CONTEXT:To evaluate the safety and efficacy of ureteroscopy (URS) in adults receiving systemic anticoagulant (AC) therapy, including vitamin K antagonists and direct oral anticoagulants (DOACs), compared with non-AC controls. OBJECTIVE:Using a Population, Intervention, Comparator, Outcomes (PICO) framework, we examined whether continuation, interruption, or peri-operative bridging of AC influences bleeding complications, thromboembolic events, and stone-free rates (SFR) in adults undergoing URS for stone disease. EVIDENCE ACQUISITION:A systematic review of PubMed, Embase, and Scopus identified studies reporting URS outcomes in anticoagulated patients. The review adhered to PRISMA standards and was registered with PROspective Register of Systematic Reviews (PROSPERO) (Centre for Reviews and Dissemination (CRD)420251154766). Studies limited to antiplatelet monotherapy were excluded. Random-effects meta-analysis was performed for outcomes where sufficient comparative data were available. SFR was summarised descriptively. Risk of bias was assessed using the Risk Of Bias In Non-randomized Studies - of Interventions (ROBINS-I). EVIDENCE SYNTHESIS:Eleven studies (1,516 AC patients; 20,708 controls) published between 1998 and 2024 met inclusion criteria. Anticoagulation was not associated with a statistically significant increase in overall postoperative complications (RR 1.83, 95% CI 0.95-3.52). Bleeding-related complications were variably reported across studies, with absolute event rates ranging from 0-20% in anticoagulated patients and 0-0.60% in controls. In the largest comparative cohort, bleeding occurred in 1.1% (8/702) of anticoagulated patients versus 0.40% (44/10,859) of controls. Thirty-day readmission rates did not differ significantly (RR 1.59, 95% CI 0.27-9.29). SFRs ranged between 70-97% across studies. Most studies were judged at serious risk of bias, primarily due to non-random allocation of AC strategies. CONCLUSIONS:Bleeding complications were variably reported across studies, with several observational cohorts reporting higher absolute bleeding rates in anticoagulated patients than controls, although definitions were heterogeneous and absolute event rates were low. Thromboembolic events were rare. Continuation may be justified in carefully selected high-thrombotic-risk patients.

PURPOSE OF REVIEW:Urolithiasis is a common condition, with an increasing prevalence. Rigid ureteroscopy (rURS) and flexible ureteroscopy (fURS) are two management approaches for proximal ureteric calculi. The aim of this systematic review and meta-analysis was to compare perioperative outcomes in rURS versus fURS in the management of proximal ureteric calculi. RECENT FINDINGS:This systematic review was conducted according to PRISMA guidelines. Systematic search of online databases was performed in November 2024. A combination of MeSH and free text terms were applied. Primary outcome was stone free status. Secondary outcomes included operative time, complication rates, and hospital stay. Six studies met inclusion criteria, in which a total of 1085 patients underwent ureteroscopy (fURS, n  = 537 versus rURS, n  = 548). Five studies were retrospective comparative, one was prospective randomized comparative. FURS use was associated with significantly superior stone free rates (92%) when compared with rURS (84.5%) ( P  < 0.001). Secondary outcomes of complication rates ( P  = 0.17), length of stay ( P  = 0.39), and operative time ( P  = 0.08) did not reach statistical significance. SUMMARY:Both rURS and fURS have acceptable stone clearance and complication rates for managing proximal ureteric calculi. Regarding stone clearance, fURS is superior to rURS, both interventions are comparable with regards to complications, operative time, and hospital stay.

ABSTRACT Background Molecular mechanisms of kidney stone formation remain unknown in most patients. Previous studies showed high heritability of nephrolithiasis, but data on prevalence and characteristics of genetic disease in unselected adults with nephrolithiasis are lacking. Methods We performed whole exome sequencing in 787 participants of the Bern Kidney Stone Registry, an unselected cohort of adults with ≥ 1 past kidney stone episode (KSF), and 114 non- stone-forming individuals (NKSF). A total of 34 established nephrolithiasis genes were analyzed and variants assessed according to ACMG criteria. Pathogenic (P) or likely pathogenic (LP) variants were considered diagnostic. Results Mean age of KSF was 47±15 years, and 18 % were first time KSF. A Mendelian kidney stone disease was present in 2.9% (23 of 787) of KSF. The most common genetic diagnoses were cystinuria ( SLC3A1 , SLC7A9 ; n=13), Vitamin D-24 hydroxylase deficiency ( CYP24A1 ; n=5) and primary hyperoxaluria ( AGXT, GRHPR, HOGA1 ; n=3). 8.1% (64 of 787) of KSF were monoallelic for LP/P variants predisposing to nephrolithiasis, most frequently in SLC34A1/A3 or SLC9A3R1 (n=37), CLDN16 (n=8) and CYP24A1 (n=8). KSF with Mendelian disease had a lower age at the first stone event (30±14 years vs. 36±14 years, p=0.003), were more likely to have cystine stones (23.4 % vs. 1.4 %) and less likely to have calcium oxalate monohydrates stones (31.9 % vs. 52.5 %) compared to KSF without genetic diagnosis. The phenotype of KSF with variants predisposing to nephrolithiasis was subtle and showed significant overlap with KSF without diagnostic variants. In NKSF, no Mendelian disease was detected, and LP/P variants were significantly less prevalent compared to KSF (1.8 % vs. 8.1%). Conclusion Mendelian disease is uncommon in unselected adult KSF, yet variants predisposing to nephrolithiasis are significantly enriched in adult KSF.

Background and objective The aim of this review was to define patients who are at high risk of recurrence of urolithiasis, to delineate diagnostic and therapeutic algorithms for each type of stone, and to clarify general guidelines and recommendations for prevention of recurrence. Methods A professional research librarian carried out literature searches for all sections of the urolithiasis guidelines, covering the timeframe between 1976 and June 2023. Key findings and limitations For every patient with urolithiasis, an attempt should be made to analyse the stone. Patients should be given general instructions on how to prevent recurrence, including adequate fluid and calcium intake, and low consumption of sodium and protein. Identifying and correcting the causative factors is a cornerstone in preventing the recurrence of urolithiasis. Diagnostic and therapeutic algorithms by stone composition are available. Every patient should undergo baseline metabolic screening, while patients with calcium stones, who are at high risk of relapse and complications, should undergo extensive metabolic screening with two 24-h urine collections and should receive targeted therapy. Patients with uric acid, infection, or cystine stones are at high risk of relapse. All patients at high risk of recurrence should be closely monitored, especially those not complying with therapy in the long term. Conclusions and clinical implications Metabolic stone evaluation and patient follow-up are highly recommended to prevent urolithiasis recurrence. Patient summary We reviewed the evidence for proper evaluation of patients with urinary and stones and the treatment options for preventing stone recurrence. It is essential to determine the type of stone and to carry out specific blood and urine tests for planning the best treatment course for each patient.

Kidney stone disease (KSD) is a complex disease. Besides the high risk of recurrence, its association with systemic disorders contributes to the burden of disease. Sufficient water intake is crucial for prevention of KSD, however, the mineral content of water might influence stone formation, bone health and cardiovascular (CVD) risk. This study aims to analyse the variations in mineral content of bottled drinking water worldwide to evaluate the differences and describes the possible impact on nephrological and urological diseases. The information regarding mineral composition (mg/L) on calcium, bicarbonate, magnesium, sodium and sulphates was read from the ingredients label on water bottles by visiting the supermarket or consulting the online shop. The bottled waters in two main supermarkets in 21 countries were included. The evaluation shows that on a global level the mineral composition of bottled drinkable water varies enormously. Median bicarbonate levels varied by factors of 12.6 and 57.3 for still and sparkling water, respectively. Median calcium levels varied by factors of 18.7 and 7.4 for still and sparkling water, respectively. As the mineral content of bottled drinking water varies enormously worldwide and mineral intake through water might influence stone formation, bone health and CVD risk, urologists and nephrologists should counsel their patients on an individual level regarding water intake.

INTRODUCTION:Kidney stone disease is a common disease with high recurrence rates. Sufficient intake of water is the cornerstone in primary prevention of stone disease. However, the mineral composition of water can affect urinary minerals and influence stone formation. The aim of this study is to assess the variation in the mineral composition of bottled sparkling or carbonated drinking water across Europe.MATERIAL AND METHODS:The two largest supermarket chains in each participating country were visited to obtain data on mineral composition regarding bicarbonate, calcium, magnesium, potassium, sodium and sulphates of sparkling or carbonated waters by reading the ingredient labels on the bottles supplied by the manufacturers. Alternatively, the web-shops of these supermarkets were consulted.RESULTS:In total, 126 sparkling water brands across ten European countries were analysed regarding mineral composition. The median concentrations per mineral varied greatly. The greatest variation in median mineral content was found for sodium and sulphates with levels ranging from 3.1 mg/l to 63.0 mg/l and 6.0 mg/l to 263.0 mg/l respectively. A wide distribution of calcium content was found in Switzerland, with calcium levels reaching up to 581.6 mg/l.CONCLUSIONS:This study confirms that the mineral composition of sparkling or carbonated water varies greatly across Europe. Patients with kidney stone disease should be aware that the mineral content of water may influence stone formation and be mindful of the great variation that exists between different water brands. Mineral water can be a source of potential promotors or inhibitors of stone formation and patients and urologists need to be mindful of this.

We performed a systematic review and meta-analysis to investigate the use of machine learning techniques for predicting stone-free rates following Shockwave Lithotripsy (SWL). Eight papers (3264 patients) were included. Two studies used decision-tree approaches, five studies utilised Artificial Neural Networks (ANN), and one study combined a variety of approaches. The summary true positive rate was 79%, summary false positive rate was 14%, and Receiver Operator Characteristic (ROC) was 0.90 for machine learning approaches. Machine learning algorithms were at least as good as standard approaches. Further prospective evidence is needed to routinely apply machine learning algorithms in clinical practice.

Introduction: Kidney stone disease (KSD) is a highly prevalent disease worldwide. As water intake and its mineral content influence stone formation and recurrence, patients and physicians must be aware of the mineral content of drinkable water. We analyzed commercial bottled still water within Europe to assess the variation in its mineral composition across different manufacturers and countries. Materials and Methods: Data on the mineral composition of bottled still water regarding bicarbonate, calcium, magnesium, potassium, sodium, and sulfate concentration (mg/L) were collected from ten European countries. To collect the data, the two main supermarket chains in each participating country were either visited to check for the ingredient label on bottles or the online shop was consulted through the website of the supermarket in question. Descriptive statistics such as simple boxplots were used to illustrate the variation in mineral content. Results: One hundred eighty-two different commercial water brands were analyzed. Up to a fivefold variation in average concentrations per mineral between countries was observed. For calcium, a wide distribution was found in France and Switzerland compared with other countries with calcium levels ranging from 10.5 to 565 mg/L and 8.4 to 579 mg/L, respectively. By consuming 2 L of water with such high calcium levels, the daily reference intake for calcium is already achieved. Conclusions: The mineral content of bottled still water across Europe varies greatly. For patients with KSD it is important to be aware of the mineral content of the water they drink, as it might influence stone recurrence rates and necessitate alterations of their diet.

CONTEXT:The role of multiparametric magnetic resonance imaging (mp-MRI) during active surveillance (AS) of prostate cancer needs evaluation. It remains unclear whether mp-MRI can replace prostate biopsies completely during AS. OBJECTIVE:To evaluate the diagnostic performance of mp-MRI for disease progression in men on AS for prostate cancer. EVIDENCE ACQUISITION:This systematic review was performed in accordance with the Cochrane Handbook and the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA). Cross-sectional studies that evaluate the diagnostic performance of mp-MRI (index test) for disease progression compared with systematic and targeted prostate/template biopsies or a composite of this (reference standard) were included. A meta-analysis was performed using STATA with "metandi" and "midas" commands. EVIDENCE SYNTHESIS:Seven studies with 800 patients were included in this systematic review. The pooled pathological progression rate was 27%. The pooled sensitivity and specificity of mp-MRI for disease progression were 0.61 (95% confidence interval [CI]: 0.46-0.74) and 0.78 (95% CI: 0.54-0.91), respectively. Adjusting for a prevalence of disease progression of 30% results in a positive predictive value of 0.43 (95% CI: 0.39-0.46) and a negative predictive value of 0.81 (95% CI: 0.78-0.84). Significant heterogeneity was observed. The meta-regression analysis did not demonstrate any significant outliers. CONCLUSIONS:It is not possible to supplant prostate biopsies with mp-MRI in AS protocols with the current level of evidence. There is significant institutional variation in the diagnostic performance of mp-MRI during AS. Institutions must internally audit the diagnostic performance of mp-MRI in the AS setting. AS protocols must be based on local diagnostic performance, rather than on international AS protocols that may have limited applicability at individual settings. PATIENT SUMMARY:In this review, we explored the accuracy of multiparametric magnetic resonance imaging in diagnosing disease progression for patients who were enrolled in active surveillance programmes for prostate cancer.

ABSTRACT Objective: To investigate the bibliometric (publication) trends in surgical and ablative treatment of localised renal cell carcinoma (RCC) over a period of 16-years, from 2000 to 2015, as publication trends reflect clinical practice and new innovations. Material and methods: We performed a systematic review using PubMed over a 16-year period from 2000 to 2015 for all published papers on surgical and ablative management of renal tumours. Data were further analysed in two time periods, period-1 (2000–2007) and period-2 (2008–2015). Results: During the last 16 years a total of 2415 papers were published on surgical (n = 1662, 69%) and ablative (n = 753, 31%) management of RCC. This included partial nephrectomy (PN; n = 1662, 69%), cryoablation (CA; n = 405, 17%), and radiofrequency ablation (RFA; n = 348, 14%). When comparing the two time periods for PN, during period-2, the change was +189% (P < 0.001), +69% (P = 0.004) and +4600% (P < 0.001) for open PN, laparoscopic PN and robotic PN, respectively. Regarding ablative techniques, a change of +109% (P = 0.002) and +78% (P = 0.036) was seen for CA and RFA, respectively. There was also a significant rise in percutaneous CA when compared to laparoscopic CA (P < 0.002). Conclusions: There has been a rise in all forms of PN and ablative techniques over the last 16 years. This rise has been particularly steep for robotic PN potentially reflecting a change in surgical practice. Abbreviations: CA: cryoablation; CC: correlation coefficient; MIS: minimally invasive surgery/surgical; NSS: nephron-sparing surgery; (L)(O)(R)PN: (laparoscopic) (open) (robotic) partial nephrectomy; PRISMA: Preferred Reporting Items for Systematic Reviews and Meta-Analyses; RFA: radiofrequency ablation; RN: radical nephrectomy; SRM: small renal mass

BACKGROUND:The European School of Urology (ESU) started the European Urology Residents Education Programme (EUREP) in 2003 for final year urology residents, with hands-on training (HOT) added later in 2007. OBJECTIVE:To assess the geographical reach of EUREP, trainee demographics, and individual quality feedback in relation to annual methodology improvements in HOT. DESIGN, SETTING, AND PARTICIPANTS:From September 2014 to October 2017 (four EUREP courses) several new features have been applied to the HOT format of the EUREP course: 1:1 training sessions (2015), fixed 60-min time slots (2016), and standardised teaching methodology (2017). The resulting EUREP HOT format was verified by collecting and prospectively analysing the following data: total number of participants attending different HOT courses; participants' age; country of origin; and feedback obtained annually. RESULTS AND LIMITATIONS:A total of 796 participants from 54 countries participated in 1450 HOT sessions over the last 4 yr. This included 294 (20%) ureteroscopy (URS) sessions, 237 (16.5%) transurethral resection (TUR) sessions, 840 (58%) basic laparoscopic sessions, and 79 (5.5%) intermediate laparoscopic sessions. While 712 residents (89%) were from Europe, 84 (11%) were from non-European nations. Of the European residents, most came from Italy (16%), Germany (15%), Spain (15%), and Romania (8%). Feedback for the basic laparoscopic session showed a constant improvement in scores over the last 4 yr, with the highest scores achieved last year. This included feedback on improvements in tutor rating (p=0.017), organisation (p<0.001), and personal experience with EUREP (p<0.001). Limitations lie in the difficulties associated with the use of an advanced training curriculum with wet laboratory or cadaveric courses in this format, although these could be performed in other training centres in conjunction with EUREP. CONCLUSIONS:The EUREP trainee demographics show that the purpose of the course is being achieved, with excellent feedback reported. While European trainees dominate the demographics, participation from a number of non-European countries suggests continued ESU collaboration with other national societies and wider dissemination of simulation training worldwide. PATIENT SUMMARY:In this paper we look at methodological improvements and feedback for the European Urology Residents Education Programme hands-on-training over the last 4 yr.

Aim This project aimed to evaluate the time taken for formal reporting of blood culture results, the associated impact of this on prescribing appropriate antibiotic therapy and defining the period of starvation whilst PN is withheld for patients with catheter related bloodstream infections (CRBSI) Method Clinical data were retrospectively collected from electronic and paper records for patients with Type 1 intestinal failure diagnosed with CRBSI outside of an intestinal failure unit at a single centre from April 1 st 2016 to March 31 st 2017. Data were collected on clinical presentation, co-morbidities, time for blood cultures to be reported and the impact this had on antibiotic and parental nutrition prescribing. Results 44 patients with CRBSI were evaluated. Male: Female ratio was 29:15 with a median age of 61 years. The median Charlson co-morbidity index for this cohort was 3. The indications for PN are shown in figure 1. The median Modified Early Warning Score (MEWS) at presentation with each infection episode was 4. All patients had central line cultures taken of which 64% (28/44) were positive. 73% (32/44) of patients also had peripheral blood cultures taken and 47% (15/32) were positive. The most frequent organism cultured was streptococci. The median duration for blood cultures to be initially reported was 24 hours and a total duration of 72 hours for antibiotic sensitivities to be reported. Blood culture results led to changes in clinical management in 66% (29/44) of cases-PN being restarted or antibiotics changed. The median time for the correct organism-specific antibiotic to be prescribed from initial suspected infection episode was 48 hours. PN was withheld for a median of 72 hours in patients who were subsequently found to have negative blood cultures. During the time period, 300 patients with type 1 intestinal failure received parenteral nutrition via a central venous catheter. 14 episodes of line infection were recorded in 3854 catheter days giving an infection rate of 3.6/1000 catheter days. 68% (30/44) of patients had a diagnosis of infection other than CRBSI-67% (20/30) of these patients did not meet sepsis parameters and therefore PN could have been continued. Discussion These data show that where patients receiving PN present with a suspected CRBSI there is a considerable delay before they receive organism-specific antibiotic therapy, or are able to restart PN where this has been withheld. We also found that a significant proportion of patients did not have CRBSI and in many of these cases PN was unnecessarily withheld. The CRBSI rate in this group are similar to other reported studies. Further work is needed to examine the impact of diagnostic delays on clinical and nutritional outcomes as well as exploring the potential role of new technologies such as point of care testing on diagnostic and treatment times for CRBSI Conflicts of interest None declared

To look at the bibliometric publication trends on ‘Urolithiasis’ and aspects of treatment and training associated with it over a period of 16 years from 2000 to 2015. To this end, we conducted this study to look at the publication trends associated with urolithiasis, including the use of simulation, laser technology, and all types of interventions for it.