A single-center clinical study of 61 children with ammonium urate stones / 现代泌尿外科杂志

【Objective】 To analyze the clinical characteristics of children with ammonium urate stones in Xinjiang, so as to provide reference for the prevention and treatment of this disease. 【Methods】 The clinical data of all children with ammonium urate stones admitted to the People’s Hospital of Xinjiang Uygur Autonomous Region from 2016 to 2021 were retrospectively analyzed, including age, sex, body mass index, stone site, stone size, stone component, urine pH, urine culture and biochemical examination results. The serum total protein, albumin, sodium, potassium, calcium, magnesium, uric acid and urine pH were compared between the pure and mixed groups. 【Results】 A total of 61 children (31.6%) had ammonium urate stones, their average age was (4.05±3.37) years, and the male to female ratio was 2.21∶1. Among them, there were 37 cases (60.7%) of renal calculi and 50 cases (82.0%) of upper urinary calculi. The most common component of mixed ammonium urate stones was calcium oxalate, including calcium oxalate monohydrate, calcium oxalate monohydrate and calcium oxalate dihydrate. Compared with mixed type, children with pure stone type had a younger age (P=0.001) and a smaller stone size (P=0.003). Positive urine culture was detected in 14 cases (23.0%), 7 of which (50% were infected with Escherichia coli, and 11 (78.6%) with non-urease bacteria. 【Conclusion】 Non-urease bacteria are the main pathogens of urinary tract infection in children with ammonium urate stones. The incidence is higher in boys, and the most common stone location is upper urinary tract. Calcium oxalate is the most common mixed component. Pure type is more common in young children and the stones are relatively small.

Research progress of percutaneous nephrolithotomy in ambulatory surgery mode / 现代泌尿外科杂志

Ambulatory percutaneous nephrolithotomy (APNL) is the mode of treatment in which patients are admitted to hospital for percutaneous nephrolithotomy (PNL) and discharged smoothly within 24 hours, and the total length of hospital stay in special cases is less than 48 hours. APNL can optimize the utilization of hospital beds and upgrade patients’ satisfaction. Miniaturized channel has been applied to the preliminary exploration of APNL. The mode is often operated with paravertebral block and partial or total tubeless after surgery, which can reduce postoperative pain and shorten hospital stay. Meanwhile, the stone-free rate and postoperative complication rate are not significantly different from those of PNL. The key of successful APNL depends on strict screening of cases, and careful formulating of clinical pathways and emergency plans to standardize medical practices and improve service efficiency. This article reviews the clinical safety and efficacy of APNL and summarizes the criteria for selecting cases suitable for this mode.

Advances in the study of the correlation between urolithiasis and non-alcoholic fatty liver disease / 中华泌尿外科杂志

In recent years, researchers have found that patients with nonalcoholic fatty liver disease (NAFLD) often have urolithiasis, and the incidence of urolithiasis increases gradually with the severity of NAFLD. Meanwhile, the detection rate of NAFLD was higher in patients with urolithiasis than in normal controls. In this paper, we reviewed the domestic and international studies on the correlation between urolithiasis and NAFLD and described the related pathogenesis, such as insulin resistance, oxidative stress, abnormal lipid metabolism and impaired glyoxalate detoxification. Meanwhile, this paper proposed preventive measures to reduce the risk of development and recurrence of NAFLD-associated urolithiasis by addressing the common risk factors of both diseases, including metabolism-related diseases, lifestyle and diet.

Comparison of temperature rise curve and steady state temperature during thulium and holmium laser lithotripsy / 中华泌尿外科杂志

Objective:To compare the temperature rise curve and steady-state temperature of thulium and holmium laser in lithotripsy.Methods:This study was conducted from November to December 2021. Firstly, we designed an experimental water tank(10 cm×10 cm×10 cm) that can carry out constant temperature water bath, with a 8ml simulated renal pelvis, and can carry out constant velocity perfusion in the simulated renal pelvis. A 1 cm×1 cm×1 cm cubic artificial stone was placed in the simulated renal pelvis to perform 36.5℃-37.5 ℃ water bath. The simulated renal pelvis was closed with an oak plug, the temperature measuring probe and flexible ureteroscope were placed through the hole on the oak plug and entered into the simulated renal pelvis. Flexible ureteroscope was carried out by urologists. The lithotripsy lasted a total of 180 seconds for thulium and holmium laser respectively under different parameter settings (10 Hz×1.0 J, 10 Hz×2.0 J, 10 Hz×3.0 J, 20 Hz×0.5 J, 20 Hz×1.0 J, 20 Hz×1.5 J, the corresponding gravel power is 10 W, 20 W and 30 W respectively), the constant speed water pump flow rate was separate as the high flow rate group (35 ml/min) and low flow rate group (15ml/min), and leave a temperature probe 5mm around the optical fiber. Water temperature change during the lithotripsy was recorded by probes, the average of 10 temperature values of two probes measured every 5 seconds was taken as the water temperature value of this period, with a total of 216 time points in 6 parameter settings. Under the same parameter settings, the temperature of two lasers at each time point was plotted and compared to form the corresponding temperature rise curve. The average temperature in the last 30 seconds during lithotripsy in the record was used as the steady-state temperature, which of thulium and holmium laser lithotripsy was compared under the same parameter setting and the same water flow velocity. Finally, 43℃ was taken as the safety threshold temperature to evaluate whether the temperature of the two lasers during lithotripsy exceeds the safety threshold.Results:According to the temperature rise curve, the water temperature of thulium laser during lithotripsy was higher than that of holmium laser at 77.7% (168/216)of time points. At the flow rate of 15 ml/min, thulium laser was significantly higher than that of holmium laser at 10 Hz×1.0 J[(32.43±2.19℃)vs. (30.99±0.90)℃, P<0.01], 10 Hz×2.0 J[(41.21±3.30℃) vs. (38.13±1.26)℃, P<0.01], 10 Hz×3.0 J[(49.54±2.44)℃vs. (44.91±0.65)℃, P<0.01], 20 Hz×0.5 J[(32.75±1.41)℃vs. (30.84±1.16)℃, P<0.01], 20 Hz×1.0 J[(41.67±1.76)℃vs. (37.51±1.25)℃, P<0.01], 20 Hz×1.5 J [(47.54 ± 3.48)℃vs. (46.12±1.04)℃, P<0.01]. At the flow rate of 35 ml/min, the thulium laser was significantly higher than that of holmium laser at 10 Hz×1.0 J[(28.01±0.57)℃ vs. (26.84±0.97)℃, P<0.01], 10 Hz×2.0 J[(31.31±1.07)℃vs.(30.41±1.39)℃, P<0.01], 10 Hz×3.0 J[(33.29±0.70)℃vs.(32.25±2.55)℃, P<0.01], 20 Hz×0.5 J[(28.36±0.99)℃vs.(26.22±0.66)℃, P<0.01], 20 Hz×1.0 J [(30.80±2.06)℃vs.(30.08±0.78)℃, P=0.012], and the steady-state temperature was not significant different between two laser at 20 Hz×1.5 J [(34.54±3.08)℃ and(33.93±1.49)℃, P=0.163]. In the low flow rate group, thulium laser at 10 Hz×1.0 J, 10 Hz×2.0 J, 20 Hz×0.5 J and 20 Hz×1.0 J does not exceed the safety threshold temperature, while in the high flow rate group, any combination of laser parameters of the two lasers does not exceed the safety threshold temperature. Conclusion:Under the same laser parameter setting and flow rate, the thermal eff of thulium laser is more obvious. When using thulium laser for lithotripsy, the flow rate in the process of lithotripsy being faster than that of holmium laser with the same laser setting should be ensured to avoid tissue damage.

Preclinical evaluation of Hibiscus cannabinus Linn. in the treatment of urolithiasis and cholelithiasis / 数字中医药（英文）

@#【Objective】  To investigate the therapeutic effect of Hibiscus cannabinus Linn. (H. cannabinus) leaves on cholelithiasis and urolithiasis. 【Methods】  The study evaluated the effect of aqueous leaf extract of H. cannabinus on thiouracil and cholesterol cholic acid diet induced cholelithiasis in BALB/c mice and ethylene glycol induced urolithiasis in Wistar rats. Three doses of aqueous extract (40, 80, and 160 mg/kg) were selected to evaluate the effectiveness in cholelithiasis in mice; another three doses of aqueous extract (400, 800, and 1 600 mg/kg) were administered for evaluating the effect on urolithiasis in rats. Biochemical parameters such as biliary cholesterol, biliary phospholipid, and bile acid were determined in cholelithiasis model. Similarly, 24-hour urine output, urinary parameters such as creatinine, uric acid, protein, urea, presence of calcium oxalate crystals, red blood cells (RBCs), and pyuria were determined in urolithiasis model. 【Results】  Statistically significant differences were noted in the biliary and urinary parameters after administrating three test doses of H. cannabinus aqueous extract (P < 0.05). 【Conclusion】 H. cannabinus was found to be effective against high fat lithogenic diet urolithiasis and cholelithiasis.

Characteristics of Traditional Chinese Medicine Syndromes in 296 Patients with Urolithiasis / 中国实验方剂学杂志

ObjectiveTo analyze the characteristics of tradition Chinese medicine (TCM) syndromes in patients with urolithiasis. MethodA syndrome questionnaire was developed to collect the general data and four diagnosis information on 296 patients with urolithiasis who were treated from September 2021 to September 2022. Tongue images, pulse images, symptoms, and signs were statistically analyzed, and the characteristics of syndrome were explored by association rule analysis, factor analysis, and cluster analysis. Result① In the distribution of tongue images, the single tongue images with a frequency of more than 20% were white fur, red tongue, thick fur, greasy fur, and yellow fur. In the distribution pf pulse images, the single pulse with the frequency of more than 20% was fine pulse, string pulse, slippery pulse, and sinking pulse. There were 27 symptoms and signs with a frequency of more than 10%. The characteristic symptoms of acute onset such as lumbar and abdominal pain and nausea, frequent urination, hematuria, and poor urination were relatively common, and other symptoms were chill and fever, defecation, and digestion. ② Among the 14 strong association rules, 5 were yang-deficiency and cold-dampness syndromes, 4 were yin-deficiency and heat syndromes, 1 was kidney-deficiency syndrome, and 3 were renal colic with accompanying symptoms. ③ Sixteen common factors were extracted by factor analysis, and the main elements of the disease location were represented by spleen and kidney. The main elements of disease natures were Yin deficiency, Yang deficiency, dampness, and heat, and often mixed with deficiency-excess in complexity. Six syndromes were obtained by cluster analysis, and the represented syndromes were mainly kidney deficiency and dampness and stasis, Qi stagnation and heat accumulation, Yin deficiency and dampness heat, spleen-kidney Yang deficiency, spleen deficiency and dampness, and dampness-heat accumulation. ConclusionThe syndrome manifestations of urolithiasis are chill and fever, defecation, sweating, and digestive tract symptoms. The deficiency syndromes are mainly Yin deficiency, Yang deficiency, kidney deficiency, and spleen deficiency. The excess syndromes are mainly wet and heat. The deficiency and excess syndromes often exist simultaneously. The spleen deficiency is the important pathogenesis of urolithiasis besides the kidney deficiency.

Protocolo de manejo metabólico multidisciplinario de la litiasis urinaria

La enfermedad de cálculos renales, (nefrolitiasis) es un problema común en la atención en salud. Entre algunos de los factores que ayudan a la prevalencia de litiasis se encuentra la obesidad, altas temperaturas ambientales, y los climas secos. La frecuencia de las diferentes composiciones de los cálculos es: Oxalato de calcio entre el 70-80 %, fosfato calcico el 15 % (la apatita es más común y la brushita es menos común), Ácido úrico el 8%, cistina entre el 1-2 %, Estruvita -1%, Varios - <1 %3.No existen muchos datos sobre la recurrencia de los mismos, pero se sabe que la tasa de recurrencia de litiasis urinaria es del 10 al 30% a los 5 años en pacientes que tienen cálculos de oxalato de calcio idiopáticos. Se plantea elaborar un protocolo de manejo metabólico multidisciplinario de la litiasis urinaria en base a la bibliografía actual tomando en cuanto los puntos de vistas de las especialidades destinadas al manejo del paciente con litiasis urinaria. Nuestro objetivo es establecer un protocolo de manejo capaz de identificar y establecer una terapia que pueda prevenir los cálculos urinarios de forma eficiente y económica, mejorando el pronóstico y minimizando las complicaciones.

Kidney stone disease is a common problem in health care. Among the factors that contribute to the prevalence of lithiasis are obesity, high environmental temperatures, and dry climates. The frequency of the different stone compositions is: Calcium Oxalate 70-80%, Calcium Phosphate -15% (Apatite is more common and Brushite is less common), Uric Acid 8%, Cystine - 1-2%, Struvite -1%, Various - <1%3. There are not many data on their recurrence, but it is known that the recurrence rate of urinary lithiasis is 10 to 30% at 5 years in patients with idiopathic calcium oxalate stones. It is proposed to develop a multidisciplinary metabolic management protocol for urinary lithiasis based on the current bibliography, taking the point of specialties dedicated to the management of patients with urinary lithiasis. Our goal is to establish a management protocol capable of identifying and establishing a therapy that can efficiently and economically prevent urinary stones, improving prognosis and minimizing complications.

Descripción de las características sociodemográficas y clínicas de pacientes con litiasis renal

Contexto: los cálculos renales son cúmulos o depósitos de minerales que se forman en los cálices, la pelvis renal o el tracto urinario. Objetivo: describir las características sociodemográficas y clínicas de una muestra de pacientes con litiasis renal, mayores de 18 años. Metodología: estudio observacional descriptivo de pacientes atendidos en una consulta ambulatoria de Nefrología en Manizales en el periodo 2010-2020, donde se contaba con estudios en sangre, orina de 24 horas y estudio fisicoquímico del cálculo, además de datos sociodemográficos y clínicos relacionados. Se fragmentaron en grupos, de acuerdo con los hallazgos encontrados en los cálculos disponibles, dividiéndose en oxalato de calcio en su totalidad, calcio mixto con otro compuesto y el último grupo de cálculo no calcio. Resultados: se identificaron 54 pacientes con nefrolitiasis, de los cuales 14 de ellos fueron excluidos. Finalmente, 40 pacientes cumplieron con los criterios de inclusión. La mediana de edad fue 52,5 años, predominio del sexo masculino (55 %), donde se encontró en 20,5 % hiperuricemia, hipercalcemia en 17,6 %, hiperfosfatemia en 5 % e hipercaliemia en 7,5 %. En orina se encontró: hipocitraturia en el 71,1 %, seguido de hipercalciuria (12,5 %), hiperuricosuria (10 %) e hiperoxaluria (5 %). En 17 de los pacientes (42,5 %) se logró el estudio de la composición fisicoquímica del cálculo, en ellos la variedad de calcio mixto fue la más frecuente (55,5 %). Conclusiones: este estudio describe las características de pacientes con cálculos renales, mostrando que la mayoría tiene alteraciones metabólicas asociadas a nefrolitiasis, siendo la hipocitraturia el hallazgo más frecuente y que la mayoría de los cálculos tiene calcio en su composición.

Background: Kidney stones are accumulations or mineral deposits that form in the calyces, renal pelvis, or urinary tract. Purpose: To describe the sociodemographic and clinical characteristics of a sample of patients with kidney stones over 18 years of age. Methodology: Descriptive observational study. Patients treated in an outpatient nephrology and urology consultation in Manizales during the years 2010 to 2020, in which there were studies in blood, 24-hour urine, and a physicochemical study of the stone, as well as related sociodemographic and clinical data. They were divided into groups, according to the findings found in the available stones, dividing into calcium oxalate in its entirety, calcium mixed with another compound and the last group of non-calcium stone. Results: 54 patients with nephrolithiasis were identified, 14 of them were excluded. Finally, 40 patients met the inclusion criteria. Median age was 52.5 years, male predominance (55%), hyperuricemia was found in 20.5%, hypercalcemia in 17.6%, hyperphosphatemia in 5% and hyperkalemia in 7.5%. In urine, hypocitraturia was found in 71.1%, followed by hypercalciuria (12.5%), hyperuricosuria (10%), and hyperoxaluria (5%). In 17 patients (42.5%) there was a result of the physicochemical composition of the stone, in them the mixed calcium variety was the most frequent (55.5%). Conclusions: This study describes the characteristics of patients with kidney stones, showing that the majority have metabolic alterations associated with nephrolithiasis, hypocitraturia being the most frequent finding, and that most stones have calcium in their composition.

Caracterización clínico-epidemiológica de la urolitiasis / Clinical-epidemiological description of urolithiasis

Introducción: Las urolitiasis ocasionan dolor, deterioro funcional renal y notorias erogaciones económicas. Objetivos: Identificar las características clínico-epidemiológicas de la nefrolitiasis. Métodos: Estudio descriptivo, transversal. Se estudiaron 2 923 personas pertenecientes a tres consultorios del Policlínico Plaza; municipio Plaza de la Revolución, provincia La Habana, Cuba., seleccionados por muestreo simple aleatorio de los 16 con que cuenta el área de salud. Los datos se obtuvieron mediante encuesta y entrevista estructurada. La información fue procesada de forma automatizada (IBMSPSS 22.0). Se utilizó análisis de distribución de frecuencias, se calcularon tasas de prevalencia, y fue empleado el test de homogeneidad. Resultados: La prevalencia de urolitiasis fue de 4,99 por cada 100 habitantes, de 6,3 entre los varones y de 5,7 en los de piel blanca. La edad promedio al diagnóstico fue de 39,3 años. Entre los factores de riesgo de litiasis predominó la alta ingestión de oxalatos (97,3 por ciento). La ecografía fue la forma de diagnóstico más usada (67,8 por ciento). La fitoterapia fue el tratamiento médico más utilizado (69,2 por ciento). Al 16,4 por ciento de los pacientes se les expidió certificado médico en los últimos dos años. Conclusiones: La prevalencia de litiasis urinaria en el Policlínico Docente Plaza de la Revolución es elevada, con predominio en el sexo masculino, en sujetos de piel blanca y en las edades medias de la vida. La alta ingestión de oxalato es el factor de riesgo de litiasis urinaria más frecuente encontrado. La forma de diagnóstico más utilizada es la ecografía y el tratamiento más empleado es la fitoterapia(AU)

Introduction: Urolithiasis causes pain, renal functional deterioration and notorious economic expenses. Objectives: To identify the clinical-epidemiological characteristics of nephrolithiasis. Methods: A descriptive, cross-sectional study was conducted in a total of 2,923 people from to three clinics of Plaza de la Revolution Teaching Community Clinic, Plaza de la Revolution municipality, Havana province, Cuba. They were selected by simple random sampling from the 16 clinics that the health area has. The data was obtained through a survey and structured interview. The information was processed automatically (IBMSPSS 22.0). Frequency distribution analysis was used, prevalence rates were calculated and the homogeneity test was used. Results: The prevalence of urolithiasis was 4.99 per 100 inhabitants, 6.3 among men and 5.7 among white-skinned men. The average age at diagnosis was 39.3 years. Among the risk factors for lithiasis, the high intake of oxalates prevailed (97.3 percent). Ultrasound was the most used form of diagnosis (67.8 percent). Phytotherapy was the most used medical treatment (69.2 percent). A medical permit was issued to 16.4 percent of the patients in the last two years. Conclusions: The prevalence of urinary lithiasis in Plaza de la Revolution Teaching Community Clinic is high, prevailing in males, in white-skinned and middle aged subjects. High oxalate intake is the most common risk factor for urinary lithiasis found. The most used form of diagnosis is ultrasound and the most used treatment is phytotherapy(AU)

COVID-19: The impact on urolithiasis treatment in Brazil

ABSTRACT Introduction: It has been more than a year since the first case of Covid-19 was diagnosed in Brazil, and its most problematic feature is the oversaturation of the healthcare system capacity. Urolithiasis is a disease that requires timely and appropriate management. The present study aimed to evaluate the impact of the pandemic in hospital admissions for urolithiasis in the Brazilian public healthcare system. Materials and Methods: In this cross-sectional study, hospital admissions were obtained from the Brazilian Public Health Information system. All hospital admissions associated with urolithiasis diagnosis (ICD-10 N20) between March 2017 and February 2021 were analyzed. Results: During the COVID-19 outbreak, there was a significant decrease in hospital admissions (p<0.0001). More than 20.000 patients probably did not have the opportunity to undergo their surgeries. The impact of the COVID-19 outbreak on women's admissions was significantly more intense than for men, reducing from 48.91% to 48.36% of the total (p=0.0281). The extremes of age seemed to be more affected, with patients younger than 20 years and older than 60 years having a significant reduction in access to hospital services (p=0.033). Conclusions: In conclusion, we have noticed a considerable reduction in overall admissions for the treatment of urolithiasis in the Brazilian public healthcare system during the first year of the Covid-19 pandemic. Women and individuals older than 60 years were especially affected. In contrast, we noted a rise in urgent procedures, comparing with the average of the corresponding period of the three previous years. Recovery plans will be needed while returning to activities to handle the impounded surgical volume.

Conhecimento e atitudes de pacientes portadores de nefrolitíase: estudo transversal / Knowledge and attitudes of patients with nephrolithiasis: a crosssectional study

Nefrolitíase é uma doença comum do trato urinário com crescente aumento da prevalência, principalmente pela falta de controle dos fatores de risco modificáveis. O objetivo deste estudo foi avaliar o nível de conhecimento sobre fatores de risco para nefrolitíase e atitudes dos pacientes. Trata-se de um estudo transversal, observacional, descritivo e analítico com base em revisão de prontuários e por meio de um inquérito online de pacientes com diagnóstico de nefrolitíase em acompanhamento em uma clínica privada de nefrologia em Joinville, Brasil. Avaliou-se sexo, idade, comorbidades, valores laboratoriais, conhecimento e atitudes. Um modelo multivariado explicativo foi proposto para avaliar o efeito do conhecimento e atitudes com os fatores de risco para nefrolitíase. Dos 129 participantes, 44 (34%) eram homens, mediana da idade de 42 anos e mediana do tempo do diagnóstico de 5 anos. Hipertensão foi a comorbidade mais prevalente em 26%. Em 42% dos pacientes, houve aumento do peso desde a primeira consulta. Isoladamente, o consumo excessivo de sal (98%), baixa ingesta de água (77%) e alto consumo de proteína (67%) foram os fatores de risco mais identificados. Após ajuste para confundidores, o maior conhecimento não foi associado com o aumento de peso (OR=0,94; IC 95% 0,73-1,22; p=0,661 ou para menor ingesta de sal (OR=1,26; IC 95% 0,95-1,67; p=0,106). O maior conhecimento foi associado com maior ingesta de líquido diário (OR=1,50; IC 95% 1,11-2,01; p=0,008). Embora exista baixo conhecimento de todos os fatores de risco de nefrolitíase, medidas para ampliar a conscientização pode contribuir para atitudes preventivas.

Nephrolithiasis is a common urinary tract disease with an increasing prevalence, mainly due to the lack of control of modifiable risk factors. The aim of this study was to assess the level of knowledge about risk factors for nephrolithiasis and patients' attitudes. This is a cross-sectional, observational, descriptive, and analytical study based on a review of medical records and through an online survey of patients diagnosed with nephrolithiasis during follow-up at a private nephrology clinic in Joinville, Brazil. Gender, age, comorbidities, laboratory values, knowledge, and attitudes were evaluated. An explanatory multivariate model was proposed to assess the effect of knowledge and attitudes on risk factors for nephrolithiasis. Of the 129 participants, 44 (34%) were men, median age 42 years and median time to diagnosis 5 years. Hypertension was the most prevalent comorbidity in 26%. In 42% of patients, there was weight gain since the first consultation. Alone, excessive salt consumption (98%), low water intake (77%) and high protein consumption (67%) were the most identified risk factors. After adjusting for confounders, greater knowledge was not associated with weight gain (OR=0.94; 95% CI 0.73-1.22; p=0.661) or lower salt intake (OR=1.26; 95% CI 0.95-1.67; p=0.106). Greater knowledge was associated with greater daily fluid intake (OR=1.50; 95% CI 1.11-2.01; p=0.008). Although there is little knowledge of all nephrolithiasis risk factors, measures to increase awareness can contribute to preventive attitudes.

Anti urolithiatic activity of Cyperus rotundus tubers: In silico, In vitro and In vivo approaches

Abstract The present research evaluated the anti urolithic potential of Cyperus rotundus tubers extract using in silico, in vitro and in vivo techniques. In silicostudy was performed of Cyperus rotundus constituents and pathological protein oxalate oxidase (PDB Id: 2ETE). In vitrostudy, nucleation and aggregation assay involved for assessment of ethanol extract of Cyperus rotundus tuber (50-3000 µg/ml).In vivo studies involved that the Cyperus rotundusethanolic extract (100, 200 and 400 mg/kg B.wt.) wastreatedonsodium oxalate induced urolithiatic rats for seven days,evaluated kidney function by urine and serum biochemical analysis and statistical analysis performed usingGraphPad prism5 software.In silico results showedthat Cyperus rotundus constituents,Humulene epoxide, 4-Oxo-alpha-ylangene, Cubebol were exhibited better binding energyonoxalate oxidase.Ethanolic extract of Cyperus rotundustuber was exhibited nucleation, aggregation of calcium oxalate monohydrate crystals inhibition in dosedependent manner. Sodium oxalate treatment was triggered biochemical changesin the urine that have been substantially prevented by the ethanolic extract of Cyperus rotundus tuber. The current findings Cyperus rotundus anti urolithic activity due to antioxidant essential oils. The molecular docking results could be used to optimize lead and develop the appropriate urolithiasis treatment.

Physicochemical techniques for determining the composition of canine and feline uroliths: a literature review / Técnicas físico-químicas para determinação da composição de urólitos em caninos e felinos: uma revisão de literatura

ABSTRACT: Urinary lithiasis has been reported as a problem that affects humankind since ancient times and has been described in several animal species. The condition is a consequence of other diseases that may be present in the urinary system or related to other body disorders. The stone composition needs to be analyzed to identify the possible causes that led to the formation and development of uroliths. For this, several techniques are currently available, some of which are promptly accessible, while others are not. Thus, this literature review aimed to perform a brief introduction on urolithiasis, present the most used techniques in the analysis of the composition of canine and feline uroliths and point out the advantages and disadvantages of each technique.

RESUMO: A litíase urinária foi reportada como um problema que atinge a humanidade desde a antiguidade e já foi descrita em diversas espécies de animais. A doença é considerada consequência de outras enfermidades que podem estar presentes no sistema urinário, ou relacionados com outros distúrbios do organismo. Para identificar as possíveis causas que levaram à formação e desenvolvimento de urólitos é importante analisar a composição dos cálculos. Para isso, existem várias técnicas disponíveis atualmente, algumas de mais fácil acesso e outras, nem tanto. Dessa forma, objetiva-se com a presente revisão realizar uma breve introdução sobre a urolitíase e apresentar as técnicas mais utilizadas na análise da composição de urólitos, em caninos e felinos, bem como apontar as vantagens e desvantagens de cada uma das técnicas.

The consistency of tomographic infrared spectroscopy with conventional infrared spectroscopy for the analysis of the composition of larger-volume urinary calculi / 中华泌尿外科杂志

Objective:To compare the consistency of tomographic infrared spectrum analysis with conventional infrared spectrum analysis for the composition analysis of large-volume of urinary stones in vitro.Methods:Postoperative urinary stone specimens collected from 105 patients admitted to Beijing Tsinghua Changgung Hospital from January 2019 to June 2021 were analyzed, including 81 (77.14%) kidney stones, 16 (15.24%) ureteral stones, and 8 (7.62%) bladder stones. All stones measured ≥0.8 cm in maximum diameter on preoperative imaging. Eighty-four specimens, which were mainly stone fragments, were collected from percutaneous nephrolithotomy and ureteroscopic lithotripsy. These 84 specimens were analyzed and retested for stone composition using conventional infrared spectrum analysis by random multiple sampling. Other 21 renal stone specimens were obtained by laparoscopic lithotomy or standard percutaneous nephrolithotomy after November 1, 2020. These 21 specimens had a maximum diameter of ≥0.8 cm measured postoperatively. Based on intraoperative observation, stone specimens with typical layered structures were chosed. Then, all 21 samples were analyzed and retested by conventional infrared spectrum analysis and tomographic infrared spectrum analysis, respectively. When using tomographic infrared spectrum analysis, we need to take two maximum cross sections with a vertical spacing of these sections >2 mm, then perform multiple points sampling according to the morphological stratification of the first section. If the section's structure was homogeneous, we equidistantly took 2 to 3 samples from the center to the periphery. Otherwise, every layer needed to take a stone sample according to the stratification. Putting all the results of one section together, we obtained complete tomographic infrared spectrum analysis data. Take another coaxial cross-section of the same specimen for retesting. We recorded the characteristics of the three-dimensional distribution of stone composition in 21 stone specimens. Meanwhile, we compared the consistency of the results of conventional infrared spectrum analysis and tomographic infrared spectrum analysis for the same sample.Results:The consistency rate of the conventional infrared spectrum analysis was 56.19% (59/105), and that of tomographic infrared spectrum analysis was 80.95% (17/21). The difference in consistency between two methods was statistically significant ( χ2=4.447, P=0.035). Among 21 specimens, the consistency rate of conventional infrared spectrum analysis was 38.10% (8/21), which was significantly lower than that of tomographic infrared spectrum analysis ( χ2=7.814, P=0.005). Regarding the characteristics of the three-dimensional distribution of the components, the color and crystal morphology of five common types of stone components were different, and layered structure in the cross-section of the stones were observed. When the calculi were of the same composition, they were displayed in different morphology. We observed a trending change in the composition ratio between sublayers from the center to the edge in some compound-composition stones. Conclusions:For the composition analysis of larger-volume urinary stones, tomographic infrared spectrum analysis showed a higher consistency of retesting than conventional infrared spectrum analysis, and the three-dimensional distribution of stone composition had some characteristic features.

Pathogenic bacteria spectrum of infectious stones and experience of preventing stone recurrence / 中华泌尿外科杂志

Objective:To investigate the pathogenic bacteria profiles in preoperative urine bacterial cultures of patients with infected kidney stones and use antibacterial drugs to prevent recurrence.Methods:The data of 79 cases with infected kidney stones admitted to the Second Affiliated Hospital of Zhengzhou University from January 2017 to July 2021 were retrospectively analyzed, among whom 29 (36.7%) were male and 50 (63.3%) were female. The age ranged from 17-75 years, with a median age of 49.0 (40, 55) years. Fifteen cases (19.0%) combined hypertension, 13 cases (16.5%) combined diabetes mellitus, and 3 cases (3.8%) combined with cardiovascular disease. Fifty-one cases (64.6%) were diagnosed with cast infectious stones. All patients underwent surgical lithotripsy, and postoperative review of the urological computerized tomography (CT) revealed no residual stones defined as complete lithotripsy, and postoperative oral medication was continued to control infection and prevent stone recurrence. According to post-hospitalization compliance, patients were divided into high and low compliance groups. The high compliance group consisted of patients who returned to the hospital regularly for routine urinalysis and urine bacterial culture after discharge, followed the doctor's prescription for standardized antibacterial drug therapy, and complied with urease inhibitor therapy for ≥6 months. The low compliance group included patients who did not take sensitive antimicrobial drugs regularly and/or were unable to adhere to the medication even after the reduction of vinblastine due to adverse events such as tremor, palpitations, headache, anemia, or gastrointestinal discomfort. The recurrence of stones at 3, 6 and 12 months of follow-up was compared between the two groups.Results:Of the 79 cases in this group, 56(70.9%) were completely clear of stone after surgery. Thirty-three cases (41.8%) presented positive in preoperative urine bacterial culture, and the most common causative organism was Aspergillus oddus in 17 cases (21.5%), followed by Escherichia coli in 8 cases (10.1%) and Klebsiella pneumoniae in 3 cases (3.8%). Among the 17 positive cases of A. oddis, six were positive for ultra broad spectrum β-lactamases (ESBLs), 6/6 were resistant to ampicillin, cefazolin, and cotrimoxazole, 1/6 were resistant to amikacin, cefoxitin, and ticarcillin/stick acid, and none were resistant to imipenem, polymyxin, or aminotrans (0/6 cases). Of the cases, 11 were negative for ESBLs. Ten out of eleven cases were resistant to ampicillin. Furthermore, 8/11 cases were resistant to cefazolin, levofloxacin, ciprofloxacin, and cotrimoxazole and 1/11 were resistant to cefoxitin, cefaclor, furantoin, amikacin, and minocycline, and 0/11 were resistant to imipenem, ticarcillin/stick acid, aminotrans. ESBLs positive strains were resistant to 78.6% of the tested drugs (cefaclor, cefazolin, ceftazidime, furantoin, norfloxacin, levofloxacin, ciprofloxacin, cefoxitin, amoxicillin/rod acid, ticarcillin/rod acid, ampicillin, ceftriaxone, cefotaxime, cefuroxime, cefepime, gentamicin, cotrimoxazole, tobramycin, amikacin, tetracycline, chloramphenicol, and minocycline) at a lower rate of resistance than ESBLs positive strains. Of the eight positive cases of E. coli, seven were ESBLs positive, 7/7 were resistant to ampicillin, cefazolin, cefotaxime, cefuroxime, and cefepime, 1/7 were resistant to cefoxitin and minocycline, and 0/7 were resistant to imipenem, furantoin, or amikacin. One case was ESBLs negative and was resistant to all antimicrobial drugs except for ampicillin. Stone recurrence rates at 3, 6, and 12 months after discharge were 9.1%(4/44) and 31.4%(11/35), 13.6%(6/44), respectively, in the high compliance group, and 60.0%(21/35), 36.4%(16/44), and 71.4% (25/35), respectively, in the low compliance group. All differences were statistically significant.Conclusion:The most common pathogenic bacteria isolated from urine bacterial cultures of patients with infectious stones were A. chimaera, E. coli, and K. pneumoniae. The resistance rate of ESBLs-positive strains to antimicrobial drugs was significantly higher than that of ESBL-negative strains, and the resistance rate of antimicrobial drugs such as β-lactamase inhibitors, cefoxitin, amikacin, and imipenem was low. Combination therapy with standardized sensitive antimicrobial drugs and urease inhibitors significantly reduced the recurrence rate of stones among patients.

Serum and urinary amino acid profiling analysis for urinary stone disease using GC-MS / 中华检验医学杂志

Objective:To analyze the serum and urinary amino acid (AA) profiles of urolithiasis patients to explore the potential biomarkers for clinical screening and early diagnosis.Methods:Case-control study. Serum and urine samples were collected from 74 urolithiasis patients (aged 20-82 years, 41 men, 33 female) in the department of urology of the First Affiliated Hospital of Fujian Medical University and 35 healthy controls (HC, aged 22-80 years old, 20 men, 15 female) from the health examination center from February 2015 to October 2017. Serum and urinary AA levels of patients and HC were analyzed using Gas Chromatography-Mass Spectrometry (GC-MS) based metabolomic strategy. The multivariate statistical analysis methods of principal component analysis (PCA) and orthogonal partial least squares discrimination analysis (OPLS-DA) were employed for modeling. The variable importance projection (VIP) value of OPLS-DA model>1 and P<0.05 of t test were selected to screen the differential amino acid metabolites. The diagnostic capabilities of potential markers were evaluated by receiver operating characteristic (ROC) curve and binary logistic regression analysis. Results:Five AA metabolites including serine, glutamate, aspartic acid, isoleucine and glycine were found, which had statistically significant differences between the patient group and the control group ( P<0.05) and were associated with seven metabolic pathways. Serum serine, glutamate, aspartic acid, isoleucine and urine glycine and aspartic acid were combined into an integrated marker panel whose AUC value was 0.890, the sensitivity was 78.0%, and the specificity was 96.4%. Conclusion:Five amino acids in serum and urine could be used as an integrated biomarker panel for the clinical screening and early diagnosis of urolithiasis, which could provide some experimental basis for molecular urolithiasis research.

Publication Trends in Pediatric Stone Disease: A Bibliometric Analysis / Tendencias de publicación en la litiasis pediátrica: Un análisis bibliométrico

Introduction In the pediatric population, the prevalence of stone disease has increased in recent years. We aim to analyze the bibliometric characteristic of available literature on the management of stones in this population. Methods We performed a search for articles published until December 2019 on the Scopus, Google Scholar, PubMed, Embase, and Web of Science databases using the keywords children, lithiasis, and stones. We excluded articles involving patients older than 18 years of age and those with non-urological lithiasis. Then, we performed a bibliometric analysis using the original language, year of publication, impact factor (yearly number of citations), and absolute citation count as variables to calculate the impact index (number of sources adjusted for the time since publication). Results We included 291 articles published between 1940 and December 2019 for analysis. The average number of citations per manuscript was of 15.3 (± 21.9), and the average impact index was of 502 (± 976.4). A total of 4 articles were published before 1970. The evaluation of historical landmarks that could affect citation counts, such as the launch of a journal specialized in pediatric urology (Journal of Pediatric Urology), showed a mean citation count of 23.29 before the first edition, and of 14.96 after (p = 0.0006). The variation on the impact index with the same criteria was of 539.6 before the first edition of the Journal of Pediatric Urology, and of 316.32 after (p = 0.001). The average number of citations before internet access was of 17.9, and, after the internet, of 15.1 (p = 0.17). We also observed a difference in counts regarding languages of publication. Conclusions The proportional academic productivity on pediatric stone disease demonstrates that citation counts do not reflect the true academic impact of subspecialized topics.

Introducción La prevalencia de la urolitiasis en la población pediátrica ha venido aumentando en los últimos años. Este manuscrito busca analizar las características bibliométricas de la literatura disponible sobre el manejo de la urolitiasis pediátrica. Métodos Realizamos una búsqueda por artículos publicados hasta diciembre de 2019 en las bases de datos Scopus, Google Scholar, PubMed, Embase y Web of Science con las palabras children, lithiasis, y stones. Excluimos artículos con pacientes mayores de 18 años y litiasis no urológica. Posteriormente, realizamos un análisis bibliométrico utilizando el idioma original, el año de publicación, el factor de impacto (número de citas anuales), y el recuento absoluto de citas para calcular el índice de impacto (número de fuentes ajustadas por el tiempo desde la publicación). Resultados Analizamos 291 artículos publicados desde 1940 hasta diciembre de 2019. El promedio de citas por artículo fue de 15,3 (± 21,9), y el índice de impacto fue de 502 (± 976,4). Un total de 4 artículos fueron publicados antes de 1970. La evaluación de hitos históricos que pudieran afectar el recuento de citas, como el lanzamiento de una revista de urología pediátrica (Journal of Pediatric Urology), mostró un recuento medio de citas de 23,29 antes de la primera edición, y de 14,96 después (p = 0,0006). La variación del índice de impacto con los mismos criterios fue de 539,6 antes de la primera edición de esta revista, y de 316,32 después (p = 0,001). El promedio de citas antes del acceso a la internet fue de 17,9, y después, de 15,1 (p = 0,17). Observamos también una diferencia en los recuentos respecto a los idiomas de publicación. Conclusiones La productividad académica sobre la litiasis pediátrica demuestra que los recuentos de citas no reflejan el verdadero impacto académico de los temas subespecializados.

Comparación de la costo-efectividad de la nefrolitotomía percutánea y de la nefrolitotomía retrógrada flexible con láser de holmio en pacientes con litiasis renal de 20 a 30 mm en Colombia / Comparison of the Cost-effectiveness of Percutaneous Nephrolithotomy and Flexible Retrograde Holmium Laser Nephrolithotomy in Patients with Kidney Stones of 20 to 30 mm in Colombia

Introducción y Objetivo Con el advenimiento de nuevas tecnologías, vienen controversias respecto al espectro de sus aplicaciones. El costo derivado de estas tecnologías juega un papel muy importante en el momento de la toma de decisiones terapéuticas. Es por esto que consideramos relevante estimar la costo-efectividad de la nefrolitotomía percutánea comparada con la nefrolitotomía retrógrada flexible con láser de holmio en pacientes con litiasis renal de 20 mm a 30 mm en Colombia. Materiales y Métodos Por medio de la construcción de un modelo de árbol de decisión usando el programa Treeage (TreeAge Software, LLC, Williamstown, MA, EE.UU.), se realizó una comparación entre la nefrolitotomía percutánea y la nefrolitotomía retrógrada flexible con láser de holmio en pacientes con litiasis renal de 20 mm a 30 mm. La perspectiva fue la del tercer pagador, y se incluyeron los costos directos. Las cifras fueron expresadas en pesos colombianos de 2018. La mejoría clínica, definida como el paciente libre de cálculos, fue la unidad de resultado. Se hizo una extracción de datos de efectividad y seguridad por medio de una revisión sistemática de la literatura. La razón de costo-efectividad incremental fue calculada. Resultados El modelo final indica que la nefrolitotomía percutánea puede ser considerada como la alternativa más costo-efectiva. Los hallazgos fueron sensibles a la probabilidad de mejoría clínica de la nefrolitotomía percutánea. Conclusión Teniendo en cuenta las variables económicas, los supuestos del modelo y desde la perspectiva del tercer pagador, la nefrolitotomía percutánea para el tratamiento de pacientes con cálculos renales de 20 mm a 30 mm es costo-efectiva en nuestro país. Estos hallazgos fueron sensibles a los costos y a la efectividad de los procedimientos quirúrgicos.

Introduction and Objective The advent of new technologies leads to controversies regarding the spectrum of their applications and their cost. The cost of these technologies plays a very important role when making therapeutic decisions. Therefore, we consider it relevant to estimate the cost-effectiveness of percutaneous nephrolithotomy compared with flexible retrograde holmium laser nephrolithotomy in patients with kidney stones of 20 mm to 30 mm in Colombia. Materials and Methods Through the development of a decision tree model using the Treeage (TreeAge Software, LLC, Williamstown, MA, US) software, we compared percutaneous nephrolithotomy with flexible holmium laser retrograde nephrolithotomy in patients with kidney stones of 20 mm to 30 mm. The perspective was that of the third payer, and all direct costs were included. The figures were expressed in terms of 2018 Colombian pesos. Clinical improvement, which was defined as a stone-free patient, was the outcome unit. We extracted data on effectiveness and safety through a systematic review of the literature. The incremental cost-effectiveness ratio was calculated. Results In terms of cost-effectiveness the final model indicates that percutaneous nephrolithotomy may be considered the best alternative. These findings were sensitive to the probability of clinical improvement of the percutaneous nephrolithotomy. Conclusion Taking into account the economic variables, the assumptions of the model, and through the perspective of the third payer, percutaneous nephrolithotomy for the treatment of patients with kidney stones of 20 mm to 30mm is cost-effective in our country. These findings were sensitive to the costs and effectiveness of the surgical procedures.

Trastornos metabólicos urinarios en pacientes urolitiásicos con enfermedad renal poliquística y sin ella / Urinary metabolic disorders in urolithiasis patients with and without polycystic kidney disease

Introducción: La urolitiasis se ha incrementado en las últimas décadas. La enfermedad renal poliquística autosómica dominante (ERPAD), enfermedad renal hereditaria más frecuente, ocupa un lugar preponderante. Objetivos: Identificar la frecuencia de presentación de los trastornos metabólicos urinarios en pacientes litiásicos cubanos con ERPAD y sin ella Métodos: Estudio descriptivo, transversal. Fueron estudiados 579 pacientes adultos sin ERPAD, seleccionados por muestreo simple aleatorio y los 21 pacientes con ERPAD, del total de pacientes con litiasis urinaria que se realizó estudio metabólico renal en el Laboratorio de Fisiopatología Renal del Instituto de Nefrología, en el periodo 2010-2015. Los datos fueron tomados de la historia clínica y del informe de estudio metabólico renal. La información se procesó de forma automatizada (SPSS 22.0). Se utilizó el promedio, desviación estándar, análisis de distribución de frecuencias y el test de homogeneidad. Resultados: En los pacientes con ERPAD predominó el sexo femenino (57,1 por ciento), mientras que en los pacientes sin ERPAD, el masculino (63,4 por ciento). Los trastornos más frecuentes en la población no poliquística fueron hipercalciuria (45,3 por ciento) e hipofosfatemia (17,1 por ciento). En los poliquísticos, aclaramiento aumentado de ácido úrico (38,1 por ciento) e hipercalciuria (23,8 por ciento). Se encontraron diferencias estadísticamente significativas para aumento del aclaramiento de ácido úrico (p = 0,01) e hiperfosfatemia (p = 0,04). Conclusiones: Los principales trastornos metabólicos de los pacientes litiásicos, tanto poliquísticos como no poliquísticos, son el aclaramiento de ácido úrico aumentado, hipercalciuria, hiperuricosuria e hipofosfatemia, aunque el orden de presentación es diferente. El aclaramiento de ácido úrico aumentado y la hiperfosfatemia se presentan con mayor frecuencia en los pacientes litiásicos poliquísticos(AU)

Introduction: Urolithiasis has increased in recent decades. Autosomal dominant polycystic kidney disease (ADPKD), the most common of all hereditary kidney diseases, occupies a predominant position in terms of incidence. Objectives: Identify the frequency of occurrence of urinary metabolic disorders in Cuban urolithiasis patients with and without ADPKD. Methods: A descriptive cross-sectional study was conducted of 579 adult patients without ADPKD selected by simple random sampling, and 21 patients with ADPKD, from the total urolithiasis patients undergoing renal metabolic evaluation at the Renal Physiopathology Laboratory of the Institute of Nephrology in the period 2010-2015. Data were obtained from medical records and reports of renal metabolic studies. Information was processed with the statistical software SPSS version 22.0. Average and standard deviation were estimated and use was made of frequency distribution analysis and homogeneity testing. Results: A predominance was found of female sex among patients with ADPKD (57.1 percent) and male sex among patients without ADPKD (63.4 percent). The most common disorders were hypercalciuria (45.3 percent) and hypophosphatemia (17.1 percent) in the non-polycystic population, and increased uric acid clearance (38.1 percent) and hypercalciuria (23.8 percent) in polycystic patients. Statistically significant differences were found in uric acid clearance increase (p = 0.01) and hyperphosphatemia (p = 0.04). Conclusions: The main metabolic disorders of lithiasis patients, polycystic as well as non-polycystic, are increased uric acid clearance, hypercalciuria, hyperuricosuria and hypophosphatemia, with a varying order of presentation. Increased uric acid clearance and hyperphosphatemia are more common in polycystic lithiasis patients(AU)

Complicaciones de la nefrolitotomía percutánea como tratamiento de la litiasis renal coraliforme

RESUMEN Introducción: La nefrolitotomía percutánea es la primera opción terapéutica para la litiasis renal coraliforme. Objetivo: Caracterizar a los pacientes con complicaciones de la nefrolitotomía percutánea para el tratamiento de la litiasis renal coraliforme. Método: Se estudió una serie de 191 pacientes, operados mediante nefrolitotomía percutánea. Variables estudiadas: tipo de litiasis coraliforme, posición para la técnica, condición de libre de litiasis después de la operación, presencia de complicaciones, momento, tipo y grado según clasificación de Clavien-Dindo. Se hallaron frecuencias absolutas, relativas y se utilizó el test de ji cuadrado para determinar asociación entre variables. Resultados: El 86,9 % tenía menos de 60 años, 67,0 % eran masculinos, 61,7 % presentaba comorbilidades. La litiasis coraliforme era parcial o total (30,3 % y 46,5 %, respectivamente). En 60,2 % afectaba el riñón izquierdo; 58,1 % se operaron en supino y 70,2 % quedaron libre de litiasis con la nefrolitotomía percutánea monoterapéutica. Ocurrieron complicaciones en 19,9 %; 16,2 % fueron postoperatorias, 14,1 % infecciosas, 7,8 % Clavien-Dindo I y 5,2 % IIIb. El tipo de litiasis y la posición de la nefrolitotomía percutánea no se asociaron con las complicaciones (p> 0,05). El grado de la complicación no se relacionó con el tipo de litiasis (p> 0,05). Conclusiones: Las complicaciones postoperatorias más frecuentes son las relacionadas con la infección y el sangrado; predominan ligeramente en los pacientes con litiasis coraliformes parcial, total y en los operados en supino; el grado Clavien-Dindo de las complicaciones, es mayor en las litiasis coraliformes más complejas.

ABSTRACT Introduction: Percutaneous nephrolithotomy is the first therapeutic option for staghorn kidney stones. Objective: To characterize patients with complications of percutaneous nephrolithotomy for the treatment of staghorn renal lithiasis. Method: A series of 191 patients, operated by percutaneous nephrolithotomy, was studied. Variables studied: type of staghorn lithiasis, position for the technique, stone-free condition after the operation, presence of complications, time, type and grade according to the Clavien-Dindo classification. Absolute and relative frequencies were found and the chi-square test was used to determine the association between variables. Results: 86.9 % were less than 60 years old, 67,0 % were male, 61,7 % had comorbidities. The staghorn lithiasis was partial or total (30,3 % and 46,5 %, respectively). In 60,2 % it affected the left kidney; 58.1 % underwent supine surgery and 70,2 % were stone free with monotherapeutic percutaneous nephrolithotomy. Complications occurred in 19,9 %; 16,2 % were postoperative, 14,1 % infectious, 7,8 % Clavien-Dindo I, and 5,2 % IIIb. The type of lithiasis and the position of the percutaneous nephrolithotomy were not associated with complications (p> 0,05). The degree of complication was not related to the type of lithiasis (p> 0,05). Conclusions: The most frequent postoperative complications are those related to infection and bleeding; they slightly predominate in patients with partial and total staghorn stones and in those operated on in the supine position; the Clavien-Dindo grade of complications is higher in the more complex staghorn stones.