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Renal fibrosis is considered as the pathway of almost all kinds of chronic kidney diseases (CKD) to the end stage of renal diseases (ESRD). Ganoderic acid (GA) is a group of lanostane triterpenes isolated from Ganoderma lucidum , which has shown a variety of pharmacological activities. In this study we investigated whether GA exerted antirenal fibrosis effect in a unilateral ureteral obstruction (UUO) mouse model. After UUO surgery, the mice were treated with GA (3.125, 12.5, and 50 mg· kg −1  ·d − 1 , ip) for 7 or 14 days. Then the mice were sacrificed for collecting blood and kidneys. We showed that GA treatment dose-dependently attenuated UUO-induced tubular injury and renal fibrosis; GA (50 mg· kg −1  ·d − 1 ) significantly ameliorated renal disfunction during fibrosis progression. We further revealed that GA treatment inhibited the extracellular matrix (ECM) deposition in the kidney by suppressing the expression of fibronectin, mainly through hindering the over activation of TGF-β/Smad signaling. On the other hand, GA treatment significantly decreased the expression of mesenchymal cell markers alpha-smooth muscle actin (α-SMA) and vimentin, and upregulated E-cadherin expression in the kidney, suggesting the suppression of tubular epithelial-mesenchymal transition (EMT) partially via inhibiting both TGF-β/Smad and MAPK (ERK, JNK, p38) signaling pathways. The inhibitory effects of GA on TGF-β/Smad and MAPK signaling pathways were confirmed in TGF-β1-stimulated HK-2 cell model. GA-A, a GA monomer, was identified as a potent inhibitor on renal fibrosis in vitro. These data demonstrate that GA or GA-A might be developed as a potential therapeutic agent in the treatment of renal fibrosis.

Ureteral endometriosis is a rare manifestation of endometriosis that involves the infiltration of endometrial tissue into the ureters, leading to ureteral obstruction and potential renal dysfunction. However, its preoperative diagnosis is difficult. Herein, we report the case of a woman in her early 50s who presented with severe hydronephrosis of the right kidney, ureteral dilation, and suspicion of a ureteral tumor based on initial imaging studies. However, the pathological results after resection of the right kidney and right ureter revealed the presence of endometrial tissue in an ectopic location. This case highlights the importance of considering endometriosis as a differential diagnosis in cases of ureteral obstruction, even in atypical clinical scenarios, and emphasizes the need for prompt diagnosis and intervention to prevent irreversible renal damage and optimize patient outcomes.

Purpose We aimed to accurately determine ureteral stricture (US) rates following urolithiasis treatments and their related risk factors. Methods We conducted a systematic review and meta-analysis following the PRISMA guidelines using databases from inception to November 2023. Studies were deemed eligible for analysis if they included ≥ 18 years old patients with urinary lithiasis (Patients) who were subjected to endoscopic treatment (Intervention) with ureteroscopy (URS), percutaneous nephrolithotomy (PCNL), or shock wave lithotripsy (SWL) (Comparator) to assess the incidence of US (Outcome) in prospective and retrospective studies (Study design). Results A total of 43 studies were included. The pooled US rate was 1.3% post-SWL and 2.1% post-PCNL. The pooled rate of US post-URS was 1.9% but raised to 2.7% considering the last five years’ studies and 4.9% if the stone was impacted. Moreover, the pooled US rate differed if follow-ups were under or over six months. Patients with proximal ureteral stone, preoperative hydronephrosis, intraoperative ureteral perforation, and impacted stones showed higher US risk post-endoscopic intervention with odds ratio of 1.6 ( P  = 0.05), 2.6 ( P  = 0.009), 7.1 ( P  < 0.001), and 7.47 ( P  = 0.003), respectively. Conclusions The overall US rate ranges from 0.3 to 4.9%, with an increasing trend in the last few years. It is influenced by type of treatment, stone location and impaction, preoperative hydronephrosis and intraoperative perforation. Future standardized reporting and prospective and more extended follow-up studies might contribute to a better understanding of US risks related to calculi treatment.

ABSTRACT Background Limited information on the patency of native ureters after subcutaneous ureteral bypass (SUB) device placement is available. Objective Evaluate the patency of native ureters in cats treated with SUB device placement for benign ureteral obstruction. Animals Cats with SUB presented for routine evaluation. Methods Routine ultrasound‐guided SUB irrigations were performed, focusing on ureteral irrigation in the trigone and proximal urethra. Cats with obstructed nephrostomy catheters or subcutaneous ports were excluded. Fluoroscopic‐guided SUB irrigations with iodinated contrast then were used to assess patency. Ureters were deemed patent if contrast filled the lumen evenly along their length, and obstructed if the contrast column was interrupted on consecutive images. Intraoperative fluoroscopy was reviewed to confirm the cause and location of the obstructions. Results Overall, 18 cats (18 SUBs; 10 unilateral, 8 bilateral) were included. The causes of obstruction were ureteroliths (23 ureters) and presumed stricture (3 ureters). A trigonal irrigation was visible in 14/18 cats (77%; 95% confidence interval [CI]: 54.8%–91.0%); the patent side in bilateral SUBs could not be differentiated. Three ureters were excluded (nondiagnostic study, n = 1; obstructed nephrostomy, n = 2). Of the remaining 23 ureters, 19 (82.6%; 95% CI: 62.9%–93.0%) were patent: 16/20 patent ureters were obstructed with ureteroliths (80%; 95% CI: 58.4%–91.9%) and 3/3 with presumed stricture (100%; 95% CI: 43.9%–100%). Ureteral irrigations at the trigone were associated with patency. Conclusions A high patency rate of native ureters after SUB placement was observed. Ureteral irrigations at the trigone reliably indicate patency. Supraphysiologic SUB irrigations may result in underdiagnosed persistent partial obstructions.

Purpose Iatrogenic ureteral strictures (US) after endoscopic treatment for urolithiasis represent a significant healthcare concern. However, high-quality evidence on the risk factors associated with US is currently lacking. We aimed to develop a consensus statement addressing the definition, risk factors, and follow-up management of iatrogenic US after endoscopic treatment for urolithiasis. Methods Utilizing a modified Delphi method, a steering committee developed survey statements based on a systematic literature review. Then, a two-round online survey was submitted to 25 experts, offering voting options to assess agreement levels. A consensus panel meeting was held for unresolved statements. The predetermined consensus threshold was set at 70%. Results The steering committee formulated 73 statements. In the initial survey, consensus was reached on 56 (77%) statements. Following in-depth discussions and refinement of 17 (23%) statements in a consensus meeting, the second survey achieved consensus on 63 (86%) statements. This process underscored agreement on pivotal factors influencing US in endoscopic urolithiasis treatments. Conclusions This study provides a comprehensive list of categorized risk factors for US following endoscopic urolithiasis treatments. The objectives include enhancing uniformity in research, minimizing redundancy in outcome assessments, and effectively addressing risk factors associated with US. These findings are crucial for designing future clinical trials and guiding endoscopic surgeons in mitigating the risk of US.

Ureteral obstruction is a prevalent urological condition associated with significant complications. The purpose of our study was to assess the safety and efficacy of a novel self-expanding, large caliber, biocompatible polymer-coated ureteral stent (Allium) for the treatment of ureteral obstructions. We conducted a retrospective analysis of data from patients who underwent Allium ureteral stent placement at our institute between November 2018 and May 2023. Demographic, clinical, and perioperative parameters were collected and analyzed. Logistic regression analyses were performed to identify preoperative factors predicting Allium stent migration. The study cohort comprised 30 patients who received a total of 40 successfully implanted Allium stents. No significant adverse events related to the insertion procedure were observed. During a median follow-up period of 29 months (range: 1–60 months), migration occurred in 11 (27.5%) stents while encrustation was noted in 8 (20%) stents. The median functional duration of the Allium stents was found to be 22 months (range:1–60 months), with an overall functioning rate at last follow-up being recorded as 59.5%. Multivariate analysis revealed that the glomerular filtration rate of the ipsilateral kidney was the sole risk factor predictive of Allium stent migration. With its minimal invasiveness and good tolerability, the Allium stent represents a safe and viable management option for treating ureteric obstructions; however, it should not be considered as definitive treatment but rather as an alternative option for patients unwilling or unsuitable for definitive treatment, particularly high-risk individuals or elderly patients exhibiting decreased ipsilateral glomerular filtration rates.

Purpose To describe stone-free rates and complications of ureteroscopic treatment for impacted compared with non-impacted ureteral stones and evaluate predictive variables for impaction. Methods The Clinical Research Office of the Endourological Society prospectively collected 1 consecutive year of data from 114 centers worldwide. Patients eligible for inclusion were patients treated with ureteroscopy for ureteral stones. Patient characteristics, treatment details, and outcomes were compared with regard to stone impaction. Logistic regression analyses were conducted to explore predictive variables for ureteral stone impaction and to analyse the effect of impaction on outcomes. Results Of the 8543 treated patients, 2650 (31%) had impacted and 5893 (69%) non-impacted stones. The stone-free rate was 87.1% for impacted stones, which is lower compared with 92.7% for non-impacted stones ( p  < 0.001). Intra-operative complication rates were higher for impacted stones (7.9 versus 3.0%, p  < 0.001). Significantly higher ureteral perforation- and avulsion rates were reported in the impacted stone group compared with the non-impacted stone group. No association between stone impaction and post-operative complications could be shown. Female gender, ASA-score >1, prior stone treatment, positive pre-operative urine culture, and larger stones showed to be predictive variables for stone impaction. Conclusions Ureteroscopic treatment for impacted stones is associated with lower stone-free rates and higher intra-operative complication rates compared with treatment for non-impacted stones. The predictive variables for the presence of stone impaction may contribute to the identification of stone impaction during the diagnostic process. Moreover, identification of stone impaction may aid the selection of the optimal treatment modality.

The reversible unilateral ureteral obstruction (RUUO) model is pivotal for studying obstructive nephropathy (ON) but has limitations, including procedure complexity and inconsistent recanalization success. We developed a simpler, reliable, and efficient RUUO model, and utilized advanced auxiliary examination methods to assess hydronephrosis and renal function changes, providing evidence for procedural success. Male Sprague-Dawley rats were divided into control and experimental groups. Baseline data on glomerular filtration rate (GFR) and magnetic resonance imaging (MRI) were obtained from the control group. The experimental group was subdivided based on obstruction durations of 3, 7, 10, and 14 days. Unilateral ureteral obstruction models were created followed by obstruction release to establish the RUUO models. Dynamic renal scintigraphy with single-photon emission computed tomography was used to measure left kidney GFR pre-recanalization and on day 7 and 14 post-recanalization. MRI was used to evaluate hydronephrosis resolution. Key surgical modifications included complete removal of ligated ureter segments and wider ureter-bladder anastomosis, improving consistency and 93.35% recanalization success rate. MRI and Tc-DTPA dynamic renal scintigraphy indicated varying degrees of renal functional recovery. The 3-day obstruction group showed near-complete restoration within 1 week of recanalization. Conversely, extended obstruction durations significantly impaired recovery. The 14-day group demonstrated marked functional decline due to progressive renal fibrosis observed at 2 weeks post-recanalization. The optimized model offers simplified surgical techniques, enhanced recanalization success, and high reproducibility. These findings highlight the importance of early recanalization in preserving renal function, and provide a robust framework for future research on ON, including therapeutic strategies.

Objective To evaluate the impact of coiling of the proximal end of the ureteral stent on stent-related symptoms (SRS) in in subgroup of patients undergoing preoperative ureteral stenting preceding flexible retrograde intrarenal surgery (RIRS). Materials and methods We performed a prospective comparative study including patients undergoing stent placement 7–10 days prior to RIRS. Patients were divided into 2 groups; in Group 1 coiling of proximal end of the DJ was present, while in Group 2 coiling was absent. Bladder pain, flank pain, hematuria, urgency, frequency, nocturia, and urge incontinence were evaluated on the day of surgery using Visual Analog Score (VAS). Results In total, 81 patients, 45 males (55.6%) and 36 (44.4%) females were included. Patients in Group 2 had statistically significant severe representation of flank (43.2% vs. 22.7%, p-value = 0.049) and bladder pain compared to Group 1 (48.4% vs. 25.0%, p-value = 0.027). Additionally, they required analgesic medications more frequently (64.9% vs. 34.1%, p-value = 0.006), and experienced significantly more pronounced frequency (p-value = 0.012) and urgency (2.7 vs. 2.1, p-value = 0.033) compared to Group 1. Patients in group 1 recovered from their symptoms more frequently (52.3% vs. 29.7%, p-value = 0.041), occurring on day 4 and 5 following ureteral stenting. Conclusion Coiling of the proximal end of the DJ stent impacts stent-related symptoms significantly. Better outcomes of post-procedural frequency, urgency, bladder and flank pain were observed in patients in whom coiling was achieved. Moreover, those patients reported faster recovery from SRSs.

ObjectiveTo define which long-term stent would work best in malignant ureteral obstruction (MUO) and benign ureteral obstruction (BUO), focusing on their mechanisms of action, price and insertion approach.MethodsA systematic review was developed using the MEDLINE and Scopus databases and in accordance with the PRISMA checklist. There were no language restrictions for the search. Studies describing the use of metallic ureteric stents for MUO and for BUO in humans were included.ResultsWe analyzed five types of metallic stents (35 papers) and also the experience with the tumor and extra-anatomical stents. The Resonance, Memokath and Allium ureteral stents were found to be useful in BUO and MUO. The Uventa stent performed well in chronic ureteral obstruction. The Detour bypass stent was a recommended option in those patients who had complete obstruction of the ureter and were unfit for reconstructive surgery.There was no difference with regard to the insertion technique and both antegrade and retrograde approaches were equally successful. Although tumor stents showed a good performance, there were very few published studies on it.ConclusionMetallic stents are a suitable option for MUO and BUO. When compared to standard double J stents, although they are relatively high priced, they show a financial benefit in the long-term. The Detour bypass stent seems to be an effective alternative for complete ureteral obstruction or patients unfit for surgery. Further prospective randomized studies should be done on the effectiveness of tumor stents versus metallic stents.