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Background and Objective The flexible and navigable suction ureteral access sheath (FANS) with continuous flow lithotripsy may improve stone-free rates (SFR) in ureterorenolithotripsy procedures, reducing operative time and the need for fragment extraction. This study aimed to compare the safety and efficacy of FANS versus conventional sheaths in patients undergoing retrograde intrarenal surgery (RIRS) for renal stones. Methods From January to September 2024, patients undergoing RIRS with high-power pulsed lasers (60 W Ho:YAG or 100 W pTm:YAG) were randomized to receive either a conventional sheath (Group 1) or FANS (Group 2). Data on baseline characteristics, operative details, and complications were collected. SFR, defined as the absence of fragments > 3 mm, was assessed with non-contrast CT scans one-month post-surgery. Statistical significance was set at p < 0.05. Results A total of 132 patients were enrolled (70 with conventional sheath, 62 with FANS). The FANS group had shorter operative times (55.25 vs. 61.36 min, p = 0.028), while laser time was similar between groups. Postoperative complications were lower in the FANS group. At one month, the FANS group had a higher SFR (95% vs. 67%, p < 0.005) and fewer re-interventions (p = 0.02). Conclusions FANS significantly improves SFR without increasing postoperative complications postoperative complications or negatively affecting recovery, offering a promising alternative to conventional sheaths in ureterorenolithotripsy procedures. Patient Summary FANS improves kidney stone surgery outcomes, providing better stone removal, fewer complications, and faster recovery compared to the standard tool.

Objective To compare the efficacy of Holmium laser lithotripsy with that of extracorporeal shock lithotripsy (SWL) for post-SWL ureteral steinstrasse. Materials and methods From January 2022 to July 2023, 36 patients with post-SWL ureteral steinstrasse were randomly divided into laser lithotripsy and SWL groups. Patients with pain, moderate to marked hydronephrosis, large leading stone fragments, and showing no spontaneous resolution within 3–4 weeks after medical expulsive therapy were included. Patients with sepsis were excluded. The success rate was the primary outcome. We compared the perioperative data between the groups. Results The success rate was higher in the ureteroscopy group than in the SWL group ( p  = 0.034). SWL was a significantly longer operation, and the fluoroscopy time was significantly longer in the SWL group than in the URS group ( p  = 0.027). Auxiliary procedures were more frequently performed in the SWL group than in the URS group ( p  = 0.02). JJ stents were inserted in 100% of patients in the URS group. Three patients (16.7%) underwent conversion to laser ureteroscopy after the second SWL session failed. No significant difference in the incidence of postoperative complications was observed between the groups, but the incidence of postoperative LUT was high in the ureteroscopy group. The mean hospital stay was 30 h in the ureteroscopy group. SWL was performed without the need for hospital admission. Conclusion Ureteroscopic laser lithotripsy for steinstrasse was safe and effective, with a higher success rate, shorter fluoroscopy time, and shorter recovery period than SWL.

This study aims to compare the efficacy of ureteroscopy with holmium laser lithotripsy and extracorporeal shock wave lithotripsy (ESWL) in treating ureteral calculus (UC). We enrolled 86 patients with UC treated in our urology department from November 2020 to November 2022. Group A (n=43) underwent ureteroscopic holmium laser lithotripsy, while Group B (n=43) received ESWL. We recorded treatment duration, post-treatment hematuria duration, and post-treatment stone clearance rates. Renal function and stress response were assessed before and 3 days after treatment. Post-treatment complications were documented, and patient quality of life was evaluated using the SF-36 health questionnaire. Group A exhibited significantly shorter treatment and post-treatment hematuria durations compared to Group B (P < .05). In stones >1 cm, group A demonstrated a higher clearance rate (P < .05). Post-treatment, Group A showed improved renal function and lower stress response (P < .05). The incidence of post-treatment complications did not differ significantly between groups (P > .05), but SF-36 scores were higher in Group A (P < .05). Ureteroscopy with holmium laser lithotripsy proves effective in UC treatment, contributing to a shortened recovery period and enhanced patient quality of life.

Purpose To prospectively evaluate the efficacy and safety of RIRS, SWL and PCNL for lower calyceal stones sized 1–2 cm. Materials and methods Patients with a single lower calyceal stone with an evidence of a CT diameter between 1 and 2 cm were enrolled in this multicenter, randomized, unblinded, clinical trial study. Patients were randomized into three groups: group A: SWL (194 pts); group B: RIRS (207 pts); group C: PCNL (181 pts). Patients were evaluated with KUB radiography (US for uric acid stones) at day 10 and a CT scan after 3 months. The CONSORT 2010 statement was adhered to where possible. The collected data were analyzed. Results The mean stone size was 13.78 mm in group A, 14.82 mm in group B and 15.23 mm in group C ( p  = 0.34). Group C compared to group B showed longer operative time [72.3 vs. 55.8 min ( p  = 0.082)], fluoroscopic time [175.6 vs. 31.8 min ( p  = 0.004)] and hospital stay [3.7 vs. 1.3 days ( p  = 0.039)]. The overall stone-free rate (SFR) was 61.8% for group A, 82.1% for group B and 87.3% for group C. The re-treatment rate was significantly higher in group A compared to the other two groups, 61.3% ( p  < 0.05). The auxiliary procedure rate was comparable for groups A and B and lower for group C ( p  < 0.05). The complication rate was 6.7, 14.5 and 19.3% for groups A, B and C, respectively. Conclusions RIRS and PCNL were more effective than SWL to obtain a better SFR and less auxiliary and re-treatment rate in single lower calyceal stone with a CT diameter between 1 and 2 cm. RIRS compared to PCNL offers the best outcome in terms of procedure length, radiation exposure and hospital stay. ISRCTN 55546280.

To compare the safety and effectiveness of the combination of intelligent intrarenal pressure control platforms and flexible end ureteral access sheath combined with flexible ureteroscopic lithotripsy (FURL) for the treatment of renal stones less than 2 cm with day case mode. From November 2023 to July 2024, a prospective, randomized, double-blind, parallel-controlled study was conducted to recruit 60 patients with upper urinary tract calculi measuring ≤ 2 cm in longest diameter. A total of 60 eligible patients were consecutively enrolled. Based on a pre-generated random number table and allocation scheme using SPSS 27.0, patients were assigned to either the intelligent pressure control group (IFURL, n  = 30) or the head bending group (BFURL, n  = 30). Blinding measures were implemented for patients, data collectors, statisticians, and analysts, with the allocation results disclosed to the surgeons prior to the start of the procedure in the operating room. The operation duration for IFURL and BFURL was 52.50 (48.00, 60.00) vs. 46.00 (36.00, 56.25), respectively ( p  = 0.047). Stone free rate (SFR) on the first postoperative day was 73.33% vs. 93.33% for IFURL and BFURL, respectively ( p  = 0.038). While, SFR was no significant difference between the two groups after two months(90.00% vs. 96.67%, p  = 0.301). One patient in IFURL was readmitted after discharge due to fever 2 days post-discharge, and improved after 2 days of anti-infection treatment. One patient in BFURL was readmitted due to lumbar and abdominal pain from urine extravasation, which improved after 3 days of anti-infection treatment. SFR of one-month post-surgery for renal calculi ≤ 2 cm treated with intelligent pressure control and flexible UAS combined with FURL in day surgery mode was similar, with low infection-related complications and rehospitalization rates, showing no statistical difference. However, the overall hospitalization costs for the BFURL was lower than IFURL.

This study evaluated the adherence of bacteria, calcium, and magnesium to three different ureteral stents after endoscopic surgery for urinary calculi. We randomly assigned 61 patients requiring the insertion of ureteral stents after urinary calculi treatment into three groups: Percuflex with a coating composition of Hydroplus ( n  = 21); Tria with a coating composition of Percushied ( n  = 22); and InLay Optima, which had a proprietary pHreeCoat coating ( n  = 18). All stents were removed and evaluated 1 month after treatment. The primary outcome was biomineral attachment to the ureteral stent. Calcium and magnesium contents were measured using atomic absorption spectrometry after the stent had been vortexed in a solution of saline and hydrochloric acid at pH 2. Bacteria were measured through flow cytometry of the washing solution collected by decantation after stent fragments had been immersed and vortexed in a saline solution. Median amounts of calcium and magnesium adhered to Percuflex were significantly higher than those adhered to Tria and InLay Optima. The median number of bacteria adhered was also highest in Percuflex compared to that in the other two groups, although without a statistically significant difference. These findings suggest that selecting stents with superior coating materials enhances patient outcomes and reduces stent-related complications.

The removal of large bile duct stones (>12 mm) after endoscopic sphincterotomy (EST) remains a challenging issue in therapeutic endoscopy. The aim of this prospective, randomized, controlled trial was to compare the effectiveness and complications of EST followed by large balloon dilation (LBD) with that of EST followed by mechanical lithotripsy (ML) for the management of large bile duct stones. A total of 90 patients with large bile duct stones (12-20 mm) were randomized to EST followed by LBD (n=45) or EST followed by ML (n=45). Success rate was determined with a final cholangiogram, whereas type and rate of post-procedure complications were assessed prospectively. Complete bile duct stone removal was accomplished in 97.7% of patients subjected to EST-LBD as compared with 91.1% of those subjected to EST-ML (P=0.36). Post-procedure complications were observed in two (4.4%) patients subjected to EST-LBD and in nine (20%) patients subjected to EST-ML (P=0.049). Rates of pancreatitis were similar between the two groups (one case in each), as was post-endoscopic retrograde cholangio pancreatography (ERCP) hemorrhage (one case in each group). None of the patients subjected to EST-LBD developed cholangitis, while this was seen in six patients subjected to EST-ML (0.0 vs. 13.3%, P=0.026). One patient subjected to EST-ML developed perforation, which was successfully managed conservatively. None of our patients with complications died. EST followed by LBD is equally effective as EST followed by ML for the removal of large bile duct stones, although it is associated with fewer complications.

Purpose To evaluate the therapeutic efficacy and safety of electroacupuncture (EA) combined with extracorporeal shock wave lithotripsy (ESWL) in treating ureteral calculi. Methods This prospective randomized controlled trial included 207 patients with ureteral calculi who were randomly allocated to an experimental group that underwent EA plus ESWL ( n  = 95) and a control group that underwent only ESWL ( n  = 112). Imaging examinations were performed at 1, 2, and 4 weeks after the operation, followed by comparing the stone-clearance rate, time to first stone expulsion, and incidence of major complications between the two groups. Results The stone-clearance rates at 1 (59.1 vs. 37%, P  = 0.002), 2 (86.4 vs. 59.3%, P  = 0.000), and 4 (90.9 vs. 77.8%, P  = 0.013) weeks after the operation in the experimental group were significantly higher than those in the control group. The time to first stone expulsion in the experimental group was significantly lower than that in the control group (1.29 ± 1.55 vs. 2.45 ± 3.11 days, respectively; P  = 0.001). However, we found no difference in the incidence of major complications between the two groups (15.9 vs. 17.6%, P  = 0.754). Conclusion EA-assisted ESWL significantly improved stone clearance and shortened the time to stone expulsion without elevating the complication risk. However, a large-scale multicenter, prospective study is required to corroborate our conclusions.

Introduction Renal stones are common, with a lifetime prevalence of 10% in adults. Global incidence is increasing due to increases in obesity and diabetes, with these patient populations being more likely to suffer renal stone disease. Flank pain from stones (renal colic) is the most common cause of emergency admission to UK urology departments. Stones most commonly develop in the lower pole of the kidney (in ~35% of cases) and here are least likely to pass without intervention. Currently there are three technologies available within the UK National Health Service to remove lower pole kidney stones: extracorporeal shockwave lithotripsy (ESWL), percutaneous nephrolithotomy (PCNL) and flexible ureterorenoscopy (FURS) with laser lithotripsy. Current evidence indicates there is uncertainty regarding the management of lower pole stones, and each treatment has advantages and disadvantages. The aim of this trial is to determine the clinical and cost effectiveness of FURS compared with ESWL or PCNL in the treatment of lower pole kidney stones. Methods The PUrE (PCNL, FURS and ESWL for lower pole kidney stones) trial is a multi-centre, randomised controlled trial (RCT) evaluating FURS versus ESWL or PCNL for lower pole kidney stones. Patients aged ≥16 years with a stone(s) in the lower pole of either kidney confirmed by non-contrast computed tomography of the kidney, ureter and bladder (CTKUB) and requiring treatment for a stone ≤10 mm will be randomised to receive FURS or ESWL (RCT1), and those requiring treatment for a stone >10 mm to ≤25 mm will be randomised to receive FURS or PCNL (RCT2). Participants will undergo follow-up by questionnaires every week up to 12 weeks post-intervention and at 12 months post-randomisation. The primary clinical outcome is health status measured by the area under the curve calculated from multiple measurements of the EuroQol five dimensions five-level version (EQ-5D-5L) questionnaire up to 12 weeks post-intervention. The primary economic outcome is the incremental cost per quality-adjusted life year gained at 12 months post-randomisation. Discussion The PUrE trial aims to provide robust evidence on health status, quality of life, clinical outcomes and resource use to directly inform choice and National Health Service provision of the three treatment options. Trial registration ISRCTN: ISRCTN98970319. Registered on 11 November 2015.

AimTo analyze efficacy of endoscopic lithotripsy combined with drug lithotripsy as compared with drug lithotripsy for the treatment of phytobezoars.MethodsWe collected and evaluated case records of 165 patients with phytobezoars from 2014 to 2023. And we analyzed demographic and clinical characteristics, imaging features, endoscopic features, complications of phytobezoars, and compared efficacy between endoscopic lithotripsy combined with drug lithotripsy (Group A) and drug lithotripsy (sodium bicarbonate combined with proton pump inhibitor) (Group B).ResultsThe median age of patients with phytobezoars was 67.84 ± 4.286 years old. Abdominal pain was the most common symptom and peptic ulcers (67.5%) were the most common complication. Bezoar-induced ulcers were more frequent in the gastric angle. The success rate of phytobezoars vanishing in Group A and Group B were similar (92.3% vs. 85.1% within 48 h, 98.7% vs. 97.7% within a week), while the average hospitalization period, average hospitalization cost, second endoscopy rate, and average endoscopic operation time were significantly lower in patients in Group B than in Group A.ConclusionDrug lithotripsy is the preferred effective and safe treatment option for phytobezoars. We advise that an endoscopy should be completed after 48 h for drug lithotripsy.