Ureteral Calculi

PurposeTo describe the change in upper urinary tract stone management in Germany over a 14-year period.MethodsUsing remote data processing we analyzed the nationwide German billing data from 2006 to 2019. To analyze the clinics' case numbers and regional trends, we used the reimbursement.INFO tool based on standardized quality reports of all German hospitals. To also cover shock wave lithotripsy (SWL) as an outpatient procedure, we analyzed the research database of the Institute for Applied Health Research with a representative anonymous sample of 4 million insured persons.ResultsThe number of inpatient interventional therapies for upper tract urolithiasis in Germany increased from 70,099 cases in 2006 to 94,815 cases in 2019 (trend p ConclusionWe observed an increase in interventional therapy for upper tract urolithiasis in Germany with a dramatic shift from SWL to endoscopic/percutaneous treatment. These changes may be attributed to enormous technological advances of the endoscopic armamentarium and to reimbursement issues.

The objectives were to develop and validate a Convolutional Neural Network (CNN) using local features for differentiating distal ureteral stones from pelvic phleboliths, compare the CNN method with a semi-quantitative method and with radiologists' assessments and to evaluate whether the assessment of a calcification and its local surroundings is sufficient for discriminating ureteral stones from pelvic phleboliths in non-contrast-enhanced CT (NECT). We retrospectively included 341 consecutive patients with acute renal colic and a ureteral stone on NECT showing either a distal ureteral stone, a phlebolith or both. A 2.5-dimensional CNN (2.5D-CNN) model was used, where perpendicular axial, coronal and sagittal images through each calcification were used as input data for the CNN. The CNN was trained on 384 calcifications, and evaluated on an unseen dataset of 50 stones and 50 phleboliths. The CNN was compared to the assessment by seven radiologists who reviewed a local 5 × 5 × 5 cm image stack surrounding each calcification, and to a semi-quantitative method using cut-off values based on the attenuation and volume of the calcifications. The CNN differentiated stones and phleboliths with a sensitivity, specificity and accuracy of 94%, 90% and 92% and an AUC of 0.95. This was similar to a majority vote accuracy of 93% and significantly higher (p = 0.03) than the mean radiologist accuracy of 86%. The semi-quantitative method accuracy was 49%. In conclusion, the CNN differentiated ureteral stones from phleboliths with higher accuracy than the mean of seven radiologists' assessments using local features. However, more than local features are needed to reach optimal discrimination.

BackgroundUpper urinary tract stones is the most common diseases in urology. Percutaneous nephrolithotomy (PCNL) and ureteroscopic lithotripsy (fURL) are common treatment, but both their efficacy and safety are controversial. Thus we aim to evaluate the efficacy and safety of PCNL and fURL in the treatment of upper urinary tract stones, providing a reference for clinical work.MethodsPubMed, Web of Science, Embase and CNKI were searched through Apr. 1, 2019 to identify eligible studies. Data were analyzed by using RevMan 5.3 and Stata 12.0 software. Pooled relative risks (RRs) or weighted mean difference (WMD) with 95% confidence intervals (CIs) were calculated using fixed or random effects methods. Publication bias and sensitivity analysis were performed.ResultsFour randomized controlled trials (RCTs), fifteen cohort studies involving 1822 patients were included. Stone-free rate of PCNL was significantly high than that of fURL (RR: 1.07; 95% CI: 1.03, 1.12; P = 0.0004). The decline of hemoglobin in PCNL was significantly high than that of fURL (WMD: 1.07; 95% CI: 0.54, 1.61; P ConclusionsIn the treatment of upper urinary tract stones, the stones clearance rate of PCNL is higher than fURL, and the safety of fURL is higher than PCNL.

PURPOSE: In this scoping review, we mapped the available clinical evidence on the use of double-J (DJ) ureteral stents in pediatric patients across reconstructive, stone-related, and other endourological indications, synthesizing contemporary data on techniques, sizing, dwell time, removal strategies, outcomes, and emerging technologies. METHODS: A scoping review was conducted in accordance with the PRISMA Extension for Scoping Reviews (PRISMA-ScR). The review protocol was prospectively registered in PROSPERO (CRD420251147003). PubMed, Scopus, Cochrane Library, and Web of Science were searched without date limits to 9 September 2025. Original clinical studies on double-J (DJ) ureteral stents in children were screened, data were extracted into a harmonized database, and risk of bias was appraised using RoB 2, ROBINS-I, or the Joanna Briggs Institute checklist as appropriate. RESULTS: Fifty studies (2003–2025) were included. In reconstruction, internal DJ and externalized stents achieved similar success after pyeloplasty; externalized options commonly enabled office removal without general anesthesia (GA) but often increased length of stay and/or operating time. During ureteroneocystostomy for vesicoureteral reflux, routine stenting was associated with worse adjusted short-term outcomes; these findings are consistent with selective use. In stone disease, routine pre-stenting before ureteroscopy or extracorporeal shock-wave lithotripsy did not improve stone-free rates and increased infectious morbidity; when performed, a short dwell time (~ 2 weeks) was adequate. Across indications, modifiable drivers of morbidity included prolonged dwell, bilateral placement, and multiple lifetime stents. Practical aids included the “Age + 10 cm” length rule and strategies that reduce GA exposure (e.g., stent-on-string with disciplined protocols). Magnetic DJ systems showed high outpatient retrieval success with familiar complication profiles, while anti-biofilm/anti-encrustation coatings remain promising but require pediatric clinical validation. CONCLUSION: Pediatric ureteral stenting practices vary widely across indications. The mapped literature suggests broadly comparable success between internal and externalized stents in reconstruction, while highlighting the importance of dwell time, anesthesia exposure, and individualized decision-making. In stone disease, routine pre-stenting does not appear to confer consistent benefit. Overall, careful patient selection, planned dwell duration, and structured follow-up remain central to optimizing outcomes, while prospective multicenter studies are needed to strengthen the evidence base.