The present paper proposes a generalized net model of the male urinary system that reflects the principal anatomical and functional relations among the kidneys, ureters, urinary bladder, urethra, nervous system, muscle system, and prostate gland, both in norm and pathology. Particular attention is given to the role of the prostate gland and to changes in urinary flow and bladder emptying associated with prostate-related outflow obstruction. By representing material and informational flows and their interactions across several physiological subsystems, the model is conceptually aligned with the perspective of network physiology. The proposed framework provides a formal basis for the qualitative comparison of normal and pathological states and for future extension, parameterization, scenario-based simulation, and clinical validation.

Abstract In recent decades, multicriteria analysis methods have been increasingly used in decision-making in the field of medicine. In this work, we present a modification of an established approach for this purpose—InterCriteria Analysis. In the new algorithm, the determination of the similarity in behaviour between pairs of criteria is based on the relations of the respective pairs of objects to the mean values of the respective criteria. The proposed modification of InterCriteria Analysis was applied to a dataset of 276 prostate cancer patients (obtained from a retrospective study). The obtained results for positive and negative consonance between the studied criteria are confirmed by reports in authoritative literature sources in the field of urology. The registered potential of the new method for detecting relationships between investigated criteria enables its application both independently and in combination with other methods of multicriteria analysis. This article is part of the theme issue ‘Data driven modelling for living systems’.

The formation of kidney stones is a complex biologic process involving interactions among genetic, anatomic, dietary, and environmental factors. Traditional lithogenic models were based on urine supersaturation in relation to the activity of crystallization promoters and inhibitors. However, modern research has added new principles such as the "renal epithelial cell response" and the role of inflammation and oxidative stress leading to the development of a "multi-hit hypothesis". A strong correlation between urinary stones and kidney damage has been well demonstrated by both cohort and case-control studies. The main contributors to chronic kidney damage associated with urinary stones include crystal deposition within the renal parenchyma, associated comorbidities, repeated obstructive and infectious episodes, as well as the potential adverse effects of stone removal procedures. Most hereditary stones may cause high urinary saturation levels promoting obstruction of the Bellini ducts and consequent glomerulosclerosis and interstitial fibrosis in the cortex. These include hereditary hypercalciurias, primary hyperoxalurias, cystinuria, adenine phosphoribosyltransferase (APRT) deficiency (associated with 2,8-dihydroxyadenine lithiasis) and xanthinuria. Complete distal renal tubular acidosis occurs in childhood and presents deafness, rickets, and a short life expectancy. The incomplete form usually manifests in adulthood, primarily with recurrent urinary lithiasis, and less frequently with nephrocalcinosis. In all stone formers stone analysis and a basic metabolic evaluation, including blood biochemistry, urine sediment examination, urinary pH and culture are mandatory, in contrast high-risk stone formers require a more specific metabolic evaluation, including a 24-hour urine sample to measure calcium, phosphate, citrate, oxalate, uric acid, magnesium, sodium and proteinuria. The morpho compositional analysis of kidney stones offers essential insights beyond merely identifying their predominant chemical component. This approach reveals key aspets of the stone formation, such as nucleation sites, crystal growth patterns, and the presence of specific lithogenic processes. The ideal analytical protocol combines stereoscopic microscopy (StM), scanning electron microscopy with energy-dispersive X-ray spectroscopy (SEM-EDS), and, when necessary, Fourier-transform infrared spectroscopy (FTIR). Recurrence prevention and managing residual fragments require complementary strategies such as lifestyle modifications, dietary interventions, and pharmacological therapies. Among pharmacological options, alkaline citrate salts, particularly potassium citrate, are widely used due to their ability to modify urinary chemistry and inhibit stone formation. Recently, novel molecules have been introduced into the management of renal stone disease. Phytate a naturally occurring polyphosphorylated carbohydrate, exibits a potent inhibitory effect on calcium salt's nucleation, growth, and aggregation. Theobromine, another natural compound, has been shown to effectively inhibit uric acid crystallization. The co-administration of urinary alkalinizing agents, such as potassium citrate, alongside theobromine has been proposed as a therapeutic strategy to optimize uric acid solubility and to reduce the risk of excessive alkalinization and subsequent sodium urate precipitation. Struvite stones are caused by urinary tract infection with urease- producing microorganisms. Their treatment requires specific measures including complete surgical stone removal, short or long-term antibiotic treatment, to maintain urinary acidification to a pH below 6.2, and a urine volume of at least 2 litres/24 hours. L-methionine has been shown to effectively lower urine pH and the relative supersaturation of struvite. An essential aspect of medical management of urinary stone disease is treatment adherence, which depends on perceived benefit, treatment duration, and side effect profile. The side effects of citrate treatment are mild gastrointestinal disorders whereas thiazide diuretics tend to cause hypokalemia-related symptoms and less frequent metabolic and dermatologic side effects. Urease inhibitors for struvite stones and drugs used to enhance cystine solubility are more frequently associated with side effects. The use of smartphone applications can support patients by promoting adequate hydration, adherence to dietary recommendations, and compliance with prophylactic medication. Endoscopic techniques currently play a prevalent role in the removal of renal stones, while extracorporeal shock wave lithotripsy is today marginally used for specific indications. Different technical modalities can be used for percutaneous nephrolithotomy (PCNL), each with its own advantages and disadvntages (standard vs. mini, prone vs. supine, fluoroscopic vs ultrasound-guided). Flexible ureteroscopy or retrograde intrarenal renal surgery (RIRS) has extended its indications due to technological advancements in endoscopes and their accessories. The availability of new laser technologies (thulium fiber laser and pulse-modulated Ho:YAG laser) has enhanced stone fragmentation and dusting capabilities. However, their use exposes the renal parenchyma to high temperatures and pressures which could potentially contribute to renal damage. Factors influencing heat release include laser type and settings, exposure time, stone location, fiber-to-stone distance, irrigation volume and fluid circulation. Reduction of heat release can be achieved by limiting the laser settings to reasonable values or by improving fluid circulation with use of ureteral access sheaths, especially those navigable and equipped with suction. High intrarenal pressure is also closely associated with renal damage. Sustained high pressure or even pressure spikes may increase this risk, highlighting the importance of real-time pressure monitoring through sensors integrated on guidewires, scopes, access sheath and use of innovative platforms regulating irrigation/suction systems. Direct In-Scope Suction (DISS) system was developed to control intrarenal pressure and facilitate the removal of residual fragments. Flexible and Navigable Suction Ureteral Access Sheath (FANS-UAS) is a flexi-bendable UAS equipped with suction capabilities combining mechanical flexibility with continuous irrigation management and stone clearance mechanisms. Ultra-thin scopes (7.5 F) make it easy to perform RIRS without the need for pre-placed double-J stents or with a 9 F sheath achieving more space for stone fragments expulsion or infusion. All these technological advancements have enhanced the efficacy of fURS or RIRS which can be an alternative treatment (salvage fURS) when standard stone management techniques, such as percutaneous nephrolithotomy (PCNL), are contraindicated or fail. Salvage fURS has shown favorable outcomes in complex or high-risk cases, including patients with coagulopathies, morbid obesity, renal anatomical abnormalities (e.g., horseshoe or pelvic kidneys), urinary diversion, calyceal diverticula, and altered urinary tracts. In such scenarios it demonstrated favorable outcomes with stone-free rates ranging from 55.6% to 64% for stones > 2 cm. Although non-invasive, extracorporeal and endoscopic treatments for renal and ureteral stones carry a risk of complications that can be classified according to the Clavien-Dindo system. The complication rate after SWL was estimated at 18.43% for Clavien grade I-II complications (pain, hematuria) and 2.48% for Clavien III-IV complications (hematoma, sepsis). The most frequent complication after RIRS is fever or urinary tract infection observed in 0.2-15% (with 0.1-4.3% of cases of urinary sepsis). Complications after PCNL are more frequent and may include moderate events (hemorrhage requiring transfusion 2-7%, urosepsis 1-2%, bowel injury < 1%) as well as severe events (arteriovenous fistula 0.5-1%, thoracic complications < 1% , loss of access tract 1-3%, death < 0.5%). The risk of bleeding complications is significantly increased in patients on antithrombotic therapy. A personalized, interdisciplinary approach enables optimal decision-making in balancing antithrombotic therapy with surgical safety during urological stone interventions Finally, it must be considered that endourological procedures can be harmful to the surgeons themselves and their team due to exposure to ionizing radiation. For this reason, procedures must be carried out in strict accordance with safety guidelines and regulations to minimize radiation exposure. Safety is vital in any surgical intervention, with efficacy being the next most critical consideration. However, cost-effectiveness should be also considered. Endourology involves high costs largely due to the use of sophisticated equipment that requires frequent renewal due to the continuous rapid technological evolution. Using disposable devices brings numerous benefits but also leads to a further increase in costs. Finally, in the cost-benefit assessment, the rate of reintervention associated with some types of procedures must be considered.

OBJECTIVE:This retrospective study evaluates the clinical significance of mutations in effector genes (BRCA1, BRCA2, PALB2, RAD51, FANCD2) versus sensor genes (ATM, ATR, CHEK1, CHEK2, NBS1) in patients with metastatic castration-resistant prostate cancer (mCRPC) classified as homologous recombination deficiency (HRD)-positive. The study assesses their predictive value for response to poly(ADP-ribose) polymerase inhibitors (PARPi) combined with androgen receptor signaling inhibitors (ARSi). DESIGN:A multicenter, retrospective real-world study conducted across 6 oncology hospitals in Bulgaria. Patient data were obtained through a formal request to the Ministry of Health's United Information Portal, an electronic health records repository. The analysis included mCRPC patients treated with olaparib plus abiraterone who underwent next-generation sequencing (NGS) between January 1, 2022, and January 1, 2025, conducted in a certified national reference laboratory, with a median follow-up of 16 months. The primary endpoints were overall survival (OS) and progression-free survival (PFS). RESULTS:Of the 210 mCRPC patients screened via NGS, 28% (n = 58) harbored mutations in at least one HRR gene, classified as sensor (n = 27) or effector (n = 31). Patients with effector mutations demonstrated a statistically significant improvement in PFS compared to those with sensor mutations (median PFS: 20 vs. 14 months, HR = 0.48, 95% CI: 0.252-0.914, P = .0294). Similarly, overall survival (OS) was significantly prolonged in the effector group. While the median OS for the sensor group was 19 months, the effector group had not yet reached median OS at the time of analysis (HR = 0.38, 95% CI, 0.154-0.945, P = .0373). Logistic regression analysis and PSM supported findings. CONCLUSION:Patients with mCRPC harboring effector HRR mutations derive greater clinical benefit from PARPi plus ARSi than those with sensor mutations. These findings highlight the heterogeneous predictive value of HRR gene alterations and suggest that mutation sub-class should guide treatment decisions in HRD-positive mCRPC.

Strictures of the male urethra are a relatively common disease with a serious impact on the quality of life in men. The lack of a universal operative technique gives rise to different opinions and recommendations when choosing the most appropriate treatment approach. The present study aimed to prospectively analyze the results of surgical treatment of male urethral strictures with a free oral mucosa graft in comparison with other operative techniques, and to compare the obtained results with the data from the other reference centres. For a period of 5 years – from January 2017 to March 2022, 84 patients with a urethral stricture (newly diagnosed and recurrent) were operated on and followed up at the Clinic of Urology with a specific activity in Andrology of “Tsaritsa Yoanna – ISUL” University Hospital. Patients were divided into 3 groups: patients after urethroplasty with a free oral mucosa graft; patients after urethroplasty using extragenital tissue graft and anastomotic urethroplasty; transurethral minimally invasive operative techniques. Patients from Group 1 and Group 2 had a mean recurrence-free period of 19.35 ± 8.24 months and 20.62 ± 6.5 months, respectively, which were statistically significantly longer compared to Group 3 (10.44 ± 9.84), p = 0.000. Lingual mucosa proves to be a highly efficient alternative material in urethroplasty.

The search for dependable molecular biomarkers to enhance routine clinical practice is a compelling challenge across all oncology fields. Urothelial bladder carcinoma, known for its significant heterogeneity, presents difficulties in predicting responses to systemic therapies and outcomes post-radical cystectomy. Recent advancements in molecular cancer biology offer promising avenues to understand the disease’s biology and identify emerging predictive biomarkers. Stratifying patients based on their recurrence risk post-curative treatment or predicting the efficacy of conventional and targeted therapies could catalyze personalized treatment selection and disease surveillance. Despite progress, reliable molecular biomarkers to forecast responses to systemic agents, in neoadjuvant, adjuvant, or palliative treatment settings, are still lacking, underscoring an urgent unmet need. This review aims to delve into the utilization of current and emerging molecular signatures across various stages of urothelial bladder carcinoma to predict responses to systemic therapy.

Aim: To present state of the art on the management of urinary stones from a panel of globally recognized urolithiasis experts who met during the Experts in Stone Disease Congress in Valencia in January 2024.Options of treatment: The surgical treatment modalities of renal and ureteral stones are well defined by the guidelines of international societies, although for some index cases more alternative options are possible. For 1.5 cm renal stones, both m-PCNL and RIRS have proven to be valid treatment alternatives with comparable stone-free rates. The m-PCNL has proven to be more cost effective and requires a shorter operative time, while the RIRS has demonstrated lower morbidity in terms of blood loss and shorter recovery times. SWL has proven to be less effective at least for lower calyceal stones but has the highest safety profile. For a 6mm obstructing stone of the pelviureteric junction (PUJ) stone, SWL should be the first choice for a stone less than 1 cm, due to less invasiveness and lower risk of complications although it has a lower stone free-rate. RIRS has advantages in certain conditions such as anticoagulant treatment, obesity, or body deformity.Technical issues of the surgical procedures for stone removal: In patients receiving antithrombotic therapy, SWL, PCN and open surgery are at elevated risk of hemorrhage or perinephric hematoma. URS, is associated with less morbidity in these cases. An individualized combined evaluation of risks of bleeding and thromboembolism should determine the perioperative thromboprophylactic strategy. Pre-interventional urine culture and antibiotic therapy are mandatory although UTI treatment is becoming more challenging due to increasing resistance to routinely applied antibiotics. The use of an intrarenal urine culture and stone culture is recommended to adapt antibiotic therapy in case of postoperative infectious complications. Measurements of temperature and pressure during RIRS are vital for ensuring patient safety and optimizing surgical outcomes although techniques of measurements and methods for data analysis are still to be refined. Ureteral stents were improved by the development of new biomaterials, new coatings, and new stent designs. Topics of current research are the development of drug eluting and bioresorbable stents.Complications of endoscopic treatment: PCNL is considered the most invasive surgical option. Fever and sepsis were observed in 11 and 0.5% and need for transfusion and embolization for bleeding in 7 and 0.4%. Major complications, as colonic, splenic, liver, gall bladder and bowel injuries are quite rare but are associated with significant morbidity. Ureteroscopy causes less complications, although some of them can be severe. They depend on high pressure in the urinary tract (sepsis or renal bleeding) or application of excessive force to the urinary tract (ureteral avulsion or stricture).Diagnostic work up: Genetic testing consents the diagnosis of monogenetic conditions causing stones. It should be carried out in children and in selected adults. In adults, monogenetic diseases can be diagnosed by systematic genetic testing in no more than 4%, when cystinuria, APRT deficiency, and xanthinuria are excluded. A reliable stone analysis by infrared spectroscopy or X-ray diffraction is mandatory and should be associated to examination of the stone under a stereomicroscope. The analysis of digital images of stones by deep convolutional neural networks in dry laboratory or during endoscopic examination could allow the classification of stones based on their color and texture. Scanning electron microscopy (SEM) in association with energy dispersive spectrometry (EDS) is another fundamental research tool for the study of kidney stones. The combination of metagenomic analysis using Next Generation Sequencing (NGS) techniques and the enhanced quantitative urine culture (EQUC) protocol can be used to evaluate the urobiome of renal stone formers. Twenty-four hour urine analysis has a place during patient evaluation together with repeated measurements of urinary pH with a digital pH meter. Urinary supersaturation is the most comprehensive physicochemical risk factor employed in urolithiasis research. Urinary macromolecules can act as both promoters or inhibitors of stone formation depending on the chemical composition of urine in which they are operating. At the moment, there are no clinical applications of macromolecules in stone management or prophylaxis. Patients should be evaluated for the association with systemic pathologies.Prophylaxis: Personalized medicine and public health interventions are complementary to prevent stone recurrence. Personalized medicine addresses a small part of stone patients with a high risk of recurrence and systemic complications requiring specific dietary and pharmacological treatment to prevent stone recurrence and complications of associated systemic diseases. The more numerous subjects who form one or a few stones during their entire lifespan should be treated by modifications of diet and lifestyle. Primary prevention by public health interventions is advisable to reduce prevalence of stones in the general population. Renal stone formers at "high-risk" for recurrence need early diagnosis to start specific treatment. Stone analysis allows the identification of most “high-risk” patients forming non-calcium stones: infection stones (struvite), uric acid and urates, cystine and other rare stones (dihydroxyadenine, xanthine). Patients at “high-risk” forming calcium stones require a more difficult diagnosis by clinical and laboratory evaluation. Particularly, patients with cystinuria and primary hyperoxaluria should be actively searched.Future research: Application of Artificial Intelligence are promising for automated identification of ureteral stones on CT imaging, prediction of stone composition and 24-hour urinary risk factors by demographics and clinical parameters, assessment of stone composition by evaluation of endoscopic images and prediction of outcomes of stone treatments. The synergy between urologists, nephrologists, and scientists in basic kidney stone research will enhance the depth and breadth of investigations, leading to a more comprehensive understanding of kidney stone formation.

After recent approvals, poly-adenosine diphosphate [ADP]-ribose polymerase inhibitors (PARPis) have emerged as a frontline treatment for metastatic castration-resistant prostate cancer (mCRPC). Unlike their restricted use in breast or ovarian cancers, where approval is limited to those with BRCA1/2 alterations, PARPis in mCRPC are applied across a broader spectrum of genetic aberrations. Key findings from the phase III PROPEL trial suggest that PARPis’ accessibility may broaden, even without mandatory testing. An increasing body of evidence underscores the importance of distinct alterations in homologous recombination repair (HRR) genes, revealing unique sensitivities to PARPis. Nonetheless, despite the initial effectiveness of PARPis in treating BRCA-mutated tumors, resistance to therapy is frequently encountered. This review aims to discuss patient stratification based on biomarkers and genetic signatures, offering insights into the nuances of first-line PARPis’ efficacy in the intricate landscape of mCRPC.

A generalized net model of the prostate cancer early stages of development is described. The relationship of the prostate with the human body respiratory, blood and circulatory, and endocrine systems are represented.

This paper describes a generalized net model of the process of diagnostic work-up of the basic nephrological diseases and conditions: AKI, oliguria, proteinuria, hematuria, and its‘implementation in everyday clinical practice for education, differential diagnosis and multidisciplinary collaboration.

Solitary fibrous tumor (SFT) is a spindle cell neoplasm of mesenchymal origin. First reported in 1931, the pleura is the most common localization of SFT, and it’s exceptionally rare in the kidney. Overall, it represents less than 2% of all soft tissue tumors. In most cases, renal SFT (rSFT) presents with hematuria, flank pain, and a palpable mass. To our knowledge, less than 112 cases of rSFT have been reported. We report a case of rSFT of a 30-year-old male thought to be a renal cell carcinoma (RCC). Radical nephrectomy (RN) was done to remove a large right-sided mass invading the inferior vena cava. Immunohistochemistry confirmed the diagnosis of SFT showing positivity for CD34, CD99, and Bcl-2 protein, with no staining for cytokeratin. A post-operative CT (15 months) showed tumor recurrence in the renal compartment with huge inferior vena cava thrombus extending to the external iliac veins. With this case, we illustrate and highlight the importance of this diagnosis because of the uncertain biological behavior and prognosis of these tumors.

OBJECTIVE:The purposes of this multi-center study were to evaluate the rate of infection stones and to evaluate the urine cultures of patients with infection stones.MATERIALS:Charts of adulpatients with urinary stones were reviewed and data on stone analyses and urine cultures were collected.RESULTS:In total, 1204 renal stone formers (RSFs) from 10 countries were included (776 males, 428 females). Fifty-six patients (4.6%) had struvite stones. The highest frequency of struvite stones was observed in India (23%) and Pakistan (18%). Lower rates were reported in Canada (2%), China (3%), Argentina (3%), Iraq (3%), Italy (3.5%) and Poland (3%), and intermediate rates in Egypt (5.5%) and Bulgaria (5.4%). Urine cultures were retrieved from 508 patients. Patients with struvite stones had a positive culture in 64.3% of the samples and patients with other stones, in 26.7%. In struvite stones, the most common isolates were Escherichia coli (27.7%) and Proteus spp. (27.7%), followed by Klebsiella spp. (16.7%); in other types of stone, it was Escherichia coli (47.6%), followed by Gram-positive bacteria (14.0%) Conclusions: The struvite stone composition was associated with a urinary infection, although an infection was not demonstrable with a conventional midstream urine culture in about 30%.

In the present work two modifications of the InterCriteria Analysis are proposed in order to extend its theoretical foundation. The results obtained from the application of these methods over real data (from patients with prostate carcinoma) have been analyzed to determine the reliability of the calculated consonance and dissonance. The similarity scores obtained by the modified versions of the InterCriteria Analysis are close to those given by the classical InterCriteria Analysis, as well as to the values of the correlation coefficients between the considered criteria. This shows the reliability of the proposed modification with respect to determining the consonance and dissonance between criteria in different problems.

Background and Objective: Phytotherapy, a scientifically based usage of plant extracts for treatment and prevention of disease, is as old as humanity. In the last century, it has marked a significant advancement in the field of Urology, giving additional treatment options in a variety of unsolved problems in everyday urological practice. Phytotherapeutica has its most prominent place in the therapeutic arsenal of Western Urology regarding benign prostatic hyperplasia (BPH)/lower urinary tract symptoms (LUTS), erectile dysfunction (ED) and sexual disorders, chronic prostatitis (CP)/chronic pelvic pain syndrome (CPPS), urinary tract infections (UTIs) and urolithiasis. The aim of this review is to present the most frequently used plant extracts for treatment of those conditions and to discuss on their strengths and weaknesses.

Introduction: Pheochromocytomas are rare tumors of the adrenal gland. Intestinal pseudo-obstruction is a very rare presentation of a functioning catecholamine-secreting tumor. We present a case of intestinal pseudoobstruction due to a large functioning pheochromocytoma. Case report: A 29-year-old female presented with abdominal distension, pain, nausea, and vomiting with constipation for 3 weeks. She was hypertensive and diabetic and was on multiple medications. She reported frequent spells of severe headaches, palpitations, night sweats, and a 17 kg weight loss over 6 months. She had pallor, dyspnea, marked abdominal distension, and diminished bowel sounds. Her blood pressure was high at 200/120 mmHg. She had tachycardia (pulse 120 bpm) and tachypnea (35 pm). Serum metanephrine levels were significantly elevated, measuring 1203 pg/ml. Abdominal CT showed a heterogeneous, hyper-vascular mass near the upper pole of the left kidney, measuring 10.75 cm x 8.72 cm. Open left adrenalectomy was performed through an anterior subcostal approach to remove the tumor with the left adrenal gland. Histopathological examinations were consistent with pheochromocytoma. Discussion: Some authors documented the correlation between tumor size and metabolic activity of catecholamine-secreting tumors with intestinal pseudo-obstruction by paralytic ileus. This case corresponds with these findings, with a tumor mass of 350 g and a serum metanephrine level of 1203 pg/ml. Conclusion: Although it is extremely rare, functioning pheochomocytoma could be a cause of instestinal obstruction or pseudo-obstruction.

Over the last 20 years, many Generalized Net (GN) models of the ways of functioning of the different systems and organs in the human body and models related to the description of biomedical processes in living organisms have been constructed. In this paper, a GN model of the prostate gland's functioning was developed, as a continuation of the previous research. The model provides the possibility to trace the logical relations of the interactions of the prostate gland and various individual organs in the human body. The model shows the possibility for the existence of currently unknown feedback loops.

OBJECTIVETo study urinary stone composition patterns in different populations around the world.MATERIALS AND METHODSData were collected by reviewing charts of 1204 adult patients of 10 countries with renal or ureteral stones (> 18 years) in whom a stone analysis was done and available. Any method of stone analysis was accepted, but the methodology had to be registered.RESULTSIn total, we observed 710 (59%) patients with calcium oxalate, 31 (1%) with calcium phosphate, 161 (13%) with mixed calcium oxalate/calcium phosphate, 15 (1%) with carbapatite, 110 (9%) with uric acid, 7 (< 1%) with urate (ammonium or sodium), 100 (9%) with mixed with uric acid/ calcium oxalate, 56 (5%) with struvite and 14 (1%) with cystine stones. Calciumcontaining stones were the most common in all countries ranging from 43 to 91%. Oxalate stones were more common than phosphate or mixed phosphate/oxalate stones in most countries except Egypt and India. The rate of uric acid containing stones ranged from 4 to 34%, being higher in Egypt, India, Pakistan, Iraq, Poland and Bulgaria. Struvite stones occurred in less than 5% in all countries except India (23%) and Pakistan (16%). Cystine stones occurred in 1% of cases.CONCLUSIONSThe frequency of different types of urinary stones varies from country to country. Calcium-containing stones are prevalent in all countries. The frequency of uric acid containing stones seems to depend mainly on climatic factors, being higher in countries with desert or tropical climates. Dietary patterns can also lead to an increase in the frequency of uric acid containing stones in association with high obesity rates. Struvite stones are decreasing in most countries due to improved health conditions.

Objective: To collect evidence on the rate of obesity in renal stone formers (RSFs) living in different climatic areas and consuming different diets. Materials and methods: Data of adult renal stone formers were retrospectively collected by members of U-merge from 13 participant centers in Argentina, Brazil, Bulgaria (2), China, India, Iraq (2), Italy (2), Nigeria, Pakistan and Poland. The following data were collected: age, gender, weight, height, stone analysis and procedure of stone removal. Results: In total, 1689 renal stone formers (1032 males, 657 females) from 10 countries were considered. Average age was 48 (±14) years, male to female ratio was 1.57 (M/F 1032/657), the average body mass index (BMI) was 26.5 (±4.8) kg/m2. The obesity rates of RSFs in different countries were significantly different from each other. The highest rates were observed in Pakistan (50%), Iraq (32%), and Brazil (32%), while the lowest rates were observed in China (2%), Nigeria (3%) and Italy (10%). Intermediate rates were observed in Argentina (17%), Bulgaria (17%), India (15%) and Poland (22%). The age-adjusted obesity rate of RSFs was higher than the age-adjusted obesity rate in the general population in Brazil, India, and Pakistan, whereas it was lower in Argentina, Bulgaria, China, Italy, and Nigeria, and similar in Iraq and Poland. Conclusions: The age-adjusted obesity rate of RSFs was not higher than the age-adjusted obesity rate of the general population in most countries. The relationship between obesity and the risk of kidney stone formation should be reconsidered by further studies carried out in different populations.

Abstract To compare urinary stone composition patterns in different populations around the world in relation to the structure of their population, dietary habits, and climate. 1204 adult patients with urolithiasis and stone analysis was included . International websites were searched to obtain data. We observed 710(59%) patients with calcium oxalate, 31(1%) calcium phosphate, 161(13%) mixed calcium oxalate/calcium phosphate, 15(1%) carbapatite, 110(9%) uric acid, 7(<1%) urate, 100(9%) mixed uric acid/ calcium oxalate, 56(5%) struvite and 14(1%) cystine stones. Calcium stones were the most common in all countries (up to 91%) with the highest rates in Canada and China. Oxalate stones were more common than phosphate or mixed phosphate/oxalate stones except Egypt and India. The rate of uric acid stones, being higher in Egypt, India, Pakistan, Iraq, Poland, and Bulgaria. Struvite stones occurred in less than 5% except India (23%) and Pakistan (16%). Cystine stones occurred in 1%. The frequency of different types of urinary stones varies from country to country. Calcium stones are prevalent in all countries. Uric acid stones seems to depend mainly on climatic factors, being higher in countries with desert or tropical climates. Dietary patterns can also lead to an increase it. Struvite stones are decreasing in most countries.