Belthangady Monu Zeeshan Hameed

Modern healthcare systems (particularly those with limited resources and in remote locations) require real-time monitoring and telemedicine. Conventional cloud-reliant solutions face challenges with latency, data privacy, and trust. The system integrates a CNN-GRU hybrid deep learning model for classifying physiological signals, a Trust-Aware Diagnostic Engine based on EMA scoring, and a Federated Learning system augmented with Differential Privacy (DP) to ensure decentralized training. The system was extensively tested on PhysioNet MIT-BIH, MIMIC-III, and a simulated H-IoT dataset to assess real-time performance, accuracy, and efficiency. The proposed CNN-GRU model outperformed the baseline models (LSTM, Transformer-only) in average accuracy (96.3), F1-score (0.94), and ROC-AUC (0.97). In the hybrid edge-fog, latency was reduced by 28%. When device signal noise was intermittent, the trust score remained stable at over 0.85. Under DP noise (epsilon = 0.1), the federated learning model converged in 40 rounds with a negligible loss of accuracy. SHAP feature attribution made the predictions interpretable. The framework presents a new combination of federated learning, privacy-preserving and trust-based decision-making, and adaptive edge-fog orchestration for smart healthcare. This work provides a standard for the design of clinically relevant, safe, and interpretable systems based on AI-powered telemedicine and strongly aligns with translational impact.

Introduction: While reviews and book chapters focus on certain aspects of evolution and perhaps key milestones, a comprehensive overview of the history and evolution of percutaneous nephrolithotomy (PCNL) is lacking. This review looks at different aspects of PCNL evolution with procedural and technological advancements, with specific aspects of history, positioning, imaging and puncture, tract dilation, miniaturization, and lithotripsy devices. Material and Methods: We conducted a thorough search in October 2024 across multiple databases, social media platforms, and Google with specific terms and Boolean operators to determine the main dates for the development of individual PCNL stages. To be more specific, the main focus was on identifying chronological events that led to the evolution of PCNL with respect to these six categories: (1) history of PCNL; (2) patient positioning; (3) imaging and puncture; (4) tract dilation; (5) nephroscope size; and (6) lithotripsy devices. Results: All six aspects that have been investigated have undergone significant changes, leading to the modernization of PCNL in the 21st century. There is a trend toward supine position, miniaturization of instruments, an increase in image quality, the active development of various imaging modalities, and the integration of various digital and prototyping technologies. There are tools to help with puncture and needle guidance, as well as the emergence of navigation and robotic systems. Tract dilation seems to move toward single-step approach rather than serial dilatation. Major discoveries in energy sources such as lasers have now been incorporated into lithotripsy for PCNL. Conclusion: The modernization of PCNL has been a result of multiple evolutions along its journey, from imaging advancements, lithotripsy devices, miniaturization, learning from cross-disciplinary techniques, and digital integration with the use of virtual and augmented reality. While the journey continues to evolve, we summarize the key milestones that have led to the current clinical standard of practice.

Introduction: Our comprehension of the actual diversity of kidney pyelocaliceal system (PCS) is lacking and many crucial features have been overlooked in the existing literature on this subject. The purpose of this review is to provide a concise summary of the current understanding of the structure of the pelvicalyceal system, considering both anatomical and surgical perspectives, as well as to highlight any limitations or inconsistencies in these approaches. Material and Methods: A full review of all the literature on the anatomical and surgical methods used to classify pelvicalyceal system was conducted in several databases in August 2024. This included all the articles that talked about classifications for the whole pelvicalyceal system, minor calyces, and morphometric measurements within the pelvicalyceal system. Results: Despite over a century of studying this anatomical zone and numerous approaches, some classifications still rely on pelvic branching or the division site related to the renal sinus. However, no single classification has incorporated both aspects. In addition, despite the consensus regarding the number of minor calyces, there are many approaches to determining their orientation. Finally, researchers have described a sufficient number of morphometric measurements within the pelvicalyceal system, considering their prognostic value before endourological interventions and their correlation with individual patterns of the structure of pelvicalyceal system. However, these measurements often lead to contradictions in interpreting the anatomical favorability of the same pelvicalyceal system using different approaches. Conclusion: Despite the numerous approaches to identify pelvicalyceal system from both morphological and surgical perspectives, there are significant gaps in our understanding of the real anatomy of the renal cavity that, even after more than a century, remain unanswered. There needs to be more correlation of anatomy with modern minimally invasive clinical interventions for stone disease.

Background and Objective: The cost of imaging and interventions in the surgical field varies between countries and sometimes within different regions of the same country. Procedural cost takes into account equipment, consumables, operating room, surgical, anesthetic and nursing teams, radiology, medications, and hospital stay. Health care systems therefore face an incredible burden related to investigations and surgical procedures. The aim of this study was to collect costs of imaging and interventions for kidney calculi across different hospitals and health care systems in the world. Methods: An online shared Google spreadsheet was created by the European Association of Urology Young Academic Urology urolithiasis group. The survey consisted of the cost of four radiological imaging (ultrasound of the urinary tract [USS], plain X-ray radiography of the abdomen including kidneys, ureter, and bladder [XRKUB], noncontrast-enhanced computerized tomography [CTKUB], and contrast-enhanced CT with urographic phase [CTU]) and seven interventions (endoscopic laser treatment of renal stones, ureteroscopic treatment or extraction of ureteral stones, percutaneous nephrolithotomy (PCNL), insertion of ureteral stent, diagnostic ureteroscopy, and cystolitholapaxy). A chosen representative from each country collected and collated the data, and this was converted to Euros (€). Key Findings and Limitations: Data were collected from 32 countries, which include Turkey, Armenia, Nepal, Uzbekistan, Brazil, Chile, Qatar, Peru, Israel, Singapore, Thailand, Colombia, Argentina, Saudi Arabia, Asia, North America, 15 countries from the European continent, and the United States. The mean cost of USS, XRKUB, CTKUB, and CTU was 51.3 € (range: 2–160 €), 27.1 € (range: 2.5–187 €), 105.8 € (range: 19–405 €), and 171.5 € (range: 19–674 €), respectively. Similarly, the cost of endoscopic laser treatment of renal stones, ureteroscopic treatment/extraction of ureteral stones, PCNL, insertion of ureteral stent, diagnostic ureteroscopy, and cystolitholapaxy was 1942.6 € (range: 100–7887 €), 1626.8 € (range: 80–9787 €), 2884.6 € (range: 110–12642 €), 631 € (range: 110–2787 €), 861.6 € (range: 3–2667 €), and 876 € (range: 19–3457 €), respectively. Wide differences in cost between countries were found within the study. Conclusions and Clinical Implications: This study highlights the significant economic impact of kidney stone management on health care systems worldwide. There seem to be significant disparities between costs, and this study shows the social and economic inequalities in health care access, which can differ significantly between private and public health care. These results can aid policymakers to address these disparities and perhaps to learn from other health care providers.

Purpose To investigate the current thoughts and perspectives on kidney stone analysis amongst urologists and urology residents worldwide. Methods In October 2022 an online survey supported by the EULIS was circulated amongst urologists and urology residents worldwide. The survey was based on the current EAU guidelines regarding stone analysis and its role in urolithiasis management. Responses were collected until February 2023. Results The survey was completed by 351 urologists (75.4%) and 115 urology residents (24.7%). 49.1% of the participants stated that performing kidney stone analysis was of utmost importance in every patient. 91.8% were of the opinion that stone analysis changes KSD management. 62.3% of the participants declared to adhere to the guidelines. 44.7% aim to perform stone analysis in first-time stone formers. 1 out of 11 does not send stones for kidney stone analysis at all. Urologists that pursued an additional endo-urology sub-specialism performed stone analysis more frequently compared to those who were not endo-urologists. Conclusion Although majority of urologists consider stone analysis an essential part of kidney stone management, in reality the practice patterns regarding stone analysis deviate from the EAU guidelines. Our aim should be to bridge the knowledge gap regarding stone analysis, foster collaboration to streamline logistics regarding stone analysis and enhance the quality of care we provide for kidney stone patients.

Introduction: Kidney stones in pregnant is not a common emergency, but it is one that is extremely challenging to manage. There exists no previous survey, which maps the different practice patterns adopted. Our aim was to deliver a survey to evaluate the current status of practice patterns across different parts of the world regarding the management of stone disease in pregnancy. Methods: Through an iterative process, 19-item survey was devised. This contained the following five sections: (1) Demographics, (2) General items, (3) Diagnosis and Imaging, (4) Initial management, (5) Surgery. It was disseminated via social media and email chains. Results: A total of 355 responses were collected, and the majority (66.2%) reported no established hospital protocol for stones in pregnancy. Ultrasound was the most popular first line imaging choice (89.9%) but 8% would choose non-contrast CT. The latter was also chosen as second line choicer in 34.6% as opposed to magnetic resonance imaging. A large proportion (42.5%) had requested CT in pregnancy previously. With equivocal ultra sound results, only 19.4% would proceed to ureteroscopy (URS) but 40.9% would opt for CT. Twenty-four–48 hours were the most popular (37.6%) time period to observe before surgical intervention. Ureteral stent and nephrostomy were regarded as equally effective, and 6 weeks was most popular frequency for an exchange. Most do not use fetal heart rate monitoring intraoperatively. A total of 3.94% had previously performed percutaneous nephrolithotomy during pregnancy. Conclusion: Practice patterns vary widely for suspected kidney stones in pregnancy and use of CT appears increasingly popular. This includes when faced with equivocal ultrasound results and instead of proceeding to ureteroscopy. Most hospitals lack an established management protocol for this scenario.

Purpose of Review: Researchers have examined how telemedicine affects endourological patients. This review analyzes the literature to determine telemedicine's benefits and limitations in endourology. Recent Findings: Many studies were devoted to describing the effect of telemedicine on endourological patient satisfaction, optimization of the clinical decision-making among patients with kidney and ureteric stones, the effectiveness of telemedicine in the management of patients with indications for PCNL, follow-up for patients with urolithiasis and describing financial effectiveness for the patients after BOO surgery. The authors describe phone calls, video calls, and online booking platforms as used as telemedicine technology. However, several concerns also exist, such as the necessity of internet connections and appropriate devices, different receptivity among certain subgroups, data safety, and different regulatory environments among countries. Summary: Telemedicine offers the potential to reduce patient travel time, expedite decision-making, and save costs in endourology. However, its everyday implementation is challenging due to various obstacles faced by patients and providers, hindering the realization of its full potential and necessitating a systematic approach to problem-solving.

The purpose of this review is to analyze the trend in optical features and flexibility changes of flexible ureteroscopes over the past decades, and determine the correlation of individual parameters with release period as well as with dimensional parameters. Flexible ureteroscopes mentioned in the literature or those commercially available were searched. To minimize the search bias, the instruments were grouped by release date time-periods of < 2000 year, 2000–2009, 2010–2019, and 2020 onwards. The final review included only those instrument models for which data on minimum and maximum depth of field, field of view, direction of view, and deflection degree had been determined. The correlation among features investigated as well as with release period was also determined. 61 models of flexible ureteroscopes (27 fibreoptic and 34 digital scopes) were included. Among the different features investigated among fiberoptic endoscopes, minimum depth of field positively and negatively correlated with channel size and field of view, respectively, whereas maximum depth of view and field of view positively correlated with overall shaft and deflection degree, respectively. Up and down deflection strongly correlated with each other and both were negatively proportional to the distal tip size. For the digital endoscopes, minimum depth of field negatively and positively correlated with distal tip size and working length, respectively. Maximum depth of field positively correlated with field of view, whereas the latter was negatively proportional to the overall shaft. As for the fiberoptic counterparts, up and down deflection strongly correlated with each other. Field of view, up and down deflection of fiberoptic flexible ureteroscopes, were significantly increased among fiberoptic and digital endoscopes over decades. As flexible ureteroscopy technology has evolved, there has been a trend towards increasing field of view with up and down deflection. Given the importance of scope ergonomics, one aspect of this popularity is the improvement of optical characteristics and deflection degree, which significantly correlates with the release period.

Introduction and Objective: Renal transplantation is the treatment for end-stage renal disease that offers better quality of life and survival. Among the possible complications that might affect allografts, urolithiasis might have severe consequences, causing acute kidney injury (AKI) or septic events in immunocompromised patients. Allograft stones might be treated with percutaneous nephrolithotomy (PCNL). The aim of this Cochrane style review was to assess the safety and efficacy of PCNL in patients with renal transplant. Methods: A comprehensive search in the literature was performed including articles between July 1982 and June 2023, with only English original articles selected for this review. Results: The final review encompassed nine articles (108 patients). The mean age was 46.4 ± 8.7 years, with a male:female ratio of 54:44. The average time from transplantation to urolithiasis onset was 47.54 ± 23.9 months. Predominant symptoms upon presentation were AKI (32.3%), followed by urinary tract infection and fever (24.2%), and oliguria (12.9%). The mean stone size was 20.1 ± 7.3 mm, with stones located in the calices or pelvis (41%), ureteropelvic junction (23.1%), or proximal ureter (28.2%). PCNL (22F–30F) was more frequently performed than mini-PCNLs (16F–20F) (52.4% vs 47.6%). Puncture was guided by ultrasound (42.9%), fluoroscopy (14.3%), or both (42.9%). The stone-free rate (SFR) and complication rates were 92.95% (range: 77%–100%) and 5.5%, respectively, with only one major complication reported. Postoperatively, a ureteral stent and nephrostomy were commonly placed in 47%, with four patients needing a second look PCNL. During an average follow-up of 32.5 months, the recurrence rate was 3.7% (4/108), and the mean creatinine level was 1.37 ± 0.28 mg/dL. Conclusions: PCNL remains a safe and effective option in de novo allograft urolithiasis, allowing to treat large stones in one-step surgery. A good SFR is achieved with a low risk of minor complications. These patients should be treated in an endourology center in conjunction with the renal or transplant team.