The efficacy and safety of one-stage endoscopy combined with intrarenal surgery (mini-nephrostomy tract) in the prone split-leg position for complex renal calculi.

Background: The goal of this study was to determine the safety and efficacy of endoscopic combined intrarenal surgery (ECIRS) performed in the prone split-leg position for the treatment of complex renal stones. Materials and methods: A mature ECIRS protocol was designed. Retrospective analysis was conducted of medical records between January 2020 and December 2021 of patients with complex renal stones at one center who underwent ECIRS by 2 skilled surgeons using retrograde flexible ureteroscopy and mini-percutaneous nephrolithotomy in the prone split-leg position. Results: A total of 44 patients were included in this study. Mean stone size was 26.1 ± 12.7 mm, and the number of calyces involved was 4.36 ± 2.09. Mean operative time was 71.1 ± 21.8 minutes. Postoperative decline in hemoglobin was 15.8 ± 9.8 g/L. Seventy-five percent of patients achieved stone-free status. The mean number of residual stones was 2.8 ± 2.3, and the mean residual stone size was 10.30 ± 4.76 mm. Six patients (13.6%) developed postoperative complications, including 4 with fever during the first 2 days postoperatively and 2 patients with transient postoperative pain. No patients developed severe complications. Conclusions: Endoscopic combined intrarenal surgery in the prone split-leg position can be performed safely by experienced surgeons using retrograde flexible ureteroscopy in conjunction with mini-percutaneous nephrolithotomy as a successful technique for the treatment of complex renal stones.

Comparison of outcomes between flexible ureteroscopy and mini-percutaneous nephrolithotomy in the management of upper calyceal calculi larger than 2 cm.

OBJECTIVE: To compare the outcomes of FURSL and m-PNL in the management of upper calyceal calculi larger than 2 cm. METHODS: A total of 75 patients with upper calyceal calculi larger than 2 cm that were treated by FURSL (n = 37) or mini-PNL (n = 38) were retrospectively analysed. The mean age, sex, stone burden, operative time, complications, length of hospitalization, and stone-free rate (SFR) were compared between the groups. The success of the procedure was defined by the absence of residual stones or residual fragments smaller than 4 mm on computed tomography at 4 weeks postoperatively. RESULTS: The two groups had comparable preoperative parameters. The mean operative time was significantly longer in the mini-PNL group than in the FURSL group (87.8 vs. 69.8 min, p < 0.001). The length of hospitalization was greater in the mini-PNL group than in the FURSL group (2.5 vs. 1.3 days, p < 0.001). Although the perioperative complication rate was higher in the mini-PNL group (23.7%) than in the FURSL group (13.5%), this difference was not statistically significant (p = 0.258). The SFR for the mini-PNL group was 89.5%, and that of the FURSL group was 81.1%; the difference was not significantly different (p = 0.304). CONCLUSIONS: Both FURSL and mini-PNL are effective and safe for the management of upper calyceal calculi larger than 2 cm. Of these two procedures, mini-PNL is less time consuming, FURSL is associated with faster recovery. FURSL can be considered a good alternative treatment in selected patients.

Computational Analysis of Influencing Factors and Multiple Scoring Systems of Stone Clearance Rate after Flexible Ureteroscopic Lithotripsy.

Our research aims at the analysis of various stone scoring systems which are referred to as STONE scoring system (SSS) in this study. GUY's scoring system and RUSS scoring system (RSS) are utilized to predict stone-free status (SFS) after surgery and problems after percutaneous nephrolithotomy (PCNL) for harder stones. The data of 68 patients with renal calculi who received FURL in Ren Ji Hospital from Jan 2020 to Mar 2021 are collected as the study subjects. There were 44 male and 24 female patients, with an average age of 55.6 ± 11.4 years. Reliability analysis of related influencing factors (IF) of stone clearance rate (SCR) and multiple scoring systems after flexible ureteroscopic lithotripsy (FURL) was performed. Relevant factors with statistical significance for postoperative SCR were selected for logistic regression analysis (RA). According to the SSS score, GSS classification, and RUSS score, the SCR after FURL was statistically analyzed. The results showed that the P values corresponding to stone position (lower caliceal), cumulative stone diameter (CSD), urinary tract infection, and external physical vibration lithecbole (EPVL) were less than 0.05. The area under the ROC curve of RUSS score, SSS score, and GSS grading was 0.932, 0.841, and 0.533, respectively. The main IF of SCR after FURL were stone location (lower caliceal), CSD, urinary tract infection, and EPVL. The RUSS score system was the best in the evaluation of SCR after FURL. In the previous research, the score systems such as CROES (CRS), SSS, S-ReS, C, and GSS for the prediction of SFS were compared. In our analysis, we have compared the RUSS scoring system which has proven to be giving better results as compared to SSS and GSS. We also performed the regression analysis and found that the stone location shows the strongest correlation of all the other factors for stone clearing rate.

Comprehensive analysis based in silico study of organophosphate flame retardants - environmental explanation of bladder cancer progression.

Brominated flame retardants are associated with increased toxicity and high concerns for environmental pollution. Therefore, organophosphate flame retardants (OPFRs) are considered safer alternatives and are widely used in building materials and electronics. This study aimed to determine whether organophosphate flame retardants are implicated in bladder cancer development and progression. Data of interactive genes associated with OPFRs was obtained from the CTD database (http://ctdbase.org/) in July 2021. Gene Ontology and Kyoto Encyclopedia of Genes and Genomes enrichment analysis revealed that organophosphate flame retardants were closely linked to bladder cancer. Furthermore, the immune-related genes showed a strong correlation with bladder cancer. Further analysis revealed that the immune-related genes were associated with the prognosis, clinical characteristics, and response to immunotherapies in bladder cancer. In conclusion, OPFRs and their metabolites could promote the progression of bladder cancer by affecting the expression of immune genes.

The retrospective experience of day-surgery semi tubeless ultra-mini percutaneous nephrolithotomy.

BACKGROUND: To retrospectively assess the experience of day-surgery semi tubeless ultra-mini percutaneous nephrolithotomy (UMP) for the treatment of kidney stones by experienced surgeons. METHODS: Clinical data of 358 patients with kidney stones (254 males and 104 females; mean age: 59.60±11.70) who were performed UMP surgery in Shanghai Jiao Tong University School of Medicine affiliated Renji Hospital from June 2015 to December 2018. Patient demographics, operative data, complications, and readmission rates were recorded. Day-surgery UMP was defined as discharge of patients either the same day or within 24 h after surgery. Semi tubeless UMP was defined as no placement of DJ and nephrostomy tube after surgery. RESULTS: The average size of stones was 14.56±6.24 mm (range, 4-30 mm). There are solitary stones in 192 cases, multiple stones in 142 cases and 29 cases with Staghorn stones. F13 outer sheath was used for all operations; 358 patients completed UMP on the day of admission; 326 (91.06%) patients achieved same-day discharge or received overnight observation prior to discharge, and 32 patients (8.94%) required full admission (longer than 24 h). The readmission rate was 0.56% (2 patients). The postoperative complications within 1 week occurred in 36 (10.06%) patients, including 23, 10, 3 of grades I, II, IIIa complications (Clavien-System). The average operation time was 29.64 min and the hemoglobin drop were 13.42±9.55 g/L. The stone clearance rate was 91.62% (328/358). The semi tubeless rate war 95.25% (341/358). CONCLUSIONS: For day-surgery semi tubeless UMP, experienced surgeons gain excellent patient outcomes in appropriately selected patients. Day-surgery semi tubeless UMP is worth promoting.

Trends and projections of kidney cancer incidence at the global and national levels, 1990-2030: a Bayesian age-period-cohort modeling study.

BACKGROUND: Identifying the temporal trends of kidney cancer (KC) incidence in both the past and the future at the global and national levels is critical for KC prevention. METHODS: We retrieved annual KC case data between 1990 and 2017 from the Global Burden of Disease (GBD) online database. The average annual percentage change (AAPC) was used to quantify the temporal trends of KC age-standardized incidence rates (ASRs) from 1990 to 2017. Bayesian age-period-cohort models were used to predict KC incidence through 2030. RESULTS: Worldwide, the number of newly diagnosed KC cases increased from 207.3 thousand in 1990 to 393.0 thousand in 2017. The KC ASR increased from 4.72 per 100,000 to 4.94 per 100,000 during the same period. Between 2018 and 2030, the number of KC cases is projected to increase further to 475.4 thousand (95% highest density interval [HDI] 423.9, 526.9). The KC ASR is predicted to decrease slightly to 4.46 per 100,000 (95% HDI 4.06, 4.86). A total of 90, 2, and 80 countries or territories are projected to experience increases, remain stable, and experience decreases in KC ASR between 2018 and 2030, respectively. In most developed countries, the KC incidence is forecasted to decrease irrespective of past trends. In most developing countries, the KC incidence is predicted to increase persistently through 2030. CONCLUSIONS: KC incidence is predicted to decrease in the next decade, and this predicted decrease is mainly driven by the decreases in developed countries. More attention should be placed on developing countries.

Renal mass biopsy using Raman spectroscopy identifies malignant and benign renal tumors: potential for pre-operative diagnosis.

The accuracy of renal mass biopsy to diagnose malignancy can be affected by multiple factors. Here, we investigated the feasibility of Raman spectroscopy to distinguish malignant and benign renal tumors using biopsy specimens. Samples were collected from 63 patients who received radical or partial nephrectomy, mass suspicious of cancer and distal parenchyma were obtained from resected kidney using an 18-gauge biopsy needle. Four Raman spectra were obtained for each sample, and Discriminant Analysis was applied for data analysis. A total of 383 Raman spectra were eventually gathered and each type of tumor had its characteristic spectrum. Raman could separate tumoral and normal tissues with an accuracy of 82.53%, and distinguish malignant and benign tumors with a sensitivity of 91.79% and specificity of 71.15%. It could classify low-grade and high-grade tumors with an accuracy of 86.98%. Besides, clear cell renal carcinoma was differentiated with oncocytoma and angiomyolipoma with accuracy of 100% and 89.25%, respectively. And histological subtypes of cell carcinoma were distinguished with an accuracy of 93.48%. When compared with final pathology and biopsy, Raman spectroscopy was able to correctly identify 7 of 11 "missed" biopsy diagnoses. These results suggested that Raman may serve as a promising non-invasive approach in the future for pre-operative diagnosis.

Ureteroscopic lithotripsy in Trendelenburg position for proximal ureteral calculi: a prospective, randomized, comparative study.

PURPOSE: We conducted a prospective, randomized, comparative study to compare the clinical outcome between the Trendelenburg position ureteroscopic lithotripsy (tURSL) and the conventional position ureteroscopic lithotripsy (cURSL) for the management of single proximal ureteral stone. METHODS: From January 2012 to September 2013, consecutive patients with single proximal ureteral calculi less than 2 cm and planned for ureteroscopic lithotripsy at our institution were enrolled in this study. The eligible patients were randomized into cURSL group and tURSL group according to sequence of random numbers generated by computer. In tURSL group, patients were turned into a Trendelenburg lithotomy position with head down 30° while the conventional lithotomy position was applied in cURSL group. URSL was performed using a 6/7.5F semi-rigid ureteroscope with holmium laser. When retropulsion occurred, the stones fragments were followed by semi-rigid ureteroscope up to the renal collecting system. The Olympus P5 flexible ureteroscope was used if there was any suspicion of stone migration into lower calices or incomplete stone fragmentation by semi-rigid ureteroscope. Patients' demographics between the two groups, perioperative course, clinical outcome and complication rates were compared. Data were analyzed using Chi-square test, Fisher's exact test or Student's t test. Binary logistic regression analysis was applied to estimate the effects of surgical position and stone size on stone migration. RESULTS: A total of 355 cases were finally analyzed in this study (176 in cURSL group and 179 in tURSL group). The mean operative time was significantly prolonged in cURSL group than in tURSL group, while the stone-free rate (SFR) at 4 weeks was significantly higher in tURSL group. A statistically significant difference was found in stone migration rate between the two groups (26.7 vs. 43.6 %, P = 0.001). In the stone migration subsetting, less stones fragments were found to migrate into lower calices in tURSL stone migration subgroup (P = 0.000). Also, the flexible ureteroscope utilization as well as the operative time was significantly decreased in tURSL stone migration subgroup (25.5 vs. 72.3 %, P = 0.000), (44.96 ± 11.0 min vs. 59.17 ± 9.2 min, P = 0.000) with higher SFR after retrograde intrarenal surgery (RIRS) (96.2 vs. 74.5 %, P = 0.000). CONCLUSION: The tURSL was safe and highly efficacious for the management of proximal ureteral calculus, especially in nonobese patient. Even with important stone migration risk, it rendered higher SFR and less operative time compared with cURSL. Moreover, less utilization of flexible ureteroscope and decreased deflection time in tURSL could potentially reduce the medical cost.