Yi Shao

Purpose To determine whether omitting routine indwelling catheterization after ureteroscopic lithotripsy reduces postoperative lower urinary tract symptoms and enhances patient comfort, without compromising safety. Methods In this prospective, multicenter, randomized controlled trial, 180 patients undergoing ureteroscopic lithotripsy from August 2024 to June 2025 at four centers were allocated to either the No-Catheter group (n = 91) or the Catheter group (n = 89). The primary outcome was the incidence of lower urinary tract symptoms (LUTS) evaluated by the Patient Perception of Intensity of Urgency Scale and the Visual Analog Scale for pain at 1 h, 4 h, 1 day postoperatively. Secondary outcomes included complications (fever and urinary retention) and distressing memories assessed at a 1-month follow-up using the Subjective Units of Distress Scale. Results The No-Catheter group had significantly lower LUTS incidence at day 1 (9.9% vs. 24.7%, p = 0.012) and reduced urgency at 1 h and 4 h (p < 0.05). Fewer No-Catheter patients reported distressing LUTS memories at 1 month (7.7% vs. 25.8%, p < 0.001). Complication rates were comparable between groups (p > 0.05). Conclusion Omitting routine indwelling catheterization after ureteroscopic lithotripsy appears to be a safe strategy that significantly reduces postoperative lower urinary tract symptoms and improves the patient experience. These findings support a change in clinical practice away from routine catheterization.

Hyperoxaluria is a recognized risk factor for calcium oxalate nephrolithiasis, often contributing to tubular injury and crystal deposition. This study aimed to investigate the involvement of ferroptosis in hyperoxaluria-induced renal damage and identify key regulatory genes with therapeutic relevance. In vivo and in vitro hyperoxaluria models were established, and ferroptosis-related differentially expressed genes (FRDEGs) were screened via GEO and FerrDb databases. Functional enrichment analyses were conducted using GO and KEGG. CDKN1A was identified as a hub gene through PPI network analysis and subsequently validated in both in vivo and in vitro hyperoxaluria models via RT-qPCR and Western blotting. Concurrently, activation of ferroptosis was observed under hyperoxaluric conditions in both models, as indicated by changes in key ferroptosis markers. In HK-2 cells, CDKN1A expression decreased upon Erastin exposure, and its knockdown enhanced ferroptosis sensitivity, confirming its potential suppressive role. Additionally, analysis of the human dataset GSE73680 revealed a significant upregulation of CDKN1A expression in Randall’s plaques from calcium oxalate stone patients and enrichment of ferroptosis-related pathways, consistent with findings from the mouse dataset, supporting its relevance in crystal-associated pathology. Furthermore, candidate compounds potentially activating CDKN1A were predicted based on GTEx-derived expression profiles. These findings suggest that ferroptosis contributes to hyperoxaluria-associated renal epithelial injury and crystal deposition. CDKN1A may exert a protective role by modulating ferroptosis, providing mechanistic insight into oxalate-induced kidney injury and offering a basis for developing strategies to mitigate the risk of calcium oxalate stone formation.

Objective: The objective of this study is to assess the effectiveness and safety of ureteroscopic lithotripsy and flexible ureteroscopy (fURS) for treating patients on anticoagulant (AC) or antiplatelet (AP) medications. Patients and Methods: The study included 213 patients with urinary stones who underwent ureteroscopic lithotripsy or fURS between January 2019 and October 2022 at the Shanghai Municipal Hospital Urology Specialist Alliance. Among these patients, 15 received AC therapy, 193 received AP therapy, and 5 received both AC and AP therapy. Patients were divided into 3 groups based on the real-world management of antithrombotic drugs: the continuation group (n = 62), the discontinuation group (n = 91), and the discontinuation and bridge heparin group (n = 60). Intraoperative and postoperative outcomes were compared among the 3 groups. Results: Age, sex, body mass index, stone location, stone size, stone side, and residual fragments were not different among the groups. None of the patients received blood transfusions or had thromboembolic events, emergencies for gross hematuria, significant bleeding-related complications, or unplanned secondary ureteroscopic surgery. The mean duration of hospital stay of the continuation group (3.97 days) was significantly lower than that of the discontinuation group (5.99 days) and the discontinuation and bridge heparin group (5.75 days) ( p < 0.001). Conclusions: Ureteroscopic lithotripsy and fURS can be performed safely and effectively in patients on AC or AP drugs, resulting in reduced duration of hospital stay.

Purpose To evaluate the necessity and effectiveness of actively extracting kidney stones with different complexity that have been visually dusted in flexible ureteroscopic lithotripsy (fURL). Methods We retrospectively reviewed the medical records of patients who underwent fURL with dusting technique in established hospitals. A total of 535 cases were divided into the dusting group or the dusting plus basketing group according to the use of stone basket. Their characteristics and operative parameters were collected and analyzed. We used the R.I.R.S. scoring system to classify the complexity of kidney stones and divided these kidney stones into three subgroups, namely, mild-, moderate-, and severe-complexity group. And then, the effectiveness of stone basket in these subgroups was analyzed. Results Although using a stone basket significantly reduced re-operation rate (17.8% in dusting group versus 10.2% in dusting plus basketing group, p = 0.013), no significant difference on stone-free rate (SFR) and overall incidence of complications were noticed between groups. After we classified the complexity of kidney stones using the R.I.R.S. scoring system, we found a stone basket was helpful to improve SFR in kidney stones with moderate-complexity that had been visually dusted in fURL (73.5% in dusting group versus 87.3% in dusting plus basketing group, p = 0.002) but had limited influence on SFR in mild (93.8% in dusting group versus 92.6% in dusting plus basketing group, p = 0.783) or severe (28.5% in dusting group versus 34.0% in dusting plus basketing group, p = 0.598)—complexity kidney stones. Conclusion The use of stone basket should be encouraged in moderate-complexity kidney stones which can be visually dusted in fURL.

Objectives To investigate the role of the oral and gut microbiome related to systemic metabolism and clinical parameters in various types of kidney stone disease. Patients and methods We conducted a case–control study by analyzing 16S rRNA and untargeted metabolomics profiling of 76 fecal, 68 saliva, 73 urine, and 43 serum samples from 76 participants aged 18–75 years old. The participants included 15 patients with uric acid stones, 41 patients with calcium oxalate stones, and 20 healthy controls. Correlations among microbiome, metabolism, and clinical parameters were identified through Spearman’s correlation analysis. (Clinical trial No. ChiCTR2200055316). Results Patients with uric acid stones exhibited reduced richness and diversity in their microbiome, as well as altered composition in both oral and gut microbiome. Furthermore, their fecal samples showed lower relative abundances of Bacteroides and Lachnospiraceae, while their saliva samples showed higher relative abundances of Porphyromonas and Neisseria. Predicted KEGG metabolism pathways, including amino acid and fatty acid metabolisms, were significantly altered in subjects with uric acid stones. Oral, gut microbiota, and metabolism were also associated with low water intake and urine pH. The area under the curve (AUC) of the specific microbiota and metabolite prediction models was over 0.85. Conclusion The structure and composition of the oral and gut microbiome in different types of kidney stone disease, the correlations between oral and gut microbiome, and the associations among oral and gut microbiota, systemic metabolism and clinical parameters imply an important role that the oral and gut microbiome may play in kidney stone disease.

As the most common modification of RNA, N⁶-methyladenosin (m⁶A) has been confirmed to be involved in the occurrence and development of various cancers. However, the relationship between m⁶A and castration resistance prostate cancer (CRPC), has not been fully studied. By m⁶A-sequencing of patient cancer tissues, we identified that the overall level of m⁶A in CRPC was up-regulated than castration sensitive prostate cancer (CSPC). Based on the analysis of m⁶A-sequencing data, we found m⁶A modification level of HRas proto-oncogene, GTPase (HRAS) and mitogen-activated protein kinase kinase 2 (MEK2 or MAP2K2) were enhanced in CRPC. Specifically, tissue microarray analysis and molecular biology experiments confirmed that METTL3, an m⁶A “writer” up-regulated after castration, activated the ERK pathway to contribute to malignant phenotype including ADT resistance, cell proliferation and invasion. We revealed that METTL3-mediated ERK phosphorylation by stabilizing the transcription of HRAS and positively regulating the translation of MEK2. In the Enzalutamide-resistant (Enz-R) C4-2 and LNCap cell line (C4-2^R, LNCap^R) established in the current study, the ERK pathway was confirmed to be regulated by METTL3. We also found that applying antisense oligonucleotides (ASOs) to target the METTL3/ERK axis can restore Enzalutamide resistance in vitro and in vivo. In conclusion, METTL3 activated the ERK pathway and induced the resistance to Enzalutamide by regulating the m⁶A level of critical gene transcription in the ERK pathway.

Purpose To evaluate the management of antithrombotic drugs made by different urologists before ureteroscopic lithotripsy and flexible ureteroscopy in stone patients undergoing active anticoagulant or antiplatelet therapy. Methods A survey was distributed to 613 urologists in China, which included personal work information and views on the management of anticoagulants (AC) or antiplatelet (AP) drugs during the perioperative period of ureteroscopic lithotripsy (URL) and flexible ureteroscopy (fURS). Results 20.5% of urologists believed that AP drugs could be continued and 14.7% believed that AC drugs could be continued. 26.1% of the urologists who participated in more than 100 ureteroscopic lithotripsy or flexible ureteroscopy surgeries each year believed that AP drugs could be continued and 19.1% believed that AC drugs could be continued, compared with 13.6% (P < 0.01) and 9.2% (P < 0.01) of the urologists who performed less than 100 surgeries. Among the urologists with more than 20 cases undergoing active AC or AP therapy per year, 25.9% thought that AP drugs could be continued and 19.7% thought that AC drugs could be continued, compared with 17.1% (P = 0.008) and 11.5% (P = 0.005) of the urologists with less than 20 cases. Conclusion The decision on the continuation of AC or AP drugs before ureteroscopic and flexible ureteroscopic lithotripsy should be individualized. The experience in URL and fURS surgeries and in dealing with patients under AC or AP therapy is the influencing factor.

In some patients, the passage of semi-rigid ureteroscopes up the ureter is impossible due to narrow ureteral lumen. We established a neural network to predict the inability of the ureter to accommodate the semi-rigid ureteroscope and the need for active or passive dilatation using non-contrast computed tomography (CT) images. Data were collected retrospectively from two centers of 1989 eligible patients who underwent ureteroscopic lithotripsy with ureteral stones. Patients were categorized into two groups: control and narrow ureter. The network was designed and trained for predicting a narrow ureter during initial ureteroscopic lithotripsy, which integrated multi-scale features of the ureter. The predictive efficacy of neural networks DenseNet3D, ResNet3D, ResNet3D MC, and TimeSformer was compared. Furthermore, a previous ureteroscopy or a history of double-J stent placement, ureteral wall thickness and Hounsfield unit (HU) density of the ureter under the stone were compared. Model performance was assessed based on the accuracy, area under the receiver operating characteristic curve (AUC ROC), etc. The DenseNet3D-based network achieved an AUC ROC score of 0.884 and an accuracy of 85.29%, followed by the ResNet3D-based network, the ResNet3D MC-based network, and the TimeSformer-based network. The DenseNet3D-based network significantly outperformed other candidate predictors. Furthermore, the networks were validated in an external test set. Decision curve analysis showed the clinical utility of the neural network. The neural network provides an individualized preoperative prediction of narrow ureter based on non-contrast CT images, which could be employed as part of a surgical decision-making support system.