Percutaneous nephrostomy versus ureteral stent in hydronephrosis secondary to obstructive urolithiasis:A systematic review and meta-analysis

Objective: To assess if there is a preferable intervention between retrograde ureteral stent (RUS) and percutaneous nephrostomy (PCN) tube, in cases of upper urinary tract stone obstruction with complications requiring urgent drainage, by evaluating outcomes regarding urinary symptoms, quality of life (QoL), spontaneous stone passage, and length of hospital stays, since there is no literature stating the superiority of one modality over the other.Methods: We searched MEDLINE and other sources for relevant articles in June 2019 without any date restrictions or filters applied. The selection was done first by the title and abstract screening and then by full-text assessment for eligibility. Only randomized controlled trials or cohort studies in patients with hydronephrosis secondary to obstructive urolithiasis that presented comparative data between PCN and RUS placement concerning at least one of the defined outcome measures were included. Lastly, MEDLINE database and PubMed platform were screened again using the same terms, from June 2019 until November 2022.Results: Of 556 initial articles, seven were included in this review. Most works were considered of moderate-to-high quality. Three studies regarding QoL showed a tendency against stenting, even though only one demonstrated statistically significant negative impact on overall health state. Two works reported significantly more post-intervention urinary symptoms in stenting patients. One article found that PCN is a significant predictor of spontaneous stone passage, when adjusted for stone size and location. Findings on length of hospital stays were not consistent among articles.Conclusion: PCN appears to be the intervention better tolerated, with less impact on the patient’s perceived QoL and less post-operative urinary symptoms, in comparison with RUS. Nevertheless, further studies with larger samples and a randomized controlled design are suggested.

Retrograde intrarenal surgery:An expanding role in treatment of urolithiasis

During the past 3 decades,the surgical management of kidney stones has undergone many technological advances and one is the development of the flexible ureteroscopy.The development of this instrument as well as ancillary equipment such as baskets,graspers,and others,and improvements in lithotripsy with Holmium:YAG laser have led to expand its indications with diagnostic and therapeutic management of medical issues of the upper urinary tract such as urolithiasis and urothelial tumors.The objective of this review is to describe its indications and results in the different scenarios for the treatment of urinary stones.

A Survey of Urolithiasis in Young Children Fed Infant Formula Contaminated with Melamine in Two Townships of Gansu,China

Objective To determine the prevalence of urolithiasis in young children fed infant formula（IF） contaminated with melamine,and the association between IF consumption and urolithiasis.Design A total of 2 733 children ≤3 years of age on September 1,2008 in two townships of Gansu Province,China were studied.Cases of urolithiasis were diagnosed by ultrasonography.Milk product consumption was determined by their caregivers.Remaining IF samples were tested for melamine and cyanuric acid.Results Of 2 733 eligible children in the two townships,2 186（80%） were enrolled in our study.Overall,16.6%（362） of 2 186 children had urolithiasis.The prevalence was 24.6% in children exclusively fed Sanlu brand IF,9.7% in those fed other IF,and 8.5% in those fed exclusively on other milk products.For children exclusively breast-fed,no urolithiasis was found（P0.05）.The prevalence of urolithiasis was 11.4% in children fed 400 g of Sanlu IF,rising to 37.5% in children fed over 25 600 g.Of 48 Sanlu IF samples,91.7% contained melamine（median=1 800 ppm;range=45-4 700） and 66.7% contained cyanuric acid（median=1.2 ppm;range=0.4-6.3）.Melamine was also detected in 22.2% of 36 other brand IF（median=27.5 ppm,range=4-50）.Conclusions Urolithiasis was associated with melamine-contaminated IF.Although one product caused most morbidity,other milk products may have also contributed to the outbreak.

Urolithiasis in Pregnancy: Survey in Clinical Epidemiology

This study examined the association of pregnancy with urolithiasis and provided new insights into urolithiasis in pregnancy. A total of 462 subjects were studied from January 2004 to December 2009 in Foshan Maternal and Child Health Hospital, China. Among the 462 subjects, 162 cases of urolithiasis during pregnancy （UPG） were selected as the observation group, 150 cases of no urolithiasis during pregnancy （NUPG） served as pregnancy control group, and 150 cases of no pregnancy （NPG） at reproductive age who took part in physical examination were randomly assigned into non-pregnant control group. At the same time, the patients in observation group were divided into the following sub-groups： no symptomatic urinary calculus （NSUC） and symptomatic urinary calculus （SUC） groups; SUC group was further divided into surgical intervention （SI） and conservative management （CM） groups. The general information and the data of blood and urine were collected and compared among the groups. The results showed that the incidence of urinary calculi in pregnant women was lower than that in non-pregnant women, the formation of urinary stone was associated with the change of metabolism of protein and sugar in pregnant women, and the surgical intervention was a practicable alternative to treat the clinical intractable symptomatic urinary calculi in pregnancy.

Medical management of urolithiasis: Great efforts and limited progress

Objective:To provide a comprehensive review on the existing literature on medical management of urolithiasis.Methods:A thorough literature review was performed using Medline,PubMed/PMC,Embase,and the Cochrane Database of Systematic Reviews up to December 2022 to identify publications on the medical management of urolithiasis.Studies that assessed dietary and pharmacologic management of urolithiasis were reviewed;studies on medical expulsive therapy were not included in this review.Results:Medical management of urolithiasis ranges from the prophylactic management of kidney stone disease to dissolution therapies.While most treatment concepts have been long established,large randomized controlled trials are scarce.Dietary modification and increased fluid intake remain cornerstones in the conservative management of urolithiasis.A major limitation for medical management of urolithiasis is poor patient compliance.Conclusion:Medical management of urolithiasis is more important in patients with recurrent urolithiasis and patients with metabolic abnormalities putting them at higher risk of developing stones.Although medical management can be effective in limiting stone recurrence,medical interventions often fail due to poor compliance.

Decreased Expression of Vitamin K Epoxide Reductase Complex Subunit 1 in Kidney of Patients with Calcium Oxalate Urolithiasis

Urinary prothrombin fragment 1 （UPTFl） is a potent inhibitor of urinary stone formation. UPTF1 exerts such inhibitory effect by effective 7-carboxylation in which vitamin K epoxide reductase complex subunit 1 （VKORC1）, the rate-limiting enzyme, is involved. This study examined the correlation between VKORC1 expression and calcium oxalate urolithiasis. The renal cortex samples were obtained from patients undergoing nephrectomy and then divided into 3 groups： urolithiasis group, control group A [hydronephrosis-without-stone （HWS） group], control group B （normal control group）, The localization and expression of VKORC1 in renal tissues were determined by using immunohistochemistry, immunofluorescence microscopy, Western blotting and SYBR Green I real-time reverse-transcription PCR. The rapid amplification of cDNA ends （RACE） were conducted to obtain the 3＇- and 5＇-untranslated region （UTR） of VKORC1. The results showed that VKORC1 was located in the cytoplasm of renal tubular epithelial cells. The expression of VKORC1 in the uro- lithiasis group was significantly lower than that in the other two control groups （P〈0.05）. Moreover, the 3＇- and 5＇-UTR sequence of the VKORC1 gene was successfully cloned. No insertion or deletion was found in the 3＇- and 5＇-UTR. However, a 171-bp new base sequence was discovered in the up- stream of 5＇-UTR end in the urolithiasis group. It was concluded that the decreased expression of VKORC 1 may contribute to the development of calcium oxalate urolithiasis in the kidney.

Monogenic features of urolithiasis: A comprehensive review

Objective: Urolithiasis formation has been attributed to environmental and dietary factors. However, evidence is accumulating that genetic background can contribute to urolithiasis formation. Advancements in the identification of monogenic causes using high-throughput sequencing technologies have shown that urolithiasis has a strong heritable component.Methods: This review describes monogenic factors implicated in a genetic predisposition to urolithiasis. Peer-reviewed journals were evaluated by a PubMed search until July 2023 to summarize disorders associated with monogenic traits, and discuss clinical implications of identification of patients genetically susceptible to urolithiasis formation.Results: Given that more than 80% of urolithiases cases are associated with calcium accumulation, studies have focused mainly on monogenetic contributors to hypercalciuric urolithiases, leading to the identification of receptors, channels, and transporters involved in the regulation of calcium renal tubular reabsorption. Nevertheless, available candidate genes and linkage methods have a low resolution for evaluation of the effects of genetic components versus those of environmental, dietary, and hormonal factors, and genotypes remain undetermined in the majority of urolithiasis formers.Conclusion: The pathophysiology underlying urolithiasis formation is complex and multifactorial, but evidence strongly suggests the existence of numerous monogenic causes of urolithiasis in humans.

Urolithiasis in inflammatory bowel disease and bariatric surgery

AIM To analyse current literature focusing on pathogenesis and therapeutic aspects of urolithiasis with inflammatory bowel disease(IBD) and following bariatric surgery. METHODS A systematic literature search was performed using PubMed, supplemented with additional references. Studies assessing the association of IBD or bariatric surgery with renal stones in both paediatric and adulthood were included. RESULTS Certain types of stones are seen more frequently with IBD. Hyperoxaluria and hypocitraturia are the main metabolic changes responsible for urolithiasis. The incidence of renal stones in malabsorptive types of bariatric surgery such as gastric bypass is high; this is not as common in modern restrictive surgical methods. Preventative methods and urine alkalinisation have been shown to be beneficial.CONCLUSION Both conditions are associated with renal stones. Patients' counselling and prevention strategies are the mainstay of urolithiasis management in these patients.

Urinary supersaturation as a diagnostic measure in urolithiasis

AIM To demonstrate that urinary supersaturation per se is not a reliable diagnostic measure of the risk for stone formation.METHODS Available physical and chemical data for calcium oxalate monohydrate(COM) and calcium hydrogen phosphate dihydrate(brushite, BRU), and urinary supersaturations with respect to COM and BRU in healthy individuals and stone formers, were obtained from the literature. Classical theory of nucleation was used for calculations.RESULTS It was found that the rate of homogeneous nucleation(unaided by substrates) of COM and BRU is nil at all conceivable supersaturations of urine. Consequently spontaneous formation of crystals in urine requires the presence of nucleation substrates for(heteronuclei).CONCLUSION Urinary supersaturation with respect to lithiatic compounds is a necessary, but not a sufficient condition for nephrolithiasis. The absence of crystallization inhibitors and the presence of efficient nucleation promoters(heteronuclei) in urine are further necessary conditions of urolithiasis occurrence. Urinary supersaturation per se is not a reliable diagnostic measure of the risk of kidney stone formation.

The Deleterious Effect of Inappropriate Calcium and Vitamin D Supplementation during Pregnancy in Women Predisposed to Calcium Oxalate Urolithiasis

Background: Gestational formation of new urolithiasis is rare yet the impact of inappropriate gestational calcium and vitamin D supplementation (Ca/DS) is underestimated. Patients and Methods: we retrospectively evaluated 75 pregnant women with history of UL, yet were stable for >2 years on dietary restrictions, for new UL after Ca/DS. Results: During the past 5 years 21 (48%) of those who had received Ca/DS had developed UL and all had high Vitamin D with hypercalcemia while the remaining 31 patients, without Ca/DS, did not have UL and maintained normal vitamin D urinary calcium without need for supplementation. Overt UL was evident by 30th weeks of gestations and most were diagnosed by ultrasonography and managed by medical expulsive therapy. Conclusion: in patients with history of UL, prudent use of Ca/DS is indicated to avoid new UL.

Epidemiological Profile of Patients Suffering from Urolithiasis in African Urological Environments from 2016 to 2020

Introduction: Urolithiasis is a very common pathology in the world. Its epidemiological profile varies from one region to another. In Africa in general and in the Congo in particular, it seems to be unknown. Objective: To determine the sociodemographic, diagnostic, therapeutic and evolutionary paraclinical parameters of 167 adult patients with urolithiasis. Patients and Methods: Cross-sectional, descriptive, retrospective study conducted in the urology department of Brazzaville University Hospital over a period of five years. We studied sociodemographic, therapeutic and evolutive. Results: During the study period 167 patients were treated for urolithiasis out of 2236 patients, a hospital frequency of 7.46%. The sex ratio M/F was 1.49. The average age of the patients was 42.05 years. They were overweight and/or obese in 53% of cases. Workers accounted for 46.53% of cases, with a low socio-economic level (42.5%) and a lower level of education (68.31%). There was a high percentage of complications, dominated by hydronephrosis (66.33%) and urinary tract infection (59.4%). The treatment was surgical in the majority of cases or 74.8%. Thirty-three patients had a lithiasis recurrence, a frequency of 19.7%. Conclusion: Urolithiasis is common. Being overweight is the most found risk factor. Lithiasis recurrence affects nearly one in five patients.

Surgical Management of Obstructive Urolithiasis in Small Ruminants by Tube Cystostomy in Chittagong, Bangladesh

The present study was conducted to evaluate minimally invasive tube cystostomy technique in goats and calves suffering from obstructive urolithiasis having intact and ruptured urinary bladder. This clinical study was carried out on 84 clinical cases （61 goats and 23 calves） based on the history, clinical signs and physical examination along with common laboratory techniques at the Chittagong Veterinary and Animal Sciences University during January 2015-December 2016. Physical parameters like heart rate, respiratory rate, rectal temperature and dehydration status of animals were noted and corrected abnormality before surgery. Some cases had slightly higher haemoglobin （Hb）, packed cell volume （PCV） and uric acid and epithelial casts in urine. The study revealed that abnormal calcium-phosphorus ratio was predisposing the animals to urolithiasis. It was found that young ruminants （3-5 months） were most commonly affected in both species. All affected animals were male in this study, in which calves were not castrated but in goats 95.08% animals were castrated. Rupture of bladder was more common in calves as compared to goats. Postoperatively all cases were administered with broad-spectrum antibiotic, anti-inflammatory agent and caliculolytic agents like ammonium chloride. Tube cystostomy with Foley’s catheter was the most satisfactory technique for the management of obstructive urolithiasis in small ruminants. Postoperative complications were recorded only in four animals and remaining 80 animals had a normal recovery from tube cystostomy. Tube cystostomy is a simple, inexpensive and very effective procedure for the treatment of urolithiasis in ruminants.

改进YOLOv5su模型检测桃树缩叶病

为实现自然环境下桃树缩叶病的检测,该研究提出了一种基于YOLOv5su的桃树缩叶病识别改进模型DLLYOLOv5su。首先,针对桃树缩叶病目标特征变化较大的问题,在骨干网络最后一层C3模块中加入可变形自注意力模块(deformable attention,DA),使模型更加关注目标区域,降低背景对模型的影响,提高模型在复杂背景下的拟合能力。其次在SPPF(fast spatial pyramid pooling)模块中引入LSKA(large separable kernel attention)结构,大核卷积增大了模型的感受野,使模型能够关注更多信息。最后,提出了LAWD(lightweight adaptive weighted downsampling)模块,使用轻量化的下采样结构替换卷积模块,减少计算开销。在桃树缩叶病数据集上进行试验,结果显示,DLL-YOLOv5su模型权重大小为17.6 MB,检测速度为83帧/s。识别准确率P、召回率R和平均精度均值mAP_(50)分别达到了80.7%、73.1%和80.4%,相较于原始YOLOv5su分别提高了4.2、2.4和4.3个百分点。与YOLOv3-tiny、Faster R-CNN、YOLOv7和YOLOv8相比mAP_(50)分别高出了28.5、11.8、2.1和4.1个百分点。改进模型识别精度高,误检、漏检率低,检测速度满足实时检测的要求,可以为桃树缩叶病的实时监测和预警提供参考。

Epidemiology of urolithiasis in Asia

In Asia,about 1%-19.1% of the population suffer fromurolithiasis.However,due to variations in socio-economic status and geographic locations,the prevalence and incidence have changed in different countries or regions over the years.The research for risk factors of urinary tract stones is of predominant importance.In this review,we find the prevalence of urolithiasis is 5%-19.1% in West Asia,Southeast Asia,South Asia,aswellas somedevelopedcountries(SouthKorea and Japan),whereas,it is only 1%e8%inmost part of East Asia and North Asia.The recurrence rate ranges from 21% to 53% after 3e5 years.Calciumoxalate(75%-90%)is themost frequent component of calculi,followed by uric acid(5%-20%),calciumphosphate(6%-13%),struvite(2%-15%),apatite(1%)and cystine(0.5%-1%).The incidence of urolithiasis reaches its peak in population agedover 30 years.Males aremore likely to suffer fromurinary calculi.Because of different dietary habits or genetic background,differences of prevalence among races or nationalities also exist.Geneticmutation of specific locus may contribute to the formation of different kinds of calculi.Dietary habits(westernized dietary habits and less fluid intake),as well as climatic factors(hot temperature andmany hours of exposure to sunshine)play a crucial role in the development of stones.Other diseases,especially metabolic syndrome,may also contribute to urinary tract stones.

Flexible ureteroscopy:Technological advancements,current indications and outcomes in the treatment of urolithiasis

The last 3 decades have witnessed great improvements in the technology and clinical applications of many minimally invasive procedures in the urological field.Flexible ureteroscopy(fURS)has advanced considerably to become a widely utilized diagnostic and therapeutic tool for multiple upper urinary tract pathologies.The most common indication for fURS is the treatment of upper urinary tract stones with the aid of Holmium:Yttrium Aluminium Garnet(YAG)laser lithotripsy.Advancements in endoscope technologies and operative techniques have lead to a broader application of fURS in the management of urolithiasis to include larger and more complex stones.fURS has proved to be an effective and safe procedure with few contraindications.Continued progression in fURS may increase its clinical applicability and supplant other procedures as the first line treatment option for urolithiasis.

Ureteral stents in urolithiasis

Ever since the ureteral stent design was fitted with a curl on both sides to prevent it from migrating up or down the ureter some 40 years ago,its use has gained tremendous momentum,aiding in the rise and evolution of endourology and has confidently kept its place in modern time urology.Over the past four decades,several designs,coating and biomaterials have been developed,trying to reduce infection,encrustation and other stent related symptoms.As the ideal stent has not yet been discovered,different ways of helping patients with their complaints have been researched.This review will cover these aspects of stent use in urolithiasis.

小麦SUS基因家族鉴定与生物信息学分析

【目的】对小麦蔗糖合成酶(sucrose synthase,SUS)基因家族进行鉴定和生物信息学分析,为探究小麦SUS(TaSUS)基因家族的作用机制提供理论参考。【方法】采用生物信息学方法在小麦全基因组上鉴定TaSUS基因家族成员,并对其系统进化关系、染色体位置、基因结构、保守结构域、启动子顺式作用元件和基因表达模式进行分析。【结果】在小麦基因组中共鉴定到分布于14条染色体上的24个TaSUS基因,可分为3个亚组。TaSUS基因含有多个外显子,但部分基因缺失非翻译区结构。TaSUS基因家族成员启动子区域包含45种顺式作用元件,涉及植物生长发育和逆境胁迫响应。大多数TaSUS基因在小麦穗中显著表达,在叶、茎和根中的相对表达量较低。【结论】研究结果有助于了解小麦SUS基因家族的进化,为后期小麦SUS基因家族的生物功能研究奠定理论基础。

Whole Leea macrophylla ethanolic extract normalizes kidney deposits and recovers renal impairments in an ethylene glycol-induced urolithiasis model of rats

Objective:To investigate the antilithiatic effect of the whole Leea macrophylla(L macrophylla) Roxb(Leeaeeae) ethanol extract in ediylene glycol-induced urolithiasis model of rats.Methods: Forty two seven weeks old male wistar albino rats were randomly divided into two major groups namely:preventive(n=18) and therapeutic(n=24).Preventive group was further subdivided into 3 groups of 6 rats namely:preventive control(PC),preventive lithiatic control(PLC) and preventive lithiatic L.macrophylla(PLLM).Similarly,therapeutic group was also subdivided into 4 groups of 6 rats namely:therapeutic control(TC),therapeutic lithiatic control(TLC).therapeutic lithitatic L macrophylla(TLLM) and therapeutic lithiatic cystone(TLCYS).The lithiasis was induced by 0.75%(v/v) ethylene glycol in the drinking water of all groups except the PC and TC groups.The urinary ionic parameters such as calcium,inorganic phosphate,oxalate,magnesium & creatinine and renal morphology were altered by ediylene glycol,which were partially recovered by 14 d preventive and almost fully recovered by 28 d therapeutic intervention trials with L macrophylla extract(500 mg/kg BW daily).Results:Significant difference on recovery was observed between preventive and dierapeutic interventional trials.Anti-urolithiatic effect of cystone was significantly(P【0.001) higher than extracts.L macrophylla extract was found nontoxic in the acute toxicity test.Conclusions:The results of this study demonstrated very promising antiurolithiatic effect of L.macrophylla extract with preventive and therapeutic treatments in this experimental condition.

Epidemiological trends of urinary tract infections,urolithiasis and benign prostatic hyperplasia in 203 countries and territories from 1990 to 2019

Background:Urinary tract infections(UTI),urolithiasis,and benign prostatic hyperplasia(BPH)are three of the most common nonmalignant conditions in urology.However,there is still a lack of comprehensive and updated epidemiological data.This study aimed to investigate the disease burden of UTI,urolithiasis,and BPH in 203 countries and territories from 1990 to 2019.Methods:Data were extracted from the Global Burden of Disease 2019,including incident cases,deaths,disabilityadjusted life-years(DALYs)and corresponding age-standardized rate(ASR)from 1990 to 2019.Estimated annual percentage changes(EAPC)were calculated to evaluate the trends of ASR.The associations between disease burden and social development degrees were analyzed using a sociodemographic index(SDI).Results:Compared with 1990,the incident cases of UTI,urolithiasis,and BPH increased by 60.40%,48.57%,and 105.70%in 2019,respectively.The age-standardized incidence rate(ASIR)of UTI increased(EAPC=0.08),while urolithiasis(EAPC=–0.83)and BPH(EAPC=–0.03)decreased from 1990 to 2019.In 2019,the age-standardized mortality rate(ASMR)of UTI and urolithiasis were 3.13/100,000 and 0.17/100,000,respectively.BPH had the largest increase(110.56%)in DALYs in the past three decades,followed by UTI(68.89%)and urolithiasis(16.95%).The burden of UTI was mainly concentrated in South Asia and Tropical Latin America,while the burden of urolithiasis and BPH was recorded in Asia and Eastern Europe.Moreover,the ASIR and SDI of urolithiasis in high-SDI regions from 1990to 2019 were negatively correlated,while the opposite trend was seen in low-SDI regions.In 2019,the ASIR of UTI in females was 3.59 times that of males,while the ASIR of urolithiasis in males was 1.96 times higher than that in females.The incidence was highest in the 30–34,55–59,and 65–69 age groups among the UTI,urolithiasis,and BPH groups,respectively.Conclusions:Over the past three decades,the disease burden has increased for UTI but decreased for urolithiasis and BPH.The allocation of medical resources should be based more on the epidemiological characteristics and geographical distribution of diseases.

CLINICAL STUDY ON THE TREATMENT OF UROLITHIASIS WITH ACUPUNCTURE

120 cases of urolithlasis were randomly divided into 3 groups of 40 persons each.The first group was solely treated with an improved acupuncture method,the second group was treatedwith Chinese herbal medicine,and the third group was treated with both of the above methods.Results showed that the improved acupuncture method possessed better stone-removing effect thanthe herbal medicine method and no much difference occurred between the patients treated withacupuncture and those treated with both above methods.Besides,the authors also experienced the excellentanalgesic and stone-dissolving effect of acupuncture in this study.