BACKGROUND AND OBJECTIVE:Shockwave lithotripsy (SWL) carries a risk of postprocedural infection. Use of antibiotic prophylaxis by clinicians is variable and international guidelines provide conflicting recommendations, reflecting low-certainty evidence. We investigated whether antibiotic prophylaxis reduces bacteriuria and post-SWL urinary tract infections (UTIs). METHODS:APPEAL, an international multicenter, blinded trial, randomized adults undergoing SWL for urolithiasis to a single dose of ciprofloxacin or placebo. The primary outcome was the incidence of a composite of bacteriuria or symptomatic UTI after SWL. Other outcomes included the incidence of pyelonephritis or urosepsis. KEY FINDINGS AND LIMITATIONS:Of the 1722 randomized patients, 28 underwent postrandomization exclusions (mainly nonvisualizable stones). Among the analysis population (n = 1694; median age 50 yr; 30% female), 74% had kidney stones and 26% had ureteral stones. Bacteriuria (without symptoms) or symptomatic UTI occurred in 20 patients (2.7%) in the ciprofloxacin arm and 30 (3.9%) in the placebo arm (risk ratio [RR] 0.68, 95% confidence interval [CI] 0.41-1.15). Symptomatic UTI occurred in ten patients (1.3%) in the ciprofloxacin arm and 21 (2.7%) in the placebo arm (RR 0.49, 95% CI 0.19-1.23). No patients in the ciprofloxacin arm and nine (1.2%) in the placebo arm developed pyelonephritis (RR 0.05, 95% CI 0.003-0.93). No patients developed urosepsis and no serious adverse events occurred. CONCLUSIONS AND CLINICAL IMPLICATIONS:A single dose of ciprofloxacin reduced the risk of post-SWL pyelonephritis, with a modest absolute benefit. The patient importance of this reduction depends on individual preferences in weighing a small absolute reduction in risk against the potential harms and resistance-related implications of antibiotic use. Results from the APPEAL trial will inform global practice and support evidence-based decision-making for patients undergoing SWL.

Background Urinary tract infection (UTI) is a recognized complication of shock wave lithotripsy (SWL) for urolithiasis. Evidence guiding antibiotic prophylaxis remains of low certainty, contributing to substantial practice variation and conflicting guidelines. A well-powered, blinded randomized trial is essential to provide trustworthy evidence for clinical practice. Study Design An international, multicentre, randomized controlled trial (the APPEAL trial) assessing the benefits and harms of a single dose of ciprofloxacin versus placebo before SWL in reducing post-procedure UTI. Patients, healthcare providers, data collectors, outcome adjudicators and statisticians blinded to treatment assignment. Endpoints Appeal's primary outcome is bacteriuria or symptomatic UTI (symptomatic UTI defined as symptomatic cystitis, pyelonephritis, or urosepsis) within approximately 7-14 days post-SWL. Other outcomes include pyelonephritis or urosepsis, and serious adverse events. Patients and Methods Over 1,500 patients from high- and middle-income countries undergoing SWL for nephrolithiasis or ureterolithiasis. Exclusion criteria include a positive pre-SWL urine analysis for nitrites or urine culture, ongoing or planned antibiotic use, suspected struvite stones, urinary catheters or diversion, or a history of urosepsis. Imminent report of APPEAL will provide high-quality evidence on the role of antibiotic prophylaxis in SWL and identify subgroups that may benefit most. Trial Registration ClinicalTrial.gov identifier (ID): [NCT03692715][1]. Keywords antibiotic prophylaxis; clinical trials; lithotripsy; randomized controlled trial; statistical analysis; urinary tract infections; urolithiasis ### Competing Interest Statement Le Mai Tu has received speaker honoraria from Abbvie, Astellas and Fotona. Thomas Tailly is company consultant for Ambu GmbH, Cook Medical, Storz Medical AG, Photocure, Dornier Med Tech GmbH, BD; received speaker honoraria from Boston Scientific; and is panel member of the EAU Guidelines on Urolithiasis. Patrick O Richard is company consultant for Novartis and has received speaker honoraria from Astellas, Abbvie, Bayer, Knight, Novartis and Tolmar. Murilo de Almeida Luz is company consultant for Astellas, Janssen and ProScan; received speaker honoraria from Astellas, Bayer, Ipsen, Janssen and Sanofi; has received research grants from Amgen, Astra-Zeneca, Ferring and ProScan; participates in trials for Active Biotech, Bayer, Ferring, GSK and Janssen; and has received travel grants from Astra-Zeneca, Bayer, Janssen and Pfizer. Samuel Lagabrielle is company consultant for Alnylam and Boston Scientific; and has received speaker honoraria from Alnylam and Boston Scientific. John Denstedt has received royalties from Cook Medical, speaker honoraria from Becton Dickenson and Boston Scientific; and research grants from Vathin Medical. Other authors declare no conflicts of interest. ### Clinical Protocols ### Funding Statement Funded by the Competitive Research Fund of the Helsinki and Uusimaa Hospital District (TYH2017114, TYH2018120; TYH2019321, TYH2020248, TYH2022330, TYH2023236), Sigrid Juselius Foundation, Research Council of Finland (309387), Vyborg Tuberculosis Foundation, Physicians' Services Incorporated Foundation, Lawson Health Research Institute, Quebec Urological Association Scholarship Fund and Dr H. Olding and Mrs J. Hildigar Foucar Memorial Fund. The sponsors had no role in the study design or in manuscript preparation, review or approval. ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes All data produced in the present work are contained in the manuscript. [1]: /lookup/external-ref?link_type=CLINTRIALGOV&access_num=NCT03692715&atom=%2Fmedrxiv%2Fearly%2F2025%2F03%2F10%2F2025.03.09.25323609.atom

Introduction. Teaching the skill of renal cavity puncture remains a pressing issue for both resident trainees and practicing physicians. Because patient-based training is ethically questionable and can be unsafe in terms of complications, training models have been created to practice skills.Objective. To compare two non-biological simulators for renal cavity puncture under ultrasound guidance: “UROSON”, GEOTAR, Russia and the kidney phantom “SafeToAct”, Estonia.Materials & methods. The study involved 40 young doctors with no experience in kidney puncture. Group 1 (20 people) practised on the UROSON simulator (GEOTAR, Russia). Group 2 (20 people) trained on a kidney phantom (SafeToAct, Estonia). Both simulators were evaluated by doctors before and after practice, as well as in the long-term period for 3 and 6 months. The assessment was carried out using a Likert scale.Results. The UROSON was rated higher (p < 0.05) according to the results of the comparison of the parameters (colour and consistency, visualisation of the cavity and calyx on ultrasound). Renal cavity visualisation of the UROSON simulator was rated as "good" throughout the study. Visualisation deteriorated by 6.9% after six months of use. Meanwhile, the SafeToAct kidney phantom showed a 64% deterioration in visualisation after one month of use. The SafeToAct kidney phantom was not evaluated later point because it became unusable. Both simulators had "tracks" after punctures. The UROSON had 30% and the SafeToAct kidney phantom 100% (p < 0.0001).Conclusion. The UROSON simulator can be used for training, master classes and accreditation of specialists. This simulator can be used for a long time.

Introduction. The skill of puncture of the kidney pelvicalyceal system is one of the basic urological skills, as it is used for various surgical interventions. There are different training models, from laboratory animals to virtual reality simulators. Objective. To evaluate a non-biological model of the pelvicalyceal system puncture simulator UroATOM (“Alfa-Rhythm”, Russian Federation) and to compare it with a virtual reality simulator PERC Mentor TM (“Simbionix”, Beit Golan, Israel). Materials & methods. The results of fluoroscopic guided puncture training were analyzed among 50 physicians. The specialists were divided into two equal groups by experience: group 1 — beginners, group 2 — experienced urologists. In phase 1, both simulators were evaluated by the physicians using Likert questionnaires. In phase 2, the puncture results in beginners were evaluated before and after the UroATOM simulator practise. Results. Comparing the indices of both simulators showed that UroATOM was rated as more convenient to use (p = 0.0001) and cheaper (p < 0.0001). The analysis of the puncture performance by "beginners" before and after UroATOM training revealed a statistically significant improvement in the performance. The puncture time index improved by 79 seconds. The index of fluoroscopy duration decreased by 40.9 seconds. The number of puncture attempts decreased by 1.4 times. The amount of contrast decreased by 5.4 ml. Conclusions. The UroATOM simulator is effective for training young specialists in fluoroscopy-guided renal cavity puncture.

BACKGROUND: A rational choice of antibacterial therapy for hospital infections is a condition for successful treatment of patients. AIM: The aim of this study is a comparative assessment of the species composition of pathogens and the level of their resistance to antibacterial drugs in patients with complicated urinary tract infections in a urological hospital. MATERIALS AND METHODS: An analysis of the results of microbiological examination of urine samples from 1317 patients (795 men and 522 women) with complicated urinary tract infection who were hospitalized in a urology clinic during the period 2020–2021 was carried out. RESULTS: Gram-negative microflora was detected in 703 (53.4%) patients, gram-positive microflora in 531 (40.3%) patients and mixed microflora in 83 (6.3%) patients. Among gram-negative bacteria Escherichia coli (23.1%) and Klebsiella pneumoniae (16.1%) were predominate, Pseudomonas aeruginosa (4.9%) and Proteus mirabilis (2.8%) were less frequently detected. A high frequency of detection of gram-positive microflora of the genera Enterococcus (21.4%) and Staphylococcus (12.7%) was noted. When compared with the results of a similar study from 2018 to 2020 there is a decrease in the detection rate of E. coli from 28.2% to 23.1%. Antibiotic resistance of hospital strains of uropathogens varies significantly for different antimicrobial drugs. Most often resistance to representatives of three or more groups of antibiotics was observed in K. pneumoniae (46.6%), less commonly in E. coli (19.5%) and rarely in Enterococcus spp. (5.9%). CONCLUSIONS: Microbiological monitoring allows us to assess the etiological structure and level of antibiotic resistance of nosocomial urinary tract infections. Local data on the sensitivity of microorganisms to antibacterial drugs make it possible to rationally carry out perioperative antibiotic prophylaxis and prescribe empirical therapy for urinary tract infections before obtaining the results of a microbiological study.

No Abstract

Currently, various types of stents are widely used in urological practice. One of the indications is the presence of upper urinary tract strictures. The factors leading to the development of strictures can be endogenous and exogenous, iatrogenic and non-iatrogenic, benign and malignant. After open, laparoscopic and X-ray-endoscopic procedures a double-J stent is usually placed or, less often, nephrostomy tube. It should be noted that both methods have certain side effects and may affect the patient's quality of life. To reduce the stent-related symptoms and increase their tolerability, various modifications of ureteral stents have been developed. In this article, we analyze the publications devoted to the most commonly used segmental stents without renal and bladder coils, such as Memokath, Uventa, Allium, Memotherm and nitinol stents manufactured by MIT LLC.

To collect a multicentric database on behalf of TOWER research group to assess practice patterns and outcomes of retrograde intrarenal surgery (RIRS) for kidney stones. Inclusion criteria: age ≥ 18 years, normal renal/calyceal system anatomy, calculi of any size, number, and position. Study period: January 2018 and August 2021. Stone-free status: absence of fragments > 2 mm, assessed post procedure according to the local protocol (KUB X-Ray and/or ultrasound or non-contrast CT scan). Twenty centers from fifteen countries enrolled 6669 patients. There were 4407 (66.2

Urolithiasis is a common multifactorial disease characterized by a high recurrence rate. This review is devoted to the urine pH as one of the main factors determining its lithogenic properties. It affects the excretion of lithogenic substances and stone formation inhibitors, the solubility, and the crystallization of substances involved in stone formation. The urine pH significantly affects the solubility of uric acid in urine, which decreases at a pH < 5.5. This explains the high incidence of uric acid concretions in patients with metabolic syndrome. Their insulin resistance leads to a decrease in the excretion of ammonium ions in the proximal tubules, leading to persistent urine acidification. The activity of many transport processes involved in the processing of calcium, citrates and phosphates is sensitive to changes in systemic or local pH. The data on the effect of urine pH on the solubility of calcium oxalate remain contradictory. At the same time, there is no doubt about the determining role of urine pH in the excretion of citrate, the most important stone formation inhibitor. The alkaline urine pH promotes the formation of concretions containing calcium phosphates. In conditions of constantly elevated urine pH in patients with persistent urease-producing urinary tract infection, a rapid growth of "infectious" concretions occurs. The review summarizes information on the causes of the decrease and increase in the urine pH, as well as the possibilities of medicinal and non-medicinal methods of modifying the urine pH during the prevention of stone formation recurrence.

BACKGROUND:Endourologic interventions for urolithiasis in patients with anomalous kidneys can be challenging, and comparisons between these interventions are not well studied. We aim to compare the safety, outcomes and complications of retrograde intrarenal surgery (RIRS) versus percutaneous nephrolithotomy (PCNL) in patients with urolithiasis in anomalous kidneys. METHODS:A propensity score-matched pair analysis (PSM) was performed on pooled patient data from 20 centers. 569 patients with anomalous kidneys (horseshoe kidney [HSK], ectopic kidney, malrotated kidney) and urolithiasis who received either PCNL or RIRS as the primary modality of intervention from 2010 to 2020 were analyzed. Patients were matched based on calculated propensity scores by a regression model using age, sex, comorbidities, stone size, and renal anomaly type as co-variates. Multivariate logistic regression of factors (mode of treatment [PCNL or RIRS], comorbidities, stone size) and their effects on outcomes of stone-free rate (SFR), need to abandon surgery due to intraoperative difficulty, postoperative hematuria and sepsis and were analyzed when applicable. RESULTS:After PSM, there were a total of 127 pairs in each group. Overall, PCNL conferred a higher SFR compared to RIRS (OR=3.69, 95% CI 1.91-7.46, P<0.001), particularly in HSK (OR=3.33, 95% CI 1.22-9.99, P=0.023), and ectopic kidneys (OR=18.10, 95% CI 3.62-147.63, P=0.002), with no significant difference in malrotated kidneys. There was no significant difference in postoperative sepsis observed. Surgery was abandoned more often in RIRS than PCNL (6.3% vs. 0%, P=0.014). Although PSM provides a robust analysis due to baseline differences in the unmatched cohorts, this study was limited by an inevitable degree of selection bias. CONCLUSIONS:While both modalities are safe and efficacious, PCNL yields better SFR than RIRS in patients with anomalous kidneys, with no difference in postoperative sepsis rates. Patients may benefit from personalized management best carried out in high volume endourology centers.

Encrusted cystitis (IC) is a rare chronic inflammatory disorder of the bladder characterized by mucosal inflammation with encrustations. This pathological process is directly related to the activity of urea-splitting bacteria in the urine. Bladder encrustations are deposits of ammonium and magnesium phosphate, as well as struvite, on the surface of the urothelium. However, the pathogenesis of this disease has not been thoroughly studied. Treatment of encrusted cystitis is aimed to complete eradication of the uropathogen, surgical removal of encrustations, and lowering urine pH. Early diagnosis is a key prerequisite for effective treatment.

Background: With recent technological advancement, new and improved endoscopic instruments and laser devices have catapulted flexible ureteroscopy to the forefront, hence making retrograde intrarenal surgery (RIRS) a popular choice for the management of renal stones. However, RIRS has also resulted in an increasing number of work-related musculoskeletal disorders, which can have a detrimental impact on surgeons' physical health and operative lifespan. The aim of our review is to examine the impact and feasibility of ergonomic adjustments and outline future directions and recommendations to improve the awareness of and reduce the prevalence of musculoskeletal injuries among urologists. Methods: This study was carried out according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. A thorough literature review was conducted of several databases using the following keywords and Medical Subject Headings (MeSH) terms to generate a search strategy: nephrolithiasis, kidney calculus, renal calculus, staghorn calculus, ergonomics, position, fatigue, comfort, tire, physical strain, visual strain, muscle, ureteroscopy, RIRS, laser, and lithotripsy. Studies were chosen for inclusion by reviewers independently, and the data were consolidated for analysis. Results: A total of 1446 articles were identified on initial literature search; 23 were included in the final analysis. The impact of various ergonomic modifications on operative outcomes, surgeons, surgical equipment, and patients, was analyzed. In addition, we summarized all the improvements that resulted in better ergonomics in RIRS. Conclusion: Ergonomics in RIRS is poorly understood and there are currently no formal guidelines for this aspect. While modern endourology armamentarium seems to help with procedural ergonomics, more needs to be done to enhance surgeon comfort, protect surgeon longevity, and prioritize the health and safety of endourologists.

Introduction. In the modern world, training on medical simulators is actively used in the training of specialists. To improve the skill of puncture of the cavity system of the kidney, many simulators have been created, from biological ones to virtual reality simulators, but all of them have drawbacks - high cost, short shelf life, inconsistency with reality.Purpose of the study. To create a simulator model that will be identical in its anatomical and acoustic properties to the kidney and adjacent human tissues, as well as convenient to use and affordable for most universities and clinics.Materials and methods. The samples of simulators based on glycerin and gelatin were created. A study of the speed of sound in all compositions was carried out, as well as a study of track formation after passing the puncture needle, as well as the ability of the compositions to overgrow (sticking) tracks. The model of the simulator was tested by urologists.Results. As a result of the tests, it was found that the samples based on gelatin and glycerin are more wear-resistant, the shelf life is longer than that of other samples, and this model is as close as possible in its acoustic properties to human tissues. When testing the simulator, specialists highly appreciated the quality of visualization of both the kidney model itself and the needle during puncture, as well as visualization during repeated punctures.Conclusion. The simulator developed by us can be used to train young specialists, to assess the practical and theoretical skills of graduates within the framework of accreditation, as well as to continuously improve the qualifications of specialists and when planning surgical intervention for a particular patient.

Introduction. Urolithiasis is a widespread disease with high the frequency of recurrence. An important preventive measure is an increase in daily urine output. Patients with urolithiasis need to take into account the mineral the composition of the fluid consumed, since it can affect the formation of stones. It is especially important to pay attention to the composition of bottled water purchased in retail chains due to its significant differences. Purpose. Analyze the composition of bottled water sold in retail chains of the Northwestern federal district (NWFD). Conduct a comparative analysis of the compositions carbonated and still water, as well as compare the composition of domestic and European bottled still water. Materials and methods. An independent laboratory determined the mineral composition of 36 samples of bottled water purchased in 2 retail chains of the NWFD. Done сomparison of the compositions of 19 samples of still and 16 samples of carbonated water. Comparison of the compositions of domestic and European non-carbonated bottled water. Results. The data obtained by us on the mineral composition of the purchased water samples corresponded to the indicators declared by the manufacturers. Comparison of carbonated and still water showed no statistically significant differences in the content of calcium, sodium, magnesium, potassium, sulfates, hydrocarbons. Comparison of the mineral composition of domestic still and European still bottled water showed the presence of statistically significant differences in the content of calcium and hydrocarbonates, which were higher in the water of European manufacturers. Conclusions. The mineral composition of bottled water can vary significantly. It is important for patients with urolithiasis to take into account the mineral composition of the water, which they consume, so it can influence the development of relapse.

Urolithiasis is currently one of the most urgent problems in the world. Every eleventh worldwide inhabitant suffers from this disease. Previously, the only way to get rid of kidney stones and the urinary tract was open surgery, which was characterized by high trauma. Over the past decades, the development of technologies has made a significant contribution to the development of new methods of urolithiasis treatment. One of these methods is extracorporeal shock wave lithotripsy (ESWL). The first lithotripter Dornier HM-1 was produced in 1980. Subsequent models have got many changes, both in terms of ergonomics and power. The researchers noticed that the efficiency of stone crushing in the Dornier HM-1 lithotripter was higher than in newer models since the lower power provided the less intensive formation of cavitation bubbles that prevent the effective transit of subsequent waves through the stone. Nowadays, a new method of remote stone crushing is being developed based on low-amplitude high-frequency technology combined with ultrasonic propulsion, which is the main difference from traditional shock-wave lithotripters. The new technology of stone crushing is called «burst wave lithotripsy» (BWL). Currently, the data have been obtained that this method is more effective in terms of crushing quality and less traumatic.

In this article, we review the basic principles of brief psychotherapeutic intervention in patients with urolithiasis. The brief psychotherapeutic intervention has proven successful in the treatment of addictive behaviour. Currently, this method is also used in the treatment of many chronic diseases, such as hypertension, diabetes mellitus, and ischemic heart disease. Adaptation of this method can be a successful tool to increase the level of adherence to therapy for patients with urolithiasis since adherence to medical recommendations can significantly reduce the frequency of recurrent stone formation.

Ureteral stents have a long history of use. Their main goal is to provide effective drainage of the upper urinary tract. Morbidity is mostly related to low biocompatibility of materials, from which stents are made. Since stent introduction, there have been many stages of evolution and modernization. However, there is a significant problem associated with their widespread use. Despite technological progress, stent-associated symptoms, incrustation, bacterial infection are the problems that still have to be resolved while creating an "ideal" stent. The continued development of new materials and coatings also will lead to the improvement of such an indispensable urological device as the ureteral stent.