Distribution and antimicrobial resistance patterns of urinary pathogens in preoperative midstream urine cultures from Chinese patients with urinary calculi: a meta-analysis.

BACKGROUND AND OBJECTIVE: This study comprehensively evaluates the distribution patterns and antimicrobial resistance profiles of urinary pathogens in Preoperative midstream urine cultures collected from patients with urinary calculi in China over the last two decades. METHODS: A cross-sectional analysis of 41 studies was conducted. A systematic search across various databases, including Wanfang Data, CNKI, SinoMed, Embase, PubMed, and Web of Science, was carried out, covering the time period from 2002 to 2022. Using R 4.2.1 software, a meta-analysis was performed to assess heterogeneity using Cochran's Q test and the I2 statistic. RESULTS: In the analysis of preoperative midstream urine cultures from Chinese patients with urinary calculi, gram-negative bacteria dominated at 69%, with Escherichia coli (43%), Klebsiella pneumoniae (8%), Proteus mirabilis (6%), Pseudomonas aeruginosa (5%), Acinetobacter baumannii (3%), and Enterobacter cloacae (4%) being prominent. Gram-positive organisms included Enterococcus faecalis (9%), Enterococcus faecium (5%), and Staphylococcus aureus (4%). Over time, proportions of Proteus mirabilis, Enterococcus faecalis, and Staphylococcus aureus decreased, while Klebsiella pneumoniae and Pseudomonas aeruginosa increased. Notably, Escherichia coli proportion reduced from 37 to 33% within the last two decades. Antimicrobial resistance analysis indicated declining resistance in E. coli (e.g., co-trimoxazole from 73 to 55%, gentamicin from 64 to 40%), but rising resistance in piperacillin and cefotaxime (34-60%). Enterococcus faecalis exhibited increasing resistance to ampicillin (5-69%), gentamicin (59-94%), and tetracycline (77-89%) over time, while resistance to levofloxacin and ciprofloxacin notably decreased (72-16% and 49-8%, respectively). CONCLUSION: Over the past two decades, the proportion of gram-negative bacteria was declined, while the proportion of gram-positive bacteria increased. Escherichia coli remained the most common pathogen in the urine culture of patients with urinary calculi in China and the resistance of Escherichia coli to commonly used antibiotics increased. Clinicians should select appropriate antibiotics according to the results of urine culture and drug sensitivity test to reduce the occurrence of antibiotic resistance.

Preventive Pharmacological Therapy and Risk of Recurrent Urinary Stone Disease.

BACKGROUND: Urinary stone disease is a prevalent condition associated with a high recurrence risk. Preventive pharmacological therapy has been proposed to reduce recurrent stone episodes. However, limited evidence exists regarding its effectiveness, contributing to its underutilization by physicians. This study aimed to evaluate the association between preventive pharmacological therapy (thiazide diuretics, alkali therapy, and uric acid-lowering medications) and clinically significant urinary stone disease recurrence. METHODS: Using data from the Veterans Health Administration, adults with an index episode of urinary stone disease from 2012 through 2019 and at least one urinary abnormality (hypercalciuria, hypocitraturia, or hyperuricosuria) on 24-hour urine collection were included. The primary outcome was a composite variable representing recurrent stone events that resulted in emergency department visits, hospitalizations, or surgery for urinary stone disease. Cox proportional hazards regression was performed to estimate the association between preventive pharmacological therapy use and recurrent urinary stone disease while adjusting for relevant baseline patient characteristics. RESULTS: Among the cohort of patients with urinary abnormalities ( n =5637), treatment with preventive pharmacological therapy was associated with a significant 19% lower risk of recurrent urinary stone disease during the 12-36-month period after the initial urine collection (hazard ratio, 0.81; 95% confidence interval, 0.65 to 1.00; P = 0.0496). However, the effectiveness of preventive pharmacological therapy diminished over longer follow-up periods (12-48 and 12-60 months after the urine collection) and did not reach statistical significance. When examining specific urinary abnormalities, only alkali therapy for hypocitraturia was associated with a significant 26% lower recurrence risk within the 12-36-month timeframe (hazard ratio, 0.74; 95% confidence interval, 0.56 to 0.97; P = 0.03). CONCLUSIONS: When considering all urinary abnormalities together, this study demonstrates that the use of preventive pharmacological therapy is associated with a lower risk of clinically significant recurrent episodes of urinary stone disease in the 12-36 month timeframe after urine collection, although only the association with the use of alkali therapy for hypocitraturia was significant when individual abnormalities were examined.

Understanding the Barriers to Preventive Pharmacological Therapy Use in Older Patients With Urinary Stone Disease.

INTRODUCTION: Despite compelling clinical trial evidence and professional society guideline recommendations, prescription rates of preventative pharmacological therapy (PPT) for urinary stone disease are low. We sought to understand how patient- and clinician-level factors contribute to the decision to prescribe PPT after an index stone event. METHODS: We identified Medicare beneficiaries with urinary stone disease who had a 24-hour urine collection processed by a central laboratory. Among the subset with a urine chemistry abnormality (ie, hypercalciuria, hypocitraturia, hyperuricosuria, or low urine pH), we determined whether PPT was prescribed within 6 months of their collection. After assigning patients to the clinicians who ordered their collection, we fit multilevel models to determine how much of the variation in PPT prescription was attributable to patient vs clinician factors. RESULTS: Of the 11,563 patients meeting inclusion criteria, 33.6% were prescribed PPT. There was nearly sevenfold variation between the treating clinician with the lowest prescription rate (11%) and the one with the highest (75%). Nineteen percent of this variation was attributable to clinician factors. After accounting for measured patient differences and clinician volume, patients had twice the odds of being prescribed PPT if they were treated by a nephrologist (odds ratio [OR], 2.15; 95% CI, 1.79-2.57) or a primary care physician (OR, 1.78; 95% CI, 1.22-2.58) compared to being treated by a urologist. CONCLUSIONS: These findings suggest that the type of clinician whom a patient sees for his stone care determines, to a large extent, whether PPT will be prescribed.

[Prevention of urolithiasis using febuxostat in patients with metabolic syndrome].

INTRODUCTION: Urolithiasis is a chronic highly recurrent disease. The development of new methods of its pathogenetic treatment and prevention is a priority task of practical urology. AIM: To evaluate the clinical efficiency and safety of Febuxostat-SZ and to develop the rec-ommendations for its use in patients with uric acid stones. MATERIALS AND METHODS: The analysis of 525 patients with urolithiasis was carried out. On the basis of a comprehensive examination, they were divided into two groups: in the group 1, pa-tients (n=231) had urolithiasis and metabolic syndrome, while in the group 2 (n=294), only urolithia-sis was diagnosed without metabolic syndrome. In both groups, depending on the stone composi-tion, in addition to general measures, specific stone prevention was carried out, which included die-tary regimen and drug therapy. RESULTS: Uric acid excretion after 6 months of therapy in patients with urolithiasis and meta-bolic syndrome decreased from 9.8+/-1.8 to 3.9+/-1.1 mmol/l, urinary excretion of citrates and urine acidity increased from 0.8 +/-0.6 to 2.5+/-0.8 mmol/l and from 5.4+/-0.5 to 6.3+/-0.5, respectively, while serum uric acid level decreased from 451.4+/-15.1 up to 385.2+/-16.2 mmol/l. In the group of patients who, in addition to prescribing stone prevention, underwent correction of the metabolic syndrome, uric acid excretion after 3 months decreased by half: from 9.7+/-1.9 to 5.0+/-1.2 mmol/l, urine pH and citrate excretion increased from 5.4+/-0.4 to 6.3+/-0.5 and from 0.8+/-0.5 to 2.3+/-1.0 mmol/l, respective-ly, while serum uric acid level decreased from 459.5+/-17.7 to 370.9+/-15.1 mmol/l after 6 months of treatment. CONCLUSION: The use of Febuxostat-SZ in the complex therapy of urinary stone disease showed high efficiency in normalizing urine acidity, the level of daily excretion and serum uric acid level, as well as satisfactory tolerability and a minimal profile of side effects.

Associations Between Provider Specialty and Use of Follow-up Testing Among Patients on Preventive Pharmacological Therapy for Urinary Stone Disease.

INTRODUCTION: The AUA Medical Management of Kidney Stones guideline outlines recommendations on follow-up testing for patients prescribed preventive pharmacological therapy. We evaluated adherence to these recommendations by provider specialty. METHODS: Using claims data from working-age adults with urinary stone disease (2008-2019), we identified patients prescribed a preventive pharmacological therapy agent (a thiazide diuretic, alkali citrate therapy, allopurinol, or a combination thereof) and the specialty of the prescribing physician (urology, nephrology, and general practice). Next, we identified patients who completed a 24-hour urine collection prior to their prescription fill. We then measured adherence to 3 recommendations outlined in the AUA guideline. Finally, we fit multivariable logistic regression models evaluating associations between prescribing provider specialty and adherence to recommended follow-up testing. RESULTS: Among 2,600 patients meeting study criteria, 1,523 (59%) adhered to ≥1 follow-up testing recommendation, with a significant increase over the study period. Nephrologists had higher odds of adherence to ≥1 follow-up test compared to urologists (odds ratio, 1.52; 95% confidence interval, 1.19-1.94; P < .01). Significant differences in adherence to the 3 individual guideline recommendations were also observed by specialty. CONCLUSIONS: Following initiation of preventive pharmacological therapy, adherence to guideline-recommended follow-up testing was low overall. There exist meaningful specialty-specific differences in the use of this testing.

Characteristics of and antibiotic resistance in urinary tract pathogens isolated from patients with upper urinary tract stones.

To investigate the distribution characteristics and antibiotic resistance patterns of uropathogens in patients with upper urinary calculi and urinary tract infections, data on sex, age, positive midstream urine culture results and drug sensitivity results were collected. The statistical program SPSS 26.0 was used for statistical analysis. Among the 1414 positive urine samples, the most common pathogens were Escherichia coli (36.4%), Enterococcus faecalis (13.8%), Staphylococcus epidermidis (7.5%), Klebsiella pneumoniae (5.0%), Streptococcus agalactiae (3.4%) and Enterococcus faecium (3.3%). The incidences of E. coli (48.6%), K. pneumoniae (6.3%) and Proteus mirabilis (4.2%) were higher in female patients than in male patients (23.2%, 3.5%, 0.6%, respectively; P<0.05). E. faecalis was detected more frequently in the young group (16.0%) than in the elderly group (11.2%; P<0.01). Most of the isolates were resistant to levofloxacin and ciprofloxacin, while few were resistant to imipenem, meropenem, cefoperazone/sulbactam, piperacillin/tazobactam and amikacin. The bacterial spectra in patients with urinary stones varied by sex and age, which should be taken into consideration during treatment. The proportion of E. faecium showed an upward trend, while those of S. epidermidis and S. agalactiae demonstrated downward trends in the study period. Regardless, carbapenems, cefoperazone/sulbactam, piperacillin/tazobactam and amikacin are good choices for serious cases.

A Comparison of Boron Supplement and Tamsulosin as Medical Expulsive Therapy for Urinary Stones After Extracorporeal Shock Wave Lithotripsy: a Randomized Controlled Clinical Trial.

Treatment with alpha-blockers has been used in many studies to facilitate stone clearance after extra-corporeal shock wave lithotripsy (ESWL), based on mediating ureteral wall relaxation. Ureteral wall edema is another barrier against the stone passage. We aimed to compare the effectiveness of boron supplement (due to its anti-inflammatory effect) and tamsulosin in the passage of stone fragments after ESWL. Eligible patients after ESWL were randomly assigned to two groups and were treated with boron supplement (10 mg/BD) or tamsulosin (0.4 mg per night) for 2 weeks. The primary outcome was the stone expulsion rate according to the remained fragmented stone burden. The secondary outcomes were the time of stone clearance, pain intensity, drug side effects, and the need for auxiliary procedures. In this randomized control trial, 200 eligible patients were treated with boron supplement or tamsulosin. Finally, 89 and 81 patients in the two groups completed the study, respectively. The expulsion rate was 46.6% in the boron and 38.7% in the tamsulosin group, which there was no statistically significant difference between the two groups (p = 0.003), as well as the time of stone clearance (7.47 ± 22.4 vs 6.52 ± 18.45, days, p = 0.648, respectively), after 2-week follow-up. Moreover, pain intensity was the same in both groups. No Significant side effects were reported in the two groups. Boron supplement could be effective as adjuvant medical expulsive therapy after ESWL with no significant side effects in short-term follow-up. Iranian Clinical Trial Registration number and date of registration: IRCT20191026045244N3, 07/29/2020.

[Current state of metaphylaxis of urinary stones in Russian Federation].

INTRODUCTION: Urolithiasis is one of the most common urological diseases in adults. Increased life expectancy of the population in developed countries, make urolithiasis topical issue and requires close attention. Due to the high risk of recurrent stone formation causing repeated surgical interventions, the issue of effective urinary stone metaphylaxis is very important today. MATERIALS AND METHODS: To study the current state of the problem of urolithiasis metaphylaxis among Russian urologists, an anonymous questionnaire was applied. A 25-question questionnaire was sent to e-mail to more than 4,000 Russian urologists. A total of 1,238 specialists completed the questionnaire. The database compiled from the received responses was processed and presented with descriptive statistics in the form of tables and charts. RESULTS: According to the survey, more than half of the 831 (67.1%) specialists specialized in the treatment of urolithiasis. It was noted that 626 (86%) inpatient urologists and 205 (40%) outpatient urologists specialized in the treatment of urolithiasis. Only 521 (69.6%) urologists specializing in surgical treatment of urolithiasis give a patient a stone fragment to analyze its chemical composition. At the same time, half of the respondents reported that less than 10% of patients come to them for further metaphylaxis. One of the main reasons for not analyzing the chemical composition of the stone was the fact that 877 (70,84%) specialists indicated the inaccessibility of analysis under the state guarantee program, 503 (40,63%) specialists indicated the patients satisfaction with the results of minimally invasive surgical treatment and lack of sufficient motivation for further examinations. At the same time, less than 3% of specialists can perform stone analysis within the framework of the state guaranty program. 1180 (96,8%) respondents practiced the prophylaxis of recurrent calculi formation, but only 336 (28,47%) performed comprehensive metabolic examination of all patients followed by prescription of drug therapy and appropriate diet. CONCLUSIONS: Our survey revealed low involvement of urologists at the outpatient level in the process of conservative treatment and metaphylaxis of urolithiasis, low activity of urologists in performing complex metabolic study and comprehensive prevention of recurrent stone formation, low percentage of performing chemical composition analysis of stone and low activity of urologists in performing primary litholytic therapy of urate stones. Based on this analysis of the responses of most Russian urologists, it is possible to formulate recommendations to remove the obstacles to providing patients with urolithiasis with quality medical care in terms of conservative therapy and metaphylaxis of urolithiasis.

A prospective randomized study evaluating the necessity of narcotics following ureteroscopy for urinary stone disease.

PURPOSE: To evaluate the efficacy of non-narcotic analgesics and preoperative counseling in managing postoperative pain and narcotic use following ureteroscopic laser lithotripsy (URS). METHODS: Adult patients at a single academic center undergoing URS for nephrourolithiasis were recruited. After informed consent, subjects were randomized into three groups: NARC-15 tablets oxycodone-acetaminophen 5/325 mg (A-OXY), 2. NSAID-15 tablets ibuprofen (IBU) 600 mg, 3. CNSL-15 tablets A-OXY, 15 tablets IBU, and preoperative counseling from the surgeon to avoid narcotic if possible. Patients who did not receive an intraoperative stent were excluded. At the time of stent removal subjects completed the Universal Stent Symptom Questionnaire (USSQ), and a pill count was performed. USSQ pain indices were the primary study endpoint. RESULTS: Of 115 patients enrolled, 104 met the primary endpoint and were included in the analysis. No significant differences were noted in patient demographic, clinical, or operative characteristics. No differences were noted in median USSQ pain indices. The CNSL group used a significantly lower median number of A-OXY pills compared to the NARC group (2.4 vs. 5.4, p = 0.001) and less IBU compared to the NSAID group (3.1 vs. 5.9, p = 0.008). No differences in median total pill count, office calls, medication requests, nor ED visits were noted. CONCLUSION: Our data suggest that patients can achieve equivalent postoperative analgesic satisfaction with non-narcotics compared to opiates following URS. Further, counseling patients on postoperative pain before surgery can reduce the total number of postoperative narcotic and non-narcotic medications taken. We suggest surgeons strongly consider omission of narcotic prescriptions following non-complicated URS.

Evaluation of the potential pathogenicity of microorganisms associated with urinary calculi.

Due to the prevalence of postoperative complications in the treatment of urolithiasis, the study of the contamination of urinary calculi and the potential pathogenicity of isolated bacteria is of great importance in laboratory diagnostic practice. It has been shown that uropathogenic bacteria are found in the composition of urinary stones in 65±7.1% of cases, mainly representatives of the Enterobacteriaceae and Staphylococcaceae families. Bacteria of the generas Escherichia, Enterococcus, Staphylococcus were most frequently detected. The analysis of biofilm activity and antibiotic resistance in 50 uropathogenic strains was carried out. It was shown that all the studied strains were resistant to at least two tested drugs, and the average value of the multiple resistance index was 0.51. When cultured on nutrient agar with Congo red, it was shown that more than half of the tested strains have high biofilm activity and about 80% potential for biofilm formation. The greatest biofilm activity was observed in bacteria of the generas Escherichia, Klebsiella, Enterobacter, Staphylococcus.

Comparative study of the bacterial distribution and antimicrobial susceptibility of uropathogens in older and younger patients with urinary stones.

BACKGROUND: This study compared the bacterial spectrum and antibiotic susceptibility of uropathogens in older and younger patients with urinary stones to provide appropriate antibiotic management. METHODS: We retrospectively reviewed urinary tract infection patients with urolithiasis, presented to Xiangya Hospital from March 2014 to April 2021. Patients were divided into older and younger groups according to 60 years of age. The bacterial spectrum and drug sensitivity of uropathogens were compared. RESULTS: A total of 542 strains of uropathogens (177 in older and 365 in younger groups) were isolated from 507 patients. E. coli (41.8% vs 43.6%) remains the most common pathogen, followed by E. faecalis (6.2% vs 9.6%) in older and younger groups, respectively. Particularly, K. pneumoniae was significantly more frequent in older (9.6%) than in younger group (4.7%, P < .05). E. faecium was substantially more prevalent in older group (6.2%) than in younger group (2.7%, P < .05). The proportion of males increased in older patients (47.3%) than in younger patients (34.9%, P = 0.007). In both groups, major Gram-negative bacteria (E. coli and K. pneumoniae) revealed a high sensitivity over 70% to piperacillin/tazobactam, imipenem and amikacin, whereas the resistance level was high to penicillin, tetracycline and vancomycin. Major Gram-positive (E. faecalis and E. faecium) isolates demonstrated high sensitivity of over 50% to gentamicin and vancomycin in both groups. Furthermore, uropathogens isolated from younger urolithiasis patients were more susceptible to antimicrobials than those isolated from older patients. CONCLUSIONS: The male increased in the older urolithiasis patients with UTI and uropathogens microbial spectrum in older urolithiasis patients are different from younger. High susceptibility and age should be utilized in empirical antibiotic selection to avoid increased multidrug-resistant bacteria.

Xanthine Oxidoreductase Inhibitors Suppress the Onset of Exercise-Induced AKI in High HPRT Activity Urat1-Uox Double Knockout Mice.

BACKGROUND: Hereditary renal hypouricemia type 1 (RHUC1) is caused by URAT1/SLC22A12 dysfunction, resulting in urolithiasis and exercise-induced AKI (EIAKI). However, because there is no useful experimental RHUC1 animal model, the precise pathophysiologic mechanisms underlying EIAKI have yet to be elucidated. We established a high HPRT activity Urat1-Uox double knockout (DKO) mouse as a novel RHUC1 animal model for investigating the cause of EIAKI and the potential therapeutic effect of xanthine oxidoreductase inhibitors (XOIs). METHODS: The novel Urat1-Uox DKO mice were used in a forced swimming test as loading exercise to explore the onset mechanism of EIAKI and evaluate related purine metabolism and renal injury parameters. RESULTS: Urat1-Uox DKO mice had uricosuric effects and elevated levels of plasma creatinine and BUN as renal injury markers, and decreased creatinine clearance observed in a forced swimming test. In addition, Urat1-Uox DKO mice had increased NLRP3 inflammasome activity and downregulated levels of Na+-K+-ATPase protein in the kidney, as Western blot analysis showed. Finally, we demonstrated that topiroxostat and allopurinol, XOIs, improved renal injury and functional parameters of EIAKI. CONCLUSIONS: Urat1-Uox DKO mice are a useful experimental animal model for human RHUC1. The pathogenic mechanism of EIAKI was found to be due to increased levels of IL-1ß via NLRP3 inflammasome signaling and Na+-K+-ATPase dysfunction associated with excessive urinary urate excretion. In addition, XOIs appear to be a promising therapeutic agent for the treatment of EIAKI.

Phyllanthus niruri and Chrysanthellum americanum in association with potassium and magnesium citrates are able to prevent symptomatic episode in patients affected by recurrent urinary stones: A prospective study.

OBJECTIVE: The aim of this study is to evaluate the efficacy of a food supplement containing Phyllanthus niruri and Chrysanthellum americanum in association with potassium and magnesium citrates in the treatment and prophylaxis of urinary stones. MATERIALS AND METHODS: Eighty-two patients (mean age 49.7 ± 11.2) with history of urinary stones received this food supplement, one capsule a day for 6 months. Each administration contained a combination of the following ingredients: 244 mg Potassium citrate, 735 mg Magnesium citrate, Phyllanthus (Phyllantus niruri) herb d.e. 15% mg Tannins 220 mg, Chrysanthellum (Chrysanthellum americanum Vatke) plant d.e. » 55 mg. After 6 months, all patients underwent urologic visit, urinalysis, imaging and quality of life (QoL) questionnaires evaluation. Each patient was also evaluated by computed tomography (CT) scan at baseline and at 6 months. RESULT: From January 2018 to March 2019, 82 patients (mean age 49.7 ± 11.2) completed the follow-up period and were analyzed. Fifty patients showed lower stone dimensions (60.9%). The average stone size was 0.9 mm, with a significant reduction in comparison with the baseline (-6.7 mm ± 3 mm) (p < 0.001). Forty-nine patients (59.7%) did not show any symptomatic episode with an improving in QoL (+0.4 ± 0.1) (p < 0.001) in comparison with the baseline. At the end of the follow-up period, 27 patients out of 82 were stone-free (32.9%). Moreover, we report a significant reduction of patients with asymptomatic bacteriuria (ABU) between the baseline and the end of the follow-up evaluation (p < 0.001). CONCLUSIONS: In conclusion, this food supplement is able to improve quality of life in patients with urinary stones, reducing symptomatic episodes and the prevalence of ABU.

Multiple drug resistance bacterial isolates and associated factors among urinary stone patients at the University of Gondar Comprehensive Specialized Hospital, Northwest Ethiopia.

BACKGROUND: The urinary stone and urinary tract infection (UTI) are invariably associated and are frequent causes of morbidity. Date on burden of UTI among urinary stone patients is lacking in Ethiopia. This study was aimed to assess bacterial profile, antimicrobial susceptibility and associated factors among urinary stone patients at the University of Gondar Comprehensive Specialized Hospital. METHODS: An institution based cross sectional study was conducted. Basic sociodemographic data were collected using a structured questionnaire. Bacterial identification of uropathogens and drug susceptibility testing were done following standard microbiological techniques. The data were entered and analyzed using SPSS version-23. Bivariate and multivariate logistic regressions were used to identify possible associated risk factors. Results with P value < 0.05 was considered statistically significant. RESULT: A total of 300 urinary stone patients were enrolled. Of these, 153 (51%) were male and 261(87%) were urban residents. The overall prevalence of urinary tract infection was 49 (16.3%) (95% CI 12-21%). A high level of resistance was observed to ampicillin, penicillin and trimethoprim-sulfamethoxazole while majority of isolates were most sensitive to nitrofurantoin and ciprofloxacin. Multi-drug resistant isolates were 16/49 (32.7%), 75% of them being Enterobacteriaceae isolates. More than one-third 9/26 (34.6%) of Gram-negative isolates were Extended Spectrum Beta-Lactamase (ESBL) producing E. coli and K. pneumoniae. Being female, history of urinary tract infection and history of drug use were the independent risk factors. CONCLUSION: Most of the bacterial isolates from urinary stone patients were resistant to ampicillin, penicillin and trimethoprim-sulfamethoxazole. E. coli and K. pneumoniae were the most common extended spectrum beta-lactamase producing isolates. Sex, history of urinary tract infection and previous drug use were found to be risk factors. Routine diagnosis of urinary stone patients for urinary tract infection should be promoted and further researches are encouraged.

Is medical treatment necessary for infants with small urinary stones?

Urinary stone disease is a common condition. We investigated the usefulness of medical treatment for infants with urinary stones 5 mm or smaller. The study included 197 infants (86 girls and 111 boys) with urolithiasis ≤ 5 mm who were referred to our Department of Nephrology between 2014 and 2016. Infants with metabolic or anatomical risk factors requiring medical treatment were excluded from the study. We retrospectively reviewed urine and serum metabolic profiles and compared stone resolution rates in patients who did and did not receive treatment. The mean age at diagnosis was 5.2 months (range, 14 days to 12 months). The most common complaint was restlessness (n = 92, 46.7%), and 49 infants (24.9%) were asymptomatic. Multiple stones were detected in 166 infants (84.3%). Hypomagnesuria, hypocitraturia, and hypercalciuria were present in 25.3, 19.7, and 18.7% of patients, respectively. Stones < 3 mm (microlithiasis) were detected in 97 infants (49.2%), and 100 (50.8%) patients had 3-5 mm stones. In total, 130 infants (66.5%) received regular treatment and 67 (33.5%) were not treated. Stone resolution was significantly higher in the group receiving K-citrate treatment at the 6th month follow-up, while there were no significantly difference between the two groups at the 12th month control. No previous studies have investigated treatment outcomes in infants with 3-5 mm urinary stones. According to our results, K-citrate treatment may accelerate the resolution of the stone in infants with stones smaller than 5 mm.

Tolvaptan treatment of cystine urolithiasis in a mouse model of cystinuria.

INTRODUCTION: Cystinuria is an inherited disease characterized by increased urinary cystine excretion and recurrent cystine stones. Current treatment regimens have limited effectiveness in preventing stone recurrence and are often poorly tolerated. The aim of this study was to evaluate the effect of tolvaptan, a vasopressin receptor 2 (V2) antagonist, on cystine stone volume in mice with cystinuria. MATERIALS AND METHODS: Tolvaptan (0.4 mg per mouse) or placebo was delivered by gavage daily for 30 days. Urinary amino acids and cystine stones were analyzed to assess drug efficacy in preventing L-cystine stone growth using several analytical methods. Data were entered into SPSS and analyzed by paired sample T test. p value < 0.05 was considered significant. RESULTS: Compared with control group, the liquid intake and urine volume in tolvaptan-treated mice were significantly increased. The urinary cystine concentrations in group tolvaptan was lower than the baseline concentration before the experiment. After treatment, mice treated with tolvaptan had significantly delayed stone growth, exhibited lower overall stone volume accumulation, compared with control group. The increased stone volume of tolvaptan group was less than control group (8.00 ± 4.93 mm3 vs 27.90 ± 4.48 mm3, p < 0.001). The serum creatinine in the control group (11.75 ± 1.634 µmol/L) was higher than that in the tolvaptan group (7.625 ± 1.401 µmol/L) (p = 0.0759). In addition, tolvaptan significantly inhibited the formation and growth of stones in mice after cystolithotomy. CONCLUSION: The present study indicated that tolvaptan's efficacy in preventing L-cystine stone growth through increased liquid intake and urine volume of cystinuric mice.

[Possibilities of using dietary supplements with antioxidant properties in urinary stone disease].

INTRODUCTION: Dietary supplements are successfully used in many fields of medicine, including urology. In particular, urologists often prescribe dietary supplements for patients with urolithiasis. AIM: to study an influence of dietary supplements Nefradoz on the metabolism of the main stone-forming substances and inhibitors of stone formation in patients with urolithiasis. INTRODUCTION: Dietary supplements are successfully used in many fields of medicine, including urology. In particular, urologists often prescribe dietary supplements for patients with urolithiasis. AIM: to study an influence of dietary supplements Nefradoz on the metabolism of the main stone-forming substances and inhibitors of stone formation in patients with urolithiasis. MATERIALS AND METHODS: A total of 60 patients with urinary stone diseases were included in a single-center prospective randomized study. All patients were divided into 2 groups of 30 people, depending on the treatment. In the main group, patients followed standard diet, received general recommendations and dietary supplements Nefradoz for 28-30 days, 1 capsule (150 mg) 2 times a day with meals. In the control group, patients received only general recommendations and followed standard diet therapy for 28-30 days. The blood biochemical profile and 24-hour urine analysis were evaluated, as well as a urinalysis was performed on daily basis. RESULTS: In patients receiving Nefradoz, urinary uric acid excretion increased by 0.9 mmol/day. It must be emphasized that an increase in uric acid excretion did not exceed the upper normal limit. A tendency towards an increase in urine excretion of sodium (by 54 mmol / day), magnesium (by 1 mmol / day) and citrates (by 0.6 mmol / day) was also found. The analysis of urinalysis showed that in the main group, urine specific gravity was lower than in the control group. Higher urine pH in the main group compared to the control group was also shown. The severity of hematuria with the use of Nefradoz was almost two times lower than in patients who did not receive dietary supplement. CONCLUSION: Considering our data on the ability of dietary supplement Nefradoz to increase the concentration of main inhibitors of stone formation (magnesium and citrates), Nefradoz can be recommended for patients with urinary stone diseases, especially with concomitant hypomagnesuria and hypocitraturia.

[Adjustment of urine PH as effective tool for successful metaphylaxis of urinary stone disease. phytotherapy].

Urinary stone disease constitutes significant burden for healthcare system worldwide. Metaphylaxis after removal or spontaneous passage of urinary stone may be an effective measure for the prevention of recurrent stone episodes. An adjustment of urine pH, based on the type of urinary stone plays a key role in the metaphylaxis of urolithiasis. The use of combined preparations based on herbal plants, which has antioxidant, anti-inflammatory, antimicrobial activity and diuretic effect, and also affects pH level of urine without impairment of the body microbiome, is very promising for the metaphylaxis of urinary stone disease.

The efficacy and safety of diuretics on extracorporeal shockwave lithotripsy treatment of urolithiasis: A systematic review and meta analysis.

BACKGROUND: The aim of this systematic review and meta-analysis was to demonstrate the efficacy and safety of diuretics on extracorporeal shockwave lithotripsy (SWL) treatment of urolithiasis. METHODS: The databases MEDLINE, EMBASE, and the Cochrane Controlled Trial Register of Controlled Trials from January 1980 until November 2019 were searched to identify randomized controlled trials that referred to the use of diuretics on extracorporeal SWL treatment of urolithiasis. RESULTS: Six randomized controlled trials containing 1344 patients were included in this meta-analysis, which compared diuretics with placebo on extracorporeal SWL treatment of urolithiasis. In the analysis, we found that diuretics on extracorporeal SWL treatment were more effective for the management of urinary stones. Compared with placebo, patients who received diuretics during extracorporeal SWL treatment had significantly higher successful stone clearance rate (Odds ratio; 1.73, 95% confidence interval (CI); 1.35 to 2.21, P < .0001), higher stone fragmentation rate (odds ratio; 2.83, 95% CI; 1.30 to 6.16, P = .009), less average number of sessions per stone (mean difference; -0.13; 95% CI, -0.25 to -0.01, P = .03) and similar average number of shocks per stone (mean difference; -126.89; 95% CI, -394.53 to 140.76, P = .35). CONCLUSION: This systematic review and meta-analysis indicates that diuretics during extracorporeal SWL was effective in the management of urolithiasis with lower risk of complications.