radiating to both flanks and inability to void. Bedside ultrasonography showed urinary retention and bilateral hydronephrosis, and a 16-Fr Foley catheter drained 900 mL of urine. Admission evaluation showed severe acute kidney injury, microscopic hematuria, minimal leukocyturia, and elevated inflammatory markers. Post-obstructive diuresis developed after bladder decompression. CT urography with excretory-phase imaging on hospital day 3 demonstrated severe bilateral hydroureteronephrosis with bilateral renal forniceal rupture and associated urinomas, including a larger left-sided collection extending toward the psoas compartment. Bilateral percutaneous nephrostomies were placed on hospital day 4 for upper-tract diversion. Immediate nephrostography showed no active contrast extravasation. At one-month follow-up, combined CT and nephrostographic assessment confirmed complete resolution of the bilateral urinomas without persistent leak, and the nephrostomy tubes were removed; Conclusions: This case suggests that urinary retention in an older man with prior prostate radiotherapy may reflect radiation-associated outlet pathology and/or impaired detrusor function rather than simple prostate enlargement. Delayed-phase CT urography was essential for diagnosis, and active bilateral diversion was justified by bilateral rupture, acute kidney injury, and the extent of urinary extravasation. The report expands the limited PubMed-indexed literature on retention-related upper urinary tract rupture and supports cautious follow-up aimed at defining the underlying mechanism of retention. Full article

Elymus repens (L.) Gould, commonly known as couch grass, is mainly distributed as a medicinal herb of great ethnopharmacological importance. This review presented for the first time the significance of nomenclature clarity, current insights on distribution, traditional use, phytochemistry and their biological activities. The bioactive compound composition of E. repens displayed a variety of compounds including carbohydrates, phenolic acids, flavonoids, benzoxazinoids and volatile compounds, all of which contributed to its medicinal properties. The biological potential of this plant underlines diuretic, antiurolithiatic, anti-inflammatory, antioxidant and also antidiabetic qualities with molecular insights showing synergistic interactions across many compound classes. The current reported data notably confirmed its potential in lowering renal calculi and alleviating associated symptoms; however, the findings remain limited. E. repens’ medicinal potential is further confirmed by its historical application as an herbal tea and aqueous preparation, which clearly indicates its favorable safety profile. Along with this, from many encouraging results, there exist considerable deficiencies in standardization, clinical validation and also mechanistic clarification. This review highlights the necessity for careful studies to determine the therapeutic efficiency, enhance formulation and promote E. repens as a scientifically therapeutic agent. Full article

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

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

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

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 and Clinical Significance: Retained intrarenal foreign bodies are rare adverse events after endourological stone surgery. Guidewire fracture or detachment is uncommon and can trigger infection, obstruction, or encrustation if unrecognized. We report antegrade percutaneous snare retrieval of a retained hydrophilic guidewire tip and provide a concise literature review (seven PubMed-indexed intrarenal cases identified by a structured search) to inform diagnosis, management, and prevention. We also clarify the clinical rationale for an antegrade versus retrograde approach and the sequencing of decompression, definitive stone management, and stenting in the context of sepsis. Case Presentation: A 75-year-old woman with diabetes presented with obstructive left pyelonephritis from ureteral and renal calculi. After urgent percutaneous nephrostomy, she underwent semirigid and flexible ureteroscopic lithotripsy with double-J stenting; the nephrostomy remained. During routine tube removal, the stent was inadvertently extracted. Seven days later she re-presented with fever and flank pain. KUB and non-contrast CT showed a linear 4 cm radiopaque foreign body in the left renal pelvis with dilatation. Under local anesthesia and fluoroscopy, a percutaneous tract was used to deploy a 35 mm gooseneck snare and retrieve the distal tip of a hydrophilic guidewire (Sensor/ZIP-type). Inflammatory markers were normalized; the nephrostomy was removed on day 5; six-week imaging confirmed complete clearance without complications. Conclusions: Retained guidewire fragments should be suspected in postoperative patients with unexplained urinary symptoms or infection. Cross-sectional imaging confirms the diagnosis, while minimally invasive extraction—preferably an antegrade percutaneous approach for rigid or coiled fragments—achieves prompt resolution. This case adds to the seven prior PubMed-indexed intrarenal reports identified in our review, bringing the total to eight, underscoring prevention through pre-/post-use instrument checks, immediate fluoroscopy when withdrawal resistance occurs, and structured device accounting to avoid “never events.” Full article

Background and Objective: Information about the type of kidney stones is important for informed therapeutic decisions and the prevention of urolithiasis. Urinary stones are heterogeneous, and their elemental composition and crystal structure vary between patients. The formation of urinary stone deposits depends, among other things, on physiological conditions, the concentration of promoters and inhibitors of crystallization, and proteins found in the urine. The aim of this study was to determine differences in urine osteopontin (OPN) levels between groups of different stone-formers. Methods: Urinary stone specimens (n = 44) were acquired during elective endoscopic procedures. Specimens were divided into subgroups by k-means cluster analysis depending on calcium and phosphorus concentrations. The concentration of urine OPN was determined and compared for each subgroup and the control group. Results: Cluster analysis divided the deposits into three clusters. Cluster 1 contained mainly calcium oxalate deposits; Cluster 2 contained uric acid deposits; Cluster 3 contained deposits with a high content of calcium phosphate. Urine OPN concentration in CaP stone-formers (5.77 ng/mL) differed significantly from those of controls (17.05 ng/mL, p = 0.013) and CaOx stone-formers (15.31 ng/mL, p = 0.048). Conclusions: The concentration of urine OPN varies depending on the elemental composition of renal calculi. The lowest concentration of OPN was determined in the group of patients with a high content of calcium phosphate in the deposits. Full article

Purpose: This study investigates the role of CASR gene polymorphisms (A986S, R990G, Q1011E) in PHPT genetic susceptibility and its clinical variability. The aim is to evaluate the prevalence of these polymorphisms in patients with sporadic PHPT and their impact on clinical course, biochemistry, and histological features. Methods: 106 patients underwent clinical and anamnestic evaluations, focusing on major PHPT complications, as well as biochemical analyses of blood and urine. Genetic testing was conducted for CASR gene polymorphisms. Histological data were available for 68 patients who underwent parathyroidectomy. Results: The sample included 83 women and 23 men; mean age at diagnosis was 54.5 years. 55 patients carried CASR gene polymorphisms, while 51 were wild-type. Prevalence rates of polymorphisms were consistent with data for the Caucasian population, with A986S being the most common (31%). No significant associations were found between polymorphisms and increased levels of ionized calcium or other blood phospho-calcium metabolism parameters. However, 24-h urinary calcium levels were higher in patients with polymorphisms (p = 0.0185), particularly in those older than 50 years (p = 0.030) and with the A986S variant. Hypercalciuria was predictive of CASR polymorphism presence (OR = 2.76, p = 0.003). No significant association with PHPT complications, such as renal calculi or bone involvement, was confirmed. Histological data revealed no clear links between polymorphisms and more aggressive variants. Conclusions: CASR gene polymorphisms are associated with hypercalciuria but do not significantly influence age of onset or clinical phenotype in PHPT. Genetic analysis may be useful in selected cases to better understand individual clinical profiles. Full article

Background/Objectives: Achieving renal access is a key step in percutaneous nephrolithotomy (PNL), with transpapillary access considered the safest anatomical approach. This prospective pilot study aimed to compare the effectiveness of freehand ultrasound-guided (F-UG) versus fluoroscopy-guided (FG) punctures in achieving anatomically accurate transpapillary access during supine PNL, confirmed by endoscopic visualization. Perioperative and postoperative outcomes were also evaluated. Methods: Forty-three patients undergoing supine PNL for renal pelvic or lower calyceal stones were prospectively enrolled and assigned to either the FG group (n = 23) or F-UG group (n = 20). Following renal access, intraoperative flexible ureteroscopy confirmed the anatomical nature of the puncture (transpapillary vs. nonpapillary). The puncture time, fluoroscopy time, operative time, complications (Clavien–Dindo classification), transfusion requirement, hospital stay, and one-month stone-free rates were recorded. Results: Transpapillary access was achieved in 95.7% of FG cases and 55.0% of F-UG cases (p = 0.003). Radiation exposure was significantly lower in the F-UG group (p < 0.001). Complication (15.0% vs. 0.0%) and transfusion rates (10.0% vs. 0.0%) were higher in the F-UG group but not statistically significant (p = 0.092 and p = 0.210, respectively). Other outcomes, including the operative time, hospital stay, and stone-free rates, were similar between groups. Conclusions: FG puncture is more effective for achieving transpapillary access, while F-UG significantly reduces radiation exposure. The endoscopic confirmation method may provide a reference for future comparative studies on access techniques in PNL. Full article

Aim: This study aimed to evaluate the potential impact of stone characteristics, patient factors, and upper tract anatomical parameters in the prediction of residual fragments (RFs) following the flexible ureteroscopic (fURS) management of renal stones. Patients and Methods: Between June 2023 and July 2024, a total of 104 cases underwent fURS for the minimally invasive management of medium-sized renal stones (10–25 mm), and 28 cases presenting with RFs 3 months after these procedures were included for further evaluation. In addition to the assessment of patient-related factors, non-contrast computed tomography (NCCT) was performed in all cases in an attempt to assess specific stone characteristics and upper tract anatomical parameters in detail during the 3-month follow-up period. Results: An evaluation of our findings indicated that, among the evaluated parameters, a higher degree of hydronephrosis (>Grade 2), a larger stone size (>15 mm), and the presence of multiple stones were found to affect the presence of RFs significantly (p = 0.020, p = 0.012, and p = 0.040, respectively). On the other hand, although the analysis of other parameters such as patient gender, stone side, stone hardness, and the use of an access sheath with univariate regression demonstrated potential correlations, none of these parameters demonstrated a significant impact when analyzed using backward logistic regression. Logistic regression revealed that Grade 2 hydronephrosis (OR = 18.3, p = 0.020), stone size > 15 mm (OR = 7.0, p = 0.012), and multiple stones (OR = 3.7, p = 0.040) significantly increased the risk of residual fragments following fURS. Conclusions: In light of our findings and published data, we can conclude that endourologists should consider the likelihood of RFs’ presence after successful stone disintegration with fURS. A detailed evaluation of the relevant factors revealed that patients with larger stones, higher degrees of hydronephrosis, and multiple calculi may carry the risk of residual fragments after these procedures. Thus, the utilization of such reliable predictive parameters may aid in selecting optimal stone removal strategies and planning subsequent interventions in the rational management of RFs. Full article

Background/Objectives: Urolithiasis is a common disease in Western societies, affecting approximately 10% of the population, and more often men than women. The formation of renal calculi is a complex process, including various compounds and proteins. The aim of this study is to compare differences between the trace element concentrations in male and female renal calculi as well as differences between the trace element concentrations in different stone types. Material and Methods: Renal calculi specimens were obtained during elective nephrolithotripsy procedures. Crystallography of renal calculi was performed using X-ray diffraction; an elemental analysis was performed using Inductively Coupled Plasma–Optical Emission Spectrometry. Statistical analysis was performed to assess the differences in the metal element concentration between men and women. The second part of the analysis measured the differences in the metal element concentration between stones containing calcium phosphate (CaP) and pure calcium oxalate (CaOx) stones. Results: The renal calculi (n = 20) obtained from the male patients had a lower potassium concentration than the calculi (n = 24) from the female patients: 393.4 vs. 792.3 mg/kg, p = 0.007. A comparison of the CaP calculi and CaOx calculi showed a higher zinc concentration (p < 0.001) and potassium concentration (p < 0.001) in the stones containing calcium phosphate. Conclusions: The renal calculi from females had a significantly higher potassium content than those from males. This difference was not correlated with hyperkalemia or the blood potassium levels, suggesting a sex-dependent role of uromodulin in stone formation. The stones containing calcium phosphate exhibited higher zinc and potassium concentrations compared to the pure calcium oxalate stones. The increased presence of zinc and potassium in urine may accelerate the formation of calcium phosphate calculi. Full article

Background/Objectives: Large language models (LLMs), such as ChatGPT, have emerged as potential clinical support tools to enhance precision in personalized patient care, but their reliability in radiological image interpretation remains uncertain. The primary aim of our study was to evaluate the diagnostic accuracy of ChatGPT-4o in interpreting chest X-rays (CXRs) and abdominal X-rays (AXRs) by comparing its performance to expert radiology findings, whilst secondary aims were diagnostic confidence and patient safety. Methods: A total of 500 X-rays, including 257 CXR (51.4%) and 243 AXR (48.5%), were analyzed. Diagnoses made by ChatGPT-4o were compared to expert interpretations. Confidence scores (1–4) were assigned and responses were evaluated for patient safety. Results: ChatGPT-4o correctly identified 345 of 500 (69%) pathologies (95% CI: 64.81–72.9). For AXRs 175 of 243 (72.02%) pathologies were correctly diagnosed (95% CI: 66.06–77.28), while for CXRs 170 of 257 (66.15%) were accurate (95% CI: 60.16–71.66). The highest detection rates among CXRs were observed for pulmonary edema, tumor, pneumonia, pleural effusion, cardiomegaly, and emphysema, and lower rates were observed for pneumothorax, rib fractures, and enlarged mediastinum. AXR performance was highest for intestinal obstruction and foreign bodies, and weaker for pneumoperitoneum, renal calculi, and diverticulitis. Confidence scores were higher for AXRs (mean 3.45 ± 1.1) than CXRs (mean 2.48 ± 1.45). All responses (100%) were considered to be safe for the patient. Interobserver agreement was high (kappa = 0.920), and reliability (second prompt) was moderate (kappa = 0.750). Conclusions: ChatGPT-4o demonstrated moderate accuracy for the interpretation of X-rays, being higher for AXRs compared to CXRs. Improvements are required for its use as efficient clinical support tool. Full article

Background and Objectives: Diagnostic imaging is essential for evaluating urinary tract disorders, offering critical insights into renal pathology. This review examines the strengths, limitations, and clinical applications of various imaging modalities, with a focus on pediatric populations. Materials and Methods: A narrative review was conducted, synthesizing current literature on ultrasound (US), computed tomography (CT), magnetic resonance imaging (MRI), nuclear medicine, and voiding cystourethrography (VCUG). Relevant studies were selected based on diagnostic accuracy, clinical utility, and safety considerations. Results: US is the preferred first-line imaging due to its safety, accessibility, and cost-effectiveness. CT excels in detecting renal calculi, trauma, and malignancies but is limited by radiation exposure. MRI offers superior soft tissue contrast without radiation but is costly and often requires sedation. Nuclear medicine evaluates renal function and scarring, while VCUG remains the gold standard for diagnosing vesicoureteral reflux and posterior urethral valves. Conclusions: Imaging modalities are vital for diagnosing and managing urinary tract disorders, with selection based on clinical needs, patient age, and safety. Ultrasound is the primary choice for its non-invasiveness and cost-effectiveness, while CT, MRI, nuclear medicine, and VCUG provide essential structural and functional insights. A balanced approach ensures accuracy while minimizing patient risk, especially in pediatrics. Full article