SWL Blog - The shock wave lithotripsy literature database

Seitz C, Türk C, Neisius A.
Universitätsklinik für Urologie, Medizinische Universität Wien, Allgemeines Krankenhaus der Stadt Wien, Währinger Gürtel 18-20, 1090, Wien, Österreich.
Urologische Praxis mit Steinzentrum Wien, Urologische Abteilung, Barmherzige Schwestern Krankenhaus Wien, Wien, Österreich.
Abteilung für Urologie und Kinderurologie, Krankenhaus der Barmherzigen Brüder, Trier, Deutschland.

Jagtap N, Tandan M, Reddy DN.
Department of Medical Gastroenterology, Asian Institute of Gastroenterology, Hyderabad, India.

Jiang P, Xie L, Arada R, Patel RM, Landman J, Clayman RV.
Department of Urology, University of California, Irvine.

Yuan C, Jian Z, Jin X, Ma YC, Li H, Wang KJ.
Department of Urology, Institute of Urology (Laboratory of Reconstructive Urology), West China Hospital, Sichuan University, Chengdu, People's Republic of China.

Azal Neto W, Reis LO, Pedro RN.
Department of Urology, State University of Campinas, Unicamp, Campinas, Brazil.
Department of UroScience, Pontifical Catholic University of Campinas, PUC-Campinas, Campinas, Brazil.

Di Franco CA, Burrello M, Guzzardi F, Intagliata E, Oxenius I, Galvagno L, Cordaro C.
Department of Urology, S. Elia Emergency Hospital, Caltanissetta.

Seker KG, Arikan Y, Cetin Seker Y, Ozlu DN, Evren I.
Urology, Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Istanbul, TUR.
Emergency Medicine, Muş State Hospital, Muş, TUR.
Urology, Bakirkoy Dr. Sadi Konuk Training and Research Hospital, İstanbul, TUR.

Popov SV, Orlov IN, Asfandiyarov FR, Skryabin ON, Suleymanov MM, Sytnik DA.
Department of Urology of FGBOU VO North-Western State Medical University named after I.I. Mechnikov, GBUZ Public Hospital of Saint Luca, Saint Petersburg, Russia.
2Astrakhan State Medicine University, Astrakhan, Russia.

Lai S, Jiao B, Diao T, Seery S, Hu M, Wang M, Hou H, Wang J, Zhang G, Liu M.
Department of Urology, Beijing Hospital, Beijing, 100730, China; National Center of Gerontology, Beijing, 100730, China; Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, 100730, China; Graduate School of Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, 100730, China.
Graduate School of Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, 100730, China; Department of Urology, China-Japan Friendship Hospital, Beijing, 100029, China.
Department of Urology, Beijing Hospital, Beijing, 100730, China; National Center of Gerontology, Beijing, 100730, China; Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, 100730, China; Peking University Fifth School of Clinical Medicine, China.
School of Humanities and Social Sciences, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, China.
Department of Urology, Beijing Hospital, Beijing, 100730, China; National Center of Gerontology, Beijing, 100730, China; Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, 100730, China.
Department of Urology, Beijing Hospital, Beijing, 100730, China; National Center of Gerontology, Beijing, 100730, China; Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, 100730, China; Graduate School of Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, 100730, China.
Graduate School of Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, 100730, China; Department of Urology, China-Japan Friendship Hospital, Beijing, 100029, China.
Department of Urology, Beijing Hospital, Beijing, 100730, China; National Center of Gerontology, Beijing, 100730, China; Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, 100730, China; Graduate School of Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, 100730, China.

Abstract

Background: The aims of this study were to determine the predictive value of decision support analysis for the shock wave lithotripsy (SWL) success rate and to analyze the data obtained from patients who underwent SWL to assess the factors influencing the outcome by using machine learning methods.

Methods: We retrospectively reviewed the medical records of 358 patients who underwent SWL for urinary stone (kidney and upper-ureter stone) between 2015 and 2018 and evaluated the possible prognostic features, including patient population characteristics, urinary stone characteristics on a non-contrast, computed tomographic image. We performed 80% training set and 20% test set for the predictions of success and mainly used decision tree-based machine learning algorithms, such as random forest (RF), extreme gradient boosting trees (XGBoost), and light gradient boosting method (LightGBM).

Results: In machine learning analysis, the prediction accuracies for stone-free were 86.0, 87.5, and 87.9%, and those for one-session success were 78.0, 77.4, and 77.0% using RF, XGBoost, and LightGBM, respectively. In predictions for stone-free, LightGBM yielded the best accuracy and RF yielded the best one in those for one-session success among those methods. The sensitivity and specificity values for machine learning analytics are (0.74 to 0.78 and 0.92 to 0.93) for stone-free and (0.79 to 0.81 and 0.74 to 0.75) for one-session success, respectively. The area under curve (AUC) values for machine learning analytics are (0.84 to 0.85) for stone-free and (0.77 to 0.78) for one-session success and their 95% confidence intervals (CIs) are (0.730 to 0.933) and (0.673 to 0.866) in average of methods, respectively.

Conclusions: We applied a selected machine learning analysis to predict the result after treatment of SWL for urinary stone. About 88% accurate machine learning based predictive model was evaluated. The importance of machine learning algorithm can give matched insights to domain knowledge on effective and influential factors for SWL success outcomes.
BMC Urol. 2020 Jul 3;20(1):88. doi: 10.1186/s12894-020-00662-x. PMID: 32620102. FREE ARTICLE

Saraogi M, Geraghty RM, Hameed B, Rob S, Pietropaolo A, Sarica K, Gozen A, Liatsikos E, Somani BK.
Faculty of Life and Environmental Sciences, University of Southampton, United Kindom.
Department of Urology, University hospital Newcastle, United Kindom.
Department of Urology, Kasturba Medical College Manipal, Manipal Academy of Higher Education (MAHE), Karnataka, India.
Department of Urology, University Hospital Southampton NHS Trust, United Kindom.
Department of Urology, Biruni University Medical School, Istanbul, Turkey.
Department of Urology, Klinikum Heilbronn, Heilbronn, Germany.
Department of Urology, University of Patras, Patras, Greece.
Department of Urology, University Hospital Southampton NHS Trust, United Kindom.

Raheem OA, Natale C, Dick B, Reddy AG, Yousif A, Khera M, Baum N.
Tulane University School of Medicine, Department of Urology, New Orleans, LA, USA.
Tulane University School of Medicine, Department of Urology, New Orleans, LA, USA.
Scott Department of Urology, Baylor College of Medicine, Houston, TX, USA.

Gadelkareem RA, Abdelsalam YM, Ibraheim MA, Reda A, Sayed MA, El-Azab AS.J.
Assiut Urology and Nephrology Hospital, Faculty of Medicine, Assiut University, Assiut, Egypt.
Department of Urology, Armed Forces Medical Complex, Cairo, Egypt.

Peng L, Wen J, Zhong W, Zeng G.
Urology, the First Affiliated Hospital of Guangzhou Medical University, Kangda Road 1, Haizhu District, Guangzhou, 510230, China.
Guangdong Key Laboratory of Urology, Kangda Road 1, Haizhu District, Guangzhou, 510230, China.
Guangzhou Institute of Urology, Kangda Road 1, Haizhu District, Guangzhou, 510230, China.
Guangzhou Medical University, Guangzhou, China.
Urology, the First Affiliated Hospital of Guangzhou Medical University, Kangda Road 1, Haizhu District, Guangzhou, 510230, China.
Guangdong Key Laboratory of Urology, Kangda Road 1, Haizhu District, Guangzhou, 510230, China.
Guangzhou Institute of Urology, Kangda Road 1, Haizhu District, Guangzhou, 510230, China.
Urology, the First Affiliated Hospital of Guangzhou Medical University, Kangda Road 1, Haizhu District, Guangzhou, 510230, China.
Guangdong Key Laboratory of Urology, Kangda Road 1, Haizhu District, Guangzhou, 510230, China.
Guangzhou Institute of Urology, Kangda Road 1, Haizhu District, Guangzhou, 510230, China. 

Soliman MG, Gameel T, El-Tatawy H, El-Abd AS.
Urology Department, Faculty of Medicine, Tanta University, Tanta, Egypt.
Urology Department, Faculty of Medicine, Tanta University, Tanta, Egypt.

Palmieri A, Arcaniolo D, Palumbo F, Verze P, Liguori G, Mondaini N, Falcone M, Scroppo FI, Salonia A, Cai T.
Department of Urology, University Federico II, Naples, Italy.
Department of Urology, University Vanvitelli, Naples, Italy.
San Giacomo Hospital, Monopoli, Bari, Italy.
Department of Urology, University of Trieste, Trieste, Italy.
Urology Unit, Nuovo San Giovanni di Dio Hospital, Florence, Italy.
Department of Urology, University of Turin, Turin, Italy.
Urology Unit, Ospedale di Circolo di Varese, Varese, Italy.
Department of Urology, University Vita e Salute, San Raffaele, Milan, Italy.
Department of Urology, Santa Chiara Regional Hospital, Trento, Italy.

Vinay J, Moreno D, Rajmil O, Ruiz-Castañe E, Sanchez-Curbelo J.
Andrology Department, Fundació Puigvert/Universidad Autònoma de Barcelona, Carrer de Cartagena, 340-350, 08025, Barcelona, Spain.
Urology Department, University of Chile Clinical Hospital, Santiago, Chile.
Andrology Unit, Shady Grove Fertility, Santiago, Chile.
Andrology Department, Fundació Puigvert/Universidad Autònoma de Barcelona, Carrer de Cartagena, 340-350, 08025, Barcelona, Spain.

Wang T, Xia Q, Chen X, Jin X.
Department of Urology, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, Shandong, People's Republic of China.

Jaben IL, Cote GA, Forster E, Moran RA, Broussard KA, Scott N, Cotton PB, Keane T, Elmunzer BJ.
Division of Gastroenterology and Hepatology, Medical University of South Carolina, Charleston, South Carolina; Department of Internal Medicine, Medical University of South Carolina, Charleston, South Carolina.
Division of Gastroenterology and Hepatology, Medical University of South Carolina, Charleston, South Carolina.
Department of Internal Medicine, Medical University of South Carolina, Charleston, South Carolina.
NextMed Management Services, Tucson, Arizona.
Department of Urology, Medical University of South Carolina, Charleston, South Carolina.
Division of Gastroenterology and Hepatology, Medical University of South Carolina, Charleston, South Carolina.

Manzoor H, Saikali SW.
Mayo Hospital Lahore
Clemenceau Medical Center

Grivas N, Thomas K, Drake T, Donaldson J, Neisius A, Petřík A, Ruhayel Y, Seitz C, Türk C, Skolarikos A.
Department of Urology, G.Hatzikosta General Hospital, Ioannina, Greece; Department of Urology, The Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, Netherlands.
Department of Urology, Guy's and St Thomas' NHS Foundation Trust, The Stone Unit, London, UK.
Department of Urology, Southmead Hospital, Bristol, UK.
Department of Urology, Aberdeen Royal Infirmary, Aberdeen, Scotland, UK.
Department of Urology, Hospital of the Brothers of Mercy Trier, Johannes Gutenberg University Mainz, Trier, Germany.
Department of Urology, Region Hospital, Ceske Budejovice, Czech Republic; Dept. of Urology, First Faculty of Medicine, Charles University in Prague, Prague, Czech Republic.
Department of Urology, Skåne University Hospital, Malmö, Sweden.
Department of Urology, Vienna General Hospital, Medical University of Vienna, Vienna, Austria.
Department of Urology, Hospital of the Sisters of Charity, Vienna, Austria; Urologische Praxis Mit Steinzentrum, Vienna, Austria.
Second Department of Urology, Sismanoglio Hospital, National and Kapodistrian University of Athens, Athens, Greece.

van Huijgevoort NCM, Veld JV, Fockens P, Besselink MG, Boermeester MA, Arvanitakis M, van Hooft JE.
Department of Gastroenterology and Hepatology, Amsterdam Gastroenterology and Metabolism, Amsterdam UMC, location AMC, Amsterdam, The Netherlands.
Department of Surgery, Amsterdam Gastroenterology and Metabolism, Amsterdam UMC, location AMC, Amsterdam, The Netherlands.
Department of Gastroenterology and Hepatology, Erasme University Hospital, Université Libre de Bruxelles, Brussels, Belgium.

Randad A, Ghanem MA, Bailey MR, Maxwell AD.
Center for Industrial and Medical Ultrasound, Applied Physics Laboratory, University of Washington, 1606 San Juan Road, Seattle, Washington 98195, USA.

Kalatharan V, Jandoc R, Grewal G, Nash DM, Welk B, Sarma S, Pei Y, Garg AX.
Department of Epidemiology & Biostatistics, Western University, London, ON, Canada.
ICES, London, ON, Canada.
Division of Nephrology, University Health Network and University of Toronto, ON, Canada.
Division of Nephrology, Department of Medicine, Western University, London, ON, Canada.

Cassell A 3rd, Jalloh M, Ndoye M, Mbodji M, Gaye O, Thiam NM, Diallo A, Labou I, Niang L, Gueye S.
Department of Urology and Andrology, Hospital General De Grand Yoff, Dakar, Senegal.
2Department of Surgery, Liberia College of Physicians and Surgeons, Monrovia, Liberia.

Golan R, Cooper KL, Shah O.
Department of Urology, Columbia University Medical Center-NewYork-Presbyterian New York, NY.

Browne C, Redmond E, Kelly T, Rogers E, O'Malley P, Nusrat N, Jaffry S, Durkan G, Walsh K, Dowling C, D'Arcy FT.
Department of Urology, University College Hospital Galway, Newcastle Road, Galway, Ireland.
Department of Urology, University College Hospital Galway, Newcastle Road, Galway, Ireland.

Türer ÖB, Soyer T, Parlak E, Özcan HN, Bilen CY, Tanyel FC. Turk J.
Departments of Pediatric Surgery, Hacettepe University Faculty of Medicine, Ankara, Turkey.
Departments of Gastroenterology, Hacettepe University Faculty of Medicine, Ankara, Turkey.
Departments of Radiology, Hacettepe University Faculty of Medicine, Ankara, Turkey.
Departments of Urology, Hacettepe University Faculty of Medicine, Ankara, Turkey.

Abstract

Background: Over the last 30 years, the incidence of pediatric urolithiasis (PU) has been increasing and the surgical management has evolved toward a minimally invasive approach (MIA). We reported the experience of two Centers of Pediatric Surgery in the management of PU, focusing on MIA as first choice in treatment.

Methods: Data were retrospectively analyzed from October 2009 to October 2019 in children with urolithiasis who were admitted to two referral Italian Centers of Pediatric Surgery. Demographic and clinical data of the patients, features of the urolithiasis, type of surgery were considered.

Results: Seventy patients (7.3 ± 5.0 years) with normal renal function were treated for calculi in the pyelocaliceal system (45.7%), ureter (34.3%), bladder (4.3%), urethra (1.4%), and multiple locations (14.3%). Size of calculi was >10 mm in 55.7% of cases (kidney>bladder/urethra>multiple>ureter, p = 0.01). Symptoms were present in 75.7% of patients. Family history was positive in 16.9% of cases. MIA was performed in 59 patients (84.3%): 11.8% shockwave lithotripsy (kidney>ureter>multiple); 32.2% ureteral retrograde surgery (ureteral>other localizations); 30.5% retrograde intrarenal surgery (kidney>other localizations); and 25.4% other procedures including percutaneous nephrolithotomy, cystoscopic bladder stone removal or laser cystolithotripsy (kidney>bladder>multiple). Preoperative stenting was necessary in 52.8% of cases. Four MIA procedures (6.9%, kidney>ureter/multiple) were converted to open surgery. Open surgery was required as first approach in 15.7% of patients (kidney>ureter>multiple) who needed urgent surgery or had associated congenital renal anomalies. In 18/70 of children (25.7%), with prevalence of stones in kidney and multiple location (p < 0.01), a second procedure completed the treatment (88.8% MIA). Intraoperative difficulties were recorded in 8.5% of cases, without difference between location and size of calculi. Late complications (5.7%) were related to displacement and infection of the ureteral stent.

Conclusions: MIA resulted to be feasible in more than 75% of primary surgery and in more than 85% of cases requiring a second procedure. Preoperative stent was mandatory in more than 50% of children. The technological evolution allowed to overcome many of the technical difficulties related to the approach to the papilla and lower calyxes. Open surgery is reserved for selected cases and endoscopic surgery represents the best choice of treatment for PU.
Front Pediatr. 2020 Jul 24;8:377. doi: 10.3389/fped.2020.00377. eCollection 2020. PMID: 32793523. FREE ARTICLE

Ang AJS, Sharma AA, Sharma A.
Yong Loo Lin School of Medicine, Singapore, Singapore.
Johns Hopkins University, Baltimore, USA.
Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.

Chen JX, Wang CY.
Department of Urology, Jiangshan People's Hospital/Jiangshan Branch of Sir Run Run Shaw Hospital of Zhejiang University, Jiangshan 324100, China.

Larrazabal RJB, Chiu HHC, Sandoval MAS.
Department of Medicine, Philippine General Hospital, University of the Philippines Manila, Manila, National Capital Region, Philippines.
Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, Philippine General Hospital, University of the Philippines Manila, Manila, National Capital Region, Philippines.
Division of Endocrinology, Diabetes and Metabolism, Department of Physiology, College of Medicine and Philippine General Hospital, University of the Philippines Manila, Manila, National Capital Region, Philippines.

Yoshioka T, Omae K, Kawada T, Inoue Y, Sugimoto M, Oeda T, Uehara S, Araki M, Fukuhara S.
1Center for Innovative Research for Communities and Clinical Excellence (CiRC2LE), Fukushima Medical University, Fukushima 960-1295, Japan.
2Department of Healthcare Epidemiology, Kyoto University School of Public Health in the Graduate School of Medicine, Kyoto 606-8501, Japan.
3Department of Innovative Research and Education for Clinicians and Trainees (DiRECT), Fukushima Medical University, Fukushima 960-1295, Japan.
4Department of Urology, Onomichi Municipal Hospital, Hiroshima 722-8503, Japan.
5Department of Urology, Hiroshima City Hiroshima Citizens Hospital, Hiroshima 730-8519, Japan.
6Department of Urology, Kawasaki Medical School General Medical Center, Okayama 700-8505, Japan.
7Department of Urology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama 700-8558, Japan.

Prosyannikov MY, Zolotuhin OV, Madykin YY, Konstantinova OV, Voytko DA, Anokhin NV, Sivkov AV.
Department of urolithiasis of N.A. Lopatkin Scientific Research Institute of Urology and Interventional Radiology Branch of the National Medical Research Centre of Radiology of the Ministry of Health of Russian Federation, Moscow, Russia.
Voronezh regional hospital 1, chief urologist of the Voronezh region, Voronezh, Russia.
VGMU of. N. N. Burdenko, Voronezh, Russia.

Gul A, Gul M.
Department of Urology, University of Health Science, Bursa Yuksek Ihtisas Training and Research Hospital, 16100, Bursa, Turkey.
Department of Urology, Aksaray University School of Medicine, 68100, Aksaray, Turkey.
Laboratory of Reproductive Biology, Section 5701, Copenhagen University Hospital Rigshospitalet, University of Copenhagen, 2100, Copenhagen, Denmark.

Kırlı EA, Türegün FA, Selçuk B, Gültekin MH, Tansu N, Erözenci A, Önal B.
Does Previous Open Stone Surgery Affect the Outcome of Shock Wave Lithotripsy Treatment in Children?

Friedlander DF, Brant A, McClure TD, Del Pizzo J, Nowels MA, Trinh QD, Sedrakyan A, Chughtai B.
Brigham and Women's Hospital, Division of Urological Surgery, Harvard Medical School, Boston, MA, USA.
Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
Department of Urology, Weill Cornell Medical College, New York-Presbyterian Hospital, New York, NY, USA.
Department of Urology, Weill Cornell Medical College, New York-Presbyterian Hospital, New York, NY, USA.

Grabsky AM, Minasyan GM, Khachatryan YA, Martirosyan SA, Toqmajyan MG, Tadevosyan GG, Shadyan GG, Qocharyan AA, Shindyan IM.
Urological Clinic of Izmirlian Medical Center, Yerevan, Armenia.

Belmir H, Azghari A, Sedki N.J.
Department of Vascular Surgery, Mohammed VI University of Health Sciences, Casablanca, Morocco.
Department of Vascular Surgery, Mohammed V University, Rabat, Morocco.
Department of Vascular Surgery, Cheikh Zaid Hospital, Rabat, Morocco.

Zhao FZ, Li J, Tang L, Li CM, Zhang Y, Wang WY, Chen N, Tian Y.J .
Department of Urology, Capital Medical University Affiliated Beijing Friendship Hospital, Beijing, 100050, PR China.

Sonmez G, Demir F, Keske M, Karadag MA, Demirtaş A.J.
Department of Urology, Erciyes University, Kayseri, Turkey.
Department of Urology, Kayseri City Hospital, Kayseri, Turkey.

Yang B, Veneziano D, Somani BK.
Royal Hampshire Hospital, Winchester, UK.
Department of Urology and Kidney Transplant, GOM, Reggio Calabria, Italy.
University Hospital Southampton NHS Trust, UK.

Cui HW, Tan TK, Christiansen FE, Osther PJS, Turney BW.
Oxford Stone Group, University of Oxford, Oxford, UK.
Ninewells Hospital and Medical School, University of Dundee, Dundee, DD1 9SY, UK.
Department of Urology, Urological Research Center, Lillebaelt Hospital, University of Southern Denmark, Vejle, Denmark.
Oxford Stone Group, University of Oxford, Oxford, UK.

Harper JD, Metzler I, Hall MK, Chen TT, Maxwell AD, Cunitz BW, Dunmire B, Thiel J, Williams JC Jr, Bailey MR, Sorensen MDJ.
University of Washington, Department of Urology, 1959 NE Pacific Street, Box 356510, Seattle, Washington, United States.
University of Washington School of Medicine, 12353, Department of Urology, Seattle, Washington, United States.
University of Washington School of Medicine, 12353, Department of Emergency Medicine, Seattle, Washington, United States.
University of Washington, Urology, 1959 NE Pacific St., BB-1121, Box 356510, Seattle, Washington, United States.
Duke University Medical Center, Urology, DUMC 3167, Durham, North Carolina, United States.
University of Washington School of Medicine, 12353, Department of Urology, 1013 NE 40th St, Seattle, Washington, United States.
7University of Washington Applied Physics Lab, Center for Industrial and Medical Ultrasound, 1013 NE 40th ave, Seattle, Washington, United States.
University of Washington, Applied Physics Lab, 1013 NE 40th St, Seattle, Washington, United States.
University of Washington School of Medicine, Radiology, Seattle, Washington, United States.
Indiana Univ Sch Med, Anatomy & Cell Biology, 635 Barnhill Dr MS5035, Department of Anatomy & Cell Biology, Indianapolis, Indiana, United States.
University of Washington, Center for Industrial and Medical Ultrasound, Applied Physics Laboratory, 1013 NE 40th St., Seattle, Washington, United States.
University of Washington, Department of Urology, 1959 NE Pacific Street, Box 356510, Seattle, Washington, United States

Liao B, Mou XX, Liu JB, Wu T, Cui S.Zhonghua Nan Ke Xue.
Department of Urology, The Affiliated Hospital of North Sichuan Medical College, Nanchong, Sichuan 637000, China.

Kızılay F, Özdemir T, Turna B, Karaca N, Şimşir A, Alper I, Nazlı O.
Departments of Urology, Ege University Faculty of Medicine, İzmir, Turkey.
Departments of Anaesthesiology, Ege University Faculty of Medicine, İzmir, Turkey.

Abstract

Technological advances in minimally invasive treatment of stone disease and its integration with concomitant clinical practice are amongst the most important achievements in urology. Despite the wealth of information accumulated over the years and the richness of existing literature, the knowledge about the definition, treatment and outcomes of residual stone fragments after percutaneous nephrolithotomy (PNL) is still insufficient. Due to the high stone load a lot of patients with staghorn stones have residual fragments (RFs) after treatment with PNL, which depends on the size of tract, definition of stone free rate (SFR), timing of evaluation and the imaging used. No consensus exists on the imaging modality or their timing in the evaluation of possible RFs. The treatment of residual stones is apparently different depending on the facilities of the department and the preference of the surgeon, which includes active surveillance, shock wave lithotripsy (SWL), retrograde intrarenal surgery (RIRS) or a second look PNL.
Asian J Urol. 2020 Apr;7(2):116-121. doi: 10.1016/j.ajur.2019.12.013. Epub 2019 Dec 31. PMID: 32257804. FREE ARTICLE

Aditya I, Kwong JCC, Krakowsky Y, Grober ED.
Faculty of Medicine, University of Toronto, Toronto, ON, Canada.
Division of Urology, Department of Surgery, Women's College Hospital & Mount Sinai Hospital, University of Toronto, Toronto, ON, Canada.

Yoshioka T, Omae K, Kawada T, Inoue Y, Sugimoto M, Oeda T, Yamasaki T, Fujio K, Otsuki H, Uehara S, Araki M, Fukuhara.
Center for Innovative Research for Communities and Clinical Excellence (CiRC2LE), Fukushima Medical University, Fukushima, Japan.
Department of Healthcare Epidemiology, Kyoto University School of Public Health in the Graduate School of Medicine, Kyoto, Japan.
Center for Innovative Research for Communities and Clinical Excellence (CiRC2LE), Fukushima Medical University, Fukushima, Japan.
Department of Healthcare Epidemiology, Kyoto University School of Public Health in the Graduate School of Medicine, Kyoto, Japan.
Department of Innovative Research and Education for Clinicians and Trainees (DiRECT), Fukushima Medical University, Fukushima, Japan.
Department of Urology, Onomichi Municipal Hospital, Hiroshima, Japan.
Department of Urology, Hiroshima City Hiroshima Citizens Hospital, Hiroshima, Japan.
Department of Urology, Abiko Toho Hospital, Chiba, Japan.
Department of Urology, Kawasaki Medical School General Medical Center, Okayama, Japan.
Department of Urology, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Japan.

Abstract

Purpose: To identify the role of Doppler US (DUS) in the prediction of factors affecting stone-clearance post-SWL for ureteral stones in addition to its role in prediction of pretreatment stone impaction.

Methods: We prospectively included patients with ureteric stone for SWL between October 2018 and September 2019. Patient's demographics were collected. Using DUS, resistive index (RI), Δ RI, and ureteric jets were evaluated in both kidneys. Also, stone site, volume, density, skin to stone distance, degree of hydronephrosis, ureteral wall thickness (UWT) were evaluated by NCCT. Univariate and multivariate logistic regression analyses were performed to identify factors that contribute to treatment success. Correlation between ipsilateral RI with other radiological findings predicting stone impaction was done.

Results: A total of 93 patients were finally included (61 males and 32 females). The mean age was 31.4 ± 7.7 years. The success rate (absence of significant residuals post 1 month by NCCT) was 51.6%. In multivariate analysis, the presence of ureteric jet, ipsilateral lower RI, and ipsilateral lower UWT were independent factors for treatment success (P = 0.0001, 0.002, and 0.03, respectively). Also, ipsilateral absence of ureteric jet, increased hydronephrosis, and increased UWT were correlated with higher ipsilateral RI in prediction of stone impaction. Ipsilateral higher RI was found to achieve higher accuracy in stone impaction prediction (PPV of 94.8%).

Conclusion: Pretreatment DUS is a useful, non-invasive with a less irradiative tool for prediction of stone impaction and stone-free rate post-SWL for ureteric stones.

Minerva Urol Nefrol. 2020 Apr 16. doi: 10.23736/S0393-2249.20.03792-3. Online ahead of print. PMID: 32298068.

Jdaini A, Aynaou M, Irzi M, Mhanna T, El Farhaoui H, Barki A.
Department of Urology, Mohammed IV University Medical Center, Mohammed the First University Oujda, Morocco.

Dhawan S, Olweny EO.
Rutgers-Robert Wood Johnson Medical School, Piscataway, New Jersey, USA.

Turan T, Isman FK, Efiloğlu Ö, Genc Kahraman N, Şendoğan F, Danacioğlu YO, Atis RG, Yildirim A.
Department of Urology, Istanbul Medeniyet University, Istanbul, Turkey.
Department, of Biochemistry, Istanbul Medeniyet University, Istanbul, Turkey.
Department of Urology, Istanbul Bakirkoy Dr. Sadi Konuk Education Research Hospital, Istanbul, Turkey.

Lorio E, Patel P, Rosenkranz L, Patel S, Sayana H.
Department of Internal Medicine, UT Health San Antonio - Long School of Medicine, San Antonio, TX, 78229-3900, USA.
Division of Gastroenterology & Nutrition, Department of Medicine, UT Health San Antonio - Long School of Medicine, MC 7878, 7703 Floyd Curl Dr., San Antonio, TX, 78229-3900, USA.
Division of Gastroenterology & Nutrition, Department of Medicine, UT Health San Antonio - Long School of Medicine, MC 7878, 7703 Floyd Curl Dr., San Antonio, TX, 78229-3900, USA.

Maxwell AD, MacConaghy B, Bailey MR, Sapozhnikov OA.
Department of Urology, University of Washington School of Medicine, 1959 Northeast Pacific Street, Seattle, Washington 98195, USA.
Center for Industrial and Medical Ultrasound, Applied Physics Laboratory, University of Washington, Seattle, Washington 98105, USA.
Department of Acoustics, Physics Faculty, Lomonosov Moscow State University, Leninskie Gory, Moscow 119992, Russia.

Hyun JJ, Irani SS, Ross AS, Larsen MC, Gluck M, Kozarek RA.
Department of Internal Medicine, Korea University Ansan Hospital, Ansan, Korea.
Digestive Disease Institute, Virginia Mason Medical Center, Seattle, WA, USA.

Kartal I, Baylan B, Çakıcı MÇ, Sarı S, Selmi V, Ozdemir H, Yalçınkaya F.
Department of Urology, Dıskapı Yıldırım Beyazıt Training and Research Hospital, Health Sciences University, Ankara.

Huang Y, Chai S, Wang D, Li W, Zhang X.
Department of Urology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China.

Gao X, Fang Z, Lu C, Shen R, Dong H, Sun Y.
Department of Urology, Changhai Hospital, Second Military Medical University, Shanghai, China.

Nesheiwat Z, Sheikh T, Patel D, Burmeister C, Balla M.
Cardiology, University of Toledo Medical Center, Toledo, USA.
Internal Medicine, University of Toledo College of Medicine and Life Sciences, Toledo, USA.
Internal Medicine, University of Toledo Medical Center, Toledo, USA.
Internal Medicine, University of Toledo, Toledo, USA.
Internal Medicine, Promedical Toledo Hospital, Toledo, USA.

Guler Y, Erbin A, Kafkasli A, Ozmerdiven G.
Department of Urology, Private Safa Hospital, Istanbul, Turkey.
Department of Urology, Haseki Traning and Research Hospital, Istanbul, Turkey.
Department of Urology, Dr. Lutfi Kirdar Kartal Traning and Research Hospital, Istanbul, Turkey.
Department of Urology, Istanbul Aydin University Medical Faculty, Istanbul, Turkey.

Nemirovsky C, López Furst MJ, Pryluka D, De Vedia L, Scapellato P, Colque A, Barcelona L, Desse J, Caradonti M, Varcasia D, Ipohorski G, Votta R, Zylberman M, Romani A, Valdez P, Amalfa F, Lucero C, Fernández Lausi A, Fernández Garces A, Rodríguez C, Chattas A, Farina J, Clara L, Nuccetelli Y; Grupo de trabajo del Consenso Argentino de Infección.
Sociedad Argentina de Infectología, Argentina.
Sociedad Argentina de Infectología, Argentina.
Sociedad Argentina de Urología, Argentina.
Federación Argentina de Urología, Argentina.
Federación Argentina de Sociedades de Ginecología y Obstetricia, Argentina.
Sociedad Argentina de Medicina, Argentina.
Sociedad Argentina de Bacteriología, Micología y Parasitología Clínica, Argentina.
Administración Nacional de Laboratorios e Institutos de Salud Dr. Carlos Malbrán, Buenos Aires, Argentina.

Fathelbab TK, Hasanein MGS, Fawzy AM.
Urology Department, Minia Urology & Nephrology University Hospital, School of Medicine, Minia University, Minia, Egypt.
Specialized SWL Center, Nile SWL, Minia, Egypt.
Urology Department, Minia Urology & Nephrology University Hospital, School of Medicine, Minia University, Minia, Egypt.
Specialized SWL Center, Nile SWL, Minia, Egypt.

Wang Y, Chang X, Li J, Han Z.
Department of Urology, The Second Hospital of Hebei Medical University, Shijiazhuang, China.

Olesen SS, Drewes AM, Gaud R, Tandan M, Lakhtakia S, Ramchandani M, Rao GV, Reddy DN, Talukdar R.
Department of Gastroenterology and Hepatology, Centre for Pancreatic Diseases, Aalborg University Hospital, Aalborg, Denmark. .
Department of Gastroenterology and Hepatology, Centre for Pancreatic Diseases, Aalborg University Hospital, Aalborg, Denmark.
Department of Medical Gastroenterology, Asian Institute of Gastroenterology, Hyderabad, Telangana, India.
Department of Surgical Gastroenterology, Asian Institute of Gastroenterology, Hyderabad, Telangana, India.
Pancreas Research Group, Wellcome DBT Labs, Asian Healthcare Foundation, Hyderabad, Telangana, India.

Ur Rehman MF, Adnan M, Hassan A 3rd, Humayun Akhtar F, Javed N, Ali F.
Urology, Bakhtawar Amin Medical and Dental College, Multan, PAK.
Urology, University of Lahore Teaching Hospital, Lahore, PAK.
Urology, Children Hospital and Institute of Child Health, Lahore, PAK.
Paediatric Urology, Children Hospital and Institute of Child Health, Lahore, PAK.
Internal Medicine, District Headquarter Hospital, Khanewal, PAK.

Sampogna G, Maltagliati M, Rocco B, Micali S, Montanari E, Spinelli M.
Urology Unit, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, University of Milan, Via della Commenda 15, 20122, Milano, MI, Italy.
Neuro-urology Unit, ASST Grande Ospedale Metropolitano Niguarda, Piazza dell'Ospedale Maggiore 3, 20162 Milano, MI, Italy.
Urology Unit, Ospedale Policlinico e Nuovo Ospedale Civile S. Agostino-Estense, University of Modena and Reggio Emilia, Via Pietro Giardini 1355, 41126 Baggiovara, MO, Italy.

Hughes SF, Jones N, Thomas-Wright SJ, Banwell J, Moyes AJ, Shergill I.

North Wales Clinical Research Centre, Betsi Cadwaladr University Health Board (BCUHB) Wrexham Maelor Hospital, Wrexham, Wales, UK.
North Wales & North West Urological Research Centre, Betsi Cadwaladr University Health Board (BCUHB) Wrexham Maelor Hospital, Wrexham, Wales, UK.
Department of Biological Sciences, University of Chester, Chester, UK.
Department of Haematology, Countess of Chester Hospital, Chester, UK.
North Wales & North West Urological Research Centre, Betsi Cadwaladr University Health Board (BCUHB) Wrexham Maelor Hospital, Wrexham, Wales, UK.
Department of Blood Sciences, BCUHB Wrexham Maelor Hospital, Wrexham, Wales, UK.
School of Medical Sciences, Bangor University, Bangor, Wales, UK.
North Wales Clinical Research Centre, Betsi Cadwaladr University Health Board (BCUHB) Wrexham Maelor Hospital, Wrexham, Wales, UK.
The Alan de Bolla Department of Urology, BCUHB Wrexham Maelor Hospital, Wrexham, Wales, UK.

Zhong P.
Department of Mechanical Engineering and Materials Science, Duke University, Durham, North Carolina, USA.

Patel VV, Mohindroo A.
Community Medical Center, Toms River, New Jersey.

Porst H.
European Institute for Sexual Health (EISH), Hamburg, Germany.

Wang X, Zhang B, Zhu Y, Ge H.
Department of Vascular Surgery, The Third Affiliated Hospital of Soochow University, Changzhou, China.

Qiang YC, Guo YG, Wang YQ.
Department of Urology, Xianyang Hospital of Yan'an University.
Department of Obstetrics and Gynecology.
Department of Urology, Yangling Demonstration District Hospital, Xianyang, China.

Al Darrab R, Addar AM, Al Shohaib I, Ghazwani Y.
Division of Urology, King Abdullah International Medical Research Center, College of Medicine, King Abdulaziz Medical City, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia.
Division of Urology, King Abdulaziz Medical City, Riyadh, Saudi Arabia.

Chuang YC, Meng E, Chancellor M, Kuo HC.
Department of Urology, Center for Shockwave Medicine and Tissue Engineering, Kaohsiung Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Taoyuan City, Taiwan.
Division of Urology, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan.
Department of urology, Oakland University William Beaumont School of
Department of Urology, Hualien Tzu Chi General Hospital, Tzu Chi Medical Foundation, Buddhist Tzu Chi University, Hualien, Taiwan.

Li X, Li B, Meng Y, Yang L, Wu G, Jing H, Bi J, Zhang J.
Department of Hepatobiliary Surgery, First Affiliated Hospital, China Medical University, No.155, Nanjing North Street, Heping District, Shenyang, 110001, Liaoning Province, People's Republic of China.
Department of Urology, First Affiliated Hospital, China Medical University, No.155, Nanjing North Street, Shenyang, 110001, Liaoning Province, People's Republic of China.
Department of Hepatobiliary Surgery, First Affiliated Hospital, China Medical University, No.155, Nanjing North Street, Heping District, Shenyang, 110001, Liaoning Province, People's Republic of China.

Hirsch B, Abt D, Güsewell S, Langenauer J, Betschart P, Pratsinis M, Vetterlein MW, Schmid HP, Wildermuth S, Zumstein V.
Department of Urology, Kantonsspital St. Gallen, Rorschacherstrasse 95, 9007, St. Gallen, Switzerland.
Biostatistics, Clinical Trials Unit, Rorschacherstrasse 95, 9007, St. Gallen, Switzerland.
Department of Urology, University Medical Centre Hamburg-Eppendorf, Martinistrasse 52, 20247, Hamburg, Germany.
Department of Radiology and Nuclear Medicine, Kantonsspital St. Gallen, 9007, St. Gallen, Switzerland.
Department of Urology, Kantonsspital St. Gallen, Rorschacherstrasse 95, 9007, St. Gallen, Switzerland.

Ouyang W, Sun G, Long G, Liu M, Xu H, Chen Z, Ye Z, Li H, Zhang Y.
Hubei Institute of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China.
Department of Geriatrics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China.

Yang SY, Jung HD, Kwon SH, Lee EK, Lee JY, Lee SH.
School of Pharmacy, Sungkyunkwan University, Suwon, Korea.
Department of Urology, Wonkwang University Sanbon Hospital, Wonkwang University College of Medicine, Gunpo, Korea.
Department of Urology, Severance Hospital, Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea.
Department of Nursing Science, College of Nursing, Gachon University, Incheon, Korea.

Paul CJ, Gruca TS, Morrison PG, Ghareeb GM, Kim SH, Erickson BA.
University of Iowa Hospitals & Clinics, Department of Urology, Iowa City, IA.
University of Iowa, Tippie College of Business, Iowa City, IA.
United Regional Physician Group, Wichita Falls, TX.
Emory University, Department of Urology, Atlanta, GA.
University of Iowa Hospitals & Clinics, Department of Urology, Iowa City, IA.

McClinton S, Starr K, Thomas R, MacLennan G, Lam T, Hernandez R, Pickard R, Anson K, Clark T, MacLennan S, Thomas D, Smith D, Turney B, McDonald A, Cameron S, Wiseman O.
Aberdeen Royal Infirmary, Foresterhill, Aberdeen, UK.
Academic Urology Unit, University of Aberdeen, Health Sciences Building, Foresterhill, Aberdeen, UK.
Health Services Research Unit, University of Aberdeen, Health Sciences Building, Foresterhill, Aberdeen, UK.
Health Economics Research Unit, University of Aberdeen, Polwarth Building, Foresterhill, Aberdeen, UK.
5Institute of Cellular Medicine, Newcastle University, Newcastle Upon Tyne, UK.
St George’s Hospital, London, UK.
Stone Patient Advisory Group, Section of Endourology, British Association of Urological Surgeons, London, UK.
Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, UK.
University College London Hospitals NHS Foundation Trust, London, UK
Oxford University Hospitals NHS Trust, Headley Way, Oxford, UK.
Addenbrooke’s NHS Trust, Hills Road, Cambridge, UK.

Nikhi P. Singh, BS, Carter J. Boyd, BS, William Poore, BS, Kyle Wood, MD, Dean G. Assimos, MD.
University of Alabama-Birmingham School of Medicine, Birmingham, AL.
Department of Urology, University of Alabama-Birmingham, Birmingham, AL.

Dong L, , Wang F, Chen H, Youyi Lu Y, Zhang Y, Chen L, Cui Y.
Department of Urology, The Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai.
Department of Urology, Qingdao Third People's Hospital, Qingdao.
Department of Urology, Beijing Tian Tan Hospital, Capital Medical University, Beijing.
Operating Room, The Affiliated YantaiYuhuangding Hospital of Qingdao University, Yantai, Shandong.
Department of Urology, Beijing Tian Tan Hospital, Capital Medical University, Beijing, China.

Thomas GPL, Chapelon JY, Birer A, Inserra C, Lafon C.
INSERM, LabTAU, F-69003 Lyon, France; Université Lyon 1, Univ Lyon, F-69003 Lyon, France.
INSERM, LabTAU, F-69003 Lyon, France.

Çift A, Benlioglu C.
Department of Urology, Faculty of Medicine, Adıyaman University, Adıyaman, Turkey.
Department of Urology, Faculty of Medicine, Adıyaman University, Adıyaman, Turkey.

Kaya C, Kaynak Y, Karabag A, Aykaç A.
Department of Urology, Eskisehir City Hospital, Eskisehir, Turkey.
Department of Urology, Eskisehir Ümit Visnelik Hospital, Eskisehir, Turkey.
Department of Radiology, Eskisehir City Hospital, Eskisehir, Turkey.
Department of Urology, Medical School, Karabuk University, Karabuk, Turkey.

Danilovic A.
Serviço de Urologia, Hospital das Clínicas da Faculdade de Medicina da USP - HCFMUSP, São Paulo, SP, Brasil.

Chen TT, Samson PC, Sorensen MD, Bailey MR.
Department of Urology, University of Washington, Seattle, Washington.
Department of Urology, Weill Cornell Medicine, New York, New York.
Applied Physics Laboratory, Center for Industrial and Medical Ultrasound, University of Washington, Seattle, Washington, USA.

Yayık AM, Ahıskalıoğlu A, Ergüney ÖD, Oral Ahıskalıoğlu E, Alıcı H, Demirdöğen ŞO, Adanur Ş.
Department of Anesthesiology and Reanimation, Ataturk University Faculty of Medicine, Erzurum, Turkey.
Department of Anesthesiology, Regional Training Hospital, Erzurum, Turkey.
Department of Urology, Ataturk University Faculty of Medicine, Erzurum, Turkey.

Rassweiler J, Rieker P, Rassweiler-Seyfried MC.
Department of Urology, SLK Kliniken Heilbronn.
Department of Urology, Medical School Mannheim, University of Heidelberg, Heidelberg, Germany.

Asi T, Dogan HS, Altan M, Bozaci AC, Ceylan T, Asci A, Tekgul S.
Department of Urology, Hacettepe University, Faculty of Medicine, Ankara, Turkey.
Department of Urology, Hacettepe University, Faculty of Medicine, Ankara, Turkey.

Veser J, Jahrreiss V, Seitz C, Özsoy M.
Department of Urology, Comprehensive Cancer Center, Medical Vienna General Hospital, University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria.
Department of Urology, Comprehensive Cancer Center, Medical Vienna General Hospital, University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria.
Karl Landsteiner SocietyUrology and Andrology, Vienna, Austria.

Musa ZS, El-Assmy A, Shokry AM, Shokeir AA, Zween T, Al-Kenawy MR.
Department of Urology, Urology and Nephrology Center, Mansoura University, Mansoura, Egypt.
Department of Radiology, Urology and Nephrology Center, Mansoura University, Mansoura, Egypt.

Thompson E, Lai A, Morrey L, Borofsky MS, Dahm P.
Department of Urology, University of Minnesota, Minneapolis, Minnesota, USA.
Urology Section, Minneapolis VA Health Care System, Minneapolis, Minnesota, USA.
Department of Urology, University of Illinois, Chicago, Illinois, USA.

Ramesh S, Chen TT, Maxwell AD, Cunitz BW, Dunmire B, Thiel J, Williams JC, Gardner A, Liu Z, Metzler I, Harper JD, Sorensen MD, Bailey MR.
Applied Physics Laboratory, Center for Industrial and Medical Ultrasound, University of Washington, Seattle, Washington.
Department of Urology, University of Washington School of Medicine, Seattle, Washington.
Department of Anatomy, Cell Biology and Physiology and Indiana University School of Medicine, Indianapolis, Indiana.
Department of Biostatistics, Indiana University School of Medicine, Indianapolis, Indiana.
Division of Urology, VA Puget Sound Health Care System, Seattle, Washington.

Strohmaier WL.
Regiomed-Klinikum Coburg, Regiomed Medical School Coburg, Universität Split, Ketschendorfer Str. 33, 96450, Coburg, Deutschland.

Stoykov B, Kolev N, Dunev V, Genov P.
Department of Urology, Medical University Pleven, Bulgaria.
Department of Urology, UMHAT, Ruse, Bulgaria.

Mains EAA, Blackmur JP, Sharma AD, Gietzmann WK, El-Mokadem I, Stephenson C, Wallace S, Phipps S, Thomas BG, Tolley DA, Cutress ML.
Department of Urology, Western General Hospital, Edinburgh, United Kingdom.
MRC Human Genetics Unit, Western General Hospital, Edinburgh, United Kingdom.
Department of Urology, Aberdeen Royal Infirmary, Aberdeen, United Kingdom.
Department of Urology, The Scottish Lithotriptor Centre, Western General Hospital, Edinburgh, United Kingdom.

Kallidonis P, Ntasiotis P, Somani B, Adamou C, Emiliani E, Knoll T, Skolarikos A, Tailly T.
Department of Urology, University of Patras, Patras, Greece.
European Section of Uro-Technology.
Young Academic Urologist.
Department of Urology, University Hospital Southampton NHS Foundation Trust, Southampton, UK.
Department of Urology, Fundacion Puigvert, University Autonoma of Barcelona, Barcelona, Spain.
Department of Urology, Sindelfingen-Böblingen Medical Centre, University of Tübingen, Sindelfingen, Germany.
2nd Department of Urology, Sismanoglio Hospital, National and Kapodistrian University of Athens, Athens, Greece.
Department of Urology, Ghent University Hospital, Ghent, Belgium.

Hegazy M, El-Assmy A, Ali-El-Dein B, Sheir KZ.
Urology and Nephrology Center, Mansoura University, Mansoura, Egypt.
Urology and Nephrology Center, Mansoura University, Mansoura, Egypt.