Extracorporeal shockwave lithotripsy in the management of urinary stones: New concepts and techniques to improve outcomes

Objective: Extracorporeal shockwave lithotripsy (SWL) currently plays an important role in the treatment of urinary tract lithiasis. The purpose of this article was to describe new concepts and procedural strategies that would improve results using SWL as a treatment for urolithiasis, thereby achieving better clinical practice.Methods: A systematic review process was carried in PubMed/PMC from January 2003 to March 2023. A narrative synthesis of the most important aspects has been made.Results: The important recommendations for the adequate selection of the candidate patient for treatment with SWL are summarized, as well as the new strategies for a better application of the technique. Aspects about intraoperative position, stone localization and monitoring, analgesic control, machine and energy settings, and measures aiming at reduced risk of complications are described.Conclusion: To achieve the therapeutic goal of efficient stone disintegration without increasing the risk of complications, it is necessary to make an adequate selection of patients and to pay special attention to several important factors in the application of treatment. Technological development in later generation devices will help to improve current SWL results.

Epidemiologic, Diagnostic, and Therapeutic Features of Urinary Stone Disease in Northern Benin from 2018 to 2023

Objective: To determine the epidemiologic, diagnostic, and therapeutic features of urinary in northern Benin from 2018 to 2023. Patients and Method: The study was an observational and descriptive one. We exhaustively and retrospectively collected data from the medical records of the patients that were managed from February 1, 2018 to February 1, 2023 at the Department of Surgery of “Centre Hospitalier Universitaire Départmental Borgou-Alibori or CHUD-BA”. Results: Among the 4522 patients managed, 75% or 1.7% had urinary stone disease. Their mean age was 41 years. The sex ratio was 2.75, the males being predominantly affected. Of the 75 cases of urinary stone disease, 30.7% (n = 23) were renal, 46.7% (n = 35) were ureteral, and 22.7% (n = 17) were vesical. The patients came from variable geographical areas, ethnic groups, and professional sectors. Their main complaints were pain (57.3%), hematuria (14.7%), dysuria (12%), and fever (5.3%). 15 (20%) patients, i.e., 7 renal stone and 8 ureteral stone patients, had an obstructive renal failure. The imaging tools available were ultrasonography, tomography and computed tomographic scan. 11 of the bladder stone cases (64.7%) were associated with a bladder outlet obstruction. Overall, 38.7% of the patients had either diabetes mellitus (6.7%), hypertension or high blood pressure (6.7%), benign prostate hyperplasia (8%), urinary schistosomiasis (6.7%), ureteral pelvic junction obstruction (2.7%), and prostate cancer (1.3%). Of the 19 patients whose dietary behavior was investigated 15 (79%), 11 (57.9%) et 11 (57.9%) demonstrated a diet which was respectively rich in milk, fromage and meat. 100% of bladder stones were removed through cystolithotomy. Renal stones were removed by pyelolithtomy (52.2%) and nephrolithotomy (21.7%). Ureteral stones were removed through ureterolithotomy (40%), expelled by means of alpha-blockers (40%) or managed with ureteral pigtail stent (20%). Conclusion: The hospital prevalence of urinary stone disease was 1.7%. The mean age in urinary stone-affected patients was 41 years. The urinary stone predominantly affected male patients: the sex ratio was 2.75. The stones were mainly removed through open surgery.

Antilithic Effects of Extracts from Urtica dentata Hand on Calcium Oxalate Urinary Stones in Rats

This study examined the potential antilithic effects of a traditional Chinese medicine Urtica dentata Hand （UDH） in experimental rats and screened the optimal extract of UDH as a possible therapeutic agent for kidney stones. The rat model of urinary calcium oxalate stones was induced by intragastric （i.g.） administration of 2 mL of 1.25% ethylene glycol （EG） and 1% ammonium chloride （AC） for 28 days and was confirmed by Color Doppler ultrasound imaging. The rats in different experimental groups were then intragastrically given petroleum ether extract （PEE）, N-butanol extract （NBE）, aqueous extract （AqE） of UDH, Jieshitong （positive control drug）, and saline, respectively. Treatment with NBE significantly reduced the elevated levels of urinary calcium, uric acid, phosphate, as well as increased urinary output. Accordingly, the increased calcium, oxalate levels and the number of calcium oxalate crystals deposits were remarkably reverted in the renal tissue of NBE-treated rats. In addition, NBE also prevented the impairment of renal function to decrease the contents of blood urea nitrogen （BUN） and creatinine. Taken together, these data suggest that NBE of UDH has a beneficial effect on calcium oxalate urinary stones in rats by flushing the stones out and protecting renal function.

Usefulness of hounsfield unit and density in the assessment and treatment of urinary stones

Computed tomography(CT) is widely used to examine stones in the urinary system.In addition to the size and location of the stone and the overall health of the kidney,CT can also assess the density of the stone in Hounsfield units(HU).The HU,or Hounsfield density,measured by CT,is related to the density of the tissue or stone.A number of studies have assessed the use of HU in urology.HUs have been used to predict the type and opacity of stones during diagnosis,and the efficacy has been assessed using methods including extracorporeal shock wave lithotripsy(ESWL),percutaneous nephrolithotomy(PCNL),ureterorenoscopic ureterolithotripsy(URSL),and medical expulsive treatment(MET).Previous studies have focused on the success rate of HU for predicting the type of stone and of ESWL treatment.Understanding the composition of the stone plays a key role in determining the most appropriate treatment modality.The most recent reports have suggested that the HU value and its variants facilitate prediction of stone composition.However,the inclusion of data regarding urine,such as pH and presence of crystals,increases the predictive accuracy.HUs,which now form part of the clinical guidelines,allow us to predict the success of ESWL; therefore,they should be takeninto account when ESWL is considered as a treatment option.However,there are currently insufficient data available regarding the value of HU for assessing the efficacy of PCNL,URSL,and MET.Studies performed to date suggest that these values would make a significant contribution to the diagnosis and treatment of urinary system stones.However,more data are required to assess this further.

Urinary stone disease and obesity: Different pathologies sharing common biochemical mechanisms

The prevalence of urolithiasis is increasing in parallel with the escalating rate of obesity worldwide. It has previously been speculated that obesity is a potential risk factor for urinary stone disease. The possibility that common biochemical mechanisms underlie both obesity and urolithiasis is remarkable. Better understanding of possible common mechanisms of these diseases could potentially lead to a better management of urinary stone prevention. The prevention of urinary stone for-mation gives clinicians an acceptable reason to encour-age lifestyle modification and weight loss through a regular diet. In this review, the association of obesity with urinary stone disease, possible common biochemi-cal mechanisms, effects of dietary habits and weight loss on stone formation, as well as diffculties in surgi-cal management of obese individuals with urolithiasis are discussed.

Effect of urinary stone disease and its treatment on renal function

Urolithiasis is a common disease that affects urinary tract in all age groups. Both in adults and in children, stone size, location, renal anatomy, and other factors, can infuence the success of treatment modalities. Recently, there has been a great advancement in technology for minimally invasive management of urinary stones.The epoch of open treatment modalities has passed and currently there are much less invasive treatment approaches, such as percutaneous nephrolithotomy, ureteroscopy, shockwave lithotripsy, and retrograde internal Surgery. Furthermore, advancement in imaging technics ensures substantial knowledge that permit physician to decide the most convenient treatment method for the patient. Thus, effective and rapid treatment of urinary tract stones is substantial for the preservation of the renal function. In this review, the effects of the treatment options for urinary stones on renal function have been reviewed.

Determination of components in traditional Chinese medicines associated with promoting or inhibiting urinary stone formation

Objective:To measure oxalate,calcium,and sodium contents of traditional Chinese medicines(TCMs)that are commonly used to prevent and dissolve urinary stones to exclude the possibility that long-term use of such medicines promotes stone formation.The second objective was to measure citrate,potassium,and magnesium contents in the same medicines to provide possible clues about the mechanisms of prevention and dissolution of urinary stones by TCMs.Methods:Ten of the most commonly-used TCMs for preventing and dissolving urinary stones were chosen and subjected to ion chromatography(IC)to measure water-soluble and total oxalate and citrate contents.Inductively coupled plasma atomic emission spectrometry(ICPAES)was used to measure calcium,potassium,magnesium,and sodium contents in a water extract and in digestion liquid.Results:Average contents of water-soluble oxalate,calcium,and sodium in the water extract were 41.92,84.32,and 22.82 mg/100 g,respectively,far below the normal dietary intake of adults in China.The average contents of citrate and magnesium in water extracts were 268.99 and 66.65 mg/100 g,respectively,below the recommended intake for adults.These ion contents are therefore insufficient to inhibit the formation of urinary stones.The average content of potassium in the water extract was 867.71 mg/100 g,which was relatively abundant,so taking the prescription used in this experimental protocol can increase the body’s potassium content to some extent.Conclusions:Long-term use of TCMs would not increase the risk of urinary stone formation.The potassium content in TCMs is high,which is one possible reason for the prevention of urinary stones by TCMs.

Neodymium:Yttrium Aluminum Garnet Laser for Mini-Percutaneous Treatment of Upper Urinary Tract Stones

To observe the efficacy and safety of mini-percutaneous nephrolithotomy with Neodymium：Yttrium Aluminum Garnet （Nd-YAG） laser in the treatment for upper urinary tract stones, from December 2005 to September 2006, 31 patients with renal stones, 15 patients with ureteral stones and 7 patients with renal and ureteral stones underwent mini-percutaneous nephrolithotomy with Nd-YAG laser by combination of rigid ureteroscope and flexible ureteroscope under B-ultrasound guidance. Clinical data including operation time, lithotripsy time, complications and stone-free rate were analyzed retrospectively. Our study showed that the percutaneous renal access （F14-F18） was successfully established under B-ultrasound guidance in all cases. Immediate phase Ⅰ lithotripsy was performed in 47 cases through single tract, and in one case through two tracts. Delayed phase Ⅱ lithotripsy was done in 5 cases of renal stones. Operation time ranged from 55 to 180 rain with an average time of 100±15 min. Lithotripsy time was from 25 to 135 min and the average lithotripsy time was 65±11 min. No severe complications occurred in our series. Complex renal stones were cleared in 34 of 38 cases （89.5 %）. All ureteral stones were completely removed in 15 cases （100 %）. It was concluded that mini-percutaneous nephrolithotomy with Nd：YAG laser for the treatment of upper urinary tract stones by combination of rigid ureteroscope and flexible ureteroscope has the advantages of effectiveness, mini-invasion, shorter operative time and safety.

The association of benign prostatic hyperplasia with lower urinary tract stones in adult men: A retrospective multicenter study

Objective:To examine the relationship between benign prostatic hyperplasia(BPH)and the presence of lower urinary tract stones.Methods:We retrospectively reviewed the records of men with lower urinary tract stones who presented to three clinical centers in Korea over a 4-year period.We divided the patients into two groups based on the location of urinary stones:Group 1(bladder calculi)and Group 2(urethral calculi).We compared the characteristics of both groups and performed univariate and multivariate analyses with a logistic regression model to investigate the relationship between BPH and lower urinary tract stones.Results:Of 221 patients,194(87.8%)had bladder calculi and 27(12.2%)had urethral calculi.The mean age of Group 1 was higher than that of Group 2(68.96
12.11 years vs.55.74
14.20 years,p<0.001).The mean prostate volume of Group 1 was higher than that of Group 2(44.47
27.14 mL vs.24.70
6.41 mL,respectively,p<0.001).Multivariate logistic regression showed that age(OR Z 1.075,95%CI:1.023e1.129)and prostate volume(OR Z 1.069,95%CI:1.017e1.123)were independently associated with increased risk for bladder calculi.Upper urinary tract stones and/or hydronephrosis conferred a 3-fold risk for urethral calculi(OR Z 3.468,95%CI:1.093e10.999).Conclusion:Age and prostate volume are independent risk factors for bladder calculi.In addition,men with upper urinary tract disease are at greater risk for urethral calculi,which may migrate from the upper urinary tract rather than from the bladder.

Research Progress on Flexible Ureteroscopy

The ureteroscopic surgical technique has developed rapidly in recent years and has become an important method of urological surgery. The manufacturing and production of corresponding ureteroscopes are also constantly improving. This article systematically reviews and analyzes existing literature, summarizes the characteristics of various ureteroscopes in recent years, studies the advantages and disadvantages of ureteroscopes with different characteristics, summarizes relevant clinical experience in the use of ureteroscopes, and provides preliminary prospects for the future development of ureteroscopes. The results indicate that disposable electronic ureteroscopes and robotic ureteroscope systems may be an important development direction in the future.

Association between heat and upper urinary tract stones morbidity and medical costs: A study in the subtropical humid climate zone

Urolithiasis is a heat-specific disease.Exploring heat-related urolithiasis susceptibility subtypes,economic burden,and modifying factors could assist governments in targeting interventions to reduce the heat-related health risks of urolithiasis morbidity.We collected data on 23,492 patients with upper urinary tract stones(main subtypes of urolithiasis)from 2013 to 2017 in Nanjing,China.We adopted generalized additive quasi-Poisson models to examine the associations between daily mean temperatures and morbidity of upper urinary tract stones,while generalized additive Gaussian models were used to explore the relationships between temperatures and log-transformed medical costs.We examined the modification effects of disease subtypes(kidney and ureteral calculus),sex,and age through stratified analyses and the modif-cation effects of other meteorological factors by introducing interaction terms in the models.We found that short-term summer heat exposure has a statistically significant effect on ureteral calculus morbidity but not on kidney calculus morbidity.For ureter calculus,a 1℃ temperature increase was associated with a 4.36%(95%confidence interval[CI]:1.94%,6.83%)increase in daily hospitalization and a 5.44%(95%CI:2.71%,8.25%)increase in daily medical costs.The attributable fraction associated with heat(greater than the median value of daily mean temperature,26.8℃)was 7.85%(95%empirical confidence interval[eCI]:3.64%,11.44%)for hospitalization and 9.36%(95%eCI:4.91%,13.14%)for medical costs.The effects of heat on ureter calculus morbidity were significantly higher among the males and those with high sunshine duration than females and those with low sunshine duration.Short-term summer heat exposure was associated with increased morbidity and medical costs of ureteral calculus.Relevant government organizations should take effective intervention measures,including community health education,to reduce the health hazards and economic losses caused by heat.

A Review on Kidney Stone and Its Herbal Treatment

Medicinal plants have been valued for millennia as a rich source of therapeutic compounds for the prevention of various ailments all throughout the world.Kidney stones and urinary calculi affect a huge percentage of the population nowadays.Stone sickness has become more prevalent as a result of changes in living conditions,such as industrialization and hunger.The most common stone recorded in India is calcium oxalate kidney stones.Changes in prevalence and incidence,the occurrence of stone kinds and stone position,and stone removal treatment are all discussed.Medicinal herbs have been utilised for centuries because they are safer,more effective,culturally acceptable,and have less adverse effects than manufactured medications.Patients are advised to consume a low-fat diet,as well as fibres from naturally occurring plants and herbal treatments.The current article discusses the steps that should be taken to maximise the potential of medicinal plants for stone dissolving action.Combining herbal remedies with allopathic treatment is an excellent way to eliminate all issues associated with kidney stones.The purpose of this article is to emphasise the use of herbs as a treatment for urinary stones.

Inhibition of the Crystal Growth and Aggregation of Calcium Oxalate by Algae Sulfated Polysaccharide In-vitro

The influence of sulfated polysaccharide （SPS） isolated from marine algae Sargassum fusiforme on the morphology and phase compositions of urinary crystal calcium oxalate was investigated in vitro by means of scanning electron microscopy and X-ray diffraction. SPS maybe is a potential inhibitor to CaOxa urinary stones by inhibiting the growth of calcium oxalate monohydrate （COM）, preventing the aggregation of COM, and inducing the formation of calcium oxalate dihydrate （COD） crystals.

The Effect of Potassium Citrate on Simultaneous Growth of Calcium Oxalate Mono-, Di-, and Trihydrate in Synthetic Urine

The inducing effect of potassium citrate （K3cit） on simultaneous growth of calcium oxalate mono-（COM）, di-（COD）, and trihydrate （COT） crystals in synthetic urine was observed with double diffusion gelatinous technique. K3cit can induce the formation of COD and COT, inhibit the aggregation and decrease the surface area of COM crystals. It supported the clinical use of K3cit and may provide important clues to this disease in cure and in search for new drugs.

Effect of Concentration of Structurally-Different Carboxylic Acids on Growth and Aggregation of Calcium Oxalate in Gel Systems

The effect of concentration of structurally-different carboxylic acids such as ethylene diamine tetraacetic acid （H4edta）, citric acid （H3cit）, tartaric acid （H2tart）, and acetic acid （HOAc） on growth and aggregation of calcium oxalate （CaOxa） in gel systems was comparatively investigated. H2tart and H3cit could change the morphology of cal- cium oxalate monohydrate （COM） and induce the formation of calcium oxalate dihydrate （COD）. H4edta could induce the formation of COD at a lower concentration of 0.33 mmol/L and have the strongest ability to inhibit aggregation of COM. HOAc inhibited COM aggregation only at a higher concentration than 500 mmol/L. With increasing the number of carboxylic groups in an acid or increasing the concentration of carboxylic acid, the capacity of this acid to induce COD formation and to inhibit growth and aggregation of COM crystals increased. That is, this capacity followed the order： H4edta〉H3cit〉H2tart〉 〉HOAc. The result in this work suggested that the presence of H3cit and H2tart in urine played a role in the natural defense against stone formation.