Predictors of Ureteral Strictures after Retrograde Ureteroscopic Treatment of Impacted Ureteral Stones: A Systematic Literature Review

BACKGROUND The stricture-formation rate following ureteroscopy ranges from 0.5 to 5% and might amount to 24% in patients with impacted ureteral stones. The pathogenesis of ureteral stricture formation is not yet fully understood. It is likely that the patient and stone characteristics, as well as intervention factors, play a role in this process. In this systematic review, we aimed to determine the potential factors responsible for ureteral stricture formation in patients having impacted ureteral stones. METHODS Following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) criteria, we conducted systematic online research through PubMed and Web of Science without a time restriction, applying the keywords "ureteral stone", "ureteral calculus", "impacted stone", "ureteral stenosis", "ureteroscopic lithotripsy", "impacted calculus", and "ureteral strictures" singly or in combination. RESULTS After eliminating non-eligible studies, we identified five articles on ureteral stricture formation following treatment of impacted ureteral stones. Ureteral perforation and/or mucosal damage appeared as key predictors of ureteral stricture following retrograde ureteroscopy (URS) for impacted ureteral stones. Besides ureteral perforation stone size, embedded stone fragments into the ureter during lithotripsy, failed URS, degree of hydronephrosis, nephrostomy tube or double-J stent (DJS)/ureter catheter insertion were also suggested factors leading to ureteral strictures. CONCLUSION Ureteral perforation during surgery might be considered the main risk factor for ureteral stricture formation following retrograde ureteroscopic stone removal for impacted ureteral stones

Additively manufactured Ni-20Cr to V functionally graded material: computational predictions and experimental verification of phase formations

A database for the Cr-Ni-V system was constructed by modeling the binary Cr-V and ternary Cr-Ni-V systems using the CALPHAD approach aided by density functional theory (DFT)-based first-principles calculations and ab initio molecular dynamics (AIMD) simulations. To validate this new database, a functionally graded material (FGM) using Ni-20Cr and elemental V was fabricated using directed energy deposition additive manufacturing (DED AM) and experimentally characterized. The deposited Ni-20Cr was pure fcc phase, while increasing the amount of V across the gradient resulted in the formation of sigma phase, followed by the bcc phase. The experimentally measured phase data was compared with computational predictions made using a Cr-Ni-V thermodynamic database from the literature as well as the database developed in the present work. The newly developed database was shown to better predict the experimentally observed phases due to its accurate modeling of binary systems within the database and the ternary liquid phase, which is critical for accurate Scheil calculations

Application of virtual reality, augmented reality, and mixed reality in endourology and urolithiasis: An update by YAU endourology and Urolithiasis Working Group

The integration of virtual reality (VR), augmented reality (AR), and mixed reality (MR) in urological practices and medical education has led to modern training systems that are cost-effective and with an increased expectation toward surgical performance and outcomes. VR aids the user in interacting with the virtual environment realistically by providing a three-dimensional (3D) view of the structures inside the body with high-level precision. AR enhances the real environment around users by integrating experience with virtual information over physical models and objects, which in turn has improved understanding of physiological mechanisms and anatomical structures. MR is an immersive technology that provides virtual content to interact with real elements. The field of urolithiasis has adapted the technological advancements, newer instruments, and methods to perform endourologic treatment procedures. This mini-review discusses the applications of Virtual Reality, Augmented Reality, and Mixed Reality in endourology and urolithiasis.publishedVersio

Definition of clinically insignificant residual fragments after percutaneous nephrolithotomy among urologists: a world-wide survey by EAU-YAU Endourology and Urolithiasis Working Group

INTRODUCTION The aim of this article was to evaluate the current perception of urologists as to what size is considered as a clinically insignificant residual fragment (CIRF). MATERIAL AND METHODS A survey was globally distributed to the members of the Endourological Society via SurveyMonkey. RESULTS A total of 385 participants responded to the survey on CIRF. Most participants considered 2 mm (29%) as CIRF threshold, followed by 3 mm (24%), 4 mm (22%), 0 mm (14%), 5 mm (8%) and 1 mm (3%). North American urologists considered CIRF to be smaller than urologists from Asia, Eurasia and South America, (p-values ≤0.001, 0.037 and 0.015 respectively). European urologists identified smaller CIRF in comparison to Asian urologists (p-value = 0.001). Urologists mainly using a pneumatic lithotripter accepted larger fragments as CIRF, compared to urologists mainly using ultrasonic devices or a combination of ultrasonic and pneumatic devices (p-value = 0.026 and 0.005 respectively). Similarly, urologists mainly performing X-Ray and ultrasound as post-operative imaging accepted larger fragments as CIRF in comparison to urologists mainly performing non-contrast computed tomography (p-value = 0.001). CONCLUSIONS What is considered as CIRF varies between urologist from different continents and seems to be associated with the lithotripter used and the post-operative imaging modality of preference to assess treatment success

New Technologies in Endourology and Laser Lithotripsy: The Need for Evidence in Comprehensive Clinical Settings

Flexible ureteroscopy (fURS) with laser lithotripsy is currently the gold standard surgical treatment for ureteral and kidney stones with a maximum diameter of 2 cm [...]

Brief transcranial focused ultrasound stimulation causes lasting modifications to the synaptic circuitry of the hippocampus

BackgroundBrief transcranial focused ultrasound stimulation (tFUS) is used in cognitive mapping, where it is assumed that the intervention itself does not cause lasting modifications to the underlying networks being targeted. However, how so-called ‘offline’ effects impact the dynamic function of neural circuits is largely unknown. ObjectivesTo determine the persistent effects of ultrasound stimulation on hippocampal circuit function. MethodsAcute rat hippocampal slices in vitro, and rat hippocampi in vivo, were exposed to 40 s, 5 Hz pulsed ultrasound or sham stimulation. The effects of ultrasound on the dynamic synaptic and circuit function of the hippocampus were assessed through quantitative proteomics and extracellular field electrophysiology. ResultsWe find that ultrasound stimulation induces persistent and differential changes in protein expression and kinase activity in the hippocampus. This occurs concurrently with an enhancement of basal synaptic transmission and modifications to the susceptibility for the hippocampal circuit to undergo synaptic plasticity. These effects occur via a canonical Akt-dependent metaplastic process. ConclusionThe results indicate that tFUS can fundamentally modulate key signalling mechanisms that are responsible for determining the synaptic efficacy in a neural circuit. Importantly, these effects last beyond the duration of the stimulus. These findings provide a mechanistic insight into the sustained impact of tFUS on network function, and emphasise the importance of considering such effects in animal and human studies.</p

Comparison of long-term kidney functions after radical nephrectomy and simple nephrectomy

Objective To determine if there is a difference in proceeding to CKD between patients who had undergone radical nephrectomy (RN) and simple nephrectomy (SN) for different indications by comparing the short- and long-term renal function. Materials and Methods We retrospectively analyzed the records of all patients who underwent nephrectomy (either for malign or benign indications) in our clinic between January 2007 and September 2017. The patients were divided into 2 groups according the type of surgery: 1) Radical nephrectomy Group, 2) Simple Nephrectomy Group. Renal function was evaluated with Glomerular Filtration Rate (GFR) calculated using the MDRD formula. Results A total of 276 patients were included in the study. There were 202 patients in RN Group and 74 patients in SN Group. The mean age of the patients in RN Group and SN Group were age 59,2 ± 11,5 and 49,9 ± 15,1 years, respectively (p = 0.001). GFR levels of patients in RN Group versus SN Group were as follows: Preoperative period: 84.9 vs. 81 mL/min/1.73 m2; postoperative 1st day: 60.5 vs. 84.4 mL/min/1.73 m2, postoperative 1st month 58.9 vs. 76 mL/min/1.73 m2, postoperative 1st year: 59.5 vs. 74.1 mL/min/1.73 m2; at last control 60.3 and 76.1 mL/min/1.73 m2. While preoperative GFR was found to be similar in two groups (p = 0.26), postoperative GFR values were found to be significantly lower in Group RN (p < 0.001). In comparison of the decrease in GFR in two groups at last follow-up, significantly higher decrease was observed in RN Group, 29% vs. 6%, (p < 0.05). Conclusion The decrease in GFR exists more common and intensive after RN compared to SN. In long-term, compensation mechanisms that develop after sudden nephron loss like radical nephrectomy deteriorates kidney function more than gradual nephron loss as in benign etiologies which indicates simple nephrectomy

Rheological and sensorial behavior of tomato product enriched with pea protein and olive powder

In this study, a new functional product using Mediterranean ingredients (tomato, tomato peel powder and olive powder) was formulated where two different concentrations of protein (1 and 2%) and peel (2 and 4%) were tested. Olive powder was kept at a constant concentration of 2%. Physico-chemical, Rheological, and Sensorial analysis were carried out on the formulated samples. Soluble protein content was found as the highest in the sample containing 4% peel and 2% protein and it was affected by the pH and tomato peel concentration. Rheological results reveal shear-thinning behavior, as defined by the Herschel-Bulkley model, with protein and peel concentrations having a major influence on yield stress and viscosity. A positive trend was noticed between apparent viscosity and peel concentration, meantime protein concentration affected apparent viscosity adversely. Contrary relation between consistency index (k) values and apparent viscosity illustrate the complex interaction between protein and peel, particularly at higher concentrations. Furthermore, Principal Component Analysis (PCA) was used to investigate the complicated sensory landscape of tomato products with different quantities of pea protein and tomato peel. While higher tomato peel and protein levels have no direct impact on rheological qualities, they do add to astringency and sourness, which influences overall acceptability. Remarkably, the sample with the greatest quantities of peel and protein exhibits a delicate balance, with a loss in perceived tomato taste intensity and overall acceptability offsetting an increase in astringency. In terms of overall acceptability, the most preferred beverage was selected as the sample formulated with 2% peel and 1% protein

Surgical techniques to preserve continence after robot-assisted radical prostatectomy

Radical prostatectomy significantly impacts the inherent anatomy of the male pelvis and the functional mechanisms of urinary continence. Incontinence has a considerable negative influence on the quality of life of patients, as well as their social and psychological wellbeing. Numerous surgical techniques have been demonstrated to support the preservation of continence during robot-assisted radical prostatectomy (RARP). In this in-depth analysis, we give a general summary of the surgical techniques used in RARP and their impact on incontinence rates