ABSTRACT Introduction: Endoscopic Combined Intrarenal Surgery (ECIRS) has emerged as a promising technique for the management of large and complex kidney stones, potentially offering advantages over traditional Percutaneous Nephrolithotomy (PCNL). This study aims to evaluate best practices, outcomes, and future perspectives associated with ECIRS. Materials and Methods: A comprehensive PubMed search was conducted from 2008 to 2024, using MESH terms and the following key words: "ECIRS" and "Endoscopic Combined Intrarenal Surgery" The search yielded 157 articles, including retrospective cohort studies, two randomized controlled trials (RCTs), and four meta-analyses comparing ECIRS with PCNL. Most important findings were summarized regarding indications, patient positioning, kidney access, tract size, surgical outcomes, and complications. Results: ECIRS demonstrated higher stone-free rate, lower complication rate, and a reduced need for multiple procedures compared to traditional PCNL. Additionally, ECIRS has the potential to integrate new technologies to further enhance outcomes. Conclusion: ECIRS demonstrates significant advantages in the management of large kidney stones. Future research should focus on well-designed RCTs to provide robust evidence of its efficacy, safety, and cost-effectiveness, potentially establishing ECIRS as the first option treatment for complex kidney stones. Introduction (ECIRS stones PCNL . (PCNL) practices outcomes Methods 200 2024 words "ECIRS 15 articles studies RCTs, , (RCTs) metaanalyses meta analyses indications positioning access size complications Results stonefree stone free rate Additionally Conclusion welldesigned well designed efficacy safety costeffectiveness, costeffectiveness cost effectiveness, effectiveness cost-effectiveness (PCNL 20 202 1 (RCTs 2

ABSTRACT Introduction: The ureteral access sheath (UAS) is a medical device that enables repeated entrance into the ureter and collecting system during retrograde intrarenal surgery (RIRS). Its impact on stone-free rates, ureteral injuries, operative time, and postoperative complications remains controversial. Therefore, we performed a systematic review and meta-analysis comparing RIRS with versus without UAS for urolithiasis management. Purpose: To compare outcomes from retrograde intrarenal surgery (RIRS) for stone extraction with or without ureteral access sheath (UAS); evaluating stone-free rate (SFR), ureteral injuries, operative time, and postoperative complications. Materials and Methods: We systematically searched PubMed, Embase, and Cochrane Library in June 2024 for randomized controlled trials (RCTs) evaluating the efficacy and safety outcomes of UAS use in RIRS for urolithiasis treatment. Articles published between 2014 and 2024 were included. Pooled risk ratios (RRs) and mean differences (MDs) were calculated for binary and continuous outcomes, respectively. Results: Five RCTs comprising 466 procedures were included. Of these, 246 (52.7%) utilized UAS. The follow-up ranged from 1 week to 1 month. UAS reduced the incidence of postoperative fever (RR 0.49; 95% confidence interval [CI] 0.29–0.84; p=0.009), and postoperative infection (RR 0.50; 95% CI 0.30–0.83; p=0.008). There were no significant differences between groups in terms of SFR (RR 1.05; 95% CI 0.99–1.11; p=0.10), ureteral injuries (RR 1.29; 95% CI 0.95–1.75; p=0.11), operative time (MD 3.56 minutes; 95% CI −4.15 to 11.27 minutes; p=0.36), or length of stay (MD 0.32 days; 95% CI −0.42 to 1.07 days; p=0.40). Conclusion: UAS leads to a lower rate of post-operative fever and infection. However, UAS did not significantly reduce or increase the SFR or the rate of ureteral injuries during RIRS for patients with urolithiasis. The use of UAS should be considered to decrease the risk of infectious complications, particularly in those who may be at higher risk for such complications. Introduction (UAS RIRS. . stonefree free rates controversial Therefore metaanalysis meta analysis management Purpose (RIRS SFR, , (SFR) Methods PubMed Embase 202 (RCTs treatment 201 included RRs (RRs MDs (MDs respectively Results 46 these 24 52.7% 527 52 7 (52.7% followup follow up month RR 0.49 049 0 49 95 [CI 0.29–0.84 029084 29 84 p=0.009, p0009 p p=0.009 009 p=0.009) 0.50 050 50 0.30–0.83 030083 30 83 p=0.008. p0008 p=0.008 008 p=0.008) 1.05 105 05 0.99–1.11 099111 99 11 p=0.10, p010 p=0.10 10 p=0.10) 1.29 129 0.95–1.75 095175 75 p=0.11, p011 p=0.11 p=0.11) MD 356 3 56 3.5 minutes 415 4 15 −4.1 1127 27 11.2 p=0.36, p036 p=0.36 36 p=0.36) 032 32 0.3 days 042 42 −0.4 107 07 1.0 p=0.40. p040 p=0.40 40 p=0.40) Conclusion post However (SFR 20 2 52.7 5 (52.7 0.4 04 9 0.29–0.8 02908 8 p000 p=0.00 00 0.5 0.30–0.8 03008 0.99–1.1 09911 p01 p=0.1 1.2 12 0.95–1.7 09517 35 3. 41 −4. 112 11. p03 p=0.3 03 0. −0. 1. p04 p=0.4 52. (52. 0.29–0. 0290 p00 p=0.0 0.30–0. 0300 0.99–1. 0991 p0 p=0. 0.95–1. 0951 −4 −0 (52 0.29–0 029 0.30–0 030 0.99–1 099 p=0 0.95–1 095 − (5 0.29– 02 0.30– 0.99– 09 p= 0.95– ( 0.29 0.30 0.99 0.95 0.2 0.9

ABSTRACT Introduction Ureteral stricture is often a consequence of urolithiasis or previous endourological procedures (1-3). Precisely delineating the stricture zone intraoperatively is crucial to minimize ureter shortening and target only the affected tissue (4, 5). Flexible ureteroscopy offers a significant advantage in this regard. Objective This video aims to demonstrate the step-by-step technique of flexible ureteroscopic guided laparoscopic ureteroplasty for treating ureteral stricture caused by urolithiasis and prior endourological interventions. Patient and Methods We present a case of a 36-year-old male with a history of urolithiasis and unsuccessful endourological treatments, including endoureterotomy and balloon dilation, diagnosed with re-stenosis of the proximal ureter of 1 cm through ureteroscopy and pyelography. He underwent a successful laparoscopic ureteroplasty. While the lead surgeon performed the laparoscopy, an assistant conducted the flexible ureteroscopy. Intraoperatively, using transillumination facilitated by the flexible ureteroscope, we can precisely identify the narrowed area, allowing for resection of only the damaged segment. Subsequently, we perform the end-to-end ureteroplasty, confirming its patency through the seamless passage of the ureteroscope. Upon completion, we employ a fat patch to safeguard the anastomosis. Results The patient was discharged on the third postoperative day. Double J stent was removed six weeks after surgery. Symptoms resolved. Renal function improved: eGFR 49 to 67 ml/min. Furthermore, improvement was observed in the DTPA scan, and a decrease in hydronephrosis was noted on the follow-up tomography. Conclusion Flexible ureteroscopy effectively identifies the stricture zone in laparoscopic ureteroplasty, enhancing surgical precision and outcomes. This approach is safe, effective, and reproducible, offering a valuable technique in the surgical treatment of ureteral strictures. 13. 13 3 . (1-3) 4, 4 (4 5. 5 5) regard stepbystep step interventions 36yearold yearold 36 year old treatments dilation restenosis re stenosis pyelography laparoscopy Intraoperatively ureteroscope area segment Subsequently endtoend end completion anastomosis day surgery resolved improved 6 mlmin ml min ml/min Furthermore scan followup follow up tomography outcomes safe effective reproducible strictures (1-3 ( (1- (1

ABSTRACT Background: Success rates in endourological procedures, notably percutaneous nephrolithotomy (PCNL) and ureteroscopy (URS), have demonstrated suboptimal outcomes, leading to more reinterventions and radiation exposure. Recently, the use of intraoperative computed tomography (ICT) scans has been hypothesized as a promising solution for improving outcomes in endourology procedures. With this considered, we conducted a comprehensive systematic review and meta-analysis encompassing all available studies that evaluate the impact of the use of intraoperative CT scans on surgical outcomes compared to conventional fluoroscopic-guided procedures. Methods: This systematic review was conducted in accordance with PRISMA guidelines. Multiple databases were systematically searched up to December of 2023. This study aimed to directly compare the use of an ICT scan with the standard non-ICT-guided procedure. The primary endpoint of interest was success rate, and the secondary endpoints were complications and reintervention rates, while radiation exposure was also evaluated. Data extraction and quality assessment were performed following Cochrane recommendations. Data was presented as an Odds ratio with 95%CI across trials and a random-effects model was selected for pooling of data. Results: A comprehensive search yielded 533 studies, resulting in the selection of 3 cohorts including 327 patients (103 ICT vs 224 in non-ICT). Primary outcome was significantly higher in the experimental group versus the control group (84.5% vs 41.4% respectively, 307 patients; 95% CI [3.61, 12.72]; p<0.00001; I2=0). Reintervention rates also decreased from 32.6% in the control to 12.6% in the ICT group (OR 0.34; 95%CI [0.12,0.94]; p =0.04; I2= 48%), whereas complication rates did not exhibit significant differences. Radiation exposure was also significantly reduced in two of the included studies. Conclusion: This meta-analysis highlights a favorable outcome with intraoperative CT scan use in PCNL procedures, showing a considerable increase in SFR when compared to standard fluoroscopy and nephroscopy. Despite limited studies, our synthesis underscores the potential of ICT scans to significantly reduce residual stones and their consequences for endourology patients, as reinterventions and follow-up ionizing radiation studies. Background procedures (PCNL URS, URS , (URS) Recently (ICT considered metaanalysis meta analysis fluoroscopicguided fluoroscopic guided Methods guidelines 2023 nonICTguided non procedure rate evaluated recommendations 95CI 95 randomeffects random effects data Results 53 32 103 (10 22 nonICT. nonICT . non-ICT) 84.5% 845 84 5 (84.5 414 41 4 41.4 respectively 30 3.61, 361 61 [3.61 12.72 1272 12 72 12.72] p<0.00001 p000001 0 00001 I2=0. I20 I I2=0 I2 I2=0) 326 6 32.6 126 12.6 OR 0.34 034 34 0.12,0.94 012094 94 [0.12,0.94] =0.04 004 04 48%, 48 48% 48%) differences Conclusion nephroscopy followup follow (URS 202 9 10 (1 2 non-ICT 84.5 8 (84. 41. 3.61 36 [3.6 12.7 127 1 7 p<0.0000 p00000 0000 32. 12. 0.3 03 0.12,0.9 01209 [0.12,0.94 =0.0 00 20 ( 84. (84 3.6 [3. p<0.000 p0000 000 0. 0.12,0. 0120 [0.12,0.9 =0. (8 3. [3 p<0.00 p000 0.12,0 012 [0.12,0. =0 [ p<0.0 p00 0.12, 01 [0.12,0 = p<0. p0 0.12 [0.12, p<0 0.1 [0.12 p< [0.1 [0. [0

ABSTRACT Purpose: The aim of this study is to perform a high-quality meta-analysis using only randomized controlled trials (RCT) to better define the role of postoperative antibiotics in patients undergoing percutaneous nephrolithotomy (PCNL). Materials and Methods: A literature search for RCTs in EMBASE, PubMed, and Web of Science up to May 2023 was conducted following the PICO framework: Population—adult patients who underwent PCNL; Intervention—postoperative antibiotic prophylaxis until nephrostomy tube withdrawal; Control—single dose of antibiotic during the induction of anesthesia; and Outcome—systemic inflammatory response syndrome (SIRS) or sepsis and fever after PCNL. The protocol was registered on the PROSPERO database (CRD42022361579). We calculated odds ratios (OR) and 95% confidence intervals (CI). A random-effects model was employed, and the alpha risk was defined as < 0.05. Results: Seven articles, encompassing a total of 629 patients, were included in the analysis. The outcome of SIRS or sepsis was extracted from six of the included studies, while the outcome of postoperative fever was extracted from four studies. The analysis revealed no statistical association between the use of postoperative antibiotic prophylaxis until nephrostomy tube withdrawal and the occurrence of SIRS/sepsis (OR 1.236, 95% CI 0.731 – 2.089, p=0.429) or fever (OR 2.049, 95% CI 0.790 – 5.316, p=0.140). Conclusion: Our findings suggest that there is no benefit associated with the use of postoperative antibiotic prophylaxis until nephrostomy tube withdrawal in patients undergoing percutaneous nephrolithotomy (PCNL). We recommend that antibiotic prophylaxis should be administered only until the induction of anesthesia in PCNL. Purpose highquality high quality metaanalysis meta RCT (RCT PCNL . (PCNL) Methods EMBASE PubMed 202 framework Populationadult Population adult Interventionpostoperative Intervention Controlsingle Control single Outcomesystemic Outcome systemic (SIRS CRD42022361579. CRD42022361579 CRD (CRD42022361579) OR 95 CI. (CI) randomeffects random effects employed 005 0 05 0.05 Results articles 62 studies SIRSsepsis 1236 1 236 1.236 0731 731 0.73 2089 2 089 2.089 p=0.429 p0429 p 429 2049 049 2.049 0790 790 0.79 5316 5 316 5.316 p=0.140. p0140 p=0.140 140 p=0.140) Conclusion (PCNL 20 CRD4202236157 (CRD42022361579 9 (CI 00 0.0 6 123 23 1.23 073 73 0.7 208 08 2.08 p=0.42 p042 42 204 04 2.04 079 79 531 31 5.31 p014 p=0.14 14 CRD420223615 (CRD4202236157 0. 12 1.2 07 7 2.0 p=0.4 p04 4 53 3 5.3 p01 p=0.1 CRD42022361 (CRD420223615 1. 2. p=0. p0 5. CRD4202236 (CRD42022361 p=0 CRD420223 (CRD4202236 p= CRD42022 (CRD420223 CRD4202 (CRD42022 CRD420 (CRD4202 CRD42 (CRD420 CRD4 (CRD42 (CRD4 (CRD

ABSTRACT Purpose: to identify risk factors for urinary septic shock in patients who underwent percutaneous nephrolithotomy (PCNL). Materials and Methods: Data from PCNL procedures performed between January 2009 and February 2020 were retrospectively analyzed. The study included all patients over 18 years old with kidney stones larger than 15 mm who underwent PCNL. Patients who underwent mini-PCNL or combined surgeries, such as ureteroscopy or bilateral procedures, were not included in the study. Logistic regression was conducted to determine the risk factors for urinary septic shock within 30 days post-operation in patients who underwent PCNL. Results: Urinary septic shock was observed in 8 out of the 1,424 patients analyzed (0.56%). The presence of comorbidities, evaluated using the Charlson Comorbidity Index (CCI) (OR 1.46 [CI 95% 1.15-1.86], p=0.01), larger stones (41.0 mm [IQR 30.0-47.5 mm] vs. 24.0 mm [IQR 17.0-35.0 mm], OR 1.03 [CI 95% 1.01-1.06], p=0.04), and a positive preoperative urine culture (OR 8.53 [CI 95% 1.71-42.45], p <0.01) were shown to significantly increase the risk of postoperative urinary septic shock. Patients with a CCI > 2, larger stones (≥ 35 mm), and a positive preoperative urine culture were at even higher risk of urinary septic shock (OR 15.40 [CI 95% 1.77-134.21], p=0.01). Conclusion: Patients with larger stones, positive preoperative urine culture, and a higher CCI are at risk for urinary septic shock after PCNL. These findings are of utmost importance for optimizing the perioperative care of these patients to prevent life-threatening complications. Purpose . (PCNL) Methods 200 202 1 miniPCNL mini surgeries 3 postoperation post operation Results 1424 424 1,42 0.56%. 056 0.56% 0 56 (0.56%) comorbidities (CCI 146 46 1.4 CI 95 1.151.86, 115186 1.15 1.86 , 86 1.15-1.86] p=0.01, p001 p=0.01 01 p=0.01) 41.0 410 41 (41. IQR 30.047.5 300475 30.0 47.5 47 5 30.0-47. vs 240 24 24. 17.035.0 170350 17.0 35.0 17 17.0-35. mm, 103 03 1.0 1.011.06, 101106 1.01 1.06 06 1.01-1.06] p=0.04, p004 p=0.04 04 p=0.04) 853 53 8.5 1.7142.45, 1714245 1.71 42.45 71 42 45 1.71-42.45] <0.01 001 2 ≥ ( mm) 1540 40 15.4 1.77134.21, 17713421 1.77 134.21 77 134 21 1.77-134.21] p=0.01. Conclusion lifethreatening life threatening complications (PCNL 20 142 1,4 05 0.56 (0.56% 14 4 1. 9 151 1.151.86 11518 115 1.1 186 1.8 1.15-1.86 p00 p=0.0 41. (41 047 30.047. 30047 300 30. 475 47. 30.0-47 035 17.035. 17035 170 17. 350 35. 17.0-35 10 011 1.011.06 10110 101 106 1.01-1.06 85 8. 7142 1.7142.45 171424 171 1.7 4245 42.4 7 1.71-42.45 <0.0 00 154 15. 77134 1.77134.21 1771342 177 13421 134.2 13 1.77-134.21 1, 0.5 (0.56 1.151.8 1151 11 1.15-1.8 p0 p=0. (4 30.047 3004 30.0-4 17.035 1703 17.0-3 1.011.0 1011 1.01-1.0 714 1.7142.4 17142 42. 1.71-42.4 <0. 7713 1.77134.2 177134 1342 134. 1.77-134.2 0. (0.5 1.151. 1.15-1. p=0 30.04 30.0- 17.03 17.0- 1.011. 1.01-1. 1.7142. 1714 1.71-42. <0 771 1.77134. 17713 1.77-134. (0. 1.151 1.15-1 p= 1.011 1.01-1 1.7142 1.71-42 < 1.77134 1771 1.77-134 (0 1.15- 1.01- 1.714 1.71-4 1.7713 1.77-13 1.71- 1.771 1.77-1 1.77-

ABSTRACT Introduction: We aim to publish our innovative modified biplanar 0-90 endoscopic guided puncture technique for percutaneous nephrolithotomy in supine recorded with a GoPro® camera for standardization of the technique. It solves drawbacks of the fluoroscopic technique, i.e., in kidneys with complex anatomy, it may be challenging to distinguish calyces as they are often superposed, and it does not allow for all benefits of a combined endoscopic approach (1, 2). Our technique shortens puncture and fluoroscopic time and is easy to teach and reproduce. Methods: A 77-year-old female patient had previous double J insertion due to an obstructing stone in the right distal ureter. She managed to pass the distal stone but remained with the double J and a 20mm stone (1300HU) in the right renal pelvis. The shared decision was for the actual standard of care (3, 4) endoscopic combined intrarenal surgery (ECIRS). The MiniECIRS started with flexible ureteroscopy and a posterior calix which gave direct access to the stone was chosen. The tip of the flexible scope was used to mark point A with the C-arm in the 0-degree position and line B in the 90-degree position. Puncture was fast and the MiniECIRS was uneventful with a single mid-pole access guided by the flexible scope. The surgeon had a Full-HD GoPro® camera mounted on his head, controlled by the surgical staff. All essential surgical steps were recorded. Results: The quality of the recorded movie was graded as excellent, and the camera did not cause any discomfort to the surgeon. Operative and X-Ray time were 120minutes and 2minutes (7.64mGy). Hemoglobin drop was 0.8g/dL. The post-operative day-1 computed tomography scan was stone-free. The patient was discharged 24h after surgery. Kidney stent was left with a string and removed after 5days. The patient remained asymptomatic and metabolic evaluation revealed a calcium oxalate stone, low urinary volume and hypocitraturia which were treated with potassium citrate and hydration. Conclusion: The Modified Biplanar (0-90 degree) Endoscopic-Guided Puncture Technique for Percutaneous Nephrolithotomy joins the reproducibility of the same technique under fluoroscopy with advantages regarding safety and efficiency of ECIRS. Introduction 090 0 90 0-9 GoPro ie i e i.e. anatomy superposed 1, 1 (1 2. 2 . 2) reproduce Methods 77yearold yearold 77 year old ureter mm 1300HU HU (1300HU pelvis 3, 3 (3 4 ECIRS (ECIRS) chosen Carm C arm 0degree degree 90degree midpole mid pole FullHD Full HD head staff Results excellent XRay X Ray minutes 7.64mGy. 764mGy mGy 7.64mGy 7 64mGy (7.64mGy) 08gdL gdL 8g dL g 0.8g/dL postoperative post operative day1 day day- stonefree. stonefree free. free stone-free h 5days days hydration Conclusion (0-9 EndoscopicGuided Endoscopic Guided 09 9 0- i.e ( (ECIRS (7.64mGy (0- (0

ABSTRACT Introduction: Thulium Fiber Laser (TFL) is the most modern technology to treat nephrolithiasis and ureterolithiasis in endourology. Although there are a lot of new studies coming up, we still don't have data on how this laser works in some rare diseases. Cystinuria is the most common genetic nephrolithiasis disorder (1), known for its recurrent lithiasis (2). Our main goal in this video is to show a successful case of cystine calculi treated with Thulium Fiber Laser (Laser Fiber Dust/Quanta System™). Cystinuria is the most common genetic nephrolithiasis disorder (1), known for its recurrent lithiasis (2). Materials and Methods: A 25 years-old male, cystinuric, presented with a CT scan, showing a 10mm stone on the right side and two calculi 6 and 7 mm on the left side, all located in the lower calyx. Bilateral flexible ureteroscopy was done using a reusable digital flexible ureteroscope. Starting on the left side, we repositioned the stone from the lower to the upper calyx, using a tipless front opening basket. Lithotripsy was performed using TFL. Settings were 100 Hz (frequency) and 100 mJ (energy) for dusting. Popcorn technique was also used, setting the laser at 100Hz and 200 mJ, obtaining good dusting. On the right side, lithotripsy was performed in the inferior calyx, also resulting in “snowstorm”. Procedure time was 120 minutes. Results: The postoperative was uneventful. Follow up CT showed a 3 mm residual fragment in the right kidney. Conclusion: This video demonstrates the treatment of bilateral cystine calculi with Thulium Fiber Laser. Reasonable procedure time and excellent dusting results are encouraging, pointing towards great improvements in endourology. Introduction TFL (TFL endourology dont don t diseases 1, 1 , (1) 2. 2 . (2) DustQuanta Dust Quanta System™. System System™ System™) Methods yearsold years old male cystinuric scan calyx ureteroscope basket 10 frequency (frequency energy (energy used 20 snowstorm. snowstorm “snowstorm” 12 minutes Results uneventful kidney Conclusion encouraging (1 (2 “snowstorm (

ABSTRACT Purpose The aim of this meta-analysis is to assess the efficacy of extended dose of preoperative antibiotics to reduce infectious risk in patients undergoing percutaneous nephrolithotomy (PCNL). Materials and Methods A literature search for prospective case-control studies or randomized controlled trials was done. PICO framework was used. Population: adult patients that underwent to PCNL; Intervention: extended dose preoperative antibiotic prophylaxis before PCNL; Control: short dose preoperative antibiotic prophylaxis before PCNL; and Outcome: systemic inflammatory response syndrome (SIRS) or sepsis, fever after PCNL and positive intraoperative urine and stone culture. This meta-analysis was registered in PROSPERO database under the number: CRD42022359589. Results Three RCT and two prospective studies (475 patients) were included. SIRS/sepsis outcome was retrieved from all studies included. Seven days preoperative oral antibiotics for PCNL was a protective factor for developing SIRS/sepsis (OR 0.366, 95% CI 0.234 - 0.527, p < 0.001). There was no statistical association between seven-day use of antibiotics and fever (OR 0.592, 95% CI 0.147 – 2.388, p = 0.462). Patients who received seven days preoperative antibiotics had lower positive intraoperative urine culture (OR 0.284, 95% CI 0.120 – 0.674, p = 0.004) and stone culture (OR 0.351, 95% CI 0.185 – 0.663, p = 0.001) than the control group. Conclusion one week of prophylactic oral antibiotics based on local bacterial sensitivity pattern plus a dose of intravenous antibiotics at the time of surgery in patients undergoing PCNL reduces the risk of infection. metaanalysis meta analysis PCNL. . (PCNL) casecontrol case done used Population Intervention Control Outcome SIRS (SIRS sepsis number CRD42022359589 CRD 475 (47 included SIRSsepsis OR 0366 0 366 0.366 95 0234 234 0.23 0527 527 0.527 0.001. 0001 0.001 001 sevenday day 0592 592 0.592 0147 147 0.14 2388 2 388 2.388 0.462. 0462 0.462 462 0.462) 0284 284 0.284 0120 120 0.12 0674 674 0.674 0.004 0004 004 0351 351 0.351 0185 185 0.18 0663 663 0.663 group infection (PCNL CRD4202235958 47 (4 036 36 0.36 9 023 23 0.2 052 52 0.52 000 0.00 00 059 59 0.59 014 14 0.1 238 38 2.38 046 0.46 46 028 28 0.28 012 12 067 67 0.67 035 35 0.35 018 18 066 66 0.66 CRD420223595 4 ( 03 3 0.3 02 0. 05 5 0.5 0.0 01 1 2.3 04 0.4 06 6 0.6 CRD42022359 2. CRD4202235 CRD420223 CRD42022 CRD4202 CRD420 CRD42 CRD4

SUMMARY OBJECTIVE: Mini-percutaneous nephrolithotomy is a recent advancement in the field of kidney stone treatment; however, its role has not been completely established. We aimed to compare the outcomes of initial Mini-percutaneous nephrolithotomy and flexible ureteroscopy. METHODS: A retrospective review of consecutive mini-percutaneous procedures was performed. Inclusion criteria were as follows: all percutaneous nephrolithotomy procedures performed with an access sheath up to 24Fr, kidney stone burdens up to 1550 mm3; and the presence of postoperative computed tomography (for control). The data collected for Mini-percutaneous nephrolithotomy procedures were paired 1:2 with patients treated with flexible ureteroscopy for stones between 100 and 1550 mm3, and with postoperative computed tomography for control. A 14Fr Mini-percutaneous nephrolithotomy set was used. The stone-free rate was defined as the absence of fragments on the control computed tomography, whereas success was limited to 2-mm residual fragments. Statistical analysis was performed using SPSS version 19. RESULTS: A total of 63 patients met the inclusion criteria (42 with flexible ureteroscopy and 21 with mini-percutaneous nephrolithotomy). Demographic data were comparable. The stone-free rate and success were similar between the groups (76.2 vs. 66.7%, p=0.42 and 90.5 vs. 85.7%, p=0.57). The complication rate was also similar (26.1 vs. 9.6%, p=0.188), but Mini-percutaneous nephrolithotomy had longer hospitalization and fluoroscopy time (p=0.001 in both). CONCLUSIONS: Our initial study of Mini-percutaneous nephrolithotomy showed that it is a promising procedure, with outcomes similar to flexible ureteroscopy, but with higher inpatient numbers and fluoroscopy times. A larger study population size and better equipment may improve the outcomes of mini-percutaneous nephrolithotomy.

ABSTRACT Flexible ureteroscopy is a well-established method for treatment of urinary stones but flexible ureteroscopes are expensive and fragile devices with a very limited lifetime. Since 2006 with the advent of digital flexible ureteroscopes a great evolution has occurred. The first single-use flexible ureteroscope was launched in 2011 and new models are coming to the market. The aim of this article is to review the characteristics of these devices, compare their results with the reusable devices and evaluate the cost-benefits of adopting single-use flexible ureteroscopes in developing countries. Materials and Methods: an extensive review of articles listed at PubMed and published between 2000 and 2021 was performed. Results: Single-use flexible ureteroscopes have a shaft with 65 to 68cm length and weight between 119 and 277g. Their deflection goes up to 300 degrees. Their stone-free rates vary between 60 and 95% which is comparable to reusable scopes and operative times ranges from 54 to 86 minutes which are lower when compared to reusable flexible scopes. Their costs vary between 800 and 3180 US dollars. Conclusion: single-use flexible ureteroscopes are lighter and have superior quality of image when compared to fiberoptic ones. There are no definite data showing a higher stone-free rate or less complications with the use of single-use flexible ureteroscopes. Each institution must perform a cost-benefit analysis before making the decision of adopting or not such devices depending on the local circumstances.

ABSTRACT Purpose: to evaluate the effect of low-calorie diet on 24-hour urinary metabolic parameters of obese adults with idiopathic calcium oxalate kidney stones. Materials and Methods: Adult idiopathic calcium oxalate stone formers, with body mass index (BMI) ≥30kg/m2 and a known lithogenic metabolic abnormality, were submitted to low-calorie diet for twelve weeks. After enrolment, anthropometric measures, serum exams, 24-hour urinary metabolic parameters and body impedance were collected one month prior to dietary intervention and at the end of twelve weeks. Correlations between weight loss, waist circumference loss, fat loss and variation in 24-hour urinary lithogenic parameters and calcium oxalate urinary supersaturation (CaOx SS) as per Tiselius equation were analysed. Results: From January 2017 to January 2018, 39 patients were enrolled to participate in this study. Median (range) prescribed diet was 1300 (1100-2100) Kcal/day. Mean age was 51.7±11.0 (29-68) years old and 69.2% were female. 30.8% of the participants shifted from obesity to BMI <30kg/m2 and none to BMI <25kg/m2. A significant correlation was found between baseline 24-hour urinary oxalate and weight (p=0.018) and BMI (p=0.026). No correlation was found between variation of weight, waist circumference, fat mass and 24-h urinary stone risk factors or CaOx SS. Conclusions: Short-term modest weight loss induced by twelve weeks of low-calorie diet is not associated with a decrease of 24-hour urinary lithogenic parameters in idiopathic calcium oxalate stone formers. Calcium oxalate urinary stone formation is probably multifactorial and driven by other factors than weight.