Validation of an Automated CT Image Analysis in the Prevention of Urinary Stones with Hydration Trial.

Kidney stone growth and new stone formation are common clinical trial endpoints and are associated with future symptomatic events. To date, a manual review of CT scans has been required to assess stone growth and new stone formation, which is laborious. We validated the performance of a software algorithm that automatically identified, registered, and measured stones over longitudinal CT studies.

Ureteroscopy vs Shockwave Lithotripsy to Remove Kidney Stones in Children and Adolescents: A Nonrandomized Clinical Trial.

Importance: Most children and adolescents with kidney and ureteral stones are treated with ureteroscopy, despite the uncertainty and equal weight of guideline recommendations for ureteroscopy or shockwave lithotripsy.

Objective: To compare stone clearance and patient-reported outcomes among children and adolescents after ureteroscopy or shockwave lithotripsy.

Design, Setting, And Participants: This nonrandomized clinical trial enrolled patients between March 16, 2020, and July 31, 2023, at 31 medical centers in the US and Canada.

Longitudinal image-based prediction of surgical intervention in infants with hydronephrosis using deep learning: Is a single ultrasound enough?

The potential of deep learning to predict renal obstruction using kidney ultrasound images has been demonstrated. However, these image-based classifiers have incorporated information using only single-visit ultrasounds. Here, we developed machine learning (ML) models incorporating ultrasounds from multiple clinic visits for hydronephrosis to generate a hydronephrosis severity index score to discriminate patients into high versus low risk for needing pyeloplasty and compare these against models trained with single clinic visit data.

Percutaneous Nephrolithotomy vs Ureteroscopy for Kidney Stones in Children.

Importance: Based on expert opinion, clinical guidelines recommend percutaneous nephrolithotomy or shockwave lithotripsy for children and adolescents with kidney stones 20 mm or larger, without mention of ureteroscopy as an alternative.

Objective: To compare clinical and patient-reported outcomes for percutaneous nephrolithotomy vs ureteroscopy in children and adolescents with kidney and/or ureteral stones.

Design, Setting, And Participants: This prospective cohort study was performed at 31 medical centers in the US and Canada.

From Scanner to Science: Reusing Clinically Acquired Medical Images for Research.

Growth in the field of medical imaging research has revealed a need for larger volume and variety in available data. This need could be met using curated clinically acquired data, but the process for getting this data from the scanners to the scientists is complex and lengthy. We present a manifest-driven modular Extract, Transform, and Load (ETL) process named Locutus designed to appropriately handle difficulties present in the process of reusing clinically acquired medical imaging data.

Machine Learning Analysis of Videourodynamics to Predict Incident Hydronephrosis in Patients With Spina Bifida.

Purpose: Variability in the interpretation of videourodynamics studies limits reliable classification of kidney injury risk for patients with spina bifida. We developed machine learning models to predict incident hydronephrosis in patients with spina bifida using videourodynamics data.

Materials And Methods: We trained machine learning models using data from videourodynamics studies performed between 2016 and 2022 on patients with spina bifida aged 2 months to 42 years.

Engaging Patients in Clinical Trials on Kidney Stones: Lessons Learned.

Although kidney stone disease is one of the most common benign urologic diseases worldwide, there are significant knowledge gaps regarding care for these patients. Well-designed, high-impact clinical trials are essential to close these knowledge gaps. However, there are significant barriers for clinical trials in this setting, which include ensuring continued relevance for the study population, achieving requisite accrual, and disseminating evidence back to the communities of interest.

A novel cross-modal data augmentation method based on contrastive unpaired translation network for kidney segmentation in ultrasound imaging.

Background: Kidney ultrasound (US) image segmentation is one of the key steps in computer-aided diagnosis and treatment planning of kidney diseases. Recently, deep learning (DL) technology has demonstrated promising prospects in automatic kidney US segmentation. However, due to the poor quality, particularly the weak boundaries in kidney US imaging, obtaining accurate annotations for DL-based segmentation methods remain a challenging and time-consuming task.

Emergency department utilization patterns for pediatric urinary stone patients in the United States.

Background: The prevalence of pediatric urolithiasis has increased rapidly, leading to more emergency department (ED) visits across the United States.

Objective: The purpose of this study was to determine emergency care practices for children and adolescents with urinary stones and characteristics associated with management.

Methods: We performed a cross-sectional study of the 2021 Nationwide Emergency Department Sample to identify pediatric patients (≤21 years) presenting to an ED in the United States with a primary diagnosis of urinary stone disease.

Development of Prediction Models for Severe Pain and Urinary Symptoms After Ureteroscopy With Ureteral Stent Placement: Results From the STENTS Study and Initial Validation of Pain Interference.

Purpose: We developed prediction models for severe pain and urinary symptoms after ureteroscopy with ureteral stent placement.

Materials And Methods: The development cohort included 424 adults and adolescents enrolled in the multicenter STENTS prospective cohort study who underwent ureteroscopy with stent placement for urinary stones. The validation cohort was an independent prospective cohort of 115 adults.

Opportunities in Primary and Enteric Hyperoxaluria at the Cross-Roads Between the Clinic and Laboratory.

Hyperoxaluria is a condition in which there is a pathologic abundance of oxalate in the urine through either hepatic overproduction (primary hyperoxaluria [PH]) or excessive enteric absorption of dietary oxalate (enteric hyperoxaluria [EH]). Severity can vary with the most severe forms causing kidney failure and extrarenal manifestations. To address the current challenges and innovations in hyperoxaluria, the 14th International Hyperoxaluria Workshop convened in Perugia, Italy, bringing together international experts for focused presentation and discussion.

The Hydronephrosis Severity Index guides paediatric antenatal hydronephrosis management based on artificial intelligence applied to ultrasound images alone.

Antenatal hydronephrosis (HN) impacts up to 5% of pregnancies and requires close, frequent follow-up monitoring to determine who may benefit from surgical intervention. To create an automated HN Severity Index (HSI) that helps guide clinical decision-making directly from renal ultrasound images. We applied a deep learning model to paediatric renal ultrasound images to predict the need for surgical intervention based on the HSI.

A Patient-Prioritized Research Agenda for Clinical Trials in Kidney Stone Disease.

Purpose: To ensure that research on kidney stones provides meaningful impact for the kidney stone community, patients and caregivers should be engaged as stakeholders in clinical trial design, starting at study inception. This project aimed to elicit, refine, and prioritize research ideas from kidney stone stakeholders to develop a patient-centered research agenda for clinical trials.

Materials And Methods: The Kidney Stone Engagement Core, a group of patients, caregivers, advocates, clinicians, and researchers, executed an iterative process of surveys and focus groups to elicit and refine research themes, which were then translated into research questions.

Adjudication of Self-reported Symptomatic Stone Recurrence in the Prevention of Urinary Stones With Hydration Trial.

Objective: To assess accuracy of self-reported stone events in a large clinical trial by adjudication against the weight of documentation for spontaneous stone passage or surgical intervention.

Methods: Participants in the Prevention of Urinary Stones with Hydration (PUSH) trial were randomized to a multi-component behavioral intervention or control arm to increase and maintain high fluid intake. The primary endpoint was urinary stone events including symptomatic stone passage or procedural intervention.

Cross-modal Transfer Learning Based on an Improved CycleGAN Model for Accurate Kidney Segmentation in Ultrasound Images.

Objective: Deep-learning algorithms have been widely applied in the field of automatic kidney ultrasound (US) image segmentation. However, obtaining a large number of accurate kidney labels clinically is very difficult and time-consuming. To solve this problem, we have proposed an efficient cross-modal transfer learning method to improve the performance of the segmentation network on a limited labeled kidney US dataset.

The Evolving Role of Genetic Testing in Monogenic Kidney Stone Disease: Spotlight on Primary Hyperoxaluria.

Purpose: Multiple factors are thought to give rise to common, recurrent kidney stone disease, but for monogenic stone disorders a firm diagnosis is possible through genetic testing. The autosomal recessive primary hyperoxalurias (PH) are rare forms of monogenic kidney stone disease. All 3 types of PH are caused by inborn errors of glyoxylate metabolism in the liver, leading to hepatic oxalate overproduction and excessive renal urinary oxalate excretion.

Preoperative vs Postoperative Opioid Prescriptions and Prolonged Opioid Refills Among US Youths.

Importance: High-risk practices, including dispensing an opioid prescription before surgery when not recommended, remain poorly characterized among US youths and may contribute to new persistent opioid use.

Objective: To characterize changes in preoperative, postoperative, and refill opioid prescriptions up to 180 days after surgery.

Design, Setting, And Participants: This retrospective cohort study was performed using national claims data to determine opioid prescribing practices among a cohort of opioid-naive youths aged 11 to 20 years undergoing 22 inpatient and outpatient surgical procedures between 2015 and 2020.

Using structured problem solving to promote fluid consumption in the prevention of urinary stones with hydration (PUSH) trial.

Background: Structured Problem Solving (SPS) is a patient-centered approach to promoting behavior change that relies on productive collaboration between coaches and participants and reinforces participant autonomy. We aimed to describe the design, implementation, and assessment of SPS in the multicenter Prevention of Urinary Stones with Hydration (PUSH) randomized trial.

Methods: In the PUSH trial, individuals with a history of urinary stone disease and low urine output were randomized to control versus a multicomponent intervention including SPS that was designed to promote fluid consumption and thereby prevent recurrent stones.

Postoperative Recovery of Quality-of-Life Following Ureteroscopy for Nephrolithiasis: The Impact on Pain Intensity and Interference and the Ability to Participate in Social Roles.

Objective: To prospectively capture patient-reported outcomes to assess the recovery profile of ureteroscopy (URS).

Materials And Methods: Adults undergoing URS for renal/ureteral stones were eligible for inclusion (11/2020-8/2022). Patients prospectively completed PROMIS - Pain Intensity, - Pain Interference, and - Ability to participate in social roles and activities in-person preoperatively (POD 0) and via email on POD 1, 7, 14, and 30.