Association between Urinary Flora and Urinary Stones

This cross-sectional study aimed to explore the knowledge, attitudes, and practices (KAP) regarding urinary system stones among the general public in Chengdu, China. Conducted between January and June 2023, this research targeted individuals undergoing physical examinations at the Health Management Center of Sichuan Provincial People's Hospital. Structured questionnaires were administered to collect demographic information and assess KAP related to urinary system stones. Following meticulous scrutiny, 1014 valid questionnaires were retained for analysis. The computed scores for knowledge, attitude, and practice were 9.36 ± 4.23 (possible score range 0–17), 37.75 ± 7.20 (possible score range 11–55), and 30.77 ± 4.00 (possible score range 10–50), respectively. These outcomes suggested insufficient knowledge and moderately positive attitudes and practices among the participants. Structural Equation Modeling (SEM) analysis revealed a direct impact of knowledge on attitude (β = 0.967, P < 0.001), with attitude subsequently exerting a direct influence on practice (β = 0.167, P < 0.001). This indicated an indirect impact of knowledge on practice. Additionally, there was a direct effect of knowledge on practice (β = 0.167, P < 0.001). In conclusion, the general populace in Chengdu exhibited insufficient knowledge and moderate attitudes and practices concerning urinary stones. These findings underscore the imperative for targeted educational interventions aimed at enhancing public awareness and fostering positive attitudes and practices toward urinary stone prevention and management.

In the last years, laser has gained increasingly high popularity in Endourology. The newer generation Ho-YAG lasers represent the most updated laser used in Urology, being able to successfully treat both urinary stones and soft tissue lesions. The aim of this work was to report a multicentre 4-year experience using the Ho-YAG laser in the treatment of stones and soft tissue lesions, in order to offer parameters and modalities of use in several different situations. MATERIALS AND METHODS. Two urological Centers were asked between 2002 and 2005 to use Coherent Versa Pulse 20 Ho-YAG laser source in the treatment of urinary stones in 212 patients, and urinary soft tissue lesions (urethra, ureter or bladder neck strictures or urinary tract tumors) in 56 patients. According to the various situations (either stone fragmentation or treatment of soft tissue lesions), pulse frequency and energy per impulse were differently dosed and set. RESULTS. The following parameters were identified as the starting points for the correct use of the Ho-YAG laser: a) lithotripsy with rigid endoscope: 365 μm fiber, 0.8 - 1.2 Joule (J) energy and 6-8 Hz frequency; 365 μm fiber, 0.8-1.2 J energy and 10-12 Hz frequency; 550 μm fiber, 1.0-1.5 J energy and 10-12 Hz frequency. b) lithotripsy with flexible endoscope: 270 μm fiber, 0.6-1.0 J energy and 6-10 Hz frequency. c) soft tissue resection in case of: c1) ureteral stricture, 365 μm fiber, 0.6 J energy and 14-16 Hz frequency; c2) urethral stricture, 365 μm fiber, 0.7 J energy and 16-18 Hz frequency; c3) upper urinary tract tumors, 365 μm fiber, 0.7 J energy and 16 Hz frequency; c4) bladder tumors 365 μm fiber, 0.8 J energy and 16-20 Hz frequency; c5) bladder neck strictures, 365 μm fiber, 1.0 J energy and 16-18 Hz frequency. CONCLUSIONS. In the light of these parameters, Ho-YAG laser is a very handy instrument for the treatment of both urinary stones and soft tissue lesions, which allows to put aside the current tools used for the same purposes.

Urolithiasis is a condition where crystalline mineral deposits (stones) form within the urinary tract. Urinary stones can be located in any part of the urinary tract. Affected children may present with abdominal pain, blood in the urine or signs of infection. Radiological evaluation is used to confirm the diagnosis, to assess the size of the stone, its location, and the degree of possible urinary obstruction.To assess the effects of different medical and surgical interventions in the treatment of urinary tract stones of the kidney or ureter in children.We searched the Cochrane Register of Controlled Trials (CENTRAL), MEDLINE (Ovid), Embase (Ovid) as well as the World Health Organization International Clinical Trials Registry Platform Search Portal and ClinicalTrials.gov. We searched reference lists of retrieved articles and conducted an electronic search for conference abstracts for the years 2012 to 2017. The date of the last search of all electronic databases was 31 December 2017 and we applied no language restrictions.We included all randomised controlled trials (RCTs) and quasi-RCTs looking at interventions for upper urinary tract stones in children. These included shock wave lithotripsy, percutaneous nephrolithotripsy, ureterorenoscopy, open surgery and medical expulsion therapy for upper urinary tract stones in children aged 0 to 18 years.We used standard methodological procedures according to Cochrane guidance. Two review authors independently searched and assessed studies for eligibility and conducted data extraction. 'Risk of bias' assessments were completed by three review authors independently. We used Review Manager 5 for data synthesis and analysis. We used the GRADE approach to assess the quality of evidence.We included 14 studies with a total of 978 randomised participants in our review, informing eight comparisons. The studies contributing to most comparisons were at high or unclear risk of bias for most domains.Shock wave lithotripsy versus dissolution therapy for intrarenal stones: based on one study (87 participants) and consistently very low quality evidence, we are uncertain about the effects of SWL on stone-free rate (SFR), serious adverse events or complications of treatment and secondary procedures for residual fragments.Slow shock wave lithotripsy versus rapid shock wave lithotripsy for renal stones: based on one study (60 participants) and consistently very low quality evidence, we are uncertain about the effects of SWL on SFR, serious adverse events or complications of treatment and secondary procedures for residual fragments.Shock wave lithotripsy versus ureteroscopy with holmium laser or pneumatic lithotripsy for renal and distal ureteric stones: based on three studies (153 participants) and consistently very low quality evidence, we are uncertain about the effects of SWL on SFR, serious adverse events or complications of treatment and secondary procedures.Shock wave lithotripsy versus mini-percutaneous nephrolithotripsy for renal stones: based on one study (212 participants), SWL likely has a lower SFR (RR 0.88, 95% CI 0.80 to 0.97; moderate quality evidence); this corresponds to 113 fewer stone-free patients per 1000 (189 fewer to 28 fewer). SWL may reduce severe adverse events (RR 0.13, 95% CI 0.02 to 0.98; low quality evidence); this corresponds to 66 fewer serious adverse events or complications per 1000 (74 fewer to 2 fewer). Rates of secondary procedures may be higher (RR 2.50, 95% CI 1.01 to 6.20; low-quality evidence); this corresponds to 85 more secondary procedures per 1000 (1 more to 294 more).Percutaneous nephrolithotripsy versus tubeless percutaneous nephrolithotripsy for renal stones: based on one study (23 participants) and consistently very low quality evidence, we are uncertain about the effects of SWL on SFR, serious adverse events or complications of treatment and secondary procedures.Percutaneous nephrolithotripsy versus tubeless mini-percutaneous nephrolithotripsy for renal stones: based on one study (70 participants), SFR are likely similar (RR 1.03, 95% CI 0.93 to 1.14; moderate-quality evidence); this corresponds to 28 more per 1,000 (66 fewer to 132 more). We did not find any data relating to serious adverse events. Based on very low quality evidence we are uncertain about secondary procedures.Alpha-blockers versus placebo with or without analgesics for distal ureteric stones: based on six studies (335 participants), alpha-blockers may increase SFR (RR 1.34, 95% CI 1.16 to 1.54; low quality evidence); this corresponds to 199 more stone-free patients per 1000 (94 more to 317 more). Based on very low quality evidence we are uncertain about serious adverse events or complications and secondary procedures.Based on mostly very low-quality evidence for most comparisons and outcomes, we are uncertain about the effect of nearly all medical and surgical interventions to treat stone disease in children.Common reasons why we downgraded our assessments of the quality of evidence were: study limitations (risk of bias), indirectness, and imprecision. These issues make it difficult to draw clinical inferences. It is important that affected individuals, clinicians, and policy-makers are aware of these limitations of the evidence. There is a critical need for better quality trials assessing patient-important outcomes in children with stone disease to inform future guidelines on the management of this condition.

MP34-04 INHIBITION OF GLYCOLATE OXIDASE REDUCES URINARY OXALATE EXCRETION IN A MOUSE MODEL OF PRIMARY HYPEROXALURIA TYPE 1

1051 URINARY INCONTINENCE IS AN INDEPENDENT RISK FACTOR FOR UPPER URINARY TRACT STONE: A NATION-WIDE POPULATION-BASED AND WITH AN 8-YEAR FOLLOW-UP STUDY

BackgroundUrolithiasis has emerged as a global affliction, recognized as one of the most excruciating medical issues. The elemental composition of stones provides crucial information, aiding in understanding the causes, mechanisms, and individual variations in stone formation. By understanding the interactions between elements in various types of stones and exploring the key role of elements in stone formation, insights are provided for the prevention and treatment of urinary stone disease.MethodsThis study collected urinary stone samples from 80 patients in Beijing. The chemical compositions of urinary stones were identified using an infrared spectrometer. The concentrations of major and trace elements in the urinary stones were determined using Inductively Coupled Plasma Optical Emission Spectrometry (ICP-OES) and Inductively Coupled Plasma Mass Spectrometry (ICP-MS), respectively. The data were processed using correlation analysis and Principal Component Analysis (PCA) methods.ResultsUrinary stones are categorized into five types: the calcium oxalate (CO) stone, carbonate apatite (CA) stone, uric acid (UA) stone, mixed CO and CA stone, and mixed CO and UA stone. Ca is the predominant element, with an average content ranging from 2.64 to 27.68% across the five stone groups. Based on geochemical analysis, the high-content elements follow this order: Ca > Mg > Na > K > Zn > Sr. Correlation analysis and PCA suggested significant variations in the interactions between elements for different types of urinary stones. Trace elements with charges and ionic structures similar to Ca may substitute for Ca during the process of stone formation, such as Sr and Pb affecting the Ca in most stone types except mixed stone types. Moreover, the Mg, Zn and Ba can substitute for Ca in the mixed stone types, showing element behavior dependents on the stone types.ConclusionThis study primarily reveals distinct elemental features associated with five types of urinary stones. Additionally, the analysis of these elements indicates that substitutions of trace elements with charges and ion structures similar to Ca (such as Sr and Pb) impact most stone types. This suggests a dependence of stone composition on elemental behavior. The findings of this study will enhance our ability to address the challenges posed by urinary stones to global health and improve the precision of interventions for individuals with different stone compositions.

Objective: To compare the efficacy of thulium fiber laser (TFL) and holmium laser (HL) in the treatment of upper urinary tract stones. Methods: A total of 76 patients diagnosed with upper urinary tract stones by radiographic examination and who required ureteroscopy lithotripsy or retrograde intrarenal stone surgery were prospectively enrolled from the Department of Urology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine between January 2022 and June 2022. Patients were divided into TFL group (n=38) and HL group (n=38) in a 1∶1 ratio according to the randomization schedule. The perioperative outcomes and stone-free rate of two groups were recorded and compared. Results: Finally, the clinical data of 71 patients were completely collected, including 55 males and 16 females, with a mean age of (45.7±14.1) years old. There were 36 patients in TFL group and 35 patients in HL group, and there was no significant difference in age, body mass index, gender, Charlson comorbidity index, stone site, stone location, stone size and stone density between two groups (all P>0.05). All the surgeries were successfully performed with no intraoperative complications. There were no significant differences between the two groups in terms of operation time, stone displacement during lithotripsy, visual field clarity, changes in hemoglobin, leukocyte, and C-reactive protein, and length of postoperative hospital stay (all P>0.05), but the laser action time[M (Q1,Q3)] in the TFL group was 30.0 (20.0, 48.8)s, which was significantly shorter than that in the HL group [90.0 (50.0, 120.0)s, P<0.001]. The stone-free rates of TFL group and HL group were 97.2% (35/36) and 88.6% (31/35), and there was no significant difference (P=0.337). The postoperative complication incidences of TFL group and HL group were 36.1% (13/36)and 22.9% (8/35), respectively, and the difference was not significant either (P=0.221). For ureter stones, the laser action time in TFL group was 22.5 (20.0, 43.8)s, which was significantly shorter than that in HL group [80.0 (50.0, 120.0)s, P<0.001]. For stones with maximum diameter≤10 mm, the laser action time in TFL group was 20.0 (10.0, 25.0)s, which was significantly shorter than that in HL group [50.0 (40.0, 80.0)s, P<0.001]. For stones with maximum diameter>10 mm, the laser action time in TFL group was 60.0(42.5, 180.0)s, which was significantly shorter than that in HL group [180.0(120.0, 210.0)s, P=0.035]. For stones with density≤1 000 CT, the laser action time in TFL group was 30.0 (20.0, 45.0)s, which was significantly shorter than that in HL group [95.0 (47.5, 120.0), P=0.001]. For stones with density>1 000 CT, the laser action time in TFL group was 30.0 (20.0, 90.0)s, which was significantly shorter than that in HL group [80.0 (55.0, 180.0)s, P=0.033]. Conclusion: TFL lithotripsy is an effective and safe surgical procedure for the treatment of upper urinary tract stones, with similar clinical efficacy but shorter laser action time compared to HL lithotripsy.

Lithotripsie extracorporelle et obésité avec un IMC supérieur à 35

The diagnosis of symptomatic urinary stones during pregnancy is challenging; ultrasonography has a low specificity and sensitivity for diagnosing urinary stones. This study aimed to develop a clinical diagnostic model to assist clinicians in distinguishing symptomatic urinary stones in pregnant women. In this retrospective cohort study, we consecutively collected clinical data from pregnant women who presented with acute abdominal, lumbar, and lumbar and abdominal pain at the emergency department of our hospital between January 1, 2017, and December 31, 2019. To distinguish patients with urinary calculi from those without, we reviewed the follow-up records within 2 weeks post-consultation, ultrasonography results within 2 weeks, or self-reports of stone passage within 2 weeks. We selected risk factors from the baseline clinical and laboratory data of patients to establish a diagnostic model. Of the total patients included in the study, 105 patients were diagnosed as having symptomatic urinary stones and 126 were determined to have abdominal pain for reasons other than urinary stones. The initial model had an area under the curve (AUC) of 0.9966. The No-Lab Model had an AUC of 0.9856. The Lab Model had an AUC of 0.832. The Stone Model had an AUC of 0.9952. The simplified Stone Model did not show a decrease in discriminative ability. Of the four diagnostic models that we established for preliminary diagnosis of symptomatic urinary tract stones in pregnant women, the simplified Stone Model demonstrated excellent performance. Users can scan quick response codes to access web-based diagnostic model interfaces, facilitating easy clinical operation.

Objective: To diagnose, treat, and prevent stone recurrence, it is important to determine the metabolic risk factors that play a role in developing urinary system stone disease in children. This study assessed children with urinary system stones’ clinical, radiological, and metabolic characteristics. Material And Methods: A retrospective study was conducted on the records of pediatric patients who applied to our pediatric outpatient nephrology clinic for various reasons between February 2018 and December 2023 and were diagnosed with urinary system stones. Results: Of the 122 patients with a mean age of 4.40±4.16 years (1 month-17 years), 63 (51.6%) were boys and 59 (48.4%) were girls. In 61.4% of the children, a family history was identified. The most common presenting symptom was abdominal/flank pain or restlessness (47.5%). In 25.4% of the patients, the stones were ≤3 mm (microlithiasis), and most stones were in the upper system. One or more metabolic abnormalities have been detected during urine analysis for 58.2% of patients. The most frequent metabolic abnormalities were hypercalciuria (20.5%) and hypocitraturia (17.2%). In 74.6% of patients, the size of stones decreased or completely disappeared with medical treatment based on underlying metabolic abnormalities, and in 17.2%, they did not change at all. Only eight (6.6%) patients required interventional procedures. Conclusion: Metabolic causes should be investigated first in all children with urinary tract stones. Special medical treatments designed to alter metabolism reduce the need for invasive stone procedures.

BACKGROUND AND AIMS The risk of urinary tract stone formation in patients with autosomal dominant polycystic kidney disease (ADPKD) is 20%, twice as high as in the normal population. The most important reason for this increased tendency to stone disease is thought to be anatomic changes in the kidney. To investigate metabolic factors that predispose to urinary system stone formation in individuals with ADPKD. METHOD A total of 180 volunteers who applied to our outpatient clinic between December 2019 and May 2021 were included in the study. Four groups were formed: patients with ADPKD and urinary system stones (ADPKD + STONE) (n = 42), patients with ADPKD but no stones (ADPKD + STONE FREE) (n = 43), stone patients without ADPKD (STONE) (n = 47) and healthy controls (HEALTHY) (n = 48) groups. Spot urine pH, 24-h urine volume, calcium, uric acid, oxalate, citrate, sodium and magnesium parameters were measured. STONE group data were obtained retrospectively. Along with these parameters, serum electrolyte, parathormone (PTH), ferritin, albumin, creatinine, urea and uric acid values were also compared. A P value of &amp;lt;.05 was considered significant for statistical analysis. RESULTS There was no statistically significant difference between the four groups in terms of age and gender (P &amp;gt; .05). The citrate value in 24-h urine was significantly lower in the ADPKD + STONE and ADPKD + STONE-FREE groups than the STONE and HEALTHY groups (P &amp;lt; .05). The citrate value in the 24-h urine was significantly lower in the STONE group than in the HEALTHY group (P &amp;lt; .05). The citrate value in 24-h urine did not differ significantly between the ADPKD + STONE and ADPKD + STONE FREE groups (P &amp;gt; .05). In the ADPKD + STONE and ADPKD + STONE-FREE groups, the 24-h urinary calcium value was significantly lower than the STONE and HEALTHY groups (P &amp;lt; .05). In the STONE group, the 24-h urinary calcium value was significantly higher than the HEALTHY group (P &amp;lt; .05). There was no significant difference in the 24-h urinary calcium value between the ADPKD + STONE and ADPKD + STONE FREE groups (P &amp;gt; .05). The uric acid level in 24-h urine was significantly lower in the ADPKD + STONE and ADPKD + STONE-FREE groups than in the HEALTHY group (P &amp;lt; .05). The uric acid value in the 24-h urine did not differ significantly between the ODPBH + STONE, ADPKD + STONE-FREE and STONE groups (P &amp;gt; .05). The uric acid value in 24-h urine did not differ significantly between the STONE and HEALTHY groups (P &amp;gt; .05). Oxalate, sodium and magnesium values in 24-h urine and 24-h urine volume did not differ significantly between the groups (P &amp;gt; .05). Urine pH value was significantly lower in the ADPKD + STONE, ADPKD + STONE-FREE and STONE groups than in the HEALTHY group (P &amp;lt; .05). The pH value did not differ significantly between ADPKD + STONE, ADPKD + STONE-FREE and STONE groups (P &amp;gt; .05). Serum PTH values were significantly higher in the ADPKD + STONE and ADPKD + STONE-FREE groups than in the HEALTHY group (P &amp;lt; .05). The PTH values did not differ significantly between the STONE and HEALTHY groups (P &amp;gt; .05). PTH values did not differ significantly between ODPBH + STONE, ADPKD + STONE-FREE and STONE groups (P &amp;gt; .05). There was no significant difference between the groups in terms of serum ferritin, sodium, potassium, calcium, phosphorus, magnesium and uric acid values (P &amp;gt; .05). CONCLUSION In our study, 24-h urine citrate level was found to be significantly lower in both ADPKD + STONE and ADPKD + STONE-FREE patients compared to the volunteers in the STONE and HEALTHY groups (P &amp;lt; .05). In conclusion, patients with ADPKD should also be evaluated for hypocitraturia in the outpatient clinic.

To evaluate factors affecting the success rate of stone fragmentation and stone-free rate after extracorporeal shockwave lithotripsy (SWL) in treatment of upper urinary tract stones. A total of 121 patients with upper urinary tract calculi underwent SWL treatment. Success rate of stone fragmentation after SWL was 73.6% (89/121). In 89 patients who had success of breaking stones, 71 patients were followed up for the assessment of stone-free status, of whom 51 (71.8%) patients were stone-free at 3-month follow-up. Among four prognostic factors, including body mass index (BMI), stone size, stone position, and hydronephrosis, BMI and stone position had a significant impact on the success rate of stone fragmentation (P = .04 and U1: P = .0108, respectively). Among five prognostic factors of BMI, stone size, stone position, hydronephrosis, and times of SWL treatments, stone size was the only factor with significant impact on the stone-free rate (middle: P = .0229). Our study suggests that stone fragmentation and stone-free rate after SWL treatment for upper urinary tract stones can be predicted.

Although most ureteral and urinary stones are managed using endourologic techniques or shockwave lithotripsy in daily clinical practice, stone surgery has not completely disappeared. Laparoscopy, another minimally invasive treatment, is continuously gaining place in the treatment of urinary stones, mainly replacing open surgery. Indications for open or laparoscopic stone surgery are anatomic abnormalities, such as horseshoe kidneys, malrotated kidneys, ureteropelvic junction obstruction with stones, or ectopic kidneys; symptomatic stones in diverticula; extremely large stones and all those situations in which conventional endourologic procedures and extracorporeal shock-wave lithotripsy are not available or were unsuccessful or in those conditions where laparoscopy offers a priori the best solution to an endourologic complex condition. Laparoscopic surgery is effective for complex urinary stones and allows adjunctive procedures. It complements other minimally invasive procedures, and a need for open surgery has strongly diminished.

To evaluate the results of Holmium:YAG (Ho:YAG) laser lithotripsy in the treatment of urinary stones. Between 1993 and 1997, 59 patients with 85 urinary stones were treated with the Ho:YAG laser lithotripsy. Retrospective evaluation was done on the 64 procedures available, comprising 53 ureteric, 8 bladder, and 2 renal calculi, and one stone in a ureterocele. The Ho:YAG laser fragmented all types of calculi. Of 38 patients, 29 (76%) with ureteric stones were stone-free and 7 (18%) had stone fragments smaller than 2 mm left 1-3 months after the lithotripsy, resulting in a total clinical success rate of 95%. The procedure caused four ureteric perforations. One ureteric stricture, after repeated treatments for a Steinstrasse formation, led to nephrectomy. The Ho:YAG laser was reliable and effective for most of the urinary stones. The largest stones in any location, and stones of hard composition, however, were treated with combined disintegration methods. Four minor ureteric perforations and one ureteric stricture were related to laser use.

BackgroundUrolithiasis, as a common disease in urology, has high incidence and recurrence rates. Although there are various treatments and most patients can receive minimally invasive treatment such as ureteroscopic lithotripsy, the high recurrence rate still carries a large disease burden. To explore the potential risk factors, we conducted this retrospective study to evaluate laboratory and demographic factors associated with recurrence of upper urinary tract stones within 3 years in 247 patients.Material/MethodsWe performed a retrospective analysis of 247 patients who underwent surgical treatment for upper urinary tract stones at Shanghai Tenth People’s Hospital from June 2019 to December 2021, among whom 133 patients had at least 1 recurrence within 3 years. Basic information, medical history, blood test results, and urine test results were collected to explore the association of the risk factors with recurrence of upper urinary tract stones. Patients were assigned to either the recurrence group or the n-recurrence group. We analyzed the baseline levels of the 2 groups, and multivariate logistic regression was performed to assess potential risk factors.ResultsVariables with P value less than 0.05 in single-factor analysis were included in the multifactor analysis. In multivariate logistic regression, the results showed that C-reactive protein-albumin-lymphocyte index and serum creatinine level are risk factors of recurrence of upper urinary tract stones (P<0.05).ConclusionsPatients who underwent surgery for upper urinary tract stones for the first time who had a low C-reactive protein albumin lymphocyte (CALLY) index and high serum creatinine level were at higher risk of recurrence at least once within 3 years.