Objectives: To evaluate the efficacy and safety of using the vacuum-assisted access sheaths in single-tract and multitract percutaneous nephrolithotomy (PCNL) for the treatment of staghorn stones. Methods: This retrospective study analyzed 216 patients with partial or complete staghorn stones who underwent single-tract or multitract PCNL. Patients were divided into two groups based on the use of vacuum-assisted access sheaths: the vacuum-assisted PCNL (VA) group and traditional PCNL (Control) group. Pre-, intra-, and postoperative data were analyzed using t-test, Pearson chi-square, and Fischer exact statistical measures. Results: There was no significant difference in stone-free rate (SFR) in both groups. In single-tract PCNL, the VA group had higher rates of normal blood routine (93.3% vs. 63.6%, p < 0.001), fewer infections (4.4% vs 21.2%, p = 0.01), shorter operating times (94.3 +/- 25.9 min vs. 112.0 +/- 39.9 min, p = 0.01), and faster recovery (5.0 +/- 1.4 days vs. 5.8 +/- 1.6 days, p = 0.01). In multitract PCNL, the trend toward lower infection rates with suction did not reach statistical significance (p = 0.28). Logistic regression showed that vacuum assistance significantly reduced the odds of infectious complications (OR = 0.343, p = 0.02). Conclusions: Vacuum-assisted access sheath in single-tract PCNL significantly reduces infection rate, operating time, and recovery time in staghorn calculi patients. However, the vacuum-assisted access sheath is used in the main tract but not in other tracts during the multitract PCNL, and its benefit in reducing postoperative infections is limited.

Hyperoxaluria disrupts the balance between cellular damage and repair within renal tubular epithelial cells contributing to the development of crystal nephropathy. SIRT6 repairs damage in many diseases. How about in kidney stones? In our present investigation, we confirmed that SIRT6 was abundantly located in normal renal tubular epithelial cells. However, its expression was significantly reduced in cells of patients with kidney stones. Meanwhile the level of DNA damage was markedly elevated. A negative correlation was found. Functionally, the agonist or the overexpression of SIRT6 could effectively alleviate the cells injury and suppress the crystals deposition in kidney. In addition, the inhibitor of SIRT6 reversed these beneficial effects and exacerbated the formation of crystal nephropathy. Furthermore, we discovered that SIRT6 exerted its protective function by promoting DNA damage repair with MacroH2A1 and PARP1. However, in hyperoxaluria, SIRT6 underwent ubiquitination and bound to heat shock protein 70, then extensively degraded via the autophagy lysosome pathway. Blocking the degradation protected cells from hyperoxaluria. In summary, our findings confirm that modulating SIRT6 levels can re-establish the intrinsic balance between injury and repair in renal tubular epithelial cells under hyperoxaluria. These results hold great promise in providing a novel therapeutic target for the prevention and treatment of kidney stones.

BACKGROUND:The metabolic reprogramming of macrophages plays a crucial role in calcium oxalate(CaOx) crystal-induced kidney injury. Pro-inflammatory macrophages exacerbate CaOx-induced kidney injury by enhancing inflammatory responses, while anti-inflammatory macrophages promote the phagocytosis of crystals by macrophages, thereby mitigating kidney damage. This study aims to investigate the mechanisms that exosome-mediated oxidative stress in regulating macrophage metabolic reprogramming in CaOx crystal-induced kidney injury. METHODS:Exosomes derived from HK2 cells with((EXO(S)) or without (EXO(C)) the stimulation of CaOx crystal were collected and purified. In vitro experiments were conducted to evaluate the effects of EXO(C) and EXO(S) on oxidative stress and macrophage polarization. These experiments included measurements of reactive oxygen species (ROS), malondialdehyde (MDA), superoxide dismutase (SOD), and catalase (CAT) activities. Additionally, in vivo renal subcapsular injection was performed in mice to assess the metabolic cycle of exosomes and their effects on CaOx crystal deposition and tubular damage in rats. High-throughput sequencing and transcriptomic analysis were used to identify dysregulated miRNAs and their associated pathways, as well as upregulated genes in macrophages exposed to EXO(C). RESULTS:EXO(C) significantly attenuated oxidative stress by reducing ROS and MDA levels while enhancing SOD and CAT activities. It also suppressed pro-inflammatory M1 macrophage polarization, whereas EXO(S) exacerbated these effects. In vivo studies revealed a 7-day metabolic cycle for exosomes in mice, with EXO(C) effectively reducing CaOx crystal deposition and tubular damage in rats, as evidenced by Von Kossa and periodic acid-Schiff (PAS) staining. High-throughput sequencing identified 59 dysregulated miRNAs in EXO(C), predominantly enriched in oxidative stress and inflammation-related pathways (e.g., PI3K-Akt, MAPK). Transcriptomic analysis of macrophages exposed to EXO(C) highlighted upregulated genes (e.g., NCOA5, CXCR5) associated with antioxidant activity and immune regulation. Integrative bioinformatics further revealed cross-talk between exosomal miRNAs (e.g., miR-146a-5p, miR-200a-3p) and macrophage genes (EGFR, BCL11A), implicating their roles in modulating oxidative stress and inflammatory responses. CONCLUSION:These findings collectively demonstrate that EXO(C) mitigates CaOx-induced renal injury by suppressing oxidative stress and macrophage M1 polarization through miRNA-mediated regulatory networks. RNA-seq analysis revealed EXO(C) promoted an M2-like anti-inflammatory state, while EXO(S) drived M1-like pro-inflammatory polarization. This study provides potential therapeutic strategies for the treatment of CaOx-induced kidney injury.

Objective: Most bladder cancers are non-muscle invasive bladder cancer (NMIBC), and transurethral resection of bladder tumors (TURBT) is the standard treatment. However, postoperative recurrence remains a significant challenge, and the influence of bladder tumor location on prognosis is still unclear. This study aims to investigate how tumor location affects the prognosis of NMIBC patients undergoing TURBT and to identify the optimal surgical approach. Methods: A multicenter study was conducted, which included Chinese NMIBC data from 15 hospitals (1996-2019) and data from 17 registries of the Surveillance, Epidemiology, and End Results database (SEER) (2000-2020). Patients initially diagnosed with NMIBC and undergoing TURBT or partial cystectomy were analyzed, with cases lost to follow-up or with missing data excluded. The study investigated the overall survival (OS), disease-specific survival (DSS), and recurrence-free survival (RFS) among patients with different tumor locations. Kaplan-Meier, Cox regression, and propensity score matching methods were employed to explore the association between tumor location and prognosis. Stratified populations were analyzed to minimize bias. Results: This study included 118,477 NMIBC patients and highlighted tumor location as a crucial factor impacting post-TURBT prognosis. Both anterior wall and dome tumors independently predicted adverse outcomes in two cohorts. For anterior wall tumors, the Chinese cohort showed hazard ratios (HR) for OS of 4.35 ( P < 0.0001); RFS of 2.21 ( P < 0.0001); SEER cohort OS HR of 1.10 ( P = 0.0001); DSS HR of 1.13 ( P = 0.0183). Dome tumors displayed similar trends (Chinese NMIBC cohort OS HR of 7.91 ( P < 0.0001); RFS HR of 2.12 ( P < 0.0001); SEER OS HR of 1.05 ( P = 0.0087); DSS HR of 1.14 ( P = 0.0006)). Partial cystectomy significantly improved the survival of dome tumor patients compared to standard TURBT treatment ( P < 0.01). Conclusion: This study reveals the significant impact of tumor location in NMIBC patients on the outcomes of TURBT treatment, with tumors in the anterior wall and bladder dome showing poor post-TURBT prognosis. Compared to TURBT treatment, partial cystectomy improves the prognosis for bladder dome tumors. This study provides guidance for personalized treatment and prognosis management for NMIBC patients.

Urgent detection of calculous pyonephrosis is crucial for surgical planning and preventing severe outcomes. This study aims to evaluate the performance of computed tomography (CT)-based radiomics and a three-dimensional convolutional neural network (3D-CNN) model, integrated with independent clinical factors, to identify patients with calculous pyonephrosis. We recruited 182 patients receiving either percutaneous nephrostomy tube placement or percutaneous nephrolithotomy for calculous hydronephrosis or pyonephrosis. The regions of interest were manually delineated on plain CT images and the CT attenuation value (HU) was measured. Radiomics analysis was performed using least absolute shrinkage and selection operator (LASSO). A 3D-CNN model was also developed. The better-performing machine-learning model was combined with independent clinical factors to build a comprehensive clinical machine-learning model. The performance of these models was assessed using receiver operating characteristic analysis and decision curve analysis. Fever, blood neutrophils, and urine leukocytes were independent risk factors for pyonephrosis. The radiomics model showed higher area under the curve (AUC) than the 3D-CNN model and HU (0.876 vs. 0.599, 0.578; p = 0.003, 0.002) in the testing cohort. The clinical machine-learning model surpassed the clinical model in both the training (0.975 vs. 0.904, p = 0.019) and testing (0.967 vs. 0.889, p = 0.045) cohorts.

This study aims to evaluate the feasibility, safety, and effectiveness of an optimized treatment approach for complex renal calculi, utilizing visual needle nephroscopy in conjunction with standard PCNL and holmium YAG laser. We collected data from 62 patients diagnosed with complex kidney stones who underwent this combined procedure using the visual needle nephroscope (Needle-perc®, Youcare Tech, Wuhan, China). The percutaneous nephroscopic working channel was established by visual needle nephroscope, and the primary channel was expanded to 20 F to treat most of the main body of the calculi with a 550 μm holmium laser fiber. Visual needle nephroscope was used to locate the renal calyx where the residual calculi were located for precise puncture as a secondary channel, and the residual stones were treated by a 200 μm holmium laser fiber. Clinical data were collected, and intraoperative variables, postoperative complications and outcomes were assessed. All 62 patients successfully completed the operation without severe complications. The S.T.O.N.E. score of 62 patients before operation was 10.5 ± 0.9 points and above, of which the N score was more than 2 points. The average operation time was (65.5 ± 12.7) minutes, and the average hospital stay was (7.3 ± 2.1) days. After operation, 2 patients developed a fever, which improved after symptomatic treatment by intravenous antibiotics. 4 patients had clinically significant residual fragments, and the stone-free rate of primary operation was 93.5

Flexible and semirigid ureteroscopy are two often used modalities in treating for upper ureteral stone. How about the outcome of each procedure? A retrospective cohort study among 167 patients who underwent flexible or semirigid ureteroscopic lithotripsy was performed. The pre-, intra-, postoperative and one-year follow-up outcomes were taken into comparison. Significantly higher instant stone-clearance rate (81.3

Objectives: To introduce a novel hydrodynamic design for a flexible ureteroscope that can increase stone debris clearance. Methods: Based on hydrodynamics, the new design allowed the ureteroscope to have six water jets. Fluid gushed from the six jets and would ultimately converge into an eddy. The safety and stone debris clearance efficiency were tested in a 3D-printed kidney model. Stone fragments between 0.5 and 1 mm were used to mimic the debris. A ureteroscope already approved for marketing was used as a control. Results: The new design did not change the local renal pressure and did not raise the whole renal pressure under irrigation at 80 or 100 mL/min but slightly raised it under irrigation at 120 mL/min. The pressures in the 2 g stone clearance procedures were 26.0, 33.1, and 37.5 cmH(2)O for the new design and 25.1, 30.2, and 39.3 cmH(2)O for the current design; in the 4 g stone clearance procedures, the pressures were 30.1, 37.2, and 40.0 cmH(2)O for the new design and 26.9, 30.8, and 39.8 cmH(2)O for the current design, all under conditions of 80, 100, and 120 mL/min irrigation, respectively. The new design significantly improved the stone clearance rate by similar to 10-fold. It effectively cleared 2 and 4 g stones within 900 seconds under the three irrigation rates. In contrast, the current design cleared <10% of the stone debris in all tests. Conclusion: The new hydrodynamic design significantly improved the stone debris clearance rate without causing obviously increased renal pressure, and the improvement was maintained under different irrigation pressures and stone burdens.

目的:探讨负压清石辅助工具配合钬激光在经皮肾镜取石术治疗复杂性肾结石中的应用价值.方法:回顾性分析2018年8月—2021年7月在华中科技大学同济医学院附属同济医院行单通道(F20)经皮肾镜取石术的96例复杂性肾结石患者资料.根据术中是否应用负压清石辅助工具分为负压组(47例)和对照组(49例).所有手术均采用超声引导经12肋下或11肋间穿刺目标盏或结石,建立20F经皮肾手术通道,并采用钬激光碎石.统计所有患者基本资料、手术相关参数、术后主要并发症发生率等数据.结果:所有患者均顺利完成手术.负压组患者年龄大于对照组.负压组与对照组的性别、体重指数(BMI)、是否合并糖尿病、术前尿培养阳性史占比、结石最长径、手术时长等指标差异均无统计学意义.2组术后输血率、结石清除率差异无统计学意义.负压组术后全身炎症反应综合征(SIRS)的发生率低于对照组(2.12％vs 16.33％,P = 0.042),且负压组术后恢复时间更短[(5.04±1.37)d vs(6.16±1.51)d,P＜0.01].负压组术后血常规白细胞基本正常比例显著高于对照组(95.74％vs 73.47％,P = 0.004),多因素分析显示使用负压清石辅助工具是术后血常规白细胞正常与否的独立影响因素.结论:对于复杂性肾结石,应用负压清石辅助工具有助于减少经皮肾镜碎石取石术术后感染相关并发症发生,从而促进患者快速恢复.

Urolithiasis is a common urological disease with increasing incidence and a high recurrence rate, whose etiology is not fully understood. The application of sequencing and culturomics has revealed that urolithiasis is closely related to the urinary microbiome (urobiome), shedding new light on the pathogenesis of stone formation. In this study, we recruited 30 patients with unilateral stones and collected their renal pelvis urine from both sides. Then, we performed 2bRAD-M, a novel sequencing technique that provides precise microbial identification at the species level, to characterize the renal pelvis urobiome of unilateral stone formers in the both sides. We first found that the urobiome in the stone side could be divided into two clusters (Stone1 and Stone2) based on distance algorithms. Stone2 harbored higher microbial richness and diversity compared to Stone1. The genera Cupriavidus and Sphingomonas were overrepresented in Stone1, whereas Acinetobacter and Pseudomonas were overrepresented in Stone2. Meanwhile, differential species were identified between Stone1 and Stone2. We further constructed a random forest model to discriminate two clusters which achieved a powerful diagnostic potential. Moreover, the urobiome of the non-stone side (Control1/2) was compared with that of the stone side (Stone1/2). Stone1 and Control1 showed different microbial community distributions, while Stone2 was similar to Control2 based on diversity analysis. We also identified differentially abundant species among all groups. We assumed that there might be different mechanisms of how microbiota contribute to stone formation in two clusters. Our findings might assist in the selection of suitable medical treatments for urolithiasis.

经皮肾造瘘术和经皮肾镜取石术(percutaneous nephrolithotripsy,PCNL)并发脾脏损伤是一项罕见但可能致命的并发症,国外报道 20 余例[1-3],国内仅2 例报道[4-5].华中科技大学同济医学院附属同济医院收治 2 例经皮肾手术并发脾脏损伤的患者,现报告如下.

BACKGROUND:Considering the essential roles that genetic factors play in azoospermia and oligospermia, this study aims to identify abnormal chromosomes using karyotyping and CNVs and elucidate the associated genes in patients.METHODS:A total of 1157 azoospermia and oligospermia patients were recruited, of whom, 769 and 674 underwent next-generation sequencing (NGS) to identify CNVs and routine G-band karyotyping, respectively.RESULTS:First, 286 patients were co-analyzed using CNV sequencing (CNV-seq) and karyotyping. Of the 725 and 432 patients with azoospermia and oligospermia, 33.8% and 48.9% had abnormal karyotypes and CNVs, respectively. In particular, 47,XXY accounted for 44.18% and 26.33% of abnormal karyotypes and CNVs, respectively, representing the most frequent genetic aberration in azoospermia and oligospermia patients. Nevertheless, big Y and small Y accounted for 7.46% and 16.67% of abnormal karyotypes, respectively. We also identified high-frequency CNVs-loci, such as Xp22.31 and 2p24.3, in azoospermia and oligospermia patients.CONCLUSION:Sex chromosome and autosomal CNV loci, such as Xp22.31 and 2p24.3, as well as the associated genes, such as VCX and NACAP9, could be candidate spermatogenesis genes. The high-frequency abnormal karyotypes, CNV loci, and hot genes represent new targets for future research.

Abstract Purpose: To present the feasibility, safety and effectiveness of an optimized treatment of complex renal calculi based on visual needle nephroscopy. Methods: We collected data of 31 patients with complex kidney calculi, who underwent standard PCNL combined with visual needle nephroscope (“needle-perc”, Youcare@, Wuhan, China). The percutaneous nephroscopic working channel was established by visual needle nephroscope, and the primary channel was expanded to 20F to treat most of the main body of the calculi with a 550 μm holmium laser fiber. Visual needle nephroscope was used to locate the renal calyx where the residual calculi were located for precise puncture as a secondary channel, and the residual stones were treated by a 200 μm holmium laser fiber. Clinical data were collected, and intraoperative variables, postoperative complications and outcomes were assessed. Results: All 31 patients successfully completed the operation without severe complications. The S.T.O.N.E. score of 31 patients before operation was 10.5±0.9 points and above, of which the N score was more than 2 points. The average operation time was (65.5±12.7) minutes, and the average hospital stay was (7.3±2.1) days. After operation, 1 patient developed a fever, which improved after symptomatic treatment by intravenous antibiotics. 2 patients had clinically significant residual fragments, and the stone-free rate of primary operation was 93.5% (29/31). Conclusions: The optimized operation for the treatment of complex renal calculi based on standard PCNL combined with visual needle nephroscope has good feasibility, safety and effectiveness.

Background. Urolithiasis is common worldwide and can predispose to urinary tract infections and renal failure. We aimed to explore the global, regional, and national burden of urolithiasis between 1990 and 2019, stratified by sex, age, and sociodemographic index (SDI). Methods. From 1990 to 2019, data on the number of incident cases of urolithiasis, associated deaths, and disability-adjusted life years (DALYs) were extracted from the 2019 Global Burden of Disease (GBD) study. The trends for the incidence rate, mortality, and DALYs were evaluated using estimated annual percentage changes (EAPCs). Results. The incidence of urolithiasis increased by 48.57%, from 77.78 million incident cases in 1990 to 115.55 million in 2019, while its age-standardized incidence rate (ASIR) decreased. The ASIR increased slightly in the low SDI regions (EAPC = 0.33; 95% confidence interval [CI]: 0.24–0.43), while ASIRs in other SDI regions decreased. The incidence of urolithiasis by age presented a unimodal distribution, with the peak observed in patients aged between 50 years and 70 years. Urolithiasis-related mortality and DALYs also increased over time. Yet, the age-standardized death rate (ASDR) decreased by 2.05% (95% CI, −2.25% to −1.85%) per year, and the annual age-standardized DALY rate decreased by 1.77% (95% CI, −1.92% to −1.63%). The mortality and DALYs increased with age. The incidence, mortality, and DALYs were greater in males than those in females. The burden of urolithiasis showed obvious differences in its regional distribution over the past three decades. Conclusion. From 1990 to 2019, ASIR, ASDR, and age-standardized DALY rate of urolithiasis have decreased. Yet, particularly significant differences exist in the geographic, age, and sex distribution. Thus, medical resources should be rationally allocated and adjusted according to the geographic and demographic distribution of urolithiasis.

ObjectiveRenal collecting duct carcinoma (CDC) is an extremely rare disease with few studies, and the current understanding of its prognosis is limited. We used the Surveillance, Epidemiology, and End Results (SEER) registry data to explore the prognostic factors and effect of treatment modalities on the overall survival (OS) and cancer-specific survival (CSS) in patients with CDC.MethodsPatients’ information of CDCs diagnosed by pathological examination between 2000 and 2018 was extracted from the SEER database. The Kaplan–Meier method was used to calculate OS and CSS and log-rank tests to evaluate the differences in OS and CSS. The associations between clinicopathological variables and survival outcomes were assessed with the Cox proportional hazard model. A directed acyclic graph (DAG) was drawn to recognize confounding factors and to obtain the multivariable regression model, and the impact of surgery, radiotherapy, and chemotherapy on OS and CSS was analyzed, respectively.ResultsA total of 242 patients with CDC were enrolled. The median OS and CSS time were 17 and 21 months, respectively. The OS rates at 1, 2, and 5 years were 56.9%, 41.9%, and 30.0%, respectively, while the CSS rates at 1, 2, and 5 years were 60.1%, 47.5%, and 34.8%, respectively. Patients who had a large tumor size, poor pathological grade, and advanced TNM classification exhibited worse survival outcomes. Univariable and multivariable Cox regression analyses revealed that surgery, chemotherapy, T stage, N stage, and M stage were independent prognostic factors for OS and CSS. The DAG-guided multivariate Cox regression model revealed that surgery and chemotherapy improved OS and CSS.ConclusionsCDC is an exceedingly rare disease and has malignant behavior. Most patients have a high pathological grade and advanced TNM stage at diagnosis and exhibited poor survival. Resection of all visible tumors including metastatic lesions or chemotherapy can be beneficial to prognosis, while healthier benefits are less likely to receive radiotherapy. More relevant studies with larger samples are needed to verify the value of surgery and adjuvant therapy in the treatment of CDCs.

International guidelines recommend repeat transurethral resection of bladder tumors (reTURB) for selected patients with high-risk non-muscle invasive bladder cancer to remove possible residual tumors, restage tumors and improve the therapeutic outcome. However, most evidence supporting the benefits of reTURB is from conventional TURB. The role of reTURB in patients receiving initial En bloc resection of bladder tumor (ERBT) is still unknown. PubMed, Embase, Web of Science, The Cochrane Library, and China National Knowledge Infrastructure (CNKI) were systematically searched. Finally, this systematic review and meta-analysis included twelve articles, including 539 patients. The rates of residual tumor and tumor upstaging detected by reTURB after ERBT were 5.9% (95%CI, 2.0%–11.1%) and 0.0% (95%CI, 0.0%–0.5%), respectively. Recurrence-free survival, tumor recurrence and progression were comparable between patients with and without reTURB after initial ERBT. The pooled hazard ratios of 1-year, 2-year, 3-year and 5-year recurrence-free survival were 0.74 (95%CI, 0.36–1.51; p = 0.40), 0.76 (95%CI, 0.45–1.26; p = 0.28), 0.83 (95%CI, 0.53–1.32; p = 0.43) and 0.83 (95%CI, 0.56–1.23; p = 0.36), respectively. The pooled relative risks of recurrence and progression were 0.87 (95%CI, 0.64–1.20; p = 0.40) and 1.11 (95%CI, 0.54–2.32; p = 0.77), respectively. Current evidence demonstrates that reTURB after ERBT for bladder cancer can detect relatively low rates of residual tumor and tumor upstaging and appears not to improve either recurrence or progression.

Background:Stone free rate in upper ureteral stones is not as high. We sought to identify easily accessible risk factors attributing to stones left in the ureteroscopy in the treatment of upper ureteral calculi, and to build a simple and reliable predictive model.Methods:Patients treating only for upper ureteral stones in 2018 were retrospectively analyzed. Correlations between factors and the stone free rate were analyzed using bidirectional stepwise regression, curve fitting and binary logistic regression. Stone shape was judged by the gap between length and width in the two-dimensional section. A predictive nomogram model was built based on those selected variables (P<0.05). The area under the receiver operator characteristic curve (AUC) and calibration curve were used to access its discrimination and calibration. Decision curve analysis (DCA) was conducted to test the clinical usefulness.Results:Totally, 275 patients with 284 stones were enrolled in this research. Bidirectional stepwise regression showed that stone length had a significant effect on stone free, instead of width or burden. Stone shapes were also found playing a big role. Curve fitting showed that quasi-circular stones had a high risk of retropulsion, and eventually led to stone left. Finally, stone length, shape, modality, and the distance of stones to the ureteropelvic junction were enrolled in the model. Among them, the distance of the stone to the ureteropelvic junction showed a noticeable impact on stone left. AUC was 0.803 (95% CI: 0.730-0.876), and the calibration curve showed good calibration of the model (concordance index, 0.792). DCA indicated the model added net benefit to patients.Conclusions:The present predictive model based on those factors, stones length, shape, modality, and distance of the stone to the ureteropelvic junction was easy, reliable and useful.

Background:To evaluate the clinical characteristics and angiographic features of transcatheter angiographic embolization (TAE) in patients with active bleeding after percutaneous nephrolithotomy (PCNL).Methods:Between 2009 and 2018, 45 patients who underwent TAE for hemorrhage control after PCNL were reviewed retrospectively. Patient clinical characteristics and angiographic features of TAE were analyzed.Results:Of the 3148 patients, 45 (1.4%) patients were treated with TAE after PCNL. The interval from the bleeding episode to TAE was 3 days (1,6). Arterial laceration, arteriovenous fistula, and negative angiographic finding were found in 28 (62.2%), 7 (15.6%), and 10 patients (22.2%). Thirty-five patients (92.1%) achieved primary clinical success. The median-corrected hemoglobin decrease from bleeding episode to TAE was 52 g/L (25.25, 71.00). The median-corrected hemoglobin decrease rate from bleeding episode to TAE was 13.11 g/L·d (5.60, 26.12). The hemoglobin decrease from bleeding episode to TAE was lesser in negative angiographic patients (28.50 (10.75,51.25) g/L VS 53.7 (35.0,73.13) g/L) than in positive angiographic patients (P < 0.05).Conclusions:TAE is a safe and effective treatment for post-PCNL bleeding patients. Previous kidney surgery is associated with a higher risk of TAE. Patients with bleeding from multiple negative angiographic findings can be considered for prophylactic embolization.

Hyperoxaluria is a risk factor for urolithiasis and can cause renal epithelial cell injury secondary to oxidative stress. Reactive oxygen species (ROS) produced during cell damage originate from different sources and play different roles. Here, we explored the potential sources of ROS production and investigated the role of ROS from various sources in oxalate-induced oxidative stress and cell injury in normal rat kidney-52 epithelial (NRK-52E) cells. Oxalate-induced injury was assessed by lactate dehydrogenase (LDH) release experiments. 2,7-dichlorodihydrofluorescein diacetate and mitoSOX Red were used to determine the intracellular and mitochondrial ROS (mtROS) production, respectively. The expression level of Nox4, Nox2, and p22 protein was detected by Western blotting to observe the effect of oxalate on nicotinamide adenine dinucleotide phosphate oxidase (NADPH) oxidase (Nox). Furthermore, a specific NADPH oxidase subtype inhibitor and targeted mitochondrial antioxidants were used to preliminarily identify the role of ROS from different sources in renal tubular epithelial cell injury induced by oxalate. We found that oxalate inhibited cell viability, induced LDH release, and prompted intracellular and mitochondrial ROS (mtROS) production. Oxalate also decreased the protein expression level of Nox4 and increased the protein expression level of p22. Mitochondria were also a source of ROS production. In addition, Nox2 inhibitor or mtROS scavenging prevented oxalate-induced cell injury, reversed by an inhibitor of Nox4/1. We concluded that ROS from different sources might play different roles in oxalate-induced renal tubular epithelial cell injury. We also identified new potential targets for preventing or alleviating oxalate-induced renal tubular epithelial cell injury.

Urolithiasis, referred to as the formation of stones in the urinary tract, is a common disease with growing prevalence and high recurrence rate worldwide. Although researchers have endeavoured to explore the mechanism of urinary stone formation for novel effective therapeutic and preventative measures, the exact aetiology and pathogenesis remain unclear. Propelled by sequencing technologies and culturomics, great advances have been made in understanding the pivotal contribution of the human microbiome to urolithiasis. Indeed, there are diverse and abundant microbes interacting with the host in the urinary tract, overturning the dogma that urinary system, and urine are sterile. The urinary microbiome of stone formers was clearly distinct from healthy individuals. Besides, dysbiosis of the intestinal microbiome appears to be involved in stone formation through the gut-kidney axis. Thus, the human microbiome has potential significant implications for the aetiology of urolithiasis, providing a novel insight into diagnostic, therapeutic, and prognostic strategies. Herein, we review and summarize the landmark microbiome studies in urolithiasis and identify therapeutic implications, challenges, and future perspectives in this rapidly evolving field. To conclude, a new front has opened with the evidence for a microbial role in stone formation, offering potential applications in the prevention, and treatment of urolithiasis.