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ABSTRACT Purpose: To investigate the risk factors associated with adverse outcomes in patients with residual stones after percutaneous nephrolithotomy (PCNL) and to establish a nomogram to predict the probability of adverse outcomes based on these risk factors. Methods: We conducted a retrospective review of 233 patients who underwent PCNL for upper urinary tract calculi and had postoperative residual stones. The patients were divided into two groups according to whether adverse outcomes occurred, and the risk factors for adverse outcomes were explored by univariate and multivariate analyses. Finally, we created a nomogram for predicting the risk of adverse outcomes in patients with residual stones after PCNL. Results: In this study, adverse outcomes occurred in 125 (53.6%) patients. Multivariate logistic regression analysis indicated that the independent risk factors for adverse outcomes were the diameter of the postoperative residual stones (P < 0.001), a positive urine culture (P = 0.022), and previous stone surgery (P = 0.004). The above independent risk factors were used as variables to construct the nomogram. The nomogram model was internally validated. The calculated concordance index was 0.772. The Hosmer- Lemeshow goodness-of-fit test was performed (P > 0.05). The area under the ROC curve of this model was 0.772. Conclusions: Larger diameter of residual stones, positive urine culture, and previous stone surgery were significant predictors associated with adverse outcomes in patients with residual stones after PCNL. Our nomogram could help to assess the risk of adverse outcomes quickly and effectively in patients with residual stones after PCNL
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ABSTRACT Background Several studies have explored the impact of BMI on size and composition of urinary stones. Because there were controversies, a meta-analysis was necessary to be carried out to provide some evidence of the relationship of BMI and urolithiasis. Materials and Methods PubMed, Medline, Embase, Web of Science databases, and the Cochrane Library were searched up to August 12th 2022 for eligible studies. The urolithiasis patients were summarized into two groups: BMI < 25 and ≥ 25 kg/m2. Summary weighted mean difference (WMD), relative risk (RR) and 95% confidence intervals (CI) were calculated through random effects models in RevMan 5.4 software. Results A total of fifteen studies involving 13,233 patients were enrolled in this meta-analysis. There was no significant correlation of BMI and size of urinary stone (WMD -0.13mm, 95% CI [-0.98, 0.73], p = 0.77). Overweight and obesity increased the risk of uric acid stones in both genders and in different regions (RR=0.87, [95% CI] = 0.83, 0.91, p<0.00001). There was a higher risk of calcium oxalate stones formation in overweight and obesity group in total patients (RR=0.95, [95% CI] = 0.91, 0.98, p = 0.006). The relationship of BMI and calcium phosphate was not observed in this meta-analysis (RR=1.12, [95% CI] = 0.98, 1.26, p = 0.09). Sensitivity analysis was performed and indicated similar results. Conclusions The current evidence suggests a positive association between BMI and uric acid and calcium oxalate stones. It would be of great guiding significance to consider losing weight when treating and preventing urinary stones.
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ABSTRACT Purpose To construct a predicting model for urosepsis risk for patients with upper urinary tract calculi based on ultrasound and urinalysis. Materials and Methods A retrospective study was conducted in patients with upper urinary tract calculi admitted between January 2016 and January 2020. The patients were randomly grouped into the training and validation sets. The training set was used to identify the urosepsis risk factors and construct a risk prediction model based on ultrasound and urinalysis. The validation set was used to test the performance of the artificial neural network (ANN). Results Ultimately, 1716 patients (10.8% cases and 89.2% control) were included. Eight variables were selected for the model: sex, age, body temperature, diabetes history, urine leukocytes, urine nitrite, urine glucose, and degree of hydronephrosis. The area under the receiver operating curve in the validation and training sets was 0.945 (95% CI: 0.903-0.988) and 0.992 (95% CI: 0.988-0.997), respectively. Sensitivity, specificity, and Yuden index of the validation set (training set) were 80.4% (85.9%), 98.2% (99.0%), and 0.786 (0.849), respectively. Conclusions A preliminary screening model for urosepsis based on ultrasound and urinalysis was constructed using ANN. The model could provide risk assessments for urosepsis in patients with upper urinary tract calculi.
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Objective:To compare the safety and efficacy of 7.5 Fr and 9.5 Fr flexible ureteroscopy in the primary treatment of upper urinary tract calculi with maximum diameter<1.5 cm.Methods:Using a prospective randomized controlled study method, 96 patients with upper urinary tract calculi with maximum diameter<1.5 cm admitted to the Department of Urology, Beijing Friendship Hospital, Capital Medical University from August 2020 to May 2022 were selected as the study subjects. The patients were divided into two groups by random number table method: the experimental group and the control group, with 48 patients in each group. The experimental group patients underwent 7.5 Fr flexible ureteroscopic lithotripsy, while the control group patients underwent 9.5 Fr flexible ureteroscopic lithotripsy. Collect preoperative, intraoperative, and postoperative data from these patients, including success rate of ureteral access sheath insertion, surgical time, lithotripsy time, stone-free rate, ureteral injury status, and complications status. The measurement data were expressed as mean±standard deviation ( ± s), Student- t test was used for comparison between groups; the Chi-square test was used for inter-group comparison of count data, and the Mann-Whitney U test was used for inter-group comparison of rank data. Results:The success rate of primary sheath insertion in the experimental group was 93.8% (45/48), and that in the control group was 79.2% (38/48), the difference between the two groups was statistically significant ( P<0.05). There were no statistically significant difference between the experimental group and the control group in terms of surgical time [(52.0±11.0) min vs (55.1±11.4) min, P>0.05] and lithotripsy time [(26.0±9.3) min vs (23.7±8.7) min, P>0.05]. At four weeks after surgery, the stone-free rate in the experimental group was 93.3% (42/45), while that in the control group was 97.4% (37/38), there was no statistically significant difference between the two groups ( P>0.05). In terms of the degree of ureteral injury, there were 17 patients had grade 0 injury, 27 patients had grade 1 injury, 4 patients had grade 2 injury, and no patient had grade 3 injury in the experimental group; there were 9 patients had grade 0 injury, 23 patients had grade 1 injury, 13 patients had grade 2 injury, and 3 patients had grade 3 injury in the control group; the difference between the two groups was statistically significant ( P<0.05). In terms of complications, there were 22 cases of hematuria, 9 cases of pain, 8 cases of bladder spasm, and 2 cases of mild fever in the experimental group; there were 24 cases of hematuria, 12 cases of pain, 9 cases of bladder spasm, and 1 case of mild fever in the control group; there was no statistically significant difference between the two groups ( P>0.05). Conclusion:The application of 7.5 Fr flexible ureteroscopy and 9.5 Fr flexible ureteroscopy in the primary treatment of upper urinary tract calculi with maximum diameter<1.5 cm can achieve good stone-free rates, but the 7.5 Fr flexible ureteroscopy has a higher success rate of sheath insertion and less damage to the ureter.
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【Objective】 To reduce the misdiagnosis rate by analyzing the clinical data of patients with primary upper tract urothelial carcinoma (UTUC) complicated with calculi. 【Methods】 Clinical data of 7 UTUC with calculi patients treated during Sep.2018 and Apr.2022 were retrospectively analyzed, including general data, time from visit to diagnosis, imaging data, urine exudation cytological results, surgical methods, pathological stages and follow-up data. 【Results】 The ratio of male to female was 3∶4, and the mean age was 66.4 (55-72) years. The initiate imaging examination results only showed calculi, but did not indicate suspicious tumor (including 1 case with missing data). The median time from the first visit to diagnosis was 12 months (5-36 months). Of all 7 cases, 2 (2/4) were clinically diagnosed by enhanced CT, 3 (3/4) by MRI, and 2 (2/7) by positive urine exudation cytology. All patients received surgical treatment. Postoperative pathology showed 85.71% (6/7) were high-grade UTUC. Postoperative staging was T1N0M0 in 4 cases, T3N0M0 in 2 cases, and T4N2M0 in 1 case. Adjuvant chemotherapy was conducted in 2 cases. During the median follow-up of 12 months (6-41), 1 case developed multiple systemic metastases in month 9, while the other cases had no recurrence or metastasis. 【Conclusion】 For UTUC patients without obvious filling defect on imaging, especially when ipsilateral calculi were complicated, misdiagnosis should be alerted for timely treatment and better prognosis.
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【Objective】 To analyze the composition of urinary calculi in Longnan, Gansu province, and the relationship between the composition and clinical characteristics of patients, so as to provide reference for the prevention and treatment of this disease. 【Methods】 The composition of 500 cases of urinary calculi hospitalized in our department during Apr. 2021 and Feb.2023 were analyzed using the infrared spectrum stone composition analyzer. The clinical characteristics of the patients were evaluated and analyzed. 【Results】 The male-to-female ration of patients was 2.70∶1. Most patients aged 21 to 60 years (437, 87.4%). Most cases were ureteral calculi (72.8%), followed by renal calculi (22.2%), and bladder calculi (5.0%). There were 166 cases of calcium oxalate calculi, 293 cases of calcium oxalate + carbonated apatite calculi, 24 cases of calcium oxalate + carbonated apatite + hydroxyl apatite calculi, 4 cases of calcium oxalate + calcium bicarbonate calculi, 7 cases of urate calculi, 6 cases of carbonated apatite + struvite calculi. Oxalate calculi were the most common in all age groups, and urate calculi were the most common in the 21 to 40 age group. Calcium oxalate calculi were most common in the ureter (127, 76.5%), significantly higher than in other sites (χ2=3.222, P=0.020). Calcium oxalate + calcium hydrogen phosphate calculi was the least common in the bladder, significantly different from the other parts (χ2=2.092, P=0.037). Magnesium ammonium phosphate hexahydrate and/or calcium carbonate or calcium oxalate calculi were the most common in the kidney (50.0%), significantly different from the other parts (χ2=9.448, P=0.007). 【Conclusion】 In Longnan area, the incidence of urinary calculi is significantly higher in male than in female. Ureteral calculi are mainly composed of calcium oxalate + carbonated apatite and calcium oxalate. According to different risk factors, individual prevention programs should be developed.
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【Objective】 To investigate the effects of extracorporeal shock wave lithotripsy (ESWL) on procalcitonin (PCT), renal function and inflammatory index levels in patients with indinavir-induced urinary calculi so as to provide reference for clinical practice. 【Methods】 A total of 77 patients with urinary calculi admitted to the Department of Urology of our hospital from January 2017 to January 2021 were selected for retrospective analysis. They were divided into control group (38 cases, non-indinavir related urinary calculi) and observation group (39 cases, indinavir-related urinary calculi) according to the years of the disease. Before treatment and 7 days after treatment, the serum levels of PCT, CRP, Scr, UA, Kim1, VAS scores, and IgG, IgM, MDA, and SOD levels were compared between the two groups. 【Results】 The expressions of serum PCT and CRP at 7 days after treatment in the two groups were significantly lower than those before treatment, and the improvement degree of the observation group was significantly higher than that in the control group (P0.05), but the intraoperative blood loss and MAP 20 min after induction of anesthesia were significantly better than those in the control group. Seven days after treatment, GSH-Px and SOD were significantly better in the observation group than in the control group and before treatment (P<0.05). 【Conclusion】 ESWL treatment for patients with indinavir-induced urinary calculi can effectively reduce the expressions of serum PCT and CRP, improve renal function indexes, reduce intraoperative blood loss, and reduce the level of inflammatory indexes; the clinical effect is good.
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The incidence and recurrence rates of urinary stone diseases have remained high recently, and stone analysis is of great significance for further understanding of the pathophysiological processes of urinary stones and to develop effective prevention strategies and precise treatment. Imaging evaluation is the main method of preoperative stone analysis, and dual-energy CT has shown its potential in identifying common main components of stones. The emergence of photon counting spectral CT is expected to achieve accurate analysis of stone components at the pixel level. The intraoperative stone analysis mainly relies on the automatic recognition of endoscopic images, and using machine learning algorithms can more reliably predict common stone composition. It is of great significance for stone analysis and assessment of metabolic causes by introducing morpho-constitutional classification (MCC)and observing and describing the papillary renal lesions during operation. This article reviews the progress of preoperative and intraoperative stone analysis, in order to improve clinicians' understanding of the importance of stone analysis, and provide a direction for further clinical research.
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Upper urinary tract calculi combined with dual infections is rare, and the antimicrobial therapy is complicated. This retrospective study analyzed the clinical data of 3 patients with upper urinary tract calculi combined with dual infection who were admitted to our hospital. Three patients were treated with piperacillin sulbactam combined with fluconazole for 1 week, according to the preoperative urine culture and drug sensitivity results. Endoscopic surgery was performed after the efficacy was determined by routine urine examination. After surgery, fluconazole was administered until the removal of the double-J tube for 2 weeks, and fluconazole was discontinued when no white blood cells or fungus were found. No recurrence of stones or infection was observed at a follow-up of 11 months to 2 years. The rational choice of antimicrobial drugs to treat upper urinary tract calculi combined with dual infection could create good conditions for endoscopic surgical intervention, thus achieving satisfactory clinical outcomes.
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Objective:To discuss the clinical experience and efficacy of minimally invasive anterograde multiple endoscopic treatment of upper urinary tract stones in allograft kidney.Methods:We retrospectively analyzed 14 patients with upper urinary tract stones in allograft kidney admitted to our hospital from June 2018 to August 2020. 8 cases were female and 6 cases were male, with an average age of 47.3±11.1 years. 3 patients had hyperuricemia and four had hypertension and diabetes. The history of renal transplantation was over ten years in 3 cases, three to five years in 4 cases, two years in 3 cases, 1 year in 3 cases, and 4 months in 1 case. 3 patients had a history of RIRS, and the operation was terminated due to severe ureteral tortuosity resulting in failure of sheathing or ureteroscopy. Ureteral stent was performed in 2 cases due to stone obstruction and hydronephrosis. Serum creatinine was normal in 7 patients before operation, and serum creatinine was 91-139μmol/L in 4 patients in the compensatory stage of chronic renal insufficiency. The serum creatinine was 292, 544 and 708μmol/L respectively in 3 patients in the decompensated stage of chronic renal insufficiency or renal failure stage. The preoperative average hemoglobin was 117.5g/L. 3 cases were partial staghorn calculi, 4 cases were single caliceal or renal pelvis calculi, 2 cases were renal pelvis or caliceal calculi with upper ureteral calculi, and 5 cases were renal pelvis or renal caliceal calculi with multiple calculi. Stone size were 1 case of single upper caliceal stone of 0.7cm, 3 cases of lower caliceal stones of 1.5, 1.6 and 2.0cm, 1 case of renal pelvic stone of 1.5cm, 2 cases of middle and upper caliceal stones of 2.8 and 3.1cm, 2 cases of middle and lower caliceal stones of 1.5 and 3.2cm, respectively. 3 cases of middle upper caliceal and renal pelvic stones were 2.2, 2.5 and 2.6cm. 2 cases of renal pelvis with upper ureteral stones were 1.3 and 1.7cm, 0.7 and 0.5cm respectively. Preoperative routine urine examination showed that 9 cases had urinary tract infection, among which 5 cases had positive urine culture. Surgery was performed after therapeutic improvement with sensitive antibiotics. According to the size and distribution of stone, the combination of single access or multi-access PCNL in different diameters was adopted, supplemented by FURS. Surgical methods selection and performance: 2 cases performed in single S-PCNL with stone size were 2.2cm and 2.6cm, 2 cases performed in single M-PCNL with stone size were 1.5cm and 1.5cm, 1 case performed in Needle-perc with stone size was 0.7cm, 2 cases performed in S-PCNL combined M-PCNL with stone size were 2.8cm and 3.1cm, 3 cases performed in S-PCNL combined Needle-perc with stone size were 2.0cm, 2.5cm and 3.2cm, 2 cases performed in M-PCNL combined Needle-perc with stone size were 1.5cm and 1.6cm, 2 cases performed in S-PCNL combined anterograde FURS with stones size were 1.3cm and 1.7cm in allograft kidney and ureter stone were 0.7cm and 0.5cm, a total of 7 kinds of way, and postoperative stone free rate, laboratory indexes (serum creatinine, blood hemoglobin), surgical complications, postoperative hospital stay were analyzed.Results:All 14 patients (mean age was 47.3±11.1 years) were successfully operated. Postoperative examination revealed 1 case had 0.6cm residual stone and it was cleared at the second stage anterograde FURS through the original access. The mean operative time and postoperative hospital stay were 68.2±21.6min and 6.2±1.3 days. Compared with preoperative serum creatinine changes, 2 cases showed slight increase (mean 12.6±0.3μmol/L), 3 cases showed significant decrease (mean 329.6±216.6μmol/L), and the other 9 cases showed no significant change (range<10μmol/L), among which 5 cases showed an increase (mean 5.4±0.7 μmol/L) and 4 cases showed a decrease (mean 3.7±0.4 μmol/L). The mean decrease of hemoglobin was 9.3±4.1g/L. Two patients had fever and their body temperature returned to normal after anti-inflammatory treatment. No blood transfusion, abdominal organ injury or urogenic sepsis occurred.Conclusions:Invasive anterograde multiple endoscopic treatment of upper urinary tract stones in allograft kidney is a single or combined operation using single-channel PCNL, multi-channel PCNL of different sizes and diameters and anterograde FURS according to individual differences, which can effectively reduce renal function injury is safe, efficient and feasible.
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Objective:To investigate the characteristics of urinary stones composition in children and the differences in their distribution among different sexes and age groups.Methods:The clinical data of 592 children with urinary stones who underwent stone composition analysis using infrared spectroscopy at Hunan Children's Hospital from October 2015 to October 2019 were retrospectively analyzed. There were 430 males and 162 females.The median age was 4.0 (0.3 to 18.0) years old. The stone composition and the differences in its distribution in different sex and age groups were analyzed.Results:A total of 643 urinary stones were analyzed in 592 cases, with 419 (65.2%) single-component stones and 224 (34.8%) mixed-component stones. The main stone components were calcium oxalate in 361 cases (56.1%), ammonium hydrogen urate in 130 cases (20.0%), cystine in 56 cases (8.7%), calcium phosphate in 33 cases (5.1%), uric acids in 33 cases (5.1%), magnesium ammonium phosphate in 25 cases (3.9%), and xanthine in 5 cases (0.8%). The percentage of calcium oxalate stones was higher in women than in men [65.6% (118/180) vs. 52.5% (243/463), P<0.05]. The proportion of upper urinary tract stones was higher in girl than in boy[93.4%(168/180) vs. 73.2%(339/463), P<0.05]. The differences in the composition ratios of calcium oxalate stones, ammonium hydrogen urate, cystine, and magnesium ammonium phosphate stones in different age groups were statistically significant ( P<0.05), with the highest proportion of calcium oxalate stones (35.6%) at 6 to 10 years of age, ammonium hydrogen urate and cystine stones at 1 to 2 years of age (45.4% and 42.9%), and magnesium ammonium phosphate stones at 3 to 5, 6 to 10, and 11 to 18 years of age, the percentage of urinary stones in children was 24%. Conclusions:The main component of urinary stones in children is calcium oxalate, followed by ammonium hydrogen urate and cystine. Age and gender correlate with the distribution of stone components. Calcium oxalate stones are common in females and in children aged 6 to 10 years, ammonium hydrogen urate and cystine stones are common in children aged 1 to 2 years, and magnesium ammonium phosphate stones are more common in children aged 3 to 5 years, 6 to 10 years, and 11 to 18 years.
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Objective:Objectives To introduce the preliminary experience of flexible vacuum-assisted ureteral access sheath(FV-UAS) in the treatment of upper urinary calculi in retrograde intrarenal lithotripsy(RIRS).Methods:The clinical data of 11 patients with upper urinary calculi who were treated in Jiangxi Provincial People's Hospital from August to September 2021 were analyzed retrospectively. There were 6 males and 5 females, with the mean age of 48 years (32-72 years), the mean size of stone of 15.5 mm (11-20mm), and the mean stone volume of 1 958 mm3 (1 108-4 036 mm3), including 1 case with upper ureteral calculi, 10 cases with renal calculi, and 2 cases with calculi in multiple renal calyces. Ureteral stents were placed in 2 cases preoperatively. There were 2 cases of grade Ⅱ hydronephrosis according to Grignon classification. All patients were treated by retrograde intrarenal lithotripsy, and the FV-UAS(F12/14) was used during the operation. FV-UAS can be passively bent(>90°) with the bending of the flexible ureteroscopy(f-URS), and connect vacuum suction devices. The method of placing the FV-UAS during the operation was the same as traditional ureteral access sheath. The FV-UAS should be as close to the target stone as possible by the f-URS during the operation. F6 ureteral stent was routinely indwelled for 2-4 weeks. The operation time, postoperative complications, and stone volume clearance rate were summarized and analyzed, and stone volume clearance rate was calculated as(1-residual stone volume/preoperative stone volume)×100%. The stone volume was obtained by CT 3-D reconstruction preoperatively and first day postoperatively.Results:All patients underwent RIRS successfully at the first stage, with the usage of FV-UAS(F12/14)during the operation. The mean operation time was 57.1 minutes(34-90 minutes), and the mean stone volume clearance rate was 98.9%(94.8%-100.0%)on the first day postoperatively. Seven cases reached 100.0% stone-free rate, and 4 cases presented residual calculi. The mean hemoglobin drop was 0.8 g/L, and 1 case presented vomiting without fever on the first day postoperatively. For the 4 cases with residual calculi, no residual stone was found by B-ultrasound when the ureteral stent was removed.Conclusions:Our preliminary study found that it is feasible and safe to use FV-UAS in RIRS, which can follow the f-URS to extend into the renal pelvis and renal calyces. Vacuum-assist can increase the probability of stone-free.
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Objective:To analyze the risk factors of the elderly patients with upper urinary tract stones treated by flexible ureteroscope lithotripsy affect the patients′ stone escape.Methods:A retrospective study of 160 patients with upper urinary tract calculi admitted to Baise People′s Hospital from January 2015 to January 2021, all patients were treated with flexible ureteroscopic lithotripsy, and they were 60-85 years old. According to whether the patients had escaped stones, the patients were divided into stone escape group ( n=53) and stone non-escape group ( n=107). Chi-square test was used for comparison of count data between groups. Multivariate Logistic regression analysis was used to analyze the independent risk factors for stone escape in patients; Use R3.3.2 software and software package rms to build a nomogram prediction model; receiver operating characteristic curve (ROC) was used to evaluate the discrimination of the nomogram model in predicting patients with stone escape, and the results were expressed as the area under the curve (AUC) and the 95% confidence interval (95% CI) of the area. Results:Flexible ureteroscope lithotripsy for the treatment of elderly patients with upper urinary tract stones has been found to have good efficacy, low risk of bleeding and fewer complications. In univariate analysis, compared with the stone not-escape group, in the stone escape group, the proportion of patients with mild or moderate preoperative hydronephrosis, the ureteral tube occluder was not used during the operation, intraoperative pump injection pressure of 0.9% sodium chloride injection >200 mmHg, number of stones >1, the location of the stones in the upper and lower calyces of the kidney were significantly increased ( P<0.05). Multivariate Logistic regression analysis found that the preoperative hydronephrosis was mild or moderate, the ureteral tube occluder was not used during the operation, and the intraoperative pump injection pressure of 0.9% sodium chloride injection >200 mmHg were independent risk factors for stone escape in patients. The consistency index (C-index) of the nomogram prediction model and the AUC of the ROC were 0.804 (95% CI: 0.746-0.862) and 0.821 (95% CI: 0.763-0.879), respectively, indicating that the model has good discrimination. Conclusion:Mild or moderate preoperative hydronephrosis, no ureteral tube occluder during operation, and intraoperative pump injection pressure of 0.9% sodium chloride injection >200 mmHg are all risk factors for stone escape in patients.
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Objective:To explore the etiology, clinical diagnosis and treatment strategy of Lesch Nyhan syndrome.Methods:We retrospectively analyzed 2 patients with severe dyskinesia, mental retardation and complicated renal calculi who were admitted to the first people's Hospital of Zhengzhou in August 2019. Case 1, male, 9 years old, had multiple urinary calculi for 1 year. The patient came to the local hospital because double multiple kidney stones and bladder stonesa year ago. The patient had been treated with transurethral holmium laser lithotripsy for bladder stones. The results of infrared spectrum showed that the bladder stone was anhydrous uric acid stone. A week ago, color Doppler ultrasound showed multiple kidney stones and bladder stones. The patient was underdeveloped, mentally retarded and had a full-term cesarean section. There was no history of hypoxia, asphyxia and rescue of the patient. He had the following clinical manifestations: In the waking state, he was no language response to any stimulation. The nasolabial fold on the right was shallow and the corner of the mouth was oblique to the left. He lost the large movements such as lifting head, sitting alone, standing. The trunk showed torsion spasticity, limb muscle strength 2-3, limbs showing spastic hypertonia, limb joints stiff, hands showing fist-like, no involuntary movement and muscle fasciculation. The biceps reflex and knee tendon reflex were not elicited, and the pathological reflex was positive. Serum uric acid was 517 μmol/L. The Case 2 came from the same family, male, 6 years old, had the similar symptoms to his elder brother case 1. The family members complained on behalf of the child about intermittent fever for more than 2 years. The imaging examination of case 2 revealed kidney stones. Serum uric acid was 373 μmol/L. Whole Exome Sequencing and Sanger Sequencing were used to find the genetic causes of the two siblings. The NCBI-Homologene database was used to find the homologous sequence of the human HPRT1 gene, and the human HPRT1 gene sequence was compared with other species to analyze the protein conservation. The online website PredictProtein (http: //www.predactprotein) was used to predict the two-dimensional structure of the HPRT1 gene. The reported cases were summarized and same with the treatment plan.Results:A De novo mutation [c.571T>G(p.Tyr191Asp)] was found in the HPRT1 gene of the child, which was inherited from the mother. Lesch Nyhan syndrome can be diagnosed by the results of gene examination combined with clinical manifestations. The amino acid Tyr at the 191 position and the amino acids before and after it were highly conserved. Amino acid 191 was involved in the β-strand of the protein. We treated the patients with the lowest dose of allopurinol and children's conventional dose of potassium sodium bicitrate granules, and low purine diet. After 3 months of treatment, the serum uric acid was decreased, and the urinary calculi did not increase significantly.Conclusions:Combining with the clinical manifestations of children, HPRT1 gene might be the cause of pediatric disease and the two siblings could be diagnosed as Lesch-Nyhan syndrome. For such patients, the lowest dose of allopurinol and children's conventional dose of potassium sodium hydrogen citrate granule combined with diet could be more effective.
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Renal subcapsular abscess(RSA) is a rare disease with unknown etiology and pathogenesis. CT is an important assistant examination for the diagnosis. In this study, we reported 2 cases of RSA. One case achieved good therapeutic effect by timely debridement and surgery drainage, and the other case refused to perform debridement and drainage, which lead to the death. This kind of disease develops quickly and progresses rapidly. The adequate debridement and surgery drainage are important in treating this disease.
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Objective:To investigate the characters and emergency treatment strategy of upper urinary tract stone obstruction complicated with urosepsis.Methods:Clinical data of 28 cases of urosepsis, caused by upper urinary tract stone obstruction and arranged for emergency admission in our hospital during January 2018 to December 2019, were retrospectively analyzed. There were 6 males and 22 females. The median age was 54(32-93)years old. All patients had fever with the temperature ranged from 38.5 to 41.0 ℃. The median course of disease was 3 (ranging 1-14) days. The systolic blood pressure ranged from 76 to 138 mmHg at admission. Hypotension group was defined as the systolic blood pressure<90 mmHg after admission. Normotensive group was defined as the systolic blood pressure≥90 mmHg. There were 12 cases in hypotension group, including 3 males and 9 females. The median age was 57 (ranging 32-93) years old. The stones located at left side in 7 cases and right side in 5 cases. The stones located at the upper ureter in 5 cases, middle ureter in 2 cases, lower ureter in 4 cases and renal calculi in one case. The median length of the stone was 10 (ranging 6-20) mm. Six cases suffered with diabetes mellitus. One case suffered with neuron system disease. 3 cases have history of recent extracorporeal shock wave lithotripsy(ESWL). There were 16 cases in normotensive group, including 3 males and 13 females with the median age of 53 (ranging 33-76) years old. The stones located at left side in 5 cases, right side in 9 cases and bilateral in 2 cases. The stones located at the upper ureter in 10 cases, middle ureter in 4 cases, lower ureter in 2 cases. The length of the stone was 10 (ranging 8-14) mm. There were 3 cases with neurological diseases and 3 cases with recent ESWL history. There was significant difference between hypotension group and normotensive group in ration of diabetes mellitus ( P=0.024). Blood routine examination, C-reactive protein (CRP), procalcitonin(PCT), blood and urine bacterial culture were performed in both groups. The patients were treated with empiric antibiotics after the evaluation based on the sequential organ failure assessment (SOFA). Patients with hypotension were given blood volume expansion, and vasoactive drugs were added when the blood pressure was still low. After the blood pressure was stable, the collection system decompression was performed. The difference of infection indicators and therapeutic methods between the two groups was compared. Results:There was no significant difference in median WBC [16.34 (2.55-41.65) × 10 9/L vs. 13.97(6.23-26.65) × 10 9/L, P=0.577], median CRP [143.0(74.2-200.0) ng/ml vs.110.0 (22.7-200.0) ng/ml, P=0.771] between hypotension group and normotensive group. The difference of PCT [95.5 (26.5-200.0) ng / ml vs. 57.6 (1.0-200.0) ng / ml, P=0.040] and PLT [65.5(14.0-170.0)×10 9/L vs. 73.0(17.0-412.0)×10 9/L, P=0.030] between hypotension group and normotensive group was statistically significant. The median SOFA scores of hypotension group and normotensive group were significantly different [8.5(3.0-13.0) vs. 5.0(2.0-8.0), P=0.001]. Ureteral stent placement was performed in 23 cases, and nephrostomy was performed in 5 cases. There was no significant difference in surgical drainage between the two groups ( P=0.887). Eight patients in hypotension group were admitted to ICU. There was no significant difference in the duration of antibiotic use between hypotension group and normotensive group [8 (3-12) d vs. 5 (3-7) d, P=0.453]. Sepsis was cured in both groups after decompression, fluid resuscitation and antibiotic treatment. Conclusions:In severe cases of upper urinary tract stone obstruction complicated with urogenic sepsis, septic shock may occur. The condition is urgent, severe and dangerous. Patients with hypotension had higher PCT and SOFA scores, and lower PLT. It is very important to carry out the collection system decompression drainage in time, liquid resuscitation, early effective antibiotic use.
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Objective:To evaluate the application value of dual-source CT in detecting the components of urinary calculi in children.Methods:A retrospective analysis of 433 children treated for urinary calculi in the Urological Center, People′s Hospital of Xinjiang Uygur Autonomous Region from March 2018 to January 2021 was performed in parallel with dual-source CT examination. The data was processed by the post-processing workstation and the stone composition was analyzed. The analysis results were compared with the results of infrared spectroscopy, and the accuracy of dual-source CT analysis of stones and the predictive value of dual-source CT various measurement indexes for the types of stones were compared. The measurement data were expressed as mean±standard deviation ( Mean± SD), and the comparison of the measurement indexes of each stone type [average CT value, dual energy difference, dual energy ratio and dual energy index (DEI)] were compared by One-way Anova analysis of variance. Draw receiver operator characteristic curve and calculate the area under the curve (AVC), then evaluate the diagnostic efficacy of each index. Results:Dual-source CT detected 282 calcium oxalate stones, 238 calcium phosphate stones, 39 uric acid stones and 7 cystine stones. Compared with the results of infrared spectroscopy, the accuracy rates of dual-source for calcium oxalate stones and hydroxyapatite stones were 84.2% and 81.8%, respectively. Both uric acid stones and cystine stones were accurately detected. In addition, dual energy difference, dual energy ratio, and DEI have reliable predictive value for calcium oxalate stones and calcium phosphate stones, especially dual energy ratio and DEI, both AUC>0.75.Conclusion:Using advanced post-processing analysis methods, dual-source CT can reliably analyze the components of children′s urinary tract stones, and provide a reference for choosing personalized treatment plans.
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SUMMARY INTRODUCTION: Patients with bilateral kidney stones and burdened by large stones are challenging cases for endourologists. Simultaneous bilateral percutaneous nephrolithotomy (sbPCNL) is an option; however, it may be accompanied by important morbidity. An alternative is a staged PCNL, operating one side each time. Herein, we compare the impact of sbPCNL and staged PCNL on complication rates and renal function. METHODS: Patients who underwent sbPCNL or staged bilateral PCNL with a frame time of 6 months were searched in our prospectively collected kidney stone database. Groups were compared for age, gender, body mass index (BMI), comorbidities (classification by the American Society of Anesthesiology - ASA), stone size, Guy's score, stone-free status, renal function, blood loss, blood transfusion rate, complication rate, and length of hospital stay. RESULTS: Twenty-six patients and 52 kidney units were enrolled. The mean operative time was 134.7 min. Only 11.3% of cases had complications, all of them minor (Clavien ≤ 2). Overall, the stone-free rate was 61.50%. Comparing the groups, there was a significantly longer operative time in the sbPCNL group (172.5 vs. 126.3 min; p=0.016), as well as a higher transfusion rate (12.5% vs. 5.6%; p=0.036). There was no statistically significant difference in creatinine levels between the groups. Regarding the stone-free rate, there was a significantly higher proportion of patients in the staged PCNL group (64.9% vs. 43.8%; p=0.012). CONCLUSION: sbPCNL is a safe procedure; however, when compared to staged procedures it has a higher transfusion and lower stone-free rate.
RESUMO INTRODUÇÃO: Paciente com cálculos renais bilaterais e de grande volume são casos desafiadores para os endourologistas. A nefrolitotripsia percutânea bilateral simultânea (NLPbs) é um opção, entretanto esse procedimento pode ser acompanhado de morbidade importante. Uma alternativa é a NLP estagiada, operando um lado de cada vez. Aqui, nós comparamos o impacto da NLPbs e da NLP estagiada nas taxas de complicações e função renal. MÉTODOS: Pacientes que foram submetidos a NLPsb ou NLP stagiada com intervalo de até 6 meses foram pesquisados em nossa base de dados de cálculos renais prospectivamente coletada. Os grupos foram comparados em idade, gênero, índice de massa corpórea (IMC), comorbidades (classificação da Sociedade Americana de Anestesiologia - ASA), tamanho do cálculo, Classificação de Guys, taxa de pacientes livres de cálculos, função renal, perda sanguínea, taxa de transfusão, taxa de complicações e tempo de internação hospitalar. RESULTADOS: Vinte e seis paciente e 52 unidades renais foram incluídas. O tempo operatório médio foi de 134,7 min. Apenas 11.3% dos casos tiveram complicações, sendo todas menores (Clavien ≤ 2). No geral, a taxa de pacientes livres de cálculos foi de 61,5%. Comparando os grupos houve um tempo operatório significativamente maior no grupo NLPbs(172,5 vs. 126,3 min; p=0,016), assim como uma maior taxa de transfusão (12,5% vs. 5,6%; p=0.036). Não houve diferença significante nos níveis de creatinina entre os grupos. Em relação a taxa de doentes livre de cálculos houve uma proporção significativamente maior de pacientes livres de cálculos na NLP estagiada (64,9% vs. 43,8%; p=0,012). CONCLUSÃO: A NLPsb é um procedimento seguro, entretando quando comparada ao procedimento estagiado apresenta uma maior taxa de transfusão e uma menor taxa de pacientes livres de cálculos.
Subject(s)
Humans , Nephrostomy, Percutaneous/adverse effects , Kidney Calculi/surgery , Nephrolithotomy, Percutaneous/adverse effects , Postoperative Complications/etiology , Retrospective Studies , Treatment Outcome , Operative Time , Length of StayABSTRACT
ABSTRACT Patients with staghorn renal stones are challenging cases, requiring careful preoperative evaluation and close follow-up to avoid stone recurrence. In this article we aim to discuss the main topics related to staghorn renal stones with focus on surgical approach. Most of staghorn renal stones are composed of struvite (magnesium ammonium phosphate) and are linked to urinary tract infection by urease-producing pathogens. Preoperative computed tomography scan and careful evaluation of all urine cultures made prior surgery are essential for a well-planning surgical approach and a right antibiotics choice. Gold standard surgical technique is the percutaneous nephrolithotomy (PCNL). In cases of impossible percutaneous renal access, anatrophic nephrolithotomy is an alternative. Shockwave lithotripsy and flexible ureteroscopy are useful tools to treat residual fragments that can be left after treatment of complete staghorn renal stone. PCNL can be performed in supine or prone position according to surgeon's experience. Tranexamic acid can be used to avoid bleeding. To check postoperative stone-free status, computed tomography is the most accurate imaging exam, but ultrasound combined to KUB is an option. Intra-operative high-resolution fluoroscopy and flexible nephroscopy have been described as an alternative for looking at residual fragments and save radiation exposure. The main goals of treatment are stone-free status, infection eradication, and recurrence prevention. Long-term or short-term antibiotic therapy is recommended and regular control imaging exams and urine culture should be done.
Subject(s)
Humans , Male , Female , Nephrostomy, Percutaneous , Staghorn Calculi/surgery , Staghorn Calculi/diagnostic imaging , Kidney , Treatment Outcome , UrologistsABSTRACT
ABSTRACT Objective: This study aims to design a novel semirigid ureterorenoscope with irrigation and vacuum suction system and a modified ureteral access sheath (UAS) named Sotn ureterorenoscope® (Sotn=ShuoTong Medical Company) to overcome the deficiencies of the current procedure and to improve the efficiency and safety of using Sotn ureterorenoscope® for treatment of upper urinary calculi. Materials and Methods: Fifty-eight patients, comprising 31 males and 27 females, were evaluated. The medical records of 58 patients with upper urinary calculi treated with Sotn ureterorenoscope® from March 2015 to June 2017 were retrospectively reviewed at the Second Affiliate Hospital of Guangzhou University of Chinese Medicine in China. The primary outcome was stone-free rate (SFR) assessed by computed tomography on the 1st day and one month after treatment. The secondary outcome was postoperative complication rate. Results: The mean and SD of operative duration was 48.5 (10.4) min, and the mean and SD of stone size was 15.6 (5.6) mm. The primary overall SFR was 89.7% (52/58) and 100% at 1 month follow-up. Complication, which was Clavien I (minor fever managed by antipyretic therapy), was detected in 1.7% (1/58) of the patients. Conclusions: Sotn ureterorenoscope® is technically feasible, efficacious and safe for treatment of upper urinary calculi because of its advantages of high SFR and low complication rates.