The genetic framework for development of nephrolithiasis

Over 1%-15% of the population worldwide is affected by nephrolithiasis,which remains the most common and costly disease that urologists manage today.Identification of atrisk individuals remains a theoretical and technological challenge.The search for monogenic causes of stone disease has been largely unfruitful and a technological challenge;however,several candidate genes have been implicated in the development of nephrolithiasis.In this review,we will review current data on the genetic inheritance of stone disease,as well as investigate the evolving role of genetic analysis and counseling in the management of nephrolithiasis.

Renal functional outcomes are not adversely affected by selective angioembolization following percutaneous nephrolithotomy

Objective:Selective angioembolization(SAE)effectively diagnoses and treats iatrogenic vascular complications following percutaneous nephrolithotomy(PCNL).Methods:We retrospectively reviewed 1329 consecutive PCNLs and identified patients who underwent SAE following PCNL with at least 12-month follow-up.Estimated glomerular filtration rate(eGFR)was calculated for all patients preoperatively,postoperatively and at last followup.A 1:2 matched cohort analysis was performed.Results:Twenty-three patients underwent SAE and matched to 46 controls.There was no statistically significant difference in preoperative,postoperative,and follow-up eGFR when comparing patients who underwent SAE and those with an uneventful course.Conclusion:Long-term eGFR is comparable in patients who undergo uncomplicated PCNL and those requiring SAE.

Percutaneous nephrolithotomy in octogenarians and beyond:How old is too old?

Objective:To specifically report perioperative characteristics and outcomes in patients 80 years and older undergoing percutaneous nephrolithotomy(PCNL).PCNL has been established as feasible in the elderly;however,to our knowledge no one has specifically reported feasibility in patients 80 years and older.Methods:We retrospectively reviewed perioperative data of octogenarians who underwent PCNL at a high stone volume single institution,and matched them to patients<65 years of age by stone burden and sex.Patient demographics,perioperative outcomes and postoperative complications were compared.Results:Thirty-three octogenarians(mean age 83.6 years)with 36 renal units were matched to 67 controls(mean age 48.6 years)with 72 renal units.Octogenarians had a higher mean American Society of Anesthesiologists(ASA)score,more comorbidities,and worse renal function.There were no differences in operative characteristics,length of hospital stay or stone free rates.Of the patients with preoperative urinary decompression(ureteral stent or nephrostomy tube)prior to PCNL,the elderly were more likely to have a history of urosepsis.Octogenarians did not experience more minor Clavien(Ⅰ-Ⅱ)or major Clavien(Ⅲa-Ⅳb)complications.Conclusion:Octogenarians who undergo PCNL were more likely to have cardiovascular comorbidities and a prior history of sepsis.Despite these risk factors,in appropriately selected patients PCNL can be safely and successfully performed in octogenarians without increased perioperative complications relative to a younger cohort.

Advances in percutaneous stone surgery

Treatment of large renal stones has changed considerably in recent years.The increasing prevalence of nephrolithiasis has mandated that urologists perform more surgeries for large renal calculi than before,and this has been met with improvements in percutaneous stone surgery.In this review paper,we examine recent developments in percutaneous stone surgery,including advances in diagnosis and preoperative planning,renal access,patient position,tract dilation,nephroscopes,lithotripsy,exit strategies,and post-operative antibiotic prophylaxis.