Urolithiasis

The objective of this study was to perform a multi-centre and global study evaluating the clinical outcomes and complications associated with of URS for stone disease in patients aged 80 years and above. Retrospective analysis was conducted on patients aged ≥ 80 years who underwent URS for stone disease between January 2014 and December 2024, across 20 centres in 14 countries. A total of 679 patients aged ≥ 80 years underwent ureteroscopy (URS), with a median age of 83 years (IQR 81–86) and a male-to-female ratio of 1.2:1. Most patients were ASA grade 2 (52%) and presented electively (95%), with general anaesthesia used in 77% of cases. The median cumulative stone size was 11 mm (IQR 7–15), and 56% had a single stone. The overall stone-free rate (SFR) was 70% for zero fragments, increasing to 84% when including fragments ≤ 2 mm, and 90% when including fragments ≤ 4 mm. The overall 30-day complication rate was 16%, with major complications (Clavien-Dindo grade ≥ 3) in 2.8% of patients. The most common complication was urinary tract infection (9.4%). One procedure-related death (0.1%) was recorded. Multivariable analysis identified ASA score ≥ 3 (OR 1.60), operative time > 60 min (OR 1.73), and emergency surgery (OR 2.96) as independent predictors of complications. Ureteroscopy can be performed in patients aged 80 years and above with a low risk of major complications and acceptable stone clearance rates. Avoiding both emergency surgery and prolonged operative times can help reduce the morbidity profile.

Urinary tract infections (UTIs) are among the most prevalent infections in the human population. Uropathogenic Escherichia coli, the primary causative agent of UTIs, may also contribute to the development of metabolic kidney stones, particularly those composed of calcium oxalate. Kidney stone disease (KSD), known as nephrolithiasis or urolithiasis, is one of the most common disorders of the urinary system. This review explores the significant clinical association between UTIs and kidney stones, focusing on the mechanisms by which UPEC may promote stone formation, including oxidative stress, inflammation, and altered citrate metabolism. It also examines the role of immune responses, particularly macrophage activity, in the progression of KSD. Recent evidence suggests that the composition of the gut microbiota and metabolic imbalances have an additional impact on stone development. In light of these findings, current prevention and treatment strategies, including microbiota-targeted therapies, probiotics, and immune modulation, are also reviewed. Understanding the complex links between UTI, immunity, and metabolism provide new insights into the pathogenesis of KSD and allows for the development of more effective treatments for this disease.

BackgroundRecurrent urolithiasis is a major clinical challenge, with more than 50% of patients experiencing recurrence within 5 years. While potassium citrate effectively reduces recurrence, poor adherence due to cost and gastrointestinal side effects limits its long-term use. Citrus-based interventions, such as lime juice, have shown potential in enhancing urinary citrate and alkalinity but require further validation. This study evaluated the efficacy of a lime-based phytochemical-rich regimen (LPR) in preventing stone recurrence and reducing urinary inflammation in post-operative urolithiasis patients.ObjectiveThis multicenter, double-blind, randomized controlled trial aimed to evaluate the efficacy and safety of a novel lime-based preparation called LPR in preventing kidney stone recurrence over 24 months.MethodsIn a double-blind, randomized, placebo-controlled, multicenter trial, 173 patients with calcium oxalate urolithiasis who had undergone successful stone removal were enrolled from six hospitals in Thailand. Participants were randomized to receive either LPR or placebo for 24 months. The primary outcome was the incidence of stone recurrence confirmed by computerized topography (CT). Secondary outcomes included changes in urinary protein excretion and urinary interleukin-8 (IL-8) level, a pro-inflammatory cytokine implicated in renal inflammation and stone formation. Kaplan-Meier survival analysis and multivariate Cox regression were used to assess recurrence risk.ResultsOf 173 enrolled participants, 151 completed the study. The recurrence rate at 2 years was significantly lower in the LPR group (14%) compared to placebo (45%) (p ConclusionLPR, a lime-based supplement rich in citrate and flavonoids, significantly reduced the 2-year recurrence rate of calcium oxalate stones by approximately 76%. This effect may be mediated by increased urinary citrate excretion, alkalinization, and attenuation of renal inflammation, as evidenced by reduced urinary IL-8 and proteinuria. LPR was well tolerated, with minimal adverse effects, and may serve as a safe, cost-effective adjunct for secondary prevention in patients intolerant to conventional alkali therapy.

Background: Kidney stone disease (KSD) is a growing global health issue, while hyperuricemia has been linked to various health conditions. This study aimed to explore the association between hyperuricemia and KSD. Methods: This study analyzed the data of 118,963 generally healthy participants aged 30-70 years from the Taiwan Biobank. KSD was defined based on self-reported diagnoses, and hyperuricemia was defined as a serum uric acid level > 7 mg/dL in men and > 6 mg/dL in women. Key variables including age, sex, body mass index, lifestyle factors, presence of hypertension, diabetes, and chronic kidney disease were recorded. Statistical analysis was conducted using descriptive statistics and logistic regression to evaluate the association between hyperuricemia and KSD. Odds ratios (ORs) and corresponding 95% confidence intervals (CIs) were reported, with statistical significance set at p Results: Among the 118,963 participants, 23,094 (19.4%) had hyperuricemia. Those with hyperuricemia were older, had a higher body mass index, and were more likely to smoke, consume alcohol, and have elevated blood pressure. They also had higher rates of comorbidities such as hypertension, diabetes, metabolic syndrome, chronic kidney disease, and gout, along with worse laboratory profiles. Multivariable analysis revealed that hyperuricemia was significantly associated with an increased risk of KSD (OR: 1.155, 95% CI: 1.089-1.224, p Conclusion: Hyperuricemia was an independent risk factor for KSD in this large Taiwanese cohort study, with a stronger association observed in females. Gout partially mediates this relationship, suggesting overlapping yet distinct pathways linking hyperuricemia to kidney stone formation. These findings underscore the importance of sex-specific management strategies for KSD. Routine monitoring of serum uric acid levels is recommended to mitigate KSD risk, especially among high-risk individuals. Future research should focus on elucidating the long-term impact of hyperuricemia on KSD and tailoring prevention strategies to regional and population-specific needs.